Andi, Author at CPD Centre

Ibuprofen for the symptomatic management of acute respiratory tract infections

Introduction Acute respiratory tract infections (ARTIs) are among the most frequently encountered illnesses in clinical practice, affecting individuals of all ages. 1 a p2 Azh Globally, they contribute substantially to both morbidity and mortality and are recognised as a persistent public health challenge. The majority—over 50%—are viral in origin, with common culprits including human rhinovirus, coronaviruses, influenza A and [...]

Sore throat and antibiotic use

Background Sore throat (acute pharyngitis) is prevalent worldwide and one of the most frequent complaints in children and adults requiring healthcare. 1 a p2 Coutinho It accounts for 2–5% of paediatric outpatient visits and is a leading cause of antibiotic prescriptions in children. 2 a p5260 Pellegrino In fact, sore throat is one of the most common reasons for [...]

Effectively managing pain in older children

Background Acute pain is highly prevalent among children and adolescents, with certain types of pain becoming more common as children age. Females tend to report pain more frequently than males. If a child’s pain is not adequately identified and treated, it can negatively influence their future pain experiences—affecting their behavioural, sensory, and emotional responses. Poorly managed pain can lower [...]

Promoting the Use of Alginates for GORD Management in Healthcare

Introduction Gastroesophageal reflux disease (GORD) is among the most common gastrointestinal disorders, characterised by oesophageal and extra-oesophageal symptoms resulting from the reflux of gastric contents. 1 p2 Returra GORD symptoms include typical manifestations such as heartburn and regurgitation, as well as atypical symptoms such as chest pain, chronic cough, laryngeal burn, globus sensation, and hoarseness. 1 p2 Returra While [...]

Dysmenorrhoea is more than ‘just’ pain

Background Dysmenorrhoea, commonly referred to as "period pain," is one of the most frequently reported gynaecological symptoms. 1 a p1 Wiggleton-Little It is characterised by cramping in the lower abdomen before or during menstruation. 2 a p1 Cook, 3 a p1 Ní Chéileachair While primary dysmenorrhoea occurs without an underlying condition, secondary dysmenorrhoea is often associated with gynaecological disorders [...]

Musculoskeletal Injuries in Padel: Biomechanics, Prevention, and Management Strategies

Background Padel is an increasingly popular doubles racket sport that originated in Acapulco, Mexico in 1962. It follows a scoring system and rules similar to tennis, with two pairs of players competing against each other. 1 a p1 Dahmen, 2 p335 Cocco The main distinction lies in the enclosed synthetic glass and metal padel court with a size of [...]

One medication, many forms: how aspirin formulations influence patient outcomes

Background Long-term, low-dose aspirin doses (usually 75–325 mg daily) have been used for primary and secondary prevention of cardiovascular disease due to its antiplatelet properties. 1 a p4757 Kedir As it is associated with gastrointestinal (GI) toxicity, 1 b p4757 Kedir strategies to reduce aspirin-induced GI injury have been developed, including lowering the dose, and co-administering gastroprotective agents such [...]

Managing fever in children

Introduction Fever is among the most frequent reasons for pediatric consultations, with studies estimating that 20–40% of children visit a physician due to elevated temperature. This is particularly common in infants under 18 months old. 1 a p89 Castellano Fever in children frequently causes significant anxiety and fear, known as "fever phobia," among parents and healthcare providers. 1 b [...]

An overview of pain assessment and management in adults

Introduction Pain is a universal and complex experience, influenced by biological, physical, and psychological factors, and involving both the mind and body. 1 a p246 Ford Its prevalence and impact on individuals, healthcare systems, and society underscore its importance as a critical healthcare issue. Effective pain management, which requires a multidisciplinary approach combining pharmacological and non-pharmacological methods, is essential [...]

Update on antimicrobial resistance – from awareness to action

Background The continuing emergence and spread of bacterial antimicrobial resistance (AMR) poses a significant threat to public health and patient safety due to greater numbers of infections that are becoming untreatable, associated morbidity and mortality, as well as increased healthcare expenditure. In 2019, an estimated 5 million deaths worldwide were associated with bacterial AMR, and this figure is predicted [...]

Relationships between movement and musculoskeletal pain

Background Pain serves as a protective mechanism that leads to changes in movement. 1 a p1503 Butera Although it is a normal protective response to injury and potentially harmful stimuli, prolonged or dysfunctional neuromuscular adaptations in response to pain may contribute to disability and chronicity in a variety of pain conditions. 2 a,b p1, a p2 Merkle Alternatively, movement [...]

Aspects relating to aspirin dosing in secondary prevention

Background Aspirin as one of the most widely used medications since its introduction in the 1890s, 1 a p1062 Sleem is recommended in secondary prevention of atherothrombotic events in most patients with established atherosclerotic cardiovascular disease (ASCVD). 2 a p1 Marquis-Gravel Antiplatelet drugs are the cornerstone of treatment in patients with ASCVD with multiple randomised controlled trials showing they [...]

Effects of diet and dietary habits on GORD

Background Gastroesophageal reflux disease (GORD) is a very common disease, affecting about 1 billion people worldwide with some degree of variability according to the geographical location. 1 a p7 Rizzo Depending on severity, GORD can impact the quality of life of patients and their emotional, social, and physical functioning, as well as their work productivity. 2 a p217 Al-Marhabi [...]

Dysmenorrhoea and endometriosis in adolescents

The majority (70-93%) of adolescents experience menstrual discomfort. Dysmenorrhoea affects 20-40% of adolescents, causing them to miss school, while 40% report it negatively impacts their school performance and concentration.

The burden of influenza in adults

Influenza poses a significant global clinical burden, with about one billion cases annually, including up to five million severe cases and up to 640,000 deaths.

Assessment and management of pain in children

Background Pain is the most prevalent symptom in an emergency setting and continues to be one of the most difficult challenges for emergency care providers, particularly management of pain in children. Up to 80% of paediatrics’ emergency department (ED) visits are pain-related, most commonly with musculoskeletal injury, followed by headache, abdominal discomfort, otalgia and sore throat. 1 a p1 [...]

Insights on fever in children

Background Fever is normally defined as a core body (rectal) temperature of 38.0oC. 1 a p1 Consolini Nevertheless, normal body temperature varies from person to person, fluctuates throughout the day, and is observed to be highest in children who are preschool-aged (18 to 24 months) where many healthy children can have a temperature as high as 38.3oC. 1 a [...]

The Advantage of Combination Therapy in Common Cold Treatment

The common cold, stemming from various virus families, notably the rhinoviruses with approximately 100 serotypes, is the most frequent human illness.

Insights into the Use of Aspirin for Secondary Prevention of Cardiovascular Disease

Background Aspirin a widely used nonsteroidal anti-inflammatory and antiplatelet medication, serves as an effective and cost-efficient option in preventing atherosclerotic cardiovascular disease (CVD), reducing CVD events, and improving mortality rates among individuals with established CVD. 1 a p716 Yoo Cardiovascular diseases are the primary cause of global mortality and loss of disability-adjusted life-years. 1 b p716 Yoo Suboptimal prevention [...]

An updated look at erosive oesophagitis in GORD

Background Gastro-oesophageal reflux disease (GORD) encompasses various syndromes and complications associated with abnormal movement of gastric refluxate from the stomach into the oesophagus, the oral pharynx, lungs, and/or throat. It can be divided into non-erosive reflux disease (NERD) and erosive oesophagitis (EE). 1 a pS3 Pandolfino Erosive oesophagitis is linked to increased rates of lung diseases such as asthma, [...]

Managing acute sore throat: can global experts agree?

An acute sore throat is a frequent cause for seeking medical attention, particularly in primary healthcare settings.

Minding the gender gap in pain management

In recent years, there has been an increase in research on the relationship between gender and pain, with investigations including preclinical studies on sex differences in pain, gender differences in pain perception...

Is it time for PPI treatment of GORD to ‘step down’?

Background Gastro-oesophageal reflux disease (GORD) is a common reason for patient visits to primary care providers, and depending on severity, GORD can impact the quality of life, emotional, social, and physical functioning, as well as work productivity of patients. 1 a,b p217 Al-Marhabi In terms of treatment, lifestyle modifications represent a useful means of managing symptoms of mild GORD, [...]

The sex and gender disparities of cardiovascular disease in women

Introduction Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide for both men and women, however, it remains understudied, underdiagnosed, and undertreated in women. This bias has resulted in women being disproportionately affected by CVD when compared to men. 1 a p701 Gauci There remains a misconception that women are at a lower risk of CVD [...]

Antimicrobial resistance and consumer misconceptions about antibiotic use: a focus on sore throat

Antimicrobial resistance (AMR) is one of the most urgent global health challenges of the 21st century and is consistently listed as one of the top ten global public health threats annually by the World Health Organization (WHO).

Use of topical NSAIDs in musculoskeletal pain

The term musculoskeletal condition includes a range of health conditions affecting bones, joints and muscles, and of rarer conditions of the immune system.

The role of the pharmacist in the treatment of headache

Headache disorders are among the most prevalent and disabling orders worldwide. The estimated prevalence of migraine is 14% and tension-type headache (TTH) is 26%

Use of aspirin for secondary prevention of cardiovascular disease

Background Cardiovascular diseases are the leading cause of global mortality and loss of disability-adjusted life-years. 1 a p716 Yoo Aspirin’s antithrombotic effects have a long-established place in the prevention of cardiovascular disease (CVD), and its traditional use as a core therapy for secondary prevention of CVD is well recognised. 2 a p36 Murphy Studied in one of the first [...]

Up to 75 % of adults will miss work due to influenza ^{1 a p254 Zumofen}

Epidemic influenza is a contagious disease that affects people of all ages and places substantial burdens on healthcare systems. The World Health Organization (WHO) estimates that 5–15% of the population is affected during each annual influenza epidemic...

Overview of sex differences in tension-type headache

In the Global Burden of Disease Study 2019, headache was the fifth most prevalent disorder in the world. Tension-type headache (TTH) is the most frequently occurring headache disorder with a general prevalence of 42%.

African and Middle Eastern Gastroenterologists views on managing gastro-oesophageal reflux disease

Introduction Gastro-oesophageal reflux disease (GORD) is a common gastrointestinal disorder that occurs when reflux of the gastric contents into the oesophagus and oral cavity results in troublesome symptoms and/or complications. 1 a p217 Al-Marhabi GORD represents a common reason for patient visits to primary care providers, and depending on severity, it can impact the quality of life of patients as [...]

An update on back pain

Introduction Back pain is one of the major public health problems among individuals of working age. The prevalence of back pain varies between 15% and 30% in different populations and most people will experience back pain at some point in their life. Low back pain (LBP) is the most common type of back pain, with a lifetime prevalence of 84%. [...]

An update on the management of sore throat

Acute sore throat, including pharyngitis and tonsillitis, is self-limiting and often triggered by a viral infection of the upper respiratory tract.

An overview of the management of acute fever in children at low risk for serious infection

Fever is one of the most common symptoms in children, accounting for approximately one third of the reasons for paediatric visits. 1 a p1 Zhang, 2 a p285 Green While it is a normal physiological response to illness that facilitates and accelerates recovery, there is no correlation between fever and the severity of the disease. 1 b p1 Zhang, 2 [...]

Proton pump inhibitor failure in gastro-oesophageal reflux disease

Introduction Proton pump inhibitors (PPIs) have become the cornerstone of therapy for gastro-oesophageal reflux disease (GORD) due to their efficacy in healing oesophagitis in patients with erosive reflux disease (ERD). However, their ability to establish complete symptom resolution is less notable, with breakthrough symptoms reported in 30% to 60% of PPI-treated patients. Unresolved symptoms can have an impact on [...]

An update on musculoskeletal pain

Introduction Musculoskeletal conditions are relevant across the life-course – from childhood to older age. They range from those conditions that arise suddenly and are short-lived (such as fractures, sprains and strains, associated with pain and limitations in functioning) through to long-term conditions such as chronic low back pain and osteoarthritis. 1 a p2 WHO Musculoskeletal conditions are typically characterised by [...]

An update on cardiovascular disease in younger adults

Background Cardiovascular disease (CVD) is the most common cause of death worldwide. The Global Burden of Disease study reported that ~17 million global deaths per year between 2006 and 2016 were attributable to CVD, which surpasses the number of deaths from any other disease. Therefore, the risk factors for CVD should be managed properly considering its clinical importance. 1 [...]

An update on pain assessment in paediatric patients

Background Assessing pain in infants, children and young people remains a challenge due to diverse patient conditions, types of pain and often a reduced ability or inability of patients to communicate verbally. 1 a p30 Chan Effective pain assessment is a necessary component of successful pain management and the pursuit of optimal health outcomes for patients of all ages. [...]

An update on migraine and cluster headache

Background Headache is one of the most common disorders seen worldwide (for example, 50% of the European population are classified as headache sufferers), and is associated with high levels of disability, poor quality of life, and reduced labour productivity. 1 a, b p1 Anarte According to the International Headache Society (IHS), headaches can be broadly classified as [...]

Management of PPI-refractory GORD

Background Gastro-oesophageal reflux disease (GORD) is one of the most common upper gastrointestinal disorders worldwide with a high burden of morbidity and high cost of management. Proton pump inhibitors (PPIs), as the first-line drugs, cannot completely relieve symptoms and patients are prone to recurrence after prolonged drug withdrawal. 1 a p1349 Cheng Gastro-oesophageal reflux disease is a series of [...]

Endometriosis and chronic pelvic pain

Background Endometriosis (EM) is an oestrogen-dependent benign, chronic inflammatory disease that is associated with pain and infertility, affecting up to 10 to 15% of reproductive-aged women. 1 a p1 Cui, 2 a p1 Velho The pathophysiology and aetiology of EM remain poorly understood, and diagnostic delays are common. Inflammation is known to play a key role in the development [...]

An update on management of dysmenorrhoea

Background Dysmenorrhoea is characterised by abdominal cramps just before or during menstruation and is the most common menstrual symptom among adolescent girls and young women. 1 a p1 Chen, 2 a pe249 ACOG According to World Health Organization (WHO) data, as many as 94% of young girls aged 10–20 and 8.8% of women aged 19–41 suffer from menstrual pains. [...]

Association between gastroesophageal reflux and respiratory disorders in children

Background Gastro-oesophageal reflux disease (GORD) is a complex problem in children. Suspected respiratory manifestations of GORD, such as asthma, chronic cough and laryngopharyngitis, are commonly encountered in the paediatric practice, but continue to be entities with more questions than answers. 1 a, b p1 de Benedictis It is now several years since the relationship between gastro-oesophageal reflux (GOR) and [...]

An update on cardiovascular disease and pregnancy

An update on cardiovascular disease and pregnancy Background Cardiovascular disease (CVD) is the leading cause of death among women, while pregnancy offers an opportunity for early detection of CVD as it acts as a physiological vascular stress test. 1 a p1 Ackerman-Banks Hypertensive disorders of pregnancy (HDP), such as gestational hypertension and pre-eclampsia, affect up to 10% of all [...]

An update on paediatric gastroesophageal reflux disease

Background Gastroesophageal reflux disease (GORD) is a common disorder with increasing prevalence in children. 1 a p12 Friedman GORD is a medical diagnosis that requires clear understanding by primary care clinicians to appropriately address symptoms, prevent long term complications, and alleviate parental anxiety. In terms of definitions, gastroesophageal reflux (GOR) is defined as the passage of gastric contents into [...]

An update on the management of dental pain

Dental pain (odontogenic pain) is pain that initiates from the teeth or their supporting structures. It is primarily due to insult to the tooth (e.g., caused by trauma or infection) or due to oral surgery (e.g., extraction/s), but may even occur due to non-odontogenic sources.

Sex and gender differences in myocardial infarction

Introduction Worldwide, acute myocardial infarction (MI) is the leading cause of death for both males and females. 1 a p23 Shah However, young women with heart disease have a higher risk of dying from their acute MI as compared with similarly aged men. 2 a p2 Lichtman Furthermore, one in 4 patients with acute MI gets re-hospitalised within 12 [...]

Optimal management of inflammatory pain – a focus on NSAIDs

Pain represents the most commonly reported health problem in the clinical setting as well as in the general population, and its inadequate control is a persistent, major, unmet need in medicine worldwide.

Sex-specific differences in cardiovascular disease risk factors, treatment, and outcomes

Background Age-standardised rates of cardiovascular disease (CVD) are substantially higher in men than in women, which explains why CVD has traditionally been seen as a “man’s problem”. However, CVD is the leading cause of death in women (mainly due to coronary heart disease [CHD] and stroke) worldwide, and it is one of the most common causes of disability-adjusted life-years [...]

Optimising management of postoperative sore throat (POST) and tonsillectomy pain

Background The development of postoperative sore throat (POST) is thought to be due to inflammation caused by traumatic laryngoscopy and endotracheal tube (ETT) cuff injury to the pharynx and trachea mucosa. Drugs with analgesic and anti-inflammatory effects may be the best option for POST prevention after ETT intubation under general anaesthesia. 1 a p64 Wang Tonsillectomy is one of the [...]

Topical flurbiprofen for the treatment of sore throat

Sore throat (pharyngitis) is a common, self-limiting condition caused by inflammation of mucous membranes in the oropharynx, often due to viral upper respiratory tract infections (URTIs).

An overview of the most common, least studied and most costly form of headache – Tension Type Headache

An overview of the most common, least studied and most costly form of headache - Tension Type Headache 1 a p525, a p256 Bendtsen 2009; 2 a p1319 Abboud, 3 a p339 Jensen 2018 Tension-type headache (TTH) represent approximately 80% of all headache disorders. 4 a p1250 Cathcart The pain is typically bilateral in 90% of cases. 3 a p341 [...]

Sore Throat – What is all the fuss about?

Background Sore throat (pharyngitis) is a condition that frequently presents to primary care. 1 p1 Mantzourani Sore throat may have an infectious or non-infectious cause, although these sometimes overlap. Most cases are infectious, with a large proportion (up to 40 %) caused by rhinovirus and adenovirus. 2 a p1041 Reiner 2012 A proportion of sore throats however have non-infectious aetiologies, [...]

A Focus on Cardiovascular Disease in Women

Introduction Cardiovascular disease (CVD) remains the most frequent cause of morbidity and mortality in women, despite recent advances in disease prevention, detection and treatment. 1 a p1 Bayoumi Much of the burden of CVD can be avoided by keeping blood pressure, cholesterol, and glucose at healthy levels, avoiding tobacco, and maintaining a healthy weight. Although the contribution of these risk [...]

An update on the use of over-the-counter analgesics

Pain is a highly prevalent condition associated with self‐care management. A variety of over-the-counter (OTC) analgesics exist for the self-management of acute pain relief, and their use is commonplace.

What is the impact of low back pain on a patient’s quality of life and productivity?

Low back pain (LBP) is defined “as pain, muscle tension or stiffness localised below the costal margin and above the inferior gluteal folds with or without leg pain”. 1 a p125 Tom It affects various domains of daily life from basic self-care activities to advanced and complex social interactions, work and leisure activities, eventually leading to poor quality of life. [...]

What is the relationship between GORD and sleep?

The relationship between gastro-oesophageal reflux disease (GORD) and sleep is often overlooked. 1 a p1 Kurin GORD is characterised by pathological acid or non-acid reflux and is associated with a variety of disturbances that may affect the upper GI tract (regurgitation, heartburn, pain) and/or induce respiratory symptoms (hoarseness, dysphonia, chronic laryngitis, cough, asthma, and chronic bronchitis). Awakenings due to heartburn, [...]

Gastro-oesophageal reflux disease in pregnancy – what we know

Gastroesophageal reflux disease (GORD) affects about 80% of pregnant women. 1 a p4 Kang, 2 a p1 Thelin The prevalence of GORD can double from the 1st to 3rd trimester (26 to 51%) 1 b p4 Kang and active counselling on this condition is important for effective prenatal care. 3 a p1 KS Lee Symptoms and exacerbation of symptoms of [...]

Update on the management of children with acute fever

Fever in children is one of the most common reasons for parents or caregivers to seek medical attention for their child. 1 a p285 Green A multidisciplinary consensus guide has recently been published to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to [...]

Physical inactivity as a key driver for cardiovascular disease.

Physical inactivity is highly prevalent worldwide, despite strong scientific evidence supporting the benefits of regular exercise for the prevention and management of cardiovascular disease (CVD). 2 a p1 Fiuza- Luces The effects of sedentary behaviour and physical activity on health outcomes are currently an object of intense scrutiny. There is emerging evidence of negative health consequences associated with sedentary behaviour, [...]

Reviewing the role of smoking and alcohol consumption in cardiovascular disease

Cardiovascular disease (CVD) is a leading cause of mortality and morbidity with an estimated annual 17.9 million deaths worldwide.

Seasonal patterns of rhinoviral, coronaviral, enteroviral, and adenoviral upper respiratory tract infections (URIs)

The seasonal cycle of respiratory viral diseases has been widely recognized, as annual epidemics of the common cold and influenza disease hit the human population every winter season in temperate regions

Pain and the Global Disease Burden

Musculoskeletal pain is one of the biggest disease burdens globally, and an estimated 1.71 billion people have musculoskeletal conditions worldwide.

Exciting developments are reshaping our understanding of atopic dermatitis (AD)

Atopic dermatitis (AD) is one of the most common inflammatory skin diseases. Childhood-onset AD begins early in life, with 50% diagnosed in the first year of life and 85% by 5 years of age.

Women’s health is a nation’s wealth

Women’s day is a good opportunity to focus on women's health issues throughout the COVID-19 pandemic. The data is dynamic and new insights are being learned each day as researchers publish more findings. This clinical article provides a brief overview of prominent issues faced by women during COVID-19 that impact on their health “Often, we hear about women’s independence in [...]

Treatment of Pharyngitis

Inappropriate antibiotic use for pharyngitis contributes to the development and spread of antibiotic resistance. A small proportion of sore throats caused by group A streptococcal (GAS) infection may benefit from the provision of antibiotics.

Winter Indulgences

Winter is often a time when people tend to be less physically active and spend more time in positions that could compromise GERD symptoms. They may also follow a less healthy diet, taking comfort from the cold with hot, fatty-rich foods. Certain food groups such as fatty foods, spicy foods, chocolate, coffee, as well as alcohol can aggravate acid reflux symptoms.

An overview of developments in the understanding and management of psoriasis

Psoriasis is a chronic, immune-mediated, inflammatory, systemic disease with predominant skin and joint manifestations. It represents one of the most common chronic inflammatory diseases worldwide, affecting approximately 2–3% of the population. About 80–90% of patients with psoriasis have the plaque form of the disease.

A closer look at the management of lower back pain

Low back pain (LBP) is a common musculoskeletal condition, with a lifetime prevalence of 84% in the general adult population. The severity of LBP varies from patient to patient and episode to episode, with only 15% suffering from severe disability and 20% to 25% visiting a health provider.

Overview of non-prescription treatment recommendations for common pain conditions

Pain negatively interferes with many aspects of life, affecting a person’s ability to perform daily activities, changing their overall perception of general health, increasing the risk of depression and affecting relationships with others – all exacerbated by increasing pain severity.

Insights and Future Directions in Dysmenorrhoea

According to the WHO data, as many as 94% of young girls aged 10–19 and 8.8% of women aged 19–41 suffer from menstrual pain. Primary dysmenorrhoea is pain with menses for which there is no underlying abnormality,

An overview of treatment options for itch associated with dry skin

Dry skin is one of the most common conditions seen by dermatologists and general practitioners in everyday clinical practice. The worldwide overall prevalence of dry skin is estimated at 29% to 85%. Many chronic skin disorders, such as atopic dermatitis (AD) and psoriasis, are associated with impaired skin barrier function. It has been linked to dry, itchy skin characterised by [...]

Proposed new techniques in the treatment of GORD

Acid suppressive therapy, especially proton pump inhibitor (PPI), is still the first-line approach for gastroesophageal reflux disease (GORD). However, up to a third of patients with GORD will continue to experience reflux symptoms despite adequately dosed PPI therapy. GORD in these patients are usually termed as refractory GORD (rGORD), defined as reflux symptoms that fail to respond partially or completely [...]

Cardiovascular disease is responsible for one-third of all deaths among women

Heart disease is the number one killer of women and more than 8.6 million women die of cardiovascular disease (CVD) (including heart disease and stroke) around the world each year. In low- and middle-income countries, women who develop CVD are more likely to die from it than women in industrialised nations. For example, in South Africa, the proportion of CVD [...]

Pain in Children

Unlike fever, which is often over-treated especially in children, pain is underestimated and under-treated in paediatric age. Children are particularly susceptible to suboptimal pain management. Untreated pain in childhood has been reported to lead to short-term problems such as slower healing and to long-term issues such as anxiety, hyperesthesia and fear of medical care.

The relationship between stress and GORD

Modern society imposes demands that may increase chronic stress. As stress activates behavioural and physiological response patterns, maladaptation to chronic stress could play a role in many diseases. Recent evidence suggests that stress may play an important role in gastro-oesophageal reflux disease (GORD).

Physical activity and COVID

Across the globe, governments’ have imposed protective measures, such as full or partial lockdowns of cities, in an attempt to slow down the ongoing spread of the COVID-19 disease. This is likely to impair our daily life with physical activity for months, affecting the health of a significant portion of society.

Pregnancy

The patient Maria is 28 years old and has been experiencing heartburn, indigestion and a sour taste in her mouth for the last 3 weeks. She is in the second trimester of her pregnancy and her symptoms are getting progressively worse. They occur daily and are particularly bad after meals. Occasionally, she experiences them whilst sleeping and has had to [...]

Occasional Reflux

The patient Lewis is 22 years old and has recently been experiencing intermittent heartburn and regurgitation for the last 4 weeks. His symptoms occur 1–2 times a week and usually occur late in the evening whilst going to sleep. He does not experience symptoms after eating and believes that they coincide with his football training and socials after work, where [...]

Chronic Reflux

The patient Fifty-two-year-old John has been treated with proton pump inhibitors (PPIs) for the last 2 months to treat his gastro-oesophageal reflux disease (GORD). In the last 2 weeks he has started to experience regurgitation and heartburn again. His symptoms occur after eating dinner 3–4 times a week and are especially problematic on weekends. He is also struggling with heartburn [...]

Infant

Rosie, a 3-month old baby, has been regurgitating most of her milk (formula) within 1 hour of feeding. For the last 2 weeks, she has been crying uncontrollably during and after her feeds and is uncharacteristically irritable. 3 days ago, she began to refuse feed, creating great anxiety for her parents.

Skin conditions : Unit 2 – Dermatitis and xerosis

Dermatitis Dermatitis is a general term that describes inflammation of the skin. Although dermatitis can have many causes and occurs in many forms (see below), this condition usually involves an itchy rash on swollen, reddened skin. A cluster of symptoms manifest at different stages during the development of the condition and recur at various intervals. These symptoms are dehydrated (dry) [...]

Skin conditions : Unit 1 – Structure and functions

Accounting for approximately 15% of total adult body weight, the skin is the largest organ of the body. It performs many vital functions, including protection against external physical, chemical and biological assailants.

Heartburn and acid pocket

Gastro-oesophageal reflux disease (GORD) is a disorder of gastrointestinal motility associated with reflux of stomach contents into the oesophagus and oral cavity. It is identified when reflux of stomach contents cause troublesome symptoms and/or complications. GORD is characterised by two cardinal oesophageal symptoms, namely heartburn (reflux) and regurgitation.

Diarrhoea

Acute diarrhoea is usually defined as the passage of a greater number of stools of looser form compared with normal form lasting less than 14 days, or as an abrupt onset of the passage of 3 or more loose or liquid stools above baseline within 24 hours.

Swine Flu (H1N1)

Swine influenza is a respiratory infection common to pigs worldwide caused by type A influenza viruses, principally subtypes H1N1, H1N2, H2N1, H3N1, H3N2, and H2N3.

Antimicrobial Resistance and Antimicrobial Stewardship

Antimicrobial resistance (AMR) is a growing global health threat. There is an emerging risk that standard antibiotic treatments no longer work making infections harder or impossible to control.

Noninfectious Sore Throat

Overall, sore throat is a very common complaint and a frequent reason for seeking medical care.

Common Skin Infections

Superficial soft tissue infections are common in the outpatient setting. In the emergency care setting, SSTIs represent the third most common diagnosis after chest pain and asthma.

Getting a GRIP on antimicrobial stewardship

Antibiotic resistance is a critical health issue on a global scale. It correlates with overall antibiotic use, with high-consuming countries often having the highest levels of resistant organisms.

Wound Care

A wound is any damage or break in the surface of the skin. Wound management is not wound healing – the actual generation of granulation tissue etc. is physiologically done by the patient and is more dependent on factors such as nutrition than dressings.

Sore throat treatment guidelines are fanning the flames of antimicrobial resistance

Sore throat represents a significant yet under-recognised battle in the war against antimicrobial resistance (AMR). It is one of the most common reasons people visit a doctor and approximately 60% walk away with a prescription for antibiotics.

High fever in children

Fever is one of the most common clinical reasons for paediatric consultations, accounting for about one-third of all presenting conditions in children. It can be miserable for the child, cause anxiety for parents, and be expensive for health services.

Diagnosis of TTH and warning signs

The most common primary headache, tension-type headache (TTH), represents approximately 80% of all headache diagnoses, is extremely prevalent and is associated with significant socioeconomic cost and reduced quality of life.

Bathroom Hygiene

A significant percentage of the total infectious disease burden world-wide is due to person-to-person spread of pathogens within households. Apart from transmission by inhalation of airborne particles, these infections are preventable by good hygiene practices.

Atypical reflux

Gastroesophageal reflux disease (GORD) is the most common gastrointestinal disorder of the oesophagus.

General Pain

The International Association for the Study of Pain’s (IASP) currently defines pain as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Update on Ibuprofen and COVID-19

Bruce et al. August 2020

A UK multicentre observational study showed no significant negative effect* of routine NSAID use on mortality in patients with COVID-19 (n=1,222) *Defined as increased mortality rate or length of hospitalisation

Pain is among the most frequent reasons for visits to a general practitioner

The International Association for the Study of Pain’s (IASP) currently defines pain as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Among adults, 90% suffer pain at least once a month, 42% have daily pain, and 22% of all primary care patients have chronic pain. According to [...]

Smart et al. July 2020

A literature search was conducted alongside considerations of the pharmacological properties of ibuprofen, in order to provide clarity regarding the safety and efficacy of ibuprofen use in patients with symptoms of, or confirmed, COVID-19.

Lund et al. July 2020

A Danish population-based study found that NSAID use was not associated with an increased risk of 30-day mortality or adverse outcomes* in patients infected with COVID–19 (n=9236)

Dysmenorrhoea: more than a belly ache

Dysmenorrhoea, or menstrual pain, is the most common menstrual symptom among adolescent girls and young women, with 90% of women presenting for primary care experiencing some menstrual pain. Dysmenorrhoea negatively affects women’s quality of life and is the leading cause of absence from school and work among women in the reproductive age.

An Explanation for Some of the Extreme Vulnerability During Covid-19 and Practical Ways to Manage it

Written by Lindsay Braithwaite and David Webb There is a tsunami of information on the subject of human emotion circulating at the moment. The mainstream media and social media are awash with reports of increasing levels of anxiety and depression. Having become an instant source of news, real and contrived (and frequently impossible to determine which), they are paradoxically at [...]

Ebola Virus Disease

Ebola virus disease (EVD), is a rare but severe, often fatal illness in humans. The virus is transmitted to people from wild animals and then spreads through human-to-human transmission. EVD first appeared in 1976 in 2 simultaneous outbreaks, one of which occurred in a village near the Ebola River, from which the disease takes its name. The 2014–2016 outbreak in [...]

Low Dose Aspirin- The Balancing Act!

Aspirin – a fascinating history of use for over 120 years Globally an estimated 16.7 million deaths in the year 2010 were attributed to CVD; by 2030 this is projected to be a staggering 23.3 million worldwide. In 2017, Aspirin celebrated its 120th birthday. Aspirin, used in preventing cardiovascular and cerebrovascular diseases, is the most widely prescribed drug all over [...]

Emollients: the underused treatment in the management of dry skin

Dry skin is a skin-barrier defect, and is caused by loss of water from the stratum corneum (SC). The skin barrier prevents the entry of harmful agents, such as antigens and infectious microorganisms, and prevents moisture loss. Impaired barrier function has been linked to dry, itchy skin characterised by redness, flakes, cracks and a rough texture, but epidermal inflammation can [...]

Moore et al. June 2020

This review analyses the literature available at the date of publication to interrogate the validity of unconfirmed reports on ibuprofen’s impact on the aggravation of COVID-19

Jeong et al. June 2020

A South Korean population-based cohort study found NSAID use to be associated with worse outcomes* among patients hospitalised with COVID-19 compared to non-use (n=1,824).

Rinott et al. June 2020

An Israeli retrospective cohort study of patients with COVID-19 did not associate ibuprofen use with worse clinical outcomes* vs. paracetamol or when using no antipyretic (n=403).

Choi et al. June 2020

A South Korean population-based study found that prior history of ibuprofen use was not a risk factor associated with disease progression in COVID-19 (n=293)

Imam et al. June 2020

A population-based cohort study of general patient records from eight Michigan hospitals found prior NSAID use was not associated with worse outcomes* among patients hospitalised with COVID-19 (n=1,305)

Conjunctivitis

Conjunctivitis is the most common cause of red eye in primary care Conjunctivitis is any redness (injection) of the conjunctiva, which is the thin mucous membrane that covers the posterior eyelids (palpebral conjunctiva) and anterior sclera (bulbar conjunctiva). Conjunctivitis is characterized by inflammation of the conjunctiva and may be infectious or non-infectious. Adapted from Phlipsen M, et al Symptoms of [...]

Management and Treatment of dry skin

Dry skin (xerosis) is a common symptom of a number of skin conditions, including atopic dermatitis/eczema (AD/AE), irritant contact dermatitis and psoriasis. It is synonymous with a skin-barrier defect, and is caused by loss of water from the stratum corneum (SC). The healthy SC forms the skin barrier, an effective permeability barrier, which restricts water loss from the body, and prevents [...]

The differences and management between colds and flu

Dr Liesl Brown, BPharm, MSc (Pharm) Cum Laude, PhD (Pharmacology) Introduction Flu and the common cold are both respiratory illnesses and are caused by different viruses. They can have similar symptoms (1), and can be difficult to tell the difference based on the symptoms alone. Flu is worse than the common cold, and the symptoms are more intense. Colds are [...]

Fever in Children: Pearls and Pitfalls Part 2

Egidio Barbi,1 Pierluigi Marzuillo,2,* Elena Neri,1 Samuele Naviglio,1,3 and Baruch S. Krauss4 Sari A. Acra, Academic Editor Children (Basel). 2017 Sep; 4(9): 81. Published with permission 2017 Sep 1. doi: 10.3390/children4090081 PMCID: PMC5615271 PMID: 28862659 7. Fever in Children with Disability and Cognitive Impairment Fever in children with cerebral palsy, cognitive impairment or disability can represent a clinical challenge, since these children may have specific vulnerabilities, reduced communication abilities and [...]

Not every sore throat is infectious!

Overall, sore throat is a very common complaint and a frequent reason for seeking medical care. 1 a p306 Claasen 2012 While pharyngitis is defined as inflammation of the oropharynx, sore throat is often used as an umbrella term which is poorly defined. Although sore throat is the SYMPTOM that the patient complains of, examination may reveal nasopharyngitis, sinusitis or [...]

Zolk et al. May 2020

The article reviews and summarises current evidence regarding the risk of use of ibuprofen (and other angiotensin converting enzyme 2 (ACE2)* regulating drugs) during an unfavourable course of COVID-19.

Jamerson et al. May 2020

A discussion paper explored related literature published prior to the outbreak to interrogate the hypothesis that the antipyretic efficacy of ibuprofen may be hindering the benefits of a fever response in patients with COVID-19.

Ibuprofen: optimising safety when choosing a first-line treatment for pain

From: Moore N, Van Ganse E, Le Parc J-M. The PAIN Study: Paracetamol, Aspirin and Ibuprofen New Tolerability Study A large-scale, randomised clinical trial comparing the tolerability of aspirin, ibuprofen and paracetamol for short-term analgesia. Clin Drug Invest 1999; 18(2): 89-98. This blinded, muticenter study was designed to evaluate and compare the tolerability and safety of ibuprofen, aspirin and paracetamol [...]

In adults with tension-type headache, ibuprofen starts to work on pain within 15 minutes

From: Schachtel BP, Thoden WR. Onset of action of ibuprofen in the treatment of muscle contraction headache. Headache 1988; 28: 471-474. Schachtel and Thoden designed a study to evaluate the onset of pain relief with ibuprofen in adults with tension-type headache who reported a history of at least moderately severe muscle contraction headache occurring at least twice a month during [...]

Nonprescription ibuprofen is more effective than paracetamol in adults with tension-type headache.

From: Schachtel BP, Furey SA, Thoden WR. Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache. J Clin Pharmacol 1996; 36: 1120-1125. Study aims The study aims to directly compare the efficacy of ibuprofen 400 mg with paracetamol 1000 mg in the treatment of muscle contraction headache.a Study design Double-blind, randomised, placebo-controlled study.a Adults with tension type headache were [...]

Gianfrancesco et al. May 2020

A global rheumatic population-based study found NSAID use was reported less frequently among hospitalised patients than in non-hospitalised patients (n=600).

The only reason to treat fever in children is to relieve the child’s discomfort

Fever is one of the most common clinical reasons for paediatric consultations, accounting for about one-third of all presenting conditions in children. It can be miserable for the child, cause anxiety for parents, and be expensive for health services. Up to 40% of preschool children see a health professional for a febrile illness each year. Fever is defined as a [...]

Fever in Children: Pearls and Pitfalls Part 1

Egidio Barbi,1 Pierluigi Marzuillo,2,* Elena Neri,1 Samuele Naviglio,1,3 and Baruch S. Krauss4 Sari A. Acra, Academic Editor Children (Basel). 2017 Sep; 4(9): 81. Published with permission 2017 Sep 1. doi: 10.3390/children4090081 PMCID: PMC5615271 PMID: 28862659 Abstract Fever in children is a common concern for parents and one of the most frequent presenting complaints in emergency department visits, often involving non-pediatric emergency physicians. Although the incidence of serious infections has decreased [...]

Fever In Babies And Children

The normal body temperature for a baby or child is the same as for an adult: 36–37 °C. Feeling Baby’s forehead will give you an indication of whether or not Baby is warmer than usual, but you should always use a thermometer to get an exact temperature. Baby’ temperature control system only really develops when he is about four years [...]

How much do you know about soothing a child’s pain?

Pain, much like fever, is not a disease, but a symptom alerting one to an underlying problem. Here’s how health professionals can best advise parents. Causes and types of pain Pain may be caused by many factors and may be experienced as sharp, burning, dull, constant, intermittent, pressure or even needling. Parents should take note of the type, location and [...]

Pharmacy Advisory board newsletter Ibuprofen

Dear Healthcare Practitioner Thank you for participating in the Ibuprofen advisory board, hosted by RB on 26th February 2020 at the InterContinental Johannesburg O.R. Tambo Airport. RB values your insight and looks forward to an ongoing relationship with the healthcare professions of South Africa and its neighbouring countries. The advisory board was chaired and facilitated by Dr David Webb, a [...]

Redefining hygiene

Lifestyle hygiene – balancing infection prevention from the “clean hypothesis” It is well known that in the third world, respiratory and diarrhoeal diseases are a serious global public health problem and a major cause of death. These diseases are highly concentrated in children and disproportionately affects those living in low- and middle-income countries. Transmission of both respiratory infections and diarrhoea [...]

RB Position Statement on COVID19 & Ibuprofen

Concerns over possible link between ibuprofen and worsening COVID-19 are unfounded: WHO and EMA issue statements supporting use of ibuprofen for management of pain and fever Recently, mainly through social media channels, concern has been expressed in relation to use of steroids & non-steroidal anti-inflammatory (NSAIDs) products, including ibuprofen, for the alleviation of COVID-19 symptoms. However, there is currently no [...]

Positioning Statement on COVID-19 and Ibuprofen – Prof Robin Green

And so it evolves …. After a few months of hope South Africa is now part of what has evolved into a ‘Pandemic’. The novel corona virus and its disease even has a new sexy name ‘COVID-19’. Along with new information there has also been a wildfire of disinformation or ‘fake news’. Some facts first: South Africa does have cases [...]

EMA gives advice on the use of non-steroidal anti-inflammatories for COVID-19

EMA is aware of reports, especially on social media, which raise questions about whether non-steroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen could worsen coronavirus disease (COVID-19). There is currently no scientific evidence establishing a link between ibuprofen and worsening of COVID-19. EMA is monitoring the situation closely and will review any new information that becomes available on this issue in [...]

The International Pharmaceutical Federation Statement

FIP position statement on the association between the use of non-steroidal anti-inflammatory medicines (including ibuprofen), ACE inhibitors, angiotensin receptor blockers (ARBs) and corticosteroids, and an increased risk of coronavirus/COVID-19 infection or disease severity. Read More Source: https://www.fip.org/coronavirus

FIP : Coronavirus SARS-CoV-2/COVID-19 pandemic

Information and interim guidance for pharmacists and the pharmacy workforce Click here to view document Source: https://www.fip.org/coronavirus

NSAIDs in COVID-19

Today’s pearl provides some insight and updates regarding the use of NSAIDs in patients infected with COVID-19. What should be used for fever? There has been a lot of discussion surrounding the use of NSAIDs in COVID-19 patients. Here is the best we know right now (subject to change). Background On March 14, 2020 the French Health Minister Olivier Veran [...]

The great imitator and the diagnostic challenge it poses

The most common primary headache, tension-type headache (TTH), represents approximately 80% of all headache diagnoses, is extremely prevalent and is associated with significant socioeconomic cost and reduced quality of life. TTH can present as a great imitator and may mimic chronic migraine, medication overuse headache (MOH), and very rarely, a life threatening secondary headache. The diagnostic difficulty most often encountered [...]

Does ibuprofen relieve tension type headaches?

Introduction Headache is a common symptom of many different conditions and can be the major complaint, e.g. tension type headache (TTH), or one of many symptoms, e.g. upper respiratory tract infection. In most patients presenting with headache, there are no physical signs, therefore the treatment will depend on an accurate diagnosis1 . Tension type headache (TTH) is by far the [...]

Tension Type Headache Overview

An overview of the most common, least studied and most costly form of headache - Tension Type Headache Tension-type headache (TTH) which represent approximately 80% of all headache disorders. The pain is typically bilateral in 90% of cases. When asked to describe their pain quality patients may use terms such as a sensation of “tightness,” “pressure,” or “soreness” are used. [...]

Pharmacy Advisory board (Mauritius) Newsletter Reflux

Dear Healthcare Practitioner Thank you for participating in the Reflux advisory board, hosted by RB on 9th October 2019 at La Pirogue Resort, Flic-en-Flac, Mauritius. RB values your insights and looks forward to an ongoing relationship with the independent community pharmacists of Mauritius. The advisory board was chaired and facilitated by Vivette Dalgleish, an independent consultant. It was attended by [...]

Pharmacy Advisory board (Mauritius) Newsletter Fever-Children

Dear Healthcare Practitioner Thank you for participating in the Fever in Children advisory board, hosted by RB on 9th October 2019 at La Pirogue Resort, Flic-en-Flac, Mauritius. RB values your insights and looks forward to an ongoing relationship with the independent community pharmacists of Mauritius. The advisory board was chaired and facilitated by Vivette Dalgleish, an independent consultant. It was [...]

The Coronavirus outbreak

The Coronavirus outbreak: a novel virus threatening humankind. Coronaviruses (CoVs), so called because of the crown-like spikes that protrude from its surface, are not new to the human race and consists of a large family of viruses known to cause human diseases which range from trivial, such as the common cold, to the life-threating Severe Acute Respiratory Syndrome (SARS-CoV). The strain [...]

Your digestive system in pregnancy

Many of the digestive problems of modern humans, including in pregnancy, can be traced back to non-physiological birth practices, not breastfeeding, and over-filling the stomach from babyhood. That’s why, in order to break this vicious cycle, an expectant mom should take the messages of her digestive health seriously, while also considering how birth impacts her baby’s future digestive health. That [...]

Supplements In Pregnancy

During pregnancy a woman’s body has increased need for certain vitamins and minerals such as calcium, magnesium, and iron. The ideal way to achieve micro-nutritional status is through eating healthy food, including a wide variety of fruit, vegetables, and legumes. Unfortunately, the value of food nowadays is affected by cultivation and other techniques, so supplementation often becomes necessary. It’s generally [...]

Foods And Nutrients For Mom And Baby

For The Healthiest Pregnancy Diet: Eat more plant foods Eat fewer animal foods Include foods from all the vibrant colour groups Keep meals simple, with not too many ingredients Don’t eat for two; simply follow your appetite Eat as little processed, refined food as possible Don’t drink large amounts with meals Keep hydrated between meals Avoid fasting Go slow on [...]

The Coronavirus Problem

This article is provided to try and place into context the problem with the new novel Huwan coronavirus (now called novel coronavirus pneumonia) and to suggest the facts of the disease and minimise the current frightening mis-information doing the rounds. First what is this virus? Coronaviruses have been known as respiratory viruses for many years and have probably been around [...]

Fever in Children:

Pearls and Pitfalls Part 2

About Andi

CPD Points Query