|Year : 2022 | Volume
| Issue : 1 | Page : 22-43
|Date of Web Publication||30-Mar-2022|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Abstracts. Saudi J Clin Pharm 2022;1:22-43
| Transition of Care from Hospital to Community Pharmacies: A Literature Review and a Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis|| |
Najala Salah Al-Shakmobarak, Anne Boyter
Background: Improving the quality of care during the transition of care from hospital to home, with the associated cost savings, waste reduction and improvements in service efficiency, is under pressure at the governmental level from the National Health Service in the UK. In terms of pharmacies, there are important issues regarding medicine prescribing and dispensing, where the reliance is currently on the hospitals rather than community pharmacies to provide prescribed medicines. This leads to delayed discharges, exacerbates the gap between demand and capacity and places additional demands on primary care to provide repeat prescriptions.
Objective: A systematic review of the literature was undertaken to explore the different models used in implementing a change in the service due the transfer of dispensing from hospitals to community pharmacies, with the related benefits and limitations.
Methods: Electronic databases and citation screening were used to conduct this review. Included studies were appraised using the Scottish Intercollegiate Guideline Network checklists. Narrative analysis was used to produce the findings of this review, followed by a strengths, weaknesses, opportunities, and threats (SWOT) analysis.
Results: Most of the transition of care models were found to have beneficial effects for both service and patient outcomes, especially with regard to cost savings, reduced hospital readmission rates due to medication and the greater efficiency and productivity of the service. Conversely, there were a number of limitations associated with dispensing by community pharmacies, including incomplete/incorrect prescriptions, increasing the demands and time required of the community pharmacists to resolve prescription issues and, most importantly, delays in the dispensing process as a result of these issues.
Conclusion: This review highlights the current issues concerning the transitional models for dispensing medicine to patients who have been discharged from hospital. Future research is needed to pilot the proposed change in service with greater applicability to the UK to improve both the patient and service outcomes.
| Polypharmacy Management Policies and Procedures in Saudi Arabia: A Literature Review|| |
Amjad M Alrashed
Polypharmacy refers to the use of various medications and is commonly used in managing patients with long-term illnesses. The prevalence of polypharmacy continues to increase especially in the United Kingdom where the physicians prescribe more than one medication to the patients. The prescription of various medications to a patient may help in addressing multiple health conditions a patient presents with. For example, when managing a diabetic patient with PUD, several medications may be administered to reduce the acid reflux as well as control the sugar levels for the patient. There is currently no standard for the definition of polypharmacy; however, various studies have defined the term based on the number of prescription drugs given to a patient. It is important to note that the number of drugs a patient is given is not directly correlated to the beneficial outcomes they receive. The prescription patterns among the physicians seem to have changed significantly with time. It is estimated that the number of drugs prescribed to patients increased to 4.4 in 2010 from 3.3 in 1995. The possible reasons for polypharmacy include inappropriate drug combinations. However, there are cases where inappropriate polypharmacy is practiced, and this may be due to the ill-intentions from the clinicians. For example, clinicians may prescribe a variety of drugs to earn more financial gain. Such prescriptions are defined as problematic polypharmacy.
| The Incidence of TB Infection in Patients Receiving Anti-(TNF)-α mAbs Infliximab and Adalimumab|| |
Areej Mohammed Bin Salman, Wafa A Al-Fahad, Bedor A Al-Omary, Abdulaziz Al-Towaijri
Background: Several Anti-tumor necrosis factor (TNF)-α are available including Monoclonal antibodies (mAbs), such as Infliximab, and Adalimumab. Although they show benefits in inflammatory conditions, there is evidence of increased risk of Tuberculosis (TB) infection. In this study, we identified the incidence of active TB among patients received Infliximab or Adalimumab. Also, determined the indication mostly correlated.
Methods: We conducted this retrospective chart review, for adult patients received Infliximab or Adalimumab, in a tertiary hospital in Riyadh, Saudi Arabia. Data for three years, taken from pharmacy system, and patient files reviewed through computer system for the presence of anti-TB medications, acid fast bacilli smear, culture, and latent TB screening test. Analysis using Microsoft Excel.
Results: A Total of (243) patients received Infliximab, (60.91%) males, (39.09%) females, and (672) received Adalimumab, (42.26%) males, (57.74%) females, were screened. Common indication for Infliximab: Rheumatoid arthritis (32.34%), for Adalimumab: Crohn’s disease (50.62%).148 patients (60.91%) on Infliximab, 373 patients (55.51%) on Adalimumab, were screened for latent TB before starting Anti-(TNF). Of which, 9 patients (3.70%) on Infliximab, and 63 on Adalimumab (9.38%), received latent TB treatment. We found that, one patient (0.41%) on Infliximab (N=243), and (2) patients (0.30%) on Adalimumab (N= 672), developed active TB. They received Infliximab for Crohn’s disease, and Adalimumab for Crohn’s disease and Chronic plaque psoriasis. All 3 were screened for latent TB before starting Anti-(TNF), and the patient on Infliximab has latent TB and received treatment.
Conclusion: There is no difference in the incidence of TB infection for Infliximab and Adalimumab. We need more compliance to the protocols of latent TB screening before Anti-(TNF)- treatment, in both groups
| Efficacy of Levetiracetam in Neonatal Seizures|| |
Wed Alzahrani, Faisal Alsehli, Jehad Alghamdi, Buthainah Alawad, Atheer Alfulaij, Nora Almamon
Background: Neonatal seizures are common complication in neonatal intensive care units. they were noticed to be more common in preterm infant, but it can also affect term infants as well. Levetiracetam is abroad-spectrum anti- epileptic drug that been studied for the management of seizures, yet a limited data is present on its use in neonatal seizures.
Objectives: studying the effect of levetiracetam in neonatal seizures in terms of maintaining seizure freedom after initiation of levetiracetam and the safety profile in neonate population.
Method: Retrospective Cohort study comparing two groups of patients identified through accessing their medical profiles after searching key words: Phenobarbital, Levetiracetam and Neonatal seizures amongst all NICU admissions in king Abdelaziz Medical city Ministry of National Guard-Health Affairs from the period between Dec 2016 to Jan 2020, 48 patients were included based on inclusion, exclusion criteria. sample further Subclassified to 28 neonates who received phenobarbital, while 20 were on the levetiracetam group.
Results: in the first arm 22 neonates out of 28 neonates achieved seizure freedom while using phenobarbital, in the second arm 11 neonates out of 20 neonates achieved seizure control on levetiracetam after failing phenobarbital. While seizure control was better achieved on phenobarbital, the side effect was almost 57 % of the first arm developed side effect on phenobarbital while only 10 % of the neonates on levetiracetam developed side effect.
Conclusion: the study concluded that adding levetiracetam could result in improved outcomes. Number of patients who received levetiracetam initially are not considered representative to give conclusion on the use of levetiracetam as monotherapy.
| The Use of Antibiotics in Caesarean Section to Prevent Surgical Site Infection: A Retrospective Evaluation|| |
Leena Ibraheem AlAwn, Busra Mohamed Elfatih Mukhtar, Alnada Ibrahim, Salma Mohammed AlDossari, Hessa Hamad AlHaidar
Background: The rate of cesarean section (CS) worldwide has increased substantially over the past three decades. Among women undergoing CS, surgical site infections (SSIs) are the most common complication. Antibiotics are among the utilized measures for the prevention of SSIs after cesarean deliveries. At Dr. Sulaiman Al Habib Hospital, Riyadh, Saudi Arabia, a prophylactic antibiotic protocol, based on cefazolin IV 2g preoperatively, was gradually implemented in 2017. Prior to that, different regimens were used including cefazolin 2g.
Objectives: To investigate SSI incidence rate among a cohort of women who underwent CS at Dr. Sulaiman Al Habib Hospital. Additionally, the study aimed to compare the incidence rate of SSIs among women who received antibiotics according to the protocol (cefazolin IV 2 g) and women who received other regimens.
Methods: The study implemented a retrospective chart review for women who underwent CS at Dr. Sulaiman Al Habib Hospital. A random sample of the hospital records for CS deliveries was obtained. The sample was based on the year when the study started (2020) and two years before the protocol was implemented.
Results: During the study period, December 2020 – January 2021, a total of 735 women met the inclusion criteria. Overall, the SSI incidence rate was 5.3%. There was no significant difference in SSI incidence rate between women who received antibiotic according to the protocol (4.5%) and those who received other regimens (6.7%) (P-value = 0.127).
Conclusion: The overall rate of SSIs was comparable to what has been published in the literature. No significant difference in SSI incidence rate was found between the different antibiotics used. Therefore, further studies are needed to investigate the role of preoperative antibiotics and to determine the association of certain risk factors in terms of SSI incidence.
| Pharmacist’s Awareness on Evidence Based Practice (EBP), in Western Region; Saudi Arabia: A Cross-Sectional Study|| |
Sabirin Bakhsh, Fathia Elserafy, Heba Ashraf, Rawan Al raddadi, Nesreen Bawazeer
Background: The role of pharmacist is expanding to patient-focused care providers. Being updated and evidence–based is a key tool for effective pharmaceutical care services. To accurately assess evidence-based practice (EBP), pharmacist must understand the basic knowledge, know searching process, critically review and appraise professional literature.
Objectives: To determine the attitude, knowledge, institutional support, and barriers of pharmacists regarding EBP in western region of Saudi Arabia (SA).
Methods: This is a cross-sectional study where 188 questionnaires were distributed to the study subjects; hospital and community pharmacies, academic institution, and others. Data were collected and analyzed by SPSS version 20.
Results: Valid responses were received from 188 participants, 78.7% from Jeddah and 21.3% from Mekkah, SA. 63.3% were males while 36.7% were females. 61.2% of the study participants aged from 20 to 30 years. Majority of participants were working in in-outpatient hospital pharmacies (44.1%) but 29.3% were community pharmacies. Clinical Pharmacists were 8.5%. Participants showed a positive attitude toward EBP; > 84% believe that EBP is helpful for patient care, knowledge update and has significant value in pharmacy practice, however, only 52% of pharmacists depend on/utilize EBP in their practice. But despite this positive attitude, pharmacists showed partial understanding of searching process. Overall, 68.6% of respondents relied on textbooks in making their decisions, 45.5 % depends on their own judgment/ medical representatives. 59% of the respondents had learned EBP basics during their academic studies. Identified barriers to conduct EBP are: lack of time (58%), patient overload (51.6%), lack of knowledge (49.5%), too much/complicated evidence (44.35%) and difficulty in critical appraisal (42.6%).
Conclusion: In spite of the positive attitudes toward EBP, this study showed barriers towards implementing EBP in western region-SA, which necessitate action by healthcare decision makers to formulate plan to overcome such barriers for improving quality of healthcare.
| The Biological Evaluation of CDK9/CDK2 Selective Inhibitors as Novel Anticancer Drugs to Treat Colorectal Cancer|| |
Wafa Mosa Saud Alharbi, Aisha Alsfouk, Hanan Henidi, Alaa Alhamid, Najla Altwaijry, Elham Kasab
Background: Colorectal cancer is the second leading cause of death among cancer types. Cyclin-dependent kinases (CDKs) inhibitors have promising therapeutic potential to treat different cancer types, and that is because of their role in cell cycle transcription which makes it a possible potential target for colorectal cancer treatment.Seliciclib is an anticancer agent in phase II clinical trials as a CDKs inhibitor. Novel derivatives of seliciclib were successfully synthesized. This study aims to investigate the anticancer effect of these novel compounds against colorectal cancer.
Methods: In vitro biological evaluation of these compounds was conducted using colorectal cancer cells (HT29 and HCT116). The cytotoxicity of all compounds was assessed using Sulforhodamine B (SRB) assay. Further assessment to investigate the mechanism of cytotoxicity conducted by measuring the apoptosis effect and cell cycle arrest using flow cytometry.
Results: After 72 hours of treatment, Compound 3j showed stronger cytotoxic effects compared to seliciclib against HCT116 and HT29 with IC50’s of 4.86±0.06 μM and 3.6±2.5 μM respectively. Other compounds 3a and 3d, also showed cytotoxic activities against HCT116 and HT29 with IC50’s of 27.4 ± 8.7 μM, 27.3 ± 5.0 μM, 51.6 ± 11.2 μM, and 50.5 ± 1.1 μM respectively. All compounds which showed IC50 lower than the positive control Seliciclib (20 μM) were further examined using cell cycle analysis and annexin-V/FITC apoptosis assessments. The preliminary findings showed significant improvement in the apoptosis after treatment with 3j compared to Seliciclib with the percentage of apoptosis of 38.79% compared to 35.04% respectively in the HCT116 cell line. Compound 3j also showed an induction of cell cycle arrest at the G2/M phase with a cell of 24.21±2.8 and 35.6±0.6% compared to 12.7 ±0.8 and 15.1±8.06 % for Seliciclib for HCT116 and HT29 cells respectively.
Conclusion: The preliminary in vitro findings of the modified derivative of Seliciclib 3j are very promising, with significant cytotoxic effects in colorectal cancer cell lines and significant improvement in apoptosis effect and cell cycle arrest at the G2/M phase compared to Seliciclib. Further in vitro and in vivo investigation should be conducted to more understand the mechanism of this therapeutic effect.
| Green Accelerated Solvent Extraction (ASE) with Solvent and Temperature Effect and Green UHPLC-DAD Analysis of Phenolics in Pepper Fruit (Capsicum annum L.)|| |
Mohammed Aqeel Alyousef
This study presents for the first time, a green and efficient accelerated solvent extraction (ASE) method for phenolic compounds (GA gallic acid, QT quercetin, RT rutin, LT luteolin) with simultaneous determination using a green and effective UHPLC-DAD method. The effect of solvents (ACE acetone, EtOH ethanol, and H2O water) and temperatures (60, 80, 100 ◦C) Vs extract yield and phenolic recovery was investigated. The scale-up for ASEUHPLC method was accomplished in 27 food-grade samples of Capsicum annum/pepper fruit (PF). ASE-MD (method development) showed a high extract yield (198.23 mg/g) in water (33 mL) at 100 ◦C within a time frame of 19.5 min. UHPLC-DAD revealed more yield for GA in ACE whereas, for RT, QT, LT in EtOH at 60 ◦C. Binary solvent system (ACE: EtOH; 1:1) and 60 ◦C was optimized the extraction set. The UHPLC-MDMV showed a run time of 5 min with individual retention times of 0.667 (GA), 1.05 (RT), 3.24 (QT), and 3.78 (LT) in the linearity range (1–100 ppm). The average for phenolics (ppm) in 27 PF-food samples was; GA (19.46) > QT (10.19) > LT (4.06) > RT (2.41). SP4 (Spanish green bell pepper) sample showed more amount of total phenolics (32.52 ppm, 25.36 %) whereas the order for individual phenolic amount (ppm) was GA (53.39) > QT (13.58) > RT (10.04) > LT (4.62). Multivariate analysis resulted a significant correlation for solvent temperature with extract yield but with a lack of correlation for phenolics amount. K-mean correlation was positive for solvent Vs phenolic yield (P < 0.05) whereas, extract yield and temperature were less significant for phenolics content. Solvent established a high significant role for extraction and phenolic recovery whereas, temperature was more significant for extract yield rather than phenolic amount.
| A Role for Enalapril Inhibitors in Reversing Drug-Induced Cardiotoxicity by Anti-Cancer Drug (Crizotinib)|| |
Hayam Yousef Mubarak, Afthab Hussain
Cardiotoxicity is one of the significant adverse effects related to a large number of antineoplastic agents used in cancer management. These side events had contributed to an increase in the morbidity and mortality rate in cancer survivors. Crizotinib is a novel, and first- in-class multitargeted tyrosine kinase inhibitor that has been shown to be an effective antineoplastic agent in the treatment of anaplastic lymphoma kinase (ALK) rearranged non- small cell lung cancer (NSCLC) and ROS proto-oncogene 1(ROS1). Although it is an antineoplastic agent with high objective response, few clinical research has notified cardiovascular toxicities associated with it. The role of mitochondrial permeability transition pore (mPTP) associated with cell death both via necrosis or apoptosis, which has been involved in antineoplastic therapy-induced cardiotoxicity. However, the mechanism of crizotinib-induced cardiotoxicity is unknown. The effects of ACE (enalapril) inhibitor were investigated crizotinib- induced cardiotoxicity in H9C2 rat cardiomyocyte cell line; the following drug treatments control DMSO (0.01%), Crizotinib (10 μM, 0.1μM or 1μM), Enalapril 1 μM ± Crizotinib 1μM or Enalapril 1 μM by using CellRox Green assay to assess the oxidative stress (ROS). Cell viability was measured through a trypan blue assay dye-exclusion assay. The involvement of apoptosis and necrosis was evaluated via the level of the cleaved caspase-3 assay by flow cytometry. JC-1 detected mitochondrial membrane potential (Δψm). Crizotinib treatment has been reported to produce drug induced cardiotoxicity including cardiac dysfunction, QT trace prolongation and hypertension. Angiotensin converting enzyme (ACE) inhibitors are used in the treatment of hypertension and widely deemed to be cardioprotective. Crizotinib (0, 1, 1, 10 μM) significantly decreased the cell viability in a dose- dependent manner, Increased levels of necrosis and apoptosis, accompanied by increased the level of Cleaved caspase-3, increased ROS and induced membrane potential of mitochondrial. Finally, interestingly, the combination of crizotinib with enalapril reduced the cytotoxicity of crizotinib against H9C2 cells. These data suggest that ACEI as a novel cardioprotective drug in ameliorating crizotinib induced cardiotoxicity without influencing its antineoplastic drug properties.
| Prevalence and Epidemiological Trends in Mortality Due to COVID-19 in Saudi Arabia|| |
Wejdan Aburas, Dema A Alissa, Hajar Y Almudaiheem, Zohair Al Aseri, Fahad Alrabiah, Hatoon Ezzat, Eid Al-mutairy, Tareef Alaama, Mohammed S Alamri, Edward Bentz Devol, Ahmed H Al-jedai
Background: Coronavirus disease of 2019 (COVID-19) created a major public health emergency and an international concern. It is an infectious respiratory illness caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The international mortality rates due to COVID-19 reached 2,748,763 on March 24, 2021. We describe the prevalence, case fatality rate, and epidemiological trends of COVID-19 mortality in Saudi Arabia in this paper.
Method: A systematic approach of evaluating COVID-19 related mortalities was established in Saudi Arabia. A scientific committee that evaluated all reported cases with suspicious or confirmed COVID-19 disease using a standardized electronic form. A data registry of all deaths with all clinical parameters was built based on active reporting from all healthcare facilities in Saudi Arabia. Analysis of data using national and regional crude case fatality rate (cCFR) and death per 100,000 population was carried. Descriptive analysis of age, gender, nationality, and comorbidities. Mortality trend was plotted per week and compared to international figures.
Results: The total reported number of deaths between March 23 rd until April 9, 2021, was 6,737. cCFR was reported as 1.70%, and death per 100,000 population was reported as 19.24 which compared favorably to figures reported by several developed countries. Highest percentages of deaths were among individuals aged between 60-69 years, males (74%), individuals with diabetes (60%), and Hypertension (50%).
Conclusion: Case fatality rate and death per 100,000 population in Saudi Arabia is among the lowest in the world due to multiple factors. Several comorbidities have been identified namely diabetes, hypertension, obesity, and cardiac arrhythmias.
| Ascorbic Acid as an Adjunctive Therapy in Critically Ill Patients with COVID-19: A Multicenter Propensity Score Matched Study|| |
Abdullah Fahad Alharthi, Khalid Al Sulaiman, Ohoud Al Juhani, Khalid Bin Salah, Hisham A Badreldin, Mohammed Alenazi, Shmeylan Al harbi, Abdullah Alhammad, Ramesh Vishwakarma, Sarah Aldekhyl
Background: Ascorbic acid represents an appealing option for clinicians to utilize in the context of a global health pandemic of COVID-19 patients due to its proposed clinical efficacy, relative safety, and low cost.
Objectives: The aim of this study was to evaluate the efficacy and safety of using ascorbic acid in supplemental dose as adjunctive therapy in critically ill patients with COVID-19.
Methods: This was a multi-center, non-interventional, retrospective cohort study. All critically ill adult patients admitted to ICU with a confirmed COVID-19 between March 1st to December 31st, 2020, were included in the final analysis. The study was conducted at two large governmental tertiary hospitals in Saudi Arabia. The purpose was to investigate the association between clinical outcomes with ascorbic acid use as an adjunctive therapy in COVID-19 after propensity score matching using baseline severity scores, systemic use of corticosteroids and study centers.
Results: A 739 patients were included in this study; 296 patients were included after propensity score matching. There was no association between the administration of ascorbic acid and in-hospital mortality nor 30-day ICU mortality (OR (95%CI): 0.77 (0.476, 1.234), p-value=0.2738 and OR (95%CI): 0.73 (0.438,1.204), p-value=0.215 respectively). Using ascorbic acid was associated with lower incidence of thrombosis compared with the non-ascorbic acid group (6.1% vs. 13% respectively); OR (95%CI): 0.42 (0.184, 0.937), p-value=0.0342).
Conclusion: Supplemental dose of ascorbic acid as an adjunctive therapy in COVID19 critically ill patients was not associated with mortality benefits; but associated with lower incidence of thrombosis. Further studies are required to confirm these findings.
| Medication Non-Adherence Associated Factors among Hypertensive Population from Saudi Arabia: A Review Study|| |
Wejdan Abdulrahman Alhajri, Ahmed Alenazi
Objective: To assess the contributing factors of medication non-adherence in Saudi hypertensive patient population.
Method: This review article conducted in Saudi Arabia and the search was performed by using PubMed and Scopus databases. We included all studies published in English between 2008 and 2019. Including also any hypertensive Saudi patient aged ≥ 18 years in the study sample. Studies that include non-Saudi population and that did not assess the factors contributing to medication non-adherence were excluded.
Results: A total of 3 studies were identified from different regions of Saudi Arabia: Jeddah, Taif and Makkah. The studies assessed the medication adherence in hypertensive patients. Older and married patients were found to be more adherent to their medications. Other factors associated with lower adherence were having non-formal education, poor relationship with health care providers, absence of co-morbidities and negative beliefs about medications. However, gender has been found to be unreliable factor to assess medication adherence in these specific population.
Conclusion: Variable factors were identified including age, gender, marital status, educational level, absence of comorbidities, poor patient-health care provider relationship and negative beliefs about medication. Pharmacists have a crucial role in encouraging patient medication adherence behavior. This can be achieved by understanding patients concern that interfere with their medication adherence and using strategies to overcome any obstacles that patient may encounter.
| Extended Infusion vs. Intermittent Infusion of Piperacillin/Tazobactam: Altering Current Methods to Optimize Future Outcomes|| |
Nada Ahmed Alhamed, Ahmed Alenazi, Ammar Alabdullatif, Maha Aldhafeeri
The current prevalence of multidrug-resistant (MDR) Gram-negative infections challenges clinicians to optimize the existing antimicrobials by influencing the pharmacokinetics and pharmacodynamics (PK/PD) features. Piperacillin/tazobactam (PIP/TZB) is one of the most frequent empirical antibiotics prescribed worldwide. This study aims to evaluate the use of extended infusion (EI) versus intermittent infusion (II) of PIP/TZB in hospital settings for patient safety and efficacy. This is a descriptive review article; clinical data reviewed in this article included PK/PD studies, prospective trials, systematic reviews, and meta-analyses conducted globally and nationally from 1994 until 2021. Several PK/PD studies assessed the use of extended infusion PIP/TZB to reach different MIC levels for many microorganisms, including Pseudomonas aeruginosa. One of the main parameters to define the size of the effect of PIP/TZB toward various microorganisms is (%fT > MIC). Many studies have compared EI versus II with regard to mortality rates, clinical cure or efficacy, length of stay whether in Intensive care unit (ICU) or hospital, duration of therapy, and cost. Most of the studies conducted in Saudi Arabia in the past years favor adopting extended infusion. However, some obstacles and challenges rose during the implementation, which needs to be addressed appropriately. In addition, this review emphasized the role of extended infusion on special populations with altered pharmacokinetics such as augmented renal clarence, obese patients, cystic fibrosis, and others. More studies are needed to attain generalized and reliable data to determine whether extended infusion benefits do exist.
| Pharmacy Graduates’ Preparedness to Practice, Saudi Arabia|| |
Batool Albaqshi, Dhafer Alshayban, Weqar Al Mohammed Hussein, Bayan Alquraini, Hebh Abu kabbus, Yusuf Garwan, Mohammad Ashraful Islam
Background: Pharmacy schools in Saudi Arabia have nowadays large numbers of students including graduated students, due to there is a huge demand to assess the readiness of their students to practice pharmacy in their internship year.
Objectives: Study aimed to evaluate the pharmacy interns’ preparedness to practice in a professional manner. Moreover, baseline reflection of the current performance and making reflection of the weakness point of the intern students that’s needed further improvement. Finally, attract the attention of educational institutions to the point of weakness of interns to improve it.
Methods: A cross sectional study was conducted using, self-administrated questionnaire via online and paper-based survey. The questioner distributed among different hospital and community pharmacies in the Eastern province Saudi Arabia. Pharmacies and preceptors work in the hospitals and the community pharmacy that train and work with interns randomly.
Result: Almost two third of the participants (64.9%) was pharmacist with bachelor’s degree in pharmacy, majority of them work in hospitals pharmacy (85.6%) and graduated from Saudi University (76.8%), while around half of the participant have 5 years’ experience in pharmacy filed. In terms of Pharmacy Professionals perceptions of pharmacy graduates’ preparedness to practice, majority of pharmacists who’s working with internships students agree that intern student show professionalism requirements of pharmacy practices. Furthermore, more than half agreed that the basic therapeutic knowledge and rational use of meditation was facilitated by intern student. Lower rate of agreement observed for the competence standard ‘dispense medicine’ around half of the pharmacist disagreed about the intern perception about the ‘effectively counsel patients about their medicines’.
Conclusion: Finding of the study will provide insight about the strength and degrees of internship student preparedness for internship year in term of professionalism, communication, medicine rationale use. Competence standard ‘effectively counsel patients about their medicines’ oriented further attention from the educational institutions.
| Physician Adherence to Ivabradine Guideline-Recommendation for Heart Failure Patients|| |
Njood Saeed Aldhahri, Fadwa F Alkhuraisi
Background: Heart failure (HF) is a significant health problem that may lead to hospitalization and mortality among patients. The therapeutic approach of Chronic heart failure (CHF) has changed over the years. According to 2017 AHA/ACC/HFSA guidelines adding ivabradine is reducing HF hospitalization for CHF patients, it’s recommended to start 5mg twice daily aiming to achieve the target doses used in the randomized clinical trials. However, following the guideline recommendations in the practice takes time, for that this study was conducted to evaluate the compliance of physicians with the guideline recommendation of initiation and adding ivabradine to the patient management plan.
Methods: This study is a cross-sectional, retrospective single-center study using a chart review of outpatient prescriptions that identify patients who received Ivabradine based upon a Computerized Prescription Order Entry summary report from January to December 2019. The population of this study included all outpatient adults above the age of 18 who diagnosed with CHF and treated with ivabradine as excluded patients using it for off-label use. The primary outcome is to assess the physician’s adherence to the guidelines recommendation of initiation and adding ivabradine, and the second outcome is to identify the tolerance of patients who started with high doses.
Results: A total of 102 patients with heart failure started on ivabradine were screened for 12 months, only 88 of patients met the inclusion criteria, whereas 14 patients were excluded. There were 39 (44%) of patients started ivabradine following the guidelines recommendation. On the other hand, 49 (56%) patients weren’t followed the guidelines recommendation as 37 (76%) of those patients were not on the maximum tolerated beta-blocker and 12 patients (24%) were not having heart failure with reduced ejection fraction. Moreover, 53 (47%) of the total patients started on the high dose (7.5 mg) and there were 8 (17%) patients who didn’t tolerate this high dose, whereas 39 (83%) of patients tolerated the high dose well
Conclusion: This research has shown that a moderate proportion of the physicians didn’t adhere to the guideline recommendation of initiation ivabradine. Essentially, this study suggests that developing internal protocol or guidelines is essential to improve physician adherence, patient outcome and overcome adverse effects.
| Efficacy of Antibiotic Loaded Cement in Arthroplasty at Academic Medical Center|| |
Imtinan Abdullah Almasoudi, Abdullah Alhammad, Thamer Almangour, Wesal Alaylat
Background: Total joint arthroplasty (TJA) is a successful intervention of orthopedic surgery to restore joint function and improve mobility and the patient’s quality of life. Periprosthetic joint infection (PJI) is one of the complications following TJA. Antibiotic-loaded cement (ABLC) used by some surgeons to prevent such an infection. Data regarding the rate of PJI will reflect the effectiveness of ABLC and help optimize the quality and efficiency of care.
Methods: A retrospective cohort study for adult patients aged ≥ 18 years who underwent TJA and used either ABLC or plain cement from January 2018 to December 2020 were included. Patients with a history of knee infection, a history of allergy to the antibiotics used in the cement or performed other types of surgeries were excluded.The primary outcome was to estimate the efficacy of ABLC on early and late PJI rates and evaluate the economic impact of using antibiotics.
Result: A total of 844 were screened; 319 patients were included and received either ABLC (n=247) or plain cement (n=72). Baseline characteristics and comorbidities were similar in both groups. The differences of patients undergo knee replacement (84.2%VS 100%, P=<0.001). Vancomycin powder was the only antibiotic used in the ABLC, and 50% of the patient received vancomycin 2 g. The rate of early or late PJI between the two groups was not statically significant (5.2% vs 1.4%, OR 3.9; CI 0.5-169.9; P=0.158). Similarly, no difference in the early or late PJI rates among patients who underwent one surgery or two surgeries (P=0.140).
Conclusion: Using ABLC for arthroplasty surgeries did not decrease PJI rates, suggesting that ABLC may be unnecessary and may be associated with additional cost to the healthcare system.
| Medication-Related COVID-19 Mortalities in Saudi Arabia: A Single Institution Experience in Riyadh City|| |
Nasser Alqahtani, Rita Alkaed, Sara Altahhan, Lamia Alzahrawi, Wedad Almadani
Background: Coronavirus disease 2019 (COVID-19) has spread from Wuhan, China leading to a worldwide pandemic. Approximately 1.3 million people died globally and 5,700 in (Kingdom of Saudi Arabia) KSA. Due to the rapid transmission of the virus and increased death rates worldwide, the health care system was challenged in providing patient care and treatment. Patient-specific demographics and preexisting comorbidities were found to increase the risk of death. KSA handled the pandemic by enforcing early precautions and following current evidence in disease management. Since the outbreak, current literature is scarce with variable quality and controversial results with regard to medication-related COVID-19 mortality.
Aim: To investigate the association between medication use and COVID-19 mortality.
Methods: This study is a retrospective case control study in Imam Abdulrahman AL Faisal hospital (IAFH) that included an estimate of 2400 hospitalized adult patients with confirmed COVID-19. A multivariate logistic regression analysis was conducted among survivors and non-survivors to analyze the association between all medications taken during hospitalization and mortality rate.
Results: Among 2400 subjects, 277 were deceased and 2100 were cured. Intubated patients were at higher death risk. We had significant results for the relationship of several medications and death. Our study concluded that tocilizumab use increases the odds of death by eight-fold (P=0.043, OR=8.43, CI= 1.06-66.69). The use of omeprazole was associated with higher COVID-19 mortality risk (P=0.001, OR=2.10, CI=1.34-3.3).
Conclusion: The study results indicate that certain medication uses in COVID-19 pose an increased risk of death in the population studied on. On the contrast, we observed protective effects of some medications used to support COVID-19 patients.
| Quality Improvement Project to Enhance Pharmacy Medication Safety Reporting: A Secondary Healthcare Experience|| |
Lina Hussain Al Lehaibi, Mukhtar Alomar, Laila AlGhalawin, Layla Almarzooq, Zahra Alabdulaal, Zaki Alnahab, Hussain Albahrani, Batool Aldubaisi
Background: improvement in the quality of medication safety reporting is an essential process in the healthcare system.
Aim: to improve the medication safety reporting through designing a quality improvement project for the pharmaceutical care services in a Dammam Medical complex.
Methods: the process of medication safety reporting was evaluated to detect the area that needs to be improved. Pharmacy quality indicators were designed to detect the improvement in medication safety report at any stage of the medication order process, including prescribing, preparing, administering, or monitoring the drugs. A quality improvement project was designed using many quality improvement techniques to improve medication safety reporting in each drug handling stage. Brainstorming, fishbone charts, and workflow analysis were the main quality tools used to detect the causes of medication safety underreporting reasons. Certain actions were implemented, including an in-service educational program, utilizing the computerized hospital system, and unifying the reporting method.
Results: the quality improvement interventions succeeded in improving the medication safety reporting in each stage. These interventions succeeded in increasing medication safety reports from 277 reports in June to 1378 reports in July, representing an approximately five-fold increase in one month.
Conclusion: pharmacists can have a crucial role in improving medication safety reporting in the healthcare system, which is crucial for patient safety.
| Tuberculosis Screening Test Predicting Tuberculosis Infection in Solid Organ Transplant Recipients: A Retrospective Cohort Study|| |
Fatima Alyahya, Ghazwa B Korayem, Heba Alruwaisan, Dema Alissa, Reem Almaghrabi, Lama Aljuaid, Ghaida alzimami
Background: Tuberculosis (TB) is a common post solid organ transplantation (SOT) infection. Thus, the American Society of transplantation (AST) recommends screening all transplant candidates using either a tuberculin skin test (TST) or interferon-gamma release assay (IGRAs) for latent TB (LTBI). In immunocompromised patients, both TST and IGRA have low sensitivity and have predictive value for active TB progression. The frequency at which TST or IGRA positive patients later progress to active TB after transplantation has yet to be determined. Therefore, this study measures IGRA and TST predictive values for the progression to active TB within 2 years in SOT recipients living in TB endemic region.
Methods: A retrospective cohort study including adult patients at the age of 14 years old or above who underwent deceased donor solid organ transplantation in Riyadh. Recipients were screened for LTBI using either QFT or TST or both pre-transplantation and followed for two years to determine whether they had TB reactivation or de novo TB infection progression.
Result: A total of 183 recipients were included in this study. Within the first year after transplantation, 9 (5%) of transplant recipients were diagnosed with TB. Patients with a positive IGRA test were almost four times more likely to develop TB (RR; 3.857, 95%CI 1.090 to 12.68). IGRA had a positive predictive value of 15% and a negative predictive value of 93.3%.
Conclusion: In conclusion, positive IGRA pre-transplantation was significantly associated with the increased risk of TB development or progression regardless of INH reception. In SOT recipients living in a TB endemic area, relying on IGRA results to determine the need for prescribing INH needs to be revised.
| Comparison of the Efficacy and Safety of Enoxaparin vs Unfractionated Heparin for Venous Thromboembolism (VTE) Prophylaxis in Critically ill Medical Patients|| |
Asma Awad Ali Alshehri, Khalid Al Sulaiman, Ramesh Vishwakarma
Background: Critically ill patients are at higher risk of VTE due to underlying severe illness, sedative drugs, invasive lines, and prolonged immobilization. Thromboprophylaxis is a crucial component of critically ill patients because of their high risk of venous thromboembolism. However, there is uncertainty about the appropriate dosing regimen in critically ill medical patients. Therefore, our study aims to evaluate the efficacy and safety of standard dosing of different regimens (Enoxaparin vs. UFH) as a pharmacological VTE prophylaxis in those populations.
Methods: A retrospective cohort study including critically ill medical patients aged ≥ 18-years with a normal BMI who received either Enoxaparin 40 mg daily or UFH 5000 Unit three times daily as a VTE prophylaxis between January 1, 2018, to December 31, 2018. The primary outcome was thrombosis, and the secondary outcomes included ICU-related complication (s) during the ICU stay (i.e., major bleeding, minor bleeding, RBC transfusion during ICU stay, HAT, and HIT). Propensity score (PS) adjustment used for patient’s APACHE II score, serum creatinine baseline, INR baseline, and cancer as coexisting illness.
Results: A total of 1866 patients were screened; 307 patients were included in the study. The differences in venous thromboembolism (OR 0.47; 95% CI 0.10-4.10; P =0.49) and any case of thrombosis (OR 0.43;95%CI 0.14-1.32; P=0.14) during ICU were less likely to occur in enoxaparin group; however, were not statistically significant. Moreover, no statistically difference in either minor bleeding (OR 0.83; 95% CI 0.46-1.50; P =0.54), major bleeding (OR 3.30; 95% CI 0.85-12.61; P =0.08) nor and any case of bleeding (OR 1.03; 95% CI 0.59-1.79; P =0.93) between the two groups.
Conclusion: Standard dosing of enoxaparin associated with thrombosis benefit; however, was not statistically significant. Given the current differences in cost and the frequency of administration, VTE prophylaxis with enoxaparin should be considered in critically ill medical patients.
| Evaluation of Standard Dosing for Selected Broad Spectrum Hydrophilic Antibiotics in Critically Ill Patients with Augmented Renal Clearance: An Observational Study|| |
Majed Almutairi, Khalid Al Sulaiman, Sultan Alenazi, Ramesh Vishwakarma, Ohoud Aljuhani
Background: Inappropriate antibiotics dosing in critically ill patients with augmented renal clearance (ARC) may be associated with pathogens resistance and worse outcomes. Unfortunately, studies regarding the relationship between ARC and clinical outcomes in patients treated with antibiotics medication are rare. The study aims to evaluate the efficacy and clinical outcomes of selected broad spectrum hydrophilic antibiotics (Meropenem, Imipinem, Piperacillin/Tazobactam) in augmented renal function critically ill patients with confirmed infections.
Methods: A retrospective cohort study in critically ill patients who were admitted to intensive care units (ICUs) at King Abdulaziz Medical City (KAMC)-Riyadh and received broad-spectrum Hydrophilic antibiotics (Meropenem, Imipenem, or Piperacillin/Tazobactam) with confirmed infection. All the patients who met our inclusion criteria during the study period (01/01/2018 – 31/12/2019) were included. Eligible patients have been divided into two groups (augmented renal clearance (ARC) Vs. Non-ARC) according to the estimated creatinine clearance (CrCl) to assess pathogen eradication at 10-14 days.
Results: A total of 2682 patients were screened; 133 patients were included in the study. The eradication of pathogen at 10-14 days in ARC group was non-inferior to non-ARC group (OR 1.08; 95% CI, 0.41–2.78 p = 0.88). The Resistance (OR 0.78; 95% CI, 0.25–2.40 p = 0.66), and Persistence after 3 days (OR 0.88; 95% CI, 0.35–2.18 p = 0.78) were not significantly different between the groups. In other words, patients with ARC have the same rate of resistance and persistence of pathogen after three days. There was no difference in the 30-day mortality between the two groups (OR 0.22; 95% CI, 0.04–1.40 p = 0.11). Also, there was no difference in the ICU length of stay (LOS) nor in hospital LOS between the two groups (22.0 days vs. 17.5 days, p = 0.37), and (51.0 days vs. 30.0 days, p = 0.07) respectively.
Conclusion: Using standard dosing of hydrophilic broad-spectrum antibiotics in ARC patients was not inferior to non-ARC patients in terms of the pathogen eradication, resistance, and persistence. Further randomized clinical and interventional studies are required to confirm our findings.
| Doxycycline vs. Macrolides for the Treatment of Community-Acquired Pneumonia in Inpatients in Combination with a β-Lactam Antibiotic|| |
Raghad Khalid Aldhahri, Shahad Gabb, Ohoud A Shoaib, Reem M Almadani, Abrar K Thabit, Khalid Eljaaly
Background: Hospitalized patients with non-severe community-acquired pneumonia (CAP) are treated with a β-lactam plus either a macrolide or doxycycline. Data on doxycycline use in combination with a β-lactam are scarce. Therefore, we aimed to compare the effectiveness of doxycycline vs. macrolide when either of them is combined with a β-lactam antibiotic in the inpatient setting.
Methods: This was a retrospective cohort study in CAP patients admitted between December 2013-November 2020. Patients were divided according to therapy to β-lactam plus doxycycline (BL-D) and β-lactam plus a macrolide [azithromycin or clarithromycin] (BL-M) groups. Eligible patients were adults (≥ 18 years) who were diagnosed with CAP based on clinical criteria and received the study regimens for ≥ 5 days. Patients were excluded if they were pregnant, discharged or died within 48h of diagnosis, had respiratory comorbidities, had active tuberculosis, or had active COVID-19. The primary endpoint was time to clinical stability (the resolution of clinical signs and symptoms). Secondary endpoints included length of stay (LOS) and in-hospital mortality.
Results: A total of 145 patients were included, 64 in the BL-D arm and 81 in the BL-M arm. Patients were similar at baseline, except for the median duration of antibiotic therapy which was longer in the BL-D group (8.5 vs. 7 days; P=0.005), and white blood cell count (9.8 vs. 12.5×103 cells/mm3; P=0.02). No difference in clinical cure was observed (95.3% vs. 91.4%; P=0.35). Time to clinical stability was shorter by only one day in the BL-D group, but the difference was not statistically significant (4 [3-6] vs. 5 [3-7] days; P=0.46). LOS was 7 days in both groups (P=0.86). Only one patient in the BL-D group died, but due to intracranial hemorrhage.
Conclusion: Our study showed that a regimen combining doxycycline with a β-lactam was comparable in effectiveness to regimens involving macrolides.
| Evaluation of Zinc Sulfate as an Adjunctive Therapy in COVID-19 Critically Ill Patients: A Two Center Propensity-Score Matched Study|| |
Alhomaidi Hmoud Alghuwairy, Khalid Al Sulaiman, Ohoud Al Juhani, Abdulrahman I Al Shaya, Abdullah Kharbosh, Raed Kensara, Aisha Alharbi, Rahmah Algarni, Shmeylan Al Harbi, Ramesh Vishwakarma, Ghazwa Korayem
Background: Zinc is a trace element that plays a role in stimulating innate and acquired immunity. The role of zinc in critically ill patients with COVID-19 remains unclear. This study aims to evaluate the efficacy and safety of zinc sulfate as adjunctive therapy in critically ill patients with COVID-19.
Methods: Patients aged ≥ 18 years with a COVID-19 who were admitted to the intensive care unit (ICU) in two tertiary hospitals in Saudi Arabia were retrospectively assessed for zinc use, from 01 March 2020 until 31-December 2020. We assessed the association of zinc use as adjunctive therapy with the in-hospital and 30-day mortality after propensity score matching. Secondary outcomes included mechanical ventilation (MV) duration, ICU length of stay (LOS), hospital LOS, and complication (s) during ICU stay.
Results: A total of 266 patients were included in this study after using propensity score matching. Zinc sulfate as adjunctive therapy during ICU stay was not associated with statistically significant reduction in 30-day mortality nor in-hospital mortality compared to those who did not receive zinc (HR= 0.65 CI = 0.41,1.01; p= 0.05 and HR= 0.67 CI = 0.45,1.00; p= 0.05; respectively). Moreover, MV duration (Beta coefficient 0.10 CI = -0.19,0.39; p= 0.48), ICU LOS (Beta coefficient 0.19 CI = -0.02,0.40; p=0.08) and hospital LOS (Beta coefficient 0.15 CI = -0.02,0.32; p=0.08) were not statistically significant between the two groups. Patients who received zinc have a higher odds of acute kidney injury (AKI) during ICU stay (OR= 1.80 CI = 1.08-3.0; p= 0.02).
Conclusion: Zinc sulfate as adjunctive therapy in critically ill patients with COVID-19 may have survival benefit; however, was not statistically significant. Zinc use was linked with an increased risk of AKI development during ICU stay.
| Early Versus Late Use of Dexamethasone in Critically Ill Patients with COVID-19: A Multicenter, Prospective Cohort Study|| |
Abdullah Fahad Alharthi, Khalid Al Sulaiman, Ohoud Aljuhani, Ghazwa B Korayem, Khalid Eljaaly, Ali Al Tebainawi, Hisham A Badreldin, Nada Akhani, Aisha Alharbi, Rahmah Algarni, Ghassan Al Ghamdi
Background: Corticosteroids, especially dexamethasone, showed a survival benefit in critically ill COVID 19 patients. However, it is unclear whether the timing of dexamethasone initiation is associated with positive outcomes. This study aims to evaluate the safety and efficacy for the timing of dexamethasone initiation in critically ill patients with COVID19.
Methods: A multicenter, non-interventional, prospective study for all adult COVID19 patients admitted to intensive care units (ICUs) received systemic dexamethasone between March 01 to January 31, 2021. Patients were divided into two groups based on the timing for dexamethasone use (early vs. late). Early use is defined as the new initiation of dexamethasone within 24 hours of ICU admission. Propensity score matching was used based on the patient’s SOFA score, MV within 24 hours of ICU admission, proning status, and tocilizumab Use during ICU stay.
Results: A total of 480 patients were included in the study; dexamethasone was initiated early within 24 hours of ICU admission in 367 patients. Among 202 patients matched using propensity score, 101 had received dexamethasone after 24 hours of ICU admission (1:1 ratio). The 30-day mortality (OR [95%CI]: 1.82[1.04, 3.19], p-value=0.04) and in-hospital mortality (OR [95%CI]: 1.80[1.03, 3.15], p-value=0.04) were statistically significant higher in patients who received dexamethasone after 24 hours of ICU admission. Amon the non-mechanically ventilated patients, late use of dexamethasone was associated with higher odds of developing respiratory failure that required MV (OR [95%CI]: 3.8 [1.41, 10.3], p-value=0.008) and longer hospital length of stay (IRR [95% CI]: 1.61 [1.12, 2.31], p-value=0.009).
Conclusion: Early use of dexamethasone within 24 hours of ICU admission in COVID-19 critically ill patients was associated with mortality benefits. Moreover, dexamethasone’s early use might be considered a proactive measure in all critically ill patients, even the non-mechanically ventilated, to prevent further complications.
| The Impact of Statins Therapy on the Clinical Course and Outcomes in COVID-19 Critically Ill Patients: A Multicenter, Cohort Study|| |
Raed Ehsan Kensara, Khalid Al Sulaiman, Shmeylan Al Harbi, Abdullah Kharbosh, Ohoud Aljuhani, Ghazwa B Korayem, Reem Abdulhafeez mahboob, Ali Al Tebainawi, Abdulrahman Al Shaya, Abdulrahman Al Essa, Abdullah Al Harthi
Background: Severe Corona Virus Disease 2019 (COVID-19) can heighten the systematic inflammatory response in critically ill patients, causing a systemic hyperinflammatory state leading to multiple complications. Statins can potentially be a potent adjuvant therapy in COVID-19 infection due to pleiotropic effects; it exerts anti-inflammatory actions independent of their cholesterol-lowering effects. This study investigates the impact of statin use on the outcome of critically ill patients with COVID-19.
Method: A multicenter, retrospective cohort study for all adult critically ill patients with confirmed COVID-19 admitted to Intensive Care Units (ICUs) between March 1, 2020, and January 31, 2021. Eligible patients were classified into two groups based on statin use during ICU stay. Propensity score-matched used based on patient’s age, APACHE 2, and SOFA score within 24 hours of ICU admission. We considered a P value of < 0.05 statistically significant.
Results: A total of 1049 patients were eligible; 502 patients were included after propensity score matching (1:1 ratio). The 30-day (HR (95%CI): 0.75 (0.58, 0.98), p-value=0.03) and in-hospital mortality (HR (95%CI): 0.69 (0.54, 0.89), p-value=0.004) were statistically significant lower in patients who received statin therapy. Moreover, patients who received statin have a lower odd of secondary bacterial/fungal pneumonia (OR (95%CI): 0.48(0.32, 0.69), p-value=<0.001). During ICU stay follow-up of inflammatory markers, the patient who received statin have a lower D-dimer, procalcitonin, and total WBC count.
Conclusion: The use of statin as adjunctive therapy in COVID-19 critically ill patients may have a beneficial role and survival benefits with a good safety profile.
| The Role of Inhaled Corticosteroids (ICS) in Critically Ill Patients with COVID-19: A Multicenter, Prospective Cohort Study|| |
Raed Ehsan Kensara, Khalid Al Sulaiman, Ohoud Aljuhani, Kholoud Al Aamer, Omar Al Shaya, Reem Abdulhafeez mahboob, Abdulrahman Al Shaya, Ali Al Tebainawi, Alaa Al Harthi, Ghazwa B Korayem, Huda Al Enazi
Background: Severe Corona Virus Disease 2019 (COVID-19) can enhance the systematic inflammatory response in critically ill patients, causing a systemic hyperinflammatory state leading to multiple complications. In COVID-19 patients, the use of inhaled corticosteroids (ICSs) is surrounded by controversy regarding their impacts on viral infections. This study aims to evaluate the safety and efficacy of ICS in critically ill patients with COVID19 and its clinical outcomes.
Methods: A multicenter, non-interventional, prospective study for COVID19 critically ill patients who received inhaled corticosteroids. All patients aged ≥ 18-years old with confirmed COVID-19 and admitted to Intensive Care Units (ICUs) between March 1, 2020, to January 31, 2021, were screened. Eligible patients were classified into two groups based on the use of ICS ± LABA during ICU stay. Propensity score-matched used based on patient’s APACHE 2 score, SOFA score, systemic corticosteroids use during ICU stay, Acute Kidney Injury (AKI) within 24 hours of ICU admission. We considered a P value of < 0.05 statistically significant.
Results: A total of 954 patients were eligible; 130 patients were included after propensity score matching (1:1 ratio). The 30-day mortality (HR (95%CI): 0.53 (0.31, 0.93), p-value=0.03) was statistically significant lower in patients who received ICS. Conversely, the in-hospital mortality, ventilator-free days, ICU length of stay (LOS), and hospital LOS were not statistically significant between the two groups.
Conclusion: The use of ICS ± LABA in COVID-19 patients may have mortality benefits at 30 days. However, it was not associated with in-hospital mortality benefits nor ventilator-free days.
| Cardioprotective Activity of Butea Monospermia Leaves against Isoproterenol Induced Cardiotoxicity|| |
Ghaida Abdullah Aldajani, Dr. Maheshwari C, Raghgad Sultan Alsultan, Yara Aldajani
Background: Butea monospermia leaves are used for various ailments such as wound healing. In Asian countries these plants leaves are used by tribes for the treatment of different heart diseases including heart attack. However, there is lack of scientific information regarding the effect of it on isoproterenol induced myocardial infarction.
Methods: The plant was authenticated by Botanical survey of India and Institutional Animal Ethics Committee permitted the study.Leaves of this plant extracted with ethanol and used for further studies.Acute oral toxicity study was done, and the methanol extract was devoid of mortality of animals at the dose of 2000mg/kg. Male Albino rats Animals divided into 4 groups each consist of 6 animals. Group I served as control. Groups IIanimals received Isoproterenol 200mg/kg for 2 days.Groups III and IV animals pretreated with BME (100 and 200 mg /kg-1) daily for a period of 14 days. After the treatment period, Isoproterenol(200 mg /kg-1) was SC injected to rats at an interval of 24 hr for two days to induce MI. After 48 hr, rats were anaesthetizedwith anaesthetic ether, the levels of biochemical enzymes such as ALT, AST, LDH and CPK were estimated, and histological observations of the heart tissues were performed. Results were analysed by using one way ANOVA.
Results: The activities of serum marker enzymes were increased significantly in ISO-induced rats. BME at concentration of 200 mg kg-1,when administered orally showed a decrease in serum enzyme levels and brought to the near normal values. 100 mg/kg-1 the effect wasonly marginal. Our data showed that BME (200 mg /kg-1, po) significantly restored most of the biochemical parameters and normal histopathology.
Conclusion: The present study concluded that BME may be therapeutic value in the treatment of MI. The activity of this plant may be due to presence of flavonoids present in the leaves.
| Influence of Clinical Pharmacist on Intravenous to Oral Antibiotic Therapy Switch|| |
Abdulaziz Kardam, Yasir Alhazmi, Mabrouk AL-Rasheedi, Abdulrahman S Alshaiban, Ibrahim M almalki
Background: Some oral antibiotics if given in the correct time will have nearly the same effects but with lower cost. Medications could be switched are many including antibiotics, analgesics, antipsychotics, and antiviral. Pharmacist-assisted antimicrobial stewardship initiatives can help to IV to PO switches based on documented guidelines. Switching has many advantages including benefit of reducing the frequency of adverse effects associated with parenteral drugs, lower cost, and reduced hospitalization period.
Aim: The current study aimed to evaluate the clinicians ‘adherence to the standard antibiotic switching guidelines from IV to oral guideline after being noticed by clinical pharmacist for patients’ eligibility for switch.
Methods: An uncontrolled pre and post assessment study was conducted at Aseer central hospital. The study was conducted on two phases. First phase included pharmacist evaluation of the patients’ eligibility for drug switch without writing notes for the clinicians in the patients file then, physicians’ adherence for switch guidelines was assessed. At the second phase, clinical pharmacist wrote a note for the clinicians for patients’ eligibility and the adherence rate was re-assessed again.
Results: Phase 1 included 94 IV prescriptions for 16 different antibiotics while phase included 89 prescriptions of 17 different antibiotics. At phase 1, 51 cases (54.3%) met the criteria for antibiotic switch and only 2 were switched (2.1%). In phase 2 after applying the intervention, 31 patients (34.8%) met the criteria among which 14 (15.7%) were switched. Regarding causes of continuing on IV antibiotics with no switch, high WBCs was the most recorded reason at the two study phases (71%) followed with NPO criteria.
Conclusions: In conclusion, the study revealed that the intervention applied by the clinical pharmacists caused highly significant improvement in physicians’ adherence to the switch guidelines with reduced cost.
| Incidence and Risk Factors of Colistin-Induced Nephrotoxicity Associated with The International Consensus Guidelines: A Retrospective Observational Study in a Tertiary Care Hospital, Saudi Arabia|| |
Najla Alhamed, Amal Alenezi, Reyouf Alqarni, Zainab Aljamea, Bashayer Alshahil, Joseph Royes, Fawaz Alotaibi
Background: Colistin is an effective therapy against multidrug-resistant gram-negative bacteria. However, nephrotoxicity is a major adverse drug event associated with colistin administration. Therefore, we aimed to evaluate the incidence and the potential risk factors of nephrotoxicity in colistin-treated patients.
Methods: An observational retrospective cohort study (from January 2020 to November 2020) was conducted. All adult patients receiving colistin for ≥ 72 hours were included in the study, while patients who require renal replacement therapy or undergo renal transplants were excluded. The severity of Acute Kidney Injury (AKI) was assessed by Kidney Disease Improving Global Outcomes KDIGO Guidelines. All variables were collected from the hospital’s electronic medical record system. A Survival analysis model was performed to predict the incidence of AKI and its risk factors. P-value <0.05 is considered statistically significant.
Result: Out of 128 patients who received colistin, 51.56% of them have experienced AKI. The incidence is increasing among oldest old patients (above 80) (p-value=0.0003). In addition, the average time until the AKI occurred was ten days after receiving colistin treatment. Patients with previous AKI (71.7%) were three times higher than patients who did not experience AKI (HR=2.97, 95%CI [1.8*4.8]). Furthermore, DM, HTN, Charlson Co-Morbidity Index, co-administration of loop diuretics, NSAID consumption along with colistin were positively associated with AKI incidence. AKI has occurred less (42%) among patients who received the appropriate dose adjustment than those who didn’t receive the proper dosing.
Conclusion: Nephrotoxicity is a significant issue among patients who receive colistin treatment in our setting especially among older patients and those who did not receive the appropriate dose. However, healthcare providers and pharmacists should play a major role preventing such serious side effect to increase patient quality of life. More studies are needed to investigate nephrotoxicity incidence and risk factors associated with the new dosing guidelines of colistin.
| Physician Adherence to Screening of Diabetes Patients According to ADA Guideline in Central Region, Saudi Arabia|| |
Rawabi Saleh Abdulmohsin Al Abdulgader, Mabrouk AL-Rasheedi, Nouf Awad Almistadi, Fatimah Ismail Mobarki, Khuzama Mohammed Almuhaysini, Lamees Abdullah Aldaiji, Nouf Suliman Almaqwashi, Lamya Abdullah Aldaiji, Jawza Salem Alshammari, Sadeen Saleh Alamr
Background: Diabetes defined as a group of metabolic disorders characterized by high blood glucose levels as a subsequence of defects in insulin secretion or action or possibly both, the guidelines are used to prevent diabetes-related morbidity. Saudi Arabia is reported to rank the second in the Middle East and the seventh worldwide in terms of the rate of diabetes.
Purpose: To assess the level of physicians' adherence to the American Diabetes Association Guidelines while patient follow ups.
Methods: Observational retrospective study was conducted among different hospital in the central region, K.S.A. Patient’s data were collected from the medical records of the last three years, records were selected randomly. Study focuses on all patients with comorbidity and following standards of the ADA not changed at least three updating. Those standards: hypertension should be less than <140/90 or less than <130/80 who at high risk for ASCVD, A1c less than 7% and monitoring of foot examination, neuropathy, and vaccination annually
Result: Total of 153 patients have been selected to represent the commitment of central region to the ADA guidelines. Out of the 153 patients, 83% were poorly controlling their diabetes with A1c over 7 for the last three A1c results of each patient. According to the ADA, patients with no ASCVD risk should maintain a blood pressure level of 140/90. In the study, 86.3% of the whole sample maintained a normal level. On the other side, the ADA mark the 130/80 levels is the normal levels for the ASCVD patients. A total of 59 patients were at the risk of the ACSVD out of the 153 patients and out of which 78% has maintained the target levels. ADA recommends that patients should have annual foot and neuropathy examination, results showed that only one patient had a foot examination and only two patients had a neuropathy monitoring out of the 153 patients who did not receive any considerations towards those matters. Results showed that only one patient had received a flu vaccination where the ADA recommended should receive vaccination against flu annually.
Conclusion: Physicians should follow updated guidelines to enhance diabetics controlled and screening the complication.
| Medication Related Fall Risk among Elderly Patients with Fractures|| |
Background: Falls establish a leading cause of fractures, while the causes of falls in elderly patients are multifactorial, medication has been considered as one of the most important factors.
Aim: To investigate the prevalence of medication-related falls risk among elderly patients with fractures and to assess the role of fall risk increase drugs (FRIDs) and their association with falls among elderly, focusing on individual demographics, and health status.
Methods: A retrospective cross- sectional study was conducted on sixty-one elderly patients with fractures admitted to Alrass General Hospital, Al. Qassim, Kingdom of Saudi Arabia during the period from February 2021 to March 2021. The study participants were divided into two groups according to inclusion and exclusion criteria. The first group included patients with FRIDs and the other included those without FRIDs.
Results: Out of the whole number of participants, 41 patients were using FRIDs which represent 67% of the sample, and the remaining weren’t using FRIDs. Females represent 71% of those who treated with FRIDs. FRIDs were considered a likely contributor to the fall in about 67% of the total participants. The most frequently utilized FRIDs were antihypertensive and antidiabetic drugs (59% and 51% respectively) followed by statins and anticoagulants. The most prevalent comorbidities among the participants, with statistically significant difference between patients with FRIDs compared to those without FRIDs (P=0.000).
Conclusion: We found that most of old people get fall and majority of them were female with significant increase in fall with patient who have hypertension or diabetes mellitus and have been used FRIDs. However, future studies are strongly warranted with a larger sample size.
| Evaluation of Aspirin Use among COVID-19 Critically Ill patients: A Multicenter Propensity Score Matched Study|| |
Abdullah Fahad Alharthi, Khalid Al Sulaiman, Ohoud Aljuhani, Ghazwa B Korayem, Ali Al Tebainawi, Shmeylan Al Harbi, Jawaher Gramish, Raed Kensara, Abdulaziz Alshehri, Omar Alhuthaili, Ramesh Vishwakarma
Background: Due to the nature of COVID-19 complications, multiple medications with anti-inflammatory effect have been to investigate their impact on this virus. Aspirin is used widely as a cardioprotective due to its antiplatelet and anti-inflammatory. Its role in hospitalized COVID-19 patients has been assessed and evaluated in the literature. However, no data regards its role in COVID-19 critically ill patients. This study evaluates the use of low-dose aspirin (81-100 mg) and its impact on outcomes in COVID-19 critically ill patients.
Methods: This is a multicenter, retrospective cohort study for all adult critically ill patients with confirmed COVID-19 admitted to Intensive Care Units between March 1, 2020, and January 31, 2021. The primary outcome was to evaluate aspirin use in COVID-19 critically ill patients and its association with mortality; other outcomes were considered secondary. Eligible patients were classified into two groups based on Aspirin use during ICU stay. Propensity score-matched used based on patient’s SOFA score, MV status within 24 hours of ICU admission, proning position status, the use of VTE pharmacological prophylaxis, ischemic heart disease (IHD), and stroke as co-existing illness and, ferritin’s baseline. We considered a P value of < 0.05 statistically significant.
Results: A total of 1033 patients were eligible; 280 patients were included after propensity score matching (1:1 ratio). Patients who received aspirin during ICU stay have a higher 30-day (OR (95%CI): 1.66 (1.03, 2.70), p-value=0.04) and in-hospital mortality (OR (95%CI): 1.60 (1.01, 2.65), p-value=0.04). Moreover, patients who received aspirin have a higher odd of major bleeding (OR (95%CI): 2.93 (0.91, 9.45), p-value=0.07); however, it did not reach statistical significance.
Conclusion: The use of aspirin in COVID-19 critically ill patients was associated with a higher mortality rate. Benefit-risk assessment for continuation or new initiation of aspirin during ICU stay should be narrowly scoped for each patient individually.
| The Adherence to the International Antiemetic Guidelines for Chemotherapy-Induced Nausea and Vomiting (CINV) in Worldwide Oncology Practices: A Systematic Review|| |
Marwah Atiah Almuzaini, Sarah Sameer Salamah, Sultan Othman Alolayan
Background: Two of the most common side effects of chemotherapy are nausea and vomiting which can lead to an economic burden on hospitals and countries, by increasing chemotherapy-induced nausea and vomiting (CINV) related office visits and hospitalizations, reducing patient compliance, and leading to negative effects on patients’ quality of life and work attendance. Adherence to antiemetic guidelines can reduce CINV events. However, some evidence indicates that the adherence to these guidelines is less than optimal. Thus, the purpose of this systematic review is to assess the adherence to the international antiemetic guidelines for CINV in worldwide clinical settings and identify reasons of non-adherence in order to explore interventions that enhance the adherence to antiemetic guidelines and that may result in better control of CINV and enhance patient compliance. These consequently reduce the hospital and emergency visits, utilization of the healthcare resources, and total costs of care.
Methods: Based on PRISMA guidelines, PubMed database were systematically searched, by three reviewers, for published studies that assessed the adherence to the different international antiemetic guidelines for CINV in worldwide oncology practices.
Results: Out of 39 identified studies, 15 studies were included in the final analysis. These studies, which conducted in 10 countries, between 2003 and 2020, show that the adherence to international antiemetic guidelines for CINV is less than optimal. Among these studies, lowest and highest rates of adherence were 3% and 87.7%, respectively. Patient’s preference and income, cost of the antiemetics and insurance coverage, professionals’ knowledge, and hospital’s type are important factors that can affect the adherence to the antiemetic guidelines.
Conclusion: The rate of adherence to the antiemetic guidelines (MASCC, ESMO, NCCN, ASCO) was suboptimal among different countries in USA, Asia, and Europe. Patients, healthcare professionals, and types of hospitals are all contributed to these low adherence rate.
| Safety and Efficacy of Systemic Thrombolytic Therapy in Cardiac Arrest Caused by Cardiac Etiologies or Presumed Pulmonary Embolism: An Updated Systematic Review and Meta-Analysis|| |
Omar A Alshaya, Hisham A Badreldin, Sarah T Albalawi, Sarah T Alghonaim, Abdulrahman I Alshaya
Background: A massive number of cardiac arrest (CA) cases are encountered yearly worldwide with poor survival rates. Cardiopulmonary causes such as pulmonary embolism (PE) and acute myocardial infarction (AMI) are main potentially reversible causes of cardiac arrest. The use of systemic thrombolysis during cardiopulmonary resuscitation (CPR) to treat these conditions is still controversial.
Methods: We searched through Medline (PubMed) and Cochrane databases from inception through April 2021 to identify relevant studies. The primary efficacy endpoint was survival to hospital discharge and the primary safety endpoint was any reported bleeding. The secondary endpoints included survival at 24 hours, hospital admission, and return of spontaneous circulation (ROSC).
Results: A total of 365 articles were identified, and 11 studies met our inclusion criteria. The total number of patients was 4,696, in which 1,178 patients received systemic thrombolysis, and 3,518 patients received traditional therapy. There was no significant difference between the two groups in survival to hospital discharge RR=1.38 (0.95-1.91). However, patients who received systemic thrombolysis had more bleeding events as compared to traditional therapy RR=1.65 (1.20-2.27). For the secondary outcomes, there were no differences between the two groups in survival at 24 hours RR= 1.24 (0.97-1.59). In addition, the rates of hospital admission and ROSC were significantly higher in patients who received systemic thrombolysis compared to traditional therapy RR= 1.53 (1.04-2.24) and RR= 1.34 (1.05-1.71), respectively.
Conclusion: Systemic thrombolysis in CA did not improve survival to hospital discharge yet led to more bleeding events. However, it did increase the rates of hospital admission and ROSC achievement which could provide more time for further treatments. Further rigorous and high-quality studies are needed to confirm these findings.
| Blood Pressure Variability When Transitioning from Intravenous to Oral Antihypertensive Agents in Intracranial Hemorrhage Patients|| |
Abdulrahman Alshaya, Meshari Alghamdi, Sumaya Almuhareb
Background: Blood pressure variability (BPV) in patients with intracranial hemorrhage (ICH) is linked with an increased risk of mortality. Intravenous (IV) antihypertensive agents are commonly used to achieve sustained target blood pressure goals; however, this is not a feasible long-term option. The transition process of antihypertensive agents from IV to an enteral route is not well-established yet in patients with ICH. We aim to investigate the BPV of antihypertensive agents during the transition period from IV to enteral route in ICH patients.
Methods: This is a retrospective single-center study at a tertiary teaching hospital in Riyadh, Saudi Arabia. Data were extracted from electronic medical records after obtaining IRB approval. Patients were included if they were > 18 years old, admitted with spontaneous ICH, and had administered antihypertensive agents’ continuous infusion prior to transitioning to oral agents. The major outcome was average BPV on the first day after the transition. The minor outcome was the incidence of acute kidney injury (AKI) on day 7.
Results: We screened 175 patients, of which 36 patients were included. An aim of systolic blood pressure goal of <160 mmHg was documented for 91.5% of patients. Nicardipine was used in 69.4% and labetalol in 30.6% of patients. BPV after the transition was a median of 29 [IQR 34 - 63] mmHg, and AKI was documented in 25% of the included patients.
Conclusion: Our findings demonstrated high BPV during the transition period from intravenous to enteral antihypertensive agents for patients with ICH. Proper attention should be implemented to ensure a safe transition process. More data are needed to optimize BPV in ICH patients.
| Evaluation of Medication Renal Dose Adjustment in Hospitalized Intensive Care Unit (ICU) Patients with Chronic Kidney Disease (CKD); A Prospective Study|| |
Fares Goniman Almutairi, Abubker Omaer, Nora Almutairi
Background: With the increasing incidence of chronic kidney disease (CKD), appropriate medication dosing adjustment becomes important part of patient care. Inappropriate renal dose adjustment may lead to many adverse drug reactions (ADRs) as well as drug toxicity. Several studies have outlined various degrees of inappropriate renal dose adjustments by physicians while others investigated the magnitude of pharmacist’s involvement in this process, so we are assessing the appropriateness of renal dose adjustment by physicians in critically ill patients with CKD in ICU at King Saud Medical City (KSMC).
Method: This is a prospective observational study that included patients with CKD or those with unknown history of CKD but fits the following criteria: creatinine clearance (CrCl) less than 60 ml/min and receiving at least one medication that requires renal dosing adjustment. Kidney function was estimated from serum creatinine using Cockcroft-Gault equation, and dose appropriateness was determined by following the recommended dose adjustments in the respective medication monograph.
Result: A total of 93 patients with CKD were screened during the three-weeks study period, out of which 31 were included. A total of 78 orders were analyzed for these patients. Among these, 43 (55%) orders, corresponding to the majority, were adjusted adequately, 30 (38.5%) were adjusted inadequately, and 5 (6.4%) orders were not adjusted at all. Based on the different CKD categories, 34 (38 %) drug orders that required dose adjustment were prescribed to patients with stage 2 CKD, of which 13 (38%) were adjusted inadequately or not adjusted at all. Piperacillin/Tazobactam represented the highest medication (30%) for not being adjusted appropriately, followed by meropenem(28%)
Conclusion: We concluded that inappropriate renal dose adjustment was common in critically ill patients with CKD. Ensuring the appropriateness of medication orders in patients with CKD is necessary to avoid deleterious events in such patients.
| Impact of Pharmacists Led Anticoagulation Clinic Versus Physicians on Efficacy and Safety of Thromboembolic Disorder Management in Saudi Arabia Tertiary Care Hospital|| |
Morooj Abdullah Al-Muwallad, Amnah Mukhtar, Shroug Al-Harbi, Asmaa Alzubaidi, Aljohara Alzaydi, Mohammed Osailan
Background: Oral anticoagulants are the mainstay for the treatment and prevention of thromboembolic disorders. However, the safety and efficacy depend on optimal control and monitoring of anticoagulation therapy. Many studies assessed the role of pharmacists versus physicians in the management of anticoagulation clinics, which demonstrated improvement in clinical outcomes.
Methods: To examine the effectiveness and safety of pharmacists compared to the physician-led anticoagulation clinic. A single-center, retrospective cohort study was conducted on King Faisal Specialist Hospital and Research Center- Jeddah. All adult patients who attended the anticoagulation clinic between March 2018 and March 2020 on Warfarin, Apixaban, and Rivaroxaban were considered for the study.The primary endpoints include the percentage of INRs within the therapeutic range (%TTR) for warfarin therapy and the percentage of patients with appropriate DOAC therapy. The secondary endpoints include the percentage of time the INR in the range, major bleeding, or thrombosis events that lead to ER visits or hospital admission.
Results: A total of 264 patients were included. The percentage of TTR was 62 % for the pharmacist group and 70 % for the physician group (P = 0.073). The appropriateness of DOAC therapy, including appropriate indication, dose, and duration, was similar between the two groups (p = 0.527, p = 0.555, and p = 0.627). However, reporting of minor bleeding and drug interaction was significantly higher in the pharmacist group due to better documentation and use of standardizing notes (12.3 % vs. 2.7%, p< 0.001) and (30.6% vs. 12.2%, p = 0.004), respectively. In addition, more frequent visits characterized the pharmacist group compared with physicians (25.3% vs. 4.5%, p<0.001). As a result, the mean INR level less fluctuated in the pharmacist group.
Conclusion: The pharmacist-led anticoagulation clinic was as effective as the physician. However, the pharmacist has less INR fluctuated and better documentation with higher drug interaction and minor bleeding reporting.
| Novel Polymeric-Drug Delivery Systems for Reducing Paclitaxel-Associated Adverse Drug Events|| |
Cancer is the world’s second leading cause of mortality, after only cardiovascular illnesses. Chemotherapy is the most common treatment used against most types of tumors. Paclitaxel is among the highly researched medications that prevent cancer cell growth and proliferation. However, there are many challenges that limit the use of Paclitaxel, such as its poor aqueous solubility; thus it is delivered as a micellular formulation in Cremophor EL as a vehicle causes hypersensitivity reactions in many cases. This project studied a sample of 41-cancer patients who were treated with Cremophor EL-based Paclitaxel and developed adverse drug reactions in JHAH. The results of this study indicate the studied patients’ parameters, which are the patient weight, height, BMI, BSA and the serum creatine levels are insignificant factors in determining the Paclitaxel unit-dose Thus they cannot be considered as factors that we can modify to avoid Paclitaxel-associated adverse events. Other patients parameters, such as serum glucose levels and the number of chemotherapy cycle can be considered in future research.
| The Role of Clinical Pharmacist Intervention in CDTM to Improve Outcomes and Decrease Hospitalization in Heart Failure Clinic|| |
Sanaa S Mekdad, Leenah Alsayed
Background: Pharmacists play an important role in the Collaborative Drug Therapy Management (CDTM) in the care of patients with heart failure (HF). CDTM allows specialized, dedicated clinical pharmacists to engage in an agreement, formal collaborative practice with physicians.
Objectives: To study the role of cardiology clinical pharmacist in CDTM in decreasing hospitalization and cost.
Methods: We studied patients with left ventricular systolic dysfunction in a cluster-randomized selection in tertiary care center. We allocated 296 patients to pharmacist intervention from 1480 patients.
Results: We documented 696 interventions done by cardiology clinical pharmacists with average of intervention 2.4 per patient with acceptance rate of 86 %, admission after interventions was reduced from 0.79 to 0.24 (p value=0.001).
Conclusion: In heart failure CDTM, clinical pharmacists play an important role in improving medication management, patients ‘education and lifestyle modification of the patients which help in improving patients’ outcome and help in decreasing hospitalization.
| Clinical Neuropharmacology Cefepime-Induced Neurotoxicity in Medical Patients: A Retrospective Cohort Study|| |
Sarah Ibrahim AlAmer, Kathleen Blomquist, Fawaz M Alotaibi, Suliman Almohaish, Fatimah Fouad Al Doughan, Yazed Saleh Alsowaida, Ahmad Alamer, Abdulaziz Almulhim
Background: Cefepime is a broad-spectrum cephalosporin. Several studies reported the association of cefepime with neurotoxicity in renally impaired patients. The incidence of neurotoxicity in the intensive care setting is well documented. This study aimed to report the incidence of neurotoxicity in medically ill patients.
Methods: This was a retrospective study of medically ill patients treated with cefepime. Patients who received cefepime were screened for eligibility. Exclusion criteria was the following: Intensive Care Unit (ICU) admission, had Alzheimer’s disease, admission due to altered mental status due to any cause, or history of epilepsy. Naranjo adverse event scale was used to describe the probability of adverse events in the suspected cases was categorized into definite, probable, possible, and doubtful.
Results: A total of 601 patients were screened and 93 cases met inclusion criteria. The mean age (±SD) was 56 years (±17). Majority of patients were male (66%). Common comorbidities were hypertension (60%) and diabetes (40%). The cefepime mean (±SD) dose was 4 grams/day (±1.4) with a mean (±SD) duration of 4.8 days (±2.9). Only 2 patients (2.2%) developed neurological symptoms. After careful evaluation of the cases, one case was found to be a doubtful and another possible for cefepime-induced neurotoxicity on the Naranjo probability of adverse events scale
Conclusion: The incidence of neurotoxicity among medically ill patients was low. After careful examination of the suspected cases, the probability of the neurotoxicity related to cefepime was also low. Careful evaluation of other possible causes of neurological symptoms while on cefepime therapy is advised.
| Studying the Knowledge of Pharmacists toward Pharmacogenomic in Saudi Arabia|| |
Zahra Abdulathim Alhaddad, Hessa Almousa, Nancy S Younis
Background: Saudi Genome program is a pioneering national transformation initiative of Saudi Vision 2030. The program objectives are to reduce the incidence of genetic diseases in the kingdom, establish a genetic database, and document the first Saudi genetic map by sequencing the genome of Saudi population. Consequently, the program will establish the foundation for personalized medicine and genomic sciences in the Kingdom of Saudi Arabia. Pharmacogenomics is the study of how genes affect a person’s response to drugs. It is a relatively new field combines pharmacology and genomics to develop effective, safe medications and doses that will be tailored to a person’s genetic makeup. Applying pharmacogenomics education to the clinical practice is required for practitioners to develop personalized medicine.
Objective: To evaluate the knowledge of pharmacists toward pharmacogenomics in Saudi Arabia.
Methods: A cross-sectional study was conducted by using an online valid questioner. Pharmacists working in government, private, community pharmacists, and others who worked at pharmaceutical companies were participated.
Result: A total of 230 pharmacists were included in this study. 69% of the participants hadn’t any education or training in pharmacogenomics field. Furthermore, 80% of them didn’t apply pharmacogenomics in practice. However, there was a positive attitude toward general knowledge of pharmacogenomic. There were several barriers to pharmacogenomic in Saudi Arabia, 60% agreed that lack of education or training was the most barrier for the implementation of pharmacogenetic testing.
Conclusion: Most participants were aware and agreed about the importance of applying pharmacogenomics in practice. This study highlighted the need to introduce new courses and training workshops or seminars for pharmacists to improve the pharmacogenomic application in Saudi Arabia.
| Evaluation of the Antimicrobial Effect of Expired Oral Antibiotics In-Vitro|| |
Background: In spite of significant risks, as well as non-clinical importance due to loss of potency, stiff penalties against administration of expired antibiotics are still not appropriately enforced by health policy makers in many developing countries, possibly because of little evidence to support those expired medications are hazardous.
Objective: To investigate the effect of expiration dates on in vitro bacteriostatic potentials of different oral antibiotics.
Methods: The potency of five antibiotics, both expired and unexpired, Azithromycin, Clarithromycin, Levofloxacin and Cloxicillin, and Tetracycline were investigated, based on the antimicrobial potentials. The investigation was done by challenging local isolates of different concentrations of S. aureus bacteria, using Disc diffusion technique.
Results: Although the expired antibiotics potency was less than that of the control ones, it was found that the microorganisms challenged with these antibiotics were evaluated as susceptible (According to NCCLS), as the diameter of inhibition zone lies within the susceptible range. Shown the comparison of effectiveness between expired and unexpired Azithromycin against different bacteria Srcina sp., bacillus sp., staphylococci, salmonella sp, and M.phelei. The difference between the expired and control antibiotic is not significant with P value = 0.570.
| Prescribers’ Adherence to Darbepoetin Dosing Guideline at a Large Tertiary Hospital in Saudi Arabia: A Retrospective Chart Review Study|| |
Reem Qubaiban, Nora Almutairi, Sheraz Ali
Background: Anemia is one of the complications of Chronic Kidney Disease (CKD). Treatment of anemia of CKD is a step wise approach. ESAs, such as darbepoetin, decrease morbidity associated with anemia of CKD. However, they have major adverse events, especially if prescribers are non-adherent to international dosing guidelines. Since there is a paucity of data in Saudi Arabia regarding the prescribers’ adherence to darbepoetin dosing guideline, we aimed to assess their adherence to the international guidelines.
Methods: A retrospective chart review study that was conducted from January 2019 to January 2020 in the Nephrology Department. A sample size of 269 was estimated. Adult CKD patients were screened and patients who received darbepoetin in the mentioned period were included. Patients with no clear documentation were excluded. The data was collected from the patient files and organized on data collection sheet. Primary endpoint was prescriber’s adherence to dosing guideline which was assessed by comparing the current dose with Kidney Disease Improving Global Outcomes (KDIGO) guidelines dosing recommendations. Secondary endpoint was safety of darbepoetin.
Results: In this study, 269 patients were included. The majority of these patients were less then 65 years old (86.9%) and the distribution of male gender versus female was 48.3% and 51.7%, respectively. Prescribers’ adherence to KDIGO guideline was observed in 45% of the prescriptions. Moreover, dosing errors were more frequently observed in younger adults comparing with older adults, 56.2% versus 48.6%. On the other hand, dosing errors were equally observed between obese versus non-obese, dialysis versus non-dialysis, and male versus female. Indeed, among the total patients, 11.2 % of them observed to have at least one adverse event of darbepoetin.
Conclusion: Darbepoetin therapy is critical step in treatment of anemia of CKD. Although Prescribers’ adherence to KDIGO dosing guideline of darbepoetin is crucial, it is not optimal in Saudi Arabia.
| Psychoeconomic Impact of the Coronavirus Pandemic on the General Population in Saudi Arabia: A Cross-Sectional Study|| |
Amal Khaleel Abualhommos, Abdallah Y Naser, Loay khalil Abu Alhommous
Objective: We aimed to explore the psychological and economic impact of the COVID-19 pandemic and identify people at higher risk of being affected economically.
Methods: A cross-sectional study using an online survey was conducted in Saudi Arabia between 27 June and 27 September 2020. Logistic regression was conducted to identify people at higher risk of being affected economically by the COVID-19 pandemic.
Results: A total of 440 participants were involved in this study, of which, 57.0% reported that they have been affected economically by the pandemic. More than 11.0% of the participants reported that they feel abnormally anxious because of COVID-19 and around 18.0% reported feeling depressed or fearful because of COVID-19. Males were around twice (OR: 1.83; 95% CI: 1.24–2.72) as likely to be affected economically during the COVID-19 pandemic (p<0.01). Saudis were 59.0% less likely to be affected (OR: 0.41; 95% CI: 0.27–0.60; p<0.001).
Conclusion: The COVID-19 pandemic has affected the psychological and economic status of individuals in Saudi Arabia deeply. Decision-makers are advised to implement supporting strategies and programs to help the whole community cope with the pandemic. This will help prevent further psychological and economic deterioration in the long run and will accelerate societal recovery.
| Daptomycin Dosing in Hospitalized Obese Patients: Safety and Efficacy Comparison|| |
Sumaya Nasser Almohareb, Kateryna Yenina, Marilyn Means
Background: Dosing daptomycin using actual body weight (ABW) can be challenging, specifically with obese patients since that patient population was not well studied in clinical trials. Recently, there have been some controversies regarding daptomycin dosing and which weight should be used in this population. The purpose of this study was to compare the efficacy and safety outcomes in hospitalized obese patients who received daptomycin dosing based on ABW versus adjusted body weight (AdjBW).
Methods: A multicenter retrospective cohort study conducted in 24 hospitals in the United States. All hospital-admitted obese patients (BMI ≥ 30 kg/m) who received daptomycin between September 2016 to August 2019 were eligible for inclusion. The primary outcome was clinical failure. Secondary outcomes include microbiological success, 30-day readmission, in-hospital mortality, creatine phosphokinase (CPK) elevation, and incidence of myopathy and rhabdomyolysis.
Results: A total of 300 patients were included in this study; 274 patients in ABW group and 26 patients in AdjBW group. Clinical failure occurred in 20 patients (7.3%) in ABW group compared to no documented clinical failure in AdjBW group; however, the result was not statistically significant (p = 0.15). The two groups were similar in microbiological success (51.8% ABW versus 63.2% AdjBW, p = 0.28), in-hospital mortality (5.1% ABW versus 7.7% AdjBW, p = 0.58), and 30-day readmission (22.6% ABW versus 15.4% AdjBW, p = 0.42). The incidence of CPK elevation, rhabdomyolysis, and myopathy were documented only in ABW group, however the results were not statistically significant.
Conclusion: This study found no significant difference for efficacy outcomes when comparing using ABW versus AdjBW for daptomycin dosing. Although the results were not significant, AdjBW dosing was associated with a lower incidence of CPK elevation and rhabdomyolysis compared to ABW dosing.
| Evaluation of Analgesic Effect of Pomegranate Seed Oil in Experimental Animal|| |
Aldanah Abdulaziz Alsenani
Background: Plants produce bioactive compounds that have pharmacological and toxicological activity. Pomegranate is one of the oldest fruits used since ancient times in medicine.
Objective: To evaluate the analgesic activity of pomegranate seed oil in Albino mice and to compare the analgesic effect with standard drug diclofenac sodium.
Methods: The study was carried out in 20 albino mice divided into 4 groups each consisting of 5 mice. All the groups were administered the doses acutely by oral route as follows: group A normal saline 10 ml/kg, group B and C 250 & 500 mg/kg pomegranate seed oil and group D diclofenac sodium 10 mg/kg. The analgesic activity of seed oil was examined using hot plate method, and the latency for hind paw licking or jump response considered as indicator for pain. A cut off time 15 sec was noticed to avoid paws damage. The reaction time of animals on the hot plate maintained at 55°C was measured at 30, 60, 120 minutes.
Results: Pomegranate seed oil (250 mg and 500mg), showed statistically significant increase in reaction time (p<0.05) at all time intervals when compared to control and diclofenac group (at 30 and 60min). moreover, diclofenac sodium and the pomegranate seed oil 500mg showed nearly the same significant increase in reaction time compared to pomegranate seed oil 250mg (13.66±1.06, 13.7±2.17 vs 10.3±1.08) after 120 minutes.
Conclusion: From the results we concluded that pomegranate seed oil possesses analgesic properties. However, further studies are needed to determine the active component responsible for this effect.
| Respiratory Tract Infections (RTI) in Non-Neutropenic Fever (NNF) Children with Cancer Lessons from Identified Cases during Mass Religious Gathering and Influenza Seasons|| |
Aeshah Abdu Mubarak AlAzmi, Wasil Jastaniah, Mona AlDabbagh, Naglla Elimam, Mohammed AlHindi, Mohammed Aseeri
Background: None of the existing reports address respiratory tract illness (RTIs) in children with non-neutropenic fever (NNF) who present during the religious mass gatherings seasons (Hajj, Ramadan) especially if coincidence with influenza season, hence the treatment approach of such cases may not be applicable as in the normal season.
Method: Retrospective analysis of RTI in NNF children who were presented during mass religious gathering seasons and/or flu season and treated for malignancy at princess Noorah Oncology Center from May 01, 2016, through December 2017.
Results: A total of 4599 spikes of fever were identified in 124 non-neutropenic children in whom 455 Spikes (9.9%, 455 out of 4599) were documented during the mass religious gatherings and/or flu season. NNF secondary to RTIs was documented in 59.7% of patients during the study seasons with a total of 245 fever spikes recorded. Ceftriaxone-based therapy was the main treatment approach for NNF including the RTI cases that were associated with 50% of subsequent hospitalization for further management. Among all the examined risk factors, prolonged fever of more than three days was significantly associated with NNF secondary to RTI during mass religious gathering if coincident with flu season, OR=0.034 [95% CI, 0.013 - 0.09] P-value <0.001.
Conclusion: The present study showed that the rate of RTI in NNF children is increased during periods of mass gathering. There is a need for national consensus to address NNF management during mass religious gatherings particularly if coincident with flu season.
| Tele-Health Implementation during COVID19 Pandemic on Liver Transplant Population: A Focus on Medication Adherence, Patient Satisfaction, and Cost Impact|| |
Mohammed Farooq Janjua, Hala Joharji, Saleh Alqahtani, Saad Alghamdi, Ahmed Aljedai, Dema Alissa, Jumana Khader, Delal Alkortas, Zinah Alabdulkarim, Aziza Ajlan, Dieter Broering
Background: The COVID-19 pandemic affected many aspects of health care, including the provision of care in ambulatory care clinics, necessitating the utilization of telehealth. In our hospital, we implemented phone clinics to ease the access to health care for liver transplant patients. This study aims to assess the impact of phone clinics on patients’ perception, adherence to medication, and potential cost reduction.
Methods: This prospective observational study utilized validated questionnaires: the telehealth usability questionnaire (TUQ) and Morisky medication adherence scale (MMAS-8), to assess patients’ perception of telehealth and medication adherence, respectively. We included all liver transplant patients who received their care through phone clinics from June 1st, 2020, to December 31st, 2020.
Results: We had 422 patients served through phone clinics; 416 met the inclusion criteria. The majority of patients were males (61.5%), lived outside Riyadh (63%), used 5-10 medications per day (71%), and were above the age of 60 years (43.7%). The average overall adherence scale was 7.2 (0.91 SD), where 94.5% scored to have medium adherence (score of 6-8), followed by 5.5% with low adherence, while no one had high adherence score. Patients’ perception scores average toward the utilization of phone clinic were: 1.5 (0.76 SD) for the usefulness of telehealth, 1.4 (0.7 SD) for the ease of use and learnability, 1.54 (0.8 SD) for the interface quality, 1.45 (0.8 SD) for the interaction quality, 2.07 (1.17 SD) for the reliability, and 1.59 (0.88 SD) for satisfaction and future use. The estimated average direct out-of-pocket cost savings per patient was 703 SAR (187 USD) per person, with a total reduction of 292,630 SAR (78,033 USD) in all served patients.
Conclusion: Our results show that the utilization of phone clinics in the liver transplant settings was associated with a high satisfaction rate among the served patients with a medium score of medication adherence and potential cost reduction impact.
| Perception of Safety and Efficacy of COVID 19 Vaccine among the Community of Eastern Province, Saudi Arabia|| |
Anhar Mohammed Almohsin, Mohammad Daud Ali, Lojain Adel Alhammad, Razan Yasser Aloush, Nuzhat Banu, Ayaz Ahmad, Yousif Amin Hassan
Background: The current study has been conducted to assess the perception towards safety and efficacy of COVID-19 vaccine among the community of the eastern province, Saudi Arabia.
Methods: A descriptive, cross-sectional Web based survey has been conducted for a period of two months from February to March 2021. A pre-tested self-administered questionnaire was used for data collections. Questionnaire link of survey disseminated through the social media among convenient number of populations in the community of Eastern province, Saudi Arabia.
Results: Our research included 1243 participants in the purpose of Knowledge, Attitude, and perception among the population of Eastern Province, Saudi Arabia. 697(56.07%) are female and 546 (43.93%) are male. 760(61.14%,P = 0.0) have a positive attitude that a pandemic of coronavirus disease is about to end because vaccination started in Saudi Arabia, and it is therapeutically about 95% effective. 678(54.54%,P = 0.0) respondents have a positive attitude towards effectiveness and safety results of vaccine tested in clinical trial and reported to regulatory authority. 853(68.62%,P = 0.0) respondents also knows that after successful clinical trial coronavirus vaccine approved by the world health organization and ministry of health, Saudi Arabia. 876(70.47%,P = 0.0) respondents are knowledgeable about common adverse drug reaction of coronavirus vaccines are mild like fatigue, headache, muscle pain, skin rashes. 1039(83.59%,P = 0.0) respondents agree that there are no specific drugs for COVID-19 treatment rather vaccines are available for prophylaxis. 828 (69.34%,P = 0.0) respondents agree that existing vaccine is medically suitable, effective, safe, and arrived in the kingdom on the right time. 940(75.62%.P = 0.0) believe that the cases of COVID-19 become zero by the application of coronavirus vaccine.
Conclusion: Our study showed most of the eastern province population in Saudi Arabia is, knowledgeable, and has a positive perception about the COVID-19 vaccine. Motivation and education of the community by healthcare providers to help persuade the public towards prompt vaccination is the necessity of the hour.
| Parkinson’s Symptoms Worsening with Antidiabetic Medications: A Case Study|| |
Ghaida Abdullah Aldajani, Abdulaziz M Alhossan
Background: Parkinson’s disease (PD) is one of the most prevalent neurologic disorders, leading to progressive disability, It is characterized by tremors, slow movements, stiffness in arms and legs, and balance impairment, PD symptoms can be slowed but not stopped by treatment such as Sinemet which is a combination of Carbidopa/Levodopa. Although it’s widely used for PD, it carries a risk of dysarthria, orthostatic hypotension, and dizziness. The prevalence of PD in Saudi Arabia has been estimated to be 27 per 100,000 population.
Case presentation: A 61-year-old male presented with worsening dysarthria symptom, he had a history of diabetes with A1c of 8.5%, on metformin, insulin glargine, liraglutide, and linagliptin, with good adherence, and he had a history of Parkinson on sinemet. Even there’s no known drug-drug interactions between antidiabetic medication and sinemet, he reported that coadministration of antidiabetic medications with sinemet cause dysarthria worsening, association of the dysarthria worsening noticed when patient tried to stop all of his antidiabetic medication except insulin mixtard, then dysarthria symptom improved. He is currently on insulin mixtard for diabetes with A1C of 6.7%.
Conclusion: Unintentional drug-drug interaction poses a challenge to healthcare provider, so this report highlights the importance of adverse drug-drug interaction of metformin with sinemet, its presentation, and management.
| Fasting during Ramadan and Acute Kidney Injury: What Is the Association?|| |
Maryam altukhaim, Numan Alabdan, Norah Alshuraym, Shahad Al ghoson, Hazza Al Otaibi
Background: Acute Kidney Injury (AKI) is associated with adverse clinical outcomes as well as increase health care expenditure. Although, fasting Ramadan may affect kidney function, there is no study assess the association between fasting Ramadan and AKI. Therefore, the purpose of this study is to assess the effect of fasting Ramadan month on admission to the hospital with a diagnosis of AKI.
Method: A case control study used that included adult patients who were admitted to the hospital during Ramadan (R) and none Ramadan (NR) month with a diagnosis of AKI. Risk factors for AKI were compared between the AKI and non-AKI groups. We included patients who develop AKI and excluded cancer patients on active treatment, patients without baseline serum creatinine, and elective admissions. The Chi Square test was used to evaluate nominal data and logistic regression analysis was used to examine the correlation between fasting Ramadan and risk factors. The study was approved by IRB at King Abdullah International Medical Research Center.
Results: 1199 patients included and after matching controls with cases we had 998 patients. Among matched cohorts we had 50% admitted patient during R with age 49.6 ± 20.5, 48.5% female with 37.7% charlson comorbidity index (CCI) >4 versus NR with age 50.4 ± 22, 44.5% female with 37.7% CCI >4. After matching controls with cases, we had non-statistical differences for all AKI risk factor of interest except Serum Creatinine (SCr) at baseline R 35.1% vs NR 38.9% p0.037, Proton-pump inhibitors R 33.5% vs NR 43.7% p < 0.001, Angiotensin-receptor blockers R 5.6% vs 36.7% p < 0.001, Diuretics R 13.4% vs NR 18.4% p 0.030, Angiotensin-converting-enzyme inhibitors R 3.6% vs NR 14.6% p < 0.001, and nonsteroidal anti-inflammatory-drugs R 5.0% vs NR 14.4% p < 0.001. The adjusted odds ratio for factors associated with AKI were CCI>4 (AOR = 2.55, 95%CI 1.40–4.64) and history of AKI (AOR = 4.08, 95%CI 2.68–6.22), however fasting Ramadan (AOR = 0.61, 95%CI 0.40–0.92) was not risk factor.
Conclusions: Fasting Ramadan may be associated with a protective effect against AKI however patients who have CCI>4 or history of AKI were associated with high risk of AKI during Ramadan.
| Ceftazidime-Avibactam Versus Colistin in the Treatment of Infections Due to Carbapenem-Resistant Enterobacterales: A Retrospective Cohort Study|| |
Leen Ghenem, Thamer A Almangour, Alya Alruwaili, Nader Damfu, Mohammed Al Musawa, Mesfer Almalki, Majda Alattas, Hossam Abed, Doaa Naeem, Nawaf Almalki, Abdullah Alhifany
Background: The aim of this study was to compare the safety and effectiveness of Ceftazidime-Avibactam (CAZ-AVI) to colistin-based regimen in treating infections caused by Carbapenem-Resistant Enterobacterales (CRE).
Methods: This was a retrospective, observational cohort study of inpatients who received either CAZ-AVI or intravenous colistin for the treatment of infections due to CRE. The study was conducted in 5 tertiary care hospitals in Saudi Arabia. Eligible patients were hospitalized adults, aged ≥ 18 years, who developed infection due to CRE and treated with either antibiotic. Primary endpoints included in-hospital mortality and clinical cure at end of treatment. Secondary endpoints included acute kidney injury (AKI), microbiologic eradication, 30-day readmission, 30 and 90-day recurrence, length of stay, and duration of mechanical ventilation. Univariate analysis and multivariate logistic regression model were conducted using STATA 15.1 (StataCorp LP, College Station, Texas, USA). Ethical approvals had been granted.
Results: A total of 230 patients were included in this study: 149 patients received CAZ-AVI, and 81 patients received colistin-based regimen. Demographics and baseline characteristics were comparable between the two groups. Clinical cure (71% vs 52%; P = 0.004; OR, 2.29; 95% CI, 1.31–4.01) was significantly more common in patients who received CAZ-AVI. After adjusting the difference between the two groups, treatment with CAZ-AVI is independently associated with clinical cure (adjusted OR, 2.56; 95% CI, 1.21-5.42). In-hospital mortality (35% vs 44%; P = 0.156; OR, 0.67; 95% CI, 0.39-1.16) was lower in patients who received CAZ-AVI, but the difference was not significant. AKI (15% vs 33%; P = 0.002; OR, 0.37; 95% CI, 0.19-0.69) was significantly less common in patients who received CAZ-AVI. Differences between the 2 groups in all other outcomes were not statistically significant.
Conclusion: Our findings support the preferential use of CAZ-AVI over colistin-based regimen for treatment of infections caused by CRE.
| Antimicrobial Stewardship Measures and Quality Improvement During COVID-19 and the Role of Pharmacist|| |
Rasha Abdelsalam Elshenawy, Zoe Aslanpour, Nkiruka Umaru
Background: In 2016 the UK report, antimicrobial resistance (AMR) could cause 10 million deaths a year by 2050. Antimicrobial stewardship (AMS) is a set of actions promote the effective use of the antimicrobials. Interventions (“strategies”) used to improve antibiotics. The COVID-19 pandemics accelerate the threat of AMR. Due to the increased ‘just in case’ prescribing of antimicrobials, the WHO argues AMS implementation. This study aims to investigate the effectiveness of AMS strategies in acute-care hospitals generally and during the COVID-19 pandemics.
Methods: This systematic literature search was conducted from 2007 to March 2021 from different databases using PRISMA 2020 flowchart. The Inclusion Criteria are (i) targeting use of antibiotics; (ii) AMS strategies in acute-care settings. The Exclusion Criteria are (i) non-HCPs; (ii) AMS in other settings.
Results: In this systematic review, the search retrieved 8,763 unique citations, 16 studies were included. Defined Daily Dose (DDD) and Day of Therapy (DOT) are among the most effective measures for antimicrobial stewardship implementation during COVID-19, they are found in 75% (12 of 16 studies). Quality improvement projects that use the specific tests such as procalcitonin test pandemics and interdisciplinary rounds used effectively during the COVID-19. Among AMS strategies, the UK Public Health England (PHE) Fingertip’s database reporting system among hospitals in the UK as a local and national indicator. AMS was led by 33% of the pharmacists as a champion for AMS implementation strategies, such as clinical guidelines in 50% of study results, prospective audit with feedback (30%), formulary restrictions (30%), AMS education (50%) and multidisciplinary team (50%) during the COVID-19 pandemics.
Conclusion: There may be lessons learned from pandemics. The use of measurable strategies promotes the AMS effective implementation during the pandemics. The pharmacists are the drug expert and have shown a great AMS contributions during the pandemics - COVID-19.
| Evaluation of Adherence to Treatment and Causes of Non-Adherence among Diabetic Patients in Eastern Province, Saudi Arabia: A Cross Sectional Study|| |
Batool Al Salem, Sahar Ibrahim
Background: Diabetes (DM) is one of the most common diseases worldwide. Not only diabetes but also its complications affect patients’ quality of life and life span. There is no cure for most people with diabetes. However, optimal drug regimen and patient adherence to it is essential to improve patients’ symptoms and reduce complications related to DM. The aim of this study is to assess diabetic patients’ adherence to their medications and reasons behind non-adherence because adherence is necessary to have controlled glycemic parameters, improve quality of life, and prevent diabetic complications.
Objectives: evaluating diabetic patients’ adherence to their medications and establishing reasons for patients’ non-adherence.
Methods: A cross sectional study through an electronic survey was conducted to measure patients’ adherence and rationales for non-adherence.
Results: one-hundred thirty diabetics completed the survey. Males were composed (59.2%) of the participants and the rest were females. Most patients stated that they adhere to their medications. This is supported by (87.14%) of patients who included in the study were adherent to their follow up schedule. Also, (55.38 %) had never reduced their medication frequency. Moreover, (66.15%) had never decided to stop antidiabetics medication. Ninety percent of patients were educated about diabetes and its treatment by either themselves, health care providers, or educational courses. This may explain that (56.92%) of patients knew optimal HbA1c. Some of patients were not adherent to their medications due to several reasons, including forgetting, medications’ side effects, disappearing of uncontrolled diabetes symptoms, or having controlled glycemic measures.
Conclusion: Most of diabetics in Eastern Region, Saudi Arabia who entered the study were adherent to their medications and free of diabetes’ complications. However, some of participants were not adherent due to multiple causes. One way to increase patients’ adherence is increasing awareness from health care facility.
| The Prevalence of Metformin Uses for Type 2 Diabetes Mellitus Prevention. A Retrospective Study in Saudi Arabia|| |
Abdulhadi Alshammari, Osamah Alfayez, Omar Almohammed, Majed Al Yami
Objective: The goal of our study was to estimate the proportion of patients with prediabetes that were prescribed metformin in accordance with the clinical practice guidelines.
Methods: A retrospective study was conducted using data from medical records for patients that were followed in three tertiary care hospitals in Saudi Arabia between January 2015 and June 2019. Patients were eligible for inclusion if they had diagnosed prediabetes (A1C of 5.7% to 6.4%) or history of gestational diabetes, age 20 to 70 years and a body mass index (BMI) over 25. Descriptive statistics such as mean and standard deviation for continuous data, as well as frequency and percentages for categorical variables were used. All statistical analyses were performed using STATA software.
Results: A total of 256 patients with prediabetes were included in this study. A total of 13 patients (5.1%) had a history of gestational diabetes. A total of 93 patients (36.3%) had dyslipidemia and 56.2% of patients taking metformin for T2DM prevention were on statins therapy. Regarding the primary outcome, metformin found to be used in 16 patients (6.3%) with prediabetes.
Conclusion: The finding of our study showed that the prescription of metformin was under used for the prevention of T2DM despite the existing evidence supporting the use of metformin in the addition to lifestyle modification for diabetes delay and prevention.