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Cost Effectiveness / Yield / Medical Economics
 
One Test for Osteoporosis or Osteomalacia
O P Kapoor
 

Very often we come across patients who cannotafford any investigations. This article is especially for such patients. In a woman having backache, bodyache and muscular weakness, if osteomalacia is to be confirmed by one test only, then it should be ‘serum alkaline phosphatase’, which is nearly always markedly elevated.

If an elderly, menopausal woman complains of severe backache and the doctor wants to exclude osteoporosis of the vertebra with/without a crush fracture, only an X-ray film (lateral view) of the thoracolumbar spine is sufficient. If digital radiography is available, it will mean an additional bonus and a much better diagnosis.

Remember that the usual reports of PA and lateral view of spine reported by an average radiologist regarding the presence/absence of osteoporosis are often wrong, specially in “Asymptomatic” patients.
 

Corticosteroids reduce Mortality in Intensive Care

Long courses of corticosteroids may reduce mortality in patients who have severe sepsis and septic shock. Reviewing 16 trials on 2063 patients, Annane and colleagues found that corticosteroid did not change mortality at 28 days or hospital mortality. However, those patients who had low dose hydrocortisone (£ 300 mg) for at least five days were more likely to survive, without increased risk of gastroduodenal bleeding, superinfection, or hyperglycaemia, than those receiving a short course of corticosteroids or placebo. This treatment may be more effective in patients with impaired production of corticosteroids, say the authors.

BMJ, 2004; 329 : 480.