The rate of exacerbations in patients with asthma in Qatar: A retrospective study during 2019-2021.

Background: The prevalence of asthma is 9% among adults in Qatar, and its severity can be attributed to intrinsic and extrinsic factors such as environmental changes. As part of the project to investigate the association between air pollution and asthma severity, the rate of exacerbations in adult patients with asthma has been studied in Qatar. Methods: Retrospective data of patients with asthma (16-70 years) from January 2019 to December 2021 was retrieved from Cerner medical records. Frequencies of exacerbations in inpatient and outpatient departments were analyzed using means ± SD and median (IQR) for descriptive data and frequency and percentage for categorical data. Exacerbations were divided into single, double, and more than double for each quarter of the year (January 2019-December 2021) using SPSS and Minitab statistical packages. Results: A total of 6977 exacerbations visits (representing 6558 patients) were identified during the study period. The mean ± SD age was 41±14.3 years, with a female: male ratio of almost 1:1. The patients from the MENA region, including Qataris, presented 67% compared to 33% from the Indian subcontinent and other countries. The number of patient visits for hospitalization due to exacerbations showed a distinctive pattern during the three years. The highest record of asthmatics with exacerbations was observed in 2019 (42.7%) compared to half the rate in 2020 and 2021 (28.5%, 28.8%), respectively. The single exacerbation group was almost five times higher than 2 or >2 exacerbation groups in all years (2019-2021). Conclusion: This preliminary overview provides the rate of exacerbation episodes in patients with asthma in Qatar. One cause of these exacerbations can be attributed to air quality changes. The drop in the exacerbation rate observed in 2020-2021 could be explained by COVID-19 lockdown regulations or patients' adherence to prescribed meds. We aim to propose preventive and therapeutic strategies to alleviate asthmatics' symptoms and improve their quality of life.

Fc Epsilon RI-Neuroimmune Interplay in Pruritus Triggered by Particulate Matter in Atopic Dermatitis Patients.

Atopic dermatitis (AD) is the most common chronic relapsing neuroinflammatory skin disease that is characterized by a complex and multifactorial pathophysiology. It reflects a profound interplay between genetic and environmental factors, and a recently disclosed neuroimmune dysregulation that drives skin barrier disruption, pruritus, and microbial imbalance. In terms of the key external environmental players that impact AD, air quality and itch severity linkage have been thoroughly researched. The impact of ambient air pollutants including particulate matter (PM) and AD pruritic exacerbation has been recorded despite reductions in air pollution levels in in developed countries. The developing countries have, on the contrary, experienced significant urbanization and industrialization with limited environmental protection standards in the past decades. This unprecedented construction, petrochemical industry utilization, and increment in population counts has been paired with consistent exposure to outdoor PM. This may present a key cause of AD pruritic exacerbation supported by the fact that AD prevalence has intensified globally in the past 50 years, indicating that environmental exposure may act as a trigger that could flare up itch in vulnerable persons. At the molecular level, the impact of PM on severe pruritus in AD could be interpreted by the toxic effects on the complex neuroimmune pathways that govern this disease. AD has been recently viewed as a manifestation of the disruption of both the immune and neurological systems. In light of these facts, this current review aims to introduce the basic concepts of itch sensory circuits in the neuroimmune system. In addition, it describes the impact of PM on the potential neuroimmune pathways in AD pathogenesis with a special focus on the Fc Epsilon RI pathway. Finally, the review proposes potential treatment lines that could be targeted to alleviate pruritus based on immune mediators involved in the Fc Epsilon signaling map.

Health risk assessment of methyl mercury from fish consumption in a sample of adult Qatari residents.

Fish constitutes an essential source of high-quality protein and is, at the same time, the source of exposure to many hazardous contaminants, namely mercury and methyl mercury (MeHg). This study aims at assessing the risk that MeHg poses to the health of adult Qatari residents through fish consumption. Data on fish consumption were collected using a self-administered online survey composed of three sections that collected information about the fish-eating patterns of the participants. The fish species that were reported to be consumed by ≥ 3% of the respondents were sampled and analyzed for their total mercury (T-Hg) content levels. MeHg concentrations were derived from T-Hg content levels using a scenario-based approach. Disaggregated fish consumption and contamination data were combined using the deterministic approach to estimate MeHg intakes. The average, 75th, and 95th percentiles of the MeHg intake estimates were determined and compared to the tolerable weekly intake (TWI) set by the European Food Safety Agency (EFSA) (1.3 µg·kg-1·w-1). All fish samples contained T-Hg at levels ˂ 0.3-0.5 µg/g with a mean value of 0.077 µg/g. The study population had an average fish consumption of 736.0 g/week. The average estimated weekly intakes of MeHg exceeded TWI for some fish consumers including females of childbearing age and those following a high-protein diet. Our study highlights the need to establish regulatory guidelines and dietary advice based on risk/benefit ratio.

Total Hg levels distribution in fish and fish products and their relationships with fish types, weights, and protein and lipid contents: A multivariate analysis.

This study investigates the mercury (Hg) levels distribution in fish and fish products and their relationships with fish types, weights, protein, and lipid contents in Qatar. Principal component analysis (PCA) was employed to analyze the influence of lipids and protein content on Hg accumulation in the fish tissues. Additionally, the impact of Hg concentration and fish consumption on the estimated weekly intake (EWI). The PCA results showed that Hg contamination levels are primarily affected by protein-lipid content in predatory species. The results showed that high lipid content reflected lower Hg levels and that high Hg levels in fish with high lipid content indicated a polluted environment. The finding of the PCA of EWI, consumption, and Mercury concentration indicate that EWI is highly correlated to Mercury concentration except in the case of low Mercury concentration.

Pharmacist Role in Hypertension Management in the Community Setting: Questionnaire Development, Validation, and Application.

Background: Hypertension is a leading cause of mortality and morbidity globally. Pharmacists can play a substantial role in decreasing the burden of the disease. Purpose: The primary aim of this study was to develop and validate a scale assessing the pharmacist role in hypertension management in the community pharmacy setting. The secondary aims were to assess the services/interventions in hypertension management that were performed in the real-life setting, as well as the patient satisfaction from these services/interventions. Methods: This cross-sectional study was conducted in Egypt. The data were collected using a survey composed of three sections: a general section, the pharmacist role questionnaire section, and the patient satisfaction from the provided interventions/services section. The pharmacist role questionnaire was developed based on the pharmaceutical care practice conceptual model and included 23 questions. The face validity, content validity, reliability testing using Cronbach alpha, and construct validity using exploratory factor analysis were determined. The percentage of the frequency by which each role was reported to be performed was determined. Patient satisfaction from the provided interventions/services was determined by means of an overall rating. The correlation between practiced roles and patient satisfaction with received interventions/services was determined. Results: The questionnaire was valid with a 4-factor structure and a Cronbach alpha >0.75, reiterating the main pharmaceutical care practice domains: medication management, disease-state education, disease-state management, and care plan monitoring. Roles falling in the domains of disease state management and disease state education were significantly more practiced than roles falling in the other domains. Conclusion: Pharmacist practice in hypertension management in the community setting was inclined towards contemporary roles, such as disease state education and management. Patients seem to be satisfied with these roles.

Comprehensive care for patients with diabetes in Ramadan: A module for pharmacy students and pharmacists.

Introduction: Prior studies show that many patients with diabetes whose health maybe impacted by fasting, choose to fast during Ramadan. This study describes the implementation and evaluation of an online module targeting bachelor of pharmacy (BPharm) and doctor of pharmacy (PharmD) students that aims to improve participants' knowledge, communication, and self-efficacy concerning proper care for patients with diabetes in Ramadan. Methods: An online module consisting of two phases targeting both BPharm and PharmD students was implemented over two semesters in fall 2020 and spring 2021. Participants were directed to fill pre-module and post-module assessments to evaluate the change in their knowledge and self-efficacy using two scales. Pre- and post-survey data for participants' knowledge and self-efficacy were analyzed for significance using paired sample t-tests. Qualitative data analysis was performed to assess participants' responses to the open-ended question concerning what they liked and disliked about the module. Results: All BPharm and PharmD students taking the lesson responded to both the baseline survey and the follow-up one resulting in 92 responses (participation rate of 100%). The average score for participants in the pre-module self-efficacy section was 1.5 (SD = 1) and increased post-module to 3.5 (SD = 0.7), t (91) = 20.2, p < 0.001. Further, the average score for participants in the pre-module knowledge section was 14 (SD = 3), which similarly increased to 22 (SD = 3) post-module t (91) = 19.7, p < 0.001. Qualitative analysis provided insights on how participants perceived the module design, content, and its impact on practice. Participants described the module as an informative one that addresses a much-needed issue they haven't been exposed to before. They emphasized how the module addresses the cultural needs of patients in their communities. They particularly appreciated seeing instructor videos depicting real-life scenarios and the focus on their communication skills, but some preferred learning about this topic through live sessions. Conclusion: An online module positively impacted both self-efficacy and knowledge in relation to caring for patients with diabetes considering fasting in Ramadan. Future studies should explore how different versions of this module can be integrated into educational activities for pharmacy students, pharmacists in different settings, and for other health care professionals.

Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates.

Primary dysmenorrhea (PD) is a common, disregarded, underdiagnosed, and inadequately treated complaint of both young and adult females. It is characterized by painful cramps in the lower abdomen, which start shortly before or at the onset of menses and which could last for 3 days. In particular, PD negatively impacts the quality of life (QOL) of young females and is the main reason behind their absenteeism from school or work. It is suggested that increased intrauterine secretion of prostaglandins F2α and E2 are responsible for the pelvic pain associated with this disorder. Its associated symptoms are physical and/or psychological. Its physical symptoms include headache, lethargy, sleep disturbances, tender breasts, various body pains, disturbed appetite, nausea, vomiting, constipation or diarrhea, and increased urination, whereas its psychological symptoms include mood disturbances, such as anxiety, depression, and irritability. While its diagnosis is based on patients' history, symptoms, and physical examination, its treatment aims to improve the QOL through the administration of nonsteroidal anti-inflammatory drugs, hormonal contraceptives, and/or the use of non-pharmacological aids (e.g., topical heat application and exercise). Patients must be monitored to measure their response to treatment, assess their adherence, observe potential side effects, and perform further investigations, if needed.

Acute Kidney Injury Related to Intravenous Colistin Use in Lebanese Hospitalized Patients: Incidence and Associated Factors.

BACKGROUND: Colistin use has increased because of the emergence of infections caused by resistant gram-negative bacteria. Acute kidney injury (AKI) remains a treatment-limiting factor for widespread colistin clinical use. This study aimed at determining the incidence and the factors associated with the development of colistin-induced AKI. METHODS: A retrospective observational study was conducted by reviewing files of adult patients with normal kidney function between January 2015 to March 2019 at a university hospital located in Beirut city. AKI was defined based on KDIGO criteria. Independent variables associated with colistin-induced AKI were also tested. RESULTS: In this study, a total of 113 patients were included. AKI occurred in 53 patients (46.9%). The Charlson Comorbidity Index (CCI) was found to be significantly greater in the AKI group (2.26, P-value = 0.026). In the multivariate analysis, low serum albumen was found as an independent significant predictor for AKI (OR=.065, 95%CI: .013-.337, P-value=0.001). Moreover, the risk for AKI increased by 2 folds (OR=2.019, 95%CI: 1.094-3.728, P-value: 0.025), when two or more nephrotoxic agents were administered simultaneously with colistin. The patient's age was also found as a significant predictor for AKI (OR=1.034, 95%CI:1-1.07), with a cut-off value of 58.5-year-old. CONCLUSION: This study demonstrated that the concomitant use of two or more nephrotoxic drugs, patient's age of 58.5 or above, and the presence of hypoalbuminemia were independent factors for the development of colistin-induced AKI. These factors should be therefore taken into consideration when prescribing colistin in clinical practice to decrease the risk of AKI.

Prevalence, risk factors, and management practices of primary dysmenorrhea among young females.

BACKGROUND: Primary dysmenorrhea (PD) is one of the most common gynecological conditions among young females, which has a significant negative impact on health-related quality of life and productivity. Despite its high prevalence, the evidence is limited regarding the management-seeking practices and its perceived effectiveness among females with PD. METHODS: This is a cross-sectional study conducted among 550 female students in six universities across Lebanon. The prevalence of PD, associated risk factors, and management-seeking practices were assessed using a self-administered questionnaire. RESULTS: The prevalence of PD was 80.9%. Most of the females with PD described their menstrual pain as moderate (56%) to severe (34.6%), which significantly affected their daily activities and studying ability (P < 0.001). The major risk factors associated with PD included heavy menstrual flow (adjusted odds ratio [AOR] = 10.28), family history of PD (AOR = 2.52), history of weight loss attempt (AOR = 2.05), and medical specialization (AOR = 1.663). Only 36.9% of females with PD sought formal medical advice. Most dysmenorrheic females (76.4%) received medications for the management of PD, and remarkably none of them took hormonal contraceptives. Drugs commonly used for PD were mefenamic acid (26.2%), ibuprofen (25%), and paracetamol (11.5%), which were administered when the pain started (58.2%). All medications were significantly effective in reducing the pain score (P = 0.001), and most NSAIDs were more potent than paracetamol in managing PD (P = 0.001). However, no significant difference in adverse effects among medications was revealed. Moreover, no superiority of any individual NSAID for pain relief was established. Nevertheless, mefenamic acid was associated with the lowest risk of abdominal pain (OR: 0.03, P = 0.005) and the highest risk of flank pain (OR = 12, P = 0.02). CONCLUSIONS: Suboptimal management of PD is practiced among university students in Lebanon. Therefore, health care providers should educate dysmenorrheic females to optimize the self-management support of PD. Furthermore, future research is required to investigate females' misconceptions about hormonal contraceptives in the management of PD, aiming to raise awareness and correct misconceptions.

Dispensing errors in Lebanese community pharmacies: incidence, types, underlying causes, and associated factors.

OBJECTIVES: To assess the incidence, types, the causes of as well as the factors associated with dispensing errors in community pharmacies in Lebanon. METHODS: An observational cross-sectional study was conducted in 286 pharmacies located all over Lebanon. Data were collected by senior pharmacy students during their experiential learning placement. Collected data included information on the types of dispensing errors, the underlying causes of errors, handling approaches, and used strategies for dispensing error prevention. Data were analyzed using multiple logistic regression to determine factors that were associated with dispensing errors. RESULTS: In the twelve thousand eight hundred sixty dispensed medications, there were 376 dispensing errors, yielding an error rate of 2.92%. Of these errors, 67.1% (252) corresponded to dispensing near-miss errors. The most common types of dispensing errors were giving incomplete/incorrect use instructions (40.9% (154)), followed by the omission of warning(s) (23.6% (89)). Work overloads/time pressures, illegible handwriting, distractions/interruptions, and similar drug naming/packaging were reported as the underlying causes in 55% (206), 23.13% (87), 15.15 % (57), and 7% (26) of the errors respectively. Besides, high prescription turnover volume, having one pharmacist working at a time, and extended working hours, were found to be independent factors that were significantly associated with dispensing errors occurrence (p<0.05). CONCLUSIONS: This study sheds light on the need to establish national strategies for preventing dispensing errors in community pharmacies to maintain drug therapy safety, considering identified underlying causes and associated factors.

Dispensing errors in Lebanese community pharmacies: incidence, types, underlying causes, and associated factors

OBJECTIVES: To assess the incidence, types, the causes of as well as the factors associated with dispensing errors in community pharmacies in Lebanon. METHODS: An observational cross-sectional study was conducted in 286 pharmacies located all over Lebanon. Data were collected by senior pharmacy students during their experiential learning placement. Collected data included information on the types of dispensing errors, the underlying causes of errors, handling approaches, and used strategies for dispensing error prevention. Data were analyzed using multiple logistic regression to determine factors that were associated with dispensing errors. RESULTS: In the twelve thousand eight hundred sixty dispensed medications, there were 376 dispensing errors, yielding an error rate of 2.92%. Of these errors, 67.1% (252) corresponded to dispensing near-miss errors. The most common types of dispensing errors were giving incomplete/incorrect use instructions (40.9% (154)), followed by the omission of warning(s) (23.6% (89)). Work overloads/time pressures, illegible handwriting, distractions/interruptions, and similar drug naming/packaging were reported as the underlying causes in 55% (206), 23.13% (87), 15.15 % (57), and 7% (26) of the errors respectively. Besides, high prescription turnover volume, having one pharmacist working at a time, and extended working hours, were found to be independent factors that were significantly associated with dispensing errors occurrence (p < 0.05). CONCLUSIONS: This study sheds light on the need to establish national strategies for preventing dispensing errors in community pharmacies to maintain drug therapy safety, considering identified underlying causes and associated factors

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Prescribing of proton pump inhibitors for gastrointestinal bleeding prophylaxis in the Lebanese outpatient setting: patterns, compliance with guidelines and risks.

OBJECTIVES: To determine patterns of proton pump inhibitor (PPIs) prescribing for gastrointestinal bleeding prophylaxis (GIBP) in the Lebanese outpatient setting, to assess their compliance with guidelines for approved GIBP indications and to delineate independent factors that are associated with non-compliance. METHODS: A community-based multicentre cross-sectional study was conducted. Eligible patients were those who presented to the community pharmacy setting with a PPI prescription for GIBP. Prescriptions were reviewed by a clinical pharmacist to ascertain their compliance with guidelines approved for GIBP indications. Several variables were tested to determine independent factors that were associated with guidelines non-compliance. KEY FINDINGS: Of the 720 reviewed PPI prescriptions, 297 (41.25%) were found to be compliant with guidelines approved for GIBP indications. The presence of two or more comorbid conditions, prescribing initiated by a primary care physician, patients taking three or more medications, and prescribing of NSAIDs including low-dose aspirin were found to be independent factors that were significantly associated with PPI prescribing non-compliance (P ≤ 0.05). PPIs were also inappropriately coprescribed with corticosteroids (102 (24.1%)), selective serotonin reuptake inhibitors (SSRIs) (48 (11.4%)), amoxicillin-clavulanic acid (20 (4.7%)) and bisphosphonates (13 (3.1%)) for GIBP. CONCLUSION: This study demonstrated that PPIs were appropriately prescribed for GIBP in less than the half of the study patients. The need for improvement of clinical practice in this regard is therefore indispensable since inappropriate prescribing is costly and put the patient at risk for adverse health outcomes. Strategies to alter inappropriate prescribing may include education, guidelines awareness and decision support systems.

The economic impact of patients with heart failure on the Lebanese healthcare system.

AIMS: This paper aimed to calculate the annual cost for heart failure (HF) patients in Lebanon. METHODS AND RESULTS: Heart failure care can reach up to $31 billion annually in the USA. Data in Lebanon are lacking. Estimating it based on USA data is biased; hence, collecting data from all healthcare providers will reflect the actual cost in Lebanon. Data were collected from all healthcare providers on HF hospitalization during the year 2012. In addition, data from 600 outpatient visits were collected by medical students to estimate the cost for outpatient care. The total cost was calculated by adding up all hospitalization cost-plus outpatient-estimated cost. There were 72 000 individuals suffering from HF. The hospitalization care in Lebanon is largely delivered by the public sector (91% public vs 9% private). However, the outpatient care is largely paid cash by patients. The direct cost for HF hospitalizations paid by the public and the private sector was $38 081 535. The average cost for each HF hospitalization was $3769. The direct cost for outpatients care was estimated at $65 592 000. The average cost for outpatient care was $911 per patient per year. The annual total direct cost was calculated at $103 673 535. The true cost was almost one third the extrapolated cost based on US statistics ($103 673 535 vs 268 370 607, respectively). CONCLUSIONS: The annual total direct cost for HF patients in Lebanon in 2012 was $103 673 535, which is much less than the extrapolated cost based on US statistics.

Level of A1C control and its predictors among Lebanese type 2 diabetic patients.

AIM: Lebanon is among the top 10 countries with the highest prevalence of diabetes in the Middle East region with estimates reaching as high as 16.6% in adults aged 20-79 years. The objective of this study was to assess the level of A1C control among a cohort of type 2 diabetic patients and factors associated with uncontrolled A1C. METHODS: We carried out a retrospective observational study among type 2 diabetes mellitus patients attending an outpatient endocrinologist's clinic between June 2008 and July 2012 in Beirut, Lebanon. Two groups were compared, based on their diabetic control (A1C < 7% and A1C ≥ 7%). RESULTS: A total of 551 patients were included in this study, where 31.8% attained A1C control. Crude analyses showed that some factors were significantly associated with uncontrolled A1C, and these were long-standing diabetes, diabetes-related complications, uncontrolled blood pressure, lipid profile, as well as the use of metformin, sulfonylurea, or insulin. When multivariate analysis was carried out, the chances of having uncontrolled A1C were significantly higher among patients who developed neuropathy (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.11-3.90), had uncontrolled triglycerides (OR 1.98, 95% CI 1.33-2.94), used insulin (OR 4.52, 95% CI 2.32-8.83), and sulfonylureas (OR 2.88, 95% CI 1.88-4.40). CONCLUSION: Uncontrolled diabetes is more likely to exist in patients with neuropathy, uncontrolled triglycerides and those using insulin or sulfonylurea. Further research is needed to confirm the findings.

Variables associated with stress ulcer prophylaxis misuse: a retrospective analysis.

BACKGROUND: Stress ulcer prophylaxis (SUP) is commonly used in hospitals. Although its indications are better delineated for intensive care unit (ICU) patients, its use in non-ICU settings is somewhat arbitrary and based on judgment. OBJECTIVE: We attempted to assess the extent of SUP overuse in our hospital. We also carefully collected and analyzed several variables to detect associations governing this flawed behavior and its financial burden on the hospital's budget. MATERIALS AND METHODS: We retrospectively analyzed charts of patients admitted to the medical floor of a tertiary referral university hospital over a 1 year period. All adult patients admitted to the medical ward who received at least one dose of SUP were included and reviewed for a multitude of variables in addition to the appropriateness of acid suppression therapy (AST). RESULTS: We included 320 charts and found that 92% of patients admitted during that period were not eligible for SUP. The total inappropriateness of SUP was noted to be 58% (p = 0.015). Increasing age and male gender were found to be significant variables in AST misuse (p = 0.045 and p = 0.010), much like duration of hospital stay (p = 0.008). Comorbidities was also found to be a defining variable for AST overuse (odds ratio [OR] = 3.27). Patients with two or more minor risk factors were also subjected more to SUP inappropriately (OR = 3.53), in addition to patients of certain specialties (Neurology, Infectious Diseases, etc.). Our calculated financial burden was more than $23,000 per year for the medical floor. CONCLUSION: This retrospective study confirmed the growing suspicion that SUP misuse is evident on the medical floors. We also delineated several factors and variables associated with and affecting SUP overuse.