Metformin, a widely prescribed oral hypoglycemic agent, has recently received a big interest because of its potential antitumorigenic effects in different cancer types. The present study investigated the impact of adding metformin to breast cancer adjuvant therapy in nondiabetic women on, insulin like growth factor-1 (IGF-1), IGF binding protein-3 (IGFBP-3), insulin, fasting blood glucose (FBG), the molar ratio of IGF-1 to IGFBP-3, homeostatic model assessment of insulin resistance (HOMA-IR) and metastasis. 102 women with newly diagnosed breast cancer were divided into 2 main groups, a control group and a metformin group. All women were treated with adjuvant therapy, according to the protocols of Ministry of Health and Population and National Cancer Institute, Egypt. Moreover, the women in the metformin group received 850 mg of metformin twice daily. Blood samples were collected at baseline, after chemotherapy (CT), after 6 months of hormonal therapy (6-HT) and 12 months of hormonal therapy (12-HT) for analysis of serum IGF-1, IGFBP-3, insulin, FBG and cancer antigen 15-3 (CA15-3). Metformin resulted in a significant reduction of IGF-1, IGF-1: IGFBP-3 molar ratio, insulin, FBG and HOMA-IR. On the other hand, metformin caused a significant increase of IGFBP-3. Moreover, metformin significantly decreased the numbers of metastatic cases after 6-HT. Metformin may have potential antitumor and antimetastatic effects that need further clinical investigations. This may be attributed to either the significant increase of the apoptotic inducer IGFBP-3 or/and the significant reduction of mitogenic insulin, IGF-1, free bioactive IGF-1, FBG and HOMA-IR.

Aims of the study To describe the experience of six hospitals in the management of COVID‐19 patients in rural areas through an assessment of proportions, types and clinical outcomes of remote clinical interventions. Methods This was a prospective observational study conducted in six Egyptian hospitals over a period five months. An emergency response was implemented in each hospital in order to connect clinical pharmacists with COVID‐19 patients living in rural areas. Pharmacists used phone calls and social media applications, such as WhatsApp ® to conduct two types of interventions; (a) Proactive interventions and (b) outcome‐based interventions. IBM SPSS V26 was used for data analysis. Results Of the 418 patients included, 351 (83.97%) recovered, 60 (14.35%) were hospitalised and 7 (1.67%) were deceased. Medication orders per patient, high‐alert medications per patient and prescribing errors per patient were 5.82, 1.45 and 0.74, respectively. Telepharmacy teams conducted 3318 phone calls, 2116 WhatsApp ® chats and 1128 interventions, of which 812 (71.92%) were process‐based and 316 (27.98%) were outcome‐based. Among these interventions, four significant determinants of improvement in clinical outcomes were found: substitution of a prescribed drug (Adjusted odds ratio [AOR] = 4.03; 95% confidence interval [CI], 2.54‐5.87), adding a drug to the prescription (AOR = 3.15; 95% CI, 1.87‐4.76), advice the patient to stop smoking (AOR = 3.53; 95% CI, 1.98‐5.17) and cessation of drug therapy (AOR = 3.11; 95% CI, 1.25‐4.55). The most common medications involved in drug‐related interventions were Hydroxychloroquine, Azithromycin and Paracetamol. Conclusion Our findings demonstrate significant impact of the remote pharmacist interventions on both medicines use and clinical outcomes of COVID‐19 patients in rural areas. Pharmacists in developing countries should be supported to implement remote clinical services to provide patients in rural places with optimal care.

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Background and Objective Breast cancer patients treated with adriamycin-cyclophosphamide plus paclitaxel (AC-T) are often challenged with serious adverse effects for which no effective therapies are available. Here, we investigated whether metformin, an antidiabetic drug with additional pleiotropic effects could favourably offset AC-T induced toxicities. Patients and Methods Seventy non-diabetic breast cancer patients were randomised to receive either AC-T (adriamycin 60 mg/m 2 + cyclophosphamide 600 mg/m 2 × 4 cycles Q21 days, followed by weekly paclitaxel 80 mg/m 2 × 12 cycles) alone or AC-T plus metformin (1700 mg/day). Patients were assessed regularly after each cycle to record the incidence and severity of adverse events based on the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 5.0. Moreover, baseline echocardiography and ultrasonography were done and repeated after the end of neoadjuvant therapy. Results Addition of metformin to AC-T resulted in significantly less incidence and severity of peripheral neuropathy, oral mucositis, and fatigue ( p < 0.05) compared to control arm. Moreover, the left ventricular ejection fraction (LVEF%) in the control arm dropped from a mean of 66.69 ± 4.57 to 62.2 ± 5.22% ( p = 0.0004) versus a preserved cardiac function in the metformin arm (64.87 ± 4.84 to 65.94 ± 3.44%, p = 0.2667). Furthermore, fatty liver incidence was significantly lower in metformin compared with control arm (8.33% vs 51.85%, p = 0.001). By contrast, haematological disturbances caused by AC-T were preserved after concurrent metformin administration ( p > 0.05). Conclusion Metformin offers a therapeutic opportunity for controlling toxicities caused by neoadjuvant chemotherapy in non-diabetic breast cancer patients. Trial Registration This randomised controlled trial was registered on November 20, 2019 in ClinicalTrials.gov under registration number: NCT04170465. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-023-01305-4.

Introduction: Coronavirus disease 2019 (COVID-19) outbreak is considered one of the most important public health crises all over the world and in Egypt. Community pharmacists represent the third largest health care professional group after physicians and nurses. Community pharmacists are expected to be fully prepared at the frontline of defending their community needs by limiting the spread of COVID-19 via different pharmaceutical care services.Aim: This study aimed to evaluate the sources of knowledge and readiness of community pharmacists in facing COVID-19 early outbreak in Egypt. Methods:A descriptive cross-sectional study was performed via a self-administered online google form questionnaire during the early period from 14 April to 3 June 2020.The questionnaire focused on; evaluating education level, sources of information, and readiness of Egyptian community pharmacists in the COVID-19 pandemic crisis.Results: A total of 318 community pharmacists from Egypt participated in this questionnaire. About half of the surveyed pharmacists reported that they were frequently consulted and that their patients were seeking consultation regarding COVID-19 management more than 10 times per day. More than half of the pharmacists reported using social media as a source of information and knew the right social distancing recommendations. Regarding protective measures, only a quarter of pharmacists disclosed the availability of personal protective equipment (PPE). Nevertheless, the majority of pharmacists significantly reported some initial lack of support either inform of recommendations or PPE supply. Conclusion:The study revealed the dependence of community pharmacists on social media as the main source of information and the lack of early awareness of evidencebased practice resources. Community pharmacists were in need of more initial support to achieve better satisfaction, patient counselling and infection control.Corrective measures were promptly undertaken to support and satisfy the Egyptian community pharmacists' initial awareness and readiness facing COVID-19. | INTRODUC TI ONCoronavirus disease 2019 (COVID-19) outbreak is considered one of the most important public health crises all over the world. 1 The first case of the novel COVID-19 was identified in China's Wuhan City in December 2019. 1 At the end of January 2020, the World Health Organization (WHO) declared the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a pandemic disease.