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Geetha Kandasamy,1 Dalia Almaghaslah,1 Mona Almanasef,1 Tahani Musleh Almeleebia,1 Khalid Orayj,1 Ayesha Siddiqua,1 Eman Shorog,1 Asma M Alshahrani,1 Kousalya Prabahar,2 Vinoth Prabhu Veeramani,2 Palanisamy Amirthalingam,2 Saleh Alqifari,2 Naif Alshahrani,3 Aram Hamad AlSaedi,4 Alhanouf A Alsaab,5 Fatimah Aljohani,6 M Yasmin Begum,7 Akhtar Atiya8 1Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia; 2Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Kingdom of Saudi Arabia; 3Department of Pharmacy, Ad Diriyah Hospital, Ministry of Health (MOH), Riyadh, 13717, Kingdom of Saudi Arabia; 4College of Medicine, Taibah University, Al Madinah, Al Munawwarah, Saudi Arabia; 5Pharmacist at Abha International Private Hospital, Abha, Saudi Arabia; 6Pharmacist at Prince Sultan Armed Forces Hospital, Almadenah, Almonwarah, Saudi Arabia; 7Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia; 8Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi ArabiaCorrespondence: Geetha Kandasamy, Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia, Email glakshmi@kku.edu.saBackground: Migraine is a disabling disease that poses a significant societal burden. Migraine is a major cause of disability. Migraine is the eighth leading disease-causing disability in the population.Objective: To study the clinical profile and measure the pain and migraine-related disability of patients with all types of migraine using the McGill pain assessment scale and Migraine Disability Assessment (MIDAS) before and after 3 months of effect on the medication.Methods: A Prospective-Cross sectional study was carried out in a multispecialty hospital with male and female patients between 18 and 65 years. The data were collected from the patients directly through the questionnaire of McGill pain assessment scale-short form (SF) and MIDAS, which was provided before and after the medication.&#x00A0Results: There were 165 subjects of which 52 were men and 113 were women. The mean age of all the subjects was 43 years. About 26.06% of the subjects had a family history of headaches. The scores of McGill pain and MIDAS assessment before and after medication were as follows: 0– 15 were 30.90% and 73.33%, Score 16– 30 were 54.54% and 18.18%, the score of 31– 45 were 14.54% and 7.87% of the subjects. MIDAS grade I was 17.57% and 50.90%, Grade II 33.93% and 21.81%, Grade III 30.30% and 15.75% Grade IV 18.18% and 11.51% of the subjects.Discussion: The calculated “t” value between the before and after medication values of McGill and MIDAS by paired ‘t-test was 13.85 and 17.49 respectively. As the calculated “t” value is more than the table value, the alternate hypothesis is accepted.Conclusion: This study confirms that there is a significant difference in disability levels before and after acute and preventative treatments when measured over 3 months. In addition, the preponderance of females was high, and the functional disability that affects work and social activity associated with migraine is moderate to severe.Keywords: migraine, pain, disability, loss of productivity, MIDAS

Sultan M Alshahrani,1 Khalid Orayj,1 Ali M Alqahtani,2 Adel Alfatease,3 Atheer Alshahrani,4 Ahmed RN Ibrahim1,5 1Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 2Pharmacology Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 3Pharmaceutics Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 4Alnahdi Pharmacies, Khamis Mushait, Saudi Arabia; 5Department of Biochemistry, Faculty of Pharmacy, Minia University, Minia, EgyptCorrespondence: Ahmed RN Ibrahim, Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia, Tel +966 554088979, Email aribrahim@kku.edu.saIntroduction: Community pharmacists play a key role as vaccinators for COVID-19. They can reduce the burden of the disease worldwide.Objective: This study used a cross-sectional questionnaire to determine whether the Saudi Arabian public was willing to obtain the COVID-19 vaccine via community pharmacists.Results: The questionnaire focused on the satisfaction, concerns, and opinions towards providing vaccination by community pharmacists. The study featured 415 individuals aged 18 and older (eligible for the COVID-19 vaccine). Of the participants in this study, 58.1% were aged 18– 25, with 55.4% female. Most participants (72.8%) have not been exposed to COVID-19 and are not aware of the approval of COVID-19 vaccination by community pharmacists. Of the 415 complete questionnaires, 45% believed that community pharmacists are not experienced in administering vaccines. However, 63% of participants are satisfied with getting the COVID-19 vaccination by a community pharmacist if no other option is available. More than 68% of the respondents agree that community pharmacies should expand their health care services to include vaccinations, prescriptions, checkups, and other forms of preventative medicine.Discussion: The availability of community pharmacist-administered vaccination in Saudi Arabia could be a significant factor in the success of the country’s vaccination program. This study may serve as a model to expand the role of pharmacists in other countries’ vaccination programs.Keywords: SARS-CoV-2, community pharmacy, immunization, perspective, adherence, patient satisfaction

Khalid Orayj,1 Khalid Alahmari,2 Moath Alasiri2 1Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 2College of Pharmacy, King Khalid University, Abha, Saudi ArabiaCorrespondence: Khalid Orayj, Email korayg@kku.edu.saIntroduction: Pharmacists’ involvement in patient care is expanding. The inclusion of this function within a complex healthcare system populated by demanding patients may create ethical challenges. In Saudi Arabia, few studies have been conducted on pharmacy ethics, and the available data are quantitative in nature. Thus, there remains a need for a qualitative assessment of the ethical dilemmas facing pharmacists.Methods: This exploratory study utilized a qualitative methodology that included open-ended, in-depth, semi-structured interviews, followed by content analysis. The study recruited credentialed pharmacists from community and hospital pharmacies. Themes and codes were created and classified.Results: Eighteen pharmacists were interviewed, and their responses were categorized into eight areas of ethical dilemma: beneficence and non-maleficence, autonomy, justice, confidentiality, veracity, communication skills, sincerity and religion, and law. Taken together, it appears that most of the ethical challenges to the practice of pharmacy center on the theme of beneficence and non-maleficence. Additionally, it was found that some social and religious practices and beliefs contribute to the formation of participants’ ethical backgrounds.Conclusion: These findings may aid in the development of national pharmacy ethics guidelines in Saudi Arabia. Additional quantitative research is necessary to confirm the study’s findings.Keywords: pharmacy ethics, community pharmacy, hospital pharmacy, bioethics

Adel Alfatease,1 Ali M Alqahtani,2 Khalid Orayj,3 Sultan M Alshahrani3 1Pharmaceutics Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 2Pharmacology Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 3Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi ArabiaCorrespondence: Sultan M AlshahraniClinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, 61441, Saudi ArabiaTel +966 508747473Email shahrani@kku.edu.saIntroduction: Social media platforms are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination.Purpose: The objective of this study is to understand the influence of social media on the attitudes and willingness of the general public of the Aseer region of Saudi Arabia to receive COVID-19 vaccination.Materials and Methods: A cross-sectional self-administrated online survey was conducted in Saudi Arabia Aseer region, where 613 persons willingly took part in the survey in April and May 2021. Residents of Aseer in Saudi Arabia, who are over the age of 18 (eligible for COVID-19 vaccination) and willing to participate in the survey, were included in the study.Results: Overall, 74.6% agreed that the COVID-19 vaccine was misrepresented via social media. However, 37% of those respondents strongly agreed that social media had increased their willingness to get the COVID-19 vaccine. In addition, employees reported (21.8%) or strongly agreed (28%) that the quantity and quality of information on social media has a detrimental impact on their psychological well-being. Additionally, participants also agreed (21.8%) or strongly agreed (28%) that social media had a negative effect on their psychological condition.Conclusion: The study provides that there was a high degree of awareness indicated among Aseer population regarding misleading information about COVID-19 vaccination via social media. Thus, social media that can share up-to-date scientific information about vaccination must be utilized optimally by the government to assist people in making decisions about accepting vaccinations.Keywords: social media, COVID-19, vaccination, survey, Saudi Arabia

Purpose: This study investigated the 1-year risk of ischemic heart disease (IHD), all cardiovascular events, and all-cause mortality among newly diagnosed Parkinson's disease (PD) patients who used antidepressants compared to those who did not., Patients and Methods: Patients with PD aged 40 years or older were identified using data from 2000 through 2016 held within the Welsh Secure Anonymized Information Linkage (SAIL) databank. Antidepressant users were propensity-score matched 1:1 with non-users, adjusting for patients' demographics, socioeconomic status, and multiple comorbidities. Cox proportional hazard regression analyses were performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between the antidepressants and the study outcomes. The follow-up period was 1 year after the initial prescription of antidepressants., Results: The study group comprised a total of 3364 participants, with numbers split equally between the antidepressant-user and non-user groups, based on the propensity score-matching process. Overall, the propensity score-adjusted model showed that antidepressant usage in PD patients was not significantly associated with the risk of IHD (HR = 1.05; 95% CI 0.63-1.75) or all cardiovascular events (HR = 1.01; 95% CI 0.71-1.45) compared to non-users. The propensity score-adjusted model also showed that the use of any antidepressant, regardless of its category, was not statistically significantly associated with all-cause mortality (HR = 0.81; 95% CI 0.65-1.02). However, this association reached statistical significance in the multivariate adjusted model (HR = 0.67; 95% CI 0.54-0.84)., Conclusion: There was no evidence that antidepressant use was associated with an increased risk of IHD or all cardiovascular events in newly diagnosed PD patients who suffered from depression. Furthermore, antidepressant use might reduce the mortality rate in PD patients during the first year after initiation., Competing Interests: The author reports no conflicts of interest in this work., (© 2021 Orayj.)

Purpose: Observational studies have examined the association between antipsychotics and ischemic heart disease (IHD) in general populations, but results did not take into account other comorbid diseases, such as Parkinson's disease (PD). This study investigates the one-year risk of IHD, all cardiovascular events, and all-cause mortality among newly diagnosed PD patients who used antipsychotics compared to non-users., Materials and Methods: This study included individuals aged 40 years or older with a first definitive PD diagnosis Read Code in the Secure Anonymised Information Linkage (SAIL) databank who had been initiated on any PD medication between 2000 and 2016. Antipsychotic users were matched 1:1 with non-users by a propensity score model to control the confounding effects of patients' demographics, social deprivation status, comorbidities, and medication history. Cox regression was performed to calculate the hazard ratios (HR) and 95% CIs for the association between antipsychotics and study outcomes., Results: A total of 1837 participants were included in the analysis. Users of first-generation antipsychotics (FGA) were significantly more likely to develop IHD compared to non-users, with an HR of 2.60 (95% CI 1.103-6.167). Among the FGAs, haloperidol had the highest likelihood of IHD developing, with an HR of 3.01 (95% CI 1.038-8.729). Any use of antipsychotics, regardless of whether they were FGA or second-generation antipsychotics (SGA), was linked to all-cause mortality, with an HR of 4.201 (95% CI 3.272-5.394). When subdividing antipsychotics into FGAs and SGAs, mortality was more likely in FGA users, with an HR of 7.557 (95% CI 5.633-10.139). Mortality also occurred in SGA users, but with a lower HR of 3.278 (95% CI 2.509-4.282)., Conclusion: FGAs were associated with an increased risk of IHD and all-cause mortality in newly diagnosed PD patients with psychosis. This finding emphasizes the need to use antipsychotics with caution in PD patients with psychosis., Competing Interests: The author reports no conflicts of interest in this work., (© 2021 Orayj.)

Purpose: During examinations, many students use various over-the-counter (OTC) drugs to improve their concentration or treat exam-related medical symptoms. The purpose of this study was to scrutinize the use of OTC drugs during examinations in Saudi Arabia., Materials and Methods: A cross-sectional study was designed, consisting of online, self-administered questionnaires comprising 27 items, including the awareness, knowledge, and attitude of students toward OTC drug use during examinations. A logistic regression model was fitted to determine factors that predict OTC drug use. The data were analyzed using Statistical Package for Social Science (SPSS)., Results: A total of 463 (92.6%) completed questionnaires were received from 500 recruited participants. Among participants, 58.5% were women, 47.9% were 22 years or older and completing their final year of study, and 44.1% of students preferred not to disclose their monthly income. The most common cause (35.6%) for OTC drug use during the examination period was headache, followed by pain (21%), fever (16.6%), and cough (8.2%). The most commonly used medication were painkillers, antipyretics, cough and cold medications, and vitamins (57.2%, 16.4%, 11%, and 7.3%, respectively). Male students showed a significant lack of awareness and knowledge regarding the safety and reasons for OTC drug use compared with their female counterparts and were less likely to read the medication leaflet before use (p < 0.001, odds ratio [OR]: 0.36, confidence interval [CI]: 0.23-0.57) and did not know which drugs require prescriptions (p < 0.001, OR: 0.41, CI: 0.27-0.63). Other significant factors that predicted OTC drug use included age, university level, and drug income., Conclusion: The most common reported cause for OTC drug use during examinations among students was headache. Sex, age, university level, and monthly income were significant factors affecting OTC drug use during examinations., Competing Interests: The authors reported no conflicts of interest for this work., (© 2021 Orayj et al.)

Purpose: Psychosis is very common in later stages of Parkinson's disease (PD) patients, but its prevalence in newly diagnosed patients is not rare. The use of antipsychotics in PD patients is complex given their association with worsening Parkinsonian motor symptoms and increased mortality rate. This study aims to examine factors that affect the use of antipsychotics in newly diagnosed PD patients and to identify changes in prescribing over time., Patients and Methods: The Secure Anonymized Information Linkage (SAIL) databank was used to identify a cohort of newly diagnosed PD patients aged 40 years and older in Wales. The cohort was longitudinally examined over 17 years to determine the incidence of new antipsychotic use. Logistic regression models were used to analyze the data and were adjusted for several potential confounding variables., Results: A total of 9142 PD patients were identified after applying inclusion and exclusion criteria, of whom 58.6% were male. During the first year of PD diagnosis, 12% of the patients developed psychosis and were prescribed antipsychotics. Quetiapine was the most commonly prescribed (49%), followed by risperidone (10.7%). The use of antipsychotics in newly diagnosed PD patients was significantly lower in the years 2009-2016 compared to 2000-2008 (OR 0.37, 95% CI 0.32-0.43). Other significant prescribing factors included patient's age and history of dementia., Conclusion: A dramatic decline in antipsychotic use was identified across years, showing adherence to warnings against use of antipsychotics for PD patients. Given that psychosis is prevalent in PD patients, the continuous assessment of the safety risks of antipsychotics is a matter of priority., Competing Interests: The author reports no conflicts of interest in this work., (© 2021 Orayj.)