A ten-year surveillance of P aeruginosa bloodstream infections in a tertiary care hospital: Trends and risk factors for mortality.

BACKGROUND: Pseudomonas aeruginosa (P aeruginosa) is a leading cause of nosocomial bloodstream infections worldwide. This study aimed to evaluate the incidence of P aeruginosa bloodstream infections and to identify predictors of 30-day mortality. METHODS: A retrospective study was conducted in an academic tertiary hospital in Jordan. The medical records of patients hospitalised over ten years (1 January 2008-31 December 2017) were reviewed to identify patients' positive blood culture of P aeruginosa. Annual incidence, antimicrobial susceptibility patterns and risk factors for 30-day mortality were analysed. RESULTS: A total of 169 cases of P aeruginosa bloodstream infection were identified, with an overall incidence rate of 0.23 case/1000 admission. The overall crude 30-day mortality was 36.7%. Receipt of corticosteroids (OR = 4.5; P = .0017), severe sepsis and septic shock (OR = 2.7; P = .0476), admission to intensive care unit (OR = 5.9; P = .0004), end-stage renal disease (OR = 4.1; P = .0123), inappropriate empirical therapy (OR = 3.2; P = .0143) and inappropriate definitive therapy (OR = 2.9; P = .0110) were identified as independent risk factors for mortality. CONCLUSION: The annual incidence of P aeruginosa BSIs was fluctuating over ten years period. Several predictors for 30-day mortality in patients with P aeruginosa BSIs were identified, including inappropriate empirical and definitive therapy.

Evaluation of physician's knowledge in Jordan about the ACC/AHA blood cholesterol guidelines.

BACKGROUND: Elevated levels of blood lipids are considered a major modifiable risk factor for the development of cardiovascular diseases. The optimal management of dyslipidaemia remains inadequate worldwide. Accordingly, there is an increasing need to evaluate the basis that health care providers are using to control dyslipidaemia. AIM: To evaluate the awareness of Jordanian physicians about the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for dyslipidaemia management. METHOD: A written questionnaire was distributed to 250 physicians from different areas of Jordan during 7 months period (from February 2018 until the end of August 2018). The target population is composed of the following categories: juniors, residents, fellows and consultants who were recruited from private, government and military practice settings. The validated developed questionnaire was distributed by trained medical personnel. RESULTS: A total of 207 physicians filled and handed back the questionnaire. The response rate was 82.8%. Generally, there was a difference in the level of knowledge between physicians (juniors/ residents/ consultants) while there was no difference between genders or practice settings (private or government). The current study showed that the awareness of physicians in different areas of Jordan regarding the 2013 (ACC/AHA) dyslipidaemia guidelines is suboptimal. CONCLUSION: Results indicated low levels of knowledge of 2013 ACC/AHA guidelines for the management of dyslipidaemia among physicians in Jordan. Hence, multiple interventions are needed to be implemented in order to increase the level of awareness among Jordanian physicians.

Health-related quality of life and its associated factors among patients with angina in Jordan.

BACKGROUND: Despite the negative impact of angina and its worsening symptoms on the quality of life of the affected patients, little research has evaluated the factors associated with poor health-related quality of life (HRQOL) among patients with angina. OBJECTIVE: The study aim was to evaluate HRQOL and to explore factors associated with poor HRQOL in patients with angina in Jordan. SETTING: The present study used data collected for patients attending the cardiology clinic at the Royal Medical Services (RMS) Hospital in Amman. METHODS: In addition to collecting sociodemographic and clinical data, the EQ-5D questionnaire was used to assess HRQOL in outpatients with angina in the present study. Multiple linear regression analysis was conducted to build a model with variables that are significantly and independently associated with poor HRQOL. MAIN OUTCOME MEASURE: HRQOL quantified using the EQ-5D. RESULTS: The mean of the total EQ-5D score of the 500 participants was 0.392. Most of the patients reported 'some problems' through the five dimensions, with the highest percentage (66.6%) related to mobility domain. Regression analysis identified female gender (B = - 0.232; P < 0.05) elevated fasting blood sugar (FBS) (P < 0.05; B = - 0.219), and low high density lipoprotein (HDL) (B = - 0.183; P < 0.05) as being significantly associated with poor HRQOL. CONCLUSIONS: The HRQOL has considerable scope for improvement for patients with angina in Jordan. Female gender, elevated FBS, and decreased HDL levels were significantly associated with poor HRQoL in the present study.

Awareness of Jordanian Investigators About the Importance of Ethics Review Committees: A Pilot Study.

Protection of study participants is an integral function of the Institutional Review Board (IRB). Recently, great efforts were dedicated to enhance investigators' awareness of ethical principles in conducting human research and to implement reviewing committees' standards in Jordan to ensure the transparency, versatility, and responsibility in handling human subjects research in the country. The aim of the current study is to evaluate the awareness and attitudes of healthcare investigators in Jordan towards the structure and importance of IRBs. A questionnaire was distributed to 200 investigators and graduate students from the Jordan University of Science and Technology. The majority of the responses indicated positive knowledge towards core ethics guidelines and the importance of IRBs. This includes beneficence, confidentiality, informed consent, and treating participants with respect. In addition, the majority of participants (> 82%) agreed on the importance of the IRB for ensuring the rights, safety, and well-being of the research subjects. Moreover, the majority of participants (> 80%) agreed that the IRB members should be trained on ethics regulations in conducting research and declare any conflict of interest with the investigators. On the other hand, about 30% of participants believed that being reviewed by the IRB would delay research and make it more difficult for the researcher. Jordanian investigators have good awareness of and knowledge about research ethics and the importance of IRBs, though more education is needed.

Waterpipe tobacco smoke distresses cardiovascular biomarkers in mice: alterations in protein expression of metalloproteinases, endothelin and myeloperoxidase.

Introduction: Tobacco use is a major risk factor of cardiovascular diseases (CVD) and atherosclerosis in particular. The use of waterpipe smoking (WPS) is increasing due to the misperception that it is less harmful than cigarette smoking due to its flavor and the use of water as a filter. Thus, research that investigates toxic effects of WPS is essential. The aim of this study was to investigate the effect of WPS on major cardiovascular biomarkers that may develop atherosclerosis in mice. Methods: BALB/c mice were exposed to WPS for either two weeks (acute exposure) or eight weeks (chronic exposure). Then, the heart tissue homogenates were analyzed to elucidate the effects of WPS on matrix metalloproteinase (MMPs: isoforms 1, 3, and 9), metallopeptidase inhibitor (TIMP1), endothelin-1 (ET-1) and myeloperoxidase (MPO) using ELISA technique. Results: Current data showed that acute exposure to WPS significantly enhanced the levels of MMP-3, MMP-9, and MPO (p < 0.05) compared to their corresponding control. However, the body was capable to restore the increased levels of these parameters following chronic exposure to WPS for 8 weeks (p > 0.05). Additionally, the levels of ET-1 were significantly higher upon chronic exposure to WPS compared to both control and acute exposure groups (p < 0.05). Conclusions: Waterpipe exposure has a significant negative effect on the cardiovascular system. The enhancement of the atherosclerotic biomarkers (MMP-3, MMP-9, MPO, and ET-1) might represent an early scavenger of compensatory efforts to maintain cardiovascular function after WPS exposure.

Levosimendan enhances memory through antioxidant effect in rat model: behavioral and molecular study.

Impairment of learning and memory has been associated with accumulation of reactive oxygen species in the body. It has also been found that antioxidants enhance learning and memory. Levosimendan is a cardiac inotropic and vasodilator agent that has pleotropic effects including antioxidant, anti-inflammatory, and smooth muscle vasodilatory actions. In this study, we investigated the effect of levosimendan on learning and memory in rats. Levosimendan (12 µg/kg, intraperitoneally) or vehicle was administered once a week for 8 weeks. The radial arm water maze was used to assess spatial learning and memory. In addition, hippocampus levels of antioxidant biomarkers/enzyme - reduced glutathione (GSH), oxidized glutathione (GSSG), GSH/GSSG ratio, glutathione peroxidase, superoxide dismutase, catalase, and thiobarbituric acid reactive substance - were assessed. Levosimendan significantly enhanced short-term (30 min) and long-term (5 h) memory. Levosimendan also significantly increased levels of glutathione peroxidase and GSH and decreased thiobarbituric acid reactive substance. There were no significant effects on the level of other oxidative stress biomarkers. In conclusion, levosimendan enhanced short-term and long-term memory by potentiating antioxidant defense mechanism in the hippocampus.

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

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.

Hawthorn Herb Increases the Risk of Bleeding after Cardiac Surgery: An Evidence-Based Approach.

OBJECTIVES: Hawthorn extract consumption is becoming more widespread among the Jordanian population with cardiovascular disorders. We conducted this prospective observational longitudinal study to determine the impact of hawthorn extract on bleeding risk in patients who undergo cardiac surgery. METHODS: A prospective observational study was performed on 116 patients who underwent cardiac surgery in the period between June 2014 and May 2015. Patients were divided into two groups: Group I (patients recently consumed hawthorn extract) and Group II (patients never consumed hawthorn extract). Endpoint measures included the rates of reopening to control bleeding, early mortality, duration of intensive care unit stay, total in-hospital stay period, and duration and amount of chest tube drainage. RESULTS: Hawthorn patients had a significantly higher rate of postoperative bleeding necessitating take back to the operating room compared to the control group (10% versus 1%; P = .03) respectively. The overall mortality rate for group I and II was 4% and 0% respectively; P = .17. Chest tubes were kept in for longer times in group I compared to group II (54 ± 14.6 versus 49 ± 14.7 hours respectively; P = .01). Group I stayed longer in the intensive care unit compared to group II (24 versus 22 hours respectively; P = .01). The total in-hospital stay period was comparable between the two groups. CONCLUSION: Hawthorn extract consumption does increase the potential for bleeding and the amount of chest tube output after cardiac surgery.

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.

Sildenafil prevents chronic psychosocial stress-induced working memory impairment: Role of brain-derived neurotrophic factor.

Background: Psychosocial stress, a common feature in modern societies, impairs cognitive functions. It is suggested that stress hormones and elevated excitatory amino acids during stress are responsible for stress-induced cognitive deficits. Reduced brain-derived neurotrophic factor (BDNF) levels, increased oxidative stress, and alteration of synaptic plasticity biomarkers are also possible contributors to the negative impact of stress on learning and memory. Sildenafil citrate is a selective phosphodiesterase type 5 (PDE5) inhibitor and the first oral therapy for the treatment of erectile dysfunction. It has been shown that sildenafil improves learning and memory and possesses antioxidant properties. We hypothesized that administering sildenafil to stressed rats prevents the cognitive deficit induced by chronic psychosocial stress. Methods: Psychosocial stress was generated using the intruder model. Sildenafil 3 mg/kg/day was administered intraperitoneally to animals. Behavioral studies were conducted to test spatial learning and memory using the radial arm water maze. Then, the hippocampal BDNF level and several antioxidant markers were assessed. Results: This study revealed that chronic psychosocial stress impaired short-term but not long-term memory. The administration of sildenafil prevented this short-term memory impairment. Chronic psychosocial stress markedly reduced the level of hippocampal BDNF (P˂0.05), and this reduction in BDNF was normalized by sildenafil treatment. In addition, neither chronic psychosocial stress nor sildenafil significantly altered the activity of measured oxidative parameters (P > 0.05). Conclusion: Chronic psychosocial stress induces short-term memory impairment. The administration of sildenafil citrate prevented this impairment, possibly by normalizing the level of BDNF.

The protective effect of rivaroxaban with or without aspirin on inflammation, oxidative stress, and platelet reactivity in isoproterenol-induced cardiac injury in rats.

Coronary artery diseases are principal sources of mortality and disability in global human population. Progressively, rivaroxaban is being evaluated for the prevention of atherosclerotic thrombi, particularly with anti-platelet agents. Hence, the current report aimed to investigate the cardioprotective effect of rivaroxaban on isoproterenol (ISO)-induced cardiac injury model in rats and the possible synergistic effect when combined with aspirin. Male Wistar rats were randomly assigned into five different groups. Cardiac injury was induced by subcutaneous injection of ISO (85 mg/kg) for 2 consecutive days. Rat tail bleeding time was performed prior to sacrifice. Cardiac enzymes, platelet activity, inflammatory, and oxidative stress biomarkers levels were measured using enzyme-linked immunoassay (ELISA). Pre-administration of rivaroxaban alone and on combination with aspirin prevented ISO-induced increase in cardiac thiobarbituric acid reactive substances (TBARS), interleukin 6 (IL-6), and thromboxane B2 (TXB2) levels. Moreover, a significant prolongation of bleeding time was demonstrated among aspirin, rivaroxaban, and aspirin plus rivaroxaban treated groups. On the other hand, the combination treatment of aspirin plus rivaroxaban showed no marked difference in these biomarkers and bleeding time relative to either drug administered separately. However, a prominent decrease of cardiac 6-keto prostaglandin F1α (6-Keto-PGF1α) level was displayed in the combination treatment when compared with ISO and rivaroxaban-treated groups, whereas no significant improvement was seen in cardiac glycoprotein V (GPV) levels except in aspirin-treated group. The study results demonstrated that rivaroxaban decreases cardiac oxidative stress, inflammation, and platelets reactivity. However, the addition of rivaroxaban to aspirin did not seem to show synergistic antioxidant, anti-inflammatory, or antiplatelet effect.

The Effects of Acute and Chronic Sleep Deprivation on the Immune Profile in the Rat.

BACKGROUND: Acute and chronic sleep deprivation present many health-related problems in modern societies, mainly concerning the immune system. Immune factors, particularly the interleukins, regulate sleep and, therefore, may be altered by sleep deprivation (SD). OBJECTIVES: We aimed to investigate the possible effects of acute and chronic sleep deprivation on selected cytokines, including interleukins (IL-1ß, IL-9, IL-17, and IL-23) and tumor necrosis factor- alpha (TNF-α). METHODS: The animals were grouped into acute sleep-deprived (SD; for 24 hours) and chronic sleep-deprived (8 hours a day for 10, 20, and 30-days). The SD was induced using the multipleplatforms model. The serum levels of cytokines were measured using commercially available ELISA. RESULTS: The serum levels of IL-1ß were significantly reduced after acute SD, whereas they were increased after 20-days of chronic SD. The IL-9 levels were reduced after acute SD, increased after 10-days of SD, and reduced again after 30-days of SD. Conversely, the levels of IL-23 were not changed after acute SD, reduced after 10 days of SD, and increased after 30-days of SD. Levels of TNF-α were not changed after acute SD, whereas they were increased after 20 and 30- days of SD. CONCLUSION: In conclusion, both acute and chronic SD distinctly disturb the immune profile, which might result in the emergence of various pathologies presented during sleep deprivation.

Knowledge, awareness, and attitude among pharmacists regarding the risk estimation of cardiovascular disease in Jordan: Immersion of lipid-lowering agents.

The Risk Estimation of Cardiovascular Disease (CVD) is an important factor for predicting the incidence of cardiovascular events in a given population. This study aimed to assess the knowledge, awareness, and attitude of pharmacists in Jordan regarding the risk estimation of CVD and the use of lipid-lowering agents. The study is particularly interested in investigating the extent to which pharmacists are immersed in this area of practice, which can significantly impact patient health outcomes. The study employed a cross-sectional design, with a sample of pharmacists drawn from various regions in Jordan. Data were collected through a self-administered questionnaire, which was designed to explore pharmacists' knowledge of CVD risk estimation tools and their awareness of lipid-lowering agents' efficacy and side effects. The questionnaire also assessed pharmacists' attitudes towards the use of these agents in practice and their perceptions of the barriers to implementing CVD risk estimation tools. The study's findings shed light on the suboptimal levels of overall knowledge score of pharmacists in Jordan regarding CVD risk estimation and lipid-lowering agents' use. The results provided insights into the gaps that exist in pharmacists' knowledge and practice and help to identify areas for improvement. Ultimately, the present findings inform strategies to enhance pharmacists' engagement in CVD risk estimation and improve patient outcomes in Jordan and highlight the urgent need for ongoing education and training for pharmacists to improve their knowledge and skills in managing patients with dyslipidemia.

The Protective Role of L-carnitine on Psychosocial Stress-induced Changes in Gene Expression and Protein Levels of Matrix Metalloproteinases, Serum Corticosterone in a Rat Model.

BACKGROUND: Psychosocial stress (STS) is a common stress in modern societies. Chronic STS is associated with the impairment of a broad range of cognitive functions in humans and with prolonged abnormalities in memory. Matrix metalloproteinases (MMPs), a protein family of zinccontaining endopeptidases, are essential in neuro-inflammation and involved in neurodegenerative diseases. L-Car possessed neuroprotective, antioxidant, and anti-inflammatory properties and was shown to modulate MMPs. OBJECTIVE: The current study aimed to examine the protective effect of L-Carnitine (L-CAR) on STSinduced changes in serum corticosterone levels, MMP-2, -9, and -12 protein and mRNA expression in the hippocampus as a possible mechanism for L-CAR protective effect on STS-induced memory impairment. METHODS: The chronic STS and L-CAR (300 mg/kg/day, i.p) were simultaneously administered for 6 weeks to adult male Wistar rats. Serum corticosterone and protein levels of MMP-2, -9 and -12 were evaluated using ELISA. Real-Time PCR techniques were used to determine the mRNA levels of MMP-2, -9 and -12 in the hippocampus. RESULTS: The findings showed that serum corticosterone levels and MMP-2 and -9 protein levels were significantly increased (p<0.05) in the STS group compared to the control. Similarly, RT-PCR findings showed that the mRNA of those proteinases significantly increased (p<0.05) following the intruder method. On the other hand, the administration of L-CAR restored the alterations in corticosterone levels and MMPs gene and protein expression induced by chronic STS. CONCLUSION: STS induced elevations in corticosterone and MMP-2 and -9 levels in the hippocampus. L-CAR, on the other hand, exhibited protective effects against the STS-induced changes in MMP-2 and -9.

An update of polycystic ovary syndrome: causes and therapeutics options.

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by menstrual irregularities, chronic anovulation, hirsutism, androgenic alopecia, and acne. At diagnosis, patients can with different manifestations according to the disease phenotype, patient's age, and lifestyle. However, most patients pursue medical care because of the clinical symptoms of PCOS, such as hyperandrogenism, menstrual irregularities and infertility. Recent studies have shown that PCOS is associated with 80% of anovulatory infertility; however, the precise mechanism of PCOS-induced anovulation is still undetermined. The treatment strategies of PCOS are symptomatic depending mainly on the desired goals and clinical benefits. Life style intervention is still the first line treatment option for overweight females seeking pregnancy. In addition, there are many pharmacological agents that could be added to induce ovulation such as metformin, and clomiphene citrate. Nowadays, many patients preferred to use some herbal medicine that was proved to have potential therapeutic benefits in many studies in the management of PCOS. The purpose of this review was to discuss PCOS-induced infertility and the available therapeutic options as well as the impact of COVID-19 infection on the success of fertility attempts. To address this purpose, Pubmed, Scopus, EMBASE and Google databases were searched for studies discussing PCOS-induced infertility. The literature search revealed the proper therapeutic plans to treat PCOS-induced infertility, and that treatment should be modified according to patient's complaints, reproductive desires, and disease phenotypes. In conclusion, the use of specific therapeutic agents and patients' adherence to lifestyle interventions could help patients recover their reproductive and metabolic health.

Antimicrobial use and mortality among intensive care unit patients with bloodstream infections: implications for stewardship programs.

Background: Bloodstream infections (BSIs) are one of the most critical illnesses requiring intensive care unit (ICU) admission. Antimicrobial therapy (AMT) is one of the vital management strategies for the treatment of BSIs; it should be chosen appropriately to reduce mortality. Objectives: This is the first study to investigate the types of antimicrobial agents administered in the ICU setting and the predictor variables associated with mortality. Methods: This retrospective study was conducted at King Abdullah University Hospital (KAUH). All hospitalized patients admitted to the ICU and received at least one antimicrobial agent over 3 years period (January 1, 2017, to December 31, 2019) were included in the study. Electronic patients' medical records were used to collect patients' demographic and clinical characteristics, patient general health status, events that occurred during hospitalization, and events after obtaining the blood culture. Descriptive analysis was done to identify the types of antimicrobials used and the distribution of the microorganisms among the study participants. The susceptibility test of the bloodstream culture was checked for each patient. Moreover, crude mortality and its associated factors were investigated. Results: A total of 1051 patients were enrolled in the study, where 650 patients (61.84%) were treated with three or more antimicrobial agents. The most frequent antimicrobials used were piperacillin/tazobactam followed by teicoplanin, meropenem, and levofloxacin. About half of the patients died within 30-days of BSI, which was associated with several factors including advanced age, presence of co-morbidities, nosocomial infections or healthcare-associated infections, length of ICU stay, respiratory tract infections, receiving vasopressor during the hospital stay, concurrent positive culture other than blood with BSI, receiving combination antimicrobial therapy, those who were complicated with septic shock or renal failure, receiving total parenteral protein (TPN) nutrition, and inappropriate empiric antimicrobial therapy. Conclusion: In conclusion, the administration of the antimicrobials among ICU patients was highly based on a combination of three or more agents covering a broad spectrum of microorganisms. The mortality rate was high among patients which were associated with inappropriate empirical therapy. Therefore, the antimicrobial stewardship (ASP) protocol has to be evaluated in the hospital for ICU patients. Moreover, we suggest recommending that hospital policies should apply the ASP protocol, infection control, implement the antimicrobial de-escalation protocol, and do best controlling on the co-morbid conditions, especially for ages 65 years or more to reduce the mortality rate in the ICU.

Surveillance study of bloodstream infections, antimicrobial use, and resistance patterns among intensive care unit patients: A retrospective cross-sectional study.

Background: Bloodstream infections (BSIs) are one of the most critical illnesses requiring intensive care unit (ICU) admission. This study assessed patterns of antimicrobial use and resistance in ICU patients with BSIs. Methods: Inpatients admitted to the ICU and who received at least one antimicrobial agent between January 1, 2017, and December 31, 2019, were included in the study. Electronic patients' medical records were used to collect patients' demographic, clinical, and microbiological data. Results: A total of 1051 patients were enrolled in the study, where 650 patients (61.84%) were treated with three or more antimicrobial agents. The most frequently used antimicrobials were piperacillin/tazobactam followed by teicoplanin, meropenem, and levofloxacin. The most predominant multidrug-resistant pathogens were Acinetobacter baumannii, followed by Escherichia coli, Methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumonia, and Pseudomonas aeruginosa. Conclusions: The administration of the antimicrobials among ICU patients was highly based on a combination of three or more broad-spectrum agents. MDR pathogens were found to be highly prevalent among ICU patients with BSI. Therefore, we suggest recommending that hospital policies should apply the antimicrobial stewardship protocols, infection control, and implement antimicrobial de-escalation protocol to reduce the harm pressure of antimicrobial resistance.

Evaluating the effect of selenium on spatial memory impairment induced by sleep deprivation.

Sleep deprivation (SD) impairs memory due to disturbing oxidative stress parameters. Selenium is a main component of several antioxidant enzymes and provides a neuroprotective effect. The present study aimed to investigate the potential neuroprotective effect of chronic selenium administration on cognitive impairments induced by chronic SD. Adult male Wister rats were randomly assigned into five groups (n = 12/group). The SD was induced in rats using modified multiple platform model. Selenium (6 µg/kg of animal's body weight) was administered to rats via oral gavage for 6 weeks. The spatial learning and memory were assessed using the radial arm water maze (RAWM). Moreover, we measured the levels of reduced glutathione (GSH), oxidized glutathione (GSSG) and GSH/GSSG, catalase, glutathione peroxidase (GPx), superoxide dismutase (SOD), thiobarbituric acid reactive substances (TBARS) and brain derived neurotrophic factor (BDNF) in the hippocampus. The results indicate that short- and long-term memory were impaired by chronic sleep deprivation (P < 0.05), while selenium administration prevented this effect. Moreover, selenium normalized antioxidants activities which were reduced by SD such as: catalase (P < 0.05), and SOD (P < 0.05), and significantly enhanced the ratio of GSH/GSSG in sleep-deprived rats (P < 0.05), without significant alteration of BDNF (P > 0.05), GSH (P > 0.05), or TBARS levels (P > 0.05). In conclusion, chronic SD induced memory impairment, and chronic treatment with selenium prevented this impairment by normalizing antioxidant enzymes activities in the hippocampus.

Medication errors in Jordan: A systematic review.

Medication errors (MEs) present a significant issue in health care area, as they pose a threat to patient safety and could occur at any stage of the medication use process. The objective of this systematic review was to review studies reporting the rates, prevalence, and/or incidence of various MEs in different health care clinical settings in Jordan. We searched PubMed, HINARI, Google, and SCOPUS for relevant published studies. We included observational, cross-sectional or cohort studies on MEs targeting adults in different health-care settings in Jordan. A total of 411 records were identified through searching different databases. Following the removal of duplicates, screening of title, abstract and full-text screening, 24 papers were included for the final review step. Prescribing errors was the most common error reported in the included studies, where it was reported in 15 studies. The prevalence of prescribing errors ranged from 0.1% to 96%. Two studies reported unintentional discrepancies and documentation errors as other types of MEs, where the prevalence of unintentional discrepancies ranged from 47% to 67.9%, and the prevalence of documentation errors ranged from 33.7% to 65%. In conclusion, a wide variation was found between the reviewed studies in the error prevalence rates. This variation may be due to the variation in the clinical settings, targeted populations, methodologies employed. There is an imperative need for addressing the issue of MEs and improving drug therapy practice among health-care professionals by introducing education and training.

Assessing the Influence of Salvia triloba on Memory Deficit Caused by Sleep Deprivation in the Context of Oxidative Stress.

BACKGROUND: Learning and memory deficit has been reported to be correlated to oxidative mutilation in the hippocampus. Moreover, sleep deprivation (SD) mitigates memory via distressing oxidative stress balance. In the current report, the prospective neuroprotective role of oral sage (Salvia triloba) extract on cognitive impairment induced by chronic SD was investigated. METHODS: The SD was induced in adult male Wistar rats employing a modified multiple platform (8 h/day; for six weeks). Simultaneously, S. triloba extract (375 mg/kg, orally) was administered for six weeks. Thereafter, the Radial Arm Water Maze test was utilized to evaluate spatial learning and memory. Moreover, activities of different hippocampal antioxidant parameters: glutathione peroxidase (GPx), oxidized glutathione (GSSG), reduced glutathione (GSH), catalase, superoxide dismutase (SOD), and the thiobarbituric acid reactive substance (TBARS) were measured in rats' hippocampus. Moreover, the level of brain derived neurotrophic factor (BDNF) was assessed. RESULTS: Current results illustrate that chronic SD significantly compromised both memories, shortand long-term, while sage extract inhibited these consequences. Moreover, sage extract remarkably stabilized the antioxidant enzyme levels, which were decreased by SD, such as: SOD, catalase, and GPx (P < 0.05), and remarkably augmented the GSH/GSSG ratio in SD rats (P < 0.05). However, no substantial alterations of GSH, TBARS or BDNF levels (P > 0.05) were seen with sage extract administration. CONCLUSION: Chronic treatment with sage extract (S. Triloba) precluded SD-induced memory impairment by regularizing antioxidant parameters levels in rats' hippocampus.