Prevalence of cerebral venous thrombosis with the use of oral contraceptive pills during the Holy month of Ramadan

Objectives:To identify the epidemiologic profile of cerebral vein thrombosis (CVT) among fasting women using oral contraceptive pills (OCPs) during the holy month of Ramadan.Methods:This retrospective study was conducted on all patients diagnosed with CVT and using OCPs from records at a tertiary care hospital in Riyadh, Saudi Arabia during 2016-2017. The study participants were categorized into 2 groups (an intermittently fasting group during the holy month of Ramadan and a non-fasting group).Results:Out of 108 female patients with CVT, 36.1% were secondary to OCP, of whom 41% participants were fasting. The most affected site was the transverse sinus. Holocephalic headache was more common amongst fasting group (68.8%) compared to non-fasting group (30.4%) (p=0.025). Dehydration (p=0.003) amongst the fasting group and protein S deficiency (p=0.027) in the non-fasting group were identified as the 2 prominent risk factors. Unfractionated heparin was the most common anticoagulant therapies used during the initiation phase for non-fasting (36.4%) and fasting groups (50%).Conclusion:All women who are using OCP should undergo formal written risk assessments for factors of CVT. Our study suggests that the negative effects of OCPs use might outweigh its benefits; thus, it should be prescribed with caution, more so in fasting patients.     

Bilirubin and its oxidation products damage brain white matter

Brain injury after intracerebral hemorrhage (ICH) occurs in cortex and white matter and may be mediated by blood breakdown products, including hemoglobin and heme. Effects of blood breakdown products, bilirubin and bilirubin oxidation products, have not been widely investigated in adult brain. Here, we first determined the effect of bilirubin and its oxidation products on the structure and function of white matter in vitro using brain slices. Subsequently, we determined whether these compounds have an effect on the structure and function of white matter in vivo. In all, 0.5 mmol/L bilirubin treatment significantly damaged both the function and the structure of myelinated axons but not the unmyelinated axons in brain slices. Toxicity of bilirubin in vitro was prevented by dimethyl sulfoxide. Bilirubin oxidation products (BOXes) may be responsible for the toxicity of bilirubin. In in vivo experiments, unmyelinated axons were found more susceptible to damage from bilirubin injection. These results suggest that unmyelinated axons may have a major role in white-matter damage in vivo. Since bilirubin and BOXes appear in a delayed manner after ICH, preventing their toxic effects may be worth investigating therapeutically. Dimethyl sulfoxide or its structurally related derivatives may have a potential therapeutic value at antagonizing axonal damage after hemorrhagic stroke.     

Comparison of drug administration logistics between prothrombin complex concentrates and plasma in the emergency department

Background

Prothrombin complex concentrate (PCC) is used as an alternative to fresh frozen plasma (FFP) for emergency bleeding. The primary objective of this study was to compare the time from order to start of administration between 3-factor PCC (PCC3), 4-factor (PCC4), and FFP in the emergency department (ED). The secondary objective was to evaluate the effect of an ED pharmacist on time to administration of PCCs.

Fluorimetric determination of isoxsuprine hydrochloride in pharmaceuticals and biological fluids

Two simple and highly sensitive fluorimetric methods have been developed for the determination of isoxsuprine hydrochloride in bulk, in dosage forms and in biological fluids. The first method involves the direct measurement of the native fluorescence of the drug in the concentration range 0.4-4.0 microg ml(-1), the second method is based on the oxidation of isoxsuprine HCl with cerium(IV) followed by fluorimetric measurement in the concentration range 0.02-0.2 microg ml(-1). The average % found were 99.9 +/- 0.78 and 100.0 +/- 0.62 for the two methods, respectively. The minimum detectability (3 S(B)) were 0.11 and 0.007 microg ml(-1) for the two methods, respectively. The methods results showed insignificant difference with those of the official method.     

Learning by Doing and Learning by Observing: Training Parents in Saudi Arabia to Implement the Natural Language Paradigm

The present study trained six parents of children with Autism Spectrum Disorder to implement the Natural Language Paradigm in Saudi Arabia. Three of the parents participated in direct training using a Behavioral Skills Training (BST) model involving instructions, modeling, rehearsal, and feedback. As each of the three parents were being trained directly an additional parent observed the training (i.e., there were three trainee-observer dyads). While all of the parents learned from observing other parents being trained directly, only one observer met the predetermined performance criteria after observation alone, with the other two requiring direct training using BST. The parents demonstrated maintenance of their skills at follow-up, and social validity evaluations were strong. In addition, all parents implemented the NLP procedures at mastery criteria in another setting during generalization probes. Implications for further training research are provided.     

Flow-injection chemiluminescent determination of cefprozil using Tris (2,2'-bipyridyl) ruthenium (II)-permanganate system

A rapid and sensitive chemiluminescence (CL) method using flow-injection (FI) has been developed for the determination of a second generation cephalosporin, cefprozil. The method is based on the CL reaction of cefprozil with acidic potassium permanganate and tris (2,2'-bipyridyl) ruthenium (II), Ru (bipy)3(2+). The CL intensity is greatly enhanced when quinine sulfate is used as a sensitizer. After optimization of the different experimental parameters, a calibration graph was obtained over a concentration range of 0.1-3.0 microg ml(-1) with minimum detectability of 0.005 microgml(-1) (S/N=3). The correlation coefficient was 0.9998 (n=6) with a relative standard deviation (%R.S.D.) of 1.63% for 2.0 microgml(-1). The proposed method was successfully applied to commercial tablets. The average percentage recovery (n=6) was 99.9+/-1.40.     

Safety of tumor necrosis factor inhibitors use for rheumatoid arthritis and ankylosing spondylitis in Africa, the Middle East, and Asia: focus on severe infections and tuberculosis

Multiple studies of patients in Western countries with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have indicated increased risk for active tuberculosis (TB) and other infections among these individuals. It has also been consistently reported that patients receiving tumor necrosis factor (TNF) inhibitors for these conditions have higher rates of active TB and other infections than RA or AS patients not receiving these medications. These issues have been studied less extensively in the Asia and Africa–Middle East regions, and information from these regions is important because of higher rates of TB in the general population. This paper reviews studies of RA and AS patients from Asia, Africa, and the Middle East who received TNF inhibitors. A literature search was conducted using http://www.ncbi.nlm.nih.gov/pubmed to collect and report these data. The years included in the PubMed literature search ranged from January 2000 to October 2011. Additionally, information from the China Hospital Knowledge Database was used to report data from Chinese patients with RA and AS treated with TNF inhibitors. Results from these studies indicate that the risk for active TB and other infections in AS and RA patients from Asia, Africa, and the Middle East are increased in patients receiving TNF inhibitors and that the risk is higher among those treated with monoclonal antibodies versus soluble TNF receptor.     

Visual outcomes and patient satisfaction after bilateral implantation of a new trifocal diffractive intraocular lens

Purpose

To assess the visual outcomes, patient satisfaction and spectacle independence following implantation of new diffractive trifocal intraocular lenses.