Pharmac MARCH 2020
Valuable education for pharmacy staff
MAGAZINE
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Coronavirus: the facts Endometriosis
101
Autumn skincare & vitamin A
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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
{
Dr Paterson advised couples to consult a
{
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
{
{
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.
{ {
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
{
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
{
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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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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