The power of laughter: a study on humor and creativity in undergraduate nursing education in Egypt.

BACKGROUND: Creativity in nursing education is crucial for developing practical problem-solving skills, and humor is a valuable tool for stress management and fostering a positive learning environment. This study explored the relationship between creativity and humor among nursing students. METHODS: A cross-sectional survey was conducted with 265 convenient undergraduate nursing students aged 20 to 25. The Short Scale of Creative Self (SSCS) and the Multidimensional Sense of Humor Scale (MSHS) were used to measure creativity and various aspects of humor. RESULTS: Showed a significant positive correlation between humor and creativity (r = 0.238, p < 0.001). Positive correlations were found between Humor Production, Coping or Adaptive Humor, and Appreciation of Humor with creativity (r = 0.254, 0.230, and 0.461, p < 0.001, respectively). In contrast, Attitudes Toward Humor and Humorous People were negatively correlated with creativity (r=-0.343, p < 0.05). Humor accounted for 16.2% of the variance in creativity. CONCLUSION: The study concluded a strong link between humor and creativity, with positive correlations observed between creative self-efficacy and creative personal identity with different aspects of humor. The study recommends the incorporation of humor into nursing education and healthcare settings to encourage creative problem-solving and reduce burnout among students and staff.

Understanding the relationship of academic motivation and social support in graduate nursing education in Egypt.

BACKGROUND: Obtaining a postgraduate nursing education in Egypt requires substantial resources, including a robust academic drive and supportive relationships. These resources help students overcome challenges and navigate their educational journey. This study examines the relationship between academic motivation and social support among nursing graduate students. DESIGN: A cross-sectional survey was conducted at two nursing colleges in Egypt, involving 410 randomly selected graduate students. MEASURES: The Academic Motivation Scale-College Version (AMS-C 28) and the Multidimensional Scale of Perceived Social Support (MSPSS) were used. FINDINGS: Findings revealed a statistically significant positive relationship between academic motivation and perceived social support (r = 0.515, p < 0.001). Hierarchical regression analysis revealed that 12.9% (Adjusted R² = 0.129) of the variance in academic motivation could be explained by perceived social support and level of education. CONCLUSION: This study pinpointed intrinsic motivation as the primary impetus for graduate nursing students. Robust social support and active participation in social and recreational activities were also significant motivators. Nursing education programs can enhance intrinsic motivation by integrating authentic learning experiences, providing empowering mentorship, offering condensed doctoral programs, and ensuring substantial peer support. The exploration of the role of novelty in graduate nursing education, facilitated by innovative teaching methods such as collaborative virtual reality simulations, gamification, and team-based research projects, can be advantageous. Building robust social networks is vital for establishing a supportive and motivating learning environment for nursing graduates in Egypt.

A closer look: obsessive-compulsive symptoms among intern nurses amidst COVID-19 pandemic.

BACKGROUND: The distinctive circumstances and socio-cultural context in Egypt make it crucial to explore the psychological well-being of intern nurses amid the COVID-19 pandemic, with a specific focus on obsessive-compulsive symptoms. This study aimed to investigate the influence of fear of COVID-19 on obsessive-compulsive symptoms among intern nurses. METHODS: A cross-sectional survey involving 375 randomly recruited intern nurses was conducted. Data collected included the Fear of COVID-19 Scale and the Short Version of the Arabic Obsessive-Compulsive Scale. RESULTS: A significant relationship was found between the fear of COVID-19 and the severity of obsessive-compulsive symptoms among the participants (r = 0.472, p = 0.000). A stepwise regression analysis indicated that the fear of COVID-19, living in urban regions, frequency of COVID-19 infection, and increased number of infected family members may contribute to the severity of Obsessive-Compulsive Symptoms with adjusted R2 value = 27.5%. CONCLUSION: The findings suggest that the COVID-19 pandemic has had significant psychological impacts on newly qualified nurses during their internship training period, including the manifestation of mental health symptoms such as Obsessive-Compulsive Symptoms. It was observed that urban residents, intern nurses with recurrent COVID-19 infections, and those with more infected family members exhibited a higher severity of OCS. These findings underscore the need for further research to investigate additional factors that may influence OCS severity.

Cognitive flexibility's role in shaping self-perception of aging, body appreciation, and self-efficacy among community-dwelling older women.

BACKGROUND: Cognitive flexibility, the capacity to adjust to new information, affects how aging is perceived. In Egyptian culture, older women's views on aging are shaped by societal gender roles and expectations. These views influence their body image and belief in their abilities, all melded by cultural standards and values. AIM: Investigate the mediating role of cognitive flexibility in the relationship between self-aging perception, body appreciation, and self-efficacy among community-dwelling older women. METHODS: A correlational analytical design was used on 200 women aged 60 years or older using the Cognitive Flexibility Inventory, Self-Perceptions of Aging, General Self-Efficacy Scale, and Body Appreciation Scales. Structural equation modeling was used in the analysis. RESULTS: The study found that cognitive flexibility is positively related to self-perception of aging and body appreciation and is also significantly related to general self-efficacy. However, no significant relationship was found between body appreciation and general self-efficacy. Additionally, the study found that cognitive flexibility partially mediates the relationship between self-perception of aging and body appreciation and fully mediates the relationship between body appreciation and self-efficacy. CONCLUSION: Cognitive flexibility is vital in the relationships between self-perceptions of aging, body appreciation, and self-efficacy among older women. Therefore, nursing interventions targeting cognitive flexibility are recommended to promote positive self-aging perceptions, body appreciation, and self-efficacy in this population.

Association between health-related empowerment and health-protective behaviors among community-dwelling older adults.

BACKGROUND: Empowerment is a broad concept seen as a critical approach for helping older adults who lack power to gain control over various aspects of their lives, including their health-protective behaviors. AIM: The study investigated the association between health-related empowerment and health-protective behaviors in older adults. DESIGN: A cross-sectional correlational research design was used by recruiting a convenient sample of 200 older adults. TOOLS: The Elder Health Empowerment Scale and Health Protective Behavior Scale were used to collect the participant data. RESULTS: It showed a significant positive correlation between health-related empowerment and health-protective behaviors in older adults (r = 0.891, p = 0.001), indicating that as health-related empowerment increases, engagement in health-protective behaviors also increases. Furthermore, health-related empowerment accounted for a large proportion of the variation in health-protective behaviors (85.7 %). CONCLUSION: Overall, these findings suggest that there is a need for interventions to improve the health-related empowerment of older adults, particularly in terms of their ability to turn their health goals into actionable plans, overcome barriers to health, and make informed healthcare choices. However, the studied older adults generally engage in health protective behaviors; there is variability in the extent to which they engage in specific behaviors, which may provide valuable insights for developing targeted health promotion programs and interventions.

Cluttered spaces, strained bonds: Examining the correlation between hoarding symptoms and social functioning among long-term care facilities older adult residents.

BACKGROUND: Symptoms of hoarding, such as the inability to part with possessions, leading to significant clutter, are commonly observed among residents in long-term care facilities in Egypt. This behavior significantly impacts their social interactions and functioning. Therefore, this study examined the relationship between hoarding symptoms and social functioning among older adult residents in long-term care facilities. METHODS: The study employed a cross-sectional survey on a purposive sample of 300 older adults. TOOLS: Saving Inventory-Revised and Functional Idiographic Assessment Template-Questionnaire-Short Form were used. RESULTS: The findings revealed a significant positive correlation between hoarding symptoms and social functioning (r = 0.682, p < 0.000). A linear regression analysis supported this correlation, establishing hoarding symptoms as a significant predictor of social functioning (adjusted R2 = 0.32). CONCLUSION: The current study highlighted that a significant proportion of long-term care older adult residents displayed moderate hoarding symptoms and compromised social functioning. A noticeable positive association was observed between hoarding symptoms and social functioning. These results underscore the potential impact of hoarding symptoms on various aspects of social functioning. Given these findings, long-term care nurses should comprehend the various facets of compulsive hoarding behavior and devise effective strategies for assessment and intervention. Establishing support groups within these facilities could provide a platform for these residents to share their experiences and coping strategies. This could reduce interpersonal conflicts and argumentativeness and foster emotional expression and intimacy.

Emotional eating behaviors in later life: Identifying key factors for healthy aging.

BACKGROUND: Pathological, physiological, and psychosocial factors could influence the eating behaviors of older adults in Egypt. Nurses and other healthcare professionals should understand this complex interaction to effectively address their nutritional issues. This study aimed to identify the predictors of emotional eating behaviors among older adults. METHODS: The study followed a cross-sectional survey. A probability sampling technique was used to select the participants. Data was collected using the Emotional Eating Questionnaire and Perceived Stress Scales. RESULTS: 98 % of the respondents were identified as moderate or severe emotional eaters. The study found a significant positive correlation between perceived stress and emotional eating behaviors (r = .436; p = .000). Multivariate analysis revealed that perceived stress, age, gender, marital status, and body mass index (BMI) have a significant positive relationship with emotional eating behaviors (p < .001), accounting for 39.3 % of the variation. CONCLUSION: Emotional eating is common among older adults and is influenced by factors such as age, gender, marital status, BMI, and perceived stress. Nurses can use these findings to develop nutritional plans to promote healthy eating habits of this population.

Surveillance and treatment of primary hepatocellular carcinoma (aka. STOP HCC): protocol for a prospective cohort study of high-risk patients for HCC using GALAD-score.

BACKGROUND: Vietnam and Saudi Arabia have high disease burden of primary hepatocellular carcinoma (HCC). Early detection in asymptomatic patients at risk for HCC is a strategy to improve survival outcomes in HCC management. GALAD score, a serum-based panel, has demonstrated promising clinical utility in HCC management. However, in order to ascertain its potential role in the surveillance of the early detection of HCC, GALAD needs to be validated prospectively for clinical surveillance of HCC (i.e., phase IV biomarker validation study). Thus, we propose to conduct a phase IV biomarker validation study to prospectively survey a cohort of patients with advanced fibrosis or compensated cirrhosis, irrespective of etiologies, using semi-annual abdominal ultrasound and GALAD score for five years. METHODS: We plan to recruit a cohort of 1,600 patients, male or female, with advanced fibrosis or cirrhosis (i.e., F3 or F4) and MELD ≤ 15, in Vietnam and Saudi Arabia (n = 800 each). Individuals with a liver mass ≥ 1 cm in diameter, elevated alpha-fetoprotein (AFP) (≥ 9 ng/mL), and/or elevated GALAD score (≥ -0.63) will be scanned with dynamic contrast-enhanced magnetic resonance imaging (MRI), and a diagnosis of HCC will be made by Liver Imaging Reporting and Data System (LiRADS) assessment (LiRADS-5). Additionally, those who do not exhibit abnormal imaging findings, elevated AFP titer, and/or elevated GALAD score will obtain a dynamic contrast-enhanced MRI annually for five years to assess for HCC. Only MRI nearest to the time of GALAD score measurement, ultrasound and/or AFP evaluation will be included in the diagnostic validation analysis. MRI will be replaced with an abdominal computed tomography scan when MRI results are poor due to patient conditions such as movement etc. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced MRI will not be carried out in study sites in both countries. Bootstrap resampling technique will be used to account for repeated measures to estimate standard errors and confidence intervals. Additionally, we will use the Cox proportional hazards regression model with covariates tailored to the hypothesis under investigation for time-to-HCC data as predicted by time-varying biomarker data. DISCUSSION: The present work will evaluate the performance of GALAD score in early detection of liver cancer. Furthermore, by leveraging the prospective cohort, we will establish a biorepository of longitudinally collected biospecimens from patients with advanced fibrosis or cirrhosis to be used as a reference set for future research in early detection of HCC in the two countries. TRIAL REGISTRATION: Name of the registry: ClinicalTrials.gov Registration date: 22 April 2022 Trial registration number: NCT05342350 URL of trial registry record.

Inhibitors of histone deacetylase as antitumor agents: A critical review.

Histone deacetylase (EC 3.5.1.98 - HDAC) is an amidohydrolase involved in deacetylating the histone lysine residues for chromatin remodeling and thus plays a vital role in the epigenetic regulation of gene expression. Due to its aberrant activity and over expression in several forms of cancer, HDAC is considered as a potential anticancer drug target. HDAC inhibitors alter the acetylation status of histone and non-histone proteins to regulate various cellular events such as cell survival, differentiation and apoptosis in tumor cells and thus exhibit anticancer activity. Till date, four drugs, namely Vorinostat (SAHA), Romidepsin (FK-228), Belinostat (PXD-101) and Panobinostat (LBH-589) have been granted FDA approval for cancer and several HDAC inhibitors are currently in various phases of clinical trials, either as monotherapy and/or in combination with existing/novel anticancer agents. Regardless of this, today scientific efforts have fortified the quest for newer and novel HDAC inhibitors that show isoform selectivity. This review focuses on the chemistry of the molecules of two classes of HDAC inhibitors, namely short chain fatty acids and hydroxamic acids, investigated so far as novel therapeutic agents for cancer.

Symptom Burden and Quality of Life Among Patients With Heart Failure.

Introduction: Heart failure is a debilitating condition that is associated with several burdensome symptoms that impede patients' quality of life. However, patients' experience of distressing symptoms and their impacts on their quality of life is not studied in Jordan. Objectives: To assess the severity of distressing symptoms and to assess the relationships between these symptoms and the quality of life among patients with heart failure in Jordan. Methods: A descriptive cross-sectional design was used. A convenience sampling approach was used to recruit the participants. Heart failure patients (n = 167) who visited the outpatient clinics in three hospitals in Amman between July and November 2021 were included. The Edmonton Symptom Assessment System and Short-Form 36 tool were used. Results: Participants were more likely males with a mean age of 55.2 years (SD = 13.7). The most distressing symptoms among patients with heart failure were tiredness (M = 4.56, SD = 3.24), worse well-being (M = 4.34, SD = 2.52), and drowsiness (M = 3.5, SD = 3.06), respectively. Symptoms burden were negatively associated with the physical and the mental components summary of the quality of life. Pain, tiredness, nausea, loss of appetite, anxiety, and poor well-being were significant predictors of the physical components. The predictors of the mental components were tiredness, nausea, loss of appetite, and anxiety. Conclusions: This study revealed that patients with heart failure facing significant symptom burden. The patients showed inadequate quality of life in both physical and mental components that were inversely associated with symptom burden. Given the debilitating effects of symptom burden on heart failure patients' quality of life, therefore, symptom assessment and management have to be a priority.

Knowledge, attitudes, and practices related to dietary salt among older adults in Abha, Saudi Arabia.

The need to foster successful aging has intensified with the aging of the global population. This study aimed to assess the knowledge, attitudes, and practices (KAP) concerning dietary salt consumption and to investigate the correlations between sociodemographic variables and salt-related KAP. A structured interview was administered to a cohort of 200 older adults in Abha City, Saudi Arabia, recruited through a convenience sampling approach. The evaluation of salt-related KAP revealed widespread low knowledge (91.5%) as participants scored less than 3, negative attitudes (85.5%) scored less than 12, and predominantly unsatisfactory practices (69.5%) with scores less than 26. Noteworthy differences emerged between participants with poor overall KAP (81.5%) and those with good KAP (18.5%). Significantly weak negative correlations were found between age (r=-0.212), marital status (-0.236), and body mass index (-0.243) with overall KAP. Further examination revealed a significantly weak positive correlation between attitude and practice (r = 0.141). KAP scores show a highly significant positive correlation with overall KAP scores (r = 0.169, 0.352, 0.969). The uncovered correlations contribute to a valuable understanding of the complex dynamics surrounding salt-related KAP. This understanding guides the design of targeted interventions, such as health education programs, promoting successful aging and public health outcomes.

Association between microRNA expression and risk of male idiopathic infertility in Iraq.

OBJECTIVE: The World Health Organization defines infertility as the inability to get pregnant after 12 months of unprotected sexual activity. This study was conducted to estimate the levels of gene expression for two mature miRNAs (i.e., miR-122 and miR-34c-5p) to evaluate susceptibility to male infertility. METHODS: This study included 50 male patients with idiopathic infertility who were admitted to hospital from the period November 2021 to May 2022 and another group consisting of 50 apparently healthy individuals used as controls. RESULTS: miR-122 level was significantly highest in azoospermia and followed by oligospermia, 39.22 (31.88) versus 37.34 (20.45), respectively. In addition, there was a very significant difference in miR-34c-5p levels between the study groups (p<0.05). CONCLUSION: Two miRNAs, namely, miR-34c-5p and miR-122, can be used as predictive and diagnostic biomarkers for infertility.

Prevalence, attitudes, and practices of dietary supplements among middle-aged and older adults in Asir region, Saudi Arabia: A cross-sectional study.

The objectives of this study were to 1) identify the prevalence of dietary supplements (DS) among middle-aged and older adults; 2) determine attitudes toward DS and patterns of DS usage among middle-aged and older adults; and 3) assess the association of sociodemographic, clinical, and lifestyle factors with DS attitudes and DS usage. A cross-sectional online survey was undertaken among middle-aged and older adults. Data were collected by an online self-administered pretested questionnaire used as a study tool and distributed to respondents via social media applications. The DS usage prevalence among 501 respondents was 50.7%, and 53.5% of participants reported a positive attitude toward DS. The positive attitudes and higher usage of dietary supplements were statistically significant in higher proportions among older adults compared to middle-aged individuals. Significantly lower proportion of middle aged (54.9%) reported taking DS daily compared to 59.9% of older adults. A significant difference in the type of DS among the two groups was found for Omega-3 (p<0.001), minerals (p = 0.004), proteins (p = 0.002), fibers (p = 0.002), phytonutrients (p = 0.007), and probiotics (p = 0.015), with a higher proportion of middle-aged respondents reporting their use compared to older adults. Dietary supplement usage is a prevalent phenomenon among older adults and the middle-aged population. However, some undesirable practices regarding their use still exist in the community. Thus, there is a need of focussed health education to enhance attitudes and improve practices regarding the use of DS.

Cinnamon Oil Alleviates Acetaminophen-Induced Uterine Toxicity in Rats by Abrogation of Oxidative Stress, Apoptosis, and Inflammation.

Paracetamol, or acetaminophen (APAP), is one of the first-line medications that is used for fever and pain. However, APAP can induce uterine toxicity when overused. The mode of action of APAP toxicity is due to the production of free radicals. The main goal of our study is to determine uterine toxicity from APAP overdose and the antioxidative activity of cinnamon oil (CO) in female rats. The effect of different doses of CO (50-200 mg/kg b.w.) was assessed in the uterus toxicity induced by APAP. Additionally, the imbalance in oxidative parameters, interleukins, and caspases was evaluated for the protective effects of CO. A single dose of APAP (2 g/kg b.w.) resulted in uterus toxicity, indicated by a significant increase in the level of lipid peroxidation (LPO), inflammatory interleukins cytokines (IL-1 and 6), expression of caspases 3 and 9, and a marked change in uterus tissue architecture evaluated by histopathology. Co-treatment of CO resulted in a significant amelioration of all the parameters such as LPO, interleukins IL-1ß, IL-6, caspases 3 and 9 expression, and distortion of tissue architecture in a dose-dependent manner. Therefore, we can conclude that APAP-induced uterine injury due to oxidative stress can be restored by co-treatment with cinnamon oil (CO).

The whole experience of public hospital physicians from several specialties with biopharmaceutical effectiveness, safety, adverse drug reactions and interchangeability: A qualitative study.

Background: Although there is increasing support for biosimilar medicines by the Iraqi Ministry of Health (MOH), there is scarce information about whether physicians accept these medicines and support movement toward replacing reference medicines with their biosimilar counterparts. Objectives: The study objectives were to 1) explore in-depth the perceptions of Iraqi physicians working in public hospitals about the difference in effectiveness and safety between biosimilar medicines and their reference biological counterparts, 2) evaluate physicians' barriers to prescribing biosimilar medicines, 3) assess the adherence of physicians to the new pharmacovigilance regulations on reporting biopharmaceutical adverse drug reactions (ADRs) and 4) identify any barriers facing physicians to reporting biopharmaceutical- ADRs. Methods: This qualitative study included face-to-face and virtual semi-structured interviews involving physicians from different disciplines who had experience with biological or biosimilar medicines. The interviews were conducted between November 6, 2020, and February 7, 2021. Thematic analyses were used to analyze qualitative data generated from the interviews. Results: The study sample included 36 physicians (6 women and 30 men) from seven different specialties at ten governmental hospitals mainly in Baghdad, and one physician was from Mosul, Iraq. Because most physicians had insufficient experience with biosimilar medications and were not sure about their effectiveness, the majority were hesitant to prescribe them. Most physicians preferred to prescribe reference biological medicines initially. However, the initial prescribing and switching between a reference and counterpart biosimilar relies on its availability. They chose biosimilar medications that have been approved by the U.S. FDA or EMA. Most physicians were unaware about the new pharmacovigilance regulations to report adverse biopharmaceutical reactions. The physicians tended to underreport biopharmaceutical ADRs and believed that inadequate physician-pharmacist collaboration negatively impacts preventing and reporting ADRs. Conclusions: Medicine procurement in healthcare settings should focus on sustainably securing high-quality biopharmaceuticals rather than looking only at costs to enhance physician experience and patient clinical outcomes. Promoting documentation, monitoring, and physician-pharmacist collaboration is pivotal to prevent, monitor, and treat biopharmaceutical ADRs.

Awareness of Child Abuse and Neglect Among the General Public in Saudi Arabia: A Systematic Review.

Child abuse represents a serious problem worldwide. In Arab countries, the problem is complicated because abuse may be perceived as a method of discipline. This review aimed to describe awareness of the public in Saudi Arabia regarding child abuse. A search was performed in the databases of MEDLINE/PubMed, Scopus, Academic Search Complete (EBSCOhost), and Web of Science for articles published in English from the 1st of January, 2000, to the 14th of November, 2022. The search was conducted during the period from the 7th to the 14th of November 2022. The used search words were {"Child Abuse"} AND {"Saudi Arabia"} AND {"awareness"}. The risk of bias (ROB) was assessed using the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Six studies were included in this review. Most studies had high ROB in recruiting the participants, designing the questionnaires, and stating the rate of response. The awareness regarding physical abuse seemed fair in most studies, but the awareness about shaken baby syndrome was poor. Also, there was a misconception about the parent's right to discipline their children through corporal punishment. Most participants did not perceive a need for establishing protective laws or programs. Public awareness about emotional abuse and neglect was lower than in cases of physical abuse. The overall knowledge about child abuse seems to be fair, but poor knowledge was observed in some forms, such as shaken baby syndrome. The public concepts about physical punishment and the need for protective laws and programs are also negative and require more efforts to alter them.

Association of BMI, Physical Activity with Academic Performance among Female Students of Health Colleges of King Khalid University, Saudi Arabia.

Body mass index (BMI) is an indicator to detect weight category and known to influence the academic achievements of students. The present study assesses the association of BMI, physical activity with academic performance among undergraduate female students of health colleges, King Khalid University (KKU). Responses from 379 participants were analyzed in the study. Data collection was done by administering an online questionnaire using the university website portal. The questionnaire consists of two sections: the first section includes demographic information along with cumulative Grade point average (GPA) and another section rated student's physical activity. A high frequency of respondents (53.6%) ranged within the normal BMI category. For academic performance, the majority (79.9%) of students reported high GPA scores with a mean of 4.28 ± 0.41. Upon correlation, academic performance was found negatively correlated with BMI at 0.0001 level of significance, and insignificantly correlated with physical activity. The present study observed that more than half of the respondents had normal BMI. An inverse relationship was observed between BMI and academic performance, showing participants within the normal BMI category achieved significantly higher GPA. In contrast, physical activity directly influenced the academic performance of the subjects. Therefore, the study suggests to enact counselling centers, health clubs in universities urging the students to adopt regular exercise and healthy lifestyle which could prepare them in achieving future endeavors.

The relationship between exacerbated diabetic peripheral neuropathy and metformin treatment in type 2 diabetes mellitus.

Metformin-treated diabetics (MTD) showed a decrease in cobalamin, a rise in homocysteine, and methylmalonic acid, leading to accentuated diabetic peripheral neuropathy (DPN). This study aimed to determine whether or not metformin is a risk factor for DPN. We compared MTD to non-metformin-treated diabetics (NMTD) clinically using the Toronto Clinical Scoring System (TCSS), laboratory (methylmalonic acid, cobalamin, and homocysteine), and electrophysiological studies. Median homocysteine and methylmalonic acid levels in MTD vs. NMTD were 15.3 vs. 9.6 µmol/l; P < 0.001 and 0.25 vs. 0.13 µmol/l; P = 0.02, respectively with high statistical significance in MTD. There was a significantly lower plasma level of cobalamin in MTD than NMTD. Spearman's correlation showed a significant negative correlation between cobalamin and increased dose of metformin and a significant positive correlation between TCSS and increased dose of metformin. Logistic regression analysis showed that MTD had significantly longer metformin use duration, higher metformin dose > 2 g, higher TCSS, lower plasma cobalamin, and significant higher homocysteine. Diabetics treated with metformin for prolonged duration and higher doses were associated with lower cobalamin and more severe DPN.

The Epidemic of Substandard and Falsified Medications in Iraq: Evaluating the Effectiveness of National Pharmacovigilance Alerts to Community Pharmacies.

BACKGROUND: Assessing Iraqi experience with the impact of substandard and falsified (S/F) medicines can help other countries deal comprehensively with the underlying causes of this multifactorial problem. The tools used in this study to assess strategies to prevent the use of S/F medications can be used in other developing countries. This study investigated the problem of S/F medications at three levels: the Ministry of Health (MOH), pharmaceutical company representatives, and community pharmacists. OBJECTIVES: Study objectives were to evaluate the effectiveness of alerts about S/F medications issued by the national Iraqi Pharmacovigilance Center (IqPhvc) to community pharmacies and to explore the reasons and potential solutions for this problem from the perspective of both pharmaceutical companies and pharmacists. METHODS: This was an exploratory mixed-method study. The qualitative phase comprised seven 1-h semi-structured interviews and one focus group conducted via Zoom. Thematic analysis was used to analyse the qualitative data. The findings of the qualitative phase were then used to develop the survey items. The quantitative phase included an electronic survey distributed among pharmacists via two professional Facebook groups between 23 April and 19 May 2020. The Kruskal-Wallis test was used to measure differences in pharmacists' knowledge of and ability to detect S/F medications according to their years of experience in the private sector. RESULTS: Over the last 5 years (2016-2020), the IqPhvc received 183 reports about S/F medications from representatives of 25 international companies. Only 29 (15.8%) of the reports were about falsified medications; the majority were about substandard (parallel) medicines. We interviewed 12 pharmacists (11 male, 1 female) representing ten large international pharmaceutical companies. We also received surveys from 590 pharmacists, of whom 475 (80.9%) were women. Although 72% of the participants had not received any training in the identification of S/F medications, 59.4% of them easily identified S/F medications. Likewise, approximately three-quarters of the participating pharmacists recognized genuine registered medications through three means: medication price sticker, cost, and packaging features. Although 61% of the pharmacists followed-up alerts about S/F medications, only 25.6% were willing to report S/F medications. CONCLUSIONS: Most reports to the IqPhvc were about substandard medications. Participants of the two study phases agreed on several reasons for the problem of S/F medications, including their low prices, the unavailability of registered medications, the lengthy medicine registration process, and inadequate awareness of S/F medications among healthcare providers and the public. They also agreed that national alerts and price stickers are helpful in the identification of S/F medications. Community pharmacists can increase their efforts to report S/F medicines, but they need training, awareness, and tools. The study highlighted the need for a track-and-trace system to detect S/F medicines in the supply chain. In brief, the problem of S/F medication is multifaceted. Reducing it will require effective collaboration among different entities, including health officials, border agencies, healthcare providers, and registered pharmaceutical companies.

The Association of COVID-19 Pandemic Stress With Health-Related Quality of Life in the Kingdom of Saudi Arabia: A Cross-Sectional Analytical Study.

Background: There is a global disaster since WHO declared Covid-19 as a pandemic. With the increase in cases & mortality rate, various health issues viz., stress, mental disorders and altered health-related quality of life have been noted as a result of pandemic and lockdowns. This study aimed to assess the association of COVID-19 pandemic stress with health-related quality of life in the Kingdom of Saudi Arabia. Methodology: It was a cross-sectional analytical study. Subjects included 878 citizens and residents of Saudi Arabia aged 18 years and above. Convenience, non-probability sampling technique was used. A web-based, self-administered, electronic questionnaire in Arabic language having three sections; Sociodemographic & clinical profile, Standard PSS-10, and Standard SF-12 was used as the study tool and distributed through various social media means. The study period was of 2 months. Data were analyzed using SPS version 25. Descriptive statistics, Pearson's correlation coefficient, independent sample t-test and the one-way analysis of variance (ANOVA) were employed for suitable statistical analysis. Results: Almost two-thirds of the subjects were between the age of 18 to < 40 and majority (74.1%) being females. Majority (83.0%) reported as having no chronic diseases, and 69.5% had no contact history with COVID-19 cases. The mean of MCS & PCS was (32.34 ± 25.30) & (41.65 ± 11.82), respectively. Majority (67.6%) had a moderate level of COVID-19 stress. A significant negative relationship between total stress scores and HRQOL domains was observed. Conclusion: Majority subjects had a moderate level of stress related to COVID-19 lockdown. Stress during COVID-19 has a significant negative association with both physical and mental HRQOL in which MCS was significantly lower than PCS. It is recommended to evaluate the effectiveness of stress management program and follow a holistic approach.