Evaluating pharmacists' knowledge, attitude, and practices toward amiodarone cross-reactivity with iodine: a cross-sectional pilot study.

Introduction: Iodine is a vital mineral of the human body that acts by maintaining the health of the thyroid gland. Research has shown that iodine-rich food allergy (i.e., seafood allergy) is not caused by iodine itself; instead, it is caused by other proteins including tropomyosin and parvalbumin in shellfish and fish, respectively. Amiodarone is a commonly used antiarrhythmic agent containing a significant amount of iodine. Objective: This study's objective was to assess pharmacists' knowledge, attitude, and practices toward the misconception of iodine allergy and the cross-reactivity with amiodarone. Methods: In February 2020, a cross-sectional study was conducted by sending out an online survey to three pharmaceutical organizations (Saudi Pharmaceutical Society, Kuwait Pharmaceutical Association, and Oman Pharmaceutical Society). Additionally, an electronic questionnaire was administered to pharmacists attending the Dubai International Pharmaceuticals and Technologies Conference and Exhibition 2020 (DUPHAT). Chi-square or Fisher's exact test, when appropriate, were used to compare categorical variables. The statistical analyses were carried out using SPSS software. Results: Data were collected from 66 respondents. However, only 61 (92.4%) were included in the final analysis following the exclusion of incomplete responses. The mean age of participants was 35 ± 8.48 years. The majority of participants did not have the Board of Pharmacy Specialties Certification (54.1%). Moreover, (41%) of participants licensed as pharmacists with more than 10 years of initial pharmacy licensure. Forty-three (70.5%) of participants had the misconception that iodine allergy should be considered before amiodarone administration, 20/32 (62.5%) of whom considered iodine allergy alone thought that premedication with corticosteroids and/or antihistamines is necessary. Concerning iodine allergy and amiodarone use, there was no significant difference in knowledge between the pharmacists who have board certification and those who did not. Conclusion: Pharmacists' misconception concerning iodine allergy and cross-reactivity with amiodarone was evident. Implementation of educational programs targeting pharmacists is necessary to correct these misconceptions.

Assessment of Saudi Women's Adherence and Experience with Venous Thromboembolism Prophylaxis after Cesarean Section Delivery Using Telemedicine Technology.

Background: Telemedicine technology is widely used especially after the COVID-19 pandemic. It can be used to give medical advice as well as follow up with the patients at home in the outpatient setting. Low molecular weight heparin, such as enoxaparin, decreases the risk of venous thromboembolism after cesarean delivery. Objective: assessing postcesarean women's adherence and experience to enoxaparin thromboprophylaxis regimens in the outpatient setting via telephone calls. Methods: prospective cohort study was conducted in the Maternity and Children Hospital (MCH). Postcesarean women were interviewed at the postnatal ward in the MCH. The participants were followed up for 10 days of the delivery to assess their adherence to and experience with enoxaparin thromboprophylaxis. Suboptimal adherence was defined as the missing of one or more doses of enoxaparin. Results: 170 women participated in this study. The majority of them (78.8%) were fully adherent to enoxaparin while 21.2% missed at least one dose. The most-reported causes for suboptimal adherence were perceived lack of necessity (44.4%), forget to take the injection (30.6%), feeling of high load going to the primary care unit to take injection (27.8%), and fear of injection (11.1%). Conclusion: Telemedicine technology could be used to assess patients' adherence. The study results showed that the majority of participants were fully adherent to postcesarean enoxaparin but more than 20% of the participants were suboptimal adherent. Proper patient education techniques could influence patients' adherence and potentially decrease the risk of DVT in those populations.

Sensorineural hearing loss with macrolide antibiotics exposure: a meta-analysis of the association.

OBJECTIVE: Macrolide antibiotics are among the most commonly used antibiotics; the association of macrolide antibiotics exposure with sensorineural hearing loss (SNHL) has been hypothesized. A systematic search was conducted in PubMed, EMBASE and Cochrane Library from inception to 15 July 2019 to identify studies used macrolide antibiotics for any indication. The results were reported as odds ratio (OR) with 95% confidence interval (CI) using random-effects model to derive the association of macrolide antibiotics exposure with SNHL. The objective of this meta-analysis was to estimate the association of macrolide antibiotics exposure and SNHL from up-to-date evidence. KEY FINDINGS: Nine studies met the inclusion criteria. There was no statistically significant association between macrolide antibiotics exposure and SNHL; the OR was 1.20 (95% CI: 0.96 to 1.49). No significant association was found with any of the subgroup meta-analyses. SUMMARY: Whilst the frequency of SNHL was higher with macrolide antibiotics exposure compared with controls, overall, no association was found between macrolide antibiotics and SNHL.

Optimization of antibiotic selection in the emergency department for urine culture follow ups, a retrospective pre-post intervention study: clinical pharmacist efforts.

INTRODUCTION: Urinary tract infections (UTI) are commonly encountered in the emergency department (ED). ED culture follow up is an important tool to provide the appropriate therapy after the identification of the causative pathogen. There is a growing body of evidence for the positive role of pharmacists in following up the ED cultures. The purpose of this study was to compare pharmacist driven urine culture follow ups to the nurse-practitioner (NP) driven follow ups in term of the appropriateness of antibiotic selections in patients with resistant isolates, inappropriately treated asymptomatic bacteriuria, and inappropriately chosen antibiotic. METHODOLOGY: This was a retrospective pre-post intervention study divided into a two group period to compare pharmacist to NP led ED culture follow up interventions. Statistical Package for Social Sciences (SPSS) version 20 was used for analysis. Student's t-test was used for continuous variables and Chi-square test/or fisher's-exact test when appropriate were used for the primary outcome. RESULTS: Fifty-five patients (25.7%) and 102 (34%) met the inclusion criteria in the pharmacist arm and in the NP arm, respectively. Escherichia coli was the most commonly isolated pathogen in both arms. Asymptomatic bacteriuria was often treated in the ED in both groups (45/157, 28.7%) and there were no efforts in discontinuation of antibiotics in these patients. Neither the interventions group nor the no interventions groups were statistically different between the pharmacist and NP arms (P 0.0778), (P 0.797), respectively. CONCLUSION: No statistically significant difference was observed between pharmacist driven monitoring and NP driven monitoring. In our institution, asymptomatic bacteriuria was commonly treated even in the absence of indications. We recommend that Pharmacists' roles in the ED cultures follow up be expanded to include antibiotic discontinuation in patients who meet asymptomatic bacteriuria criteria or have confirmed negative urine culture.

Comparing incomparables with the wrong analytics: Anticoagulation, disability, intracranial hemorrhage, and mortality in acute cerebral vein thrombosis.

Significant progress has been made in the prevention and management of hypercoagulation. Unfractionated heparin (UF) and low molecular weight heparin (LMWH) are indicated for acute cerebral vein thrombosis with or without intracranial hemorrhage (ICH). A recent meta-analysis of four trials comparing UF and LMWH aimed to evaluate the efficacy and safety of both agents in terms of disability, intracranial hemorrhage, and mortality. However, several methodological aspects of the meta-analysis warrant further discussion. It appears that the disability outcome was not sufficiently harmonized by design or statistical standardization, some inputs could not be validated, incorrect statistical analyses were performed, major results could not be replicated, and conclusions were not supported by the statistical results. The conclusion of a statistically significant reduction in mortality is not supported by the data.

Comparison of broad-spectrum antibiotics and narrow-spectrum antibiotics in the treatment of lower extremity cellulitis.

OBJECTIVE: Cellulitis is a commonly encountered medical illness and is most frequently caused by Group A ß-hemolytic Streptococcus species and Staphylococcus aureus. The purpose of this study was to compare clinical outcomes of patients with lower extremity cellulitis treated with broad-spectrum and narrow-spectrum antibiotics. METHODS: This was a retrospective cohort study conducted in a community tertiary hospital between January 2016 and May 2016. Patients were included if they were diagnosed with uncomplicated non-purulent lower extremity cellulitis. Patients were divided into two groups: Individuals receiving narrow-spectrum antibiotics or receiving broad-spectrum antibiotics. Logistic regression analysis was used to estimate the odds ratio of repeat visit between the groups. RESULTS: A total of 599 patients with uncomplicated cellulitis were identified; of which 120 were included in the study (93 in narrow-spectrum arm and 27 in broad-spectrum arm). Repeat visit due to cellulitis was similar in both Groups 1 (4%) and 3 (3%) (P = 0.89) in the broad-spectrum arm and narrow-spectrum arm, respectively. CONCLUSION: Broad-spectrum antibiotic use in uncomplicated cellulitis was common and unjustified given the results of our study. Implementation of clinical practice guidelines is recommended in limiting broad-spectrum antibiotics use in such population.

Sodium polystyrene sulfonate induced intestinal necrosis; a case report.

BACKGROUND: Hyperkalemia is a commonly encountered medical problem. The treatment of hyperkalemia involves the use of pharmacological agents with different mechanism of actions. Sodium Polystyrene sulfonate (SPS) is a cation-exchange resin that exchanges sodium for potassium. In 2009, the United States Food and Drug Administration issued warning against the use of SPS with sorbitol due to risk of colonic necrosis. We present a case of SPS induced colonic necrosis in the absence of sorbitol and risk factors deemed to increase risk of colonic necrosis. CASE REPORT: Here we report a 64-year old male with past medical history of kidney stones who was admitted for treatment of colitis which was complicated by septic shock requiring vasopressors. His course was further complicated by hyperkalemia attributed to acute kidney injury. One dose 30 gm of SPS was administered which normalized his serum potassium. The patient's course was complicated by duodenal ulcer, and colonic perforation. The initial pathology findings of the resected specimen were suggestive of inflammatory bowel disease which resulted in starting patient on mesalamine. The patient then developed fistula which was resected and sent for pathology. SPS induced colonic necrosis was made based on the pathology findings. CONCLUSION: SPS is commonly used to decrease potassium levels. SPS has been reported to be associated with several gastrointestinal complications. FDA issued warning against the use of SPS in patients at risk for complications. Here we report a case with SPS induced colonic necrosis in the absence of risk factors reported in the literature.