CARDIOVASCULAR RISK SCREENING SERVICES IN SUDANESE COMMUNITY PHARMACIES

Objectives: The objective of this study was to investigate the Sudanese community pharmacists' knowledge and practice of cardiovascular disease risk assessment services.Methods: The study was conducted as a non-interventional, descriptive, cross sectional community-pharmacy based survey.Results: The Response rate was 91%. The obese and the elderly received the highest ratings for cardiovascular disease risk assessment. Hypertension, type 1 and type 2 diabetes mellitus and ages >55 and 36-55 years were mostly targeted for screening. Variable responses were reported regarding the type of fasting lipid profile that is screened. One third of the participants claimed to have screening evaluation forms. Most participants had the appropriate equipment for screening but only a few had cholesterol measures. Only 27% reported the use of cardiovascular risk charts or calculator for the evaluation. Overwhelming majority had no documentation records and the most available reference was the BNF.Conclusion: The current knowledge and practice of cardiovascular disease risk assessment is poor and need fundamental development. Community pharmacy practice in the Sudan is still product oriented. These services were provided by respondents on voluntary bases without full knowledge or appropriate training on proper assessment and evaluation of the risks that they measured. This needs to change if pharmacy's potential is to be reached. Collaboration between health authorities and universities is essential to acknowledge the new roles of the pharmacist and provide the appropriate knowledge and training needed to promote and implement the change process that is required

PHARMACOGNOSY AND NEW TRENDS OF B. PHARM SYLLABI

Objective: The Pharmacy profession has evolved from its conventional drug focused basis to an advanced patient focused basis over the years. Accordingly, many universities worldwide are modifying their Curricula in order to reflect this change.Methods: This paper investigates and compares the syllabi of B. Pharm for different Universities in Africa and Asia. Pharmacy Syllabi of the included Universities is presented in the form of Sectors, i.e. Pharmaceutical Sciences, Clinical Pharmacy, Biomedical, Training and University Requirements. Percentage analysis of credit hours allotted to courses of each Sector performed with special emphasis on courses of Pharmacognosy and Pharmaceutical Science in comparison to courses of Clinical Pharmacy.There is a substantial decrease in teaching hours of Pharmaceutical Sciences, particularly Pharmacognosy within the B. Pharm Curricula of some of the included Universities at the expense of including more courses in Clinical Pharmacy.Results: Pharmacists are scientists as well as clinicians, and basic science knowledge such as pharmaceutical sciences, give pharmacy graduates critical scientific foundations, in this regard, the reduction in pharmaceutical sciences content in a pharmacy curriculum may compromise the competence of pharmacy graduates, as the drug experts from the basic science level to the clinical level.Conclusion: The impact of reducing pharmaceutical science content, may compromise the Pharmacist ability to assume certain duties in the countries included in the study. This in consideration that Clinical Pharmacy is not widely practiced in the investigated countries and its application is limited compared to other job opportunities available for Pharmacy graduates of these countries such as Community Pharmacy, Pharmaceutical Industries, marketing and sales and utilization of natural resources of medicinal plants by research and development units.Recommendations on how to avoid such decrease in teaching hours of Pharmaceutical Courses and fulfil the job requirements in the above countries are given

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Insight into potassium's role in childhood mortality due to severe acute malnutrition

Hypokalaemia is associated with an increase in mortality in children with severe acute malnutrition (SAM) and diarrhoea. This is a descriptive cross-sectional retrospective study conducted in the Nutritional Ward at Mohamed Alamin Hamid Pediatrics Hospital in Omdurman, Sudan. It aimed to assess the frequency of hypokalaemia among children with SAM to understand the influence of hypokalaemia and potassium supplementations contributed on the children survival rates (January-December 2015). It included 215 patients with SAM and acute diarrhoea. The potassium levels of all the patients were assessed upon hospital admission and this correlated with the mortality according to the degree of hypokalaemia and treatment initiated. Hypokalaemia was evident in 70.2% of the patients. Mortality was 3.1% in normokalaemic and 13.9% in hypokalaemic patients. The patients' survival was significantly associated with their serum potassium levels and the treatment received. The survival rates have been assessed via the Multinomial Logistic Model, which reveals that normokalaemic children had a chance of 157.349 (95% confidence interval 18.479-1,339.811) times higher than that compared to the baseline children with advanced hypokalaemia with serum levels <2 mEq/l (; p; -value < 0.001). Children with mild hypokalaemia within the serum levels of 3.0-3.4 mEq/ml showed an increased survival chance of 549.970 (95% CI 19.293-3,238.716) times compared to the baseline children (p-value = 0.000). In patients with SAM, who presented with acute diarrhoea, there was an increase in mortality in patients with hypokalaemia compared with patients who presented with normal potassium levels. Corresponding mortality rates increased significantly with the severity of hypokalaemia. In severe hypokalaemia, there is a significant difference in mortality between patients treated with oral rehydration solutions for malnutrition in relation to patients treated with oral potassium supplements or with intravenous potassium

Proinsulin C-Peptide Enhances Cell Survival and Protects against Simvastatin-Induced Myotoxicity in L6 Rat Myoblasts.

The repair capacity of progenitor skeletal muscle satellite cells (SC) in Type 1 diabetes mellitus (T1DM) is decreased. This is associated with the loss of skeletal muscle function. In T1DM, the deficiency of C-peptide along with insulin is associated with an impairment of skeletal muscle functions such as growth, and repair, and is thought to be an important contributor to increased morbidity and mortality. Recently, cholesterol-lowering drugs (statins) have also been reported to increase the risk of skeletal muscle dysfunction. We hypothesised that C-peptide activates key signaling pathways in myoblasts, thus promoting cell survival and protecting against simvastatin-induced myotoxicity. This was tested by investigating the effects of C-peptide on the L6 rat myoblast cell line under serum-starved conditions. Results: C-peptide at concentrations as low as 0.03 nM exerted stimulatory effects on intracellular signaling pathways-MAP kinase (ERK1/2) and Akt. When apoptosis was induced by simvastatin, 3 nM C-peptide potently suppressed the apoptotic effect through a pertussis toxin-sensitive pathway. Simvastatin strongly impaired Akt signaling and stimulated the reactive oxygen species (ROS) production; suggesting that Akt signaling and oxidative stress are important factors in statin-induced apoptosis in L6 myoblasts. The findings indicate that C-peptide exerts an important protective effect against death signaling in myoblasts. Therefore, in T1DM, the deficiency of C-peptide may contribute to myopathy by rendering myoblast-like progenitor cells (involved in muscle regeneration) more susceptible to the toxic effects of insults such as simvastatin

Association of methylenetetrahydrofolate reductase C677T and reduced-f carrier-1 G80A gene polymorphism with preeclampsia in Sudanese women

Purpose To assess the associations between preeclampsia, methylenetetrahydrofolate reductase (MTHFR) C677T, and reduced folate carrier-1 (RFC-1) G80A gene polymorphism in Sudanese women. Methods A matched (for age and parity) case–control study was conducted in a tertiary hospital (Saad Abualila) in Khartoum, Sudan during February to September 2018. The cases were women with preeclampsia and healthy pregnant women were the controls (160 women in each arm of the study). Genotyping for MTHFR C677T and RFC-1 G80A was performed by polymerase chain reaction–restriction fragment length polymorphism. Results . . The MTHFR C677T variation was significantly more frequent in women with preeclampsia (16.2%) than in healthy pregnant women (1.8%) (OR = 10.1, 95% CI = 3.0–34.2, P < 0.001). There was borderline significance in the RFC-1 G80A variation, which was present in 2.50% of women with preeclampsia, but was not found in healthy pregnant women (P = 0.052). Conclusion s: A higher prevalence of MTHFR C677T polymorphism in women with preeclampsia compared with healthy pregnant women suggests involvement of this variation in preeclampsia in Sudan

Population pharmacokinetics of artemether and dihydroartemisinin following single intramuscular dosing of artemether in African children with severe falciparum malaria

Aims To determine the population pharmacokinetics of artemether and dihydroartemisinin in African children with severe malaria and acidosis associated with respiratory distress following an intramuscular injection of artemether. Methods Following a single intramuscular (i.m.) injection of 3.2 mg kg(-1) artemether, blood samples were withdrawn at various times over 24 h after the dose. Plasma was assayed for artemether and dihydroartemisinin by gas chromatography-mass spectrometry. The software program NONMEM was used to fit the concentration-time data and investigate the influence of a range of clinical characteristics (respiratory distress and metabolic acidosis, demographic features and disease) on the pharmacokinetics of artemether and dihydroartemisinin. Results A total of 100 children with a median age of 36.4 (range 5-108) months were recruited into the study and data from 90 of these children (30 with respiratory distress and 60 with no respiratory distress) were used in the population pharmacokinetic analysis. The best model to describe the disposition of artemether was a one-compartment model with first-order absorption and elimination. The population estimate of clearance (clearance/bioavailability, CL/F) was 14.3 l h(-1) with 53% intersubject variability and that of the terminal half-life was 18.5 h. If it was assumed that artemisin displays 'flip-flop' kinetics, the elimination half-life was estimated to be 21 min and the corresponding volume of distribution was 8.44 l, with an intersubject variability of 104%. None of the covariates could be identified as having any influence on the disposition of artemether. The disposition of dihydroartemisinin was fitted separately using a one-compartment linear model in which the volume of distribution was fixed to the same value as that of artemether. Assuming that artemether is completely converted to dihydroartemisinin, the estimated value of CL/F for dihydroartemisinin was 93.5 l h(-1), with an intersubject variability of 90.2%. The clearance of dihydroartemisinin was formation rate limited. Conclusions Administration of a single 3.2 mg kg(-1) i.m. dose of artemether to African children with severe malaria and acidosis is characterized by variable absorption kinetics, probably related to drug formulation characteristics rather than to pathophysiological factors. Use of i.m. artemether in such children needs to be reconsidered

The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BackgroundUnderstanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally.MethodsThe GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented.FindingsGlobally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]).InterpretationThe leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden