A highly sensitive spectrofluorimetric method for the determination of bilastine in human plasma: Application of content uniformity testing.

Bilastine, a new second generation antihistaminic drug, has been widely used for relieving symptoms of allergic rhinitis and urticaria without a sedative effect. A simple, cost-effective, and highly sensitive fluorimetric method was developed for the estimation of bilastine in human plasma, in addition to its pure state and tablets. The suggested method depended on binary complex formation of eosin with bilastine in a buffered medium at pH 4.2. The formed complex resulted in quantitative quenching of eosin emission at 538 nm after excitation at 335 nm. This method demonstrates a broad range of linearity, spanning from 200 to 1000 ng/mL, and exhibits exceptional sensitivity, with a limit of detection and quantitation of 30.85 and 93.48 ng/mL, respectively. In addition, this spectrofluorimetric method may be employed to determine the amount of bilastine in human plasma and tablets with satisfactory accuracy and excellent precision. Furthermore, the content uniformity of bilastine in commercially available tablets was successfully tested by this approach. Compared with the reference method, there were no significant variations in terms of precision or accuracy. In conclusion, the proposed protocol is highly recommended to quantitatively estimate bilastine in different quality control settings.

The cost-effectiveness of metformin in the US diabetes prevention program trial: Simple interpretations need not apply.

Based on previously published US Diabetes Prevention Program (DPP) cost-effectiveness analyses (CEAs) metformin continues to be promoted as "cost-effective." We review the DPP within-trial CEA to assess this claim. Treatment alternatives included placebo (plus standard lifestyle advice), branded metformin and individual lifestyle modification. We added generic metformin as an alternative. Original published CEA data were taken as given and re-analyzed according to accepted principles for calculating incremental cost-effectiveness ratios (ICERs) in the economic evaluation field. With more than two treatments as in the DPP, these require attention to the rankings of interventions according to cost or effect prior to stipulating appropriate ICERs to calculate. With proper ICERs neither branded nor generic metformin was cost-effective, regardless of the value assumed for the willingness to pay for the quality-adjusted life year outcome assessed. Metformin alternatives were technically inefficient compared to placebo or the lifestyle modification alternative. Net loss calculations indicated substantial costs/health losses to using metformin instead of the optimal lifestyle alternative in response to metformin having been inaccurately labelled "cost-effective" in the original CEA. That CEA and subsequent analyses and citations of such analyses continue to claim that both metformin and lifestyle modification are cost-effective in diabetes prevention based on DPP data. Using metformin implies substantial costs and health losses compared to the cost-effective lifestyle modification. It may be that metformin has a role in cost-effective diabetes prevention, but this has yet to be shown based on DPP data.

Assessment of Public Knowledge about Chronic Kidney Disease and Factors Influencing Knowledge Levels: A Cross-Sectional Study.

Background and Objectives: Chronic kidney disease (CKD) poses a significant risk for end-stage renal disease (ESRD), cardiovascular diseases, and premature death. The study aims to assess CKD knowledge and predictive variables among the general public. Materials and Methods: A cross-sectional study was conducted among the general public in Al Medina Al-Munawara, Saudi Arabia, utilizing a 21-item questionnaire-based approach over a 4-month period from January 2023 to April 2023. The developed questionnaire was validated for readability by experts and refined in light of the feedback received from the experts and the final version was prepared. The reliability of the questionnaire was 0.71, which shows an acceptable level of internal consistency. The data analysis was performed using IBM SPSS software (version 25). Results: A total of 777 complete surveys were received after applying the exclusion criteria. The study results revealed that the majority of the respondents had poor knowledge 505 (65%), 203 (26.1) had moderate knowledge, and 69 (8.9%) had good knowledge. Gender (p = 0.004), age (<0.001), education level (p = 0.039), marital status (p = 0.003), and occupation (p = 0.002) play significant roles in shaping participants' knowledge levels regarding CKD. Lower odds of good knowledge were associated with females with an OR (95% CI) of 0.448 (0.263-0.764) and intermediate or higher secondary school level of education displayed an OR (95% CI) of 0.39 (0.18-0.89). Higher odds of good knowledge levels were associated with the age group of 18-27 with an OR (95% CI) of 5.077 (1.21-21.38) and being employed with an OR of 3.555 (1.04-12.21). Conclusions: A significant proportion of respondents had poor knowledge about CKD. Several demographic factors were associated with CKD knowledge. Further research is needed to explore these knowledge disparities and develop targeted interventions to improve CKD knowledge among the general public.

Migraine Management in Community Pharmacies: Knowledge, Attitude and Practice Patterns of Pharmacists in Saudi Arabia.

In Saudi Arabia, community pharmacies offer healthcare services for different conditions. However, clarity of the competence of pharmacists in managing migraines is lacking. This study aimed to explore the current knowledge, attitude, and practice patterns of community pharmacists concerning migraine management in the northwestern part of Saudi Arabia. A cross-sectional study was carried out between June and September 2022 among 215 Saudi community pharmacists. Data analysis was performed by descriptive and inferential statistics using SPSS version 27. Most community pharmacists (87.9%) feel that migraine management is essential to their practice, and 83.3% suggest between one and five over-the-counter (OTC) migraine products daily. Among the study pharmacists, 83.7% feel migraine patients should try OTC before prescription medications. Only 9.3% of the community pharmacists do not believe that migraine is a neurological disorder. The medications most prescribed for migraine were triptans, representing 52.1% of prescriptions. There were significant differences between the gender of the pharmacists and their knowledge, attitude, and practice overall score (p-value = 0.04). Male pharmacists exhibited higher knowledge, attitude, and practice scores than female pharmacists. Although many community pharmacists acknowledge their expertise and involvement in managing migraines, there is a requirement for further education and training to enhance their capacity to offer complete care to migraine patients. Pharmacists should also consider non-pharmacological interventions and complementary therapies when treating migraine symptoms.

Uptake, Safety and Attitudes Towards COVID-19 Vaccination: A Cross-Sectional Study on First and Second Doses Among the General Public.

Objective: To investigate public uptake, attitudes and the safety of the first and second doses of COVID-19 vaccination. Methods: This was a cross-sectional web-based survey study. A self-administered questionnaire was prepared from a literature search and information about COVID-19 available at various resources. The developed questionnaire was validated for readability by experts and refined in light of the feedback received from the experts and the final version was prepared. The reliability of the questionnaire was 0.7 which shows an acceptable level of scale internal consistency. The data analysis was performed using IBM SPSS software (version 25). Results: A total of 513 participants completed the survey, including 311 (60.6%) women and 202 (39.4%) men. The mean age was (31.5±12.8) years. It was found that 493 (96.1%) took the first and second doses of COVID-19 and 376 (73.3%) suffered from side effects, of these 14% (56/376) reported the side effects to the health authorities. The most common side effects were fatigue (51.5%), fever (42.3%), headache (39.5%), and injection site pain (37.6%). Half of the participants (50.5%) had a positive attitude towards COVID-19 preventive measures. Females had higher odds of experiencing side effects than males OR (95% CI); 2.002 (1.312-3.056). Individuals living in urban areas had lower odds of experiencing side effects than those living in rural areas OR (95% CI); 0.364 (0.142-0.933). Conclusion: Vaccine uptake was massive and side effects due to the COVID-19 vaccine were common but minor. The majority of the participants had positive attitudes towards recommended COVID-19 preventive measures. Being female and living in rural areas were associated with experiencing side effects.

Stakeholders' Perspectives Regarding Supply Chain System of Pharmaceuticals and Vaccines in Pakistan: A Qualitative Study.

The present study was undertaken to assess the current supply chain system of pharmaceuticals and vaccines in Pakistan in terms of structure, process, and outcomes, as well as related barriers and solutions for an effective supply chain system. A qualitative study was designed to explore stakeholders' perceptions selected using the snowball sampling technique. A semi-structured interview guide was used to interview these respondents at a convenient time and place. After data collection, recorded interviews were transcribed verbatim and subjected to thematic analysis. The results highlighted that the standard operating procedures (SOPs), checklists, and government guidelines were available at different levels, except for community pharmacies. Timely delivery of quality products and services along with market reputation, experience, and authorization were the key criteria used for supplier selection and evaluation. Good inventory management, financial models, effective coordination, training, and skill development programs were identified as key factors responsible for an efficient supply chain process. Availability of vaccines, their appropriate temperature monitoring, and transportation are also highly compromised in Pakistan. The results of the present study concluded that the current supply chain system in Pakistan is not up to the mark; major factors include poor forecasting and inventory control, delayed order placement, lack of training, inadequate involvement of professionally qualified staff, inadequate financing and procurement processes, and poor coordination and integration among all stakeholders.

Regen-Cov and Covid-19, Update on the Drug Profile and Fda Status: A Mini-Review and Bibliometric Study.

COVID-19 is caused by coronavirus (SARS-CoV-2) is a worldwide health crisis. This severe acute respiratory syndrome was declared an outbreak after the first case was reported in Wuhan, the capital city of Hubei Province in China. On March 11th, 2020, the World Health Organization (WHO) declared it as a pandemic. The pharmaceutical treatment of COVID-19 has garnered significant critical attention due to the unavailability of medications to treat COVID-19. Recently, researchers have shown an increased interest in the monoclonal antibody drugs to treat COVID-19 especially REGEN-COV (casirivimab and imde-vimab). This review aims to highlight the relation between the drug and COVID-19 and the recently updated information on the monoclonal antibody REGEN-COV from the U.S. Food and Drug Administration and other authorities. It is also designed to focus on the bibliometric data of REGEN-COV for the last three years (2020, 2021, and 2021) in PubMed and Google Scholar.

Dactylospongia elegans-A Promising Drug Source: Metabolites, Bioactivities, Biosynthesis, Synthesis, and Structural-Activity Relationship.

Marine environment has been identified as a huge reservoir of novel biometabolites that are beneficial for medical treatments, as well as improving human health and well-being. Sponges have been highlighted as one of the most interesting phyla as new metabolites producers. Dactylospongia elegans Thiele (Thorectidae) is a wealth pool of various classes of sesquiterpenes, including hydroquinones, quinones, and tetronic acid derivatives. These metabolites possessed a wide array of potent bioactivities such as antitumor, cytotoxicity, antibacterial, and anti-inflammatory. In the current work, the reported metabolites from D. elegans have been reviewed, including their bioactivities, biosynthesis, and synthesis, as well as the structural-activity relationship studies. Reviewing the reported studies revealed that these metabolites could contribute to new drug discovery, however, further mechanistic and in vivo studies of these metabolites are needed.

Prevalence, Predictors and Point of View Toward Self-Medication Among Residents of Riyadh, Saudi Arabia: A Cross-Sectional Study.

Irrational Self-Medication (SM) practice leads to incorrect diagnosis and is a risk factor for disease exacerbation and serious health consequences. Hence Responsible SM is vital for better health outcomes. In the present community-based study we explored the SM practice during the last 3 months, frequency, outcome, medications used, reasons influencing SM, source of the drug, and information. Data were analyzed using SPSS; chi-square test was performed to indicate significance, Odds ratio, Pearson correlation, univariant and multivariant regression analysis were performed to find out factors and predictors of SM. A total of 611 residents completed the survey. SM was practiced by 52.9% of participants during the last 3 months, with a frequency of one to two times. Headache (64.8%), pain (35.4%), fever/flu (31.4%), cold & cough (21.9%) and dysmenorrhea (20.9%) were illnesses managed using pain killers (75.9%), multivitamins (25.5%), anti-pyretic (24.7%) and herbal medicines (18.5%). Minor illness (67.9%), earlier experience (33.9%) and shortness of time to attend healthcare facilities (18.8%) were the reasons for practicing SM. Distance to healthcare and routine physical activity have significantly influenced the SM practice. Residents stated that inappropriate SM would lead to negative outcomes, including drug side effects (70%), Interaction (34.2%), poor treatment outcome (32.6%) and return of symptoms (26.5%). Interestingly, two-thirds of participants (68.9%) have recommended SM in case of minor illnesses only, 85.3% of respondents have expressed their desire to learn more about appropriate SM, and 76.6% are willing to return their leftover or unused medications to drug take-back centers.

Incidence of Medication Errors in King Fahad Hospital Madina Saudi Arabia

Abstract This study aimed to evaluate the incidence of medication errors over a period of one year in King Fahad Hospital Madina Saudi Arabia. This retrospective, cross-sectional study was conducted over a period of one year from 2018 January to 2018 December using patient's records. King Fahad Hospital in Madina was selected for the study center. Data collected include the number and types of errors, severity, location of errors, errors by profession, and errors occurred in the medical wards. Statistical analysis was carried out using statistical package for social science version22. A total of twenty- six hundred and fifty-eight medication errors were reported during the study period. Among the reports 2567(96.5%) of the errors were due to near misses, followed by transcribing errors 1597(60%), ordering errors 928(34.9%), duplicative therapy 765(28.7%), wrong dose 454(%). The most common procedures involve medication errors were wrong documentation 442(16.6%), duration 168(6.3%) wrong quantity 162(6.4%). Majority of the medication errors were contributed by physicians (99.2%) and 0.7% of them were due to the pharmacist. In conclusion study findings reported that yet some kind of medication errors has been under reported and it was common in most hospital, further studies with intervention programs needed to control the incidence of medication errors in a Saudi hospital

Validation of the Arabic Version of General Medication Adherence Scale (GMAS) in Sudanese Patients with Diabetes Mellitus.

OBJECTIVE: The aim of this study was to validate the Arabic version of General Medication Adherence Scale (GMAS) in Sudanese patients with type 2 diabetes mellitus (T2DM). METHODS: A 3-month cross-sectional study was conducted among patients with T2DM at Al-Daraja Health Center, located in Wad Medani, Sudan. A convenient sample of patients was selected, and the study sample size was calculated using the item response ratio. Factorial, known group, and construct validities were determined. Internal consistency and reliability were also determined. RESULTS: Responses were provided by 500 patients. The average medication adherence score was 30 (median 31). The normed fit index (NFI) was 0.950, the comparative fit index (CFI) was 0.963, the incremental fit index (IFI) was 0.963, and the root-mean-square error of approximation (RMSEA) was 0.071. The results from these fit indices indicated a good model. Factorial, known group and construct validities were all established. A significant association was found between adherence score and age (P = 0.03) since a larger proportion of older patients were found to have high adherence compared to patients in other age groups. The reliability (α) of the questionnaire was 0.834. CONCLUSION: The Arabic version of GMAS was validated in Sudanese patients with T2DM making it a suitable scale to be used in this population.

Impacts of deficiency in vitamin D derivatives on disease severity in adult bronchial asthma patients.

Vitamin D affects innate and adaptive immunity processes that impact treatment, severity, and morbidity of acute asthma episodes. Several vitamin D forms may help modulate immunity, including vitamin D2 (D2), vitamin D3 (D3), 25-hydroxyvitamin D3 (25(OH)D3), and 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3). This study assessed serum levels of vitamin D derivatives in bronchial asthma patients and their correlation with disease markers. One hundred thirteen subjects, divided into two groups, were enrolled. The first group included 73 asthmatic patients (57 males and 16 females), and the second included 40 healthy adults (31 males and 9 females) as a control group. All subjects were evaluated with a careful history and clinical examination, a chest X-ray with a posteroanterior view, routine laboratory examination, spirometry, and asthma control tests (ACT). Vitamin D serum levels were assessed using ultra-performance liquid chromatography (UPLC) with tandem mass spectrometry. Disease markers were assessed and correlated with serum levels of vitamin D forms. Markers included forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC%, peak expiratory flow (PEF), forced expiratory flow25-75% (FEF25-75%), eosinophilic blood count, and total immunoglobulin E (IgE). Asthmatic patients had significantly lower serum levels of vitamin D than healthy controls (p ≤ 0.001). Further, serum vitamin D levels decreased significantly in uncontrolled asthmatic patients than partially controlled and controlled patients. Correlations for 25(OH)D3 and 1,25-(OH) 2D3 were stronger than for D2 and D3. There were negative correlations for eosinophilic blood count, total IgE, and ACT. Serum levels of all vitamin D forms were reduced in asthmatic patients with moderate to strong correlations with disease severity. Vitamin D deficiency or even insufficiency may thus play a role in disease severity.

Reporting Quality of Cost-Effectiveness Analyses Conducted in Saudi Arabia: A Systematic Review.

OBJECTIVES: Pharmacoeconomics and health economics in general is a new field that is still developing and emerging, not only in Saudi Arabia but all over the world. The objective of this study is to collect all published cost-effectiveness analysis (CEA) studies conducted based on Saudi settings and to evaluate their reporting quality. METHODS: We used PRISMA guidelines to search for all English-language CEAs conducted in Saudi Arabia in 3 databases: Medline, Embase, and Scopus. Keywords used in the search were: cost-effectiveness, cost-benefit, cost-utility, economic evaluation, Saudi Arabia. The data extracted were analyzed to assess reporting quality based on Consolidated Health Economic Evaluation Reporting Guidelines (CHEERS) and the second panel recommendations. RESULTS: The 3 databases yielded 859 articles after removing duplicates. Only 7 articles included as final results following PRISMA guidelines. These 7 studies were published between 2015 and 2020. The CEA studies varied in their reporting quality; however, there were common missing required items among all of them, such as justifying choosing of a specific model and time horizon and reporting the ethical implications of the studied interventions. CONCLUSION: Seven published CEA studies were conducted based on Saudi settings as revealed by this review. The included studies reported the more important aspects of CEA studies. However, there were missed reporting items based on the checklists we used to assess CEAs in this review. Although perfect and complete adherence to CHEERS or the second panel guidelines is a high standard, future CEAs should adhere to such standards. Transparency and good reporting are cornerstones in CEAs, and future CEAs should report their methods, findings, and results in a more transparent and efficient way.

Protective effect of metformin on rat diabetic retinopathy involves suppression of toll-like receptor 4/nuclear factor-k B expression and glutamate excitotoxicity.

Microvascular complications of diabetes mellitus are progressively significant reasons for mortality. Metformin (MET) is considered as the first-line therapy for type 2 diabetes patients, and may be especially beneficial in cases of diabetic retinopathy although the precise mechanisms of MET action are not fully elucidated. The current study was designed to inspect the antioxidant and modulatory actions of MET on DRET in streptozotocin-induced diabetic rats. The effect of MET on the toll-like receptor 4/nuclear factor kappa B (TLR4/NFkB), inflammatory burden and glutamate excitotoxicity was assessed. Twenty-four male rats were assigned to four experimental groups: (1) Vehicle group, (2) Diabetic control: developed diabetes by injection of streptozotocin (60 mg/kg, i.p.). (3&4) Diabetic + MET group: diabetic rats were left for 9 weeks without treatment and then received oral MET 100 and 200 mg/kg for 6 weeks. Retinal samples were utilized in biochemical, histological, immunohistochemical and electron microscopic studies. MET administration significantly decreased retinal level of insulin growth factor and significantly suppressed the diabetic induced increase of malondialdehyde, glutamate, tumor necrosis factor-α and vascular endothelial growth factor (VEGF). Further, MET decreased the retinal mRNA expression of NFkB, tumor necrosis factor-α and TLR4 in diabetic rats. The current findings shed the light on MET's efficacy as an adjuvant therapy to hinder the development of diabetic retinopathy, at least partly, via inhibition of oxidative stress-induced NFkB/TLR4 pathway and suppression of glutamate excitotoxicity.

Translation and validation of the Arabic version of the General Medication Adherence Scale (GMAS) in Saudi patients with chronic illnesses.

PURPOSE: The study aimed to translate and validate the Arabic version of General Medication Adherence Scale (GMAS) in Saudi patients with chronic diseases. METHODS: A multi-center cross sectional study was conducted for a month in out-patient wards of hospitals in Khobar, Dammam, Makkah, and Madinah, Saudi Arabia. Patients were randomly selected from a registered patient pools at hospitals and the item-subject ratio was kept at 1:20. The tool was assessed for factorial, construct, convergent, known group and predictive validities as well as, reliability and internal consistency of scale were also evaluated. Sensitivity, specificity, and accuracy were also evaluated. Data were analyzed using SPSS v24 and MedCalc v19.2. The study was approved by concerned ethics committees (IRB-129-25/6/1439) and (IRB-2019-05-002). RESULTS: A total of 282 responses were received. The values for normed fit index (NFI), comparative fit index (CFI), Tucker Lewis index (TLI) and incremental fit index (IFI) were 0.960, 0.979, 0.954 and 0.980. All values were >0.95. The value for root mean square error of approximation (RMSEA) was 0.059, i.e., <0.06. Hence, factorial validity was established. The average factor loading of the scale was 0.725, i.e., >0.7, that established convergent validity. Known group validity was established by obtaining significant p-value <0.05, for the associations based on hypotheses. Cronbach's α was 0.865, i.e., >0.7. Predictive validity was established by evaluating odds ratios (OR) of demographic factors with adherence score using logistic regression. Sensitivity was 78.16%, specificity was 76.85% and, accuracy of the tool was 77.66%, i.e., >70%. CONCLUSION: The Arabic version of GMAS achieved all required statistical parameters and was validated in Saudi patients with chronic diseases.