South African Family Practice - Volume 54, Issue 2, 2012
Volume 54, Issue 2, 2012
Author Brian RaynerSource: South African Family Practice 54 (2012)More Less
It gives me great pleasure to introduce this supplement edition of South African Family Practice. This issue will be devoted to the presentations from the South African Hypertension Society Congress refresher day. The theme of this day will primarily be directed at "What the hypertension practitioner needs to know." In other words, the core knowledge required by practitioners to treat hypertension and associated cardiovascular and renal disease, mainly at the primary care level. This is essential reading for all hypertension practitioners.
Source: South African Family Practice 54, pp 4 –8 (2012)More Less
Extensive data from randomised controlled trials have shown the benefit of treating hypertension. The target blood pressure (BP) for antihypertensive management is < 140/90 mmHg, and < 130/80 mmHg in patients with end-organ damage, co-existing risk factors, and co-morbidity. Benefits of management include reduced risk of death, stroke, cardiac failure, chronic kidney disease, and coronary heart disease. The correct BP measurement procedure is described, and evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy, are stipulated. Lifestyle modification and patient education are cornerstones in the management of every patient. Major indications, precautions, and contraindications to each recommended antihypertensive drug are listed. Combination therapy should be considered ab initio if the BP is ≥ 20/10 mmHg above goal. First-line drug therapy for uncomplicated essential hypertension includes low-dose thiazide-like diuretics, calcium-channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers. The guideline was developed by the Southern African Hypertension Society.
Author E. O'BrienSource: South African Family Practice 54, pp 9 –11 (2012)More Less
With the publication of the recommendations of the National Institute for Health and Clinical Excellence (NICE), ambulatory blood pressure measurement (ABPM) must be seen as an indispensible investigation for good clinical practice. The technique provides a means of achieving blood pressure (BP) control in clinical practice, which is essential if the epidemic of the cardiovascular consequences of hypertension is to be halted. However, if ABPM is to be implemented for these purposes, certain requirements need to be fulfilled. These include the availability of accurate, patient-friendly and inexpensive devices, standardisation of the presentation and plotting of data with summary statistics for day-to-day practice, provision of comprehensive data analysis for research, an interpretative report to facilitate use in busy clinical practice, a trend report to demonstrate efficacy or otherwise of treatment in clinical practice, and online transmission of data to provide immediate real-time data analysis.
Author V. Mungal-SinghSource: South African Family Practice 54, pp 12 –16 (2012)More Less
There is sufficient evidence to support the critical need for health promotion and lifestyle modification interventions in dealing with the rising tide of hypertension and CVD. At the same time, clinicians do not have the resources to single-handedly stem this tide. Therefore, partnerships with lifestyle interventionists are crucial to make a significant impact.
Author Y. VeriavaSource: South African Family Practice 54, pp 17 –19 (2012)More Less
Hypertension and diabetes mellitus are the major causes of renal damage and cardiovascular events. The co-existence of these conditions further increases the risk of progressive renal disease, cardiovascular events, and mortality. Urinary excretion of albumin, even in small amounts, and a lowered glomerular filtration rate (GFR) are early markers of such a tendency. The importance of screening for microalbuminuria, and a lowered GFR in hypertensive and diabetic patients, lies in the early detection of preclinical kidney disease, and identification of individuals at increased risk of progressive renal disease, cardiovascularevents, and mortality. Intensive therapy, directed at the optimal control of blood pressure, blood sugar, and cardiovascular risk factors, as well as interventions aimed at decreasing albuminuria and slowing the progression of renal disease, have demonstrable beneficial effects.
What the primary healthcare worker needs to know about the management of type 2 diabetes : SA Hypertension Society SupplementAuthor W.F. MollentzeSource: South African Family Practice 54, pp 20 –22 (2012)More Less
Globally, type 2 diabetes remains the most common type of diabetes, and its prevalence is rising, unabatedly driven by physical inactivity and the emerging epidemic of obesity. The risk of developing type 2 diabetes is especially increased in rural girls, of whom up to 25% are already overweight or obese in late adolescence.
Author L.H. OpieSource: South African Family Practice 54, pp 23 –25 (2012)More Less
The pharmacodynamic interactions of beta blockers can be predicted. Beta blockers depress the sinoatrial (SA) and atrioventricular (AV) nodes when combined with other negative inotropic agents (Table I). Those drugs that are metabolised by the liver, metoprolol, carvedilol, labetalol and propranolol, are prone to hepatic interactions. Of this group, metoprolol and carvedilol are more frequently used. Metoprolol is metabolised by the hepatic CYP2D6 system, that is inhibited by paroxetine, a widely used antidepressant and selective serotonin reuptake inhibitor. The hepatic system is also inhibited by propoxyphene, an opioid pain-relief agent, available in South Africa as Distalgesic®, although it was recently withdrawn in the USA. Carvedilol is metabolised by the same system, with the same possible interactions.
The detection of left ventricular hypertrophy and diastolic dysfunction : SA Hypertension Society SupplementAuthor G.R. NortonSource: South African Family Practice 54, pp 26 –28 (2012)More Less
All guidelines for the diagnosis and management of hypertension recommend that electrocardiographic (ECG) evidence of left ventricular hypertrophy (LVH) is sought for accurate risk assessment. The presence of ECG patterns that fulfill the criteria for LVH suggest a > 20% absolute 10-year risk of developing cardiovascular disease, and is a compelling indication for the use of antihypertensives that block the renin angiotensin system. Many guidelines also suggest that an echocardiogram is performed to confirm or refute the presence of LVH suggested by ECG criteria. However, in South Africa, access to echocardiography is costly and limited. However, echocardiography may be a critically important tool in the care of the hypertensive patient with LVH who presents with dyspnoea, when the cause is not obvious. These patients may have heart failure caused by diastolic dysfunction.
Author F. FarrerSource: South African Family Practice 54, pp 26 –31 (2012)More Less
A sore throat is a common complaint, and often an early indication of another medical condition, such as a cold. In the absence of life-threatening conditions or bacterial infection, local symptomatic treatment will ease the pain. This article reviews the common causes and symptoms of sore throats, and provides an overview of some of the sprays and lozenges that are available to treat this problem.
Author B. RaynerSource: South African Family Practice 54, pp 29 –30 (2012)More Less
Increasingly, hypertension in children and adolescents is becoming more prevalent as a result of the burgeoning obesity epidemic, and the effects of low birthweight and underlying genetic predisposition. Blood pressure (BP) is lower in children, and it is therefore imperative to consult age, gender, and height norms for BP. Pre-hypertension is defined as BP persistently above the 90th centile, and hypertension as BP persistently above the 95th centile. Before a diagnosis can be made, BP needs to be taken frequently, and 24-hour ambulatory BP monitoring is recommended. Contrary to expectation, most cases of elevated BP in adolescents are due to primary or essential hypertension. However, in each case, a full history and examination should be performed using a few basic investigations. Special investigations and referral need to be reserved for those children with a suspected secondary cause, and those with more severe hypertension. The mainstay of treatment is lifestyle modification, and pharmacotherapy should be reserved for patients with symptomatic or severe hypertension, secondary hypertension, hypertension with overt target-organ damage, type 1 and 2 diabetes, and persistent hypertension refractory to lifestyle intervention.
Common and less common adverse effects of antihypertensives : a general practitioner's perspective : SA Hypertension Society SupplementAuthor Y. TrinderSource: South African Family Practice 54, pp 31 –32 (2012)More Less
About 35% of hypertensive patients will discontinue their medication within six months, and in at least 50% of cases, the reason for discontinuation relates to adverse effects and patient dissatisfaction. Therefore, it is imperative that hypertension practitioners are fully cognisant of the adverse effects of antihypertensive drugs. The focus in this article will be on the six major classes of drugs, namely diuretics, angiotensin-converting (ACE) inhibitors, angiotensinreceptor blockers (ARBs), calcium-channel blockers, beta blockers and alpha blockers.
Source: South African Family Practice 54 (2012)More Less
This is my first editorial as the new editor-in-chief of the South African Family Practice journal having been the associate editor for six years. During the last 3 years, I was simultaneously appointed the editor-in-chief of the first African Journal of Primary Health Care and Family Medicine (AJPHCFM), the tenure which I completed on 31st December 2011. Pierre de Villiers became the editor-in-chief of AJPHCFM with effect from 1st January 2012.
Source: South African Family Practice 54 (2012)More Less
Does the introduction of a management protocol improve the control of type 2 diabetes?
Emotional intelligence and locus of control of adult breast cancer patients receiving treatment : a relatively new research area in South Africa
Hazardous alcohol drinking patterns during adolescence in South Africa
Depression and adherence to antiretroviral therapy in HIV-positive patients
Source: South African Family Practice 54, pp 88 –92 (2012)More Less
Psoriasis is a genetically determined inflammatory and proliferative disease of the skin, presenting with sharply demarcated scaly plaques, especially on the extensor prominences and the scalp. Although it is a clinical diagnosis, biopsy can help to confirm the diagnosis. Treatment modalities include topical corticosteroids, tar preparations, vitamin D analogues, systemic retinoids, immunosuppressive drugs, phototherapy, and recently, biologicals.
Author K. KochSource: South African Family Practice 54, pp 94 –99 (2012)More Less
Chronic pain affects almost one in five patients, making it one of the most common conditions that any practitioner has to manage on a daily basis. Poorly managed chronic pain has a significant impact on work, social and psychological functioning. This guideline aims to review the most common medications and treatments available in general practice, and how to follow a safe, stepwise approach to managing chronic pain.
Source: South African Family Practice 54, pp 100 –105 (2012)More Less
Hypertension is the most common, and potent universal contributor to cardiovascular mortality. Elevated blood pressure, labile or fixed, systolic or diastolic, at any age, in either sex, is a contributor to all forms of cardiovascular disease. Hypertension in children is currently recognised as an important health issue. Treatment includes weight loss and exercise.
Source: South African Family Practice 54, pp 106 –110 (2012)More Less
Thickened infant formula is widely used as a first-line treatment for gastro-oesophageal reflux (GOR) in infants. The use thereof remains controversial, and conflicting evidence exists with regards to its efficiency. The safety of anti-reflux formula has been proven, with only a few adverse effects reported, making it safe for infants with mild symptoms of reflux.
Author N. KhamkerSource: South African Family Practice 54, pp 111 –116 (2012)More Less
Schizophrenia is a psychiatric illness of unknown aetiology, and impairs cognition and social and occupational functioning. It is challenging in terms of the disability it causes, the unclear nature of what causes it, the complexity of diagnosis and treatment limitations. General practitioners can play a role in various phases of the illness, from early intervention to chronic care, in liaison with the psychiatrist.
Author J.A. KerSource: South African Family Practice 54, pp 117 –118 (2012)More Less
Sexual dysfunction is defined by the World Health Organization as the various ways in which an individual is unable to participate in a sexual relationship as desired.
Erectile dysfunction was formerly viewed as a psychological entity and dismissed as such, but currently, it is considered to be a disease of vascular origin. Sexual dysfunction has been called: "the 'prima ballerina' of hypertension-related, quality-of-life complications".
Currently, erectile dysfunction is also considered to be an independent predictor of future cardiovascular disease, as it may be viewed as a manifestation of vascular dysfunction, and endothelial dysfunction underlies this symptom.
Assessing the knowledge and perceptions of medical students from the Western Cape, South Africa, regarding the Millennium Development Goals : original researchSource: South African Family Practice 54, pp 126 –131 (2012)More Less
Background: Health science students are key players in implementing the Millennium Development Goals (MDG). Knowledge and understanding at university level is essential to achieve the goals by 2015. The primary objective of this study was to assess the knowledge and perceptions of fifth-year medical students at Stellenbosch University and the University of Cape Town regarding the MDG. The secondary objectives were to determine the degree to which students are involved in awareness campaigns and implementation of the MDG, and to assess students' perceptions regarding the need for the MDG in South Africa.
Method: This observational, descriptive, cross-sectional study collected quantitative data. A census was carried out. All participants completed a self-administered questionnaire.
Results: Of the 176 participants, 61.14% said they had previously heard or read about the MDG. Forty per cent had heard about the MDG through awareness campaigns. More than half (54.86%) claimed to know what the MDG were, but could not name all of the goals. Participants identified a mean of three out of eight MDG correctly. The majority of students considered MDG implementation in South Africa important but ineffective (69.85%), and 85.82% believed that the MDG would not be achieved on time.
Conclusion: It was found that fifth-year medical students in the Western Cape were not adequately informed about the MDG and their importance in South Africa. However, their perceptions were positive, in that the majority agreed that the implementation of the MDG in South Africa is important and that more needs to be done in creating awareness about the goals.