An Update on the Effect Of Sodium Glucose Cotransporter 2 Inhibitors on Non-Alcoholic Fatty Liver Disease: A Systematic Review of Clinical Trials

Non-alcoholic fatty liver disease (NAFLD) is one of the main causes of liver disease, specifically chronic liver disease. Type 2 diabetes (T2DM) is associated with the risk of NAFLD given that patients usually have insulin resistance as one of the observed complications with NAFLD. Hypoglycemic agents, including sodium glucose cotransporter 2 (SGLT-2), have shown to improve NAFLD. The objective of this study is to evaluate the effect of SGLT-2 inhibitors on NAFLD patients' outcomes, whether they have T2DM or not. We conducted a comprehensive search using the PubMed and Ovid databases to identify published studies that addressed the use of SGLT-2 inhibitors in NAFLD patients. The outcomes assessed include changes in liver enzymes, lipid profiles, weight changes, the fibrosis-4-index (FIB4), and magnetic resonance imaging proton density-based fat fraction (MRI-PDFF). Only clinical trials that met the quality measures were included in this review. Out of 382 potential studies, we included 16 clinical trials that discussed the use of SGLT-2 inhibitors in NAFLD patients. A total of 753 patients were enrolled in these trials. The majority of the trials reported positive effects of SGLT-2 inhibitors on liver enzymes; alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase. All 10 trials that reported changes in body mass index (BMI) from baseline showed a statistically significant reduction with SGLT-2 inhibitor use, while 11 studies reported a significant increase in high density lipoprotein (HDL) levels, 3 studies reported a reduction in triglycerides (TG) levels, and 2 studies showed a decrease in low density lipoprotein (LDL) levels. The available evidence shows that the use of SGLT-2 inhibitors in NAFLD is associated with positive outcomes on liver enzymes, lipid profiles, and BMI. Further studies with larger sample size and longer follow-up time are warranted.

The influence of telemedicine in primary healthcare on diabetes mellitus control and treatment adherence in Riyadh region

Several studies have found that telemedicine has the potential to enhance the outcomes of patients with diabetes. This study aimed to determine the impact of telemedicine on the clinical outcomes of patients with type 2 diabetes mellitus (T2DM) in Saudi Arabia. We conducted a cross-sectional study among T2DM patients in selected primary healthcare centers in Riyadh, Saudi Arabia, from March 1, 2023, to August 20, 2023. We looked at how telemedicine affected HbA1c control, adherence, the number of diabetic complications, and polypharmacy using adjusted multivariable logistic regression models. Among the 583 patients, 140 (24.05 %) received care via telemedicine, while 442 (75.95 %) received in-person care. Patients who utilized telemedicine had significantly better glycemic control than those who received in-person care only (AOR = 5.123, 95 % CI = 3.107-8.447). Telemedicine also showed positive effects on treatment adherence (AOR = 2.552, 95 % CI = 1.6284-4.2414). Telemedicine can effectively reduce diabetic complications (AOR = 0.277, 95 % CI = 0.134-0.571). Regarding polypharmacy, patients with telemedicine use were less likely to report polypharmacy (AOR = 0.559, 95 % CI = 0.361-0.866). Telemedicine is considered one of the factors that improve HbA1c management and might increase therapeutic adherence and reduce diabetic complications and polypharmacy.

Research barriers in Saudi pharmacy residency training programs

Background

The aim of this study is to identify potential barriers to conducting and publishing pharmacy residency research.

Methods

A cross-sectional study surveyed pharmacy residents in Saudi Arabia from August to September 2020. The online survey assesses residents' characteristics, residency research experience, barriers to completion, and challenges in publishing. A Likert scale assessed factors and barriers to conducting and publishing research during residency. Descriptive statistics were performed for binary variables, with Likert scale responses visualized using Gannt charts.

Results

A total of 69 residents completed the survey, of whom 63.5 percent were female, and the median age was 28 years. More than half of the residents were in R2 (56.5 %), followed by R1 (24.6 %) and R3 (4.4 %). Half of residents had prior research experience, while 84.1 % had prior research training in workshops or courses. Cohort study design was the most common type of residency research project conducted. According to residents, the main barriers to conducting research were a lack of allocated time for research during rotations (81.7 %) and a lack of a realistic timeline determined by the SCFHS to finish the research project (66.2 %). Regarding barriers to publishing research, the majority of residents reported lack of time to work on the publication process (78.6 %), lack of previous publication experience (60 %), and lack of guidance from mentors (55.7 %) as the most important barriers.

Conclusion

Pharmacy residents face barriers to conducting research during their residency program, including limited allocated time during rotations, a lack of realistic timelines, and data collection limitations. Additionally, they face challenges in publishing their research due to a lack of experience, mentorship, and guidance. Future research should consider seeking the perspective of residency program directors and preceptors on research barriers and evaluating the publication rate of residents' projects.

The effectiveness of single and two-dose Pfizer-BioNTech vaccine against SARS-COV-2: A real-world evidence from Saudi Arabia

BACKGROUND

Several studies proved the effectiveness of Severe Acute Respiratory Syndrome Corona Virus (SARS-CoV-2) vaccines; however, the number of doses and the period between doses that warrant the highest protection remain unclear. This study aims to assess the effectiveness of the Pfizer-BioNTech vaccine and to evaluate the effectiveness of early and delayed second-dose administration of the vaccine.

METHODS

This is a retrospective cohort study that was conducted using the data from March 1st, 2021, to August 31st, 2021. Data regarding vaccination coverage and confirmed SARS-CoV-2 infection were obtained using academic hospitals databases and Health Electronic Surveillance Network (HESN) platform. The vaccination status of the participants were categorized as: unvaccinated, vaccinated 1st dose, and vaccinated 2nd dose of Pfizer-BioNTech vaccine. The outcome of interest was positive polymerase chain reaction test for SARS-CoV-2. Generalized linear model with a Poisson distribution was used to estimate the incidence of the infection.

FINDINGS

Among 66,775 participants included, 2615 SARS-CoV-2 infections were observed. The sample was relatively young with median age of 22 years and 43% female. A single dose of Pfizer-BioNTech vaccine had 40 % effectiveness. The effectiveness of the vaccine was doubled after the second dose of Pfizer-BioNTech (80 %). The time between the first and the second dose appears to be crucial after observing 75 %, 90 % and 85 % effectiveness with early vaccination, on-time vaccination, and delayed vaccination, respectively.

CONCLUSION

For Pfizer-BioNTech vaccine recipients in Saudi Arabia, particularly among a predominantly young population, higher effectiveness against SARS-CoV-2 was observed with two doses of the vaccine. The timing of the second dose appears crucial for the extent of protection against SARS-CoV-2. However, potential residual confounding cannot be discounted, and further studies are needed to validate these findings and improve generalizability.

Interethnic differences in drug response: projected impact of genetic variations in the Saudi population

Ethnicity is known to have an impact on drug responses. This is particularly important for drugs that have a narrow therapeutic window, nonlinearity in pharmacokinetics and are metabolized by enzymes that demonstrate genetic polymorphisms. However, most clinical trials are conducted among Caucasians, which might limit the usefulness of the findings of such studies for other ethnicities. The representation of participants from Saudi Arabia in global clinical trials is low. Therefore, there is a paucity of evidence to assess the impact of ethnic variability in the Saudi population on drug response. In this article, the authors assess the projected impact of genetic polymorphisms in drug-metabolizing enzymes and drug targets on drug response in the Saudi population.

Types, Trends, and Patterns of the Reported Antimicrobial Errors to the Eastern Region’s Medical Centers in Saudi Arabia: A Cross-Sectional Study

Introduction

Medication errors (MEs) are a huge burden on any healthcare system and have been associated with significant morbidity and mortality. The medical literature reported heavily on MEs but lacked focus on analyzing high-risk medications such as antimicrobials.

Research design and methods

This was a retrospective analysis of the MEs database reported by the eastern region's medical centers in Saudi Arabia from January 1, 2019 to December 31, 2019. We used descriptive analysis to identify most common antimicrobials with errors, the stage of antimicrobial errors, type of the errors, contributing factors to the errors, and categories of errors based on the National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) classification of errors.

Results

A total of 1422 (22.1%) antimicrobial errors were identified out of 6412 MEs. Amoxicillin/Clavulanate (18%) was the most common antimicrobial reported in the database. Most errors occurred in the prescribing phase (87.6%) and included mainly incorrect doses (32.1%) and duplicate therapy (20.5%). In addition, most errors were identified as category B (72.5%). Finally, inexperienced personnel (57.9%) was the most cited contributing factor.

Conclusion

This study revealed that antimicrobial errors occur primarily during prescription and that policy gaps and inexperienced staff were contributory factors. To improve, the focus should shift to physician education, clear dosing guidelines, efficient workload management, and implementing antimicrobial stewardship programs to promote appropriate antimicrobial use.

Comparative Safety of Sleeve Gastrectomy and Roux-en-Y: A Propensity Score Analysis

BACKGROUND

Use of bariatric surgery has increased dramatically in the USA. However, there are growing concerns regarding the safety outcomes of different bariatric procedures. We aim to compare the safety of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), which includes hospital readmissions, emergency room (ER) visits, gastrointestinal bleeding, and revisional surgery.

METHODS

A retrospective cohort analysis was conducted for adults (≥ 18 years) who received SG and RYGB in the USA. We used Truven MarketScan Commercial and Medicare supplemental claims databases from January 1, 2005, to October 1, 2015. To adjust for baseline demographic and clinical characteristics, we used stabilized inverse probability of treatment weighting using propensity score. Cox proportional hazard models was used to compare safety outcomes between SG and RYGB after bariatric surgery.

RESULTS

A total of 194,248 patients met inclusion criteria; 79,813 patients (41%) received SG and 114,435 patients (59%) received RYGB. The use of SG was associated with a significantly lower 30-day hospital readmission rate [adjusted hazard ratios (aHRs) 0.77; 95% confidence interval (CI), 0.74-0.81] and ER visits [aHR, 0.82; 95% CI, 0.80-0.83], and decreased risk of gastrointestinal bleeding [aHR, 0.87; 95% CI, 0.78-0.98] compared to RYGB. However, SG was associated with an increased risk of revisional surgery, compared to RYGB [aHR,1.21; 95% CI, 1.08-1.35].

CONCLUSIONS

Among patients receiving bariatric surgery in a real-world setting, SG was associated with lower complication rate but a higher risk of revisional surgery compared to RYGB. Further longitudinal studies are needed to assess long-term findings.

US national trends in bariatric surgery: A decade of study

BACKGROUND

Since the 1990s, the number of bariatric surgeries has dramatically increased, including the number of bariatric centers in the United States; no recent studies have yet assessed trends of bariatric surgery. This study aims to assess the trends of bariatric surgery and the change in utilization by the type of surgery, from 2006 to 2015, using real-world data.

METHODS

A cross-sectional analysis of MarketScan databases of privately insured beneficiaries aged equal to or more than 18 years, to assess the annual incidence rate of bariatric surgery type of surgery from 2006 to 2015. Linear regression analysis was used to assess the significance of bariatric surgery changes over time.

RESULTS

A gradual increase in overall bariatric surgery was observed from 43.5 per 100,000 in 2006 to 70.6 per 100,000 in 2009. This increasing trend plateaued from 2010 to 2015. Among all bariatric surgeries performed, the sleeve gastrectomy showed a significant increase from (n = 596) 11% in 2006 to (n = 15,425) 70% in 2015 (P < .001), whereas there was a decrease in Roux-en-Y from (n = 10,129) 45% in 2010 to (n = 5074) 24% in 2015 (P < .001).

CONCLUSION

Utilization of bariatric surgery showed a gradual increase in the first 5 years, with steady rates in the last 5 years of the study period. Sleeve gastrectomy and Roux-en-Y remain the most performed bariatric procedures. Laparoscopic surgery continues to dominate bariatric surgery compared with open surgery.

Trends in utilization of warfarin and direct oral anticoagulants in older adult patients with atrial fibrillation

PURPOSE

Results of a study to determine trends in oral anticoagulant (OAC) use and OAC switching in patients with atrial fibrillation (AF) or atrial flutter are presented.

METHODS

Warfarin has been the most prescribed anticoagulant in patients with AF for decades. Since 2010, several direct OACs (DOACs) have gained U.S. marketing approval for stroke prevention in AF or atrial flutter. A cross-sectional longitudinal analysis was conducted using healthcare and prescription claims databases to characterize OAC use and rates of OAC and DOAC switching during the period 2008-14 in cohorts of Medicare beneficiaries 65 years of age or older with AF or atrial flutter.

RESULTS

Overall, 66% of patients with AF or atrial flutter were receiving OACs during the study period. The prevalence of warfarin use decreased from 69.8% in 2008 to 42.2% in 2014. This decrease in warfarin use was paralleled by an increase in dabigatran use, which rose from 1.3% in 2010 to 12.1% in 2011 and then declined to 7.6% in 2014. The prevalence of rivaroxaban use increased from 0.13% in 2011 to 13.87% in 2014. Among anticoagulated patients, an average of 6% annually were switched from one OAC to another.

CONCLUSION

Overall OAC utilization in patients with AF or atrial flutter remained steady over the study period. Beginning in 2010, a gradual decrease in use of warfarin was paralleled by an increase in use of DOACs.