A 'look' into conjunctivitis

Conjunctivitis is a common condition characterised by inflammation of the conjunctiva and is the most likely diagnosis in a patient with a red eye and discharge. Acute conjunctivitis is usually a self-limiting condition or one that is easily treated with topical ophthalmic preparations in most cases. Viral conjunctivitis is the most common cause of conjunctivitis followed by bacterial conjunctivitis. Purulent discharge and adherence of the eyelids upon awakening are strong indicators of bacterial conjunctivitis, however other similarities in presentation of conjunctivitis often leads to misdiagnoses. Acute viral conjunctivitis is most commonly caused by adenoviruses and allergic conjunctivitis is usually caused by seasonal pollens. Acute viral conjunctivitis is treated symptomatically while the use of topical antibiotics are useful in limiting the duration of conjunctivitis with a bacterial aetiology. Allergic conjunctivitis is also treated symptomatically with topical antihistamine/mast cell stabiliser preparations. Conjunctivitis secondary to sexually transmitted diseases such as chlamydia or gonorrhoea require systemic antimicrobials in addition to topical treatment

Understanding Alzheimer disease

Alzheimer disease (AD) is a neurodegenerative disorder with an uncertain pathogenesis. It is characterised by symptoms of memory impairment, executive dysfunction and visuospatial impairment. Management goals and interventions should be based on a solid alliance with the patient and family and on thorough psychiatric, neurological and general medical evaluations of the nature and cause of cognitive deficits and associated non-cognitive symptoms. There are currently three cholinesterase inhibitors and one N-methyl-D-aspartate (NMDA) antagonist indicated in the treatment of AD as monotherapy or in combination. Cholinesterase inhibitors remain the first-line therapy in patients with mild to moderate AD, which may stabilise the symptomatic cognitive and functional decline. Other pharmacotherapy options include the use of memantine which may be used by itself or in combination with cholinesterase inhibitors. These treatments are for symptomatic relief and are not disease modifying in preventing the progression of the disease

An update on the measurement and management of cholesterol with specific reference to secondary prevention of cardiovascular disease (CVD)

Cardiovascular disease remains the largest contributor to non-communicable adverse disease outcomes. Treatment and prevention of cardiovascular disease have evolved at a dramatic pace in the last 40 years. Serum-cholesterol has emerged as the dominant risk factor for coronary artery disease and events. The link between serum-cholesterol and arterial atherosclerosis is well documented. The attainment of cholesterol goals has historically concentrated on low-density lipoprotein cholesterol (LDL-C) levels. Current evidence and guidelines have shifted to the attainment of non-HDL-C target levels which represent a more thorough inclusion of small dense atherogenic particles. Methods to reduce serum-cholesterol mainly centre around the use of the HMG CoA-reductase inhibitors also known as the statins. High intensity statins like atorvastatin (80 mg) and rosuvastatin (40 mg) are now the preferred starting therapies to lower cholesterol by at least 40­50% in patients with established cardiovascular disease as secondary prevention. In the event of failure of these medications, evidence suggests that the addition of ezetimibe may enhance the total serum-lowering levels to 50­60%. New therapies aimed at inhibiting PCSK9 revealed exciting new targets for LDL-C lowering, but the high cost of these antibodies could preclude access to this therapeutic intervention. Aggressive pursuit of lower LDL-C or non-high-density lipoprotein cholesterol (non-HDL-C) levels may reduce the incidence of secondary myocardial infarctions, strokes and death from cardiovascular disease