Page 1

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

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Pharmac JUNE 2017

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Valuable education for pharmacy staff

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Atopic dermatitis: risk factors

JUNE 2017 EDITOR'S COMMENT

4

INNOVATION 8 12

The ‘gut microbiota decade’

Depending on demographics, about 50-90% of the population gets cold sores

38 Parkinson's disease: an overview

Genetic testing offers personalised healthcare

Know your products

16

MEN’S

19 Skin protection: shielding lotion vs moisturiser 22 The plague that is cold sores

Warning: update vaccinations before travelling

20

EDUCATION

Control what you can

6

Also known as atopic eczema, AD is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2-3% of adults

47

CONTENTS

Vitamin D deficiency ‘epidemic’ can be reversed

With such an important role to play in our mobility it is important to care and support our joints through regular exercise, lifestyle choices, diet, and vitamins. Featured: 3 products specially engineered to assist patients to support and lubricate joints, relieve pain, and rebuild cartilage

Although there isn’t yet a cure for this chronic and progressive movement disorder, there are numerous therapies that help the symptoms as an adult

HEALTH

MONTH

26 Health and wellness

40 Undiagnosed ADHD in adults

Adults who have ADHD were either diagnosed and treated as children and are well aware that they have the condition, or they present for the first time

42 Allergic diseases on the rise in SA's children

z zz

Z

21

Sleep quality vs quantity

Generally recognising and celebrating men in Men’s Health Month we look at 8 products specially engineered for them

29 Real men have regular health checks

Studies have assessed whether measures of health, wellbeing, are better related to sleep quality or sleep quantity

Some health needs are specific to men. As such it’s important for them to take their health seriously and be proactive about it

35 Check your prostate from 40

OPINION 57

A shot in the arm is not a shot in the dark

Be a self-leader

PROFILE

58

Yasmina Baulackey – Pharmacist Assistant, DHL

1 st Run ner-up 2016 Pharm a Assistacist of the nt year

“Sometimes what you’re most afraid of doing, is the very thing that will set you free”

Kidney stones more prevalent in men, can be avoided

Why should people get vaccinated against the flu?

25 36

CUT OUT & KEEP: MEN AND CARDIOVASCULAR DISEASE

CPD FEATURES 50 Diabetes - managing a monster 55 Reducing severity and duration of colds

THE TEAM EDITOR: Nicky Belseck Email: nicky.belseck@newmediapub.co.za Tel: 011 877 6155 LAYOUT AND DESIGN: Nazreen Bhyat ADVERTISING SALES EXECUTIVES: Alex Tschumi Cell: 082 697 3437 Email: alex.tschumi@newmediapub.co.za SALES INTERN: Quanita Pikini Email: quanita.pikini@newmediapub.co.za PUBLISHING TEAM GENERAL MANAGER: Dev Naidoo PUBLISHING MANAGER: Johann Gerber Email: johann.gerber@newmediapub.co.za PRODUCTION MANAGER: Angela Silver Email: angela.silver@newmediapub.co.za ART DIRECTOR: David Kyslinger

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Unless previously agreed in writing Frontshop Pharmacy Magazine, owns all rights to all contributions, whether image or text. SOURCES: Shutterstock, supplied images, editorial staff. While precautions have been taken to ensure the accuracy of its contents and information given to readers, neither the editor, publisher, or its agents can accept responsibility for damages or injury which may arise therefrom. All rights reserved. © Frontshop Pharmacy Magazine. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, photocopying, electronic, mechanical or otherwise without the prior written permission of the copyright owners.

Pharmacy Magazine JUNE 2017 |

3


EDITOR’S NOTE

EVENTS JUNE 2017

Men’s Health Month

World Heart Rhythm Week

Control what you can

A

s Mother Nature ravages our beautiful

· Men and

country with record storms in Cape Town

cardiovascular

and devastating fires in Knysna I feel almost

disease

helpless. Looking at photos and videos online

Winter always

toll is soul destroying and I’m reminded how many things

brings with it a

we have absolutely no control of.

number of health flu and dry skin.

we may not be able to do anything about our genes

In the June issue

or our predisposition to certain maladies, but there is

of Frontshop

certainly a lot we can do to postpone, limit, and in some

Pharmacy Magazine

cases even prevent potential health issues. Working in

we focus on cold

the pharmacy industry you are uniquely positioned to

sores (page 22),

help many other people with their health concerns too.

the flu vaccine

conscientious when it comes to theirs, and their family’s health, while many men still adopt a ‘head in the sand’

(page 25), shielding lotion vs moisturiser (19), atopic dermatitis (page 47), and joint health (page 16). Other interesting topics include vaccinations linked

mentality. This can lead to later discovery of ailments

to travelling (page 6), the ‘gut microbiota decade’

which, had they been treated earlier, would not have

(page 8), and personalised healthcare enabled

been as severe or have done as much damage. It was

through genetic testing (page 12). The two CPD

with these concerns in mind that June was established

articles look at diabetes (page 50), and reducing the

as Men’s Health Month – to heighten awareness of the

severity and duration of colds (page 55).

health risks men may face, how to prevent them, what

8

World Brain Tumour Day

14

World Blood Donor Day

19

concerns like the

situations we can control? When it comes to our health

Statistically women tend to be a little more

4

International Cancer Survivors Day

(page 38)

as the destruction unfolds and reading about the death

Given this vulnerability, surely we should jump at any

3 9

We compare sleep quality vs quantity (page 21),

World Sickle Cell Day

21 27 National Epilepsy Week 24 28 SANCA Drug Awareness Week JULY 2017

International Group B Strep Awareness Month

18

International Mandela Day

symptoms to look out for, and where to get medical

discuss undiagnosed ADHD in adults (page 40),

assistance. With this in mind we dedicate a section of

and do an overview of Parkinson’s Disease

this month’s magazine to men:

(page 38) to enable a better understanding.

· Products engineered for men (page 26)

Lastly, there’s an alarming rise of allergic diseases

· Real men have regular health checks (page 29)

in SA children (page 42).

World Hepatitis Day

Editor Nicky Belseck

AUGUST 2017

· Check your prostate from 40 (page 35) · Kidney stones more common in men (page 35)

WORDS TO

LIVE BY

“Your body is your most priceless possession so take care of it” – Jack Lalanne

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

4

| JUNE 2017

Pharmacy Magazine

28

Psoriasis Awareness Month 1 6 World Breastfeeding Week


INNOVATION

Warning:

update vaccinations before travelling With the July school holidays fast approaching, many people will be looking forward to enjoying a well-earned break from work. Many of us, however, forget that there can be health hazards associated with travel and that we should properly prepare for these if we don’t want them to spoil our holiday.

D

octor Pete Vincent of Netcare Travel

Fears of Middle East respiratory syndrome (MERS),

Clinics and Medicross Tokai, in Cape

a new type of coronavirus, which includes the common

Town points out that certain areas pose

cold and severe acute respiratory syndrome (SARS),

specific medical risks to travellers, such as

is growing daily in South Korea, which is battling the

malaria, yellow fever, hepatitis, rabies, tetanus, Ebola,

biggest outbreak of the disease outside the Middle East.

influenza, or meningitis. We can take precautions against

Official figures indicate that 87 people have to date

contracting many of these diseases through vaccination,

contracted the virus, while six people have died from

prophylactic medication, and by taking proper

this serious condition. More than 2 300 people are at

precautions when it comes to food and water intake.

present under quarantine while BBC News reports that

Dr Vincent reports that there has been a diphtheria

nearly 1 900 schools will be closed for several days as

outbreak in KwaZulu-Natal with, according to the

the country grapples this illness. It remains unclear if the

National Institute of Communicable Diseases (NICD),

vector for this disease originates from bats or camels.

13 suspected cases including five deaths. This is due to

However, its spread is due to non-adherence to basic

non-adherence to South Africa’s Expanded Programme

hygiene rules, such as hand washing, coughing etiquette,

of Immunisation [EPI]. It is very important that all adult

and barrier nursing.

travellers consider a booster dose of a one-in-four

“Internationally, Guinea and Sierra Leone remain

vaccine that combines lifelong immunity for diphtheria,

high risk areas for Ebola and are best avoided. Yellow

polio, and whooping cough, as well as providing ten

fever is prevalent in certain tropical areas of Africa and

years cover for tetanus. The NICD also reported a case

South America and travellers are required by law to be

of rabies in a six-year-old in Limpopo recently. This

inoculated when travelling to these countries. It is very

emphasises the importance of teaching children not to

important to visit a travel clinic which can advise on your

touch any furry animals – as they will not be bitten if they

risk of exposure and whether a yellow fever vaccine is

do not touch.

indicated.” Dr Vincent advises travellers to do their research on the possible healthcare risks associated with their holiday destinations so that they can take all the necessary precautions to ensure they remain healthy while on holiday. “Your local travel clinic will be able to keep you up to date regarding local and international healthcare issues and should recommend steps you can take to protect the health of you and your family,” he notes. An individual’s own health status may be as important a consideration as the holiday destination. If you suffer from chronic medical conditions, you should make sure that these will not be aggravated by your

{ 6

| JUNE 2017

Pharmacy Magazine

There has been a diphtheria outbreak in KwaZulu-Natal with 13 suspected cases including five deaths

{


INNOVATION

planned trip, that you take sufficient supplies of your chronic medication and that you will be able to get the necessary medical treatment if needed.”

TRAVELLING WITH YOUNG CHILDREN The prospect of air travel with babies or young

PROTECTING YOUR FAMILY

children can be hard, not only

Dr Vincent advises travellers to consider the

for parents but also for fellow

following when planning their vacation:

passengers. Airlines, not wishing

· Destination: Certain destinations may pose specific

to discourage either from travelling,

medical risks such as malaria, yellow fever, meningitis,

go to great lengths to provide

or hepatitis. Most of these diseases can be avoided by

maximum comfort and convenience.

vaccination, prophylactic medication, and precautions regarding food and water consumption. · Planned activities: Are you going white-water rafting,

than others and require a shorter notice period.

specific activities you will be undertaking.

Please check with your travel agent and your of your children. Be vigilant around any water source and remember that, after traffic accidents, drowning is the most

replacement of medicine will not pose problems if

prevalent cause of mortality in travelling children. to look both ways before crossing a street,

medication on hand. Travel insurance that covers

especially while travelling.

· Accommodation: If you will be staying in a five-star

· Self-treatment for respiratory infections · A small pair of scissors and tweezers can also come in handy

Encourage everyone, particularly children,

of your prescription or the generic names of your repatriation is an imperative.

· Self-treatment for travellers’ diarrhoea

travel clinic to ensure the health and wellbeing

the necessary medical treatment if needed and that yours gets lost or damaged. It is wise to have copies

· Anti-bacterial cream for cuts and abrasions and associated band-aids

departure, of the presence of a baby and his/her age. Some airlines are more flexible

planned trip. Check whether you will be able to get

· Insect repellents if appropriate

of booking, and at least 24-48 hours prior to

Always remember to wear a helmet. Also, plan for the

make sure that it is not likely to be aggravated by your

· Sunscreen Protection

It is important to notify the airline at the time

diving, backpacking, bicycling, or riding a scooter?

· If you suffer from chronic medical conditions

WHAT TO PACK · Small packs of sealed wet wipes

“If you’re travelling by air, make sure the items and packaging comply with airline requirements.

air-conditioned beach resort in Mombasa, you have a

The most important part of your holiday is to enjoy

different risk profile than if you are staying in a hut in

it to the fullest and to return home happy, healthy,

rural Brazil with the locals.

and safe,” concludes Dr Vincent.

· Chronic medication – always remember to take your medication along, together with copies of your prescription and the generic names of your medication

Pharmacy Magazine JUNE 2017 |

7


INNOVATION Source: Gut Microbiota for Health

The ‘gut microbiota decade’ The past 10 years have seen remarkable gains in knowledge about the gut microbiota, thanks to major gut microbiota research projects in the US, Europe, and Asia

an important challenge

A

understand ‘man-microbe symbiosis’ have gained in

immune system, vascular system, and nervous system,”

in the field – and one

resolution and sensitivity.”

Versalovic points out. “In other words, to be fully human

Understanding and modelling the

ccording to Dr Joël Doré, Research Director at

be afforded the same level of attention as any other

the French Research Institute in Agricultural

part of the body.

Sciences (INRA): “The tools we can use to

complexity of the intestinal ecosystem is

that may be critical to the future of healthcare

assess the microbiome and thereby try and

For Prof James Versalovic, Pathologist-in-Chief at

“The gut microbiota is essential for any mammal, including humans, to fully develop its intestine,

requires a diverse and fully functional gut microbiome.

Texas Children’s Hospital and professor of Pathology

It is not possible to discuss human health today without

at Baylor College of Medicine (US), “The US Human

describing the role of gut microbiota in sustaining and

Microbiome Project has provided a new perspective on

restoring human health.”

the body of a healthy human through the study of its associated microorganisms. Each body site, including the

MODERN LIFE: A KICK IN THE GUT

intestine, has a distinct microbial community.”

In many disease conditions, from functional bowel

Increasing data supports the idea that the human

disorders and inflammatory bowel disease to type two

body is not complete without microbes – especially the

diabetes and obesity, scientists find a disruption of the

microbes living in the intestinal tract.

normal microbial community that leads to a breakdown

Given the unique functions of the gut microbiota, some have described it as a ‘supra organ’ that should

8

| JUNE 2017

Pharmacy Magazine

of host-microbe symbiosis - a condition called ‘dysbiosis’. Continued on next page...


INNOVATION

An unbalanced diet including a lack of fibre could have detrimental effects on health through the gut microbiota

According to Doré “We changed many things over

Probiotics have been tested in many clinical trials

the past few generations that were key to the mutualistic

to date. Some of them demonstrated benefits of

association with our microbes. This probably contributed

probiotics in prevention of antibiotic-associated

in a marked way to the increase in incidence of

diarrhoea, of allergy disease in early life, or

immune-mediated diseases we have seen on the rise

improvement of symptoms in adult irritable bowel

for more than 60 years now, seemingly uncontrolled.”

syndrome and some liver diseases. Further insights

Doré points out that there are three major elements

are needed into the yeast strains or bacterial species

of modern lifestyle that have the strongest impact on

and the doses that effectively modulate the gut

the human-microbe symbiosis: nutrition, environmental

microbiota to produce different health outcomes.

exposures to chemicals and drugs, and conditions

Understanding and modelling the complexity

surrounding birth. When it comes to nutrition, research

of the intestinal ecosystem is an important challenge

shows an unbalanced diet including a lack of fibre

in the field – and one that may be critical to the future

could have detrimental effects on health through the

of healthcare.

gut microbiota. Doré says, “After 100 000 generations

“Concepts and practices in human nutrition will

receiving more than 60% of their energy from plant-based

change as we begin to couple food intake with changes

food, over 2-3 generations we brought this down to 10%.”

in the behaviour of the gut microbiota,” predicts

Modern day ailments such as stress together with

Versalovic. “We will consider nutrition and medications

treatments such as antibiotics and chemotherapy

differently in paediatric and adult medicine based on

have also been shown to have an important impact

life-stage-specific differences in the microbiota.”

on gut bacteria.

Specific new therapies that target gut bacteria

More recently, research has also confirmed that

are also on the global research agenda. Going from

gut microbiome has an influence on the bidirectional

the basic science to the clinic, however, will not be

communication between the gut and the brain.

without its challenges.

Discoveries around the gut microbiome-brain axis

“The biggest barrier to translation is that the gut

will maybe change the way some conditions are

microbiota is so complex that it is taking time – plenty

perceived (including autism, depression, and

of time in years – for many scientists to find the signals

anxiety among others).

and ‘hike’ through the noise to get to new diagnostics and therapeutics as cornerstones of metagenomic

MICROBIOTA MODULATION: NUTRITION AND MEDICATIONS AS KEY STRATEGIES

| JUNE 2017

The Gut Microbiota for Health World Summit takes

One of the insights to come out of Chinese

place in an important context: In view of the recent

metagenomics projects reinforced the importance of

discoveries on the broad impact of gut microbiota in

nutrition, as it showed a close connection between

human health, experts point out the need for medical

diet and health. “Diet is the major force in shaping the

practice guidelines for physicians, nutritionists, and

gut microbiota,” points out Dr Liping Zhao, professor of

other healthcare professionals. Sharing knowledge and

microbiology at Shanghai Jiao Tong University and leader

experiences, as will be done in this conference, is key for

of the Functional Metagenomics Platform at Shanghai

achieving a better understanding and implementation of

Center for Systems Biomedicine emphasises.

10

medicine,” Prof Versalovic says.

Pharmacy Magazine

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interventions to protect our unique bacterial partners.

The three major elements of modern lifestyle that have the strongest impact on the human-microbe symbiosis: nutrition, environmental exposures to chemicals and drugs, and conditions surrounding birth


Irritable Bowel Syndrome is hard to stomach. Bowel Balance It’s what your tummy’s been aching for! TM

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References: 1. Irritable Bowel Syndrome (IBS). The Merck Manual Home Edition. (Last accessed 7 April 2015) From: http://www.merckmanuals.com/home/digestive_ disorders/irritable_bowel_syndrome_ibs/irritable_bowel_syndrome_ibs.html 2. Canavan, C. et al. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014; 6: 71–80. (Last accessed 7 April 2015) From: http://www.ncbi.nlm.nih.gov/pmc/articles/ pmc3921083/ 3. Bowel Balance™ Package Insert; Data on file. Bowel Balance™ Capsules. D 32.16 Others: 33. Minerals. Each capsule contains 700 mg Potentiated Absorbatox® CEC 3.5.IBS. For full prescribing information refer to the package insert. Further information is available on request from the applicant. This medicine has not been evaluated by the Medical Control Council. This medicine is not intended to diagnose, treat, cure or prevent any disease. Applicant: Absorbatox (Pty) Ltd. Marketed by: Ranbaxy (SA) (Pty) Ltd, a Sun Pharma company. Reg. no.: 1993/001413/07. Ground Floor, Tugela House, Riverside Office Park, 1303 Heuwel Avenue, Centurion. Tel: +27 12 643 2000. Website: www.sunpharma.com


INNOVATION

Genetic testing offers personalised healthcare Experts in the field of human genetics predict the growth of personalised medicine, as patients increasingly take control of their health – and medical practitioners aim to prescribe more accurate and effective treatment

S

tate of the art genetic technology

EXPERTS WEIGH IN

is now available in South Africa,

Dr Daniel Meyersfeld, molecular biologist and

and done via a simple cheek swab.

founder of DNAlysis Biotechnology, suggests

This means both individuals

extensive research conducted over the past few years

seeking or on medical treatment can be genetically tested as a means of tailoring treatment

Most tests are as simple as a cheek swab that can be done anywhere, at any time, and couriered to a lab to be tested

for better outcomes.

| JUNE 2017

patient-specific precision medicine. “Medicine is no longer ‘one dose fits all’. By analysing DNA, it’s possible to understand how different genotypes

PRECISION IS POWER

affect the metabolism of medication in the body,” explains

Personalised medicine is underpinned by

Meyersfeld. “With these scientific insights, medical

pharmacogenomics – the study of genetic variation

practitioners can pre-emptively optimise medications for

that determines how individuals respond to certain

their patient and see better results by avoiding a ‘trial-and-

drugs and how those drugs are metabolised in the

error’ approach to drug prescription.”

body. Also known as ‘precision medicine’, personalised medicine gives medical practitioners the power to

MIND THE (KNOWLEDGE) GAP

accurately determine the right drug and dose for the

Meyersfeld adds there’s a lack of awareness about

patient, based on their DNA.

genetic testing in South Africa – how it’s conducted, and the science behind it. This has prevented many South

HOW IT WORKS

Africans from exploring genetic testing to enhance their

With advancements in the field of pharmacogenomics,

own healthcare – and that of their loved ones.

the process of genetic testing has become increasingly

“In SA, there’s a misconception that genetic testing is

simple and user-friendly. Genetic tests available in

hugely expensive and invasive, which simply isn’t the truth.

South Africa now include those as simple as a cheek

There’s also a fear of genetic information falling into the

swab done in the comfort of the patient’s own home –

wrong hands – being used by insurance companies to

countering the perception that genetic testing is invasive,

determine risk, for example,” says Meyersfeld.

complicated, or excessively expensive.

12

supports genotype testing as means of determining

Pharmacy Magazine

Continued on next page...


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INNOVATION

Most tests are as simple as a cheek swab that can be

HARNESSING HEALTHCARE

done anywhere, at any time, and couriered to a lab to

Meyersfeld urges South Africans to discuss genetic

be tested. The results are strictly confidential and only

testing with their medical practitioner, and take

shared with the nominated healthcare practitioner.

control of their healthcare.

“The cost, when weighed up with the lifetime

“We’re in the information age on steroids. There’s

benefits of accurate and safe medical treatment, is

nothing we can’t know these days. So why do we

almost negligible. Not to mention patients will actually

know so little about our own DNA? It’s the roadmap

save money in the long run by avoiding medications

for how our bodies work, so it makes sense for

that don’t work.”

individuals – and their trusted medical practitioners – to understand everything about their unique genetics,

MEDS TO WATCH

so they can access more informed, more effective

Areas of particular focus for genetic testing and

medical treatment,” concludes Meyersfeld.

personalised medicine include cardiovascular disease, psychiatry, and pain management, as these clusters are frequently prescribed as chronic medications. Clopidogrel, as an example, is the standard treatment

Personalised medicine gives medical practitioners the power to accurately determine the right drug and dose for the patient, based on their DNA

14

| JUNE 2017

to stop blood clotting, heart attacks, or strokes after coronary stent surgery – but studies show 2-14% of the population don’t metabolise the medication adequately, which can leave them vulnerable. Widely used blood-thinner Warfarin is also known to vary in effectiveness from patient to patient, which makes dosing problematic for medical practitioners. “Currently, drugs are prescribed to meet the needs of the general population – not the individual. Now, we can analyse our DNA to understand how each of us processes medication in the body, and to flag medications with more extreme side effects for individuals. What’s most exciting is that this world-class test is available to the South African public,” says Meyersfeld.

Pharmacy Magazine


EDUCATION

Know your products With such an important role to play in our mobility it is important to care and support our joints through regular exercise, lifestyle choices, diet, and vitamins

JOINT HEALTH

{ 16

Caring for your joints early on will help with preventing further damage and manage pain

| JUNE 2017

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Pharmacy Magazine


EDUCATION A joint is the connection between two bones. Smooth tissue called cartilage and synovium and a lubricant called synovial fluid cushion the joints so bones do not rub together. But increasing age and injury can wear and tear your cartilage. This can lead to a reaction that can damage your joints and lead to arthritis. The best way to care for your joints is to keep them and your muscles, ligaments, and bones strong and stable. Here are 3 products specially engineered to assist patients to support and lubricate joints, relieve pain, and rebuild cartilage

S0 PRODUCT:

Flexiseq® Active

S0

DOSAGE: Unless otherwise directed by your doctor, apply twice daily, in the

INDICATION:

morning and the evening, to the soft

Flexiseq® Active lubricates the

tissues around the affected joint.

cartilage in joints to relieve pain

Apply a quantity appropriate to the

and stiffness, and improve impaired

size of the joint being treated:

joint function associated with all

· For a knee, shoulder or hip, a line as

stages of osteoarthritis.

long as your index finger. · For an ankle, wrist or the fingers on

INGREDIENTS: Aqua, Phosphatidylcholine, Glycerin, Alcohol, Carbomer, Disodium Phosphate, Sodium Hydroxide, Polysorbate 80,

the one hand, a line as long as half of your index finger. Twice-daily treatment with Flexiseq Active can provide pain relief after as little as 2 days. However, it may take up

Benzyl Alcohol, Methylparaben,

to several days of continuous use for

Ethylparaben, Disodium EDTA,

the full effect to be seen.

Linalool, Sodium Phosphate,

www.flexiseq.co.za

Sodium Metabisulfite, BHT

011 791 1007

S0 PRODUCT:

Vitabiotics Jointace® Patch

S0

INDICATION: Jointace® Patch has been developed to provide extra support for joints and muscles. The patch is for external use only and provides direct and sustained contact with the skin. Its unique formula combines Aroma-Active™ essential oils with soluble Glucosamine and Chondroitin, delivered by Liposome Release for active absorption. A convenient patch for both short and long

S0 PRODUCT:

Arthrosan® Plus

S0

term support Jointace® Patch is ideally suited for use under clothes. INGREDIENTS:

INDICATION:

Aqua, Sorbitol, Glycerin, Carbomer, PVP,

Arthrosan® Plus has been formulated

Alcohol, Triethanolamine, Glucosamine

to preserve and rebuild joint cartilage

Hydrochloride, Aluminium Hydroxide, Citrus

as well as provide relief from joint pain.

Dulcis (Sweet Orange) Oil, Lavendula Angustifolia (Lavender) Oil (Eucalyptus Oil,

INGREDIENTS:

Pinene Alpha, Benzyl Alcohol, Comphre

Each tablet contains 500mg

Codex, Terpineal, Lavendra grosso

Glucosamine Sulphate, 200mg MSM

essence), Menthol, Zingiber Officinalis

(Methylsulphonylmethane), 100mg

(Ginger) Oil, Chondroitin Sulphate Sodium,

Chondroitin Sulphate, 50mg Vitamin C,

Lecithin, Foeniculum Vulgare (Fennel) Oil,

10µg Selenium, 1mg Manganese, 75mg

Imidazolidinyl Urea, Eucalyptus Globulus

Shiitake mushroom powder

(Eucalyptus) Oil (Limonene), Eugenia

DOSAGE:

Caryophyllus (Clove) Oil.

ADULTS: Take 3 tablets daily or as

DOSAGE:

recommended by your healthcare

Each patch can be worn for up to 12 hours

practitioner.

after which time it should be discarded and

Not for children under the age of 12

replaced with a new patch.

www.peppina.co.za

www.vitabiotics.co.za

011 314 0445

011 454 3257

Pharmacy Magazine JUNE 2017 |

17


EDUCATION Source: Gloves in a bottle

Skin protection: shielding lotion vs moisturiser

The outer layer of skin is made up of dead skin cells, natural oils, and lipids (fats). It is designed by nature to protect your deeper layers of skin from irritants and toxins. This is natural skin care at its very best

EFFECTS OF MODERN LIFE ON SKIN

of skin resulting in dry, irritated or itchy skin. Furthermore

Most soaps and cleansers contain fragrances, colourants,

the deeper layers of skin are left exposed to a host of

antibacterial agents and many other ingredients that

damaging, everyday substances including many cosmetics,

strip away these protective elements from the outer layer

detergents, anti-bacterial soaps, solvents, cleaners,

of skin, compromising your natural skin care. A shielding

gardening chemicals, dirt ad grease, latex glove powder,

lotion replenishes this protective layer on the skin and

etc. The result is skin that is drier, irritated, or itchy and more

helps heal skin disorders.

susceptible to becoming cracked and further damaged.

Daily use of most soaps and cleansers can greatly

Conventional moisturisers, lotions, and skin creams (artificial

reduce your skin’s natural ability to repel the thousands

moisturisers) only attempt to replace natural moisture with

of irritants and toxins that are commonly found in the

artificial moisture. They only mask the symptoms by offering

home and work place. Once these irritants penetrate

temporary relief that does little to heal the skin.

your outer layer of skin they can cause dry skin conditions,

Regular use of conventional moisturisers, lotions, and

eczema, psoriasis, skin allergies and many other less

skin creams can send the wrong message to the skin (that

desirable skin and health problems.

there is enough moisture present), causing it to produce less

When applied, a shielding lotion bonds with the outer layer of your skin creating an undetectable protective layer

natural moisture. Natural moisture is the only thing that is THE OUTER LAYER OF SKIN

going to truly resolve a dry skin condition.

The outer, protective layer of skin consists of dead cells. These cells need to stay moisturised in order to perform the

HOW A SHIELDING LOTION WORKS

function of protecting the deeper layers of skin. To keep the

A shielding lotion bonds with the outer-most layer

skin’s natural moisture from leaving the outer layer of skin,

of skin, locking in natural moisture and oils.

the skin produces natural oils. These oils also help keep

Loss of natural moisture and oil is the leading

irritants away from the deeper, more delicate layers of skin.

cause of dry and irritated skin.

Modern living (frequently washing with soap and exposure

Unlike contemporary skin moisturisers which try

to an ever increasing number of chemicals), harsh weather

to replace the skin’s natural moisture with artificial, often

and other irritants can remove these natural oils.

greasy moisture, shielding lotions bond with dead skin cells to create what can only be termed an invisible pair of gloves.

WHAT HAPPENS WHEN YOUR NATURAL OIL IS STRIPPED AWAY?

This new outer layer helps prevent the loss of natural oil and

When the natural oils are stripped away from the outer layer

improves the overall ability of the epidermis to protect the

of skin, the skin’s own moisture quickly leaves the outer layer

inner skin cell layers.

moisture, supports skin elasticity, and

Pharmacy Magazine JUNE 2017 |

19


EDUCATION

Vitamin D deficiency “epidemic” can be reversed

Vitamin D deficiency affects about two in three South Africans and may be a major underlying cause of illness and serious infections, according to top SA nutritional consultant, Vanessa Ascencao

A

scencao was responding to a recent

Capetonians are deficient while Ascencao said

Cape Town residents, in particular,

an independent pilot study showed only two of

were at risk of vitamin D deficiency

17 South Africans tested across the country had

in winter when UVB exposure from sunlight was extremely low, making it harder to fight

Pharmacy Magazine

“Some scientists consider this an unrecognised global epidemic and the world’s

supplementation may reverse deficiency and

single deadliest vitamin deficiency as it

even slow down HIV infection.

has been linked to diabetes, osteoporosis, rheumatoid arthritis, inflammatory bowel

of Cape Town, Stellenbosch, and Pennsylvania

disease, multiple sclerosis, and autism. Vitamin

State in the US examined 100 healthy

D, along with a healthy diet and lifestyle, may be

Khayelitsha and Bellville adults between 18 and

the most important factor in fighting infections,

24-years-old. A statement from UCT said: “The

including flu and HIV,” said Ascencao.

results suggest that vitamin D supplementation

| JUNE 2017

adequate vitamin D levels.

disease and infection. The study said vitamin D

The study by scientists from the Universities

20

The study further showed that 63% of

international study which found

In addition to direct sunlight on exposed skin

may prevent winter anaemia and boost white

for at least 20 minutes a day, Ascencao said

blood cell count, possibly serving as a cost-

foods high in vitamin D include fish oils and fatty

effective intervention to reduce risk of HIV

fish, mushrooms, liver, and egg yolk. She added

infection and slow down HIV progression in

that the most effective supplementation was

infected individuals”.

via vitamin D mouth sprays.


EDUCATION

Sleep quality vs quantity Studies have assessed whether measures of health, wellbeing, and sleepiness are better related to sleep quality or sleep quantity

S

leep breaks down into three forms: light sleep,

affect and a decrease in satisfaction with life. In addition,

rapid eye movement sleep (REM), which

poor sleepers reported increased levels of sleepiness,

nourishes our emotional and creative abilities;

especially as measured by the Stanford Sleepiness Scale.

and deep sleep, which is when the brain and

Measures of health, wellbeing and sleepiness were more

body rebuild and when our bodies secrete the most human growth hormone. While REM and deep sleep

significantly different from the sleep quantity relationships. The components of sleep quality other than simply

seem to do more restorative work than light sleep, sleep

sleep quantity (e.g., number of awakenings at night, general

analysis shows that we spend more time every night in

satisfaction with sleep) appear to be largely responsible for

light sleep than anything else.

the relationships between sleep quality and measures of

While gaining an extra 40 hours a week by only sleeping two hours a day might sound attractive, polyphasic sleep has a major drawback: as long as the

Rapid eye movement, or REM, sleep nourishes our emotional and creative abilities

health, wellbeing, and sleepiness. Overall, findings indicate that sleep quality accounts for more of the variance in health measures.

rest of the world is sleeping monophasically (in one, single phase, those six or eight hours spent in bed), the time gained by polyphasic sleep is at night, precisely when the rest of the world is shut down. DEEP, RESTORATIVE SLEEP IS ESSENTIAL Study results suggest that poor sleep quality was correlated with increased physical health

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Sleep quality accounts for more of the variance in health measures

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complaints, as measured by the Cornell Medical Index, and with increased feelings of anxiety, depression, anger, fatigue and confusion, as measured by the Profile of Mood States. Furthermore, poor sleepers reported a decrease in positive

Study results suggest that poor sleep quality was correlated with increased physical health complaints Pharmacy Magazine JUNE 2017 |

21


EDUCATION

The plague that is cold sores Depending on demographics, about 50-90% of the population gets cold sores

Cold sores may develop as late as 20 days after exposure to the virus

A

ffecting such a large segment of the

infected with the virus that causes cold sores

population, cold sores is one of the

never develop signs and symptoms.”

most common complaints you’ll face from frustrated customers over the

winter season.

You can't cure HSV or a cold sore, but you can alleviate the pain it causes.

Cold sores are described as “small, painful,

TREATMENT Panic is often the first reaction of those affected by cold sores. You are in the unique position to

fluid-filled blisters or sores that appear on the

allay their fears and assure them of the various

lips, mouth, or nose that are caused by a virus,”

treatments available

by emedicinehealth.com.

There is no cure for HSV. Once infected, the virus will lie dormant in the body for the rest of your life with

SYMPTOMS

occasional flair-ups resulting in cold sores. As such,

· Tingling and itching – Most people feel an

treatment targets the symptoms rather than the virus

itching, burning or tingling sensation around their

itself. The earlier the symptoms are addressed the

lips a while before blisters break out.

more effective the treatment will be.

· Blisters – these are small blisters that consist

Over-the-counter medicine assists in dealing

of fluid in them. These typically break out on the

with relieving the irritation and pain, but won’t do

tip, where the skin meets the lip.

much in healing the sore.

· Oozing and rushing – the blisters merge and

Phenol and menthol are believed to assist in

then eventually burst, leaving open sores that

preventing scabs and cracks, while docosanol is

ooze fluid and then crust over.

also identified as helping faster healing and minimising pain.

CAUSE

22

| JUNE 2017

HSV tends to be more active when the body is

Cold sores are caused by certain strains of the herpes

run down. As such patients should proactively boost

simplex virus (HSV). “HSV-1 usually causes cold sores,”

their immune system when they know their body

explains Mayo Clinic. “HSV-2 is usually responsible for

will be weaker and more susceptible to cold sores

genital herpes. However, either type can cause sores in

(e.g. during winter or periods of increased stress).

the facial area or on the genitals. Most people who are

Prevention is always preferable to a cure.

Pharmacy Magazine


Influenza is a serious threat…

A healthy start today

Rea t othe dy to infec rs tomorrow

…to life 3 to 5 million cases of severe influenza illness result in 250 000 to 500 000 deaths per year1.

…to society

The economic impact of influenza because of healthcare costs and lost productivity is considerable2. Vaccination results in a significant reduction in hospitalization due to chronic respiratory conditions and pneumonia. Overall mortality – a decrease of up to 50%3 References: 1. Van de Witte SV et al. Trivalent inactivated subunit influenza vaccine Influvac®: 30-year experience of safety and immunogenicity. Trials in Vaccinology 1 2012; pp42-48. 2. Rohde G et al. Vaccinating High-risk Patients Against Influenza: Doing More to Protect Patients with Asthma. Annals of Respiratory Medicine 2010; 1:1-7. 3. Nichol KL et al. Influenza Vaccination and Reduction in Hospitalizations for Cardiac Disease and Stroke among the Elderly. N Engl J Med 2003; 348:1322-1332. S2 Influvac Subunit 2016. Composition: Each 0,5 ml Influvac Subunit 2016 influenza vaccine contains influenza virus surface antigens (haemagglutinin and neuraminidase) of strains: A/ California/7/2009 (H1N1) pdm09-like strain used (A/California/7/2009, X-181) 15 µg HA; A/Hong Kong/4801/2014 (H3N2)-like strain used (A/New Caledonia/71/2014, X-257A) 15 µg HA; B/ Brisbane/60/2008-like strain used (B/Brisbane/60/2008, wild type) 15 µg HA. Abbott Laboratories S.A. (Pty) Ltd, Reg. No. 1940/014043/07, Abbott Place, 219 Golf Club Terrace, Constantia Kloof, 1709. Tel No.: 011 858 2000 For full prescribing information refer to the package insert approved by the medicines regulatory authority. Date of publication: March 2016 Promotional Review Number: ZAEINF150254.

Vaccinate your patients with ABBOTT’s Influvac® this winter!


EDUCATION Source: CDC

A shot in the arm Why should people get vaccinated against the flu?

I

nfluenza is a serious disease that can lead to

is not a shot in the dark

There is no preference for one vaccine over

hospitalisation and sometimes even death. Every

another among the recommended, approved

flu season is different, and influenza infection can

injectable influenza vaccines.

affect people differently, but millions of people get

There are many vaccine options to choose from,

the flu every year, hundreds of thousands of people are

but the most important thing is for all people six months

hospitalised and thousands or tens of thousands of

and older to get a flu vaccine every year.

people die from flu related causes every year. Even healthy people can get very sick from the flu and spread it to others. An annual seasonal flu vaccine is the best way to reduce risk of getting sick with seasonal flu and spreading it to others. When more people get vaccinated against the flu, less flu can spread through that community. HOW DO FLU VACCINES WORK? Flu vaccines cause antibodies to develop in the body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine. The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Traditional trivalent flu vaccines are made to protect against three flu viruses; an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. Quadrivalent vaccines protect against an additional B virus. ARE ANY OF THE AVAILABLE FLU VACCINES RECOMMENDED OVER OTHERS?

WHO SHOULD NOT BE VACCINATED? CDC recommends use of the inactivated influenza vaccine or IIV and the recombinant influenza vaccine (RIV). The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2016-2017. Different flu vaccines are approved for use in different groups of people. Factors that can determine a person’s suitability for vaccination, or vaccination with a particular vaccine, include a person’s age, health (current and past) and any allergies to flu vaccine or its components.

Annual influenza vaccination is recommended for everyone six months and older with either the inactivated influenza vaccine (IIV) or the recombinant influenza vaccine (RIV).

WHEN SHOULD PATIENTS BE VACCINATED? Flu vaccination should begin soon after the vaccine becomes available. However, as long as flu viruses are circulating, vaccination should continue to be offered throughout the flu season. Since it takes about two weeks after vaccination for antibodies to develop in the body that protect against influenza virus infection, it is best that people are vaccinated so they are protected before influenza begins spreading in their community. Flu vaccine is produced by private manufacturers, and the timing of availability depends on when production is completed.

Pharmacy Magazine JUNE 2017 |

25


EDUCATION HEALTH & WELLNESS

Man-made The purpose of Men’s Health Month is to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. It is about the health risks men may face, how to prevent them, what symptoms to look out for, and where to get medical assistance. Generally recognising and celebrating men in June, we look at 8 products specially engineered for them.

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The easiest way to protect skin on a daily basis is to use sunscreen which blends into skin quickly and has an SPF of at least 30

{

DAILY SUPPLEMENT:

Solal All You Need™ Men Ages 20-50

Sorbet Man Body Lotion Hydro Cool

nutraceutical that

Boosted with

combines different

DuraQuench™ IQ

classes of nutrients,

moisturising complex,

specifically formulated

Sorbet Man Hydro

for men between

Cool Body Lotion is a

the ages of 20-50.

supercharged body

It includes natural

quencher for the gent

bioidentical vitamins,

who needs more for

Wellvita Prostate Health™

minerals, antioxidants,

his pores. Suitable for

With age, physiological

and other nutrients to

normal to dry skin, and

factors such as

promote immune and

developed to provide

hormone imbalances,

general health, and to

optimum skin hydration,

inflammation, and

help maintain proper

this lotion is akin to male

oxidative stress can

DX Smooth Even Tone Face Lotion

muscle function. It

body magic potion. By

begin to affect the size

Active ingredients in

Vaya™ Sport Head & Body Hair Removal Cream

further helps the body

hydrating the epidermis,

of the prostate.

DX Smooth® Even Tone

Vaya™ Sport Head

Wellvita™ Prostate

Face Lotion help fade

& Body Hair Removal

dark spots and restore

Cream is a clean and

while boosting mental focus and stamina.

26

| JUNE 2017

and moisturising, it, essentially, helps ensure your skin has more swagger than Jagger.

Pharmacy Magazine

Health incorporates herbal extracts, phytochemicals, and nutraceuticals that can benefit prostate health.

HAIRLESS:

®

natural, even skin tone. With ongoing daily use, results can be visible in as little as 2-3 weeks.

www.vaya.co.za

symptoms of stress

softening, rejuvenating

NATURAL TONE:

www.dxsmooth.co.za

and to relieve the

regulating water loss,

CARE & SUPPORT:

www.wellvita.co.za

and carbohydrates;

www.sorbetman.co.za

It is a comprehensive

to metabolise fats www.solal.co.za

SKIN HYDRATION:

painless way to remove unwanted head and body hair quickly and easily.


EDUCATION HEALTH & WELLNESS

MEN'S

HEALTH Men are taking a greater interest in personal grooming and in body hair removal

MONTH

SMOOTH SHAVE:

Bump Patrol With an advanced gel

NO SWEAT:

solution. An aftershave

Rockface 48hr Antiperspirant Deodorant™

intensive treatment

With pioneering

that helps prevent

formulations

and treat razor

Rockface™ is the high

provides a dermatologist

bumps and irritation caused by shaving in just seven days. Contains chamomile to help soothe and calm the skin.

www.rockface4men.com

www.bumppatrolafrica.com

recommended bump

performance range for men who work harder and play harder. A hard working deodorant to give 48 hour protection.

SKIN HYDRATION:

The Hairgum Barber Shop Beard Oil

www.hairgum.com

formula Bump Patrol

Formulated with 100%

is hydrated. Your beard

natural ingredients,

is smoother, tamer, sleek

Hairgum Barber Shop’s

and soft to the touch -

Special Beard Care Oil

while not feeling greasy!

is a unique combination

Its light and nourishing

of 50% of shea and 8

texture prevents itchy

carefully selected organic

regrowth and helps your

oils. Your beard is highly

beard regrow in a clean,

nourished and your skin

disciplined way.

Pharmacy Magazine JUNE 2017 |

27


Be part of a

nation wide challenge to identify who is invading your Pharmacy this winter!

STAND A CHANCE TO

WoIf N 20 1

R2500

CASH PRIZES

Biobalance™ Mystery Shopper Competition will run

FROM

June 2017

July

Pharmacy Staff in South Africa

FOR

2017

Talk to your Biobalance™ Representative for more information. Biobalance™ mystery shoppers will enter your pharmacy seeking your advice on how to beat the cold and flu this winter.

I’mmuned with biobalance TM

Protect your space.

Protect yourself against unwanted space invaders.

Biobalance™ contains a unique formula with Carbohydrate Derived Fulvic Acid (CHD-FA®). Fulvic acid is an antioxidant that occurs naturally in certain soils, plants and plant-based foods. Some of the benefits of taking fulvic acid include: • • •

Ascendis Supply Chain (Pty) Ltd. Consumer care line: 011 036 9420 healthinfo@ascendishealth.com www.ascendis.co.za

It boosts the immune system It enhances the body’s resistance against viruses that cause cold and flu It enhances the body’s ability to absorb zinc, an important immune boosting mineral


EDUCATION

MEN'S

HEALTH

n have e m l ea

MONTH

regular health checks

R TYPE 2 DIABETES

diabetes or blood pressure problems would

Type 2 diabetes is one of the largest global health

never happen to us. Adding to this is the fact that

emergencies of the 21st century. Worldwide, it is a

diabetes can go unnoticed for many years as the

leading cause of cardiovascular disease (heart attacks

typical warning symptoms only occur once the glucose

and stroke), blindness, kidney failure, and lower limb

rises to extremely high levels. Or even worse, that

amputation, and a major cause of death. It affects up to

something has been very wrong with our health is

4.5 million South Africans, more than half of whom are

only considered when a devastating complication

unaware that they have it, and majority of whom will be

such as a heart attack has occurred.”

dead before the age of 60.

Primarily caused by an unhealthy diet, lack of physical

ERECTILE DYSFUNCTION AND DIABETES

activity and excess body weight, type 2 diabetes occurs

In men, one of the first signs that something is wrong in

when the body stops making enough insulin, or does not

the arteries may be erectile dysfunction (ED). The chance

respond properly to the insulin it has. This deficiency of

of having ED increases with longer duration of diabetes,

effective insulin causes glucose (sugar) to accumulate

but eventually up to around 7 out of 10 men with diabetes

in the blood stream, rather than entering cells where

can be unable to get or keep an erection. For many

it would normally provide energy. The sustained

men, ED is devastating, leading to depression, reduced

abnormally high blood glucose level causes damage

self-esteem and strained relationships. Nevertheless,

to blood vessels and nerves, resulting in these

paradoxically, ED itself might be a blessing in disguise.

horrendous health consequences.

Although that sounds counterintuitive, ED is an early

Dr Zane Stevens, an endocrinologist in private practice

warning sign that a heart attack could be imminent,

in Cape Town, is very concerned that men are not

affording time to do something about it before it’s too

proactive about their health. “Diseases of lifestyle creep

late. In fact, men with ED are almost 15 times more

up slowly. Many previously fit, active men get married

likely than those without to suffer a heart attack and

and, as the years go by, adopt unhealthy lifestyles due to

ED has been identified as the most significant predictor

the stresses of work, financial pressures, and trying to get

of that in comparison to any other conventional

ahead in their career. Health becomes far from a priority.

cardiovascular risk factor.

With regards to the diagnosis of diabetes in men,

“I should have told my doctor, but I was too shy to bring

unfortunately many men tend to seek help very late. I

it up,” says a patient, Sam*. “Looking back, that was silly,

think it’s partly because, as men, we often feel like we

because it could have prevented what came next”.

are supposed to be invincible and prefer to believe that

ED, diminished interest in sex and depressed mood

Some health needs are specific to men. As such it’s important for them to take their health seriously and be proactive about it

The key to a healthy future is awareness of that. But men don’t talk about their health Continued on next page...

Pharmacy Magazine JUNE 2017 |

29


EDUCATION

MEN'S

HEALTH

MONTH

are also symptoms of low testosterone, which occurs twice as commonly in men with diabetes than in those without. And diabetes itself also predisposes to

Men are prone

depression. “The problem

to developing a

is,” explains Sam, “that all

boep, which in turn

of these symptoms overlap,

can lead to higher

so you don’t really connect

risk of diabetes, cardiovascular disease.

them to one cause. I put most of them down to me just putting on weight.” And that’s where it starts. In fact, overweight and obesity, together with physical inactivity are the strongest risk factors for type 2 diabetes and

Approximately 40% of South African men are overweight and less than 1 out of 4 participates insufficient exercise

30

| JUNE 2017

the majority of people with type 2 diabetes

conscientious with my treatment, I could have prevented

are overweight. It’s a big problem in our country –

some of the problems that I am facing now.”

approximately 40% of South African men are overweight and less than 1 out of 4 participates in

DIABETES AND LIFESTYLE

sufficient exercise. In fact less than half participate

Stevens agrees: “Remaining balanced is key. Making time

in any physical activity at all.

for exercise and creating a culture of healthy eating is

“Men have to be told that diabetes is preventable,”

not only important for us but serves to set an example

says Sam. “It’s not that difficult to make healthier food

and ensure the health of our families. Men who have risk

choices and do a bit of exercise. And get a regular

factors for diabetes such as being overweight or having

check-up. My doctor told me that if my diabetes

a family history of the condition should consider being

had been detected a bit earlier and I had been more

Pharmacy Magazine

Continued on next page...


New SensodyneÂŽ Rapid Relief

ACTS FAST to help prevent moments like these

Help patients BEAT SENSITIVITY PAIN FAST New SensodyneÂŽ Rapid Relief is a unique formulation engineered for speed that supports accelerated occlusion of dentine tubules.1 It provides ckinically proven relief in just 60 seconds after brushing sensitive areas, 2,3 giving patients long-lasting protection* from sensitivity and its impact on everyday life.4,5 *With twice-daily brushing References: 1. Accepted for presentation at IADR 2017, Abstract no: 2631820. 2. GSK Data on File Report NPD/EU/049/16, December 2016. 8. Accepted for presentation at IADR 2017, Abstract no: 2635085. 4. Parkinson CR et al. Am J Dent. 2015 Aug;28(4):190-196. 5. Baker S et al. Longitudinal validation of the Dentine Hypersensitivity Experience Questionnaire (DHEQ). Poster presented at: IADR/AADR/CADR General Session & Exhibition; 2013 March 20-23, Seattle, Washington. Date of preparation: February 2017. GCSAE/CHSENO/0150/16(1)


EDUCATION

MEN'S

HEALTH

MONTH

Men with ED are almost 15 times more likely than those without to suffer a heart attack screened for the condition.” Once diabetes has been diagnosed, careful control

Stevens. “Regular follow up is also important. The name of the game in diabetes management is

of blood glucose can help to prevent or delay the

prevention. By regularly screening for complications

complications. When control is achieved early on, the

and intensifying therapy as needed, complications can

benefits remain for many years, despite it becoming more

be minimised.”

difficult to maintain control of glucose levels. For many

You are a man. Some health needs are specific to

men, this merely requires a change in diet, some exercise

men. Men are prone to developing a boep, which in

and sometimes medication. However, because diabetes

turn can lead to higher risk of diabetes, cardiovascular

is a progressive disease, over time insulin may also be

disease, and low testosterone. Each one of these

required. Insulin is the most effective treatment to control

presents its own challenges to a healthy future,

blood glucose. Despite what many people believe, insulin

but all are manageable if they are addressed proactively

does not need to be complicated to use and often only

or, when they do occur, early and before complications

needs to be taken once a day. A small price to pay for

start. And the key to a healthy future is awareness of

protecting your future health and lifestyle.

that. But men don’t talk about their health. That’s not what being a man is all about.

BEING PROACTIVE ABOUT YOUR HEALTH AND TREATMENT

Be a man. Speak up. Talk to your doctor about your health before it’s too late.

“The earlier treatment can be initiated, the better the chances of avoiding diabetes complications”, explains

*

Not his real name

Men who have risk factors for diabetes such as being overweight or having a family history of the condition should consider being screened for the condition

{

{

Many previously fit, active men get married and, as the years go by, adopt unhealthy lifestyles due to the stresses of work, financial pressures, and trying to get ahead in their career.

32

| JUNE 2017

Pharmacy Magazine


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References: 1. Roznal OTC approved package insert, Dec. 2009. 2. Peura DA, Gudmundson J, Siepman N, et al. Proton pump inhibitors: effective first-line treatment for management of dyspepsia. Dig Dis Sci 2007;52(4):983-7. 3. Drugs.com. Antacids. [Online] Available at: https://www.drugs.com/monograph/antacids. html. Accessed March 2017. 4. Drugbank. Lansoprazole. [Online] Available at: https://www.drugbank.ca/drugs/DB00448. Accessed March 2017. Roznal OTC. Each capsule contains lansoprazole 15 mg. Reg. No: A40/11.4.3/0154. For full prescribing information, please refer to the package insert approved by the Medicines Regulatory Authority. Adcock Ingram Limited. Reg. No.: 1949/034385/06. 1 New Road, Midrand, 1685. Private Bag X69, Bryanston, 2021. Tel.: +27 11 635 0000. www.adcock.com. 1028398 04/2017.

1,4


EDUCATION

MEN'S

Check your

HEALTH

MONTH

prostate from 40 Men with a family history of prostate cancer should have prostate examinations from the age of 40, says top SA urologist

D

octor Dirk Ligthelm of The Urology Hospital in

cause of cancer

Pretoria says men should consult their GP

death worldwide

or urologist for a prostate blood test (PSA)

Ligthelm explained

and a rectal examination. A PSA measures

that the latest

the level of prostate-specific antigen (protein) in the

trend in cancer

blood and a rectal examination allows a urologist to

detection in the

feel for irregularities on the prostate.

prostate involves

“An elevated PSA level and a suspicious nodule on

combining MRI (magnetic resonance imaging)

the prostate on rectal examination should be followed

and ultrasound scanning, to create a 3D image

by a prostate biopsy to detect whether there is cancer

of the prostate to more accurately locate suspicious

and at what stage it is. Appropriate treatment is then

areas and help diagnose cancer.

considered,” said Ligthelm.

“This new approach is helping improve the

He added that men without a family history or with no symptoms of prostate cancer should start having

detection rate and also helps make a better and more accurate diagnosis.”

annual prostate examinations from age 45.

The most common treatment for a cancerous

The prostate is a gland in the male reproductive

Prostate cancer is the second leading cause of cancer death worldwide

prostate is a prostatectomy (removal of the prostate)

system which secretes fluid that nourishes sperm. A

and minimally invasive robotic surgery is fast becoming

study shows that prostate cancer is the second leading

the most effective option, added Ligthelm.

Kidney stones more prevalent in men, can be avoided Kidney stones are twice as common in males as females and although sometimes genetic, they may be avoided through adopting a balanced diet and a healthy lifestyle

K

Dr GF Duvenage of The Urology Hospital in Pretoria

idney stones develop when

calcium and too much oxalate may also lead to

urine contains high levels of

kidney stones.

crystal-forming substances such

High oxalate levels are found in a host of

as calcium, oxalate and uric acid,

common foods which should be consumed in

resulting in a hard mass known as a kidney stone.

moderation to avoid kidney stones.

There are four types of kidney stones:

in Pretoria explains that kidney stones are

· Calcium stones

treated regularly at the hospital. Treatment

· Struvite stones

includes endoscopic management with laser

· Uric acid stones

or conservative management.

Dr GF Duvenage of The Urology Hospital

{

Common symptoms of kidney stones included severe lower back pain, nausea and vomiting, chills and/or fever, and frequent urination

{

· Cystine stones

He said common symptoms included severe lower back pain, nausea and vomiting, chills

In some cases, urine may also lack substances that prevent crystals from sticking together,

and/or fever, and frequent urination. “If you experience these symptoms, consult

resulting in kidney stones. A lack of water

your doctor or urologist immediately for the

and an unbalanced diet comprising too little

appropriate treatment,” he said. Pharmacy Magazine JUNE 2017 |

35


EDUCATION Cardiovascular disease (CVD) is one of the leading health risks facing men today. According to the American Heart Association (AHA), more than one in three adult men has heart disease

MEN'S

HEALTH

MONTH

CUT& OUTEP KE

MEN AND CARDIOVASCULAR DISEASE

H

eart disease comes in many forms. All of its forms can lead to serious, fatal complications if undetected. Cardiovascular disease (CVD) is a class of

diseases that involve the heart or blood vessels. CVDs that involve the blood vessels (also known as vascular diseases) Coronary artery disease, peripheral arterial disease, cerebrovascular disease (includes stroke), renal artery stenosis, and aortic aneurysm. CVSs that involve the heart Cardiomyopathy, hypertensive heart disease, heart failure, pulmonary heart disease, cardiac dysrhythmias, valvular heart disease, congenital heart disease, rheumatic heart disease, inflammatory heart disease (endocarditis, cardiomegaly, myocarditis).

WARNING SIGNS

RISK FACTORS FOR HEART DISEASES

While many men may be

Age, gender, tobacco

unaware that they suffer

use, physical

from CVD until a major

inactivity, excessive

incident, like a heart attack,

alcohol consumption,

occurs, there are several red

unhealthy diet,

flags to be aware of to better

obesity, genetic

detect problems with the heart

predisposition

during the earliest and most

and family history

treatable phases. In the early stages,

of cardiovascular disease, raised

symptoms that seem like mere

blood pressure

annoyances may come and go.

For example, you may have heart arrhythmias, which can cause:

Difficulty catching your breath after moderate physical exertion, like walking up a flight of stairs

A sense of discomfort or squeezing in your chest that lasts for 30 minutes to a few hours

Unexplained pain in your upper torso, neck, and jaw

Dizziness or fainting

A heartbeat that is faster or slower than usual

(hypertension), raised blood

These can be signs that

sugar (diabetes

the blood vessels have

mellitus), raised

narrowed. This narrowing,

blood cholesterol

which can be caused by

(hyperlipidaemia),

plaque build-up, makes it

psychosocial factors,

more difficult for the heart

poverty and low

to pump and circulate

educational status,

oxygenated blood efficiently

and air pollution.

through your body.

Heart disease that involves your blood vessels is often signalled by:

Chest pain (angina)

Shortness of breath

Irregular heartbeat

Extreme fatigue

Changes in your extremities, such as pain, swelling, tingling, numbness, coldness, and weakness

}FAST FACTS ON MEN AND CARDIOVASCULAR DISEASE}

36

| JUNE 2017

Coronary artery disease and stroke account for 80% of CVD deaths in males

Pharmacy Magazine

Stroke targets more than 3 million men

High blood pressure is common in males under the age of 45

50% of men who die from CVD have never experienced previous symptoms before

✂

More than one in three adult men has some form of CVD


Dual action, expectorant and bronchodilator.

opens your chest to get you active again.

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EDUCATION Author: Dr Rakesh Newaj, Specialist Dermatologist, Arwyp Medical Centre and Glynwood Hospital

Parkinson’s disease is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time

Parkinson's: an overview There is no cure yet for Parkinson’s disease, but there are numerous therapies that help the symptoms

P

arkinson’s disease (PD) is a chronic and

in PD, and this may be important in the gastrointestinal

meaning that symptoms continue and

symptoms that are part of the disease.

worsen over time.

Nearly one million people in the US are

The four primary symptoms of PD are tremor or

and although there is presently no cure, there are

trembling in hands, arms, legs, jaw, and face; rigidity or

treatment options such as medication and surgery

stiffness of the limbs and trunk; bradykinesia, or

to manage its symptoms.

slowness of movement and postural instability or

in 1817 by Dr James Parkinson, a London-based

jaw, and face

disease remains elusive.

chronic and progressive. PD is not usually inherited. Early symptoms are subtle and occur gradually. Dyskinesia is usually lifelong and progressive; therefore,

tremor, slowness of movement, stiffness of movement,

physicians generally see the disorder in elderly patients.

and impairment of balance. There is no test for PD.

Medical treatment must be carefully selected on the

Diagnosis is established by listening to the symptoms

basis of the cause of the dyskinesia. Parkinsonian

and physical examination by an experienced clinician.

dyskinesia is well controlled by drug therapy. However,

PD involves the malfunction and death of neurons.

patients can become less responsive to a drug after

PD primarily affects neurons in the substantia nigra.

years of use and may experience unwelcome side

Some of these dying neurons produce dopamine,

effects. Cerebellar tremor is extremely disabling because

which sends messages to the part of the brain that

it worsens with activity, but no satisfactory therapy is

controls movement and coordination. As PD

available. Senile, essential, and familial tremors are also

progresses, the amount of dopamine produced in the

intensified by action, but they can often be suppressed

brain decreases, leaving a person unable to control

with a mild tranquiliser or a beta blocker. Drug treatment

movement normally.

of blepharospasm and spastic dysphonia has been

Scientists are also exploring the idea that loss of cells

disappointing: Facial or laryngeal surgery is sometimes

in other areas of the brain and body contribute to PD. For

required. Tardive dyskinesia is caused by neuroleptic

or slowness of

example, researchers have discovered that the hallmark

drugs, so the only therapy for the disorder is withdrawal of

movement

sign of PD – clumps of a protein alpha-synuclein, which are

the offending drug.

· Bradykinesia

also called Lewy Bodies – are found not only in the mid-

· Rigidity or stiffness

brain but also in the brain stem and the olfactory bulb.

of the limbs

These areas of the brain correlate to nonmotor functions

and trunk · Postural instability or impaired balance and coordination.

38

Patients may also have difficulty walking, talking, or completing other simple tasks. The disease is both

but the four basic, so called ‘cardinal signs’ include

hands, arms, legs,

impaired balance and coordination.

physician. However, the cause of this neurological PD may produce a great variety of symptoms,

· Tremor of the

SYMPTOMS

living with PD disease. The cause is unknown,

The disease was first described 200 years ago

The specific group of symptoms that an individual experiences varies from person to person. Primary motor signs of PD include the following.

The intestines also have dopamine cells that degenerate

progressive movement disorder,

| JUNE 2017

TREATMENT A variety of medications provide dramatic relief from

such as sense of smell and sleep regulation. The presence

the symptoms, but no drug can stop the progression

of Lewy bodies in these areas could explain the nonmotor

of the disease. In some cases, surgery is an appropriate

symptoms experienced by some people with PD before any

treatment. Some doctors recommend physical therapy

motor sign of the disease appears.

or muscle-strengthening exercises.

Pharmacy Magazine


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Sleep tight with Calmettes nite is indicated for the relief of temporary difficulty in falling asleep2 References: 1. Calmettes registered Package Insert. 2. Calmettes Nite registered Package Insert. S0 Calmettes tablets. Composition: Per tablet: Valerian dispert powder of natural origin 45 mg (extract of plant root Valeriana officinalis). Pharmacological Classification: A.2.6 Tranquillisers. Reg.No. F/2.6/60. Calmettes nite tablets. Composition: Per tablet: Valerian dry root extract 125 mg. Pharmacological Classification: A.34 Herbals. MCC Application No.: 003445. Name and business address of license holder: Abbott Laboratories S.A. (Pty) Ltd. Abbott Place, 219 Golf Club Terrace, Constantia Kloof, 1709. Tel: (011) 858 2000. For full prescribing information refer to package insert approved by the medicines regulatory authority. Date of publication of this promotional material: January 2017. Promotional Material Reference Number: ZAECALM160215a.


EDUCATION

Undiagnosed ADHD in adults The vast majority of people who have attention deficit hyperactivity disorder (ADHD) inherit the condition

A

dults who have ADHD were either diagnosed

Difficulty with FOCUS

and treated as children and are well aware

This involves being able to stay focused on

that they have the condition, or they present

work, particularly relatively uninteresting,

for the first time as an adult.

unstimulating work – reading, or writing

This will usually happen because the adult concerned

might be a parent of a child recently diagnosed with the

reports, etc. Also pertinent is the liability to easily get distracted.

condition, and has recognised the same symptoms in him- or herself. The individual might also become aware

Difficulty with EFFORT

of ADHD through reading a magazine article or watching a

This ties in with the above, and refers

TV programme.

to problems with sustaining effort to

This article will focus on this group of never previously diagnosed adults. The cardinal features of ADHD, being inattention,

the point of task completion, ahead of deadlines – being able to avoid flitting from one activity to another, and getting nothing finished.

impulsivity, and hyperactivity, are all pertinent to making the diagnosis in adults, the same as with children, but

Difficulty with MEMORY

with differences. However, the individual concerned will

ADHD adults often have marked problems

generally present with features that are the results of

with forgetfulness, misplacing things,

these underlying problems, referred to as ‘disturbances

missing appointments, and forgetting to

of executive functions’.

pass on messages. These are largely short-term memory functions. However, adults

COMMONLY ENCOUNTERED, SUCH DISTURBED EXECUTIVE FUNCTIONS ARE:

with ADHD also have dysfunction of active working

Difficulty with ACTIVATION

mind until it can be dealt with. Hence the individual

This refers to the ability to structure

can struggle to make his meaning clear, because he

and organise a working day, to do time

loses the thread of what he was trying to say. He might

management, to prioritise tasks for each

also talk about something out of context with what

day, and to get started on a task. Part of this

a conversation might have been about. Similarly, he

issue is chronic procrastination, frequently a

might interrupt conversations, for fear of forgetting

significant problem for ADHD adults.

what he wanted to say.

memory, which is the ability to keep a thought in

The cardinal features of ADHD are inattention, impulsivity, and hyperactivity

{ 40

| JUNE 2017

Pharmacy Magazine

Feelings of restlessness, of being unable to sit still, and a tendency to be prone to fidgeting are common in individuals with ADHD.

{


EDUCATION

HERBAL COUGH MIX - anti-inflammatory - antispasmodic - decongestive - expectorant - soothing

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ADHD individuals tend to find it difficult to handle frustration Difficulties with EMOTIONS

impulsive spending of money,

ADHD individuals

frustration of others, starting

tend to find

many new projects but quickly

it difficult to

losing interest.

frequent changes of plan to the

handle frustration. They are

CINNAMON

prone to quickly become angry,

ADDITIONAL

or to be beset by worries, often

PSYCHOLOGICAL PROBLEMS

endlessly and needlessly. They

More often than not, adults with

also frequently under-value

ADHD are prone to have additional

themselves and can have a

psychological problems. They

markedly negative self-image.

are prone to have mood swings,

Tied in with these executive function disturbances, adults

which impact on work and family relationships.

who have ADHD can have certain

Beyond this, ADHD adults

behaviours that form part of the

are more liable than the general

overall pattern.

population to develop frank

They can have feelings of

depression; they can have various

restlessness, of being unable to

forms of anxiety disorders,

sit still, and tend to be prone to

including obsessive compulsive

fidget. They are prone to seek

behaviours and can develop

activities of high stimulation,

bipolar disorder. They are also

often with an element of danger.

prone to become ensnared by

Such activities as sky-diving, rock-

addiction to alcohol or drugs. The

climbing, driving too fast, and, in

picture is frequently complex and

women, promiscuous behaviour

evaluation needs to be careful and

come to mind.

detailed.

There can be problems with

YOUR NATURAL CHOICE

As a further consequence of all

going through established

this, adults with ADHD frequently

channels, wanting to by-pass

have problems with relationships.

regulations, leading to work-

They struggle to make a marriage

related confrontations and

work and divorce is common.

arguments. Quite often, there are

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many changes of employment,

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usually laterally, not advancing up

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the corporate ladder.

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Impulsiveness can result in

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an adult who has ADHD. Pharmacy Magazine JUNE 2017 | 1835_FF_FrontShopx3_June_.indd 1

41

5/24/17 11:47 AM


EDUCATION

Allergic diseases on the rise in SA’s children According to the Allergy Foundation of South Africa (AFSA), allergies, or allergic diseases as they are otherwise known, are on the increase globally from lower through to upperincome countries, and some 40% of allergy sufferers are children

T

he Allergy Foundation of South Africa (AFSA),

WHAT IS AN ALLERGY?

says that no fewer than a third of all South

An allergy is caused by the human body’s own

Africans will develop some allergic disease

immune system overreacting to a substance from

such as asthma, allergic rhinitis (hay fever),

the environment that is completely harmless to most

eczema, food allergy, or a severe allergic reaction

other people. The immune system mistakenly

(anaphylaxis) at some point during their lifetime.

responds to an otherwise harmless substance as if it

Netcare’s medical director Dr Anchen Laubscher says allergies cannot only have a negative impact on

were a serious threat. “This triggers the release of chemicals such as

an affected child’s quality of life, but a severe allergic

histamine, which may result in a number of symptoms.

reaction can even be life threatening.

The substances to which the immune system reacts are known as allergens, and some of the best known of these

TAKE PRECAUTIONS “Allergic conditions are among the most common of

Children or adults who are allergic to bee or wasp stings, or tree nuts, for example, should strictly avoid all contact with these 42

| JUNE 2017

are peanuts, penicillin and bee sting toxin.” Laubscher points out that children may develop

childhood chronic diseases. It is of critical importance

allergies from exposure to substances such as

for parents and childminders to be aware of what

certain foods, medicines, house dust mites, pollens,

could elicit an allergic response as well as to the

mould spores, animal dander, insect spore (i.e. from

symptoms of allergies and, severe allergic reaction

cockroaches), latex rubber, pet hair, cow’s milk, seafood,

in particular, so that they can take the appropriate

insect bites and stings, and many others. Allergic

action to protect their children, should it ever

symptoms may affect the throat, nose, ears, eyes,

become necessary,” warns Laubscher.

airways, skin, and digestive system.

“The severity of an allergic reaction can vary widely. The chronic, persistent effects generally

THE IMPORTANCE OF MANAGING ALLERGIES

range from mild and hardly noticed to significantly

“Among the problems with allergies in children is

inconveniencing. In some cases, however, there

that we may not be aware that they have them and

can be a sudden and dramatic reaction such as

yet the symptoms may be causing the little one to

severe skin inflammation, vomiting, swelling, and

suffer from malaise, and severely negatively impacting

respiratory compromise. Such a reaction may be

their quality of life. Your child’s concentration may be

an indication that the child is suffering a severe

impaired by the allergy, for instance, and their school

allergic reaction, or anaphylactic shock, which is

grades may suffer.

considered a medical emergency.”

Pharmacy Magazine

Continued on next page...


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EDUCATION

“In addition, the fact that a child may not normally

An allergy is caused by the human body’s

have a severe reaction to an allergen does not mean that

own immune system

they will not develop one at some future time. For this

overreacting to a

reason, it is important that possible allergies in children

substance from the

be medically investigated and if positively identified,

environment that is

closely managed with the assistance of a healthcare

completely harmless

professional,” adds Dr Laubscher.

to most other people. ANAPHYLACTIC SHOCK Head of clinical leadership at Netcare 911, David Stanton, says that anaphylactic shock is a severe whole-body allergic reaction to a substance to which the child or adult is allergic, and happens immediately after exposure to the allergen. “The child’s blood pressure may drop severely and their airways swell up and become blocked

Stanton says that the following may be signs that a child is suffering anaphylaxis: · Swelling at the throat or mouth that may constrict breathing · Difficulty breathing or swallowing, and choking or wheezing · Rapid pulse or irregular heartbeat · General or localised skin changes such as a rash or itching, pale skin, blue skin colour, skin redness, sweating · Pain in the abdomen and/or chest · Nausea and vomiting · Feeling faint/loss of consciousness · Severe headache

as their system attempts to process the allergen or the substance causing the reaction.”

According to Stanton, the symptoms of anaphylactic shock usually appear within two hours after exposure to the allergen, although they may only be evident as much as four hours later. In some cases the allergic reaction can be almost immediate. WHAT SHOULD YOU DO? “Should your child suffer a severe allergic reaction, call an emergency medical services provider immediately. While it can be alarming to witness someone develop anaphylactic shock, particularly as they may swell up and suffer difficulties breathing, try to stay calm and remain on the line with emergency medical services provider call-operator who will be able to provide guidance to you while you are waiting for medical assistance. “You should lie the child down and elevate their

44

| JUNE 2017

Pharmacy Magazine


EDUCATION

feet to assist in reducing the risk of shock. Avoid administering an antihistamine in a child younger than six months, or if they are struggling to breathe, as they may choke on the tablet. AVOID CONTACT Mande Toubkin, Netcare’s general manager emergency, trauma, transplant, and corporate social investment, says that although it is not always easy, the best way to prevent a child suffering a serious allergic reaction is to as far as possible make sure that they avoid having contact with their particular allergen or allergens. “Children or adults who are allergic to bee or wasp stings, or tree nuts, for example, should strictly avoid all contact with these. Those who are allergic to foods such as peanuts or tree nuts can suffer a reaction from even trace amounts, so they must be sure to even avoid foods that have been prepared in close proximity to nuts,” she points out. Fortunately, food manufacturers will usually place a warning on packages if foods have been prepared with nuts. “If your child is allergic to bee stings, you can take steps to try to ensure they don’t get stung. For instance, if they are playing in the grass, request that they wear shoes so that they can avoid stepping on a bee. Highly allergic children should also wear a medical bracelet and parents should carry an adrenalin auto-injector with them at all times as per the advice of a medical doctor. Antihistamine pills should also be kept close at hand, as they may be useful in the event of a less serious allergic reaction in an older child.” FOREWARNED IS FOREARMED “In addition, if your child does have a serious allergy problem, inform their teachers and caregivers about it and explain what should be done in the event of a reaction. Forewarned is forearmed, and a few basic precautions can assist to keep your child safe,” she concludes.

Pharmacy Magazine JUNE 2017 |

45


EDUCATION

Atopic dermatitis: risk factors Atopic dermatitis (AD), also known as atopic eczema, is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2-3% of adults

{

Most patients suffering from atopic dermatitis improve in summer and are worse in winter.

{

A

topic individuals are predisposed to skin

therapeutic risks. Standard treatment

infections because of a compromised

modalities for the management of

physical barrier, coupled with diminished

these patients are centred around

immune recognition and impaired

the use of topical anti-inflammatory

antimicrobial peptide production. Atopic Dermatitis (AD) follows a relapsing course and is associated with elevated serum immunoglobulin (IgE) levels and a personal or family history of type I allergies, allergic rhinitis, and asthma. Most patients improve in summer and are worse in winter.

preparations and moisturisation of the skin, but patients with severe disease may require phototherapy or systemic treatment. Topical agents include topical corticosteroids (TCS), calcineurin inhibitors (TCI), antimicrobials, and antiseptics and antihistamines.

RISK FACTORS

TOPICAL CORTICOSTEROIDS

According to the updated American Academy of

Topical corticosteroids (TCS) have been used to treat

Dermatology guideline, two risk factors appear to be

AD for more than 60 years. TCS are used in the

consistently and strongly associated with the development

management of AD in both adults and children and are

of AD: A family history of atopy and a loss of function

the mainstay of anti-inflammatory therapy.

mutations in the filaggrin (FLG) gene. Approximately 70% of AD patients have a positive

TCSs are used for both active inflammatory disease and for prevention of relapses. They are typically

family history of atopic diseases. The odds of

introduced into the treatment regimen after failure

developing AD are two- to three-fold higher in

of lesions to respond to good skin care and regular

children with one atopic parent, and this increases

use of moisturisers alone.

to three- to five-fold if both parents are atopic.

Approximately 70% of atopic dermatitis patients have a positive family history of atopic diseases

TCS are grouped into seven classes, from very low/lowest potency (VII) to very high potency (I),

TREATMENT

based on vasoconstriction assays. TCSs are

The goals of treatment are to reduce symptoms (pruritus

recommended for AD-affected individuals who

and dermatitis), prevent exacerbations, and minimise

Continued on next page...

Pharmacy Magazine JUNE 2017 |

47


Feeling trapped by constipation?

Free Yourself S0 Duphalac SyrupÂŽ & Duphalac DryÂŽ. Composition: 5ml of Duphalac Syrup contains lactulose 3,3 g. 10 g of Duphalac Dry contains 10 g lactulose. Pharmacological Classification: A. 11.5 Laxatives. Reg.No. K/11.5/180; 28/11.5/0427. Name and business address of license holder: Abbott Laboratories S.A. (Pty) Ltd. Abbott Place, 219 Golf Club Terrace, Constantia Kloof, 1709. Tel: (011) 858 2000. Reg No. 1940/014043/07. For full prescribing information refer to package insert approved by the Medical Regulatory Authority. Date of publication of this promotional material: January 2017. Promotional Material Reference Number: Duphalac - ZAEDULAC160217. www.duphalac.com


EDUCATION

important to monitor quantities of TCS used over time, which may impact efficacy and safety. TOPICAL CALCINEURIN INHIBITORS Topical calcineurin inhibitors (TCI) are a second class of anti-inflammatory therapy introduced in 2000. They are naturally produced by Streptomyces bacteria and inhibit calcineurin dependent T-cell activation, blocking the production of proinflammatory cytokines and mediators of the AD inflammatory reaction. They have also been demonstrated to affect mast cell activation, and tacrolimus decreases both the number and costimulatory ability of epidermal dendritic cells. Two TCIs are available, topical tacrolimus ointment have failed to respond to good skin care and regular

(0.03% and 0.1% strengths) and pimecrolimus cream

use of emollients alone.

(1% strength). Both agents have been shown to be more

A variety of factors should be considered when

effective than vehicle in short-term (three to 12 weeks)

choosing a particular topical corticosteroid for the

and long-term (up to 12 months) studies in adults and

treatment of AD, including patient age, areas of the

children with active disease.

body to which the medication will be applied, and

Physician global evaluation scores showed decline, as

other patient factors such as degree of xerosis,

did the percent body surface area involved and patient

patient preference, and cost of medication.

evaluation of symptoms and signs of disease. Tacrolimus

Twice-daily application of corticosteroids is

is approved for moderate to severe disease, whereas

generally recommended for the treatment of AD,

pimecrolimus is indicated for mild to moderate AD, and

however, evidence suggests that once-daily

six-week comparative studies support a greater effect

application of some corticosteroids may be sufficient.

for tacrolimus over this time period for all AD severities.

Proactive, intermittent use of TCS as

In the US, TCIs are approved as second-line therapy

maintenance therapy (one to two times weekly)

for the short-term and non-continuous chronic

on areas that commonly flare is recommended

treatment of AD in non-immunocompromised

to help prevent relapses and is more effective

individuals who have failed to respond adequately to

than use of emollients alone.

other topical prescription treatments for AD, or when

No universal standard exists for quantity of application, although suggested methods include

those treatments are not advisable. TCIs have the benefit of not carrying risk for

use of the adult fingertip unit (the amount from

cutaneous atrophy, with little negative effect on collagen

the distal interphalangeal joint to the fingertip,

synthesis and skin thickness. TCI can therefore be used

or approximately 0.5g, being applied over an

as steroid-sparing agents and long-term studies.

area equal to two adult palms), following

Topical corticosteroids (TCS) have been used to treat atopic dermatitis for more than 60 years

the rule of nines that measures the percent affected area, and use of charts that propose amounts based on patient age and body site. Children have a proportionately greater body surface area to weight ratio, and as a result, have a higher degree of absorption for the same amount applied. But during significant acute flares, the use of mid- or higher potency TCS for short courses may be appropriate to gain rapid control of symptoms, even in children. However, for long-term management, the least-potent corticosteroid that is effective should be used to minimise the risk of adverse effects. Greater caution regarding TCS potency is also needed when treating thin skin sites (e.g. face, neck, and other skin folds), where there is greater penetration and higher likelihood for systemic absorption. It is

Pharmacy Magazine JUNE 2017 |

49


CPD - DIABETES

Diabetes: managing a monster RISK FACTORS AND PREVENTION While certain factors make getting diabetes more likely, they won’t create the disease. • Age: 45 or older • Genes: A parent, sister, or brother with diabetes • Ethnicity: AfricanAmerican, Alaska Native, Native American, AsianAmerican, Hispanic or Latino, or Pacific Islander-American • Prediabetes • Heart and blood vessel disease

Diabetes is a life-long disease that affects the way the body handles glucose, a sugar in the blood

{

People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides

M

{

ost people with diabetes have

WHAT CAUSES DIABETES?

type 2. Type 2 diabetes has

The pancreas makes insulin, which allows cells to

been increasing substantially

turn glucose from food into energy. People with type

over the last 20 years. The

2 diabetes make insulin, but their cells don’t use it as

World Health Organization (WHO) says that

they should, which is insulin resistance.

• High blood pressure, even if it’s treated and under control

about 8.5% of the world’s adult population

• Low HDL cholesterol

although it is higher in certain groups, for example

• High triglycerides

among the Indian population in KwaZulu-Natal,

diabetes, including genes and extra weight. Being

13.5% of adults have type 2 diabetes.

overweight or obese can cause insulin resistance.

• Being overweight or obese

has diabetes. Its prevalence is a similar percentage in SA,

It is not surprising that 415 million people are

• Having a baby that weighed more than 4 kilograms • Having gestational diabetes while you were pregnant

Usually a combination of things cause type 2

This is often seen in the ‘apple shape’ body type, with extra weight carried in the stomach area.

WHO predicts that these figures will increase

Type 2 diabetes affects children and teens as well

to 642 million cases worldwide by 2040. In SA,

as adults, mainly because of childhood obesity.

which has the highest incidence of type 2 diabetes

Metabolic syndrome is another cause. People

on the African continent, about half of diabetic

with insulin resistance often have a group of

patients remain undiagnosed.

conditions including high blood glucose, extra

• Acanthosis nigricans, a skin condition with dark rashes around the neck or armpits • Depression • Getting little or no exercise • Smoking • Stress • Sleeping too little or too much. Losing just 7-10% of weight can cut your risk of type 2 diabetes in half.

| JUNE 2017

up, and the sugar builds up in the blood instead.

estimated to have diabetes in the world and

• Polycystic ovarian syndrome (PCOS)

50

At first, the pancreas produces more insulin, to try to get glucose into the cells. Eventually, it can’t keep

Pharmacy Magazine

Continued on next page...


CPD - DIABETES

SYMPTOMS The symptoms of type 2 diabetes can be so mild that patients don’t notice them. In fact, about 8 million people who have it don’t know. Symptoms include: • Being very thirsty • Frequent urination • Blurry vision • Irritability fat around the waist, high blood pressure, and high

PATHOPHYSIOLOGY

cholesterol and triglycerides.

Although insulin resistance is a key component in the

• Tingling or numbness in hands or feet • Feeling worn out

Too much glucose from the liver. When blood

pathophysiology of type 2 diabetes mellitus (T2DM), with

sugar is low, the liver produces and releases glucose.

time, declining beta cell dysfunction means many patients

After eating, your blood sugar goes up, and usually the

require insulin therapy to maintain glycaemic control.

liver will slow down and store its glucose for later. But

Glycaemic control is the key factor.

some people’s livers keep producing glucose. Broken beta cells. If the cells that make the insulin

There is no scientific evidence to suggest that obtaining glycaemic control with insulin is more beneficial than using

send out the wrong amount of insulin at the wrong

any other agent. However, in some patients with type 2

time, blood sugar is thrown off. High blood glucose

diabetes, due to significant beta-cell failure, only the use of

can damage these cells, too.

insulin is able to achieve their individualised HbA1C target.

NO LONGER A DISEASE OF THE OLD

glycaemic control, there is some resistance to initiate

The trend used to be that

insulin therapy. Some of the factors include concerns

type 2 diabetes was a disease

of hypoglycaemia, weight gain, fear of injections and

Despite the well-established benefits of optimal

of people over the age of

• Wounds that don’t heal • Recurrent yeast infections

LONG-TERM EFFECTS Over time, high blood sugar can damage, or affect: • Heart and blood vessels • Kidneys

complexity of insulin self-management.

60, but now many of the

• Eyes

middle and lower income countries have more people under the age of 60

People with type 2 diabetes

with diabetes compared to

make insulin, but their cells

the global average.

don’t use it as they should,

Countries like SA have

which is insulin resistance.

younger populations moving

• Nerves, which can lead to trouble with digestion, feeling in the feet, and sexual response • Wound healing • Pregnancy

into more sedentary work as they complete school and

The best way to avoid

university, as opposed to the

these complications is to

manual work of their predecessors.

manage diabetes well. Patients need to take

The number of cases of type 2

diabetes medications

diabetes is increasing. They often

or insulin on time, check

follow a starch-based diet, continuing

blood glucose. Eat

learned eating habits.

healthy, regular meals. This SAMA accredited article first appeared in the Medical Chronicle in June 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 JUNE 2017 |

53


CPD - COLDS Source: Sponsored content

Reducing severity and duration of colds

F

lugon is indicated for the relief of upper

a Pelargonium root extract on the function of human

respiratory tract conditions, accompanied by

phagocytes. Candida albicans was used as the target

coughing and chronic inflammatory bronchial

organism. Significant stimulated phagocytosis and

symptoms associated with upper respiratory

oxidative burst were observed while intracellular killing was

infections (e.g. bronchitis, cough, sore throat, tonsillitis, sinusitis, colds and flu).

hardly influenced. The current data provide convincing support for the

Pelargonium sidoides is widely used as a traditional

improvement of immune functions at various levels, hence,

medicine for various ailments, including TB, cough, and

validating the medicinal uses of the Pelargonium root

gonorrhoea (Brendler and van Wyk, 2008; Colling et al.,

extract (Kolodzieja and Kiderlenb, 2007).

2010). Powdered plant materials soaked in water are used

Mickenhagen et al. (2004) and Neugebauer et al. (2005)

as a facial cream in the treatment of pimples (Lewu et al.,

investigated the influence of Pelargonium root extract on

2007). These applications indicate antimicrobial activity of

the stimulation of ciliary beat frequency (an important

constituents found in these plant extracts.

defence mechanism of the mucociliary system) in

Pelargonium sidoides extract has anti-oxidant, anti-microbial, anti-inflammatory, anti-fungal and anti-viral properties

ciliated cell cultures of human nasal epithelium in PHARMACODYNAMIC PROPERTIES

vitro. Three concentrations of the extracts were

The antibacterial activity of extracts and isolated

tested, which significantly increased ciliary beat

constituents of Pelargonium sidoides was evaluated by

frequency in a dose-dependent manner.

Kayser and Kolodziej (1997) against three gram-positive (Staphylococcus aureus, Streptococcus pneumoniae,

CLINICAL STUDIES

Streptococcus 1451) and five gram-negative bacteria

Agbabiaka and Ernst, 2008, reported that findings

(Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis,

of randomised clinical trials confirmed the

Pseudomonas aeruginosa, Haemophilus influenzae).

effectiveness of Pelargonium sidoides in treating acute

Minimum inhibitory concentrations varied between

bronchitis. Meta-analysis of four placebo-controlled

200-1 000μg/ml depending on the extracts and

trials suggested that root extracts significantly reduced

microorganisms tested indicated weak antibacterial activity.

bronchitis symptom scores in patients with acute bronchitis

Further investigations by Lewu et al. (2006) confirmed these findings.

by day 7. No serious adverse events were reported. Lizogub et al., (2007) performed a randomised,

The demonstrated weak antibacterial activity in

double blind, placebo-controlled clinical trial which showed

comparison with the activities of antibiotics cannot

that a liquid preparation from the roots of Pelargonium

adequately explain the documented clinical efficacy of

sidoides represented an effective treatment for the

Pelargonium-containing herbal medicines in the treatment

common cold. It significantly reduces the severity of

of respiratory tract infections.

symptoms and shortens the duration of the common cold

Hansmann (2005) also investigated the influence of

compared with placebo.

This SAMA accredited article first appeared in the Medical Chronicle in May 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 JUNE 2017 |

55


OPINION

Email: greg@storysamurais.com

Be a self-leader Greg Zurnamer (B.Com MBA), the Story Samurai, is an innovative thinker that challenges conventional approaches in both sales and marketing

A leaders is one who knows the way, goes the way, and shows the way – John Maxwell

L

eadership has become a real topical issue in South Africa. Universally today people have opinions on what this very important aspect of our lives should look like, who are the bad ones, and what would the future look like if we had good leaders at the helm.

These opinions may be very valuable and topical now, but in most cases I find the conversations to be irrelevant and blaming in subject matter. It is so easy to pass the buck and point our fingers at those in power and

Self-leadership demands of individuals to have 3 distinct traits

1

Ability to be self-aware: This allows individuals to understand and appreciate what they hold

dear and how these values and beliefs influence their behaviour and intentions. This means they are sensitised to what will influence their behaviour and actions.

2

Act with great self-confidence: There is a keen understanding of one’s strengths and

positions of authority as the cause of society’s problems.

weaknesses and how it impacts their ability to act

In most cases, you will get a sympathetic ear and back

with confidence.

slap acknowledging your expertise on the subject. For me leadership starts with one’s self. Societies are made up of individuals and in the free one we live in

3

Display resilience: We all encounter difficulties and barriers to overcome. Individuals that are

we should take the lead and change it for the good. Too

driven by self-leadership can weather life’s storms.

many people are sitting back and expecting everybody

They accept feedback and adjust behaviour to

else to take charge and make the difference. The typical

ensure a better outcome. This allows them to be

NIMBY (not in my back yard) syndrome. If it does not

more creative and innovative to solving complex

directly impact me and my surroundings then I have no

problems and challenges.

interest in fixing the problem. Yet when you engage the guru’s they will tell you that

Self-leadership allows individuals to start creating

leadership is more of an attitude than a title. John Maxwell

meaning in their own lives. This meaning is not self-

said, “a leaders is one who knows the way, goes the way,

centred but reaches out to the broader good of the

and shows the way” Equally insightful is the great Madiba’s

community. When people all act in the interest of each

take on leadership: “We can change the world and make it a

other we create better communities for all.

better place. It is in your hands to make a difference”. Self-leadership is one of the great traits that

Don’t wait for others to take the lead. If you find a cause that particularly speaks to you,

distinguish exceptional individuals from the ordinary.

pursue it. Ghandi expressed the intent

Self-leadership has been described as the process of

self-leadership the best, “become the person

influencing yourself to influence others.

you want the world to be”.

Societies are made up of individuals and in the free one we live in we should take the lead and change it for the good Pharmacy Magazine JUNE 2017 |

57


PROFILE

“Sometimes what you're most afraid of doing, is the very thing that will set you free”

Always up for a challenge ner-up 1st Run macist har 2016 P stant s s A i year of the

1

Where did you grow up?

I grew up in the

2

Western Cape.

Who inspires you and why?

My parents. They are

NAME &

both 75 years old, full of

SURNAME:

life, with so much energy.

Yasmina Baulackey

Last year my father graduated with honours

5 cage. I am fortunate

over-the-counter

Supply Chain

to be a part of an

(OTC) medications.

Management. My

experienced and

Pharmacist assistants

5 year aspirational goal

dedicated team, who

play key leadership roles

is to be debt free and to

all excel at what they

in all aspects of the

do. It gives me great

healthcare system. The

satisfaction after a hard

pharmacy industry also

day’s work, to know that

offers working flexibility

4

in full time, part-time,

9

I’m in the right field.

6

or as locum work.

What is the hardest part of your job?

have financial freedom.

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

How long is your commute to work?

We live in a connected world with information

PHARMACY:

in Islamic Studies after

DHL

studying for six years,

Investigation of stock

and is currently teaching

discrepancies and

I am extremely fortunate

every opportunity you

JOB TITLE:

first year students.

minimising the risk of

to live close to work. It

get to empower yourself.

Pharmacist Assistant

Running the college tuck

takes me less than 5

Learn, learn, learn.

shop every day, my mom AGE:

makes sure students

50

have a selection of soup, sandwiches, and other sweet and savoury dishes

3

to satisfy their hunger.

5

discrepancies occurring.

7

minutes to get to work.

Why did you choose a career in the pharmacy industry?

My advice is also to subscribe to a trusted and

What do you do to relax?

As they say “different

Pharmacy is a diverse

stokes for different folks”.

and rewarding career,

My hobby is entering and

What do you enjoy most about your job?

with opportunities for

“WINNING” competitions,

patient care, scientific

which brings me much

The responsibilities

As a pharmacist assistant,

and challenges that

one can work in a

come with inventory

myriad of professional

control in the schedule

settings. The majority

research, and innovation.

at our finger tips. Grab

8

pleasure and joy.

informative magazine such as Frontshop

10

Pharmacy Magazine.

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

work in an independent

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

or retail chain community

My short term goal is to

economy. Sometimes

pharmacy and provide

successfully complete

what you’re most afraid

counselling to patients on

my studies in

of doing – is the very thing

the use of prescription and

Procurement and

that will set you free.

of pharmacist assistants

harder and completed my degree in Pharmacy. Education is the cornerstone in today’s

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

58

| JUNE 2017

Pharmacy Magazine


S2 Adco-FlupainÂŽ. Each 5 ml syrup contains triprolidine HCl 0,625 mg; pseudoephedrine HCl 15,0 mg; paracetamol 125 mg. Reg. No. 27/5.8/0260.


Neurotropic B Vitamins (B1, B6 and B12) are all necessary for healthy nerve function, and symptoms of a Vitamin B deficiency may include: 1-4*

Mood disturbance

Forgetfulness, confusion

Pins-and-needles, numbness or weakness (hands & feet)

Difficulty walking, maintaining balance and ataxia

Patients at risk of Vitamin B deficiency include: 1, 5-7

The elderly

Vegetarians and vegans

Those who consume excessive amounts of alcohol

Neurobion® - the market-leading Vitamin B complex product in 74 countries worldwide. 8**

* Symptoms may be related to another medical condition. ** Neurobion® is the market-leading Vitamin B complex product/ Vitamin B combination product for the last two-year period, based on a combined market of 74 countries worldwide. References: 1. da Silva L, McCray S. Vitamin B12: No One Should Be Without It. Pract Gastroenterol 2009:34-46. 2. Disorders of Nutrition and Metabolism. Section 11. In: The Merck Manual of Medical Information. Second Edition. (eds) Beers SL, Bowman MA. Pocket Books, New York, London, Toronto, Sydney. Pp 918-926. 3. National Institute of Health. Vitamin B12. Dietary Supplement Fact Sheet. [online] [cited] 2017 Jan 17]. Available from: URL: http://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/. 4. Frye RE, Griffing GT. Pyridoxine Deficiency Clinical Presentation. Medscape Reference: Drugs, Diseases and Procedures. [online] [cited 2017 Jan 2017]. Available from: URL: http://emedicine.medscape.com/article/124947-clinical. 5. Briani C, Torre CD, Citton V, Manara R, Pompanin S, Binotto G, Adami F. Cobalamin Deficiency: Clinical Picture and Radiological Findings. Nutrients 2013;5:4521-4539. 6. Stabler SP. Vitamin B12 Deficiency. N Eng J Med 2013;368:149-160. 7. Becker DA, Balcer LJ, Galetta SL. The Neurological Complications of Nutritional Deficiency following Bariatric Surgery. J Obesity 2012;2012. 8. Internal calculations based on IMS Health MIDAS sales for MAT 09/2015 through MAT 09/2016. For full prescribing information refer to the package insert approved by the Medicine Regulatory Authority

S1 Neurobion® Tablets. Each tablet contains Vitamin B1 100 mg, Vitamin B6 200 mg and Vitamin B12 200 μg. Reg. No.: H2487 (Act 101/1965). Applicant: 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-NEU-1705-0160 May 2017.

Frontshop Pharmacy Magazine - June 2017  

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