November 2017 Edition

We welcome you to come and read through our latest, November, edition of Modern Medicine.

This month we have a jam packed edition for you. Our features this month include; Diabetes, Cardiology, Addiction and Rehab and many more.

We encourage all of our readers to complete the CPD questionnaire for this edition, this can be done on the answer-form included in the magazine, or on our website CPD system.

Modern Medicine, the journal that’s with you wherever you go.

Hashimoto’s Thyroiditis When to observe, to treat or to refer

Hashimoto’s Thyroiditis When to observe, to treat or to refer

Hashimoto’s thyroiditis is a common autoimmune disease, mainly
affecting women. The aetiology of HT is believed to involve genetic
and envi ronmenta l fac tors. Presentations of HT range from
incidental detection of antithyroid antibodies, clinical euthyroidism
with goitre to subclinical or overt hypothyroidism. Diagnosis of HT
relies on a combination of clinical and biochemical parameters.
Levothyroxine is the mainstay of treatment. Patients with disease that
is difficult to diagnose or manage should be referred for specialist
opinion.

Modern Medicine – November 2017

How Does Diabetes Damage the Heart? The clock starts ticking early

How Does Diabetes Damage the Heart? The clock starts ticking early

Cardiovascular disease causes more than 70% of deaths in people with type 2 diabetes. Atheroma in patients with
diabetes develops silently preceding hyperglycaemia, particularly when features of the metabolic syndrome
are present. Classic coronary risk factors in people with diabetes (including hypercholesterolaemia and
hypertension) contribute to the atheroma and should be actively treated, remembering that women in particular
may be undertreated. Additional risk factors specific to diabetes (such as dyslipidaemia, central obesity,
hyperglycaemia and autonomic neuropathy) accelerate atheroma in people with type 2 diabetes or can worsen
the outcome.

Modern Medicine – November 2017

Type 2 Diabetes in Adolescents A growing issue

Type 2 Diabetes in Adolescents A growing issue

Type 2 diabetes is becoming more common in adolescents. Type 2 diabetes onset generally coincides
with mid to late puberty, during the peak of physiological pubertal insulin resistance. Patients with type 2 diabetes
are usually asymptomatic at presentation, being diagnosed incidentally or on screening after consideration
of risk factors. Diagnosis of type 2 diabetes is by glucosebased tests or glycated haemoglobin (HbA1c). Each
test has its limitations. Treatment of type 2 diabetes is multidisciplinary. Vigilance in follow-up healthcare is
required in adolescents with diabetes as lifestyle and antihyperglycaemic medication interventions are often not
very effective or durable in this patient population.

Modern Medicine – November 2017

Combating the Prescription Opioid Abuse Epidemic

Combating the Prescription Opioid Abuse Epidemic

Over the past two decades, as the prevalence of chronic pain and health care costs have exploded,
an opioid epidemic with adverse consequences has escalated. Efforts to increase opioid use and
a campaign touting the alleged under-treatment of pain continue to be significant factors in the
escalation. Many arguments in favour of opioids are based solely on traditions, expert opinion,
practical experience and uncontrolled anecdotal observations. Opioids should only be used when
benefits are expected to outweigh risks. Ensuring that patients have access to safe, effective
treatment is critical and involves improving the way opioids are prescribed.

Modern Medicine – November 2017

How Can we Improve Secondary Prevention After ACS?

How Can we Improve Secondary Prevention After ACS?

Evidence-based lifestyle changes and drug therapies are known to reduce the risk of further cardiovascular
events in patients who have survived an acute coronary syndrome. Secondary prevention strategies should
be implemented before the patient is discharged from hospital and continued by GPs. Establishing a strong
therapeutic alliance with the patient can help GPs promote a lifelong approach to secondary prevention
measures. Patient education about coronary heart disease, personalised interventions and strategies such
as referral to a cardiac rehabilitation program can improve adherence to secondary prevention measures. Increased
use of chronic disease management items might support more systematic care for people living with cardiovascular
disease.

Modern Medicine – November 2017

October 2017 Edition

We welcome you to come and read through our latest, October, edition of Modern Medicine.

This month we have a jam packed edition for you. Our features this month include; Ethics, Cardiology, Pain and many more.

We encourage all of our readers to complete the CPD questionnaire for this edition, this can be done on the answer-form included in the magazine, or on our website CPD system.

Modern Medicine, the journal that’s with you wherever you go.

The Role of MRI in Prostate Cancer A changing paradigm

The Role of MRI in Prostate Cancer A changing paradigm

Multiparametric magnetic resonance imaging (mpMRI)
is proving to be an excellent tool for detecting aggressive prostate
cancers and performing targeted biopsies. Potentially, it will reduce
overdetection and underdetection and optimise active surveillance
and other aspects of cancer assessment and treatment. mpMRI
of the prostate is still evolving and is not without limitations.

Modern Medicine – October 2017

Understanding the Structure-symptom Discordance in Osteoarthritic Pain

Understanding the Structure-symptom Discordance in Osteoarthritic Pain

Treating chronic musculoskeletal pain and chronic joint pain (osteoarthritis) in particular, is challenging as the
peripheral and central pain mechanisms have not been fully discovered. The pain associated with joint discomfort
is highly variable, often underestimated by clinicians and shows only modest association with crude radiological
scorings. One reason for the disconnect between the extent of structural damage and pain is neuroplastic
changes occurring in the peripheral and central nervous system resulting in pain sensitisation impacting the
patient’s experience of pain.

Modern Medicine – October 2017

Heart Failure with Preserved Ejection Fraction Improving Diagnosis and Management

Heart Failure with Preserved Ejection Fraction Improving Diagnosis and Management

Heart failure with preserved ejection fraction (HFpEF, diastolic heart failure) is equally as common as heart
failure with reduced ejection fraction (HFrEF, systolic heart failure). HFpEF is an emerging epidemic, due to the
increasing age of the population and increasing incidence of risk factors such as obesity and hypertension.
Recognition of the typical signs and symptoms of heart failure in the setting of specific echocardiographic
features is key to diagnosis. The diagnosis can be confirmed with exercise right heart catheterisation.
Key principles of management are blood pressure control, physical activity, optimisation of comorbidities
and judicious volume management. Few therapies are effective at reducing morbidity or mortality in HFpEF
at present. Active research is under way to develop appropriate diagnostic and management strategies.

Modern Medicine – October 2017