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
Helping Couples Conceive When Infertility Looms – MM1704
Infertility indicates a difficulty in conceiving or carrying a pregnancy to term, but it is not synonymous with sterility (the inability to reproduce). The distinction
matters as over 50% of young adults who experience infertility may eventually conceive. In general, an estimated 84% of couples who have regular sexual
intercourse and do not use contraception will conceive within a year.2 About half of the remaining couples will conceive in the second year, with a cumulative
pregnancy rate of 92% after two years.
Modern Medicine – April 2017
Diagnosing Bacterial Eye Infections – MM1704
Management of patients with bacterial eye disease may involve nothing more
than supportive and palliative therapy; however, in other instances, it may
require aggressive intervention with antimicrobial and anti-inflammatory
agents.
Modern Medicine – April 2017
How Ethical is Paediatric Research? – MM1704
The ethical challenges in paediatric research rest in part on the understanding that physiologically, developmentally, emotionally, and in myriad other ways
children are not merely miniature adults. In an attempt to protect them from potential risks of human research, treatments are often developed for children
by extrapolating results from adult studies, which may actually impose harm. Inclusion of children as research participants requires ethical considerations
over and above those usually applied in the clinic or in the arena of research on adults.
Modern Medicine – April 2017
We welcome you to come and read through our latest, March, edition of Modern Medicine.
This month we focus on; Pulmonology , Diabetes and Cardiology.
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.
Heart Failure, a Growing Yet Treatable Epidemic – MM1703
The clinical syndrome of heart failure (HF) is a final common pathway of most forms of cardiovascular disease.1 Affected patients typically experience poor
quality of life, recurrent hospitalisations, and premature mortality.2 Although in general the prognosis of patients with HF is considered worse than that for
patients with many cancers, the increasing use of effective selective therapies has led to considerable improvement in the prognosis.
Modern Medicine – March 2017
Acute Coronary Syndromes in Women Different Presentation and Poorer Outcomes – MM1703
The community perception that heart attack is a ‘man’s disease’ contributes to longer delays in women presenting with acute coronary syndrome (ACS).
Heart attacks are common in older women and urgent hospital transfer for management is vital. Presentation of ACS in women can be atypical rather than
typical angina pain. Takotsubo cardiomyopathy is far more common in women than in men. It is brought on by emotional stress and resolves with a favourable
prognosis. Women have a worse prognosis after an ACS. Women respond just as well as men to early reperfusion therapies for coronary occlusion but if there
are delays in diagnosis or treatment delivery, their outcome is worse.
Modern Medicine – March 2017