Investigating the human rhinovirus co-infection in patients with asthma exacerbations and COVID-19
Authors : Abdullah Al-Dulaimi, Ahmad R. Alsayed, Mohammed Al Maqbali, Malek Alzihlif
Abstract : Objective: To investigate the co-infections with human rhinovirus (HRV) among patients with asthma exacerbation 105 and COVID-19 in Jordan. Also, to determine the frequency of acute asthma exacerbation before and during the 106 COVID-19 pandemic on a matched basis. 107 Methods: The data of this prospective cohort research consisted of clinical variables. During the first visit, and after 108 14-days, nasopharyngeal swabs were taken and the quantitative polymerase chain reaction was performed for HRV 109 and SARS-CoV-2 detection. 110 Results: During the first visit, and after 14-days, nasopharyngeal swabs were taken and the quantitative polymerase 111 chain reaction was performed for HRV and SARS-CoV-2 detection. Forty-seven out of 175 (26.9%) COVID-19 adult 112 cases have been diagnosed with asthma. The number of asthma exacerbations among the study participants was higher 113 during 2021 than in 2020 (p=0.035). Most of the included asthmatic participants(61.7%) were only positive for SARS114 CoV-2 and 38.3% were co-infected with HRV. The SARS-CoV-2 cycle threshold value was lower in samples infected 115 with both viruses compared to samples infected with SARS-CoV-2 alone, p<0.005.
Conclusion: Our findings indicate that HRV and SARS-CoV-2 were significantly more prevalent in asthma exacerbations than stable asthma. Thus, HRV and/or SARS-CoV-2 infections were potentially cofactors or contributors to the asthma exacerbation in this cohort. This is the first study, in Jordan, to investigate the HRV co119 infection in COVID-19 asthmatic patients and HRV could be related with a higher severity of COVID-19.
Keywords : asthma, exacerbation, human rhinovirus, SARS-CoV-2, viral infection, multiplex polymerase chain reaction
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The first detection of Pneumocystis jirovecii in asthmatic patients post COVID-19 in Jordan
Authors : Ahmad R. Alsayed, Wamidh Talib, Abdullah Al-Dulaimi, Safa Daoud, Mohammed Al Maqbali
Abstract : Pneumocystis jirovecii pneumonia (PCP), caused by fungal species named Pneumocystis jirovecii, is a frequent opportunistic infection in those with human immunodeficiency virus (HIV) infection. However, PCP has been documented in immunocompetent patients. This study aims to determine if P. jirovecii detection occurs in asthma patients following coronavirus disease 2019 (COVID-19) in a Jordanian cohort. Also, to evaluate a method of TaqMan quantitative polymerase chain reaction (qPCR) assay to detect P. jirovecii, from sputum samples. The nasopharyngeal swabs were used to detect SARS-CoV-2 and sputum samples were tested for P. jirovecii using real time qPCR assay. Beta-tubulin (BT) and Dihydrofolate reductase (DHFR) genes were the directed targets of P. jirovecii. The results showed that the mean qPCR efficiencies of BT and DHFR were 96.37% and 100.13%, respectively. Three out of 31 included patients (9.7%) had a positive P. jirovecii. All of the three patients had used oral corticosteroids (OCS) in the last two months due asthma exacerbation and were treated with OCS for COVID-19. This is the first study based in Jordan to demonstrate that P. jirovecii and COVID-19 can co-exist and that it is important to maintain a broad differential diagnosis, especially in immunocompromised patients. Chronic lung disease can be a risk factor for the P. jirovecii colonization possibly due to corticosteroid's immunosuppression
Keywords : Asthma; COVID-19; developing country; Pneumocystis jirovecii; polymerase chain reaction
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Evaluation of the effectiveness of educational medical informatics tutorial on improving pharmacy students’ knowledge and skills about the clinical problem-solving process
Authors : Alsayed AR, Hasoun L, Al-Dulaimi A, AbuAwad A, Basheti I, Khader HA, Maqbali MA
Abstract : Objective: To investigate the effectiveness of an online tutorial and its impact on improving knowledge and skills of pharmacy students in the clinical problem-solving process that is necessary to implement pharmaceutical care. Methods: This is a prospective interventional study conducted during the COVID-19 pandemic restrictions using four novel templates. The first two levels of Kirkpatrick’s Model (Reaction and Learning) were used. Results: 129 participants completed all of the online training parts. The findings indicated a significant improvement in the students’ knowledge and skills. The participants achieved higher score following the tutorial than the baseline, with a statistically significant difference (p < 0.001). There was a significant improvement in the number of detected treatment-related problems. The majority of students were satisfied with the overall training process and stated a high evaluation score out of 10 (mean = 7.93 ± 1.42, median = 8.00). Conclusion: The educational intervention achieved a substantial positive impact on decision-making skills of participating students and was considered effective in helping them attain basic skills such as teamwork, peer assessment, communication and critical evaluation. Healthcare providers must work together to ensure accurate medication use during care transitions. Pharmacists, as medication experts, play an important role in the implementation process. Pharmacy educators must prepare pharmacy student to use pharmaceutical care in their future practice.
Keywords : Clinical problem-solving; pharmacy; informatics; online learning
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Prevalence of Sleep Disturbance in Patients With Cancer: A Systematic Review and Meta-Analysis
Authors : Al Maqbali, Mohammed, Mohammed Al Sinani, Ahmad Alsayed, and Alexander M. Gleason
Abstract : Sleep disturbance is one of the most common and troubling symptoms that harm the quality of life throughout all phases of treatment and stages of the illness among patients with cancer. The aim of this meta-analysis is to examine the present status of sleep disturbance prevalence in patients with cancer. The following databases were searched: PubMed, CINAHL, MEDLINE, EMBASE, PsycINFO, from inception to April 2021. Prevalence rates were pooled with meta-analysis using a random-effects model. A total of 160 studies (N=46,279) published between 1998 and 2021 met the inclusion criteria. The overall prevalence of sleep disturbance was 60.7% (26,448/46,279 participants, 95% CI 58.1–63.3%) with significant heterogeneity between studies (p <.000 τ2=.0000, I 2=96.4%). This meta-analysis highlights the importance of developing optimal monitoring strategies to reduce sleep disturbance and improve the quality of life of cancer patients.
Keywords : prevalence, sleep disturbance, insomnia, cancer, meta-analysis
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Perspectives of the community in the developing countries toward telemedicine and pharmaceutical care during the COVID-19 pandemic
Authors : Alsayed, Ahmad R., Shiraz Halloush, Luai Hasoun, Dalal Alnatour, Abdullah Al-Dulaimi, Munther S. Alnajjar, Anaheed Blaibleh, Amniyah Al-Imam, Farhan Alshammari, and Heba A. Khader
Abstract : Background: Pharmaceutical care (PC) services have expanded in recent years, resulting in improved patient outcomes. However, such PC services are currently available for free in the majority of Arabic countries. During the coronavirus disease (COVID-19) pandemic, telemedicine is especially beneficial since it allows for continuity of care while allowing for social distancing and minimizing the risk of infection. Objective: To assess the community’s attitude, opinion, and willingness to pay for telemedicine and PC services during COVID-19 pandemic, as well as to create a website provision for telemedicine and PC services. Methods: This cross-sectional study was conducted, over five months (December 2020– April 2021), among the general population in Arabic countries, excluding pharmacists, physicians, and pharmacy students. Results: A total of 1717 participants were involved, most of them were from Jordan (52.2%) and Iraq (24.8%). Sixty two percent of participants seek pharmacists’ advice whenever they have any medication changes and 45.1% of the participants agreed with the idea of paying pharmacists to decrease medication errors. Interestingly, 89.5% of participants encouraged the idea of creating a website that provides a PC, and 35.5% of them would pay for it. The failure to document the medical information of the patients had most applicants’ agreement as a reason of medical errors (M=4.17/5, SD=0.787). More than three-quarters of participants agreed that creating a database containing the patients’ medical information will reduce medical errors. Conclusion: From a patients’ perspective, this study suggests a large patient need for expanding PC services in Arabic countries and introduces a direct estimate of the monetary value for the PC services to contribute to higher savings. The majority of participants supported the idea of creating a website provision of telemedicine and PC services, and a considerable proportion of them agreed to pay for it.
Keywords : Telemedicine; Pharmaceutical Care; Developing Countries; COVID-19
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Patterns of antibiotic use, knowledge, and perceptions among different population categories: A comprehensive study based in Arabic countries
Authors : Alsayed, Ahmad, Feras Darwish El Hajji, Mohammad AA Al-Najjar, Husam Abazid, and Abdullah Al-Dulaimi
Abstract : Background: Antibiotics are essential for the treatment of bacterial infections and are considered among the most commonly sold drug classes from the community pharmacy in the developing countries without a prescription in most cases.
Purpose: This study aims to explore the knowledge, practices, and attitudes regarding antibiotic use.
Materials and methods: This study employs a cross-sectional descriptive design that used a pre-validated survey. The participants were classified into three main mutually exclusive groups: healthcare professionals, medical students, and other adults in the community.
Results: Of the 10,226 participants, 1157 (11%) were healthcare professionals; 2322 (23%) were medical students and 6747 (66%) were other adults in community. The majority of participants used antibiotic at least once during the past year. A total of 838 (72.4%) healthcare professionals and 800 (34.5%) medical students had prescribed an antibiotic during the last 6 months. Almost half of the medical students and adults in the community and almost one-third of healthcare professionals reported that the aim of antibiotics use is for fever. Furthermore, around one-quarter of participants reported that the aim of antibiotics use is for viral infection. Around one-quarter of respondents stated that the antibiotic will always be effective in the treatment of the same infection in the future. Around one-quarter of participants stated that 21 to 50% of antibiotics are considered to be unnecessary or inappropriate prescriptions. Different factors were perceived as being very important causes of antibiotic resistance among the participants.
Keywords : Antibiotic; Arabic Countries; Knowledge; Perceptions
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Implementing and evaluating a course in professional ethics for an undergraduate pharmacy curriculum: A feasibility study
Authors : Fino, Leen B., Ahmad R. Alsayed, Iman A. Basheti, Bandana Saini, Rebekah Moles, and Betty B. Chaar
Abstract : Background Pharmacy practice today mandates “patient-centered care”, thereby assigning higher levels of professional responsibility for pharmacists leading to ethical challenges. These challenges often involve ethical principles, institutional, personal, or other constraints that can pull practitioners in incompatible opposite directions, creating “ethical dilemmas” in many circumstances. Pharmacists are expected to handle challenges competently and in the best interest of patients. Literature underlines the positive impact of educational interventions focusing on ethical awareness and competence, and that “gaps” existed in pharmacy training/curricula for Jordanian pharmacists. The objective of this study was to develop, implement, and evaluate the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian university. Educational activity and setting Fifth-year pharmacy students attending summer school at a university in Jordan from July to September 2020 were invited to participate in an educational intervention (suite of didactic online lectures and skills-based workshops). This study was delivered in four parts, with a pretest administered immediately before and a posttest survey immediately after the educational intervention, the educational intervention (three phases), and focus-group discussions to elicit students' feedback. Findings Findings indicated enhanced levels of confidence in students' decision-making. The development of students' moral reasoning and decision-making skills were also observed to be improved. Summary This study highlighted the importance of the implementation of an ethics course in pharmacy undergraduate curricula. It emphasized the positive impact this course made on the students' learning experiences and provided a strong environment for discussion and group learning
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Potentially inappropriate medications use and its associated factors among geriatric patients: a cross-sectional study based on 2019 Beers Criteria
Authors : Khader, Heba, Luai Z. Hasoun, Ahmad Alsayed, and Mahmoud Abu-Samak
Abstract : The aims of this study were to estimate the prevalence of potentially inappropriate medications (PIMs) in a community-dwelling Jordanian population of geriatrics according to the 2019 American Geriatrics Society Beers Criteria, to identify the most used PIMs and factors independently associated with PIMs use. This was an observational, descriptive, cross-sectional study. The sample population included 386 participants. Data were collected by face-to-face interviews. A total of 2894 medications were evaluated. The prevalence of patients using at least one PIM was 49.2%. The most used PIMs were proton pump inhibitors (24.6%) and long-acting sulfonylurea (20.5%). Participants who had diabetes mellitus, peptic ulcer, or irritable bowel syndrome had significantly higher numbers of PIMs. The use of PIMs was high in Jordanian geriatric patients. The results of this study might help healthcare providers to detect high-risk patients and reconsider the necessity of using PIMs to decrease the risk of adverse drug events
Keywords : AGS Beers Criteria, Geriatrics, Jordan, Potentially inappropriate medications
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Targeting drug chemo-resistance in cancer using natural products
Authors : Talib, Wamidh H., Ahmad Riyad Alsayed, Muna Barakat, May Ibrahim Abu-Taha, and Asma Ismail Mahmod
Abstract : Cancer is one of the leading causes of death globally. The development of drug resistance is the main contributor to cancer-related mortality. Cancer cells exploit multiple mechanisms to reduce the therapeutic effects of anticancer drugs, thereby causing chemotherapy failure. Natural products are accessible, inexpensive, and less toxic sources of chemotherapeutic agents. Additionally, they have multiple mechanisms of action to inhibit various targets involved in the development of drug resistance. In this review, we have summarized the basic research and clinical applications of natural products as possible inhibitors for drug resistance in cancer. The molecular targets and the mechanisms of action of each natural product are also explained. Diverse drug resistance biomarkers were sensitive to natural products. P-glycoprotein and breast cancer resistance protein can be targeted by a large number of natural products. On the other hand, protein kinase C and topoisomerases were less sensitive to most of the studied natural products. The studies discussed in this review will provide a solid ground for scientists to explore the possible use of natural products in combination anticancer therapies to overcome drug resistance by targeting multiple drug resistance mechanisms
Keywords : anticancer natural products; drug efflux; drug detoxification; plants derived natural products
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Melatonin in Cancer Treatment: Current Knowledge and Future Opportunities
Authors : Talib, Wamidh H., Ahmad Riyad Alsayed, Alaa Abuawad, Safa Daoud, and Asma Ismail Mahmod
Abstract : Melatonin is a pleotropic molecule with numerous biological activities. Epidemiological and experimental studies have documented that melatonin could inhibit different types of cancer in vitro and in vivo. Results showed the involvement of melatonin in different anticancer mechanisms including apoptosis induction, cell proliferation inhibition, reduction in tumor growth and metastases, reduction in the side effects associated with chemotherapy and radiotherapy, decreasing drug resistance in cancer therapy, and augmentation of the therapeutic effects of conventional anticancer therapies. Clinical trials revealed that melatonin is an effective adjuvant drug to all conventional therapies. This review summarized melatonin biosynthesis, availability from natural sources, metabolism, bioavailability, anticancer mechanisms of melatonin, its use in clinical trials, and pharmaceutical formulation. Studies discussed in this review will provide a solid foundation for researchers and physicians to design and develop new therapies to treat and prevent cancer using melatonin
Keywords : pineal gland; anticancer; cancer therapy; hormonal therapy; phytomelatonin
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'Resveratrol and Tumor Microenvironment: Mechanistic Basis and Therapeutic Targets'
Authors : Talib, Wamidh H, Ahmad Riyad Alsayed, Faten Farhan, and Lina T Al Kury
Abstract : Resveratrol (3,40 ,5 trihydroxystilbene) is a naturally occurring non-flavonoid polyphenol. It has various pharmacological effects including antioxidant, anti-diabetic, anti-inflammatory and anti-cancer. Many studies have given special attention to different aspects of resveratrol anti-cancer properties and proved its high efficiency in targeting multiple cancer hallmarks. Tumor microenvironment has a critical role in cancer development and progression. Tumor cells coordinate with a cast of normal cells to aid the malignant behavior of cancer. Many cancer supporting players were detected in tumor microenvironment. These players include blood and lymphatic vessels, infiltrating immune cells, stromal fibroblasts and the extracellular matrix. Targeting tumor microenvironment components is a promising strategy in cancer therapy. Resveratrol with its diverse biological activities has the capacity to target tumor microenvironment by manipulating the function of many components surrounding cancer cells. This review summarizes the targets of resveratrol in tumor microenvironment and the mechanisms involved in this targeting. Studies discussed in this review will participate in building a solid ground for researchers to have more insight into the mechanism of action of resveratrol in tumor microenvironment
Keywords : resveratrol; tumor microenvironment; natural products; anti-cancer; phytotherapy
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Influences of bovine colostrum on nasal swab microbiome and viral upper respiratory tract infections–A case report
Authors : Alsayed, Ahmad, Abdulhameed Al-Doori, Abdullah Al-Dulaimi, Abdullah Alnaseri, Juhayna Abuhashish, Khaled Aliasin, and Ibrahim Alfayoumi
Abstract : Bovine colostrum has been advocated as a source of immunity against external environmental microorganisms. Recurrent upper respiratory tract infections present a critical public health concern in the developing countries. The present case report was performed to assess the influence of bovine colostrum in preventing recurrent upper respiratory tract infections caused by respiratory viruses in an adult in Jordan in addition to its effect on respiratory microbiome. In conclusion, bovine colostrum was successful in the prevention of upper respiratory tract infections and significantly affected the nasal swab microbiome. This is the first case report investigating the influence of bovine colostrum on the nasal swab microbiome.
Keywords : Colostrum; Microbiome; Upper respiratory tract infection
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'Relevance of vancomycin suceptibility on patients outcome infected with Staphylococcus aureus'
Authors : Alsayed, Ahmad Riyad, Malek Alzihlif, and Jamal Ahmad Wadi Al Ramahi
Abstract : Background: Staphylococcus aureus is a serious pathogen with high rates of complications. We aim to study the susceptibility and outcome of S. aureus infection. Methods: A retrospective multicentre study conducted in three hospitals, Amman - Jordan. Between June 2013 and March 2014 laboratory records were reviewed for culture-positive samples growing S. aureus, also, medical records for the patients were reviewed for the demographic data, predisposing conditions, vancomycin MIC level and outcome. Inpatients and outpatients were included, a case was classified as either hospital-associated (HA), community-associated (CA), or healthcare-associated (HCA). Data were entered as excel sheets and were statistically analysed using SPSS version 22.
Results: A total of 127 patient (46% MRSA) were culture-positive for S. aureus from different sources were collected. Eighty (63%) were inpatients. High resistance rates to non β-lactam antimicrobials were recorded. Glycopeptides agents were the antibiotics of choice for the treatment of infections caused by MRSA strains. Complications rates were higher for patients with MRSA infections including mortality, but hospital stay was longer for MSSA.
Conclusion: MRSA rates were high though it lately appeared plateauing in Jordan. There is a value for knowing vancomycin MICs for S. aureus as it has its own implications for outcomes, though most outcomes evaluated were significantly worse with MRSA infection.
Keywords : Staphylococcus aureus, S. aureus susceptibility, MRSA, MRSA outcome, S. aureus minimum inhibitory concentration
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'Respiratory fluoroquinolones vs. other commonly used antimicrobials in mild-to-moderate severity community-acquired pneumonia'
Authors : Al Ramah, Jamal Wadi, Ahmad Alsayed, Ayham Nassar, Mais F Kadr, Omar Al-Eter, Hiba F Nour, Muhannad Qulaghassi, Nader Abdel Jawad, and Dareen Smaik
Abstract : Objective: Respiratory Fluoroquinolones (RFQs) are widely used in the treatment of community-acquired pneumonia (CAP) in our part of the world. Our aim was to find if there was outcome difference between RFQ-based versus RFQ-exempt regimens.
Methods: A retrospective study of RFQs versus other commonly used antimicrobial therapy (OUAT) in the treatment of patients with mid-to-moderate CAP adjusted by pneumonia severity score (PSI). Rates of treatment outcome at end-of- therapy i.e. clinical improvement, length of hospital stay and speed of recovery were evaluated. Patients were included if they had Mild-to-Moderate severity CAP, ≥18 years old, completed ≥ 3 days of antimicrobials.
Results: 320 patients were included, mean age for all groups was 49.63 years (P = 0.204), males 60.3 % (P = 0.219). All had similar PSI score (Pearson X2 test = 13.75, P = 0.185). The first group (24.4%) is composed of RFQs monotherapy. The second group (50.6%) is composed of RFQs plus β-lactams. The third group (25%) is composed of OUAT. Diabetes was the most common comorbidity among all (P = 0.847). There was no significant difference among the three groups in clinical improvement (P = 0.424) and speed of recovery (P = 0.398), however length of hospital stay was significantly shorter for the RFQs monotherapy (P = 0.004). Cumulative curve for probability of discharge did not show significant difference among the three therapy groups (P ≥ 0.20)
Conclusion: There were no significant difference among the groups regarding end-of-treatment clinical improvement rates, speed of recovery and probability of hospital discharge. However, they significantly differ in length of hospital stay for RFQs monotherapy (P = 0.004).
Keywords : Respiratory quinolones, quinolones, Community-acquired pneumonia, length of hospital stay, 30 days mortality, speed of recovery
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