Development and psychometric evaluation of the asthma Action plan questionnaire (AAPQ).

OBJECTIVE: To develop a practical and psychometrically sound tool to evaluate caregiver knowledge of their child's asthma action plan (AAP). METHODS: A pilot study was conducted in a sample of 40 caregivers of children with asthma to assess the content validity, item difficulty, and item discrimination of the Asthma Action Plan Questionnaire (AAPQ). The inter-rater and intra-rater agreement of the AAPQ's scoring rubric were also examined. Subsequently, a large-scale study was conducted in a sample of 80 caregivers of children with asthma and 40 caregivers of children without current asthma and no prior exposure to patients with asthma to evaluate the internal consistency, test-retest reliability, and known-groups validity of the AAPQ. RESULTS: The 7-item AAPQ demonstrated acceptable content validity (a scale-content validity index of 0.98) and internal consistency (Cronbach's alpha =.63 and mean inter-item correlation coefficient of.20) and very strong test-retest reliability over a two-to-four-week period (r = .88, p < .001). The AAPQ discriminated between caregivers of children with asthma and caregivers of children without asthma (M ± SD 8.3 ± 1.6 vs. 4.3 ± 1.7, p < .001, respectively). CONCLUSION: The AAPQ is a valid and reliable questionnaire that provides an assessment of caregivers' knowledge of their child's AAP and can guide educational interventions by healthcare providers.

Preparation and Characterization of Uniform and Controlled Silica Encapsulating on Lithium Yttrium Fluoride-Based Upconversion Nanoparticles.

In this work, we present an advancement in the encapsulation of lithium yttrium fluoride-based (YLiF4:Yb,Er) upconversion nanocrystals (UCNPs) with silica (SiO2) shells through a reverse microemulsion technique, achieving UCNPs@SiO2 core/shell structures. Key parameters of this approach were optimized to eliminate the occurrence of core-free silica particles and ensure a controlled silica shell thickness growth on the UCNPs. The optimal conditions for this method were using 6 mg of UCNPs, 1.5 mL of Igepal CO-520, 0.25 mL of ammonia, and 50 µL of tetraethyl orthosilicate (TEOS), resulting in a uniform silica shell around UCNPs with a thickness of 8 nm. The optical characteristics of the silica-encased UCNPs were examined, confirming the retention of their intrinsic upconversion luminescence (UC). Furthermore, we developed a reliable strategy to avoid the coencapsulation of multiple UCNPs within a single silica shell. This approach led to a tenfold increase in the UC luminescence of the annealed particles compared to their nonannealed counterparts, under identical silica shell thickness and excitation conditions. This significant improvement addresses a critical challenge and amplifies the applicability of the resulting UCNPs@SiO2 core/shell structures in various fields.

Novel Nanocomposites for Luminescent Thermometry with Two Different Modalities.

In this work, we successfully integrated fluorescent nanodiamonds (FNDs) and lanthanide ion-doped upconversion nanoparticles (UCNPs) in a nanocomposite structure for simultaneous optical temperature sensing. The effective integration of FND and UCNP shells was confirmed by employing high-resolution TEM imaging, X-ray diffraction, and dual-excitation optical spectroscopy. Furthermore, the synthesized ND@UCNP nanocomposites were tested by making simultaneous optical temperature measurements, and the detected temperatures showed excellent agreement within their sensitivity limit. The simultaneous measurement of temperature using two different modalities having different sensing physics but with the same composite nanoparticles inside is expected to greatly improve the confidence of nanoscale temperature measurements. This should resolve some of the controversy surrounding nanoscale temperature measurements in biological applications.

Efficient Lithium-Based Upconversion Nanoparticles for Single-Particle Imaging and Temperature Sensing.

Upconversion Nanoparticles (UCNPs) have attracted exceptional attention due to their great potential in high-contrast, free-background biofluorescence deep tissue imaging and quantum sensing. Most of these interesting studies have been performed using an ensemble of UCNPs as fluorescent probes in bioapplications. Here, we report a synthesis of small and efficient YLiF4:Yb,Er UCNPs for single-particle imaging as well as sensitive optical temperature sensing. The reported particles demonstrated a bright and photostable upconversion emission at a single particle level under a low laser intensity excitation of 20 W/cm2. Furthermore, the synthesized UCNPs were tested and compared to the commonly used two-photon excitation QDs and organic dyes and showed a nine times better performance at a single particle level under the same experimental conditions. In addition, the synthesized UCNPs demonstrated sensitive optical temperature sensing at a single particle level within the biological temperature range. The good optical properties of single YLiF4:Yb,Er UCNPs open an avenue for small and efficient fluorescent markers in imaging and sensing applications.

Altered Pharmacokinetics Parameters of Vancomycin in Patients with Hematological Malignancy with Febrile Neutropenia, a Bayesian Software Estimation.

The pharmacokinetics of vancomycin vary significantly between specific groups of patients, such as critically ill patients and patients with hematological malignancy (HM) with febrile neutropenia (FN). Recent evidence suggests that the use of the usual standard dose of antibiotics in patients with FN may not offer adequate exposure due to pharmacokinetic variability (PK). Therefore, the purpose of this study is to assess the effect of FN on AUC0-24 as a key parameter for vancomycin monitoring, as well as to determine which vancomycin PK parameters are affected by the presence of FN using Bayesian software PrecisePK in HM with FN. This study was carried out in King Abdulaziz Medical City. All adult patients who were admitted to the Princess Norah Oncology Center PNOC between 1 January and 2017 and 31 December 2020, hospitalized and received vancomycin with a steady-state trough concentration measured before the fourth dose, were included. During the trial period, 297 patients received vancomycin during their stay at the oncology center, 217 of them meeting the inclusion criteria. Pharmacokinetic parameters were estimated for the neutropenic and non-FN patients using the precise PK Bayesian platform. The result showed that there was a significant difference (p < 0.05) in vancomycin clearance Clvan, the volume of distribution at a steady-state Vdss, the volume of distribution for peripheral compartment Vdp, half-life for the elimination phase t½ß, and the first-order rate constant for the elimination process ß in FN compared to non-FN patients. Furthermore, AUC0-24 was lower for FN patients compared to non-FN patients, p < 0.05. FN has a significant effect on the PK parameters of vancomycin and AUC0-24, which may require specific consideration during the treatment initiation.

The Bayesian-Based Area under the Curve of Vancomycin by Using a Single Trough Level: An Evaluation of Accuracy and Discordance at Tertiary Care Hospital in KSA.

The AUC0-24 is the most accurate way to track the vancomycin level while the Cmin is not an accurate surrogate. Most hospitals in Saudi Arabia are under-practicing the AUC-guided vancomycin dosing and monitoring. No previous work has been conducted to evaluate such practice in the whole kingdom. The current study objective is to calculate the AUC0-24 using the Bayesian dosing software (PrecisePK), identify the probability of patients who receive the optimum dose of vancomycin, and evaluate the accuracy and precision of the Bayesian platform. This retrospective study was conducted at King Abdulaziz medical city, Jeddah. All adult patients treated with vancomycin were included. Pediatric patients, critically ill patients requiring ICU admission, patients with acute renal failure or undergoing dialysis, and febrile neutropenic patients were excluded. The AUC0-24 was predicted using the PrecisePK platform based on the Bayesian principle. The two-compartmental model by Rodvold et al. in this platform and patients' dose data were utilized to calculate the AUC0-24 and trough level. Among 342 patients included in the present study, the mean of the estimated vancomycin AUC0-24 by the posterior model of PrecisePK was 573 ± 199.6 mg, and the model had a bias of 16.8%, whereas the precision was 2.85 mg/L. The target AUC0-24 (400 to 600 mg·h/L) and measured trough (10 to 20 mg/L) were documented in 127 (37.1%) and 185 (54%), respectively. Furthermore, the result demonstrated an increase in odds of AUC0-24 > 600 mg·h/L among trough level 15-20 mg/L group (OR = 13.2, p < 0.05) as compared with trough level 10-14.9 mg/L group. In conclusion, the discordance in the AUC0-24 ratio and measured trough concentration may jeopardize patient safety, and implantation of the Bayesian approach as a workable alternative to the traditional trough method should be considered.

The Effects of Booking Status on the Outcome of Infants of ≥32 Weeks Gestational Age Admitted to the Neonatal Intensive Care Unit in a Tertiary Academic Center.

Introduction Antenatal care (ANC) is a systematic examination and follow-up of pregnant women that involves education, counseling, screening, and treatment of any complications encountered. ANC is an essential measure that significantly decreases devastating maternal and fetal outcomes. This study aimed to explore the maternal and fetal outcomes of mothers who did and did not book follow-ups and had their newborns admitted to the neonatal intensive care unit (NICU) at the King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Methodology We conducted a cross-sectional study between January 1, 2021, and January 1, 2022, at KAUH in Jeddah, Saudi Arabia. Data were collected from electronic medical records and paper documents. Maternal demographic and pregnancy information were collected in addition to neonatal outcomes. Results The study included 186 participants, with a median maternal age of 32 years (interquartile range (IQR) 27-36). Cesarean section was the predominant mode of delivery (67.2%), with a median gestational age at birth of 36 weeks (IQR 34-38). Most women (69.4%) booked follow-ups, while 40.3% developed chronic comorbid conditions during pregnancy. The newborn sex ratio was nearly even between males and females, with a median birthweight of 2325 g (IQR 1740-2900) and median Apgar scores of 7 (IQR 5-9) and 9 (IQR 8-10) at 1 and 5 min, respectively. Jaundice was the most common postnatal complication (51.6%), followed by hypoglycemia (18.8%), while 23.7% of babies had congenital anomalies. There was a significant association between booking status and nationality, maternal age, cesarean section, maternal comorbid conditions, the outcome of multiple gestations, and postnatal complications, including jaundice and hypoglycemia. Decreasing maternal age (odds ratio (OR) 0.755, 95% confidence interval (CI) 0.585-0.974) and Apgar score at 5 min (OR 0.096, 95% CI 0.012-0.795) were the only significant predictors of fetal mortality. Conclusion The study revealed suboptimal adherence to ANC among pregnant women with newborns admitted to the NICU, along with poorer maternal and fetal outcomes, with respect to neonatal jaundice, hypoglycemia, and the need for resuscitation.

The Overriding of Computerized Physician Order Entry (CPOE) Drug Safety Alerts Fired by the Clinical Decision Support (CDS) Tool: Evaluation of Appropriate Responses and Alert Fatigue Solutions.

Introduction Most computerized physician order entry (CPOE) software come with clinical decision-support components (CDS) that provide prescribers assistance and notify them about adverse drug reactions. An excessive number of alerts in a repeated and non-relevant manner leads to alert fatigue and enforces physicians and pharmacists to alert overrides. King Abdulaziz Medical City (KAMC) in Jeddah still reports a higher percentage of drug alerts overridden by clinicians and pharmacists. Thus, this study was conducted to evaluate CDS alerts overriding and to determine which alerts are clinically irrelevant and need modifications. Methods The study was carried out in the inpatient setting at KAMC in Jeddah, from September 1, 2020, to December 31, 2020. It was designed as a retrospective chart review study that included all red alerts that required comments and were overridden by a physician and pharmacist. Results Among 11350 red alerts, potential drug-drug interaction (pDDI), dose, and allergy alerts represent 57%, 41%, and 2%, respectively, of the total alerts. The most common drug-drug interactions (DDIs) in category X were proton pump inhibitors and clopidogrel (9.9%). The appropriate response by prescribers and pharmacists toward allergy alerts was associated with the highest odds compared with the other alerts (p < 0.05) while there is a significant decrease in the odds of appropriate action being taken by both prescribers and pharmacists in the dose screen alerts (p < 0.05). Among all clinical specialties, there is an increased odds of appropriate action being taken by residents and fellows for allergy and dose alerts, respectively, compared to other groups (p < 0.05). For diminishing the unnecessary alerts, we provided 14 alert refinements strategies and advised turning off four alerts. Applying this will terminate 32% of irrelevant alerts. Conclusion Our study's findings indicated that a substantial number of alerts are ignored, and the rate of appropriateness varies significantly by alert type and prescriber level.

High-Performance and Stable Perovskite Solar Cells Using Carbon Quantum Dots and Upconversion Nanoparticles.

Upconversion nanoparticles (UCNPs) and carbon quantum dots (CQDs) have recently received a lot of attention as promising materials to improve the stability and efficiency of perovskite solar cells (PSCs). This is because they can passivate the surfaces of perovskite-sensitive materials and act as a spectrum converter for sunlight. In this study, we mixed and added both promising nanomaterials to PSC layers at the ideal mixing ratios. When compared to the pristine PSCs, the fabricated PSCs showed improved power conversion efficiency (PCE), from 16.57% to 20.44%, a higher photocurrent, and a superior fill factor (FF), which increased from 70% to 75%. Furthermore, the incorporation of CQDs into the manufactured PSCs shielded the perovskite layer from water contact, producing a device that was more stable than the original.

Augmented Renal Clearance and Hypoalbuminemia-Induced Low Vancomycin Trough Concentrations in Febrile Neutropenic Patients With Hematological Malignancies.

INTRODUCTION: Vancomycin administration in individuals with hematological malignancy or neutropenia is associated with a suboptimal trough concentration. Nonetheless, most studies did not distinguish whether low vancomycin trough concentrations were due to hematological malignancies or neutropenia. This study aimed to determine the association between types of hematological malignancy and febrile neutropenia with low vancomycin concentrations. METHODS: The present retrospective chart review study was conducted by using clinical data adopted from computerized physician order entries (BestCare®) for all of the patients who received intravenous vancomycin treatment between January 2017 and December 2020 at King Abdulaziz Medical City in Jeddah. RESULTS: Out of the 296 patients, 217 were included. There was no significant association between the type of hematological malignancy and the incidence of a low trough concentration (p > 0.05), while a significant association between febrile neutropenia and the incidence of a low trough concentration was observed (p < 0.05). Furthermore, the predictors for a low trough among febrile neutropenic patients were creatinine clearance (CrCI) and a low albumin concentration. In addition, there was a significant association between febrile neutropenia and augmented renal clearance (p < 0.05). CONCLUSIONS: The findings of this study conclude that febrile neutropenia is associated with low vancomycin concentrations. Interestingly, augmented renal clearance was observed in most of the febrile neutropenia patients with a significant association, which is considered the main driver for a low trough in neutropenic patients.

Health Sciences Students' Attitude, Perception, and Experience of Using Educational Simulation in Saudi Arabia: A Cross-Sectional Study.

Background: Simulation-based education (SBE) provides a safe, effective, and stimulating environment for training medical and healthcare students. This is especially valuable for skills that cannot be practiced on real patients due to ethical and practical reasons. We aimed to assess medical students' attitude, perception, and experience of simulation-based medical education in Saudi Arabia. Method: A validated cross-sectional survey, using the KidSIM scale, was conducted to measure the level of perception and experience of students from different health sciences specialties toward integrating simulation as an educational tool. Participants responded to questions investigated the importance of simulation, opportunities for Inter-Professional Education (IPE), communication, roles and responsibilities, and situation awareness. Only students with previous experience of SBE were considered for participation. Result: This survey was completed by 246 participants, of whom 165 (67%) were male students and 228 (93%) were aged between the range of 18-30 years old. Of the respondents, 104 (67%) were respiratory care students, 90 (37%) were anesthesia technology students, and 45 (18%) were nursing students. Most of the participants had previous experience in IPE simulation activities (84%), and more than half of the students (54%) had a grade point average (GPA) ranging between 5.00 and 4.50. Overall, students had positive attitudes toward and beliefs about SBE, with a mean score of 129.76 ± 14.27, on the KidSIM scale, out of 150. Students' GPA was significantly associated with a better perception to the relevance of simulation (p = 0.005), communication (p = 0.003), roles and responsibilities (p = 0.04), and situation awareness (p = 0.009). GPA is merely the sole predictor for positive attitude toward simulation with coefficient Beta value of 4.285 (p = 0.001). There were no significant correlations between other students' characteristic variables (gender, specialty, study year, experience in IPE, and prior critical care experience). Conclusion: We found that health sciences students' perception of SBE in Saudi Arabia is generally positive, and students' performance is a significant determinant of the positive perception.

Ligand-based design and synthesis of N'-Benzylidene-3,4-dimethoxybenzohydrazide derivatives as potential antimicrobial agents; evaluation by in vitro, in vivo, and in silico approaches with SAR studies.

Herein, a series of N'-benzylidene-3,4-dimethoxybenzohydrazide derivatives were designed and synthesised to target the multidrug efflux pump (MATE). The antibacterial activities were screened against S. aureus, Acinetobacter, S. typhi, E. coli, and P. aeruginosa, whereas their antifungal activities were screened against C. albicans. Compounds 4a, 4h, and 4i showed the most promising antibacterial and antifungal activities. Moreover, compounds 4h and 4i being the broader and superior members regarding their antimicrobial effects were selected to be further evaluated via in vivo testing using biochemical analysis and liver/kidney histological examination. Additionally, molecular docking was carried out to attain further deep insights into the synthesised compounds' binding modes. Also, ADMET studies were performed to investigate the physicochemical/pharmacokinetics features and toxicity parameters of the synthesised derivatives. Finally, a structure-antimicrobial activity relationship study was established to facilitate further structural modifications in the future. HighlightsA series of new N'-benzylidene-3,4-dimethoxybenzohydrazide derivatives were designed and synthesised targeting the multidrug efflux pump (MATE) guided by the pharmacophoric features of the co-crystallized native inhibitor of the target protein.The newly synthesised compounds were assessed through in vitro, in vivo, and in silico approaches.Using the agar well diffusion assay, the antibacterial activities of the synthesised compounds were screened against S. aureus, Acinetobacter, S. typhi, E. coli, and P. aeruginosa, whereas, their antifungal activities were screened against C. albicans.The minimal inhibitory concentration (MIC) and the minimal bactericidal concentration (MBC) of the synthesised compounds were investigated on variable microbial species.Compounds (4h and 4i) -as the broader and superior members regarding their antimicrobial effects- were further evaluated via in vivo testing using bio-chemical analysis and liver/kidney histological examination.A molecular docking study and ADMET in silico studies were performed.A structure-antimicrobial activity relationship study was established to facilitate further structural modifications in the future.

Hesitancy towards the COVID-19 vaccine among health care practitioners in the Kingdom of Saudi Arabia: a cross-sectional study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is a major public health crisis worldwide. In less than 12 months since the World Health Organization declared the outbreak, several different COVID-19 vaccines have been approved and deployed mostly in developed countries since January 2021. However, hesitancy to accept the newly developed vaccines is a well-known public health challenge that needs to be addressed. The aim of this study was to measure willingness and hesitancy toward COVID-19 vaccines among health care practitioners' (HCPs) in Saudi Arabia.   Methods: A cross-sectional study using an online self-reported survey was conducted among HCPs in Saudi Arabia between April 4th to April 25th 2021 using snowball sampling. Multivariate logistic regression was employed to identify the possible factors affecting HCPs' willingness and hesitancy to receive COVID-19 vaccines.   Results: Out of 776 participants who started the survey, 505 (65%) completed it and were included in the results. Among all HCPs, 47 (9.3%) either said "no" to receive the vaccine [20 (4%)] or were hesitant to receive it [27 (5.3%)]. Of the total number of the HCPs, 376 (74.5%) already received the COVID-19 vaccine, and 48 (9.50%) were registered to receive it. The main reason of agreement to receive the COVID-19 vaccine was "wanting to protect self and others from getting the infection" (24%).   Conclusion: Our findings have shown that hesitancy toward receiving COVID-19 vaccines among HCPs in Saudi Arabia is limited and therefore may not be a serious issue. The outcomes of this study may help to understand factors that lead to vaccine hesitancy in Saudi Arabia and help public health authorities to design targeted health education interventions aiming to increase uptake of these vaccines.

Lithium-Based Upconversion Nanoparticles for High Performance Perovskite Solar Cells.

In this work, we report an easy, efficient method to synthesize high quality lithium-based upconversion nanoparticles (UCNPs) which combine two promising materials (UCNPs and lithium ions) known to enhance the photovoltaic performance of perovskite solar cells (PSCs). Incorporating the synthesized YLiF4:Yb,Er nanoparticles into the mesoporous layer of the PSCs cells, at a certain doping level, demonstrated a higher power conversion efficiency (PCE) of 19%, additional photocurrent, and a better fill factor (FF) of 82% in comparison to undoped PSCs (PCE = ~16.5%; FF = 71%). The reported results open a new avenue toward efficient PSCs for renewable energy applications.

Causes of vancomycin dosing error; problem detection and practical solutions; a retrospective, single-center, cross-sectional study.

Vancomycindosing error and inappropriate monitoring is a common problem in hospital daily practice. In King Abdulaziz Medical City (KAMC) in Jeddah, a high percentage of abnormal vancomycin trough levels is still detected despite using the recommended dose. Therefore, the current research objective is to study the major causes of vancomycin dosing errors. This retrospective, single-center, cross-sectional study was carried out at KAMC hospital in Jeddah from January 1st until December 31st 2019. All adult patients (≥15 years) who received vancomycin and had an initial abnormal trough level at the measured steady-state were included in this study. 472 patients have met the study inclusion criteria. The current study evaluated the factors that play a role in causing vancomycin trough level abnormalities such as sampling time, vancomycin dosing, and patient's pharmacokinetic and pharmacodynamic variations. In this study, we found that pharmacokinetic and pharmacodynamic variability was attributed to 65% of vancomycin's abnormal trough level. Also, the result showed a significantly increased odds of the low trough in the non-elderly group (OR 6, 95% CI 2.48 - 14.9, P < 0.001) and febrile neutropenic patients (OR 2.21, 95% CI 1.119 - 4.365, P < 0.05). However, the odds of high trough levels were significantly elevated among patients who have CrCl < 50 ml/min (OR 5, 95% CI 1.262-20.539, P < 0.05). In addition, the present investigation revealed that the occurrence of abnormal vancomycin levels was not affected by daily duty time or working days (p > 0.05). The current study indicated that vancomycin dosing errors were common in KAMC patients; thus, there is an unmet need to evaluate the causes of vancomycin abnormal trough level and optimize a strategy that would enhance the therapeutic effectiveness and minimize the potential toxicity.

A Process for Hydrogen Production from the Catalytic Decomposition of Formic Acid over Iridium-Palladium Nanoparticles.

The present study investigates a process for the selective production of hydrogen from the catalytic decomposition of formic acid in the presence of iridium and iridium-palladium nanoparticles under various conditions. It was found that a loading of 1 wt.% of 2% palladium in the presence of 1% iridium over activated charcoal led to a 43% conversion of formic acid to hydrogen at room temperature after 4 h. Increasing the temperature to 60 °C led to further decomposition and an improvement in conversion yield to 63%. Dilution of formic acid from 0.5 to 0.2 M improved the decomposition, reaching conversion to 81%. The reported process could potentially be used in commercial applications.

Iris Melanocytoma in a Child: Clinical and Histopathological Findings.

BACKGROUND Melanocytoma is rare and can affect any part of the uveal tract. In rare cases, iris melanocytoma shows signs of growth, with extrascleral extension that mimics melanoma. This phenomenon makes clinical differentiation between the 2 pathologies particularly challenging. CASE REPORT A 3-year-old boy presented with recurrent ocular inflammation. Examination revealed a large, solid, homogenous mass in the inferior quadrants of the iris, with secondary localized corneal edema. The lesion did not extend to the ciliary body and fundus examination showed no lesions in the posterior segment, including the head of the optic nerve. The patient underwent a sectoral iridocyclectomy and excisional biopsy of the lesion in the iris. Histopathology of the lesion confirmed the diagnosis of iris melanocytoma. CONCLUSIONS The differential diagnosis for a mass in the iris is broad, ranging from benign cysts to melanoma, which is a life-threatening ocular condition. An iris melanocytoma always should be considered in the differential of these masses, despite their exceedingly low incidence. Although iris melanocytoma mainly manifests in patients who are middle-aged or older, it should be suspected in young children, as underscored by the present report.

A Methodological Assessment of Pharmacist Therapeutic Intervention Documentation (TID) in a Single Tertiary Care Hospital in Jeddah, Kingdom of Saudi Arabia.

Pharmacist intervention has valuable input to the healthcare system by reducing medication errors, costs of treatment and improving therapeutic outcomes. This study aimed to analyze pharmacists' interventions during the verification of computerized physician order entry and to determine the association between prescribers' level and type of prescribing errors. In this cross-sectional, observational study, data collection was carried out over three months starting from 1 January 2020 to 31 March 2020. Included were 2405 interventions documented by 52 different pharmacists. The prevalence of prescribing order entry errors was 9.1%. The most identifiable type of intervention was incorrect dilution (40.2%) followed by dose substitution (27.7%). The drug category associated with a high percentage of interventions was perfusion solutions (41%), followed by antibacterial (35%). The number of junior physician orders that required pharmacist intervention was higher than other prescribers (45.2%), followed by specialist and senior physicians, (31.4% and 15.5%, respectively). Prescriber ordering time and types of prescribing errors were shown to have a significant (p < 0.05) association. Internal medicine physicians entered the highest percentage of prescribing errors, representing 22.7%. The current study concluded that TID has significant potential to reduce drug-related problems; TID fatigue is a real problem that might be under-reported and addressing this point in future studies would be of great value.

Frequency and Management of Acute Poisoning Among Children Attending an Emergency Department in Saudi Arabia.

Background: Acute poisoning is one of the common medical emergencies in children that leads to morbidity and mortality. Medications and chemical agents play a major role in these adverse events resulting in social, economic, and health consequences. Aims of the study: This study aimed to evaluate the frequency and management of acute poisoning among children attending the emergency room at East Jeddah Hospital, Jeddah city, Saudi Arabia. Methods: This study was a retrospective chart review of all acute pediatric poisoning incidences in children (0-16 years of age) from October-21-2016 to March-03-2020 who were attending the emergency department. Data were analyzed via SPSS software. Results: A total of 69 incidences of acute poisoning in children who attended the emergency department at East Jeddah Hospital; males (n = 38, 55.1%). Most children were aged 5 years or younger (n = 41, 59.4%). Unintentional poisoning occurred among 56.5% of observed cases of which 52.2% occurred in children younger than 5 years; 7.20% (n = 5) of patients were 12 to 16 years of age and had deliberate self-poisoning. The association between type of poisoning and age groups was statistically significant (chi-square = 28.5057, p = 0.0001). Most incidences occurred at home (n = 64, 92.8%). Medicines were the most common cause of poisoning (n = 53, 76.8%). An excessive dose of prescribed medicine poisoning accidents was reported in 10.1% cases. Analgesics such as paracetamol were the most documented medication associated with poisoning (39.1%) followed by anticonvulsants and other central nervous system acting medicines (18.8%). The most common route of poisoning was oral ingestion (81.2%). One mortality case was documented. Conclusion: Although not common, accidental and deliberate acute poisoning in children does occur. More can be done to educate parents on safe storage of medicines, household cleaning and other products associated with acute poisoning in children. Likewise, children can be taught more about the risks of poisoning from an early age. As importantly, clinicians need to include more detailed notes in the electronic medical records (EMR) or the system needs to be improved to encourage completeness to more accurately inform the research evidence-base for future service design, health policy and strategy.

Foveal Congenital Simple Hamartoma of Retinal Pigment Epithelium: A Report of Two Cases.

We report two cases with foveal congenital simple hamartoma of the retinal pigment epithelium (CSHRPE), as both patients presented to our retina services complaining of a unilateral decreased vision. Full ophthalmic examination and multimodal imaging were performed including fundus photography, fundus autofluorescence, optical coherence tomography, fluorescein angiography, and electrophysiological testing. Both patients presented with 20/80 vision in the affected eyes. Foveal CSHRPE was found in both eyes, along with parapapillary hyperpigmented rim, multiple pinpoint macular lesions, and few posterior pole hyperpigmented lesions. Multifocal electroretinogram showed diminished central amplitude in both eyes, with three-dimensional topography map showing blunted foveal peaks in one eye and the absence of a central peak in the other patient. Both patients had a stable vision and clinical examination of the CSHRPE during 5 and 6 years follow up, respectively. Foveal CSHRPE is usually symptomatic and results in a decline in visual acuity. Follow-up of these patients showed stable vision and clinical examination.