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BACKGROUND: Antimicrobial resistance (AMR) is promoted by inappropriate use and is a greater burden for low to middle income countries (LMIC) than high income countries (HIC). OBJECTIVE: This systematic review aimed to compare the awareness of inappropriate use related to AMR among medical doctors from LMIC and HIC using published knowledge, attitude and practice (KAP) studies. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, sequential systematic literature search of PubMed and Web of Science databases for articles published since inception up to June 1, 2022 for KAP studies involving medical doctors. Using fifteen KAP items related to promoting AMR, data on proportion of participants responding affirmatively was extracted and reported using means, ranges and 95% confidence intervals (CI). RESULTS: Forty-two studies met the inclusion criteria and involved 13,089 medical doctors from 11HIC and 21LMIC. All were cross-sectional studies, 71.4% involved non-probability sampling and 78.6% were of satisfactory quality. Knowledge items showed mean proportion of more medical doctors responding correctly. Similar affirmation trends were observed for attitude and prescribing practice items. Awareness appeared similar between medical doctors of the economic groups, except for a greater interest in training for LMIC (95.4%; 95%CI 93.0%, 97.9%) versus HIC (81.7%; 95%CI 65.6%, 97.9%). Countries with poor proportions were identified in both economic groups. CONCLUSION: For identified studies, trends suggest good awareness among medical doctors of the known Inappropriate use and perceived threat of AMR, as well as prescribing practices to reduce the risk of AMR. Trends were similar across HIC and LMIC; however, countries with evidence of poor awareness exist in both economic groups.

AimThis study sought to identify adolescents’ health information sources and determine the gap between what adolescents want to hear and what they actually hear from their healthcare providers (HCPs), a proxy for unmet health needs.MethodsA cross-sectional study was conducted in four high schools conveniently selected in Jamaica to ensure adequate representation in rural and urban locales. Adolescents 11–19 years old with relevant assent/consent completed a paper-based self-administered questionnaire. Questions were adapted from the Young Adult Health Care Survey to determine proportion of adolescents receiving confidential care, the level of counselling offered and difference between location and unmet needs.ResultsAdolescents acknowledged multiple sources of information, with urban adolescents reporting television, radio and parents as sources more frequently than in rural setting (p ConclusionThis study highlights that while there is some access to health information in Jamaica, especially via television, radio and internet, the needs of the adolescent population remain unmet. HCPs need to employ a patient-centred approach where confidentiality is established and screening is done for unmet needs in an effort to optimize health outcomes.

In the Caribbean there is limited data on orthostatic hypertension (OHT) in elderly hypertensive patients with atherosclerotic disease who are at risk for cardiovascular events. We examined the association of antihypertensive classes of drugs with diastolic OHT in patients 60 year and older with hypertension and hyperlipidemia attending public primary care facilities. Methods: Cross-sectional study of hypertensive hyperlipidemic older patients (n=400) to determine orthostatic changes in blood pressure based on seated to standing measurements. OHT was defined as an increase in systolic blood pressure of ≥ 20mmHg and/or increase in diastolic blood pressure of ≥ 10mmHg upon orthostasis at 3 minutes. Patients were categorized based on their orthostatic blood pressure response: orthostatic normotensive (n=200) and blood pressure dysregulated (n=200) of which 168 were diastolic OHT. Multivariable logistic regression models were used to examine associations of antihypertensive classes and diastolic OHT. Results: Renin-angiotensin-aldosterone-system (RAAS) blockers were the most commonly prescribed (79.3%), followed by diuretics (DIUs) (61.6%), dihydropyridine calcium channel blockers (dCCBs) (53.8%) and beta-blockers (BBs) (19.3%). Most normotensive (76.0%) and diastolic OHT (75.0%) patients were prescribed two or more antihypertensive medications. Pharmaceutical prescription of triple combination RAAS blockers+dCCBs+DIUs (OR, 0.55; 95% CI, 0.31–0.99) or RAAS blockers+dCCBs+BBs (OR, 0.23; 95% CI, 0.06–0.92) showed a protective effect of diastolic OHT in analyses adjusted for age, gender, sitting diastolic blood pressure and comorbidities. Conclusion: Our study suggests prescription of triple combination antihypertensive drugs of RAAS blockers+dCCBs+DIUs or RAAS blockers+dCCBs+BBs may reduce the likelihood of diastolic OHT.

This review is intended to present perspectives from the US experience in enhancing pharmacovigilance on current practices and future opportunities. Best practices concepts could be applied worldwide through the presentation of how three pillars of pharmacovigilance: (1) medical and scientific excellence, (2) operational and compliance excellence, and (3) knowledge sharing and experts development in the field could serve as a framework for the establishment of an efficient and successful global pharmacovigilance system.

This study sought to evaluate the types and frequencies of nuclear medicine studies that were carried out at a privately-run nuclear medicine facility in Kingston, Jamaica. Previous studies of this nature have not been done among this population, therefore the researchers sought to gather data which may prove to be useful for the growth of nuclear medicine practice in Jamaica. The study was a nonexperimental, retrospective study which involved an assessment of the records of all nuclear medicine patients who received a radiopharmaceutical during January 01, 2017, to December 31, 2018. The data extracted included age, gender, radiopharmaceutical administered, indication for study, and impression from scan. The total number of nuclear medicine scans that were carried out at the facility for the 2-year period was 3756. Of this number, 1889 (50.3%) were male and 1866 (49.7%) were female, with the age ranging from 3 months to 100 years. The types and frequencies of the most frequently occurring studies conducted were bone (2116, 56.3%), renal (867, 23.1%), thyroid (307, 8.2%), and lung (254, 6.8%). Patients aged 60 years and over accounted for the majority of the bone scans (1353/2116). The age group 26–59 years accounted for most of the scans of the lung (123/254), thyroid (209/307), parathyroid (34/65), and whole body (26/34). Patients under 12 years of age accounted for the majority of the renal (596/867), gastrointestinal (22/26), and hepatobiliary (16/28) scans. The audit of this private facility reflects the documented demand on the International Atomic Energy Agency database for Latin America and the Caribbean, and demonstrates the need for continuity of this specialized service in our population.

Background Pharmacovigilance is an important aspect of clinical practice; however, there is limited evidence that it exists as a theme in medical education curricula. Objective We developed and used a Basic Research Skill Special Study Module to introduce pharmacovigilance to medical students in the early years of their programme. Methods Students completing year one or two of the Faculty of Medical Sciences, Bachelor of Medicine, Bachelor of Surgery programme at The University of the West Indies, Jamaica participated in the four week experience from May 16th to June 12th 2019 to complete structured content sessions and self-directed activity. Sessions focused on the importance of pharmacovigilance and guided steps to complete a secondary data research project on an adverse reaction reported for a drug of personal interest. The final output was a poster mini-symposium at which each student held a five minute oral presentation. Posters were assessed for compliance with content guidelines, quality and presentation. Results Ten students participated in this experience and nine students produced posters of greater than 80% compliance with the content guidelines that were provided. The points awarded also reflected high scores for the required elements, relevant graphics, attractiveness/neatness and oral presentation. Students expressed overall satisfaction with the learning experience of the module. Conclusion Moving forward, the authors will continue using this innovative active learning methodology to increase student exposure to pharmacovigilance, conducting and sharing research. Quantitative outcome assessment tools will be developed and long term goals will focus on its utility in curriculum improvement.

Background: Clinical electives, provide opportunities to inform future career paths. The primary purpose of this study was to examine whether the clinical electives were being used as intended i.e. to help with specialization choice and to determine the factors that influence trainee decisions for specialty training at The University of the West Indies. Methods: A cross-sectional study was conducted between July 2019 and March 2020, using a self-administered questionnaire. Results: 193 participants completed the questionnaire, aged 20 to 35 years, 133 (68.9%) were females. The most common electives completed were internal medicine specialties (80, 41.5%), followed by surgical specialties (53. 27.5%). Only 64(33.2%) participants reported electives used to gain experience for future career; other reasons included filling knowledge gaps (101, 52.3%), having to repeat failed clerkships (19, 9.8%). Future career preferences were the specialties of surgery (75, 40.8%), internal medicine (41, 22.3%), anaesthetics (20,10.4%) and obstetrics & gynaecology (18, 9.3%). Males showed a preference for surgical specialties (p=0.002). The use of the elective for determining career path showed significant correlation with future specialty choice (Likelihood ratio chi-square test (32) = 98.37, p

BACKGROUND: Many people use the Internet for obtaining information about their medications. OBJECTIVE: To investigate whether information about antidepressants on popular websites reflects the scientific evidence and enables people to make informed choices. METHODS: Cross-sectional study using a checklist with 14 predefined criteria of 39 websites from 10 countries. RESULTS: All 39 websites mentioned the benefits of antidepressants. Twenty-nine (74%) websites attributed depression to a “chemical imbalance” or claimed they could fix an imbalance. Sexual dysfunction was mentioned as a harmful effect on 23 (59%) websites while five (13%) mentioned emotional numbing. Twenty-five (64%) stated that antidepressants may cause increased suicidal ideation, but 23 (92%) of them contained incorrect information, and only two (5%) websites noted that the suicide risk is increased in people of all ages. Twenty-eight websites (72%) warned patients about withdrawal effects but only one stated that antidepressants can be addictive. CONCLUSIONS: None of the websites met our predefined criteria. The information was generally inaccurate and unhelpful and has potential to lead to inappropriate use and overuse of antidepressants and reduce the likelihood that people will seek better options for depression like psychotherapy.

Children with epilepsy (CWE) are more likely to have sleep and behavioral disorders. With differences in reports, the aim was to evaluate sleep and behavior in Jamaican CWE and determine any association with epilepsy-related variables. Children with epilepsy were identified along with age and gender-matched controls from the University Hospital of the West Indies and the Bustamante Hospital for Children. Written informed consent was obtained followed by the completion of questionnaires assessing sleep, behavior, and background of both cases and controls. Parents of 61 children (26 cases and 35 controls) participated in the study. There was no difference in sleep scores or frequency of sleep disorders between cases and controls (p 0.05). Children with epilepsy had worse scores than controls in peer problems (3.85 vs 2.32, p 0.01), internal problems (7.42 vs 4.71, p 0.01), and total behavioral problem (16.27 vs 12.09, p 0.01). When compared with controls, CWE had a higher frequency of abnormal peer problems (66% vs 32%, p 0.05) and emotional problems score (42% vs 15%, p 0.05). Children with learning difficulty were three times more likely to have abnormal behavioral score Odds Ratio (OR) = 3.818, p 0.05). Jamaican CWE have similar sleep scores to their healthy peers but have a higher frequency of peer and emotional problems.

Background: Pharmacist managed warfarin clinics can improve the anticoagulation status ofnon-valvular patients. The first of such services was implemented at the Cornwall Regional Hospital in Jamaica in 2013. Objectives: To assess the anticoagulation control of patients on warfarin therapy over six months in the pharmacist managed warfarin clinic at Cornwall Regional Hospital. Methods: Retrospective docket review for the period January 2014 to December 2016 was done to include data of patients attending routine clinic appointments for at least six months. Age, gender, date of visit, indication for warfarin therapy, warfarin dose and International Normalized Ratio readings were extracted. Percentage time spent in therapeutic range (TTR) was calculated by month for six months using the Rosendaal linear interpolation method. Patient anticoagulation status was categorized as poor (TTR40% and sustaining these values over six months. The services should therefore be encouraged.

The toxicological manifestation of many pollutants relies upon their binding to the aryl hydrocarbon receptor (AHR), and it follows a cascade of reactions culminating in an elevated expression of cytochrome P450 (CYP) 1 enzymes. CYP1A1 and CYP1B1 are associated with enhanced carcinogenesis when chronically exposed to certain polyaromatic hydrocarbons, and their inhibition may lead to chemoprevention. We evaluated dibenzyl trisulfide (DTS), expressed in the ethnomedical plant, Petiveria alliacea, for such potential chemoprevention. Using recombinant human CYP1A1 and CYP1B1 bactosomes on a fluorogenic assay, we first demonstrated that DTS moderately inhibited both enzymes with half maximal inhibitory concentration (IC50) values of 1.3 ± 0.3 and 1.7 ± 0.3 μM, respectively. Against CYP1A1, DTS was a reversible, competitive inhibitor with an apparent inhibitory constant (Ki) of 4.55 ± 0.37 μM. In silico molecular modeling showed that DTS binds with an affinity of −39.8 kJ·mol−1, situated inside the binding pocket, approximately 4.3 A away from the heme group, exhibiting interactions with phenylalanine residue 123 (Phe-123), Phe-224, and Phe-258. Lastly, zebrafish (Danio rerio) embryos were exposed to 0.08–0.8 μM DTS from 24 to 96 h post fertilization (hpf) with the in vivo ethoxyresorufin-O-deethylase (EROD) assay, and, at 96 hpf, DTS significantly suppressed EROD CYP1A activity in a dose-dependent manner, with up to 60% suppression in the highest 0.8 μM exposure group. DTS had no impact on gene transcription levels for cyp1a and aryl hydrocarbon receptor 2 (ahr2). In co-exposure experiments, DTS suppressed CYP1A activity induced by both B[a]P and PCB-126, although these reductions were not significant. Taken together, these results demonstrate that DTS is a direct, reversible, competitive inhibitor of the carcinogen-activating CYP1A enzyme, binding in the active site pocket close to the heme site, and shows potential in chemoprevention.

This study sought to answer the calls that have been made for the European Association of Nuclear Medicine to restore its surveys of reported adverse reactions. We assessed all reports of adverse reactions to radiopharmaceuticals that were submitted to the British Nuclear Medicine Society (BNMS) online database (Radiopharmaceutical Adverse Events and Product Defects) from January 2007 to December 2016. Methods: This investigation was a pharmacovigilance-based, nonexperimental, cross-sectional study aimed at finding the prevalence of, and association between, radiopharmaceuticals and adverse reactions. Results: During the study period, there were 204 reports of radiopharmaceutical adverse reactions, of which 13 were considered invalid, primarily because of incomplete entries or because a causal relationship between the radiopharmaceutical and the adverse reaction could not be determined. Tetrofosmin (34 reports) and oxidronate (32 reports) had the highest prevalence, followed by medronate (21 reports) and then sestamibi and nanocolloid (14 reports each). Rash (84 reports), itching (46 reports), and vomiting (30 reports) were the 3 most frequently occurring adverse reactions. Most reports (96.8%) were for diagnostic radiopharmaceuticals. Conclusion: The prevalence of adverse reactions to radiopharmaceuticals reported in the BNMS database remains low, with a frequency of 3.1 reports per 100,000 administrations in 2013 and 2.5 per 100,000 administrations in 2015. In our review spanning 10 years, we did not find any particular concern about the use of radiopharmaceuticals.

Triple-negative breast cancer (TNBC), characterized by tumors that lack expression of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), carries a poor prognosis. African American women develop TNBC at disproportionately higher rates than women of other ethnic groups. Dibenzyl trisulfide (DTS), found expressed in the Jamaican plant Petiveria alliacea, has been shown to inhibit the growth of several cancer types. However, little is known about whether this plant isolate displays anticancer activity in TNBC cells from African American patients or modulates cytochrome P450 1 (CYP1) enzyme activity. This work, as part of an ongoing ethnopharmacology-based bioactivity screening, was designed to fill this deficit. African American TNBC (AA-TNBC) cells HCC1806 and MDA-MB-468 were treated with varying concentrations of DTS for 48 h and cell viability was assessed using the Alamar Blue assay. DTS potently inhibited the growth of HCC1806 and MDA-MB-468 cells, producing IC50 values of 10.6 ± 1.2μM and 10.3 ± 2.0μM, respectively. Additionally, we discovered that DTS induced apoptosis in these cells. Furthermore, we investigated the ability DTS to impact the activities of the CYP1 family of enzymes, which are known to convert procarcinogens to carcinogens. The IC50 values obtained for CYPs 1A1, 1A2 and 1B1 were 1.68 ± 0.3μM, 1.9 ± 0.2μM and 1.29 ± 0.3μM, respectively. These data indicate DTS exhibits potent inhibition of the activities of these enzymes. In particular, DTS was able to bind to CYP1A2 in accordance with irreversible kinetics. In addition, DTS reduced CYP1 mRNA expression in both cell lines. Our findings provide a rationale for in vivo evaluations of DTS as a potential candidate for chemoprevention and for treating AA-TNBC patients. Citation Format: Jonathan V. Wooten, Shaniece Wauchope, Nicole Mavingire, Petreena Campbell, JéAnn Watson, Maxine Gossell-Williams, Rupika Delgoda, Eileen Brantley. Plant isolate dibenzyl trisulfide potently inhibits cytochrome P450 1 enzyme activity and the growth of breast cancer cells derived from African American patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C126.

A high percentage of persons with Schizophrenia also uses Cannabis and this may potentially alter the therapeutic benefits of the antipsychotic medications prescribed. The aim of this study was to assess the impact of Cannabis usage on antipsychotic therapy of sleep disturbances in schizophrenia subjects. Male subjects, ≥18 years, admitted to the University Hospital of the West Indies psychiatric ward between October 2015 and October 2016, and diagnosed with schizophrenia were recruited for the study. Following written informed consent to the study, subjects were prescribed either risperidone monotherapy or haloperidol monotherapy orally for 14 days and classified as Cannabis users (CU) or non-users (non-CU), with presence/absence of Cannabis metabolite in urine samples. After 1 week of admission, subjects wore the Actiwatch-2 device, to record sleep data for 7 consecutive nights. Inferential statistical analysis involved non-parametric tests, expressed as median and inter-quartile ranges (IQR), with p

Conjugated oestrogen is one of the more affordable secondary hormonal options available for castrate-resistant prostate cancer (CRPC) in Jamaica. The present study was conducted to examine the disease response in Jamaican men with CRPC treated with conjugated oestrogen. This study retrospectively reviewed the medical notes of patients who attended the urologic clinic of the University Hospital of the West Indies from 1 January 2009 to 31 December 2013 and a private urology clinic from 2 November 2005 to 3 June 2015 to identify patients diagnosed with CRPC treated with conjugated oestrogen (Premarin ®) as secondary therapy. The primary endpoint of favourable response, using the Prostate Cancer Clinical Trials Working Group 2 criteria is a decline of ≥50% in serum prostate-specific antigen (PSA) concentrations from baseline after treatment. The proportion of patients responding by the first 3-month follow-up visit and the maximal PSA declined over the 24 months of follow-up which were recorded. Thirty-two patients diagnosed with CRPC and treated with conjugated oestrogen were identified. All patients were prescribed 5.0 mg (2.5 mg tablets, twice daily) orally, as well as low dose aspirin. Favourable response was observed in 14 (43.8%) patients; however, eight other patients showed a decline in serum PSA concentration of

Studies have shown that the metabolic syndrome (MetS), a major risk factor for the development of Type 2 diabetes mellitus and cardiovascular disease, is higher among psychiatric patients on antipsychotic medications than the general population. While studies on the prevalence of MetS in the Jamaican adult population have been undertaken, no such study has been done on the corresponding psychiatric population. The purpose of this study was to determine the prevalence of MetS in a Jamaican adult psychiatric inpatient population. The study group comprised thirty-eight patients with a primary DSM-IV-TR Axis 1 diagnosis. Criteria for the diagnosis of MetS were the presence of any three or more of five factors as defined by using the International Diabetes Federation (IDF) and American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) consensus agreement. The prevalence of MetS in this cohort was 28.9% and was associated with significantly higher abdominal obesity (p = 0.010), elevated blood pressure (p = 0.000), elevated triglycerides (p = 0.019) and low high density lipoprotein-cholesterol (p = 0.016) when compared with patients not diagnosed with MetS. Metabolic syndrome was common in this group of psychiatric patients and likely represents a pathway to the future development of Type 2 diabetes mellitus and cardiovascular disease. Screening and continuous monitoring will allow for early intervention and possibly prevention of increased morbidity and mortality in this vulnerable population.

Selecting peer reviewers is a crucial stage of the editorial process that ensures the quality of scholarly publications. An alternative to selecting peer reviewers from data bases created with expressions of interest of volunteers consists in systematically searching PubMed for similar articles and inviting their authors to act as peer reviewers. Although this process might identify more appropriate peers, it also can increase the time of the editorial process. In 2018, Pharmacy Practice had to invite 4.70 (SE=0.33) potential reviewers per one accepting. The time from the first reviewer invitation to the last reviewer report received was 61 days (SE=2.1). These figures confirm the existence of a peer review crisis which is significantly increasing the publication delay.

Objective Diabetes mellitus is a chronic non-communicable disease with high prevalence in the North American and Caribbean region. Diabetic Foot Syndrome which is an associated complication can lead to the development of wounds and ulcers which can become infected. Justicia secunda, a plant known locally in Barbados as Bloodroot used in folklore for wound healing, was selected to test its ability to aid diabetic wound healing by antimicrobial activity. It was therefore tested against the bacteria Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa ATCC 27853, and Enterococcus feacalis (clincal strain) which are commonly found in diabetic wounds. Methods The plant was collected by local users. Methanol and acetone extracts of the plant were prepared with use of soxhlet extraction. The antimicrobial activity was assessed with the use of a modified Kirby-Baurer method. Concentrations of 200 mg/ml, 100 mg/ml, 10 mg/ml, and 1 mg/ml of the extract were used, with a standard ciprofloxacin 5 microg positive control, and a 5% dimethyl sulfoxide (DMSO) solution negative control. Results The J secunda methanol and acetone extracts with an extraction yield of 15.3% and 0.75%, respectively yielded no activity within the concentration range against the three strains of bacteria tested. In comparison with the positive control, relative inhibition zone diameter (RIZD) values of 0% resulted for both the negative control and the extracts, with the positive control having a value of 100%. Conclusion The in vitro screen of the extracts prepared from J secunda, yielded no antimicrobial activity against the three strains of bacteria tested and therefore does not support the folklore claims by this mechanism of action.

Standard drug monographs (SDMs) have been described as deficient in providing information in a manner simplified enough for patient reading. The aim of this study was to design patient information leaflets for hydrochlorothiazide, nifedipine and enalapril with content indicated by patients as relevant and to evaluate them against the SDM. Patient information leaflet (PIL) for each drug was designed to contain information on name, use of drug, how it works, how it is to be taken, common side effects, storage, missed dose action, things to avoid and when to contact the physician. Appropriateness was assessed by 10 practising pharmacists. For each drug, 40 patients were recruited, of which 20 were given SDM and 20 PIL. The knowledge of each participant was examined before and after exposure to SDM or PIL, as well as opinion on ease of reading and attractiveness using Pearson s Chi-square analysis. The results showed that both SDM and PIL improved knowledge of common side effects when compared with responses before exposure (chi2 = 24.26 for SDM and 27.64 for PIL, p < 0.001) with no difference between the groups. Respondents receiving PILs were better able to recall "things to avoid" after exposure to PIL (chi2 =10.85, p < 0.001). After exposure to SDM or PIL, the respondents who received PIL were more aware of when to contact the physician, compared to the SDM group (chi2 = 8.41, p < 0.01). When compared with SDM, respondents receiving PIL were more likely to indicate that PIL was easy to read (chi2 = 20.00, p < 0.001), attractive (chi2 = 12.45, p < 0.001) and they were more likely to recommend distribution of their reading material to other patients (chi2 = 22.11, p < 0.001). We conclude that there is benefit in designing information leaflets that simplify language and medication information contained in SDMs, including better understanding of precautions to take while on medication and when to consult physicians.

Seven new 1,3-diazepinium chlorides exhibiting some structural similarities to the 1,4-benzodiazepines were synthesized. In a Hippocratic screen using mice, three of these salts, 3-methoxy-6-oxo-7,13-dihydro-6 H -benzofuro[2,3- e ]pyrido[1,2- a ][1,3]diazepin-12-ium chloride ( 8a ), 3-methoxy-9-methyl-6-oxo-7,13-dihydro-6 H -benzofuro[2,3- e ]pyrido[1,2- a ][1,3]diazepin-12-ium chloride ( 8c ) and 3-methoxy-11-methyl-6-oxo-7,13-dihydro-6 H -benzofuro[2,3- e ]pyrido[1,2- a ][1,3]diazepin-12-ium chloride ( 8e ) were examined for their effect on the central nervous system, and their activities compared to that of diazepam. On their own, salts 8a , 8c and 8e solicited no sedative effects on the behaviour of the animals. However, they elicited significant effects in combination with diazepam on diazepam-induced activities such as decreased motor activity, ataxia and loss of righting reflex. Compounds 8a and 8c were fitted into the pharmacophore/receptor model developed by Cook et al. with interaction at the L 1 , H 1 and A 2 sites indicating that they are potential inverse agonists of the Bz receptor. The compounds displayed some affinity for the α1 isoform of the GABA A /BzR (L Di interaction) but are non-selective for α5 (no L 2 interaction). Results of binding affinity studies showed that compound 8a is mildly selective for the α1 receptor although not very potent ( K i = 746.5 nM). The significant potentiation of diazepam-induced ataxia and decreased motor activity by compounds 8a and 8c in the Hippocratic screen may be associated with α1 selectivity.

Pumpkin (Cucurbita species) seed oil (PSO) is a rich source of phytoestrogens and the aim of this study was to examine the effect of PSO supplementation on the total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglycerides, high density lipoprotein cholesterol (HDL-C), systolic and diastolic blood pressure in non-ovariectomized and ovariectomized Sprague-Dawley rats. Female rats weighing 220-300 g were divided into non-ovariectomized rats for supplementation with corn oil (control CO; n = 6) or PSO (control PSO; n = 5) and ovariectomized rats for supplementation with corn oil (OVX/CO; n = 6) or PSO (OVX/PSO; n = 5) for 5 days per week for 12 weeks (corn oil 40 mg/kg or PSO 40 mg/kg given orally). Systolic and diastolic blood pressures were measured weekly. Blood was collected at the end of the period for plasma lipid assays. Control PSO had lower TC, LDL-C, triglycerides and higher HDL-C than the control CO. The OVX/CO had higher TC, LDL-C, triglycerides and lower HDL-C than the control CO and these changes were prevented in the OVX/PSO rats. PSO supplementation also resulted in lower systolic and diastolic blood pressures in both non-ovariectomized and ovariectomized rats. It is concluded that PSO supplementation can prevent changes in plasma lipids and blood pressure associated with inadequate oestrogen availability.

Ptyalism gravidarum is an oral pathological condition specific to gravidity. We present a review of the literature regarding epidemiology internationally, and then highlight therapies reported by patients and caregivers. This often distressing repeated filling of the mouth with watery saliva in a pregnant patient was previously exclusively associated with hyperemesis gravidarum, and the consequent maternal-fetal risk. Our dissertation includes reference to a rare case of isolated sialorrhoea of pregnancy, without nausea or emesis. Both pharmacological and homoeopathic therapies are discussed, and inherent risks to mother and infant are highlighted. It is strongly recommended that this condition be given attention in antenatal care settings, to optimize short, middle and long term pregnancy outcomes.

Background: Atypical antipsychotics are preferentially prescribed over typical agents for greater efficacy in treating symptoms associated with schizophrenia and related psychoses. However, these a...

Objective: To assess the impact of cannabis use on the efficacy of antipsychotic drugs in male subjects presenting to the University Hospital of the West Indies (UHWI) with psychotic episodes. Methods: Male subjects, 18–40 years old, admitted to the psychiatric ward of the UHWI between February 2013 and May 2013, diagnosed with schizophrenia, schizophreniform disorder and who tested positive for ∆9-tetrahydrocannabinol were recruited for the study. On day one, consenting subjects were assessed using the Brief Psychiatric Rating Scale (BPRS). Patients were prescribed seven days of an oral antipsychotic medication (haloperidol, chlorpromazine, risperidone, quetiapine, olanzapine). Medicated subjects were then reassessed using the BPRS on days three and seven. Statistical analysis involved the use of Student’s t-test and repeated measure analysis of variance. Results: In total, 20 subjects were recruited (mean age = 26.00 ± 5.96 years). Subjects were grouped based on the daily chlorpromazine equivalent (CPZE) dose given on day one into CPZE1 (CPZE dose of 100–300mg; n = 8) and CPZE2 (CPZE dose of 400–1250 mg; n = 12). There was no significant difference in the total BPRS score between the groups on day one (CPZE1 = 41.38 ± 16.47 versus CPZE2 = 49.42 ± 25.58; p = 0.44); similar findings were obtained for the positive (26.75 ± 9.27 versus 31.83 ± 17.30; p = 0.46) and negative (14.63 ± 7.73 versus 17.58 ± 9.74; p = 0.48) symptom component on the BPRS. For subjects in CPZE1, there was no significant decrease in total BPRS score [F(2,21) = 0.07, p = 0.93] over the study period. For CPZE2, significant reduction in total BPRS scores was achieved [F(2,33) =7.12, p = 0.01], contributed by significant decrease in the positive [F(2,33) = 5.64, p = 0.02) and negative [F(2,33) = 7.53, p = 0.01) symptom components of the BPRS. Conclusion: The findings of this study purport that male cannabis users presenting with psychotic disorders may not achieve optimal therapeutic benefit within seven days with CPZE doses ≤ 300 mg. As such, it appears that initiating treatment with CPZE doses of > 300 mg will provide better therapeutic outcomes for this patient population.

Objective: To identify major potential drug-drug interactions (DDIs) on prescriptions filled at the University Health Centre Pharmacy, Mona Campus, Jamaica. Methods: This investigation utilised a cross-sectional analysis on all prescriptions with more than one drug that were filled at the Health Centre Pharmacy between November 2012 and February 2013. Potential DDIs were identified using the online Drug Interactions Checker database of Drugs.com. Results: During the period of the study, a total of 2814 prescriptions were analysed for potential DDIs. The prevalence of potential DDIs found during the study period was 49.82%. Major potential DDIs accounted for 4.7 % of the total number of interactions detected, while moderate potential DDIs and minor potential DDIs were 80.8 % and 14.5 % respectively. The three most frequently occurring major potential DDIs were amlodipine and simvastatin (n=46), amiloride and losartan (n=27) and amiloride and lisinopril (n=16). Conclusion: This study has highlighted the need for educational initiatives to ensure that physicians and pharmacists collaborate in an effort to minimise the risks to the patients. These interactions are avoidable for the most part, as the use of online tools can facilitate the selection of therapeutic alternatives or guide decisions for closer patient monitoring and thus reduce the risks of adverse events.

The second Jamaica Health and Lifestyle Survey completed in 2007-2008 provided evidence that the prevalence of hypertension has increased significantly since 2000-2001. With more of the population living with hypertension, greater will be the need to ensure the best quality of life. A recent survey conducted in the ambulatory section of the Emergency Medicine Division at the University Hospital of the West Indies, identified a 36.5% non-compliance rate among the 52 patients prescribed with antihypertensive drugs. The reasons given for non-compliance with their antihypertensive medications are not new and included adverse effects, inconvenience and fear of dependence. However, in the same survey, it was also found that blood pressure was poorly controlled in 69.7% of the self-reported compliant subjects. Together, these points suggest that simply providing access to drugs is inadequate and a more holistic approach will be required to reduce blood pressure at the population level.

OBJECTIVE To determine the drug options used for pain in patients with acute sickle cell painful crisis at the University Hospital of the West Indies (UHWI), Jamaica. METHOD This retrospective study assessed all patients admitted to the UHWI between January 1, 2006 and December 31, 2010 with acute sickle cell anaemia painful crisis and the data obtained regarding site, severity, outcome and drug options selected for pain. RESULTS There were 101 patients with a mean age (± SD) of 18.6 (± 14.3) years; there was no difference in gender (42 females, 59 males). Eight sites of pain were reported, with the most common site being the lower limbs (44.6%) and 60.3% experienced pain in more than one site. Most of the patients (75.2%) were diagnosed with severe pain. Drug options included opioid, non-opioid or a combination, with pethidine (76) and paracetamol (79) being the most common chosen opioid and non-opioid drugs selected for therapy. There was low correlation between pain severity and appropriate first-line treatment (Spearman's rho = 0.344; p < 0.000). All patients with "mild" and "mild to moderate" pain were initially treated and obtained resolution of pain with non-opioid based therapy. However, most of the patients with severe pain (55.3%) required a second-line and some third-line (14.5%) of therapy for resolution at the time of discharge from the hospital. CONCLUSION Painful crisis in patients with sickle cell anaemia is associated with severe pain in 75% and most will require second-line therapy for adequate resolution. Physicians need to provide adequate pain relief to decrease morbidity in these patients.

Rituximab was the first chemotherapeutic monoclonal antibody (CmAb) approved for clinical use in cancer therapeutics in 1997 and has significantly improved the clinical outcomes in non-Hodgkin's lymphoma. Since then, numerous CmAbs have been developed and approved for the treatment of various haematologic and solid human cancers. In this review, the classification, efficacy and significantly reduced toxicity of CmAbs available for use in the United States of America are presented. Finally, the limitations of CmAbs and future considerations are explored.

A muscarinic alkaloid with a quaternary nitrogen was isolated from Trophis racemosa. Aqueous solutions (0.5%-2%) of the chloride salt of the alkaloid produced dose-dependent reductions of intra-ocular pressure ranging from 6.6 +/- 0.7 mmHg to 15.7 +/- 0.3 mmHg, (p < 0. 001, n = 5) in dogs. Atropine (0.1 mL of a 1% solution) and pirenzepine at a non selective antagonist dose (0.1 mL of 0.5% solution) for M(1) and M(3) receptors blocked the reduction of intra-ocular pressure, but alpha-adrenoceptor blockade with phenoxybenzamine (0.1 mL of a 1% solution) did not block the reduction of intra-ocular pressure. On the isolated guinea-pig ileum and trachea, the alkaloid produced contractions which were inhibited by atropine (6 x 10(-7) M or 0.4 microg/mL) and by pirenzepine at a non-selective antagonist dose (3.1 x 10(-6) M or 1.3 microg/mL) for M(1) and M(3) receptors. But neither selective blockade of M(2) receptors with gallamine (1.7 x 10(-6) M or 1.5 microg/mL) nor selective blockade of M(1) receptors with pirenzepine (7 x 10(-9) M or 3 ng/mL) inhibited the alkaloid-induced contractions. There was also no inhibition of the alkaloid-induced contractions in the presence of ganglionic nicotinic receptor blockade with pentolinium (5.6 x 10(-7) M or 0.3 microg/mL) and hexamethonium (1.7 x 10(-6) M or 0.6 microg/mL), but nicotine-induced contractions were inhibited by these ganglionic blockers. These results suggest that a muscarinic alkaloid from Trophis racemosa produced ocular hypotension via M(3) receptor stimulation in dogs.

Pharmacovigilance supports safe and appropriate use of drugs. Spontaneous reporting of adverse drug reactions (ADRs) is an essential component of pharmacovigilance. However, there is significant underreporting of ADRs. Adverse drug reactions have become a major problem in developing countries. Knowledge of pharmacovigilance could form the basis for interventions aimed at improving reporting rates and decreasing ADRs.