A BSTRACT Objective: This study evaluated the impact of structured clinical pharmacist-led counseling on hospital admissions due to chemotherapy side effects, patient satisfaction, and cost avoidance in patients receiving intravenous chemotherapy. Methods: A prospective pre–post quality improvement study was conducted at a tertiary care center in Saudi Arabia. The preintervention cohort (October 2024–February 2025, n = 118) received standard care; the postintervention cohort (April–August 2025, n = 135) received structured 30-min pharmacist-led counseling covering regimen-specific education, anticipatory guidance on toxicity, self-management strategies, red-flag symptom recognition, and monitoring protocols. The primary outcome was the hospital admission rate due to chemotherapy-related side effects. Secondary outcomes included side effect-specific admissions, patient satisfaction, and economic impact. Findings: The intervention achieved a 34.4% relative reduction in admission rates (13.56%–8.89%; P = 0.02; number needed to treat = 22). Complete elimination of admissions for gastrointestinal toxicities and 38.8% reduction in febrile neutropenia admissions were observed. Patient satisfaction reached 94.4%, with 97.2% service coverage. Net cost savings totaled $38,850 over 5 months (ROI: 747%), with febrile neutropenia prevention accounting for 76.6% of savings. Conclusion: Structured pharmacist-led counseling significantly reduced chemotherapy-related hospital admissions, achieved exceptional patient satisfaction, and demonstrated strong economic value, supporting its integration as standard supportive care in oncology practice.
A BSTRACT Objective: The objective is to evaluate the efficacy and safety of adding 1% topical cetirizine to 5% topical minoxidil compared with topical minoxidil alone in patients with androgenetic alopecia (AGA). Methods: In this single-blind randomized clinical trial, 62 patients with AGA were allocated to receive either topical minoxidil 5% twice daily (monotherapy group, n = 31) or topical minoxidil 5% twice daily plus topical cetirizine 1% once daily (adjunctive therapy group, n = 31) for 16 weeks. Primary outcomes included changes in hair density and hair diameter scores. Secondary outcomes were global photography score, patient satisfaction, and treatment-related adverse events. Findings: Both groups demonstrated improvement from baseline in hair density and hair diameter scores after 16 weeks of treatment. However, no significant differences were observed between groups in hair density score (0.65 ± 0.61 vs. 0.68 ± 0.60, P = 0.987), hair diameter score (1.29 ± 0.59 vs. 1.39 ± 0.62, P = 0.628), or global photography score (1.00 ± 0.68 vs. 1.06 ± 0.57, P = 0.697). Patient satisfaction was significantly higher in the adjunctive therapy group than in the monotherapy group (1.82 ± 1.07 vs. 1.13 ± 0.85, P = 0.004). Two cases of local irritation were reported in the monotherapy group, whereas no adverse events were reported in the adjunctive therapy group. Conclusion: The addition of 1% topical cetirizine to topical minoxidil did not result in superior objective hair-growth outcomes compared with minoxidil alone. Although patient satisfaction was higher among patients receiving adjunctive cetirizine, this finding may be attributable to factors other than a direct pharmacologic effect. Further double-blind, vehicle-controlled studies with larger sample sizes are warranted to clarify the role of topical cetirizine in the management of AGA.
A BSTRACT Objective: Opioids are essential for cancer pain management but often require dose or route adjustments, leading to disposal of unused medications. This study investigated opioid disposal by dosage form, dose, economic impact, and admission type. Methods: This retrospective observational study included patients who received oral or transdermal opioids at Ogaki Municipal Hospital between January 2023 and December 2024. Opioid disposal, defined as nonreusable opioids discarded according to narcotics management records, was identified retrospectively. Disposal volume, cost, and reasons for disposal were evaluated. Costs were calculated using official drug prices (April 2025). Associations between admission type and disposal reasons were analyzed using the Chi-square test. Findings: Eighty-eight patients experienced opioid disposal. The total disposal volume was 3022 units, with a total cost of JPY 599,736 (mean: JPY 6815 per patient). Disposal frequently involved low-dose oral opioid formulations, particularly sustained-release oxycodone (5, 10 mg). Pareto analysis showed that the top five drugs accounted for 59.5% of total disposal costs. Disposal reasons differed significantly by admission type ( χ 2 = 40.8, df = 4, P < 0.001): death-related disposal occurred only in emergency admissions, whereas planned admissions were more frequently associated with drug changes and represcriptions. Conclusion: Opioid disposal in hospitalized patients occurs frequently, including with low-dose oral formulations. Costs are concentrated in a limited number of drugs and vary by admission type. Optimizing opioid selection and early assessment of administration routes may help reduce unnecessary disposal while maintaining adequate pain control.
A BSTRACT Objective: The objective of this study was to assess whether a district-led multifaceted e-prescribing quality-improvement intervention improved outpatient prescription completeness and selected prescribing indicators in rural Vietnamese primary care. Methods: In this uncontrolled before-and-after study, 1000 health-insurance outpatient e-prescriptions were sampled before the intervention (September–November 2022) and 1000 after it (March–May 2023) from nine public primary healthcare facilities using the Health Information System of Vietnam Posts and Telecommunications (HIS-VNPT; locally recorded as VNPT-HIS). The intervention (December 2022–February 2023) combined prescriber education, drug-information support, audit-feedback, pharmacist-prescriber cross-checking, and administrative reminders. The primary outcome was complete key dosing-instruction documentation. Secondary outcomes were other mandatory completeness fields and selected the World Health Organization/International Network for Rational Use of Drugs prescribing indicators. Findings: Full address documentation remained low (31/1000 [3.1%] vs. 29/1000 [2.9%]; P = 0.79). Complete key dosing instructions increased from 956/1000 (95.6%) to 974/1000 (97.4%; P = 0.03). Mean medicines per prescription did not change significantly (4.08 ± 1.535 vs. 4.20 ± 1.348; P = 0.07), and all medicines were prescribed by international nonproprietary name. Antibiotic prescribing increased from 335/1000 (33.5%) to 447/1000 (44.7%; P < 0.001), vitamin prescribing from 136/1000 (13.6%) to 190/1000 (19.0%; P = 0.001), and essential-medicine use changed only slightly (1480/4078 [36.3%] vs. 1568/4197 [37.4%]; P = 0.31). Conclusion: E-prescribing may provide an infrastructure for quality improvement but requires clinical decision support and pharmacy review.
Objectives: The objectives of this study were to determine the incidence, severity, temporal profile, and management outcomes of flare reactions following ultrasound (US)-guided intra-articular steroid injection (IASI) for frozen shoulder. Methods: This retrospective study included adult patients undergoing US-guided glenohumeral joint IASI for frozen shoulder over 1 year. Flare reactions were assessed using the Numeric Rating Scale at 1-, 4-, and 24-h postinjection. Analgesic strategies were evaluated based on pain severity. Findings: Among 84 patients, flare reaction occurred in 19 (22.6%). Most reactions were mild (63.2%) and self-limiting. Moderate-to-severe reactions (36.8%) required pharmacological treatment. Early-onset severe pain responded rapidly to low-dose sublingual buprenorphine, with complete relief in most patients within 4 h, while late-onset moderate pain was effectively managed with oral diclofenac. No adverse effects were observed. Conclusion: Flare reaction after IASI for frozen shoulder is not uncommon and, in most cases, can be effectively managed with appropriate analgesic strategies. Sublingual buprenorphine for moderate–severe early-onset pain ensures effective symptom control without major side effects.
Objective: Poor adherence to oral antipsychotics is an important challenge in schizophrenia, highlighting long-acting injectables (LAIs) as an alternative. This study aimed to compare the clinical and demographic profiles of patients with schizophrenia with prior LAI exposure versus those maintained exclusively on oral antipsychotics. Methods: This cross-sectional, observational study enrolled eligible schizophrenia inpatients aged 18–65 diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition criteria from June 2022 to October 2023. Participants were divided into two groups: those with prior LAI exposure and those who had maintained only oral antipsychotics. Demographic data, clinical history, and baseline laboratory parameters were collected. The primary outcome was the severity of psychotic symptoms, assessed using the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression Severity (CGI-S) Scale upon admission. Findings: A total of 70 patients were included in the final analysis, with 36 patients having a history of LAI and 34 on only oral treatment. Demographically, both groups were comparable across most characteristics. Baseline PANSS score and its subscales, CGI-S scores, and laboratory markers showed no statistical difference. However, the LAI group showed a significantly longer duration of illness ( P = 0.017), more hospitalizations ( P < 0.001), and greater prior exposure to first-generation antipsychotics ( P < 0.001) with higher chlorpromazine equivalent doses ( P < 0.001) compared to the oral-only group. Conclusion: This study highlights treatment patterns among Iranian schizophrenia patients, showing that patients on LAIs generally have a history of longer illness durations, more hospitalizations, and more expose to first generation antipsychotics. Further studies should be conducted to investigate the efficacy of early versus delayed initiation of LAI and their long-term outcomes.
Objective: The objective is to determine the prevalence and types of drug-related problems (DRPs), identify associated factors, and evaluate the impact of a structured pharmacist-led intervention on prescribing quality in pediatric outpatient care in a resource-limited health system with limited advanced prescribing decision-support. Methods: A pre–post intervention study was conducted from July 2023 to June 2024 at a secondary-level hospital in a lower-middle-income country setting (Vietnam). Two independent cross-sectional prescription samples were obtained using systematic random sampling (323 prescriptions preintervention and 323 postintervention). DRPs were identified using national prescribing frameworks and mapped to the Pharmaceutical Care Network Europe DRP Classification (v9.1). The intervention comprised pharmacist-led educational sessions and the dissemination of drug information bulletins, with ongoing reminders, targeting the most frequent baseline DRPs. Factors associated with DRP occurrence (≥1 DRP per prescription) were examined using logistic regression; pre–post comparisons used Chi-square tests. Findings: At baseline, 57.9% of prescriptions contained at least one DRP, predominantly dosage regimen-related problems, with incorrect timing of administration being the most frequent (32.20%). In multivariable analysis, prescriptions issued by male prescribers had higher odds of DRPs (odds ratio 2.51, 95% confidence interval 1.51–4.18), whereas prescriptions for children aged 2–6 years and 6–12 years had lower odds than those for children aged ≤2 years. Following the intervention, DRP prevalence decreased significantly to 40.2% (P < 0.001), with marked reductions in timing- and dosing-related DRPs. Conclusion: A structured, low-cost pharmacist-led intervention integrated into routine outpatient practice was associated with a clinically meaningful reduction in DRPs. Strengthening clinical pharmacy services is a feasible and scalable strategy to improve pediatric prescribing safety in resource-limited settings where systematic medication review and electronic decision support are constrained.
The high mutations of the Omicron variant of severe acute respiratory syndrome coronavirus 2 raised concerns regarding the efficacy of antivirals. This meta-analysis aimed to determine the impact of nirmatrelvir/ritonavir on the outcomes of immunocompetent patients with confirmed Omicron variant. Three reviewers systemically searched PubMed (Medline), Cochrane Library, and Embase databases up to June 9, 2025. Randomized clinical trials (RCTs) and observational studies with a control group were screened for eligibility to extract data. Studies that included only patients with immunosuppression, malignancy, or renal failure, severe disease, or assessed nirmatrelvir/ritonavir efficacy on variants other than Omicron were excluded. Forty-six observational studies, including 6,099,805 participants, were involved in the meta-analysis. Our findings revealed that nirmatrelvir/ritonavir significantly decreases death (risk ratio [RR] =0.31; 95% confidence interval [CI]: 0.23–0.40), disease progression (RR = 0.57; 95% CI: 0.42–0.71), hospitalization (RR = 0.45; 95% CI: 0.35–0.56), composite outcome of hospitalization and death (RR = 0.58; 95% CI: 0.44–0.71), ventilation (RR = 0.46; 95% CI: 0.19–0.72), and intensive care unit admission (RR = 0.56; 95% CI: 0.38–0.73) compared to the control group. However, no significant difference was shown across the two groups regarding hospitalization duration (mean difference = −2.34; 95% CI: −5.60–0.93). The current updated meta-analysis supported the efficacy of nirmatrelvir/ritonavir on the Omicron variant. However, further RCTs are recommended for accurate results.
Objective:Given the association between medication literacy (ML) and its correct use, assessing the status of ML is essential in the community. This study aimed to validate a Persian-language ML assessment instrument, addressing the lack of a previously validated Persian tool. Methods:This was a cross-sectional study conducted in Tehran. A database search was conducted to identify current tools. The selected instrument was translated and then back-translated into English. Questions regarding medication information-seeking behaviors and attitudes toward pharmacist guidance were added. The instrument was presented to the Academy of Medical Sciences, and their feedback was incorporated. The content validity index (CVI), content validity ratio (CVR), and comprehensiveness were assessed based on the experts. Reliability was evaluated through test-retest (intraclass correlation coefficient [ICC]) and internal consistency (Kuder-Richardson [KR] coefficient). Findings:Two systematic reviews that evaluated 52 ML tools were assessed. ML measure (MLM-17) was selected. Four questions on attitudes and behaviors were added. Following feedback from the academy, the number of these questions increased to 7, while one ML question was replaced. Following the experts' comments, a CVI of 0.77 was calculated, and questions with a CVR <0.99 were revised or removed. Accordingly, two questions were removed from the attitude and behavior sections, and one question was added to the ML section. The assessment of reliability showed ICC = 0.67 and KR = 0.71. Conclusions:The psychometric evaluation confirmed the tool's validity and reliability. Therefore, it is a suitable instrument for assessing ML in Persian-speaking populations.
Objectives: This study aimed to evaluate and compare three popular drug interaction checkers – Lexidrug, Medscape, and Drugs.com – in detecting major drug–drug interactions (DDIs) from real-world prescriptions in a tertiary care hospital. Methods: We analyzed 500 randomly selected prescriptions from a hospital database, identifying 1133 unique drug pairs. Each pair was checked for potential interactions using all three platforms. We compared how often DDIs were detected, their severity ratings, and agreement between tools using Cohen’s kappa for concordance. Finding: Polypharmacy, defined as five or more drugs, was present in 23.8% of prescriptions, with an average of 6.3 drugs per patient. Polypharmacy was strongly linked to severe DDIs, showing nearly a threefold increased risk. Drugs.com identified the highest number of DDIs (21%), followed by Lexidrug (19.6%) and Medscape (16.2%). Severity ratings varied, and agreement between the tools was moderate (κ = 0.47–0.50). Conclusion: There is notable variation in detecting and classifying major DDIs among these common tools. Standardizing databases and interaction definitions is important. Meanwhile, clinicians should use multiple checkers alongside their clinical judgment to ensure safer prescribing when managing patients on many drugs.
Diabetic foot ulcers (DFUs) represent a major complication in patients with diabetes mellitus, resulting in reduced quality of life, frequent hospitalizations, and increased healthcare costs. Our study analyzed the clinical records of 200 patients with DFU selected from a pool of medical records from a tertiary care hospital in India. Our study assessed patterns of drug prescription, determined pathogen profiles and antimicrobial susceptibility, evaluated economic burden, and identified the prevalence and severity of drug–drug interactions (DDIs) among patients with DFUs. Antibiotics were the most commonly prescribed drugs (18.5%) with the highest incidence of serious DDIs (28.5%). These results underscore the importance of optimizing antibiotic stewardship and rational prescribing practices to improve clinical outcomes.
Medication adherence is a critical issue in managing chronic kidney disease (CKD) patients for slowing CKD progression. Objective:The aim of this study was to evaluate the relationship between individual medication adherence and secondary clinical outcomes (pill burden, medication knowledge, and CKD stages) over a 6-month period. This prospective observational study with repeated measures was performed among patients with CKD in a tertiary hospital in Malaysia. Methods:A prospective observational study was conducted among CKD patients, with assessments at baseline, month 3, and month 6. Individual adherence, pill burden, medication knowledge, and CKD stages were assessed at each visit. Groups were compared using Mann-Whitney U test, Chi-squared, T-test, McNemar test, or ANOVA as necessary. Findings:A total of 200 patients were included, with 140 completing the 6-month follow-up. Medication adherence remained stable over time, with 58.0% (n = 116/200) adherent at baseline, 59.7% (n = 86/144) at month 3, and 59.3% (n = 83/140) at month 6 (all P > 0.05). For the secondary outcomes, adherent patients had a significantly lower pill burden at baseline (mean 9.9 vs. 11.5 pills; P = 0.033), although this was not observed at month 3 or month 6. Medication knowledge scores were consistently higher among adherent patients at baseline (P < 0.001), month 3 (P = 0.002), and month 6 (P < 0.001). CKD stages differed significantly between adherent and nonadherent patients at all time points (baseline, P = 0.005; month 3, P = 0.006; month 6, P = 0.001). Conclusion:These findings highlight the clinical value of pharmacist-led, medication-level adherence assessment, enabling targeted interventions to optimize therapy, reduce complications, and improve patient outcomes.
Urinary tract infections (UTIs) are one of the most important infectious complications in kidney transplant recipients; hence, antibiotic prophylaxis is warranted. Due to limited information for selection of an appropriate antibiotic for prophylaxis, as well as the varying reports concerning increasing resistance of Escherichia coli as the common related pathogen, this systematic review and meta-analysis assess the effect of a combined regimen including fluoroquinolone + co-trimoxazole as prophylaxis in high-risk group patients. PubMed, Cochrane Library, Embase, and Web of Science were used as electronic databases to perform a systematic literature between 2010 and December 2024. A commercially available software program (EndNote X9) was used for electronic title management. Searches were performed with keywords, (“Urinary Tract Infections” OR “urinary tract infection” OR “UTI”) AND (“Kidney Transplantation” OR “renal transplant*” OR “kidney transplant*”) AND (“Co-Trimoxazole” OR “co-trimoxazole” OR “trimethoprim sulfamethoxazole” OR “TMP-SMX”) AND (“Fluoroquinolones” OR “fluoroquinolone*” OR “ciprofloxacin” OR “levofloxacin”). A total of 454 potentially relevant titles and abstracts were found during the electronic and manual search, finally two studies were included. Heterogeneity showed a higher percentage of patients in Group I suffered from urinary infection, compared to Group II. Addition of ciprofloxacin to the standard regimen, co-trimoxazole, was related to a reduced risk of UTI in kidney transplant recipients.
Postoperative endophthalmitis is a rare but severe complication of phacoemulsification cataract surgery (PCS). Acinetobacter baumannii is an uncommon pathogen, often associated with multidrug resistance and poor outcomes. In this report, a 73-year-old male who developed endophthalmitis following PCS is introduced, who, despite intensive empirical therapy, experienced no clinical improvement. Following a vitreous sample analysis with polymerase chain reaction, A. baumannii infection was diagnosed. The patient was treated with fortified topical colistin, amikacin, and subconjunctival and intravitreal colistin, which responded with the resolution of intraocular inflammation. This case emphasizes the therapeutic challenges of A. baumannii endophthalmitis. It highlights colistin as an effective treatment option in cases resistant to conventional regimens.
Objective:This study aimed to assess cephalosporin prescribing patterns, clinical appropriateness, susceptibility and resistance profiles, potential drug-drug interactions, and de-escalation practices in the management of infectious diseases. Methods:This prospective observational study was conducted over 6 months (May-October 2024) at a tertiary care hospital in South India. A total of 288 adult patients (>18 years) who received at least one cephalosporin prescription were included. Relevant demographic, clinical, and prescription data were collected from the patient case records. The appropriateness of antimicrobial therapy was evaluated according to the Indian Council of Medical Research antimicrobial stewardship guidelines. Data were entered into Microsoft Excel and analyzed using IBM SPSS Statistics version 20.0. Findings:Among the 288 patients, 383 cephalosporin prescriptions were documented. Culture testing was performed in 63% (n = 181) of cases; however, only 13.9% (n = 40) showed positive microbial growth. Escherichia coli was the most frequently isolated organism, accounting for 30% (n = 12) of culture-positive cases. Guideline-based evaluation revealed that 32.4% of cephalosporin prescriptions were inappropriate, indicating a significant deviation from evidence-based practice. Conclusion:Third-generation cephalosporins were predominantly prescribed in the study population. Although cephalosporins remain important and accessible therapeutic agents, inappropriate and empirical prescribing practices contribute to the rising antimicrobial resistance. Rational use guided by culture sensitivity results and antimicrobial stewardship principles is essential to preserve their clinical efficacy and limit further resistance.
Objectives: An adverse drug reaction (ADR) is an unintended and harmful response to a medicinal product and is a significant cause of morbidity and mortality. Despite its importance, no prior systematic ADR evaluation has been conducted at Hospital Besut. This study aimed to analyze ADR patterns reported within 5 years (2019 to 2023) in Hospital Besut, focusing on affected organ systems and types of drugs involved, causality, severity, outcomes, and identifying associations between demographics, severity, and reaction onset. Methods: A retrospective observational study was conducted using all ADR reports recorded in the Pharmacy Information System (PhIS) and submitted to the National Pharmaceutical Regulatory Agency. Data from January 2019 to December 2023 were collected and analyzed from June to November 2024. The descriptive and statistical analyses, including the Chi-square test, were used to present the findings, with significance set at P < 0.05 using SPSS software version 27. Findings: A total of 289 ADR forms with 413 reactions were analyzed. The occurrence of ADRs was common among females (n = 151, 52.2%), followed by males (n = 138, 47.8%). The average mean age of patients was 36 ± 21.9 years. Most ADRs involved the skin (n = 280, 67.8%) and respiratory system (n = 44, 11.6%). The drug–reaction relationships were mostly classified as probable and possible, which were 114 (39.4%), respectively. In addition, most of the onset of ADR occurred within minutes (n = 117, 40.5%), and the reactions were mild (n = 171, 59.2%), with 181 (62.6%) of patients recovering from the ADR. Antibiotics (n = 94, 32.5%) and analgesics (n = 55, 19.03%) were responsible for most ADRs. Only age was significantly associated with the reaction severity (P = 0.037). Conclusion: This study emphasizes the importance of pharmacovigilance in identifying common ADR patterns and promoting safer medication practices in Hospital Besut.
Objective: This cross-sectional descriptive study was conducted over 3 months (April–June 2025) among acute coronary syndrome (ACS) patients who received eptifibatide at Shahid Chamran Hospital, Isfahan. Methods: Patient demographics, diagnosis, and the chosen therapeutic approach (revascularization or ischemia-guided) were collected. Data on concomitant medications (including aspirin and P2Y12 inhibitors), timing, and dosing were extracted from medical records. Details on eptifibatide administration (total dose and time) were captured. The procedural time and intra-procedural events (thrombotic events, no-reflow) were documented. The appropriateness of eptifibatide use was evaluated against European Society of Cardiology-ACS 2023 and American Heart Association-ACS 2025 guidelines. Findings: A total of 150 patient records were reviewed. Only 48% of eptifibatide prescriptions were guideline-concordant. Of the rational prescriptions, two cases were due to intra-procedural thrombotic events, five due to no-reflow phenomena, and 65 due to insufficient time for the P2Y12 inhibitor to achieve a therapeutic effect (all received clopidogrel as the P2Y12 inhibitor) at percutaneous coronary intervention. Notably, 97.33% of patients received clopidogrel, while only 2.66% received ticagrelor, the faster-onset P2Y12 inhibitor preferred by guidelines over clopidogrel. This suggests that using ticagrelor instead of clopidogrel in these cases might have eliminated the need for eptifibatide owing to its quicker onset. Conclusion: The study shows limited concordance between eptifibatide prescribing and guidelines. In addition, using ticagrelor instead of clopidogrel might eliminate the need for eptifibatide owing to its quicker onset.
Objective: Highly sensitized kidney transplant candidates, those with high levels of antihuman leukocyte antigens antibodies, are at increased risk of antibody-mediated graft rejection. The goal of desensitization therapy is to reduce alloantibody titers and increase the chance and success of transplantation. The proteasome inhibitor bortezomib, which acts against plasma cells, has been reported to be an effective agent in this setting. This systematic review evaluates the efficacy and safety of bortezomib-based desensitization regimens in sensitized kidney transplant recipients. Methods: A systematic search of various databases was conducted between January 2005 and July 2025. Studies that considered sensitized kidney transplant candidates treated with bortezomib-based desensitization were included, and outcomes included reduction in donor-specific antibodies (DSA), engraftment rate, graft rejection, and adverse events. Findings: A total of 21 studies involving about 185 patients were included, comprising 11 case reports, 6 case series, and 4 clinical trials or prospective studies. Overall graft success rate was 87% rejection-free outcomes 76% and no more adverse events in 81%. While most studies showed significant DSA reduction, one reported limited effectiveness. Bortezomib was generally well-tolerated, with no major adverse events in approximately 81% of studies. Mild neuropathy was noted in some cases, and treatment discontinuation occurred in 20% of patients in one trial. Conclusion: It can be concluded that bortezomib-based therapies are a potentially effective and well-tolerated option for desensitization and treatment of antibody-mediated rejection in kidney transplant candidates.
Objective: Intensive care unit (ICU) patients on mechanical ventilation, in particular, may experience changes in pharmacokinetics due to alterations in cardiac output and organ blood flow. This study aims to evaluate the effects of mechanical ventilation on the steady-state pharmacokinetic changes of vancomycin. Methods: In this prospective cohort study, eligible patients were enrolled into either the ventilated or non-ventilated group. Demographic and clinical data were gathered, and peak and trough blood samples were collected to measure their levels. Additional pharmacokinetic parameters were calculated using appropriate formulas. Findings: A total of 39 ICU patients were enrolled in the final analysis. Of these, 32 matched patients were divided into two equal groups: ventilated and nonventilated. None of the pharmacokinetic parameters, including peak plasma concentration (P = 0.878), trough plasma concentration (P = 0.437), volume of distribution (P = 0.468), K (P = 0.234), t½ (P = 0.266), clearance (P = 0.709), and daily area under the curve (P = 0.418), were significantly different between the two groups. Bivariate correlation analysis showed a significant correlation between estimated glomerular filtration rate, acute physiology and chronic health evaluation II score, and C-reactive protein (CRP) level with vancomycin pharmacokinetic parameters. Furthermore, significant effects of augmented renal clearance (ARC) on vancomycin pharmacokinetics were determined. Conclusion: The key finding of this study was that ARC significantly impacted vancomycin serum levels, resulting in subtherapeutic concentrations in 23.1% of patients. High CRP levels also significantly correlated with increased vancomycin distribution volume, emphasizing the role of inflammation. These findings underscore the importance of personalized vancomycin dosing, taking into account factors such as ARC and inflammation, to improve patient outcomes. However, due to the small sample size, further studies with larger cohorts are necessary.
Objective:Fibrocystic breast disease (FBD) is a prevalent benign breast disorder primarily affecting women of reproductive age. Characterized by breast pain (mastalgia), cystic and solid breast lesions, and associated hormonal imbalances. Melatonin, a hormone produced by the pineal gland, exhibits potent antioxidant, anti-inflammatory, and has been shown to improve sleep quality and mental health in various clinical populations. These properties suggest that melatonin may be a promising therapeutic option for symptom management in women with FBD. Methods:This randomized, double-blind, placebo-controlled trial enrolled 66 women aged 18-40 years with FBD, diagnosed according to American Cancer Society guidelines, at Beheshti Clinic, Kashan University of Medical Sciences. Participants were randomized to receive either melatonin (6 mg/day; n = 33) or placebo (n = 33) for 12 weeks. Primary outcomes included breast pain severity and high-sensitivity C-reactive protein (hs-CRP), while secondary outcomes assessed sleep quality, depression, anxiety, and biomarkers of oxidative stress and inflammation, including total antioxidant capacity (TAC), malondialdehyde (MDA). Findings:After 12 weeks, melatonin supplementation resulted in a significant reduction in breast pain scores (P = 0.006) and improvement in sleep quality (P = 0.02) compared to placebo. Additionally, TAC was significantly increased in the melatonin group (P = 0.01). No significant differences were observed for depression, anxiety, serum hs-CRP, or MDA levels. Conclusion:Twelve weeks of melatonin supplementation (6 mg/day) significantly alleviates breast pain, enhances sleep quality, and improves antioxidant status in women with FBD. These findings support the use of melatonin as a safe and effective adjunctive treatment for FBD symptom management.
