Practice implications of an antimicrobial stewardship intervention in a tertiary care teaching hospital, Qatar

Background: Antibiotic misuse is a worldwide public health problem and has been associated with increased morbidity, length of hospital stay, mortality, healthcare costs, and most importantly antibiotic resistance. Aims: We aimed to evaluate the compliance of antibiotic prescribing with national guidelines, assess how educational interventions can best be utilized to make impact and fill gaps for optimal antibiotic utilization, and to identify facilitators and barriers to implementing ASPs in Qatar. Methods: Six cross-sectional baseline audits of antibiotic prescribing were conducted over a two-week period at a tertiary care teaching hospital. A sub-analysis of prescriptions with follow up has followed. An educational intervention utilizing the PDSA (Plan-Do-Study-Act) tool was implemented to address gaps identified. A repeated audit was done to assess the impact of change. Lastly, interviews were conducted to recognize perceived facilitators and barriers for ASP implementation, identify strategies to overcome barriers, and evaluate the effectiveness of educational interventions. Results: The most common indication for antibiotic prescribing was febrile neutropenia (20.7%). The most frequently used class of antibiotics was carbapenems (21.4%). Sixty percent of prescriptions complied with guidelines. The rationale behind choosing not to adhere to guidelines was not documented in 37.2% of cases. Suboptimal documentation in records was targeted through our intervention. The audit post intervention showed slight improvement in documentation. Facilitators and barriers included: collaboration and communication among teams, compliance with guidelines, interventions documented by clinical pharmacists, and electronic system errors. Conclusions: Effective communication, continuous documentation in records, and repetitive education promote rational antibiotic prescribing and enhance ASPs.This report was made possible by a UREP award [UREP18-033-3-010] from the Qatar National Research Fund (a member of The Qatar Foundation)

Treatment of Extensive Plaque Psoriasis and Psoriatic Arthropathy using Methotrexate in a Patient with High Serum Alkaline Phosphatase

Background: Psoriasis is an autoimmune inflammatory, chronic, and relapsing disease of the skin, which can also present with severe joint inflammation and deformity. There are many treatment options, but the severe forms of psoriasis are treated successfully with cytotoxic and biologic therapies. Methotrexate being cheap and available in Sudan is considered a good option for patients with severe and extensive forms of psoriasis.One of the main drawbacks is hepatotoxicity. The aim of this report is to share an experience of treating the patient with oral methotrexate in the presence of a relative contraindication to this therapy. Method: We present a 60-year-old female with extensive skin psoriasis and psoriatic arthropathy. Investigations showed high serum alkaline phosphatase and low serum albumen. Other liver enzymes, CBC, ultrasound abdomen were all unremarkable. Patient was admitted and a weekly dose of methotrexate was given in addition to topical preparation and supportive treatment; three months later, patient improved andwas moved to topical therapy. A check of serum alkaline phosphatase and albumen every week was done. Results: The patient was successfully and safely treated with methotrexate. Serum alkaline phosphatase was normal within the second month treatment, and serum albumen was normal after only one month of treatment. Conclusion: High serum alkaline phosphatase is considered a relative contraindication to the use of methotrexate, high level can be found in bone diseases. Serum albumen can be low in dermatologic diseases with excessive shedding of scales and can be corrected with protein formulas and high protein diets. Recommendations: Methotrexate is recommended for the treatment of severe morbid forms of psoriasis. The biologic therapy for severe forms of psoriasis is now available and can be a good alternative for the treatment of severe forms of psoriasis in good centers and for patients who can afford and in patients with absolute contraindications to methotrexate therapy

Textile UWB antenna bending and wet performances

The vision and ideas of wearable computing systems describe future electronic systems as an integral part of our everyday clothing that provides the wearer with such intelligent personal assistants. Recently, there has been growing interest in the antenna community to merge between wearable systems technology, ultrawideband (UWB) technology and textile technology. This work aimed to make closer steps towards real wearability by investigating the possibilities of designing wearable UWB antenna where textile materials are used for the substrate as well as the conducting parts of the designed antenna. Two types of conducting materials have been used for conducting parts, while a nonconducting fabric has been used as antenna substrate material. A set of comparative results of the proposed design were presented and discussed. Moreover, effects on the return loss by means of measurements for each fabricated antenna prototype under bent and fully wet conditions were discussed in more details

Hereditary Hemorrhagic Telangiectasia in a Sudanese Patient

Background. Hereditary hemorrhagic telangiectasia (HHT) also known as Osler–Weber–Rendu syndrome is a rare autosomal dominant disorder, which results in vascular dysplasia affecting mainly visceral and mucocutaneous organs. Case Presentation. A 65-year-old woman with a 12-year history of recurrent spontaneous epistaxis presented with shortness of breath, easy fatigability, and bilateral lower limb edema. Her family history was significant for definite hereditary hemorrhagic telangiectasia in first-degree relatives. During the previous 15 days, she has experienced three episodes of recurrent nasal bleeding. She has a background of chronic mitral regurgitation. Physical examination revealed telangiectases in her tongue, lower lip, and hand in addition to signs of congestive heart failure. The patient met 3\4 Curacao criteria and had a definite HHT. Her laboratory workup revealed a hemoglobin count of 5.4 g/dl. Echocardiography revealed a left systolic ejection fraction of 51% with left atrial dilatation and severe mitral regurgitation. Chest X-ray showed features of cardiomegaly and pulmonary edema. The abdominal ultrasonography showed enlarged liver size with homogenous texture and congested hepatic veins without features of hepatic AVMs. She was treated with intravenous frusemide, iron supplement, tranexamic acid, blood transfusion, and nasal packing. Conclusions. HTT usually passes unnoticed in Sudan. The rarity of HHT, difficulties in affording diagnostic imaging studies, and low clinical suspicion among doctors are important contributing factors. Anemia resulting from recurrent epistaxis might have an influential role in precipitating acute heart failure in those with chronic rheumatic valvular disease