Pharmacists 1. Because the pharmacies continue to stock and dispense mainly those medicines (branded and/or generic) that are more profitable for them, a new policy should be applied to control the dispensing pattern. 2. To overcome the limited patient choice and escalating drug expenditure, reference pricing is one of the recommended solutions. doi: 10.1016/j.jcrc.2010.07.022 Association of genetic polymorphism of 5-HT 2A receptor gene and stress related psychological measures in healthy medical students Anam Ahmed a , Rommana Mehdi a , Sadia Maqbool a , Saidmari Baadshah a , Mona Faramawy b a Second year medical students, Dubai Medical College for Girls, Dubai, UAE b Third year medical students, Dubai Medical College for Girls, Dubai, UAE Introduction: A majority of medical students (73%) perceive stress, and a small group of students repeatedly experience psychological distress during their medical training. The 5-HT2A receptor gene codes for the 5-HT2A receptor (5-HT2A), which is a serotonin receptor. A common polymorphism of the 5-HT2A that has been identified is the 1438 G/A gene. It is seen that variations in the -1438 SNP modulates 5-HT2A promoter activity, with the AA genotype associated with higher gene expression in cell lines that endogenously express 5-HT2A. Objective: The objective was to study whether there is any association between genetic polymorphism of 5-HT2A receptor gene and stress-related psychological measures in healthy medical students. Material and method: A questionnaire-based cross-sectional study was conducted on 65 medical students to assess stress-related personality traits. DNA was then extracted from white blood cells by a salting-out method. 1438 G/A genotypes were determined by polymerase chain reaction–restriction fragment length polymor- phism. The fragments were then analyzed by agarose gel electropho- resis. Statistical analysis was done with SPSS (Chicago, IL) program. Results: Frequency of carriers of the (AA & AG) genotype of the 1438 G/A polymorphism was 76.7% in the nonstressed group as compared with 65.7% in the stressed group. Frequency of carriers of the (GG) genotype of the 1438 G/A polymorphism was 23.3% in the nonstressed group as compared with 34.3% in the stressed group. Carriers of the GG allele were at a higher risk of developing stress (odds ratio = 1.7, 95% confidence interval = 0.6-5.1). Conclusion: Polymorphism of 5-HT2A 1438 G/A can be considered a risk factor for developing stress-related personality traits. doi: 10.1016/j.jcrc.2010.07.023 Efficacy and cardiovascular tolerability of continuous venovenous hemodiafiltration in acute decompensated heart failure: a randomized comparative study S.S.I. Badawy MD, A. Fahmy MD Department of Anesthesia and Intensive Care, Kasr-Aini Hospital, Cairo, Egypt Introduction: Diuretics have been considered the mainstay of treatment of congestive heart failure (CHF). Recently, continuous venovenous hemodiafiltration (CVVHDF) has received increased attention in the treatment of CHF. The aim of this study is to assess the safety and efficacy of CVVHDF compared with intravenous furosemide in patients with CHF. Methods: Forty patients with CHF were included in this prospective randomized comparative trial. We randomized patients to treatment for 72 hours with CVVHDF or intravenous furosemide. Outcomes assessed were weight loss, total fluid output, length of stay in the intensive care unit, 30-day mortality, and cardiovascular stability. Results: The demographic data were comparable in both groups. The weight loss (P ≤ .05) and the total fluid loss (P ≤ .05) were greater in the CVVHDF group. Length of stay in intensive care unit was significantly reduced in the CVVHDF group (P ≤ .05). The mortality rates were comparable in both groups. The cardiac output and the stroke volume significantly increased, whereas the pulmonary capillary wedge pressure significantly decreased (P ≤ .05), in both groups compared with the baseline. Conclusion: In CHF patients, the use of CVVHDF effectively and safely produced greater weight and fluid loss and decreased the length of stay in the intensive care unit more than the intravenous furosemide with no hemodynamic instability. doi: 10.1016/j.jcrc.2010.07.024 Clinical experience with severe 2009 H1N1 influenza in intensive care unit At King Saud Medical Complex, Saudi Arabia A. Mady a , O.S. Ramadan a , A. Yousef a , Y. Mandourah b , A.A. Amr a , M. Kherallah c a King Saud Medical Complex, Riyadh, Saudi Arabia b Riyadh Military Hospital, Riyadh, Saudi Arabia c King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia Introduction: The objective of this study was to describe the epidemiological characteristics, clinical features, treatment, and outcome of severe cases of 2009 H1N1 infections who were admitted to the intensive care unit (ICU) at the King Saud Medical Complex in Riyadh, Kingdom of Saudi Arabia. Methods: Retrospectively, we collected demographic data, clinical presentation, risk factors, and management data on all patients who were admitted to the ICU at the King Saud Medical Complex with the confirmed diagnosis of severe 2009 H1N1 influenza A with respiratory failure. Acute Physiology and Chronic Health Evalua- tion (APACHE) IV system was used to assess the severity of illness within the first 24 hours after admission. Outcome was overall hospital mortality and mortality based on the use of steroids and the time of administration of oseltamivir treatment. χ 2 test was used to obtain P value for statistical significance. Results: A total of 86 patients in the ICU with severe 2009 H1N1 infection were included, of whom 72% were men. The mean age was 40.8 years, with 46.5% of the patients in the age group of 30 to 50 years. A total of 87.8% of the patients had one or more of the risk factors, 33% of them were asthmatics, 14% had obesity defined as body mass index of at least 25, 9% of patients were pregnant, and 12.8% had no risk factors. Eighty-one percent were mechanically ventilated, with an average duration of mechanical ventilation of 7.5 days and an average ICU length of stay of 8 days. Airway E14 ECCC Abstracts