Modern Medicine

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

Iron Deficiency Impacts Life Quality – MM1706

Iron deficiency (ID) is the most common and widespread nutritional disorder in the world; 2 billion people >30% of the world’s population are anaemic, many
because of ID. ID is the only nutrient deficiency that is also prevalent in industrialised countries,1 particularly in women of childbearing age with heavy menstrual
flow and miscarriages. In clinical practice, several chronic conditions are also associated with ID.

Modern Medicine – June 2017

Ethical Considerations of Sterilisation as a Contraceptive – MM1706

Is it ethical to sterilise a young woman who has decided that she never wants children, even if there are no strong medical reasons to avoid pregnancy?
Although sterilisation is among the most straightforward surgical procedures it is enormously complex when considered from a historical, sociological,
or ethical perspective. Permanent sterilisation permits heterosexually active women to enjoy their sexual lives without fear of pregnancy. Sterilisation is
therefore a route to reproductive autonomy for many women. At the same time, it can also result in reproductive injustice.

Modern Medicine – June 2017

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

This month we have a jam packed edition for you to help you cope with the freezing temperature. Our features this month include; Cardiology, Nutrition, Nephrology 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.

Hard to Swallow? The Tale of Eosinophilic Oesophagitis – MM1705

Eosinophilic oesophagitis (EoE) is a chronic immune- or antigen-mediated oesophageal disease. Although EoE is often similar in presentation to gastrooesophageal reflux disease (GORD), especially in young children, its symptoms do not resolve when optimally treated with antireflux medication. Symptoms of EoE are age-dependent. Adolescents and adults often present with dysphagia, odynophagia and food impaction. Corticosteroids can be extremely effective in inducing remission but discontinuation of treatment may result in relapse. Greater awareness of this disease is necessary for early diagnosis and treatment and thus prevention of sequelae such as oesophageal fibrosis and stricturing disease.

Modern Medicine – May 2017