COVID-19 and role of pharmacists: Knowledge and perceptions of pharmacists from Iraq and Syria
Authors : Iman A Bashet, Razan Nassar, Feras El-Hajji, Bayan Othman, Kinda T Alkoudsi, Zaid Al-Ani
Abstract : Objectives: To assess pharmacists from Syria and Iraq on their knowledge, readiness, and perspectives on their roles during the COVID-19 pandemic. In addition to investigate pharmacists' perceived barriers towards delivering their emergency roles during the COVID-19 pandemic and perceived policymakers' responsibilities. Methods: This cross-sectional study design was conducted in Iraq and Syria during COVID-19 outbreak over one month (April 2020). The study objectives were addressed through a validated online questionnaire. Data was analyzed using statistical package for social science (SPSS). Results: A total of 916 individuals participated in this study (447 from Iraq and 439 from Syria). Most of Iraqi participants were students while most of Syrian participants were graduates and technicians. The mean age for the Iraqi participants was 22.5 (SD= 4.1) while the mean age for the Syrian participants was 28.7 (SD= 9.1). A significant difference (p< 0.001) was found in following the latest coronavirus updates on management among pharmacy graduates and technicians and undergraduate students. Media was reported as the most used source for knowledge about epidemics/ pandemics among the Iraqi and the Syrian participants. Around 72% strongly agreed/agreed that the faculties of pharmacy have a role in preparing them to deal with epidemics/pandemics. In addition, 64.3% strongly agreed/agreed that pharmacist associations and societies have a role in preparing them to deal with epidemics/pandemics such as the coronavirus. Moreover, 82.9% believed that pharmacists should receive training programs on how to provide mental health support for people during epidemic and pandemic outbreaks. Conclusion: Tertiary pharmacy education providers and pharmacy professional bodies have a strong role in preparing pharmacists to deal with pandemics. Therefore, the importance of providing beforehand training programs on epidemics/pandemics management, workshops, lectures, and online information resources for such circumstances is crucial for pharmacists.
Keywords : CORONAVIRUS; IRAQ; PANDEMICS; PHARMACEUTICAL ASSOCIATIONS; PHARMACISTS; SYRIAspan>
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Changes in gut microbiota of alloxan-induced diabetic rats in response to orally administered combined aqueous extracts of olive leaves and ginger
Authors : Shatha Alshaer, Feras Darwish El-Hajji, Reem Abu-Tayeh, Iman Basheti, Mohammad AA Al-Najjar
Abstract : Olive leaves and ginger rhizomes are examples of medicinal plants that have been used, separately, for the management of different ailments. Diabetes mellitus is a chronic disease that is prevalent around the whole world and is significant among adults in Middle Eastern countries. The effect of the combined mixture of olive leaves and ginger rhizome aqueous extracts has not been previously studied for its hypoglycemic effect, nor for its effect on gut microbiota in the diabetes-induced rat model. This study aims to elucidate the potential effect of the orally ingested combination of the aqueous extract of olive leaves and ginger rhizome on the gut microbiota in both healthy and diabetic rats. Diabetes was induced by intraperitoneal injection of alloxan monohydrate, and the aqueous extracts were prepared in the same homemade preparation method. Each extract and subsequent combination were given separately at a dose of 500 mg/kg per day, with or without insulin (6 IU/kg) for 7 days, to every rat in the different groups. Fasting blood glucose was carried out to evaluate the diabetic state, and fecal samples were collected at different time points for 16s rRNA gene sequencing. The combination of extracts increased bacterial diversity in general and raised the Firmicutes/Bacteroidetes ratio in both healthy and diabetic rats. Moreover, while it increased the relative abundance of Lactobacillus and Prevotella, it decreased the relative abundance of Clostridium and Bacteroides in healthy rats. These results have positive effects on the management of diabetes, by increasing short-chain fatty acid production, which can suppress the appetite and prevent damage to pancreatic cells. This study underlines the additional benefits of using herbal extracts to retain dysbiosis and improve gut microbiota.
Keywords : Diabetes mellites, gut microbiota, olive leaves extracts, ginger rhizome extract, prebiotic effect, short-chain fatty acid production
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Patterns of antibiotic use, knowledge, and perceptions among different population categories: A comprehensive study based in Arabic countries
Authors : Ahmad Alsayed, Feras Darwish El Hajji, Mohammad AA Al-Najjar, Husam Abazid, 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. Conclusions: These findings indicated that this study participants showed unsatisfactory knowledge and perceptions of proper antibiotic use. Therefore, there is a requirement for a comprehensive and effective antibiotic-stewardship program to promote rational antibiotics use, and compensate for knowledge and perceptions gaps to prevent antibiotic resistance development.
Keywords : Antibiotic, Arabic Countries, Knowledge, Perceptions
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Influence of Castor Oil on Glycated Hemoglobin (HbA1c) on Induced Type 2 Diabetes Mellitus in Rats
Authors : Wael Abu Dayyih, Mohamad H Manaysa, Mohammad M Hailat, Zainab Zakareia, Feras El Hajji
Abstract : Many T2D use CAO as a laxative. We did not find sufficient research to explain CAO's potential effect on the levels of HbA1c in T2D patients. This study will study this effect. Rats (n=80) were divided into eight groups (n=10). Five groups (n=50) were injected with streptozotocin intravenously to induce T2D. One group was given CAO with empagliflozin, and the second was assigned CAO only daily. The third was assigned CAO every two days, with empagliflozin, which was given daily. A fourth was assigned CAO alone daily. Also, the fifth was given empagliflozin alone. In the healthy groups, one group was given CAO, and the other was given empagliflozin. Also, the last healthy group was not assigned any drug. CAO's result on HbA1c in healthy rats was noted to decrease when delivered alone for eight weeks. HbA1c of the diabetic groups showed no significant difference (P-value<0.05) when comparing the rats given CAO with empagliflozin, and the rats were given CAO only. There was also no noticeable effect among the groups of rats given CAO daily and every two days. This study explains that CAO does not lead to a significant difference in HbA1c levels in diabetic rats, even it did for healthy rats, and if given alone, CAO could affect HbA1c levels if given over a long period. Also, CAO has a noticeable impact on experimental rats that co-administered Empagliflozin on HbA1c levels, and that Empagliflozin effect is not significantly affected if taken with CAO.
Keywords : Castor Oil, HbA1c, Type 2 Diabetes Mellitus, Rats, Empagliflozin, Blood Sugar
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Cost-effectiveness analysis for the parenteral anticoagulants in Jordan
Authors : Shatha Alquraan, Feras Darwish El-Hajji
Abstract : Objectives: Pharmacoeconomic dimensions linking clinical effectiveness of parenteral anticoagulants for management of acute venous thromboembolism (VTE) and cost of treatment are needed to support choices by healthcare providers. The objective of the study was to conduct a cost-effectiveness analysis for 5-day treatment with parenteral anticoagulants in Jordan. Methods: Cost-effectiveness analysis was conducted based on decision analysis tree model. The perspective was the payer, considering direct medical costs. Probabilities of failure of treatment and major bleeding were derived from published clinical studies. Costs were estimated based on 2019 prices in Jordan. Key findings: The average cost of VTE hospitalization and major bleeding management in Jordan were 2324.00 US$ and 3347.40 US$, respectively. Bemiparin was associated with the highest clinical efficacy and lowest probability of major bleeding. Nadroparin had the lowest clinical efficacy, while tinzaparin was found to have the highest risk of major bleeding. Bemiparin had the lowest average cost-effectiveness ratio (101.63 US$/success) and nadroparin had the highest cost-effectiveness ratio (295.56 US$/success). Throughout the sensitivity analysis calculations, bemiparin and nadroparin had the lowest and highest cost of treatment, respectively. Conclusions: The cost of parenteral anticoagulant drugs, the same as many other drugs, does not always correlate with cost of VTE treatment. Other direct medical costs (e.g. treatment failure and management of bleeding) have a high contribution to the total cost calculation. Pharmacoeconomically, bemiparin is the dominant cost-effective parenteral anticoagulant in Jordan, while nadroparin is the dominated one.
Keywords : anticoagulants, low-molecular weight heparin, bleeding, cost-effectiveness, VTE, Jordan
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Pharmacists’ awareness of COVID‐19 and perceptions of their roles, barriers, and roles of policymakers: Exploring the Middle East and North Africa (MENA)
Authors : Iman A Basheti, Feras El‐hajji, Razan Nassar, Samar Thiab, Muna Barakat, Mariam Basheti, Alberto Berardi, Bandana Saini
Abstract : Background: The coronavirus disease (COVID-19) was declared in January 2020 as a public health emergency of international concern. The Middle East and North Africa (MENA) suffered from several pandemics previously. Pharmacists have vital roles to play to prevent the spread of this virus. Objectives: To assess the COVID-19 awareness amongst pharmacists from Arabic-speaking countries located in the MENA region, and to assess their perspectives of their role, barriers, and roles of the educational institutions/pharmaceutical associations. Methods: An online survey was conducted to run a descriptive cross-sectional study in Jordan from 12th to 22nd April 2020. The questionnaire was validated (face validity) and put on Facebook and directed for pharmacists only (clarified in the introduction of the questionnaire). Assessment of pharmacists’ awareness (20 questions) about pandemics and COVID-19, their perceived roles and barriers, and roles of the educational institutions (eg, universities) and pharmaceutical associations (eg, Pharmacists Syndicate) was performed. Data were analysed using Statistical Package for the Social Science (SPSS). Results: Study participants (n = 2589) had a mean age of 29.3 (8.2) years and 1329 (51.5%) were females. Most of the participants were from Egypt (n = 819, 40.8%), followed by Jordan, Algeria, and Syria. Regarding the sources of information about coronavirus management, 60.8% of participants got their information from social media. Fear of contracting the coronavirus while performing their duties was reported by the majority of pharmacists as the main barrier to delivering their roles (82.3%). The majority of pharmacists identified positive roles for the pharmaceutical institutions (74.8%) and pharmaceutical associations (63.6%). Conclusion: Pharmacists from the MENA countries believe they got enough education previously about pandemics, and the majority follow the latest coronavirus updates from social media. Fear was reported as the major barrier that requires resolution by the policymakers. Certain gaps in the awareness about COVID-19 were identified.
Keywords : pharmacist, middle-east, covid-19, awareness
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Antimicrobial stewardship in community pharmacies in Jordan: assessing current status
Authors : Doaa Saleh, Rana Abu Farha, Feras Darwish El-Hajji
Abstract : Objectives: The aim of this study was to assess knowledge and perceptions of the Jordanian community pharmacists towards antimicrobial resistance and antimicrobial stewardship programmes (ASPs). Methods: A descriptive cross-sectional questionnaire-based study was conducted between August and September 2020. The validated questionnaire consisted of sections that measure participants’ demographics, knowledge and perceptions towards ASPs, and assess antibiotic prescribing practice. Questionnaires were distributed via social media to be filled by community pharmacists in Jordan. For knowledge questions, participants gained one point for each correct answer and zero point for each incorrect answer. Then, a knowledge score was calculated out of 10. Key findings: During the study period, a convenience sample of 200 pharmacists were recruited and were asked to fill out the study questionnaire, with a majority claimed attending ASPs workshops previously (n = 162, 81.0%). The main sources of knowledge about antimicrobial resistance were university courses and books. With a median knowledge score of 6/10, participants knew that antimicrobials are not always safe. Although only less than 25% knew that ASPs does not necessarily increase treatment duration, most of the pharmacists had positive perceptions towards ASPs. Barriers against application of ASPs were mainly lack of training and lack of physicians’ cooperation (89.0% and 87.5%, respectively). It was agreed by 90.0% of the respondents that ASPs would boost public health confidence in community pharmacists, and 86.0% believed that ASPs would enhance their job satisfaction. Multivariate linear regression showed that female gender of pharmacist was significantly associated with higher knowledge score (P-value = 0.045). Conclusions: This study highlighted that community pharmacists have a good knowledge in antibiotics and a positive perception regarding ASPs. Despite not being highly familiar with ASPs concept, pharmacists showed great support for involvement in ASPs. They also encouraged incorporating ASPs within community pharmacy level which is considered crucial to control antimicrobial resistance throughout the world.
Keywords : antimicrobial stewardship, knowledge, perception, community pharmacists, Jordan
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Perception and attitude of the public on vaccine practices and pharmacists as immunizers in Jordan
Authors : Yazan S Batarseh, Feras W Darwish ElHajji, Samira Shammas, Rula M Darwish, Rula Fakhoury, Maram Al Haj Ahmad, Ahmed Al Rusasi, Laila Jarrar
Abstract : Objective: To assess general perception and attitude of the public on vaccines current practices and pharmacists as immunizers in Jordan Methods: In this study, computer-assisted personal interviews technique was utilized using a quantitative approach of a structured questionnaire. The survey instrument was completed with random telephonic interviews covering different geographic areas in the country of Jordan with a total sample size of 366. Key findings: Majority of respondents had a positive perception of vaccines in general. Regarding the respondents’ perception of current vaccination status, the majority felt it is good as is or requires some enhancements. Furthermore, 53% believe pharmacists should administer vaccines. Majority strongly agree (76%) that pharmacists should be trained and certified to do so. However, 57% strongly disagree that current pharmacies in Jordan have the facilities allowing them to administer vaccines. Finally, a significant increase of 26% in public willingness to have a pharmacist immunizer after certification was observed compared to without being certified (52%). Conclusions: Respondents support the role of vaccination as a preventative tool. However, to their opinion, contrary to the high effectiveness in paediatric vaccination in Jordan, current adult vaccination systems need to be revised and improved to increase its adult coverage. Additionally, respondents highly support the idea of allowing pharmacists to become immunizers under certain conditions regarding proper training, accredited certification and licensed administration facilities.
Keywords : pharmacists immunizers, clinical pharmacy, vaccination, Jordan, preventative medicine, pharmaceutical care
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Reproductive safety assessment of Thymus vulgaris L. extract and quantification of thymol sulfate in pregnant rats and fetuses using a validated LC/MS method of analysis
Authors : Zaineh Q Tafesh, Kenza A Mansoor, Nidal A Qinna, Feras D El-Hajji, Tawfiq A Arafat, Luay F Abu-Qatouseh, Bayan Y Ghanim, Iman A Basheti, Eyad M Mallah
Abstract : The current study aimed to investigate the safety of ingesting standardized thyme extract (Thymus vulgaris L.) during pregnancy in rats. For this purpose, postmortem examination and thymol sulfate (TS) concentration in maternal and fetal effluent extracts were determined. TS concentrations were analyzed by developing and validating a new liquid chromatography–mass spectrophotometer method for quantification. Three dose levels of 1-, 10-, and 20-fold (x) of the recommended dose of standardized thyme extract in parallel to thymol were administered to evaluate the development of rat fetuses from the 5th to the 19th day of gestation. Blood samples from pregnant rats and fetal tissue samples were analyzed to detect the presence of TS that is a major thymol metabolite. The average concentration of TS detected in pregnant rats’ plasma-administered thyme extract was 648 ± 106 ng/ml at 1x dose compared to 3,429 ± 865 ng/ml for its equivalent amount of thymol compound. Quantities of TS in the dams and fetal tissue were found to increase in a dose-dependent manner. The administration of the 1x and 10x doses of the extract resulted in a significant increase in the fetal and placental weights. However, 20x dose of both thyme extract and thymol compound exhibited an increase in the number of adsorbing sites in the uterus and reduced birth weights compared to control. In conclusion, TS was capable of crossing the placental barrier in rats and increased the resorption index when high and repeated doses of thyme extract were administered. The current investigation highlights the expected danger of exceeding the therapeutic dose when consuming thyme remedies during pregnancy.
Keywords : Thyme, essential oil, toxicity, fetus, pregnancy, cough syrups
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Impact of education workshop on improving pharmacy students’ knowledge about Helicobacter pylori infection: A randomized controlled study
Authors : Anas Alshkweiki, Feras Elhajji, Rana Abu Farha, Raja'a Alqudah
Abstract : Rationale, aims, and objective: Evidences show that the level of awareness about H.pylori is still low, and working on this issue is expected to be very impactful to improve infection rates and disease spread. This research aimed is to assess the level of knowledge and the degree of awareness among undergraduate pharmacy students in regard to H pylori diagnosis and management before and after delivering an educational pharmacy intervention. Methods: This is a randomized controlled study that was conducted in May 2020. During the study period, 72 pharmacy students were invited to attend a workshop about H pylori management and diagnosis. Participants’ knowledge and general awareness about H pylori infection was evaluated before and after the workshop (25-minute educational lecture for the intervention group and educational pamphlet for the control group). At the end of the workshop participants’ ability to distinguish and correctly diagnose virtual cases was tested. Results: Most of the participating students (n=58, 80.6%) haven’t been involved in similar workshops previously. Following education workshop, students in the intervention group showed a significant improvement in their knowledge score (from 9.2 (SD=1.9) pre-workshop to 10.4 (SD= 1.9) post-workshop, (P-value =0.001) while students in the control group didn’t (preworkshop knowledge score of 9.1 (SD= 2.2) and post-workshop score of 9.4 (SD= 1.6), (P-value =0.324). Also, students in the intervention group produced better results than the control group in distinguishing and diagnosing provided H pylori cases in the workshop with higher score of 2.2 for the intervention group compared to 1.6 for the control group (P-value= 0.026). Conclusion: Education workshops about H pylori infection are needed to build a strong base of qualified healthcare providers as an outstanding output of our higher educational programs, which in turn improves the quality and reduces the burden on healthcare systems.
Keywords : H pylori; educational intervention; pharmacy student; knowledge; diagnosis
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Evaluation of lipid lowering effect of milk thistle (silybum marianum) in comparison with rosuvastatin in rats by using ACE-Alera® analyser
Authors : Fatima Shahin, Eyad Mallah, Reem Emad, Luay Abu-Qatouseh, Wael Abu Dayyih, Feras Darwish El-hajji, Kenza Mansoor, Mona Bostami, Kamal Sweidan, Tawfiq Arafat
Abstract : Dyslipidemia is a metabolic disorder that is characterized with an elevation in the cholesterol serum levels that can be treated with various hypolipidemic drugs like rosuvastatin. The present study was undertaken to determine and evaluate the hypolipidemic effect of milk thistle seeds extract in comparison with rosuvastatin and the combination of both for the treatment of dyslipidemia in rats. Also its effect on blood glucose levels on experimentally induced dyslipidemic rats. In vivo studies were conducted on wister albino laboratory rats, in which 49 rats were induced to be dyslipidemic by a daily intragastric administration of cholesterol (2 g/kg). The induction of dyslipidemia was evaluated by comparing these rats with a negative control group that was composed of 10 healthy rats. Then, after one month dyslipidemia was induced in 49 rats that were divided into 6 groups, as the following; positive control group (n=9) received cholesterol (2 g/kg) for another one month, and the other five groups each of 8 rats continued to receive cholesterol (2 g/kg) for one month along with therapy as; rosuvastatin low dose (RL) group received 10 mg/kg, rosuvastatin high dose (RH) group received 20 mg/kg, milk thistle (MT) group received 7.15 mg/kg, (RL+MT) group received a combination of 10 mg/kg of rosuvastatin and 7.15 mg/kg of milk thistle, and (RH+MT) group received a combination of 20 mg/kg of rosuvastatin and 7.15 mg/kg of milk thistle. The statistical results of biochemical analysis showed that all the studied therapeutic protocols whether given alone; RL, RH, and MT or in a combination; RL+MT and RH+MT led to a significant (p≤0.05) hypolipidemic effect that reduced the total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and very low density lipoprotein (VLDL) and increased the high density lipoprotein (HDL) cholesterol levels. In conclusion, all therapeutic protocols were effective in treating dyslipidemia, as they all reduced the TC, TG, LDL, and VLDL, and increased the HDL cholesterol significantly (p≤0.05). Furthermore, we found that milk thistle can be used in the management of dyslipidemia, as it has a hypolipidemic effect. Also, the addition of milk thistle to rosuvastatin therapy reduced the risk of developing diabetes mellitus (DM), as it has a glucose modulating activity either when it was given alone or in combination with rosuvastatin. Moreover, the combination of milk thistle and rosuvastatin was of a great benefit, as it gave an intensive goal of therapy than each one alone in altering all lipid profile parameters.
Keywords : cholesterol, dyslipidemia, milk thistle, rosuvastatin
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Influence of Angiotensin Receptor Blocker (Candesartan) and Angiotensin-Converting-Enzyme Inhibitor (Enalapril) Combined with Glimepiride on Glycated Hemoglobin in Non-Insulin Dependent Diabetic Rats (NIDDM)
Authors : Al-Badri, Abdulwahab; Mallah, Eyad; Zakarya, Zainab; Al-Shdefat, Ramadan; El-Hajji, Feras Darwish; Ifraitekh, Mo’ath; Kharshid, Abeer; Dayyih, Wael Abu
Abstract : Background: Antihypertensive agents like Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin-Converting Enzyme Blockers (ARBs) are commonly indicated for patients with both hypertension and diabetes. However, the effect of these agents on blood sugar level or glycated hemoglobin (HbA1c) is still controversial. This study aims at investigating theshort, and long term effects of ACEIs and ARBs on blood sugar level and HbA1c of a group of streptozocin (STZ)-induced NIDDM rats when given in combination with Glimepiride (antidiabetic drug from Sulfonylureas group). Methods: Diabetes mellitus (DM) was induced in 100 Wistar albino adult male and female laboratory rats above 8 weeks old, and weigh between 250-300 gm by the administration of Streptozocin 75% α-anomer. Two weeks later, the100 rats were then randomized into four groups (25 rats each). Groupone was the untreated control group (received placebo only), while other groups (II, III, and IV) were treated by Glimepiride only, Glimepiride plus ARB (Candesartan), and Glimepiride plus ACEI (Enalapril)respectively. HbA1C levels were measured at baseline (pre-test/directly after randomization) to ensure that there was no significant difference between study groups at the baseline, post-test (after two weeks), and delayed-post-test (12 weeks after randomization/ 10 weeks after post-test) to measure short and long-term changes in the study groups. Results: There was no significant difference (p-values >0.05) between the four groups (groups I, II, III, and IV) in the HbA1C mean level at the beginning of this study (two-weeks after randomization and injection of STZ) (mean = 7.62 ±SD = 0.41, 7.72 ±SD = 0.48, 7.66 ±SD = 0.47, and 7.52 ±SD = 0.51respectively). However, two weeks later, treated groups (groups II, III, and IV) showed moderate reduction of HbA1C mean level compared to the untreated (placebo) group I, that was significant in groups III, and IV, and insignificant in group II (mean =7.43±SD 0.54, 6.97±SD 0.33, 6.72±SD 0.26, and 7.71 ±SD 0.44 respectively). Furthermore, treated groups (groups II, III, and IV) showed significant dramatic reduction of HbA1C mean level when compared to the untreated group (group I) (mean = 6.22 ±SD 0.51, 5.24 ±SD 0.62, 5.22 ±SD 0.13, and 7.62 ±SD 0.42 respectively).Overall, treated groups showed significantly lower HbA1C level than placebo groups. Moreover, Glimepiride + Enalapril combination showed a stronger hypoglycemic effect than the Glimepiride + Candesartan combination at post, and post-delayed tests, however, these differences were not significant. Conclusion: The addition of either ACEIs like Enalapril, or ARBs like Candesartan to Sulfonylureas like Glimepiride to in NIDDM patients will synergize its anti-diabetic effect in NIDDM subjects, and might increase the possibility of hypoglycemia. Caution and/or dose adjustment should be considered upon using these agentstogether in patients with hypertension along with diabetes.
Keywords : Candesartan; Enalapril; dependent diabetic; HbA1c; glimepiride
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Translation and psychometric properties of the Arabic version of the revised Patients' Attitudes Towards Deprescribing questionnaire
Authors : Mohammad B Nusair, Rasha Arabyat, Sayer Al‐Azzam, Feras Darwish El‐Hajji, Amal T Nusir, Mohammed Al‐Batineh
Abstract : Objectives: This study aims to validate an Arabic version of the revised Patients' Attitudes Toward Deprescribing (rPATD) translated tool and to describe polypharmacy patients' attitudes toward deprescribing in Jordan. Methods: rPATD translation was guided by ISPOR’s Principles of Good Practice. A convenient sample of adult outpatients with polypharmacy was recruited from a major teaching hospital in Jordan. Reliability was assessed using Cronbach's alpha and the intraclass correlation coefficient (ICC). Validity was assessed using face and construct validity using confirmatory factor analysis. Key findings: A total of 358 questionnaires were collected from patients (mean age: 60.4 ± 12.03). Overall, polypharmacy patients were willing to stop one or more of their medications upon a physician's recommendations and were not concerned about deprescribing. Similar to the original rPATD tool, factor analysis resulted in four factors (burden, appropriateness, concern about stopping, and involvement). Internal consistencies for constructs ranged from 0.718 (appropriateness) to 0.85 (concerns about stopping). ICC ranged from 0.718–0.972, indicating good to excellent reliability. Conclusions: This study provided an Arabic translation of the rPATD with evidence of validity and reliability comparable to the original tool. The Arabic rPATD could be used for adult patients in Arabic-speaking countries to ultimately contribute to the global literature of deprescribing. Overall, the patients in this study showed a favourable attitude towards deprescribing through a shared decision-making process with their physicians. This can be seen as an opportunity to reduce the burden of polypharmacy and unnecessary medications.
Keywords : Arabic validation, deprescribing, patient attitudes, polypharmacy
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Comparative cost efficiency of the originator drug of infliximab and its biosimilar for the treatment of rheumatoid arthritis in the MENA region
Authors : Ammar Almaaytah, Feras Darwish Elhajji
Abstract : Objectives: To study and assess the comparative cost efficiency of Infliximab’s originator (Remicade®) and its biosimilar (Remsima®) in the treatment of Rheumatoid Arthritis (RA) across seven Middle Eastern and Northern African countries including Saudi Arabia, Jordan, Morocco, UAE, Tunisia, Algeria and Iraq. Methods: Direct costs incurred by one patient for the treatment of moderate to severe RA according to clinical practice were calculated with a treatment regimen consisting of the recommended initial dose of infliximab which is 3 mg/kg every 8 weeks after taking initial loading doses at weeks 0, 2 and 6. The budget impact analysis also depended on two different scenarios. The first scenario disallows the interchangeability between Remicade® and Remsima® during the treatment duration, while the second scenario assumes interchangeability after 6 months of treatment from the infliximab’s originator to its biosimilar. Results: The cumulative cost for treatment with the originator infliximab (Remicade®) and its biosimilar Remsima® for the three-year period was 27054.00 $ and 21384.00 $, respectively and according to the first treatment scenario. For the second scenario which assumes interchangeability, the total 3 year cost for both Remicade® and Remsima® was 27054.00 $ and 22335.30 $, respectively. The overall cost savings over three years ranged between 17.4–21% for the two simulated scenarios. Conclusion: Our study displayed that employing Infliximab’s biosimilar (Remsima®) for the treatment of RA makes a significant decrease in the overall cost of treatment incurred by the patient (or the payer). Our results clearly highlight that employing Infliximab’s biosimilar, Remsima®, for the treatment of RA in the MENA regions would provide significant savings both for the patient or the institutional health care organizations responsible for covering the cost of therapy.
Keywords : Rheumatoid arthritis, Biosimilars, Infliximab, Budget impact analysis, Cost Efficiency
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Pharmacodynamic and Pharmacokinetic Interaction of Warfarin in the Presence of Some Commonly Used Complementary and Alternative Medicines (CAMs) in Rat Plasma by Using HPLC
Authors : Farah Al-Mamoori, Kenza Mansoor, Eyad Mallah, Elhajji, Feras
Abstract : Complementary and alternative medicines (CAM), specifically herbal medicine, has been used since antiquity for the treatment of different ailments. However, a large number of studies on minor and significant drug–herb interactions have been recently reported since many people believe that “herbal products are harmless”. The study was conducted regarding the pharmacodynamic (PD) and pharmacokinetic (PK) interaction between a warfarin and some commonly used CAMs (turmeric, hawthorn and cinnamon). To address this aim, Prothrombin Time (PT) and International Normalized Ratio (INR) were monitored. In vivo studies were conducted on Wistar laboratory rats and were divided into multiple and single dosing groups. Besides, they were analyzed by using High performance liquid chromatography (HPLC). It was developed and validated over concentration range100-4000 ng/ml of warfarin. The mobile phase was (40% acetonitrile, 60% water with triethylamine 1 ml/1L), BDS herpasil C18colum (150mm x4.6 mm, 5μm), 1.0 ml/min flow rate, 20μl auto-sampler injection volume and metronidazole as an internal standard. The pharmacodynamic results showed that the three CAMs contributed to a significant (p0.05) in mean plasma concentration of warfarin and pharmacokinetic parameters (C max, AUC, t0.5, Kel) when combined with CAMs. The type of interaction between warfarin in combination with turmeric, hawthorn and cinnamon is a pharmacodynamic interaction. Therefore, patients using warfarin as an anti-coagulant have to use these herbal medicines cautiously.
Keywords : Warfarin, Complementary and alternative medicine (CAM), Turmeric, Hawthorn, Cinnamon, Drug-herb interaction
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Comparative point prevalence survey of antimicrobial consumption between a hospital in Northern Ireland and a hospital in Jordan
Authors : Feras Darwish Elhajji, Ghaith M Al-Taani, Lana Anani, Sahar Al-Masri, Haneen Abdalaziz, Su’ad H Qabba’h, Abdel Qader Al Bawab, Michael Scott, David Farren, Fiona Gilmore, Ann Versporten, Herman Goossens, Mamoon A Aldeyab
Abstract : Background: To assess antimicrobial prescribing in a Northern Ireland hospital (Antrim Area Hospital (AAH)) and compare them with those of a hospital in Jordan (Specialty Hospital). Methods: Using the Global-PPS approach, the present study surveyed patients admitted to the hospital in 2015, the prescribed antibiotics, and a set of quality control indicators related to antibiotics. Results: Ultimately, 444 and 112 inpatients in the AAH and the Specialty Hospital, respectively, were surveyed. For the medical group, 165 inpatients were prescribed 239 antibiotics in the AAH, while 44 patients in the Specialty Hospital were prescribed 65 antibiotics. In relation to the surgical group, 34 inpatients treated for infection were prescribed 66 antibiotics in the AAH, while 41 patients in the Specialty Hospital treated for infection were prescribed 56 antibiotics. For the medical patients, the most frequently prescribed antibiotics in the AAH were a combination of penicillins (18.8%) and penicillins with extended spectrum (18.8%). For the surgical patients, the most frequently prescribed antibiotics in the AAH were imidazole derivatives (24.2%). For the medical and surgical patients in the Specialty Hospital, the most frequently prescribed antibiotics were third-generation cephalosporins (26.2 and 37.5%, respectively). In medical patients, compliance to guidelines was 92.2% in the Specialty Hospital compared to 72.0% in the AAH (p < 0.001). In surgical patients, compliance to guidelines was 92.7% in the Specialty Hospital compared to 81.8% in the AAH (p = 0.012). Conclusions: The present study highlighted differences in the utilisation of antimicrobials between two hospitals in two distinct regions and benchmarked antibiotic prescriptions across two hospitals.
Keywords : Antimicrobials, Point prevalence survey, Global point prevalence survey, Jordan, Northern Ireland, Antimicrobial surveillance
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Animal use in pharmacy undergraduate pharmacology laboratories: Students’ perceptions and need assessments
Authors : Feras D Elhajji, Iman A Basheti
Abstract : Background: During the undergraduate years, laboratory practical classes using experimental animals are important in pharmacy schools. Limitations for experimental use of animals exist, including the procurement of animals, the difficulty in performing animal experiments, ethical considerations, and more often students' preferences. Objective: To evaluate pharmacy students’ perceptions, barriers, and confidence regarding animal use in the pharmacology laboratory course, and the effect of animal handling on their confidence. Methods: This observational pre- and post-course parallel group design study was conducted during the Pharmacology laboratory involving 3rd-year pharmacology students from one school of pharmacy in Jordan. A questionnaire was designed and validated to collect students’ demographic characteristics, perceived barriers and perceptions regarding animal handling during the lab, and the level of confidence pre- and post-course, assessing differences between those who handled and those who did not handle animals. Results: All Pharmacology lab students (n = 212) with a mean age of 21.11 (SD 1.32) and the majority being females (77.0%) were enrolled. Students who refused to handle animals (n = 105, 49.5%) stated phobia as the main barrier. Students who accepted to handle animals agreed more with the importance of seeing and practicing animal handling, with animal handling being essential to understand the effect of drugs on animals and in its importance to gain skills, than those who refused. More than half of students (55.9%) reported feeling confident/somewhat confident in animal handling and in giving animals injections (50.8%) at baseline. At the end of the course, students who accepted animal handling reported significantly higher confidence. Conclusion: This study revealed important students’ barriers and perspectives to animal handling. Those who handled the animals reported better confidence in certain areas at the end of the course than those who refused. Engaging students when making decisions regarding educational practices paves the way for change to the current traditional paradigm in the education of future scholars.
Keywords : Animal use, Pharmacy, Tertiary education, Pharmacology laboratory
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DETERMINATION OF CARBAMAZEPINE IN RAT PLASMA BY USING HIGH PERFORMANCE LIQUID CHROMATOGRAPHY (HPLC) IN PRESENCE OF SOME TRADITIONAL BEVERAGES (TAMARIND, MANGO, SUGARCANE, RED BULL) AND ITS PHARMACOKINETIC APPLICATIONS
Authors : Reem Emad, Eyad Mallah, Fatima Shahin, Feras Darwish El-Hajji, Wael Abu Dayyih, Nasir Idkaidek, Luay Abu-Qatouseh, Da'san M. M. Jaradat, Tawfiq Arafat
Abstract : A simple, rapid and accurate method of High-Performance Liquid Chromatography (HPLC) with UV detector was used for determination of Carbamazepine (CBZ). The mobile phase was a mixture of 55% of water contains (1 ml triethylamine per 1 liter) and 45% acetonitrile, the pH was adjusted with phosphoric acid, BDS hypersil C18 column (5 μmx150mmx4.6mm) equipped with UV detection at 285 nm with flow rate of 1.0ml/min, using 15μl injection volume and 10°C auto-sampler temperature. Metronidazole benzoate was used as internal standard; the method was precise, and accurate. Beverages were given in drinking water to the rats before giving CBZ dose (10mg/kg). Plasma level of CBZ alone (group 1) was compared to CBZ with tamarind (group 2), mango (group 3), sugarcane (group 4), and red bull (group 5). Maximum plasma concentrations (Cmax) were 2222.7 ng/ml, 1006.3 ng/ml, 2090.4 ng/ml, 4446.3 ng/ml, and 4523.6 ng/ml respectively for the five groups, group 2 was significantly decreased in Cmax (p-value 0.05). The times for reaching the peak of concentration (Tmax) were significantly increased in all comparison to drug alone (p-value <0.05). In conclusion, we recommend to be cautious in intake the previous beverages because it will delay the Tmax of the drug and will change the maximum concentration of CBZ in the plasma when pre-administrated, therefore dose adjustment during consumption of these beverages is needed.
Keywords : Carbamazepine; Tamarind; Mango; Sugarcane; Red bull; HPLC
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Influence of Energy Drinks on Pharmacokinetic Parameters of Sildenafil in Rats
Authors : Arafat T. Abdulla M, Mallah E, Dayyih W. A, Rayyan W. A, El-Hajji F. D, Bustami M, Mansour K, Al-Ani I, Seder N
Abstract : Both sildenafil and RED BULL®(energy drink) are claimed to boost up energy.RED BULL®, one of the most commonly used energy drinks and its easily and widely available for daily use, the idea of this research work had arisen from observations about the concomitant use of sildenafil with RED BULL® by men seeking for better sexual performance. To study the effect of RED BULL® on the pharmacokinetic profile of sildenafil by using HPLC.The pharmacokinetic parameters (Cmax, Tmax and AUC) were determined in 10 rats following oral administration of 0.57 mg/ml sildenafil with and without RED BULL® in crossover design, to achieve this purpose,simple, rapid and accurate method for validation and determination of sildenafil in rat plasma in the presence of RED BULL® has been developed. This was performed using High-Performance Liquid Chromatography- Ultra Violet (HPLC-UV). The pharmacokinetic data showed that sildenafil plasma level was lower when combined with RED BULL® According to the results obtained, maximum concentration (Cmax) for sildenafil alone was (162.05 ng/ ml) after 0.5 hours of administration. The Cmax decreased to (44.68 ng/ml) after 0.5 hoursof administration RED BULL® concomitantly with sildenafil which showed a significant effect on sildenafil plasma level (P<0.001). The area under the curve (AUC) decreased significantly from (370.53 ng/ml*hr) for sildenafil alone to (87.74 ng/ml*hr) when combined with RED BULL®. RED BULL® can alter sildenafil pharmacokinetic if they were taken together.
Keywords : Drug Interaction; Energy Drinks; Pharmacokinetic; Sildenafil; Validation
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Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey
Authors : El-Hajji F.
Abstract : Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8%) received a targeted antibacterial treatment for systemic use, and 1769 (5·9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9%]) and east and south Asia (5363 [10·1%]). Overall, the reason for treatment was recorded in 31 694 (76·9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3%). Local antibiotic guidelines were missing for 7050 (19·2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4%. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals.
Keywords : antimicrobials, Global-PPS, point prevalence
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Screening for Depressive Symptoms in Patients with Diabetic Foot using (CES-D) Scale: A Cross-Sectional Study
Authors : Mervat Alsous, Feras Darwish Elhajji, Ghada Abu Amara, Eman Elayeh, Amal Akour, Ayman Mismar
Abstract : Aim: The aim of this study was to assess levels of depressive symptoms present in patients with diabetic foot. Methods: A convenience sampling method was used to recruit 108 patients with diabetic foot. After having completed the Centre for Epidemiologic Studies Depression Scale CES-D scale, the patients' demographic data and medical history were collected using pre-structured forms. Results: Of the entire sample, 38.9% have CES-D score ≥27, which indicates risk of major depression. Logistic regression analysis showed that retinopathy was significantly associated with increased depressive symptoms among diabetic foot patients (odds ratio 3.41(p=0.017)). Taking supplement therapy and not taking a combination of oral hypoglycemic agent and insulin treatment were significantly associated with higher depressive symptoms (odds ratio 3.38 (p=0.022), 2.83 (p=0.030)), respectively. Patients with primary education level have the highest odds ratio among all factors associated with risk of major depression (OR, 4.07; p=0.003). Conclusions: The risk of major depression among patients with diabetic foot in Jordan is high compared to general diabetic population. This was associated with low educational level, retinopathy, taking supplement therapy, but not taking a combination of oral hypoglycemic agent and insulin. There is a need for routine screening for depressive symptoms in patients with diabetic foot to help in the prevention, early detection of depression and even referral to a psychiatrist.
Keywords : CES-D, depression , Diabetic foot
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Evaluating scientific research knowledge and attitude among medical representatives in Jordan: A cross-sectional survey
Authors : Tareq L Mukattash, Meys Alattar, Rana K Abu-Farha, Mervat Alsous, Anan S Jarab, Feras W Darwish Elhajji, Ibrahim L Mukattash
Abstract : Background: Pharmaceutical companies provide a broad range of different mandatory trainings to their medical representatives to keep the business running; however research related training has often been neglected by these companies. Thus, this study was developed to assess the amount of scientific research knowledge and interest among pharmacy medical representatives in Jordan. Method: A cross sectional study was conducted in Jordan in 2016. During the study period, a questionnaire was administered to 250 medical representatives working in pharmaceutical companies to evaluate their scientific research knowledge and attitudes. Results: The majority of medical representatives had positive attitudes towards clinical trials and research communication and believe that it will increase the value of their work, but a considerable number of medical representatives did not detail clinical trials on every visit and found difficulty in answering clinical trials and research related questions asked by health care professionals. Most of the medical representatives did not have a complete understanding of some basic research terminologies. Medical representatives working in multinational companies seemed to have a significantly better understanding of research and terminologies compared to local companies (P-value= 0.000). Also Medical representatives with higher educational degrees seemed to have significantly better understanding of basic research terminologies (P-value= 0.023). Conclusion: The majority of medical representatives had positive attitudes towards clinical trials and research communication and found that it will increase the value of their work, but still there is a gap in their frequency of detailing. Thus, local pharmaceutical companies need to invest more in research and clinical trials knowledge kind of training. Also, universities need to include research related courses and subject in their bachelors' program curriculum in order to make pharmacists equipped in terms of research knowledge, regardless of the career path they choose.
Keywords : Jordan; Medical representative; attitude; knowledge; patient-centric; research
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Influence of testing parameters on in vitro tramadol release from poloxamer thermogels using the immersion cell method
Authors : Lorina Bisharat, Diego R Perinelli, Alberto Berardi, Giulia Bonacucina, Serena Logrippo, Feras W Darwish Elhajji, Marco Cespi, Giovanni F Palmieri
Abstract : The immersion cell is an in vitro performance test of drug release from semisolids. Several studies made use of immersion cells to investigate drug release from thermosensitive Poloxamer-based gels; however, specifications on the parameter setting are not yet available. Therefore, the aim of this study was to evaluate the influence of testing parameters on tramadol (a model drug) release, release rate, and dissolution efficiency (DE) from Poloxamer gels, using immersion cells. The thermosensitive gelling formulation showed batch-to-batch uniformity of gelling behavior, drug content, and drug release. The use of a membrane in the immersion cell resulted in slower drug release as compared to the absence of a membrane. Moreover, the faster the paddle rotation, the faster the drug release was. Membrane thickness showed a strong and significant linear relationship with corresponding DE values (Pearson’s correlation coefficient, r = −0.9470; p = 0.004). Factors that did not influence drug release include paddle position, i.e., distance between paddle and membrane, as well as membrane mean pore size. This study sets forth the importance of carefully controlling the following parameters including presence/absence of membrane, paddle rotation speed, and membrane thickness during the setup of release experiments from gels using immersion cells.
Keywords : drug release; IVRT; Poloxamer 407; thermogels; USP 2 dissolution apparatus
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Chlorpheniramine and escitalopram: Similar antidepressant and nitric oxide lowering roles in a mouse model of anxiety
Authors : Omar Gammoh, Fadia Mayyas, Feras Darwish Elhajji
Abstract : There is a crosstalk between mood disorders and oxidative stress. Chlorpheniramine (CPA), a first generation antihistamine, is hypothesized to have an anxiolytic role at high doses; however, its antidepressant and antioxidant roles have not previously been investigated. The aim of the current study was to evaluate the antidepressant and anxiolytic effects of CPA treatment in association with nitric oxide (NO) and super oxide dismutase (SOD) activity in a mouse model of anxiety. BALB/c mice were divided into unstressed (naïve), control, and CPA (0.5 mg/kg) and escitalopram (ESC; 10 mg/kg) treated groups for 3 weeks. Subsequently, they were immobilized for 6 h and subjected to behavioural paradigms as follows: The open field test, the elevated plus maze (EPM) and the forced swim test to investigate motor function, anxiety and depression, respectively. The mice were sacrificed and serum was obtained to detect NO and SOD activity. Compared with the control group, the CPA treated group demonstrated an antidepressant effect similar to that of the ESC treated group. In addition, CPA prevented stress induced NO without affecting SOD activity. CPA did not improve anxiety-like behaviour in the EPM, nor did it improve stress induced locomotion and rearing, as demonstrated by the OFT. Thus, to the best of our knowledge, this is the first study to evaluate the antidepressant role of CPA in association with NO metabolism. However, further studies are required to elucidate the underlying mechanism.
Keywords : chlorpheniramine, antidepressant, nitric oxide
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Prediction of drug-related problems in diabetic outpatients in a number of hospitals, using a modeling approach
Authors : Ghaith M Al-Taani, Sayer I Al-Azzam, Karem H Alzoubi, Feras W Darwish Elhajji, Michael G Scott, Hamzah Alfahel, Mamoon A Aldeyab
Abstract : Objective: Drug-related problems (DRPs) are considered a serious, expensive, and important undesirable complication of health care. However, as current health care resources are limited, pharmacist DRP services cannot be provided to all patients. Using a modeling approach, we aimed to identify risk factors for DRPs so that patients for DRP-reduction services can be better identified. Methods: Patients with diabetes from outpatient clinics from five key university-affiliated and public hospitals in Jordan were assessed for DRPs (drug without an indication, untreated indication, and drug efficacy problems). Potential risk factors for DRPs were assessed. A logistic regression model was used to identify risk factors using a randomly selected, independent, nonoverlapping development (75%) subsample from full dataset. The remaining validation subsample (25%) was reserved to assess the discriminative ability of the model. Results: A total of 1,494 patients were recruited. Of them, 81.2% had at least one DRP. Using the development subsample (n=1,085), independent risk factors for DRPs identified were male gender, number of medications, prescribed gastrointestinal medication, and nonadherence to self-care and non-pharmacological recommendations. Validation results (n=403) showed an area under the receiver operating characteristic curve of 0.679 (95% confidence interval=0.629–0.720); the model sensitivity and specificity values were 65.4% and 63.0%, respectively. Conclusion: Within the outpatient setting, the results of this study predicted DRPs with acceptable accuracy and validity. Such an approach will help in identifying patients needing pharmacist DRP services, which is an important first step in appropriate intervention to address DRPs.
Keywords : medication-related problems, drug-related problems, pharmaceutical care, outpatient, diabetes
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