Vitamin E TPGS-Based Nanomedicine, Nanotheranostics, and Targeted Drug Delivery: Past, Present, and Future.

It has been seventy years since a water-soluble version of vitamin E called tocophersolan (also known as TPGS) was produced; it was approved by USFDA in 1998 as an inactive ingredient. Drug formulation developers were initially intrigued by its surfactant qualities, and gradually it made its way into the toolkit of pharmaceutical drug delivery. Since then, four drugs with TPGS in their formulation have been approved for sale in the United States and Europe including ibuprofen, tipranavir, amprenavir, and tocophersolan. Improvement and implementation of novel diagnostic and therapeutic techniques for disease are goals of nanomedicine and the succeeding field of nanotheranostics. Specifically, imaging and treating tumors with nanohybrid theranostics shows promising potential. Docetaxel, paclitaxel, and doxorubicin are examples of poorly bioavailable therapeutic agents; hence, much effort is applied for developing TPGS-based nanomedicine, nanotheranostics, and targeted drug delivery systems to increase circulation time and promote the reticular endothelial escape of these drug delivery systems. TPGS has been used in a number of ways for improving drug solubility, bioavailability improvement, and prevention of drug efflux from the targeted cells, which makes it an excellent candidate for therapeutic delivery. Through the downregulation of P-gp expression and modulation of efflux pump activity, TPGS can also mitigate multidrug resistance (MDR). Novel materials such as TPGS-based copolymers are being studied for their potential use in various diseases. In recent clinical trials, TPGS has been utilized in a huge number of Phase I, II, and III studies. Additionally, numerous TPGS-based nanomedicine and nanotheranostic applications are reported in the literature which are in their preclinical stage. However, various randomized or human clinical trials have been underway for TPGS-based drug delivery systems for multiple diseases such as pneumonia, malaria, ocular disease, keratoconus, etc. In this review, we have emphasized in detail the review of the nanotheranostics and targeted drug delivery approaches premised on TPGS. In addition, we have covered various therapeutic systems involving TPGS and its analogs with special references to its patent and clinical trials.

Knowledge and Attitude of First-Aid Treatments for Snakebites, and the Perception of Snakes among the Students of Health Sciences at Jazan University, Saudi Arabia.

First aid is the most basic and life-saving service provided before emergency care is received. This study aimed to assess students' knowledge and attitudes about performing first aid for snakebite emergencies and their perception of snakes. A cross-sectional study was conducted between January and March 2019 among upper-level students (3rd year and above) of health-related courses at Jazan University, Saudi Arabia. Three hundred and nine students from four programs responded to the self-administered questionnaire. The collected data were analyzed using SPSS 23.0. The highest percentage of the study sample comprised pharmacy students (44%), followed by nursing (25.2%), medical (16.8%), and emergency medicine students (13.9%). Overall, the emergency medicine students exhibited greater knowledge of snakebite first aid. However, over three-fourths of the students were unaware of dry bites. Around two-thirds were sure that they should not massage the bite site, while nearly one-fourth were not sure about the use of a tourniquet. The fifth- and sixth-year students had extremely diverse perspectives on snakes. The majority of the participants (92.8%) did not feel good about snakes. However, most of the students (95.2%) wanted to learn about snakebite first aid and overcome their fear of snakes. Overall, the students had a positive attitude towards first aid but lacked knowledge of snakebite emergencies. Public health awareness is required to dispel first-aid myths about snakebites and misconceptions regarding snakes.

Psychological impact of COVID-19 restrictions among individuals at risk of exercise addiction and their socio-demographic correlates: A Saudi Arabian survey study.

Exercise addiction (EA) has been described as a condition of psychological dysfunction characterized by excessive and obsessive exercise patterns, show withdrawal symptoms when unable to exercise, and experience numerous conflicts and other negative consequences in their social and professional lives, due to the extremely high volumes of exercise. The main objective of the present study was to assess the risk of exercise addiction among a Saudi Arabian sample of regular exercisers and to investigate possible associations between their inability to exercise during the COVID-19 pandemic lockdown (due to the closure of public gyms, swimming pools, and health clubs) and depression, anxiety, and loneliness. A total of 388 regular-exercising Saudis participated in an online cross-sectional survey over three months (December to February 2021). The study sample comprised 89.9% (males) and 10.1% (females), with a mean age of 28.59 years (SD ± 6.69). A 36-item online self-report survey was used for data collection. The prevalence of being at risk of exercise addiction among participants of the present study was 13.1%. Positive significant associations were noted between risk of exercise addiction and depression (r = .41; p < .01), risk of exercise addiction and anxiety (r = .20; p < .01), and risk of exercise addiction and loneliness (r = .17; p < .01). The findings of the present study suggest that those individuals at risk of exercise addiction might also be at an elevated risk of developing negative psychological impact owing to the disruption of the amount of exercise engaged in due to COVID-19 pandemic-related restrictions and therefore these high-risk individuals should receive appropriate psychological support to help them overcome the negative impact of the ongoing pandemic. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-02892-8.

Post-vaccination survey for monitoring the side effects associated with COVID-19 vaccines among healthcare professionals of Jazan province, Saudi Arabia.

OBJECTIVES: To identify the self-reported vaccine-related side effects among healthcare professionals (HCPs) in the Jazan province, Saudi Arabia, and determine the associated socio-demographic factors. With the recent second and third waves of coronavirus disease -19 (COVID-19) infections worldwide, the race is not only to encourage but also to achieve mass vaccination. METHODS: A total of 397 HCPs from across Jazan province participated in an anonymous online cross-sectional survey conducted for a period of 45 days (March 30, 2021 to May 13, 2021) in Jazan province, Saudi Arabia. Data was collected using a validated 22-items self-report survey. RESULTS: For both COVID-19 vaccines, majority of reports were related to flu-like symptoms including fever, chills, headache, fatigue, tiredness, and myalgia. Statistically significant associations were observed between the severity of side effects and gender (χ2=73.32; p<0.001), type of vaccine (χ2=112.08; p<0.001), and presence of known allergies (χ2=99.69; p<0.001). Female HCPs were more likely to report any side effects compared with male HCPs (adjusted odds ratio [AOR]: 3.72; p<0.001). Furthermore, HCPs with known allergies were more likely to report any side effects than their counterparts with unknown allergies (AOR: 16.29; p<0.001). CONCLUSION: The findings of the present study would help in designing educational programs aimed at combating the misconstrued fear of vaccination and highlighting the urgent need of getting vaccinated. This study also helps in the identification of factors affecting the presence and severity of side effects.

Clinical Pharmacist's Intervention to Improve Medication Titration for Heart Failure: First Experience from Sudan.

BACKGROUND: Medications known to improve outcomes in heart failure (HF) are either not prescribed or prescribed at sub-therapeutic doses. The addition of clinical pharmacists to the HF team positively impacts optimizing prognostic medications for a patient with HF with reduced ejection fraction (HFrEF). OBJECTIVE: To assess the intervention of the clinical pharmacist as part of the multidisciplinary (MD) team in up-titration to achieve target doses of key therapeutic agents for HFrEF. METHODS: This was a prospective one group pretest-posttest interventional study; a comparison of the target dose achievement of key therapeutic agents for HFrEF was performed before and after clinical pharmacist interventions. RESULTS: Out of 110 HFrEF patients, 57.3% were males, and the mean age of patients was 55.8 years (SD 12.6). Cardiomyopathy was the leading cause of HF. At baseline, 86% were on angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEIs/ARBs/ARNi) and 93.6% on beta blockers (BBs). At the end of study, the proportion of patients achieved the target dose was significantly increased (0 vs 77.4%, 6.8 vs 85.4%, and 0 vs 55.6%) for ACEIs, ARBs and ARNi, respectively, and (8.6% vs 66.1%; P = 0.001) for BBs. Moreover, the up-titration process was associated with significant improvement in most clinical as ejection fraction and New York Heart Association (NYHA) scale and laboratory characteristics. CONCLUSION: As a part of the MD team in the outpatient HF clinic, the clinical pharmacists increased the percentage of HFrEF patients achieving the target or maximal doses of key therapeutic agents and improving clinical and laboratory parameters.

Application of the health Belief Model to assess community preventive practices against COVID-19 in Saudi Arabia.

BACKGROUND: The novel coronavirus disease (COVID-19) has affected hundreds of thousands of people across more than 200 countries. As the pandemic continues, the health agencies, worldwide, are recommending strict preventive practices to avert its transmission at community scale. We sought to predict the behavior of the Saudi population for adopting community preventive practices during the COVID-19 pandemic. METHODS: An online questionnaire consisting of 22 items pertaining to the Health Belief Model constructs was used to measure the perceived susceptibility and perceived severity of contracting COVID-19, along with the perceived benefits and perceived barriers to follow the Ministry of Health's recommendations. The outcome was assessed by their readiness to be compliant with the community protective measures. Data were analyzed using STATA at significance level of 0.05. RESULTS: A total of 900 individuals received the online survey link, of which 688 (response rate: 76.4%) respondents consented to participate in the study. The mean age of the respondents was 31.39 (SD = 8.94). Positive associations were observed between perceived susceptibility (Beta: 0.24; p value < 0.001), perceived severity (Beta: 0.16; p value < 0.001), perceived benefits (Beta: 0.41; p value < 0.001), cue to action (Beta: 2.61; p value < 0.001) and the participation in community preventive practices during the pandemic of the COVID-19. CONCLUSIONS: Health belief model's constructs of perceived susceptibility, severity, benefits and cue to action can be adopted to help strengthen COVID-19 limiting behaviors and prevention programs which can delivered through community pharmacies in Saudi Arabia as well as around the world.

Preparation, Characterization, and Anti-Cancer Activity of Nanostructured Lipid Carriers Containing Imatinib.

Breast cancer is the most widespread malignancy in women worldwide. Nanostructured lipid carriers (NLCs) have proven effective in the treatment of cancer. NLCs loaded with imatinib (IMA) (NANIMA) were prepared and evaluated for their in vitro efficacy in MCF-7 breast cancer cells. The hot homogenization method was used for the preparation of NANIMAs. An aqueous solution of surfactants (hot) was mixed with a molten mixture of stearic acid and sesame oil (hot) under homogenization. The prepared NANIMAs were characterized and evaluated for size, polydispersity index, zeta potential, encapsulation efficiency, release studies, stability studies, and MTT assay (cytotoxicity studies). The optimized NANIMAs revealed a particle size of 104.63 ± 9.55 d.nm, PdI of 0.227 ± 0.06, and EE of 99.79 ± 0.03. All of the NANIMAs revealed slow and sustained release behavior. The surfactants used in the preparation of the NANIMAs exhibited their effects on particle size, zeta potential, encapsulation efficiency, stability studies, and release studies. The cytotoxicity studies unveiled an 8.75 times increase in cytotoxicity for the optimized NANIMAs (IC50 = 6 µM) when compared to IMA alone (IC50 = 52.5 µM) on MCF-7 breast cancer cells. In the future, NLCs containing IMA will possibly be employed to cure breast cancer. A small amount of IMA loaded into the NLCs will be better than IMA alone for the treatment of breast cancer. Moreover, patients will likely exhibit less adverse effects than in the case of IMA alone. Consequently, NANIMAs could prove to be useful for effective breast cancer treatment.

Intravenous colistin in the treatment of multidrug-resistant gram-negative organism in tertiary hospital, Jazan, KSA.

BACKGROUND: It was considered that the resistance of drugs such as carbapenems and cephalosporins against severe or high risk gram-negative bacteria became a tremendous confront. This might be attributed to the little amount of these drugs to be used against the multi-resistant bacteria (MRB). Therefore, Colistin, Fosfomycin, Temocillin, and Rifampicin are antibiotics that have been used as multidrug-resistant bacterial infections in the treatment of some species of bacteria such as Acinetobacter, Pseudomonas species, and Enterobacteriaceae. AIM: the present study is aimed to assess the integrity and efficiency of colistin for treating of the multidrug-resistant bacteria (MDR) especially gram-negative one among critical and non-critical patients in tertiary hospital in Jazan city. Ninety four patients who met the selection criteria and received colistimethate sodium (colistin) in the period between Februarys 2017 and March 2018 were recruited and their charts were reviewed retrospectively. Patients' information, medical conditions, and laboratory data were extracted. All patients received IV colistin, and the majority of the patients showed in their culture reports multidrug-resistant bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. Patients who had normal renal function received from 2.5 to 5.0 mg of colistin/kg, which was divided in two or three doses intravenously, for duration ranging between 10 and 14 days. RESULTS AND CONCLUSION: Approximately half of patients (48.93%) were fully recovered, while 19% of them were partially responded to colistin treatment. In the current study it was showed that IV colistin treatment against the multidrug-resistant bacteria (gram-negative bacteria) was strongly related to mild nephrotoxicity in addition to with a proper response as shown only in three of our patients.

Awareness and Preparedness of COVID-19 Outbreak Among Healthcare Workers and Other Residents of South-West Saudi Arabia: A Cross-Sectional Survey.

Background: Coronavirus disease-2019 (COVID-19) was declared a "pandemic" by the World Health Organization (WHO) in early March 2020. Globally, extraordinary measures are being adopted to combat the formidable spread of the ongoing outbreak. Under such conditions, people's adherence to preventive measures is greatly affected by their awareness of the disease. Aim: This study was aimed to assess the level of awareness and preparedness to fight against COVID-19 among the healthcare workers (HCWs) and other residents of the South-West Saudi Arabia. Methods: A community-based, cross-sectional survey was conducted using a self-developed structured questionnaire that was randomly distributed online among HCWs and other residents (age ≥ 12 years) of South-West Saudi Arabia for feedback. The collected data were analyzed using Stata 15 statistical software. Results: Among 1,000 participants, 36.7% were HCWs, 53.9% were female, and 44.1% were aged ≥ 30 years. Majority of respondents showed awareness of COVID-19 (98.7%) as a deadly, contagious, and life-threatening disease (99.6%) that is transmitted through human-to-human contact (97.7%). They were familiar with the associated symptoms and common causes of COVID-19. Health organizations were chosen as the most reliable source of information by majority of the participants (89.6%). Hand hygiene (92.7%) and social distancing (92.3%) were the most common preventive measures taken by respondents that were followed by avoiding traveling (86.9%) to an infected area or country and wearing face masks (86.5%). Significant proportions of HCWs (P < 0.05) and more educated participants (P < 0.05) showed considerable knowledge of the disease, and all respondents displayed good preparedness for the prevention and control of COVID-19. Age, gender, and area were non-significant predictors of COVID-19 awareness. Conclusion: As the global threat of COVID-19 continues to emerge, it is critical to improve the awareness and preparedness of the targeted community members, especially the less educated ones. Educational interventions are urgently needed to reach the targeted residents beyond borders and further measures are warranted. The outcome of this study highlighted a growing need for the adoption of innovative local strategies to improve awareness in general population related to COVID-19 and its preventative practices in order to meet its elimination goals.

The association of dietary behaviors and practices with overweight and obesity parameters among Saudi university students.

BACKGROUND: Western dietary habits, coupled with a sedentary lifestyle, are potential contributors to the prevalence and rapid increase in the incidence of obesity in Saudi Arabia. This study aimed to investigate the association between students' weight status and their eating behaviors and practices. Another aim was to assess students' awareness of the health risks associated with obesity. METHODS: A cross-sectional survey was conducted among a sample of 416 (53% male and 47% female) undergraduate students, aged 18-26 years old, between January 6 and April 6, 2019, from colleges of Health Sciences at Jazan University in the Kingdom of Saudi Arabia (K.S.A). Students completed a self-administered questionnaire and recorded their measured anthropometric parameters. RESULTS: The prevalence of overweight (20.4%) and obesity (14.9%) were relatively high among the participants. There were statistically significant associations between Body Mass Index (BMI) and the different settings of food consumption (i.e., dining on a table (or) in the Islamic way: squatting on the ground) (p<0.001)). BMI was also associated with students' dietary habits regarding consuming food, snacks, and drinking carbonated beverages while watching television (p<0.001), as well as consuming the same pattern of food/drink while watching television, playing video games on mobile phones or computers (p<0.001). Nearly most of the students were oblivious to the fact that metabolic syndrome, reproductive disorders, respiratory disorders along with liver and gallbladder diseases are some of the health risks associated with obesity. CONCLUSION: The prevalence of obesity and overweight were reasonably high in our study sample and were affected by several factors related to students' eating behaviors and practices. This warrants the need for rigorous and frequent health education interventions on healthy eating behaviors, dietary practices, with an emphasis on the importance of adopting an active, healthy lifestyle.

Utilization pattern and side effect profile of oral anticonceptives: A community-based cross-sectional study among Saudi women.

BACKGROUND: The rapid change in the socio-demographic pattern and changing beliefs toward fertility and birth spacing have resulted in a notable increase in the use of oral anticonceptives in the Saudi Arabian community. However, information on the current utilization of oral anticonceptives and attitudes toward their use remains sparse. OBJECTIVE: The present study evaluated the utilization pattern of oral anticonceptives, attitude toward pill use, and incidence of side effects among Saudi women. SETTING: The study was conducted in a community setting in Jazan, Kingdom of Saudi Arabia. METHODS: Eligible Saudi women routinely using oral anticonceptive pills were invited to participate in this prospective, cross-sectional survey. Data were collected using a standardized, pretested, semi-structured questionnaire. Jazan was selected as it recorded the highest number of women using contraceptives in Saudi Arabia. MAIN OUTCOME MEASURE: The pattern of pill utilization, attitude toward pill use, and incidence of side effects. RESULTS: A total of 496 women consented to participate in this study. Most of the respondents (87.5%) were using or had used oral anticonceptives for birth control. In nearly half (49.2%) of participants, oral pills were advised by a gynaecologist, and approximately two-thirds (69.0%) were using or had used combined oral anticonceptives. Nearly two-thirds (63.1%) of respondents preferred pills over other contraception methods due to their ease of use. More than one-third (39.3%) of participants agreed that oral pills are safe. Approximately half (53.2%) of participants were aware that a missed pill must be taken immediately after recalling that a dose was missed. A total of 69.6% of participants experienced at least one side effect, of which mood swings (61.1%), weight gain or increase appetite (42.2%), decreased libido (34.1%), and nausea (31.2%) were most common. CONCLUSION: Saudi women had a high acceptance rate for oral anticonceptives as a legitimate method to prevent unintended pregnancy. This was associated with a modest degree of understanding about their risks and benefits. Pharmacists should provide up-to-date information and counsel patients about the use and side effects of oral anticonceptives.

Ameliorative potential of omega 3 fatty acids and HMG-CoA reductase inhibitors on experimentally-induced non-alcoholic steatohepatitis.

Non-alcoholic steatohepatitis (NASH) has a relation to obesity. It may lead to hepatocellular carcinoma. To date, the therapeutic options are limited due to complex pathogenesis. This study aimed to investigate the effect of atorvastatin and omega 3 fatty acids on experimentally-induced NASH. Sixty male albino rats were divided into 6 equal groups; control group, high fat emulsion/sucrose (HFE/S) diet, HFE/S+carboxymethyl cellulose, HFE/S +Atorvastatin, HFE/S+Fish oil and HFE/S+Atorvastatin+Fish oil. Serum alanine aminotransferase, total cholesterol (TC), triglycerides (TG), high density lipoproteins, insulin, glucose, C-reactive protein and quantitative insulin sensitivity check index were measured. Also, hepatic TC, TG, malondialdehyde, tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6) and transforming growth factor beta 1 (TGF-ß1) were determined. Liver sections were examined histopathologically. Atorvastatin improved lipid profile, inflammation and oxidative stress but did not improve insulin resistance, hepatic TGF-ß1 or body weight while fish oil improved lipid profile, decreased inflammation and oxidative stress, improved insulin resistance, hepatic TGF-ß1 and body weight compared to HFE/S group. Atorvastatin/fish oil combination produced significant improvement in the lipid profile, inflammation, oxidative stress, insulin resistance, hepatic TGF-ß1 and body weight compared to the use of each of these drugs alone. This might be attributed to the effect of fish oil on the lipid profile, inflammatory cytokines, insulin resistance and TGF-ß1 which potentiates the effect of atorvastatin on NASH.

Use, attitudes and knowledge of medications among pregnant women: A Saudi study.

OBJECTIVE: Medication use during pregnancy is a major concern for most women. The aim of the present study was to assess medication use, knowledge and beliefs about medications among pregnant women in Saudi Arabia. METHODS: More than 760 pregnant women, attending the obstetric clinic, filled a semi-structured questionnaire. Data were collected about their sociodemographic background, medication use during pregnancy, medication/pregnancy risk awareness, sources of drug information and beliefs about medications. RESULTS: Most women had a positive attitude toward medications in general but they believed pregnant women should be more cautious regarding drug-use during pregnancy. A significant association was found between participants' education and occupation, and beliefs about medications. In this context, well educated women and those working in a health-related career demonstrated more correct beliefs about medications. Women with health-related occupations were more knowledgeable about the life saving effect of drugs on unborn children. Women indicated inadequate provision of drug-related information from physician and pharmacist; they rely on medication pamphlet to get such information. The most frequently used drugs were paracetamol and vitamins (13.2%). Most pregnant women (59.2%) were able to identify drugs to-be avoided in pregnancy that agreed roughly with FDA categories with 23 hits out of 32. They indicated that newborn anomalies (6.5%) were not attributed to drug-use during pregnancy. CONCLUSION: During pregnancy, women were more conservative and skeptic toward medication, health-care professionals should be aware of such attitudes when advising pregnant women to take medication.