The South African General Practitioner

Rethinking asthma management: the overuse of SABAs and updated adult treatment guidelines

2024-11-08T07:50:12+00:00

The global overuse of short-acting β2-agonists (SABAs), like salbutamol, has prompted a need to update asthma management protocols. Excessive reliance on SABAs—defined as using more than three canisters per year (or more than twice weekly)—is now recognised as a marker of poor asthma control and is associated with significant patient risk.

In South Africa, SABA overuse is alarmingly high. The Short-Acting Beta-Agonist Use IN Asthma (SABINA) III trial found that 75% of asthma patients in South Africa are overusing SABAs, compared to the global average of 38%. Furthermore, 51% of patients have uncontrolled asthma, with only 28% achieving adequate control and 21% achieving partial control, underscoring the need for a paradigm shift in asthma care.¹

Combating drug-resistant tuberculosis in South Africa: strategies, challenges, and progress

2024-11-20T14:59:31+00:00

South Africa faces a critical challenge with drug-resistant tuberculosis (DR-TB), which includes high rates of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). Recent innovations in treatment, particularly the all-oral bedaquiline, pretomanid, linezolid (BPaL) and bedaquiline, pretomanid, linezolid, moxifloxacin (BPaLM) regimens, and evidence from studies on extended bedaquiline use and paediatric therapies, show promise in enhancing patient outcomes and reducing treatment duration. This review explores South Africa’s approach to DR-TB treatment, diagnostics, and strategic initiatives, examining challenges such as patient adherence, infrastructure limitations, and socioeconomic obstacles. We highlight the progress made and the potential for further advances through collaborative research and supportive healthcare policies.

Optimising nutrition: a cornerstone of health and longevity

2024-11-25T04:54:28+00:00

This article focuses on the critical importance of optimising nutrition for overall health and longevity. It explores the biological mechanisms of health, ageing, and disease, highlighting how nutrition can positively influence these processes. Current dietary recommendations are reviewed, focusing on personalised nutrition approaches to address individual needs. The article further discusses strategies for optimising nutrition, including weight reduction and specialised diets for specific populations like older adults and critically ill patients. By understanding the underlying mechanisms and implementing evidence-based practices, individuals can harness the power of nutrition to improve their health and well-being.

Artificial intelligence (AI) or augmented intelligence? How big data and AI are transforming healthcare: Challenges and opportunities

2024-12-10T12:46:01+00:00

The sanctity of the doctor-patient relationship is deeply embedded in tradition – the Hippocratic oath, medical ethics, professional codes of conduct, and legislation – all of which are being disrupted by big data and ‘artificial’ intelligence (AI). The transition from paper-based records to electronic health records, wearables, mobile health applications and mobile phone data has created new opportunities to scale up data collection. Databases of unimaginable magnitude can be harnessed to develop algorithms for AI and to refine machine learning. Complex neural networks now lie at the core of ubiquitous AI systems in healthcare. A transformed healthcare environment enhanced by innovation, robotics, digital technology, and improved diagnostics and therapeutics is plagued by ethical, legal and social challenges. Global guidelines are emerging to ensure governance in AI, but many low- and middle-income countries have yet to develop context-specific frameworks. Legislation must be developed to frame liability and account for negligence due to robotics in the same way human healthcare providers are held accountable. The digital divide between high- and low-income settings is significant and has the potential to exacerbate health inequities globally.

Pregnant teens: girls in South Africa need focused, supportive healthcare and more information about safe sex

2024-11-08T08:50:56+00:00

An estimated 12 million teenage pregnancies are reported globally every year.

Girls and young women in this age group face multiple risk factors that contribute to early pregnancies. These include a lack of access to comprehensive sexual education, socioeconomic inequality, cultural norms, and limited availability of contraceptives. They’re also less likely than older women to get prenatal care, and more likely to experience stigma and discrimination in healthcare facilities if they do seek care.

CPD Questionnaire (V05N04)

2024-11-28T10:00:19+00:00

CPD Questionnaire

I see you: AVATAR therapy for auditory hallucinations

2024-11-21T08:18:34+00:00

A recent Nature Medicine article¹ delves into AVATAR therapy, a relatively novel concept that inspired a deeper investigation into avatars, their origins, evolving meanings, and therapeutic applications. This exploration reveals how the concept of an avatar has transformed from its historical and cultural roots to its contemporary use as a therapeutic tool and symbolic representation. Currently, the meaning of avatar is an embodiment of something else.² The term is derived from avatara which signified a divine descent into physical form, as seen in ancient Hinduism. When gods appeared in our world as human sages for instance, that human served as their avatar. Avatars thus represented the earthly incarnation of a powerful deity or spirit. The term later expanded to mean any manifestation in human form and, more broadly, any embodiment of an idea or philosophy, regardless of whether or not it took a human shape. Rapid advances in computer technology have facilitated the widespread use of these virtual characters. The digital entities, often with human-like features, but not necessarily, are operated either by people or through software programs.³ Thus, an avatar may refer to the digital image or character that a person selects to represent themselves in an electronic setting.

The Light at the End of the Tunnel

2024-11-12T13:34:36+00:00

Some time ago a young welldressed woman came into see me as a patient. She was a social worker but also worked as an artist. It turned out that she was in a severe depression so I prescribed an antidepressant for her and asked her to return after two weeks to check on her progress.