Impact of early vs. delayed initiation of dutasteride/tamsulosin combination therapy on the risk of acute urinary retention or BPH-related surgery in LUTS/ BPH patients with moderate-to-severe symptoms at risk of disease progression
Management of bothersome lower urinary tract symptoms (LUTS) constitutes the main focus of therapeutic interventions, including those patients who have confirmed diagnosis of benign prostatic hyperplasia (BPH). However, in patients at risk of disease progression, clinical deterioration is observed over time, with increasing LUTS severity (IPSS), reduction in maximum urine flow rate (Qmax), episodes of acute urinary retention(AUR), or the need for BPH-related surgery. Currently, LUTS/ BPH management considers conservative, pharmacological and surgical treatments. Specifically, on pharmacological treatment for men with moderate or severe LUTS at increased risk of disease progression, i.e. higher prostate volume, higher PSA concentration, advanced age, higher PVR, lower Qmax, etc., the initial treatment of choice is a 5α-reductase inhibitor (5ARI) with or without an α-adrenoreceptor antagonist (α-blocker) or a phosphodiesterase 5 inhibitor (PDE5I). In some cases, patients experiencing failure of pharmacological treatment or symptom deterioration may require minimally invasive or surgical procedures.
Prostate safety events during testosterone replacement therapy in men with hypogonadism - a randomized clinical trial
The relationship between testosterone replacement therapy (TRT) and the risk of prostate cancer remains incompletely studied. Epidemiologic studies have not found a consistent association between prostate cancer risk and testosterone levels or polymorphisms in genes involved in androgen action. Prostate events were not adjudicated in any testosterone trial, and none have reported the incidence of high-grade prostate cancer or other prostate events, such as acute urinary retention, invasive prostate procedures, or initiation of new pharmacologic therapy for benign prostatic hyperplasia (BPH). Because of uncertainty about the risk of prostate events during TRT, most professional society guidelines recommend against TRT in men with a history or increased risk of prostate cancer.
Assessing the clinical impact of sodium-glucose cotransporter type 2 (SGLT2)- inhibitors in treating heart failure with reduced ejection fraction
Heart failure manifests through a spectrum of symptoms reflecting its complex pathophysiology. Classification of heart failure is primarily based on ejection fraction (EF), though, dividing it into two main categories: heart failure with reduced ejection fraction (HFrEF), characterised by EF ≤ 40%, and heart failure with preserved ejection fraction (HFpEF), where EF is ≥ 50%. An intermediate category, heart failure with mid-range ejection fraction (HFmrEF), falls between these two extremes with EF ranging from 41%–49%. This classification guides treatment decisions and helps tailor management strategies to address the underlying mechanisms and severity.
Self-reported practices and learning needs of private general practitioners during the pandemic in South Africa
The COVID-19 pandemic emphasised the need for a coordinated national response that harnesses the resources of the current two-tier health system in South Africa. Success in managing the spread of the coronavirus was achieved with a coordinated and integrated health systems approach involving private general practitioners (GPs). A coordinated national response may have provided a framework for future public health emergencies. Improving the efficiency and effectiveness of the healthcare system by allocating adequate resources, particularly during a pandemic, promotes a better quality of service for everyone in South Africa.
Acne vulgaris and variants
Acne vulgaris is a common skin condition that affects all skin types and ethnic groups. Although perceived to be a teenage disease, acne often persists into adulthood and can result in significant scarring. The condition typically begins at puberty when sex hormones begin to be produced, with the prevalence of acne in boys increasing from 40% at age 12 years to 95% at age 16 years, and the prevalence increases similarly from 61% to 83% in girls.
The link between thyroid hormones and cutaneous squamous cell carcinom
There are multiple risk factors strongly associated with the development of SCC. The most well-known are the phenotypic characteristics: red hair, fair skin (with long exposure to UV radiation), suntanning, HIV, as well as other genetic or immune and environmental risk factors. In the African population, high levels of melanin serve as a protective factor against UV rays. However, SCC is still a frequently diagnosed dermatological malignancy, developing in sun-protected areas of the body such as the lower leg, particularly in sites of chronic ulceration and previous burns that are not related to sunburns. The development of SCC occurs by malignant transformation of epidermal skin cells. UV rays damage DNA in cells, leading to genetic defects with ongoing replication.
Unveiling the grip of opioid addiction in South Africa: a call for community-centred interventions
Opioid addiction has emerged as a formidable challenge within the fabric of South African society, particularly ensnaring the vulnerable and communities. As the nation is due for the imminent rollout of opioid substitution therapy (OST), notably in the form of replacement agonists such as methadone, it prompts a critical reflection on combating the pervasive grip of opioid addiction among South Africa’s youth. Amidst this backdrop, there arises a compelling need for a coherent understanding and clear delineation of the complex nature of a potent opioid known as whoonga or nyaope. This introductory discourse aims to provide a guiding framework amidst the ambiguity surrounding the “white powder,” whose elusive contents have baffled many, even as its consistent and debilitating effects unmistakably categorise it as a hard drug. The urgent call for clarity extends beyond mere identification to untangling the web of adulterants with which it has become intertwined, ranging from antiretroviral (ARV) medication to rat poison.