Adherence to Advisory Committee on Immunization Practices in diabetes mellitus patients in Saudi Arabia: A multicenter retrospective study.

BACKGROUND: Patients with diabetes mellitus (DM) are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications. The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices (CDC/ACIP) issued immunization re-commendations to protect this patient population. AIM: To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate. METHODS: An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey. RESULTS: Among participants, 10.01% (n = 71) had never received any vaccine, while 85.89% (n = 609) received at least one dose of the coronavirus disease 2019 (COVID-19) vaccine, and 34.83% (n = 247) had received the annual influenza vaccine. Only 2.96% (n = 21), 2.11% (n = 15), and 1.12% (n = 8) received herpes zoster, tetanus, diphtheria, and pertussis (Tdap), and human papillomavirus (HPV) vaccines, respectively. For patients with DM in Saudi Arabia, the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster, Tdap, pneumococcal, and HPV. Factors such as vaccine recommendations provided by family physicians or specialists, site of care, income level, DM-related hospitalization history, residency site, hemoglobin A1c (HbA1c) level, and health sector type can significantly influence the vaccination rate in patients with DM. Among non-vaccinated patients with DM, the most reported barriers were lack of knowledge and fear of side effects. This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM. CONCLUSION: In Saudi Arabia, patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster, Tdap, pneumococcal, and HPV. Factors such as vaccine recommendations provided by family physicians or specialists, the site of care, income level, DM-related hospitalization history, residency site, HbA1c level, and health sector type can significantly influence the vaccination rate in patients with DM.

The effects of bupropion alone and combined with naltrexone on weight loss: a systematic review and meta-regression analysis of randomized controlled trials.

BACKGROUND: The global prevalence of obesity and overweight is a significant concern in the field of public health. However, addressing and combating these conditions pose considerable challenges. Numerous interventional studies have been conducted to assess the possible impact of bupropion on weight reduction. The primary objective of this study was to conduct a comprehensive investigation into the effects of bupropiona alone and in combination with naltrexone on weight, body mass index (BMI), and waist circumferences (WC). METHODS: A systematic search was conducted in five databases using established keywords. The purpose of this search was to uncover controlled trials that examined the impact of bupropion, either as a standalone intervention or in combination with naltrexone, on weight loss outcomes. The random-effects model analysis was used to provide pooled weighted mean difference and 95% confidence intervals. RESULTS: Twenty five studies with 22,165 participants' were included in this article. The pooled findings showed that bupropion administration has an effect on lowering weight (WMD: -3.67 kg, 95% CI: -4.43 to -2.93) and WC (WMD: -2.98 cm, 95% CI -3.78 to -2.19) in compared with control groups. The analysis also showed that the effects of the present intervention on weight and WC during the intervention are > 26 weeks and ≤ 26 weeks compared to the other group, respectively. In addition, changes in weight loss and WC after receiving bupropion together with naltrexone were more compared to bupropion alone. CONCLUSIONS: In conclusion, the addition of combination therapies like bupropion and naltrexone to lifestyle modifications including diet would cause significant weight loss.

Biosocial predictors and blood pressure goal attainment among postmenopausal women with hypertension.

Objectives: In postmenopausal states, women may not maintain blood pressure (BP) in the same way as men, even though most women follow their treatment plans and prescriptions more consistently than men. Biological and lifestyle factors influence the progression of hypertension in postmenopausal women (PMW). This study aimed to determine biosocial predictors associated with achieving the target BP in PMW with hypertension. Methods: A prospective observational study was conducted in the General Medicine Department at Karuna Medical College Hospital, Kerala, India. The definition of BP goal attainment was established based on the guidelines outlined by the VIII Joint National Committee 2014 (JNC VIII). Multivariate logistic regression analysis was used to analyse biosocial predictors, such as educational status, employment status, body mass index (BMI), number of children, age at menarche, age at menopause, and number of co-morbidities, associated with BP goal achievement. Results: Of the patients, 56.4% achieved their BP goals on monotherapy and 59.7% achieved it on combination therapy. Level of education [odds ratio (OR) = 1.275, 95% confidence interval (CI): 0.234-7.172], employment status (OR = 0.853, 95% CI: 0.400-1.819), age at menopause (OR = 1.106, 95% CI: 0.881-1.149), number of children (OR = 1.152, 95% CI: 0.771-1.720), BMI (OR = 0.998, 95% CI: 0.929-1.071), and number of co-morbidities (OR = 0.068, 95% CI: 0.088-1.093) did not show a significant relationship, and age at menarche (OR = 1.577, 95% CI: 1.031-2.412) showed a significant association with BP goal attainment among hypertensive postmenopausal women. Conclusion: Half of the hypertensive postmenopausal women did not achieve their BP goals. Interventions are required to expand screening coverage and, under the direction of medical professionals, there should be plans to improve hypertension control and increase awareness of the condition.

Prescribing Patterns of Psychotropic Medications for Common Psychiatric Disorders in a Mental Health Hospital in Tabuk.

INTRODUCTION: Mental health disorders are often chronic and disabling conditions that impact different populations, irrespective of age, cultural background, or socioeconomic status. This study aimed to describe the prescribing pattern of psychotropic medications in patients with psychiatric disorders. METHODS: This research was a retrospective investigation of psychotropic medication prescribing patterns and conducted at Eradah Mental Health Hospital at Tabuk City, Saudi Arabia. The data were extracted from the electronic medical database of adult patients presenting to the outpatient and inpatient clinics of a mental health hospital between 2020 and 2023. The diagnosis of psychiatric disorders was identified using the International Classification of Diseases 10th Revision (ICD-10) codes version 2019 for mental and behavioral disorders (F00 to F99). RESULTS: The electronic medication records of 526 patients were reviewed, of whom 510 (97%) were Saudi nationals, 368 (69.9%) were males, 235 (44.7%) were between 31 and 40 years of age, and 233 (44.3%) were outpatients. The most common psychiatric diagnoses were schizophrenia (33.3%), followed by bipolar affective disorder (16.9%). A total of 2,153 medication orders for psychotropic medications were quantified. Second-generation antipsychotics (SGAs) and first-generation antipsychotics (FGAs) were the top prescribed medication classes (1,290, 60%), followed by mood stabilizers (324, 15%). More than one-half of the patients (282, 53.6%) received a combination of antipsychotic and mood stabilizers, and 155 (29.5%) received a combination of antipsychotic and antidepressant medications. No significant differences were observed in prescribing for males and females. CONCLUSION: Schizophrenia was highly prevalent among adult patients who sought mental healthcare. Polypharmacy of psychotropic medication was common depending on the symptoms' severity and comorbid psychiatric diseases.

An evaluation of knee osteoarthritis pain in the general community-Asir region, Saudi Arabia.

BACKGROUND: Knee osteoarthritis (KOA) is one of the most common conditions resulting in disability, particularly in the elderly population. Osteoarthritis (OA) is the most common articular disease and the leading cause of chronic disability in the developed world. OBJECTIVE: This study was carried out to evaluate knee pain in the Asir region of Saudi Arabia. An analytical cross-sectional survey design was adopted in the Asir region from April 2023 to August 2023 to assess the knee pain of the adult population using an anonymous online questionnaire. RESULTS: Of 1234, 332 were men (26.90) and 902 were women (73.09). WOMAC index score category 55.34% (n = 683) of the subjects had a low risk (score <60), 28.68% (n = 354) had a moderate risk (score 60-80), and 15.96% (n = 197) had a high risk (score ≥81) for KOA. According to clinical criteria, 79.33% (n = 979) of the study subjects had OA. Age group, gender 2.17 (1. 67-2.82) [OR 2.17; 95% CI 1.67-2.82), family history of OA [OR 0.47; 95% CI 0.37-0.62], diabetes [OR 2.78; 95% CI 2.17-3.56], hypertension [OR 0.35; 95% CI 0.26-0.45] were significantly associated with the percentage of the WOMAC index score using the Chi-square test analysis (P<0.05). Therefore, the WOMAC index showed higher diagnostic precision with a statistically significant association [OR 9.31 CI 6.90-12.81] with a P< 0.0001. CONCLUSION: KOA is more common in older, obese people who have reached the age of 50 in the Asir region, and it is more prevalent in women. Alarms the need for appropriate awareness programs for better disease prevention and health outcomes for the benefit of the community through general public health programs.

The consumption pattern and perception of using artificial sweeteners among the public in Tabuk region, Saudi Arabia.

Background: Obesity and weight gain have become major problems worldwide. Thus, several forms of alternative intense sweeteners are extensively used, offering a non-caloric sweet taste. To the best of our knowledge, no research has studied either the consumption pattern or the perception of using artificial sweeteners in Saudi Arabia. Objectives: Our research aimed to study the usage pattern of such artificial sweeteners in the Tabuk region and estimate the knowledge of and attitudes toward their usage among the population. Methods: A cross-sectional study promoted on multiple social media platforms and face-to-face interviews in different malls and hospitals in the Tabuk region. We grouped the participants into two major groups: the users and the non-users of artificial sweeteners. Each group has been subdivided into a healthy subgroup and those with a medical record subgroup. Participants' characteristics and their choice of sweeteners were analyzed using bivariate analysis. The age, gender, and education level of the participants were adjusted using binary logistic regression in order to adjust for potential confounders. Results: A total of 2,760 participants were included in our study. We found that more than 59% of the participants that were over 45 years old were non-hospitalized non-hospitalized diseased irrespective of their usage of artificial sweeteners. Furthermore, females, graduates, diabetics were significantly high irrespective of their subgroup. Moreover, Steviana® is the most commonly used artificial sweetener. In addition, healthy participants showed a greater perception of the usage and adverse effects of artificial sweeteners. Furthermore, bivariate analysis using logistic regression revealed significant associations (p < 0.05) with confounders such as gender, age, and education level. Conclusion: Educational programs and nutritional advice for the safe consumption and the daily permissible doses of artificial sweeteners are essential and should be directed specifically at females.

Neuroprotective Effect of Methanolic Ajwa Seed Extract on Lipopolysaccharide-Induced Memory Dysfunction and Neuroinflammation: In Vivo, Molecular Docking and Dynamics Studies.

Islamic literature has indicated that daily consumption of Ajwa dates heals a variety of chronic diseases and disorders. The current research investigates the neuroprotective effect of methanolic Ajwa seed extract (MASE) on lipopolysaccharide (LPS)-induced cognitive deficits using multiple approaches. For animal studies, MASE (200 and 400 mg/kg, p.o.) was administrated for thirty consecutive days, and four doses of LPS (250 µg/kg, i.p.) were injected to induce neurotoxicity. Memory functions were evaluated using elevated plus-maze and novel object recognition tests. Acetylcholine (ACh) and neuroinflammatory markers (cyclooxygenase (COX)-2, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and transforming growth factor (TGF)-ß1) were estimated in brain tissues. Studies of molecular docking and dynamics were conducted to provide insight into the molecular-level mechanisms. MASE administration resulted in a significant reversal of LPS-induced memory impairment in both maze models. Both doses of MASE elevated the ACh levels in an LPS-treated rat brain. In addition, the extract lowered COX-2 and proinflammatory cytokines (TNF-α and IL-6) while increasing anti-inflammatory cytokines (IL-10 and TGF-ß1) in LPS-treated brain tissues. Molecular modeling results revealed that the compound's ellagic acid, epicatechin, catechin, kaempferol, quercetin, and apigenin have the potential to act as a dual inhibitor of acetylcholinesterase (AChE) and COX-2 and can be responsible for the improvement of both cholinergic and inflammatory conditions, while the cinnamic acid, hesperidin, hesperetin, narengin, and rutin compounds are responsible only for the improvement of cholinergic transmission. The above compounds acted by interacting with the key residues Trp84, Asp72, Gly118, Ser200, Tyr334, and His440, which are responsible for the hydrolysis of ACh in AChE, while the COX-2 is inhibited by interacting with the residues (Val349, Leu352, Tyr355, Tyr385, Ala527, Ser530, and Leu531) of the hydrophobic channel. By promoting cholinergic activity and protecting neuroinflammation in the rat brain, MASE provides neuroprotection against LPS-induced cognitive deficits. Our preliminary findings will help with further drug discovery processes related to neuroinflammation-related neurodegeneration.

A Structured Educational Intervention Aims to Improve Pneumococcal Vaccination Practices in Primary Healthcare Centers.

Objective: The Centers for Disease Control and Prevention (CDC) provide evidence-based recommendations on vaccine use in the US Current CDC recommendations for the two available pneumococcal vaccine types can be confusing for providers and nursing staff, introducing the potential for administering the wrong product to patients. The pneumococcal vaccine products come with specific recommendations and target-specific patient groups. This intervention aims to improve pneumococcal vaccine practices per CDC recommendations, at primary health-care centers in Saudi Arabia. Materials and Methods: This intervention is conducted with nursing staff and mid-level providers. An educational intervention consisting of a five-question assessment questionnaire and containing brief scenario cases on pneumococcal vaccine indication. The assessment questionnaire was administered twice separated by a brief educational session on proper vaccine use by a clinical pharmacist. The educational intervention and the pre/post assessment required 15 min to complete. Assessments were collected, and a pre-intervention assessment was compared with a post-intervention assessment to capture the effect of the educational intervention. Test score changes from the baseline were analyzed via a paired Student's t-test. Results: Eighty-five nursing staff and mid-level providers completed the assessment. Questionnaire scores signaled an improvement trend in both centers, but the results were not statistically significant in center 1 (p=0.767) and center 2 (p=0.125). Conclusion: Focusing education on nursing staff by clinical pharmacists on proper vaccine use does not appear to be as effective as previously thought. The desire for improvement in practices was evident in the overwhelming desire to participate in the educational session by nursing staff and mid-level providers. However, the results reflect the complex nature of vaccine practices and the need for further training on proper vaccine use for nursing and mid-level providers.

A study on the prevalence of smoking habits among the student community in Aseer Region, Saudi Arabia.

Objectives: A cross-sectional study was aimed to assess the prevalence of smoking habits among students at King Khalid University (KKU), Abha, KSA. Methods: This was a cross-sectional study using a Modified Fagerstrom Tolerance Questionnaire (mFTQ), online survey was carried out among the students of KKU. This tool uses a five-point Likert scale for all seven questions, except one question on smoking during the first 2 h of the day. Results: The prevalence of smoking among male students was 67% (n = 243) and females 33% (n = 122). Of the current cigarette smokers, 19% had a nicotine dependence score of ≥6 (high), 48% scored 4-6 (moderate) and 33% scored <4 (minimal). Association between mFTQ and the number of cigarettes per day (p < 0.001), first smoke of your cigarettes (p < 0.018), smoking in the morning (p < 0.007), and difficulty refraining from smoking in public areas (p < 0.000). The results of the current study recommend that cigarette smoking habits are a significant risk behavior among young students. The strength of this study signifies that most participants (62%) intend to quit if appropriately supported. Conclusion: According to the findings of the current investigation, smoking was quite common among males. It raises the alarm about the critical need for adequate education to support health education initiatives, discourage teen smoking, and enhance health outcomes for the community.

Piracetam as a Therapeutic Agent for Doxorubicin-Induced Cognitive Deficits by Enhancing Cholinergic Functions and Reducing Neuronal Inflammation, Apoptosis, and Oxidative Stress in Rats.

Cancer chemotherapy is known to cause cognitive defects in patients. Our study investigated the effect of piracetam (PIRA; 200 or 400 mg/kg) against doxorubicin (DOX)-induced cognitive deficits in a rat model. The cognitive parameters were analyzed using elevated plus-maze, novel object recognition, and Y-maze tests. Acetylcholinesterase (AChE), neuroinflammatory mediators (cyclooxygenase-2 (COX-2), prostaglandin E2 (PGE2), nuclear factor-κB (NF-κB), tumor necrosis factor-alpha (TNF-α)), apoptotic proteins (B-cell lymphoma-2 (Bcl-2), Bcl2 associated X protein (Bax), cysteine aspartate specific protease-3 (caspase-3)), oxidative parameters (malondialdehyde (MDA), catalase (CAT), and glutathione (GSH)) were also determined in the brain. PIRA administration offered significant protection against DOX-induced cognitive deficits in all maze tests and restored cholinergic functions via a significant reduction in AChE levels. Additionally, PIRA suppressed DOX-induced neuroinflammatory mediators (COX-2, PGE2, NF-κB, and TNF-α), pro-apoptotic proteins (Bax and caspase-3), and oxidative stress (MDA). Besides, it facilitated antioxidant (CAT and GSH) levels. Hence, our study highlighted that the neuroprotective activity of PIRA against DOX-induced cognitive deficits can be linked to reductions of AChE levels, neuro-inflammatory mediators, pro-apoptotic proteins, and oxidative stress.

Levetiracetam Ameliorates Doxorubicin-Induced Chemobrain by Enhancing Cholinergic Transmission and Reducing Neuroinflammation Using an Experimental Rat Model and Molecular Docking Study.

Cancer chemotherapy-induced cognitive impairment (chemobrain) is a major complication that affects the prognosis of therapy. Our study evaluates the nootropic-like activity of levetiracetam (LEVE) against doxorubicin (DOX)-induced memory defects using in vivo and molecular modelling. Rats were treated with LEVE (100 and 200 mg/kg, 30 days) and chemobrain was induced by four doses of DOX (2 mg/kg, i.p.). Spatial memory parameters were evaluated using an elevated plus maze (EPM) and Y-maze. Additionally, acetylcholinesterase (AChE) and the neuroinflammatory biomarkers cyclooxygenase-2 (COX-2), prostaglandin E2 (PGE2), nuclear factor-κB (NF-κB), and tumor necrosis factor-alpha (TNF-α) were analyzed using brain homogenate. PharmMapper was used for inverse docking and AutoDock Vina was used for molecular docking. LEVE treatment significantly diminished the DOX-induced memory impairment parameters in both the EPM and Y-maze. In addition, the drug treatment significantly reduced AChE, COX-2, PGE2, NF-κB, and TNF-α levels compared to DOX-treated animals. The inverse docking procedures resulted in the identification of AChE as the potential target. Further molecular modelling studies displayed interactions with residues Gly118, Gly119, and Ser200, critical for the hydrolysis of ACh. Analysis of the results suggested that administration of LEVE improved memory-related parameters in DOX-induced animals. The 'nootropic-like' activity could be related to diminished AChE and neuroinflammatory mediator levels.

Ethnicity affects the risk factors of acute myocardial infarction and should be considered in educational programs.

Acute Myocardial infarction is a non-communicable disease representing the leading cause of death in Saudi Arabia. Studying the ethnicity in its risk factors has been poorly investigated. Objectives: To compare risk factors among Saudi nationals and expatriates. Methods: A retrospective cohort study for patients admitted to the Cardiac Care Unit of one of the largest tertiary care hospitals in Tabuk diagnosed with acute myocardial infarction from September 2018 to August 2019. Risk factors were compared among groups on the basis of their ethnicity. Results: In total 18,746 patients were included. Gender and age were the predominant risk factors; Male (p < 0.05) and age >50 years (p < 0.05). There were significant differences between Saudis and expatriates in all measurable parameters indicating that a genetic factor contributes to the risk factors, which was proved by the significant differences between the Middle East North Africa and South Asia subgroups. Interestingly, the mean values of laboratory results were higher than Saudi populations. Conclusions: The disparity in lipid profile among the studied groups addresses the patient ethnicity should be considered during education programs for the risk factors of cardiovascular disease.

Impact of automated drug dispensing system on patient safety

Objectives: Automated drug dispensing system (ADDs) is an emerging technology positively impacts drug dispensing efficiency by minimizing medication errors. However, the pharmacist perception of the impact of ADDs on patient safety is not well-established. This cross-sectional observational study aimed to evaluate the dispensing practice and pharmacist perception of ADDs towards patient safety through a validated questionnaire. Methods: A selfdesigned questionnaire was validated and the pharmacist perception of dispensing practice was compared between two hospitals adopting ADDs and traditional drug dispensing system (TDDs). Results: The developed questionnaire had an excellent internal consistency (both Cronbach’s α and McDonald’s ω coefficients were >0.9). Factor analysis retained three significant factors (subscales) that explained pharmacist perception of dispensing system, dispensing practice, and patient counseling (p<0.001 for each factor). The average number of prescriptions dispensed per day, drugs contained in each prescription, average time for labeling each prescription and inventory management were significantly varied between ADDs and TDDs (p=0.027, 0.013 0.044 and 0.004, respectively). The perception of pharmacists using ADDs on three domains were higher than the TDDs. The pharmacists in ADDs agreed that they had enough time to review the medications before dispensing than TDDs and this difference was found to be statistically significant (p=0.028). Conclusions: ADDs was highly effective in improving dispensing practice and medication review; however, the pharmacists need to emphasize the importance of ADDs to translate the pharmacists’ freed-time towards patient care. (AU)

Patient Satisfaction of Ambulatory Care Pharmacy Services.

The Ministry of Health (MOH) recently developed the Health Sector Transformation Program (HTSP) to focus on patient satisfaction, safety, and care. This study explored patient satisfaction with outpatient care services. A semi-structured questionnaire was designed to collect the data of patient satisfaction with pharmacy care services through face-to face interviews of participants and over the internet using an electronic format of the same questionnaire (web-based survey). A total of 508 participants responded of whom, 51.8% were male and 83% were below 46 years old. The average scores of domains 1, 2, 3, 4, 5, 6, 7, and 8 were 4.51, 4.11, 4.30, 3.70, 3.57, 3.82, 3.63, and 4.15, respectively. The general evaluation of pharmacy services demonstrated that respondents were very satisfied (245; 48.2%), satisfied (143; 28%), and willing to recommend the pharmacy to their families (380; 76.4%). There was no statistically significant difference in the overall satisfaction with pharmacy services among the 2 hospitals (P > .05). Most respondents were satisfied with outpatient care pharmacy services. More efforts are needed to improve the service of following up on patients' adherence by the pharmacists.

Comparison of Cardiac Risk Scores among the East Mediterranean and South Asian Population.

BACKGROUND: Cardiovascular disease (CVD) is a global burden particularly in developing countries necessitates the periodical monitoring for these vulnerable population. This study aimed to compare four tools to measure the CVD risk between the East Mediterranean and South Asian population. METHODS: This retrospective analysis included 139 patients from East Mediterranean (n=90) and South Asians (n=49) ethnicity who were admitted during the one-year period in a multi-specialty tertiary care hospital located in Tabuk, Saudi Arabia. Four different tools currently in use across the world were used to analyses the CVD risk. RESULTS: Atherosclerotic Cardiovascular Disease (ASCVD) from American College of Cardiology/American Heart Association (ACC/AHA) was found to be significant (P=0.0000) than World Health Organization/International Society of Hypertension (WHO/ISH) and Framingham Risk Score (FRS) European SCORE (Systematic Coronary Risk Evaluation) memo card from European Society of Cardiology risk prediction charts. Meanwhile, FRS looks equally good as it detects 44.89% of South Asian study population with >10% CVD risk while ACC/AHA detects 46.93%. CONCLUSION: The present study recommends ACC/AHA cardiac risk estimator to identify the CVD risk in East Mediterranean population. However, the South Asian population needed a population-based tool to assess the accurate CVD risk.

Impact of automated drug dispensing system on patient safety.

Objectives: Automated drug dispensing system (ADDs) is an emerging technology positively impacts drug dispensing efficiency by minimizing medication errors. However, the pharmacist perception of the impact of ADDs on patient safety is not well-established. This cross-sectional observational study aimed to evaluate the dispensing practice and pharmacist perception of ADDs towards patient safety through a validated questionnaire. Methods: A self-designed questionnaire was validated and the pharmacist perception of dispensing practice was compared between two hospitals adopting ADDs and traditional drug dispensing system (TDDs). Results: The developed questionnaire had an excellent internal consistency (both Cronbach's α and McDonald's ω coefficients were >0.9). Factor analysis retained three significant factors (subscales) that explained pharmacist perception of dispensing system, dispensing practice, and patient counseling (p<0.001 for each factor). The average number of prescriptions dispensed per day, drugs contained in each prescription, average time for labeling each prescription and inventory management were significantly varied between ADDs and TDDs (p=0.027, 0.013 0.044 and 0.004, respectively). The perception of pharmacists using ADDs on three domains were higher than the TDDs. The pharmacists in ADDs agreed that they had enough time to review the medications before dispensing than TDDs and this difference was found to be statistically significant (p=0.028). Conclusions: ADDs was highly effective in improving dispensing practice and medication review; however, the pharmacists need to emphasize the importance of ADDs to translate the pharmacists' freed-time towards patient care.

Pre-pregnancy body mass index in mothers, birth weight and the risk of type I diabetes in their offspring: A dose-response meta-analysis of cohort studies.

BACKGROUND: The incidence of type I diabetes among children has increased significantly and the relationship between maternal pre-pregnancy Body Mass Index (BMI), Birth weight and risk of Type 1 diabetes in children (T1DMC) is controversial. OBJECTIVE: This dose-response meta-analysis was performed to investigate the association between maternal Pre-Pregnancy Body-Mass Index, Birth Weight and the Risk of Childhood Type I Diabetes. SEARCH STRATEGY: A comprehensive systematic search was conducted in MEDLINE/PubMed, SCOPUS, Cochrane, and Web of Science databases from inception to April 2019. Key search terms included "body mass index" OR "Birth weight" AND "Type 1 diabetes". SELECTION CRITERIA: Peer-reviewed studies that reporting association between BMI or birth weight and type I diabetes in a retrospective or prospective study by appropriate estimates such as the hazard ratio (HR), risk ratio (RR), or odds ratio (OR) and the corresponding 95 % confidence intervals (CI). DATA COLLECTION AND ANALYSIS: MOOSE guidelines were followed. Data were extracted by 2 researchers, independently. Combined hazard ratios (HRs) was evaluated by DerSimonian and Laird Random-effects model. RESULTS: Two studies continuing four arms with 1,209,122 participants were eligible for pre-pregnancy BMI section meta-analysis and six studies were eligible for inclusion, providing 10,340,036 participants for birth weight section meta-analysis. Pooled results demonstrated a significant association between obesity and risk of T1DMC (HR: 1.30, 95 % CI: 1.16-1.46, I2 = 7%). The combined HR (95 % CI) showed lower risk of T1DMC in low birth weight infants (HR: 0.78, 95 % CI: 0.69-0.88, I2 = 0%) and higher risk of T1DMC in the high birth weight infants versus the normal category of birth weight (HR: 1.08, 95 % CI: 1.00-1.17, I2 = 31 %). There was a significant non-linear association between birth weight and risk of T1DMC in children (Coef =-0.00032, p = 0.001). CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis identified high maternal BMI and High birth weight (HBW) increase risk of childhood T1DMC.

The effect of Bertholletia excelsa on body weight, cholestrol, and c-reactive protein: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND & OBJECTIVE(S): Bertholletia excelsa is a rich herbal source of anti-oxidants and phenols. The goal of this study is to evaluation the effect of bertholletia excelsa nut on body weight, C-reactive protein (CRP) and lipid profile. METHODS: A literature search was conducted in PubMed, Scopus and Web of sciences databases by two reviewers up to October 2019. Random effect model used to combine results. RESULTS: Six studies included in analysis with 71 participants. The population was public population. Pooled results showed Bertholletia excelsa have reduction effect on triglyceride weighted mean difference (WMD: -8.23 mg/dl, 95 % CI -15.09, -1.38, I² = 0%), Cholesterol (WMD: -14.31 mg/dl, 95 % CI -23.38, -5.24, I² = 47 %), Low-density lipoprotein (LDL) (WMD: -9.27 mg/dl, 95 % CI -13.48, -5.06, I² = 0%). CONCLUSION: This study provided an evidence that Bertholletia excelsa nuts have reduction effect on triglyceride, cholesterol, and LDL levels.

Effect of tomato consumption on fasting blood glucose and lipid profiles: A systematic review and meta-analysis of randomized controlled trials.

Tomato (Solanum lycopersicum) phytochemicals, which include phytoene, phytofluene, beta-carotene, flavonoids, lycopene, and polyphenols, have been shown to improve the effects of fasting on plasma triglyceride (TG), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), total cholesterol (TC), and fasting blood sugar (FBS). The aim of this study was to systematically evaluate the effects of Tomato TC, TG, HDL, LDL, and FBS in humans. A systematic literature search was conducted in PubMed/MEDLINE, Web of sciences, and SCOPUS databases by two researchers for studies published until August of 2019 without language and time limitations. Results were combined with random effect models. Six studies were included in this meta-analysis. Combined results reveal a significant reduction in cholesterol (weighted mean difference [WMD]: -4.39 mg/dl, 95% CI: -7.09, -1.68, I2 = % 48, p heterogeneity: .05), TG (WMD: -3.94 mg/dl, 95% CI: -7.67, -0.21, I2 = % 90, p heterogeneity: .001), LDL levels (WMD: -2.09 mg/dl, 95% CI: -3.73, -0.81, I2 = % 78, p heterogeneity: .001), and increasing in HDL levels (WMD: 2.25 mg/dl, 95% CI: 0.41, 4.10, I2 = % 97, p heterogeneity: .001). Tomato was found to have a higher reduction effect on TG and LDL in younger participants. While pooled results indicate no significant effect on FBS levels (WMD: 0.59 mg/dl, 95% CI: -0.28, 1.46, I2 = % 95, p heterogeneity: .001). In conclusion, the results indicate a significant reduction in total cholesterol, TG, and LDL and increase in HDL levels that is caused by tomato consumption.

Chemical pneumonitis due to accidental inhalation of benzene: A case report.

Acute accidental inhaled benzene toxicity is rare; however, it associates with the complications including chemical pneumonitis frequently and rarely with the cardiac and neurological complications. The patient should be treated symptomatically since there are no specific clinical practice guidelines especially antidotes established in this regard. The follow-up and monitoring of the patient are crucial for the remission and also to rule out further complications.