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INSIDE: INNOVATION • EDUCATION • MANAGEMENT • NEW PRODUCTS • PROFILE

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Pharmac JULY 2017

www.frontshop.co.za

Valuable education for pharmacy staff

MAGAZINE


The Strength of our Immune Product is in the Balance. An underactive or weakened immune system will expose the body to increased susceptibility to infections and disease, therefore there is a definite need to strengthen the immune system; not to boost it or suppress it! The all-natural ingredient EpiCor® found in IMMUNO ARMOUR, has been clinically proven to strengthen the immune system. IMMUNO ARMOUR builds a strong immune system by significantly increasing Natural Killer (NK) Cell activity and antioxidant protection within 2 hours of consumption and helps increase sIgA antibodies, which are important for mucosal health. Marketed by: Kenza Health www.immunoarmour.co.za | Customer Care: 0860 103 359 Refernces: Jensen, G. S.; Redman, K. A.; Benson, K. F.; Carter, S. G.; Mitzner, M. A.; Reeves, S.; Robinson, L., Antioxidant bioavailability and rapid immune-modulating effects after consumption of a single acute dose of a high-metabolite yeast immunogen: results of a placebo-controlled double-blinded crossover pilot study. J Med Food 2011, 14 (9), 1002-10. Jensen, G. S.; Patterson, K. M.; Barnes, J.; Schauss, A. G.; Beaman, R.; Reeves, S.; Robinson, L., A Double-Blind Placebo-Controlled, Randomized Pilot Study: Consumption of a High-Metabolite Immunogen from Yeast Culture has Beneficial Effects on Erythrocyte Health and Mucosal Immune Protection in Healthy Subjects. The Open Nutrition Journal 2008, 2, 68-75.


STUDY: probiotics and diarrhoea cause by antibiotics

JULY 2017

CONTENTS EDITOR'S COMMENT

4

43

A Rand Corporation study found that taking probiotics can reduce the risk of developing the diarrhoea that is a common side effect of taking antibiotics

EDUCATION 10

Mid-year slump

The dry environment of a temperature- and pressurecontrolled airplane cabin can take its toll on your eyes

INNOVATION 6

New Pharmacy Advisory board to drive collaborative change

8

7 Annual SASOCP conference th

Differences in hypertension between the races

39 Flu vaccines: debunking the myths

The complications of hypertension seem to be similar globally but there are differences between black and white patients with hypertension

15

PROFILE

50

12

All about eyebrows

Do eyebrows serve more than a cosmetic purpose?

16 27

Buchu: combat winter ailments naturally

Synonymous with intermittent nocturnal incontinence, enuresis refers to discrete episodes of urinary incontinence during sleep in children ≥5 years of age

18

Know your products

Whether trying to conceive, already pregnant, or breastfeeding, a woman’s body is in need of vital vitamins and minerals

Understanding enuresis

29 Tackling inflammatory skin conditions

CUT OUT & KEEP: OPTIMUM NUTRITION WHEN BREAST-FEEDING

From occasional rashes accompanied by skin itching and redness, to chronic conditions such as dermatitis, rosacea, seborrheic dermatitis, and psoriasis, inflammatory skin conditions come in many forms

30 Don't let hand rashes ruin your winter 31 Exploring anaemia 32 Antimicrobial resistance in vaginal infections

Bacteria vaginosis is the worldwide leading vaginal disorder among women of reproductive age

20

44 CPD: The importance of a balanced immune system

34

OPINION 49 Food for thought

NEW LIFE

Sore eyes on a plane

1 st Run ner-up 2016 Front Shop Assista of the nt year

Krishnie Maharaj – Front Shop Assistant, Dischem Pavillion

“You need to win your customer by providing quality service”

22

The truth about stretch marks

About 90% of women get stretch marks during pregnancy, particularly after the sixth or seventh month

24

Health and wellness

Pregnancy can be an exciting but scary time for customers. Here are 8 products that may help make the lives of new and expectant moms a little easier

Osteoporosis isn't inevitable The best insurance against osteoporosis is building the highest bone density possible by ones 30s and minimising bone loss thereafter

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Pharmacy Magazine JULY 2017 |

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EDITOR’S NOTE

EVENTS JULY 2017

International Group B Strep Awareness Month Corporate Wellness Week

Mid-year slump W ith low energy levels, and compromised

issue to women

immune systems, everyone appears to

on their journey

be feeling the mid-year slump. Winter

to becoming

seems adamant to clinging on rather

new moms:

stubbornly with a rather nasty flu doing the rounds this

· Products ideal

year. Many who managed to avoid it at the beginning of the

during each

season have now succumbed with coughs, sore throats,

of the phases

and runny noses becoming the order of the day. There

to becoming a

has been much debate at our office about whether or not having the annual flu vaccine is the best idea. With this

nutrition when

around the flu vaccine on page 15. We also look at Buchu

breast-feeding

The skin, our largest organ, can take a beating in the colder months of the year. Turn to page 30 for more information on how to prevent hand rashes ruining winter. We also tackle inflammatory skin conditions on page 29.

(page 20) · The truth about (page 22) · Products that may help make the lives of new and Other interesting topics include antimicrobial

the winter weather flying to warmer destinations

resistance in vaginal infections (page 32), and the

during the July holidays we investigate the effects of

fact that osteoporosis is not inevitable (page 34).

the dry environment of a temperature- and

We pause to understand enuresis – or intermittent

pressure-controlled airplane cabin on a person’s

nocturnal incontinence (page 27), before exploring

eyes (page 10). While on the topic of eyes, we explain

anaemia (page 31).

why eyebrows serve more than just a cosmetic

A study has found that taking probiotics can

purpose (page 12). If you’re one of those who aren’t able

reduce the risk of developing the diarrhoea that is a

to get away from the chaos of day-to-day work, it’s a

common side effect of taking antibiotics (page 43),

good idea to find ways to unwind wherever possible.

and while the complications of hypertension seem

Take a yoga class, meet a friend for coffee, or spend

to be similar globally, there are differences between

some time outdoors gardening. Don’t underestimate the

black and white patients with hypertension (page 39).

importance of stopping to take stock of your life.

Finally July’s CPD article focuses on the importance

Recognising the blessing of motherhood as well as the fears and concerns that come with bringing a new baby into the world we dedicate a special section of the July

WORDS TO

LIVE BY

of a balanced immune system (page 45). Editor Nicky Belseck

“Sometimes you’ve got to take a break from all the noise to appreciate the silence” – Robert Tew

FEEDBACK Send your letters and any news or events to nicky.belseck@newmediapub.co.za

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Pharmacy Magazine

18

International Mandela Day

28

AUGUST 2017 15 15 Aug Oct

Bone Marrow Stem Cell Donation and Leukaemia Awareness Month National Women’s Month Organ Donor Month

stretch marks

expectant moms a little easier (page 24)

For those lucky enough to temporarily escape

11

World Population Day

World Hepatitis Day

5

mother (page 18) · Optimum

in mind we debunk some of the more common myths as a natural treatment to winter ailment (page 16).

1

Child Health Month 1 7 World Breastfeeding Week 1 CANSA Care Week

7

6 12 Polio Awareness Week 4 10 Rheumatic Fever and Rheumatic Heart Disease Week National Women’s Day

9

22 27 HPV Vaccination Campaign 26 31 African Traditional Medicine Week


INNOVATION

New Pharmacy Advisory Board

to drive collaborative change

{

T

Pharmacists and pharmacies have an increasingly important role to play in the provision of primary health care services

he multi-stakeholder Pharmacy Advisory

pharmacy stakeholders in a common platform to

Board believes that pharmacists and

identify key challenges and opportunities in training,

pharmacies have an increasingly important

quality and regulatory issues; and help address the

role to play in the provision of primary health

skills shortage in the pharmacy sector by supporting

care services in South Africa.

{

training for pharmacists, pharmacy assistants and

Pharmacists play a vital role in the overall health

front shop assistants. The board will benchmark

care system through the provision of affordable and

South African pharmacy against international best

accessible minor ailments diagnosis and referral,

practice, and help to develop the sector to meet

patient education and screening, and drug information,

changing local needs.

particularly in under-resourced areas.

The Pharmacy Advisory Board further aims to

The new Pharmacy Advisory Board aims to unite

add value to the pharmacists and pharmacies of South Africa by driving insight and education, and facilitating discussion amongst key-opinion leaders in the South African pharmacy sector that identifies key challenges and opportunities, creates multi-stakeholder

To ensure that the board drives inclusive change, the new seven-member board represents stakeholders from various pharmacy sectors and geographic regions 6

| JULY 2017

Pharmacy Magazine


INNOVATION

A new Pharmacy Advisory Board has been constituted to bring together stakeholders across various pharmacy bodies and academia, to seek solutions to challenges facing the South African pharmacy sector.

solutions and implements strategies that drive the board’s vision. Among the proposed measures the Board hopes to facilitate are sponsorships of tertiary institutions and teaching posts, professional development portals for pharmacists and front shop assistants, product training sessions, and the distribution of good pharmacy practice guides and operating procedure manuals. A potential outcome of the new Board’s work will also be to support ongoing and effective communication between the South African Pharmacy Council (SAPC), professional bodies, and pharmacists across South Africa. The new board is supported by RB South Africa, which noted that pharmacy is a key channel for health education and the provision of primary healthcare, and so provided the platform for multi-stakeholder

Pharmacy is a key channel for health education

engagement within the pharmacy sector. To ensure that the board drives inclusive change, the new seven-member board represents stakeholders from various pharmacy sectors and geographic regions.

THE BOARD MEMBERS ARE: Pharmacist, Mirshelle Abrahams; Professor in Pharmaceutical Sciences and South African Research Chair in Antibiotic Resistance, Prof Sabiha Essack; Retail Pharmacist and owner of Synergy Pharmacy, Amaan Kajee ; Pharmacist who runs two retail community pharmacies, Patrick Makhesha; Community Pharmacist and a Director in the Care Group of Pharmacies, Sham Moodley; Community Pharmacist and pharmacy owner, Tobje Nortje; and member of the National Executive Committee of the Pharmaceutical Society of South Africa, Johannes Ravele.

Pharmacy Magazine JULY 2017 |

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INNOVATION

7th Annual SASOCP conference Clinical Pharmacy in South Africa has expanded its wings to liaison with nearly every aspect of health care as was evident last month at the 7th Annual Conference of the South African Society of Clinical Pharmacy (SASOCP)

T

he highlight of the SASOCP calendar, members and other qualified professionals gathered to discuss and explore the developments and achievements of the industry.

SASOCP’s main objectives are to promote and maintain

the highest ethical standards possible in the clinical pharmacy environment. The theme “Passionate about Clinical Pharmacy” was chosen to highlight the foundation of clinical pharmacy and how necessary it is to have the drive to further the profession. Further to this the programme allowed for emphasis on scientific knowledge to help to dispel misconceptions in clinical pharmacy in South Africa and provide a platform for discussion. The conference covered the developing trends in Clinical Pharmacy, like how to tackle challenges in antimicrobial stewardship, practice related issues in clinical pharmacy, medication safety, case reports, drug interactions, and more. It served as a forum of interaction for delegates and generated interest and awareness about the topics highlighted in clinical pharmacy. Three international guest speakers were featured this year, namely Professor Jason Roberts from the University of Queensland, Australia, Mr Mark Gilchrist from the Imperial College in London, and Professor Debra Goff from the Ohio State University joined to the Wexner Medical Centre from the United States.

ABOUT SASOCP The South African Society of Clinical Pharmacists (SASOCP) is a non-profit organisation established by pharmacists with an interest in clinical pharmacy to promote the rational and appropriate use of medicines. All activities of the Society must be considered, directly or indirectly, as patient-oriented. DEFINITION OF CLINICAL PHARMACY Clinical pharmacy is an area of pharmacy involved with the science, practice, activity, and service to develop and promote the rational and appropriate use of medicines, in the interest of the patient and the community. VISION Unify, empower, and promote clinical pharmacy in South Africa. MISSION Provide leadership, education, advocacy, and resources enabling clinical pharmacists to achieve excellence in practice and research. OBJECTIVES · To promote the practice of clinical pharmacy · To promote the interests of clinical pharmacists · To provide a platform for clinical pharmacists’ viewpoints and networking · To develop and provide clinical pharmacy practice guidelines · To provide clinical pharmacy continuing professional development and education · To promote research in clinical pharmacy

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Pharmacy Magazine


LipiTechTM supplements and stabilises the lipid layer of the tear film and reduces excessive tear evaporation

Fast, long-lasting relief from symptoms of burning and irritation associated with dry eye

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An effective way to maintain eyelid hygiene through gentle daily cleansing

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A thicker eye drop to lubricate and restore the ocular surface, protecting it from further damage – day or night

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EDUCATION

Sore eyes on a plane

Although the dry environment of a temperature- and pressure-controlled airplane cabin can take its toll on your eyes, there are a number of things you can do to limit discomfort

1

There are a number of steps that patients can take to reduce the uncomfortable symptoms associated with travellers’ dry eye Since dehydration makes dry

3 4

There are two categories of

to the cabin atmosphere to

artificial tears:

reduce the dryness on the

• Eye drops with preservatives.

flight. Those who suffer with

This type often comes in multi-dose

dry eyes may want to consider seeking

bottles and contains chemicals

out airlines that do this before booking

(preservatives) that discourage

your tickets.

growth of bacteria once the bottle

eye symptoms worse, drink

Artificial tears are used to lubricate

consistently before, during

dry eyes and help maintain moisture on

may irritate your eyes, especially if

and after the flight. If you

the outer surface of your eyes. Such eye

you have moderate or severe dry

enjoy an on-flight alcoholic

drops may be used to treat dry eyes that

drink or caffeinated tea or

result from ageing, certain medications,

coffee, be sure to drink extra

a medical condition, eye surgery, or

type has fewer additives and is

environmental factors, such as smoky,

generally recommended if you apply

or windy conditions.

artificial tears more than four times a

fluids to rehydrate.

2

S

ome airlines add moisture

Apply artificial tears as needed to maintain moisture on the outer surface of your eyes. Turn off the air conditioning vent above your seat and use

has been opened. The preservatives

eyes. • Preservative-free eye drops. This

It’s best to avoid eye drops aimed at

day, or if you have moderate or severe

reducing redness, as they can cause eye

dry eyes. Preservative-free eye drops

irritation when used for a long time.

may come in single-dose vials.

Besides lubricating the eyes, some artificial tears contain electrolytes.

Artificial tears are also available as

These additives may promote healing

non-prescription gels and gel inserts.

of the surface of the eyes. Artificial tears

Fortunately, patients with severe dry

Patients who wear contact

may also contain thickening agents,

eye or patients who are hypersensitive

lenses should switch to a

which keep the solution on the surface

to preservatives now have options of

pair of glasses for the

of the eyes for longer.

preservative-free drops.

an eye mask to protect eyes while sleeping.

duration of the flight to avoid additional dryness that often accompanies contact lens use.

Artificial tears are used to lubricate dry eyes and help maintain moisture on the outer surface of your eyes Pharmacy Magazine JULY 2017 |

11


EDUCATION

DID YOU KNOW? · The average lifespan of an eyebrow is four months, meaning the time it takes for each hair to fall out and new growth to fill in. · The average person has about 250 hairs per eyebrow · Eyebrows are the slowest growing hair on the human body · Brows help us signal emotions, but they’re also on autopilot.

All about eyebrows Dark, light, bushy, smooth, arched, straight, eyebrows come in all sorts of shapes and sizes, and both men and women alike groom them to enhance their overall appearance. But do they serve more than just a cosmetic purpose?

A

s humans have evolved, our body and facial

in human communication and facial expression,” the AAO

hair have diminished, however eyebrows

explains. “Eyebrows can exaggerate expressions such as

and eyelashes have remained a core part of

happiness, surprise and anger.”

our features. And while we wax, tweeze, and

even dye them, do eyebrows play a more important role

FACIAL RECOGNITION

than just our foremost eye accessory? Researchers and

A study by Massachusetts Institute of Technology (MIT)

ophthalmologists believe there is a biological, or functional

behavioural neuroscientist Javid Sadr and his colleagues

reason we have hair above and around our eyes.

found that people had more trouble correctly identifying the faces of people they knew when they were presented

As the pitch of your voice rises, so do your eyebrows and vice versa

PROTECTION

with images of them missing their eyebrows. This led them

According to the American Academy of Ophthalmology

to conclude that brows may be more important for facial

(AAO) the curved, delicate hairs above our eyes are

recognition than eyes themselves.

believed to channel unwanted moisture – sweat and rain · According to the book Amazing Face Reading by Mac Fuller, J.D., the type of eyebrow you have defines who you are. Curved eyebrows indicate someone

in particular – away from the eye to help keep vision clear.

MYTH

“The shape and direction of the hairs make it easier for

The most common myth about eyebrows is that once

moisture to flow sideways around the eyes, along the side

you’ve over-plucked, your eyebrows won’t grow back.

of the head. They also help to block out light and filter dust

While excessive plucking, rubbing eyebrows from habit,

and dirt that may fall into the eyes.”

or applying aggressive skincare treatments can cause eyebrows to fall out, for a healthy young adult the average

who is people-

EMOTION AND COMMUNICATION

oriented and needs

“Experts also believe that eyebrows play an important role

time for tweezed hair to grow back is 56 days.

real-world examples

COLOURING EYEBROWS

to understand a

Never colour eyebrows with at-home box colour that’s

problem, while straight

designed for dying hair. The peroxide levels that at-home

eyebrows imply that

colour contains are just too intense for the brow and eye

someone is more

area and can actually burn the skin, cause the eye area to

direct, factual, and

become red, and create a burning sensation in the eyes. It

logical, thriving on

is important to only use dyes and tints specially designed

technical details.

for eyebrows.

Angled eyebrows, Fuller says, show someone who likes to be right and strives to be mentally in-control, no matter the situation.

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Pharmacy Magazine

Eyebrows move moisture away from eyes and help identify individuals


She’s got 99 problems but her brows ain’t one. Even customers wearing the most original out ts want their look s to be individual and type-matching. When creating these looks the style of brows and lashes is as i mportant as the hair colour.

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EACH GENERATION LIVES LONGER THAN THE ONE BEFORE 1 TODAY

Medical advances have helped to increase life expectancy 2,3

A newborn can expect to live 100+ years

Modern lifestyles, diet and ageing have led to a rise in lifestyle diseases 4-9

The increasing burden of lifestyle diseases

means

‘healthy’ life expectancy has not increased at the same rate as life expectancy

creating

THE LONGEVITY GAP 10

GEN100™

MERCK CONSUMER HEALTH’S WE100TM MOVEMENT EXISTS TO HELP PREPARE SOCIETY FOR A NEW ERA OF HUMANS LIVING A POTENTIAL HEALTHY 100 YEARS

is an educational TM programme under the WE100 movement, which aims to assist the current young generation of South Africa to develop the skills to make healthy lifestyle choices and live a potential healthy 100 years.

GEN100™

The educational programme is currently being piloted in 40 primary and high schools in Gauteng. It has been received with much enthusiam by learners, teachers and principals.

Encourage your patients to

JOIN GEN100 TODAY TM

References: 1. He W, Goodkind D, Kowal P. U.S. Census Bureau. An Aging World: 2015. International Population Reports. [Online] 2015 [cited 2017 Mar 15]. Available from: URL: https://www.census.gov/content/ dam/Census/library/publications/2016/demo/p95-16-1.pdf 2. Bunker JP. The role of medical care in contributing to health improvements within societies. Int J Epidemiol 2001;30(6):1260-1263. 3. American Hospital Association. When I’m 64. How Boomers Will Change Health Care. [online] [Cited 2017 Mar 29]. Available from: URL: http://www.aha.org/content/00-10/070508-boomerreport.pdf 4. World Health Organization (WHO). Global Health and Aging. [online] [Cited 2017 Mar 29]. Available from: URL: www.who.int/ageing/publications/global_health.pdf 5. World Health Organization (WHO). Obesity and overweight. [online] [Cited 2017 Mar 29]. Available from: URL: http://www.who.int/mediacentre/factsheet/fs322/en/ 6. World Health Organization (WHO). Global status report on noncommunicable diseases 2010. [online] [Cited 2017 Mar 29]. Available from: http://www.who.int/nmh/publications/ncd_report_full_en.pdf 7. Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A. Growing epidemic of coronary heart disease in low-and middle-income countries. Curr Probl Cardiol 2010;35(2):72-115. 8. Peltzer K, Phaswana-Mafuya N. Hypertension and associated factors in older adults in South Africa. Cardiovasc J Afr 2013;24(3):67-72. 9. Dalal S, Beunza JJ, Volmink J, Adebamowo C, Bajunirwe F, Njelekela M, et al. Non-communicable diseases in sub-Saharan Africa: what we know now. Int J Epidemiol 2011;40:885–901. 10. Stanner S, Denny A. Healthy ageing: the role of nutrition and lifestyle – a new British Nutrition Foundation Task Force Report. Nutr Bull 2009;34:58-63. Merck (Pty) Ltd. Reg. No.: 1970/004059/07. 1 Friesland Drive, Longmeadow Business Estate South, Modderfontein, South Africa, 1645. Tel: +27 (0) 11 372 5000 /Fax: +27 (0) 11 372 5252. Report adverse events to drug. safety.southeastafrica@merckgroup.com or +27 (0) 11 608 2588 (Fax Line). SNA-OTH-1705-0156 May 2017(2).

supported by


EDUCATION Source: CDC

Flu vaccines: debunking the myths According to the World Health Organization (WHO), the influenza virus infection is responsible for between 250 000 and 500 000 deaths per year globally There are many misconceptions surrounding flu and

WHEN TO GET VACCINATED

the vaccine. Here are a few that have been discredited.

Flu vaccines cause antibodies to develop in the

Myth: Flu is not that serious. Fact: Flu is a severe and possibly life-threatening disease that kills hundreds of thousands of people

body about two weeks after vaccination. These antibodies provide protection against infection from the viruses that are contained in the vaccine. The vaccine increases a person’s defence against

worldwide every year.

the influenza virus.

Myth: It is natural and almost

viral components into the body. These components

It works by introducing very small amounts of

expected to get the flu every year.

are enough to stimulate the production of antibodies

Fact: Flu can be avoided by getting the flu vaccine.

(cells designed to attack that particular virus), which

Myth: The flu shot causes flu.

virus in the future. The vaccine is used to prevent

Fact: Only minor side effects might occur, such as a headache or a low-grade fever.

Myth: The flu vaccine is only for the elderly and high-risk patients.

Fact: Flu affects people of all ages. Those who are

will remain in the body ready to attack that same influenza and is developed for those who want to reduce their chances of contracting the flu. “The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season,” explains the Independent Community Pharmacy Association (ICPA).

particularly at risk are pregnant women, the elderly, those with a compromised immune system, people

OTHER WAYS OF AVOIDING FLU

suffering with cardio-vascular disease, young

South Africans can also take some basic hygiene

children and diabetics

steps to protect themselves and their families

Myth: I was vaccinated last year so

from coming down with the flu. Take the necessary precautions by washing your hands often, covering

don’t need to be vaccinated again.

coughs and sneezes with a tissue and stay at home

Fact: Every year a new vaccine is manufactured

when you are ill so that you don’t spread germs.

based on that year’s prevalent flu strains that are circulating. You are only safe if you are vaccinated every year.

The ICPA concludes that if you think you’re coming down with a bug, and especially if you have a fever, rather wait until you’re feeling better before being vaccinated.

Flu vaccines cause antibodies to develop in the body about two weeks after vaccination

Pharmacy Magazine JULY 2017 |

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EDUCATION

Buchu: combat winter ailments naturally Some health problems, such as colds, flu, dry skin or eczema, arthritis, and back pain are triggered or aggravated by the cold weather we experience in the winter months. Here’s how to help the body deal with these cold weather ailments

1 2 3 4

COLDS AND FLU

turn a bout of flu into full blown pneumonia.

The common cold, including chest and head

Supplementing with a natural anti-inflammatory

cold, as well as seasonal flu are caused by

such as buchu, can assist in the prevention of

viruses. While flu symptoms are similar to that

inflammation which is responsible for worsening

of cold symptoms, they include fever, headache,

the degree of one’s illness significantly. Buchu

and muscle soreness. With one’s immunity at

is also a source of vitamin A, an ideal vitamin in

a low point once targeted by the flu virus, you

the guard against viral infections such as cold

are left susceptible to inflammation which can

and flu.

PAINFUL JOINTS – RHEUMATIC DISEASE

or more of the bone joints being inflamed.

Arthritis and other rheumatic diseases are a

Quercitin, a naturally occurring antioxidant

family of illnesses that can cause inflammation

in buchu, has proven to be highly successful

in the joints and pain in the surrounding

in aiding the relief of arthritis pain as it has

structures. Arthritis is a serious auto-immune

demonstrated impressive anti-inflammatory

disease or joint disorder that involves one

properties.

DRY SKIN OR ECZEMA

which has potent anti-inflammatory, antifungal

Eczema is a recurring, non-infectious,

and antibacterial properties, assists in the

inflammatory skin condition characterised

successful management of eczema in

by itchy, dry, inflamed, flaky, and reddened

addition to bringing immediate relief to

skin. Extensive scientific research has

the inflammation and itchiness symptomatic

proven that formulated organic buchu oil,

of eczema.

URINARY TRACT INFECTIONS

pyelonephritis, ultimately causing kidney damage.

The winter season sees a surge in urinary tract

According to Karin McCann of Cape Kingdom

infections (UTIs) due to the consumption of

Nutraceuticals, “Often our go to response for

less water. Buchu herbal tea can be ingested

the treatment of winter illnesses, aches and

consistently to reduce symptoms as it has been

pains is to treat it with chemical drugs such as

known to remedy and aid the pain caused in

antibiotics and anti-inflammatory medications.

the urinary tract system as it has natural

While these have their place, it need not be

anti-septic and mild diuretic properties. If not

our first port of call when we have access to

treated correctly, a UTI could damage the kidneys

products harnessing the medicinal benefits

resulting in a more serious infection called

of a plant such as buchu.”

WHAT IS BUCHU Buchu is a Fynbos shrub that is indigenous to South African and has a long history of use in traditional herbal medicine. Buchu is a powerful natural resource which, due to naturally occurring components such as quercetin, rutin, hesperidin, diosmin (bioflavonoids), diosphenol, and vitamins A, B and E yields fantastic results without any harmful side effects in keeping illness at bay during the winter months.

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Pharmacy Magazine


Y E A RS

T WENT Y

SADAG

MENTAL HEALTH FACT SHEET

LIFE-TIME PREVALENCE OF MENTAL DISORDERS IN SA Compared with 14 other countries in the WMH Survey, South Africa is the:

2nd highest for substance abuse disorders (13.3%) 6th highest for anxiety disorders (15.8%) 7th highest for mood disorders (9.8%) PATIENT ADHERENCE AT A GOVERNMENT HOSPITAL

MENTAL HEALTH IN SOUTH AFRICA • 3rd biggest contributor to the burden of disease • 7.7% reduction in mental hospital beds across all provinces • 11% of all non-natural death in SA is due to suicide • 16.5% of South Africans suffer from common mental health problems • 43.7% of people with HIV/AIDS have a mental health condition • 75% of clinic staff does not have a caring attitude • South Africa is in the bottom 4 countries providing mental health treatment

Only 15.4% of patients take their meds as suggested by their dr 1 in 3 patients do not attend their dr’s appointments • Most common reasons are +/- 6 mil South African suffers from PTSD • Forgetfulness 28.6% +/- 8000 South Africans commit suicide each year • Lack of Support 24.2% • Adverse reactions 13% 82.1% cannot afford private health care • Unavailability 11% > 1% of health budget devoted to mental health

SOCIAL BURDEN FOR MENTAL HEALTH PATIENTS

Can’t take care of dependants

Separated/ Divorced

Lost friends

Negative Family Relationships

17%

26%

47%

49%

SEEKING TREATMENT FOR MENTAL HEALTH

RESOURCES FOR MENTAL HEALTH Per 100,000 of the population there are: 9.72 Nurses 0.4 Social workers 0.27 Psychiatrists 0.32 Psychologists 2.8 beds for in-patients 1% beds for children

Research compiled by SADAG – References: DoH, 2012; WHO, 2012, SASH, 2009; MHaPP, 2007; Freeman, 2007; MRC, 2006; ALLERS, 2009; Janse van Rensburg, 2013


EDUCATION

Know your products

Pregnancy Whether a patient is trying to conceive, is already pregnant, or has given birth, her body is in need of vital vitamins and minerals. While eating a healthy, varied diet will help to get most of the vitamins and minerals needed, we look at one product ideal during each of the phases to becoming a mother

S0 PRODUCT:

Vitabiotics Pregnacare® Conception INDICATION: Vitabiotics Pregnacare® Conception S0 PRODUCT:

is specially formulated with nutrients

LactOcare® Breastfeeding supplement

to maximise your chances of falling pregnant. It contains key elements, like folic acid and zinc, to promote good reproductive health.

150µg Biotin, 6mg Pantothenic Acid, 60mg Magnesium, 14mg Iron,

INGREDIENTS:

15mg Zinc, 1 000µg Copper,

Each tablet contains

50µg Selenium, 140µg Iodine.

100mg L-Arginine, 50mg Inositol, 50mg N-Acetyl Cysteine,

DOSAGE:

3mg Betacarotene, 15µg Vitamin D

One tablet per day with your main

(as D3 600iu), 30mg α-TE Vitamin

meal. Swallow with water or a cold

E, 90mg Vitamin C, 8mg Thiamin

drink. Not to be chewed. Do not

(Vitamin B1), 5mg Riboflavin

exceed recommended intake. To

(Vitamin B2), 20mg NE Niacin

be taken on a full stomach.

(Vitamin B3), 10mg Vitamin B6,

www.pregnacare.co.za

400µg Folic Acid, 20µg Vitamin B12,

011 454 3257

INDICATION: LactOcare® Breastfeeding supplement has been specifically formulated to meet the nutritional requirements of new moms. INGREDIENTS: Each multivitamin and mineral tablet contains: 2 666iu Vitamin A, 2mg Vitamin B1, 2mg Vitamin B2, 20mg Vitamin B3, 7mg Vitamin B5, 2mg Vitamin B6, 2.8µg Vitamin B12, 75mg Vitamin C, 200iu Vitamin D3, 35µg Biotin, 150mg Calcium, 10.3mg Cholien, 1mg Copper (from Amino Acid Chelate),

S0 PRODUCT:

500µg Folic Acid, 15mg Iron

Chela-Preg

(from Amino Acid Chelate), 30mg Magnesium, 60µg

INDICATION:

Selenium (from Amino Acid

Chela-Preg is a complete ™

Chelate), 20mg Zinc.

vitamin and mineral supplement

Each Omega-3 capsule

specifically formulated for

contains: 822mg Total Omega-3

pregnant women. It therefore

fish oil, providing 260mg DHA,

contains essential nutrients

91mg EPA. Lemon oil added as a

including iron (FerroChel ), ®

masking agent to prevent reflux.

calcium, and folic acid. Chela-Preg™ is recommended

50mg Vitamin C, 400iu Vitamin D3,

before, during, and 3 months

500µg Folic Acid, 130mg Calcium,

DOSAGE:

after pregnancy, while the

150µg Copper (chelate form),

Take one multivitamin and

mother continues to breastfeed.

15mg FerroChel Iron (chelate form),

mineral tablet and one omega-3

0.5mg Magnesium, 0.085mg Zinc.

soft gel capsule daily with

®

a meal, as directed by your

INGREDIENTS: Each tablet contains 1 000iu

DOSAGE:

healthcare provider. Do not

Vitamin A, 3mg Vitamin B1,

Take 1 tablet daily after meals.

exceed the recommended dose.

2mg Vitamin B2, 10mg Vitamin B3,

www.ascendis.co.za

www.georen.co.za

1mg Vitamin B6, 2 µg Vitaminn B12,

011 036 9423

011 087 0000

18

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Pharmacy Magazine


EDUCATION

NEW

LIFE

Folic acid is important for pregnancy, as it can help to prevent birth defects known as neural tube defects, including spina bifida

{

Low levels of vitamin D during pregnancy are associated with an increased risk of complications including gestational diabetes, preeclampsia, and low birth weight of newborns

{ Pharmacy Magazine JULY 2017 |

19


EDUCATION

NEW

LIFE

CUT& OUTEP KE

As soon as they fall pregnant mom’s-to-be are advised to start taking nutritional supplements to help meet their increased nutritional needs

OPTIMUM NUTRITION WHEN BREAST-FEEDING

D

ietician, Andrea du Plessis advises that

the mother’s body will ensure that her milk, and thereby

nutrition during breast-feeding is vitally

the growing baby, receive the necessary nutrients.

important, for the mother as much as for the baby. The energy, protein, and other nutrients

The mother’s own energy and nutrient reserves will suffer, a process called maternal depletion. All breast-

in breast-milk come from the mother’s diet or from her

feeding mothers should therefore know how to optimise

body stores. If there are nutritional shortages at this time

their nutritional intake for optimal health.

NUTRITIONAL RECOMMENDATIONS DURING BREAST-FEEDING MAGNESIUM

ZINC

VITAMIN B2

VITAMIN B6

VITAMIN B12

RDI: 1 300mg per day

RDI: 310mg

RDI: 12mg

RDI: 1.3mg

RDI: 2mg

RDI: 2.8µg

Function: Building

Function: Helps with

Function: Formation of

Function: Energy

Function: Supports

Function:

material for bone as

calcium absorption,

DNA (genetic material),

metabolism

protein metabolism

Important for

well as maintenance

building of bone

tissue formation and

assists growth and

that forms part of the

division of blood

of the mother’s bone

tissue and muscle

maintenance in mother

development of

growth of new body

cells and may help

density

development and

and baby

new body tissues in

tissues in mother and

in the prevention of

Sources: Dairy

functioning

Sources: Lean meat,

mother and baby

baby

anaemia

products, tinned

Sources: Dark-green

seafood, whole grains,

Sources: Whole

Sources: Eggs, lean

Sources: Lean

sardines (bones),

leafy vegetables,

dried beans, eggs

grains, breakfast

meat, whole grains,

meat and poultry,

anchovy paste,

legumes, sardines,

cereals, dairy, eggs,

nuts, dairy

dairy, eggs

dark green leafy

breakfast cereals, lean

legumes, nuts, green

vegetables, almonds.

red meat, nuts

vegetables

Since it is unlikely that optimal daily dietary intake of calcium will be achieved, supplementation is highly recommended

20

| JULY 2017

{

DID YOU KNOW? Since it is highly unlikely that new moms will be able to achieve sufficient calcium intake to meet the increased needs resulting from breast-milk production, supplementation is vital. To ensure optimal nutritional value, calcium supplements should be formulated with magnesium and vitamin D

Pharmacy Magazine

{ ✂

CALCIUM


EDUCATION

NEW

LIFE

Stretch marks: the truth

Stretch marks can be a cause of concern for anyone that develops them. More than just an aesthetic problem, stretch marks, especially when severe, can dampen a person’s self-confidence

S

tretch marks, medically known as striae,

quick muscle development, commonly develop

are smooth, white, scar-like lesions that

stretch marks on their arms, chests, buttocks, and

are caused when skin changes shape more

thighs due to rapid skin expansion to accommodate

rapidly than it is capable of and, as a result,

tears and scars. They often develop during pregnancy, sudden weight gain or loss, and adolescence. Striae tend to occur in parts of the body where there is a high concentration of fat like on the abdomen,

new muscle development. · PUBERTY: Teenagers and preteens commonly develop stretch marks during puberty due to growth spurts that cause skin to stretch rapidly. · WEIGHT GAIN OR LOSS: When weight is gained

thighs, breasts, and armpits. Some people develop

or lost rapidly, skin will expand or contract to

stretch marks that are almost invisible while some

accommodate for the amount of fat present beneath

develop marks that appear like deep scars often even

the skin. Because of this, gaining or losing weight

pinkish, reddish or, purplish but the colour eventually

rapidly can result in stretch mark formation on any

fades to white or silvery. That said, stretchmarks

part of the body.

don’t heal on their own regardless of how much time passes after originally appearing.

FAST FACTS · Genes play an important part in determining

WHO’S AT RISK FOR STRETCH MARKS? Because stretch marks are a common concern for pregnant women, many people believe that only pregnant women are at risk for developing stretch marks. However, stretch marks can develop on anyone regardless of gender or age. Stretch marks commonly develop under the following conditions:

whether or not a person will develop stretch marks. · Though the stomach is the most common location for stretch marks, they can also appear on other parts of the body such as the breasts, thighs, calves, buttocks, lower back, upper arms, and elbow and knee creases.

· PREGNANCY: Stretch marks commonly develop on a

· Though rare, certain health conditions such as

pregnant woman’s belly and breasts due to the rapid

Marfan syndrome, Cushing’s syndrome, and

growth in those areas during pregnancy.

prolonged use of topical corticosteroids can also

· WEIGHT LIFTING: Male and female body builders, especially those using supplements to promote

cause stretchmarks · Stretch marks initially appear as red, pink, or reddish-brown lines. This is actually the colour of blood vessels showing through the tearing of the

About 90% of women get stretch marks during pregnancy, particularly after the sixth or seventh month

dermis (middle layer of skin). Gradually, as the blood vessels contract, the reddish streaks go on to become white or silvery lines due to the palecoloured fat beneath the skin. · Although stretch marks can fade and lighten with certain treatments and remedial measures stretch marks are caused by skin trauma on the dermis, which is the second layer of the skin, they are scars, so they cannot be eliminated completely. · The most important tip experts make to help prevent stretch marks is to keep skin ultrahydrated when stretching of the skin is expected, particularly during pregnancy. Regular exercising is also recommended to tighten the skin to make the skin more elastic and therefore more capable of withstanding tears when stretched most especially when extreme weight gain or weight loss is expected, such as during pregnancy or dieting.

22

| JULY 2017

Pharmacy Magazine


FCB CAPE TOWN 10013061CT/E

K PAC NEWESIGN D

Introducing the newest addition to our family. Happy Event Fragrance Free. Happy Event understands that different moms have different needs. That’s why consumers now have the choice between the tried and tested original formula, as well as the brand new Fragrance Free variant. The packaging has also been updated for a fresh new look. The formula still contains the same blend of emollients, olive oil and vitamin E and A to help regenerate your skin and regulate its moisturising process, helping consumers keep their skin smooth and supple through all stages of pregnancy.

www.happyevent.co.za

For more information on these and other quality brands, contact your nearest A .J. Nor th of fice: Cape Town: (021) 532 2113 • Johannesburg: (011) 680 5210

or www.ajnor th.co.za


EDUCATION HEALTH & WELLNESS

New life

{

Pregnancy can be an exciting but scary time for customers. There is so much information out there that it can seem overwhelming. Which supplements to take, dealing with cramps, struggling to fit into clothes as the baby grows, heartburn, exhaustion, stretchmarks, the list is endless. Introducing pregnant women and new moms to products that may help make their lives easier can help ease some of the uncertainty. Here are eight potential products to consider.

The amount of blood that is pumped by the heart

increases by 40-50%

when a woman is pregnant

{

Hormones play a big role in pregnancy. Progesterone is nature’s sedative. It gives you a natural lethargy to make sure you don’t do anything strenuous that may affect the developing foetus

TIME OUT:

NEUTRALISE ACID:

As the baby grows,

Oh So Heavenly™ Mum & Cherub Bath Soak

heartburn and

Steal a moment for

indigestion are

some much needed

common complaints

and well-deserved

in most pregnancies.

‘me-time’ as you soak

Soothing, protecting,

in a warm bath filled

and neutralising acid,

with Oh So Heavenly™

Gaviscon® Plus Tablets

Mum & Cherub

are for the treatment

decadent, creamy

of symptoms of

bath soak. Lovingly

gastro-oesophageal

created for moms

reflux such as

and moms-to-be, the

acid regurgitation,

unique formulations

Gaviscon Plus Tablets

Tummy Tucker®

skin product, Happy

Carriwell Seamless Preggy Belly Bando™

Post Pregnancy Belt

Event has helped

The essential super

assists with tightening

moms-to-be prevent

stretchy seamless

and reducing your

stretchmarks for

belly band that

post preggie tummy.

over 50 years. Happy

turns regular wear

Designed for a

Event understands

into maternity

woman’s body, by

that moms have

wear providing an

a mother, Tummy

different needs which

inexpensive alternative

Tucker® is easy to wear

is why they’ve added a

to maternity pants

with adjustable Velcro,

fragrance free variant,

and skirts. Covers

soft and breathable

a tried and tested

unbuttoned pants,

fabric. It helps lose a

formula of emollients,

skirts, and shorts

post-pregnancy belly

olive oil, and vitamin

allowing you to wear

fast while reducing

A and E, blended in

your normal clothes

water retention and

harmony to keep

throughout your

stretch marks. Discreet

skin soft and supple

pregnancy. Light

under clothing,

through all stages of

support in a unique

pregnancy and beyond.

soft seamless fabric

Happy Event

®

circulation within the internal organs, and provides much needed and comfort after

Boasting a new, updated contemporary look Happy Event remains the same trusted product.

having birth.

24

| JULY 2017

Pharmacy Magazine

www.carriwell.co.za

www.cocodrama.com

the belt increases

abdominal support

A trusted antenatal

www.happyevent.co.za

Tummy Tucker by Coco Drama

CLOTHING SOLUTION:

NO STRETCHMARKS:

Preggy Belly Bando™ is the perfect solution to bridge the gap when tops become too short to cover your tummy.

www.gaviscon.co.za

BELLY SUPPORT:

heartburn, and indigestion.

www.ohsoheavenly.co.za

®

are enriched with a combination of natural active ingredients to work in harmony with your skin as it grows and changes.


EDUCATION HEALTH & WELLNESS

NEW

LIFE

DAILY SUPPLEMENT:

Preg Omega® Plus and minerals, omega-3 fish oil, and extra calcium, Preg Omega® Plus is the ideal COMBAT CRAMPS:

all-in-one supplement before, during, and

Slow-Mag® Fizzies

after pregnancy.

Pregnant and breastfeeding women often experience leg cramps. Slow-Mag® Fizzies not only assist in treating this, but also improves energy

www.slowmag.co.za

levels, reduces fatigue, irritability, anxiety, panic attacks, and insomnia, while easing and preventing general muscle cramps and pain.

WINGED COMFORT:

Lil-lets® essential thick pads Designed by women, for women, Lil-lets® essential thick pads with wings for extra security have cotton soft cover for added comfort, and side www.lil-lets.com

www.inovapharma.co.za

With folic acid, vitamins

channels to help prevent leakage. Individually wrapped the pads are shaped for comfort.

Pharmacy Magazine JULY 2017 |

25


W E N

Is bedwetting keeping your child up at night? Then try NEW DryNites® Pyjama Pants to help your child manage this phase by providing secure, comfortable overnight protection. Discreet, looks and feels like underwear Super absorbent for a growing child Soft stretchy sides for a comfortable fit Especially designed with silent material

4-7 YEARS

8-15 YEARS

17-30kg

27-50kg

Looking for more information? Ask Dr Michael Mol: www.drynites.co.za

AVAILABLE AT SELECT INDEPENDENT PHARMACIES, CLICKS AND TAKEALOT.COM


EDUCATION Source: Swedish Enuresis Academy www.svenskaenures.sa

{

{

Many bedwetting children suffer from low self-esteem, which may be socially handicapping

Understanding

enuresis

Enuresis (synonymous with intermittent nocturnal incontinence) refers to discrete episodes of urinary incontinence during sleep in children ≥5 years of age HOW COMMON IS IT?

HOW DO WE TREAT IT?

Bedwetting, or enuresis, is very common. It afflicts 5-10%

GENERAL ADVICE

of children below the age of ten years, and a few per

Many families have tried to solve the problem by not

cent of older children and teenagers as well. It is equally

allowing the child to drink in the evening or by waking him/

common in all cultures and among all social groups. Boys

her up during the night. These strategies are usually not

are more often affected than girls.

effective.

WHAT ARE THE CAUSES?

voiding habits; this means that the child should go to the

The old ideas about enuresis as a psychiatric disorder

toilet six times per day (when getting up, mid-morning, at

are false. Usually neither the parents nor the child him/

lunch, early afternoon, at dinner and at bedtime) and drink

herself is to blame. Modern research has shown that

extra water in the morning and day.

A better idea is to give the child sound drinking and

bedwetting has three major causes:

1 2

3

bedwetting children are difficult to arouse from sleep, the kidneys of many bedwetting children produce too much urine during the night, and the urinary bladder may be too “irritable” and contract too easily. Furthermore, enuresis is often inherited.

5-10% of children below the age of ten years suffer from enuresis

Bedwetting children who suffer from day-time incontinence as well should receive help for the latter condition first, before the enuresis is addressed. The parents must explain to the child that the bedwetting is not his/her fault. It is of utmost importance that the child doesn’t restrict its social activities because of the bedwetting. ACTIVE TREATMENT

IS ENURESIS HARMFUL?

There are two first-line treatment alternatives with proven

The body is not harmed by bedwetting. Sleeping in

effect: the enuresis alarm and the drug desmopressin.

wet sheets does not, for instance, cause urinary tract

The alarm is a device that by sending off a sound signal

infections. But many bedwetting children suffer from low

when the child wets the bed gradually teaches him/her

self-esteem, which may be socially handicapping.

to recognise the body’s own signals, while desmopressin reduces the amount of urine produced at night by the

DOES ONE “GROW OUT OF IT”?

kidneys. Approximately 75% of all bedwetting children

Yes, the problem will usually go away by itself, but it may

become dry by these methods; the remainder should

take many years. Thus, for a bedwetting child six years

seek help from a paediatric clinic, where more advanced

old or more, who is bothered by his/her predicament,

therapy can be offered. Almost every child with enuresis

active treatment should definitively be started.

will become dry with correct treatment. Pharmacy Magazine JULY 2017 |

27


Stand a chance to win a Cetaphil® hamper worth R500 for winter Answer the following question:

Cetaphil® Restoraderm™ Skin Restoring Body Wash & Moisturiser are specifically formulated for the treatment of very dry, itchy skin (Eczema)?

True or False

SMS your answer to: 071 140 8209

Cetaphil® Restoraderm™ Body Wash and Body Moisturiser, are both clinically proven to moisturise dry, itchy skin. • Hypoallergenic. • Fragrance free. • The range is suitable for both children and adults.

Everyday skin resilience Full product information on Cetaphil® RestoradermTM is available from Galderma Laboratories South Africa (Pty) Ltd., Co. Reg. No.: 1996/000311/07, PO Box 71150, Bryanston, 2021. Tel.: (011) 706 2339. www.galderma.com CET 1602-07. Final approval date: 02/03/2016.


EDUCATION

{

Treating infection in atopic eczema is very important, since 90% of the flare-ups are due to S. aureus

{

Tackling

inflammatory skin conditions Inflammatory skin conditions are the most common problem in dermatology. They come in many forms, from occasional rashes accompanied by skin itching and redness, to chronic conditions such as dermatitis (eczema), rosacea, seborrheic dermatitis, and psoriasis

I

n the atopic dermatitis patient, S. aureus colonises

antibiotic is recommended as first-line therapy in atopic

skin lesions in at least 90% of patients. It releases

dermatitis as the steroid component treats inflammation

potent exotoxins (superantigens) damaging the

and the fusidic acid component treats S. aureus infection.

epidermis and causing exudates.

The combination cream/ointment penetrates normal, damaged and avascular skin. Within 30 minutes, fusidic

TREATMENT STRATEGY

acid reaches the deepest skin layer at 18 times MIC of

Treatment will address dry skin, itch, eczema, infections,

target bacteria. It is highly active against Gram-positive

and other complications. Basic local treatment includes

bacteria, which are the main pathogens causing bacterial

emollients. The first choice is topical corticosteroids. The

skin infections, particularly S. aureus, including MRSA and

second is immunomodulatory agents. One must always

vancomycin-resistant isolates over many years of use.

consider infection in these cases.

It is often effective against bacteria which have multiple

Complications include hand and foot warts, molluscum contagiosum, and chronic hand eczema. Approximately

resistance against other antibiotics. When a combination therapy of topical steroid plus an

40-50% of patients with irritant hand dermatitis had

antibiotic is applied, there is a dramatic increase in the

atopic eczema as a child. Treating infection in atopic

elimination of S. aureus and in the primary efficacy criteria

eczema is very important, since 90% of the flare-ups are

for atopic dermatitis compared to the application of

due to S. aureus. Topical treatment with a combination

corticosteroid cream or topical antibiotic alone.

drug is recommended. The fusidic acid molecule has a corticosteroid-like ring system with no hormonal or anti-inflammatory activity. It

The degree and frequency of flare ups may also be reduced. This reduces the systemic use of antibiotics. Combination therapy formulations feature deep

has good skin and bone penetration. It is chemically very

penetration into the skin layers. Fusidic acid is very

distinct to other antibiotics, with no cross resistance.

effective against S. aureus resulting in rapid healing of

The steroid-like structure enables fusidic acid to exhibit a high degree of skin penetration similar to that of steroids. A combination therapy of topical steroid plus an

Approximately 40-50% of patients with irritant hand dermatitis had atopic eczema as a child

skin and soft tissue infections. There is a low allergenic potential and a choice of formulations and steroid potencies, suitable for a variety of patients. Pharmacy Magazine JULY 2017 |

29


EDUCATION

Don’t let hand rashes ruin your winter Hand rashes can be frustrating, especially when the cause of the rash is unknown. Was it a new brand of hand soap? Eczema? Or just really dry skin?

A

ccording to dermatologists from the American Academy of Dermatology, it could be any of these things and more. Hand rashes, they say, commonly occur because of something you touched or something

happening inside your body. “There are many reasons for hand rashes,” said Melissa Piliang, MD, FAAD, a board-certified dermatologist at the Cleveland Clinic in Ohio. “The most common cause is eczema, but some hand rashes may have an allergic cause. Sometimes, an allergy can develop after years of touching the same things daily without a problem, like your wedding ring, skin care products, or foods such as fish, garlic or citrus fruits.” TO HELP PREVENT A HAND RASH, DR PILIANG RECOMMENDS THE FOLLOWING TIPS: · Wear task-appropriate, protective gloves. Harsh chemicals, such as dyes and detergents, and even water can irritate your skin and cause a hand rash. To protect your hands, wear gloves while gardening or doing housework. Remember to replace gloves that develop a hole, and never wear wet gloves. · Wear warm gloves in cold temperatures. Cold weather can be very drying to your hands, making it a good idea to wear warm, insulated gloves or mittens outdoors. · Wash your hands without irritating them. Since soap and water can remove oils from your skin, wash your hands with warm water and a mild cleanser, such as a beauty bar or moisturising liquid. · Apply moisturiser often and generously. Apply it immediately after washing your hands and multiple times throughout the day. For the best results, use a product that contains glycerine or petrolatum. “Thousands of things can cause a hand rash, yet most hand rashes look a lot alike to the untrained eye,” said Dr Piliang. “If you get a hand rash, see a board-certified dermatologist to help identify the cause and prevent it from becoming painful or disabling.” Treatment plans for hand rashes may include a non-prescription cream or lotion, or prescription medication. If a dermatologist suspects that an allergy is the cause, he or she may recommend an allergy skin test called patch testing.

30

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Pharmacy Magazine


EDUCATION Source: Mediclinic Infohub

Exploring anaemia

Red blood cells account for 90% of the body’s iron

Iron deficiency is the most common cause of anaemia

Stage 1: Iron loss exceeds intake. As a result, there is a negative

{ A

Iron deficiency occurs when the rate of loss or use of iron exceeds its rate of uptake and assimilation

iron balance and the

{

iron stored in the bone marrow is progressively depleted. As stored iron decreases, there is a compensatory increase in the absorption of iron in the diet and an increase in the iron binding capacity of

naemia is defined as a haemoglobin

SYMPTOMS AND SIGNS

concentration lower than normal for the

Symptoms such as tiredness, weakness, shortness of

age and sex of the person involved.

breath are commonly seen, sometimes accompanied by

Stage 2: The exhausted

Anaemia is not a diagnosis, and an

tachycardia. There may also be difficulty concentrating,

iron stores cannot

and some neurocognitive deficits.

meet the needs of the

underlying cause should always be sought.

the cells.

The tongue may be smooth, shiny, and inflamed

bone marrow. This

CAUSES

(glossitis). Angular stomatitis may also occur. In some

means that there is

Iron deficiency occurs when the rate of loss or use of

children, there may be poor growth overall, and growth

progressively less

iron exceeds its rate of uptake and assimilation. The

faltering. Pica - a craving for strange foods such as

reasons for this are:

starch, ice, and sand - may develop. The symptoms

• Chronic blood loss is most commonly due to excessive

of the underlying cause of the iron deficiency may be

iron available for the formation of red blood cells.

menstruation or due to bleeding into or from the gut as a

present, such as menorrhagia or abdominal pain due

Stage 3: By now

result of a peptic ulcer, gastritis, haemorrhoids, or worm

to peptic ulceration.

anaemia has developed, but the red blood cells

infestation in children. • An increased need for iron occurs in pregnancy, due to

still look normal.

STAGES OF DEVELOPMENT

the growth of the foetus, or in children undergoing rapid

The body keeps the amount of iron in balance by

growth spurts in infancy and adolescence. Inadequate

regulating iron absorption in the gastro-intestinal tract.

intake of iron to meet the body’s requirements is often

Red blood cells account for 90% of the body’s iron.

because of diets with insufficient iron.

When these cells die, the iron is carefully recycled by

• It also occurs during the weaning period when babies are

Stage 4: The red blood cells become smaller (microcytic) and pale (hypochromic).

the body. There is a balance that the body needs to

switched from breast milk to solids. Breast milk contains

maintain, and this is carefully regulated. However, the

Stage 5: Iron deficiency

lactoferrin, a type of iron which is very easily absorbed.

demands at some periods, e.g. growth, or when there is

affects the tissues,

• Decreased absorption of iron is common after a partial or

excess blood loss, may be far greater than the diet can

resulting in the

total removal of the stomach, lack of stomach acid, chronic

provide. If this occurs, iron deficiency will develop. Iron

diarrhoea or malabsorption.

deficiency develops slowly in stages.

symptoms and signs of iron deficiency anaemia.

{ Anaemia {

Pharmacy Magazine JULY 2017 |

31


EDUCATION

Antimicrobial resistance

in vaginal infections Bacterial vaginosis (BV) is the worldwide leading vaginal disorder among women of reproductive age. BV is characterised by the replacement of beneficial lactobacilli and the augmentation of anaerobic bacteria

G

ardnerella vaginalis is a predominant bacterial species, but BV is also associated

or recurrence. Although antibiotic therapy can effectively eradicate

with other numerous anaerobes, such as

vaginal infection, it also depletes the normal vaginal

Atopobium vaginae, Mobiluncus mulieris,

flora. Indiscriminate use of antibiotics may reduce

Prevotella bivia, Fusobacterium nucleatum, and

normal Lactobacillus flora, further increasing the

Peptoniphilus species. Currently, the role of G. vaginalis

chances of recurrence by depleting the host’s

in the aetiology of BV remains a matter of controversy.

defensive mechanism. Repeated use of antibiotics

However, it is known that, in patients with BV, a biofilm

increases the chances of developing antimicrobial

is usually formed on the vaginal epithelium and that

resistance among the pathogens. Maintaining

G. vaginalis is typically the predominant species. So,

vaginal flora balance should be a selection criterion

the current paradigm is that the establishment of a

when choosing an anti-infective therapy.

biofilm plays a key role in the pathogenesis of BV. This

It is acknowledged that oral antibiotics can lead

review provides background on the influence of biofilm

to vaginal mycosis. According to Neut et al (2015), 3%-

formation by G. vaginalis and other anaerobes, from

20% of patients with idiopathic vulvovaginal candidiasis

the time of their initial adhesion until biofilm formation,

recently took oral antibiotics. The longer the treatment

in the polymicrobial etiology of BV and discusses the

duration the greater the risk of candidiasis.

commensal and synergic interactions established

The change in Lactobacillus flora could explain

between them to understand the phenotypic shift of

candidiasis induced by antibiotics, given that an

G. vaginalis biofilm formation to BV establishment. The

inverse correlation between the presence of protective

balance of the vaginal ecosystem depends on lactobacilli

lactobacilli in vaginal flora and vaginitis development

whose biofilm protects against microorganisms that are

can be observed.

not normally present or are subdominant in vaginal flora.

Furthermore, it demonstrated that recolonisation

Vaginal infection treatments should eliminate pathogens

by hydrogen peroxide producing lactobacilli one month

while preserving the Lactobacillus flora to prevent relapse

after treatment of genital infections only occurs in 40% of patients when oral metronidazole is taken and in 57% when topical clindamycin is used. The high concentrations of these vaginal formulations’ active ingredients in the vaginal mucosa are capable of inhibiting one or more Lactobacillus strains, with harmful effects on the balance of normal vaginal flora. This study indicates that, of the 17 vaginal formulations indicated to treat vaginitis, six combinations of antibiotic and antifungal agents (out of eight), one antiseptic (out of three) and one antifungal agent (out of the six tested) could interfere with the growth of lactobacilli in healthy vaginal flora. This should be taken into account when choosing first-line topical treatments for infectious vaginitis. Petersen et al (2002) and Kanagalingam et al (2015) found that povidone-iodine (PVP-I) effectively inhibits the release of toxins and tissue destroying enzymes, and pathogens don’t develop resistance against PVP-I due to the unique mechanism of action. Wide spectrum of anti-microbial activity makes PVP-I suitable for treatment of disturbed/abnormal flora.

The balance of the vaginal ecosystem depends on lactobacilli whose biofilm protects against microorganisms that are not normally present or are subdominant in vaginal flora 32

| JULY 2017

Pharmacy Magazine


FACE FULL-BODY FOO-FOO MAINTAIN YOUR pH BALANCE. ADD GYNAGUARD TO YOUR DAILY ROUTINE.

Ladies, you wouldn’t use toothpaste to wash your hair, so why use just any soap to care for your vagina? Ordinary soaps can cause vaginal irritation and a pH imbalance, causing dryness and irritation. GynaGuard’s range of products are specially formulated by a gynaecologist to take care of your vagina and support a healthy, ideal pH balance. Take on every day with a face that’s flawless, full-body that’s fabulous and Ms. Foo-foo that’s fresh. For more info visit gynaguard.co.za or join the conversation on our Facebook page.

Feminine Hygiene Mastered


EDUCATION

{

The best insurance against osteoporosis is building the highest bone density possible by ones 30s and minimising bone loss after that

{

Osteoporosis isn’t inevitable Osteoporosis is a skeletal disease associated with an imbalance between formation and resorption, leading to net loss of bone mass, loss of bone microarchitecture, and development of fractures

B

one resorption is primarily due to an activation

less calcium from the diet, and the kidneys seem to be

of osteoclastogenesis and an increase in

less efficient at conserving calcium.

receptor activator of nuclear factor kappa-B ligand (RANKL) expression, a cytokine

involved in the final pathway of the osteoclast cycle. Although bone-weakening osteoporosis is quite

As a result, the body can steal calcium from bone for a variety of important metabolic functions. Because some research suggest that high calcium intake may increase the risk of prostate cancer, men

common among older people, it isn’t an inevitable

should avoid taking calcium supplements or taking

part of ageing.

too many calcium-rich antacids.

The best insurance against osteoporosis is building the highest bone density possible by ones 30s and

VITAMIN D

minimising bone loss after that. But for patients in midlife

In building bone, calcium has an indispensable assistant:

or beyond, there is still much you can do to preserve the

vitamin D. This vitamin helps the body absorb calcium,

bone you have and perhaps even to replace lost bone.

and some researchers think that increasing vitamin D

Daily weight-bearing exercise, like walking, is the best

can help prevent osteoporosis. Vitamin D is also

medicine. Getting enough calcium and vitamin D are two

prevalent in fortified breakfast cereals, eggs, and

other critical strategies for keeping bones strong.

vitamin supplements. Some brands of yogurt are fortified with it, as well as some juices.

CALCIUM

help the body manufacture its own vitamin D –

slowing the pace of bone loss. But it’s not a single magic

about 5-30 minutes of sunlight between 10am and 3pm.

bullet, and some scientists suggest that too much

Twice a week to your face, arms, legs, or back without

calcium or dairy products may be unhealthy. Keep in

sunscreen will enable you to make enough of the

mind that in addition to calcium, there are other nutrients

vitamin. People with fair skin that burns easily should

and foods that help keep your bones strong – most

protect themselves from skin cancer by limiting sun

importantly vitamin D, but also vitamin K.

exposure to 10 minutes or less.

How much calcium? The recommended daily intake

| JULY 2017

Food and sun exposure should suffice, but if

for calcium is 1 000mg a day for adults up through age

not, some experts advise getting 1 000iu of vitamin D

50 and 1 200mg a day for people ages 51 and older, when

daily from a supplement.

bone loss accelerates. With age, the intestines absorb

34

If possible, a small amount of sun exposure can

Calcium is an important nutrient for building bone and

Pharmacy Magazine

Continued on next page...


Muscular dystrophy and neuromuscular disorders is a cause close to all our hearts and it is something that could affect any one of us. The term muscular dystrophy (MD) describes a disorder that affects the muscles, resulting in progressive wasting and weakness of the muscle. Symptoms may appear at birth, in early childhood, or later in life. Neuromuscular disorders affect not only the muscles but also the nervous system. Individuals of either sex and all ages and ethnic backgrounds can be affected by MD.

Contact us for further information: NATIONAL OFFICE Tel: 011 472-9703 E-mail: national@mdsa.org.za Website: www.mdsa.org.za CAPE BRANCH (Western Cape, Northern Cape & part of Eastern Cape) Tel: 021 592-7306 E-mail: cape@mdsa.org.za GAUTENG BRANCH (Gauteng, Free State, Mpumalanga, Limpopo & North West) Tel: 011 472-9824 E-mail: gauteng@mdsa.org.za KZN BRANCH (KZN & part of Eastern Cape) Tel: 031 332-0211 E-mail: kzn@mdsa.org.za


EDUCATION

{

Calcium is an important nutrient for building bone and slowing the pace of bone loss

{

{

In building bone, calcium has an indispensable assistant: vitamin D

MONITORING BMD PROVIDES A USEFUL INDEX OF EFFICACY FOR OSTEOPOROSIS THERAPY

In the first large-scale post marketing surveillance study

The role of bone mineral density (BMD) measurement

in Japan, teriparatide was shown to have

to monitor efficacy of osteoporosis treatment is

favourable safety and effectiveness profiles in

controversial. In a registry-based Canadian cohort

osteoporotic patients at high risk of fracture. Importantly,

study, 6 629 women (mean baseline age, 64) were

teriparatide was well tolerated, with no new clinically

identified who had baseline BMD tests, began

significant safety concerns identified, and persistence

osteoporosis treatment (bisphosphonates in 85%),

with teriparatide treatment was similar to or higher than

and had repeat BMD testing a mean 4.5 years later.

that reported in other studies.

By BMD criteria, most participants (57%) had

Early significant increases in bone formation biomarkers

osteoporosis while 18% had BMD T scores between

were followed by subsequent increases in bone resorption

-2.0 and -2.5 at baseline.

biomarkers. The cumulative incidence of new vertebral

At the total hip, 30% of women had significant

The role of bone mineral density (BMD) measurement to monitor efficacy of osteoporosis treatment is controversial

{

and non-vertebral fracture to 24 months was 2% and 4%,

increases in BMD (>0.03 g/cm2), 51% remained stable,

respectively, and patient reported back pain and overall

and 19% had significant decreases.

HRQoL improved significantly.

Risk for major osteoporotic fracture over five years

The patients received teriparatide 20Îźg daily by

was 7.2% in women with stable BMD, 5.9% in those

subcutaneous injection, for a maximum of 24 months.

with gains in BMD, and 10% among those who

Safety and effectiveness analyses were based on data

experienced bone loss. Results of BMD measurement

from 1 847 patients who were predominantly female

in the femoral neck or lumbar spine were generally

(92%) with a mean age of 75 years. A total of 157 adverse

similar but less robust than those at the total hip.

drug reactions (ADRs) were reported in 140 (7%) patients; the most common ADRs were hyperuricemia, nausea, and

TERIPARATIDE

dizziness. Only six (0.32%) patients reported serious

Teriparatide is the first anabolic agent approved for

ADRs, the most common being nausea (two patients;

the treatment of patients with osteoporosis and has

0.1%). Persistence with teriparatide treatment was 60%

been reported to reduce the risk of fracture by

and 39% at 18 and 24 months, respectively. There were

increasing bone formation.

significant increases in biomarkers for bone formation (procollagen type 1 N-terminal propeptide and bone specific alkaline phosphatase) and bone resorption (collagen type I cross-linked C telopeptide and tartrateresistant acid phosphatase 5b) throughout the study. These were accompanied by significant increases in bone mineral density and low incidences of new vertebral and non-vertebral fractures. Patient-reported measurements for health-related quality of life revealed significant improvements from baseline in back pain and overall health-related quality of life. The results of this 24-month study imply that teriparatide has a favourable safety profile and is effective in the treatment of patients with osteoporosis at high risk of fracture in Japan. Teriparatide may also be a useful treatment for osteoporosis in other societies with ageing populations.

36

| JULY 2017

Pharmacy Magazine


INTRODUCING SOLAL® VITA PQQ (Pyrroloquinoline Quinone)

THE

“HEALTHY AGING” VITAMIN ABOUT VITA PQQ Naturally occurring in some foods, PQQ was discovered in 1948. It acts as a catalyst, to rejuvenate and generate new mitochondria, providing the cells of the body with the energy needed for life itself. This energy is also needed to repair and rejuvenate DNA and other cellular structures, and to optimise brain function and energy supply to the body. This is why we say that Vita PQQ is the ultimate healthy aging vitamin, because it supplies molecular energy that cells need to survive, revive and thrive. WHY SUSTAINED RELEASE? Vita PQQ is in a micronized, sustained-release matrix.

Since Vita PQQ is released over time it stays in the blood longer – it’s therefore active longer than regular PQQ. In fact, a human study showed that the sustained release PQQ contained in Vita PQQ is more bioavailable than regular PQQ and has a sustained release for continuous cellular energising and rejuvenation. WHEN CELLS DON’T GET ENOUGH ENERGY THEY DIE Degradation of energy-producing mitochondria is a key contributing factor to aging, since cells age more quickly and die prematurely if they are starved of the energy they need for life. Therefore, Vita PQQ may slow the aging process, with the added benefit of increased energy levels of the body and brain at the same time. ADDITIONAL BENEFITS OF PQQ Scientific research has shown that PQQ: • Protects nerve cells • Improves cognitive function • Alleviates stress and sleeplessness

IS PQQ SAFE AND NATURAL? PQQ is a safe, naturally occurring essential nutrient found in foods such as green peppers, tofu and green tea. It has been the subject of numerous safety studies, in both humans and animals, and has been found to be safe within the prescibed dosage regiment. Unfortunately foods don’t supply the PQQ dosage needed to provide the many benefits described here. Furthermore, the processing of modern foods strips many foods of PQQ. This means that supplementation is important if you want to your cells to optimally survive, revive and thrive.


?

Your blood saves lives A pint of blood is drawn from a volunteer donor.

O+

Blood Donor

Blood is transfused to patients in need. Just one blood donation has the potential to save three lives!

Blood is collected into a sterile bag and labelled.

South African National Blood Service

CK 06

Units are transported to the nearest SANBS testing and processing lab.

In the processing laboratory, blood is spun down in a centrifuge and then separated in to its dierent components.

What happens to your blood

donation

Red Blood Cells Contain haemoglobin, a protein that carries oxygen throughout the body. Used to treat patients with anaemia or blood loss due to trauma or surgery.

Plasma Contains special proteins and clotting factors required to assist platelets to form blood clots and to treat patients with serious blood disorders.

Blood products are stored prior to transfusion. The shelf life of blood is limited. Platelets expire in 5 days. Red blood cells expire in 42 days. Plasma has a 2 year shelf life from the day of collection.

Local hospitals place orders with SANBS for blood products based on their needs.

Blood is tested to ensure that it is safe for transfusion.

Platelets Crucial in helping blood clot. Patients with low platelet levels often suer from bruising and bleeding.

Toll free: 0800 11 9031 www.sanbs.org.za


EDUCATION Author: Professor James Ker

Differences in hypertension

between the races The complications of hypertension seem to be similar globally but there are differences between black and white patients with hypertension

H

ypertension is a common condition

excess dietary salt or poor potassium intake or

globally and can affect as many as four in

sensitivity to alcohol or other factors.

every 10 adults above the age of 25 years. The pathophysiology is complex and not

SOME GENETIC FACTORS

completely understood but most accept a genetic

Attempts to unravel the genetic influences in hypertension

factor interacting with an environmental factor.

using genome-wide association studies were not that

Prof Brian Rayner wrote an article recently highlighting

successful and only about 1% of the genetic contribution

some differences in hypertension between black

to the development of hypertension could be found.

patients and white patients with hypertension. African Americans have among the highest

In hypertension in blacks some insight into the nature of hypertension did emerge. There seems to be an

prevalence of hypertension in the world. This excess

intermediate phenotype in blacks consisting of low renin

prevalence of hypertension is also seen in SA among

low aldosterone in normotensive blacks as compared

black patients who can have up to 9.7mmHg higher

to whites. This is not related to excess sodium intake as

systolic blood pressures than African Americans.

studies in South Africa has shown that blacks consume as

Target organ damage and complications are also

much sodium in their diet as whites.

more prevalent in black patients with hypertension. Hypertension in blacks also appears to be more

Although the RAAS (renin-angiotensin aldosterone) system is a key player but there is no described

resistant to treatment and they are less likely to

abnormalities in that system in blacks as compared to

have their blood pressure controlled by treatment.

whites. Another phenotype in blacks is the salt-sensitive

The issue is really whether these differences are

type where an increase or decrease in salt intake leads to

due to genetic differences, environmental factors,

elevated blood pressure or decreased blood pressure.

{

Hypertension is a common condition globally and can affect as many as four in every 10 adults above the age of 25 years

Black patients with hypertension have in general a more severe form of hypertension with more severe target organ damage

Continued on next page...

{

Pharmacy Magazine JULY 2017 |

39


EDUCATION

{

{

Most guidelines recommend that the elderly patients and black patients receive monotherapy with a diuretic or a calcium channel antagonist

A hypothesis is proposed that variants of genes

of dopamine and G protein-coupled receptor kinase

regulating sodium reabsorption in the kidney could lead

4(GRK4) in the development of low renin hypertension

to hypertension.

and even salt sensitive type of hypertension in the

The aldosterone-sensitive ENaC, situated in the

black population. Dopamine, through GRK4 promotes

collecting ducts of the kidney, is the final regulator of

natriuresis and opposes the effect of angiotensin-2

sodium balance in the kidney. This ENaC gene is an

and norepinephrine. This subject was reviewed recently

attractive gene in blacks that may result in hypertension

by Yang et al.

with low renin and low aldosterone as is typically seen in black patients with hypertension. There are SNP’s described in black patients with

There are a few variants of GRK4 and p.Ala142Val is the genotype most frequently underlying the difference between black and white with 66.1% of blacks having

hypertension. In South Africa Professor Rayner and his

this variant as compared to 15.6% of whites. It could be

group also described a novel mutation in the ENaC,

that this variant of GRK4 is the possible candidate gene

the so-called Arg563Gln (or R563Q) associated with

to account for the low renin low aldosterone phenotype

hypertension with low renin and low aldosterone in black

in normotensive blacks. What cause the transition from

patients with hypertension.

this phenotype in normotensive blacks to hypertension

This mutation was present in up to 5% of hypertensive

with low renin low aldosterone is not really known.

patients. This mutation is also present in up to 20% of the indigenous San people of Southern Africa which

SHOULD WE TREAT THEM DIFFERENTLY?

could have offered a survival benefit in a hot-arid

Most guidelines recommend that the elderly patients and

environment scarce of sodium.

black patients receive monotherapy with a diuretic or a

In patients with treatment resistant type of hypertension amiloride, a specific inhibitor of ENaC resulted in a reduction in blood pressure of 36/17mmHg. In SA, p.Arg563Gln SNP is strongly linked to hypertension, but is only present in 5% of hypertension patients and is present in about 1% of normotensive

calcium channel antagonist.

• Hypertension in black patients are more difficult to control • There is a recognised phenotype of low renin low aldosterone in normotensive blacks • And gene variants in GRK4 and ENaC and other factors in the kidney probably underlie this phenotype • Transition of the phenotype to hypertension of the low renin low aldosterone type is probably due to these gene variants with environmental factors

These two groups are the ones with low renin levels. It is also said that combining a diuretic with a blocker of the RAAS (ACE-Inhibitor or ARB) will result in stimulating renin and increase the effectiveness of the RAAS blocker. There are few data on the specific use of aldosterone

people and therefore cannot be responsible or account

antagonist (spironolactone) or amiloride for the treatment

for the phenotype of low renin low aldosterone seen in the

of hypertension in black patients and the use of these two

normotensive black population.

drugs to treat resistant hypertension in black patients is

Recently attention has shifted to a focus on the role

CONCLUSIONS • Black patients with hypertension have in general a more severe form of hypertension with more severe target organ damage

• Further research on the use of spironolactone and amiloride as treatment for this group of patients is needed.

not well studied.

Pharmacy Magazine JULY 2017 |

41


STUDY EDUCATION

{

{

Use of probiotics was associated with a 42% lower risk of developing diarrhoea when taking antibiotics as compared to not using probiotics

Probiotics and diarrhoea caused by antibiotics Probiotics are microorganisms that are believed to improve health by maintaining a normal balance of microorganisms in the human intestines. They are contained in some food products and also are sold as nutritional supplements

A

Rand Corporation study found that taking probiotics can reduce the risk of

treat antibiotic-associated diarrhoea. Use of probiotics was associated with a

developing the diarrhoea that is a common

42% lower risk of developing diarrhoea when taking

side effect of taking antibiotics.

antibiotics as compared to not using probiotics.

Pooling evidence from a large number of

The Rand analysis estimates that 13 people would

published research studies examining the effects

need to use probiotics in order to prevent one case

of probiotics, Rand researchers found consistent

of antibiotic-associated diarrhoea.

evidence that probiotics can benefit people who are taking antibiotics. “We found a clear beneficial effect of probiotics

However, researchers say the evidence was insufficient to show which type of microorganism was better than another because the included

in preventing or treating antibiotic-associated

strains were poorly documented and often given

diarrhoea,” said study co-author Sydne J. Newberry,

as blends of several types. Further, there was no

a nutritional scientist and a researcher at Rand, a

indication that the response varied systematically by

non-profit research organisation. “However, more

a person’s age, the duration of antibiotic use or

work is needed to determine which types of

other clinical indications.

probiotics work best, which patients are most

The Rand team

likely to benefit from probiotics and whether there

says that future

are any risks in using them.”

efforts to study

As many as 30% of patients who take antibiotics

the effects of

suffer from diarrhoea, a side effect that is a key

probiotics should

reason why some patients do not follow through

try to determine

with a full course of antibiotic treatment. Interest in

whether some strains

the possibility that probiotics might help or prevent

or combinations

this type of diarrhoea has grown in recent years,

of probiotics work

resulting in a proliferation of individual studies.

better than others,

Researchers from the Rand-based Southern

Taking probiotics can reduce the risk of developing the diarrhoea that is a common side effect of taking antibiotics

work best with

California Evidence-Based Practice Center

specific antibiotics,

conducted an extensive review of the medical

and whether use

literature to find studies that examined whether

of probiotics for

probiotic use can prevent and treat antibiotic-

antibiotic-associated

associated diarrhoea. Researchers pooled results

diarrhoea is

from the studies together to gain a clearer

associated with any

understanding of whether probiotics can prevent or

health risks.

Pharmacy Magazine JULY 2017 |

43


CPD - BALANCED IMMUNE SYSTEM

The importance of a balanced immune system When out of balance, the immune system not only fails to protect the body but can even attack it, mistaking ‘self’ cells for invading pathogens, resulting in debilitating autoimmune diseases such as lupus and rheumatoid arthritis

An underactive or weakened immune system will expose the body to increased susceptibility to infections and disease

T

he immune system is key to human health and

from the innate system to be initiated. Though considered

is defined as “the bodily system that protects

separate, each interacts with the other in critical and

the body from foreign substances, cells, and

complex ways. A rudimentary understanding of both

tissues.” Allergies can result when the immune

responses helps to explain and further substantiate the

system mistakes an innocuous particle (such as pollen) level inflammation, another indicator of an out-of-balance

INNATE IMMUNE RESPONSES

immune system, can contribute to diseases such as

The innate system consists of many parts. It includes

cancer and cardiovascular disease.

physical barriers to infection, such as the skin and mucous

The immune system is also very sensitive to stresses

such as acidic environments that kill cells or prevent their

exercise, and change in diet can all cause imbalances in

growth, and enzymes, like lysozyme found in tears, that

the immune system and affect overall health.

destroy bacterial cells.

Generally, the immune system is described as having

The complement system, which is a group of serum

two parts: The innate and adaptive immune responses.

proteins, is also an important part of innate immunity

The innate system is the more primitive and less specific.

that can kill pathogens directly (lysis) or mark them

However, from an evolutionary perspective it is quite

(opsonisation) for later destruction (phagocytosis)

complex and sophisticated. It is the body’s first line of

by certain immune cells. These immune cells, called

defence against foreign substances that may lead to

phagocytes, are also an integral part of the innate

disease.

response that acts by internalising and killing pathogens.

much more specific, delayed response and requires action | JULY 2017

membranes. In addition, there are chemical barriers,

of normal life – travel, personal problems, strenuous

The adaptive system, found only in vertebrates, is a

44

importance of immune balance.

for an invading parasite. In addition, years of chronic low-

Pharmacy Magazine

Importantly, these same cells are also able to produce chemical signalling proteins

Continued on next page...


The Strength of our Immune Product is in the Balance. An underactive or weakened immune system will expose the body to increased susceptibility to infections and disease, therefore there is a definite need to strengthen the immune system; not to boost it or suppress it! The all-natural ingredient EpiCor® found in IMMUNO ARMOUR, has been clinically proven to strengthen the immune system. IMMUNO ARMOUR builds a strong immune system by significantly increasing Natural Killer (NK) Cell activity and antioxidant protection within 2 hours of consumption and helps increase sIgA antibodies, which are important for mucosal health. Marketed by: Kenza Health www.immunoarmour.co.za | Customer Care: 0860 103 359 Refernces: Jensen, G. S.; Redman, K. A.; Benson, K. F.; Carter, S. G.; Mitzner, M. A.; Reeves, S.; Robinson, L., Antioxidant bioavailability and rapid immune-modulating effects after consumption of a single acute dose of a high-metabolite yeast immunogen: results of a placebo-controlled double-blinded crossover pilot study. J Med Food 2011, 14 (9), 1002-10. Jensen, G. S.; Patterson, K. M.; Barnes, J.; Schauss, A. G.; Beaman, R.; Reeves, S.; Robinson, L., A Double-Blind Placebo-Controlled, Randomized Pilot Study: Consumption of a High-Metabolite Immunogen from Yeast Culture has Beneficial Effects on Erythrocyte Health and Mucosal Immune Protection in Healthy Subjects. The Open Nutrition Journal 2008, 2, 68-75.


FLUTICASONE PROPIONATE 50 µg

“If you don’t use your nasal spray every day, you might as well throw it away!”

12708

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Each metered dose contains 50 μg Fluticasone propionate. For further prescribing information, refer to the package insert. S2 Reg. No. 37/21.5.1/0289 CIPLA MEDPRO (PTY) LTD Reg. No. 1995/004182/07. Building 9, Parc du Cap, Mispel Street, Bellville, 7530, RSA. Website: www.cipla.co.za Customer Care: 080 222 6662

ADVANCING HEALTHCARE FOR ALL


CPD - BALANCED IMMUNE SYSTEM called cytokines and chemokines that have important effects on both the innate and adaptive systems. ADAPTIVE IMMUNE REPONSES The adaptive response is a delayed response and is dependent on the innate system for activation. Although initially a delayed response, the adaptive system has memory, and the second time the body is exposed to the same pathogen, the response is almost immediate. The main cells in the adaptive response are T lymphocytes and B lymphocytes. Most T cells are either cytotoxic T lymphocytes (CTLs) or T helper cells (TH cells). CTLs can recognise virus-infected cells and kill them. TH cells serve to activate other cells in the immune system by producing cytokines. These can help promote an inflammatory response (supporting innate immunity) and can also support an adaptive response by activation of B cells. It should be noted that there are different subsets of TH cells; their classification is dependent on the types of cytokines secreted. Major subsets include TH1 cells, TH2 cells and TREG cells. For example, when TH1 cells dominate, the body is better able to defend against bacteria and viruses, and when TH2 cells dominate, the cells are better able to defend against parasitic and mucosal infections. A well-balanced immune system will recognise and give the proper response to an immune challenge. B cells produce antibodies (immunoglobulins). These are proteins that are very specific for a particular antigen (a molecule or part of a molecule). When the antibody binds the antigen on a pathogen, the pathogen can be destroyed. To become effective, T and B cells must first interact with the specific antigen. There are several types of antibodies expressed by B cells. The type of antibody produced is influenced by cytokines.

Thus, it is conceivable that whereas cancer risk may be reduced, the risk of other diseases may be increased. For example, over stimulated T cells may enhance the pathology associated with inflammatory bowel disease,” (Percival and Milner, 2005). Logically, this concern may extend to sufferers of allergies, autoimmune and other inflammatory conditions. The other side of the immune balance equation is an overactive or hyper-responsive immune system. Sufferers of autoimmune disease, inflammatory disease and allergies may benefit by suppressing their overactive immune response. A dysfunctional (overactive) immune system may result in allergies by mistaking harmless environmental substances such as pollen for an

IMMUNE BALANCE An underactive or weakened immune system will expose the body to increased susceptibility to infections and disease. Many things can weaken the immune system, including common everyday physical or emotional stress. Secondary bacterial infections are possible during colds of viral origin since the immune system can be compromised by certain viruses. Biological agents can harm the immune system by killing off T helper cells (also called CD4 cells). UV light can suppress the immune system, resulting in greater susceptibility to cancers. There are a host of pharmaceuticals and nutraceuticals developed and sold as immune boosters. It is generally believed that the immune system should not stay in a constant state of stimulation such as would occur through prolonged, daily use. In discussing the need for achieving immunobalance in a recent paper, Percival and Milner stated: “By lowering cancer risk with excessive

attacking parasite. In this case a stimulated TH2 response could cause B cells to increase antibody production (IgE)

A diet rich in vegetables, fruits, and whole grains, while low in red meat and processed foods, should be the goal

and cause an allergic response by interacting with mast cells, basophils and eosinophils, which in turn release histamine causing the allergic reaction (and the need for over-the-counter antihistamine products). CONCLUSION In summary, keeping the immune system in balance is crucial for maintaining health. The immune system is very complex and care should be taken to ensure it stays in balance. Ideally, one should lead a healthy lifestyle. A diet rich in vegetables, fruits, and whole grains, while low in red meat and processed foods, should be the goal. This should be combined with regular exercise, reduced stress, and for those without optimal diets, nutritional supplementation.

supplementation use, there may be ill consequences. This SAMA accredited article first appeared in the Medical Chronicle in July 2017. CPD points cannot be guaranteed as they are awarded at the South African Pharmacy’s discretion.

TO COMPLETE THE CPD QUESTIONS VISIT WWW.MEDICALCHRONICLE.CO.ZA INSTRUCTIONS: 1. Go to www.medicalchronicle.co.za 2. Click the tab labelled ‘CPD Portal’ on the far right tab near the top of the page. 3. Select the relevant questionnaire from the list and complete the form.

Pharmacy Magazine JULY 2017 |

47


OPINION

Food for thought Email: greg@storysamurais.com

A garden of love grows in a Grandmother’s heart – Author unknown Greg Zurnamer (B.Com MBA), the Story Samurai, is an innovative thinker that challenges conventional approaches in both sales and marketing

MY GRAN My Grandmother was an amazing woman, with a warm

was clear that a fight to the death was imminent. A small distance away on the top of a hill stood a

soul and loving arms. She may have left us for heaven many

grandfather and his grandson, watching this pre-fight dance

years ago, but her presence remains forever. She was small in

with amazement. Through their binoculars they were fully

stature but large in existence. For some reason, any group in a

engaged and could see every muscle move in the two wolves.

room seemed always to make way for her when she entered.

They were too afraid to breathe as they feared if the wolves

Her smile was contagious and when she spoke she always

noticed their presence they might turn and run away.

demanded attention. It goes without saying that she was my hero when I was growing up. I always took to heart what she said. “Count your blessing my boy” was her favourite saying if things got tough.

After, what seemed like an eternity, watching the wolves circle each other, the grandson turned to his grandfather and asked: “Do the wolves have names, Grandad?” “Yes,” said the grandfather, “the ones name is Evil, it is filled

I remember that this was especially her reaction whenever

with anger, resentment, blame, lies, and ego. The other’s name

my dad’s discipline was forthcoming for one or other of my

is Good, it is filled with joy, kindness, love, hope, and empathy.”

indiscretions. HER STORY I particularly remember a story my gran told me once when I was going through a difficult time trying to get to grips with high school demands. She could never stand self-pity and did not respond kindly to my complaints and blame game. The story

“I don’t understand,” said the boy, “why are we watching them”. “Because”, said the grandfather, “they live within you every day, and they are always fighting.” “Then who wins”, asked the boy “It depends on which one you feed”, said the grandfather.

is not a new one and I am sure many grans may have told it

YOU CAN KEEP IT TOO

before, but I still believe it holds relevance.

This story has stayed with me forever, and today more than ever its meaning rings true. We are overwhelmed daily with

The story goes like this….

negative news and surrounded by pessimistic people. There

Two male wolves approached each other growling, snarling with

is not a conversation around that does not contain stories of

teeth exposed. Their bodies were tense and the erect back hairs

doom and gloom. It easy to get sucked into a spiral of despair

signalled their intent to dominate. They were both alpha males

and anguish.

and had happened to by chance, stumble upon each other. Both

Don’t let that wolf win. Only you have to power to feed him.

were strong and proud and they did their best to show off their

You have the ability to feed the good wolf and live your life with

strength and presences. It was obvious that none of the wolves

fulfilment and joy. Don’t let today spoil your future. Create the

intended to give up an inch and by their body language made it

happiness you deserve. Be great!

Don’t let today spoil your future Pharmacy Magazine JULY 2017 |

49


PROFILE

“You need to win your customer by providing quality service”

Age is just a number ner-up 1st Run t Shop ron 2016 F stant s s A i year of the

1

Where did you grow up?

I grew up in

2

Parlock-Durban.

Who inspires you and why?

My inspiration comes from my late dad who worked

4

What is the hardest part of your job?

7

What do you do to relax?

to your scope of practise when helping

In my spare time I

your patients. You

Dealing with grumpy and

enjoy entering

should know what

impatient customers, and

competitions, watching

advice to give them.

having to work long hours

movies, and cooking.

Then your customer

I also love socialising

will be happy. If they

5

(till 7pm) on weekends.

8

with my friends.

Why did you choose a career in the pharmacy industry?

are happy then they’ll always come back to

Berea Spar for many years.

What is your dream (where would you like to be in say 5 or 10 years time)?

I was always very friendly

I would like to go for more

I enjoy helping my

with my customers. The

holidays if I can afford it.

JOB TITLE:

customers to the best of

pharmacist shopped at

I will do locums as long

Front Shop Assistant

my ability especially the

Spar, and he offered me

as I can. Knowledge is the

What have you learnt that you wish you could tell your 16-year-old self?

older patients. I have a

a job. I was very happy

key to success, and to me

Trust that whatever

passion for what I do.

and have never looked

in the pharmaceutical

NAME &

3

field for 35 years.

SURNAME: Krishnie Maharaj PHARMACY: Dischem Pavillion

AGE:

What do you enjoy most about your job?

I worked as a cashier in

back. I always wanted to

58

9

age is just a number.

you. So you need to win your customer by

10

providing quality service.

decision you make it will always be the

What advice do you have for front shop and pharmacist assistants?

best. Don’t waste time;

My drive to work takes me

My advice to Front

will come again.

approximately

Shop Assistants would

10-15 minutes.

be to make sure to keep

6

work in pharmacy.

How long is your commute to work?

knowledge is the key to success. Grab any golden opportunities as you never know if it

“Knowledge is the key to success”

Do you want to feature on our profile page or perhaps nominate a worthy colleague? Email the editor: nicky.belseck@newmediapub.co.za

50

| JULY 2017

Pharmacy Magazine


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Frontshop Pharmacy Magazine - July 17  

Valuable education information for Pharmacists, Pharmacist Assistants, Front Shop Assistants, and Clinic Sisters