Prescribing errors among adult patients in a large tertiary care system in Saudi Arabia

Background: Multiple studies have investigated medication errors in hospitals in Saudi Arabia; however, prevalence data on prescribing errors and associated factors remains uncertain.Objective: Assess the prevalence, type, severity, and factors associated with prescribing errors.Design: Retrospective database review.Setting: Large tertiary care setting in Riyadh.Patients and methods: We described and analyzed data related to prescribing errors in adults (>14 years of age) from the Medication Error Electronic Report Forms database for the two-year period from January 2017 to December 2018.Main outcome measure: The prevalence of prescribing errors and associated factors among adult patients.Sample size: 315 166 prescriptions screened.Results: Of the total number of inpatient and outpatient prescriptions screened, 4934 prescribing errors were identified for a prevalence of 1.56%. The most prevalent types of prescribing errors were improper dose (n=1516; 30.7%) and frequency (n=987; 20.0%). Two-thirds of prescribing errors did not cause any harm to patients. Most prescribing errors were made by medical residents (n=2577; 52%) followed by specialists (n=1629; 33%). Prescribing errors were associated with a lack of documenting clinical information (adjusted odds ratio: 14.1; 95% CI 7.7-16.8, PPConclusion: Inadequate documentation in electronic health records and prescribing of anti-infective medications were the most common factors for predicting prescribing errors. Future studies should focus on testing innovative measures to control these factors and their impact on minimizing prescribing errors

Search for Gravitational Waves from Primordial Black Hole Binary Coalescences in the Galactic Halo

We use data from the second science run of the LIGO gravitational-wave detectors to search for the gravitational waves from primordial black hole (PBH) binary coalescence with component masses in the range 0.2--$1.0 M_\odot$. The analysis requires a signal to be found in the data from both LIGO observatories, according to a set of coincidence criteria. No inspiral signals were found. Assuming a spherical halo with core radius 5 kpc extending to 50 kpc containing non-spinning black holes with masses in the range 0.2--$1.0 M_\odot$, we place an observational upper limit on the rate of PBH coalescence of 63 per year per Milky Way halo (MWH) with 90% confidence.Comment: 7 pages, 4 figures, to be submitted to Phys. Rev.

A comparison of nutritional intake and daily physical activity of girls aged 8-11 years old in Makkah, Saudi Arabia according to weight status

Abstract Background Obesity rates in Saudi Arabia are amongst the highest in the world. It is known that teenage girls are less active than teenage boys, but less is known about the diet and activity patterns in younger girls. Therefore this study sought to investigate dietary intake and daily physical activity in girls aged 8-11 years old in Saudi Arabia. Methods This was a cross- sectional observational study conducted in seven schools across the city of Makkah. A total of 266 girls had anthropometric measurements taken including height, weight, waist circumference and body fat estimations. Dietary assessment using a 4 day unweighed diet diary was undertaken in 136 of these participants, and 134 agreed to monitor their physical activity for the 4 days using an accelerometer. After exclusion for under-reporting, 109 remained in the dietary analysis and 78 in the physical activity analyses. Differences in means between BMI groups were determined using one-way ANOVA with post hoc Tukey test. Multivariable linear regression analysis was performed to look at the effect of multiple variables on body weight. Results A total of 30% of participants were classified obese or overweight. There was a significant difference in the mean daily energy intake between the BMI groups with the obese group having the highest energy, fat, carbohydrate and protein intake (obese group: 2677 ± 804 kcal/d; healthy weight group: 1806 ± 403 kcal/d, p < 0.001), but the percentage contribution of the macronutrients to energy intake remained the same across the BMI groups. There were no differences in number of steps taken per day or time spent in moderate to vigorous intensity exercise according to BMI category. Most of the girls did not meet daily physical activity guidelines (5969 to 6773 steps per day and 18.5 - 22.5 mins per day of moderate to vigorous activity). Multiple linear regression showed that energy intake positively predicted body weight (Beta = 0.279, p =0 .001), whereas, total energy expenditure per kg of body weight and family income had a significant negative influence on body weight (Beta = −0.661, p < 0.001; −0.131, p = 0.028 respectively). Conclusions The results of this cross sectional analysis suggest that obesity in girls aged 8-11 years is linked to excessive energy intake from all macronutrients and the majority of girls in all weight categories are inactive. Research should be conducted to further investigate causal relationships in longitudinal studies and develop interventions to promote dietary change and activity that is culturally acceptable for girls in Saudi Arabia

Numerical Simulation Research on the Interactive Propagation of Hydraulic Fractures and Natural Fractures

In order to study the fracture propagation behavior after the interaction between hydraulic fractures and natural fractures, the cohensive unit of Abaqus finite element software is used to simulate the influence of natural fractures in the rock on the propagation behavior of hydraulic fractures. The simulation results show that when the approach angle is kept constant, as the in-situ stress difference increases, hydraulic fractures are more likely to penetrate the natural fractures and expand along the direction of the maximum horizontal principal stress; while the stress difference remains the same, as the approach angle increases, hydraulic fractures are easier to penetrate natural fractures and expand along the direction of maximum horizontal principal stress. When the approach angle is kept constant, as the tensile strength of natural fractures increases, hydraulic fractures are more likely to penetrate the natural cracks and expand along the direction of the maximum horizontal principal stress; while the tensile strength of natural cracks remains unchanged, as the approach angle increases, the probability of forming a complex fracture network between hydraulic fractures and natural fractures is reduced, and it is easier to penetrate the natural fractures and expand along the direction of the maximum horizontal principal stress

Is radiation-induced ovarian ablation in breast cancer an obsolete procedure? Results of a meta-analysis

Mushabbab Al Asiri,1,* Mutahir A Tunio,1,* Reham Abdulmoniem,2,*1Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 2Radiation Oncology, National Cancer Institute, Cairo, Egypt *These authors contributed equally to this work Background: A meta-analysis was conducted to assess the impact of radiation-induced ovarian ablation (RT-OA) on amenorrhea cessation rates, progression-free survival, and overall survival in pre/perimenopausal women with breast cancer. Materials and methods: The Medline, CANCERLIT, and Cochrane Library databases and search engines were searched to identify randomized controlled studies comparing RT-OA with control for early or metastatic breast cancer. Further, radiotherapy doses, techniques, and associated side effects were evaluated. Results: Six controlled trials with a total patient population of 3,317 were identified. Pooled results from these trials showed significant amenorrhea rates (P&lt;0.00001) and increase in progression-free survival in patients treated with RT-OA (P&lt;0.00001). However, there was no difference in overall survival (P=0.37). The majority of patients were treated with larger field sizes with parallel-opposed anteroposterior and posteroanterior pelvic fields. RT-OA was generally well tolerated. Radiotherapy doses of 1,500 cGy in five fractions, 1,500 cGy in four fractions, 1,600 cGy in four fractions, and 2,000 cGy in ten fractions were associated with excellent amenorrhea rates. The resultant funnel plot showed no publication bias (Egger test P=0.16). Conclusion: RT-OA is cost-effective and can safely be used in pre/perimenopausal women with metastatic breast cancer, or if luteinizing hormone-releasing hormone analogs are contraindicated, or in patients in whom fertility preservation is not an issue. Radiation dose of 1,500 cGy in five fractions, 1,500 cGy in four fractions, 1,600 cGy in four fractions, and 2,000 cGy in ten fractions showed more efficacies. However, further studies incorporating three-dimensional conformal radiotherapy and intensity-modulated radiotherapy are warranted. Keywords: radiation-induced ovarian ablation, pre/perimenopausal, breast cancer, meta-analysi

Comparative clinicopathological and outcome analysis of differentiated thyroid cancer in Saudi patients aged below 60 years and above 60 years

Khalid Hussain AL-Qahtani,1 Mutahir A Tunio,2 Mushabbab Al Asiri,2 Yasser Bayoumi,3 Ali Balbaid,2 Naji J Aljohani,4 Hanadi Fatani5 1Department of Otolaryngology-Head &amp; Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 3Department of Radiation Oncology, NCI, Cairo University, Cairo, Egypt; 4Department of Endocrinology and Thyroid Oncology, 5Histopathology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia Introduction: The aim of this study was to evaluate the treatment outcomes of differentiated thyroid cancer in Saudi patients aged above 60 years. Materials and methods: Comparative analysis was performed in 252 patients aged 46&ndash;60 years (Group A) and 118 patients aged above 60 years (Group B), who had thyroidectomy, radioactive iodine-131, and thyroid-stimulating hormone suppression therapy between July 2000 and December 2012. Different clinicopathological features, treatment, complications, disease-free survival, and overall survival rates were compared. Results: Mean age of patients in Group A was 51.9 years (range: 46&ndash;60), and mean age of those in Group B was 68.6 years (range: 62&ndash;97). Group B patients had higher positive lymph nodes (43.2%), P=0.011. The frequency of extrathyroidal extension, multifocality, and lymphovascular space invasion was seen more in Group B than in Group A. Postsurgical complications (permanent hypoparathyroidism, bleeding, and wound infections) were also seen more in Group B (P=0.043, P=0.011, and P=0.021, respectively). Group B patients experienced more locoregional recurrences (11.0%, P=0.025); similarly, more distant metastases were observed in Group B (15.3%, P=0.003). The 10-year disease-free survival rates were 87.6% in Group A and 70.8% in Group B (P&lt;0.0001). Conclusion: Differentiated thyroid cancer in patients aged above 60 years are more aggressive biologically and associated with a worse prognosis, and the morbidity is significantly high as compared to patients aged below 60 years. Keywords: differentiated thyroid cancers, patients aged above 45 years, aged above 60 years, clinicopathological characteristics, treatment outcomes, elderly patients, aged below 60 years, comparative analysi

Calvarium and dura mater as delayed sites of distant metastasis from papillary thyroid carcinoma

Khalid Hussain AL-Qahtani,1 Mutahir A Tunio,2 Mushabbab Al Asiri,3 Hanadi Fatani,4 Yasser Bayoumi5 1Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, 2Radiation Oncology Department, King Fahad Medical City, 3Radiation Oncology Department, 4Histopathology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 5Radiation Oncology Department, National Cancer Institute, Cairo, Egypt Background: Skull calvarium and dura mater are rare sites of distant metastasis, and mostly have been reported in lung, breast, and prostate malignancies. However, the calvarial and dural metastases from papillary thyroid cancer (PTC) are rare entities and pose diagnostic and therapeutic challenges. To date, only seven cases of calvarial metastasis with intracranial extension from PTC have been reported in literature. However, true dural metastasis from PTC has not yet been reported. Case presentation: A 65-year-old Saudi woman presented with 6 months history of painful posterior scalp lump, 7 years after initial diagnosis of PTC. Computed tomography and magnetic resonance imaging showed occipitoparietal calvarial lesion with massive intracranial extension. Another para-sagittal lesion was found at the top of corpus callosum mimicking a meningioma. Histopathology of para-sagittal lesion and the biopsy of calvarial mass confirmed the diagnosis of metastatic PTC. After surgical resection, residual tumors were treated with postoperative intensity-modulated radiation therapy. At 13 months of follow-up, patient was alive and without any signs of recurrence. Conclusion: Calvarial and dural metastases from PTC are extremely rare clinical entities. Surgical resection followed by postoperative radiotherapy is the treatment of choice. However, for such cases, multidisciplinary approach can prolong the treatment outcome and survival. Keywords: papillary thyroid carcinoma, calvarial metastasis, intracranial extension, true dural metastasi

Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node, locally advanced cervical cancer?

Mushabbab Al Asiri,1 Mutahir A Tunio,1 Reham Mohamed,2 Yasser Bayoumi,2 Abdulrehman Alhadab,1 Rasha M Saleh,3 Muhannad Saud AlArifi,1 Abdelaziz Alobaid4 1Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 2Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt; 3Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 4Women&#39;s Specialized Hospital, King Fahad Medical City, Riyadh, Saudi ArabiaBackground: The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to results better than those obtained by standard whole-pelvis concurrent chemoradiation (WP-CCRT) in locally advanced cervical cancer with radiologic negative paraaortic lymph nodes (PALNs).Patients and methods: A total of 102 patients with histopathologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cell carcinoma, and radiologic negative PALN locally advanced cervical cancer, stage IIB-IVA, were accrued between July 2007 and April 2008 and were randomly assigned to WP-CCRT (50 patients) or EF-CCRT (52 patients), followed by high-dose rate brachytherapy. Data regarding the safety profile, response rates, and occurrence of local, PALN, or distant failure were recorded.Results: During a median follow-up time of 60 months (18&ndash;66), 74/102 patients completed the treatment protocol and were analyzed. Overall PALN, distant-metastasis control, disease-free survival, and overall survival rates were 97.1%, 86.9%, 80.3%, and 72.4% in EF-CCRT respectively in comparison with WP-CCRT (82.1%,74.7%, 69.1%, and 60.4%), with P-values of 0.02, 0.03, 0.03 and 0.04 respectively. No difference in acute toxicity profile was seen between the groups, and late toxicities were mild and minimal.Conclusion: Prophylactic EF-CCRT can be a reasonable option in patients with locally advanced cervical cancer with radiologic positive pelvic lymph nodes and radiologic negative PALN.Keywords: prophylactic extended field radiation therapy, concurrent chemotherap

Nimesulide prevents oxidative stress damage following transient forebrain ischemia in the rat hippocampus.

This investigation was performed to evaluate the effects of nimesulide (NIM), a selective cyclo-oxygenase-2 (COX-2) inhibitor, on forebrain ischemia-induced in vivo oxidative stress damage in the rat hippocampus. Hippocampal tissue glutathione (GSH) and malondialdehyde (MDA) contents, the activities of the antioxidants superoxide dismutase (SOD) and catalase as well as nitric oxide (NO) concentration were estimated. A clinically relevant dose of NIM (18 mg x kg(-1) x d(-1), p.o.) was administered immediately after induction of forebrain ischemia for 7 consecutive days. Forebrain ischemia induced oxidative stress after 7 days manifested by significant decrease in GSH and increase in MDA levels as compared to control (p < 0.05). Also, in rats subjected to ischemia, SOD and catalase activities were decreased significantly compared to the control group (p < 0 .05). On the other hand, ischemic rats showed a significant increase in NO concentration compared to those in the control group (p < 0.05). Treatment with NIM protected the rats from ischemia-induced oxidative stress as evident by normalization of measured parameters. The present study indicates the ability of NIM to reduce oxidative stress induced by transient forebrain ischemia. This suggests that the induction of COX-2 might be involved in transient forebrain ischemia-induced oxidative damage and hence the selective COX-2 inhibitors might be a valuable therapeutic strategy against ischemic brain injury