Focus on zinc

Zinc is an essential micronutrient that performs numerous functions. It works to maintain a healthy immune system and is a powerful antioxidant and anti-inflammatory. Zinc deficiency is damaging to health and increases the risk of infection and illness. A healthy diet can help meet zinc requirements through all stages of life. Zinc supplements may help treat and prevent zinc deficiency but should be used cautiously, as overdosing can be dangerous.

Focus on fosfomycin trometamol

Fosfomycin, a phosphonic acid derivative and a naturallyoccurring antibiotic, was discovered in 1969 when it was successfully cultured from Streptomyces spp. Fosfomycin is in an antimicrobial class of its own and is structurally unrelated to any other agent currently approved for clinical use. Fosfomycin was initially developed as a calcium salt for oral use and a sodium salt for intravenous use. The tromethamine salt (also known as trometamol) is water soluble and provides markedly improved oral bioavailability compared to the calcium salt.

Diabetes and matters of the heart – why people with diabetes should regularly have their cardiac risks assessed

Diabetes can lead to severe morbidity from chronic kidney disease, nerve damage, and vision and hearing impairment. However, a potentially deadly complication is cardiovascular disease (CVD). Following the commemoration of World Diabetes Day on November 14, it is fitting to remind those at risk that heart disease is prevalent among people with Type 2 diabetes. In 2019 alone, more than one million deaths were attributed to CVD in sub-Saharan Africa. In the broader context, that constitutes 5.4% of all global CVD-related fatalities and 13% of all deaths in Africa. People with diabetes are twice as likely to have heart disease or a stroke than people without diabetes. Thirty per cent of type 2 diabetes patients will develop heart failure in their lifetime. 

Hypertension and diabetes mellitus: a collision of two heavyweight non-communicable diseases

Non-communicable diseases (NCDs) are placing a tremendous burden on the South African population, both at patient and at fiscal levels. Diabetes mellitus (DM), hypertension (HPT) and obesity, three of the major NCDs, have been shown to possess interrelated pathophysiology. Patients living with DM without HPT (PLWD) are at a twofold increased risk of developing HPT, which is secondary to hyperinsulinaemia. The presence of HPT in these PLWD increases and accelerates the risk of developing both micro- and macro-vascular complications. Obesity is related to the development of both HPT and DM on the basis of insulin resistance.

A “heart-to-hormone” conversation: The challenges of cardiovascular disease and vascular risk factors in perimenopause for HRT decision-making in menopause

In the last edition, we discussed a number of clinical trials which attempted to determine whether HRT resulted in any preventative or therapeutic benefits for cardiovascular disease and here is a short recap. The Women’s Health Initiative (WHI) hormone trials used a daily conjugated equine oestrogen and medroxyprogesterone acetate combination and demonstrated an increase in breast cancer, stroke, pulmonary embolism, and myocardial infarction in women on hormone therapy who had a uterus and was terminated. The group of women without a uterus was also terminated, as an increased risk of stroke was observed. The 1993 Heart and Oestrogen/Progestin Replacement Study (HERS) found that the incidence of cardiac events in women in the treatment group was higher than that in women on the placebo. Overall, no benefit was found in women with CHD taking hormone therapy. The interventional trial Women’s Oestrogen for Stroke Trial (WEST) began in 1993 and ended in 2001, enlisting 664 postmenopausal women who had already experienced an ischaemic stroke or a transient ischaemic attack. Women in the trial received either 17β-oestradiol or a placebo. The risk of stroke within the first six months after enrolment and the incidence of death due to stroke were higher in the treatment group. The researchers concluded that “this therapy should not be prescribed for the secondary prevention of cerebrovascular disease.” 

Heavy menstrual bleeding associated with oral anticoagulant use

Heavy menstrual bleeding (HMB) associated with oral anticoagulant (OAC) use, hereon referred to as HMB-OAC, is devoid of evidence-based guidelines for optimal prevention and management. Throughout this article, reference to OAC is restricted to the vitamin K antagonist (VKA), warfarin, and the direct-acting oral anticoagulants (DOACs) currently available in South Africa, such as the direct thrombin inhibitor, dabigatran, and the Factor Xa inhibitors, rivaroxaban and apixaban. A paucity of robust data has persisted in the 30 years since the first documented cases of HMB associated with OAC use. Research was initially impeded by confusingly inconsistent application of terms describing abnormal variations of menstruation (i.e., menorrhagia, metrorrhagia and dysfunctional uterine bleeding). The subacute, chronic and recurrent nature of HMB precludes its inclusion as a major bleeding or clinically relevant non-major bleeding event in safety assessments of randomised clinical trials (RCT) investigating OAC and contributed to the initial underestimation of its incidence in the DOAC registration trials.5 Hence, the evidence to guide optimal management of HMB-OAC largely stems from data derived from posthoc analyses of RCTs and observational studies.

Stop cramping your style: treatment options for muscle spasms

Muscle spasms, which are a form of involuntary spasticity, are colloquially referred to as a charley horse (United States, English), cramps (United Kingdom, English) or a vastrek (South Africa, Afrikaans). They are associated with painful contractions of a single muscle or a muscle group, and normally relieved with the contraction of an antagonist muscle(s). Symptoms include pain, hyperexcitability of the muscle and hypertonicity of the affected area. Clinical features can vary due to the intensity and duration of the spastic episode. Aetiology is wide and unspecific due to various factors, such as age, activity level and metabolic systems. Common causes include electrolyte imbalance and dehydration, excessive perspiration and overexcretion. Medications may also precipitate spastic symptoms (e.g. from myopathy), such as anti-cholesterol drugs (statins) and β-adrenergic agonists. Non-pharmacological interventions exist as well, but can be behind several barriers, including cost and accessibility.

The use of epidermal growth factor in diabetic foot ulcers in South Africa

Diabetes mellitus (DM) represents a global health problem and is a significant risk factor for other diseases of vascular origin that are among the leading causes of death. More than 463 million adults suffer from DM, and 578 million have been estimated by 2030. The diabetic foot ulcer (DFU) is one of the most harmful complications of DM. DF, a complex pathology, defined as a neuropathic etiopathogenic-based clinical alteration induced by sustained hyperglycaemia, in which, with or without coexistence of ischaemia and previous traumatic trigger, produces injury or ulceration of the foot.


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South African General Practitioner - 2022 Vol 3 No 6

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