Sowndramalingam Sankaralingam

Background and Objectives: There is consensus on the negative effects of obesity on the development of heart failure. However, several studies have suggested that obesity may have paradoxical survival benefits in heart failure patients. Therefore, the aim of this study is to investigate whether the obesity paradox exists in heart failure with reduced ejection fraction (HFrEF) patients in Jordan. Materials and Methods: In this retrospective cohort study, data were retrieved from electronic hospital records of heart failure patients admitted to King Abdullah University Hospital between January 2010 and January 2020. Patients were divided into five BMI (kg/m²) subgroups: (1) Less than 25.0, (2) Overweight 25.0–29.9, (3) Obese Class I 30.0–34.9, (4) Obese Class II 35.0–39.9, and (5) Obese Class III ≥40.0. Changes in patients’ clinical and echocardiographic parameters over one year were analyzed. Results: Data of a total of 297 patients were analyzed to determine the effect of obesity on heart failure. The mean age was 64.6 ± 12.4 years, and most patients (65.7%) were male. Among several co-morbidities, diabetes mellitus and hypertension were the most common and were present in 81.8% and 81.1% of patients, respectively. Over all patients, there was no significant change in EF after 1 year compared to baseline. However, only patients in the Obese Class I group had a statistically significant improvement in EF of 38.0 ± 9.81% vs. 34.8 ± 6.35% (p = 0.004) after 1 year. Importantly, among non-diabetic individuals, only Obese Class I patients had a significant (p < 0.001) increase in EF after 1 year compared to other BMI subgroups, a feature that was not observed among patients with diabetes. On the other hand, only Obese Class I patients with hypertension had a significant improvement (p < 0.05) in EF after 1 year compared to other BMI subgroups, a feature that was not observed among patients without hypertension. Conclusions: Our study demonstrates an inverted U-shaped relationship between BMI and EF such that patients with mild obesity (i.e., Obese Class I) had significant improvement in EF compared to those having a lower and higher BMI. We, therefore, suggest the existence of the obesity paradox among HFrEF patients in Jordan.

Background Diabetes mellitus is a complex multi-system disorder, requiring multi-disciplinary care. The conventional care model, where physicians are the sole caregivers may not be optimal. Addition of other healthcare team members improves healthcare outcomes for patients with diabetes. Aim To evaluate the impact of pharmacist-involved collaborative care on diabetes-related outcomes among patients with diabetes attending a primary healthcare setting in Qatar using real-world data. Method A retrospective cohort study was conducted among patients with diabetes attending Qatar Petroleum Diabetes Clinic. Patients were categorized as either receiving pharmacist-involved collaborative care (intervention group) or usual care (control group). Data were analyzed using SPSS^®. Glycemic control (glycated hemoglobin A₁c, HbA₁c), blood pressure, lipid profile, and body mass index were evaluated at baseline and up to 17 months of follow-up. Results After 17 months of follow-up, pharmacist-involved collaborative care compared to usual care resulted in a significant decrease in HbA₁c (6.8 ± 1.2% vs. 7.1 ± 1.3%, p < 0.01). Moreover, compared to baseline, pharmacist-involved collaborative care significantly improved (p < 0.05) the levels of HbA_1c (7.5% vs. 6.8%), low-density lipoprotein cholesterol (3.7 mmol/L vs. 2.8 mmol/L), total cholesterol (5.43 mmol/L vs. 4.34 mmol/L), and body mass index (30.42 kg/m² vs. 30.17 kg/m²) after 17 months within the intervention group. However, no significant changes for these parameters occurred within the control group. Conclusion The implementation of pharmacist-involved collaborative care in a primary healthcare setting improved several diabetes-related outcomes over 17 months. Future studies should determine the long-term impact of this care model.

Introduction: Community pharmacists are often the first point of contact for the public, especially during pandemics. As outlined by the International Pharmaceutical Federation, community pharmacists have an important public health role during this Coronavirus Disease 2019 (COVID-19) public health emergency. We therefore investigated the current practices, response preparedness and professional development needs of community pharmacists in Qatar. Methodology: A descriptive cross-sectional online 38-item questionnaire-based survey constructed on evidence-based public health roles of pharmacists was conducted between 28 May and 18 June 2020. Questions related to current practices required responses on a 5-point Likert-type scale ranging from “always” to “never”. The questionnaire was evaluated for validity and the reliability analysis showed a Cronbach’s alpha coefficient of 0.921. Results: The response (n = 311) rate for the survey was 34.2%. More than 75% of pharmacists “always” encouraged and practiced hygiene and social distancing measures. On the other hand, the proportion of pharmacists “always” involved in patient assessment, education or providing information related to COVID-19 and application of evidence-based protocol ranged from 32 to 73%. The vast majority (87-96%) of pharmacists indicated that they needed professional development related to COVID-19. Overall, 77% of pharmacists either “strongly agreed” or “agreed” that they have all the necessary COVID-19 related emergency response preparedness and training. Country from which pharmacists obtained their first degree, and the type of pharmacy where they practice influenced their overall perception toward emergency response preparedness. Conclusions: Community pharmacists in Qatar are willing to receive additional training related to COVID-19 public health crisis despite being prepared to engage with patients.

Purpose: Cardiovascular disease (CVD) risk assessment is an important strategy for the prevention of CVD. Pharmacists play an important role in CVD risk assessment and management (CVDRAM). Our previous study identified gaps in knowledge among community pharmacists for the provision of CVDRAM services as assessed through patient simulation. Therefore, our objectives were: a) to develop and evaluate an educational program on CVD risk assessment for community pharmacists, b) to assess the knowledge and skills of participating pharmacists in assessing and managing CVD risk before and after enrolling in the educational program and c) to explore pharmacists’ satisfaction and perceived effectiveness of the educational program. Methods: Using a blended learning instructional approach, the educational program for a subset of 25 community pharmacists recruited from our previous study consisted of two face-to-face workshops, and an online 5-module course on CVD risk factors such as hyperlipidemia, hypertension, diabetes, obesity, and smoking cessation based on principles of adult learning. A repeated measures study design was utilized by measuring participants’ knowledge on pre- and post-questionnaires and an objective structured clinical examination (OSCE) at the conclusion of the educational program was also used to assess its impact on the knowledge and skills of community pharmacists in the provision of CVD risk assessment and management (CVDRAM) services. The knowledge questionnaire was completed by 23 pharmacists while the OSCE was completed by 8 pharmacists. In addition, a survey assessed the pharmacists’ level of satisfaction with the educational program. Results: At the conclusion of the educational program, the participating pharmacists achieved knowledge and skills for the provision of CVDRAM services. Knowledge scores in relation to CVDRAM significantly improved after the educational program [out of a maximum of 20 points, the median (interquartile range) = 9 (7– 9) at pre- vs 12 (12– 13) at post-educational program], p< 0.001. On the OSCE, the median (interquartile range) scores for Stations 1 and 2 were 66 (63– 71) and 71 (67– 76), respectively. Out of the 21 pharmacists that completed the satisfaction survey, 71% were very satisfied and 29% were satisfied with the educational program. Conclusion: The educational program improved pharmacists’ knowledge and skills for the provision of CVDRAM services.

Women who develop gestational diabetes mellitis (GDM) display endothelial dysfunction up to 1 yr after pregnancy, despite a return to normoglycemia. It is unknown whether this dysfunction was preexisting or whether GDM pregnancy leads to long-term endothelial dysfunction. A mouse model that spontaneously develops GDM ( Lepr^db/+) was used to determine whether the endothelial dysfunction that develops during GDM is evident in later life. Heterozygous and wild-type (WT) controls were allowed to litter once, then age to 9–10 mo, and were compared with virgin controls. Vascular function of small mesenteric arteries was assessed using wire myography. Concentration response curves to the thromboxane A₂mimetic U46619 and the endothelium-dependent vasodilator methacholine were constructed. Superoxide production and peroxynitrite formation was also measured. Mice with previous GDM displayed blood glucose concentrations similar to previously pregnant WT mice (8.0 ± 0.1 vs. 7.1 ± 0.3 mmol/l, P > 0.05). Arteries from mice with previous GDM displayed increased sensitivity to U46619 (EC₅₀5.2 ± 0.7 vs. 45.2 ± 1.0 nmol/l, P < 0.01) and impaired endothelium-dependent relaxation compared with WT controls (29 ± 8 vs. 58 ± 16 percent relaxation, P < 0.05). This was associated with increased superoxide production (93.3 ± 2.3 vs. 64.6 ± 1.6 mean fluorescence intensity, P < 0.001) and increased peroxynitrite formation (173.5 ± 11.0 vs. 57.4 ± 16.2 mean fluorescence intensity, P < 0.01) compared with virgin controls. In summary, endothelial dysfunction was evident in mice with previous GDM compared with previously healthy pregnant mice or virgin controls. These data suggest that GDM affects endothelial function and may contribute to an increased risk of cardiovascular disease.