Patients, Prescribers, and Institutional Factors Associated with Inappropriate Use of Acid Suppressive Therapy in Medical Wards: An Experience of a Single-Center in Saudi Arabia.

PURPOSE: To identify factors associated with inappropriate acid-suppressive therapy (AST) use in hospitalized medical ward patients. PATIENTS AND METHODS: This was a combined retrospective cohort study reviewing the electronic medical records of medical ward in a secondary university hospital between January 2018 and July 2019, in addition to prescriber surveys about AST knowledge. We included adult patients (≥18 years old) admitted to the medical ward who received at least one dose of AST during their hospitalization. Statistical analyses included descriptive statistics and logistic regression. RESULTS: A total of 335 patients were included. Most of the patients were female (66.6%), with a mean age of 42.37 ± 17.72 years; 76% (n=256) of the study subjects were prescribed AST for an inappropriate indication. Patients who were not receiving any home medications associated with high bleeding risk had higher odds of being prescribed AST inappropriately (OR, 4.06; 95% CI, 1.09-13.8). A total of 27 physicians completed the prescriber survey, and the average prescriber's knowledge score was 46.8 ± 15.6%. This score did not differ by the prescriber's position. CONCLUSION: This study demonstrated the overuse of AST in the medical ward. Therefore, improving providers' awareness about AST and implementing an AST stewardship program in institutions is necessary to limit this long-lasting issue.

The prevalence of emergence delirium and its associated factors among children at a postoperative unit: A retrospective cohort at a Middle Eastern hospital.

BACKGROUND: Emergence delirium (ED) has been reported among children at a postoperative setting, which delays their recovery and exposes them to traumas. The aim of this study was to determine the prevalence of ED and its associated factors among children who underwent surgeries at a major tertiary healthcare facility in Saudi Arabia. MATERIALS AND METHODS: Between March and August 2018, a retrospective cohort study was conducted based on a review of 413 medical charts of children (<14 years) who underwent an elective/nonemergency surgery and then were admitted to a Post Anesthesia Care Unit. Patient and surgery-related characteristics were analyzed as potential factors associated with ED. The anxiety level was assessed preoperatively using the Modified Yale Preoperative Anxiety Scale (four domains), while the ED was detected after surgery using the Watcha scale (child is agitated and thrashing around). RESULTS: The leading surgery category was ear, nose, and throat surgeries [184 (44.6%)] and dental surgeries [109 (26.4%)]. Almost one-third received only general anesthesia (31.2%), while 271 (68.8%) received an additional regional block/skin infiltrate. The anxiety domains preop showed that the percentage mean score ± standard deviation of expression of emotions was 37.1 ± 21.6, apparent arousal 33.7 ± 20.4, activeness 30.1 ± 13.5, and vocalization 26.9 ± 20.3. The prevalence of ED among children who underwent surgeries during the 6-month period was 23 (6.6%). Almost 18.8% of those who received opioid analgesics (fentanyl alone) developed ED, while 12% of those who received both opioid and nonopioid analgesics (fentanyl/paracetamol) developed ED. ED was significantly associated with longer recovery duration 69.5 + 27.1 min, P = 0.007. Binary logistics regression analysis showed that participants who did not receive Precedex were adj. odds ratio = 10.3 (2.4-48.9) times more likely to develop ED, compared with those who received it, adj. P = 0.003. Lower preoperative scores of expression of emotions and higher scores of apparent arousal were significantly associated with ED, adj. P = 0.035 and adj. P = 0.023, respectively. CONCLUSION: ED appears to be inevitable in postoperative settings. It is crucial to address any preoperative anxiety assessment as it is associated with ED. Anxiety remains a modifiable factor that can be managed, as well as to the administration of Precedex and adjunct analgesic treatments.

Frequency, risk factors, and outcomes in patients with significant carotid artery disease admitted to King Abdulaziz Medical City, Riyadh with Ischemic Stroke.

OBJECTIVE: To determine the frequency, risk factors, and outcomes of significant carotid artery disease (CAD) in patients with ischemic stroke. METHODS: The frequency of significant CAD in patients admitted to the Stroke Unit between January 2014 and December 2015 was determined from radiological data. Outcomes were determined clinically and radiologically. RESULTS: Among 435 patients, 273 were men (62.8%), with a mean age of 57.4+/-12.2 years. Significant CAD was found in 48 vessels in 40 (9.2%) patients, of which 30 patients were symptomatic. Nine of these patients were treated with carotid artery stenting, one underwent carotid endarterectomy, and 3 underwent an urgent thrombectomy, without stenting. Seventeen symptomatic patients were not treated for the following reasons: patient/family refusal (n=2), contraindications (n=5), and complete occlusion (n=10). One (7.7%) of the 13 treated patients had an ipsilateral stroke on follow up, one (7.7%) had contralateral transient ischemic attack (TIA), 9 (69.2%) had no recurrence, and no clinical data were available for 2 patients. Among the 17 untreated patients, one (5.9%) had an ipsilateral stroke, 7 (41.2%) had no recurrence, and 9 (52.9%) were lost to follow up. CONCLUSION: Significant carotid artery disease is uncommon in our cohort found in less than 10% of patients. Vascular risk factors are more or less similar between patients with or without CAD except obesity which appears to have inverse relation with CAD. A small number of patients received carotid intervention with no recurrence of stroke at limited follow up.

Epidemiology of Alzheimer's Disease and Dementia in Arab Countries: A Systematic Review.

BACKGROUND/OBJECTIVES: Contrary to popular belief, the condition of dementia is not an actual discrete disease, but rather a group of symptoms, most notable of which is the disturbance of memory and social ability, often severe enough to impair daily functioning. As a result, it has been a major cause of functional deterioration among varying populations in the world. This study is aimed at reviewing the epidemiology of dementia in Arab countries in terms of its prevalence, distribution, and risk factors. METHODS: A systematic literature review was conducted using articles published in PubMed, Embase, Scopus, and other local journals between 1990 and 2018. After applying the inclusion and exclusion criteria, a total of 18 studies were concluded to be eligible for the review. RESULTS: Prevalence studies demonstrated that dementia is indeed a prevalent condition in Arab countries, ranging between 1.1% and 2.3% among age groups of 50 years and older, as well as between 13.5% and 18.5% among age groups of 80 years and above. However, these results are not different from those of many other countries in the world. Moreover, prevalence was found to vary depending on sociodemographic characteristics. Major risk factors of dementia included hypertension, low income, and low education, while the risk of developing dementia is increased by obesity, diabetes mellitus, and cardiovascular risk factors. Despite the growing evidence regarding the epidemiological distribution and determinants of dementia worldwide, studies from the Arab region remain scarce. CONCLUSION: This systematic review highlights the need for population-based studies to provide necessary information for developing preventive and curative strategies specific to the Arab region.

Prevalence triggers and clinical severity associated with anaphylaxis at a tertiary care facility in Saudi Arabia: A cross-sectional study.

Anaphylaxis is a systemic and hypersensitive allergic reaction caused by various triggers such as environmental, food, drug, and insects. The aim of this study was to identify the prevalence, triggers, and clinical severity of anaphylaxis in 2 emergency departments (EDs) in Saudi Arabia.A cross-sectional study based on a screening of medical records was conducted between January 2015 and August 2017, to identify confirmed cases of anaphylaxis. Patient characteristics were age, sex, previously known allergies, and the triggering allergens. The clinical severity was measured on the basis of the anaphylaxis international assessment tool (mild, moderate, severe). Factors associated with triggers and severities were identified.The period prevalence of anaphylaxis among ED admissions was 0.00026%. Pediatric cases (age 1-16 years) were 98 (60.9%), while adults (age 17-40 years) were 63 (39.1%). Triggers of anaphylaxis were food 63 (39.1%), insects 62 (38.5%), drugs 28 (17.4%), and environmental 8 (5.0%). Mild symptoms were observed in 41 (25%) of the sample, while moderate and severe symptoms were observed in 116 (72%) and 4 (3%) of the cases, respectively. Adults were 1.25 times more likely to endure drug allergy rather than food allergy, than pediatrics with adj.P = .015. ED admissions in summer season were 1.29 less likely to be due to drug allergy rather than insect allergy, compared with admissions in winter season, adj.P = .01. Cases with known allergy were 1.72 times less likely to endure drug allergy rather than food allergy, compared with those with unknown allergy, adj.P = .001. Adults were 4.79 more likely to endure severe symptoms than pediatrics with adj.P = .001.Although the prevalence of anaphylaxis was higher in pediatrics, yet the disease was more severe in adults. Special consideration should be paid to anaphylaxis triggered by insect bites in summer, and food allergy among cases with unknown allergy upon ED admission.