The preparedness and knowledge of pharmacists and general practitioners in managing human monkeypox: a highly spreading infectious disease.

BACKGROUND: After the era of the COVID-19 pandemic, the role of pharmacists was emphasized in the battle against highly spreading and infectious diseases like human Monkeypox (hMPV). AIM: Assess the hMPV knowledge of the community, clinical pharmacists, and general practitioners (GPs) and raise their awareness about hMPV. METHODS: A web-based questionnaire was distributed randomly to Egyptian community pharmacists, clinical pharmacists, and GPs from all governorates. The questionnaire was divided into two sections: one for demographic information and the other for hMPV knowledge (nature of the disease, incubation period, transmission, symptoms, Prophylaxis, Prevention, and management). The evidence-based answers were provided after completing the submission. Data were descriptively analyzed using IBM SPSS software. RESULTS: From a total of 753 respondents, only 710 participants were included in the final data analysis. The % of respondents who presented good total knowledge scores about hMPV was comparable between study groups (P = 0.826). There were no differences between groups identifying different disease clinical characteristics (P = 0.689) and hMPV management (P = 0.324). Community pharmacists had better knowledge scores than GPs in the prevention and prophylaxis domain (P = 0.037). CONCLUSION: Pharmacists and GPs have good and similar knowledge levels of hMPV. However, a gap exists in recognizing the right hMPV incubation period, prophylaxis, and omitting antibiotics from hMPV management. Pharmacists and GPs are the frontline health care providers (HCPs), so they would require more knowledge enhancement about such contagious diseases to offer the best possible patient care.

The impact of mindfulness-based stress reduction on psychological health among patients with chronic diseases during COVID-19 outbreak lockdown.

Background: The emergence of COVID-19 has spurred a wide range of psychological morbidities. However, its influence on a vulnerable population with chronic conditions is less addressed. Therefore, this study aimed to investigate the psychological health among patients with chronic diseases during the elevated psychiatric distress associated with the outbreak and examine the efficacy and feasibility of mindfulness-based stress reduction intervention (MBSR). The study involved 149 participants recruited from university hospital outpatient clinics. Patients were allocated into two groups: MBSR training program and control group. Standardized questionnaires were administered to assess depression, anxiety and stress prior to the MBSR program and at completion of the training after 8 weeks. Results: The results showed that MBSR intervention improved psychological distress and decreased the mean scores of depression, anxiety and stress. Conclusions: Mindfulness training program based on audio and smartphone was feasible and effective when it was applied to patients with chronic diseases and showed positive impact on negative psychological stress domains. These findings pave the way for the integration of psychological support for patients with chronic illnesses in clinical settings.

Effect of Fixed-dose Combination Amlodipine/Valsartan in Comparison to Two Drug Combination Nebivolol/Valsartan on 24-Hour Ambulatory Blood Pressure.

BACKGROUND: Nebivolol has a dual mechanism of action, exerting a moderate b- blockade effect and reducing peripheral arterial resistance, as a result, the antihypertensive effect of nebivolol may be higher than that of a potent vasodilator CCB such as amlodipine. AIM: The study evaluated the effect of two nebivolol/valsartan on 24 hour ambulatory blood pressure versus amlodipine/valsartan in grade II or III hypertension patients or having uncontrolled BP despite treatment. Ambulatory blood pressure monitoring is a powerful method to monitor the changes in blood pressure over the 24 hour. MATERIALS AND METHODS: A total of 74 from 90 patients continued the study. Fourty patients received amlodipine 10 mg/valsartan 160 mg (group I), and thirty-four patients received nebivolol 5 mg/ valsartan 160 mg (group II). Peripheral blood pressure readings were measured at randomization at 6 and 12 weeks. Ambulatory blood pressure was measured at randomization and 12 weeks. RESULTS: Both drug combinations showed high efficacy in reducing peripheral and 24 hour ambulatory BP. There was no statistically significant difference between the groups in lowering peripheral systolic and diastolic blood pressure at 6 and 12 weeks. Furthermore, both groups failed to show any significant difference in reducing 24 hour SBP and DBP. Regarding day SBP, the blood pressure dropped by -5.63 ± 14.87 in group I and -6.25 ± 11.59 in group II (p = 0.844). Also, group I reduced the day DBP average by -2.53 ± 9.83 and group II by -3.61 ± 9.78 (p = 0.640). In addition, both drug combinations had no statistically significant difference in lowering night SBP and DBP average. CONCLUSION: Both treatment groups reached the target ambulatory blood pressure, and there was no statistically significant difference between both groups as a regard reduction in all ambulatory blood pressure readings.

The Impact of an SGLT2 Inhibitor versus Ursodeoxycholic Acid on Liver Steatosis in Diabetic Patients.

Non-alcoholic fatty liver disease (NAFLD) is related to metabolic syndrome via insulin resistance, where preventing disease progression is crucial in the management process. The study included 240 NAFLD patients with type 2 diabetes who were randomly allocated into empagliflozin 25 mg (EMPA group), ursodeoxycholic acid 250 mg (UDCA group), or the control group (placebo). The study outcomes included: changes in liver fat content (LFC; %) (utilizing the Dixon-based MRI-PDFF approach), liver enzymes, lipid and glycemic profiles, FIB-4 index, and non-alcoholic fatty liver score (NFS). All endpoints were assessed at baseline and after 6 months. EMPA outperformed UDCA and placebo in decreasing LFC (−8.73% vs. −5.71% vs. −1.99%; p < 0.0001). In post-treatment ultrasound images and MRI-PDFF calculations, more patients had normal fatty liver grade (no steatosis or LFC < 6.5%) with EMPA compared to UDCA. EMPA and UDCA showed significant regression in the FIB-4 index (−0.34 vs. −0.55; p = 0.011) and NFS scores (−1.00 vs. −1.11; p = 0.392), respectively. UDCA achieved higher reductions in insulin resistance than EMPA (p = 0.03); however, only EMPA significantly increased beta-cell function (54.20; p = 0.03). When exploring the differences between the two drugs, EMPA was better in decreasing LFC (%), while UDCA achieved higher reductions in liver fibrosis scores. Both showed a similar safety profile in managing liver steatosis.

Target Blood Pressure and Combination Therapy: Focus on Angiotensin Receptor Blockers Combination with Either Calcium Channel Blockers or Beta Blockers.

BACKGROUND: The target blood pressure has changed many times in the guidelines in past years. However, there is always a question; is it good to lower blood pressure below 120/80 or not? Control of blood pressure in hypertension is very important in reducing hypertension-modified organ damage. So, the guidelines recommend combining more than one antihypertensive drug to reach the target blood pressure goal. RESULTS: Combination therapy is recommended by guidelines to reach the blood pressure goal. The guidelines recommend many combinations, such as the combination of angiotensin receptor blockers with either calcium channel blockers (CCB) or beta-blocker (BB). Angiotensin receptor blocker (ARB) combination with CCB has gained superiority over other antihypertension drug combinations because it reduces blood pressure and decreases the incidence of CV events and organ damage. BB combinations are recommended by guidelines in patients with ischemic events but not all hypertensive patients. Unfortunately, the new generation BB, for example, nebivolol, has a vasodilator effect, making it new hope for BB. CONCLUSION: Combination therapy is a must in treating the hypertensive patient. The new generation BBs may change the recommendations of guidelines because they have an effect that is similar to CCBs.

Efficacy and Safety of Ombitasvir plus Paritaprevir, Ritonavir and Ribavirin in Non-cirrhotic Treatment-naïve and Treatment-experienced Egyptians with Chronic HCV Genotype-4 Infection.

Hepatitis C virus genotype 4 (HCV-GT4) is a risk factor for cirrhosis, hepatocellular carcinoma and liver failure. A combination of three new direct-acting antivirals ombitasvir, paritaprevir, and ritonavir has been recommended for treatment of HCV-GT4 infection. The current study was aimed to assess the efficacy and safety of this combination plus ribavirin in non-cirrhotic, treatment-naïve and -experienced Egyptians with HCV-GT4 infection in a real-world setting. A total of 255 Egyptians with HCV-GT4 infection were enrolled, including 82 treatment-experienced and 173 treatment-naïve patients. All of them completed 12-week treatment protocol of ombitasvir, paritaprevir and ritonavir as an oral dose combination with ribavirin. Virological response (VR) was measured, as well as the biochemical parameters related to treatment efficacy and adverse events at baseline and after treatment, at 4 (VR4) and 12 (VR12) weeks post-treatment. The results showed that the VR4 rates were 98.8% in both groups, and VR12 rates were 97.7% and 96.3% in treatment-naïve and -experienced patients, respectively, with no significant differences found between the groups concerning VR4 (P=0.9) and VR12 (P=0.3). The most common adverse events were headache and fatigue, which were significantly more common (P=0.001 and 0.003, respectively) in treatment-experienced than in treatment-naïve group. The quadruple regimen was well-tolerated, and the reported adverse events were generally mild to moderate. This real-world setting study confirms that the combination of ombitasvir, paritaprevir, ritonavir, and ribavirin is highly effective in the treatment of HCV- GT4 infection with a good safety and tolerability profile.

Effect of Amlodipine/Valsartan Versus Nebivolol/Valsartan Fixed Dose Combinations on Peripheral and Central Blood Pressure.

INTRODUCTION: Although hypertensive drugs may have the same effect on peripheral blood pressure, they vary in their effect on central blood pressure and its indices. AIM: To evaluate efficacy of fixed-dose combination of amlodipine 10 mg/valsartan 160 mg versus nebivolol 5 mg/valsartan 160 mg in grade 2 or more hypertensive patients assessed by peripheral and central blood pressure. METHODS: A prospective, open label, randomized study done in the outpatient cardiology clinic at Beni-Suef University Hospital. A total of 137 patients continued the study; group I (n = 75) received Amlodipine 10 mg/Valsartan 160 mg (A/V) and group II (n = 62) received Nebivolol 5 mg/Valsartan 160 mg (N/V). Peripheral, central blood pressure and its indices were measured at baseline, after 6 and 12 weeks. RESULTS: The two combinations reduced peripheral and central BP (P < 0.0001) after 6 and 12 weeks. A/V combination significantly reduces central Pulse Pressure (PP) after 6 and 12 weeks (- 8.53 ± 13.80 and - 10.17 ± 11.29 (P < 0.0001) respectively), while N/V showed its efficacy in reducing central PP after 12 weeks (- 7.03 ± 13.10, P = 0.005). A/V combination was more effective in reducing Pulse Wave Velocity (PWV) after 6 and 12 weeks; P < 0.0001 vs P = 0.004. After 6 weeks, N/V was more effective in reducing Augmentation Index (AIx) (- 6.00 ± 10.94 (P = 0.002) vs. - 3.44 ± 9.80 (P = 0.026)) while after 12 weeks A/V did not show any significance (P = 0.085). CONCLUSIONS: Both treatment groups lowered patients' peripheral, central blood pressure after 6 and 12 week of treatment, but Amlodipine/Valsartan combination was more effective. Both treatments exerted different effects on central indices.

Transradial artery approach in STEMI patients reperfused early and late by either primary PCI or pharmaco-invasive approach.

The purpose of the study was to investigate the safety and efficacy of transradial artery approach (TRA) in STEMI patients who reperfused early (≤3 h from symptoms onset) or late (>3 h from symptoms onset) by either PPCI or pharmaco-invasive strategy (PI), thrombolysis followed by CA. Therefore, a total 143 STEMI patients (who were presented within 12 h from symptoms onset or 12-24 h with an evidence of ongoing ischemia or suffered from an acute STEMI were randomized for either PI or PPCI. Eighty-two patients were assigned to PI arm while the rest assigned were to PPCI arm. Patients who were taken to a non-PCI capable hospital received streptokinase and were then transferred to our Hospital for CA. TRA was used in the catheterization laboratory for all patients. Each arm was divided according to reperfusion time into early and late subgroups. A primary endpoint was death, shock, congestive heart failure, or reinfarction up to 30 days. There was a non-significant difference regarding LVEF in both arms. Myocardium wall preservation was significant in the early PI arm (P = 0.023). TIMI flow had no discrepancy between both arms (P = 0.569). Mean procedural and fluoroscopic time were 35.1 ± 6.1 and 6.3 ± 0.9 min. There were no reported entry site complications. There was no difference in primary endpoint complications (P = 0.326) considering the different times of patients' reperfusion (early; P = 0.696 vs. late; P = 0.424). In conclusion, it is safe and effective to use TRA in STEMI patients who reperfused by either early or late PPCI or PI. We recommend PI for STEMI patients with delay presentation if PPCI is not available.