Independent pharmacist prescriber in critical care: One step closer with artificial intelligence
Authors : Saadah LM, Khan AH, Syed Sulaiman SA, Bashiti IA
Abstract : Objective Prescribers usually authorize 80% of clinical pharmacy interventions (CPI). Current study aimed to determine if full authorization of CPI (i.e. 100% acceptance) would rather reduce the length of intensive care stay and readmissions. Data source/study setting This is usual care CPI data obtained in a 100-bed, tertiary, acute care private hospital with 12-bed intensive care unit. Study design Observational artificial neural network model of CPI data. Data collection/extraction methods Clinical pharmacists documented CPI data using a special Excel sheet on a daily basis. Data analyst consolidated CPI to one accepted (124 of 167) and/or one rejected (43 of 167) per patient per admission to intensive care unit (ICU). Then analyst compared the two groups at two alpha levels (0.10 and 0.05) of significance. Artificial neural networks (ANN) were trained and validated for length of intensive care stay after the index CPI (LOSICUA, primary outcome) as well as for the secondary outcomes of mortality, readmissions and costs. Finally, we used the best ANN to compare the outcomes with 80% vs. 100% approval of CPI. Principal findings Models had significant reduction in LOSICUA with 100% versus 80% authorization. At alpha of 0.05 (8 variables model), we observed ∼0.8 days reduction in LOSICUA (1.4 days (0.3–22.9) to 0.6 days (0.0–39.0), respectively, P-value = 0.001). Readmissions were less likely with 100% (16 of 167) versus 80% (22 of 167) approval (P-value = 0.041). Costs saved with 100% approval in this model would be almost 100 US dollars and would help hire 1.6 full time equivalents of competent doctor of pharmacy. Conclusions Maximizing acceptance of CPI in this model reduced LOSICUA, readmissions, and costs. Pharmacists qualify for independent prescribing with further privileging and definitions of scopes of practice.
Keywords : Clinical pharmacy interventionsLength of intensive care stayNeural networksIndependent pharmacist prescribingPatient readmissionHospitalization
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Maximizing Acceptance of Clinical Pharmacy Recommendations May Reduce The Length of Hospital Stay in a Private Hospital from Amman, Jordan: Toward Fully Independent Pharmacist Prescribers
Authors : Saadah LM, Khan AH, Syed Sulaiman SA, Bashiti I.
Abstract : Background: Clinical pharmacy interventions (CPI) usually require prior medical authorization with 20% being rejected. If pharmacists prove to be more competent in this area (accept 100% of CPI), the profession will step closer to a fully-independent prescriber status. Objective: This study use an articial neural network (ANN) model to determine whether clinical pharmacy (CP) may improve outcomes associated with rejected CPI. Setting: This is a non-interventional, retrospective analysis of documented CPI in a 100-bed, acute-care private hospital in Amman, Jordan. Method: Study consists of 542 patients, 574 admissions, and 1694 CPI. Team collected demographic and clinical data using a standardized tool. Input consisted of 54 variables with some taking merely repetitive values for each CPI in a given patient whereas others varying with every CPI. Therefore, CPI was consolidated to one rejected and/or one accepted per patient per admission. Groups of accepted and rejected CPI were compared with matched and unmatched variables. ANN were, subsequently, trained and internally as well as cross validated for outcomes of interest. Outcomes were length of hospital and intensive care stay after the index CPI (LOSTA & LOSICUA, respectively), readmissions, mortality, and cost of hospitalization. Best models were nally used to compare the two scenarios of approving 80% versus 100% of CPI. Variable impacts (VI) automatically generated by the ANN were compared to evaluate the effect of rejecting CPI Main outcome measure: Lengths of hospital stay after the index CPI (LOSTA). Results: ANN congurations converged within 18 seconds and 300 trials. All models showed a signicant reduction in LOSTA with 100% versus 80% accepted CPI of about 0.4 days (2.6 ± 3.4, median (range) of 2 (0 – 28) versus 3.0 ± 3.8, 2 (0 – 30), P-value = 0.022). Average savings with acceptance of those rejected CPI was 55 JD (~ 78 US dollars) and could help hire about 1.3 extra clinical pharmacist full-time equivalents. Conclusion: Maximizing acceptance of CPI reduces the length of hospital stay in this model. Pharmacists seem to be well-positioned to target gain the upper hand on prescribing in these situations
Keywords : Pharmacists, Length of Stay, Neural Networks, Jordan, Patient Readmission, Hospitalization Private Hospital
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Carnosine to Combat Novel Coronavirus (nCoV, COVID-19): Molecular Docking and Modeling to Co-crystallized Host Angiotensin-Converting Enzyme 2 (ACE2( and Viral Spike Protein
Authors : Loai M Saadah, Ghina’a I Abu Deiab, Qosay Al-Balas and Iman A Basheti
Abstract : Aims: Angiotensin-converting enzyme 2 (ACE2) plays an important role in the entry of coronaviruses into host cells. This paper described how carnosine, a naturally occurring supplement, can be an effective drug candidate for coronavirus disease (COVID-19) on the basis of molecular docking and modeling to host ACE2 co-crystallized with COVID-19 spike protein Methods: First, the starting point was ACE2 inhibitors and their structure-activity relationship (SAR) Next, chemical similarity (or diversity) and PubMed searches made it possible to repurpose and assess approved or experimental drugs for COVID-19. In parallel, at all stages, authors performed bioactivity scoring to assess potential repurposed inhibitors at ACE2. Finally, investigators performed molecular docking and modeling of the identified drug candidate to host ACE2 cocrystallized with COVID-19 spike protein. Results: Carnosine emerged as the best known drug candidate to match ACE2 inhibitor structure Preliminary docking was more optimal to ACE2 than the known typical angiotensin-converting enzyme 1 (ACE1) inhibitor (enalapril) and quite comparable to known or presumed ACE2 inhibitors Viral spike protein elements binding to ACE2 were retained in the best carnosine pose in SwissDock at 1.75 Angstroms. Out of the three main areas of attachment expected to the co-crystallized protein structure, carnosine bind with higher affinity to two compared to the known ACE2 active site LibDock score was 92.40 for site 3, 90.88 for site 1, and inside the active site 85.49. Conclusion: Carnosine has promising inhibitory interactions with host ACE2 co-crystallized with COVID-19 spike protein and hence could offer potential mitigating effect against current COVID-19 pandemic.
Keywords : COVID-19, carnosine, angiotensin-converting enzyme 2 (ACE2), practitioner, molecular docking, modeling
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The coronavirus pandemic: could combining melatonin and glycyrrhizin be the solution for this ongoing emergency?
Authors : Loai M. Saadah, Iman A. Basheti
Abstract : Abstract: Novel Corona Virus Disease 2019 (COVID-19) continue to sweep various nations causing more than 4.5 million confirmed cases and close to 300,000 deaths. Current pharmacotherapy largely fall short of controlling the pandemic. In this letter, we critically appraise the hydroxychloroquine plus azithromycin regimen recommended by Gautret et al and provide rationale for new treatments
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Effectiveness of Liraglutide in Type II Diabetes Mellitus Management: Experience in Emirati Patients
Authors : Nasrullah K. Ghuman, Loai M. Saadah, Majdi S. Al Najjar, Duha Y. Shaheen, Shady I. AM and Mouza M. Al Ali
Abstract : Abstract: OBJECTIVE: To measure effectiveness of liraglutide in reducing glycated hemoglobin (HbA1C), weight, and systolic blood pressure (SBP) in Emirati patients. DESIGN: A retrospective cohort study. SETTING: Endocrinology clinic in a 300-bed military hospital. PATIENTS: A total of 152 patients who qualified for liraglutide between September 21, 2012, (first patient visit) and May 5, 2014 (last patient visit( METHODS: Team collected demographic and clinical data using a standard form. Data keeper performed univariate analyses to measure the effect of liraglutide in reducing the three outcomes of interest; namely, HbA1C, weight, and SBP. RESULTS: One hundred patients had at least the first visit in the clinic and 98 patients came for a second follow-up visit while on the medication. Adherence of clinicians to the internal criteria for prescribing liraglutide was 92%. Patients’ ages were 47.9 ± 11.7 years. Male-to-female ratio was almost 1:1. Overall, in the paired analyses, HbA1C decreased from first to second visits (8.7 ± 1.9 vs. 7.6 ± 1.8, P , 0.0001) and remained unchanged in subsequent visits (eg, in visit 3, HbA1C was 7.4 ± 1.8). Patients lost an average of 1.3 kg between the first and second visits (99.3 ± 19.3 vs. 98.0 ± 19.5, P = 0.0003). The reduction in SBP between visits 1 and 2 was less (130.9 ± 15.8 vs. 129.9 ± 16.5, P = 0.5896). ANOVA yielded a significant reduction in HbA1C at 4 months and 6 months (P values , 0.05). SBP dropped by about 3.6 mmHg and weight by about 2.3 kg (P values . 0.05( CONCLUSIONS: Liraglutide is effective in reducing HbA1C, weight, and to a lesser extent, SBP in Emirati patients.
Keywords : liraglutide, diabetes mellitus, type II, Emirati
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Influence of Macrolide Susceptibility on Efficacies of Clarithromycin and Azithromycin against Streptococcus pneumoniae in a Murine Lung Infection Model
Authors : Holly L. Hoffman, Michael E. Klepser,* Erika J. Ernst, C. Rosemarie Petzold, Loai Mohammed Sa’adah, and Gary V. Doern
Abstract : We evaluated the activities of clarithromycin and azithromycin against 19 isolates of Streptococcus pneumoniae using a neutropenic lung infection model. The isolates included five susceptible isolates (clarithromycin and azithromycin MICs, <0.12 g/ml), nine isolates exhibiting low-level, mefA-mediated resistance (clarithromycin and azithromycin MICs, 0.5 to 32 g/ml), and five isolates expressing high-level, ermB-mediated macrolide resistance (clarithromycin and azithromycin MICs, >64 g/ml). Infected mice were administered either saline (control), clarithromycin (4, 40, or 200 mg/kg of body weight twice daily or 200 mg/kg once daily or azithromycin (4, 40, or 200 mg/kg once daily or 40 mg/kg twice daily) by oral gavage for 72 h. Mortality was assessed at regular intervals for 10 days, and survival in each group was compared to that of untreated controls. Animals infected with susceptible isolates demonstrated significant improvement in survival compared to the controls following treatment with either agent at doses of >40 mg/kg. In contrast, none of the regimens improved the survival of animals infected with isolates exhibiting high-level macrolide resistance Among mice infected with strains expressing low-level resistance, significant improvement in survival compared to the controls was noted among isolates treated with clarithromycin at 40 (seven of nine isolates) and 200 (nine of nine isolates) mg/kg twice a day and with azithromycin at 40 (one of nine isolates) and 200 (three of nine isolates) mg/kg once a day. Animals infected with isolates of S. pneumoniae exhibiting low-level mefA-mediated macrolide resistance responded to treatment with clarithromycin at rates similar to those observed among mice infected with fully susceptible isolates.
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Concordance Among Methods for Empiric Renal Drug Dosing: Meropenem as a Role Model for Clinical Superiority of Cockroft–Gault or Modification of Diet in Renal Disease
Authors : Sabaa M Al Jasmi, Amer H Khan, Loai M Saadah, Syed Azhar Syed Sulaiman and Doaa Kamal Al Khalidi
Abstract : Object ive: The objectives of this study are, first, to measure concordance between 5 different renal function estimates (methods) in terms of recommended drug doses, and, subsequently, to establish the potential for significant clinical differences between Cockroft–Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations in dosing a specific medication, namely, meropenem Des ign and sett ing: This study used a Monte Carlo simulation, and this is a computer–based study with no actual patient data. Pat ients : A total of 1200 and 8701 simulated cases to study the concordance for the 5 methods and the potential clinical significance of discordance between CG and MDRD, respectively, were chosen for the study. Met hods : Simulated factors were age, sex, height, weight, serum creatinine, ethnicity, and albumin. We estimated the renal function using5 formulas (ie, 10 combinations) including CG, MDRD, and Chronic Kidney Disease Epidemiology Collaboration (CKD–EPI). Next, the team evaluated concordance for each combination in dosing 22 drugs. Finally, our researchers reviewed and simulated data from the literature to show how CG versus MDRD use can result in clinically significant differences for meropenem. Res ults : Pairwise combinations yielded statistically significant differences (P < .0001) except for CG and MDRD (P < .5147). In addition, the highest concordance was for MDRD and CKD–EPI. Average discordance is in the range of 25% to 30% with the lowest being between CG and albumin–based estimates. Both CG and MDRD were largely discordant which can reach up to 40% with a drug like meropenem and may be associated with significant adverse outcomes. Conclusions: Both CG and MDRD in our simulation are statistically comparable. Clinically, nonetheless, they are significantly inconsistent in terms of recommended drug dosing. We encourage practical comparisons of outcomes for individual or groups of medications (eg, meropenem and antibiotics) empirically dosed in renal patients on the basis of equations used in distinct populations.
Keywords : Cockroft–Gault, Modification of Diet in Renal Disease, renal, dosing, concordance, discordance, estimate, simulation, clinical
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Progressive myoclonic epilepsy type 1: Report of an Emirati family and literature review
Authors : Mohammed Saadah , Mahfoud El Beshari, Loai Saadahb, Hisham Hamdallah, Zeinab Alloubc Amani Ali Al Zaabi , Abdelmatlob Ben-Mussa , Anwaar Ben-Nour
Abstract : Purpose: Progressive myoclonic epilepsy type one is a neurodegenerative disorder characterized by action- and stimulus-sensitive myoclonus, tonic–clonic seizures, progressive cerebellar ataxia, preserved cognition, and poor outcome. The authors report clinical, neurophysiological, radiological, and genetic findings of an Emirati family with five affected siblings and review the literature. Methods: All data concerning familial and clinical history, neurologic examination, laboratory tests, electroencephalogram, brain imaging, and DNA analysis were examined. Results: Genetic testing confirmed the diagnosis of autosomal recessive progressive myoclonic epilepsy type 1 (EPM1) in two males and three females. The median age at onset was three years. Action- or stimulus-sensitive myoclonus and generalized seizures were recorded in 100% of our patients, at median age at onset of 3 and 4 years, respectively. Multisegmental myoclonus and generalized status myoclonicus were observed in 80% of our patients. Dysarthria and ataxia developed in 100% of our patients. Vitamin D deficiency and recurrent viral infections were noticed in 100% of our cohort. Cognitive, learning, and motor dysfunctions were involved in 100% of our patients. The sphincters were affected in 60% of our patients. Abnormal EEG was recorded in 100% of our cohort. Generalized brain atrophy progressively occurred in 60% of our patients. Phenytoin and carbamazepine were used in 60% of our patients with worsening effect. Valproate and levetiracetam were used in 100% of our patients with improving effect. Conclusions: This is the first to report a family with EPM1 in UAE. Our study emphasized a particular phenotype expressed as earlier disease onset, severemyoclonus, and generalized seizures. Cognitive, cerebellar,motor, and autonomic dysfunctions and brain atrophy were also earlier at onset and more severe than previously reported. Recurrent viral infections are another unique feature. This constellation in tout à fait was not previously reported
Keywords : Unverricht–Lundborg disease Progressive myoclonic epilepsy EPM
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Homocystinemia and stroke in vegetarians
Authors : Mohammed A. Saadah, Mona C. Thakre, Loai M. Saadah, Mahmoud E. Nazzal
Abstract : Homocysteine is a sulfurated amino acid with a central role in the metabolism of thiol compounds. Homocystinemia is a recognized independent potentially remediable risk factor for vascular disease. It is associated with both macro and micro vascular ischemic stroke. It can often be normalized by polyvitamin therapy. This inexpensive and well-tolerated treatment is considered effective in decreasing the incidence of stroke. We report 2 young strict vegetarians with no known vascular risk factors. The first suffered a left middle cerebral artery infarct, and the second multiple bilateral small cerebral infarctions. Extensive investigations showed moderately elevated homocysteine and low serum B12 levels, suggesting that these are most probably the underlying etiology. We believe that a high index of suspicion is needed, particularly in younger people with a potential underlying cause for B12 deficiency and no identifiable stroke risk factor.
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Acute ischemic stroke: Relationship of brain lesion location & functional outcome
Authors : MAHMOUD EZZAT NAZZAL, MOHAMMED AHMED SAADAH LOAI MOHAMMED SAADAH5 & SUAD MUSTAFA TREBINJAC
Abstract : Purpose. To establish, using brain spiral computerised tomography (SCT) and modified Barthel index (MBI), whether the location of cerebral infarction could be correlated with functional outcome in acute ischemic stroke patients who undergo early intensive rehabilitation. Methods. Observational cohort, assessor blinded and correlational prospective 12-weeks study that included 111 acute ischemic stroke patients, admitted consecutively to an early intensive inpatient rehabilitation programme (5 days a week,3–5 h a day) during 2003. Confirmation of diagnosis and stratification was done by brain SCT. Brain lesion locations were correlated to motor performance and functional outcome, on admission and discharge, using MBI. Results. Statistical analysis demonstrated a significant correlation between motor performance, functional outcome and brain lesion locations. The groups with deep, combined deep and large superficial, small superficial and large superficial infarcts showed the most consistent improvement in that order of frequency. Normal brain SCT group did not reach statistical significance (p¼0.051) while the bi-hemispheric infarcts group did not show any change. The inter and intra group differences were highly significant (p50.05). Conclusions. Immediate non-contrasted brain SCT may act as an independent predictor of final functional outcome in acute ischemic stroke. It may provide clinicians with an opportunity to offer realistic expectations to stroke patients and their relatives.
Keywords : Ischemic stroke, spiral CT brain, MBI, functional outcome
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Atypical presentations of conus medullaris and filum terminale myxopapillary ependymomas
Authors : Mohammed Sa’adah, Kassem Al Shunnar, Loai Saadah, Ahmed Shogan, Jihad Inshasi, Hani Afifi
Abstract : Summary Out of 27 cases of spinal ependymomas seen during a 21 year period (1978–1999), we observed three out of 12 myxopapillary tumours of the conus medullaris and filum terminale with atypical presentations. All the three cases presented with subarachnoid haemorrhage and intracranial hypertension. In addition, the second patient developed persistently low CSF sugar, while the third patient developed hydrocephalus, acute autonomic crisis and SIADH. Although subarachnoid haemorrhage (SAH), intracranial hypertension and hydrocephalus were previously scarcely reported in the literature, the low CSF sugar, acute autonomic crisis and SIADH were never reported singly or in combination. Up to our best knowledge, this is the first report that clearly outlines all these atypical manifestations in this particularly interesting neoplasm. Hence, the above challenging clinical presentations should be borne in mind with cryptic presentations of lower spinal cord and filum terminale ependymomas. A proposal of the mechanism of their production is suggested.
Keywords : myxopapillary ependymomas, atypical presentations, conus-filum
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Intracephalic glomus tumor presenting as peripheral neuropathic pain and literature review
Authors : Mohammed Ahmed Saadah, Mahfoud El Beshari, Mwaffaq Al Heis, Loai M Saadah, Amani Ali Al Zaabi, Abdul Rahman Al Bloushi, Gamal Rashid
Abstract : Background: Glomus tumors are benign highly vascular neoplasms, originating from glomus body and sprout in subcutaneous layer of acral parts, particularly subangual or digital pulp locations. Extra digital glomus tumors were reported in palm, feet, ear, tongue, nose, mouth, vagina and glans penis. Extra cutaneous glomus was rarely seen in strointestinal tract, mesentery, mediastinum, trachea, and cervix, with infrequent occurrence in muscles, bones, periosteal, and intraneural layers. The subcutaneous layer of forearm is the most common extra digital location; however, it is exceedingly rare in intravascular layer of forearm. We are reporting an intracephalic glomus tumor presenting as peripheral neuropathic pain. This presentation was not previously reported in literature. Case report: A 38-year-old male presented with two years history of spontaneous and nocturnal right forearm pain, provoked by exposure to cold, light touch or brushing of skin. Non painful stimulus and painless touch evoked allodynia, and hyperesthesia respectively. Neurologic examination was negative apart from focal tenderness with no sensory alterations. Grey scale and colored ultrasound, MR and CT venography demonstrated an echo poor small round and avidly enhancing lesion in right cephalic vein. Complete surgical excisional resection was performed. Gross examination revealed dark-red, well defined soft tissue tumor, and histopathology confirmed glomus tumor. Symptoms completely resolved postoperatively. Conclusion: Intravascular glomus tumors rarely occur in forearm; and exceedingly rare to present as neuropathic pain, therefore, comprehensive history, and thorough physical examination, neuroimaging techniques, and early surgical excision will likely prevent delayed or incorrect diagnosis.
Keywords : Glomus, Glomangioma, Extra digital, Intravascular, Neuropathic pain, MRI
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Palivizumab Prophylaxis during Nosocomial Outbreaks of Respiratory Syncytial Virus in a Neonatal Intensive Care Unit: Predicting Effectiveness with an Artificial Neural Network Model
Authors : Loai M. Saadah, Fares D. Chedid, Muhammad R. Sohail, Yazied M. Nazzal Mohammed R. Al Kaabi, and Aiman Y. Rahmani
Abstract : STUDY OBJECTIVE To identify subgroups of premature infants who may benefit from palivizumab prophylaxis during nosocomial outbreaks of respiratory syncytial virus (RSV) infection. DESIGN Retrospective analysis using an artificial intelligence model. SETTING Level IIIB, 35-bed, neonatal intensive care unit (NICU) at a tertiary care hospital in the United Arab Emirates. PATIENTS One hundred seventy six premature infants, born at a gestational age of 22–34 weeks, and hospitalized during four RSV outbreaks that occurred between April 2005 and July 2007. MEASUREMENTS AND MAIN RESULTS We collected demographic and clinical data for each patient by using a standardized form. Input data consisted of seven categoric and continuous variables each. We trained, tested, and validated artificial neural networks for three outcomes of interest: mortality, days of supplemental oxygen, and length of NICU stay after the index case was identified. We compared variable impacts and performed reassignments with live predictions to evaluate the effect of palivizumab. Of the 176 infants, 31 (17.6%) received palivizumab during the outbreaks. All neural network configurations converged within 4 seconds in less than 400 training cycles. Infants who received palivizumab required supplemental oxygen for a shorter duration compared with controls (105.2 7.2 days vs 113.2 10.4 days, p=0.003). This benefit was statistically significant in male infants whose birth weight was less than 0.7 kg and who had hemodynamically significant congenital heart disease. Length of NICU stay after identification of the index case and mortality were independent of palivizumab use. CONCLUSION Palivizumab may be an effective intervention during nosocomial outbreaks of RSV in a subgroup of extremely low-birth-weight male infants with hemodynamically significant congenital heart disease.
Keywords : artificial, neural networks, palivizumab, respiratory syncytial virus, nosocomial, outbreak, premature
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Does Ringer Lactate Used in Parkland Formula for Burn Resuscitation Adequately Restore Body Electrolytes and Proteins?
Authors : Medhat E. Habib, Loai M. Saadah, Mazen Al-Samerrae, Fathy E. Shoeib,Mahaba Mamoun3, Gehan A. Latif, Dalia M. Habib
Abstract : Objective: Evaluation of the effect of Ringer Lactate, as the resuscitative burn fluid according to Parkland Formula, on restoring the levels of body electrolytes and proteins. Design: A retrospective cohort study. Setting: The National Burns Unit, Mafraq Hospital, Abu Dhabi, United Arab Emirates (UAE). Patients: One hundred and fifteen patients admitted with fresh burns between 1st of January 2011 and 31st of December 2013, who met inclusion and exclusion criteria. Methods: Team collected demographic and clinical data for each patient using a standard form. Patients received Ringer Lactate solely as the resuscitative burn fluid according to Parkland Formula. Baseline (pre-) and third-day (post-) variables included levels of sodium, potassium, chloride, proteins and albumin. Researchers then performed paired comparisons of serum electrolytes and protein levels. Results: Mean values showed maintenance of the potassium and chloride levels within the normal range after administering the Ringer Lactate, significant decline in sodium, and a marked hypoproteinaemia and hypoalbuminaemia post-resuscitation. Conclusions: Ringer Lactate used as the mere resuscitative post burn fluid is suboptimal. Sodium supplementation may be required to correct hyponatremia. Colloids, preferably intravenous albumin should be added, as advised by the original Parkland Formula.
Keywords : Ringer Lactate, Burn, Parkland, Electrolytes, Proteins
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Attention deficit hyperactivity disorder: Current status and future perspectives
Authors : MA Saadah, LM Saadah
Abstract : Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioural syndrome of childhood onset. It can be diagnosed by a competent paediatric neuropsychiatrist, although a multidisciplinary team approach is preferable. As yet, there is no single treatment strategy proven to cure this syndrome and no long-lasting documented effects once the adopted line of treatment is withdrawn. A combined therapeutic approach that includes pharmaceutical and nonpharmaceutical treatments is used in the management of ADHD in the developed countries – an approach that cannot be used in the developing countries, which do not have well structured health services. The need for further research is paramount, as a deeper understanding of the complex neural network is an important preliminary step. This article argues that multiple paradoxes found within the concept of ADHD will open new horizons in the aetiopathogenesis, molecular basis and treatment approaches of this syndrome.
Keywords : ADHD, epidemiology, aetiopathogenesis, molecular genetics, neurobiology, treatment
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Management options of chronic low back pain A randomized blinded clinical trial
Authors : Mahmoud E. Nazzal, Mohammed A. Saadah, Loai M. Saadah, Mahmoud A. Al-Omari, Ziad A. Al-Oudat, Mohammed S. Nazzal, Mahfoud Y. El-Beshari, Amani A. Al-Zaabi, Yousif I. Alnuaimi.
Abstract : Objective: To compare efficacies of 2 active programs in the management of chronic low back pain (CLBP( Methods: This prospective, stratified, randomized single-blinded controlled study was conducted in the Department of Rehabilitation Medicine King Abdullah University Hospital, Irbid, Jordan, between February and December 2010. A total of 100 patients were randomized to either 6-weeks of multidisciplinary rehabilitation (group A) or therapist-assisted exercise (group B). At baseline and 6 weeks, the visual analogue scale (VAS) pain score was estimated, as a primary outcome measure. McGill pain score, Oswestry Disability Index (ODI), trunk forward flexion and extension, left and right lateral bending, were applied before and after treatment and were employed as secondary outcome measures Results: All outcome measures significantly improved in group A after treatment, compared with group B. The VAS, McGill, ODI scores, left and right lateral bending decreased significantly, whereas forward and backward bending increased. A significant number of patients returned to work in group A at the end of 6 weeks, compared with group B. These effects were maintained over 12 and 24 weeks of follow-up. Conclusion: Multidisciplinary rehabilitation improved functional indices and pain scale scores in group A compared with B. This would be an effective strategy in CLBP management.
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