Knowledge and attitude regarding coronavirus disease 2019 (COVID-19) among hospital pharmacists in Qatar

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) gained global attention because of its high transmissibility and the devastating impact on both clinical and economic outcomes. Pharmacists are among the front-line healthcare workers who contributed widely to COVID-19 pandemic control. We aim to evaluate knowledge and attitude of hospital pharmacists in Qatar about COVID-19. Methods: A descriptive cross-sectional web-based survey was distributed over a 2-months period. The study included pharmacists who are working in 10 different hospitals under Hamad Medical Corporation (HMC). The survey was developed based on information available at World Health Organization (WHO) website, Qatar Ministry of Health, and COVID-19 guideline created by HMC. The study was approved by HMC’s institutional review board (MRC-01-20-1009). Data analysis was done using SPSS version 22. Results: A total of 187 pharmacists were included (response rate 33%). The overall level of knowledge was not affected by the participants’ demographics (p-value ≥0.05). Pharmacists provided more correct answers to questions related to general knowledge about COVID-19 compared to questions specificto treatment aspects of the disease. More than 50% of pharmacists were using national resources as main source of information related to COVID-19. Good health practices and attitudes regarding disease control was reported by pharmacists, including preventive measures implementation and self-isolation when needed. Around 80% of pharmacists are in favor of taking influenza vaccine and COVID-19 vaccine. (AU)

Knowledge and attitude regarding coronavirus disease 2019 (COVID-19) among hospital pharmacists in Qatar.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) gained global attention because of its high transmissibility and the devastating impact on both clinical and economic outcomes. Pharmacists are among the front-line healthcare workers who contributed widely to COVID-19 pandemic control. We aim to evaluate knowledge and attitude of hospital pharmacists in Qatar about COVID-19. Methods: A descriptive cross-sectional web-based survey was distributed over a 2-months period. The study included pharmacists who are working in 10 different hospitals under Hamad Medical Corporation (HMC). The survey was developed based on information available at World Health Organization (WHO) website, Qatar Ministry of Health, and COVID-19 guideline created by HMC. The study was approved by HMC's institutional review board (MRC-01-20-1009). Data analysis was done using SPSS version 22. Results: A total of 187 pharmacists were included (response rate 33%). The overall level of knowledge was not affected by the participants' demographics (p-value ≥0.05). Pharmacists provided more correct answers to questions related to general knowledge about COVID-19 compared to questions specificto treatment aspects of the disease. More than 50% of pharmacists were using national resources as main source of information related to COVID-19. Good health practices and attitudes regarding disease control was reported by pharmacists, including preventive measures implementation and self-isolation when needed. Around 80% of pharmacists are in favor of taking influenza vaccine and COVID-19 vaccine. Conclusion: Overall, hospital pharmacists' knowledge about COVID-19 is good in relation to the disease nature and transmission. Knowledge about treatment aspects including medications needs further enhancement. Providing continuing professional development activities regarding latest information about COVID-19 and its management, and serial newsletters updates, and encouraging journal club activities for recently published research can help improve hospital pharmacist knowledge.

Finasteride use during pregnancy and early neonatal outcome: a case report.

The use of antiandrogen drugs such as finasteride during pregnancy may carry the risk of birth defects, especially hypospadias. We report a 39-year-old woman, with 5 weeks unplanned pregnancy, the patient conceived while receiving daily dose of finasteride 2.5 mg for treatment of alopecia. The patient's partner was concurrently using finasteride for the same purpose. Ultrasound scans including detailed anatomy were normal throughout pregnancy and the fetal gender was detected to be male. The patient had her delivery at 38+5 weeks' gestation, by elective cesarean section, a male infant with a weight of 3.58 kg and Apgar score of 9 and 10 at 1 and 5-min, respectively. The infant was healthy with no obvious dysmorphic features. In this case report, maternal use of finasteride in early pregnancy was not associated with external genitalia abnormalities of a male baby. Moreover, maternal exposure to the semen of partner who received finasteride did not adversely affect the short term neonatal outcomes. However, absence of apparent neonatal adverse effects in a single case report does not indicate safety of use. Population-based long term neonatal outcomes are yet to be established.

Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review.

BACKGROUND: Misoprostol is an effective medical method for the management of pregnancy loss. However, data on its efficacy and safety in women with previous cesarean deliveries are limited. CASE PRESENTATION: We report a 36-year-old patient, gravida 11 para 6, with a diagnosis of missed miscarriage at 15 weeks of gestation. The patient had a significant obstetric history of previous five cesarean deliveries and uterine rupture. Following patient counseling about the medical and surgical options of managing her miscarriage, the patient opted for medical method. Low-dose misoprostol of 100 µg was inserted vaginally and repeated again after 6 hours. The patient had an uneventful complete miscarriage following the second dose of misoprostol. No uterine rupture, no extra vaginal bleeding, and no blood transfusion were observed. CONCLUSION: We conclude that adopting a low-dose misoprostol protocol could be potentially safe and effective in managing second trimester missed miscarriage in women with repeated cesarean deliveries and/or uterine rupture history. Further studies are needed to confirm these results.

Misoprostol use in medical evacuation of spontaneous miscarriage: Pilot drug use evaluation study at the Women's Hospital in Qatar.

BACKGROUND: Misoprostol is a synthetic prostaglandin E1 that induces cervical effacement and uterine contractions at all gestational ages, thus facilitating uterine evacuation and pregnancy termination. Successful medical evacuation of spontaneous miscarriage with minimal adverse effects can be performed using misoprostol-only regimen if given as indicated and if the administered dose, frequency of the dosage, and number of total doses are appropriate. AIM: To conduct a drug use evaluation by investigating indications, appropriateness of dosing, and clinical outcome of misoprostol-only regimen when used for medical evacuation of spontaneous miscarriage at the Women's Hospital in Doha, Qatar. MATERIALS AND METHODS: A retrospective descriptive drug use evaluation was conducted on women with spontaneous miscarriage who received misoprostol for medical evacuation during August 2013. The current practice at the Women's Hospital was compared with the recommendation from the World Health Organization (WHO). Patients were stratified into three groups based on weeks of amenorrhea. RESULTS: A total of 107 patients received misoprostol during August 2013, of which 33 (31%) were included in the study. In these patients, the main indication for misoprostol use was missed miscarriage (54.5%). In the group of patients at ≤ 9 weeks of gestation, 80% received an initial dose of 800 µg, 80% received frequency within the WHO recommendation, and the majority had surgical evacuation (80%). In the group of patients at 10-12 weeks of gestation, more than 80% received an initial dose of 800 µg, 6% received frequency within the WHO recommendation, and more than 75% had successful medical evacuation. In the group of patients at 13-22 weeks of gestation, more than 80% received an initial dose of 400 µg, more than 80% received frequency within the WHO recommendation, and 54% had successful medical evacuation. Overall, more than 70% of the patients received ≤ 3 total doses of misoprostol and more than 60% had successful medical evacuation as a clinical outcome. CONCLUSIONS: Despite the current practice at the Women's Hospital not always being in accordance with the WHO recommendation, successful medical evacuation was achieved in most patients.

A retrospective drug use evaluation of cabergoline for lactation inhibition at a tertiary care teaching hospital in Qatar.

BACKGROUND: Breastfeeding is considered as gold standard for infant nutrition and should be interrupted only when a compelling indication exists. Certain medical conditions such as abortion, stillbirth, HIV infection, or infant galactosemia and certain medications such as chemotherapy necessitate lactation inhibition to protect the health of mother and infant. Drug use evaluation (DUE) studies are done to explore the current practice in a setting and help to identify areas in which further information and education may be needed by clinicians. OBJECTIVE: The aim of this study was to conduct a DUE of cabergoline to assess indications for lactation inhibition, dosage regimen, and its safety. METHOD: A retrospective cross-sectional DUE study was conducted over a period of 4 months from September 1, 2013, till December 31, 2013, at the Women's Hospital, Qatar. All cabergoline prescriptions written for lactation inhibition within 10 days of delivery or abortion were included in the study. A descriptive data analysis was undertaken. RESULTS: Of the 85 patients included, stillbirth (50.6%) was considered as the main reason for lactation inhibition, followed by abortion (27.1%) and neonatal death (12.9%). The remaining 9.4% of the patients had live baby, and the majority of them were prescribed cabergoline for lactation inhibition because their maternal medical conditions required the use of drugs with insufficient safety data (n=6). Seventy-four percent of patients received cabergoline at accurate time and dose. However, 14% of the patients had preexisting hypertensive disorder and 58.3% of them were diagnosed as uncontrolled hypertension. CONCLUSION: The current DUE study found that cabergoline was mainly used to inhibit lactation for patients with stillbirth, abortion, and neonatal death. In mothers who use medications for other medical conditions, benefits and risks of breastfeeding should be carefully balanced before prescribing cabergoline. Current prescribing pattern can be further enhanced through informing health care providers regarding appropriate cabergoline dosage regimen and its safety in patients with uncontrolled hypertension.

Neonatal outcomes after oral administration of antenatal corticosteroid: A case report.

The use of antenatal corticosteroids is associated with reduction in morbidity and mortality rates in preterm delivery. A 34 year-old pregnant woman, gravida 2 para1, was planned for elective cesarean section at 36 weeks of gestation as ultrasound study showed intrauterine growth retardation. She has idiopathic thrombocytopenia and anemia, with suspected hypoplastic anemia. Due to mother's low platelet count, antenatal intramuscular corticosteroids injection was avoided. Instead, oral dexamethasone was given for fetal lung maturity. Baby's Apgar score at 1-min and 5-min was 9 and 10, respectively. The baby girl did not develop respiratory distress syndrome. She had mild transient tachypnea of newborn that needed only mild respiratory support with nasal cannula in room air.