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Monogenic Diabetes: Does Making the Diagnosis Matter?

Monogenic diabetes (maturity onset diabetes in the young; MODY) should be considered as a diagnosis
in the young person diagnosed with ‘atypical’ type 1 or type 2 diabetes. Insulin may be ceased
in patients with certain types of MODY and be replaced by sulfonylurea monotherapy, often to the
great relief of patients. Monogenic diabetes due to glucokinase (GCK) gene mutation usually remains
mild and nonprogressive and unless more significant glucose elevation develops may be controlled
by lifestyle measures alone. Patients with gestational diabetes should be referred for specialist review
as treatment of patients with diabetes due to GCK mutation may adversely affect the foetus if the foetus
has inherited this mutation.

Modern Medicine – July 2017

Real World Data of Aflibercept in Wet AMD

Neovascular or wet age-related macular degeneration (AMD)
accounts for 10–15% of all cases of AMD. The prevalence of wet AMD
is rising and is expected to increase by one-third by 2020. Without
treatment, wet AMD leads to severe central vision loss. Anti-VEGF
agents such as aflibercept have become the mainstay of treatment
for wet AMD. Real world data from two large-scale UK audits show that
use of aflibercept in clinical practice stabilised or improved outcomes
in both treatment-naïve and pretreated patients with wet AMD.

Modern Medicine – July 2017

Peripheral Arterial Disease A Systematic Management Strategy

Although a proportion of patients with peripheral arterial disease (PAD) are asymptomatic, some may experience
intermittent claudication (IC) or symptoms of critical limb ischaemia (CLI). Patients with PAD are at a higher
risk of cardiovascular and cerebrovascular morbidity and mortality. Measurement of the ankle brachial index
is a simple, noninvasive test for quantifying vascular compromise to the lower limb extremities. Management
of atherosclerotic risk factors is crucial in all patients with PAD. In patients with IC, revascularisation should
be reserved for those with severe limitation to mobility or who have failed medical management. In patients with
CLI, revascularisation aims to prevent limb loss, resolve rest pain and heal ischaemic ulceration or gangrene.

Modern Medicine – July 2017

Restoring Cardiac Rhythm with Amiodarone

Arrhythmias are the causes of 12-20% of emergency department admissions and one of the most important
differential diagnoses in patients with complaint of tachycardia, syncope, or chest pain. Atrial fibrillation
is the most common supraventricular tachyarrhythmia found in 1-1.5% of the population. Its prevalence
rate is less than 0.5% in 40-50 year old population but reaches 5-15% in 80 year olds. The effect of amiodarone
in controlling heart rhythm has been proved in most conditions such as cardiomyopathy and coronary artery
and valvular diseases.

Modern Medicine – July 2017

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

This month we have a jam packed edition for you. Our features this month include; Cardiology, Nutrition, Haematology 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.

Faecal Incontinence: Under-reported, Under-diagnosed – MM1706

Faecal incontinence is common and under-reported. It impacts
significantly on a patient’s quality of life and may result in social
isolation. Faecal incontinence may occur as a result of neurological
conditions, anorectal trauma and conditions such as inflammatory
bowel disease, constipation and diabetes. Obesity, smoking,
cholecystectomy and immobility are risk factors. Investigations
include endoscopy, manometry and imaging with CT or MRI if indicated.
Pelvic floor exercises, biofeedback and newer treatments such as
sacral nerve stimulation and injection of biocompatible materials
into the anal sphincter complex may lead to symptomatic improvement.
Surgery, including colostomy, may need to be considered in severe
refractory cases.

Modern Medicine – June 2017

Management of the Moderate and Late Preterm Infant – MM1706

Preterm birth (<37 completed weeks) is the leading cause of morbidity and mortality in the neonatal period. The
majority of research in Southern Africa is traditionally focused on premature infants born at a gestational age
(GA) < 32 weeks, which are at greatest risk. Until recently preterm infants with GA >32 to 36 weeks,
the moderate preterm (32 0/7 – 33 6/7) and late preterm (34 0/7 to 36 6/7) had not been evaluated.3 In practice,
the late preterm infant tends to be considered by the obstetrician and neonatologist, to have a very similar
course to those infants born at term. However, despite being lower risk than extremely premature infants,
moderate and late preterm infants have a much higher risk of death and complications than those infants born at
term.

Modern Medicine – June 2017

Acute Rhinosinusitis: Tailoring Treatment to Presentation – MM1706

Management of acute rhinosinusitis should be tailored to the presentation. A viral episode of ARS is generally present for fewer than 10 days. Bacteria are
generally thought to be the chief pathogen if symptoms persist beyond 10 days or worsen after five days. In children, inflammation of the adenoid pad can
mimic or cause rhinosinusitis. Important differential diagnoses of ARS include allergic rhinitis, dental disease, headache and facial pain syndromes. Patients
presenting with complications of rhinosinusitis require hospital admission and specialist consultation. Children should be assessed by an otolaryngologist
before CT scans are ordered.

Modern Medicine – June 2017

Unpacking the Importance of a Healthy Gut – MM1706

If the latest health trends have been followed, one would know that gut health is a topical theme within the health
and wellness sphere. According to the latest research by Gut Microbiota News Watch, the status of one’s gut
microbes impact everything from inflammation and weight to one’s skin, brain health and most importantly one’s
state of mind.

Modern Medicine – June 2017

Stroke and TIA: Crucial Knowledge for a Critical Event – MM1706

Accurate diagnosis of stroke relies on the identification of acute onset
focal neurological syndromes. Rapid assessment, triage and
management are essential in patients with acute stroke. Patients
with a transient ischaemic attack should be rapidly assessed
and investigated, especially for symptomatic carotid stenosis
and atrial fibrillation. When an acute stroke is recognised in the
community, the patient should be transferred by ambulance
to the nearest hospital with the appropriate stroke services.
Premedication with aspirin is not appropriate as it is impossible to
confidently distinguish ischaemic stroke from intracerebral
haemorrhage without a CT scan of the brain.

Modern Medicine – June 2017