Appraisal of antimicrobial prescribing practices of governmental and non-governmental dentists for hospitals in the western region of Saudi Arabia

To scrutinize the knowledge, attitude, and antimicrobial practices in Saudi Arabian Dentistry. In this cross-sectional survey of dentists, a self-administered questionnaire comprising of 61 questions was dispersed to the participants randomly, which included their professional profile, awareness of the current scope of antimicrobial resistance, prescribing practice, frequency of antimicrobial prescription, and sources of continuing education of antimicrobials. The study took place in the Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia between February and April 2013. Knowledge and awareness concerning specific antimicrobials, with specific oral cavity lesion was 78% for the students and interns, 80% for residents, and 95.3% for specialists. Approximately 89% of the students, interns and residents, and 98.4% of the specialists endorsed indiscriminate use of antibiotics. In addition, 93.4% of students, 90% of interns and residents, and 90.6% of specialists agreed that lack of health education is one of the contributors to overuse of antimicrobials. Moreover, 91.9% of the interns, 80% of residents, and 75.5% of specialists preferred amoxicillin + clavulanate as their first choice; however, a wide variation in the dosage frequency, and duration was observed. Participants are well aware of the significance of antimicrobial resistance, and considered that judicious use of antimicrobials is highly imperative to restrain this fiery predicament. Divergence was demonstrated between specialists and residents in prescribing practices. Institutional antimicrobial guideline was not interesting to all the respondents. This highlights the need for incessant instructive intervention in order to accomplish the prime objective of retreating antimicrobial resistance

Pharmacokinetics of theophylline in preterm neonates during the first month of life

The present work aimed to estimate the theophylline pharmacokinetic parameters [TH-PKP] in preterm neonates with apnea during the first month of life in order to optimize its dosage regimen. Fifty preterm neonates enrolled in the study with recurrent apnea were admitted during 1998-2000 to the Neonatal Intensive Care Unit of Maternity and Children's Hospital, Al-Mosaida, Jeddah, Kingdom of Saudi Arabia. Criteria for this study were preterm with gestational age [GA] of 26-33 weeks [mean +/- SD 30 +/- 3.9]. They received TH of 3-6 mg/kg loading dose [LD] followed by maintenance dose [MD] of 0.5 - 3.0 mg/kg/12 hours. Eight of these patients received phenobarbital and 19 received cimetidine concomitantly for at least 7 days. Blood samples were taken one hour post LD and at steady state [Css]. Theophylline levels were determined by fluorescence polarization immunoassay. Phenobarbital significantly enhanced TH clearance [CL] and reduced its half-life [t0.5] but cimetidine had no significant effect. Excluding patients receiving phenobarbital. The mean +/- SD TH-PKP were volume of distribution [Vd] = 0.77 +/- 0.25 L/kg; elimination rate constant [Ke] = 0.027 +/- 0.011 h-1; CL = 0.019 +/- 0.006 L/h/kg, t0.5 = 30.7 +/- 12.1. There was marked intra patient variability in all TH-PKP. In view of the results and practical considerations, initial dosage regimen to attain a TH Css level within the therapeutic range [6-12 ug/ml] was suggested: LD 6-7 mg/kg, MD 1.5 - 2.0 mg/kg/12 hours. To compensate for maturation changes or drug interaction, a method, based on estimation of individual TH CL, was described for adjusting MD

evaluation of theophylline dosing. suggested by the Saudi national protocol for children with severe asthma

To evaluate the impact of Saudi national protocol on the diagnosis and management of asthma for optimizing theophylline use in children with severe asthma. To also review theophylline clearance and provide guidelines for individualization of doses. Theophylline level was estimated in blood samples of 66 children with severe asthma who were admitted to King Abdulaziz University Hospital during the period 1998-1999. The theophylline doses given to these patients was reviewed and patients were categorized into 2 groups: Group one had received doses recommended by Saudi national protocol +/- 10%, group 2 had received doses <90% of that recommended by Saudi national protocol. The distribution of theophylline levels in blood samples of each group was estimated. Theophylline steady state level was used to estimate theophylline clearance using a standard pharmacokinetic equation. Out of the total samples from group one, 70% of theophylline levels were within therapeutic range, while only 10% of the total samples of group 2 were within therapeutic range. The mean theophylline clearance in children [1-8 years] was estimated as 0.092 +/- 0.023 and was found significantly higher than the mean theophylline clearance [0.069 +/- 0.014] which is observed in older children [9-13 years]. Saudi national protocol theophylline dose guidelines had a favorable impact on the optimization of theophylline use in children with severe asthma. Guidelines that ensure accurate adjustment of doses on individual basis in view of drug level were suggested

Histological and manometric studies of the external anal sphincter before and after excision of the internal anal sphincter in dogs

The histologic changes in the external anal sphincter after internal sphincter excision were studied in 20 dogs. An external sphincter biopsy was taken before internal sphincterotomy, 2 weeks and monthly thereafter for 10 months. The excised material was studied microscopically after being stained with hematoxylin-eosin and Verhoeff-Van Gieson's stains. A manometric record of the anal pressure before and after excision of the internal sphincter was also done. 70% of external sphincter specimens before internal sphincter excision showed smooth muscle fibers scattered between the striated fibers. These smooth fibers could be responsible for the resting tone of the external sphincter. After internal sphincter excision, characteristic histologic changes could be identified in the external sphincter. From the 2nd week to the 5th month post-excision, the external sphincter showed degenerative and hypertrophic changes. From the 6th to the 10 month, there was a regeneration of the striated muscle fibers and an increase in the number of smooth muscle fibers, so that the 10th month a "compound muscle" of mainly smooth and scanty striated muscle fibers was identified. Theories were put forward to explain the smooth muscle preponderance in the external sphincter after internal sphincter excision. The increased non-striated element in the external sphincter seems to be a structural-functional adaptation, so that the external sphincter takes on the involuntary function of the excised muscle. Results of the manometric study showed that the mean anal pressure before excision was 78 cm H20. Two weeks after excision, there was a rapid drop of the anal pressure. This was followed by a rapid rise of the pressure till the 5th month, then slow rise up to 69 cm H20 in the 10th month