Utilization of direct oral anticoagulants in a Saudi tertiary hospital: a retrospective cohort study.

OBJECTIVE: This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital. PATIENTS AND METHODS: Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence. RESULTS: 778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications. CONCLUSIONS: In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs.

Generalized and localized osteoarthritis and risk of fall among older adults: the role of chronic diseases and medications using real world data from a single center.

OBJECTIVE: This study examined the prevalence of falls among older adults with generalized and localized osteoarthritis (OA) and identified the association between falls and both chronic diseases and medications. PATIENTS AND METHODS: A retrospective design using the Healthcare Enterprise Repository for Ontological Narration (HERON) database was used. A cohort of 760 patients aged ≥65 years with at least two diagnosis codes for either localized or generalized OA were included. The extracted data included demographics (age, sex, and race), body mass index (BMI), fall history, comorbid health conditions (i.e., type 2 diabetes, hypertension, dyslipidemia, neuropathy, cardiovascular diseases, depression, anxiety, and sleep disorders), and medications [i.e., pain medication (opioids, non-opioids), antidiabetics (insulin or hypoglycemic), antihypertensives, antilipemic, and antidepressants]. RESULTS: The prevalence rates of falls and recurrent falls were 27.77% and 9.88%, respectively. Individuals with generalized OA had a higher prevalence of falls (33.8%) than those with localized OA (24.2%). Multivariable logistic regression analysis showed that individuals with OA who had hypertension [odds ratio (OR):1.86, 95% CI, (1.20, 2.89), p=0.006] and used antidepressants [OR: 1.72, 95% CI, (1.04, 2.84), p=0.035] were more likely to have a fall. Individuals with OA who had hypertension [OR: 2.69, 95% CI, (1.30, 5.60), p=0.008], neuropathy [OR: 4.95, 95% CI, (2.95, 11.68), p<0.001], and insulin [OR: 2.85, 95% CI, (1.12, 7.22), p=0.035] were more likely to have a recurrent fall (two or more falls). CONCLUSIONS: Falls are common in individuals with generalized OA. Comorbid health conditions, including hypertension and neuropathy, need to be considered in the screening of the risk of fall. Fall risk needs to be considered when discussing medication prescriptions, especially antidepressants and insulin.

Prospective analysis of physical activity levels and associated fitness factors amid COVID-19 pandemic and social-distancing rules. A special focus on adolescents.

Objective: Physical activity is a significant health determinant and is likely to be influenced by social-distancing rules imposed by authorities during the COVID-19 pandemic. This study explored gender-based differences in physical activity levels (PALs) and associated factors amid COVID-19 pandemic in adolescents. Methods: In this prospective analysis, 112 healthy adolescents (15.63 ± 1.21 years) participated. They were assessed at the baseline (before the announcement of COVID-19 as a global pandemic) for anthropometry, fitness status, and PALs (baseline-PALs), and next at the follow-up (three months of imposed social-distancing rules) for PALs (follow-up-PALs) over an internet-based platform through the Physical Activity Questionnaire for Adolescents. Results: A significant PALs decline was evidenced for the whole sample (P < .001) and such a decline was predominantly affected by significant PALs reduction among males (P < .001) rather than in females (P = .06). The fitness variables (explosive power, muscle endurance, flexibility, and aerobic endurance) were consistently positively correlated with the baseline- and follow-up-PALs in both genders with particularly prominent associations of PALs with explosive power and aerobic endurance. Conclusion: Physical literacy is necessary for PALs preservation, given the remarkable PALs decreases among adolescents during challenging circumstances such as the COVID-19 pandemic.

Objectif: L'activité physique est un déterminant important de la santé et est susceptible d'être influencée par les règles de distanciation sociale imposées par les autorités pendant la pandémie de COVID-19. Cette étude a exploré les différences basées sur le sexe dans les niveaux d'activité physique (PAL) et les facteurs associés au milieu de la pandémie de COVID-19 chez les adolescents. Méthodes: Dans cette analyse prospective, 112 adolescents en bonne santé (15,63 ± 1,21 ans) ont participé. Ils ont été évalués au départ (avant l'annonce du COVID-19 en tant que pandémie mondiale) pour l'anthropométrie, le statut de forme physique et les PAL (PAL de référence), et ensuite lors du suivi (trois mois de règles de distanciation sociale imposées) pour les PAL (suivi-PAL) sur une plate-forme internet via le questionnaire sur l'activité physique pour adolescents. Résultats: Une baisse significative des PAL a été mise en évidence pour l'ensemble de l'échantillon (p < ,001) et une telle baisse a été principalement affectée par une réduction significative des PAL chez les hommes (p < ,001) plutôt que chez les femmes (p = ,06). Les variables de forme physique (puissance explosive, endurance musculaire, flexibilité et endurance aérobie) étaient constamment corrélées positivement avec les PAL de référence et de suivi chez les deux sexes avec des associations particulièrement importantes de PAL avec la puissance explosive et l'endurance aérobie. Conclusion: La littératie physique est nécessaire pour la préservation des PAL, étant donné les diminutions remarquables des PAL chez les adolescents lors de circonstances difficiles telles que la pandémie de COVID-19.