Systemic Nickel Allergy Syndrome: A Critical Appraisal of an Unvalidated Diagnostic Entity

Systemic (gastrointestinal and skin) reactions to ingestion of nickel rich foods in patients with nickel allergic contact dermatitis characterize Systemic Nickel Allergy Syndrome (SNAS). The objective of the study was to describe the nosologic framework of the syndrome and to compare sensibility and specificity for SNAS diagnosis between two different low nickel diets - BraMa-Ni and the usually prescribed list of forbidden foods - along with patient adherence to diet. One hundred forty-five patients with suspected SNAS (by history and benefit from nickel dietary restrictions) were selected and orally challenged with nickel for a definite diagnosis. Specificity and sensibility of the diets were calculated in relation to the results of nickel challenges. The nosologic framework of SNAS was deduced from the clinical pictures of 98 patients with positive nickel challenge and characterized essentially by skin and gastrointestinal symptoms, whereas all other symptoms (dizziness, headache etc.) were never elicited by the oral nickel challenge. The specificity and sensibility of BraMa-Ni in detecting SNAS were significantly higher than the forbidden food list diet, with an excellent patient adherence. Therefore, BraMa-Ni diet can be prescribed for the treatment of the syndrome other than for the diagnosis, the gold standard of which remains the oral nickel challenge.

Background: The study focused on a new dietary approach to treatment of diet-related immune pathologies interesting an increasing number of people sensi- tive to dietary antigens like gluten or nickel. In particular we paid particular atten- tion to pathological condition that is a combination of two frequent conditions not still perfectly known: gluten-related syndrome defined as non-celiac gluten sensitivi- ty (NCGS) and systemic (gastrointestinal and skin) reactions to ingestion of nickel rich food that characterizes Systemic Nickel Allergy Syndrome (SNAS). Objective: The aim of this study was to implement a new exclusion diet (DICE diet) in patients with the mentioned pathologies. Usually, for this condition, diet is represented by a list of forbidden food that doesn't consider the initial weight. This is why there is a loss of the adherence of patients to the diet as a consequence of efficacy of treatment. Method: The new exclusion diet is developed, keeping in mind, the initial weight, considering the gen- eral patient's state to ensure the respect for a sufficient time in order to reduce symptoms. The compliance and the effects on the weight have been detected by a questionnaire during the 6-month follow up. Results: 17 patients, with SNAS and NCGS, have been treated with the DICE diet and after 6 months, 70% of them have reported symptoms disappearance. Conclusion: We suggest that the DICE diet could be prescribed for the treatment of these diet-related immune-pathologies. Keywords: Systemic Nickel Allergy Syndrome (SNAS), non-celiac gluten sensitivity (NCGC), obesity, exclusion DICE diet.

Nickel sensitized patients may suffer of contact dermatitis,but also of urticaria-like, pruritus-erythema and cutaneous rush,sometimes associated with intestinal symptoms.The role of Nickel absorption due to food is still debated, but a clinical framework of Systemic Nickel Allergy Syndrome (SNAS) may be proposed, while a possible induction of oral tolerance deserves to be investigated. In the same Allergy Unit 152 subjects (126 F,26 M) were diagnosed as allergic by positive patch test to Nickel sulphate (class 2-3). All underwent Urinary Nickel determinations (NiU), by AAS with Zeman corrector and results standardized to creatinine concentration. According to single diagnosis patients were selected. Group A (65 pt) with only contact dermatitis. Group B (87 pt) with skin troubles of SNAS. At the first determinationt NiU values in Group B (mean 2,25 mcg/g creatinine) were significantly higher when compared to Group A (mean 0,87 mcg/g creatinine), with p<0,0001. Abnormal values measured at free diet exceeded the fixed limit of attention of 1,7 in 55% of Group B (48/87 cases) and only 20% in Group A (13/65). The 48 subjects of Group B received a Nickel-scanty diet that observed for six months; end-NiU resulted below the adopted limit for all patients. In spite of this dietary restriction 30 of them claimed again episodic cutaneous urticaria-like symptoms and frequent itching. 12 subjects were included in an experimental oral treatment (Lofarma Laboratories, Milan) based on subsequent microdoses of Nickel sulphate,from 0,1 to 1000 nanograms (1 mcg), aimed to induce an immunotolerance. Treatments were monitored by NiU. All these cases reported improvement; absence of symptoms was documented after 8 months of maintenance with the highest dose. SNAS is statistically related to an increased Nickel intake from dietary habit. NiU seems to be a reliable indicator in biological monitoring. A Nickel-scantydiet may reduce the incidence of SNAS, according to a decrease of NiU. A surveilled oral treatment by microdoses of Nickel sulphate seems to induce a specific immunotolerance and clinically to realise reduction or suppression of symptoms.

This study examines the bidirectional tension between public and scientific attention amid informatization, analyzing their mutualistic symbiosis to address science communication challenges. We constructed a mathematical model of mutualistic symbiosis in their relationship was developed based on the Logistic Model. Subsequently, numerical simulations were employed to investigate the evolutionary trends and patterns of scientific attention, public attention, and the effectiveness of science communication under varying modes of public attention and initial values of scientific attention. Furthermore, using “COVID-19” as a case study, an empirical analysis was conducted on to assess the correlation between public attention and scientific attention and evaluate the constructed mathematical Model, verifying its scientific validity and effectiveness. This study underscores the critical role of science communication in fostering advantageous interactions between scientific and public attention. Nonetheless, it is imperative to adopt tailored science communication strategies that accommodate diverse public attention modes and initial levels of scientific attention while selecting appropriate symbiotic models for specific contexts. This proposed approach ensures the effective dissemination of scientific information and fosters a robust science communication ecosystem.

Is carbohydrate intake in the first years of life related to future risk of NCDs?

From the ancient period to the current day, each cultural area has had their distinctive dietary pattern (combinations of dietary components, such as food or nutrients, to summarize a total diet) to adapt to their lifestyle and environments, such as a Western style diet (American style), Mediterranean diet and Asian diet (Japanese style). In recent years, chronic diseases such as diabetes, obesity, atherosclerosis, cardiovascular disease, and hypertension incidence and prevalence rate, have rapidly increased and have become a burden of public health management. Because lifestyle modification is the only confirmed preventive method for the rapid increase of these patients, several methods are recommended, such as nutritional modification and diverse exercise without drug therapy. In these lifestyle modification methods, dietary modification is extremely important for chronic disease prevention and management. So many dietary recommendations released by the international scientific committees and organizations state that a diet should be moderately low in caloric content, low in fat and carbohydrate content, and high in protein and fiber. These diets emphasize the reduction of carbohydrate intake and thereby encourage high protein intake, given that, in Western countries, high fat diets are also generally avoided. Many diets are low in carbohydrates and high in protein, such as the Atkins diet. Very low-carbohydrate diets typically contain <10% carbohydrates, 25–35% proteins and 55–65% lipids. For comparison, the average American diet contains 50% carbohydrates (275 g/day), 15% protein (83 g/day) and 35% lipids (85 g/day). In the UK, the mean intake, as a percentage of total energy, is approximately 48% carbohydrates, 17% protein and 35% lipids1. Hession et al.2 suggest that low-carbohydrate, high-protein diets were associated with a slightly greater increase in high-density lipoprotein cholesterol and to a slightly greater decrease in triglycerides. In contrast, these diets were associated with a slightly greater increase in low-density lipoprotein cholesterol. Recently, low-carbohydrate and high-protein diets have become extremely popular with consumers and patients. However, concerns have been expressed about the health effects of low-carbohydrate and high-protein diets3, 4, even though little documented information exists about the long-term health consequences of low-carbohydrate and high-protein diets. Also these methods have not been fully confirmed for their benefit and usefulness by long-term, large, randomized clinical trials, but have only been found by short-term, small, randomized clinical trials and meta-analysis. Last year in Annals of Internal Medicine, Fung et al.5 published a very interesting article about all cause and cause-specific mortality in a Nurses’ Health Study and Health Professionals’ Follow-up Study cohort. They examined the relationships of animal based or vegetable based fat and protein mixed low-carbohydrate diets with cardiovascular and cancer mortality over 20-years prospective follow up in two cohorts. They used a low-carbohydrate score, which was based on the percentage of energy as carbohydrate, fat and protein. They concluded that a low-carbohydrate diet based on animal sources was associated with higher all-cause cardiovascular and cancer mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates5. Another three long-term observational studies on the effects of a long-term low-carbohydrate diet on mortality were carried out1, 6. In a long-term cohort study of Swedish women6, decreasing carbohydrate or increasing protein intake by one decile were associated with an increase in total mortality by 6% (95% CI 0, 12) and 2% (95% CI −1, 5), respectively. So, they concluded that low carbohydrate and high protein intake was associated with increased total and, particularly, cardiovascular mortality amongst women. During 10 years of follow up in Greek participants of the European Prospective Investigation Cancer and Nutrition study1, higher intake of carbohydrates was associated with a significant reduction of total mortality, whereas higher intake of protein was associated with a non-significant increase of total mortality. Positive associations of low-carbohydrate and high-protein score were noted with respect to both cardiovascular and cancer mortality. Therefore, they suggested that prolonged consumption of diets low in carbohydrates and high in protein is associated with an increase in total mortality. In an elderly Swedish cohort study6 for 10.2-year median follow up, adjusted hazard ratios for the Mediterranean diet score were 0.71 (95% CI 0.55, 0.92) for all-cause mortality and 0.63 (95% CI 0.42, 0.96) for cardiovascular mortality, and the carbohydrate restricted diet scores were 1.19 (95% CI 0.97, 1.45) for all-cause mortality and 1.44 (95% CI 1.03, 2.02) for cardiovascular mortality. They concluded that adherence to a Mediterranean dietary pattern decreased mortality, but adherence to a carbohydrate-restricted dietary pattern increased mortality in elderly Swedish men. Another Asian population-based cohort study7 was divided into three major dietary patterns (vegetable-rich, fruit-rich and meat-rich) and followed up for 5.7 years. They reported that the meat-rich diet was associated with increased risk of diabetes (HR = 1.18; 95% CI 0.98, 1.42) and a slightly elevated risk of total mortality, whereas the fruit-rich diet lowered mortality. From the aforementioned four studies’ results, low-carbohydrate and high-protein diets didn’t show favorable effects for cardiovascular and cancer mortality. On the contrary, adverse effects have not been reported for the long-term consumption of Mediterranean-type diets, low-glycemic index/glycemic load diets or low-carbohydrate, high vegetable protein diets. Are all kinds of low-carbohydrate high-protein diets sustainable and safe for very long periods? Are all low-carbohydrate high-protein from vegetable origin diets really beneficial to specific disease mortality? No definitive answer exists. Future studies will need to address the long-term safety of low carbohydrate high-vegetable protein diets. How did we interpret and understand these results? All forms of low-carbohydrate and high-protein diets did not have adverse long-term effects. Therefore, frequently recommended dietary patterns that indiscriminately focus on low intake of carbohydrates and high intake of proteins in general, should be considered for effectiveness. However, large population-based, long-term intervention studies analyzing the impact of specific dietary patterns on the mortality of specific diseases are not feasible. The results of the study by Fung et al.5 must be confirmed by well-designed, large, population-based, long-term interventional studies. Until now, observational trials remain a major source of evidence for differential effects of the quantity and quality of carbohydrates and protein on the risk and mortality of specific diseases. In observational studies for dietary pattern, many researchers use exploratory and hypothesis-oriented approaches (Table 1). Therefore, these epidemiological observation studies have many limitations, such as the selective under-reporting of nutritional intake possibly being related to specific diseases and the conscious awareness of the relationship between food intake and specific diseases. These limitations are of particular concern for cross-sectional studies and less pertinent for prospective studies addressing disease outcomes, such as cardiovascular disease and cancer. So, simultaneous consideration for the prospective epidemiological evidence linking diet to the subsequent development of outcome was very important. In conclusion, each dietary pattern reflects the specific traditional cultures and environments where the population lives. Therefore, frequently recommended dietary pattern modification to prevent specific disease development and adverse outcomes should be considered seriously before being applied to the whole population. Dietary pattern modification must be evaluated for its efficacy and adverse effects, not by an observational study, but a prospective epidemiological intervention study.

Traditional weight loss and dukan diets as to nutritional and laboratory results

In obese patients, brain serotonergic stimulation via orally administered 5-hydroxy-tryptophan (5-HTP), the precursor of serotonin, causes decreased carbohydrate intake and weight loss. Since diabetes mellitus is associated with depressed brain serotonin, hyperphagia and carbohydrate craving, we hypothesized that in diabetic patients, orally administered 5-HTP stimulates brain serotonergic activity and thus normalizes eating behaviour. To test this hypothesis, we investigated whether in diabetic patients: 1) predicted brain serotonin concentrations are depressed as a result of decreased availability of the precursor, tryptophan; and 2) oral 5-HTP is effective in reducing energy and carbohydrate intake. 25 overweight non-insulin dependent diabetic outpatients were enrolled in a double-blind, placebo-controlled study, and randomized to receive either 5-HTP (750 mg/d) or placebo for two consecutive weeks, during which no dietary restriction was prescribed. Energy intake and eating behaviour, as expressed by macronutrient selection, were evaluated using a daily diet diary. Plasma amino acid concentrations and body weight, as well as serum glucose, insulin and glycosylated haemoglobin were assessed. 20 patients (nine from the 5-HTP group and 11 from the Placebo group) completed the study. Brain tryptophan availability in diabetic patients was significantly reduced when compared to a group of healthy controls. Patients receiving 5-HTP significantly decreased their daily energy intake, by reducing carbohydrate and fat intake, and reduced their body weight. These data confirm the role of the serotonergic system in reducing energy intake, by predominantly inhibiting carbohydrate intake, and suggest that 5-HTP may be safely utilized to improve the compliance to dietary prescriptions in non-insulin dependent diabetes mellitus.

BackgroundPediatric pulmonary embolism is a rare yet potentially life-threatening condition, presenting significant diagnostic and therapeutic challenges owing to its nonspecific symptoms and diverse underlying risk factors. This systematic review aims to consolidate data from case series and case reports to provide a comprehensive overview of pediatric pulmonary embolism, focusing on clinical characteristics, diagnostic approaches, treatment strategies, and outcomes.MethodsThis systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and the Cochrane Handbook for Systematic Reviews of Interventions, version 6.3. The study protocol was registered with PROSPERO (ID: CRD42024532471). We utilized the Covidence systematic review software for deduplication and screening of search results. The literature search was developed with a subject specialist and included Medical Subject Headings terms and free-text keywords such as “pulmonary embolism,” “pediatric,” and “case reports.” Databases searched included PubMed, Scopus, Web of Science, and the Cochrane Library up to April 2024, limited to English-language publications. Reference lists of relevant articles were also reviewed.ResultsPulmonary embolism affected males and females with age ranging from 1 to 18 years. Common underlying conditions included malignancies (for example, Wilms tumor), chronic diseases (for example, nephrotic syndrome), and recent surgical interventions. Diagnostic practices primarily relied on computed tomography pulmonary angiography, supplemented by chest X-ray and ultrasound. Treatment typically involved anticoagulation therapy with unfractionated heparin and low-molecular-weight heparin, transitioning to oral anticoagulants for long-term management. Thrombolytic therapy was used in severe cases. Outcomes varied, with many patients recovering well, though complications such as recurrent embolism and pleural effusion were observed. Fatal cases underscored the critical need for early detection and prompt treatment.ConclusionThis systemic review underscores the rarity and complexity of pediatric pulmonary embolism, highlighting the necessity for increased clinical vigilance given its nonspecific presentation and diverse underlying risk factors. Accurate diagnosis, primarily via computed tomography pulmonary angiography, with the prompt initiation of anticoagulation therapy are essential for optimal outcomes. Despite favorable recovery rates for most patients, the potential for severe complications and fatalities reinforces the value of timely diagnosis and personalized management approaches. Further research is essential to refine diagnostic protocols, optimize treatment approaches, establish evidence-based guidelines, and improve long-term outcomes for children with pulmonary embolism.

Levels of Clinical Evidence

Evaluating the Effects of Low Carbohydrate and High Protein Diet on Erectile Function in Rats.

Dietary sodium restriction in the prophylaxis of hypertensive disorders of pregnancy: effects on the intake of other nutrients

Andes virus-associated cardiopulmonary syndrome: diagnostic approaches, clinical management, and evidence gaps-a scoping review.

STUDY QUESTION In patients with Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS; population), is the presence of functional endometrium (FE) in uterine remnants (URs) (exposure), compared with the absence of FE in UR/absence of UR (comparison), associated with a higher prevalence of endometriosis (outcome)? SUMMARY ANSWER The aggregate prevalence of endometriosis was considerably higher in MRKHS patients with FE (MRKHSFE+) than in those without FE (MRKHSFE−). WHAT IS KNOWN ALREADY The pathogenesis of endometriosis is not fully understood. The finding of pelvic endometriosis in patients with MRKHS is one of the main objections to the retrograde menstruation (RM) hypothesis. The recent advent of high-resolution ultrasonography and magnetic resonance imaging (MRI) allowed the reliable preoperative identification of FE concealed within UR, and histopathological examination after UR removal is no longer the only means of verifying the presence of a mucosal component. A similar prevalence of endometriosis in MRKHSFE+ and MRKHSFE− patients, as assessed by preoperative ultrasound (US) and/or MRI, would essentially rule out the RM/implantation theory, whereas a substantially higher prevalence of endometriosis in MRKHSFE+ than in MRKHSFE− patients would challenge the embryonic remnants/coelomic metaplasia hypothesis. STUDY DESIGN, SIZE, DURATION This systematic review was restricted to full-length, English-language articles published in peer-reviewed journals between 1 January 1980 and 1 June 2024. The electronic PubMed and Embase databases were searched in June 2024. The keyword ‘endometriosis’ was used in combination with ‘Mayer–Rokitansky–Küster–Hauser syndrome’, ‘Müllerian agenesis’, ‘uterine agenesis’, ‘vaginal agenesis’, ‘Müllerian anomalies’, and ‘female genital malformations’. References from relevant publications were screened, and PubMed’s ‘similar articles’ and ‘cited by’ functions were used. PARTICIPANTS/MATERIALS, SETTING, METHODS Studies were selected if they reported the presence or absence of FE within UR investigated by preoperative US or MRI or histology after surgical removal, and the presence or absence of surgically confirmed endometriosis. Case series and case reports were deemed eligible for inclusion. Studies not specifically stating the intent to search for the presence of endometrium within UR, or not reporting the results of ultrasonography or MRI, or histological examinations were excluded. Two reviewers independently abstracted data. The risk of bias was assessed using a tool specifically devised to ascertain the methodological quality of case series and case reports. MAIN RESULTS AND THE ROLE OF CHANCE A total of 102 studies (29 case series and 73 case reports), comprising 666 MRKHS patients in whom the presence or absence of FE was verified were included. Endometriosis was detected in 71 participants (10.7%; 95% CI, 8.5–13.2%), and its prevalence was 8.6% (51/593; 95% CI, 6.6–11.2%) in case series and 27.4% (20/73; 95% CI, 18.4–38.6%) in case reports (P&amp;lt;0.0001). When considering only the 19 case series with ≥10 participants, the proportion of MRKHS patients with endometriosis was 3.4% (41/1219; 95% CI, 2.5–4.5%). Among the 71 MRKHS patients with endometriosis, 64 had coexisting FE, and only seven had no evidence of FE within UR or did not have UR. The proportion of patients with endometriosis was 32.0% in the subgroup with FE (64/200; 95% CI, 25.9–38.8%) and 1.5% (7/466; 95% CI, 0.7–3.1%) in the subgroup without FE within UR/without UR. At meta-analysis considering case series, the overall prevalence estimates of endometriosis in patients with and without FE were, respectively, 16.8% (95% CI, 1.8–38.5%) and 0% (95% CI, 0–0%). In order to evaluate the association between FE and endometriosis we also conducted a meta-analysis that included case series reporting both FE+ and FE− patients. A significantly increased risk of endometriosis was observed in MRKHSFE+ patients compared with MRKHSFE− patients (overall odds ratio estimate was 12.0; 95% CI, 5.1–28.3%). The quality of the evidence score was higher in the case series subgroup (median score, 4 points; interquartile range, 3–5 points) than in the case reports subgroup (median score, 3 points; interquartile range, 2–4 points). LIMITATIONS, REASON FOR CAUTION Due to the uncontrolled and non-experimental study design, case series and case reports are associated with an increased risk of selection, performance, detection, attrition, and reporting bias. In the seven cases of endometriosis in patients purportedly without detected FE, a preoperative MRI was not systematically performed or erroneous findings were reported, the anatomical description at surgery was incomplete or inconsistent, the histopathological diagnosis of endometriosis was missing or questionable, and precise microscopic features were not always described. Whether FE (exposure) was truly absent in all these cases and/or whether all lesions diagnosed as endometriosis (outcome) were indeed true disease, seems uncertain. WIDER IMPLICATIONS OF THE FINDINGS Our findings should raise awareness of the importance of accurately assessing and reporting the presence or absence of FE within UR, and of systematically performing biopsies of visually diagnosed endometriosis in MRKHS patients. Considering the high risk of bias, the detection of endometriosis in MRKHS patients allegedly without FE in the few relevant case reports published in the last four decades should no longer be interpreted tout court as proof for the coelomic metaplasia/embryonic remnants theory. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for this review. P.Ve. is a member of the Editorial Board of Human Reproduction Open, the Journal of Obstetrics and Gynaecology Canada, and the International Editorial Board of Acta Obstetricia et Gynecologica Scandinavica; has received royalties from Wolters Kluwer for chapters on endometriosis management in the clinical decision support resource UpToDate; and maintains both a public and private gynaecological practice. E.S. is Editor-in-Chief of Human Reproduction Open; discloses payments from Ferring for research grants and honoraria from Merck-Serono for lectures; and maintains both a public and private gynaecological practice. P.Vi. is Co-Editor-in-Chief of Journal of Endometriosis and Uterine Disorders. All other authors declare they have no conflict of interest. REGISTRATION NUMBER The study protocol was registered on PROSPERO (registration number, CRD42024512351).

International Journal of Pharmacology and Clinical Sciences,2022,11,2,36-40.DOI:10.5530/ijpcs.2022.11.8Published:June 2022Type:Review ArticleAuthors:Yousef Ahmed Alomi, Amal Hassan Al-Najjar, Esraa S. Altawil, Maha Hussein Almadany, Ghudair Tashan Alanazi, and Abeer Hussin Almasoudi Author(s) affiliations:Yousef Ahmed Alomi*, BSc.Pharm, MSc. Clin Pharm, BCPS, BCNSP, DiBA, CDE Critical Care Clinical Pharmacists, TPN Clinical Pharmacist, Freelancer Business Planner, Content Editor, and Data Analyst, Riyadh, SAUDI ARABIA. Amal Hassan Al-Najjar, BSc, MSc,Drug and Poison Information Center, Security Forces Hospitals, Riyadh, SAUDI ARABIA. Esraa S. Altawil, SCCPN, MSc. Pharm,BCCCP, BCNSP, BCPS Consultant Clinical Pharmacist, Critical Care and Nutrition Support, King Saud University Medical City, SAUDI ARABIA. Maha Hussein Almadany, BSc. Pharm. Health Care Quality Management Professional Diploma (HCQM), Pharmacy Quality Department, King Salman bin Abdulaziz Medical City, Al Madina Al Monwarah, SAUDI ARABIA. Ghudair Tashan Alanazi, BSc. Pharm, Pharm.D, MSc. Clin Pharm, Diploma of Epid, Critical Care Clinical Pharmacist, Internal Medicine Clinical Pharmacist, MOH, Hafrbatin, SAUDI ARABIA. Abeer Hussin Almasoudi, BSc.Pharm Director, Administration of Research and Studies, Ministry of Health, Tabuk, SAUDI ARABIA. Abstract:Objectives: This study aims to declare the Research policy of case reports and case series design in pharmacy practice as a new initiative in Saudi Arabia. Methods: This article is a narrative review of pharmacy research. Litterateur looked up specific research policies and procedures in pharmacy practice in databases such as PubMed, Medline, and Google Scholar. The time frame for the search was from the 1960s to October 2021. The terms used are in the English language and encompasses narrative reviews, systemic reviews, meta-analyses, and guidelines. The search term includes all hospital and community pharmacy-related services. Besides, there are national and international guidelines for conducting general research in hospital practice was revised. The pharmacy research committee was formed and consisted of expert members, including clinical pharmacists, pharmacists who specialise in drug information, and clinical research specialists. A member drafted the policy’s guidelines, which were then reviewed and corrected by another member. The research specialist made the third revision. The topic emphasizes the Pharmacy Research policy of case reports and case series design. Results: The Pharmacy Research policy regarding the design of case reports and case series in pharmaceutical care services included several items. This included the advantages and disadvantages of case reports and case series, the steps involved in conducting case report research, and the steps involved in implementing the case series model in pharmacy practice. Conclusion: The case report and case series policy in pharmacy is a new initiative that is part of the pharmacy research services and the pharmacy strategic plan. The case report and case series pharmacy policies help a healthcare organisation address its unique drug related issues. Additionally, the efficacy of the particular drug in treating the particular disease condition. Therefore, in Saudi Arabia, the case report and case series in pharmacy research policy are highly recommended. Keywords:Case report, Case series, Pharmacy, Policy, Research, Saudi ArabiaView:PDF (265.06 KB) PDFClick here to download the PDF file. Images Research Policy of Case Report and Case Series Design