Prevalence of depression among diabetic patients attending the Armed Forces Hospital, Southern Region, Saudi Arabia: A prospective cross-sectional study.

Background: Depression associated with diabetes is one of major obstacles in diabetic patient management. This study aims to determine the prevalence of depression and its associated risk factors among diabetic patients of both types (I and II). Materials and Methods: A cross-sectional analytical study was conducted at Armed Forces Hospital, Southern Region, Kingdom of Saudi Arabia, among adult diabetic patients attending the diabetic center. An interview-validated questionnaire was utilized to collect data. It consists of three main parts: demographic data, diabetic assessment tool, and patient health questionnaire-9. Results: A total of 386 diabetic patients were included. The age of them ranged between 17 and 95 years with an arithmetic mean of 53.4 years and a standard deviation of ± 18.2 years. Almost two-thirds (62.2%) were males. The prevalence of depression among diabetic patients was 48.2%, mostly of mild (31.4%) or moderate severity (12.7%). Multivariate logistic regression analysis revealed that female diabetic patients were at almost double-fold risk of developing depression compared to males [adjusted odds ratio (AOR) =2.73, 95% confidence interval (CI): 1.70-4.38], P < 0.001. Also, type II diabetic patients were at almost double-fold risk of developing depression compared to type I diabetic patients (AOR = 2.07, 95% CI: 1.16-3.67), P = 0.013. Patients with history of any social issue with the family, relatives, or friends were at about three-fold risk of developing depression compared to those without such history (AOR = 3.45, 95% CI: 2.11-5.66), P < 0.001. Patients who reported compliance to diet were at higher risk for developing depression compared to their peers (AOR = 2.57, 95% CI: 1.25-5.28), P = 0.010, while those compliant to physical activity about 150 min/week or more were at significant lower risk to develop depression (AOR = 0.56, 95% CI: 0.35-0.89), P = 0.015. Patients with nephropathy or neuropathy were more likely to have depression compared to their counterparts (AOR = 2.52. 95% CI: 1.33-4.80, P = 0.005 and AOR = 1.80, 95% CI: 1.11-2.90, P = 0.016, respectively). Conclusion: Depression is a very prevalent problem affecting diabetic patients, particularly those of type II, female patients, and those with nephropathy or neuropathy. Therefore, regular screening of diabetic patients for depression and referral of severe cases to psychiatric care are highly warranted.

Long-term outcomes of cyclophotocoagulation in refractory pediatric glaucoma: treatment response and success in 262 eyes.

PURPOSE: To report the surgical success and response to treatment for children undergoing cyclophotocoagulation (CPC) for refractory pediatric glaucoma. METHODS: The medical records of children with a diagnosis of glaucoma who underwent a first CPC between May 2000 and May 2020 were reviewed retrospectively. The cumulative probability of success was assessed. For definition 1, treatment success was defined as IOP ≤21 mm Hg at all the visits after the first 3 months without the need for additional glaucoma surgery or repeat CPC. For definition 2, repeat CPC did not constitute failure. RESULTS: Of 300 eyes that underwent CPC, we identified 262 eyes eligible for inclusion. The mean age at time of first treatment was 5.33 ± 5.03 years, with a mean follow-up of 4.3 ± 4.2 years (31 eyes having at least 10 years of follow-up). The success rates for definitions 1 and 2 were 26.7% (95% CI, 21.7%-32.4%) and 46.2% (95% CI, 40.2%-52.3%), respectively. Older age was associated with a lower risk of failure after both single CPC (HR, 0.92; 95% CI, 0.88-0.96; P < 0.001) and multiple CPCs (HR, 0.95; 95% CI, 0.90-1.00, P = 0.073). Of the 262 eyes, 107 (41%) had sustained IOP-lowering with a single treatment and 56 (21%) with multiple treatments; 35 (13%) had a transient response, and 64 (24%) had no response. CONCLUSIONS: Glaucoma control through CPC often requires multiple treatments, with around a quarter of children responding suboptimally. Older children are more likely to exhibit successful IOP lowering.

Chemoprofiling and antimicrobial activity of medicinal herbs used in the treatment of inflammatory bowel disease.

Inflammatory bowel disease (IBD) is a term utilized to illustrate two different chronic disorders of the gastro-intestinal tract i.e., Crohn's disease and ulcerative colitis. The symptoms of IBD are mainly characterized by inflammation, including abdominal pain, chronic diarrhoea, weight loss, shortening of the colon and rectal bleeding. The objective of this study was to evaluate the antimicrobial activity and Gas Chromatography-Mass Spectrometry (GC-MS) analysis of herbs used in the treatment of IBD in Saudi Arabia. Ethanolic extracts of five different herbs from Saudi Arabia namely Pimpinella anisum (Anise), Foeniculum vulgare (Fennel), Matricaria chamomilla (Chamomile), Linum usitatissimum (Linseed), and Punica granatum (Pomegranate) were prepared by Soxhlet extraction. The systemic chemical composition of the extracts was identified by GC-MS with their relative concentrations. The ethanolic extract of P. anisum, F. vulgare, M. chamomilla, L. usitatissimum, and P. granatum showed the presence of 35, 42, 34, 37, and 47 chemical components in these extracts, respectively. The five extracts and an equal mixture of them were examined for their antimicrobial activity by broth dilution method against different organisms. These included Gram-positive (Staphylococcus aureus), Gram-negative (Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Pseudomonas aeruginosa) bacteria and one yeast (Candida albicans). P. anisum, F. vulgare, M. chamomilla, L. usitatissimum, P. granatum and the mixture of all five extracts had good activity against E. coli (MIC=3.125, 0.050, 6.25, 0.050 and 0.100 mg/ml, respectively). P. granatum also had a MIC of 3.125 mg/ml against S. aureus. In conclusion. the plants' extracts and an equal mixture of them showed a narrow spectrum of antimicrobial activity against S. aureus, K. pneumoniae, P. mirabilis, P. aeruginosa and C. albicans.

Emerging trends: the involvement of community pharmacists in the planning and execution of pharmaceutical policies and economics.

INTRODUCTION: The aim of this study was to analyze existing research on the involvement of community pharmacists in the planning and execution of pharmaceutical policies and economic strategies. METHODS: The researcher searched five scholarly databases: Medline, BioMed Central (BMC), Excerpta Medica Database (EMBASE), ProQuest, and PubMed for the reviewed articles. The search and selection of the articles involved searching each of the databases using specific keywords and a combination of them to form phrases and the Boolean search string. The researcher adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in developing this study. RESULTS: From the original search, a total of 537 articles emerged from which 17 articles remained upon screening. Findings show that the community pharmacy role has expanded over the past years to enable pharmacists serve diverse roles, but there is a high lack of involvement of these stakeholders in the planning and execution of policies. The pharmaceutical and health-care sectors operate in a way that does not recognize nor engage community pharmacists sufficiently in the policy planning and execution. CONCLUSIONS: Relevant stakeholders need to create an enabling and supportive environment for utilizing the abilities, knowledge, and skills of community pharmacists in policy planning and execution.

The Impact of Diabetes Mellitus Duration and Complications on Health-Related Quality of Life Among Type 2 Diabetic Patients in Khamis Mushit City, Saudi Arabia.

BACKGROUND AND OBJECTIVES:  Diabetes mellitus is one of the most significant public health problems in Saudi Arabia. Therefore, this study aims to investigate the impact of disease duration and disease complications on health-related quality of life among type 2 diabetic patients. MATERIALS AND METHODS: A cross-sectional study was conducted on 380 adult diabetic type 2 patients at a tertiary hospital in the city of Khamis Mushit in Saudi Arabia. The participants were asked to complete a pre-validated health status questionnaire (SF-36) consisting of 36 questions measuring eight domains of health, with each domain providing a score from 0 to 100. Demographic and clinical variables were collected using a diabetes type 2 specification form designed to be used in conjunction with the health status questionnaire. The clinical data included variables such as duration of diabetes, co-morbidities, and treatment modality. Statistical analysis was conducted using SPSS version 22 (IBM Corp., Armonk, NY, USA), with differences tested using various statistical tests. Spearman correlation was done between the score and continuous variables, such as age and BMI. A p-value less than 0.05 was considered statistically significant. RESULTS: Most of the participants (40%) were recently diagnosed with diabetes mellitus (less than one year ago) and 29.5% of the participants were diagnosed with diabetes mellitus within one to five years. The percentage of those with complications was 39.2%, which was mainly diabetic foot (43.4%) followed by nephropathy (29.5%). 46.8% of the participants were admitted due to conditions related to diabetes mellitus. Dietary modifications were prescribed in 38.4% of the participants, 19.5% used non-insulin medications only, 22.6% were on insulin, and 19.5% were using oral medications and insulin. The relationship between diabetes mellitus complications and quality of life domains revealed no significant difference in most of the domains except physical function and general health, which were lower with complicated diabetes melitus. Similarly, the relation between diabetes mellitus duration and quality of life domains was also not significant in all domains except physical function, which was low with a duration of more than 10 years. CONCLUSIONS: Understandably, the complications associated with diabetes melitus resulted in low quality of life - in terms of physical function and general health - due to the organ-dysfunction associated with poor glycaemic control. Similarly, disease duration greater than 10 years resulted in impaired physical functioning.

Is triple antithrombotic therapy a safe option in patients with AF who receive drug-eluting stents?: a review article.

BACKGROUND: Optimal antithrombotic therapy depicts a challenge to clinicians treating atrial fibrillation (AF) patients who are undergoing percutaneous coronary intervention (PCI). Theoretically, these patients would require a combination therapy of oral anticoagulant and dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor, known as triple antithrombotic therapy (TAT). However, TAT is known to carry a significant risk of bleeding. The purpose of the present paper is to provide a focused review of the evidence about the safety of TAT as well as to address contemporary directions regarding antithrombotic therapy following PCI in patients with AF who received a drug-eluting stent. MAIN BODY: Novel oral anticoagulant studies consistently demonstrated a better safety profile when compared to Vitamin K antagonist (warfarin), especially in AF patients who have other indications of DAPT after PCI. Evidence from several studies showed that the use of TAT in AF patients undergoing stent implantation or PCI has no significant clinical benefit with more risk of major bleeding when compared to DAT. Therefore, the current recommendations for AF have taken into account the mounting evidence of antithrombotic treatment after PCI in AF patients, which has caused a major shift away from the TAT strategy toward DAT over time. CONCLUSIONS: Cardiologists face challenges in determining the best antithrombotic treatment for AF patients after PCI with DES implantation. Growing data suggest that TAT is associated with considerable bleeding and worse safety, without significant effectiveness. Hence, TAT is strictly applied for individuals with significant thrombotic risk and low bleeding risk, and for a limited duration. This paper highlights the safety concerns of TAT and current trends in antithrombotic therapy after PCI in patients with AF and DES.

Generic Substitutions and Therapeutic Interchanges in Hospital Pharmacies: A Qualitative Study from Western Saudi Arabia.

Background: The aim of the present study was to understand hospital pharmacists' views and practices regarding generic substitution and therapeutic interchange. Method: This was a qualitative study involving pharmacists from three Western Saudi governorates: Taif, Makkah, and Jeddah. It included respondents from the Ministry of Health (MoH), military and private hospitals. Pharmacists were selected using a convenient sampling technique and data were collected using a structured face-to-face interview. Results: Fifty-seven pharmacists agreed to participate in this study. In MoH and private hospitals, generic substitution is a pharmacist-initiated act, while therapeutic interchange requires physician approval. Medication unavailability, side effects, patient characteristics, outcomes, and economic status justified most substitution decisions. In military hospitals, both types of substitutions are controlled by an auto-switch policy and physicians should be informed. In all hospitals, there are policies regulating substitution. Medications eligible for interchange mentioned by pharmacists from different hospitals were comparable to some extent. Pharmacists from the private sector considered substitution a supportive economic measure for both hospitals and patients. Most pharmacists highlighted that patient convenience and physician approval are the most challenging situations in substitution practice. Conclusions: An enhanced understanding of substitution and knowledge about medications included in the hospital formulary will be valuable support to the implementation of substitution practice which responds to the patients' needs to improve their outcomes.

Metabolic and renal outcomes of empagliflozin in patients with type 2 diabetes mellitus attending Armed Forces Hospital in Saudi Arabia: Retrospective cohort study.

OBJECTIVES: To explore the effects of empagliflozin (25 mg) on metabolic and renal parameters in patients with type 2 diabetes mellitus (T2DM). METHODS: This retrospective observational comparative study was conducted at a military hospital in southern Saudi Arabia. All adults (aged >18 years) with T2DM who attended diabetic clinics between October 2021 to March 2022 (6 months), with or without insulin treatment, were eligible for inclusion in the study. RESULTS: Following the initiation of empagliflozin treatment, statistically significant reductions in patient weight (kg) were observed at 1, 3-5, and 6 months. In addition, low-density lipoprotein levels significantly decreased 3-5 months post-treatment initiation (p=0.011). However, serum creatinine level decreased gradually with time during the treatment with empagliflozin, from 87.45±31.78 (0.105) to 78.39±27.43 (0.033). Furthermore, after empagliflozin treatment, the urinary albumin-to-creatinine ratio significantly decreased at 3-5 and 6 months. Moreover, HbA1c levels exhibited statistically significant decreases at 3-5 months (p<0.001) and at 6 months (p<0.001) following the initiation of empagliflozin treatment. Notably, systolic and diastolic blood pressure significantly reduced 6 months after empagliflozin treatment. CONCLUSION: In the current study, empagliflozin has demonstrated efficacy in controlling blood pressure and body weight, and improving renal function, short-term dyslipidemia, and glycemic control in patients with T2DM.

Healthcare professionals' awareness, attitudes and practices towards pharmacovigilance and spontaneous adverse drug reaction reporting in Jazan Province, Saudi Arabia: A survey study.

Background: Globally, adverse drug reactions (ADRs) are the foremost cause of morbidity as well as mortality. This necessitates a system of surveillance that can effectively and efficiently monitor the effect of drugs on the general population. The role of pharmacovigilance (PV) is paramount in ensuring drug safety through spontaneous ADR reporting. Methods: Data collection in the current research was carried out by an anonymous, online 36-item self-report questionnaire amongst a sample of 351 working healthcare professionals (HCPs) across different regions of Jazan Province, Kingdom of Saudi Arabia (KSA). The current sample comprised 54.4% males and 45.6% females, having an age range of 26-57 years, and was conducted between August 21 and October 21, 2022. Participants were recruited using the convenience snowball sampling technique. Results: The participants' awareness of PV as well as spontaneous ADR reporting, had a significant association with having <40 years of age (χ2 = 27.40; p < 0.001), being pharmacists (χ2 = 212.20; p < 0.001), with more than five years of experience (χ2 = 40.80; p < 0.001), having Masters (or) Doctorate/Fellowship (χ2 = 171.94; p < 0.001), and having their practice located in an urban area (χ2 = 50.30; p < 0.001). It was also observed that most participants with excellent awareness of PV and spontaneous ADR reporting also demonstrated excellent attitudes (χ2 = 147.70; p < 0.001). Similarly, it was also seen that almost all (97%) of the study sample with excellent attitudes towards PV and spontaneous ADR reporting also demonstrated excellent practices (χ2 = 250.73; p < 0.001). Conclusion: Our results demonstrate a need for designing and conducting educational programs, providing training and conducting workshops for all the HCPs to improve their awareness towards PV and spontaneous ADR reporting while also highlighting the need and importance of having positive attitudes towards spontaneous ADR reporting. Cooperation between different HCPs should be encouraged to improve their practices towards spontaneous ADR reporting.

The Relation between Atrial Fibrillation Cardioversion Success Rate with Vitamin D Level in Patients Underwent Elective Cardioversion in King Abdulaziz Cardiac Center, King Abdulaziz Medical City for National Guards, Riyadh Saudi Arabia.

Objectives: To investigate the relation between serum Vitamin D (Vit-D) levels and the success rate of cardioversion for atrial fibrillation (AF). To examine the association between Vit-D level and successful cardioversion. This study also describes the general characteristics of patients with successful cardioversion. Materials and Methods: In this retrospective study, patients with AF who were treated using electrical cardioversion at King Abdulaziz Cardiovascular Center (KACC) between 2010 and 2021 were included. The information on demographic and clinical characteristics as well as outcome variables was collected. Results: Of 100 patients who were admitted to KACC during the study period, 63% were females and 9% were diagnosed with Vit-D deficiency. Furthermore, 66% of patients had successful cardioversion. Moreover, no significant difference in Vit-D deficiency was observed between patients who had successful cardioversion and those with unsuccessful outcomes (P = 0.485). Conclusions: There is no association between serum Vit-D levels and the success rate of cardioversion in patients with AF. However, further studies are needed for more conclusive evidence.

Assessment of the Association Between Use of WhatsApp for Work-Related Purposes and Levels of Depression, Anxiety, and Stress Among Healthcare Workers from Jazan, Saudi Arabia.

Purpose: This study aims to investigate the potential association between use of WhatsApp in healthcare settings for work-related purposes and depression, stress, and anxiety levels among a sample of healthcare workers in Saudi Arabia. Methods: This was a cross-sectional study of healthcare employees working in different hospitals in Jazan. The data was collected via a semi-structured, self-administered questionnaire with three components that measured the demographics of the sample; the presence of depression, anxiety, and stress; and their use of WhatsApp in the work environment. A multivariate regression analysis was carried out to estimate the statistical likelihood of depression, anxiety, and stress as a result of using WhatsApp and how these factors affected occupational and social relationships. Results: A total of 294 healthcare workers participated in the current study. The median age of the participants was 32 years, and the gender distribution was almost even. Over 90% of the participants stated that they were members of work-related WhatsApp groups, and nearly 70% agreed that use of WhatsApp in work-related settings could be stressful. Among the recruited sample, 48.6% exhibited abnormal levels of depression, 55.8% had abnormal levels of anxiety, and 63% showed abnormal levels of stress. The findings of the regression analysis (P values <0.05) indicated that the likelihood of these participants suffering with depression, anxiety, and stress was high, with the participants themselves agreeing that using WhatsApp in work settings could be stressful and affect their relationships with colleagues, friends, and family members. Conclusion: The findings suggests the presence of a potential association between use of WhatsApp for work-related purposes and levels of depression, anxiety, and stress, especially among those who perceive its use as a stressor and influencer on occupational and social relationships.

The expected economic burden on the healthcare system because of quarantining patients with monkeypox virus.

Quarantine is a common public health intervention that is often used to curb pandemics of infectious diseases. Quarantine is the intentional separation of people who are either suspected or confirmed to be infected with a contagious virus from the uninfected population. The goal of this study was to determine the expected economic cost for healthcare systems due to quarantine in the case of the monkeypox virus. A systematic literature review of studies on similar virus outbreaks was performed. The findings affirm that quarantine effectively mitigates the spread of a virus outbreak, but it has high direct and indirect costs that can only be justifiable for a dangerous virus with high mortality. The monkeypox virus presents moderate risk, unlike high-risk diseases for which quarantine is mandatory. The study recommends the introduction of mass vaccination programs and public awareness and sensitization forums to inform the population about the best behavioral practices to curb the spread of monkeypox virus.

Hybrid Thoracic Aortic Repair and Aortic Valve-In-Valve Replacement for Chronic Type A Dissection.

We describe a case of hybrid total thoracic aortic repair and valve-in-valve transcatheter aortic valve replacement in a high-risk patient with complicated chronic type A dissection and severe prosthetic aortic stenosis. The patient underwent a three-stage-procedure including aortic arch debranching, thoracic endovascular aortic repair of the ascending aorta, aortic arch and descending thoracic aorta, and direct aortic valve-in-valve replacement using transcatheter heart valve. The details of the procedures are described with a discussion of the challenges and the decision-making process.

Factors influencing the quality of life of GERD patients in the Aseer Region, Saudi Arabia.

Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder characterized by troublesome symptoms, including heartburn and acid regurgitation. GERD is associated with complications such as peptic stricture, Barrett's esophagus, and esophageal adenocarcinoma, and it negatively affects quality of life (QoL). Aims: To assess the factors influencing the QoL of GERD patients in the Aseer region of Saudi Arabia. Settings and Design: This descriptive cross-sectional study used self-administered questionnaires in a study population of patients aged ≥18 years from Aseer, Saudi Arabia, between January 15, 2023-February 15, 2023. Materials and Methods: A previously validated GERD health-related QoL (GERD-HRQoL) questionnaire was used to assess the patients' sociodemographic data, GERD, and GERD-HRQoL. Statistical Analysis Used: Descriptive analysis included describing the frequency distribution and percentage for study variables, including demographic data, GERD-related QoL symptoms, and QoL, which were graphed. Cross-tabulation presented the distribution of GERD-HRQoL scores by their personal data and other factors using the Pearson Chi-square and exact probability tests. Results: Overall, 502 participants previously diagnosed with GERD completed the questionnaire. Participants' were aged 18-65 years (mean age of 31.5 ± 14.6 years), and 384 (76.5%) were male. The most frequent symptom affecting QoL was heartburn (85.9%), followed by postprandial heartburn (84.3%), heartburn while lying down (82.7%), bloating or gassy feelings (79.9%), and heartburn while standing up (77.3%). Conclusions: Our study showed that patients with GERD had a poor QoL due to GERD-related symptoms, mainly heartburn. Younger age, male sex, and lower educational status were associated with lower GERD-HRQoL scores.

Association of Fine-Needle Aspiration of Thyroid Nodules With Final Histopathology in Diagnosing Thyroid Malignancy: A Single Institute Retrospective Study.

Background Fine needle aspiration cytology (FNAC) is the gold standard for detecting thyroid nodules. It is a cost-efficient approach that affords prompt and accurate evaluation. It is crucial in deciding to treat patients with suspected malignancy of thyroid nodules that might have thyroid surgery. According to findings in cytology, patients may be observed when the cytology is benign, and surgery can be performed if the cytology is malignant, which leads to a reduction in the incidence of unneeded surgery. Aim The current study aims to assess the concordance between FNAC of thyroid nodules with final histopathology and identify the different types of detected thyroid lesions. Methodology A retrospective record-based study reviewed the medical files of all patients presenting to the Armed Forces Hospital, Southern region, with suspected thyroid nodules from April 2018 to January 2020. Data were extracted using pre-structured data extraction sheet to avoid inconsistency. Data extracted included patients' demographic data, swelling laterality, size, ultrasound, and histopathological findings.  Results The baseline characteristics of studied samples in the present study: Forty-seven samples had a mean age of 44.27 (SD=±13.5) years, and 85.1% were female gender. The study showed that 12.5% of benign samples were lymphocytic in histopathology, 25% suspicious for follicular neoplasm samples were benign multi-nodular goiter in histopathology, and all 100% of samples suspicious for malignancy were malignant in final histopathology. Conclusions The current study showed that the malignancy rate of the examined nodules was not uncommon in FNAC and histopathology. Where papillary carcinoma was the most detected malignancy, the diagnosis of malignancy using FNAC is a cost-efficient approach that affords prompt and accurate evaluation. Once diagnosed, these cases should be subjected to surgery.

Home Drug Delivery Service from the Perspective of Community Pharmacy Staff in Saudi Arabia.

Background: In response to COVID-19, many big pharmacy chains in Saudi Arabia have started to provide home drug delivery services. This study aims to understand home drug delivery service from the perspective of community pharmacists in Saudi Arabia. Also, the study investigates the obstacles that may limit the use of home drug delivery service. Methods: A cross-sectional self-reported survey was distributed from February 2021 to May 2021. Descriptive analysis of sociodemographic characteristics was conducted and presented. Frequencies and percentages were calculated for all variables. Results: A total of 965 community pharmacists were surveyed. Most of the pharmacists, (73.5%) were young, aged 23 to 34 years old. The vast majority of the participants, (93.6%), said that the service will improve drug adherence. The lack of required knowledge and skills among pharmacists could be the main obstacle to implement home drug delivery service (34%). A shortage in the number of community pharmacists was the second main obstacle (24%). Conclusion: Home delivery services in the future may largely replace the tradition of going in person to the pharmacy. There are obstacles that may limit the full use of the service like shortage in number of pharmacists and the lack of required training.

Association of Ultrasonography With Final Histopathology in Diagnosing Thyroid Malignancy: A Single-Institute Retrospective Study.

Background Thyroid nodules are well-defined regions of aberrant echogenicity within the thyroid parenchyma that are radiologically distinct from the normal thyroid gland. The most common incidental finding in imaging scans that include the neck is a thyroid nodule. Rarely are thyroid nodules cancerous, as the majority are benign. Aim The current study aims to assess the concordance between ultrasound (US) of thyroid nodules and final histopathology results to identify the different types of detected thyroid lesions. Methodology A retrospective study reviewed the medical files of all patients presenting to the Armed Forces Hospital, Southern Region, with suspected thyroid nodules from April 2018 to January 2020. Data were extracted using pre-structured proforma to avoid inconsistency. Data extracted included patient demographic, swelling laterality, size, and US and histopathological findings. Results In the present study, 47 samples had a mean age of 44.27 (SD = ±13.5) years, 85.1% were of the female gender, the majority (85.1%) had multiple nodules, 38.3% were with Thyroid Imaging Reporting and Data System (TI-RADS) TR4 US score, and the median size of the nodule on US was 3 cm with a range of 0.6 to 14 cm. The study showed that 10% of TR1 samples were lymphocytic in histopathology, 66.7% of TR3 samples were benign multinodular goiter in histopathology, and 55.6% of samples of TR4 were malignant in histopathology. Conclusions The current study showed that the malignancy rate of the examined nodules was not uncommon both by US and histopathology, where papillary carcinoma was the most detected malignancy. The study showed a satisfactory agreement rate between TI-RADS classification by US sonography and histopathological reporting, where TR4 and TR5 by the US were mainly categorized as pre-malignant/malignant lesions by histopathology.

Cost-Benefit Analysis of Interventions to Mitigate the Monkeypox Virus.

When a viral outbreak occurs, governments are obligated to protect their citizens from the diverse adverse effects of the disease. Health policymakers often have several interventions to consider based on the health of the population, as well as the cascading social and economic consequences of the possible mitigation strategies. The current outbreak of the monkeypox virus has elicited debate on the best mitigation strategy, especially given that most world economies are still recovering from the harsh economic effects of the COVID-19 pandemic. This paper sought to analyze the costs and benefits of three possible strategies and determine which option has the best health outcomes and positive economic effects. A case study of Jeddah was performed, whereby a model was simulated to determine the number of infections over 28 days based on one case of the monkeypox virus. Findings reveal that the vaccination provides the best intervention, as it effectively reduces the transmission rate and prevents loss of lives in the city. From the model, only three people were infected over the research period, while no deaths were reported. Although vaccination incurs a huge direct cost at the beginning, in the long run, it saves the economy from the disease's financial burden in terms of productivity loss from work absenteeism and premature deaths.

Patterns of adverse drug reactions (ADRs) in Saudi Arabia.

BACKGROUND: Pharmacovigilance enhances post-market drug safety. However, analytical reports of a pattern of adverse drug reactions (ADRs) experienced by patients in Saudi Arabia are demanded. OBJECTIVE: To describe patterns of ADRs submitted to the Saudi Central National Pharmacovigilance and Drug Safety Center (NPC), Saudi Food and Drug Administration (SFDA), from its inception in 2015 until the end of 2017 to understand the pattern of ADR reporting in Saudi Arabia. METHODS: In this retrospective study, data from cases reported to the NPC were used to determine ADRs and identify the most common associated drug classes based on anatomical therapeutic chemical (ATC) classification system. RESULT: A total of 17,730 ADR cases were reported during study period. An annual increase in ADRs was clearly evident. Approximately 54% of the total ADRs reported were serious. Most commonly reported ATC drug classes were anti-infective agents for systemic use (22.27%), antineoplastic and immunomodulating agents (21.49%), alimentary tract and metabolism (15.48 %), cardiovascular system (11.11%) and nervous system (10.23%). Vancomycin (2.7%), ceftiraxone (1.8%), fingolimod (1.4%) and paracetamol (1.4%) were the most common drugs associated with serious ADRs. CONCLUSION: This study provide valuable insights in hypothesis generation for future studies on drug-event interactions and amplification studies. The NPC educational programs and awareness campaigns to promote systematic reporting of ADRs among healthcare professionals and general public should be continued.

Pre-Clinical Safety and Efficacy Evaluation of a Herbal Nanoemulsion-Based Formulation for Treating Inflammatory Bowel Disease.

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic autoimmune sickness that affects the gastrointestinal tract (GIT). Currently available treatment regimens have various adverse effects and create a financial burden. OBJECTIVE: This paper presents the development of an oral liquid formulation containing a nanoemulsion (NE) of herbal extracts for the treatment of IBD. METHODS: A NE-based formulation was prepared and characterized. Stability studies based on the physical appearance, viscosity, pH, total microbial count, and assay were performed. The antioxidant activity of the individual extract, mixture, and formulation was compared by the DPPH method. In order to assess both the efficacy and the safety of the formulation, a TNBS-induced colitis model was used. RESULTS: A herbal extract of fennel, anise, chamomile, linseed, and pomegranate fruit peel was used as the oil phase, PEG as a surfactant, Tween 80 as a co-surfactant, and benzalkonium chloride (0.001% w/v) as a preservative in the NE. Average particle size, PDI, viscosity, and pH were 283 nm, 0.33, 48 cp, and 5.9, respectively. Assay of the product by standard marker anethole was 99.6%. It was established that the formulation remains stable at least for 6 months. The antioxidant activity of the combined extract was higher than the individual extracts. The colon mucosa damage index (CMDI) from the formulation was negligible and similar to that of the control group. CONCLUSION: The results suggest that it is worthwhile developing the NE of herbal extracts for treating IBD. Additionally, the benefit of selecting a multi-herb extract for NE formulation is demonstrated by the antioxidant activity of the combined extracts. HIGHLIGHTS: This study revealed that the NE of the herbal extract is a promising approach for IBD treatment. A patent related to the work is published in the Indian Official Journal of the Patent Office (14/2021).