Analysis of drug prescriptions in primary health care centres in Bahrain

The aim of this study was to analyse drug prescribing practices in primary health care centres in Bahrain. We retrospectively evaluated 600 prescriptions selected randomly from all primary health care centres in Bahrain [n = 20] in 2004. Analysis followed WHO recommended prescribing core indicators. The mean number of drugs prescribed at each encounter was 3.3 [SD 0.7]. A single drug was prescribed on 6.3% of prescriptions and drugs were prescribed by generic name on 10.2%. The percentage of total prescriptions for antibiotics was 45.8%, for injections was 9.3% and for vitamins was 12.5%. The prescribing pattern in primary health care centres in Bahrain is associated with polypharmacy, over-prescribing of antibiotics and an under-prescribing of drugs by generic names

The use of medicinal herbs by diabetic Jordanian patients.

Diabetes mellitus is the most common metabolic disorder worldwide. To date, there have been no reports on the frequency of use of herb medicines in the managements of diabetes mellitus in Jordan. This cross-sectional study was conducted by interviewing 310 diabetic patients visiting two medical centers in Jordan: Jordan University of Science & Technology Medical Center and Sarih Medical Center between December 2003 and August 2004. It is found that 31% of interviewed patients have used herbal products (96 patients). The results revealed that the most commonly used herbs by diabetic patients in Jordan were Trigonella foenumgraecum (22.9%), Lupinus albus (14.6%), Allium sativum (11.5%), Allium cepa (5.2%), Nigella sativa (7.3%), Zea mays L. (6.3%), Urtica dioica L. (8.3%), Eucalyptus globules LA (9.4%), Olea europea L. (3.1%), Cumminum cyminum (9.4%), Coriandrum sativum (10.4%), Salvia officinalis L. (3.1%), and Tilia cordata (1%). Furthermore, it is found that 47.9% of the patients used herbs according to advice from their friends on a daily basis. The side effects were reported by 36.5% of the patients and include headache, nausea, dizziness, itching, palpitation, and sweating. Among the patients, 72.9% used the herbs as adjunctive therapy along with their anti-diabetic drugs and 80.2% of the patients informed their physicians about their use. A 79.2% of the sample confirmed their intention to re-use these herbs as 86.5% of them were satisfied with their diabetes control. There was a significant relationship between the use of herbs, the patient's place of residence and his/her level of education. The main conclusion of this survey is that the use of medicinal herbs among diabetic patient in Jordan is common. Therefore, it is essential to increase the level of awareness among diabetic patients and health care providers regarding the efficacy and toxicity of these medicinal herbs.

Health care providers' perceptions of the problems and causes of irrational use of drugs in two Middle East countries.

It is now evident that both developed and developing countries are experiencing many aspects of inappropriate use of drugs in their health care facilities. This is the first study in the region performed to examine the most common problems of irrational use of drugs and their causes in two Middle East countries--Jordan and Syria. Ninety senior participants from Jordan (50-15 physicians and 35 pharmacists) and Syria (40-12 physicians and 28 pharmacists) were enrolled in this study. The participants were asked to fill two questionnaires that deal with the problems and causes of irrational use of drugs in their country. Additionally, the participants were asked to perform a prescription analysis using WHO prescribing indicators on 40 prescriptions taken randomly from a comprehensive health centre in their country. The main drug use problems identified in the two countries were almost the same, but they vary in the percentage of occurrence and include excessive use of antibiotics and antidiarrhoeals, overprescribing of nonsteroidal anti-inflammatory drugs, prescribing by tradename, excessive use of antibiotics to treat minor upper respiratory infections and self-medication by the public. The main causes of irrational use of drugs were poor medical records, lack of patient education about illnesses and drugs, no family doctor system, lack of standard treatment guidelines and lack of continuing medical education for doctors and pharmacists. The results of this study are important for decision-makers to utilise when putting policies and strategies to improve the use of drugs in both countries.

Psychiatric morbidity and its sociodemographic correlates among women in Irbid, Jordan.

The rate of psychiatric morbidity and its sociodemographic correlates was estimated in 2000 women attending 3 primary care centres in Irbid, Jordan. Women completed standardized diagnostic tools that yielded psychiatric diagnoses, a stress scale and sociodemographic details. The rate of psychiatric morbidity was 26.3% and psychological distress 39.0%. A significant association was found between the amount and severity of stress and psychiatric morbidity. Post-marital status (separated, divorced, widowed), woman's illiteracy, family violence, violent marital relationship, living independently, being in a non-cousin marriage, being a second wife, poor housing and absence of a social support system were significantly associated with psychiatric morbidity in this group of women.

Psychiatric morbidity and its sociodemographic correlates among women in Irbid, Jordan

The rate of psychiatric morbidity and its sociodemographic correlates was estimated in 2000 women attending 3 primary care centres in Irbid, Jordan. Women completed standardized diagnostic tools that yielded psychiatric diagnoses, a stress scale and sociodemographic details. The rate of psychiatric morbidity was 26.3% and psychological distress 39.0%. A significant association was found between the amount and severity of stress and psychiatric morbidity. Post-marital status [separated, divorced, widowed], woman's illiteracy, family violence, violent marital relationship, living independently, being in a non-cousin marriage, being a second wife, poor housing and absence of a social support system were significantly associated with psychiatric morbidity in this group of women

The effect of Vigabatrin, Lamotrigine and Gabapentin on the fertility, weights, sex hormones and biochemical profiles of male rats.

PURPOSE: A case control study was conducted to assess the effect of Sabril (Vigabatrin), Lamictal (Lamotrigine) and Neurontin (Gabapentin) on fertility in male rats. Their effect on the body and organs weight and certain biochemical profiles including total serum protein, cholesterol, triglycerides, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), serum testosterone, and FSH levels were also measured. METHODS: several parameters, concerning fertility were measured in 40 albino male rats of Sprague Dawley strain, they were divided into 4 groups, group one received vehicle (distilled water), group two received Vigabatrin in a dose of 200 mg/kg body weight, group three received Lamotrigine in a dose of 30 mg/kg body weight, and group four received Gabapentin 100 mg/kg body weight. All the male rats in these groups received the different medications for a complete reproductive cycle (60 days). After 24 hours of the last dose, the animals were weighed and autopsied under light ether anesthesia. Parameter of fertility that has been measured in this study includes: sperm count and motility, weight of different reproductive organs, germ cell and interstitial cell population, serum testosterone and FSH levels and assessment of pregnancies in females mixed with tested males. Biochemical profiles such as serum cholesterol, serum triglycerides, serum bilirubin, SGOT, SGPT level are all measured. The results of the histological, histometerical studies and biochemical profiles were compared to that of the control group, and the significance of these results was measured using student's "t" test. RESULTS: There was significant reduction in the body weight and the weight of the testes, epididymis, seminal vesicles, ventral prostate, and vas deferens in the antiepileptic fed male rats in comparison to the control group (p > 0.001). There was significant reduction in testicular cells population dynamics including both germinal cell types and interstitial cell types in the antiepileptic fed male rats in comparison to the control group. There was also significant reduction in histometrical parameters and sperm dynamics in the antiepileptic fed male rats histologies in comparison to the control group. There was significant reduction in both testosterone and FSH levels (p < 0.001) in the antiepileptics fed male rats in comparison to the control group. There was also significant reduction in pregnancy rate observed in female rats exposed to the tested male rats among antiepileptic fed male rats compared to controls. The results of biochemical profiles assessment showed significant reduction in serum glucose, serum cholesterol, serum triglycerides levels and significant increase in serum bilirubin, SGOT, and SGPT levels in antiepileptics fed male rats in comparison to the control group. CONCLUSIONS: Fertility rate and other parameters concerned with fertility, sex hormones and certain biochemical profiles were significantly disturbed in male rats fed with three of the second-generation antiepileptic drugs Vigabatrin, Lamotrigine, and Gabapentin, indicating a possible toxic effect of these three medications on sexual organs, liver, and lipid metabolism.

Comparative bioavailability of two cefadroxil products using serum and urine data in healthy human volunteers.

1. The aim of the present study was to assess the bioequivalence of two cefadroxil products, namely Ultracef (a reference product) in the form of a 500 mg capsule (produced by Bristol-Myers Squibb Laboratories, Princeton, NJ, USA) and Roxil (a test product) in the form of a 500 mg capsule (produced by Tabuk Pharmaceutical Manufacturing, Tabuk, Saudi Arabia). 2. The study was performed under US Food and Drug Administration (FDA) guidelines (http://www.fda.gov/cder) on 24 healthy male subjects. Both products were administered orally as a single dose (1 x 500 mg capsule) separated by a 1 week washout period. Following oral administration, blood and urine samples were obtained and analysed for cefadroxil concentrations using a sensitive and specific HPLC assay. 3. There were no statistically significant differences between the two products in either the mean concentration-time profiles or the cumulative urinary excretion of cefadroxil at various times. Similarly, no statistical significance was observed in the pharmacokinetic parameters reflecting rate and extent of drug absorption. The relative extent of drug absorption, assessed by calculating the area under the curve (AUC) ratio for Roxil/Ultracef for 10 h and for infinity was 0.94 with 90% confidence limits (CL) of 0.91-0.98. In agreement with serum data, the average ratio (Roxil/Ultracef) of the cumulative amount of cefadroxil excreted in urine 10 h after the dose was found to be 0.97, with 90% CL of 0.88-1.05. The CL of the AUC and cumulative urinary excretion ratios are within the FDA accepted limits for bioequivalent products (0.80-1.25). 4. These findings show that serum and urine data of cefadroxil are in agreement and indicate that Roxil (the test product) and Ultracef (the reference product) are bioequivalent in terms of the rate and extent of drug absorption.

Risk of seizure recurrence after a first unprovoked seizure: a prospective study among Jordanian children.

PURPOSE: There is wide variation in the reported recurrence rate after a first unprovoked seizure in children. We investigated the risk of recurrence after a first unprovoked seizure in Jordanian children and the risk factors associated with increased recurrence rate. METHODS: All consecutive patients aged 3 months-14 years who presented with their first unprovoked seizures between January 1997 and 2000, were included in a prospective study and followed up for 3 years for possible recurrence. Of the patients studied, there was slight male predominance (56.6%) and 55% of them were 2-9 years of age. Generalised seizures were reported in 75% and the remaining 25% had partial seizures. The duration of seizure was 1-4 minutes in 59%. Family history of epilepsy was positive in 31% and parental consanguinity in 32%. The role of these factors in increasing the risk of recurrence was also investigated. RESULTS: Two hundred sixty-five patients were included in the study and continued follow up for 3 years. Ninety-eight (37%) of them experienced seizure recurrence. Among the predictor factors for recurrence, partial seizure (P = 0.003) and positive family history (P = 0.000) were associated with a statistically significant increased risk. Sex, age, duration of seizure and consanguinity were not associated with increased risk of recurrence. CONCLUSION: Thirty-seven percent of the children studied experienced a second attack after a first unprovoked seizure over the 3 years follows up period. The risk of recurrence was significantly higher in children with a partial seizure (55%) and among those with a positive family history of epilepsy (59%). Age at first seizure, sex, duration of seizure and consanguinity were not significantly related to the risk of recurrence.

Association of polycystic ovaries with the use of valproic Acid in jordanian epileptic patients.

OBJECTIVE: To investigate the frequency of occurrence of polycystic ovaries (PCO) in women taking valproic acid (VPA) as monotherapy for epilepsy. STUDY DESIGN AND PATIENTS: 163 epileptic patients were seen at the outpatient neurology clinic at Princess's Basma Teaching Hospital, Irbid, and Basheer Hospital, Amman, Jordan. A detailed medical history was taken from the patients followed by a clinical examination and vaginal ultrasonography of the ovaries. RESULTS: 102 patients (62.5%) had primary generalised seizures, 46 patients (28.2%) had partial seizures and 15 patients (9.2%) had partial secondary generalised seizures. Mean age +/- standard error of the mean (SEM) was 29.8 +/- 0.97 years. The duration of epilepsy and treatment with VPA were (mean +/- SD) 9.1 +/- 0.48 and 7.9 +/- 0.4 years, respectively. The dose and serum concentrations of VPA were (mean +/- SD) 983.9 +/- 101.96mg and 52.7 +/- 4.7 mg/L, respectively. Mean body mass index (BMI) was 25.6 +/- 0.92 kg/m(2). The mean weight gain was 6.6 +/- 1.3kg (range 2-24kg). Menstrual abnormalities were detected in 58 (35.6%) patients. Twelve patients (7.4%) had PCO; these patients were compared with 17 patients without PCO selected randomly. There was a statistically significant difference in testosterone level and BMI values in patients with PCO compared with those without negative PCO. Patients with PCO had a mean +/- SEM serum testosterone level of 1.2 +/- 0.18 mug/L and BMI values of 29.24 +/- 1.75 kg/m(2). However, patients without PCO had a serum testosterone level of 0.61 +/- 0.1 mug/L and a BMI of 21.91 +/- 0.7 kg/m(2). Menstrual abnormalities were detected in all patients with PCO and in eight patients without PCO. Hirsutism was found in four cases with PCO and in one case with no PCO. There were no statistically significant differences in the duration of therapy, doses and serum concentrations of VPA in patients with PCO compared with those without PCO. CONCLUSION: These results suggest an association between the use of VPA and PCO, hyperandrogenism, obesity and menstrual abnormalities. For women receiving VPA therapy, clinicians should consider performing an assessment of ovarian structure and function, especially if these patients develop menstrual cycle disturbances during treatment.

Evaluation of drug use in Jordan using WHO patient care and health facility indicators.

We prospectively studied current drug use in Jordan in 21 primary health care facilities in northern Jordan over a three-month period, using World Health Organization-recommended indicators. Both the mean time spent on physician-patient consultations (3.9 +/- 3.5 minutes) and mean pharmacy dispensing time (28.8 +/- 23.7 seconds) were short, resulting in a mean patient knowledge of prescribed drug dose of 77.7%. No centre had an essential drugs list and/or formulary available. An average of 80% of key drugs were available at centres. Baseline data gathered by this study can be used by researchers and policymakers to monitor and improve pharmaceutical prescribing and consumption practices in Jordan.

Evaluation of drug use in Jordan using WHO prescribing indicators.

Patterns of prescribing and use of pharmaceuticals by physicians and patients in Jordan have not previously been studied. We retrospectively evaluated pharmaceutical drug prescribing practices in 21 primary health care facilities in Irbid governorate, northern Jordan using World Health Organization-recommended core indicators. The mean number of drugs prescribed was 2.3 overall, ranging from 1.9 to 3.0. The percentage of drugs prescribed by generic name was very low, as was the percentage of prescriptions involving injections. The percentages of prescriptions involving antibiotics and drugs from the essential drugs list averaged 60.9% and 93% respectively. We conclude that the prescribing and use of drugs in Jordan requires rationalization, particularly the over-prescribing of antibiotics and the under-prescribing of generic drugs.

Evaluation of drug use in Jordan using WHO patient care and health facility indicators

We prospectively studied current drug use in Jordan in 21 primary health care facilities in northern Jordan over a three-month period, using World Health Organization-recommended indicators. Both the mean time spent on physician-patient consultations [3.9 +/- 3.5 minutes] and mean pharmacy dispensing time [28.8 +/- 23.7 seconds] were short, resulting in a mean patient knowledge of prescribed drug dose of 77.7%. No centre had an essential drugs list and/or formulary available. An average of 80% of key drugs were available at centres. Baseline data gathered by this study can be used by researchers and policymakers to monitor and improve pharmaceutical prescribing and consumption practices in Jordan

Evaluation of drug use in Jordan using WHO prescribing indicators

Patterns of prescribing and use of pharmaceuticals by physicians and patients in Jordan have not previously been studied. We retrospectively evaluated pharmaceutical drug prescribing practices in 21 primary health care facilities in Irbid governorate, northern Jordan using World Health Organization-recommended core indicators.The mean number of drugs prescribed was 2.3 overall, ranging from 1.9 to 3.0. The percentage of drugs prescribed by generic name was very low, as was the percentage of prescriptions involving injections. The percentages of prescriptions involving antibiotics and drugs from the essential drugs list averaged 60.9% and 93% respectively. We conclude that the prescribing and use of drugs in Jordan requires rationalization, particularly the over-prescribing of antibiotics and the under-prescribing of generic drugs

Inhibition of ganglionic long-term potentiation decreases blood pressure in spontaneously hypertensive rats.

Long-term potentiation of sympathetic ganglia (gLTP), a unique form of synaptic plasticity, is serotonin dependent and can be blocked with 5-HT3 receptor antagonists. Long-lasting enhancement of the basal tone of ganglionic transmission (as with gLTP) is expected to result in sustained increase in peripheral resistance that would lead to elevated blood pressure. We examined the possibility that in sympathetic ganglia, gLTP may be involved in the expression of stress-induced (neurogenic) form of hypertension. High blood pressure in spontaneously hypertensive rat (SHR), known to show exaggerated cardiovascular defense reactions to environmental stimuli, is partly due to a neurogenic factor. Chronic treatment of SHR and their normotensive counterpart, the Wistar Kyoto (WKY) rats with the 5-HT3 receptor antagonist tropisetron (ICS; 5 mg/kg/day), caused a marked decrease in the blood pressure of the SHR but not of WKY rats. Increasing the daily dose of ICS cumulatively (7 and 10 mg/kg) did not result in significant additional decrease in blood pressure of SHR, indicating that the drug blocks only the neurogenic component of hypertension in the SHR. electrophysiological procedures for indirectly testing for the presence of gLTP in ganglia excised from SHR suggest that gLTP has been previously expressed in these ganglia in vivo. This contrasts with the absence of gLTP in ganglia from normotensive rats. The results support contribution of gLTP to the expression of neurogenic hypertension.

Effect of lamotrigine on a novel model of epilepsy.

The effect of lamotrigine (LTG) on evoked and spontaneous seizure-like activity induced by veratridine, was investigated. Rat brain slices were examined using conventional electrophysiological intracellular techniques. Alteration of sodium channel function by veratridine (0.3 microM) induced spontaneous seizure-like activity in the hippocampal CA1 pyramidal neurons. Therapeutic concentrations of LTG (5-10 microM) inhibited both evoked and spontaneous bursting induced by veratridine. This inhibition was voltage-dependent indicating possible interaction between the drug and the inactivated state of sodium channels. There was an increase in the firing threshold of the bursting but no change in the resting membrane potential (RMP) and membrane input resistance. Results from this work suggest that the veratridine model of epilepsy is very sensitive to drugs which act on sodium channels. These data make the veratridine model a suitable tool for screening potential sodium channel-dependent antiepileptic drugs.

Action of carbamazepine on epileptiform activity of the verartidine model in CA1 neurons.

The veratridine epileptiform model was utilized to assess the antiepileptic effect of Carbamazepine (CBZ) in rat hippocampal CA1 pyramidal neurons using conventional intracellular recording techniques. In the veratridine model, where brain slices are treated with veratridine (0.3 microM), a single intracellular stimulus evokes epileptiform bursting. Additionally, spontaneous epileptiform activity commonly appears on prolonged exposure to veratridine in this model. In this model, therapeutic (7-15 microM) and high (50 microM) concentrations of CBZ inhibited the evoked and spontaneous epileptiform bursting in a concentration- and voltage-dependent manner. At all concentrations tested, CBZ produced inhibition of epileptiform activity without affecting the membrane resting potential or input resistance. However, at 50 microM, the drug increased the firing threshold of neurons. These results confirm the suitability of this model for testing sodium channel-dependent antiepileptic agents.

Epileptiform activity of veratridine model in rat brain slices: effects of antiepileptic drugs.

The effects of the antiepileptic drugs valproic acid (VPA), phenytoin (PHT), and ethosuximide (ESM) on evoked and spontaneous seizure-like (epileptiform) activity were studied in the veratridine epileptiform model in rat brain slices, using conventional electrophysiological intracellular recording techniques. The veratridine model is generated by treatment of brain slices with a low concentration (0.3 microM) of the alkaloid veratridine. The drug modifies sodium channel function so that a brief current injection in hippocampal CA1 pyramidal neurons evokes bursts of epileptiform activity. Therapeutic concentrations of VAP (50-200 microM) inhibited both evoked and spontaneous bursting in a voltage-dependent manner without affecting membrane resting potential or input resistance. Similarly, therapeutic concentrations of PHT (4-15 microM) inhibited both evoked and spontaneous bursting in a voltage-dependent fashion with no apparent change in the membrane resting potential. However, PHT increased the membrane input resistance and elevated the firing threshold of neurons. The antiepileptic drug ESM failed to inhibit evoked or spontaneous bursting even at high concentrations. The results suggest that the veratridine model of epileptiform activity is sensitive only to antiepileptic drugs that primarily affect the sodium channels.

Valproic acid intensifies epileptiform activity in the hippocampal pyramidal neurons.

The effects of large concentrations of valproic acid (VPA) on veratridine-induced epileptiform activity (veratridine model) were investigated in rat hippocampal CA1 pyramidal neurons. Studies were performed on the veratridine model in rat brain slices using conventional electrophysiological intracellular techniques. Large concentrations of VPA (5 mM or more) enhanced rather than inhibited epileptiform activity induced by veratridine. During the proepileptic phase of VPA, a membrane depolarization accompanied by a decrease in membrane input resistance were evident. The voltage-dependent proepileptic effect of VPA was blocked by tetrodotoxin (TTX; 100 nM) but not by the calcium channel blockers, diltiazem (5 microM) or omega-conotoxin GVIA (5 microM). VPA did not induce a proepileptic effect when it was superfused at high concentration (0.5-10 mM) on sodium channel-independent models such as the bicuculline or magnesium-free artificial cerebrospinal fluid. Large concentrations of VPA had no significant effect on untreated neurons. The VPA-enhanced veratridine bursting is probably related to the reported proepileptic activities observed in patients taking high doses of this drug. These data also suggest the involvement of sodium channels in the proepileptic effect of VPA.