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Heart failure (HF) often occurs in patients who have more than one comorbidity, with resultant polypharmacy. Medication errors may occur, along with adverse interactions between medicines. This highlights the importance of the pharmacist as part of the multidisciplinary team in the management of HF. Many advances have been made in the way in which heart failure is classified, diagnosed, managed and treated. The body of knowledge is ever-expanding and hence the need for frequent review of treatment guidelines in light of the data emerging from ongoing research. This article focuses on elucidating some of the currrent strategies to manage and treat this condition. Certain associated pathological conditions and modalities are therefore beyond the scope of this article and the reader is advised to consult the the latest international guidelines for more detailed explanations of advanced treatment strategies, the cardiomyopathies, congenital heart defects, acute cardiac failure, and heart failure within the context of myocardial infarction, cardiac valve replacement surgery, coronary artery revascularisation and other specialised examples. [ABSTRACT FROM AUTHOR]

Since the outbreak of COVID-19, and its declaration as a pandemic by the World Health Organization (WHO), the reliance on pharmacists as one of the first points of contact within the healthcare system has been highlighted. This evidence-based review is aimed at providing guidance for pharmacists in community, hospital and other settings in South Africa, on the management of patients with suspected or confirmed coronavirus disease 2019, or COVID-19. The situation is rapidly evolving, and new evidence continues to emerge on a daily basis. This guidance document takes into account and includes newly available evidence and recommendations, particularly around the following aspects relating to COVID-19: • Epidemiology • The virus, its modes of transmission and incubation period • Symptom identification, including the differentiation between influenza, allergic rhinitis, sinusitis and COVID-19 • Social media myths and misinformation • Treatment guidelines and medicines that may need to be kept in stock • Treatment and prevention options, including an update on vaccine development • The case for and against the use of NSAIDs, ACE-inhibitors and angiotensin receptor blockers (ARBs) in patients with COVID-19 • Interventions and patient counselling by the pharmacist. It is critical, though, that pharmacists access the most recent and authoritative information to guide their practice. Key websites that can be relied upon are: • World Health Organization (WHO): https://www.who.int/emergencies/diseases/novel- coronavirus-2019 • National Institute for Communicable Diseases (NICD): https://www.nicd.ac.za/diseases- a-z-index/covid-19/ • National Department of Health (NDoH): http://www.health.gov.za/index.php/ outbreaks/145-corona-virus-outbreak/465-corona-virusoutbreak; https://sacoronavirus. co.za/ [ABSTRACT FROM AUTHOR]

The smoking habit is particularly rife in South Africa, compared to the rest of the world. Although smoking rates in South Africa have been declining since the implementation of tobacco control measures in 1993, we still have an estimated eight million smokers in the country. Smoking has been associated with detrimental heath risks and related complications for decades, and such health issues are further compounded by the high incidence of tuberculosis and HIV/AIDS in the South African population. This article aims to provide an overview of the importance of smoking cessation, and the non-pharmacological and pharmacological measures aimed at successfully quitting the habit of smoking. [ABSTRACT FROM AUTHOR]

Common colds and flu are caused by very different viruses but share similar symptoms. The common cold is a self-limiting upper respiratory tract infection and it is typically caused by a rhinovirus, coronavirus or adenovirus. It usually resolves within 7-10 days. The flu is caused by the influenza virus and typically presents with headaches, myalgia, fever and generalised body aches. In South Africa deaths related to colds and flu are at least three times higher when compared to the USA. The burden of infections with the human immunodeficiency virus (HIV) and tuberculosis (TB) in our country, heightens the risk of severe flu-related illness. However, treatment remains mostly symptomatic. [ABSTRACT FROM AUTHOR]

Parental knowledge of antibiotic use in upper respiratory tract infections (URTI) impacts significantly in the preservation of antibiotic efficacy, yet has not been adequately studied in Nigerian settings. This present study evaluated the knowledge, attitudes and self-medicating practices of caregivers towards the use of antibiotics in URTI among children. The study was a cross-sectional and prospective survey. Parents visiting two hospitals (Nsukka General Hospital - rural and Enugu State University of Technology Teaching Hospital- urban) with their sick children (12 years and under) were approached to complete a 24-item questionnaire. The items assessed parental knowledge of, attitudes and self-medicating practices towards antibiotics in cases of URTI. Frequencies, means and inferential multivariate (chi-square, t-tests and regression) data analysis were conducted. The parents exhibited poor knowledge in most of the knowledge items. Younger parents, those visiting the urban hospital and those with higher educational status exhibited significantly better knowledge of antibiotics and URTI (p<0.05). The parents indicated marginally accepting attitudes towards antibiotics use and misuse and this was influenced largely by better antibiotic knowledge and better educational qualifications (p<0.001). However parents from both hospitals frequently self-medicated (88.6%) and acknowledged poor practices towards antibiotics such as the use of left over antibiotics. Majority (85%) of the parents also said they received antibiotics after they demanded it from their physicians. Parents in these study settings in Nigeria, possessed poor knowledge and positive attitudes of antibiotic use in their children, and exhibited poor practices when utilizing them. [ABSTRACT FROM AUTHOR]

Heart failure is considered to be a common condition in the adult population and is associated with substantial morbidity and mortality rates worldwide. Many advances have been made in the way in which heart failure is classified, diagnosed, managed and treated, and the body of knowledge is ever-expanding. This results in a need for frequent re-review of treatment guidelines and the emerging data from ongoing research. Due to the vastness of the subject matter, however, this article can only focus on the basic essentials to try and elucidate some of the current strategies pertaining to this condition in general. Certain associated pathological conditions and modalities are therefore beyond the scope of this article and the reader is advised to consult the latest international guidelines for more detailed explanations of advanced treatment strategies, the cardiomyopathies, congenital heart defects, acute cardiac failure, and heart failure within the context of myocardial infarction, cardiac valve replacement surgery, coronary artery revascularisation and other specialised examples. [ABSTRACT FROM AUTHOR]

Fever is a normal response to a variety of conditions, the most common of which is infection. Fever occurs when the body's temperature is elevated, because its thermostat is being reset to a higher-than-usual temperature. Nearly every child will develop a fever at some point in time. The challenge for health care workers is to know when to be concerned. This topic review will discuss the definition of fever, its pathophysiology and basic overview, how and when to treat fever, as well as the signs and symptoms that require further assessment and evaluation. A short overview of febrile seizures has also been included. [ABSTRACT FROM AUTHOR]

Fungi normally originate from the environment that surrounds us, and appear to be harmless until inhaled or ingestion of spores occur. For many years fungal infections were thought of as superficial diseases or infections such as athlete's foot, or vulvovaginal candidiasis. Subsequently, when invasive fungal infections were first encountered, amphotericin B was the only treatment for systemic mycoses. However, with the advances in medical technology such as bone marrow transplants, cytotoxic chemotherapy, indwelling catheters as well as with the increased use of broad spectrum antimicrobials in antimicrobial resistance, there has been a marked increase of fungal infections worldwide. Populations at risk of acquiring fungal infections are those living with human immunodeficiency virus (HIV), cancer, patients receiving immunosuppressant therapy, neonates and those of advanced age. The management of superficial fungal infections is mainly topical, with agents including terbinafine, miconazole and ketoconazole. Oral treatment includes griseofulvin and fluconazole. Historically the management of invasive fungal infections involved the use of amphotericin B, however newer agents include the azoles and the echinocandins. This paper provides a general overview of the management of fungus infections. [ABSTRACT FROM AUTHOR]

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder and involves the academic, social and family functioning of the child. It is the most commonly diagnosed behavioural disorder amongst children with a prevalence of approximately 7.2% worldwide, occurring mostly in boys. The consequences of ADHD may be substance abuse and other personality disorders, e.g. delinquency. Research has indicated that drug or behavioural interventions may decrease the rate of conduct and personality disorders. Diet therapy may include polyunsaturated fatty acids (fish oil) and iron supplements in children with low ferritin levels which may improve ADHD symptoms. Drug therapy that involves stimulants (methylphenidate) has been proven to be effective with a good safety profile. However, concerns have been raised about cardiac, psychiatric and growth side-effects. The non-stimulants (atomoxetine) have no abuse potential and reduce insomnia. They also have a better effect on growth in children. Other therapies include antidepressants and α2-agonists. It is important to treat each patient using individualised therapy. The role of the pharmacist is important to monitor and minimise side-effects. New treatment options comprise modified formulations of currently available medicines. [ABSTRACT FROM AUTHOR]

Asthma is a chronic inflammatory disease that causes hyper-responsiveness of the bronchial tree, with reversible airflow obstruction. The condition places a significant burden on our healthcare system. Chronic asthma can cause remodelling of the airway. Patients suffering from asthma should be aware of the signs and symptoms thereof, as well as the factors that can precipitate an asthmatic attack. Asthma is mostly classified as either acute or chronic; the diagnosis of asthma is based on identifying both a characteristic pattern of respiratory symptoms and variable expiratory airflow limitation. Treatment is based on how the patient presents and includes bronchodilators, inhaled corticosteroids and mast cell stabilisers. This article provides an overview on the diagnosis, characterisation and treatment of asthma. [ABSTRACT FROM AUTHOR]

Allergic diseases affect many people across the globe. They significantly impact on the quality of life of the people who are affected, creating personal and economic predicaments. Some of the most commonly diagnosed allergic diseases include atopic dermatitis, rhinitis, allergic conjunctivitis and sinusitis. Allergic conjunctivitis is an allergic disease characterised by the inflammation of the conjunctiva caused by airborne allergens; it presents as itching, excessive lacrimation, discharge and pink eye. Usually it is associated with other allergic conditions such as allergic rhinitis and bronchial asthma. Allergic conjunctivitis is further divided into acute, seasonal allergic conjunctivitis (SAC), and perennial allergic conjunctivitis (PAC). [ABSTRACT FROM AUTHOR]

Back pain affects people across any socio-economic category and is a leading cause of absenteeism and decreased productivity in the workplace. This symptomatic condition is caused by multiple factors, making it difficult to manage. With a small proportion of people experiencing back pain due to pathological reasons, in the larger majority, back pain is due to a mechanical cause. Taking a complete history that includes identifying risk factors such as depression, poor posture, lack of exercise, older age and a physically demanding job is crucial to the effective management of the condition. Behavioural, psychological and social factors of the patient should form the backbone for treatment of back pain. Non-pharmacological management such as exercise and targeted physiotherapy should be the first-line treatment. However, if this provides poor results then pharmacological measures such as the use of nonsteroidal antiinflammatory drugs (NSAIDs) like ibuprofen or muscle relaxants such as cyclobenzaprine should be considered. The pharmacist at the frontline can play a major role in assisting in the recovery of many patients. [ABSTRACT FROM AUTHOR]

Coughing is one of the most common symptoms for which patients consult their healthcare practitioners. Their coughing may be caused by various factors such as respiratory tract infections, asthma, inhaled irritants, postnasal drip syndrome and gastro-oesophageal reflux disease (GORD). Terminology that includes 'wet' and 'dry' has become outdated and should be revisited. An understanding of the pathophysiology of coughs and how they manifest themselves enables the health professional to provide the necessary therapy. [ABSTRACT FROM AUTHOR]

Osteoporosis is a common systemic progressive skeletal disease that remains a significant problem worldwide. It is important to understand the pathogenesis and the possible mechanism of action of anti-osteoporotic drugs. Treatment of osteoporosis is strictly related to severity of pathology and consists of prevention of fragility fractures with the correct lifestyle and adequate nutritional supplements. Bisphosphonates are the agents most extensively studied and prescribed in clinical practice for more than 20 years. They give the most effective protection from various fractures including vertebral, hip and other non-vertebral fractures. Bisphosphonates are generally well tolerated and have a favourable safety profile when used in the treatment of osteoporosis. This review aims to provide an overview of the management of osteoporosis with the use of bisphosphonate medicines. The purpose of this review is to focus on the main current pharmacological products available for the treatment of osteoporotic patients. [ABSTRACT FROM AUTHOR]

This article aims to provide a concise, high-level overview of the classification, management and treatment of migraine. Migraine is a common, debilitating neurological disorder that is characterised by the presence of severe headaches, which may last anything from a few hours to a few days (4-72 hours). Thus, the condition is characterised by episodes of severe migraine headache, frequently accompanied by nausea and vomiting. These headaches may be unilateral or bilateral and patients may also experience a range of associated features. Acute attacks require rapid, abortive treatment and the rate of recurrence needs to be reduced and managed through the use of effective prophylactic measures. [ABSTRACT FROM AUTHOR]

Fever is a normal response to a variety of conditions, the most common of which is infection. Fever occurs when the body's temperature is elevated, because its thermostat is being reset to a higher-than-usual temperature. Nearly every child will develop a fever at some point in time. The challenge for health care workers is to know when to be concerned. This topic review will discuss the definition of fever, its pathophysiology and basic overview, how and when to treat fever, as well as the signs and symptoms that require further assessment and evaluation. A short overview of febrile seizures has also been included. [ABSTRACT FROM AUTHOR]

Vitamins are either fat-soluble or water-soluble micronutrients that are derived from a healthy, well-balanced diet. The B-complex vitamins are well-known examples of such water-soluble nutrients that are readily absorbed from a healthy gut, and easily eliminated via renal excretion. They are required for their vital physiological functions and are significant contributors towards maintaining optimal health. Multiple B-vitamin deficiencies are quite commonly seen and therefore a balanced diet, including a full spectrum of B-vitamins, is usually needed when any of them is found to be deficient. Conversely, their therapeutic value will be limited to supplementation during states of deficiency, since they have no additional benefits in the presence of an adequate dietary intake. In general, their active supplementation should only be used to correct deficiencies. This article provides an overview of such B-complex vitamin deficiencies and their supplementation. [ABSTRACT FROM AUTHOR]

In South Africa deaths related to colds and flu are at least three times higher when compared to the USA. The burden of HIV and tuberculosis in our country heightens the risk of severe flu-related illness. The common cold and flu are caused by very different viruses that share very similar symptoms. The common cold is a self-limiting upper respiratory tract viral infection and it is caused by the rhinovirus, coronavirus or the adenovirus. It usually resolves within 7-10 days. Flu is caused by the influenza virus and usually presents with headaches, myalgia, fever and body aches. There is no place for antibiotic usage in colds and flu management, and there is no clinical evidence which suggests that using antibiotics alters the course of the disease or prevents secondary infection. Treatment is mainly symptomatic and includes many over-the counter-medicines, specific antiviral agents and herbal treatment. [ABSTRACT FROM AUTHOR]

Hypercholesterolaemia and dyslipidaemia, marked by decreased levels of high-density lipoproteins (HDL) and elevated levels of lowdensity lipoprotein cholesterol (LDL-C), increase the risk of cardiovascular disease. By agreement, statin therapy constitute the agents of choice for the reduction of LDL-C. Despite being the most commonly prescribed lipid-lowering agents, with an exceptional safety profile and good tolerability, 10-25% of statin users experience muscle toxicity. This is known as the statin-associated muscle symptoms (SAMS), which range from myalgia to rare, life-threatening cases of rhabdomyolysis, in the presence of normal or elevated creatine kinase (CK). Familial hypercholesterolaemia (FH), diagnosed based on the clinical features seen in patients with a positive family history, constitutes a heritable disorder involving a single gene. FH can exist in either the heterozygous (HeFH), or the homozygous (HoFH) form, and may be differentiated based on clinical features and genetic studies. A novel drug target, namely proprotein convertase subtilisin/kexin type 9 (PCSK9), has resulted in the development and subsequent approval of new, targeted monoclonal antibodies in the treatment of hypercholesterolaemia. Targeting PCSK9 with such monoclonal antibodies (evolocumab and alirocumab) inhibits the degradation of LDL-receptors and, against a background of optimised statin therapy, increases the life expectancy of patients with hypercholesterolaemia by reducing the incidence and severity of coronary artery diseases. This article gives an overview on the management of hypercholesterolaemia in this setting. [ABSTRACT FROM AUTHOR]

Disorders of the thyroid gland are frequently encountered in the clinical practice setting and typically fall into one of two categories, namely hypothyroidism (i.e. deficient levels of circulating thyroid hormone), or hyperthyroidism (or thyrotoxicosis) that involves abnormally high levels of thyroid hormone in the blood stream. This article provides a high-level overview of thyroid function, the two major pathophysiological abnormalities of the thyroid gland, as well as treatment modalities aimed at managing patients with thyroid pathology. In addition, a brief description of two major autoimmune conditions of the thyroid gland, namely Graves' disease and Hashimoto's thyroiditis, is also provided. [ABSTRACT FROM AUTHOR]

Pain is defined by the International Association for the Study of Pain (IASP) as an "unpleasant sensory and emotional experience, associated with actual or potential tissue damage or described in terms of such damage". It can be steady, throbbing, stabbing, aching, pinching or described in many other ways as being either acute or chronic pain. This pain definition can be applied to any patient, regardless of his/her age, however, paediatric pain expression is dependent on the child's level of cognitive development and sociocultural background. Children older than four years of age can usually talk about their pain; at the age of six to eight years they can use the visual analogue pain (VAP) scale in the same manner as adults. Nevertheless, their capacity to describe pain increases with age and changes throughout their developmental stages. This article provides an overview of paediatric pain management. [ABSTRACT FROM AUTHOR]

Gastro-oesophageal reflux disease (GORD) produces symptoms that cause great irritation to the patient. Pharmacotherapeutic management is directed at minimising these symptoms and reducing the causative factors, e.g. acid production, thereby providing relief. Currently available agents include simple antacids and acid suppression therapy, including histamine 2-receptor antagonists, proton pump inhibitors, mucosal or cytoprotective agents and pro-motility agents. Deciding on appropriate therapy will depend on the diagnosis, side-effects and cost-effectiveness of the treatment [ABSTRACT FROM AUTHOR]

Sport injuries and muscle pain can occur as a result of engagement in exercise and or organized sporting activities. These injuries affect all age groups and gender. The most common types of sporting activities known to cause these injuries include jogging, cycling, volleyball, swimming and heavy weight lifting. Lack of warm-ups before participating in sporting activity, overtraining and or excessive exposure to these physical activities may increase risk of causing injuries. These factors are categorized as extrinsic factors. Intrinsic factors that may lead to sport injuries or may precipitate these injuries are age, previous injuries and level of flexibility. The most common type of injuries seen are sprains and strains. These injuries are accompanied with pain, swelling and redness of injured area. Non-pharmacological and pharmacological management are available for the effective management of these injuries. Pain may vary from mild to severe depending on the severity of injury. These varying types of pain can be managed optimally using non-narcotics such as paracetamol and non-steroidal anti-inflammatory (NSAIDs) like ibuprofen. When pain is categorized as moderated to severe, narcotics may be prescribed and administered. [ABSTRACT FROM AUTHOR]

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is commonly diagnosed and involves the academic, social and family functioning of the child. Prevalence of the disorder is approximately 5.3% worldwide and occurs mostly in boys. The consequences of ADHD may be substance abuse and other personality disorders, e.g. delinquency. Research has indicated that drug or behavioural interventions may decrease the rate of conduct and personality disorders. Diet therapy may include polyunsaturated fatty acids (fish oil) and iron supplements in children with low ferritin levels which may improve ADHD symptoms. Drug therapy that involves stimulants (methylphenidate) has been proven to be effective with a good safety profile. However, concerns have been raised about cardiac, psychiatric and growth side-effects. The nonstimulants (atomoxetine) have no abuse potential and reduce insomnia. They also have a better effect on growth in children. Other therapies include antidepressants and α2-agonists. It is important to treat each patient using individualised therapy. The role of the pharmacist is important to monitor and minimise sideeffects. New treatment options comprise modified formulations of currently available medicines. [ABSTRACT FROM AUTHOR]

Travel and volume of passengers and goods carried continue to expand in reach as more sophisticated air, sea and land transport networks develop. People are travelling for business and leisure, taking with them pathogens and their vectors bringing about diseases such as the global influenza pandemics. This review briefly examines some of the important vaccine preventable diseases related to travel. We then outline diseases known to Africa and other similar parts of the world, and potential approaches for preventing these conditions. The paper provides practical advice for health care practitioners when consulting with the international traveler and hence may strengthen the battle against vaccine preventable diseases. [ABSTRACT FROM AUTHOR]

Allergic diseases are on the increase globally. There has been a doubling in the number of scholars suffering from allergy-related disease in the past two decades. This article describes the predisposing factors which contribute to an increased incidence of allergies within the population. These factors include a genetic predisposition, allergen exposure, abnormalities in the bowel fora and infection exposure. Some of these relate to the hygiene hypothesis and the microfora hypothesis, which are discussed in this article. Treatment options for those suffering from allergic disease are also discussed, with an emphasis on asthma, anaphylaxis, allergic rhinitis and atopic dermatitis. This article was originally published in 2015 and has since been updated with more recent literature. [ABSTRACT FROM AUTHOR]

Psychosis is an umbrella term used in the description of various conditions involving delusions and hallucinations. This article focuses mainly on the management of schizophrenia. Schizophrenia is a complex disorder, which provides many pharmacotherapy-related challenges. Advances have been made in the treatment of the condition; however, this requires a team approach, with the pharmacist having to monitor treatment both for safety and efficacy. The involvement of medicines that might modulate the N-methyl-D-aspartate (NMDA) receptors is an exciting development that should be monitored. [ABSTRACT FROM AUTHOR]

This article aims to provide a concise, high-level overview of the classification, management and treatment of migraine. Migraine is a common, debilitating neurological disorder that is characterised by the presence of severe headaches, which may last anything from a few hours to a few days (4-72 hours). Thus, the condition is characterised by episodes of severe migraine headache, frequently accompanied by nausea and vomiting. These headaches may be unilateral or bilateral and patients may also experience a range of associated features. Acute attacks require rapid, abortive treatment and the rate of recurrence needs to be reduced and managed through the use of effective prophylactic measures. [ABSTRACT FROM AUTHOR]

Travel and volume of passengers and goods carried continue to expand in reach as more sophisticated air, sea and land transport networks develop. People are travelling for business and leisure, taking with them pathogens and their vectors bringing about diseases such as the global influenza pandemics. This review briefly examines some of the important vaccine preventable diseases related to travel. We then outline diseases known to Africa and other similar parts of the world, and potential approaches for preventing these conditions. The paper provides practical advice for health care practitioners when consulting with the international traveler and hence may strengthen the battle against vaccine preventable diseases. [ABSTRACT FROM AUTHOR]

Pharyngitis, or sore throat, is most commonly a symptom of pharyngeal inflammation and is a common complaint among children, adolescents and adults. Medicinal lozenges and throat sprays form an essential part of the management of pharyngitis or sore throat at primary care level. The pharmacist should ensure that patients understand how to correctly use the throat spray applicator, and not exceed the recommended dosages of these products. This article provides a brief overview of these products and their use in the management of pharyngitis. [ABSTRACT FROM AUTHOR]

Bacterial vaginosis (BV) is a commonly-occurring and well-studied cause of vaginal discharge. It is characterised by typical and unsettling symptoms, with an array of risk factors and complications associated with the condition. Treatment is aimed at reducing symptoms and preventing any further complications or infections. This paper is intended to provide a review of recent information on the pathophysiology, an overview of the clinical presentation, complications and treatment of bacterial vaginosis. [ABSTRACT FROM AUTHOR]

Dyslipidaemia poses a significant challenge in the paediatric population, mostly due to the fact that serum lipid abnormalities in children are often missed. It has been shown that the lack of routine screening in children and adolescents may account for as many as half of this population, with either inherited or acquired cholesterol abnormalities, being missed during childhood. This article provides a high-level overview of dyslipidaemia in children and adolescents, including the screening and management of lipid abnormalities in the paediatric population. [ABSTRACT FROM AUTHOR]

Attention-deficit hyperactivity disorder (ADHD) is a disorder that is commonly diagnosed and involves the academic, social and family functioning of the child. Prevalence of the disorder is approximately 5.3% worldwide and occurs mostly in boys. The consequences of ADHD may be substance abuse and other personality disorders, e.g. delinquency. Research has indicated that drug or behavioural interventions may decrease the rate of conduct and personality disorders. Diet therapy may include polyunsaturated fatty acids (fish oil) and iron supplements in children with low ferritin levels which may improve ADHD symptoms. Drug therapy that involves stimulants (methylphenidate) has been proven to be effective with a good safety profile. However, concerns have been raised about cardiac, psychiatric and growth side-effects. The nonstimulants (atomoxetine) have no abuse potential and reduce insomnia. They also have a better effect on growth in children. Other therapies include antidepressants and α2-agonists. It is important to treat each patient using individualised therapy. The role of the pharmacist is important to monitor and minimise side-effects. New treatment options comprise modified formulations of currently available medicines. [ABSTRACT FROM AUTHOR]