SA Pharmaceutical Journal - Volume 73, Issue 10, 2006
Volume 73, Issue 10, 2006
Author Kathy MngadiSource: SA Pharmaceutical Journal 73, pp 14 –18 (2006)More Less
The natural course of untreated HIV / AIDS is characterised by a progressive deterioration of the underlying immune system, punctuated by consequent opportunistic infections and cancers. <BR>ART is the most effective palliation for HIV / AIDS so far. Patient care from the time of diagnosis should be multidisciplinary. Palliative care in AIDS is characterised by a higher proportion of extremely emotive issues surrounding sexuality, reproduction, guilt, loss of vitality, loss of productivity and death. <BR>Practical management of AIDS patients entails the formulation of individualised care plans for each patient and their families, drawn up by the multidisciplinary team in conjunction with the patient and family or caregivers. <BR>Symptoms in the terminal phase may be due to the HIV itself, treatment of HIV or opportunistic infections, associated debility or concomitant illness. Clinical care involves a detailed assessment to ascertain cause, followed by treatment of reversible causes, drug and non-drug palliation of chronic symptoms, and re-evaluation to assess response. <BR>Psychosocial care is facilitated by a family meeting involving relevant family members, with or without the patient, which allows for the transfer of information, education of the family on the patient's condition and for support on a practical and emotional level. <BR>Caring for terminally ill patients, especially young patients, can be a physically, psychologically and emotionally exhausting task, with which health care workers need to feel confident and comfortable, as personal fears and anxieties surrounding mortality are often conveyed to the patient. <BR>AIDS has provided a challenge to the medical fraternity at large, calling for closer collaboration between curative and palliative care, demanding that curative medicine adopts a higher level of care, and that palliative medicine adopt a reasonable measure of cure.
Author Mike DaveySource: SA Pharmaceutical Journal 73, pp 24 –36 (2006)More Less
Recent publications of prospective randomised controlled trials have called into question the role of progestogen use in menopausal women. <BR>Progestogens are necessary to protect the endometrium from the hyperplastic effect of oestrogen. <BR>Progestogens differ markedly in their effects on different organ systems. <BR>In the cardiovascular system, the less androgenic progestogens have potential advantages as regards their effect on lipid profile, direct vascular effect, insulin resistance and haemostasis. <BR>By virtue of their effect on breast tissue enzymes, progestogens may increase the concentration of oestradiol in breast tissue. Progestins differ in this effect. <BR>Less androgenic progestogens have a favourable effect on the apoptosis proliferation ratio in breast tissue. <BR>Individualisation of menopausal hormone therapy is important, especially in the high-risk patient.
Author Bev TraubSource: SA Pharmaceutical Journal 73, pp 32 –36 (2006)More Less
OA results from a combination of factors that include genetic predisposition, joint integrity, local mechanical forces and inflammatory responses. <br>Traditionally, OA has been divided into primary or secondary type. <br>The joint involvement in the primary form often affects the hands, feet, knee, hip and spine. <br>Secondary OA often follows on an insult to a joint, e.g. trauma, inflammation from rheumatoid arthritis, joint sepsis or crystal deposition. <br>The primary pathology in OA is articular cartilage failure. <br>Risk factors are age, female gender, obesity, muscle weakness, a combination of exercise with proprioceptive defects, and calcium crystal pyrophosphate deposition disease. <br>The diagnosis of OA remains a clinical one, based on patient history, examination and radiographic findings. <br>The aims of management are to control pain, improve quality of life and prevent progression of the disease. <br>Non-pharmacological therapy includes weight management, short-term rest and low-impact exercise. <br>Pharmacological treatment should start with paracetamol. Tramadol may be added and NSAIDs are sometimes used, but must be administered with caution, particularly in the elderly. <br>Intra-articular glucocorticoid therapy can be useful, as can diseasemodifying drugs. <br>Surgery is reserved for patients with intractable pain in whom nonpharmacological and pharmacological management have failed, or who suffer loss of function.
Author Larry LoebensteinSource: SA Pharmaceutical Journal 73, pp 40 –42 (2006)More Less
The thalamus, hippocampus and amygdala are all structures that respond to the perception of danger stimuli. <BR>Anxiety disorders include the various forms of phobia, post-traumatic stress disorder, obsessive compulsive disorder and generalised anxiety disorder. The central feature of panic is an overwhelming and powerful element in all these disorders. The frontal or thinking and planning areas of the brain are significantly excluded in the presence of the arousal process triggered by anxiety, as their functioning could delay and interfere with a speedy response to danger. <BR>The power of anxiety will overwhelm any rational thought that might have been lodged in the frontal areas. <BR>Most classes of antidepressant have panic-blocking properties, the mode of action being very poorly understood. <BR>Cognitive behaviour therapeutic intervention is directed towards better anxiety management rather than towards original causes or putative precipitating events. <BR>Outcomes studies in the treatment of anxiety disorders demonstrate that combined therapy in the form of antidepressant medication and cognitive behaviour therapy has the best outcome. <BR>Whereas anxiety forces an individual to monitor the danger in the external environment, cognitive behaviour therapy redirects the individual to monitor and manage their internal environment in situations of varying anxiety intensity.
Author G.J. MullerSource: SA Pharmaceutical Journal 73, pp 44 –46 (2006)More Less
Paralytic shellfish poisoning (PSP) is caused by ingestion of mussels that have concentrated the poison, saxitoxin, produced by the 'red tide' dinoflagellate <I>Alexandrium catenella</I>. In severe cases, progressive muscular paralysis, with pronounced respiratory difficulty, develops. Since respiratory depression can develop surreptitiously, extreme vigilance should be exercised to monitor and support patients, especially during the first 12 hours. <BR>Scombroid poisoning is caused by the consumption of 'spoiled' fish which has undergone autolytic changes as a result of improper storage conditions. It resembles a histamine-like or acute allergic reaction. The treatment of the condition is symptomatic and supportive. The majority of patients respond well to antihistamines. <BR>Venomous marine animals may inflict injury by means of bites, stings or simply by direct contact. Secondary infection is a common complication. Coelenterata are responsible for most marine envenomations. These include bluebottles (the Portuguese man-of-war or <I>Physalia</I>).