Assessing mental health literacy in Jordan: a factor analysis and Rasch analysis study.

Background: Mental health literacy (MHL) research in Jordan is sparse and validated MHL measures are lacking. The present study validated a Jordanian version of the Mental Health Literacy Scale (MHLS) and examined Jordanian individuals' MHL. Method: A Google Forms survey was designed, and the link was shared through various Jordanian social media platforms. Factor analysis and Rasch analysis were performed to validate the Jordanian version of the MHLS. Binary logistic regression was performed to assess variables associated with MHL. Results: The Jordanian MHLS was administered to 974 participants (74.4% females; median age 27 years). The mean MHL score of the participants was 71.1% indicating average literacy levels. The factor analysis indicated that 27 items distributed across four factors had the best model fit. The Rasch analysis confirmed item separation reliability and person reliability. The regression showed a correlation between educational attainment, income, marital status and MHL level. These findings emphasize the role of educational attainment in MHL, pointing to the necessity of integrating mental health education into formal curricula to enhance MHL across all societal levels. Stigma and limited-service availability act as barriers to mental health service and access, which compound the challenge of improving MHL. Targeted educational interventions and policy reforms may help improve MHL, thereby contributing to improving mental health outcomes in Jordan and potentially other similar settings.

Evaluating the Validity of International Standards of Height, Weight, and Body Mass Index on Jordanian Children and Adolescents.

BACKGROUND: the variations in a child's overall body shape and figure among different countries are attributable to differences in genetics, environmental factors, and the interaction between these elements. This study aims to evaluate the validity, reliability, and appropriateness of applying international growth standards to Jordanian children and adolescents aged 2-19 years old. METHODS: 65,828 Jordanian children and adolescents (43% males; 57% females) aged 2-19 years old were selected from the Hakeem Program database and various private schools across Jordan. Height-for-age, weight-for-age, and body mass index (BMI)-for-age were analyzed comparatively for Jordanian children and adolescents against international growth standards. The z-score for each record was computed based on international equations. RESULTS: Mean z-scores for height-for-age, weight-for-age, and BMI-for-age for both genders showed significant deviation from international standards across most age intervals. It was found that in most age groups, Jordanian children and adolescents were shorter and lighter than CDC and WHO standards, except for females at ages ≥ 16 years, who were heavier with higher BMI-for-age values than CDC standards based on weight-for-age and BMI-for-age equations. Moreover, Jordanian males at ages ≥ 12 years had lower BMI-for-age values than CDC standards. CONCLUSIONS: Jordanian children and adolescents showed significant deviations in their measurements from international standards and growth reference values. The development of a population-specific growth chart is highly recommended to enhance the accuracy of evaluating children's and adolescents' wellness.

The Clinical Impact of Paravalvular Leaks With Transcutaneous Aortic Valve Implantation (TAVI) Versus Surgical Aortic Valve Replacement (SAVR): A Systematic Review and Meta-Analysis.

BACKGROUND: Aortic valve stenosis is a common cardiac condition that requires intervention for symptomatic and/or prognostic reasons. The two most common interventions are surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). The ratio of TAVI:SAVR has increased twofold over the past few years and is now being considered in intermediate-risk patients as well. One of the significant benefits of TAVI is that it is less invasive; however, one of the drawbacks is a high paravalvular leaks (PVLs) rate compared to SAVR. To assess the impact of PVLs on survival, progression of heart failure, and the need for re-intervention. METHOD: We conducted a comprehensive systematic literature search from the conception of TAVI 2002 until December 2022 through Embase (Ovid), MEDLINE (Ovid), Science Direct, and CENTRAL (Wiley). We followed PRISMA guidelines and checklists. Review protocol registration ID in PROSPERO: CRD42023393742. RESULTS: We identified 28 studies that met our eligibility criteria, and only 24 studies were suitable for pooling in a meta-analysis (including their hazard ratio with a confidence interval of 95%) assessing our primary outcome (all-cause mortality). The remaining four studies were narratively synthesised. RevMan V5.4 (Version 5.4. Cochrane Collaboration, 2020) was utilised to pool meta-analysis data to assess effect estimates of PVLs in both intervention arms, using a random effect model for calculation (hazard ratio 1.14 confidence interval 95% 1.08-1.21 [p<0.0001]), with a follow-up duration between 30 days to 5 years. CONCLUSION: Patients with mild or higher degrees of PVLs in both intervention arms incurred unfavourable outcomes. The incidence of PVLs was significantly higher with TAVI; even a mild degree led to poor quality of life and increased all-cause mortality on long-term follow-up.

Sex Differences in Withdrawal-Induced Anxiety in Rats After Exposure to Tobacco Smoke.

Nicotine, a component of cigarettes, possesses strong reinforcing properties and improves cognitive function, which can lead to dependence. Upon cigarette smoking cessation, withdrawal symptoms occur and may cause an individual to relapse. Affective withdrawal symptoms, such as anxiety, is of great concern as studies have shown its ability to cause relapse in men and women. In this in vivo study, anxiety resulting from smoking cessation after 2-day smoke-free intervals per week for the duration of 4 weeks was investigated in 8 male and 8 female rats after their exposure to cigarette smoke compared to unexposed control rats (8 males and 8 female rats). The anxiety in rats during smoke-free intervals was investigated using an elevated plus-maze (EPM), open-field (OF), and light/dark test (LD). In all tests male rats exhibited significantly higher anxiety symptoms compared to female rats during nicotine withdrawal, despite control rats showing no differences. In the EPM, male rats spent less time in open arm as well having as lower number of crossings than female rats. As for the OFT, the amount of time spent in the center of the open field was also lower in male rats than female rats. In the LD test, the time spent in the light chamber and the latency (delay) to enter the dark chamber was lower in male rats compared to female rats. Our study showed that male rats show greater nicotine withdrawal effects, in terms of anxiety-like behavior than female rats.

An Online-Based Survey to Assess Knowledge, Attitudes, and Barriers to Perform First Aid after Road Accidents Conducted among Adult Jordanians.

(1) Background: First aid administered during road accidents can save millions of lives. However, the knowledge and attitudes of the Jordanian population towards first aid are lacking. This study aimed to examine the knowledge, attitudes, and barriers to performing first aid among the Jordanian population during road accidents. (2) Methods: An online questionnaire was developed and distributed using various Jordanian social media platforms. The questionnaire collected the participants' sociodemographic details and assessed their first aid knowledge, attitudes toward first aid, and barriers preventing the participants from performing first aid in emergencies. (3) Results: 732 participants participated in this study. The median knowledge score regarding first aid items was 9 (7-10) out of the maximum possible score of 15. The median first aid attitude score was 24 (22-27) out of a maximum possible score of 30. The most commonly reported barrier to performing first aid among the participants was "lack of first aid training" (76.78%), followed by "lack of knowledge about first aid" (75.81%) and "fear of performing first aid" (57.51%). The participants with lower income levels exhibited more negative attitudes towards first aid (4). Conclusions: This study underscores the urgent need for enhanced first aid training and awareness in Jordan. The participants' first-aid knowledge overall was limited, although positive attitudes toward first-aid delivery were observed. The findings emphasize the need for regular and structured first-aid training courses, addressing barriers such as fear and misinformation and ensuring accessibility across all socioeconomic levels to improve preparedness for road traffic accidents and other emergencies. This comprehensive approach can better equip the Jordanian population to effectively manage emergencies and improve public health outcomes.

Triglyceride Glucose Index as an Indicator of Cardiovascular Risk in Syrian Refugees.

Background: The triglyceride glucose (TyG) index is a quick and inexpensive approach to measure insulin resistance. The aim of this study was to evaluate the TyG index's ability to predict cardiovascular risk and determine the TyG index cutoff values in Syrian refugees. Methods: A retrospective research study was conducted with 756 Syrian refugees. Data on demographics and clinical laboratory assessments were obtained from refugee's files. The formula Ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg (dL)/2] was used to calculate the TyG index. The Framingham risk score was used to calculate ten-year cardiovascular risk. The TyG index cutoff point was determined using the receiver operating characteristic curve (ROC). Results: Included participants had a mean age of 56.76 ± 10.78 years and a mean body mass index (BMI) of 27.42 ± 4.03 kg/m2. 28.57% of the subjects were smokers, and the majority were female (56.75%). A significant moderate correlation was observed between TyG index and Framingham score (r = 0.428, p < 0.001). ROC curve analysis for TyG index and Framingham score showed an area under the curve (AUC) of 0.741 (95% CI = 0.691-0.791; p < 0.001). The cutoff value of the TyG index to recognize intermediate/high risk Framingham risk score was 9.33, with a sensitivity of 64.3%, and specificity of 75.0%. Conclusion: Our findings determine that, given a TyG index cutoff value of 9.33, the TyG index has a predictive ability to assess ten-year cardiovascular risk by comparison to the Framingham risk score in a high-risk group of Syrian refugees and can be used as an independent indicator of cardiovascular risk.

Acceptance of Flu Vaccine among Parents of Diabetic Children in Jordan.

There is a critical need to understand vaccine decision-making in high-risk groups. This study explored flu vaccine acceptance among Jordanian parents of diabetic children. Employing a cross-sectional approach, 405 parents from multiple healthcare centers across Jordan were recruited through stratified sampling, ensuring a broad representation of socioeconomic backgrounds. A structured questionnaire, distributed both in-person and online, evaluated their knowledge, attitudes, and acceptance of the flu vaccine for their diabetic children. The results indicated that only 6.4% of the study sample reported vaccinating their children against the flu annually, and only 23% are planning to vaccinate their children this year. A multinomial logistic regression analysis revealed notable variability in responses. Specifically, parents with a positive attitude towards the flu vaccine and those with older children had less odds to reject the vaccine (OR = 0.589, 95% CI (0.518-0.670), p < 0.001 and OR = 0.846, 95% CI (0.736-0.974), p = 0.02, respectively). Conversely, prevalent misconceptions regarding vaccine safety and efficacy emerged as significant barriers to acceptance. Our findings advocate for targeted educational programs that directly address and debunk these specific misconceptions. Additionally, strengthened healthcare communication to provide clear, consistent information about the flu vaccine's safety and benefits is vital to help enhance vaccine uptake among this vulnerable population, emphasizing the need to address specific concerns and misinformation directly.

Nanoencapsulated Curcumin Mitigates Liver Injury and Drug-Metabolizing Enzymes Induction in Diclofenac-Treated Mice.

Curcumin (CUR) is a natural product with known anti-inflammatory, antioxidant, and hepatoprotective properties. The aim of this study was to formulate CUR into a polymeric nanoparticle (NP) formulation and examine its potential hepatoprotective activity in an animal model of diclofenac (DIC)-induced hepatotoxicity. CUR was loaded into polymeric NPs composed of poly(ethylene glycol)-polycaprolactone (PEG-PCL). The optimal CUR NPs were evaluated against DIC-induced hepatotoxicity in mice, by studying the histopathological changes and gene expression of drug-metabolizing cyp450 (cyp2c29 and cyp2d9) and ugt (ugt2b1) genes in the livers of the animals. The optimal NPs were around 67 nm in diameter with more than 80% loading efficiency and sustained release. Histological findings of mice livers revealed that CUR NPs exhibited a superior hepatoprotective effect compared to free CUR, and both groups reduced DIC-mediated liver tissue injury. While treatment with DIC alone or with CUR and CUR NPs had no effect on cyp2c29 gene expression, cyp2d9 and ugt2b1 genes were upregulated in the DIC-treated group, and this effect was reversed by CUR both as a free drug and as CUR NPs. Our findings present a promising application for nanoencapsulated CUR in the treatment of nonsteroidal anti-inflammatory drugs-induced liver injury and the associated dysregulation in the expression of hepatic drug-metabolizing enzymes.

Biological evaluation of combinations of tyrosine kinase inhibitors with Inecalcitol as novel treatments for human chronic myeloid leukemia.

Background: The use of tyrosine kinase inhibitors (TKIs) as a treatment for chronic myeloid leukemia (CML) has improved the natural history of the disease and increased the duration of survival. Tyrosine kinase inhibitors represent the success of target therapies that work on molecular targets, although some patients still have therapy failure. Vitamin D has antiproliferative, pro-apoptotic, and anti-angiogenic effects on cells, therefore it can be considered as a potential cancer preventative and treatment agent. Inecalcitol (TX-522) is the 14-epi-analogue of Calcitriol (1,25(OH)2-vitamin D3), and inhibits cancer cell proliferation more effectively than Calcitriol. This study was conducted to evaluate the antiproliferative and synergistic effects of the anticancer drugs Imatinib and Dasatinib in combinations with Inecalcitol on human chronic myeloid leukemia K-562 cells. Method: The growth inhibitory activities of Inecalcitol, Imatinib, Dasatinib, and different combinations of one of the two drugs (Imatinib and Dasatinib) with Inecalcitol, were determined in vitro using MTT assay against K-562 cell line. Results: Inecalcitol, Imatinib, and Dasatinib showed potent antiproliferative activities against K-562 cells with GI50 values of 5.6 µM, 0.327 µM, and 0.446 nM, respectively. Combinations of Imatinib or Dasatinib with different concentrations of Inecalcitol increased significantly the antiproliferative activities and potencies of both drugs (****p < 0.0001), with optimal GI50 values of 580 pM (Imatinib) and 0.51 pM (Dasatinib). Furthermore, the combination treatments showed synergistic interaction between the antileukemic drugs and Inecalcitol, with combination indices (CI) < 1. Conclusion: The study demonstrated that the human chronic myeloid leukemia K-562 cells were subjected to a synergistic growth inhibitory impact when antileukemic drugs (Imatinib or Dasatinib) were combined with Inecalcitol, therefore, it is recommended that these combinations be viewed as promising novel antileukemic medications and used in place of individual medications with lower dosages and negligible side effects in the treatment of CML.

Effects of Beta Lactams on Behavioral Outcomes of Substance Use Disorders: A Meta-Analysis of Preclinical Studies.

INTRODUCTION: Preclinical studies demonstrated that beta-lactams have neuroprotective effects in conditions involving glutamate neuroexcitotoxicity, including substance use disorders (SUDs). This meta-analysis aims to analyze the existing evidences on the effects of beta-lactams as glutamate transporter 1 (GLT-1) upregulators in animal models of SUDs, identification of gaps in the literature, and setting the stage for potential translation into clinical phases. METHODS: Meta-analysis was conducted on preclinical studies retrieved systematically from MEDLINE and ScienceDirect databases. Abused substances were identified by refereeing to the National Institute on Drug Abuse (NIDA). The results were quantitatively described with a focus on the behavioral outcomes. Treatment effect sizes were described using standardized mean difference, and they were pooled using random effect model. I2-statistic was used to assess heterogeneity, and Funnel plot and Egger's test were used for assessment of publication bias. RESULTS: Literature search yielded a total of 71 studies that were eligible to be included in the analysis. Through these studies, the effects of beta-lactams were evaluated in animal models of nicotine, cannabis, amphetamines, synthetic cathinone, opioids, ethanol, and cocaine use disorders as well as steroids-related aggressive behaviors. Meta-analysis showed that treatments with beta-lactams consistently reduced the pooled undesired effects of the abused substances in several paradigms, including drug-self administration, conditioned place preference, drug seeking behaviors, hyperlocomotion, withdrawal syndromes, tolerance to analgesic effects, hyperalgesia, and hyperthermia. CONCLUSION: This meta-analysis revealed that enhancing GLT-1 expression in the brain through beta-lactams seemed to be a promising treatment approach in the context of substance use disorders, as indicated by results in animal models.

Exploring knowledge, attitudes, and practices towards artificial intelligence among health professions' students in Jordan.

INTRODUCTION: The integration of Artificial Intelligence (AI) in medical education and practice is a significant development. This study examined the Knowledge, Attitudes, and Practices (KAP) of health professions' students in Jordan concerning AI, providing insights into their preparedness and perceptions. METHODS: An online questionnaire was distributed to 483 Jordanian health professions' students via social media. Demographic data, AI-related KAP, and barriers were collected. Quantile regression models analyzed associations between variables and KAP scores. RESULTS: Moderate AI knowledge was observed among participants, with specific understanding of data requirements and barriers. Attitudes varied, combining skepticism about AI replacing human teachers with recognition of its value. While AI tools were used for specific tasks, broader integration in medical education and practice was limited. Barriers included lack of knowledge, access, time constraints, and curriculum gaps. CONCLUSIONS: This study highlights the need to enhance medical education with AI topics and address barriers. Students need to be better prepared for AI integration, in order to enable medical education to harness AI's potential for improved patient care and training.

Examining Influenza Vaccination Patterns and Barriers: Insights into Knowledge, Attitudes, and Practices among Diabetic Adults (A Cross-Sectional Survey).

Diabetes mellitus is a prevalent global chronic condition affecting individuals of all ages. People with diabetes face an elevated risk of lower respiratory tract infections such as pulmonary tuberculosis, influenza, and pneumonia. Additionally, the influenza virus increases the likelihood of deep venous thrombosis and pulmonary embolism. This study examined the knowledge, attitudes, and practices of diabetic patients regarding the influenza vaccine. This study involved 418 diabetic patients (53.3% female) at Jordanian outpatient respiratory clinics, with an average age of 49 (±14) years. The results showed that 70.6% had never received the influenza vaccine, and only 23.7% intended to do so in the current year. A positive attitude toward the influenza vaccine significantly reduced hesitancy to get vaccinated (OR = 0.505, 95% CI 0.424-0.601, p < 0.001). The duration of diabetes exhibited a positive association with vaccine hesitancy (OR = 1.053, 95% CI 1.006-1.102, p = 0.028). The primary reason for not getting vaccinated was a lack of awareness of its benefits (42.6%). Future health education programs should emphasize the importance of the influenza vaccine for diabetic patients and address their concerns.

Examining Influenza Vaccination Patterns Among Young Adults with Asthma: Insights into Knowledge, Attitudes, and Practices.

Purpose: Asthma is a major chronic disease of all ages, globally. Exacerbations are a significant problem for asthmatic patients. Despite advances in asthma management and efforts to identify asthma triggers, viral infections of the respiratory tract remain the most frequent triggers of asthma exacerbations. This study explored knowledge, attitudes, and practices (KAP) of asthmatic patients towards receiving the influenza vaccine. Patients and Methods: This cross-sectional study enrolled 397 adult asthmatic patients visiting the outpatient respiratory clinics of three Jordanian medical facilities. Results: The research included 66.4% females, with a median age of 32 years. The results showed that 42.4% of enrolled asthmatics had never received the flu vaccine and only 51.1% reported that they intended to take the vaccine in the current year. Most of those who had been vaccinated at least once in their lifetime reported that the side effects were mild (61.8%). Variables that decreased refusal/hesitancy towards receiving the flu vaccine in the current year included having well-controlled asthma (RRR = 0.193, 95% Cl (0.053-0.698), p =0.012), and high knowledge about asthma and flu (RRR= 0.916, 95% Cl (0.847-0.990), p =0.028, respectively). Conclusion: A small number of the participants adhered to vaccinating against the flu which is due to lack of knowledge about the asthma, flu, and the vaccine. To address this challenge, we propose targeted health education campaigns, collaboration with healthcare providers, and utilization of digital platforms.

Investigating Carvedilol's Repurposing for the Treatment of Non-Small Cell Lung Cancer via Aldehyde Dehydrogenase Activity Modulation in the Presence of ß-Adrenergic Agonists.

Repurposing existing drugs appears to be a potential solution for addressing the challenges in the treatment of non-small cell lung cancer (NSCLC). ß-adrenoceptor antagonist drugs (ß-blockers) have tumor-inhibiting effects, making them promising candidates for potential NSCLC treatment. This study investigates the anticancer potential of a subset of ß-blockers in NSCLC cell lines; A549 and H1299. Additionally, it investigates the underlying mechanism behind ß-blockers' anticancer effect by influencing a potential novel target named aldehyde dehydrogenase (ALDH). The MTT assay assessed ß-blockers' cytotoxicity on both cell lines, while Western blot and NADH fluorescence assays evaluated their influence on ALDH protein expression and activity. Carvedilol (CAR) was the most effective blocker in reducing cell survival of A549 and H1299 with IC50 of 18 µM and 13.7 µM, respectively. Significantly, CAR led to a 50% reduction in ALDH expression and 80% decrease in ALDH activity in A549 cells, especially when combined with ß-agonists, in comparison to the control. This effect might be attributed to ß-agonist blockade or an alternative pathway. This novel finding adds to our understanding of CAR's multifaceted anticancer properties, implying that combining CAR with ß-agonists could be a useful strategy for lung cancer treatment.

COVID-19 Vaccination Booster Dose: Knowledge, Practices, and Intention among Pregnant/Planning to Get Pregnant and Lactating Women.

Pregnant women are at higher risk of developing severe COVID-19 symptoms. Therefore, booster dose against COVID-19 was recommended for this special population in Jordan. However, vaccine hesitancy/refusal remains the main obstacle to providing immunity against the spread of COVID-19. Thus, the aim of this study is to examine the intention of pregnant/planning to get pregnant and lactating women towards receiving a booster dose against COVID-19 and its associated factors. A questionnaire was given to Jordanian pregnant/planning to get pregnant and lactating females. A total of 695 females were enrolled in the study. Older age, having a chronic disease, high education, high income, and high perceived risk of COVID-19 were significantly associated with higher knowledge about COVID-19. High perceived risk of COVID-19 was significantly associated with better practice. Participants who anticipated they might contract COVID-19 in the next six months, had high perceived risk of COVID-19, had high knowledge, had received the COVID-19 vaccine based on conviction, and smokers had higher intention to receive a booster dose of the COVID-19 vaccination. In order to increase pregnant and lactating women's intention to receive a booster dose of the COVID-19 vaccine, public health organizations should consider developing comprehensive health education campaigns.

Development and Comparative Evaluation of Ciprofloxacin Nanoemulsion-Loaded Bigels Prepared Using Different Ratios of Oleogel to Hydrogels.

Nanoemulsions and bigels are biphasic delivery systems that can be used for topical applications. The aim of this study was to incorporate an oil-in-water ciprofloxacin hydrochloride nanoemulsion (CIP.HCl NE) into two types of bigels, Type I (oleogel (OL)-in-hydrogel (WH)) and Type II (WH-in-OL) to enhance drug penetration into skin and treat topical bacterial infections. Bigels were prepared at various ratios of OL and WH (1:1, 1:2, and 1:4). Initially, CIP.HCl NE was prepared and characterized in terms of droplet size, zeta potential, polydispersity index, morphology, and thermodynamic and chemical stability. Then CIP.HCl NE was dispersed into the OL or WH phase of the bigel. The primary physical stability studies showed that Type I bigels were physically stable, showing no phase separation. Whereas Type II bigels were physically unstable, hence excluded from the study. Type I bigels were subjected to microstructural, rheological, in vitro release, antimicrobial, and stability studies. The microscopic images showed a highly structured bigel network with nanoemulsion droplets dispersed within the bigel network. Additionally, bigels exhibited pseudoplastic flow and viscoelastic properties. A complete drug release was achieved after 4-5 h. The in vitro and ex vivo antimicrobial studies revealed that bigels exhibited antimicrobial activity against different bacterial strains. Moreover, stability studies showed that the rheological properties and physical and chemical stability varied based on the bigel composition over three months. Therefore, the physicochemical and rheological properties, drug release rate, and antimicrobial activity of Type I bigels could be modified by altering the OL to WH ratio and the phase in which the nanoemulsion dispersed in.

Exhausted Grape Seed Residues as a Valuable Source of Antioxidant Molecules for the Formulation of Biocompatible Cosmetic Scrubs.

Grape seed of Obeidi, a white Lebanese autochthonous variety, was previously tested in different studies as a valuable source of bioactive molecules such as polyphenols, oils, and proteins by means of extraction procedures for the development of cosmetic and therapeutic products. However, an un-valorized, exhausted grape seed residue remains as "secondary waste" after the extraction processes. In this study, the exhausted seeds have been further exploited to produce cosmetic scrubs capable of releasing antioxidant molecules during the exfoliation process, in accordance with the principles of the circular economy and going toward a zero-waste process. The deep characterization of the exhausted seeds confirmed the presence of antioxidant phenolic molecules including gallic acid, catechins and protocatechuic acid (0.13, 0.126, and 0.089 mg/g of dry matter DM), and a high phenolic content (11.85 mg gallic acid equivalents (GAE)/g of dry matter (DM)). Moreover, these residues were shown to possess a sandy texture (Hausner ratio (HR): 1.154, Carr index (CI): 0.133, and angle of repose: 31.62 (°) degrees), similar to commercial natural exfoliants. In this respect, exhausted Obeidi grape seed residues were incorporated at increasing concentrations (0.5, 1, 1.5, and 2% w/w) in a cosmetic scrub, and stored for 5 weeks at 4, 25, and 50 °C for stability testing. All tested scrub formulations exhibited good spreadability with a spread diameter of 3.6-4.7 cm and excellent physical stability, as no phase separation or color change were observed after four cycles of heat shock at 4 and 50 °C. Finally, an in vivo skin irritation test showed that the scrub enriched with 1.5% of exhausted Obeidi grape seed residues was the most promising formulation, as it possessed a high amount of phenolic molecules (0.042 ± 0.001 mg GAE/mL of scrub) and good stability and could be safely applied to the skin with no irritation phenomena. Overall results underlined that exhausted grape seed residues can be transformed into promising systems for both physical and chemical exfoliation, thus confirming the importance of the effective exploitation of agro-industrial by-products for the development of high value cosmeceutics towards a more sustainable and zero-waste approach.

Knowledge, Attitudes, and Practices of Influenza Vaccination among Parents of Children with Asthma: A Cross-Sectional Study.

Asthma is the most common chronic disease in childhood. Exacerbation is a significant problem for asthmatic patients, and viral infections remain the most frequent triggers of asthma exacerbations. This study explored knowledge, attitudes, and practices (KAP) of parents of asthmatic children towards providing influenza vaccine to their children. This cross-sectional study enrolled parents of asthmatic children who visited the outpatient respiratory clinics of two Jordanian hospitals. The present study enrolled 667 parents of asthmatic children (62.8% female). The median age of the participants' children was 7 years. The results showed that 60.4% of the children with asthma never received a flu vaccine. Most of those who had received the flu vaccine reported that the side effects were mild (62.7%). Asthma duration was positively and significantly associated with increased vaccine hesitancy/rejection (OR = 1.093, 95% CI = (1.004-1.190), p = 0.04; and OR = 1.092, 95% CI = (1.002-1.189), p = 0.044, respectively). As the attitude towards flu vaccine score increases, odds of vaccination hesitancy/rejection decreased (OR = 0.735, 95% CI = (0.676-0.800), p < 0.001; and OR = 0.571, 95% CI = (0.514-0.634), p < 0.001, respectively). The main reasons for vaccination hesitancy/refusal included "I don't think my child needs it" (22.3%) followed by "I forget it" (19.5%). The rate of vaccination among children was low and emphasized the necessity of encouraging parents with asthmatic children to vaccinate their children by conducting health awareness campaigns and also emphasized the role of doctors and other healthcare professionals.

Encapsulation of morin in lipid core/PLGA shell nanoparticles significantly enhances its anti-inflammatory activity and oral bioavailability.

Morin (3,5,7,2',4'-pentahydroxyflavone; MR) is a bioactive plant polyphenol whose therapeutic efficacy is hindered by its poor biopharmaceutical properties. The purpose of this study was to develop a nanoparticle (NP) formulation to enhance the bioactivity and oral bioavailability of MR. The nanoprecipitation technique was employed to encapsulate MR in lipid-cored poly(lactide-co-glycolide) (PLGA) NPs. The optimal NPs were about 200 nm in size with an almost neutral surface charge and a loading efficiency of 82%. The NPs exhibited sustained release of MR within 24 h. In vitro antioxidant assays showed that MR encapsulation did not affect its antioxidant activity. On the other hand, anti-inflammatory assays in lipopolysaccharide-stimulated macrophages revealed a superior anti-inflammatory activity of MR NPs compared to free MR. Furthermore, oral administration of MR NPs to mice at a single dose of 20 mg/kg MR achieved a 5.6-fold enhancement in bioavailability and a prolongation of plasma half-life from 0.13 to 0.98 h. The results of this study present a promising NP formulation for MR which can enhance its oral bioavailability and bioactivity for the treatment of different diseases such as inflammation.

The Length of Hospital Stay of Patients with Venous Thromboembolism: A Cross-Sectional Study from Jordan.

Background and Objectives: Venous thromboembolism is one of the leading causes of mortality and disability worldwide. Treatment with anticoagulation therapy is essential and requires a delicate approach to select the most appropriate option to improve patient outcomes, including the length of hospital stay (LOS). The aim of this study was to determine the LOS among patients with acute onset of VTE in several public hospitals in Jordan. Materials and Methods: In this study, we recruited hospitalized patients with a confirmed diagnosis of VTE. We reviewed the electronic medical records and charts of VTE admitted patients in addition to a detailed survey to collect the patients' self-reported data. Hospital LOS was categorized into three levels: 1-3 days, 4-6 days, and ≥7 days. An ordered logistic regression model was used to study the significant predictors of LOS. Results: A total of 317 VTE patients were recruited, with 52.4% of them were male and 35.3% aged between 50 and 69 years. Most patients had a deep vein thrombosis (DVT) diagnosis (84.2%), and most of the VTE cases were admitted for the first-time (64.6%). The majority of the patients were smokers (57.2%), overweight/obese (66.3%), and hypertensive (59%). Most of the VTE patients received Warfarin overlapped with low molecular weight heparins as their treatment regimen (>70%). Almost half of the admitted VTE patients (45%) were hospitalized for at least 7 days. Longer LOS was significantly associated with hypertension. Conclusions: We recommend using therapies that have been proven to reduce hospital LOS, such as non-vitamin K antagonist oral anticoagulants or direct oral anticoagulants, to treat VTE patients in Jordan. Additionally, preventing and controlling comorbidities such as hypertension is essential.