BACKGROUND: Antimicrobial prophylaxis in cardiac surgery has been demonstrated to lower the incidence of surgical site infection (SSI). Inappropriate antimicrobial prophylaxis, such as inappropriate selection of the antimicrobial agent or inappropriate dosing regimen, can increase the prevalence of antibiotic resistant strains, prolong hospital stay, cause adverse reactions, and negatively affect an institution's pharmacy budget for antibiotics. In developing countries such as Jordan, where the role of clinical pharmacists is still in its primary stages, the first step in establishing an organized clinical pharmacy service is the evaluation of current practice to determine the need for improvement.

Multiple factors such as vitamin K consumption, drug interactions, herbs interactions, disease states, and alcohol intake affect international normalized ratio (INR) values and thus warfarin dosing. These variables have been described in general and for all patients in the literature. In contrast, the factors that affect INR control in a specific population are rarely studied. Being aware of these factors contributes a lot in maintaining an INR control and avoiding the supratherapeutic or subtherapeutic anticoagulation and the associated risks of hemorrhage or thromboembolism. The aim of this study is to recognize the specific population factors in Jordanian patients that interrupt INR control. Such recognition provides clinical pharmacists managing the anti-coagulation clinic (ACC) with necessary tools and predictors of dose adjustment, nontarget INR handling, and points to add on to the educational session. A total of 2788 patients were referred to the first clinical pharmacists managed ACC at Queen Alia Heart Institute-the only official referral hospital for cardiac patients in Jordan-for education and monitoring between November 1, 2013, and November 1, 2016. We evaluated specific population factors that interrupt INR control using a pretested, structured clinical data collection form. The patients were followed up regularly for achieving target INR (TINR). For patients who were not achieving TINR, the possible cause was examined thoroughly by reviewing the patient's medical file for recent medication intake, comorbidities, and laboratory results. Then the patients or their caregiver were asked direct questions regarding their diet, food supplements, cigarette smoking, shisha smoking, alcohol intake, herbs, and complementary medicine use and compliance, in addition to performing pharmacogenetic testing (polymorphisms of vitamin K-epoxide reductase complex [VKORC1] and cytochrome P450 2C9 [CYP2C9] genes) in special cases. For a total of 2788 patients, 89 488 INR values were included in the study. Of all, 20 365 (22.8%) were non-TINR values, 13 145 (14%) were subtherapeutic, and 7220 (8.1%) were supratherapeutic. All patients included in the study had a non-TINR at least 3 times (n ¼ 65, 2.3%) and as frequent as 50 times (n ¼ 21, 0.8%) during the study period. Non-TINR values ranged from 1 to 11. Serious side effects reported in 7 patients with uncontrolled INR, 6 were bleeding, which required hospitalization (2 upper gastrointestinal [GI] bleeding, 3 nasal bleeding, and 1 eye bleeding), 1 was cerebrovascular accident (CVA thrombolytic). Factors that interrupted INR control in our population, arranged in descending sequence, were concurrent medication use 46.9% (mainly Salicylates and Amiodarone), smoking cigarettes and shisha 17% (represented the most frequent single factor that caused non-TINR in the present study), a nonbalanced dietary vitamin K intake 16.88% caused changes in INR (lower) was related to an increase in the intake of vitamin K-rich food, were noticed to be much more in the spring season in Jo...

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Objectives Antiepileptic drugs have been used in pain management since the 1960s. Pregabalin is a recently developed antiepileptic drug also used in management of chronic neuropathic pain conditions. The aim of this observational prospective study was to assess the analgesic efficacy and associated adverse events of pregabalin in treated patients with neuropathic pain. The source of medication was the free samples that have been provided by the company for evaluation. Methods Neurologists and Endocrinologists at king Hussein Medical Center prescribed Pregabalin for selected patients (no. =50) who were diagnosed to have neuropathic pain according to pre-formulated questionnaire that was developed by researchers. The majority of patients received Pregabalin 150mg as a starting dose, 300 mg as a maintenance dose for three months. then the magnitude of pain was assessed first after one week of treatment, if the patient had pain relief after one week and maintained on treatment further assessment was performed at intervals of one, two and three months. Then for each patient the average score of pain relief was calculated (0=worst value, 10=best value).patients were also encouraged to report any adverse effect during treatment period. Results A total of 50 patients with neuropathic pain were included. During the course of the study 17 patients terminated treatment during the first week (but were replaced by other 15 patients) either due to lack of efficacy (12%, n=6) or due to intolerable adverse effects (22%, n= 11). For the remaining patients the average score of pain relief was 2.8 ±1.2. The average score of pain reduction was higher among patients with diabetic neuropathy (3.4) than with other types of neuropathic pain (2.2). The most frequently reported adverse effects were dizziness, fatigue, somnolence, and gastrointestinal disturbances. Conclusion Pregabalin is effective in reducing diabetic neuropathy and to a lesser extent than other types of neuropathic pain. (But) However intolerable adverse effects still face a problem. Further studies comparing its efficacy and tolerability with other neuropathic treatment choices are needed.