CME : Your SA Journal of CPD - Volume 21, Issue 2, 2003
Volume 21, Issue 2, 2003
Author Patrick J.D. BouicSource: CME : Your SA Journal of CPD 21, pp 60 –63 (2003)More Less
Many HIV-infected patients have recourse to alternative therapies freely available on the market. <br>Although marketed as immunity-enhancing herbs, not all have been clinically tested specifically in HIV disease. <br>Some therapies should be used with reservation: those which can promote inflammation should be avoided in HIV disease. <br>Due to the numerous micro-nutrient deficiencies which develop in HIV patients, balanced multivitamin intake should be encouraged. <br>Many complementary therapies can be used in conjunction with registered ARVs : the practitioner should be informed of their usage.
Author John StraughanSource: CME : Your SA Journal of CPD 21, pp 66 –72 (2003)More Less
Individual antioxidants are widely advocated for their presumed health benefits. <br>While the theory seems convincing, major clinical studies show no benefits and some show deleterious repercussions. <br>The true Mediterranean type diets have been shown to confer remarkable benefits. <br>We give quite insufficient attention given to such overwhelmingly positive information. <br>Our emphasis should be on actively 'prescribing' a good lifestyle. <br>A good lifestyle includes a daily intake of a diet rich in fruits and vegetables, and with a balanced intake of omega-3 fatty acids, low in saturated fats and trans-fatty acid, with no smoking and with regular physical exercise. <br>The benefits of such a lifestyle can't be mimicked by any 'pill or potion'.
Source: CME : Your SA Journal of CPD 21, pp 74 –77 (2003)More Less
Over-the-counter medications are often taken by adults, and given to children, to relieve minor ailments. <br>Despite being freely available from a pharmacy or supermarket, many preparations are of unproven benefit. <br>Some OTCs have the potential for harm, especially in the young. <br>Health professionals, as well as parents, have a responsibility to be cautious about giving drugs to children.
Author Roger WisemanSource: CME : Your SA Journal of CPD 21, pp 80 –84 (2003)More Less
Inflammation is a defensive and protective response characterised by erythema, pain, heat and oedema. <br>The acute inflammatory response is initiated by tissue injury and mediated by autacoids, namely histamine, serotonin, prostaglandins and leukotrienes. <br>Normal gastrointestinal function depends on a balance between protective mechanisms and acid secretions. <br>NSAIDs upset this balance by inhibiting the COX enzyme ( I and II) which convert arachidonic acid into prostaglandins. <br>NSAIDs which selectively inhibit the COX II enzyme have emerged as effective therapy for inflammatory diseases, while leaving the COX I pathway intact. <br>As they are selective rather than specific inhibitors of COX II, some inhibition of the COX I enzyme still occurs. <br>NSAIDs, should always be used with caution, especially in patients at risk for gastrointestinal complications, fluid retention, heart failure and hypertension.
Author Joe TalmudSource: CME : Your SA Journal of CPD 21, pp 85 –88 (2003)More Less
72% of people taking prescription medication also take OTC preparations. <br>Doctors should be aware of clinically significant drug interactions when prescribing. <br>Habits and OTC preparations which may cause interactions : smoking, alcohol, herbal and complementary drugs, antacids and H2-receptor blockers, antihistamines and antinauseants, decongestants, analgesics, laxatives, bronchodilators, topical preparations. <br>It is critically important to take a comprehensive medication history.
Author Peter SmithSource: CME : Your SA Journal of CPD 21, pp 89 –95 (2003)More Less
Herbal medicines are products which contain exclusively plant material and / or vegetable drug preparations as active ingredients. <br>In the past there has been a move away from plant-based medicine, but a move back to phytotherapy is now evident from statistics on patient spending. <br>The herbal remedies used in South Africa include St John's wort, garlic, kava, ginkgo, saw palmetto, licorice root, valerian, milk thistle and evening primrose. <br>Problems with herbal medicines include: <br>lack of sufficient research <br>quality issues: misidentification, adulteration, substitution and contamination <br>hypersensitivity reactions <br>lack of safety studies in pregnancy and lactation. <br>Misconceptions about herbal remedies: <br>herbals don't work <br>misunderstanding of how one medicine can cure many conditions <br>herbs are dangerous. <br>Practitioners and pharmacists should develop guidelines for advising patients about the use of herbal remedies. <br>Patients must be actively questioned and encouraged to inform practitioners of all herbal remedies they are taking, particularly prior to surgery, or to prescription of other medication. <br>Training of health care professionals, education of patients, improvement of quality assurance, guidelines for claims made for the medications, and reporting of ADRs are all urgently needed.