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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). Other conditions, such as eosinophilic oesophagitis, are on the rise and are being diagnosed across all continents except Africa. The diagnosis is primarily clinical. Antihistamines have been the mainstay of therapy for most allergic conditions, except for other conditions that require corticosteroids, or in severe allergic conditions such as anaphylaxis where antihistamines are ineffective as main therapy. It is important to consider first- versus second-generation options when treating allergic diseases, also bearing in mind the duration of therapy and any comorbid conditions that a patient might have. This article provides an overview of these conditions and their current management options. [ABSTRACT FROM AUTHOR]

Pain is an uncomfortable experience associated with various pathologies, including cancer. Advances in medical science have allowed for the development of effective analgesics, and opioids are the most effective in combating pain. Concerted efforts from healthcare workers and an understanding of the characteristics of different opioid drugs are cardinal in the effective use of these chemical entities in the effective management of pain. This short review focuses on discussing the currently available opioids for the management of pain. [ABSTRACT FROM AUTHOR]

Hypertension is a pressing global health issue, contributing to an increase in cardiovascular risk, as well as being the most common condition seen in South Africa. Lack of compliance with the prescribed therapy is one of the largest obstacles to achieving goal blood pressure in antihypertensive patients. The complexity of the drug therapy is a very important factor that is associated with noncompliance, as most patients require treatment with two or more drugs. The use of fixed-dose combination (FDC) therapy has various advantages, including simplification of the regimen, resulting in improved adherence. However, there are also disadvantages, e.g. the inability to provide individualised dose flexibility. This article provides an overview of available FDC therapy for hypertension in South Africa and the rational use thereof, by taking into account each combination’s complementary action, efficacy, safety and tolerability. [ABSTRACT FROM AUTHOR]

Gastro-oesophageal reflux disease (GORD) presents with patients experiencing discomfort due to acid-containing stomach contents persistently being refluxed into the oesophagus. This condition can lead to serious complications if left untreated. The two chief complaints of GORD are heartburn and regurgitation. The management of GORD is wide and varied and includes antacids, H2-antagonists, alginates, pro-kinetics, or proton pump inhibitors. GORD is known to cause economic and social burdens, thus appropriate management is vital to improving a patient’s quality of life. [ABSTRACT FROM AUTHOR]

Muscle pain, also known as myalgia, is most commonly associated with sprains or strains. It frequently presents as redness at the site of injury, tenderness, swelling and fever. Muscle pain may occur as a result of excitation of the muscle nociceptor due to overuse of the muscle, viral infections or trauma. The most important endogenous substance released in response to the damaged tissues or nociceptor nerve endings in regards to muscle pain is adenosine triphosphate (ATP). Optimal pain management involves a combination of non-opioid, opioid analgesics, adjuvants, as well as non-pharmacological strategies. Non-opioid analgesics include paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, which are indicated for mild to moderate pain. Moderate to severe pain requires opioid analgesics. This article provides an overview of muscle pain, the management and treatment thereof. [ABSTRACT FROM AUTHOR]

Coughing is one of the most common symptomatic reasons for patients to 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. Coughing can be classified as either acute or chronic cough, and acute coughing is usually self-limiting. Patients can present with either 'wet' (chesty or productive) or 'dry' (non-productive) coughs. Unfortunately, a cough is generally uncomfortable and may interfere with daily activities, including sleep. Understanding how coughs manifest enables the health professional to provide adequate therapy. Evidence suggests that cough mixtures' effectiveness is disputable, but many patients have reported good results; hence, the medication is used in various combinations. This article provides an overview of the pathophysiology, causes and treatment of acute cough. [ABSTRACT FROM AUTHOR]

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 current 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]

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]

Pain is an uncomfortable experience associated with various pathologies, including cancer. Advances in medical science have allowed for the development of effective analgesics, and opioids are the most effective in combating pain. Concerted efforts from healthcare workers and an understanding of the characteristics of different opioid drugs are cardinal in the effective use of these chemical entities in the effective management of pain. This short review focuses on discussing the currently available opioids for the management of pain. [ABSTRACT FROM AUTHOR]

This article provides an overview of the changes that have taken place in the diagnosis and management of hypertension over the past decade. Hypertension remains a widespread condition seen in South Africa. The approach to managing hypertension includes necessary lifestyle modifications and a decisive, stepwise escalation process in the pharmacotherapeutic management thereof. Most guidelines are still promoting thiazide diuretics to be the initial (first-line) drug of choice, with the addition of other suitable antihypertensive agents, if necessary, and according to any relevant comorbid conditions. [ABSTRACT FROM AUTHOR]

Throat infections, referred to as pharyngitis, are most commonly of viral origin; however, bacterial pharyngitis does occur, in which case group A streptococci (GAS) is the most observed causative pathogen. Regardless of the aetiology, pharyngitis is typically a self-limiting condition. Viral cases are managed by providing symptomatic treatment of inflammation and pain. GAS is managed with antimicrobials, after a Centor Criteria score has been calculated and a throat swab or rapid antigen test performed, should it be indicated. The biggest concern with GAS is the associated complications, such as acute rheumatic fever, which enforces the importance of an accurate diagnosis. [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 of the diagnosis, characterisation and treatment of asthma. [ABSTRACT FROM AUTHOR]

Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for a large scale of morbidities and mortalities worldwide, posing a significant threat to global health. COVID-19 has been challenging due to a lack of established treatment guidelines. Nonsteroidal anti-inflammatory drugs (NSAIDs) comprise of a heterogeneous group of compounds used for the symptomatic relief of fever, pain and inflammation. NSAIDs exert their effects by inhibiting prostaglandins' biosynthesis, resulting in anti-inflammatory, analgesic, and antipyretic effects. They may be beneficial in reducing inflammation and prevent fatal cytokine storms in COVID-19. However, the use of NSAIDs by COVID-19 patients has been controversial, with some reports recommending their use, while others contraindicated them. This may be due to the heterogeneous nature of COVID-19 including different strains or cases. There seem to be COVID-19 cases where NSAIDs should not be used; however, there is no evidence that NSAIDs should be avoided in all COVID-19 patients. [ABSTRACT FROM AUTHOR]

Throat infections, referred to as pharyngitis, are most commonly of viral origin; however, bacterial pharyngitis does occur, in which case group A streptococci (GAS) is the most observed causative pathogen. Regardless of the aetiology, pharyngitis is typically a self-limiting condition. Viral cases are managed by providing symptomatic treatment of inflammation and pain. GAS is managed with antimicrobials, after a Centor Criteria score has been calculated and a throat swab or rapid antigen test performed, should it be indicated. The biggest concern with GAS is the associated complications such as acute rheumatic fever, which enforces the importance of an accurate diagnosis. [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]

Of all medication, nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used in athletes. The high consumption rates seen in sporting disciplines such as soccer and endurance sports suggest that in addition to treating injuries, NSAIDs could be used in an attempt to enhance performance. There are discordant findings in human studies that probe the benefit of NSAIDs in improving the quality of muscle or as ergogenic agents. Therefore, there is a paucity of clinical evidence that demonstrates the value of the use of NSAIDs for purposes beyond pain modulation. The inhibition of NSAIDs required for normal physiological functions by NSAIDs leads to the emergence of gastrointestinal, renal and cardiovascular side effects, which consequentially could reduce the quality of life of athletes. As such, the routine recommendation for the use of NSAIDs for the acceleration of muscle healing and performance enhancement is not justified. [ABSTRACT FROM AUTHOR]

The development of low-molecular and ultra-low-molecular weight heparins has changed anticoagulation treatment options. Enoxaparin is a low-molecular weight heparin (LMWH), which works on Factor Xa and is indicated for both the prevention and treatment of various thrombotic conditions. Dosing is individualised to patient and condition. There is uncertainty about the dose in obese patients, with no clear consensus on an appropriate dose. COVID-19-associated coagulopathy has resulted in the investigation of enoxaparin to help reduce mortality. [ABSTRACT FROM AUTHOR]

The global number of deaths due to COVID-19 is almost at the two million mark, with over 35 000 deaths in South Africa. Although there are hopes of a safe and effective vaccination programme, the increasing number of COVID-19 cases in the country is putting a significant strain on the healthcare system. Ivermectin, an antiparasitic drug, has been widely published on social media platforms and news outlets as a socalled miracle drug for the treatment of COVID-19. Ivermectin is not registered in SA as a drug for human use, but rather as a veterinary and agricultural product. Currently, from a small number of randomised controlled trials (RCTs), there does seem to be a signal of evidence for the use of ivermectin in the management of COVID-19. Pharmacists must, however, remain cognisant of their ethical responsibilities as well as the applicable regulations that prohibit the procurement and dispensing of any unregistered medicine. [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). Other conditions, such as eosinophilic oesophagitis, are on the rise and are being diagnosed across all continents except Africa. The diagnosis is primarily clinical. Antihistamines have been the mainstay of therapy for most allergic conditions, except for other conditions that require corticosteroids, or in severe allergic conditions such as anaphylaxis where antihistamines are ineffective as main therapy. It is important to consider first-versus secondgeneration options when treating allergic diseases, also bearing in mind the duration of therapy and any comorbid conditions that a patient might have. This article provides an overview of these conditions and their current management options. [ABSTRACT FROM AUTHOR]

Coughing is one of the most common symptomatic reasons for patients to 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. Coughing can be classified as either acute or chronic cough, and acute coughing is usually self-limiting. Patients can present with either 'wet' (chesty or productive) or 'dry' (non-productive) coughs. Unfortunately, a cough is generally uncomfortable and may interfere with daily activities, including sleep. Understanding how coughs manifest enables the health professional to provide adequate therapy. Evidence suggests that cough mixtures' effectiveness is disputable, but many patients have reported good results; hence, the medication is used in various combinations. This article provides an overview of the pathophysiology, causes and treatment of acute cough. [ABSTRACT FROM AUTHOR]

Being overweight or obese has become a significant global health concern, even a worldwide epidemic, and may actually be viewed as chronic disease conditions. In addition to the necessary lifestyle modifications required to effect weight-loss, which constitutes an essential healthcare intervention in this patient population, the use of adjunctive pharmacotherapeutic agents is often required. This article provides an overview of new advances in the treatment of obesity and the role of the pharmacist in promoting weight-loss in this patient population. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) encompasses two vascular conditions that are of significant importance, namely deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is also the most common cause of PE. Medical and surgical patients, and individuals who are at increased risk of developing VTE through a variety of factors, require adequate thromboprophylaxis. Primary and secondary prevention, as well as the definitive treatment of VTE, are accomplished through the use of a variety of anticoagulant drugs. This article attempts to provide an overview of VTE, and its prevention and treatment. [ABSTRACT FROM AUTHOR]

This article provides an overview of the changes that have taken place in the diagnosis and management of hypertension over the past decade. Hypertension remains a very common condition seen in South Africa. The approach to the management of hypertension includes necessary lifestyle modifications and a decisive, stepwise escalation process in the pharmacotherapeutic management thereof. Thiazide diuretics are still being promoted by most guidelines to be the initial (first-line) drug of choice, with the addition of other suitable antihypertensive agents, if necessary, and according to any relevant comorbid conditions. [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 anti-inflammatory 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]

Stroke is one of the leading causes of mortality worldwide. Stroke can either be haemorrhagic (13%) or ischaemic (87%) in nature. Within the first few days of stroke, transient ischaemic attacks may occur and will require urgent intervention. However, this is often missed by healthcare workers. This article outlines the current evidence-based practice for stroke management and care. Based on the aetiology, this may include early reperfusion with a tissue plasminogen activator (t-PA), antiplatelet therapy and warfarin. This paper outlines many of the recommendations of the published National Clinical Guidelines for Stroke. It also covers aspects of multidisciplinary stroke care, from initial assessment and acute treatment, to rehabilitation strategies and the management of complications. [ABSTRACT FROM AUTHOR]