Impact of medical specialty on the prescription patterns of topical corticosteroid among healthcare professionals

Background: topical corticosteroids are among the most commonly prescribed skin preparations for the management of a plethora of inflammatory and allergic conditions

Objective: the main aim of this study is to assess the discrepancies in topical corticosteroid prescription patterns and practice recommendations among various healthcare professionals and to identify factors leading to such discrepancies

Methods: the current study is a prospective cross-sectional observational study that was conducted over a period of six months. A validated structured questionnaire was handed out to one hundred community pharmacists working in independent and chain pharmacies with only one pharmacist interviewed per pharmacy store. Prescriptions for topical corticosteroids over a period of six months were reviewed for discrepancies in prescription patterns between general practitioners and dermatologists in one hundred independent and chain community pharmacies included in the study

Results: the most commonly prescribed topical corticosteroid for initial treatment of mild symptoms of atopic dermatitis in children by general practitioners was hydrocortisone acetate [45%], followed by mometasone furoate [33%]. In contrast, dermatologists prescribed mostly mometasone furoate [48%], for the aforementioned indications followed by combination products of topical corticosteroid with an antibiotic or an antifungal [22%] for children and adults. On the other hand, Pharmacists mostly recommended an emollient as an initial treatment. Only 14 % of pharmacists interviewed in the study recommended using the fingertip unit to quantify the proper amount of topical corticosteroids. None of the prescribers provided written instructions to patients in fingertip units. Interestingly, only 15% of pharmacists in the study were found to have adequate knowledge about topical corticosteroids use. Adequacy of knowledge was not significantly associated with age of the pharmacist [p value 0.447], gender [p value 0.628], years of experience [p value 0.288], and pharmacy degree [B.SC vs Pharm D, p value 0.444]

Conclusion: this study shows that Physician and pharmacist adherence to clinical guidelines for safe prescription of topical corticosteroids was poor. Updating Physicians and pharmacists on practice guidelines is the most urgent recommendation to improve treatment of atopic dermatitis

Evaluation of the correlation of oxytocin plasma levels and metabolic syndrome biomarkers [leptin, adiponectin and resistin] in newly diagnosed type 2 diabetes patients in Jordan: a cross sectional study

Levels of oxytocin [OXT] hormone and inflammatory biomarkers [leptin, resistin and adiponectin] were measured in 166 plasma samples of Metabolic Syndrome [MS] patients [1] that visited the outpatients' endocrinology clinics, Jordan University Hospital [JUH]. Patients were subdivided into two arms according to their glucose profile status, subjects with glucose profile disturbances and normoglycemic subjects. MS biomarkers were significantly different [P<0.01] between study groups, mean OXT levels [ng/mL] were exceptionally higher [p<0.01] in MS-control group [2.25+0.85] than in MS-pre/T2DM group [1.20+0.50]. Conversely, in comparison to MS-controls; MS-pre/T2DM patients had significantly higher adipocytokines plasma levels; namely resistin was 13 times higher [ng/mL] [82.05+ 32.44 vs. 6.45+4.39]; leptin two times higher [ng/mL] [42.43+30.44 vs. 22.76+14.19] and adiponectin was 3-fold higher [micro g/mL] [6.869+1.082 vs. 1.97+0.606]. These findings were indicative for the potential pharmacologic benefit of this hormone in minimization of inflammatory markers chronic deleterious effect

Evaluation of oxytocin [OXT], endothelin-1 and nesfatin plasma concentrations in newly-diagnosed diabetic and non-diabetic patients with metabolic syndrome

Oxytocin [OXT] is implicated as a novel therapy of obesity-diabetes. Nesfatin is an anorexigenic adipokine linked to improve insulin sensitivity and dysglycemia in obese/T2DM mice, while endothelin-1 [ET-1] is an endothelium vasoconstrictor that is dysregulated in metabolic insulin resistance. The aim of this study was to investigate OXT, ET-1, and nesfatin plasma levels and the correlation between these biomarkers and the various metabolic parameters in the human. In a cross-sectional study, MS-subjects attended the National Center for Diabetes Endocrinology and Genetics were enrolled based on their blood glucose levels into [82 MS-non-diabetic vs. 89 MS-pre/diabetic patients]. Plasma OXT, ET-1 and nesfatin levels were measured by competitive binding and sandwich enzyme-linked immunosorbent assays [ELISA]. When MS-pre/T2DM patients were compared to MS-controls, plasma OXT concentrations [pg/mL] were significantly lower [P < 0.001] [mean +/- SD; 1206.28 +/- 507.68 vs. 2224 +/- 871.22]; nesfatin plasma levels [ng/mL] were significantly higher [P < 0.01] [1.04 +/- 2.20 vs. 0.31 +/- 0.25]; while no differences were observed in ET-1 [pg/mL] plasma levels [P > 0.05] [4.21 +/- 4.19 vs. 4.01 +/- 3.51]. In conclusion, the present study is the first one which demonstrates an increase in nesfatin concentrations in MS-pre/diabetic patients vs. MS-non-diabetic. Our study reported a decrease in OXT levels in MS-pre/T2DM compared to MS-control. Besides, ET-1 concentrations had no significant difference between non-diabetic and diabetic-MS patients, serum OXT concentrations correlated with several clinical parameters; this is suggestive of OXT as a pharmacologic agent that opposes weight gain and improves insulin resistance

impact of lack of pharmacist contribution on the prescription patterns and the appropriateness of indications of nsaids, a cross-sectional study

Non-steroidal anti-inflammatory drugs [NSAIDs] are among the most commonly used medications worldwide. However, recent literature strongly points to gastrointestinal [GI] and cardiovascular [CV] risks associated with NSAIDs use. The current study was carried out in Jordan University Hospital. The main objective was to evaluate the role of pharmacists in directing the current prescription patterns and appropriateness of NSAID therapiesto establish strategies for medication reconciliation in the healthcare systems in the region. This is a prospective cross-sectional qualitative study that enrolled a total of 400 patients over a period of 10 months. The NSAID use was evaluated in patients with and without established CVD and various GI risk stratifications. In addition, 30 physicians were recruited into the study to determine the current prescription patterns. A structured questionnaire was validated and handed to physicians to determine strengths and weaknesses in the current system. NSAID-related drug interactions were evaluated in 200 of the patients. Sixty five percent of the patients without CVD were at moderate GI risk and 12% were at high risk. Sixty nine percent of patients with CVD were at high GI risk and 28% were at moderate risk. Pharmacists were not involved in decision therapies pertaining to NSAIDs, which led to serious drug-related problems in the therapeutic regimens for patients using the NSAIDs. In 64% of the patients without CVD, NSAID therapy did not meet the recommendations of current guidelines. There was no drug therapy monitoring or patient counseling by a proficient clinical pharmacist, which led to virtually no identification of potential drug interactions or optimization of medication therapy. The study unraveled a great opportunity to improve the clinical outcomes in patients on NSAID therapy. The lack of pharmacist involvement puts patients at major health risks. Updating physicians on practice guidelines, including a clinical pharmacist in therapy decisions, and modifying hospital formularies are the most urgent recommendations.

Evaluation of a binary carrier system for the dissolution enhancement of a high dose poorly soluble drug

The role of two surface active carriers, Gelucire[registered] 44/14 and Lutrol[registered] F127, for improvement of solubility and dissolution of the high-dose, poorly water-soluble drug, albendazole, using solid dispersion approach was evaluated. The solubility of albendazole in solutions of the studied carriers and binary mixtures showed improvement, with solutions containing higher percentages of Lutrol[registered] F127 as best solvents. Albendazole was then incorporated in matrices made of either carrier alone or mixtures of the two carriers at different ratios using a melting procedure. The resulting particles were compressed into tablets. In vitro dissolution of particles and tablets showed fast dissolution. Increased wettability of albendazole by the carriers and formation of partial solid solutions of it in the carrier system were shown to be the mechanisms of the improvement in its dissolution

Prevalence of aspirin use and its concurrent use with ibuprofen among two middle eastern countries: Jordan and the UAE - a cross sectional study

The objective of this study was to assess the prevalence of aspirin use as a prophylactic agent in two countries: Jordan and the United Arab Emirates in addition to the frequency of concurrent use of aspirin and ibuprofen which might be associated with lower cardio protection. The data was collected using a structured questionnaire from December 2009 to February 2010. The results showed significantly higher proportion of Jordanian patients with cardiovascular problems [85.97%] who were using aspirin as compared to patients from the United Arab Emirates [71.26%] [p= 0.0205, chi square test]. The percentage of Jordanian patients with different cardiovascular problems taking aspirin concurrently with ibuprofen was relatively high. Patients' adherence to aspirin administration in both populations was suboptimal. Patients' age and previous myocardial infarction episodes were found to have a significant [p<0.001] association with the use of aspirin in both populations. These results call for reasonable strategies for aspirin administration in both countries

In vivo acute toxicity study of thyme- primulae syrup

The current study is an acute toxicity study of Thyme - Primulae syrup in Albino male and female rats. The syrup was administered in three escalating doses: 3, 6 and 12 ml/kg body weight. The weight-based doses were given to the rats by intra gastric to minimize loss and variability among them. The treated groups were compared to the untreated control in regards to their body weight gain, hepatic and kidney appearances and their weight. Even at the highest dose, the syrup was found to be non-toxic under the conditions of this study

Acute oral toxicity study of ivy-thyme syrup in albino rats

This study was designed to assess the acute oral toxicity of Ivy-Thyme syrup in rats. The tested product was administered at a dose level of 3, 6 and 12 mL/kg. All animals were examined for clinical signs of ill-health or mortality at 1,2,4 and 8 hours after oral administration, and twice daily thereafter for 14 days. At the end of the study, all rats were alive with normal appearance and showed body weight gain during the study. The kidneys and livers of the sacrificed animals appeared normal. Ivy-Thyme syrup having 0.75% Ivy leaf dry extract and 5% thyme fluid extract was found to be non-toxic by the oral route at a dose level of 3,6 and 12 ml/kg in female rats under the conditions of this study

In vitro xanthine oxidase inhibition by selected Jordanian medicinal plants

In the present study, 18 Jordanian medicinal plants were evaluated for their Xanthine Oxidase [XO] inhibitory potential. Their aqueous extracts, prepared from used parts, were tested in vitro, at 200 micro g/mL concentration, for their inhibition potencies expressed as% inhibition of XO activity. Five of the tested plants were found most active [% inhibition more than 35%] and their inhibition profiles [dose-dependent] were further evaluated by estimating the IC[50] values of their corresponding extracts. These plants were Hyoscyamus reticulates L. [IC[50] = 12.8 micro g/mL], Achillea fragrantissima [Forssk.] Sch. Bip. [197.6 micro g/mL], Pimpinella anism L., [300.4 micro g/mL]. Origanum syriacum L. [317.0 micro g/mL], and Origanum vulgare L. [403.9 micro g/mL]. Moreover, five more plants showed XO inhibitory activity in the range of 14-30%. Namely: Daphne linearifolia L. [29.5% inhibition], Hibiscus sabdoriffa L. [19.44], Aristolochia maurorum L. [15.6%], Citrullus colocynthis [L.] Schr. [14.4%], and Laurus nobilis L. [13.97%]. Considering the results of the present screening study, many of the investigated plants species can be used as potential sources of natural XO inhibitors that can be elaborated as successful herbal remedies for gout, arthritis and other XO-related disorders

comparative enzymatic inhibition assay as a surrogate indicator of pharmaceutical and potency equivalence of two orlistat formulations

The most practical measure of therapeutic equivalence between two commercially available and generic formulation of a certain drug is to determine their in vivo bioavailability. However, for the oral dosage form that is not intended to be absorbed [e.g. orlistat], in vivo bioavailability studies are irrelevant to the achievement of the product's intended purposes. However, specific requirements for these drug products may be set in a way that they should meet acceptable in vitro standards. For this purpose, a comparative enzymatic inhibition assay of the target enzyme, pancreatic lipase, was developed to demonstrate orlistat products' pharmaceutical and potency equivalence. In this study we compared the pancreatic lipase inhibition that is achieved by two orlistat formulations; a generic product manufactured by local company [Jordan Sweden Medical Company, JOSWE] and the reference one Xenical manufactured by Roche. The inhibition was expressed by the concentration of product which inhibits 50% of the activity of the pancreatic lipase enzyme [IC[50]]. The results of these studies showed that both formulations have equivalent potency that was demonstrated by in vitro studies