Abla Albsoul-Younes

Abuse and Misuse of Prescription and Nonprescription Drugs Sold in Community Pharmacies in Jordan

The aim of this study was to investigate abuse/misuse of prescription and nonprescription drugs in community pharmacies in Jordan by random distribution of a structured questionnaire to 405 pharmacies (November 2005–January 2006). Data were analyzed using SPSS for windows (version 14.0). Most respondents (94.1%) suspected that some level of abuse/misuse occurred in their pharmacy, which was highest for decongestants, cough/cold preparations, benzodiazepines, and antibiotics. Abuse/misuse of prescription and nonprescription drugs is present in Jordan, but current methods for controlling the problem are ineffective, and better methods should be developed. The studys limitations are noted..

Calcium phosphate-mediated transfection of primary cultured brain neurons using GFP expression as a marker: application for single neuron electrophysiology

We investigated the efficiency of transfecting primary cultured rat postnatal brain neurons (substantia nigra pars compacta neurons and locus coeruleus neurons) with cDNA encoding GFP (jellyfish green fluorescent protein) using a calcium phosphate method. The proportion of transfected neurons (transfection efficiency) was approximately 5%, when cultures from the substantia nigra pars compacta were transfected 3 days after plating. The transfection efficiency decreased when cultures were transfected 10 days after plating (1.7%). Neurons were cotransfected at a very high probability ( > 78%) with the muscarinic m2-receptor cDNAs together with GFP plasmids. Transfected neurons were very healthy as indicated by the zero-current potential and the microscopical appearance. Because the transfection efficiency is low, this method cannot be used for experiments involving the whole cell population. The transfection efficiency of 1.7% corresponded to approximately 20 transfected cells per dish in our culture conditions and these cells are sufficient in number for electrophysiological studies. Therefore, this is an excellent method for studying the influence of exogenous genes on single neurons using electrophysiological techniques.

Two different inward rectifier K+ channels are effectors for transmitter-induced slow excitation in brain neurons

Substance P (SP) excites large neurons of the nucleus basalis (NB) by inhibiting an inward rectifier K+ channel (Kir). The properties of the Kir in NB (KirNB) in comparison with the G protein-coupled Kir (GIRK) were investigated. Single-channel recordings with the cell-attached mode showed constitutively active KirNB channels, which were inhibited by SP. When the recording method was changed from the on-cell to the inside-out mode, the channel activity of KirNB remained intact with its constitutive activity unaltered. Application of Gβ1γ2 to inside-out patches induced activity of a second type of Kir (GIRK). Application of Gβ1γ2, however, did not change the KirNB activity. Sequestering Gβ1γ2 with Gαi2 abolished the GIRK activity, whereas the KirNB activity was not affected. The mean open time of KirNB channels (1.1 ms) was almost the same as that of GIRKs. The unitary conductance of KirNB was 23 pS (155 mM [K+]o), whereas that of the GIRK was larger (32–39 pS). The results indicate that KirNB is different from GIRKs and from any of the classical Kirs (IRKs). Whole-cell current recordings revealed that application of muscarine to NB neurons induced a GIRK current, and this GIRK current was also inhibited by SP. Thus, SP inhibits both KirNB and GIRKs. We conclude that the excitatory transmitter SP has two types of Kirs as its effectors: the constitutively active, Gβγ-independent KirNB channel and the Gβγ-dependent GIRK.

Evaluation of VTE Prophylaxis in an Educational Hospital Comparison Between the Institutional Guideline (Caprini 2006) and the ACCP Guideline (Ninth Edition)

Venous thromboembolism (VTE) is the most common preventable cause of hospital death; the burden of VTE includes the management of the acute event (deep vein thrombosis [DVT]/pulmonary embolism) and the chronic subsequents such as postthrombotic syndrome and recurrent DVT. All experts agree that despite the abundance of knowledge available on VTE and how to prevent it, it is still underused, and since the first step in prophylaxis is to identify those who are at high risk of VTE, several risk assessment models have been developed to identify these patients and provide appropriate prophylaxis. In our study, the institutional guideline in a tertiary educational hospital is the Caprini score (2006), a comparison was conducted between the institutional guideline and the American College of Chest Physicians guideline (ACCP ninth edition [ACCP-9]) in terms of the degree of agreement of the actual prophylaxis with the institutional guideline and the ACCP-9 and the differences in risk levels. The concordance with the ACCP-9 guideline was higher than with the institutional guideline, specifically in those patients receiving prophylaxis, and there was an overestimation of the risk levels in the institutional guideline, especially in medical patients. The replacement of the existing Caprini-2006 with the ACCP-9 is prudent, since it agrees with the physicians’ clinical judgment and may result in reduced use of pharmacologic prophylaxis which could lead to lower costs and fewer adverse effects.

Evaluation of Outpatient-Pharmacists' Counseling Behavior and Content in a Teaching Hospital in Jordan- An Observational Study

Pharmacists do have a unique opportunity to educate patients about their medications in order to identify, prevent and manage any potential problems they may have faced. This study aimed to characterize and evaluate the counseling behavior and content by pharmacists and pharmacy assistants in a sample of outpatient pharmacies in a teaching hospital in Jordan. The study was conducted in 6 outpatient pharmacies at the participating hospital; Endocrinology, Cardiology, Respiratory, Pediatrics, Family Medicine and Emergency staff. The study consisted of observing 60 patient-pharmacist/assistant interactions behaviors and counseling content (if exists) in 6 different outpatient pharmacies at the participating hospital. Observations were conducted by a trained researcher using a pre-validated and piloted data collection form. Out of the 60 observed interactions, only 18 interactions involved patient counseling, the type of which was both verbal and written. The initiator of counseling in 44.4% of the cases was the patient. More than 2/3 (70.0 %) of provided information to patients in all interactions was conducted using written labels only. The overall observed rate of counseling at the participating hospital pharmacies is low. There is a need to train pharmacists to offer more counseling to patients and have better communication and counseling skills.

Patterns of antiepileptic drugs use in epileptic pediatric patients in Jordan.

Objectives: To determine prescribing patterns of antiepileptic drugs (AEDs) in pediatric patients with confirmed diagnosis of epilepsy, and to provide knowledge of general practice of physicians. Methods: The study was a multi-center cross-sectional observational study, in specialized clinics for management of epilepsy in north, central and south Jordan. This study was conducted from January 2014 to July 2014. These were 3 from university tertiary care hospitals and 4 from governmental tertiary care hospitals. Results: A total of 694 pediatric patients were included. Monotherapy AED use had the highest frequency 465 (67.0%), followed by dual therapy 162 (23.3%). The frequency of monotherapy in university hospitals was lower than governmental hospitals (p<0.05); however, Polytherapy was more frequent in younger children. Two old AEDs were most frequently prescribed as a monotherapy; Valproic acid 235 (50.5%) and carbamazepine 155 (33.3%). The most common combination in dual therapy was valproic acid with carbamazepine 28 (17.3%). The second most common combinations were carbamazepine with levetiracetam 21 (13.0%) or valproic acid with levetiracetam 20 (12.3%). Conclusion: Older AED remain first line drugs for use in both monotherapy and combination therapy for epileptic disorders. Polytherapy is associated with younger kids and being treated in a university hospital.

Dominant negative effects of a Gβ mutant on G-protein coupled inward rectifier K+ channel

HEK293 cells were transfected with cDNAs for Gβ1(W332A) [a mutant Gβ1], Gγ2, and inward rectifier K+ channels (Kir3.1/Kir3.2). Application of Gβ1γ2 protein to these cells activated the K+ channels only slightly. When mu‐opioid receptors and Kir3.1/Kir3.2 were transfected, application of a mu‐opioid agonist induced a Kir3 current. However, co‐expression of Gβ1(W332A) suppressed this current. Most likely, Gβ1(W332A) inhibited the action of the endogenous Gβ. Such a dominant negative effect of Gβ1(W332A) was also observed in neuronal Kir3 channels in locus coeruleus. The mutant, Gβ1(W332A) protein, although inactive, retains its ability to bind Kir3 and prevents the wild type Gβ from activating the channel.

Jordanian community pharmacists’ experience regarding prescription and nonprescription drug abuse and misuse in Jordan – An update

ABSTRACT Background: The problem of prescription and nonprescription drug abuse and misuse is well known worldwide. It has been 8 years since this problem has been investigated in Jordan. Objectives: This study aims to investigate the abuse/misuse of drugs sold with or without a prescription in community pharmacies in Jordan in 2014 and to document any changes that may have aroused in the past 8 years. Methods: A cross-sectional survey using a structured questionnaire based on one used previously in 2006 was sent to a stratified random sample of 320 community pharmacies. Data were managed and analyzed in SPSS. Results: A total of 290 questionnaires were completed (response rate = 92.4%). The pharmacists named 727 nonprescription and 372 prescription drugs as being suspected of abuse, each classified into 6 categories. New products have appeared on the list such as: ophthalmic drops (n = 39, 13.4%) and the anti-epileptic; Lyrica (pregabalin; n = 19, 6.5%). Other drugs previously on the 2008 list like misoprostol have retracted in 2014 (from 7.1% to 1.3%). Conclusion: Patterns of suspected prescription and nonprescription drug abuse/misuse have slightly changed in Jordan over time, with new drugs emerging and previous ones disappearing from the list.

Perception of efficacy and safety as determinants for use and discontinuation of birth control methods in Muslim Jordanian women.

Objective: This study was conducted to identify the perceptions of working Muslim Jordanian women regarding the efficacy and safety of their contraceptive methods, and whether these perceptions affected method choice or discontinuation. Methods: A prospective study on 207 married working women of reproductive age was conducted between March and June 2002. Results: The majority of women were using an intrauterine device (IUD), fewer were using traditional methods and oral contraceptive pills. Effectiveness was the main reason for choosing IUD and pill methods, while concerns about safety were the main reason for discontinuation. Safety was the main reason for choosing traditional methods and poor efficacy was the reason for discontinuation. Conclusion: Health-care professionals need to increase the use of proper contraceptive methods and compliance by providing counseling services and correcting any misperceptions regarding birth control methods before and during use.

Improving quality of life in asthmatic children

Objective: To assess quality of life changes in pediatric asthmatic patients switched into a single inhaler device of BudesonideJFormoterol.Methods: Thirty pediatric patients (ages 6–15 years) with moderate to severe chronic asthma previously treated with inhaled beclometasone dipropionate at a daily dose of ≥400 μg were selected to participate in an open label study. At the baselinephase (one month), pulmonary function tests (PFTs), indicators of asthma control, and a quality of life assessment (using a special questionnaire) were evaluated. Patients were initiated on a single inhaler device containing budesonide 160 μg/formoterol 4.5 μg, one inhalation twice daily instead of their previous inhaled corticosteroid and followed for two months. PFTs, indicators of asthma control, and a quality of life assessment were evaluated at each visit.Results: After switching to the new therapy, patients showed significant changes towards better quality of life in all aspects. The overall score dropped from 1.75±0.04 to 0.80 ±0.07 (mean ±SEM), p<0.001 (Score scale varies between 0: excellent to 2: very bad Health related quality of life). There was an improvement in the PFTs, where the FEV1% improved from 62.7±2.8 to 87.4 ±4.6 (mean ±SEM), and the FVC% improved from 83.2 ±3.5 to 101.9 ±5.3 (mean ±SEM), p <0.001, and better control of asthma.Conclusion: Switching treatment from beclomethasone dipropionate to budesonideJformoterol combination appeared to improve quality of life in the patient population evaluated and in the appropriate clinical indices.