Attitudes of Iraqi society towards the role of community pharmacists

Objectives: The main aims of this study were to assess society’s use of community pharmacies; evaluate attitudes towards the role of the community pharmacist; and describe required pharmacist characteristics and future services.Study design: A cross-sectional survey with a stratified sampling technique.Methods: A self-administered, validated, questionnaire was distributed to 500 consumers in attendance at 50 community pharmacies in Baghdad, Iraq. Data were gathered from January to April 2012. Mann-Whitney and Kruskal-Wallis tests were performed to test for statistical differences among the study variables. Further analysis through the Chi-square test and logistic regression was completed to assess the predictors of society’s attitudes.Results: Twenty-six percent of respondents visited their community pharmacies at least once per week and an additional 65% reported visiting their pharmacy at least once per month. Fifty-five percent of respondents listed the community pharmacist as the first person they would contact in case of any drug-related problem. However, the pharmacist’s role was under-appreciated by the majority of respondents (79.8%). These attitudes varied significantly with regard to the demographic characteristics of respondents. Logistic regression analysis showed that gender and age were the influential predictors of favourable versus non-favourable attitudes towards the role of pharmacist.Conclusions: The use of community pharmacies in Iraq was characterized by frequent visits to purchase medicines. Selection of the pharmacy primarily depended on its location. Overall, an under-appreciation of the professional performance of pharmacists was predominant. Raising public awareness towards the important role of community pharmacists in providing public health is warranted

Chimeric Antigen Receptor T-Cell Therapy in Glioblastoma: Charging the T Cells to Fight

Glioblastoma multiforme (GBM) is the most common malignant brain cancer that invades normal brain tissue and impedes surgical eradication, resulting in early local recurrence and high mortality. In addition, most therapeutic agents lack permeability across the blood brain barrier (BBB), further reducing the efficacy of chemotherapy. Thus, effective treatment against GBM requires tumor specific targets and efficient intracranial drug delivery. With the most recent advances in immunotherapy, genetically engineered T cells with chimeric antigen receptors (CARs) are becoming a promising approach for treating cancer. By transducing T lymphocytes with CAR constructs containing a tumor-associated antigen (TAA) recognition domain linked to the constant regions of a signaling T cell receptor, CAR T cells may recognize a predefined TAA with high specificity in a non-MHC restricted manner, and is independent of antigen processing. Active T cells can travel across the BBB, providing additional advantage for drug delivery and tumor targeting. Here we review the CAR design and technical innovations, the major targets that are in pre-clinical and clinical development with a focus on GBM, and multiple strategies developed to improve CAR T cell efficacy

A Comparative Study of Efficacy and Safety among Metformin, Sitagliptin, and Glimepiride Monotherapies in Patients with Type 2 Diabetes Mellitus

Effective management of type 2 diabetes mellitus (T2DM) requires lifestyle changes and suitable medications to enhance quality of life and prevent complications. Choosing the right treatment involves considering the patient's clinical profile, drug efficacy, side effects, and cost. This study compares the safety and efficacy of sitagliptin, glimepiride, and metformin in T2DM patients. A prospective cross-sectional study was conducted at the Diabetes Center of Layla Qasim, Erbil, Iraq, including 143 diabetic patients. They were divided into three groups: group A received glimepiride (N=50), group B metformin (N=48), and group C sitagliptin (N=45). Drug costs, therapeutic outcomes, and side effects were analyzed. Patients aged 30 to 78 participated, with a female-to-male ratio of 83:60. All groups showed significantly improved HbA1c levels (P=0.001). Total cholesterol (TC) and LDL levels were also significantly different (P=0.047 and P=0.010, respectively). Sitagliptin significantly increased triglycerides (TG) and HDL-C. Gastrointestinal side effects were prominent in the metformin group. When selecting medication for T2DM, factors like age, HbA1c, glucose levels, obesity, metabolic syndrome, insulin secretion, and hypoglycemia risk should be considered. Both sitagliptin and glimepiride were well tolerated, with minimal hypoglycemia risk and no significant weight differences between groups. Glimepiride is an effective, safe, and weight-neutral adjunct to metformin, offering extrapancreatic benefits and remains a viable second-line treatment option for T2DM patients

Distinguishing sequences for partially specified FSMs

Distinguishing Sequences (DSs) are used inmany Finite State Machine (FSM) based test techniques. Although Partially Specified FSMs (PSFSMs) generalise FSMs, the computational complexity of constructing Adaptive and Preset DSs (ADSs/PDSs) for PSFSMs has not been addressed. This paper shows that it is possible to check the existence of an ADS in polynomial time but the corresponding problem for PDSs is PSPACE-complete. We also report on the results of experiments with benchmarks and over 8 * 106 PSFSMs. © 2014 Springer International Publishing

Generating a checking sequence with a minimum number of reset transitions

Given a finite state machine M, a checking sequence is an input sequence that is guaranteed to lead to a failure if the implementation under test is faulty and has no more states than M. There has been much interest in the automated generation of a short checking sequence from a finite state machine. However, such sequences can contain reset transitions whose use can adversely affect both the cost of applying the checking sequence and the effectiveness of the checking sequence. Thus, we sometimes want a checking sequence with a minimum number of reset transitions rather than a shortest checking sequence. This paper describes a new algorithm for generating a checking sequence, based on a distinguishing sequence, that minimises the number of reset transitions used.This work was supported in part by Leverhulme Trust grant number F/00275/D, Testing State Based Systems, Natural Sciences and Engineering Research Council (NSERC) of Canada grant number RGPIN 976, and Engineering and Physical Sciences Research Council grant number GR/R43150, Formal Methods and Testing (FORTEST)

Azithromycin Therapy Reduces Cardiac Inflammation and Mitigates Adverse Cardiac Remodeling After Myocardial Infarction: Potential Therapeutic Targets in Ischemic Heart Disease

Introduction Acute myocardial infarction (MI) is a primary cause of worldwide morbidity and mortality. Macrophages are fundamental components of post-MI inflammation. Pro-inflammatory macrophages can lead to adverse cardiac remodeling and heart failure while anti-inflammatory/reparative macrophages enhance tissue healing. Shifting the balance between pro-inflammatory and reparative macrophages post-MI is a novel therapeutic strategy. Azithromycin (AZM), a commonly used macrolide antibiotic, polarizes macrophages towards the anti-inflammatory phenotype, as shown in animal and human studies. We hypothesized that AZM modulates post-MI inflammation and improves cardiac recovery. Methods and results Male WT mice (C57BL/6, 6–8 weeks old) were treated with either oral AZM (160 mg/kg/day) or vehicle (control) starting 3 days prior to MI and continued to day 7 post-MI. We observed a significant reduction in mortality with AZM therapy. AZM-treated mice showed a significant decrease in pro-inflammatory (CD45+/Ly6G-/F4-80+/CD86+) and increase in anti-inflammatory (CD45+/Ly6G-/F4-80+/CD206+) macrophages, decreasing the pro-inflammatory/anti-inflammatory macrophage ratio in the heart and peripheral blood as assessed by flow cytometry and immunohistochemistry. Macrophage changes were associated with a significant decline in pro- and increase in anti-inflammatory cytokines. Mechanistic studies confirmed the ability of AZM to shift macrophage response towards an anti-inflammatory state under hypoxia/reperfusion stress. Additionally, AZM treatment was associated with a distinct decrease in neutrophil count due to apoptosis, a known signal for shifting macrophages towards the anti-inflammatory phenotype. Finally, AZM treatment improved cardiac recovery, scar size, and angiogenesis. Conclusion Azithromycin plays a cardioprotective role in the early phase post-MI through attenuating inflammation and enhancing cardiac recovery. Post-MI treatment and human translational studies are warranted to examine the therapeutic applications of AZM

Liposomal Delivery of Azithromycin Enhances Its Immunotherapeutic Efficacy and Reduces Toxicity in Myocardial Infarction

A growing body of evidence shows that altering the inflammatory response by alternative macrophage polarization is protective against complications related to acute myocardial infarction (MI). We have previously shown that oral azithromycin (AZM), initiated prior to MI, reduces inflammation and its negative sequelae on the myocardium. Here, we investigated the immunomodulatory role of a liposomal AZM formulation (L-AZM) in a clinically relevant model to enhance its therapeutic potency and avoid off-target effects. L-AZM (40 or 10 mg/kg, IV) was administered immediately post-MI and compared to free AZM (F-AZM). L-AZM reduced cardiac toxicity and associated mortality by 50% in mice. We observed a significant shift favoring reparatory/anti-inflammatory macrophages with L-AZM formulation. L-AZM use resulted in a remarkable decrease in cardiac inflammatory neutrophils and the infiltration of inflammatory monocytes. Immune cell modulation was associated with the downregulation of pro-inflammatory genes and the upregulation of anti-inflammatory genes. The immunomodulatory effects of L-AZM were associated with a reduction in cardiac cell death and scar size as well as enhanced angiogenesis. Overall, L-AZM use enhanced cardiac recovery and survival after MI. Importantly, L-AZM was protective from F-AZM cardiac off-target effects. We demonstrate that the liposomal formulation of AZM enhances the drug\u27s efficacy and safety in an animal model of acute myocardial injury. This is the first study to establish the immunomodulatory properties of liposomal AZM formulations. Our findings strongly support clinical trials using L-AZM as a novel and clinically relevant therapeutic target to improve cardiac recovery and reduce heart failure post-MI in humans

Estimation and Correlation Analysis of Heavy Metals of Some Well Water in Zakho City, Iraq

This study was carried out to examine the concentrations of major heavy metals in fifteen different well water in Zakho City, Kurdistan Region, Iraq. The studied heavy metals were iron, copper, chromium, aluminum, cadmium, cobalt, nickel, manganese, zinc and lead. The results obtained in the studied area showed that copper, chromium, cobalt, zinc, manganese, aluminum, iron and lead were within the acceptable limits as recommended by WHO for water drinking. However, in all studied areas, cadmium and nickel were mostly founded to exceed the maximum permissible limit set by WHO. It is found that zinc and copper possess a very good positive correlation between each other. The results obtained in this study confirmed the groundwater pollution and hence it is not suitable for consumption without any prior treatment