Advertisement

Advertisement

Hyperhidrosis: A Brief Review

Teaser: 

Mahan Maazi, MEng,1 Joseph M. Lam, MD, FRCPC,2

1 Faculty of Medicine, University of British Columbia.
2Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

CLINICAL TOOLS

Abstract: Hyperhidrosis (HH) is a disorder of the eccrine sweat glands causing excessive sweating. It is caused by hyperactivity of the sympathetic nervous system resulting in excessive release of acetylcholine and activation of the sweat glands. Primary essential HH is thought to have a large genetic component, while secondary HH is the result of an underlying condition or medications. HH will often cause excessive sweating in areas with a high density of eccrine sweat glands that include the palms, soles, face, head, or axillae. Diagnosis is largely based on history and physical which can help differentiate between primary and secondary HH. Hyperhidrosis can have a significant impact on quality of life. Management includes identifying and avoiding triggers, the use of topical antiperspirants, and advanced therapies in recalcitrant cases (such as tap water iontophoresis, botulinum toxin injection and surgical options).
Key Words: hyperhidrosis (HH), primary (essential) hyperhidrosis, secondary hyperhidrosis, excessive sweating, eccrine sweat gland.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Hyperhidrosis is common and affects about 5% of the population
A simple measure of the severity of hyperhidrosis can be done with the 4-question hyperhidrosis disease severity score
Secondary hyperhidrosis should be ruled out with a good history and physical exam
Patients who fail treatment with topical antiperspirants can be treated with tap-water iontophoresis, botulinum toxin injections, oral anticholinergics and surgical options.
Hyperhidrosis is excessive sweating that can be most commonly primary but can have secondary causes
Patients with hyperhidrosis can experience significant impairment on quality of life and this should be explored
First-line treatment consists of topical antiperspirants
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Dermatology, hyperhidrosis, primary (essential) hyperhidrosis, secondary hyperhidrosis, excessive sweating, eccrine sweat gland
Disclaimer: 
Disclaimer at the end of each page

#4: Understanding Radiology Reports

Welcome to Inside Radiology: A Primary Care Perspective where we explore the world of radiology and its applications in primary care.

Please note that while the first episode is available to listen to without registration, accessing additional episodes will require you to subscribe and log in.

  Back to Inside Radiology: A Primary Care Perspective

Hello. Welcome back to another episode of Inside Radiology, a Primary Care Perspective podcast. I'm Dr. D'Arcy Little, your host. I'm a community radiologist and a former family physician. And in today's episode, we're looking at radiology reports.

...

 

1

7 applauses

Welcome to Inside Radiology: A Primary Care Perspective podcast! I'm Dr. D'Arcy Little, your host. As a community radiologist and former family physician, I'm passionate about empowering primary care doctors with the knowledge and insights they need. With my unique perspective, I aim to bridge the gap between primary care and radiology, presenting the complexities of radiology in a way that resonates with you. My goal is to equip you with tools to enhance patient care and decision-making. Join me on this educational journey as we explore the world of radiology, tailored for primary care physicians like you. Together, let's elevate primary care radiology.

Opioid Use in Patients Undergoing Spine Surgery

Teaser: 

Eric J. Crawford MD, FRCSC,1 Ronit Kulkarni,2 Rajesh Kumar MBBS, FRCS, FCPS, FACS, FEBNS, MRCPS,3 Ted Findlay DO, CCFP, FCFP,4 Christopher J. Nielsen MD, FRCSC,5 Stephen J. Lewis MD, FRCSC,6 Robert A. Ravinsky MDCM, MPH, FRCSC,7

1 Divisions of Orthopaedic and Spine Surgery, Sunnybrook Health Sciences Centre, Toronto, ON.
2 Medical University of South Carolina, College of Medicine, Charleston, SC.
3Division of Spine Surgery, Sunnybrook Health Sciences Centre & Department of Surgery, University of Toronto, Toronto, ON.
4Calgary Chronic Pain Center at Alberta Health Services, Calgary, AB.
5Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network & Department of Surgery, University of Toronto, Toronto, ON.
6Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network & Department of Surgery, University of Toronto, Toronto, ON.
7Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC.

CLINICAL TOOLS

Abstract: Opioid medications have long been known for their analgesic properties and play an important role in the treatment of acute post-surgical pain. However, in recent years there has been an increase in chronic opioid therapy (COT) for painful conditions, in particular spinal disorders. These patients can have increased postoperative analgesic requirements and may be at increased risk of complications after surgery. In this evidence-based review, we provide guidance for managing opioid and analgesic medications for patients on COT from the preoperative assessment to post-surgical management including recommendations for appropriate opioid reduction.
Key Words: low back pain, surgery, opioid sparing, peri-operative pain management.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. Pre-operative chronic opioid usage is associated with poorer surgical outcomes.
2. Pre-operative chronic opioid usage is associated with prolonged post-surgical opioid therapy.
3. Pre-operative opioid tapering can achieve clinical surgical outcomes comparable to an opioid-naïve group.
4. Non-pharmacological or non-narcotic medications may help reduce pre-operative opioid usage.
5. A clear plan for a post-surgical opioid taper should be prepared prior to surgery.
The OPAL trial notes that opioids for acute non-specific low back or neck pain present no significant difference to placebo for pain at 6 weeks.
Buprenorphine is commonly used as an opioid rotation pre-operatively to assist in opioid weaning.
Discontinuing opioid prescriptions should be considered if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, or lack of progress towards meeting agreed therapeutic goals.
Gabapentin in doses over 1800 mg/day is associated with 60% increased odds of opioid related death.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, low back pain, surgery, opioid sparing, peri-operative pain management