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Steroid-resistant nephrotic syndrome (SRNS) is a leading cause of end-stage renal disease in children, with an increasing number of cases. Polymorphisms in the MDR-1 gene were reported to contribute to SRNS development, but with varying results among different ethnicities. Thus, we investigated the association of the MDR-1 rs1128503 (C1236T) and rs1045642 (C3435T) polymorphisms with steroid responsiveness in Iraqi children with idiopathic nephrotic syndrome (INS). This case-control study was conducted at the Babylon Hospital for Maternity and Pediatrics. Children with SRNS (n=32) and steroid-sensitive nephrotic syndrome (SSNS; n=32) were genotyped via the polymerase chain reaction-restriction fragment length polymorphism. The genotypes were subjected to association testing and haplotype analysis. The C1236T TT genotype was associated with a higher risk of developing SRNS compared to the CC and TC genotypes (odds ratio [OR]=10.33, 95% confidence interval [95% CI]=1.208-88.362; p-value=0.026; recessive model). The combination of the two TT genotypes of C1236T and C3435T variants was significantly more frequent (p-value=0.029) in SRNS (88.9%) than in SSNS (11.1%). The haplotype analysis showed no association between the C1236T and C3435T haplotypes and steroid responsiveness, but the TC haplotype was associated with an age at onset of =8 years (p-value=0.0028). In conclusion, this study revealed that children who have the MRD-1 C1236T TT genotype alone or combined with the C3435T TT genotype may be at increased risk of developing SRNS and in need of other therapeutic strategies. Additional research is required to identify other genetic contributions to steroid responsiveness and further understand their pharmacogenetics in INS. [ABSTRACT FROM AUTHOR]

Objective: To determine the ability of uVDBP to differentiate SRNS from steroid-sensitive nephrotic syndrome (SSNS) in Iraqi children. Materials and Methods: This cross-sectional study enrolled children with SRNS (n=31) and SSNS (n=32) from the pediatric nephrology clinic of Babylon Hospital for Maternity and Pediatrics over three months. Patients' characteristics in terms of demographics, clinical data, and urinary investigations were collected. Quantitative analysis of uVDBP levels was undertaken via a commercially available ELISA kit. Results: The median uVDBP values were significantly higher (p-value<0.001) in the SRNS group (median=10.26, IQR=5.91 μg/mL) than in the SSNS group (median=0.953, IQR=4.12 μg/mL). A negative correlation was noted between uVDBP levels and estimated glomerular filtration rate (eGFR) (Spearman's rho coefficient = -0.494, p=0.001). Nevertheless, the rise in uVDBP concentrations was still considerable in children with SRNS whose eGFR measurements were above 60 mL/min/1.73 m2 . The study revealed a good discriminatory power for uVDBP as a predicting parameter to distinguish SRNS from SSNS (AUC= 0.909, p<0.0001. The optimal uVDBP cut-off value of 5.781 μg/mL was associated with a sensitivity of 83.9% and specificity of 84.4% to differentiate SRNS from SSNS. Conclusion: Considering its significant discriminatory strength, uVDBP can be considered as a potential marker to noninvasively distinguish children with SRNS from those with SSNS. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the preparedness and adherence of community pharmacists to the International Pharmaceutical Federation (FIP) Health Advisory COVID-19 guidelines for pharmacists (July 2020) during COVID-19 pandemic. This was a cross-sectional study based on electronic survey using google form, which was distributed from November 19, 2020 to January 1, 2021 using social media platforms. The survey measured 21 pharmacy preventive measures (PM). A multivariate regression analysis was used to identify factors influencing pharmacy implementing of PM. Hand disinfection after serving patients represented the main adopted measure (89.3%). Surprisingly, only 35.4% of participants implemented the proper ways of hand disinfection during face mask handling and 35.4% could not recognize the purpose behind medical mask uses. Significant (p-value<0.05) positive association with pharmacy adoption of PM during COVID-19 was recorded for high influx of patients into pharmacy and working for extended hours, while inadequate information of pharmacists about COVID-19 (which represented the main difficulty that down regulated the adoption of PM in pharmacies) had significant negative association. This study revealed suboptimal implementation of the PM in community pharmacies, and a gap in the pharmacists' knowledge about safety protocols to limit COVID-19 transmissions in the pharmacies. Official health organizations might need to develop a national guideline for community pharmacies to enhance the pharmacists' and patient safety during COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objectives: The study aim was to explore the knowledge, perceptions, and attitudes of Iraqi physicians regarding generic and locally manufactured medicines., Methods: A total of 124 physicians were involved in this cross -sectional study. The convenience sample was collected from five public hospitals in Baghdad. A self-administered questionnaire was distributed and collected in-person. Fisher's Exact Test was used to measure the association between physician years of experience, gender and categorical (perception and knowledge) variables., Results: Most respondent answers regarding the knowledge of generic medicines were incorrect. Only up to one-third of the participants knew that generic medicines are therapeutically equivalent to brand name medicines (26.6%), as safe as brand name medicines (34.7%) and required to meet similar safety standards as brand name medicines (12.1%). With respect to perception, many physicians had negative perceptions about generic medicines such as viewing generic medicines as lower quality (57.3%) and cause more side effects (41.1%) compared to brand name medicines. Regarding physician attitudes toward generic medicines, about two-thirds (64.5%) of the physicians were willing to prescribe low cost medicines; however, only about half (51.6%) of the physicians reported they offer generic medicines to their patients. Finally, 64.5% of the participants were not comfortable with pharmacist replacing prescribed brand with generic medicines., Conclusions: In general, Iraqi physicians have negative perceptions and attitudes about generic and locally manufactured medicines. Significant gaps were identified in the knowledge and perceptions among physicians regarding generic medicines especially in relation to efficacy and safety of generic medicines., (© Individual authors.)