Posts tagged Womens health

The Falsified Medicines Directive (FMD) is to be implemented in all member states of the European Union (including the UK) and the European Free Trade Area on 9th February 2019. This is a response to the growing number of falsified medicines entering the pharmaceutical supply chain, which can have serious consequences for patient health and safety. But how will it work? (1)

What is FMD?

FMD stands for Falsified Medicines Directive, a term used both to describe the process by which pharmacies will identify the medicines they receive from wholesalers as legitimate or falsified, and to refer to the European Directive on Falsified Medicinal Products, the piece of legislation concerning this process. (2)

What are falsified medicines?

Falsified medicines are illegitimate copies of legitimate medicines, from unlicensed manufacturers. Despite tight controls, some find their way into the supply chain, allowing them to reach patients. They have not been produced in the same highly regulated way in which legitimate medicines are produced by licensed pharmaceutical companies, but are often passed off as coming from such companies due to identical or stolen packaging. Falsified medicines can contain too much or too little of the active ingredient(s), no active ingredients at all, different active ingredients to what is stated on the packaging, and potentially harmful, banned or dangerously concentrated excipients (excipients are all ingredients of a medicine other than active ingredients). Clearly, there is a risk posed to patients, with overdose, drug interactions, poisoning or a condition being left untreated all possible outcomes of taking falsified medicines. (1)

How can you tell if you are buying falsified medicines?

Legitimate online pharmacies such as Webmed are approved and accredited by official regulatory bodies including the  MHRA, GPhC and CQC. The independence and unbiased nature of these bodies provide regulation, monitoring and inspection to ensure we and our peers are held to the highest standards.

You can rest assured that when you purchase treatments from Webmed (from erectile dysfunction medication all the way to Hair Loss Treatments) you are purchasing legitimate, official medicines.

How will FMD be implemented in pharmacies?

From 9th February 2019, two new features will be present on all prescription medicines supplied to pharmacies (bar a handful of specialist medications):

• A unique identifier (UI) – a 2D data matrix, or barcode, unique to each pack of medication

• An anti-tampering device (ATD) – an addition to the packaging that will make it evident whether or not it has been tampered with, such as adhesive seals, shrink wrap, or perforated sections of boxes that must be broken to open the pack. (2)

It is expected that electronic patient medication record (PMR) systems in pharmacies will be updated to incorporate a medicines verification feature that can be used to scan the UIs on packs and identify the medicine as genuine or falsified. By law, stock will not need to be verified until it is being prepared for a patient, but optional verification will most likely be performed when stock is received into the pharmacy, allowing suppliers to be alerted as soon as possible when a suspected falsified medicine is found. (2)

The safest way to verify medicines before supply to patients will be using aggregated codes, if PMR systems allow. During the dispensing process, each pack of medicine will be scanned and codes for all packs to be bagged up for the patient will be ‘aggregated’ and printed on a label to attach to the outside of the bag. Then, when the patient comes in to collect the bagged prescription items (or before handover to delivery drivers), the aggregated codes will be scanned and, if verified as legitimate, all packs inside the bag will be decommissioned, meaning that their UI codes become inactive. Since UIs will be unique by name and nature, the same UI showing up on a further pack will be flagged, highlighting the pack as potentially falsified and unsuitable for supply to the patient. Aggregated codes will be preferable to scanning each item individually as it will mean that the bag does not need to be reopened on handing over to the patient or delivery driver, which will uphold patient confidentiality, save time and lower the risk of a dispensing error. (2)

Once packs are decommissioned, they can be recommissioned (the UI reactivated and the pack put back to stock as long as it hasn’t left the pharmacy) within 10 days. This may happen if a patient no longer requires the item(s) or if a pack is decommissioned in error. (2)

Scanning will also flag up any recalled, discontinued or out of date medicines, further minimising the impact of human error on patient safety. It is hoped that eventually it will even be used to ensure the correct medicine has been picked against the prescription! (2)

Will Brexit have an impact on FMD?

Since FMD is part of EU law, there has been confusion over whether FMD in the UK will be continued after the UK leaves the EU on 29th March 2019. The Department of Health and Social Care (DHSC) and the Medicines and Healthcare products Regulatory Agency (MHRA) have assured “high regulatory alignment” with the EU, meaning FMD will be here to stay. It is also believed that the UK will still be considered part of the EU for the purposes of FMD after Brexit, so the process should remain unchanged – this is the best outcome for ease of operation in pharmacies and for patient safety. (2)

References

1. UKFMD Working Group for Community Pharmacy. FMD (1): What is the Falsified Medicines Directive? [cited 31 October 2018].

2. UKFMD Working Group for Community Pharmacy. The way forward for FMD in community pharmacy [cited 31 October 2018]. Available at: https://www.communitypharmacyni.co.uk/wp-content/uploads/2018/02/fmd-cp-working-group-way-forward-paper-jan-18-public-v1-0-final.pdf

Author: Gabby Gallagher MPharm

Despite there being a dramatic increase in bowel cancer cases above the age of 50, the screening programme in England is currently only offered to those aged 60 and over. However, Public Health England have recently announced that it plans to bring the starting age for screening down to 50, a move which will mean countless more cases are spotted in the earlier, more easily treatable stages. (1)

What is bowel cancer?

Bowel cancer is cancer of the large intestine, and depending on the area affected, may be referred to as colon cancer or rectal cancer. It is the fourth most commonly diagnosed cancer in the UK, responsible for 42,000 cases and over 16,000 deaths each year. (1, 2)

What are the symptoms?

One of the most common symptoms is blood in your poo. This may be noticed as red streaks on the surface of your poo or the poo being discoloured (red, very dark red/brown or black), toilet water being stained red or pink, or blood visible on toilet paper. Often, blood in poo has other, less serious causes, such as haemorrhoids or anal fissures (cuts). But if you’ve had any of the above symptoms for three weeks or longer, visit your GP. (2, 3)

A change in bowel habit can also be a sign of bowel cancer. One off changes in bowel habit can be caused by eating certain foods or stressful situations, but if this occurs persistently don’t ignore it. If you find you are needing to poo more frequently than what’s usual for you, and the poo is softer and thinner than usual for three weeks or more, see your GP. (2,3)

Another common symptom is lower abdominal pain, discomfort or bloating. This tends to worsen after eating and may therefore put you off eating, leading to weight loss. See your GP if you experience any of the above symptoms. (2, 3)

Other symptoms may include tiredness from anaemia caused by persistent blood loss from the bowel, slime in your poo and feeling like you can’t fully empty your bowel when you poo. (2, 3)

Bowel cancer screening

Currently, the bowel cancer screening programme in England involves inviting everyone aged between 60 and 74 to have a faecal occult blood (FOB) test every two years. This is a simple home testing kit which allows a small stool sample to be collected. When sent to the laboratory, this sample is tested for traces of blood, which could indicate bowel cancer. (1, 2)

A new, more accurate bowel screening kit is due to replace the FOB test this autumn, known as the faecal immunochemical test (FIT). It is the FIT that will be in use when bowel screening is introduced to people aged 50 and over in England. (1)

In some parts of England, a different test is also offered to 55 year olds, called bowel scope screening. During this screening, a healthcare professional will inspect the lower bowel for polyps (small growths that can be an early sign of cancer) using a gentle instrument. (2)

What causes bowel cancer?

Bowel cancer, like all cancers, doesn’t have a definite cause, but there are several risk factors:

• Regularly eating red or processed meat
• Not eating enough fibre
• Being overweight or obese
• Sedentary lifestyle
• Excessive alcohol consumption
• Smoking
• Being 60 years of age or older
• Having a parent or sibling who had bowel cancer under 50 years of age
• Having had ulcerative colitis or Crohn’s disease for over 10 years

As you can see, some factors are unavoidable, but others can be changed. A diet high in fibre, fruit and vegetables and low in red and processed meat will help protect against bowel cancer, as will stopping smoking (if applicable), drinking alcohol in moderation or not at all, getting moderate exercise regularly and maintaining or attaining a healthy weight. (2)

For more information and support, visit Bowel Cancer UK here.

References

1. BBC News (2018). Bowel cancer screening to start earlier at age 50 in England [cited 13 August 2018]. Available at: https://www.bbc.co.uk/news/health-45143895

2. NHS Choices. Overview: Bowel cancer [cited 13 August 2018]. Available at: https://www.nhs.uk/conditions/bowel-cancer/

3. NHS Choices. Bleeding from the bottom (rectal bleeding) [cited 13 August 2018]. Available at: https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 15/08/18

Meet Poorly Boo

How did it all start?

Poorly Boo was the vision of Mumpreneur Manju Bhatia, who quickly realised that many new parents did not have the essential remedies in their homes for when their little ones became ill. Having young children herself, Manju was often in the company of other mums with small children and often heard them saying their baby had a high temperature and had to run out to get some medicine.

Manju thought, “Why are so many new parents so ill equipped at home? Why do so many not have the medicine in the cupboard to alleviate their symptoms?”

When Manju become a mum in 2013, she made sure she was prepared with all of the remedies and over-the-counter medications that she might need. Although it didn’t stop the sleepless nights when they were poorly, it did mean she had what she needed so the family could all rest a bit easier.

Since 2017, Poorly Boo has been selling essential healthcare products online at: https://poorlyboo.com/

Who is Manju?

Manju Bahtia is originally from Yorkshire, where her interest in business came from working in her parents’ uniform shop, Natasha’s.  The family run business, which had several outlets in Yorkshire, sold school uniforms to dozens of schools in the region. At a young age, Manju had a strong business nous and enjoyed the buzz of a business environment.

Manju helped her father set business goals and was successful in growing the business to reach a turnover of more than £1 million.

After successfully reaching their goal of £1million, Manju left her family home to get married and start her own family. She focused her attention on raising her 2 children, and after spending time with new mums and their babies, Manju realised there wasn’t anything in the market to help new parents understand what medicines and remedies were important to have on hand.

Her eureka moment came during these conversations, and PoorlyBoo was soon launched.

Discover Poorly Boo's Products

PoorlyBoo Baby Box

13 carefully selected must have products, all parents will need to deal with the most common baby illnesses and give peace of mind to all worried parents. Put together in a travel sized medicine box, that can be stored at home or taken away with you.
RRP £34.99

What's in the box?

• Vapour rub
• Teething gel
• Teething granules
• Digital thermometer
• Sudocrem - antiseptic healing cream
• Metanium nappy ointment
• Medicine dispenser
• Olbas for children – inhalant decongestant oil
• Paracetamol 120mg/5ml oral suspension
• Ibuprofen 100mg/5ml oral suspension
• Saline solution nasal drops
• Nasal aspirator
• Infacol oral suspension

Poorly Boo First Aid Kit

100 piece First Aid Kit, for Travel, Car, Home, or Work.  A complete kit to protect you and your family.
RRP £14.99

What does the first aid kit include?

• Ice pack
• Thermal blanket
• Tweezers
• Scissors
• Bandages
• Plasters
• and much more

Find out more

You can find Poorly Boo at https://poorlyboo.com or join the conversation on Twitter, Facebook and Instagram

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 03/08/18

Group B Strep - should I get tested?

Group B Strep is the most common cause of life-threatening infection in newborn babies in the UK, and the most common cause of meningitis in babies under age 3 months and yet a lot of pregnant mums know nothing about it!

At least two babies every day in the UK fall ill with Group B Streptococcus (often known as Group B Strep or just GBS). For some, the illness is fatal, for others, it can cause permanent disabilities.

The following information may help you to gain a better understanding of GBS and to make an informed decision on whether a GBS test may be right for you! (1)

What is GBS?

GBS is a type of bacteria which forms part of the natural bodily flora of up to four in ten people. Up to a quarter of women also carry the bacteria in the vagina. Usually, the bacteria are harmless, but in certain cases such as in people with a compromised immune system, babies and pregnant women, it may develop into an infection. (1)

If a woman carries GBS in her vagina and becomes pregnant, there’s a small chance that she could pass the bacteria on to the baby during childbirth. Because the immune system of babies is not yet developed, it is much easier for GBS to get out of control and make them ill. For a small number of babies it can be life-threatening, causing blood poisoning, pneumonia and meningitis. This may lead to death in a very small number of cases. (2)

Will the NHS test for Group B strep?

Despite this, there is no routine testing provided on the NHS. Even if a pregnant woman is offered testing it’s usually the Standard ‘non-selective’ test for group B Strep carriage. A negative result using this method is not very reliable – it gives a high proportion of falsely negative results. 

However, there is another test that can be obtained from Webmed Pharmacy and this is the GBS-specific ECM(Enriched Culture Medium), which is the international ‘gold standard’ for detecting GBS. These tests are highly reliable and are good predictors of your GBS carriage status for 5 weeks after the swabs have been taken.  

Therefore, it’s best to test in the 5 weeks before you go into labour and give birth. The 35-37 week ‘window’ for testing is usually thought to be the best time to test for most people as your GBS carriage status is not likely to change between testing and giving birth, and you should receive the result before your baby arrives.

What are the symptoms of GBS?

If GBS infection is going to occur, it usually does within the first few hours of birth, but it may occur as late as when the baby is aged three months. Symptoms include:

• the baby becoming limp and floppy

• lack of response to stimuli

• a grunting noise when breathing

• high or low temperature

• rapid or slow breaths

• rapid or slow heartbeat

The appearance of any of these symptoms warrants a 999 call or an immediate visit to A&E. Time is of the essence as once the infection has taken hold, the difference between life and death can be a matter of hours. If the baby is diagnosed with GBS, they will be treated in hospital with antibiotics administered via a vein. (2)

How does GBS testing work?

If you’re pregnant and concerned about your baby contracting GBS, you can  consult your midwife or GP to help you decide whether to get tested. (2)

At Webmed Pharmacy, our testing kit allows you to take both a vaginal swab and a rectal swab to send off for testing (the above link takes you to the product specific page which explains the test in detail). If your results come back positive, you need to tell your midwife or GP. Your birth plan will need to be reconsidered if you’ve intended not to give birth in hospital. (2)

When you go into labour or your waters break, let your midwife know immediately. You will need regular injections of antibiotics into a vein throughout the labour. Any allergies to antibiotics must be reported to your midwife so they can ensure hospital staff administer a safe antibiotic for you. The hospital may want to keep a close eye on the newborn baby in case any signs of GBS infection arise, so you may need to stay in hospital for up to twelve hours after the birth as a precaution. If symptoms do appear, the baby will be given urgent antibiotics into a vein. (2)

For further information, visit the Group B Strep Support website.

Why take the risk - test now!

Click here to buy your Group B Strep test.

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent Pharmacist Margaret Hudson BSc(Hons)MRPharmS 10/07/18

References

1. Group B Strep Support. What is group B Strep? [cited 6 July 2018]. Available at: https://gbss.org.uk/info-support/pregnancy-and-birth/what-is-group-b-strep/

2. NHS Choices. What is group B strep? [cited 6 July 2018]. Available at: https://www.nhs.uk/conditions/group-b-strep/

The current heatwave in the UK has provided perfect conditions for a wide range of biting and stinging insects to thrive – and this has been demonstrated by the huge increase in medical help being sought for insect bites and their complications. Twice the usual number of calls to NHS Direct (111) have been made recently regarding this issue, and there has been a spike in hospital admissions to treat infected bites, particularly horsefly bites. (1)

In light of this news, this blog explores some of the most common insect bites and stings in the UK, highlighting what to look out for and how to manage them.

Horseflies are common in the UK, and as the name suggests they do bite horses, but also other mammals including humans. If you’ve been bitten by a horsefly you’ll know about it! That’s because not only do horseflies tend to ‘hone in’ on their targets by buzzing round them before finally finding a place on their body to land and bite, but their razor sharp mouthparts dig in to the skin, tearing rather than piercing it to extract as much blood as possible. This will be particularly painful and leave a nasty looking raised red bite which takes longer to heal than most other insect bites. Because of this, the bite can become infected. Look out for pus appearing in or from the bite, worsening pain, fever, or redness and swelling spreading from the bite to the surrounding areas – see your GP if you notice any of these symptoms as you may need treatment with antibiotics. (1, 2)

Mosquitoes are also abundant and particularly favour areas with standing water, such as those near lakes and ponds, but they can be found in other areas too. Generally, people do not realise they have been bitten by a mosquito until a rash develops, as their bite is painless. The bites appear as small red lumps which may contain fluid-filled sacs and can be intensely itchy. (1, 2)

Bees tend to keep themselves to themselves as they travel between flowers collecting pollen. They will usually only sting if they feel threatened. A sharp, piercing pain is felt and a small red mark may be left which often contains the bee sting. It is important that the sting is removed as soon as possible as it is venomous. Scrape the sting out using an object with a thin, hard edge, such as a bank card, or your fingernail. Do this in a sideways motion to draw the sting out of the wound. Don’t try to pluck or squeeze it out as this may release more venom into the surrounding tissue. (2, 3)

Wasps and hornets can be more bothersome, attacking people who are just keeping themselves to themselves! Also, they may sting more than once at a time. The sensation will be similar to a bee sting, but there is no sting left in the wound. Within hours, a red, painful and itchy lump can form around the sting wound, and in some cases the irritation and swelling can cover a considerable area for up to a week as part of a mild allergic reaction. (2)

Bee, wasp or hornet stings can occasionally cause serious allergic reactions (anaphylaxis). If you or someone around you begins to struggle breathing, experiences severe swelling on the face (mainly around the eyes and lips), or dizziness after being stung, call 999 immediately. (2)

Ticks are tiny spider-like creatures which can leave a small red, itchy bite and sometimes a blistered or bruised surrounding area. The bite doesn’t tend to cause any pain, so you may not notice you’ve been bitten. In the UK, ticks are generally harmless unless they carry Lyme disease (covered in more detail in an earlier blog), in which case a characteristic ‘bullseye’ rash may develop. See your GP if this happens.

To ease itching, apply calamine lotion or crotamiton cream to the bites or stings. You can also purchase hydrocortisone cream and antihistamines such as chlorphenamine or loratadine over the counter. Painkillers such as paracetamol can be taken to ease pain associated with stings or bites. Applying a cold compress to the affected area can help to reduce swelling. (3)

Continual scratching of the stung or bitten area can break the skin, which makes infection more likely. Signs of infection include pus or yellow crusting, spreading of the red and swollen area, worsening pain and fever. Don’t hesitate to contact your GP if this develops as you may need antibiotics to clear the infection.

If you’ve been stung or bitten in a sensitive area, such as inside the mouth or near the eyes, or if you experience worsening symptoms or see no improvement after a few days, see your GP or call NHS 111. (3)

To learn more, there is a great article called Bug Bite Identification - The 10 most common bug bites and how to identify them. It starts by explaining why bugs bite and then how to identify if you really have a bug bite. It goes on to venomous versus non venomous bites and when to seek medical attention. (4) 

References

1. Ives L (2018).Heatwave causes spike in insect bite calls to NHS [cited 18 July 2018]. Available at: https://www.bbc.co.uk/news/health-44823286

2. NHS Choices. Insect bites and stings – Symptoms [cited 18 July 2018]. Available at: https://www.nhs.uk/conditions/insect-bites-and-stings/symptoms

3. NHS Choices. Insect bites and stings – Treatment [cited 18 July 2018]. Available at: https://www.nhs.uk/conditions/insect-bites-and-stings/treatment

   4. Bug Bite Identification - The 10 most common bug bites and how to identify them. [cited 26 July 2020]. https://howigetridof.com/bug-bite-identification/

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 08/07/18

   Update: 21/11/20 by Margaret Hudson

We’re well into hay fever season which, for a fifth of the UK population, means relentless cold-like symptoms, headaches and general exhaustion. If this sounds all too familiar, it’s the perfect time to review the steps you can take to help reduce the intensity of your symptoms and make your day to day life easier! (1)

What is hay fever?

Hay fever, also known as seasonal allergic rhinitis, is a condition caused by the immune system’s reaction to pollen. Pollen is a fine powder produced by plants for the purpose of reproduction, and is easily carried by the air and therefore breathed in and deposited on hair, skin and clothes. (1)

Symptoms include sneezing, coughing, nasal congestion and running, reduced sense of smell, itching of the eyes, nose, throat and ears, headache and temple pain, earache and a lack of energy. Hay fever may also worsen asthma symptoms. (2)

Symptoms tend to be present for the whole hay fever season (March to September), particularly when the pollen count is high. This usually happens on hot and humid days with a breeze or wind. (2)

How is hay fever treated?

Antihistamines are the most common medical treatment for hay fever symptoms and can be purchased over the counter in pharmacies. They work by antagonising the effects of histamine, a chemical produced by the immune system in response to allergens. This will help with all symptoms. Over-the-counter antihistamines include chlorphenamine, acrivastine, cetirizine and loratadine and are available as tablets and oral solution. Chlorphenamine is a ‘drowsy’ antihistamine, so is useful for people who have trouble sleeping due to their symptoms, whereas acrivastine, cetirizine and loratadine are considered ‘non-drowsy’ and may be more suitable for daytime use, driving, working, school and exam time.

Other treatments that can be bought over the counter include steroid nasal sprays (beclometasone or fluticasone), decongestant nasal sprays (xylometazoline), and saline nasal sprays, which can help with stubborn congestion not relieved by antihistamines, and sodium cromoglicate eye drops to help specifically with itchy eyes.

If your symptoms still persist after trying medicines from the pharmacy, your GP can help. Other antihistamines unavailable over the counter, such as fexofenadine, can be prescribed, as can a wider range of stronger steroids in tablet or nasal spray form.

If this also fails, your GP may consider referring you to a specialist for immunotherapy treatment. This involves administering injections of low doses of pollen at regular intervals, usually starting around December time, to gradually build your immunity to pollen. Once hay fever season comes around, your body should have had enough exposure to no longer treat pollen as an allergen, therefore symptoms should not develop. Unfortunately, this is not a cure - you’ll need to have this done every year. (2)

What else can I do to help ease my hay fever symptoms?

Try to avoid going outside whenever possible, and particularly early in the morning and late in the afternoon/early evening. This is when pollen counts are highest. Also, avoid opening windows and doors in the house, and don’t allow outdoor pets in if possible. Vacuum daily if you can - consider investing in a vacuum incorporating a HEPA filter - and dust surfaces each day with a damp cloth. And although it seems obvious, don’t bring flowers into your house. (1, 2)

If you must go outside, create as many barriers as you can between you and the pollen! Protect your eyes with wraparound sunglasses, protect your airways by applying petroleum jelly around your nostrils, and stop pollen from getting into your car by attaching pollen filters to the air vents. Washing clothes, showering or bathing and washing hair after going outside will wash away any pollen stuck to you or your clothes. And don’t proceed to dry your clothes on the line - they’ll only become covered in pollen again! (2)

Stick to paths and pavements where possible, as walking on grass can release pollen into the air. Cutting grass also has this effect, so let someone else mow the lawn! (2)

Smoking and breathing in other people’s smoke can worsen hay fever symptoms, so avoid this at all costs. (2)

Click here for further information and support from Allergy UK.

References

1. BBC News. Tips for reducing hay fever symptoms [cited 12 June 2018]. Available at: https://www.bbc.co.uk/news/health-44381799
2. NHS Choices. Hay fever [cited 12 June 2018]. Available at: https://www.nhs.uk/conditions/hay-fever/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 13/06/18

Although rare in the UK, botulism can have serious consequences if caught. Up to one in ten people affected with botulism die as a result of the condition, but this risk is greatly reduced if treatment is started as soon as possible, so it is important to know the signs to look out for. (1)

What is botulism?

Botulism is a condition caused by exposure to a type of bacteria called Clostridium botulinum. These bacteria release a toxin called the botulinum toxin, which is one of the most potent toxins known. It is these toxins rather than the bacteria themselves which pose such a threat to health. The toxins attack the cells of the nervous system, leading to paralysis. In cases where the muscles controlling the respiratory (breathing) system are affected, this can prove fatal. (1)

The bacteria which release the toxin can be found in the soil, sea or river sediments, and even dust. Perhaps the best known source is home canning, pickling or other types of preserving involving food in closed containers. If guidelines on safe and hygienic preparation are not followed, the food may become contaminated with Clostridium botulinum, and the low oxygen environment inside the jar or can is perfect for botulinum toxin production. For food preserved in jars, cans and bottles sold in UK shops, the risk of botulism is minute as stringent hygiene practices must be adhered to during their preparation. Nevertheless, be wary of warped or damaged containers and preserved food that smells or tastes ‘off’. (1)

Botulism can also develop as a result of injecting illegal drugs contaminated with the bacteria into muscle. The reason why this risk applies to illegal drugs in particular is because they are not prepared in a sterile environment, unlike prescribed injectable drugs. Whilst the best advice is obviously to refrain from injecting illegal drugs altogether, it is safer to inject into a vein rather than a muscle. (1)

Babies aged one year or younger are also at risk of contracting botulism from ingesting spores (a dormant form) of the causative bacteria. The spores may be found in soil or food, but honey is a particularly risky source. For this reason, honey should not be given to babies until they are at least 12 months old. (1)

What are the symptoms?

Initially, symptoms may be similar to those of a ‘stomach bug’, including feeling and being sick, diarrhoea and abdominal cramps. This may occur hours or days after first exposure. (1)

Symptoms of paralysis include blurred vision, droopy eyelids, problems swallowing, difficulty speaking or making facial expressions, and eventually problems breathing. (1)

Babies may be quieter than normal, struggle to feed and their body may appear floppy. (1)

How is botulism treated?

The aim of treatment for botulism is to deactivate the toxins produced by the bacteria. This is achieved by administering post-exposure vaccines containing botulism antitoxins or antibodies, which work as toxin neutralisers, stopping any further damage from occurring. Additionally, help with breathing and other essential bodily functions should be given until patients recover. Paralysis that has already occurred can’t be undone by treatment, but it should eventually ease off over time regardless. (1)

If you suspect that you or someone else in your presence may have contracted botulism, it is essential to seek emergency medical attention and to begin treatment at the earliest opportunity, as the more time passes, the greater the damage that will be caused by the deadly toxins. In this instance, do not hesitate to call 999 for an ambulance or to visit A&E as soon as possible. (1)

References

1. NHS Choices. Botulism [cited 4 June 2018]. Available at: https://www.nhs.uk/conditions/botulism/

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 6/06/18

This time of year, many of us like to make the most of the warmer weather and lighter evenings. A nice long country walk is a great way to unwind - the exercise benefits the body and the sights, smells and sounds of nature help to clear the mind and promote mental wellbeing. Given this, it can be easy to overlook a growing risk posed by this seemingly harmless activity -  Lyme disease.

What is Lyme disease?

Lyme disease is a bacterial infection caused by the bacterial species Borrelia burgdorferi. It is transmitted via tick bites. Ticks are tiny arachnids (in the same class as spiders) which feed on the blood of several different animals, depending on the species of tick. In the UK, the species most likely to transmit Lyme disease to humans is the sheep tick - as the name suggests, this tick feeds primarily on sheep’s blood, but will feed on the blood of other animals and birds if it needs to. Ticks will wait on tall grass or other shrubs for an animal or human to brush past them, allowing the tick to attach itself to the skin of the animal or human. If the animal is infected with Lyme disease, this is transferred to the tick when it feeds, then the infection can be passed onto the next animal or human that the tick bites. (1, 2)

Usually, the earliest symptom of Lyme disease is a characteristic red rash with the appearance of a bull’s eye on a dartboard. At the centre of the rash is the tick bite. The edges may feel bumpy or raised to the touch. This rash most often develops within a month of being bitten, but it can take as long as three months, and in some cases it may not appear at all. Other symptoms of Lyme disease include flu-like illness (headache, bodily aches and pains, raised temperature, chills and lethargy). (3)

Occasionally, Lyme disease may cause symptoms which persist for years after infection and treatment. These symptoms include aches and pains, low energy and lethargy and are known as post-infectious Lyme disease. There is no known treatment for this post-infectious condition, but speak to your GP if you are still suffering with symptoms after treatment for Lyme disease, as they may be able to help you with arrangements to make your everyday or working life easier. (3)

If Lyme disease is left untreated or if treatment is unsuccessful, it may lead to arthritis and complications in several organs including the heart and brain. (1)

Figures released by Public Health England from 2017 demonstrated an increase in cases of over a third compared to the previous year. (4)

How do I know if I’ve been bitten?

Tick bites are rarely painful, so the main way to tell whether you’ve been bitten by a tick is by seeing the tick attached to your skin. This is why it’s important to check your skin thoroughly after walking in rural or grassy areas - particularly after walking in tall grass. Ticks are very small - ranging from the size of a full stop on this page (a tick larva) to a small pea (an adult female tick after a large feed). (2, 3)

If you spot a tick on your skin, you should carefully remove it as soon as possible. Using clean pointed tweezers (not regular hair plucking tweezers) a tick removal tool or looped fine thread, get hold of the tick at the closest point to the skin as possible and slowly, carefully pull the tick upwards and outwards. Take care not to squeeze or crush the tick’s body, as this can cause the body to detach from the head, leaving the head attached to the skin, or cause the tick’s stomach contents to enter the bite, increasing the risk of infection. (3, 5)

Once you’ve removed the tick, throw it away and wash the bite and the tweezers or tool with soapy water or antiseptic. (3, 5)

You don’t need to visit your GP after removing a tick unless you develop a rash or illness. (3)

How is Lyme disease treated?

If you do feel ill or develop the characteristic bull’s eye rash, visit your GP who may arrange a diagnostic blood test. The usual treatment is a two to four week course of oral antibiotics, namely doxycycline, amoxicillin or cefuroxime. Other antibiotics may be used if the first choices are unsuitable for the patient, and antibiotic injections may be prescribed by a specialist for particularly severe cases. (3, 6)

How can I avoid tick bites?

The best way to prevent tick bites when out in the countryside, woods or in parks is to stop ticks from reaching your skin - by wearing long trousers tucked into your socks and long sleeved tops. Apply a DEET- based insect repellent to your skin and clothes. Avoid wearing dark clothing when out walking as this can make any ticks you’ve picked up harder to spot. Also, avoid walking through tall grass and shrubs and walk along paths where available. Remain responsible and vigilant and continue to enjoy our abundance of beautiful countryside and green spaces this summer! (3)

References

1. Lyme Disease Action. About Lyme [cited 24 May 2018]. Available at: http://www.lymediseaseaction.org.uk/about-lyme/
2. Lyme Disease Action. About Ticks [cited 24 May 2018]. Available at: http://www.lymediseaseaction.org.uk/about-ticks/
3. NHS Choices. Lyme disease [cited 27 April 2018]. Available at: https://www.nhs.uk/conditions/lyme-disease/
4. Lyme Disease Action. Significant rise in cases of Lyme disease [cited 24 May 2018]. Available at: http://www.lymediseaseaction.org.uk/press-releases/significant-rise-in-cases-of-lyme-disease/
5. Lyme Disease Action. Tick Removal [cited 25 October 2017]. Available at: http://www.lymediseaseaction.org.uk/about-ticks/tick-removal/
6. British National Formulary (version 2.0.2) [Mobile application software]. Retrieved from: www.bnf.org

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 30/05/18

The weather is getting warmer, the nights are getting longer and the summer months are fast approaching. This goes hand in hand with people wanting to spend more time outside in the sun. But did you know a single episode of sunburn every two years can increase your chances of developing skin cancer threefold? (1)

“I don’t burn, I tan, so I’m safe!” you might say. But it’s been proven that there’s no safe or healthy way to develop a suntan either. So take note of the advice in this blog to make sure you stay safe in the sun this summer! (2)

The link between sun exposure and skin cancer

Ultraviolet (UV) light is a type of radiation found in the sun’s rays and is invisible to the naked eye. It is the component of sunlight that causes sunburn, suntan and the damage to the DNA in your skin’s cells that can lead to skin cancer. The UV light that reaches our atmosphere comprises two varieties: UVA and UVB. UVA can reach the deeper layers of the skin, whereas UVB affects the superficial layers, therefore both varieties of UV light damage the skin in different ways. (1, 2)

Skin cancer can be categorised into melanoma and non-melanoma. Around 250,000 people in the UK are diagnosed with non-melanoma annually. It is generally less serious than melanoma but can leave those affected with disfigurements, since the main treatment is to remove the affected area of skin if possible. (2)

Melanoma kills approximately 2,000 UK people annually. (2)

How to stay safe in the sun

Overall, the best way to avoid overexposure to the sun is to avoid going out in it, particularly at times when sunlight is strongest, between 11am and 3pm from March through to October. In the summer months, UV rays can filter through cloud in the above hours. If you need to go out, cover as much of the skin with clothing as possible as long as it is not too warm (for example, long sleeved tops and full length trousers), apply sunscreen to bare skin, and seek shade whenever you have the chance. Sunglasses are also important as even eyes can be damaged by sun exposure, but they must bear the CE Marking and European Standard EN 1836:2005 - if they don’t, you run the risk of having less or no eye protection, and this can be very dangerous as looking through tinted glass allows the eyes to open more widely in sunlight, meaning more harmful UV rays reach the eyes. (2)

Your sunscreen needs to offer protection against both UVA and UVB light. You can identify this by looking on the container for the letters ‘UVA’ within a circle, as well as a four star UVA protection rating or above, and SPF15 or higher. Apply sunscreen generously - around eight teaspoons’ worth as a minimum for an adult of average size, half an hour before you’re due to go outside and again immediately before you go out. Remember to cover all areas that will be exposed to the sun, including ears, neck, and the scalp if you have thinning, little or no hair - but wide-brimmed hats are more reliable for this purpose. Sunscreen should be reapplied if the skin is wet, rubbed or sweating occurs. (2)

Children’s skin is generally much more sensitive than that of adults. Up to the age of 6 months, they should not be taken outside in strong sunlight, or if it cannot be avoided, they should be shaded. For older children, it is crucial to follow the advice stated above with regard to covering the skin, seeking shade and applying sunscreen, as childhood sunburn is a major risk factor for skin cancer in later life. (2)

A ‘healthy glow’ - a common misconception

In 2016, the National Institute for Health and Care Excellence (NICE) released new guidelines stating that, contrary to popular belief, there is no safe way to tan in the sun. It might make you look healthier, but that’s as far as it goes. A suntan, just like sunburn, is a sign that potentially harmful changes have occurred in the skin. And protection from the effects of further UV exposure offered by tanned skin is negligible. Even if you have naturally dark or black skin you can still be at risk of skin cancer from overexposure to UV light. (2)

Since sunbeds also utilise UV light, often at higher concentrations than in sunlight, they are equally unsafe. If you crave darker skin as summer approaches, fake tanning products exist as a safe alternative to the sun or sunbeds. Or ideally, we can embrace our skin just the way it is! (2)

References

1. Cancer Research UK. How the sun and UV cause cancer [cited 26 April 2018]. Available at: http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/sun-uv-and-cancer/how-the-sun-and-uv-cause-cancer
2. NHS Choices. New NICE guidelines on sun exposure warn 'tanning is unsafe' [cited 26 April 2018]. Available at: https://www.nhs.uk/news/cancer/new-nice-guidelines-on-sun-exposure-warn-tanning-is-unsafe/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 02/05/18

Pulmonary arterial hypertension is a rare but serious disease which affects smaller branches of the pulmonary arteries, which are the blood vessels which carry oxygen-poor blood from the heart to the lungs to be re-oxygenated, ready to be pumped back around the body. Currently, half of people with the condition die within five years of it first appearing, but will a new genetic discovery lead to earlier diagnoses and therefore a more positive outlook for those affected? (1, 2, 3)

What is pulmonary arterial hypertension?

Pulmonary arterial hypertension (PAH) is raised blood pressure in the smaller branches of the pulmonary arteries, caused by the arterial walls stiffening and thickening. It is difficult for blood to be pumped through stiff, thick arteries as there is less ‘give’, therefore the right side of the heart, which supplies the pulmonary arteries, is forced to pump harder to make sure enough blood reaches the lungs, and blood pressure rises. This increased workload can weaken the right side of the heart over time and eventually cause heart failure. (1, 3)

What causes PAH?

A number of pre-existing conditions can be linked to PAH, including scleroderma (a condition associated with thickened skin, which can occur in blood vessels), HIV, thyroid problems, sickle cell disease, and particular medication. However, a cause cannot be established in around 20% of cases. (1, 2)

What are the symptoms of PAH?

PAH can cause you to experience shortness of breath, feel tired, faint or dizzy, experience palpitations (unusually fast or erratic heartbeat), experience pain in the chest, and develop swelling in the ankles, feet, legs or abdominal area. Usually, exercise worsens these symptoms. Unfortunately, contrary to other types of pulmonary hypertension, symptoms often do not occur until the later stages of the disease, when a lot of the damage is already done. (1)

How is PAH treated?

If a pre-existing condition has led to PAH, the first step is to treat this condition if possible. (4)

To treat PAH itself, a range of medicines can be taken including anticoagulants (such as warfarin), diuretics, inhaled oxygen therapy, digoxin (encourages the heart to pump more forcefully whilst lowering heart rate). Sildenafil and tadalafil are primarily used to treat erectile dysfunction but can be prescribed by specialists to treat PAH. (4)

In severe cases, PAH which is not sufficiently controlled by medication may call for surgery or a lung transplant. (4)

Unfortunately, PAH cannot be cured, but the treatments may help to slow, halt or even reverse the progression of the disease to an extent. (4)

The latest news

An exciting discovery has been made by researchers working on the 100,000 Genomes Project - four new genetic mutations have been found that are responsible for causing PAH. Previously, experts knew of only one mutation linked to the disease. These mutations code for faulty proteins which are incorporated into tissues including the pulmonary arteries. Knowing about these mutations opens up the opportunity for more targeted treatments to be produced in future, and if people with a family history of PAH can be genetically screened for the condition, it enables earlier diagnosis and earlier interventions. (2)

References

• NHS Choices. Pulmonary hypertension: Overview [cited 14 March 2017]. Available at: https://www.nhs.uk/conditions/pulmonary-hypertension/
• Therrien A. Genes behind deadly heart condition found, scientists say [cited 17 April 2018]. Available at: http://www.bbc.co.uk/news/health-43727026
• NHS Choices. Pulmonary hypertension: Causes [cited 17 April 2018]. Available at: https://www.nhs.uk/conditions/pulmonary-hypertension/causes/#PAH
• NHS Choices. Pulmonary hypertension: Treatment [cited 17 April 2018]. Available at: https://www.nhs.uk/conditions/pulmonary-hypertension/treatment/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 19/04/18