The South African General Practitioner

TB research shows a good diet can cut infections by nearly 50%

2023-10-17T07:51:58+00:00

For centuries, we have known that tuberculosis is a social disease. It thrives on poverty and social factors such as malnutrition, poor housing, overcrowding, unsafe work environments and stigma.

Globally in 2021 an estimated 2.2 million cases of TB were attributable to undernourishment, 0.86 million to HIV infection, 0.74 million to alcohol use disorders, 0.69 million to smoking and 0.37 million to diabetes.

But knowledge about social determinants alone does not always translate into tangible action and progress. A new trial in India, called RATIONS, aimed to determine the effect of nutritional supplementation on new cases of tuberculosis in households of adults with pulmonary TB. The research found that providing food baskets to people with TB and their households could go a long way to prevent and mitigate the disease.

Unlocking the potential of pharmacogenetics in South Africa

2023-08-21T13:53:06+00:00

Pharmacogenetics, often abbreviated as PGx, is the study of how an individual's genetic makeup influences their response to drugs. By utilising individual genetic data, PGx can optimise drug therapy plans, minimise adverse effects and reduce healthcare costs associated with ineffective treatments. In our article, we explain the critical role of PGx in shaping personalised medicine, with focus on South Africa region, where unique disease patterns require specialised treatments. We outline challenges such as the cost of testing, the need for more research, and the importance of education for both physicians and patients.

Allergic rhinitis: Review of the diagnosis and management: South African Allergic Rhinitis Working Group

2023-11-06T09:15:45+00:00

Background: Allergic rhinitis (AR) has a significant impact on the community as a whole with regard to quality of life and its relationship to allergic multi-morbidities. Appropriate diagnosis, treatment and review of the efficacy of interventions can ameliorate these effects. Yet, the importance of AR is often overlooked, and appropriate therapy is neglected. The availability of effective medications and knowledge as to management are often lacking in both public and private health systems.

Methods: This review is based on a comprehensive literature search and detailed discussions by the South African Allergic Rhinitis Working Group (SAARWG).

Results: The working group provided up-to-date recommendations on the epidemiology, pathology, diagnosis and management of AR, appropriate to the South African setting.

Conclusion: Allergic rhinitis causes significant, often unappreciated, morbidity. It is a complex disease related to an inflammatory response to environmental allergens. Therapy involves education, evaluation of allergen sensitisation, pharmacological treatment, allergen immunotherapy (AIT) and evaluation of the success of interventions. Regular use of saline; the important role of intranasal corticosteroids, including those combined with topical antihistamines and reduction in the use of systemic steroids are key. Practitioners should have a thorough knowledge of associated morbidities and the need for specialist referral.

Contribution: This review summarises the latest developments in the diagnosis and management of AR such that it is a resource that allows easy access for family practitioners and specialists alike.

Vitamin D supplementation in a post-pandemic era: a narrative review

2023-11-02T12:28:07+00:00

Vitamin D is a fat-soluble molecule referring to the different isoforms, ergocalciferol (D2) and cholecalciferol (D3). Its physiological functions include increasing calcium serum concentrations. 25-hydroxyvitamin D3 (25(OH)D) (Calcifediol), a non-active, circulating instant precursor is seen as a pre-hormone. Studies have shown that a deficiency in calcifediol is related to chronic conditions such as cardiovascular, musculoskeletal, immune system, neurological, and anti-neoplastic functions. Vitamin D supplementation has shown its benefit as prophylaxis and treatment during the coronavirus disease 2019 (COVID-19) pandemic, and an increase in the prescribing of vitamin D supplementation has been observed. The intention of this review article is to provide guidance on the recommended dosage regimen as a prophylactic measure during COVID-19 and its use as a supplement in general. From this review article, it is clear that vitamin D has an important role to play not only in COVID-19 but also in various other health aspects of the human body.

Contribution: This review article highlighted the role of vitamin D in managing vitamin D deficiency and its role as a supplement in the management of respiratory tract infections, especially COVID-19. This overview can assist physicians in optimising healthcare by optimised dosing recommendations and indications.

Recognising the true value of testosterone therapy in health care

2023-11-16T08:38:21+00:00

There has been little recognition within the medical community of the health impact of testosterone (T) deficiency (TD), also known as hypogonadism, and the substantial benefits of testosterone therapy (TTh) on health and quality of life despite high-level clinical evidence. In a roundtable symposium, investigators summarized the contemporary evidence in several key clinical areas. TD negatively impacts human health and quality of life and is associated with increased mortality. Several studies have demonstrated that TTh in men with TD reduced all-cause and cardiovascular mortality. The longstanding belief that TTh is associated with increased prostate cancer (PCa) risk is contradicted by recent evidence, including multiple studies showing that TTh is associated with reduced PCa risk. Similarly, the weight of current evidence indicates the purported concern that TTh is associated with increased cardiovascular risk is incorrect. Normalisation of physiological T reduces myocardial infarction, stroke, and deaths compared with men whose testosterone levels failed to normalize. In diabetic men TTh improves insulin resistance, and a large 2-year controlled study in men with abnormal glucose tolerance showed a substantially reduced rate of diabetes among men treated with TTh compared with untreated controls. Long-term TTh in diabetic men resulted in progressive improvements in obesity and insulin requirements, including a substantial number who experienced complete remission of diabetes. Finally, TTh has been shown to reduce severe outcomes with COVID-19 infection. These lines of evidence argue strongly for the need for greater awareness in the medical community of the impact of TD on health, and of the health benefits of TTh.

A case of neurodivergence – the basics of autism spectrum disorder

2023-10-03T13:25:24+00:00

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder commencing in early childhood and is associated with neurological symptoms that are expressed as behavioural characteristics and vary depending on age as well as linguistic and cognitive abilities. To provide effective care and education, general practitioners should understand the needs of individuals with ASD and their caregivers.

Less-than-lethal weapons and the general practitioner

2023-09-18T10:42:15+00:00

When general practitioners are faced with claims of less-than-lethal weapon injuries, or when such injuries are suspected based on limited evidence or information, they are obliged to investigate and manage the process. This paper will consider an approach to such a situation. It will briefly introduce some underlying basic theory behind these weapons and the potential effects, as well as some illustrations of how to document and manage such cases.

The Test of Time

2023-10-24T11:08:53+00:00

I like to believe that general practitioners are specialists or experts in several areas in the practice of medicine. We are experts in the management of mild-to-moderate asthma, mild-to-moderate eczema, mild-to-moderate depression and a whole range of lifestyle illnesses. We also deal in all forms of anxiety known to man. We are, in addition, experts in timing – when to refer, when to hang on and when to send the patient into the medical marketplace. We come to be authorities in the anticipation of both the causes, costs and consequences of medical care and treatment.

The role of kindness in medical ethics: balancing virtue and ethical principles

2023-09-08T11:59:03+00:00

The practice of medicine relies on a profound connection with people’s bodies, their personal vulnerabilities and overall wellbeing. This intimacy must be subjected to legal as well as ethical scrutiny, restrictions and guidance to impress upon doctors and other healthcare practitioners their duty to behave competently and without reproach. Respecting patients as persons with intrinsic worth while protecting their best interests are delicately intertwined to inform our medical practice. Above all, the South African Constitution plays a principled role in overseeing these morals, with the Health Professions Council of South Africa (HPCSA) mandated to not only set the ethical standard but also to maintain it. The HPCSA’s Booklet 1 (December 2021) underscores compassion as a core ethical value for good practice, alongside truthfulness, integrity, patient autonomy, and justice.1 Compassion, empathy, and kindness, the psycho-social attributes, are at the heart of medical consultations, embodying high moral standards befitting the trusted position of doctors in society. This article explores the integration of kindness within the ethical framework of medicine.

CPD Questionnaire (V04N04)

2023-11-14T09:10:44+00:00

CPD Questionnaire