A focus group study of patient’s perspective and experiences of type 2 diabetes and its management in Jordan

Background: Diabetes is increasingly becoming a major health problem in Jordan and glycemic goals are often not achieved. Objective: To explore the patients’ perspectives regarding type 2 diabetes and its management in order to “fine-tune” future pharmaceutical care intervention programs. Method: Focus groups method was used to explore views from individuals with type 2 diabetes attending outpatient diabetes clinic at the Royal Medical Services Hospital. All interviews were recorded, transcribed and analyzed using a thematic analysis approach. Results: A total of 6 focus groups, with 6 participants in each one, were conducted. Participants in the present study demonstrated a great information needs about diabetes and the prescribed treatment. Medication regimen characteristics including rout of administration, number of prescribed medications and dosage frequency in addition to perceived side effects represented the major barriers to medication adherence. In addition to demonstrating negative beliefs about the illness and the prescribed medications, participants showed negative attitudes and low self-efficacy to adhere to necessary self-care activities including diet, physical activity and self-monitoring of blood glucose. Conclusion: Future pharmaceutical care interventions designed to improve patients’ adherence and health outcomes in patients with type 2 diabetes should consider improving patients’ understanding of type 2 diabetes and its management, simplifying dosage regimen, improving patient's beliefs and attitudes toward type 2 diabetes, prescribed medications and different self-care activities in addition to improving patient's self efficacy to perform different treatment recommendations

Prevalence of Torsades de Pointes inducing drugs usage among elderly outpatients in North Jordan Hospitals

Background: Torsade de Pointes (TdP) is an abnormal cardiac rhythm associated with a prolongation of QT interval. Although in most cases it spontaneously returns to the normal rhythm, TdP can lead to sudden cardiac death. Medications are the main cause of QT-prolongation and subsequent TdP flare, even though the exact mechanism of why some people evoke TdP but others do not is still unknown. It is evident that elderly patients are more susceptible to experience drug's side effects especially with chronically used medications. Objectives: To describe the pattern of prescribing drugs with risk of Torsade’s de Pointes among elderly patients who were visiting different outpatient clinics in North Jordan Hospitals. Methods: All patients who were aged ≥65 years old and were visiting outpatient clinics in King Abdullah University Hospital (KAUH) and Princess Basma Hospital (PBH) through December 2016 were included in the study. A total of 5319 patients’ dispending records were collected and analyzed for the prevalence of drug-induced TdP using both Microsoft Excel and the SPSS statistical software. Results: A total of 5319 patients were included in the study, more than half (58.5%, n = 3114) of patients were consuming drugs with risk of TdP. Almost half (49.4%, n = 1539) of these patients were women. The majority of patients (62.3%, n = 1939) were using only one drug with TdP risk. However, other patients were found to take five or six different TdP-inducing drugs. Excluding age and gender, 94.3% (n = 2937) of patients who were using TdP-inducing drugs had at least one additional risk factor of inducing TdP. Conclusion: High usage of TdP-inducing drugs among geriatric patients in North Jordan demonstrated the urgent need for increasing awareness of TdP’s risk induced by commonly prescribed medications. Keywords: Torsdes de pointes, Drug-induced side effects, Jordan, Hospitals, Elderly, Outpatient

Anticholinergic burden risk and prevalence of medications carrying anticholinergic properties in elderly cancer patients in Jordan

Background: Geriatric cancer patients are susceptible to adverse drug events due to the complexity of their chemotherapy regimens and collateral treatments for their comorbid conditions. Prescribing medications with anticholinergic burden characteristics can complicate their condition, leading to negative impacts on their health outcomes and quality of life, including an increase in adverse drug event frequency, physical and cognitive impairments. Objective: This study aims to examine the prevalence of anticholinergic prescribing and identify the cumulative anticholinergic load risk associated with drugs prescribed to elderly cancer patients. Also, to identify the predictors that might lead to raised anticholinergic burden in these patients. Methodology: This retrospective cross-sectional study included elderly patients (age ≥ 65) diagnosed with cancer and admitted to the adult oncology unit at King Abdullah University Hospital (KAUH) in Jordan during the period between (January 1st, 2019, and January 1st, 2022). The medication charts of 420 patients were evaluated for study outcomes. Results: Of the total subjects, females represented 49.3%, and the average age was 72.95 (SD = 7.33). A total of 354 (84.3%) patients were prescribed at least one drug carrying anticholinergic burden properties. Median for anticholinergic medications was 3 (IQR = 4). Our study found that 194 (46.2%) patients were at a high risk of adverse events associated with anticholinergic load (cumulative score ≥ 3). Metoclopramide, furosemide, and tramadol were the most frequently prescribed drugs with anticholinergic properties. Alimentary tract drugs with anticholinergic action were the most commonly encountered items in our study population. Conclusion: Our study revealed a significantly high prevalence of anticholinergic prescribing among elderly cancer patients. Nearly half of the patients were at high risk of developing serious effects related to anticholinergic activity from the drugs administered. Polypharmacy was strongly associated with increased anticholinergic burden score. Evidence-based recommendations utilizing prescribing strategies for safer alternatives and deprescribing of inappropriate medications could reduce such inappropriate prescribing

Protein 14-3-3ζ dimerization is necessary for

<p><b>LNCaP and PC3 cell migration.</b> (A-D) WT-14-3-3ζ and DM-14-3-3ζ expression plasmids or control vector were transfected to LNCaP and PC3 cells. Cells were then subjected to cell migration assay through a scratch made in the monolayer of cells. Bars depict migration of PC3 cells as measured by its scratch recovery. (*<i>p</i><0.001; Δ<i>p</i><0.01; #<i>p</i><0.05; n = 4 of quadruplicates).</p

Rac1 activation is necessary for the Protein 14-3-3ζ-mediated PC3 cell-matrix interactions.

<p>(A-D) WT-14-3-3ζ, DM-14-3-3ζ, CA-Rac1 (L⁶¹) and DN-Rac1 (N¹⁷) expression plasmids and vector, alone or in combinations, were transfected to PC3 cells and serum starved cells were subjected to cell adhesion assay on extracellular matrix proteins such as Fibronectin (FN), Collagen type I (COLL-1), Laminin (LN) and Vitronectin (VN), respectively, with a cell density of 1×10⁴ cells/well in the presence of 10% FBS. Bars depict number of PC3 cells adhered to specific ECM proteins. (*<i>p</i><0.001; Δ<i>p</i><0.01; #<i>p</i><0.05; n = 3 of quadruplicates).</p

Protein 14-3-3

<p>ζ<b>-Rac1 cooperation regulates lamellipodia formation in PC3 cells.</b> (A-B) WT-14-3-3ζ, DM-14-3-3ζ, CA-Rac1 (L⁶¹) and DN-Rac1 (N¹⁷) expression plasmids and vector, alone or in combinations, were transfected to PC3 cells, plated on cell culture chambers in the presence of 10% FBS and fixed at 40 minutes (A) or 16 hours (B) after plating. Paraformaldehyde fixed cells were stained with Alexa Fluor (Red) labeled phalloidin to detect newly polymerized actin cytoskeleton and lamellipodia.</p

Protein 14-3-3ζ expression and dimerization leads to activation of Rac1-p21 activated kinase (Pak1) pathway in prostate cancer cells.

<p>(A) WT-14-3-3ζ, DM-14-3-3ζ, CA-Rac1 (L⁶¹) and DN-Rac1 (N¹⁷) expression plasmids and vector, alone or in combinations, were transfected to PC3 cells and cell lysates were subjected to Western analysis of phosphorylated Pak1. (B) Quantification of the above data by band densitometry analysis. Bars depict Pak1 activity as measured by the levels of phosphorylation. (*<i>p</i><0.001; Δ<i>p</i><0.01; #<i>p</i><0.05; n = 3).</p

Protein 14-3-3

<p>ζ <b>expression increases with oncogenic transformation in prostate cancer cells.</b> (A) Murine TRAMP (TR-C2D, TR-C2 and TR-C2N), human hormone responsive LNCaP as well as hormone insensitive LNCaP C4-2 and PC3 prostate cancer cell lysates were subjected for western blot comparative analysis for 14-3-3ζ expression. (B) Quantification of the above data by band densitometry analysis showing increased expression of 14-3-3ζ in prostate cancer cells compared to non-tumorigenic murine TRC2D cells. (C-E) PC3 cells were transfected with control vector, WT-14-3-3ζ and DM-14-3-3ζ and were subjected to viability (Trypan blue assay), Proliferation (MTT assay) and colony formation assay, respectively. (*<i>p</i><0.001; Δ<i>p</i><0.01; #<i>p</i><0.05; n = 3).</p

Rac1 activation is necessary for the Protein 14-3-3

<p>ζ<b>-mediated PC3 cell migration.</b> (A-F) WT-14-3-3ζ, DM-14-3-3ζ, CA-Rac1 (L⁶¹) and DN-Rac1 (N¹⁷) expression plasmids and vector, alone or in combinations, were transfected to PC3 cells and cells were subjected to cell migration assay on plastic or extracellular matrix proteins such as Fibronectin (FN), Laminin (LN) and Vitronectin (VN), Osteonectin (SPARC) and Bone sialoprotein (BSP; Osteopontin), respectively. Bars depict migration of PC3 cells on various ECM proteins as measured by its scratch recovery. (*<i>p</i><0.001; Δ<i>p</i><0.01; #<i>p</i><0.05; n = 4 of quadruplicates).</p

Protein 14-3-3

<p>ζ<b>-mediated Rac1 activation regulates PC3 cell transendothelial migration.</b> (A-B) WT-14-3-3ζ, DM-14-3-3ζ, CA-Rac1 (L⁶¹) and DN-Rac1 (N¹⁷) expression plasmids, vector control as well as a combination of DN-Rac1 and WT-14-3-3ζ, were transfected to PC3 cells and cells were subjected to transendothelial migration assay <i>in vitro</i> using ECIS. (C) Analysis of transendothelial migration of PC3 cells at 1.5 h after introduction of cells to endothelial monolayer in ECIS array chips demonstrating the role of 14-3-3ζ dimerization on activation of Rac1 in mediating transendothelial migration of PC3 cells (Δ<i>p</i><0.01; #<i>p</i><0.05; n = 5).</p