Diabetes care and prevention services provided by pharmacists: progress made during the COVID-19 pandemic and the need for additional efforts in the post-pandemic era

Diabetes is a challenging metabolic disease that significantly impacts people's health worldwide. It requires a comprehensive approach for better prevention and control, especially during challenging times such as the recent pandemic. The COVID-19 pandemic has altered how health care professionals, including pharmacists, provide health care. With the widespread use of virtual and online platforms for service delivery, pharmacist-led diabetes care has been transformed to meet the needs of patients during the pandemic. This article aims to discuss examples of pharmacist-led diabetes care services during the pandemic and highlight areas where additional pharmacist efforts are needed in the post-pandemic era

Erectile dysfunction

The aim of this course is to share existing evidence on the diagnosis and management of patients suffering from erectile dysfunction (ED). ED is one of the main growing complaints among males. This course is planned for healthcare providers as a self-study course and assessment materials to ensure that by the upon completion of this course, you will have the understanding and details about the epidemiology, aetiology and pathophysiology, diagnosis, management and treatment options for the ED patients and last but not the least about the pharmacist’s role in the management and counselling of ED patients. We hope that you will find this course useful not only to collect CPD points (A8: 3 CPD Points) but more importantly, to enable you to provide the effective counselling to your ED patients as part of your professional role as a healthcare provider. The course structure consists fo four chapters followed by an assessment: Chapter 01: Epidemiology & Aetiology of Erectile Dysfunction Chapter 02: Anatomy & Pathophysiology of the Penis Chapter 03: Management & Treatment Options for Erectile Dysfunction Chapter 04: Role of Pharmacists in Erectile Dysfunction Assessment: (20 randomized quiz questions, passing mark 80%, unlimited attempts) Feedback Lastly, we invite you to provide feedback regarding this course so that can it can be continuously improved and made relevant, practical and useful for you and others

Cardiovascular outcomes and the use of oral antidiabetic drugs: a review of current evidence from observational studies

Type 2 diabetes mellitus (T2DM) is a major global disease burden that affects millions of people worldwide. The disease is well known to predispose patients to a wide range of macro- and microvascular complications. Cardiovascular complications are common macrovascular consequences among patients with T2DM. The primary goal of T2DM management is to achieve proper glycaemic control that helps to avoid or delay the incidence of disease complications. T2DM management involves the utilisation of oral antidiabetic medications and injectables, including insulin. Hence, we conducted this work to discuss and summarise the cardiovascular outcomes associated with the oral antidiabetic pharmacotherapy prescribed for patients with T2DM. The agents involved were metformin, sulfonylurea, dipeptidyl peptidase-4 inhibitors, thiazolidinediones, alpha-glucosidase inhibitors, and sodium-glucose cotransporter-2 inhibitors. We decided to focus on the findings reported from observational studies published between 2009 to 2019 to provide an updated and more realistic insight on these cardiovascular outcomes associated with the oral antidiabetic drugs in the usual clinical practice

Mortality and its predictors among hospitalized patients with infections due to extended spectrum beta-lactamase (ESBL) Enterobacteriaceae in Malaysia: a retrospective observational study

Background: Extended spectrum beta-lactamase (ESBL) pathogens are associated with morbidity and mortality. There is a paucity of data describing the treatments and outcomes of ESBL infections in Malaysia. This study evaluated the treatments, mortality and associated factors among patients hospitalized with infections due to ESBL positive enterobacteriaceae. This is a retrospective study conducted in a tertiary hospital from January 2018 to June 2020. Hospitalized patients with ESBL-positive enterobacteriaceae infections were included. A clinical pharmacist collected data by reviewing the patients’ electronic medical records. The data were analysed using both descriptive and inferential analyses. Results: This analysis included 110 patients with a mean age of 62.1±14.4 years. Klebsiella pneumoniae (53.6%) and Escherichia coli (40.9%) were the most prevalent pathogens among the 110 infections. Bacteremia (42.7%) was the most frequent diagnosis. The isolates were resistant to majority of penicillins and cephalosporins. However, over a third (39.3%) were susceptible to piperacillin–tazobactam, while carbapenem susceptibility was extremely high (≥99%). The most frequently used empiric and defnitive antibiotics was piperacillin–tazobactam and meropenem, respectively. Less than a third (28.2%) of patients received active empiric antibiotics, and the mean duration before active antibiotics was 3.9±2.7. Overall, hospital mortality rate was 13.6%, and mortality was signifcantly associated with ICU admission (AOR 8.75; 95% CI 1.05–72.75; P=0.045) and diabetes mellitus (AOR 9.85; 95% CI 1.04–93.09; P=0.046). Conclusions: Carbapenems are the major antibiotics used to treat ESBL-positive enterobacteriaceae infections. Hospital mortality rate is relatively high and is signifcantly associated with in patients admitted to ICU and those with diabetes mellitus. Antibiotic stewardship interventions are necessary to promote early administration of active antibiotics and to reduce overuse of carbapenem antibiotics

Knowledge, attitude, and perception of public about participation in COVID-19 clinical trials: A study from Egypt and Saudi Arabia

Background Pharmaceutical firms are striving to find potential treatments to prevent and treat COVID-19. One of the gold standards to evaluate treatment is a clinical trial; however, the difficulty in patient recruitment could act as a determinant. It is evident from the registry data that very few studies have been conducted involving the population of the Middle East and North Africa (MENA) region. Aim To document knowledge, perception, and attitude of the public from Two large countries in the MENA region (Egypt and Saudi Arabia) towards participation in clinical trials focused on evaluating potential COVID-19 treatments. Method A cross-sectional study was conducted that used a snowball sampling strategy for recruitment. General population 18 years old or older, who lived in Saudi Arabia or Egypt were invited. The survey was adopted from literature and was approved by an ethics committee. Results Out of 800 participants in the survey, 407 participants were from Egypt, and 393 were from Saudi Arabia. Most participants (48%) had moderate knowledge, i.e., >60% <80%. The results revealed poor attitude (88.5%) and poor perceptions (45.8%) regarding participation in COVID-19 clinical trials. Education and residence were identified as determinants of participants’ knowledge, attitude, and perceptions. Participants' knowledge and understanding of COVID-19 trials did not impact their willingness to participate. This coupled with a poor attitude and perception among the masses drastically affects any potential for participation in future clinical trials. Conclusion A relatively small proportion of participants were interested in enrolling in COVID-19 studies. Increased collective engagement through social media and healthcare professionals can help improve attitudes and perceptions toward trial participation

The intraperitoneal ondansetron for postoperative pain management following laparoscopic cholecystectomy: A proof-of-concept, double-blind, placebo-controlled trial

Background Pain after laparoscopic cholecystectomy remains a major challenge. Ondansetron blocks sodium channels and may have local anesthetic properties. Aims To investigate the effect of intraperitoneal administration of ondansetron for postoperative pain management as an adjuvant to intravenous acetaminophen in patients undergoing laparoscopic cholecystectomy. Methods Patients scheduled for elective laparoscopic cholecystectomy were randomized into two groups (n = 25 each) to receive either intraperitoneal ondansetron or saline injected in the gall bladder bed at the end of the procedure. The primary outcome was the difference in pain from baseline to 24-h post-operative assessed by comparing the area under the curve of visual analog score between the two groups. Results The derived area under response curve of visual analog scores in the ondansetron group (735.8 ± 418.3) was 33.97% lower than (p = 0.005) that calculated for the control group (1114.4 ± 423.9). The need for rescue analgesia was significantly lower in the ondansetron (16%) versus in the control group (54.17%) (p = 0.005), indicating better pain control. The correlation between the time for unassisted mobilization and the area under response curve of visual analog scores signified the positive analgesic influence of ondansetron (rs = 0.315, p = 0.028). The frequency of nausea and vomiting was significantly lower in patients who received ondansetron than that reported in the control group (p = 0.023 (8 h), and 0.016 (24 h) respectively). Conclusions The added positive impact of ondansetron on postoperative pain control alongside its anti-emetic effect made it a unique novel option for patients undergoing laparoscopic cholecystectomy

Disparities in prevalence and barriers to hypertension control: a systematic review

Controlling hypertension (HTN) remains a challenge, as it is affected by various factors in different settings. This study aimed to describe the disparities in the prevalence and barriers to hypertension control across countries of various income categories. Three scholarly databases—ScienceDirect, PubMed, and Google Scholar—were systematically examined using predefined search terms to identify potentially relevant studies. Original research articles published in English between 2011 and 2022 that reported the prevalence and barriers to HTN control were included. A total of 33 studies were included in this systematic review. Twenty-three studies were conducted in low and middle-income countries (LMIC), and ten studies were from high-income countries (HIC). The prevalence of hypertension control in the LMIC and HIC studies ranged from (3.8% to 50.4%) to (36.3% to 69.6%), respectively. Concerning barriers to hypertension control, patient-related barriers were the most frequently reported (n = 20), followed by medication adherence barriers (n = 10), lifestyle-related barriers (n = 8), barriers related to the affordability and accessibility of care (n = 8), awareness-related barriers (n = 7), and, finally, barriers related to prescribed pharmacotherapy (n = 6). A combination of more than one category of barriers was frequently encountered, with 59 barriers reported overall across the 33 studies. This work reported disparities in hypertension control and barriers across studies conducted in LMIC and HIC. Recognizing the multifactorial nature of the barriers to hypertension control, particularly in LMIC, is crucial in designing and implementing customized interventions