CME : Your SA Journal of CPD - Volume 31, Issue 9, 2013
Volume 31, Issue 9, 2013
Author Bridget FarhamSource: CME : Your SA Journal of CPD 31 (2013)More Less
The British Medical Journal is currently running a series of articles in the 'Too much medicine' series, and recently one in particular caught my eye. Called 'Too much medicine; too little care', the editorial starts with a quote from Margaret McCartney: 'Too much testing of well people and not enough care for the sick worsens health inequalities and drains professionalism, harming both those who need treatment and those who don't'.
Author K. DhedaSource: CME : Your SA Journal of CPD 31 (2013)More Less
The current issue of CME on respiratory diseases is timely and appropriate for several reasons. Respiratory-related symptoms, either with regard to the upper or lower respiratory tract, are responsible for almost 50% of consultations in general practice. Respiratory complaints are also the most common reason for HIV-infected persons to seek healthcare, either at primary or secondary level. Almost 12% of the nation's population are co-infected with HIV, and in some communities these rates are as high as 40%.
Source: CME : Your SA Journal of CPD 31, pp 320 –325 (2013)More Less
Excessive fluid accumulating within the pleural space is a common medical affliction and invariably indicates disease. Under physiological conditions fluid enters and exits the pleural space at the same rate. The rate of production is determined by Starling's forces, i.e. hydrostatic pressure, osmotic pressure and membrane permeability, whereas the exit rate is determined by clearance through lymphatic drainage. Alterations in any of these forces can lead to the formation of a pleural effusion. While the physiological amount of pleural fluid present has various positive effects on respiratory function, e.g. assisting in creating a negative intrathoracic pressure and reducing friction between pleural membranes, excessive fluid can significantly impair normal respiratory function. Once the volume of fluid in the pleural space reaches 200 - 250ml, it is detectable on a standard PA chest radiograph (CXR). The presence of a pleural effusion can be clinically detected only after the fluid volume reaches 300 - 350ml, but in the event of small volumes the sensitivity and specificity in its detection rates remain low. Because the differential diagnosis for intrapleural fluid accumulation encompasses a wide spectrum of conditions, a systematic approach to these effusions is particularly important in their investigation.
Source: CME : Your SA Journal of CPD 31, pp 326 –330 (2013)More Less
The term 'sarkoid' was first coined by Caesar Boeck in 1899 while describing skin lesions initially documented by the English physician Jonathan Hutchinson in 1877. Boeck used the term to describe what he presumed were benign 'sarcoma-like' lesions, and more than a century later sarcoidosis remains an enigma. As a result sarcoidosis is still defined vaguely as a disease where granulomas are formed in multiple organ systems, without a recognised cause.
Author A. Goolam-MahomedSource: CME : Your SA Journal of CPD 31, pp 335 –338 (2013)More Less
Pulmonary thrombo-embolic disease can be a cause of sudden death, but the diagnosis is often missed. This review aims to increase awareness towards early diagnosis and treatment of the condition. In addition, a number of new and exciting anticoagulant therapies are being developed for this disease.
Author K. NyamandeSource: CME : Your SA Journal of CPD 31, pp 339 –341 (2013)More Less
Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality worldwide, but its incidence in South Africa is unknown. In the USA, the incidence is 5 - 6 cases per 1 000 person-years, and 60 000 deaths caused by pneumonia were reported in that country in 2005. Given that South Africa is a developing country with a very high HIV prevalence, the incidence and death rate of pneumonia are likely to be higher. High morbidity and mortality rates of up to 23% are associated with CAP in the USA. In South Africa, the rates are not dissimilar.
Author B. ScharSource: CME : Your SA Journal of CPD 31, pp 342 –344 (2013)More Less
The diffuse parenchymal lung diseases (DPLDs), also called interstitial lung diseases (ILDs), are a heterogeneous group of rare disorders that cause expansion of the interstitial compartment by varying degrees of inflammation and fibrosis, resulting in parenchymal damage. This group of lung diseases is subdivided into four categories, one of which is the idiopathic interstitial pneumonias (IIPs) (Table 1). The IIPs account for 25 - 30% of all DPLDs, each with distinct clinicopathological and radiological features. Within this subgroup, idiopathic pulmonary fibrosis (IPF) and idiopathic nonspecific interstitial pneumonia (iNSIP) account for 55% and 25% of cases, respectively.
Source: CME : Your SA Journal of CPD 31, pp 344 –346 (2013)More Less
The epidemic of drug-resistant tuberculosis (DR-TB) is a public health emergency that threatens to destabilise global TB control. Although TB incidence and mortality are decreasing in several parts of the world, the overall prevalence of multidrug-resistant tuberculosis (MDR-TB) is increasing in many high-burden countries, particularly in Africa. World Health Organization (WHO) statistics show that almost half a million new cases of MDR-TB develop every year, of which approximately 40 000 (in more than 80 countries) are thought to be extensively drug-resistant tuberculosis (XDR-TB) (Fig. 1). Limited laboratory capacity and lack of widespread drug susceptibility in resource-poor settings mean that only a fraction of that number are correctly diagnosed and started on treatment.
Author Chris BatemanSource: CME : Your SA Journal of CPD 31, pp 348 –349 (2013)More Less
International - Study scotches 'left-brained, right brained' stereotyping
International - Vitamin C kills TB bacteria in experiment
Africa - MSF finally pulls out of deadly Somalia
South Africa - Public private partnerships may answer doctor shortage
South Africa - Two hundred doctors found guilty of misconduct
South Africa - High-tech translation tool eases doctors' task