SA Pharmaceutical Journal - Volume 74, Issue 7, 2007
Volume 74, Issue 7, 2007
Source: SA Pharmaceutical Journal 74, pp 12 –17 (2007)More Less
Atherosclerosis is a process that starts early in life and progresses silently and slowly for decades, usually only manifesting clinically in middle age.
The main objectives of primary prevention are to reduce morbidity, to improve quality of life and to increase life expectancy. There is growing evidence that lifestyle changes and primary risk factor modification can reduce both morbidity and mortality.
The major risk factors for atherosclerosis are age, family history, dyslipidaemia, cigarette smoking, hypertension and diabetes. These risk factors rarely occur in isolation.
A low level of HDL cholesterol is an independent risk factor for future cardiovascular events. Low HDL is defined as less than 1.03 mmol/l in men and less than 1.30 mmol/l in women.
Clustering of CAD risk factors such as hypertension and dyslipidaemia may begin in childhood, indicating a need for screening for cardiovascular risk early in life.
The major finding of prevention trials with cholesterol-lowering agents is an early and dramatic reduction in clinical events in treated patients who have a baseline LDL-cholesterol > 4.0 mmol/l; an LDL cholesterol level that was previously considered normal that did not warrant drug therapy.
Lifestyle interventions are crucially important in the control of obesity, dyslipidaemia and diabetes.
Novel risk factors are emerging which may prove to be the key to improving the current risk estimation approach which is lacking in certain respects.
Author Alison BentleySource: SA Pharmaceutical Journal 74, pp 22 –24 (2007)More Less
Secondary insomnia is less common than primary insomnia.
Secondary causes of insomnia include:
- depression and anxiety
- conditions causing nocturnal pain or breathlessness
- side-effects of medications and substance abuse
- less common but usually obvious medical conditions, such as hyperthyroidism
- frank sleep disorders such as obstructive sleep apnoea and restless legs syndrome (RLS).
The main symptom of insomnia is insufficient sleep to carry out the full range of daily functions.
The patient who sleeps for only 5 hours a night, but is not sleepy during the day, is a 'short sleeper' and not an insomniac.
Primary insomniacs have a good response to hypnotics, but feel out of control if they use them continuously.
Two components are involved in maintaining the insomnia - a psychological anxiety and a physiological response to this anxiety, including raised muscle tone and respiratory rate.
A behavioural regimen based on a cognitive-behavioural approach designed to improve sleep quality gradually over a period of 4 - 6 weeks is often helpful.
A hypnotic can be prescribed for use every third night during this regimen - zolpidem and zopiclone are preferred.
Referral to a sleep specialist may be necessary if this approach does not work.
Author Ernest SongSource: SA Pharmaceutical Journal 74, pp 40 –46 (2007)More Less
There are five clinically important hepatotropic viruses, hepatitis A - E.
Hepatitis A and E are spread by the faecal-oral route.
Hepatitis B, C and D are bloodborne.
Their clinical manifestations are protean.
Fatigue is a common symptom of chronic viral hepatitis.
Specific diagnosis depends on serological and molecular testing.
Chronic viral hepatitis is a serious illness which can lead to cirrhosis and liver cancer.
Effective antiviral therapy exists for chronic hepatitis B and C.
Effective vaccines are available for hepatitis A and B.