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Papers by khizra sultana

Research paper thumbnail of Additional file 1: of Attitude, barriers and facilitators to practice-based research: cross-sectional survey of hospital pharmacists in Saudi Arabia

Survey Instrument. (DOCX 211 kb)

Research paper thumbnail of Development and Validation of a new model to predict bleeding risk score

Research paper thumbnail of Attitude of pediatricians towards suspected cases of child abuse and neglect in Saudi Arabia

Research paper thumbnail of Tele-pharmacy Anticoagulation Clinic Tele-pharmacy Anticoagulation Clinic during COVID-19 Pandemic: Patient's

Research paper thumbnail of Efficacy of favipiravir in adults with mild COVID-19: a randomized, double-blind, multicenter, placebo-controlled trial clinical trial

Clinical Microbiology and Infection

Research paper thumbnail of The development and validation of a multivariable model to predict the bleeding risk score for patients with non-valvular atrial fibrillation using direct oral anticoagulants in the Arab population

Background Frequently used models, such as the HAS-BLED, ATRIA, ORBIT, and GARFIELD-AF evaluate t... more Background Frequently used models, such as the HAS-BLED, ATRIA, ORBIT, and GARFIELD-AF evaluate the risk of bleeding when using an anticoagulant, for example warfarin, in patients with non-valvular atrial fibrillation. Limited studies are available reporting a model with a good discriminative ability to predict the bleeding risk score when using direct oral anticoagulants. Methods Patient data were collected from King Abdulaziz Medical City, King Fahad Cardiac Center, and Prince Sultan Cardiac Center in Riyadh, from outpatients, inpatients, or primary care clinics. In total, 1722 patients with a prescription for a new oral anticoagulant, Dabigatran, Rivaroxaban, or Apixaban, were enrolled. A resampling approach for variable selection was used and a five-fold cross-validation to assess the model fit and misclassification probabilities. The analysis used the receiver operating characteristics curve (ROC) and the concordance (c) statistic to assess the validation models’ discriminative...

Research paper thumbnail of Multicentre randomised double-blinded placebo-controlled trial of favipiravir in adults with mild COVID-19

BMJ Open

IntroductionA novel coronavirus, designated SARS-CoV-2, caused an international outbreak of a res... more IntroductionA novel coronavirus, designated SARS-CoV-2, caused an international outbreak of a respiratory illness, termed COVID-19 in December 2019. There is a lack of specific therapeutic agents based on evidence for this novel coronavirus infection; however, several medications have been evaluated as a potential therapy. Therapy is required to treat symptomatic patients and decrease the virus carriage duration to limit the communitytransmission.Methods and analysisWe hypothesise that patients with mild COVID-19 treated with favipiravir will have a shorter duration of time to virus clearance than the control group. The primary outcome is to evaluate the effect of favipiravir on the timing of the PCR test conversion from positive to negative within 15 days after starting the medicine.Adults (>18 years, men or nonpregnant women, diagnosed with mild COVID-19 within 5 days of disease onset) are being recruited by physicians participating from the Ministry of National Guard Health Af...

Research paper thumbnail of Attitude of pediatricians toward suspected cases of Child Sexual Abuse (CSA) in Saudi Arabia

International Journal of Pediatrics and Adolescent Medicine

Research paper thumbnail of Tele-pharmacy Anticoagulation Clinic During COVID-19 Pandemic: Patient Outcomes

Frontiers in Pharmacology

Introduction: It is well-established that clinical pharmacist-managed anticoagulation services ac... more Introduction: It is well-established that clinical pharmacist-managed anticoagulation services achieve superior anticoagulation control, with a positive impact. At King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, the structure of anticoagulation management is a pharmacist-managed specialty service. With the current COVID-19 situation, measures were taken to assure the continuity of patient care by establishing tele-pharmacy anticoagulation clinics.Materials and Methods: This was a prospective study with patients prescribed anticoagulation and followed up for 3 months. Since establishing the anticoagulation virtual clinic in March 2020, 270 patients were recruited in the study. The data collected included age, gender, comorbidities, indication for anticoagulation, intended duration of treatment, warfarin dose, testing of International Normalized Ratio (INR), INR target, range of INR values, time INR that was within the therapeutic range (TTR), and complications of therapy (b...

Research paper thumbnail of Mental Health Outcomes Amongst Health Care Workers During COVID 19 Pandemic in Saudi Arabia

Frontiers in Psychiatry

Objectives: The study aimed to assess the mental health outcomes and associated factors among hea... more Objectives: The study aimed to assess the mental health outcomes and associated factors among health care workers during COVID 19 in Saudi Arabia.Design, Setting, and Participants: We conducted a cross-sectional survey of health care workers from tertiary care and ministry of health Centers across the Central, Eastern, and Western regions of Saudi Arabia. There were 1,130 participants in the survey, and we collected demographic and mental health measurements from the participants.Primary Outcomes and Measures: The magnitude of symptoms of depression, anxiety, and insomnia was measured using the original version of 9-item patient health questionnaire (PHQ-9), the 7-item generalized anxiety disorder scale (GAD-7), and 7-item insomnia severity index (ISI). We use the multiple logistic regression analysis to identify the associated risk factors of individual outcomes.Results: The scores on the PHQ-9 showed that the largest proportion of health care workers (76.93%) experienced only norm...

Research paper thumbnail of Validation and Psychometric Properties of the Arabic Version of the Duke Anticoagulation Satisfaction Scale (DASS)

Frontiers in Pharmacology

Background: To assess the health-related quality of life (HRQoL) of oral anticoagulant therapy us... more Background: To assess the health-related quality of life (HRQoL) of oral anticoagulant therapy users, different types of instruments are available, either general or specific tools like Duke Anticoagulation Satisfaction Scale (DASS). These tools allow the clinician to adjust the treatment regimen to focus on increasing anticoagulation adherence and reduce adverse clinical outcomes. This study aims to validate the translated Arabic version of DASS to assess the satisfaction level of patients using oral anticoagulants in the Arab population.Methods: The Duke Anticoagulation satisfaction scale (DASS) was translated into the Arabic language using MAPI group services. DASS was administered to 505 patients receiving anticoagulation with warfarin or apixaban. The generic scale measuring the quality of life EQ-5D-5L was also administered. Psychometric properties were assessed by Confirmatory Factor Analysis, internal consistency (Cronbach’s Alpha), exploratory factor analysis, convergent an...

Research paper thumbnail of Association Between Minimum Inhibitory Concentration, Beta-lactamase Genes and Mortality for Patients Treated With Piperacillin/Tazobactam or Meropenem From the MERINO Study

Clinical Infectious Diseases

Introduction This study aims to assess the association of piperacillin/tazobactam and meropenem m... more Introduction This study aims to assess the association of piperacillin/tazobactam and meropenem minimum inhibitory concentration (MIC) and beta-lactam resistance genes with mortality in the MERINO trial. Methods Blood culture isolates from enrolled patients were tested by broth microdilution and whole genome sequencing at a central laboratory. Multivariate logistic regression was performed to account for confounders. Absolute risk increase for 30-day mortality between treatment groups was calculated for the primary analysis (PA) and the microbiologic assessable (MA) populations. Results In total, 320 isolates from 379 enrolled patients were available with susceptibility to piperacillin/tazobactam 94% and meropenem 100%. The piperacillin/tazobactam nonsusceptible breakpoint (MIC >16 mg/L) best predicted 30-day mortality after accounting for confounders (odds ratio 14.9, 95% confidence interval [CI] 2.8–87.2). The absolute risk increase for 30-day mortality for patients treated wit...

Research paper thumbnail of The effect of the VKORC1 promoter variant on warfarin responsiveness in the Saudi WArfarin Pharmacogenetic (SWAP) cohort

Scientific Reports

Warfarin is a frequently prescribed oral anticoagulant with a narrow therapeutic index, requiring... more Warfarin is a frequently prescribed oral anticoagulant with a narrow therapeutic index, requiring careful dosing and monitoring. However, patients respond with significant inter-individual variability in terms of the dose and responsiveness of warfarin, attributed to genetic polymorphisms within the genes responsible for the pharmacokinetics and pharmacodynamics of warfarin. Extensive warfarin pharmacogenetic studies have been conducted, including studies resulting in genotype-guided dosing guidelines, but few large scale studies have been conducted with the Saudi population. In this study, we report the study design and baseline characteristics of the Saudi WArfarin Pharmacogenomics (SWAP) cohort, as well as the association of the VKORC1 promoter variants with the warfarin dose and the time to a stable INR. In the 936 Saudi patients recruited in the SWAP study, the minor allele C of rs9923231 was significantly associated with a 8.45 mg higher weekly warfarin dose (p value = 4.0 × 10-46), as well as with a significant delay in achieving a stable INR level. The addition of the rs9923231 status to the model, containing all the significant clinical variables, doubled the warfarin dose explained variance to 31%. The SWAP cohort represents a valuable resource for future research with the objective of identifying rare and prevalent genetic variants, which can be incorporated in personalized anticoagulation therapy for the Saudi population. Warfarin is a frequently prescribed oral anticoagulant agent inhibiting the synthesis of the Vitamin K dependent clotting factors II, VII, IX, X as well as anticoagulation factors protein C and S. It also causes anticoagulation by inhibiting the Vitamin K-epoxide reductase complex, which result in the accumulation of reduced vitamin K2, 3-epoxide and vitamin K hydroquinone 1. Warfarin is indicated for the treatment or prophylaxis of patients with various disease states, including venous thromboembolic events 2 , atrial fibrillation and flutter 3 , cardiac surgery for valve replacement and orthopedic surgery 4,5. Warfarin exhibits a narrow therapeutic index and is monitored through the International Normalized Ratio (INR), which measures the ability of the blood to clot. The optimal effect of warfarin, for most of the indications, is when the INR ranges from 2 to 3, except for metallic atrial valve replacement, in which a higher INR value is required 6. Several studies reported ethnic differences in the warfarin response and dosage requirements 7-9. Even for populations with very close ancestry within the Middle East and North Africa (MENA) region, differences in

Research paper thumbnail of A comparison between warfarin and apixaban: A patient's perspective

Annals of Thoracic Medicine

Research paper thumbnail of Attitude, barriers and facilitators to practice-based research: cross-sectional survey of hospital pharmacists in Saudi Arabia

Journal of pharmaceutical policy and practice, 2016

Little is known about the perceived attitude, barriers and facilitators of Saudi Pharmacists abou... more Little is known about the perceived attitude, barriers and facilitators of Saudi Pharmacists about practice based research. We aimed to measure the attitude, barriers, and facilitators of Saudi hospital pharmacists towards pharmacy practice research. A cross-sectional survey of hospital pharmacists (n = 216) working in King Abdulaziz Medical Cities in Central, Eastern and Western region hospitals was conducted during first week of September, 2013. The survey instrument comprised of six different sections that explored pharmacists previous participation in research, items regarding attitude, perception and willingness to participate, motivators, barriers, different areas of interest for doing research and patient demographics. Quantitative data collected was initially explored using frequency distribution, and descriptive analysis was carried out. Mann-Whitney U and independent samples t-test were used to explore the differences between the study variables. One hundred and eighty two...

Research paper thumbnail of A cross-sectional observational study to assess inhaler technique in Saudi hospitalized patients with asthma and chronic obstructive pulmonary disease

Saudi Medical Journal, 2016

Objectives: To assess the proportion of critical errors committed while demonstrating the inhaler... more Objectives: To assess the proportion of critical errors committed while demonstrating the inhaler technique in hospitalized patients diagnosed with asthma and chronic obstructive pulmonary disease (COPD). Methods: This cross-sectional observational study was conducted in 47 asthmatic and COPD patients using inhaler devices. The study took place at King Abdulaziz Medical City, Riyadh, Saudi Arabia between September and December 2013. Two pharmacists independently assessed inhaler technique with a validated checklist. Results: Seventy percent of patients made at least one critical error while demonstrating their inhaler technique, and the mean number of critical errors per patient was 1.6. Most patients used metered dose inhaler (MDI), and 73% of MDI users and 92% of dry powder inhaler users committed at least one critical error. Conclusion: Inhaler technique in hospitalized Saudi patients was inadequate. Health care professionals should understand the importance of reassessing and educating patients on a regular basis for inhaler technique, recommend the use of a spacer when needed, and regularly assess and update their own inhaler technique skills.

Research paper thumbnail of Additional file 1: of Attitude, barriers and facilitators to practice-based research: cross-sectional survey of hospital pharmacists in Saudi Arabia

Survey Instrument. (DOCX 211 kb)

Research paper thumbnail of Development and Validation of a new model to predict bleeding risk score

Research paper thumbnail of Attitude of pediatricians towards suspected cases of child abuse and neglect in Saudi Arabia

Research paper thumbnail of Tele-pharmacy Anticoagulation Clinic Tele-pharmacy Anticoagulation Clinic during COVID-19 Pandemic: Patient's

Research paper thumbnail of Efficacy of favipiravir in adults with mild COVID-19: a randomized, double-blind, multicenter, placebo-controlled trial clinical trial

Clinical Microbiology and Infection

Research paper thumbnail of The development and validation of a multivariable model to predict the bleeding risk score for patients with non-valvular atrial fibrillation using direct oral anticoagulants in the Arab population

Background Frequently used models, such as the HAS-BLED, ATRIA, ORBIT, and GARFIELD-AF evaluate t... more Background Frequently used models, such as the HAS-BLED, ATRIA, ORBIT, and GARFIELD-AF evaluate the risk of bleeding when using an anticoagulant, for example warfarin, in patients with non-valvular atrial fibrillation. Limited studies are available reporting a model with a good discriminative ability to predict the bleeding risk score when using direct oral anticoagulants. Methods Patient data were collected from King Abdulaziz Medical City, King Fahad Cardiac Center, and Prince Sultan Cardiac Center in Riyadh, from outpatients, inpatients, or primary care clinics. In total, 1722 patients with a prescription for a new oral anticoagulant, Dabigatran, Rivaroxaban, or Apixaban, were enrolled. A resampling approach for variable selection was used and a five-fold cross-validation to assess the model fit and misclassification probabilities. The analysis used the receiver operating characteristics curve (ROC) and the concordance (c) statistic to assess the validation models’ discriminative...

Research paper thumbnail of Multicentre randomised double-blinded placebo-controlled trial of favipiravir in adults with mild COVID-19

BMJ Open

IntroductionA novel coronavirus, designated SARS-CoV-2, caused an international outbreak of a res... more IntroductionA novel coronavirus, designated SARS-CoV-2, caused an international outbreak of a respiratory illness, termed COVID-19 in December 2019. There is a lack of specific therapeutic agents based on evidence for this novel coronavirus infection; however, several medications have been evaluated as a potential therapy. Therapy is required to treat symptomatic patients and decrease the virus carriage duration to limit the communitytransmission.Methods and analysisWe hypothesise that patients with mild COVID-19 treated with favipiravir will have a shorter duration of time to virus clearance than the control group. The primary outcome is to evaluate the effect of favipiravir on the timing of the PCR test conversion from positive to negative within 15 days after starting the medicine.Adults (>18 years, men or nonpregnant women, diagnosed with mild COVID-19 within 5 days of disease onset) are being recruited by physicians participating from the Ministry of National Guard Health Af...

Research paper thumbnail of Attitude of pediatricians toward suspected cases of Child Sexual Abuse (CSA) in Saudi Arabia

International Journal of Pediatrics and Adolescent Medicine

Research paper thumbnail of Tele-pharmacy Anticoagulation Clinic During COVID-19 Pandemic: Patient Outcomes

Frontiers in Pharmacology

Introduction: It is well-established that clinical pharmacist-managed anticoagulation services ac... more Introduction: It is well-established that clinical pharmacist-managed anticoagulation services achieve superior anticoagulation control, with a positive impact. At King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, the structure of anticoagulation management is a pharmacist-managed specialty service. With the current COVID-19 situation, measures were taken to assure the continuity of patient care by establishing tele-pharmacy anticoagulation clinics.Materials and Methods: This was a prospective study with patients prescribed anticoagulation and followed up for 3 months. Since establishing the anticoagulation virtual clinic in March 2020, 270 patients were recruited in the study. The data collected included age, gender, comorbidities, indication for anticoagulation, intended duration of treatment, warfarin dose, testing of International Normalized Ratio (INR), INR target, range of INR values, time INR that was within the therapeutic range (TTR), and complications of therapy (b...

Research paper thumbnail of Mental Health Outcomes Amongst Health Care Workers During COVID 19 Pandemic in Saudi Arabia

Frontiers in Psychiatry

Objectives: The study aimed to assess the mental health outcomes and associated factors among hea... more Objectives: The study aimed to assess the mental health outcomes and associated factors among health care workers during COVID 19 in Saudi Arabia.Design, Setting, and Participants: We conducted a cross-sectional survey of health care workers from tertiary care and ministry of health Centers across the Central, Eastern, and Western regions of Saudi Arabia. There were 1,130 participants in the survey, and we collected demographic and mental health measurements from the participants.Primary Outcomes and Measures: The magnitude of symptoms of depression, anxiety, and insomnia was measured using the original version of 9-item patient health questionnaire (PHQ-9), the 7-item generalized anxiety disorder scale (GAD-7), and 7-item insomnia severity index (ISI). We use the multiple logistic regression analysis to identify the associated risk factors of individual outcomes.Results: The scores on the PHQ-9 showed that the largest proportion of health care workers (76.93%) experienced only norm...

Research paper thumbnail of Validation and Psychometric Properties of the Arabic Version of the Duke Anticoagulation Satisfaction Scale (DASS)

Frontiers in Pharmacology

Background: To assess the health-related quality of life (HRQoL) of oral anticoagulant therapy us... more Background: To assess the health-related quality of life (HRQoL) of oral anticoagulant therapy users, different types of instruments are available, either general or specific tools like Duke Anticoagulation Satisfaction Scale (DASS). These tools allow the clinician to adjust the treatment regimen to focus on increasing anticoagulation adherence and reduce adverse clinical outcomes. This study aims to validate the translated Arabic version of DASS to assess the satisfaction level of patients using oral anticoagulants in the Arab population.Methods: The Duke Anticoagulation satisfaction scale (DASS) was translated into the Arabic language using MAPI group services. DASS was administered to 505 patients receiving anticoagulation with warfarin or apixaban. The generic scale measuring the quality of life EQ-5D-5L was also administered. Psychometric properties were assessed by Confirmatory Factor Analysis, internal consistency (Cronbach’s Alpha), exploratory factor analysis, convergent an...

Research paper thumbnail of Association Between Minimum Inhibitory Concentration, Beta-lactamase Genes and Mortality for Patients Treated With Piperacillin/Tazobactam or Meropenem From the MERINO Study

Clinical Infectious Diseases

Introduction This study aims to assess the association of piperacillin/tazobactam and meropenem m... more Introduction This study aims to assess the association of piperacillin/tazobactam and meropenem minimum inhibitory concentration (MIC) and beta-lactam resistance genes with mortality in the MERINO trial. Methods Blood culture isolates from enrolled patients were tested by broth microdilution and whole genome sequencing at a central laboratory. Multivariate logistic regression was performed to account for confounders. Absolute risk increase for 30-day mortality between treatment groups was calculated for the primary analysis (PA) and the microbiologic assessable (MA) populations. Results In total, 320 isolates from 379 enrolled patients were available with susceptibility to piperacillin/tazobactam 94% and meropenem 100%. The piperacillin/tazobactam nonsusceptible breakpoint (MIC >16 mg/L) best predicted 30-day mortality after accounting for confounders (odds ratio 14.9, 95% confidence interval [CI] 2.8–87.2). The absolute risk increase for 30-day mortality for patients treated wit...

Research paper thumbnail of The effect of the VKORC1 promoter variant on warfarin responsiveness in the Saudi WArfarin Pharmacogenetic (SWAP) cohort

Scientific Reports

Warfarin is a frequently prescribed oral anticoagulant with a narrow therapeutic index, requiring... more Warfarin is a frequently prescribed oral anticoagulant with a narrow therapeutic index, requiring careful dosing and monitoring. However, patients respond with significant inter-individual variability in terms of the dose and responsiveness of warfarin, attributed to genetic polymorphisms within the genes responsible for the pharmacokinetics and pharmacodynamics of warfarin. Extensive warfarin pharmacogenetic studies have been conducted, including studies resulting in genotype-guided dosing guidelines, but few large scale studies have been conducted with the Saudi population. In this study, we report the study design and baseline characteristics of the Saudi WArfarin Pharmacogenomics (SWAP) cohort, as well as the association of the VKORC1 promoter variants with the warfarin dose and the time to a stable INR. In the 936 Saudi patients recruited in the SWAP study, the minor allele C of rs9923231 was significantly associated with a 8.45 mg higher weekly warfarin dose (p value = 4.0 × 10-46), as well as with a significant delay in achieving a stable INR level. The addition of the rs9923231 status to the model, containing all the significant clinical variables, doubled the warfarin dose explained variance to 31%. The SWAP cohort represents a valuable resource for future research with the objective of identifying rare and prevalent genetic variants, which can be incorporated in personalized anticoagulation therapy for the Saudi population. Warfarin is a frequently prescribed oral anticoagulant agent inhibiting the synthesis of the Vitamin K dependent clotting factors II, VII, IX, X as well as anticoagulation factors protein C and S. It also causes anticoagulation by inhibiting the Vitamin K-epoxide reductase complex, which result in the accumulation of reduced vitamin K2, 3-epoxide and vitamin K hydroquinone 1. Warfarin is indicated for the treatment or prophylaxis of patients with various disease states, including venous thromboembolic events 2 , atrial fibrillation and flutter 3 , cardiac surgery for valve replacement and orthopedic surgery 4,5. Warfarin exhibits a narrow therapeutic index and is monitored through the International Normalized Ratio (INR), which measures the ability of the blood to clot. The optimal effect of warfarin, for most of the indications, is when the INR ranges from 2 to 3, except for metallic atrial valve replacement, in which a higher INR value is required 6. Several studies reported ethnic differences in the warfarin response and dosage requirements 7-9. Even for populations with very close ancestry within the Middle East and North Africa (MENA) region, differences in

Research paper thumbnail of A comparison between warfarin and apixaban: A patient's perspective

Annals of Thoracic Medicine

Research paper thumbnail of Attitude, barriers and facilitators to practice-based research: cross-sectional survey of hospital pharmacists in Saudi Arabia

Journal of pharmaceutical policy and practice, 2016

Little is known about the perceived attitude, barriers and facilitators of Saudi Pharmacists abou... more Little is known about the perceived attitude, barriers and facilitators of Saudi Pharmacists about practice based research. We aimed to measure the attitude, barriers, and facilitators of Saudi hospital pharmacists towards pharmacy practice research. A cross-sectional survey of hospital pharmacists (n = 216) working in King Abdulaziz Medical Cities in Central, Eastern and Western region hospitals was conducted during first week of September, 2013. The survey instrument comprised of six different sections that explored pharmacists previous participation in research, items regarding attitude, perception and willingness to participate, motivators, barriers, different areas of interest for doing research and patient demographics. Quantitative data collected was initially explored using frequency distribution, and descriptive analysis was carried out. Mann-Whitney U and independent samples t-test were used to explore the differences between the study variables. One hundred and eighty two...

Research paper thumbnail of A cross-sectional observational study to assess inhaler technique in Saudi hospitalized patients with asthma and chronic obstructive pulmonary disease

Saudi Medical Journal, 2016

Objectives: To assess the proportion of critical errors committed while demonstrating the inhaler... more Objectives: To assess the proportion of critical errors committed while demonstrating the inhaler technique in hospitalized patients diagnosed with asthma and chronic obstructive pulmonary disease (COPD). Methods: This cross-sectional observational study was conducted in 47 asthmatic and COPD patients using inhaler devices. The study took place at King Abdulaziz Medical City, Riyadh, Saudi Arabia between September and December 2013. Two pharmacists independently assessed inhaler technique with a validated checklist. Results: Seventy percent of patients made at least one critical error while demonstrating their inhaler technique, and the mean number of critical errors per patient was 1.6. Most patients used metered dose inhaler (MDI), and 73% of MDI users and 92% of dry powder inhaler users committed at least one critical error. Conclusion: Inhaler technique in hospitalized Saudi patients was inadequate. Health care professionals should understand the importance of reassessing and educating patients on a regular basis for inhaler technique, recommend the use of a spacer when needed, and regularly assess and update their own inhaler technique skills.