Assessment of venous thromboembolism risk and adequacy of prophylaxis in selected acute care medical centres in Arabian Gulf States: results from the ENDORSE study

OBJECTIVES: To assess the prevalence of venous thromboembolism (VTE) risk in acutely ill surgical and medical patients in selected acute care centres in the Arabian Gulf States, and to determine the proportion of at-risk patients who received effective prophylaxis in accordance with 2004 American College of Chest Physicians (ACCP) guidelines. MATERIALS AND METHODS: Eight hospitals from 3 countries (Kuwait, Kingdom of Saudi Arabia, and United Arab Emirates) contributed to the global ENDORSE (Epidemiological International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study. Medical records were reviewed for all the in-patients aged \u3e / = 40 years admitted to medical wards, and in patients aged \u3e / = 18 admitted to surgical wards. The VTE risk and recommended prophylaxis were assessed according to the 2004 ACCP guidelines. RESULTS: Of 1,291 evaluable patients, 801 were considered at risk of VTE; 391 (48.8%) surgical patients and 410 (51.2%) medical patients. Of the 801 patients, 322 (40.2%) received ACCP-recommended VTE prophylaxis; 159 (40.7%) of surgical patients and 163 (39.8%) of medical patients. CONCLUSIONS: The data showed that VTE prophylaxis was underutilized in high-risk hospitalized patients. We recommend that active measures should be implemented in acute care centres in these Arabian Gulf countries to ensure identification of patients at risk of VTE and institute the appropriate prophylaxis

Redesigning the advanced pharmacy practice experiential education from hospital to home: A COVID-19 scenario

Introduction: During the 2020 COVID-19 pandemic, suspension of many educational activities occurred to mitigate the risks of infection spread. For pharmacy students in their internship year, many efforts have been made to move their experiential training to a virtual platform without compromising learning outcomes. Objectives: Redesign the advanced pharmacy practice experience (APPE) to remote learning without compromising the learning outcomes; Develop an appropriate teaching modality/strategy and assessment method for remote APPE; To drive the change in experiential education by providing guidance for other pharmacy schools dealing with similar situations. Restructured APPE: Eighty-seven interns were switched to an online internship with five specialties based on the availability of the preceptors, namely internal medicine, infectious diseases, oncology, total parenteral nutrition, and psychiatry. Experiential education activities such as drug information questions, case presentations, and clinical pharmacy topic discussions took place on virtual platforms. Student assessment was done using adjusted rubrics to suit the online platforms. Student feedback was taken using an online questionnaire and was mostly positive, indicating that they improved their clinical pharmacy knowledge. Conclusion: The authors highlighted the various restructuring modalities and learning methods used for different clinical rotations to achieve the learning outcomes in difficult situations. In future, the authors plan to work with their colleagues in other health colleges to adapt their practices together

An Under-Recognized Disease: A Rare Case of Idiopathic CD4 Lymphopenia Mislabeled as Primary Ciliary Dyskinesia

Idiopathic CD4 Lymphopenia is a heterogeneous condition, recognized in the late 20th century, with a wide spectrum of presentations, requiring a high index of suspicion to avoid misdiagnosing the condition. This case highlights the diversity in its clinical presentations in the context of an autosomal dominant pattern of inheritance. We are reporting a case of a nine-year-old child, initially labelled by her primary treating hospital as primary ciliary dyskinesia after presenting with chronic cough, purulent nasal discharge, and recurrent chest infections. She was referred to our facility, a tertiary center, as her condition marginally improved. After the patient has undergone a comprehensive diagnostic workup, including a gene study, she was found to be carrying a mutation known to cause idiopathic CD4 lymphopenia. Extended work up of her family showed that two of her siblings have inherited an autosomal dominant mutation from their mother who had a milder form of the disease. This condition is an extremely rare condition in children, which can be easily mislabeled. Thus, healthcare providers should avoid labeling certain long-standing diseases unless the diagnosis has been established. We encourage leveraging the use of the latest revolutionary genetic testing techniques to confirm the diagnosis of such puzzling cases

Immediate effect of different herbal solutions on tensile strength of suture materials in oral cavity

This pilot study evaluated the immediate effect of different herbal solutions in oral use on the tensile strength of the sutures used in oral surgical procedures. Three frequently used suture materials, polyglactin 910 (PGA), poliglecaprone (PGCL), and polypropylene (PP), were chosen in a 4-0-gauge size. The sutures' tensile stress was evaluated before being immersed (baseline) and after immersion at 24 h, 1 week, and 2 weeks in four different media: artificial saliva, chlorhexidine, Commiphora myrrh, and frankincense. The tensile strength was assessed by applying a 50 N load at a standardized speed of 2 mm/min. The data were analyzed using one-way and three-way analysis of variance (ANOVA) and the Tukey post hoc test with a significance level of p ≤ 0.05 significance level. The mean values of the maximum load showed a significant statistical difference across the three types of sutures (PGA, PGCL, and PP). The mean tensile strength of the PP suture was statistically lower than that of the other sutures. There was a statistically significant difference in the mean tensile strength of the PGA suture when stored in chlorohexidine media and the PGCL suture for frankincense media. The tensile strength for all sutures was the lowest value when immersed in Commiphora myrrh media. Home-prepared herbal solutions can affect the tensile strength and maximum load of suture materials. Careful and controlled use of herbal solutions after any dental surgical procedures is advisable.</p

Anatomical Distribution Patterns of Peripheral Arterial Disease According to Patient Characteristics: A Unicentral Cohort Study

Ibrahim Abobaker Alghanimi,1 Abdulaziz Mohammad Al-Sharydah,1 Afnan Amro Alqutub,2 Nehal Zeidan,2 Fatimah Bukhamseen,2 Alzahra Alradhi,2 Aqilah Taleb Alqassab,2 Mohammed Saad Al-Aftan1 1Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar City, Eastern Province, Saudi Arabia; 2College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar City, Eastern Province, Saudi ArabiaCorrespondence: Ibrahim Abobaker Alghanimi, Assistant Professor and Consultant of Radiology, Vascular and Interventional Radiologist, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Radiology Department, King Fahd Hospital of the University, Khobar City, Eastern Province, Saudi Arabia, Tel +138957999 Ext 2007, Email [email protected]: Peripheral arterial disease (PAD) is a common disease with multiple risk factors and affects patients worldwide. Several international studies have established correlations between anatomical topography/distribution of atherosclerosis and comorbidities in patients with PAD. In this cohort study, we aimed to analyze the patterns of atherosclerosis (site, distribution, and degree) in patients who underwent lower limb computed tomography angiography and arterial angiography by identifying the atherosclerotic plaque(s) that were possibly responsible for thrombi. Additionally, we aimed to determine any relationship between comorbidities and identified patterns.Patients and Methods: Between January 2015 and January 2021, we retrospectively recruited 140 patients at King Fahd Hospital of the University of Saudi Arabia. Data collected included patient characteristics, risk factors, and metabolic disorders, such as hypertension (HTN), diabetes mellitus (DM), dyslipidemia, and chronic kidney disease. Patients with incomplete records or unavailable radiological images were excluded.Results: The infrapopliteal territory was the most common segment that was affected. HTN, DM, and dyslipidemia were found in 81.4%, 77.9%, and 62.9% of patients, respectively. Correlation analyses revealed that DM was the only independent metabolic disorder associated with a PAD distribution pattern in the femoropopliteal segment (p=0.039), thus denoting distal involvement. No significant association was found between PAD distribution and the severity of stenosis.Conclusion: Segmental involvement in PAD varies with the risk factors and metabolic comorbidities present in patients. DM is an independent predictor of the anatomical distribution of PAD. The identification of such an anatomical distribution is paramount for screening procedures, early detection of disease, and prevention of complications, particularly limb amputation.Keywords: angiography, computed tomography, diabetes mellitus, peripheral arterial disease, stenosi

Application of CRISPR/Cas9 Technology in Cancer Treatment: A Future Direction

Gene editing, especially with clustered regularly interspaced short palindromic repeats associated protein 9 (CRISPR-Cas9), has advanced gene function science. Gene editing’s rapid advancement has increased its medical/clinical value. Due to its great specificity and efficiency, CRISPR/Cas9 can accurately and swiftly screen the whole genome. This simplifies disease-specific gene therapy. To study tumor origins, development, and metastasis, CRISPR/Cas9 can change genomes. In recent years, tumor treatment research has increasingly employed this method. CRISPR/Cas9 can treat cancer by removing genes or correcting mutations. Numerous preliminary tumor treatment studies have been conducted in relevant fields. CRISPR/Cas9 may treat gene-level tumors. CRISPR/Cas9-based personalized and targeted medicines may shape tumor treatment. This review examines CRISPR/Cas9 for tumor therapy research, which will be helpful in providing references for future studies on the pathogenesis of malignancy and its treatment

Colorectal cancer in patients with SARS-CoV-2: a systematic review and meta-analysis

Background: Patients with colorectal cancer (CRC) are more likely to develop severe course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and experience increased risk of mortality compared to SARS-CoV-2 patients without CRC. Objectives: To estimate the prevalence of SARS-CoV-2 infection in CRC patients and analyse the demographic parameters, clinical characteristics and treatment outcomes in CRC patients with COVID-19 illness. Methods: For this systematic review and meta-analysis, we searched Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature for studies on the incidence of SARS-CoV-2 infection in CRC patients, published from December 1, 2019 to December 31, 2021, with English language restriction. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). Sub-group analyses were performed to minimize heterogeneity. Binary logistic regression model was used to explore the effect of various demographic and clinical characteristics on patient's final treatment outcome (survival or death). Results: Of the 472 papers that were identified, 69 articles were included in the systematic review and meta-analysis (41 cohort, 16 case-report, 9 case-series, 2 cross-sectional, and 1 case-control studies). Studies involving 3362 CRC patients with confirmed SARS-CoV-2 (all patients were adults) were analyzed. The overall pooled proportions of CRC patients who had laboratory-confirmed community-acquired and hospital-acquired SARS-CoV-2 infections were 8.1% (95% CI 6.1 to 10.1, n = 1308, 24 studies, I2 98%, p = 0.66), and 1.5% (95% CI 1.1 to 1.9, n = 472, 27 studies, I2 94%, p < 0.01). The median patient age ranged from 51.6 years to 80 years across studies. The majority of the patients were male (n = 2243, 66.7%) and belonged to White (Caucasian) (n = 262, 7.8%), Hispanic (n = 156, 4.6%) and Asian (n = 153, 4.4%) ethnicity. The main source of SARS-CoV-2 infection in CRC patients was community-acquired (n = 2882, 85.7%; p = 0.014). Most of those SARS-CoV-2 patients had stage III CRC (n = 725, 21.6%; p = 0.036) and were treated mainly with surgical resections (n = 304, 9%) and chemotherapies (n = 187, 5.6%), p = 0.008. The odd ratios of death were significantly high in patients with old age (≥ 60 years) (OR 1.96, 95% CI 0.94-0.96; p < 0.001), male gender (OR 1.44, 95% CI 0.41-0.47; p < 0.001) CRC stage III (OR 1.54, 95% CI 0.02-1.05; p = 0.041), CRC stage IV (OR 1.69, 95% CI 0.17-1.2; p = 0.009), recent active treatment with chemotherapies (OR 1.35, 95% CI 0.5-0.66; p = 0.023) or surgical resections (OR 1.4, 95% CI 0.8-0.73; p = 0.016) and admission to ICU (OR 1.88, 95% CI 0.85-1.12; p < 0.001) compared to those who survived. Conclusion: SARS-CoV-2 infection in CRC patient is not uncommon and results in a mortality rate of 26.2%. Key determinants that lead to increased mortality in CRC patients infected with COVID-19 include older age (≥ 60 years old); male gender; Asian and Hispanic ethnicity; if SARS-CoV-2 was acquired from hospital source; advanced CRC (stage III and IV); if patient received chemotherapies or surgical treatment; and if patient was admitted to ICU, ventilated or experienced ARDS