The attitude and acceptability towards medical promotional tools and their influence on physicians' prescribing practices in Jordan and Iraq: a cross-sectional study

Background

Pharmaceutical companies spend more than one-third of their sales revenue on marketing and promotion directed toward healthcare professionals. There has been a focus on the relationship between healthcare professionals and the pharmaceutical industry in recent years. This study aims to explore the attitude toward and acceptability of medical promotional tools and their influence on physicians’ prescribing practices in Jordan and Iraq.

Methods

A cross-sectional survey study was conducted to explore the influence of visits by medical representatives (MRs) and medical promotions on physicians’ prescribing practices between June and October 2020 in Jordan and Iraq. Previously validated questionnaires were used.

Results

A total of 801 physicians completed the questionnaires. Face-to-face visits, followed by the dispensing of medical samples, were the two most common promotional methods used by MRs. 48% of participating physicians reported that they would accept the promotional marketing tools offered to them. MRs focused on the key selling points of their product during medical promotions, and 39.6% of the physicians reported that MRs had a negative attitude toward their competitors’ products. 69.9% of the physicians reported that they would change their practice after participating in conferences or meetings.

Conclusion

Medical promotional tools have a clear influence on physicians’ prescribing practices in Jordan and Iraq. Therefore, medical promotion should be controlled and guided by clear and country-specific ethical guidelines. This will ensure safe medical promotion to physicians and optimise the healthcare practices provided to patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07525-1.

Production of Healthy Functional Soft White Cheese Using <i>Moringa oleifera </i>Oil

BACKGROUND AND OBJECTIVE

Moringa oleifera oil is composed of highly unsaturated fatty acids containing 80.4% polyunsaturated, mainly oleic acids 67.9% and had a low acid value and low free fatty acids composition, so it is acceptable for edible application. The objective of study was the feasibility of using Moringa oleifera oil in manufacture of cheese compared with other oils (olive, sun flower) and the effect of using Moringa oleifera oil in chemically; organoleptically and microbial content in cheese.

MATERIALS AND METHODS

Fat was mechanically separated from buffalo's milk to reach 3% fat. Then the resultant milk divided into four portions. First let as control, then, the rest milk divided into three portions and fat substituted with 1, 1.5 and 3% of olive, moringa and sunflower oils. The resultant milk manufactured to soft white cheese and the resultant cheese was analyzed chemically, microbiologically and organoleptically.

RESULTS

Findings showed that 1.5% of different oils are best ratio and had gained highest scores for appearance, body and texture and flavor. The soft white cheese manufactured by Moringa oleifera oil was a best treatment than control and other treatments and has antimicrobial properties. Acidity, fat, total nitrogen, soluble nitrogen, total volatile fatty acids (TVFA) and thiobarbituric acid (TBA) increased during cold storage at 5°C+1 for 3 weeks cheese with Moringa oleifera oil had lower (PV) peroxide value than other treatments and pH took an opposite trend.

CONCLUSION

It was concluded that Moringa oleifera oil in soft cheese improved body and texture, flavor, than olive and sunflower oils and also increased the shelf life of cheese.

Effect of quinine therapy on plasma glucose and plasma insulin levels in pregnant women infected with Plasmodium falciparum malaria in Gezira state

To determine if quinine has a metabolic effect during treatment of severe or complicated malaria, we studied its effects on plasma glucose and plasma insulin levels in 150 pregnant women with malaria referred to Madani maternity teaching hospital, Gezira state and 50 healthy pregnant controls. Levels were determined at baseline (day 0) before the start of quinine treatment, after 2 days of treatment (2 hours after the 4th dose) and after 7 days of treatment (day 8). There was a statistically significant increase in plasma insulin concentrations during the quinine infusion and fall in plasma glucose concentration (P < 0.001). Quinine administered at the recommended dose and rate can disrupt plasma glucose homeostasis although it is still the drug of choice for severe and complicated malaria in Sudan.

MRI of bone marrow oedema associated with focal bone lesions

AIM

To quantify the volume of bone marrow oedema surrounding focal bone lesions and to identify its relevance relative to diagnosis.

METHODS

Three hundred and eighty-eight of 1456 patients included in the orthopaedic oncology database who underwent magnetic resonance imaging (MRI) demonstrated bone marrow oedema and were included in the study. There were 225 males and 163 females, age range 1-87 years (mean 29 years). MRI images were retrospectively reviewed and assessed for the extent of bone marrow oedema. The amount of oedema was graded: grade 1: oedema present but smaller than the lesion size; grade 2: oedema equivalent to the lesion size; grade 3: oedema greater than the lesion size.

RESULTS

There were 190 grade 1 lesions: 56% malignant, 33% benign, 11% non-neoplastic; 74 grade 2 lesions: 19% malignant, 50% benign, 31% non-neoplastic; and 124 grade 3 lesions: 10% malignant, 46% benign, 44% non-neoplastic. There was a significant relationship between oedema grade (i.e., volume of oedema) and final diagnosis (p<0.0005).

CONCLUSION

Bone marrow oedema may be associated with a wide range of focal bony lesions, including malignant, benign and non-neoplastic causes. As the volume of bone marrow oedema increases relative to the size of the underlying lesion, the probability that the underlying lesion is benign is increased.

Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment?

OBJECTIVE

To assess if ultrasound guided autologous blood injection is an effective treatment for medial epicondylitis.

METHODS

Twenty patients (13 men, 7 women) with refractory medial epicondylitis with symptom duration of 12 months underwent sonographic evaluation. Tendinosis was confirmed according to three sonographic criteria: echo texture, interstitial tears and neovascularity. The tendon was then dry needled and autologous blood was injected. Patients were reviewed at 4 weeks and at 10 months. VAS scores and modified Nirschl scores were assessed pre-procedure and post-procedure.

RESULTS

There was significant reduction in VAS pain score between pre-procedure and 10 months post-procedure when it had a median (IQR) of 1.00 (1-1.75), range 0-7. The median (IQR) Nirschl score, which at pre-procedure was 6.00 (5-7), range 4-7, had decreased at 4 weeks to 4.00 (2.25-5), range 2-7, and at 10 months to 1.00 (1-1.75), range 0-7, revealing a significant decrease (z = 3.763, p<0.001). The hypo-echoic change in the flexor tendon significantly decreased between pre-procedure, when there was a mean (SD) of 6.45 (1.47), and at 10 months, when it was 3.85 (2.37) (p<0.001). Doppler ultrasound showed that neovascularity decreased between pre-procedure, when there was a mean (SD) of 6.10 (1.62), range 4-9, and at 10 months, when it was 3.60 (2.56), range 0-9 (p<0.001).

DISCUSSION

The combined action of dry needling and autologous blood injection under ultrasound guidance appears to be an effective treatment for refractory medial epicondylitis as demonstrated by a significant decrease in VAS pain and a fall in the modified Nirschl scores.

CT-guided obturator nerve block via the posterior approach

OBJECTIVE

To describe the technique of obturator nerve block under CT guidance via the posterior approach, and to evaluate the efficacy of the procedure in the short-term and mid-term relief of chronic hip pain.

DESIGN AND PATIENTS

Consecutive patients referred for obturator nerve block were prospectively enrolled in this study. Under CT-guidance, via a posterior approach through the pelvis, local anaesthetic and steroid were infiltrated around the obturator nerve using a 22G spinal needle. Fifty-one patients (19 male, 32 female), mean age 54 years, with hip pain refractory to conventional therapy underwent the procedure. Visual Analogue Scale pain scores were recorded before the procedure and at 30 minutes, 24 hours, 1 week and 3 months thereafter.

RESULTS

Pain scores within 30 minutes showed a decrease from a mean +/- SD score of 8.41+/-1.22 pre-procedure to 2.86+/-2.1, p<0.001. At 24 hours, the mean pain score was 2.06+/-1.76, a decrease of 76% from pre-procedural score, p<0.001. Sustained pain relief at 1 week and 3 months was attained in 92% (mean pain score 2.41+/-2.2, p<0.001) and 82% (mean pain score 3.80+/-2.94, p<0.001) of cases respectively. Follow-up data was complete for all 51 patients. No serious side-effects were reported.

CONCLUSIONS

In patients with hip pain refractory to conventional pain control measures, CT-guided obturator nerve block can provide relief from pain in the short to medium term. The posterior approach offers safe, reliable and effective access to the nerve, in a procedure which is well-tolerated by the patient.

Biochemical assessment of home made fluids and their acceptability in the management of diarrhea in children in the gezira state, Sudan

OBJECTIVES

To determine the biochemical constitution of homemade fluids and assess their acceptability and efficacy for the management of acute diarrhea in Sudanese children.

MATERIAL AND METHODS

This is a cross-sectional study of 150 children selected randomly. The fluids studied were 36 samples of sorghum-based solutions (nasha) and 10 samples of rice water. Samples were randomly collected from households and analyzed to determine the pH, carbohydrates, proteins, fat, crude fiber, ash and electrolytes (Na(+), K(+) and Cl(-)).

RESULTS

In addition to being very useful for rehydration, the two fluids were found to contain considerable amounts of nutrients. The sodium and chloride contents of homemade fluids were found to be much lower than those of the WHO/UNICEF ORS (oral rehydration solution). These electrolytes can be adjusted by adding table salt (3-3.5 g NaCl to one litre of sorghum-based solution and 2.3-2.6 g NaCl to one liter of rice water) to bring them to concentration comparable to that of the standard ORS.

CONCLUSION

Homemade solutions can be modified by adding table salt to bring them to the standard ORS and can be used successfully to prevent dehydration. This will solve the problem of the availability of ORS and reduce morbidity and mortality from diarrhea.

Copper status of Najdi sheep in eastern Saudi Arabia under penned and grazing conditions

Concentrations of serum copper were significantly lower in penned Najdi sheep (zero grazed) than in grazing sheep in eastern Saudi Arabia. Soil-plant-animal interrelationships studies suggest that this could be attributed to the low copper to molybdenum ratio in the forages (berseem and Rhodes grass) fed to the penned sheep as compared to pasture plants. This was in line with the status of these minerals in the soils.

Effects of water deprivation on urea metabolism in camels, desert sheep and desert goats fed dry desert grass

1. The effects of water restriction and complete water deprivation on nitrogen retention and urea recycling were examined in camels, desert sheep and desert goats fed only dry desert grass of 3.2% crude protein content. 2. All three species were in negative nitrogen balance when water was available ad libitum. 3. In camels urea recycling was consistently high (94-97%) and nitrogen balance did not change with treatment. 4. In sheep and goats urea recycling increased from 75% to 94% (sheep) and from 79% to 95% (goats) during water deprivation, and nitrogen balance improved to positive values. 5. In all species water deprivation depressed dry matter intake and increased apparent digestibility of dry matter and nitrogen. 6. The effects of water restriction were generally intermediate. 7. These results suggest that nitrogen metabolism in adult domestic livestock raised by nomadic pastoralists in Sudan is not harmed, and may in fact be improved by short periods of water deprivation.

The pathology of experimental Schistosoma bovis infection in sheep

Five desert sheep were exposed to 5000 or 10000 Schistosoma bovis cercariae each, and the parasitological clinical and pathological parameters were recorded. The pre-patent period was approximately 7 weeks and from that time onwards, the animals became progressively ill and emaciated. Following necropsy at the 12th week, a percentage schistosome recovery ranging from 36%--63.6% was found, and there were high egg densities in the intestinal tract and the liver. These organs revealed severe pathological lesions which were described in detail along with the changes occurring in other tissues.

The pathology of naturally-occurring bovine schistosomiasis in the Sudan

The gross and histopathological lesions of naturally-occurring bovine schistosomiasis in the Sudan are detailed. Out of 61 animals examined, 53 were found infected with Schistosoma bovis, showing lesions in their livers, intestinal tracts and other organs. Apart from granulomas, periportal inflammatory infiltration, fibrosis and pigmentation of Kupffer cells, livers of infected cattle revealed peculiar lesions in the form of "nodular sclerosis", medial hypertrophy of portal veins and lymphoid nodule and follicle formation around parasites. In the intestines, variable manifestations of catarrh, with eosinophilic infiltration, granulomatous reaction and vascular changes, were observed. Pancreatic schistosomiasis was common and some animals had lesions in their lungs and lymph nodes. Urogenital lesions, rectal and colonic polyps, congestive splenomegaly, gastro-oesophageal variaces and Symmer's clay-pipe stem fibrosis of the liver were not seen in cattle. The haematological and serum protein findings in infected animals were included. The findings were related to the lesions observed and the need for detailed study of functional disturbances in bovine schistosomiasis is indicated.