Salim A. Hamadi

Effect of trigonelline and ethanol extract of Iraqi Fenugreek seeds on oxidative stress in alloxan diabetic rabbits

Abstract This study was designed to evaluate effect of trigonelline and ethanol extract of Iraqi Fenugreek seeds on oxidative stress in alloxan diabetic rabbits. Oral dose of (10 mg/12 h) isolated trigonelline or (7.7 ml/12 h) of ethanol extract of Iraqi Fenugreek seeds was administered to the rabbits for four weeks. Plasma malondialdehyde (MDA) and glutathione (GSH), as oxidative stress markers were measured in all rabbits before treatment and once weekly for four weeks after the treatment. The results showed a significant improvement in the stress induced oxidation parameters by alloxan-induced diabetes in rabbits. The ethanol extract of Fenugreek seeds significantly decreases the plasma malondialdehyde (MDA) from 2.51 ± 0.34 lmol/l in diabetic control rabbits to 1.57 ±0.12 lmol/l after four weeks (P <0.05). The plasma glutathione (GSH) level increases significantly from 0.11 ±0.02 lmol/l to 0.26 ± 0.02 lmol/l after four weeks of treatment of the ethanol extract (P <0.05). The percent reduction in plasma MDA level was 37.45%, while the percent elevation in plasma GSH was 136% after four weeks of treatment. The data showed that isolated trigonelline was less effective than the ethanol extract of Fenugreek seeds in lowering plasma MDA or increasing the plasma GSH markers. The results of this study clearly indicate that both ethanol extract of Fenugreek and its major alkaloid, trigonelline are promising natural antioxidants and may be used in the treatment of many diseases, especially diabetes mellitus.

Inter-professional education unveiling significant association between asthma knowledge and inhaler technique

Objectives: To explore whether an association exists between health care professionals’ (HCPs) asthma knowledge and inhaler technique demonstration skills. Methods: HCPs’ asthma knowledge and inhaler technique demonstration skills were assessed at baseline at an inter-professional educational workshop focusing on asthma medication use. Asthma knowledge was assessed via a published questionnaire. Correct inhaler technique for the three inhalers, the Accuhaler, Turbuhaler and pressurized Metered Dose Inhaler (pMDI) was assessed using published checklists. Results: Two hundred HCPs agreed to participate: 10 specialists (medical doctors specialized in respiratory diseases) (5%), 46 general practitioners (23%), 79 pharmacists (39%), 15 pharmacists’ assistants (8%), 40 nurses (20%) and 10 respiratory therapists (5%). Backwards stepwise multiple regression conducted to determine predictors of HCPs’ inhaler technique, showed that out of many independent variables (asthma knowledge score, profession, age, gender, place of work, years in practice and previous personal use of the study inhaler/s), asthma knowledge score was the only variable showing significant association with inhaler technique (R2=0.162, p<0.001). Conclusion: This study revealed significant associations between asthma knowledge and inhaler technique scores for all HCPs. Providing inter-professional workshops for all HCPs involved integrating education on asthma knowledge and practice of inhaler technique skills are looked-for.

Impact of Dermatologistsâ Perceptions about Antibiotic Resistance on Antibiotic Prescribing for Acne

Background/objective: The use of antibiotics in the treatment of acne has been debatable especially when the abuse of antibiotics is strongly linked to emerging antibiotic resistant strains of bacteria. The aim of this study is to assess dermatologists’ knowledge about antimicrobial drug resistance and find out if their trends of antibiotic prescribing for acne would contribute to spread antibiotic resistance. Methods: A cross sectional survey was conducted on 51 dermatologists in the city of Amman, Jordan. The study sample was categorized to dermatologists from the private and public sectors and those who work in academia and those who don’t. The questionnaire collected demographical characteristics of dermatologists, patterns of antibiotic and acne drugs prescribing and causes of microbial antibiotic resistance and therapeutic failure. Answers were compared to the European guidelines for acne treatment 2012. Results: Total Percentage of deviation from the European standard guidelines was 56.94%. This percentage was almost the same for the four groups of dermatologists. Patterns of antibiotic prescribing varied between dermatologists. 43% of the sample acknowledged the occurrence of antibiotic resistant P. acnes in Jordan. 45.5% of dermatologists were unaware of the relation between antibiotics prescribing and the spread of antibiotic resistance. A large percentage of dermatologists (71%) attributed therapeutic failure to patient noncompliance. Opinions of dermatologists differed about factors resulting in antibiotic resistance. Conclusion: Ambiguous knowledge about antibiotic resistance among dermatologists affects their antibiotic prescribing patterns and highlights the need for awareness campaigns. High percentage of deviation from the European guidelines in treatment of acne stresses the need for national standardized therapeutic guidelines.

Saliva versus Plasma Therapeutic Drug Monitoring of Pregabalin in Jordanian Patients

The objective is using saliva instead of plasma for pregabalin therapeutic drug monitoring (TDM) since saliva reflects the free non-protein bound drug concentration, simple and noninvasive sampling, cheaper and does not require the expertise of drawing blood. Forty four patients participated in this study, two samples of saliva and another two of blood were taken from each patient; first sample of both saliva and blood is the trough sample and was taken just before the first dose of the day and second sample is the peak sample and was taken 1 h after taking the first dose of the day. Descriptive statistics and t-testing after log transformation were done using Excel, p-value=0.05 was adopted for significant difference. Optimized effective intestinal permeability of pregabalin was estimated by PK-Sim program version 7. This study for the first time revealed that pregabalin is excreted in saliva and classified as class 1 based on Salivary Excretion Classification System (SECS). A good correlation of 0.71-0.83 between Cmin and Cmax of plasma and saliva pregabalin was observed respectively which indicate that saliva sampling is a good alternative matrix for pregabalin TDM. C/D-ratios were calculated to demonstrate pharmacokinetic variability of Pregabalin; the results showed that C/D-ratio was higher in women, elderly and in those patients who had Scr.≥0.9 mg/dl. Proposed pregabalin therapeutic ranges are 0.7 to 1.84 µg/ml in plasma and 0.055 to 0.145 µg/ml in saliva, for neuropathic pain, diabetic neuropathy and disc prolapse patients.

Evaluating Medication Errors for Hospitalized Patients : The Jordanian Experience = تقييم الأخطاء الدوائية لمرضى المستشفى : التجربة الأردنية

To investigate the rate, frequency, and severity of medication errors detected by a clinical pharmacist at a teaching hospital in Amman, Jordan. Secondly, to determine the risk factors associated with the occurrence of these errors. This prospective observational study used two methods of medication error detection, direct observation and the chart review method. Both methods were conducted in the internal medicine ward between June and December 2013. In the selected shifts, all procedures performed on the patients were observed and recorded by the clinical pharmacist. The number and types of medication errors were documented. Risk factors associated with more medication errors were then tested using multiple univariate regression to identify potential risk factors. All collected data were entered into SPSS and analyzed accordingly. The study included 283 patients and 15 nurses. A total of 803 medication errors per 6396 opportunities for errors (12.6%) were observed. The most frequent errors were administration errors (n= 739, 20.2%), transcription errors (n= 40, 1.5%), dispensing errors (n= 21, 0.8%) and prescribing errors (n= 3, 0.1%). Risk factors associated with the total number of detected medication errors were mainly shorter nurses experience in the ward (R2 = 0.456, p< 0.042) and patients with higher number of prescribed doses (R2 = 0.451, p< 0.025). This study revealed that medication errors happening in a teaching hospital occur mainly during the administration and transcription stages of the medication use process. Shorter nurse experience and caring for inpatients with more complicated therapeutic regimens can lead to higher rates of medication errors.