Search

Umaani Rauf,1 Majid Ali,2 Inderpal Dehele,1 Vibhu Paudyal,1 Mohamed Hassan Elnaem,3,4 Ejaz Cheema1 1School of Pharmacy, University of Birmingham, Birmingham, B15 2TT, UK; 2Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; 3Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 4Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, MalaysiaCorrespondence: Ejaz CheemaSchool of Pharmacy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UKTel +44 121-4146845Email E.Cheema@bham.ac.ukObjective: Mortalities due to fentanyl derivatives are on the rise with novel fentanyl analogues and still emerging on the global illicit drug market. They are highly potent and very fatal in low doses, yet there has been a lack of systematic research surrounding this subject. This review aims to assess the causes, nature, and toxicology of fatalities associated with fentanyl analogues.Methods: Five databases: Scopus, Embase, Medline, PubMed and Google Scholar were searched from inception to October 2020 to identify case studies and case series reporting fentanyl analogue-related fatalities. Two independent reviewers screened and selected the articles followed by the data extraction from each article, which included demography, route of administration, causes and nature of death, and the fentanyl analogue implicated. All articles were then subject to quality assessment tools developed by the Joanna Briggs Institute (JBI). A narrative synthesis was undertaken.Results: The initial data search yielded 834 articles, only 14 of which met the inclusion criteria – this included nine case reports and five case series. Of the 1079 fentanyl-analogue related deaths reported, the majority of them occurred in the US (n=1044, 96.8%). The majority of fatalities were male (n=766, 71%), white (n=884, 87%) and in the age ranges 25– 34 and 35– 44 years (30.5% and 29.6%, respectively). The most common route of administration was intravenous (n=319, 66%) and the manner of death was almost exclusively accidental (99.7%). The predominant cause of death was fentanyl-analogue toxicity (n=292, 85.4%) and involved mixed drug toxicity (n=47, 13.7%). The mean post-mortem fentanyl analogue concentration was 31.6 ng/mL.Conclusion: Most fatalities were reported in the US involving young white males. Overdose through intravenous administration and by mixed drug toxicities with other opioids were the major causes of death. Deaths reported in peer-reviewed literature were relatively less than those reported by real-world data.Keywords: fentanyl-analogues, fatalities, systematic review, case series, case reports

Manar Mosaad,1 Mohamed Hassan Elnaem,2 Ejaz Cheema,3 Ismail Ibrahim,1 Jamalludin Ab Rahman,4 Ahlam Naila Kori,5 How Soon Hin1 1Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 2Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 3School of Pharmacy, University of Birmingham, Birmingham, B15 2TT, UK; 4Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 5Haematology Unit, Tengku Ampuan Afzan Hospital, Kuantan, Pahang, MalaysiaCorrespondence: Ejaz CheemaSchool of Pharmacy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UKEmail manarmosaad@gmail.com; E.Cheema@bham.ac.ukAbstract: Cancer-associated thrombosis (CAT) is a leading cause of death in cancer patients receiving outpatient chemotherapy. The latest guidelines emphasize stratifying the patients in terms of CAT risks periodically. Multiple risk assessment models (RAMs) were developed to classify patients and guide thromboprophylaxis to high-risk patients. This study aimed to discuss and highlight different RAMs across various malignancy types with their related advantages and disadvantages. A scoping review was conducted using predefined search terms in three scientific databases, including Google Scholar, Science Direct, and PubMed. The search for studies was restricted to original research articles that reported risk assessment models published in the last thirteen years (between 2008 and 2021) to cover the most recently published evidence following the development of the principal risk assessment score in 2008. Data charting of the relevant trials, scores, advantages, and disadvantages were done iteratively considering the malignancy type. Of the initially identified 1115 studies, 39 studies with over 67,680 patients were included in the review. In solid organ malignancy, nine risk assessment scores were generated. The first and most known Khorana risk score still offers the best available risk assessment model when used for high-risk populations with a threshold of 2 and above. However, KRS has a limitation of failure to stratify low-risk patients. The COMPASS-CAT score showed the best performance in the lung carcinoma patients who have a higher prevalence of thrombosis than other malignancy subtypes. In testicular germ cell tumours, Bezan et al RAM is a validated good discriminatory RAM for this malignancy subtype. CAT in haematological malignancy seems to be under-investigated and has multiple disease-related, and treatment-related confounding factors. AL-Ani et al score performed efficiently in acute leukemia. In multiple myeloma, both SAVED and IMPEDED VTE scores showed good performance. Despite the availability of different disease-specific scores in lymphoma-related thrombosis, the standard of care needs to be redefined.Keywords: thrombosis, cancer, prophylaxis, risk assessment

Mohamed Hassan Elnaem, 1, 2 Noha O Mansour, 3 Abdulrahman Fata Nahas, 1, 2 Mohamed Baraka, 4, 5 Ramadan Elkalmi, 6, 7 Ejaz Cheema 8 1Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang; 2Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang; 3Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Cairo, Egypt; 4Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates; 5Department of Clinical Pharmacy, College of Pharmacy, Al-Azhar University, Cairo, Egypt; 6Department of Clinical Pharmacy and Pharmacotherapeutics, Dubai Pharmacy College, Dubai, United Arab Emirates; 7Department of Pharmacology, Faculty of Medicine, University of Sabha, Sabha, Libya; 8School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UKCorrespondence: Ejaz CheemaSchool of Pharmacy, University of Birmingham, Edgbaston, Birmingham B15 2TT, UKEmail E.Cheema@bham.ac.ukBackground: This study aims to discuss, summarize and compare the renal outcomes associated with non-insulin antidiabetic (AD) pharmacotherapy prescribed for patients with type 2 diabetes mellitus (T2DM).Methods: A systematic search using predefined search terms in three scholarly databases, ScienceDirect, Google Scholar, and PubMed, was conducted. Original research articles published in the English language between 2012 and 2020 that reported renal outcomes associated with the use of non-insulin AD pharmacotherapy were eligible for inclusion. Review articles, meta-analysis studies, and conference proceedings were excluded. A study-specific data extraction form was designed to extract the author’s name, country, publication year, study design, study population, objectives, key findings, and conclusions. A narrative review of the key findings that focused on renal outcomes and renal safety issues was conducted.Results: Of the 18,872 results identified through the initial search, a total of 32 articles were included in this review. Of these, 18 of the included articles reported the renal outcomes of newer antidiabetic medications, eg, SGLT2 inhibitors and GLP-1 agonists. Eight studies focussed on the well-established antidiabetic medications, eg, metformin and sulphonylureas. The review reported three main types of the clinical impact of the prescribed AD on the renal outcomes: “renoprotective effects”, “no additional risk” and “associated with a decline in renal parameters”. Seventeen studies reported the renoprotective effects of AD, including SGLT2i studies (n=8), GLP1 studies (n=6), and DPP4i studies (n=3). The reported renoprotective effects included slowing down the GFR decline, improving albuminuria, and reducing renal adverse events. The “no additional risk” impact was reported in eight studies, including DPP4i studies (n=3), two SGLT2i studies (n=2), metformin studies (n=2), and one study involving pioglitazone. Furthermore, seven studies highlighted the “associated with a decline in renal parameters” effect. Of these, three involved SGLT2i, two with metformin, and one for each DPP4i and sulphonylurea.Conclusion: More than half of the studies included in this review supported the renoprotective effects associated with the use of AD medications, particularly GLP-1A, SGLT2i, and some of the DPP4i. Further studies involving patients with various stages of chronic kidney disease (CKD) are required to compare AD medications’ renal effects, particularly the newer agents.Keywords: hypoglycemic agents, antidiabetic drugs, type 2 diabetes mellitus, renal effects, renal outcomes

Ejaz Cheema,1 Khalil McGuinness,1 Muhammad Abdul Hadi,1 Vibhu Paudyal,1 Mohammed Hassan Elnaem,2 Abdullah A Alhifany,3 Mahmoud E Elrggal,3 Abdullah Al Hamid1 1School of Pharmacy, University of Birmingham, Birmingham, UK; 2Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University, Kuantan, Malaysia; 3Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi ArabiaCorrespondence: Ejaz CheemaSchool of Pharmacy, University of Birmingham, Room 356, Robert Aitken Building, Edgbaston, Birmingham B15 2TT, UKEmail e.cheema@bham.ac.ukPurpose: Fentanyl poisoning has been widely reported, yet there is a lack of systematic evaluation of the nature and toxicology of associated deaths in the published literature. This article aims to systematically review the nature, causes, routes of administration and toxicology of fentanyl-associated deaths using case studies and case series in peer-reviewed published literature.Methods: Four electronic databases including Embase, Medline (via Ovid), Scopus and Google Scholar were searched from inception until October 2019 to identify the studies reporting fentanyl related deaths. Two independent reviewers screened and selected the titles and then evaluated the full texts. Only case studies and case series were included. A structured data extraction tool was used to extract data on the number of deaths, routes of administration, concomitant drug use and toxicological data. The Joanna Briggs Institute quality assessment tool was used to evaluate the quality of included studies. Data were synthesized narratively.Results: Of 1251 articles identified during initial search, 8 case reports and 9 case series met the inclusion criteria. A total of 1969 deaths were reported in the included studies. Deaths were concentrated in the north American region (n = 1946) and the Nordic region (n = 22). Reported causes of death included fentanyl overdose (n = 321, 56.4%), mixed drug toxicity (n = 196, 34.5%), natural (n = 28, 4.9%), other drug toxicity (n = 10, 1.8%), fentanyl and ethanol intoxication (n = 8, 1.4%), incidental (n = 5, < 1%) and aspiration (n = 1). Most common routes of use were intravenous (70.5%) and transdermal routes (23.0%). Deaths came swiftly via the intravenous route. Mean level of blood fentanyl amongst all reported deaths was 0.024 μg/mL.Conclusion: Literature related to fentanyl-associated deaths predominantly come from North America. Deaths are comparatively lower or not reported in peer-reviewed publications from the rest of the world. Abuse through intravenous administration, mixed drug toxicities and self-treatment of breakthrough pain are mainly responsible for majority of the reported deaths.Keywords: fentanyl, death, nature, cause, toxicology

Abdullah Abdulmajid Abdo Ahmed,1 Abdulkareem Mohammed AL-Shami,1,2 Shazia Jamshed,1– 3 Mohammed Zawiah,4,5 Mohamed Hassan Elnaem,1,2 Mohamed Izham Mohamed Ibrahim6 1Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 2Quality Use of Medicines Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 3Department of Clinical Pharmacy and Practice, Faculty of Pharmacy, UniSZA, Kuala Terengganu 22000, Malaysia; 4Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 5Department of Pharmacy Practice, Faculty of Clinical Pharmacy, Al Hodeidah University, Al Hudaydah, Yemen; 6Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha, QatarCorrespondence: Mohamed Izham Mohamed IbrahimCollege of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, QatarTel +974 4403 5580 (GMT +3 hrs.)Fax +974 4403 5551Email mohamedizham@qu.edu.qaBackground: Cardiovascular disease is a leading nationwide cause of morbidity and mortality. Public awareness of risk factors for heart attacks is thought to impact the burden of disease, prevention, and timely management. The objective of this study was to assess the awareness of risk factors for heart attack and to identify the factors associated with the awareness of all modifiable risk factors for heart attack in the general population.Methods: This is a cross-sectional study conducted among 393 adult individuals in Kuantan, Pahang, Malaysia. Data collection was conducted through face-to-face interviews among the lay public members who were 18– 64 years old, excluding healthcare professionals in clinical settings and academic settings. Statistical analysis was performed using chi-square test and logistic regression analysis.Results: The majority of the individuals identified smoking as a risk factor for heart attack, followed by atrial fibrillation (57.7%), heart disease (54.1%), and obesity (53.8%). However, diabetes (26%) was the risk factor that was least recognized by the participants. A total of 90.6% of participants identified at least one risk factor for heart attack, while 9.8% of the participants did not identify any risk factors for heart attack, whereas 5.6% identified all modifiable heart attack risk factors. Furthermore, participants aged 46– 64 years old, married respondents, and Chinese participants, those with higher educational levels, and received prior information demonstrated great awareness of eight modifiable risk factors for heart attack. Multivariable logistic regression presented that participants with aged 55– 64, those with family history of heart attack and individuals with dyslipidemia were factors independently related to excellent awareness (p=0.04, OR=6.21, 95% CL= 1.081– 35.641), (p=0.049, OR=2.11, 95% CL=0.721– 6.230) and (p=0.009, OR= 4.08, 95% CL= 1.427– 11.685), respectively.Conclusion: Awareness of risk factors for heart attack appears to be poor, where most of the respondents recognized only one modifiable risk factor. According to these findings, programs and strategies to raise awareness of modifiable risk factors for HA are urgently needed to protect the lay public from HA.Keywords: knowledge, risk factor, cardiovascular disease, modifiable risk factors, layman, Malaysia

Mohamed Hassan Elnaem,1,2 Nor Afifah Irwan,1 Usman Abubakar,1 Syed Azhar Syed Sulaiman,3 Mahmoud E Elrggal,4 Ejaz Cheema5 1Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 2Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 3Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 4Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia; 5School of Pharmacy, University of Birmingham, Edgbaston, Birmingham B15 2TT, UKCorrespondence: Ejaz CheemaSchool of Pharmacy, University of Birmingham, Edgbaston, Birmingham B15 2TT, UKTel +44-121-4146845Email E.Cheema@bham.ac.ukBackground: This study aims to identify interventions used to reduce medication regimen complexity and to assess their impact on medication adherence and clinical outcomes.Methods: A literature search was conducted using pre-defined search terms in three scientific databases, including ScienceDirect, ProQuest and MEDLINE. Original research articles published in English between 2009 and 2020 that assessed the impact of medication regimen simplification on medication adherence in patients with long-term medical conditions were eligible for inclusion. Review articles, meta-analysis studies and conference proceedings were excluded. Data charting was done in an iterative process using a study-specific extraction form.Results: Of the 684 studies identified through initial searches, 17 studies were included in the review. Nine studies involved simplification of medication regimen related to HIV, while three studies focused on patients with diabetes with or without coronary artery disease. The remaining five studies included medications used among elderly patients or medications related to hypertension, psychiatric disorders, glaucoma and kidney diseases. Three medication regimen simplification strategies were identified; fixed-dose combination (n = 7), once-daily dosing (n = 4) and the combination of both fixed-dose and once-daily dosing (n = 6). Overall, most of the regimen simplification strategies (14 out of 17) were found to be useful in improving medication adherence. There was no assessment of clinical outcomes in four out of 17 studies. Furthermore, more than half of the studies that assessed clinical outcomes did not show any additional impact on clinical outcomes.Conclusion: The findings suggest that there was an equal utilization of the three main approaches of regimen simplifications; fixed-dose combination, once-daily dosing and a combination of both. Overall, most of the regimen simplification strategies were found to be effective in improving medication adherence. However, the associated improvement in medication adherence did not extend to improvement in the clinical outcomes.Keywords: medication adherence, regimen simplification, clinical outcomes, review

Mohamed Hassan Elnaem,1,2 Nor Fatin Farahin Rosley,1 Abdullah A Alhifany,3 Mahmoud E Elrggal,3 Ejaz Cheema4 1Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia; 2Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia; 3Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia; 4School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UKCorrespondence: Ejaz CheemaSchool of Pharmacy, University of Birmingham, Edgbaston, Birmingham B15 2TT, UKTel +44-121-4146805Email E.Cheema@bham.ac.ukBackground: The aim of this study was to provide a scoping review of the impact of pharmacist-led interventions on medication adherence and clinical outcomes in patients with hypertension and hyperlipidemia.Methods: A scoping review was conducted using pre-defined search terms in three scientific databases, including Google Scholar, ScienceDirect, and PubMed. A multi-stage screening process that considered relevancy, publication year (2009– 2019), English language, and article type (original research) was followed. Review articles, meta-analysis studies, and conference proceedings were excluded. Data charting was done in an iterative process using a study-specific extraction form.Results: Of the initially identified 681 studies, 17 studies with 136,026 patients were included in the review. Of these, 16 were randomized controlled trials, while the remaining study was a retrospective cohort study. The majority of pharmacist-led interventions were face-to-face counseling sessions (n=8), followed by remote- or telephone-based interventions (n=5) and multi-faceted interventions (n=4). The majority of the studies (n=7) used self-reported adherence measures and pharmacy refill records (n=8) to measure the rate of adherence to prescribed medications. Eleven of the included studies reported a statistically significant (P< 0.05) impact on medication adherence. Overall, twelve studies assessed the effect of the interventions on the clinical outcome measures; of these, only four studies were associated with significant impact.Conclusion: Pharmacist-led interventions were associated with improved patients’ adherence to their medications but were less likely to be consistently associated with the attainment of clinical outcomes. Face-to-face counseling was the most commonly used intervention; while, the multi-faceted interventions were more likely to be effective in improving the overall outcome measures. The rigorous design of targeted interventions with more frequent follow-ups, careful consideration of the involved medications, and patients’ characteristics could increase the effectiveness of these interventions.Keywords: adherence, hyperlipidemia, antihypertensive, pharmacists, intervention, pharmacy services

Mohamed Hassan Elnaem,1 Mohamad Haniki Nik Mohamed,1 Hasniza Zaman Huri,2 Azarisman Shah Mohd Shah3 1Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 2Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 3Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia Background: Cardiovascular diseases (CVDs) are the main complication leading to morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). There is a large amount of evidence to support the use of lipid-lowering therapy (LLT) for the prevention of CVD. This study aimed to assess the effectiveness and prescription quality of LLT among T2DM patients and to identify its associated factors.Methods: A multicenter cross-sectional study included 816 T2DM patients from four different primary care centers in Pahang, Malaysia. We involved LLT-eligible T2DM patients as per the national clinical practice guidelines (CPG). The assessment of therapy effectiveness focused on the attainment of target lipid measures stated in the CPG. Evaluation of the prescription quality was classified into appropriate, potentially inappropriate, and inappropriate, based on the compliance with guidelines and existence of potential safety concerns. Binomial logistic regression was employed to identify the predictors of LLT effectiveness and prescription quality.Results: The overall percentage of T2DM patients receiving statin therapy was 87.6% (715/816). Statin therapy was appropriately prescribed in 71.5% of the cases. About 17.5% of the LLT prescriptions have at least one significant drug interaction with co-prescribed medications. The achievement of the primary target of low-density lipoprotein cholesterol (LDL-C) levels was observed in only 37% of T2DM patients. The LLT indication and appropriateness of prescription were significantly associated with the attainment of LDL-C treatment goals. Primary prevention, Malay race, and hypertension were identified as predictors for appropriate prescribing of LLT among T2DM subjects.Conclusion: There is a need to enhance the quality of LLT prescribing in the primary care setting to cover all eligible high-risk patients and ensure patient safety. Strategies to improve the achievement of LDL-C goals among patients with T2DM, such as investigating the potential role of the combination therapy and high-intensity statin therapy, are required. Keywords: primary care, statin therapy, diabetes, dyslipidemia, Malaysia

Objective: Academic resilience, a critical determinant of academic achievement, is affected by various factors. There is a paucity of large-scale international assessments of academic resilience among pharmacy students. Therefore, this study aimed to assess academic resilience among pharmacy students in 12 countries and to evaluate factors associated with their academic resilience levels., Methods: A cross-sectional online survey-based study was conducted among randomly selected pharmacy students in 12 countries: Egypt, Türkiye, Indonesia, Pakistan, Bangladesh, Iraq, Jordan, Nigeria, Malaysia, Saudi Arabia, Sudan, and the United Arab Emirates. After pilot testing, the validated 30-item academic resilience scale (ARS) was used for the assessment. The data were collected between November 1, 2022 and April 15, 2023. Descriptive and inferential statistics were performed, as appropriate., Results: A total of 3950 were received from the 12 participating countries. The mean age was 21.68 ± 2.62 years. About two-thirds of the responses were from female participants and those studying for Bachelor of Pharmacy degrees. Overall, the findings show moderate academic resilience, which varied across countries. The median (IQR) of the total ARS-30 was 114 (103-124). Females exhibited lower negative affective and emotional response subscale levels than males. There were significant cross-country variations in the ARS-30 and all subscales. The highest overall levels were reported for Sudan, Pakistan, and Nigeria and the lowest were reported for Indonesia and Türkiye. Students in private universities tended to have higher overall ARS levels than public university students. Higher academic performance was significantly associated with ARS levels, whereas those with excellent performance exhibited the highest ARS levels. Students with exercise routines had higher ARS levels than those without exercise routines. Finally, students who were engaged in extracurricular activities had higher ARS levels than those who did not participate in these activities., Conclusion: The study offers insights into the factors affecting academic resilience in pharmacy students across several countries. The findings could guide interventions and support activities to improve resilience and academic outcomes., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Burnout, resilience, and thriving significantly impact academics, particularly in health professions, where responsibilities are extensive. This study aimed to explore these constructs among academic health professionals, examining sociodemographic and work-related factors influencing these outcomes., Methods: A cross-sectional study was conducted among academic health professionals via web-based professional networks from August 2022 to February 2023. Validated tools were used, and descriptive and inferential statistics were applied., Results: 505 participants were included, predominantly female (63%), with a mean age of 38.15 ± 9.6 years. High burnout was reported by 10.9%, 13.7% experienced exhaustion, and 6.3% were disengaged. Resilience and thriving were moderate at 59.2 and 51.9%, respectively. Age correlated negatively with burnout ( r  = -0.131, p  = 0.003) but positively with resilience ( r  = 0.178, p  < 0.001). Females reported higher exhaustion ( p  = 0.014), while males showed greater resilience ( p  = 0.016). Instructors exhibited lower resilience compared to assistant professors ( p  < 0.001) and associate professors ( p  < 0.001). Those at public universities reported higher exhaustion than those at private universities ( p  < 0.001)., Conclusion: Variable levels of burnout, resilience, and thriving were observed among academic health professionals, influenced by sociodemographic and work-related factors. Interventions targeting resilience and thriving may mitigate burnout risk and enhance engagement among academics in health professions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Nahas, Elnaem, Mubarak, Khatwa, Barakat, Faller, Kassem, Ramatillah, Jaber, Akkawi, Al-Shami, Chandran, Mohamed, Jack, Abouelhana, Courtenay and Elrggal.)

Introduction: Countries are grappling with a rapidly worsening upsurge in the opioid-related overdose deaths, misuse and abuse. There is a dearth of data in Pakistan regarding the practices and competencies of pharmacists in handling opioid-related issues., Study Design: A cross-sectional study, conducted across Punjab, Pakistan., Method: The study deployed a validated survey to evaluate the competencies and practices of the community and hospital pharmacists., Results: 504 community pharmacists and 279 hospital pharmacists participated in the survey with an overall response rate of 85.5%. Almost half of the respondents 'never' or 'sometimes' made clinical notes in a journal or dispensing software to monitor ongoing opioid use. Generally, pharmacists were reluctant to collaborate with physicians or notify police regarding the abuse/misuse of opioids. Hospital pharmacists achieved significantly higher mean competency scores than chain and independent community pharmacists (p<0.05). In competency evaluation, three priority areas emerged that require additional training, that is, 'opioid overdose management', 'opioid use monitoring' and 'therapeutic uses of opioids'., Conclusion: Both community and hospital pharmacists hold significant positions and potential to contribute meaningfully to the mitigation of harms and risks associated with opioids. Nevertheless, this study underscores notable deficiencies in the competence of pharmacists, whether in hospital or community settings in Punjab, concerning various aspects related to the dispensing and utilisation of opioids. It also highlights the pressing need for the development of strategies aimed at improving several practice areas including the documentation, the quality of patient counselling, the effectiveness of reporting mechanisms for opioid abuse and the stringent enforcement of regulatory policies to curtail opioid misuse. Thus, to mitigate the opioid epidemic in Pakistan, it is imperative to institute opioid stewardship initiatives aimed at rectifying the competency and procedural deficiencies within the pharmacist workforce., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: While considerable evidence supports the safety and efficacy of COVID-19 vaccines, a sizable population expresses vaccine hesitancy. As per the World Health Organization, vaccine hesitancy is one of the top 10 hazards to global health. Vaccine hesitancy varies across countries, with India reporting the least vaccine hesitancy. Vaccine hesitancy was higher toward COVID-19 booster doses than previous shots. Therefore, identifying factors determining COVID-19 vaccine booster hesitance (VBH) is the sine qua non of a successful vaccination campaign., Methodology: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) 2020 standards. A total of 982 articles were pooled from Scopus, PubMed and Embase, while 42 articles that addressed the factors of COVID-19 VBH were finally included for further analysis., Result: We identified factors responsible for VBH and divided them into three major groups: sociodemographic, financial, and psychological. Hence, 17 articles stated age to be a major factor for vaccine hesitancy, with most reports suggesting a negative correlation between age and fear of poor vaccination outcomes. Nine studies found females expressing greater vaccine hesitancy than males. Trust deficit in science (n = 14), concerns about safety and efficacy (n = 12), lower levels of fear regarding infection (n = 11), and worry about side effects (n = 8) were also reasons for vaccine hesitancy. Blacks, Democrats, and pregnant women showed high vaccine hesitancy. Few studies have stated income, obesity, social media, and the population living with vulnerable members as factors influencing vaccine hesitancy. A study in India showed that 44.1% of vaccine hesitancy towards booster doses could be attributed dominantly to low income, rural origin, previously unvaccinated status, or living with vulnerable individuals. However, two other Indian studies reported a lack of availability of vaccination slots, a lack of trust in the government, and concerns regarding safety as factors for vaccine hesitancy toward booster doses., Conclusion: Many studies have confirmed the multifactorial nature of VBH, which necessitates multifaceted, individually tailored interventions that address all potentially modifiable factors. This systematic review chiefly recommends strategizing the campaign for booster doses by identifying and evaluating the reasons for vaccine hesitancy, followed by appropriate communication (at both individual and community levels) about the benefits of booster doses and the risk of losing immunity without them.

Introduction: Grit is proposed as an essential trait for academic achievement. Thus, evaluating its current status and the associated factors could aid academic support planning., Objective: The present study aimed to assess grit level and its related factors among undergraduate pharmacy students from 14 countries amid the COVID-19 pandemic., Methods: A cross-sectional survey-based study was conducted among pharmacy students from 14 countries in Asia and the Middle East. A 31-item questionnaire was developed, validated, and pilot-tested, including the validated short scale for grit assessment. The data was collected between 1 February and 15 April 2022. Descriptive and inferential statistics were employed as appropriate., Results: A total of 2665 responses were received, mainly from females (68.7 %), living in urban areas (69.2 %) and studying at private universities (59.1 %). The average grit score on a scale of 5 was 3.15 ± 0.54. The responses revealed higher favourable responses to items on the perseverance of efforts (34.9 % to 54 %) compared to items on the consistency of interests (26.5 % to 31.1 %). Students who did not exercise (AOR: 0.47, 95 %CI: 0.33-0.67) or exercised irregularly (AOR: 0.64, 95 %CI: 0.45-0.90) were less likely to have higher grit scores than those who exercised regularly. Additionally, students who did not receive COVID-19 vaccination (AOR: 0.50, 95 %CI: 0.36-0.71) or received only one dose (AOR: 0.67, 95 %CI: 0.46-0.99) were less likely to have higher grit scores than those who received their booster vaccination. Interestingly, students who chose the pharmacy program as their only available or reasonable choice (AOR: 0.33, 95 %CI: 0.17-0.62) and students from public universities (AOR: 0.82, 95 %CI: 0.68-0.98) were less likely to have higher grit scores. On the other hand, students who did not face educational challenges with online learning (AOR: 1.19, 95 %CI: 1.003-1.416) and students with excellent (AOR: 2.28, 95 %CI: 1.57-3.31) and very good (AOR: 2.16, 95 %CI: 1.53-3.04) academic performance were more likely to have higher grit scores., Conclusion: The findings revealed moderate grit levels. Higher grit levels were thought to be associated with several personal, lifestyle and academic factors. Further interventions to support students' grit attributes are required, particularly concerning the consistency of interests., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Globally, the prevalence of attention deficit hyperactivity disorder (ADHD) is increasing. The treatment for ADHD is multifaceted and requires long-term care and support. Pharmacists are capable of assisting patients and their caretakers in achieving desired outcomes. This work discusses and summarizes pharmacists' roles in ADHD care and their associated outcomes. Overall, pharmacists are positioned to educate on ADHD, optimize medications in a collaborative practice model, manage and monitor side effects, and provide remote and virtual pharmaceutical care. Pharmacists could directly contribute to ensuring medication safety and increasing awareness regarding the optimal use of ADHD medications. Patients with ADHD can benefit from pharmacist involvement in a variety of ways, including, but not limited to, initial screening and referral, the provision of clinical consultation and feedback, and the improvement of self-management and self-awareness of the illness. Pharmacists also play a significant role in therapeutic decision making regarding the initiation, intensification, and monitoring of ADHD treatment to ensure its effectiveness and quality of life improvement. Lastly, pharmacists could help identify more cost-effective treatment approaches for ADHD patients based on the clinical scenario that is encountered.

Background: Corticosteroids play a significant role in managing the vast majority of inflammatory and immunologic conditions. To date, population-based studies on knowledge and attitudes concerning corticosteroids are scarce. This study aims to comprehensively assess knowledge, perception, experience and phobia toward corticosteroid use among the general population in the era of COVID-19., Methods: A cross-sectional self-administrated questionnaire was used to collect the data from 6 countries. Knowledge and corticophobia scores, descriptive statistics and logistic regression were computed., Results: A total of 2354 participants were enrolled in this study; the majority were females (61.6%) with an average age of 30. Around 61.9% had been infected previously with COVID-19, and about one-third of the participants had experience with corticosteroid use. The mean knowledge score was relatively satisfactory (8.7 ± 4.5 out of 14), and Corticophobia ranked a high score in all countries. Age, female gender, and history of COVID-19 were positively correlated with developing corticophobia., Conclusion: Our study highlights that the general knowledge about steroids was satisfactory. However, the phobia toward its use upon indication is high. Therefore, enhancing awareness and providing essential counseling regarding the rational use of corticosteroids may reduce corticophobia.

Obesity might adversely affect the health and well-being of children and their families. Childhood obesity has crucial implications for health, both during childhood and as they age. It is highly associated with many acute problems and is commonly present during childhood, making visits and hospital admissions polarized in this group of children. The problems that may affect these children can be medical, such as asthma, chronic inflammation, orthopedic abnormalities, liver disease, diabetes mellitus or dyslipidemia. Long-term consequences of cardiovascular risk factors, the persistence of obesity and premature mortality are common among adults who had obesity during their early lives. Additionally, they could also suffer from psychological issues, such as low self-esteem, which puts them at risk of a much more serious psychosocial problem that may lead to depression, as well as a disruption in educational achievements and social relationships. A healthy diet, physical activity, adequate sleep, and limited screen time are all preventive measures that should be implemented at the family and community levels, preferably through well-structured programs. Furthermore, pharmacological management of childhood obesity is limited and only used after non-pharmacological interventions have failed or in the late stages of obesity. However, recent guidelines advocate the early use of medical interventions. Approved pharmacotherapeutic options include orlistat, phentermine/topiramate combination and liraglutide. There are several other options approved primarily for other specific forms of obesity or for other indications, including setmelanotide, metformin, lisdexamfetamine, zonisamide and fluoxetine. Bariatric surgery is a safe and effective option in cases with extreme obesity and comorbidities considering the need for long-term monitoring and support for cases and their families post-surgery. This review aims to discuss and highlight the recent evidence regarding risk factors, clinical consequences, prevention, and treatment of childhood obesity.

This study evaluated the treatments, mortality rate and patient-related factors associated with mortality. This is a retrospective study involving hospitalised patients with infections caused by carbapenem-resistant Gram-negative bacilli (CR-GNB) in a tertiary hospital in Malaysia from January 2018 to June 2020. A clinical pharmacist reviewed patients' electronic records and collected the data according to a pre-designed form. Data were analysed using both descriptive and inferential tests. The study included 145 patients with CR-GNB infections including 77, 40 and 28 Acinetobacter baumannii , enterobacteriaceae and Pseudomonas aeruginosa , respectively. The mean age was 57.9 ± 15.8 years. Pneumonia (40.7%) and bacteremia (25.5%) were the most common infections. Meropenem (24.7%) and piperacillin-tazobactam (20.4%) were the most commonly used empiric antibiotics while colistin (63.3%) and amikacin (8.3%) were the most common definitive antibiotics. The mean duration before active antibiotics was 4.6 ± 3.3 days. Overall, the in-hospital mortality rate was 41.4%. Multivariate logistic regression analysis showed that intensive care unit (ICU) admission (adjusted odds ratio (AOR): 5.201; 95% confidence interval (CI): 1.603-16.872; p = 0.006), sepsis/septic shock (AOR: 3.430; 95% CI: 1.021-11.522; p = 0.049) and elevated serum creatinine (AOR: 2.752; 95% CI: 1.005-7.536; p = 0.049) were independently associated with mortality. The mortality rate among patients with CR-GNB infection is high. A high rate of inappropriate antibiotic use was observed, including combination antibiotic therapy and delays in starting active antibiotics. Mortality was significantly associated with ICU admission, sepsis/septic shock and elevated serum creatinine.

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.

Background: Pharmacy students will assume future roles as frontline healthcare providers. Therefore, evaluating their current state of mental wellbeing and its associated factors is essential for better planning students' support initiatives. This study aimed to assess mental wellbeing and its associated factors among undergraduate pharmacy students from 14 countries during the pandemic., Methods: A cross-sectional study was conducted among undergraduate pharmacy students in 14 countries in Asia and the Middle East. The validated Warwick-Edinburgh Mental Wellbeing Scale (the 14-item WEMWBS) was adopted to assess mental wellbeing. Data collection was performed online between February and April 2022. Descriptive and inferential statistics were used as appropriate., Results: A total of 2,665 responses were received, mainly from females (68.7%) with a higher presence of private universities (59.1%). About 34.9% had low mental wellbeing levels, while 57 and 8.1% had medium, and high levels, respectively. Binary logistic regression showed that males (AOR: 1.34; CI 95%: 1.11-1.61; p < 0.01) and students with no chronic illnesses (AOR: 2.01; CI 95%: 1.45-2.80; p < 0.001) were more likely to have higher mental wellbeing. Also, participants who did not engage in any exercise (AOR: 0.71; CI 95%: 0.52-0.98; p = 0.04) and those in public universities (AOR: 0.82; CI 95%: 0.69-0.97; p = 0.02) were less likely to have higher mental wellbeing. Additionally, students who had interest/passion for pharmacy (AOR: 1.69; CI 95%: 1.07-2.68; p = 0.02), and those who known pharmacists inspired (AOR: 1.81; CI 95%: 1.06-3.12; p = 0.03), were more likely to have higher mental wellbeing compared with those who had no specific reason for their choice to study pharmacy. The participants with excellent (AOR: 1.87; CI 95%: 1.29-2.70; p = 0.001) or very good self-reported academic performance (AOR: 1.57; CI 95%: 1.12-2.22; p = 0.01) were more likely to have higher mental wellbeing compared to those with fair academic performance., Conclusion: More than a third of the participants had low mental wellbeing. Various demographic, lifestyle, medical and academic factors appeared to affect students' mental wellbeing. Careful consideration of these factors and their integration into the pharmacy schools' plans for student support services and academic advising would be essential to improve students' mental wellbeing., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Elnaem, Mubarak, K. T., Barakat, Abdelaziz, Mansour, Thabit, Ramatillah, Al-Jumaili, Syed, Adam, Hossain, Baraka, Jose, Elkalmi, Chandran, Singh Dehele, Elrggal and Fathelrahman.)

Background: The pain pattern after laparoscopic cholecystectomy (LC) is complex and distinct from postoperative pain after other laparoscopic procedures, suggesting that procedure-specific optimal analgesic management plans should be proposed. Duloxetine, a non-opioid neuromodulator, has been widely used to manage pain with dual central and peripheral analgesic properties. Aims: To assess the effect of preoperative administration of duloxetine compared to placebo on postoperative pain control in patients undergoing LC. Patients and Methods: This study was a randomized, parallel-group, placebo-controlled, double-blinded study performed on patients undergoing LC. Patients were randomly divided into two groups of 30 each on the day of surgery in the preoperative holding area, using a computer-generated random number to receive 60 mg duloxetine as a single oral dose 2 h before the procedure or placebo. The primary outcome was the difference in the mean of visual analogue scale (VAS) scores between the two studied groups, as measured by the area under the curve (AUC) of the VAS scores. Results: The derived AUC of VAS scores in the duloxetine group (757.89 ± 326.01 mm × h) was significantly lower than that calculated for the control group (1005.1 ± 432.5 mm × h). The mean postoperative VAS scores recorded at 4 and 24 h were statistically different between the study groups ( p = 0.041 and 0.003, respectively). As observed in the survival curve analysis, there was no significant difference ( p = 0.665) for the time until the patient's first request for rescue medications in the two groups. The frequency of postoperative nausea and vomiting (PONV) was lower in patients of the duloxetine group than that recorded in those allocated to the control group at 8 and 24-h time intervals ( p = 0.734 and 0.572, respectively). Conclusion: Preoperative use of duloxetine reduces postoperative pain significantly compared with placebo. In addition, its use is associated with a reduction in PONV. These preliminary findings suggest that duloxetine could play a role in the acute preoperative period for patients undergoing LC. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT05115123, identifier NCT05115123]., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mansour, Boraii, Elnaem, Elrggal, Omar, Abdelraouf and Abdelaziz.)

(1) Objectives: Clinical pharmacists are now playing a significant role in hospitals aiming to reduce medication errors, adverse drug reactions, and healthcare costs. Therefore, the main objective of this study was to assess the interventions provided by a clinical pharmacist in the intensive care unit at the King Faisal Hospital in Taif city. (2) Methods: For this single-center retrospective study, patients were included from December 2021 to May 2022. In the present study, all the interventions of clinical pharmacists made over six months were included. The Intensive care unit (ICU) ward was covered by three clinical pharmacists, and the interventions made were categorized into four groups: (1) interventions related to indications; (2) interventions regarding safety; (3) interventions regarding dosing, and (4) miscellaneous. Descriptive statistics was applied to evaluate the results in the form of frequencies and percentages. Analysis was performed using the statistical package SPSS 20.0. (3) Results: Overall, a total of 404 interventions were recommended for 165 patients during the six- month period of study. Among them, 370 interventions (91.5%) were accepted by physicians. Among all the interventions, the majority were suggested regarding 'indication' (45.7%), including the addition of drugs, drugs with no indications, and duplication. The acceptance rate of clinical pharmacist intervention was 98.5%. (4) Conclusions: This retrospective study shows that clinical pharmacists played a critical role in optimizing drug therapy which could subsequently help to prevent drug-related issues and lower drug costs. More research is needed to do a thorough cost-benefit analysis.

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., (© 2022 The Authors.)

Diuretic therapy is the mainstay during episodes of acute heart failure (AHF). Diuretic resistance is often encountered and poses a substantial challenge for clinicians. There is a lack of evidence on the optimal strategies to tackle this problem. This review aimed to compare the outcomes associated with congestion management based on a strategy of pharmacological nondiuretic-based regimens. The PubMed, Cochrane Library, Scopus, and ScienceDirect databases were systematically searched for all randomised controlled trials (RCTs) of adjuvant pharmacological treatments used during hospitalisation episodes of AHF patients. Congestion relief constitutes the main target in AHF; hence, only studies with efficacy indicators related to decongestion enhancement were included. The Cochrane risk-of-bias tool was used to evaluate the methodological quality of the included RCTs. Twenty-three studies were included; dyspnea relief constituted the critical efficacy endpoint in most included studies. However, substantial variations in dyspnea measurement were found. Tolvaptan and serelaxin were found to be promising options that might improve decongestion in AHF patients. However, further high-quality RCTs using a standardised approach to diuretic management, including dosing and monitoring strategies, are crucial to provide new insights and recommendations for managing heart failure in acute settings.

Exercise addiction (EA) has been described as a condition of psychological dysfunction characterized by excessive and obsessive exercise patterns, show withdrawal symptoms when unable to exercise, and experience numerous conflicts and other negative consequences in their social and professional lives, due to the extremely high volumes of exercise. The main objective of the present study was to assess the risk of exercise addiction among a Saudi Arabian sample of regular exercisers and to investigate possible associations between their inability to exercise during the COVID-19 pandemic lockdown (due to the closure of public gyms, swimming pools, and health clubs) and depression, anxiety, and loneliness. A total of 388 regular-exercising Saudis participated in an online cross-sectional survey over three months (December to February 2021). The study sample comprised 89.9% (males) and 10.1% (females), with a mean age of 28.59 years (SD ± 6.69). A 36-item online self-report survey was used for data collection. The prevalence of being at risk of exercise addiction among participants of the present study was 13.1%. Positive significant associations were noted between risk of exercise addiction and depression (r = .41; p  <  . 01), risk of exercise addiction and anxiety (r = .20; p  <  . 01), and risk of exercise addiction and loneliness (r = .17; p  <  . 01). The findings of the present study suggest that those individuals at risk of exercise addiction might also be at an elevated risk of developing negative psychological impact owing to the disruption of the amount of exercise engaged in due to COVID-19 pandemic-related restrictions and therefore these high-risk individuals should receive appropriate psychological support to help them overcome the negative impact of the ongoing pandemic., Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-02892-8., Competing Interests: Conflicts of interest/Competing interestsThe authors declare that the research was conducted in the absence of any commercial or financial relationships that might be construed as a potential conflict of interest. The authors also declare that no competing interests., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022.)

Vaccine hesitancy has surfaced globally within the last few decades, and the fears and misconceptions of people about vaccine safety and effectiveness have been identified as key factors for their under-utilization. The familiarity, attitudes, and religious beliefs of the public and of future healthcare practitioners regarding vaccination are extensive areas needing exploration. The present exploratory cross-sectional study was designed, planned and carried out on students enrolled in health science and non-health science courses in one of the public universities of Malaysia. A research instrument that had been formulated, validated and subjected to reliability testing was used to collect the data, which were analyzed using descriptive and inferential statistics. A response rate of 80.8% (n = 202) was obtained: the majority were female (n = 161, 79.7%), and had been vaccinated before (n = 190, 97.5%), while a mere 2% did not support vaccination for reasons pertaining to safety issues. The vaccine familiarity score was 10.79 ± 1.4, which significantly differed among the study disciplines ( p < 0.001). The mean of the total attitude score was 14.95 ± 1.5, with no significant difference among demographics being noted. The mean of the total religious beliefs score was 24.29 ± 2.8 and significantly differed based on gender ( p = 0.040) and study disciplines ( p < 0.001). The current findings showed that the participants were familiar with vaccines and had generally positive attitudes and positive religious beliefs toward vaccination; thus, one can expect that their inclusion in immunization campaigns will generate positive outcomes of the immunization program. Although the current research reported few knowledge gaps, these may be handled with the introduction of a specialized immunization course at an undergraduate level.

This study aimed to investigate the attitudes, perceptions, and experiences of side effects with the COVID-19 vaccines in Malaysia among participants in the National Vaccination Program. A cross-sectional survey was conducted among a sample of vaccine-eligible and vaccinated individuals in Malaysia between May and July 2021. A total of 428 respondents completed the survey. A vast majority (98.6%) of the respondents had registered to be vaccinated. Twenty participants (4.7%) expressed concerns about either registering or receiving the COVID-19 vaccination, mainly due to their uncertainty of vaccine safety. Approximately 77.5% received their vaccinations. Of them, 76.8% had experienced vaccine-related side effects. About 40% of the side effects occurred more with the second dose, particularly those who received the Pfizer-BioNTech vaccine ( p < 0.001). Pain at the injection site (61.1%) and tiredness (48.8%) were the most reported side effects. Compared to those aged ≥60 years, all age groups were more likely to exhibit vaccine-related side effects; meanwhile, males (OR: 0.51, 95% CI: 0.27-0.93) were less likely to experience side effects than females. Those who received the Sinovac vaccine were at lower risk of experiencing side effects (OR: 0.08, 95% CI: 0.03-0.22) and were more likely to report fewer side effects than Pfizer-BioNTech ( p = 0.012) and Oxford-AstraZeneca groups ( p = 0.001). The overall attitudes toward the COVID-19 vaccination program were positive. Several differences in the experiences of vaccine-related side effects, in terms of prevalence and numbers, were attributed to age, gender, and received vaccine type.

The perspectives of hypertensive patients on the state of hypertension control during the ongoing pandemic restrictions have not been extensively studied in Malaysia. Therefore, this study aimed to assess the impact of socio-demographic factors, health literacy, and adherence on the overall hypertension management in a group of Malaysian hypertensive patients during the COVID-19 pandemic. An anonymous, online cross-sectional study was conducted over three months that involved a group of Malaysian adults with hypertension. A validated, self-administered 30-item questionnaire was prepared in Malay and English languages on Google Forms. The link was then distributed to participants on social media (Facebook and WhatsApp). Following survey validation, a pilot study with 30 participants who met the inclusion criteria was carried out. The total scores for health literacy, adherence, and pandemic impact on hypertension control were calculated and compared across all independent variables. In a total of 144 study participants, controlled blood pressure was reported in 77% (N = 111). There were good levels of adherence and health literacy scores but moderate levels of pandemic impact scores. The total adherence scores showed a statistically significant difference between age groups (χ 2 = 6.48, p = 0.039) and those who reported having controlled and uncontrolled blood pressure (U = 1116, p = 0.001). Moreover, the analysis revealed statistically significant differences in total pandemic impact scores based on the age group (χ 2 = 15.008, p = 0.001), household income (χ 2 = 6.887, p = 0.032), employment (U = 1712, p = 0.006), and marital status (U = 520.5, p < 0.001). The youngest age group (18-39) years, the lowest income group, unemployed and unmarried individuals, had significantly higher pandemic impact scores. This denotes that those individuals were more prone to be negatively affected by the pandemic regarding their hypertension management. Most participants reported relatively controlled blood pressure and good levels of health literacy as well as adherence amidst the pandemic. To a moderate extent, study participants perceived that the pandemic had a negative effect on hypertension management. The perceived negative impact of the pandemic was attributed to several socio-demographic factors, such as age, household income, employment, and marital status.

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 (r s =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., (Copyright © 2021 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Objectives: This study aimed to assess the completeness and quality of adverse drug reaction (ADR) reports that were submitted to the Pharmacovigilance Unit (PVU) in clinical training center (CTC), Faculty of Medicine, UiTM Sungai Buloh Campus., Materials and Methods: A retrospective study was conducted using all ADR reports that were submitted to the PVU in CTC from December 31, 2000, to December 31, 2018. The completeness was assessed by reviewing all the required elements to be filled in the ADR reports. The quality was assessed by investigating the required information in the ADR reporting form. Descriptive statistics have been used to present the findings., Key Findings: In a total of 31 reports that were submitted to the PVU in CTC, 98.9% of patient's information and 100% of ADR descriptions were completed. Suspected drug information and the reporter's details were completed by 52.2% and 79.6%, respectively. Of 58.0% of the information about seriousness recorded, 38.9% ( n = 7) is mild, 44.4% ( n = 8) is moderate, and 16.7% ( n = 3) is severe. Among all the suspected medicines, drug class of antibiotics (32.4%, n = 12) is the most reported suspected drugs that caused ADR, followed by opioid analgesic (8.1%, n = 3) and nonsteroidal anti-inflammatory drugs (8.1%, n = 3)., Conclusion: Further efforts and relevant interventions should be considered to increase the reporting frequency and to enhance the completeness and the quality of the ADR reports in the study setting., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Pharmacy and Bioallied Sciences.)

Introduction: Patients with type 2 diabetes mellitus (T2DM) are at significantly higher risk of developing cardiovascular diseases (CVD). There is a scarcity of literature reviews that describe and summarize T2DM patients' knowledge and perception about CVD prevention., Objectives: To describe and summarize the assessment of knowledge and perceptions about CVD risk and preventive approaches among patients with T2DM., Methods: A scoping review methodology was adopted, and three scientific databases, Google Scholar, Science Direct, and PubMed were searched using predefined search terms. A multistage screening process that considered relevancy, publication year (2009-2019), English language, and article type (original research) was followed. We formulated research questions focused on the assessment of levels of knowledge and perceptions of the illness relevant to CVD prevention and the identification of associated patients' characteristics., Results: A total of 16 studies were included. Patients were not confident to identify CVD risk and other clinical consequences that may occur in the prognostic pathway of T2DM. Furthermore, patients were less likely to identify all CV risk factors indicating a lack of understanding of the multi-- factorial contribution of CVD risk. Patients' beliefs about medications were correlated with their level of adherence to medications for CVD prevention. Many knowledge gaps were identified, including the basic disease expectations at the time of diagnosis, identification of individuals' CVD risk factors, and management aspects. Knowledge and perceptions were affected by patients' demographic characteristics, e.g., educational level, race, age, and area of residence., Conclusion: There are knowledge gaps concerning the understanding of CVD risk among patients with T2DM. The findings necessitate educational initiatives to boost CVD prevention among patients with T2DM. Furthermore, these should be individualized based on patients' characteristics, knowledge gaps, disease duration, and estimated CVD risk., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Purpose: This study investigated pharmacy students' perceptions of various aspects of virtual objective structured clinical examinations (vOSCEs) conducted during the coronavirus disease 2019 pandemic in Malaysia., Methods: This cross-sectional study involved third- and fourth-year pharmacy students at the International Islamic University Malaysia. A validated self-administered questionnaire was distributed to students who had taken a vOSCE a week before., Results: Out of the 253 students who were approached, 231 (91.3%) completed the questionnaire. More than 75% of the participants agreed that the instructions and preparations were clear and helpful in familiarizing them with the vOSCE flow. It was found that 53.2% of the respondents were satisfied with the flow and conduct of the vOSCE. However, only approximately one-third of the respondents believed that the tasks provided in the vOSCE were more convenient, less stressful, and easier to perform than those in the conventional OSCE. Furthermore, 49.7% of the students favored not having a vOSCE in the future when conducting a conventional OSCE becomes feasible again. Internet connection was reported as a problem hindering the performance of the vOSCE by 51.9% of the participants. Students who were interested in clinical pharmacy courses were more satisfied than other students with the preparation and operation of the vOSCE, the faculty support, and the allocated time., Conclusion: Students were satisfied with the organization and operation of the vOSCE. However, they still preferred the conventional OSCE over the vOSCE. These findings might indicate a further need to expose students to telehealthcare models.

The current pandemic of the COVID-19 infection, coupled with the increased global burden of diabetes, has imposed significant challenges to the healthcare providers in providing effective and sustained care to patients with diabetes during the ongoing pandemic. It is, therefore, important for healthcare providers to understand and follow the recommended changes in the delivery of care, lifestyle modifications, and pharmacotherapy to ensure optimal care to the patients during and post-pandemic era. This commentary aims to discuss the impact of COVID-19 on diabetes care and the important considerations for pharmacists during this pandemic., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Fruit of salak (Salacca zalacca) is traditionally used and commercialized as an antidiabetic agent. However, the scientific evidence to prove this traditional use is lacking. This research was aimed to evaluate the metabolic changes of obese-diabetic (OBDC) rats treated with S. zalacca fruit extract using proton-nuclear magnetic resonance ( 1 H NMR)-based metabolomics approach. This research presents the first report on the in vitro antidiabetic effect of S. zalacca fruits extract using this approach. The obtained results indicated that the administration of 400 mg/kg bw of 60% ethanolic S. zalacca extract for 6 weeks significantly decreased the blood glucose level and normalized the blood lipid profile of the OBDC rats. The potential biomarkers in urine were 2-oxoglutarate, alanine, leucine, succinate 3-hydroxybutyrate, taurine, betaine, allantoin, acetate, dimethylamine, creatine, creatinine, glucose, phenyl-acetylglycine, and hippurate. Based on the data obtained, the 60% ethanolic extract could not fully improved the metabolic complications of diabetic rats. The extract of S. zalacca fruit was able to decrease the ketones bodies as 3-hydroxybutyrate and acetoacetate. It also improved energy metabolism, involving glucose, acetate, lactate, 2-hydroxybutyrate, 2-oxoglutarate, citrate, and succinate. Moreover, it decreased metabolites from gut microflora, including choline. This extract had significant effect on amino acid metabolism, metabolites from gut microflora, bile acid metabolism and creatine. The result can further support the traditional claims of S. zalacca fruits in management of diabetes. This finding might be valuable in understanding the molecular mechanism and pharmacological properties of this medicinal plant for managing diabetes mellitus., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Western dietary habits, coupled with a sedentary lifestyle, are potential contributors to the prevalence and rapid increase in the incidence of obesity in Saudi Arabia. This study aimed to investigate the association between students' weight status and their eating behaviors and practices. Another aim was to assess students' awareness of the health risks associated with obesity., Methods: A cross-sectional survey was conducted among a sample of 416 (53% male and 47% female) undergraduate students, aged 18-26 years old, between January 6 and April 6, 2019, from colleges of Health Sciences at Jazan University in the Kingdom of Saudi Arabia (K.S.A). Students completed a self-administered questionnaire and recorded their measured anthropometric parameters., Results: The prevalence of overweight (20.4%) and obesity (14.9%) were relatively high among the participants. There were statistically significant associations between Body Mass Index (BMI) and the different settings of food consumption (i.e., dining on a table (or) in the Islamic way: squatting on the ground) (p<0.001)). BMI was also associated with students' dietary habits regarding consuming food, snacks, and drinking carbonated beverages while watching television (p<0.001), as well as consuming the same pattern of food/drink while watching television, playing video games on mobile phones or computers (p<0.001). Nearly most of the students were oblivious to the fact that metabolic syndrome, reproductive disorders, respiratory disorders along with liver and gallbladder diseases are some of the health risks associated with obesity., Conclusion: The prevalence of obesity and overweight were reasonably high in our study sample and were affected by several factors related to students' eating behaviors and practices. This warrants the need for rigorous and frequent health education interventions on healthy eating behaviors, dietary practices, with an emphasis on the importance of adopting an active, healthy lifestyle., Competing Interests: The authors have declared that no competing interests exist.

Objective: Previous reports have highlighted the suboptimal utilization and prescription of statin therapy among patients with type 2 diabetes mellitus (T2DM) in the Malaysian clinical practice. This study aims to test the impact of a pharmacist-led academic detailing program on improving the overall statin therapy prescribing in Malaysian hospital and primary care settings., Methods: As a quasi-experimental design with a control group and pre-tests., we examined 1,598 medical records of T2DM subjects in six healthcare facilities in the state of Pahang, Malaysia. In all study sites, there was a pre and post-intervention assessment of the percentage of appropriate statin therapy prescribing that complied with the clinical guidelines with no potential safety issues. The intervention was an academic detailing program offered to the health care providers in three study sites, while the other three sites served as the control group. A comparison of the overall percentage of appropriate statin therapy prescribing before and after the academic detailing was performed in all intervention and control sites., Results: Overall, 797 medical records were examined in the pre-intervention phase, and 801 records were evaluated in the post-intervention phase. The academic detailing program was associated with a statistically significant difference in the proportion of appropriate statin therapy prescribing between the post-intervention phase compared to the pre-intervention phase (n = 246, 61.7% versus n = 188, 47.1%), p = 0.001. Whereas, the appropriate statin therapy prescribing in the control study sites experienced a modest change from 53.8% (214/398) to 56.7% (228/402), p = 0.220. The academic detailing showed significant increases in the proportions of appropriate statin therapy prescribing in both hospital and primary care settings., Conclusions: The academic detailing program was found to be significantly associated with a positive impact on the overall statin therapy prescribing among patients with T2DM in Malaysian hospital and primary care settings., Competing Interests: The authors have declared that no competing interests exist.

Background and Objectives: Various devices have been used to maintain oral hygiene. These include toothbrush and toothpaste, mouthwash, dental floss, miswak, and toothpick. This study attempts to investigate the use of various oral cleaning devices and their perceived benefits among Malaysians., Methods: A quantitative cross-sectional study conducted in two different cities of Malaysia. A convenience sampling approach was adopted. A total of 787 participants agreed to participate in the current research. A validated questionnaire translated into national language was used for data collection., Statistical Analysis Used: Data analysis was performed using Statistical Package for Social Sciences version 20., Results: About 302 respondents were in the age range of 18 - 25 years old (38.4%). There were marginally more females (55.7%) than males (44.3%). Although 99.9% of the participants used a toothbrush, a significant majority ( n = 590, 75%) used more than a single device to maintain their oral hygiene. Only 311 respondents knew that toothpicks were inappropriate to use to remove food between teeth and gums, while a majority ( n = 592, 75.2%) did not realize that some mouthwashes can stain the teeth. Less than half (42.1%) knew that improper use of miswak might harm the teeth., Conclusions: Although their oral hygiene behaviors are relatively at a higher level, their perceived oral health benefits did not compare well.

Rationale: Previous research reported underutilization of statin therapy among patients with type 2 diabetes mellitus. Improving health care providers' awareness and understanding of the benefits and risks of statin treatment could be of assistance in optimizing the statin prescribing process., Aims and Objectives: This study aimed to assess health care providers' knowledge related to statin therapy and the impact of educational outreach intervention based on the perceived knowledge., Methods: This was a cross-sectional study based on educational outreach intervention targeting physicians and pharmacists in 1 major tertiary hospital in the state of Pahang, Malaysia. Participants responded to a 12-item, validated questionnaire both prior to and after the outreach educational program. Two sessions were conducted separately for 2 cohorts of pharmacists and physicians. The knowledge scores prior to and after the educational intervention were calculated and compared using a paired-samples t-test., Results: The response rate to both pre-and post-educational outreach questionnaires was 91% (40/44). Prior to the intervention, around 84% (n37) of the participants decided to initiate statin therapy for both pre-assessment clinical case scenarios; however, only 27% (n12) could state the clinical benefits of statin therapy. Forty-five percent (n20) could state the drug to drug interactions, and 52.3% (n23) could identify the statin therapy that can be given at any time day/evening. The educational outreach program increased participants' knowledge scores of 1.450 (95% CI, 0.918 to 1.982) point, P < .0005, which is statistically significant. Forty respondents (91%) were of the opinion that statin side effects are the most common cause of treatment discontinuation., Conclusion: This work demonstrated the impact of an educational outreach intervention on improving health care providers' knowledge and beliefs about statin therapy. This type of intervention is considered effective for short-term knowledge enhancement. Further research is needed to test the long-term efficacy of such intervention., (© 2018 John Wiley & Sons, Ltd.)

Introduction: The role of pharmacists in the patient care process is developing in the Malaysian healthcare setting. Pharmacy students are required to be aware of cardiology pharmacy practice as this is one of the top national disease burdens in Malaysia. This study was conducted to assess the knowledge and perceptions of pharmacy students toward the cardiology pharmacy specialty practice., Methods: A descriptive cross-sectional study was conducted. The study instrument was a 31-item self-developed questionnaire. The target participants were third and fourth-year pharmacy students in one of the public Malaysian pharmacy schools., Results: The overall response rate was 174/209 students (83.3%); 42 (24.1%) were male and 132 (75.9%) were female. The majority of students possessed a sound knowledge regarding cardiology pharmacy services and roles of the cardiology pharmacist. Nevertheless, important differences were noted between the participants in a few particular areas. These included prior familiarity with the term "cardiology pharmacy" (p = 0.032), limitations to the active participation of pharmacists in the cardiology unit in Malaysia (p = 0.013), and perceptions toward the necessity of a cardiology pharmacist to the Malaysian healthcare system (p = 0.005)., Conclusions: Overall, the pharmacy students in our sample have high knowledge of and positive perceptions toward cardiology pharmacy practice. The majority of students perceived the introduction of cardiology pharmacy as a stand-alone subject in the undergraduate pharmacy curriculum in a positive manner. This study may be considered as a starting point for Malaysian pharmacy schools to consider offering focused clinical learning aligned with both the nation's health priorities and the prospective specialty level of clinical pharmacy practice in the country., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background and Objectives: Students in relevant health-care academic programs are the future professionals who should play an active role in increasing community awareness regarding chronic diseases such as osteoporosis. This research aimed to evaluate the knowledge of osteoporosis, one of the growing health-care burdens in Malaysia, among students belong to three different health occupations programs in a Malaysian University., Methods: A cross-sectional study design was conducted to assess the level of knowledge on osteoporosis and to explore the potential association between the study program and osteoporosis-related knowledge among medicine, pharmacy, and allied health sciences students in a Malaysian University. A total of 348 students were approached. The data were collected using validated revised Osteoporosis Knowledge Test questionnaire., Results: The results showed variability in knowledge score between students belonging to different study programs. allied health sciences students have the highest overall total score (median = 20) and nutrition score (median = 16), but for exercise score, both students in allied health sciences and medicine programs shared a similar median score (median = 11.5). More than half of the respondents showed adequate knowledge on osteoporosis. The students from allied health sciences exhibited more knowledge on osteoporosis compared to students in other study programs. Among the Kulliyyah of Pharmacy respondents, the majority did not manage to answer correctly on the whole scale. This was evident by total percentage of 69.91% of the respondents scored below than median score., Conclusion: There is a considerable gap of knowledge regarding osteoporosis among students in various health occupations academic programs. Pharmacy students particularly need focused learning related to exercise and nutrition in preventing osteoporosis during their academic program., Competing Interests: There are no conflicts of interest.

Use of statin therapy in patients with type 2 diabetes mellitus (T2DM) has been recommended by most clinical guidelines. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among T2DM patients. It has been proved that statins are effective for primary or secondary CVD prophylaxis. Reports have highlighted the underutilization of statins in clinical practice and the suboptimal adherence to guideline recommendations. This review article points to summarize the current evidence confirming the role of statins in T2DM patients and to provide an overview of factors that may affect statins' prescribing patterns and compliance in clinical practice. Initiatives to enhance statin therapy prescribing should recognize the comprehensive nature of the prescribing process. Attempts to assure proper statin prescribing and utilization can help in achieving better clinical outcomes of statin therapy., Competing Interests: There are no conflicts of interest.