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Objective In 2012, the Commission on Human Medicines mandated lowering the acetaminophen toxicity nomogram treatment threshold in the UK to 100 µg/ml at 4 h post-ingestion. The present study aim was to evaluate biochemical and liver toxicity patterns in patients who presented with acetaminophen overdose and had low serum acetaminophen concentrations (150 µg/ml or an unknown ingestion time were excluded. Data were extracted from electronic medical records and are presented as mean ± SD or median (interquartile range). Results A total of 103 patients were included (median age, 17 [4–21] years) and 80 (78%) were female. The median ingested acetaminophen dose was 5000 (2850–7650) mg. At baseline, the median serum acetaminophen concentration was 42 (4.5–64.8) µg/ml, and median alanine aminotransferase and aspartate aminotransferase levels were 22 (17–28) and 27 (16–45) IU/L, respectively. Twenty patients were treated with acetylcysteine, with none developing adverse reactions. No patient developed hepatotoxicity, including patients with initial multiple product ingestion or other risk factors. Conclusions Patients presenting with an acute acetaminophen overdose with acetaminophen level

Introduction Cancer patients’ quality of life (QoL) significantly influences treatment response and mortality rates. Understanding QoL domains among patients with cancer and what affects it can help create interventions that improve QoL and ease patients’ experience. This study measures the OoL among patients with cancer and influencing factors. Methods A prospective cross-sectional questionnaire-based study included cancer patients aged >18 currently receiving treatment. The questionnaire collected social and economic data, followed by the validated Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Means and standard deviations for described numeric variables and frequencies and percentages described categorical variables. Analysis of variance, F-tests, and P -values were reported. Results Among 182 cancer patients, 60% were female. Younger patients exhibited higher QoL in physical and role functioning ( P = .016 and .03) and experienced more significant financial impact ( P = .0144). Females reported more adverse effects from cancer symptoms, including fatigue, nausea, vomiting, and pain (36.7% vs 25.5%, P = .005; 20.6% vs 11.5%, P = .0186; 34.7% vs 25.1%, P = .0281). Single patients had superior QoL in physical functioning compared to others ( P = .0127). Patients traveling long distances were more likely to face adverse financial consequences ( P = .007). Asthmatic patients exhibited lower QoL in physical, role, and cognitive functioning (72.3 vs 37.8, P = .0147; 76.4 vs 22.2, P = .0024; 84.7 vs 44.4, P = .0038) and reported increased dyspnea and appetite loss (16 vs 55.6 and 26.1 vs 66.7, both P < .05). Conclusion Factors influencing QoL in Saudi cancer patients include age, marital status, gender, hospital distance, and chronic conditions. Thus emphasizing the necessity for personalized care strategies to enhance outcomes and alleviate the overall burden of cancer care.

Introduction: The universal increase in obesity and diabetes has increased the chronic kidney disease (CKD) rate. In 2017, almost 800 million individuals suffered from CKD worldwide. Kidney dialysis becomes necessary as the disease progresses. Dialysis negatively impacts CKD patients' quality of life (QoL). It causes several complications that affect patients' physical, social, psychological, and spiritual aspects of life. This systematic review aims to identify condition-specific tools used to assess CKD patients' quality of life on dialysis. Material and Methods: A systematic literature search was conducted to investigate studies using QoL tools among patients on dialysis from February 2000 to June 2023. The search was conducted in several databases and followed the PRISMA guidelines. The focus was to identify tools that capture intrinsic factors, such as spiritual subdomains, rather than extrinsic factors, such as environmental subdomains. Results: The review identified five studies and seven dialysis-specific tools for assessing the QoL of CKD patients on dialysis. The physical domain was the most assessed, followed by the psychological and social domains. Fatigue, muscle weakness, sleep disorders, and pain were identified as the most common concerns in the physical domain. Conclusion: Dialysis negatively impacts all aspects of QoL in CKD patients. This review can guide clinicians in understanding the disease and treatment burden by identifying the most appropriate tools for assessing the QoL of adult CKD patients undergoing dialysis. There is a need for further studies to explore the detrimental effects of CKD treatment and better understand its impact on patients' QoL.

Background and Objective: The first month of life is a significant period for child survival. The highest rate of death was reported in the neonatal period in the world. This study was conducted to estimate the mortality rate in neonates and to determine the main causes and their demographic characteristics in Misan Hospital for Child and Maternity in Iraq. Methods: This cross-sectional study was performed in Misan Hospital for Child and Maternity. The required data were collected from the files in the neonatal and obstetrical units for two consecutive years (2018 and 2019). Any neonatal death in time period from 0 to 28 days was enrolled in this study whether preterm or term. Causes and time of neonatal death were studied based on demographic characteristics (gender, gestational age, type of delivery, and type of pregnancy). The neonatal mortality rate was calculated according to the recommendation of the World Health Organization and expressed per 1000 live births in each year. Findings: The total live birth was 11343 and 11063 in 2018 and 2019, respectively. The mortality rate among neonates was 14.8 and 12.8 deaths per 1000 live births in 2018 and 2019, respectively. The major cause of neonatal mortality was respiratory distress syndrome with approximately similar rates in both years (65.5% vs 63.4%). The subsequent causes were birth asphyxia, congenital anomalies, meconium aspiration, and sepsis. The mean gestational age was 32.33±4.065 weeks in 2018 and it was 32.40±4.339 weeks in 2019. Conclusion: The results of the study showed that the mortality rate in babies of Misan hospital is high. Premature birth and its complications had led to the highest rate of death among neonates. Therefore, focusing on prenatal care is still a big challenge.

Background and objectives: High-quality documentation is critical in medical settings for providing safe patient care. This study was done with the objective of assessing the standard of medical records in anticoagulation clinics and investigating the distinctions between notes written by pharmacists and physicians. Methods: A retrospective cross-sectional analysis of data from electronic health records (EHRs) was performed on patients who received anticoagulation and were observed at anticoagulation clinics from October to December 2020. Patients were monitored in two anticoagulation clinics, one administered by pharmacists and the other by physicians. The quality of the documentation was assessed using a score, and the note was assigned one of five categories according to its score: very good, good, average, poor, and very poor. The data was analyzed using Stata/SE 13.1. P value

Background and Objectives: The percentage of Saudi older adults (SOA) is increasing over time. With advanced age, the prevalence of chronic diseases and multiple disabilities are increasing. This leads to increase utilization of multiple medications. The objectives of this study were to describe medication utilization, determine the prevalence of polypharmacy (PP) and factors associated with it among SOA. Methods: This cross-sectional study was conducted among community-dwelling SOA aged ≥ 60 years old using the Saudi National Survey for Elderly Health (SNSEH). The survey was conducted between 2006 and 2007 by the Ministry of Health on a nationally representative sample of SOA. The data included demographics, socioeconomic and health information such as diseases and medications. Polypharmacy was defined as the concurrent use of medications from ≥ 5 therapeutic classes. A modified Poisson multivariable regression was used to study factors associated with PP controlling for confounders. All analyses were done using STATA 14. Results: The study included 2,946 SOA; 50.4% were males, 60.9% were 60–70 years old, and 69.6% were illiterate. The most common medications used among SOA were: Paracetamol (67%), joint pain medications and NSAIDs (50% each), anti-diabetic and multivitamins and minerals (47% each). PP was identified in (51.5%) of participants. The most medication associated with PP were: Paracetamol (79.9%), multivitamins and minerals (71.6%), steroid and DMARDs (70.1%), NSAIDs (66.4%), anti-diabetic and anti-hypertensive (61.3%). Higher risk of PP was associated with diabetes (RR: 1.863; 95% CI: 1.686–2.059), hypertension (RR: 1.829; 95% CI: 1.624–2.060), having pain (RR: 2.282; 95% CI: 1.918–2.713), urinary incontinence (RR: 1.389; 95% CI: 1.238–1.560; ref: no urinary incontinence) or suggestive depression (RR: 1.379; 95% CI: 1.259–1.512). Similarly, compared to low income (

IntroductionThere is growing interest in Mindfulness-based Stress Reduction (MBSR) program to combat mental distress in medical students. In Saudi Arabia, literature is insufficient about MBSR and its effectiveness. This study aims to measure the effectiveness of MBSR in improving mindful state, stress, anxiety, and depression in medical students. Also, the study explores the association between the attendance rate of MBSR sessions and its effectiveness. Lastly, the study examines gender differences in response to MBSR.MethodsThis is a stratified randomized controlled study of 84 medical students from two medical schools in Riyadh, Saudi Arabia. They were recruited voluntarily from November 2018 to April 2021, and allocated to MBSR and waitlist groups using a stratified randomization method based on gender. MBSR group received eight weeks of sessions through audiovisual materials. An online survey utilizing validated questionnaires assessing stress, mindfulness, anxiety, and depression was used to evaluate both groups pre-program (time 0), post-program (time 1), and three months later (time 2).ResultsSeventy-one participants completed the post-test (time 1). There were no differences between study groups at time 0 and 1. However, in 41 subjects who completed the follow-up test (time 2), the anxiety dropped significantly in MBSR group (mean difference (MD), -3.935; 95% CI, -7.580 to -0.290). Furthermore, attending more MBSR sessions was inversely correlated with depression (r, -0.556; P, 0.002), and anxiety (r, -0.630; P, 0.000). Compared to their baseline, males in MBSR group improved in stress (MD, 3.08; 95% CI, 0.30 to 5.86), anxiety (MD, 4.91; 95% CI, 3.32 to 6.50), and mindfulness (MD, -0.58; 95% CI, -1.01 to -0.15), while females improved in stress (MD, 2.64; 95% CI, 0.02 to 5.26).ConclusionDespite the study being interrupted by the stressful COVID-19 outbreak, the findings suggest that MBSR improved psychological outcomes when participants commit to the program.

Discharge counseling by pharmacists reduces adverse medication events, emergency department visits, and readmissions. Studies indicate that pharmacy students in advanced pharmacy practice experiences (APPE) can deliver effective medication-related activities. An open label randomized controlled trial was conducted in adults discharged on warfarin, insulin, or both. Pharmacy students performed medication reconciliation, structured medication counseling, and follow-up calls 72-hours post-discharge. The usual care arm received traditional education. The primary outcome was the 30-day readmission rate post-discharge. Ninety-eight patients on high-risk medications were randomized to intervention (n = 51) or usual care (n = 47). The 30-day hospital readmission rate was lower in the intervention group (8/51, 15% vs. 11/47, 23%); (p = 0.48). There was no statistical difference in the time to first unplanned health care use (hazard ratio = 0.49 (95 %CI, 0.19–1.24), or the time-to-first clinic visit post-discharge (p = 0.94) between the two arms. Students identified 26 drug-related problems during reconciliation. Patients in the intervention arm reported high satisfaction with the service (mean 3.94; SD 0.11). Involving APPE students in the transition of care activities presents an excellent opportunity to minimize pharmacists' workload while maintaining patient care services.

Background: Clinical trials are crucial in contemporary evidence-based medicine for discovering new treatments for diseases. Their registration in a registry increases the transparency in the dissemination of knowledge about clinical research. It is essential to understand the activity of clinical trials in a country, thus identifying research gaps. Objective: This study, therefore, aims to describe the clinical trial activity since the inception of clinical trials’ administration and national clinical trials’ registry within the Kingdom of Saudi Arabia (KSA). Method: A descriptive study was conducted by reviewing all clinical studies that have been registered during 2009 and June 2020. The inclusion criterion was all phases of the clinical trials registered in the national registry during that period. Data analysis was done using descriptive statistics. Results: Since 2009, 352 studies have been registered. However, a total of 333 studies with complete data was included in the analysis. A total of 80 sponsors funded the clinical studies in the KSA. The majority of the clinical studies are funded by multinational pharmaceutical companies. Oncology (13.81%) and diabetes (11.71%) were the most common therapeutic areas and constituted the largest proportion of the overall studies. 44% were phase 4 and 40% were phase 3 studies. Conclusion: With a population approaching 34 million, the number of clinical trials in the KSA is not sufficient. Since the inception of the clinical trial’s administration and SCTR, the emphasis has been on phase 3 and phase 4 clinical studies. The most studied therapeutic areas were oncology and diabetes. Many clinical studies in the KSA were sponsored by multinational pharmaceutical companies.

الملخص: أهداف البحث: تحديد مدى انتشار أعراض وخطر انقطاع النفس الانسدادي النومي، وتحديد العوامل المرتبطة بانقطاع النفس الانسدادي النومي بين كبار السن السعوديين. طرق البحث: استخدمت الدراسة المسح الوطني السعودي لصحة المسنين، وهو مسح يشمل عينة وطنية لكبار السن بين عامي ٢٠٠٦ و٢٠٠٧ في المملكة العربية السعودية. وتم تحديد أعراض انقطاع النفس الانسدادي النومي والمخاطر من خلال استبانة برلين. كما تم استخدام تحليل الانحدار اللوجستي متعدد المتغيرات لتحديد العوامل الرئيسة المرتبطة بخطر انقطاع النفس الانسدادي النومي. النتائج: من بين ٢٩٤٦ من كبار السن، كان ١٥٤٤ (٥٢.٤٪) معرضين لخطر الإصابة بانقطاع النفس الانسدادي النومي مع تعرض النساء لخطر أعلى من الرجال (٦٠.٨٪ مقابل ٤٤.٢٪ على التوالي، القيمة الاحتمالية

Consumption of Cytochrome P450 2D6 (CYP2D6) inhibiting drugs along with tamoxifen treatment results in decrease in plasma concentration of endoxifen, the major active tamoxifen metabolite. Simultaneous use of CYP2D6 inhibitors, such as selective serotonin reuptake inhibitors (SSIs), as well as lesser tamoxifen adherence may negatively impact tamoxifen efficacy in patients with breast cancer. The objective of our study was to assess the co-prescription of CYP2D6 inhibitors and tamoxifen use and also to relate concomitant CYP2D6 inhibitor use and tamoxifen adherence to breast cancer in Riyadh, Saudi Arabia. All patients treated for breast cancer who had at least one tamoxifen prescription in their electronic medical records (EMRs) from June 2015 to June 2017 were included. Patients who had other adjuvant hormonal therapy were excluded from the study. In total, 499 patients (25 males and 474 females) with breast cancer using tamoxifen were included. Our study was purely observational study revealed that prescription of weak inhibitors with tamoxifen increased in the second year as opposed to decrease in the prescription of strong inhibitors. Also, a substantial percentage of patient population were found to be non-adherent to the tamoxifen therapy in this study. Keywords: Adherence, Breast cancer, CYP2D6 inhibitor, Tamoxifen

BACKGROUND AND OBJECTIVE: Prematurity is a serious health problem and an important risk factor in neonatal mortality. This study aimed to determine the incidence rate of preterm newborns in the neonatal care unit and to study their different causes and risk factors in relation to their outcomes. METHODS: We conducted a prospective cross-sectional study in Misan Hospital for Child and Maternity during the whole year of 2018. All preterm neonates with gestational age 26-37 weeks needed ventilation support and associated with risk factors were enrolled in this study. Different preterm variables were studied in relation to their outcome including gestational age, birth weight, length, head circumference, gender, type of pregnancy, mode of delivery, presence of congenital anomaly, ventilation support. While maternal variables include age, address, antenatal care, education, past maternal history, and maternal risk factor such as antepartum hemorrhage, premature rupture of membrane, hypertension, diabetes mellitus, previous cesarean section, and previous premature labor. FINDINGS: There was a predominance of males with mean gestational age and birth weight of (32.6±3.1) weeks and (1755.25±485.8) grams, respectively. Prematurity and its complications were responsible for more than one-third of neonatal hospitalization and their mortality rate was 36.1%. We found a converse significant correlation between the gestational age, as well as, anthropometric parameters of preterm infants and their outcomes (p

Objective: To assess pharmacy students’ satisfaction with introductory pharmacy practice experiences (IPPE) at community pharmacy and the impact of the training on their future career. Methods: A self-administered questionnaire was made available to 74 male pharmacy students who completed 4 weeks community pharmacy IPPE. The questionnaire consists of 24 questions that were organized into 5 domains with a scale of six options were used to answer each question. Results: A total of 43 students completed the survey (58%). Most of them evaluated their training experience as either as good (41.86%) or excellent (41.86%). One third of students (34.88%) were very satisfied about the clarity of the community pharmacy IPPE goals and objectives given prior to the training period. About half of students (51.6%) received a good direction and feedback from their preceptors. Regarding the contact with the patient or guardian, (39.53%) of the students chose neutral while (25.58%) of the students were very satisfied. The learning environment was satisfactory for (32.56%) of students. Regarding skills domain, students strongly agreed that their skills were improved; Communication skills as reported by (48.84%) of students, documentation skills as reported by (34.88%) of students, and clinical skills as reported by (34.88%) of students. Conclusion: Surveyed male students were in general satisfied with their training experience at community pharmacy. Providing an orientation to the community pharmacy preceptors and granted electronic access of necessary information to the students might increase their satisfaction. Keywords: Community pharmacy, Saudi Arabia, IPPE

This paper focuses on the in-field transporting machines currently used in oil palm plantations in Malaysia. It highlights the field conditions, the capacity of the machines and the time of completion of the transporting process which help to identify the determinants of the development of agricultural mechanization in Malaysian oil palm plantations. Understanding of the issues will help facilitate the elimination of weaknesses and defects prior to the manufacturing or modification stage. This will assist designers and manufacturers in the development and production of improved and more efficient field transportation equipment.

Background: Respiratory distress is considered one of the most frequent causes of admission in the neonatal unit. Additionally, it is the leading cause of neonatal morbidity and mortality. This study aimed to determine the incidence of neonatal respiratory distress and its causes, risk factors, and outcomes to have a baseline data about the magnitude of respiratory distress with a further step toward the development of the neonatal field.Methods: This cross-sectional study was conducted in the neonatal care unit of Misan Hospital for Child and Maternity in Misan, Iraq, during one year. All the neonates who developed respiratory distress were included in this study according to the World Health Organization criteria.Results: The total number of neonatal admission during the study period was 870 cases among whom 738 (84.8%) subjects developed respiratory distress. The fatality rate was 21%, and the majority of deaths were found in respiratory distress syndrome (RDS) (67.1%). The RDS, transient tachypnea, and birth asphyxia were the major causes of neonatal respiratory distress. Statistically, prematurity, type of delivery, and number of babies at the delivery time were significantly associated with respiratory distress development.Conclusion: The incidence rate of neonatal respiratory distress was apparently high in Misan forming the most common cause of neonatal admission associated with a high mortality rate. Efforts toward preventing the causes and risk factors for neonatal respiratory distress, as well as, improving the efficacy of neonatal care unit are the significant challenges to improve the neonatal care and outcome.

Objectives: We sought to determine the prevalence of inborn errors of metabolism (IEM) in children with unexplained developmental delay and their types. Methods: We conducted a cross-sectional study in Misan, Iraq, over a period of one year. A total of 112 infants with unexplained developmental delay were included in the study, and the required information was taken from their parents by direct interview. Tandem mass spectrometry (MS/MS) was done in collaboration with MedLabs’ Referral Laboratory in Amman, Jordan. Results: Twenty (17.9%) cases had abnormal MS/MS. Disorders of amino acid metabolism represented the majority of IEM (10 cases) in which phenylketonuria and maple syrup urine disease were the most common (found in five cases each). Organic and fatty acid metabolisms were found in five and two cases, respectively. Most cases of IEM had a positive family history and consanguinity, however, family history was the only significant factor (p < 0.001). Conclusions: A high rate of IEM was detected in children with unexplained developmental delay in Misan. A high clinical suspicion with positive family history and consanguinity supported by the MS/MS results played an essential role in the diagnosis. However, implementation of newborn screening is essential for early diagnosis and to determine appropriate therapy in newborns with IEM in Iraq generally and in Misan in particular.

Background and objective: Collective high fertility behaviors is a term that refers to mothers who had got married during their teenage and having parity of five or more living children with less than 24 months apart. The present study aimed to estimate the prevalence of collective high fertility behaviors among mothers in Mosul city, Iraq. Methods: A cross-sectional study was carried out using a multi-stage stratified sampling method. Inclusion criteria included mothers in child-bearing age who had at least two living children. The required data were collected by filling an especially structured questionnaire in the eligible primary health care centers over a period of ten months, from April, 1st 2011 to the end of January 2012. Results: Among 1302 participants, the prevalence of high fertility behaviors was 17.7% within all age groups. The prevalence was significantly higher among Muslim, low social classes (P ˂0.001), nuclear family structure (P ˂0.001), consanguineous marriage (P ˂0.001) and low educated mothers and husbands (P ˂0.001). Conclusion: The study found that collective high fertility behaviors are prevalent among almost two out of ten mothers of all age groups in Mosul city. Thus, effective engagement of all human resources is recommended for constructing healthy fertility behaviors and confirming the non-reproductive role of women.