Crosstalk between Sodium-Glucose Cotransporter Inhibitors and Sodium-Hydrogen Exchanger 1 and 3 in Cardiometabolic Diseases.

Abnormality in glucose homeostasis due to hyperglycemia or insulin resistance is the hallmark of type 2 diabetes mellitus (T2DM). These metabolic abnormalities in T2DM lead to cellular dysfunction and the development of diabetic cardiomyopathy leading to heart failure. New antihyperglycemic agents including glucagon-like peptide-1 receptor agonists and the sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to attenuate endothelial dysfunction at the cellular level. In addition, they improved cardiovascular safety by exhibiting cardioprotective effects. The mechanism by which these drugs exert their cardioprotective effects is unknown, although recent studies have shown that cardiovascular homeostasis occurs through the interplay of the sodium-hydrogen exchangers (NHE), specifically NHE1 and NHE3, with SGLT2i. Another theoretical explanation for the cardioprotective effects of SGLT2i is through natriuresis by the kidney. This theory highlights the possible involvement of renal NHE transporters in the management of heart failure. This review outlines the possible mechanisms responsible for causing diabetic cardiomyopathy and discusses the interaction between NHE and SGLT2i in cardiovascular diseases.

Public attitudes towards community pharmacy in Arabic speaking Middle Eastern countries: A systematic review.

BACKGROUND: Over the last few years, pharmacy practice in the Arab regions of the Middle East has started to change and develop. There have been small but promising steps to recognize the importance of extending community pharmacists' roles to meet the expanding public healthcare demands. OBJECTIVES: This systematic review aims to identify, synthesize and assess the quality of the literature in the Middle East concerning public attitudes on community pharmacist role and services and in relation to public perceptions on strategies to improve pharmacy services and the image of community pharmacist. METHODS: A systematic search of 11 electronic databases was conducted to identify all published relevant studies from inception till January 2020. Data was extracted using a designed and tested tool. Studies were assessed for quality using Crowe Critical Appraisal Tool. RESULTS: The final study results included 36 studies of which 31 adopted a cross-sectional-survey-based design. Included studies were published between 2004 and 2019. Most studies were done in Saudi Arabia (n = 11) or the United Arab Emirates (UAE) (n = 10). We identified four overarching themes across included studies 1) Use of Community Pharmacies; 2) Attitudes towards Community Pharmacist role; 3) Attitudes towards Current Community Pharmacy Services and 4) Strategies to Improve Community Pharmacy Practice. The most common reason for visiting a community pharmacy was to purchase a prescription or over-the counter-medication. The most common factors that affected patients' choice of a particular pharmacy included convenient pharmacy location, availability of a good range of products or medicines, friendliness of the pharmacy staff and convenient pharmacy opening hours. There was a general public perception of community pharmacist as a business oriented person. Expectations of pharmacist duties included treatment of minor health ailments, consultation on over-the-counter medications and parapharmaceutical products, and accuracy checking of dispensed medications. Overall satisfaction with community pharmacy varied between the studies and ranged from 33% to 67.1%. Most commonly reported recommendations to improve pharmacy practice were provision of diagnostic, screening and monitoring services, keeping patient records in the pharmacy, advice on minor illness and provision of a private area for consultation. Seven articles were considered of low quality and 13 articles were considered of high quality. CONCLUSIONS: While the public in the Middle East has a good understanding of the basic duties of a community pharmacist, there is lack of awareness of advanced pharmaceutical services. Decision makers in Middle Eastern countries should set strategies to improve community pharmacist professional image and competence beyond medication dispensing.