Patient's compliance on the use of extended low molecular weight heparin post major pelvic surgeries in cancer patients at King Hussein cancer center

Effective Venous Thrombo-Embolism [VTE] prophylaxis is used in less than 50% of oncology patients despite its wide availability. Low molecular weight heparin [LMWH] as a daily injection is an essential tool for effective prophylaxis against deep vein thrombosis [DVT]. Daily outpatient self-injection by the patients or their family members is common practice. The effectiveness of this measure depends on patient compliance. The purpose of this study is to determine the degree of compliance and the factors that affect compliance to the extended out-patient use of prophylactic LMWH for 1 month after major abdominal/pelvic surgeries in cancer patients at King Hussein Cancer Center [KHCC]. Following major abdominal/pelvic surgeries, data on 160 cancer patients at KHCC from January 2007 until July 2012 were collected concerning knowledge of DVT and compliance with prophylactic self-injections by answering a questionnaire. We have achieved a high compliance rate, this was explained by the medical team's role in educating the patients about the risk of VTE and the importance of thromboprophylaxis. The compliance with self-injections was directly associated with younger age, employment and higher degree of education. The high compliance rate outside clinical trials can be achieved through comprehensive patient education by a well-qualified medical team, clarification of the importance of DVT prophylaxis and patients' support

Pancreatic lipase inhibition by papaverine: investigation by simulated molecular docking and subsequent in vitro evaluation

In order to develop safe and effective lipid lowering drug that affecting the absorption of dietary lipids. the pancreatic lipase inhibitory effect of papaverine alkaloid was probed. The investigation included molecular docking to fit papaverine into the binding site of pancreatic lipase employing optimal set of parameters succeeded in retrieving the closest model to the cocrystallized pose. Docking simulation suggested four binding modes for papaverine. The highest ranking binding mode have potential hydrophobic interactions with the key aniino acids Phe-215, Ala-178, Pro-180 and Ala-259 and potential aromatic stacking between isoquinoline ring and Phe-77 and Tyr-114. Moreover, papaverine forms strong hydrogen bonds with the key amino acid Ser-152 in the catalytic triad. Experimentally, papaverine illustrated substantial in vitro inhibitory effect against PL with IC[50] = 36.2 microg/ml [106.6 microM]

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

Characteristics of gastrointestinal stromal tumors in a Middle Eastern population

To demonstrate the immunohistochemical and epidemiological characteristics of gastrointestinal stromal tumors [GIST] in a Middle Eastern population. This is a retrospective analysis of all intra-abdominal mesenchymal tumors [excluding childhood embryonal rhabdomyosarcoma and small round blue cell tumors] collected from the archives of the Pathology Departments of King Hussein Cancer Center, Amman, and King Abdullah University Hospital, Irbid, Jordan between 2001 and 2008. The immunohistochemical profile of all cases was studied at King Hussein Cancer Center, Amman, Jordan, between January and August 2009. Gastrointestinal stromal tumors comprised 45% of the intra-abdominal mesenchymal tumors [42 out of 93 cases], with the most common site being the stomach [n=17, 40.5%]. Twenty-seven GIST cases [64.3%] were classified as high risk, 4 [9.5%] as intermediate risk, 6 [14.3%] as low risk, and 2 [4.8%] as very low risk. Immunohistochemistry showed diffuse and strong positivity [+3] for CD117 in 85.7% of GIST cases, and for CD34 in 65% of cases. The high-risk tumors were more common in male patients [M:F=1.7:1], while the non-high risk tumors were more common in female patients. The immunohistochemical profile of GIST in Jordanian patients is similar to previously published data from other populations, with a slight male preponderance for high-risk GISTs

Bcl-2 gene rearrangement in Jordanian follicular and diffuse large B-cell lymphomas

Follicular lymphoma [FL], a common subtype of non-Hodgkin's lymphoma [NHL] in the West, represents a rare subtype in Jordan. Bcl-2 gene rearrangement plays a crucial role in the biology of the vast majority of FL and a substantial number of diffuse large B-cell lymphoma [DLBCL] in the West; but its presence has not been studied in Jordan. Our aims are to document if bcl-2 gene rearrangement exists in Jordanian FL and DLBCL, and if present to determine whether its frequency among these lymphomas is different from the West and therefore may be responsible for some of the epidemiological differences seen between Jordan and the West. The study was conducted in the year 2001 using polymerase chain reaction [PCR], to detect bcl-2 gene rearrangement in paraffin sections in 5 FL and 23 DLBCL cases diagnosed at the Department of Pathology at Jordan University of Science and Technology, Irbid, Jordan. Two sets of primers including the major breakpoint region [MBR] and the minor cluster region [MCR] were used. Amplifiable DNA was extracted from all cases. Bcl-2 gene rearrangement was seen among 4 [80%] of 5 FL cases, and 8 [35%] of 23 DLBCL cases. The majority of the rearrangements involved the MBR; however, one fourth of cases [one of 4 FL; 2 of 8 DLBCL] with bcl-2 rearrangement involved the MCR. Bcl-2 gene rearrangement was seen in the vast majority of Jordanian FL cases and approximately one third of all DLBCL cases. These figures are similar to those reported in the West, and therefore bcl-2 gene rearrangement does not help in explaining the epidemiological differences of NHL between Jordan and the West. The presence of bcl-2 gene rearrangement in DLBCL may define a subset of lymphomas that may be biologically and clinically unique and different from the rest of DLBCL

Hodgkins' lymphoma in North Jordan. Does it have a different pattern?

To study the pattern of Hodgkin's lymphoma [HL] in North Jordan, identify the epidemiological features of this disease, and to see if these patterns are unique or follow the patterns seen in developed or developing countries. All of the cases of HL diagnosed at the Department of Pathology, Jordan University of Science and Technology, Irbid, Jordan between January 1996 and September 2002 were retrieved and reviewed histologically. Seventy-five confirmed HL cases were classified according to the WHO classification of hematological malignancies. Data on the age and gender of the patients were correlated with those of the histopathologic types of the disease. Patients range in age from 3-72 years with a median of 20 years. The young adult population [15-34 years] was the largest group in this study accounting for 45.9% of all cases followed by the childhood group [0-14 years], which accounted for 25.6% of the cases. The age distribution displayed only one peak between 11 and 20 years. Classic HL accounted for 91% of the cases, half of these cases belong to the mixed cellularity [MC] type and 46% belong to the nodular sclerosis [NS] type. The overall male to female ratio was 1.7:1; but the ratio was the highest [3.75:1] among children, and reversed among patients with NS type in the young adult group [0.78:1]. The MC and NS types of HL accounted for the vast majority of HL in North Jordan. Similar to other developing countries the MC type of HL was the most common type followed by the NS type. The age distribution displayed a unimodal pattern with a peak between 11 and 20 years of age, which is a decade earlier than the first peak seen in the West. This pattern is also different from developing countries, where HL peaks in children less than 10 years of age. Hodgkin's lymphoma in Jordan appears to have an intermediate pattern between developing countries and the West

Non-Hodgkin Lymphoma in Jordan. Types and patterns of 111 cases classified according to the WHO classification of hematological malignancies

Non-Hodgkin lymphoma [NHL] is one of the most frequent malignancies in Jordan. The aims of this study are: 1. To classify NHL cases in Jordan, using the new World Health Organization [WHO] classification system, 2. To identify the most common types of NHL in Jordan, and 3. To compare lymphoma types and patterns in Jordan with those in surrounding countries and the West. We studied all NHL cases, diagnosed during 1996 through to 1999 inclusive, at 2 major medical centers in Jordan, in order to identify their main types and patterns. One hundred and eleven cases of confirmed NHLs were reexamined and immunophenotyped in the year 2000, at the Department of Pathology, Jordan University of Science and Technology, Irbid, Jordan, using an immunohistochemical panel of antibodies, including CD3, CD15, CD20, CD30, CD43, CD45 and CD45RO. Confirmed NHL cases were reclassified according to the recently proposed WHO system of Hematological Malignancies. The median age of NHL cases was 44-years [range 2-85]. The vast majority of cases were of B-cell phenotype; only 14% of the cases were T-cell lymphomas. Most of the cases were of the aggressive intermediate to high-grade large cell type. Diffuse large B-cell lymphoma [DLBCL] comprised 53% of NHLs and 62% of B-cell NHLs. Indolent lymphomas were uncommon, comprising 14% of all NHL cases. Twenty-nine cases were seen among patients less than 20-years. Burkitt lymphoma represented the largest group [55%] of the childhood NHLs followed by diffuse large cell and lymphoblastic types. Indolent lymphomas are rare in Jordan and account for less than 15% of all NHLs. Aggressive lymphomas; on the other h and, account for the majority of NHLs in Jordan. Burkitt lymphoma affected children less than 10-years of age with a median of 4.5-years. These observations indicate that NHLs in Jordan have different type distribution and patterns from those seen in the West

Epstein-barr virus expression in Hodgkin's disease in Jordan

Epstein-Barr virus [EBV] has been associated with many hematopoietic malignancies including Hodgkin's disease [HD]. The association of HD correlates with the histologic subtype, age of presentation and geographic location. Our aims were to find out if EBV is associated with Jordanian HD; and if EBV association exists, to determine its relationship to certain age groups or specific histologic subtypes of HD; and finally to establish whether such association follows patterns seen in developing or developed countries. We have examined 64 cases of HD diagnosed in 2 major medical centers in Jordan for evidence of EBV association. We used immunohistochemistry and in-situ hybridization techniques to detect latent membrane protein [LMP-1] and Epstein-Barr virus encoded RNA [EBER] in the Reed-Sternberg cells. The study was conducted at the Department of Pathology, Jordan University of Science and Technology, Irbid, Jordan in the years 2000 and 2001. Epstein Barr virus was seen in 47% of our cases: 22 [65%] of the 34 mixed cellularity and 8 [29%] of 28 nodular sclerosis HD. None of our 2 lymphocyte predominant HD cases showed evidence of EBV. Epstein-Barr virus was seen in 73% of HD cases in children below 15 years of age as opposed to 34% of the young adult group. Our results confirm the presence of EBV in Jordanian HD in approximately half of the cases, a figure close to those reported in the West. Epstein-Barr virus association with HD in Jordan is seen mostly in the mixed cellularity subtype and childhood HD

role of young population structure in determining age distribution of breast cancer in Jordan

Previous reports noted a high proportion of young Jordanian breast cancer [BC] patients. This study was performed to find whether this is reproducible and to examine the role, if any, of a young population structure in causing this. We hypothesized that the age distribution [AD] of BC in Jordan is independent from the population structure. By finding that the AD of BC in a model population, where the population structure of Jordan is similar to the USA, was significantly different [P = 0.01] from the observed AD in Jordan, we rejected this hypothesis. We conclude that a young population structure, as well as a low incidence in older patients, are the main reasone behind a high proportion of young patients with BC in Jordan. This may also be valid in other countries having an early onset/low incidence rate of BC

Assessing predictors of outcome in necrotizing fasciitis at Jordan University Hospital

Necrotizing fasciitis is a life threatening infection characterized by rapidly developing necrosis of the subcutaneous tissue and fascia with subsequent gangrene of the overlying skin. Necrotizing fasciitis [NF] is increasingly being diagnosed at Jordan University Hospital [JUH] with an apparent difference in the bacteriology of this disease. The aim of this study was to examine the presentation, etiology, course of the disease, treatment, and to identify the variables that are associated with high mortality. Information on the presentation, etiology, treatment, pathology and complications in all cases diagnosed with necrotizing fasciitis from January 1987 to January 1998 A total of 23 patients underwent surgical exploration for necrotizing fasciitis during the study period. Six variables identified that significantly increased the risk of death from necrotizing fasciitis: Age above 60 years, female sex, perineal location, delayed operative management, white blood cell count more than 30,000 cell per mm[3] and infection mainly with Gram negative [G-ve] bacteria species. This study suggests that necrotizing% fasciitis is a serious and potentially fatal infection particularly in old, female patients presenting with perineal infection, high WBC count, and Gram negative [G-ve] bacterial isolates. Early diagnosis, aggressive initial debridement and redebridement in addition to adequate nutritional support and antibiotics are the mainstay of treatment