SA Pharmaceutical Journal - Volume 77, Issue 10, November 2010

It's usually difficult to give you a piece of my mind at this time of year, mainly because there's nothing left in it after a year of trying to cram everything into the limited time that we have available. (Mind you, I get annoyed when people wish for more hours in the day, I'm quite happy with the current 24, thank you. If we had more, we'd be expected to fit more into them and I really don't want to do that.)

"Feel it. It is here." When these words were first introduced to South Africa nobody had any idea what was in store for us. With hindsight, they express the most significant event and experience in our life time. For thirty-one days, we experienced a South Africa that we all aspire to live in - relatively "crime-free" with swift justice, effective public transportation and goodwill on which no price can be put, and some surprises. Who ever thought the vuvuzela would take the world by storm? We also introduced the late Paul, the octopus, to the world. Well, well. If an octopus can be a "seer" and predict the outcomes of games, then maybe there is something in "bone X-Ray" as used by traditional healers to tell people about their lives and sickness!

Pharmacy Week 2010 - your pharmacist holds the key to good health

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THE PSSA / ALPHA PHARM Distance Learning Programme 2010

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Welcoming new members

Obesity is a global pandemic and is associated with many morbidities and early death. Obesity is increasing in prevalence in South Africa. Weight loss has been shown to reduce cardiovascular risks and prolong life. Interventions for weight loss include behavioural and lifestyle modification including diet and exercise, pharmacotherapy, and for the very obese, surgery may be an option. Pharmacists are responsible for informing patients of safe and effective weight loss and weight maintenance programmes which may or may not include pharmacotherapy. There are many herbal and food supplements available that are promoted for weight loss. There is limited evidence on their efficacy and safety but they are purchased and consumed widely, sometimes with deleterious effects.

Patients at high risk for developing type 2 diabetes mellitus often need treatment for one or more chronic conditions. Since conditions such as obesity, hypertension, schizophrenia and depression may increase the risk for diabetes, all additional risk factors need to be minimised. Lifestyle management remains the first step in this process. Control of the chronic condition is the first priority using the least diabetogenic drug or combination as far as possible. Guidelines for treating hypertension in high risk patients are to use a diuretic in combination with either an angiotensin-converting enzyme inhibitor (ACE inhibitor) or an angiotensin II receptor blocker (ARB). Fluoxetine, citalopram and sertralin have not shown an increase in new onset diabetes when used to treat depression. The least diabetogenic drugs to treat psychosis seem to be aripiprazole or ziprasodone. Continuous monitoring, switching when possible to lower risk drugs or sometimes treatment may be necessary to prevent or manage diabetes in these patients.

Vaccination is widely considered one of the greatest medical achievements of modern civilisation. Yet, despite this life-saving innovation, ancient diseases such as tetanus, diphtheria and pertussis still exist in the 21^st century. In this article we review the historical facts, microbiology, pathogenesis, diagnosis, treatment and prevention of tetanus, diphtheria and pertussis in South Africa.

Gastro-oesophageal reflux disease is a common gastrointestinal disease. Patients who suffer from this condition report a broad spectrum of symptoms. The symptom most commonly associated with gastro-oesophageal disease is heartburn (usually experienced behind the breastbone) occurring at least two to three times per week. It usually occurs 30-60 minutes after meals, resolving spontaneously or with the use of antacids. The goal of the treatment of GORD is to provide adequate symptomatic relief, to heal oesophagitis if it is present and to prevent complications from developing. Empirical treatment is often implemented based on an adequate history and presence of the most common symptoms.

Parasitic worms are among the most common human infections in the world. Most patients are unaware of the infection. Adherence to good hygiene practices and provision of adequate sanitation play an important role in decreasing the incidence of worm infestations. Some of the most common worms affecting humans are reviewed in this article.

Both known species of HIV, viz. HIV-1 and HIV-2 originated in Africa (HIV-1 from Central Africa and HIV-2 from West Africa) as zoonotic infections from primate hosts. Human infection is thought to have been facilitated during the slaughtering of primates for the bush meat trade. About 65% of the global total of HIV infection is located in sub-Saharan Africa, with South Africa having the highest number of persons, 5 to 6 million, living with HIV. HIV-1, which is found through out the world and is responsible for the majority of cases of HIV infection, has been subdivided into 10 subtypes A to J (also known as clades or genotypes); within the South African context, reference to HIV implies HIV-1 subtype C. (See Table I.)

Atopic dermatitis (AD), the dermatologic manifestation of the atopic diathesis, has a variety of clinical presentations. It is a chronic and relapsing inflammatory disorder, requiring a multifaceted treatment approach. Topical corticosteroids are the backbone of therapy. However, concerns over adverse drug reactions associated with their long-term application, limit their use.

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Tacrolimus, on the other hand, has been shown to be effective in stabilising the symptoms of AD in the long-term setting, without the side effects that hamper the use of topical corticosteroids. Long-term safety data up to ten years is available in the literature. Despite this, the US Food and Drug Administration (FDA)'s black box warning of possible malignancies has resulted in much debate amongst experts.

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The main focus of this article is to compare the safety and efficacy of topical corticosteroids to calcineurin inhibitors, particularly tacrolimus. Furthermore, the aim is to evaluate the place of tacrolimus in the therapy of AD. A brief overview of the condition and other treatment modalities will also be discussed.

Recently asked questions : drug info

Orlistat (ALLI®) now available OTC

The 2010 public servants strike and mass action brought out the best and the worst in ordinary people. Inherent qualities came to the fore. Colleagues turned on each other, baring teeth and clawing wildly, some to prevent others from presenting for duty and the rest fought to get to workplaces to ensure provision of a service. Hospitals and schools were the worst affected.

The 2010 public sector strike lasted just over 3 weeks ending in the first week in September 2010. For about a month prior to this, the strike had been bubbling underneath. Various unions represented in the Public Service Co-ordinating Bargaining Council (PSCBC) called for 'stay-aways' for a day or two, there were protest marches, demonstrations, picketing, etc. During this time, it was very quiet on the issue of the Occupation Specific Dispensation (OSD) for the Medical Cluster (including pharmacists).

Dr Johann Kruger and Johan Bothma were privileged to represent South Africa at the annual Pharmintercom meeting. The Pharmintercom group is made up of the community pharmacy associations of the major English speaking countries, namely Australia, Canada, Ireland, New Zealand, South Africa, the United Kingdom and the United States of America.

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This year the meeting was held at the Gold Coast in Australia in the beautiful Palazzo Versace hotel.

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We would like to thank (IHD) UTI for their financial support, which made it possible for us to attend this very important meeting.

Pharmaceutical professional organisations, both nationally and internationally, contend that pharmaceutical care should be the defining philosophy of pharmacy practice. In South Africa, the Pharmaceutical Society of South Africa and the South African Pharmacy Council undoubtedly place pharmaceutical care at the heart of the philosophy of pharmacy practice. Research has however demonstrated a seeming opposition or resistance by pharmacists in South Africa, to pharmaceutical care, as both a philosophy and an approach to practice.

About 15 years ago as young and eager academics we published an article in which we tried to indicate that pharmacy training institutions in close proximity to the pharmaceutical industry have better liaison and thus cooperation with industry, leading to 'relevant and problem solving' research which culminated in research publication and thus academic prosperity.

Erratum in September issue of SAPJ, Cum Laude page

The Constitution of the Republic of South Africa (Act 108, 1996) upholds access to healthcare services as a basic human right, further reinforced by the Patients' Rights Charter which endorses patient counselling and information in a language that the patient is able to understand. Effective patient counselling and proper communication between patient and health practitioner are paramount in achieving positive therapeutic outcomes.

Obstructive Sleep Apnoea Syndrome