Frequency of antiepileptic drugs and response change in pediatric patients receiving 2 or more antiepileptic drugs.

OBJECTIVE: To investigate the frequency of changes in antiepileptic drugs (AEDs) use, as well as concomitant changes in the degree of seizure control in pediatric patients, who are receiving 2 or more AEDs. METHODS: A prospective follow-up study at Jordan University Hospital`s pediatric neurology clinics was conducted on epileptic pediatric patients receiving at least 2 AEDs between December 2013 and April 2014. Patients were followed for 12 months. RESULTS: A total of 82 patients were included, with a mean age of 7.2+/- 4.7 years. The mean number of AEDs received by patients at enrollment was 2.4+/-0.6, and 2.5+/-0.7 after follow-up. Most patients (63.4%) experienced no change in seizure control, and the majority reported at least one adverse drug reaction. Most patients received lower doses than recommended, both at the beginning and end of the study. During the year, only 3 patients (4%) were eligible for dose tapering, which would then be converted to monotherapy. Follow-up appointments average was 4.2+/-2.9 visits/patients in one year. The frequency of medication changes and dose adjustment was very low, about one-third (29.3%) of patients requiring no change in AEDs during any follow-up visits. CONCLUSION: During the one year follow-up study, most patients on polytherapy maintained their level of response to the AEDs, with minimal changes in their regimen despite frequent follow-up visits. Only a small percent could be converted to AEDs monotherapy.

Knowledge, awareness and practices towards seasonal influenza and its vaccine: implications for future vaccination campaigns in Jordan.

BACKGROUND: Influenza is an underestimated contributor to morbidity and mortality. Population knowledge regarding influenza and its vaccination has a key role in enhancing vaccination coverage. OBJECTIVES: This study aimed to identify the gaps of knowledge among Jordanian population towards influenza and its vaccine, and to identify the major determinants of accepting seasonal influenza vaccine in adults and children in Jordan. METHODS: This was a cross-sectional study that enrolled 941 randomly selected adults in Amman, Jordan. A four-section questionnaire was used which included questions about the sociodemographic characteristics, knowledge about influenza and the factors that affect seasonal influenza vaccine acceptance and refusal. RESULTS: Only 47.3% of the participants were considered knowledgeable. About half of the participants (51.9%) correctly identified the main influenza preventative measures. Lack of knowledge about the important role of seasonal influenza vaccine in disease prevention was observed. Low vaccination rate (20% of adults) was reported. The most critical barrier against vaccination in adults and children was the concern about the safety and the efficacy of the vaccine, while the most important predictors for future vaccination in adults and children were physician recommendation and government role. In children, the inclusion of the vaccine within the national immunization program was an important determinant of vaccine acceptance. CONCLUSION: Formulating new strategies to improve the population's level of knowledge, assuring the population about the safety and the efficacy of the vaccine and the inclusion of the vaccine within the national immunization program are the essential factors to enhance vaccination coverage in Jordan.

Prevalence and predictive factors for infertility-related stress among infertile couples: A cross-sectional study from Jordan and the occupied Palestinian territories.

OBJECTIVES: To assess the level of infertility-related stress, associated socio-economic, and demographic factors among infertile couples living in Jordan and those living under the chronic Israeli-Palestinian conflict in the occupied Palestinian territories. METHODS: A cross-sectional study was carried out in a number of fertility and reproductive clinics in Jordan and occupied Palestinian territories over a period of 6 months. Trained clinical pharmacists interviewed the identified couples. RESULTS: A total of 443 participants were interviewed. Three variables were significantly and independently associated with global stress scores. The need of parenthood appears higher in women than men among infertile couples in Jordan and Palestine (p=0.005). The country of origin (p<0.001) made the greatest contribution of unique variance followed by family type (p=0.035). Additionally, a significant contribution to the model was carried out by the number of clinicians who followed up on the case (p=0.013). The average total cost of treatment since the problem had been diagnosed was 2936±4529 Jordanian dinar, which may be of concern to both Jordanians and Palestinians given the limited resources available in developing nations. CONCLUSION: This study shows a significant degree of stress among infertile couples. The place of origin, family structure, and presence of medical insurance had a significant impact on the infertility global stress score. This study emphasizes the necessity for specific psychological therapies that are currently lacking in public healthcare practices in both Jordan and Palestine.

The Role of the Middle East in ZIKA Virus Circulation: Implications of a Cross-Sectional Study in Jordan.

ZIKA virus (ZIKAV) outbreak in Latin America was associated with international concerns of ZIKAV circulation. The lack of vaccine and Food and Drug Administration (FDA)-approved drugs against this virus rendered prevention as the single most effective method to control its spread. Hence, this study aimed to assess Jordanian population knowledge, attitude, and practices toward ZIKAV and its prevention. An anonymous questionnaire was administered to adults in Amman, Jordan. The overall knowledge of participants was poor (mean knowledge score of 13.7/32). Between 75% and 86% of the respondents did not know the highest risk group of ZIKAV infection, its complications, and the major routes of transmission. About 40% of the population did not know that ZIKAV is sexually transmitted. Only 40% of the population believed that prevention measures are effective. Female gender, working in the medical field, having children, and the source of medical information were associated with significantly higher level of knowledge (R 2 = 0.143, P-value < 0.0001). Being pregnant, however, was not associated with a significantly high knowledge score. Physician recommendations and government's role were the most important predictors of practices toward ZIKAV prevention. Of the 14 returnees from outbreak areas, only six were tested for ZIKAV on coming back and only three continued the use of prevention measures for a sufficient time. Therefore, formulation of a national health policy, preparedness plans against any potential transmission, and organization of educational campaigns to meet the population's health educational needs are required. Special emphasis should be placed on pregnant women and travelers to/returnees from ZIKAV-affected areas.

Dominant negative effects of a Gbeta mutant on G-protein coupled inward rectifier K+ channel.

HEK293 cells were transfected with cDNAs for Gbeta1(W332A) [a mutant Gbeta1], Ggamma2, and inward rectifier K+ channels (Kir3.1/Kir3.2). Application of Gbeta1gamma2 protein to these cells activated the K+ channels only slightly. When mu-opioid receptors and Kir3.1/Kir3.2 were transfected, application of a mu-opioid agonist induced a Kir3 current. However, co-expression of Gbeta1(W332A) suppressed this current. Most likely, Gbeta1(W332A) inhibited the action of the endogenous Gbeta. Such a dominant negative effect of Gbeta1(W332A) was also observed in neuronal Kir3 channels in locus coeruleus. The mutant, Gbeta1(W332A) protein, although inactive, retains its ability to bind Kir3 and prevents the wild type Gbeta from activating the channel.

Primary prevention of cardiovascular disease in a primary care setting.

AIM: This study was designed to investigate primary prevention of cardiovascular disease in a primary care setting in Jordan. METHODS: Adult patients without clinical cardiovascular disease who attended a primary care setting were interviewed and their medical files were reviewed. Data collected to assess primary prevention of cardiovascular disease included lifestyle/risk factor screening, weight assessment, blood pressure measurement and control, and blood lipid measurement and control. RESULTS: A total of 224 patients were interviewed. The proportions of patients' files with risk factors documentation were 37.9% for smoking status, 30.4% for physical activity assessment and 72.8% for blood pressure assessment. The majority of hypertensive patients (95.9%) had a blood pressure reading at their most recent visit of ⩽ 140/90 or was prescribed ⩾ 2 antihypertensive medications. CONCLUSION: Documentation of cardiovascular disease risk factors was suboptimal. Healthcare providers should be encouraged to document and assess cardiovascular risk factors to improve primary prevention.

Topiramate slow dose titration: improved efficacy and tolerability.

Topiramate is an effective treatment for several types of seizures. The aim of this study is to assess the efficacy and tolerability of slow topiramate dose titration as add-on therapy in childhood epilepsy. This investigation is a prospective open-label, single-center, add-on study in 22 children with a diagnosis of refractory epilepsy. Topiramate (dose 0.5-2 mg/kg/day) was titrated at 2-week intervals up to the recommended dose of 6-12 mg/kg/day. Seizure frequency rate reduction was significant, declining from 23 +/- 5.1 seizures/week (mean +/- S.E.M.) at baseline phase to 3.5 +/- 1.2 seizures/week at the end of the 16-week stabilization phase (P < 0.001). After 16 weeks of stabilization, 19 patients (86%) had more than 50% seizure reduction. Seven patients (31%) were 100% seizure-free. Two patients (9%) manifested no improvement; only one patient (5%) did not tolerate the added drug and discontinued topiramate. One patient manifested severe side effects, whereas 21 patients experienced mild to moderate side effects mostly represented by somnolence, nervousness, and anorexia with or without weight loss. We conclude that slow dose titration improves efficacy and tolerability of topiramate as add-on therapy in the treatment in refractory epilepsy.

Awareness and frequency of potential side effects on nonsteroidal anti-inflammatory drugs among the Jordanian patient population.

OBJECTIVE: To investigate patient awareness of the proper use and frequency of side effects in nonsteroidal anti-inflammatory drugs (NSAIDs) users in Jordan. METHODS: This study was a prospective 8 question interview of subjects purchasing medications, during randomized 4 hour/day pharmacy visits over a one month study period (March 2002). Two hundred and twelve patients were included in this study. Two community pharmacies located in Irbid were chosen. The other 2 were Albashir Hospital Pharmacy and Prince Basma Hospital pharmacy. RESULTS: Overall NSAIDs use during last year was 69%: Diclofenac was the most used NSAID. The majority of patients (58%) reported having side effects upon NSAIDs-use; gastrointestinal upset was the most frequently reported side effect. Patients' awareness regarding proper NSAIDs use was poor, and pharmacist role in counseling was inadequate. However, user ability to discover the most common side effect to the drug seemed not to be affected. CONCLUSION: Nonsteroidal anti-inflammatory drugs use awareness and knowledge of probable serious side effects and how to handle them was not adequate. This probably reflected on high incidence of side effects. Nonsteroidal anti-inflammatory drugs are available on prescription as well as over the counter drugs. Pharmacist involvement in education of patients using them is highly recommended and much needed to help decrease frequency of side effects.

Pharmacist-physician collaboration improves blood pressure control.

OBJECTIVE: To evaluate the effect of teamwork (physician and pharmacist) on the management of uncontrolled hypertensive patients. METHODS: This is a randomized controlled clinical trial conducted from March to November 2009. Patients attending the Family Medicine Clinic at Jordan University Hospital, Amman, Jordan with uncontrolled hypertension were invited to participate in the study. A total of 253 patients were randomly allocated to an intervention (n=130) or control group. In the intervention group, patients were managed by a physician-pharmacist team. In the control group, patients were managed by physician(s) only. RESULTS: In the intervention group, 79.4% of patients achieved blood pressure (BP) goals specified by the Joint National Committee on Prevention and Management, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) compared to 65.6% in the control group (p=0.01). Decline in systolic BP was 16.1 +/- 14.6 mm Hg in the intervention group, and 10.6 +/- 13.5 mm Hg in the control group (p=0.002). Reduction in diastolic BP was 10.5 +/- 12.9 mm Hg in the intervention group, and 7.17 +/- 13.11 mm Hg in the control group, (p=0.04). Data were presented as mean +/- standard deviation. CONCLUSION: This study found that the physician-pharmacist collaborative approach to uncontrolled hypertension in Jordan improved the rate of BP control in hypertensive patients, and resulted in more profound decline in both systolic and diastolic BP, and this will probably reflect on better outcomes in cardiovascular diseases. Establishing pharmaceutical care managed clinic in the setting of outpatient-clinics is possible, and provides better management of patients.

A randomized controlled trial to assess pharmacist- physician collaborative practice in the management of metabolic syndrome in a university medical clinic in Jordan.

BACKGROUND: The prevalence of metabolic syndrome is increasing worldwide, and patients with metabolic syndrome have increased risk of developing cardiovascular disease and type 2 diabetes. Although specific criteria vary, the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) criteria (2002) defined metabolic syndrome as the presence of 3 or more of the following 5 components: waist circumference more than 102 centimeters (cm) for men or more than 88 cm for women; triglycerides 150 milligrams per deciliter (mg per dL) or more; high-density lipoprotein cholesterol (HDL-C) less than 40 mg per dL for men or less than 50 mg per dL for women; blood pressure (BP) 130/85 millimeters mercury (mm Hg) or more; and fasting blood glucose 110 mg per dL or more. OBJECTIVE: To evaluate the effect of a pharmacist-physician collaborative practice compared with usual care in the management of patients with metabolic syndrome as defined by the NCEP/ATP III criteria. METHODS: A prospective, randomized controlled trial conducted in family medicine outpatient clinics in Jordan enrolled 199 patients who met the NCEP/ATP III criteria for metabolic syndrome during an enrollment period from March 15, 2009, through May 10, 2009. Patients were randomized into 2 groups, with 110 in the intervention group (pharmacist-physician collaborative practice) and 89 in usual care (physician only). The patients in the intervention group were provided with pharmacist recommendations and pharmaceutical care counseling. Outcome measures included metabolic syndrome status (binomial) and changes in mean values for each metabolic syndrome component (waist circumference, triglycerides, HDL-C, fasting blood glucose, and systolic and diastolic BP) and for body weight. A 2 ￗ 2 contingency table with a Pearson chi-square test was used to assess bygroup differences in metabolic syndrome status after 6 months of followup. In difference-in-difference analyses, t-tests (Mann-Whitney U tests when appropriate) were used to assess by-group differences in changes in the individual metabolic syndrome components and body weight. RESULTS: From baseline to follow-up, 39.1% (n = 43) of intervention group patients versus 24.7% (n = 22) of usual care patients were successfully shifted from a status of metabolic syndrome to no metabolic syndrome (P = 0.032). Three of 7 outcome measures were improved more in the intervention group compared with the usual care group. Mean (SD) triglyceride (mg per dL) declined by 30.9 (54.4) from 189.3 (79.6) to 158.4 (77.3) in the intervention group and by 14.5 (50.7) from 202.5 (88.0) to 188.5 (89.0) in the usual care group (P = 0.029). For the intervention and usual care groups, mean baseline systolic BPs were 134.7 (16.2) mm Hg and 134.6 (12.2) mm Hg, respectively, declining after 6 months follow-up by 12.1 (20.1) mm Hg in the intervention group versus 6.9 (14.6) mm Hg in the usual care group (P = 0.018). Mean baseline diastolic BPs were 83.6 (10.7) mm Hg and 83.6 (7.9) mm Hg, respectively, declining by 7.2 (12.6) mm Hg in the intervention group versus 4.9 (8.1) mm Hg in the usual care group (P = 0.049). CONCLUSIONS: Compared with usual care provided by physicians only, pharmacist involvement in the clinical management of patients with metabolic syndrome increased the proportion of patients who no longer met criteria for the syndrome after 6 months follow-up and improved control of BP and triglycerides.

Improving quality of life in asthmatic children.

OBJECTIVE: To assess quality of life changes in pediatric asthmatic patients switched into a single inhaler device of Budesonide/Formoterol. METHODS: Thirty pediatric patients (ages 6-15 years) with moderate to severe chronic asthma previously treated with inhaled beclometasone dipropionate at a daily dose of 400 g were selected to participate in an open label study. At the baseline- phase (one month), pulmonary function tests (PFTs), indicators of asthma control, and a quality of life assessment (using a special questionnaire) were evaluated. Patients were initiated on a single inhaler device containing budesonide 160 g/formoterol 4.5 microg, one inhalation twice daily instead of their previous inhaled corticosteroid and followed for two months. PFTs, indicators of asthma control, and a quality of life assessment were evaluated at each visit. RESULTS: After switching to the new therapy, patients showed significant changes towards better quality of life in all aspects. The overall score dropped from 1.75+/- 0.04 to 0.80 +/- 0.07 (mean +/- SEM), p< 0.001 (Score scale varies between 0: excellent to 2: very bad Health related quality of life). There was an improvement in the PFTs, where the FEV1% improved from 62.7+/- 2.8 to 87.4 +/- 4.6 (mean +/- SEM), and the FVC% improved from 83.2 +/- 3.5 to 101.9 +/- 5.3 (mean +/-SEM), p < 0.001, and better control of asthma. CONCLUSION: Switching treatment from beclomethasone dipropionate to budesonide/formoterol combination appeared to improve quality of life in the patient population evaluated and in the appropriate clinical indices.