Non-coding RNA genes modulate PI3K/AKT signaling pathway in polycystic ovary syndrome.

BACKGROUND: The PI3K protein kinase B (PI3K/AKT) signaling pathway has crucial roles in insulin signaling and other endocrine disorders. The purpose of this study is to validate the association of PCOS with PI3K/AKT pathway target genes, miRNA486-5p, and miRNA483-5p as well as to evaluate the outcome of metformin on the pathogenesis of PCOS.  METHODS: This case-controlled study included 3 subject groups: twenty healthy females (control group), twenty PCOS females before treatment, and twenty PCOS females treated with metformin at a dose (500 mg 3 times per day for 3 months). The following gene expressions were assessed by real-time PCR: PI3K, AKT, ERK, GLUT4, miRNA486-5p, and miRNA483-5p in the whole blood. RESULTS: There was a significant decrease in miRNA486-5p and miRNA483-5p in the PCOS group with a significant negative correlation between miRNA486-5p and PI3K and a significant negative correlation between miRNA483-5p and ERK. Metformin treatment resulted in significant elevation of the studied miRNA, significant downregulation of PI3K/AKT target genes, and significant amelioration of the gonadotrophic hormonal imbalance and insulin resistance markers: fasting blood glucose, HBA1C, fasting insulin, and GLUT4 gene expression. CONCLUSIONS: miRNA486 and miRNA483 downregulation may contribute to the etiology of PCOS, influence glucose metabolism, and result in IR in PCOS. Metformin's upregulation of those miRNAs affects glucose metabolism by controlling the expression of GLUT4, ameliorates PCOS-related insulin resistance, and improves PCOS-related hormonal imbalance by controlling the PI3K/AKT signaling pathway.

Effect of metformin as an adjuvant therapy to letrozole on estradiol and other biomarkers involved in the pathogenesis of breast cancer in overweight and obese postmenopausal women: a pilot study.

INTRODUCTION: Metformin may provide a therapeutic benefit in different types of malignancy. PURPOSE: We aimed at evaluating the effect of metformin as an adjuvant therapy to letrozole on estradiol and other biomarkers involved in the pathogenesis of breast cancer in overweight and obese postmenopausal women. METHODS: Seventy-five postmenopausal stages II-III breast cancer female patients were assessed for eligibility in an open-labeled parallel pilot study. Forty-five patients met the inclusion criteria and were assigned into three arms: the lean arm (n = 15) women who received letrozole 2.5 mg/day, the control arm (n = 15) overweight/obese women who received letrozole 2.5 mg/day, and the metformin arm (n = 15) overweight/obese women who received letrozole 2.5 mg/day plus metformin (2000 ± 500 mg/day). The intervention duration was 6 months. Blood samples were obtained at baseline and 6 months after intervention for the measurement of serum estradiol, leptin, osteocalcin levels, fasting blood glucose concentration, and serum insulin. RESULTS: After the intervention and as compared to the control arm, the metformin arm showed a significantly lower ratio to the baseline (significant reduction) for estradiol (p = 0.0433), leptin (p < 0.0001), fasting blood glucose (p = 0.0128), insulin (p = 0.0360), osteocalcin serum levels (p < 0.0001), and the homeostatic model assessment of insulin resistance "HOMA-IR" value (p = 0.0145). There was a non-significant variation in the lactate ratio to the baseline among the three study arms (p = 0.5298). CONCLUSION: Metformin may exert anti-cancer activity by decreasing the circulating estradiol, leptin, and insulin. Metformin might represent a safe and promising adjuvant therapy to letrozole in overweight/obese postmenopausal women with breast cancer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05053841/Registered September 23, 2021 - Retrospectively.

Investigating the current environmental situation in the Middle East and North Africa (MENA) region during the third wave of COVID-19 pandemic: urban vs. rural context.

BACKGROUND: Coronavirus 2019 (COVID-19) pandemic led to a massive global socio-economic tragedy that has impacted the ecosystem. This paper aims to contextualize urban and rural environmental situations during the COVID-19 pandemic in the Middle East and North Africa (MENA) Region. RESULTS: An online survey was conducted, 6770 participants were included in the final analysis, and 64% were females. The majority of the participants were urban citizens (74%). Over 50% of the urban residents significantly (p < 0.001) reported a reduction in noise, gathering in tourist areas, and gathering in malls and restaurants. Concerning the pollutants, most urban and rural areas have reported an increase in masks thrown in streets (69.49% vs. 73.22%, resp.; p = 0.003). Plastic bags and hospital waste also increased significantly with the same p-value of < 0.001 in urban areas compared with rural ones. The multifactorial logistic model for urban resident predictors achieved acceptable discrimination (AUROC = 0.633) according to age, crowdedness, noise and few pollutants. CONCLUSION: The COVID-19 pandemic had a beneficial impact on the environment and at the same time, various challenges regarding plastic and medical wastes are rising which requires environmental interventions.

The patterns and determinants of telemedicine use during the COVID-19 crisis: A nationwide study.

BACKGROUND: Although telemedicine services have been adopted on a large scale in the United Arab Emirates (UAE) during the coronavirus disease 2019 (COVID-19) pandemic, a little is known about the public experience. OBJECTIVES: This study aimed to investigate consumers' patterns, nature, and predictors of telemedicine utilization and consumers' attitude toward this technology. METHODS: A quantitative, self-administered questionnaire was developed, validated, and delivered randomly to adults living across the United Arab Emirates (UAE) between January 2021 and January 2022. The questionnaire included questions about categories of telemedicine used, purpose of use, challenges encountered during the use of telemedicine, and reasons for not using telemedicine technology. We adopted a proportionate random sampling technique to recruit participants by 3 ways: social media, phone calls, and face to face. RESULTS: The final dataset included 1584 participants, of which 496 (31.3%) used telemedicine during the coronavirus disease 2019 (COVID-19) pandemic. The most common reasons for not using telemedicine during COVID-19 was having no idea that telemedicine exists (38.3%, 417 of 1088) or having no idea how to use it (33.5%, 365 of 1088). Telemedicine users reported that that telepharmacy (89.7%), teleconsultation (78.2%), and telediagnosis (23.0%) were the most frequently used telemedicine services during the COVID-19 crisis. Of the 496 telemedicine users, 469 (94.6%) reported using telemedicine for seeking a pharmacist advice about medication instructions, 422 (85.1%) for ordering nonprescription drugs, and 401 (80.8%) for seeking a physician advice. Those with high activity on social media were less likely to be associated with telemedicine users versus nonusers. DISCUSSION: Although telepharmacy has been increasingly used by consumers, more attention is needed to fix its limitations and improve patient safety. CONCLUSION: This study shows a positive attitude and a general acceptance of telemedicine services among the UAE population. Some sociodemographic and clinical characteristics were significantly associated with the use of telemedicine during the pandemic.

Assessment of a new strategy for catalyzing deprescribing in community pharmacies.

BACKGROUND: Although community pharmacists have been actively engaged in patient care, their role in deprescribing is still restricted. OBJECTIVES: This study aimed to assess the effectiveness of a new educational approach designed to catalyze deprescribing in community pharmacies. METHODS: In this 4-month, randomized, controlled trial, 108 community pharmacies in Egypt were randomly and equally distributed to either the active or the control groups. Participants from the active group pharmacies received 31 deprescribing-related clinical case scenarios, designed according to the available deprescribing guideline and clinical experiences of an expert panel members, and delivered through WhatsApp. Then participants from both groups reported the incidence of potentially inappropriate medicines (PIMs), the frequency of deprescribing opportunities, and related pharmacist interventions. RESULTS: Pharmacists from the active group reported a considerably higher incidence of PIMs (20.87%) than that reported by pharmacists from the control group (5.03%). In addition, they made 1326 deprescribing-related interventions, of which 1022 (77.07%) were accepted and 641 (48.34%) were significant interventions. The proportions of cessation of drug therapy, reducing the dose, and persuasion of patients to accept deprescribing pharmacist interventions in the active group were 37.85%, 22.09%, and 10.63%, respectively. In contrast, 150 of 268 deprescribing-related interventions (55.97%) in the active group were accepted. The clinical value and type of deprescribing decision were statistically significant determinants for the acceptance of deprescribing decisions. The mean time needed to persuade the patient about deprescribing and the cost saved per patient across the active and the control groups were 5.09 ± 3.54 minutes versus 10.03 ± 6.19 minutes and 17.88 ± 9.60 U.S. dollars versus 4.49 ± 2.44 U.S. dollars, respectively. CONCLUSION: The intervention proposed improved the frequency and clinical value of deprescribing decisions.

Shedding the light on Pharmacists' roles during COVID-19 global pandemic.

INTRODUCTION: (Background)The role of pharmacists revolves around providing the highest levels of care to society and ensuring the provision of medicine to all patients. However, with the spread of coronavirus disease 2019 (COVID -19), pharmacists as a very important part of healthcare professionals' team are responsible for fighting against the disease regardless of their setting of practice. The role of pharmacists will undergo a little change to extend and include other roles in order to ensure the safety of the community and limit the virus spread. Also, they will be required to obtain information from reliable sources, and to be up to date, so they can be reliable advisors to the community and raise their awareness. OBJECTIVES: The purpose of this review is to highlight community and hospital pharmacists' roles during (COVID-19) global pandemic, and to clearly illustrate how they are contributing to maintain pharmacy services continuity, supporting other healthcare professionals, and facilitating the patient's education. SUMMARY: Clinical pharmacists provide direct patient care through monitoring adverse drug reactions, ensuring individualized treatment, performing evidence-based practice, and evaluating drugs in clinical trials. On the other hand, community pharmacists which are the most accessible healthcare providers by the community increase their awareness regarding the preventive measures, balance medicines supply and demand, provide drive-thru and home delivery services, offer telehealth counselling, psychological support, refer suspected COVID-19 patients, and provide vaccination when available. CONCLUSION: Innovative pharmacists' roles have emerged to adapt to changes during COVID-19 pandemic, however, they may be needed in the post COVID-19 world as well.

Virtual Coaching Delivered by Pharmacists to Prevent COVID-19 Transmission.

Background: While the role of pharmacists in the current pandemic control has been recognized worldwide, their coaching efforts to improve public's behaviors that could prevent COVID-19 transmission has been rarely investigated. Objectives: To assess whether pharmacist-based virtual health coaching sessions could increase the proportion of people who practised healthy social behaviors, to test whether this model can increase the public acceptance of COVID-19 vaccines, and to measure whether these behaviors could actually prevent contracting COVID-19. Method: In this randomized controlled trial, adults who matched specific criteria were randomly allocated into 2 arms. The active arm received 12 pharmacist-based virtual coaching sessions delivered via Zoom® over a month. Participants allocated to the control arm received no coaching. At the end of the last coaching session, both groups were asked to complete a structured questionnaire for outcome assessment. Participants in the active group were followed up to 2 weeks after the end of the last coaching session to check if they contracted COVID-19 or not. The SPSS software version 26.0 (IBM Corp., Chicago, IL) was used for statistical analysis. Results: Of the 300 participants who gave consent for participation, 295 completed the study (147 from the active arm and 148 from the control arm). The proportion of those using face masks, avoiding crowds, and willing to be isolated if infected in the active arm was increased from 51.70%, 53.74%, and 59.86% at baseline to 91.83%, 80.27%, and 96.59% at the end of coaching, respectively (all with P < .05). In addition, the proportion of behaviors, such as disinfecting surfaces, not touching the T-zone, and avoid sharing personal belongings with colleagues at work was increased from 36.05%, 27.89%, and 46.93% at baseline to 63.94%, 52.38%, and 87.75% at the end of coaching, respectively (all with P < .05). Avoid touching the T-zone (OR = 0.43; 95% CI, 0.24-0.89) and using disposable tissues (OR = 0.30; 95% CI, 0.18-0.77), each versus using face masks appropriately were more likely to get COVID-19. Conclusion: Pharmacist-based virtual health coaching could be a potential strategy to increase the proportion of behaviors that could curtail the spread of COVID-19.

Assessment of A new Strategy to Prevent Prescribing Errors Involving COVID-19 Patients in Community Pharmacies.

Background: Because COVID-19 patients are vulnerable to prescribing errors (PEs) and adverse drug events, designing and implementing a new approach to prevent prescribing errors (PEs) involving COVID-19 patients has become a priority in pharmacotherapy research. Objectives: To investigate whether using WhatsApp to deliver prescribing error (PE)-related clinical scenarios to community pharmacists could enhance their ability to detect PEs and conduct successful pharmaceutical interventions (PIs). Methods: In this study, 110 community pharmacies were recruited from different regions across Jordan and equally allocated to 2 groups. Over the course of 4 weeks, WhatsApp was used to send PEs-related clinical case scenarios to the active group. The second group was controlled with no clinical scenarios. After completion of the 4-week phase, pharmacists from both groups were asked to document PEs in COVID-19 patients and their interventions using a data-collection form. Results: The incidence of PEs in COVID-19 patients documented in the active group (18.54%) was higher than that reported in the control group (3.09%) (P = .001). Of the 6598 and 968 PIs conducted by participants working in the active and control group pharmacies, 6013 (91.13%) and 651 (67.25%) were accepted, respectively. The proportions of wrong drug (contraindication), wrong drug (unnecessary drug prescribed/no proof of its benefits), and omission of a drug between the active and control groups were 15.30% versus 7.21% (P = .001), 11.85% versus 6.29% (P = .03), and 17.78% versus 10.50% (0.01), respectively. Additionally, the proportions of lethal, serious, and significant errors were 0.74% versus 0.35% (P = .04), 10.52% versus 2.57% (0.002), and 47.88% versus 9.57% (0.001), respectively. Addition of drug therapy interventions (AOR = 0.62; 95% CI, 0.21-0.84) and errors with significant clinical seriousness (AOR = 0.32; 95% CI, 0.16-0.64). Conclusions PEs involving COVID-19 patients in community settings are common and clinically significant. The intervention assessed in this study could be promising for designing a feasible and time-efficient interventional tool to encourage pharmacists' involvement in identifying and correcting PEs in light of COVID-19.

An emergency plan for management of COVID-19 patients in rural areas.

AIMS OF THE STUDY: To describe the experience of six hospitals in the management of COVID-19 patients in rural areas through an assessment of proportions, types and clinical outcomes of remote clinical interventions. METHODS: This was a prospective observational study conducted in six Egyptian hospitals over a period five months. An emergency response was implemented in each hospital in order to connect clinical pharmacists with COVID-19 patients living in rural areas. Pharmacists used phone calls and social media applications, such as WhatsApp® to conduct two types of interventions; (a) Proactive interventions and (b) outcome-based interventions. IBM SPSS V26 was used for data analysis. RESULTS: Of the 418 patients included, 351 (83.97%) recovered, 60 (14.35%) were hospitalised and 7 (1.67%) were deceased. Medication orders per patient, high-alert medications per patient and prescribing errors per patient were 5.82, 1.45 and 0.74, respectively. Telepharmacy teams conducted 3318 phone calls, 2116 WhatsApp® chats and 1128 interventions, of which 812 (71.92%) were process-based and 316 (27.98%) were outcome-based. Among these interventions, four significant determinants of improvement in clinical outcomes were found: substitution of a prescribed drug (Adjusted odds ratio [AOR] = 4.03; 95% confidence interval [CI], 2.54-5.87), adding a drug to the prescription (AOR = 3.15; 95% CI, 1.87-4.76), advice the patient to stop smoking (AOR = 3.53; 95% CI, 1.98-5.17) and cessation of drug therapy (AOR = 3.11; 95% CI, 1.25-4.55). The most common medications involved in drug-related interventions were Hydroxychloroquine, Azithromycin and Paracetamol. CONCLUSION: Our findings demonstrate significant impact of the remote pharmacist interventions on both medicines use and clinical outcomes of COVID-19 patients in rural areas. Pharmacists in developing countries should be supported to implement remote clinical services to provide patients in rural places with optimal care.

Evaluation of the use and attitudes of pregnant and postpartum women towards medicine utilisation during pregnancy in the United Arab Emirates: A national cross-sectional study.

INTRODUCTION: Pregnancy period is of high concern to every woman. Knowledge about medication use needs to be highlighted at such a critical stage. OBJECTIVE: This study aimed to assess pregnant and postpartum women's use and attitude regarding the utilisation of medications during pregnancy in the United Arab Emirates (UAE). METHODS: A self-administrated survey was distributed among 500 pregnant and postpartum women randomly selected from the general population of five different cities within the UAE: Abu Dhabi, Dubai, Sharjah, AL Fujairah and Ajman over a period of 3 months. All analyses were two-sided, and a P-value of ≤.05 was taken as the cut-off for statistical significance. RESULTS: Overall, 434 participants took part in the survey. Forty-one percent of respondents reported that they use drugs during pregnancy, and the most frequently used medications during pregnancy were multivitamins, analgesics and folic acid. Moreover, 77.9% of female participants acquired their knowledge from their gynaecologists. Only 21.7% of respondents reported that the pharmacist provided enough information during dispensing. Most ladies had an uplifting mentality towards medicines, but they believed pregnant ladies should be more wary with respect to medication use during pregnancy. A significant association was found between participants' nationality and occupation, and attitudes about medications (P < .001), where women with Arab nationality and those with health-related careers agreed that they have a higher threshold for using medicines during pregnancy. CONCLUSION: During pregnancy, ladies were more moderate and doubter towards the drug, healthcare providers should know about such mentalities while encouraging pregnant ladies to take prescription.

The Early Effects of Alcohol Consumption on Functional Visual Acuity, Tear Functions, and the Ocular Surface.

PURPOSE: We investigated the early effects of alcohol intake on tear functions and ocular surface health in this prospective controlled study. METHODS: Forty-four eyes of 22 subjects (17 males, 5 females; mean age: 35.3 years) who drank 200 mL of 25% Japanese vodka and 44 eyes of age- and sex-matched 22 control subjects who drank water were investigated. Subjects were requested to refrain from alcohol consumption from the previous day and food ingestion 6 hr before the study. Each subject consumed exactly the same order prepared dinner and same quantity of alcohol over the same time frame. Subjects underwent breath alcohol level, tear evaporation and blink rate, tear lipid layer interferometry, tear film break-up time (BUT), fluorescein and Rose Bengal stainings, Schirmer test, and visual analog scale (VAS) evaluation of dry eye symptoms before, as well as 2 and 12 hr after alcohol intake. RESULTS: The mean breath alcohol level was significantly higher in the alcohol group compared to the water group at 2 and 12 hr (P<0.001). The mean tear evaporation increased significantly from 2.5×10-7 to 8.8×10-7 gr/cm2/sec 12 hr after alcohol intake (P<0.001). The mean BUT shortened significantly from 15.0±5.0 to 5.0±2.5 sec 12 hr after alcohol intake. Lipid layer interferometry showed signs of tear film thinning 12 hr after alcohol intake in all subjects of the alcohol intake group, which was not observed in the water group. The mean blink rates increased significantly from 10.6±1.5 blinks/min to 13.5±0.9 blinks/min and 15.1±1.2 blinks/min at 2 and 12 hr, respectively, in the alcohol group (P<0.001). The Schirmer test values decreased significantly 12 hr after alcohol intake (P<0.001). The mean VAS score for dryness increased from baseline significantly in the alcohol group at 12 hr (P<0.001). No significant time-wise changes in tear functions were observed in the water group. CONCLUSION: The tear film and ocular surface epithelia showed early and distinctive quantitative and qualitative changes associated with visual disturbances after alcohol intake.

Virtual pharmacist interventions on abuse of over-the-counter medications during COVID-19 versus traditional pharmacist interventions.

OBJECTIVES: This study aimed to investigate the frequency, nature, and clinical significance of pharmacist interventions on over-the-counter (OTC) medicines with abuse potential across community pharmacies with and without virtual care. METHODS: In this prospective observational study, a trained research team observed the dispensary teams of 12 community pharmacies in the United Arab Emirates (UAE), 6 of which were operating virtual pharmacy care. A standardized data collection form was used to include information about dispensing of OTC medicines and pharmacist interventions on those with abuse/misuse potential. The clinical significance of the interventions was evaluated by a multidisciplinary committee. RESULTS: The frequency of pharmacist interventions on OTC medicines with abuse potential across pharmacies with and without virtual services was 83.2% versus 91.0%, respectively, whereas the frequency of pharmacist interventions on OTC medicines with misuse potential across pharmacies with and without virtual services was 79.8% versus 41.2%, respectively. The proportions of clinically significant interventions across pharmacies with and without virtual services were 19.7% versus 10.5%, respectively. Cough medicines were dispensed significantly more across pharmacies with virtual care than across pharmacies without virtual care (25.6% vs. 9.7%, respectively; P = 0.04). Asking the patient to seek the advice of an addiction specialist (adjusted odds ratio = 4.11; P = 0.001) versus refusing to sell the drug was more likely to be associated with pharmacies with virtual services than with pharmacies operating traditional pharmacy services. CONCLUSION: Virtual pharmaceutical care is a potential approach to reduce the abuse/misuse of OTC medicines but needs some improvements regarding detection of these cases. The UAE is the first country in the region to implement and regulate virtual pharmacy practice.

Evaluation of Telepharmacy Services in Light of COVID-19.

Background: Telepharmacy services are expected to have an important role in increasing access of patients to pharmaceutical care and reducing potential dispensing errors in community pharmacies. Objective: To assess the predictors for effective telepharmacy services on increasing access of patients to care and reducing dispensing errors in community pharmacies. Method: This is a prospective study carried out for 4 months in 52 community pharmacies across the United Arab Emirates (UAE) using disguised direct observation. Multivariable logistic regression was used as a tool to predict factors associated with effective telepharmacy services in improving dispensing safety and increasing access of patients to pharmaceutical care. Data were entered and analyzed using the Statistical Package for Social Science (SPSS) software version 26. Results: Pharmacist recommendations related to COVID-19 at pharmacies with telepharmacy (n = 63,714) versus those without remote services (n = 15,539) were significantly more likely to be (1) contact the nearest testing center (adjusted odds ratio [AOR] = 7.93), (2) maintain home quarantine (AOR = 5.64), and (3) take paracetamol for fever (AOR = 3.53), all were significant results (p < 0.05). Rates of medication dispensing errors (MDEs) and its subcategories, prescription-related errors, and pharmacist counseling errors across pharmacies with telepharmacy versus those without remote services were (15.81% vs. 19.43%, p < 0.05), (5.38% vs. 10.08%, p < 0.05), and (10.42% vs. 9.35%, p > 0.05), respectively. However, pharmacies with telepharmacy were more likely to include wrong patient errors (AOR = 5.38, p < 0.05). Conclusions: Telepharmacy can be used as a tool to reduce the burden on the health care system and improve drug dispensing safety in community pharmacies.

Efficacy and Cost-effectiveness Comparison of 10-Day, 14-Day Sequential Versus 14-Day Triple Therapies for Treating Helicobacter pylori Infection in Egyptian Patients.

GOALS: The aim of this study was to clarify whether 10-day or 14-day sequential therapy (ST) can replace conventional triple therapy (TT) as a first-line treatment in Egypt. BACKGROUND: Antimicrobial resistance has decreased the eradication rates for Helicobacter pylori infection worldwide. MATERIALS AND METHODS: Patients who tested positive for H. pylori infection were randomly assigned to the 14-day triple-therapy group (n=34), 10-day ST group (n=34), or 14-day ST group (n=35). Sequential treatment includes lansoprazole 30 mg and amoxicillin 1000 mg, both twice for 5 or 7 days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and tinidazole 500 mg, each twice for 5 or 7 days. Triple treatment consists of lansoprazole 30 mg, clarithromycin 500 mg, and amoxicillin 1000 mg, each twice for 14 days. Six weeks after treatment discontinuation, patients were examined by the urea breath test. Eradication rates, the incidence of adverse effects, compliance, and cost-effectiveness were evaluated. RESULTS: The eradication rate was 90% with 10-day ST, 96.7% with 14-day ST, and 63.3% for TT (P=0.001). Mild tolerated adverse effects occurred in the 3 groups. The cost-effectiveness ratio was 2194 LE, 1241 LE, 1157 LE for standard triple therapy, 10-day, and 14-day ST, respectively. CONCLUSIONS: Sequential therapies for 10 or 14 days are more cost-effective than standard TT, with 14-day ST being the most cost-effective. Accordingly, ST might replace TT as a first-line treatment for H. pylori infection in Egyptian patients.

Challenges associated with mental health management: Barriers and consequences.

INTRODUCTION: Mental illness has become a global public health issue and according to WHO report in 2015, United Arab Emirates (UAE) recorded the highest level of depression among all countries at Eastern Mediterranean Region. Many people frequently suffer from mental health diseases but tend not to obtain help. Treatment delay can become life-threatening. OBJECTIVES: This study aimed to identify the barriers to seeking professional help for mental illness and the consequences of untreated mental health disorders. The study also aimed to examine outcomes in patients when help was provided by health care providers. METHODS: A self-administrated survey was distributed among 377 people randomly selected from general population of three different cities at United Arab Emirates (UAE): Abu Dhabi, Dubai and Sharjah. Their perception of the barriers, consequences and outcomes was analyzed to achieve the objectives of the study. RESULTS: Overall, 341 participants completed the survey. Wrong thought regarding mental disorders (60.1%) and being ashamed (58.9%) were identified to be the most common and significant barriers (P < 0.001) that prevent people from obtaining healthcare providers' assistance. The majority of responders reported building confidence (78.9%) and improvement in relationships (73.0%) as outcomes for taking professional help in mental illness. Moreover, many individuals believed that untreated mental illness could lead to problems with family and friends (69.2%) as well as to suicidal thoughts (56.3%). CONCLUSION: This research gives some insights regarding the challenges associated with mental diseases management in the UAE. Majority of responders had a negative perception of mental health service due to a lack of awareness regarding treatment effectiveness for mental disorders.

Parasite-specific proliferative responses of chicken spleen cells upon in vitro stimulation with Eimeria tenella antigen.

This study aimed to set up methodology to monitor parasite-specific T-cell activation in vitro using Eimeria tenella-infected chickens. A sonicated E. tenella sporozoite protein preparation was used for the activation of chicken spleen cell cultures. Proliferation assessed by 3H-thymidin incorporation or blast transformation of T-cells assessed by immunofluorescence labelling and flow cytometry were used as read-outs for activation. Results showed that E. tenella-specific proliferation was detected in cultures of spleen cells collected in a 'window' between 8 and 14 days after primary infection. However, due to high variation in proliferative responses between individuals and to high background proliferation, large numbers of observations were needed to obtain significant results. Moreover, the outcome was not improved by increasing the infection dose to chickens or by depletion of T-cell receptor (TCR) γ/δ expressing cells from cultures. An E. tenella-specific blast transformation response was observed for TCRα/ß expressing cells within the same 'window', confirming the identity of the responding cells as classic T-cells. Thus, it is possible to study the kinetics of E. tenella-specific T-cell responses in vitro. However, more in-depth phenotypic identification of the responding T-cells could improve the methodology.

Exergy Analysis of Directional Solvent Extraction Desalination Process.

This paper presents an exergy analysis to evaluate the performance of a continuous directional solvent extraction (DSE) desalination process using octanoic acid. The flow of exergy was calculated for each thermodynamic state and balanced for different components of the system to quantify the inefficiencies in the process. A parametric study was performed to evaluate the impact of three critical design variables on exergy consumption. The parametric study reveals that the total exergy input decreases significantly with an increase in heat exchanger effectiveness. The results also indicate that the heat exchangers account for the highest exergy destruction. The total exergy consumption, however, has a slightly declining trend as the recovery-ratio increases. There is a small variation in the total exergy consumption, within the uncertainty of the calculation, as the highest process temperature increases. When compared to conventional desalination processes, the exergy consumption of the DSE, with heat recovery of 90%, is comparable to those of multi-stage flashing (MSF), but much higher than reverse osmosis (RO). Octanoic acid, which has low product water yield, is identified as the primary factor negatively impacting the exergy consumptions. To exploit the low-grade and low-temperature heat source feature of the DSE process, directional solvents with higher yield should be identified or designed to enable its full implementation.

Role of metformin in oxaliplatin-induced peripheral neuropathy in patients with stage III colorectal cancer: randomized, controlled study.

PURPOSE: Peripheral sensory neuropathy is the most prominently reported adverse effect of oxaliplatin. The purpose of this study was to evaluate metformin role in oxaliplatin-induced neuropathy. PATIENTS AND METHODS: From November 2014 to May 2016, 40 patients with stage III colorectal cancer completed 12 cycles of FOLFOX-4 regimen. Twenty patients in the control arm received FOLFOX-4 regimen only, and 20 patients in the metformin arm, received the same regimen along with metformin 500 mg three times daily. The metformin efficacy was evaluated using National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE version 4.0), a12-item neurotoxicity questionnaire (Ntx-12) from the validated Functional Assessment of Cancer Therapy/Gynecologic Oncology Group and, the brief pain inventory short form "worst pain" item. In addition to neurotensin, malondialdehyde and interleukin-6 serum levels assessment. RESULTS: At the end of the 12th cycle, there were less patients with grade 2 and 3 neuropathy in metformin arm as compared to control arm. (60 versus 95%, P = 0.009) In addition, metformin arm showed significantly higher total scores of Ntx-12 questionnaire than control arm (24.0 versus 19.2, P < 0.001). Furthermore, the mean pain score in metformin arm was significantly lower than those of control arm, (6.7 versus 7.3, P = 0.005). Mean serum levels of malondialdehyde and neurotensin were significantly lower in metformin arm after the 6th and the 12th cycles. CONCLUSION: Metformin may be a promising drug in protecting colorectal cancer patients against oxaliplatin-induced chronic peripheral sensory neuropathy.

The effect of Nrf2 knockout on ocular surface protection from acute tobacco smoke exposure: evidence from Nrf2 knockout mice.

Ocular surface mucosa is the first-line ocular tissue to be exposed to environmental stress. We evaluated tear functions and keratoconjunctival epithelial alterations after sidestream cigarette smoke (SCS) exposure and tried to clarify the role of the transcription factor nuclear factor erythroid 2-related factor 2 (Nfe2l2, also known as Nrf2), on the ocular surface. In wild-type and Nrf2(-/-) mice, tear volume did not change after SCS exposure. Tear film breakup time (tear stability) in Nrf2(-/-) mice was significantly shorter than that in wild-type mice after SCS exposure. Vital staining scores, including fluorescein and Rose Bengal staining, showed significantly higher values in Nrf2(-/-) mice than in wild-type mice after SCS exposure. Excessive oxidative stress accumulation was detected in Nrf2(-/-) mice after SCS exposure using immunohistochemical analysis. Immunohistochemical analysis also revealed decreased mucin 1 (Muc1) and Muc5ac staining in Nrf2(-/-) mice after SCS exposure. mRNA expression levels of Muc1, Muc4, and Muc5ac and of SAM-pointed domain epithelial-specific transcription factor in Nrf2(-/-) mice were lower than those in wild-type mice after SCS exposure. Mean tear IL-6 concentrations increased significantly in Nrf2(-/-) mice after SCS exposure. In conclusion, SCS exposure induced decreased tear stability, ocular surface damage, and altered conjunctival phenotype in Nrf2(-/-) mice. Nrf2 could play an important role in protection of the ocular surface against SCS exposure.

Topical 5-Fluorouracil 1% as Primary Treatment for Ocular Surface Squamous Neoplasia.

PURPOSE: To determine the efficacy of topical 5-fluorouracil 1% (5-FU) as a primary treatment of ocular surface squamous neoplasia (OSSN). DESIGN: Retrospective study. PARTICIPANTS: Topical 5-FU was used as primary therapy in 44 patients with OSSN. METHODS: 5-Fluorouracil 1% administered topically 4 times daily for 1 week followed by a drug holiday of 3 weeks. Patients were identified through a pharmacy database. Patients were excluded if 5-FU was used as adjuvant therapy, if they did not complete therapy, or if they were still actively receiving treatment for OSSN at the time of last follow-up. MAIN OUTCOME MEASURES: The primary outcome measures were the frequency of complete resolution with topical 5-FU treatment and the rate of OSSN recurrence. RESULTS: Of the 44 patients identified, 32 were men and 12 were women. The mean age was 68 years. Complete resolution of OSSN was noted in 82% of patients (36/44); 18% (8/44) were considered treatment nonresponders. Patients were treated with a median of 4 cycles (range, 2-9 cycles). Nasal location was the only risk factor identified for nonresponse to therapy (P = 0.04). The median follow-up after resolution was 10 months (range, 2-77 months). In the 36 patients who showed complete resolution, 4 experienced tumor recurrence. Recurrence rates at 1 and 2 years were 6% and 15%, respectively, using Kaplan-Meier survival analysis. At least 1 side effect from the medication was reported by 61% of patients (21/44), but only 1 patient discontinued the medication because of intolerance. The most common side effect was pain (n = 17; 39%), followed by tearing (n = 10; 23%), photophobia (n = 6; 14%), itching (n = 4; 9%), swelling (n = 2; 5%), and infection (n = 1; 2%). No long-term complications were reported. CONCLUSIONS: 5-Fluorouracil is effective and well tolerated as a primary treatment for OSSN, with 82% of tumors responding completely to therapy.