Focus on Androgel

Testosterone has an important role in adult males. It is necessary for the production of sperm and plays a role in regulating libido, bone mass, fat distribution, muscle mass and strength.Male hypogonadism is a clinical syndrome caused by androgen deficiency which may adversely affect multiple organ functions and quality of life (QoL). The diagnosis must comprise both persistent clinical symptoms and biochemical evidence of testosterone deficiency (TD). Hypogonadism results from testicular failure, or it is due to the disruption of one or several levels of the hypothalamic-pituitary-gonadal axis. Primary hypogonadism is caused by defects of the gonads, for example, undescended testes, mumps orchitis, Klinefelter syndrome and testicular tumours. 

Treatment of hypercholesterolaemia to improve cardiovascular disease risk in South Africa 

Cholesterol, a spherical steroid molecule, is instrumental in steroid hormone and bile acid synthesis and forms an integral part of cell membranes. Cholesterol is transported as part of specific proteins (lipoproteins) due to their insolubility in aqueous media. These lipoproteins can be divided into different classes based on their composition, associated apoproteins and size. Apolipoproteins play a functional role in the structural integrity and metabolism of lipoproteins, whilst acting as ligands for lipoprotein receptors. Lipoproteins include, amongst others, high-density lipoprotein (HDL), intermediate-density lipoproteins (IDL), low-density lipoproteins (LDL) and lipoprotein (a) (Lp(a)).

Factors affecting the control of new psychoactive substances

New psychoactive substances (NPS), also known as synthetic drugs of abuse, designer drugs and research chemicals, refer to a heterogeneous group of substances that are either analogues of existing controlled drugs and pharmaceutical products or newly synthesised chemicals designed to mimic the psychoactive effects of controlled drugs. NPS are chemically manufactured to produce psychoactive constituents of a drug that are not actual derivatives of the naturally occurring substance. 

Spinal revival: The management of lower back pain 

Non-specific lower back pain is defined as pain with no known aetiology (such as a visible or known trauma, tumour, or bruising), with complaints increasing in the Western world.1 While the reporting of lower back pain has not decreased dramatically, the cost of treatment has been steadily increasing. Acute lower back pain can be caused by several factors, inclusive of activities related to lifestyle, career, and sports.4 Generally, patients who have active jobs with high degrees of mechanical movement (such as labourers, builders, and craftsmen) suffer from a greater frequency of lower back pain than those with more sedentary jobs (such as typists and office workers).

Achilles tendinopathy 

Achilles tendinopathy (AT) is one of the most common overuse conditions. The term “tendinopathy” is much more preferable than “tendinitis/tendinosis” as the pathology is primarily that of a degenerative process, whilst the role of inflammation is limited. The overuse leads to repetitive microtrauma and with a tendon that already has poor vascularity, there is further loss of normal collagenous architecture with hypercellularity and neovascularisation. The mid-portion of the tendon, two to six centimetres above its insertion, is commonly affected. The condition is more commonly encountered in athletes, affecting 9% of recreational and up to 5% of professional athletes, whilst 6% of the general population experience the problem during their lifetime. 

In a heartbeat: Important cardiac arrhythmias in clinical practice 

The heartbeat is triggered by the cardiac electrical system, and each beat is represented on the ECG by a wave arm. In sinus rhythm, the electrical activity follows its normal pathway (Figure 1), whereas in dysrhythmias, the electrical activity is aberrant. Basic skills in ECG interpretation are recommended in order to determine sinus rhythm or dysrhythmias.

Emergency medicine and the general practitioner

The fading art of communicating with patients, the thorough clinical examination, reviewing a lengthy academic article – these all take time and are essential to the practice of good quality medicine. The only ingredient missing from your approach to emergency medicine – particularly a potentially life-threatening situation – is also time! And knowing that time is not your friend and that lost seconds might compromise life or limb can generate anxiety or even analysis paralysis if you don’t have some basic protocols to fall back on. The beauty of the well learned protocol is that the recipe for action is then hardcoded into your memory – allowing you to engage and resuscitate immediately with confidence. Emergency situations might not all look like a scene from the Dr Strange movie or the old ER TV series (written by a Harvard trained doctor incidentally), but they can certainly be intimidating, begging those nasty thoughts like “do I know what to do here?” or “I wish I’d finished that ALS course” or “can I be sued if I make a mistake and someone dies”. 


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South African General Practitioner - 2022 Vol 3 No 1

3.0 CPD Points