Modified geometry three-layered tablet as a platform for class II drugs zero-order release system

Purpose: To optimize a geometrical design of three-layered tablets for controlling the release of indomethacin (Ind) as a BCS class II model.Methods: The core formulation was optimized to ensure non-disintegrating tablet with a slow release behavior. Three-layered tablets were prepared by a single-step direct compression method by manual feeding of a hydrophobic layer in the bottom followed by Ind core layer and another hydrophobic layer at the top using 6 and 12 mm round compression sets. Four batches were prepared, differing only in either thickness of the drug layer or tablet diameter. A number of factors were studied, including tablet thickness to diameter ratio and drug layer surface area. The rate of Ind released was determined using USP dissolution apparatus I.Results: The optimum drug layer formulation contained Ind (40%), polyvinylpyrolidone K30 (40 %), and ethyl cellulose (20 %). The t50% (time taken for 50 % drug release) for the four three-layered tablet batches with varying diameter to thickness ratios were in the range of 1.5 to 3.7 h. The diameter to thickness ratios were in good correlation with % Ind release after 4 h (R2 = 0.94). It was found that all batches complied with zero order kinetic model.Conclusion: The new one-compression phase applied in this study is successful in producing threelayered tablets in a single-step with very good mechanical attributes. The approach of designing a controlled release tablet via control of the surface area of drug release is feasible for non-swelling matrices.Keywords: Controlled release, Indomethacin, BCS class II drugs, Ethyl cellulose, Release kinetics, Direct compressio

A comparative study of voluntarily reported medication errors among adult patients in intensive care (IC) and non- IC settings in Riyadh, Saudi Arabia

Purpose: To investigate the risk factors associated with medication errors and to compare the incidence and types of voluntarily reported medication errors among adult intensive care unit (ICU) and non-ICU patients at King Abdulaziz Medical City, Riyadh, Saudi Arabia.Methods: The design of this study was retrospective. All voluntarily reported medication errors involving adult patients (≥ 18 years) who were admitted into King Abdulaziz Medical City during the study period (January 2012 to June 2013) were included in the study. Reported medication errors were classified as ICU or non-ICU errors. Medication errors were also classified according to the node of medication use, harm category, and type of medication errors.Results: A total of 31,399 patients admitted into the hospital were included in the study, with 1,966 (6 %) admitted into the ICU and 29,433 (94 %) admitted into the non-ICU units. Overall, the incidence of medication errors was 1.2 % (390/31,399), 1. Over half of the errors were administration-related (51 %). The incidence of medication errors was 5.5 % (108/1,966) in ICU compared with 0.96 % (282/29,433) in non-ICU units (p < 0.001. In both settings, prescribing errors, delay in drug administration and dispensing extra dose were the most common medication errors. Higher risk for medication errors was significantly associated with admission into ICU vs. non-ICU units [OR = 5.24, 95 % CI: (4.12, 6.65); p < 0.001] and with patients’ age ≥ 60 vs. < 60 years [OR = 1.48, 95 % CI: (1.19, 1.83); p < 0.001].Conclusion: Medication errors are common in the health facility and occur during all stages of medication use from prescribing to administration. Higher risk for medication errors is associated with admission into the ICU and with patients’ age ≥ 60. Physician, pharmacists, and nurses need to be vigilant, up-to-date, and continuously trained to reduce the incidence of medication errors.Keywords: Medication errors, Voluntary reporting, Intensive care unit, Hospital settin

Journal of Infectious Diseases and Immunity Full Length Research Paper Urinary tract infections in Saudi renal transplant recipients

Urinary tract infections (UTIs) are common post-renal transplant complications. During the first month post-transplantation, bacterial septicemia due to UTIs is an important cause of morbidity and mortality. The incidence, risk factors and causative bacteria of UTIs were assessed in 27 renal transplant recipients (RTRs). Bacterial UTI was diagnosed based on urine culture that was positive for bacterial growth greater than 10 5 colony-forming unit (CFU)/ml. The average age of the participants was 41.3±16.2 years, ranging from 16 to 73 years. Male RTRs were 51.9 % (N = 14) and females were 48.1 % (N = 13). Patients who received kidneys from living-related donors were 63.0 % (N = 17) and those who received cadaveric kidneys were 27.0 % (N = 10). Incidence of urinary tract infections post-renal transplant was 55.5 % (N = 15). Gender (69.2 % of the female RTRs developed UTI versus 30.8 % of the males) and age (66.7 % of the RTRs ≥ 50 years developed UTI) seemed to be risk factors for post-renal transplant UTIs. Escherichia coli was the most common pathogen (53.3%, N = 8) followed by Pseudomonas aeruginosa (20%, N = 3). Most of the UTIs (73.3%) were detected within one month post-renal transplant. Recurrent infection was observed in 40.1 % of the patients. The implication of this study is the need to implement a new prophylaxis regimen that takes into consideration the causative bacteria and its antibiotic sensitivity

A Successfully Treated Case of Aspergillus Flavus Fungal Keratitis Caused by Stale Bread Corneal Injury

Abstract Fungal keratitis is difficult to treat that can result in corneal blindness requiring penetrating keratoplasty and in fungal endophthalmitis. We report a case of fungal keratitis following a recent eye trauma by stale bread particle. Ophthalmological and Microbiological investigation revealed a fungal keratitis with aspergillus flavus. The case was successfully treated with oral antifungal (voriconazole), and combination of topical antifungal medications. The patient responded well to the antifungal treatment and gain 20/20 vision with complete resolution of the fungal keratitis and absence of recurrence. Early presentation and diagnosis are the key factor toward successful management of fungal keratitis

Strategic initiatives to maintain pharmaceutical care and clinical pharmacists sufficiency in Saudi Arabia

Objectives: The shortage of clinical pharmacists in Saudi Arabia has limited the full implementation of pharmaceutical care in most of its hospitals. The National Guard Health Affairs hospitals. This work discussed the Department of Pharmaceutical Care, and the King Saud Bin Abdulaziz University for Health Sciences College of Pharmacy four initiatives that were planned in 2009–2010 to develop and recruit clinical pharmacists, practitioners, or faculty. Methods: The combined initiatives were aimed at (1) instituting a 4-year clinical skills development career ladder, (2) expanding the National Guard Health Affairs postgraduate residency program, (3) offering scholarships to qualified pharmacy graduates to pursue the PharmD degree and a PGY-1 residency training in the United States, and (4) recruiting non-Saudi clinical pharmacists educated and trained in the United States to ameliorate the current shortage of practitioner. Results: The current number of clinical pharmacists practicing at the National Guard Health Affairs at central region is 24, most of whom are Board Certified by the American Pharmacists Association Board of Pharmacy Specialties. Conclusions: The four initiatives, based on current trends, suggest that 60–65 positions will be added by 2017–2018, barring attrition. Saudi Arabia and many developing countries will continue to experience a shortage in clinical pharmacists due to the high demand for clinical pharmacy services. A multifaceted approach is recommended to address the problem

Implementation of an Outcome-Based Longitudinal Pharmacology Teaching in Undergraduate Dental Curriculum at KSAU-HS Experience

Purpose/objectives: The aim of this study is to present a modification of the structure of the pharmacology educational experience for dental students as a result of the early introduction of a pharmacology course into the pre-professional curriculum. Methods: Three courses of professional dental pharmacology were modified before and/or after delivery by developing general course learning outcomes, lecture-by-lecture learning outcomes and theme mapping to align topics taught within these courses and with those taught in the pre-professional dental program. Results: Final proposals for three professional dental pharmacology courses, which are distributed over three professional years, were prepared based on teaching experience and theme mapping. Topics were added, deleted, transferred from one course to another to afford courses that are fully aligned, relatively comprehensive, longitudinal, with focus on topics relevant to the dental practice without redundancy. In addition, the design of these courses took into consideration the level of coverage of the pre-professional dental pharmacology course. Conclusions: This longitudinal inclusion of pharmacology courses form the second pre-professional year to the third professional year is expected to improve dental students’ pharmacology education experience. Although the last of these courses is a pharmacotherapeutic course, more courses with clinically oriented therapeutic approach are recommended. Keywords: Pharmacology course design, Dental students, Curriculum development, Curriculum mappin

Adherence and treatment satisfaction in liver transplant recipients

Background/Aims: Liver transplantation (LT) is a life-saving intervention for patients with liver failure. LT recipients' adherence to their therapeutic regimen is an essential element for graft survival. According to WHO, the impact of medication non-adherence in solid organ transplantation has shown to cost $15–100 million annually. The aim of the present study was to identify the factors that best predict medication adherence and to explore the relationship between treatment satisfaction and medication adherence in liver transplant recipients. Patients and Methods: Adult liver transplant patients at King Abdulaziz Medical City were included in the study. Patients completed the 8-item Morisky Medication Adherence Scale (MMAS-8) and the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) in addition to several socio-demographic and transplant-related data. Results: A total of 154 patients were included in the study and of these 59.7% were adherent. Older age was a significant predictor of adherence (P < 0.05). The mean treatment satisfaction score was 91.9 ± 12.7 in Effectiveness, 80.0 ± 25.9 in Side Effects, 83.5 ± 15.7 in Convenience, and 94.6 ± 8.6 in Global Satisfaction. Further analysis indicated that patients in the adherent group had reported significantly higher satisfaction scores than those in the non-adherent group (P < 0.05) in all treatment satisfaction domains: Effectiveness (94.4 ± 10.4 vs. 88.6 ± 14.8), Side Effects (83.9 ± 22.0 vs. 74.2 ± 30.1), Convenience (87.0 ± 13.9 vs. 77.2 ± 16.1), and Global Satisfaction (96.9 ± 6.6 vs. 91.2 ± 8.6). Conclusion: Older patients and those who were more satisfied with their treatment tend to have better adherence to the prescribed medications. Therefore, increasing patients' satisfaction with their treatment should be an integral element of future care plans designed to improve treatment outcomes in liver transplant recipients

Assessment of anti-factor Xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patients

Background: Venous thromboembolism (VTE) can be encountered by 60% of hospitalized patients. Anticoagulants have been recommended to reduce the risk of VTE in patients with risk factors. However, no specific dosing recommendations for obese patients are provided in the current practice guidelines. The purpose of this study was to determine the efficacy and safety of weight-based dosing of enoxaparin for VTE prophylaxis among morbidly obese patients undergoing surgery. Methods: Adult patients were enrolled if they have a body mass index (BMI) of ≥35 kg/m2 and were scheduled for surgery. These patients were prescribed enoxaparin (0.5 mg/kg subcutaneously [SC] once daily). Peak anti-factor Xa levels were measured 4 h after the third dose of enoxaparin. The primary outcome measure was to determine whether a weight-based dosing of enoxaparin of 0.5 mg/kg produce the anticipated peak anti-Xa levels (0.2–0.6 IU/m) among obese patients undergoing surgery. Secondary outcomes include the incidence of VTE, the incidence of minor or major bleeding, and the incidence of heparin-induced thrombocytopenia (HIT). Results: Fifty patients were enrolled in the study. The mean age was 53 ± 16 years, 74% of the patients were female. The mean BMI was 40.5 ± 5, and the average enoxaparin dose was 50 ± 9.8 SC daily. Nearly 88% of the patients reached the target anti-factor Xa (0.427 ± 0.17). None of the patients developed HIT or VTE. There was no incidence of major or minor bleeding. Conclusions: Weight-based enoxaparin dose led to the anticipated peak anti-Xa levels (0.2–0.6 IU/mL) in most of the morbidly obese study patients undergoing surgery without any evidence of major side effects. The weight-based dosing of enoxaparin was also effective in preventing VTE in all patients. Although these results are promising, further comparative trials are needed in the setting of morbidly obese surgical patients

Assessment and comparison of CHADS2, CHA2DS2-VASc, and HAS-BLED scores in patients with atrial fibrillation in Saudi Arabia

Aims: No previous reports on the utilization of CHADS2, CHA2DS2-VASc, and HAS-BLED scores in atrial fibrillation (AF) patients in Saudi Arabia have been identified in the literature. The main objectives of this study were to assess and compare the distribution of CHADS2, CHA2DS2-VASc, and HAS-BLED scores and to identify the most common risk factors for stroke and bleeding among AF patients attending clinical pharmacists managed anticoagulation clinic. Settings and Design: This cross-sectional study was conducted over 2 months period at clinical pharmacists managed anticoagulation clinic. Methods: CHADS2, CHA2DS2-VASc, and HAS-BLED scores were calculated and compared for all eligible patients. Results: Two hundred and sixty-four patients with AF were included in the analysis. The number of patients at low risk for stroke was found to be 14 (5.3%) using CHADS2 and only 4 (1.5%) using CHA2DS2-VASc. On the other hand, 64 patients (24.2%) were found at moderate risk for stroke using CHADS2 compared with 17 patients (6.4%) using CHA2DS2-VASc. Most of the patients were found to be at high risk for stroke using either the CHADS2 (70.5%) and CHA2DS2-VASc (92%). The study also revealed that most of the patients were at moderate (63.3%) to high (27.7%) risk of bleeding. Conclusions: The results of this study show that the percentage of patients at high risk for stroke and bleeding is very high. The study revealed that this could be attributed to the high prevalence of modifiable risk factors for stroke and for bleeding in Saudi patients with AF