Considering the short duration of the trials, the lack of trials including newer laxatives and the low quality of some of the included trials, the long-term efficacy and safety of these laxatives are not conclusive. There is a need to conduct more robust RCTs that include newer agents to evaluate long-term outcomes.

Objective: Proton pump inhibitors (PPIs) are still widely used despite increasing reports of their adverse events. This drug use evaluation study was conducted to assess the prescribing pattern of PPIs for patients admitted to the Qatar Rehabilitation Institute (QRI). Methods: An observational, retrospective, patients' chart-based study included all patients who received a PPI in QRI between April 1, 2017, and October 1, 2017. A standardized tool was prepared and reviewed by the involved clinical pharmacists to collect appropriate data for the evaluation. Statistical analysis was performed using the 25 th Version of the Statistical Package of the Social Sciences (SPSS ® ). Findings: A total of 119 patients received PPIs during the audit period, of which esomeprazole was the most frequently prescribed (34%). Majority of the patients (94%) were started on PPI without further investigations for confirming the indication, and the indication was not documented in 78% of the participants. Nonsteroidal anti-inflammatory drugs were the most commonly co-prescribed medications with PPIs (59%). Pantoprazole was co-prescribed with clopidogrel in 42% of the patients. Conclusion: This drug utilization study shows the need for a proper prescribing practice considering a clear indication and recommendations about the duration of therapy and the need for reassessment in QRI.

Amlodipine is a commonly prescribed antihypertensive drug, well tolerated and has rarely been attributed as a cause for elevated liver enzymes. Here, we present a 47-year-old male patient known to be hypertensive and admitted to our rehabilitation facility after an acute stroke. During his stay, amlodipine was started in addition to other antihypertensive medications to control his blood pressure. His liver transaminases after 4 days (notably alanine aminotransferase) were found to be markedly elevated. After reviewing the medications and investigating probable causes, amlodipine was suspended. After 5 days of suspending amlodipine, the transaminases started to trend downward. The Naranjo Adverse Drug Reaction Probability Scale and the Roussel Uclaf Causality Assessment Method were performed to assess causality in this suspected idiosyncratic drug-induced liver injury case. Both the scores denoted a probable amlodipine-induced liver injury. Previous case reports related to amlodipine-induced liver injury are mentioned and presented in the table below. In conclusion, amlodipine, though not well known to be hepatotoxic, can induce liver enzyme elevations in an idiosyncratic manner.

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Objective This study aims to appraise 2017 AACE Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease by using Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Method A total of seven investigators who have obtained a postgraduate Doctor of Pharmacy or Masters of Clinical Pharmacy, appraised the dyslipidaemia guidelines independently, by using AGREE II tool. Key findings Among all the domains, the highest-scoring domain was the clarity of presentation (87%), and the lowest was the applicability (26%). The assessors gave the top ranking for both 'scope and purpose' (78%) and 'Editorial independence' (79%). The overall guideline assessment was 61%. Most of the investigators (four out of seven) recommended using the guidelines in clinical practice with modifications. Conclusion The appraisal obtained in this article can be utilized by guideline developers to improve the quality of their upcoming guidelines. Healthcare professionals can be aware of guideline limitations and the importance of quality assessment of the guideline before applying their recommendations whenever possible by using Agree II tool.

Background: The safety of the COVID-19 mRNA vaccine in the outpatient setting has been extensively studied; however, there need to be more reports that specifically assess their safety in the inpatient population. It is hence imperative to explore the adverse drug reaction (ADR) profile in this population and monitor the progression of these ADRs in a hospital setting. This provides a unique opportunity to closely observe patients to ensure no side effects go undiagnosed. This study aims to explore and quantify the incidence and severity of ADRs in patients who have received the COVID-19 vaccine during their stay in the rehabilitation facility. Methods: This is a prospective observational study, which included adult patients admitted to the rehabilitation facility who were deemed eligible to receive the COVID-19 vaccine during their hospital stay. Data were collected by the investigators from June 2021 to May 2022 at 24 hours, 48 hours, and 7 days post-vaccination. A piloted data collection tool was utilized. Results: Thirty-five patients met the inclusion criteria. Pain at the injection site was the most commonly reported local ADR, while headache was the most frequent systemic ADR. The majority of the reported ADRs were mild to moderate in nature, with only one severe reaction detected. Although no statistical significance was noted among the variables, common patterns were identified, such as a higher occurrence of fever at 24 hours after the second dose as opposed to the first dose. Close monitoring of the included study subjects did not reveal any unanticipated ADRs or an increase in ADRs susceptibility and severity compared to the general population. Conclusion: This study supports the initiation of vaccination campaigns in inpatient rehabilitation settings. This approach would offer the advantage of gaining full immunity and reducing the risk of contracting COVID-19 infection and complications once discharged.

The present study was designed to investigate the possible prophylactic and therapeutic effect of cannabinoid receptors type1 (CB1) antagonist (AM251) on fructose-induced metabolic syndrome in rats, through administration of high fructose diet for 12 weeks. Prophylactic treatment by CB1-antagonist (AM251) significantly returned triglyceride, inflammatory, oxidative stress parameters and liver enzymes to the normal values while it significantly improved blood pressure, glucose, insulin, and IR and lipid profile but not significantly returned to the normal values. Interestingly, it significantly decreased body weight to values less than corresponding normal group. Histopathological findings confirmed that CB1-antagonist (AM251) in both prophylactic and therapeutic group improved histopathological changes of the liver and aorta induced by high fructose (60%) diet, with no drug had the upper hand of improvement of these histopathological changes.

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