Medical Chronicle November 2024

MEDChronicle

NOVEMBER

An appeal for greater humility in our (bio)ethics discourse

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PROMINENT FIGURE

IN the field of bioethics and director of the Steve Biko Centre for Bioethics, School of Clinical Medicine at Wits, Professor Kevin Behrens, recently delivered his inaugural lecture titled, ‘An Appeal for Greater Humility in Our (Bio) ethics Discourse’. His address stressed the essential need for humility within bioethical discussions, emphasising how this quality can significantly influence the discourse and decision-making processes in health sciences.

During his enlightening lecture, Prof Behrens expressed compelling arguments advocating for a paradigm shift in how bioethics is approached. He believes that a change in mindset – from one of certainty and authority to one of humility and openness – can lead to more ethical and effective health decisions.

HUMILITY IN ETHICAL DECISION-MAKING

Prof Behrens opened his lecture by highlighting the inherent complexities and uncertainties that characterise ethical decision-making in health sciences. "Ethics in healthcare is not an exact science," he said, emphasising that the multifaceted nature of bioethics often leaves room for diverse, sometimes conflicting viewpoints. He pointed out that too often, professionals in the field operate under the assumption that their perspective is inherently superior or definitive.

"One of the profound realisations we must come to is that our knowledge is invariably limited, and our understanding of ethical dilemmas is often incomplete," Prof Behrens said. This acknowledgment, according to him, is the core of humility in ethical discourse.

COLLABORATIVE AND OPEN-MINDED APPROACH

Prof Behrens articulated a vision for a more collaborative and inclusive bioethics dialogue. He underscored the importance of listening

to and incorporating diverse perspectives, particularly those that are frequently marginalised. "A more humble approach requires us to actively seek out and genuinely consider viewpoints that differ from our own," he said. In his lecture, Prof Behrens made a compelling case for why bioethics should be a collaborative venture, likening it to a dialogue rather than a monologue. He stressed that ethical decision-making should be informed not only by scientific facts and logical analysis but also by empathy and understanding of the human condition.

"For our decisions to be truly ethical, they must be grounded in a deep appreciation of the lived experiences of those affected by them," he added.

THE ROLE OF HUMILITY IN BIOETHICAL DIALOGUE

Humility, as explained by Prof Behrens, goes beyond mere acknowledgment of one's limitations. It involves a willingness to challenge one's own assumptions and a readiness to revise one's stance in light of new evidence or arguments. This mindset, he

argued, is crucial in a field where the lives and well-being of individuals are at stake.

Prof Behrens recounted many instances where a lack of humility in bioethical discourse led to detrimental outcomes. These examples illustrated how rigid adherence to one's own viewpoint can lead to ethical blind spots, ultimately harming those the policies are meant to benefit.

"When we approach bioethics discourse with humility, we make room for a richer, more nuanced understanding of ethical dilemmas. We open ourselves up to the possibility that we might be wrong, or that there might be more than one 'right' answer."

ADDRESSING POWER DYNAMICS

A significant portion of Prof Behrens' lecture was dedicated to addressing the power dynamics inherent in healthcare and bioethical decision-making. He pointed out that those in positions of authority often unwittingly perpetuate their own biases and assumptions, which can suppress alternative viewpoints.

EADV Congress highlights advances in skin care

Prof Kevin Behrens

Adobestock, Credit: BillionPhotos.com

Nicky Belseck, medical journalist

"True humility in ethics requires us to be acutely aware of our own positionality and the power we wield, often unconsciously,” he explained. He stressed the importance of creating spaces where all voices, especially those of marginalised communities, are heard and valued. "Ethical decisions must be made with the input and consent of those who are most affected by them," Prof Behrens said, calling for structures and practices that promote inclusivity and equity in bioethical discourse.

FOSTERING AN INCLUSIVE BIOETHICS DIALOGUE

Building on his argument for inclusivity, Prof Behrens discussed practical steps for fostering a more humble and inclusive bioethics dialogue. He proposed educational reforms that integrate these values into the training of healthcare professionals. “Our educational curriculum

must reflect the complexities of realworld ethical dilemmas and prepare future health professionals to navigate them with humility and empathy,” he said. Moreover, he advocated for institutional changes that support ongoing dialogue and reflection among bioethics professionals. "We need forums and frameworks where continuous, open-ended discussions about ethics in healthcare can take place,” he said.

Such environments, according to Prof Behrens, would not only enhance ethical decision-making but also advance the entire field of bioethics. Prof Behrens concluded his lecture with a powerful message: "The call for humility in our bioethics discourse is not a call for passivity or indecision. Rather, it is a call for deeper engagement, for a more nuanced and empathetic approach to ethical decision-making in health sciences." His appeal for greater humility

is a timely reminder of the importance of open-mindedness, empathy, and collaboration in bioethical discourse. As Prof Behrens eloquently put it, "Being humble does not mean we have less to offer; it means recognising that others have much to offer too."

In summarising his lecture, Prof Behrens left his audience with a thought-provoking challenge: "Let us commit to a bioethics discourse that is as inclusive and empathetic as it is rigorous and analytical. Only then can we truly serve the best interests of those we are entrusted to care for."

This inaugural lecture by Prof Kevin Behrens marks a significant moment in the ongoing evolution of bioethics. His call for greater humility not only highlights the ethical complexities within the health sciences but also charts a path toward a more inclusive and empathetic future.

Humility, empathy in bioethical decision-making

DEAR DEVOTED READERS,

Thank you for taking a break in a busy season, to dive into the latest issue of Medical Chronicle.

In this issue, Prof Kevin Behrens, a leading bioethics expert, discusses the importance of humility and empathy in bioethical decision-making, advocating for a collaborative approach that includes diverse perspectives, especially from marginalised communities.

A survey by Sadag reveals a concerning state of mental health among South African employees, with over half diagnosed with conditions like depression and anxiety due to stressful work environments. This highlights the urgent need for improved mental health resources and support systems in the workplace.

We also explore groundbreaking research from the University of Bristol on arsenic contamination in water, and bring attention to postpartum depression in South Africa, advocating for early screening and holistic treatment.

Misconceptions about ADHD are addressed, emphasising its persistence into adulthood and the necessity for comprehensive treatment plans.

Egypt's certification as malaria-free underscores the importance of sustained public health efforts. We also cover norovirus outbreaks and the health challenges faced by retired male rugby players, who experience high rates of joint pain and mental health issues, highlighting the need for tailored support for this demographic.

In dermatology, we note advancements in treatments for atopic dermatitis and acne, focusing on maintaining skin barrier function.

In our webinar report section, Dr Corli Lodder highlights the issue of patients underestimating allergy symptoms, often relying on over-the-counter medications instead of seeking effective treatments like allergy immunotherapy. She emphasises the chronic nature of allergic rhinitis and its long-term effects, advocating for proper identification of allergens and antiinflammatory treatments. Financial concerns regarding the costs of over-the-counter medications are raised, along with the need for better understanding of allergic rhinitis among healthcare providers.

Happy reading!

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Burnout & mental health in the SA workplace

Key findings from Sadag’s new survey serve as a crucial reminder of the work that still needs to be done to support mental health in the workplace.

By Nicky Belseck, medical journalist

N RECENT TIMES, workplace mental health has become a critical topic of discussion, especially considering the challenges posed by the Covid-19 pandemic. Sadag's new Working Life survey provides a revealing insight into the state of mental health among South African employees. The study, encompassing respondents from various sectors such as education, health, finance, retail, and media, highlights significant concerns and trends regarding employee well-being.

ALARMINGLY HIGH RATES OF DIAGNOSED MENTAL HEALTH CONDITIONS

One of the standout findings of the survey is that over half (52%) of the employees have been medically diagnosed with a mental health condition. The most prevalent conditions are depression (32%), clinical stress (25%), general anxiety (18%), and burnout (13%). These statistics reveal a critical need for better mental health support mechanisms within workplaces.

THE STRAIN OF THE WORK ENVIRONMENT

The survey respondents indicated that the work environment is a significant stressor. A staggering 61% of employees expressed a desire to leave their jobs if they could afford to do so. This dissatisfaction is further reflected in the fact that 50% of employees feel unhappy at the start of the workweek. The constant mental engagement with work, even outside working hours, is draining for many, with 75% of employees reporting that they cannot ‘switch off’ after work.

DEMOGRAPHICS AND WORK PATTERNS

The survey also sheds light on demographic patterns within the workforce. A notable 83% of respondents were female, with

a racial composition of 39% white, 37% black, and 11% coloured. Interestingly, despite the pandemic-induced shift, only one in three employees continue to experience hybrid work arrangements, which they find beneficial for managing mental health issues.

INSUFFICIENT SUPPORT FOR MENTAL HEALTH

The findings underscore a significant gap in mental health support. While 47% of employees work in organisations offering Employee Assistance Programmes (EAPs), the effectiveness and accessibility of these programmes are often inadequate. Issues such as insufficient leave, tight deadlines, and minimal medical benefits compound the challenges faced by employees. Moreover, 38% of employees expressed fear of job loss, adding another layer of stress and insecurity.

CALLS FOR BETTER MENTAL HEALTH INITIATIVES

Sadag stressed the urgent need for enhanced mental health support and innovative workplace programmes. The organisation advocates for more flexible work arrangements, reliable hybrid work models, and reduced toxic workplace behaviours. Sadag’s founder, Zane Wilson, emphasised that creating a mentally healthy environment can lead to a more productive workforce. Sadag offers tailored support services and strategies to help companies foster mental well-being among their employees.

The survey results present a sobering view of the mental health landscape in SA workplaces. The high levels of diagnosed mental health conditions, coupled with widespread dissatisfaction and stress, highlight the pressing need for comprehensive mental health interventions. By adopting flexible work policies, improving

EAP accessibility, and creating supportive environments, employers can significantly contribute to the mental well-being of their employees. These findings serve as a crucial reminder of the work that still needs to be

done to support mental health in the workplace.

For more information on the survey and to access Sadag's mental health resources, visit their website: https://www.sadag.org/

Scientist makes groundbreaking discovery in water safety quest

A study led by the University of Bristol shedding new light on how arsenic can be made less dangerous to humans has the potential to dramatically improve water and food safety.

F

OR THE LEAD researcher it’s an academic and personal mission because he witnessed first-hand the constant struggle to find clean, arsenic-free water as a child in India.

Lead author Dr Jagannath Biswakarma, Senior Research Associate at the University’s School of Earth Sciences, said: “There are millions of people living in regions affected by arsenic, like I was growing up. This breakthrough could pave the way for safer drinking water and a healthier future.”

Arsenic pollution exposure is a huge environmental and public health issue in southern and central Asia and South America, where people depend on groundwater for drinking and farming. The more toxic and mobile form of arsenic, called arsenite, easily seeps into water supplies and can lead to cancers, heart disease and other serious conditions.

Dr Biswakarma said: “I’ve seen the daily battle for safe drinking water in my hometown Assam. It’s very hard to find groundwater sources that aren’t contaminated with arsenic, so for me this research hits close to home. It’s an opportunity to not only advance science, but also better understand the extent of a problem which has affected so many people in my own community and across the world for many decades.”

Scientists previously believed arsenite could only be turned into the less harmful form, called arsenate, with oxygen. But this new study has shown it can still be oxidised,

even in the absence of oxygen, with small amounts of iron which act as a catalyst for oxidation. Dr Biswakarma said:

“This study presents a new approach to addressing one of the world's most persistent environmental health crises by showing that naturally occurring iron minerals can help oxidise, lowering the mobility of arsenic, even in low-oxygen conditions.” Study findings revealed that arsenite could be oxidised by green rust sulfate, a source of iron prevalent in lowoxygen conditions, such as groundwater supplies. They also showed this oxidation process is further enhanced with a chemical released by plants and commonly found in soils and groundwater.

“These organic ligands, such as citrate from plant roots, could play a critical role in controlling arsenic mobility and toxicity in natural environments,” Dr Biswakarma added.

The implications of this discovery are particularly significant for regions in the Global South facing some of the world’s highest levels of arsenic pollution. In countries such as India and Bangladesh, the local geology is rich in iron, and reducing conditions often dominate in groundwater systems, leading to high levels of arsenic contamination. In the GangesBrahmaputra-Meghna Delta, which spans Bangladesh and eastern India, millions of people have been exposed to arseniccontaminated groundwater for decades as the chemical enters the water through

natural processes.

Dr Biswakarma said: “Many households rely on tube wells and hand pumps, but these systems do not guarantee access to clean water. The water often cannot be used for drinking or other household tasks due to its toxicity, odour, and discoloration. Additionally, there is an ongoing financial burden associated with obtaining new tube wells or hand pumps. As a result, economically disadvantaged families continue to struggle to find safe water for their daily needs.”

Similarly, the Mekong Delta and the Red River Delta, in Vietnam, face ongoing challenges with arsenic pollution, affecting drinking water supplies and agricultural productivity. Rice paddies can become hotspots of arsenic exposure, as the toxic chemical can accumulate in soil and be absorbed by rice plants, posing a further health risk through food consumption.

“The research opens the door for developing new strategies to mitigate arsenic pollution. Understanding the role of iron minerals in arsenic oxidation could lead to innovative approaches to water treatment or soil remediation, using natural processes to convert arsenic into its less harmful form before it enters drinking water supplies,” said co-author Molly Matthews, who worked on the paper during her Masters degree in Environmental Geoscience at the University of Bristol. Identifying the specific form of arsenic in a sample can be challenging. Even a trace amount of oxygen

can convert arsenite into arsenate, so it is vital to protect samples from exposure to air. Thanks to funding from the European Synchrotron Radiation Facility (ESRF) the team was able to conduct these complex experiments at its XMaS synchrotron facility, in Grenoble, France. Co-author Dr James Byrne, Associate Professor of Earth Sciences, added: “Determining arsenic formation at the atomic level using X-ray absorption spectroscopy was crucial for confirming changes to the arsenic oxidation state. The synchrotron therefore played a pivotal role in supporting our findings, which have potentially broad implications for our understanding of water quality.”

This work at University of Bristol was supported through a UK Research & Innovation (UKRI) Future Leaders Fellowship (FLF) awarded to Dr James Byrne. Further research is now needed to explore how these findings can be applied in real-world settings.

Dr Biswakarma said: “The whole research team worked tirelessly on this project, putting in 24/7 shifts including over Easter to conduct the experiments in France. “I genuinely believe, with more work, we can find effective possible solutions and we’re already making great inroads to overcoming this big global issue. We’re excited to investigate how this process might work in different types of soils and groundwater systems, especially in areas where arsenic contamination is most severe.”

Adobestock, Credit: Anastasiia

Motherhood's hidden struggles: unveiling PPD & PMDD

Despite their prevalence, postpartum depression (PPD) and premenstrual dysphoric disorder (PMDD) remain underdiagnosed and surrounded by misconceptions.

By Nicky Belseck, medical journalist

SPEAKING DURING THE ‘Breaking the Stigma: Responsible Leadership in Action’ workshop hosted by Stellenbosch Business School last month for World Mental Health Day, Dr Bavi Vythilingum provided an insightful exploration of postpartum depression (PPD) and premenstrual dysphoric disorder (PMDD), highlighting key myths and essential messages for healthcare professionals.

PPD PREVALENCE AND IMPACT

In SA, around 30%-40% of women experience postpartum depression, highlighting the need for greater awareness and proactive mental health support.

KEY MYTHS AND FACTS ABOUT PPD

Myth: PPD is a rare condition.

Fact: Postpartum depression is quite common, with a substantial percentage of women experiencing symptoms significant enough to disrupt their daily lives. Understanding its prevalence is crucial for early identification and treatment.

Myth: PPD only occurs immediately after childbirth.

Fact: Postpartum depression can develop at any point within the first year after childbirth. Many women might not recognise their symptoms as PPD if they occur later, which delays seeking help.

Myth: PPD is just ‘baby blues’.

Fact: While ‘baby blues’ involve brief, mild mood swings, PPD is more severe and persistent. It includes profound sadness, anxiety, and exhaustion that interferes with a woman’s ability to care for herself or her baby.

Myth: Women with PPD are always sad and crying.

Fact: PPD can manifest through a variety of symptoms, including irritability, anger, disinterest in the baby, and severe anxiety. Identifying these diverse symptoms can aid in better diagnosis and treatment.

KEY MESSAGES ABOUT PPD

Early screening: Regular screening for mood disorders should be part of postpartum care. Healthcare professionals should conduct screenings at multiple intervals, not just immediately after delivery. Holistic approach: Treatment of PPD should encompass medication, counselling, and support groups. Tailoring treatments to individual needs can significantly improve outcomes.

Awareness and education: Educate new mothers and their families about the signs and symptoms of PPD to promote early intervention and reduce stigma.

PREMENSTRUAL DYSPHORIC DISORDER (PMDD)

PMDD is a severe form of PMS with profound symptoms that can disrupt daily life. Diagnosis is challenging due to symptom overlap with other mental health disorders.

KEY MYTHS AND FACTS ABOUT PMDD

Myth: PMDD is just severe PMS. Fact: PMDD goes beyond PMS and involves extreme mood swings, irritability, depression, and anxiety.

It can significantly impair one's quality of life and daily function.

Myth: PMDD is purely psychological. Fact: PMDD has both physiological and psychological aspects, often requiring hormonal treatment alongside psychological support.

Break the stigma: Debunking ADHD myths

Discover the truth behind common ADHD myths and gain valuable insights from Prof Renata Schoeman on effective diagnosis and treatment strategies.

ATTENTION DEFICIT

HYPERACTIVITY disorder (ADHD)

is a condition often surrounded by misconceptions and myths. In her presentation at the ‘Breaking the Stigma’ conference on World Mental Health Day last month, Prof Renata Schoeman shed light on these myths and provided valuable insights for healthcare professionals. Here are the key takeaways from her presentation.

UNDERSTANDING ADHD

ADHD is characterised by attention dysregulation and hyperactivity. It is crucial to recognise that ADHD is not merely a childhood disorder but can persist into adulthood, affecting various aspects of life, including academic, occupational, and social functioning. Prof Schoeman emphasised the importance of accurate diagnosis and treatment to manage the condition effectively.

MYTH 1: ADHD IS OVERDIAGNOSED

One of the prevalent myths is that ADHD is overdiagnosed. Prof Schoeman clarified that while there is an increase in ADHD diagnoses, it is not necessarily indicative of overdiagnosis. Instead, it reflects a growing awareness and better understanding of the condition. Misdiagnosis, however, remains a concern, and it is essential to differentiate ADHD from other conditions with similar symptoms.

MYTH 2: ADHD IS A RESULT OF POOR PARENTING

Another common misconception is that ADHD is caused by poor parenting. Prof Schoeman debunked this myth, explaining that ADHD is a neurodevelopmental disorder with a strong genetic component. Environmental factors may influence the severity of symptoms, but they are not the root cause of ADHD.

MYTH 3: MEDICATION IS THE ONLY TREATMENT

While medication is a cornerstone in the management of ADHD, it is not the only treatment. Prof Schoeman highlighted the importance of a multimodal approach, including behavioural therapy, psychoeducation, and lifestyle modifications. Medication can help manage symptoms, but it should be part of a comprehensive treatment plan tailored to the individual's needs.

THE IMPACT OF OVERPRESCRIBING

Prof Schoeman raised concerns about the overprescribing of medication to individuals who do not need it. This practice can lead to increased healthcare costs and potential side effects for patients. It underscores the need for careful assessment and diagnosis before initiating treatment. Healthcare professionals should be vigilant in monitoring the effectiveness and side effects of medication, adjusting treatment

Rheumatologist recognised for lifetime contribution to global research

Prof Dessein has been recognised internationally.

ESTEEMED RHEUMATOLOGIST and respected academic Prof Patrick Dessein has been recognised by the international online scholarly analytics platform

ScholarGPS. Prof Dessein, who practises at Netcare Rosebank Hospital, was recently recognised as one of the top 0.5% of ScholarGPS researchers worldwide based on his strong publication record, the impact of his work, and the notable quality of his scholarly contributions. “We heartily congratulate Prof Dessein on this latest acknowledgement of his academic prowess and the immense body of work that is continually being referenced and built on by other academics internationally,” says Sibusiso Vilakazi, general manager of Netcare Rosebank Hospital.

Prof Dessein holds dual Honorary Professorship at the Internal Medicine and Physiology Departments of the University of the Witwatersrand. He moved to South Africa from Belgium in August 1983 and started working at Kalafong Hospital, Pretoria. In January 1988, he became a registrar in the Department of Internal Medicine at the Johannesburg Hospital (now Charlotte Maxeke Johannesburg Academic Hospital) and Hillbrow Hospital, where he was later a consultant physician internist for the Department of Rheumatology. “Since 1986, my main interest has been in rheumatology research, particularly pathogenetic mechanisms, including sympathetic overactivity and instability and overlapping risk factors and pathogenetic mechanisms between rheumatic diseases and cardiovascular disease, with their implications for improved therapies of disease manifestations and disease outcomes as well as neuroendocrine deficiencies,” Prof Dessein explains.

He also practised at Netcare Milpark Hospital from 1995 to 2016. From 2016 to 2018, he served as Head of Rheumatology at the University Hospital and Free University in Brussels, Belgium, before returning to South Africa and

By Nicky Belseck,

plans as necessary.

PROMOTING INFORMED PERSPECTIVES

The session aimed to address misconceptions about ADHD and promote a more informed perspective on its diagnosis and treatment. Prof Schoeman encouraged healthcare professionals to stay updated with the latest research and guidelines to provide the best care for their patients. Understanding the nuances of ADHD can help in reducing stigma and improving the quality of life for those affected by the condition. By debunking common misconceptions and emphasising a comprehensive approach to treatment, Prof Schoeman highlighted the importance of accurate diagnosis and individualised care. She stressed that as healthcare professionals, it is our responsibility to stay informed and provide evidence-based care to those with ADHD, ensuring they receive the support they need to thrive.

Netcare Rosebank Hospital. Over the past 12 years, Prof Dessein’s academic work has focused mostly on cardiovascular risk and atherogenesis, including molecular mechanisms such as altered endothelial activation and altered adipokine production and cardiac function and structure in patients with rheumatoid arthritis and chronic kidney disease. “More recently, a new interest has been the identification of predictors of poor outcome and optimising interventions in socio-demographically disadvantaged patients seen in public care in South Africa,” Prof Dessein explains.

Prof Dessein has maintained strong international relationships, including as a member of the TransAltantic Cardiovascular Risk Calculator for Rheumatoid Arthritis Consortium, which consists of 15 research groups in 10 countries dealing with combined data from 5 685 patients with rheumatoid arthritis. He has also served as an editorial board member of the Journal of Rheumatology and the Journal of Cardiology and Therapy.

In addition to consulting patients, Prof Dessein remains a leading hands-on figure in empowering local medical professionals by generously sharing his specialised knowledge. He also supervises numerous PhD students.

“On behalf of the Netcare family, we warmly applaud Prof Dessein for the extraordinary reach of his academic contributions and thank him for his dedication over decades to improving outcomes for patients, both those under his direct care at home in South Africa and the patients of the many healthcare practitioners internationally who have benefitted from his invaluable, wide-ranging research contributions,” Dr Erich Bock, managing director of Netcare’s hospital division, concludes.

Prof Patrick Dessein

medical journalist

How to strengthen patient trust through proactive care

EngageMX integrates data, to build unique health and risk profiles for each patient.

IT’S THAT TIME of the year when breast cancer and prostate cancer awareness months remind the public to be proactive when it comes to their health. But as doctors know only too well, there’s a gap between good intentions and meaningful action. Reminding patients to get checkups is one of the simplest ways to improve outcomes – but staying on top of this process can be an administrative nightmare for healthcare providers.

This is where EngageMX comes in. Powered by Altron HealthTech, this innovative South African digital medical assistant was developed by Dr Benji Ozynsky with input from Prof Carol-Anne Benn and Prof Jeffrey Wing. Since its launch two years ago, it has proven a hit with both doctors and patients. Over 250 000 patients have been processed on the EngageMX platform, leading to a 37% increase in screenings and a 25% decrease in chronic disease complications.

EngageMX integrates practice data, pharmacy data and pathology data to build unique health and risk profiles for each patient. This allows the system to identify individuals who may need proactive care, such as cancer screenings, chronic disease check-ups, or specific followup tests. Patients receive personalised reminders from their doctors, guiding them to take preventive actions, like scheduling mammograms or prostate screenings.

Dr Melinda Whitfield, director of Health with Heart, has noticed a notable improvement in patient compliance since her practice started using EngageMX. “By proactively reaching out to patients for necessary healthcare interventions, such as screenings or chronic disease management appointments, the system has effectively increased patient engagement and adherence to recommended healthcare protocols.

This proactive approach has resulted in better health outcomes for our patients and a reduction in missed appointments.”

When working with Altron HealthTech on developing EngageMX, Dr Ozynski understood that, while many patients don’t follow up on appointments and often present too late, doctors simply don’t have the time to keep track and remind them. Did doctors know how many of their patients were compliant with follow up appointments? It was important for the solution to actively involve the doctor, but it could not be an administrative burden.

Data-driven healthcare makes it possible to provide a personalised approach to every single patient, including their genome, their medication, and their lifestyle habits. In addition, its proactive approach means that instead of waiting for symptoms to manifest, EngageMX prompts patients

for routine checks, reducing the risk of late-stage diagnoses and improving overall health outcomes.

“I have lost fewer clients to follow up and overall, this has increased my productivity and effectivity,” said Dr Dean Alon Sevel. “By

the practice engaging with them directly they feel mutual care is present and they have remarked that it’s a first-of-its-kind service in health promotion.”

As we focus on cancer awareness this November, EngageMX’s proactive care

model emphasises that early detection saves lives, making it easier for healthcare providers to partner with patients to take charge of their health. Technology and the human touch working together: this is the future of healthcare.

Discovery Foundation Awards honour exceptional healthcare professionals in 2024

The Discovery Foundation has reached its R300 million investment milestone, achieving a 72% Black Economic Empowerment (BEE) target directed towards black beneficiaries.

THE DISCOVERY FOUNDATION

has proudly announced the recipients of its annual medical research and training grants for 2024 during an awards ceremony that celebrated the commitment and achievements of South Africa’s healthcare professionals. The awards recognise exceptional South African medical specialists, researchers, and institutions dedicated to enhancing healthcare across the country, particularly in underserved and rural areas.

DISCOVERY FOUNDATION CONFERENCE 2024: INNOVATIVE CARE STRATEGIES AND CHALLENGES

Before the awards ceremony to celebrate this year’s alumni, delegates, healthcare professionals, and stakeholders convened at the Discovery Foundation Conference. This event has served as a valuable platform for alumni to connect, share insights, and showcase diverse research supported by the Foundation.

The 2024 conference focused on the theme “Developing a Skilled Healthcare Workforce for Innovative Care: Strategies and Challenges,” addressing ongoing issues such as staffing shortages, budget constraints, and disparities in access to care.The conference featured a welcome address by Dr Maurice Goodman, Foundation Trustee and Discovery Health Chief Medical Officer, who discussed the Foundation’s impact since its inception while also highlighting the need to retain and support healthcare professionals in underserved areas. Keynote speaker and Discovery Health CEO, Ron Whelan, gave an insightful talk on the future of healthcare and the importance of innovation. In his keynote address Whelan

said, “As healthcare leaders, we need to interchangeably look at healthcare through a microscope and through a telescope. Sometimes you have to zoom in to solve specific problems, and other times you have look into the future. Today I’d like us to focus on looking through the telescope to view the future of healthcare in South Africa,” emphasising the importance of building on the strengths of South Africa’s healthcare system and new developments in technology, big data and artificial intelligence to propel the health system forward.

Notable conference speakers included Dr Percy Mahlati - deputy director general: National Department of Health - and Professor Arthur Rantloane - Emeritus Professor: Anaesthesiology at the University of Pretoria; vice-chair: HPCSA's Medical and Dental Professions Board; chairman: HPCSA Medical Education Training and Registration committee - who led a panel discussion on 'Overcoming Challenges in Healthcare Training', with the discussion focusing on policy and regulations, as well as budget constraints and funding. Dr Mahlati and Prof Rantloane agreed that “the aim is to have more collaboration and less competition in training institutions as a way to improve the overall healthcare system in South Africa.”

Professor Vanessa Burch - executive director: CMSA Education and assessment - spoke about 'Successful Strategies in Workforce Training'. She highlighted the importance of trustworthiness for trainees and how this can be effectively assessed. “While capability is important, it’s not all there is. Being competent is not enough, it’s about training people to have agency, humility – the ability to say when you need help, receive feedback and the ability to

make decisions that trainees can be trusted with to care for patients.

This means we need many observations, by many people to assess the competency levels of trainees. This is how we effectively affect the careers of future healthcare professionals,” she said. This perspective of doing things differently was echoed by Dr Raymond Campbell - CEO of Phulikisa Health Solutions - “To say that we’re going to do things a certain way because that’s how they’ve been done in the past is no longer going to work for the future of medicine,” emphasising the need for critical skills to shift from prevention to pre-emptive care, and how this is a shared responsibility with patients.

On the topic of 'Understanding the national health research landscape and ushering the next generation of researchers and innovators', head of the department of Obstetrics and Gynaecology and Chair of the National Health Research Committee (NHRC), Professor Mushi Matjila, said: “The mandate of the committee is to have an integrated national strategy for health research priorities,” adding that “we should remind ourselves that unless we’re champions of the issues we’re trying to solve, our efforts are not going to lead to tangible results”. Closing off the proceedings was Professor Nasreen Mahomed - a specialist radiologist and Associate Professor of Radiology and academic head of Radiology at the University of Witwatersrand. Prof Mahomed discussed the vision for the future, looking at collaborative approaches to healthcare education from an African perspective.

Key insights from the conference highlighted the essential themes for advancing South Africa’s healthcare

system. Discussions centred on the future of healthcare, emphasising the need to embrace innovation and skill development to tackle existing challenges. Participants addressed the obstacles in healthcare training, the importance of identifying critical skills for tomorrow’s healthcare providers was highlighted, alongside successful strategies in workforce training that showcase effective programmes and their outcomes across various healthcare settings. Additionally, the conference explored the critical need to foster innovation through education by integrating technology and implementing innovative practices to enhance healthcare services.

DISCOVERY FOUNDATION AWARDS 2024

Since its establishment nearly two decades ago, the Discovery Foundation has been a driving force in strengthening the South Africa’s healthcare sector. A total of over 550 awards have been granted to date, benefiting both individuals and institutions. Of these, 290 awards have been allocated to predominantly black medical specialists in the public sector, while 150 awards have supported institutions focused on training. Furthermore, the Foundation has reached its R300 million investment milestone, achieving a 72% Black Economic Empowerment (BEE) target in terms of spending and rand value directed towards black beneficiaries.

Dr Vincent Maphai, chairperson of the Discovery Foundation, highlighted how this year’s recipients are making a difference by incorporating technology into quality healthcare. “Each year, the Discovery Foundation Awards bring to light remarkable individuals who are not only excelling in their

fields but also pushing the boundaries of medical research and care. These doctors and specialists demonstrate resilience and ingenuity, contributing to some of the most pressing healthcare challenges of our time — palliative care, healthcare digitisation, and the integration of artificial intelligence (AI) into medical practices,” said Dr Maphai, emphasising how all these advances are all in service of the population.

This year’s awards reflect the Foundation’s commitment to addressing the urgent need for skilled medical professionals in South Africa, particularly within the public healthcare system. The grants provide essential support for doctors, researchers, and specialists working to strengthen healthcare delivery, especially in underserved areas where access to adequate services is often limited. This includes the MGH Fellowship Award, which offers recipients a one-year residency at Massachusetts General Hospital, providing invaluable supervision and exposure to leading research environments.

Head of Corporate Social Investment at Discovery, Andronica Mabuya, reinforces the Foundation’s dedication to uplifting the public healthcare system. “Despite South Africa’s proud legacy of medical innovation, many communities still lack access to quality healthcare.

The Discovery Foundation is committed to changing this reality by ensuring affordable, high-quality healthcare for all. The achievements of our award recipients this year demonstrate the incredible potential within our healthcare system. Their research and clinical practices are vital in bridging gaps in healthcare delivery.” With nearly 20 years of investment and growth, in addition to its focus on healthcare, the Discovery Foundation is committed to sustainability. As a signatory to the United Nations Global Compact since 2015, the Foundation upholds the call to end poverty, protect the planet, and improve lives worldwide. “The concept of

sustainability goes beyond environmental considerations; it is fundamentally linked to the creation of resilient systems that guarantee equitable access to healthcare for all individuals, regardless of their location or circumstances,” explains Mabuya.

Over the years, the Discovery Foundation funding has impacted and collaborated with many talented professionals, whose achievements continue to have an indelible effect on South Africa’s healthcare system. Notably, this year Professor Mosa Moshabela – who received the Discovery Foundation Academic Fellowship Award in 2009 to pursue his PhD in public health, focusing on HIV and AIDS – was appointed vice chancellor at the University of Cape Town. Additionally, Professor Salome Maswime, a 2018 MGH Fellowship Award recipient, was recently announced as director of the WHO Collaborating Centre at the University of Cape Town, which will significantly influence maternal healthcare across Africa.

What began with an investment of R100 million to support the development of 300 healthcare professionals has grown significantly, with the Foundation now surpassing R320 million in grants. By 2026, the aim is to have trained and supported 600 specialists and institutions who will contribute to the improvement of healthcare across the country. Recipients of the Discovery Foundation Award are required to serve in the public sector for a minimum of two years following the completion of their training. More than 60% of the Foundation’s alumni choose to remain in the public sector even after fulfilling their contractual obligations.

The impact of the Discovery Foundation’s grants extends beyond financial support; they foster a collaborative environment where healthcare professionals can thrive and make a lasting impact in their communities. Dr Maphai concludes, “The recipients of the Discovery Foundation Awards represent the future leaders in

our healthcare sector. With their focus on academic medicine, specialist training, and rural healthcare, these investments will benefit South Africa for many years to come.”

THE 2023/2024 DISCOVERY FOUNDATION AWARD CATEGORIES AND RECIPIENTS

The awards are given in four main categories:

Academic Fellowship Awards that promote research-focused training in academic medicine to develop more clinician scientists in South Africa Sub-specialist Awards that promote training, research and development in health faculties in South Africa.

• Individual awards for healthcare for rural and underserved areas

• Institutional awards for healthcare in rural and underserved areas.

The 2024 Discovery Foundation Awards encompass several categories, celebrating a diverse group of healthcare professionals who are making significant contributions to the field. The recipients of this year’s awards are as follows:

ACADEMIC FELLOWSHIP AWARDS

1. Dr Nondumiso Dlamini – Radiological assessment of breast cancer in young South African women (40 years) and the use of artificial intelligence to improve early detection of breast cancer in this population.

2. Dr Tshilidzi Van der Iecq – Current research focuses on the Epidemiology of Retinopathy of Prematurity (ROP) in South Africa, one of the most common eye conditions affecting premature infants and a potentially preventable cause of blindness.

3. Dr Fusi Godwin Madela – Cytokine response and severity stratification of acute pancreatitis in HIV seropositive patients in KwaZulu-Natal.

4. Dr Yakheka Dyasi – Interventions to improve the quality of patients’ lives postcritical care admission in public and private

health facilities in the Eastern Cape (QoL PAC Study).

5. Dr Cascia Day – ACE-inhibitor angioedema biomarkers and genetics, aiming to predict which patients are at risk of developing life-threatening reactions to common blood pressure medications.

Individual awards for healthcare in rural and underserved areas

1. Dr Jennifer Kent – An exploration of the reasons behind poor cervical cancer screening uptake in rural Eastern Cape.

2. Dr Nangamso Malashe – Knowledge, attitudes, and practices regarding contraception among women seeking termination of pregnancy services in the KSD sub-district, Eastern Cape.

3. Dr Sibusiso Mbili – Exploring the prevalence and characteristics of cardiac diseases among pregnant women at the Nelson Mandela Academic Hospital, in the Eastern Cape.

4. Dr Kgothatso Mothapo – Prevalence of type 2 diabetes mellitus and associated risk factors in Madombidhza Village, Vhembe District, Limpopo Province.

5. Dr Christopher Westwood – Assessing the effectiveness of decentralised antenatal ultrasound compared to a hospital-based service at a clinic in rural South Africa.

6. Dr Amanda Dlamini – Antiretroviral drug resistance testing among patients on second-line therapy in a tertiary hospital in Tshwane.

Institutional awards for healthcare in rural and underserved areas

1. Dr Jacobus A. van Rooy – The development of a rural training platform to improve the quality and delivery of healthcare through support for capacity building of healthcare workers in the Central Karoo district.

2. Prof Gert Marincowitz – Expansion of the implementation of quality palliative care in Limpopo Province.

3. Dr Rihangwele Mukhinindi – Development of cancer awareness, screening, and care, and training healthcare workers on cancer screening specifics.

4. Prof Thozama Dubula – Database of patients seen at the rheumatology clinic and further education and training on prevalent conditions.

5. Dr Janet Stanford – Project expansion addressing the pressing need for compassionate, holistic palliative care for terminally ill patients at the Knysna Sedgefield Hospice.

SUB-SPECIALIST AWARDS

1. Dr Petrus Thabo Mogotlane – Training to become one of South Africa’s first black addiction psychiatrists, focused on addressing the roots of addiction.

2. Dr Darlene Boakye – Research on maternal and fetal outcomes in patients with chronic kidney disease, at the Nelson Mandela Academic Hospital.

3. Dr Vashini Pillay – Specialisation in paediatric infectious diseases at Red Cross Memorial Hospital, focusing on treating infections like TB and HIV in children.

GoodX Software Pioneering health technology solutions globally

GoodX Software is a health technology company that provides advanced, user-friendly healthcare practice management solutions to institutions worldwide.

FOUNDED WITH THE vision to transform the healthcare industry through cutting-edge software solutions, GoodX Software is designed to meet the dynamic needs of healthcare providers. Whether private practices, multi-speciality clinics, or hospitals, GoodX’s software empowers healthcare professionals to deliver more efficient and patient-centric care. GoodX Software is ISO27001 certified and focuses on innovation, customer support, and the highest data security standards. GoodX is dedicated to transforming healthcare delivery through cutting-edge technology.

REVOLUTIONISING HEALTHCARE PRACTICE MANAGEMENT

GoodX Software specialises in providing an all-in-one, integrated healthcare practice management solution that enables healthcare institutions to manage various tasks seamlessly.

Our core offering includes features like:

1. Practice management: Streamline day-to-day operations with powerful e-scheduling, billing, and reporting tools that optimise efficiency.

2. Electronic Health Records (EHR): Access

patient information in real-time, ensuring accurate and secure data handling while improving the quality of patient care.

3. Healthcare billing solutions: Automate invoicing and payments with advanced billing features, enabling healthcare providers to easily manage finances.

4. Telehealth capabilities: Deliver virtual care through a secure, user-friendly platform that connects patients with healthcare providers remotely.

5. Custom reporting and analytics: Monitor practice performance with customisable reports that provide deep insights into operational effectiveness.

Our solutions are tailored to help healthcare institutions focus on what truly matters – their patients – by reducing administrative burdens and enhancing operational productivity.

WHY GOODX SOFTWARE?

GoodX believes that the key to transforming healthcare lies in technological innovation and understanding the industry’s unique challenges. GoodX Software stands out for the following reasons:

1. User-centric design: Our software is developed with the user experience

in mind, ensuring that healthcare professionals find it intuitive, reliable, and easy to navigate.

2. Comprehensive solutions: From small private practices to large healthcare networks, GoodX Software can be customised to meet the unique requirements of different healthcare environments.

3. Data security and compliance: Patient data is safeguarded with the highest security standards, ensuring compliance with global regulations, including GDPR and HIPAA.

4. Proven track record: Over the years, we have built a reputation for delivering highly effective software solutions that have a measurable impact on healthcare service delivery.

5. World-class support: Our global customer support team is available 24/7 to assist clients, ensuring seamless integration and long-term success with our platform.

ENTERING THE GLOBAL STAGE

GoodX Software has officially expanded its innovative solutions beyond its initial borders. Having established a robust presence in South Africa, with a growing demand for high-quality healthcare

software solutions worldwide, GoodX has expanded its operations into multiple international markets. GoodX is actively engaging with healthcare providers in regions such as Canada, the UK, and New Zealand as part of its global strategy. GoodX is already seeing positive responses to its software solutions.

SHOWCASING

INNOVATION AT GLOBAL CONFERENCES

In our continued commitment to sharing our vision and expertise with the global healthcare community, GoodX Software participates in renowned international conferences. These events provide the perfect platform to connect with industry leaders, showcase their latest innovations, and stay at the forefront of healthcare technology advancements. GoodX recently attended ESCRS and Best Practice, Birmingham, and is set to present at upcoming conferences in 2025. GoodX Software is strengthening its position as a trusted partner in the global healthcare sector through these engagements.

For more information, visit our website at goodx.healthcare.

Adobe Stock, Credit : Toowongsa

Billing

Features Voice to typing/Dictation

Stylus compatible for those who think when writing

Turn your phone into a clinical camera (Capture App)

Facial recognition

CLINICAL | GASTROENTEROLOGY

The link between IBS and mental health

Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder affecting 5%-10% of the global population.

WHILE GASTROINTESTINAL

SYMPTOMS are crucial, psychological comorbidities play a substantial role in influencing longterm quality of life. There are shared pathophysiological mechanisms between IBS and mental health disorders, including genetic factors, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, and interactions within the gut-brain axis. Evidence suggests that individuals with

IBS are at an increased risk for developing anxiety and depression, and vice versa. The economic burden of IBS is also addressed, noting that psychological comorbidities exacerbate healthcare costs and work impairment.

MULTIDISCIPLINARY MANAGEMENT

APPROACH

Researchers advocate for a multidisciplinary management approach that integrates

medical treatment, dietary changes, and psychological therapies. This approach is considered best practice for managing IBS and involves personalized treatment plans that account for the interplay of gastrointestinal and psychological symptoms. The management strategy is divided into three domains:

1. Medical domain: Diagnosis relies on gastrointestinal symptoms meeting the Rome criteria, with limited testing to

exclude other conditions. Treatment focuses on symptom relief using medications for abdominal pain, diarrhoea, and constipation. Neuromodulators like tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors are effective for pain management.

2. Dietary domain: Dietary interventions, such as the low FODMAP diet and the Mediterranean diet, are highlighted for their effectiveness in managing IBS symptoms and enhancing quality of life. Dietary counselling is crucial for successful implementation.

3. Behavioural domain: Psychological therapies, including cognitive behavioural therapy, gut-directed hypnotherapy, and mindfulness-based stress reduction, are recommended to address psychological stress and maladaptive cognitive processes.

BIOPSYCHOSOCIAL APPROACH

A biopsychosocial approach to assessing and managing IBS considers medical, dietary, and psychological factors. Future research is needed to explore effective management strategies for individuals with co-occurring IBS and mental health disorders. Recognising and addressing the psychological aspects of IBS is essential to improve patient outcomes and quality of life.

PSYCHOBIOTICS

Psychobiotics are compounds that affect gut–brain communication through the gut microbiome. These include probiotics, prebiotics, synbiotics, postbiotics, and fermented foods. They can be consumed as supplements, through specific foods, or by making changes to the overall diet. The strongest evidence supporting the benefits of psychobiotics for depression comes from studies on probiotic supplementation. The largest systematic review and meta-analysis of such studies found modest benefits for depression overall, with more pronounced effects in individuals formally diagnosed with depression. With growing interest in dietary approaches to support mental health, a ‘psychobiotic’ diet enriched with prebiotics and fermented foods has shown some potential in reducing perceived stress among healthy people.

CONCLUSION

An integrated, patient-centred approach to managing IBS is advised, in managing the complexity of the condition and the necessity for tailored interventions that address both gastrointestinal and psychological health. There is the potential of psychobiotics in improving mood and reducing stress. Individualised dietary counselling considers both physical and mental health comorbidities.

REFERENCE

Staudacher, H.M., Black, C.J., Teasdale, S.B. et al. Irritable bowel syndrome and mental health comorbidity — approach to multidisciplinary management. Nat Rev Gastroenterol Hepatol 2023:20, 582–596. https://doi. org/10.1038/s41575-023-00794-z.

Egypt declared malaria free

Egypt has been certified malaria free by the World Health Organization (WHO), marking a significant public health milestone for the nation of over 100 million people.

THIS ACHIEVEMENT IS the culmination of nearly a century of efforts by the Egyptian government and its citizens to eradicate a disease that has plagued the country since ancient times. WHO director-general Dr Tedros Adhanom Ghebreyesus praised this historic certification, highlighting Egypt's commitment to eliminating malaria and inspiring other countries in the region.

Egypt is the third country in the WHO Eastern Mediterranean Region to receive this certification, following the United Arab Emirates and Morocco, and the first since 2010. Globally, 44 countries and one territory have achieved this status. Dr Khaled Abdel Ghaffar, Deputy Prime Minister of Egypt, emphasised that this certification marks the beginning of a new phase, requiring ongoing vigilance in surveillance, diagnosis, treatment, and vector management to maintain the malaria-free status.

Malaria's history in Egypt dates back to 4000 B.C.E., with evidence found in ancient mummies. Initial efforts to combat the disease began in the 1920s, including prohibiting rice cultivation near homes. By 1930, malaria was designated a notifiable disease, leading to the establishment of the first malaria control station. Despite a spike in cases during World War II, Egypt managed to control the outbreak through extensive health worker recruitment and treatment divisions.

The construction of the Aswan Dam in 1969 posed new malaria risks, prompting Egypt to collaborate with Sudan on vector control and public health surveillance. By 2001, malaria was under control, and the Ministry of Health focused on preventing local transmission. A small outbreak in 2014 was swiftly contained through effective measures. Today, malaria diagnosis and treatment are provided free to all residents, and health professionals are trained to detect cases nationwide, including at borders. Egypt's strong partnerships with neighbouring countries have been crucial in preventing the re-establishment of malaria transmission, leading to its official certification as malaria-free.

The certification process by WHO is rigorous and requires a country to prove, beyond reasonable doubt, that the chain of indigenous malaria transmission by Anopheles mosquitoes has been interrupted nationwide for at least the previous three consecutive years. Additionally, a country must demonstrate the capacity to prevent the re-establishment of transmission. This involves maintaining high standards for surveillance, diagnosis, treatment, and integrated vector management.

Egypt's journey to malaria elimination is a testament to the power of sustained public health efforts and international

collaboration. The country's success story serves as an inspiration to other nations still battling malaria. It underscores the importance of a robust health system, community engagement, and partnerships in achieving and maintaining disease elimination. The Egyptian government

remains committed to safeguarding the health of its people and enhancing its healthcare system to protect against future threats.

Although South Africa is considered an elimination candidate country, it has not made the expected progress towards being

declared malaria free. That requires three consecutive years with no local transmission of malaria. Local transmission continues in three provinces: Limpopo, Mpumalanga and KwaZulu-Natal.

References available on request.

The need-to-knows of norovirus

Adobestock, Credit: auntspray

Norovirus, commonly referred to as the stomach flu, is an acute form of gastroenteritis characterised by inflammation of the stomach or intestinal lining caused by a virus, bacteria, or parasite. In this instance, the causative agent is a virus.

THE SYMPTOMS OF norovirus infection are typically unmistakable and the virus is highly contagious, spreading easily through direct contact or shared food and drink. Consequently, if one member of a household contracts norovirus, it is highly probable that others will also become infected. Data from the Centers for Disease Control norovirus national dashboard shows the latest trends in the US.

SYMPTOMS OF NOROVIRUS INFECTION

The clinical presentation of norovirus infection ranges from mild discomfort to severe gastrointestinal distress, commonly including nausea, abdominal pain or tenderness, vomiting, and diarrhoea. In most cases, symptoms resolve spontaneously within a few days. Bloody diarrhoea or fever could be signs of another condition.

CONTAGIOUS NATURE OF NOROVIRUS

Outbreaks are common across various settings, with norovirus frequently causing gastroenteritis outbreaks in hospitals and other healthcare facilities. Besides healthcare environments, norovirus outbreaks can also occur in schools, military barracks, cruise ships, and resorts. While person-to-person transmission is the primary mode of spread, contaminated surfaces also play a significant role. Viral particles can contaminate surfaces through splashes from vomit or stool or via aerosolised particles. Studies indicate that washing hands with soap and running water for at least 20 seconds is the most effective way to remove norovirus. Surfaces like sinks, toilets, tables, chairs, and beds should be disinfected using a bleach (hypochlorite) solution, with sufficient contact time to ensure effectiveness.

MANAGEMENT OF NOROVIRUS INFECTION

Dehydration is a significant concern in

patients with norovirus, as maintaining adequate hydration can be challenging. Patients should be encouraged to stay hydrated with water or low-sugar electrolyte solutions. For children, electrolyte drinks or popsicles can be effective alternatives. The goal is to provide fluids in small, steady increments to avoid exacerbating vomiting. A few sips every five minutes is generally recommended. Some adults may find it helpful to take loperamide or bismuth subsalicylate to manage their symptoms.

Additional management tips:

• Encourage rest and adequate sleep

• Hydrate with water or electrolyte solutions. Energy drinks may be suitable for mild cases, but their sugar content can sometimes worsen symptoms

• Recommend easily digestible foods such as bananas, rice, applesauce, toast (BRAT diet), and plain mashed potatoes.

• Advise against heavy, fried foods, and rich sauces, as these can aggravate

gastrointestinal symptoms.

DATA FROM SA

In 2023, enteric virus activity peaked between April and August, coinciding with South Africa’s cooler months. Rotavirus was identified in 30% of samples, predominantly in children under five. Adenovirus was found in 15% of cases, also affecting younger children, while norovirus was detected in 10% of samples. These findings highlight the heightened vulnerability of young children to enteric infections and emphasise the need for targeted public health interventions to mitigate the impact.

Sources: Mayo Clinic, Ochsner Health. Das R, Haque MA, Kotloff KL, et al. Enteric viral pathogens and child growth among under-five children: findings from South Asia and sub-Saharan Africa. Sci Rep. 2024:15;14(1):13871. doi: 10.1038/s41598-02464374-0. Capece G, Gignac E. Norovirus. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513265/

MS care through patient-centred pathways

Multiple sclerosis (MS) is a complex and often debilitating condition that requires a multifaceted approach to care. Interprofessional collaboration is crucial in the management of MS-related symptoms, such as fatigue, cognitive impairment, and mental health issues like depression and anxiety.

AMAJOR ISSUE IN MS management

is that cognitive impairment is experienced by over 40% of MS patients. There is a notable gap between the symptoms reported by patients and the perceptions of neurologists, which can hinder effective symptom management. Barriers include healthcare providers’ limitations in conducting regular assessments and patients’ fears regarding the implications of cognitive testing.

Increasing awareness among both patients and providers about cognitive impairment is crucial. The use of cognitive assessment screening tools can help in early detection and management. Additionally, involving patients in their care planning can lead to better outcomes. Early intervention with disease-modifying therapies is a means to improve patient outcomes.

There are many challenges of managing cognitive symptoms in MS patients and there is a lack of patient education on cognitive impairment and medication options. Cognitive difficulties can affect all aspects of life, including job performance, highlighting the need for thorough symptom evaluation and treatment adjustments when needed. Quality of life issues for MS patients include the impact of invisible symptoms like fatigue and pain on daily life and mental health. These symptoms can significantly affect a patient's quality of life, making it essential to address them comprehensively. There should be shared decision-making in treatment planning, with collaborative discussions between patients and providers. This approach can enhance treatment adherence and satisfaction, leading to better overall outcomes.

Personalised treatment approaches consider disease activity, patient preferences, and treatment tolerability. By empowering patients with knowledge and involving them in their care decisions, healthcare providers can help improve the quality of life for individuals with MS.

Tools and resources aimed at improving patient knowledge and engagement in their care decisions include:

• Cognitive assessment screening tools (regular use of these screening tools can identify cognitive issues early, allowing for timely intervention and management)

• Educational materials

• Patient portals (where individuals can access their medical records, test results, and educational resources. These portals often include tools for tracking symptoms, medication adherence, and appointment scheduling)

• Support groups and community resources

• Mobile apps (to track symptoms, remind patients to take their medications, and provide educational content. Some apps also offer features for setting goals and monitoring progress)

• Decision aids (include charts, videos, and interactive online tools that present information in a clear and balanced way, helping patients make informed decisions about their care)

• Telehealth services

• Personalised care plans

• Interactive workshops and webinars

• Patient advocacy organisations.

CONCLUSION

In conclusion, delivering comprehensive MS care requires a patient-centred approach that addresses the multifaceted nature of

the disease. By focusing on interprofessional collaboration, early intervention, and patient engagement, healthcare providers can improve outcomes for individuals with MS.

Source: Prime: Everyday Health Group.

Health challenges faced by retired rugby players

Rugby is a sport renowned for its physical intensity and high injury rates. While the thrill of the game captivates many, the long-term health consequences for players, particularly after retirement, are often overlooked.

LE ROUX et al the health challenges faced by retired professional male rugby players, focusing on pain, impairment, medication use, and healthrelated quality of life compared to non-elite sports controls. The insights are drawn from a recent study that sheds light on the unique health issues these athletes encounter post-career.

THE PHYSICAL TOLL OF RUGBY

Rugby, by its very nature, is a physically demanding sport. The frequent collisions, tackles, and high-impact activities contribute to a high injury rate among players. These injuries often lead to chronic pain and other long-term health issues, which persist even after players hang up their boots. The study in question involved 142 retired male rugby players and 49 matched controls, aiming to assess joint pain, health-related quality of life, and medication usage through comprehensive questionnaires.

JOINT PAIN AND IMPAIRMENT

One of the most significant findings of the study is the high prevalence of joint pain and impairment among retired rugby players. A substantial portion of these players, ranging from 51% to 60%, suffer from osteoarthritis, with joint pain being a common complaint. The study revealed that retired rugby players reported significantly higher levels of joint pain and impairment in daily activities compared to the control group. Specifically, retired players had a mean joint impairment score of 1.2, whereas the controls had a score of 0.7. This indicates that the physical demands of rugby have a lasting impact on joint health, leading to chronic pain and reduced mobility.

HEALTH-RELATED QUALITY OF LIFE

The study utilised the PROMIS-GH tool to assess the health-related quality of life of the participants. The results indicated that retired rugby players had lower scores in both global physical health and global mental health compared to the control group. The mean global mental health score for retired players was 13.63, while the controls had a mean score of 14.71. This suggests that the physical toll of rugby extends beyond joint pain, affecting the overall well-being of retired players.

MEDICATION USAGE

Despite the high levels of pain reported by retired rugby players, the study found that a majority of them did not rely heavily on medication for pain management. Specifically, 75% of retired players did not use prescription pain medication, and

56% did not use over-the-counter pain medication. This raises questions about the adequacy of pain management strategies available to retired players and highlights the need for better support systems to address their pain and discomfort.

MENTAL HEALTH CHALLENGES

In addition to physical pain, the study also highlighted the mental health challenges faced by retired rugby players. Symptoms of depression and anxiety were prevalent among the participants, indicating a need for better mental health support. The study found weak correlations between joint pain and both global physical health (negative correlation) and global mental health (positive correlation). This suggests that while joint pain negatively impacts physical health, it also has a complex relationship with mental health, potentially exacerbating symptoms of depression and anxiety.

THE NEED FOR TAILORED SUPPORT

The findings of the study emphsise the unique challenges faced by retired rugby

players and the need for tailored support and resources to address their specific health issues post-career.

The high prevalence of joint pain, impairment, and mental health challenges among retired players calls for a comprehensive approach to after-care support. This includes not only physical rehabilitation and pain management strategies but also mental health support to help players cope with the psychological impact of their injuries and the transition to life after rugby.

FUTURE RESEARCH DIRECTIONS

The study highlights the importance of further research to explore the long-term mental and physical health challenges faced by retired rugby players.

This includes investigating pain management strategies, the effectiveness of different rehabilitation approaches, and the experiences of retired players. Qualitative studies are particularly valuable in capturing the perspectives of retired players, providing insights into their lived

experiences and the challenges they face post-career.

CONCLUSION

The research article provides a comprehensive analysis of the health challenges faced by retired professional male rugby players.

The findings highlight the significant impact of a professional rugby career on joint health and overall well-being, highlighting the need for improved aftercare support to enhance the quality of life for retired players. As the sport continues to grow in popularity, it is crucial to address the long-term health consequences for players and ensure that they receive the support and resources they need to lead healthy and fulfilling lives post-retirement.

REFERENCE Le Roux, J., Janse van Rensburg, C., Den Hollander, et al Pain, impairment, medication use and healthrelated quality of life of retired professional rugby players. South African Journal of Sports Medicine 2024:36(1). https://doi.org/10.17159/2078-

Johan le Roux is a researcher, registered clinical psychologist and multi-award winning rugby broadcaster. His recent presentation at the South African Sports Medicine Association congress covered several critical topics that are highly relevant to our current healthcare landscape. Below, we delve into the main points discussed during the presentation.

1. Advances in Medical Technology: One of the key areas of focus was the rapid advancement in medical technology. Le Roux discussed several cutting-edge technologies that are transforming patient care, including:

• Telemedicine: The rise of telemedicine has made healthcare more accessible, especially in remote areas. Le Roux highlighted the benefits of telemedicine in improving patient outcomes and reducing healthcare costs.

• Artificial intelligence (AI): AI is playing an increasingly important role in diagnostics and treatment planning. Le Roux provided examples of how AI is being used to analyse medical images and predict patient outcomes.

• Wearable devices: The use of wearable devices for monitoring patient health was another significant topic. Le Roux discussed how these devices are helping in the early detection of diseases and in managing chronic conditions.

3. Patient-Centred Care: Le Roux emphasised the importance of patient-centred care, where the focus is on providing care that is respectful of, and responsive to, individual patient preferences, needs, and values. He discussed several strategies to enhance patientcentred care, including:

• Shared decision making: Encouraging patients to be active participants in their care decisions.

• Personalised medicine: Tailoring medical treatment to the individual characteristics of each patient.

• Patient education: Providing patients with the information they need to make informed decisions about their health.

4. Challenges in healthcare: The presentation also addressed several challenges facing the healthcare industry, such as:

• Healthcare costs: Rising healthcare costs are a significant concern. Le Roux discussed various strategies to manage and reduce costs without compromising the quality of care.

• Workforce shortages: The shortage of healthcare professionals is another critical issue. Le Roux highlighted the need for better workforce planning and the use of technology to alleviate some of the burdens on healthcare workers.

• Regulatory and compliance issues: Navigating the complex regulatory environment is a challenge for healthcare providers. Le Roux discussed the importance of staying compliant with regulations to avoid penalties and ensure patient safety.

5. Future trends: Le Roux concluded the presentation by discussing future trends in healthcare. He predicted that the integration of technology and healthcare will continue to grow, leading to more efficient and effective patient care. He also emphasised the importance of continuous learning and adaptation in the ever-evolving healthcare landscape.

CONCLUSION

By embracing new technologies, focusing on patient-centred care, and addressing the challenges head-on, the healthcare industry can continue to improve and provide better outcomes for patients.

KEY INSIGHTS FROM LE ROUX'S PRESENTATION AT SASMA

Diclofenac potassium 50 mg

K-Fenak OTC contains diclofenac potassium, which dissolves and absorbs faster than diclofenac sodium.2

INDICATIONS1

For the treatment of fever or mild to moderate pain of inflammatory origin, for a maximum treatment period of 5 days.

The emergency treatment of acute gout attacks, for a maximum treatment period of 3 days.

Anti-Inflammatory1

Pain, Swelling & Inflammation1

S2 Reg. No. A38/3.1/0651. K-Fenak OTC. Each film-coated tablet contains Diclofenac potassium 50 mg. For full prescribing information, refer to the Professional Information approved by the medicines regulatory authority.

References:

1. Professional Information: K-Fenak OTC (Film-coated tablets).

2.Chuasuwan, B. et al. Biowaiver monographs for immediate release solid oral dosage forms: Diclofenac sodium and diclofenac potassium. Journal of Pharmaceutical Sciences 98(4) 1206–1219 (2009).

CIPLA MEDPRO (PTY) LTD. Co. Reg. No. 1995/004182/07. Building 9, Parc du Cap, Mispel Street, Bellville, 7530, RSA. Website: www.cipla.co.za. Customer Care: 080 222 6662. [1453996205]

EADV Congress highlights advances in skin care

Dermatologists from around the globe gathered for the 33rd European Academy of Dermatology and Venereology (EADV) Congress, held in Amsterdam from 25-28 September 2024. This prestigious event provided an extraordinary platform for dermatologists to engage with the latest scientific research and best practices.

OVER THE FOUR-DAY congress, more than 17 000 delegates participated in an extensive programme featuring over 180 sessions, including lectures, workshops, and poster presentations. Topics ranged from updates on atopic dermatitis and acne management to anti-aging and prevention of skin cancers, reflecting EADV’s commitment to ongoing learning and evidence-based practice.

ATOPIC DERMATITIS MANAGEMENT

Academic presentations on atopic dermatitis highlighted the efficacy of newer, targeted small molecule and biologic treatments, such as Dupilumab, and Janus kinase (JAK) inhibitors, for managing moderate to severe cases. These advanced therapies are critical for patients resistant to standard topical and immunosuppressive treatments, emphasising the need to incorporate innovative therapeutic options into clinical dermatology practice. Effective moisturisation remains the cornerstone of daily at-home management for atopic dermatitis at all severity levels. Clinical studies indicate that colloidal oatmeal-based moisturisers have antiinflammatory and antioxidant effects, achieved through the inhibition of reactive oxygen species (ROS) and pro-inflammatory cytokines, including IL-6, IL-8 and TNFalpha. Furthermore, colloidal oatmeal enhances ceramide production and acts as a probiotic, thus supporting the skin barrier and microbiome – key factors in maintaining skin health for individuals with atopic dermatitis.

ACNE MANAGEMENT

In managing acne, particularly concerning skin of colour, it is essential to address both active inflammatory lesions as well as post acne dyspigmentation and scarring simultaneously. A forth generation retinoid, Trifarotene, has recently been approved for use from age nine years. This retinoid is highly specific for skin RAR-γ receptors.

The mechanism of barrier dysfunction in acne was well elucidated leading to an improved understanding of the importance of moisturisers in acne prone skin. Clinical studies underscore the importance of hydrating, barrier-supporting ingredients, in maintaining skin hydration while minimising irritation during acne treatment.

Retinoids promote epidermal cell turnover, prevent follicular occlusion and decrease inflammation in acne, thereby reducing the risk of subsequent scarring. While retinoids are more potent, retinol is often better tolerated and still offers significant benefits in improving skin tone and texture over time.

PHOTOPROTECTION

Incorporatingretinoids can enhance theefficacyof sunscreens,mitigating photodamageand improvingskintexture

Photoprotection using broad-spectrum sunscreen remains a cornerstone of antiageing practice. Ultraviolet (UV) radiation is a documented risk factor and accelerant of extrinsic ageing. Research has shown that daily use of broad-spectrum sunscreens significantly reduces the signs of ageing. Moreover, incorporating retinoids (including retinol) can enhance the efficacy of sunscreens, mitigating photodamage and improving skin texture over time.

KENVUE/NEUTROGENA/AVEENO

During the congress, the Kenvue booth showcased an impressive array of products from Neutrogena and Aveeno. Engaging presentations highlighted the efficacy of various formulations, focusing on the science behind their skin care solutions. Interactive demonstrations showered the

mechanisms of action of star ingredients. Neutrogena’s focus on using innovative technology to enhance skin health was evident, with presentations discussing the role of hyaluronic acid and retinol in hydration and anti-ageing respectively. Meanwhile, Aveeno highlighted the effectiveness of colloidal oatmeal in aiding to soothe and protect the skin, particularly for patients with eczema-prone and sensitive skin.

CONCLUSION

The EADV Congress 2024 was a remarkable gathering that underscored the dynamic and evolving nature of dermatological science. The wealth of knowledge shared throughout the event highlighted advancements in the management of various skin conditions.

Dr Zena Malinga – dermatologist

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Reducing allergic sensitisation in atopic dermatitis

Atopic dermatitis (AD), commonly known as eczema, is a chronic pruritic inflammatory skin disease that predominantly affects children but can also be seen in adults. The prevalence of AD is increasing, affecting 5%-20% of the population, with 20%-30% of children being affected. This condition imposes a significant burden on healthcare resources worldwide and severely impacts the quality of life.

PROF CLAUDIA GRAY, paediatrician and allergologist: Vincent Pallotti Hospital and Red Cross Children’s Hospital Allergy and Asthma Department, recently presented on this topic. This article is based on her presentation.

THE ALLERGIC MARCH

AD is often the first step in the allergic march, preceding food allergies and respiratory allergy manifestations. The manifestations of AD include severe itching, poor sleep, chronic illness, and failure to thrive. Physical consequences include infections, food allergies, and respiratory allergies, while emotional consequences can include depression, isolation, anxiety, ADHD, and ASD.

CAUSES OF ECZEMA

The causes of eczema are multifactorial and include:

1. Skin barrier (epithelial) abnormalities, both genetic and environmental.

2. Defects in the innate immune response, with a Th2-skewed adaptive immune response.

3. Aberrant skin microbial community, with increased Staphylococcus aureus and reduced diversity.

4. Neuroimmune dysregulation.

EXACERBATING FACTORS

Eczema can be exacerbated by various environmental stimuli, including exposure to food and inhalant allergens, irritants (sweat, saliva, chlorine, microplastics, detergents, harsh soaps), changes in the physical environment (pollution, heat, humidity), microbial infections, stress, and trauma from scratching. This leads to the release of pro-inflammatory mediators and perpetuates the 'itch-scratch' cycle.

THE SKIN BARRIER IN HEALTH AND DISEASE

The epidermis is the first line of defense between the body and the environment, preventing the entry of environmental irritants, allergens, and microbes, and preventing excessive water loss. The permeability of the epidermis is determined by interactions between terminally differentiated keratinocytes, structural proteins, regulatory enzymes, and lipids

such as ceramides. Tight junctions in the stratum granulosum also play a crucial role.

SKIN BARRIER DEFECTS IN ECZEMA

In eczema, there is a decrease in ceramide levels and an increase in transcutaneous water loss, which can be detected in the first few days of life in infants who develop eczema by 12 months of age. This leads to localised immune activation, skin inflammation, and a dysregulated response to environmental allergens.

THE ROLE OF THE SKIN MICROBIOME

The skin hosts trillions of microorganisms, and the key to a healthy skin microbiome is the balance and diversity of these microorganisms. In eczema, there is often an overgrowth of harmful bacteria like Staphylococcus aureus, which can exacerbate the condition.

ITCH MEDIATION IN AD

Itching in AD is mediated by the aggravation of keratinocytes, which release thymic stromal lymphopoietin (TSLP) and activate a Th2-mediated response. This activates the TRPV1 receptor on sensory neurons, leading to the sensation of itch and the urge to scratch.

EVIDENCE FOR SKIN AS AN ENTRY POINT FOR ALLERGENS

There is mounting evidence that a defective skin barrier can lead to the development of sensitisation to food and aeroallergens via the epicutaneous route. This can subsequently lead to food allergies and allergic respiratory diseases. Studies have shown that the use of topical creams containing peanut oil for nappy rashes increases the risk of peanut allergy, and higher environmental peanut allergen levels in households increase the risk of peanut sensitisation and allergy in high-risk infants.

PREVENTION OF ECZEMA WITH EMOLLIENTS

Initial pilot studies have shown that the daily use of standard emollients from the first few weeks of life can reduce the risk of developing AD by 40%-50%. Larger trials have shown mixed results, but emollients containing ceramides have shown promise in reducing AD. Regular use of emollients

can also reduce AD flares, prolong the time to flare, improve dryness, reduce steroid use, and reduce itching.

STUDIES ON THE PREVENTION OF ECZEMA WITH EMOLLIENTS

1. Horimukai and Simpson Studies (2014): These initial pilot studies showed promising results, with a 40%-50% reduction in the incidence of atopic dermatitis in infants who were treated with daily standard emollients. The treatment was started within the first few weeks of life and continued until the infants were 6-8 months old. These studies highlighted the potential of early intervention with emollients in preventing the onset of AD.

2. Lowe et al. (Australia, 2018): The PEBBLES (Prevention of Eczema by a Barrier Lipid Equilibrium Strategy) pilot study conducted by Lowe and colleagues showed a similar reduction in eczema incidence. The study used a ceramiderich formula and found a promising trend towards a persistent decrease in atopic dermatitis at 12 months, six months after stopping the treatment. Additionally, there was a decrease in food sensitisation at 6 and 12 months. The study suggested that more frequent application of the emollient (twice daily, at least five days a week, starting from two weeks of age) yielded better effects.

3. BEEP (Barrier Enhancement for Eczema Prevention) Trial: This larger trial used a combination of ceramide, monoglyceride, and petroleum-based emollients. However, it did not show a significant benefit in preventing atopic dermatitis. The study highlighted the need for further research to identify the most effective emollient formulations and application strategies.

4. PreventADALL (Preventing Atopic Dermatitis and Allergies in Children) Study: This study used petroleum-based emollients and found no significant benefit in preventing atopic dermatitis. Additionally, there was an increased infection rate among the participants. The study underscored the importance of selecting the right emollient formulation and the correct containers to minimise the chance of emollient contamination, to

achieve the desired preventive effects.

5. Cochrane Review: A Cochrane review concluded that topical active treatments combined with moisturisers were more effective than topical active treatments alone in the management of eczema. Regular use of emollients was associated with fewer flares, prolonged time to flare, improved dryness, reduced steroid use, and reduced itching. Specific emollients, such as those containing glycerol and oats, showed significant benefits in reducing the severity and frequency of eczema flares.

THE IDEAL EMOLLIENT

An ideal emollient should provide an occlusive barrier for the skin, help the skin retain moisture, contain an emollient, be free from irritants and sensitisers, and promote patient compliance. Bonus components like ceramides, anti-itch, and anti-microbial properties can enhance the effectiveness of the emollient.

AN ODE TO OATS

Oats have been used for thousands of years for their skin-soothing properties. Colloidal oatmeal, oat oils, and avenanthramides are the main components of oats that provide these benefits.

Colloidal oatmeal forms an occlusive barrier, has water-binding properties, and contains phenolic compounds that inhibit inflammation and reduce itch. Oat oil contain linoleic acid, a vital component of ceramides, and essential fatty acids that activate PPAR receptors, increasing epidermal lipid production and expediting barrier and wound healing. Avenanthramides have potent anti-inflammatory and antioxidant effects, reducing neurogenic inflammation and itch.

CONCLUSION

Closing the skin barrier gap in atopic dermatitis is crucial to reducing allergic sensitisation. Regular use of emollients, especially those containing ceramides and oats, can help prevent and manage AD, reducing the risk of developing other allergic diseases. Further research is ongoing to determine the best strategies for preventing and managing AD and its associated conditions.

CLINICAL | GASTROENTEROLOGY

Colonoscopy screening for older adults: balancing benefits and risks

Colonoscopy remains the primary method for detecting colorectal cancer (CRC) and removing precancerous polyps.

CURRENT GUIDELINES IN the United States recommend CRC screening for individuals aged 45 to 75, as evidence suggests that the benefits of colonoscopy significantly decline beyond this age.

The increased risk of complications in older adults is a key consideration when deciding on continued screening. Bowel preparation may lead to dehydration or electrolyte imbalances, while the procedure itself carries risks of bleeding, bowel perforation, and, in the postoperative period, pulmonary or cardiovascular events. In many cases, these risks outweigh the potential benefits of detecting a precancerous lesion, given the lower rates of advanced neoplasia and CRC detected in individuals over 75. Despite this, more than half of older adults continue to receive colonoscopies for screening and surveillance beyond the recommended age range.

The question of whether there is an age at which colonoscopy should be discontinued is complex. Dr Michael Rothberg, vice chair for research at Cleveland Clinic’s Medical Institute, suggests that life expectancy is a critical factor. “Taking the most extreme example, if you have six months to live, finding earlystage cancer is not going to help you,” he noted. For those with a longer life expectancy, the decision to continue screening is nuanced. The US Preventive

Services Task Force recommends selective screening for adults aged 76 to 85 based on individual health status, and the American Gastroenterological Association advises assessing the risks and benefits of both initial screening and post-polypectomy surveillance for this age group. For older adults without significant comorbidities, screening may be reasonable up to age 80 for men and 90 for women, while individuals with severe comorbidities and shorter life expectancies might discontinue screening sooner.

DECIDING WHEN TO DISCONTINUE COLONOSCOPY SCREENING

Research indicates that a significant number of older adults continue to undergo screening colonoscopies even when life expectancy is limited. A 2023 study in JAMA Internal Medicine found that 30% of individuals aged 76-80 with a life expectancy of less than 10 years received colonoscopies, and the percentage rose in older age groups. However, the benefit in terms of CRC detection was modest, with a small percentage of patients diagnosed with advanced neoplasia, and only 0.2% diagnosed with CRC. Conversely, adverse events were frequent, with hospitalisation rates increasing with age.

Dr Rothberg notes that life expectancy can guide whether patients should continue

screening or receive treatment if CRC is diagnosed. For patients aged 76-80 in relatively good health, screening and potentially treatment might be beneficial. However, comorbidities can also guide this decision, especially in cases where life expectancy is uncertain.

THE ROLE OF SURVEILLANCE COLONOSCOPY

Surveillance colonoscopy after polyp removal is commonly recommended to lower CRC risk, but its benefits for adults over 75 are less clear. Evidence shows that older adults with a history of small adenomas have only a slightly elevated risk of developing CRC. Recent studies found low rates of CRC detection in surveillance colonoscopies, suggesting that the risk of CRC may be outweighed by procedural risks in older patients, especially those with comorbidities or limited life expectancy.

Dr Samir Gupta, a professor of gastroenterology at the University of California San Diego, points out that older adults should carefully consider whether to continue surveillance colonoscopy. He emphasises the importance of balancing the patient’s cumulative CRC risk against competing health risks.

COMMUNICATION AND DECISIONMAKING IN OLDER ADULTS

When discussing the discontinuation

of screening with older patients, communication is key. Dr Audrey Calderwood, MD, director of the Comprehensive Gastroenterology Center at Dartmouth Hitchcock Medical Center, highlights the importance of reassessing patients’ needs as they age. Primary care providers should have open lines of communication with gastroenterologists to make informed decisions based on current patient health, rather than adhering strictly to recommendations from years earlier.

Although some patients may be receptive to stopping screening, others may be hesitant. Dr Rothberg suggests a gentle approach, encouraging clinicians to steer patients toward less invasive options when appropriate and emphasising other health priorities.

This approach can help ensure that patients feel supported in their care, even when screening is no longer recommended. Ultimately, the decision to continue or discontinue colonoscopy in older adults should be individualised, factoring in life expectancy, comorbidities, and patient preference. Clear, compassionate communication can support patients in making informed decisions that align with their health goals and expectations.

Source: Medscape.

For adult patients with type 2 diabetes1,2

PROVEN GLYCAEMIC CONTROL*2-4

PROVEN CV RISK REDUCTION † 3-5

PROVEN WEIGHT LOSS ǂ3,4

February 2023. 2. Rodbard HW, Lingvay I, Reed J, et al. Semaglutide Added to Basal Insulin in Type 2 Diabetes (SUSTAIN 5): A Randomized, Controlled Trial. J Clin Endocrinol Metab 2018;103(6):2291-2301. 3. Lingvay I, Catarig AM, Frías JP, et al. Efficacy and safety of once-weekly semaglutide versus daily canagliflozin as add-on to metformin in patients with type 2 diabetes (SUSTAIN 8): a double-blind, phase 3b, randomised controlled trial. Lancet Diabetes Endocrinol 2019;7(11):834-844. 4. Capehorn MS, Catarig AM, Furberg JK, et al Efficacy and safety of once-weekly semaglutide 1.0 mg vs once-daily liraglutide 1.2 mg as add-on to 1-3 oral antidiabetic drugs in subjects with type 2 diabetes (SUSTAIN 10). Diabetes Metab 2020;46(2):100-109. 5. Marso SP, Bain SC, Consoli A, et al. SUSTAIN-6 Investigators. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016;375(19):1834-1844. 6. Davies MJ, Aroda VR, Collins BS, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2022;45(11):2753-2786.

Abbreviated Professional Information

Scheduling status: S4 Name of the medicine: Ozempic® Qualitative and quantitative composition: Semaglutide 1,34 mg/ml. Therapeutic indication: Ozempic® is indicated: a) for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise • as monotherapy when metformin is considered inappropriate due to intolerance or contraindications. • as combination therapy with oral anti-diabetic medicines (metformin, thiazolidinediones, sulphonylurea), basal insulin with or without metformin and pre-mix insulin. b) to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease. Posology and method of administration: Ozempic® starting dose is 0,25 mg once weekly. After 4 weeks, the dose should be increased to 0,5 mg once weekly. After at least 4 weeks with a dose of 0,5 mg once weekly, the dose can be increased to 1 mg once weekly to further improve glycaemic control. Ozempic® is to be administered once weekly at any time of the day, with or without meals. Ozempic® is to be injected subcutaneously in the abdomen, in the thigh or in the upper arm. The injection site can be changed without dose adjustment. Ozempic® should not be administered intravenously or intramuscularly. The day of weekly administration can be changed if necessary as long as the time between two doses is at least 2 days (>48 hours). When Ozempic® is added to existing sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy, the current dose of SGLT2 inhibitor can be continued unchanged. Contraindications: Hypersensitivity to semaglutide or to any of the excipients, a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), pregnancy and lactation. Special warnings and precautions for use: Ozempic® should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Ozempic® is not a substitute for insulin. Acute pancreatitis has been observed with the use of Ozempic®. Patients should be informed of the characteristic symptoms of acute pancreatitis. If pancreatitis is suspected, Ozempic® should be discontinued; if confirmed, Ozempic® should not be restarted. Patients treated with Ozempic® in combination with a sulfonylurea or insulin may have an increased risk of hypoglycaemia. The risk of hypoglycaemia can be lowered by reducing the dose of sulfonylurea or insulin when initiating treatment with Ozempic®. Risk of Thyroid C-cell Tumours: Cases of MTC in patients treated with liraglutide, another GLP-1 receptor agonist have been reported in the post marketing period; the data in these reports are insufficient to establish or exclude a causal relationship between MTC and GLP-1 receptor agonist use in humans. Interaction with other medicines and other forms of interaction: In vitro studies have shown very low potential for Ozempic® to inhibit or induce CYP enzymes and to inhibit drug transporters. The delay of gastric emptying with Ozempic® may influence the absorption of concomitantly administered oral medicines. The potential effect of Ozempic® on the absorption of co-administered oral medicines was studied in trials at Ozempic® 1 mg steady state exposure. Fertility, pregnancy and lactation: Ozempic® is contraindicated during pregnancy and lactation. Undesirable effects: The most frequently reported adverse reactions with Ozempic® in clinical trials were gastrointestinal disorders, including nausea, diarrhoea and vomiting. Adverse reactions by system organ class and absolute frequencies identified in all phase 3a trials listed here as Very common (≥1/10): Hypoglycaemia when used with insulin or sulfonylurea, nausea, diarrhoea; Common (≥1/100 to <1/10): Hypoglycaemia when used with other OADs, decreased appetite, dizziness, diabetic retinopathy complications, vomiting, abdominal pain, abdominal distension, constipation, dyspepsia, gastritis, gastrooesophageal reflux disease, eructation, flatulence, cholelithiasis, fatigue, increased lipase, increased amylase, weight decreased; Uncommon (≥1/1,000 to <1/100): hypersensitivity, dysgeusia, increased heart rate, injection site reactions, hypersensitivity, acute pancreatitis; Rare (≥1/10,000 to <1/1,000): anaphylactic reaction.Frequency unknown: angioedema. Overdose: There is no specific antidote for overdose with Ozempic®. In the event of overdose, appropriate supportive treatment should be initiated according to the patient’s clinical signs and symptoms. A prolonged period of observation and treatment for these symptoms may be necessary, taking into account the long half-life of Ozempic® of approximately 1 week. Reg. No.: 53/21.13/0497. For full prescribing information, refer to the Professional Information approved by the Medicines Regulatory Authority.

Nordisk (Pty) Ltd. Reg. No.: 1959/000833/07. 150 Rivonia Road, 10 Marion Street Office Park, Building C1, Sandton, Johannesburg, 2196, South Africa. Tel: (011) 202 0500. Fax: (011) 807

A AI tackles antimicrobial resistance in ICUs

Artificial intelligence (AI) can provide same-day assessments of antimicrobial resistance for patients in intensive care – critical to preventing life-threatening sepsis.

NTIMICROBIAL RESISTANCE, the process of microorganisms developing defences against treatment, poses a huge challenge to healthcare around the world. It is estimated to cause 1.2 million deaths globally and cost the NHS at least £180 million per year.1

Infections in the bloodstream can become resistant to antibiotics and lead to the life-threatening condition, sepsis. Once the infection has reached a stage of sepsis there is a high probability that patients will rapidly develop organ failure, shock, and even death.

Some patients have more antimicrobial resistance than others, due to previous exposure to antibiotics, their genetics and even diet, which can alter their microbiome.

Now, scientists are harnessing the power of AI to assess the antimicrobial resistance of patients in intensive care units (ICUs) and identify sepsis-causing bloodstream infections. Researchers from across Kings College London’s Faculty of Life Sciences & Medicine and clinicians at Guy’s and St Thomas’ NHS Foundation Trust have collaborated in this interdisciplinary study – which they hope will help to improve outcomes of critically ill patients.

Making significant steps forward in this

field, the team showed how AI and machine learning can provide same-day triaging for patients in ICU, particularly in environments with limited resources. The technology is also much more cost-effective than manual testing. Current assessments of ICU patients are time consuming and require lengthy laboratory tests, requiring bacteria to be cultured in a laboratory, taking up to five days. This can have a huge impact on care outcomes, especially given the fragility of ICU patients, who may be suffering from life-threatening illnesses.

Having access to this information sooner would enable clinicians to make quicker, more informed decisions, on care – including whether to use antibiotics. Proper use of antibiotics has a strong relationship with positive patient outcomes.

First author Davide Ferrari, King’s College London, said: “Our study provides further evidence on the benefits of AI in healthcare, this time relating to the crucial issues of antimicrobial resistance and bloodstream infections. It comes at an important time, as the NHS is investing in shared data resources, helping to make patient care more collaborative and efficient.

“Our use of machine learning provides a new way of tackling the important clinical

issue of antimicrobial resistance. We hope that the AI will provide a useful tool for clinicians in making important decisions, particularly in relation to ICU.”

Dr Lindsey Edwards, expert in microbiology at King’s College London added: “An important way to tackle the grave threat of antimicrobial resistance is to protect the antibiotics we already have, which goes hand in hand with the urgent need for fast diagnostics. Often patients with a drug-resistant infection will present to ICU in a critical condition and may not survive long enough for the current gold standards of diagnostics to determine what they are infected with. So, clinicians are faced with a difficult situation where they must prescribe ‘in a blinded fashion’ a broad-spectrum antibiotic to save the patient. “However, this will also kill many of the beneficial microbes in the patient’s microbiome, without killing the harmful pathogen. It could even make the pathogen more resistant to the drug.

“The findings of this study are incredibly promising as using AI to speed up the diagnostics of infection to allow for prescription of the correct antibiotic could not only have a huge impact on the patient’s survival and their

care outcomes; but could help to preserve the antibiotics we already have developed and prevent the development of further antibiotic resistance.”

Data from 1 142 patients at Guy’s and St Thomas’ NHS Foundation Trust were used in this study, which has paved the way for further ongoing research using datasets of more than 20 000 individuals. It is hoped that a more advanced approach to this study, particular within a multi-hospital setting through the popular technology of Federated Machine Learning, could fulfil the regulatory requirements for an actual deployment of this AI approach in the front line of the NHS.

Prof Yanzhong Wang, expert in population health at King's College London, added: "The simplicity and scalability of this innovative machine learning approach indicate its potential for widespread implementation, offering a robust solution to address these critical healthcare issues on a larger scale and ultimately improve patient outcomes.

1. According to Gov.uk (www.gov.uk/ government/publications/uk-5-yearaction-plan-for-antimicrobial-resistance2024-to-2029/confronting-antimicrobialresistance-2024-to-2029).

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Experience the freedom* with a 2-in-1 insulin co-formulation providing basal and mealtime control1-5

Targets both FPG and PPG for HbA1c control1,3,6,7

Ryzodeg®

Once-

ability to concentrate and react may be impaired as a result of hypoglycaemia. Patients must be advised to take precautions to avoid hypoglycaemia while driving or operating machinery. Hyperglycaemia: Ryzodeg® should not be used to treat severe hyperglycaemia. Inadequate dosing and/or discontinuation of treatment in patients requiring insulin may lead to hyperglycaemia and potentially to diabetic ketoacidosis, which is potentially lethal. Concomitant illness, especially infections, may lead to hyperglycaemia and thereby cause an increased insulin requirement. Transferring to a new type, brand, or manufacturer of insulin must be done under strict medical supervision. Interactions: When using Ryzodeg® in combination with thiazolidinediones, patients should be observed for signs and symptoms of congestive heart failure, weight gain and oedema. Thiazolidinediones should be discontinued if any deterioration in cardiac function occurs. The following substances may reduce the insulin requirement: Oral antidiabetic medicines, glucagon-like peptide-1 (GLP-1) receptor agonists, monoamine oxidase inhibitors (MAOI), beta-blockers, angiotensin converting enzyme (ACE) inhibitors, salicylates, anabolic steroids and sulphonamides. The following substances may increase the insulin requirement: oral contraceptive, thiazides, glucocorticoids, thyroid hormones, sympathomimetics, growth hormones and danazol. Beta-blocking medicines may mask the symptoms of hypoglycaemia and may reduce the body’s response to hypoglycaemia. Octreotide and lanreotide may either increase or decrease the insulin requirement. Alcohol may intensify or reduce the hypoglycaemic effect of insulin. Insulin antibodies: Ryzodeg® administration may cause insulin antibodies to form. In rare cases, the presence of such insulin antibodies may necessitate adjustment of the insulin dose to correct a tendency to hyper- or hypoglycaemia. Immediate-type allergic reactions to either insulin itself or the excipients may potentially be life threatening. Skin and subcutaneous tissue disorders: Injection site reactions may occur. Patients must be instructed to perform continuous rotation of the injection site to reduce the risk of developing lipodystrophy (including lipohypertrophy, lipoatrophy) and cutaneous amyloidosis. There is a potential risk of delayed insulin absorption and worsened glycaemic control following insulin injections at sites with these reactions. A sudden change in the injection site to an unaffected area has been reported to result in hypoglycaemia. Blood glucose monitoring is recommended after the change in the injection site from an affected to an unaffected area, and dose adjustment of antidiabetic medications may be considered. In children, extra care should be taken to match insulin doses with food intake and physical activities to minimise the risk of hypoglycaemia. Paediatric population: Ryzodeg® may be associated with higher occurrence of severe hypoglycaemia compared to a basal-bolus regimen in the paediatric population, particularly in children 2 to 5 years old. For this age group, Ryzodeg® should be considered on an individual basis. Insulin initiation and glucose control intensification: Intensification or rapid improvement in glucose control has been associated with transitory, reversible ophthalmologic refraction disorder, worsening of diabetic retinopathy, and acute painful peripheral neuropathy. However, long-term glycaemic control decreases the risk of diabetic retinopathy and neuropathy. Fertility, pregnancy and lactation: Safety has not been established in pregnancy and lactation and Ryzodeg® should not be recommended for use during pregnancy. Posology and administration: Ryzodeg® can be administered once- or twice-daily with the main meal(s). When needed, the patient can change the time of administration, if Ryzodeg® is dosed with a main meal. The potency of insulin analogues, including Ryzodeg®, is expressed in units (U). 1 unit (U) Ryzodeg® corresponds to 1 international unit (IU) of human insulin and one unit of all other insulin analogues. In patients with type 2 diabetes mellitus, Ryzodeg® can be combined with oral anti-diabetic products approved for use with insulin, with or without bolus insulin. When using Ryzodeg® once-daily, it is recommended to consider changing to twice-daily when reaching 60 units. Split the dose based on individual patient’s needs and administer with main meals. In type 1 diabetes mellitus, Ryzodeg® is combined with short-/rapid-acting insulin at the remaining meals. Ryzodeg® is to be dosed in accordance with individual patients’ needs. Dose-adjustments are recommended to be primarily based on pre-breakfast glucose measurements. An adjustment of dose may be necessary if patients undertake increased physical activity, change their usual diet or during concomitant illness. Initiation: For patients with type 2 diabetes mellitus, the recommended total daily starting dose of Ryzodeg® is 10 units once daily with meal(s) followed by individual dosage adjustments. For patients with type 1 diabetes mellitus, Ryzodeg® is to be used once-daily at a mealtime and a short-/rapid-acting insulin should be used at the remaining meals with individual dosage adjustments. The recommended starting dose of Ryzodeg® is 60 - 70 % of the total daily insulin requirements. Transfer from other insulin medicines: Close glucose monitoring is recommended during transfer and in the following weeks. Patients with type 2 diabetes: Patients switching from once-daily basal or premix insulin therapy can be converted unit-to-unit to once- or twice-daily Ryzodeg® at the same total insulin dose as the patient’s previous total daily insulin dose. Patients switching from more than once-daily basal or premix insulin therapy can be converted unit-to-unit to once- or twice-daily Ryzodeg® at the same total insulin dose as the patient’s previous total daily insulin dose. Patients switching from basal/bolus insulin therapy to Ryzodeg® will need to convert their dose based on individual needs. In general, patients are initiated on the same number of basal units. Doses and timing of concomitant antidiabetic treatment may need to be adjusted. Patients with type 1 diabetes: For patients with type 1 diabetes mellitus, the recommended starting dose of Ryzodeg® is 60 - 70 % of the total daily insulin requirements in combination with short-/rapid-acting insulin at the remaining meals followed by individual dosage adjustments. Doses and timing of concurrent short-/rapid-acting insulin products may need to be adjusted. Flexibility: Ryzodeg® allows for flexibility in the timing of insulin administration if it is dosed with the main meal(s). If a dose of Ryzodeg® is missed, the patient can take the next dose with the next main meal of that day, and thereafter resume the usual dosing schedule. Patients should not take an extra dose to make up for

No cause for alarm regarding recent KwaZulu-Natal outbreak.

I Managing & preventing conjunctivitis

N LIGHT OF A recent notification from the KwaZulu-Natal Department of Health about an outbreak of conjunctivitis (pink eye) in certain areas, Netcare Medicross reassures healthcare providers that while public concern should be mitigated, understanding and disseminating accurate information about conjunctivitis is essential for effective prevention and management.

Conjunctivitis, commonly known as pink eye, involves inflammation of the conjunctiva, the thin membrane covering the sclera and lining the eyelids. General practitioner Dr Nishen Gounder of Netcare Medicross Malvern outlines the key information needed to support patient education and care.

AETIOLOGY AND PRESENTATION

• Viral conjunctivitis: Often associated with respiratory viruses, viral conjunctivitis is highly contagious, spreading via contact with infected eye secretions. Symptoms may begin in one eye and typically involve the other within 24-48 hours. Presentation includes redness, irritation, watery discharge, and a gritty sensation. While mild cases usually resolve within 1-2 weeks without treatment, patients who use

contact lenses should be promptly evaluated for potential corneal involvement.

• Bacterial conjunctivitis: Although slightly less transmissible than its viral counterpart, bacterial conjunctivitis remains highly contagious. It is characterized by a yellow, white, or green discharge, with patients frequently waking up with eyelids ‘stuck shut’ due to crusted discharge. Effective treatment includes prescribed topical antibiotics.

SYMPTOMS REQUIRING URGENT ATTENTION

Remain vigilant for symptoms that may indicate more severe pathology, including:

• Significant eye pain and tenderness

• Visual disturbances

• Photophobia or difficulty keeping the eyes open

• Severe headache accompanied by nausea.

PREVENTIVE AND TREATMENT RECOMMENDATIONS FOR CLINICAL PRACTICE

1. Encourage patients to seek prompt evaluation if conjunctivitis is suspected, and issue appropriate sick notes for those requiring school or work leave.

2. Reinforce hygiene education, emphasising thorough handwashing with soap or the use of alcohol-based sanitisers.

3. Advise patients to avoid close contact with affected individuals and refrain from sharing personal items (eg, towels, makeup).

4. Counsel patients exposed to conjunctivitis on preventive measures, including frequent handwashing and daily linen changes.

5. Recommend the immediate discontinuation of contact lens use at the onset of symptoms.

6. Direct patients to seek urgent evaluation for severe pain, vision changes, significant discharge, or marked redness.

7. Pay special attention to immunocompromised patients (eg, those undergoing cancer treatment or living with diabetes or HIV), who should be assessed promptly.

8. Instruct diagnosed patients on measures to prevent transmission, such as frequent handwashing and minimising physical contact with household members.

9. Emphasise the importance of prompt medical assessment for infants and young children showing signs of conjunctivitis.

Healthcare providers play a crucial role in controlling the spread of conjunctivitis through education, appropriate diagnosis, and treatment. Ensuring that patients and caregivers are well-informed is essential in managing this common eye condition effectively.

Credit: thodonal

Hypogonadism & sexual function

Sexual function in men is a complex interplay of hormonal, psychological, and relational factors.

HYPOGONADISM, CHARACTERISED BY low testosterone levels, is a significant contributor to sexual dysfunction.

We examine the TRAVERSE sexual function sub-study, examining which patients benefit the most from testosterone replacement therapy (TRT).

Hypogonadism can be congenital or acquired, with symptoms often overlapping with normal ageing and chronic diseases, complicating diagnosis (Rastrelli et al., 2018). Testosterone is crucial for male sexual response, influencing libido, erectile function, and overall sexual activity. However, sexual disorders cannot be solely attributed to low testosterone levels, as various factors, including organic, relational, and psychological influences, contribute to sexual dysfunction (Corona et al., 2022).

THE TRAVERSE SEXUAL FUNCTION SUB-STUDY

The TRAVERSE trial primarily focused on the cardiovascular safety of TRT in middleaged and older men with hypogonadism. The sexual function sub-study involved 1161 men aged 45 to 80, randomly assigned to receive either testosterone gel or a placebo for two years (Pencina et al., 2023). It is important to note that all patients had pre-existing cardiovascular disease or were at risk. The study aimed to assess the impact of TRT on sexual activity, desire, and hypogonadal symptoms.

KEY FINDINGS

1. Sexual activity and desire: TRT significantly enhanced sexual activity, with participants reporting nearly a 50% increase in sexual activity compared to baseline, and a 25% greater improvement than those receiving placebo. Improvements in sexual desire and hypogonadal symptoms were also notable, although there was no significant effect on erectile function (Pencina et al., 2023).

2. Patient demographics: The study highlighted the prevalence of sexual symptoms in older men, emphasising the importance of addressing these issues as they often lead to seeking testosterone treatment. Many participants had chronic health conditions, such as cardiovascular disease and diabetes, which could influence their sexual health. This demonstrates that even in older patients with CVD or risk factors, TRT improves sexual function, which is in line with previous research. (Pencina et al., 2023).

3. Safety and adverse effects: The TRAVERSE trial demonstrated that TRT does not significantly increase the risk of major cardiovascular events in men with hypogonadism (Lincoff et al., 2023).

CLINICAL IMPLICATIONS

The findings from the TRAVERSE sexual function sub-study provide valuable insights for clinicians and patients considering testosterone treatment.

TRT can effectively improve sexual activity and hypogonadal symptoms in men with low testosterone, particularly in older men and those with prior cardiovascular

disease (Pencina et al., 2023).

CONCLUSION

Testosterone plays a multifaceted role in male sexual health, and TRT can significantly enhance sexual activity and hypogonadal symptoms in men with low testosterone. The TRAVERSE sexual function sub-study underscores the

importance of a comprehensive approach to diagnosing and treating sexual dysfunction in men, considering both hormonal and nonhormonal factors. Further long-term studies are warranted to explore the efficacy and safety of TRT in this demographic.

References available on request.

Effects of dapagliflozin in CKD

The DAPA-CKD trial, a landmark study, has provided significant insights into the effects of dapagliflozin, an SGLT2 inhibitor, on patients with chronic kidney disease (CKD) and albuminuria.

THIS STUDY IS particularly noteworthy as it includes patients with and without type 2 diabetes, thereby broadening the scope of its findings. The trial involved 4 304 adults with an

estimated glomerular filtration rate (eGFR) ranging from 25 to 75ml/min/1.73m² and a urinary albumin-to-creatinine ratio of 200 to 5 000mg/g. Participants were randomly assigned to receive either

dapagliflozin 10mg or a placebo daily. The primary endpoint of the study focused on significant kidney decline, end-stage kidney disease, and kidney or cardiovascular death. Secondary endpoints included various

kidney and cardiovascular outcomes and all-cause mortality.

A key aspect of the study was the requirement for participants to be on stable doses of renin-angiotensin-aldosterone system (RAAS) inhibitors. The study also categorised patients based on their use of other cardiovascular medications, allowing for a comprehensive analysis of dapagliflozin's effects across different patient profiles.

The results of the DAPA-CKD trial were compelling. Dapagliflozin significantly lowered the risk of adverse kidney and cardiovascular events compared to placebo, regardless of the concurrent use of cardiovascular medications. This finding is crucial as it suggests that dapagliflozin can be safely and effectively used in CKD patients, even those who are on various cardiovascular treatments. The safety profile of dapagliflozin remained consistent throughout the study, with no increase in serious adverse events reported.

The trial was conducted from February 2017 to June 2020 across 386 sites in 21 countries. The analysis showed that dapagliflozin consistently reduced the risk of both primary and secondary composite endpoints. Importantly, there were no significant differences in outcomes based on the use of cardiovascular medications, further supporting the broad applicability of dapagliflozin in managing CKD and associated cardiovascular issues.

The collaborative nature of the research is also highlighted in the document, with numerous contributors from various medical institutions worldwide. This global effort underscores the importance and impact of the study in the field of nephrology research.

CONCLUSION

In conclusion, the DAPA-CKD trial supports the use of dapagliflozin in CKD patients, demonstrating its compatibility with standard cardiovascular treatments and its potential benefits in managing kidney health. The findings of this study are likely to influence clinical practice, offering a new avenue for the treatment of CKD patients at higher risk of adverse kidney and cardiovascular events. The trial's comprehensive approach and robust results make a strong case for the inclusion of dapagliflozin in the therapeutic arsenal against chronic kidney disease.

REFERENCE

Chertow GM, Correa-Rotter R, Vart P, Jongs N, et al. Effects of Dapagliflozin in Chronic Kidney Disease, With and Without Other Cardiovascular Medications: DAPACKD Trial. J Am Heart Assoc. 2023:2;12(9):e028739. doi: 10.1161/JAHA.122.028739. Epub 2023 Apr 29. PMID: 37119064; PMCID: PMC10227210.

Embracing oral health holistically

By Dr Pumela Gwengu, HOD

of the Department of Operative Dentistry at the Sefako Makgatho Health Sciences University & Specialist in community dentistry.

AS A SPECIALIST in community dentistry, my role extends beyond providing clinical care to educating individuals about oral hygiene and advocating for a more holistic approach to oral health. We cannot view dental health in isolation, as it is intricately connected to overall well-being.

THE HOLISTIC APPROACH TO ORAL CARE

To reduce the burden of dental diseases, we must prioritise prevention. Too often, individuals seek dental care only when problems arise. Early intervention can help address issues before they escalate into more severe conditions. Holistic dentistry considers a patient’s overall health, lifestyle, and wellbeing to inform preventative and treatments. There are three key aspects to be considered when implementing this approach:

1. Overall health and whole-body approach

Oral care should not be looked at in isolation as it impacts overall health and vitality. Scientific research has shown that people suffering from certain non-communicable diseases are more susceptible to oral diseases such as periodontitis.1 Maintaining good oral health is crucial for overall health management.

2. Natural treatments and alternative therapies

There are several natural remedies that can be used to complement oral hygiene practices such as brushing and flossing. Herbal extracts that have been proven to have antimicrobial effects and aid in the maintenance of oral hygiene, include Neem, Echinacea, and tincture of Myrrh.2

3. Preventative focus and care

Broader public health recommendations emphasise the need for preventative care and lifestyle changes. This aspect focuses addressing oral hygiene education, nutrition, stress management and lifestyle changes such as the implementation of harm reduction strategies for use of substances like tobacco and alcohol. Harm reduction strategies have been proven to offer a practical and transformative approach that empowers individuals to make informed decisions and promoting health and self-regulation.

PUBLIC HEALTH APPROACH TO ORAL CARE

Public health approaches aim to reduce the burden of oral diseases and promote overall health and wellbeing. Examining the oral cavity is vital for understanding the burden of disease, as it can reveal early signs of conditions like HIV infection. Regular dental check-ups and consultations contribute to the early detection and prevention of oral health problems. As healthcare practitioners, we need to ensure that all South Africans have access to dental care,

this includes providing services to outlying communities and integrating oral health into primary healthcare. Education and awareness programmes play a crucial role in informing communities about the importance of oral hygiene, proper brushing and flossing techniques, and the impact of diet on oral health. Excessive sugar consumption can lead to lifestyle diseases and negatively impact oral health. Advocating for a balanced diet with proper nutrition and reduced sugar intake is crucial. Simple steps like drinking more water and avoiding sugary beverages can significantly improve oral health. Water helps neutralise the pH levels in the mouth, reducing the risk of acid erosion.

As with sugar, smoking is a well-known risk factor for oral health, contributing to dental enamel erosion, tooth discoloration, and both extrinsic and intrinsic stains. While quitting smoking is the ideal goal, a harm reduction approach can involve gradually reducing cigarette consumption. For example, a smoker who currently consumes six to ten cigarettes daily could aim to cut back to one or two.

If a patient is unable to quit smoking completely, alternative smoke free products exist like heat ‘not burn’ products and oral nicotine which pose a lower risk to the oral cavity when compared to traditional cigarettes. We must do more to educate communities to understand the importance of advocating for themselves and seeking necessary care.

A comprehensive approach to health management requires addressing oral health issues within the broader context of overall well-being. Health promotion policies that support oral health need to be enacted into law.

GOING BACK TO THE BASICS

• Health promotion is as simple as going into communities and educating people about oral health. Knowing how to brush your teeth correctly and having regular dental check-ups every six months is essential for good oral health

• The importance of daily flossing cannot be understated. Brushing alone is not enough; you need to get in between the tooth surfaces with flossing

• Using toothpaste with fluoride is critical as it helps strengthen the tooth enamel, making it more resistant to tooth decay. It reduces the amount of acid the bacteria on your teeth produce. We cannot stress enough the need for harm reduction, to focus on preventing dental diseases. Too often by the time people come in for help, it is for a problem. Early intervention can help address the burden of disease before it gets to the disease stage.

REFERENCES:

Liccardo D, et al. 2019. Periodontal disease: a risk factor for diabetes and cardiovascular disease. Int J Mol Sci, 20 (6) 1414 Rajagopalan A. 2015. Herbal products in oral hygiene maintenance-a review. J of Pharmacy, 5(1) 48

Dr Pumela Gwengu

Adobe Stock, Credit Vanessa

GERD diagnosis Lyon consensus

The Lyon Consensus 2.0 has introduced updated criteria for diagnosing gastro-oesophageal reflux disease (GERD), focusing on the necessity of conclusive evidence from oesophageal testing to support diagnosis and management.

THIS INTERNATIONAL EXPERT group has refined the definition of actionable GERD, which now requires clear evidence of reflux-related pathology alongside troublesome symptoms.

KEY UPDATES AND DIAGNOSTIC CRITERIA

One of the significant updates includes recognising Los Angeles grade B oesophagitis as definitive evidence of GERD.

The consensus differentiates between proven and unproven GERD and establishes specific testing strategies based on symptom presentation. For patients with unproven GERD, prolonged wireless pH

monitoring or catheter-based pH monitoring is recommended. In contrast, those with proven GERD and ongoing symptoms should undergo pH-impedance monitoring while on optimised antisecretory therapy.

The consensus emphasises the importance of personalising GERD management according to individual patient presentations and improving specificity in diagnostic algorithms. Symptoms are categorised by their likelihood of being related to reflux episodes, with typical symptoms like heartburn and regurgitation being more closely associated with GERD than atypical symptoms such as chronic cough or hoarseness.

DIAGNOSTIC TESTING AND SYMPTOM ASSESSMENT

DEXILANT DDR:

• TRUE once-daily dosing.5

The document highlights the complexity of diagnosing and managing GERD, advocating for thorough assessments of symptoms and appropriate diagnostic testing. Endoscopy is crucial for accurately assessing oesophageal damage, particularly after discontinuing proton pump inhibitor (PPI) therapy. The Los Angeles classification system is used to categorise esophagitis, with grades B, C, and D being conclusive for GERD. Prolonged wireless pH monitoring is emphasised as a preferred method for diagnosing GERD, with metrics like Acid Exposure Time (AET) being critical in determining the need for continued PPI therapy or further management strategies. The document also discusses the management of refractory GERD, suggesting that pH-impedance monitoring can help identify patients who may benefit from surgical interventions when medical management fails.

SYMPTOM REMINDER

Typical symptoms of GERD consist of: heartburn, oesophageal chest pain and regurgitation. The relationship of belching to reflux disease is variable, but belching can be part of reflux pathophysiology.

Chronic cough and wheezing have a low but potential pathophysiological relationship to reflux disease.

Hoarseness, globus, nausea, abdominal pain and other dyspeptic symptoms in the absence of typical symptoms have a low likelihood of pathophysiological relationship to reflux disease.

Cataract surgery may reduce dementia risk by 25%

Individuals who undergo cataract surgery could experience about a 25% lower risk of long-term cognitive decline compared to those who do not have the surgery.

HOWEVER, THE SHORT-TERM effects of the surgery on cognitive function remain uncertain. These findings are drawn from a systematic review and meta-analysis, reinforcing previous research that suggests addressing sensory impairments may help slow cognitive decline. This underlines the importance of discussing cataract surgery as a potential cognitive health benefit with patients.

Visual impairment is known to contribute to faster cognitive decline and an increased risk of dementia, possibly due to the reduction in visual stimuli accelerating neurodegenerative processes. The potential for cataract surgery to mitigate this risk, however, has not been definitively established. While some studies indicate short-term cognitive benefits, others suggest long-term advantages, with mixed and sometimes conflicting results.

To better understand these impacts, a research team from Singapore conducted an extensive review and meta-analysis of data from studies published up to September 2022. The selected studies examined adults who underwent cataract surgery, comparing their cognitive outcomes with control groups (either those without cataract or with untreated cataract).

CLEAR EVIDENCE OF LONG-TERM BENEFITS

The review included 24 studies encompassing 558 276 participants (average age 66 years, 46% male). This comprised 16 prospective cohort studies and one randomised controlled trial, with an overall low to moderate risk of bias. In eight of the 11 studies that specified laterality, the cataracts were bilateral. Six of the 11 studies detailed phacoemulsification as the surgical method used.

For short-term outcomes (3-12 months), pooled data from eight studies (662 patients) indicated a modest 4% improvement in cognitive scores postsurgery among patients with normal cognitive function compared to controls (mean ratio 0.96 [0.94-0.99]). However, there was significant variability across studies (I² = 75%). Despite differences in cognitive tests used, the benefit was consistent.

Conversely, for patients with preexisting cognitive impairment (358 patients across four studies), no significant change in cognitive scores was observed after surgery. For long-term outcomes, data from six studies with 246 640 participants and a follow-up of 7-10 years showed a 25% reduction in the risk of cognitive decline or dementia in those who had undergone

cataract surgery compared to those who had not (hazard ratio 0.75 [0.72-0.78], I² = 9%). This benefit was consistent for both cognitive decline and dementia risk.

However, when comparing patients who had surgery to those without cataracts, long-term cognitive decline risk was similar (pooled analysis of 308,795 participants,

follow-up of 24-101 months, hazard ratio 0.84 [0.66-1.06]).

Source: MedScape UK

Goes beyond itchy eyes.1, 2

Rapid onset of action, within 15 minutes 4 Long acting, at least 8 hours 4 • Prevents reoccurrence, more than just a ‘quick

Hearty & healthy recipe book launched

In a bid to revolutionise healthy eating and promote cardiovascular wellness, Pharma Dynamics has unveiled the Hearty collection (www.heartyfood.co.za), which features exclusive gourmet recipes inspired by the Dietary Approaches to Stop Hypertension (DASH) diet.

THE DASH DIET has been extensively researched and its efficacy has been proven through many studies over the years. Originally developed by the National Heart, Lung, and Blood Institute (NHLBI) to combat hypertension (high blood pressure), the DASH diet has demonstrated effectiveness not only in lowering blood pressure, but also in improving overall cardiovascular health and reducing the risk of chronic diseases. Nicole Jennings, spokesperson for Pharma Dynamics, says this innovative culinary venture merges the realms of gastronomy and health under one delectable umbrella.

“Pharma Dynamics has been the country’s leading provider of cardiovascular medicine for over a decade, and we view it as our responsibility to educate patients of the important role that lifestyle and food plays in managing the burden of cardiovascular disease. Hearty stands as a testament to Pharma Dynamics' longstanding commitment to fostering healthier lifestyles and combating chronic diseases, beyond just providing medication.”

“For many years healthy living has been associated with dieting and therefore carries an association with depravation in the minds of many South Africans. This unique collection is a celebration of food and a testament to the joy of nourishing ingredients. Drawing inspiration from the DASH diet, Hearty aims to make nutritious eating not only beneficial, but also indulgently enjoyable.”

What sets Hearty apart is its collaboration with SA's culinary elite – all recipients of the prestigious Gourmand World Cookbook Award. The collection features exclusive recipes curated by five accomplished local chefs and food writers, namely Monché Muller, Zola Nene, Herman Lensing, Isabella Niehaus and Heleen Meyer. Each contributor brings their unique flair and expertise to the table, crafting dishes that are not only flavourful, but also heart friendly.

Jennings says the recipes included in Hearty have received the stamp of approval from the Heart and Stroke Foundation South Africa (HSFSA), further attesting to their nutritional value and health benefits. Prof Pamela Naidoo, the CEO of the HSFSA, is excited about the partnership with Pharma Dynamics. “The Hearty collection of recipes raises the importance of knowing that health outcomes rely on a healthy heart and brain, and it fits seamlessly with the Foundation’s mascot, Hearty, which is a symbol of good heart health!”

Monché Muller, executive chef of the international wines label Oddo Vins et Domaines in SA and author of Harvest Table – A Culinary Journey Through the Wine Regions of France, Italy, Spain and South Africa, is renowned for her innovative and clean approach to cooking. Her dishes are as visually stunning as they are delicious.

Zola Nene, chef, TV personality and the author of Simply Delicious, Simply Zola and Simply Seven Colours is celebrated for her contemporary South African cuisine. Her dishes infuse recipes with bold flavours and vibrant, local ingredients.

Herman Lensing, one of SA’s top food writers, TV cooking host and author of Voorskoot, Nog ‘n Voorskoot (In my Kitchen), 30, Dit Proe Soos Huis, Nostalgie and Home Cooking (Huiskos), Herman se Kortpaaie, Air-fryer and 100 Best Biscuits, is known for his expertise in healthy eating and offers a selection of dishes that are both wholesome and satisfying.

Heleen Meyer is an independent food consultant, stylist, businesswoman, TV/ radio cooking host and author of a number of cookbooks including Make Five/Maak Vyf, Kos is op die tafel! and Onthoukos, amongst others. Heleen is the food consultant for Pharma Dynamics’ Cooking from the Heart recipe book collection. Her dishes strike the perfect harmony between taste and health.

Isabella Niehaus, chef, entrepreneur, stylist, author of Isabella’s Mussel Feast, Isabella’s Pork Feast, and Duinhuis, and co-author of Daar’s ‘n Vegan op my Verandah/ There’s a Vegan on my Verandah. She is passionate about farm-fresh ingredients and brings a rustic charm to her recipes.

The Hearty collection builds on the success of Pharma Dynamics' popular Cooking from the Heart cookbook collection, which has garnered acclaim for its focus on promoting heart health through mindful eating and living. With Hearty, Pharma Dynamics aims to expand its culinary offerings while continuing to champion the cause of preventive healthcare.

“We are thrilled to introduce this collection to the public. At Pharma Dynamics, we believe that good health begins with good food, and Hearty embodies this philosophy. Through this collaboration, we hope to inspire people to make healthier choices without compromising on taste."

The launch of Hearty comes at a time when the importance of preventive healthcare is increasingly recognised, with emphasis placed on lifestyle interventions to mitigate the risk of chronic diseases. By promoting a diet rich in fruits, vegetables, whole grains, and lean proteins, which are naturally high in potassium, calcium, magnesium, fibre, and low in salt, sugar, and unhealthy fats (saturated and trans fats), Hearty offers a practical and delicious way to support heart health and overall well-being.

Adobe Stock, Credit : annaileish

U Managing ulcerative colitis

A survival guide for healthcare workers and their patients

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that significantly impacts patients' lives. This survival guide, presented by Dr Peter Barrow, aims to provide healthcare professionals with a comprehensive understanding of UC, its pathogenesis, impact, and management strategies. This webinar was sponsored by Adcock Ingram.

To watch a replay of this webinar and still earn a CPD point, go to: https://event.webinarjam.com/replay/877/ r46v4ivm4bwy5f0o1u1kgl. Email john.woodford@newmedia.co.za to let him know to allocate your point/ request an attendance certificate for those who don’t fall under the HPCSA.

LCERATIVE COLITIS IS a type of IBD that causes long-lasting inflammation and ulcers in the digestive tract, primarily affecting the innermost lining of the large intestine and rectum. The condition can be debilitating and sometimes lead to life-threatening complications. Historically, UC was rarely diagnosed in black South African patients, but recent data from the IBD Africa database shows an increase in registered cases, highlighting the growing need for effective management strategies.

PATHOGENESIS OF

UC

The exact cause of UC remains unknown, but it is believed to result from an abnormal immune response in genetically predisposed individuals. Environmental factors, such as diet and stress, may also play a role in triggering the disease. The pathogenesis of UC involves a complex interplay between the immune system, gut microbiome, and epithelial barrier function, leading to chronic inflammation and tissue damage.

IMPACT OF UC

UC has a profound impact on patients' quality of life. During a flare, 96% of patients report feeling weak, tired, and worn-out, and 83% experience these symptoms even during remission. The disease affects various aspects of life, including stress levels, the ability to lead a normal life, and social interactions. Physicians often underestimate the impact of UC on their patients, underscoring the need for a more empathetic and comprehensive approach to care.

MANAGEMENT

Effective management of UC requires a multifaceted approach, including clinical assessment, stress management, dietary modifications, microbiome support, and medication.

1. Clinical assessment: Regular monitoring of objective markers such as haemoglobin (Hb), C-reactive protein (CRP), and stool calprotectin levels is essential for assessing disease activity and guiding

treatment decisions.

2. Stress management: Stress can exacerbate UC symptoms, so it is crucial to incorporate stressreduction techniques into the management plan. This may include mindfulness practices, counselling, and support groups.

3. Diet: An anti-inflammatory diet can help reduce symptoms and promote gut health. This diet typically includes foods rich in omega-3 fatty acids, antioxidants, and fibre, while avoiding processed foods, sugar, and trans fats.

4. Microbiome: Supporting a healthy gut microbiome through probiotics, prebiotics, and dietary changes can improve UC symptoms and overall gut health.

5. Medication: Treatment options for UC vary depending on the severity of the disease. For mild cases, antiinflammatory medications such as aminosalicylates may be sufficient. Moderate to severe cases may require

DMTs for MS: An overview

corticosteroids, immunomodulators, or biologics. The treatment targets include early clinical response, clinical remission, normalisation of growth in paediatric patients, normalisation of CRP levels, decrease in calprotectin levels, endoscopic healing, and restoration of quality of life.

CONCLUSION

Managing ulcerative colitis is a complex and ongoing process that requires a comprehensive and empathetic approach. By understanding the pathogenesis, impact, and management strategies of UC, healthcare professionals can better support their patients in achieving remission and improving their quality of life. Regular assessment, stress management, dietary modifications, microbiome support, and appropriate medication are key components of an effective management plan. With the right care and support, patients with UC can lead healthier and more fulfilling lives.

Dr Dion Craig Opperman recently presented a webinar for us on disease-modifying therapies (DMTs) for multiple sclerosis (MS). This webinar was sponsored by Activo. The following article is a summary of the presentation.

To watch a replay of this webinar and still earn a CPD point, go to: https://event.webinarjam.com/replay/863/ lp6vpbyr4szkzfgvysgkk1.Email john.woodford@newmedia.co.za to let him know to allocate your point/ request an attendance certificate for those who don’t fall under the HPCSA.

S IS A CHRONIC inflammatory disease that affects the central nervous system (CNS), leading to the formation of sclerotic plaques in the brain and spinal cord. These plaques result in a variety of neurological symptoms, which can significantly impact the quality of life of those affected.

The disease was first described in 1866 and has since been the subject of extensive research and treatment development. MS is characterised by relapses, defined as the emergence of new neurological symptoms or the exacerbation of existing ones, lasting at least 48 hours after a stable period of 30 days. The management of MS involves both acute treatment for relapses and long-term strategies for secondary prevention.

ACUTE TREATMENT FOR RELAPSES

During relapses, high-dose corticosteroids are commonly used to reduce inflammation and hasten recovery. These steroids help to manage the acute symptoms but do not

alter the long-term course of the disease.

LONG-TERM MANAGEMENT AND DMTS

The primary goal of long-term management in MS is to reduce the frequency and severity of relapses, manage symptoms, and prevent disease progression. Several first-line therapies are currently funded and widely used, including interferonbeta (IFN-beta), glatiramer acetate (GA), teriflunomide, and fingolimod.

Interferon-beta (IFN-beta): This therapy modulates the immune response and is known to reduce the frequency of relapses. However, it can cause side effects such as flu-like symptoms and injection site pain.

Glatiramer acetate (GA): GA promotes anti-inflammatory responses and is generally well tolerated. It is considered safe for use during pregnancy, making it a preferred option for women of childbearing age.

Teriflunomide: This oral medication inhibits

the proliferation of T and B cells, which are involved in the autoimmune response in MS. Common side effects include gastrointestinal issues and hair loss.

Fingolimod: Fingolimod works by retaining T lymphocytes in lymph nodes, preventing them from reaching the CNS and causing damage. It has a good tolerance profile but can increase liver enzymes.

OTHER TREATMENT OPTIONS

In addition to the first-line therapies, several other DMTs are available for the management of MS:

Natalizumab: This monoclonal antibody prevents lymphocyte migration across the blood-brain barrier (BBB), reducing inflammation in the CNS.

Alemtuzumab: Alemtuzumab depletes various immune cells, including T and B cells, but carries risks of future autoimmune disorders.

Cladribine: This drug interferes with DNA synthesis, reducing the population of

immune cells involved in the autoimmune response.

Anti-CD20 therapies: Therapies like rituximab and ocrelizumab target B cells, which play a crucial role in the pathogenesis of MS.

Dimethyl fumarate (DMF): DMF protects the integrity of the BBB and myelin, though it may cause gastrointestinal side effects.

CONCLUSION

The management of MS involves a combination of acute and long-term therapies aimed at reducing relapses, managing symptoms, and preventing disease progression. The choice of therapy depends on various factors, including the patient's disease course, tolerance to medications, and individual preferences. Ongoing research continues to improve our understanding of MS and develop more effective treatments to enhance the quality of life for those affected by this chronic disease.

Breast cancer care, diagnosis and risk assessment in primary care

On 14 October 2024, renowned breast cancer expert Prof Carol-Ann Benn presented a webinar entitled Breast cancer care, diagnosis and risk assessment in primary care. The webinar was proudly sponsored by AstraZeneca.

PROF BENN SPOKE passionately about the evolving landscape of breast cancer management. Reflecting on Breast Awareness Month, she emphasised the importance of collaboration in making a difference for individuals diagnosed with breast cancer or facing breast health concerns.

Prof Benn began by highlighting the sobering reality of late breast cancer presentations, sharing a distressing image of a patient from an affluent background who had delayed seeking help. She noted, “You’ve got to ask yourself, why do people present late for screening?” Traditionally, individuals approached screening with concerns about lumps or changes in their breasts. She argued that a fundamental shift in awareness and education is needed: “We need to encourage people to examine their breasts, to lift their arms up and look for any changes.”

A fear of medical environments, compounded by concerns about treatments like chemotherapy, often prevents timely presentations. Prof Benn illustrated this point with an example from her practice, explaining, “I saw a lady today with pulling or tugging on the nipple, and her mammogram

was normal, but actually there’s a small little cancer sitting there that is doing that.”

BREAST CANCER SCREENING

Prof Benn highlighted the historical context of breast cancer screening. Years ago, the US task force recommended shifting to biennial screenings, a guideline they later reversed upon realising it did not reduce late diagnoses. She pointed out that “screening today is really about understanding what your risk is, and can we determine it?”

Age is a significant risk factor, with older individuals being more susceptible to breast cancer. “Everyone talks about hormones causing cancers,” Prof Benn explained, “but they’re more like fertilisers. Only about 8% to 12% of people have single gene abnormalities that cause breast cancer.”

The need for community-based awareness and education was a recurring theme in her discussion. She remarked, “We need to set up the concept of community-based screening, health awareness, what to do if you’ve got a problem and where to go.” Screening guidelines vary across countries based on local economic factors, and Prof Benn advocated for tailored approaches to

PROGRESS

Reflecting on progress made over the years, she noted, “Thirty years ago, we used to see about 80% of our patients presenting with advanced cancers in our public clinics. Now it’s down to 60 and 50.” This improvement, however, has been overshadowed by the continued need for effective communication about available healthcare resources.

Prof Benn also addressed the alarming rise of breast cancer cases in low- and middle-income countries, which account for about 45% of new breast cancer diagnoses globally. “We do know that if you pick up cancers early, you have a better chance of better outcomes from a survival point of view,” she asserted, reinforcing the need for early detection and access to quality care.

The evolution of breast cancer treatment is an area where Prof Benn sees potential for improvement. She recounted how, historically, surgical interventions were the primary treatment method until evidence emerged showing that a more conservative approach was often more effective.

“We started to see a change. We

began doing better with mammograms, ultrasounds, and needle biopsies for breast cancer.”

However, she cautioned against a rushed approach to biopsies, advocating for careful consideration of costs and patient pathways in accessing care. “We want to biopsy people who have breast cancer and not lots of benign biopsies,” she explained, noting the importance of assessing the economic impact on patients.

PERSONALISED ONCOLOGY

Prof Benn expressed optimism about the advancements in personalised oncology. “We are past the era of recipes and regurgitating formulas,” she remarked, highlighting the growing understanding of the biology of cancer cells and the need for tailored treatments. With the integration of AI and telemedicine, she believes that healthcare professionals can enhance patient access to crucial resources and support.

This is a summary of a portion of Prof Benn’s talk. To view a recording of the full presentation, please visit bit.ly/4e9LWNA. The recording is accredited for 1 General CPD point.

mammography and ultrasound based on community needs.

Stock, Credit : Axel Kock

This is a summary of a portion of Prof Benn’s talk. To view a recording of the full presentation, please visit bit.ly/4e9LWNA. The recording is accredited for 1 General CPD point.

Exciting options in the treatment of allergic inflammation

R LODDER'S PRESENTATION

addressed the complexities of allergic rhinitis, a condition which leads to various symptoms, including rhinorrhoea, sneezing, nasal congestion, and itching. In many cases, allergic rhinitis is associated with ocular symptoms, particularly among patients with severe disease or those experiencing seasonal allergic rhinitis. "Many patients often overlook their symptoms, thinking they simply have a cold,” Dr Lodder said. Citing Glynis Cunningham, Dr Lodder noted that “the diagnosis is still missed and inadequately treated, which prevents patients from accessing allergy immunotherapy.” While symptoms like sneezing and itching are easily recognisable, other manifestations, such as chronic post-nasal drip, can lead to confusion in diagnosis. This confusion can result in frustration and a sense of helplessness among patients, who feel they are simply “not getting over this cold.” As a consequence, many patients suffer from a lack of concentration, sleep disturbances, and even migraines, all stemming from untreated allergic inflammation.

PATIENT ATTITUDES

Dr Lodder stated, “82% of patients say that they don’t really need a healthcare practitioner to help them manage allergic rhinitis,” highlighting a pervasive belief that they can handle their symptoms with over-the-counter medications. Furthermore, 72% indicated they would likely consult a healthcare practitioner only after multiple unsuccessful attempts to self-medicate. “This mindset can lead to prolonged suffering and mismanagement of the condition,” Dr Lodder said. Dr Lodder shared insights from an observational study involving 225 adult patients with asthma, some with allergic rhinitis and some without. After 10 years, the findings revealed that while some patients developed allergic rhinitis, others remained unchanged. Once sensitised to an allergen, the potential for future symptoms remains, as allergic rhinitis is not merely a cold but a chronic condition.

Moreover, Dr Lodder pointed out that many patients, particularly children, could face long- term consequences if allergic rhinitis remains untreated. “If they have a blocked nose because of chronic

inflammation, they are going to mouth breathe,” she noted. This can lead to abnormal facial development, malocclusion of teeth, and chronic inflammation of the nasal mucosa, resulting in recurrent infections. The frustration surrounding misdiagnosis and inadequate treatment can lead to overuse of antibiotics and further complications. Dr Lodder stressed the importance of identifying allergens to provide effective treatment. She remarked that allergic rhinitis requires proper anti-inflammatory treatment rather than symptomatic management alone. The parallels between allergic rhinitis and asthma were particularly notable in her discussion. For years, asthma was treated solely with bronchodilators until the understanding of its underlying chronic inflammation evolved. “It doesn’t make sense if we do not take this seriously,” she warned, emphasising the need for safe antiinflammatory medications.

EMOTIONAL TOLL

The emotional toll of allergic rhinitis is also significant, as patients often feel

embarrassed by their symptoms, such as snoring. Dr Lodder explained that, “It’s not something that you are doing wrong, but it is embarrassing.”

This embarrassment can affect selfesteem and social interactions, particularly in children who may require dental braces or exhibit noticeable symptoms. The financial implications of managing allergic rhinitis were also a focal point. Many patients are left to cover the costs of over-thecounter medications themselves, leading to increased medical bills. “A lot of our medical aids do not think that allergic rhinitis is a chronic condition,”

Dr Lodder pointed out. This leaves patients to purchase immune boosters and various remedies in hopes of improving their quality of life. “Once you’ve been having allergic rhinitis, it’s a vicious circle causing more chronic inflammation,” she explained. By understanding the condition better, healthcare practitioners can make a significant difference in the lives of their patients, helping them manage their symptoms more effectively and improving their overall quality of life.

Adobe Stock, Credit TheoTheWizard

Impact of behavioural science on health

Behavioural science is one of several disciplines that can help us understand and address behaviours that affect health.

BEHAVIOURAL SCIENCE IS crucial for understanding and addressing health-related behaviours. The international community aims to eliminate or reduce diseases, ensure proper antibiotic use, increase vaccine uptake, and respond to epidemics. The WHO is enhancing the use of behavioural science to help member states achieve better health outcomes. This discipline, supported by other sciences, analyses environmental factors influencing behaviours and can make impactful changes. Despite its potential, behavioural science is underutilised in public health programmes and policies. Increased research, investment, and collaboration are needed. Recognising its role is essential for universal health coverage and effective public health emergency responses, including managing misinformation during the Covid-19 pandemic.

HUMAN BEHAVIOUR TO HELP IMPROVE PATIENT ADHERENCE AND BEHAVIOURAL SCIENCE

Adherence is essential to maximise patient’s benefit from treatment and therapy, a key factor for subsequent health outcomes. Lack of adherence is associated with poor patient outcomes and increasing healthcare costs. Adherence to medical treatment is crucial for improving overall population health, but despite medical advances, control over various chronic diseases has not improved, driven primarily by nonadherence to treatment. In the EU, 200 000 premature deaths annually are linked to non-adherence, causing personal suffering and significant healthcare costs. In the US, non-adherence leads to about 125 000 premature deaths, 50% of treatment failures and 25% of hospitalisations, resulting in $105bn in avoidable costs. Globally poor medication adherence has devastating consequences: 31% of patients have not filled their first prescription 50% of patients do not take their medication as prescribed 33% of patients stopped their treatments earlier than recommended. The annual costs in Europe of avoidable hospitalisations, emergency care, and adult outpatient visits are assessed at €125bn and similar figures exist for other parts of the world.

ADHERENCE IS BEHAVIOUR Most patients state ‘forgetting’ is the main reason for non-adherence. Recent studies show that providing reminders is only helpful

if patients are motivated to take their medicines and follow the treatment.

HUMAN BEHAVIOUR

TO HELP IMPROVE ADHERENCE

Evidence shows that 25% of patients are non-adherent to prevention activities and disease management activities including medication intake, use of medical devices, appointment scheduling, screening, exercise, and dietary changes. When one focuses on treatment, estimates show that nearly 50% of patients fail in following recommendations. This is more noticeable when regimens are complex and/or require changes to existing habits or lifestyle, non-adherence can be as high as 70%. Non-adherence to medications and medical devices is a major barrier to effectively managing chronic conditions, resulting in poorer health outcomes, higher hospitalisation rates, and increased mortality.

Recent studies showthatproviding remindersisonly helpfulifpatientsare motivated to take their medicines

When reviewed, non-adherence and non-compliance contribute to financial burdens on the healthcare systems and contribute to overall societal costs. Enhancing adherence and applying behavioural science strategies can improve patient outcomes, make healthcare costs more sustainable, and maximise the patient experience Focusing on potentially modifiable aspects in approach to the treatment and control of diseases like diabetes, it is possible to see that the behavioural, motivational and self-care components of the patient, undoubtedly contribute to their success of the pharmacological and non-pharmacological therapeutics instituted. In diabetes management, alongside appropriate drug therapy, maintaining a healthy lifestyle is essential to maximise therapeutic effects and reduce acute exacerbations, morbidity, and mortality. More research is needed to enhance discussions on investing in the social and behavioural aspects of chronic illness.

THE USE OF SOCIAL BEHAVIOURAL MODELS

The use of social behavioural models offering multiple advantages in both practice and in research environments, however the breadth and depth of these models can deter many from engaging in this important exercise. A lot has improved with the adherence, but not enough A patient's behaviour is the key factor in treatment outcomes. The healthcare industry has sought to enhance adherence through improved patient experiences and shared decision-making. Drug development has become more patient-centric, resulting in less burdensome clinical studies and care. Patient information now better addresses needs, improving understanding of conditions and treatments. However, adherence rates remain largely unchanged. To tackle this, the Innovative Medicines Initiative 2 (IMI2) approved the Beamer project, aimed at enhancing patient support and treatment adherence. Beamer stands for Behavioural and Adherence Model for improving quality health outcomes and cost-effectiveness of healthcare. Its aim is to provide a better understanding of the psychological factors that affect patient adherence behaviour to enable the healthcare industry to design and deliver more targeted and relevant support. Beamer will create an open-source model based on behavioural science to identify key factors affecting adherence and provide solutions for timely support for the right patients. The purpose of Beamer is not only to generate a better understanding of adherence behaviour but also to effectively improve adherence behaviour during treatment. The Beamer model also aims to balance simplicity with personalisation to make it easy to use but effective in guiding improvements to adherence. A simple and pragmatic approach, also has the benefit that it will be implemented to improve adherence sooner than later. We all need our healthcare to be efficient, effective, and sustainable as it is a key constituent in the smooth functioning of our society. Behavioural science – a global boost in health outcomes?If you review the data, this is not a far-fetched idea. Globally nearly 50% of patients do not take their medication as prescribed. Despite medical advancement in several areas, illness management and outcomes have not improved. Combine this with the fact that –- the rise in costs, healthcare

complications and morbidity may only be the tip of the iceberg. The WHO has outlined increased effectiveness of adherence interventions. A far more effective tool to improve global health outcomes than any medical advancement (WHO). The first step to implement the strategy is to generate awareness. There is still a great lack of awareness around non-adherence to medication.

“Healthcare professionals are not seeing the scale of the problem and how they themselves are best equipped to target the issue during routine consultation. They can make a difference.” [John Weinman –King’s College, London] When healthcare professionals are aware of the issues, they have packed waiting rooms and short consultation slots, that impact the outcomes. Healthcare professionals need to work with their patients, not just tell them what to do. “We need to take a patient centred approach,” states Atul Pathak, Prof of Medicine, at Princess Grace hospital in Monaco, “We need to plan, organise, identify patients' willingness and readiness to change and we need to change our own behaviours towards the patient. We are equal partners.” Patients, like all of us, are complex human beings that need time to adjust, gain motivation and come to terms with medical diagnosis and treatment. We need to tailor the advice to the patient. It is important to start small and do not tell patients what to do – ask open-ended questions and use their emotions and values to increase adherence to medical advice.

We need to have an awareness around adherence to medication and the tools and techniques used to address potential issues.

“This could have a major impact on the quality of life of the individual, healthcare systems as a whole and generate a global boost in improved health outcomes.”

Dr Sheri Pritt – principal and founder of Evidence-based answers, LLC.

Behavioural science can help us to understand why patients do not take their treatment” [A-Care: Abbott] A-Care aims to transform care and advance Health Equity through education, insight, and coaching: Recognising the challenges of nonadherence Improving medication adherence by understanding drivers Changing mindsets from 'treating diseases' to 'treating people' The future approach to improving adherence represents a new world of educating healthcare professionals and empowering patients.

Prof Morgan Chetty, Visiting Prof: Health Sciences, DUT chairman, IPAF, CEO: KZNDHC

PLACEBO

A sister’s gift: life after leukaemia

An oncology pharmacist and mother of two is in remission from leukaemia thanks to the lifesaving gift of a stem cell donation from her loving sister and a whole community of people who were willing to be tested as potential donors for the bone marrow transplant she needed.

"O

N THE DAY before Father’s Day in 2010, I was diagnosed with chronic myeloid leukaemia when my general practitioner ran some tests after I sought treatment for referred shoulder pain,” says Amanda Busch, oncology manager at Medipost Pharmacy.

Before long, she found herself needing the highly specialised medications she usually dispensed to others.

“I was placed on first line treatment, which can help manage the cancer for years, but there are only a handful of medications that can treat this type of cancer. When I fell pregnant unexpectedly, I had to pause the treatment and use an injectable pregnancy-safe medication instead until my baby was born,” she recalls.

“The doctors recommended that I start looking for possible matches, as I would need a bone marrow transplant as my best option for beating the cancer – and they warned us it can be a very long process to find someone who is genetically similar enough to provide a feasible tissue match,” Amanda says.

“So many kind friends and members of the community came forward offering to be tested as bone marrow donors. Only one person in 100 000 on average, could be a suitable match outside your biological relatives, so I thank my lucky stars that I have an amazing sister who was an almost perfect match and was so generous in her support and willingness to make this lifesaving stem cell donation to me.”

In many cases, donation involves the matching donor taking medication to increase their production of the right kind of stem cells, which are then drawn from the donor in a process similar to donating blood. With South Africa’s unique demographics, there is a great need to grow the local registry of stem cell donors

from different parts of the country and all ethnic groups.

“Although the chance of being a match for a stranger in need of a lifesaving transfusion is small, there are children, mothers and fathers praying to find a genetically similar tissue match from a donor who can give them the same chance at life I had,” Amanda says.

“It takes more than a village to find a potentially life-saving matching donor, it takes a nation. I would like to encourage all caring South Africans to consider registering to become donors – the gift of life is yours to give.”

Amanda’s bone marrow transplant procedure was at the haematology unit of Netcare Pretoria East Hospital, where she had to remain in isolation for 16 days to protect against infection.

“To help the recipient’s body accept the stem cells from the donor, before the transplant the recipient needs to have an intense course of specialised chemotherapy to suppress their immune system.

“Thankfully, in my case, the side

effects were not too severe, and I began the path to recovery that has led me to still be in remission seven years later. I have so much to be grateful for,” Amanda says. Awareness of blood cancers and the power individuals hold to help save lives is key for improving survival rates, according to Medipost Holdings group sales and marketing director Rentia Myburgh. Registering as a bone marrow donor is free of charge and non-invasive, and by joining, you could save a precious life. For more information, visit https://sabmr. co.za/become-a-donor and https://www. dkms-africa.org/get-involved/becomea-donor.

“We salute the haematologists and healthcare professionals, as well as all registered donors, for your contribution to saving the lives of people like our valued colleague Amanda. We encourage other corporates, cultural and religious organisations and community groups to amplify awareness, as you never know if you, a dear friend or a loved one may require a lifesaving donation in future,” Myburgh concludes.

EDITORIAL

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Stock, Credit DZMITRY

Sisters Marionette Venter (left) and oncology manager at Medipost Pharmacy Amanda Busch (right) are pictured recently, years after Amanda’s lifesaving bone marrow transplant from Marionette’s donated stem cells.