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Papers by Hind Almodaimegh

International Journal of Medical Research and Health Sciences, 2019

Objectives: To examine the association between hypoglycemia requiring presentation at an emergenc... more Objectives: To examine the association between hypoglycemia requiring presentation at an emergency department and patient health outcomes in terms of duration of hospital stay and mortality rate. Method: A retrospective chart review study of all patients with hypoglycemia as the primary diagnosis admitted to the emergency department and met the inclusion criteria was conducted at King Abdulaziz Medical City in Riyadh (Saudi Arabia) between January 2015 and March 2016. Data were collected from an electronic health records database (Best care) and medical charts and pharmacy records were reviewed. Results: A total of 51 patients were included in the study. Twenty-two patients (42.31%) were admitted because of hypoglycemia. The total mortality rate was 3.92% (2 patients). The total length of hospitalization was higher in deceased patients (4.00 ± 4.24 days) compared to that in surviving patients (1.45 ± 1.21 days). At presentation, 22 patients (44.00%) had no prior interventions; nine were hypoglycemic, while 13 were non-hypoglycemic. In contrast, five patients (10.00%) received hypoglycemic intervention prior to arrival in the ER; one was hypoglycemic, and four were non-hypoglycemic. There was a zero mortality rate among patients who received pre-arrival interventions compared to a rate of 9.09% among patients who did not receive pre-arrival interventions. The chi-square test was used to assess statistical significance. Conclusion: In conclusion, this study shows no correlation between hypoglycemia and mortality or the total duration of hospitalization. In addition, there was no significant relationship between the incidence of hypoglycemic events and different comorbidities.

International Journal of Medical Research and Health Sciences, Jul 7, 2018

Introduction: Considering the threat imposed by postoperative atrial fibrillation (POAF) after co... more Introduction: Considering the threat imposed by postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) and the potential benefits of off-pump CABG, the objective of this study was to describe the incidence and identify predictor factors for POAF in patients undergoing CABG without cardiopulmonary bypass (CPB). Methods: In this retrospective cohort study, we enrolled patients undergoing CABG without CPB between December 2008 and December 2011. The independent variables evaluated in this study were major patients' characteristics (age, sex, and ethnia), associated comorbidities (systemic arterial hypertension, diabetes mellitus, thyroid dysfunction, chronic renal failure (CRF), chronic obstructive pulmonary disease, and ischemic stroke), and the revascularization approach (the number of grafts used, the revascularized branch, and the choice of vascular graft (arterial or venous). The dependent variable was the onset of atrial fibrillation after the procedure. Results: Two hundred and eighty patients were included in the present study. The overall incidence of POAF after off-pump CABG was 5.0%. In the univariate analysis, the presence of chronic renal failure (odds ratio [OR], 3.

Saudi critical care journal, 2019

Neuromuscular-blocking agents (NMBAs) are a cornerstone in the management of critically ill patie... more Neuromuscular-blocking agents (NMBAs) are a cornerstone in the management of critically ill patients. There is evidence supporting short course (<48 h) of paralysis for patients with moderate-to-severe acute respiratory distress syndrome with PaO2/FiO2 ratio <150. Proper knowledge of these agents and their evidence-based use is fundamental. Health-care providers can play an important role in the regulation and the use of NMBAs in critically ill patients.

Value in Health, May 1, 2019

Objectives: Statins are effective in reducing low-density lipoprotein cholesterol (LDL-C) and car... more Objectives: Statins are effective in reducing low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease risk, however, despite treatment, patients in the real-world setting may not reach lipid goals. Ensuring timely treatment intensification (TI) is important in reducing the risk of adverse outcomes. The objectives of this study, conducted in patients with ASCVD and baseline LDL-C.70 despite existing statin therapy were to (a) To evaluate predictors of TI (b) To assess the association between TI and LDL-C lowering. Methods: A retrospective cohort study was conducted using Truven MarketScan database from 2013-2017. The first prescription of statin between January 2014-February 2016 was identified as the index date. A preindex period of 180 days to identify baseline characteristics and a follow-up period of 360 days for outcomes was determined. TI was defined as an increase in the intensity of statin from low to moderate, moderate to high or low to high. Logistic regression was conducted to identify predictors of TI. To measure the effect of TI on LDL-C reduction, multiple linear regression with follow-up LDL-C as the outcome was performed. Results: There were 14,395 patients included in the study with 3,909 patients having follow-up LDL-C values. TI in the follow-up was observed in 1,914 (13.30%) patients. Age older than 75 [OR: 0.7(95%CI: 0.59-0.84)] was associated with lower likelihood of TI in the multivariable logistic regression model. Baseline characteristics positively associated with TI included higher LDL-C value and adherence, low and moderate statin intensity, male sex and diabetes. For patients with follow-up LDL-C values, TI was associated with significant mean reduction in LDL-C (b:-9.68, p=,0.0001). Conclusions: Even though TI was associated with significant LDL-C lowering, a significant proportion of patients not at goal were not intensified. Future studies need to examine the relationship of TI with factors such as patient adherence and side-effects as well as cardiovascular outcomes.

Cureus, Sep 12, 2020

Background Hyperkalemia is a serious life-threatening condition that leads to significant morbidi... more Background Hyperkalemia is a serious life-threatening condition that leads to significant morbidity and mortality. Objectives The aim of this study is to investigate the association between the duration and outcomes in patients hospitalized with hyperkalemia, as well as associated risk factors and drug-induced hyperkalemia. Methods A three-year retrospective chart review study was conducted at a tertiary hospital at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between January 2016 and April 2019. We included all hospitalized adults and patients with hyperkalemia. Pediatric patients and dialysis patients with end-stage renal failure were excluded. Results Out of a total of 300 hospitalized patients who were screened for hyperkalemia, only 142 patients were included. The majority of cases were males (56.3%), whereas 43.7% were females. Most patients were above 55 years old. Regarding comorbidities in patients with hyperkalemia, most of them suffered from high blood pressure or diabetes. The mean serum potassium value was 5.7 ± 0.51 mEq. The most frequent medications used in the study population were azole antifungal medication followed by nonsteroidal anti-inflammatory drugs, beta-blockers, and angiotensin-converting enzyme inhibitors. Around 54 patients were not treated with medication and were monitored for spontaneous correction of hyperkalemia. Insulin was the most used medication for the treatment of hyperkalemia. The mean duration for the resolution of hyperkalemia was 12 ±9.4 hours. Out of 142 patients, only 10 (7%) patients died with hyperkalemia. Conclusions Hospitalized patients are at risk of hyperkalemia. In our study, we found that patients who had hyperkalemia were significantly likely to have acute kidney injury or cardiovascular diseases, and azole antifungals and beta-blockers were the most commonly used medications.

International Journal of Medicine in Developing Countries

Background: Excessive daytime sleepiness (EDS) is a significant problem especially among medical ... more Background: Excessive daytime sleepiness (EDS) is a significant problem especially among medical students, which is affecting negatively the quality of their lives. We aimed to assess the prevalence of this issue and encourage healthy and adequate sleep to improve the academic performance of medical students. The Epworth Sleepiness Scale (ESS) has been used in this study. Methods: This cross-sectional study targeted medical students and interns from different universities in Saudi Arabia. The survey included three parts: socio-demographic data, the Kessler Psychological Distress Scale (K10), and ESS. The data were collected from July to August 2021. A total of 1,295 participants were included in the study. Results: On the ESS, (62.69%) of the students had a normal range of sleepiness with (10.88%) having severe sleepiness. While on the K10 test, (70.19%) had no psychological distress, and only (5.5%) of the students had very high psychological distress. A higher score on the ESS is ...

International Journal of Public Health and Clinical Sciences, 2018

Background: Obesity has been recognized by most physicians and some public as a chronic disease a... more Background: Obesity has been recognized by most physicians and some public as a chronic disease associated with increased risk of several health-related complications that could necessitate medical interventions. Study Design: A cross-sectional questionnaire-based survey was used to assess experiences and knowledge of primary care physicians towards current guidelines for management of obesity and to explore possible barriers for optimal obesity management. Result: 91 physicians were recruited into this study, 32 were family medicine (FM) and 59 were internal medicine (IM). Analysis of data revealed an overall overweight with mean BMI of 26.8 ± 5.8 kg/m 2 . No significant difference was found between BMIs or age groups of FM and IM physicians. Although, 96.7% of participants recognized risks associated with obesity, only 9.9% believed in the feasibility of obesity treatment. The main perceived causes of obesity by physicians were junk foods and sedentary lifestyle. A number of barri...

International Journal of Medical Research and Health Sciences, 2020

Objectives: To assess the use of Midodrine among patients with orthostatic hypotension and withdr... more Objectives: To assess the use of Midodrine among patients with orthostatic hypotension and withdrawal vasopressin in King Abdulaziz Medical City (KAMC), demonstrate the effectiveness and safety of Midodrine and detect side effects to provide clear evidence of the efficacy and safety of the drug. Methods: A retrospective cohort study was done in King Abdulaziz Medical City in Riyadh (Saudi Arabia). The study targeted adult patients who suffered from hypotension between January 2015 and January 2018. The data was extracted using the BESTCare system. Results: A total of 173 patients were included (55.5% male and 44.5% female). The mean age of the study participants was 67.34 ± 16.0 years. The differences in patients’ parameters before and after midodrine administration were detected and analyzed. The mean difference in hemoglobin (g/l) level was significantly changed before (94.97 ± 21.9) and after (90.84 ± 20.4) the use of Midodrine (p=0.031). However, there were no significant change...

International Journal of Medicine in Developing Countries

International Research Journal of Public and Environmental Health, Feb 16, 2020

Currently, many pharmacists suffer from burnout as a result of high demand for their services, la... more Currently, many pharmacists suffer from burnout as a result of high demand for their services, lack of resources, shortage of pharmacy staff. No studies in Saudi Arabia among hospital pharmacists have focused on burnout. Therefore, this study was conducted to assess the prevalence of burnout among pharmacists at the National Guard Hospital (NGHA).A cross-sectional study was conducted at National Guard Hospital (NGHA) Riyadh, Saudi Arabia. Data were collected using a questionnaire through Google form by a smart device. The questionnaire consists of two sections: the first section is demographic data while the second section is the Maslach Burnout Inventory for Health Services Workers (MBI-HSS). Participants were selected by the non-probability consecutive sampling method. They were 159 full-time employees working in the hospital, including clinical pharmacists, pharmacy residents, general pharmacists, and pharmacy technicians. Forty employees (25.16%) had high emotional exhaustion, 89 (55.97%) had high depersonalization, and 101 (63.52%) had low scores for personal accomplishment. The common criteria are high emotional exhaustion, high depersonalization, and low personal accomplishment which indicated pharmacists with burnout (17.6%). Roughly, a quarter of the National Guard Hospital pharmacists have burnout. A correlation between personal accomplishment, gender, and the number of exercises per week is significant. Pharmacy employee satisfaction with their income, age and the number of sleeping hours per day was inversely correlated with emotional exhaustion and depersonalization level.

<sec> <title>UNSTRUCTURED</title> <p>In response to the announcement of c... more <sec> <title>UNSTRUCTURED</title> <p>In response to the announcement of coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization on March 11, 2020, a worldwide closure of schools and educational institutions has been implemented to combat the spread of the disease. This has resulted in transferring from face-to-face teaching to virtual schooling and e-learning to continue the second semester of the academic year 2019-2020. The main objective of this article is to review and reflect on the experience of the College of Pharmacy at King Saud Bin Abdulaziz University for Health Sciences in implementing action plans concerning applying e-learning in the delivery of the remaining curriculum and assessment methods after the announcement of COVID-19 pandemic. The feedback of the students was surveyed to address issues of preparedness, attitude and barriers concerning e-learning. Action plans were implemented at the university and the college levels. The educational process went very smooth by e-learning and several assessment methods have been applied in continuous assessment and final examinations. A total of 170 contact hours have been delivered by live broadcasting whereas 125 contact hours were recorded. Minimal number of lectures and topic discussion sessions have been deleted and some have been transferred to the next semester. The survey results indicated good satisfaction of the students in the e-learning process were approximately 75% of them have responded to a survey that was prepared for this purpose. This experience could provide a helpful guidance and insight to deal with such a crisis to rapidly move from regular educational activities by face-to-face teaching to e-learning.</p> </sec>

This study aimed to assess knowledge and perception of pharmacovigilance in addition to identifyi... more This study aimed to assess knowledge and perception of pharmacovigilance in addition to identifying the plausible barriers for employing an effective ADRs reporting system from the perspective of healthcare students. A questionnaire-based survey was conducted among randomly selected students from five healthcare colleges. The overall knowledge score of 367 respondents was 5.1±2.1 (out of 10) that reflects substantial knowledge deficits in principles of pharmacovigilance and ADRs reporting. College of Pharmacy students and students in the third and fourth academic years demonstrated relatively significant higher knowledge scores (7.3±1.6, 5.5±2.1 and 6.2±2.1, respectively) compared to other students. On the other hand, 99.5% of respondents expressed a pronounced negative perception towards pharmacovigilance with an overall mean score of 22.0±3.9 (out of 50).Although, the vast majority of respondents had unanimously agreed on the importance of ADRs reporting, most of them felt unconfident, because they were either uncertain or unprepared to do so. The major recognized barriers for employing an effective ADRs reporting system were knowledge deficits and insufficient training received during academic and internship stages. In conclusion, this study revealed significant knowledge deficits and negative perception among most healthcare students owning to the lack of awareness and deficiencies in the colleges' program curricula.

The Egyptian Journal of Hospital Medicine, 2018

Background: The use of complementary and alternative medicine (CAM) for treatment purposes in Sau... more Background: The use of complementary and alternative medicine (CAM) for treatment purposes in Saudi Arabia is a common practice by the public. Studies have found that using these products is not always a safe practice. Research has showed that many of CAM products could result in fatal adverse effects either when used alone or combined with conventional medicine. Health institutions are currently working on increasing the awareness of these adverse effects and the proper utilization of CAM, however addressing the knowledge gap among healthcare professionals is still an area of demand. Thus, this study aims to assess the knowledge and attitude of primary and specialized physicians at King Abdulaziz Medical City KAMC about CAM. Method: This is a cross sectional study based on an interview structured questionnaire that was validated through pilot testing and distributed among physicians in the following fields at KAMC; internal medicine, family medicine, Surgery, pediatrics, and obstetrics and gynecology. We included physicians from both genders, any nationality, and excluded all physicians who have not been practicing for more than one year. The minimum sample size required was 231. All the data were entered and analyzed by SPSS software version 21. A confidence interval of 95% was used and a P value less than or equal.05 is significant. Results: The research team was able to interview 220 physicians from different specialties and occupation with a response rate of 95.5%. The overall results were that the majority of participants (73.7%) had a poor knowledge about CAM. Also, it was found that there is no correlation between the level of knowledge and the specialty (P=0.26). Unlike Saudi physicians who believe in the beneficence of CAM, non-Saudis tend to have a more negative attitude toward this practice (P= 0.023). Resident and newly practicing medicine physicians had more positive attitude toward CAM compared to physicians with long history of practice (P=0.037). Almost 50% of our participants have obtained some knowledge about CAM from websites, books, and EBM articles. 81.1 % of the physicians insisted on the importance of receiving formal education about CAM. Conclusion: In conclusion we recommend that education about CAM to be given in the form of seminars, lectures, or part of the medical school curriculum. We also emphasize that this education should not be given to a certain medical specialties as our result showed that the knowledge and attitude toward CAM does not have a correlation with specialty.

Cureus, 2021

Background and objective Hypertension (HTN) is a common disease among patients who visit primary ... more Background and objective Hypertension (HTN) is a common disease among patients who visit primary healthcare clinics. Uncontrolled HTN is associated with increased morbidity and mortality; therefore, awareness of its risk factors and adherence to treatment can lead to better control of HTN. In this study, we aimed to determine the level of adherence to treatment and satisfaction among Saudi hypertensive patients. Methods In this cross-sectional study, we used an interviewer-administered questionnaire among hypertensive patients aged 40 years or older who attended primary healthcare centers in the five main regions within Saudi Arabia. We excluded patients with mental disorders, dementia, or those unable to provide consent to participate. The estimated sample size was 384 patients as calculated by Raosoft® based on the AlNozha study (prevalence of HTN in Saudi Arabia is 26.1%). The questionnaire included questions about demographic data, awareness about HTN risk factors and complications, adherence to treatment, and patient satisfaction along with the information related to management from their physicians. Microsoft Excel was used for data entry, and SPSS Statistics version 23 (IBM, Armonk, NY) was used for statistical analysis. Results Of the 384 hypertensive patients recruited, most were in the age group of 40-49 years (36.5%), and the majority of them were female (75%). Most patients (n=305, 79.4%) reported good adherence to the management plan. Also, most of the patients (73.4%) were satisfied in terms of receiving simplified information and justification of the management plan from their physicians. Conclusions A good level of satisfaction was observed among patients of HTN in Saudi Arabia with respect to information, simplification, and justification of treatment plans provided by health professionals. This high satisfaction level accounts for the high adherence to the treatment plan.

P & T : a peer-reviewed journal for formulary management, 2018

Introduction The workflow of a P&T committee can become overwhelming and may be affected by many ... more Introduction The workflow of a P&T committee can become overwhelming and may be affected by many internal and external factors. Organization, standardization, and an enhanced systematic approach for drug evaluations are necessary to ensure that all requested drugs receive an equal and unbiased evaluation and consideration for addition based on the institution's objectives, priorities, and budget. Our aim was to create a scoring tool that would assist in systematically prioritizing drugs being requested for formulary addition and to eliminate cumbersome evaluations for drugs that clearly do not offer any additional advantage. Methods A working group consisting of P&T committee members met with the task of creating initial screening criteria for prioritizing drugs requested for formulary addition. Members conducted independent literature searches and focused meetings to develop a scoring tool that would be piloted on drugs being requested for addition. Results We developed a scori...

International Journal of Medical Research and Health Sciences, 2019

Background: The incidence of Venous thromboembolism (VTE) in pregnant women is 4-5 times higher t... more Background: The incidence of Venous thromboembolism (VTE) in pregnant women is 4-5 times higher than that in non-pregnant women, and the risk is increased postpartum. There are limited studies that assess the awareness of VTE among at-risk pregnant and postpartum women. Methods: A quantitative cross-sectional study including a validated survey was administered to pregnant women in the outpatient clinic and those hospitalized for labor at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. Results: Out of 340 participants, 57% correctly described the cause of deep vein thrombosis (DVT). Only 26.8% and 13.8% reported awareness of DVT and Pulmonary embolism (PE) respectively. About 32% of the participants who had previous knowledge about DVT, knew that swelling of the leg is one of its major symptoms, and only 25% recognized the shortness of breath as a major symptom of PE. Long periods of inactivity or undergoing surgery were correctly identified as key risk factors for develo...

Introduction: The workflow of a P&T committee can become overwhelming and may be affected by many... more Introduction: The workflow of a P&T committee can become overwhelming and may be affected by many internal and external factors. Organization, standardization, and an enhanced systematic approach for drug evaluations are necessary to ensure that all requested drugs receive an equal and unbiased evaluation and consideration for addition based on the institution’s objectives, priorities, and budget. Our aim was to create a scoring tool that would assist in systematically prioritizing drugs being requested for formulary addition and to eliminate cumbersome evaluations for drugs that clearly do not offer any additional advantage. Methods: A working group consisting of P&T committee members met with the task of creating initial screening criteria for prioritizing drugs requested for formulary addition. Members conducted independent literature searches and focused meetings to develop a scoring tool that would be piloted on drugs being requested for addition. Results: We developed a scorin...

This chapter provides an overview of the themes of the book. Largely in response to their own nat... more This chapter provides an overview of the themes of the book. Largely in response to their own national predicament in post-Union imperial Britain, Scottish writers of the Romantic period brought to the British Atlantic a historiography of collective or cultural memory, which imagined an unprecedented fissure within the flow of time that had rent the present from the past. This sense of an immense gulf between past and present – measured in only one or two generations and imagined to be within reach of, or just beyond, living memory – was attended by deep national anxieties but also by a renewed optimism, of social and cultural reinvention. As it circulated along the routes of the British empire, Scottish history writing of the period made a fundamental contribution to the culture of modernity in the Atlantic world.

Pediatric Research, 1992

Vascular endothelial damage is a major component of the physiological derangement seen in scptica... more Vascular endothelial damage is a major component of the physiological derangement seen in scpticacmia. The sulphated glycosaminoglycans (GAGS) are thought to be involved in regulating endothelial permeability, thromboresistance and leucocyte traffic across the blood vessel wall. Modulation of GAG metabolism may therefore be important in causing the capillaw leak and disseminated intravascular thrombosis often seen in bacterial sepsis. .WC h:\ve previously shown that lie cyrobnss 11. 1 and TNF modulale glycow&~noglyc~n mctabul~sm. resulun~r in a reductlon of Its~arln and dcrm~lan sulohdte from thc cell surface of culturcd hu'mon unLilical vein endothelii cell cultures (HUVEC); In the present study we have investigated the correlation between neutrophil activation and endothelial cell damage. To perform these experiments we hove developed an endothelial model of surface injury using a cytochemical technique to visualise both endolhelial GAGS and cellular fibronectin. Rcsults: We have demonstrated that the release of neutrophil proteases and neutrophil heparatinase are determined by the degree of both neutrophil and endothelial activation. When unstimulatcd neutrophils were added to HWEC prcstimulated with endotoxin, GAGS alone were derraded from the endothelial cell surface. However. when the formvl tri~e~tide,. .. . IMLP, was included in the incubation, we also observed extensive destruction of the protease sensitive flbronectin network. When endotoxin and fMLP were added simultaneously with the neulrophils there was minimal endothelial damage. Conclusion: These results indicate that both neutrophil and endothelial activation is necessary to cause the breakdown of endothelial GAGS and fibronectin. Thesf results may be important in understanding the n~echanisms of neutrophil induced endothelial damage in inflammation.

International Journal of Medical Research and Health Sciences, 2019

International Journal of Medical Research and Health Sciences, Jul 7, 2018

Saudi critical care journal, 2019

Value in Health, May 1, 2019

Cureus, Sep 12, 2020

International Journal of Medicine in Developing Countries

International Journal of Public Health and Clinical Sciences, 2018

International Journal of Medical Research and Health Sciences, 2020

International Journal of Medicine in Developing Countries

International Research Journal of Public and Environmental Health, Feb 16, 2020

The Egyptian Journal of Hospital Medicine, 2018

Cureus, 2021

P & T : a peer-reviewed journal for formulary management, 2018

International Journal of Medical Research and Health Sciences, 2019

Pediatric Research, 1992