Introduction

Monkeypox: from tropical rain forest to urban jungle and beyond

Monkeypox, first identified in humans in the Congo Basin of Zaire (now the Democratic Republic of Congo) in 1970,2 is an infectious disease caused by the double-stranded Monkeypox virus, which is part of the Orthopoxvirus genus, which also comprises the Cowpox, Molluscum contagiosum, Vaccinia and the smallpox Variola viruses. The monkeypox virus’s natural animal reservoir is thought to be small mammals including non-human primates and rodents such as the impressively named Giant Gambian rat, that dwell in the rainforests of West and Central Africa. However, the disease was first identified in Macacus Cynomolgus monkeys at a polio vaccine production and research unit in Denmark by Preben von Magnus and his research team as early as 1958.3 Small outbreaks were described in two separate shipments of these monkeys that travelled by aeroplane from Singapore.

The management of rhinosinusitis in general practice

Rhinosinusitis is one of the most common conditions treated in general practice and the name is preferred to the older term “sinusitis” because sinus disease almost always occurs with rhinitis. In South Africa, general practitioners (GPs) are usually the first point of contact for patients with rhinosinusitis who seek medical attention. Patients of all ages present at various stages of the disease, ranging from mild and insidious to debilitating and potentially life-threatening, and GPs must make an accurate diagnosis, institute appropriate treatment, monitor the progress of the disease, and timeously recognise the need for a change of treatment or specialist referral.

Genetic resources for general practitioners

In recent years there have been rapid advancements in genetic and genomic technology from the completion of The Human Genome Project in the early 2000s to the publication in March 2022 of a full human genome sequence from telomere to telomere. While these developments have led to and improved understanding of genetic information, a consequence is a substantial increase in the amount of genetic information that is available to clinicians. We can now link specific genes to more than 4 000 different genetic conditions. The aim of this article is to provide much-needed information regarding the resources that general practitioners (GPs) can rely on when queries regarding genetics and heritability arise.

The GLP-1 receptor agonists: what’s all the (cardiovascular) hype about?

Over four million people in South Africa are estimated to have diabetes. People living with diabetes (PLWD) have an increased risk of microvascular and macrovascular disease, with an estimated prevalence of coronary artery disease among PLWD of 8.7% in South Africa. The pathogenesis of increased risk of atherosclerotic cardiovascular disease in diabetes is multifactorial, and related to hyperglycaemia, hyperinsulinaemia, dyslipidaemia, inflammation, increased reactive oxygen species, endothelial dysfunction, hypercoagulability, and vascular calcification. Mitigation of this increased risk requires lifestyle modification, glycaemic control and pharmacological management. Therefore, an understanding of the cardiovascular benefits and risks associated with the classes of anti-diabetic drugs utilised in type 2 diabetes mellitus is essential.

The management of attention-deficit hyperactivity disorder in children: updated 2022

Attention-deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed chronic childhood disorders. It is a neurocognitive behavioural developmental disorder that is characterised by a persistent pattern of inattention or hyperactivity-impulsivity. Usually, the condition presents in childhood before the age of seven, but is also seen in adolescence and often extends to the adult years. Children with ADHD find it difficult to control their behaviour within their social and school environment. Normally, this interferes with their ability to live normal lives and often results in them not being able to achieve their full potential academically.

The 1960’s gave us hippies, free sex, and HRT – hormone replacement therapy was conceived out of wedlock

The last time we had coffee, I left you in 1963 (this is the third article in this series on menopause). Let us continue on our journey into menopause and beyond, by engaging in an abbreviated historical tour of some of the events around what, by all accounts, seems to be a ‘cure’ looking for a disease. Bear with me.

Coming clean: Saying ‘know’ to drugs – Part III

This is a problem, particularly in the United States. We need to encourage doctors to think about their original oaths. They have a responsibility to relieve pain, and that does not just mean physical pain. Not all drugs are created equal; some give more emotional and physical pain relief. It is difficult when the doctors have made up their minds with preconceived ideas and are concerned about iatrogenic addictions. But I believe they should always put the patient first. And if they can relieve the pain, then they should do so. I have seen people worrying about patients who are in their 70s, 80s, and even 90s becoming addicted. The clinician may confuse dependence with addiction. Dependence and addiction are very different things. Dependence is a state of biology and physiology. Addiction is a state of mind. Dependence is not an issue. Unless there are particular circumstances, patients requiring analgesia will not develop an addiction. But if clinicians remove their pain medications, there is the risk of their patient accessing unregulated pain medication from the street market.

Accreditation

Health Professions Council of South Africa

MDB015/133/01/2022

3 Clinical

Certification

Attempts allowed: 2

70% pass rate





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South African General Practitioner - 2022 Vol 3 No 4