The construct of major depressive disorder makes no etiological
assumptions about populations with diverse symptom clusters.
“Depressed mood” and “loss of interest or pleasure in nearly all
activities” are core features of a major depressive episode, though
a strong case can be made to pay increasing attention to symptoms of
fatigue, sleep disturbance, anxiety and neurocognitive and sexual
dysfunction in the diagnosis. Mood, guilt, work and interest,
as well as psychic anxiety, are consistently identified across
validated subscales of the Hamilton Depression Rating Scale as
prevalent and sensitive to change with existing treatments.
Subarachnoid haemorrhage (SAH) due to a ruptured cerebral aneurysm is a potentially fatal condition that
presents as headache. A raised index of suspicion must exist for all patients with sudden, severe headache with or
without associated symptoms. Initial investigation of suspected SAH should be a
noncontrast CT scan. Management of SAH is increasingly becoming endovascular. The outcome for patients with
no or only a mild global or focal neurological deficit on presentation has improved, but pre-hospital mortality and
disability from the initial haemorrhage remains a problem. Unruptured asymptomatic aneurysms are not an urgent
scenario and can be dealt with in consultative outpatient fashion.
Globally, coronary artery disease (CAD) is the leading cause of death
and is predicted to remain so for the foreseeable future. Stable angina
pectoris is defined as chest pain that develops when the heart rate
rises, for example, during intense sports or exciting emotions. In such
situations, the blood supply cannot meet the myocardial metabolism
needs, thus leading to angina.
Pulmonary arterial hypertension (PAH) is a life-threatening disease of the small pulmonary arteries that progresses
to right heart failure and death if untreated. Early diagnosis and timely initiation of therapy is crucial to good
outcomes. PAH must be considered in any patient with unexplained breathlessness. Unexplained breathlessness
should be viewed just as seriously as chest pain. Definitive diagnosis requires right heart catheterisation.
Annual screening for PAH should be undertaken in high risk patient groups, such as those with systemic sclerosis
or past repair of a septal defect. Many efficacious drug therapies are available and combination therapy is now
the evidence-based standard of care.
The introduction of anti-vascular endothelial growth factor (anti-VEGF) has significantly reduced visual loss due to
neovascular age-related macular degeneration (n-AMD). However there are significant inter-individual differences
in response to an anti-VEGF agent due to a variety of factors including patient’s age, lesion characteristics,
lesion duration, baseline visual acuity (VA) and the presence of particular genotype risk alleles.
We welcome you to come and read through our latest, February, edition of Modern Medicine.
This month we have a jam packed edition for you. Our features this month include; Diabetes, Gastroenterology, Immunisation, Ethics 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 ourwebsite CPD system.
Modern Medicine,the journal that’s with you wherever you go.
Early and optimal glycaemic control in patients with type 2 diabetes is imperative for reducing microvascular
and potentially macrovascular complications. Glycated haemoglobin remains the key focus of glycaemic
management although targets should be individualised based on age, comorbidities and life expectancy.
Treatment choice should be guided by patient comorbidities, adverse effect profile, acceptability of the
method of administration and cost. Metformin remains first-line treatment unless contraindicated. Insulin may
be considered at any stage, particularly where control is poor. Patients with pre-existing cardiovascular disease
can be safely managed with new agents, including some DPP4-inhibitors, GLP-1 receptor agonists and SGLT-2
inhibitors and some therapies may offer cardiovascular mortality benefit.
Adults may require vaccines for multiple reasons, including incomplete childhood schedules, waning
immunity, medical and lifestyle risk factors, occupationrelated risks, travel and migration. The majority of
undervaccinated people are adults. Vaccines are one of the key components to healthy ageing, given the high
burden of vaccine-preventable diseases in the older population. More vaccines are becoming available and
are recommended for the adult population, including zoster vaccine for adults aged 70 to 79 years. Barriers
to the delivery of adult vaccinations include cost, lack of documentation of doses previously received and
public misconceptions about the need for vaccination in adulthood.
Gastrointestinal symptoms are common in pregnancy and can result in significant morbidity. Some conditions
may occur for the first time during pregnancy or may be exacerbated by pregnancy. A careful history and
physical examination are essential for diagnosis. Nausea and gastro-oesophageal reflux may respond to lifestyle
and dietary modification, although medications are often required. When indicated, medications should be
used judiciously with knowledge of the potential risks to the fetus. Active coeliac disease and inflammatory
bowel disease (IBD) have potential adverse effects on pregnancy outcomes. Recurrent miscarriages may be a
clue to undiagnosed coeliac disease.
Ineffective and harmful medical practices have always been
present, but the scale and institutionalisation of overdiagnosis
and overtreatment have expanded exponentially in the last few
decades.
The concept of ‘ too much medicine’ reflects a growing
concern in the medical community regarding the over- testing,
overdiagnosis and overtreatment of various pathologies. In the
past few decades, the number of people diagnosed with diseases
or risk factors like high blood pressure, cancer and asthma
have dramatically increased, and hence the number of people being
treated for these problems has also increased.
