Practices of Jeddah Residents Regarding the Disposal of Unused and Expired Medications: A Community-Based Survey

Inappropriate disposal of stored medications leads to an increased risk of environmental toxicity. This study aims to examine practices of Jeddah residents with regard to disposing unused and/or expired medications and to view their opinions about the presence of drug take-back centres. Over a three-month period, 771 participants completed an online questionnaire, that focused on disposal methods and the importance of having drug retrieval centres. The data demonstrated that 91.57% of the participants reported discarding their expired medications in household waste, and 2.98% of them return their medications to hospitals or pharmacies. With respect to unused medications, 67.07% of the participants disposed of them in household waste, and only 10.84% donated their medications. This improper practice, however, contradicted the fact that 92.35% of the respondents were interested in knowing the appropriate methods of disposing. In addition, 90.66% agreed to the need for drug take-back centres. This study demonstrated that a low percentage of respondents knew about correct medication disposal. This emphasizes the need for the Ministry of Health, the pharmaceutical industry and pharmacies to collaborate on a national program about the proper methods of medication disposal and to initiate drug retrieval programs.

Enhancement of Liver Toxicity on Diabetes Mellitus by a Universal Chemical Pollutant (Acrylonitrile) in Rats

The present study was designed to investigate potential liver damage due to acrylonitrile in Streptozotocin induced diabetes in rats. Twenty-four rats were divided into 4 treatment groups. Nondiabetic control rat receiving distilled water, non-diabetic rat receiving acrylonitrile aqueous solution (10 mg/kg/day), diabetic control rat receiving distilled water and diabetic rat receiving acrylonitrile aqueous solution. All groups received the treatment for 4 weeks. The animals were assessed for hepatoxicity markers in serum, oxidative stress markers, CYP2E1 activity and cyanide formation in tissues. Acrylonitrile significantly elevated serum aminotransferase, alanine aminotransferase, total bilirubin levels, triglycerides and total cholesterol in diabetic groups as compared to normal control group. Antioxidant markers like glutathione showed significant decline while a significant increase in malondialdehyde, superoxide dismutase and catalase in diabetic rats treated with acrylonitrile. CYP2E1 activity was observed in acrylonitrile – exposed nondiabetic and diabetic groups as compared to control. Cyanide formation was raised in both the nondiabetic and diabetic groups as compared to control group. Acrylonitriles can produce acute hepatic injury, induction of diabetes mellitus type II, and accomplish the CYP2E1 enzyme which sequentially leads to generation of oxidative stress and its metabolic product–cyanide that may potentiate the oxidative stress posing more deleterious effect.

Characterizing Occupational Low Back Pain among Surgeons Working in Ministry of Health Hospitals: Prevalence, Clinical Features and Risk and Protective Factors

A cross-sectional study was conducted to investigate the prevalence as well as the determinants and clinical features of occupational low back pain among surgeons working at Ministry of Health hospitals in Jeddah, Saudi Arabia by exploring its history combined with time of onset after starting the operating room work and self-appraisal of the relationship with the surgical work. Factors and predictors such as professional, socio-demographic and lifestyle factors, medical history, etc. were collected and analyzed. Two hundred and sixteen surgeons (69.9% males, mean age 39.03 years, median work: 5.00 years) responded. Prevalence of occupational low back pain was 55.8% (95% CI: 49.0%, 62.3%); high rates of inadequate management and self-treatment had a notable impact on all 4 domains. Multivariate regression showed two independent protective factors (regular physical exercise [OR = 0.27, P = 0.002] and back health education [OR = 0.41, P = 0.031] and two independent risk factors (high exposure to risky activities [OR = 1.06, P = 0.048] and presence of chronic pain other than back pain [OR = 2.59, P = 0.012]). More than one in two surgeons are likely to suffer from occupational low back pain. The protective roles of regular physical activity and back health education are highlighted

Portal Vein Aneurysm Complicated by Thrombosis

The current study described a case of portal vein aneurysm at the confluence of the superior mesenteric and splenic veins, complicated by thrombosis in a patient with no liver pathology but with Factor V Leiden mutation.

Effect of Pharmacists’ Interventions on the Appropriateness of Empiric Vancomycin Therapy in Oncology Patients with Febrile Neutropenia

The purpose of this observational study is to evaluate the effect of an active pharmacy intervention to facilitate timely discontinuation of empiric vancomycin therapy in oncology patients with febrile neutropenia who lack objective evidence of a Gram-positive infection. This was a two-phase study. Vancomycin use was evaluated retrospectively on all oncology patients with febrile neutropenia over four weeks (phase I). In a parallel four weeks a year later, vancomycin use in this patient population was evaluated prospectively (phase II). In the absence of evidence of Gram-positive infection after 72 hours of treatment initiation, the team was contacted by a pharmacist to encourage discontinuation. Usage was compared between both phases. Forty-three patients in phase I and 25 patients in phase II were treated with vancomycin with no evidence for Gram-positive infections. Pharmacists’ interventions were documented on 18 patients in phase II. Of these, 56% of interventions to discontinue vancomycin were accepted, but only 33.3% of patients had treatment stopped within 72 hours of initiation. Although not significant, a trend in more appropriate use of vancomycin in oncology patients with febrile neutropenia was observed. Pharmacist’s interventions might have played a role in this observation.

Evaluating Saudi Nursing Students’ Knowledge and Attitudes toward Cancer Pain Management: Implications for Nursing Education

Ineffective pain management has been recognized as a major problem faced by many patients with cancer. There is a lack of emphasis on cancer pain management in the undergraduate nursing curriculum which is one part of this problem. A descriptive cross-sectional study was carried out with a convenience sample of 135 nursing students at two universities in Jeddah, Saudi Arabia, to evaluate students’ current knowledge and attitudes toward cancer pain management. Data were collected using Pain Management Principles Assessment Test and Nurses’ Pain Management Attitudes Survey. The data were analyzed using IBM Statistical Package for the Social Sciences version 22, and P < 0.05 was interpreted as significant. Descriptive and inferential statistics and Pearson correlations were performed. Nursing students have insufficient knowledge (11.4 ± 2.92) and negative attitudes (68.8 ± 5.75) toward cancer pain management. None of the nursing students achieved complete, correct responses (31 or 100%) in the knowledge test. Students had poor knowledge regarding areas of pain physiology and assessment, pharmacologic and nonpharmacologic pain management such as cutaneous stimulation. A weak positive significant relationship between students’ knowledge and attitudes was also found (r = 0.225, P = 0.009). Continued work is required to develop specific strategies to effectively teach nursing students and enhance their knowledge and attitudes toward cancer pain management.

Frequency of Red Blood Cells Alloimmunization in Thalassemia Patients at King Abdulaziz University Hospital in Jeddah, Saudi Arabia

The aim of the study is to assess the alloimmunization rate to red blood cell in thalassemia patients at King Abdulaziz University Hospital. Thalassemia is the most common genetic disorder worldwide that represents a major public health problem and requires long life blood transfusion to the patients as the main treatment. Alloimmunization to the transfused red blood cell can cause hemolytic transfusion reactions and significantly complicate transfusion therapy. Screening and identification of alloantibodies and transfusion of extended phenotyped blood can minimize these risks. A retrospective study was conducted on 134 thalassemia patients at King Abdulaziz University Hospital in Jeddah. Patients’ samples were subjected to red cell typing, antibody screening and identifi cation of red blood cell antibodies. Alloimmunization in thalassemia patients was 20.15%; antibodies were mainly to the Rh and Kell blood group systems, the highest rate was for anti-E (32.4%) followed by anti-K (21.6%). Alloimmunization rate was the highest in the age group from > 10 – 20 years (40.7%). Red cell alloimmunization is a frequent event among thalassemia patient. A national protocol for screening and identifying of the red cell alloantibodies and transfusion of phenotype blood is required for proper management of these patients.

Male Circumcision: A Practice Survey from Saudi Arabia

The study aims to evaluate the various techniques used to perform circumcision in Saudi Arabia. In September 2018, this cross-sectional survey was performed. A questionnaire was sent to all pediatric surgery units across the Kingdom. The responses to the questionnaire were analyzed and categorized. A total of 176 questionnaires were send and more than half (56.3%) of the practitioners filled the questioners, 62 (63%) were consultants, 19 (19%) were specialists and 19 (19%) were trainee in pediatric surgery fellowship program. Circumcisions were performed in Maternity and Children hospitals (32.3%), tertiary hospitals (32.3%), private hospitals (16%) and in general or academic hospitals (19%). The most commonly used method for circumcision was Gomco clamp (n = 39; 39.6%) followed by Plastibell (n = 30; 30%) and bone cutter (n = 25; 25.4%). The optimal time for circumcision was in neonatal period. Eighty-six percent of the surgeons agree that 2.5 to 5 kg is the optimal weight for the baby to do circumcision. In Saudi Arabia circumcision is a religious practice done for every Muslim male. It should be done by trained medical practitioner and circumcision done by non-medical personal should be avoided. Circumcision should be performed in the neonatal period and attention should be given to analgesia.

Extracorporeal Shockwave Therapy for Acromion Pseudarthrosis

Fracture of acromion is uncommon because of its unique anatomical structure and location. Usually it heals by itself using conservative therapy intervention, and a subject’s shoulder can get back to its functional performance without surgical approach. However, rare cases may not recover due to pseudarthrosis taking place, surgical avoidance plus using noninvasive tools to manage acromion pseudarthrosis with the application of extracorporeal shockwave therapy at medium to high intensity is the author's motivation to report this condition. Likewise, to our knowledge, there is no published literature using extracorporeal shockwave therapy specific to acromion. A case of 36 old male, active, and alert had been referred to the physical therapy outpatient clinic for high density extracorporeal shockwave therapy to manage the acromion pseudarthrosis after going on range of motion and strengthening rehabilitation program for seven months. After having six sessions of extracorporeal shockwave therapy, the acromion nonunion fracture unified, with complete patient recovery. The pain was stopped. The range of motion became full, with the restoration of the shoulder's functional abilities.