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Background: This review summarises the impact of virtual patient simulation (VPS) on pharmacy students’ knowledge, skills, and perceptions. Methods: The PubMed, Cochrane Library, and Web of Science databases were searched using relevant keywords. Full-text articles in English, published between 2010 and August 2021, were retrieved if they evaluate the impact of web-based interactive VPS in pharmacy education. Results: This review included 19 studies, 9 of which were comparative. VPS was used to develop or assess different pharmacy-related skills. In general, post-VPS exposure test scores were better than the pre-VPS test scores in 12 studies. VPS significantly improved higher-level learning, counselling, and decision-making skills more than paper-based cases. The favourable impact of VPS on learners’ confidence, student engagement, and satisfaction was noted. Conclusion: VPS enhances knowledge and clinical decision-making skills. It can also address the needs of pharmacy students with active learning preferences.

Acute respiratory distress syndrome (ARDS), a serious manifestation of acute lung injury (ALI), is a debilitating inflammatory lung disease that is caused by multiple risk factors. One of the primary causes that can lead to ALI/ ARDS is cigarette smoke (CS) and its primary mode of action is via oxidative stress. Despite extensive research, no appropriate therapy is currently available to treat ALI/ARDS, which means there is a dire need for new potential approaches. In our study we explored the protective effects of 70 % methanolic-aqueous extract of Ipomoea nil (Linn.) Roth, named as In.Mcx against CS-induced ALI mice models and RAW 264.7 macrophages because Ipomoea nil has traditionally been used to treat breathing irregularities. Male Swiss albino mice (20-25 +/- 2 g) were subjected to CS for 10 uninterrupted days in order to establish CS-induced ALI murine models. Dexamethasone (1 mg/kg), In.Mcx (100 200, and 300 mg/kg) and normal saline (10 mL/kg) were given to respective animal groups, 1 h before CS-exposure. 24 h after the last CS exposure, the lungs and bronchoalveolar lavage fluid (BALF) of all euthanized mice were harvested. Altered alveolar integrity and elevated lung weightcoefficient, total inflammatory cells, oxidative stress, expression of pro-inflammatory cytokines (IL-10 and IL-6) and chemokines (KC) were significantly decreased by In.Mcx in CS-exposed mice. In.Mcx also revealed significant lowering IL-10, IL-6 and KC expression in CSE (4 %)-activated RAW 264.7 macrophage. Additionally, In.Mcx showed marked enzyme inhibition activity against Acetylcholinesterase, Butyrylcholinesterase and Lipoxygenase. Importantly, In.Mcx dose-dependently and remarkably suppressed the CS-induced oxidative stress via not only reducing the MPO, TOS and MDA content but also improving TAC production in the lungs. Accordingly, HPLC analysis revealed the presence of many important antioxidant components. Finally, In.Mcx showed a marked decrease in the NF-KB expression both in in vivo and in vitro models. Our findings suggest that In.Mcx has positive therapeutic effects against CS-induced ALI via suppressing uncontrolled inflammatory response, oxidative stress, lipoxygenase and NF-KB p65 pathway.

Health literacy is how well the patients are able to attain, deal with, and understand basic health information. This is particularly important when it comes to comprehending prescribed medication instructions. To improve the communication strategies for health-care professionals during patient counseling, our study aimed to assess the influence of health literacy and medication adherence in older patients. The objectives of the study were to evaluate associations that occur between the level of health literacy and medication adherence. This study used a convenience sampling method of females (older than 60 years) attending the diabetic clinic in two hospital settings ( N = 524). All study participants filled three validated questionnaires: these were the Literacy Assessment for Diabetes, the Diabetes Numeracy Test, and a modified Brief Adherence Rating Scale. To assess the spectrum of health literacy differences, we used χ2 analysis and linear regression analysis. Individuals with adequate health literacy were more likely to remember to take their medications compared with those with inadequate health literacy, χ2(4) = 11.6, p = .04. Adequate literacy level study participants were more likely to not change the dose of their medications without medical advice (12.3%) compared with those individuals with inadequate health literacy (2.8%), χ2(4) = 11.13, p = .03. The results in our study suggest that health-care professionals should focus on appropriate communication attuned to the assessment of health literacy levels particularly in older female patients when discussing medication instructions.

The objectives of this article were to review the mechanism and clinical significance of statins-macrolides interaction, determine which combination has the highest risk for the interaction, and identify key patients' risk factors for the interaction in relation to the development of muscle toxicity. A literature review was conducted in PubMed and Embase (1946 to December 2018) using combined terms: statins - as group and individual agents, macrolides - as group and individual agents, drug interaction, muscle toxicity, rhabdomyolysis, CYP3A4 inhibitors, and OAT1B inhibitors, with forward and backward citation tracking. Relevant English language in vivo studies in healthy volunteers, case reports, and population studies were included. The interaction between statins and macrolides depends on the type of statin and macrolide used. The mechanism of the interaction is due to macrolides' inhibition of CYP3A4 isoenzyme and OAT1B transporter causing increased exposure to statins. The correlation of this increased statin's exposure to the development of muscle toxicity could not be established, unless the patient had other risk factors such as advanced age, cardiovascular diseases, renal impairment, diabetes, and the concomitant use of other CYP3A4 inhibitors. Simvastatin, lovastatin, and to lesser extent atorvastatin are the statins most affected by this interaction. Rosuvastatin, fluvastatin, and pravastatin are not significantly affected by this interaction. Telithromycin, clarithromycin, and erythromycin are the most "offending" macrolides, while azithromycin appears to be safe to use with statins. This review presented a clear description of the clinical significance of this interaction in real practice. Also, it provided health care professionals with clear suggestions and recommendations on how to overcome this interaction. In conclusion, understanding the different characteristics of each statin and macrolide, as well as key patients' risk factors, will enable health care providers to utilize both groups effectively without compromising patient safety.

AIMS: Diabetic peripheral neuropathy affects up to 60% of individuals and often leads to foot ulceration and eventual amputation. When oral therapy has failed to achieve pain relief, the first line local treatment is the 5% lidocaine-medicated plaster which provides local relief. Capsaicin 8% patch is considered a promising topical treatment for diabetic peripheral neuropathy. The present study investigated the efficacy, safety and tolerability of capsaicin 8% patch vs 5% lidocaine patch treatments over 24 weeks in South Asian male diabetic patients with established peripheral diabetic neuropathy. METHODS: Analgesic effectiveness was assessed by observing any change in the Numeric Pain Rating Scale (NPRS) score, Brief Pain Inventory (BPI) for painful diabetic peripheral neuropathy (BPI-DPN question 4) and Patient Global Impression of Change (PGIC). All patients received 4% lidocaine gel/cream for 60 min prior to patch application. The trial was probably underpowered, taking into account the smaller than expected number of participants from the calculated 350 sample size required for the whole study. Two hundred ninety-one individuals were divided into three groups based on treatment regimen; Group LL (Lidocaine + Lidocaine), Group LP (Lidocaine + Placebo), Group LC (Lidocaine + Capsaicin). The treatment procedure was conducted once initially and then repeated once at 12 weeks. The patients were followed up on alternate weeks till 24 weeks after the initial treatment. RESULTS: Group LC experienced a more significant reduction in the average pain intensity (p

OBJECTIVES: The inappropriate use of medications is harmful and is a common issue in hospitalised patients. Patients hospitalised in general surgery wards are usually at high risk for drug-related problems (DRPs). This randomised controlled trial aimed to explore the value of a pharmaceutical care service conducted in general surgery wards in the identification and reduction of DRPs in comparison with standard medical care. METHODS: This study was conducted in general surgery wards including abdominal, cardiovascular, vascular, endocrine, orthopaedic and oncological surgeries at one of the largest teaching hospitals in Jordan over a period of 6 months. Recruited patients were randomised into intervention or control groups. Clinical pharmacists assessed patients’ DRPs and submitted recommendations to resolve the identified DRPs in the intervention group. RESULTS: Patients in the intervention group (n=63) and the control group (n=60) had a mean age of 55±14.4 years, with 52.0% being women. A total of 1062 DRPs were identified, with a mean of 8.6±3.6 per patient (intervention group, 8.65±4.2; control group, 8.62±2.6; p=0.56). The commonly identified DRPs included safety (20.2%) and efficacy (19.0%) issues. The acceptance rate for pharmacists’ recommendations by physicians was very high (90%) with a good DRP correction rate of 58.9% during patients’ hospital stay. The value of pharmaceutical care was significantly reflected in the achievement of the therapeutic outcomes and prevention of morbidity (resolved/improved or prevented) of 68.2% (24.2%+44%) in the intervention group compared with 19.2% (12.4%+6.8%) in the control group (p

Background Diabetes mellitus (DM) is a leading cause of chronic kidney disease (CKD). The antihyperglycemic treatment options for patients with Type 2 DM are limited because of safety and tolerability concerns. Aims To retrospectively assess the effect of using Alogliptin; a dipeptidyl peptidase-4 inhibitor (DPP-4i) along with conventional gliclazide: a sulphonylurea (SU) on renal outcomes and glycaemic control in T2DM patients with mild CKD and hypertension. Methods A total of 76 patient records (38 males and 38 females) of patient ages 40–60 were analysed from the kidney unit at Punjab Care hospital, Lahore, Pakistan. All patients had a confirmed history of T2DM with mild CKD and established hypertension. Eligible patients were divided into two groups of 38 individuals each. Group SU received gliclazide monotherapy (SU) or Alogliptin (DPP-4i)+gliclazide (SU) add on therapy. All patients were followed up for 12 months. Results The alogliptin (DPP-4i) plus gliclazide (SU) add on therapy group, in comparison to the group only receiving gliclazide (SU), showed a significant difference in eGFR values. The mean±SD GFR values post 12 months were 74.8±0.31 (95%CI:74.8±0.09;74.7–74.9) and 76.1±0.25 (95%CI: 76.1±0.08;76.0-76.2) for SU vs. SU+DPP-4i, respectively, with mean calculated effect size of 1.6,. HbA1c, 1,5 AG and ipid profile values have significantly changed (p

Background: Inhaled Corticosteroid therapy is the cornerstone of asthma treatment. Yet, the reported prevalence of steroid phobia among parents of asthmatic children has been concerning. This study aimed to assess the impact of steroid phobia on ICS adherence, and asthma management. Method: A multicenter, cross-sectional study was held among 500 parents of asthmatic children over 12-months. Each participant completed a structured questionnaire that recorded patients' demographic data, and explored participants’ main concerns regarding ICS. Additionally, participants level of asthma control was assessed by the Arabic childhood asthma control test C-ACT. Result: Of 500 interviewed asthmatic children, up to 66.6% reported having ICS fears, yet only 25.8% reported discussing their concerns with their healthcare providers. In addition, over 50% of parents reported requesting ICS sparing. Regarding ICS adherence, a significant difference (

Background: Underreporting of adverse drug reactions (ADRs) has placed a heavy financial burden on health care resources worldwide. Realizing the importance of proper ADR reporting is paramount for implementing better patient care. Objective: This study was designed to assess knowledge, attitude, and practice (KAP) of ADR reporting among United Arab Emirates (UAE) health care professionals to clarify their present strategies and identify steps to avoid underreporting. Methods: A self-administered cross-sectional questionnaire was designed and randomly distributed to different health care personnel ( n = 150). All participants were briefly informed about the aim of the study and given sufficient time to respond. The responses were collected over 6 months. The data were statistically analyzed for each reporter category (community pharmacist, hospital pharmacist, and doctors) using the chi-square test. Results: We found that 81%, 83%, and 83.3% of doctors, community pharmacists, and hospital pharmacists, respectively, were not aware of the existence of a reporting center and 56%, 60%, and 72% were not aware of a reporting procedure. Poor ADR reporting practices were shown by responders; only 19%, 14%, and 12.1% of doctors, community pharmacists, and hospital pharmacists reported ADRs. Conclusion: This study showed poor KAP results among health care professionals. Proper educational intervention strategies should be established in different health care settings for better patient care. With proper guidance, objectives in all health care settings should be targeted to positively change the concept of health care to consider ADR reporting as a common accepted daily routine practice.

Background The impact of Excision repair cross-complementation group 1 ( ERCC1 ) and group 2 ( ERCC2 ) expression levels on the efficacy of oxaliplatin-based chemotherapy is still controversial. The present study was conducted to determine the predictive value of these molecular biomarkers in stage III and IV colorectal cancer (CRC) patients receiving oxaliplatin (OX)-based chemotherapy as first-line treatment. Methods The study included 80 CRC patients who received first line oxaliplatin based chemotherapy The expression levels of ERCC1 and ERCC2 -mRNA and proteins were determined in the primary tumors by quantitative real time reverse transcription polymerase chain reaction(RT-qPCR) and immunohistochemistry (IHC); respectively. The results of mRNA expression were correlated with patients' characteristics, response to treatment, overall- and event free survival (OS & EFS). Results Sixty four out of the 80 patients were legible for assessment of ERCC1 and ERCC2 expression. The cut-off levels of ERCC1 and ERCC2 -RNA were 3.8 × 10 − 3 & 4.6 × 10 − 3 ; respectively. Reduced ERCC1 and ERCC2 RNA expressions were detected in 50 (78.1%) and 48 (75%) cases, respectively whereas reduced proteins were detected in 48 cases (75%) for ERCC1 and ERCC2 . After The median follow up period was 30.5 months (range: 7–104 months), Patients with low mRNA ERCC1 levels showed significantly longer OS ( p = 0.011) and EFS ( p ˂ 0.001). However, no significant relation was found between ERCC2 levels and OS or EFS. In multivariate analysis performance status (PS), stage of the disease and ERCC1 -mRNA expression were independent prognostic factors for EFS whereas tumor histology and stage of the disease were independent factors for OS. Conclusions ERCC1 expression levels may help in selecting patients who benefit from oxaliplatin chemotherapy in stage III & IV CRC. Further large trials are needed to validate these data.

Substituting nebulisers by another in non-invasive ventilation circuit (NIV) involves many process variables which must be adjusted to ensure patient optimum therapy. However, there is a doubt when nebulisers use the same technology. Data mining technology based on artificial neural networks and genetic algorithms were used here to model in-vitro inhalation process and predict bioavailability from inhaled doses delivered by three different vibrating mesh nebulisers (VMNs) in NIV. Modelling of data indicated that in-vitro performance of VMNs was dependent mainly on fine particle fraction, mass median aerodynamic diameter (MMAD), total emitted dose (TED) and to lesser extent on nebuliser type. Ex-vivo model indicated that amount of salbutamol collected on facemask filter was directly affected by TED. In-vivo model showed that amount of salbutamol deposited into the lung (0.5hQ) and amount absorbed systemically (24hQ) were dependent directly on MMAD and TED. Female patients showed higher 24hQ values than males. Nebuliser type affected TED, 0.5hQ but not 24hQ values. Results indicate suitability of VMNs in achieving appropriate in-vitro inhalation performance model. The results also, indicate that the three VMNs are comparable and can be interchanged with no fear of any additional toxicity.

Chronic pain, the most common complication of diabetes, is treated with medication often to no avail. Our study aimed to compare the use of mindfulness meditation and progressive relaxation to reduce chronic pain in older females with diabetes. Methods The 105 study participants were divided randomly into 3 groups: Group MM (mindfulness meditation), Group CM (control meditation), and Group PM (progressive relaxation meditation). Assessment of analgesic effectiveness required changes in average daily pain Brief Pain Inventory (BPI) modified for painful diabetic peripheral neuropathy and Patient Global Impression of Change using descriptive statistics, Student’s t test, and analysis of variance where applicable. Results Both Groups MM and PM experienced significant ( P < .05) reduction in average daily pain in last 24 hours at study end compared to baseline (28.7% and 39.7%, respectively). Group MM had more significant ( P < .01) reduction of pain compared to control, a score of 5.2 ± 1.2 dropped to 3.0 ± 1.1 by week 12 of treatment. Groups MM and PM showed significant improvement in patients’ impression at study end, 75 ± 5.1% (n = 36) and 61 ± 6.5% (n = 32), respectively. In Group MM, patient satisfaction scores increased significantly ( P < .05) to 3.8 ± 1.9 by week 12. Conclusion Integrative therapies such as mindfulness meditation can be part of a comprehensive pain management plan. Benefits include reduction of pain-related medication consumption, better treatment outcomes, improvement in comorbid conditions such as anxiety and depression as well as no risk of addiction or abuse.

BACKGROUND: The drug delivery characteristics of each inhaler/spacer combination are unique. The spacer size as well as the presence of electrostatic charge greatly influence the inhaler dose emission and in vivo delivery. Using a previously developed urinary pharmacokinetic method, we have measured the relative lung and systemic bioavailability of beclometasone dipropionate (BDP) after inhalation from 2 hydrofluroalkane-beclometasone dipropionate (HFA-BDP) formulations when used with a spacer. METHODS: 12 healthy volunteers received 8 randomized doses, separated by 7 d, of inhaled of BDP with either the Clenil pressurized metered-dose inhaler (pMDI; 250 μg) or the breath-actuated Qvar Easi-Breathe inhaler (100 μg), used alone or with a spacer. The urinary amounts of BDP excreted and retained in the spacer were assayed using a liquid chromatographic mass spectrometer. The spacer was assessed after washing with a detergent solution that was either rinsed or not rinsed with water. In addition, the aerodynamic characterization of each inhaler/spacer combination was assessed using the Andersen Cascade Impactor operated at 28 L/min using a 4-L inhalation volume. The amount of BDP deposited in the induction port, spacer, and various Anderson Cascade Impactor stages were determined. RESULTS: The in vivo 30-min urinary excretion and the in vitro fine particle dose results were only slightly affected by adding the spacer to the Clenil pMDI or the Qvar Easi-Breathe inhaler. However, the spacer significantly reduced drug particle impaction in the oropharynx and minimized deposition in the gastrointestinal tract. Therefore, using spacers with BDP inhalers is associated with a more favorable therapeutic ratio because it has little effect on lung dose, but it significantly reduced throat deposition. An improved lung deposition was achieved with non-rinsed spacers compared to spacers rinsed with water. CONCLUSION: The difference in the BDP particle size between formulations as well as spacer size greatly affected drug deposition in different regions of the respiratory tract.

Objectives This study aimed to investigate physicians’ and pharmacists’ perceptions of the importance of pharmacists’ role in healthcare in Egypt, and actual delivery of these roles in practice. Identifying any differences and inconsistencies between these will inform future strategies that maximize pharmacists’ professional contribution to hospital practice. Methods A self-administered questionnaire using a 5-point Likert scale was distributed to a convenience sample of physicians (500) and pharmacists (500) practicing in selected private or public hospitals in Egypt. The main sections of the questionnaire comprised statements that pertained to physicians’/pharmacists’ views on the importance of pharmacists’ roles and their actual delivery in practice. Key findings In this study, physicians showed low scores for both the importance of and the delivery of advanced patient-facing clinical pharmacy roles such as suggesting prescription medications, and designing treatment plans. In comparison, pharmacists were more positive on both of these aspects of their roles. High mean scores were reported by the physicians for pharmacist’s traditional roles such as patient counselling, assessing compliance, preventing medication errors and treating minor illnesses. Both physicians and pharmacists reported poor pharmacists practice as drug information resources despite their high perception of the importance of that role. Conclusion This study suggested that in hospitals in Egypt, there are significant differences between physicians’ and pharmacists’ perception and practice, and pharmacists’ clinical skills are underutilized in health care.

Dyslipidemia, particularly increased low-density lipoprotein cholesterol (LDL-C) levels, are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD) events. There is an unmet need for ASCVD risk reduction even with the optimal use of statin therapy, which has led to an ongoing search for novel targets for cholesterol reduction to decrease ASCVD events. Objectives: The main aim of this review was to summarize current evidence on approved and emerging non-statin lipid-lowering therapies. Methods and Materials: Recent literature on U.S. FDA approved non-statin lipid-lowering therapies and evolving lipid-lowering drugs currently under development was reviewed. Results and Discussion: In the past 20 years, the emergence of non-statin cholesterol-lowering drugs has changed the landscape of dyslipidemia management. Food and Drug Administration approval of non-statin lipid-lowering therapies such as ezetimibe, proprotein convertase subtilisin/Kexin type 9 (PCSK9) inhibitors (evolocumab, alirocumab), bempedoic acid and combination of bempedoic acid and ezetimibe, evinacumab and other triglyceride-lowering agents (eg, icosapent ethyl) has emerged. The European Commission has also recently approved inclisiran for treatment of hypercholesterolemia and mixed hypercholesterolemia even though FDA has put the approval of this drug on hold. Recent guidelines have incorporated PCSK9 inhibitors to treat patients with primary hyperlipidemia and patients with very high-risk ASCVD, who could not achieve adequate lipid-lowering with combination therapy of maximally tolerated statin and ezetimibe. Icosapent ethyl use as an adjunct therapy to statins is also recommended to reduce the risk of ASCVD in patients with hypertriglyceridemia. Conclusion: Despite cost limitations, the uptake of PCSK9 inhibitors is increasing. Approval of bempedoic acid alone or in combination with ezetimibe has provided additional oral lipid-lowering drug alternatives to ezetimibe. Various lipid-lowering drug targets are under investigation.

Hypertension and proteinuria are well-known predictors of chronic kidney disease (CKD) progression. Therapeutic interventions have different magnitude of albuminuria and hypertension. This study was designed to evaluate the efficacy and safety of combined vs. single renin-angiotensin-aldosterone system (RAAS) blockade in chronic kidney disease. Forty (28 female) patients with chronic kidney diseases were collected from nephrology outpatient clinic, internal medicine department, Beni Suef University hospital. They were divided randomly into 2 groups. Group A was 24 (20 females) patients treated with Enalapril, as angiotensin converting enzyme inhibitor (ACE-I) alone. Group B was 16 (8 females) patients treated with combination of Enalapril and Irbesartan, as angiotensin receptor blocker (ARB). All patients were subjected to full history taking; thorough clinical examination; certain laboratory tests and renal function tests at the start of the study, 1.5 and 3 months later. Proteinuria, urinary albumin/creatinine ratio (UACR), systolic blood pressure (SBP) and glomerular filtration rate (GFR) were significantly (p [Med-Science 2016; 5(3.000): 751-7]

Aerodynamic characteristics of aerosol delivery during invasive mechanical ventilation (IMV) are mostly determined by inserting cascade impactor in the circuit. Impactor might have some effect on airflow within IMV. Hence, the aim of the present study was to develop and evaluate new in vitro aerodynamic characterization methodology without affecting airflow in IMV. Breathing simulator was set in standard adult IMV circuit with inspiratory and expiratory pressures of 20 and 5 cm H2O, 1:3 inspiratory–expiratory ratio, 15 breaths min−1, and tidal volume of 500 ml. Two ml of salbutamol solution containing 10,000 μg was nebulized using three different vibrating mesh nebulizers (VMNs) and Sidestream jet nebulizer (JET). Sixteen-metered doses, containing 100 μg salbutamol each, were delivered using three different spacers. Each device was placed in inspiration limb of Y-piece of ventilator tubing. Aerodynamic characteristics of aerosol delivered were measured using cooled Andersen cascade impactor, with ...

Diarrhea is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and electrolyte imbalances. Hence, the aim in the present study was to evaluate the effect of elemental zinc in treatment of diarrhea in children. 100 diarrheic patients (50 females) aged from 1-12 years old collected from the-clinics of pediatric department at Beni suef University Hospital, were divided into two equal groups. Group A received elemental Zinc in the form of Zinc Sulphate (10 mg elemental Zinc daily for infants and 20 mg for children) with the normal diarrhea treatment. Group B received the normal anti-diarrhea treatment only. There was no significant difference between the two groups regarding most of the parameters studied. However, the mean±SD recovery time in group A was significantly higher (p-value=0.019) than in group B. However, when antibiotic alone was used as anti-diarrheal treatment the recovery time in days in group A was less than in group B but with no significant difference. The expected beneficial efficacy of elemental Zinc in the form of Zinc Sulphate on the duration and severity of acute diarrhea was not observed. However, the study showed that Zinc may be effective in diarrhea due to bacterial infections. [Med-Science 2015; 4(1.000): 1788-95]

Aim. To evaluate the safety issues and adverse effects of using TCHP regimen (docetaxel, carboplatin, trastuzumab, and pertuzumab) versus TCP regimen (docetaxel, carboplatin, and trastuzumab) in older postmenopausal women with nonmetastatic HER2-positive breast cancer. HER2 overexpressed in 20–25% of breast cancer signals an aggressive form of breast cancer and is treated with trastuzumab and pertuzumab. Methods. The patient record database was accessed to identify all postmenopausal women in the Punjab Care hospital who were above 65 years old, with stages 1–3 HER2-positive breast cancer and treated with neoadjuvant TCHP and neoadjuvant TCP from 2013 till 2016. Results. In TCH-P group and TCH group, mild fatigue (34% versus 36%) and diarrhea (48% versus 49%) were most common toxicities. Fever in TCH-P group and TCH group (12% versus 13%) was common. Anorexia affected 21% and 16% of patients receiving TCH and TCHP regimen, respectively. Febrile neutropenia was higher in TCH-P group 13% (3/23) versus 4.5% (1/22) in TCH group. Also 27.2% (6/22) of TCH-P group was hospitalized for treatment related toxicities versus 21.7% (5/23) of TCH group. Conclusion. Comparing neoadjuvant TCP and neoadjuvant TCH-P showed TCH-P regimen had an acceptable toxicity profile. Severe cardiac dysfunction was not observed. Using TCH-P regimen can be considered as relatively safe therapeutic option for elderly postmenopausal women with nonmetastatic HER2-positive breast cancer.

Patient receiving invasive mechanical ventilation (IMV) may benefit from medical aerosol, but guidance on dosing with different aerosol devices is limited to in-vitro studies. The study was designed to compare aerosol delivery with five different types of aerosol generators during IMV.In randomized design, 60 (30 female) mechanically ventilated chronic obstructive pulmonary disease (COPD) patients were assigned to one of 5 groups. Groups 1-4 received 5000 μg salbutamol using Aerogen Pro (PRO), Aerogen Solo (SOLO), NIVO vibrating mesh and jet nebulizers (JN), respectively, while group 5 received 800 μg (8 puffs) of salbutamol via metered dose inhaler with AeroChamber-MV (MDI-AC). All devices were place in the inspiratory limb of ventilator downstream from humidifier which was switched off while delivery. Patients received the inhaled dose on day 1 and provided urine 30 post dosing. They also recived the same inhaled dose with a filter before the endotracheal tube on day 2. Amount of salbutamol excreted in urine 30 min post inhalation and the amount deposited on the filter from all the COPD patients were determined as indeces of pulmonary deposition and systemic absorption, respectively.No significant difference was found between the 3 vibrating mesh nebulizers (VMNs). The in-vivo and ex-vivo testing showed that all the VMNs resulted in better aerosol delivery compared to JN (p 0.01). However, MDI-AC resulted in better aerosol delivery to VMNs but must be accompanied with careful attention and proper delivery of MDI-AC doses by healthcare provider.VMNs can be exchanged with each other, with no dose adjustment. However, dose adjustment is a must when replacing VMNs by JN or MDI-AC. This similarity and difference between the 5 aerosol delivery methods suggest that for IMV patients, aerosol delivery methods should be chosen or substituted with care.

AIM Urinary pharmacokinetic methods have been identified to determine the relative lung and systemic bioavailability after an inhalation. We have extended this methodology to inhaled beclometasone dipropionate (BDP).

Background: Supplementation of zinc and Vitamin A shows inconsistent effects on the respiratory morbidity in children in developing countries. Aims and Objectives: The aim of this study is to evaluate the effect of zinc and zinc + Vitamin A supplementation on the acute upper respiratory infections (AURTIs) in the pediatric patients aged between 2 and 12 years. Materials and Methods: A randomized double-blind placebo-controlled trial was employed in the present study. A total of 80 children suffering with AURTI were randomly assigned to one of three intervention groups: Placebo group, daily zinc (2–2.5 mg elemental zinc/Kg divided on 1–3 doses) group, and daily zinc + once dosing of Vitamin A (50000 IU) group in addition to the required treatment for their respiratory illness. Differential blood count analysis and C-reactive protein (C-RP) were assayed on days 1 and 5, and then, zinc or placebo was given daily for 6 months to the children, which were followed up and monitored once weekly for 6 months. The information regarding adverse effects, AURTI incidence, and missing school days were then collected. Results: The total white blood cells count, neutrophil (staph) percentage, and C-RP significantly decreased by post-supplementation with both zinc and zinc + Vitamin A. Monocytes percentage showed a significant increase by post-supplementation with zinc + Vitamin A (P = 0.011). In addition, AURTI and school absence incidences were significantly decreased in both zinc and zinc + Vitamin A recipients compared to placebo patients. Conclusion: We concluded that zinc alone or simultaneous zinc and Vitamin A supplementation in AURTI patients significantly improved the clinical outcome by improving the immune status.

The aim of the trial was to study the effect of Gentamicin as an aminoglycoside on Atracurium as a neuromuscular blocker. Forty patients (20-60 years old) who had minor surgical procedures were enrolled in the study. All the patients were with the American Society of Anaesthesiologists (ASA) physical status I-II with elective surgery in supine position. Patients were represented to full history, clinical examination and laboratory tests at Beni suef University Hospital to be sure that they met the criteria. Patients were divided into two equal groups. Group I (atracurium-gentamicin) and Group II (atracurium alone). Group I received gentamicin at dose of 2 mg/kg 5 minutes before starting the general anesthesia. The degree of muscle relaxation was monitored by using peripheral nerve stimulator with recording of Train of Four (TOF) ratio every 10 minutes, clinical duration (p=0.89), onset time (p=0.76), time to spontaneous recovery T4/T1 ratio(0.84) and occurrence of recurrence of the neuromuscular blockade were assessed. At the end of anesthesia it was noticed that there was no significant difference according to onset time, clinical duration or time to spontaneous recovery. Hence, there was no effect of using gentamicin preoperatively on the action of the atracurium. Key Words: Gentamicin, atracutium, neuromuscular blocker

Diarrheal disease is a leading cause of illness and death in children worldwide. Diarrhea is caused by a blend of bacterial, viral and parasitic pathogens. Enteric protozoal infections such as giardiasis, amebiasis and cryptosporidiosis are among the most common and most prevalent forms of gastrointestinal parasitic infections worldwide. Both nitazoxanide and metronidazole are used in treatment of protozoal diarrhea. Nitazoxanide was found to have a very broad spectrum of activity against many forms of parasites. Metronidazole also produces good results when it is used for treatment of parasitic infections. The aim in this study was to evaluate and compare the effect of nitazoxanide and metronidazole in treatment of protozoal diarrhea in children. This study was carried out on 160 diarrheic patients (83 males and 77 females), aged from 1-11 years old collected from the-clinics of pediatric department at Beni suef University Hospital. Patients were divided into two groups. Group A received Nitazoxanide 100 mg in 1-4 years aged patients and 200 mg in 4-11 years aged patients twice daily for 3 days respectively, Group B received Metronidazole 50 mg/Kg/body weight daily for 7 days. Patients were represented to full history taking, physical examination, laboratory investigations in the form of stool analysis, culture and complete blood count (CBC). There was a significant increase in the number of cases resolved by Nitazoxanide compared to Metronidazole group in both amebiasis and giardiasis (p-value < 0.05) with similar clinical improvement when using Nitazoxanide for 3 days and Metronidazole for 7 days. This study confirms the efficacy and safety of nitazoxanide as a 3-day treatment of diarrhea due to giardiasis & amebiasis in children. A 3-day course of nitazoxanide could replace much longer regimens of metronidazole. Key Words: Gastroenteritis, diarrhea, metronidazole, nitazoxanide

Substituting spacer by another in noninvasive ventilation (NIV) involves many variables, e.g. total emitted dose (TED), mass median aerodynamic diameter (MMAD), type of spacer, total lung deposition and total systemic absorption, which must be adjusted to ensure patient optimum therapy. Data mining based on artificial neural networks and genetic algorithms were used to model in vitro inhalation process, predict and optimize bioavailability from inhaled doses delivered by metered dose inhaler (MDI) using different spacers in NIV. Modeling of data indicated that in vitro performance of MDI-spacer systems was dependent mainly on fine particle dose (FPD), fine particle fraction (FPF), MMAD and to lesser extent on spacer type. Ex vivo model indicated that amount of salbutamol collected on facemask filter was directly affected by FPF. In vivo model (24hQ) depended directly on spacer type, FPF and TED. Female patients showed higher 0.5hQ and 24hQ values than males. AeroChamber VC spacer demonstrated higher TED and 24hQ in vivo values. Results indicated suitability of MDI-spacer systems in achieving appropriate in vitro inhalation performance. The possibility of modeling and predicting both ex vivo and in vivo capabilities of MDI-spacer systems from knowledge of in vitro attributes enabled detailed focus on important variables required to deliver safe and accurate doses of salbutamol to ventilated patients.

Background: Corticosteroids (CS) have long been known as the most powerful of all known anti-inflammatory agents. Since their introduction in 1949, they have shown pivotal role in the treatment of various serious disorders such as autoimmune diseases, allergic processes, organ transplantation, rheumatologic, dermatological, pulmonary, hematological, ophthalmologic, gastrointestinal disorders, and others. Nevertheless, such massive clinical use does not come without risks, where prolonged use has been linked to several serious side effects. Therefore, careful consideration of precautions recommended for safe use of CS is of paramount importance. Aims and Objectives: To assess knowledge, attitude, and practice (KAP) analysis of the proper use of different dosage forms of CS medications in different sets of CS users in the United Arab Emirates (UAE), to explore the extent to which steroid outpatients were well engaged with medication proper use and safety-related behaviors. Materials and Methods: A structured interview-based methodology was adopted to assess the KAPs revolving around steroid usage in patients located in the UAE cities; Dubai, Sharjah, Ajman and Al Ain. Patients (n = 250) were selected randomly from different outpatient clinics all over the previously designated cities. The prepared interview questions were selected based on related therapeutics guidelines regarding aspects of proper patients CS use. Data were collected by well-trained researchers to conduct such interviews. SPSS V16.0 (SPSS Inc., Chicago, USA) was used for data analysis. Standard descriptive and analytical statistics were used to analyze the data. Student’s t-test was used to compare the mean difference of continuous variables. Results: Overall, our study showed poor KAP results among different UAE patients using different CS dosage forms. Conclusion: Despite the massive use of CS in almost every clinical settings and its inherent associated risks, patients still needs provisions for better education regarding their medication efficacy, safety, and proper use. By careful follow-up of proper CS use instructions, both patients and physicians would positively reach an optimized cost-effective therapeutic approach with much more improved benefit/risk ratio.

Objective: The aim of this study was is to investigate the proposed beneficial cardiovascular effects of a novel class of antidiabetic drugs named; dipeptidyl peptidase 4 inhibitors. In this study, we compared the effect of using add-on therapy of vildagliptin (dipeptidyl peptidase-4 inhibitor; DPP-4i) and gliclazide (sulphonylurea; SU) to that when using gliclazide monotherapy in patients with type 2 diabetes mellitus (T2DM) and acute coronary syndrome (ACS) on different cardiovascular outcomes.Methods: A total of 60 patients diagnosed with T2DM, and ACS were randomly recruited into two treatment groups each of 30 patients to receive either gliclazide monotherapy (SU) or vildagliptin (DPP4i)+gliclazide (SU) add-on therapy, administered in a double-blind fashion. Outpatient visits were scheduled at 3, 6, and 12 mo where patient was reevaluated for cardiovascular (CV) outcomes and followed up for any arising cardiovascular complication.Results: The vildagliptin (DPP4i) plus gliclazide (SU) add-on therapy group have significantly shown more improved glycemic control, lipid profile and ventricular performance compared to gliclazide (SU) monotherapy group with p valuesConclusion: Vildagliptin as a DPP4i provides favourable cardiovascular effects beyond glucose control. Yet, its long-term safety and efficacy data still needs further investigations.

The incidence of upper gastrointestinal (GI) complications of non-steroidal anti-inflammatory drugs remains the most common side effect. The objective of this study was to compare the incidence of upper gastrointestinal complications of Ibuprofen as non-selective non-steroidal anti-inflammatory drug (NSAID) to Celecoxib and Meloxicam as selective non-steroidal anti-inflammatory drugs. This study included 4 groups of subjects aging above 50 years old divided into control group including 10 healthy volunteers suffering from the symptom of dyspepsia and three test groups, each test group included 10 osteoarthritic or rheumatic patients receiving only one NSAIDs (Ibuprofen, Celecoxib or Meloxicam) from at least 1 month. There was a statistically highly significant difference between the studied groups regarding the incidence of dyspepsia (p-value=0.008) and regarding the incidence of gastritis (p-value=0.042). In group II, there was a statistically significant correlation between the duration of administration of Ibuprofen and the incidence of dyspepsia. Similarly, in group III, there was a statistically significant correlation between the duration of administration of Celecoxib and the incidence of dyspepsia. Controversial, in group IV, there was no statistically significant correlation between the duration of administration of Meloxicam and the incidence of dyspepsia or gastritis or ulcer. Incidence of gastrointestinal side effects was lower for Celecoxib than for Meloxicam than for Ibuprofen. The study concluded that Celecoxib was safer than Meloxicam than Ibuprofen on the upper gastrointestinal tract. [Med-Science 2014; 3(1.000): 1032-45]

Many devices (e.g., nebulizers and spacers) are used to deliver aerosol in a non-invasive ventilation circuit (NIV) without any special recommendation. The aim of the present work was to compare the doses delivered from seven different aerosol delivery systems when placed in the NIV using automatic continuous positive airway pressure (Auto-CPAP). Three spacers and three vibrating mesh nebulizers were compared to a Sidestream jet nebulizer (SIDE). Each device was placed proximal to a breathing simulator in a standard NIV circuit with a 500 ml tidal volume, 15 breaths/min and a 1:3 inspiratory-expiratory ratio. Two ml of salbutamol solution containing 10,000 μg was nebulized using Aerogen Pro (PRO), Aerogen Solo (SOLO), NIVO and SIDE. Twelve metered dose inhaler doses, containing 100 μg salbutamol each, were delivered using AeroChamber MV (AC), AeroChamber Vent (VC) and AeroChamber Mini (MC). Total emitted dose (TED) and its percentage were determined. Aerodynamic droplet characteristics were measured using cooled Andersen Cascade Impactor. The vibrating mesh nebulizers used had significantly more (p