Pediatric skeletal injuries in emergency department; an alarm of child maltreatment in Egypt: A cross-sectional study.

BACKGROUND: Child physical abuse, a type of child maltreatment (CM), poses a significant global public health concern. Nonaccidental fractures and soft tissue injuries, which encompass any action that directly or indirectly harms a child, are the primary indicators of physical abuse in children. OBJECTIVE: This study aimed to investigate the prevalence, risk factors, and outcomes of accidental and nonaccidental skeletal fractures in a sample of Egyptian children. METHODS: A cross-sectional analytical study was conducted between March 2022 and August 2022. A total of 156 children who presented with skeletal injuries and attended Mobarak Central Hospital were enrolled. Patients were subjected to full history taking, complete examination, and investigations. A structured questionnaire was administered to all the legal guardians. RESULTS: Physical abuse was reported in 22.4 % of cases, while medical neglect was reported in 19.9 % of cases. The incidence of physical abuse was notably higher among children whose fathers were smokers and/or drug addicts (p ≤ 0.05). The most common form of physical abuse was hitting (94.3 %). Among skeletal injuries, fractures were predominant (94.3 %), primarily closed fractures associated with contusions. Fractures of the upper limb accounted for the highest incidence (94.3 %) of skeletal injuries, and 60 % of physically abused children experienced moderate-severity injuries. CONCLUSION: The most common fracture observed in abused children is the upper limb fracture, typically involving a single bone. Clinicians should be more vigilant in suspecting abuse, even in cases where there is an isolated fracture, and advocate for the development of parental training programs.

Pentoxifylline as Add-On Treatment to Donepezil in Copper Sulphate-Induced Alzheimer's Disease-Like Neurodegeneration in Rats.

Alzheimer's disease (AD), the most common neurodegenerative disorder, is characterized by behavioral, cognitive, and progressive memory impairments. Extensive neuronal loss, extracellular accumulation of insoluble senile amyloid-ß (Aß) plaques, and intracellular neurofibrillary tangles (NFTs) are the major pathological features. The present study aimed to investigate the therapeutic effect of donepezil (DON) and pentoxifylline (PTX) in combination to combat the neurodegenerative disorders (experimental AD) induced by CuSO4 intake in experimental rats. Thirty adult male Wistar rats (140-160 g) were used in this study. AD was first induced in rats by CuSO4 supplement to drinking water (10 mg/L) for 14 weeks. The AD group received no further treatment. Oral treatment with DON (10 mg/kg/day), PTX (100 mg/kg/day), or DON + PTX for the other three groups was started from the 10th week of CuSO4 intake for 4 weeks. Cortex markers like acetylcholine (ACh), acetylcholinesterase (AChE), total antioxidant capacity (TAC), and malondialdehyde (MDA) and hippocampus markers like ß-amyloid precursor protein cleaving enzyme 1 (BACE1), phosphorylated Tau (p-tau), Clusterin (CLU), tumor necrosis factor-α (TNF-α), caspase-9 (CAS-9), Bax, and Bcl-2 were measured. The histopathology studies were done by using hematoxylin and eosin and Congo red stains as well as immunohistochemistry for neurofilament. CuSO4 induced adverse histological and biochemical changes. The histological injury in the hippocampus was inhibited following the administration of the DON and PTX. The brain tissue levels of AChE, MDA, BACE1, p-tau, CLU, CAS-9, Bax, and TNF-α were significantly increased, while brain tissue levels of ACh, TAC, and Bcl-2 were significantly decreased in CuSO4-treated rats as compared with the untreated control group. The effects induced by either DON or PTX on most studied parameters were comparable. Combined treatment of DON and PTX induced remarkable results compared with their individual use. However, more clinical and preclinical studies are still required to further confirm and prove the long-term efficacy of such combination.

Vitamin D alleviates cognitive dysfunction and brain damage induced by copper sulfate intake in experimental rats: focus on its combination with donepezil.

This study aimed to demonstrate the potential benefits of donepezil (DPZ) and vitamin D (Vit D) in combination to counteract the neurodegenerative disorders induced by CuSO4 intake in experimental rats. Neurodegeneration (Alzheimer-like) was induced in twenty-four male Wistar albino rats by CuSO4 supplement to drinking water (10 mg/L) for 14 weeks. AD rats were divided into four groups: untreated AD group (Cu-AD) and three treated AD groups; orally treated for 4 weeks with either DPZ (10 mg/kg/day), Vit D (500 IU/kg/day), or DPZ + Vit D starting from the 10th week of CuSO4 intake. Another six rats were used as normal control (NC) group. The hippocampal tissue content of ß-amyloid precursor protein cleaving enzyme 1 (BACE1), phosphorylated Tau (p-tau), clusterin (CLU), tumor necrosis factor-α (TNF-α), caspase-9 (CAS-9), Bax, and Bcl-2 and the cortical content of acetylcholine (Ach), acetylcholinesterase (AChE), total antioxidant capacity (TAC), and malondialdehyde (MDA) were measured. Cognitive function tests (Y-maze) and histopathology studies (hematoxylin and eosin and Congo red stains) and immunohistochemistry for neurofilament. Vit D supplementation alleviated CuSO4-induced memory deficits including significant reduction hippocampal BACE1, p-tau, CLU, CAS-9, Bax, and TNF-α and cortical AChE and MDA. Vit D remarkably increased cortical Ach, TAC, and hippocampal Bcl-2. It also improved neurobehavioral and histological abnormalities. The effects attained by Vit D treatment were better than those attained by DPZ. Furthermore, Vit D boosted the therapeutic potential of DPZ in almost all AD associated behavioral and pathological changes. Vit D is suggested as a potential therapy to retard neurodegeneration.

Right ventricular function as a predictor of short-term mortality in patients with sepsis and septic shock: an observational study.

BACKGROUND: In recent years, attention has shifted to the role of right ventricular (RV) dysfunction in prediction of clinical outcome among patients with septic shock. However, very few studies have correlated RV dysfunction with survival early in the course of sepsis. In the period from September 2021 to July 2022, we included a total number of 248 patients within 24 h of their presentation with sepsis. All patients were subjected to a comprehensive echocardiographic study to evaluate different parameters of RV function and LV systolic and diastolic functions. We aimed primarily to study the predictive value of RV dysfunction on 30-day all-cause mortality rates and ventilator-free days. RESULTS: Almost half of study population (48.4%) showed evidence of RV dysfunction (in isolation or with LV dysfunction), with 25.4% showing evidence of isolated RV dysfunction. Patients with RV dysfunction had a significantly higher APACHE 2 (P < 0.001) score and 30-day all-cause mortality rates (P = 0.003) compared to those without RV dysfunction. A significant association was reported between 30-d mortality and dysfunction status (P = 0.025). Those with no dysfunction had lower mortality (14.1%) than in those with RV dysfunction only (33.3%), LV dysfunction only (20%), and RV + LV dysfunction (31.6%). No significant difference was observed in ventilator free days according to dysfunction status (P = 0.081). A multivariate logistic regression analysis showed that RV dysfunction was among the significant independent predictors for 30-day mortality (OR 2.01, 95% CI 1.07-3.81, P = 0.031), controlling for the effect of age and gender. CONCLUSIONS: In a cohort of ICU patients with early sepsis, RV dysfunction is found to be common and predictive of 30-day mortality irrespective to the LV function.

A lab-on-a-chip approach integrating in-situ characterization and reactive transport modelling diagnostics to unravel (Ba,Sr)SO4 oscillatory zoning.

The co-precipitation of sulphate minerals such as celestine and barite is widely studied because their formation is ubiquitous in natural and anthropogenic systems. Co-precipitation in porous media results in crystallization of solid solutions yielding characteristics such as oscillatory zoning that are rarely observed in bulk solution or in batch experiments. In the past, the precipitation of compositionally-zoned (Ba,Sr)SO4 crystals was observed post-mortem in macroscopic silica gel counter-diffusion experiments. Their formation was originally explained by the difference in the solubility products of the end-members combined with diffusion-limited transport of solutes to the mineral-fluid interface, while a later study favored the idea of kinetically controlled reactions. With recent advances combining in-operando microfluidic experiments and reactive transport modelling, it is now possible to verify hypotheses on the driving forces of transport-coupled geochemical processes. We developed a "lab on a chip" experiment that enabled the systematic study of the nucleation and growth of oscillatory-zoned (Ba,Sr)SO4 crystals in a microfluidic reactor. The compositions of the solid solutions were determined by in-situ Raman spectroscopy. Our investigation shows (1) that the composition of the nucleating phases can be approximated using classical nucleation theory, (2) that the oscillatory zoning is not solely controlled by the limited diffusional transport of solutes, and (3) that nucleation kinetics plays a major role in the switch between different stoichiometric compositions. The zoning phenomena is governed by the complex interplay between the diffusion of reactants and the crystallization kinetics as well as other factors, e.g. surface tension and lattice mismatch.

Evaluation of clinical outcomes and efficacy of palonosetron and granisetron in combination with dexamethasone in Egyptian patients receiving highly emetogenic chemotherapy.

BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) is considered one of the most serious adverse events affecting chemotherapy-receiving cancer patients. It dramatically affects their food intake, nutritional status and more importantly their quality of life. We can observe CINV in highly emetogenic chemotherapy (HEC) such as adriamycin-cyclophosphamide combination (AC) in breast cancer patients and cisplatin-based regimens in other cancer types. This study aimed to evaluate the antiemetic efficacy of palonosetron (PALO) over granisetron (GRA) in combination with dexamethasone for multiple highly emetogenic chemotherapy drugs (HEC), especially in chemotherapy regimens in Egyptian breast cancer patients and cisplatin-based regimens in other diseases. PATIENTS AND METHODS: An open-label randomized trial was carried out, including 115 patients receiving at least four cycles of highly emetogenic chemotherapy regimens. All patients received dexamethasone in combination with the 5-HT3 receptor antagonist. We recorded patients' clinical and biochemical characteristics and withdraw blood samples to monitor serum substance P and serotonin in correlation with chemotherapy-induced nausea and vomiting (CINV). We use the MASCC antiemetic tool in the acute phase (0-24 hr) and delayed phase (24-120 h) to evaluate patient outcomes in both stages after each chemotherapy cycle. RESULTS: In (PALO) group, only 7.84% of patients showed acute vomiting, and 11.76% showed acute nausea, whereas 43.75% of patients showed acute vomiting and 89.06% showed acute nausea in (GRA) group (P < 0.0001). For delayed CINV, 23.53% of patients showed delayed vomiting, and 47.06% showed delayed nausea in the (PALO) group, while 82.81% of patients showed delayed emesis, and 92.19% showed delayed nausea in (GRA) group (P < 0.0001). The study showed that PALO is a cost-effective choice when compared to GRA in CINV prevention as 45.10% of patients in (PALO) required additional rescue medications (Domperidone 10 mg orally three times per day plus Trimebutine 200 mg orally three times per week both for 5 days), while 95.24% in the (GRA) group used the same medications. Adverse events of both antiemetic drugs (PALO and GRA) include headaches and constipation and QTc prolongation reports, mostly mild to moderate, with relatively low rates among the two groups. CONCLUSION: Palonosetron, combined with dexamethasone, is more effective than granisetron and dexamethasone combination against both acute and delayed emesis induced by highly emetogenic chemotherapy (HEC) cisplatin-based protocols and the combination of cyclophosphamide and anthracyclines (AC). Medical team members should make more efforts, especially clinical pharmacy personnel, to monitor medications' effectiveness and help the medical team achieve a suitable and reliable care plan.

Influence of black tea on Streptococcus mutans and Lactobacillus levels in saliva in a Saudi cohort.

OBJECTIVES: Dental caries are associated with high counts of Streptococcus mutans (SM) and Lactobacillus (LB) and low saliva buffering capacity (BC). This study aimed to evaluate the antimicrobial activity of black tea on salivary cariogenic microflora, SM and LB species in an adult population. Antimicrobial activity was measured from the number of colony forming units (CFUs) of SM and LB, and BC of saliva. METHODS: In this prospective experimental study, unstimulated saliva samples were acquired from the participants before, immediately after, and 1 h after drinking tea by collecting saliva in sterilised containers. Samples were taken to the laboratory for incubation and subsequent counting. SM and LB counts and BC of saliva were calculated using the caries risk test (CRT). RESULTS: A total of 21 participants, 13 males and 8 females, with a mean age of 32.6 ± 8.02, were recruited in this study. Black tea had no significant effect on reducing the cariogenic bacterial counts (p > 0.05). CONCLUSION: Based on this study, it can be deduced that black tea exhibits an insignificant antimicrobial effect against Streptococcus mutans and Lactobacillus bacteria.

Frequency of use of non-prescribed medication among population sample from Al Madina City and its impact on quality of care in Saudi Arabia.

OBJECTIVE: Self-medication can be defined as the practice of using drugs that have not been prescribed, recommended, or controlled by a certified health-care professional. This term can be used when discussing patients who use non-prescription medications to treat self-diagnosed disorders or symptoms, without consulting a medical practitioner and without any medical supervision. The objectives of this study are to identify patterns of self-medication in Saudi Arabia, to measure the association between gender and the use of non-prescribed medication, and to identify the type of medications involved, the dosages used, and patient's sources of knowledge regarding the types, and doses of medications. METHOD: Cross-section analytical observational study, conducted in Al Medina city, Saudi Arabia, over 6 months using a pretested self-administered questionnaire using a convenience sampling technique. RESULTS: With a response rate of 68.8%, it was found that 72.5% reported the use of non-prescribed medication and 24.3% reported a history of experiencing side effects from using non-prescribed medication with no significant difference between male and female. 81% were keen to read the medication instruction with higher response among females.Analgesics were the most common type of medication used with an 86.5% agreement with no statistical significant differences between male and females. CONCLUSION: The study found heavy use of non-prescribed medication among the Al Medina residents sampled. This suggests a need for specialist training programs that could be directed at pharmacists, to help them disseminate information on the safe use of OTC or non-prescribed medications.

Faculty perceptions regarding community-based medical education: The case of KSA.

OBJECTIVES: There is great concern about the selection and quality of health college graduates and about their ability to respond to local community health needs. Community-based medical education (CBME) is a means of achieving educational relevance to community needs. In KSA, medical education has rapidly progressed in tandem with huge expansions in community health needs and expectations. This study aimed to assess the perceptions of the faculty members of the colleges of medicine and dentistry towards different concepts reflecting CBME. METHODOLOGY: This analytical, observational and cross-sectional study used a self-administered questionnaire that was given to the faculty members of the colleges of medicine and dentistry at Taibah University, KSA. RESULTS: As many as 136 faculty members responded, a response rate of 64%. The percentage of agreement was strongest among the faculty members of the college of medicine. The study findings also showed a relationship between different concepts of CBME and faculty teaching experiences by academic positions for applying CBME. There were significant differences in the social, cultural, and ethnic aspects of medical practice. CONCLUSION: CBME is a means of achieving educational relevance to community needs and consequently serves as a means of implementing a community-oriented education programme.

Patient safety culture as a quality indicator for a safe health system: Experience from Almadinah Almunawwarah, KSA.

OBJECTIVES: Safety culture assessments allow healthcare organisations to get a clear understanding of those aspects of patient safety requiring urgent attention and highlight safety culture strengths and weaknesses. This study aimed to evaluate the extent to which the culture supports patient safety at a hospital in KSA. METHODS: A cross-section analytical observational study was conducted at King Fahad Hospital in Almadinah Almunawwarah, KSA. RESULTS: After the survey, the staff felt less certain about the patient safety culture inside the institution. The greatest positive scores were obtained for teamwork within units, safety culture composites, feedback, communication about error, management expectations, actions promoting patient safety, organisational learning, and continuous improvement. However, none of these features achieved a positive score of 75% or more as an area of strength. The rest of the aspects were negatively ranked as areas for probable development, with the lowest scores obtained for non-punitive reaction to error, staffing, hospital handoff and transition, communication openness, and hospital management support for patient safety. CONCLUSION: Commitment to quality care as an outcome is certainly correlated with patient safety. There is a strong need to improve and promote applicable policies to improve the culture of patient safety in hospitals. The development of strong management competence to promote an environment of open consultation and administrative wisdom will contribute to improving patient safety culture.

Relating family satisfaction to the care provided in intensive care units: quality outcomes in Saudi accredited hospitals. / Relação da satisfação dos familiares com os cuidados prestados em unidades de terapia intensiva: desfechos de qualidade em hospitais sauditas acreditados.

OBJECTIVES: This study aims to identify the satisfaction levels of the family members of patients in intensive care units. METHODS: This is a cross-sectional analytical study. General intensive care units offer a variety of services to clinical and surgical patients. For the purpose of this study, a trained interviewer communicated with the families of patients, either before or after visiting hours. RESULTS: The study included 208 participants: 119 (57.2%) males and 89 (42.8%) females. Seventy-three (35.1%) of the patients attended a private hospital, and 135 (64.9%) attended a public hospital in the city of Al Madinah Al- Munawarah. All of the participants were either family members or friends of patients admitted to the intensive care units at the hospitals. The responses of both groups yielded low scores on the satisfaction index. However, a relatively high score was noted in response to questions 2, 6, and 10, which concerned the care that was extended by the hospital staff to their patients, the courteous attitude of intensive care unit staff members towards patients, and patients' satisfaction with the medical care provided, respectively. A very low score was obtained for item 11, which was related to the possibility for improvements to the medical care that the patients received. Overall, greater satisfaction with the services offered by the public intensive care units was reported compared to the satisfaction with the services offered by the private intensive care units. CONCLUSION: An overall low score on the satisfaction index was obtained, and further studies are recommended to assess the current situation and improve the satisfaction and quality of care provided by intensive care units.

OBJETIVO: Identificar os níveis de satisfação dos familiares de pacientes internados em unidades de terapia intensiva. MÉTODOS: Este foi um estudo analítico transversal. As unidades gerais de terapia intensiva oferecem uma variedade de serviços a pacientes clínicos e cirúrgicos. Para as finalidades deste estudo, um entrevistador treinado fez contato com familiares dos pacientes, antes ou após o horário de visita. RESULTADOS: O estudo incluiu 208 participantes, sendo 119 (57,2%) do sexo masculino. Dentre os pacientes, 73 (35,1%) se encontravam em um hospital particular e 135 (64,9%) em um hospital público na cidade de Al Madinah Al-Munawarah. Todos os participantes eram membros da família ou amigos de pacientes admitidos às unidades de terapia intensiva dos hospitais. As respostas de ambos os grupos proporcionaram escores baixos nos índices de satisfação. Observou-se, porém, um escore relativamente elevado nas respostas às questões 2, 6 e 10, concernentes, respectivamente, aos cuidados proporcionados pela equipe do hospital a seus pacientes, à atitude de cortesia dos membros da equipe das unidades de terapia intensiva para com os pacientes, e à satisfação dos pacientes com os cuidados médicos proporcionados. O escore foi muito baixo para o item 11, relacionado à possibilidade de melhorias nos cuidados médicos que os pacientes recebiam. Em geral foi relatada uma satisfação maior com os serviços oferecidos pelas unidades de terapia intensiva dos hospitais públicos, em comparação com a satisfação com os cuidados oferecidos pelas unidades de terapia intensiva dos hospitais privados. CONCLUSÃO: Em geral, foi obtido um escore baixo nos índices de satisfação, recomendando-se a realização de outros estudos para avaliar a situação atual, e melhorar a satisfação e a qualidade dos serviços fornecidos pelas unidades de terapia intensiva.

Relação da satisfação dos familiares com os cuidados prestados em unidades de terapia intensiva: desfechos de qualidade em hospitais sauditas acreditados / Relating family satisfaction to the care provided in intensive care units: quality outcomes in Saudi accredited hospitals

RESUMO Objetivo: Identificar os níveis de satisfação dos familiares de pacientes internados em unidades de terapia intensiva. Métodos: Este foi um estudo analítico transversal. As unidades gerais de terapia intensiva oferecem uma variedade de serviços a pacientes clínicos e cirúrgicos. Para as finalidades deste estudo, um entrevistador treinado fez contato com familiares dos pacientes, antes ou após o horário de visita. Resultados: O estudo incluiu 208 participantes, sendo 119 (57,2%) do sexo masculino. Dentre os pacientes, 73 (35,1%) se encontravam em um hospital particular e 135 (64,9%) em um hospital público na cidade de Al Madinah Al-Munawarah. Todos os participantes eram membros da família ou amigos de pacientes admitidos às unidades de terapia intensiva dos hospitais. As respostas de ambos os grupos proporcionaram escores baixos nos índices de satisfação. Observou-se, porém, um escore relativamente elevado nas respostas às questões 2, 6 e 10, concernentes, respectivamente, aos cuidados proporcionados pela equipe do hospital a seus pacientes, à atitude de cortesia dos membros da equipe das unidades de terapia intensiva para com os pacientes, e à satisfação dos pacientes com os cuidados médicos proporcionados. O escore foi muito baixo para o item 11, relacionado à possibilidade de melhorias nos cuidados médicos que os pacientes recebiam. Em geral foi relatada uma satisfação maior com os serviços oferecidos pelas unidades de terapia intensiva dos hospitais públicos, em comparação com a satisfação com os cuidados oferecidos pelas unidades de terapia intensiva dos hospitais privados. Conclusão: Em geral, foi obtido um escore baixo nos índices de satisfação, recomendando-se a realização de outros estudos para avaliar a situação atual, e melhorar a satisfação e a qualidade dos serviços fornecidos pelas unidades de terapia intensiva.

ABSTRACT Objectives: This study aims to identify the satisfaction levels of the family members of patients in intensive care units. Methods: This is a cross-sectional analytical study. General intensive care units offer a variety of services to clinical and surgical patients. For the purpose of this study, a trained interviewer communicated with the families of patients, either before or after visiting hours. Results: The study included 208 participants: 119 (57.2%) males and 89 (42.8%) females. Seventy-three (35.1%) of the patients attended a private hospital, and 135 (64.9%) attended a public hospital in the city of Al Madinah Al- Munawarah. All of the participants were either family members or friends of patients admitted to the intensive care units at the hospitals. The responses of both groups yielded low scores on the satisfaction index. However, a relatively high score was noted in response to questions 2, 6, and 10, which concerned the care that was extended by the hospital staff to their patients, the courteous attitude of intensive care unit staff members towards patients, and patients' satisfaction with the medical care provided, respectively. A very low score was obtained for item 11, which was related to the possibility for improvements to the medical care that the patients received. Overall, greater satisfaction with the services offered by the public intensive care units was reported compared to the satisfaction with the services offered by the private intensive care units. Conclusion: An overall low score on the satisfaction index was obtained, and further studies are recommended to assess the current situation and improve the satisfaction and quality of care provided by intensive care units.

Validated Spectrophotometric and RP-HPLC-DAD Methods for the Determination of Ursodeoxycholic Acid Based on Derivatization with 2-Nitrophenylhydrazine.

This work describes the development, validation, and application of two simple, accurate, and reliable methods for the determination of ursodeoxycholic acid (UDCA) in bulk powder and in pharmaceutical dosage forms. The carboxylic acid group in UDCA was exploited for the development of these novel methods. Method 1 is the colorimetric determination of the drug based on its reaction with 2-nitrophenylhydrazine hydrochloride in the presence of a water-soluble carbodiimide coupler [1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide hydrochloride] and pyridine to produce an acid hydrazide derivative, which ionizes to yield an intense violet color with maximum absorption at 553 nm. Method 2 uses reversed-phase HPLC with diode-array detection for the determination of UDCA after precolumn derivatization using the same reaction mentioned above. The acid hydrazide reaction product was separated using a Pinnacle DB C8 column (4.6 × 150 mm, 5 µm particle size) and a mobile phase consisting of 0.01 M acetate buffer (pH 3)-methanol-acetonitrile (30 + 30 + 40, v/v/v) isocratically pumped at a flow rate of 1 mL/min. Ibuprofen was used as the internal standard (IS). The peaks of the reaction product and IS were monitored at 400 nm. Different experimental parameters for both methods were carefully optimized. Analytical performance of the developed methods were statistically validated for linearity, range, precision, accuracy, specificity, robustness, LOD, and LOQ. Calibration curves showed good linear relationships for concentration ranges 32-192 and 60-600 µg/mL for methods 1 and 2, respectively. The proposed methods were successfully applied for the assay of UDCA in bulk form, capsules, and oral suspension with good accuracy and precision. Assay results were statistically compared with a reference pharmacopeial HPLC method, and no significant differences were observed between proposed and reference methods.

Patient's Bill of Rights: Is it a Challenge for Quality Health Care in Saudi Arabia?

BACKGROUND: Increasing interest in patients' rights and the certainty of its impact on the quality of patient care has led to extensive research in both developed and developing countries. In 2006, the Government of Saudi Arabia publicized the Patient's Bill of Rights (PBR) that was aimed at improving patients' and health-care professionals' experience, with a focus on the quality of care provided. OBJECTIVE: To determine the degree of awareness of rights among patients admitted to hospitals in Al-Madinah Al-Munawarah. The results would help policymakers understand the impact of patients' rights, and thus provide them with evidence to provide quality health-care service delivery and patient care through patients' rights. METHODOLOGY: This is an observational, analytical, cross-sectional study implemented in Al-Madinah Al-Munawarah, Saudi Arabia, using a self-administered questionnaire. RESULTS: The study had a response rate of 83.01% and found an association between gender and knowledge for the selected items of patients' rights. However, there was no statistically significant difference between the knowledge of males and females regarding the consent form, with an awareness rate of 90% among the total sample size. However, almost half had never heard about patients' rights. CONCLUSION: This study shows that in Al-Madinah Al-Munawarah, Saudi Arabia, there is a low level of awareness among patients admitted to hospitals regarding their rights. Further, it was found that wall placards, mass media and health-care providers are important sources of knowledge regarding patients' rights. Health-care policymakers in Saudi Arabia should recognize the importance of patients' rights as means of providing better quality care and a higher rate of patient satisfaction by establishing measures to tackle obstacles that may impede the implementation of PBR.

Fibrinolytic therapy in patients with ST-segment elevation myocardial infarction: Accelerated versus standard Streptokinase infusion regimen.

Introduction: Timely fibrinolysis for acute ST-segment elevation myocardial infarction (STEMI) reduces infarct size and hence preserves LV function and reduces mortality. Optimal regimen of streptokinase (SK) infusion in such patients is a matter of interest. The current study aimed to compare efficacy and safety of accelerated SK infusion regimen in patients with STEMI versus the standard one. Methods: One hundred consecutive STEMI patients were randomly allocated into one of 2 groups: group I (50 patients) who received accelerated SK regimen (1.5 million units over 30 minutes) and group II (50 patients) received standard SK regimen (1.5 million units over 60 minutes). Efficacy was evaluated non-invasively using clinical (chest pain), ECG (resolution of ST segment) and laboratory tests (earlier and higher peaking of cardiac troponin I). Safety was evaluated by assessment of multiple in-hospital adverse events. Results: Both groups were statistically matched in all baseline criteria. There was a significant difference between both groups regarding each parameter of successful reperfusion in favor of accelerated regimen. When all these parameters were combined, 31 patients (62%) had successful reperfusion in group I versus 19 patients (38%) in group II (P = 0.016). We did not report any significant difference between both groups regarding in-hospital mortality, in-hospital heart failure, major bleeding, hypotension or allergic reaction to SK. Mean pre-discharge ejection fraction was higher in group I than group II (50.9 ±â€…6.6% versus 47.3 ±â€…4.6%, P = 0.002). Conclusion: Accelerated regimen of SK infusion is safe and effective method of reperfusion in patients with STEMI.

High-performance liquid chromatography with diode array detection method for the simultaneous determination of seven selected phosphodiesterase-5 inhibitors and serotonin reuptake inhibitors used as male sexual enhancers.

This work presents a simple, sensitive and generic high-performance liquid chromatography with diode array detection method for the simultaneous determination of seven drugs prescribed for the treatment of erectile dysfunction and premature ejaculation. Investigated drugs include the phosphodiesterase-5 inhibitors: sildenafil, tadalafil, and vardenafil, in addition to the selective serotonin reuptake inhibitors: dapoxetine, duloxetine, fluoxetine, and paroxetine. The drugs were separated using a Waters C8 column (4.6 × 250 mm, 5 µm) with the mobile phase consisting of phosphate buffer pH 3, acetonitrile and methanol in the ratio 60:33:7. The flow rate was 1.2 mL/min, and quantification was based on measuring peak areas at 225 nm. Peaks were perfectly resolved with retention times 3.3, 3.9, 6.4, 7.5, 9.5, 10.7, and 13.4 min for vardenafil, sildenafil, paroxetine, duloxetine, dapoxetine, fluoxetine, and tadalafil, respectively. The developed method was validated with respect to system suitability, linearity, ranges, accuracy, precision, robustness, and limits of detection and quantification. The proposed method showed good linearity in the ranges 5-500, 2-200, 2-200, 3-300, 1.5-150, 2-200, and 2-200 µg/mL for sildenafil, tadalafil, vardenafil, dapoxetine, duloxetine fluoxetine, and paroxetine, respectively. The limits of detection were 0.18-0.38 µg/mL for the analyzed compounds. The applicability of the proposed method to real life situations was assessed through the analysis of commercial tablets, and satisfactory results were obtained.

Validated spectrophotometric methods for determination of sodium valproate based on charge transfer complexation reactions.

This work presents the development, validation and application of four simple and direct spectrophotometric methods for determination of sodium valproate (VP) through charge transfer complexation reactions. The first method is based on the reaction of the drug with p-chloranilic acid (p-CA) in acetone to give a purple colored product with maximum absorbance at 524nm. The second method depends on the reaction of VP with dichlone (DC) in dimethylformamide forming a reddish orange product measured at 490nm. The third method is based upon the interaction of VP and picric acid (PA) in chloroform resulting in the formation of a yellow complex measured at 415nm. The fourth method involves the formation of a yellow complex peaking at 361nm upon the reaction of the drug with iodine in chloroform. Experimental conditions affecting the color development were studied and optimized. Stoichiometry of the reactions was determined. The proposed spectrophotometric procedures were effectively validated with respect to linearity, ranges, precision, accuracy, specificity, robustness, detection and quantification limits. Calibration curves of the formed color products with p-CA, DC, PA and iodine showed good linear relationships over the concentration ranges 24-144, 40-200, 2-20 and 1-8µg/mL respectively. The proposed methods were successfully applied to the assay of sodium valproate in tablets and oral solution dosage forms with good accuracy and precision. Assay results were statistically compared to a reference pharmacopoeial HPLC method where no significant differences were observed between the proposed methods and reference method.

Validated spectrofluorimetric determination of two pharmaceutical antihypertensive mixtures containing amlodipine besylate together with either candesartan cilexetil or telmisartan.

Amlodipine besylate (AML) is available in fixed-dose combination tablets with either candesartan cilexetil (CAN) or telmisartan (TEL). This work describes a simple, selective and sensitive spectrofluorimetric method for analysis of AML/CAN and AML/TEL binary mixtures without prior separation. The method involves measurement of the native fluorescence of AML at excitation and emission wavelengths of 367 and 454 nm, respectively, in water without interference from either of the two drugs. By contrast, the intrinsic fluorescence of CAN was measured at excitation and emission wavelengths of 265 and 392 nm, respectively, in ethanol, while TEL was measured at 366 nm in 0.05 M sodium hydroxide solution using 294 nm as the excitation wavelength. The proposed spectrofluorimetric procedure was validated with respect to linearity, ranges, precision, accuracy, selectivity, robustness, detection and quantification limits. Regression analysis showed a good correlation between fluorescence intensity and concentration over the ranges 0.1-1.4, 0.025-0.25 and 0.0025-0.05 µg/mL for AML, CAN and TEL, respectively. Limits of detection were 0.034, 0.0063 and 0.0007 µg/mL for AML, CAN and TEL, respectively. The proposed method was successfully applied for the analysis of several synthetic binary mixtures of different ratios and laboratory-prepared tablets with good recoveries, and no interference from common pharmaceutical additives was observed.

Agreement and disagreement on health care quality concepts among academic health professionals: the Saudi case.

A systematic and rigorous implementation of quality improvement processes is likely to improve the well-being of staff members and heighten their job satisfaction. Assessing professionals' perceptions of health care quality should lead to the betterment of health care services. In Saudi Arabia, no previous studies examine how university health professionals view health care quality concepts. A cross-sectional analytical study employing a self-administered questionnaire with 43 statements assessing quality perceptions of academic health care professionals was used. Despite the agreement of health professionals on numerous quality concepts addressed in this study, there was insufficient agreement on 10 core quality concepts, 3 of which were the following: "quality focuses on customers" (50%), "quality is tangible and therefore measurable" (29.3%), and "quality is data-driven" (62%). Hence, providing health professionals with relevant training likely will generate a better understanding of quality concepts and optimize their performance.