The Impact of Cancer Relapse and Poor Patient Outcomes on Health Care Providers Practicing in the Oncology Field.

INTRODUCTION: Devastating cancer-related events are not uncommon, and these events have weakened communication performance and induced stress among health care providers (HCPs), particularly physicians. This study aimed to investigate the perspective of HCPs emotionally affected by poor clinical outcomes due to the failure of cancer therapy. METHODS: A cross-sectional, online survey was conducted over 3 months among HCPs practicing in the field of oncology in Saudi Arabia, comprising physicians, pharmacists, and nurses. Data were analyzed using Statistical Package for Social Sciences version 26.0. A P-value <.05 was considered statistically significant. RESULTS: This study demonstrated a positive correlation between HCPs' length of experience and emotional impact of treatment failure, albeit this was not statistically significant (P = .071). Analysis of their perspective toward failure of cancer therapies revealed a significant impact of occupation and sex (P = .014 and P = .047, respectively). Moreover, occupation played a significant role in shaping the viewpoint of HCPs toward the need for conducing further research to test the appropriateness of treatment protocols on local patients (P = .022). Despite the emotional responses of HCPs to suboptimal clinical outcomes, factors such as work burnout, lack of concentration and patience, work or personal problems, and under appreciation were frequently identified as triggers of such outcomes. CONCLUSION: Our results revealed that poor clinical outcomes observed among cancer patients are emotional triggers for HCPs practicing in the oncology field. The emotional response is often perceived negatively, and can potentially lead to a decline in the quality of care provided to these patients.

Role of pharmacist during COVID-19 pandemic: A retrospective study focused on critically ill COVID-19 patients.

BACKGROUND AND AIM: During the Coronavirus 2019 (COVID-19) crisis, there has been a huge demand for medications and unprecedented utilization of intensive care unit (ICU) services that subsequently and profoundly impacted the quality of medical care provided to COVID-19 patients. This study aimed to shed light on the role of pharmacists on the health care provided to critically ill COVID-19 patients. METHODS: A retrospective study, was conducted in Diriyah hospital in Riyadh, Saudi Arabia on all COVID-19 patients admitted to the ICU between June 27th and August 15th, 2020 until patients were transferred to the medical ward, discharged, or deceased. All medication related interventions performed by pharmacists have been documented electronically, collected and subsequently categorized and analyzed. RESULTS: The mean age of patients was 58.8 years (±12.98 SD), with age of >64 years in approximately 37%. Four hundred and seventy interventions (470) were made by pharmacists of which 32%, 11.7%, 4%, 2.6%, 2.1% were due to error in dosing regimens, drug duplication, missing drug information, drugs requiring prior authorization, and missing critical information, respectively; while 40.6% were due to medication shortage of which 40.3% were substituted with alternative medications. Based on the analysis of drugs involved in interventions, medication groups that were mainly associated with interventions included antibiotics (16.8%), electrolytes/minerals (11.7%) and vitamins (9.4%). CONCLUSION: During health crises such as COVID-19 pandemic, the role of pharmacists in the ICU services becomes extremely crucial for providing better patients' outcomes. Further studies should be conducted to follow up these findings in the context of COVID-19 pandemic.

Prevalence and severity of dyspepsia in Saudi Arabia: A survey-based study.

BACKGROUND AND AIM: Dyspepsia is one of the gastrointestinal diseases that is very common worldwide. Despite its prevalence globally, which ranges between 1.8% and 57%, no study has assessed the prevalence in Saudi Arabia. This study was aimed to investigate the prevalence and severity of dyspepsia in the general population of Saudi Arabia. METHODS: A modified Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) was utilized to conduct our study. The questionnaire score ranges between 0 and 32, where zero indicated no dyspepsia, a score of 1-8 indicated mild dyspepsia, a score of 9-15 indicated moderate dyspepsia and a score of higher than 15 represented severe dyspepsia. Socio-demographic data of the participants including age, gender, marital status, BMI, job description, insurance, and education level were collected. Using Statistical Package for Social Sciences version 21.0 (SPSS), a univariate analysis was performed to assess the association of participants characteristics with the prevalence of dyspepsia, whereas logistic regression analysis was used to correlate their characteristics with the severity of dyspepsia. RESULTS: During a period of one month, March 1st to 31st 2019, a total of 778 participants have completed the survey. Most of them were females accounting for 68% of the population, married (63.9%), middle aged (range 34-51 years old) and literate with high school education (72.3%). Ninety two percent (92%) of the study population were found to experience dyspepsia. However, there is no significant association between socio-demographic characteristics and dyspepsia or its severity as well. CONCLUSION: The prevalence of dyspepsia in Saudi Arabia is the highest in the gulf region which would potentially lead to more GI complications, and associate to poor health and economic outcomes. Education programs are essential to raise the people awareness of dyspepsia and the appropriate ways to prevent it.

Genotoxic impact of long-term cigarette and waterpipe smoking on DNA damage and oxidative stress in healthy subjects.

Although a plethora of studies have examined tobacco smoke-cancer disease association, the involvement of cellular genetic toxicity remains unclear. Therefore, the present study provides molecular evidence for a pathway involved in the DNA damage induced by long-term cigarette and waterpipe smoke in human subjects. The study population consisted of 45 subjects who were divided into three groups; healthy nonsmokers group, cigarette smokers group, and waterpipe smokers group. A questionnaire and consent form was distributed and signed by all participants. Total RNA was extracted from the blood using PAXgene Blood RNA Kit and mRNA expression levels of target genes were quantified by RT-PCR. Our results showed that 80% of the participants smoke 20-39 cigarettes/day, whereas 12% smoke more than 40 cigarettes/day. With regard to waterpipe smoke, the majority (46%) smoke more than 5 times/week. Both cigarette and waterpipe smokers showed increased the plasma levels 8-hydroxy-2'-deoxyguanosine (8-OHdG), of DNA damage marker. In addition, the mRNA expression levels of DNA repair genes (OGG1 and XRCC1) were significantly inhibited in both cigarette and waterpipe smokers groups by 30% and 60%, respectively. This was associated with a marked decrease (50%) in the expression of detoxifying genes (NQO1 and GSTA1) with an increase in CYP1A1 mRNA expression, a cancer-activating gene. Both cigarette and waterpipe smokers increased in the plasma concentrations of several toxic heavy metals such as Cd (130%), Pb (47%), and Ni (30%). In conclusion: the present findings clearly explore the genotoxic effect of cigarette and waterpipe smoking on human DNA.

Attitudes of pharmacy students towards scientific research and academic career in Saudi Arabia.

BACKGROUND: Academic research is an essential part of undergraduate and post graduate education to become qualified health care professionals. The objective of this study was to evaluate the attitudes of pharmacy students towards scientific research and/or academic careers in Saudi Arabia. METHODS: A cross-sectional survey based study was conducted among pharmacy students at King Saud University. A self-administered questionnaire was implemented over a period of 3 months (January to March 2018). RESULTS: A total of 223 students returned the survey. More than one third students (66.3%) agreed that participation in research increased their interest in pursuing a career in research/academic pharmacy. Most students (75.3%) were interested in participating research during the course of study and 73.6% believed that research training should be a compulsory part of teaching curriculum. In addition, more than half of students (54.5%) were interested in higher studies such as PhD after graduation. Most of students (70.3%) ranked lifestyle (73.6%) and earning potential (70.3%) as an important factor for them when choosing a specialty. CONCLUSIONS: Pharmacy students had positive attitudes towards research activities and they desired to be involved more in research publications. However, addressing the barriers and improving student participation will increase their interest in academic research.

Attitude and knowledge of Saudi community pharmacists towards use of proton pump inhibitors.

INTRODUCTION: Proton pump inhibitors (PPIs) effectively suppress acid secretion and play an important role in peptic ulcer disease and gastroesophageal reflux disease. There is a real concern about the overutilization of PPIs, which will lead to significant high cost and undesirable outcomes. Despite that most of PPIs are classified as prescribed medications, yet most of their users take them without prescription in Saudi Arabia. Therefore, it was important to understand community pharmacists practice in dealing with PPIs and to evaluate their despising pattern of these medications. METHOD: A cross-sectional survey-based study that was carried out between September and December 2017. The survey intended to evaluate the knowledge and attitude of CPs towards use of proton pump inhibitors and was built as an online survey. RESULTS: The results of this study showed that almost all CPs prescribe anti-ulcer drugs for their patients. Most of the participants (68.4%) have prescribed PPI for acute gastritis (68.4%), prophylaxis for stress ulcers (17.7%) and stress ulcer (11.1%). 54.9 percent of the participants recommend using acid suppression drugs for 1 to 2 weeks when they prescribe them to their patients. Thirty-two percent of the respondents had reported adverse events with PPIs. The study showed a significant association between length of work experience in community pharmacy and reporting adverse events. CONCLUSION: Community pharmacists in Saudi Arabia usually recommend and prescribe PPIs to their patients. Most of them have some knowledge on PPIs indications and side effects. Managing OTC PPI use in the community pharmacy setting is necessary to promote both patient and medication safety.

Evaluating the preceptor-preceptee relationship among Pharm D students at the King Saud University School of Pharmacy.

OBJECTIVE: To evaluate preceptee satisfaction concerning preceptorship and the preceptor-preceptee relationship among pharmacy students. METHODS: A cross-sectional study was conducted from May 2017 to August 2017 on senior Pharm D students at King Saud University (KSU) College of Pharmacy. A survey instrument was used to get feedback from students regarding their clinical rotations and internships and to evaluate their satisfaction toward preceptorship to meet the goals of the curriculum. Data were entered into SPSS, version 24. RESULTS: Of the 52 students surveyed, 36 (69.2%) were female. More than half of respondents were somewhat satisfied with their preceptors and 11.5% were satisfied. Additionally, only 17% of students rated their preceptors as having excellent clinical teaching skills; about 19% of students rated them as "needs improvement." About 40% of students rated their preceptors as very good, concerned, competent, and safe in their care for persons living with serious co-morbidities and diseases. About half of students (48.1%) rated their non-faculty KSU preceptors' teaching behavior as not satisfactory compared with only four respondents with respect to KSU faculty preceptors' teaching behavior. CONCLUSION: Pharm D students were somewhat satisfied with their preceptors' teaching behaviors in communication skills, practice, and teaching skills as well as feedback and evaluation to students. To enhance the quality of experiential education, preceptors should be trained to develop programs that direct and energize advancement.

Development of cardiac hypertrophy by sunitinib in vivo and in vitro rat cardiomyocytes is influenced by the aryl hydrocarbon receptor signaling pathway.

Sunitinib (SUN) is a new tyrosine kinase inhibitor that possesses both anti-angiogenic and anti-tumor activities. Although SUN has improved survival rate in cancer patients, cardiotoxicity has been reported as a significant side effect. Several studies suggested a role for the aryl hydrocarbon receptor (AhR) and its regulated genes such as cytochrome P4501A1 (CYP1A1) in the pathogenesis of heart failure and cardiac hypertrophy. To test the hypothesis that SUN induces cardiac hypertrophy through the modulation of AhR, Wistar albino rats were treated for 15 and 30 days with increasing doses of SUN (25, 50, and 100 mg/kg), whereas at the in vitro level, rat cardiomyocyte H9c2 cells were incubated with SUN (1, 2.5, and 5 µM). Thereafter, cardiac hypertrophy parameters were determined at the biochemical, histopathology, and gene expression levels. SUN treatment causes increase in cardiac enzymes, changes in histopathology, and induction in several hypertrophic markers. This was associated with proportional increase in the CYP1A1 gene in a concentration- and time-dependent manner. The direct involvement of AhR in the SUN-induced cardiac hypertrophy in H9c2 cells was supported by the ability of resveratrol, an AhR antagonist, to block the SUN-induced hypertrophy and the ability of SB203580, a novel AhR agonist, to potentiate SUN-induced hypertrophic genes. This is the first demonstration that SUN induces hypertrophic genes in vivo and in vitro rat cardiomyocyte through AhR/CYP1A1-mediated mechanism.

Community Pharmacists' Practice, Awareness, and Beliefs about Drug Disposal in Saudi Arabia.

The awareness among Saudi people regarding the good and safe practice of drug disposal is fairly low. Community pharmacists' potential toward drugs disposal directions and practice are not emphasized enough. Therefore, a cross sectional study was conducted in Riyadh, Saudi Arabia, to evaluate the practice, awareness and beliefs of community pharmacists about disposal of unused drugs. Out of 360 subjects who participated in the study, more than 70% returned the unused drugs to the pharmaceutical distributors. Around 80% of the participants confirmed the risk of environmental damage due to the inappropriate disposal of drugs, and 87.5% of them held themselves responsible for preventing such risk. Approximately 85% of surveyed pharmacists believed community pharmacies to be an appropriate location for the collection of unused drugs. There was no significant association between the community pharmacists' age group and years of practice as community pharmacists with either the awareness of unused medication disposal on environmental hazards, or the beliefs about the appropriate location for collecting unused drugs (p > 0.05). The awareness and proactive accountable responsibility, along with community pharmacists' belief of appointing pharmacies to collect unused drugs, strongly support the institution of drug take-back programs.

Community pharmacists attitudes towards mental illness and providing pharmaceutical care for mentally ill patients.

OBJECTIVE: To examine the attitudes of community pharmacist to both mental illness and provision of pharmaceutical care. METHODS: The study was conducted from May 2006 to September 2006 in College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. The survey composed of the demographic characteristics of the respondents, who were asked 6 Likert type questions on the attitudes of the pharmacists toward mental illness, providing pharmaceutical care to mentally ill patients, the barriers of the provision of the service and differentiation between different types of mental illness. RESULTS: Forty-three pharmacists participated in the study. Eighty-eight percent of the pharmacists felt that mental illness was the same as other illnesses. Sixty-six percent of the respondents "strongly agree," or "agree" that mentally ill patients were easily recognizable. Thirty-three percent of the respondents "disagree," or "strongly disagree" that mentally ill patients have no ability to tell right from wrong. In general, 43.3-87.7% of respondents are being "much more" or "more" interested, comfortable, and confident to perform pharmaceutical care to mentally ill patients. An average range of 30-67% of respondents felt neutral, or "much more" or "more" comfortable, confident for screening and solving drug-related problems, and compliance with drug therapy. Barriers that limit the provision of pharmaceutical care to the mentally ill patients include the lack of training in pharmaceutical care practice (88.4%), lack of therapeutic knowledge (83.7%), lack of documentation skill (79%), lack of communication (76.8%), lack of space for counseling (76.7%), insufficient time (74.5%) and lack of staff (72.1%). CONCLUSION: Although pharmacists have positive attitudes to both mental illness and providing pharmaceutical care to mentally ill patients, they felt uncomfortable counseling or carrying out follow-up monitoring of patients for adverse drug-related problems.

Evaluation of drug and poison information center in Saudi Arabia during the period 2000-2002.

OBJECTIVE: To evaluate the profile of the requestors, the number and content of questions which were received during the period of May 2000 - December 2002. METHODS: A total of 1967 requests were evaluated. The questions were sorted according to source of callers, caller identification, the content of the questions, search data and time required to answer the questions. All data analysis were performed using the Statistical Package for Social Sciences Version 9.0. RESULTS: The questions were received from different places, including Riyadh (90.1%), overall the Kingdom (8.9%) and gulf countries (1%). The Drug and Poison Information Center (DPIC) provides information to pharmacists, community, employee of King Saud University, physicians, nurses, dentists and others. The type of requests most frequently inquired about were drug related, health related, article/information, and poisoning. Requested data include information about therapeutics uses, drug identification, articles, adverse effects, dosage/administration, drug interactions, poisoning, with very few questions about availability, pregnancy and lactation, and IV incompatibilities. The most common resources used were Drugdex and internet, reference books, Iowa Drug Information Services (IDIS), PubMed and Poisondex. The time devoted to the service is varied ranging from 5 minutes to weeks. CONCLUSION: This study emphasizes on how important to document type of the activities of the DPIC to be used as a vital quality assurance tool. It also revealed the need to stimulate more requestors particularly physicians by advertising the drug information activities or possibly by establishing a website for the DPIC.

Glucagon-like peptide-1 derivatives and dipeptidyl peptidase-IV inhibitors. New hope for the treatment of type-2 diabetes.

Glucagon-like peptide GLP-1 is an endogenous insulinotropic/glucagonostatic hormone that acts in a self-limiting mechanism. It is a multifunctional hormone that leads to insulin release stimulation, liver glucagon breakdown suppression, upregulation of islet cell proliferation, and neogenesis and retardation of gastric emptying. The short half-life and high renal clearance due to degradation via dipeptidyl peptidase-IV DPP-IV, and active glomerular filtration rate make this hormone ineffectual as an exogenous agent. More stable and long acting GLP-1 analogues and DPP-1 inhibitors have been developed with promising clinical value for the treatment of type-2 diabetes. The GLP-1 derivatives have the advantage of decreasing body weight while the DPP-IV inhibitors can be administered orally up to once daily. The mechanism of action as well as the tolerable side effect is astounding. This review article covers this new generation of anti-diabetics.

Drug-induced pulmonary fibrosis.

Pulmonary fibrosis is characterized by the accumulation of excessive connective tissue in the lungs. Its causes include chronic administration of some drugs for example bleomycin, cyclophosphamide, amiodarone, procainamide, penicillamine, gold and nitrofurantoin; exposure to certain environmental factors such as gases, asbestos and silica and bacterial or fungal infections. Some systemic diseases also predispose to the disease for example rheumatoid arthritis and systemic lupus erythematosus. The disease is associated with release of oxygen radicals and some mediators such as tumor necrosis factor-alpha TNF-alpha, transforming growth factor-beta TGF-beta, PDGF, IGF-I, ET-I and interleukins 1, 4, 8 and 13. The symptoms of the disease include dyspnea, non-productive cough, fever and damage to the lung cells. It is diagnosed with the aid of chest radiography, high resolution computed tomographic scanning and the result of pulmonary function tests. Drug-induced pulmonary fibrosis may involve release of free oxygen radicals and various cytokines for example IL-Ibeta and TNF-alpha via activation of nuclear transcription factor NF-beta as in the case of bleomycin and mitomycin or via release of TGF-beta as in case of tamoxifen or via inhibition of macrophages' and lymphocytes' phospholipases as in the case of amiodarone with the resultant accumulation of phospholipids and reduction of the immune system.