Yakugaku Zasshi. 2023;143(3):217-221. doi: 10.1248/yakushi.22-00160-2.

ABSTRACT

Important tasks performed by pharmacists include dispensing medicines based on prescriptions and explaining medication to patients. However, pharmacists are now required not only to perform these tasks but also to provide patients with pharmacotherapy that maximises the efficacy of drugs and minimises side effects. In particular, chemotherapy has a wide variety of side effects and a higher incidence of side effects than pharmacotherapy for lifestyle-related diseases. The Cancer Institute Hospital has conducted a oncology pharmacist outpatient clinic for patients undergoing chemotherapy, pharmacists meet with patients on an outpatient basis. The content of these visits includes assessing the severity of side effects and adherence to oral anti-cancer drugs, and proposing supportive therapy to doctors. This symposium will focus on hand-foot syndrome caused by 5-fluorouracil (5-Fu) anticancer drugs and molecular-targeted drugs, and will share information on skills in assessing the severity of these side effects and on side-effect management based on reducing doses of anticancer drugs, taking off drugs and proposing supportive therapy. Furthermore, how the pill counts and Self-report methods are used in clinical practice to assess adherence to oral anti-cancer drugs will be shared. Recently, trainees from insurance dispensing pharmacies have been accepted and training has been provided on the management of adverse effects of chemotherapy and adherence assessment of oral anticancer drugs in the oncology pharmacist outpatient clinic. This symposium will share details of pharmaceutical care practices such as side-effect management in chemotherapy and adherence assessment of oral anticancer drugs, and discuss the skills required for patient safety management.

PMID:36858551 | DOI:10.1248/yakushi.22-00160-2

Yakugaku Zasshi. 2023;143(3):213-216. doi: 10.1248/yakushi.22-00160-1.

ABSTRACT

The School Education Law was revised in 2006, and the university pharmacy education system and the national pharmacist examination system were changed. In line with the advancement of medical technology and the division of labor, 16 years have passed since the length of undergraduate pharmacy education was extended from 4 to 6 years in order to foster highly qualified pharmacists. During this period, the curriculum for practical training has been revised, and lectures and exercises focused on clinical education have been incorporated to foster pharmacists who can be useful in the medical field. In the area of cancer drug therapy, the university provides students with opportunities to learn about the basic mechanisms of action and side effects of anticancer drugs, but there is little coverage of clinical guidelines and pharmacological management of the latest therapies, such as cancer immunotherapy. Prior to my arrival at Hoshi University, I was involved in clinical work and clinical research at an oncology hospital for 13 years. Since my arrival, I have been exploring the gap between oncology pharmacotherapy and pharmacy education, and have been working to fill it. We have incorporated new curricula, such as exercises in formulation suggestions, lectures to deepen understanding of guidelines and supportive care, and information on the latest cancer drug therapies, such as cancer immunotherapy. This paper outlines the pharmacy education required to produce pharmacists who can practice safe cancer drug therapy.

PMID:36858550 | DOI:10.1248/yakushi.22-00160-1

Nihon Yakurigaku Zasshi. 2023;158(2):112-118. doi: 10.1254/fpj.22092.

ABSTRACT

A variety of new methods are being tried in education of pharmacology for medical students, to make pharmacology be directly oriented to practical medical treatment. Among them, thinking that the method of "selection of personal drug (P-drug)" is suitable for learning "evidence-based medicine (EBM)", I have been engaged in "P-drug education" in Kyushu university for many years. If doctors carefully select medicines that are indispensable for their medical treatment based on clinical evidence, are made familiar with how to use them, and in principle perform daily medical treatment using only those medicines, EBM can be really practiced. And moreover, it may also lead to the suppression of medical errors and adverse drug reactions. Such essential medicines for an individual doctor are called P-drug. Since 2003, I have adopted "P-drug selection" in the education of pharmacology for upper grade medical students. After more than 15 years of trial and error, I have been able to create an educational model using "P-drug selection" that I think could be easily adopted at any medical school. At this symposium, I talked about the relationship between "P-drug selection" and EBM and demonstrate the "P-drug education" model.

PMID:36858488 | DOI:10.1254/fpj.22092

Sci Adv. 2023 Mar;9(9):eabo2810. doi: 10.1126/sciadv.abo2810. Epub 2023 Mar 1.

ABSTRACT

Autoimmune central nervous system (CNS) demyelinating diseases are a major public health burden and poorly controlled by current immunosuppressants. More precise immunotherapies with higher efficacy and fewer side effects are sought. We investigated the effectiveness and mechanism of an injectable myelin-based antigenic polyprotein MMPt (myelin oligodendrocyte glycoprotein, myelin basic protein and proteolipid protein, truncated). We find that it suppresses mouse experimental autoimmune encephalomyelitis without major side effects. MMPt induces rapid apoptosis of the encephalitogenic T cells and suppresses inflammation in the affected CNS. Intravital microscopy shows that MMPt is taken up by perivascular F4/80+ cells but not conventional antigen-presenting dendritic cells, B cells, or microglia. MMPt-stimulated F4/80+ cells induce reactive T cell immobilization and apoptosis in situ, resulting in reduced infiltration of inflammatory cells and chemokine production. Our study reveals alternative mechanisms that explain how cognate antigen suppresses CNS inflammation and may be applicable for effectively and safely treating demyelinating diseases.

PMID:36857453 | DOI:10.1126/sciadv.abo2810

Health Informatics J. 2023 Jan-Mar;29(1):14604582221136712. doi: 10.1177/14604582221136712.

ABSTRACT

Drugs have the potential of causing adverse reactions or side effects and prior knowledge of these reactions can help prevent hospitalizations and premature deaths. Public databases of common adverse drug reactions (ADRs) depend on individual reports from drug manufacturers and health professionals. However, this passive approach to ADR surveillance has been shown to suffer from severe under-reporting. Social media, such as online health forums where patients across the globe willingly share their drug intake experience, is a viable and rich source for detecting unreported ADRs. In this paper, we design an ADR Detection Framework (ADF) using Natural Language Processing techniques to identify ADRs in drug reviews mined from social media. We demonstrate the applicability of ADF in the domain of Diabetes by identifying ADRs associated with diabetes drugs using data extracted from three online patient-based health forums: askapatient.com, webmd.com, and iodine.com. Next, we analyze and visualize the ADRs identified and present valuable insights including prevalent and less prevalent ADRs, age and gender differences in ADRs detected, as well as the previously unknown ADRs detected by our framework. Our work could promote active (real-time) ADR surveillance and also advance pharmacovigilance research.

PMID:36857033 | DOI:10.1177/14604582221136712

Database (Oxford). 2023 Feb 28;2023:baad006. doi: 10.1093/database/baad006.

ABSTRACT

The development of high-throughput molecular testing techniques has enabled the large-scale exploration of the underlying molecular causes of diseases and the development of targeted treatment for specific genetic alterations. However, knowledge to interpret the impact of genetic variants on disease or treatment is distributed in different databases, scientific literature studies and clinical guidelines. AIMedGraph was designed to comprehensively collect and interrogate standardized information about genes, genetic alterations and their therapeutic and diagnostic relevance and build a multi-relational, evidence-based knowledge graph. Graph database Neo4j was used to represent precision medicine knowledge as nodes and edges in AIMedGraph. Entities in the current release include 30 340 diseases/phenotypes, 26 140 genes, 187 541 genetic variants, 2821 drugs, 15 125 clinical trials and 797 911 supporting literature studies. Edges in this release cover 621 731 drug interactions, 9279 drug susceptibility impacts, 6330 pharmacogenomics effects, 30 339 variant pathogenicity and 1485 drug adverse reactions. The knowledge graph technique enables hidden knowledge inference and provides insight into potential disease or drug molecular mechanisms. Database URL: http://aimedgraph.tongshugene.net:8201.

PMID:36856726 | DOI:10.1093/database/baad006

Ren Fail. 2023 Dec;45(1):2175590. doi: 10.1080/0886022X.2023.2175590.

ABSTRACT

Background: Chronic kidney disease-associated pruritus (CKD-aP) is very common and sometimes refractory to treatment in hemodialysis patients. In a trial conducted in Japan, nalfurafine, effectively reduced itching of treatment-resistant CKD-aP. Our present bridging study aimed to evaluate the efficacy and safety of nalfurafine in Chinese cohort with refractory CKD-aP.Methods: In this phase III, multicenter bridging study conducted at 22 sites in China, 141 Chinese cases with refractory CKD-aP were randomly (2:2:1) assigned to receive 5 μg, 2.5 μg of nalfurafine or a placebo orally for 14 days in a double-blind manner. The primary end point was the mean decrease in the mean visual analogue scale (VAS) from baseline.Results: A total of 141 patients were included. The primary endpoint analysis based on full analysis set (FAS), the difference of mean VAS decrease between 5 μg nalfurafine and placebo group was 11.37 mm (p = .041); the difference of mean VAS decrease between 2.5 μg and placebo group was 8.81 mm, but not statistically significantly different. Both differences were greater than 4.13 mm, which met its predefined success criterion of at least 50% efficacy of the key Japanese clinical trial. The per protocol set (PPS) analysis got similar results. The incidence of adverse drug reactions (ADRs) was 49.1% in 5μg, 38.6% in 2.5 μg and 33.3% in placebo group. The most common ADR was insomnia, seen in 21 of the 114 nalfurafine patients.Conclusions: Oral nalfurafine effectively reduced itching with few significant ADRs in Chinese hemodialysis patients with refractory pruritus.

PMID:36856148 | DOI:10.1080/0886022X.2023.2175590

Am J Psychiatry. 2023 Mar 1;180(3):190-199. doi: 10.1176/appi.ajp.20230025.

ABSTRACT

One in three adults with major depressive disorder (MDD) do not experience clinically significant improvement after multiple sequential courses of antidepressants and have treatment-resistant depression (TRD). The presence of TRD contributes to the morbidity and excess mortality associated with MDD and has been linked to significantly increased health care expenses. In the absence of a consensus definition of TRD, this report takes a broad approach by considering inadequate response to one or more courses of antidepressants and focuses on atypical antipsychotics that are approved by the U.S. Food and Drug Administration for treatment of depression (aripiprazole, brexpiprazole, cariprazine, extended-release quetiapine, and olanzapine-fluoxetine combination). While multiple acute-phase studies have demonstrated the efficacy of these medications in improving depressive symptoms, clinically meaningful improvement (i.e., remission) remains limited, with significant concerns about side effects (including weight gain, metabolic dysfunction, extrapyramidal symptoms, and tardive dyskinesia), especially with long-term use. With the rapidly evolving landscape of antidepressant treatments over the past few years, which has witnessed approval of rapid-acting antidepressants (e.g., esketamine nasal spray and dextromethorphan-bupropion combination) and several more in the late-stage pipeline (e.g., zuranolone and psilocybin), it remains to be seen whether the use of atypical antipsychotics will go the way of the older and rarely prescribed antidepressants (such as tricyclics and monoamine oxidase inhibitors). Pragmatic clinical trials are needed to compare the effectiveness of atypical antipsychotics with TRD-specific pharmacotherapies and neuromodulation treatments and to identify the optimal sequencing of these varied approaches for patients with MDD. When using atypical antipsychotics, clinicians and patients are encouraged to use a shared decision-making approach by personalizing treatment selection based on anticipated side effects, tolerability, cost, and feasibility.

PMID:36855876 | DOI:10.1176/appi.ajp.20230025

Reg Anesth Pain Med. 2023 Mar 1:rapm-2022-104189. doi: 10.1136/rapm-2022-104189. Online ahead of print.

ABSTRACT

People who use or sell drugs develop their own in-group terms and language, much like any other group of people with a common experience. Slang terms are derived from a wide variety of sources. These might include the physical appearance and/or type of drug, the place where it originates, the effect it has on users, or how it is packaged for sale. To assist and educate the clinical practitioner who may deal with this nomenclature, we have compiled a list of some of the most common street names and some explanations (when known) of their origins.

PMID:36858482 | DOI:10.1136/rapm-2022-104189

Reg Anesth Pain Med. 2023 Mar 1:rapm-2023-104429. doi: 10.1136/rapm-2023-104429. Online ahead of print.

NO ABSTRACT

PMID:36858481 | DOI:10.1136/rapm-2023-104429

Pediatr Rev. 2023 Mar 1;44(3):153-164. doi: 10.1542/pir.2021-005456.

ABSTRACT

Musculoskeletal complaints are common among children in the primary care setting. Joint pain can be categorized as either inflammatory or noninflammatory (also known as mechanical), and differentiating between these 2 categories affects a physician's differential diagnosis and plan for evaluation. Patients with inflammatory arthritis will frequently present to the primary care physician with musculoskeletal complaints. Specific features in the history and physical examination distinguish juvenile idiopathic arthritis (JIA) from other musculoskeletal etiologies. (1)JIA is the most common cause of inflammatory joint pain in children younger than 16 years, with a variable worldwide incidence; in Europe and North America, the incidence is approximately 7.8 to 8.3 per 1,000, with prevalence rates between 12.8 and 45 per 100,000. (2) It is thought that as many as 8 million children in the world have chronic arthritis. (2) Given its prevalence, it is important for the primary care physician to be able to appropriately recognize this condition and in doing so prevent a delay in diagnosis and management. Arthritis is a common cause of disability in children, and complications of JIA can be severe. Many therapies used in JIA have adverse effects and contraindications (specifically vaccinations and teratogen exposure) that require recognition by the primary care physician. This article discusses the differences between inflammatory and noninflammatory joint pain, the diagnosis and various categories of JIA, long-term outcomes and complications associated with JIA, and the general management of JIA with special emphasis on adverse effects and contraindications of therapies.

PMID:36854831 | DOI:10.1542/pir.2021-005456

Anticancer Res. 2023 Mar;43(3):1341-1349. doi: 10.21873/anticanres.16282.

ABSTRACT

BACKGROUND/AIM: Azoles are widely used for prophylaxis in patients with haematologic malignancies and are well known as selective cytochrome P450 isoenzyme 3A4 inhibitors. Although the interaction between bortezomib and azoles has been reported, most previous studies were case reports or small clinical studies. Hence, we conducted a pharmacoepidemiological study to elucidate the impact of azoles on bortezomib-related adverse reactions, using the Japanese adverse drug event report database (JADER).

PATIENTS AND METHODS: We extracted 19,567 reports on patients prescribed bortezomib and/or azoles. We classified cases into three groups, namely bortezomib, bortezomib and azoles, and azoles groups. We estimated the odds ratios (OR) for the impact of concomitant azole use on five bortezomib-related adverse drug reactions (peripheral neuropathy, thrombocytopenia, neutropenia, leukopenia, and interstitial lung disease) using logistic regression.

RESULTS: The OR for peripheral neuropathy in the 'bortezomib and azoles' group was higher than that in the bortezomib group [OR=2.02, 95% confidence interval (CI)=1.32-3.08]. The magnitude of the interaction was stronger with itraconazole than that with fluconazole (itraconazole, OR=3.22, 95% CI=1.78-5.70; fluconazole, OR=1.56, 95% CI=0.86-2.72).

CONCLUSION: We found an association between concomitant administration of azoles with bortezomib and peripheral neuropathy. Azoles may enhance bortezomib-induced peripheral neuropathy based on their pharmacokinetic properties.

PMID:36854533 | DOI:10.21873/anticanres.16282

Anticancer Res. 2023 Mar;43(3):983-991. doi: 10.21873/anticanres.16242.

ABSTRACT

The treatment of advanced renal cell carcinoma has been substantially improved by the introduction of targeted and immune therapies and their respective combinations. Unleashing the activity of the immune system opened a new and successful front in the fight against cancers. Despite the benefits, drug resistance phenomena and adverse side effects can compromise efficacy. The development of new modalities of drugs and therapies with properties and mechanisms of action that break away from conventional medicines was expanded in recent years. This perspective discusses the prospects of these innovative and highly potent novel treatments in overcoming much of the current issues surrounding the resistance to approved renal cell carcinoma treatments and the challenges facing their introduction.

PMID:36854518 | DOI:10.21873/anticanres.16242

J Infus Nurs. 2023 Mar-Apr 01;46(2):107-115. doi: 10.1097/NAN.0000000000000496.

ABSTRACT

This study aimed to analyze the factors associated with local adverse effects resulting from hypodermoclysis in older adult patients in palliative care. The study involved 127 older adults undergoing palliative care at a hospital in southeastern Brazil. Data collection was performed from August to November 2019. Patients aged 60 years or older, with a prescription for hypodermoclysis at the time of admission and who were not receiving hypodermoclysis at the time of admission, were included. Data collected included sociodemographic, clinical, pharmacotherapeutic, and adverse effects of hypodermoclysis administration. Most participants were women (59.0%), with a mean age of 78.5 years. Frailty was the most prevalent diagnosis (26.8%), and 80.2% of patients were in the end-of-life stage. There was an incidence of 24.0% of adverse events, with catheter obstruction and swelling in the surrounding area of the hypodermoclysis site being the most frequent at 11.3% and 8.5%, respectively. Ondansetron administration by hypodermoclysis was 3 times more likely to have an adverse effect compared to not using this drug. In contrast, a protective factor was evident with the administration of 0.9% sodium chloride, which contributed to the reduction of complications. The occurrence of adverse effects from hypodermoclysis in the study population of older adults in palliative care was low.

PMID:36853873 | DOI:10.1097/NAN.0000000000000496

Asian Pac J Cancer Prev. 2023 Feb 1;24(2):389-400. doi: 10.31557/APJCP.2023.24.2.389.

ABSTRACT

BACKGROUND: Tacrolimus is a powerful macrolide calcineurin inhibitor that has low adverse effects which lead to a rapid response in the control of signs and symptoms in comparison to that of corticosteroids in Oral Lichen Planus(OLP). There have been increasing number of studies establishing the use of topical tacrolimus in oral lichen planus. Still, there is a need to find evidence of the successful use of tacrolimus in comparison to other drugs used in the treatment of OLP, by means of a systematic review and meta-analysis, so that an informed and accurate approach can be utilized.

METHODS: A comprehensive literature review was performed, including PubMed, the Cochrane Library, published up to and including December 2021. There were no restrictions on date of publication. Articles available in English language were included. Using the Cochrane Collaboration tool, we assessed the risk of bias for randomized controlled trials. A meta-analysis was performed on the relevant studies.

RESULTS: A total of 11 RCTs evaluating the effects of tacrolimus were included in this study after application of inclusion and exclusion criteria. Seven studies revealed a low bias risk, three presented a moderate risk and one had a high risk of bias. The results revealed no significant difference in clinical resolution and adverse effects between tacrolimus and corticosteroids. The pooled data from our meta-analysis shows that there is not sufficient evidence to prove that Tacrolimus is better in efficacy than other topical corticosteroids.

CONCLUSION: According to the current systematic study and meta-analysis, there is not sufficient evidence to prove that Tacrolimus is better in efficacy than other drugs. Uniform trials are required with larger sample sizes and standardized methodology are required for a better analysis.

PMID:36853285 | DOI:10.31557/APJCP.2023.24.2.389

Int J Tuberc Lung Dis. 2023 Jan 1;27(1):7-12. doi: 10.5588/ijtld.22.0249.

ABSTRACT

The need to address the impact of air pollution on health is reinforced by recent scientific evidence and the 2021 WHO Air Quality Guidelines (AQG). Air pollution is an avoidable risk factor causing a high burden for society with elevated deaths, health disorders, disabilities and huge socio-economic costs, especially in low- and middle-income countries. We have evaluated recent evidence from international reports, systematic reviews and official websites of international agencies. Growing evidence shows a causal relationship between air pollution exposure and acute lower respiratory infections, chronic obstructive pulmonary disease, asthma and lung cancer. Exposure to air pollution in both the short- and long-term has a serious impact on respiratory health. Harmful effects occur even at very low pollutant concentration levels, and there are no detectable thresholds below which exposure may be considered safe. The adverse respiratory health effects of air pollutants, even at low levels, are confirmed by recent epidemiological studies. Scientific respiratory societies and patient associations, along with other stakeholders in the health sector, should increase their engagement and advocacy to raise awareness of clean air policies and the latest WHO AQG.

PMID:36853127 | DOI:10.5588/ijtld.22.0249

J Int Med Res. 2023 Feb;51(2):3000605231156761. doi: 10.1177/03000605231156761.

ABSTRACT

Oral vancomycin is mainly used to treat and prevent active Clostridium difficile infection. Because it is widely believed that there is a very low absorption rate via the gastrointestinal tract, reports of adverse reactions following oral vancomycin administration are rare. This case report describes for the first time a case of antibiotic-associated diarrhoea in a 2-month-old infant treated with oral vancomycin. After oral vancomycin treatment, the number of eosinophils increased significantly and the levels gradually recovered after drug withdrawal. A review and analysis of the previously reported adverse reactions caused by oral vancomycin and eosinophilia caused by vancomycin confirm the need for physicians to pay close attention to vancomycin-related adverse reactions, to monitor the required concentration and to measure eosinophil counts in patients with rash-related adverse reactions. Patients with concomitant diseases and children should be monitored for adverse events as it is possible that they have increased gastrointestinal absorption of vancomycin following oral administration. When vancomycin causes eosinophilia, fever and rash, physicians should be alert to the possibility of organ damage.

PMID:36852821 | DOI:10.1177/03000605231156761

Sensors (Basel). 2023 Feb 20;23(4):2351. doi: 10.3390/s23042351.

ABSTRACT

The article's subject is the investigation of electromagnetic fields (EMF) of the microwave frequency band in a typical human living environment, especially in shielded areas. The point of view of electromagnetic field presence in the environment with the rapid increase in the level of the electromagnetic background is currently an essential point concerning population protection against the potential adverse effects of such EMFs. The authors focus on actual measurements, especially in shielded spaces frequently used in everyday life, such as elevator cabins and cars. The goal is a quantitative evaluation of the distribution of specific vector quantities of the EM field and a comparison with the currently valid hygiene standards. Measured values in shielded spaces show elevated levels in contrast to the open space. However, the values do not exceed limits set by considering the thermal effect on living tissues.

PMID:36850949 | PMC:PMC9961501 | DOI:10.3390/s23042351

Sensors (Basel). 2023 Feb 8;23(4):1918. doi: 10.3390/s23041918.

ABSTRACT

Mitigation or even elimination of adverse effects caused by ionizing radiation is the main scope of the radiation protection discipline. The interaction of radiation with living matter is quantified and correlated with biological effects by dose. The Sievert is the most well-known quantity, and it is used with the equivalent and effective dose to minimize stochastic effects. However, Gray is the reference quantity for sizing tissue reactions that could occur under high-exposure conditions such as in a radiation emergency. The topics addressed in this review are the choice to move from Sievert to Gray, how the operational quantities for environmental and individual monitoring of the detectors should consider such a change of units, and why reference levels substitute dose levels in emergency exposure.

PMID:36850517 | PMC:PMC9959072 | DOI:10.3390/s23041918

Anticancer Res. 2023 Mar;43(3):1377-1384. doi: 10.21873/anticanres.16286.

ABSTRACT

BACKGROUND/AIM: This study aimed to assess the clinical impact of lenvatinib after disease progression on atezolizumab plus bevacizumab in patients with advanced hepatocellular carcinoma (HCC).

PATIENTS AND METHODS: A total of 14 patients who received lenvatinib after failure of atezolizumab plus bevacizumab and all patients were classified as having a Barcelona Clinic Liver Cancer stage C. Six patients had macrovascular invasion, and a liver occupation rate of >50% was reported in seven patients. The Kaplan-Meier method was performed to analyze the cumulative survival, while log-rank test was used to detect the differences. The dose of lenvatinib was determined based on body weight.

RESULTS: The participants' responses to lenvatinib treatment were as follows: 21.4% achieved partial response (PR), while 35.7% had a stable disease, with a disease control rate of 57.1%. The median progression-free survival (PFS) and overall survival (OS) were 4.2 months and 8.3 months, respectively; the median PFS and OS were 6.7 months and 10.5 months in the PR group. No significant difference was observed in the median PFS and OS between patients with and without macrovascular invasion or liver occupation rate of >50%. Most of the adverse events (AEs) were categorized as grade 1-2; all patients tolerated the AEs, and no drug-related mortality was reported. Additionally, half of the population underwent subsequent therapy after progression on lenvatinib treatment.

CONCLUSION: Lenvatinib is effective and can be safely used as second-line systemic therapy after progression on atezolizumab plus bevacizumab in patients with advanced HCC in real-world clinical practice.

PMID:36854513 | DOI:10.21873/anticanres.16286