Frasia Oosthuizen

Adenosine Monophosphate-Activated Protein Kinase (AMPK) as a Diverse Therapeutic Target: A Computational Perspective.

AbstractAdenosine monophosphate-activated protein kinase (AMPK) is viewed as a privileged therapeutic target for several diseases such as cancer, diabetes, inflammation, obesity, etc. In addition, AMPK has entered the limelight of current drug discovery with its evolution as a key metabolic regulator. AMPK also plays a key role in the maintenance of cellular energy homeostasis. Structurally, AMPK is a heterotrimeric protein, which consists of three protein subunits (α, β, and γ). The crystal structure of AMPK was solved, and several computational studies including homology modeling, molecular docking, molecular dynamics, and QSAR have been reported in order to explore the structure and function of this diverse therapeutic target. In this review, we present a comprehensive up-to-date overview on the computational and molecular modeling approaches that have been carried out on AMPK in order to understand its structure, function, dynamics, and its drug binding landscape. Information provided in this review would be of great interest to a wide pool of researchers involved in the design of new molecules against various diseases where AMPK plays a predominant role. Graphical Abstractᅟ

Quality teaching and learning in the Health Sciences

Quality teaching is a central tenet to the retention and success of students in higher education but teaching quality measures and indicators have not enjoyed sufficient debate and discourse within the higher education sector. The Faculty of Health Sciences at the University of KwaZulu-Natal investigated the use of various programme and module statistics as well as student and peer evaluations of teaching to inform quality improvements in teaching and learning. Quantitative data allowed benchmarking in relation to internal University targets and national norms and pointed to the student cohorts who collectively required teaching and learning interventions but was found to have limited use in improving individual teaching practice. Qualitative data from students and peers was best able to highlight strengths and weaknesses and provided the most useful data to inform changes in teaching practice as it engendered and enhanced reflective practice. The Organization for Economic Co-operation and Development (OECD) report on quality teaching in higher education found that most evaluation instruments were related to teaching input indicators and that there was a dearth of instruments to evaluate the impact of teaching, i.e. there was no explicit evaluation criteria linking teaching input to learning outcome. The challenge for the second cycle of institutional reviews/audits will thus be (1)identifying suitable qualitative indicators/measures for quality teaching , (2) striking the correct balance between quantitative and qualitative teaching quality indicators/measures, and (3), ensuring that such indicators, both quantitative/qualitative address teaching impact/learning outcomes in addition to teaching inputs.

Medication adherence of psychiatric patients in an outpatient setting

The success of medication treatment is dependent on a patient’s adherence to the medication regimen and non-adherence amongst psychiatric patients is associated with poor clinical outcomes and high resource utilization. The aim of this study was to assess the levels of medication adherence in psychiatric outpatients and explore factors that influence adherence. Adult, psychiatric outpatients were assessed to (1) determine medication adherence and (2) identify factors that might impact on adherence, using the Morisky Medication Adherence Questionnaire. The impact of socio- demographic factors as well as treatment related factors were considered. 95 outpatients participated in the study. The eight item Morisky medication adherence scale indicated high adherence levels amongst 12.6%, moderate adherence levels amongst 50.8%, and low adherence levels amongst 37% of participants. Significant predictors of adherence to psychiatric treatment were age (p=0.045) and race (p=0.055). The impact of socio-demographic variables on adherence, such as the type of condition, employment status and educational level, were insignificant. Adherence levels amongst psychiatric outpatients were found to be acceptable, with race and age predictors of adherence levels in this study population.

Adverse drug reactions associated with antiretroviral therapy in South Africa

South Africa has one of the highest prevalences of HIV and AIDS in the world. HIV/AIDS patients face countless challenges, one of which is the risk of adverse drug reactions (ADRs). This study aimed to describe the ADRs reported in South Africa with reference to the type of ADRs, antiretrovirals (ARVs) implicated, seriousness of the ADRs and patient demographics associated with specific ADRs. A retrospective quantitative study was carried out using ADR reports submitted to the National Department of Health (NDoH) from 1 January 2010 to 31 December 2014. A descriptive and inferential analysis was carried out to determine the strength of the relationships between different variables. A total of 2 489 reports were analysed. This study found evidence of ADRs among patients on regimens based on stavudine (n = 1 256, 50.46%), efavirenz (n = 572, 22.98%), zidovudine (n = 209, 8.40%), tenofovir (n = 203, 8.16%) and nevirapine (n = 153, 6.15%). The 10 most common ADRs reported with the use of ARVs were peripheral neuropathy (n = 472, 19%), lipodystrophy (n = 471, 18.9%), serious skin reactions (n = 266, 10.7%), gynaecomastia (n = 219, 8.8%), renal failure (n = 140, 5.6%), dizziness (n = 133, 5.3%), hyperlactatemia (n = 118, 4.7%), psychosis/hallucinations (n = 47, 1.9%), sleep disturbances (n = 44, 1.8%) and vomiting (n = 44, 1.8%). Female patients were more likely to experience peripheral neuropathy, lipodystrophy, skin rash, anaemia and hyperlactatemia, while male patients were more prone to experience gynaecomastia and peripheral neuropathy. In addition, patients aged 30–44 years reported the most ADRs. Most reactions resulted from the use of stavudine, efavirenz, zidovudine, nevirapine and tenofovir in the population groups identified in this study.

Cancer awareness among community pharmacist: a systematic review

BackgroundThe WHO recognises that community pharmacists are the most accessible healthcare professionals to the general public. Most patients regularly visit community pharmacies for health information and also seek advice from pharmacists with respect to signs and symptoms of cancer. As readily accessible health care professionals, community pharmacists are also in the best position to include cancer-screening initiatives into their practice. Pharmacists are therefore in a good position to raise awareness when they counsel people who buy over-the-counter medication for the control of possible cancer-related symptoms. The aim of this review was to critically appraise evidence gathered from studies that; (1) explore or assess knowledge of community pharmacist on signs and symptoms of cancer, (2) explore or assess knowledge of community pharmacist on cancer screening.MethodsEMBASE (ovid), CINAHL (EBSCOhost) and MEDLINE (EBSCOhost) were systematically searched for studies conducted between 2005 to July 2017. Studies that focused on knowledge of community pharmacist in cancer screening, signs and symptoms were included.ResultsA total of 1538 articles were identified from the search, of which 4 out of the 28 potentially relevant abstracts were included in the review. Findings of the selected studies revealed lack of sufficient knowledge on breast cancer screening, signs and symptoms. Both studies attributed knowledge limitation as the cause of reason for the key findings of their studies.ConclusionThe selected studies focused largely on breast cancer, which hinder the generalizability and transferability of the findings. Hence there is a need for more studies to be conducted in this area to draw a better conclusion.

Complementary medicines: When regulation results in revolution

Medicines have evolved over time and so has the realisation of the importance of quality control and regulatory processes. The regulatory practices include all the steps from the development and manufacture of the active ingredients until the medicines reach the consumer. The Medicines Control Council (MCC) is mandated to regulate medicines in South Africa. Complementary medicines were previously perceived to be unregulated, although the Medicines Act does not distinguish between allopathic and complementary medicine. As the era of unregulated complementary medicine ended, the requirements in terms of dossier content left many role-players at odds. However, the MCC has a mandate to ensure that the registration of a medicine is in the interest of the public and that complementary medicine is manufactured in a facility adhering to good manufacturing practice, according to which efficacy and safety are supported by reliable data with a known shelf-life.

Use of concomitant medication in the treatment of schizophrenia

Schizophrenia is a life-long disorder that requires continuous pharmacotherapy. About 10 to 30% of patients with schizophrenia show poor response to antipsychotic medication alone, therefore concomitant medication is often used. The rationale for the addition of concomitant medication is often unclear and based on limited evidence. The most frequently prescribed concomitant medications in the treatment of schizophrenia include anticholinergic medication, antidepressants, anxiolytics for example, benzodiazepines, lithium and anticonvulsant medication for example, valproex. Indications for adding these medications to antipsychotic treatment regimens vary from controlling specific symptoms associated with schizophrenia for example, anxiety symptoms, aggressive behavior and suicidality, to managing adverse effects for example, parkinsonian side effects caused by antipsychotic medication. Although there is a need for concomitant medication in the treatment of schizophrenia, each patient needs to be assessed individually since the use of concomitant medication can also have negative treatment implications, for example an increase in the occurrence of adverse effects and drug interactions. Due to the diversity of the disease profile of schizophrenia, no one adjunctive treatment benefits all patients, therefore the choice of specific treatment is best guided by the clinical characteristics and presentation of the individual patient. The aim of this paper is thus to present a qualitative review of the literature. Key words: Schizophrenia, concomitant medication, antipsychotics, anticholinergics, antidepressants.