Antimicrobial resistance (AMR) poses a significant global health challenge, and antimicrobial stewardship (AMS) initiatives are acknowledged as vital measures to enhance antibiotic utilization in healthcare facilities. Nevertheless, the effective execution of AMS programs continues to be exceptionally difficult across various healthcare environments. This opinion paper consolidates findings globally to pinpoint the primary obstacles and emerging viewpoints related to the implementation of hospital-based AMS. The analysis indicates that the challenges are complex, encompassing organizational, structural, cultural, educational, and behavioural aspects. Deficiencies in leadership and governance at various institutional tiers create a lack of accountability and commitment, while insufficient human and financial resources—including a shortage of infectious disease specialists, clinical pharmacists, and microbiologists—compromise the sustainability of these programs. Deeply rooted professional hierarchies and power dynamics among healthcare disciplines hinder interprofessional collaboration and diminish the acceptance of stewardship recommendations. Knowledge deficits and a lack of AMS-specific training across all professional categories further limit implementation, as do inadequate diagnostic laboratory capabilities and restricted health information technology. A persistent gap between national policies and local implementation realities leads to guidelines that are poorly suited to institutional contexts, while mandatory strategies may result in unintended outcomes such as regulatory evasion and decreased motivation among healthcare workers. These challenges are intensified in low- and middle-income countries but remain significant even in well-resourced environments. Promising strategies encompass multidisciplinary team approaches, governmentled accountability frameworks, contextualized implementation plans, and expanded roles for healthcare professionals.
Background: Adipose tissue is an active endocrine organ responsible for the production of adipokines. Aim: This study aimed to investigate whether serum levels of four adipokines (leptin, adiponectin, resistin, visfatin) and lipid parameters (cholesterol, triglycerides, LDL-cholesterol, HDL-cholesterol) are affected by adjuvant chemotherapy. Methodology: Twenty-five Greek patients who had been operated and received adjuvant chemotherapy with a good response were included. Blood samples were collected at three distinct time points during treatment, in order to mesure the above parameters. Results: Cholesterol, LDL and HDL levels did not show statistically significant differences at the three time points. In contrast, triglycerides were statistically significant higher ( p =0.0030) at the final time point. Serum leptin and resistin levels prior to treatment were significantly higher ( p <0.0001) than those observed during mid- and end-treatment. Comparison between the mid- and end- treatment time points showed a statistically significant difference ( p <0.0001), with higher levels observed at the mid-treatment time point. Serum adiponectin lev-els yielded a significant difference (lower value) between the baseline and the end time points ( p <0.0001), as well as across the other time points. Visfatin levels were significantly higher at the baseline of the treatment compared to both mid- and end-treatment levels (both p <0.0001). Conclusion: Increased levels of adiponectin, together with decreased values of the other three adipokines, are consistent with the results from previous studies, suggesting their potential use as auxiliary parameters. Regarding lipids, only levels of triglycerides provide relevant information. However, due to the absence of a control group and the small sample size (n=25), these findings should be interpreted as exploratory and hypothesis-generating rather than confirmatory.
Background: Spirometric reference equations are essential for accurate interpretation of lung function tests. However, most globally used equations are derived from Western populations and may not reflect the physiological norms of Arab populations. Aim: To systematically evaluate the applicability of internationally adopted spirometric reference equations within Arab populations and to assess the availability of population-specific equations in the Arab world. Methodology: A systematic review was conducted using PubMed, Scopus, Google Scholar, and CORE databases for studies published up to July 2023. Studies were included if they developed, validated, or assessed spirometric reference equations in Arab populations. Out of 57 initially identified studies, 14 met the inclusion criteria. Results: Based on the 14 studies conducted, the majority of studies reported that predicted values for forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC) in Arab populations were significantly lower than those predicted by equations derived from Western populations. This discrepancy suggests potential misclassification of respiratory diseases when non-local reference values are applied. Conclusion: The routine application of spirometric reference equations developed in Western populations may lead to inaccurate interpretation of lung function in Arab individuals. There is a clear need for developing standardized, population-specific reference equations that account for the ethnic and anthropometric characteristics of Arab populations to enhance diagnostic accuracy and clinical decision-making.
This review explores the complex relationship between thyroid function and menopause, focusing on physiological interactions, clinical implications, and diagnostic challenges associated with thyroid dysfunction in postmenopausal women. Drawing on recent studies and current understanding, it examines how menopausal hormonal changes influ¬ence thyroid health, increasing the risk of conditions such as hypothyroidism, hyperthyroidism, and subclinical thyroid disorders. Overlapping symptoms, including mood changes, sleep disturbances, weight fluctuations, and reduced libido, complicate diagnosis, as they can be attributed to both menopause and thyroid dysfunction. Hormonal shifts can also impact bone mineral density, cardiovascular health, and metabolism, while prolonged estrogen exposure and surgical menopause are linked to an elevated risk of thyroid cancer. Diagnostic complexity is heightened by age-related changes, comorbidities, and potential interferences in thyroid function tests. Routine thyroid assessment is recommended for women with surgical menopause or other risk factors. Personalized management, including meno¬pausal hormone therapy (MHT), can address overlapping symptoms and mitigate skeletal and cardiovascular risks. A patient-centred approach is crucial, with treatment tailored to individual health profiles. Further research is needed to clarify the interactions between menopause and thyroid function to improve clinical care.
Background: Prescription errors in substitution therapy for addiction treatment, including opioid substitution therapy (OST) with methadone and buprenorphine and pharmacotherapy for alcohol use disorder (AUD) with naltrexone, acamprosate, and disulfiram, pose a critical patient safety issue. These errors are a major contributing factor to adverse drug events (ADEs), poor treatment adherence, discontinuation, and severe outcomes such as fatal overdoses. Additional factors such as miscommunication, inadequate training, and complex medication regimens exacerbate the risk. Aim: This systematic review aims to evaluate the prevalence, causes, and consequences of prescription errors in substitution therapy for addiction treatment. It explores the roles of healthcare professionals, system-level factors and their impact on patient safety, focusing on adherence, treatment outcomes, and ADEs. Methodology: A systematic search was conducted in PubMed, Scopus, and Google Scholar for studies published between January 2000 and July 2025. Studies addressing prescription errors in OST or AUD pharmacotherapy, including generic or therapeutic substitution, were included. Data on error types, prevalence, contributing factors, consequences, and interventions were extracted. Qualitative data underwent thematic analysis, while quantitative data were synthesized descriptively. Results: Prescription error rates in OST varied widely, from 1.7% in older adults to 30.3% in overdose reports, with methadone and buprenorphine implicated most frequently. Common errors included incorrect dosing, dispensing errors, and inadequate monitoring, leading to respiratory depression, overdose, and treatment failure. Key contributing factors were miscommunication, insufficient training, frequent formulary changes, and patient-related factors such as cognitive impairment. Pharmacist-led interventions, digital prescribing systems, and standardized protocols significantly reduced errors. Data on AUD pharmacotherapy errors were sparse, highlighting a critical research gap. Conclusion: Prescription errors in substitution therapy pose significant risks to patient safety, primarily due to systemic and human factors. Enhanced training, standardized protocols, and digital tools are effective mitigation strategies. Further research is needed to quantify errors in AUD pharmacotherapy and develop targeted interventions.
