Knowledge and Perceptions of Pharmacy Students in Qatar on Anti-Doping in Sports and on Sports Pharmacy in Undergraduate Curricula

Objective. To assess pharmacy students’ knowledge and perceptions of doping and anti-doping in sports and to explore the curricular needs for undergraduate pharmacy in the field of sports pharmacy. Methods. A cross-sectional, descriptive, web-based survey of pharmacy students was conducted at Qatar University College of Pharmacy from March to May 2014. Data were analyzed using descriptive and inferential statistics. Results. Eighty respondents completed the online survey (80% response rate). Sixty percent were unaware of the World Anti-Doping Agency, and 85% were unaware of the International Pharmaceutical Federation’s statement on the pharmacist’s role in anti-doping. Students’ knowledge score regarding the prohibited status of drugs that may be used by athletes was around 50%. Fourth-year pharmacy students had significantly higher knowledge scores than the other groups of students. Respondents acknowledged the important role of health care professionals, including pharmacists, as advisors on the safe and effective use of drugs in sports. Ninety percent of the students supported the inclusion of sports pharmacy in the curriculum. Conclusion. Pharmacy students indicated a strong desire to play a role in doping prevention and ensure safe and rational use of drugs among athletes. They suggested requiring an education and training strategy for sports pharmacy in undergraduate pharmacy curricula.Qatar University Undergraduate Student Research Grant

Calcium Channel Blockers

Vasospasm refers to a condition in which an arterial spasm leads to vasoconstriction. This can lead to tissue ischemia and necrosis. Coronary vasospasm can lead to significant cardiac ischemia associated with symptomatic ischemia or cardiac arrhythmia. Cerebral vasospasm is an essential source of morbidity and mortality in subarachnoid hemorrhage patients. It can happen within 3–15 days with a peak incidence at 7 days after aneurysmal subarachnoid hemorrhage (SAH). Calcium channel blockers are widely used in the treatment of hypertension, angina pectoris, cardiac arrhythmias, and other disorders like SAH vasospasm related and Migraine. The specific treatment of cerebral vasospasm helps improving cerebral blood flow to avoid delayed ischemic neurologic deficit by reducing ICP, optimizing the rate of cerebral oxygen demand, and enhancing cerebral blood flow with one of the following approaches: indirect pharmacological protection of brain tissue or direct mechanical dilation of the vasospastic vessel. Nimodipine is the standard of care in aneurysmal SAH patients. Nimodipine 60 mg every 4 hours can be used for all patients with aneurysmal SAH once the diagnosis is made for 21 days

Applications of Artificial Intelligence in Philadelphia-Negative Myeloproliferative Neoplasms.

Philadelphia-negative (Ph-) myeloproliferative neoplasms (MPNs) are a group of hematopoietic malignancies identified by clonal proliferation of blood cell lineages and encompasses polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). The clinical and laboratory features of Philadelphia-negative MPNs are similar, making them difficult to diagnose, especially in the preliminary stages. Because treatment goals and progression risk differ amongst MPNs, accurate classification and prognostication are critical for optimal management. Artificial intelligence (AI) and machine learning (ML) algorithms provide a plethora of possible tools to clinicians in general, and particularly in the field of malignant hematology, to better improve diagnosis, prognosis, therapy planning, and fundamental knowledge. In this review, we summarize the literature discussing the application of AI and ML algorithms in patients with diagnosed or suspected Philadelphia-negative MPNs. A literature search was conducted on PubMed/MEDLINE, Embase, Scopus, and Web of Science databases and yielded 125 studies, out of which 17 studies were included after screening. The included studies demonstrated the potential for the practical use of ML and AI in the diagnosis, prognosis, and genomic landscaping of patients with Philadelphia-negative MPNs

Acute Stent Thrombosis Associated with Eptifibatide-Induced Profound Thrombocytopenia

Background. Eptifibatide is an inhibitor of the platelet glycoprotein (GP) IIb/IIIa receptor that is commonly used in patients undergoing percutaneous coronary intervention (PCI). Case. We describe a case of a 62-year-old female patient admitted with acute ST-elevation myocardial infarction (STEMI) treated by primary coronary intervention (primary PCI) with a drug-eluting stent placement. She developed profound thrombocytopenia within 8 hours of first administration of eptifibatide and subsequent acute stent thrombosis next day. Other causes of thrombocytopenia were excluded and intravascular ultrasound (IVUS) showed good stent expansion and opposition to the coronary wall. Platelet count gradually returned to normal after discontinuation of eptifibatide. Conclusion. Although Eptifibatide has been associated with the development of thrombocytopenia, to the best of our knowledge, this is the first case report in the medical literature that associates acute stent thrombosis and eptifibatide-induced thrombocytopenia

دراسة تأثير اختلاف لزوجة الموائع على أداء المضخات الطاردة المركزية والمسننة الخارجية باستخدام دارة تجريبية تحاكي الدورة الدموية في جسم الإنسان

تم في هذا البحث دراسة وتصميم نموذجٍ ميكانيكيٍ تجريبي يشرحُ أليةَ عملِ الدَّورةِ الدَّمويَّة باستبدال كلِّ مكوِّنٍ من مكوناتِ جهاز الدوران بجزءٍ هندسيّ يؤدي عمله، وتمَّ تشغيل الجهاز باستخدام مائعين مختلفي اللزوجة: الأوَّل ماء مقطَّر والثاني ذو لزوجةٍ مشابهةٍ للزوجةِ الدَّم، ومقارنة البارامترات الأساسيَّة لعمل المضخات كالضغط ومُعدَّل التَّدفق واستهلاكِ الطَّاقة، للحصول على القيم المشابهة لضغط الدَّم الانقباضي والانبساطي في جسم الإنسان. تبيَّن من التجارب: أنَّ المضخة الممثِّلة للبطين الأيسر (Left Ventricular Pump) وهي مضخة طرد مركزية أعطت ضغطاً انقباضياً P=118.72 mm Hg بمعدل تدفق  Q=78.3 L/hour واستهلاكِ طاقةٍ 29.15 W وذلك عند التشغيل باستخدام الماء المقطر، وعند استخدام محلول (غليسيرين-ماء) ذو اللزوجة µ=0.003517 N.S/m2 أعطت المضخة ضغطاً انقباضياً P=116 mm Hg بمعدل تدفق يبلغ Q=63 L/hour واستهلاك طاقة 39.28 W، بينما المضخة الممثلة للبطين الأيمن (Right Ventricular Pump) وهي مضخة مسننة خارجية أعطت ضغطاً انقباضياً P=102.74 mm Hg عند معدل تدفقٍ Q=15 L/hour واستهلاك طاقة 10.62 W وذلك للماء المقطر، وعند استخدام محلول(غليسيرين-ماء) أعطت المضخة ضغطاً انقباضياً P=119.63 mm Hg عند مُعدَّل تدفق حجمي Q=12.5 L/hour واستهلاك طاقة مقداره 19.72 W

The Conditions of Al-Mujtahid between Grounding and Renewal - A Fundamental Study in the Approach and Content

The study deals with the fundamentalist statements about the conditions of the diligent and analyzing their methods, to facilitate comparison between them in mentioning the conditions of the diligent and its impact on Ijtihad, and studying the renewal that took place in the conditions of the diligent in the curriculum and content. The study showed that the conditions of the hardworking of the fundamentalists started with al-Shafi\u27i was the most detailed and specialized. Then there was a noticeable decrease in the conditions of the diligent people in the era of tradition, especially in al-Ghazali and those who followed it. The study showed that Shat by created a new approach by dividing the ijtihad. He reduced the number of conditions and added the condition of knowing the purposes of the Shariah in detail, and the leniency in the conditions of the diligent in the ijtihad which can not be interrupted. The study pointed out that contemporary scholars agree on the necessity of ijtihad in the present age, despite the fact that their curricula differed in expressing the conditions of the diligent, and that the conditions in contemporary times are conditioned by the old fundamentalists, with a change in wording and arrangement

Adding colchicine to tocilizumab in hospitalized patients with severe COVID-19 pneumonia: An open-label randomized controlled trial

INTRODUCTION: Colchicine acts upstream in the cytokines cascade by inhibiting the nod-like receptor protein 3 (NLRP3) inflammasome while interleukin 6 (IL-6) receptor antagonists, such as tocilizumab, block the end result of the cytokines cascade. Hence, adding colchicine to tocilizumab with the aim of blocking the early and end products of the cytokines cascade, might reduce the risk of developing cytokine storm. METHODS AND ANALYSIS: We aim to conduct an open-label randomized controlled trial to evaluate the efficacy and safety of adding colchicine to tocilizumab among patients with severe COVID-19 pneumonia to reduce the rate of invasive mechanical ventilation and mortality. We will include patients with severe COVID-19 pneumonia who received tocilizumab according to our local guidelines. Enrolled patients will be then randomized in 1:1 to colchicine versus no colchicine. Patients will be followed up for 30 days. The primary outcome is the rate of invasive mechanical ventilation and will be determined using Cox proportional hazard model. DISCUSSION: Given colchicine\u27s ease of use, low cost, good safety profile, and having different anti-inflammatory mechanism of action than other IL-6 blockade, colchicine might serve as a potential anti-inflammatory agent among patients with severe COVID-19 pneumonia. This study will provide valuable insights on the use of colchicine in severe COVID-19 when added to IL-6 antagonists. ETHICS AND DISSEMINATION: The Medical Research Center and Institutional Review Board at Hamad Medical Corporation in Qatar approved the study protocol (MRC-01-21-299). Results of the analysis will be submitted for publication in a peer-reviewed journal

Mobitz Type II atrioventricular block following tramadol and fentanyl in a patient with acute coronary syndrome and systolic heart failure

Serotonin syndrome is a potentially fatal condition allied with increased serotonergic activity in the central nervous system. There are published data reporting serotonin syndrome induced by either tramadol or fentanyl in combination with selective serotonin reuptake inhibitors in adult patients; however, there are no reports of serotonin syndrome resulting from the combination of tramadol and fentanyl. We report a case of a 52-year-old woman who was admitted to cardiology service and who developed Mobitz Type II atrioventricular (AV) block after administration of oral tramadol and intravenous fentanyl

Prevalence and predictors of digoxin utilization among heart failure patients with reduced ejection fraction in Qatar

Background Digoxin is a cardiac glycoside that is recommended by clinical practice guidelines to be used in patients with heart failure with reduced ejection fraction (HFrEF) who still have persistent symptoms despite optimal medical therapy. However, this recommendation is based on limited and old trial data. Moreover, pharmacoepidemiologic studies are important in determining the prevalence of digoxin use and factors influencing this. Objective This study aimed to determine the prevalence and the predictors of digoxin utilization among patients with HFrEF with or without atrial fibrillation (AF) in Qatar. Setting Heart Hospital, a specialized tertiary care center in Qatar. Methods A retrospective observational study was conducted using Cerner electronic medical records. Subjects included 736 patients admitted between January 1, 2013 and December 31, 2014 with the diagnosis of HFrEF with or without AF. Two groups of patients were studied: digoxin users and digoxin non-users at index hospitalization until discharge. Univariate and multivariate binary logistic regression analyses were conducted to determine the predictors of digoxin prescription. Data analyses were performed using IBM SPSS® version 23.0. Main outcome measures Prevalence and predictors of digoxin prescriptions among HFrEF patients measured in percentages and odds rations, respectively. Results A total of 736 patients who met the inclusion criteria were analyzed for digoxin prevalence, including 80 patients (11%) who were newly prescribed digoxin during the index hospitalization. After adjusting for patient demographics and clinical characteristics, the use of thiazide diuretics (aOR = 10.14, CI 2.31–44.6, p value = 0.002), concurrent AF (aOR = 8.2, CI 3.11–21.7, p < 0.001), and an ejection fraction (EF) <25% (aOR = 3.2, CI 1.5–6.8, p value = 0.002) significantly predicted digoxin prescriptions among patients with HFrEF. Conclusion The rate of digoxin prescription among patients with HFrEF in Qatar is relatively low. The strongest predictors of digoxin use in HFrEF patients were the concomitant use of thiazide diuretics and concurrent diagnosis of AF. The findings may potentially serve as useful guides for the rational utilization of digoxin in patients with HFrEF.Funding This study was supported by the Hamad Medical Corporation (Grant No. 16228/16).Scopu

Pediatric Philadelphia-Negative Myeloproliferative Neoplasms in the Era of WHO Classification: A Systematic Review

Background: Philadelphia-negative myeloproliferative neoplasms (MPN) are most prevalent in the older population (median age at the diagnosis is above 60 years) and rarely diagnosed in pediatrics. Thus, our knowledge about the clinical presentation, mutational status, and complications of MPNs in pediatrics is limited. Methods: The literature in English (PubMed, SCOPUS, and Google Scholar) was searched for studies, reviews, case series, and case reports of patients with Philadelphia-negative MPNs (including essential thrombocythemia, polycythemia vera, primary myelofibrosis, and profibrotic myelofibrosis) in the pediatrics age group (less than 18 years). Only studies that fulfilled WHO 2008 or 2016 criteria for MPNs were included. We aimed to describe the clinical characteristics, vascular and long-term complications, types of driver mutations, and treatment approaches in pediatric patients with MPNs. Results: We reviewed 33 articles of available published literature from 2008 to 2022 and collected data from a total of 196 patients of the pediatric population. Among the cohort of patients, 139 had essential thrombocythemia (ET), 20 had polycythemia vera (PV), and 37 had primary myelofibrosis (PMF). The median age at the time of diagnosis for each disease varied, with 8.8 years for ET, 10 years for PV, and 3.6 years for MF. There was a slight difference in gender prevalence between both gender groups and all three diseases. The presenting symptoms were not mentioned in more than 50% of studies. We found that JAK2 was the most prevalent among all mutations. Both bleeding and thrombosis were present equally in ET, with 9% of cases complicated by bleeding and 9% complicated by thrombosis. Hemorrhagic events did not occur in patients with PV; thrombosis in children with MF was also not found. The progression into AML occurred in two patients with PV and one with ET. Conclusion: Given the rarity of MPNs in pediatrics and their different characteristics compared with adults, we believe there is a need for unique diagnostic criteria to match the different molecular statuses in pediatrics. Based on our review, the incidence of MPN complications in pediatrics, including thrombotic events, hemorrhage, and leukemic transformation, differs from that in adults