Pharmacist’s knowledge,practice and attitudes toward pharmacovigilance and adverse drug reactions reporting process

Background

Adverse drug reactions (ADRs) are a major cause of drug related morbidity and mortality. Pharmacovigilance is the science that plays an essential role in the reduction of ADRs, thus the evolution and growth of this science are critical for effective and safe clinical practice.

Objectives

This study is considered the first study in the region to evaluate pharmacist’s knowledge, practice and attitudes toward ADRs reporting after establishing the national ADRs reporting center in Jordan.

Method

A cross sectional study was used to evaluate pharmacist knowledge and attitude toward ADRs reporting. A structured validated questionnaire was developed for this purpose and a total of 208 pharmacists were recruited to participate in this study.

Results

The majority of pharmacists have insufficient awareness and lack of knowledge about pharmacovigilance and ADRs reporting. Also the rate of reporting of ADRs was extremely poor. Several factors were found to discourage pharmacists from reporting ADRs, which include inadequate information available from the patient, unavailability of pharmacist ADRs form when needed, unawareness of the existence of the national ADRs reporting system. Also pharmacists think that ADRs are unimportant or they did not know how to report them.

Conclusion

The results of this study suggest that pharmacists have insufficient knowledge about the concept of pharmacovigilance and spontaneous ADRs reporting. On the other hand, pharmacists had positive attitudes toward pharmacovigilance, despite their little experience with ADRs reporting. Educational programs are needed to increase pharmacist’s role in the reporting process, and thus to have a positive impact on the overall patient caring process.     

Low temperature synthesis of BiFeO3 nanoparticles with enhanced magnetization and promising photocatalytic performance in dye degradation and hydrogen evolution

In this investigation, we have synthesized BiFeO₃ nanoparticles by varying hydrothermal reaction temperatures from 200 °C to 120 °C to assess their visible-light driven photocatalytic activity along with their applicability for hydrogen production via water splitting. The rhombohedral perovskite structure of BiFeO₃ is formed for hydrothermal reaction temperature up to 160 °C. However, for a further decrement of hydrothermal reaction temperature a mixed sillenite phase is observed. The XRD Rietveld analysis, XPS analysis and FESEM imaging ensure the formation of single-phase and well crystalline nanoparticles at 160 °C reaction temperature with 20 nm of average size. The nanoparticles fabricated at this particular reaction temperature also exhibit improved magnetization, reduced leakage current density and excellent ferroelectric behavior. These nanoparticles demonstrate considerably high absorbance in the visible range with a low band gap (2.1 eV). The experimentally observed band gap is in excellent agreement with the calculated band gap using first-principles calculations. The favorable photocatalytic performance of these nanoparticles has been able to generate more than two times of solar hydrogen compared to that produced by bulk BiFeO₃ as well as commercially available Degussa P25 titania. Notably, the experimentally observed band gap is almost equal for both bulk material and nanoparticles prepared at different reaction temperatures. Therefore, in solar energy applications, the superiority of BiFeO₃ nanoparticles prepared at 160 °C reaction temperature may be attributed not only to their band gap but also to other factors, such as reduced particle size, excellent morphology, good crystallinity, large surface to volume ratio, ferroelectricity and so on.

Multiferroic BiFeO₃ nanoparticles were synthesized using low temperature hydrothermal technique to assess their visible-light driven photocatalytic activity along with their applicability for the production of hydrogen via water splitting.     

Horizontal Condylar Path in Patients with Disk Displacement with Reduction

In 32 patients with disk displacement with reduction, the condylar path in the horizontal plane during opening and closing movements of the mandible were analyzed with a computerized axiograph. The horizontal condylar tracings during opening were divided into 15 types. There was no clear relationship between the types and clinical symptoms. The specific correspondence of the types were revealed between the right and left joint. In 21 of 32 patients, the condyle on one side deviated medially, while the contralateral condyle deviated laterally at maximum opening. In most of the patients showing medio-lateral condylar deviation at maximum opening, a straight condylar path was observed from the maximum opening to the position just before the closing click. In some of the patients, the type of horizontal condylar tracing during opening was related to the displacement pattern of the disk assessed by magnetic resonance imaging (MRI).     

Evaluation of natural killer cells as diagnostic markers of early onset neonatal sepsis: comparison with C-reactive protein and interleukin-8

This study was conducted on thirty-seven neonates and healthy neonates (sixteen full term and fourteen preterm). The study aimed at revealing the role played by the NK cells in neonatal sepsis and evaluating the sensitivity of NK cell number and cytotoxicity as diagnostic markers in infants with suspected early neonatal sepsis compared with the circulating cytokine IL-8 and CRP levels. All samples of peripheral blood lymphocytes were subjected to determination of CD16 and CD56 positive cells using flow cytometry and NK cytotoxicity using the standard 4h 51Cr release assay. Sera were separated to measure IL-8 using ELISA. Determination of CRP, using turbdimetric assay, as well as blood cultures were done for patient's group only. Out of the 37 cases of suspected early neonatal sepsis, 16 were given final diagnosis of sepsis. Seven infants (43.8%) in the sepsis group had culture-proven diagnosis, one of which had meningitis. The median CRP value was significantly higher in sepsis group (88 mg/L; range: 17-159 mg/L) compared with that in non-septic group (15.4 mg/L; range: 7.6-23.2 mg/L, p < 0.001) only 12-60 h after admission. On the other hand, newborns in the sepsis group had significantly higher serum levels of IL-8 (median 310 pg/mL; range: 37-583 pg/ml) at study entry than that in the non septic group (median 63 pg/mL; range: 32-94 pg/ml, P < 0.001). On admission, the NK activity, rather than the number of CD16 and CD56 positive cells was much affected where NK cytotoxicity was significantly lower in sepsis group (3.4 +/- 2.1%, range 0.9-7%) than that of the nonseptic group (18.3 +/- 6.7%: range 10.7- 25.3%, p < 0.01) and healthy neonates (23.8 +/- 4.7%: range 12.2-32.3%, p < 0.001). We may conclude that defective NK cell activity rather than NK cell number plays an important role in susceptibility to early onset neonatal sepsis. Evaluation of NK cytotoxicity as a marker in early diagnosis of neonatal sepsis reveals that the sensitivity, specificity and predictive values of reduced NK cytotoxicity (10% killing) was higher than both of CRP and IL-8, either individually or in combination. Additionally, reduced NK cytotoxicity showed high correlation with the severity and outcome of neonatal sepsis. Our data raise the possibility that the addition of NK cell activity to the standard work-up of critically ill patients with suspected sepsis could increase diagnostic certainty and generate an improved patient management.     

Proinflammatory cytokines (IL-12 and IL-18) in immune rheumatic diseases: relation with disease activity and autoantibodies production

Interleukin-18 (IL-18) and its inducer IL-12 have multiple biological activities that are important in generating Th1 responses and inflammatory tissue damage. We investigated serum concentration of the novel proinflammatory Th1 cytokine; IL-18, and its inducer IL-12 in patients with immune rheumatic diseases. Group I comprised32 patients of systemic lupus erythmatosus (SLE), Group II comprised 36 patients of rheumatoid arthritis (RA). Group III comprised 9 patients (2 patients of Behcet, 2 patients of Dermatomyositis, 2 patients of Sicca syndrome, one patient of Scleroderma, and 2 patients of Mixed connective tissue disease). Group IV is a control group consists of 21 sex and age matched healthy subjects and correlated their levels with autoantibody concentration (ANA and ds-DNA), clinical grades and SLE disease activity index (SLEDAI). Serum IL-18, IL-12, ANA and ds-DNA were measured by enzyme immuno sorbent assay. IL-18, IL-12 and ANA were significantly higher in the three studied groups than in the control group (IL-18; P < 0.001 in the three groups, IL-12; P = 0.019, P = 0.002, and P = 0.006, and ANA; P < 0.001, P = 0.002,and P = 0.006, respectively).ds-DNA was significantly higher in SLE patients than in control group (P < 0.001). There were significant positive correlations between; A) levels of IL-18,and both ANA and ds-DNA in SLE patient (r = 0.41,P = 0.001, r = 0.58 and P=0.001 respectively); and B) IL-18 and ANA in both RA and group III patients (r = 0.32, P = 0.005, r = 0.61and P = 0.022 respectively). Also, there were significant positive correlation between the levels of IL-18 and clinical grades of the three groups (r = 0.60,P = 0.001, r = 0.79,P = 0.001, r = 0.78 and P= 0.001 respectively). In SLE patients , IL-18 concentration shows significant positive correlation with SLEDAI score (r = 0.76, P = 0.001). In conclusion, the elevation of proinflammatory cytokines (IL-18 and IL-12 ) may trigger the inflammatory process in immune rheumatic diseases and IL-18 is correlated with disease activity     

Targeted delivery of thermoresponsive polymeric nanoparticle-encapsulated lycopene: in vitro anticancer activity and chemopreventive effect on murine skin inflammation and tumorigenesis

Naturally occurring lycopene has been reported for its chemopreventive and chemotherapeutic efficiency in various cancers, but its exceptional lipophilicity, poor aqueous solubility, instability, and consequently poor bioavailability limit its usage as a chemopreventive and chemotherapeutic agent. The present study aimed to synthesize co-polymeric nanoparticle-encapsulated formulations of commercial lycopene (NLY) and extracted lycopene (NLX) and evaluate their in vitro anticancer activity and inhibitory effect on 12-O-tetradecanoylphorbol-13-acetate (TPA)-promoted skin inflammation and tumorigenesis in Swiss albino mice. To prepare the nanoparticle-encapsulated formulations of lycopene, thermosensitive PNIPAAM–PEG-based co-polymeric nanoparticles were synthesized and characterized by FTIR spectroscopy, NMR spectroscopy, DLS, and TEM. Nanolycopene, unlike free lycopene, could be readily dispersed in aqueous media. Nanolycopene demonstrated stronger antioxidant activity and comparable in vitro anticancer efficacy to free lycopene against the melanoma cell line B16. Furthermore, nanolycopene showed comparable reduction of TPA-induced skin edema, expression of COX-2, and oxidative stress response. Additionally, it showed significant inhibition of tumor promotion. It also altered Bax and Bcl2 expressions, which led to the induction of apoptosis. The results also supported that the extracted lycopene-encapsulated nanoparticles may be a good alternative to the expensive commercial lycopene for cancer treatment.

Nanolycopene demonstrated strong antioxidant activity and enhanced chemopreventive effect on skin tumorigenesis in mouse.     

Therapeutic and cosmetic applications of mangiferin: an updated patent review (patents published after 2013)

Introduction: Mangiferin and its derivatives possess diverse biological activities and desirable drug like properties. In continuation with the authors’ previous publication, the present study reviews recently published patents in correlation with efforts of drug development using mangiferin.

Areas covered: Patents published after the year 2013 were analyzed for therapeutic and cosmetic applications of mangiferin, its salts, derivatives, and preparations. Patent information pertaining to improving solubility and bioavailability of mangiferin and related bioactives has also been presented. Methods of extraction of mangiferin and poly herbal preparations have not been included. Biological testing data has been put forth to understand the clinical trial status of products comprising mangiferin and/or its derivatives.

Expert opinion: Mangiferin has been highlighted as a multitarget bioactive with therapeutic potential. Research efforts in the recent years have contributed to development of new mangiferin derivatives as well as mangiferin formulations with enhanced solubility and bioavailability. Improvements in drug delivery systems for mangiferin might contribute to designing clinical trials to validate its therapeutic potential in humans. Majority of the recent patents have been filed by Chinese inventors claiming second medical use of mangiferin or its related compounds. However, a number of these patents remain in the prosecution stage.     

Cardiovascular symptoms in coronary-artery disease patients are strongly correlated with emotional distress

BACKGROUND: The relationship of cardiovascular events and cardiovascular symptoms is unclear, and physical symptoms, including most cardiovascular symptoms, are known to be influenced by emotional distress. OBJECTIVE: Authors examined the relative strength of association of multiple measures of emotional distress and accepted cardiac risk factors with five common cardiac symptoms (chest pain, fatigue, palpitations, presyncope, and dyspnea). METHOD: The authors tested the association of multiple cardiovascular symptoms with various measures of emotional distress (i.e., the scales of the Symptom Checklist-90-Revised) and the putative risk factors for disease status in 109 patients with documented coronary artery disease. RESULTS: Measures of emotional distress were stronger correlates of patient-rated distress due to the symptoms than were traditional risk factors. CONCLUSION: Treatment of emotional distress may be a viable strategy for symptom-control in cardiovascular disease.     

Primary therapy for small cell lung cancer reversing the Eaton-Lambert syndrome

We have described a patient with small cell cancer of the lung manifested as the Eaton-Lambert syndrome. Primary therapy proved effective in reversing the syndrome, whereas anticholinesterase agents did not. This case illustrates the value of primary therapy for the tumor-produced syndrome and the need to avoid losing time with symptomatic therapy.