Clinical Pharmacy

The role of the extracellular matrix (ECM) in uterine fibroids (UF) has recently been appreciated. Overhydroxylation of lysine residues and the subsequent formation of hydroxylysylpyridinoline (HP) and lysylpyridinoline (LP) cross-links underlie the ECM stiffness and profoundly affect tumor progression. The aim of the current study was to investigate the relationship between ECM of UF, collagen and collagen cross-linking enzymes [lysyl hydroxylases (LH) and lysyl oxidases (LOX)], and the development and progression of UF. Our results indicated that hydroxyl lysine (Hyl) and HP cross-links are significantly higher in UF compared to the normal myometrial tissues accompanied by increased expression of LH (LH2b) and LOX. Also, increased resistance to matrix metalloproteinases (MMP) proteolytic degradation activity was observed. Furthermore, the extent of collagen cross-links was positively correlated with the expression of myofibroblast marker (α-SMA), growth-promoting markers (PCNA; pE...

In the article titled "Overhydroxylation of Lysine of Collagen Increases Uterine Fibroids Proliferation: Roles of Lysyl Hydroxylases, Lysyl Oxidases, and Matrix Metalloproteinases" [1], there was an error in the affiliation of the second author. The corrected affiliations are shown above.

Background Infections result from invasions of an organism into body tissues leading to diseases and complications that might eventually lead to death. Inappropriate use of antimicrobials has led to development of antimicrobial resistance (AMR) which has been associated with increased mortality, morbidity and health costs. Antimicrobial stewardship (AMS) programs are designed to ensure appropriate selections of an effective antimicrobial drugs and optimizing antibiotic use to minimize antibiotic resistance by implementing certain policies, strategies and guidelines. The aim of this study was to investigate practitioners’ perceptions regarding AMS implementation and to identify challenges and facilitators of these programs execution. Methods Cross-sectional study among health care providers in Eastern province of Saudi Arabia Hospitals. The data was collected using a survey including questions about demographic data and information about clinicians’ (physicians, pharmacists and nurse...

Background Antimicrobial agents are among the most commonly prescribed drugs in pregnancy due to the increased susceptibility to infections during pregnancy. Antimicrobials can contribute to different maternal complications. Therefore, it is important to study their patterns in prescription and utilization. The data regarding this issue is scarce in Saudi Arabia. Therefore, the aim of this study is to generate data on the antimicrobial agents that are most commonly prescribed during pregnancy as well as their indications and safety. Methods This is a retrospective study focusing on pregnant women with a known antimicrobial use at Johns Hopkins Aramco Healthcare (JHAH). The sample included 344 pregnant women with a total of 688 antimicrobial agents prescribed. Data was collected on the proportion of pregnant women who received antimicrobial agents and on the drug safety during pregnancy using the risk categorization system of the U.S. Food and Drug Administration (FDA). Results The r...

Aim: This study was aimed to evaluate the motivation, learning styles and programme selections of pharmacy and non- pharmacy candidates doing the preparatory year. Method: A questionnaire survey was conducted at the end of the preparatory-year in Dammam University during the Orientation Week in April 2014. Interviews with some students and instructors were also conducted to triangulate the survey data. A semi-structured questionnaire was specially designed, checked for face validity and piloted in students. A chi-squared or t test was utilised to compare the programme selections and relevant variables with the significance level ( α ) set at 0.05. Results: A total of 74 pharmacy and 342 non-pharmacy candidates completed the questionnaire. Both groups mostly consisted of males aged 19 (60% – 70%) with the secondary school scores in the range of 96% - 100%. Almost all students could identify their strengths and weaknesses, especially in Chemistry, Physics and English. They felt stress...

Objective This study aimed to assess the correlation between body mass index (BMI) and plasma lipid profile levels in mild and severe COVID-19 patients. Method This was a prospective, observational, cohort study, conducted in a medical referral center specializing in management of COVID-19 cases. Patients were divided into two groups according to infection severity (mild and severe). Blood samples were obtained from all patients who tested positive to a PCR test for measuring biochemical and inflammatory markers such as lactate dehydrogenase, ferritin, C-reactive protein, and d-dimer, as well as lipid profile, including total cholesterol, triacylglycerols, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), which were analyzed and compared between the two groups. Pearson's correlation was used to assess the correlation between BMI and plasma lipid profile among mild and severe cases. Results The levels of plasma triacylglycerols, d-dimer, lactate dehydrogenase, ferritin, and C-reactive protein with severe infection were significantly different between patients with mild and severe COVID-19 symptoms (p = 0.036, 0.03, 0.001, 0.014, and 0.006, respectively). A positive correlation between BMI and triglyceride levels was observed only in the severe infection group. However, HDL-C was negatively correlated with BMI. Conclusion A routine lipid profile test might help as a marker of inflammation and risk stratification in patients with COVID-19. Especially in middle-or low-income countries, the test can rapidly help clinicians to delineate prognostic measures and hence management and treatment plans for this disease as the levels of the lipid profile were correlated with the patients' BMI and infection severity.

The quality of articles the editors accept for publications in the Journal of International Relations and Development depends on the valuable suggestions from colleagues who serve as external reviewers. The editors gratefully acknowledge the service of the following colleagues who provided reviews during the preparation of volume 9:

The last 70 years of Warfarin use has been associated with extreme problems. The Novel Oral Anticoagulants (NOACs) are not well utilized in patients with Atrial Fibrillation (AF). We thought to excavate the clinical utility of NOACs and provide some insights into their usefulness as suitable alternatives to Warfarin. Methods: The main objective is to raise awareness of clinicians regarding the underutilized NOACs and shed light on concerns surrounding their utility as suitable alternatives to Warfarin. We searched the literature for recent meta-analysis about NOACs. Results: The choice between the four NOACs depends largely on the cost and patient's preferences rather on their safety profile. They were better when compared with Warfarin, nevertheless; no head-to-head comparison was performed between NOACs members. The selection of one NOAC over the others rely on patients characteristics (age), cost, insurance coverage, dosing interval (once versus twice) and renal status. One more obstacle to utilization of NOACs is the reversal of bleeding. Discussion: There are three integrated grey areas for suitability to NOAC required to be discussed and argued in light of all of the trials, meta-analysis and pharmaceutical-race. The first is relevant to patient in term of demographics (e.g. age), co-morbidities (e.g. chronic kidney disease), degree of renal impairment (creatinine clearance > 30 mL/min), adherence to daily dosing and risk of bleeding. Most patients with AF are having comorbidities with problematic poly-pharmacy issues. The second is implications of cost and insurance coverage on NOAC selection which is considered highly significant for clinicians. The third is relevant to each NOAC pharmacokinetic and pharmacodynamics profile as dosing interval. Conclusion: The messages taken from this overview is to encourage utility of NOACs in daily clinical practice, evaluate the patient preferences, consider cost and insurance coverage and select a NOAC over Warfarin when the overall clinical judgment is optimal.

2 of 13 key factors which contribute to AMR from participants' perspectives. Furthermore, internal policy and guidelines are needed to ensure that the antimicrobials are prescribed in accordance with standard protocols and clinical guidelines.

Factors reported in the literature associated with inappropriate prescribing of antimicrobials include physicians with less experience, uncertain diagnosis, and patient caregiver influences on physicians’ decisions. Monitoring antimicrobial resistance is critical for identifying emerging resistance patterns, developing, and assessing the effectiveness of mitigation strategies. Improvement in prescribing antimicrobials would minimize the risk of resistance and, consequently, improve patients’ clinical and health outcomes. The purpose of the study is to delineate factors associated with antimicrobial resistance, describe the factors influencing prescriber’s choice during prescribing of antimicrobial, and examine factors related to consequences of inappropriate prescribing of antimicrobial. A cross-sectional study was conducted among healthcare providers (190) in six tertiary hospitals in the Eastern province of Saudi Arabia. The research panel has developed, validated, and piloted sur...

Chronic infection with HCV is a worldwide health problem that may lead to cirrhosis, portal hypertension, hepatocellular failure and hepatocellular carcinoma in most of cases. A new era in HCV treatment has been started using direct acting antiviral activity. In this study we assess the safety and efficacy of a combination therapy Sofosbuvir/Simprevir in the treatment of chronic HCV patients genotype IV either cirrhotic or non-cirrhotic. In the outpatient clinic, one hundred and seventy five chronic HCV patients were recruited from Tropical Medicine Department at Fayoum public hospital. A combination of Sofosbuvir (400 mg) and Simeprevir (150 mg) was administered for those patients once daily over a period of 12 weeks. All patients have been followed up for clinical and laboratory parameters and HCV PCR to evaluate the efficacy and safety of this therapy. Sustained Virologic Response rate (SVR12) were 97.7% (169/173) (primary end point), and same results obtained at the second end point (SVR 24). In this study, cirrhotic patients showed lower SVR (92.7%) compared to non-cirrhotic patients (98.5%) (p-value 0.085). Majority of patients (57.14%) reported adverse events (AEs) during treatment and most common AEs were headache, fatigue, pruritus, dizziness and photosensitivity. On the basis of the evidence currently available, it seems fair to suggest that the combination therapy of (SMV/SOF) in the treatment of chronic HCV genotype IV naïve and experienced patient whether cirrhotic or non-cirrhotic is safe and effective. This was evidenced by monitoring patients' clinically and using hepatic parameters after drug administration. The adverse events affected patients were mild and tolerable among patients.

Vaccine hesitancy is widespread in many parts of the globe, particularly in low–middle-income countries. Therefore, we surveyed a sample of hospitalized COVID-19 patients to assess COVID-19 vaccine acceptance and vaccine hesitancy in a low–middle-income country. A cross-sectional sample of 385 confirmed reverse transcriptase–polymerase chain reaction COVID-19 patients treated at secondary and tertiary care hospitals in Punjab, Pakistan, were analyzed to assess COVID-19 vaccine uptake and vaccine hesitancy. The construct validity and reliability of the 11-item vaccine hesitancy questionnaire were also examined. In addition, multivariate logistic regression was used. The majority of the COVID-19 patients admitted to hospitals were not vaccinated (84%). Of those who were willing to receive vaccination, the majority (55%) considered vaccines an effective way to protect people from COVID-19. However, those who were not willing to receive their COVID-19 vaccine had significantly higher he...

Introduction:The Coronavirus disease 2019 (COVID-19) caused many problems in the health sector. Effective and safe vaccines are the only tool to combat the COVID-19 disease. Researchers and regulatory agencies have made efforts to develop such vaccines and healthcare professionals were prioritized for the vaccination program as first-line care providers. Considering this prioritization, we aimed to assess the physicians’ perceptions regarding the side effects of the COVID-19 vaccine.Methods:An interview-based study was conducted from May 5 May to November 5, 2021 (6 months) in a teaching hospital in the capital city of Islamabad, Pakistan.Results:Among the 200 physicians who agreed to participate in the interview, 74% were male. A total of 94% did not experience any side effects after receiving the COVID-19 vaccine, regardless of the type of vaccine; 6% experienced side effects. Furthermore, 90% of physicians were afraid of side effects due to the high number of vaccine doses.Conclu...