Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia

The objective of this study is to determine the outcome of pulmonary embolism [PE] and the clinico-radiological predictors of mortality in a university hospital setting. A Prospective observational study conducted at King Khalid University Hospital, Riyadh Saudi Arabia between January 2009 and 2012. A total of 105 consecutive patients [49.9 +/- 18.7 years] with PE diagnosed by computed tomography pulmonary angiography were followed until death or hospital discharge. Overall in hospital mortality rate was 8.6%, which is lower than other international reports. Two-thirds of patients developed PE during the hospitalization. The most common risk factors were surgery [35.2%], obesity [34.3%] and immobility [30.5%]. The localization of the embolus was central in 32.4%, lobar in 19% and distal in 48.6%. A total of 26 patients [25%] had evidence of right ventricular strain and 14 [13.3%] were hypotensive. Multivariate analysis revealed that heart failure [Beta = -0.53, P< 0.001], palpitation [Beta = -0.24, P= 0.014] and high respiratory rate [Beta = 0.211, P < 0.036] were significant predictors of mortality. There was no significant difference in the localization of the embolus or obstruction score between survivors and non-survivors. The outcome of PE is improving; however, it remains an important risk factor for mortality in hospitalized patients. Congestive heart failure, tachypnea and tachycardia at presentation were associated with higher mortality. These factors need to be considered for risk stratification and management decisions of PE patients. Radiological quantification of clot burden was not a predictor of death

Knowledge on adherence and safety of the oral contraceptive pill in Saudi women

To assess knowledge regarding adherence and safety of oral contraceptive pills [OCP] in Saudi women. We conducted a cross-sectional prospective study in an outpatient pharmacy at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from April to September 2011. Participants were healthy women aged >/= 18 years with an OCP prescription for contraception. We used a validated questionnaire to assess their knowledge regarding adherence and safety of OCPs. Four hundred and sixty women participated. Most [79%] knew to take an extra pill if they missed one in less than 12 hours, but only 6.5% knew they also had to use extra protection for the next 7 days if it was more than 12 hours. Multiple logistic regression analyses indicated that years of contraceptive use and educational level are predictive factors of better knowledge regarding adherence. Few were aware of the action if they experienced diarrhea for more than 12 hours [10%] or vomiting within 2 hours [13.5%] of taking an OCP. Only 30% knew of the adverse effects of smoking while on OCPs. Weight gain [51%] was the most commonly reported side effect. Most Saudi women taking OCPs have limited knowledge of its correct use regarding missing pills, vomiting and diarrhea, and poor awareness of the effects of smoking while using OCPs.

Pattern of intravenous proton pump inhibitors use in ICU and Non-ICU setting: a prospective observational study

The use of intravenous acid-suppressive therapy for stress ulcer prophylaxis in critically ill patients with specific risk factors has been recommended for over a decade. However, there is a lack of supporting data regarding the extension of such therapy to non-critically ill patients [non-ICU]. The aim of this study was to compare appropriate indications with current practicing patterns in adult non-ICU and ICU patients, contributing factors and financial impact of inappropriate use. A prospective cross-sectional study was carried out at a tertiary teaching Hospital in Riyadh, Saudi Arabia. For a period of 4 consecutive months, all hospitalized patients on IV PPI, aged 18 and above, were identified. A concise listing of indications considered appropriate for the use of IV PPI was pre-defined based on material from available literature and guidelines. A total of 255 patients received IV PPI. Inappropriate use of IV PPI was significantly higher in non-ICU [71.7%] than in ICU [19.8%] patients [P=0.01]. The most common cause for inappropriate use in non-ICU patients was stress ulcer prophylaxis [SUP]. In ICU patients, appropriate indicators for IV PPI were SUP [47.9%], PUD [11.5%], and the UGIB [20.8%]. There was a high association between appropriate uses of IV PPI with respect to endoscopic procedure and also between appropriate uses of IV PPI to subsequent discharge with oral PPI in non-ICU patients. The total estimated direct cost [drug acquisition cost] for inappropriate use of IV PPI during the study period was 11,000 US dollars. Inappropriate IV PPI utilization was predominant in non-ICU patients, mostly for stress ulcer prophylaxis that leads to a waste of resources. Applying appropriate policies, procedures and evidence-based guidelines, educated physicians and surgeons can clearly limit inappropriate IV PPI use

Erythema multiforme under the treatment with amoxicillin/clavulanate: a case report and review of the literature

To report a case of Erythema Multiforme [EM] in a boy who was treated with oral Amoxicillin/Clavulanate for upper respiratory infection. A 14-years-old boy with upper respiratory infection was treated with amoxicillin/calvulanate 625 milligram every eight hours for a week for his symptoms. Four days later, he developed erythematous rash all over the body plus genital lesion, and mouth ulceration. The skin biopsies confirmed Erythema Multiforme [EM]. The drug was immediately stopped and he was given a corticosteroid orally and supportive therapy for his symptoms. Within a few days, his skin and mouth lesions were dramatically improved and he was discharged on prednisone tapering dose for additional ten days. Erythema multiforme [EM] is an acute mucocutaneous hypersensitivity reaction that occurs in response to certain types of drugs, chemicals or infections. The severity of the skin lesions is variable. A Medline search from 1984 to October 2007 revealed only five cases of amoxicillin/clavulanate induced EM. The Naranjo algorithm score was 4 for EM in our patient, representing a possible relationship of amoxicillin/clavulanate treatment. We described the case of a 14-year-old boy who developed EM while on amoxicillin/clavulanate. The patient completely recovered after stopping the offending drug and treated with oral prednisone and supportive therapy