The South African General Practitioner <p>The South African General Practitioner (SAGP) circulates to general practitioners and family physicians in South Africa via Medicross and Intercare. This new title is a peer reviewed journal that publishes the contributions of local key opinion leaders and researchers. CPD articles, evidence based review articles, pharmaceutical product updates and original research address the information needs of the target audience. Sections include therapy in practice, focus on the young patient, practice management, home health care, chronic disease management, geriatric care and medical malpractice.</p> <p> <strong>EDITORIAL BOARD:</strong></p> <p><strong>Editor-in-Chief</strong>:<br /><span style="font-size: 0.875rem;">Prof. Kim Outhoff – University of Pretoria</span></p> <p><strong><span style="font-size: 0.875rem;">Editorial Board Members:<br /></span></strong>Dr Zuki Tshabalala – University of Pretoria<br />Prof. Oppel Greeff – Medwell South Africa<br />Dr Morné Strydom – Intercare Woodhill</p> en-US The South African General Practitioner The ethical conundrums of antenatal corticosteroid therapy <p>We all know the dictum, <em>primum non nocere</em> or “first do no harm”, often attributed to Hippocrates (460–370 BC) and to one of the earlier versions of his famous oath to desist from doing harm. Although the specific phrase may have been uttered and adopted much later in the 17th century, its importance in more contemporary medicine is commonly invoked when risking more harm than good. This fundamental bioethics principle of nonmaleficence should really guide our daily clinical practice in concert with the other three pillars: beneficence, autonomy, and justice.<sup>1,2</sup></p> J Markram K Outhoff Copyright (c) 2024 The South African General Practitioner 2024-04-12 2024-04-12 5 1 4 7 Cape Verde is the third African country to eliminate malaria: here’s how <p>Cape Verde has been certified malaria-free by the World Health Organization (WHO).</p> <p>The archipelago to the west of Senegal consists of 10 islands, and has a population of over 500 000 people. It is the third country in Africa to be declared malaria-free, after Mauritius (in 1973) and Algeria (in 2019).</p> <p>This brings the total of malaria-free countries to 43 worldwide.</p> <p>Achieving malaria-free certification is no simple feat. As specialists in malaria prevention and control, we explain Cape Verde’s long journey to eliminating the disease that killed over 600 000 people worldwide in 2022.</p> T de Jager T Kruger Copyright (c) 2024 The South African General Practitioner 2024-04-12 2024-04-12 5 1 45 46 We’re a step closer to having a universal antivenom for snake bites – new study <p>If you’re bitten by a venomous snake, the medicine you need is antivenom. Unfortunately, antivenoms are species specific, meaning you need to have the right antivenom for the snake that bit you. Most of the time, people have no idea what species of snake has bitten them. And for some snakes, antivenoms are simply not available.</p> S Ainsworth C Abada Copyright (c) 2024 The South African General Practitioner 2024-04-12 2024-04-12 5 1 47 48 Simplified antiretroviral treatment regimens: the dolutegravir revolution <p>The complexity of antiretroviral treatment (ART) over the last three decades has evolved significantly as new drugs, regimens, and strategies have been introduced and implemented to improve the outcomes and quality of life of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS).</p> MM Makiwane KC Mothata-Motswaledi E Osuch Copyright (c) 2024 The South African General Practitioner 2024-04-12 2024-04-12 5 1 8 12 Counseling in menopausal women: How to address the benefits and risks of menopause hormone therapy. A FIGO position paper <p>Menopause marks the end of menstrual cyclicity and, depending on individual vulnerability, has several consequences related to gonadal steroid deprivation, especially if it is premature. Menopause may be more burdensome for some women than for others. Individual factors, such as personal history, socioeconomic status, ethnicity, and current health conditions, affect symptomatology and, thereby, the menopausal experience. In addition, some menopausal symptoms, such as severe hot flashes, sleep disorders, and depression, are markers of future health risks. Counseling is a fundamental part of health care in the peri- and postmenopause periods. It must include an assessment of the patient's symptoms, needs, desires, and risk profile to address the benefits and risks of menopausal hormone therapy (MHT) on an individual basis and promote a healthy lifestyle. Indeed, healthcare practitioners can and must protect the health and lives of mid-life women by increasing awareness of menopausal symptoms and ensuring healthcare options, especially MHT. The type and duration of MHT should be tailored based on the patient's history, menopausal age, physical characteristics, and current health status so that the benefits always outweigh the risks. This FIGO position paper focuses on the benefits and risks of MHT on health domains, target organs, and systems, and on systemic and vaginal MHT regimens, to provide indications that can be used in the clinical practice for menopausal counseling. Moreover, it offers insights into what FIGO considers the mainstay for the healthcare management of women in peri- and postmenopause, worldwide.</p> AR Genazzani H Divakar SS Khadilkar P Monteleone B Evangelisti AF Galal PIR Priego T Simoncini A Giannini G Goba C Benedetto Copyright (c) 2024 The South African General Practitioner 2024-04-12 2024-04-12 5 1 14 24 Treatment and prevention of herpes simplex virus type 1 in immunocompetent adolescents and adults <p>Herpes simplex virus type 1 (HSV-1) is a cause of recurrent vesiculoulcerative lesions of the oral or genital mucosa. It can also cause infection in the eye, skin, central nervous system, and/or visceral organs.</p> <p>This topic will review treatment and prevention of primary and recurrent HSV-1 infections in immunocompetent adolescents and adults. The epidemiology and clinical manifestations of HSV-1, as well as the treatment of HSV-1 infections in young children, are discussed elsewhere. (See “Epidemiology, clinical manifestations, and diagnosis of herpes simplex virus type 1 infection” and “Herpetic gingivostomatitis in young children”.)</p> A Wald C Johnston Copyright (c) 2024 The South African General Practitioner 2024-04-12 2024-04-12 5 1 25 32 The role of flavonoids in the pharmacological treatment of haemorrhoids <p><strong>Ethnopharmacological relevance:</strong> Flavonoids have been used for many years by traditional medical practitioners. Flavonoids possess a variety of beneficial effects, namely anti-inflammatory and analgesic properties used to treat typical haemorrhoidal disease (HD) symptoms, such as pain, bleeding, and inflammation.</p> <p><strong>Aim of the study:</strong> The aim of the study was to investigate the therapeutic potential of flavonoids in the conservative treatment of HD by analysing the safety and efficacy of flavonoids in the treatment and post-treatment remission of HD and determining if flavonoids are more effective on their own or when combined with other treatments.</p> <p><strong>Materials and methods:</strong> Five databases were searched to conduct this narrative review. The search was conducted using the following keywords namely, "haemorrhoids", "haemorrhoidal disease", "flavonoids", "safety and efficacy", "clinical trial", "treatment" and "therapy". Articles were filtered based on the inclusion and exclusion criteria. Data from 35 selected articles were charted and included in the qualitative synthesis of this narrative review.</p> <p><strong>Results:</strong> Flavonoids were found to be more effective when used in combination with other treatments such as sclerotherapy (SCL) and rubber band ligation (RBL); as well as in combination with other flavonoids. Micronised purified flavonoid fractions (MPFF), such as Daflon<sup>®</sup> were the most prescribed flavonoids due to their high efficacy in alleviating symptoms quickly for lower grades of HD. Some studies followed a two-phase dosing system in order to prevent relapse. Flavonoids administered orally displayed minimal sideeffects in comparison to conventional conservative treatments.</p> <p><strong>Conclusion:</strong> Flavonoids have shown to be an effective and safe therapy in the treatment of acute, internal lower grades of HD. Flavonoids can be used synergistically with other conservative measures and procedures. They have been shown to avert relapses, decrease symptoms linked to HD, escalate the recovery time post-surgery, and often act as a bridge therapy.</p> SS Singh MA Strydom M Balmith C Megaw MJ Nell Copyright (c) 2024 The South African General Practitioner 2024-04-12 2024-04-12 5 1 36 44 Hereditary breast ovarian cancer syndrome <p>In South Africa, breast cancer is the most frequently diagnosed cancer among women, with a lifetime risk of 1 in 27.<sup>1</sup> There are many known causes of breast cancer, such as lifestyle choices, genetic predisposition and environmental factors. The majority of breast cancers are sporadic and not caused by inherited mutations (as shown in Figure 1), and only 5% -10% of breast and 10%-15% of ovarian cancers are hereditary.<sup>2</sup> Hereditary cancer indicates that cancer may result from germline pathogenic variants (mutations) in specific genes, inherited from either parent. Familial cancers (15–20%) are those that appear to have a genetic component, affecting more family members than would be expected by chance alone; however, a single genetic cause or explanation is not known. Familial cancers may not be linked to a known gene mutation but may be due to a combination of factors shared by a family, including genetic and environmental factors.</p> J Malan Copyright (c) 2024 The South African General Practitioner 2024-04-12 2024-04-12 5 1 33 35 CPD Questionnaire (V05N01) <p>CPD Questionnaire</p> Editorial Office Copyright (c) 2024 The South African General Practitioner 2024-04-12 2024-04-12 5 1 51 52 Subtle influences on decision-making in medical practice <p>There are many external influences, beyond the direct medical diagnosis of an illness, that affect how we manage patients in medical practice. Take for instance, the effect of receiving a gift from a patient, which ethically is discouraged but is sometimes unavoidable.</p> Chris Ellis Copyright (c) 2024 The South African General Practitioner 2024-04-12 2024-04-12 5 1 49 50