Familial hypercholesterolaemia workshop for leveraging point-of-care testing and personalised medicine in association with the Lipid and Atherosclerosis Society of Southern Africa

Familial hypercholesterolaemia (FH) is a common autosomal dominantly inherited disorder in which impaired clearance of plasma low-density lipoprotein cholesterol causes premature atherosclerotic vascular disease and tendon xanthomata. This workshop aimed to consolidate information on the diagnosis and management of FH in South Africa. The genetic causes include mutations in the LDL receptor, apolipoprotein B100 and proprotein convertase subtilisin/kexin type 9 (PCSK9). Additionally, the concatenation of multiple gene variants can result in polygenic FH. Therapeutic measures include a healthy lifestyle, statins and cholesterol-absorption inhibitors that will achieve control of the dyslipidaemia in the majority of cases. The recently introduced monoclonal antibodies to PCSK9 can improve achievement of target concentration in severe cases. FH is present in all sectors of the South African population but there is sparse documentation in the indigenous African populations. FH should be actively sought, diagnosed and treated with judicious pharmacotherapy and screening of relatives.

Itch in Elderly People: A Cross-sectional Study

Ageing is associated with numerous medical afflictions, including dermatological symptoms and diseases. Chronic itch (CI) in elderly people is a frequent symptom of diverse aetiology. This study assessed the prevalence and detailed clinical features of CI among 153 elderly patients hospitalized in the geriatric ward, including associations with comorbidities and pharmacotherapy. CI affected 35.3% of subjects, most commonly due to cutaneous conditions, mixed aetiology and neurological disorders (53.7%, 25.9% and 11.1% of pruritic subjects, respectively). The mean itch intensity assessed with the 4-Item Itch Questionnaire (4IIQ) was 6.6 ± 2.8 points. Viral hepatitis (p = 0.02), higher serum creatinine concentration (p = 0.02) and coexistent purpuric lesions (p = 0.002) were associated with higher 4IIQ scores. In logistic regression analysis CI correlated positively with female sex, atopic dermatitis, immobility, rheumatoid arthritis and ischaemic neurological diseases, while low-molecular-weight heparins, antipruritic drugs, allergy, rosacea and higher haemoglobin concentration had the contrary effect. CI is a frequent and interdisciplinary problem among elderly subjects, which requires a holistic clinical approach.

Genetic algorithm for making pharmacotherapy decision in the patients with multimorbidity: approaches for clinicians

OBJECTIVE

Purpose of our investigation was to propose and verify the algorithm for making pharmacotherapy decision in the patients with multimorbidity.

PATIENTS AND METHODS

Material and methods: Object of investigation: patients with multimorbidity. Observations were conducted according to European Guidelines. We proposed and tested genetic algorithm for making pharmacotherapy decision for such patients. It is necessary to mention, that each person is representing a variant of treating with certain pathology. Chromosome of this variant is composed from genes, where each gene is certain group of drugs. The sequence of solutions of this problem comes down to the selection of drugs for the di-morbid conditions as the descendants of mono-morbidity. At the next stage of selection continues the most successful combinations of drugs for multimorbid conditions as descendants di-morbid and monomorbid conditions. When breeding pairs must take into account the mutual potentiating pathogenic and / or sanogenetic effects.

RESULTS

Results: We had optimal patient's treatment as a result of crossing genes, groups of drugs and obtaining their offspring with the best combination without absolute contraindications and minimal relative contraindications.

CONCLUSION

Conclusion: Thus, genetic algorithm for making pharmacotherapy decision in the patients with multimorbidity showed effectiveness of drugs choosing.

[Current views on the interaction between the treatment of osteoporosis and cardiovascular diseases]

The most common medical conditions after menopause are osteoporosis and atherosclerotic disease. Traditionally these two conditions were considered unrelated and their coexistence has been attributed to independent processess exclusively reated to age. The possible link between cardiovascular disease and osteoporosis stimulates today to analyse not only the evidence of a possible association, but also to identify mutual beneficial and adverse effects of drugs used in these two diseases. That's why, the focus on the interference between osteoporosis treatment and drugs used for atherosclerosis is made. Moreover side effects of cardiological drug considering bones are analysed. Additionally possible advantages of selected drugs used for cardiovascular diseases on osteoporosis prevention are evaluated. Drugs used for osteoporosis treatment may heave adverse effects on cardiovascular system. The article has detailed analyses of current drug classes, such as the bisphosphonates, strontium ranelate as well as a review of the controversy surrounding hormone replacement therapy (HRT) and the selective oestrogen receptor modulators (SERMs). Lastly discussion of adverse effects on the heart of calcium and drugs influencing calcium metabolism such as vitamin D, parathormone and calcitonin is performed.