Pharmacy Magazine teaser - March 2020

Pharmac MARCH 2020

Valuable education for pharmacy staff

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Coronavirus: the facts Endometriosis

101

Autumn skincare & vitamin A

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www.medicalacademic.co.za

MARCH

2020

EDITOR’S NOTE

EVENTS

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TB Awareness Month

Soap+water =

National Colorectal Cancer Awareness Month National Kidney Cancer Awareness Month

first line of defense

I

t was only a matter of time before the first case

do to protect themselves is washing their hands with

of COVID-19 in SA was confirmed. This, along

soap and water. It is however important to do so for

with the fact the World Health Organisation

long enough and in the correct way. The Centre for

(WHO) declared the outbreak a pandemic on

Disease Control (CDC) suggests you sing Happy

11 March, you’ve no doubt faced even more queries

Birthday twice when washing your hands. Although

about the novel coronavirus.

washing your hands with soap and water for 40-60

Although COVID-19 is serious, there really is

Multiple Myeloma Awareness Month 11 Feb20 Mar

Human Papillomavirus (HPV) Vaccination First Round

1 Mar

Endometriosis Awareness Day

3 Mar

World Hearing Day

seconds is the best way to protect yourself, when you

no reason for people to panic, despite all the

don’t have access to either, hand sanitiser is the next

sensationalist news coverage. Unfortunately, as a

best option. But even if the label says it kills 99.99% of

result of social media and how connected the world is

illness causing germs, if the sanitiser doesn’t contain

today, the spreading of frightening or ominous reports

the CDC’s recommended minimum of 60% alcohol,

or rumours can prove scary to patients. This is what

it probably won’t protect you from COVID-19. It’s

makes the role of a pharmacist so important – you are

information like this that is important to convey to

uniquely positioned to provide clear facts and dispel

patients. The method for washing hands with soap

the rampant myths and misinformation.

and water and rubbing hands with sanitiser are also different. We’ve included a poster from the WHO

1 Mar

World Birth Defects Day

8 Mar

International Women’s Day

FLU VS COVID-19

(page 5) on how to correctly clean your hands with

As it’s flu season it’s inevitable you’re going to

sanitiser and one on how to correctly wash your hands with

encounter some paranoid patients, perhaps the easiest

soap and water (page 35), to

way to allay their fears is to discuss

make it easy to show staff and

symptoms with them. Although COVID-19 typically

patients how to do so.

8-14 Mar

World Glaucoma Week

dry cough. After a week, it can lead to shortness of

CROSSWORD CHALLENGE

9-15 Mar

World Salt Awareness Week

breath, with about 20% of patients requiring hospital

Congratulations to the

treatment. Notably, the COVID-19 infection rarely

winner of Crossword

seems to cause a runny nose, sneezing, or sore

#15 Razia Toffie. For your

throat (these symptoms have been observed in only

chance to win a R500

about 5% of patients). Sore throat, sneezing, and

Woolworths voucher don’t

stuffy nose are most often signs of a cold.

miss this month’s crossword

12 Mar

World Kidney Day

20 Mar

World Oral Health Day

21 Mar

World Down Syndrome Day

24 Mar

World Tuberculosis Day

causes flu-like symptoms including a fever and cough, it seems to start with a fever, followed by a

The single most important thing everyone can

WORDS TO

LIVE BY

puzzle on page 33.

PM

“Fake news can spread online because as users we have no idea where any of the content we see comes from.”

– Ramesh Srinivasan

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

2

| MARCH 2020 Pharmacy Magazine

Our time with ANTIBIOTICS is running out.

Antibiotics are in danger of losing their effectiveness due to misuse and overuse, and in many cases they aren’t even needed.

Always seek the advice of a healthcare professional before taking antibiotics.

reproduction / INNOVATION

FERTILITY IN SA ON THE DECLINE

The average fertility rate in SA is on the decline. Couples unable to conceive after a year of trying should seek help from a specialist There are often no obvious symptoms of infertility

rates in SA for 2020 are projected at an

although some women may have irregular or absent

average 2.3 children per woman, slightly

menstrual periods. Men may display hormonal signs

lower than the global average of about 2.5.

such as changes in hair growth or sexual function.

“Global fertility is projected to decline to 2.4 children per

Some causes of infertility in women may include

woman by 2030 and 2.2 children per woman by 2050,”

ovulation disorders, uterine or cervical abnormalities,

the report said.

fallopian tube damage or blockage, endometriosis, early

Urogynaecologist, Dr Frances Paterson from The Urology Hospital, Pretoria, said research shows that up to 20% of South African couples struggle with infertility affecting both males and females almost equally.

The World Health Organisation describes infertility

menopause, pelvic adhesions, and certain cancers and their treatment such as radiation and chemotherapy.

Causes in men may include increasing age, obesity, smoking, using addictive substances, radiation, nutrition, taking supplements and steroids, a high

as a “disease of the reproductive system, defined by the

testicular temperature, infections and STIs, genital

failure to achieve a clinical pregnancy after 12 months or

injuries, and varicocoele (enlargement of veins in

more of regular, unprotected intercourse”.

the scrotal sack).

“Infertility may often be successfully treated

urogynaecologist if they’re unable to conceive after

and couples struggling to fall pregnant should

having regular unprotected sex for a year, or if a woman

consult an obstetrician, gynaecologist, urologist,

is unable to carry a baby to full term.

or urogynaecologist,” said Dr Paterson.

PM

Up to 20% of South African couples struggle with infertility affecting both males and females almost equally

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Dr Paterson advised couples to consult a

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A

recent United Nations report found fertility

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Causes of infertility in men may include increasing age, obesity, smoking, using addictive substances, radiation, nutrition, and taking supplements and steroids

Pharmacy Magazine MARCH 2020 |

5

Breast Cancer DID YOU KNOW? Breast cancer is the most common cancer W A R N I N G

S I G N S

A puckering of the skin of the breast.

A lump in the breast or armpit.

A change in the skin around the nipple or nipple discharge.

Dimpling of the nipple or nipple retraction.

An unusual increase or shrinkage in the size of one breast or recent asymmetry of the breasts

One breast unusually lower than the other. Nipples at different levels.

An enlargement of the glands.

An unusual swelling in the armpit.

MYTH vs FACT I am too young to get breast cancer Being overweight/obese doesn’t matter

Many women who are under 40 are diagnosed with breast cancer Overweight women have a higher risk of being diagnosed with breast cancer, especially after menopause

Alcohol is not linked to breast cancer

Alcohol use increases the risk of breast cancer

Only women with a family history of breast cancer are at risk

All women are at risk, but family history increases the risk

I have never had children, so I can’t get breast cancer

Women who have never had children, or only had them after 30, have increased risk of breast cancer

Toll Free 0800 22 66 22 | www.cansa.org.za

EARLY DETECTION IS KEY Do monthly breast self-examinations Go for regular screening (clinical breast examinations) at CANSA Care Centres Symptom-free women aged 40 to 54 should go for a mammogram every year (women & years and older should change to every 2 years) CANSA has Mobile Health Clinics that do screening in communities Did you know? CANSA offers a variety of BREAST PROSTHESIS at our Care Centres, for those who had to undergo a mastectomy/lumpectomy

dermatology / FRONT SHOP

Autumn skincare

AND VITAMIN A ENRICHED FOODS It’s hard to believe, but traditionally it’s that time of year again, when the wind starts to feel a little chilly, and the leaves turn an assortment of sunset-hued colours. Global warming may be messing with the seasons, but with the arrival of March, autumn is inevitably around the corner

I

t’s common for the skin to feel a little blah as the

excellent benefits for skin. In fact, did you know, that if

season starts to change. Customers can thank the

there’s one product I encourage customers start using as

dry air for that. They may be tempted to cover up

soon as their early twenties already, it’s a retinol cream?

in a scarf, with just their eyes peeking out, but you

Remember, it’s what one does now that sets the

should rather encourage them to tackle their skincare

foundation for how skin ages. Prevention is better than

woes head-on to enjoy radiant and bright skin, no matter

a cure, so recommend customers start now before they

how dark and gloomy the weather gets.

spot their first pesky wrinkle.

There is an array of autumn foods the skin simply

I could write an essay about the benefits of vitamin A

loves. The one vitamin that most autumn fruits and

for skin, but all you really need to know is that it will

veggies have in common is vitamin A, which has

hydrate skin cells, smooth skin texture, increase blood

awesome benefits for skin.

flow, regulate sebum production, and normalise cellular turnover. The exciting thing about increased blood flow

WHAT’S THE BIG DEAL ABOUT VITAMIN A?

is that not only will skin start to rival Jennifer Lopez’s

Vitamin A is essential for healthy skin, end of story. You

famous glow, it’ll help promote the formation of

may have heard of a retinol cream but been unaware

collagen in skin, ensuring it stays firm and plump as

that retinol is in fact vitamin A derivatives that have some

each birthday rolls around.

AUTHOR: Dr Janine Ellenberger GR8SKN Skincare

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You may have heard of a retinol cream but been unaware that retinol is in fact vitamin A derivatives that have some excellent benefits for skin

PM

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Vitamin A hydrates skin cells, smooths skin texture, increases blood flow, regulates sebum production, and normalises cellular turnover

ˇ´

Pharmacy Magazine MARCH 2020 |

7

dermatology / EDUCATION

Stay sun safe

this Easter holiday As we head into autumn and the Easter holiday period, it’s important to remind patients the harsh radiation of the sun’s rays can potentially cause irreversible damage to the skin and eyes all year round

M

“

HOW PATIENTS CAN PROTECT THEMSELVES FROM THE SUN • Stay out of the direct rays of the sun where possible, especially between 9am-4pm, when UV rays are strongest.

• Always apply sunscreen or sunblock to protect skin.

Apply sunscreen of at least Factor 30 (more if you have fair skin or

any people believe

LESS PROTECTION

other risk factors) approximately

the ultraviolet [UV]

According to Dr Vincent, an additional

30 minutes before exposure to

radiation from the sun is

challenge globally is that, as the earth’s

the sun. Keep sunscreen handy

weaker and less harmful

ozone levels become more depleted,

and reapply often, especially after

in autumn and winter,” said Dr Peter

our atmosphere tends to offer less

swimming or sweating excessively.

Vincent, of Netcare Travel Clinics and

protection from the sun’s rays and

Medicross Tokai. “However, it should be

more solar UV radiation reaches its

kept in mind that SA has high levels of

surface. It is believed this is among the

year-round ambient radiation from the

reasons why several countries have

sun, and patients should therefore remain

seen increases in the incidence of skin

vigilant about taking measures to protect

cancer in recent years.

their skin even during the cooler months.”

NEED TO IMPROVE AWARENESS

• Wear a hat with a wide brim that extends all the way around and shades your face and the back of your neck. Where possible wear clothes that cover arms and legs, preferably made with fabric offering complete UV protection.

HIGH RISK OF EXPOSURE

“While there has been a substantial

“South Africans are at higher risk for

increase in awareness of the possible

shaded areas so seek out

chronic exposure to harmful UV radiation,

dangers of over-exposure to solar

the shade of a tree or use an

which is the leading cause of skin

radiation in SA, and an increasing

umbrella on hot days.

cancer. An estimated 30% of all cancers

number of local schools are starting

Make sure the umbrella

diagnosed in SA are a type of skin

to put sun-safe measures in place for

offers 100% UV protection.

cancer,” said Dr Vincent.

pupils, much still needs to be done in

Over-exposure to the sun’s rays may also cause sunburn, premature skin ageing, and damage to the eyes,

this regard, as many people do not take sufficient measures to protect themselves.

Dr Vincent said patients should

• Solar radiation is reduced in

• Place emphasis on protecting children with sunscreen and clothing, as they have more

increasing the risk of developing cataracts

remember they may be exposed to

delicate skin and most

in later life. Being sun safe is therefore

solar radiation when outdoors,

sun-related skin damage

not only a critical aspect of patients’ skin

including on overcast days, at all

occurs before the age of 18.

cancer prevention, but also of protecting

times of the year.

Children under the age of one

other aspects of their health.

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The caucasian, or white, population in South Africa is particularly, although not exclusively, at risk of suffering sun damage, and has one of the highest incidences of malignant melanoma in the world

PM

9am-4pm

should not be exposed to the direct rays of the sun at all.

• Wear good quality sunglasses to protect eyes.

• Avoid tanning and do not tan under artificial sunlamps and sunbeds, which have been strongly associated with skin damage.

• Regularly inspect your body for new growths and size, shape, and colour changes to moles. Also be sure to check for moles that may have developed under the nails, the palms of the hand and the soles of the feet. If you have any concerns about any moles, changes to the skin, or sores that don’t heal, don’t delay in having these investigated by your doctor.

Pharmacy Magazine MARCH 2020 |

9

virology / CUT OUT & KEEP

CORONAVIRUSe f acts

CUT& OUTEP KE

th

Facts, not fear will stop the spread of novel coronavirus (COVID-19)

DON’T GET CONFUSED BY THE NAME • DISEASE: coronavirus disease (COVID-19) • VIRUS: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the

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Masks are recommended for sick people and healthcare professionals, not healthy people

cause of an ongoing international outbreak of respiratory illness, known as coronavirus disease 2019 (COVID-19).

Why do the virus and the disease have different names?

Viruses, and the diseases they cause, often have different names. For example, HIV is the virus that causes AIDS. People often know the name of a disease, such as measles, but not the name of the virus that causes it (rubeola).

SYMPTOMS MUCH LIKE THE WINTER FLU, THE MOST COMMONLY REPORTED SYMPTOMS INCLUDED FEVER, DRY COUGH, AND SHORTNESS OF BREATH. While most patients (80%) experience mild illness, a small proportion develop pneumonia which, in sever cases, can result in organ failure (3%). Early evidence shows most fatalities are patients who are immunocompromised either due to extremes of age or pre-existing conditions.

TREATMENT There is no currently available treatment or vaccine for COVID-19. However, many of the symptoms can be treated.

RECOVERY

1—14 DAYS

Most cases are mild with recovery taking on average 10 days

FORGET THE MASK, WASH YOUR HANDS There is no evidence that masks protect people who are not already

INCUBATION PERIOD most commonly 5 days

SARS-COV-2 VS OTHER VIRUSES The number of people that one sick person will infect (on average) is called R0. Here are the maximum R0 values for some well-known viruses.

HEPATITIS C (R2)

sick/infected. The most important thing you can do to protect yourself

EBOLA (R2)

is to regularly wash your hands and to touch your face as little as possible

COVID-19 (R2.2)

when you are in public. Masks are better at preventing someone with a viral infection from transmitting the virus

HIV (R4)

than it is at preventing a healthy person from contracting the virus. As such, masks are recommended for infected people,

SARS (R4)

or healthcare professionals treating infected people, and not recommended for most healthy people.

MUMPS (R10)

*N95 masks are the ones that provide protection from respiratory droplets.

MEASLES (R18)

✂

SA General Public Hotline Number: 0800 029 999, operates Monday-Friday, 8am-4pm Pharmacy Magazine MARCH 2020 |

11

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dermatology / EDUCATION

The influence of exposome on acne

An international team has identified the broad categories of environmental, psychological, and social factors that encourage the appearance of acne.

A sound knowledge of these parameters – collectively called the exposome – facilitates the implementation of preventive or corrective actions

A

cne exposome is defined as the sum of

sebaceous gland, innate immunity, and cutaneous

all environmental factors influencing

microbiota. They may be classified into the following

the occurrence, duration, and severity

six main categories: nutrition, psychological,

of acne. Exposome factors impact

and lifestyle factors, occupational factors

on the response and the frequency of relapse to

including cosmetics, as well as pollutants,

treatments by interacting with the skin barrier,

medication, and climatic factors.

NUTRITION This first category is by far the most published acne exposome factor. Main food classes considered as triggering acne are dairy products (especially

Dr Liesl Brown BPharm, MSc (Pharm) Cum Laude, PhD

MEDICATION The following androgenic progestins have been identified to cause or worsen acne: desogestrel and 3-cetodesogestrel,

skim milk) and hyperglycaemic

levonorgestrel, lynestrenol,

carbohydrates. An average regimen

norgestrienone, norethisterone,

of dairy products has been reported

norgestrel, gestodene, norgestimate, and etonogestrel. In contrast to

impacting on acne, and one paper

this, chlormadinone acetate, dienogest, drospirenone, and norgestimate

indicated that cow milk impacts on acne

oral contraceptive pills have been reported to be beneficial in the

after drinking two glasses per day.

treatment of acne. Corticosteroids, halogens, isoniazid, lithium, vitamin B12, immunosuppressants, and certain anticancer agents and radiotherapy have been reported as causing acneiform eruptions.

OCCUPATIONAL FACTORS E.g. cosmetics, mechanical factors The use of aggressive skin care regimens and inappropriate cosmetics may cause acne flare-ups.

These products modify the skin barrier and the skin microbiota balance especially in the sebaceous area, thus activating the innate immunity triggering inflammation.

Mechanical factors comprising rubbing, scrubbing, the use of home devices or medical devices such as sonic brushes, derma rollers, or micro needling systems may trigger acne flare-up.

POLLUTANTS E.g. air, industrial, and human-dependant pollutants.

Air pollutants exert a harmful effect on the skin by increasing oxidative stress inducing severe alterations of the normal functions of lipids, deoxyribonucleic acid, and/or proteins in the human skin.

Acne has been frequently observed in industrial workers after prolonged exposure to certain organic molecules, such as coal, tar, or crude oil.

Tobacco and cannabis use may be considered

CLIMATIC CONDITIONS

human-dependent pollutants which may play a role in acne.

Climatic conditions and seasonal variations resulting in a combination of heat, humidity, and intensive ultraviolet rays (UVR) may trigger inflammatory acne flare-up, which have been called acne Tropicana, acne Majorca, or tropical acne.

One of the major environmental factors affecting the skin is ultraviolet radiation. Both UVB and UVA have been reported to cause hyperplasia of the sebaceous gland, thickening of the stratum corneum, increase in sebum secretion,

PSYCHOSOCIAL AND LIFESTYLE FACTORS Modern lifestyle, defined as stressful situations including urban noises, socioeconomic pressures, and light exposure, may play a role in acne.

PM

and in the number of comedones.

Pharmacy Magazine MARCH 2020 |

13

Misuse of ANTIBIOTICS puts us all at risk.

Taking antibiotics when you don’t need them speeds up antibiotic resistance. Antibiotic resistant infections are more complex and harder to treat.

They can affect anyone, of any age, in any country.

Always seek the advice of a healthcare professional before taking antibiotics.

women’s health / EDUCATION

Endometriosis

ENDOMETRIOSIS AWARENESS DAY

1 MARCH

101

Endometriosis is a progressive, chronic condition in which cells like those that line the uterus are found in other parts of the body

S

tudies suggest that endometriosis affects 1 in 10 women of reproductive age, with an

estimated 176 million women worldwide having the condition.

Unfortunately, for many of these women, there is often a delay in diagnosis of endometriosis resulting in unnecessary suffering and reduced quality of life. In patients aged 18-45 years, the average delay is 6.7 years.

As most women with endometriosis report the onset of symptoms during adolescence, early referral, diagnosis,

SYMPTOMS

identification of disease, and treatment

The symptoms vary from woman to woman. Some experience symptoms of severe pains, others

may mitigate pain, prevent disease

have no symptoms at all.

progression, and thus preserve fertility.

PAIN: The most common symptom of endometriosis is chronic pelvic pain especially just before, or during the menstrual period. Pain may also occur during sexual intercourse. If endometriosis is present on the bowel, pain during bowel movements can occur.

If the bladder is affected, pain may be felt during urination.

Heavy bleeding can occur with or without clots. Bleeding may be irregular, continue for

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a long period, or spotting may occur before the menstrual period.

Endometriosis should be viewed as a chronic disease that requires a life-long management plan with the goal of maximising the use of medical treatment and avoiding repeat surgical procedures

SEVERE MENSTRUAL CRAMPS: Many women experience mild menstrual cramps, which are considered normal. When cramping is more severe it is called dysmenorrhoea. Severe cramping may occasionally cause nausea, vomiting, or diarrhoea. Primary dysmenorrhoea occurs during the early years of menstruation, tends to improve with age, and is usually not related to endometriosis. Secondary dysmenorrhea occurs after the early years of menstruation and may continue to worsen with age. This may be a warning sign of endometriosis, although some women with endometriosis feel no cramping at all and many women with dysmenorrhoea don’t have endometriosis.

BLADDER AND BOWEL PROBLEMS: Changes in the pattern of bowel habit such as constipation or diarrhoea, feeling the need to urinate more frequently, and increased abdominal bloating with or without pain at the time of the period.

INFERTILITY: There is a large body of evidence that demonstrates an association between endometriosis and infertility. Almost 40% of women with infertility problems have endometriosis. Inflammation from endometriosis may damage the sperm or egg or interfere with

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their movement through the fallopian tubes and uterus. In severe cases of endometriosis, the fallopian tubes may be blocked by adhesions or scar tissues.

Continued on next page...

Pharmacy Magazine MARCH 2020 |

15

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women’s health / EDUCATION

COMPLICATIONS

TREATMENT

endometriosis and particularly in women

Common in women with

The optimal management of endometriosis

who are unresponsive to combined OCs

endometriosis, long-term

is unclear. The main aims of treatment are

or progestins or have a recurrence of

complications include:

therefore to relieve symptoms of pain and

symptoms after initial improvement.

• Adhesion formations and ovarian

infertility and to treat endometriomas.

GnRH agonist treatment coupled with

• Combined oestrogen and progestin

induced hypoestrogenism is effective in

failure post-surgery. The bleeding can form bonds of scar tissue that

therapy: Oral contraceptives (OCs) that

can attach to organs in the pelvis

combine oestrogen and progestin are

and abdomen.

considered as first-line treatment for pelvic

patients with incapacitating symptoms

pain associated with endometriosis.

who do not respond to medical treatment,

• Reduced fertility that may have no obvious cause or may be caused by

managing endometriosis.

• Surgical treatment is reserved for

who cannot tolerate medical treatment

• Progestogens are effective for the

adhesions forming on or near the

treatment of pelvic pain associated

owing to side-effects, for those with

ovaries or fallopian tubes.

with endometriosis. They also induce

endometriomas, and for those with

decidualisation and atrophy of

symptoms and signs of urinary or bowel

endometriotic tissue and inhibit

obstruction. The modalities of surgery

gonadotrophin secretion, with resultant

include laparoscopy and laparotomy.

reduction in the production of ovarian

There is better visualisation of endometrial

hormones. Medroxyprogesterone acetate

lesions with laparoscopy compared with

and norethindrone acetate are both

laparotomy. The latter is therefore reserved

commonly used for the treatment of pain

for women with extensive diseases.

in endometriosis. The use of progestogens

Surgical management of endometriosis

is limited by side-effects, including weight

requires careful consideration of the

gain, irregular bleeding, and mood changes.

indications of surgery, preoperative

• An increased risk of miscarriage or giving birth prematurely.

• Cysts can bleed or rupture, causing severe pain.

• Endometriosis of the intestine can cause the bowel to become blocked or twisted.

• An increased risk of certain types of cancer, particularly ovarian.

*

evaluation, surgical techniques,

• Gonadotrophin-releasing hormone agonists (GnRH agnostics) should be

surgeon’s experience, and ancillary

considered as the first line of treatment for

techniques and procedures.

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anaemia / CPD

COMBATING NUTRIENT DEFICIENCY ANAEMIA

A

Normal level of red blood cells

Anaemia level of red blood cells

naemia is not a disease but rather a symptom

CAUSES OF IRON-DEFICIENCY ANAEMIA

of various diseases. Anything that causes a

Iron deficiency refers to the reduction in iron stores

deficiency in the formation of red blood cells

that either precedes overt iron-deficiency anaemia

or that leads to the accelerated destruction

or persists without progression. Low iron levels in

of red blood cells can result in anaemia. Anaemia can be

iron-deficiency anaemia result in anaemia with the

an early indicator of arthritis, infection, or certain major

presence of microcytic hypochromic red cells.4 The

illnesses like cancer.1,2

reported prevalence of iron deficiency in the absence

Drug use, hormonal disorders, chronic inflammation in

Anaemia is a very common blood disorder that results from a reduction in either the number of red blood cells or the amount of haemoglobin in the blood. The oxygen-carrying capacity of blood is decreased, and less oxygen is available to cells of the body to perform their functions

of dietary fortification is estimated to be 40% in

the body, surgery, infections, peptic ulcers, haemorrhoids,

preschool children, 30% in menstruating girls and

diverticular disease, heavy menstrual bleeding, repeated

women, and 38% in pregnant women. These high rates

pregnancies, liver damage, thyroid diseases, rheumatoid

reflect the increased physiological demands during

arthritis, bone marrow disease, hereditary disorders, and

particular life-stages and according to gender. A further

dietary deficiencies (especially deficiencies of iron, folate,

critical period is the growth spurt of adolescence.4

Anastasia Dobson Du Toit, Managing Director and Pharmacist, Anastellar

and vitamins B6 and B12) can all lead to anaemia.

Severe anaemia is associated with fatigue, weakness,

DIETARY IRON SUPPLEMENTATION

dizziness, and drowsiness. The risk for anaemia increases

Once iron deficiency has been diagnosed and the

because of poor diet, intestinal disorders, chronic diseases,

physician has identified and, where possible, addressed

infections, and other conditions. Women who are

the underlying cause, it is important to restore iron levels

menstruating or pregnant, people with chronic medical

through supplementation. A dietary assessment should

conditions, and children have a higher risk profile of

be conducted, and appropriate advice provided. Although

developing anaemia. The risk of anaemia also increases

dietary changes and counselling are important, dietary

in the elderly. Nutritional interventions can have a positive

changes alone are not usually adequate and medicinal

impact on micronutrient deficiencies and undernutrition,

iron supplementation should be considered.5

Caragh Cooper, Consultant Medical Writer and Pharmacist

as well as on acute infections like diarrhoea, malaria, HIV/AIDS, and tuberculosis.1,2

REFERENCES

IRON DEFICIENCY AND ITS ROLE IN ANAEMIA Iron deficiency and iron-deficiency anaemia are global health problems and common medical conditions seen in everyday clinical practice. The classic textbook symptoms of iron-deficiency such as koilonychia (spoon nails), glossitis, or dysphagia are not commonly seen in developed countries.3 Iron plays a crucial role in biologic functions, including energy production, respiration, cell proliferation, and DNA synthesis. Due to the absence of an excretion mechanism and the potential for iron levels to become toxic, daily absorption is

1. Organisation, World Health. Anaemia. Health Topics. [Online] [Cited: January 24, 2020.] https://www.who.int/topics/ anaemia/en/.

2. Royal Pharmaceutical Society of Great Britain. Dietary Supplements. [ed.] P Mason. 4th. London: The Pharmaceutical Press, 2012.

3. Iron Defiency Anaemia. Killip, Shersten, Bennett, John M and Chambers, Mara D. 5, 2007, American Family Physician, Vol. 75,

Michelle Dateling, Sales and Marketing Director, Anastellar

pp. 671-678.

4. Iron-Deficiency Anaemia. Camaschella, Clara. [ed.] Dan L Longo. 19, 2015, The New England Journal of Medicine, Vol. 372, pp. 1832-1843.

5. Individualized Treatment for Iron-deficiency Anaemia in Adults.

limited as the body has developed mechanisms to recycle the

Alleyne, Michael, Horne, McDonald K and Miller, Jeffery L. 11,

iron which is released after the breakdown of red blood cells.

2008, The American Journal of Medicine, Vol. 121, pp. 943-948.

This is a condensed version of the full CPD-accredited article which first appeared in the Medical Chronicle in February 2020.

CPD points cannot be guaranteed as they are awarded at the South African Pharmacy’s discretion.

FOR THE FULL ARTICLE AND 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 to access this and other CPD accredited articles.

Pharmacy Magazine MARCH 2020 |

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CANSA also invites Survivors who would like to encourage fellow Survivors in their own community, to start a local CANSA support group.

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2. The most important thing you can do to protect yourself

4. Which Glenmark product is dermatologist recommended?

from COVID-19 is to regularly wash your _ _ _ _ _ _ _. (PAGE 19)

(PAGE 20)

3. Main food classes considered as triggering acne are dairy

6. PregOmega Plus is SA’s number one _ _ _ _ _ _ _ _ _ choice.

products and _ _ _ _ _ _ _ _ _ _ carbohydrates. (PAGE 21)

(PAGE 26)

5. Otrivin Ear, Nose and Throat Paediatric Drops are indicated

7. Severe anaemia is associated with fatigue, weakness,

for the _ _ _ _ _ _ _ _ _ of naso-pharyngeal mucosa in colds, sinusitis,

dizziness, and _ _ _ _ _ _ _ _. (PAGE 31)

otitis media, and to facilitate rhinoscopy. (PAGE 12-13)

12. _ _ _ _ _ _ _ _ _ _ Toothache Drops are indicated for temporary

8. Catidral assists in the treatment of _ _ _ _ _ _ _ _ _. (PAGE 32)

relief of pain. (PAGE 22-23)

9. Research shows that up to 20% of South African couples

13. _ _ _ _ _ _ _ is a progressive, chronic condition in which

struggle with _ _ _ _ _ _ _ _ _ affecting both males and females

cells like those that line the uterus are found in other parts

almost equally. (PAGE 7)

of the body. (PAGE 25-27)

10. Endometriosis of the intestine can cause the bowel to become blocked or _ _ _ _ _ _ _ _. (PAGE 25-27)

DOWN

11. South Africans are at higher risk for chronic exposure

1. While most patients with COVID-19 experience mild illness,

to _ _ _ _ _ _ _ _ UV radiation, which is the leading cause of

a small proportion develop _ _ _ _ _ _. (PAGE 19)

skin cancer. (PAGE 15).

Continued on next page...

Pharmacy Magazine MARCH 2020 |

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ANSWERS: CROSSWORD #16

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