The concomitant use of ultra short beta-blockers with vasopressors and inotropes in critically ill patients with septic shock: A systematic review and meta-analysis of randomized controlled trials.

Background: Septic shock is associated with systemic inflammatory response, hemodynamic instability, impaired sympathetic control, and the development of multiorgan dysfunction that requires vasopressor or inotropic support. The regulation of immune function in sepsis is complex and varies over time. However, activating Beta-2 receptors and blocking Beta-1 receptors reduces the proinflammatory response by influencing cytokine production. Evidence that supports the concomitant use of ultra short beta-blockers with inotropes and vasopressors in patients with septic shock is still limited. This study aimed to evaluate the use of ultra short beta-blockers and its impact on the ICU related outcomes such as mortality, length of stay, heart rate control, shock resolution, and vasopressors/inotropes requirements. Methods: A systematic review and meta-analysis of randomized controlled trials including critically ill patients with septic shock who received inotropes and vasopressors. Patients who received either epinephrine or norepinephrine without beta-blockers "control group" were compared to patients who received ultra short beta-blockers concomitantly with either epinephrine or norepinephrine "Intervention group". MEDLINE and Embase databases were utilized to systematically search for studies investigating the use of ultra short beta-blockers in critically ill patients on either epinephrine or norepinephrine from inception to October 10, 2023. The primary outcome was the 28-day mortality. While, length of stay, heart rate control, and inotropes/ vasopressors requirements were considered secondary outcomes. Results: Among 47 potentially relevant studies, nine were included in the analysis. The 28-day mortality risk was lower in patients with septic shock who used ultra short beta-blockers concomitantly with either epinephrine or norepinephrine compared with the control group (RR (95%CI): 0.69 (0.53, 0.89), I2=26%; P=0.24). In addition, heart rate was statistically significantly lower with a standardized mean difference (SMD) of -22.39 (95% CI: -24.71, -20.06) among the beta-blockers group than the control group. The SMD for hospital length of stay and the inotropes requirement were not statistically different between the two groups (SMD (95%CI): -0.57 (-2.77, 1.64), and SMD (95%CI): 0.08 (-0.02, 0.19), respectively). Conclusion: The use of ultra short beta-blockers concomitantly with either epinephrine or norepinephrine in critically ill patients with septic shock was associated with better heart rate control and survival benefits without increment in the inotropes and vasopressors requirement.

The Social Attitudes Towards the Booster Dose of the COVID-19 Vaccine and the Associated Factors Among Residents of Riyadh, Saudi Arabia.

Background As a result of the Coronavirus (COVID-19) pandemic, global health was significantly affected. Therefore, the booster dose was approved to be administered to people who had completed a primary vaccination series in order to enhance their immunity. This study aims to identify the factors that lead to willingness or hesitancy toward the third/booster dose of the COVID-19 vaccine, to estimate the rate of acceptance and hesitancy toward the third/booster dose of the COVID-19 vaccine, and to measure third/booster dose COVID-19 vaccine literacy among residents of Riyadh. Methods This study is a quantitative analytical cross-sectional, questionnaire-based study from March 2022 to December 2022. The data were gathered using a convenience sampling technique from 435 participants in the Riyadh region 16 years old and above by using a validated questionnaire. Results Among the participants, 72.6% were females; 53.4% of young participants aged 16-25 years had a good knowledge of the booster dose versus 26.2% of those aged 45 years or above, with reported statistical significance (P=0.001). The functional literacy of the COVID-19 vaccine which is defined as the ability to read and write effectively was higher among the non-hesitant group compared to the hesitant group. The interactive/critical literacy of the COVID-19 vaccine, which is defined as the advanced abilities that enable people to make sense of information so they may take decisions that are relevant to their own lives, was higher among the non-hesitant group compared to the hesitant group. 72.2% of the study participants reported that if the booster dose of the COVID-19 vaccine was not mandatory by the government, they would not have taken it. Also, 19.1% thought that taking the booster dose of the COVID-19 vaccine would endanger their lives. Conclusion The findings of the current study revealed that the factors leading to the willingness or hesitancy toward the booster dose of the COVID-19 vaccine include age, gender, and side effects. Also, measuring the COVID-19 vaccine literacy revealed that it is higher among the non-hesitant group than the hesitant group although it was statistically insignificant. Meanwhile, further studies should be done to track and measure COVID-19 vaccine literacy over time, and examine the factors associated with the booster dose of COVID-19 vaccine hesitancy for more validation and application.

Bias in artificial intelligence algorithms and recommendations for mitigation.

The adoption of artificial intelligence (AI) algorithms is rapidly increasing in healthcare. Such algorithms may be shaped by various factors such as social determinants of health that can influence health outcomes. While AI algorithms have been proposed as a tool to expand the reach of quality healthcare to underserved communities and improve health equity, recent literature has raised concerns about the propagation of biases and healthcare disparities through implementation of these algorithms. Thus, it is critical to understand the sources of bias inherent in AI-based algorithms. This review aims to highlight the potential sources of bias within each step of developing AI algorithms in healthcare, starting from framing the problem, data collection, preprocessing, development, and validation, as well as their full implementation. For each of these steps, we also discuss strategies to mitigate the bias and disparities. A checklist was developed with recommendations for reducing bias during the development and implementation stages. It is important for developers and users of AI-based algorithms to keep these important considerations in mind to advance health equity for all populations.

Assessing Radiation Dosage in Pediatric Head and Neck Computed Tomography Examinations During COVID-19 in a Tertiary Hospital in Saudi Arabia, Jeddah.

This study aimed to assess the practice of imaging and optimization of the radiation dose in pediatric head and neck computed tomography (CT) examinations during the coronavirus disease of 2019 (COVID-19) period. This study is based on a retrospective analysis of pediatric head CT records, conducted in the Radiology Department of the King Abdulaziz University Hospital in Jeddah, Saudi Arabia. We examined the data of all pediatric patients between 0 and 14 years of age who underwent head CT scans between March and September in both 2019 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic). In total, we analyzed 1005 scans; 531 (52.8%) were performed before and 474 (47.2%) during COVID-19. The dose parameters were similar; however, the exposure time was significantly lower during COVID-19 (5432 ms vs. 5811 before; p < 0.001). In contrast, the mean total CTDIvol and dose-length product (DLP) were slightly higher during COVID-19 than those before (23.34 mGy vs. 22.04 mGy (p-value=0.565) and 577.36 mGy*cm vs. 518.93 mGy*cm (p-value=0.193) respectively). These changes could be attributed to the desire to limit the contact between technicians and patients. The limitation of contact with the patient allows the technicians to be independent during the scan, possibly accounting for this slight decrease.

Clinical manifestations of COVID-19 versus other upper respiratory tract infections in pediatric patients.

OBJECTIVES: To explore the differences between COVID-19 and upper respiratory tract infections (URTI) in the pediatric population, emphasizing smell and taste disturbances. METHODS: A case-control study included 468 patients, 234 with COVID-19 (cases) and 234 with URTI (controls) at a tertiary hospital, Riyadh, Saudi Arabia, from 2020-2021. Patients with bacterial URTI, lower tract respiratory infections, and speech or developmental delays were excluded. Statistical analysis was carried out using Statistical Analysis System, 9.2 version. A p-value of ≤0.05 was considered significant. RESULTS: The male-to-female ratio was almost equal, with a mean age of 9.90±2.34. Multivariable logistic regression analysis showed that a change in taste significantly increases the probability of COVID-19 by 21.98 times. On the other hand, sore throat (81.5%), dyspnea (63.5%), nasal obstruction (72.7%), and otalgia significantly (74.8%) decrease the likelihood of COVID-19. CONCLUSION: Taste disturbances increase the probability of COVID-19 infections, whereas sore throat, dyspnea, nasal obstruction, and otalgia increase the likelihood of other URTIs. The described differences might aid physicians in their differential diagnosis and treatment during the pandemic.

A retrospective cohort study on the use of machine learning to predict stone-free status following percutaneous nephrolithotomy: An experience from Saudi Arabia.

Background: Machine learning techniques have been used extensively in the field of clinical medicine, especially when used for the construction of prediction models. The aim of the study was to use machine learning to predict the stone-free status after percutaneous nephrolithotomy (PCNL). Materials and methods: This is a retrospective cohort study of 137 patients. Data from adult patients who underwent PCNL at our institute were used for the purpose of this study. Three supervised machine learning algorithms were employed: Logistic Regression, XGBoost Regressor, and Random Forests. A set of variables comprising independent attributes including age, gender, body mass index (BMI), chronic kidney disease (CKD), hypertension (HTN), diabetes mellitus, gout, renal and stone factors (previous surgery, stone location, size, and staghorn status), and pre-operative surgical factors (infections, stent, hemoglobin, creatinine, and bacteriuria) were entered. Results: 137 patients were identified. The majority were males (65.4%; n = 89), aged 50 years and above (41.9%; n = 57). The stone-free status (SFS) rate was 86% (n = 118). An inverse relation was detected between SFS, and CKD and HTN. The accuracies were 71.4%, 74.5% and 75% using Logistic Regression, XGBoost, and Random Forest algorithms, respectively. Stone size, pre-operative hemoglobin, pre-operative creatinine, and stone type were the most important factors in predicting the SFS following PCNL. Conclusion: The Random Forest model showed the highest efficacy in predicting SFS. We developed an effective machine learning model to assist physicians and other healthcare professionals in selecting patients with renal stones who are most likely to have successful PCNL treatment based on their demographics and stone characteristics. Larger multicenter studies are needed to develop more powerful algorithms, such as deep learning and other AI subsets.

Bayesian method application: Integrating mathematical modeling into clinical pharmacy through vancomycin therapeutic monitoring.

The most recent consensus guidelines for dosing and monitoring vancomycin recommended the use of area-under-the-curve with Bayesian estimation for therapeutic monitoring. As this is a modern concept in the practice of clinical pharmacy, the main objective of this review is to introduce the fundamentals of Bayesian estimation and its mathematical application as it relates to vancomycin therapeutic drug monitoring. In addition, we aim to identify pharmacokinetic (PK) software programs that incorporate Bayesian estimation for vancomycin dosing and to describe the PK models utilized in those software programs for the adult population. Twelve software programs that utilize Bayesian estimation were identified, which included: Adult and Pediatric Kinetics, Best Dose, ClinCalc, DoseMeRx, ID-ODS, InsightRx, MwPharm++, NextDose, PrecisePK, TDMx, Tucuxi, and VancoCalc. The software programs varied in the population PK models used as the Bayesian a priori. With the presence of various vancomycin Bayesian software programs, it is important to choose those that utilize PK models reflective of the specific patient population.

A Systematic Review and Meta-Analysis Evaluating Geographical Variation in Outcomes of Cancer Patients Treated in ICUs.

The reported mortality rates of cancer patients admitted to ICUs vary widely. In addition, there are no studies that examined the outcomes of critically ill cancer patients based on the geographical regions. Therefore, we aimed to evaluate the mortality rates among critically ill cancer patients and provide a comparison based on geography. DATA SOURCES: PubMed, EMBASE, and Web of Science. STUDY SELECTION: We included observational studies evaluating adult patients with cancer treated in ICUs. We excluded non-English studies, those with greater than 30% hematopoietic stem cell transplant or postsurgical patients, and those that evaluated a specific type of critical illness, stage of malignancy, or age group. DATA EXTRACTION: Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. Studies were classified based on the continent in which they were conducted. Primary outcomes were ICU and hospital mortality. We pooled effect sizes by geographical region. DATA SYNTHESIS: Forty-six studies were included (n = 110,366). The overall quality of studies was moderate. Most of the published literature was from Europe (n = 22), followed by North America (n = 9), Asia (n = 8), South America (n = 5), and Oceania (n = 2). Pooled ICU mortality rate was 38% (95% CI, 33-43%); the lowest mortality rate was in Oceania (26%; 95% CI, 22-30%) and highest in Asia (51%; 95% CI, 44-57%). Pooled hospital mortality rate was 45% (95% CI, 41-49%), with the lowest in North America (37%; 95% CI, 31-43%) and highest in Asia (54%; 95% CI, 37-71%). CONCLUSIONS: More than half of cancer patients admitted to ICUs survived hospitalization. However, there was wide variability in the mortality rates, as well as the number of available studies among geographical regions. This variability suggests an opportunity to improve outcomes worldwide, through optimizing practice and research.

Serum vitamin D level in healthy individuals versus patients with symptomatic and asymptomatic oral lichen planus.

The aetiology of oral lichen planus (OLP) is multifactorial, having variable triggers. A role for vitamin D related to the immune system has been established. Vitamin D modulating effect is on the adaptive and innate immune responses. Our study aimed to compare serum levels of vitamin D in patients having different clinical symptoms of OLP (symptomatic or asymptomatic) with healthy individuals. Also, in this study, for further evaluation, the expression level of interleukin-17A and interleukin-6 (IL-17A and IL-6) was evaluated because the presence of active vitamin D reduces the expression of these pro-inflammatory factors. This study was included three groups with 30 volunteers in each. The first group included asymptomatic oral lichen planus patients (reticular or plaque-like lesions). The second group consisted of symptomatic oral lichen planus patients (atrophic or bullous-erosive lesions). In contrast, the third group consisted of healthy control subjects. The serum 25-hydroxyvitamin D was measured between the three groups and then correlated with clinical manifestation of oral lichen planus, either symptomatic or non-symptomatic. The Real-Time PCR technique was used to evaluate the expression of IL-17A and IL-6. Patients with symptomatic OLP (second group) had statistically significantly lower Vitamin D levels than asymptomatic OLP patients (first group). Healthy Controls (third group) exhibited statistically significantly higher vitamin D levels than OLP groups. The results of IL-17A and IL-6 genes expression showed that the presence of vitamin D had a statistically significant effect on reducing the expression of these two pro-inflammatory cytokines among symptomatic and asymptomatic OLP patients. Also, the results showed that there was a statistically significant difference between OLP patients (group I and II) and the control group (group III). In general, the current study results showed that lack of vitamin D had an important role in initiating or increasing the OLP's severity.

Antidepressants and health-related quality of life (HRQoL) for patients with depression: Analysis of the medical expenditure panel survey from the United States.

BACKGROUND: Despite the empirical literature demonstrating the efficacy of antidepressant medications for treatment of depression disorder, these medications' effect on patients' overall well-being and health-related quality of life (HRQoL) remains controversial. This study investigates the effect of antidepressant medication use on patient-reported HRQoL for patients who have depression. METHODS: A comparative cohort, secondary database analysis was conducted using data from the United States' Medical Expenditures Panel Survey for patients who had depression. HRQoL was measured using the SF-12 and reported as physical and mental component summaries (PCS and MCS). A cohort of patients that used antidepressant medications were compared to a cohort of patients that did not. Univariate and multivariate difference-in-differences (D-I-D) analyses were used to assess the significance of the mean difference of change on the PCS and MCS from baseline to follow-up. RESULTS: On average, 17.5 million adults were diagnosed with depression disorder each year during the period 2005-2016. The majority were female (67.9%), a larger proportion of whom received antidepressant medications (60.5% vs. 51.5% of males). Although use of antidepressants was associated with some improvement on the MCS, D-I-D univariate analysis revealed no significant difference between the two cohorts in PCS (-0.35 vs. -0.34, p = 0.9595) or MCS (1.28 vs. 1.13, p = 0.6405). The multivariate D-I-D analyses ensured the robustness of these results. CONCLUSION: The real-world effect of using antidepressant medications does not continue to improve patients' HRQoL over time. Future studies should not only focus on the short-term effect of pharmacotherapy, it should rather investigate the long-term impact of pharmacological and non-pharmacological interventions on these patients' HRQoL.

Effects of Abstinence Self-Efficacy and Outcome Expectancies of Tobacco Smoking on the Desire to Quit Among Saudi Women: A Cross-Sectional Mediation Analysis.

BACKGROUND: Smoking is one of the major preventable causes of morbidity and mortality and has been associated with numerous illnesses. While smoking is increasing among Saudi women, the characteristics of smoking behavior related to abstinence self-efficacy, which is a belief regarding one's ability to successfully resist performing a behavior, and outcome expectancies, meaning the anticipated consequences of performing a behavior, are unknown. Therefore, this study aimed to test whether abstinence self-efficacy mediated the relationship between tobacco smoking outcome expectancies and the desire to quit tobacco among Saudi women who smoke. METHODS: This cross-sectional study collected a sample of 211 Saudi women who smoked tobacco, including cigarettes and shisha. A self-administered questionnaire was used to examine several variables, including abstinence self-efficacy, outcome expectancies, and desire to quit tobacco smoking. Mediational path analysis was used to answer the research question. Indirect effects were estimated through a bootstrapping of 10,000. RESULTS: All 4 constructs of outcome expectancies (negative consequences, positive reinforcement, negative reinforcement, and appetite/weight control) were associated with lower abstinence self-efficacy and desire to quit tobacco smoking. In the mediation analysis, the indirect effect of negative consequences (standardized beta = -.013, SE = .008, 95% CI [-.030, -.001]), negative reinforcement (standardized beta = -.012, SE = .006, 95% CI [-.025, -.001]), and appetite/weight control (standardized beta = -.008, SE = .006, 95% CI [-.022, -.001]) through abstinence self-efficacy were significant, suggesting mediation in the relationship between outcome expectancies and desire to quit tobacco smoking. CONCLUSION: Cognitive mechanisms that may explain the desire to quit tobacco smoking among Saudi women were identified. Although future longitudinal studies are required to determine relationships prospectively, targeted interventions that correct tobacco smoking outcome expectancies and boost abstinence self-efficacy skills may reduce tobacco smoking among Saudi women.

Fasting during Ramadan and acute kidney injury (AKI): a retrospective, propensity matched cohort study.

BACKGROUND: During the month of Ramadan, Muslims abstain from daytime consumption of fluids and foods, although some high-risk individuals are exempt. Because fasting's effects on the risk of acute kidney injury (AKI) have not been established, this study assesses the relationship between fasting and risk of AKI and identifies patients at high risk. METHODS: A single-center, retrospective, propensity-score matched, cohort study was conducted with data collected from adult patients admitted to the emergency room during Ramadan and the following month over two consecutive years (2016 and 2017). AKI was diagnosed based on the 2012 definition from the Kidney Disease: Improving Global Outcomes clinical practice guideline. Multivariable logistic regression analyses were used to examine the correlation and measure the effect of fasting on the incidence of AKI, and assess the effect of different variables on the incidence of AKI between the matching cohorts. RESULTS: A total of 1199 patients were included; after matching, each cohort had 499 patients. In the fasting cohort, the incidence of AKI and the risk of developing AKI were significantly lower (adjusted odds ratio (AOR) 0.65;95% confidence interval (CI) 0.44-0.98). The most indicative risk factors for AKI were hypertension (AOR 2.17; 95% CI 1.48-3.18), history of AKI (AOR 5.05; 95% CI 3.46-7.39), and liver cirrhosis (AOR 3.01; 95% CI 1.04-8.70). Patients with these factors or most other comorbidities in the fasting cohort had a lower risk of AKI as compared with their nonfasting counterparts. CONCLUSION: The data show a strong reduction in the risk of developing AKI as a benefit of fasting, particularly in patients with comorbid conditions. Therefore, most patients with comorbid conditions are not harmed from fasting during Ramadan. However, larger prospective studies are needed to investigate the benefit of fasting in reducing the risk of developing AKI.

First report of rare persistence granulomatous extra respiratory Rhinoscleroma of oral pathology.

Rhinoscleroma (RS) is a rare chronic specific progressive granulomatous disease of the upper airway and affect the nasal cavity, larynx, nasopharynx and may spread to the lower respiratory tract. Extra-respiratory involvement has rarely been described. A case report of extra-respiratory RS with oral manifestation in Egyptian female patient has been presented as a tumour extruded from mucosal lining of upper lip. She was living in crowded conditions with malnutrition and poor hygiene. On the first look, the lesion appeared to be carcinoma without any indication of infectious disease, and then patient was prepared for incisional biopsy. Upon clinicopathological evaluation, the diagnosis was made as RS in the granulomatous stage based on the presence of dense plasma cell infiltration with Mikulicz cells and Russell bodies. Long term oral ciprofloxacin 500 mg twice/day was started as a single treatment. By the end of six weeks antibiotic therapy, the large granulomatous mass reached the cicatricial stage, became very stiff fibrotic mass with sclerotic scar, markedly indurated & significantly decreased in size. This case shows the significant of through clinical examination and lab investigations to achieve correct diagnosis.

Vancomycin therapeutic monitoring by measured trough concentration versus Bayesian-derived area under the curve in critically ill patients with cancer.

The updated vancomycin guideline and recent studies suggested that trough concentrations may result in underestimation of the actual area under the curve (AUC), leading to excessive dosing and nephrotoxicity. With limited data available on critically ill cancer patients, this study aimed to compare the two methods in this patient population. This was a 5-year retrospective study on patients treated with vancomycin in the intensive care unit (ICU) of a comprehensive cancer center. The measured trough concentration was compared to Bayesian-derived AUC/minimum-inhibitory-concentration (MIC), considering MIC as 1. Trough concentrations of 15-20 mg/L and AUC of 400-600 mg h/L were considered the targeted goal. Multivariate analysis was performed to identify factors associated with an AUC below the targeted goal. During the study period, 316 patients were included. The mean age was 54 years ±16 (SD); most patients had solid tumors (75%), and 11% had neutropenia. A targeted goal AUC and trough were recorded in 128 (41%) patients and in 64 (20%) patients, respectively. Of the 128 patients with targeted goal AUC, 31 (24%) had targeted goal trough concentrations and 91 (71%) had trough concentrations below 15 mg/L. Furthermore, among the patients with targeted goal trough concentration (n = 64), 33 (52%) had higher than targeted goal AUC. Augmented renal clearance (ARC), defined as a calculated creatinine-clearance ≥130 ml/min, was associated with an AUC below the targeted goal. In a cohort of critically ill patients with cancer, over two-thirds of the patients with a targeted goal Bayesian AUC/MIC had trough concentrations below the targeted goal. ARC was associated with AUC below the targeted goal.

Impact of Clinical Pharmacy Services on Patient Management in the Chemotherapy Infusion Clinics: A 5-Year Study at a Comprehensive Cancer Center.

BACKGROUND: Chemotherapy requires careful dosing and monitoring and is associated with numerous adverse events. There is limited data describing the impact of clinical pharmacists in the chemotherapy ambulatory setting. OBJECTIVE: This study aimed to evaluate the impact of clinical pharmacy services on patient management in the adult chemotherapy infusion clinics. METHODS: This was a 5-year retrospective study that utilized the pharmacy electronic documentation system to determine the type of interventions and adverse drug events (ADEs) reported by the clinical pharmacists in the chemotherapy infusion clinics. Interventions were described based on the type of intervention and medication involved. ADEs were evaluated based on the type of ADE, the suspected medication, and the required management. RESULTS: During the study period, 3,279 interventions and 1,445 ADEs were reported. The most common interventions involved dose adjustments (51%), followed by addition (23%) or discontinuation (21%) of prescribed medications. Carboplatin (20%) and zoledronic acid (14%) were the most common medications that required pharmacist interventions. The most common types of ADEs were hematologic (22%) and infusion-related reactions (20%). Docetaxel was the most common medication associated with ADEs (20%). Among the reported ADEs, most required adding supportive care (44%), followed by adjusting chemotherapy doses (22%). CONCLUSION: Clinical pharmacy services at the chemotherapy infusion clinics play an important role in optimizing the chemotherapy regimens as well as identifying and managing ADEs. Future studies should be directed to measure the impact of these services on patient outcomes as well as, physicians and pharmacy operational workload and cost savings.

Impacts of a Mail-Order Service for Refilling Prescriptions on Patient Satisfaction and Operational Load at a Comprehensive Cancer Center in Jordan.

BACKGROUND: Mail-order services for refilling prescriptions for medications have been established in many countries and have increased patient satisfaction. We developed a mail-order service for the outpatient pharmacy of a comprehensive cancer center in Jordan. OBJECTIVE: To describe the implementation of a mail-order service and to report the impact of the service on patient satisfaction and the pharmacy workload. METHODS: A multidisciplinary team was formed to plan a mail-order service for refilling prescriptions for medications, and a survey was designed to evaluate patient satisfaction with the service. Patients were instructed to call the refill call center and order their medications at least 48 hours before their refill is due. The pharmacy workflow for refilling prescriptions was evaluated, and the time required with and without the mail-order service was documented, with a calculation of the time saved. RESULTS: At 1 year after the mail-order service had been established, 14 200 prescriptions had been refilled through the service, with the majority (97.5%) dispensed within 48 hours of the order time. As per the survey conducted with 219 patients, on the overall satisfaction, 69.4% reported being highly satisfied with the service and 27.9% reported being satisfied. The problems reported with the service were delay in arrival (n = 23, 10.5%), medication-related errors (n = 9, 4.1%), cash-related error (n = 1, 0.45%), improper storage condition (n = 1, 0.45%), and delivery to the wrong address (n = 4, 1.8%). The service was also associated with reduced overall time for processing in the outpatient pharmacy service; for patients receiving their medications from the pharmacy, resulting in reduced patients' overall waiting time (from 11.4 to 8.2 minutes). The service resulted in saving of 0.4 full-time employee at 1 year of implementation. CONCLUSIONS: A mail-order service for refilling prescriptions within a hospital setting had positive outcomes on both patient satisfaction and the pharmacy workflow. The major issues were related to transportation and logistics.

[Coronary aneurysm secondary to Kawasaki disease in an adult. Report of one case]. / Aneurisma coronario secundario a enfermedad de Kawasaki en paciente adulto. Caso Clínico.

Kawasaki disease (KD) can be a primary cause of an acute coronary syndrome in young adults, with or without a history of KD during childhood. We report a 31year old female, admitted for acute chest pain. She had negative T waves on DIII and AVF leads of the electrocardiogram. Troponins were positive. A cardiac magnetic resonance was compatible with an acute inferior myocardial infarction. In the coronary angiography she had a calcified complete occlusion of the proximal right coronary artery. The left coronary artery had no visible lesions. A computed angiogram showed an extensive calcified and thrombotic aneurysm of the right coronary artery, compatible with Kawasaki disease (KD). The patient was discharged seven days after admission in good conditions.

Current practices of plastic surgeons at King Abdulaziz University Hospital in requesting breast imaging studies prior to non-oncological breast surgeries.

BACKGROUND: In the context of the high incidence of breast cancer and the high frequency of breast cosmetic surgeries, malignant and/or premalignant lesions are frequently detected incidentally in postoperative histopathology specimens. The current literature does not provide clear practice guidelines for the use of preoperative imaging prior to non-oncological breast surgeries. OBJECTIVES: In this study, we aimed to determine the current practices of plastic surgeons at King Abdulaziz University Hospital (KAUH) and their use of preoperative breast imaging before non-oncological breast surgeries. DESIGN: Non-intervention/ retrospective record review. SETTINGS: Department of Radiology at King Abdulaziz University Hospital (KAUH). METHODS: In 08/06/2017 at King Abdulaziz University Hospital, we conducted a single-center, retrospective chart review of the medical files of candidates for non-oncological breast surgery in order to examine preoperative imaging requests by plastic surgeons in the period 01/01/2013 to 08/06/2017. MAIN OUTCOME MEASURES: The practice of plastic surgeons at KAUH in requesting preoperative imaging prior non-oncological breast surgeries. SAMPLE SIZE: 104 patients. RESULTS: We found that, in the period 2013 to 2017, 104 women who underwent non-oncological breast surgeries were evaluated for recent preoperative breast imaging. Only 37 patients (35.6%) were found to have had preoperative imaging, and only less than one fifth (19.4%) of those 37 patients had abnormal preoperative imaging results, all of which were negative for malignancy. CONCLUSIONS: Although the yield of malignancy on preoperative breast imaging was zero in women seeking non-oncological breast surgeries at KAUH, we recommend the establishment of unified practice guidelines to be followed by plastic surgeons for better postoperative screening in different risk groups. LIMITATIONS: Lack of follow up of patients postoperatively for any development of malignancy.

Knowledge, attitude, and practice of medical ethics among health practitioners in Taif government, KSA.

OBJECTIVES: Medical ethics practice and the attitude and knowledge toward it was our concern and aim to investigate. METHODS: A cross-sectional study was conducted on 1943 healthcare practitioners from three tertiary care hospitals. A questionnaire requesting demographic data and items related to the level of knowledge and awareness beside the real-life practice of medical ethics among healthcare providers was used. A score was given for each response and a total score was calculated. RESULTS: Of the participants, 86.9% had studied medical ethics, 70.3% thought patients should know about their rights, 87.4% supported that the patient have the right to know and be informed if any malpractice happened, 61.8% never engaged in healthcare-related act on a patient without informed consent, 73% ensured that no one was present other than medical team during assessments or procedures, and 86.6% tried to give only what was necessary to the patient regarding their situation. Nursing specialists/technicians, with of 20-<30 years of practice and participants who had previous training in bioethics had significantly higher mean attitude scores than others. Females, laboratory specialists/technicians, and those who reported previous study of medical ethics had a significantly higher practice scores. A cogent positive correlation was found between the practice and attitude scores. CONCLUSION: Interduce medical ethics and insist on its importance in medical institutions will positively affect practitioners' knowledge, attitude, and practice.

Iatrogenic Toxicities in the Intensive Care Unit.

Drug-induced iatrogenic toxicities are common in critically ill patients and have been associated with increased morbidity and mortality. Early recognition and management of iatrogenic toxicities is essential; however, the diagnosis is usually complicated by the underlying critical illness, comorbidities, and administration of multiple medications. This article reviews several types of iatrogenic toxicities associated with medications that are commonly used in critically ill patients. The mechanism of the iatrogenic toxicities, clinical presentation, and diagnosis, as well as management are discussed.