Utilization of direct oral anticoagulants in a Saudi tertiary hospital: a retrospective cohort study.

OBJECTIVE: This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital. PATIENTS AND METHODS: Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence. RESULTS: 778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications. CONCLUSIONS: In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs.

Removal of benzene, MTBE and toluene from contaminated waters using biochar-based liquid activated carbon.

Fuel components such as benzene, toluene, and methyl tertiary-butyl ether (MTBE) are frequently detected pollutants in groundwater resources. Ex-situ remediation technologies by activated carbon have been used for treatment for many years. However, due to high cost of these technology, more attention has been given to the in-situ remediation methods of contaminated groundwaters using liquid carbon adsorbents. Literature search showed limited studies on using adsorbents in liquid form for the removal of such contaminants. Therefore, this lab-scale study investigates the capacity of using raw biochar-based liquid activated carbon and iron-modified biochar-based liquid activated carbon to remove these pollutants. The adsorption efficiency of the synthesized liquid activated carbon and iron-modified liquid activated carbon mixed with sand, limestone, and 1:1 mixture of sand/limestone, was tested using batch suspension experiments. Adsorption by granular activated carbon was also investigated for comparison with liquid activated carbon. Results of the study revealed that mixing of liquid activated carbon or LAC-Fe on subsurface materials had not improved the removal efficiency of MTBE. At the same time, it showed a slight improvement in the adsorption efficiency of benzene and toluene. In all cases, the removal by GAC was higher with around 80% and 90% for MTBE and BT, respectively. Results also showed that benzene and toluene were better removed by liquid activated carbon and iron-modified liquid activated carbon (∼ 40%) than MTBE (∼ 20%). It is also found that water chemistry (i.e., salinity and pH) had insignificant effects on the removal efficiency of pollutants under the study conditions. It can be concluded that more research is needed to improve the capacity of biochar-based liquid-activated carbon in removing MTBE, benzene and toluene compounds that will lead to improve the utilization of liquid activated carbon for the in-situ remediation of contaminated groundwaters.

The correlation of maxillomandibular advancement and airway volume change in obstructive sleep apnea using cone beam computed tomography.

The purpose of this retrospective study was to evaluate the correlation of maxillomandibular advancement (MMA) and airway volume changes in patients with obstructive sleep apnea (OSA), and to determine the surgical skeletal movements necessary to achieve an increase in total airway volume (TAV) of ≥70%. Thirty patients with OSA treated by MMA were evaluated. Pre- and postoperative cone beam computed tomography images were used to determine the horizontal distance and angular changes in surgical parameters and linear, area, and volumetric airway parameters. Postoperatively, the horizontal distance of surgical parameters (A-point, UI, B-point, pogonion, and menton) and craniofacial angulation (SNA and SNB) increased significantly, similar to total surface area, TAV, and minimum cross-sectional area of the airway (p<0.0001). The total airway length decreased significantly (p<0.0001). The mean increase in TAV was 67.2%. There were positive correlations between linear surgical changes and the percentage change in TAV. All surgical parameters were predictive of a change in TAV ≥70%. The optimal surgical change was 6mm for A-point, 7.9mm for UI, 7.6mm for B-point, 11.2mm for pogonion, and 10mm for menton. In conclusion, maxillary advancement of less than 10mm was adequate in this study to obtain an increase in the TAV of at least 70%.