SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: Drug and therapeutics bulletin

43

Ensuring that a woman is well-nourished, both before and during pregnancy, is crucial for the health of the woman and that of the unborn child.(1) Maternal deficiency in key nutrients has been linked to pre-eclampsia, restricted fetal growth, neural tube defects, skeletal deformity and low birth weight.(1,2) Many nutritional supplements containing vitamins, minerals and other micronutrients are heavily marketed to women for all stages of pregnancy. However, much of the evidence for vitamin supplementation in pregnancy comes from studies carried out in low-income countries,(3) where women are more likely to be undernourished or malnourished than within the UK population. The challenges lie in knowing which supplements are beneficial and in improving uptake among those at most need. Here we summarise current UK guidance for vitamin supplementation in pregnancy and review the evidence behind it.

Concepts: Nutrition, Nutrient, Vitamin, Essential nutrient, Dietary supplement, Dietary mineral, Folic acid, Malnutrition

25

▼ Apremilast (Otezla - Celgene Europe Ltd.) is a novel orally administered immunomodulatory medicine licensed for the treatment of plaque psoriasis and psoriatic arthritis.(1) The company suggests that it has demonstrated proven and durable efficacy in both conditions and has a favourable safety profile with no requirement for drug-specific pre-screening or ongoing laboratory monitoring.(i) Here we review the evidence on the safety and efficacy of apremilast in the management of psoriasis and psoriatic arthritis.

Concepts: Infliximab, Psoriatic arthritis, Psoriasis

4

▼Zoely is the second estradiol-containing oral contraceptive formulated as an ‘extended regimen’ (pill-free interval <7 days) to be licensed in the UK. However, unlike the quadraphasic estradiol-containing contraceptive Qlaira, it is a monophasic preparation.1,2 It is postulated that combined oral contraceptives (COCs) containing synthetic estradiol, which is structurally identical to endogenous oestrogen,3 are potentially safer and better tolerated than those containing ethinylestradiol, the synthetic oestrogen most commonly used in COCs.4 The progestogen in Zoely is nomegestrol acetate, which is structurally related to progesterone,5 in contrast to the majority of progestogens in COCs that are derived from 19-nortestosterone6 and associated with androgenic effects.7 It is suggested that nomegestrol acetate, with its greater specificity for progesterone receptors, may minimise the potential for androgenic, oestrogenic and glucocorticoid effects.7 The company considers Zoely an option for women "who want a contraceptive with hormones similar to her own", and claims that it has a high level of contraceptive efficacy, produces shorter, lighter periods compared with a 21-day regimen of drospirenone 3mg/ethinylestradiol 30µg (Yasmin) and that most women report no negative impact on weight and skin.8 Here we review the effectiveness and place of Zoely.

Concepts: Birth control, Hormonal contraception, Combined oral contraceptive pill, Estrogen, Estradiol, Menstrual cycle, Steroid, Progestagen

3

Irritable bowel syndrome (IBS) is a common condition that can have a significant impact on a person’s quality of life.(1) The cause of IBS is unknown but several mechanisms have been proposed including visceral hypersensitivity, central sensitisation, abnormal gut motility and altered gut microbiota.(2,3) IBS is challenging to manage and many patients report insufficient symptomatic relief from treatment.(2) Approximately 60% of patients identify food as a trigger for their symptoms,(2) and there has been interest in exclusion diets for managing IBS.(4) Dietary adaptation is a common self-management strategy for patients with IBS, with many self-diagnosing intolerance to specific foods. This may lead to patients adopting over-restrictive or inappropriate diets.(5)In recent years, a diet low in poorly absorbed short-chain carbohydrates, known collectively as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols), has been advocated for the treatment of IBS.(2) Here, we discuss the background to the FODMAP diet and review the evidence supporting its use for people with IBS.

Concepts: Immune system, Human, Nutrition, Constipation, Irritable bowel syndrome, Flatulence, Carbohydrate, Monosaccharide

1

Drug shortages are recognised as being an important global issue1 that cause significant problems by delaying, and in some cases even preventing access to essential medicines.2 In the UK, problems caused by drug shortages have led to an enquiry by the All-Party Pharmacy Group (APPG)3,4 and publication of best practice guidance by the Department of Health (DH) working in conjunction with the manufacturers of branded and generic medicines.5-8 Widespread shortages of medicines commonly prescribed in primary care are now a regular occurrence and have significant impact on patients and healthcare professionals. In this article we discuss the reasons why shortages occur, how shortages are being addressed at a national and international level and what actions need to be taken to help minimise the impact on patients.

Concepts: Health care, Health care provider, Pharmacology, Medicine, Illness, United Kingdom, Pharmaceutical drug, Pharmacy

0

Every month, DTB scans sources of information on treatments, disease management and other healthcare topics for key items to bring to our readers' attention and help them keep up to date. To do this, we produce succinct, contextualised summaries of the information concerned.

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Every month, DTB scans sources of information on treatments, disease management and other healthcare topics for key items to bring to our readers' attention and help them keep up to date. To do this, we produce succinct, contextualised summaries of the information concerned.

0

Every month, DTB scans sources of information on treatments, disease management and other healthcare topics for key items to bring to our readers' attention and help them keep up to date. To do this, we produce succinct, contextualised summaries of the information concerned.

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Topics for DTB review articles are selected by DTB’s editorial board to provide concise overviews of medicines and other treatments to help patients get the best care. Articles include a summary of key points and a brief overview for patients. Articles may also have a series of multiple choice CME questions.

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Every month, DTB scans sources of information on treatments, disease management and other healthcare topics for key items to bring to our readers' attention and help them keep up to date. To do this, we produce succinct, contextualised summaries of the information concerned.