Simplified processing and rapid quantification of buprenorphine, norbuprenorphine, and their conjugated metabolites in human plasma using UPLC-MS/MS: Assessment of buprenorphine exposure during opioid use disorder treatment.

Opioid use disorder (OUD) is a chronic neurobehavioral ailment and is prevalent in pregnancy. OUD is commonly treated with methadone or buprenorphine (BUP). Pregnancy is known to alter the pharmacokinetics of drugs and may lead to changes in drug exposure and response. A simple, specific, and sensitive analytical method for measuring the parent drug and its metabolites is valuable for assessing the impact of pregnancy on drug exposure. A new liquid chromatography-tandem mass spectrometric method that utilized a simple protein precipitation procedure for sample preparation and four deuterated internal standards for quantification was developed and validated for BUP and its major metabolites (norbuprenorphine [NBUP], buprenorphine-glucuronide [BUP-G], and norbuprenorphine-glucuronide [NBUP-G]) in human plasma. The standard curve was linear over the concentration range of 0.05-100 ng/mL for BUP and NBUP, and 0.1-200 ng/mL for BUP-G and NBUP-G. Intra- and inter-day bias and precision were within ±15% of nominal values for all the analytes. Quality controls assessed at four levels showed high recovery consistently for all the analytes with minimal matrix effect. Adequate analyte stability was observed at various laboratory conditions tested. Overall, the developed method is simple, sensitive, accurate and reproducible, and was successfully applied for the quantification of BUP and its metabolites in plasma samples collected from pregnant women in a clinical study assessing BUP exposure during OUD treatment.

Assessment of osteoporosis knowledge, awareness, and risk factors among premenopausal and postmenopausal women from Jordan: a cross-sectional study.

RATIONALE: Lack of information about osteoporosis knowledge and awareness among premenopausal compared to postmenopausal women in Jordan. MAIN RESULT: Women had an average-poor knowledge and awareness about osteoporosis. SIGNIFICANCE: This study highlights the need to improve women's knowledge about osteoporosis, its consequences, potential risk factors, preventive measures, and treatment options. PURPOSE: To assess osteoporosis knowledge, awareness, and risk factor profile among premenopausal and postmenopausal women from Jordan. METHODS: This was a cross-sectional study that involved 490 premenopausal and 488 postmenopausal women from the general population of Jordan. Face-to-face interviews were conducted to collect the sociodemographic and clinical data and to complete the Osteoporosis Knowledge Assessment Tool (OKAT) questionnaire. RESULTS: Premenopausal and postmenopausal women had an average-poor level of knowledge and awareness regarding osteoporosis, with a total mean score of 51.3 and 50.9, respectively, out of the total OKAT score of 100. More than 50% of premenopausal women correctly answered 11 questions, while >50% of postmenopausal women correctly answered 9 questions out of 20 in OKAT, which are related to knowledge and awareness about osteoporosis. The participants' marital status (being married), higher educational level, and higher economic status were significantly associated with better knowledge and awareness about osteoporosis (p-values < 0.05). Postmenopausal women had higher osteoporosis risk profile including older age, higher body mass index, less regular exercise, and less exposure to sunlight versus premenopausal women. CONCLUSION: Premenopausal and postmenopausal women from Jordan had an average-poor level of knowledge and awareness about osteoporosis. Higher educational levels and higher income are associated with better knowledge and awareness about osteoporosis. It is therefore crucial to improve the knowledge of women in Jordan about osteoporosis and its consequences, as well as the potential risk factors, preventive measures, and treatment options. Conducting periodic osteoporosis awareness and educational campaigns are necessary to spread the awareness of the disease.

Incidence, predictors, clinical outcomes, and economic burden of recurrent acute kidney injury: a retrospective cohort study.

OBJECTIVE: This study aimed to assess the incidence, predictors, mortality, and economic outcomes of recurrent Acute kidney injury (AKI) in Jordan. METHODS: This was a retrospective cohort study that included adult patients who were admitted with AKI to university hospitals in the country from 2010-2019. Recurrent episodes of AKI, laboratory data, baseline medication list, and death dates were retrieved from patient's medical records. The incidence rate of recurrent AKI was estimated. Predictors of recurrent AKI and mortality during the five years post-discharge was evaluated. Total admission charges were described and evaluated in total and by service provided. RESULTS: Among 1162 AKI patients, 57 patients (4.9%) died during the index admission (first admission during the study period), and among the survivors, 220 patients were re-hospitalized with a recurrent AKI during five years of follow-up. Patients with higher discharge serum creatinine level (SCr) at index admission had higher odds of AKI recurrence (OR = 1.001). Patients who were on respiratory, antineoplastic, or anticoagulant medications were also more susceptible to recurrence; ORs were 1.69, 2.77, and 4.16, respectively. Patients who were elderly, with recurrent AKI episodes, or with a more extended hospital stay at index admission were more likely to die during the five years post discharge. The median charge of recurrent admissions was higher than the median charge of the index admissions; 1519.17 JOD ($2142.7) versus 1362.85 JOD ($1922.2), respectively. CONCLUSIONS: Recurrent AKI is associated with increased mortality and health expenditures. Higher discharge SCr levels at index admission, and chronic comorbidities are associated with a higher likelihood of AKI recurrence.

Acute kidney injury development and impact on clinical and economic outcomes in patients with cirrhosis: an observational cohort study over a 10-year period.

OBJECTIVES: Acute kidney injury (AKI) is a severe complication that is associated with significant morbidity and mortality in hospitalized cirrhotic patients. Data about AKI incidence and outcomes in patients with cirrhosis is scarce in the Middle East region. This study explored the incidence and impact of AKI on clinical and economic outcomes in cirrhosis. METHODS: This was a retrospective cohort study of cirrhosis patients admitted to an educational hospital in Jordan during the years 2012-2022. Demographics, clinical and biochemical information, and charges were retrieved from medical electronic records. Logistic regression models were conducted to evaluate predictors of AKI and mortality in cirrhosis adjusting for covariates. Hospital charges were also described. RESULTS: A total of 380 cirrhosis patients were included with an AKI incidence of 27.9%. Male sex, elevated baseline serum creatinine, presence of spontaneous bacterial peritonitis, and higher comorbidity score were independently associated with AKI development ( P < 0.05). The hospital mortality rate was markedly higher for patients with AKI versus those without AKI (51.9% vs. 6.2%, respectively; P < 0.001). AKI was associated independently with higher odds of hospital death (OR = 5.83, P < 0.001), prolongation of the median hospital stays by 5 days ( P < 0.001), more clinical complications, and increased total hospital charges per admission by $2500. CONCLUSION: AKI is prevalent in cirrhosis patients, and it is associated with increased mortality, hospitalization, and cost. This burden in cirrhosis emphasizes the need for early identification of patients at high risk of AKI and applying prompt and effective management approaches, aiming at improving outcomes.

Clinical Outcomes and Direct Medical Expenditures Associated With Intensive Care Unit Admission for Inpatients With COVID-19 in Jordan: A Retrospective Cohort Study.

OBJECTIVES: This study aimed to describe clinical outcomes and medical expenditures associated with COVID-19 admissions. In addition, this study aimed to investigate the impact of patients' characteristics and baseline comorbidities on intensive care unit (ICU) admission, mortality, and medical expenditures for hospitalized patients with COVID-19. METHODS: This retrospective cohort study included all hospitalized patients with confirmed COVID-19 in Prince Hamza Hospital and King Abdullah University Hospital, during the period from March 2020 to June 2021. Medical records and pharmacy data were followed and reviewed throughout their admissions. The ICU admission, inpatient mortality, hospital length of stay, and inpatient charges were described. Predictors of ICU admission and inpatient charges were evaluated. RESULTS: A total of 7694 COVID-19 hospital admissions were included. Approximately 1189 patients (15.5%) were admitted to ICU and 21.4% died in the hospital. The fatality rate among those admitted to ICU was 82.6% compared with 10.2% for non-ICU admitted patients. The average admission charge and charge per admission day were 1598.2 and 200.2 Jordanian dinar, respectively, and both charges were higher in ICU admitted patients than non-ICU admitted patients. Being older in age, smoker or ex-smoker, and having chronic diseases were all significantly associated with a higher likelihood of ICU admission and mortality among admitted patients. CONCLUSIONS: ICU admission in patients with COVID-19 is associated with poor clinical outcomes and substantial medical expenditures and is more likely among older adults, smokers, and those with chronic diseases.

Predictors of symptom burden among hemodialysis patients: a cross-sectional study at 13 hospitals.

PURPOSE: This study investigated the clinical characteristics and symptomatology of ESRD patients in Jordan taking a multidimensional approach. METHODS: This was a cross-sectional study that included a cohort of 620 patients undergoing maintenance hemodialysis (HD). Data were retrieved via patient survey administration and electronic health records. A modified version of the Charlson Comorbidity index (CCI) was utilized to assess comorbidity. Symptoms were assessed using the validated Arabic version of the CKD Symptom Burden Index (CKD-SBI). RESULTS: The mean (± SD) age of participants was 50.9 ± 16.1 years, with the 59.8% being males. Diabetes was the leading cause of kidney disease among patients (29.2%), followed by hypertension (20.7%) and medication use (8.6%). Common comorbidities included hypertension (72.4%), diabetes (38.4%), and cardiovascular disease (18.7%). Patients experienced 13 CKD-related symptoms on average, with a total symptom burden score of 29.6. Muscle strain was the most common symptom (62.6%), followed by itchiness (59.7%), nervousness (57.7%), and anxiety (57.7%). Charlson comorbidity index (CCI) [ß = 0.88, 95% CI (0.34-1.41)], male gender [ß = - 5.59; 95% CI (- 8.34 to - 2.85)], higher educational level [ß = - 3.38; 95% CI (- 6.39 to - 0.37)], and number of dialysis sessions/week (ß = 6.22, 95% CI 3.37-9.07) were independent predictors of total symptom burden. Similarly, these factors predicted symptom troublesomeness, intensity, and recurrence. CONCLUSION: A holistic clinical picture of ESRD that includes multidimensional symptom assessment is warranted for better disease management and resource allocation. Our paper identifies key characteristic of this population and factors contributing to total symptom burden.

Cost-Utility Analysis of Apixaban versus Warfarin in Atrial Fibrillation Patients with Chronic Kidney Disease.

BACKGROUND: Warfarin use for stroke prevention in atrial fibrillation (AF) patients with chronic kidney disease is debated. Apixaban was shown to be safer than warfarin, with superior reduction in the risk of stroke, systemic embolism, mortality, and major bleeding irrespective of kidney function. OBJECTIVES: To evaluate the cost-utility of apixaban compared with warfarin in AF patients at different levels of kidney function. METHODS: A Markov model was used to estimate the cost effectiveness of apixaban compared with warfarin in AF patients at three levels of kidney function: estimated glomerular filtration rate (eGFR) of more than 80 ml/min, 50 to 80 ml/min, and 50 ml/min or less. Event rates and associated utilities were obtained from previous literature. The model adopted the US health care system perspective, with hospitalization costs extracted from the Healthcare and Utilization Project. Treatment costs were obtained from official price lists. Univariate and probabilistic sensitivity analyses were performed to evaluate the robustness of results. RESULTS: Apixaban was a dominant treatment strategy compared with warfarin in AF patients with eGFR levels of 50 ml/min or less and 50 to 80 ml/min. In patients with an eGFR of more than 80 ml/min, apixaban was cost-effective compared with warfarin, costing $6307 per quality-adjusted life-year gained. Results were consistent assuming anticoagulant discontinuation after major bleeding events. Compared with dabigatran and rivaroxaban, apixaban was the only cost-effective anticoagulant strategy relative to warfarin in both mild and moderate renal impairment settings. CONCLUSIONS: Apixaban is a favorably cost-effective alternative to warfarin in AF patients with normal kidney function and potentially cost-saving in those with renal impairment.