signs and symptoms causes - ministry of healthwhat is hepatitis c: hepatitis means inflammation of...

Sore Throat Prepared By : Miss Ivy Lau Chu Chung

Inside this issue:

Sore Throat 1

Benzalkonium Chloride 2

Post Exposure

Prophylaxis for NSI

3

Hepatitis C 4-5

Osteogenesis Imperfecta 6-7

Pharmacy Activities 8

A sore throat is a common symptom that frequently results in a medical consultation and unnecessary prescrip-

tion of antibiotics. The commonest cause of a sore throat in children is a viral illness. 15 - 30% of children

with a sore throat will have Group A streptococcal (GAS) pharyngitis, the peak incidence being 3-15 years of

age. Bacterial causes for sore throat other than GAS are rare.

signs and symptoms

Signs and symptoms of a sore throat includes pain

or scratchy sensation in the throat; pain that wors-

ens with swallowing or talking; serious sore throat

will experience sore, swollen glands in neck or jaw

or white patches or pus on your tonsils. Sore throat

normally with come together with fever, cough

and running nose. Body aches will be happened if

the symptoms getting serious. When sore throat

causes difficulty in breathing or difficulty in swal-

lowing or lasts longer than a week and join pain,

this is the time you have to see your doctor to have

further examination.

causes

There are several causes of sore

throat which includes viral infection,

bacteria infection (Strep throat) and

toxins or irritants. The most common

cause of sore throat is virus infection

compared to bacteria infection. Viral infection normally

comes with common cold while Strep throat usually does

not occur with congestion or cough. Sometimes, white

patches or areas of pus will form on the tonsils. These

white patches are more common in Strep throat than in

sore throat caused by a virus. Besides, toxins like ciga-

rette smoke, air pollution can lead to a sore throat.

Treatment

A sore throat caused by a viral infection usually lasts 5 to 7 days and does not need

medical treatment. However, there are some ways to soothe sore throat including

medications like Ibuprofen or Paracetamol (recommended for children). Beside

medications, people with sore throat must drink plenty of warm fluids and eat

cool, soft foods. Lozenges sometime relieve pain in sore throat while gargling salt

water is somehow useful in relieving the pain. Antibiotics are not really needed in

sore throat unless the doctors diagnosed it is caused by bacteria infection.

PREVENTION

It is recommended to wash your hands regularly throughout the day especially be-

fore you prepare or eat food; before and after you spend time with someone who is

ill and after you sneeze or cough. Beside hand washing, you can always bring

along your hand sanitizer, especially when you are travelling somewhere without

washroom. If there is someone in your family who is having Strep throat, do avoid

sharing food, drinks or eating utensils. Other than that, you can boost your immune

system during the cold and flu season with vitamins, herbs and good nutrition.

Vitamin C and E are the common and good vitamin as supplement.

\

Pharmacy Bulletin August 2018

Publication of Drug Information

Service (DIS) Pharmacy

Hospital Labuan

ADVISOR:

Pn Ashrafinah binti Ahmad

EDITOR:

Pn Fatin Nabila binti Mohd Asri

Any comment, query, recommendation kindly contact DIS Pharmacy 087-596888

Preservatives are used in ophthalmic medications because they are cost effective.

A large bottle of eye drops can last an entire month when a preservative is added com-

pared with preservative free (PF) counterparts.

Benefits of bak

What is bak?

Benzalkonium chloride (BAK) is the most common preservative that has been used in

ophthalmology. BAK is a quaternary ammonium compound that acts as a detergent,

lysing cell membranes, and killing microorganisms. This makes it very effective as a

preservative.

Benzalkonium Chloride (BAK) Prepared By : Miss Siu Loe Ching

The Controversy

BAK’s toxicity in patients, especially in those with

pre-existing ocular surface disease (OSD) or on mul-

tiple medications is supported by few non-

randomised controlled studies.

However, there have been very few randomised con-

trolled trials that compare the same medication with

and without BAK preservative. Several of these trials

have never been published in any peer reviewed

journals. Notwithstanding, those that have been pub-

lished, have not demonstrated any clear benefits of

the BAK-free formulations.

Controversy arose as BAK has been reported to ac-

cumulate in ocular tissues, causing different types of

cell injury with frequent dosing.

It is recognized as the cause of corneal and conjunc-

tival toxicity that cause changes to the corneal and

conjunctival surfaces, ocular discomfort, tear film

instability, conjunctival inflammation, subconjuncti-

val fibrosis, and epithelial apoptosis. It has been in-

ferred that BAK damages the trabecular meshwork

as well.

recommendation

Therefore, pharmacists and other healthcare providers should recommend PF drops in patients with established

OSD only. In these patients, switching to PF medications has been shown to improve symptoms, signs and tol-

erability. Patients on multiple medications (3 or more) may also benefit from a PF preparation. Generally most

patients are not necessarily require the more expensive PF glaucoma medications. Other factors to consider

when selecting the right eye drop are cost, patient preference, tolerability, frequency, and duration of use.

References: 1. Mohammad Walled. 2018. Eye catching study: The truth about benzalkonium chlo-

ride. Pharmacy Times. 2. Steven DW, Alaghband P, Lim KS. 2018. Preservatives in glaucoma medication.

Br J Ophthalmol doi:10.1136/ bjophthalmol-2017-311544 3. Simmons ST. 2013. Benzalkonium chloride and glaucoma management today.

Glaucoma Today January/February 2013

Post Exposure Prophylaxis for NSI Prepared By : En Daniel Ung Yew Jye

VACCINATION AND ANTIBODY STA-

TUS OF EXPOSED WORKER TREATMENT

WORKER: Unvaccinated

SOURCE: Hepatitis B POSITIVE

Give Hepatitis B Immunoglobulin x 1 AND Initiate Hepatitis

B vaccine series


SOURCE: Hepatitis B NEGATIVE

Initiate Hepatitis B vaccine series


SOURCE: Unknown


WORKER: Vaccinated, known responsder


No Treatment



No Treatment


SOURCE: Unknown

No Treatment

WORKER: Vaccinated, Non- responsder


1st Option: Give Hepatitis B Immunoglobulin x 1 AND


2nd Option: Give Hepatitis B Immunoglobulin x 2



No Treatment


SOURCE: Unknown

If known high risk source, then treat as Give Hepatitis B Im-

munoglobulin x 1 AND Initiate Hepatitis B vaccine series

WORKER: Antibody response unknown


Test the exposed person Hepatitis B antibody

1. If adequate, no treatment is needed

2. If inadequate, give Hepatitis B Immunoglobulin x 1 AND

vaccine booster



No Treatment


SOURCE: Unknown

Test the exposed person Hepatitis B antibody

1. If adequate, no treatment is needed

2. If inadequate, give vaccine booster and recheck in 1-2

months

RECOMMENDED POST EXPOSURE PROPHYLAXIS (PEP) FOR

EXPOSURE TO HEPATITIS B VIRUS IN NEEDLE PRICK INJURY

References: 1. GUIDELINES ON OCCUPATIONAL EXPOSURES TO HUMAN IMMUNOEFFICIENCY VIRUS (HIV), HEPATITIS B VIRUS(HBV), AND HEPATIS C VIRUS, AND

RECOMMENDATIONS FOR POST EXPOSURE PROPHYLAXIS (PEP). DECEMBER 2007. MINISTRY OF HEALTH MALAYSIA .

Hepatitis C Prepared By : Mrs Fatin Nabila

Figure 1: Hepatitis C virus seropreva-

lence from 1990 to 2014 .2

What is Hepatitis C:

Hepatitis means inflammation of the liver which may

lead to damage and loss of liver function. It is com-

monly caused by viral infection, but there are other

possible causes of hepatitis such as autoimmune dis-

ease and alcohol.

Hepatitis C is caused by HCV which can lead to both

acute and chronic infection. There are different geno-

types or forms of hepatitis C and the most common

genotypes found in Malaysia are genotype 3 and 1.2

Transmission:

HCV is a blood borne virus. It can be spread via blood

transfusion, organ transplant, needle prick, tattoo,

body piercing, acupuncture, sharp instruments sharing

(e.g. toothbrush, razor), sharing unsterilized needles/

dental equipment, unprotected sex/high risk sexual

practice (may cause bleeding), vertical transmission/

mother-to-child (low risk) and long-term haemodialy-

sis.

Common social contacts like sharing utensils, hug-

ging, holding hand or kissing does not spread the vi-

rus. It is also not spread through breast milk, food,

water, sneeze and cough.

Screening & Diagnosis:

1. Serological test is done to screen for anti-HCV

antibodies.

2. If the test is positive for anti-HCV antibodies , a

nucleic acid test is done to detect presence of

HCV RNA. This is necessary to confirm chronic

infection due to the fact that about 30% of infected

people have strong immune response that sponta-

neously cleared HCV without treatment. These

group of people will still test positive for anti-

HCV antibodies although no longer infected .

Introduction of Hepatitis C:

Hepatitis C virus (HCV) has become an important emerging public

health issue where; an estimated 185 million people world-wide have

been infected with HCV.1 In Malaysia, it is a growing problem as

there are an increased number of people detected with positive HCV

during routine screening which result in an estimation of 2.5% adult

population that are anti-HCV positive. Among those, 59% are trans-

mitted through injection.2 It is also known that hepatitis C is often

undiagnosed due to lack of awareness as well as the disease asymp-

tomatic nature where symptoms only develop decades after infection.3

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663777/#B2





Most people who get

infected with the

Hepatitis C virus

develop a chronic, or

lifelong, infection.

Hepatitis C — CONTINUES Prepared By : Mrs Fatin Nabila

References: 1. McDonald SA, Dahlui M, Mohamed R, Naning H, Shabaruddin FH, Kamarulzaman A. Projections of the current and future disease burden of hepatitis C

virus infection in Malaysia. PloS one. 2015 Jun 4;10(6):e0128091. 2. Raihan R. Hepatitis in Malaysia: Past, Present, and Future. Euroasian journal of hepato-gastroenterology. 2016 Jan;6(1):52 3. Hepatitis C - World Health Organization (WHO), 2018 July 18. Available from: http://www.who.int/news-room/fact-sheets/detail/hepatitis-c 4. Viral Hepatitis - Centers for Disease Control and Prevention (CDC), 2015 May 31. Available from: https://www.cdc.gov/hepatitis/hcv/index.htm 5. Jayan N, Chari Suchitra. Hepatitis C. Medinidia, 2018 Mar 20. Available from: https://www.medindia.net/patients/patientinfo/hepatitis-c.htm

Symptoms of Hepatitis C:

Following initial infection, most people will not experience any symptoms. If symptoms develop, it may oc-

curs between 2 weeks to 6 months after exposure to the virus and it is called as acute phase symptoms. These

includes fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured fae-

ces, joint pain and jaundice (yellowing of skin and the whites of the eyes).

People with chronic HCV infection also do not exhibit symptoms . With chronic infection , the liver damage

progresses from slowly from stage to stage e.g. fibrosis to cirrhosis. Thus, symptoms are only developed when

the liver is seriously damaged.

Treatment:

HCV infection does not necessarily need treatment as

some people have strong immune response to clear the

virus in acute infection where as some people does not

developed liver damage with chronic infection . When

treatment is indicated, the direct-acting antiviral

(DAA) medications such as Sofosbuvir, Daclatasvir

and the Sofosbuvir/Ledipasvir combination are the

preferred regimens which can achieve cure rates

above 95%.3 DAAs are much more effective, safer,

well-tolerated than the older therapies (e.g. pegylated

interferon / ribavirin) with shorter duration of treat-

ment (noted that types of HCV genotypes may affect

the treatment length). Meanwhile, pegylated interfer-

on / ribavirin regimens still play roles for certain pa-

tients if needed.

Prevention:

Prevention to reduce the risk of HCV infection has

become the main goal since there is no vaccine for

hepatitis C. It is especially targeted in population with

higher risk of exposure to HCV such as people who

inject drugs and in health-care settings. For primary

preventions, it recommended to test donated blood for

hepatitis virus and practice safe handling and disposal

of health care injections, sharp and waste to avoid

blood to blood contact. Also, HCV infected people is

educated to not donate blood or organs, inform person

who might come into contact with their blood or body

fluids (e.g. doctor), clean up blood spills by them-

selves (if possible), practice correct and consistent use

of condom and avoid sharing of needles and personal

toiletry items (e.g. razor, toothbrush).


Osteogenesis Imperfecta (OI) Prepared By : Mrs Sanggeri M. Veloo

Each person with the condition may have a different com-

bination of symptoms. All people with OI, however, have

weaker bones. Some common symptoms of OI include:

Short stature

Triangular-shaped face

Breathing problems

Hearing loss

Brittle teeth

Bone deformities, such as bowed legs or sco-

liosis

Signs, Symptoms and Diagnosis: In most cases of OI, children inherit the defective gene from one of their parents. But, the child's

symptoms and the degree of disability can be very different from that of the parent. In some children,

neither parent has OI. It is often, though not always, possible to diagnose OI based solely on clinical fea-

tures. Clinical geneticists can also perform biochemical (collagen) or molecular (DNA) tests that can help

confirm a diagnosis of OI in some situations.

Osteogenesis imperfecta (OI) is

a genetic disorder characterized

by bones that break easily and

mostly without any specific rea-

son. OI is caused by genetic de-

fects that affect the body’s abil-

ity to make strong bones.

In these cases, the genetic defect

is a spontaneous mutation

(change) in the gene, and it stops

functioning correctly. In domi-

nant (classical) OI, a person has

too little type I collagen or a poor

quality of type I collagen due to a

mutation in one of the type I colla-

gen genes.

Collagen is the major protein of

the body’s connective tissue. It

is part of the framework that

bones are formed around. In re-

cessive OI, mutations in other

genes interfere with collagen

production. The result in all cas-

es is fragile bones that break

easily.

Introduction of OI :

References: 1. American Academy of Orthopaedic Surgeons, 1995-2018

2. Osteogenesis Imperfecta Foundation

Osteogenesis Imperfecta (OI) — CONTIN-

Prepared By : Mrs Sanggeri M. Veloo

Type III

Type III osteogenesis imper-

fecta also has improperly

formed collagen and often severe bone deformities,

plus additional complications. The infant is often

born with fractures. The whites of the eyes may be

white, blue, purple, or gray. People with type III os-

teogenesis imperfecta are generally shorter than av-

erage. They may have spinal deformities, respiratory

complications, and brittle teeth.

Type IV

Type IV osteogene-

sis imperfecta is

moderately severe, with improperly formed

collagen. Bones fracture easily, but the whites

of the eyes are normal. Some people with type

IV osteogenesis imperfecta may be shorter

than average and may have brittle teeth. Bone

deformities are mild to moderate.

Type I Type I osteogenesis imperfecta is the most common and mildest

type of this disease. While the structure of the collagen is normal,

there is less collagen than there should be. There is little or no bone

deformity, although the bones are fragile and easily broken. The

effects of OI may extend to

the teeth, making them prone

to cavities and cracking. The

whites of the eyes may have

a blue, purple, or gray tint.

Type II Type II osteogenesis imperfecta is

the most severe form of the dis-

ease. The collagen does not form

properly. Bones may break even

while the fetus is in

the womb. Many in-

fants with type II os-

teogenesis imperfecta

do not survive.

Types of OI : There are different types of osteogenesis imperfecta with symptoms that range from mild to severe.

The characteristic features of OI vary greatly from person to person, even among people with the same

type of OI, and even within the same family. All types of the disorder, however, have symptoms and se-

verity that fall somewhere within the range of the first four types recognized.

Treatment : There is not yet a cure for OI. Treatment is directed toward preventing or controlling the symptoms, max-

imizing independent mobility, and developing optimal bone mass and muscle strength. Care of fractures,

extensive surgical and dental procedures, and physical therapy are often recommended for people with OI.

Use of wheelchairs, braces, and other mobility aids is common, particularly (although not exclusively)

among people with more severe types of OI.

FROM JUNE TO AUG 2018

PHARMACY’S ACTIVITES & EVENTS

WEDDING CELEBRATION FOR

PUAN SANGGERI PF UF44

FAREWELL FOR PUAN NORLELA

UGANG PPF U29

New Staff:

1. Deina Amanda binti Khairudin (PF UF41)

2. Thum En (PF UF41)

Transferred:

1. Norlela Ugang (PPF U29)

PHARMACY STAFF MOVEMENT

KNOW YOUR MEDICINE

EXHIBITION AT SG MIRI

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