Use of angiotensin receptor – neprilysin inhibitors in heart failure: a paradigm shift

Heart failure is a clinical syndrome responsible for at least one-third of hospitalisations amongst cardiac patients, with escalating mortality and healthcare costs on both public and private health care. Both prevalence and incidence of heart failure increase steeply with advancing age, making it a growing public health problem. Pathophysiologically, heart failure clinically presents in two common forms: heart failure with preserved ejection fraction and heart failure with reduced ejection fraction The cornerstone of heart failure management includes the use of angiotensin-converting enzyme inhibitors A recently developed pharmacotherapy that inhibits both the angiotensin receptor and the enzyme neprilysin has shown promise in the management of heart failure with reduced ejection fraction This article will highlight the impact of this new therapy and its potential use in heart failure with reduced ejection fraction.Keywords: ACE-inhibitors, angiotensin receptor blockers, ARBs, enalapril, heart failure, HFrEF management, neprilysin inhibitors, sacubitril, valsarta

Primary prevention of coronary artery disease

There were an estimated one million deaths from cardiovascular disease in sub-Saharan Africa in 2013. The deaths can in some part be prevented through the control of risk factors for coronary artery disease. The major modifiable risk factors in adults include: smoking, obesity, unhealthy diet, dyslipidaemia, hypertension and diabetes. This article aims to discuss the primary prevention of coronary artery disease through examining the evidence regarding the control of these modifiable risk factors. It also briefly explains a pragmatic approach to the use of aspirin as primary prevention for coronary artery disease which takes into account both the risks and benefits associated with aspirin use.Keywords: cardiovascular risk factors, primary prevention, aspirin therapy, dyslipidaemi

Allergic Conjunctivitis

Allergic conjunctivitis is a condition characterized by conjunctival inflammation caused by airborne allergens. The symptoms include: itching, excessive lacrimation, discharge, and conjunctival hyperaemia (pink eye). The disease usually affects young adults and is associated with other allergic conditions like allergic rhinitis, and bronchial asthma for example. There are three types of allergic conjunctivitis, namely acute allergic conjunctivitis, seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC). The diagnosis is primarily clinical and the prevalence is on the increase. Therapeutic modalities include a combination of topical vasoconstrictor and antihistamine therapies, topical antihistamines with mast cell stabilising properties, topical mast cell stabilisers, topical glucocorticosteroids and (in some cases) oral antihistamines when necessary.Keywords: conjunctivitis, allergic conjunctivitis, seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC

Management of Cough: a practical approach

On a regular day, healthcare providers will be contacted by one or more health seekers presenting with cough as a symptom. Cough has been considered an important physiological reflex that protects the airways from aspiration of foreign materials. Cough is one of the most common symptoms for which people seek medical attention from their healthcare practitioners. The common classifications for cough include acute, subacute and chronic cough. Such classification is time dependant. Acute cough is generally self-limiting, while subacute and chronic coughs have various different causes. There are many different causes of cough, and the common causes of persistent coughs include: upper airway cough syndrome, asthma, gastroesophageal reflux disease (GORD) and even pharmacological therapy. There are other important causes of chronic cough especially in the Southern African region that include: pulmonary tuberculosis (TB), environmental diseases, and others, which will not be covered by this article. Management of subacute and chronic coughs should be individualised according to their cause. Currently, there is no evidence to suggest acute coughs need to be treated. Moreover, there is poor evidence to recommend the use of over the counter (OTC) cough syrups in the management of acute coughs.Keywords: cough, acute cough, chronic cough, subacute cough, cough syru

An investigation of diverticular disease among black patients undergoing colonoscopy at Dr George Mukhari Academic Hospital, Pretoria, South Africa

Background. Diverticular disease was previously thought to be non-existent in the black African population. Studies over the past four decades, however, have shown a steady increase in the prevalence of the disease.Objective. To report on the profile and current prevalence of diverticular disease in the black South African (SA) population at Dr George Mukhari Academic Hospital, Pretoria, SA.Methods. A retrospective descriptive study was performed in black SA patients who were diagnosed with diverticular disease by colonoscopy between 1 January and 31 December 2015.Results. Of 348 patients who had undergone colonoscopies and who were eligible for inclusion in this study, 47 were diagnosed with diverticular disease – a prevalence of 13.50% (95% confidence interval 10.30 - 17.50). The greatest number of patients diagnosed were in their 7th and 8th decades, with an age range of 46 - 86 (mean 67) years. There was a female predominance of 57.45%. Lower gastrointestinal bleeding was the most common (65.96%) indication for colonoscopy. The left colon was most commonly involved (72.34%), followed by the right colon (55.31%). A substantial number of patients had pancolonic involvement (27.65%).Conclusion. This retrospective study suggests that there has been a considerable increase in the prevalence of diverticular disease among black South Africans, possibly owing to changes in dietary habits and socioeconomic status

An investigation of diverticular disease among black patients undergoing colonoscopy at Dr George Mukhari Academic Hospital, Pretoria, South Africa

Background. Diverticular disease was previously thought to be non-existent in the black African population. Studies over the past four decades, however, have shown a steady increase in the prevalence of the disease.Objective. To report on the profile and current prevalence of diverticular disease in the black South African (SA) population at Dr George Mukhari Academic Hospital, Pretoria, SA.Methods. A retrospective descriptive study was performed in black SA patients who were diagnosed with diverticular disease by colonoscopy between 1 January and 31 December 2015.Results. Of 348 patients who had undergone colonoscopies and who were eligible for inclusion in this study, 47 were diagnosed with diverticular disease – a prevalence of 13.50% (95% confidence interval 10.30 - 17.50). The greatest number of patients diagnosed were in their 7th and 8th decades, with an age range of 46 - 86 (mean 67) years. There was a female predominance of 57.45%. Lower gastrointestinal bleeding was the most common (65.96%) indication for colonoscopy. The left colon was most commonly involved (72.34%), followed by the right colon (55.31%). A substantial number of patients had pancolonic involvement (27.65%).Conclusion. This retrospective study suggests that there has been a considerable increase in the prevalence of diverticular disease among black South Africans, possibly owing to changes in dietary habits and socioeconomic status

Multicultural awareness through English: A potential contribution of TESOL to Greek schools

The cultural diversity now evident in Greek society creates educational challenges and opportunities. Space to address these is provided by the multicultural awareness aspects of the discourse of the Cross‐Thematic Curriculum Framework (CTCF). For English language classes, multicultural direction is provided through the disciplinary discussion of new teaching paradigm possibilities. In particular, these discussions encourage us to explore the repositioning of English teaching in Greek state schooling from a foreign language orientation towards a multicultural one. In this article, having set the context, we present the Multicultural Awareness Through English (MATE) paradigm. We conclude by illustrating the MATE paradigm in action

A comparison of lay and professional opinion on treatment need and treatment outcome

Magister Chirurgiae Dentium (MChD)The psychological, social, and cultural aspects of facial and dental attractiveness is an integral part of health care. Lay persons perceptions of facial and dental attractiveness are influenced by many factors including age, gender, geographic location (nationally or international), ethnic status, employment status, cultural differences and social class will effect the social impact of the anomalies. In addition, the public response to dental anomalies will vary according to experience of good health or ill health of the individual, relatives and friends. The perception of malocclusion is often seen differently between orthodontists, patients and lay public. The differing perceptions of patients and dental practitioners may influence the delivery of orthodontic care. It has been reported that 70% of orthodontic treatment is dentist induced and that orthodontic treatment may be undertaken without the patient or parents perceiving a problem with the teeth. (DHSS, Schanscheiff Report, 1986). The thresholds of entry and exit for orthodontic care may be different as perceived by orthodontists and lay persons. Orthodontists may pursue full alignment and perfect occlusion whereas lay persons may accept varying degrees of deviation from normal. This current study has assessed and recorded the differences in opinions of professional orthodontists and lay persons on dento-facial aesthetics, orthodontic treatment need and orthodontic treatment outcome. The study was carried out at the Orthodontic Department, University of Wales, College of Medicine, School of Dentistry. The opinions of 56 lay persons (dental technicians, dental nurses and lay persons not involved in the clinical process) and 97 orthodontists was collected by recording judgements using various patient records as stimuli. For each set of records examined, each member of the panel indicated their opinion using Likert scales. Judgements were made by assessments of 68 study casts in respect of:- * the need for orthodontic treatment on dental health grounds. the need for orthodontic treatment on dental aesthetic grounds. deviation from normal occlusion. the decision whether to treat. ** * In addition, judgements were made on a sample of 50 pairs of outline facial profiles before and after treatment in respect of: * * deviation from normal facial aesthetics comparison of aesthetics pre-treatment and post-treatment. Furthermore, assessments on 50 pairs of pre-treatment and post-treatment study casts in respect of: * * degree of improvement as a result of treatment. acceptability of result. Orthodontists subjective judgements are more reliable than lay persons in their assessments of dental aesthetics, dental health and deviation from normal. The level of agreement for the decision to recommend treatment is similar between orthodontists and lay groups ie. lay persons are as reliable as orthodontists in the decision to recommend treatment. Orthodontists tend to recommend 10 - 12 % more treatment than lay persons. The orthodontist group were more reliable than the lay group in assessing degree of improvement and assessment of outcome. Orthodontists reject approximately 25% of cases deemed acceptable by the lay group. Dental aesthetics appeared to be the most important feature in the assessment of treatment outcome by both orthodontists and lay groups

Risk of allergic reactions to wine, in milk, egg and fish-allergic patients

<p>Abstract</p> <p>Background</p> <p>European legislators and wine producers still debate on the requirement for labeling of wines fined with potentially allergenic food proteins (casein, egg white or fish-derived isinglass). We investigated whether wines fined with known concentrations of these proteins have the potential to provoke clinical allergic reactions in relevant patients.</p> <p>Methods</p> <p>In-house wines were produced for the study, fined with different concentrations of casein (n = 7), egg albumin (n = 1) and isinglass (n = 3). ELISA and PCR kits specific for the respective proteins were used to identify the fining agents. Skin prick tests and basophil activation tests were performed in patients with confirmed IgE-mediated relevant food allergies (n = 24). A wine consumption questionnaire and detailed history on possible reactions to wine was obtained in a multinational cohort of milk, egg or fish allergic patients (n = 53) and patients allergic to irrelevant foods as controls (n = 13).</p> <p>Results</p> <p>Fining agents were not detectable in wines with the available laboratory methods. Nevertheless, positive skin prick test reactions and basophil activation to the relevant wines were observed in the majority of patients with allergy to milk, egg or fish, correlating with the concentration of the fining agent. Among patients consuming wine, reported reactions were few and mild and similar with the ones reported from the control group.</p> <p>Conclusion</p> <p>Casein, isinglass or egg, remaining in traces in wine after fining, present a very low risk for the respective food allergic consumers. Physician and patient awareness campaigns may be more suitable than generalized labeling to address this issue, as the latter may have negative impact on both non-allergic and allergic consumers.</p

Statistical terms Part 1 : The meaning of the MEAN, and other statistical terms commonly used in medical research

No abstract available.https://www.sada.co.za/the-sadjam2016Prosthodontic