PCP visits declined 18 percent over 4 years
Unfortunately not looking good for primary care bound physicians in the current environment where instant gratification culture has led to the proliferation of urgent care and minute clinics that cost the same up front to the patient. The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care Big corporations — giant retailers and health insurance companies — are teaming up to become your doctor. www.nytimes.com Excerpt: "CVS [...], and most recently Walmart [...], are eyeing deals with Aetna and Humana, respectively, to use their stores to deliver medical care... PCP visits declined 18 percent over 4 years
We present the case of a girl who underwent VPH for hemimegalencephaly in early infancy. Postoperatively, she developed unexpected seizures of mesio-temporal origin. Stereo-EEG provided arguments for an amygdalar origin. High-resolution MRI with tractography confirmed the presence of the amygdalo-fugal pathway to be responsible of epileptic discharges propagation. She became seizure-free after temporal resection.
ConclusionWe successfully utilized biportal endoscopy to decompress the combined lumbar lateral recess, foraminal, and extraforaminal lesions using a contralateral sublaminar approach.
We describe a patient with a long history of seizures and a remote status epilepticus event. On magnetic resonance imaging, a presumed left temporal lobe tumor was observed. On neurosurgical consultation, the lesion was identified as a chronic mesial temporal lobe herniation. The patient lacked history that would suggest risk of cerebral herniation. Accurately identifying the patient ’s chronic temporal lobe herniation radiographically likely saved this patient from unnecessary surgery or biopsy and allowed the patient to receive appropriate conservative care.
ConclusionsThe study represents the much-needed, large-volume, epidemiological profile of HI from an LMIC, highlighting the suboptimal utilization of peripheral healthcare systems. Strengthening and integrating these facilities with the tertiary centers in a hub and enhanced spoke model, task sharing design, and efficient back-referrals promise effective neurotrauma care while avoiding overburden in the tertiary centers. Better implementation of road safety laws also has the potential to reduce the burden of HI.