Natural bio-convective flow of Maxwell nanofluid over an exponentially stretching surface with slip effect and convective boundary condition.

The under-consideration article mainly focuses an unsteady three-dimensional Maxwell bio-convective nanomaterial liquid flow towards an exponentially expanding surface with the influence of chemical reaction slip condition. The feature of heat transport is achieving in the existenceof convective boundary condition and variable thermal conductivity. With the help of similarity variables, the flow form of equations is turned into a nonlinear form of coupled ODEs. The numerical solutions are calculated by adopting bvp4c function of MATLAB. Impact of distinct characteristics on the temperature, velocity microorganism and concentration field is graphically evaluated. Moreover, physical quantities are observed via graphs and tabulated data in details. It has been seen by the observation that the involvement of unsteadiness parameter restricts the change of laminar to turbulent flow. Further, for increasing velocity slip parameter velocity component in both directions shows lessening behavior. The Nusselt number exhibits diminishing behavior for larger values of Deborah number, and it shows the opposite behavior for larger values of convective parameter.

Medication errors associated with direct-acting oral anticoagulants: analysis of data from national pharmacovigilance and local incidents reporting databases.

BACKGROUND: For more than a decade, direct oral anticoagulants (DOACs) have been approved in clinical practice for multiple indications such as stroke prevention in non-valvular atrial fibrillation treatment of deep vein thrombosis and pulmonary embolism. This study aimed to explore the nature and contributory factors related to medication errors associated with DOACs in hospital settings. METHODS: Analysis of error reports using data from (a) Saudi Food and Drug Authority pharmacovigilance database and (b) local incidents reporting system from two tertiary care hospitals were included. Errors reported between January 2010 to December 2020 were also included. Statistical analyses were performed using IBM (SPSS) Statistics Version 24.0 software. RESULTS: A total of 199 medication error incidents were included. The mean (range) age of affected patients was 63.5 (19-96) years. The mean reported duration of treatment when incidents happened was 90 days, with a very wide range from one day to 12 months. Prescribing error was the most common error type representing 81.4% of all errors. Apixaban was the most frequent drug associated with error reporting with 134 (67.3%) incidents, followed by rivaroxaban (18.6%) and dabigatran (14.1%). The majority of the patients (n = 188, 94.5%) showed comorbidities in addition to the conditions related to DOACs. Polypharmacy, an indication of treatment and duration of therapy were amongst the important contributory factors associated with errors. CONCLUSIONS: This observational study demonstrates the nature of DOAC related medication errors in clinical practice. Developing risk prevention and reduction strategies using the expertise of clinical pharmacists are imperative in promoting patient safety associated with DOAC use.

The development and validation of a multivariable model to predict the bleeding risk score for patients with non-valvular atrial fibrillation using direct oral anticoagulants in the Arab population.

BACKGROUND: Frequently used models, such as the HAS-BLED, ATRIA, ORBIT, and GARFIELD-AF evaluate the risk of bleeding when using an anticoagulant, for example warfarin, in patients with non-valvular atrial fibrillation. Limited studies are available reporting a model with a good discriminative ability to predict the bleeding risk score when using direct oral anticoagulants. METHODS: Patient data were collected from King Abdulaziz Medical City, King Fahad Cardiac Center, and Prince Sultan Cardiac Center in Riyadh, from outpatients, inpatients, or primary care clinics. In total, 1722 patients with a prescription for a new oral anticoagulant, Dabigatran, Rivaroxaban, or Apixaban, were enrolled. A resampling approach for variable selection was used and a five-fold cross-validation to assess the model fit and misclassification probabilities. The analysis used the receiver operating characteristics curve (ROC) and the concordance (c) statistic to assess the validation models' discriminative power. The final penalized likelihood parameters were used for the development of the risk prediction tool. The accuracy of a classification and the prediction are reported with the sensitivity, specificity, and Brier score. RESULTS: Bleeding occurred in 11.15% of cases, of which 23.08% required a blood transfusion and 51.65% had a reduction in haemoglobin of more than 2 gm. The variable selection model identified 15 predictors associated with major bleeding. The discriminative ability of the model was good (c-statistic 0.75, p = 0.035). The Brier score of the model was 0.095. With a fixed cut-off probability value of 0.12 for the logistic regression equation, the sensitivity was 72.7%, and the specificity 66.3%. CONCLUSION: This model demonstrated a good performance in predicting the bleeding risk in Arab patients treated with novel oral anticoagulants. This easy to use bleeding risk score will allow the clinician to quickly classify patients according to their risk category, supporting close monitoring and follow-up for high-risk patients, without laboratory and radiological monitoring.

Pattern of hydromorphone use in King Abdulaziz Medical City-Central Region (KAMC-CR).

Hydromorphone is a semi-synthetic opioid that acts mainly on the µ-opioid receptor. Hydromorphone has a fast onset of action, usually within 5 min, and its effectiveness peaks at approximately 20 min, which makes it favourable in the postoperative setting. It plays a role in the management of moderate to severe chronic pain. The most common adverse effects of hydromorphone are hypotension, bradycardia, and respiratory distress. The aim of this study was to determine the trend in the use of hydromorphone analgesics and to evaluate hydromorphone-related toxicity in King Abdulaziz Medical City-Central Region (KAMC-CR). A retrospective, cross-sectional study was carried out in KAMC-CR, and medical and pharmacological data were retrieved from electronic health records for adult patients who used hydromorphone between December 2014 and December 2015. The characteristics of the enrolled patients, including measured blood pressure, heart rate, respiration rate, oxygen saturation, and pain severity score, were collected. Moreover, we identified patients who received naloxone as a hydromorphone antidote. A total of 153 patients were included; 64.1% were male and 35.8% were female. The mean age of the included patients was 55.5 years old (+/- 18.6). Although the majority of patients reported an improvement in pain severity, 75 patients (49%) needed naloxone to overcome adverse effects of hydromorphone. The mean age of patients who received naloxone was 56.2 years old (+/- 20.5), their mean weight was 75.9 kg (+/- 17.2), and 61.3% of them were male (n = 46). Among those who received naloxone, 84% patients (n = 63) had received hydromorphone intravenously. The risk of respiratory depression was significantly higher in patients who received hydromorphone intravenously (IV) than in those who received it orally (p = 0.02). Hydromorphone can have adverse effect. Thus, we recommend evaluating cardiac parameters, oxygen saturation, respiration rate, and pain severity before administering hydromorphone, particularly in patients who have a high risk of cardiorespiratory adverse events, such as patients with cardiac disease, asthma, or chronic obstructive pulmonary disease. Additionally, we recommend the use of appropriate hydromorphone doses in cases of conversion from other opioid therapy or changes between oral and IV routes of the administration of hydromorphone. Moreover, we recommend establishing a policy to restrict the prescription of hydromorphone to avoid the overuse of hydromorphone and minimize the risk of adverse effects and medication errors.

Validation and Psychometric Properties of the Arabic Version of the Duke Anticoagulation Satisfaction Scale (DASS).

Background: To assess the health-related quality of life (HRQoL) of oral anticoagulant therapy users, different types of instruments are available, either general or specific tools like Duke Anticoagulation Satisfaction Scale (DASS). These tools allow the clinician to adjust the treatment regimen to focus on increasing anticoagulation adherence and reduce adverse clinical outcomes. This study aims to validate the translated Arabic version of DASS to assess the satisfaction level of patients using oral anticoagulants in the Arab population. Methods: The Duke Anticoagulation satisfaction scale (DASS) was translated into the Arabic language using MAPI group services. DASS was administered to 505 patients receiving anticoagulation with warfarin or apixaban. The generic scale measuring the quality of life EQ-5D-5L was also administered. Psychometric properties were assessed by Confirmatory Factor Analysis, internal consistency (Cronbach's Alpha), exploratory factor analysis, convergent and divergent validity, and the correlation between the DASS and demographic variables, clinical characteristics, and the EQ-5D-5L instrument. Results: 439 subjects answered all the questions. From a total of 25 items, 22 grouped into three factors (limitations, positive impact, and negative impact). Each factor had good internal consistency (Cronbach Alpha 0.78-0.88). All the three factors correlated consistently with EQ-5D-5L measuring generic quality of life. Conclusion: The psychometric properties of the Arabic DASS version were comparable to the original English version. The Arabic version of the DASS showed very good reliability and validity. It can be used by health care professionals in other settings of anticoagulation clinics to assess patient's satisfaction and limitations to anticoagulant treatment.

Association between omeprazole use and Clostridium difficile infection among hospitalized patients: A case-control study of the Saudi population.

Background: While few international studies have assessed the association between omeprazole use and the risk of Clostridium difficile infection (CDI), research into this is lacking in Saudi Arabia and the Middle East region. The aim of this study was to determine whether exposure to omeprazole is associated with the risk of Clostridium difficile infection in a sample of hospitalized Saudi patients. Methodology: A retrospective matched case-control study was conducted at the King Abdulaziz Medical City in Riyadh, Saudi Arabia, from 1 August 2010 through 31 July 2015. The analysis included a total of 200 patients: 100 CDI cases and 100 matched controls. Results: The majority (60%, 120 out of 200) of patients had received proton pump inhibitors (PPIs), and a minority (18.5%, 37 out of 200) had received omeprazole. The PPI use was insignificantly higher in CDI cases than in controls. However, the use of omeprazole was significantly higher in CDI cases compared with controls. Specifically, patients receiving omeprazole were two times more likely to develop CDI compared with controls (aOR = 2.1, 95% confidence interval (CI) = (1.007-4.437)). After adjusting for potential predictors of CDI, watery diarrhea (aOR = 59.1, 95% CI = 19.831-175.974) and abdominal pain (aOR = 7.5, 95% CI = 2.184-25.445) were found to be independent predictors of CDI. Conclusions: The data suggests that PPIs were commonly used in patients admitted to King Abdulaziz Medical City in Riyadh: six out of ten patients received PPIs. The findings support a possible association between the use of omeprazole and a high risk of CDI. To confirm causality, the link between omeprazole and CDI should be assessed in a large interventional study.

The outcome of pharmacist counseling at the time of hospital discharge: an observational nonrandomized study.

BACKGROUND AND OBJECTIVES: Adverse drug events (ADEs) may occur after discharge from acute care hospitalization because of limited instruction on medications at discharge. The right instructions given to patients may reduce the risk of ADEs. The objective of our study was to assess a program involving comprehensive medication counseling provided by pharmacists at the time of discharge from a tertiary hospital in Riyadh, Saudi Arabia. DESIGN AND SETTING: A prospective, nonrandomized observational study over a period of 3 months in a 1000-bed tertiary hospital. PATIENTS AND METHODS: Patients discharged from the internal medicine wards with more than three medications received comprehensive pharmacist counseling. The intervention pharmacist counseled patients about their discharge medications and provided written materials as needed. Topics discussed with the patients included the importance of following prescribed medication regimens and the indications, directions, and any potential side effects of discharge medications. The control group included similar patients who received routine discharge counseling by nurses. Two weeks after discharge, the same pharmacist called the patients and assessed the frequency of ADEs. Two independent clinicians reviewed each ADEs and judged its severity and preventability. RESULTS: Out of 200 patients included in the study (100 patients from the intervention group and 100 patients from the control group), 175 patients (87.5%) were successfully contacted two weeks after discharge (88 patients from the intervention group and 87 patients from the control group). ADEs occurred in 2 patients (2.3%) in the intervention group and in 21 patients (24%; 23 incidents in 21 patients) in the control group (P < .001). In the control group, 14 ADEs (61%) were judged as preventable, and 9 (39%) were judged as serious. CONCLUSIONS: A comprehensive medication counseling program at hospital discharge reduced the incidence of ADEs two weeks after discharge from a tertiary hospital in Riyadh, Saudi Arabia. Further studies assessing the long-term outcomes of such a program are needed.