Type 2 Diabetes Patients' Views of Local Pharmacists and Fulfilment with Pharmaceutical Diabetes Care in Syria's Latakia Governorate: An Online Survey Research.

Assessing the attitudes of diabetic patients towards community-pharmacy services and determining the demand for new services could help monitor and evaluate the therapeutic response. This study aimed to evaluate type 2 diabetes patients' satisfaction regarding pharmacy care in community pharmacies and shed a light on the reasons for diabetic patients' non-adherence to treatments. An online survey was conducted on a random sample of patients (n = 196) at the national Diabetes Centre in Latakia, Syria, from April to November 2022. The questionnaire consisted of four primary parts: (1) demographic characteristics of responders, (2) patients' therapeutic behaviors, (3) diabetes knowledge, and (4) the general level of satisfaction with pharmacy diabetes services. The data were analyzed using descriptive analysis. Around 89% of respondents were satisfied with the information provided by community pharmacists. The patients' non-adherence showed a maximum as a function of the number of concomitantly taken medicines, which indicated that in most serious cases patients' adherence was increasing. Overall, most patients were delighted with community pharmacists' expertise and pharmacy services. This positive image allows pharmacists to expand their duties as healthcare providers in diabetes care, and increase the patient therapeutic adherence by performing a reconciliation of the patient's medicines, which involves reviewing all patients' drugs and identifying realistic solutions to their adherence issues.

The Effect of Interventions Led by Community Pharmacists in Primary Care for Adults with Type 2 Diabetes Mellitus on Therapeutic Adherence and HbA1c Levels: A Systematic Review.

Type 2 diabetes mellitus has been assessed as a widespread disease globally. Unfortunately, this illness can occasionally go undetected and without symptoms until it reaches the emergency condition, and this can be notably true in patients who do not receive routine medical care. Pharmacists are the foremost accessible health care providers. They can help patients select the most appropriate hypoglycemic management strategy through their experiences. This review aimed to provide an overview of the literature published on community pharmacists' interventions that are currently used and their usefulness in improving patient adherence and glycosylated hemoglobin (HbA1c) levels. Relevant studies were retrieved through a comprehensive search of three databases, PubMed/Medline, Web of Science, and CINAHL (2010 to 2020). In total, 8362 publications were identified. The final protocol was based on the "Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)". After applying inclusion and exclusion measures, 21 articles were deemed relevant. In pharmacists' interventions in diabetes care, patient education and counseling were the most common intervention methods. Essentially, this systematic review provides evidence and identifies the key features that may predict success in enhancing clinical outcomes and patient adherence to treatment. Based on our findings, we suggest further investigations of the root causes of non-adherence problems.

Recent exploration of nanoemulsions for drugs and cosmeceuticals delivery.

BACKGROUND: Nanoemulsions (NEs) have been explored as nanocarriers for the delivery of many drugs and cosmeceuticals. The extraordinary expansion of using NEs is due to their capability to conquer the main challenges of conventional delivery systems such as short residence time with low patient acceptance, poor stability, low aqueous solubility, permeability, and hence bioavailability. METHODS: This review recapitulated the most recent pharmaceutical and cosmeceutical applications of NEs as effective delivery nanocarriers. The outputs of our research studies and the literature review on the latest NEs applications were assessed to highlight the NEs components, preparations, applications, and the improved quality and elegance of the used product. RESULTS: NEs are stable submicronic translucent dispersions with narrow droplet size distribution. They exhibited excellent ability to efficiently encapsulate therapeutics of diverse nature of drugs and cosmeceuticals. NE formulations showed superiority over conventional delivery approaches with overabundances of advantages through different routes of administration. This novel technology exhibited better aesthetic appeal, higher bioavailability, and a longer duration compared to the conventional delivery systems. CONCLUSION: This novel technology holds promise for different therapeutics fields. However, the success of NEs use advocated the development of robust formulations, proper choice of equipment, ample process characterization, and assurance of their efficacy, stability, safety and cosmetic appeal.

Multiparametric MRI with in-bore targeted biopsy in the diagnostic pathway of prostate cancer: Data from a single institution experience.

BACKGROUND: Accuracy of multiparametric MRI (mpMRI) for the detection of significant prostate cancer (CaP) varies in the literature as only few studies use radical prostatectomy specimens as their gold standard. On another hand, MRI-targeted prostate biopsy is emerging as an alternative to the traditional randomized biopsy, with a higher detection rate of high-grade cancers. However, data on MRI guided in bore biopsy is lacking. MATERIAL AND METHODS: We reviewed every patient that had his mpMRI, MRI guided in bore biopsy and radical prostatectomy performed in our hospital between November 2015 and December 2020. The diagnostic performances of both mpMRI and MRI targeted biopsy in sampling PIRADS index lesions were studied, using radical prostatectomy specimens as the gold standard. Sensitivity, specificity, positive predictive value and negative predictive value of mpMRI for detecting T3 stage, extra-capsular extension, seminal vesicles involvement and lymph node disease were also evaluated. RESULTS: Sixty-two met our inclusion criteria. For PIRADS≥3 lesions, sensitivity and positive predictive value for detecting clinically significant CaP were of 83.5% and 94.7%. A total of 32.2% prostate cancers on targeted biopsy were upgraded on final pathology, with an upgrading to ISUP≥2 in 3.2% and to ISUP≥3 in 14.5%. A total of 20.9% of cancers were downgraded but without any downgrading to ISUP 1. When final pathology is taken as a gold standard, sensitivity of mpMRI was 31.8% for T3 staging prediction, 30.0% for extra-capsular extension, 28.7% for seminal vesicles involvement and 66.7% for lymph node disease prediction. Specificity was 89.3%, 93.1%, 95.3%, and 92.7%, respectively. CONCLUSION: mpMRI has an acceptable accuracy for the prediction of significant CaP and index lesion detection but is unreliable for CaP staging. Comparison between pathology and biopsy results revealed that the in-bore biopsy technique has an upgrading and downgrading rate comparable in the literature to fusion biopsy, but higher than the combined biopsy approach.

Aberrant gastroduodenal artery with splenic origin.

PURPOSE: Knowledge of the wide variability in celiac trunk branches is of paramount importance when planning an abdominal surgery. METHODS: We, hereby, report a previously undescribed origin of the gastroduodenal artery discovered on an abdominal angio-CT. RESULTS: CT-angiogram performed on a 33-year-old female randomly revealed a new variant of gastroduodenal artery arising directly from the splenic artery along with other vascular aberrations. The latter were previously described in medical literature. CONCLUSION: High-quality preoperative imaging is crucial for identification of visceral artery variations, as those can technically modify the surgical or interventional procedure.

Sites of colonization in hospitalized patients with infections caused by extended-spectrum beta-lactamase organisms: a prospective cohort study.

BACKGROUND: The objective of this study was to determine whether patients infected with extended-spectrum beta-lactamase (ESBL)-producing organisms are colonized at multiple body sites. METHODS: This was a prospective cohort study at a tertiary care center in Beirut, Lebanon. Hospitalized patients with infections caused by ESBL-producing organisms were included. Cultures were obtained from the primary site of infection as well as from other sites (skin, nasopharynx, urine, rectum). Molecular analysis was performed on isolates to determine clonal relatedness. RESULTS: One hundred patients were included in the study. Only 22 patients had positive cultures from sites other than the primary site of infection. The most common ESBL gene was CTX-M-15 followed by TEM-1. In 11 of 22 patients, isolates collected from the same patient were 100% genetically related, while in the remaining patients, genomic relatedness ranged from 42.9% to 97.1%. CONCLUSIONS: Colonization at sites other than the primary site of infection was not common among our patient population infected with ESBL-producing organisms. The dynamics of transmission of these bacterial strains should be studied in further prospective studies to determine the value of routine active surveillance and the need for expanded precautions in infected and colonized patients.

A histologically proven case of lymphocytic interstitial pneumonia in a HIV infected adult with an undetectable viral load.

Lymphocytic interstitial pneumonia (LIP) is on the spectrum of lymphoproliferative diseases that can affect the lungs. Although common in human immunodeficiency virus (HIV) infected children, it is rarely reported in adults. A 51-year-old HIV infected female patient presented with worsening dyspnea over five months. She had radiological findings of bilateral lung nodular infiltrates. Her CD4 count was 835 cells/uL and her HIV viral load was undetectable. Bronchoalveolar lavage did not yield any infectious pathogen. The pathology on an open lung biopsy revealed marked lymphocytic infiltrates and widening of alveolar septa consistent with the diagnosis of LIP. LIP is a rare entity in adults. Previously reported cases in HIV infected adults were associated with a high HIV viral load at the time of diagnosis. Here we present the first case of LIP in an HIV infected adult with an undetectable viral load.