Understanding the Kidney – Bone Endocrine Axis

Understanding the Kidney – Bone Endocrine Axis – MM1705

Bone provides the structural framework for the human body, protecting internal organs and maintaining mineral ion balance. Bone is a target organ for several hormones such as parathyroid hormone, 1,25-dihydroxyvitamin D [1,25(OH)2D], calcitonin and sex hormones. Recent studies found important roles of bone-derived factors including osteocalcin and fibroblast growth factor 23 in systemic regulation of glucose and phosphate metabolism, respectively. Optimal phosphate balance is essential for normal skeletal growth, development and maintenance. However, maintaining optimal phosphate levels is a significant clinical challenge in various osteo-renal diseases because phosphate toxicity has a wide range of harmful effects and because its therapeutic control is difficult, particularly in patients with chronic kidney disease.

Modern Medicine – May 2017

Diagnosing and Managing Common Adult Valvular Heart Diseases

Diagnosing and Managing Common Adult Valvular Heart Diseases – MM1705

Transthoracic echocardiography is the imaging modality of choice for diagnosis and follow up of patients with valvular hear t diseases. Exercise testing has a role in evaluating apparently asymptomatic patients with valvular heart disease to identify whether they are truly asymptomatic. Transcatheter aortic valve implantation has emerged as an alternative treatment to valve replacement by open heart surgery for the management of aortic stenosis in patients with a prohibitive surgical risk. Anticoagulation for atrial fibrillation in those with concomitant valve disease (including valve replacement) is currently limited to warfarin.

Modern Medicine – May 2017

Quality Cleansing Essential for Colonoscopy

Quality Cleansing Essential for Colonoscopy – MM1705

Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. The most commonly used agents are high-volume polyethylene glycol electrolyte solution and sodium phosphate. The timing of administration is recognised as one of the central factors to the quality of cleansing. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions.

Modern Medicine – May 2017

Atherogenic Dyslipidaemia and Residual CV Risk

Atherogenic Dyslipidaemia and Residual CV Risk – MM1705

Statin therapy has long been the cornerstone of cardiovascular disease (CVD) prevention for reducing levels of atherogenic low-density lipoprotein cholesterol (LDL-c). Therapy solely directed at reducing LDL-c levels will not address other lipid abnormalities present [eg, high levels of triglycerides (TGs) and/or low levels of high-density lipoprotein cholesterol (HDL-c)], which contribute to the presence of a residual risk of CV events.

Modern Medicine – May 2017

The Role of Cardiac MRI in Clinical Practice

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

April 2017 edition

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

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

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

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

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