Context: Tobacco products and nicotine-delivery systems have been associated with oral changes, but comparative salivary effects remain insufficiently characterized. Aims: The salivary biochemical, immunological, and microbiological profile was assessed in young adult users of conventional cigarettes, e-cigarettes, and IQOS and compared with non-smoking controls. Methods: In this exploratory pilot observational study, mixed saliva was collected from 40 students aged 18–25 years, with 10 participants in each group. Biochemical markers, immunoglobulin concentrations, microbial growth on agar media, and salivary crystallization patterns were evaluated. Between-group differences were assessed at p<0.05. Results: Compared with controls, tobacco-product users had lower salivary pH, altered enzyme activity, increased urea, altered mineral concentrations, reduced IgA, IgG, and IgM, increased IgE, increased microbial growth, and altered crystallographic patterns. The magnitude of change differed by marker and product type. Conclusions: Tobacco-product use was associated with adverse changes in multiple salivary markers in this young adult sample. Because exposure was classified solely by self-report without biochemical verification (cotinine, exhaled CO), the findings are exploratory and pilot in nature. Causal, dose-dependent, or product-specific interpretations should be avoided. Larger controlled studies with validated biomarkers are required.
Context: Delayed inflammatory reactions at cosmetic implant sites have been reported after coronavirus disease 2019 vaccination, but population-level data from Indonesia remain limited. Aims: To estimate the prevalence of self-reported implant-site inflammatory reactions after coronavirus disease 2019 vaccination among cosmetic implant users in Indonesia and to explore associated factors. Methods: A cross-sectional online survey was distributed in Indonesia from November 2021 to July 2022. Respondents receiving at least one coronavirus disease 2019 vaccine dose who reported having a cosmetic implant were included. The primary outcome was self-reported localized redness, swelling, or pain at the implant site rather than clinically verified foreign-body reaction. Results: Among 1,610 valid responses, 266 respondents reported having cosmetic implants. Implant-site inflammatory reactions were reported by 10 respondents, corresponding to a period prevalence of 3.76% (95% CI: 1.82–6.80%). Adverse vaccine reactions were reported by 91 respondents (34.2%). An exploratory analysis suggested these respondents had higher odds of implant-site inflammatory reactions (OR: 4.78; 95% CI: 1.21–18.94; p = 0.04). However, this finding must be interpreted cautiously because only 10 events were observed and multivariable adjustment was not possible. No significant association was observed with age, sex, or vaccine type. Conclusions: A small proportion of respondents with cosmetic implants reported implant-site inflammatory symptoms following coronavirus disease 2019 vaccination. Because outcomes were self-reported, derived from a cross-sectional design, and key confounders were unmeasured, causal interpretation remains uncertain. These findings should be interpreted strictly as hypothesis-generating pharmacovigilance evidence. Prospective, clinically validated studies incorporating detailed implant characterization and reaction timing are required.
Context: Quercetin oral delivery is limited by low aqueous solubility, chemical instability, and poor bioavailability. Semi-solid extrusion (SSE) three-dimensional (3D) printing may provide a flexible approach for preparing individualized oral dosage forms for quercetin. Aims: To develop and evaluate the feasibility of novel quercetin-loaded aqueous polyethylene oxide (PEO)-poloxamer gel inks for SSE 3D printing, and to investigate the physicochemical characteristics and in vitro performance of the resulting 3D-printed systems evaluated as candidates for oral formulation development. Methods: Six aqueous-ethanolic gel formulations containing quercetin dihydrate, PEO, and either Tween 80, Eumulgin® SMO 20, Pluronic® F-68, Pluronic® F-108, or Pluronic® F-87 were prepared. Gel viscosity, microscopic appearance, Fourier transform infrared (FTIR) spectral homogeneity, printability, scaffold mass, surface area, quercetin content, and in vitro dissolution were evaluated. Quercetin was quantified by high-performance liquid chromatography (HPLC) and ultraviolet (UV) spectrophotometry. Results: All formulations were printable, although quercetin crystals were detected microscopically in all gels. The addition of Tween 80 or poloxamers reduced viscosity and improved macroscopic homogeneity compared with the PEO-only formulation. Printed scaffolds showed uniform appearance and acceptable mass variation. Quercetin content in dried scaffolds was generally close to theoretical values. Poloxamer-containing formulations accelerated quercetin release. The Pluronic® F-68 formulation released approximately 95% of quercetin within 60 min, whereas the PEO-only formulation released approximately 51%. Conclusions: This proof-of-concept study demonstrated that PEO-based gels containing Tween 80 or Pluronic® F-68 may represent suitable candidates for further development of SSE 3D printing of quercetin oral dosage forms. Further analytical validation, biorelevant dissolution, stability, and bioavailability studies are required.
Context: In-stent restenosis (ISR) remains a major complication following percutaneous coronary intervention. Increasing evidence suggests that genetic and inflammatory mechanisms contribute to ISR pathogenesis. Colchicine has demonstrated anti-inflammatory effects in cardiovascular diseases; however, its molecular targets in ISR remain unclear. Aims: To identify potential molecular targets and signaling pathways through which colchicine may modulate ISR using integrated computational approaches. Methods: ISR-related genes were retrieved from GeneCards, OMIM, and CTD databases. Colchicine targets were predicted using SwissTargetPrediction, BindingDB, SEASearch, and DrugBank. Overlapping genes were analyzed using protein–protein interaction networks and hub gene identification. Functional enrichment analysis was performed using GO and KEGG pathways. Molecular docking and 200 ns molecular dynamics simulations were conducted to evaluate binding stability. Binding free energies were calculated using MM-GBSA. Results: Sixteen overlapping targets were identified, and ten hub genes were prioritized. Docking analysis demonstrated moderate binding affinity of colchicine toward CYP3A4, TUBB1, and CYP2B6 (−6.9 to −7.4 kcal/mol). Molecular dynamics simulations indicated stable ligand–protein complexes with RMSD values below 2.5 Å. MM-GBSA analysis suggested favorable binding energies, particularly for TUBB1. Conclusions: Colchicine was predicted to interact with several ISR-associated targets and pathways, providing a computational basis for further experimental validation.
Context: Digital transformation has increasingly influenced pharmaceutical value chains, but evidence from emerging economies remains limited. Aims: To assess digital transformation maturity among surveyed pharmaceutical enterprises in Vietnam and to compare maturity according to firm size and operational age. Methods: A cross-sectional survey was conducted from January to June 2025 among managers and executives from 150 enterprises. A 64-item, five-point Likert questionnaire was used to assess seven maturity dimensions. Responses from 518 participants were aggregated at the enterprise level after intraclass correlation coefficients were evaluated. Descriptive statistics, exploratory factor analysis, reliability testing, one-way analysis of variance, Tukey post hoc tests, and thematic analysis of open-ended responses were performed. Results: The firm-level maturity score was 3.87 ± 0.60. Dimension means ranged from 3.85 to 3.89. Maturity differed significantly by firm size, with small and large enterprises scoring higher than medium-sized enterprises. Older enterprises reported slightly higher maturity than newer enterprises. The main barriers were limited information-technology infrastructure and insufficient workforce digital skills. Conclusions: Perceived digital-transformation maturity was relatively high among the surveyed enterprises. Medium-sized enterprises may require targeted financial, technical, and training support. Findings should be interpreted cautiously because of convenience sampling, self-reported measurement, and common method variance.
Context: The validation of microbiological methods in medical devices is key to ensuring patient safety and the efficacy of healthcare products. These types of studies respond to the need to comply with international regulatory requirements and ensure the quality of analytical techniques. Aims: To validate the analytical technique of microbial count by dilution-neutralisation of 0.25% quaternary ammonium. Methods: Deductive, applied, quantitative and experimental, method, consisting of six batches of three samples with different percentages of cake enriched with oyster mushroom (Pleurotus ostreatus) and 30 panelists of different ages and genders where a checklist was applied for data collection. Results: The results obtained count lower than 100 CFU for the strains Pseudomonas aeruginosa ATCC 9027, Staphylococcus aureus ATCC 6538, Bacillus subtilis ATCC 6633, Candida albicans ATCC 10231, and Aspergillus brasiliensis ATCC 16404. The proficiency test successfully recovered all the test microorganisms in the 10-2 dilution, presenting growth and identification of specific microorganisms. Validation of the neutralisation method showed adequate efficacy of the neutraliser at the 10-2 dilution and demonstrated the absence of toxicity of the neutraliser. The accuracy of the recovery percentages was within the 90% confidence interval, the precision of the test was <15% of the coefficient of variation, and it was demonstrated that the neutralisers used were specific to inhibit the antimicrobial properties of quaternary ammonium. The limit of detection recovered Pseudomonas aeruginosa >11 CFU and Staphylococcus aureus >17 CFU, robustness demonstrated that there was no significant variability in the counts, at different incubation times. Conclusions: The dilution method - neutralisation with soy lecithin 0.5% and polysorbate 80 4%, allowed the recovery of the test microorganisms at the 10-2 dilution.
Context: Protein tyrosine phosphatase 1B (PTP1B) is a validated therapeutic target for type 2 diabetes mellitus (DM) as it can deactivate insulin signalling. Aims: To isolate the secondary metabolites from the roots of Rhinacanthus nasutus and assess their predicted binding affinity toward the PTP1B allosteric site using an in silico approach. Methods: The isolated compounds were identified using spectroscopic techniques and the binding at the allosteric site of PTP1B was predicted by molecular docking. In addition, the most relevant complex was analyzed using molecular dynamics simulation and molecular mechanics-Poisson Boltzmann surface area (MM-PBSA) binding free-energy calculation. Results: Compound 1 was identified as 4-oxo-rhinacanthin B, along with five known analogues of rhinacanthin obtained from the roots of R. nasutus. Docking indicated that compounds 1-6 may fit into the PTP1B allosteric pocket, with compound 1 forming contacts with Asn193, Phe196 and Arg199. The compound 1–PTP1B complex remained associated with the allosteric pocket for most of the simulation period of 100 ns, although a larger deviation was observed towards the end of the trajectory. MM-PBSA suggested that compound 1 had slightly less favorable predicted binding free energy than ursolic acid, mainly because of a higher positive solvation penalty. Conclusions: Pyranonaphthoquinones from R. nasutus showed plausible in silico accommodation within the PTP1B allosteric pocket and may serve as starting scaffolds for further optimization. However, compound 1 has not been evaluated in an enzymatic assay and should therefore be regarded as a computationally prioritized scaffold for future biochemical validation, not as a validated PTP1B inhibitor.
Context: Honey contains phenolic constituents and minerals that contribute to measurable in vitro antioxidant capacity, which may vary with botanical and geographic origin. Aims: To evaluate physicochemical parameters, total polyphenol content (TPC), total flavonoid content (TFC), mineral composition, and in vitro antioxidant capacity in artisanal honey samples collected from coastal and Andean regions of Peru. Methods: Eleven coded honey samples were analyzed in triplicate (analytical replicates). TPC was determined by the Folin–Ciocalteu assay and TFC by an AlCl₃-based colorimetric assay. Antioxidant capacity was assessed using DPPH and FRAP assays. Minerals were quantified by flame atomic absorption spectrophotometry after incineration and acid digestion. Results: TPC and TFC differed across samples, and DPPH/FRAP responses varied by sample. A significant correlation was observed between TPC and TFC, and between DPPH and FRAP; however, no significant monotonic association between antioxidant capacity and TPC/TFC was detected in this dataset. Conclusions: Peruvian artisanal honey samples showed acceptable physicochemical indices and variable in vitro antioxidant capacity. Botanical authentication and compound-level profiling are required to strengthen floral-origin conclusions and to clarify the determinants of antioxidant capacity.
Context: Hyperuricemia is associated with gout, oxidative stress, and renal and hepatic dysfunction. Erythrina subumbrans (Hassk.) Merr. contains bioactive metabolites, but its antihyperuricemic activity remains insufficiently evaluated. Aims: To evaluate the antihyperuricemic activity of the ethanol extract of E. subumbrans leaves in vitro and in a fructose-potassium oxonate-induced hyperuricemic rat model. Methods: Xanthine oxidase inhibition was assessed colorimetrically. Male Wistar rats were assigned to normal control, negative control, allopurinol, and extract-treated groups (100, 200, and 400 mg/kg body weight) in a preventive/co-treatment design. Serum uric acid, creatinine, aminotransferases, and malondialdehyde were measured and analyzed using repeated measures analysis. Liver and kidney tissues were examined histologically. Results: The ethanol extract of E. subumbrans leaves inhibited xanthine oxidase in vitro, with a 50% inhibitory concentration of 30.98 ± 0.64 µg/mL, indicating lower activity than allopurinol (1.24 ± 0.64 µg/mL). At day 60, the extract at 100, 200, and 400 mg/kg attenuated serum uric acid levels to 3.28 ± 0.14, 3.26 ± 0.19, and 2.64 ± 0.09 mg/dL, respectively, compared with the negative control group (p<0.05). Lower creatinine, aminotransferase, and malondialdehyde values were observed in the extract-treated groups than in the negative control group. Histopathological alterations of the liver and kidney were numerically reduced, although not all pairwise comparisons reached statistical significance. Conclusions: The ethanol extract of E. subumbrans leaves showed antihyperuricemic activity in this preventive/co-treatment model. The observed effect may have been partly related to xanthine oxidase inhibition; however, further mechanistic, standardization, and safety studies are required.
Context: Sepsis remains a major cause of mortality in intensive care units, and antimicrobial selection is complicated by local resistance patterns. Aims: To describe antimicrobial use and evaluate the association between guideline adherence and discharge outcomes among adult ICU patients with sepsis or septic shock. Methods: A retrospective observational cohort study was conducted using 106 medical records from adult patients admitted to the ICU of Dong Nai 2 Hospital between January 2023 and February 2024. Empirical and post-susceptibility antimicrobial regimens were assessed according to the Sanford Guide and VNACCEMT 2020 recommendations. Results: Respiratory infection was the most frequent source of sepsis. Cultures were performed in 63 patients, and blood cultures were positive in 32. The main pathogens were Klebsiella pneumoniae (38.1%), Acinetobacter baumannii (22.2%), Pseudomonas aeruginosa (14.3%), and methicillin-resistant Staphylococcus aureus (11.1%). Levofloxacin and piperacillin-tazobactam were commonly prescribed empirically, whereas meropenem, linezolid, and colistin were frequently used after susceptibility results. Empirical adherence to Sanford Guide and VNACCEMT recommendations was 32.1% and 56.6%, respectively. Post-susceptibility adherence was 46.4% and 50.0%, respectively. Adherence to the Sanford Guide after susceptibility testing was associated with treatment success at discharge, defined as recovery or improvement (OR 2.301, 95% CI 1.105–4.792; p = 0.026). The in-hospital mortality rate was 41.5%. Conclusions: Inappropriate empirical antimicrobial therapy was frequent in this high-resistance ICU cohort. Adherence to antimicrobial stewardship recommendations, particularly Sanford Guide-based adjustments after susceptibility results became available, was associated with improved discharge outcomes in the exploratory multivariable analysis. Locally adapted empirical therapy combined with PK/PD-optimized targeted dosing should be evaluated prospectively.
Context: Endometriosis is a chronic estrogen-dependent inflammatory disorder associated with pelvic pain and infertility. Flavonoids from Phaleria macrocarpa have been reported to exhibit anti-inflammatory activity; however, their molecular mechanisms relevant to endometriosis remain insufficiently characterized. Aims: To predict biological activities of selected P. macrocarpa flavonoids and to explore potential protein–ligand interactions with endometriosis-relevant targets using molecular docking. Methods: Six flavonoids (eriodictyol, glycitin, 5-O-methylgenistein, catechin 7-O-β-D-xyloside, 8-prenylnaringenin, and naringenin) were assessed using the PASS web server to estimate biological activity probabilities (Pa/Pi). The compound with the highest predicted anti-inflammatory probability (Pa > 0.7) was selected for docking against cyclooxygenase-2 (COX-2), estrogen receptor (ER), AKT, aryl hydrocarbon receptor (AHR), and caspase-3 using Molegro Virtual Docker. Docking protocol validation was performed by redocking co-crystallized ligands and evaluating RMSDs. Results: PASS prediction indicated that all compounds exhibited potential anti-inflammatory activity (Pa > Pi), with 5-O-methylgenistein showing the highest confidence prediction (Pa = 0.838). Docking analysis suggested that 5-O-methylgenistein can occupy the binding sites of COX-2, ER, AKT, and AHR, showing comparable interaction patterns and overlapping residues with those of reference ligands, as indicated by software-derived scores. Redocking validation confirmed the acceptable reproduction of the pose (RMSD ≤ 2.0 Å). Conclusions: 5-O-methylgenistein was identified as a promising candidate for further investigation. The predicted interactions support hypotheses related to inflammation- and hormone-associated pathways in endometriosis; however, these findings are based on computational models and require experimental validation to confirm biological activity and therapeutic relevance.
Context: Dietary supplements are increasingly used to maintain health and prevent illness and are often perceived as non-medicinal products that do not require a prescription or consultation with healthcare professionals. Aims: To examine the impact of psychological factors (attitudes, beliefs, and actual consumption) on customer satisfaction and dietary supplement marketing within the context of the growing global use of these products. Methods: Psychological factors were treated as independent variables, while customer satisfaction and supplement marketing were treated as dependent variables. Additionally, satisfaction was used as a mediating variable connecting psychological factors to supplement marketing. A cross-sectional online survey was conducted in Jordan from March to April 2025, yielding 321 valid responses collected through convenience sampling. The data were analyzed using partial least squares structural equation modeling (PLS-SEM). To ensure the reliability and validity of the measurement model, convergent and discriminant validity, composite reliability, and Cronbach’s alpha were evaluated. Results: Psychological factors had a significant positive impact on customer satisfaction and supplement marketing. Satisfaction exerted a significant direct effect on supplement marketing and served as a positive mediator between psychological factors and supplement marketing. Attitudes and beliefs showed limited direct impact on supplement marketing when examined separately. Conclusions: The findings suggest that psychological factors, especially actual consumption, are important drivers of satisfaction and marketing effectiveness for dietary supplements. The study recommended that individuals exercise caution when using dietary supplements without professional recommendation, as some products may pose health risks, and remain vigilant about potentially deceptive or exaggerated marketing claims.
Context: Malaria morbidity remains high, and resistance to antimalarial drugs and diagnostics continues to expand. Aims: To systematically evaluate the in vitro/in vivo antimalarial efficacy and toxicity of Garcinia mangostana L. pericarp extracts (MP)/fractions and major xanthones. Methods: A PRISMA 2020 systematic review was performed and registered in PROSPERO. Searches were conducted in six databases up to March 30, 2025, using predefined keywords. Original English-language studies reporting the antimalarial activity and/or toxicity of MP extracts, fractions, or major xanthones in vitro/in vivo were included. Risk of bias was assessed using SciRAP (in vitro) and ToxRTool (in vivo). Due to methodological heterogeneity, findings were synthesized descriptively. Results: From 3,785 records, 20 studies (16 in vitro; 4 in vivo) were included. EEs and non-polar fractions (e.g., dichloromethane, hexane) were frequently reported as active to very active in vitro. α-Mangostin (α-MG) exhibited activity against Plasmodium falciparum strains across assays (IC50 range: 2.2–36.1 μM), and intraperitoneal administration in rodent malaria models was associated with high chemosuppression (>80%) in a single study; oral activity was lower. Low acute toxicity was observed at high doses; however, chronic exposure was associated with hepatic and renal alterations in some studies. Limitations of the evidence: Reporting quality was variable. Although all in vivo studies were classified as reliable without restrictions, the risk of bias was frequently high in vitro, and reporting on cytotoxicity and selectivity was inconsistent across studies, limiting the ability to draw conclusions for clinical application. Conclusions: MP-derived materials, particularly α-MG, exhibit experimental antimalarial activity. However, heterogeneity, incomplete reporting, and limitations regarding oral exposure warrant standardized studies on efficacy, selectivity, and pharmacokinetics.
Context: Renal injury associated with carcinogen exposure is often mediated by systemic oxidative stress and inflammation. Zanthoxylum acanthopodium is a medicinal plant rich in bioactive compounds with potential protective effects. Aims: To evaluate the protective effects of Z. acanthopodium extract on renal alterations, inflammatory biomarkers, and hematological parameters in a DMBA-induced rat model. Methods: Female Wistar rats were divided into six groups: normal control, DMBA control, vitamin C-treated control, and three treatment groups receiving Z. acanthopodium extract (100, 150, and 200 mg/kg BW). Following DMBA induction and tumor development, treatments were administered for 30 days. Hematological profiles, serum urea and creatinine levels, renal histopathology, and immunohistochemical expression of NGAL, TNF-α, and IL-6 were evaluated. Results: DMBA induction resulted in significant alterations in hematological parameters, increased serum urea and creatinine levels, renal histopathological damage, and elevated expression of NGAL, TNF-α, and IL-6. Treatment with Z. acanthopodium extract attenuated these alterations, with the 150 mg/kg BW group showing the most consistent improvements across evaluated parameters. Conclusions: Z. acanthopodium extract demonstrated protective effects against renal alterations under DMBA-induced systemic conditions, potentially through antioxidant and anti-inflammatory mechanisms. However, further studies are required to confirm the underlying mechanisms and direct nephroprotective effects.
Context: A psychometrically evaluated instrument is needed to assess factors that may influence pharmacy students’ intention to study abroad, particularly in contexts where pharmacy education is increasingly internationalized. Aims: To evaluate the psychometric properties of a questionnaire measuring factors influencing Vietnamese pharmacy students’ intention to study abroad. Methods: A descriptive cross-sectional survey was conducted among undergraduate pharmacy students at one university in Can Tho, Vietnam, from March to May 2024. The questionnaire structure was examined by exploratory factor analysis and confirmatory factor analysis. Item functioning and scale targeting were assessed using the Rasch rating scale model, and item-domain relationships were explored using regularized partial correlation network analysis. Results: A six-factor structure was identified. Internal consistency was high across factors (Cronbach’s alpha = 0.86–0.96), and the model showed acceptable overall fit (CMIN/df = 4.632, CFI = 0.895, TLI = 0.882, SRMR = 0.076, RMSEA = 0.079), although AGFI was below the prespecified threshold. Rasch item-fit values were within the acceptable range (infit = 0.68–1.49; outfit = 0.69–1.49), and person reliability was 0.95. Network analysis showed stronger connections among items within the same domain than among items from different domains. Conclusions: The questionnaire showed acceptable reliability and item functioning, with preliminary evidence of construct validity for assessing factors associated with study-abroad intention among Vietnamese pharmacy students. Further refinement, quantitative content validity, test–retest assessment, measurement-invariance testing, and validation in independent and multicenter samples are recommended before broader application.
Context: Adherence to antihypertensive medication is essential for blood pressure control. However, adherence patterns in mountainous areas of Vietnam, where socioeconomic and access barriers may differ, remain insufficiently described. Aims: To evaluate adherence to antihypertensive medication and associated factors among hypertensive outpatients in a mountainous province of Vietnam. Methods: A cross-sectional study was conducted among 662 outpatients (September–November 2023). Sociodemographic information was collected using a structured questionnaire, and treatment information was extracted from medical records. Adherence was measured using the Vietnamese version of the General Medication Adherence Scale (GMAS); adherence was defined as GMAS ≥30. Factors associated with adherence were explored using multivariable logistic regression. Results: Overall adherence was 90.9% (GMAS = 33: 59.1%; GMAS = 30–32: 31.9%). Receiving medication counseling from healthcare staff was associated with higher adherence (OR = 2.31; 95% CI = 1.25–4.27; p = 0.008). Self-management of the dosing schedule, regular follow-up attendance, absence of reported side effects, and belief in treatment effectiveness were also associated with adherence. Conclusions: High self-reported adherence was observed among hypertensive outpatients in this mountainous setting. Counseling and patient beliefs were associated with adherence, supporting the need for structured counseling and follow-up reinforcement in outpatient care.
Context: Atherosclerosis is driven by lipid accumulation and chronic immune-mediated inflammation, and immunization strategies have been proposed to modulate pathogenic immune pathways in vivo. Aims: To evaluate the effectiveness of vaccine-based interventions in inducing immune responses and reducing aortic plaque burden in experimental models of atherosclerosis. Methods: This systematic review (PROSPERO: CRD420261324489) followed PRISMA 2020 and Cochrane guidance. Preclinical in vivo studies in mice or rats with atherosclerosis receiving vaccine-based interventions were identified through searches of PubMed, ScienceDirect, SpringerLink, and EBSCO up to December 2024. Risk of bias was assessed using the CAMARADES checklist, and meta-analysis (RevMan 5.4) was performed where data were comparable, with remaining outcomes synthesized narratively. Results: Twenty-four preclinical studies using atherosclerotic animal models, primarily apolipoprotein E–deficient or low-density lipoprotein receptor–deficient mice, were included. Meta-analysis showed significant reductions in aortic plaque burden in vaccine-treated groups, both as absolute lesion area (µm²) (SMD = −1.87; 95% CI: −3.27 to −0.46; p = 0.009) and percentage-based measurements (SMD = −4.44; 95% CI: −5.72 to −3.17; p < 0.00001), despite substantial heterogeneity (I² = 87% and 78%). The direction of effect consistently favored vaccination, although antibody responses did not consistently correlate with plaque reduction. Funnel plot findings were inconclusive due to the limited number of studies. Conclusions: Vaccine-based strategies may reduce atherosclerotic plaque burden in preclinical models through immune modulation, despite substantial heterogeneity. However, variability in study design and reliance on prevention models warrant cautious interpretation and further standardized translational research.
Context: Medicinal plants have been widely used for psoriasis management for centuries. However, their safety profiles remain insufficiently documented. Aims: To systematically evaluate adverse events (AEs) and potential pharmacokinetic interactions of antipsoriatic herbal treatments. Methods: A PRISMA-compliant review was conducted using PubMed, Cochrane, Google Scholar, Web of Science, and Scopus databases (January 2015-December 2022). Clinical trials, case reports, and ethnomedicinal studies reporting AEs of single plant antipsoriatic preparations were included. CONSORT criteria for herbal medicines were applied to assess study quality. Results: Eleven studies covering nine herbal treatments were included. While most of reported AEs were mild, severe cases involving Indigo naturalis, Psoralea corylifolia, and Ranunculus arvensis were documented. Several herbal metabolites (indirubin, psoralen, curcumin, triptolide) showed potential pharmacokinetic interactions with conventional drugs. Conclusions: While generally well tolerated, antipsoriatic herbal therapies can induce mild to severe AEs and may alter drug metabolism. Long-term, high-quality randomized trials are needed to establish their safety profile.
Context: Oxidative stress and neuroinflammation contribute significantly to acute stroke pathophysiology. N-acetylcysteine (NAC), a thiol-containing antioxidant and glutathione precursor, exhibits neuroprotective effects in preclinical models. However, its clinical efficacy remains unclear. Aims: To systematically evaluate the efficacy and safety of NAC as an adjunct therapy in acute stroke, focusing on neurological outcomes, biomarker modulation, and tolerability. Methods: A PRISMA-guided search of PubMed, Scopus, ScienceDirect, Google Scholar, and Cochrane Library identified randomized controlled trials (RCTs) of NAC in ischemic or hemorrhagic stroke (2013–2025). Risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: Five RCTs involving 408 patients were included. NAC improved early NIH Stroke Scale (NIHSS) scores in four trials, particularly with intravenous or selenium-combined formulations. Biomarker studies reported reduced oxidative (MDA, TOS) and inflammatory markers (IL-6, ICAM-1) with increased antioxidant enzymes (SOD, GPx). Functional recovery at 90 days (mRS) was inconsistent. No significant increase in adverse events, bleeding, or mortality was observed. Conclusions: NAC may provide short-term neurological and biochemical benefits in acute stroke without added safety risks. However, its impact on long-term functional recovery remains inconclusive, warranting larger biomarker-guided trials.
Context: Despite extensive trials of sodium-glucose cotransporter 2 (SGLT2) inhibitors in heart failure (HF), comprehensive analyses identifying emerging themes and knowledge gaps remain limited. Aims: To explore evolving areas and identify knowledge gaps on SGLT2 inhibitors in HF. Methods: A hybrid methodology was adopted. Bibliometric analysis using Scopus (as of May 12, 2025) was conducted with Biblioshiny and VOSviewer to assess research output, key contributors, and thematic trends. A subsequent systematic review, conducted using PubMed, Scopus, and ScienceDirect, was conducted for each identified trend, and the quality was assessed using the ROBINS-I and RoB 2.0 tools. Meta-analysis was performed using RStudio. Results: A total of 621 studies were included in the bibliometric analysis. Emerging themes included “ertugliflozin,” “acute heart failure,” and “fibrosis.” Six studies on ertugliflozin indicate promising results, although clinical outcomes such as HF rehospitalization and cardiovascular mortality remain unexamined. Fifteen studies assessing SGLT2 inhibitors in acute heart failure (AHF) suggested that early initiation may be clinically beneficial, with notable improvements in diuretic efficacy, diuretic response, symptom relief, and a reduced risk of composite outcomes [HR: 0.64; 95% CI: 0.47–0.86; p = 0.003], without significant adverse events. Studies assessing the effects of SGLT2 inhibitors on myocardial fibrosis have demonstrated a greater reduction in extracellular volume at 6 months [MD: −1.48; 95% CI: −1.71 to −1.25; p<0.0001]. However, biomarker-based findings across four studies were inconsistent, underscoring the need for further investigation. Conclusions: While ertugliflozin and SGLT2 inhibitors in AHF show promise, further clinical investigations are warranted, particularly regarding long-term outcomes and myocardial fibrosis.
