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UPDATE_SeptOct14: Editorial Comment - In this issue...


General practitioners manage patients with osteoarthritis on a daily basis, with treatments ranging from non-operative or conservative to orthopaedic referral for surgical intervention. In this article the epidemiology, risk factors, clinical presentation, radiographic findings and management is discussed. The majority of patients with small joint osteoarthritis respond well to non surgical treatments. Those with large joint osteoarthritis often require surgical intervention, particularly those patients with severe osteoarthritis of the hips and knees. The pain relief and improvement in quality of life as a result of these procedures is unquestionable. In the past joint replacements had limited durability. Today, techniques have improved considerably with fewer complications, less failures and increased longevity of the prostheses.

Methadone was previously used mainly in rehabilitation centres to replace heroin addiction, but is now increasingly prescribed by medical practitioners for the management of chronic pain. As a synthetic form of opium, it is affordable, long acting and a powerful analgesic. Unfortunately the number of fatalities has increased significantly due to methadone abuse by thrill seekers. It is often taken in combination with alcohol and other drugs making it more harmful. Methadone has great potential to assist in the battle with the huge problem of opioid addiction. However, this can only be achieved under strict supervision in rehabilitation programmes.

The dilemma is how do we stop methadone abuse without curtailing its valuable uses?

Wound management has become more complex over the years with changing principles of wound dressings, reflecting a growing understanding of wound healing physiology. Modern day wound dressings now have the ability to debride wounds, control infection and promote healing. In addition to dressings, there is larval therapy (maggot therapy or biosurgery) which has been recognized for hundreds of years as having a beneficial effect on wound healing. As its use for debridement of wounds has grown, the commercial availability has increased as well. The commonest uses for larval therapy are for pressure ulcers, infected surgical wounds, dehisced wounds and diabetic ulcers. Another ancient wound treatment is honey which still has a place in modern wound care. It is easy to apply, painless, creates a moist healing environment, has antibacterial properties and stimulates healing.

Skin problems such as eczema cause a lot of discomfort and they can be debilitating and disfiguring causing significant psychological distress to the patient. Eczema is by far the commonest skin disease seen in children. It is therefore essential that medical practitioners have a thorough understanding of the pathogenesis so that management of the condition is optimal and unnecessary investigations can be avoided. As you are aware the terms eczema and dermatitis are synonymous, with eczema being used more often by the public and dermatitis a more professional and scientific term. This article will cover the non pharmacological and pharmacological treatments that are available.

Hopefully you will find this issue stimulating, informative and helpful in your daily practice of medicine

The Editor

Posted on Tuesday, January 06 @ 10:40:27 SAST by E-Doc
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