The Effect of a Vegan Diet on the Health Indicators and Outcomes of P atients with Type 2 Diabetes Mellitus.

INTRODUCTION/OBJECTIVES: Recently, there has been a notable increase in interest in various forms of vegetarianism, which may be due to the growing prevalence of health issues, such as Type 2 Diabetes Mellitus (T2DM). Adhering to a vegan diet may have positive health outcomes. As a result, we conducted a review article to gather data from previous research studies on the effects of a vegan diet on different aspects of managing patients with T2DM. METHODS: We searched the PubMed website for research studies on how a vegan diet affects the outcomes of patients with T2DM. The research studies were categorized according to the type of data collected, such as prevalence, incidence, body weight, insulin resistance, glycemic control, and lipid profile. RESULTS: It was found that following a vegetarian diet can significantly reduce the risk of mortality from heart disease. Additionally, studies have demonstrated that a vegetarian diet is linked to several improvements in T2DM. However, long-term weight loss plans and managing T2DM is a comprehensive intervention that includes caloric restriction, exercise, and behavioral modification. CONCLUSION: Incorporating a vegan diet can be a valuable factor to consider in managing T2DM, as it can offer numerous benefits, such as increased insulin sensitivity, weight loss, and reduced blood sugar levels. It helps to reduce cholesterol levels, LDL, and triglyceride levels, which are all risk factors associated with T2DM. By reducing these risk factors, the vegan diet can improve the overall health of T2DM patients.

Knowledge and Awareness of Adults towards Nocturnal Enuresis in Children among the Medina Population.

Background: Nocturnal Enuresis (NE) is a common problem among children that is stressful for both the child and adults. There is a lack of adults' knowledge and awareness of the NE condition. Objective: This study aimed to evaluate the adults' knowledge and awareness of NE in Medina City, Saudi Arabia. Method: A cross-sectional observational study was conducted among adults in Medina through September and October 2023, using a questionnaire composed of socio-demographic characteristics and adults' knowledge and awareness of NE. A statistical analysis was performed using SPSS software. Results: The study was conducted among 553 adults in Medina, with a mean (standard deviation [SD]) age of 37.69 (10.775). Most participants (94.8%) were Saudi nationals, of which 84.4% were females, 76.3% were married, and 97.1% were urban residents with university degrees (80.3%). The mean (SD) total score of knowledge and awareness was 4.69 (1.783) out of 9 and 6.49 (2.167) out of 12, respectively. Being female (p < 0.001), with a university degree (p = 0.002), and knowing about enuresis in children (p = 0.011) are significant factors affecting adults' knowledge with higher scores than others. Conclusions: An inadequate knowledge and awareness level of NE in children was revealed among adults living in Medina City, Saudi Arabia. These results emphasize the need for targeted educational campaigns to enhance adults' knowledge and awareness of enuresis.

Practical guide: Glucagon-like peptide-1 and dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus.

In 2005, exenatide became the first approved glucagon-like peptide-1 receptor agonist (GLP-1 RA) for type 2 diabetes mellitus (T2DM). Since then, numerous GLP-1 RAs have been approved, including tirzepatide, a novel dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RA, which was approved in 2022. This class of drugs is considered safe with no hypoglycemia risk, making it a common second-line choice after metformin for treating T2DM. Various considerations can make selecting and switching between different GLP-1 RAs challenging. Our study aims to provide a comprehensive guide for the usage of GLP-1 RAs and dual GIP and GLP-1 RAs for the management of T2DM.

Genomic analysis of extensively drug resistant (XDR) Klebsiella pneumoniae high-risk clone ST14 co-harboring blaNDM and blaOXA-48 recovered from Saudi Arabia.

BACKGROUND: This study presents a comprehensive genomic analysis of NDM and OXA-48-producing Klebsiella pneumoniae in the Western region of Saudi Arabia, traversed by tens of millions of Muslims from various countries annually. This significant influx of visitors invariably leads to the spread and diversity of MDR bacteria. METHODS: Genome sequencing was performed using MiSeq system of 29 CPKP isolates that were NDM and OXA-48-positive isolated from nosocomial infections and demonstrated resistance to most antibiotics, including carbapenems. RESULTS: WGS analysis showed that 12 (41.3%) isolates co-harbored blaOXA-48,blaCTX-M-15 and blaNDM genes. Notably, 16 (55.1%) isolates were identified as high-risk clone ST14, with 50% of these isolates co-harbored blaOXA-48, blaNDM and blaCTX-M-15 genes. All ST14 isolates were identified as capsular genotype KL2 and O1/O2v1 antigen with yersiniabactin locus ypt 14 carried by ICEKp5. The two isolates were identified as ST2096/KL64 hypervirulent K. pneumoniae (hvKp) clone harboring several virulence factors, including the regulator of the mucoid phenotype rmpA2 and aerobactin (iuc-1). Interestingly, two of the hvKp ST383/KL30 isolates were resistant to all tested antimicrobials except colistin and tigecycline, and simultaneously carried numerous ESBLs and carbapenemase genes. These isolates also harbor several virulence factors such as rmpA1, rmpA2, carried on KpVP-1, and aerobactin (iuc-1). CONCLUSION: this study provides insights into the spread and prevalence of high-risk clones of CPKP in the Western region of Saudi Arabia. The ST14 high-risk clone appears to be the predominant CPKP clone in this region, posing a significant threat to public health. This study also reports the presence of two globally disseminated hypervirulent K. pneumoniae (hvKp) clones, namely ST2096 and ST383. Therefore, it is essential to improve surveillance and implement strict infection control measures in this region, which receives a substantial number of visitors to effectively monitor and reduce the spread of high-risk clones of antimicrobial-resistant bacteria, including CPKP.

Risk Factors for Readmission in Heart Failure Within 90 Days.

BACKGROUND: Hospital readmission rates among heart failure (HF) patients remain a persistent challenge. While various risk factors have been identified, their impact on individual patients varies, and not all patients with these risk factors will necessarily experience readmission within 90 days. This study aimed to identify and assess the significance of risk factors associated with readmission of HF patients within 90 days. METHODS: A retrospective cohort study was conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. The sample size comprised 130 patients. Data was collected from hospital records of all HF patients readmitted within 90 days of discharge between 2018 and 2022. RESULTS: The study included 130 patients. The majority (70%) were between 51 and 70 years old. Most patients had a hospital stay ranging from 1 to 10 days (83.1%). Shortness of breath (SOB) was the most common reason for readmission, accounting for 80% of cases. Other reasons included chest pain (CP) (6.2%), orthopnea (13.1%), paroxysmal nocturnal dyspnea (PND) (5.4%), lower limb edema (LLE) issues (1.5%), and heart failure (HF) itself (2.3%). Less common reasons included fever (1.5%), pneumonia (1.5%), altered level of consciousness (1.5%), and urinary tract infection (1.5%). CONCLUSION: Readmission rates for HF patients remain high, attributed to factors such as non-adherence to medication and lifestyle changes, comorbidities, inadequate discharge planning, and social determinants of health. Males may be more prone to experiencing SOB and subsequently requiring readmission at a higher rate. These findings underscore the need for comprehensive interventions that address these risk factors to minimize readmission rates and improve patient outcomes.

Knowledge, Attitude, and Practice Regarding the Risk of Diabetic Feet Among Diabetic Patients in the Madinah Region, Saudi Arabia.

Introduction A patient suffering from diabetes mellitus (DM) has a high chance of developing a diabetic foot. Awareness and attitude toward the prevention of diabetic foot ulcers are necessary for a better quality of life. Educating patients with diabetes about the methods of foot care plays an important role in preventing diabetic foot complications in individuals with DM. This study aims to determine the level of knowledge, attitude, and practices of diabetic patients about the risk of diabetic feet in Madinah, Saudi Arabia. Methodology This is an observational cross-sectional study conducted using an online questionnaire. Participants were older than 18 years of age. IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, New York, United States) was used for data analysis. The questionnaire included patient personal data, patients' knowledge regarding diabetic feet, attitude, and practice regarding the risk of diabetic feet among diabetic patients. Results A total of 1155 participants completed the questionnaire. Exactly 79.9% of people had good knowledge regarding diabetic feet and their care. The analysis revealed that age, gender, education level, and family history of DM are all significant predictors of knowledge levels among the participants. The majority of participants strongly agreed that diabetic patients should promptly seek medical assistance in case of any foot infections (90.8%) and take regular checkups (76.5%). Regarding foot care practices, people generally take good care of their feet but do not seek checkups until they experience symptoms (81.8%). Conclusion The study showed that participants had good knowledge about diabetic feet and a careful attitude toward them. Their practices toward diabetic feet were acceptable; however, the issue of late medical consultation after the development of symptomatology needs to be addressed.

Caffeine Consumption and Depression, Anxiety, and Stress Levels Among University Students in Medina: A Cross-Sectional Study.

Introduction Caffeine is a psychoactive stimulant frequently found in coffee, tea, energy drinks, and some medications. Various mental health challenges, including stress, anxiety, and depression, commonly affect college students. Moreover, an individual's mental and physical health can be significantly impacted by stress, anxiety, and depression. However, the impact of caffeine on mental health, particularly its association with depressive and anxiety symptoms, remains inconclusive. Thus, this study aimed to evaluate the amount of caffeine consumed by university students and its association with depression, anxiety, and stress levels. Material and method This cross-sectional study was performed on Taibah University students in Medina from both health-related and non-health-related colleges. We used a self-administrated questionnaire composed of four sections: the informed consent section; sociodemographic information; the Depression, Anxiety, and Stress Scale (DASS-21), which assessed the depression, anxiety, and stress levels; and a caffeine-measuring questionnaire, which reported daily caffeine intake in milligrams per day. Result This cross-sectional study examined a 520 convenience sample of Taibah University students with an age range from 17 to 29 years. The majority of the participants were single (95.2%), most of them were female (73.8%), and slightly more than half (51.5%) were recruited from health-related colleges. According to the study's DASS-21 score results, 45.8% of the students had extremely severe stress, 61% had extremely severe anxiety, and 51% had extremely severe depression. The most frequently reported sources of daily caffeine among the participants were Arabic coffee (69.6%), specialty coffee (57.5%), black tea (56.3%), cola (48.7%), and regular coffee (48.5%). The overall daily amount of consumed caffeine ranged from zero to 4276.7 mg/oz. However, no significant association was found between the severity of the DASS-21 score and the daily consumption of caffeine among Taibah University students. Conclusion Our study shows no significant association between the severity of depression, anxiety, and stress and daily caffeine consumption among university students. This proves the opposite of the theory that high levels of caffeine consumption can be correlated to high levels of depression, stress, and anxiety.

Knowledge, Attitudes, and Practices Toward the Prevention of Hepatitis B Virus Infection Among Medical Students in Medina City, Kingdom of Saudi Arabia.

INTRODUCTION: This study focuses on assessing the knowledge, attitudes, and practices related to Hepatitis B virus (HBV) prevention among medical students in Medina, Saudi Arabia. HBV is a significant global health concern, with a high prevalence in Saudi Arabia. Medical students due to their field, are at higher risk of exposure. Prior studies in Saudi Arabia show varied levels of awareness. This research aims to provide insights that can inform educational initiatives for this specific population. METHODS: This was a cross-sectional study conducted from June 2023 to September 2023 by using a pre-designed online questionnaire that was distributed among medical students in Medina. Data was analyzed using IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp. RESULTS: This study included 307 participants. 67.8% of the participants correctly identified the link between HBV and liver cancer, and 77.5% recognized the transmission risk from carriers. 91.9% acknowledged the transmission via contaminated blood and fluids, and 88.9% recognized the risk from unsterilized instruments. Positive attitudes were observed, with 92.2% agreeing that following infection control guidelines would protect them at work. Practice scores were generally positive, including high rates of screening (57.3%) and adherence to infection control measures (90.2%). Knowledge scores correlated positively with attitude (rho = 0.204) and practice scores (rho = 0.390). CONCLUSION: A significant proportion of participants had a strong understanding of HBV transmission and the importance of infection control measures. Positive attitudes towards infection control were prevalent, although some reluctance to provide care to HBV-infected individuals was noted.

The Involvement of Calcium Channels in the Endoplasmic Reticulum Membrane in Nonalcoholic Fatty Liver Disease Pathogenesis.

Nonalcoholic fatty liver disease (NAFLD) is a prevalent and complex condition that affects millions of people globally. It occurs when fat, primarily triglycerides, accumulates in liver cells, leading to inflammation and damage. Calcium, an essential mineral, is involved in various physiological processes, including the regeneration process following liver injury. The endoplasmic reticulum (ER), a complex organelle involved in protein synthesis and lipid metabolism, regulates intracellular calcium levels. Dysregulation of this process can lead to calcium overload, oxidative stress, and cellular damage, all of which are hallmarks of NAFLD. Inositol 1,4,5-trisphosphate receptor (IP3R), a type of calcium ion channel, is found throughout the body, including the liver. IP3R is classified into three subtypes: IP3R1, IP3R2, and IP3R3, and it plays a critical role in regulating intracellular calcium levels. However, excessive calcium accumulation in the mitochondria due to an overload of calcium ions or increased IP3R activity can lead to NAFLD. Therefore, targeting calcium channels in the ER membrane may represent a promising therapeutic strategy for preventing and treating this increasingly prevalent metabolic disorder. It may help prevent mitochondrial calcium accumulation and reduce the risk of hepatic damage. This review article aimed to review the relationship between IP3R modulation and the pathogenicity of NAFLD, providing valuable insights to help researchers develop more effective treatments for the condition.

Prognostic Factors Affecting Postsurgical Outcomes of Adult Patients with Intracranial Meningioma: A Retrospective Study.

OBJECTIVE: To identify the prognostic factors of surgical resection for meningioma and their relationship with patient outcomes. METHODS: This retrospective study included 53 patients (≥16 years), who underwent surgical resection for intracranial meningioma at the King Abdulaziz University Hospital from 2012 to 2022. Data regarding tumor location and size, histopathological type, chief complaint, chief complaint duration, admission date, diagnosis, operation, and discharge date were collected. These data were subjected to univariate and bivariate analyses to investigate the relationship between the postsurgical outcomes of the patients with meningioma and the variables of age at surgery, sex, length of hospitalization, chief complaint, Glasgow outcome score, World Health Organization histopathological classification, body mass index, tumor size, and nature of surgical resection. RESULTS: The mean age of our study cohort was 49.09 ± 12.64 years, with a female preponderance (75.5%) and mean body mass index of 29.31 ± 5.52 kg/m2. length of hospitalization (mean: 26.92 ± 54.88 days) demonstrated a significant (P = 0.012) impact on prognosis after surgery. In addition, convexity meningiomas (21.2%), which were observed in the maximum number of cases, and mean tumor volume (28.67 ± 48.85 mm) were significantly (P = 0.049) associated with the outcome. Most patients (78.8%) underwent total surgical resection, and histopathological examinations revealed a higher frequency of grade 1 than grade 2 tumors. CONCLUSIONS: Short duration of hospitalization and superficial location of the tumor are associated with optimal outcomes after surgical resection for patients with meningioma.

Body Mass Index Within Multifactor Predictors of Ventral Hernia Recurrence: A Retrospective Cohort Study.

Background A ventral hernia is a protrusion of the peritoneum through the defective abdominal wall. Several risk factors increase the likelihood of hernial recurrence. One of the most common risk factors is obesity, defined by the World Health Organization (WHO) as increased body mass index (BMI). Few studies have explored the effects of BMI and other factors on hernia recurrence. Hence, we aimed to investigate the role of increased BMI in hernia recurrence in conjunction with various risk factors such as age, sex, type of hernia, the time elapsed between the occurrence and recurrence, complications of hernia, and procedure. Methods This retrospective cohort study was conducted at King Abdulaziz University Hospital (KAUH). All the patients were admitted between 2015-2022. A total of 1676 medical records were obtained from all patients who underwent hernia repair more than once or were diagnosed with a recurrent hernia during the study period. Results Our study revealed an insignificant correlation between a BMI of more than 25 kg/m2 and the recurrence of inguinal hernias, predominantly indirect hernias. Furthermore, overweight and obese patients experience a longer interval between the first and second hernia repairs. Interestingly, all the patients with inguinal and umbilical hernias had the same diagnosis at the second presentation. However, the findings also included a significant increase in umbilical hernias in individuals with a high BMI and higher recurrence rates among male patients with inguinal hernias. Conclusion BMI higher than 25 kg/m2 increases recurrence rates for umbilical hernias but decreases the recurrence of inguinal hernias.

Effect of COVID-19 on Glycemic Control, Insulin Resistance, and pH in Elderly Patients With Type 2 Diabetes.

Background The coronavirus disease of 2019 (COVID-19) was spread all over the world, while diabetes mellitus (DM) remains the most prevalent chronic disease worldwide. Aims This study aims to investigate the effect of COVID-19 on glycemic control, insulin resistance (IR), and pH in elderly patients with type 2 diabetes. Methods  A retrospective study was conducted on patients with type 2 DM who were diagnosed with COVID-19 infection in the central hospitals of the Tabuk region. Patient data were collected from September 2021 to August 2022. Four non-insulin-based insulin resistance indexes were calculated for patients: the triglyceride-glucose (TyG) index, the triglyceride glucose-body mass index (TyG-BMI) index, the triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio, and the metabolic score for insulin resistance (METS-IR). Results Patients showed increased serum fasting glucose and blood HbA1c associated with a high TyG index, TyG-BMI index, TG/HDL ratio, and METS-IR as compared with results before COVID-19. Moreover, during COVID-19, patients revealed a reduction in pH, associated with a reduction in cBase and bicarbonate, and an elevation in PaCO2 as compared with their results before COVID-19. After complete remission, all patients' results turn back to their level before COVID-19. Conclusions Patients with type 2 DM who catch the COVID-19 infection suffer from dysregulation of glycemic control and elevated insulin resistance associated with a significant reduction in their pH.

Estimation of Psychological Impairment and Coping Strategies during COVID-19 Pandemic among University Students in Saudi Arabia: A Large Regional Analysis.

BACKGROUND: The COVID-19 pandemic and associated restrictive measures have substantially affected educational processes around the globe, resulting in psychological distress among students. The mental health of students in higher education is of paramount importance, and the COVID-19 pandemic has brought this vulnerable population into renewed focus. In this context, the evaluation of students' mental health at educational institutes has gained invaluable popularity during the COVID-19 pandemic. This study aimed to ascertain the psychological health and coping strategies among students from a higher education institute in Saudi Arabia. METHODS: An online study instrument was used to assess anxiety (Generalized Anxiety Disorder-7, GAD-7), depression (Patient Health Questionnaire-9, PHQ-9), post-traumatic stress disorder-PTSD (Impact of Event Scale-Revised, IES-R) and coping strategies (Brief-COPE). The severity of the psychological distress was classified as per the scoring criteria and correlated with demographics using appropriate statistical methods. RESULTS: Of 1074 students (age 21.1 ± 2.1 years), 12.9% and 9.7% had severe anxiety and depression, respectively. The mean anxiety and depression scores were 7.50 ± 5.51 and 9.31 ± 6.72, respectively. About one-third (32%) of students reported suicidal ideation, with 8.4% students having such thoughts nearly every day. The average PTSD score was 21.64 ± 17.63, where avoidance scored higher (8.10 ± 6.94) than intrusion and hyperarousal. There was no association of anxiety, depression and PTSD score with the demographics of the study participants. Religious/spiritual coping (5.43 ± 2.15) was the most adoptive coping mechanism, followed by acceptance (5.15 ± 2.10). Male students were significantly (p < 0.05) associated with active copings, instrumental support, planning, humor, acceptance and religious coping. Substance use was the least adopted coping strategy but practiced by a considerable number of students. CONCLUSIONS: The long-lasting pandemic situation, onerous protective measures and uncertainties in educational procedures have resulted in a high prevalence of psychological ailments among university students, as indicated in this study. These findings accentuate the urgent need for telepsychiatry and appropriate population-specific mental health services to assess the extent of psychological impairment and to leverage positive coping behaviors among students.

Ethnicity affects the risk factors of acute myocardial infarction and should be considered in educational programs.

Acute Myocardial infarction is a non-communicable disease representing the leading cause of death in Saudi Arabia. Studying the ethnicity in its risk factors has been poorly investigated. Objectives: To compare risk factors among Saudi nationals and expatriates. Methods: A retrospective cohort study for patients admitted to the Cardiac Care Unit of one of the largest tertiary care hospitals in Tabuk diagnosed with acute myocardial infarction from September 2018 to August 2019. Risk factors were compared among groups on the basis of their ethnicity. Results: In total 18,746 patients were included. Gender and age were the predominant risk factors; Male (p < 0.05) and age >50 years (p < 0.05). There were significant differences between Saudis and expatriates in all measurable parameters indicating that a genetic factor contributes to the risk factors, which was proved by the significant differences between the Middle East North Africa and South Asia subgroups. Interestingly, the mean values of laboratory results were higher than Saudi populations. Conclusions: The disparity in lipid profile among the studied groups addresses the patient ethnicity should be considered during education programs for the risk factors of cardiovascular disease.

Patient Satisfaction of Ambulatory Care Pharmacy Services.

The Ministry of Health (MOH) recently developed the Health Sector Transformation Program (HTSP) to focus on patient satisfaction, safety, and care. This study explored patient satisfaction with outpatient care services. A semi-structured questionnaire was designed to collect the data of patient satisfaction with pharmacy care services through face-to face interviews of participants and over the internet using an electronic format of the same questionnaire (web-based survey). A total of 508 participants responded of whom, 51.8% were male and 83% were below 46 years old. The average scores of domains 1, 2, 3, 4, 5, 6, 7, and 8 were 4.51, 4.11, 4.30, 3.70, 3.57, 3.82, 3.63, and 4.15, respectively. The general evaluation of pharmacy services demonstrated that respondents were very satisfied (245; 48.2%), satisfied (143; 28%), and willing to recommend the pharmacy to their families (380; 76.4%). There was no statistically significant difference in the overall satisfaction with pharmacy services among the 2 hospitals (P > .05). Most respondents were satisfied with outpatient care pharmacy services. More efforts are needed to improve the service of following up on patients' adherence by the pharmacists.

Evaluate the Effectiveness of Outpatient Parenteral Antimicrobial Therapy (OPAT) Program in Saudi Arabia: A Retrospective Study.

(1) Background: Outpatient parenteral antibiotic therapy (OPAT) is a well-established and cost-effective measure that improves the efficient use of healthcare resources and increases bed availability. Only limited published data is available to illustrate OPAT implementation and outcomes in Saudi Arabia. The main objective of this study was to evaluate the effectiveness of OPAT in a tertiary center in Saudi Arabia. (2) Methods: In this retrospective study, clinical charts of enrolled patients were reviewed in a tertiary care center from the initial month of November 2017 to March 2020. All admitted patients with a central line and who enrolled in the OPAT of the hospital during this study period were included. The primary outcome was the 30-days readmission rate of OPAT patients. Secondary outcomes were factors associated with OPAT failure. Descriptive analysis of the data was used to express the results. (3) Results: We enrolled 90 patients; 54 (60%) were male; the mean age was 55.16 (±17.7) years old. The mean duration of the antimicrobial treatment was 21.9 (+24.6) days. All patients completed the intended course of therapy. Ertapenem was the most frequently used antimicrobial (43%), followed by vancomycin (11.2%). Urinary tract infections (UTIs) are some of the most common bacterial infections in 25 patients (26.9%), followed by osteomyelitis in 16 patients (17.2%). Extended-spectrum beta-lactamase E.coli was the highest common isolated microorganism (44.9%), followed by methicillin-resistant Staphylococcus aureus MRSA (16.9%). The readmission to the hospital during therapy was required for 12 patients (13.3%). Shifting from hospital care to OPAT care resulted in cost savings of 18 million SAR in the overall assessment period and avoided a total of 1984 patient days of hospitalization. (4) Conclusion: The findings have shown that OPAT therapy was effective with minimum hospital readmissions and therapy complications. OPAT programs can reduce healthcare costs and should be integrated into practice.

Frequency of serum blood glucose monitoring after hyperkalaemia treatment using insulin and dextrose.

OBJECTIVES: In patients with hyperkalaemia, dextrose is administered alongside insulin treatment to prevent hypoglycaemia. However, the incidence of hypoglycaemia in the first 6 hours following this regimen remains high, and frequent blood glucose monitoring is essential. This study evaluates the frequency of blood glucose monitoring following this insulin regimen. METHODS: This retrospective, multicentre study evaluated adult patients (≥18 years) who had been hospitalised for hyperkalaemia (K ≥ 5 mEq/mL) and managed using intravenous insulin and dextrose. We excluded patients if dextrose was not administered within 60 minutes of insulin therapy. The primary outcome was the frequency of serum blood glucose monitoring within 6 hours of the regimen. Secondary outcomes were the time between insulin treatment and follow-up measurements, and the incidence of hypoglycaemia (blood glucose <70 mg/dL). RESULTS: In total, 521 hyperkalaemia episodes were available for analysis; 192 (36.9%) had at least one reported follow-up measurement, 30 had at least two follow-up measurements (5.8%), and six had at least three follow-up measurements (1.2%). The median times of obtaining the first, second, and third blood glucose measurements were 3 h (interquartile range [IQR]: 1.7-4 h), 3.9 h (IQR: 3.2-5.1 h), and 4 h (IQR: 3.2-5.1 h), respectively. The incidence of hypoglycaemia among the episodes with follow-up was 4.8%. CONCLUSIONS: The frequency of serum blood glucose monitoring following insulin therapy was low and inconsistent. This study emphasised the importance of adopting protocols incorporating more frequent blood glucose monitoring.

Hospital Pharmacy Preparedness and Pharmacist Role During Disaster in Saudi Arabia.

BACKGROUND: In case of emergencies, the number and severity of mass casualties may exceed medical services resources. Saudi Arabia is prone to different disasters, and all medical resources should be ready and prepared to serve during disasters. Pharmacists are essential during disasters; however, their roles have not been well studied during disasters in Saudi Arabia. METHODS: An observational cross-sectional study targeted tertiary hospitals in Jeddah. An electronic survey, consisting of 34 questions, was developed and distributed to pharmacy directors or their representatives to investigate the hospital pharmacies' preparedness and pharmacist roles during disasters in the city of Jeddah. RESULTS: Six hospitals participated in the survey, with a 100% response rate. All respondents confirmed the presence of disaster plans involving pharmacy departments. Hospital committee consensuses determined which medication to stock in five hospitals (83.3%). All six respondents (100%) agreed that the following medication supplies were adequate in the event of disasters: analgesics, rapid sequence intubation medications (ie, sedatives and paralytics), respiratory medications, antimicrobials, and maintenance intravenous (IV) fluids. There was disagreement on the adequacy of wound infection prophylaxis, vasopressors/inotropes, antiemetic medications, ophthalmic medications, and antidotes for chemical weapons. There were discrepancies on pharmacist roles during disaster, but hospitals agreed on the following roles: maintain effective distribution and control, collaborate on medication management, and develop and maintain first-aid skills. CONCLUSION: All included facilities have emergency preparedness plans for the hospitals and the pharmacy departments. However, the type and quantities of stocked medications, as well as pharmacist roles, are not well recognized. The results highlight the need for national guidance to enhance and support the preparedness of healthcare facilities.

Efficacy of Empiric Antibiotic Coverage in Community-Acquired Pneumonia Associated with Each Atypical Bacteria: A Meta-Analysis.

The benefit of empiric coverage for community-acquired pneumonia (CAP) for atypical bacteria is controversial. This meta-analysis purpose was to compare the clinical failure rate between adults who empirically received atypical coverage versus those who did not. We searched PubMed and EMBASE for randomized controlled trials (RCTs), comparing the clinical failure rate of CAP associated with individual atypical bacteria between adults who received empiric atypical coverage versus those who did not. Risk differences (RDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Eight double-blind RCTs (65 patients with Legionella spp., 176 patients with M. pneumoniae, and 78 patients with C. pneumoniae) were included in the meta-analysis. The rate of clinical failure was significantly lower with empiric atypical coverage in CAP associated with Legionella spp. (RD, -42.6%; 95% CI, -69.8% to -15.4%; p-value = 0.002; I2 = 0%) and Mycoplasma pneumoniae (RD, -9.5%; 95% CI, -18.9% to -0.1%; p-value = 0.048; I2 = 0%), but not with Chlamydia pneumoniae (RD, 7.1%; 95% CI, -9.0% to 23.1%; p-value = 0.390; I2 = 0%). This meta-analysis of RCTs found that empiric atypical coverage decreased the clinical failure rate of CAP associated with Legionella spp. and M. pneumoniae, but not with C. pneumoniae.

An inpatient multidisciplinary educational approach to reduce 30-day heart failure readmissions.

BACKGROUND: Despite dramatic improvements in the management of heart failure (HF), hospital readmissions due to HF exacerbation remain high. To improve quality of care, many hospitals have developed interventions to reduce HF readmission rates. The aim of this study was to evaluate the impact of an inpatient multidisciplinary educational approach utilizing pharmacist to reduce 30-day HF readmissions. METHODS: Retrospective observational study conducted at a tertiary-hospital in Tucson-Arizona, USA. It included adult patients admitted with a documented diagnosis of HF and excluded patients discharged to hospice. Patents were divided into two groups: intervention and control group. Intervention components included: (1) pharmacy student counseling; (2) HF education provided jointly by a pharmacist and a nurse as a group class to patients and caregivers and/or one-on-one education with a nurse; and (3) follow-up phone calls 1-3 days post-discharge reinforcing HF education. The main outcome was the rate of hospital readmission within 30 days post HF discharge. RESULTS: A total of 221 patients were identified in the intervention and 183 in the control groups. Of the patients in the intervention group, 44.8% received pharmacy student counseling, 47.1% received HF education, 25.3% were contacted 1-3 days post-discharge; and 5% received all intervention components. The difference in the primary outcome was not statistically different, with 3.8% readmission rate in the control group compared to 4.5% in the intervention group (p = 0.73). It is worth to notice that none of the 11 patients who received all components of the interventions were readmitted. Univariate analysis demonstrated a significant association between pharmacy student counseling and 30-day HF readmissions (p = 0.03); however, no difference was observed after adjusting for all variables. CONCLUSION: The readmission rate in both groups was below national rate, and neither the intervention nor components were associated with a significant reduction in the primary outcome. Another study is needed to assess the rate of HF readmission in patients receiving all components of the multidisciplinary interventions.