Modern Medicine

When Is It Time To Hang Up The Stethoscope or Scalpel?

When are doctors too old to practise medicine? In 1905, at the age of 55 years, Sir William Osler publicly
spoke of the “comparative uselessness” of men older than 40 years of age. He contended that men should
retire after age 60 and jokingly suggested that at 60 years of age, men be allowed a year of contemplation
before being offered a peaceful departure by chloroform. These comments provoked a storm of
controversy, but Osler maintained his stance that men of intellect should retire at 60 years of age. While
his beliefs might have been influenced by social and cultural factors of the time, the controversy of agerelated
forced retirement continues in professions such as medicine, in which public safety could be at risk.

Modern Medicine – August 2017

Using Positive Incentives to Promote Vitality

Non-communicable chronic diseases (NCDs) such as diabetes, cardiovascular
diseases, dyslipidaemias and certain cancers pose one of the greatest health
and economic challenges of the 21st century.

Modern Medicine – August 2017

 

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

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

Gut Health Starts Even Before Birth

The human intestinal tract harbours a diverse and complex microbial community which plays a central role in
human health, with an estimated range of 1000 bacterial species and 100-fold more genes than those found in
the human genome. This community impacts host metabolism, physiology, nutrition and immune function. It
is now apparent that the gut microbiome co-evolves with humans and that changes to this population can have
major consequences, both beneficial and harmful, for human health.

Modern Medicine – July 2017

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.