CME : Your SA Journal of CPD - Volume 27, Issue 5, 2009
Volume 27, Issue 5, 2009
Source: CME : Your SA Journal of CPD 27 (2009)More Less
A recent article in the British Medical Journal (BMJ 2009; 338: b873) highlights what the author calls the 'medicalisation of health'. Older people in the UK are called by their GPs for an annual check-up - which was introduced some years ago, amid controversy - and is now one of the ways that GPs make up their income. My mother (who lives in Scotland) calls it her MOT after the annual roadworthy test that older cars have to have in the UK!
Author Gill WatermeyerSource: CME : Your SA Journal of CPD 27 (2009)More Less
Gastro-oesophageal reflux disease and chronic constipation remain common symptom-based disorders in the community and, while traditional therapies are effective in some, a sizable number of patients prove refractory. Both these conditions have significant impact on patient quality of life and the need for novel diagnostic and management strategies is pressing. Christo van Rensburg and Dave Epstein provide practical approaches to these conditions in clinical practice.
Author Keith PettengellSource: CME : Your SA Journal of CPD 27, pp 204 –208 (2009)More Less
In 2001 the first susceptibility gene for Crohn's disease (CD) (IBD1) was identified. This encodes for a product (NOD2 or CARD15), the CD variant of which is associated with increased intestinal permeability in both CD patients and their unaffected relatives. It is also associated with ileal and fibro-stenosing diseases in Western populations. The mechanism of the permeability changes is uncertain but the CD variant of NOD2 impairs the secretion of antibacterial peptides (defensins) which help contain the bacteria that penetrate the intestinal wall. Subsequently, many other possible candidate genes have been identified. TLR4, which encodes for proteins involved in bacterial recognition, has recently been associated with CD in several populations, as have the IL23R gene in both CD and UC and ATG16L1 and IGRM in CD. The latter genes encode proteins that control autophagy, which is a major defense against intracellular pathogens such as mycobacteria and salmonella. These observations support the central hypothesis that the principal abnormality in irritable bowel disease (IBD) patients is the dysfunction of the intestinal epithelial barrier separating the lumen of the gut from the milieu intérieur.
Refractory gastro-oesophageal reflux disease : a major management issue in clinical practice : main articleAuthor Christo Van RensburgSource: CME : Your SA Journal of CPD 27, pp 210 –214 (2009)More Less
Refractory GORD is a complex clinical problem with especially GORD-related (both typical and atypical) symptoms that are becoming increasingly more resistant to PPIs. Optimising therapy is required before extensive testing with a rather limited yield is undertaken to define a possible underlying cause.
Source: CME : Your SA Journal of CPD 27, pp 220 –222 (2009)More Less
Gastric cancer is one of the most common forms of cancer worldwide, with an estimated 930 000 new cases diagnosed each year. It is thought to be more prevalent in men than in women. In South Africa the latest cancer statistics show that 1 004 new cases were diagnosed and recorded in 2001. Gastric cancer is not only common but is second to lung cancer as a leading cause of cancer-related deaths, with an estimated 700 000 deaths attributed to gastric cancer. Five-year survival statistics in gastric cancer are poor (less than 5%). It is more prevalent in Asian countries, such as Japan, than in Europe and America. One of the most important features of gastric cancer is a steady decline in incidence and mortality in the developed world over the last 50 years. It is, however, thought that the incidence of gastric cancer is increasing in the developing world, although cancer records are not readily available for most developing countries. In South Africa the new cancer statistics made available by the National Cancer Registry in 2009 show that new cases of gastric cancer dropped from 1 217 in 1999 to 1 004 in 2001.
Author V.G. NaidooSource: CME : Your SA Journal of CPD 27, pp 224 –226 (2009)More Less
Despite being one the most common diseases of the colon, diverticular disease remains an area of interest to the gastroenterologist and colorectal surgeon. Remarkable strides have been made regarding pathogenesis and possible management strategies. The clinical problems remain a challenge, from diagnosis to management, reflecting a wide spectrum of clinical manifestations, an extensive differential diagnosis and the need for more local evidence to provide suitable guidelines.
Author Mark SonderupSource: CME : Your SA Journal of CPD 27, pp 226 –227 (2009)More Less
Hepatitis B virus (HBV) remains an important public health issue in South Africa. Prior to the incorporation of HBV vaccination into the Expanded Programme of Immunisation (EPI) more than a decade ago, prevalence rates of HBV were estimated at between 0.3% and 15%. However, the potential benefits of introducing the vaccine have not yet been accurately assessed and may not be fully realised without complete vaccination coverage. A further potentially negative factor in HBV control is the burgeoning HIV / AIDS epidemic as the natural history of HBV is altered in those who are co-infected. The long-term risks of chronic HBV infection include chronic hepatitis, which may evolve to cirrhosis and the risk of hepatocellular carcinoma is significantly increased, irrespective of the presence of cirrhosis.
Author Corne KrugerSource: CME : Your SA Journal of CPD 27 (2009)More Less
Approximately 170 million people worldwide are chronically infected with hepatitis C. The prevalence in different countries ranges from 0.1% to >10%. In South Africa it ranges from 0.1% to 1%, depending on the province. There is an expected rise in the prevalence in South Africa owing to the HIV pandemic, an increase in substance abuse, and the migration of Africans from North Africa, where approximately 20 - 30 million people are infected.