Approach to multiple sclerosis in the primary care setting
Multiple sclerosis (MS) is an acquired chronic immune-mediated inflammatory condition of the central nervous system, affecting the brain, eyes and spinal cord. The American Academy of Neurology recently updated its guidelines on MS to recommend that physicians consider prescribing disease-modifying therapies for MS patients early in the disease process. With this emphasis on early treatment comes the necessity for the earliest possible detection and diagnosis. Often, the opportunity to notice the first signs of MS falls within the scope of primary care practice.
Colorectal cancer: a review of epidemiological trends and screening guidelines
Colorectal cancer (CRC) is a malignancy involving the large intestine and rectum, both parts of the gastrointestinal system. Globally, it is the second leading cause of cancer-related death and the third most diagnosed malignancy around the world. The 2019 Global Burden of Disease, Injuries and Risk Factors Study (GBD) looked at cancer trends for 204 countries and estimated CRC to have the second highest absolute Disability Adjusted Life Years (DALYs) score. This study demonstrated the rising impact of CRC globally and the African continent has followed a similar trend. For example, the incidence of CRC in countries such as Nigeria has continued to increase over the last three decades. This is in the setting of limited screening resources contributing to an increasing endoscopic burden in countries with a scarcity of endoscopic resources. Similar trends have been shown in South Africa (SA).
Drugs used in South Africa in the management of nausea and vomiting in adults
Nausea, the distressing sensation of being about to vomit, can occur alone or in combination with vomiting, the forceful expulsion of gastric contents through the mouth, as well as indigestion and other gastrointestinal symptoms. Nausea can occur without vomiting and vomiting without nausea, although less common. Nausea is often more troublesome and incapacitating than vomiting.
Revisiting the fundamentals of gastro-oesophageal reflux disease –a concise review
Patients often present with reflux-like dyspepsia and gastrooesophageal reflux disease (GORD) in general practice and, as indicated by the name, it is characterised by the regurgitation of gastric contents into the oesophagus. Estimates indicate a significant variation in the prevalence of GORD between geographic regions. The disease is believed to have a mean prevalence of approximately 14% globally with rates above 20% in many Western countries. Despite very little prevalence data being available for most African countries, South Africa certainly echoes the significant economic burden and impact on quality of life that has been reported elsewhere. Although often considered an acid-induced disease, its pathogenesis is multifactorial and precipitated by various risk factors.
Treating insomnia in general practice
Insomnia is a complex sleep disorder, characterised by difficulty initiating and/or maintaining sleep in the context of ample sleep opportunity. While most individuals will experience some insomnia during their lifetime, chronic insomnia typically affects 10–20% of the population, although there are no comprehensive epidemiological prevalence statistics for South African individuals. A study conducted in older rural dwelling South Africans found prevalence rates of 8–13% for insomnia symptoms, assessed using three self-report questions from the Pittsburgh Sleep Quality Index (PSQI).
Vaccines could be a game-changer in the fight against malaria in Africa.
The development of an effective vaccine for malaria has proved to be far more challenging than developing a vaccine to protect people from COVID-19. Several different COVID-19 vaccines were developed and approved for use within a year of the disease’s emergence. In contrast, it took over 30 years of intensive research and numerous clinical trials by the Walter Reed Army Institute of Research and partners before the first malaria vaccine, Mosquirix, was approved for use by the World Health Organization (WHO) in 2021.
Wounds as an overlooked burden (Part 5) – diabetic foot ulcers: keeping clinicians on their toes.
Diabetic foot ulcers in a South African context
The rising global incidence of diabetes is accompanied by an increase in observed diabetes-related complications. One common diabetic complication is poor wound healing, especially with foot ulceration. These diabetic foot ulcers (DFUs) reduce a patient’s quality of life, are extremely costly to treat and can result in amputation if not timeously and effectively treated. In 2020 about 4.2 million cases of diabetes were reported in South Africa, the highest incidence of people in Africa living with diabetes. It is inevitable that a significant percentage of people living with diabetes will develop diabetic complications such as DFUs, implying that an increase in the number of patients with DFUs will be observed. This increase in diabetic complications is burdensome on the South African health system and economy, with a 2021 report by the International Diabetes Federation that diabetes-related expenditure per patient (taking DFU care into consideration) in South Africa is approximately R30 000.