Family Medicine Notes

Arch Otolaryngol Head Neck Surg -- Abstracts: Boston et al. 129 (6): 660

Background

Nasal saline spray (NSS) used in the treatment of rhinitis and sinusitis often contains the preservative benzalkonium chloride (BKC). Previous studies have shown that corticosteroid nasal sprays and topical decongestants containing BKC damage respiratory mucosa, decrease mucociliary activity, and inhibit neutrophil functions in vitro.

Objective

To evaluate the effects of NSS with BKC on human neutrophils.

Design

Prospective, basic science observations.

Methods

Human neutrophils were exposed to NSS with BKC or to phosphate-buffered saline (PBS) at varying times and concentrations. The cells were examined for morphologic changes by light microscopy and for viability as determined by trypan blue exclusion. Lactate dehydrogenase levels were measured to quantify neutrophil cell lysis. In vivo morphologic changes were studied in neutrophils obtained from the oral mucosa in human volunteers who rinsed their mouths with NSS or PBS.

Results  Neutrophils exposed to NSS concentrations as low as 15% showed near-total cell lysis, and neutrophils exposed to 20% NSS demonstrated no cell viability by trypan blue staining. Phosphate-buffered saline–exposed cells were unaffected. The release of lactate dehydrogenase from lysed neutrophils increased sharply at NSS concentrations higher than 10% but remained stable in PBS-exposed cells. All neutrophils isolated from NSS oral rinses were lysed, while a mean of 78% of neutrophils from PBS rinses showed normal morphologic structure.

Conclusions  Nasal saline spray with BKC is toxic to human neutrophils even at concentrations far lower than those found in commercially available preparations. Saline solutions without BKC appear to be safer alternatives, and additional studies are needed to determine the clinical significance of these findings.

^{I ususally tell people to make it at home anyway ..}

Posted by Jacob Reider, MD at 11:59 PM | Permalink | Comments (3)

With apologies for my absence here recntly .. I'll begin again ...

From BMJ

Qualitative study of the meaning of personal care in general practice

This is an interesting article that looked at how patients and physicians perceive "personal care."

Patients, general practitioners, primary care nurses, and administrative staff hold similar views on the meaning of personal care, despite differences of emphasis reflecting their different roles. Personal care is promoted by but not always dependent on a continuing provider-patient relationship; human communication and individualised care emerged as important in making care personal whatever the context. Most respondents valued relationships in primary care and had clear ideas about when care in the context of a relationship was most valuable.

^{We (and our patients) know when things "click" between a patient and physician .. and when things don't.  This study is the first objective assesment of these very important componenst between the physician and patient.}

Posted by Jacob Reider, MD at 12:27 PM | Permalink

Posted by Jacob Reider, MD at 09:22 PM | Permalink

Health Talk is a peer-to-peer website with health related info, and health related forums.  Most of the forum discussions are idle .. though several (smoking cessation, for example) are quite busy.

Posted by Jacob Reider, MD at 08:53 AM | Permalink

From the International Journal of Medical Informatics : Web presence of an integrated delivery system at year one: lessons learned

An interesting look at how looking at web logs can help an institution build a better website.

Posted by Jacob Reider, MD at 01:04 PM | Permalink | Comments (1)