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The Role of Cardiac MRI in Clinical Practice – MM1705

Cardiac MRI (CMR) provides high-resolution dynamic imaging of the beating heart and is the reference standard for assessing ventricular systolic function. CMR is the only imaging modality that can identify myocardial fibrosis and inflammation, which aids in diagnosis and prognostication for patients with cardiomyopathy. CMR is widely used for the assessment of aortic and congenital heart disease, where anatomical imaging and quantification of blood flow help guide potential interventions.

Modern Medicine – May 2017

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

This month we have a jam packed edition for you to help you cope with the rapidly decreasing temperature. Our features this month include; Ethics, Winter Ailments, Osteoporosis Management 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.

Preventing Human Papillomavirus Cuts Cancer Risk – MM1704

The human papillomavirus (HPV) is an important preventable cause of sexually-transmitted disease and squamous cell carcinomas. HPV is a very
common virus, with eight out of 10 adults coming into contact with HPV and 4 248 women between the ages of 15 and 44 dying from HPV related cervical
cancer each year in South Africa. In clinical trials, the quadrivalent HPV vaccine has been found to be safe
and efficacious. The effects of HPV vaccination programmes on population health have already been observed in the form of reduced incidences of HPV
infections, genital warts, and HPV-attributed precancerous lesions.

Modern Medicine – April 2017

It’s Not too Late to Get the Flu Vaccine – MM1704

Annual vaccination against circulating influenza viruses remains the best strategy for preventing illness from influenza. Southern Hemisphere trivalent
inactivated influenza vaccine is the only influenza vaccine licensed in South Africa. Current guidelines in South Africa recommend influenza vaccine be
given to persons at high risk of influenza infection and its complications, particularly individuals with underlying medical conditions like HIV infection.
This guideline also states that medical and nursing staff caring for high-risk patients should be vaccinated annually.

Modern Medicine – April 2017

Postherpetic Neuralgia How to prevent it, How to Treat it – MM1704

Shingles, resulting from reactivation of varicella-zoster virus is a common acute disease, particularly in elderly
and immunocompromised patients. The shingles rash is accompanied with acute, often severe pain; the
persistence of neuropathic pain beyond three months is described as postherpetic neuralgia (PHN). PHN
occurs more often in the elderly and has significant negative effects on quality of life. Vaccination with
attenuated varicella-zoster virus is a preventive strategy reducing incidence of acute shingles and thereby PHN.
Treatment of PHN should follow established guidelines for neuropathic pain; in view of the localised pain and
the typically elderly and frail patients affected, topical lignocaine 5% patch is a specific first-line treatment
option. Systemic first-line treatments include pregabalin, gabapentin, tricyclic antidepressants and serotonin
noradrenaline reuptake inhibitors, with tramadol secondline and conventional opioids third-line options.

Modern Medicine – April 2017

Treating Winter’s RTIs – MM1704

Respiratory infection is any infection of the upper or lower respiratory tract. Populations most at risk for RTI are children and the elderly. Preventive
measures are the best course for avoidance but consultation with a doctor is encouraged if infection takes place. Antibiotics have their place in helping
reduce symptoms and duration.

Modern Medicine – April 2017

Treating Exocrine Pancreatic Insufficiency – MM1704

Exocrine pancreatic insufficiency (EPI) is defined by a deficiency of exocrine pancreatic enzymes resulting in an inability to maintain normal digestion.
Numerous conditions account for the aetiology of EPI, with the most common being diseases of the pancreatic parenchyma including chronic pancreatitis,
cystic fibrosis and a history of extensive necrotising acute pancreatitis.

Modern Medicine – April 2017

Angina Pectoris Why Differentiating the Type is so Important – MM1704

Angina can be classified by type, taking into account the pathogenesis and clinical features in each patient and thus
guiding management or for predominantly exertional angina, thus indicating the urgency for treatment. The diagnosis
of angina is mainly clinical; investigations are available to confirm the diagnosis but should be used only if the history
is not clear-cut. Although routine exercise stress testing rarely provides information on the presence of serious
coronary disease, exercise perfusion imaging with various radionuclides yields more reliable data. It is vital not to miss
a diagnosis of unstable angina because of the associated risk of the development of infarction. Disorders of coronary
vasomotor tone producing angina are often misdiagnosed as noncardiac chest pain.

Modern Medicine – April 2017

Improving Lipid Profiles with Fenofibrate – MM1704

Fibric acid derivatives (fibrates) are effective antilipidemic agents with peroxisome proliferator–activated receptor
agonist activity and are indicated for the treatment of severe hypertriglyceridaemia and mixed dyslipidaemia in patients who
have not responded to nonpharmacological therapies. Fibrates also have nonlipid, pleiotropic effects (eg, reducing
levels of fibrinogen, C-reactive protein and various proinflammatory markers and improving flow-mediated dilatation)
that may contribute to its clinical efficacy, particularly in terms of improving microvascular outcomes.

Modern Medicine – April 2017

Ongoing Osteoporosis Management Dealing With Dilemmas – MM1704

Osteoporotic fracture is a major cause of morbidity and mortality. Despite the availability of treatment, many of those at risk do not receive appropriate
therapy. Every patient taking antiosteoporotic therapy should be regularly reassessed regarding continuing therapy, with the ongoing risk of fracture
balanced against the small risk of continued therapy. Consideration should be given to whether treatment remains appropriate, whether any change is
warranted and whether any ‘tweaking’ is possible to lower risk, remembering nonpharmacological measures such as dietary improvement, falls prevention
and smoking cessation. Each patient should be assessed for individual risk. Patients receiving ongoing antiresorptive therapy, particularly long term, should
be asked regularly about thigh pain because of the small risk of atypical femoral fracture.

Modern Medicine – April 2017