Knowledge of pharmacists on proper use of oral contraceptive pills and missed dose instructions in United Arab Emirates

Purpose: To assess the knowledge of community pharmacists and senior pharmacy students in United Arab Emirates (UAE) about the proper use of oral contraceptive pills (OCPs) and to investigate factors associated with their knowledge.Method: A cross-sectional study was conducted using a validated self-administered questionnaire to community pharmacists and senior pharmacy students in UAE. The survey contained 22 questions divided into 3 parts: a) demographic information, b) OCPs general knowledge, c) OCPs proper use and missed dose instructions.Results: Community pharmacists had significantly higher knowledge scores than senior pharmacy students (26 vs 16.6 %; p = 0.032). Pharmacists with 10 - 20 years of experience had significantly lower knowledge scores than pharmacists with < 10 years of experience (p < 0.05). Conversely, gender, marital status and previous education on OCPs were not associated with knowledge score (p > 0.05).Conclusion: Participants had poor knowledge of proper use and missed dose instructions along with several misconceptions of OCPs. This can be enhanced by encouraging pharmacists to enroll in continuous educations activities that provide updated information about OCPs. Additionally, inclusion of an intensive elective course on OCPs in undergraduate pharmacy curricula may be helpful.Keywords: Oral contraceptives, Pharmacists, Pharmacy students, Counselling skills, misconception

Quantitative cross-species extrapolation between humans and fish: The case of the anti-depressant fluoxetine

This article has been made available through the Brunel Open Access Publishing Fund.Fish are an important model for the pharmacological and toxicological characterization of human pharmaceuticals in drug discovery, drug safety assessment and environmental toxicology. However, do fish respond to pharmaceuticals as humans do? To address this question, we provide a novel quantitative cross-species extrapolation approach (qCSE) based on the hypothesis that similar plasma concentrations of pharmaceuticals cause comparable target-mediated effects in both humans and fish at similar level of biological organization (Read-Across Hypothesis). To validate this hypothesis, the behavioural effects of the anti-depressant drug fluoxetine on the fish model fathead minnow (Pimephales promelas) were used as test case. Fish were exposed for 28 days to a range of measured water concentrations of fluoxetine (0.1, 1.0, 8.0, 16, 32, 64 μg/L) to produce plasma concentrations below, equal and above the range of Human Therapeutic Plasma Concentrations (HTPCs). Fluoxetine and its metabolite, norfluoxetine, were quantified in the plasma of individual fish and linked to behavioural anxiety-related endpoints. The minimum drug plasma concentrations that elicited anxiolytic responses in fish were above the upper value of the HTPC range, whereas no effects were observed at plasma concentrations below the HTPCs. In vivo metabolism of fluoxetine in humans and fish was similar, and displayed bi-phasic concentration-dependent kinetics driven by the auto-inhibitory dynamics and saturation of the enzymes that convert fluoxetine into norfluoxetine. The sensitivity of fish to fluoxetine was not so dissimilar from that of patients affected by general anxiety disorders. These results represent the first direct evidence of measured internal dose response effect of a pharmaceutical in fish, hence validating the Read-Across hypothesis applied to fluoxetine. Overall, this study demonstrates that the qCSE approach, anchored to internal drug concentrations, is a powerful tool to guide the assessment of the sensitivity of fish to pharmaceuticals, and strengthens the translational power of the cross-species extrapolation

Probing exotic phenomena at the interface of nuclear and particle physics with the electric dipole moments of diamagnetic atoms: A unique window to hadronic and semi-leptonic CP violation

The current status of electric dipole moments of diamagnetic atoms which involves the synergy between atomic experiments and three different theoretical areas -- particle, nuclear and atomic is reviewed. Various models of particle physics that predict CP violation, which is necessary for the existence of such electric dipole moments, are presented. These include the standard model of particle physics and various extensions of it. Effective hadron level combined charge conjugation (C) and parity (P) symmetry violating interactions are derived taking into consideration different ways in which a nucleon interacts with other nucleons as well as with electrons. Nuclear structure calculations of the CP-odd nuclear Schiff moment are discussed using the shell model and other theoretical approaches. Results of the calculations of atomic electric dipole moments due to the interaction of the nuclear Schiff moment with the electrons and the P and time-reversal (T) symmetry violating tensor-pseudotensor electron-nucleus are elucidated using different relativistic many-body theories. The principles of the measurement of the electric dipole moments of diamagnetic atoms are outlined. Upper limits for the nuclear Schiff moment and tensor-pseudotensor coupling constant are obtained combining the results of atomic experiments and relativistic many-body theories. The coefficients for the different sources of CP violation have been estimated at the elementary particle level for all the diamagnetic atoms of current experimental interest and their implications for physics beyond the standard model is discussed. Possible improvements of the current results of the measurements as well as quantum chromodynamics, nuclear and atomic calculations are suggested.Comment: 46 pages, 19 tables and 16 figures. A review article accepted for EPJ

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Evaluation of Serum Stromelysin-2 as a Potential Biomarker for Subclinical Atherosclerosis in Hypothyroid Patients

&lt;p&gt;Background: Hypothyroidism is a medical condition that happens when the thyroid fails to produce enough thyroid hormone to keep up with the requirements of the body's metabolism. Hypothyroidism that is not treated can result in a variety of serious health complications, including hypertension, dyslipidemia, atherosclerosis, and others. Subclinical atherosclerosis is a form of atherosclerosis that occurs when a patient has atherosclerotic plaque but no clinical symptoms of the disease. Stromelysin-2 have an inflammatory effect, released by macrophages in response to a wound or an inflammatory stimulus. Objectives: Measure serum stromelysin-2 levels in people who have clinical and subclinical hypothyroidism to predict an increased risk of atherosclerosis and find the correlation between stromelysin-2 and the lipid panel. Materials and Methods: In this study, there were 130 participants. They were classified into three groups. We measured serum stromelysin-2 levels and lipid profiles. Results: There is a significant rise in the mean value of serum stromelysin-2 (P=0.001), total cholesterol, (P=0.001), triglycerides (P=0.001), LDL-C (P=0.001), VLDL-C (P=0.001), risk ratio of TC/HDL-C (P=0.001), risk ratio of LDL-C/HDL-C (P=0.001), atherogenic coefficient (P=0.001) and atherogenic index of plasma (P=0.001) with significant diminish of serum HDL-C (P=0.001) in clinical and subclinical hypothyroid patients compared to healthy controls. Conclusion: Patients with clinical and subclinical hypothyroidism had higher levels of serum stromelysin-2, higher levels of castelli risk index, atherogenic index of plasma and atherogenic coefficient were found in patients could be used as more accurate risk predictors of cardiovascular disease. Moreover, significant positive correlation was found between Stromelysin-2 and lipid panel.&lt;/p&gt;&lt;p&gt;Antecedentes: El hipotiroidismo es una afección médica que ocurre cuando la tiroides no produce suficiente hormona tiroidea para satisfacer las necesidades del metabolismo del cuerpo. El hipotiroidismo que no se trata puede provocar una variedad de complicaciones de salud graves, como hipertensión, dislipidemia, aterosclerosis y otras. La aterosclerosis subclínica es una forma de aterosclerosis que ocurre cuando un paciente tiene placa aterosclerótica pero no tiene síntomas clínicos de la enfermedad. La estromelisina-2 tiene un efecto inflamatorio, liberado por los macrófagos en respuesta a una herida o un estímulo inflamatorio. Objetivos: Medir los niveles séricos de estromelisina-2 en personas que tienen hipotiroidismo clínico y subclínico para predecir un mayor riesgo de aterosclerosis y encontrar la correlación entre la estromelisina-2 y el panel de lípidos. Materiales y Métodos: En este estudio hubo 130 participantes. Fueron clasificados en tres grupos. Medimos los niveles séricos de estromelisina-2 y los perfiles de lípidos. Resultados: Hay un aumento significativo en el valor medio de estromelisina-2 sérica (P = 0,001), colesterol total (P = 0,001), triglicéridos (P = 0,001), LDL-C (P = 0,001), VLDL-C. (P = 0,001), índice de riesgo de CT/ HDL-C (P = 0,001), índice de riesgo de LDL-C/HDL-C (P = 0,001), coeficiente aterogénico (P = 0,001) e índice aterogénico del plasma (P = 0,001) con una disminución significativa del HDL-C sérico (P = 0,001) en pacientes con hipotiroidismo clínico y subclínico en comparación con controles sanos. Conclusión: Los pacientes con hipotiroidismo clínico y subclínico tuvieron niveles más altos de estromelisina-2 sérica, se encontraron niveles más altos de índice de riesgo de Castelli, índice aterogénico del plasma y coeficiente aterogénico en los pacientes que podrían usarse como predictores de riesgo más precisos de enfermedad cardiovascular. Además, se encontró una correlación positiva significativa entre Stromelysin-2 y el panel de lípidos.&lt;/p&gt

Comparative Study for Citrus Fruits Phytochemical Screening and In-vitro Antioxidant Activity

Oxidative stress is one of pharmacological & toxicology mechanisms as  an important pathological mechanism proposed for many diseases including cancer . Plant components that include antioxidant components are becoming more popular as an alternative to synthetic antioxidants because of their ability to eliminate free-radical intermediates and prevent further oxidation, Citrus genus, which belongs to the Rutaceae family, comprises among of the world's most frequently harvested crops due to its many nutritional and health advantages. The preliminary phytochemical analysis of the prepared extract shown the presence of several constituents of citrus peels as Alkaloids, Phenolics , Flavonoids and rutin. Moreover , The result of in-vitro antioxidants activity of both citrus species showed that DPPH radical scavenging activity for  peel extract demonstrate dose-dependent inhibition with IC50 was calculated (287.32 ug/ml and 341.89 µg/ml) for pomelo & orange respectively compared to IC50 value of vitamin C which was 260.06 µg/ml as standard antioxidant . in conclusion , study results showed that pomelo peel show higher antioxidant activity compared to orange moreover, citrus peel has significant antioxidant qualities and is a potentially rich source of natural antioxidants, and PPE scavenges DPPH and reactive oxygen radicals very effectively