Limited data exist regarding pneumococcal vaccination coverage among the elderly in Middle Eastern countries including Jordan. The pharmacists' role in improving vaccine acceptance has become increasingly evident. Yet, large-scale studies of the assessment of the pharmacists' role on pneumococcal vaccines acceptance among the elderly are scarce. Hence, we assessed for the first time the current state of knowledge and pneumococcal vaccination coverage among the elderly and the role of pharmacist-led educational intervention on the attitude, awareness, vaccine acceptance, and prompts for physician consultation regarding pneumococcal vaccines in Jordan. This interventional study enrolled 916 randomly selected adults aged ≥ 65 years in Amman, Jordan. We showed that only 3.9% of the participants have ever heard about pneumococcal disease with 0.5% vaccination coverage. Immediately after educational intervention, 21.7% of the participants perceived pneumococcal disease as a threat, 52.1% of them believed in the importance of the vaccine, and 93.9% of them were willing to consult a physician in this regard. At a two-month follow-up, 30.5% had a positive attitude toward the vaccine and 36% consulted their physician regarding the vaccine. Vaccination coverage was significantly increased to 1.9% (P value = 0.008). The main obstacles against vaccination were a negative attitude and that physicians had not recommended the vaccine. Vaccine uptake was significantly associated with physician consultation (P value = 0.011). Insurance, employment, attitude, and reading the booklet significantly predicted physician consultation. In conclusion, very low pneumococcal vaccination coverage was observed among the elderly in Jordan. Enrollment of pharmacists in immunization education and recommendation is suggested to improve pneumococcal vaccine coverage among the elderly in Jordan.

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Chemotherapy-induced peripheral neuropathy (CIPN) is a significant adverse effect of many anticancer drugs. Current strategies for the management of CIPN pain are still largely unmet. The aim of this study is to investigate the antinociceptive potential of combining tramadol with the synthetic cannabinoid WIN55212, and to evaluate their associated adverse effects, separately or in combination, in a CIPN rat model, and to investigate their ability to modulate the transient receptor potential vanilloid 1 (TRPV1) receptor activity. Von Frey filaments were used to determine the paw withdrawal threshold in adult male Sprague–Dawley rats (200–250 g) following intraperitoneal (i.p) injection of cisplatin. Single cell ratiometric calcium imaging was used to investigate WIN55212/tramadol combination ability to modulate the TRPV1 receptor activity. Both tramadol and WIN55212 produced dose-dependent antinociceptive effect when administered separately. The lower dose of tramadol (1 mg/kg) significantly enhanced the antinociceptive effects of WIN55212 without interfering with core body temperature. Mechanistically, capsaicin (100 nM) produced a robust increase in [Ca2+]i in dorsal root ganglia (DRG) neurons ex vivo. Capsaicin-evoked calcium responses were significantly reduced upon pre-incubation of DRG neurons with only the highest concentration of tramadol (10 µM), but not with WIN55212 at any concentration (0.1, 1 and 10 µM). However, combining sub-effective doses of WIN55212 (1 µM) and tramadol (0.1 µM) produced a significant inhibition of capsaicin-evoked calcium responses. Combining WIN55212 with tramadol shows better antinociceptive effects with no increased risk of hypothermia, and provides a potential pain management strategy for CIPN.

Lowering Intraocular pressure (IOP) is a main therapeutic objective in glaucoma patients because IOP is an important risk factor for glaucoma progression. The objective of this work was to formulate and evaluate, in vitro and in vivo, a stable and effective Solid in Oil (S/O) topical formulation of the antiglaucoma drug, timolol maleate (TM). S/O dispersions were prepared by emulsification of aqueous TM solutions in cyclohexane using different amount of the span 85 then lyophilizing the emulsion to produce TM – Span 85 complexes. The complexes were then dispersed in castor oil using tip sonicator to produce S/O nanodispersions. S/O nanodispersions were evaluated in terms of particle size, polydispersity index, encapsulation efficiency, morphology, physical stability, as well as transcorneal permeation and accumulation of TM. In addition, the in vivo tolerability and efficacy of the prepared formulation in lowering intraocular pressure were evaluated in rabbits. Spherical nanoparticles of TM with a particle size of about 134-155 nm were successfully prepared and found to be physically stable. The encapsulation efficiency was high and was found to be dependent on the level of Span 85 used. In comparison to TM solution, S/O nanodispersion enhanced TM permeation and decreased accumulation in transcorneal diffusion studies. In addition, application TM S/O nanodispersion onto rabbit eyes resulted in a significant reduction in IOP in comparison to TM aqueous solution.