Burn injuries are a major cause of morbidity and mortality, largely due to complications such as infection. Impairment of the immune system following burns increases susceptibility to both internal and external infections, underscoring the need for effective infection control strategies in burn care. In addition, burn patients frequently exhibit profound alterations in drug pharmacokinetics and pharmacodynamics (PK/PD), particularly during the resuscitation and hypermetabolic phases. In the resuscitation phase, increased capillary permeability and reduced cardiac output can prolong drug distribution, delay therapeutic response, lower peak plasma concentrations, and slow elimination. In contrast, the hypermetabolic phase is characterized by elevated catecholamine levels and enhanced tissue perfusion, which accelerate drug distribution and clearance. These physiological changes often necessitate antimicrobial dose adjustments to maintain therapeutic efficacy. This review emphasizes the critical importance of infection prevention and management in burn patients, with a focus on optimizing antimicrobial dosing and therapeutic monitoring in the context of PK/PD alterations.

Background: Pharmacists in Saudi Arabia are assuming increasingly diverse and specialized roles amid rapid healthcare transformation. However, evolving expectations and expanding responsibilities may influence their job satisfaction, well-being, and career stability. This study aimed to assess job satisfaction, burnout, well-being, and career intentions among pharmacists across multiple practice sectors in Saudi Arabia. Method: A nationwide cross-sectional survey was conducted between December 2024 and January 2025 using an electronic questionnaire distributed to licensed pharmacists. The instrument assessed mental well-being, job satisfaction, burnout, workplace environment, and career mobility. Descriptive and inferential analyses were performed using SPSS version 20.0. Results: A total of 531 pharmacists completed the survey; 65% were male, and 89.3% were Saudi nationals. Sector distribution differed significantly by gender (p < 0.001): females were more represented in clinical and hospital pharmacy, while males predominated in the pharmaceutical industry–related roles. Male pharmacists reported higher work environment scores (p = 0.028) and greater sector mobility (34.2% vs. 23.7%, p = 0.012). Approximately 30.5% of participants had changed their employment sector at least once. Community pharmacists reported the highest burnout levels, whereas those in regulatory and administrative roles demonstrated the greatest job satisfaction (both p < 0.001). Participation in professional development showed strong positive associations with job satisfaction and intention to remain in the current role. Conclusions: Marked variations exist in pharmacists’ well-being, satisfaction, and career mobility across sectors in Saudi Arabia, with notable gender differences. Enhancing professional development, ensuring equitable work environments, and promoting sector-specific support strategies may help inform discussions on pharmacist engagement and retention within the evolving national healthcare system.

Introduction: Atrial fibrillation (AF) poses a substantial worldwide health concern, significantly increasing the risk of stroke and morbidity. Direct oral anticoagulants (DOACs) such as apixaban are recommended over vitamin K antagonists for the management of AF. However, the impact of thyroid abnormalities on DOACs, specifically apixaban in AF patients remains underexplored. Given the limited data, this study aims to evaluate the effectiveness and safety of apixaban in AF patients with uncontrolled hypothyroidism. Methods: This study was a retrospective cohort analysis that categorized patients into two sub-cohorts according to their hypothyroidism status at the time they began apixaban treatment: a control group (without hypothyroidism) and an active group (with uncontrolled hypothyroidism). The primary outcome assessed was the rate of thrombosis events following the initiation of apixaban, while bleeding, stroke, and venous thromboembolism (VTE) events were considered as secondary outcomes. Logistic regression analysis was performed, with a p-value of less than .05 deemed statistically significant. Results: Among 292 patients included, 51 had uncontrolled hypothyroidism, and 241 were in the control group. Both groups had a median age of 70 years, with predominantly female patients. Any thrombosis events were higher in the uncontrolled hypothyroidism at crude analysis (17.6% vs 8.4%; p-value = .04); as well as higher odds at regression analysis [aOR: 2.40, 95%CI 0.99-5.83; p-value = .05]. In addition, stroke and major bleeding events were significantly higher in the uncontrolled hypothyroidism group (aOR: 4.26, 95%CI 1.51-12.00; p-value = .006 and aOR: 6.21, 95%CI 1.73-22.19; p-value = .005, respectively). The rate of VTE events and minor bleeding did not differ significantly between the two groups. Conclusions: The use of apixaban in patients with AF and uncontrolled hypothyroidism was linked to higher rates of thrombosis and major bleeding compared to those without known hypothyroidism. These findings highlight the need for further research through larger prospective studies in this often-overlooked population.