Diabetes Mellitus and its management : an introductory overview

Diabetes is one of the most prevalent chronic disorders worldwide. By 2010, the number of people with diabetes is expected to exceed 350 million1. Diabetic complications cause considerable morbidity in 5- 10% of these patients, with diabetic complications accounting for 4% of hospital admissions2. Malta is no exception with statistics gathered in 1987 indicating that 10% of adults aged 35 and over had diabetes while another 13% had impaired glucose tolerance (IGT). This problem is found in other Mediterranean island communities (Cyprus, Sardinia, Sicily, Pantelleria) where a prevalence of 5% is found3. Opportunities for interacting with the diabetic patient are numerous and the pharmacist is ideally positioned to intervene with the aim of optimising patient treatment. This review will deal with a brief pathophysiology of diabetes and its complications, a good knowledge of which is fundamental since it leads to a clear understanding of the factors to be considered when choosing the appropriate therapy for the individual patient.peer-reviewe

Is vaccination the only option for possible global malaria eradication?

In the last century, vaccines, together with the discovery of antibiotics have been powerful tools in the management of infectious diseases. Both were of particular importance in reducing the morbidity and mortality associated with infections prevailing in the early 20th century. Whereas antibiotics were useful in treating the infection, vaccines worked by priming the uninfected individual against future infections. The success of vaccination can be seen through numerous examples. The World Health Organisation (WHO) was able to certify that smallpox had been eradicated in 1980 whereas the European Regional Commission for the Certification of the Eradication of Poliomyelitis declared the European Region polio-free on 21 June 2002.2 On the other hand, measles has been reduced to very low levels in many regions of the world. This led to the speculation that such a good result could be extended to other diseases. Tuberculosis, human immunodeficiency virus (HIV) and malaria are currently three infectious diseases requiring urgent attention due to their serious consequences especially in less developed countries.peer-reviewe

Diabetes Mellitus : Insulin use

Insulin is required for normal carbohydrate, protein and fat metabolism. Patients with Type I diabetes depend on exogenous insulin for their survival while Type II diabetics may require insulin at a later stage of their disease.peer-reviewe

Management of type II Diabetes Mellitus

There is currently no cure for diabetes mellitus (DM). Irrespective of whether type I or type II diabetes is treated, the overall goals of management and therapy are targeted towards patient well being and may be summarised as follows.peer-reviewe

Regular follow-up as part of an Asthma management plan : a study of hospitalised patients in Malta

Objective: To study the management of specific sub-groups of patients with asthma in Malta, using locally published guidelines for comparison. Method: A piloted, structured interview among patients between the ages of 14-59 years who were hospitalised with an admission diagnosis of acute asthma. In the case of repeated admissions, only the first interview was considered. All interviews were carried out by either of two clinical pharmacists and lasted about 30 minutes. The four-year prospective study started in February 1997 (one year before publication of the Malta guidelines) and finished in January 2001 (three years after publication). Main outcome measures: · Inhaled steroids on admission · Patient partnership: use of a written self-management plan and home peak flow monitoring · Patient compliance with inhaled steroids Results: 304 patients (68% females; mean population age 33.9 years SD 13.41) were interviewed over the four year period. Of the 304 patients, 32% were regularly followed up with the majority of patients (25.3%) being under specialist care; 54% of patients were not followed up as part of a long-term asthma management plan. It was not possible to obtain complete information in 14% of patients. The chi-square test was used to compare the two groups. With the exception of home peak flow monitoring, patients who were regularly followed up had statistically significant better management as recommended by the Malta asthma guidelines compared to those who were not regularly followed up. Conclusion: The findings of this study indicate that regular physician review results in better asthma management when assessed by comparison to published guidelines. However, despite regular follow up, certain aspects of patient care are inadequate in the light of the Malta asthma guidelines. It is suggested that the clinical pharmacist is well-placed to offer advice in order to promote adherence to guidelines.peer-reviewe

Malaria and the traveller

Malaria has reached epidemic proportions. About 40% of the world’s population live in malarious areas. It is estimated that 400 million people are infected by malaria each year and of these, 1-3 million die, mostly children under five years of age. In the year 2000, malaria was estimated to be the cause for the loss of nearly 45 million Disability Adjusted Life Years (DALYs) and this accounts for 13% of all DALYs associated with infectious diseases. Malaria has gained importance in Western Europe, including Malta, mainly due to the increasing tourism to malaria endemic countries. There have been 21 reported cases of malaria in Malta between the years 2000-2003.peer-reviewe

The complexity of treatment with warfarin

Maintaining a patient within a therapeutic international normalized ratio (INR) is the main aim of treatment with warfarin. Anticoagulation above or below the therapeutic window may result in bleeding or thrombosis respectively. This is made more complex by the numerous factors that may affect warfarin management including other drugs, diet and disease. This review aims to highlight factors that may affect therapy with oral anticoagulants (Figure 1). A sound knowledge of such factors ensures safe administration of warfarin.peer-reviewe

A focus on the newer antibiotics targeting Gram-positive bacteria

The incidence of antimicrobial resistance has continued to rise with a threat to return to the “pre-antibiotic” era. This has included a sharp increase in multi-drug resistant organisms, which may cause life-threatening infections. Efforts have been made to develop new antibiotics with novel modes of action, aimed at acting against these multi-drug resistant strains. This review aims to focus on newly available and investigational antibiotics targeting Grampositive organisms. It is likely that these antibiotics will be used mainly in a secondary care setting; however primary care health care professionals also need to have an understanding of these antibiotics, since patients may be discharged home on them.peer-reviewe

Does quality of care differ when HIV patients are treated by non-specialist and specialist HIV healthcare providers in developed countries? A Systematic narrative review

Copyright © 2015 by authors and Scientific Research Publishing Inc.Peer reviewedPublisher PD

An international overview of some pharmacist prescribing models

This review aims to provide an overview of models of pharmacist prescribing outside and within the UK. Since pharmacist prescribing was pioneered in the US, most of the literature available originates within the US. Where little information was found in the literature, pharmacy societies were contacted to provide further information. Both the Australian and South African societies responded; however no information was obtained from Canada. Overall, little information is available from Canada and South Africa particularly since pharmacist prescribing in the latter case has been withdrawn. Table 1 accompanies the text below and aims to summarise different modes of pharmacist prescribing.peer-reviewe