Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review.

Background: Misoprostol is an effective medical method for the management of pregnancy loss. However, data on its efficacy and safety in women with previous cesarean deliveries are limited. Case presentation: We report a 36-year-old patient, gravida 11 para 6, with a diagnosis of missed miscarriage at 15 weeks of gestation. The patient had a significant obstetric history of previous five cesarean deliveries and uterine rupture. Following patient counseling about the medical and surgical options of managing her miscarriage, the patient opted for medical method. Low-dose misoprostol of 100 μg was inserted vaginally and repeated again after 6 hours. The patient had an uneventful complete miscarriage following the second dose of misoprostol. No uterine rupture, no extra vaginal bleeding, and no blood transfusion were observed. Conclusion: We conclude that adopting a low-dose misoprostol protocol could be potentially safe and effective in managing second trimester missed miscarriage in women with repeated cesarean deliveries and/or uterine rupture history. Further studies are needed to confirm these results

A retrospective drug use evaluation of cabergoline for lactation inhibition at a tertiary care teaching hospital in Qatar.

Background: Breastfeeding is considered as gold standard for infant nutrition and should be interrupted only when a compelling indication exists. Certain medical conditions such as abortion, stillbirth, HIV infection, or infant galactosemia and certain medications such as chemotherapy necessitate lactation inhibition to protect the health of mother and infant. Drug use evaluation (DUE) studies are done to explore the current practice in a setting and help to identify areas in which further information and education may be needed by clinicians. Objective: The aim of this study was to conduct a DUE of cabergoline to assess indications for lactation inhibition, dosage regimen, and its safety. Method: A retrospective cross-sectional DUE study was conducted over a period of 4 months from September 1, 2013, till December 31, 2013, at the Women's Hospital, Qatar. All cabergoline prescriptions written for lactation inhibition within 10 days of delivery or abortion were included in the study. A descriptive data analysis was undertaken. Results: Of the 85 patients included, stillbirth (50.6%) was considered as the main reason for lactation inhibition, followed by abortion (27.1%) and neonatal death (12.9%). The remaining 9.4% of the patients had live baby, and the majority of them were prescribed cabergoline for lactation inhibition because their maternal medical conditions required the use of drugs with insufficient safety data (n=6). Seventy-four percent of patients received cabergoline at accurate time and dose. However, 14% of the patients had preexisting hypertensive disorder and 58.3% of them were diagnosed as uncontrolled hypertension. Conclusion: The current DUE study found that cabergoline was mainly used to inhibit lactation for patients with stillbirth, abortion, and neonatal death. In mothers who use medications for other medical conditions, benefits and risks of breastfeeding should be carefully balanced before prescribing cabergoline. Current prescribing pattern can be further enhanced through informing health care providers regarding appropriate cabergoline dosage regimen and its safety in patients with uncontrolled hypertension

Enhancing medication management of older adults in Qatar : healthcare professionals’ perspectives on challenges, barriers, and Enabling solutions

We want to express our sincere gratitude to Dr Abdelaziz Darwish, Deputy Chief Medical Officer and A/CEO of RH, for his invaluable support and guidance throughout this research project, Dr Hanadi, chairperson of the Geriatric and Medical Director of the Geriatric department, and Dr Ahmed Al-Mohammed, Head of the medicine department, Dr. Youssef Almoslimani, Medical Director of Hamad General Hospital, and Dr Nasser Masoudi for their support in securing the necessary resources and facilitating access to facilities subjects]. Their continuous encouragement and belief in the significance of our research motivated us to overcome challenges and strive for excellence. We would also like to thank the entire RH, Medicine, and Mental Department team for their support and collaboration throughout this project. Their contributions have been invaluable to the successful completion of this research. Lastly, we thank the Medical Research Center (MRC) for funding this research and providing Research Assistant Dr. Ahmed Fouad. We appreciate his effort. We also thank all the participants and individuals who generously devoted their time and effort to this study. Without their cooperation, this research would not have been possible.Peer reviewe

Enhancing Medication Safety through implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in Ambulatory Older Adults

Acknowledgments We appreciate: all Rumailah Hospital OPD supervisors and staff applying the manual tool, May Abusafa, Rasha Alqatami, Asma Gabkalla, Ahmed. Karawia, Mohamed Magdy, Tresita Jabonette, and all the pharmacy team; the geriatric mental and medicine department team who were involved in reviewing, supporting, and approving the tool, Hanadi Alhamad, Mahmoud Alrefaee, Irfan Muneeb, Marwan Ramadan, Zerak, Ahmed Almohamed; Nasser Masoudi and Abdulrazaq for supporting the project.Peer reviewe

Clinical pharmacy service innovation in an obstetrics and gynecology setting: A case study from Qatar

Clinical pharmacy services have evolved rapidly and been developed largely to cover a wide range of patient care settings and therapeutic areas. However, clinical pharmacists' services in obstetrics and gynecology (OB/GYNE) setting are not commonly available in many developing countries. In addition, literature describing clinical pharmacists' role in OB/GYNE settings is limited. This chapter provides a general overview of pharmacists' role in OB/GYNE and outlines a case study of pharmacy services provided in an OB/GYNE setting in Qatar. The case study provides a description of the activities and responsibilities of the clinical pharmacist and highlights the challenges and opportunities in this setting. The current work retrospectively describes a 2-year period of clinical pharmacy service activities at the OB/GYNE Department at Women's Hospital (now Women's Wellness and Research Center) in Qatar. A narrative of the provided services is described through available resources, hospital website and electronic system, and pharmacy key informants. The estimated clinical pharmacist to bed ratio is 1 to 35-40 beds. Patient care-related activities such as medication review, patient education, and multidisciplinary rounds represent the main role of clinical pharmacists. Other nonclinical roles in which clinical pharmacists are actively involved include educational and research activities. Clinical pharmacists are challenged by the high turnover nature of the patient population, variable levels of case complexity, having patients in health transition states, and limited medication safety infrastructure. The clinical pharmacy services are limited to the inpatient setting, while documentation of activities done by clinical pharmacists needs to be enhanced. Providing clinical pharmacy services in the OB/GYNE field is a fruitful initiative in our setting. Having such a special patient population warrants the expansion of clinical pharmacy services in this clinical setting. 2021 Elsevier Inc. All rights reserved.Scopu