Awareness of combined oral contraceptives use among Jordanian women: A cross-sectional study

Purpose: To investigate Jordanian women’s knowledge, attitude, awareness and practice regarding combined oral contraceptives (COCs) benefits and risks.Methods: A cross-sectional study was conducted on 300 Jordanian women attending the Obstetrics and Gynecology clinics at Jordan University Hospital, Amman, Jordan. A closed- and open-ended questionnaire was used to explore Jordanian participants' knowledge, attitude and practice regarding COCs use, effect and side effects. Structured interviews were conducted by a trained research team. Thus, it was a pharmacist-assisted survey, and lay language was used to explain difficult medical terminologyResults: Most of participants were prescribed COCs by their physicians (77.1 %), half of them depend on others' experiences and media as sources of information rather than consulting their healthcare team. Half of participants have an idea of non-contraception uses of COCs (50.3 %). One fourth of women (26.0 %) believed that using COCs decreases fertility or even causes infertility, especially if used before their first pregnancy (43.3 %). Women in their middle age were more uncertain about the relation between COCs use and anemia (p = 0.014) or dysmenorrhea pain (p = 0.005). While women who used COCs believed more that the pills regulate menstruation (p < 0.001) and decrease dysmenorrhea pain (p < 0.001) compare with women who had never used COCs pills. Women in general are uncertain if COCs use has negative or positive relation with some types of cancer such as ovarian, cervical and breast. Women who are not affiliated to the healthcare professions were more uncertain about the relation between COCs use and atherosclerosis risk (p = 0.002), MI (p = 0.025) and stroke risk (p = 0.035).Conclusion: There is insufficient awareness and knowledge of the beneficial and non-contraceptive uses of COCs. Educational programs are needed to improve women’s awareness of the benefits and risks of COCs. Keywords: Combined oral contraceptives, COCs, Knowledge, Attitude, Practice, Beliefs, Benefits, Risk

Pregabalin Dispensing Patterns in Amman-Jordan: an Observational Study from Community Pharmacies

Objectives Pregabalin is currently approved for the treatment of epilepsy, generalized anxiety disorder, neuropathic pain and fibromyalgia. Rising attention to the abuse liability of pregabalin causing addictive behaviors is partially based on case reports and published literature of pregabalin used in dosages that override the approved therapeutic range. This study was conducted to provide background data regarding the abuse/misuse of pregabalin from community pharmacy in Jordan. Methods A prospective cross-sectional observational study design was used, which was conducted at different community pharmacies in Amman-Jordan. During the study period (November 2016-January 2017), a total 77 requests for pregabalin were observed from 14 pharmacies. A structured interview was conducted with all customers to gather information regarding their demographic and their request of pregabalin. Results A total of 77 pregabalin requests form 77 customers in a community pharmacy setting were observed in this study. Spinal disc herniation was the most common complaint for which the customer asked for the medication (n= 27, 35.1%). Self-medication was the most frequent method of requesting pregabalin (n= 44, 57.1%), while a total of 33 customers (42.9%) asked for the product using a prescription. During the observation period the number of customers suspected of abusing pregabalin for non-medical reason was 35 (45.5%). A total of 33 out of the 35 suspected customers (94.3%) asked for the product without a prescription, and 19/35 weren‘t sold due to suspicion of abuse (54.3%). Conclusion The study underscores the need for regulatory efforts to manage pregabalin abuse, through the addition of pregabalin containing products to the controlled drug list which can’t be purchased without a prescription. Also, pharmacists and customers must be educated at a community pharmacy level regarding potential hazards of pregabalin abuse

Ophthalmic drug abuse: An observational study from community pharmacies

Background: There has been a trend in the past five years in Jordan for ophthalmic anticholinergic preparations to be misused or abused. This is done mainly to experience mental altering effects such as mood changes, euphoria or hallucinations. Such products are mostly obtained from community pharmacies without a prescription. Objectives: This study aimed to observe the requests of ophthalmic preparations in community pharmacies in Amman, Jordan, and evaluating the most popular and frequently requested ophthalmic drops suspected of abuse. Also, it aimed to describe the current methods that Jordanian community pharmacists use to manage such requests. Methods: A prospective cross-sectional observational study was conducted between November 2016 and January 2017 at sixteen different community pharmacies in Amman. All ophthalmic products requested were observed during this period. Results: A total of 140 ophthalmic product requests for 130 customers were observed. Dry eye was the most common complaint for which the customer requested the medication (n = 30, 23.1%) and direct self-medication (ie-requesting the product by name), was the most frequent method of purchase (n = 63, 48.5%). In 19 cases (14.6%), product requests were suspected to be for non-medical (ie-abuse) purposes. Most of the suspected cases were for Pentolate® (n = 11, 57.9%), whereas 7 were for Prisoline® (36.8%) and 1 for Naphcon-A® (5.3%). The majority of observed cases were for products requested without a prescription (n = 16, 84.2%), and in 12 cases out of which, sale was refused (63.2%). Conclusion: More effort and enforcement of pharmacy regulation for safe dispensing is needed to reduce the abuse of ophthalmic products. Educating pharmacists and ophthalmologists would help raise awareness and control the type of drug abuse. © 2019 Elsevier Inc

Knowledge and perceptions of the risks of non-steroidal anti-inflammatory drugs among orthopaedic patients in Thailand

Background There is a high incidence of adverse effects from non-steroidal antiinflammatory drugs (NSAIDs) in Thailand, but patients’ perceptions and knowledge of NSAID risks is unknown. Objective This study aims to assess patients’ perceptions and knowledge of NSAID risks and factors affecting them. Setting University hospital in North-East of Thailand. Method A Cross-sectional study conducted over 4 months, using a self-administered questionnaire. Patients prescribed NSAIDs for at least one month duration from orthopaedic clinic were recruited using systematic random sampling. Main outcome measure Patients’ perceptions on NSAID risks, knowledge on risk factors, and their associated factors. Results A total of 474 questionnaires were assessed. Overall perceptions of risks was low (scoring below five on a 0–10 visual analogue scale), with risks associated with the renal system scoring highest. Perceived risk of gastrointestinal problems differed between patients using non-selective and selective NSAIDs (3.47 ± 2.75 vs 2.06 ± 2.98; P < 0.001). Receiving side effect information from a health professional was associated with higher risk perception. Most patients (80 %) identified high doses, renal disease and gastrointestinal ulcer increased risks of NSAIDs, but fewer than half recognized that use in the elderly, multiple NSAID use, drinking, hypertension and cardiovascular disease also increased risk of adverse events. Having underlying diseases and receiving side effect information were associated with 1.6–2.0 fold increased knowledge of NSAID risks. Conclusion Perceptions and knowledge concerning NSAID risks was generally low in Thai patients, but higher in those who had received side effect information. Risk-related information should be widely provided, especially in high-risk patients

Topiramate Monotherapy in Infantile Spasm

Infantile spasm is an age-related refractory epilepsy. Topiramate is a new anticonvulsant with multiple mechanisms of action, and it may be effective for treating pediatric epilepsies. To evaluate the efficacy and tolerability of first-line topiramate treatment for infantile spasm, 20 patients received topiramate monotherapy during this study. They were treated with an initial dose of 1 mg/kg/day, with a progressive titration of 1 mg/kg a week until their spasms were controlled and a maximum dose of 12 mg/kg/day was achieved. The evaluation of the treatment efficacy was based on the spasm frequency data that was obtained by the scalp and video-EEG, and by the parental count of spasm. Thirty percent of the subjects became spasm-free during the study. Six of 20 subjects (30%) had cessation of spasm and disappearance of hypsarrhythmia as seen via the video EEG; four (50%) of eight idiopathic patients had a response, whereas two (17%) of 12 patients with symptomatic infantile spasm responded. Seventy of the patients, including the spasm-free patients, had a reduction in their seizure frequency of more than 50%, and 10% of the patients had a reduction in their seizure frequency of less than 50%. The clusters of spasm frequency decreased from 10.6 ± 8.5 to 3.5 ± 1.4 clusters/day. Topiramate is effective and tolerated in those patients suffering from infantile spasm. Our results suggest that this drug should be considered as a new first-line drug for treating infantile spasm

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Activation of G protein-coupled inward rectifier potassium channels in cultured brain neurons.

Activation of G protein-coupled inward rectifier potassium channels in cultured brain neurons

The Role of the Clinical Pharmacist in the Identification and Management of Corticophobia – An Interventional Study

Purpose: To explore patients' attitudes and knowledge about  corticosteroids, investigate the reasons behind corticophobia (if any), explore the sources and validity of such beliefs, as well as investigate therole of the clinical pharmacist’s intervention in minimizing corticophobia and improving patient compliance.Methods: The study adopted 2 methodologies: a structured interview  technique with patients selected according to inclusion criteria, and a pre- and post-intervention to measure the effect this intervention may have had on patients’ compliance, fear and general behavior towards corticosteroids.Results: A total of 204 patients were interviewed, most of whom (56.9 %) were female, 41.2 % had several chronic diseases and 41.7 % used  steroids for the first time. Fourteen percent of respondents did not know why they had been prescribed corticosteroids. The main source of information about corticosteroids was reported to be "friends and family" (37.7 %) while the main reasons for corticophobia were reported to be theoretical/potential adverse drug reactions (ADRs, 38.5 %), actually experienced ADRs (24.6 %), or the fact that they had heard that  corticosteroids were harmful (8 %). The clinical pharmacist's intervention significantly improved patients' compliance and decreased corticophobia (p &lt; 0.001), but it did not significantly affect their general behavior towards corticosteroids (p = 0.07).Conclusion: In general, patients' sources of information about  corticosteroids may be unreliable or invalid; creating a poor background and subsequently lead to corticophobia and poor compliance. Clinical pharmacist intervention has a significant impact on lowering patents' fear of corticosteroids, and improving their compliance with corticosteroids treatment regimens.Keywords: Corticosteroids, corticophobia, patient compliance, structured interview, steroids, adverse drug reactio