Assessment of drug interactions and their associated factors among patients with cardiovascular diseases: a cross-sectional study from the occupied Palestinian territory.

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of death in the West Bank and worldwide. Potential drug-drug interactions (pDDIs) contribute to a significant proportion of adverse drug reactions, which have been shown to be a major cause of morbidity and mortality. Patients with CVD require more attention regarding these interactions owing to the complexity of their conditions and therapeutic regimens. The purpose of this study was to assess the prevalence and types of pDDIs, and their associated factors in patients with CVD. METHODS: A cross-sectional study was conducted at two large referral hospitals for patients with CVD in the northern West Bank. Inpatients who were diagnosed with any CVD during the period of the study (from Sept 1, 2016, to Feb 28, 2017) were selected by convenience sampling. Data were collected from patients' medical records and in a face-to-face interview with each of the patients (by use of a standardised data collection form). The sample size was calculated using the Raosoft calculator. pDDIs between medications prescribed at discharge were identified using the Lexicomp interaction checker. Data were analysed with SPSS version 16. FINDINGS: The study included 400 patients with CVDs. According to the Lexicomp interaction checker, 94% (375 of 400) of the patients were discharged with medications with pDDIs. Patients had an average of 3·14 (SD 1·41) diseases, and were prescribed 1-16 medications on discharge (mean 7·08, SD 2·76). The most common comorbid disease was diabetes (in 51% of patients; 205 of 400), followed by chronic kidney disease (in 14% of patients; 56 of 400). Aspirin was the most frequently prescribed medication. The most frequent pDDI was furosemide and aspirin, which were prescribed simultaneously for 37% of patients (148 of 400), followed by angiotensin-converting-enzyme inhibitor and aspirin, which were prescribed simultaneously for 33% of patients (131 of 400), and statins and proton pump inhibitors, which were prescribed simultaneously for 32% of patients (129 of 400). The number of pDDIs was associated with the number of diseases (p<0·0001), the total number of discharge medications (p<0·0001), and the length of hospital stay (p=0·0012). INTERPRETATION: The prevalence of pDDIs is very high among discharge medications for patients with CVDs. These interactions were associated with the number of diseases, the number of medications prescribed, and the length of hospital stay. Monitoring for pDDIs should be performed regularly. To prevent the risks of pDDIs, work is required to raise awareness, and clinical pharmacists should be involved in reviewing medications at discharge. FUNDING: None.

Detection and genotyping of human papilloma virus in cervical cancer specimens from Saudi patients.

OBJECTIVE: To determine the rates and types of human papilloma virus (HPV) infection in cervical cancer specimens from Saudi patients. METHODS: One hundred specimens were randomly selected and retrieved from the achieved samples stored in the pathology department accessioned under the diagnosis of cervical cancer and carcinoma in situ between the years 1997 and 2007. Human papilloma virus in the clinical samples was detected using polymerase chain reaction amplification methods. Two primer systems are commonly used: the MY09-MY11 primers and the GP5+-GP6+ that amplify a wide range of HPV genotypes. Human papilloma virus isolates were genotyped using DNA sequencing and reverse line blot hybridization assay to identify the high-risk HPV genotypes. RESULTS: Ninety cases fulfilled the diagnostic criteria and were analyzed. The rate of HPV genotype detection among cervical cancer samples was 95.5%. The most common HPV genotype detected by both methods was HPV-16 (63.4%), followed by HPV-18 (11.1%), HPV-45 (4.5%), HPV-33 (3.3%), and HPV-31, HPV-52, HPV-53, HPV-58, HPV-59, and HPV-66 with 2.2% prevalence rate each. CONCLUSIONS: Prevalence of HPV genotypes among patients with cervical cancer in Saudi Arabia is comparable to the international rates. The use of the reverse line blot hybridization assay genotyping method could be useful for classifying oncogenic HPV-positive women. It is relatively inexpensive and reliable and can be performed in routine practice or epidemiological study compared with the available standard commercial kits.

Regression of brown tumor of the maxilla in a patient with secondary hyperparathyroidism after a parathyroidectomy.

Brown tumors or osteoclastomas are erosive bony lesions arising as a complication of hyperparathyroidism. In patients with end-stage renal disease, brown tumors are uncommon skeletal manifestations that are usually seen in severe forms of secondary hyperparathyroidism. Initial treatment involves the correction of hyperparathyroidism, which usually leads to regression of the tumors. We report a case of brown tumors of the maxilla in a 24-year-old female referred to us by a local hospital, where she had been on regular hemodialysis for >10 years. After a complete biochemical and radiological workup, she underwent a total parathyroidectomy, which subsequently resulted in significant regression of her tumor.