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1. An Evaluation Of Antibiotics Prescribing Patterns In The Emergency Department Of A Tertiary Care Hospital In Saudi Arabia

Author

Mq, Alanazi, Salam M, fulwah Alqahtani, Ae, Ahmed, Aq, Alenaze, Al-Jeraisy M, Al Salamah M, Fs, Aleanizy, Al Daham D, Al Obaidy S, Al-Shareef F, dummy-AUTHOR_name, and Mh, Al-Assiri

Subjects
prescription, predictors, emergency, antibiotic, education, prevalence, errors, lcsh:RC109-216, geographic locations, lcsh:Infectious and parasitic diseases
Abstract

Menyfah Q Alanazi,1–3 Mahmoud Salam,2–4 Fulwah Y Alqahtani,5 Anwar E Ahmed,2,3 Abdullah Q Alenaze,6 Majed Al-Jeraisy,2,3,7Majed Al Salamah,8 Fadilah S Aleanizy,5 Daham Al Daham,2,3 Saad Al Obaidy,7 Fatma Al-Shareef,9 Abdulaziz H Alsaggabi,1 Mohammed H Al-Assiri2,3 1Drug Policy and Economics Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; 2King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 3King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 4Hariri School of Nursing, American University of Beirut, Beirut, Lebanon; 5Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 6Ishbilia Primary Health Care, Ministry of Health, Riyadh, Saudi Arabia; 7Pharmaceutical Care Service, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; 8Emergency Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; 9Saudi Medication Safety Centre, Ministry of National Guard-Health Affairs, Riyadh, Saudi ArabiaCorrespondence: Menyfah Q AlanaziDrug Policy and Economics Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, P.O. Box 22390, Riyadh 11426, Saudi ArabiaTel +966 11 801 1111Email menefah@gmail.comBackground: Antibiotic prescriptions at emergency departments (ED) could be a primary contributing factor to the overuse of antimicrobial agents and subsequently antimicrobial resistance. The aim of this study was to describe the pattern of antibiotic prescriptions at an emergency department of a tertiary care hospital in Saudi Arabia.Methods: A cross-sectional study, based on a review of antibiotic prescriptions was conducted. All cases who visited the emergency department over a three-month period with a complaint of infection were analyzed in terms of patient characteristics (age, sex, infection type, and number of visits) and prescription characteristics (antibiotic category, spectrum, course and costs). The World Health Organization and International Network of Rational Use of Drugs prescribing indicators were presented. Descriptive and analytic statistics were applied.Results: A total of 36,069 ED visits were recorded during the study period, of which 45,770 drug prescriptions were prescribed, including 6,354 antibiotics. The average number of drugs per encounter was 1.26, while the percentage of encounters with a prescribed antibiotic was 17.6%. Among antibiotic prescriptions, the percentage of encounters with injection antibiotics was 15.2%. Almost 77% of antibiotics were prescribed by their generic names, and the percentage of antibiotics prescribed from the essential list was 100%.Conclusion: The average number of drugs per encounter in general and antibiotics per encounter in specific at this setting was lower than the standard value. However, the percentage of antibiotics prescribed by its generic name was less than optimal.Keywords: antibiotic, prescription, errors, prevalence, predictors, emergency

Published
2019

2. The progression rate of aortic stenosis: key to tailoring the management and potential target for treatment

Author

Tafciu, E, Mandoli, Ge, Santoro, C, Setti, M, D'Andrea, A, Esposito, R, Bandera, F, Evola, V, Malagoli, A, Cameli, M, Benfari, G, dummy-AUTHOR_name, Working Group of Echocardiography of the Italian Society of Cardiology, Tafciu, E., Mandoli, G. E., Santoro, C., Setti, M., D'Andrea, A., Esposito, R., Bandera, F., Evola, V., Malagoli, A., Cameli, M., and Benfari, G.

Subjects
medicine.medical_specialty, progression rate, aortic stenosis, degenerative, progression rate, valvulopathies, 030204 cardiovascular system & hematology, Doppler echocardiography, 03 medical and health sciences, 0302 clinical medicine, Valvular disease, Risk Factors, medicine, Humans, degenerative, 030212 general & internal medicine, Heart valve, Intensive care medicine, medicine.diagnostic_test, business.industry, Disease progression, aortic stenosis, General Medicine, Aortic Valve Stenosis, medicine.disease, Prognosis, valvulopathies, Echocardiography, Doppler, Stenosis, medicine.anatomical_structure, Aortic valve stenosis, Disease Progression, Progression rate, Cardiology and Cardiovascular Medicine, business, Progressive disease
Abstract

Aortic stenosis is the most frequent valvular disease to require intervention in the western world and has always been featured as a progressive disease. The rate of progression can be assessed by carefully performed Doppler echocardiography and can vary greatly between individuals with a profound impact on prognosis. Unfortunately, the determinants of disease progression had been insufficiently studied and remain challenging to define, particularly in the outpatient setting. Multiple factors have been proposed and tested, but at present, there are no proven therapies to slow the course of the stenotic process. Heart valve clinics may be particularly important to define the progression rate and tailor follow-up and management at an individual level. This review enlightens knowledge and gaps regarding the progression-rate of aortic valve stenosis, from the historical perspective to the molecular one.

Published
2021

3. Metachromatic leukodystrophy and transplantation: remyelination, no cross-correction.

Author

Wolf, NI, Breur, M, Plug, B, Beerepoot, S, Westerveld, ASR, van, Rappard DF, de, Vries SI, Kole, MHP, Vanderver, A, van, der Knaap MS, Lindemans, CA, dummy-AUTHOR_name, null, Bugiani, M, Wolf, NI, Breur, M, Plug, B, Beerepoot, S, Westerveld, ASR, van, Rappard DF, de, Vries SI, Kole, MHP, Vanderver, A, van, der Knaap MS, Lindemans, CA, dummy-AUTHOR_name, null, and Bugiani, M

Abstract

Objective In metachromatic leukodystrophy, a lysosomal storage disorder due to decreased arylsulfatase A activity, hematopoietic stem cell transplantation may stop brain demyelination and allow remyelination, thereby halting white matter degeneration. This is the first study to define the effects and therapeutic mechanisms of hematopoietic stem cell transplantation on brain tissue of transplanted metachromatic leukodystrophy patients. Methods Autopsy brain tissue was obtained from eight (two transplanted and six nontransplanted) metachromatic leukodystrophy patients, and two age-matched controls. We examined the presence of donor cells by immunohistochemistry and microscopy. In addition, we assessed myelin content, oligodendrocyte numbers, and macrophage phenotypes. An unpaired t-test, linear regression or the nonparametric Mann–Whitney U-test was performed to evaluate differences between the transplanted, nontransplanted, and control group. Results In brain tissue of transplanted patients, we found metabolically competent donor macrophages expressing arylsulfatase A distributed throughout the entire white matter. Compared to nontransplanted patients, these macrophages preferentially expressed markers of alternatively activated, anti-inflammatory cells that may support oligodendrocyte survival and differentiation. Additionally, transplanted patients showed higher numbers of oligodendrocytes and evidence for remyelination. Contrary to the current hypothesis on therapeutic mechanism of hematopoietic cell transplantation in metachromatic leukodystrophy, we detected no enzymatic cross-correction to resident astrocytes and oligodendrocytes. Interpretation In conclusion, donor macrophages are able to digest accumulated sulfatides and may play a neuroprotective role for resident oligodendrocytes, thereby enabling remyelination, albeit without evidence of cross-correction of oligo- and astroglia. These results emphasize the importa

Published
2020

4. A novel method for engineering autologous non-thrombogenic in situ tissue-engineered blood vessels for arteriovenous grafting.

Author

Geelhoed, WJ, van, der Bogt KEA, Rothuizen, TC, Damanik, FFR, Hamming, JF, Mota, CD, van, Agen MS, de, Boer HC, Tobón Restrepo, Mauricio, Hinz, B, Kislaya, A, Poelma, C, dummy-AUTHOR_name, null, Rotmans, JI, Geelhoed, WJ, van, der Bogt KEA, Rothuizen, TC, Damanik, FFR, Hamming, JF, Mota, CD, van, Agen MS, de, Boer HC, Tobón Restrepo, Mauricio, Hinz, B, Kislaya, A, Poelma, C, dummy-AUTHOR_name, null, and Rotmans, JI

Abstract

The durability of prosthetic arteriovenous (AV) grafts for hemodialysis access is low, predominantly due to stenotic lesions in the venous outflow tract and infectious complications. Tissue engineered blood vessels (TEBVs) might offer a tailor-made autologous alternative for prosthetic grafts. We have designed a method in which TEBVs are grown in vivo, by utilizing the foreign body response to subcutaneously implanted polymeric rods in goats, resulting in the formation of an autologous fibrocellular tissue capsule (TC). One month after implantation, the polymeric rod is extracted, whereupon TCs (length 6 cm, diameter 6.8 mm) were grafted as arteriovenous conduit between the carotid artery and jugular vein of the same goats. At time of grafting, the TCs were shown to have sufficient mechanical strength in terms of bursting pressure (2382 ± 129 mmHg), and suture retention strength (SRS: 1.97 ± 0.49 N). The AV grafts were harvested at 1 or 2 months after grafting. In an ex vivo whole blood perfusion system, the lumen of the vascular grafts was shown to be less thrombogenic compared to the initial TCs and ePTFE grafts. At 8 weeks after grafting, the entire graft was covered with an endothelial layer and abundant elastin expression was present throughout the graft. Patency at 1 and 2 months was comparable with ePTFE AV-grafts. In conclusion, we demonstrate the remodeling capacity of cellularized in vivo engineered TEBVs, and their potential as autologous alternative for prosthetic vascular grafts.

Published
2020

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