Assessment of osteoporosis knowledge and its determinants among tuberculosis patients in tertiary care hospital Malaysia: A prospective study.

Objective: Osteoporosis self-care knowledge is essential to encourage the patient's contribution towards controlling the disease. Osteoporosis incidence with various infectious diseases prompts us to conduct a study on osteoporosis knowledge among Tuberculosis (TB) patients. This study aimed to assess osteoporosis-related knowledge and its influencing factors among TB patients. Methods: A prospective cross-sectional study was conducted in the TB clinic of Hospital Pulau Pinang, Malaysia, and an osteoporosis knowledge test (OKT), a structured questionnaire, was used to collect data. TB patients aged 18 years and above with compromised bone health were included in the present study. Overall knowledge scores were dichotomized, calculating the mean score, descriptive statistics, and multivariate regression analysis was used to determine the influence of risk factors on knowledge scores. Results: Of 337 patients, 129(38.28 %) had good osteoporosis knowledge and 208(61.72 %) had poor knowledge. Among them, 231(68.54 %) were males, and 106(31.45 %) were females, with a mean age of 46.5 ± 17.1 years. The mean ± SD of OKT total score was 10.5 ± 2.0. The mean ± SD of the exercise knowledge score was 5.3 ± 3.4, while the nutrition knowledge score was 5.0 ± 3.2. Male gender (OR 3.86, 95 % CI 1.98-7.53), low-income level (OR 1.92, 95 % CI 1.12-3.30), rural residents (OR 2.49, 95 % CI 1.46-4.27) and participants with no formal education (OR 4.34, 95 % CI 1.11-16.84) or ≤12 years of education (OR 3.63, 95 % CI 1.52-8.65) were significantly responsible for poor OKT score. Conclusion: The results indicated that most TB patients had a poor perception of osteoporosis. More extensive strategies should be developed to enhance the campaign of awareness programs among TB patients to improve preventive measures of osteoporosis, such as calcium intake and exercise.

Physicians and pharmacists' clinical knowledge of statin therapy and monitoring parameters, and the barriers to guideline implementation in clinical practice.

BACKGROUND: Millions of individuals worldwide use statins, and their significant impact on cardiovascular disease (CVD) has been well-established. However, a lack of knowledge about the up-to-date guideline recommendations regarding statin therapy is a common barrier to implementation in clinical practice. Therefore, the present study aimed to assess the current clinical knowledge about statin therapy and its monitoring parameters. Also, we evaluated the barriers to cholesterol management guideline implementation in Yemen. METHODS: This observational cross-sectional study was conducted over four months, from June/2021 to September/2021, in Sana'a, Yemen. A validated questionnaire was distributed face-to-face to 650 participants (350 physicians and 300 pharmacists). Physicians and pharmacists from governmental and private hospitals and those working in private clinics or community pharmacies were included in the study. RESULTS: A total of 496 participants filled out the survey, with 22 being excluded due to incomplete data. So, the study has an overall response rate of 72.9% (474). The majority of pharmacists (81.8%) and physicians (78.7%) could not identify the patient group that needed ASCVD risk assessment before statin therapy initiation. Although a significant proportion of respondents knew of the fact that high-intensity statins are recommended for patients with ASCVD (65.4%) and primary hypercholesterolemia (58.4%), the majority of physicians and pharmacists could not identify the high (61.6% and 66.7.3%, respectively) and moderate statin-intensity doses (72.2% and 68.6%, respectively). Only 21.9% of all respondents knew that atorvastatin and rosuvastatin can be administered at any time of the day. Similarly, a low overall rate of respondents (19.6%) knew that atorvastatin does not need dose adjustment in chronic kidney diseases, with a statistically significant difference in knowledge between physicians and pharmacists (12.5% vs. 25.6%, p <0.001, respectively). Notably, only 39.2% of participants were aware that statins are not safe to use during breastfeeding. Around half of respondents (52.3%) correctly identify the duration (4 to 12 weeks) at which LD-C measuring is recommended after therapy initiation or dose change. The lowest knowledge scores for respondents were related to statin-drug interactions. Age, experience, degree, and previous guideline exposure were all significantly associated with the knowledge scores (p <0.05). The four most perceived barriers to implementing cholesterol management guidelines were no audit on adherence to the guidelines in the workplace (73.4%), insufficient resources to adequately implement and follow up on the guideline's recommendations (73.6%), patient's financial status (75.7%), and lack of familiarity about the guideline's latest recommendations (63.3%). CONCLUSION: Physicians and pharmacists had suboptimal clinical knowledge regarding statin therapy, dose intensities, drug-drug interaction, contraindications, and monitoring parameters. Therefore, physicians' and pharmacists' educational interventions regarding the up-to-date recommendation about statins are recommended.

The evidence from clinical trials on Gout medicines effect on COVID-19: A protocol for systematic review and meta-analysis.

AIM: To evaluate the available evidence from clinical trials on the efficacy of gout medicines against COVID-19. DESIGN: Systematic review and Meta-analysis. METHODS: We are systematically searching five databases [PubMed, Embase, CT.gov, ICTRP, CINAHL (EBSCO)]. We are following the PRISMA statement and the EPOC guidelines. The meta-analysis will be conducted using Revman-5.4.1 from Cochrane collaboration, UK. This review's protocol was also registered in PROSPERO, University of York, UK (CRD42022299718). RESULTS: In this meta-analysis, we plan to give a conclusive overview of the available evidence on the efficacy of the medications used to manage gout in reducing COVID-19 mortality, ICU admission, ventilation rate and hospitalization duration. If the results were positive, these drugs would greatly add to the scarce treatment options against COVID-19. Furthermore, these drugs might provide an excellent alternative to inconvenient and expensive drugs. Additionally, most of these drugs have a well-established safety profile for use during nursing, making them a much safer option for nursing mothers with COVID-19.

A Retrospective Study on Tuberculous Lymphadenitis: A Finding from Multicenter Referral Hospitals.

Background: Extrapulmonary tuberculosis represents about 14% of all cases of tuberculosis (TB) in Malaysia. The aim of the study includes the evaluation of sociodemographic factors, clinical manifestations, comorbidities among patients with tuberculous lymphadenitis and their treatment outcomes. Methods: The retrospective study was conducted from 2006 to 2008. Data on sociodemographic along with histopathological results were collected. The signs and symptoms were also recorded from TB registers, treatment cards, and TB medical personal files using the standard data collection tool. Among multiple variables, the significant factors identified by univariate analysis were included in the multivariate logistic regression to estimate the odds ratios with the 95% confidence intervals. The statistically significant P value was considered <0.05. Results: There were 348 (57%) males, and on the other hand, 262 (43%) females which shows almost equal incidence rate of lymphadenitis in both genders. The age group was observed from 2 to 83 years old. Therefore, the age group between 26 and 35 years showed 194 (31.8%) patients diagnosed with lymphadenitis and followed by 16-25 years (21%). The mean age was found as 34.3 ± 14.6 years were majorly reported with positive diagnosis. One hundred and ninety-six (32.1%) Malay population were found with tuberculous lymphadenitis followed by the Chinese population of 148 (24.3%). The other prominent races were Pilipino, Indonesians, and other expatriates. Geographically, patients were from 386 (63.3%) urban population were found positive for lymphadenitis and over 224 (36.7%) population of the rural region. The treatment outcome was observed 444 (72.8%) with successful treatment. The World Health Organization states the types of treatment failures, and accordingly, 85 (13.9%) patients were continued with the therapy that can be due to noncompliance or relapse of TB. Among the unsuccessful outcomes, 194 patients of age group 26-35 years, 65 (33.5%) were reported and 38 (29.7%) patients out of 128 between ages of 16-25 years. Blood test results showed erythrocyte sedimentation rate >10 in 280 (45.9%) patients. Therefore, among 280, there were 115 (41.1%) patients were found to have unsuccessful treatment showing very strong association with P < 0.001. Conclusion: The finding signifies that effect of weight loss on poor treatment outcomes' and active screening measures for patients with comorbidities are therefore recommended in patients with tuberculous lymphadenitis along with improvements in the diagnosis and early management of comorbidities complications. As young age group was found to have poor or unsuccessful treatment outcomes and required aggressive strategy together with educating patients can further increase the treatment success rate.

Development and validation of Chronic Kidney Disease Knowledge, Attitude, and Practices (CKD-KAP) questionnaire.

Background: Chronic Kidney Disease (CKD) is a complex condition leading to loss of kidney function. The objective of this study was to develop and validate a Knowledge, Attitude, and Practice questionnaire on CKD (CKD-KAP) among practicing physicians in Pakistan since no validated tool was available for the said purpose. Methods: The study consisted of four phases with phase-I focusing on literature review, phase II was the actual questionnaire development phase, face and content validity was determined in phase III, and finally pilot testing was performed in phase IV to determine validity and reliability. The development phase encompassed a thorough review of literature, focus-group discussion, expert review, and evaluation. The validation phase consisted of content validity, face validity, construct validity, convergent validity, and reliability. The pilot testing was performed by studying the KAP of 100 practicing physicians in tertiary care hospitals in Pakistan. The knowledge section of the validation phase utilized Item Response Theory (IRT) analysis. The attitude and practices sections utilized Exploratory Factor Analysis (EFA) theory. The reliability analysis utilized Cronbach's alpha and correlations. Results: The CKD-KAP questionnaire had three main sections: knowledge, attitude, and practice. During the validation, IRT analysis was performed on knowledge, which focused on the measure of the coefficient of discrimination and difficulty of the items; 40 out of 41 knowledge items have both discrimination and difficulty coefficients within an acceptable range. The EFA model was also fitted in the attitude and practices section, and scree plot and Eigenvalues suggested three and four dimensions within the attitude and practices section. The factor loading of all items was found to be acceptable except for one item in attitude which was deleted. The convergent validity demonstrated a significant association between all three sections except knowledge and practices. The reliability (internal consistency) analysis demonstrated Cronbach's alpha values above 0.7 and significant inter-item correlation. The final model of CKD-KAP had 40 knowledge, 13 attitude, and 10 practice items with a combination of both positive as well as negative questions and statements. Conclusions: The CKD-KAP was found to be psychometrically valid and reliable, hence can be used to determine the knowledge, attitude, and practices of physicians toward chronic kidney disease.

Survey data of public in Sindh Pakistan regarding willingness to accept COVID-19 vaccination.

OBJECTIVE: The COVID-19 pandemic has badly affected the world with its devastating effects, including Sindh, Pakistan. A massive vaccination campaign against COVID-19 is considered one of the effective ways to curtail the spread of the disease. However, the acceptability of the COVID-19 vaccine is based on the general population's knowledge, attitude, perception and willingness for vaccination. Therefore, a survey among the public in Sindh, Pakistan, was done to evaluate their knowledge, attitude, perception and willingness to accept COVID-19 vaccination. METHOD: The online survey was conducted among the residents of Sindh, Pakistan, in July 2021 through a survey tool designed using Google Forms and sent to the population through various social media. RESULTS: Of 926 study participants, 59.0% were male, and 68.6% were aged between 18 and 31 years. Higher percentages of responses were recorded from the Hyderabad division (37.5%), and 60.0% of respondents were graduates, with 34.8% of them in the private sector. The results showed that 36.4% of respondents had good knowledge, and 30.3% had a positive attitude toward COVID-19 vaccination. Almost 77% of respondents perceived that everyone should get vaccinated in the country and those health care workers on priority. A majority (80.8%) of respondents were willing to accept COVID-19 vaccination. CONCLUSION: Despite having insufficient knowledge and a low percentage of positive attitude public in Sindh are willing to be vaccinated. Based on this finding, more effort has to be done to promote vaccination among the public, especially among the less educated population.

The evidence from clinical trials on colchicine and corticosteroids' effect on COVID-19: a systematic review and meta-analysis.

OBJECTIVES: With no clear end for the outbreak, identifying the drugs that are effective in COVID-19's management is of utmost importance to reduce the impact on the general population and the healthcare systems. METHODS: This is a systematic review and a meta-analysis evaluating the evidence from clinical trials on the effect of colchicine and corticosteroids against COVID-19. In this review, we have systematically searched five databases [(PubMed, Embase, clinicaltrials.gov, ICTRP, CINAHL (EBSCO)]. Cochrane's data extraction sheet was used to collect the required information, and RevMan-5.4.1 was used to conduct the meta-analysis and to assess the risk of bias. The review was registered in Prospero (CRD42022299718). RESULTS: The total number of included studies was 17, with 18,956 participants; the majority were male 12,001. Out of which, 8772 participants were on colchicine, 569 took methylprednisolone, and 64 patients received prednisolone. The meta-analysis has shown that colchicine had no significant effect on reducing the mortality rate among COVID-19 patients [OR 0.98(95% CI 0.90-1.08), p = .70), I2:1%)], corticosteroids have significantly reduced the mortality rates [OR 0.55 (95% CI 0.33-0.91), p = .02, I2:40]. Colchicine did not reduce the incidence of ICU admissions [OR 0.74 (95% CI 0.39-1.40), p = .35, I2:0%], while steroidal drugs significantly reduced the ICU admissions [OR 0.42 (95% CI 0.23-0.78), p = .005, I2:0%]. Unlike steroidal drugs [OR 0.53 (95% CI 0.30-0.95), p = .03, I2:61%], colchicine failed to reduce the need for mechanical ventilation [OR 0.73 (95% CI 0.48-1.10), p = .13, I2:76%]. Steroidal drugs significantly reduced the duration of hospitalization among COVID-19 patients [OR -0.50 (95% CI -0.79-0.21), p = .0007, I2:36%]. CONCLUSIONS: The use of colchicine did not significantly reduce the mortality rate, ICU admissions, and mechanical ventilation among COVID-19 patients. Conversely, corticosteroids significantly reduced the mortality rate, ICU admissions, mechanical ventilation, and hospitalization duration among COVID-19 patients.

Cognitive perspective of osteoporosis among adults with type 2 diabetes mellitus: The Malaysian case.

INTRODUCTION: Osteoporosis and diabetes are highly prevalent diseases. In addition, there is increasing evidence that diabetes is a common risk factor for decreasing bone mineral density and developing osteoporosis and fractures. Data on bone abnormalities in T2DM patients appear to be contradictory and complex, and the exact underlying mechanism is still unclear. Hence, the aims of this study were to assess cognitive perspective of osteoporosis among type 2 diabetes mellitus. METHODS: An observational, cross-sectional study design was chosen, where data were collected using a self-report structured questionnaire including osteoporosis self-efficacy (OSES-M), knowledge Malay version. Quantitative ultrasound was used as prescreening tool for measuring bone health by applying T-score. RESULTS: The results showed that about 231 (51.30%) were males. The average age of the DM patients was 62.67 ± 9.24 years. Moreover, the majority of T2DM patient (343, 76.20%) had poor glycaemic control. The mean ± SD OSES-M total score, OSES-M Exercise subscale and OSES-M Calcium subscale were 731.26 ± 209.83, 357.55 ± 121.23 and 373.71 ± 118.91, respectively. Overall, participants expressed a low self-efficacy for both exercise and calcium intake experiences. In addition, a significant and positive correlation was found between OSES-M and OKT-M total scores (n = 450, rs  = 0.471, p < .05). Also, there were significant correlations between OKT-M subscales and OSES-M subscales. Furthermore, significant and positive correlations were found between T-scores and OSES-M total score (r = .191), OSES-M Exercise subscale (r = .209) and OSES-M Calcium subscale (r = .124). Moreover, significant associations, differences and correlations were found out between OSES-M with many demographic and clinical data. CONCLUSION: Overall, participants expressed a low self-efficacy for both exercise and calcium intake experiences. In addition, only 28.70% of the study population was found to have high OSES-M level. Thus, self-efficacy is important and effective determinants for gaining positive health behaviours towards osteoporosis.

Risk assessment of atherosclerotic cardiovascular diseases before statin therapy initiation: Knowledge, attitude, and practice of physicians in Yemen.

BACKGROUND: Risk evaluation of atherosclerotic cardiovascular disease (ASCVD) remains the cornerstone of primary prevention. The cardiovascular risk assessment can guide the decision-making on various preventive measures such as initiating or deferring statin therapy. Thus, our study aimed to assess the physicians' knowledge, attitude, and practices regarding atherosclerotic cardiovascular diseases risk assessment. Also, we evaluated the physician-patient discussion and counseling practices before statin therapy initiation in concordance with recommendations from the latest clinical practice guideline. METHODS: A cross-sectional study was conducted between November 2020 and January 2021. A self-administered questionnaire was distributed to 350 physicians (GPs, residents, specialists, and consultants). Two trained pharmacists distributed the questionnaires in 5 major tertiary governmental hospitals and more than ten private hospitals. Also, private clinics were targeted so that we get a representative sample of physicians at different workplaces. RESULTS: A total of 270 physicians filled the questionnaire out of 350 physicians approached, with 14 being excluded due to high missing data, giving a final response rate of 73%. Participants had suboptimal knowledge and practices with a high positive attitude toward atherosclerotic cardiovascular diseases risk assessment. The knowledge and practices were higher among consultants, participants from the cardiology department, those with experience years of more than nine years, and those who reported following a specific guideline for cholesterol management or using a risk calculator in their practice. Notably, the risk assessment and counseling practices were lower among physicians who reported seeing more patients per day. CONCLUSION: Physicians had overall low knowledge, suboptimal practices, and a high positive attitude toward cardiovascular risk assessment. Therefore, physicians' training and continuing medical education regarding cholesterol management and primary prevention clinical practice guidelines are recommended. Also, the importance of adherence to clinical practice guidelines and their impact on clinical outcomes should be emphasized.

Urine Metabolites as a Predictor of Warfarin Response Based on INR in Atrial Fibrillation.

BACKGROUND: Warfarin is an anticoagulant with wide inter-individual variations in drug responses monitored based on the International Normalized Ratio (INR). It is commonly prescribed for Atrial Fibrillation (AF) and stroke. Oral anticoagulants (e.g., warfarin) reduce the risk of getting a stroke but increase the risk of hemorrhage. The proton Nuclear Magnetic Resonance (1H-NMR) pharmacometabonomics technique is useful for determining drug responses. Furthermore, pharmacometabonomics analysis can help identify novel biomarkers of warfarin outcome/ INR stability in urine. OBJECTIVES: The focus of this research was to determine if urine metabolites could predict the warfarin response based on INR in patients who were already taking warfarin (identification; phase I) and to determine if urine metabolites could distinguish between unstable and stable INR in patients who had just started taking warfarin (validation; phase II). METHODS: A cross-sectional study was conducted. Ninety urine samples were collected for phase 1, with 49 having unstable INR and 41 having stable INR. In phase II, 21 urine samples were obtained, with 13 having an unstable INR and eight having a stable INR. The metabolites associated with unstable INR and stable INR could be determined using univariate and multivariate logistic regression analysis. RESULTS: Multivariate Logistic Regression (MVLR) analysis showed that unstable INR was linked with seven regions. DISCUSSION: The urine pharmacometabonomics technique utilized could differentiate between the urine metabolite profiles of the patients on warfarin for INR stability. CONCLUSION: 1H-NMR-based pharmacometabonomics can help lead to a more individualized, controlled side effect for warfarin, thus minimizing undesirable effects in the future.

Prevalence and predictors of clinically significant statin-drug interactions among Yemeni patients taking statins for primary and secondary prevention of cardiovascular disease.

BACKGROUND: Statins are extensively used in clinical practice for the primary and secondary prevention of cardiovascular diseases. Statins are usually taken in combination with other medications. This may increase the risk of statin-drug interactions. The study aimed to evaluate the prevalence, patterns, and predictors of clinically significant statin-drug interactions among patients on statin therapy. MATERIAL AND METHODS: A cross-sectional study was conducted at the cardiology, endocrine, and internal medicine outpatient clinics in four tertiary care hospitals in Sana'a, Yemen. Lexicomp Drug Interaction database was used to analyze the prescriptions for potential statin-drug interactions. Binary and multivariable logistic regression were utilized for analysis. RESULTS: Of the total number of patients (634), 114 individuals (18%) had a total of 122 statin-drug interactions. According to Lexicomp risk classification, 102 (83.6%) DDIs were class C (monitor therapy), 19 (15.6%) were class D (therapy modification), and only one (0.8%) class X (avoid combination). Simvastatin use was significantly associated with the presence of category D and X DDIs (15.9% vs. 1.6%, p < .001). Polypharmacy (OR = 2.571, p < .001) and having ≥3 comorbidities (OR = 2.512, p < .001) were the only variables associated with the presence of statin-drug interactions (C, D, and/or X). CONCLUSION: Patients with polypharmacy and those with three or more comorbidities had a higher risk for statin-drug interactions. Therefore, routine screening by physicians and pharmacists for potential interactions should occur before prescribing or dispensing any medication to avoid clinically significant statin-drug interactions.

Knowledge, attitude, perceived barriers, and practices among pharmacists regarding risk assessment of cardiovascular disease: a cross-sectional study in Yemen.

BACKGROUND: Risk evaluation of atherosclerotic cardiovascular diseases can guide the decision-making on various preventive measures, such as initiating or deferring statin therapy. Pharmacists can play an active part in the risk evaluation and primary prevention of atherosclerotic cardiovascular diseases. Thus, our study aimed to assess the pharmacists' knowledge, attitude, perceived barriers, and practices regarding risk assessment of atherosclerotic cardiovascular disease. MATERIALS AND METHODS: A cross-sectional study was conducted among 500 pharmacists using a structured validated questionnaire between November 2020 and February 2021. The Mann-Whitney and Kruskal-Wallis tests were used to analyze the data. RESULTS: A total of 456 pharmacists completed the questionnaire out of 500 distributed (91.2% response rate). Over 60% of participants responded with never or rarely for two out of five cardiovascular diseases (CVD) prevention practices. The lowest pharmacist-patient counseling practices were for side effects of statin medication (14.5%) and reviewing the patient's medications to avoid potential statin-drug interactions (31.8%). Participants had a high positive attitude (median = 34 out of 40). The three major barriers for risk assessment were the lack of support (74.8%), the lack of resources (70.6%), and inadequate training (48.7%). Interestingly, having ≤75 customers a day, community pharmacies, PharmD degree, age ≥30 years, and experience ≥6 years were significantly associated (p < .05) with higher CVD prevention activities and counseling practices. CONCLUSION: Pharmacists have a high positive attitude toward CVD risk assessment. However, they had insufficient knowledge and only provided limited activities and counseling services for CVD prevention and statin therapy. Participants perceived several barriers to CVD risk assessment services in pharmacies. Therefore, it is necessary to remove these impediments for pharmacists to be more involved in CVD risk assessment and prevention. Also, continuing medical education and adequate training for pharmacists are required.

Evaluation of Treatment Outcome for Pneumonia among Pre-Vaccinated COVID-19 Patients with/without Comorbidity in a Public Hospital in Bengkulu, Indonesia.

Pneumonia is one of the common complications of SARS-CoV-2 infection where most patients have moderate to severe symptoms that pose a higher risk for death. This study aims to evaluate the treatment outcome of COVID-19-associated Pneumonia among patients with/without comorbidity in a public hospital in Indonesia. This is a retrospective cohort study involving unvaccinated confirmed COVID-19 patients admitted to the hospital between March and December 2020. All confirmed COVID-19 patients with Pneumonia (n = 1522) treated at the hospital were included. The majority of patients (99%) had mild COVID-19 symptoms while the remaining had moderate symptoms. The median age was about 32 years old and the average treatment duration was 6.25 ± 1.83 days. Most patients (88.8%) received a combination of azithromycin and oseltamivir. There was a very significant relationship (p < 0.001) between comorbidities with treatment and duration of treatment of Pneumonia in COVID-19 patients. Although most patients had Pneumonia and comorbidities, they were successfully treated with azithromycin and oseltamivir combination following approximately five days of treatment.

Prevalence, risk assessment, and predictors of osteoporosis among chronic obstructive pulmonary disease patients.

The link between chronic obstructive pulmonary disease (COPD) and osteoporosis is unclear and yet to be understood. The study goals were to detect the prevalence of osteoporosis and investigate its predictors among COPD patients. This is a longitudinal study conducted in a tertiary care setting. During the study, patients' bone mineral density was checked, pulmonary parameters were recorded, and a risk assessment tool was validated. Based on T-score, more than 50% of subjects were osteoporotic. Spirometric parameters were significantly lower among osteoporotic patients. For the risk assessment tool, a cutoff point of 34 made the optimum balance between sensitivity and specificity (0.867 and 0.087, respectively) with a generated area under the curve of 0.934. Severe COPD patients were four times at higher risk of getting osteoporosis, forced expiratory volume (FEV) % predicted, and FEV/forced vital capacity was inversely related to the risk of osteoporosis. Patients with severe dyspnea had twice the risk of getting osteoporosis. Osteoporosis was prevalent among COPD patients, and severe COPD patients were at higher risk of getting osteoporosis.

Misinformation, perceptions towards COVID-19 and willingness to be vaccinated: A population-based survey in Yemen.

BACKGROUND: Since the beginning of the COVID-19 outbreak, many pharmaceutical companies have been racing to develop a safe and effective COVID-19 vaccine. Simultaneously, rumors and misinformation about COVID-19 are still widely spreading. Therefore, this study aimed to investigate the prevalence of COVID-19 misinformation among the Yemeni population and its association with vaccine acceptance and perceptions. METHODS: A cross-sectional online survey was conducted in four major cities in Yemen. The constructed questionnaire consisted of four main sections (sociodemographic data, misinformation, perceptions (perceived susceptibility, severity, and worry), and vaccination acceptance evaluation). Subject recruitment and data collection were conducted online utilizing social websites and using the snowball sampling technique. Descriptive and inferential analyses were performed using SPSS version 27. RESULTS: The total number of respondents was 484. Over 60% of them were males and had a university education. More than half had less than 100$ monthly income and were khat chewers, while only 18% were smokers. Misinformation prevalence ranged from 8.9% to 38.9%, depending on the statement being asked. Men, university education, higher income, employment, and living in urban areas were associated with a lower misinformation level (p <0.05). Statistically significant association (p <0.05) between university education, living in urban areas, and being employed with perceived susceptibility were observed. The acceptance rate was 61.2% for free vaccines, but it decreased to 43% if they had to purchase it. Females, respondents with lower monthly income, and those who believed that pharmaceutical companies made the virus for financial gains were more likely to reject the vaccination (p <0.05). CONCLUSION: The study revealed that the acceptance rate to take a vaccine was suboptimal and significantly affected by gender, misinformation, cost, and income. Furthermore, being female, non-university educated, low-income, and living in rural areas were associated with higher susceptibility to misinformation about COVID-19. These findings show a clear link between misinformation susceptibility and willingness to vaccinate. Focused awareness campaigns to decrease misinformation and emphasize the vaccination's safety and efficacy might be fundamental before initiating any mass vaccination in Yemen.

Determining the risk factors associated with delayed sputum conversion at the end of the intensive phase among tuberculosis patients.

BACKGROUND: In pulmonary tuberculosis (PTB), the sputum conversion rate at 2 months is frequently used to evaluate treatment outcomes and effectiveness of a TB control programme. AIMS: The study aimed to estimate the rate of delayed sputum conversion and explore its predicting factors at the end of the intensive phase among smear-positive PTB (PTB +ve) patients. METHODS: A 3-year retrospective study was conducted in the government hospital in Pulau Pinang from 2016 to 2018. During the study, a standardized, data collection form was used to collect data from the patient record. Patients aged over 18 years were recruited. Multivariable logistic regression analysis was used to identify significant independent variables associated with delayed sputum conversion. RESULTS: A total 1128 of PTB patients were recorded visiting the TB clinic, 736 (65.2%) were diagnosed as PTB +ve; of these, 606 (82.3%) PTB +ve had a record of sputum conversion at the end of the intensive phase. Age ≥ 50 years, blue-collar jobs, smoking, heavy bacillary load, relapsed and treatment interrupted were significantly (P < 0.05) associated with delayed sputum conversion. Delayed sputum conversion rate at the end of the intensive phase was 30.5%. CONCLUSION: The rate of sputum smear conversion in the intensive phase of treatment was independently associated with high sputum smear grading at diagnosis, relapsed and treatment interrupted categories, old age and blue-collar occupations.

Effect of Pharmacist-Led Intervention on Progression of Diabetic Complications at Two Tertiary Care Hospitals of Malaysia.

BACKGROUND AND OBJECTIVE: Diabetes mellitus is a chronic disease which can lead to different complications in patients if not treated properly. An appropriate intervention from health care providers is needed to stop and decrease the progression of diabetic complication in diabetic patients. This study aimed to measure the effect of pharmacist intervention on improvement in sign and symptoms and progression of diabetic complications in diabetic patients. METHODOLOGY: Diabetic patients were randomly selected and divided into two groups from two tertiary care hospitals. Control group contained those 200 patients who were receiving usual treatment from hospitals. In contrast, the intervention group included those 200 patients who were receiving conventional treatment from hospitals together with separate counselling sessions with pharmacists from Diabetes Medication Therapy Adherence Clinic departments. The study continued for 1 year and two follow-up visits for both groups. A prevalidated data collection form was used to measure the improvement in sign and symptoms and progression of diabetic complication in diabetic patients. Statistical Package for the Social Sciences (SPSS) version 24 was used to analyze the data. RESULTS: The average hemoglobin A1c (HbA1c) values decreased up to 1.43% in the control group and 2.82% in the intervention group. The intervention group showed significant improvement in HbA1c between groups (P < 0.05). The results of univariate and multivariate regression analysis showed that a statistically significant (P < 0.001) improvement was observed in all the predictors of diabetic complications among in the intervention group when compared with the control group. CONCLUSION: Statistically significant reduction in the sign and symptoms of diabetic complications was observed in the intervention group at the end of 1 year. The progression of diabetic neuropathy was significantly reduced in the pharmacist intervention group.

Comparative efficacy assessment of antiviral alone and antiviral-antibiotic combination in prevention of influenza-B infection associated complications.

OBJECTIVE: The study aimed to compare the efficacy of antiviral drug alone and antiviral-antibiotic combination therapy in prevention of complications associated with influenza B hospitalized patients. METHOD: Laboratory confirmed influenza B hospitalized patients presented in emergency room after 48 hours of symptoms onset were identified and divided into two groups; Group-1 patients were initiated on Antiviral drug (oseltamivir) alone while Group-2 patients were initiated on Antiviral drug (oseltamivir) in combination with Antibiotic for at least 3 days. Patients were evaluated for different clinical outcomes among both treatment group. RESULTS: A total of 153 and 131 patients were identified for Group-1 and Group-2, respectively. Clinical outcomes such as secondary bacterial infections (20.9%-vs-9.1%; P = 0.031), need of respiratory support (28.7%-vs-12.9%; P = 0.002), length of hospitalization stay (6.57-vs-4.95 days; P = <0.001), incidences of ICU admission (15.7%-vs-7.6%; P = 0.036), early clinical failure (32.6%-vs-16.1%; P = 0.01), and time to clinical stability (4.83-vs-4.1 days; P = 0.001) were found to be statistically less significant (P-value <0.05) for Group-2 patients. CONCLUSION: Early initiation of antibiotic therapy in combination with oseltamivir was found to be more efficacious than oseltamivir alone in prevention of influenza B-associated complications especially in high-risk influenza patients.

The Association between Chronic Heroin Smoking and Chronic Obstructive Pulmonary Disease.

INTRODUCTION: Little is known about the correlation between chronic obstructive pulmonary disease (COPD) and heroin smoking. Heroin smoking is a recent underinvestigated problem. The goal of this study is to study the impact of heroin smoking among COPD patients. METHODS: This is a descriptive clinical study. A combination of self-reporting questionnaires and data extraction tools were used to collect information during baseline tests, interviews, and follow-ups. Patients' medical, clinical, and socioeconomic history were recorded. Participants were recruited using random sampling from multiple centers. RESULTS: Out of 1034 COPD patients, heroin smokers represented the vast majority of addiction cases (n = 133). Heroin smokers were leaner than non-addicts (19.78 ± 4.07 and 24.01 ± 5.6, respectively). The most common type of comorbidities among heroin smokers was emphysema (27%). Both the forced expiratory volume (FEV1)/forced vital capacity ratio and FEV1% predicted were lower among heroin smokers than non-addicts (52.79 ± 12.71 and 48.54 ± 14.38, respectively). The majority of heroin smokers (55%) had advanced COPD, and at least 15% of heroin smokers suffered from frequent respiratory failure. The mean ± SD for COPD onset age among heroin smokers was 44.23 ± 5.72, and it showed a statistically significant correlation (P < 0.001). CONCLUSION: Heroin smoking might be linked to the onset of COPD. Heroin smokers showed a significantrespiratory impairment compared to tobacco smokers of the same age group.

Can Newer Anti-Diabetic Therapies Delay the Development of Diabetic Nephropathy?

Type 2 diabetes mellitus (T2DM) is progressive in nature and leads to hyperglycemia-associated microvascular and macrovascular complications. Diabetic nephropathy (DN) is one of the most prominent microvascular complication induced by T2DM and is characterized by albuminuria and progressive loss of kidney function. Aggressive management of hyperglycemia and hypertension has been found effective in delaying the development and progression of DN. Although the conventional antidiabetic treatment is effective in the earlier management of hyperglycemia, the progressive loss of beta cells ultimately needs the addition of insulin to the therapy. The emergence of newer antidiabetic agents may address the limitations associated with conventional antidiabetic therapies, which not only improve the glycemic status but also effective in improving cardio-renal outcomes. Nevertheless, the exact role of these agents and their role in minimizing diabetes progression to DN still needs elaboration. The present review aimed to highlights the impact of these newer antidiabetic agents in the management of hyperglycemia and their role in delaying the progression of diabetes to DN/management of DN in patients with T2DM.