South African Family Practice - Volume 57, Issue 2, 2015
Volume 57, Issue 2, 2015
Source: South African Family Practice 57, pp 1 –4 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.975483More Less
Inhalation of volatile agents, or solvent abuse, is a dangerous pastime practised by many young adolescents in various parts of the world. Benzine, a distillate of petroleum, is a cheap and readily available solvent that is often inhaled or "sniffed" to produce a short-lived feeling of euphoria or disorientation. The aim of this report is to describe four adolescents with severe polyneuropathies secondary to chronic benzine inhalation who were seen at the Steve Biko Academic Hospital in Pretoria's Neurology Department.
Methods and patients : Four adolescent boys aged 15-18 years presented to the Department of Neurology from 2011 to 2013 with progressive weakness and muscle atrophy.
Results : On examination all patients showed signs of a severe motor and sensory neuropathy. Two were wheelchair bound at the time of presentation and an initial diagnosis of Guillain-Barré syndrome was considered. Cerebrospinal fluid analysis was normal and electromyography showed severe mixed motor and sensory mainly axonal polyneuropathies in all patients. All investigations for causes of neuropathies were normal, but all patients eventually admitted that they had been abusing benzine by inhaling it for a period of at least six months. The inhalation occurred as a group activity, involving many children.
Conclusion : Inhalant abuse appears to be a common practice amongst adolescents from Pretoria. It can lead to a catastrophic polyneuropathy, which should be considered in the differential diagnosis of a young patient presenting with a Guillain-Barré syndrome-type of clinical picture. Awareness amongst schools and drug programmes should be raised to prevent this tragic and highly disabling condition.
Profile and acute mortality outcome of patients admitted with cryptococcal meningitis to an urban district hospital in KwaZulu-Natal, South Africa : researchSource: South African Family Practice 57, pp 1 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.976962More Less
Background : Cryptococcal meningitis (CCM) is one of the leading causes of early mortality in human immunodeficiency virus (HIV)-infected patients. This study was part of a clinical audit aimed at improving care for patients with CCM at an urban district hospital in South Africa.
Method : The clinical records of patients (age > 13 years) admitted to the hospital with a diagnosis of CCM between June 2011 and December 2012 were retrospectively reviewed. Descriptive statistics and chi-square analysis were generated with EpiInfo 18.104.22.168. Ninety-five per cent confidence intervals were reported, where appropriate.
Results : Of the 127 patients admitted with CCM, only 97 (76.4%) knew their HIV status. Only 44.8% (43/96) of those who knew that they were HIV-positive were on antiretroviral therapy (ART). Seventeen of the 25 patients (68%) previously treated for CCM had defaulted on their fluconazole treatment and only 60% (15/25) were on ART. CCM-related mortality at two weeks was 55.9% (71/127). A high cerebrospinal fluid (CSF) fungal load, CD4 count < 100 cells/mm3 and poor CSF inflammatory response were associated with increased mortality risk. However, only the association between poor CSF inflammatory response and mortality was statistically significant (p = 0.03).
Conclusion : Acute CCM-related mortality remains high. The number of patients who do not know their HIV status, the number of HIV-positive patients who are not on ART, the high level of nonadherence to their fluconazole medication and the proportion of patients who are not on ART after at least one previous CCM episode indicate that there is a need to develop comprehensive strategies aimed at encouraging HIV testing and improving the retention of patients with regard to HIV care and support.
Author Serela RamklassSource: South African Family Practice 57, pp 1 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.977006More Less
Background : Caring is central to the practice of physiotherapy. However, explicit components of caring required for South African physiotherapy practice within a model of primary healthcare are not detailed.
Method : Employing a narrative enquiry as the selected methodology, data were produced through multiple methods to obtain multiple perspectives and orientation on how caring was facilitated in the physiotherapy curriculum and in practice. Data production, involving student physiotherapists, physiotherapy academics and practising physiotherapists, included in-depth focus group interviews, individual interviews, journal entries and open-ended questionnaires. Initially, the data were analysed separately for each group of research participants, followed by a cross-sectional analysis.
Results : Components of caring were identified from the interactions of student physiotherapists with patients, academics, practising physiotherapists and among the students themselves. Emerging expressions of caring were grouped as collegiality and valuing; listening, and showing empathy and nurturing; being an expert practitioner; having interdisciplinary knowledge and utilising biopsychosocial intervention; having cultural and language competence; and community and human-interconnectedness.
Conclusion : This paper identifies the components of caring that are important for physiotherapy across multiple sectors. The findings are significant for physiotherapy development and may be considered within other health science professions.
Socio-demographic risk factors for unintended pregnancy among unmarried adolescent Nigerian girls : researchAuthor Chibuogwu IzugbaraSource: South African Family Practice 57, pp 1 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.977042More Less
Background : Globally, unintended births among unmarried adolescent girls are a major contributor to maternal and childhood mortality, the vicious cycle of ill-health, poverty, and truncated educational opportunities. Nigeria has the highest rates of adolescent fertility in sub-Saharan Africa. Over 900 000 births to adolescents occur annually and 150 out of every 1000 women who give birth in Nigeria are 19 years old or under.
Objective : To document and investigate socio-demographic risk factors for unintended pregnancy among unmarried adolescent Nigerian girls.
Methods : Data for this study were drawn from the 2008 Nigeria Demographic and Health Survey. Univariate and multivariate statistical analyses were used to assess the relationship between adolescent pregnancy and socio-demographic contextual factors focusing on sex and age of household head, adolescent girls' age, and educational attainment, place of residence, religious affiliation, and household wealth index. All data were analysed using STATA Version 11.
Results : Non-pregnant adolescents had older household heads; such households were wealthy, and parents of such households had higher educational standing. Female-headed households were less likely to experience unwanted adolescent pregnancy compared to those of the reference group category (OR = 0.56, 95% CI = 0.3920-0.8073).
Conclusion : There is a significant relationship between age and sex of household head and risk of unintended adolescent pregnancy among unmarried adolescent girls. Adolescent girls from households headed by young adults are more likely to experience adolescent pregnancy compared to adolescent girls from households headed by older adults.
The role of community health workers in the re-engineering of primary health care in rural Eastern Cape : researchSource: South African Family Practice 57, pp 1 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.977063More Less
Background : Primary Health Care in South Africa is being re-engineered to create a model of integrated care across different levels of the health care system. From hospitals to clinics, in the community and in the home, health care will focus more on prevention, health promotion, and advocacy for healthy lifestyles and well-being, in addition to clinical services. We provide a best-practice model of integrating community health workers (CHWs) trained as generalists into a multi-level health system in the Oliver Tambo district of the rural Eastern Cape.
Methods : Based at Zithulele Hospital, a health care network between the hospital, 8 clinics, and 50 CHWs has been created. The functions of each tier of care are different and complementary. This article describes the recruitment, training, supervision, monitoring, and outcomes of CHWs who deliver maternal, child health, nutrition, and general care through home visits.
Results : CHWs, especially in rural settings, can find and refer new TB/HIV cases, ill children, and at-risk pregnant women; rehabilitate malnourished children at home; support TB and HIV treatment adherence; treat diarrhoea, worm infestation, and skin problems; and distribute vitamin A. CHWs provide follow-up after clinic and hospital care, support families to apply health information, problem-solve the health and social challenges of daily living, and assist in accessing social grants. Case examples of how this model functions are provided.
Conclusion : This generalist CHW home intervention is a potential model for the re-engineering of the primary health care system in South Africa.
Source: South African Family Practice 57, pp 1 –4 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.978104More Less
Aim : This study aimed at appraising the practice of bio-medical research amongst doctors working at Federal Medical Centre, Owo, Ondo State, Nigeria. Barriers to health research were also identified.
Methods : This study was conducted over a period of six months between June and November 2012 among different cadres of medical practitioners working at the Federal Medical Centre, Owo, Ondo State, Nigeria. One hundred respondents selected by simple random sampling technique were interviewed with the aid of a semi-structured questionnaire. Informed consent was obtained from each of the respondents. The information obtained included their bio-data, previous research training experience, and publication. Views of respondents on bio-medical research and barriers to health research were also sought. The data obtained with the aid of the questionnaire were collated and analysed with SPSS 15.0.1 statistical software version.
Results : A total of 85 out of the 100 medical practitioners that collected the questionnaire returned their filled questionnaire. The age range of the respondents is 25-59 years with a mean age of 36.55 years ± 8.4 years. The median age was 34 years, and the mode was 34 years. There were 71 males and 14 females. Most respondents (61; 71.8%) had training in research while the remaining 24 (28.2%) did not. Most respondents (66; 77.6%) had participated in research and few, 19 (22.4%), had not participated in research. Less than half of the respondents (41; 48.8%) had had previous research published, and more than half (43; 51.2%) had not had research published. Most respondents (79; 92.9%) believed that research helped in promoting medical practice. Lack of research funding was a major barrier to research (75; 88.2%).
Conclusion : Most respondents had participated in research. The majority of the study participants had training in bio-medical research prior to this study. There is a need for regular training of doctors in bio-medical research, and adequate funding should be provided for research.
An assessment of the risk factors for pulmonary tuberculosis among adult patients suffering from human immunodeficiency virus attending the Wellness Clinic at Themba Hospital : researchSource: South African Family Practice 57, pp 1 –6 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.978105More Less
Background : In South Africa, the data about risk factors for pulmonary tuberculosis (PTB) is limited. Therefore, the assessment of risk factors for PTB is an important step to identify which risk factors are unique in every specific population context and in this way gain a better understanding of them. The aim of this research was to assess contributory risk factors for PTB among adult patients suffering from Human Immunodeficiency Virus (HIV) attending the Wellness Clinic at Themba Hospital.
Method : A cross sectional descriptive design was employed. A total of 300 participants were interviewed using a structured questionnaire to collect data on socio-demographic information, behavioural factors and medical history of patients in the research. Data were analysed using Stata Release 11 software. Univariate and multivariable logistic regression models were used to determine factors associated with PTB.
Results : The results of this investigation showed that being of single marital status (OR = 1.96; 95% CI = 1.01-3 79), moderate/heavy drinkers (OR = 3.46; 95% CI = 1.56-7.69) and living in a dusty outdoor environment (OR = 2.05; 95% CI = 1.16-3.61) were statistically associated with pulmonary tuberculosis for the study participants in multivariable logistic regression models.
Conclusion : Single marital status, dusty outdoor environment and moderate/heavy drinkers were strongly associated with an increased risk of PTB among HIV positive patients. Pulmonary tuberculosis control and prevention strategies among HIV positive patients should be focused on reducing or limiting the impact of these risk factors.
The effect of an automated integrated management of childhood illness guideline on the training of professional nurses in the Western Cape, South Africa : researchSource: South African Family Practice 57, pp 1 –6 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.995914More Less
Background : Reducing under-five mortality rates is a global priority. Although under-five mortality has decreased in South Africa, it is still unacceptably high. The implementation of the Integrated Management of Childhood Illness (IMCI) guideline is a key World Health Organization intervention aimed at reducing under-five mortality. Most primary care consultations are with professional nurses and they are usually trained in IMCI in a year-long primary healthcare diploma, which qualifies them to be a clinical nurse practitioner. This study aimed to evaluate the effect on training outcomes of introducing an automated IMCI guideline.
Methods : Thirty professional nurses enrolled for the diploma course were purposively allocated in a quasi-experimental design to train with either paper-based or automated versions of the guideline. Their knowledge of IMCI was evaluated before and after the initial 12 hours of classroom teaching. Data on assessment, classification and management of children was extracted from the medical records of their consultations during supervised clinical training.
Results : Both groups improved their knowledge of IMCI, but were not significantly different at the end of classroom teaching. Nurses in the automated group performed significantly better in use of the IMCI guideline (p < 0.05): checking immunisations (68% vs. 93%), making a complete assessment (62% vs 100%), prescribing correct medication (50% vs 85%) and correct dose (42% vs 85%).
Conclusion : Use of automated IMCI guidelines showed potential for improved training outcomes. The potential for improved quality of care and clinical outcomes needs to be further studied along with a cost-benefit analysis.
An evaluation of factors underlying suicide attempts in patients presenting at George Hospital emergency centre : researchSource: South African Family Practice 57, pp 1 –7 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.976944More Less
Background : Roughly 130 patients are seen daily in the emergency centre (EC) at George Provincial Hospital (GPH), of whom one or two will have attempted suicide. GPH serves the population of Eden and Central Karoo Districts. Little is known about the circumstances surrounding these suicide attempts. We examined this pattern and formulated a protocol for managing these patients.
Method : All patients attending the EC after attempting suicide between December 2010 and April 2011 were identified from the EC register. Thirty nine patients gave consent and completed a questionnaire. The data were analysed in Excel®. Additional information was obtained from five members of a focus group.
Results : Patients who attempted suicide had often attempted suicide previously. They came from a community with high levels of longstanding financial and domestic stress, violence, dysfunctional family relationships, alcohol abuse and poor coping skills. Suicide attempts generally involved impulsively taking prescription medication following an argument with a family member. Patients felt abandoned or alone, were physically or mentally abused, were subjected to alcohol abuse, or had underlying anxiety or depression.
Conclusion : Patients who attempt suicide and attend GPH EC come from a chronically stressed community with dysfunctional family patterns and alcohol abuse and lack coping skills. A psychological support team has introduced a suicide-attempt protocol in the EC offering patients an opportunity to deal with their distress and learn better coping skills.
Source: South African Family Practice 57, pp 1 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.983307More Less
Lower urinary tract symptoms (LUTS) refer to the symptom complex that is the common pathway for diseases affecting the lower urinary tract. It manifests as either irritative or obstructive symptoms. LUTS have long been recognised as a significant cause of morbidity in both sexes. The long term sequelae of the underlying cause are also a significant cause of mortality. LUTS have been noted to have a recognisable progression pattern that worsens with age. This is of particular concern in African countries that continue to evolve in terms of the population dynamics. This evolution has resulted in an increase in the geriatric population in both developed and developing countries. There has been a concordant increase in the recognition of the symptom complex with age. This results in a significant percentage of males presenting with LUTS and secondary complications. Several factors interact to produce LUTS. Complex pathophysiological pathways have been investigated to define the roles of individual and cumulative risk factors in an attempt to provide better therapeutic options. It is imperative for scientists to identify reversible factors that influence LUTS. Treatment of the complex of symptoms has the potential to utilise a significant proportion of the healthcare budget. Identification of modifiable risk factors in the pathogenesis of LUTS allows for more cost effective prevention and management of the disease.
This article will discuss the definition and pathogenesis of LUTS with particular emphasis on the role of metabolic factors. An algorithm for assessment, initial management and referral criteria is also included.
Source: South African Family Practice 57, pp 1 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.1002219More Less
Background : Suicidal behaviour is highly prevalent and increasing at an alarming rate among all socio-demographic groupings in South Africa. Approximately 9.5% of all unnatural deaths in young people in South Africa are due to suicide. The ratio of non-fatal suicide attempts to attempts with fatal outcomes varies between 20:1 and 40:1 depending on the geographical region and the community composition being studied. Although depression is a common co-existing finding in many studies involving patients with suicidal behaviour, current evidence suggests that it is either not detected or it is inappropriately managed in clinical practice.
Aim : This study compared self-reported perceived and objectively assessed personal physical and mental well-being of adults attempting suicide and being admitted to two local community-based public hospitals in South Africa.
Method : Validated questionnaires were used to elicit relevant data from 688 adults attempting suicide and being admitted to two community-based public hospitals in Durban which was analysed using SPSS®.
Results : The majority of participants were female, single, younger age group, unemployed, low education and low income level. Only 30.3% of participants reported long-standing illnesses lasting more than 6 months. The majority perceived their physical and mental health to be normal. However, an objective assessment revealed a large number of participants to be suffering from varying levels of depression.
Conclusion : The study population comprised mainly the younger age group in both sexes, and showed that depression is an important co-morbid risk factor in suicidal behaviour in this and other groups. This finding cannot be ignored, and the authors endorse the call for a scaling up of screening strategies to diagnose depression, and for an improved prevention and management framework.
Source: South African Family Practice 57, pp 1 –6 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.1002220ï»¿More Less
This article aims to inform the reader about current knowledge of the effects of aminoglycosides on hearing. The hearing loss caused by aminoglycosides is permanent and can negatively affect the individualâ??s quality of life. Although treatment with aminoglycosides cannot be avoided in some instances, timely intervention can minimise the impact of the hearing loss on the individual's everyday life. The discussion includes the incidence of aminoglycoside-induced hearing loss and predisposing factors. In addition, monitoring and management of cochlear ototoxicity is described.
Health-related factors associated with intimate partner violence in women attending a primary care clinic in south-western Nigeria : researchSource: South African Family Practice 57, pp 1 –8 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.976994More Less
Background : Intimate partner violence (IPV) relates to poor physical and mental health in women. Women who have experienced it access healthcare facilities more frequently with symptoms that are often unrelated to violence. The objective of the study was to determine the prevalence of IPV and health-related factors in women in the study population.
Method : This clinic-based, cross-sectional study was carried out between November 2010 and January 2011 at the general outpatient clinic of the University College Hospital, Ibadan, Nigeria. Four hundred women aged 15 years and older with previous or current intimate partners were recruited by simple random sampling. Data were collected using an interviewer-administered questionnaire to obtain information on the respondents' socio-demographic characteristics, lifetime experience of IPV and clinical data, i.e. presenting symptoms, body mass indices and blood pressure readings. The clinical data of women who had a lifetime experience of IPV were compared with those who did not.
Results : The overall lifetime prevalence of IPV was 89.2%. Reported IPV types were controlling behaviour (79 5%), psychological violence (35.7%), and physical (19.8%) and sexual violence (9.8%). Non-specific complaints (p = 0.028), female genital complaints (p = 0.037), poor sleep (p = 0.049), headaches (p = 0.011), abrasions or scars (p = 0.012), suicidal ideation (p = 0.001) and obesity (p = 0.021) were significantly more common in women who had experienced IPV than in those who had not. The logistic regression analysis showed suicidal ideation as the most significant factor relating to IPV (odds ratio 12.658, 95% confidence interval: 1 248-29.677).
Conclusion : The high prevalence of IPV in women who routinely present to this primary care clinic suggests that there is a need for IPV screening. The association of IPV with a spectrum of clinical factors signifies its ubiquitous occurrence and underscores the need for healthcare providers to have a high index of suspicion, especially in cases whereby women present with non-specific complaints. Suicide screening should also be performed on women found to be positive for IPV.
Source: South African Family Practice 57, pp 1 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.977033More Less
Background : Pulmonary embolism (PE) is the most common preventable cause of hospital deaths, and almost all hospitalised patients have at least one risk factor for venous thromboembolism (VTE). Despite the availability of highly effective thromboprophylaxis in preventing VTE, numerous studies worldwide have demonstrated its under-utilisation. The aim of this study was to review and improve the utilisation of thromboprophylaxis in the prevention of VTE in hospitalised patients at Oudtshoorn district hospital, and to make recommendations to the Western Cape Department of Health on how to improve the quality of care for patients at risk for VTE at district hospitals.
Method : A quality improvement cycle (QIC). Retrospective analysis of files of adult patients admitted to the male and female wards at Oudtshoorn district hospital was performed prior to and after a five-month intervention phase. The target standards for the QIC were: (1) availability of a written hospital policy on VTE prevention; (2) every adult admission should have a formal VTE risk assessment documented; (3) every adult admission who is at risk for VTE should receive thromboprophylaxis.
Results : Some 38% of adult patients admitted to Oudtshoorn Hospital, excluding the maternity ward, were at risk of developing VTE. There was no written hospital policy on VTE prevention. This was developed and made available during the intervention. In the pre-intervention group there were no patients who had a documented VTE risk assessment. The post intervention group showed a considerable increase with 45.2% having had a completed VTE risk assessment on admission (p < 0.001). In the pre-intervention group only 4.6% of patients who were at risk of VTE received thromboprophylaxis. There was a statistically significant difference in the number of patients at risk who received thromboprophylaxis in the post-intervention group where 36% of these patients received thromboprophylaxis (p < 0.001).
Conclusions : The study identified a major shortcoming in the prevention of VTE in those patients at risk who were admitted to Oudtshoorn district hospital. An intervention as part of a quality improvement cycle has been able to demonstrate a significant improvement in the detection of patients who are at risk of VTE and a subsequent improvement in appropriate thromboprophylaxis. A number of barriers to their implementation have been identified and need to be addressed. This QIC may in time be of value to assist other district hospitals in addressing the issue of VTE prevention.
The influence of gender roles and traditional healing on cervical screening adherence amongst women in a Cape Town peri-urban settlement : researchSource: South African Family Practice 57, pp 1 –2 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.978096More Less
Background : Cervical cancer is the third most common gynaecologic malignancy worldwide and is the second most common cancer among South African women. Although entirely preventable, cervical cancer is responsible for the death of approximately 3 027, 53% of those diagnosed, South Africa women annually. A variety of factors influence women's cervical screening adherence.
Methods : A focus group discussion was conducted with female residents in Khayelitsha. Data from the focus group discussion was analysed using thematic analysis whereby emergent themes and subthemes were identified and reported.
Results : The study confirmed previous findings around screening barriers amongst women residing in other Cape Town peri-urban settlements. New information regarding the influence of gender inequalities and traditional healers on screening adherence also emerged.
Conclusion : The incorporation of men into cervical screening intervention programmes and the integration of traditional healers meaningfully into the health care system appear to be vital in improving adherence to screening.
Source: South African Family Practice 57, pp 1 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.1080/20786190.2014.978121More Less
Background : It has been estimated that 700 million people worldwide and 5 2 million people in South Africa are in need of annual treatment for schistosomiasis. In accordance with the current policy the Department of Health (DoH) in KwaZulu-Natal province, South Africa, aimed to reach 75% treatment coverage in a mass treatment campaign (MTC) of schools in a schistosomiasis-endemic area.
Methods : A cross-sectional study was designed to explore the implementation, coverage, challenges and limitations of a DoH MTC in a middle-income country. The study was conducted by exploring nurses' and research team records, school enrolment lists and parental consent forms.
Results : Slightly more than 10 000 learners in 43 primary and high schools were treated, achieving treatment coverage of 44 3%. A median of two schools per day were visited over the course of 39 days. We found that older learners, being male and attending a large school were independent significant predictors for low treatment coverage.
Conclusion : Our results indicate a much lower coverage than recommended by the South African National Department of Health and World Health Organization (WHO). Coverage would likely increase through improved consent procedures and repeated schools visits. Further information is needed on how to increase compliance in older teenagers, males and learners in large schools.
Author Gboyega OgunbanjoSource: South African Family Practice 57 (2015)More Less
On 23 April 2015, the World Health Organization (WHO) reported that the Ebola epidemic that started in West Africa about 18 months ago had infected 26 079 people, of whom 10 823 had died. The three worst hit countries were Guinea (2 358 deaths), Liberia (4 573 deaths) and Sierra Leone (3 877 deaths), and accounted for 99.86% of the fatalities. It is amazing that the West African Ebola epidemic is no longer headline news, and it appears as if life is back to normal in these three countries. However, the WHO has indicated that the decline in confirmed cases appeared to have stagnated, but warned that there was a need to increase efforts to stop Ebola virus transmission.
Author B.G. LindequeSource: South African Family Practice 57, pp 6 –9 (2015)More Less
Dysmenorrhoea is a descriptive term for several conditions that cause menstrual pain. While various grades of menstrual pain occur commonly in the menstruating population, approximately 15% of this group of women experience sufficient pain and discomfort to report to healthcare services.
Dysmenorrhoea is classified as either primary or secondary, and consideration should be given to a third type, i.e. once-off, at the time of passing an endometrial cast.
Primary dysmenorrhoea is predominantly found in young women, is caused by prostaglandin activity, and responds well to oral contraceptive use, as well as nonsteroidal anti-inflammatory drug medication.
Secondary dysmenorrhoea, which can occur in any age group, and appears as a consequence of other serious conditions, is the main challenge. The most common other serious conditions include endometriosis, the use of intrauterine contraceptive devices, pelvic infections, uterine adenomyosis, sometimes fibroids, and ovarian cysts. Clearly, these conditions must be considered, diagnosed and treated to resolve the main complaint of dysmenorrhoea.
Author Haley SmithSource: South African Family Practice 57, pp 12 –16 (2015)More Less
Erectile dysfunction (ED) is a medical term that describes the inability to achieve and/or maintain an erect penis adequate for sexual function. This condition is one of the most common sexual problems for men and increases with age, but it's not a natural part of ageing. Approximately one half of men aged 40 years and older have erection problems. Most men have difficulty achieving an erection from time to time, and such occurrences are considered normal. However, ED may be a regular and more severe problem in some men. It can cause low self-esteem, performance anxiety, depression and stress, and may also affect the quality of a marriage or intimate relationships. Lifestyle changes, such as losing weight, participating in more exercise, stopping smoking and minimising the risk of heart disease, may help to improve the condition. The introduction of the phosphodiesterase type 5 inhibitors has revolutionised the treatment of ED. Surgery may be considered when these inhibitors and other approaches fail or are contraindicated.
Source: South African Family Practice 57, pp 17 –21 (2015)More Less
Healthcare professionals are increasingly under pressure to return athletes to play in the shortest possible time. There is limited choice in providing treatment that speeds up tissue repair, while simultaneously maintaining good quality of healing. Inflammation forms a fundamental part in the process of tissue repair. However, excessive inflammation may cause more pain, and limit functional restoration. Although the use of anti-inflammatory treatment in the form of a cyclo-oxygenase-2 inhibitor (coxibs) has been widely recognised as being effective, the potential detrimental effect on tissue repair, as described mainly in animal model studies, needs to be taken into account. The side-effects profile on the gastrointestinal tract favour coxibs over non-traditional NSAIDs. The possible effects on the renal and cardiovascular systems also need to be considered. The prescription of coxibs should be pathology and situation specific. There are no clear guidelines on the correct time of administration and the duration of the course, but it seems that the literature is in agreement that they should be administered for a limited time at the lowest effective dose possible.