Assessment of Native Myocardial T1 Mapping for Early Detection of Anthracycline-Induced Cardiotoxicity in Patients with Cancer: a Systematic Review and Meta-analysis.

Anthracycline antibiotic is one of the most effective anti-tumor drugs used to manage certain types of breast cancers, lymphomas, and leukemias. However, anthracyclines induce a dose-dependent cardiotoxicity that may progress to heart failure. Thus, using a sensitive predictor of early cardiac dysfunction in patients treated with anthracyclines can help detect subclinical cardiac dysfunction early and help initiate interventions to protect these patients. Among parameters of myocardial measure, cardiac magnetic resonance (CMR)-measured native myocardial T1 mapping is considered a sensitive and accurate quantitative measure of early subclinical cardiac changes, particularly cardiac inflammation and fibrosis. However, to understand the quality and the validity of the current evidence supporting the use of these measures in patients treated with anthracyclines, we aimed to conduct a systematic review of clinical studies of this measure to detect early myocardial changes in cancer patients treated with anthracyclines. The primary outcome was the level of native T1 mapping. We performed fixed-effects meta-analyses and assessed certainty in effect estimates. Of the 1780 publications reviewed (till 2022), 23 were retrieved, and 9 articles met the inclusion criteria. Our study showed that exposure to anthracycline was associated with a significant elevation of native myocardial T1 mapping from baseline (95% CI 0.1121 to 0.5802; p = 0.0037) as well as compared to healthy control patients (95% CI 0.2925 to 0.7448; p < 0.0001). No significant publication bias was noted on the assessment of the funnel plot and Egger's test. According to the Q test, there was no significant heterogeneity in the included studies (I2 = 0.0000% versus healthy controls and I2 = 14.0666% versus baseline). Overall, our study suggests that native myocardial T1 mapping is useful for detecting anthracycline-induced cardiotoxicity in patients with cancer.

A model for enterprise resource planning implementation in the Saudi public sector organizations.

Studies dedicated to user's adoption, acceptance, and use of IT have been rampant since the advent of computers and IT. Therefore, it becomes essential to assess the value of IT to organizations and to understand the determinants of such value in terms of acceptance, integration, and technology use. In this regard, Enterprise Resource Planning (ERP) adoption remains challenging for professionals and practitioners alike. Previous research neglected many vital factors, such as user involvement (participation, engagement, and resilience) and environmental factors (change management, competitiveness, and pandemic pressure). Therefore, this study aims to identify the most significant factors that influence the successful adoption of ERP and propose a conceptual model. The Technology Acceptance Model with DeLone and McLean Information Success Models were the base for the study. The findings of this study reveal a conceptual model that facilitates the successful adoption of ERP systems. Through the identification of critical factors, one factor emerged as a permanent component in the adoption process. This conceptual model provides valuable insights for organizations seeking to implement and adopt ERP systems effectively. The study's findings offer valuable insights for firms pursuing long-term economic success through ERP adoption. Understanding the influencing factors enables efficient and effective deployment. Implications are relevant to organizations, ERP vendors, and decision-makers, guiding informed decision-making and prioritizing success factors.

Adolescent Health Care Needs and Relationship to Disease in Patients With Childhood-Onset Systemic Lupus Erythematosus.

OBJECTIVE: Our objective was to characterize adolescent health and psychosocial issues in patients with childhood-onset systemic lupus erythematosus (cSLE) and evaluate demographic and disease characteristics associated with adolescent health. METHODS: We retrospectively examined adolescents aged 12 to 18 years with cSLE seen at the Hospital for Sick Children meeting the American College of Rheumatology/Systemic Lupus International Collaborating Clinics classification criteria, assessed by adolescent medicine in the cSLE clinic between 2018 and 2020. Adolescent health issues were characterized using the Home, Education/Employment, Activities, Diet/Drugs, Sexuality, Suicide/mood (HEADDSS) framework. Issues were classified as presenting and/or identified; adolescent health burden was tabulated as the number of distinct adolescent issues per patient. Multiple Poisson regression models examined associations between patient and disease characteristics (age, sex, material deprivation, disease activity, disease damage, and high-dose glucocorticoid exposure) and adolescent health issues. RESULTS: A total of 108 (60%) of 181 adolescents with cSLE were seen by adolescent medicine, with a median of 2 (interquartile range [IQR] 1-3) visits and a median of 2 (IQR 1-5) adolescent health issues during the study period. Common issues were mood (presenting in 21% vs identified in 50%), sleep (27% vs 2%), school and education (26% vs 1%), and nonadherence (23% vs 8%). Psychoeducation was provided by adolescent medicine to 54% of patients. High-dose glucocorticoids (risk ratio [RR] 1.82, 95% confidence interval [CI] 1.41-2.35, P < 0.001), material deprivation (RR 1.17, 95% CI 1.04-1.30, P = 0.007), and lower SLE Disease Activity Index scores (RR 0.95, 95% CI 0.92-0.98, P = 0.004) were associated with higher adolescent health burden. CONCLUSION: Adolescents with cSLE experience many adolescent issues, especially low mood. High-dose glucocorticoids and social marginalization are associated with greater adolescent health burden. This study highlights the importance of addressing adolescent health needs as part of routine care.

Bioaerosol assessment in indoor and outdoor environments: a case study from India.

Exposure to bioaerosols has been associated with the occurrence of a variety of health impacts, including infectious illnesses, acute toxic effects, allergies, and cancer. This study aimed at evaluating airborne bacteria and fungi populations at different indoor and outdoor sites on a college campus in Bengaluru, India. Bioaerosol samples were collected using a two-stage Andersen air sampler; and isolates were identified using standard procedures. Six air samples and meteorological data were collected in March and April 2014 to examine the effects of temperature and relative humidity on bioaerosol concentration using linear regression modeling. Among all sites, the canteen showed the highest bioaerosol levels both indoors and outdoors. Specific bacterial identification was not possible, but gram staining and microscopic analysis helped to identify gram positive and gram negative bacteria. The most prevalent fungal species in the samples were Cladosporium, Aspergillus niger, Penicillium, Rhizopus, Fusarium, Mucor, and Alternaria. Due to the impact of weather conditions, such as temperature and relative humidity, the bioaerosol concentration varied greatly at each site according to the regression model. The indoor bioaerosol concentrations at all sites exceeded the values established by the American Industrial Hygiene Association (< 250 CFU/m3 for total fungi and < 500 CFU/m3 for total bacteria). Higher concentrations of bioaerosols may be attributed to the transportation of microbes from the ground surface to suspended particles, the release of microbes from the respiratory tract, higher rate of shredding of human skin cells, and many other factors.

Efficacy of Nitazoxanide, Nitazoxanide-Garlic Combination and Tinidazole in Treatment of Giardia duodenalis and Blastocystis hominis: Coproscopic Assessment.

Background: Giardia duodenalis and Blastocystis hominis are among the most common intestinal protozoa worldwide. Treatment of infection by metronidazole (MTZ) has some limitations. The objective of this study was to detect the prevalence of Blastocystis and giardiasis among school-age children from December 2021 till March 2022 from Motoubes, Kafrelsheikh, Egypt, and determine the efficacy of nitazoxanide (NTZ), NTZ plus garlic and tinidazole (TIN) on Blastocystis and giardiasis infection. Methods: Stool samples were collected from 390 children and microscopically examined using formalin-ethyl acetate concentration and culturing on Jones' medium for B. hominis. Those who tested positive for giardiasis (120 children, 30.7%) (Group I) or Blastocystis (180 children, 46.1%) (Group II) were equally divided into four subgroups. The first subgroup received NTZ orally, every 12 hours for three successive days. The second subgroup received NTZ in the same dose as the first subgroup plus dry garlic powder every 12 hours for three successive days. The third subgroup received TIN as a single oral dose, and a fourth control subgroup. Successful cure was considered if no Blastocystis or giardiasis stages were found in post-treatment faecal specimens. Results: Cure rate was significantly higher in TIN treated groups (75.5% and 96.6%) than NTZ (57.7% and 40%) or NTZ plus garlic treated groups (55.5% and 43%) in both Blastocystis and giardiasis, respectively (P<0.05). Conclusion: TIN, once, is more efficacious than NTZ or NTZ plus garlic in the treatment of Blastocystis and giardiasis in children.

Describing financial toxicity among cancer patients in different income countries: a systematic review and meta-analysis.

Background: There is limited evidence of financial toxicity (FT) among cancer patients from countries of various income levels. Hence, this study aimed to determine the prevalence of objective and subjective FT and their measurements in relation to cancer treatment. Methods: PubMed, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined FT. There was no limit on the design or setting of the study. Random-effects meta-analysis was utilized to obtain the pooled prevalence of objective FT. Results: Out of 244 identified studies during the initial screening, only 64 studies were included in this review. The catastrophic health expenditure (CHE) method was often used in the included studies to determine the objective FT. The pooled prevalence of CHE was 47% (95% CI: 24.0-70.0) in middle- and high-income countries, and the highest percentage was noted in low-income countries (74.4%). A total of 30 studies focused on subjective FT, of which 9 used the Comprehensive Score for FT (COST) tool and reported median scores ranging between 17.0 and 31.9. Conclusion: This study shows that cancer patients from various income-group countries experienced a significant financial burden during their treatment. It is imperative to conduct further studies on interventions and policies that can lower FT caused by cancer treatment.

Assessment of solid waste management practices in Kebridehar city Somali regional state, Ethiopia.

In developing countries, solid wastes are not collected and thus discharged into open spaces and drains. The consequences of this event have an impact on human life as well as the environment. The aim of this study was to assess the existing solid waste management practices, as well as sources, types, and determining characteristics of solid waste in the study area. Simple random and purposive sampling methods, respectively, were employed to select 3 sample kebeles and 160 respondents. The data were analyzed in SPSS version 26 using descriptive statistics and an econometric model. The binomial logistic model was used to determine the factors that influence solid waste management activities. The results indicated that Plastics/bags/bottles, food waste, paper/carton, tins/cans, and glasses were the major types of solid wastes in the study area. The majority (45%) of the respondents identified plastics as the dominated solid waste in Kebridehar city. Gender, marital status, and occupation had insignificant negative effects on solid waste management practice. Age (p = 0.030) and distance (p = 0.000) from the center of town, on the other hand, had statistically significant effects on solid waste management practice. The majority of respondents (76.2%) had not received any information regarding the effects of solid wastes on the environment and human life. Beside this, there were no solid waste public bins within walking distance of their residences. In conclusion, the study found that communities were not aware regarding the impacts of solid wastes on the environment; there were no solid waste public bins near the residence of communities at all. Depending on the major findings of the current study, the authors recommend that the city administration should install trash bins near the residences of the communities. The city municipalities should provide training for the communities regarding environmental and human health, the impacts of the solid wastes.

Gap analysis in manufacturing, innovation and marketing of medical devices in the Asia-Pacific region.

INTRODUCTION: Although similar in many aspects of manufacturing and regulatory provisions to medicines, medical devices have their provisions and attract considerable investments in manufacturing and innovation. While the U.S. holds the leading global position in the devices market, Asia Pacific (APAC) countries like China, Japan, Singapore, and South Korea have proved tremendous market potential holding top ten positions. Still, many APAC countries are import-reliant due to hurdles in technological innovation and regulatory provisions. AREAS COVERED: The review aimed to explore those predictors or hurdles and analyzed these to enhance the region's export capacity gradually. EXPERT OPINION: Policymakers in APAC countries with no device manufacturing and health technology assessment capacities would be benefited from the review. The findings showed the presence of a gap in manufacturing, innovation, and marketing of devices within the APAC region and between APAC and western countries. Stringent regulatory measures and quality indicators are still lacking in many APAC nations, and there is an urgent need to harmonize regulatory standards. Being a region constituting over one-third of the global population, a considerable investment in innovation, manufacturing, and establishing quality standards is urgently needed among APAC countries to ensure an adequate supply of quality medical devices.

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.

Cost-Effectiveness and Cost-Utility of Palbociclib versus Ribociclib in Women with Stage IV Breast Cancer: A Real-World Data Evaluation.

Palbociclib and ribociclib are indicated in the first-line treatment of hormonal-receptor-positive HER-2 negative (HR+/HER-2 negative) advanced breast cancer. Despite their clinical benefit, they can increase healthcare expenditure. Yet, there are no comparative pharmacoeconomic evaluations for them in developing countries, the Middle East, or Gulf countries. This study compared the cost-effectiveness of palbociclib and ribociclib in Qatar. A 10-year within-cycle-corrected Markov's model was developed using TreeAge Pro® software. The model consisted of three main health states: progression-free (PFS), progressed-disease (PD), and death. Costs were obtained from the actual hospital settings, transition probabilities were calculated from individual-patient data, and utilities were summarized from the published literature. The incremental cost-effectiveness ratio (ICER) and the incremental cost-utility ratio (ICUR) were calculated and compared to three gross-domestic-products per capita. Deterministic and probabilistic sensitivity analyses were performed. Ribociclib dominated palbociclib in terms of costs, life-years gained, and quality-adjusted life-years gained. The conclusions remained robust in the different cases of the deterministic sensitivity analyses. Taking all combined uncertainties into account, the confidence in the base-case conclusion was approximately 60%. Therefore, in HR+/HER-2 negative stage IV breast cancer patients, the use of ribociclib is considered cost-saving compared to palbociclib.

Outcomes of neonatal hypothermia among very low birth weight infants: a Meta-analysis.

BACKGROUND: Neonatal admission hypothermia (HT) is a frequently encountered problem in neonatal intensive care units (NICUs) and it has been linked to a higher risk of mortality and morbidity. However, there is a disparity in data in the existing literature regarding the prevalence and outcomes associated with HT in very low birth weight (VLBW) infants. This review aimed to provide further summary and analyses of the association between HT and adverse clinical outcomes in VLBW infants. METHODS: In July 2020, we conducted this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic database search was conducted in MEDLINE (PubMed), Google Scholar, ScienceDirect, World Health Organization Virtual Health Library, Cochrane Library databases, and System for Information on Grey Literature in Europe (SIGLE). We included studies that assessed the prevalence of HT and/or the association between HT and any adverse outcomes in VLBW infants. We calculated the pooled prevalence and Odds Ratio (OR) estimates with the corresponding 95% Confidence Interval (CI) using the Comprehensive meta-analysis software version 3.3 (Biostat, Engle-wood, NJ, USA; http://www.Meta-Analysis.com ). RESULTS: Eighteen studies that fulfilled the eligibility criteria were meta-analyzed. The pooled prevalence of HT among VLBW infants was 48.3% (95% CI, 42.0-54.7%). HT in VLBW infants was significantly associated with mortality (OR = 1.89; 1.72-2.09), intra-ventricular hemorrhage (OR = 1.86; 1.09-3.14), bronchopulmonary dysplasia (OR = 1.28; 1.16-1.40), neonatal sepsis (OR = 1.47; 1.09-2.49), and retinopathy of prematurity (OR = 1.45; 1.28-1.72). CONCLUSION: Neonatal HT rate is high in VLBW infants and it is a risk factor for mortality and morbidity in VLBW infants. This review provides a comprehensive view of the prevalence and outcomes of HT in VLBW infants.

Assessment of treatment burden and its impact on quality of life in dialysis-dependent and pre-dialysis chronic kidney disease patients.

BACKGROUND: The management of chronic kidney disease (CKD) and its complications places a significant burden on patients, resulting in impairment of their health-related quality of life (HR-QOL). Little is known about treatment-related burden in pre-dialysis and hemodialysis (HD) CKD patients. OBJECTIVE: This study aimed to investigate the magnitude of treatment-related burden and its impact on HR-QOL among patients with CKD. METHODS: This was a prospective, cross-sectional study to assess treatment-related burden and HR-QOL among patients with CKD in Qatar. Treatment-related burden and HR-QOL were assessed quantitatively using the Treatment Burden Questionnaire (TBQ) and the Kidney Disease Quality of Life (KDQOL™) questionnaire, respectively. The total TBQ score ranges from 0 to 150, with a higher score indicating higher treatment burden, while the range of total possible scores for the KDQOL™ are from 0 to 3600 with higher transformed score indicating better QOL. Pre-dialysis and hemodialysis (HD) CKD patients who had regular follow-up appointments at Fahad Bin Jassim Kidney Center in Qatar were enrolled. Data were analyzed descriptively and inferentially using SPSS version-24. RESULTS: Two hundred-eighty CKD patients (HD = 223 and pre-dialysis = 57) were included in the analyses (response rate 60.9%). Approximately 35% of the participants reported moderate to high treatment-related burden (TBQ global score 51-150). HD patients experienced significantly higher treatment burden compared to pre-dialysis patients with a median (IQR) score of 45 (36) versus 25 (33), respectively (p < 0.001). Medication burden and lifestyle changes burden were the highest perceived treatment-related burden. Overall, the perceived median (IQR) HR-QOL measured using the KDQOL-36™ among the participants was 2280.6 (1096.2) compared to the maximum global score of 3600. Similarly, the HD patients demonstrated significantly lower HR-QOL compared to the pre-dialysis patients [median (IQR) score of 2140 (1100) vs. 2930 (995), respectively; p < 0.001). There was a strong negative correlation between TBQ score and KDQOL-36™ score [rs (251) = -0.616, p < 0.001], signifying that HR-QOL decreases as treatment burden increases. CONCLUSIONS: This study suggests that a considerable proportion of CKD patients suffered from treatment-related burden and deterioration in HR-QOL at a varying degree of seriousness. HD patients experienced significantly higher burden of treatment and lower HR-QOL compared to pre-dialysis patients and that HR-QOL declines as treatment burden increases. Therefore, treatment-related burden should be considered in CKD management and factors that increase it should be considered when designing healthcare interventions directed to CKD patients.

Assessment of Knowledge, Attitudes, and Readiness to Practice Regarding Disaster Medicine and Preparedness Among University Health Students.

OBJECTIVES: The aim of this study is to assess the knowledge (K), attitude (A), and readiness to practice (rP) levels regarding disaster medicine and preparedness among health profession students at Qatar University. METHODS: A survey-based study was carried out to assess medical, pharmacy, and health sciences students' KArP levels using pretested and validated questionnaire. Student's t-test, analysis of variance, correlation, and linear regression were used with an alpha level of 0.05. RESULTS: The difference in the mean KArP level between genders was not significant (P > 0.05). Students from the College of Health Sciences had significantly higher KArP levels than those from the College of Pharmacy (101.5 vs 90.0; P = 0.033). Overall, Qatari students had better knowledge, attitude, and readiness to practice scores and total KArP scores than non-Qatari students. Moreover, students who were born in Qatar also had better knowledge, attitude, and readiness to practice scores and total KArP scores than students who were born outside Qatar. Significant direct moderate correlations were found among the 3 KArP parameters (P < 0.001). Knowledge and attitudes were indicated to be significant predictors of readiness to practice (P < 0.001). CONCLUSIONS: Students from the health colleges at Qatar University have moderate disaster medicine preparedness.

Cost-effectiveness analyses of breast cancer medications use in developing countries: a systematic review.

BACKGROUND: Pharmacoeconomic evaluation is important for breast-cancer medications due to their high costs. To our knowledge, no systematic literature reviews of pharmacoeconomic studies for breast-cancer medication use are present in developing-countries. OBJECTIVES: To systematically review the existing cost-effectiveness evaluations of breast-cancer medication in developing-countries. METHODOLOGY: A systematic literature search was performed in PubMed, EMBASE, SCOPUS, and EconLit. Two researchers determined the final articles, extracted data, and evaluated their quality using the Quality of Health-Economic Studies (QHES) tool. The interclass-correlation-coefficient (ICC) was calculated to assess interrater-reliability. Data were summarized descriptively. RESULTS: Fourteen pharmacoeconomic studies published from 2009 to 2019 were included. Thirteen used patient-life-years as their effectiveness unit, of which 10 used quality-adjusted life-years. Most of the evaluations focused on trastuzumab as a single agent or on regimens containing trastuzumab (n = 10). The conclusion of cost-effectiveness analysis varied among the studies. All the studies were of high quality (QHES score >75). Interrater reliability between the two reviewers was high (ICC = 0.76). CONCLUSION: In many studies included in the review, the use of breast-cancer drugs in developing countries was not cost-effective. Yet, more pharmacoeconomic evaluations for the use of recently approved agents in different disease stages are needed in developing countries.

Impact assessment of pharmacist-supervised intervention on health-related quality of life of newly diagnosed diabetics: A pre-post design.

INTRODUCTION: Diabetics face a series of challenges that affect all aspects of their daily life. Diabetes related complications adversely affect patient's health-related quality of life (HRQoL). Knowledge and self-care skills of diabetics are corner stones to improve their HRQoL. OBJECTIVE: To assess the impact of pharmacist-supervised intervention on HRQoL of newly diagnosed diabetics using an Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire. MATERIALS AND METHODS: A pre-post comparison study was conducted among the control group (CG), test 1 group (T1G) and test 2 group (T2G) patients with three treatment arms to explore the impact of pharmacist-supervised intervention on HRQoL of newly diagnosed diabetics for 18 months. Patients' HRQoL scores were determined using ADDQoL questionnaire at baseline, 3, 6, 9 and 12-months. T1G patients received pharmacist's intervention whereas T2G patients received diabetic kit demonstration in addition to pharmacist's intervention. CG patients were deprived of pharmacist intervention and diabetic kit demonstration, and only received care from attending physician/nurses. Non-parametric tests were used to find the differences in an average weighted impact scores (AWIS) among the groups before and after the intervention at P ≤ 0.05. RESULTS: Friedman test identified significant (P < 0.001) improvement in AWIS among the test groups' patients. Differences in scores were significant between T1G and T2G at 6-months (P = 0.033), 9-months (P < 0.001) and 12-months (P < 0.001); between CG and T1G at 12-months (P < 0.001) and between CG and T2G at 9-months (P < 0.001) and 12-months (P < 0.0010) on Mann.Whitney U test. CONCLUSION: Pharmacist's intervention improved AWIS of test groups' diabetics. Diabetic kit demonstration strengthened the disease understanding and selfcare skills of T2G patients. Disease and self-care awareness among diabetics should be increased in Nepali healthcare system by involving pharmacists for better patient's related outcomes.

An insight into the pharmaceutical sector in Yemen during conflict: challenges and recommendations.

In our world today, we need to understand, measure, and respond to inequality. The conflict and siege in Yemen have caused serious repercussions and consequences for the pharmaceutical sector and health of the people. Hospital, health centres and facilities, medicines warehouses and pharmaceutical factories have been destroyed. Further, the conflict has aggravated the health situation with shortages of medicines, an increase in chronic illnesses, and multiple epidemics and casualties. This article aims to highlight the challenges faced by the pharmaceutical sector in Yemen. It will address the overall state of health of the Yemeni people, as well as focus on the past, current status and future development of the pharmaceutical sector. Further, it will focus on possible remedial actions to solve some of these problems. These problems can be tackled if the responsible parties have the political will to do so. Acknowledging the different classes of problems is undeniably very important to provide clarity on the future of Yemen's supposedly promising pharmaceutical landscape.

Evaluation of Disaster Medicine Preparedness among Healthcare Profession Students: A Cross-Sectional Study in Pakistan.

Background: Disasters are devastating incidents, especially when occurring suddenly and causing damage, great loss of life, or suffering. Disasters can affect health and the social and economic development of a nation. The article analyzes the knowledge (K), attitude (A), and readiness to practice (rP) of healthcare professional students in universities in Pakistan. Methods: We carried out a cross-sectional study using a pretested and validated self-administered disaster medicine and preparedness questionnaire. The study recruited 310 students. Responses were scored and categorized as high (75th quartile), moderate (75-25th quartiles), and low (25th quartile). Independent t-test, one-way ANOVA, Pearson correlation, and regression analyses were performed at an alpha level of 0.05. Results: The study found that most of the students had moderate knowledge, attitude, readiness to practice, and total KArP scores. All K, A, and rP scores were significantly correlated with overall KArP scores. Knowledge and attitude factors were significant predictors of readiness to practice. Conclusions: We strongly believe that educators and health policymakers should build a strong curriculum in disaster medicine management and preparedness to prepare competent future healthcare professionals for the nation.

Availability of Essential Medicines in a Country in Conflict: A Quantitative Insight from Yemen.

BACKGROUND: Medicine and medical supplies are often in short supply in countries suffering from the scourge of conflict. Effective medicine supply policies are lacking in many low- and middle-income countries (LMICs), particularly during conflict. This study aimed to assess the availability of essential medicines in both the public and private healthcare sectors. METHODS: The study was conducted by administering a survey from November 2017 to February 2018 using the World Health Organization/Health Action International (WHO/HAI) guidelines and methodology. Thirty healthcare facilities in thirteen districts from three governorates in Yemen were included in the assessment of thirty essential medicines. The results were reported as frequencies and percentages of outlets with available medicines on the day of data collection. RESULTS: A set of 30 vital and essential medicines were selected from the list of essential medicines that are used in healthcare centers in Yemen to treat prevalent diseases. In general, only 52.8% of the selected medicines were available in public and private healthcare settings. The distribution and availability of medicines in the three governorates were approximately equal. The availability of medicines was better in the private healthcare settings, specifically 73.3% in private hospitals and approximately 79.7% in private pharmacies. CONCLUSIONS: The availability of essential medicines during this state of conflict in three governorates in Yemen is low, in both public and private hospitals and healthcare centers. Many of the medications that were not available are used to treat chronic illnesses.

Relationship between pharmaceutical pricing strategies with price, availability, and affordability of cardiovascular disease medicines: surveys in Qatar and Lebanon.

BACKGROUND: Cardiovascular diseases are the leading cause of death in Lebanon and Qatar. When lifestyle modifications prove insufficient, medication becomes a cornerstone in controlling such diseases and saving lives. Price, availability, and affordability hinder the equitable access to medicines. The study aimed to assess prices, availability, and affordability of essential cardiovascular disease medicines in relation to pricing strategies in Qatar and Lebanon. METHODS: A cross-sectional survey using a variant of the World Health Organization and Health Action International (WHO/HAI) methodology as outlined in "Measuring medicine prices, availability, affordability and price components" (2008), second edition, was adopted. Prices and availability of 27 cardiovascular medicines were collected from public and private dispensing outlets. For international comparison, prices were adjusted to purchasing power parity. Data was analyzed across multiple sectors, within and across countries. RESULTS: A total of 15 public and private outlets were surveyed in each country. Prices were more uniform in Qatar than in Lebanon. In the public sector, medicines were free-of-charge in Lebanon and priced lower than the international reference prices in Qatar. The ratio of medicine unit price to international reference price in the private sectors surveyed are significantly higher than the acceptable threshold of 4. This ratio of originator brands and lowest priced generics in Qatar were up to two and five times those in Lebanon, respectively, even after adjusting for purchasing power parity. However, prices of lowest priced generics in the private sector were at least 35% cheaper in Qatar and 65% cheaper in Lebanon than their comparative originator brands. Medicines were more available in the private sector in Lebanon than in Qatar, but only the originator brand availability in the public sector in Qatar exceeded the WHO target of more than 80%. While affordable in the public sector in Qatar, four out of thirteen medicines exceeded the threshold in all private sectors covered. Hence, only the public sector in Qatar had a satisfying level of availability and affordability. CONCLUSIONS: Except for the Qatari public sector, medicine prices, availability, and affordability are falling short from targets. Key policy decisions should be implemented to improve access to medicines.

Assessment of Dapagliflozin Effectiveness as Add-on Therapy for the Treatment of Type 2 Diabetes Mellitus in a Qatari Population.

The effectiveness of dapagliflozin in the management of type-2 diabetes mellitus (T2-DM) is an essential issue for establishing a basis for prescribing dapagliflozin. This study aimed to assess the effectiveness of dapagliflozin in combination with other hypoglycemic agents (OHAs) in reducing glycated hemoglobin (HbA1c) and fasting blood glucose (FBG) at 3, 6, 9 and 12 months. This retrospective observational study included all patients who visited the endocrine clinics at Hamad Medical Corporation (HMC) and were treated with dapagliflozin. Demographics and laboratory data were obtained retrospectively from computerized patient medical profiles (eMR-viewer). The main outcome measures were the differences in HbA1c and FBG from baseline at different months. Eighty-one Qatari patients were found to have received dapagliflozin during the study period; 72% of them (n = 58) were males, with a mean age of 57.0 ± 9.0 years and a mean baseline HbA1c of 9.0 ± 1.4%. Administration of dapagliflozin as an add-on therapy was found to decrease HbA1c significantly by 0.8 percentage point after 6 months (P = 0.006) and by 1.5 percentage point after 12 months (P = 0.062). FBG was significantly reduced at 6 months and 9 months (P = 0.001 and P = 0.03, respectively). Dapagliflozin effectively reduced the HbA1c level and FBG when used in combination with other OHAs or insulin within 6 to 12 months.