Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia

Abstract Patients with diabetes are at high risk for polypharmacy (ie, use of multiple medications) for treatment of diabetes, associated comorbidities and other coexisting conditions. This study aims to estimate the prevalence of polypharmacy and factors associated with polypharmacy among adult patients with diabetes.Methods A cross-sectional retrospective observational study of adults with diabetes, who visited the outpatient clinic of a tertiary teaching hospital in Saudi Arabia, was conducted. Data were extracted from the Electronic Health Record database for a period of 12 months (January– December 2016). Polypharmacy was defined as the cumulative use of five or more medications. Polypharmacy among adults with diabetes was measured by calculating the average number of medications prescribed per patient. A multivariable logistic regression model was used to examine the factors associated with polypharmacy. Results A total of 8932 adults with diabetes were included in this study. Of these, nearly 78% had polypharmacy which was more likely among women as compared with men and more likely among older adults (age ≥60 years) as compared with the adults. Also, polypharmacy was two times as likely among patients with coexisting cardiovascular conditions (adjusted OR (AOR)=2.89; 95% CI 2.54 to 3.29), respiratory disease (AOR=2.42; 95% CI 1.92 to 3.03) and mental health conditions (AOR=2.19; 95% CI 1.74 to 2.76), and three times as likely among patients with coexisting musculoskeletal disease (AOR=3.16; 95% CI 2.31 to 4.30) as compared with those without these coexisting chronic conditions categories. Conclusions Polypharmacy is common among patients with diabetes, with an even higher rate in older adults patients. Healthcare providers can help in detecting polypharmacy and in providing recommendations for simplifying medication regimens and minimising medications to enhance the outcome of diabetes care

Hospitalization Endpoint in Clinical Trials of Outpatient Settings: using Anti-SARS-COV-2 Therapy as an Example

Alhanouf Yousef Alnafisah,1 Ahmed Fawaz Alkhalidi,1 Hanin Aljohani,1 Manal Almutairi,1 Adel Alharf,2 Hadeel Alkofide3 1Efficacy and Safety Evaluation Department, Benefit and Risk Evaluation Directorate, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia; 2Drug Sector, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia; 3Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Ahmed Fawaz Alkhalidi, Efficacy and Safety Evaluation Department, Benefit and Risk Evaluation Directorate, SFDA, Riyadh, 5163, Saudi Arabia, Tel +966555546169, Email [email protected]: In response to the COVID-19 pandemic, the World Health Organization (WHO) developed a set of outcome measures for trials primarily aimed at hospitalised patients. However, a gap exists in defining outcome standards for non-hospitalised patients. Therefore, this study aims to discuss hospitalisation as a primary outcome in outpatient trials and its potential pitfalls, specifically focusing on trials related to anti-SARS-COV-2 therapy.Methods: In this narrative review, researchers thoroughly searched MEDLINE and ClinicalTrials.gov from January 2020 to December 2022, targeting Phase III randomized controlled trials involving outpatients with mild-to-moderate COVID-19. The trials were specifically related to anti-SARS-COV-2 monoclonal antibodies or antiviral agents. The study collected essential data, including the type of intervention, comparator, primary objective, primary endpoint, and the use of estimands in the trial.Results: The search identified 12 trials that evaluated the efficacy of anti-SARS COV-2 therapies in a predefined population. Three studies used hospitalisation and death as primary endpoints in high-risk patients receiving monoclonal antibodies. Nine studies assessed the efficacy of several antiviral agents: four trials used hospitalisation and death as the main endpoints, while others used different measures such as virologic measures using the Reverse Transcription-Polymerase Chain Reaction test (RT-PCR), the eight-point WHO ordinal scale, symptom alleviation by Day 7 and time to clinical response.Conclusion: Choosing hospitalization as an endpoint may provide meaningful data such as the cost-effectiveness ratio of a drug. However, different hospital utilisation patterns and investigator decisions could bias clinical outcomes if no specific criteria are considered. Therefore, investigators should have clear criteria for determining variables that influence this measure.Keywords: COVID-19, outcome measures, non-hospitalized patients, monoclonal antibodies, antiviral agent

Spectrum of Skull Lesions in Pediatric Population: A Single Institutional Experience

Background: Pediatric skull lesions are rare. Here, a single institutional experience dealing with such lesions is presented.Methods: A retrospective review of 18 consecutive pediatric patients was done, who were treated for a variety of skull lesions at Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh from 2010 to 2015. The clinical and pathological features, diagnosis, management and outcome were noted and analyzed.Results: In this study, eighteen skull lesions were identified in 10 male (55%) and 8 female (44%) patients, with a mean age at diagnosis of 9.5 years. These lesions were usually benign and most commonly presented as a painless mass (n = 11). Fronto-orbital (n = 6) was the most frequent site encountered in this study followed by temporo-parietal (n = 3) and parieto-occipital area (n = 2). Gross total resection achieved in 15 patients (83.3%) and reconstruction of skull defect was possible in 11 (61.1%) of them. Excluding the malignant lesions, no recurrence was found in this study cohort for a mean follow up time of 2.8 years.Conclusions: Majority of the skull lesions in children are benign. Pre-operative angiography and embolization is helpful to reduce the intraoperative blood loss. Gross total resection with reconstruction is the treatment of choice. Recurrence is uncommon after gross total resection

Ketamine-based sedation use in mechanically ventilated critically ill patients with COVID-19: A multicenter cohort study

Backgrounds: Ketamine possesses analgesia, anti-inflammation, anticonvulsant, and neuroprotection properties. However, the evidence that supports its use in mechanically ventilated critically ill patients with COVID-19 is insufficient. The study's goal was to assess ketamine's effectiveness and safety in critically ill, mechanically ventilated (MV) patients with COVID-19. Methods: Adult critically ill patients with COVID-19 were included in a multicenter retrospective-prospective cohort study. Patients admitted between March 1, 2020, and July 31, 2021, to five ICUs in Saudi Arabia were included. Eligible patients who required MV within 24 hours of ICU admission were divided into two sub-cohort groups based on their use of ketamine (Control vs. Ketamine). The primary outcome was the length of stay (LOS) in the hospital. P/F ratio differences, lactic acid normalization, MV duration, and mortality were considered secondary outcomes. Propensity score (PS) matching was used (1:2 ratio) based on the selected criteria. Results: In total, 1,130 patients met the eligibility criteria. Among these, 1036 patients (91.7 %) were in the control group, whereas 94 patients (8.3 %) received ketamine. The total number of patients after PS matching, was 264 patients, including 88 patients (33.3 %) who received ketamine. The ketamine group's LOS was significantly lower (beta coefficient (95 % CI): −0.26 (−0.45, −0.07), P = 0.008). Furthermore, the PaO2/FiO2 ratio significantly improved 24 hours after the start of ketamine treatment compared to the pre-treatment period (6 hours) (124.9 (92.1, 184.5) vs. 106 (73.1, 129.3; P = 0.002). Additionally, the ketamine group had a substantially shorter mean time for lactic acid normalization (beta coefficient (95 % CI): −1.55 (−2.42, −0.69), P 0.01). However, there were no significant differences in the duration of MV or mortality. Conclusions: Ketamine-based sedation was associated with lower hospital LOS and faster lactic acid normalization but no mortality benefits in critically ill patients with COVID-19. Thus, larger prospective studies are recommended to assess the safety and effectiveness of ketamine as a sedative in critically ill adult patients

Orthodontic treatment need of Saudi Arabian children

PLEASE NOTE: This work is protected by copyright. Downloading is restricted to the BU community: please click Download and log in with a valid BU account to access. If you are the author of this work and would like to make it publicly available, please contact [email protected] (D.Sc.D.)--Boston University. Henry M. Goldman School of Dental Medicine, 1997 (Dental Public Health).Includes bibliographic references (leaves 83-87).The purpose of this study was to determine the prevalence of malocclusion in Saudi Arabian children, and hence to determine their orthodontic treatment need. The Index of Orthodontic Treatment Need (IOTN) which was developed by Brook and Shaw in 1989 (7), was modified and used accordingly for this study. The IOTN contains two components; the Dental Health Component (DHC) and the Aesthetic Component (AC). Each component grades an individual accordingly to his/her orthodontic treatment need. The modifications (Modified DHC) that were made in this study to the IOTN included the addition of the following: Spacing, midline deviations, functional jaw limitations, bimaxillary protrusions, tooth displacements without space deficiency, facial asymmetries and future surgery. Seventy-five Saudi schoolchildren, aged 10-14 years old were examined. According to the findings of the study, a statistically significant difference between the original DHC and the Modified DHC was found (t-test = 4.161, df=74, p=0.000). When the original DHC was used, the majority of students were in a lower grade level. When the Modified DHC was used, 20.0% of the students moved to a higher grade level, indicating more treatment need. Approximately, 42% of the males and 48% of the females were in grade leve1 4, indicating great need for Orthodontic treatment. The Modified IOTN was also used to determine the most prevalent malocclusal feature present, and according to the results, overbite was determined to be the predominant feature in both males and females (30.3% and 28.6% respectively). This was followed by crowding and functional jaw limitations in both sexes (21.2% & 18.2% in males, 23.8% & 11.9% in females respectively). Explanations of why overbite was the most predominant feature is provided. [TRUNCATED

Sella Turcica Morphology and Dimensions in Cleft Subjects

OBJECTIVES: Evaluate sella turcica morphology, calculate its size in cleft subjects, and compare it with noncleft subjects. MATERIALS: Lateral cephalometric radiographs of 95 cleft and 190 noncleft individuals. Radiographs were divided into two groups by age: 11 to 14 years of age, 15 years and above. MAIN OUTCOME MEASURES: The morphology of the sella turcica was categorized into six shapes; whereas, the size of the sella turcica was measured in terms of length, depth, and diameter in millimeters. RESULTS: The sella turcica was abnormal in shape in the majority of cleft subjects when compared with noncleft subjects (p= .0000), more so in subjects with unilateral cleft lip and palate and bilateral cleft lip and palate (p= .0000, p= .020, respectively). Depth of sella turcica was smaller in unilateral cleft lip and palate subjects (p= .037). A smaller sella turcica size (length, depth, diameter) was evident in cleft subjects as compared with noncleft subjects (p= .037, p= .004, p= .000, respectively). Age correlated positively with an increase in sella turcica size in both noncleft and cleft subjects (p= .000, p= .009, p= .000). CONCLUSIONS: A majority of cleft subjects displayed an abnormal appearance of sella turcica when compared with noncleft subjects. A smaller depth of sella turcica was associated with unilateral cleft lip and palate. The sella turcica was smaller in size in cleft subjects than in noncleft subjects. Sella turcica size increased with age in subjects with and without clefts.King Saud Universit

Class II division 1 Malocclusions: The subdivision Problem

The purpose of this study was to determine the frequency of occurrence of subdivisions, in Class II division 1 malocclusions. Sixty patients seeking orthodontic treatment at the dental college of King Saud University were selected. The results revealed that 45% of Class II division 1 patients examined had subdivisions. The most commonly affected side was the right (66.7%). Mandibular shift upon closure was noted in 36% of the subdivision cases. Mandibular asymmetry was noted in 62.6% of the patients. It can be concluded from this study that subdivisions are a frequent finding in Class II division 1 malocclusions. Appropriate diagnosis of these cases should be done early in the mixed dentition phase, to avoid developing dental or skeletal asymmetries that can persist throughout adulthood.King Saud Universit

Evaluation of the Social Impact of Cleft lip and Palate on Parents and Patients and their Level of Satisfaction of Treatment

The purpose of this study was to evaluate the social impact of cleft lip and palate on both patients and parents, and to rate their overall level of satisfaction with their treatment. Two target groups were selected. The first group consisted of 34 parents of children with cleft lip and palate, while the second group consisted of 23 patients with clefts over 15 years of age who could answer the questions without the assistance of their parents. Both groups were asked to fill out 2 separate questionnaires. The results showed that 85.3% of the parents and 73.9% of the patients had no change in their social life. Approximately 68% of the parents felt that there was no change in the family cohesiveness. Eighty-seven percent thought that their academic performance was not affected by their clefts. When satisfaction with treatment was rated, 87% of the patients and 75.8% of the parents were satisfied about the overall appearance. We can conclude from this study that even though parents experienced shock and grief in their initial reaction, the majority had no change in their social lives or family cohesiveness. Most parents and patients were satisfied about the overall appearance of the face and treatment.King Saud Universit

Sella turcica size in subjects with clefts: Longitudinal cephalometric measurements

The purpose of this study was to examine the size of sella turcica in cleft subjects from the age of 4-33 years by using standardized serial lateral radiographic cepholgrams. Forty-nine subjects with cleft of the lip and/or palate were included; 24 unilateral cleft lip and palate (UCLP), 17 bilateral cleft of the lip and palate (BCLP), 6 cleft of the lip (CL), and 2 cleft palate only (CP). The length, depth, and diameter of sella turcica were measured and the mean values were analyzed longitudinally. The results show that when comparing mean dimensional changes of sella turcica between cleft groups, an increase in the diameter of sella turcica was apparent with growth, more so than length and depth. Subjects with UCLP displayed the largest dimensional changes in depth and diameter of sella turcica with age (+0.04167, +0.04167), while subjects with BCLP showed a reduction in the mean length and depth (-0.05882 mm, -0.05882 mm). Significant variations were found in the length, depth and diameter of sella turcica between cleft groups (P < 0.05, P < 0.001, and P < 0.001 respectively). When the affect of age was studied, a positive tendency towards an increase in the linear dimensions of depth and diameter of sella turcica was evident as age increased (P < 0.001). We can conclude that the diameter of sella turcica shows the largest change with growth, and that an increase in dimensional change (depth and diameter) in sella turcica occurs in cleft subjects up until the age of 25 years old.King Saud Universit