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Background: Colistin (Cst) is one of the antimicrobial peptides and is reserved for use against multi‐drug‐resistant Gram‐negative bacteria. However, the clinical value of Cst is limited by its nephrotoxic adverse effects. Caffeic acid phenethyl ester (CAPE) is a honeybee propolis flavonoid recognised for its diverse pharmacological potential. It has demonstrated d antioxidant and anti‐inflammatory properties, as well as protective effects against chemically induced toxicity in variuos biological systems. This study aimed to investigate the impact of CAPE on nephrotoxicity induced in rats by Cst. Methods: Animals were randomly divided into five groups. Group 1 served as control, group 2 received CAPE (10 mg/kg) orally, group 3 received Cst IP, group 4 received Cst + CAPE (5 mg/kg) and group 5 received Cst + CAPE (10 mg/kg). All treatments were given daily for 10 consecutive days. Results: CAPE notably attenuated Cst‐inducednephrotoxicity as shown by reducing urea serum levels, creatinine, cystatin C, urinary protein contents and urinary N‐acetyl‐β‐D‐glucosaminidase (NAG). This was confirmed by histological investigations that indicated amelioration of histopathological changes in the kidney architecture as well as the deposition of collagen in renal tissues. CAPE exhibited antioxidant effects supported by the prevention of rise in Cst‐induced lipid peroxidation and depletion of superoxide dismutase and catalase enzymatic activities. In addition, CAPE inhibited the expression of the inflammatory markers including tumour necrosis factor‐α, nuclear factor kappa B and interleukin‐6. These actions were associated with modulation of messenger ribonucleic acid (mRNA) expression of Bax and Bcl‐2 in favour of anti‐apoptosis. CAPE inhibited Cst‐induced rise in forkhead box O1 (FOXO1) expression and downregulation of nuclear factor erythroid 2–related factor 2 (Nrf2) and Sirtuin 1 (Sirt1) immune‐expression. Conclusion: CAPE protects against nephrotoxicity induced by Cst in ratsprimarily through its antioxidant, antiinflammatory and antiapoptotic activities. These pritective effects are mediated via modulation of FOXO1/Nrf2/Sirt1 axis. [ABSTRACT FROM AUTHOR]

A lack of definitive research exists regarding the application of low molecular weight heparin during pregnancy in connection with in vitro fertilization. The objective of this analysis is to determine if low molecular weight heparin enhances the success of pregnancies in women who do not have thrombophilia and are undergoing in vitro fertilization treatment. A comprehensive search was conducted across four databases (PubMed/MEDLINE, ScienceDirect, Scopus, and the Cochrane Library) for articles written in English from 2000 to 2020. All research methodologies evaluating the influence of low molecular weight heparin during in vitro fertilization on live birth rate, clinical pregnancy rate, and miscarriage rate were included. Individual case reports and studies focusing on women with hereditary or acquired thrombophilia, hormonal, or autoimmune disorders were excluded. Out of 3490 screened studies, 5 studies satisfied the selection requirements (consisting of 4 randomized and 1 observational study). The review encompassed a total of 1006 women, with 520 receiving low-molecular-weight heparin and 486 belonging to the control group. No significant differences were observed between the low molecular weight heparin and control groups in any of the evaluated outcomes (live birth rate, clinical pregnancy rate, miscarriage rate). It is important to note that the duration and dosage of low molecular weight heparin exhibited considerable variation across the studies included. While it may have a potential benefit especially in terms of live birth rate and clinical pregnancy rate, the current evidence doesn't imply a significant influence of low-molecular-weight heparin on in vitro fertilization treatment outcomes in terms of successful pregnancy rates for women without thrombophilia. Additional research is needed to evaluate the actual role of low molecular weight heparin as a treatment during in vitro fertilization procedures. [ABSTRACT FROM AUTHOR]

Purpose: The main objective of this study was to evaluate the effectiveness and safety of apixaban versus warfarin in patients with venous thromboembolism (VTE) in a "real-world" setting. Patients and Methods: A retrospective cohort study was conducted using data from a large tertiary hospital in Saudi Arabia. Patients were included if they were adults (≥ 18 years), diagnosed with VTE, and treated with either apixaban or warfarin between January 2016 and September 2018. Patients who had received anticoagulation therapy within three months of the date of the index event were excluded. The effectiveness outcomes were incidence of VTE recurrence (ie, deep vein thrombosis DVT or pulmonary embolism [PE]), while the safety outcome was incidence of any major bleeding (MB) event within 90 days of follow-up. Results: Among the 492 patients included for study, 212 (43.1%) received apixaban and 280 (56.1%) received warfarin. The mean age of patients was 53.6± 19.1 years and 62% of the cohort was female. Comparable rates of VTE recurrence were observed for apixaban and warfarin treatment groups during follow-up (adjusted odds ratio (AOR) =0.95; 95% CI 0.53– 1.68), including DVT (AOR=1.06; 95% CI 0.52– 2.17) and PE (AOR=0.78; 95% CI 0.31– 1.96). However, apixaban was associated with significantly fewer MB events than warfarin (AOR=0.18; 95% CI 0.04– 0.83). Conclusion: The use of apixaban for the treatment of Saudi patients with acute VTE is associated with a VTE recurrence rate comparable to that of warfarin, with significantly fewer MB events. [ABSTRACT FROM AUTHOR]

Background: Antimicrobials save millions of lives annually from dying because of bacterial infections, but the rapid emergence of antimicrobial resistance (AMR) becomes a global threat. The Saudi Ministry of Health (MOH) has taken containment measures to limit the misuse of antimicrobials via implementing restrictions on dispensing without prescriptions. Hence, we aim to evaluate the impact of regulating antimicrobial sales and identify challenges that pharmacists are facing to prevent self‐medication with antimicrobial agents. Materials and Methods: A cross‐sectional study was conducted using two sources of data: sales reports from 3000 pharmacies in Saudi Arabia and a self‐designed questionnaire. The questionnaire consists of 24 items written in English and Arabic languages, went through multiple steps to ensure validity and reliability and then distributed online. Descriptive analyses were used to present the results. Results: A total of 106 pharmacists completed the questionnaire. Sixty‐three per cent of the respondents observed a reduction of 40% in sales, which was consistent with pharmacies' sales reports, which revealed a 50% reduction in 2018 as compared to 2017. Seventy‐six per cent of respondents agreed that antimicrobials' sales restrictions were frustrating to patients. The percentage of pharmacists who reported receiving prescriptions with complete information about patients, prescribers, medications and issue date was 70%, 54%, 86% and 77%, respectively. And 69% of respondents revealed receiving support from their employers to prevent dispensing antimicrobial agents without prescription. Conclusion: Restriction measures implemented by the Saudi MOH led to a 40% to 50% reduction in inappropriate sales of antimicrobials. Further studies are needed to investigate the methods for improving documentation and prescribing practices. [ABSTRACT FROM AUTHOR]

Background: Dextrose is commonly administered with insulin during the management of hyperkalaemia to avoid hypoglycaemia. Previous research has evaluated the incidence of hypoglycaemia; however, none have reported the extent of blood glucose reduction after this regimen. The aim of this study was to better characterise the changes in blood glucose and to identify patients who may have an increased response to insulin.Methods: This was a multicentre retrospective study evaluating adult patients who received a regimen of 10 units of intravenous regular insulin plus 25 g of intravenous dextrose to manage hyperkalaemia between January 2014 and September 2016. The primary outcome was to evaluate the extent of blood glucose reduction (milligram per decilitre) up to 6 hours following the above regimen. Secondary outcomes included incidence of hypoglycaemia (blood glucose <70 mg/dL) and severe hypoglycaemia (blood glucose <40 mg/dL), and predictors of the extent of blood glucose reduction.Results: A total of 90 patients were included. The median blood glucose change over 6 hours was -24 mg/dL (IQR -53 to 6 mg/dL). Hypoglycaemia developed in 20 patients (22.2%, 95% CI 14.1% to 32.2%) and five patients (5.6%, 95% CI 1.8% to 12.5%) had severe hypoglycaemia. Patients who developed hypoglycaemia had a median baseline blood glucose of 110 mg/dL (IQR 80 to 127 mg/dL), which decreased to a median value of 52 mg/dL (IQR 40 to 60 mg/dL). Higher baseline blood glucose was significantly associated with greater blood glucose reduction (coefficient -0.36, 95% CI -0.55 to -0.18, p<0.001).Conclusions: The extent of blood glucose reduction is variable and hypoglycaemia is common. The high incidence of hypoglycaemia highlights the importance of frequent blood glucose monitoring. [ABSTRACT FROM AUTHOR]

Background: Dextrose is commonly administered with insulin during the management of hyperkalaemia to avoid hypoglycaemia. Previous research has evaluated the incidence of hypoglycaemia; however, none have reported the extent of blood glucose reduction after this regimen. The aim of this study was to better characterise the changes in blood glucose and to identify patients who may have an increased response to insulin., Methods: This was a multicentre retrospective study evaluating adult patients who received a regimen of 10 units of intravenous regular insulin plus 25 g of intravenous dextrose to manage hyperkalaemia between January 2014 and September 2016. The primary outcome was to evaluate the extent of blood glucose reduction (milligram per decilitre) up to 6 hours following the above regimen. Secondary outcomes included incidence of hypoglycaemia (blood glucose <70 mg/dL) and severe hypoglycaemia (blood glucose <40 mg/dL), and predictors of the extent of blood glucose reduction., Results: A total of 90 patients were included. The median blood glucose change over 6 hours was -24 mg/dL (IQR -53 to 6 mg/dL). Hypoglycaemia developed in 20 patients (22.2%, 95% CI 14.1% to 32.2%) and five patients (5.6%, 95% CI 1.8% to 12.5%) had severe hypoglycaemia. Patients who developed hypoglycaemia had a median baseline blood glucose of 110 mg/dL (IQR 80 to 127 mg/dL), which decreased to a median value of 52 mg/dL (IQR 40 to 60 mg/dL). Higher baseline blood glucose was significantly associated with greater blood glucose reduction (coefficient -0.36, 95% CI -0.55 to -0.18, p<0.001)., Conclusions: The extent of blood glucose reduction is variable and hypoglycaemia is common. The high incidence of hypoglycaemia highlights the importance of frequent blood glucose monitoring., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)