South African Family Practice - Volume 57, Issue 2, 2015
Volume 57, Issue 2, 2015
South African Dyslipidaemia Guideline Consensus Statement
A joint statement from the South African Heart Association (SA Heart) and the Lipid and Atherosclerosis Society of Southern Africa (LASSA) : guidelinesSource: South African Family Practice 57, pp 22 –31 (2015)More Less
The European Society of Cardiology together with the European Atherosclerosis Society published updated dyslipidaemia guidelines in 2011. SA Heart and the Lipid and Atherosclerosis Society of Southern Africa officially adopt these guidelines. This statement adapts aspects of the guidelines to the South African situation. Using the updated Framingham risk charts, interventional strategies are based according to the cardiovascular risk score and low-density lipoprotein cholesterol (LDL-C) levels. The Framingham risk score refers to the 10-year risk of any cardiovascular event, and includes four categories of risk. Treatment targets are those of the European guidelines. The LDL-C goal is 1.8 mmol/l for the very high-risk group (>30%), 2.5 mmol/l for the high-risk group (15 - 30%), and 3 mmol/l for those below 15% risk. Intensive management of dyslipidaemia in South Africa will significantly reduce the cardiovascular disease health burden.
Author K. OuthoffSource: South African Family Practice 57, pp 32 –34 (2015)More Less
Switching antidepressants because of lack of efficacy or unacceptable side-effects, while often required in general practice, may result in toxic drug-drug interactions, worsening depression or unpleasant discontinuation reactions. Switching strategies to minimise these risks include immediate switching, cross-tapering or incorporating a washout period. Immediate switching is generally possible when substituting a selective serotonin re-uptake inhibitor or a serotonin and noradrenaline re-uptake inhibitor for a drug from its own class. Cross-tapering over a period of weeks is preferred when switching between different antidepressant classes or from high-dose antidepressants. Dangerous interactions necessitate the observance of an adequate washout period when switching to and from monoamine oxidase inhibitors.
Author Dek SommersSource: South African Family Practice 57, pp 35 –38 (2015)More Less
Instead of considering allergic rhinitis as a disease of acute symptoms, it needs to be understood as a chronic inflammatory disease that involves a level of persistent inflammation even in the absence of symptoms. Given the close functional, immunological and clinical link between asthma and rhinitis, it is reasonable to expect that an effective treatment of rhinitis would affect the comorbid asthma; the occurrence of rhinitis in asthmatic patients ranges from 70% to about 90%. The prevalence of allergic rhinitis in patients presenting to their primary care providers with nasal symptoms is estimated to be 30% to 60%. Diagnostic allergy testing is indicated only if the test result could alter the decision to treat. Empirical treatment is a common approach, as allergic rhinitis is a nonfatal disease with safe and effective treatments. Nonsedating antihistamines and nasal steroids are relatively free of side effects, and are reasonably inexpensive. The nasal steroids reduce all symptoms, but the antihistamines are less effective for nasal congestion and minimally address the problem of inflammation. Immune-based specifically targeted molecules, such as the cloned humanised monoclonal antibody-inhibiting human IgE omalizumab, are presently being studied in patients with seasonal allergic rhinitis.
Author Chris EllisSource: South African Family Practice 57 (2015)More Less
Recently, a couple have been coming in to see me, and each time they return for a consultation they have had a good go at each other. She unloads a whole lot of hurts from the past that he has inflicted on her, and he retorts with his own repertoire of responses and adds some extra insults, for good measure.