Effect Of Pharmaceutical Intervention Research Articles

Insights into the Mechanism of Osteoporosis and the Available Treatment Options.

Osteoporosis, one of the most prevalent bone illnesses, majorly affects postmenopausal women and men over 50 years of age. Osteoporosis is associated with an increased susceptibility to fragility fractures and can result in persistent pain and significant impairment in affected individuals. The primary method for diagnosing osteoporosis involves the assessment of bone mineral density (BMD) through the utilisation of dual energy x-ray absorptiometry (DEXA). The integration of a fracture risk assessment algorithm with bone mineral density (BMD) has led to significant progress in the diagnosis of osteoporosis. Given that osteoporosis is a chronic condition and multiple factors play an important role in maintaining bone mass, comprehending its underlying mechanism is crucial for developing more effective pharmaceutical interventions for the disease. The effective management of osteoporosis involves the utilisation of appropriate pharmacological agents in conjunction with suitable dietary interventions and lifestyle modifications. This review provides a comprehensive understanding of the types of osteoporosis and elucidates the currently available pharmacological treatment options and their related mechanism of action and usage.

Predicting repurposed drugs targeting the NS3 protease of dengue virus using machine learning-based QSAR, molecular docking, and molecular dynamics simulations

ABSTRACT Dengue fever, prevalent in Southeast Asian countries, currently lacks effective pharmaceutical interventions for virus replication control. This study employs a strategy that combines machine learning (ML)-based quantitative-structure-activity relationship (QSAR), molecular docking, and molecular dynamics simulations to discover potential inhibitors of the NS3 protease of the dengue virus. We used nine molecular fingerprints from PaDEL to extract features from the NS3 protease dataset of dengue virus type 2 in the ChEMBL database. Feature selection was achieved through the low variance threshold, F-Score, and recursive feature elimination (RFE) methods. Our investigation employed three ML models – support vector machine (SVM), random forest (RF), and extreme gradient boosting (XGBoost) – for classifier development. Our SVM model, combined with SVM-RFE, had the best accuracy (0.866) and ROC_AUC (0.964) in the testing set. We identified potent inhibitors on the basis of the optimal classifier probabilities and docking binding affinities. SHAP and LIME analyses highlighted the significant molecular fingerprints (e.g. ExtFP69, ExtFP362, ExtFP576) involved in NS3 protease inhibitory activity. Molecular dynamics simulations indicated that amphotericin B exhibited the highest binding energy of −212 kJ/mol and formed a hydrogen bond with the critical residue Ser196. This approach enhances NS3 protease inhibitor identification and expedites the discovery of dengue therapeutics.

Pro- and anti-inflammatory cytokines are the game-changers in childhood obesity-associated metabolic disorders (diabetes and non-alcoholic fatty liver diseases).

Childhood obesity is a chronic inflammatory epidemic that affects children worldwide. Obesity affects approximately 1 in 5 children worldwide. Obesity in children can worsen weight gain and raise the risk of obesity-related comorbidities like diabetes and non-alcoholic fatty liver disease (NAFLD). It can also negatively impact the quality of life for these children. Obesity disrupts immune system function, influencing cytokine (interleukins) balance and expression levels, adipokines, and innate and adaptive immune cells. The altered expression of immune system mediators, including interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-17 (IL-17), interleukin-18 (IL-18), transforming growth factor (TGF), tumor necrosis factor (TNF), and others, caused inflammation, progression, and the development of pediatric obesity and linked illnesses such as diabetes and NAFLD. Furthermore, anti-inflammatory cytokines, including interleukin-2 (IL-2), have been shown to have anti-diabetes and IL-1 receptor antagonist (IL-1Ra) anti-diabetic and pro-NAFLFD properties, and interleukin-10 (IL-10) has been shown to have a dual role in managing diabetes and anti-NAFLD. In light of the substantial increase in childhood obesity-associated disorders such as diabetes and NAFLD and the absence of an effective pharmaceutical intervention to inhibit immune modulation factors, it is critical to consider the alteration of immune system components as a preventive and therapeutic approach. Thus, the current review focuses on the most recent information regarding the influence of pro- and anti-inflammatory cytokines (interleukins) and their molecular mechanisms on pediatric obesity-associated disorders (diabetes and NAFLD). Furthermore, we discussed the current therapeutic clinical trials in childhood obesity-associated diseases, diabetes, and NAFLD.

A rearranged abietane diterpenoid from Clerodendrum mandarinorum inhibits tumor progression of oral squamous cell carcinoma in vitro

Tongue cancer, a prevalent form of oral malignancy, particularly manifests as tongue squamous cell carcinoma (TSCC), which holds the highest incidence among oral squamous cell carcinoma cases, representing 43.4 % of occurrences. Presently, surgical resection stands as the primary treatment for TSCC, with no effective pharmaceutical interventions identified. This study aims to search for the potential anti-tumor properties and molecular mechanisms of a rearranged abietane diterpenoid extracted from Clerodendrum mandarinorum. Within this investigation, six known rearranged abietane diterpenoids (1–6) were isolated and characterized from C. mandarinorum. Notably, compound 1 demonstrated the most robust inhibitory effect against CAL-27 cells. Pharmacological assays further substantiated that compound 1 significantly restrained the proliferation, migration, and invasion of CAL-27 cells. Moreover, it was revealed that compound 1 directly interacted with TGFβR2, a pivotal receptor in the downstream signaling pathways of TGF-β/Smad and PI3K/AKT. Transcriptome analysis provided additional confirmation of these observations. Overall, our study highlights the promising potential of compound 1 as a therapeutic agent for the treatment of oral squamous cell carcinoma.

Screening of MMP-13 Inhibitors Using a GelMA-Alginate Interpenetrating Network Hydrogel-Based Model Mimicking Cytokine-Induced Key Features of Osteoarthritis In Vitro.

Osteoarthritis (OA) is a chronic joint disease characterized by irreversible cartilage degradation. Current clinical treatment options lack effective pharmaceutical interventions targeting the disease's root causes. MMP (matrix metalloproteinase) inhibitors represent a new approach to slowing OA progression by addressing cartilage degradation mechanisms. However, very few drugs within this class are in preclinical or clinical trial phases. Hydrogel-based 3D in vitro models have shown promise as preclinical testing platforms due to their resemblance to native extracellular matrix (ECM), abundant availability, and ease of use. Metalloproteinase-13 (MMP-13) is thought to be a major contributor to the degradation of articular cartilage in OA by aggressively breaking down type II collagen. This study focused on testing MMP-13 inhibitors using a GelMA-alginate hydrogel-based OA model induced by cytokines interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α). The results demonstrate a significant inhibition of type II collagen breakdown by measuring C2C concentration using ELISA after treatment with MMP-13 inhibitors. However, inconsistencies in human cartilage explant samples led to inconclusive results. Nonetheless, the study highlights the GelMA-alginate hydrogel-based OA model as an alternative to human-sourced cartilage explants for in vitro drug screening.

A systematic review and network meta-analysis of pharmaceutical interventions used to manage chronic pain.

It is estimated 1.5 billion of the global population suffer from chronic pain with prevalence increasing with demographics including age. It is suggested long-term exposure to chronic could cause further health challenges reducing people's quality of life. Therefore, it is imperative to use effective treatment options. We explored the current pharmaceutical treatments available for chronic pain management to better understand drug efficacy and pain reduction. A systematic methodology was developed and published in PROSPERO (CRD42021235384). Keywords of opioids, acute pain, pain management, chronic pain, opiods, NSAIDs, and analgesics were used across PubMed, Science direct, ProQuest, Web of science, Ovid Psych INFO, PROSPERO, EBSCOhost, MEDLINE, ClinicalTrials.gov and EMBASE. All randomised controlled clinical trials (RCTs), epidemiology and mixed-methods studies published in English between the 1st of January 1990 and 30th of April 2022 were included. A total of 119 studies were included. The data was synthesised using a tri-partied statistical methodology of a meta-analysis (24), pairwise meta-analysis (24) and network meta-analysis (34). Mean, median, standard deviation and confidence intervals for various pain assessments were used as the main outcomes for pre-treatment pain scores at baseline, post-treatment pain scores and pain score changes of each group. Our meta-analysis revealed the significant reduction in chronic pain scores of patients taking NSAID versus non-steroidal opioid drugs was comparative to patients given placebo under a random effects model. Pooled evidence also indicated significant drug efficiency with Botulinum Toxin Type-A (BTX-A) and Ketamine. Chronic pain is a public health problem that requires far more effective pharmaceutical interventions with minimal better side-effect profiles which will aid to develop better clinical guidelines. The importance of understanding ubiquity of pain by clinicians, policy makers, researchers and academic scholars is vital to prevent social determinant which aggravates issue.

The NRF2/ID2 Axis in Vascular Smooth Muscle Cells: Novel Insights into the Interplay between Vascular Calcification and Aging.

Vascular calcification (VC) increases with age and markedly exacerbates the risk of cardiovascular morbidity and mortality. However, effective pharmaceutical interventions are lacking and the molecular mechanisms linking aging to VC remain elusive. This study explored the role of nuclear factor erythroid 2-related factor 2 (NRF2) in age-associated VC, specifically focusing on vascular smooth muscle cell (VSMC) senescence. Using a chronologically aging mouse model, we noted a significant decline in the expression of NRF2 in the aged mice aortas, coinciding with increased VC. Administering NRF2 activators effectively reduced calcification. By establishing adenine-and vitamin D-induced VC models in VSMC-specific Nrf2 knockout (Nrf2SMCKO) mice, there was an increase in VC with increased VSMC senescence. Aortic rings and primary VSMCs from Nrf2SMCKO mice also showed increased VC under high-phosphate conditions. Furthermore, Nrf2 overexpression inhibited VSMC calcification with decreased VSMC senescence and an osteogenic phenotype, whereas Nrf2 silencing aggravated calcification. Transcriptome RNA-seq analysis of the aortas from Nrf2SMCKO and control mice revealed that inhibitor of DNA binding 2 (Id2) is a core downstream gene of NRF2. Id2 overexpression alleviated NRF2 knockdown-induced VC and VSMC senescence, while silencing Id2 negated the protective effects of NRF2. Moreover, results of a dual luciferase reporter assay indicated that NRF2 promotes the transcriptional activity of the Id2 gene promoter region. This study emphasizes the critical role of age-related NRF2 dysfunction in the nexus between VSMC senescence and VC. The NRF2-ID2 axis in VSMCs has been proposed as a promising therapeutic target for reducing VC and mitigating age-related cardiovascular diseases.

Targeted inhibition of CX3CL1 limits podocytes ferroptosis to ameliorate cisplatin-induced acute kidney injury

BackgroundIt is widely acknowledged that cisplatin-induced nephrotoxicity hinders its efficacy during clinical therapy. Effective pharmaceutical interventions for cisplatin-induced acute kidney injury (Cis-AKI) are currently lacking. Prior studies have implicated the chemokine CX3CL1 in the development of lipopolysaccharide-induced AKI; however, its specific role in Cis-AKI remains uncertain. This research aimed to comprehensively characterize the therapeutic impact and mechanism of CX3CL1 inhibition on Cis-AKI.MethodsThis study employed an in vivo Cis-AKI mouse model and in vitro cisplatin-treated podocytes. Kidney pathological changes were assessed using hematoxylin–eosin (HE) and Periodic-Schiff (PAS) staining. Transcriptome changes in mouse kidney tissue post-cisplatin treatment were analyzed through RNA sequencing (RNA-seq) datasets. Evaluation parameters included the expression of inflammatory markers, intracellular free iron levels, ferroptosis-related proteins—solute carrier family 7 member 11 (SLC7A11/XCT) and glutathione peroxidase 4 (GPX4)—as well as lipid peroxidation markers and mitochondrial function proteins. Mitochondrial morphological changes were visualized through transmission electron microscopy. The impact of CX3CL1 on the glucose-regulated protein 78/eukaryotic translation initiation factor 2A/CCAAT enhancer binding protein-homologous protein (GRP78/eIF2α/CHOP) and hypoxia-inducible factor 1-alpha/heme oxygenase-1 (HIF1A/HO-1) pathways in Cis-AKI was assessed via Western Blot and Immunofluorescence experiments, both in vivo and in vitro.ResultsKidney CX3CL1 levels were elevated following cisplatin injection in wild-type (WT) mice. Cisplatin-treated CX3CL1-Knockout mice exhibited reduced renal histological changes, lowered blood creatinine (Cre) and blood urea nitrogen (BUN) levels, and decreased expression of inflammatory mediators compared to cisplatin-treated WT mice. RNA-seq analysis revealed the modulation of markers associated with oxidative stress and lipid metabolism related to ferroptosis in the kidneys of mice with Cis-AKI. Both the in vivo Cis-AKI mouse model and in vitro cisplatin-treated podocytes demonstrated that CX3CL1 inhibition could mitigate ferroptosis. This effect was characterized by alleviated intracellular iron overload, malondialdehyde (MDA) content, and reactive oxygen species (ROS) production, alongside increased glutathione/glutathione disulfide ratio, superoxide dismutase (SOD), XCT, and GPX4 activity. CX3CL1 inhibition also ameliorated mitochondrial dysfunction and upregulated expression of mitochondrial biogenesis proteins-uncoupling protein (UCP), mitofusin 2 (Mfn2), and peroxisome proliferators-activated receptor γ coactivator l-alpha (PGC1α)-both in vivo and in vitro. Furthermore, CX3CL1 inhibition attenuated cisplatin-induced endoplasmic reticulum (ER) stress in podocytes. Notably, CX3CL1 inhibition reduced cisplatin-induced expression of HIF-1α and HO-1 in vivo and in vitro.ConclusionOur findings suggest that CX3CL1 inhibition exerts therapeutic effects against Cis-AKI by suppressing podocyte ferroptosis.

Effect of Pharmaceutical Intervention in Pharmacologically Treated Hypertensive Patients-A Cluster-Randomized Clinical Trial: AFPRES-CLM Study.

Evaluate the effect of a community pharmaceutical intervention on the control of blood pressure in hypertensive patients treated pharmacologically. A cluster-randomized clinical trial of 6 months was carried out. It was conducted in the Autonomous Community of Castilla-La Mancha (Spain). Sixty-three community pharmacies and 347 patients completed the study. Intervention patients received the community pharmaceutical intervention based on a protocol that addresses the individual needs of each patient related to the control of their blood pressure, which included Health Education, Pharmacotherapy Follow-up and 24 h Ambulatory Blood Pressure Measurement. Control patients received usual care in the community pharmacy. The pharmaceutical intervention resulted in better control of blood pressure (85.8% vs. 66.3% p < 0.001), lower use of emergencies (p = 0.002) and improvement trends in the physical components of quality of life, measured by SF-36 questionnaire, after 6 months of pharmaceutical intervention. No significant changes were observed for any of these variables in the control group. There were also detected 354 negative medication-related outcomes that were satisfactorily resolved in a 74.9% of the cases and 330 healthcare education interventions and 29 Ambulatory Blood Pressure Monitorings were performed in order to increase adherence to pharmacological treatment and minimize Negative Outcomes associated with Medication and prevent medication-related problems. Community pharmaceutical intervention can increase hypertensive patients with controlled blood pressure, after 6 months, compared with usual care.

Integrated Bioinformatics Approach Showed Linagliptin as Potential Drug for Prevention of Cardiac Arrest and Cancer

The availability of Linagliptin as a DPP4 (Dipeptidyl-peptidase-4) inhibitor for the management of type 2 diabetes in individuals has been a recent development. The primary aim of the present investigation is to gain insights into the biological, physiological, and pharmacological mechanisms of action of the substance, as well as its impact on the cellular structure of human organisms. In this study, a range of genomics approaches and in-silico tools were employed, including PASS, SwissTargetPrediction, SwissADME, SEA, CLC-Pred, and DIGEP-Pred, to ascertain the physiochemical characteristics, pharmacokinetic attributes, biological targets, and biological activity of Linagliptin. Linagliptin is employed as a novel DPP4 inhibitor for the purpose of assisting those diagnosed with type 2 diabetes in managing their body's glycemic control. Nevertheless, our study revealed that Linagliptin has affinity for other molecular targets in humans, such as CHRM1, FAP, ALDH1A1, and PDE6D, thereby modulating their gene expression patterns. Prior studies have demonstrated that the administration of the medicine exerts an influence on renal and cardiovascular problems. Based on our research findings, we have developed a solid hypothesis that Linagliptin could potentially serve as an effective pharmaceutical intervention for the treatment of blood cancer and cardiac arrest.

Understanding neuropsychiatric symptoms in Alzheimer's disease: challenges and advances in diagnosis and treatment.

Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) affect up to 97% of AD patients, with an estimated 80% of current AD patients experiencing these symptoms. Common AD-associated NPS include depression, anxiety, agitation, aggression, and apathy. The severity of NPS in AD is typically linked to the disease's progression and the extent of cognitive decline. Additionally, these symptoms are responsible for a significant increase in morbidity, mortality, caregiver burden, earlier nursing home placement, and greater healthcare expenditure. Despite their high prevalence and significant impact, there is a notable lack of clinical research on NPS in AD. In this article, we explore and analyze the prevalence, symptom manifestations, challenges in diagnosis, and treatment options of NPS associated with AD. Our literature review reveals that distinguishing and accurately diagnosing the NPS associated with AD remains a challenging task in clinical settings. It is often difficult to discern whether NPS are secondary to pathophysiological changes from AD or are comorbid psychiatric conditions. Furthermore, the availability of effective pharmaceutical interventions, as well as non-pharmacotherapies for NPS in AD, remains limited. By highlighting the advance and challenges in diagnosis and treatment of AD-associated NPS, we aspire to offer new insights into the complexity of identifying and treating these symptoms within the context of AD, and contribute to a deeper understanding of the multifaceted nature of NPS in AD.

439 Design and feasibility testing of IDC-VI: a theory-informed intervention to support medication dispensing and counselling for patients with vision impairment

Abstract Introduction Pharmaceutical services for visually impaired (VI) individuals are lacking, both worldwide and in Saudi Arabia (SA). Little evidence exists for effective pharmaceutical interventions to support medicines optimisation in this population (1). The Medical Research Council advocates theory-based intervention development and feasibility testing before full implementation. A feasibility study ‘asks whether something can be done, should we proceed with it, and if so, how’. Aim To design and test the feasibility of IDC-VI (Intervention for Dispensing and Counselling for the Visually Impaired). Methods Phase 1 focused on developing the intervention. Using the theoretical domains framework (TDF) (2), 26 hospital/community pharmacists in SA were interviewed about their dispensing/counselling behaviour with a view to developing an intervention. The research team identified nine key TDF domains and selected eight behaviour change techniques (BCTs) to include in the intervention which could potentially enhance the pharmacist’s knowledge, skills and help them monitor their behaviour. The BCTs were operationalised to produce an intervention package including a training session for pharmacists, behaviour goal setting and review sheets, a checklist with 25 steps to follow during dispensing/counselling (e.g., Ask “What is the best method to provide information about medications to you and/or your caregiver?”), sample patient scenarios, and an intervention record and manual. Phase 2 tested the feasibility of the intervention and study procedures (recruitment, data collection) at two hospital outpatient pharmacies. Two pharmacists, recruited through the pharmacy supervisor, were trained and provided with all intervention materials. Pharmacists were asked to implement the intervention with VI adult patients taking ≥3 medicines. Due to difficulties in identifying patients prior to attending the pharmacy, records of those requesting refills for out-of-stock medicines were used to recruit patients. Outcomes focused on the feasibility of recruitment, and collecting data on pharmacists’ experience and patients’ medicines/medical conditions. Pharmacists and patients provided feedback through interviews and telephone-administered questionnaires, respectively. Descriptive statistics and thematic analysis were used to analyse data. Results Two pharmacists implemented the IDC-VI with five patients. The patient recruitment process was practical at the time, but not feasible for a future study as the pharmacy stopped collecting records of those requesting out-of-stock medications. Data on pharmacists’ experience and patients’ clinical data were easily collected via interviews or extracted from medical/pharmacy records, respectively. The dispensing/counselling process took 15-30 minutes. Both pharmacists thought the intervention was useful, but were concerned about its acceptability/practicability, due to heavy workload and time constraints at the pharmacy. Shortening the dispensing/counselling checklist was suggested to improve acceptability. Three patients reported that the service had somewhat influenced how they took their medications due to the additional information obtained. Two patients reported very little or no influence at all. Conclusion The IDC-VI used a novel approach in developing and testing an intervention targeting pharmaceutical care services to VI patients. It was potentially feasible. Numbers completing the study were small, although the final sample was inclusive in terms of age, gender, and visual impairment levels. Amendments are required before testing the intervention in a larger pilot trial.

Integrated regulatory and metabolic networks of the tumor microenvironment for therapeutic target prioritization.

Translation of genomic discovery, such as single-cell sequencing data, to clinical decisions remains a longstanding bottleneck in the field. Meanwhile, computational systems biological models, such as cellular metabolism models and cell signaling pathways, have emerged as powerful approaches to provide efficient predictions in metabolites and gene expression levels, respectively. However, there has been limited research on the integration between these two models. This work develops a methodology for integrating computational models of probabilistic gene regulatory networks with a constraint-based metabolism model. By using probabilistic reasoning with Bayesian Networks, we aim to predict cell-specific changes under different interventions, which are embedded into the constraint-based models of metabolism. Applications to single-cell sequencing data of glioblastoma brain tumors generate predictions about the effects of pharmaceutical interventions on the regulatory network and downstream metabolisms in different cell types from the tumor microenvironment. The model presents possible insights into treatments that could potentially suppress anaerobic metabolism in malignant cells with minimal impact on other cell types' metabolism. The proposed integrated model can guide therapeutic target prioritization, the formulation of combination therapies, and future drug discovery. This model integration framework is also generalizable to other applications, such as different cell types, organisms, and diseases.

Gli1 promotes the phenotypic transformation of valve interstitial cells through Hedgehog pathway activation exacerbating calcific aortic valve disease

Calcific aortic valve disease (CAVD) is the most prevalent human valve disease worldwide. Multiple factors induce "irreversible" pathological changes in the aortic valve leaflets, resulting in changes in cardiac hemodynamics, eventually leading to heart failure. However, no effective pharmaceutical interventions have been found and prosthetic valve replacement is the only curative approach. Glioma-associated oncogene 1 (Gli1) exerts a regulatory role on cardiovascular diseases, and it is already a therapeutic target to combat tumors. Our research aimed to explore the role and basic mechanism of Gli1 in CAVD, to pave the way for the discovery of effective drugs in the treatment of CAVD. Human aortic valve tissues were obtained to evaluate Gli1 expression and primary valve interstitial cells (VICs) were used to perform related experiments. The results showed that Gli1 promoted cell proliferation and significantly accelerated cell osteogenic transformation through the up-regulation of the osteogenic factors Runx2 and Alp, in turn through the AKT signaling pathway by targeting P130cas expression. Furthermore, Gli1 was activated by TGF-β and sonic hedgehog through the canonical and non-canonical Hedgehog signaling pathways in VICs. Our results indicated that Gli1 promoted cell proliferation and accelerated cell osteogenic transformation in VICs, providing a new strategy for the therapy of CAVD by targeting Gli1.

Nonpharmacological Treatment Protocol of Jwara as an Immunity Regulator with Reference to Bala

Objective: In the absence of vaccines and effective pharmaceutical interventions, an economic way to deal with such a prolonged epidemic of COVID-19 is the need of the hour. Fever is a primary response of the immune system to infections, and it resembles the disease termed jwara. Ayurveda describes immunity through bala (strength) and its preservation through the nonpharmacological protocol in the first phase of jwara. The present study evaluated the physiological action of each component of the jwara management protocol. It aims to appraise an economic, safe, and efficient way to regulate immunity in fever from the perspective of bala. Review Methods: Classical Ayurvedic texts were searched for the reference of jwara and related aspects. Data Source: Physiology of fever, jwara, and assessment of the impacts and detriments of each component of the treatment protocol was explored via electronic search. Contemporary studies appraising the physiological evidence and the therapeutic and immunological significance of the jwara management protocol are selected. Results: Niruha basti and anjana, the nonconventional routes of medications and the nonpharmacological jwara management approaches such as langhana, bitter taste diet, and dhoopana, directly impact the immune system. Bala or immunity-regulating actions of jwara management can be categorized as those that can decrease the metabolic rate for the proper functioning of the immune system, those that provide nutrition to regulate innate immune responses, and those approaches that alleviate damage due to inflammatory responses. Conclusion: Jwara management protocol may be an economic way to increase the chances of self-recovery by homogenizing the immunity in infections with fever.

COVID-19 and the city: Did urbanized countries suffer more fatalities?

In this paper we derive a theoretical model of the spread of a viral infection which we use as basis for an estimation strategy to test four interrelated hypotheses on the relationship between country-level COVID-19 mortality rates and the extent of urban development. Using data covering 81 countries we find evidence that countries with a higher population density, a higher share of the urban population living in the largest city, and countries with a higher urbanization rate had on average the same or fewer COVID-19 fatalities compared to less urbanized countries in 2020. Even though COVID-19 spreads faster in cities, fatalities may be lower, conditional on economic development, trust in government, and a well-functioning health care system. Generally, urbanization and city development are associated with economic development: with the resources urbanized countries have, it is easier for them to manage and maintain stricter lockdowns, and to roll out effective pharmaceutical interventions.

Role of Pharmaceutical Care in Type 2 Diabetic Patients in Kirkuk City

Background and objectives. Diabetes Mellitus is a chronic metabolic disorder that negatively affects patient’s quality of life and creates a huge burden on both patients and health care system. Effective pharmaceutical intervention could result in a tighter disease control,&#x0D; &#x0D; reducing long term complications and improving the quality of life.&#x0D; Methods: In this study, a prospective clinical trial was performed to evaluate the role of pharmaceutical care in reducing complications and in improving the quality of life among patients with T2DM.A total of 189 patients were included and divided into two groups; the first group: consisted of 95 patients, comprised the intervention group who received regular pharmaceutical care on monthly basis. The rest 94 patients were allocated to the non-intervention group who only received usual medical care. Patient selection was carried out according to certain inclusion and exclusion criteria. Two categories of data were recorded from each participant at 6 time points during the study period. The first category was assessment of risk factors of complication such as hypertension, hyperlipidemia, uncontrolled hyperglycemia, physical inactivity and smoking. The second category was current status of diet and quality of life.&#x0D; Results: The number of drug therapy problems non-adherence to medication and HBA1c were significantly reduced and quality of life was significantly improved among intervention group. Other Clinical and blood parameters were not affected.&#x0D; Conclusion: Pharmacist collaboration with physicians regarding management of type II diabetes patients have yielded a better patient management outcome, reduced risk factors and improved the quality of life in those patients.

Cost-effectiveness and potential value of pharmaceutical treatment of nonalcoholic fatty liver disease

Background Nonalcoholic fatty liver disease (NAFLD) is associated with substantial morbidity, mortality, and economic burden. With currently no approved treatment, an effective pharmaceutical intervention for this disease must be both clinically- and cost-effective. Methods A Markov model was constructed to estimate the clinical outcomes, costs, and quality of life impact of a hypothetical pharmaceutical intervention. Lifetime clinical outcomes, life-years, quality-adjusted life-years (QALYs), costs (2020 $US), incremental cost-effectiveness ratios (ICERs), and economically justifiable prices (EJPs) were quantified. Only patients with fibrosis stage F2–F4 were assumed eligible to initiate pharmaceutical treatment. Results Over a mean life expectancy of approximately 21 years in the simulated cohort, drug treatment reduced liver-related mortality by 6.0% (2.7% absolute reduction). Assuming an annual drug cost of $36,000, total discounted medical costs were $574,238 and $120,312 for drug and usual care, respectively, with discounted QALYs estimated to be 9.452 and 9.272 for the two comparators. This yielded an ICER of $2,517,676/QALY gained. The EJP of the drug at an ICER threshold of $150,000/QALY gained was $2,633, a 93% reduction from a base case. Sensitivity analyses suggest that, without a substantial decrease in the drug price, ICERs would exceed $500,000/QALY gained even with the most favorable efficacy assumptions. Conclusions For a pharmaceutical intervention to be considered cost-effective in the NAFLD fibrosis population, the substantial clinical benefit will need to be coupled with a modest annual price. Annual drug costs exceeding $12,000 likely will not provide reasonable value, even with favorable efficacy. More work is needed to estimate the cost-effectiveness of lifestyle modifications.

Ex Vivo Hepatic Perfusion Through the Portal Vein in Mouse.

Metabolic diseases such as diabetes, pre-diabetes, non-alcoholic fatty liver disease (NAFLD), and nonalcoholic steatohepatitis (NASH) are becoming increasingly common. Ex vivo liver perfusions allow for a comprehensive analysis of liver metabolism using nuclear magnetic resonance (NMR), in nutritional conditions that can be rigorously controlled. As in silico simulations remain a primarily theoretical means of assessing hormone actions and the effects of pharmaceutical intervention, the perfused liver remains one of the most valuable test beds for understanding hepatic metabolism. As these studies guide basic insights into hepatic physiology, results must be accurate and reproducible. The greatest factor in the reproducibility of ex vivo hepatic perfusion is the quality of surgery. Therefore, we have introduced an organized and streamlined method to perform ex vivo mouse liver perfusions in the context of in situ NMR experiments. We also describe a unique application and discuss common issues encountered in these studies. The overall purpose is to provide an uncomplicated guide to a technique we have refined over several years that we deem the golden standard for obtaining reproducible results in hepatic resections and perfusions in the context of in situ NMR experiments. The distance to the center of the field for the magnet as well as the inaccessibility of the tissue to intervention during the NMR experiment makes our methods novel.

&lt;em&gt;Ex Vivo&lt;/em&gt; Hepatic Perfusion Through the Portal Vein in Mouse

Metabolic diseases such as diabetes, pre-diabetes, non-alcoholic fatty liver disease (NAFLD), and nonalcoholic steatohepatitis (NASH) are becoming increasingly common. Ex vivo liver perfusions allow for a comprehensive analysis of liver metabolism using nuclear magnetic resonance (NMR), in nutritional conditions that can be rigorously controlled. As in silico simulations remain a primarily theoretical means of assessing hormone actions and the effects of pharmaceutical intervention, the perfused liver remains one of the most valuable test beds for understanding hepatic metabolism. As these studies guide basic insights into hepatic physiology, results must be accurate and reproducible. The greatest factor in the reproducibility of ex vivo hepatic perfusion is the quality of surgery. Therefore, we have introduced an organized and streamlined method to perform ex vivo mouse liver perfusions in the context of in situ NMR experiments. We also describe a unique application and discuss common issues encountered in these studies. The overall purpose is to provide an uncomplicated guide to a technique we have refined over several years that we deem the golden standard for obtaining reproducible results in hepatic resections and perfusions in the context of in situ NMR experiments. The distance to the center of the field for the magnet as well as the inaccessibility of the tissue to intervention during the NMR experiment makes our methods novel.