Alpha Calcitonin Gene-related Peptide, Neuropeptide Y, and Substance P as Biomarkers for Diagnosis and Disease Activity and Severity in Multiple Sclerosis.

BACKGROUND: Alpha calcitonin gene-related peptide (aCGRP), neuropeptide Y (NPY), and substance P (SP) are neuropeptides that have emerged recently as potent immunomodulatory factors with potential as novel biomarkers and therapeutic targets in multiple sclerosis (MS). OBJECTIVE: The study aimed to detect serum levels of aCGRP, NPY, and SP in MS patients versus healthy controls and their association with disease activity and severity. METHODS: Serum levels were measured in MS patients and age and sex-matched healthy controls using ELISA. RESULTS: We included 67 MS patients: 61 relapsing-remitting MS (RR-MS) and 6 progressive MS (PR-MS), and 67 healthy controls. Serum NPY level was found to be lower in MS patients than in healthy controls (p < 0.001). Serum aCGRP level was higher in PR-MS compared to RR-MS (p = 0.007) and healthy controls (p = 0.001), and it positively correlated with EDSS (r = 0.270, p = 0.028). Serum NPY level was significantly higher in RR-MS and PR-MS than in healthy controls (p < 0.001 and p = 0.001, respectively), and it was lower in patients with mild or moderate/severe disease than in healthy controls (p < 0.001). Significant inverse correlations were found between SP level and MS disease duration (r = -0.279, p = 0.022) and duration of current DMT (r = -0.315, p = 0.042). CONCLUSION: Lower serum levels of NPY were revealed in MS patients compared to healthy controls. Since serum levels of aCGRP are significantly associated with disease activity and severity, it is a potential disease progression marker.

Clinical utility of prior positive cultures to optimize empiric antibiotic therapy selection: A cross-sectional analysis.

Background: Despite reduced infectious disease mortality and improved survival, infectious diseases continue to pose health threats due to their contagiousness, societal harm, and morbidity. Empiric antibiotic therapy, often prescribed without knowledge of the causative pathogen, faces challenges from rising antibiotic resistance. This study explores the potential of prior positive culture results to guide empiric antibiotic therapy. Methods: Data from King Abdullah University Hospital (Jan 2014-Dec 2019) included adult patients with recurrent bacterial infections (pneumonia, sepsis, UTIs, wounds). Excluded cases included: mixed infections, transfers, <14 days or >12 months between episodes. The study compared bacterial growth and sensitivity patterns between previous and recent cultures. Results: The study included 970 episodes from 650 patients, mainly UTIs (60.3%) and gram-negative bacteria (77.9%). The study found that (65.1%) of culture pairs matched. Empirical therapy was accurate in (71.8%) of cases. Further, accuracy of selected empiric antibiotic therapy was significantly predicted (p â€‹< â€‹0.001) by: type of infection, type of antibiotics, and concordance with prior microbiologic data. Multivariate logistic analysis showed blood culture as less predictive of pending identity (OR: 0.234, P â€‹< â€‹0.001) compared to urine culture; and prior affirmed gram negative bacterial culture was less predictive (OR: 0.606, P â€‹= â€‹0.021) compared to gram positive bacterial culture. Conclusion: This study underscores the potential of prior positive culture results in guiding empiric antibiotic therapy, enhancing accuracy and identity agreement. Future research should explore this approach in different infection contexts and across multiple centers. Reducing the indiscriminate use of broad-spectrum antibiotics is essential to combat antibiotic resistance.

Clinical pharmacist role in improving the knowledge and outcomes in patients using isotretinoin: A randomized, controlled study.

Objective: To evaluate the role of a clinical pharmacist in improving knowledge and outcomes among isotretinoin users. Methods: Patients were randomly assigned to an intervention group (received education about isotretinoin by a clinical pharmacist in addition to the physician) and a control group (received routine education by the physician), then followed for three months. Patients' knowledge about isotretinoin optimal use, and side effects and their management and other outcomes were measured in both groups at baseline and at follow up after three months using a validated questionnaire. Results: Two-hundred and three patients completed the study; 103 were in the intervention group and 100 in the control group. The knowledge improvement between baseline score and follow-up score was greater in the intervention group (mean = 2.835 ± 1.329) compared to the control group (mean = 0.530 ± 0.784) with mean differences = -2.30495, P < 0.001. Conclusion: Implementing clinical pharmacy services in dermatology clinics can positively increase patients' level of knowledge about isotretinoin, which could reduce the severity of its side effects. Therefore, improving patients' quality of life, and improvement in acne. Practice implications: Implementing clinical pharmacist services to patients using isotretinoin is feasible in an outpatient setting. Clinical pharmacist counseling and education improve the medication knowledge among patients who use isotretinoin.

Adherence and utilization of short-term antibiotics: Randomized controlled study.

Enhancing adherence to medication has the potential to improve clinical outcomes and decrease healthcare cost. The role of clinical pharmacist-led education on adherence to short-term antibiotic has never been investigated in Jordan. This study aimed to evaluate the impact of an educational intervention on antibiotic short-term adherence and to assess the antibiotic utilization pattern. A prospective, single blinded, randomized controlled study was conducted in a tertiary referral hospital in Jordan. Adult patients diagnosed with acute infection and prescribed a short-term antibiotic course (< 30 day) were included in the study. Recruited patients were randomly allocated into control and intervention groups. Pharmaceutical education about the correct use of antibiotic/s was provided to the intervention group. The results showed that penicillins were the most prescribed antibiotics (38.7%) followed by fluoroquinolones (23.9%) and cephalosporines (20.9%). Patients in the intervention group were more likely to be adherent to the prescribed antibiotics compared to control group (OR = 1.445, 95CI% = 1.029-2.030, p = 0.033). Employed patients, less frequent administration of antibiotic, and searching information related to the prescribed antibiotics were factors associated with better adherence to short-term antibiotic (p<0.05). The most common reasons for non-adherence were feeling better and forgetfulness to take medication. These findings highlighted that pharmacist-led educational intervention significantly enhance adherence to prescribed short-term antibiotics which is a major drive to control antibiotic resistance. Initiatives should be adopted to include patient education as a regular element in the medication dispensing process. Clinical trial registration: The trial is registered at ClinicalTrials.gov (identifier: NCT05293977).

Perspective of biopharmaceutics knowledge and practice of pharmacy personnel toward the effect of medication route and medical procedure on nullifying fasting.

Background: In Ramadan, most of the dosing schedules for the patients are changed, and to ensure patient compliance to medications and to healthy life among patients, appropriate guidelines and educations are needed. This can be achieved by pharmacy personnel in all clinical settings who are recognized as biopharmaceutical experts and integral educators of medications. Aims: This study aimed to identify the perspective knowledge of pharmacy personnel about effect of medication route and medical procedure on nullifying fasting in Ramadan and to determine the predictors of this knowledge. Methods: A cross-sectional study was conducted in Jordan during March-April 2022. An internet-based self-administrated questionnaire on knowledge, and views was distributed using social media groups to the pharmacy personnel among different geographical areas in Jordan. A descriptive and univariate analysis were performed. Binary logistic regression was conducted to determine the predictors of knowledge including all variables with p < 0.20 on univariate analysis. Results: A total of 1003 responses to the study questionnaire were collected and included in the analysis. The most common source that pharmacy personnel used to get information on medication intake and medical procedures during fasting in Ramadan was Fatwa (57.8%) followed by Islamic materials "books and brochures" (47.1%). The majority of respondents were knowledgeable about the effect of administration route of medication and medical procedures on nullifying fasting in Ramadan (greater than70%). The univariate analysis showed that more than half of respondents (56.1%) were considered knowledgeable, and the binary logistic regression analysis identified that both professional degree type and confidence of respondents to modify the patient's medication schedule as predictors for knowledge (OR = 1.791, 95% CI = 1.035-3.098, p = 0.037), (OR = 1.375, 95% CI = 1.04-1.817, p = 0.025), respectively. Conclusions: Most of pharmacy personnel in Jordan are knowledgeable in biopharmaceutics principles and practice toward effect of medication route and medical procedure on nullifying fasting, and the identified predictors for this knowledge, can provide an opportunity to improve safe and effective use of medications and medical procedures during the holy month of Ramadan.

GRP78 is Overexpressed in Non-small Cell Lung Cancer Tissues and is Associated with High VEGF Expression in Squamous Cell Carcinoma: A Pilot Study.

BACKGROUND: Neovascularization is essential for the growth and progression of tumor tissues. GRP78 is frequently overexpressed in various cancers and has been suggested as a proangiogenic factor. PURPOSE: This study aimed to investigate the expression levels of GRP78 and to test for significant relationships with the angiogenic markers, VEGF, and CD31. METHODS: In this study, paraffin-embedded NSCLC tissue samples (71 adenocarcinomas and 23 squamous cell carcinoma) were retrospectively collected from 94 patients with NSCLC. The expressions of VEGF, CD31, and GRP78 were determined by immunohistochemistry. RESULTS: High expression levels of VEGF and GRP78 were observed in 65 and 74 cases, respectively. Thirty-six patients expressed high CD31 levels. Adenocarcinomas expressed higher levels of the three proteins than squamous cell carcinomas (p-value < 0.05). Moreover, a statistically significant association was found between the expression levels of VEGF and CD31 (p-value = 0.001) and VEGF and GRP78 (p-value=0.028). CONCLUSION: GRP78 overexpression was revealed in most of the investigated samples. The positive association between VEGF and GRP78 may indicate the proangiogenic role of GRP78 in lung cancer. Moreover, the positive association between VEGF and CD31 expression levels suggests that VEGF may cooperate with CD31 to promote angiogenesis in NSCLC.

Students' experiences and attitudes toward a newly developed simulation-based pharmaceutical care clinical rotation: A pre-post study design.

Purpose: This study aims to evaluate Doctor of Pharmacy (PharmD) students' experience with the newly developed simulation-based pharmaceutical care (PC) rotation by evaluating their knowledge and attitudes towards PC before and after the rotation. Methods: A self-administered questionnaire was distributed to sixth year PharmD students enrolled in the clinical training rotation "Comprehensive Pharmaceutical Care" during the 2020/2021 academic semesters at Jordan University of Science and Technology's (JUST) Faculty of Pharmacy. Questionnaires were distributed before and after completing four experiential training weeks and consisted of three sections. The first section collected students' demographic details while the second and third sections evaluated students' knowledge about, and attitudes toward PC, respectively. Descriptive statistics were used to describe and compare changes in students' knowledge and attitudes pre-and post-rotation. Results: A total of 106 valid questionnaires were completed with a response rate of 99.07%. The rates of correct answers increased after the rotation with median total knowledge score increasing from 8 to 10 (out of 13, P value < 0.001). Significant improvements in students' understanding of aspects relating to the concept and process of PC, and the role of clinical pharmacist in PC provision, were shown post the simulation-based clinical rotation. Similarly, their attitudes toward performing PC were either improved or emphasized. In contrast results also revealed that specific aspects of the rotation require further refinement, such as the comprehensiveness of the PC process and responsibilities in providing PC. Conclusions: PharmD students' understanding and attitudes toward PC were either improved or emphasized after the simulation-based PC rotation. This study highlights the value of simulation as a unique instructional technique that can assist educators to develop PC competencies for pharmacy students.

Evaluation of serum VIP and aCGRP during pulmonary exacerbation in cystic fibrosis: A longitudinal pilot study of patients undergoing antibiotic therapy.

BACKGROUND: Objective monitoring of improvement during treatment of pulmonary exacerbation can be difficulty in children when pulmonary function testing cannot be obtained. Thus, the identification of predictive biomarkers to determine the efficacy of drug treatments is of high priority. The major aim of the current study was to investigate the serum levels of vasoactive intestinal peptide (VIP) and alpha calcitonin gene related peptide (aCGRP) of cystic fibrosis pediatric patients during pulmonary exacerbation and post-antibiotic therapy, and possible associations of their levels with different clinicopathological parameters. METHODS: 21 patients with cystic fibrosis were recruited at onset of pulmonary exacerbation. Serum was collected at time of admission, three days post-antibiotic therapy, and two weeks post-antibiotic therapy (end of antibiotic therapy). Serum VIP and aCGRP levels were measured using ELISA. RESULTS: Overall least square means of serum aCGRP level but not VIP changed from time of exacerbation to completion of antibiotic therapy (p = 0.005). Serum VIP was significantly associated with the presence of diabetes mellitus (p = 0.026) and other comorbidities (p = 0.013), and with type of antibiotic therapy (p = 0.019). Serum aCGRP level was significantly associated with type of antibiotic therapy (p = 0.012) and positive Staphylococcus aureus microbiology test (p = 0.046). CONCLUSION: This study could only show significant changes in serum aCGRP levels following treatment of pulmonary exacerbations. Future studies with larger sample size are required to investigate the clinical importance of VIP and aCGRP in cystic fibrosis patients.

Medication adherence to disease-modifying therapies among a cohort of Jordanian patients with relapsing-remitting multiple sclerosis: a multicentre cross-sectional study.

OBJECTIVES: To evaluate medication adherence to oral and parenteral disease-modifying therapies (DMTs) and to explore factors associated with medication non-adherence in patients with multiple sclerosis (MS). METHODS: A cross-sectional multicentre study was conducted among patients with MS. Patients who attended outpatient clinics of neurology departments from three major referral centres were invited to participate in the study. Medication adherence was measured using the Multiple Sclerosis Treatment Adherence Questionnaire. KEY FINDINGS: A total of 319 patients with MS on DMT were included in the final analyses, their average age was 35 years and more than two-thirds (72.1%) of them were women. The adherent group comprised 46.7% of patients. The results of association analyses showed that factors that were associated with adherence level were female gender (P = 0.034), non-smoking/x-smoking (P = 0.007), school education (P = 0.019), unemployment (P = 0.006), history of previous DMT (P = 0.020), longer previous treatment duration (P = 0.008), and type of current DMT (P = 0.020). Among the non-adherent patients, there were significant differences between oral and parenteral DMT users in the importance of barriers to adherence (P < 0.001). Additionally, the degree of treatment satisfaction was higher in oral users than in parenteral users (P < 0.001). CONCLUSIONS: The adherence level was quite low. Gender, smoking status, education, employment status, history of previous DMT, previous treatment duration and type of current DMT were associated with medication non-adherence in our patients with MS. These factors should be considered when evaluating medication adherence, and the modifiable factors may represent potential targets for interventions to improve pharmaceutical care planning in patients with MS.

The influence of adverse drug effects on health-related quality of life in chronic obstructive pulmonary disease patients.

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Concerns have been raised about the influence of adverse drug effects on patient's health-related quality of life (HRQoL) in COPD patients. This study aimed to evaluate the impact of COPD treatment-related adverse effects on HRQoL in COPD patients. METHODS: In a cross-sectional study, COPD patients aged 40 years or older were identified and interviewed during their hospital visits. The EuroQol 5 Dimension 5 Level (EQ-5D-5L) questionnaire was used for evaluating HRQoL. Potential treatment adverse effects were evaluated as experienced by participants during the last 2 weeks preceding the interview. The intensity of adverse effects was reported in the following categories: never, mild, moderate and severe. Multivariable linear regression model was performed to evaluate the influence of adverse drug effects on utility scores as an indicator of HRQoL. KEY FINDINGS: A total of 203 patients diagnosed with COPD were recruited in the current study. The mean utility score of the study sample was 0.68 (SD = 0.36). Moderate-severe constipation, moderate-severe confusion, mild urinary hesitation, moderate-severe urinary hesitation, moderate-severe dry eyes and moderate-severe drowsiness were significant predictors/determinants for the average utility scores (coefficients were -0.099, -0.191, -0.111, -0.157 and -0.144, respectively). In addition, having higher COPD Assessment Test scores and severe disease was negatively associated with average utility scores (coefficients were -0.287 and -0.124, respectively). CONCLUSIONS: Higher intensity of COPD treatment-related adverse effects has a negative influence on HRQoL in COPD patients. Anticholinergic drug effects are of concern in COPD adults' population.

Awareness and Knowledge of Pharmacists toward Biosimilar Medicines: A Survey in Jordan.

Aims: Pharmacists in all clinical settings are recognized drug experts and integral educators of biosimilar medicines. Therefore, the objective of this study was to assess pharmacists' knowledge, predictors of knowledge, and views toward biosimilar medicines in Jordan. Methods: A cross-sectional study was conducted in Jordan during October-December 2020. An Internet-based self-administrated questionnaire on knowledge and views was distributed using social media groups to the pharmacists among different areas in Jordan. A descriptive and univariate analysis was performed. Binary logistic regression was conducted to determine the predictors of knowledge including all variables with p < 0.20 on univariate analysis. Results: A total 536 responses were received, 502 of which were completed (93.7% response rate). A total of 52.6% of the pharmacists were knowledgeable about biosimilar medicines and the mean of knowledge level was 6.47 ± 1.62 (range 2-10). Multivariate analysis identified that respondents who had heard about biosimilars before (OR = 1.942, 95% CI = 1.231-3.063, p < 0.05) was more likely to be knowledgeable. Respondents who had not taken the course or the postgraduating training course about biosimilars that were less likely to be knowledgeable (OR = 0.548, 95% CI = 0.357-0.839, p < 0.05). A positive response was noted in pharmacist's view regarding the implementation of biosimilar medicines in healthcare setting, biosimilar medicine prescription related to decreased costs, self-study about biosimilar medicine, and incorporating biosimilar education program at the pharmacy school curriculum universities level. Conclusions: Pharmacists' views and knowledge vary regarding the particularities and key issues on biosimilar medicines in Jordan. Incorporating biosimilar course in pharmacy school curriculum could improve their acceptance for future pharmacy jobs.

Prevalence and predictors of non-adherence to short-term antibiotics: A population-based survey.

Non-adherence to antibiotics is a well-known, core player to antibiotic resistance. The current adherence behavior toward short-term antibiotic regimens has never been investigated before in Jordan. This study assessed the prevalence and predictors of non-adherence to short-term antibiotics among Jordanians and investigated participants' views about different reasons related to antibiotics non-adherence. A cross-sectional face-to-face survey-based interview was conducted in three hospital pharmacies in Jordan. Adults and mother of children (≤12 years old) who completed their short course treatment (<30 day) of oral antibiotic within the last month were recruited. A total of 2000 participants (adults: 1000 and mothers of children: 1000) were included in the study with a response rate of 91.60%. The prevalence of non-adherence was estimated to be 32.10%. Non-adherent respondents scored a lower Medication Adherence Report Scale [16.76±5.02 vs. 23.04 ±3.24] than adherent respondents (p<0.001). Adults without comorbidity and children with higher number of doses per regimen were significantly less adherent to antibiotic [(OR = 0.615, 95%CI = 0.444-0.853, p = 0.004) and (OR = 0.965, 95%CI = 0.950-0.981, p<0.001)], respectively. Patients-related factors were the most common antibiotic non-adherence reason reported by the participants. The multivariate analysis for all the participants (adults and children), indicated that mothers were 2.6 times more likely to be adherent in giving antibiotics to their children than adults (p<0.001). These findings highlight that more than half of the participants were adherent to short-term antibiotics. However, improving the current prescription-related practices and implementing pharmaceutical consultation services upon antibiotic dispensing are encouraged.

Significance of serum VIP and PACAP in multiple sclerosis: an exploratory case-control study.

BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory neurodegenerative disease of the central nervous system. Vasoactive and intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide (PACAP) are neuropeptides that play roles in anti-inflammation and neuroprotection in MS. In this study, we aimed to determine the serum levels of VIP and PACAP in MS patients versus healthy controls and to correlate them with demographics and clinical characteristics. METHODS: Serum samples were collected from MS patients (n = 145) and healthy controls (n = 73) to measure serum levels VIP and PACAP. RESULTS: VIP serum levels were lower in MS patients than healthy controls (p < 0.001). Serum PACAP levels were the same among the two groups. Gender-based analysis showed that VIP levels were lower in healthy females (1238.840 pg/ml) than healthy males (3300.105 pg/ml; p < 0.001), and PACAP serum levels were significantly lower in male MS patients (48,516.214 fg/ml) than female MS patients (62,466.400 fg/ml; p = 0.029). ROC curve suggested that serum VIP level can discriminate patients with MS from healthy controls. Relapsing-remitting MS, progressive-MS, and clinically isolated syndrome groups were different in age, MS disease duration, EDSS score, and VIP levels (p < 0.05). MS disease type and history of previous relapses in the preceding 24 months predicted serum VIP levels, while gender predicted PACAP levels. CONCLUSION: VIP serum levels are decreased in MS patients and can be used to differentiate between MS patients and healthy controls. Further studies with larger sample sizes are required to investigate VIP as a marker to reflect MS disease progression.

Exception from informed consent for biomedical research in emergency settings: A study from Jordan.

BACKGROUND: Research conduction in emergency settings is of paramount importance to promote knowledge and experiences related to treating acutely ill patients. However, the complexity of situations creates a considerable ethical challenge facing researchers who basically deal with emergent cases. This study aimed to determine attitudes of healthcare providers (HCPs) towards exception from informed consent (EFIC) and enrollment willingness in emergency research in Jordan. METHODS: A quantitative research with face-to-face questionnaire was conducted by an interviewer during 6-month period in 2019. Survey measures included items related to EFIC policy and overall willingness of HCPs to participate or support their family members' participation in emergency research. RESULTS: A total of 151 HCPs in the emergency departments (EDs) in Jordan was recruited. Positive attitude toward emergency research dominated among participants; about 21.9% of participants reported previous experience in the conduction of emergency research and 12.3% had related publications. Regarding EFIC policy, there was a general consensus of disagreement to most of the examined items. There was a trend for little support of EFIC policy when questioned about the enrollment of family members or public in emergency research, however, the application of EFIC was accepted for self-enrollment of respondents in emergency research. No significant differences (P = 0.37), among participants from different disciplines, were reported regarding the attitudes towards EFIC items or willingness to enroll in emergency research. CONCLUSIONS: Generally, HCPs reported an overall positive support to emergency research despite a consensus of disagreement related to EFIC terms. Therefore, it is recommended to pursue future studies to compare well-informed subjects; recruited from well-developed institutions in regard to emergency research potentials; with the present basic attitudinal surveillance in order to dissipate the effect of such confounder and to get better insight of the actual attitudes related to emergency research and EFIC. In addition, efficient multidisciplinary communication channels between researchers and policy makers can lather the way to collaborative research with simultaneous innovative delivery of quality emergency care.

E-cigarettes use among university students in Jordan: Perception and related knowledge.

The use of e-cigarettes has been increasing in popularity among people, especially young adults. Assessing young individuals' perceptions of e-cigarettes can help to identify factors that may influence their decision to use e-cigarettes. To examine prevalence, perceptions, and knowledge of e-cigarettes among university students in Jordan, an observational cross-sectional study using an online self-administered questionnaire was conducted among students from public and private universities between October 2020 and January 2021. A total of 1259 university students completed the questionnaire. Approximately, 11% of participants reported e-cigarettes use. Among users, 26.5% used it for the purpose of smoking cessation, while 22% of them used it out of curiosity, and 20.5% used it as they believed it is less harmful than other tobacco products. Multivariate analysis showed that conventional cigarette smokers were independently associated with a better knowledge about e-cigarettes (OR = 1.496, 95CI% = 1.018-2.197, p-value = 0.040). In addition, medical students showed a significantly better knowledge compared to non-medical students (OR = 1.710, 95CI% = 1.326-2.204, p-value = <0.001). In Jordan, e-cigarettes use is less popular compared to other countries. Nonetheless, educational interventions are needed to correct misconceptions about e-cigarettes among young adults.

Knowledge and Practice of Breast Cancer Screening Methods among Female Community Pharmacists in Jordan: A Cross-Sectional Study.

OBJECTIVES: Our study is aimed at exploring the knowledge and personal practice of breast cancer screening among female community pharmacists in Jordan. METHODS: A cross-sectional survey was carried out using a nonrandom sample selection method for pharmacists in community pharmacies. RESULTS: A total of 551 female pharmacists completed the questionnaire. The mean age of pharmacists was 29.1 ± 7.3 years (range 21-67), and most have bachelor degrees in pharmacy (89.1%). The mean score of knowledge of breast cancer signs and symptoms was 4.2 ± 1.5 out of 6 points (range 0-6). The mean score of knowledge of risk factors was 7.6 ± 1.9 out of 12 points (ranging from 2-12). The mean score for knowledge of screening guidelines was 2.8 ± 0.9 out of 4 points (range 0-4). Overall, 452 pharmacists (85.8%) had acceptable knowledge while 75 pharmacists (14.2%) had poor knowledge of breast cancer. Pharmacists surveyed were aware of the different screening methods of breast cancer. The percentage of pharmacists who has performed breast self-examination (BSE), clinical breast examination (CBE), and mammography was 46.6%, 16.5%, and 5.4%, respectively. The most common reason for the lack of BSE and CBE performance was the absence of breast symptoms. Not being at the age recommended for mammography was the most common reason for not undergoing this screening method. Knowledge and practice of screening methods were influenced by age, years of experience, geographic region, personal history of breast cancer, and educational level among community pharmacists. CONCLUSIONS: This study revealed some gaps in the knowledge of breast cancer among female community pharmacists. The practice of the different screening methods was suboptimal, and variable reasons were indicated for the low uptake of these screening methods. Community pharmacists need to practice preventive behaviors to a satisfactory level to encourage women in the community to adopt similar behavior.

Impact of COVID-19 pandemic on pediatric patients with epilepsy in Jordan: The caregiver perspective.

OBJECTIVES: The recent COVID-19 pandemic has disrupted care systems around the world. We assessed the impact of COVID-19 lockdown on the care of pediatric patients with epilepsy in Jordan. Potential predictors for seizure control during COVID-19 outbreaks were investigated. METHODS: A cross- sectional survey was conducted on pediatric patients with epilepsy in Jordan, between January and February 2021, via online questionnaires. The collected data included demographic information, epilepsy-related characteristics, views of caregivers and changes in seizure control during COVID-19 outbreak. RESULTS: A total number of 672 subjects were screened, 276 were eligible, and 154 completed the questionnaire adequately. Two thirds of caregivers (66.2%) reported that the COVID -19 outbreaks prevented their child from getting proper epilepsy care and 28.6% reported difficulty giving the drugs to their child on time because of loss of daily routine. In addition, more than half (55.8%) reported difficulty obtaining antiseizure medicines (ASMs). On the other hand, 77.3% of caregivers reported that seizure status remained unchanged or improved for their children during the COVID-19 and 22.7% reported worsened seizure control. The number of antiseizure medicines taken by patients (p < 0.001), age (p = 0.032), residency area (p = 0.013) and the difficulty in giving the medicine during COVID-19 pandemic (p = 0.002) were the major factors influencing the seizure worsening experienced by patients. CONCLUSION: Almost one of every five patients reported worsened seizure control during the outbreak of COVID-19 in Jordan. Moreover, two thirds of caregivers reported poor epilepsy care. This finding highlights the need to implement organized and efficient telemedicine programs devoted to epilepsy care.

The knowledge of community pharmacists about appropriate dosing of antibiotics among paediatrics: A national study from Jordan.

OBJECTIVE: Paediatric patients are highly exposed to medication errors especially dosing errors. This study assessed the community pharmacists' knowledge about appropriate dosing of antibiotics among paediatric patients, factors affecting community pharmacists' knowledge and barriers that lead to inappropriate dosing of antibiotics. METHODS: A self-administered questionnaire was distributed to 1283 Jordanian pharmacists who worked in community pharmacies. Descriptive statistics and multivariate regression were conducted. RESULTS: The response rate was 87.1%. The majority of pharmacists (86.4%) were non-knowledgeable about appropriate dosing of antibiotics among paediatrics. The monthly income of the pharmacist was positively associated with pharmacists' knowledge. The case of azithromycin dosing in acute bacterial pharyngitis was answered correctly by the highest percentage of community pharmacists (55.8%) while the case of trimethoprim-sulfamethoxazole dosing in lower urinary tract infection was answered correctly by the lowest percentage (15.7%). Poor scientific knowledge about dose calculation was the most reported barrier by the participants (54.7%). CONCLUSION: Most community pharmacists were non-knowledgeable about appropriate dosing of antibiotics in paediatrics and the level of knowledge was affected by monthly income. Implementing adequate and appropriate educational programmes, constructing specific guidelines that regulate antibiotics practice among community pharmacists are highly recommended.

Knowledge and perceptions of synthetic cannabinoids among university students in Jordan.

The emergence of blends of synthetic cannabinoids (SC) is an alarming public health concern in Jordan and worldwide. This study aimed to assess the knowledge and perceptions of university students of SC. A cross-sectional study employing a self-administered questionnaire was used to collect data from 1,789 university students in Jordan. The questionnaire measured the knowledge and perceptions of students of SC. Bivariate and multivariate logistic regression were used to investigate the potential predictors of good knowledge of SC. Perceptions of students regarding SC use, prevalence and availability were investigated using principal component analysis. Self-reported familiarity with SC was high (92.5%), while good knowledge was only demonstrated by (33.6%) of students. Predictors of good knowledge included being a smoker (aOR = 1.369, 95% Cl = 11.041-1.871, p = .026), an alcohol user (aOR = 2.134, 95% CI = 1.362-3.346, p = .001), being informed by traditional media (aOR = 1.367, 95% CI = 11.113-1.679, p = .003), social media (aOR = 1.241, 95% CI = 1.161-1.403, p = .021) and self-familiarity with SC (aOR = 2.499, 95% CI = 1.518-4.114, p < .0001). Students perceived SC use to be prevalent and ethically unacceptable, for religious, social, and legal reasons. There were significant differences in the ethical perceptions against the use of SC detected by gender (p < .0001), smoking (p < .0001) or alcohol use (p = .001), and being informed by both traditional media (p-.001) and social media (p = .001), but there were no differences by the level of knowledge (p = .057). Those of good knowledge and those of low knowledge did not differ on their ethical perceptions of using SC. This study showed that there was a low level of knowledge regarding SC among university students in Jordan, which may play a role in the use of SC in the country. Herein, many opportunities exist for public health education to raise awareness against SC use.

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.