Vismodegib: the first drug approved for advanced and metastatic basal cell carcinoma.

Treatment of basal cell carcinoma (BCC) usually involves surgical interventions and laser ablation, but in locally advanced BCC, which arise either from earlier untreated lesions or from recurrence of aggressive BCC, surgery and radiotherapy are not helpful. Vismodegib, the first oral-targeted therapy for locally advanced and metastatic BCC, unsuitable for surgery or radiotherapy, was recently approved by US Food and Drug Administration (FDA). The drug was under the priority review program of FDA and was approved on the basis of promising results of phase II trial. Vismodegib acts by targeting the hedgehog pathway, which is activated abnormally in most BCCs. Approval of vismodegib is a big step ahead in the treatment of advanced BCC, where there was no other effective drug therapy till now.

Pediatric iron preparations for infants in Bahrain: some therapeutic concerns.

BACKGROUND: Infants and children are at a high risk for medication errors. OBJECTIVES: This retrospective study was conducted to determine the type and prevalence of prescribing errors related to pediatric iron preparations prescribed in primary care in Bahrain. METHODS: Prescriptions issued for infants and collected at 20 health center pharmacies for 2 weeks were audited, specifically for errors. RESULTS: Of 2,282 prescriptions dispensed for infants (mean age 9.14 +/- 0.91 months), 159 (7.0%) included an iron preparation. Iron preparations were mostly prescribed (90.6%) with brand names, several of which were neither listed in the primary care drug list nor were available as pediatric dosage forms. 42 (26.4%) prescriptions were issued without specifying the dosage forms, 14 (8.8%) without the duration of therapy and 4 (2.5%) without dosage. Iron dosage was stated as metric volume (ml) and metric weight (mg elemental iron) units in 78.6% and 9.4% of the prescriptions, respectively. The mean elemental iron (+/- SD) prescribed for treating anemia was 4.5 +/- 1.7 mg/kg body weight. A significant difference was observed between physicians and nurses regarding the amount of elemental iron prescribed for treating anemia. CONCLUSIONS: Prescribing of multiple brands of pediatric iron preparations unavailable in the primary care drug list and in pediatric dosage forms, prescribing iron as inconvenient decimal fractions (metric volume units), and omission errors in prescriptions, were common. This may be related to poor communications between the prescribers and the pharmacy services and a lack of information dissemination on newly introduced iron formulations. Moreover, frequent changes in brand availability in primary care may have created confusion for prescribers. The communication between pharmacy services and prescribers should be strengthened, and the procurement of multiple brands should be discouraged. A better management of drug supply and effective policies to minimize prescribing errors are needed in Bahrain.

Influence of medical training on self-medication by students.

OBJECTIVE: To examine the influence of medical training on the knowledge, attitude and practice of self-medication by medical students. SUBJECTS AND METHODS: This was a cross-sectional, descriptive study. A self-developed, pre-validated questionnaire containing open-ended and close-ended items was used for data collection. Medical students in the 2nd and 4th year of the medical course at the Arabian Gulf University Bahrain filled in the questionnaire anonymously. Data were analyzed using SPSS and results expressed as counts and percentages. 2-tailed Chi2-test was applied and p < 0.05 was considered significant. RESULTS: The respondents (n = 141) had a mean age of 19.94 A+/- 1.21 years. Overall, they had a fair knowledge about appropriate self-medication but knowledge of the benefits and risks of self-medication was adequate. Self-medication was perceived to be time-saving, providing quick relief in common illnesses, a learning experience, economical, and convenient. Among the perceived disadvantages were adverse drug reactions, inappropriate drug use, and the risk of making a wrong diagnosis. Majority of the respondents had a positive attitude favoring self-medication and read the package insert. The practice of self-medication was common and often inappropriate. The commonest indications for self-medication were cough, cold and sore throat (63.2% in Year 2) and headache (78.3% in Year 4). Mild illness, previous experience, and lack of time were the most frequent reasons for resorting to self-medication. Analgesics were the commonest drugs used, and drugs were mostly obtained from private pharmacies. Students of Year 4 had better knowledge about appropriate self-medication (58.7% versus 35.8%, p = 0.02), had greater awareness of the risks of self-medication and would discourage others from practicing self-medication (58.7% versus 40.4%, p = 0.04). They had a more confident attitude (54.3% versus 35.1%, p = 0.03) and a smaller number of them would seek a prescription (34.8% versus 54.3%, p = 0.03). They practiced self-medication more often (73.3% versus 52.6%, p = 0.02) and more appropriately (58.7% versus 35.8%, p = 0.02). CONCLUSION: This cross-sectional study shows that senior medical students tend to have greater knowledge of appropriate self-medication, have a more confident as well as concerned attitude towards self-medication, and tend to practice self-medication more often and appropriately.

Assessing prescription writing skills of pre-clerkship medical students in a problem-based learning curriculum.

OBJECTIVE: To audit the acquisition of prescribing skills of pre-clerkship medical students in a problem-based learning (PBL) curriculum that incorporates a prescribing program. MATERIAL AND METHODS: Student performance in pharmacotherapy stations included in six out of eight end-of-unit-objective structured practical examinations (OSPE) was evaluated using a rating checklist. RESULTS: Prescription writing skills of 539 students (66.2% female and 33.8% male) were appraised. With the exception of refill element, the other physician-related components including prescriber's identity, date of prescription order, patient's identity, the symbol Rx "Take Thou", and prescriber's signature were written by 96.1% of the students (95% confidence interval (CI) 94.1 - 97.5). However, the drug-related components such as the appropriateness of drug(s) selected, strength, dosage form, quantity to be dispensed and directions for use were written satisfactorily by 50.2% of the students (95% CI 46.0 - 54.4). With respect to prescribing skills, the mean total score of Year 4 students did not significantly differ from that of Year 2 (69.4 (CI 65.7 - 73.1) vs. 66.3 (CI 62.7 to 69.9); p = 0.237). However, the mean scores of individual drug-related components such as appropriateness of drug(s) selected, dosage form, and direction for use were significantly higher in Year 4 than that of Year 2 students (p < 0.05). Of 381 rationally prescribed drugs, 81.1% were written with generic names. CONCLUSION: This study revealed that the students acquire prescribing skills to a limited extent during the pre-clerkship phase in a PBL program. Prescribing errors and deficits were found to be mainly associated with drug-related components. Further training and assessment of prescribing skills during the clerkship and internship period are needed to achieve mastery of this skill as a terminal competency of graduating physicians.

Chronic L-arginine supplementation improves endothelial cell vasoactive functions in hypercholesterolemic and atherosclerotic monkeys.

Chronic exposure to L-arginine results in regression of atherosclerotic lesions and reversal of endothelial dysfunction. We investigated whether chronic L-arginine supplementation induces regression of atherosclerotic lesions and reversal of endothelial dysfunction in atherogenic rhesus monkeys and the mechanism which leads to these effects. About 12 male rhesus monkeys were fed 1% cholesterol and 18 g butter for 6 months to create an experimental model of hypercholesterolaemia and atherosclerosis (Group I) and 12 monkeys were fed standard stock diet for 6 months (Group II). After, 6 months these two groups were further divided into 2 sub-groups which in addition to their respective diets were fed 2.5% L-arginine in drinking water for additional 6 months (Group III and Group IV). Systemic nitric oxide (NO) formation was assessed as plasma nitrite and cGMP formation every 3 months. Oxygen free radical (OFR) generation and malondialdehyde production as an index of lipid peroxidation were determined. Changes in isometric tension were compared in isolated ring segments of thoracic aorta from normal and hypercholesterolemic animals. Cholesterol feeding progressively reduced plasma nitrite and cGMP generation (p < 0.05). Dietary L-arginine partly restored the levels of plasma nitrite and cGMP (p < 0.05) but did not change plasma cholesterol levels. L-arginine significantly reduced aortic intimal thickening, blocked the production of carotid and coronary intimal plaques and completely preserved endothelium-dependent vasodilator function. Further, L-arginine significantly inhibited generation of the reactive oxygen species (ROS) generation and lipid peroxidation. Chronic oral supplementation with L-arginine blocks the progression of plaques via restoration of nitric oxide synthase substrate availability and reduction of vascular oxidative stress.

Effect of the 5-HT3 receptor antagonist ondansetron on amphetamine-induced hyperactivity and stereotypy in rats.

The effects of different doses of ondansetron (0.1, 0.5, 1, 2 mg/kg) administered intra-peritoneally were studied on amphetamine-induced hyperactivity and stereotypy in wistar rats. Ondansetron was administered 30 minutes prior to d-amphetamine (3 mg/kg, i.p.). Ondansetron in doses of 0.5 and 1 mg/kg significantly decreased the mean number of head dippings and crossings in the hole board test and in doses of 0.1 and 0.5 mg/kg significantly decreased the average stereotypic score. Since the hyperactivity and stereotypy are dopamine mediated, the effect of ondansetron to reduce these states suggests a potential role for ondansetron in conditions with dopamine excess.

EFFECT OF 5-HT3 ANTAGONIST ONDANSETRON ON WRAP-RESTRAINT AND CONDITIONED EMOTIONAL STRESS INDUCED DEFECATION.

The effect of ondansetron was investigated in wrap-restraint and conditioned emotional (footshock) stress induced colonic hypermotility in rat. Ondansetron was administered in doses of 0.1, 0.5 and 1 mg/kg, sc. In wrap-restraint group, ondansetron dose-dependently reduced the fecal output to baseline levels (0.51 ± 0.20 gm/rat, 0.48 ± 0.38 gm/rat, 0.38 ± 0.16 gm/rat with 0.1, 0.5 and 1 mg/kg respectively). Diazepam, 5 mg/kg and atropine, 1 mg/kg also decreased the fecal output in this model. In footshock group, ordansetron did not affect the emotional stress induced increase in fecal pellet output. Diazepam and atropine however, decreased the fecal output in this model also.