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Managing Fertility is More than Taking a Pill

Avoiding pregnancy when it is not desired and achieving a desired
pregnancy are matters of concern throughout the reproductive life
course. Modern contraceptives have contributed to fertility management
in what has been termed the “reproductive revolution.” These are
presumed to enable all women and men to manage fertility optimally.
Subsequent surveys of contraceptive use, pregnancy intention, pregnancy
outcome, and ideas about family formation have found that this has not
been realised.

Modern Medicine – September 2017

Pain After Stroke Challenges in assessment and management

Pain following stroke is very common and can develop in the months after stroke onset, making GPs often the first
and vital point of contact for patients. As stroke can result in communication and sensory changes, assessment and
diagnosis can be complex and a high index of suspicion with careful history and examination is required. Peripheral
sources of post-stroke pain are more common than central post-stroke pain, although both can be present
simultaneously. Central post-stroke pain as a diagnosis of exclusion helps reduce the risk of missing peripheral
causes of pain. Individual patient risks and goals must be considered when planning investigations and management
of post-stroke pain.

Modern Medicine – September 2017

Check Blood Donors for Iron Deficiency

Internationally, iron deficiency accounts for up to 70% of
deferrals for a low haemoglobin concentration, a critical cause of
donor loss. The US RISE study showed that after deferral for low
haemoglobin, 15% of repeat donors never returned and another 14%
returned only once. In response to questions regarding local donor health,
South African National Blood Services (SANBS) and Western
Province Blood Transfusion Service (WPBTS) embarked on
a collaborative study during 2014 to assess the iron status of South
African blood donors.

Modern Medicine – September 2017

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

This month we have a jam packed edition for you. Our features this month include; Ethics, Woman’s Health, Neurology 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.

Colonoscopy Reduces Colorectal Cancer Mortality

Colorectal cancer (CRC) is the third most common cancer and cause of cancer-related death worldwide. Although
the majority of individuals who develop CRC have sporadic disease, up to 20% may have a genetic predisposition.2
Survival is strongly related to the stage of the disease at diagnosis. Randomised controlled trials have shown that
screening programmes using faecal occult blood and endoscopic screening reduce mortality from CRC by early
cancer detection as well as detecting advanced adenomas which are likely to develop into cancers.

Modern Medicine – August 2017

Hidradenitis Suppurativa Debilitating and challenging to treat

Hidradenitis suppurativa (HS) is a debilitating chronic skin disease characterised by inflammatory nodules, abscesses, sinus tracts, comedones
and fibrotic scarring. HS lesions are most common in the axillae but can occur in any intertriginous area. The cause of HS is not completely understood and
is likely to be multifactorial; contributing factors may include obesity, smoking, hormonal fluctuation, inflammation and genetics.
The main clinical features supporting an HS diagnosis are a history of recurrent, painful or suppurating lesions (typically deep-seated inflammatory
nodules) in intertriginous areas, with a chronic or relapsing course. There is no single efficacious therapy for HS and a combination of lifestyle modifications,
medical and laser or surgical interventions are often required. Referral to a dermatologist is recommended for patients with moderate to severe HS.

Modern Medicine – August 2017

Disrupted Sleep Precedes Alzheimer Onset

Disturbances in the sleep–wake cycle and circadian rhythms are common symptoms of Alzheimer Disease
(AD), and they have generally been considered as late consequences of the neurodegenerative processes.
Recent evidence demonstrates that sleep–wake and circadian disruption often occur early in the course of
the disease and may even precede the development of cognitive symptoms.

Modern Medicine – August 2017

The Bidirectional Nature of Sleep Problems and Psychopathology

Most patients with psychiatric disorders experience sleep disturbance. Patients with comorbid sleep
problems have greater symptomatology and poorer treatment outcomes. Obstructive sleep apnoea (OSA)
and insomnia are associated with higher rates of depression and anxiety than community prevalence
rates. There is evidence indicating a bidirectional relation between sleep disorders and mental health.
Treatment of sleep problems may have additional benefits on mental health for patients with comorbid
psychiatric illness and may prevent the onset of psychiatric conditions in ‘at-risk’ individuals.

Modern Medicine – August 2017

Drug Adherence Impacts Multiple Sclerosis Outcomes

In the past two decades, several disease-modifying therapies
(DMTs) have become available for the treatment of relapsing-onset
multiple sclerosis (MS). While all DMTs reduce disease activity
to some extent, the efficacy rates vary.However, the success of
any pharmacological management for MS relies on the adherence
and persistence to the prescribed therapy; even the most potent DMT
will have little benefit if the drug is not taken, or not taken correctly.

Modern Medicine – August 2017

Mild COPD: Initial Steps Common questions asked by primary care practitioners

COPD is a clinical diagnosis confirmed by spirometric evidence of airflow limitation that is not fully reversible. Early detection of COPD allows early
intervention. Treatment of COPD is based on severity of symptoms, airflow obstruction and presence or absence of exacerbations. All smokers
should be assisted to quit smoking. All patients with COPD should be vaccinated against influenza. First-line pharmacotherapy for recently
diagnosed mild COPD is a short-acting bronchodilator on an as-needed basis. If symptoms persist or worsen, a long-acting bronchodilator may be
added as maintenance therapy. Long-acting bronchodilators have been shown to improve symptoms, help extend exercise tolerance and prevent
exacerbations.

Modern Medicine – August 2017