School closure as a non-pharmaceutical measure appeared as an efficient strategy in previous epidemics. We investigated the impact of school closure on the epidemic peak whether implemented before or after the epidemic reaches its peak. We also investigated the optimal duration of closure. Data sources included Medline-PubMed, ProQuest and Cochrane databases. The inclusion criteria were all articles that reported a quantified effect on school closure on an influenza epidemic. Exclusion criteria were non-English articles that have no translation and articles that only reported school closure effect as a combination with another measure. Out of 668 articles, we included 31 articles. The mean reduction of the peak of the epidemic was M=29.65%. Implementing school closure before or after the epidemic reaches its peak reduced the overall influenza epidemic. School closure reduced and delayed the epidemic peak especially if implemented earlier. The longer the duration of closure the more the epidemic peak delayed. Additionally, closure containment effect also correlated with organisms having high attack rate and longer infectiveness duration. We conclude with several implications for school closure taking into consideration the feasibility and the cost.

Antibiotics over-consumption is a pandemic that has a tremendous cost on the overwhelmed healthcare system. The accessibility of antibiotics coupled with the misconception of public toward those drugs both of which implicated in the use and misuse of antibiotics. The aim of this study was to investigate the perception of the community toward antibiotics, its purpose and harmfulness, in addition to the accessibility of those drugs as over the counter and without prescriptions. We also investigated the behavior toward antibiotic prescriptions when perceived unnecessary. This is a cross-sectional study in Riyadh-Saudi Arabia based upon a structured self-administered questionnaire. The study included 473 individuals with a mean age of 27 years old. Forty eight percent (n=227) of the participants obtain antibiotics without prescriptions. Ninety two percent (n=208) of those noted pharmacist counseling as their method of acquisition. Self-prescription noted in 8.4% (n=19). Viral illnesses accounted for the highest percentage for seeking antibiotics in 35.5% (n=166) more commonly among females. Thirty one point eight percent (n=149) used antibiotics for analgesia while 13.7% (n=64) believed in their prophylactic use. We also noted that the prevalence of sharing antibiotics is 19.7%. The perceived unnecessary prescriptions uncovered 122 of the participants who reported throwing the prescribed antibiotics away after acquisition. Dispensing antibiotics without prescription is an issue that mandates a political intervention and implementation of the existing laws that prohibit dispensing without proper prescription. We advocate public health measures targeting both healthcare providers and the public on the use and misuse of antibiotics.

Little is known about liraglutide overdose and in particular its association with hypoglycemia. The aim of this study was to report on an accidental case of liraglutide overdose and to review similar cases in the literature. Here, we report a case of a young female presented with an accidental injection of 18 mg of liraglutide subcutaneously. She presented with relative hypoglycemia with gastrointestinal symptoms that resembled pancreatitis. We concluded with several implications and policies targeting accidental injections from the use of such medication and similar subcutaneous medications in clinical practice.

Background Patient satisfaction is an important measure of the health care encounter. It is challenging to achieve a perfect patient experience during the current COVID-19 pandemic, especially from an emergency department visit. Aim This study aimed to assess the factors that improve patient experience during an emergency department (ED) visit in the western region of Saudi Arabia. Methods This is a cross-sectional study, conducted over a month from January to February 2021. Via an electronic survey tool, we used the de en (EQS-H) to measure patients’ satisfaction with their ED encounter. Results The total level of satisfaction was high in 43.66% (n=224) of participants, moderate in 37.04% (n=190), and 19.29% (n=99) were unsatisfied. We noted significant predictors of dissatisfaction, including increasing age, higher educational level, and the existence of chronic diseases. A clear treatment plan and discharge instructions were important determinants for improving patient satisfaction. Conclusion The determinants of patient satisfaction during an ED visit are an important quality marker of the emergency department encounter. Such findings should be used as a benchmark for future programs aiming to improve patients’ experience during ED visits.

BACKGROUND Diphenhydramine, commonly prescribed as an antihistamine drug, is not known for its analgesic effect and its use in acute pain management has not been thoroughly investigated. AIM In this study, we aim to explore the analgesic properties of diphenhydramine and its role in acute pain reduction in the emergency department (ED). METHODS A systematic review and meta-analysis were performed. The inclusion criteria were randomised controlled trials that investigated the effect of intravenous diphenhydramine on the management of acute pain. Acute pain reduction was defined as a reduction in the visual pain score within one hour of drug administration. We excluded non-English articles, articles that measured the impact of diphenhydramine beyond the acute period, and those that used a pain score other than the 10-point visual pain scale. The information sources included PubMed, Google Scholar, Cochrane, PROSPERO, and grey literature (ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform) databases for articles published between 1963 and January 2022, along with the articles referenced at the end of the reviews, for the keywords ‘diphenhydramine’, ‘antihistamine’, ‘pain’, and ‘analgesia’. The researchers used the RoB 2 Cochrane risk-of-bias tools for randomised controlled trials. RESULTS We included four studies out of 128,902 involving 438 patients, out of whom 218 received diphenhydramine for pain control. The mean pain score in patients who received diphenhydramine was reduced by 28%; t(6)= -2.879, 95% CI [-2.87 to -0.23], p=0.028. When the baseline pain score was included in the analysis, we noted a reduction of 48% from the initial pain score. The pooled effect size or mean difference in acute pain reduction favouring diphenhydramine, taken from a random-effects model, was -1.53 (95% CI: [-2.35 to -0.70]) using Cohen’s d. CONCLUSION This meta-analysis confirms the analgesic advantages of diphenhydramine and supports its consideration as an adjunct for acute pain management in the ED.