Alteration in the expression of the chemotherapy resistance‑related genes in response to chronic and acute hypoxia in pancreatic cancer

Pancreatic cancer is currently one of the least curable types of human cancer and remains a key health problem. One of the most important characteristics of pancreatic cancer is its ability to grow under hypoxic conditions. Hypoxia is associated with resistance of cancer cells to radiotherapy and chemotherapy. It is a major contributor to pancreatic cancer genetic instability, which local and systemic resistance that may result in poor clinical outcome. Accordingly, identifying gene expression changes in cancer resistance genes that occur under hypoxic conditions may identify a new therapeutic target. The aim of the present study was to explore the association between hypoxia and resistance to chemotherapy and determine the alteration in the expression of cancer resistance-related genes in the presence of hypoxia. Pancreatic cancer cells (PANC-1) were exposed to 8 h hypoxic episodes (<1% oxygen) three times/week for a total of 20 episodes (chronic hypoxia) or 72 h hypoxic episodes twice/week for a total of 10 episodes (acute hypoxia). The alterations in gene expression were examined using reverse transcription-quantitative PCR array compared with normoxic cells. Chemoresistance of hypoxic cells toward doxorubicin was assessed using MTT cell proliferation assay. Both chronic and acute hypoxia induced chemoresistance toward doxorubicin in PANC-1 pancreatic cancer cell line. The greatest changes occurred in estrogen Receptor Alpha Gene (ESR1) and ETS Like-1 protein (ELK1) pathways, in nucleic transcription factor Peroxisome proliferator-activated receptors (PPARs) and in a cell cycle inhibitor cyclin dependent kinase inhibitor 1A (CDKN1A). The present study demonstrated that exposing cells to prolonged hypoxia results in different gene expression changes involving pleotropic pathways that serve a role in inducing resistance in pancreatic cancer.

Use of traditional and complementary medicine for COVID 19 prophylaxis among healthcare professionals and students in Jordan: A cross-sectional study

INTRODUCTION

There is inadequate evidence to recommend the use of any traditional and complementary medicine (T&CM) methods such as vitamin, mineral, herbal or other dietary supplements to prevent or treat COVID 19. Members of the medical team are particularly at risk of exposure to high viral load of coronavirus. They have also the best access to professional information regarding disease treatment and prophylaxis and disseminate such knowledge. The aim of the study was to assess the prevalence of use of T&CM for the prophylaxis of COVID 19 among the healthcare professionals and students in Jordan, along with the most common types and the factors associated with T&CM use.

METHODOLOGY

A cross-sectional study of T&CM use was conducted in Jordan using a snowball sampling method to distribute Google Forms and to enrol participants during coronavirus outbreak between June 10, 2021, and August 28, 2021. The study included healthcare professionals or students who consented to participate in the survey. The survey excluded those participants who had filled the questionnaire at least once or were pregnant/breast-feeding at the time of the study. The questionnaire consisted of 29 items, including screening, checkbox, dichotomous, matrix and open-ended questions.

RESULTS

The response rate was 97.1%. Out of 560 study respondents, 359 (64.1%) reported using T&CM for COVID 19 prevention. Vitamins and nutrients were consumed by almost half (48.4%) of study participants, while nonpharmacological methods and herbal remedies were consumed by 35.2% and 25.2%, respectively. The most common source of information regarding T&CM use for COVID 19 prophylaxis included scientific publications (59.5%), followed by disease treatment guidelines (38.0%) and social media (32.3%). Adverse effects were reported by 8.5% and possible adverse effects were reported by another 8.5% of participants. The T&CM use was associated with working in contact with COVID 19 patients (OR: 1.625 (95% CI 1.047-2.523) (P = 0.03) and having a colleague as a source of information (OR: 1.720 (95% CI 1.026-2.883) (P = 0.04).

CONCLUSIONS

The prevalence of T&CM use for COVID 19 prevention among healthcare professionals and students in Jordan is high, with a significant proportion of participants reporting adverse effects. There is an urgent need for further research toward efficacy and safety of T&CM in COVID 19 prophylaxis as well as development of appropriate public health policy on this issue specific to each country.

Identification of Insulin Resistance Biomarkers in Metabolic Syndrome Detected by UHPLC-ESI-QTOF-MS

Metabolic syndrome (MetS) is a disorder characterized by a group of factors that can increase the risk of chronic diseases, including cardiovascular diseases and type 2 diabetes mellitus (T2D). Metabolomics has provided new insight into disease diagnosis and biomarker identification. This cross-sectional investigation used an untargeted metabolomics-based technique to uncover metabolomic alterations and their relationship to pathways in normoglycemic and prediabetic MetS participants to improve disease diagnosis. Plasma samples were collected from drug-naive prediabetic MetS patients (n = 26), normoglycemic MetS patients (n = 30), and healthy (normoglycemic lean) subjects (n = 30) who met the inclusion criteria for the study. The plasma samples were analyzed using highly sensitive ultra-high-performance liquid chromatography electrospray ionization quadrupole time-of-flight mass spectrometry (UHPLC-ESI-QTOF-MS). One-way ANOVA analysis revealed that 59 metabolites differed significantly among the three groups (p < 0.05). Glutamine, 5-hydroxy-L-tryptophan, L-sorbose, and hippurate were highly associated with MetS. However, 9-methyluric acid, sphinganine, and threonic acid were highly associated with prediabetes/MetS. Metabolic pathway analysis showed that arginine biosynthesis and glutathione metabolism were associated with MetS/prediabetes, while phenylalanine, D-glutamine and D-glutamate, and lysine degradation were highly impacted in MetS. The current study sheds light on the potential diagnostic value of some metabolites in metabolic syndrome and the role of their alteration on some of the metabolic pathways. More studies are needed in larger cohorts in order to verify the implication of the above metabolites on MetS and their diagnostic value.

The Effect of Psychotropic Medications and Their Combinations on the QTc Interval Among Jordanian Outpatients: A Cross-Sectional Study

Objective

To investigate the effect of psychotropic drugs and their combinations on the QTc interval as well as the prevalence of long QTc (LQTc) among ambulatory patients with psychiatric illness in Jordan.

Methods

A cross-sectional study that included patients treated in an outpatient psychiatric clinic was conducted. The QTc duration was calculated using a combined QT correction (Bazett’s formula for heart rate 60–100 and the Framingham formula for extremes of HR).

Results

Among 307 patients, about 60% received multiple psychotropic drugs. The LQTc frequency was 1.2%. QTc interval prolongation was observed in patients receiving selective serotonin reuptake inhibitors (SSRIs) (P = .011), tricyclic antidepressants (TCAs) (P = .033), citalopram (P = .044), or psychotropic polytherapy (P = .005). The addition of SSRIs to second-generation antipsychotics (SGAs) also lengthened the QTc interval (P = .029). There was a correlation between the number of psychotropic medications and the QTc length (P = .018). All patients with LQTc carried at least one risk factor for it other than the use of psychotropic medication(s), 3 of 4 patients had a combination therapy, all patients were prescribed SSRIs, and 2 of them had comorbid conditions.

Conclusion

There is a high prevalence of psychotropic drugs polytherapy, and it is clearly associated with LQTc. Citalopram, SSRIs, and TCAs prolong QTc interval. It is recommended to assess non-pharmacological factors for LQTc and, if necessary, to obtain an electrocardiogram before starting patients on psychotropic drugs known to prolong the QTc interval.

Pharmaceutical Care in the Treatment of Substance Use Disorders in Jordan: A Randomized Controlled Trial

BACKGROUND

Substance Use Disorder is a chronic relapsing disease that is characterized by compulsive drug seeking and use, despite harmful consequences. The aim of this study was to evaluate the impact of clinical pharmacist intervention/recommendation on the treatment of patients admitted to addiction rehabilitation centers in Jordan.

METHODS

A randomized controlled trial was conducted in two public addiction treatment centers in Amman. Patients (n = 93) were randomized into 2 groups (control and intervention). Medication review was conducted for both groups at baseline, during stay and at discharge. Treatment related problems (TRPs) were identified by the clinical pharmacist and recommendations provided to the therapeutic team in the intervention group. Additionally, quality of life and quality of sleep were assessed at baseline and 2 weeks later.

RESULTS

A total of 392 TRPs were identified during the study period. The mean number of TRPs ± SD was 4.22 ± 2.58 per patient. The clinical pharmacist intervention led to a reduction in the mean number of TRPs at discharge by 2.2 ± 0.85 (p < 0.001) in comparison to the control group (by 0.23 ± 0.27, p = 0.066). After 2 weeks of admission, there was an improvement of physical health (p = 0.035) and of the overall sleep status (p = 0.048) in the intervention vs. control groups.

CONCLUSION

Clinical pharmacy services provided to patients with substance use disorder reduced the number of TRPs and improved other outcomes such as physical health and quality of sleep during detoxification. Long term studies with larger sample sizes are needed.

A Pre-Post Study of Vitamin D Supplement Effects on Urinary Megalin: The Emerging Predictive Role of Megalin in Diabetic Nephropathy Progression

Introduction:

Megalin is a renal proximal tubular protein that reabsorbs vitamin D from glomerular filtrates. Previous studies found significantly higher levels of urinary megalin in chronic microvascular complications of diabetes with associated metabolic derangements. This study aimed at testing the effect of vitamin D supplements on urinary megalin levels in diabetic nephropathy (DN) patients with vitamin D hypovitaminosis.

Methods:

Sixty-three participants with vitamin D deficiency and diabetic nephropathy (DN) were enrolled in the pre-post study; urinary megalin levels with various clinical parameters and serum levels of vitamin D3 were measured and compared to the baseline at 3- and 6-month intervals.

Results:

Interestingly, a supplementation related increase in serum vitamin D3 levels at 3- and 6- month interventions affected a constellation of ameliorations in the DN progression of clinical and metabolic factors. There was a decrease in ACR with a concomitant decrease in urinary megalin and a decrease in blood pressure, fasting plasma glucose (FPG), and low-density lipoprotein – cholesterol (LDL-C) – but an increase in glomerular filtration rate (GFR). Principally, pellet urinary megalin associated positively (p < 0.05) with vitamin D hypovitaminosis and the albumin-to-creatinine ratio (ACR) but negatively (p < 0.05) with Ca2+ and body mass index (BMI).

Conclusion:

Vitamin D supplementation could elucidate underlying pathophysiological mechanisms and a prognostic significance of urinary megalin association with DN, obesity/MetS-related dyslipidemia, and hyperglycemia modification. Megalin is a putative sensitive and precise predictive marker and an emerging therapeutic target of renal anomalies.

Patterns of Substance Use among Patients in Addiction Rehabilitation in Jordan

Background: This study aimed to identify pattern of substance use among patients at two public addiction rehabilitation centers in Amman. It provided a description of substance use career and assessment of addiction severity, quality of life and quality of sleep among participants.Methods: A quantitative cross-sectional study using a structured data collection form consisting of 4 parts: 1. General data including the demographic characteristics, medical history and career of drug abuse. 2. Severity of addiction using the severity of dependence scale (SDS). 3. Quality of life measured by the EQ-5D and 4. Quality of sleep measured by the insomnia severity index (ISI) scale.Results: A total of 93 patients from 2 treatment settings were recruited over 5 months. The total number of actively used substances was 196, with an average of 2 substances per patient. Alcohol and synthetic cannabinoids were the two most commonly used substances (39.8% and 38.7% respectively) followed by benzodiazepines (33.4%). A notable drop in heroin use was observed (5.4%, 5 out of 23 opioid user) compared to the years 2007-2009. The mean SDS score among patients was 11.43 (SD ± 3.48) indicating high dependence. Sleep problems were reported by 45% of patients. Data showed a significant role of community pharmacies in supplying drugs of abuse for users.Conclusion: Pattern of substance use changed significantly in Jordan with synthetic cannabinoids being of the top substances used and heroin use dropping. Actions should be taken to reframe the legalization of dispensing certain drugs by pharmacists without a prescription.

Urinary megalin in association with progression factors of diabetic nephropathy

AIM

The aim of this study is to evaluate the association between urinary megalin, renal function, blood pressure, lipid profile, vitamin D and glycemic control in patients with type 2 diabetes mellitus (T2DM).

METHODS

. This was a cross-sectional study which recruited 209 patients with T2DM. Urinary megalin was positively associated with systolic blood pressure (SBP) (r=0.218, p=0.04) but negatively with glomerular filtration rate (GFR) (r=-0.16, p=0.023). The levels of urinary albumin, triglycerides (TGs) and glycosylated hemoglobin (HbA1c) were higher in the "high-megalin" group, compared to those in "low-megalin" group. Moreover, there was a significant inverse association between vitamin D3 levels and megalin levels in urine (OR=0.281, p=0.047).

CONCLUSION

Our study showed for the first time that megalin is associated with progression factors of diabetic nephropathy as well as vitamin D deficiency (Tab. 3, Fig. 1, Ref. 15).

Increased lipocalin-2 vs reduced oxytocin in relation with adiposity, atherogenicity and hematological indices in metabolic syndrome patients with and without prediabetes

OBJECTIVES

The neuropeptide hormone- Oxytocin (OXT) and glycoprotein Lipocalin-2 (LCN-2) are strongly associated with cardiometabolic risks of insulin resistance in metabolic syndrome (MetS) and prediabetes (preDM).

METHODS

In a cross sectional design we aimed to compare and correlate plasma levels of OXT and LCN-2 and a set of clinical parameters, adiposity indices, atherogenicity indices, and hematological indices in 29 MetS/preDM individuals and 29 non-diabetic MetS subjects  vs 30 normoglycemic lean controls. Colorimetric enzymatic assays of biomarkers were procured.

RESULTS

LCN-2 concentration (ng/mL) increased significantly in MetS/preDM  vs controls. Substantially in MetS recruits (both non-diabetic and pre-diabetics; n  =  58); OXT directly correlated with visceral adiposity index (VAI), non-HDL-C/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio, lipid accumulation product (LAP), and atherogenicity index of plasma (AIP). Impressively, LCN-2 correlated proportionally with waist circumference (WC), red cell distribution width (RDW), neutrophils, and neutrophils to lymphocytes ratio (NLR), but inversely with lymphocytes in the 58 (non- and preDM) MetS participants.

CONCLUSIONS

These pronounced variations and correlations of OXT and LCN-2 emphasize their putative molecular roles in MetS and preDM pathophysiologies. Thus, OXT and LCN-2 can be surrogate prognostic/diagnostic tools for the MetS/preDM pharmacotherapy/prevention (Tab. 3, Fig. 1, Ref. 44).

Correlates of zinc finger BED domain-containing protein 3 and ghrelin in metabolic syndrome patients with and without prediabetes

Background

Ghrelin and zinc finger BED domain-containing protein 3 (ZBED3) are distinctively cross linked with prediabetes (preDM) and metabolic syndrome (MetS).

Materials and methods

In a cross-sectional design with 29 normoglycemic MetS and 30 newly diagnosed drug naïve preDM/MetS patients vs. 29 lean and normoglycemic controls; ghrelin and ZBED3 were evaluated using colorimetric enzymatic assays.

Results

While ZBED3 mean circulating levels (ng/mL) in both MetS groups (normoglycemic and preDM) invariably lacked discrepancy vs. controls; Appreciably ghrelin levels (ng/mL) in preDM/MetS (but not normoglycemic MetS) participants were markedly higher vs. controls. Except for fasting plasma glucose (FPG) and glycosylated-hemoglobin (HbA1C); no further intergroup discrepancy could be identified between the MetS arms. Remarkably adiposity indices (body mass index (BMI), body adiposity index (BAI), and lipid accumulation product (LAP), but not conicity index (CI) or visceral adiposity index (VAI)); atherogenicity index of plasma (but not non-high-density lipoprotein-cholesterol (non-HDL-C/HDL-C) ratio, or total cholesterol (TC)/HDL-C ratio) or any of hematological indices (red cell distribution width (RDW-CV%), monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR) and platelet (PLT) to lymphocyte ratio (PLR)) were substantially higher in both MetS (non- and preDM) groups vs. those of controls. Exceptionally low-density lipoprotein -cholesterol (LDL-C)/HDL-C ratio, and waist circumference (WC)/hip circumference (HC) ratio were much more pronounced in MetS-preDM vs. normoglycemic MetS recruits. In the MetS pool (both normoglycemic and preDM, n = 58), neither biomarker could relate to each other, or any of clinical parameters, adiposity or atherogenecity indices. Exceptionally ghrelin correlated significantly and inversely with age. ZBED3 correlated significantly and directly with RDW-CV% in the same pool of MetS recruits (n = 59).

Conclusions

Both biomarkers can not be ruled out as putative predictive/surrogate prognostic tools for metabolic anomalies prevention and pharmacotherapy.

Increased malondialdehyde vs. reduced sirtuin 1 in relation with adiposity, atherogenicity and hematological indices in metabolic syndrome patients with and without prediabetes

BACKGROUND

Sirtuin 1 (SIRT 1) and malondialdehyde (MDA) were implicated in metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) pathophysiology.

AIMS AND METHODS

This cross-sectional study aimed to investigate both SIRT 1 and MDA in 30 lean healthy control, 31 normoglycemic MetS subjects and 30 MetS-Pre/T2DM drug naïve. C orrelation studies were established for both biomarkers with adiposity indices [conicity index (CI), waist circumference (WC), weight-to-height (WHtR) ratio, weight-to-hip (WHR) ratio, hip circumference (HC), and body adiposity index (BAI)], hematological indices [red cell distribution width (RDW), mean platelet volume (MPV), platelet-to-lymphcyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR)] and atherogenicity indices (atherogenicity index of plasma (AIP = log₁₀TG/HDL-C ratio), TC/HDL-C and LDL-C/HDL-C ratios].

RESULTS

SIRT1 levels (ng/mL) were markedly lower in both MetS groups (2.12 ± 0.06 and 2.32 ± 0.19, respectively, vs. controls 4.73 ± 0.15; P < 0.05). Conversely, a gradual increase in MDA levels (μM) was attained (MetS 72 ± 3.3 and MetS pre-T2DM 81 ± 6.1 vs. controls 62 ± 3.5; P > 0.05). A significant inverse MDA-SIRT1 relationship was observed (P = 0.006). SIRT1 correlated inversely with all the studied adiposity (WC: P < 0.001, HC: P < 0.001, WHR: P < 0.001, C-index: P < 0.001, BAI: P < 0.001) and atherogenicity indices (AIP: P < 0.001, TC/HDL-C: P < 0.001, LDL-C/HDL-C: P < 0.001) as well as MPV (P < 0.01). Whereas MDA directly with WHtR, CI and BAI (WC: P < 0.01, HC: P < 0.05, BMI: P < 001, WHtR: P < 0.001, C-index: P < 0.005, BAI: P < 0.01).

CONCLUSION

The substantial variations and correlations emphasize a potential molecular role of SIRT1 and MDA in the pathophysiology of MetS and pre/T2DM.

Glycated LDL-C and glycated HDL-C in association with adiposity, blood and atherogenicity indices in metabolic syndrome patients with and without prediabetes

BACKGROUND

The aim of the study was to compare and correlate glycated high-density lipoprotein (GHDL-C) and glycated low-density lipoprotein (GLDL-C) plasma levels with adiposity indices [weight/hip ratio (WHR) and body adiposity index (BAI)], lipid ratios and hematological indices [platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR)].

METHODS

This was a cross-sectional study of 30 nondiabetic metabolic syndrome (MetS) patients, 30 prediabetic or type 2 diabetes mellitus (T2DM) patients and 30 normoglycemic controls.

RESULTS

Remarkably both GHDL-C and GLDL-C levels lacked any intergroup statistically significant discrepancy in either MetS or MetS-pre/T2DM versus control (p > 0.05). Unlike GLDL-C/LDL-C ratios for either MetS groups; there were highly significant intergroup differences in the means of GHDL-C/HDL-C ratios when comparing both nondiabetic MetS and MetS-pre/T2DM groups versus controls (p = 0.001). In MetS patients; GHDL-C and GLDL-C proportionally correlated with WHR (p < 0.05). Also, MetS GHDL-C correlated inversely with MLR and monocytes (p < 0.05). In MetS-pre/T2DM; GLDL-C directly correlated with BAI, platelet count and PLR (p < 0.05).

CONCLUSION

GLDL-C and GHDL-C are dysfunctional glucolipotoxicity lipoproteins and may present putatively surrogate biomarkers for prediction/prevention of metabolic disturbances.

Effect of metformin combined with lifestyle modification versus lifestyle modification alone on proinflammatory-oxidative status in drug-naïve pre-diabetic and diabetic patients: A randomized controlled study

BACKGROUND

Targeting biomarkers of oxidative-proinflammatory stress may result in improvement of modifiable metabolic syndrome, pre-diabetes and diabetes risk factors and subsequent risk reduction.

METHODS

64 newly diagnosed antihyperglycemic treatment-naïve prediabetic and type 2 diabetes mellitus (T2DM) patients were randomly assigned using block design to either metformin combined with therapeutic lifestyle changes (TLC) or TLC alone. Body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), fasting lipid profile, plasma oxidative status and tumor necrosis factor (TNF)-α were measured at baseline, after 3 months and after 6 months from baseline.

RESULTS

Except for HbA1c, baseline values did not differ significantly between the two groups. The post 3-months relative reductions in BMI (P=0.014) and HbA1c (P=0.037) in metformin combined with TLC intervention were significantly greater than those in TLC alone group. TNFα plasma levels were decreased significantly vs. baseline by metformin combined with TLC intervention (-22.90±46.76%, P=0.01). Conversely, TLC alone basically worsened proinflammatory status (42.40±40.82 %), P<0.001. Metformin with TLC treatment effected a therapeutic decrement of the oxidative stress (-15.44±35.32%, P=0.029 vs. baseline) unlike TLC alone (61.49±122.66%, P=0.01 vs. baseline). Both interventions' effects were sustained in the 6-month follow up periods.

CONCLUSION

In both intervention groups, the relative changes in plasma TNFα were significantly correlated (P<0.01) with systolic blood pressure and the relative changes in oxidative stress were markedly correlated (P<0.05) with total cholesterol.

Association of Oxytocin with Glucose Intolerance and Inflammation Biomarkers in Metabolic Syndrome Patients with and without Prediabetes

OBJECTIVES

The aim of this study was to explore the differences in OXT levels in metabolic syndrome (MetS) subjects, newly diagnosed type 2 diabetes mellitus (T2D), and prediabetes subjects vs. MetS subjects without glucose intolerance (non-diabetic MetS). It was also intended to determine the relationship between plasma OXT levels and inflammatory markers in those subjects.

METHODS

Along with 45 lean and normoglycemic controls, a total of 190 MetS subjects (61 men, 129 women) were enrolled. Colorimetric enzymatic assays of the following components were performed: plasma OXT, high-sensitivity C-reactive protein (hs-CRP), macrophage chemoattractant protein 1 (MCP-1), plasminogen activator inhibitor 1 (PAI-1), matrix metalloproteinase 9 (MMP-9), resistin, adiponectin, leptin, macrophage migration inhibitory factor (MIF), tumor necrosis factor α (TNF-α), thrompospondin 1 (TSP-1), interleukin 10 (IL-10), interleukin 6 (IL-6), and glucagon.

RESULTS

hsCRP, PAI-1, resistin, leptin-to-adiponection-ratio (LAR), TNF-α, TSP-1, and MIF were significantly higher in both MetS groups (prediabetic and T2DM) than in MetS-only subjects. Leptin and MMP-9 were significantly higher in the MetS-T2DM group (but not in MetS-prediabetics) vs. MetS-only subjects. Conversely adiponectin, OXT, MCP-1, and IL-10 were significantly lower in both MetS groups (prediabetic and T2DM) than in MetS-only subjects. There was no marked discrepancy in either glucagon or IL-6 levels among the three MetS groups. In the entire MetS study population, OXT correlated substantially and proportionally with MCP-1, IL-10, and IL-6; it correlated negatively with HbA1c, fasting plasma glucose (FPG), PAI-1, MMP-9, TNF-α, TSP-1, resistin, adiponectin, leptin, LAR, and MIF. No association could be observed between OXT and glucagon.

CONCLUSIONS

OXT may be a substantial surrogate predictive/prognostic tool and putative pharmacotherapeutic target in metabolic anomalies and related disorders.

The correlation between plasma levels of oxytocin and betatrophin in non-diabetic and diabetic metabolic syndrome patients: A cross sectional study from Jordan

BACKGROUND

Oxytocin (OXT) is a neurohypophyseal hormone that has been recently shown to possess a number of beneficial effects in diabetes and obesity. Betatrophin is a protein expressed in fat and liver that regulates lipid metabolism and promotes pancreatic β-cell proliferation. It is not investigated yet whether OXT and betatrophin levels correlate in metabolic syndrome (MS) or diabetes patients.

METHODS

The aim was to assess correlations between plasma betatrophin and OXT levels in MS-diabetic or prediabetic (N=89) as compared to MS-non-diabetic (N=69) patients. Competitive binding ELISA was used to evaluate betatrophin and OXT plasma concentrations. Correlations of the above biomarkers and patient clinical characteristics were also detected.

RESULTS

As compared to the control MS participants (0.32±0.25ng/mL); betatrophin plasma levels were increased (P<0.001) in the MS-pre/T2DM patients (1.23±0.68ng/mL). On the contrary, OXT concentrations were decreased (P<0.001) in the MS-pre/T2DM patients (1222.46±514.55pg/mL) as compared to the MS control subjects (2323.42±848.68pg/mL). OXT concentration correlated negatively (r=-0.492, P<0.001), while HbA1c and FPG correlated positively with betatrophin plasma levels (P<0.001), but were inversely correlated with OXT levels (P<0.001) in the total sample.

CONCLUSION

Betatrophin levels are increased, while OXT levels are decreased in MS-pre/T2DM. We found an inverse correlation between the levels of the two biomarkers in addition to correlation between their levels and the degree of glycemic control.

The use of medicinal herbs in gynecological and pregnancy-related disorders by Jordanian women: a review of folkloric practice vs. evidence-based pharmacology

Context National statistical reports in Jordan indicate a decrease in the total fertility rate along with a parallel increase in contraceptive use. The folkloric use of medicinal herbs in gynecological disorders has been growing in Jordan, despite of deficient reports on the evidence-based safety and efficacy of these practices. Objective The aim of this comprehensive article is to review medicinal plants with claimed ethnonpharmacological usage in various gynecological and pregnancy-related issues in Jordan, and to assess their evidence-based pharmacological studies as well as their phytochemistry. Methods The published literature was surveyed using Google Scholar entering the terms "ethnopharmacology AND Jordan AND infertility AND gynecology OR gestation". We included ethnopharmacological surveys in Jordan with available full-text. Results Twelve articles were reviewed. Plant species which are commonly used for female gynecological issues such as Artemisia monosperma Del. and A. herba-alba Asso. (Asteraceae) have been found to exert an antifertility effect. Ricinus communis L. (Euphorbiaceae) and Citrullus colocynthis (L.) Schrad. (Cucurbitaceae) had antifertility effects in male rats, but Nigella sativa oil L. (Ranunculaceae) and Cinnamon zeylanicum J. Presl (Lauraceae) were found to enhance it. Conclusion Using plants for gynecological disorders is a common practice in Jordan. Many of them, whether utilised for gynecological or non-gynecological conditions equally, were found to have detrimental effects on female or male fertility. Thus, couples planning pregnancy should be discouraged from the consumption of these herbs. Further local studies are warranted to confirm the appreciable beneficial pharmacological effects and safety of these plants.

Effects of Genetic Polymorphism in CYP3A4 and CYP3A5 Genes on Tacrolimus Dose Among Kidney Transplant Recipients

INTRODUCTION

This study aimed to evaluate the effects of single nucleotide polymorphisms CYP3A4*1B and CYP3A5*3 on tacrolimus dose requirement among kidney transplant recipients.

MATERIALS AND METHODS

Blood levels of tacrolimus were measured using microparticle enzyme immunoassay. Genotyping analysis utilized specific polymerase chain reaction-restriction fragment length polymorphism methods for 137 kidney transplant recipients.

RESULTS

The median tacrolimus dose was significantly lower in the CYP3A4*1/*1 carriers (0.06 mg/kg/d; range, 0.007 mg/kg/d to 0.17 mg/kg/d) as compared to the CYP3A4*1B/*1B carriers (0.1 mg/kg/d; range, 0.03 mg/kg/d to 0.22 mg/kg/d; P = .001). Patients with at least 1 CYP3A5*1 wild-type allele required higher median doses of tacrolimus (median, 0.08 mg/kg/d; range, 0.03 mg/kg/d to 0.22 mg/kg/d) as compared to the CYP3A5*3 carriers (median, 0.05 mg/kg/d; range, 0.007 mg/kg/d  to 0.17 mg/kg/d; P = .002).

CONCLUSIONS

This study showed that tacrolimus dose requirement is lower in Jordanian kidney transplant recipients compared to other populations. Moreover, we found a correlation between genetic variations in CYP3A4 and CYP3A5 enzymes and tacrolimus blood levels among our kidney transplant recipients.

Associations between patient factors and medication adherence: A Jordanian experience

Objective:

To explore the effect of patient characteristics and health beliefs on their medication adherence.

Methods:

Patients (n=167) with chronic conditions (mean age 58.9; SD=13.54, 53% males) were recruited from March 2009- to March 2010 using a cross sectional study design. Data collected included patients’ demographics, medical conditions, medications therapeutic regimen, frequency of physician visits and health beliefs. Patient self-reported adherence to medications was assessed by the researcher using a validated and published scale. Treatment related problems (TRPs) were evaluated for each patient by competent clinical pharmacists. Associations between patient characteristics/health beliefs with adherence were explored.

Results:

About half of the patients (46.1%) were non-adherent. A significant association was found between lower adherence and higher number of disease states (p<0.001), higher number of medications (p=0.001), and higher number of identified TRPs (p = 0.003). Patient adherence was positively affected by older age, higher educational level, and higher number of physician visits per month, while it was negatively affected by reporting difficulties with getting prescription refills on time.

Conclusion:

This study identified different factors that may negatively affect adherence, including higher number of medications and disease states, higher number of identified TRPs and inability to getting prescription refills on time. Hence, more care needs to be provided to patients with complex therapeutic regimens in order to enhance adherence.

The use and safety of medications known to affect driving in Jordan: A cross-sectional study

OBJECTIVES

The aim of this study was to estimate the main driving-impairing medications used by drivers in Jordan, the reported frequency of medication side effects, the frequency of motor vehicle crashes (MVCs) while using driving-impairing medicines, as well as factors associated with MVCs.

METHODS

A cross-sectional study involving 1,049 individuals (age 18-75 years) who are actively driving vehicles and taking at least one medication known to affect driving (anxiolytics, antidepressants, hypnotics, antiepileptics, opioids, sedating antihistamines, hypoglycemic agents, antihypertensives, central nervous system [CNS] stimulants, and herbals with CNS-related effects) was conducted in Amman, Jordan, over a period of 8 months (September 2013-May 2014) using a structured validated questionnaire.

RESULTS

Sixty-three percent of participants noticed a link between a medicine taken and feeling sleepy and 57% stated that they experience at least one adverse effect other than sleepiness from their medication. About 22% of the participants reported having a MVC while on medication. Multiple logistic regression analysis showed that among the participants who reported having a crash while taking a driving-impairing medication, the odds ratios were significantly higher for the use of inhalant substance (odds ratio [OR] = 2.787, P = .014), having chronic conditions (OR = 1.869, P = .001), and use of antiepileptic medications (OR = 2.348, P = .008) and significantly lower for the use of antihypertensives (OR = 0.533, P = .008).

CONCLUSION

The study results show high prevalence of adverse effects of medications with potential for driving impairment, including involvement in MVCs. Our findings highlight the types of patient-related and medication-related factors associated with MVCs in Jordan, such as inhalant use, presence of chronic conditions, and use of antiepileptics.

Management of hypertension and factors affecting its control in Jordanian renal transplant recipients

BACKGROUND

Hypertension affects 70-90 % of all kidney transplant recipients. It is associated with poor graft survival and is a contributing factor to the increased cardiovascular mortality. The reasons for the insufficient blood pressure control in transplanted patients have not been thoroughly investigated.

OBJECTIVE

To evaluate the extent of blood pressure control in Jordanian hypertensive renal transplant recipients and to assess factors associated with such control.

SETTING

Three outpatient renal transplant clinics in Amman.

METHOD

A cross-sectional observational study including 181 patients. We have considered blood pressure <130/80 mm Hg as controlled hypertension. Bivariate and multivariate logistic regression analyses were used to determine clinical factors associated with achievement of blood pressure control.

MAIN OUTCOME MEASURES

Proportion of patients who achieved hypertension control and clinical factors associated with good blood pressure control.

RESULTS

Mean systolic blood pressure was 128.6 ± 16.3 mm Hg and mean diastolic blood pressure was 82.8 ± 11.5 mm Hg. Blood pressure control was achieved only in 58 % of patients. The most commonly prescribed antihypertensives were calcium channel blockers (58 %) followed by beta-blockers (44 %). In bivariate analysis, female gender (p = 0.017) and creatinine clearance (p = 0.002) were positively associated, while number of antihypertensive medications was inversely associated (p = 0.04) with achievement of blood pressure control. After including these factors in multivariate logistic regression analysis, only creatinine clearance remained independently associated with hypertension control (odds ratio, OR 1.04; 95 % confidence interval [CI] 1.01-1.06; p = 0.003).

CONCLUSION

Blood pressure control among renal transplant recipients in Jordan was found to be inadequate. The only factor found to be independently associated with adequate blood pressure control was creatinine clearance.

Skin prick test reactivity to aeroallergens in Jordanian allergic rhinitis patients

Identification of the most common aeroallergens to which patients are sensitized in a specific area is important in the diagnosis and treatment of allergic rhinitis. The aim of this cross-sectional study was to investigate the pattern of skin prick test reactivity to various aeroallergens among allergic rhinitis patients attending outpatient clinics in Amman, Jordan. Skin prick test with 18 standardized allergen extracts was performed on 538 patients. Most allergic rhinitis patients in the study sample had polysensitization. Grasses mix (51.4% of patients), thistleweed (46.9%) and olive tree (45.3%) pollens were the most common allergens in this group of patients (all seasonal). Cat allergen was the most common perennial allergen (41.6%), followed by dust mite Dermatophagoides pteronyssinus (32.9%). These allergens should be given the highest priority when educating allergic rhinitis patients in Amman regarding allergen avoidance strategies.

Natural hybridization between extremely divergent chromosomal races of the common shrew (Sorex araneus, Soricidae, Soricomorpha): hybrid zone in European Russia

The Moscow and Seliger chromosomal races of the common shrew differ by Robertsonian fusions and possibly whole-arm reciprocal translocations (WARTs) such that their F₁ hybrids produce a chain-of-eleven configuration at meiosis I and are expected to suffer substantial infertility. Of numerous hybrid zones that have been described in the common shrew, those between the Moscow and Seliger races involve the greatest chromosomal difference. We collected 211 individuals from this zone to generate a total dataset of 298 individuals from 187 unique global positioning system (GPS) locations within the vicinity of interracial contact. We used a geographic information system (GIS) to map the location of the hybrid zone, which follows a direct route between two lakes, as would be anticipated from tension zone theory. Even within the central area of the hybrid zone, there is a much higher frequency of pure race individuals than hybrid, making this a clear example of a bimodal zone in the sense of Jiggins & Mallet (2000). The zone runs through good habitat for common shrews, but nevertheless it is very narrow (standard cline widths: 3-4 km), as would be anticipated from low hybrid fitness. There is clear potential for an interruption to gene flow and build-up of reproductive isolation. As found in some other hybrid zones, there is a high frequency of novel genetic variants, in this case, new chromosomal rearrangements. Here, we report a de novo Robertsonian fission and a de novo reciprocal translocation, both for the first time in the common shrew. There is an extraordinarily high frequency of de novo mutations recorded in F₁ hybrids in the zone and we discuss how chromosomal instability may be associated with such hybrids. The occurrence of a de novo Robertsonian fission is of considerable significance because it provides missing evidence that fissions are the basis of the novel acrocentric forms found and apparently selected for in certain common shrew hybrid zones.

[Stimulus size and visual illusion of extent]

In psychophysical experiments, the dependence of magnitude of the illusion of extent on the length of the referential part of a modified Brentano figure with different size of the imaginary wings was studied. The experimental data obtained were interpreted in terms of a model based on the concept ofcentroid biases of excitatory patterns, evoked by stimulus terminators. A good resemblance between the expetimental and computational data confirms the modeling assumption on increase of the area of perceptual influence in dependence on the eccentricity in the visual field. The estimated model parameters support a suggestion that distortions of perceived position of the centers-of-masses of stimulus terminators may be considered as one of the main reasons of the illusion of extent. The model parameters also have showed favor to a possible link of the phenomenon of the illusion investigated with perception of three-dimensional coordinates of visual objects.