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Type 2 diabetes mellitus (T2DM) is a chronic disease with ever-increasing prevalence worldwide. In our study, we evaluated the prevalence of the risk of developing T2DM in Saudi Arabia and investigated associations between that risk and various sociodemographic characteristics. To those ends, a web-based cross-sectional survey of Saudi nationals without diabetes, all enrolled using snowball sampling, was conducted from January 2021 to January 2022. The risk of developing T2DM was evaluated using a validated risk assessment questionnaire (ARABRISK), and associations of high ARABRISK scores and sociodemographic variables were explored in multivariable logistic regression modeling. Of the 4559 participants, 88.1% were 18 to 39 years old, and 67.2% held a college or university degree. High ARABRISK scores were observed in 7.5% of the sample. Residing in a midsize city versus a large city was associated with a lower ARABRISK risk score (p = 0.007), as were having private instead of governmental insurance (p = 0.005), and being unemployed versus employed (p < 0.001). By contrast, being married (p < 0.001), divorced or widowed (p < 0.001), and/or retired (p < 0.001) were each associated with a higher ARABRISK score. A large representative study is needed to calculate the risk of T2DM among Saudi nationals.

Background: Antibiotics resistance is a serious problem around the world, which has been increasing in the last century due to misuse of antibiotics. Recently, Saudi Arabia enforced the Executive Regulations of Health Practice Law that prohibits dispensing antibiotics without prescription. Aim: (1) To assess the association between the knowledge and attitude toward the recent enforcement of the antibiotic restriction Law and the antibiotic use among Saudi population.(2) To assess the pattern of antibiotic use before and after the enforcement of the Law. Method: An online cross-sectional study was conducted among residents of Saudi Arabia. Results: The study was carried out among 570 Saudi participants; the result shows no considerable difference before and after law enforcement in purchasing and use of antibiotics. During the six months before the law implementation, antibiotics were obtained by 42 (7%) through purchase from the pharmacy without a prescription, 23 (4%) through remains of previously used containers, and 7 (1%) through a relative or a friend; while during the six months after the law implementation it was 31 (5%), 22 (4%) and 7 (1%), respectively. Only 48% agreed that they always received advice from a doctor, nurse or pharmacist on how to use your antibiotics. 32% have no knowledge about antibiotic resistance or drug resistance or antibiotic-resistant bacteria. More than two third (75%) were aware of the recent enforcement of the law that prohibits dispensing antibiotics without prescription. Among the participants, 91 (16%), 285 (50%) and 194 (34%) were expressed negative, neutral and positive attitude towards the law, respectively. Conclusion: In spite of the recent enforcement of the Law, there is still misuse of antibiotics, which indicate need for educational programs and campaigns to improve the knowledge of the population. Keywords: Antibiotic, Policy, Antibiotic resistance

Background Medication adherence in chronic diseases patients is a worldwide concern. Not achieving the goal of treatments because of non-adherence will lead to more complications and eventually may lead to death. In Saudi Arabia, we have insufficient data for interpretation. Hence, this study aims to have a better perspective at the number of the non-adherent patients with chronic diseases to their medications and its associated factors. Material and method Cross-sectional quantitative study was conducted among chronic diseases patients living in Saudi Arabia throughout social media and hospital visits from August 2018 to April 2019. A three-section questionnaire consists of patient's health, medications and adherence characteristics. Adherence to Refills and Medication Scale (ARMS) was used to identify the level of adherence among chronic diseases patients. Univariate descriptive statistics and independent sample t-test with one-way ANOVA were used as bivariate analysis. Finally, significant predictors of medical adherence with adjusted coefficient were determined by multivariable linear regression. Results A total of 385 patients were included in the analysis for the current study. Overall, 96.62% (n = 372) were non-adherent to their medications according to ARMS scale. Multiple linear regression model found types of co-morbidities, medication dosage form and dosage regimen to be independent predictors of medical adherence. Conclusion Medication adherence is alarmingly low among chronic disease patients in Saudi Arabia. There is a clear need for in-depth understanding for barriers. It is therefore important to conduct a qualitative study. What's known Medication adherence is a critical factor in treatment success. Low adherence to the medication is a common problem among chronic disease patients. Moreover, the majority of the studies in Saudi Arabia showed low adherence rate, and it focused in one single chronic disease only despite that patient may have more. What's new Most patients had more than one single chronic disease, so this study aims to take a snapshot to capture the adherence rate among patients who are suffering from chronic disease Saudi Arabia and its associated factors. This can help in understanding medication adherence behavior in clinical practice.

ObjectivesDuring the ongoing coronavirus 2019 (COVID-19) pandemic, chronic disease management and medication adherence have become challenging; thus, health-related quality of life may have been compromised. As highly trusted healthcare providers, pharmacies in Saudi Arabia have undergone restructuring or redesign to cope with the current demands during the pandemic. The study assessed satisfaction levels of patients with chronic diseases concerning pharmaceutical care services provided during COVID-19 in addition to medication adherence and quality of life during the pandemic.MethodsAn online questionnaire-based cross-sectional study was administered. Saudi residents suffering from chronic diseases and receiving pharmaceutical care from a hospital or community pharmacy during the COVID-19 pandemic were eligible. The survey was created using Google Forms and distributed through online channels. The survey targeted 385 participants.Key findingsA sample of 317 patients was included. More than half had missed a follow-up visit for their chronic conditions since the beginning of the pandemic. The overall mean score ± standard deviation for the satisfaction level with pharmaceutical care services was 22.0 ± 10.3 on a scale of 0–36 with different satisfaction levels for different services. In addition to a good level of medication adherence, a high percentage of these patients reported no problem in most of the dimensions of the EQ-5D scale.ConclusionsPharmacists should take a more proactive and consultive role to deliver healthcare needs of patients with a chronic condition and be aware of patient expectations from a pharmacist in situations, such as the current pandemic.

Background: Hospitalization can contribute to insomnia in many patients and is usually treated symptomatically. However, sedative/hypnotic misuse is associated with complications in this population, especially in the elderly. Such complications include dizziness, falls and over-sedation. Due to the implicit dangers, widespread use of these drugs for insomnia, particularly in older patients, has been discouraged by many hospitals. The aim of this study was to review and evaluate prescribing patterns and to optimize the use of the sedative/hypnotic agents through daily pharmacy interventions at a community hospital. Methods: This was a biphasic before and after study. Data on sedative/hypnotic use was collected retrospectively for a 2-month period and a sample of 100 patients was randomly selected for analysis. A 2-month prospective phase followed, in which daily orders were reviewed by one pharmacy resident and recommendations made to discontinue any unnecessary, newly prescribed sedative/hypnotic orders when appropriate. Finally, results of both phases were compared for any differences in patient demographics, being prescribed more than one sedative/hypnotic, and complications documented. Results: During the prospective phase, pharmacist interventions led to the discontinuation of 25% of a total of 97 sedative/hypnotic orders in 97 patients. The number of patients receiving more than one sedative/hypnotic agents in the intervention group was significantly lower than the retrospective control group (15 Vs. 34, P = 0.0026). The incidence of complications was not significantly different between the control and intervention groups for the following: over-sedation, falls and delirium (p = 0.835, p = 0.185, p = 0.697, respectively). Conclusion: This study suggests that the use of sedative/hypnotics in the inpatient units (excluding the critical care unit), is somewhat prevalent, and many patients may be on more than one sedative/hypnotic, which could potentially cause cumulative harm. During the intervention phase, 25% of the total in-hospital orders for sedative/hypnotics were discontinued following recommendations made by a pharmacist, and significantly lower number of patients receiving duplicate sedative/hypnotics was noted. Further efforts should be implemented to avoid unnecessary sedative/hypnotic initiation in hospitalized patients, and to ensure monitoring by pharmacists is optimized. Keywords: Sleep disorders, Medication errors, Medication safety, Geriatrics, Internal medicine, Clinical pharmacy

Goal The American Heart Association/American Stroke Association has specific recommendations for secondary stroke prevention. The aim of this study was to compare health behaviors engagement between stroke survivors and propensity score-matched controls. Methods We conducted a retrospective, cross-sectional, matched case-control study using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. We included older adults aged 50 or older who participated in the 2015 BRFSS survey and completed the interview. Each case was matched to 3 controls (1:3) based on propensity scores to increase the power of the analyses. Stroke survivors were compared with controls on their physical activity, smoking, alcohol use, body mass index (BMI), last flu immunization, last physical checkup, last blood cholesterol check, heavy drinking, and vegetable and fruit consumption. We used binomial logistic regression to assess health behaviors among stroke survivors compared with controls. Results The final study sample consisted of 13,249 stroke survivors and 39,747 controls without stroke after propensity score matching. Multivariable analyses revealed that there were significant differences between stroke survivors and matched controls in terms of BMI, physical activity, smoking status, alcohol consumption, and vegetable and fruit consumption. For example, stroke survivors were 51% more likely to be smokers (adjusted odds ratio [AOR] 1.51, 95% confidence interval [CI], 1.32-1.73) and 14% less likely to consume alcohol (AOR .86, 95% CI .78-.95). Conclusion Findings from our study indicate that compared with propensity score-matched controls, stroke survivors engage in poorer health behaviors with the exception of alcohol consumption.

Majed S Al Yami,1,2 Sawsan Kurdi,2,3 Ivo Abraham2,4,5 1Department of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA; 3Department of Pharmacy Practice, University of Dammam, Dammam, Saudi Arabia; 4Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; 5Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA Background: Standard-duration (7–10 days) thromboprophylaxis with low molecular weight heparin, low dose unfractionated heparin, or fondaparinux in hospitalized medically ill patients is associated with ~50% reduction in venous thromboembolism (VTE) risk. However, these patients remain at high risk for VTE post-discharge. The direct oral anticoagulants (DOACs) apixaban, rivaroxaban and betrixaban have been evaluated for extended-duration (30–42 days) thromboprophylaxis in this population. Methods: We review the efficacy and safety results from the 3 pivotal trials of extended-duration DOAC thromboprophylaxis in medically ill patients. We performed a meta-analysis of these pivotal trials focusing on 6 VTE (efficacy) and three bleeding outcomes (safety). These results were integrated into a quantitative risk/benefit assessment. Results: The trials evaluating extended-duration DOAC thromboprophylaxis in medically ill patients failed to establish clear efficacy and/or safety signals for each agent. Our meta-analysis shows that, as a class, DOACs have selective and partial extended-duration prophylactic activity in preventing VTE events. However, this is associated with a marked increase in the risk of various bleeding events. The risk/benefit analyses fail to show a consistent net clinical benefit of extended-duration DOAC prophylaxis in medically ill patients. Conclusion: At this time, the evidence of safe and effective extended-duration thromboprophylaxis with DOACs in this population is inconclusive. Keywords: venous thromboembolism, direct oral anticoagulants, enoxaparin, thromboprophylaxis, medically ill patients

Background Depression is one of the most common psychiatric conditions among stroke survivors and is associated with several negative health outcomes. However, little is known about the depression treatment patterns among stroke survivors. The objective of this study was to examine national-level prevalence, patterns and predictors of depression treatment among community-dwelling stroke survivors. Methods This study adopted a retrospective, cross-sectional study design using multiple years of Medical Expenditure Panel Survey (MEPS) (2002–2012) data. The study population consisted of older adults (age ≥ 50 years) who (i) were stroke survivors (ICD-9-CM codes of 430–438), (ii) did not die during the calendar year, and (iii) had co-occurring depression (ICD-9-CM code of 296.xx, or 311.xx). Depression treatment, identified by antidepressant medication and/or psychotherapy use, was the dependent variable of this study. Multinomial logistic regression analysis was conducted to examine the association of individual level factors with depression treatment among stroke survivors with co-occurring depression. Results The final study sample consisted 370 (unweighted) community-dwelling older adults with self-reported stroke and depression. The prevalence of co-occurring depression among stroke survivors was 22.03% [95% Confidence Interval (CI) 19.7–24.4%]. An overwhelming majority (87.6%) of stroke survivors with co-occurring depression reported some form of depression treatment. Antidepressants only and combination therapy was reported by 74.8% (95% CI, 71.6–78.0%] and 12.8% (95% CI, 10.5–15.1%) by stroke survivors with co-occurring depression respectively. Approximately, 61% of stroke survivors with co-occurring depression reported using SSRIs, followed by SNRIs (15.2%), miscellaneous antidepressants (12.1%), TCAs (9.8%), phenylpiperazine antidepressants (5.2%), and tetracyclic antidepressants (4%). Sertraline (15.8, 95% CI, 12.7–19.0%) had the highest reported use among individual antidepressants. Conclusions Vast majority (nearly 90%) of the study sample received some form of depression treatment and several individual level factors (such as age, education) were associated with the report of depression treatment use. Future longitudinal studies are warranted to assess the comparative treatment benefits of antidepressants, psychotherapy and their combination. Healthcare providers should carefully assess the risks and benefits of antidepressant (such as SSRIs or TCAs) use in this vulnerable population prior to their use. Electronic supplementary material The online version of this article (10.1186/s12888-018-1723-x) contains supplementary material, which is available to authorized users.

Goal The American Heart Association/American Stroke Association has specific recommendations for secondary stroke prevention. The aim of this study was to compare health behaviors engagement between stroke survivors and propensity score-matched controls. Methods We conducted a retrospective, cross-sectional, matched case-control study using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. We included older adults aged 50 or older who participated in the 2015 BRFSS survey and completed the interview. Each case was matched to 3 controls (1:3) based on propensity scores to increase the power of the analyses. Stroke survivors were compared with controls on their physical activity, smoking, alcohol use, body mass index (BMI), last flu immunization, last physical checkup, last blood cholesterol check, heavy drinking, and vegetable and fruit consumption. We used binomial logistic regression to assess health behaviors among stroke survivors compared with controls. Results The final study sample consisted of 13,249 stroke survivors and 39,747 controls without stroke after propensity score matching. Multivariable analyses revealed that there were significant differences between stroke survivors and matched controls in terms of BMI, physical activity, smoking status, alcohol consumption, and vegetable and fruit consumption. For example, stroke survivors were 51% more likely to be smokers (adjusted odds ratio [AOR] 1.51, 95% confidence interval [CI], 1.32-1.73) and 14% less likely to consume alcohol (AOR .86, 95% CI .78-.95). Conclusion Findings from our study indicate that compared with propensity score-matched controls, stroke survivors engage in poorer health behaviors with the exception of alcohol consumption.

Despite a recommended 7–10 days of thromboprophylaxis, medically ill patients remain at increased risk of developing venous thromboembolism (VTE) after hospital discharge. Here, we present a contemporary review on the efficacy and safety of extended-duration thromboprophylaxis with direct oral anticoagulants (DOACs) in hospitalized medically ill patients. A search of publication and trial databases of controlled trials conducted from 2010 to 2016 using the key terms apixaban, rivaroxaban, and betrixaban showed three phase III trials that met our search criteria. In the “ADOPT” trial, apixaban was not inferior to enoxaparin in preventing VTE events (relative risk [RR] of 0.87; 95% confidence interval [CI] 0.62–1.23; P = 0.44); however, major bleeding rate was significantly higher with apixaban (RR of 2.58; 95% CI 1.02–7.24; P = 0.04). In the “MAGELLAN” trial, rivaroxaban was superior to enoxaparin in preventing VTE events (RR of 0.77; 95% CI 0.62–0.96; P = 0.02) but with higher clinically relevant bleeding rate (RR of 2.5; 95% CI 1.85–3.25; P

ObjectiveTo evaluate the efficacy and tolerability of Levetiracetam (LEV) as an adjunctive therapy in pediatric patients with different generalized epilepsies.DesignChart review of 22 consecutive children age 4–19years who were treated with LEV for at least 1year was observed retrospectively. The mean dose rang of LEV was from 250 to 2000mg. Data were collected on epilepsy type, seizure frequency, concomitant antiepileptic drug and adverse effect.ResultsOf the 22 patient reviewed, 13 (59%) were boys and 9 (41%) were girls. Predominant seizure types were generalized tonic–clonic seizures 13 (59%) and tonic seizure 6 (27%). Other seizure types included myoclonic seizures 2 (9%) and focal seizure 3 (5%). The results showed 10 (45%) had become free of seizure for almost 7months to 1year. Eight of these 10 patients (80%) had normalized EEG. Seizure frequency was reduced in 9 (41%) patients and 3 (14%) patients still had seizure. No side effects were reported related to LEV treated patients except for 1 patient.ConclusionOur results confirm that LEV may be an effective adjunctive therapy in treatment of childhood epilepsy, especially tonic–clonic seizure, with possible no evident side effect.