Disparities in patients' understanding of cardiovascular disease management.

Non-communicable diseases, including cardiovascular disease (CVD), are some of the leading causes of mortality worldwide. Despite the effectiveness of early diagnostic and treatment options, patient screening, disease detection and disease progression remain a challenge, resulting in suboptimal outcomes. Consequently, cardiovascular diseases remain underdiagnosed and undertreated, particularly in developing countries. Several barriers, including paucity of recommended cardiovascular health information and low literacy levels, lead to a poor understanding of the importance of intervention in terms of modifiable risk factors as well as treatment adherence. This narrative review focuses on cardiovascular patients' understanding of their disease, and the need for compliance with their medication and lifestyle modifications. Low levels of perception and insufficient knowledge of CVDs among patients continue to be indispensably important factors in health behaviour. Increased awareness of these issues has the potential to improve the effectiveness of the multidisciplinary cardiovascular team and ultimately improve the care provided to these patients.

A scoping review on natural cholesterol lowering supplements sold in South African pharmacies.

Background: Dyslipidaemia is defined as elevated total or low-density lipoprotein (LDL) levels or low levels of high-density lipoprotein (HDL). Patients may often make use of natural cholesterol lowering supplements (NCLSs) available at the pharmacy; however, limited information on these supplements is readily available. Pharmacists should be knowledgeable about NCLSs to ensure that the use of these supplements is supported by evidence and to provide appropriate advice to patients for desirable therapeutic outcomes. Aim: This study aimed to identify the NCLSs being sold in South African pharmacies and review the scientific evidence for each of the ingredients in these NCLSs. Methods: Seventeen NCLS products were identified, and the Joanna Briggs Institute (JBI) scoping review methodology was used to conduct a literature review of NCLSs. Results: From the ingredients reviewed it is evident that co-enzyme Q10, probiotics and sterols have sufficient evidence supporting their use. However, there is still limited scientific evidence available to validate the remaining ingredients. Conclusion: Further research on NCLSs will provide practising pharmacists and practitioners with a guide of the evidence available on the various ingredients in NCLSs. Contribution: This study provides a review of the available literature on the NCLSs being sold in the pharmacies across South Africa to provide pharmacists with a collated document of the evidence behind these popular supplements to assist them in making evidence based informed decision regarding natural products for cholesterol.

Essential Oil Compounds in Combination with Conventional Antibiotics for Dermatology.

Antimicrobial resistance has emerged as a significant threat to public health, prompting novel combinations comprising of natural sources such as essential oil compounds with conventional antibiotics. This study aimed to determine the possible interactions between six essential oil compounds with eight antibiotics/antifungals against six pathogens (Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Acinetobacter baumannii, Cutibacterium acnes, and Candida albicans) commonly implicated in skin infections. The minimum inhibitory concentrations (MICs) for the antibiotics and essential oil compounds were evaluated singularly and in combination using the broth microdilution assay. The fractional inhibitory concentrations (FIC) were calculated to determine the interactive profile of the combinations. The synergistic interactions (FIC ≤ 0.5) were further analysed at varying ratios and depicted on isobolograms. The toxicity of the synergistic combinations was determined using the brine shrimp lethality assay. Eight synergistic interactions were identified against the selected Gram-positive and P. aeruginosa pathogens, and the combinations also demonstrated a reduced toxicity. The combination of amoxicillin and eugenol demonstrated the lowest toxicity (LC50 = 1081 µg/mL) and the highest selectivity index (14.41) when in a 70:30 ratio. This study provides insight into the in vitro antimicrobial interactions of essential oil compounds and conventional antibiotics that can form a basis for newer therapies.

High prevalence but lack of awareness of hypertension in South Africa, particularly among men and young adults.

Cardiovascular disease (CVD) is a leading cause of death in South Africa (SA) and high blood pressure (BP) is the primary risk factor. However, hypertension prevalence is high, BP control is poor and CV events occur at a younger age than in Europe or America. Increasing screening, raising awareness and improving management of hypertension are critical to prevent CVD in SA. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high BP. As part of the MMM campaign, in SA (2017, 2018, 2019 and 2021), BP measurements and a cross-sectional survey of volunteers aged ≥ 18years were performed. Of 11,320 individuals (age 36.6 ± 16.8years) screened, 29.7% had hypertension (systolic BP/diastolic BP ≥ 140/90 mmHg or antihypertensive medication use) and the prevalence was higher (p < 0.0001) in men (35.6%) than in women (26.3%). Of those with hypertension, only 54.3% were aware and 46.8% were receiving antihypertensive medication, and 53.7% of these had controlled BP. In men with hypertension, awareness (45.2%, treatment (38.2%) and controlled BP on antihypertensive medication (45.2%) were lower (p < 0.0001) than in women (awareness: 60.8%; treatment: 53.5%; controlled BP: 58.3%). In young participants (age < 40years), 15.6% had hypertension, 18.6% of these were on treatment but 76.0% were not aware, and only 57.7% had controlled BP. The high prevalence of hypertension, but low levels of awareness, treatment, and BP control in SA, especially in young adults and men, highlight the need for systematic BP screening programmes and improvements in education and management of hypertension.

Antibiotic usage in a South African paediatric medical ward following the introduction of an antibiotic prescription chart.

Introduction: the global rise in antibiotic resistance (ABR), coupled with a dry pipeline for the discovery of new antibiotics requires the conservation of currently available antibiotics. Antimicrobial stewardship (AMS) interventions are being implemented to optimize antibiotic use including the use of antibiotic prescription charts. This study reviewed the use of antibiotics before and after the introduction of an antibiotic prescription chart in a paediatric medical ward of an academic tertiary hospital in Johannesburg. Methods: a cross-sectional retrospective review of patient records was conducted for patients admitted to a paediatric medical ward of an academic tertiary hospital over two study periods; before and after the introduction of an antibiotic prescription chart. Data were captured on a Microsoft® Excel (2010) spreadsheet and analyzed using Stata/IC 15.1 (StataCorp, USA). Results: antibiotic use decreased significantly by 7.04% following the introduction of the antibiotic prescription chart (p=0.027). Fields often left unfilled on the antibiotic prescription chart include age (100%), a record of renal function (GFR/CrCl) (97.46%), time of antibiotic prescribing (83.62%) and a record of culture and sensitivity results (80.17%). Conclusion: the findings of this study show an improvement in antibiotic use, the frequency of culture and sensitivity testing and documentation of relevant parameters after the introduction of the antibiotic prescription chart. The use of an antibiotic prescription chart is a practical way to achieve optimal antibiotic use and to encourage proper detailing of the clinical components necessary for antibiotic selection in a hospital setting in a developing country.

Commercially Available Viola odorata Oil, Chemical Variability and Antimicrobial Activity.

Viola odorata L. oil is frequently recommended in the aromatherapeutic literature for treating respiratory, urinary, and skin infections; however, antimicrobial evidence is lacking. In addition, in aromatherapy, combinations of essential oils are predominantly utilized with the goal of achieving therapeutic synergy, yet no studies investigating the interaction of essential oil combinations with V. odorata oil exists. This study thus aimed to address these gaps by investigating the antimicrobial activity of three Viola odorata oil samples, sourced from different suppliers, independently and in combination with 20 different commercial essential oils, against micro-organisms involved in respiratory, skin, and urinary tract infections associated with global resistance trends. These pathogens include several of the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) The chemical profile of the oils was determined using gas chromatography coupled with mass spectrometry. The minimum inhibitory concentrations (MIC) were determined using the broth micro-dilution method. The interactive profiles for the combinations were assessed by calculating the fractional inhibitory concentration index (ΣFIC). The main compounds varied across the three samples, and included phenethyl alcohol, isopropyl myristate, 2-nonynoic acid, methyl ester, α-terpineol, α-cetone, and benzyl acetate. The V. odorata oil samples displayed overall poor antimicrobial activity when tested alone; however, the antimicrobial activity of the combinations resulted in 55 synergistic interactions where the combination with Santalum austrocaledonicum resulted in the lowest MIC values as low as 0.13 mg/mL. The frequency of the synergistic interactions predominantly occurred against Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterococcus faecium with noteworthy MIC values ranging from 0.25-1.00 mg/mL. This study also reports on the variability of V. odorata oils sold commercially. While this warrants caution, the antimicrobial benefit in combination provides an impetus for further studies to investigate the therapeutic potential.

A guide for the management of post vaccination allergy and anaphylaxis in a pharmacy clinic.

Background: Vaccination falls within the scope of practice of a pharmacist and the coronavirus disease 2019 pandemic has seen an increase in pharmacies providing vaccination services. These vaccines are not without risk of allergic reactions and anaphylaxis. The available guidelines for the management of anaphylaxis include the administration of intravenous (IV) fluids. However, IV administration does not fall within the scope of practice of a pharmacist. A gap was identified in the availability of guidelines for the management of anaphylaxis without the use of IV fluid administration. Aim: This review aimed to address this gap by describing the mechanisms of allergic reactions and anaphylaxis and developing an algorithm to assist pharmacy personnel to manage these within the scope of practice. Methods: The authors used the recommendations for developing guidelines. Results: The availability of anaphylaxis guidelines and clinical studies catering for anaphylaxis and allergy management by pharmacists was deficient, thus the review modified the available management guidelines to align the management of allergy and anaphylaxis within the scope of a pharmacist. The items required for the management were also identified and listed as items that form part of the emergency tray in the pharmacy. Conclusion: The review designed algorithms based on the available literature to assist pharmacy personnel to manage allergy and anaphylaxis within the relevant scope of practice. The review also lists the equipment needed for an emergency tray. Contribution: This review serves to offer guidance for the management of allergy and anaphylaxis in a pharmacy setting.

Pharmacy students' perceptions of an oncology pharmacy simulation.

BACKGROUND AND PURPOSE: Cancer is on the rise both globally and in South Africa, with an estimated 70% increase in incidence in Sub-Saharan Africa by 2030. While oncology pharmacy is a highly specialized field of practice, there is currently no formal certification for oncology pharmacists in South Africa. EDUCATIONAL ACTIVITY AND SETTING: To standardise the way in which oncology pharmacy is practiced within the country, the first-ever simulation-based oncology admixing training for pharmacy students in South Africa was developed at the University of the Witwatersrand. Following the simulation, a survey was conducted to determine the participants' perceptions of the simulation. Current and past pharmacy students were invited to complete a questionnaire. Data were collected through a self-administered cross-sectional REDCap (Research Electronic Data Capture) questionnaire using a Likert-like scale to determine the agreed with statements related to the simulation. FINDINGS: A total of 81 participants completed the questionnaire. Participants provided favorable feedback related to the simulation's benefit, quality, and learning experience. SUMMARY: Based on the perceptions of the participants, the purpose of the simulation exercise was achieved.

Antimicrobial Formulation of Chrysopogon zizanioides Essential Oil in an Emulsified Lotion for Acne.

Acne is a skin condition arising from excess sebum production and microbial overgrowth within the pilosebaceous unit. Several commercial essential oils have shown promising activity against acne-related pathogens. Due to their volatility and thermal instability, the formulation of essential oils into commercial products remains a pharmaceutical challenge. Thus, this study aimed to develop a viable anti-acne topical treatment as an oil-in-water emulsified lotion to overcome these challenges. Chrysopogon zizanioides (vetiver) displayed noteworthy antimicrobial activity with a mean minimum inhibitory concentration of 0.14 mg/mL against Cutibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pyogenes. Emulsified lotions containing C. zizanioides were developed through the hydrophilic-lipophilic balance approach. At tested hydrophilic-lipophilic balance values of 8, 9, and 10, C. zizanioides emulsified lotions displayed maximum stability at hydrophilic-lipophilic balance 9 with a minimum change in mean droplet size and polydispersity index of 20.61 and 33.33%, respectively, over 84 days. The C. zizanioides emulsified lotion at optimum hydrophilic-lipophilic balance 9 completely inhibited the growth of C. acnes and killed S. aureus, S. epidermidis, and S. pyogenes within 24 h. Additionally, the lotion retained antimicrobial activity against these test micro-organisms over the 84-day stability test period. Thus, the C. zizanioides emulsified lotion demonstrated physical stability and antimicrobial efficiency, making it an ideal natural product anti-acne treatment.

The Antimicrobial and Toxicity Influence of Six Carrier Oils on Essential Oil Compounds.

Essential oil compounds have been identified as alternative antimicrobials; however, their use is limited due to their toxicity on human lymphocytes, skin, and reproduction. Carrier oils can reduce the toxicity of essential oils, which raises the question as to whether such activity would extend to the essential oil compounds. Thus, this study aimed to investigate the antimicrobial and toxicity activity of essential oil compounds in combination with carrier oils. The antimicrobial properties of the essential oil compounds, alone and in combination with carrier oils, were determined using the broth microdilution assay. The toxicity was determined using the brine shrimp lethality assay. Antimicrobial synergy (ΣFIC ≤ 0.50) occurred in 3% of the samples when tested against the ESKAPE pathogens. The compound thymoquinone in combination with the carrier oil Prunus armeniaca demonstrated broad-spectrum synergistic activity and a selectivity index above four, highlighting this combination as the most favorable. The carrier oils reduced the toxicity of several compounds, with Calendula officinalis and P. armeniaca carrier oils being responsible for the majority of the reduced toxicity observed. This study provides insight into the interactions that may occur when adding a carrier oil to essential oil compounds.

Carrier oils in dermatology.

Wounds are a common medical infliction. With the increase in microbial resistance and a shift of interest towards complementary medicines, essential oils have been shown to be beneficial in suppressing microbial growth. However, in practice, essential oils are more often diluted into a base due to the risk of topical adverse effects, such as dermatitis. There is a lack of collated evidence-based information on toxicity and efficacy of carrier oils. The current information on the subject matter is restricted to generic, aroma-therapeutic books and pamphlets, based on anecdotal evidence rather than an experimental approach. Therefore, this review aimed at identifying the recommended carrier oils used in dermatology and thereafter collating the scientific evidence to support the use of carrier oils together with essential oils recommended for dermatological use. Aloe vera gel had multiple studies demonstrating the ability to enhance wound healing; however, several other carrier oils have been largely neglected. It was observed that the extracts for certain plant species had been used to justify the use of the carrier oils of the same plant species. This is an inaccurate cross assumption due to the difference in chemical composition and biological activities. Lastly, despite these carrier oils being recommended as a base for essential oils, very little data was found on the interactive profile of the carrier oil with the essential oil. This review provides a platform for further studies, especially if essential oils are to receive credence in the scientific field.

The Influence of Carrier Oils on the Antimicrobial Activity and Cytotoxicity of Essential Oils.

The topical use of essential oils requires dilution into a carrier oil; however, scientific evidence regarding the antimicrobial efficacy and cytotoxicity when a carrier oil is combined with an essential oil is lacking. This study sets out to determine the antimicrobial activity and cytotoxicity of 23 essential oils combined with six known carrier oils. Gas chromatography-mass spectrometry/flame ionization detector (GC-MS/FID) was used to characterize the methyl esters of the carrier oils. The antimicrobial activity of the carrier oils alone and in combination with the essential oils was investigated using the broth microdilution assay against 11 skin pathogens and the cytotoxicity was determined using the brine shrimp lethality assay. The interactive profiles of the combinations for both antimicrobial activity and the cytotoxicity were analysed and calculated using the fractional inhibitory concentration index (ΣFIC). The carrier oils demonstrated no antimicrobial antagonism when combined with the essential oils and the overall cytotoxicity of the majority of the combinations was decreased. The carrier oils that could be identified as enhancing the antimicrobial activity and decreasing the cytotoxicity were Aloe vera Mill. and Simmondsia chinensis C.K.Schneid (Jojoba oil), with an overall reduction in essential oil cytotoxicity of 87.5% at 24 hrs and 85% at 48 hrs by A. vera. Five of the essential oils (when diluted in A. vera and S. chinensis carrier oils) demonstrated enhanced antimicrobial activity against pathogens such as Brevibacterium epidermidis, B. linens, and P. aeruginosa with MIC values ranging from 0.09 to 0.50 mg/mL (and ΣFIC 0.14-0.39). The study could conclude that the carrier oils are complementary to essential oil formulations, mostly reducing cytotoxicity and in some cases enhancing the antimicrobial activity.

Wound Pathogens: Investigating Antimicrobial Activity of Commercial Essential Oil Combinations against Reference Strains.

This study aimed to determine the antimicrobial activity of 247 essential oil combinations against the reference strains of wound pathogens. Essential oil combinations were investigated for antimicrobial activity against five pathogens. The minimum inhibitory concentration (MIC) assay was used and the fractional inhibitory concentration index (ΣFIC) calculated to determine interactions between selected oils. Twenty-six combinations displayed broad-spectrum antimicrobial activity against all five reference strains and several displayed synergy against more than one pathogen. The combination of Santalum austrocaledonicum (sandalwood) with Commiphora myrrha (myrrh) displayed noteworthy antimicrobial activity against all five reference strains and synergy against four (MIC values 0.03-1.00 mg/ml and ΣFIC values 0.19-1.00 mg/ml) pathogens. No antagonism was observed. Santalum spp. and Vetiveria zizanioides essential oils contributed the most to antimicrobial activity in combination. Essential oil combinations are presented as a viable option in wound therapy.

Antimicrobial Essential Oil Combinations to Combat Foot Odour.

Foot odour (bromodosis) is an embarrassing and perplexing condition mostly caused by bacteria of the Brevibacterium species. Essential oils are a credible option as an affordable treatment of odour and contribute towards antimicrobial efficacy. Therefore, this study sets out to investigate the antimicrobial activity of essential oil combinations against odour-causing bacteria. The broth microdilution method was used to investigate the antimicrobial activity of 119 essential oil combinations, and the fractional inhibitory index was calculated to determine the interactive profile. Combinations that resulted in synergy in 1 : 1 ratios were further evaluated in different concentrations, and isobolograms were plotted to determine the influence of the ratio on overall activity. Numerous combinations could be identified as having synergistic interactions against the Brevibacterium spp. and no antagonism was observed. The combination of Juniperus virginiana (juniper) and Styrax benzoin (benzoin) demonstrated synergy against all three Brevibacterium spp. tested and J. virginiana was the essential oil responsible for the majority of the synergistic interactions. The results reported here confirm the promising potential of the majority of these oils and selected combinations in treating and controlling bromodosis.

Commercial Essential Oils as Potential Antimicrobials to Treat Skin Diseases.

Essential oils are one of the most notorious natural products used for medical purposes. Combined with their popular use in dermatology, their availability, and the development of antimicrobial resistance, commercial essential oils are often an option for therapy. At least 90 essential oils can be identified as being recommended for dermatological use, with at least 1500 combinations. This review explores the fundamental knowledge available on the antimicrobial properties against pathogens responsible for dermatological infections and compares the scientific evidence to what is recommended for use in common layman's literature. Also included is a review of combinations with other essential oils and antimicrobials. The minimum inhibitory concentration dilution method is the preferred means of determining antimicrobial activity. While dermatological skin pathogens such as Staphylococcus aureus have been well studied, other pathogens such as Streptococcus pyogenes, Propionibacterium acnes, Haemophilus influenzae, and Brevibacterium species have been sorely neglected. Combination studies incorporating oil blends, as well as interactions with conventional antimicrobials, have shown that mostly synergy is reported. Very few viral studies of relevance to the skin have been made. Encouragement is made for further research into essential oil combinations with other essential oils, antimicrobials, and carrier oils.

The in vitro Antimicrobial Activity and Chemometric Modelling of 59 Commercial Essential Oils against Pathogens of Dermatological Relevance.

This study reports on the inhibitory concentration of 59 commercial essential oils recommended for dermatological conditions, and identifies putative compounds responsible for antimicrobial activity. Essential oils were investigated for antimicrobial activity using minimum inhibitory concentration assays. Ten essential oils were identified as having superior antimicrobial activity. The essential oil compositions were determined using gas chromatography coupled to mass spectrometry and the data analysed with the antimicrobial activity using multivariate tools. Orthogonal projections to latent structures models were created for seven of the pathogens. Eugenol was identified as the main biomarker responsible for antimicrobial activity in the majority of the essential oils. The essential oils mostly displayed noteworthy antimicrobial activity, with five oils displaying broad-spectrum activity against the 13 tested micro-organisms. The antimicrobial efficacies of the essential oils highlight their potential in treating dermatological infections and through chemometric modelling, bioactive volatiles have been identified.