Colistin therapy is associated with the development of nephrotoxicity. We examined the incidence and risk factors of nephrotoxicity associated with colistin dosing. We included adult hospitalized patients who received intravenous (IV) colistin for >72 h between January 2014 and December 2015. The primary endpoint was the incidence of colistin-associated acute kidney injury (AKI). The secondary analyses were predictors of nephrotoxicity, proportions of patients inappropriately dosed with colistin according to the Food and Drug Administration (FDA), European Medicines Agency (EMA), and Garonzik formula and clinical cure rate. We enrolled 198 patients with a mean age of 55.67 ± 19.35 years, 62% were men, and 60% were infected with multidrug-resistant organisms. AKI occurred in 44.4% (95% CI: 37.4–51.7). Multivariable analysis demonstrated that daily colistin dose per body weight (kg) was associated with AKI (OR: 1.57, 95% CI: 1.08–2.30; p = 0.02). Other significant predictors included serum albumin level, body mass index (BMI), and severity of illness. None of the patients received loading doses, however FDA-recommended dosing was achieved in 70.2% and the clinical cure rate was 13%. The incidence of colistin-associated AKI is high. Daily colistin dose, BMI, serum albumin level, and severity of illness are independent predictors of nephrotoxicity.

Introduction Warfarin is the core component in the management of various thromboembolic disorders, which requires specialized expertise to optimize outcomes. There is limited data comparing a pharmacist vs. a haematologist-managed anticoagulation clinic in our setting, and in the Middle East. We aimed to evaluate the effectiveness and safety of a pharmacist vs. a haematologist-managed anticoagulation clinic in the Ambulatory Care Center at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Methods A retrospective cohort study was conducted from 2016 to 2018, which included adult patients who have been followed-up for at least six months and who received warfarin for an extended period. The primary outcome was the proportion of time the patients in the two arms were in the therapeutic range. The secondary outcomes were the differences in expanded time in the therapeutic range, as well as the frequency of bleeding and thromboembolic events between the two arms. Results We enrolled 104 and 124 patients in the pharmacist and haematologist arms respectively. The median time in the therapeutic range for the pharmacist arm was 71.4%, IQR (60.8–83.8) vs. 65%, IQR (43.5–79.1), in the haematologist arm (p = 0.0049). The median expanded time in the therapeutic range was 86.4%, IQR (77.5–95.3) vs. 81.21%, IQR (67.1–93.3) in the pharmacist vs. haematologist arm (p = 0.015) respectively. Major bleeding events occurred in 5.7 % vs. 3.2 %, and thromboembolic events in 5.7% vs. 4%, in the pharmacist vs. haematologist arm respectively. Conclusions Our results demonstrated that the time in the therapeutic range was significantly higher in the pharmacist arm, with no significant difference in bleeding and thromboembolic events compared to the haematologist arm.

Objective: To determine frequency of hyperuricemia in patients with backache in general population and to compare the results with international studies. Study Design: cross sectional Descriptive Case Series. Place and Duration: In outdoor patients of medicine department Allied hospital Faisalabad, from 01-08-2016 to 31-01 -2017. Methodology: Adult patients of either gender with low backache were Included in the study. Patients of chronic renal failure and osteomalacia patients were excluded. Nonprobability consecutive sampling technique was used. After enrolment of patients according to criterion an informed consent was taken. Uric acid level was checked in all patients. Uric acid level 4 to 5.7mg/dl for females and 4-7.0mg/dl for males were taken as normal. Results: We included 100 patients. Age ranged from 12-80 years (mean =40.50±15.2years). Out of these100 patients 17% patients were having hyperuricemia. Among patients regarding age distribution 57% were below age 40 and 43% were above age 40. In above 40 years age group hyperuricemia was seen in 76.47%(13pts) In below age 40 years group 23.53% (4pt) had hyperuricemia. The p value is (.002) significant indicating an important relationship between age above 40 and hyperuricemia. Out of 100 patients regarding gender distribution 54 %were females and 46 % were males. Amongst 17%patients having hyperuricemia 64.7 %(11pt) were female and 35.3 % (6pt) were male and P value regarding gender distribution was 0.331. Conclusion: hyperuricemia is common in Pakistani population and needs to be considered in most of patients with backache especially females who are more predispose to this condition.

Introduction: Immune checkpoint inhibitors (ICIs) are recommended for various types of cancer. On the other hand, these ICIs may cause immune-related adverse events (irAEs). Lichen sclerosus (LS) and lichen planus (LP) are two distinct phenotypes of irAEs that occur in a subset of patients treated with ICIs. These adverse effects have a detrimental effect on the patient’s quality of life and treatment phases; however, the clinical evaluation and assessment of LS and LP remain uncertain. This study aims to assess and evaluate the risk of LS and LP associated with the use of ICIs via a systematic review of the literature and the USA FDA Adverse Events FAERS database. Method: The study searched electronic databases such as PubMed, Medline, Cochrane, and Google Scholar for case reports on immune-checkpoint-inhibitor-associated lichen sclerosus and lichen planus published in English between inception and 31 December 2021. The FDA’s adverse event reporting system (FAERS) database was also analyzed. Results: Thirty-eight case reports and two retrospective studies with a total of 101 patients, in addition to the FAERS data, were evaluated. More cases involved lichen planus (78.9%) than lichen sclerosis (21%). Nivolumab and pembrolizumab were most frequently reported with LS and LP, among other ICIs. Thirty-six out of thirty-eight patients with LS or LP experienced complete remission, while two patients experienced partial remission. Most of the cases had an excellent response to corticosteroids (92.1%), while the remainder had moderate (5.2%) and poor (2.6%) responses. Additionally, the reporting odds ratio (ROR) of the FAERS database indicated a favorable association for ICIs, the risk of LP, and LS. A stronger association was uniquely found between nivolumab and pembrolizumab. Conclusion: There have been published case reports for these adverse events. Healthcare providers should be aware of the possibility of lichen sclerosis and lichen planus developing in patients receiving ICIs which could necessitate hospitalization or discontinuation. Regulatory agencies are advised to monitor the risks as a potential safety signal.

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Objective: To determine frequency of obesity and overweight indoor patients in tertiary care hospital and to compare the results with international studies. Study Design: Cross Sectional Descriptive Case Series. Settings: In outdoor patients of medicine department Allied hospital Faisalabad. Duration: 6 months from 01-08-2018 to 31-01 -2019. Methodology: Adult patients of either gender were included in the study. Patients of bed bound and on chemotherapy patients were excluded. Nonprobability consecutive sampling technique was used. After enrolment of patients according to criterion an informed consent was taken. Body weight and height were taken and BMI was calculated. Results: We Included 400 patients. Age ranged from 12-80 years (mean =40.50±15.2years). Out of these 400 patients 58.3% patients were found to have overweight and obesity. There were 261 females and 139 males. Age of patients ranged 12-80 years (mean = 40.50±15.2 years). Out of 400 patients 58.3% had obesity amongst which 70.4% were female and 29.6% were males and P value regarding gender distribution was (0.032) very significant showing strong association of gender and obesity and graph2 is showing that more than two third obese patients were females. In our data of 400 patients majority of patients in age above 30 years were obese and P value regarding age distribution was (0.001). very significant indicating important relationship between age and obesity. Conclusion: obesity and overweight are common in Pakistani population and needs to be considered in most of patients in outdoor patients especially females who are more predispose to having obesity and either gender with age above 30 years