Patient-guided modifications of oral anticoagulant drug intake during Ramadan fasting: a multicenter cross-sectional study.

Fasting Ramadan is known to influence patients' medication adherence. Data on patients' behavior to oral anticoagulant (OAC) drug intake during Ramadan is missing. We aimed to determine patient-guided modifications of OAC medication regimen during Ramadan and to evaluate its consequences. A multicenter cross-sectional study conducted in Saudi Arabia. Data were collected shortly after Ramadan 2019. Participants were patients who fasted Ramadan and who were on long-term anticoagulation. Patient-guided medication changes during Ramadan in comparison to the regular intake schedule before Ramadan were recorded. Modification behavior was compared between twice daily (BID) and once daily (QD) treatment regimens. Rates of hospital admission during Ramadan were determined. We included 808 patients. During Ramadan, 53.1% modified their intake schedule (31.1% adjusted intake time, 13.2% skipped intakes, 2.2% took double dosing). A higher frequency of patient-guided modification was observed in patients on BID regimen compared to QD regimen. During Ramadan, 11.3% of patients were admitted to hospital. Patient-guided modification was a strong predictor for hospital admission. Patient-guided modification of OAC intake during Ramadan is common, particularly in patients on BID regimen. It increases the risk of hospital admission during Ramadan. Planning of OAC intake during Ramadan and patient education on the risk of low adherence are advisable.

Prevalence of Self-Reported Muscle Pain Among Statin Users From National Guard Hospital, Riyadh.

Background Statin, a hydroxymethylglutaryl-coenzyme A reductase inhibitor, is one of the commonly used lipid-lowering drugs that is used for lowering lipid levels in the body. Muscle pain is a commonly reported adverse effect of statins, yet little is known about the prevalence of muscle pain and statin use in the general population. Methods The cross-sectional study was conducted in National Guard Hospital, Riyadh, Saudi Arabia. All study subjects were adult statin users aged 18 years old or above. A total of 313 patients were included in the study. The study was conducted based on a questionnaire distributed among patients according to inclusion and exclusion criteria. Results Among 313 statin users, patients underwent cardiac catheterization (39, 12.5%), stress test (62; 19.8%), percutaneous coronary intervention (three; 1.0%), and coronary artery bypass graft (six, 1.9%), while 203 patients didn't have any intervention (64.9%). Most of the study subjects were on atorvastatin (139; 44.4%). The prevalence of muscle pain was 73.5%; 95% CI = (68.4% - 78.1%). The most common sites of pain were lower limb pain (160; 51.1%), upper limb pain (145; 46.3%), and trunk pain (96; 30.7%). The common types of pain were joint pain (52; 16.6%), muscle weakness (51; 16.3%), muscle aches (43; 13.7%), and muscle cramps (41; 13.1%); and patients who reported that they stopped statin at some point because of muscle pain were 92 (29.4%). Conclusion Statins are important for managing and preventing ischemic heart diseases. Our study found that muscle pain is highly associated with statin use with a prevalence of 73.5%, which causes many patients to tend to stop taking their medication. Therefore, preventing the side effects by adjusting the proper dose or switching to another type of statin for high-risk patients will help them to continue using the drug. Also, it is important to rule out secondary causes of myopathy such as physical activity, fracture, thyroid dysfunction, or infection.

Adrenal Insufficiency in Patients with Corticosteroid-Refractory Cerebral Radiation Necrosis Treated with Bevacizumab.

Cerebral radiation necrosis is a common complication of the radiotherapy of brain tumours that can cause significant mortality. Corticosteroids are the standard of care, but their efficacy is limited and the consequences of long-term steroid therapy are problematic, including the risk of adrenal insufficiency (AI). Off-label treatment with the vascular endothelial growth factor A antibody bevacizumab is highly effective in steroid-resistant radiation necrosis. Both the preservation of neural tissue integrity and the cessation of steroid therapy are key goals of bevacizumab treatment. However, the withdrawal of steroids may be impossible in patients who develop AI. In order to elucidate the frequency of AI in patients with cerebral radiation necrosis after treatment with corticosteroids and bevacizumab, we performed a retrospective study at our institution's brain tumour centre. We obtained data on the tumour histology, age, duration and maximum dose of dexamethasone, radiologic response to bevacizumab, serum cortisol, and the need for hydrocortisone substitution for AI. We identified 17 patients with cerebral radiation necrosis who had received treatment with bevacizumab and had at least one available cortisol analysis. Fifteen patients (88%) had a radiologic response to bevacizumab. Five of the 17 patients (29%) fulfilled criteria for AI and required hormone substitution. Age, duration of dexamethasone treatment, and time since radiation were not statistically associated with the development of AI. In summary, despite the highly effective treatment of cerebral radiation necrosis with bevacizumab, steroids could yet not be discontinued due to the development of AI in roughly one-third of patients. Vigilance to spot the clinical and laboratory signs of AI and appropriate testing and management are, therefore, mandated.

Aneurysmal subarachnoid hemorrhage affects the younger age groups in a Saudi academic center.

BACKGROUND AND OBJECTIVES: The epidemiology, clinical characteristics, and risk factors of aneurysmal subarachnoid hemorrhage (aSAH) in Saudi Arabia are still largely unknown. This retrospective cohort study was aimed to determine these features of the disease. DESIGN AND SETTINGS: A retrospective cohort review was performed on all patients with aSAH who were treated and followed at King Abdulaziz University Hospital between July 2000 and December 2013. PATIENTS AND METHODS: A quantitative methodology was used and data were collected on patients' age, gender, nationality, time to hospital presentation, clinical presentation, aneurysm characteristics, treatment, complications, and outcome. RESULTS: A total of 41 patients with aSAH were included with a mean age of 43.2 (11.5) years; and males comprised 34.1%. Smoking and hypertension were the most common risk factors. Eight patients had known risk factors for aSAH, and were diagnosed using CT scans. An unfavorable outcome was associated with the presence of vasospasm (P < .001), cerebral edema (P=.001), and hydrocephalus (P=.003). CONCLUSION: A high occurrence of aSAH was observed in an age group younger than that reported in published reports. The pattern and outcome of aSAH were otherwise similar to prior reports. Future studies investigating these observations in other centers in the country can improve the prevention and treatment of this serious condition.