Saudi Pharmaceutical Journal最新文献

Johns Hopkins Aramco Healthcare (JHAH) is a leading healthcare organization dedicated to revolutionizing healthcare practices in Saudi Arabia. This review article features the significant strides made by the JHAH ambulatory care pharmacy to symbolize Saudi Arabia’s ambitious vision of healthcare transformation. This evolving journey includes details of JHAH’s adoption of modern automation tools, several technological advancements, and establishing a pharmacist role far beyond dispensing medications. Moreover, it underscores the cultivation of patient-centered care initiatives like tele-pharmacy services through pharmacy call center, systematic patient satisfaction surveys, streamlined medication home delivery services, state-of-the-art medication drive-thru pick-up facility, the efficacious Q-Matic patient queue management architecture, and the establishment of discreet individual dispensing cubicles. Key focal points encompass technological enhancements, such as the incorporation of electronic health record Epic, cutting-edge pharmacy automation systems, and the patient-centric online portal MyChart®. The article also summarizes the multifaceted ambulatory care enhancements among clinical pharmacy services offered at JHAH. This includes a pharmacist-led medication management clinic, specialized anticoagulation clinic, psychiatric and hepatitis medication management, renal dose optimization, precision-driven thyroid and benign prostatic hyperplasia patients’ treatment optimization, and clinical decision support system-backed clinical interventions. All these substantial enhancements at JHAH’s ambulatory pharmacy have been made to improve the quality of pharmaceutical services. Besides automation and technological advancements, these also include the establishment of pharmacy competency and continuous education programs, the development of an internal pharmacy webpage on the JHAH website, the implementation of a mechanism for formulary management by the pharmacy and therapeutic committee, and very importantly the adoption of electronic incidence reporting system Datix. The review highlights JHAH’s commitment to bringing ambulatory care pharmacy practice to new heights, thereby establishing a benchmark for patient-centric care and innovative excellence within the Saudi Arabian healthcare landscape.

Introduction

Despite the availability of new cardio-protective oral hypoglycemic drugs, insulin is often recommended as an add-on therapy for type-2 diabetes with hemoglobin A1C (HbA1C) ≥ 9. Introducing insulin as a choice for patients with uncontrolled hyperglycemia (HbA1C≥9) has been questionably associated with cardiovascular sequelae. This study aims to examine the association between insulin use and cardiovascular effects in type-2 diabetic patients with uncontrolled hyperglycemia.

Methodology

A retrospective observational cohort study was conducted to identify cardiovascular complications between the two groups (patients with HbA1C≥9% on insulin versus those with HbA1C≥9% without insulin) at King Saud University Medical City (KSUMC). Patients with type-2 diabetes whose HbA1C was ≥ 9 during the period from 2015 to 2018 and who were followed up within the hospital for at least 5 years until the end of 2022 were included in the study.

Results

A total of 366 patients were included in the study; 286 patients were on insulin, while 80 patients were not. The median baseline HbA1C levels were comparable between the two groups (10.2 versus 9.8). After 5 years of follow-up, there was no significant difference between the groups (29.4 % of insulin users versus 18.8 % of non-insulin users; p = 0.065). However, the incidence of other diabetes complications, such as retinopathy, nephropathy, and neuropathy, was significantly higher among patients who were on insulin compared to those not on insulin (50.7 % versus 27.5 %; p = 0.005). Additionally, the average of the last three HbA1C readings and the overall average HbA1C readings were significantly higher among patients who were on insulin (9.67 % versus 9.07 %; p = 0.001) compared to those not on insulin (9.64 % versus 9.11 %; p = 0.005).

Conclusion

Our study did not find a significant association between the use of insulin and cardiovascular complications. The association between insulin therapy and the development of other diabetes complications warrants further investigation.

Opuntia (Cactaceae) species are native to arid and semi-arid regions of Mexico and the southern United States and grow in various climatic zones. Opuntia dillenii is a cactus fruit with many beneficial properties, and it is used as a medicinal plant in various countries. This review paper provides updated information on the phytochemical and pharmacological aspects of O. dillenii. The fruit contains valuable compounds such as flavonoids, phenolics, ascorbic acid, betanin, and essential elements, which have been isolated and identified. The fruit also exhibits diverse pharmacological activities, such as antioxidant, anti-inflammatory, anti-tumor, neuroprotective, hepatoprotective, hypotensive, anti-diabetic, antifungal, and anticancer effects. Moreover, molecular docking and ADMET predictions were performed to evaluate the antibacterial potential of the fruit against Escherichia coli protein. This paper suggests that O. dillenii has significant potential as a complementary therapy for various pathological conditions.

Purpose

Despite the surge of melatonin supplement consumption in recent years, data on the prevalence and patterns of melatonin usage in Saudi Arabia is lacking. The aim of this study was to assess the prevalence and pattern of sleep-related melatonin usage among adults in Saudi Arabia.

Methods

This was a cross-sectional, web-based, self-administered survey study conducted across all regions of Saudi Arabia. Participants were recruited from the general population (≥18 years). The survey was distributed between February and April 2023. Chi-squared tests and t-tests were performed for comparative bivariate analyses where binary logistic regression was performed to derive the main predictors of melatonin consumption.

Results

Out of 5,606 participants, 536 (10 %) were consumers of melatonin. Older age (Adjusted OR = 1.01, 95 % CI = 1.01–1.02, p = 0.002), being a male (Adjusted OR = 1.76, 95 % CI = 1.46–2.14, p = 0.001), individuals with a doctorate degree or an equivalent (adjusted OR 2.37 95 % CI = 1.35–4.17, p = 0.003), perceived poor sleep quality (Adjusted OR = 1.52, 95 % CI = 1.10–2.11, p = 0.01), and being diagnosed with a sleep disorder (Adjusted OR = 2.55, 95 % CI = 2.04–3.18, p = 0.001) were all associated with increased likelihood of sleep-related melatonin usage. 35 % of consumers self-reported taking ≥1 tablet per day, while 26 % of them were uncertain about the dosage they consume.

Conclusion

With a notable prevalence of 10% among the general population in Saudi Arabia, melatonin usage was more common in older adults, males, and those with higher education.

Background

The utilization rate of antipsychotics to treat different mental disorders is rising. However, little is known about their side effects’ impact on depression levels. Therefore, the objective of this study was to examine the association between antipsychotic side effects and depression among psychiatric patients treated with antipsychotics.

Methods

This is a prospective, single-center, interview-based, cross-sectional study that examined the association between antipsychotic side effects and depression among adult patients (e.g., ≥18 yrs.) with psychiatric illnesses (e.g., depression, schizophrenia, bipolar disorder) visiting outpatient clinics in a university-affiliated tertiary care center. Antipsychotic side effects were assessed using the Arabic version of the Glasgow Antipsychotic Side-effect Scale (GASS), while depression was assessed using the Arabic version of the 9-item Patient Health Questionnaire (PHQ-9). Univariate and multiple linear regressions were conducted to examine the association between the PHQ-9 and GASS scores.

Results

One hundred patients met the inclusion criteria and consented to participate. Most of the patients were females (72 %) with a mean age of 38 years. Schizophrenia (37 %) and bipolar disorder (54 %) were the most common mental disorders among the recruited patients. The majority of patients were treated with atypical (e.g., second-generation) antipsychotics (88 %) for at least six months (74 %). Controlling for age, gender, annual family income, education, employment status, marital status, number of comorbidities, duration of treatment with antipsychotics, the type of antipsychotic, and psychiatric illness, higher GASS scores, which indicate more severe antipsychotic side effects, predicted higher PHQ-9 score (e.g., higher levels of depression) (β = 0.419, 95 % CI=[0.307–0.532], p-value < 0.0001).

Conclusion

Early identification and management of antipsychotic side effects among psychiatric patients should enhance patient adherence and improve treatment outcomes. Future studies should verify the findings of this study using more robust study designs.

Introduction

This review examines substance misuse disorder (SMD) in Saudi Arabia, drawing insights from 43 prior studies. It explores the prevalence and patterns of SMD across diverse demographics.

Methodology

Our analysis integrated data from various studies involving adolescents, university students, psychiatric patients, and the general population as well as postmortem cases. It identifies key risk factors and challenges in managing SMD, underscoring the importance of comprehensive data collection for evidence-based policymaking.

Results

SMD in Saudi Arabia were categorized into two groups: common traditionally abused drugs (such as Captagon, khat, heroin, ethanol, and cannabis) and substances that have emerged in recent years (e.g., methamphetamine “Shabu”, pregabalin, and benzodiazepines). Trends in SMD include early substance initiation and increased amphetamine and polysubstance use.

Conclusion and recommendations

Drug-related challenges persist in Saudi Arabia; however, because of limited data from recent epidemiological studies on drug disorders, the full extent is unknown. Saudi Arabia is unique because it as an Islamic country with strict regulations against drug trafficking and a religious prohibition on drugs and alcohol, which contributes to distinct trends in substance misuse disorder (SMD). Although some aspects mirror global patterns, others exhibit regional characteristics specific to the country. Despite data variability, actionable recommendations have emerged for SMD prevention and treatment. During the COVID-19 pandemic, a high number of reports was evident; however, SMD publications often reiterate old findings and overlook emerging psychoactive substances (EPS), such as ‘Shabu”, pregabalin, and benzodiazepines. Further studies are needed, including educational initiatives, national surveys, stricter drug regulations, and an early warning system for traditional SMD and EPS.

In this current research, we conceptualized a novel nanotechnology-enabled synthesis approach of targeting HIV-harboring tissues via second-generation (G2) polyamidoamine (PAMAM) mannosylated (MPG2) dendrimers for programmed delivery of anti-HIV drugs efavirenz (EFV) and ritonavir (RTV). Briefly, here mannose served purpose of ligand in this EFV and RTV-loaded PAMAM G2 dendrimers, synthesized by divergent techniques, denoted as MPG2ER. The developed nanocarriers were characterized by different analytical tools FTIR, NMR, zeta potential, particle size, and surface morphology. The results of confocal microscopy showed substantial alterations in the morphology of H9 cells, favored by relatively higher drug uptake through the MPG2ER. Interestingly, the drug uptake study and cytotoxicity assay of MPG2ER demonstrated that it showed no significant toxicity up to 12.5 µM. A typical flow cytometry histogram also revealed that MPG2ER efficiently internalized both drugs, with an increase in drug uptake of up to 81.2 %. It also enhanced the plasma pharmacokinetics of EFV, with C_max7.68 μg/ml, AUC of 149.19 (μg/ml) * hr, and MRT of 26.87 hrs. Subsequently, tissue pharmacokinetics further evidence that MPG2ER accumulated more in distant Human immunodeficiency virus (HIV) reservoir tissues, such as the lymph nodes and spleen, but without exhibiting significant toxicity. Abovementioned compelling evidences strongly favored translational roles of MPG2 as a potential therapeutic strategy in the clinical eradication of HIV from viral reservoir tissue.

Skin infections considered as one of the predominant disorders that could greatly influence humans. Topical drug delivery is believed to be an effective substitute to systemically delivered medication for skin disorders management. Erythromycin has been proven to retain anti-bacterial activity. Based on that, the aim of existent study is to develop a proper nanocarrier, namely; nanoemulsion using tea tree oil including Erythromycin. Applying quality by design approach, the optimized nanoemulsion was selected based on number of independent variables namely; particle size and in vitro release study. Yet, in order to get appropriate topical application, the optimized nanoemulsion was combined with previously prepared hydrogel base to provide Erythromycin based nanoemulgel. The developed nanoemulgel was assessed for its organoleptic and physical characters to ensure its suitability for topical application. Stability study was implemented over three months after being kept in two distinct environments. Eventually, the antibacterial behavior of the preparation was investigated on MRSA to verify the expected antibacterial improvement and validate the effectiveness of the developed nanocarrier. The formulation showed consistent appearance, with pH (6.11 ± 0.19), viscosity (10400 ± 1275 cP), spreadability (54.03 ± 2.3 mm), extrudability (80.36 ± 3.15 g/cm²) and drug content (99.3 ± 0.46 %) that seemed to be satisfied for topical application. It could provide 48.1 ± 4.2 % releases over 6 h in addition to be stable at room temperature and at refrigerator. Ultimately, the formula showed a significant antibacterial activity against MRSA proving the combination and the nanocarrier effectiveness.

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies worldwide. Sorafenib (Sf) is currently the first-line treatment for HCC. However, due to the side effects and unsatisfied efficiency of Sf, it is urgent to combine different therapeutic agents to inhibit HCC progression and increase the therapeutic efficacy. Here, our study constructed a Sf and KIAA1199-siRNA co-loaded liposome Sf-Lp-KIAA, which was prepared by electrostatic interaction of KIAA1199-siRNA and Sf loaded liposome (Sf-Lp). The particle size, zeta potential, the in vitro cumulative release was investigated. The physical and chemical properties were characterized, and the inhibition of HepG2 growth and metastasis in vitro was investigated. The cellular uptake of the co-loaded liposome was significantly higher than that of free siRNA, and the drug/siRNA could be co-delivered to the target cells. Sf-Lp-KIAA could significantly inhibit the growth, migration, invasion and down-regulate KIAA1199 expression of HepG2 cells in vitro than that of single Sf treated group. In addition, the co-delivery liposome accumulated in the HepG2 subcutaneous tumor model and suppress tumor growth after systemic administration without induce obvious toxicity. The present study implied that the co-delivery of Sf and KIAA1199-siRNA through the co-loaded liposomes exerted synergistic antitumor effects on HCC, which would lay a foundation for HCC therapy in the future.

This study explores the course review process implemented by the College of Pharmacy at King Saud University for its Pharm.D. program. Through a qualitative research design, a dedicated course review committee was established to oversee the evaluation process. The committee gathered and analyzed data from various sources, including course reports, student evaluations, and exam center reports, to achieve a holistic understanding of each course’s effectiveness. The evaluation process was structured into a Four-Step Course Evaluation Approach: data collection, data review and recommendations, taking appropriate action, and communicating the outcomes. The “closing the loop” stage ensured that recommendations were effectively implemented, and course evaluation data were systematically archived for future reference. The results of this study, based on the evaluation of 25 courses, revealed significant improvements in course quality, alignment with program learning outcomes, and adherence to accreditation standards. Key findings included the identification of gaps and discrepancies, leading to targeted interventions and enhanced course content. Overall, this study highlights the effectiveness of a structured course review process in enhancing the quality of education and ensuring continuous improvement within the college. The committee focuses on refining evaluation criteria, conducting workshops, and providing training to stay current with emerging accreditation standards and best practices. This systematic course review process demonstrates the College’s commitment to providing high-quality education and preparing students for successful careers in pharmacy, with significant implications for the improvement of pharmacy education and the overall student learning experience.