Publications by authors named "Abdulaziz Joury"

20 Publications

  • Page 1 of 1

Androgenic steroids dysregulation and the risk of coronary artery disease.

Expert Rev Cardiovasc Ther 2022 May 19:1-7. Epub 2022 May 19.

Department of Internal Medicine, Ochsner Health System, New Orleans, LA, US.

Introduction: Endogenous testosterone deficiency or excess anabolic-androgenic steroids (AAS) have been linked to alter the physiology of different organs in the body, more specifically, the vasculature of coronary arteries. Despite the health-related concerns of using synthetic testosterone derivatives, such as AAS, there has been a tremendous increase in the use of AAS among athletes and bodybuilders.

Areas Covered: We have highlighted the three main mechanisms that AAS increase the risk of coronary artery disease (CAD): altering the homeostasis of lipid metabolism which results in dyslipidemia and subsequently atherosclerosis, disturbing the function of platelet which results in platelet aggregation and subsequent thrombosis, and increasing the risk of coronary vasospasm by affecting the physiological function of vascular bed.

Expert Opinion: Despite the restriction of AAS in specific clinical conditions such as testosterone deficiency and cancer therapy, many amateurs' athletes misuse the AAS. Although there has been a strong association between the AAS misuse and risk of developing CAD, the more valued approach would be a randomized clinical double-blind trial. The suggested primary endpoint would be an occurrence of adverse cardiovascular events, such as myocardial infarction, cerebrovascular accidents, and death. Increasing awareness of the risk of missing AAS among high-risk groups is imperative.
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http://dx.doi.org/10.1080/14779072.2022.2077193DOI Listing
May 2022

Prosthesis-patient mismatch following aortic and mitral valves replacement - A comprehensive review.

Prog Cardiovasc Dis 2022 Feb 27. Epub 2022 Feb 27.

Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America. Electronic address:

Prothesis-patient mismatch (PPM) occurs when there is a mismatch between the effective orifice area (EOA) of the prosthetic valve and the required cardiac output to meet the need of the patient's body surface area (BSA). The clinical threshold for PPM occurs when the indexed effective orifice area (iEOA) is ≤0.65 cm/m for the aortic valve prosthesis, and ≤ 1.20 cm/m for the mitral valve prosthesis. The wide variation of reported incidence of PPM is most likely attributed to the variation in the methods of calculating iEOA [(for e.g., using continuity equation across the prosthesis versus using projected EOA (generated by the industry)]. Newer generation mechanical valves have shown less PPM than older generation, and stentless bioprosthesis have less PPM than stented prosthesis. Long-term clinical outcome of PPM is associated with adverse cardiovascular events especially in the presence of pre-existing left ventricle dysfunction or with concomitant procedure such as coronary artery bypass graft surgery. Strategies to mitigate the risk of PPM such as aortic root replacement in patients with the small aortic annulus should be utilized. Accurate assessment of the patient's annular size and indexing the effective orifice area (EOA) of the prosthesis to patient's BSA at the time of prosthesis implantation are important steps to preventing future PPM.
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http://dx.doi.org/10.1016/j.pcad.2022.02.004DOI Listing
February 2022

Diagnostic Tools for Cardiac Amyloidosis: A Pragmatic Comparison of Pathology, Imaging and Laboratories.

Curr Probl Cardiol 2022 Jan 7:101106. Epub 2022 Jan 7.

Department of Transplantation, Mayo Clinic, Jacksonville, FL.

Cardiac amyloidosis (CA) is a complex disease considered to be the most common underdiagnosed form of restrictive cardiomyopathy. Accumulation of misfolded proteins called amyloid fibrils in the extracellular space results in clinical deterioration and late diagnosis is associated with morbidity and mortality. Both types of this disease, light chain CA and transthyretin-related CA share many cardiac and extracardiac features that compromise multiple organs such as kidneys, musculoskeletal system, autonomic nervous system, and gastrointestinal tract. Early diagnosis and detection of CA are imperative. Clinicians should maintain a high degree of suspicion among patients with unexplained diastolic heart failure to implement different disease-altering therapies at the early stages of the disease. In this article, we provided a comprehensive review of multiple invasive and non-invasive cardiac imaging modalities with their respective degrees of sensitivities and specificity.
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http://dx.doi.org/10.1016/j.cpcardiol.2022.101106DOI Listing
January 2022

Cardiac Amyloidosis: Presentations, Diagnostic Work-up and Collaborative Approach for Comprehensive Clinical Management.

Curr Probl Cardiol 2021 Oct 29;46(10):100910. Epub 2021 May 29.

John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA. Electronic address:

Cardiac amyloidosis is a systemic disease characterized by continuous deposition of misfolded proteins called amyloid fibrils in the extracellular space which result in restrictive cardiomyopathy. The most common form of cardiac amyloidosis is light chain (AL) cardiac amyloidosis, a result of continuous deposition of misfolded monoclonal immunoglobulin light chains. Transthyretin-related cardiac amyloidosis (ATTR) results from a point mutation in the transthyretin gene in an autosomal dominant fashion and presents phenotypically similar to AL cardiac amyloidosis. Cardiac amyloidosis is being increasingly recognized due to the advancements in diagnostic cardiac imaging and pharmacotherapy. Clinicians should maintain a high index of suspicion among patients with unexplained diastolic heart failure because earlier diagnosis will allow for the implementation of disease-altering therapy. With established targeted drug therapies and further breakthroughs in immunotherapy, the potential impact of diagnostic and therapeutic advancements on morbidity and mortality of patients with cardiac amyloidosis is promising.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.100910DOI Listing
October 2021

FGF23 predicts outcomes in heart failure but questions remain unanswered.

Int J Cardiol 2021 09 19;338:145-146. Epub 2021 Jun 19.

John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.; The University of Queensland, Ochsner Clinical School, Faculty of Medicine, New Orleans, LA, USA.

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http://dx.doi.org/10.1016/j.ijcard.2021.06.036DOI Listing
September 2021

Large Cystic Intracardiac Mass Overlying Left Atrial Appendage Occlusion Device: A Case Report and Literature Review.

CASE (Phila) 2021 Feb 11;5(1):12-15. Epub 2020 Dec 11.

Department of Cardiology and Division of Electrophysiology, Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.

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http://dx.doi.org/10.1016/j.case.2020.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887612PMC
February 2021

Leadless and Wireless Cardiac Devices: The Next Frontier in Remote Patient Monitoring.

Curr Probl Cardiol 2021 May 24;46(5):100800. Epub 2021 Jan 24.

John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA. Electronic address:

In the last decade, advances in wireless and sensor technologies, and the implementation of telemedicine, have led to innovative digital health care for cardiac patients. Continuous monitoring of patients' biomedical signals, and acute changes in these signals, may result in timely, accurate diagnoses and implementation of early interventions. In this review, we discuss commonly used wireless and leadless cardiac devices including pulmonary artery pressure sensors, implantable loop recorders, leadless pacemakers and subcutaneous implantable cardioverter-defibrillators. We discuss the concept and function of each device, indications, methods of delivery, potential complications, consideration for implantation, and cost-effectiveness.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.100800DOI Listing
May 2021

Ocular Adverse Effects of Amiodarone: A Systematic Review of Case Reports.

Optom Vis Sci 2020 Jul;97(7):536-542

Department of Ophthalmology, Ochsner Health System, New Orleans, Louisiana.

Significance: Amiodarone is an excellent antiarrhythmic medication; however, it has numerous systemic and ocular adverse effects.

Purpose: We aimed to improve our understanding of amiodarone and its ocular adverse effects by performing a systematic review and meta-analysis of published case reports.

Methods: This systematic review was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We used the MEDLINE database, primarily through PubMed, and used keywords (amiodarone, eye, eye diseases, visual/ocular adverse effects/manifestations) to identify case reports of ocular adverse effects after amiodarone use. The initial search resulted in 92 total case reports. However, after excluding nonrelevant case reports, 25 cases were selected for the final analysis.

Results: Among the patients in the 25 case reports, 18 were male (72%), and the median age was 66 ± 9.9 years. In 15 cases (60%), the patients reported halos around light and/or decrease in vision after amiodarone use. The most common ophthalmic examination findings were cornea verticillata/vortex keratopathy in 19 cases (76%), followed by different patterns of papilledema and retinal hemorrhages in 5 cases (20%). Discontinuation of amiodarone was the most common intervention, followed by application of topical heparin. Outcomes among case reports were variable.

Conclusions: Cornea verticillata/vortex keratopathy was the most common ocular adverse effect in cases where amiodarone was administered. Early recognition of amiodarone-induced ocular adverse effects is imperative to prevent worsening keratopathy or uncommon adverse effects. Collaboration between physicians prescribing amiodarone-to recognize the ocular symptoms-and referral to eye care physicians are important.
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http://dx.doi.org/10.1097/OPX.0000000000001534DOI Listing
July 2020

Transaxillary TAVR Leads to Shorter Ventilator Duration and Hospital Length of Stay Compared to Transapical TAVR.

Curr Probl Cardiol 2021 Mar 22;46(3):100624. Epub 2020 May 22.

John Ochsner Heart and Vascular Center, New Orleans, LA.

There is an increasing need for alternative access in patients with prohibitive surgical risk who have unsuitable anatomy for transfemoral transcatheter aortic valve replacement (TAVR). Data on differences in periprocedural outcomes via alternative access sites are scarce. We performed a retrospective analysis of patients who underwent Transaxillary (TAX) or Transapical (TAP) TAVR at our center from 2012 to 2019. All data was summarized and displayed as mean ± SD for continuous variables and number of patients in each group. A propensity score was created for each patient in the dataset to determine the probability of axillary vs apical access. We adjusted for propensity score using multivariate logistic regression. A total of 102 patients underwent TAVR via alternative access: 28 patients (27%) via TAX and 74 patients (73%) via transapical (TAP) access. The average time to extubation in the TAX group was 5.3 ± 3.5 hours vs 9.1 ± 8.8 hours in the TAP patients (P = 0.03). None of the TAX patients required reintubation compared to 23% of TAP TAVR (P = 0.003). The average hospital length of stay for TAX was 2.4 ± 2.0 days compared to 6.9 ± 3.3 days (P < 0.0001) for TAP. TAX TAVR patients had significantly lower re-intubation rates, shorter time to extubation and in-hospital length of stay, but higher pacemaker implantation rates. TAX TAVR had improved periprocedural outcomes compared to TAP TAVR and remains the preferred TAVR alternative access.
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http://dx.doi.org/10.1016/j.cpcardiol.2020.100624DOI Listing
March 2021

Therapeutic approaches in hypertriglyceridemia-induced acute pancreatitis: A literature review of available therapies and case series.

J Clin Apher 2020 Apr 14;35(2):131-137. Epub 2019 Nov 14.

Department of Pulmonary and Critical Care, Ochsner Clinic Foundation, New Orleans, Louisiana.

Hypertriglyceridemia-induced acute pancreatitis (HGAP) is the third most common etiology of acute pancreatitis. HGAP can be attributed to genetic disturbances in triglyceride metabolism or multiple secondary causes. Here, we presented three cases for HGAP and explored different therapeutic approaches for treating HGAP. A case series of three patients who presented with HGAP and underwent different therapeutic approaches was conducted. The first patient was a 37-year-old male who presented with nonsevere HGAP; he was treated with conservative therapy with insulin and heparin infusion, which resulted in clinical and laboratory improvement. The second patient was a 64-year-old male with human immunodeficiency virus on multiple highly active antiretroviral therapy. He presented with severe HGAP and multiorgan failure. After initiation of therapeutic plasma exchange, his HGAP resolved. The third patient was a 28-year-old male who presented with recurrent episodes of HGAP; his conservative therapy failed and was eventually escalated to therapeutic plasma exchange (TPE). HGAP can be attributed to genetic disturbances of lipid or secondary etiologies. A nonsevere form of HGAP can be managed with conventional therapy including insulin and heparin; however, severe HGAP may require TPE.
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http://dx.doi.org/10.1002/jca.21763DOI Listing
April 2020

Extensive Abdominal Sarcoidosis Without Pulmonary Manifestation.

Ochsner J 2019 ;19(2):174-177

Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

Sarcoidosis is a rare multisystem disease of idiopathic etiology that affects different organs and is characterized histopathologically by the presence of noncaseating granulomas. The most common location of sarcoidosis is the lungs, accounting for approximately 95% of sarcoidosis cases. Coincident involvement of pulmonary and extrapulmonary organs is present in approximately one-third of patients. However, the sole involvement of intraabdominal organs is extremely rare. Intraabdominal sarcoidosis has a different presentation depending on the involved organs. To the best of our knowledge, a limited number of case reports have been published on intraabdominal sarcoidosis without pulmonary involvement. A 69-year-old female patient presented with short onset of abdominal pain and change in bowel habits, without a significant medical history of abdominal problems. Physical examination only revealed generalized abdominal tenderness on deep palpation. Computed tomography of the abdomen and pelvis showed mild to moderate thickening of the omentum and other abdominal organs. After excluding various etiologies such as fungi and acid-fast bacilli, the omentum, ovaries, and surrounding lymph nodes were removed via a laparoscopic procedure. The histopathology report confirmed the diagnosis of intraabdominal sarcoidosis with the presence of noncaseating granulomas. Extrapulmonary sarcoidosis is a rare disease, and intraabdominal sarcoidosis might mimic other malignant etiologies. We treated our case with laparoscopic removal of involved organs and oral steroids with significant recovery during a short period.
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http://dx.doi.org/10.31486/toj.17.0111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584200PMC
January 2019

Concurrent Persistent Cryptococcosis and Complex Infections in a Patient With Human Immunodeficiency Virus.

Ochsner J 2019 ;19(2):169-173

Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA.

Fungal infections are known for their chronicity and latency and are difficult to eradicate. The pathophysiology of these invading pathogens and the resulting alteration of the immune system are not fully understood. Fungal meningitis is associated with significant rates of morbidity and mortality, especially among immunocompromised patients. Cryptococcosis, an infection secondary to the fungus , is one of the most important opportunistic infections among patients with human immunodeficiency virus (HIV), and expediting treatment is crucial. We report the case of a 28-year-old male with HIV who had a simultaneous co-infection with cryptococcal meningitis and complex (MAC). The patient required a 2-week induction phase of antifungal medication with amphotericin B and flucytosine. Despite aggressive initial therapy and the patient's significant clinical improvement, his radiologic findings and lumbar puncture showed persistent cryptococcal infection. Concurrent infection with cryptococcosis and MAC is extremely rare even in immunosuppressed patients. In our case, the concurrent infection was associated with a prolonged course of therapy during the induction phase for cryptococcosis.
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http://dx.doi.org/10.31486/toj.17.0113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584202PMC
January 2019

Extensive necrotizing fasciitis from Fournier's gangrene.

Urol Case Rep 2019 Sep 9;26:100943. Epub 2019 Jun 9.

Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA.

Fournier's gangrene is rapidly progressive necrotizing fasciitis that mainly affects the male perineum. Despite the advancement in surgical intervention, Fournier's gangrene carries high rates of mortality. Here, we present a 51-year-old male with hypertension and history of alcohol abuse presented to the emergency department with scrotal pain and swelling for a one-week period without preceding trauma to perineal area. He underwent emergent surgical debridement for and extensive necrotizing fasciitis. Early initiation of antibiotics, surgical intervention and good wound care postoperatively were cornerstone in his recovery.
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http://dx.doi.org/10.1016/j.eucr.2019.100943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582197PMC
September 2019

Baseline characteristics, management practices, and long-term outcomes among patients with first presentation acute myocardial infarction in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-II).

J Saudi Heart Assoc 2018 Jul 17;30(3):233-239. Epub 2018 Mar 17.

King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi ArabiaaSaudi Arabia.

Background And Objectives: Limited data are available highlighting the different clinical aspects of acute coronary syndrome (ACS) patients, especially in Gulf countries. In this study, we aimed to compare patients who presented with acute myocardial infarction (AMI) as the first presentation of patients who have a history of ACS in terms of initial presentation, medical history, laboratory findings, and overall mortality.

Methods: We used the Second Gulf Registry of Acute Coronary Events (Gulf RACE-II), which is a multinational observational study of 7930 ACS patients.

Results: Among all patients, 4723 (59.6%) patients presented with AMI. First presentation AMI patients were older (mean age, 55 years vs. 53 years;  < 0.001) and had lower risk factors than patients with a history of ACS. Higher laboratory readings of cardiac markers and all aspects of mortality were significantly higher among patients with first presentation AMI. After adjustments for baseline variables, congestive heart failure [odds ratio (OR) = 1.08; 95% confidence interval (CI), 0.73-1.57], reinfarction (OR = 1.16; 95% CI, 0.58-2.30), cardiogenic shock (OR = 1.51; 95% CI, 0.74-3.08), stroke (OR = 2.30; 95% CI, 0.29-17.99), and overall mortality (OR = 1.16; 95% CI = 0.74-1.83) were independent predictive factors for first presentation AMI.

Conclusions: First presentation AMI patients tend to be older and to have lower rates of risk factors. Adverse clinical outcomes such as congestive heart failure, reinfarction, cardiogenic shock, and stroke were higher among patients with first presentation AMI compared to patients with a history of ACS.
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http://dx.doi.org/10.1016/j.jsha.2018.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6026399PMC
July 2018

Severe fibrosing mediastinitis with atypical presentation: Effective control with novel therapeutic approach.

Ann Thorac Med 2017 Jul-Sep;12(3):209-212

Department of Cardiac Sciences, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Fibrosing mediastinitis (FM), also known as sclerosing mediastinitis, is an uncommon but serious disease involving the mediastinal structures. A high index of suspicion is essential to establish the diagnosis of FM and starting the appropriate therapy for patients. Here, we report a case of a young female who presented with chest symptoms and subsequently underwent different laboratory and radiologic investigations and an excisional biopsy. The findings of these investigations were consistent with the diagnosis of idiopathic FM. Her disease was associated with complete occlusion of three pulmonary veins and the left main pulmonary artery. The patient was treated with initial high-dose steroids followed by maintenance steroid and methotrexate therapy with very good long-term disease control. Clinical response, high-sensitivity C-reactive protein, and erythrocyte sedimentation rate were used to monitor disease activity and response to therapy.
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http://dx.doi.org/10.4103/atm.ATM_47_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541970PMC
August 2017

Internet Websites for Chest Pain Symptoms Demonstrate Highly Variable Content and Quality.

Acad Emerg Med 2016 10 27;23(10):1146-1152. Epub 2016 Sep 27.

Medical Research Fellowship Program, The George Washington University School of Medicine and Health Sciences, Washington, DC.

Objective: Chest pain is a common symptom with causes that range from benign to serious. We assess the content and quality of websites about chest pain symptoms that describe its causes and when to seek care.

Methods: We used five search engines (Google, Bing, Yahoo, Ask, AOL) using the term "chest pain" and assessed the first 30 websites that resulted from each search. We excluded websites that were diagnosis-driven, intended for physicians, patient blogs, advertisements, news, or videos. For included websites, we assessed for the presence of content potentially useful to patients with chest pain symptoms; website quality with three instruments (DISCERN, HONcode, and JAMA benchmark criteria); readability using four validated scores, accessibility, usability, and reliability using the LIDA instrument; and popularity using the Alexa tool.

Results: In 27 included websites, 96 and 81% mentioned cardiac and noncardiac causes of chest pain, respectively, while 85% described when to seek emergency care. Only 51% of websites mentioned potential tests that might be used to diagnose symptoms, 22% described potential treatments, and 11% mentioned consequences if treatment is delayed or avoided. The median website DISCERN score was 23 (interquartile range [IQR] = 18-32) out of a possible 45 points, which can be interpreted as low to medium quality. A total of 44% of websites had HONcode certification, and only 11% fulfilled all four JAMA benchmark criteria. Average reading scores demonstrated that half of websites were above the eighth to ninth grade reading level. With LIDA, the average scores were "medium" for accessibility at 83% and usability at 59% and "low" for reliability at 43%.

Conclusions: Many websites that provide health information for patients about chest pain symptoms are not reliable. There is highly variable content and quality, and the average website is difficult to read for patients with low health literacy.
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http://dx.doi.org/10.1111/acem.13039DOI Listing
October 2016

The Content and Quality of Health Information on the Internet for Patients and Families on Adult Kidney Cancer.

J Cancer Educ 2017 Dec;32(4):878-884

The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

The Internet is one of the major sources for health information for patients and their families, particularly when patients face serious life-threatening conditions such as kidney cancer in adults. In this study, we evaluate the content and quality of health information on adult kidney cancer using several validated instruments. We accessed the three most popular search engines (Google, Yahoo, Bing), using two terms: "kidney cancer" and "renal cell carcinoma," and reviewed the top 30 hits. After exclusion of duplicated websites, websites targeting health care professionals, and unrelated websites, 35 websites were included. Content was assessed using a 22-item checklist adapted from the American Cancer Society. We assessed website quality using the DISCERN questionnaire, HONcode and JAMA benchmark criteria, readability using three readability scores, and ALEXA for global traffic ranking systems. The average website had 16 of 22 content items while 6 websites fulfilled all 22 items. Among all websites, the average DISCERN quality score was 42 out of 80, 15 (42.8 %) of websites had HONcode certification, and only 3 (8.5 %) fulfilled all JAMA benchmark criteria. The average website readability was at the ninth grade reading level. The content and quality of health-related information on the Internet for adult kidney cancer are variable in comprehensiveness and quality. Many websites are difficult to read without a high school education. A standardized approach to presenting cancer information on the Internet for patients and families may be warranted.
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http://dx.doi.org/10.1007/s13187-016-1039-9DOI Listing
December 2017

Quality of assessment and counselling offered by community pharmacists and medication sale without prescription to patients presenting with acute cardiac symptoms: a simulated client study.

Eur J Clin Pharmacol 2016 Mar 23;72(3):321-8. Epub 2015 Nov 23.

Department of Health Sciences, CAS, Qatar University, Doha, Qatar.

Purpose: Self-medication is common worldwide. However, the prevalence of sale of prescription medications without prescription and the quality of assessment and counselling provided by community pharmacists to cardiac patients is unknown. We sought to determine the prevalence of prescription medication sales and explore how pharmacists assess and counsel patients with acute cardiac conditions.

Methods: Six hundred community pharmacies in the two largest cities in Saudi Arabia were selected. Two simulated clients presented either an acute coronary syndrome (ACS) scenario or an acute heart failure (AHF) scenario to the pharmacists. Descriptive statistics and regression models were used to analyse and present the collected data.

Results: Of 600 pharmacies, 379 (63.2%) sold various prescription medications to simulated patients without prescription. Assessment and counselling provided by pharmacists were inadequate. Almost a quarter of pharmacists did not ask simulated patients any questions; 52% asked one or two questions; and only 24% asked three or more questions. Only 28 pharmacists (4.7%) inquired about drug allergies; 48.5% instructed simulated patients on the dosage and frequency of the sold medications; 21.6% provided instruction on treatment duration; and 19.4% gave instructions on dose, frequency, and duration of treatment. Compared to AHF, ACS simulated patients were more likely to be asked about other symptoms and comorbidities (59.7% vs. 48.7%, p = 0.007 and 46.3% vs. 37.3%, p = 0.005, respectively) and were more likely to be advised to go to hospital (70.3% vs. 56.3%, p < 0.001).

Conclusions: The sale of prescription medications by community pharmacists to simulated cardiac patients without prescription is very common; assessment and counselling qualities are suboptimal.
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http://dx.doi.org/10.1007/s00228-015-1981-1DOI Listing
March 2016

Socio-demographic determinants of antibiotic misuse in children. A survey from the central region of Saudi Arabia.

Saudi Med J 2013 Aug;34(8):832-40

College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia.

Objective: To investigate knowledge, beliefs, and practices associated with parental antibiotic misuse.

Methods: This cross-sectional study included parents visiting 4 malls in Riyadh, Saudi Arabia. The study took place at the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia between June and December 2010. Self-prescription of antibiotic for a child in the past year was defined as antibiotic misuse.

Results: From 610 parents (60.5% mothers and 39.5% fathers), 11.6% reported self-prescription. Responding parents differed by age, education, number of children, and profession. Overall, parents responded that antibiotics are required in children with runny nose or cough or sore throat or fever (50%); to reduce symptom severity and duration (57.7%), are effective against viruses (68.6%), can be stopped on clinical improvement (28.7%), and it used by another family member can be used in children (20.1%). Determinants of misuse in a multivariable model were income, number of children, type of infection treated last year, knowledge of illness requiring antibiotic or being unsure, using antibiotics used by an other family member in children, unsure of such use, and adjusting for the type of responding parent.

Conclusion: Parents with low income, more than 2 children, lack of knowledge, inappropriate beliefs and practices are vulnerable for misusing antibiotics in children.
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August 2013
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