The steady-state pharmacokinetics of the atypical antipsychotic drug clozapine in schizophrenic Saudi Arabian patients was studied and correlated with the clinical outcome.Twenty-six schizophrenic patients were given clozapine over a period of 2±41 months. The daily dose ranged from 100 to 700 mg, and the frequency of administration varied from 1 to 2 times daily. A blood sample was collected from each patient at the midpoint of the dosing interval and was repeated on different days in six randomly selected patients to establish the steady-state condition. The concentration of clozapine in plasma (C ss ) was measured by HPLC with UV detection at 250 nm using C 18 bonded SepPak cartridges for sample preparation. The apparent oral clearance (CL p.o. ) was calculated from the equation: CL p.o. doseatC ss where t is the time between two consecutive doses. The effectiveness of the treatment was evaluated by the standard Positive and Negative Syndrome Scale (PANSS). The mean AE s.d. steady-state concentration (C ss ) was 491 AE 299 ng mL À1 . There were no signi®cant differences in C ss or any of the pharmacokinetic parameters studied between the 11 patients who responded positively to the treatment and the 15 patients who responded negatively.These results do not support the hypothesis that there is a positive correlation between higher plasma concentrations and positive response from clozapine in Saudi Arabian patients.

A clinical pathway is essential to outline the main clinical interventions that are carried out by a group of professionals. Aim: to investigate effect of using clinical pathway for patients with unstable angina on nursing performance and patient's outcomes in coronary care unit at University Hospital. Study design: Quasi experimental design Study subjects: includes all available nurses working in coronary care unit, (n=25) and all available patients admitted to the unit, (n= 100). Study tools: 1. Observation checklist: consists of part one: personal data for the nurses and second part is the observation checklist 2.Patients' outcomes tool: consists of part one: personal data of the patients and second part is the patients' outcomes tool; it was developed by the researcher. Result: there were statistical significant differences between control and study groups in patient's complications items and there was statistical significant difference between nurses' performance pre and post application of clinical pathway during study periods. Conclusion: nurses' performance improved and the undesired patient's outcomes decreased after clinical pathway application at study group. Recommendation: apply the clinical pathway for unstable angina patients rather than the hospital routine care and organize training workshops for nurses about implementation of clinical pathway.

Over the past several decades, the traditional superior-subordinate model for management has given way to more democratic approaches. A core concept for most of these new approaches to management is empowerment. `Empowerment is management practice of sharing information, rewards, and power with employees so that they can take initiative and make decisions to solve problems and improve service and performance.

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We present a rare case of hydatidiform molar pregnancy, which led to the development of thyroid storm, followed by a rare complication of takotsubo cardiomyopathy in the setting of a COVID-19 infection. A 21-year-old female of 22 weeks gestational age presented with heavy vaginal blood loss, brown emesis, tachycardia, and lethargy. Through clinical presentation and ultrasound confirmation, a molar pregnancy was diagnosed. Laboratory data and clinical presentation of thyrotoxicosis supported a diagnosis of thyroid storm. Test for COVID-19 was positive. The patient was treated with dilation and curettage, antithyroid medication, and blood transfusions, resulting in symptom resolution. Thereafter, echocardiography confirmed takotsubo cardiomyopathy. It is suspected that the homology in structure between the human chorionic gonadotropin (hCG) and thyroid stimulating hormone subunits resulted in thyroid storm secondary to receptor cross-reactivity. We speculate that subsequent cardiovascular stress of b-hCG-induced thyroid storm with superimposed COVID-19 infection facilitated the development of Takotsubo cardiomyopathy.