Development of Poly(vinyl alcohol)-Chitosan Composite Nanofibers for Dual Drug Therapy of Wounds

Current trends in localized drug delivery are emphasizing the development of dual drug-loaded electrospun nanofibers (NFs) for an improved therapeutic effect on wounds, especially infected skin wounds. The objective of this study was to formulate a new healing therapy for an infected skin wound. To achieve this goal, this study involved the development and characterization of poly(vinyl alcohol) (PVA)/chitosan nanofibers loaded with ciprofloxacin and rutin hydrate. Polymers and drugs were used in different ratios. Nanofiber morphology was studied by scanning electron microscopy, thermal stability by thermogravimetric analysis, structural determination by the X-ray diffraction method, and integrity by Fourier transform infrared spectroscopy. Dissolution studies were performed to check the drug release behavior of the formulations. Antibacterial studies were performed against Staphylococcus aureus and Pseudomonas aeruginosa. The wound healing efficiency of dual drug-loaded nanofibers was measured by a full-thickness excisional wound model of rabbits. The fabricated nanofibers were smooth in morphology. According to FTIR findings, the drugs remained intact in the nanofibers. The results of swelling ratio and porosity revealed that the pore size was increased as the amount of chitosan was increased up to 30% but a further increase in chitosan concentration reduced the swelling ratio and porosity. Drug release studies of nanofibers depicted an initial burst effect and afterward controlled drug release behavior. Drug-loaded nanofibers showed better activity against S. aureus than P. aeruginosa. The antibacterial efficacy of rutin hydrate with ciprofloxacin was improved compared to that of the formulation having rutin hydrate only, likely due to the additive effect in activity. Based on wound healing studies, nanofibrous membranes acted as a promising wound dressing material as compared to the commercial wound healing formulation. Drug-loaded polymeric nanofibers were successfully fabricated by using an electrospinning method. These nanofibers showed an efficient ability to deliver drugs and treat infected wounds.

Formulation and characterization of glipizide solid dosage form with enhanced solubility

Glipizide, a poor water-soluble drug belongs to BCS class II. The proposed work aimed to enhance the solubility of glipizide by preparing solid dispersions, using polyvinyl pyrrolidone (PVP) and polyethylene glycol (PEG). Solvent evaporation method was used for the preparation of glipizide solid dispersions. Solid dispersions were prepared in four different drug-to-polymer ratios i.e. 1:1, 1:2, 1:3 and 1:4. Mainly effect of three polymers (PVP K30, PVP K90 and PEG 6000) was evaluated on the solubility and dissolution of glipizide. The in-vitro dissolution of all prepared formulations was performed under pH 6.8 at 37°C using USP type II apparatus. In-vitro dissolution results revealed that the formulations having high concentrations of the polymer showed enhanced solubility. Enhancements in the solubility and rate of dissolution of the drug were noted in solid dispersion formulations compared to the physical blends and pure drug. Solid dispersions containing polyvinyl pyrrolidone exhibited a more favorable pattern of drug release compared to the corresponding solid dispersions with PEG. An increase in the maximum solubility of the drug within the solid dispersion systems was observed in all instances. Two solid dispersion formulations were optimized and formulated into immediate-release tablets, which passed all the pharmacopoeial and non-pharmacopoeial tests. Fourier transformed Infrared (FTIR) spectroscopy X-ray diffraction (XRD) and Differential scanning calorimetry (DSC) were used to indicate drug: polymer interactions in solid state. Analysis of the solid dispersion samples through characterization tests indicated the compatibility between the drug and the polymer.

Rheumatoid Arthritis Treatment Potential of Stearic Acid Nanoparticles of Quercetin in Rats

This study aims to assess the anti-inflammatory potential of stearic acid nanoparticles of quercetin in an arthritic rat model. This article describes the fabrication of solid lipid nanoparticles (SLNs) using the hot melt encapsulation method, followed by the anti-inflammatory study of SLNs and other characterizations such as FTIR, XRD, and SEM. Thirty male healthy albino rats were taken and treated with FCA to induce rheumatoid arthritis. Quercetin loading of quercetin to stearic acid was confirmed by FTIR. The efficacy of quercetin-loaded SLNs to reduce inflammation was evaluated with the help of inflammatory biomarker levels. Quercetin-loaded stearic acid nanoparticles were successfully prepared by using a hot melt encapsulation method. Their average size and zeta potential were 100 nm and -25 mV, respectively. Rheumatoid arthritis was significantly (p < 0.001) reduced in the quercetin-loaded SLN group, as indicated by finding out the reduced levels of inflammatory mediators such as tumor necrosis factor (TNF-α) and rheumatoid factor. Quercetin-loaded stearic acid nanoparticles were found to be potentially effective in treating RA.

In Vivo Wound Healing Potential and Molecular Pathways of Amniotic Fluid and Moringa Olifera-Loaded Nanoclay Films

Cutaneous wounds pose a significant health burden, affecting millions of individuals annually and placing strain on healthcare systems and society. Nanofilm biomaterials have emerged as promising interfaces between materials and biology, offering potential for various biomedical applications. To explore this potential, our study aimed to assess the wound healing efficacy of amniotic fluid and Moringa olifera-loaded nanoclay films by using in vivo models. Additionally, we investigated the antioxidant and antibacterial properties of these films. Using a burn wound healing model on rabbits, both infected and non-infected wounds were treated with the nanoclay films for a duration of twenty-one days on by following protocols approved by the Animal Ethics Committee. We evaluated wound contraction, proinflammatory mediators, and growth factors levels by analyzing blood samples. Histopathological changes and skin integrity were assessed through H&E staining. Statistical analysis was performed using SPSS software (version 2; Chicago, IL, USA) with significance set at p < 0.05. Our findings demonstrated a significant dose-dependent increase in wound contraction in the 2%, 4%, and 8% AMF-Me.mo treatment groups throughout the study (p < 0.001). Moreover, macroscopic analysis revealed comparable effects (p > 0.05) between the 8% AMF-Me.mo treatment group and the standard treatment. Histopathological examination confirmed the preservation of skin architecture and complete epidermal closure in both infected and non-infected wounds treated with AMF-Me.mo-loaded nanofilms. RT-PCR analysis revealed elevated concentrations of matrix metalloproteinases (MMPs) and vascular endothelial growth factor (VEGF), along with decreased levels of tumor necrosis factor-alpha (TNF-α) in AMF-Me.mo-loaded nanofilm treatment groups. Additionally, the antimicrobial activity of AMF-Me.mo-loaded nanofilms contributed to the decontamination of the wound site, positioning them as potential candidates for effective wound healing. However, further extensive clinical trials-based studies are necessary to confirm these findings.

Fabrication of solid lipid nanoparticles-based patches of paroxetine and their ex-vivo permeation behaviour

Paroxetine is not suitable for oral administration due to its extensive first-pass metabolism, thus resulting in less bioavailability. This study aimed to prepare novel paroxetine-loaded solid lipid nanoparticles (SLNs) based sustained-release transdermal patches to overcome these problems by enhancing drug absorption and bioavailability. Nine formulations of paroxetine SLNs were prepared by the hot melt-homogenization method using different concentrations of glycerol monostearate (Kolliwax) and Tween 80. Then these prepared SLNs were incorporated in a matrix type transdermal patch having a matrix of ethyl cellulose and polyvinyl pyrrolidone in 3:2 with polyvinyl alcohol. The SLNs showed a particle size range of 113-230 nm and an entrapment efficiency of 85.14%. The SLNs showed sustained paroxetine release (77.86-95.63% release) up to 48 h. FTIR studies showed no interaction between drug and formulation components. Paroxetine is evenly distributed in an amorphous form in SLNs, as demonstrated by DSC as well as PXRD analysis. SLNs formulated patches showed higher drug permeation through the skin than drug-based transdermal patches., Draize patch test revealed no sign of erythema after applying paroxetine-loaded SLN patches (score 0) as observed with the marketed product. The developed SLNs based transdermal patches showed increased permeability and sustained release behaviour.

Development, Characterization, and Burn Wound-Healing Potential of Neomycin-Loaded Clay-Reinforced Nanofibers

Background: Skin wounds affect millions of individuals around the world, and their treatment is expensive. Objective: The purpose of this study was to make neomycin-loaded CG/PVA/PAN (NCPP) nanofibers to improve wound healing. Methods: The NCPP nanofibers were characterized by using thermogravimetric analysis (TGA), scanning electron microscopy (SEM), Fourier transform infrared spectroscopy, and X-ray diffraction. Drug solubility, dissolution, swelling ratio, erosion, and antibacterial studies were performed. The in vivo wound healing study of nanofibers was performed in a rabbit model and was supported by % age wound closure and histopathology. Results: The results of SEM showed some sort of agglomeration on the surface of fibers, while TGA showed 10% more stability for drug-loaded nanofibers. The drug permeation study indicated that the formulation with 15% PVA showed a controlled release profile of the drug. The NCPP nanofibers had an appreciable water retention capability. The NCPP nanofibers showed appreciable antibacterial activity against Enterococcus faecalis (Gram-positive bacteria) and Klebsiella pneumonia (Gram-negative bacteria). The wound healing study showed the better healing properties of NCPP nanofibers within 15 days. Conclusion: The findings helped us to conclude that the NCPP nanofibers were successfully fabricated and found to have a promising role in infected wound healing.

Meta-analysis of factors associated with antidiabetic drug prescribing for type 2 diabetes mellitus

BACKGROUND

There is a lack of consensus on prescribing alternatives to initial metformin therapy and intensification therapy for type 2 diabetes mellitus (T2DM) management. This review aimed to identify/quantify factors associated with prescribing of specific antidiabetic drug classes for T2DM.

METHODS

Five databases (Medline/PubMed, Embase, Scopus, Web of Science) were searched using the synonyms of each concept (patients with T2DM, antidiabetic drugs and factors influencing prescribing) in both free text and Medical Subject Heading (MeSH) forms. Quantitative observational studies evaluating factors associated with antidiabetic prescribing of metformin, sulfonylurea, thiazolidinedione, Dipeptidyl-peptidase 4 inhibitors (DPP4-I), sodium glucose transporter 2 inhibitors (SGLT2-I), Glucagon-Like peptide receptor agonist (GLP1-RA) and insulin in outpatient settings and published from January 2009 to January 2021 were included. Quality assessment was performed using a Newcastle-Ottawa scale. The validation was done for 20% of identified studies. The pooled estimate was measured using a three-level random-effect meta-analysis model based on odds ratio [95% confidence interval]. Age, sex, body mass index (BMI), glycaemic control (HbA1c) and kidney-related problems were quantified.

RESULTS

Of 2331 identified studies, 40 met the selection criteria. Of which, 36 and 31 studies included sex and age, respectively, while 20 studies examined baseline BMI, HbA1c and kidney-related problems. The majority of studies (77.5%, 31/40) were rated as good and despite that the overall heterogeneity for each studied factor was more than 75%, it is mostly related to within-study variance. Older age was significantly associated with higher sulfonylurea prescription (1.51 [1.29-1.76]), yet lower prescribing of metformin (0.70 [0.60-0.82]), SGLT2-I (0.57 [0.42-0.79]) and GLP1-RA (0.52 [0.40-0.69]); while higher baseline BMI showed opposite significant results (sulfonylurea: 0.76 [0.62-0.93], metformin: 1.22 [1.08-1.37], SGLT2-I: 1.88 [1.33-2.68], and GLP1-RA: 2.35 [1.54-3.59]). Both higher baseline HbA1c and having kidney-related problems were significantly associated with lower metformin prescription (0.74 [0.57-0.97], 0.39 [0.25-0.61]), but more insulin prescriptions (2.41 [1.87-3.10], 1.52 [1.10-2.10]). Also, DPP4-I prescriptions were higher for patients with kidney-related problems (1.37 [1.06-1.79]) yet lower among patients with higher HbA1c (0.82 [0.68-0.99]). Sex was significantly associated with GLP1-RA and thiazolidinedione prescribing (F:M; 1.38 [1.19-1.60] and 0.91 [0.84-0.98]).

CONCLUSION

Several factors were identified as potential determinants of antidiabetic drug prescribing. The magnitude and significance of each factor differed by antidiabetic class. Patient's age and baseline BMI had the most significant association with the choice of four out of the seven studied antidiabetic drugs followed by the baseline HbA1c and kidney-related problems which had an impact on three studied antidiabetic drugs, whereas sex had the least impact on prescribing decision as it was associated with GLP1-RA and thiazolidinedione only.

Readiness for Interprofessional Education Among Health Profession Students in a University in the United Arab Emirates

Introduction

Inter-Professional Education (IPE) is an educational engagement between students from two or more professions possibly leading to better collaboration among them in the future workplace. Several organizations have advocated, developed, and updated guidelines for IPE.

Objective

This study was aimed at assessing the medical, dental, and pharmacy students' readiness toward interprofessional education (IPE), and to identify the association between readiness and the demographic profile of students in a university in the United Arab Emirates (UAE).

Methods

A cross-sectional questionnaire-based exploratory study involving 215 medical, dental, and pharmacy students at Ajman University, UAE, using convenience sampling. The survey questionnaire (Readiness for Interprofessional Learning Scale, RIPLS) had a total of 19 statements. The first 9 items were related to "teamwork and collaboration", items 10-16 were related to "professional identity", and the remaining three (items 17-19) were related to "roles and responsibilities". The individual statements' median (IQR) scores were calculated and the total scores were compared with the demographic characteristics of the respondents with suitable non-parametric tests at alpha=0.05.

Results

Altogether, 215 undergraduate students (medical (n= 35)), pharmacy (n=105), and dental (n=75) responded to the survey. The median (IQR) score for the 19 individual statements was '5 (4-5)' for 12 of the statements. The total scores and domain-specific scores (teamwork and collaboration, professional identity, and roles and responsibilities) according to respondents' demography showed significant differences only in the case of the educational stream with professional identity score (p=<0.001), and the total RIPLS score (p=0.024). Further, post hoc pairwise comparison showed a significant difference between medicine-pharmacy (p<0.001), and dentistry-medicine (p=0.009), for professional identity, and medicine-pharmacy (p=0.020) for the total RIPLS score.

Conclusion

A high readiness score among students offers the possibility of conducting IPE modules. A favorable attitude can be considered by curriculum planners while initiating IPE sessions.

Development, Validation, and Utilization of a Social Media Use and Mental Health Questionnaire among Middle Eastern and Western Adults: A Pilot Study from the UAE

OBJECTIVES

We aimed to develop and validate a mental health stigma measurement tool for use within the social media context, utilizing the tool to assess whether the stigma shown in face-to-face interactions translates to social media, coupled with comparing whether social media use can cause the stigma among a sample of Middle Eastern and Western populations.

METHODS

The development and validation phase comprised a systematic process that was used to develop an assessment tool that could be used within the social media context and establish its validity and reliability. A 5-point Likert-type scale (1 = strongly disagree to 5 = strongly agree) was developed to assess mental health stigma. The anonymous questionnaire was distributed from June 2022 to August 2022 on various social media platforms and groups predominated by the two demographics of interest, enrolling 1328 participants (with only 1001 responses deemed valid). The utilization phase consisted of bivariate and multivariable analysis of the data. The cutoff points for low, medium, and high scores were the 25th, 50th, and 75th percentil, respectively.

RESULTS

The instrument comprised three dimensions: acceptance, intolerance, and digital care sentiment. In the Middle Eastern subset of participants, a higher score of intolerance (more stigma) toward mental illness was found in 72.4% of the participants, with a higher score of acceptance being 35.1% and of digital care sentiment being 46.4%. The mean scores for all the scales were as follows: intolerance (3.08 ± 0.64), acceptance (3.87 ± 0.71), and digital care sentiment (3.18 ± 0.69). For Westerners, a higher score of intolerance toward mental illness was found in 24.0% of the participants, with a higher score of acceptance being 56.8% and of digital care sentiment being 38.2%. The mean scores for all the scales were as follows: intolerance (2.28 ± 0.73), acceptance (4.21 ± 0.61), and digital care sentiment (3.08 ± 0.62). Various results were obtained regarding the effect of individual social media platforms on the different subscales.

CONCLUSIONS

Stigma does follow people on social media, whether they are Middle Easterners or Westerners, although to varying degrees. The results of social media interaction and activity varied based on the group that used them, with some having an impact on one group but not the other. For these reasons, proper guidance is advised when utilizing and interacting with social media platforms.

Obesity association with antidiabetic drugs’ prescription among patients with type 2 diabetes mellitus: a systematic review and meta-analysis

Introduction

Type 2 diabetes mellitus (T2DM) is a chronic disease of persistent elevation in blood glucose level. Several antidiabetic drugs (ADDs) with different features are currently available for T2DM management (1). The selection of appropriate ADDs is crucial for preventing/attenuating diabetes-related complications(1). All guidelines agreed on metformin to be an initial therapy for patients diagnosed with T2DM, yet the selection of an intensifying therapy or alternative initial therapy are lacking any agreements (1). Consequently, the selection of ADDs could be linked to multiple factors (2). Since obesity is a risk factor for T2DM and ADDs have variable effect on body weight, obesity is an important factor that could be associated with ADDs’ selection.

Aim

This systematic review (SR) and meta-analysis (MA) aimed to overview and quantify obesity association with the selection of ADDs among type 2 diabetic patients.

Methods

A systematic literature search was conducted on multiple databases. Eligible studies were selected based on the following inclusion criteria: quantitative observational studies, evaluated obesity association with ADDs’ prescription, in outpatient setting, and published in English over the period of Jan/2009-April/2021. Studies on other types of diabetes, about switching therapy, or published before 2009 were excluded. The following items were extracted from identified articles: study details as author, year, and method, participants’ characteristics as age and gender, type of investigated ADDs, comparison group, and stage of treatment, as well as type of analysis test. Extracted data was synthesized quantitively utilising a three-level MA approach as some studies reported more than one effect-size because of examining multiple ADDs. It was based on odds ratio and 95%confidence interval.

Results

A total of 21 studies evaluated the association of obesity with ADDs’ prescription was identified. All except one were included in the MA which contributed to a total of 66 effect sizes from all investigated ADDs. The pooled estimate of obesity association with the prescription of ADDs including all groups was 1.19[0.85 -1.67]. A subgroup analysis showed a significant difference according to the type of ADDs (p&lt; .0001). A positive significant association was found with glucagon-Like peptide receptor agonist (GLP1-RA), sodium glucose transporter 2 inhibitors (SGLT2-I), and metformin prescriptions (pooled estimate: 2.35 [1.54-3.59], 1.89[1.33-2.68], and 1.22[1.08-1.37], respectively). Whereas a negative significant association was found with sulfonylurea prescription (pooled estimate: 0.76 [0.62-0.93]). The pooled estimate of thiazolidinedione, dipeptidyl-peptidase 4 inhibitors, and insulin showed a non-significant association with obesity. None of the investigated variables showed significant influence on the overall result including stage of treatment and quality of study (p &gt;0.05).

Conclusion

Obesity is an important factor influencing ADDs’ prescription. Patients with higher weight were more likely to get ADDs with weight losing or neutral effect as GLP1-RA, SGLT2-I, and metformin. This reflects some adherence of clinical practice to the variability in drugs’ features as indicated from the consistent findings of obesity as a factor affecting ADDs’ selection with the weight effect of ADDs. Yet, further studies are required because of limited number of studies examined each antidiabetic group.

References

1. American Diabetes A. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S98-S110.

2. Wilkinson S, Douglas I, Stirnadel-Farrant H, Fogarty D, Pokrajac A, Smeeth L, et al. Changing use of antidiabetic drugs in the UK: trends in prescribing 2000-2017. BMJ Open. 2018;8(7):e022768.

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.

Preparation and characterization of ethylcellulose microspheres for sustained-release of pregabalin

Background and purpose:

Pregabalin is used in the treatment of epilepsy, chronic pain, and other psychological disorders. Preparation of pregabalin in the sustained-release formulation will enhance patient compliance and reduce the incidence of side effects. The aim of this study was to prepare sustained-release microspheres for pregabalin utilizing ethylcellulose and evaluate the processing factors that influence the fabrication and the performance of the prepared microspheres.

Experimental approach:

The microspheres were prepared using the water-oil-oil double emulsion solvent evaporation method. Microspheres were characterized for particle size, encapsulation efficiency, and in vitro drug release. The influence of the processing variables on the characteristics of the prepared microspheres was studied. Microspheres solid-state characterization performed using differential scanning calorimetry, Fourier transform infrared spectroscopy and scanning electron microscopy.

Findings/Results:

The results described in the context of the current work illustrated the suitability of the water-oil-oil system in the preparation of sustained-release microspheres for pregabalin. The optimum formulation was prepared at a drug to polymer ratio of 1:3 w/w, stirring speed of 600 rpm, surfactant concentration of 1.5%, and external phase volume of 150 mL. This formula produced microspheres particle size in the range 600-1000 μm, with 87.6% yield, and 80.14 ± 0.53% encapsulation efficiency. Drug release from the microspheres was found to be diffusion controlled, with a pH-independent behavior.

Conclusion and implication

The current work presented a successful attempt to fabricate a sustained-release microsphere comprising pregabalin. This will help overcome the frequent dosing problems with conventional pregabalin dosage forms and improve product performance.

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.

Equation of State Effects in Core-Collapse Supernovae

We investigate the impact of different properties of the nuclear equation of state in core-collapse supernovae, with a focus on the proto-neutron-star contraction and its impact on the shock evolution. To this end, we introduce a range of equations of state that vary the nucleon effective mass, incompressibility, symmetry energy, and nuclear saturation point. This allows us to point to the different effects in changing these properties from the Lattimer and Swesty to the Shen et al. equations of state, the two most commonly used equations of state in simulations. In particular, we trace the contraction behavior to the effective mass, which determines the thermal nucleonic contributions to the equation of state. Larger effective masses lead to lower pressures at nuclear densities and a lower thermal index. This results in a more rapid contraction of the proto-neutron star and consequently higher neutrino energies, which aids the shock evolution to a faster explosion.

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.