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Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is a chronic condition which affects the respiratory system and worsens over time. Cigarette smoking and advancing age are the two major risks associated with this disease. It is concerning that the global incidence of this chronic illness is on the rise. Current projections indicate that it will become the third leading cause of death by the year 2020. Inflammatory changes underlie the pathophysiology of COPD. Irreversible damage and progressive narrowing of the air passages follow. COPD is characterised by the progressive loss of lung function. In addition, the Global Initiative for Chronic Obstructive Lung Disease released the latest update on its global strategy for the diagnosis, management, and prevention of COPD in 2015. This article provides an overview of the causative risk factors, underlying disease process, pathophysiological changes, and the classification and management of COPD, including the latest perspectives on this highly prevalent condition. [ABSTRACT FROM AUTHOR]

In the era of antimicrobial resistance, where the choice of antibiotics that we have to treat infections is becoming limited, infection control and hospital epidemiology are moving from being the orphan child of antimicrobial stewardship to becoming the necessity we can't live without. The responsibility lies with every healthcare worker to know the what, when and how of infection control as we have to pursue different avenues to not only safeguard the antibiotics we have left but also to maintain a healthy environment for our patients. This article explores issues around infection control and hospital epidemiology. [ABSTRACT FROM AUTHOR]

Tobacco smoking is a global public health problem, estimated to cause over 6 million deaths per year, including more than half a million non-smokers, dying of second-hand tobacco smoke. Smoking rates in South Africa have been declining over the last 20 years since the implementation of tobacco control measures, although the current prevalence of smoking is high (18.9%) with rates amongst males being five times higher than females. Similar to the rest of the world, smoking is also a leading cause of death in South Africa, with its risk factors exacerbated by tuberculosis, human immunodeficiency virus infection and non-communicable diseases. Tobacco control has major economic benefits for the health system, hence the importance of key policies combatting tobacco use as well as smoking cessation interventions. An overview of the pharmacological and non-pharmacological treatment interventions is provided, with a focus on the application of smoking cessation interventions in routine practice to ensure successful quitting. [ABSTRACT FROM AUTHOR]

The introduction of antiretroviral therapy transformed the resultant acquired immunodeficiency syndrome (AIDS) from a disease of high morbidity and mortality to a manageable chronic condition, with a subsequent reduction in the negative impact thereof on the world's economy and global healthcare systems. However, patients living with AIDS have now become vulnerable to an increase in morbidity and mortality due to non-AIDS related illness, such as metabolic syndrome, liver and renal failure, and premature cardiovascular disease (CVD); with antiretroviral therapy being especially prone to causing iatrogenic dyslipidaemia, which increases the risk of CVD. This article provides an overview of the nature and management of dyslipidaemia associated with HIV-infection and AIDS. [ABSTRACT FROM AUTHOR]

The key to optimal pain management is the ability to effectively monitor the patient to ensure pain relief, whilst minimising or managing the side-effects of pain medication. This will only be possible through the collaborative work of all healthcare professionals managing the patient. This article provides an overview of the requirements for optimising pharmacotherapeutic pain management. [ABSTRACT FROM AUTHOR]

The term "diabetes mellitus" refers to a group of disorders that relate to carbohydrate metabolism. The condition is characterised by hyperglycaemia due to decreased and therefore inadequate levels of insulin in the body, resistance to the effects of insulin, or a combination of both. The symptoms of marked hyperglycaemia include polyuria, polydipsia, weight loss, polyphagia and blurring of vision. The aetiological types of diabetes mellitus are type 1, type 2, gestational diabetes mellitus and other specific types. However, the two major categories of diabetes mellitus are type 1 and type 2. Type 1 (formerly known as insulin-dependent diabetes mellitus) patients are usually at risk of developing ketoacidosis and require insulin therapy. Patients who suffer from type 2 diabetes mellitus, formerly known as noninsulin-dependent diabetes mellitus, as opposed to those suffering from type 1 diabetes mellitus, still have functional pancreatic ß cells which produce insulin. However, they suffer from a relative lack of insulin, i.e. a combination of insulin resistance and the impaired secretion thereof. These patients may require oral hypoglycaemic agents, or a combination of both oral hypoglycaemic agents and insulin. The effective management of diabetes mellitus is dependent upon three main aspects, namely appropriate dietary modification, suitable exercise and appropriate pharmacotherapy. The more progressive forms of this disease require combination therapy. Uncontrolled diabetes mellitus may lead to the development of micro- and macrovascular complications. Patient compliance is very important in achieving the goal target and positive treatment outcomes. Multiple co-morbid conditions often complicate diabetic treatment and increase the risk of complications. Hypertension and dyslipidaemia are the most common co-morbid conditions. Therefore, tight glycaemic and blood pressure control is important in order to prevent disease progression and the development of complications. Important aspects that require consideration when managing individuals with diabetes mellitus are reviewed in this article. The effective management of patients with diabetes mellitus involves a complex decision-making process. The ultimate goal is to attain good glycaemic control. A unique management plan for each patient can be devised through the adoption of a personalised approach to the care of these individuals, which can result in improved outcomes. [ABSTRACT FROM AUTHOR]

Allergic diseases are increasing all over the world, now affecting up to 40% of the population. The most frequently occurring allergic conditions include allergic rhinitis (hay fever), chronic sinusitis, atopic dermatitis, and chronic urticaria. The literature suggests that second-generation histamine 1 (H1) antihistamines are the preferred first-line therapy for most chronic allergic conditions, including allergic rhinitis and chronic urticaria. Patients taking these antihistamines report little to no adverse effects with long-term continuous treatment. Second-generation H1-antihistamines have been shown to exert an anti-inflammatory effect, and continuous administration may improve their efficacy. [ABSTRACT FROM AUTHOR]

Allergic diseases are on the increase globally. There has been a doubling in the number of scholars suffering from allergy-related disease in the past two decades. This article describes the predisposing factors which contribute to an increased incidence of allergies within the population. These factors include a genetic predisposition, allergen exposure, abnormalities in the bowel flora and infection exposure. Some of these relate to the hygiene hypothesis and the microflora hypothesis, which are discussed in this article. Treatment options for those suffering from allergic disease are also discussed, with an emphasis on asthma, anaphylaxis, allergic rhinitis and atopic dermatitis. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is a chronic condition that affects the respiratory system and worsens over time. The two major risks that are associated with this disease are cigarette smoking and an advancing age. It is concerning that the global incidence of this chronic illness is on the rise, with current projections indicating that it will become the third-leading cause of death by the year 2020. Inflammatory changes underlie the pathophysiology of COPD, with irreversible damage and a progressive narrowing of the air passages that follow. COPD is characterised by a progressive loss of lung function. In addition, the Global Strategy for the Diagnosis, Management, and Disease Prevention of Chronic Obstructive Pulmonary Disease, or GOLD, released the latest update of their Global Strategy for the Diagnosis, Management, and prevention of Chronic Obstructive Pulmonary Disease in 2015. This article provides an overview of the causative risk factors, the underlying disease process and pathophysiological changes, the classification and the management of COPD, including the latest perspectives on this highly-prevalent condition. [ABSTRACT FROM AUTHOR]

Glaucoma is a complex condition of the eye. It is an ophthalmic neurodegenerative condition and is characterised by raised intraocular pressure. When left untreated, patients may gradually experience visual field loss, and even lose their sight completely. It is the second leading cause of blindness around the globe. The article provides a brief, synoptic overview of this condition and its pharmacological treatment options. [ABSTRACT FROM AUTHOR]

Nonsteroidal anti-inflammatory drugs (NSAIDs) include the nonselective or traditional NSAIDs, as well as the cyclo-oxygenase-2- specific ones. These agents are most often used to manage pain associated with musculoskeletal conditions. The nonselective or traditional agents are still widely used, and are also freely available as over-the-counter analgesics. However, they carry the risk of serious cardiovascular, gastrointestinal and renal adverse effects, such as peptic ulcers and gastrointestinal bleeding, especially in patients who have a pre-existing high-risk profile. It is imperative that physicians are aware of these risk factors and choose agents that will provide the best benefit-to-risk profile, while taking into consideration the patient's individual needs and risk profile. [ABSTRACT FROM AUTHOR]

This article provides an overview of the changes that have taken place in the diagnosis and management of hypertension over the past decade. Hypertension remains a very common condition seen in South Africa. The approach to the management of hypertension includes necessary lifestyle modifications and a decisive, stepwise escalation process in the pharmacotherapeutic management thereof. Thiazide diuretics are still being promoted by most guidelines to be the initial (first-line) drug of choice, with the addition of other suitable antihypertensive agents, if necessary, and according to any relevant co-morbid conditions. [ABSTRACT FROM AUTHOR]

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) pose a significant burden to the healthcare system annually. A positive impact on, and a reduction, in the mortality rate can be achieved through an understanding of the most common microorganisms that cause these two closely-associated conditions, identifying the associated risk factors and co-morbidities, and making a timely diagnosis. With the correct understanding of these conditions, proper preventative strategies can be implemented and treatment provided according to the severity of the specific condition in question. Better outcomes for infected individuals are likely to result from newer strategies involving novel antibiotics, as well as new approaches to the use of older antibiotics for different purposes. This article provides a general overview of the nature and management of HAP and VAP. [ABSTRACT FROM AUTHOR]

Allergic disease decreases the daily quality of life of many people, and can increase the number of working days lost owing to sick leave. Associated symptoms with allergic disease depend on the origin of the disease, and can either be allergic, non-allergic and purulent, or can cause rhinitis as a result of a common cold. Treatment depends on the origin of the rhinitis. However, an antihistamine is indicated in most instances. Combination treatment includes sympathomimetic drugs (either local or systemic) and corticosteroid medication (when indicated, and in most instances, used locally). The article provides an overview of the nature and the management of allergic disease and the histamine 1 antihistamines. [ABSTRACT FROM AUTHOR]

The common cold is a viral infection that requires symptomatic treatment. It is usually self-limiting. Influenza is often referred to as the flu. There are several differences between the common cold and the flu, including the onset of the condition as influenza is typically more acute in onset and more debilitating. Treatment of both these conditions requires a symptomatic approach that should be evidence-based, including herbal remedies, over-the-counter medicines, antiviral agents and analgesics for pain and fever.This will be discussed in more detail in the ensuing section. [ABSTRACT FROM AUTHOR]

"Psychosis" is an umbrella term used in the description of various conditions that involve delusions and hallucinations. This article will focus on the management of schizophrenia. Schizophrenia is a complex disorder, which provides many pharmacotherapy-related challenges. Advances have been made in the treatment of the condition. However, this requires a team approach, with the pharmacist monitoring treatment, both for safety and efficacy. The involvement of medicines that might possibly modulate the N-methyl-D-aspartate receptors is an exciting development that should be monitored. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a common cardiac rhythm disorder and patients with this condition are at an increased risk of strokes and other thromboembolic events. Available treatment options for the prevention of strokes in patients with AF include warfarin, aspirin and the novel oral anticoagulants (NOACs). Warfarin and aspirin reduce the risk of strokes in patients with AF and have been studied extensively. The NOACs are slowly beginning to make their way onto the South African market and are specifically highlighted in this article. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a common cardiac rhythm disorder. Patients suffering from this condition are at an increased risk of stroke and other thromboembolic events. Available treatment options for the prevention of strokes in patients suffering from AF include warfarin, aspirin and the novel oral anticoagulants. Warfarin and aspirin reduce the risk of strokes in patients with AF and have been studied extensively. The novel oral anticoagulants are slowly beginning to make their way onto the South African market and are specifically highlighted in this article. [ABSTRACT FROM AUTHOR]

Vulvovaginal candidiasis (VVC) is part of a group of infections termed the superficial fungal infections. These can be classified as complicated or uncomplicated, sporadic or recurrent. Some patients are difficult to diagnose, and may not respond to standard therapies. These patients suffer from recurrent or chronic VVC. Recurrent VVC is defined as more than four episodes of VVC within a 12-month period. Patients normally present with a white, cheesy discharge and vulvovaginal itching. Clinical findings (itching or a cheesy discharge) or laboratory tests (potassium hydroxide, Gram stains and vaginal pH) are not sensitive or specific predictors of Candida vaginitis. Treating recurrent VVC requires an aggressive treatment plan using two stages, namely an induction and a maintenance stage. A high incidence of recurrent VVC requires a thorough understanding of the epidemiology and pathophysiology of the condition. Treatment with azole antifungals and nystatin derivatives may provide relief if given for an adequate period of time. [ABSTRACT FROM AUTHOR]

Nonsteroidal anti-inflammatory drugs (NSAIDs) constitute a well-known group of drugs that are most widely used for a variety of inflammatory conditions and pain. However, their gastrointestinal side-effects, i.e. ulcers and gastrointestinal bleeding, hamper their usefulness in many clinical settings. The selective cyclo-oxygenase 2 (COX-2) inhibitors (the coxibs) promised to be a group of antiinflammatory drugs with significantly fewer, or no gastrointestinal side-effects. Nevertheless, more recent research into their effectiveness and safety profiles revealed that they are also associated with an increased risk of upper- and lower-gastrointestinal toxicity. Guidelines suggest that patients at risk of NSAID-induced gastrointestinal ulcers and toxicity should be given preventative treatment. However, only a small percentage of these patients receive any therapeutic intervention. Multiple strategies exist for reducing the risk of NSAIDinduced gastrointestinal complications. An overview of these strategies and treatment options is provided in the article, as well as novel approaches to developing gastrointestinal-sparing NSAIDs (using selective inhibition of terminal prostaglandin synthases, and modified NSAIDs to slowly release gastroprotective gaseous mediators, e.g. nitric oxide and hydrogen sulphide). [ABSTRACT FROM AUTHOR]

Pharmacy has evolved over several centuries from the traditional role of dispensing and compounding a physician's order, to include modern day services, such as patient care. The underlying philosophy of clinical pharmacy is pharmaceutical care. This is a patientcentred approach which addresses all possible pharmaceutical interventions in the context of a fully integrated multidisciplinary plan of care. The most effective pharmaceutical care is achieved when pharmacists become part of the clinical team caring for patients. Clinical pharmacists are not currently part of ward staff in South Africa, as seen in the USA or the UK. This may be because of human resources and an inadequate number of trained clinical pharmacists. This has an impact on the effectiveness of the pharmacist, as he or she should be based in the wards so as to become an effective member of the healthcare team. A high-impact unit that would benefit greatly from pharmaceutical care is the neonatal intensive care unit, which has been shown to be highly vulnerable to medication errors, and in which a clinical pharmacist could play a role in decreasing medication errors. [ABSTRACT FROM AUTHOR]

Patients can develop pregnancy related conditions during pregnancy, from minor ailments to conditions that can cause adverse risks to mother and/or foetus, presenting unique challenges for healthcare providers for effective and safe treatment of pregnant patients. This review paper focusses on three common diseases in pregnancy – gestational diabetes, heartburn, nausea and vomiting – and outlines appropriate treatment options for pregnant patients. [ABSTRACT FROM AUTHOR]

Alzheimer's disease is a degenerative disease of the brain, the most common cause of dementia in the geriatric population, and a major cause of death. Alzheimer's disease places a heavy burden on families, communities and society, in terms of care and costs. This is compounded by the fact that populations across the world are having a longer life expectancy. An overview of Alzheimer's as a disease state and its pharmacological and non-pharmacological management is provided in the paper. Caring for the person diagnosed with Alzheimer's may be taxing and thus caring for the carer is also described. [ABSTRACT FROM AUTHOR]

Atherosclerosis is a systemic diffuse disease, with a complex role of lipoprotein abnormalities associated with an increased risk for cardiovascular disease (CVD) events. These abnormalities include increased levels of low-density lipoprotein cholesterol (LDL-C), elevated triglycerides and low levels of high-density lipoprotein cholesterol (HDL-C). By agreement, statin therapy is the agent of choice for the reduction of LDL-C. Despite being the most commonly prescribed lipid-lowering agent with an exceptional safety profile and good tolerability, 10-25% of statin users experience muscle toxicity. This is known as statin-associated muscle symptoms (SAMS) which range from myalgia to rare life-threatening cases of rhabdomyolysis, in the presence of normal or elevated creatine kinase (CK). Several mechanisms have been proposed to describe the pathophysiology. However, not one completely captures the leading cause of SAMS. Despite its muscle toxicity and elusive pathophysiology, statins remain the drugs of choice in hypercholesterolaemia. Accurate diagnosis and specific individual management of SAMS can drastically improve quality of life and decrease CVD event risk. This article provides an overview of SAMS, the management and treatment thereof. [ABSTRACT FROM AUTHOR]

Vitamins are either fat- or water-soluble micronutrients that are derived from a healthy, well-balanced diet. The B-complex vitamins are well-known examples of water-soluble nutrients that are readily absorbed from a healthy gut, and easily eliminated via renal excretion. They are required for their vital physiological functions and are significant contributors to the maintenance of optimal health. Multiple B-vitamin deficiencies are quite common. Therefore, a balanced diet, including a full spectrum of B vitamins, is usually needed when any of them are found to be deficient. Conversely, their therapeutic value is limited to supplementation during states of deficiency since they have no additional benefits in the presence of an adequate dietary intake. In general, their active supplementation should only be used to correct deficiencies. This article provides an overview of B-complex vitamin deficiencies and their supplementation. [ABSTRACT FROM AUTHOR]

Adverse drug events (ADEs) have been found to be a major cause of morbidity and mortality in healthcare systems around the world. More than 50% of ADEs are preventable, and have been demonstrated to be the result of an incomplete medication history, prescribing or dispensing error, and the over- or underuse of prescribed pharmacotherapy. The main aim of implementing medication reconciliation in a hospital setting is to avoid ADEs, a prevalent patient safety issue. Medication reconciliation is the process of creating the most accurate list possible of all medications a patient is taking, including drug name, dosage, frequency and route, and then comparing that list against the admission, transfer, and/or discharge orders. Medication reconciliation is one of World Health Organization's High 5s initiative to improve patient safety. The implementation of the International Standard Operating Procedure for Medication Reconciliation led to a 50% reduction in medication discrepancies in developed countries. Implementing the medication reconciliation in the hospitals of South Africa may reduce medication errors. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) encompasses two vascular conditions that are of significant importance, namely deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is also the most common cause of PE. Medical and surgical patients, and individuals who are at increased risk of developing VTE through a variety of factors, require adequate thromboprophylaxis. Primary and secondary prevention, as well as the definitive treatment of VTE, are accomplished through the use of a variety of anticoagulant drugs. This article attempts to provide an overview of VTE, and its prevention and treatment. [ABSTRACT FROM AUTHOR]

Vitamins are either fat- or water-soluble micronutrients that are derived from a healthy, well-balanced diet. The B-complex vitamins are well-known examples of water-soluble nutrients that are readily absorbed from a healthy gut, and easily eliminated via renal excretion. They are required for their vital physiological functions and are significant contributors to the maintenance of optimal health. Multiple B-vitamin deficiencies are quite common. Therefore, a balanced diet, including a full spectrum of B vitamins, is usually needed when any of them are found to be deficient. Conversely, their therapeutic value is limited to supplementation during states of deficiency since they have no additional benefits in the presence of an adequate dietary intake. In general, their active supplementation should only be used to correct deficiencies. This article provides an overview of B-complex vitamin deficiencies and their supplementation. [ABSTRACT FROM AUTHOR]

The article offers information on the role played by the pharmacists in medicine management in hospital wards. It discusses the responsibilities of the pharmacist according to good pharmacy practice which includes creating a ward stock list with the ward nurses, inventory management of medicines, and standard operating procedures to provide guidance on ordering medicines from the pharmacy. Ensuring the availability of medicines in good quality conditions and affordable price is also mentioned.

The provision of palliative care in sub-Saharan Africa is a concern. A limited number of well resourced palliative care settings are available. Patient-level outcome measures are necessary to monitor and improve practice and patient care. This paper focuses on the use of the African Palliative Care Association (APCA) African Palliative Outcome Scale (POS) and pain scales used in clinical practice. [ABSTRACT FROM AUTHOR]