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Volume 13, Number 2

Spine Infections

Teaser: 

Jessica Albanese, MD,1 Brett Rocos, MB, ChB, MD, FRCS (Tr & Orth),2

1 Adult Spine Fellow, Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
2 Assistant Professor of Orthopaedic Surgery, Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.

CLINICAL TOOLS

Abstract: Though they have significant morbidity and mortality, spine infections are a rare cause of back pain. Because they are uncommon, it is important to recognize the signs and symptoms of a spine infection, to establish the diagnosis, and to treat appropriately, guided by culture results, with antibiotic therapy. Surgical intervention is indicated in cases of significant neurologic deficit, significant spinal deformity, instability, and/or failed medical management.
Key Words:spinal infection, spondylodiscitis, discitis, vertebral osteomyelitis, epidural abscess, back pain.

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

www.cfpc.ca/Mainpro_M2

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Pre-test CME Quiz Post-test CME Quiz
Patients with spine infections often present with back pain and may have radicular pain, neurologic deficits, or constitutional signs and symptoms of infection
Workup begins with laboratory studies including, CBC, CRP, and ESR
The gold standard for imaging is MRI
Definitive diagnosis may require CT-guided biopsy and culture
The mainstay of treatment is at least 6 weeks of antibiotic therapy guided by culture results
Surgical intervention is indicated in cases of progressive neurologic deficit or spinal deformity, instability, or failed medical management
Spinal infections can present insidiously
Refer early if patients present with back pain and unexplained fever
Prompt identification with MRI improves likelihood of recovery
Antibiotic treatment for 6 weeks is recommended
Surgery is useful for neurological deficit or instability
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Related Terms: Back Health, spinal infection, spondylodiscitis, discitis, vertebral osteomyelitis, epidural abscess, back pain

JCCC 2023 Issue 2

Table of Contents

Key and Current Issues in the Management of Insomnia

Teaser: 

Louis T. van Zyl, MD, M.Med.,1 Colin Shapiro, B.Sc. (Hon.), MB, BCh, PhD,2 Dora Zalai, MD, PhD,3

1Professor of Psychiatry (Emeritus), Queen's University, Canada. 2Professor of Psychiatry and Ophthalmology (Emeritus) University of Toronto, Canada Director of the Youthdale Child & Adolescent Sleep Clinic and International Sleep Clinic Parry Sound Toronto, Canada. 3Clinical Psychologist, Sleep on the Bay, Toronto, Canada.

CLINICAL TOOLS

Abstract: There is increasing appreciation of the relevance of sleep to general well-being, especially for those with medical—including psychiatric—illnesses. This growing recognition of the relevance of sleep is reflected in the DSM-V guidelines. We endeavor to present a nuanced understanding and usage of sedative hypnotic medications in the management of insomnia. New medications that reduce wakefulness is also mapped out in this overview. In addition, we briefly discuss the intervention of cognitive behavior therapy for insomnia (CBT-I) as the mainstay of treatment for chronic insomnia.
Key Words: sleep disorders, insomnia, management, treatment.
Insomnia is a sleep disorder in its own right. It is no longer regarded as just a symptom. It calls for specific, targeted insomnia treatment, especially in situations where insomnia is comorbid with medical conditions.
Cognitive behavioural therapy for insomnia (CBT-I) produces moderate to large effects on insomnia measures when insomnia is comorbid with chronic medical conditions. It is the mainstay of treatment in most cases of chronic insomnia.
The use of hypnotics should be planned strategically. In general, short term hypnotic use should be the objective, but for many patients long term use may be necessary and appropriate.
The initial dose of sedative-hypnotics should be determined on an individual basis and titrated in accordance with the patients' needs. While too high dose is not desirable, too low a dose would result in under-treatment and is counter-productive.
Insomnia may become a chronic disorder and as such may necessitate long-term management. Prescribe carefully-chosen hypnotics for the requisite period and re-evaluate patients in follow up. Consider CBI-I as a treatment option, independently or in conjunction with pharmacotherapy.
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Related Terms: Mental Health, sleep disorders, insomnia, management, treatment
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Dermatological Findings in Body-focused Repetitive Behaviours

Teaser: 

Amir Gohari1 Joseph M. Lam, MD, FRCPC,2

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

CLINICAL TOOLS

Abstract: Body-focused repetitive behaviours (BFRBs) are common yet poorly understood conditions with significant mental and physical implications. Dermatological findings associated with BFRBs can be atypical, and recognizing them can be very beneficial. This paper reviews the dermatological findings associated with BFRBs, including habit-tic nail deformity, onychophagia, onychotillomania, trichotillomania, lip/cheek biting, dermatillomania, and compulsive washing. Recognition of these classic dermatological signs can help clinicians differentiate them from other common dermatological conditions. Body-focused repetitive behaviours require multidisciplinary management, and dermatology can contribute to their recognition and treatment.
Key Words:body-focused repetitive behaviours, dermatological findings, nail, hair, oral mucosa, skin.

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
BFRBs are common yet poorly understood conditions with significant mental and physical implications.
Recognition of classic dermatological signs can help clinicians differentiate BFRBs from other common dermatological conditions.
Dermatological findings associated with BFRBs can be atypical, and recognizing them can be very beneficial.
BFRBs require multi-disciplinary management, and dermatology can contribute to their recognition and treatment.
Recognizing dermatological findings associated with BFRBs can help clinicians make an accurate diagnosis and develop an effective treatment plan.
BFRBs can cause significant physical and psychological harm and require a multi-disciplinary approach to management.
Early recognition and treatment of BFRBs can prevent long-term physical and psychological complications.
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, body-focused repetitive behaviours, dermatological findings, nail, hair, oral mucosa, skin
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Urinary Tract Infection in the Older Population: Not Always So Simple

Teaser: 

Michael Gordon, MD, MSc., FRCPC, 1 Nada Abdel-Malek, MPH, MD, CFPC (COE),2

1Emeritus Professor, University of Toronto, Toronto, ON. 2Department of Family and Community Medicine, Baycrest Health Sciences, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: Urinary tract infections (UTIs) are common in older adults, with prevalence increasing with each decade above sixty-five. UTIs in older adults can be multi-factorial in terms of etiology, risk factors, symptoms, and interventions. A history of heart failure and diabetes increases the risk of UTIs in older adults, and these patients should be closely monitored for symptoms of infection. An enlarged prostate and urinary retention can be an all too common scenario leading to UTIs in older men. UTIs can cause acute confusion and disorientation in older people and should be considered as a possible cause of such new onset symptoms. Physicians should be aware of the variety of presentations and implications of determining a UTI in older adults.
Key Words: urinary tract infections (UTIs), older adults, risk factors, symptoms, interventions confusion, disorientation, heart failure, diabetes, enlarged prostate, urinary retention.
Urinary tract infections (UTIs) are common among the North American population, with prevalence increasing in older adults. Those with a history of heart failure and diabetes are at increased risk.
With the introduction of antibiotics before WWII, and then during the ensuing decades, treatments for UTIs moved away from previously used home-grown remedies.
Physicians should be aware of the variety of presentations and implications of determining a UTI in older adults.
The first case study describes an 84-year-old man with acute onset confusion, disorientation, and urinary retention, who was admitted to the hospital and treated with antibiotics and a small dose of an antipsychotic.
UTIs can cause acute or sub-acute confusion and disorientation in older adults and should be considered as a possible cause of such symptoms.
An enlarged prostate and urinary retention is a recognized syndrome of UTIs in older men.
UTIs are a common cause of confusion and disorientation in older adults, and should be considered as a possible cause of these neurological symptoms.
A history of heart failure and diabetes increases the risk of UTIs in older adults, and these patients should be closely monitored for symptoms of infection.
An enlarged prostate and urinary retention can be the underlying cause of UTIs in older adults, and these patients should be evaluated for infection if this constellation of findings exist.
UTIs in older adults can be multi-factorial in terms of etiology, risk factors, symptoms, and interventions, and physicians should be aware of the variety of presentations and implications of determining a UTI in this population.
It is important to use broad-spectrum antibiotics in older adults with UTIs, especially if they are antibiotic-naive patients.
Older adults with UTIs are at risk of harm if they try to remove their catheter or IV; it is important to use soft restraints as needed to ensure patient safety.
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: Gender & Health, Men’s Health, Women’s Health, Urogenital Disorders, urinary tract infection, older adults, risk factors, symptoms, interventions, heart failure, diabetes, diabetic, urinary retention
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