Preclinical evaluation of novel synthesised nanoparticles based on tyrosine poly(ester amide) for improved targeted pulmonary delivery.

Fixed dose combinations (FDCs) incorporating two or three medicines in a single inhaler have been created to enhance patient compliance and hence clinical outcomes. However, the development of dry powder inhalers (DPIs), particularly for FDCs, faces challenges pertinent to formulation uniformity and reproducibility. Therefore, this project aimed to employ nanotechnology to develop a FDC of DPIs for market-leading medicines-fluticasone propionate (FP) and salmeterol xinafoate (SAL)-for asthma management. Nanoaggregates were prepared using a novel biocompatible and biodegradable poly(ester amide) based on the amino acid tyrosine, utilising a one-step interfacial polymerisation process. The produced tyrosine poly (ester amide) drug-loaded nanoparticles were evaluated for content uniformity, PSA, FTIR, TEM, DSC, XRD and aerodynamic performance (in vitro and in vivo). The optimised formulation demonstrated high entrapment efficiency- > 90%. The aerodynamic performance in terms of the emitted dose, fine particle fraction and respirable dose was superior to the carrier-based marketed product. In-vivo studies showed that FP (above the marketed formulation) and SAL reached the lungs of mice in a reproducible manner. These results highlight the superiority of novel FDC FP/SAL nanoparticles prepared via a one-step process, which can be used as a cost-effective and efficient method to alleviate the burden of asthma.

Development and Characterization of Transdermal Patches Using Novel Thymoquinone-L-Arginine-Based Polyamide Nanocapsules for Potential Use in the Management of Psoriasis.

Thymoquinone (TQ) is a phytochemical compound present in Nigella sativa and has potential benefits for treating dermatological conditions such as psoriasis. However, its clinical use is limited due to its restricted bioavailability, caused mainly by its low solubility and permeability. To overcome this, a new transdermal drug delivery system is required. Nanoparticles are known to enhance material solubility and permeability, and hence, this study aimed to synthesize TQ-loaded L-arginine-based polyamide (TQ/Arg PA) nanocapsules incorporated into transdermal patches for prolonged delivery of TQ. To achieve this, Eudragit E polymer, plasticizers, and aloe vera as penetration enhancer were used to develop the transdermal patch. Furthermore, novel TQ/Arg-PA was synthesized via interfacial polymerization, and the resultant nanocapsules (NCs) were incorporated into the matrix transdermal patch. The Arg-PA NCs' structure was confirmed via NMR and FTIR, and optimal TQ/Arg-PA NCs containing formulation showed high entrapment efficiency of TQ (99.60%). Molecular and thermal profiling of TQ/Arg-PA and the transdermal patch revealed the effective development of spherical NCs with an average particle size of 129.23 ± 18.22 nm. Using Franz diffusion cells and synthetic membrane (STRAT M®), the in vitro permeation profile of the prepared patches demonstrated an extended release of TQ over 24 h, with enhanced permeation by 42.64% when aloe vera was employed. In conclusion, the produced formulation has a potential substitute for corticosteroids and other drugs commonly used to treat psoriasis due to its effectiveness, safety, and lack of the side effects typically associated with other drugs.

In vivo and in vitro transdermal availability of Ibuprofen using novel solubility enhancing fluid nanosized carrier systems.

The objective of this study was to explore the benefits of transdermal drug delivery systems as an alternative option for patients who are unable to tolerate oral administration of drugs, such as ibuprofen (IB). To achieve this, nonionic surfactants and three cosolvents were employed to develop new microemulsions (MEs) that contained IB as nanocarriers. The aim was to enhance the solubility and bioavailability of the drug after transdermal administration. The MEs were characterised by droplet size, polydispersity index (PDI), and rheological properties. Furthermore, the flux of IB was evaluated by Franz diffusion cells using excised rat skin and in vivo bioavailability using rats. The results showed that the MEs had ideal viscosity and droplet size below 100 nm. Moreover, using the developed MEs, an improvement in the solubility (170 mg/mL) and flux through the rat skin (94.6 ± 8.0 µg/cm2.h) was achieved. In addition, IB demonstrated a maximum plasma level of 0.064 mg/mL after 8 h of transdermal administration in rats using the ME with an increase in the bioavailability of about 1.5 times in comparison to the commercial IB gel. In conclusion, the developed nonionic MEs containing IB can be ideal nanocarriers and promising formulations for the transdermal administration of IB.

Four years after the implementation of antimicrobial stewardship program in Jordan: evaluation of program's core elements.

Objectives: To combat antimicrobial resistance, the World Health Organization (WHO) urged healthcare organizations in Low- and Middle-Income Countries (LMICs) to implement the core elements of the antimicrobial stewardship (AMS) programs. In response, Jordan took action and developed a national antimicrobial resistance action plan (NAP) in 2017 and commenced the AMS program in all healthcare facilities. It is paramount to evaluate the efforts to implement the AMS programs and understand the challenges of implementing a sustainable and effective program, in Low-Middle Income Country (LMIC) contexts. Therefore, the aim of this study was to appraise the compliance of public hospitals in Jordan to the WHO core elements of effective AMS programs after 4 years of commencement. Methods: A cross-sectional study in public hospitals in Jordan, using the WHO AMS program core elements for LMICs was carried out. The questionnaire comprised 30 questions that covered the program's six core elements: leadership commitment, accountability and responsibility, AMS actions, education and training, monitoring, and evaluation, and reporting and feedback. A five-point Likert scale was employed for each question. Results: A total of 27 public hospitals participated, with a response rate of 84.4%. Adherence to core elements ranged from (53%) in the leadership commitment domain to (72%) for AMS procedure application (actions). Based on the mean score, there was no significant difference between hospitals according to location, size, and specialty. The most neglected core elements that emerged as top priority areas were the provision of financial support, collaboration, access, as well as monitoring and evaluation. Conclusion: The current results revealed significant shortcomings in the AMS program in public hospitals despite 4 years of implementation and policy support. Most of the core elements of the AMS program were below average, which requires hospital leadership commitment, and multifaceted collaborative actions from the concerned stakeholders in Jordan.

Upholding Quality and Patient Safety during COVID-19 Pandemic-A Jordanian Case Study.

BACKGROUND: The advent of the COVID-19 pandemic caused a rapid increase in demand for healthcare services over a prolonged period, and the hospital emergency preparedness system has been essential. Therefore, this study aimed to explore Jordanian hospitals' response to emergency situations and examine the underlying role and effect of accreditation programs as a "Quality and Patient Safety" tool to deal with emergency situations during the pandemic. METHODS: An online survey for a cross-sectional study was conducted in Jordan between 1 March and 30 May 2022, to examine the opinions of hospitals' top, senior, and middle managers using a validated questionnaire. RESULTS: A total of 200 healthcare providers from 30 hospitals participated in the study. From the areas within accreditation standards that were investigated, capacity building on emergency preparedness and communication abilities received the least scores (2.46 and 2.48, respectively). Additionally, hospitals with mature quality and patient safety culture (>3 accreditation cycles) demonstrated a statistically significant difference in score in two domains-emergency preparedness (p = 0.027) and infection prevention and control (p = 0.024). CONCLUSIONS: During outbreaks, hospitals that are required to comply with accreditation standards that address all emergency preparedness aspects will fare better in quality performance.

Assessment of Hospital Readiness to Respond to COVID-19 Pandemic in Jordan-A Cross Sectional Study.

During the global COVID-19 pandemic, hospitals faced tremendous pressure to cope with the emergency preparedness situations needed to cater for the influx of patients while maintaining their essential services. This study aimed to assess the level of readiness of hospitals in Jordan to respond to the COVID-19 pandemic using the WHO hospital readiness checklist. A cross-sectional survey using the modified and validated checklist was conducted in Jordan between 15 May and 15 June 2021. The checklist entailed ten key response functions with a total of 60 activities. Data from 22 hospitals were collected through a structured survey process by two surveyors for each hospital. The overall readiness score of hospitals was 1.77 ± 0.20, with a lower overall score in the northern region (1.65 ± 0.24) than the middle (1.86 ± 0.07) or southern (1.84 ± 0.14) regions. The diagnosis response function scored highest (1.95); but despite efforts, contingency plan development was not met by most hospitals, with a total score ≤ 1.45. Provision of psychological support and occupational health support to ensure the wellbeing of staff scored below average. Outcomes from this survey exposed gaps while offering a framework for upcoming endeavors to improve hospital readiness for any potential pandemic.

Taste Masking of Promethazine Hydrochloride Using l-Arginine Polyamide-Based Nanocapsules.

Promethazine hydrochloride (PMZ), a potent H1-histamine blocker widely used to prevent motion sickness, dizziness, nausea, and vomiting, has a bitter taste. In the present study, taste masked PMZ nanocapsules (NCs) were prepared using an interfacial polycondensation technique. A one-step approach was used to expedite the synthesis of NCs made from a biocompatible and biodegradable polyamide based on l-arginine. The produced NCs had an average particle size of 193.63 ± 39.1 nm and a zeta potential of −31.7 ± 1.25 mV, indicating their stability. The NCs were characterized using differential scanning calorimetric analysis and X-ray diffraction, as well as transmission electron microscopy that demonstrated the formation of the NCs and the incorporation of PMZ within the polymer. The in vitro release study of the PMZ-loaded NCs displayed a 0.91 ± 0.02% release of PMZ after 10 min using artificial saliva as the dissolution media, indicating excellent taste masked particles. The in vivo study using mice revealed that the amount of fluid consumed by the PMZ-NCs group was significantly higher than that consumed by the free PMZ group (p < 0.05). This study confirmed that NCs using polyamides based on l-arginine and interfacial polycondensation can serve as a good platform for the effective taste masking of bitter actives.

Dermal and Transdermal Macromolecule Delivery Using Enhancer Molecules and Colloidal Carrier Systems - Part 2: Percutaneous Administration of Heparin.

INTRODUCTION: Heparin is a commonly used anti-coagulant administered either by intravenous or subcutaneous injection for a systemic effect or topically for the treatment of peripheral vascular disorders. OBJECTIVE: This study aimed to formulate heparin in non-ionic colloidal carrier systems (CCSs) having enhanced percutaneous absorption for systemic and topical administration. METHODS: Five CCSs were developed and characterized for their rheological properties, droplet size, and drug loading. The percutaneous absorption of heparin was evaluated in vitro using Franz diffusion cells with rats' skin and with the aid of a developed high-pressure chromatography method. Furthermore, the efficacy of two developed heparin CCSs was tested percutaneously in rats by measuring the response against the time in comparison to subcutaneous administration. RESULTS: The rheograms and droplet size measurements showed that the developed drug delivery systems have Newtonian properties with a droplet size between 109 and 460 nm. As much as 500 mg of heparin could be loaded in around 5 mL of CCS. Furthermore, using Franz diffusion cells, a diffusion rate of 19.216 ± 2.01 USP U/cm2.h could be achieved for heparin-loaded CCSs. Moreover, the estimated percutaneous in vivo relative bioavailability in comparison to subcutaneous administration could reflect that at least more than 50% of the drug passed through the skin. CONCLUSION: The developed novel non-toxic CCSs containing heparin can be good candidates for percutaneous administration as alternative delivery systems for subcutaneous and intravenous invasive administration.

Mechanistic modelling of targeted pulmonary delivery of dactinomycin iron oxide-loaded nanoparticles for lung cancer therapy.

With the increase in respiratory conditions including lung cancer post covid-19 pandemic, drug-loaded nanoparticulate dry powder inhalers (DPIs) can facilitate targeted lung delivery as a patient-friendly, non-invasive method. The aim of this work was to synthesise and optimise iron oxide nanoparticles (IONPs) containing dactinomycin as a model drug, using Quality by Design principles. Chitosan and sodium alginate were investigated as polymeric coatings. The mass median aerodynamic diameter (MMAD), fine particle fraction (FPF), burst-effect (BE), entrapment-efficiency and the emitted-dose (ED) were investigated in initial screening studies and outcomes used to set up a Design of Experiments. Results revealed that chitosan IONPs were superior to that of sodium alginate in delivering DPI with optimal properties [ED (89.9%), FPF (59.7%), MMAD (1.59 µm) and BE (12.7%)]. Design space for targeted IONPs included formulations containing 2.1-2.5% dactinomycin and 0.5-0.9% chitosan. Differential scanning calorimetry and X-ray diffraction and SEM-EDS analysis revealed effective formation of IONPs, and TEM images revealed the production of spherical IONPs with particle size of 4.4 ± 0.77 nm. This work overcame the light sensitivity of dactinomycin to potentially target the high molecular weight drugs to the lungs, with controlled delivery based on a reduced burst effect.

Trends in Hospital Admissions for Mental, Behavioural and Neurodevelopmental Disorders in England and Wales between 1999 and 2019: An Ecological Study.

Objectives: To investigate the trends in hospital admissions for mental, behavioural and neurodevelopmental disorders (MBNDs) in England and Wales. Methods: This is an ecological study using the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admission data was collected for the period between April 1999 and March 2019. Results: The most common type of hospital admission was for mental and behavioural disorders due to psychoactive substance use, which accounted for 26.6%. The admission rate among males increased by 8.1% [from 479.59 (95% CI 476.90−482.27) in 1999 to 518.30 (95% CI 515.71−520.90) in 2019 per 1000 persons; p < 0.001]. The admission rate among females increased by 0.3% [from 451.45 (95% CI 448.91−453.99) in 1999 to 452.77 (95% CI 450.37−455.17) in 2019 per 1000 persons; p = 0.547]. The 15−59 years' age group accounted for 65.1% of the entire number of such hospital admissions, followed by the 75 years and above age group, with 19.0%. Conclusion: We observed an obvious variation in MBNDs influenced by age and gender. Observational studies are needed to identify other factors associated with increased hospital admission rates related to MBNDs, specifically among the young population (aged 15−59 years) and males.

Assessment of vaping devices as an alternative respiratory drug delivery system.

The respiratory system has generated significant interest as an alternative drug delivery route. However, because of the limitations encountered with the present inhalation devices, alternative options could present an ideal opportunity to enhance therapeutic effectiveness and patient compliance. Vaping devices have been extensively used to deliver nicotine. This manuscript aimed to conduct an in vitro evaluation of the performance of commonly used vaping devices to assess their effectiveness in delivering fluticasone propionate (FP) to the lungs. Vaping devices were assessed for aerodynamic performance using the NGI. The e-liquid containing FP was made using glycerin and propylene glycol. The results showed the superiority of the vape-tank and vape-coil over the vape-pod. The vape-tank delivered the highest amount of nicotine. The e-liquid containing the FP was assessed and the results were compared with a marketed FP pressurized metered-dose inhaler (pMDI). The results of the respirable dose (RD) ranged from 22.10 µg for the vape pod, to 50.38 µg for the vape-tank; whereas the marketed pMDI value was 44.54 µg despite the lower content of FP per actuation in the vaping devices (100 µg versus 125 µg). Interestingly, the vaping devices showed a significantly lower level of oropharyngeal deposition than the pMDI (10% versus 50%), and hence, the potential for fewer side effects than those encountered with the chronic use of inhalers. Despite the effectiveness of the vape tank and coil in delivering a high percentage of FP, which makes them a promising alternative for delivering an effective yet user-friendly dosage of respiratory drugs, their safety and toxicity need to be established.

An Ecological Analysis of Hospitalization Patterns for Diseases of the Nervous System in England and Wales over the Last 20 Years.

Objectives: This study aims to provide a comprehensive overview of the hospitalization pattern of nervous system diseases from 1999 to 2019. Methods: This is ecological research based on data from the Hospital Episode Statistics database in England and the Patient Episode Database in Wales, both of which are publicly available. Data on hospital admissions were collected between April 1999 and March 2019. Diagnostic codes (G00−G09: inflammatory diseases of the central nervous system, G10−G14: systemic atrophies primarily affecting the central nervous system, G20−G26: extrapyramidal and movement disorders, G30−G32: other degenerative diseases of the nervous system, G35−G37: demyelinating diseases of the central nervous system, G40−G47: episodic and paroxysmal disorders, G50−G59: nerve, nerve root and plexus disorders, G60−G65: polyneuropathies and other disorders of the peripheral nervous system, G70−G73: diseases of myoneural junction and muscle, G80−G83: cerebral palsy and other paralytic syndromes, and G89−G99: other disorders of the nervous system) from the tenth edition of the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) were used to identify hospital admissions. A Poisson model was used to examine the trend in hospital admissions. Results: During the study period, hospital admission rate increased by 73.5% (from 474.44 (95% CI 472.58−476.31) in 1999 to 823.37 (95% CI 821.07−825.66) in 2019 per 100,000 persons, trend test, p < 0.01). The most prevalent diseases of the nervous system hospital admissions causes were episodic and paroxysmal disorders, nerve, nerve root, and plexus disorders, and demyelinating diseases of the central nervous system which accounted for 37.4%, 22.1%, and 9.3%, respectively. Hospital admission rate between females increased by 79.1% (from 495.92 (95% CI 493.25−498.58) in 1999 to 888.33 (95% CI 884.97−891.68) in 2019 per 100,000 persons). Hospital admission rate between males was increased by 67.5% (from 451.88 (95% CI 449.28−454.49) in 1999 to 756.82 (95% CI 753.69−759.96) in 2019 per 100,000 persons). Conclusion: In the United Kingdom, hospital admissions for diseases of the nervous system are on the rise. Future research is needed to identify high-risk groups and suggest effective interventions to reduce the prevalence of these disorders.

Novel Fluticasone Propionate and Salmeterol Fixed-Dose Combination Nano-Encapsulated Particles Using Polyamide Based on L-Lysine.

One of the key challenges in developing a dry powder inhaler (DPI) of an inhalable potent fixed-dose combination (FDC) is the ability of the formulation to generate an effective and reproducible aerosol able to reach the lower parts of the lungs. Herein, a one-step approach is presented to expedite the synthesis of nanoaggregates made from a biocompatible and biodegradable polyamide based on L-lysine amino acid employing market-leading active pharmaceutical ingredients (fluticasone propionate (FP) and salmeterol xinafoate (SAL)) for the management of asthma. The nanoaggregates were synthesized using interfacial polycondensation that produced nanocapsules with an average particle size of 226.7 ± 35.3 nm and zeta potential of -30.6 ± 4.2 mV. Differential scanning calorimetric analysis and x-ray diffraction, as well as scanning electron microscopy of the produced FDC, revealed the ability of the produced nanocapsules to encapsulate the two actives and display the best aerodynamic performance. The FDC nanocapsules displayed 88.5% and 98.5% of the emitted dose for FP and SAL, respectively. The fine particle fraction of the nominated dose was superior to the marketed product (Seretide Diskus®, Brentford, United Kingdom). The in-vitro release study showed an extended drug release profile. Our findings suggest that nanoaggregates using polyamides based on L-lysine and interfacial polycondensation can serve as a good platform for pulmonary drug delivery of FDC systems.

Novel Thymoquinone Nanoparticles Using Poly(ester amide) Based on L-Arginine-Targeting Pulmonary Drug Delivery.

Thymoquinone (TQ), the main active constituent of Nigella sativa, has demonstrated broad-spectrum antimicrobial, antioxidant, and anti-inflammatory effects, which suggest its potential use in secondary infections caused by COVID-19. However, clinical deployment has been hindered due to its limited aqueous solubility and poor bioavailability. Therefore, a targeted delivery system to the lungs using nanotechnology is needed to overcome limitations encountered with TQ. In this project, a novel TQ-loaded poly(ester amide) based on L-arginine nanoparticles was prepared using the interfacial polycondensation method for a dry powder inhaler targeting delivery of TQ to the lungs. The nanoparticles were characterized by FTIR and NMR to confirm the structure. Transmission electron microscopy and Zetasizer results confirmed the particle diameter of 52 nm. The high-dose formulation showed the entrapment efficiency and loading capacity values of TQ to be 99.77% and 35.56%, respectively. An XRD study proved that TQ did not change its crystallinity, which was further confirmed by the DSC study. Optimized nanoparticles were evaluated for their in vitro aerodynamic performance, which demonstrated an effective delivery of 22.7-23.7% of the nominal dose into the lower parts of the lungs. The high drug-targeting potential and efficiency demonstrates the significant role of the TQ nanoparticles for potential application in COVID-19 and other respiratory conditions.

Correction: Naser et al. Knowledge and Practices during the COVID-19 Outbreak in the Middle East: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2021, 18, 4699.

The authors would like to make the following corrections about the published paper [...].

In Vitro Assessment of Sunscreen Efficacy Using Fourier Transform Infrared (FTIR) Spectroscopy on Synthetic Skin.

Although there are several methods for assessing the sun protection factor (SPF) of sunscreen products, there is no standard and reliable in vitro method. Each test entails limitations and drawbacks. Therefore, this study aimed to assess the employability of FTIR as an alternative and quick method to evaluate the efficacy of various sunscreen formulations, their concentrations, and the timing of their application. Infrared radiation has longer wavelengths than ultraviolet, penetrates deeply into the skin, and hence enables the understanding of sunscreens' ability to block the transmission of radiation. The FTIR transmission using synthetic skin to study the effect of sunscreen agents (oxybenzone, octyl methoxycinnamate, titanium dioxide (TiO2), and zinc oxide (ZnO)) was conducted in the range 450-4000cm-1. Comparison studies were made at the peak of 805cm-1. After 2 h of sunscreen application, using the maximum concentrations, the FTIR peak at wavenumber 805cm-1 demonstrated a significant reduction of transmission from 96.55 to 60.09%, 57.59%, 32.02%, and 37.1% for oxybenzone, octyl methoxycinnamate, TiO2, and ZnO respectively (P<0.05). A significant reduction in transmission was observed (P<0.05) with increasing sunscreen concentrations after 2 h of application. Nevertheless, the upper limit of concentration showed no appreciable change from the middle level of concentration, and hence it is cost-effective to employ the middle concentration. Inorganic sunscreens showed a higher protection level than organic. Fixed-dose combinations of sunscreens showed an enhanced effect yet were not synergistic. In conclusion, the use of FTIR spectroscopy with synthetic skin is a quick and user-friendly technique that enables the assessment of the efficacy of sunscreen formulations.

Cost considerations of dermatological care in Jordan: a cross-sectional study.

BACKGROUND: Physicians play a key role in improving patient adherence, specifically in dermatological care. Expensive medications are associated with poor patient adherence and worsening clinical outcomes. This study aims to explore the cost estimation interest of patients with dermatological conditions, the influence of the cost on their drug use behavior, and cost communication practices by dermatologists. METHOD: A cross-sectional study was conducted between October 2019 and January 2020 in Jordan. Logistic regression was conducted to explore the predictors of patient behavior. RESULTS: A total of 1,022 patients participated in the study. Around 27.7% of them reported that their dermatologist does not discuss the cost of medications with them. About 71.4% reported that it is important for them to receive cost estimates for out of pocket medication costs. Patients with an income of 300 JD to 700 JD were more likely to be interested in cost estimations. Employed patients and males were less likely to be interested in cost estimations (p < 0.05). CONCLUSION: There is a considerable proportion of dermatologists who do not adhere to communicate about cost with their patients. Such communication should be considered necessary with all patients to enhance adherence to their prescribed therapy.

Development of orally dissolving films for pediatric-centric administration of anti-epileptic drug topiramate - A design of experiments (DoE) study.

Children have often been treated as small adults in relation to drug formulation, but research has now shown this not to be the case. Therefore, there is a push from regulatory bodies to provide drug formulations specifically tailored towards the needs of this fragmented population. Orally dissolving films (ODFs) have been identified as an emerging opportunity, to bridge this gap. Therefore, the aim of this study was to prepare ODFs containing topiramate, an antiepileptic drug, using solvent casting method as a potential alternative to oral tablets/powders for paediatrics. For this purpose, a Design of Experiment (DoE) was employed to optimise formulation parameters. 24 formulations were prepared by changing the polymer type (HPMC, Guar-Gum or PEO), concentration (0.4%-1.2%w/v); plasticizer type (glycerol\sorbitol) and concentration (0.1-0.3%w/v). Disintegration time, content-uniformity, film quality and thickness uniformity were the responses. Surface and molecular profiling were conducted on the optimal formulation (N4). TGA and XRD results demonstrated the stability of materials upon production into films, while the SEM images showed smooth films that proved to be resilient due to good mechanical properties. HPMC-glycerine based ODFs are presented as an effective dosage form to enhance the ease of administration and patient compliance of topiramate, specifically for paediatric patients.

Clinical and Therapeutic Characteristics of Cancer Patients in the Southern Region of Saudi Arabia: A Cross-Sectional Study.

AIMS: Due to the continuous changes in modern lifestyle and the need to explore the effect of these changes on the risk of developing cancer, ongoing research on the epidemiology and characteristics of cancer patients is requested. This study explored the epidemiology of cancer, its characteristics, treatment patterns, and risk factors in the southern region of Saudi Arabia. METHODS: A retrospective cross-sectional study was conducted using cancer patients' medical records at Asir Central Hospital in the southern region of Saudi Arabia. Active patients' records were extracted between January 2013 and December 2019. RESULTS: A total of 2038 patients were identified during the study period, with a mean age of 60.9 (SD: 19.0) years. The patients had survived with their cancer for a median duration of 4 years (IQR: 2-6). Around 4.6% of the patients required ICU admission with a median period of 9 days (IQR: 5-14.75). The death rate during the study period was 10.9%. Around 20.8% of the cases were metastatic, of which 77.8% were at stage four of metastasis, and 19.7% of the patients were receiving chemotherapy for their disease. The most common types of cancer were malignant neoplasms of digestive organs, comprising 40.8% of the sample. Older age (60 years and above) and using specific chronic disease medications were predictors associated with a higher risk of death due to cancer (p < 0.05). Smoking history, using specific chronic disease medications, and having previous surgery were predictors associated with a higher risk of ICU admission (p < 0.05). CONCLUSION: Breast, colon, and liver cancers were the most prevalent in the southern region of Saudi Arabia. Several modifiable cancer risk factors were identified. The results of this study should support decision-makers in the initiation of programs for key modifiable risk factors that enhance lifestyle changes and reduce cancer risks.

Depression and Anxiety in Patients With Cancer: A Cross-Sectional Study.

OBJECTIVES: Depression and anxiety persist in cancer patients, creating an additional burden during treatment and making it more challenging in terms of management and control. Studies on the prevalence of depression and anxiety among cancer patients in the Middle East are limited and include many limitations such as their small sample sizes and restriction to a specific type of cancer in specific clinical settings. This study aimed to describe the prevalence and risk factors of depression and anxiety among cancer patients in the inpatient and outpatient settings. MATERIALS AND METHODS: A total of 1,011 patients (399 inpatients and 612 outpatients) formed the study sample. Patients' psychological status was assessed using the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder 7-item (GAD-7) scale. The prevalence rate of depressive and anxious symptomatology was estimated by dividing the number of patients who exceeded the borderline score: 10 or more for each subscale of the HADS scale, 15 or more for the GAD-7 scale, and 15 or more in the PHQ-9 by the total number of the patients. Risk factors were identified using logistic regression. RESULTS: The prevalence of depressive and anxious symptomatology among all patients was 23.4% and 19.1-19.9%, respectively. Depressive symptomatology was more prevalent across patients who were hospitalized (37.1%) compared with patients in the outpatient setting (14.5%) (p < 0.001). Similarly, anxious symptomatology was more prevalent in the inpatient setting (p < 0.001). In the inpatient setting, depressive symptomatology was more prevalent among patients with bladder cancer, while severe anxious symptomatology was more prevalent across patients with lung cancer. In the outpatient setting, depressive and anxious symptomatology was more prevalent among breast and prostate cancer patients, respectively. Despite that, around 42.7% and 24.8% of the patients, respectively, reported that they feel anxious and depressed, and only 15.5% of them were using medications to manage their conditions. CONCLUSION: Our study findings demonstrated a higher prevalence of depressive and anxious symptomatology in the inpatient setting and advanced disease stages. In addition, the underutilization of antidepressant therapy was observed. There is a need to consider mental disorders as part of the treatment protocol for cancer patients. Enhanced clinical monitoring and treatment of depression and anxiety of cancer patients are required.