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Cost Effectiveness / Yield / Medical Economics |
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Diagnosis
and Treatment of Osteoporosis in Unaffording Patients Diagnosis
of Common Fevers?
O P Kapoor |
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Osteoporosis
occurs more often in females, usually 10-20 years after menopause.
The family physicians normally advise investigations like sonography,
CT scan or DXA to study the bone mineral density (BMD). All these
are very expensive tests. They then prescribe an expensive drug
called Alendronate. The duration of the treatment is not yet
definitely known.
The simpler method to diagnose osteoporosis, especially in poor elderly patients,
is to ask for history of a fracture with minimal trauma (especially in females).
Apart from this, family history and other factors can also help in picking up
the disease.
But, what I want to stress is that in case of unaffording patients' more than
65 years of age, the family physician can prescribe vit. D without doing any
investigations. Vit. D can be prescribed in a dose of about 1 lac units, taken
every 4 months for a period of 5 years. Statistical evidence shows that the incidence
of fractures in such patients will be as low as in the ones, who are investigated
and treated with Alendronate type of expensive drugs. Calcirol granules are available
in sachets, each containing 60,000 units. Two sachets of Calcirol can be given
orally and thus the cost of injection can be avoided. This treatment is cheaper
and is especially indicated in patients, who are not likely to expose themselves
to sunlight everyday. |
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CAROTID
ENDARTERECTOMY
The balance of risk and long-term benefit of carotid endarterectomy
(CEA) among patients with substantial carotid artery narrowing
but no neurological symptoms is uncertain. They found immediate
CEA halved the net 5-year risk of stroke in these patients
and comment that longer observation could reveal some further
gain. However, in a Commentary, Henry Barnett highlights
the uncertainty surrounding differential benefit between
higher and lower deciles of stenosis and suggests that
the search for asymptomatic individuals at highest risk
should continue
Lancet
Oncol, 2004; 5 : 1486, 1491.
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