Views and perceptions of the public toward COVID-19 vaccine in Saudi Arabia.

Background: Numerous surveys studied individuals' decision to receive COVID-19 vaccine but the motives behind accepting or refusing COVID-19 vaccines are not yet fully understood. We aimed to more qualitatively explore the views and perceptions toward COVID-19 vaccines in Saudi Arabia to provide recommendations to mitigate the vaccine hesitancy issue. Methods: Open-ended interviews were conducted between October 2021-January 2022. The interview guide included questions about beliefs in vaccine efficacy and safety, and previous vaccination history. The interviews were audio-recorded, transcribed verbatim, and the content was analyzed using thematic analysis. Nineteen participants were interviewed. Results: All of the interviewees were vaccine acceptors; however, three participants were hesitant as they felt they were forced to receive it. Several themes emerged as the reasons to accept or refuse the vaccine. The key reasons behind vaccine acceptance were the sense of obligation to fulfill a governmental command, trust in the government decisions, vaccine availability, and the impact of family/friends. The main reason behind vaccine hesitancy was doubts regarding vaccine efficacy and safety and that vaccines were pre-invented, and the pandemic is made-up. Participants' sources of information included social media, official authorities, and family/friends. Conclusion: Findings from this study show that the convenience of receiving the vaccine, the abundance of credible information from the Saudi authorities, and the positive influence of family/friends were among the major factors that encouraged the public in Saudi Arabia to get vaccinated against COVID-19. Such results may inform future policies regarding encouraging the public to receive vaccines in cases of pandemic.

Evaluation of grit and its associated factors among undergraduate pharmacy students from 14 Asian and Middle Eastern countries amid the COVID-19 pandemic.

Introduction: Grit is proposed as an essential trait for academic achievement. Thus, evaluating its current status and the associated factors could aid academic support planning. Objective: The present study aimed to assess grit level and its related factors among undergraduate pharmacy students from 14 countries amid the COVID-19 pandemic. Methods: A cross-sectional survey-based study was conducted among pharmacy students from 14 countries in Asia and the Middle East. A 31-item questionnaire was developed, validated, and pilot-tested, including the validated short scale for grit assessment. The data was collected between 1 February and 15 April 2022. Descriptive and inferential statistics were employed as appropriate. Results: A total of 2665 responses were received, mainly from females (68.7 %), living in urban areas (69.2 %) and studying at private universities (59.1 %). The average grit score on a scale of 5 was 3.15 ± 0.54. The responses revealed higher favourable responses to items on the perseverance of efforts (34.9 % to 54 %) compared to items on the consistency of interests (26.5 % to 31.1 %). Students who did not exercise (AOR: 0.47, 95 %CI: 0.33-0.67) or exercised irregularly (AOR: 0.64, 95 %CI: 0.45-0.90) were less likely to have higher grit scores than those who exercised regularly. Additionally, students who did not receive COVID-19 vaccination (AOR: 0.50, 95 %CI: 0.36-0.71) or received only one dose (AOR: 0.67, 95 %CI: 0.46-0.99) were less likely to have higher grit scores than those who received their booster vaccination. Interestingly, students who chose the pharmacy program as their only available or reasonable choice (AOR: 0.33, 95 %CI: 0.17-0.62) and students from public universities (AOR: 0.82, 95 %CI: 0.68-0.98) were less likely to have higher grit scores. On the other hand, students who did not face educational challenges with online learning (AOR: 1.19, 95 %CI: 1.003-1.416) and students with excellent (AOR: 2.28, 95 %CI: 1.57-3.31) and very good (AOR: 2.16, 95 %CI: 1.53-3.04) academic performance were more likely to have higher grit scores. Conclusion: The findings revealed moderate grit levels. Higher grit levels were thought to be associated with several personal, lifestyle and academic factors. Further interventions to support students' grit attributes are required, particularly concerning the consistency of interests.

Public's perception and satisfaction on the roles and services provided by pharmacists - Cross sectional survey in Sultanate of Oman.

BACKGROUND AND OBJECTIVES: An important factor that will help in advancement of the pharmacy services in any country would be to understand the public needs, expectation and satisfaction. There are limited published studies conducted in Sultanate of Oman regarding the perception and satisfaction of public on the role and services provided by pharmacists. The present study was conducted to assess the perception and satisfaction of general public in Sultanate of Oman on the roles, and services received from the pharmacists. METHODS: The survey was conducted among public in the Governorates of A'Dahera and Muscat in Oman during 2013. The questionnaire had items to assess two aspects: perception on the roles and responsibilities of pharmacists and satisfaction on the services provided. The responses to the questions marked in a five point Likert scale were assessed using a scoring scheme. Accordingly, the median perception, and satisfaction score and median total score for the participants were estimated. The median scores of the participants were related with the demographics of the participants and frequency of visit to pharmacy. RESULTS: A total of 390 completed questionnaires were obtained. The median total score of the participants based on all the questions was 79 (Inter Quartile Range (IQR), 12) which represents a moderate score. The median perception and satisfaction scores were 44 (IQR 5) and 34 (IQR 7) which represent a good and moderate score, respectively. Perception of the participants differed based on employment status, frequency of visit to pharmacy and governorate represented by participants while satisfaction was influenced by educational qualification and frequency of visit to pharmacy. CONCLUSIONS: Public had a good perception regarding the roles of the pharmacists while they were only moderately satisfied with the services provided. Steps have to be taken to improve the services and relationship of pharmacists, and thereby improve the satisfaction of the customers. An extended study in a broader population involving more governorates will provide an enhanced representation regarding this important aspect.

Targeted study to evaluate the cardiovascular risk factor status among patients and efficacy of statins in attaining goal lipid levels in a regional hospital in Sultanate of Oman.

BACKGROUND AND OBJECTIVE: Elevated LDL (Low Density Lipoprotein) cholesterol is a major cause of Coronary Heart Disease (CHD) and LDL lowering therapy reduces the risk for CHD. The study was conducted with the aim of assessing the prescribing pattern of statins based on cardiovascular risk factor category, pattern of lipid monitoring followed among the patients and extent of attainment of goal Low Density Lipoprotein (LDL-C) observed among the patients. METHODS: A group of patient files (among those on statin agent during the year 2011) from the Department of Medicine in Nizwa Hospital were selected for targeted evaluation on the risk factor status of patients and efficacy of statins in attaining goal lipid levels. Goal LDL-C levels were estimated for each patient depending on their risk factor status. Subsequent follow ups of the patients were reviewed from the patient files and accordingly the attainment and maintenance of goal-LDL-C in the patients were evaluated. RESULTS: A total of 183 patients were identified. Mean age of the evaluated patients was 63.6 ± 11.58 years. Evaluating the status of patients on the presence of risk factors, majority (63.9%) of them had presence of CHD. Simvastatin was the most commonly used agent and titration of dose was done in only 3.3% of patients. Mean LDL-C level of the patient before initiation of treatment was 3.74 ± 1.9 mmol/L. Only in 59 (32.2 %) of the total evaluated 183 patients, there was evidence of attaining goal-LDL-C levels. Among them, there was evidence of maintenance of goal LDL-C in 16 (27.1%) of the patients. CONCLUSION: Statins were used less frequently for primary prevention of CHD. Absence of lipid monitoring; base line and follow up in a good number of patients as well as lack of dose titration among the patients were observed. Importance of adequate lipid monitoring and follow up to ensure attainment of goal LDL-C needs to be stressed to serve the objective of use of statins; primary and secondary prevention of CHD.

A cross sectional pilot study on assessing the knowledge, attitude and behavior of community pharmacists to adverse drug reaction related aspects in the Sultanate of Oman.

BACKGROUND AND OBJECTIVES: Adverse drug reaction (ADR) monitoring and reporting requires a multidisciplinary approach and pharmacists have a major role to play in it. The present pilot study was conducted to assess the knowledge, attitude and behavior of community pharmacists to ADR related aspects in the Sultanate of Oman. METHODS: A self-administered questionnaire comprising of 21 questions were distributed to a random sample of pharmacists in two Governorates in the Sultanate of Oman. It assessed the knowledge of pharmacists on some of the selected basic aspects of drug safety. Further, the knowledge and attitude of community pharmacists toward ADR reporting and their behavior on ADR related aspects were assessed. A scoring scheme was used to estimate the median total score of participants for various parameters. Obtained scores were correlated with the demographics of the respondents. RESULTS: A total of 107 community pharmacists participated in the survey giving a response rate of 72.3%. The responses of the pharmacists to the questions on the drug safety of individual drugs were incorrect for some important and practical questions. Consequently, total median score corresponding to these questions was 5 (Inter Quartile Range, IQR 2) out of a possible maximum score of 9, which was below the acceptable score. Total median score based on knowledge, attitude and behavior was 38 (IQR 8) out of a possible maximum of 50 which shows a moderate score. Lack of awareness on how to report an ADR and concern that the report may be wrong were the most common factors discouraging pharmacists from reporting ADRs. Qualification as well as years of experience were the only demographic parameters which had an influence on the score obtained by the pharmacists. CONCLUSIONS: Even though the pharmacists had an acceptable knowledge, attitude and behavior on ADR reporting and related aspects, a good number of them had below than acceptable knowledge on drug safety related aspects of specific drugs. Educational programs have to be continued to generate awareness on how to report ADR and stimulate pharmacists' more active participation in the pharmacovigilance program. There is a genuine need to have training programs to improve the knowledge of pharmacists on ADR related aspects which are of benefit on a daily basis which could greatly have an impact on patient safety.

Exploring the reasons behind low COVID-19 vaccination coverage in ethnic minorities-A qualitative study among Arabic-speaking public in Denmark.

AIMS: In Denmark, COVID-19 infection rates have been higher, and vaccination coverage has been lower in areas with many residents from ethnic minority backgrounds. This study aimed to explore COVID-19 vaccination perceptions among Arabic-speaking minorities in Denmark. MATERIALS AND METHODS: A total of 16 individuals, varying in age, gender, education, employment, health, vaccination status, and the Arabic-speaking country of origin, were recruited and interviewed in Arabic. The interviews were transcribed verbatim, translated into English, and analyzed using directed thematic analysis. RESULTS: Most interviewees had some knowledge about how vaccines work to prevent infections; however, a wide spectrum of opinions about the effectiveness and safety of COVID-19 vaccines and vaccination policies in Denmark emerged. COVID-19 vaccination issues were extensively discussed in Arabic-speaking communities, but consensus was rarely reached. Many participants felt confused and only took vaccines for practical considerations, such as travel. Due to language barriers, some participants experienced difficulties in understanding vaccination-related information in electronic invitations from the health authorities and at vaccination centers, with family members often stepping in to provide translations. CONCLUSIONS: Systematic efforts to actively disseminate translated COVID-19 vaccination information are needed to support ethnic minority individuals in making informed decisions.

COVID-19 vaccine hesitancy among healthcare workers in Arab Countries: A systematic review and meta-analysis.

BACKGROUND: Vaccine hesitancy is a major obstacle to the large efforts made by governments and health organizations toward achieving successful COVID-19 vaccination programs. Healthcare worker's (HCWs) acceptance or refusal of the vaccine is an influencing factor to the attitudes of their patients and general population. This study aimed to report the acceptance rates for COVID-19 vaccines among HCWs in Arab countries and identify key factors driving the attitudes of HCWs in the Arab world toward vaccines. METHODS: This systematic review and meta-analysis followed the PRISMA guidelines. PubMed and Scopus databases were searched using pre-specified keywords. All cross-sectional studies that assessed COVID-19 vaccine hesitancy and/or acceptance among HCWs in Arab countries until July 2022, were included. The quality of the included studies and the risk of bias was assessed using the JBI critical appraisal tool. The pooled acceptance rate of the COVID-19 vaccine was assessed using a random-effects model with a 95% confidence interval. RESULTS: A total of 861 articles were identified, of which, 43 were included in the study. All the studies were cross-sectional and survey-based. The total sample size was 57,250 HCWs and the acceptance rate of the COVID-19 vaccine was 60.4% (95% CI, 53.8% to 66.6%; I2, 41.9%). In addition, the COVID-19 vaccine acceptance rate among males was 65.4% (95% CI, 55.9% to 73.9%; I2, 0%) while among females was 48.2% (95% CI, 37.8% to 58.6%; I2, 0%). The most frequently reported factors associated with COVID-19 vaccine acceptance were being male, higher risk perception of contracting COVID-19, positive attitude toward the influenza vaccine, and higher educational level. Predictors of vaccine hesitancy most frequently included concerns about COVID-19 vaccine safety, living in rural areas, low monthly income, and fewer years of practice experience. CONCLUSION: A moderate acceptance rate of COVID-19 vaccines was reported among HCWs in the Arab World. Considering potential future pandemics, regulatory bodies should raise awareness regarding vaccine safety and efficacy and tailor their efforts to target HCWs who would consequently influence the public with their attitude towards vaccines.

Effectiveness of antimicrobial stewardship interventions on early switch from intravenous-to-oral antimicrobials in hospitalized adults: A systematic review.

BACKGROUND: This review aimed to summarize the available evidence on the effectiveness and safety of antimicrobial stewardship interventions to improve the practice of IV-to-PO antimicrobial switch therapy in hospitalized adults. METHODS: Following the PRISMA guidelines, we searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed, and Scopus from inception to September 1, 2020, for original articles investigating any interventions aimed to improve the practice of IV-to-PO antimicrobial switch therapy in hospitalized adults with infectious diseases. We included randomized controlled trials (RCTs) and quasi-experimental studies. Studies were excluded if they evaluated drugs other than antimicrobials, head-to-head comparison of interventions, included pediatrics or oncology patients. RESULTS: Of 506 unique citations identified, 36 studies met the inclusion criteria. The 36 included studies reported 92 interventions as a single (n = 10) or a bundle of interventions (n = 26). The most common interventions used were guideline/protocol/pathway (n = 25), audit and feedback (n = 20), and education (n = 17). CONCLUSIONS: This review provides health care providers with a comprehensive summary on the interventions to promote IV-to-PO antimicrobial switch. While no one intervention could be identified as the safest and most effective as most of the included studies used a bundle of interventions, all interventions resulted in optimizing antibiotic use and reducing health care expenditures without compromising the clinical outcomes. As such, each hospital should design and utilize interventions that are applicable based on available resources and expertise.

Pharmacists and pharmacy services in COVID-19 literature: A bibliometirc analysis.

Background: The COVID-19 pandemic had an enormous impact on the global economy and healthcare. Pharmacists were vital members of the healthcare system, and they participated in various strategies to reduce the effect of the pandemic. Numerous papers were published discussing their roles during the pandemic. Bibliometric analysis was used to measure the impact of publications on this topic and assessed them qualitatively and quantitatively over a specific time. Objective: Evaluate published literature pertaining to the roles of pharmacists and pharmacy services during the pandemic and identify gaps. Methods: An electronic search was conducted on PubMed database using a specific query. Eligible publications were published in English between January 2020 and January 2022 and discussed the role of pharmacists, pharmacies, and pharmacy departments during the pandemic. Clinical trials, studies on pharmacy education/training, and conference abstracts were excluded. Results: Of 954 records retrieved, 338 (35.4%) from 67 countries were included. Most papers (n = 113; 33.4%) were from the community pharmacy sector, followed by the clinical pharmacy sector (n = 89; 26.3%). Sixty-one (18%) papers were multinational, mostly involving two countries. The average number of citations of the included papers was 6 times (range 0-89). The most common MeSH terms were 'humans', 'hospitals', and 'telemedicine', where the former frequently co-appeared with the terms 'COVID-19' and 'pharmacists.' Conclusions: Results from this study illustrate the innovative and proactive strategies developed by pharmacists during the pandemic. Pharmacists from around the world are encouraged to share their experiences for stronger healthcare systems to counter future pandemics and environmental disasters.

COVID-19 vaccine hesitancy and acceptance among the public in the Gulf Cooperation Council countries: A review of the literature.

Vaccine hesitancy has a significant impact on tackling infectious diseases as it has resulted in reemergence of vaccine-preventable diseases. This review aims to provide an up-to-date evaluation of COVID-19 vaccine hesitancy among the public in the Gulf Cooperation Council countries. We searched the PubMed and SCOPUS databases for manuscripts published on vaccine hesitancy and/or acceptance among the public in GCC countries up till April 1st, 2022. Forty-nine studies met the inclusion criteria and were reviewed. The average vaccine hesitancy rate across GCC countries was 43%. Concerns about vaccine safety (n = 32) and effectiveness (n = 26) were most frequently associated with hesitancy. Being male (n = 25) and having positive behavior regarding the influenza vaccine or vaccines in general (n = 22) were most frequently associated with acceptance. Collaborative efforts of governments, academic bodies, and the media to provide evidence of vaccines' effectiveness throughout history and strictly manage the spread of the vaccine safety-related rumors are warranted.

Medication Adherence and Patients' Characteristics in Chronic Diseases: A National Multi-Center Study.

Chronic diseases constitute a significant threat to health. Worldwide, medication adherence in chronic diseases remains unsatisfactory. Understanding factors affecting adherence is essential. This study examined medication adherence by characteristics of patients with chronic diseases. This cross-sectional study included 800 patients. The Adherence to Chronic Diseases Scale was used to measure adherence. Descriptive statistics and logistic regression was used to examine factors influencing medication adherence. Low adherence was found in 19.5% of the patients, 45% had medium adherence, and 35.5% had high adherence. Logistic regression showed that retired (OR 0.496, 95% CI [0.33-0.75]), having COPD (OR 0.460, 95% CI [0.32-0.67]) and duration of disease ≤5 years (OR 1.554, 95% CI [1.11-2.17]) remain independent predictors for high adherence. Mixed findings regarding the relationship between medication adherence and patients' characteristics were noticed. Patients' characteristics should be examined with the individual population when examining and attempting to improve medication adherence in clinical practice.

COVID-19 Medical Research in Oman: A Bibliometric and Visualization Study.

Objectives: To study the quantum and pattern of the COVID-19-related medical research publications that had contributions from researchers in Oman, using bibliometric analysis. Methods: Data on the COVID-19-related medical research publications with contributions from authors in Oman were sourced from the Scopus database. The main search keywords were 'COVID-19' and 'Oman'. The search included data from 1 December 2019 till 21 August 2021. A bibliometric method utilizing citation analysis and science mapping was applied to the selected data. VOSviewer software was used for constructing and visualizing various bibliometric networks. Results: The search query returned 360 documents which included those by authors from Oman. After excluding 83 of these due to irrelevance, 277 documents were finally selected for analysis. Three macro research themes emerged: treatment of COVID-19 cases, epidemiology and impact of COVID-19, and etiology and clinical manifestations of COVID-19. A total of 4533 sources were cited in the selected 277 documents. Most articles were published in the International Journal of Infectious Diseases (IJID), followed by Oman Medical Journal, and Sultan Qaboos University Medical Journal. The most cited references included the Lancet, followed by the New England Journal of Medicine, and the Journal of the American Medical Association. The largest number of papers were authored by researchers from Sultan Qaboos University followed by the Oman Ministry of Health. Regarding the number of citations received per paper, the top rank went to the Ministry of Health, followed by Sultan Qaboos University Hospital and Khoula Hospital. Conclusions: Oman has significantly contributed to the COVID-19-related medical knowledge despite the challenges of conducting research amidst the increased workload during the pandemic. Most publications in Oman were collaborative projects. Based on the evaluated literature, further research focusing on vaccines and therapeutics is warranted.

Development and validation of a mobile application based on a machine learning model to aid in predicting dosage of vitamin K antagonists among Indian patients post mechanical heart valve replacement.

Patients who undergo heart valve replacements with mechanical valves need to take Vitamin K Antagonists (VKA) drugs (Warfarin, Nicoumalone) which has got a very narrow therapeutic range and needs very close monitoring using PT-INR. Accessibility to physicians to titrate drugs doses is a major problem in low-middle income countries (LMIC) like India. Our work was aimed at predicting the maintenance dosage of these drugs, using the de-identified medical data collected from patients attending an INR Clinic in South India. We used artificial intelligence (AI) - machine learning to develop the algorithm. A Support Vector Machine (SVM) regression model was built to predict the maintenance dosage of warfarin, who have stable INR values between 2.0 and 4.0. We developed a simple user friendly android mobile application for patients to use the algorithm to predict the doses. The algorithm generated drug doses in 1100 patients were compared to cardiologist prescribed doses and found to have an excellent correlation.

Assessment of mental wellbeing of undergraduate pharmacy students from 14 countries: The role of gender, lifestyle, health-related, and academic-related factors.

Background: Pharmacy students will assume future roles as frontline healthcare providers. Therefore, evaluating their current state of mental wellbeing and its associated factors is essential for better planning students' support initiatives. This study aimed to assess mental wellbeing and its associated factors among undergraduate pharmacy students from 14 countries during the pandemic. Methods: A cross-sectional study was conducted among undergraduate pharmacy students in 14 countries in Asia and the Middle East. The validated Warwick-Edinburgh Mental Wellbeing Scale (the 14-item WEMWBS) was adopted to assess mental wellbeing. Data collection was performed online between February and April 2022. Descriptive and inferential statistics were used as appropriate. Results: A total of 2,665 responses were received, mainly from females (68.7%) with a higher presence of private universities (59.1%). About 34.9% had low mental wellbeing levels, while 57 and 8.1% had medium, and high levels, respectively. Binary logistic regression showed that males (AOR: 1.34; CI 95%: 1.11-1.61; p < 0.01) and students with no chronic illnesses (AOR: 2.01; CI 95%: 1.45-2.80; p < 0.001) were more likely to have higher mental wellbeing. Also, participants who did not engage in any exercise (AOR: 0.71; CI 95%: 0.52-0.98; p = 0.04) and those in public universities (AOR: 0.82; CI 95%: 0.69-0.97; p = 0.02) were less likely to have higher mental wellbeing. Additionally, students who had interest/passion for pharmacy (AOR: 1.69; CI 95%: 1.07-2.68; p = 0.02), and those who known pharmacists inspired (AOR: 1.81; CI 95%: 1.06-3.12; p = 0.03), were more likely to have higher mental wellbeing compared with those who had no specific reason for their choice to study pharmacy. The participants with excellent (AOR: 1.87; CI 95%: 1.29-2.70; p = 0.001) or very good self-reported academic performance (AOR: 1.57; CI 95%: 1.12-2.22; p = 0.01) were more likely to have higher mental wellbeing compared to those with fair academic performance. Conclusion: More than a third of the participants had low mental wellbeing. Various demographic, lifestyle, medical and academic factors appeared to affect students' mental wellbeing. Careful consideration of these factors and their integration into the pharmacy schools' plans for student support services and academic advising would be essential to improve students' mental wellbeing.

Hydroxyurea: Pattern of Use, Patient Adherence, and Safety Profile in Patients with Sickle Cell Disease in Oman.

OBJECTIVES: Many barriers contribute to the underutilization of hydroxyurea (HU) in the treatment of sickle cell disease (SCD), and adherence to its use is often reported to be suboptimal. It is important to have information on the safety of HU in patients with SCD. Our study assessed the pattern of use, patients' adherence to medication, discontinuation of use, and safety of HU in patients with SCD. METHODS: This cross-sectional study was conducted in the department of medicine of a referral hospital in Oman over five months and included a review of patient files and patient interview. Approval was obtained from the Regional Research and Ethics Committee of the A'Dakhiliyah Governorate and the hospital administration. The parameters were compared between groups using the chi-square test. RESULTS: Of 298 patients studied, 128 (43.0%) had used HU at some points. The difference in the prevalence of HU use was statistically significant based only on age (p = 0.014), with younger patients more likely to be currently using HU or used HU in the past. The majority of patients were adherent (82.5%) based on self-reported adherence. The prevalence of discontinuation (temporary or permanent) of HU use was high (57.0%), and suspected adverse drug reaction (ADR) was the most common reason. Among those who had never used HU, 33.7% of patients had an indication for the initiation of HU. A quarter of patients who used HU developed a suspected ADR, with blood abnormalities being the commonest. The duration of HU use influenced ADR prevalence (p = 0.015). CONCLUSIONS: Among the current users of HU, the majority of the patients were adherent based on self-reported medication adherence. The prevalence of discontinuation of HU use and instances of non-initiation of HU among those indicated were high. A larger study, ideally of a prospective nature, in various governorates of Oman, would provide a wider picture at the national level.

Acute interstitial nephritis related to lansoprazole administration.

Acute interstitial nephritis (AIN) is a rare but serious adverse effect reported with proton pump inhibitors (PPIs). Only one report (2 cases) of AIN with lansoprazole is published in literature. A case of lansoprazole induced interstitial nephritis (biopsy supported) was reported in an elderly female patient admitted to the hospital with non specific symptoms after 45 days of treatment with the drug. A recovery was noticed upon withdrawal of the drug and treatment with corticosteroids. We consider this report as a valuable addition to the existing literature on this rare adverse effect with lansoprazole. This potentially serious adverse effect with PPIs including lansoprazole has to be given due consideration, especially taking into account the wide spread use of this group of agents.

Potential negative impact of informing patients about medication side effects: a systematic review.

Background Pharmacovigilance, as it is carried out primarily by healthcare professionals is more focused on being very objective in nature. Acknowledging the importance of the subjective experience of patients in pharmacovigilance was underpinned by its unique ability to bring about a more holistic understanding through the deep information unraveled by the patients. Medication safety-related information has to be shared with patients to allow them to be actively involved in their therapy and pharmacovigilance. Despite the advantages of sharing information, it stands to reasons whether sharing information related to possible side effects would negatively affect patients and impinge upon their treatment plan and process. Aim of the Review The purpose of this systematic review was to critically assess the potential negative impact of informing patients about medication side effects by written and/or oral information on medication compliance, occurrence/development of suspected side effects and clinical outcomes. Method A comprehensive search was conducted in PubMed, and Cochrane library to identify potential records between the year 1975 and 2017; then titles, abstracts, and full texts were screened using the inclusion criteria to filter out irrelevant studies. The data extraction, and the results were narratively synthesized and presented in tables. Results A total of 2012 articles were screened for inclusion, 32 full-text articles were assessed for eligibility and finally resulting in the inclusion of 17 randomized control studies which met the set criteria. Findings unraveled that the educational intervention did not result in increased occurrence/reporting of side effects in most of the evaluated studies; except 4 studies, and no significant impact on compliance to medications and negative clinical outcome was observed. Apprehension of negative events to medications were observed in two of the four studies which evaluated these parameters. Conclusion The present review did not find enough evidence to support the over concerns on the potential negative impact of sharing of information on the adverse effects to patients, though the influence could manifest as nocebo-effect. The various components and methods employed for this information sharing process can influence the potential impact of this activity. These concerns about the undesirable effects should not deter the active involvement of patients in pharmacovigilance activities. There is a definite need to have more studies in this area, where much of concern still does exist among the various stakeholders of drug safety information.

Atorvastatin-induced early-onset rhabdomyolysis in a patient with nephrotic syndrome.

PURPOSE: A case of early-onset rhabdomyolysis in a patient treated with atorvastatin is described. SUMMARY: A 17-year-old Indian boy weighing 55 kg was admitted to the hospital after complaining of facial puffiness and pedal edema for four days. His medical history revealed a diagnosis of nephrotic syndrome when he was 2 years old. He had six relapses, the last of which occurred 10 years ago. He was not taking any medications on admission and had not for the past 9 years. His vital signs were normal on admission (day 1), but anasarca was noticed during general examination. Cardiovascular, respiratory, and abdominal examinations were normal. Relapse of nephrotic syndrome was considered, and his 24-hour urine protein value confirmed the diagnosis. Further laboratory tests revealed that the patient had high total and low-density-lipoprotein cholesterol values (597 and 465 mg/dL, respectively), and atorvastatin 10 mg p.o. once daily was initiated on day 2. Prednisolone 60 mg p.o. once daily was initiated on day 3. On day 6, the patient complained of pain in both thighs and had difficulty walking. His creatine kinase (CK) concentration was then measured and found to be elevated (11,821 IU/L). Prednisolone and atorvastatin were then stopped, as statin-induced myopathy was suspected. The patient received i.v. hydration and sodium bicarbonate, and he began to show improvement by day 9. Follow-up three weeks later revealed a normal CK level and no myopathy-related complaints. CONCLUSION: Early-onset rhabdomyolysis was reported in a patient with nephrotic syndrome who was treated with atorvastatin. Concomitant use of prednisolone and the patient's underlying renal impairment may have predisposed the patient to this adverse reaction.

Short communication: pattern of adverse drug reaction related queries received by the drug information centre of a tertiary care teaching hospital.

Accurate information about safety of drugs is very essential for health care professionals in identifying, preventing and managing Adverse Drug Reactions (ADRs), thereby ensuring safe use of medications. The objective of the present study was to assess the pattern of drug information (DI) queries related to ADRs received by the Drug Information Center (DIC) of a tertiary care teaching hospital. Retrospective evaluation of the DI queries received in the DIC over a period of three and a half years (January 2002-July 2005) was done for various parameters such as purpose and type of query, characteristics of the drugs and reactions involved, and references used. Out of 2312 DI queries received, 600 (25.9%) were related to ADRs. Majority of the queries were from the department of medicine (80.5%) and was received during ward rounds (76%). In most of the queries, the information was sought for better patient care (66.3%) and the enquirer wanted the information immediately (59.5%). The category of ADR queries most commonly asked was regarding identification of an ADR (54.3%). Considering the reaction characteristics, the organ system most commonly involved in the queries was nervous system (14.7%) and the reaction was fever and skin rash (14%). Most of the queries were on uncommon reactions. Drug class most commonly involved in the queries were antibacterials for systemic use (18.6%) and the most frequently involved drug was phenytoin (35%). MICROMEDEX system was used as the reference in answering most (57.1%) of the queries. Information on ADRs is among the most sought information on drugs by the health care professionals. Evaluation of pattern of these queries could reveal opportunities for educational and other interventions in promoting safer drug use in a health care setting. DICs could play a major role in promoting drug safety and it needs to be well equipped to respond to these needs.