Corrigendum to "A narrative review of approved and emerging anti-obesity medications" [Saudi Pharm. J. 31(10) (2023) 101757].

[This corrects the article DOI: 10.1016/j.jsps.2023.101757.].

Association of level of adherence to Mediterranean diet with cognitive and dementia status in subjects with chronic diseases: a cross-sectional study.

Background: The Mediterranean diet has been linked to brain neuroprotection. Evidence from meta-analyses showed reduced risk of dementia with greater intake of vegetables and fruits, fish, and the Mediterranean diet. The current study raises important questions about the association between low risk dementia and Mediterranean diet.Objective: The objective was to evaluate the association between levels of adherence to the Mediterranean diet and dementia and cognitive status in subjects 50 years of age and older.Method: The Mediterranean Diet Adherence Screener (MEDAS), the modified 30-item 'Diagnostic and Statistical Manual of Mental Disorders Third Edition (DSM-III) risk of dementia, and the Standard Mini-Mental Status Examination (SMMSE) cognitive status scores were used to assess the levels of adherence to the Mediterranean diet'.Results: A total of 150 subjects were enrolled in the study. Forty-one (27.3%) had 'suspected or confirmed dementia, while 48 individuals (32%) were categorized as having moderate to severe cognitive decline. Subjects who reported moderate to high adherence to the Mediterranean diet (55, 36.7%) had significantly lower dementia scores (7.0 3.8 versus 17.6 5.1) and higher cognitive (25.4 3.8 versus 8.6 7.2) scores compared to those (38, 25.3%) who reported low adherence to the Mediterranean diet.Conclusion: Subjects who were highly or moderately adherent to the Mediterranean diet had significantly lower dementia scores and better cognitive status than those with low adherence.

The flavonoid luteolin reduces mutant huntingtin aggregation and cytotoxicity in huntingtin-mutated neuroblastoma cells.

Background: Huntington's disease is an inherited progressive neurodegenerative disorder caused by an expansion of the polyglutamine tract leading to malformation and aggregation of the mutant huntingtin protein in the cell cytoplasm and nucleus of affected brain regions. The development of neuroprotective agents from plants has received considerable research attention. Objective: Our study aims to investigate the neuroprotective effects of luteolin and the mechanisms that underline its potential mediated protection in the mutant htt neuroblastoma cells. Methods: The mutant htt neuroblastoma cells were transfected with 160Q, and the control wild-type neuroblastoma cells were transfected with 20Q htt for 24 h and later treated with luteolin. Cell viability was determined by MTT and PI staining in both groups, while western blotting was used to evaluate caspase 3 protein expression. Aggregation formation was assessed via immunofluorescence microscopy. Also, western blotting was utilized to measure the protein expression of mutant htt aggregated and soluble protein, Nrf2 and HO-1. The impact of Nrf2 on luteolin-treated neuroblastoma cells was assessed using small interfering RNAs. Results: Our study reports that luteolin can protect cultured cells from mutant huntingtin cytotoxicity, evidenced by increased viability and decreased apoptosis. Also, luteolin reduced the accumulation of soluble and insoluble mutant huntingtin aggregates in mutant htt neuroblastoma cells transfected with 160Q compared to the control wild-type. The mutant htt aggregate reduction mediated by luteolin appeared to be independent of the Nrf2 -HO-1 antioxidant pathway. Conclusion: Luteolin presents a new potential therapeutic and protective agent for the treatment and decreasing the cytotoxicity in neurodegenerative diseases such as Huntington's disease.

Assessment of Knowledge and attitude towards Stroke among the UAE population during the COVID-19 pandemic: A cross-sectional study.

Background: Despite significant advancements in healthcare, the burden of stroke continues to rise in the developed world, especially during the COVID-19 pandemic. Association between COVID-19 infection and stroke is well established. Factors identified for the delay in presentation and management include a lack of awareness regarding stroke. We aimed to assess the general public knowledge and attitudes on stroke and stroke risk factors in the United Arab Emirates during the COVID-19 pandemic. Methods: A cross-sectional study was conducted between September 2021 and January 2022 among adults≥ 18 years old. Participants completed a self-administered questionnaire on sociodemographic characteristics and stroke knowledge and attitudes. Knowledge and attitude scores were calculated based on the number of correct responses. Linear regression analysis was performed to determine the factors related to knowledge and attitude towards stroke. Results: Of the 500 respondents, 69.4% were females, 53.4% were aged between 18 and 25, and nearly half were students (48.4%). The mean knowledge score was 13.66 (range 2-24). Hypertension (69%), smoking (63.2%), stress (56.4%) obesity/overweight (54.4%), and heart disease (53.6%) were identified as risk factors. Overall, the knowledge of signs/symptoms was suboptimal. The mean attitude score was 4.41 (range, 1-6); 70.2% would call an ambulance if someone were having a stroke. A monthly income of 11,000-50,000 AED and being a student were associated with positive knowledge. Being a non-health worker and lacking access to electronic media sources were associated with worse attitudes. Conclusion: Overall, we identified poor knowledge and suboptimal attitudes toward stroke. These findings reflect the need for effective public health approaches to improve stroke awareness, knowledge, and attitudes for effective prevention in the community. Presently, this is of utmost necessity, given the increased occurrence of stroke and its severity among COVID-19 patients.

Factors influencing pharmacists' participation in continuing education activities in the United Arab Emirates: insights and implications from a cross-sectional study.

BACKGROUND: Continuing professional development (CPD) is essential for pharmacists to maintain and enhance their knowledge and skills. The purpose of this research was to collect data about the perception of pharmacists in the United Arab Emirates (UAE) towards CPD and identify factors that motivate or hinder their participation in different types of CPD activities. METHODS: A cross-sectional survey was conducted among 322 pharmacists who completed a self-administered questionnaire that assessed their demographic characteristics, CPD preferences, motivators and obstacles to attending CPD programs, and perceived learning outcomes. RESULTS: Participants' average age was 33 years (mean = 30.6, SD = 5.97), and the range of years, since they graduated from a pharmacy degree program was 18 years (mean = 10.9, SD = 4.8). More than half of the participants were female; 198 (61.5%) and 193 (59.9%) of them were married. The study found that married pharmacists (AOR = 0.5, 95% CI 0.266-0.939, P value = 0.031), older participants (AOR = 0.232, 95% CI 0.266-0.939, P value = 0.04), and those who graduated longer than 16 years ago were less likely to attend live CPD events (AOR = 0.454, 95% CI 0.22-0.924). However, participants who worked up to 15 h had higher odds of attending live CPD events (AOR = 3.511, 95% CI 1.117-11.039, P value: 0.026). In addition, female pharmacists were less likely to participate in computer/internet-based continuing education than male pharmacists (AOR = 0.038, 95% CI 0.293-0.965, P value = 0.038). It also revealed that pharmacists who were not motivated by the topic of the CPD activity had a higher chance of attending computer/internet-based format (AOR = 2.289, 95% CI 1.198-4.371, P value = 0.012). In contrast, those who did not report the long distance to the CPD site as a hindrance had a lower likelihood of attending online internet-based CPD (AOR = 0.548, 95% CI 0.319-0.941, P value = 0.029). CONCLUSIONS: This study is the first to explore pharmacists' predictors of attending different CPD activities. These predictors are gender, age, marital status, experience since graduation, working hours, family barriers, work responsibilities, interest in the presentation topic, and the long travel distance to the site. These findings suggest that pharmacists have unique challenges and motivations regarding continuing education and that tailored approaches may be necessary to encourage participation.

A cross-sectional survey on the experience of people with allergic rhinitis amidst COVID-19 pandemic: The impact of the facemask: A pilot study

Background: Since outbreak of COVID-19 pandemic, almost whole world asked to wear the facemask especially in the public areas as a precaution to avoid the transmission of the disease, and curbs the pandemic. Looking from another perspective, we need to consider the effect of the facemask in reducing allergic rhinitis symptoms. Objective: The current study objective was to assess the impact of facemasks on the symptoms of allergic rhinitis in subjects who were obligatory using facemask due to the COVID-19 pandemic. Methods: The current study was ethically approved self-administered validated survey (Cronbach Alfa 0.81) comprised of 28-items to assess the impact of wearing the facemask, and whether there was an improvement in symptoms of allergic rhinitis. The outcome measure was the responses to the four domains (knowledge, attitude, symptoms, and help/advice) measured on Likert scale to assess the responses of subjects with allergic rhinitis during the COVID -19 pandemic. Results: 82 respondents (mean age was 22.59 ±2.77 years) have completed the survey, of which 73 females (89%) and (52/82, 63.4%) university students. 29 (35.4%), stated that the fabric facemask is useful in reduction of symptoms. 44 (53.7%) believe that the surgical mask N95 is very beneficial in the reduction of symptoms. There was a significant difference in knowledge levels for both eye and nasal symptoms’ reduction responses (P <0.001). Tukey’s HSD (honestly significant difference) used to determine the specifics of the variances (differences in multiple means) in symptom reduction. For eye symptoms, the analysis revealed that respondents who reported that they had reduced symptoms had higher knowledge scores (6.74±2.7) than those who reported no reduction in allergic symptoms (mean ±SD: 4.96±3.2). The lowest score was associated with respondents that were uncertain regarding their symptom alleviation (mean ±SD: 4.53±3.1). (3.94±2.5). (AU)

Exploring the pharmacy students' perspectives on off-campus online learning experiences amid COVID-19 crises: A cross-sectional survey.

Background: The pandemic of COVID-19 has placed many challenges for pharmacy students' learning experiences via the online e- system. There is paucity of studies that addresses this in colleges of pharmacies in United Arab Emirates (UAE). Objective: We have explored the preparedness, attitudes, experiences, and barriers/facilitators, and delineated factors that may affect the pharmacy students' e-learning process amid the COVID-19 crises. Methods: The current study was cross-sectional, and survey-based (anonymously self-administered) that utilized theoretical domains framework. The survey (multiple statements) was comprised of four domains (based on theoretical domain framework) that has elaborated on the preparedness, attitudes, experiences and barriers for the pharmacy students' e-learning (all years and interns). The validated (Cronbach Alfa 0.821) and piloted survey posted to the Google form and a link distributed to the pharmacy students. The survey was comprised of four domains (34 statements), distributed as five in preparedness, eleven in attitude, eleven in the experiences, and seven in the barriers/facilitators (theoretical domains framework). Outcome measure: The primary outcome was the total sum of scores of individual statements and each individual four domain of the questionnaire (preparedness, attitude, experiences, and barriers/facilitators). Results: Two hundred thirty respondents participated in the survey (230/400, response rate 57.5%), of which 193 were females (83.9%) versus 37 males (16.1%). The mean age (years) was 19.9 ± 1.9 (males 19.8 ± 1.6 and females 20.0 ± 1.9). The mean total score for preparedness Q1 to Q5 (domain maximum score 25); and for the attitude Q6 to Q16 (domain maximum score of 60) were 14.9 ± 3.8 (95% CI 14.4 - 15.4; P < 0.05), 29.5 ± 7.4 (95% CI 28.6 - 30.5; P < 0.05) respectively. While for the experiences Q17 to Q27 (domain maximum score 55); and for the barriers/facilitators Q28 to Q34 (domain maximum score 30) 40.1 ± 8.0 (95% CI 39.1 - 41.1; P < 0.0001), and 20.9 ± 4.9 (95% CI 20.3-21.5;P < 0.05) respectively. Conclusion: Our pharmacy students support the use of e-learning in pharmacy education, and seems prepared for the future technology moves in education. The colleges of pharmacies need to conduct further research on versatile innovative models such as virtual learning/artificial intelligence that fits with their students' perspectives.

Protocol for systematic review and meta-analysis on randomized clinical trials for direct oral anticoagulant in subjects with acute coronary syndrome

Background: Recently, direct oral anticoagulant (DOAC) has been projected for secondary prevention of recurrent ischemic events post-acute coronary syndrome (ACS). The addition of a DOAC to the antiplatelet regimen of subjects with the ACS is clinically practiced in candidates where compelling anticoagulation is indicated by high thromboembolic risk. The current evidence provides approved compelling indication for the DOAC, particularly for rivaroxaban which bears the strongest existing evidence. Objective: We intend to assess the role of DOAC in addition to single or dual antiplatelet therapy in subjects with ACS. We will compare the clinical characteristics and explore the efficacy and safety of the DOAC class members (apixaban, betrixaban, dabigatran, edoxaban and rivaroxaban) in terms of reduction in ischemic events in subjects with ACS (ST-segment elevation myocardial infarction [STEMI] or non–ST-segment elevation [NSTEMI]) or subjects who underwent percutaneous coronary intervention (PCI) and or ACS and coexisting atrial fibrillation (AF). Methods: Relevant data will be searched on known data-bases such as Embase, Google Scholar, the Cochrane Central, and PubMed. The trials included will be randomized controlled trials from 2009 to 2022. Subjects will be receiving DOAC for ACS were evaluated for inclusion. The extraction, synthesis, quality, and validity of data will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The risk of bias tool, version 2.0 (Cochrane) will be used for risk of bias assessment. Data will be pooled using random-effects models. The primary outcome measure will be efficacy end point (composite of cardiovascular death, myocardial infarction, and stroke), while the safety outcome will be minor/major bleeding. (AU)

Mini review: The clinical avenues of combined hydralazine-nitrate in subjects with heart failure with reduced ejection fraction

Background: Combined hydralazine-nitrate has an avenue in the management of subjects with heart failure with reduced ejection fraction. Exploring the pharmacotherapy in this context will facilitate the clinical utility of the combined therapy. Objective: The main objective of this mini-review was to evaluate the role of combined hydralazine-nitrate in subjects with heart failure with reduced ejection fraction. Methods: We conducted a literature search on Google scholar, MEDLINE, and PubMed to identify the randomized clinical trials on combined hydralazine-nitrate, in subjects with heart failure with reduced ejection fraction. 2760 articles were returned initially out of which 10 trials were conforming to the inclusion criteria. However, three trails were the focus for the current mini-review. Key findings: The current mini-review lends support to the use of combined hydralazine-nitrate in subjects with heart failure with reduced ejection fraction (HFrEF). The combination may offer subjects who have remained symptomatic with HFrEF despite optimum dosing of standard therapy. Black subjects with HFrEF have proved to benefit from combined hydralazine-nitrate. The combination (e.g. small dose of hydralazine 12.5-25 mg twice a day and isosorbide mononitrate 10 mg twice a day) may provide alternative clinical utility in subjects with contraindications (renal artery stenosis, creatinine clearance less than 30 mL/minute, sustained hyperkalemia) to the use of ACEinh, ARBs, and/or ARNI. Subjects with HFrEF on combined hydralazine-nitrate should be assessed and monitored for systolic BP (keep >120 mmHg) and subjects with chronic kidney disease (keep eGFR > 30 mL/min/1.73 m2). Hydralazine-nitrate was inferior to ACEinh (higher all-cause mortality and cardiovascular mortality. Conclusion: The current mini- review provides the key points to support the use of hydralazine-nitrate in subjects with heart failure with reduced ejection fraction. (AU)

The usage pattern of patients' drug information leaflet for oral non-prescription drugs among university students in the United Arab Emirates: cross-sectional study.

Background: Very few extensive studies have measured the prevalence and usage pattern of drug information leaflet (DIL) for oral non-prescription drugs (ONPDs) or identified the associated risk factors for not reading DIL among university students in the UAE. Objective: The current study aimed to estimate the prevalence of the usage pattern of DIL for ONPDs, and delineate the associated risk factors for not reading the DIL among university students. Methods: A cross-sectional survey-based multistage sampling technique conducted among 2875 students at three major universities in UAE. The self-administered validated questionnaire was constructed and developed based on Andersen's behavioral model. Binomial logistic regression performed to ascertain the effects of 25 potential predictors on the likelihood that participants not reading (discarded) the DIL after reading them. The primary outcome measure was reading (discarding without reading) the DIL, and the associated behaviours. Results: 2875 university students were eligible to participate in the study, but only 2519 students agreed to participate, indicating an 88% of intent participation. However, only 2,355 (81.9%) students completed the questionnaire. 1348 respondents reported using NPD (response rate 46.9%) during the past three months before conducting the study, which comprised the sample analysis (1307 were excluded). More than three-quarters of them read the DIL (always or often) at the first use (1049 of 1348, 77.8%). Approximately a quarter of those who read the DIL reported that they discarded them after reading (24.1%). The survey has identified four risk factors for not reading the DIL: those who get the drug information from physicians or pharmacists had lower odds of discarding the DIL (odds ration [OR] = 0.491, 95% confidence interval [CI]: 0.273-0.884, p value< 0.05). Medical students had lower odds of discarding the DIL (OR = 0.598, 95% CI: 0.412-0.868, p value< 0.05). Those participants who believe that NPDs are as effective as prescription drugs had lower odds of discarding the DIL (OR = 0.342, 95% CI: 0.123-0.948, p value< 0.05). Participants who use more than one NPD to treat a single symptom a day have higher odds of discarding the DIL (OR = 1.625, 95% CI: 1.122 -2.355, p value< 0.05). Conclusion: The prevalence of drug usage pattern in this population was 57.5% as 1348 subjects reported using NPD during the past 90 days before conducting the study. We have identified four risk factors for not reading the DIL, those who get the drug information from physicians or pharmacists, medical students, those respondents who believe that NPDs were as effective as prescription drugs, and respondents self-treating a single symptom with more than one NPD. It was evident from the findings that usage pattern of NPD for DIL varied among the students, with no specific pattern dominating.

The Usage Pattern of Patients’ Drug Information Leaflet for Oral Non-Prescription Drugs Among University Students in the United Arab Emirates: Cross-Sectional Study

Background: Very few extensive studies have measured the prevalence and usage pattern of drug information leaflet (DIL) for oral non-prescription drugs (ONPDs) or identified the associated risk factors for not reading DIL among university students in the UAE. Objective: The current study aimed to estimate the prevalence of the usage pattern of DIL for ONPDs, and delineate the associated risk factors for not reading the DIL among university students. Methods: A cross-sectional survey-based multistage sampling technique conducted among 2875 students at three major universities in UAE. The self-administered validated questionnaire was constructed and developed based on Andersen’s behavioral model. Binomial logistic regression performed to ascertain the effects of 25 potential predictors on the likelihood that participants not reading (discarded) the DIL after reading them. The primary outcome measure was reading (discarding without reading) the DIL, and the associated behaviours. (AU)

Randomized Clinical Trials on the Efficacy and Safety of Tocilizumab in Subjects with Rheumatoid Arthritis: A Systematic Review.

BACKGROUND: The current therapy of Rheumatoid Arthritis (RA) is confronted with many challenges such as inadequate response, infection, and treatment failure. AIM AND OBJECTIVE: The main objective was to assess the efficacy and safety of tocilizumab (TCZ) in subjects with RA using the available evidence from published randomized controlled trials. METHODS: The current systematic review was performed on nine randomized controlled trials from 2002 to 2016 for TCZ in subjects with rheumatoid arthritis. The primary outcomes were the clinical improvement in American College Rheumatology 20% (ACR20) or Disease Activity Score remission (DAS28), in addition to other outcomes such as ACR50 and ACR70 in the intention-to-treat population. RESULTS: We have conducted a systematic review on nine randomized controlled trials, with 4129 [100%] enrolled, of which 3248 [78.7%] were on the intention-to-treat. 2147 (66.1%) were treated with TCZ and 1101 (33.9%) have had received placebo or methotrexate or other conventional Disease- Modifying Anti-rheumatic Drugs (cDMARD) or biologic Disease-Modifying Anti-rheumatic Drugs (bDMARDs). In subjects taking TCZ with or without concomitant methotrexate, compared to placebo, subjects treated with TCZ 4 or 8 mg/kg were substantially and statistically significantly more likely than placebo or methotrexate to achieve the ACR20 and/or DAS28. There were no statistically significant differences in serious adverse events such as serious infection; however, subjects on TCZ were more likely to have increased lipid profiles. CONCLUSION: TCZ mono-therapy or in combination with methotrexate is valuable in diminishing rheumatoid arthritis disease activity and improving disability. Treatment with TCZ was associated with a significant surge in cholesterol levels but no serious adverse effects. Randomized clinical trials with safety as the primary outcome are warranted to report these safety issues.

A Systematic Review of Randomized Clinical Trials on the Efficacy and Safety of Pitavastatin.

BACKGROUND: A subpopulation of statin users such as subjects with chronic kidney disease (CKD), Human Immune virus (HIV), acute coronary syndrome (ACS), revascularization, metabolic syndrome, and/or diabetes may particularly benefit from pitavastatin pharmacotherapy. AIM: The current systematic review aimed systematically to evaluate the effect of pitavastatin on primary cardiac events in subjects receiving pitavastatin in comparison to the other four statin members. METHODS: We conducted a systematic review on phases III and IV of randomized controlled trials (RCT-s, 11 trials) for subjects with primary cardiac events who received pitavastatin. Subjects diagnosed with any type of dyslipidemia (population 4804) and received pitavastatin (interventions) versus comparator (comparison) with the primary efficacy endpoint of minimization of LDL-C and non- HDL-C, had an increase in HDL-C and/or reduction in major adverse cardiac events (MACE, cardiovascular death, myocardial infarction (fatal/nonfatal), and stroke (fatal/nonfatal) and/or their composite (outcomes). The secondary safety endpoint was the development of any adverse effects. RESULTS: In the included trials (11), participants (4804) were randomized for pitavastatin or its comparators such as atorvastatin, pravastatin, rosuvastatin, simvastatin and followed up for 12 to 52 weeks. In terms of the primary outcome (reduction in LDL-C), pitavastatin 4 mg was superior to pravastatin 40 mg in three trials, while the 2 mg pitavastatin was comparable to atorvastatin 10 mg in four trials and simvastatin 20 and 40 mg in two 2 trials. However, rosuvastatin 2.5 mg was superior to pitavastatin 2 mg in two trials. Pitavastatin increased HDL-C and reduced non-HDL-C in eleven trials. Regarding the safety profile, pitavastatin has proved to be tolerated and safe. CONCLUSION: The FDA-approved indications for pitavastatin included primary dyslipidemia and mixed dyslipidemia as a supplementary therapy to dietary changes to lower total cholesterol, LDL-C, apolipoprotein B (Apo B), triglycerides (TG), and enhance HDL-C. Pitavastatin might be suitable for subjects with diabetes, ACS (reduced revascularization), metabolic syndrome, CKD, HIV, and subjects with low levels of HDL-C. We highly recommend rational individualization for the selection of statin.

Motivators, Barriers, and Acceptance of COVID-19 Vaccination among Residents of Western Saudi Arabia.

BACKGROUND: There are limited studies that have assessed COVID-19 vaccine acceptance and side effects, both globally and in the western region of Saudi Arabia (SA). OBJECTIVE: This study assessed the acceptance of vaccination against COVID-19, determined motivators and barriers for taking these vaccines, and assessed vaccine side effects in the western region of SA. STUDY DESIGN: The study was an online cross-sectional study conducted among the people who lived in the western region of SA during the period from December 2021 to March 2022. Participation was voluntary for participants who were above 18 and lived in the Western region of SA. Children and those living in other countries were excluded from the study. METHODS: The study tool was a self-administered questionnaire which assessed COVID-19 vaccine acceptance, determined motivators and barriers for taking the vaccines, and assessed their side effects among 1136 participants in the western region of SA. Data gathered were analyzed by the SSPS version 22 software. RESULT: A total of 1136 individuals, aged 18 years and above, participated in the study, with 50.7% (n = 567) being males. Most of the participants were from Taif city (68.4%; n = 777), and 57.6% (n = 654) were unmarried. Pfizer was the most frequently administered vaccine (72.8%; n = 823). Most participants explained that their vaccine administration protected themselves and their families (70.5%; n = 835). The acceptance showed that 55% (n = 626) of the participants had either very high or high confidence in the efficacy of the COVID-19 vaccines, while 14.7% (n = 167) of them had low/very low confidence in its efficacy. The side effects showed that 80.8% (n = 918) of the participants showed that they did not have any difficulties attributed to COVID-19 vaccine administration. Positive attitudes and practices were apparent, and most of the participants (78.3%; n = 889) tended to be actors in the fight against COVID-19. CONCLUSIONS: The current study showed a high level of acceptance of COVID-19 vaccination among people living in the western region of SA. Health education and communication from authoritative sources will be important to alleviate public concerns about COVID-19 vaccine safety.

Double blind randomized controlled trial for subjects undergoing surgery receiving surgical antimicrobial prophylaxis at tertiary hospital: the clinical pharmacist’s interventions

Background: A surgical site infection (SSI) has significant clinical, humanistic and economic consequences. Surgical antimicrobials prophylaxis (SAP) is a reliable standard to prevent SSIs. Objective: The objective was to test that the clinical pharmacist’s interventions may facilitate the implementation of SAP protocol and subsequent reduction of SSIs. Methods: This was double blinded randomized controlled interventional hospital-based-study at Khartoum State-Sudan. A total of 226 subjects underwent general surgeries at four surgical units. Subjects were randomized to interventions and controls in a (1:1) ratio where patient, assessors and physician were blinded. The surgical team has received structured educational and behavioral SAP protocol mini courses by way of directed lecturers, workshops, seminars and awareness campaigns delivered by the clinical pharmacist. The clinical pharmacist provided SAP protocol to the interventions group. The outcome measure was the primary reduction in SSIs. Results: There were (51.8%, 117/226) females, (61/113 interventions versus 56/113 controls), and (48.2%, 109/226) males (52 interventions and 57 controls). The overall rate of SSIs was assessed during 14 days post-operatively and was documented in (35.4%, 80/226). The difference in adherence to locally developed SAP protocol regarding the recommended antimicrobial was significant (P <0.001) between the interventions group (78, 69%) and the controls group (59, 52.2%). The clinical pharmacist’s implementation of the SAP protocol revealed significant differences in SSIs with reduction in SSIs from 42.5% to 25.7% versus the controls group from 57.5% to 44.2% respectively, P = 0.001 between the interventions group and the controls group respectively. Conclusion: The clinical pharmacist’s interventions were very effective in sustainable adherence to SAP protocol and subsequent reduction in SSIs within the interventions group. (AU)

A pseudo-customer cross-sectional study to evaluate the community pharmacist’s management of migraine in pregnant women

Background: To the best of our knowledge few published studies have been conducted to evaluate customer’s care services in community pharmacies in the United Arab Emirates (UAE) using the pseudo-customer model. This further indicates that there is a paucity of information available about the current care services provided by the community pharmacists particularly for pregnant women with migraine. Objective: The main objective was to evaluate, the effectiveness of the pseudo-customer method on the care services (counseling, advice, and management) provided by the community pharmacists for migraine during pregnancy. Methods: This was a cross-sectional study conducted in community pharmacies with a cluster sampling of pharmacists. A sample of 200 community pharmacists was recruited from three emirates in the United Arab Emirates. Pregnant woman-related migraine management was assessed using the pseudo-customer model. The used script is not of a real patient but a fake/scripted used to describe the study. Results: No association was found between the gender and nationality of community pharmacists and the ability to be proactive (P =0.5, 0.568) and between the utilization of source of information and gender (P =0.31). The ability to prescribe by community pharmacists without probing or only after a probe was independent of job title (P =0.310); gender (P =0.44) and nationality (P =0.128). The community pharmacists who have offered written information have had significantly higher odds to dispense medication compared to those who have not (OR =45.547, 95% CI: 2.653 - 782.088, P =0.008). Furthermore, the pharmacists who have been reported to ask for precipitating factors of migraine had significantly higher odds to dispense medication compared to those who have not (OR =11.955, 95% CI: 1.083-131.948, P =0.043). The main outcome was the responses of the community pharmacists to the pseudocustomer visit (pregnant woman with migraine). (AU)

Parents' Perception, Acceptance, and Hesitancy to Vaccinate Their Children against COVID-19: Results from a National Study in the UAE.

Introduction: COVID-19 is considered the greatest health disaster affecting humans during the 21st century, which urged the need to develop an effective vaccine to acquire enough immunity against the virus. The main challenge faced during the development of such vaccines was the insufficiency of time, which raised the question about the vaccine safety and efficacy, especially among children. Parents' and caregivers' thoughts and acceptance of administering the vaccine to their children are still debatable topics and are yet to be explored in the UAE. Aims: The study aims to exploit parent acceptance, perception, and hesitancy toward the COVID-19 vaccine administration for their children and the link with their choice of distance learning instead of face-to-face education in the UAE. Methodology: This study utilized a cross-sectional descriptive design. A sample of 1049 parents across all emirates were conveniently approached and surveyed using Google forms from June to September 2021. The participants responded to a semi-structured questionnaire pertaining to socio-demographic, educational, and other questions related to COVID-19 and its link with their beliefs in whether the vaccination of their children will help with resuming face-to-face learning. Results: Approximately 74% of the parents confirmed that their children who are 16 years old and above have received the vaccine, and 71% were willing to give the vaccine to their children aged above 5 years. Parents with children receiving online education and those with children where the online modality of learning negatively affected their academic achievement are more prone to administer the COVID-19 vaccine to their children above five years old. The results show a significant association between vaccination of children and the parental desire for resuming physical attendance in schools (p value < 0.001). Multivariate analysis showed that the highest acceptance rate was from parents with children of low academic achievement due to online learning modality during the pandemic. Conclusion: In the UAE, parents of young children have shown a positive attitude towards COVID-19 vaccination in belief that vaccines will reduce the risk of infection and assist in resuming normal lifestyles, such as going back physically to schools. The results reflect the public awareness and the hypervigilance regarding the COVID-19 pandemic in the UAE.

Scoping Review of Six Retrospective Studies: Risk Factors Associated With the Case Fatality Rate of People Infected With Coronavirus (COVID-19).

Background: It would be rational to describe the pattern of the clinical characteristics of the survivors and the nonsurvivors during the critical intensive-infection era of coronavirus disease 2019 (COVID-19). The explicit objective of the current scoping review was to delineate the predictive risk factors associated with case fatality rate (CFR). Methods: Six retrospective studies of subjects infected with COVID-19 published between December 1, 2020, and March 30, 2020, describing nonsurvivors in Wuhan/Hubei, China, were identified. Results: There were 1769 subjects with a mean age of 52 years, and 65.9% were male. The highest comorbidity reported was cardiovascular diseases at 22.2% (393/1769). The overall number of cases admitted to the intensive care unit was 228 (12.9%). The reported overall CFR was 7.7% (136/1769), with the highest at 28.2% (54/191), and the lowest at 1.4% (15/1099). The mean duration of onset until death for nonsurvivors was 15.3 days. Conclusion: We have found that older age, male gender, the longer duration from onset till death (days), development of acute respiratory distress syndrome/shock, preexisting diabetes, and preexisting cardiovascular diseases were the major risk factors associated with high CFR.

Mini-Review on the Efficacy and Safety of Pitavastatin: "The Novel Seventh Statin Gaining Momentum".

Background: Recently, a plethora of events have affected the statin arena such as muscle-induced myalgia, myopathy, myositis, rare rhabdomyolysis, and new-onset diabetes. The latest statin pitavastatin has emerged with descent stamina (optimum efficacy and improved safety). Objective: The objective of the current review is to explore the pros and cons of pitavastatin as a novel second-generation statin in terms of efficacy and safety that delineate its clinical utility. Methods: The review was conducted via EBSCO hosted Medline search (AL Ain University, UAE subscription) for relevant English written literature articles containing "pitavastatin" as the primary search term "pitavastatin and safety;" "pitavastatin and efficacy" and "pitavastatin and safety and randomized clinical trials;" and "pitavastatin and efficacy and randomized clinical trials." Results: The number of articles containing the word "pitavastatin" as the primary search term used was (n = 901). The next retrieves MeSH term was "pitavastatin and safety" (n = 99) and then "pitavastatin and efficacy" (n = 132). Furthermore, narrowing down the search by adding study design terms revealed: "pitavastatin and safety and randomized clinical trials," (n = 10) and "pitavastatin and efficacy and randomized clinical trials" (n = 13). Combining the two main searches (safety and efficacy) has yielded 23 items, of which 15 articles were satisfying the current mini-review criteria. The prominent efficacy of pitavastatin was depicted by the increase in high-dense lipoprotein cholesterol and a decrease in low-dense lipoprotein cholesterol as illustrated by the clinical trials in the results and discussions section. The safety was enlightened with a very low propensity to cause new-onset diabetes and a low tendency for statin-induced muscular adverse events. Conclusion: Pitavastatin might be suitable for patients with the acute coronary syndrome (ACS), metabolic syndrome, and patients with diabetes. We highly recommend rational individualization for the selection of statin, especially in patients with diabetes and/or with ACS.

Protocol for systematic review and meta-analysis of randomized controlled trials, cost-benefit analysis and interrupted timeseries interventions on pharmacist’s prescribing

Background: Shortening the process of prescribing via permitting the pharmacist to select the most appropriate pharmaceuticals for each particular patient may provide great opportunities for pharmacists to develop suitable pharmaceutical care plan, monitor and follow up prescribed medications, communicate and consult physicians for more confirmations. Objective: The objective of the current protocol for the systematic review and meta-analysis of pharmacists prescribing interventions was to explore, investigate the evidence, assess and compare PICO in patients with medical conditions (population), receiving pharmacist’s prescribing care services (interventions) versus non-pharmacist’s prescribing (comparators), and identify how it will impact the clinical, humanistic, and economic patient’s outcomes (outcomes). Methods: The necessary elements of PRISMA will be strictly followed to report the systematic review. The meta-analysis will be reported in line with the Cochrane guidelines for synthesis of trials and all forms will be based on quality measures as per the validated Cochrane templates. We will present the results of the systematic review and the meta-analysis based on PICO comparison between the included trials. Results: We have identified four models of pharmacist prescribing interventions (independent, dependent [collaborative], supplementary, and emergency prescribing). The results will contain a systematic critical evaluation of the included trials in terms of the sample number of the population (characteristics), the type of interventions and the comparators, and the main outcome measures. Conclusion: This protocol will report the evidence and explore the magnitude of impact of pharmacist prescribing interventions, on clinical, humanistic, and economic outcomes. (AU)