Avoiding COVID-19 complications with diabetic patients could be achieved by multi-dose Bacillus Calmette-Guérin vaccine: a case study of beta cells regeneration.

Diabetes mellitus (DM) is one of the major risk factors for COVID-19 complications as it is one of the chronic immune-compromising conditions especially if patients have uncontrolled diabetes, poor HbA1c and/or irregular blood glucose levels. Diabetic patients' mortality rates with COVID-19 are higher than those of cardiovascular or cancer patients. Recently, Bacillus Calmette-Guérin (BCG) vaccine has shown successful results in reversing diabetes in both rats and clinical trials based on different mechanisms from aerobic glycolysis to beta cells regeneration. BCG is a multi-face vaccine that has been used extensively in protection from tuberculosis (TB) and leprosy and has been repositioned for treatment of bladder cancer, diabetes and multiple sclerosis. Recently, COVID-19 epidemiological studies confirmed that universal BCG vaccination reduced morbidity and mortality in certain geographical areas. Countries without universal policies of BCG vaccination (Italy, Nederland, USA) have been more severely affected compared to countries with universal and long-standing BCG policies that have shown low numbers of reported COVID-19 cases. Some countries have started clinical trials that included a single dose BCG vaccine as prophylaxis from COVID-19 or an attempt to minimize its side effects. This proposed research aims to use BCG vaccine as a double-edged weapon countering both COVID-19 and diabetes, not only as protection but also as therapeutic vaccination. The work includes a case study of regenerated pancreatic beta cells based on improved C-peptide and PCPRI laboratory findings after BCG vaccination for a 9 year old patient. The patient was re-vaccinated based on a negative tuberculin test and no scar at the site of injection of the 1st BCG vaccination at birth. The authors suggest and invite the scientific community to take into consideration the concept of direct BCG re-vaccination (after 4 weeks) because of the reported gene expressions and exaggerated innate immunity consequently. As the diabetic MODY-5 patient (mutation of HNF1B, Val2Leu) was on low dose Riomet® while eliminating insulin gradually, a simple analytical method for metformin assay was recommended to ensure its concentration before use as it is not approved yet by the Egyptian QC labs.

Knowledge, attitude and practice of community pharmacists towards nutrition counseling.

Background The World Health Organization considers health promotion a top health service priority. Nutrition, weight management and physical activity are necessary health promotion strategies to improve overall quality of life and decrease the personal and societal consequences or poor health. Community pharmacists are in the best position to implement health promotion strategies due to their excellent accessibility and the lack of a requirement to make an appointment to interact with them. Enabling people to change their lifestyle and control their health through nutrition education and counseling is a great opportunity for community pharmacists to promote health. Nutrition counseling as a part of clinical nutrition therapy aims to provide dietary advice and to assist the selection of appropriate over-the-counter supplements. Objective To investigate the community pharmacist role in nutrition counseling and identify the barriers and strategies to improve nutrition counseling in Egypt. Setting Community pharmacies in Egypt. Methods A descriptive, cross-sectional study was conducted with a knowledge, attitude, and practice survey. A specially developed and validated questionnaire was used to collect data via face-to-face structured interviews. Primary outcomes Pharmacists' knowledge about, attitudes towards and practice of nutrition counseling. Results A total of 368 community pharmacists participated in this study, with a response rate of 73.6%. A total of 255 (69.3%) of the participants considered medical nutrition therapy a part of a pharmacist's duties. Only 146 (39.7%) of the participants believed that dietary supplements positively impact public health. According to 321 (87.2%) of the participants, the lack of pharmacists' expertise in nutrition counseling was the main barrier to nutrition counseling. Conclusions The majority of the participating community pharmacists had positive attitudes towards their role in nutritional assessment and medical nutrition therapy. There is a need to improve the nutritional knowledge of community pharmacists in Egypt. The current practice of community pharmacists in nutrition counseling is limited to adults. Obesity, diabetes and hypertension were the main medical conditions of the patients who received nutrition counseling from the community pharmacists. Inadequate knowledge in nutrition and the unavailability of educational materials were the main barriers to nutrition counseling.