Exploring pharmacists' attitude, willingness and barriers to provide extended community pharmacy services: Implications for improved pharmacy services.

OBJECTIVE: This study aimed to evaluate pharmacists' attitude and willingness to provide extended community pharmacy services (ECPS), the barriers to ECPS, and the factors associated with attitude and willingness to implement ECPS. METHODS: In this cross-sectional study, a validated, self-administered questionnaire was distributed online to community pharmacists across the United Arab Emirates between September and November 2023. In addition to sociodemographic data, the questionnaire evaluated attitudes toward ECPS, willingness to provide ECPS, and barriers to its implementation. Binary logistic regression was conducted to explore the factors associated with attitude and willingness to implement ECPS. RESULTS: The study included 409 pharmacists. Over half of the participants reported below the median attitude (58.7%) and willingness (59.4%) scores. Female pharmacists had a lower attitude towards ECPS (OR = 0.425, 95%CI: 0.242-0.747). Higher number of daily prescriptions (OR = 1.066, 95%CI: 1.029-1.105) and being a Pharm D graduate (OR = 2.664, 95%CI: 1.439-4.932) were associated with higher willingness to provide ECPS, while an increased number of employed pharmacists (OR = 0.518, 95%CI: 0.397-0.676) was associated with a lower willingness (OR = 0.049, 95%CI: 0.004-0.660). Patients' preoccupation (76.5%), lack of specific training (76.3%), lack of clinical problem-solving skills (74.6%) and lack of a private consultation room (74.6%) were the most commonly reported barriers to ECPS. CONCLUSIONS: Community pharmacists demonstrated unsatisfactory levels of attitude and willingness towards ECPS provision. Therefore, providing training and education programs that enhance pharmacists' perception and willingness to implement ECPS and emphasize improving clinical problem-solving skills, as well as setting up specific private consultation rooms, is deemed necessary. Female pharmacy graduates, pharmacists dispensing fewer daily prescriptions, and those working with a higher number of employed pharmacists should be specifically targeted when implementing these strategies.

Predicting hypoglycemia in ICU patients: a machine learning approach.

BACKGROUND: The current study sets out to develop and validate a robust machine-learning model utilizing electronic health records (EHR) to forecast the risk of hypoglycemia among ICU patients in Jordan. RESEARCH DESIGN AND METHODS: The present study drew upon a substantial cohort of 13,567 patients admitted 26,248 times to the intensive care unit (ICU) over 10 years from July 2012 to July 2022. The primary outcome of interest was the occurrence of any hypoglycemic episode during the patient's ICU stay. Developing and testing predictor models was conducted using Python machine-learning libraries. RESULTS: A total of 1,896 were eligible to participate in the study, 206 experienced at least one hypoglycemic episode. Eight machine-learning models were trained to predict hypoglycemia. All models showed predicting power with a range of 74.53-99.69 for AUROC. Except for Naive Bayes, the six remaining models performed distinctly better than the basic logistic regression usually used for prediction in epidemiological studies. CatBoost model was consistently the best performer with the highest AUROC (0.99), accuracy and precision, sensitivity and specificity, and recall. CONCLUSIONS: We used machine learning to anticipate the likelihood of hypoglycemia, which can significantly decrease hypoglycemia incidents and enhance patient outcomes.

Antithrombotic utilization, adverse events, and associations with treatment outcomes in multiple myeloma: pooled analysis of three clinical trials.

Background: Patients with multiple myeloma (MM) are at risk of venous thromboembolism (VTE), worsened by immunomodulatory drugs. Although antithrombotics are recommended for prophylaxis, existing guidelines are suboptimal and treatment outcomes remain unclear. Objectives: This study aimed to investigate adverse events, antithrombotic utilization, and their associations with survival outcomes in patients with MM initiating multi-drug immunomodulatory combinations. Design: A posthoc analysis of individual-participant level data (IPD). Methods: IPD from three daratumumab clinical trials (MAIA, POLLUX, and CASTOR) were pooled. Adverse events incidence and antithrombotic utilization were assessed. Logistic and Cox regression were utilized to examine associations between antithrombotics use with adverse events and survival outcomes at the baseline and 6-month landmark. Results: Among 1804 patients, VTE occurred in 10%, bleeding in 14%, ischemic heart disease in 4%, and stroke in 2%. Patients with these adverse events demonstrated elevated rates of any grade ⩾3 events. Antiplatelet (primarily aspirin) and anticoagulant (primarily LMWH and direct oral anticoagulants) prescriptions have seen an increase from baseline (25% and 14%, respectively) to 6 months (35% and 31%). The primary indication for their use was prophylaxis. Anticoagulant use within 6 months was associated with reduced VTE (OR (95% CI) = 0.45 (0.26-0.77), p = 0.004), while antiplatelet use showed no associations with any evaluated adverse events. Antithrombotics and survival outcomes had no significant associations. Conclusion: This study underscores the complexities of antithrombotic therapy and adverse events in MM and highlights the need for vigilant and proactive management due to increased grade ⩾3 adverse events. While anticoagulant use was associated with reduced VTE risk, further research is needed to optimize thromboprophylaxis guidelines and explore antithrombotic efficacy and safety in patients with MM. Trial registration: MAIA (NCT02252172), POLLUX (NCT02076009), CASTOR (NCT02136134).

Blood clot prevention drugs in multiple myeloma: usage and impact on patient outcomes Aims and Purpose of the Research This study aimed to understand how blood-thinning medications are used by patients with multiple myeloma, a type of blood cancer. Specifically, we wanted to find out how often these medications are used, what side effects they might cause, and whether they are linked with how long the patients live. Background of the Research This study is important because patients with multiple myeloma often have a higher risk of blood clots, especially when they are taking certain anticancer treatments. Blood-thinning drugs are usually recommended to prevent these clots, but it's not always clear how well these drugs work or what side effects they might cause. Methods and Research Design This study looked at data from three clinical trials involving a multiple myeloma drug called daratumumab. We looked at how often side effects occurred and how often blood-thinning drugs were used. Two groups of blood thinning drugs were investigated: antiplatelets and anticoagulants. We used two types of statistical methods, called logistic and Cox regression, to see if there was a connection between the use of these blood-thinning drugs and the occurrence of side effects or survival rates at the start of the study and after six months. Results and Importance The study found that the use of blood-thinning drugs increased over time and that using anticoagulants within the first six months was linked to a lower risk of blood clots. However, blood-thinning drugs were not linked with how long the patients lived. These results are important because they can help doctors better manage the use of blood-thinning drugs in patients with multiple myeloma. The key message is that more research is needed to improve guidelines for preventing blood clots and to better understand the safety and effectiveness of blood-thinning drugs in these patients.

A non-targeted metabolomics comparative study on plasma of pfizer and sinopharm COVID-19 vaccinated individuals, assessed by (TIMS-QTOF) mass spectrometry.

COVID-19 is a highly contagious infectious disease that has posed a global threat, leading to a widespread pandemic characterized by multi-organ complications and failures. AIMS: The present study was conducted to evaluate the impact of Pfizer and Sinopharm vaccines on metabolomic changes and their correlations with immune pathways. MAIN METHODS: The study used a cross-sectional design and implemented an untargeted metabolomics-based approach. Plasma samples were obtained from three groups: non-vaccinated participants, Sinopharm-vaccinated participants, and Pfizer-vaccinated participants. Comparative metabolomic analysis was conducted using TIMS-QTOF, and multiple t-tests with a 5 % false discovery rate (FDR) were performed using MetaboAnalyst software. KEY FINDINGS: Out of the 105 metabolites detected, 72 showed statistically significant changes (p-value < 0.05) across the different groups. Notably, several metabolites such as neopterin, pyridoxal, and syringic acid were markedly altered in individuals vaccinated with Pfizer. Conversely, in the Sinopharm-vaccinated group, significant alterations were observed in sphinganine, neopterin, and sphingosine. These metabolites hold potential as biomarkers for evaluating vaccine efficacy. Additionally, both Pfizer and Sinopharm vaccinations were found to influence sphingolipid and histidine metabolisms compared to the control group. The Sinopharm group also displayed changes in lysine degradation relative to the control group. When comparing the enriched pathways between the Pfizer and Sinopharm-vaccinated groups, differences were observed in purine metabolism. Furthermore, alterations in tryptophan and vitamin B6 metabolism were noted when comparing the Pfizer-vaccinated group with both the control and Sinopharm-vaccinated groups. SIGNIFICANCE: These findings highlight the importance of metabolomics in assessing vaccine effectiveness and identifying potential biomarkers for monitoring the efficacy of newly developed vaccines in a shorter timeframe.

Prevalence and predictors of hypoglycemia in older outpatients with type 2 diabetes mellitus.

BACKGROUND: The prevalence of type 2 diabetes (DM) has been increasing globally, particularly among older adults who are more susceptible to DM-related complications. Elderly individuals with diabetes are at higher risk of developing hypoglycemia compared with younger diabetes patients. Hypoglycemia in elderly patients can result in serious consequences such as cognitive changes, increased risk of falls, heart and other vascular problems, and even high mortality rate. OBJECTIVE: To assess prevalence, and factors associated with hypoglycemia events among geriatric outpatients with type 2 diabetes mellitus. METHODS: The study was conducted at King Abdullah University Hospital (KAUH) at the outpatient diabetes clinic from October 1st, 2022 to August 1st, 2023. Variables such as socio-demographics, medication history, and comorbidities were obtained using electronic medical records. The prevalence of hypoglycemia was determined through patient interviews during their clinic visit. Patients were prospectively monitored for hospital admissions, emergency department visits, and mortality using electronic medical records over a three-month follow-up period. Logistic regression models were conducted to identify factors associated with hypoglycemia and hospital admissions/ emergency visits. Ethical Approval (Reference # 53/151/2022) was obtained on 19/9/2022. RESULTS: Electronic medical charts of 640 patients who have type 2 diabetes mellitus and age ≥ 60 years were evaluated. The mean age ± SD was 67.19 (± 5.69) years. Hypoglycemia incidents with different severity levels were prevalent in 21.7% (n = 139) of the patients. Insulin administration was significantly associated with more hypoglycemic events compared to other antidiabetic medication. Patients with liver diseases had a significantly higher risk of hypoglycemia, with odds 7.43 times higher than patients without liver diseases. Patients with dyslipidemia also had a higher risk of hypoglycemia (odd ratio = 1.87). Regression analysis revealed that hypoglycemia and educational level were significant predictors for hospital admission and emergency department (ER) visits. Hypoglycemia was a positive predictor, meaning it increased the odds of these outcomes, while having a college degree or higher was associated with reduced odds of hospital admission and ER visits. CONCLUSION: Current study identified a considerable prevalence of hypoglycemia among older patients with type 2 diabetes, particularly, among those with concurrent liver diseases and dyslipidemia. Furthermore, hypoglycemia was associated with an increased rate of emergency department visits and hospital admissions by 2 folds in this population.

Time for health change: promoting community-based diabetes screening and prevention with video vignettes and social marketing.

Meaningful communication between health service users and providers is essential. However, when stakeholders are unfamiliar with new health services, innovative communication methods are necessary to engage them. The aim of the study was to create, validate, and evaluate a video-vignette to enhance stakeholders' (physicians, pharmacists, and laypeople) engagement and understanding of an innovative pharmacy-based diabetes screening and prevention program. Also, to assess the video-vignette's capacity to measure appetite and appeal for such preventive programs. This mixed-methods study consisted of two phases. In phase one, a video-vignette depicting the proposed screening and prevention program was developed and validated following established international guidelines (n = 25). The video-vignette was then evaluated by stakeholders (n = 99). In phase two, the video-vignette's capacity as a communication tool was tested in focus groups and interviews to explore stakeholders' perspectives and engagement on the proposed service (n = 22). Quantitative data were analyzed descriptively, while qualitative data underwent thematic analysis. In total, 146 stakeholders participated. The script was well-received, deemed credible, and realistic. Furthermore, the video-vignette received high ratings for its value, content, interest, realism, and visual and audio quality. The focus groups and interviews provided valuable insights into the design and delivery of the new service. The video-vignette compellingly portrayed the novel pharmacy-based diabetes screening and prevention service. It facilitated in-depth discussions among stakeholders and significantly enhanced their understanding and appreciation of such health services. The video-vignette also generated significant interest in pharmacy-based diabetes screening and prevention programs, serving as a powerful tool to promote enrollment in these initiatives.

The Genetic Architecture of Parkinson's Disease in the AfrAbia Population: Current State and Future Perspectives.

Over 80% of genetic studies in the Parkinson's disease (PD) field have been conducted on individuals of European descent. There is a social and scientific imperative to understand the genetic basis of PD across global populations for therapeutic development and deployment. PD etiology is impacted by genetic and environmental factors that are variable by ancestry and region, emphasising the need for worldwide programs to gather large numbers of patients to identify novel candidate genes and risk loci involved in disease. Only a handful of documented genetic assessments have investigated families with PD in AfrAbia, which comprises the member nations of the Arab League and the African Union, with very limited cohort and case-control studies reported. This review article summarises prior research on PD genetics in AfrAbia, highlighting gaps and challenges. We discuss the etiological risk spectrum in the context of historical interactions, highlighting allele frequencies, penetrance, and the clinical manifestations of known genetic variants in the AfrAbian PD patient community.

Awareness, perspectives and practices of antibiotics deprescribing among physicians in Jordan: a cross-sectional study.

Background: Antibiotics have significantly reduced mortality and improved outcomes across various medical fields; however, the rise of antibiotic resistance poses a major challenge, causing millions of deaths annually. Deprescribing, a process that involves discontinuing unnecessary antibiotics, is crucial for combating this threat. This study was designed to assess the knowledge, perceptions, and practices of physicians regarding antibiotic deprescribing in Jordan. Methods: A cross-sectional survey was conducted between January-February 2024 to assess the knowledge, perceptions, and practices of physicians regarding antibiotic deprescribing in Jordan. An electronic questionnaire served as the data collection tool. Descriptive analysis was performed using SPSS software version 26. Additionally, logistic regression analysis was carried out to identify independent factors associated with physicians' willingness to deprescribe antibiotics. Results: The study involved 252 physicians, primarily male (n = 168, 67.7%), with a median age of 33 years. Regarding antibiotics deprescribing, 21.8% (n = 55) expressed willingness to deprescribe inappropriate antibiotics.High awareness of deprescribing was evident, with 92.9% (n = 234) familiar with the concept, 94% (n = 237) knowledgeable about appropriate situations, and 96.8% (n = 244) recognising its potential benefits. Furthermore, 81.8% (n = 205) reported having received formal training in antibiotics deprescribing, and 85.3% (n = 215) were informed about the availability of deprescribing tools.Physicians highlighted challenges including insufficient time (44.4%, n = 112) and resistance from patients (41.3%, n = 104) and colleagues (42.1%, n = 106). Despite challenges, a significant proportion regularly assessed antibiotic necessity (46.9%, n = 117) and educated patients about antibiotic-related harms (40.5%, n = 102). Logistic regression analysis revealed no significant demographic factors influencing physicians' willingness to deprescribe antibiotics (p > 0.05). Conclusion: Physicians in Jordan exhibit high awareness of antibiotics deprescribing and recognise its benefits. Challenges such as time constraints and communication barriers need to be addressed to facilitate effective deprescribing practices. Comprehensive guidelines and interdisciplinary collaboration are essential for promoting judicious antibiotic use and combating antimicrobial resistance.

Evaluating community pharmacists awareness, perception and roles in providing emergency contraceptives in Jordan.

OBJECTIVE: This cross-sectional study aimed to assess Jordanian community pharmacists' awareness, perception, and roles concerning emergency contraceptives provision. STUDY DESIGN: We administered a structured questionnaire to community pharmacists in Jordan using convenience sampling. The questionnaire included sections on demographic information, knowledge about emergency contraceptives, perception towards emergency contraceptive, and prior experience in emergency contraceptives provision. RESULTS: A total of 299 community pharmacists responded to the study. Most pharmacists had a Pharm D/BPharm degree (94.6%) and worked in independent community pharmacies (75.6%). While pharmacists demonstrated relatively high knowledge scores regarding emergency contraception, with a median score of 10 out of 14, misconceptions persisted, particularly regarding the mechanism of action and side effects of emergency contraception. Pharmacists expressed mixed perceptions regarding emergency contraception, with a significant proportion advocating for prescription-only access (76.6%) and expressing ethical reservations (48.2%). Only 38.1% reported prior experience in emergency contraceptives provision. Regression analyses revealed that attendance at emergency contraceptives-focused workshops significantly increased the likelihood of pharmacists providing emergency contraceptives (Adjusted Odds Ratio=2.569, p = 0.001). CONCLUSIONS: Jordanian community pharmacists exhibit readiness to provide emergency contraceptives, but persistent misconceptions and regulatory barriers hinder optimal provision. Targeted educational interventions, particularly through workshops, are crucial in enhancing pharmacists' knowledge and promoting emergency contraceptives provision. IMPLICATIONS: Responding pharmacists often reported the misconception that emergency contraceptives can cause abortion. Also, some pharmacists expressed religious or moral objections to prescribing oral emergency contraceptives. Thus, this study underscores the importance of receiving comprehensive training on ethical and religious considerations in healthcare practice.

Costs saved and avoided from pharmacist interventions to address drug-related problems identified from outpatient clinics in Jordan.

BACKGROUND: The pharmacist plays an essential role in identifying and managing drug-related problems. The aim of this research was to assess the costs avoided by clinical pharmacist interventions to resolve drug-related problems. RESEARCH DESIGN AND METHODS: Clinical pharmacists identified drug-related problems and interventions to address them in consecutive outpatients visiting internal medicine clinics at major teaching and public hospitals in Jordan from September 2012 to December 2013. The costs avoided by each intervention to address drug-related problems were collected from the literature. The collected data were used to calculate the overall cost saved and avoided by the interventions implemented to address the identified drug-related problems, adopting a Jordanian healthcare system perspective. RESULTS: A total of 2747 patients were enrolled in the study. Diagnostic interventions, such as the need for additional diagnostic testing, were employed in 95.07% of the 13935 intervention to address the drug-related problem "Miscellaneous" which was the most frequent drug-related problems. Other common drug-related problems categories included inappropriate knowledge (n = 6972), inappropriate adherence (4447), efficacy-related drug-related problem (3395) and unnecessary drug therapy (1082). The total cost avoided over the research period was JOD 1418720 per month and total cost saved over the study period was JOD 17250.204. Drug-related problems were associated the number of prescription medications (odds ratio = 1.105; 95% confidence interval = 1.069-1.142), prescribed gastrointestinal drugs (3.485; 2.86-4.247), prescribed antimicrobials (3.326; 1.084-10.205), and prescribed musculoskeletal drugs (1.385; 1.011-1.852). CONCLUSIONS: The study revealed that pharmacists have provided cognitive input to rationalize and optimize the medication use and prevent errors, that led to the reported projected avoided and saved expenditures via various interventions to address drug-related problems. This highlights the added economic impact to the clinical impact of drug-related problems on patients and the healthcare system. The high prevalence and cost of drug-related problems offer strong rationale for pharmacists to provide more vigilant intervention to improve patient outcomes while maintaining cost effectiveness.

Evaluation of Novel HLM Peptide Activity and Toxicity against Planktonic and Biofilm Bacteria: Comparison to Standard Antibiotics.

BACKGROUND: Antibiotic resistance is one of the main concerns of public health, and the whole world is trying to overcome such a challenge by finding novel therapeutic modalities and approaches. This study has applied the sequence hybridization approach to the original sequence of two cathelicidin natural parent peptides (BMAP-28 and LL-37) to design a novel HLM peptide with broad antimicrobial activity. METHODS: The physicochemical characteristics of the newly designed peptide were determined. As well, the new peptide's antimicrobial activity [Minimum Inhibitory Concentration (MIC), Minimum Bacterial Eradication Concentration (MBEC), and antibiofilm activity] was tested on two control (Staphylococcus aureus ATCC 29213, Escherichia Coli ATCC 25922) and two resistant [Methicillin-resistant Staphylococcus aureus (MRSA) ATCC BAA41, New Delhi metallo-beta- lactamase-1 Escherichia coli ATCC BAA-2452) bacterial strains. Furthermore, synergistic studies have been applied to HLM-hybridized peptides with five conventional antibiotics by checkerboard assays. Also, the toxicity of HLM-hybridized peptide was studied on Vero cell lines to obtain the IC50 value. Besides the percentage of hemolysis action, the peptide was tested in freshly heparinized blood. RESULTS: The MIC values for the HLM peptide were obtained as 20, 10, 20, and 20 µM, respectively. Also, the results showed no hemolysis action, with low to slightly moderate toxicity action against mammalian cells, with an IC50 value of 10.06. The Biomatik corporate labs, where HLM was manufactured, determined the stability results of the product by Mass Spectrophotometry (MS) and High-performance Liquid Chromatography (HPLC) methods. The HLM-hybridized peptide exhibited a range of synergistic to additive antimicrobial activities upon combination with five commercially available different antibiotics. It has demonstrated the biofilm-killing effects in the same concentration required to eradicate the control strains. CONCLUSION: The results indicated that HLM-hybridized peptide displayed a broad-spectrum activity toward different bacterial strains in planktonic and biofilm forms. It showed synergistic or additive antimicrobial activity upon combining with commercially available different antibiotics.

Perspectives of Pharmacy Students on Ethical Issues Related to Artificial Intelligence: A Comprehensive Survey Study.

Background: The integration of artificial intelligence (AI) into pharmacy education and practice holds the potential to advance learning experiences and prepare future pharmacists for evolving healthcare practice. However, it also raises ethical considerations that need to be addressed carefully. This study aimed to explore pharmacy students' attitudes regarding AI integration into pharmacy education and practice. Methods: A cross-sectional design was employed, utilizing a validated online questionnaire administered to 702 pharmacy students from diverse demographic backgrounds. The questionnaire gathered data on participants' attitudes and concerns regarding AI integration, as well as demographic information and factors influencing their attitudes. Results: Most participants were female students (72.8%), from public universities (55.6%) and not working (64.2%). Participants expressed a generally negative attitude toward AI integration, citing concerns and barriers such as patient data privacy (62.0%), susceptibility to hacking (56.2%), potential job displacement (69.3%), cost limitations (66.8%), access (69.1%) and the absence of regulations (48.1% agree), training (70.4%), physicians' reluctance (65.1%) and patient apprehension (70.8%). Factors including country of residence, academic year, cumulative GPA, work status, technology literacy, and AI understanding significantly influenced participants' attitudes (p < 0.05). Conclusion: The study highlights the need for comprehensive AI education in pharmacy curricula including related ethical concerns. Addressing students' concerns is crucial to ensuring ethical, equitable, and beneficial AI integration in pharmacy education and practice.

Metabolomics and Proteomics in Prostate Cancer Research: Overview, Analytical Techniques, Data Analysis, and Recent Clinical Applications.

Prostate cancer (PCa) is a significant global contributor to mortality, predominantly affecting males aged 65 and above. The field of omics has recently gained traction due to its capacity to provide profound insights into the biochemical mechanisms underlying conditions like prostate cancer. This involves the identification and quantification of low-molecular-weight metabolites and proteins acting as crucial biochemical signals for early detection, therapy assessment, and target identification. A spectrum of analytical methods is employed to discern and measure these molecules, revealing their altered biological pathways within diseased contexts. Metabolomics and proteomics generate refined data subjected to detailed statistical analysis through sophisticated software, yielding substantive insights. This review aims to underscore the major contributions of multi-omics to PCa research, covering its core principles, its role in tumor biology characterization, biomarker discovery, prognostic studies, various analytical technologies such as mass spectrometry and Nuclear Magnetic Resonance, data processing, and recent clinical applications made possible by an integrative "omics" approach. This approach seeks to address the challenges associated with current PCa treatments. Hence, our research endeavors to demonstrate the valuable applications of these potent tools in investigations, offering significant potential for understanding the complex biochemical environment of prostate cancer and advancing tailored therapeutic approaches for further development.

Sildenafil Effect on Atrial Natriuretic Peptide Level in Pulmonary Hypertensive Rats.

BACKGROUND: Pulmonary Hypertension (PH) leads to changes in pulmonary vascular architecture, hypertrophy of the right ventricle, and heart failure. Sildenafil is a drug that can modulate PH by inducing smooth muscle relaxation and vasodilation. AIMS: To investigate the ability of sildenafil to alleviate the monocritaline (MCT)-induced PH in rats and to estimate the role and its effect on the atrial natriuretic peptide (ANP) levels. METHODS: 28 adult male rats were divided randomly into four groups: Group A (control group; n=7). Group B (MCT-treated group; n=7) was given a single dose of MCT 60 mg/kg subcutaneously. Group C (The reversal group; n=7) received a single dose of MCT 60 mg/kg subcutaneously for three weeks and then sildenafil at 50 mg/kg/day, given daily for another three weeks. Group D (The prevention group; n=7) simultaneously received a single dose of MCT 60 mg/kg subcutaneously and sildenafil daily at 50 mg/kg for three weeks. RESULTS: The animals in the prevention group showed a significant decrease in ANP levels compared to the reversal and MCT-treated groups. This decrease was associated with a significant reduction in the Fulton index ratio in the prevention group compared to the reversal group. The nitric oxide levels were also significantly higher in the reversal group than in the control group. CONCLUSION: Preventive sildenafil treatment was associated with a significant decrease in ANP levels and reduced MCT-induced cardiac hypertrophy in rats.

Ethical considerations and concerns in the implementation of AI in pharmacy practice: a cross-sectional study.

BACKGROUND: Integrating artificial intelligence (AI) into healthcare has raised significant ethical concerns. In pharmacy practice, AI offers promising advances but also poses ethical challenges. METHODS: A cross-sectional study was conducted in countries from the Middle East and North Africa (MENA) region on 501 pharmacy professionals. A 12-item online questionnaire assessed ethical concerns related to the adoption of AI in pharmacy practice. Demographic factors associated with ethical concerns were analyzed via SPSS v.27 software using appropriate statistical tests. RESULTS: Participants expressed concerns about patient data privacy (58.9%), cybersecurity threats (58.9%), potential job displacement (62.9%), and lack of legal regulation (67.0%). Tech-savviness and basic AI understanding were correlated with higher concern scores (p < 0.001). Ethical implications include the need for informed consent, beneficence, justice, and transparency in the use of AI. CONCLUSION: The findings emphasize the importance of ethical guidelines, education, and patient autonomy in adopting AI. Collaboration, data privacy, and equitable access are crucial to the responsible use of AI in pharmacy practice.

Confidence, attitude, and practice of scientific research among health professions' students in the United Arab Emirates.

OBJECTIVE: This study aimed to assess the confidence, attitude, and scientific research practices of undergraduate students of different health profession specialties. METHODS: In this cross-sectional study, an online-based questionnaire was distributed as a Google Form via groups and pages of medical universities available on social media sites such as Facebook, WhatsApp, and Twitter to the second- to sixth-year students of different health profession specialties in different universities across the United Arab Emirates (UAE) in the period from October through December 2023 using the convenience sampling technique. The questionnaire included four parts that assessed socio-demographics and custom-designed research-related questions (6 items), perceived confidence (8 items), attitudes (14 items), and the practice in the context of scientific research and its implementation (9 items). Multivariate logistic regression analyses were conducted to explore the variables associated with the study outcomes, including confidence, attitudes, and practice levels. RESULTS: The study included 522 undergraduate students. The participants reported low confidence, a negative attitude, and low scientific research practice. Regression results revealed that individuals without prior research experiences were less likely to have high confidence and practice compared to those with previous research experience (OR = 0.634, 95% CI: 0.426-0.945, p = 0.025; and OR = 0.139, 95%Cl: 0.090-0.216, P<0.001, respectively). Additionally, participants who reported difficulty in differentiating between various literature resources were less likely to have high confidence and practice compared to those who reported the ability to differentiate (OR = 0.627, 95% CI: 0.42-0.935, p = 0.022, and OR = 0.370, 95%Cl: 0.237-0.579, p<0.001, respectively). Furthermore, individuals who had not taught research methods in their undergraduate studies were less likely to have high practice (OR = 0.505, 95%Cl: 0.309-0.823, p = 0.06). CONCLUSIONS: Undergraduates of different medical specialties in the UAE demonstrated acceptable levels of confidence and attitude toward scientific research, with several areas for practice improvement. Education and training courses focusing on various aspects of scientific research should be incorporated into the medical curricula in order to enhance students' confidence and practice of scientific research.

Determinants of Health-Related Quality of Life in Outpatients with Myocardial Infarction.

Background: The health-related quality of life (HRQOL) of patients with myocardial infarction (MI) is suboptimal because of the disease's life-threatening nature, the requirement for long-term lifestyle modifications, and the treatment regimens following MI. This study aimed to evaluate HRQOL and its associated factors in MI patients. Material and Methods: This study was conducted on patients with MI who attended the outpatient cardiology clinic at a major teaching hospital in Jordan. The EQ-5D-3L questionnaire was used to assess HRQOL of the study participants. Quantile regression analysis was conducted to identify the variables associated with HRQOL. Results: The study included 333 patients with a history of MI, with a median age of 58 (57-60). The median of the total EQ-5D score was 0.65 (0.216-0.805). Regression results revealed that male patients (Coefficient= 0.110, 95%Cl (0.022-0.197), P=0.014) and not being diagnosed with diabetes (Coefficient= 0.154, 95%Cl (0.042-0.266), P=0.007) were associated with increased HRQOL. On the other hand, low income (Coefficient= -0.115, 95%Cl (-0.203 - -0.026), P=0.011), not receiving DPP-4 (Dipeptidyl Peptidase -4) inhibitors (Coefficient= -0.321 95%Cl (-0.462 - -0.180), P<0.001), and having low (Coefficient= -0.271, 95%Cl (-0.395 - -0.147), P<0.001) or moderate (Coefficient= -0.123, 95%Cl (-0.202 - -0.044), P=0.002) medication adherence was associated with decreased HRQOL. Conclusion: The current study demonstrated diminished HRQOL among patients with MI, highlighting the necessity of tailoring interventions to tackle medication adherence barriers in this population. Personalized interventions such as educational programs, counseling, and reminders that consider each patient's needs and circumstances can greatly enhance medication adherence and, thus, the HRQOL of MI patients. Individuals with lower income levels, female patients, and those with diabetes should be the specific targets of these interventions.

Sildenafil prevents chronic psychosocial stress-induced working memory impairment: Role of brain-derived neurotrophic factor.

Background: Psychosocial stress, a common feature in modern societies, impairs cognitive functions. It is suggested that stress hormones and elevated excitatory amino acids during stress are responsible for stress-induced cognitive deficits. Reduced brain-derived neurotrophic factor (BDNF) levels, increased oxidative stress, and alteration of synaptic plasticity biomarkers are also possible contributors to the negative impact of stress on learning and memory. Sildenafil citrate is a selective phosphodiesterase type 5 (PDE5) inhibitor and the first oral therapy for the treatment of erectile dysfunction. It has been shown that sildenafil improves learning and memory and possesses antioxidant properties. We hypothesized that administering sildenafil to stressed rats prevents the cognitive deficit induced by chronic psychosocial stress. Methods: Psychosocial stress was generated using the intruder model. Sildenafil 3 mg/kg/day was administered intraperitoneally to animals. Behavioral studies were conducted to test spatial learning and memory using the radial arm water maze. Then, the hippocampal BDNF level and several antioxidant markers were assessed. Results: This study revealed that chronic psychosocial stress impaired short-term but not long-term memory. The administration of sildenafil prevented this short-term memory impairment. Chronic psychosocial stress markedly reduced the level of hippocampal BDNF (P˂0.05), and this reduction in BDNF was normalized by sildenafil treatment. In addition, neither chronic psychosocial stress nor sildenafil significantly altered the activity of measured oxidative parameters (P > 0.05). Conclusion: Chronic psychosocial stress induces short-term memory impairment. The administration of sildenafil citrate prevented this impairment, possibly by normalizing the level of BDNF.

Navigating parental attitudes on childhood vaccination in Jordan: a cross-sectional study.

This study investigated parental attitudes toward childhood vaccination in Jordan, focusing on acceptance, concerns, and perceptions. A cross-sectional survey conducted from January to February 2024 included 939 parents. Findings indicated that 85.4% (n = 802) of respondents received the COVID-19 vaccine, while only 25% (n = 229) vaccinated their children. Concerns regarding vaccine safety and efficacy were prevalent, with 63.9% (n = 600) expressing worries about side effects and 46.9% (n = 440) trusting immunization programs. Post-pandemic, 34% (n = 319) reported a more negative attitude. Logistic regression showed parents not vaccinating their children against COVID-19 were significantly less likely to exhibit positive attitudes toward childhood vaccination (OR = 0.412, p < 0.001). Older participants were more inclined toward negativity post-pandemic (OR = 1.031, p = 0.007). In conclusion, parental attitudes shifted post-COVID-19, reflecting hesitancy and decreased trust. Addressing concerns and restoring confidence are crucial, especially for children's health. Education through healthcare providers and dispelling social media misinformation are essential. Implementing strategies to enhance post-pandemic vaccine acceptance is imperative for preventing outbreaks of vaccine-preventable diseases.

Knowledge of cancer symptoms and risk factors: A cross-sectional study from a developing country.

The delayed presentation of cancer patients to healthcare facilities for diagnosis is a pressing issue, as late-stage cancer cases are often more challenging to treat effectively. In low-resource settings, such as those with limited access to healthcare facilities, the impact of inadequate awareness of cancer signs and symptoms can be particularly severe. Therefore, this study aimed to evaluate public knowledge of cancer signs and symptoms and risk factors in the context of Jordan. This cross-sectional study was conducted among participants from all settings. Data was obtained from an Arabic version of the cancer awareness measure (CAM), which was answered online. It described demographic data and knowledge of cancer prevalence, age-related risk, signs, symptoms, and risk factors in recall and recognition-type questions. Participants (n = 1998) completed the questionnaire with a Median age of 35 and an interquartile range of 24. About half (n = 1070) thought that cancer is unrelated to age. Most participants identified breast cancer as the most common cancer among women (81%). Awareness of cancer signs/symptoms significantly differed in the level of knowledge in favor of females. The symptom "unexplained weight loss" was most commonly recognized (66.3%) and "persistent difficulty swallowing" the least (42.6%). As for risk factors, "smoking" was the most identified (76.9%) and "eating less than 5 portions of fruits and vegetables a day" was the least (19%), and "doing <30 minutes of moderate physical activity 5 times a week" as a close second least (19.95%). Females identified "smoking," "passive smoking," "HPV infection," and "having a close relative with cancer" as risk factors significantly more than males. Those with good economic status were more aware that smoking is a cancer risk factor by 1.51 times compared to those with poor economic status. To enhance early diagnosis and presentation in Jordan, there is a need for increased public awareness of the signs, symptoms, and risk factors of cancer. One effective strategy to achieve this goal is to conduct targeted public campaigns that cater to different population groups, such as the youth, to improve their understanding and ensure that the message resonates.