Mera A. Ababneh

Atorvastatin treatment modulates the interaction between leptin and adiponectin, and the clinical parameters in patients with type II diabetes

The aim of this study was to examine the effect of atorvastatin treatment on levels of leptin, adiponectin and insulin resistance, and their correlation with clinical parameters, in patients with type II diabetes. Patients with diabetes (n=394) were divided into two groups, comprising 161 patients who received 20 mg/day atorvastatin (statin group), and 233 patients who did not receive statins (statin-free group). The results showed that atorvastatin treatment of patients with diabetes was not associated with changes in leptin, adiponectin, the leptin/adiponectin (L/A) ratio or homeostasis model assessment-insulin resistance (HOMA-IR). However, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and total cholesterol (Tchol) were positively correlated with leptin and L/A ratio in the statin group only (P<0.05). By contrast, high-density lipoprotein cholesterol (HDL-C) showed a significant positive correlation with adiponectin in the statin and statin-free groups (P<0.05). Additionally, a positive correlation was found between HOMA-IR and glycated hemoglobin (HbA1c), and TG, in both groups, whereas Tchol was positively correlated with HOMA-IR in the statin group only (P<0.05). When multivariate analysis was performed with HOMA-IR as the dependent variable, and with adjustment for age, body mass index (BMI) and waist circumference, HbA1c was found to be a significant predictor of HOMA-IR or insulin resistance. In conclusion, atorvastatin treatment may have several effects on the interaction between leptin and adiponectin, and on clinical parameters in patients with type II diabetes.

Exposure to waterpipe smoke induces renal functional and oxidative biomarkers variations in mice

Abstract Context: Waterpipe smoking (WPS) has been known for over 400 years. It has been spread widely especially between youth because of the addition of pleasant flavor and because it was misconsidered to be less harmful than cigarette. Objective: In this study, we investigated the effect of waterpipe smoking on renal oxidative and functional parameters and compared that at acute and chronic exposure time in mice. Materials and methods: Mice were divided into three groups, namely acute, chronic and fresh air control. Acute group was exposed to waterpipe smoke for one hour daily for six days using whole-body exposure system, while chronic group was exposed to waterpipe smoke for one hour daily for 30 days using whole-body exposure system. Result: Exposure to waterpipe smoke has shown significant changes on the mice kidney functional parameters such as creatinine and blood urea nitrogen. Both exposures (acute and chronic) has shown a significant reduction in superoxide dismutase (SOD) activity (p < 0.05), whereas the activity of other antioxidant enzymes (catalase and GPx) reduced only with chronic exposure to waterpipe smoke (p < 0.05). Additionally, the level of thiobarbituric acid reactive substances (TBARS) in mice kidney homogenates has shown a significant elevation following chronic exposure to waterpipe smoke (p < 0.05). Discussion and conclusion: In conclusion, chronic waterpipe smoke affects the kidney parameter and antioxidant markers, therefore affecting its functionality of detoxifying and removal of poisonous material from the body.

The effectiveness of clinical pharmacist's intervention in improving asthma care in children and adolescents: Randomized controlled study in Jordan.

OBJECTIVE To evaluate the effectiveness of clinical pharmacists intervention on achieving better asthma control, quality of life and other clinical parameters. METHODS A prospective randomized controlled study in north Jordan was conducted. Pediatric patients with asthma (aged 7-18 years old) were included and randomly allocated into two groups, intervention and control. Both groups were interviewed at the first visit and followed up twice by phone (at 3 and 6 months). Education was provided to patients and their caregivers in the intervention group only. RESULTS Of 206 eligible patients recruited and randomized to our study, 178 patients completed the study (48.3% intervention versus 51.7% control). There were no significant differences in all baseline data between both groups. We identified significant differences in the improvement of asthma control (p<0.001) and consequently pediatric and caregiver quality of life (p<0.001) between both groups at the end of study. Significant differences were also detected in other clinical parameters (p<0.05). CONCLUSION Implementation of clinical pharmacy service can positively influence asthma control, pediatric and caregivers quality of life, and other clinical parameters. PRACTICE IMPLICATIONS To maintain a good asthma status, education of pediatric patients and their caregivers should be part of routine assessment during clinic visit.

Analysis of circulating adipokines in patients newly diagnosed with solid cancer: Associations with measures of adiposity and tumor characteristics

The development and progression of cancer is a complex and multifactorial process and the global prevalence of obesity is markedly increasing. A number of studies have made an association between obesity and increased rates of epithelial tumors. Obesity is associated with altered adipokine levels, potentially contributing to the process of tumor development and metastasis. In the current study, the associations between circulating adipokines and measures of adiposity and tumor characteristics among patients diagnosed with solid malignancies were examined at the time of presentation, and following the administration of chemotherapy. A total of 30 patients with cancer and matched healthy controls were enrolled in the present study. Plasma adipokine levels of hepatocyte growth factor (HGF), adiponectin and leptin were determined using commercially available ELISA kits. At baseline, plasma HGF, adiponectin and leptin levels were not significantly different between patients with cancer and the healthy controls. Circulating HGF levels were significantly associated with the stage of cancer at diagnosis (P=0.044), but lacked a significant association with lymph node status (P=0.194). Plasma adiponectin and leptin levels were not significantly associated with tumor characteristics at the time of diagnosis. Only leptin was positively correlated with the body mass index of patients with cancer (P<0.001). No significant correlations were detected between the evaluated adipokines and measures of visceral obesity, as determined by waist circumference and the waist-hip ratio at presentation. Following administration of chemotherapy, adiponectin was the only adipokine evaluated in the current study that exhibited a significant difference, when compared with baseline plasma levels (P=0.013), and a significant positive correlation between baseline and follow-up circulating levels (P=0.002) among patients with cancer. In addition, there were no significant inter-correlations between circulating adipokines at baseline level and during follow-up in patients with cancer. Collectively, the findings of the current study suggest a lack of diagnostic roles for the adipokines investigated and no significant association with measures of adiposity. Adiponectin may be a potential adipokine to measure in patients with cancer, in order to further assess its prognostic and predictive potential.

Antibiotic prescribing for acute respiratory infections in children in Jordan

Background Most acute respiratory infections (ARIs) in children are due to viral etiology; however, over-prescribing of antibiotics for ARIs is common. The aim of this investigation was to identify antibiotic prescribing prevalence for children with ARIs and to identify predictors of broad-spectrum antibiotic prescribing. Methods This was a prospective cross sectional study in a sample of ambulatory care settings in Jordan. Children (<18 years) presenting with ARIs were assessed in terms of patients demographics, antibiotic prescription and clinical diagnosis. Multivariable logistic regression analysis was used to identify predictors of broad-spectrum antibiotic prescription. Results Antibiotics were prescribed for 78.4% (4575/5829) of children with ARIs. Antibiotic prescription for ARIs for which antibiotics are not indicated was 69.2% (2688/3883). Broad-spectrum antibiotic prescription occurred in 51.1% (2337/4575) of all antibiotic-prescribed participants. Some of the predictors of broad-spectrum antibiotic prescription were: otitis media (OR 4.93 [95% CI 3.44-7.14]), tonsillitis (OR 6.03 [95% CI 4.39-8.33]), age 0-5 years (OR 1.17 [95% CI 1.02-1.38]) compared to age 6-12 years, fever (OR 2.14 [95% CI 1.78-2.59]), outpatient setting (OR 73 [95% CI 2.17-3.42]) and military sector (OR 2.29 [95% CI 1.82-2.90]). Conclusions Antibiotic prescribing is high and often inappropriate. Predictors of broad-spectrum antibiotic prescribing were identified. Health policy initiatives should involve all stakeholders to minimize inappropriate antibiotic prescription and to prevent poor outcomes associated with such practice.

The Nephroprotective Effect of N-Acetyl-L-Cysteine and Atorvastatin against Imipenem induced Nephrotoxicity

BACKGROUND AND OBJECTIVE Imipenem has played an important role in the treatment of broad-spectrum bacterial infection. However, nephrotoxicity due to imipenem remains an important clinical challenge. The aim of this study is to test the hypothesis stating that N-acetyl-L-cysteine (NAC) and atorvastatin possess a nephroprotective effect against imipenem-induced nephrotoxicity. METHODS Adult Sprague Dawley rats were randomly assigned into six groups (n=8-10 rats/group; total n=55). The groups were (control, imipenem only, NAC only, atorvastatin only, NAC with imipenem, and atorvastatin with imipenem). Rats were treated with NAC or atorvastatin for six weeks. Serum and urinary creatinine and blood urea nitrogen (BUN) levels were measured. Additionally, urinary protein, urinary glucose and kidney levels of oxidants/antioxidants biomarkers were measured. RESULTS The administration of 300mg/kg/d imipenem induced nephrotoxicity as indicated by the significant reduction of serum creatinine, serum BUN and calculated GFR in the imipenem only-treated group compared to the control. These effects of imipenem were normalized by either NAC or atorvastatin. Moreover, the levels of catalase, superoxide dismutase and glutathione peroxidase were significantly reduced in the imipenem group. However, pre-administration of NAC and atorvastatin neutralized the levels of these enzymes and protected against imipenem-induced nephrotoxicity. CONCLUSION We concluded that the pre-administration of either NAC or atorvastatin protects the kidneys from imipenem-induced nephrotoxicity, through their antioxidant effects.

N-Acetyl Cysteine Therapy Does Not Prevent Renal Failure in High-Risk Patients Undergoing Open-Heart Surgery.

BACKGROUND Renal dysfunction is a common complication after cardiovascular surgery. Controversial issues have been discussed regarding the role of N-acetyl cysteine in the prevention of postoperative renal dysfunction. The purpose of this meta-analysis is to assess whether N-acetyl cysteine offers any protection against the development of acute renal dysfunction after cardiac surgery. METHODS Multiple databases were searched for randomized trials comparing the role of N-acetyl cysteine and placebo in human patients undergoing cardiac surgery. End-points studied were: the incidence of acute renal failure, hemodialysis, early mortality, duration of hospital stay, and maximal change in creatinine values. Dichotomous variables were compared using the risk difference (RD) calculated with inverse weighting; continuous data was pooled as (standardized) mean difference. Results are presented with 95% confidence interval (P < .05 is significant); results are presented within 95% confidence interval. RESULTS Thirteen randomized trials (713 and 707 patients in the N-acetyl cysteine and control groups, respectively) were included in the present analysis; nine dealing with patients at high-risk for acute renal failure. The incidence of postoperative acute renal dysfunction was 23% and 36% in the N-acetyl cysteine and control cohorts, respectively. N-acetyl cysteine therapy did not reduce acute renal dysfunction in the high-risk cohort [RD -0.03 (-0.09 to 0.02); P = .22; I2 = 24%]. Maximal change in creatinine levels after surgery was also comparable [standardized mean difference 0.07 (-0.23, 0.09); P = .39]. Early mortality was 2.9% and 3.7% in the N-acetyl cysteine and control cohorts respectively; [RD 0 (-0.03 to 0.02); P = .63; I2 = 20%]. Hospital stay (mean length of stay 10.4 and 10.1 days in the N-acetyl cysteine and control cohorts, respectively) was also similar in both cohorts [WMD 0.17 (-0.02 to 0.37) days; P = .81]. CONCLUSION Prophylactic N-acetyl cysteine therapy does not reduce the incidence of renal dysfunction in high-risk patients undergoing cardiac surgery.

Evaluation of Behavioral and Susceptibility Patterns in Premenopausal Women with Recurrent Urinary Tract Infections: A Case Control Study

Recurrent urinary tract infections (UTI) are a major source of morbidity and healthcare costs. Risk factors associated with recurrence rates in premenopausal women can be attributed to patient lifestyle behavior. The aim of this study was to assess hygienic risk factors, determine pathogen distribution, and susceptibility patterns in premenopausal women with recurrent UTI. This was case-control study in which a face-to-face interview was conducted to obtain information from premenopausal women with recurrent UTI. Microbiology cultures and susceptibility results were obtained to analyze pathogen distribution and resistance. In this study, 214 cases and 230 controls were compared and the following practices were associated with increased risk of recurrent UTI in multivariable analysis: washing genitals from back to front (OR 1.64 [95% CI 1.05–2.56]), not voiding within 15 min after intercourse (OR 2.81 [95% CI 1.72–4.66]), not drinking water after intercourse (OR 1.69 [95% CI 1.12–2.58]), using any soap to clean after urination (OR 2.11 [95% CI 1.42–3.17]). Escherichia coli were the most prevalent pathogens isolated (66.4%), followed by Klebsiella spp. (12.6%), Pseudomonas aeruginosa (12.1%), and Proteus spp., (6.6%). This study identified several modifiable sexual and hygienic practices associated with recurrent UTI in premenopausal women. Continuous surveillance of antimicrobial susceptibility patterns is important to overcome resistance.