Patient satisfaction with coronary CT angiography versus invasive coronary angiography: results of a single-center randomized trial.

OBJECTIVE: Because there is evidence for a clinical benefit of using coronary computed tomography (CT) angiography instead of invasive coronary angiography (ICA) in patients with suspected coronary artery disease (CAD), we ascertained if patient satisfaction could represent an important barrier to implementation of coronary CT in clinical practice. MATERIALS AND METHODS: A total of 329 patients with suspected CAD and clinical indication for ICA were randomly assigned to undergo either CT or ICA for guiding treatment. Satisfaction for both groups was assessed by patient questionnaire completed twice, ≥24 h after CT or ICA, and at follow-up after a median of 3.7 years. Assessment included preparation, concern, comfort, helplessness, pain, willingness to undergo tests again, overall satisfaction, and preference. Pearson's chi-square test and Wilcoxon rank-sum test were used. RESULTS: Overall, 91% of patients undergoing CT (152/167) and 86% undergoing ICA completed assessment (140/162, p = 0.19). Patients reported being significantly better prepared for CT, less concerned about the test, and felt less helpless than during ICA (all: p < 0.001). Subjective pain (horizontal nonmarked visual analogue scale) was significantly lower for CT (6.9 ± 14.7) than for ICA (17.1 ± 22.7; p < 0.001). At follow-up, significantly more patients in the CT group reported very good satisfaction with communication of findings compared with the ICA group (p < 0.001) and 92% would recommend the institution to someone referred for the same examination. CONCLUSIONS: Results from our single-center randomized study show very good satisfaction with coronary CT compared to ICA. Thus, superior acceptance of CT should be considered in shared decision-making. CLINICAL RELEVANCE STATEMENT: This evaluation of patient satisfaction in a randomized study shows that patients' preference is in line with the clinical benefit provided by CT and also suggests to prefer a CT-first strategy in suspected coronary artery disease. KEY POINTS: • Subjective pain was significantly lower for coronary CT angiography than for invasive coronary angiography and patients felt better prepared and less concerned about CT. • Patients were overall more satisfied with coronary CT angiography than invasive coronary angiography in a randomized controlled trial. • After a median follow-up of 3.7 years, more patients in the CT group indicated very good satisfaction with the communication of findings and with the examination itself.

Pyridinium-Inspired Organocatalysts for Carbon Dioxide Fixation: A Density Functional Theory Inspection.

The current project aims to apply the virtues of minimalism to examine the catalytic ability of commercially organic compounds of small chemical structures to catalyze the coupling reaction between carbon dioxide and propylene oxide (PO) under mild conditions. The proposed catalysts are pyridinium iodide (A), 2-hydroxypyridinium iodide (B), and piperidinium iodide (C), where their structure is based on cooperative acidic and nucleophilic motifs. The quantum chemistry model, M062X-D3/def2-TZVP//M062X-D3/def2-SVPP, was used to understand the reaction mechanism and the catalytic performance. Since the coupling reaction was performed under excess PO, we proposed that PO serves as a reactant and solvent. Therefore, calculations were performed in gas and liquid phases for comparison. The findings indicated that the rate-determining step depends on the chemical structure of the catalyst and whether the phase is a gas or liquid phase. In general, modeling in the liquid phase produces potential energy surfaces of lower energy barriers. The noncovalent interactions reflect the role of hydrogen bonding in controlling the kinetic behavior of the coupling reaction. Based on the finding, catalyst A is the best candidate for transforming CO2 into cyclic carbonates.

The anti-corrosive behavior of benzo-fused N-heterocycles: an in silico study toward developing organic corrosion inhibitors.

The work provides a computational protocol to predict the anti-corrosive performance of organic molecules through three successive phases of calculations; electron propagator theory (EPT), Monte Carlo (MC) simulations, and the density functional based tight-binding (DFTB) method. The protocol was applied to investigate the influence of two structural factors on the anti-corrosive performance of benzo fused-N-heterocycles (BFNHs) against the Fe(110) surface in an acidic medium; positional isomerism and the gradual insertion of nitrogen atoms in the heterocycle ring. The choice of BFNHs is attributed to their anti-corrosion activity and their use as building blocks in the molecular structure of many organic inhibitors. The findings indicate that EPT is a safe method for calculating the quantum chemical descriptors of the isolated molecules. Besides, the current work recommends using MC simulations and the DFTB method to describe the physical and chemical adsorption, respectively. Unexpected results were observed, as the gradual insertion of nitrogen atoms is not a specific factor for improving the inhibition efficiency of BFNHs. The findings were crystallized in equations linking the physical and chemical adsorption energies with the quantum chemical descriptors with a correlation exceeding 0.75. Besides, the peri steric hindrance plays an influential role in chemical adsorption. Intriguingly, the continuous introduction of nitrogen atoms does not increase the efficiency of the inhibitor along the way. For example, phthalazine exhibited better efficiency than benzotetrazine. In light of the above, the present protocol helps understand the anti-corrosive behavior of organic inhibitors and provides a feasible method to develop novel corrosion inhibitors.

A DFT-design of single component bifunctional organocatalysts for the carbon dioxide/propylene oxide coupling reaction.

The aim of this work is to develop single-component bifunctional organic catalysts capable of effective coupling reactions between CO2 and propylene epoxide (PO) under mild conditions using density functional theory (DFT) calculations. The dual functionalities of the target catalysts come from their inclusion of a hydroxyl-containing electrophile and the nucleophilicity of iodide ion. In this respect, a series of hydroxyl-functionalized quaternary onium-based ionic liquids were studied using M062X-D3/def2-TZVP//M062X-D3/def2-SVPP model chemistry. The design of catalysts was based on tailoring two structural factors; the first one is the onium center of pnictogens (N, P, As, Sb and Bi), and the second one is the number of hydrogen bond donor groups (n = 1-3). The proposed catalysts were examined by investigation of their catalytic mechanisms to afford the cyclic carbonate. Additionally, the highest active transition state, along with the potential energy difference, was examined using non-covalent interaction (NCI) analysis. Also, the activation strain model (ASM) was used to explain the kinetic behavior of PO activation. The findings showed that the ring-opening step of PO is always the critical step of the reaction. Among the suggested catalysts, the results indicated that the dihydroxyl ammonium-based catalyst (2OH-NI) is a good choice for this catalysis under mild and solvent-free conditions.

Diaryl Sulfide Derivatives as Potential Iron Corrosion Inhibitors: A Computational Study.

The present work aimed to assess six diaryl sulfide derivatives as potential corrosion inhibitors. These derivatives were compared with dapsone (4,4'-diaminodiphenyl sulfone), a common leprosy antibiotic that has been shown to resist the corrosion of mild steel in acidic media with a corrosion efficiency exceeding 90%. Since all the studied compounds possess a common molecular backbone (diphenyl sulfide), dapsone was taken as the reference compound to evaluate the efficiency of the remainder. In this respect, two structural factors were examined, namely, (i) the effect of replacement of the S-atom of diaryl sulfide by SO or SO2 group, (ii) the effect of the introduction of an electron-withdrawing or an electron-donating group in the aryl moiety. Two computational chemical approaches were used to achieve the objectives: the density functional theory (DFT) and the Monto Carlo (MC) simulation. First, B3LYP/6-311+G(d,p) model chemistry was employed to calculate quantum chemical descriptors of the studied molecules and their geometric and electronic structures. Additionally, the mode of adsorption of the tested molecules was investigated using MC simulation. In general, the adsorption process was favorable for molecules with a lower dipole moment. Based on the adsorption energy results, five diaryl sulfide derivatives are expected to act as better corrosion inhibitors than dapsone.

Association between medication adherence and quality of life of patients with diabetes and hypertension attending primary care clinics: a cross-sectional survey.

PURPOSE: To evaluate the association between medication adherence and quality of life (QoL) of patients with diabetes and/or hypertension attending primary care clinics. METHODS: In this cross-sectional study, patients with at least one long-term condition (hypertension or diabetes mellitus) meeting the eligibility criteria were recruited from five primary care clinics in Saudi Arabia. Arabic version of Morisky Medication Adherence Scale (MMAS-8) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) tool were used to assess medication adherence and QoL, respectively. Patients' sociodemographic, medical and medication data were collected using a structured, pilot-tested data collection form. RESULTS: Three hundred patients with a mean (± SD) age of 56.79 (12.8) years participated in the study. Fifty-eight had hypertension only, 96 had diabetes (Type 1 or 2), and 146 had both hypertension and diabetes. After adjusting for socioeconomic characteristics, multiple linear regression analysis found that adherent patients had significantly higher mean overall perception of QoL and health scores by 14.6 (P = 0.001) and 17.2 (P = 0.001) points, respectively, compared to non-adherent patients. In addition, irrespective of the type of long-term condition, adherence status was found to be an independent predictor of all QoL domains. CONCLUSION: There is an association between medication adherence and QoL among patients with diabetes and/or hypertension attending primary care clinics. Medication adherence should be assessed and emphasised during routine clinical consultations in primary care in order to achieve the desired clinical outcomes and overall well-being of patients.

Environmentally azithromycin pharmaceutical wastewater management and synergetic biocompatible approaches of loaded azithromycin@hematite nanoparticles.

Pharmaceutical wastewater contamination via azithromycin antibiotic and the continuous emergence of some strains of bacteria, cancer, and the Covid-19 virus. Azithromycin wastewater treatment using the biosynthesized Hematite nanoparticles (α-HNPs) and the biocompatible activities of the resulted nanosystem were reported. Biofabrication of α-HNPs using Echinacea purpurea liquid extract as a previously reported approach was implemented. An evaluation of the adsorption technique via the biofabricated α-HNPs for the removal of the Azr drug contaminant from the pharmaceutical wastewater was conducted. Adsorption isotherm, kinetics, and thermodynamic parameters of the Azr on the α-HNPs surface have been investigated as a batch mode of equilibrium experiments. Antibacterial, anticancer, and antiviral activities were conducted as Azr@α-HNPs. The optimum conditions for the adsorption study were conducted as solution pH = 10, 150 mg dose of α-HNPs, and Azr concentration 400 mg/L at 293 K. The most fitted isothermal model was described according to the Langmuir model at adsorption capacity 114.05 mg/g in a pseudo-second-order kinetic mechanistic at R2 0.9999. Thermodynamic study manifested that the adsorption behavior is a spontaneous endothermic chemisorption process. Subsequently, studying the biocompatible applications of the Azr@α-HNPs. Azr@α-HNPs antibacterial activity revealed a synergistic effect in the case of Gram-positive more than Gram-negative bacteria. IC50 of Azr@α-HNPs cytotoxicity against MCF7, HepG2, and HCT116 cell lines was investigated and it was found to be 78.1, 81.7, and 93.4 µg/mL respectively. As the first investigation of the antiviral use of Azr@α-HNPs against SARS-CoV-2, it was achieved a safety therapeutic index equal to 25.4 revealing a promising antiviral activity. An admirable impact of the use of the biosynthesized α-HNPs and its removal nanosystem product Azr@α-HNPs was manifested and it may be used soon as a platform of the drug delivery nanosystem for the biomedical applications.

Cefotaxime removal enhancement via bio-nanophotocatalyst α-Fe2O3 using photocatalytic degradation technique and its echo-biomedical applications.

The present paper evaluates the photocatalytic degradation (PCD) performance of the biofabricated hematite nanoparticles (α-HNPs) for the degradation approach of the Cefotaxime (Cfm). The optimum pH of the solution to achieve the best PCD was found to be 10.5. The kinetics study for the PCD of the Cfm via α-HNPs has been investigated and the reaction was found to be fellow pseudo-first-order at R2 = 0.992. The mass loading impact of α-HNPs was investigated and estimated for the maximum degradation of Cfm 0.4 mg/mL. UV-Vis confirmed that α-HNPs had a direct transition bandgap at 3.78 eV at a maximum absorption wavelength of 362 nm with suspension stability for 7 days. The probable mechanism of the Cfm PCD via α-HNPs and the degradation pathway was conducted. The validation of the suspension stability of the α-HNPs (-68.6 ± 11.8 mV) was determined using the zeta potential investigation test. XRD investigation was conducted after Cfm PCD showing an average crystallite size of 27.0 nm. XRD, TEM, SEM, EDX, and FT-IR analyses have been conducted for the α-HNPs before and after Cfm PCD confirming the high efficiency for the reusability of the current biocatalyst α-HNPs for further use. TEM results of the particle sizes of α-HNPs were found at 19.2 ± 4.4 and 20.6 ± 7.4 nm respectively before and after Cfm PCD. The efficiency of the Cfm PCD was found to be 99.1% after 6 h. High potent as an antibacterial agent of α-HNPs was investigated either α-HNPs alone or after its PCD activity against Cfm. The antibacterial activity revealed high sensitivity, especially toward Gram-positive species indicating its promising ability against pathogenic issues. Interestingly, Cfm@α-HNPs showed superior anti-proliferative activity as tested by MTT assay and were able to induce apoptosis in MCF7 and HepG2 cell lines using the flow cytometry technique at 20.7% and 17% respectively. Also, The IC50 of hydrogen peroxide scavenging was estimated and it was manifested that 635.8 and 665.6 µg/mL of α-HNPs before and after the PCD process of Cfm respectively.

Targeting host cell proteases as a potential treatment strategy to limit the spread of SARS-CoV-2 in the respiratory tract.

As the death toll of Coronavirus disease 19 (COVID-19) continues to rise worldwide, it is imperative to explore novel molecular mechanisms for targeting SARS-CoV-2. Rather than looking for drugs that directly interact with key viral proteins inhibiting its replication, an alternative and possibly add-on approach is to dismantle the host cell machinery that enables the virus to infect the host cell and spread from one cell to another. Excellent examples of such machinery are host cell proteases whose role in viral pathogenesis has been demonstrated in numerous coronaviruses. In this review, we propose two therapeutic modalities to tackle SARS-CoV-2 infections; the first is to transcriptionally modulate the expression of cellular proteases and their endogenous inhibitors and the second is to directly inhibit their enzymatic activity. We present a nonexhaustive collection of clinically investigated drugs that act by one of these mechanisms and thus represent promising candidates for preclinical in vitro testing and hopefully clinical testing in COVID-19 patients.

Efficacy of rTMS in decreasing postnatal depression symptoms: A systematic review.

BACKGROUND: Repetitive Transcranial Magnetic Stimulation (rTMS) has been suggested as an alternative treatment to postnatal depression (PPD). OBJECTIVES: This systematic review aims to examine and summarise evidence on rTMS efficacy in treating depression during the postnatal period. METHODS: We included randomized and non-randomized, single arm, and case report studies, with active rTMS and theta-burst stimulation, sham rTMS, pharmacotherapy or no treatment as comparators. Participants included women with PPD, who were administered rTMS after delivery and up to 12 months postpartum. The observed outcomes were response rate and acceptability. RESULTS: rTMS shows promising results, with clinically significant decreases in Edinburgh Postnatal Depression Scale (EPDS) scores at week 4 and an overall low risk of dropout. LIMITATIONS: The reduced number of reports, the lack of complete datasets and the serious/high risk of bias of the studies warrant cautious interpretations. CONCLUSIONS AND IMPLICATIONS: Despite the promising results, existing evidence on rTMS efficacy is limited, and questions remain on what the most beneficial stimulation parameters should be. Future multicentre randomized clinical trials are needed to better ascertain the clinical efficacy of rTMS in the treatment of depression in the postpartum period.

Impact of test anxiety on pharmacy students' performance in Objective Structured Clinical Examination: a cross-sectional survey.

OBJECTIVE: To assess the association between test-related anxiety and pharmacy students' performance in the Objective Structured Clinical Examination (OSCE). METHODS: A cross-sectional survey was conducted among Year-5 Doctor of Pharmacy (PharmD) students enrolled at a public university in Saudi Arabia. Students completed Test Anxiety Inventory (TAI), a 20-item validated questionnaire used to assess test-related anxiety, prior to the commencement of a summative OSCE. TAI has two subscales: TAI-Emotionality (TAI-E) and TAI-Worry (TAI-W). The overall maximum possible total score (TAI-T) is 80, with a minimum possible score of 20. KEY FINDINGS: All 25 students, 10 males and 15 females completed the survey. The overall mean scores for TAI-E, TAI-W and TAI-T were 20.2, 19.6 and 50.2, respectively. There were no statistically significant differences between males and females with respect to the TAI-E score (P = 0.43), TAI-W score (P = 0.25) and TAI-T score (P = 0.34). Females had higher marks in the OSCE compared with males (P = 0.01), however. After adjusting for gender, multiple linear regression analysis showed a statistically significant negative association between TAI-W score and marks obtained in OSCE (P = 0.02; 95% CI = -0.42, -0.03). CONCLUSION: Assessment-related worry may negatively affect students' scores in performance-based examination and could lead to overall underperformance.

The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Adverse drug events (ADEs) impose a major clinical and cost burden on acute hospital services. It has been reported that medicines reconciliation provided by pharmacists is effective in minimizing the chances of hospital admissions related to adverse drug events. OBJECTIVE: To update the previous assessment of pharmacist-led medication reconciliation by restricting the review to randomized controlled trials (RCTs) only. METHODS: Six major online databases were sifted up to 30 December 2016, without inception date (Embase, Medline Ovid, PubMed, BioMed Central, Web of Science and Scopus) to assess the effect of pharmacist-led interventions on medication discrepancies, preventable adverse drug events, potential adverse drug events and healthcare utilization. The Cochrane tool was applied to evaluate the chances of bias. Meta-analysis was carried out using a random effects model. RESULTS: From 720 articles identified on initial searching, 18 RCTs (6,038 patients) were included. The quality of the included studies was variable. Pharmacists-led interventions led to an important decrease in favour of the intervention group, with a pooled risk ratio of 42% RR 0.58 (95% CI 0.49 to 0.67) P<0.00001 in medication discrepancy. Reductions in healthcare utilization by 22% RR 0.78 (95% CI 0.61 to 1.00) P = 0.05, potential ADEs by10% RR 0.90 (95% CI 0.78 to 1.03) P = 0.65 and preventable ADEs by 27% RR 0.73 (0.22 to 2.40) P = 0.60 were not considerable. CONCLUSION: Pharmacists-led interventions were effective in reducing medication discrepancies. However, these interventions did not lead to a significant reduction in potential and preventable ADEs and healthcare utilization.

Complex formation reactions of lanthanum(III), cerium(III), thorium(IV), dioxouranyl(IV) complexes with tricine.

Equilibrium studies for the heavy metal ions La(III), Ce(III), Th(IV) and UO2(IV) (M) complexes of the zwitterionic buffer tricine (L) in aqueous solution are investigated. Stoichiometry and stability constants for the different complexes formed as well as hydrolysis products of the metal cations are determined at 25 degrees C and ionic strength 0.1 M NaNO3. The stability of the formed complexes are discussed in terms of the nature of the heavy metal cation. The solid complexes are synthesized and characterized by means of elemental analysis, FTIR, and TG analysis. The general molecular formulae of the obtained complexes is suggested to be [M(L)2](NO3)n-2(H2O)x, where n = the charge of the metal cation, x = no. of water molecules.

Predictors of Medication Adherence and Blood Pressure Control among Saudi Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study.

PURPOSE: To assess the level of medication adherence and to investigate predictors of medication adherence and blood pressure control among hypertensive patients attending primary healthcare clinics in Makkah, Saudi Arabia. PATIENTS AND METHODS: Hypertensive patients meeting the eligibility criteria were recruited from eight primary care clinics between January and May 2016 for this study. The patients completed Arabic version of Morisky Medication Adherence Scale (MMAS-8), an eight-item validated, self-reported measure to assess medication adherence. A structured data collection form was used to record patients' sociodemographic, medical and medication data. RESULTS: Two hundred and four patients, of which 71.6% were females, participated in the study. Patients' mean age was 59.1 (SD 12.2). The mean number of medication used by patients was 4.4 (SD 1.89). More than half (110; 54%) of the patients were non-adherent to their medications (MMAS score < 6). Binary regression analysis showed that highly adherent patients (MMAS score = 8) were about five times (OR 4.91 [95%CI: 1.85-12.93; P = 0.01]) more likely to have controlled blood pressure compared to low adherent patients. Female gender (OR 0.40 [95% CI: 0.20-0.80; P = 0.01]), Age > 65 years (OR 2.0 [95% CI: 1.0-4.2; P = 0.04]), and being diabetic (OR 0.25 [95% CI: 0.1-0.6; P = 0.04]) were found to be independent predictors of medication adherence. CONCLUSION: Medication adherence is alarmingly low among hypertensive patients attending primary care clinics in Saudi Arabia which may partly explain observed poor blood pressure control. There is a clear need to educate patients about the importance of medication adherence and its impact on improving clinical outcomes. Future research should identify barriers to medication adherence among Saudi hypertensive patients.

ASSERT trial - How to assess the safety and efficacy of a high frequency rTMS in postpartum depression ? A multicenter, double blinded, randomized, placebo-controlled clinical trial.

BACKGROUND: Postpartum Depression affects a considerable number of women worldwide. This condition inflicts severe consequences to mother and child health. Thus far, available treatments have low response and high relapse rates. We designed this trial to evaluate a safe and more efficacious innovative therapy. AIMS: To report a feasible and ethical study design to assess the safety and efficacy of a high frequency repetitive Transcranial Magnetic Stimulation 10 Hz (rTMS) compared to sham rTMS in women with moderate to severe Post-Partum Depression using standard treatment (sertraline).To conduct an ancillary, exploratory, randomized, active controlled, double blind study with a hypothesis to assess the safety and efficacy of 10 Hz rTMS compared to sertraline. METHODS: A multicenter, parallel arm, randomized, placebo-controlled, double-blind design to assess safety and efficacy of 10 Hz rTMS compared to sham.An ancillary study will be conducted with parallel arm, randomized, active controlled and double dummy design to assess safety and efficacy of 10 Hz rTMS compared to sertraline.

Tripropyltin(iv) complexes with some selected bioligands in 50% v/v dioxane/water mixture.

The interaction of the tri-n-propyltin(IV) (TPT) with some selected bioligands having a variety of model functional groups were investigated using potentiometric technique at 25 degrees C and 0.1 M ionic strength in 50% v/v dioxane/water mixture. TPT is hydrolyzed to give [(C3H7)3SnOH], [(C3H7)3Sn(OH)2]-, and [((C3H7)3Sn)2OH]+. Amino acids and DNA constituents form 1:1 and 1:2 complexes. Peptides form 1:1 complexes and the corresponding deprotonated amide species. The protonated complexes are formed with amino acids, peptides and some DNA constituents. The hydrolysis constants and the stepwise formation constants of the complexes formed in solution were calculated using the nonlinear least-square program MINIQUAD-75. The participation of different ligand functional groups in binding to organotin is discussed. The speciation diagrams of the various complex species were evaluated as a function of pH.

Community pharmacists' knowledge, attitude, and practices towards dispensing antibiotics without prescription (DAwP): a cross-sectional survey in Makkah Province, Saudi Arabia.

OBJECTIVES: To evaluate knowledge, attitude, and practices of community pharmacists towards dispensing antibiotics without prescription (DAwP) in Makkah Province, Saudi Arabia. METHODS: A cross-sectional survey was conducted between January and February 2016 using a structured, validated, and pilot-tested questionnaire. A four-step systematic approach was used to recruit community pharmacists who completed a 28-item questionnaire either in English or Arabic language based on their personal preference. RESULTS: Of the 200 community pharmacists approached, 189 completed the questionnaire. More than two-thirds (70.5%) of the pharmacists were not aware that DAwP is illegal practice. Lack of patient willingness to consult a physician for a non-serious infection (69.9%) and an inability to afford a consultation with a physician (65.3%) were the most common reasons cited for DAwP. A statistically significant association was found between the number of antibiotics dispensed and educating patients about the importance of adherence and completion of the full course of antibiotics (p=0.007). CONCLUSIONS: In general, community pharmacists have a poor understanding of the regulations prohibiting the over-the-counter sale of antibiotics in Saudi Arabia, explaining the high rate of DAwP in the country. A multifaceted approach consisting of educational interventions and improving the access to and affordability of healthcare facilities for the general public is required to effectively reduce DAwP and its negative consequences on public health.