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The under-consideration article mainly focuses an unsteady three-dimensional Maxwell bio-convective nanomaterial liquid flow towards an exponentially expanding surface with the influence of chemical reaction slip condition. The feature of heat transport is achieving in the existenceof convective boundary condition and variable thermal conductivity. With the help of similarity variables, the flow form of equations is turned into a nonlinear form of coupled ODEs. The numerical solutions are calculated by adopting bvp4c function of MATLAB. Impact of distinct characteristics on the temperature, velocity microorganism and concentration field is graphically evaluated. Moreover, physical quantities are observed via graphs and tabulated data in details. It has been seen by the observation that the involvement of unsteadiness parameter restricts the change of laminar to turbulent flow. Further, for increasing velocity slip parameter velocity component in both directions shows lessening behavior. The Nusselt number exhibits diminishing behavior for larger values of Deborah number, and it shows the opposite behavior for larger values of convective parameter.

Hydromorphone is a semi-synthetic opioid that acts mainly on the μ-opioid receptor. Hydromorphone has a fast onset of action, usually within 5 min, and its effectiveness peaks at approximately 20 min, which makes it favourable in the postoperative setting. It plays a role in the management of moderate to severe chronic pain. The most common adverse effects of hydromorphone are hypotension, bradycardia, and respiratory distress. The aim of this study was to determine the trend in the use of hydromorphone analgesics and to evaluate hydromorphone-related toxicity in King Abdulaziz Medical City-Central Region ( KAMC-CR). A retrospective, cross-sectional study was carried out in KAMC-CR, and medical and pharmacological data were retrieved from electronic health records for adult patients who used hydromorphone between December 2014 and December 2015. The characteristics of the enrolled patients, including measured blood pressure, heart rate, respiration rate, oxygen saturation, and pain severity score, were collected. Moreover, we identified patients who received naloxone as a hydromorphone antidote. A total of 153 patients were included; 64.1% were male and 35.8% were female. The mean age of the included patients was 55.5 years old (+/− 18.6). Although the majority of patients reported an improvement in pain severity, 75 patients (49%) needed naloxone to overcome adverse effects of hydromorphone. The mean age of patients who received naloxone was 56.2 years old (+/− 20.5), their mean weight was 75.9 kg (+/− 17.2), and 61.3% of them were male (n = 46). Among those who received naloxone, 84% patients (n = 63) had received hydromorphone intravenously. The risk of respiratory depression was significantly higher in patients who received hydromorphone intravenously (IV) than in those who received it orally ( p  = 0.02). Hydromorphone can have adverse effect. Thus, we recommend evaluating cardiac parameters, oxygen saturation, respiration rate, and pain severity before administering hydromorphone, particularly in patients who have a high risk of cardiorespiratory adverse events, such as patients with cardiac disease, asthma, or chronic obstructive pulmonary disease. Additionally, we recommend the use of appropriate hydromorphone doses in cases of conversion from other opioid therapy or changes between oral and IV routes of the administration of hydromorphone. Moreover, we recommend establishing a policy to restrict the prescription of hydromorphone to avoid the overuse of hydromorphone and minimize the risk of adverse effects and medication errors.

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. 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 power. The final penalized likelihood parameters were used for the development of the risk prediction tool. The accuracy of a classification and the prediction are reported with the sensitivity, specificity, and Brier score. Bleeding occurred in 11.15% of cases, of which 23.08% required a blood transfusion and 51.65% had a reduction in haemoglobin of more than 2 gm. The variable selection model identified 15 predictors associated with major bleeding. The discriminative ability of the model was good (c-statistic 0.75, p = 0.035). The Brier score of the model was 0.095. With a fixed cut-off probability value of 0.12 for the logistic regression equation, the sensitivity was 72.7%, and the specificity 66.3%. This model demonstrated a good performance in predicting the bleeding risk in Arab patients treated with novel oral anticoagulants. This easy to use bleeding risk score will allow the clinician to quickly classify patients according to their risk category, supporting close monitoring and follow-up for high-risk patients, without laboratory and radiological monitoring.

Al Awn L, AlAmmari M, AlAbdulkarim D, AlAhmed R, Yadav B, AL-Jahdali H. J Asthma Allerg. 2025;18:1161-1166. Page 1161, Abstract, Results, line 4, the text \"the mean number of exacerbations decreased after switching to a different biologic (6.6 vs 3.9, p = 0.1)\" should read \"the median number of exacerbations decreased after switching to a different biologic (4 vs 2, p = 0.1)\". The authors apologize for this oversight.

The Saudi Initiative for Asthma (SINA) defines severe asthma as asthma that is uncontrolled at SINA step 4 despite optimized management. Choosing the biologic agent that is most appropriate for each patient can be difficult for clinicians. Thus, switching to another biologic agent due to no or suboptimal response is a common practice among asthma specialists. Therefore, this study aims to evaluate the safety and efficacy of switching biologics in patients with severe asthma at a tertiary care center. This was an observational retrospective cohort single-center study conducted at King Abdulaziz Medical City-Central Region, Riyadh, Saudi Arabia. All adult patients ≥18 years of age with a confirmed diagnosis of severe asthma and who were switched from one biologic agent (omalizumab, mepolizumab and dupilumab) to another were included. Thirty-three patients were included in the final analysis. In the majority of patients (81%), switching occurred due to lack of clinical efficacy. Most patients were maintained on the first and second biologic for 6 months or more. Most switching occurred from omalizumab to mepolizumab and dupilumab was the most frequently used last-line biologic (54%). Compared to the first biologic, the mean number of exacerbations decreased after switching to a different biologic (6.6 vs 3.9, p = 0.1). On the other hand, sinus symptoms improved after patients were switched to a different biologic (18.5% vs 37.5%, p = 0.1). Switching from one biologic agent to another is effective and safe in patients who are not optimally controlled on the initial treatment. National and international guidelines should define and include criteria for switching biologics.

Background For more than a decade, direct oral anticoagulants (DOACs) have been approved in clinical practice for multiple indications such as stroke prevention in non-valvular atrial fibrillation treatment of deep vein thrombosis and pulmonary embolism. This study aimed to explore the nature and contributory factors related to medication errors associated with DOACs in hospital settings. Methods Analysis of error reports using data from (a) Saudi Food and Drug Authority pharmacovigilance database and (b) local incidents reporting system from two tertiary care hospitals were included. Errors reported between January 2010 to December 2020 were also included. Statistical analyses were performed using IBM (SPSS) Statistics Version 24.0 software. Results A total of 199 medication error incidents were included. The mean (range) age of affected patients was 63.5 (19–96) years. The mean reported duration of treatment when incidents happened was 90 days, with a very wide range from one day to 12 months. Prescribing error was the most common error type representing 81.4% of all errors. Apixaban was the most frequent drug associated with error reporting with 134 (67.3%) incidents, followed by rivaroxaban (18.6%) and dabigatran (14.1%). The majority of the patients ( n  = 188, 94.5%) showed comorbidities in addition to the conditions related to DOACs. Polypharmacy, an indication of treatment and duration of therapy were amongst the important contributory factors associated with errors. Conclusions This observational study demonstrates the nature of DOAC related medication errors in clinical practice. Developing risk prevention and reduction strategies using the expertise of clinical pharmacists are imperative in promoting patient safety associated with DOAC use.

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 and divergent validity, and the correlation between the DASS and demographic variables, clinical characteristics, and the EQ-5D-5L instrument. Results: 439 subjects answered all the questions. From a total of 25 items, 22 grouped into three factors (limitations, positive impact, and negative impact). Each factor had good internal consistency (Cronbach Alpha 0.78–0.88). All the three factors correlated consistently with EQ-5D-5L measuring generic quality of life. Conclusion: The psychometric properties of the Arabic DASS version were comparable to the original English version. The Arabic version of the DASS showed very good reliability and validity. It can be used by health care professionals in other settings of anticoagulation clinics to assess patient’s satisfaction and limitations to anticoagulant treatment.

In this research paper, explored the newly exact soliton solutions of the nonlinear fractional Kairat-II equation under extended simple equation method. The set of Kairat-II equations recently introduced, which have important applications in the area of physics and engineering. The fractional Kairat-II equation is an integrable equation and it is used to explain the differential geometry of curves and equivalence aspects. In this study, varieties of exact soliton solutions explored by apply the extension form of simple equation method on base of computational simulation. The extracted soliton solutions to the nonlinear fractional Kairat-II equation having interested physical structure in periodic optical solitons, bright solitons, kink solitons, anti-kink solitons, traveling waves, dark solitons, mixed solitons, peakon solitons and solitary waves. The physical structure of extracted soliton solutions visualized in 2-dim, 3-dim and contour graphically with the help of numerical simulation under computational software Mathematica. The investigation show that the proposed approach is more effective, powerful, concise and efficient for the other nonlinear partial and fractional differential equations.

In this research work, we explored the unexpected optical soliton and solitary wave to the nonlinear (2+1)-dimensional Zakharov–Kuzetsov equation by utilizing the auxiliary equation method. The explored optical soliton and solitary wave solutions obtained in variety of soliton including bright solitons, anti-kink wave solitons, periodic optical solitons, kink wave solitons, dark solitons, anti-kink dark solitons, combined solitons, crest-turf form solitons, peakon solitons and periodic solitary waves. The physical structure of extracted optical solitons visualized in three-dim, two-dim and contour plotting by utilizing the numerical simulations with computational software Mathematica. The secured optical solitons will be play important role in the investigation of nonlinear (2+1)-dim Zakharov–Kuzetsov equation and will be develop interest in the researchers for further investigation on this nonlinear model. The physical structure of explored soliton results show that, these solitons will be play important role in the areas of sciences and engineering such as nonlinear optics, transmission system, communication system, nonlinear dynamics, soliton wave theory and ocean engineering. The successful investigation is the witness that the proposed approach is effective, efficient and powerful for the exploration of solitary waves special verities of optical solitons to the various kinds of nonlinear evolution equations.

In this work, we propose a new generic class of charged stellar structures in general relativity (GR), which is consistent with observational data. The geometry considered in this study is the static and spherically symmetric with an anisotropic matter configuration inside the geometry. To make the system of governing field equations solvable, we considered the phenomenological MIT bag model equation of state. In this model, the relationship between the density profile ( ρ ) and the radial pressure ( P r ) is represented by the equation P r ( r ) = 1 3 ( ρ - 4 B g ) . The governing Einstein–Maxwell field equations are solved by taking the Tolman–Durgapal-V (TD-V) metric potentials into account, in which the Tolman metric potential (Tolman, Phys Rev 55:364, 1939) is defined by e λ ( r ) = ( 1 + a r 2 + b r 4 ) and the Durgapal-V metric potential (Durgapal, Phys Rev 15:2637, 1982) is defined by e ν ( r ) = B ( 1 + C r 2 ) 5 . The parameters a , b , B , and C included in these potentials are calculated by comparing the Reissner–Nordstr o ¨ m line element as an external geometry at the stellar surface corresponding to the interior space–time. In our study, we perform an extensive validation of the proposed model to verify its legitimacy as a physically consistent compact object under the framework of GR by considering a dozen compact star candidates as representatives of a large class of compact stellar structure. The results demonstrate that the model maintains stable behavior without singularities and successfully represents a diverse range of observed compact objects in astrophysical contexts. This thorough assessment ensures that the model complies with critical physical standards, bolstering its applicability in understanding compact star dynamics.