An Assessment of the Knowledge, Perception, and Willingness to Use Telepharmacy Services Among the General Public in the Kingdom of Saudi Arabia.

Background and objective At the height of the coronavirus disease 2019 (COVID-19) pandemic, numerous strategies were introduced by the authorities to contain the spread of the virus, which significantly affected people's lives and impeded their mobility. As the general public was unable to leave their dwellings, many digitalized pharmacist-led services were initiated to meet the public's needs for pharmaceutical care. The aim of this study was to ascertain the knowledge, perception, and willingness to utilize telepharmacy services and the determinants associated with these services among the general public in the Kingdom of Saudi Arabia (KSA). Methodology A cross-sectional survey involving participants recruited from the Saudi general public was conducted by using a validated questionnaire. We collected information regarding participants' demographics, as well as knowledge, perception, and willingness toward telepharmacy. The results were analyzed via descriptive statistics. The Mann-Whitney U Test was applied to assess the associations between knowledge, perception, willingness, and demographic variables regarding the utilization of telepharmacy services. Results A total of 273 Saudi citizens participated in the study; 71% (n=193) of them were aware of telepharmacy services. Many respondents showed a positive perception towards telepharmacy services and 83% (n=227) of the total participants showed their willingness to use telepharmacy services in the future. A significant association was identified between education, gender, and the knowledge of the participants regarding telepharmacy services. The demographic characteristics such as age, gender, and education, were not associated with the participants' perception regarding telepharmacy services. However, gender was significantly associated with the willingness to use telepharmacy services in the future. Conclusions Many participants had a fair knowledge and positive perception of telepharmacy services. More than two-thirds of the participants showed their willingness to utilize telepharmacy services in the future. However, further measures should be implemented involving strategies to increase the knowledge about telepharmacy by targeting the less educated among the Saudi population and those with limited access to technology.

A comparison of three thromboprophylaxis regimens in critically ill COVID-19 patients: An analysis of real-world data.

Introduction: Thrombotic complications of coronavirus disease 2019 (COVID-19) have received considerable attention. Although numerous conflicting findings have compared escalated thromboprophylaxis doses with a standard dose to prevent thrombosis, there is a paucity of literature comparing clinical outcomes in three different anticoagulation dosing regimens. Thus, we investigated the effectiveness and safety profiles of standard, intermediate, and high-anti-coagulation dosing strategies in COVID-19 critically ill patients. Methodology: This retrospective multicenter cohort study of intensive care unit (ICU) patients from the period of April 2020 to August 2021 in four Saudi Arabian centers. Inclusion criteria were age ≥ 18 years, diagnosis with severe or critical COVID-19 infection, and receiving prophylactic anticoagulant dose within 24-48 h of ICU admission. The primary endpoint was a composite of thrombotic events, with mortality rate and minor or major bleeding serving as secondary endpoints. We applied survival analyses with a matching weights procedure to control for confounding variables in the three arms. Results: A total of 811 patient records were reviewed, with 551 (standard-dose = 192, intermediate-dose = 180, and high-dose = 179) included in the analysis. After using weights matching, we found that the standard-dose group was not associated with an increase in the composite thrombotic events endpoint when compared to the intermediate-dose group {19.8 vs. 25%; adjusted hazard ratio (aHR) =1.46, [95% confidence of interval (CI), 0.94-2.26]} or when compared to high-dose group [19.8 vs. 24%; aHR = 1.22 (95% CI, 0.88-1.72)]. Also, there were no statistically significant differences in overall in-hospital mortality between the standard-dose and the intermediate-dose group [51 vs. 53.4%; aHR = 1.4 (95% CI, 0.88-2.33)] or standard-dose and high-dose group [51 vs. 61.1%; aHR = 1.3 (95% CI, 0.83-2.20)]. Moreover, the risk of major bleeding was comparable in all three groups [standard vs. intermediate: 4.8 vs. 2.8%; aHR = 0.8 (95% CI, 0.23-2.74); standard vs. high: 4.8 vs. 9%; aHR = 2.1 (95% CI, 0.79-5.80)]. However, intermediate-dose and high-dose were both associated with an increase in minor bleeding incidence with aHR = 2.9 (95% CI, 1.26-6.80) and aHR = 3.9 (95% CI, 1.73-8.76), respectively. Conclusion: Among COVID-19 patients admitted to the ICU, the three dosing regimens did not significantly affect the composite of thrombotic events and mortality. Compared with the standard-dose regimen, intermediate and high-dosing thromboprophylaxis were associated with a higher risk of minor but not major bleeding. Thus, these data recommend a standard dose as the preferred regimen.

Tocilizumab effectiveness in mechanically ventilated COVID-19 patients (T-MVC-19 Study): a multicenter real-world evidence.

BACKGROUND: This study aimed to evaluate the effectiveness of tocilizumab in mechanically ventilated patients with coronavirus disease 2019 (COVID-19). RESEARCH DESIGN AND METHODS: This retrospective multicenter study included adults (≥18 years) diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time polymerase chain reaction (RT-PCR) from nasopharyngeal swab, and requiring invasive mechanical ventilation during admission. Survival analyses with inverse propensity score treatment weighting (IPTW) and propensity score matching (PSM) were conducted. To account for immortal bias, we used Cox proportional modeling with time-dependent covariance. Competing risk analysis was performed for the extubation endpoint. RESULTS: A total of 556 (tocilizumab = 193, control = 363) patients were included. Males constituted the majority of the participants (69.2% in tocilizumab arm,74.1% in control arm). Tocilizumab was not associated with a reduction in mortality with hazard ratio [(HR) = 0.82,95% confidence interval (95%CI): 0.62-1.10] in the Inverse propensity score weighting (IPTW) analysis and (HR = 0.86,95% CI: 0.64-1.16) in the PSM analysis. However, tocilizumab was associated with an increased rate of extubation (33.6%) compared to the control arm (11.9%); subdistributional hazards (SHR) = 3.1, 95% CI: 1.86-5.16). CONCLUSIONS: Although tocilizumab was not found to be effective in reducing mortality, extubation rate while on mechanical ventilation was higher among tocilizumab treated group.

Celecoxib-Loaded Solid Lipid Nanoparticles for Colon Delivery: Formulation Optimization and In Vitro Assessment of Anti-Cancer Activity.

This work aimed to optimize a celecoxib (CXB)-loaded solid lipid nanoparticles (SLN) colon delivery system for the enhancement of anticancer activity. An ultrasonic melt-emulsification method was employed in this work for the preparation of SLN. The physical attributes were characterized for their particle sizes, charges, morphology, and entrapment efficiency (%EE), in addition to DSC and FTIR. The in vitro drug release profiles were evaluated, and the anticancer activity was examined utilizing an MTT assay in three cancer cell lines: the colon cancer HT29, medulloblastoma Daoy, and hepatocellular carcinoma HepG2 cells. All of the prepared SLN formulations had nanoscale particle sizes ranging from 238 nm to 757 nm. High zeta-potential values (mv) within -30 s mv were reported. The %EE was in the range 86.76-96.6%. The amorphous nature of the SLN-entrapped CXB was confirmed from SLN DSC thermograms. The in vitro release profile revealed a slow constant rate of release with no burst release, which is unusual for SLN. Both the F9 and F14 demonstrated almost complete CXB release within 24 h, with only 25% completed within the first 5 h. F9 caused a significant percentage of cell death in the three cancer cell lines tested after 24 h of incubation and maintained this effect for 72 h. The prepared CXB-loaded SLN exhibited unique properties such as slow release with no burst and a high %EE. The anticancer activity of one formulation was extremely significant in all tested cancer cell lines at all incubation times, which is very promising.

Parent-Reported Rate of the Use of Antibiotics in Children: A Cross-Sectional Study.

Background Antibiotic resistance is growing worldwide due to the magnitude of the rational and irrational use of antibiotics, particularly in children. Evidence regarding the use of antibiotics without a prescription in Saudi children is limited, and the factors that affect frequent antibiotic use in children are poorly understood. Therefore, we investigated the rate of the use of antibiotics in Saudi children reported by their parents and the factors associated with parents that affect the use of antibiotics in children. Methods A cross-sectional survey using a 27-item self-administered questionnaire was conducted among parents living in Saudi Arabia. Parents with at least one child aged 16 years or less were eligible to participate in the study. The results were analyzed via descriptive and inferential statistics. Results A total of 284 parents participated in the study. Of the participants, 81% (n = 230) had given their children at least one course of antibiotics, and 57% of their children were male (n = 164). Many parents did not have a regular general practitioner (GP) for providing care to their children (n = 201, 70%). Further, 164 (n = 71%) parents administered antibiotics without consulting a general practitioner. Neither the parent and child demographics nor the parent knowledge and behavioral variables were significantly associated with the parent's variable of interest in the administration of antibiotics. Conclusions Generally, parents reported alarmingly high rates of antibiotic use among their children. Reducing the unnecessary use of antibiotics in children is crucial for preventing antimicrobial resistance. No apparent statistically significant factor was identified as being associated with antibiotic use. The need for additional measures to limit antibiotic use in children may be warranted. Initiatives to educate parents for consulting a regular general practitioner for their children before administering antibiotics may improve the health outcomes of children.

Knowledge of Anticoagulation Among Saudi Patients With Atrial Fibrillation: A Cross-Sectional Study.

Background Knowledge about oral anticoagulant treatment can impact treatment outcomes in patients with atrial fibrillation. However, evidence is scarce regarding the knowledge of oral anticoagulants among Saudi patients with atrial fibrillation. Hence, this study aimed to assess the level of anticoagulation knowledge among patients with atrial fibrillation taking oral anticoagulants. Methodology A survey using a cross-sectional study design was conducted among patients with a confirmed diagnosis of atrial fibrillation in a tertiary care setting. The Oral Anticoagulation Knowledge Tool (AKT), a 33-item, self-administered questionnaire, was used to assess the knowledge of anticoagulation. Results A total of 290 patients with a median age of 67 years participated in the survey. More than half of those surveyed (56.2%) were females. Overall, 195 (67.2%) patients had an overall adequate anticoagulation knowledge. The median knowledge score of participants on warfarin was significantly higher than those on direct-acting oral anticoagulants (p < 0.001). Only age was found to be a predictor of AKT. Increasing age was associated with fewer odds of adequate AKT. For every one-year increase in age, the knowledge score decreased by 0.08 (95% confidence interval: -0.13 to -0.04). Conclusions This study found significant knowledge gaps among Saudi patients with atrial fibrillation taking oral anticoagulants. Advancing age was inversely associated with oral anticoagulation knowledge.

The utilization of hydroxychloroquine to reduce the main signs and symptoms of COVID-19 patients, a cross-sectional study.

Hydroxychloroquine (HCQ) and chloroquine were found to have positive results in some non-randomized clinical trials with more benefit in decreasing the viral load of COVID-19. HCQ is a lysosomotropic and lipophilic drug that can penetrate cell membranes, and accumulates in the acidic lysosomes. The high concentration of alkaline HCQ increases the pH in lysosomes from the normal levels of 4.7-4.8 to 6 which leads to inhibition of lysosomes functions and thus, prevents the entry of coronavirus into cells. OBJECTIVES: The main aim of this study is to find out the appropriateness of using HCQ in asymptomatic/mildly symptomatic COVID-19 positive patients in an attempt to reduce the development of signs and symptoms of COVID-19 and severe disease. METHODOLOGY: Randomized selection, open-label trial to evaluate the efficacy of HCQ for patients presenting with asymptomatic COVID-19 upon diagnosis. Cases that met the inclusion criteria were divided into two arms [102 subjects to take HCQ (a loading dose of 400 mg twice daily given orally, followed by a maintenance dose of 200 mg twice daily for 4 days), and 100 subjects were used as a control group]. A follow-up for all the participants on daily basis for 14 days for any signs and symptoms (fever, cough, and shortness of breath). The main variables are action profile (represented by Area under the curve (AUC) for fever, cough, and shortness of breath statistically analyzed to differentiate between the two groups. RESULTS: Data in this study showed that HCQ was effective in reducing body temperature from the first day to the fifth day; this positive effect was significant with (p < 0.001) compared with subjects who didn't receive HCQ. While there was no significant effect on cough or Shortness of breath. CONCLUSION: The recommendation of this study is to utilize HCQ to all subjects with asymptomatic COVID-19 infection providing that these subjects are within the inclusion criteria of this study. There was no adverse drug reaction observed for HCQ on daily follow-up.

Quality of Life and Awareness of Hypertension Among Hypertensive Patients in Saudi Arabia.

Background and aim Hypertension possesses significant public health challenges for both developing and developed economies. Therefore, it is crucial to evaluate the awareness of hypertension and health-related quality of life (HRQoL) among patients with hypertension. This study aims to evaluate the knowledge of hypertension and HRQoL among hypertensive patients. Materials and methods A cross-sectional study using an anonymous questionnaire was conducted over a period of 4 months (November 2020 to February 2021) in Riyadh, Kingdom of Saudi Arabia (KSA). This study included 437 questionnaires submitted by the hypertensive population. Results A total of 437 participants were included in this study, with 55.4% being males (n=242). The majority (85.1%) were aware of the normal values of blood pressure. Many participants had no problems with mobility, personal care, usual activities, pain or discomfort, and anxiety or depression. Age groups showed a significant association with mobility and usual activities. The knowledge of hypertension was significantly associated with HRQoL. Conclusion This study found that majority of the hypertensive patients were aware of the standard values of blood pressure. HRQoL concerning physical functioning and general health is found to be good based on the EuroQol visual analogue scale (EQ VAS) in the hypertensive population who are aware of their condition. This study reported a weak yet significant association between hypertension-related knowledge and HRQoL scores. Several factors can affect the HRQoL of the hypertensive population including gender, education, occupation, and income status.

Effectiveness and safety of favipiravir compared to supportive care in moderately to critically ill COVID-19 patients: a retrospective study with propensity score matching sensitivity analysis.

INTRODUCTION: Favipiravir is a repurposed drug to treat coronavirus 2019 (COVID-19). Due to a lack of available real-world data, we assessed its effectiveness and safety in moderately to critically ill COVID-19 patients. METHODS: This retrospective study was conducted in two public/specialty hospitals in Saudi Arabia. We included patients ≥18 years) admitted April-August 2020 with confirmed SARS-CoV-2 diagnosed by real-time polymerase chain reaction (RT-PCR) from nasopharyngeal swab. Patients received either favipiravir (1800 mg or 1600 mg twice daily loading dose, followed by 800 mg or 600 mg twice daily) or supportive-care treatment. Patients were excluded if they were outside the study period, classified as having a mild form of the disease per WHO criteria, or had an incomplete patient file. Kaplan-Meier (KM) models were used to estimate median time to discharge. Discharge ratios, progression to mechanical ventilation, and mortality outcomes were estimated across the severity spectrum using Cox proportional-hazards models. As a sensitivity analysis, we performed propensity score-matching (PSM) analysis. RESULTS: Overall, median time to discharge was 10 days (95%CI = 9-10) in the favipiravir arm versus 15 days (95%CI = 14-16) in the supportive-care arm. The accelerated discharge benefit was seen across the COVID-19 spectrum of severity. The adjusted discharge ratio was 1.96 (95%CI = 1.56-2.46). Progression to mechanical ventilation was slower with favipiravir (HRadj = 0.10, 95%CI = 0.04-0.29). There was no significant effect on mortality (HRadj = 1.56, 95%CI = 0.73-3.36). There was a statistically non-significant trend toward worse outcomes in the critical category (HRadj = 2.80, 95%CI = 0.99-7.89). Age was an independent risk factor for mortality in mechanically ventilated patients. PSM analyses confirmed these findings. CONCLUSION: Favipiravir was associated with clinical benefits, including accelerated discharge rate and less progression to mechanical ventilation; however, no overall mortality benefits were seen across the severity spectrum.