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2021
Abuelhana, A., L. Ashfield, M. G. Scott, G. F. Fleming, N. Sabry, S. Farid, and K. Burnett, "Analysis of activities undertaken by ward-based clinical pharmacy technicians during patient hospital journey", European Journal of Hospital Pharmacy, vol. 28, issue 6, pp. 313 - 319, 2021. AbstractWebsite

Introduction Previous studies recognise insufficient time as an obstacle to pharmacists expanding their clinical-based activities and services. For such a reason, the role of well-trained ward-based clinical pharmacy technicians (CPTs) is to work as an integral part of the pharmacy team to achieve the best patient outcomes and medicines optimisation, releasing pharmacist time to complete more complex clinical-related activities. Objective To demonstrate quantitatively the range and extent of daily activities undertaken by CPTs during a patient's hospital journey. Method A prospective-based study has been designed. All daily working services and activities undertaken by ward-based CPTs within a 450-bed Acute District General hospital were quantitatively collected and documented. Data were collected from five medical, two surgical and one cardiology wards of 30 beds in each over a period of 2 weeks for each ward representing a total of 70 working days (14 weeks, excluding weekends). Results Results showed the breakdown of seven different ward-based activities throughout a typical working day with the main working load being reviews of the patients' medication charts in order to supply new medicines and refer medicines-related issues to the ward pharmacist, with an average number reviewed of (23.17±0.85) representing 77.23% of the total patients in a 30-bed ward. The CPTs' highest workload was on Mondays and Fridays, mainly during the morning working hours (09:00-12:00). Also, statistically significant differences (p<0.05; Kruskal-Wallis test) existed between the workload of the three different ward specialties (medical, surgical and cardiology) in five clinical activities out of seven undertaken by CPT per day. Conclusion CPTs are completing more than seven different ward pharmacy-related activities which enhance medicines optimisation, medicines management and patient care. They are a valuable resource carrying out many roles which were previously completed by junior pharmacists. Their prioritising of patients for review ensures pharmacists focus their efforts on the most vulnerable patients. © European Association of Hospital Pharmacists 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Kamel, A. M., M. Sobhy, N. Magdy, N. Sabry, and S. Farid, "Anticoagulation outcomes in hospitalized Covid-19 patients: A systematic review and meta-analysis of case-control and cohort studies", Reviews in Medical Virology, vol. 31, issue 3, 2021. AbstractWebsite

Background: Coagulopathy and thromboembolic events are common in Covid-19 patients and are poor prognostic factors. Controversy exists regarding the potential of anticoagulation (AC) to reduce mortality and incidence of thromboembolic events in Covid-19 patients. The current systematic review and meta-analysis investigated the association between anticoagulants and mortality in adult hospitalized COVID-19 patients using the available published non-randomized studies. Methods: Google Scholar, PubMed, Scopus, the Cochrane Library and Clinical Trials.gov were searched for relevant studies. A meta-analysis of adjusted and unadjusted estimates was performed. The relative risk was used as a measure of effect. The random-effects model was used to pool estimates using the generic inverse variance method. Results: Sixteen studies were included in the quantitative data synthesis. Results showed a statistically significant association between AC and mortality (RR = 0.56, 95% CI 0.36; 0.92, p = 0.02). Both therapeutic (Relative risk [RR] = 0.4, 95% CI 0.27; 0.57) and prophylactic AC (RR = 0.54, 95% CI 0.41; 0.71) were associated with lower risk of mortality. Pre-admission AC was not associated with mortality (RR = 0.84, 95% CI 0.49; 1.43, p > 0.05) while prophylactic AC was associated with higher risk of mortality compared to therapeutic AC (RR = 1.58, 95% CI 1.34; 1.87, p < 0.001). Conclusion: Findings support the association of AC with mortality in Covid-19 patients. The results, synthesized from mostly low-quality studies, show that prophylactic and therapeutic AC might reduce mortality in Covid-19 patients. Findings suggest that therapeutic doses might be associated with better survival compared to prophylactic doses. © 2020 John Wiley & Sons Ltd.

Shawki, M. A., W. M. AlSetohy, K. A. Ali, M. R. Ibrahim, N. El-Husseiny, and N. A. Sabry, "Antimicrobial stewardship solutions with a smart innovative tool", Journal of the American Pharmacists Association, vol. 61, issue 5, pp. 581 - 588.e1, 2021. AbstractWebsite

Background: Antimicrobial consumption has been increasing lately. Hence, effective strategies are required to control antimicrobial use and decrease the development of antimicrobial resistance. Objective: To evaluate the impact of the use of a mobile app on the implementation of antimicrobial stewardship program (ASP) interventions. Methods: This was a longitudinal study conducted at El-Nile Badrawi Hospital in Cairo, Egypt, on inpatients receiving antimicrobials from January 2018 to December 2019. The study included 2 phases: the preimplementation phase, which included a paper-based ASP developed according to the Centers for Disease Control and Prevention Core Elements of Hospital Antibiotic Stewardship Programs 2014, and the mobile app phase where the MEDIcare Pro mobile app was developed and used in ASP intervention implementation. The study outcomes were antimicrobial consumption and cost, length of hospital and intensive care unit (ICU) stay, 30-day mortality rate and readmission rate, and detection of drug-related problems (DRPs). Results: The mobile app statistically significantly decreased antimicrobial consumption from 75.1 defined daily dose (DDD)/100 bed-days in the preimplementation phase to 64.65 DDD/100 bed-days in the mobile app phase, with a total cost savings of E£1,237,476. There was a significant reduction in the length of ICU stay, with a mean difference of 1.63 days between the 2 phases, but no significance was detected regarding length of hospital stay or readmission rate. There was a statistically significant decrease in mortality rate from 1.17% in the preimplementation phase to 0.83% in the mobile app phase (P = 0.02). The frequency of DRPs detected by pharmacists statistically significantly increased from 0.54/100 bed-days in the preimplementation phase to 3.23/100 bed-days in the mobile app phase. Conclusion: The use of a mobile app was found to be effective, applicable, and usable in guiding health professionals on rational antimicrobial use. © 2021 American Pharmacists Association®

Sabry, N., S. ElHadidi, A. Kamel, M. Abbassi, and S. Farid, "Awareness of the Egyptian public about COVID-19: what we do and do not know", Informatics for Health and Social Care, vol. 46, issue 3, pp. 244 - 255, 2021. AbstractWebsite

To survey the health-seeking behaviors and perspectives of the Egyptian population toward the COVID-19 pandemic. A descriptive survey was designed and disseminated via social media platforms. The survey consisted of 32 questions addressing respondent’s demographics, knowledge, practice, and attitude toward the COVID-19 pandemic. A total of 25,994 Egyptians participated in the survey from the 29 Egyptian governorates. More than 99% of the respondents were aware of the COVID-19 pandemic. Responses showed split opinions regarding whether people should wear gloves or masks to prevent COVID-19 infection (47.7% and 49.5% replied with “False”, respectively). Almost one-quarter (23.1%) of the respondents went to crowded places during the last 14 days. Calling the emergency hotline and self-isolation at home were the most frequent practices to deal with COVID-19 symptoms (34.1% and 44.5%, respectively). A total of 85% of respondents reported their confidence in the Egyptian healthcare system to win the battle against COVID-19 despite the challenges. A vast majority of this large population sample reported reasonable knowledge levels and potentially appropriate practices toward COVID-19. © 2021 Taylor & Francis Group, LLC.

El-Baraky, I. A., M. M. Abbassi, F. S. Ebied, M. Hassany, N. A. Sabry, and M. H. El-Sayed, "Beta-thalassemia major alters sofosbuvir/ledipasvir exposure in Hepatitis C virus infected adolescent patients", Clinics and Research in Hepatology and Gastroenterology, vol. 45, issue 5, 2021. AbstractWebsite

Background: Hepatitis C virus (HCV) infected adolescents with beta-thalassemia major (BTM) are considered a potential population for HCV micro-elimination model development where BTM may negatively impact the pharmacokinetic exposure parameters of sofosbuvir/ledipasvir (SOF/LED). Objectives: The study aimed at studying the effect of BTM on SOF/LED and SOF metabolite (GS-331007) pharmacokinetics. Methods: A prospective, controlled study recruiting BTM and control HCV infected adolescents (Clinicaltrials.gov identifier-NCT04353986). Pharmacokinetic exposure to GS-331007 and LED was the primary pharmacokinetic outcome. No-effect boundaries were set to 90% confidence interval (CI) of exposure geometric mean ratio (GMR) within 70–143%. Dose suitability was based on the 90% CI of exposure GMR within 50-200% compared to adults. The percentage of patients achieving sustained virologic response 12 weeks post-treatment (SVR12) was the primary efficacy endpoint. Results: Thirteen patients were enrolled per study group. All patients were included in the pharmacokinetic analysis (n=26). BTM patients showed lower GS-331007 and LED exposure that could, respectively, be as low as 45.4% and 36.1% compared to their control group. GS-331007 exposure in BTM patients was nearly half (56.8%, 90% CI 45.3–71.2%) that observed in adults. Despite that low drug exposure in 46.2% of BTM patients may alert dose unsuitability, they achieved SVR12. Moreover, patients with total bilirubin ≥1.93 mg/dL were predicted to have low GS-331007 exposure (0.913 receiver operating characteristic area under the curve with sensitivity and specificity >80%). Conclusion and Relevance: The identified systematically lower drug exposure in BTM patients might partially explain relapses or treatment failures among BTM patients reported in other studies. BTM may be a hurdle towards implementing HCV micro-elimination model that may necessitate dose-adjustment. © 2021 Elsevier Masson SAS

Said, E., S. Mousa, M. Fawzi, N. A. Sabry, and S. Farid, "Combined effect of high-dose vitamin A, vitamin E supplementation, and zinc on adult patients with diabetes: A randomized trial", Journal of Advanced Research, vol. 28, pp. 27 - 33, 2021. AbstractWebsite

In type 2 diabetes mellitus (T2DM), hyperglycemia leads to oxidative insult. Vitamins A and E have antioxidant potentials and may help in managing diabetes. The combined effect of high-dose vitamin A plus E supplementation with and without zinc on T2DM, has never been examined. Thus, this study aimed to evaluate and compare the effect of high-dose vitamin A plus E supplementation (AE) versus high-dose vitamin A plus E with zinc (AEZ), on different diabetic parameters. Ninety-eight patients with T2DM were randomized to receive either: 50,000 IU vitamin A and 100 mg vitamin E (AE group, N = 36), an equivalent dose of vitamin A and E combined with 25 mg zinc (AEZ group, N = 35), or no supplements (control group, N = 27) for three months. Compared to control, AEZ group showed significant reductions in fasting blood glucose, 2 h postprandial blood glucose, and glycated hemoglobin (HbA1c) with significant increases in homeostasis model assessment of beta‐cell function and difference value of fasting insulin. Two hair loss cases were recorded in both treated groups. Although vitamin A needs dose moderation, these results suggest that, high-dose vitamin A plus E supplementation combined with zinc may improve glycemic control, β-cell function, and insulin secretion in adults with T2DM. © 2020

Toukhy, A., S. Fayed, N. Sabry, and M. Shawki, "The Impact of an Established Pharmaceutical Care Pathway on Drug Related Problems in an Intensive Care Unit", American Journal of the Medical Sciences, vol. 362, issue 2, pp. 143 - 153, 2021. AbstractWebsite

Background: The incidence of drug related problems (DRPs) in intensive care units (ICU) is higher compared to any other wards in the hospital, requiring a structured pathway to ensure optimum detection of DRPs. The study aimed to evaluate the impact of implementing a pharmaceutical care pathway on the detection and management of DRPs in an ICU. Methods: The study was conducted in a general ICU and included three phases: tool preparation phase included the development of a core measures reference pathway and daily working scenario flow-charts, a control phase where the patient files and pharmacists' case assessment notes were retrospectively reviewed to detect the rate of DRPs before pathway implementation and a prospective phase similar to the control phase but with the implementation of the new pathway. The number and classification of DRPs and required core measures in the control and implementation phases were documented. Results: Using the new pathway, the detection of unmet core measures increased from 7.3% in the control phase to 99% in the implementation phase (p-value <0.001). The prevalence of unidentified DRPs/1000 patients' service days decreased from 98.1 in the control phase to 27.08 in the implementation phase (p-value <0.001). However, there was no significant difference between the phases regarding mortality rate and length of ICU stay. Conclusions: The implementation of a unified pharmaceutical care pathway improved the detection of DRPs in ICU patients. © 2021 Southern Society for Clinical Investigation

Hussein, A. A., N. A. Sabry, M. S. Abdalla, and S. F. Farid, "A prospective, randomised clinical study comparing triple therapy regimen to hydrocortisone monotherapy in reducing mortality in septic shock patients", International Journal of Clinical Practice, vol. 75, issue 9, 2021. AbstractWebsite

Objectives: This prospective, comparative and randomised clinical study evaluated the effectiveness of triple therapy regimen (hydrocortisone, thiamine and vitamin C) versus hydrocortisone alone in reducing the mortality rate and preventing progressive organ dysfunction in septic shock patients. Methods: A total of 94 patients were randomly assigned to one of two groups: the first group received hydrocortisone 50 mg/6-h IV for 7 days or till intensive care unit (ICU) discharge, if sooner, followed by tapering. The second group received hydrocortisone 50 mg/6-h IV for 7 days or ICU discharge followed by tapering, vitamin C 1.5 g/6-h IV for 4 days or till ICU discharge and thiamine 200 mg/12-h IV for 4 days or till ICU discharge. Results: The triple therapy regimen showed a non-significant reduction in 28-day mortality compared to hydrocortisone alone (17 [36.2%] vs. 21 [44.7%]; P =.4005), but it was significantly lower than the control group regarding shock time and the duration of vasopressor use in days (4.000 [3.000-7.000]; 5.000 [4.000-8.000], [P =.0100]). The patients in the control group were likely to get 0.59 more in SCr level than those in the intervention group by a linear regression model which was significant (P <.05). Also, the number of patients who developed a fever after 216 hours was significantly higher in the control group (P value =.0299). Conclusion: Vitamin C, thiamine, and hydrocortisone regimen for septic shock management showed non-significant efficacy in decreasing 28-day mortality when compared to hydrocortisone monotherapy. On the other hand, it showed significant efficacy in decreasing the shock time and duration on vasopressors. © 2021 John Wiley & Sons Ltd

Abdel Moneim, M., D. H. Abdelaziz, Y. Ibrahim Nagy, A. Abdel Baki, A. S. Attia, and N. Sabry, "Rifaximin microbial resistance and its efficacy and safety as a secondary prophylaxis of hepatic encephalopathy in patients with hepatitis C virus-related cirrhosis", International Journal of Clinical Practice, vol. 75, issue 11, 2021. AbstractWebsite

Background and aim: Rifaximin is an oral antibiotic with promising efficacy in the reduction of hepatic encephalopathy (HE) recurrence. Development of microbial resistance to rifaximin is not studied yet in HE. The study aim was to assess the microbial resistance, safety and efficacy of rifaximin as secondary prophylaxis of HE. Method: In this open-label parallel, prospective interventional study, 100 patients were randomly allocated either to receive 400 mg rifaximin 3 times/d plus 30-45 mL lactulose 3 times/d (intervention group) or to receive the standard of care only which is lactulose alone (control group) for 6 months. The primary outcome of the study was the difference between minimum inhibitory concentration (MIC) of rifaximin among the two studied groups at the end of treatment. The secondary outcomes included the time to first episode of HE, time to first hospitalisation, and patient's survival. Results: The MIC did not differ significantly after treatment exposure compared with baseline either between groups or within the same group. The time to new episode of HE was 18.84 ± 6.49 weeks (mean ± SD) in the intervention group and was significantly longer (P =.002) than that in the control group 14 ± 7.52 weeks. Moreover, only 23 (46%) patients developed overt HE in the intervention group compared with 35 patients (70%) in the control group (P =.005). Also, there was an observed 32% reduction in the risk of hospitalisation in intervention group compared with control group. Conclusion: Rifaximin succeeded to maintain remission from new episodes of HE in hepatitis C virus cirrhotic patients with limited potential for development of microbial resistance over the study period. ClinicalTrials.gov Identifier: NCT04736836. © 2021 John Wiley & Sons Ltd

M. Mansour, S., R. N. Shamma, K. A. Ahmed, N. A. Sabry, G. Esmat, A. A. Mahmoud, and A. Maged, "Safety of inhaled ivermectin as a repurposed direct drug for treatment of COVID-19: A preclinical tolerance study", International Immunopharmacology, vol. 99, 2021. AbstractWebsite

Introduction: SARS-CoV-2 replication in cell cultures has been shown to be inhibited by ivermectin. However, ivermectin's low aqueous solubility and bioavailability hinders its application in COVID-19 treatment. Also, it has been suggested that best outcomes for this medication can be achieved via direct administration to the lung. Objectives: This study aimed at evaluating the safety of a novel ivermectin inhalable formulation in rats as a pre-clinical step. Methods: Hydroxy propyl-β-cyclodextrin (HP-β-CD) was used to formulate readily soluble ivermectin lyophilized powder. Adult male rats were used to test lung toxicity for ivermectin-HP-β-CD formulations in doses of 0.05, 0.1, 0.2, 0.4 and 0.8 mg/kg for 3 successive days. Results: The X-ray diffraction for lyophilized ivermectin-HP-β-CD revealed its amorphous structure that increased drug aqueous solubility 127-fold and was rapidly dissolved within 5 s in saline. Pulmonary administration of ivermectin-HP-β-CD in doses of 0.2, 0.4 and 0.8 mg/kg showed dose-dependent increase in levels of TNF-α, IL-6, IL-13 and ICAM-1 as well as gene expression of MCP-1, protein expression of PIII-NP and serum levels of SP-D paralleled by reduction in IL-10. Moreover, lungs treated with ivermectin (0.2 mg/kg) revealed mild histopathological alterations, while severe pulmonary damage was seen in rats treated with ivermectin at doses of 0.4 and 0.8 mg/kg. However, ivermectin-HP-β-CD formulation administered in doses of 0.05 and 0.1 mg/kg revealed safety profiles. Conclusion: The safety of inhaled ivermectin-HP-β-CD formulation is dose-dependent. Nevertheless, use of low doses (0.05 and 0.1 mg/kg) could be considered as a possible therapeutic regimen in COVID-19 cases. © 2021 Elsevier B.V.

Naguib, S. N., N. A. Sabry, S. F. Farid, and A. M. Alansary, "Short-term Effects of Alfacalcidol on Hospital Length of Stay in Patients Undergoing Valve Replacement Surgery: A Randomized Clinical Trial", Clinical Therapeutics, vol. 43, issue 1, pp. e1 - e18, 2021. AbstractWebsite

Purpose: Vitamin D deficiency is highly prevalent in critically ill patients, and has been associated with more prolonged length of hospital stay and poor prognosis. Patients undergoing open-heart surgery are at higher risk due to the associated life-threatening postoperative complications. This study investigated the effect of alfacalcidol treatment on the length of hospital stay in patients undergoing valve-replacement surgery. Methods: This single-center, randomized, open-label, controlled trial was conducted at El-Demerdash Cardiac Academy Hospital (Cairo, Egypt), from April 2017 to January 2018. This study included adult patients undergoing valve-replacement surgery who were randomized to the intervention group (n = 47; alfacalcidol 2 μg/d started 48 h before surgery and continued throughout the hospital stay) or to the control group (n = 42). The primary end points were lengths of stay (LOS) in the intensive care unit (ICU) and in the hospital. Secondary end points were the prevalence of postoperative hospital-acquired infections, cardiac complications, and in-hospital mortality. Findings: A total of 86 patients were included in the final analysis, with 51 (59.3%) being vitamin D deficient on hospital admission. Treatment with alfacalcidol was associated with a statistically significant decrease in ICU LOS (hazard ratio = 1.61; 95% CI, 1.77–2.81; P = 0.041) and hospital LOS (hazard ratio = 1.63; 95% CI, 1.04–2.55; P = 0.034). Treated patients had a significantly lower postoperative infection rate than did the control group (35.5% vs 56.1%; P = 0.017). The median epinephrine dose was lower in the intervention group compared to that in the control group (5.9 vs 8.2 mg; P = 0.019). The rate of in-hospital mortality was not significantly different between the 2 groups. Implications: Early treatment with 2 μg of alfacalcidol in patients undergoing valve-replacement surgery is promising and well tolerated. This effect may be attributed to its immunomodulatory and cardioprotective mechanisms. ClinicalTrials.gov identifier: NCT04085770. © 2020 Elsevier Inc.

Abuelhana, A., L. Ashfield, M. G. Scott, G. F. Fleming, N. Sabry, S. Farid, and K. Burnett, "Analysis of activities undertaken by ward-based clinical pharmacy technicians during patient hospital journey", European Journal of Hospital Pharmacy, vol. 28, no. 6, pp. 313-319, 2021. AbstractWebsite
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Shawki, M. A., W. M. AlSetohy, K. A. Ali, M. R. Ibrahim, N. El-Husseiny, and N. A. Sabry, "Antimicrobial stewardship solutions with a smart innovative tool", Journal of the American Pharmacists Association, vol. 61, no. 5, pp. 581-588.e1, 2021. AbstractWebsite
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El-Baraky, I. A., M. M. Abbassi, F. S. Ebied, M. Hassany, N. A. Sabry, and M. H. El-Sayed, "Beta-thalassemia major alters sofosbuvir/ledipasvir exposure in Hepatitis C virus infected adolescent patients", Clinics and Research in Hepatology and Gastroenterology, vol. 45, no. 5, 2021. AbstractWebsite
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Toukhy, A., S. Fayed, N. Sabry, and M. Shawki, "The Impact of an Established Pharmaceutical Care Pathway on Drug Related Problems in an Intensive Care Unit", American Journal of the Medical Sciences, vol. 362, no. 2, pp. 143-153, 2021. AbstractWebsite
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Hussein, A. A., N. A. Sabry, M. S. Abdalla, and S. F. Farid, "A prospective, randomised clinical study comparing triple therapy regimen to hydrocortisone monotherapy in reducing mortality in septic shock patients", International Journal of Clinical Practice, vol. 75, no. 9, 2021. AbstractWebsite
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Abdel Moneim, M., D. H. Abdelaziz, Y. Ibrahim Nagy, A. Abdel Baki, A. S. Attia, and N. Sabry, "Rifaximin microbial resistance and its efficacy and safety as a secondary prophylaxis of hepatic encephalopathy in patients with hepatitis C virus-related cirrhosis", International Journal of Clinical Practice, vol. 75, no. 11, 2021. AbstractWebsite
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M. Mansour, S., R. N. Shamma, K. A. Ahmed, N. A. Sabry, G. Esmat, A. A. Mahmoud, and A. Maged, "Safety of inhaled ivermectin as a repurposed direct drug for treatment of COVID-19: A preclinical tolerance study", International Immunopharmacology, vol. 99, 2021. AbstractWebsite
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2020
Medhat, M., N. Sabry, and N. Ashoush, "Knowledge, attitude and practice of community pharmacists towards nutrition counseling", International Journal of Clinical Pharmacy, vol. 42, issue 6, pp. 1456 - 1468, 2020. AbstractWebsite

Background The World Health Organization considers health promotion a top health service priority. Nutrition, weight management and physical activity are necessary health promotion strategies to improve overall quality of life and decrease the personal and societal consequences or poor health. Community pharmacists are in the best position to implement health promotion strategies due to their excellent accessibility and the lack of a requirement to make an appointment to interact with them. Enabling people to change their lifestyle and control their health through nutrition education and counseling is a great opportunity for community pharmacists to promote health. Nutrition counseling as a part of clinical nutrition therapy aims to provide dietary advice and to assist the selection of appropriate over-the-counter supplements. Objective To investigate the community pharmacist role in nutrition counseling and identify the barriers and strategies to improve nutrition counseling in Egypt. Setting Community pharmacies in Egypt. Methods A descriptive, cross-sectional study was conducted with a knowledge, attitude, and practice survey. A specially developed and validated questionnaire was used to collect data via face-to-face structured interviews. Primary outcomes Pharmacists’ knowledge about, attitudes towards and practice of nutrition counseling. Results A total of 368 community pharmacists participated in this study, with a response rate of 73.6%. A total of 255 (69.3%) of the participants considered medical nutrition therapy a part of a pharmacist’s duties. Only 146 (39.7%) of the participants believed that dietary supplements positively impact public health. According to 321 (87.2%) of the participants, the lack of pharmacists’ expertise in nutrition counseling was the main barrier to nutrition counseling. Conclusions The majority of the participating community pharmacists had positive attitudes towards their role in nutritional assessment and medical nutrition therapy. There is a need to improve the nutritional knowledge of community pharmacists in Egypt. The current practice of community pharmacists in nutrition counseling is limited to adults. Obesity, diabetes and hypertension were the main medical conditions of the patients who received nutrition counseling from the community pharmacists. Inadequate knowledge in nutrition and the unavailability of educational materials were the main barriers to nutrition counseling. © 2020, Springer Nature Switzerland AG.

2019
Eldeib, H. K., M. M. Abbassi, M. M. Hussein, S. E. Salem, and N. A. Sabry, "The Effect of Telephone-Based Follow-Up on Adherence, Efficacy, and Toxicity of Oral Capecitabine-Based Chemotherapy", Telemedicine and e-Health, vol. 25, issue 6, pp. 462 - 470, 2019. AbstractWebsite

Background: Adherence and safety challenges aroused with the use of oral chemotherapeutic agents, such as capecitabine, necessitated implementation of a more focused follow-up for patients receiving these agents. Patients and Methods: This prospective, randomized open-label study explored the usefulness of weekly telephone-based follow-up in Egyptian patients with metastatic colorectal or gastric cancer treated with capecitabine-based chemotherapy regimens at the National Cancer Institute, Egypt, compared with a standard care group. Patients' adherence, safety, efficacy, and health service utilization were assessed and compared in 82 eligible patients; control group (n = 38) and intervention group (n = 44). Results: The intervention group showed statistically better tolerability to certain adverse effects in certain cycles with nonsignificantly higher patients' adherence and overall survival (OS), along with statistically higher passive call duration. Conclusion: These results suggested that pharmacist-led telephone follow-up (TFU) could help in building a close trusting rapport between the patient and caregiving pharmacist. They also demonstrated the potential usefulness of the TFU on patients' tolerability, adherence, and OS; however, further trials with a larger sample size should be encouraged to explore more pronounced results. Otherwise, the provided standard care could be considered good enough for these patients. © Copyright 2019, Mary Ann Liebert, Inc., publishers 2019.

Shamma, R. N., S. Sayed, N. A. Sabry, and S. I. El-Samanoudy, "Enhanced skin targeting of retinoic acid spanlastics: in vitro characterization and clinical evaluation in acne patients", Journal of Liposome Research, vol. 29, issue 3, pp. 283 - 290, 2019. AbstractWebsite

Acne vulgaris is the most common dermatological disorder affecting millions of individuals. Acne therapeutic solutions include topical treatment with retinoic acid (RA) which showed a good efficacy in treatment of mild and moderate cases. However, the high prevalence of adverse events, such as skin dryness, shedding and skin irritation affects the patient convenience and obstruct the acne treatment. Thus, the objective of this paper was to produce Span 60 based elastic vesicles enriched with penetration enhancers, and study their influence on the delivery of RA and its skin irritation. RA-loaded nanovesicles, enriched with Transcutol®/Labrasol®, were made using the thin film hydration technique, and assessed for entrapment efficiency, particle size and zeta potential. The optimized RA-loaded nanovesicles (composed of Span 60-Tween 20, and Transcutol®) were morphologically assessed via transmission electron microscopy. Moreover, RA deposition into newborn mice skin was assessed in vitro under non-occlusive conditions, where the optimized RA-loaded nanovesicles showed 2-fold higher RA deposition in the skin compared to the corresponding one lacking Transcutol. The optimized RA-loaded nanovesicles incorporated into 1% carbopol gel was evaluated for in-vivo clinical performance in acne patients, and showed appreciable advantages over the marketed formulation (Acretin®) in the treatment of acne regarding skin tolerability and patient’s compliance. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.

2018
Hassan, N. A., F. F. Awdallah, M. M. Abbassi, and N. A. Sabry, "Nebulized Versus IV Amikacin as Adjunctive Antibiotic for Hospital and Ventilator-Acquired Pneumonia Postcardiac Surgeries: A Randomized Controlled Trial", Critical Care Medicine, vol. 46, issue 1, pp. 45 - 52, 2018. AbstractWebsite

Objective: Nebulized antibiotics offer high efficacy due to significant local concentrations and safety with minimal blood levels. This study evaluates the efficacy and nephrotoxicity of nebulized versus IV amikacin in postcardiothoracic surgical patients with nosocomial pneumonia caused by multidrug-resistant Gram-negative bacilli. Design: Prospective, randomized, controlled study on surgical patients divided into two groups. Setting: Postcardiac surgery ICU. Interventions: The first gtroup was administered IV amikacin 20 mg/kg once daily. The second group was prescribed amikacin nebulizer 400 mg twice daily. Both groups were co-administered IV piperacillin/tazobactam empirically. Patients: Recruited patients were diagnosed by either hospital-acquired pneumonia or ventilator-associated pneumonia where 56 (42.1%) patients were diagnosed with hospital-acquired pneumonia, 51 (38.34%) patients were diagnosed with early ventilator-associated pneumonia, and 26 (19.54%) patients with late ventilator-associated pneumonia. Measurements and Main Results: Clinical cure in both groups assessed on day 7 of treatment was the primary outcome. Efficacy was additionally evaluated through assessing the length of hospital stay, ICU stay, days on amikacin, days on mechanical ventilator, mechanical ventilator-free days, days to reach clinical cure, and mortality rate. Lower nephrotoxicity in the nebulized group was observed through significant preservation of kidney function (p < 0.001). Although both groups were comparable regarding length of hospital stay, nebulizer group showed shorter ICU stay (p = 0.010), lower number of days to reach complete clinical cure (p = 0.001), fewer days on mechanical ventilator (p = 0.035), and fewer days on amikacin treatment (p = 0.022). Conclusion: Nebulized amikacin showed better clinical cure rates, less ICU stay, and fewer days to reach complete recovery compared to IV amikacin for surgical patients with nosocomial pneumonia. It is also a less nephrotoxic option associated with less deterioration in kidney function. © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

2017
I, A., S. Selim, M. M. Abbassi, and N. A. Sabry, "Effect of alfacalcidol on the pulmonary function of adult asthmatic patients: A randomized trial", Annals of Allergy, Asthma and Immunology, vol. 118, issue 5, pp. 557 - 563, 2017. AbstractWebsite

Background Despite the use of alfacalcidol in the management of corticosteroid-induced osteoporosis, it has never been considered an adjunct treatment for asthma management. It can target vitamin D deficiency, a possible risk factor for asthma, and, hence, improve pulmonary function of patients with asthma. Objective To explore the effect of alfacalcidol administration on pulmonary function and study the pattern of vitamin D deficiency in adults with asthma in Egypt. Methods Serum 25-hydroxyvitamin D was measured in 115 adults: 33 healthy subjects and 82 patients with asthma. Then, patients with asthma were randomized to receive standard asthma treatment only (n = 39) or receive it in addition to 1 μg of alfacalcidol daily for 4 months (n = 43). Randomization was stratified by the stage of asthma severity. Spirometry and measurement of 25-hydroxyvitamin were performed at baseline and end of follow-up. Results Vitamin D deficiency was more common in patients with asthma (57.3%) than in healthy subjects (21.2%; P <.001). In patients with asthma, alfacalcidol significantly improved forced expiratory volume in the first second and forced vital capacity (P <.001 for the 2 tests). Moreover, more patients in the intervention arm showed improvement in asthma severity stage (P =.04). A nonsignificant difference was observed in improvement of forced expiratory volume in the first second between patients with vitamin D deficiency and those without deficiency in the intervention group (P >.05). Conclusion Alfacalcidol supplementation improved the pulmonary function and severity stage of adult patients with asthma regardless of deficiency. Trial Registration ClinicalTrials.gov Identifier: NCT02747381. © 2017 American College of Allergy, Asthma & Immunology

2016
Alraie, N. A., A. Asaad, N. A. Sabry, and S. F. Farid, "Adverse drug reactions reporting: A questionnaire-based study on Egyptian pharmacists' attitudes following an awareness workshop", Journal of Evaluation in Clinical Practice, vol. 22, issue 3, pp. 349 - 355, 2016. AbstractWebsite

Rationale, aims and objectives Hospital pharmacists can promote medication safety through spontaneous reporting of adverse drug reactions (ADRs). However, different educational interventions and different factors (socio-demographic and professional) have been implicated to influence the reporting process. The aims of this study were to assess the impact of pharmacovigilance awareness workshop on knowledge of hospital pharmacists; and to identify the main factors and barriers that influence ADRs reporting. Methods Two validated self-administered questionnaires were distributed to pharmacists attending an awareness workshop (pre and post); and a telephone survey was completed three months after the workshop. ADR reports (yellow cards) received from participating pharmacists were monitored for six months, and analysed for quality (validity and seriousness) and reporter demographic and professional factors. Results Two hundred and eighty-one pharmacists (95.25%) and 270 pharmacists (91.52%) completed pre- and post-workshop questionnaires respectively. A comparison of their knowledge of ADRs to report before and after the workshop showed significant difference (Wilcoxon test P < 0.05). Two hundred and four pharmacists (72.6%) completed the follow-up questionnaire, with lack of time, administrative barriers and inability to complete patient details being the most frequent reasons for not reporting. A total of 163 yellow cards were received from 49 pharmacists (17.44%) over 6 months, of which 126 reports (77.3%) were serious ADRs. Demographics of reporting pharmacists showed significance for completion of post-graduate studies, ministry of health hospitals and pharmacist post in hospital. Conclusion Despite pharmacists' adequate knowledge after the workshop, they failed to maintain consistent reporting. Addressing the barriers to reporting and the personal factors influencing the process may be needed. © 2015 John Wiley & Sons, Ltd.

Abdelaziz, D. H., N. M. Elhosseiny, S. A. Khaleel, N. A. Sabry, A. S. Attia, and M. H. El-Sayed, "Association Between Combined Presence of Hepatitis C Virus and Polymorphisms in Different Genes With Toxicities of Methotrexate and 6-Mercaptopurine in Children With Acute Lymphoblastic Leukemia", Pediatric Blood and Cancer, vol. 63, issue 9, pp. 1539 - 1545, 2016. AbstractWebsite

Background: The aim of the present study is to determine the correlation of hepatitis C virus (HCV) infection and polymorphisms in different genes with toxicity of either methotrexate (MTX) or 6-mercaptopurine (6-MP) administered to children with acute lymphoblastic leukemia (ALL). Procedure: One hundred children with low-risk ALL, who were treated according to the St. Jude Total therapy XV, were recruited. The recruited children were receiving MTX and 6-MP during maintenance phase. Patients were excluded from the study if they had other types of leukemia. Genotyping analyses for the thiopurine methyltransferase (TPMT), methylenetetrahydrofolate reductase (MTHFR), and glutathione S-transferase (GST) genes were performed using a combination of polymerase chain reaction (PCR) and PCR-RFLP (where RFLP is restriction fragment length polymorphism) protocols. Relevant clinical data on adverse drug reactions were collected objectively (blinded to genotypes) from the patient medical records. Results: There was a significant correlation between the combined presence of HCV and TPMT*3B G460A gene polymorphisms and grades 2–4 hepatotoxicity as aspartate aminotransferase (AST) elevation (P < 0.04). The same observation was seen when comparing either the presence of HCV alone or the presence of the gene polymorphism alone. A significant association between the combined presence of HCV and MTHFR C677T polymorphism and grades 2–4 hepatotoxicity as alanine aminotransferase (ALT), AST, and alkaline phosphatase (ALP) elevation was observed (P values <0.001, 0.02, and 0.001, respectively). The presence of HCV infection had a significant negative effect on hepatic transaminases. Conclusions: The present data support a role for combining analysis of genetic variation in drug-metabolizing enzymes and the presence of HCV in the assessment of specific drugs toxicities in multiagent chemotherapeutic treatment regimens. © 2016 Wiley Periodicals, Inc.