-
Cancer Letters Jan 2024Small extracellular vesicles (sEVs) such as exosomes are nanoscale membranous particles (<200 nm) that have emerged as crucial targets for liquid biopsy and as... (Review)
Review
Small extracellular vesicles (sEVs) such as exosomes are nanoscale membranous particles (<200 nm) that have emerged as crucial targets for liquid biopsy and as promising drug delivery vehicles. They play a significant role in tumor progression as intercellular messengers. They can serve as biomarkers for tumor diagnosis and as drug carriers for cancer treatment. This article reviews recent studies on sEVs in oncology and explores their potential as biomarkers and drug delivery vehicles. Following tumorigenesis, sEVs in the tumor microenvironment (TME) and circulatory system undergo modifications to regulate various events in the TME, including angiogenesis, epithelial-mesenchymal transition (EMT), and tumor immunity, with either pro- or anti-tumor effects. sEVs have been investigated for use as diagnostic and prognostic biomarkers for a variety of tumors, including lung cancer, melanoma, breast cancer, prostate cancer, and hepatocellular carcinoma. sEVs can be used for cancer therapy by packaging drugs or proteins into them through pre- and post-isolation modification techniques. The clinical trials of sEVs as biomarkers and drug carriers are also summarized. Finally, the challenges in the use of sEVs are described and the possible approaches to tackling them are suggested. Overall, sEVs will advance the precision cancer medicine and has shown great potential in clinical applications.
Topics: Male; Humans; Lung Neoplasms; Extracellular Vesicles; Drug Carriers; Liver Neoplasms; Biomarkers; Tumor Microenvironment
PubMed: 37972701
DOI: 10.1016/j.canlet.2023.216481 -
Innovations in Pharmacy 2023Self-medication practices continue to grow due to reclassification of prescription to OTC status and self-care information on the internet, however unintended injuries...
Self-medication practices continue to grow due to reclassification of prescription to OTC status and self-care information on the internet, however unintended injuries and inappropriate use of medications continue to challenge healthcare providers during the provision of patient care. Pharmacists have an integral role in pharmacovigilance and patient education activities to ensure safe medication use, storage, and disposal practices. The objective of this medication safety and disposal educational program was to provide comprehensive informational support to the community coupled with an assessment using the Health Belief Model (HBM) to gauge participants' perceived behavior change. The HBM was selected to assess the understanding of the community members' benefits and barriers to safe medication practices. The HBM posits that health behaviors are influenced by perceptions of a diseases' severity, perceived susceptibility, perceived barriers to health practices, perceived benefits of health practices, self-efficacy, and cues to action. An 8 item pre/post survey following the HBM constructs was developed which used a 5 point Likert scale. A total of 25 senior participants attended the educational program. Twenty-three pre/post surveys were completed (RR=92%). Five items revealed a statistically significant change from pre to post-educational content including understanding risk of herbal/OTC products (p=0.021), improved awareness of medication disposal methods (p=0.044), comprehension of OTC 'Drug Facts' information (p=0.004), understanding OTC label information to prevent medication interactions and side effects (p=0.008), and routinely reviewing expiration dates on medications and disposing of these properly (p=0.019). This study suggests a comprehensive approach which covers a wide range of medication safety topics and disposal practices can successfully improve the knowledge and skill of community participants and potentially improve medication harm reduction practices.
PubMed: 38487380
DOI: 10.24926/iip.v14i3.5546 -
Frontiers in Endocrinology 2023The most common cause of infertility and metabolic problems among women of reproductive age is polycystic ovary syndrome (PCOS), a multifaceted disorder. It is an... (Review)
Review
The most common cause of infertility and metabolic problems among women of reproductive age is polycystic ovary syndrome (PCOS), a multifaceted disorder. It is an endocrine disorder that occurs in approximately one in seven women. Among these PCOS patients, two thirds will not ovulate on a regular basis and seek treatment for ovulation induction. The symptoms vary in their severity, namely ovulation disorders, excessive androgen levels, or polycystic ovarian morphology. All these symptoms require a therapeutic approach. Many drugs are used to eradicate PCOS symptoms, like metformin, clomiphene citrate, spironolactone, and pioglitazone. Long-term treatment is required to achieve the desired outcome, which is often accompanied by significant adverse reactions. Some herbs and phytochemicals are equally effective for treating PCOS and produce minimal side effects. Recently, herbal products are gaining popularity due to their wide biological activities, safety, availability, and efficacy. The present review covers aetiology, current treatment, pathophysiology, and detailed pre-clinical and clinical studies on plants and phytochemicals that are proven to be useful for the treatment of symptoms associated with PCOS.
Topics: Polycystic Ovary Syndrome; Humans; Female; Phytotherapy; Phytochemicals; Animals; Plant Extracts
PubMed: 38725974
DOI: 10.3389/fendo.2023.1294406 -
The Journal of Adolescent Health :... Sep 2023To provide a population-based examination of psychotropic medication use before and after entry into foster care (FC), with special attention on the use of concerning...
PURPOSE
To provide a population-based examination of psychotropic medication use before and after entry into foster care (FC), with special attention on the use of concerning medication regimens: polypharmacy, stimulants, and antipsychotics.
METHODS
Using linked administrative Medicaid and child protective service data from Wisconsin, we follow a cohort of early adolescents ages 10-13 years who entered FC between June 2009 and December 2016 (N = 2,998). Descriptive statistics and Kaplan Meyer survival curves illustrate the timing of medication. Cox proportional hazard models identify hazard of outcomes (new medication, polypharmacy, antipsychotic, and stimulant medication) during FC. Separate models were run for adolescents with and without a psychotropic medication claim in the six months before FC.
RESULTS
Overall 34% of the cohort entered with a pre-existing psychotropic medication, accounting for 69% of adolescents with any psychotropic medication claim during FC. Similarly, the majority of adolescents with polypharmacy, antipsychotics or stimulants during FC entered with those prescriptions. Among youth with pre-entry medication, rates of polypharmacy (56%), antipsychotic (50%) and stimulants (64%) were high. Among adolescents who entered FC with no prior medication, placement disruptions (30 days before or after) predicted new medication.
DISCUSSION
Although a great deal of attention - and policies - have focused on youth in care, there is high reliance on psychotropic medications within the broader population of maltreated adolescents, indicating a need for timely and accurate re-assessment of current and past medications upon entry. Adolescents should also be actively involved in their own health care.
Topics: Child; United States; Humans; Adolescent; Antipsychotic Agents; Psychotropic Drugs; Foster Home Care; Central Nervous System Stimulants; Polypharmacy
PubMed: 37318407
DOI: 10.1016/j.jadohealth.2023.04.022 -
Journal of Controlled Release :... Sep 2023Microneedle Array Patches (MAPs) are an emerging dosage form that creates transient micron-sized disruptions in the outermost physical skin barrier, the stratum corneum,...
Microneedle Array Patches (MAPs) are an emerging dosage form that creates transient micron-sized disruptions in the outermost physical skin barrier, the stratum corneum, to facilitate delivery of active pharmaceutical ingredients to the underlying tissue. Numerous MAP products are proposed and there is significant clinical potential in priority areas such as vaccination. However, since their inception scientists have hypothesized about the risk of a clinically significant MAP-induced infection. Safety data from two major Phase 3 clinical trials involving hundreds of participants, who in total received tens of thousands of MAP applications, does not identify any clinically significant infections. However, the incumbent data set is not extensive enough to make definitive generalizable conclusions. A comprehensive assessment of the infection risk is therefore advised for MAP products, and this should be informed by clinical and pre-clinical data, theoretical analysis and informed opinions. In this article, a group of key stakeholders identify some of the key product- and patient-specific factors that may contribute to the risk of infection from a MAP product and provide expert opinions in the context of guidance from regulatory authorities. Considerations that are particularly pertinent to the MAP dosage form include the specifications of the finished product (e.g. microbial specification), it's design features, the setting for administration, the skill of the administrator, the anatomical application site, the target population and the clinical context. These factors, and others discussed in this article, provide a platform for the development of MAP risk assessments and a stimulus for early and open dialogue between developers, regulatory authorities and other key stakeholders, to expedite and promote development of safe and effective MAP products.
Topics: Humans; Administration, Cutaneous; Drug Delivery Systems; Epidermis; Needles; Pharmaceutical Preparations; Risk Assessment; Skin; Clinical Trials, Phase III as Topic
PubMed: 37437849
DOI: 10.1016/j.jconrel.2023.07.001 -
Journal of Infection in Developing... Jun 2023Stenotrophomonas maltophilia is a Gram-negative, opportunistic pathogen associated with a high morbidity and mortality rate. We report our clinical experience in...
INTRODUCTION
Stenotrophomonas maltophilia is a Gram-negative, opportunistic pathogen associated with a high morbidity and mortality rate. We report our clinical experience in treating a patient with infected pancreatic necrosis caused by multidrug-resistant (MDR) S. maltophilia with a novel drug combination.
CASE REPORT
A 65-year-old male with history of type II diabetes was admitted with acute pancreatitis, voluminous ascites, and signs of sepsis after undergoing an echo-endoscopy procedure with pancreas biopsy to investigate a Wirsung duct dilatation. Retroperitoneal fluid culture revealed S. maltophilia resistant to colistin and with intermediate susceptibility to trimethoprim-sulfamethoxazole and levofloxacin. The synergy between aztreonam (ATM) and ceftazidime/avibactam (CZA) was demonstrated using the combined disk pre-diffusion test.
CONCLUSIONS
There are sparse data providing guidance on the optimal regimen against MDR S. maltophilia infections. Although in this case a surgical excision was essential, combination of ATM and CZA provided effective synergistic antimicrobial treatment with clinical cure of severe acute pancreatitis infected with S. maltophilia. The combined disk pre-diffusion test with ATM and CZA requires no special equipment and can be routinely performed in clinical microbiology labs. Combination of ATM with CZA should be considered for cases of MDR S. maltophilia infections with limited treatment options.
Topics: Male; Humans; Aged; Aztreonam; Ceftazidime; Anti-Bacterial Agents; Stenotrophomonas maltophilia; Diabetes Mellitus, Type 2; Acute Disease; Pancreatitis; Drug Combinations; Microbial Sensitivity Tests; Gram-Negative Bacterial Infections
PubMed: 37406060
DOI: 10.3855/jidc.17290 -
Hypertension in Pregnancy Dec 2023Blood pressure medication is often prescribed to patients with preeclampsia. We are not aware of any study on readmission of those with preeclampsia to the hospital that...
BACKGROUND
Blood pressure medication is often prescribed to patients with preeclampsia. We are not aware of any study on readmission of those with preeclampsia to the hospital that considers blood pressure medication use or dose.
METHODS
This was a retrospective study of 440 preeclampsia patients diagnosed during the antepartum, intrapartum, or immediate postpartum period prior to discharge from the hospital. The outcome was hospital readmission. One analysis compared blood pressure medication (oral labetalol and oral extended release nifedipine) use and nonuse. Another analysis compared low-dose and high-dose blood pressure medication use.
RESULTS
Blood pressure medication use was not significantly associated with readmission (OR: 0.79, 95% CI: 0.39, 1.63, = 0.53). Low dose of blood pressure medication was significantly associated with increased odds for readmission (OR: 2.29, 95% CI: 1.00, 5.25, = 0.05).
CONCLUSION
We found that low dose of blood pressure medication was associated with increased odds for readmission within 6 weeks among those with preeclampsia. We recommend that clinicians balance the preference to reduce a blood pressure medication dose with the possible concern that too low a dose may place certain patients on track for hospital readmission after discharge.
Topics: Pregnancy; Female; Humans; Blood Pressure; Pre-Eclampsia; Antihypertensive Agents; Patient Readmission; Retrospective Studies; Postpartum Period
PubMed: 37358058
DOI: 10.1080/10641955.2023.2226210 -
Journal of Artificial Organs : the... Dec 2023Online hemodiafiltration (OHDF) for renal replacement therapy has two modes: pre- (pre-OHDF) and post-dilution OHDF (post-OHDF). To elucidate the precise differences...
Online hemodiafiltration (OHDF) for renal replacement therapy has two modes: pre- (pre-OHDF) and post-dilution OHDF (post-OHDF). To elucidate the precise differences between the two modes, a clinical study was performed using the same polysulfone hemodiafilters in the same patients. Eight patients were treated with ABH-22PA for 6 weeks: 3 weeks of pre-OHDF (with substitution volumes of 24, 36, and 48 L) and 3 weeks of post-OHDF (6, 8, and 10 L). The reduction ratios of urea, uric acid (UA), creatinine (CRE), inorganic phosphorus (iP), beta-2-microglobulin (β-MG), and alpha-1-microglobulin (α-MG) were evaluated. The removal amounts of β-MG, α-MG, and albumin were also evaluated by analyzing the spent dialysis fluids. The types and numbers of adverse events (AEs) and device malfunctions were recorded. The reduction ratios of urea, UA, CRE, iP, and β-MG were comparable among all conditions, while that of α-MG tended to be slightly higher in post-OHDF than in pre-OHDF. The removal amounts of α-MG and albumin in pre-OHDF and post-OHDF were significantly greater with the maximum substitution volume than with the minimum volume. However, the selective removal indices, which were obtained by dividing the amount of α-MG removed by the albumin level, tended to be slightly higher in pre- than in post-OHDF. No device-related AEs or device malfunctions occurred in either mode. No significant differences in inflammatory responses, evaluated by high-sensitivity C-reactive protein and interleukin-6, were observed. This study provides removal performance and safety data regarding the application of ABH-22PA for pre- and post-OHDF.
Topics: Humans; Hemodiafiltration; Renal Dialysis; Dialysis Solutions; Albumins; Urea; beta 2-Microglobulin; Creatinine
PubMed: 36513897
DOI: 10.1007/s10047-022-01379-4 -
Journal of Managed Care & Specialty... Nov 2023Unmet social health needs are associated with medication nonadherence. Although pharmacists are well positioned to address medication nonadherence, there is limited...
Unmet social health needs are associated with medication nonadherence. Although pharmacists are well positioned to address medication nonadherence, there is limited experience with screening for and addressing social health needs. To compare the prevalence of social health needs among Medicare patients with higher vs lower social health risk using a predictive model. To also evaluate pre-post changes in medication adherence and health care use following a pharmacist-initiated social health screening. A social health screening workflow was implemented into a routine pharmacist adherence program at an integrated health care delivery system. The social health screening was conducted during medication adherence outreach phone calls with Medicare members who were overdue for statin, blood pressure, or diabetes medications. We developed a social health need predictive algorithm to flag higher-risk patients and tested this algorithm against a random subset of lower-risk patients. Screening conversations were guided by a focus group that developed open-ended questions to identify social health needs. Comparisons in social health needs were made between higher- and lower-risk patients. Use and adherence outcomes were compared pre and post for patients who accepted a referral to social health resources and patients who declined a referral. 1,217 patients were contacted and screened for social health needs by pharmacists. Patients flagged by the social risk algorithm were more likely to report social health needs (28.7% vs 12.7% in the unflagged group; < 0.01). Commonly reported needs included transportation (43%), finances (34%), caregiving (22%), mental health (11%), and food access (10%). 221 patients accepted a referral to a central resource website and call center that connected patients to local services. One year after screening dates, patients who did not accept a referral spent more time in the hospital (mean change +0.7 days, SD = 7.3, < 0.01), had fewer primary care visits (mean change -0.5 visits, SD = 6.5, < 0.01), and had a shorter length of membership (mean change -0.4 months, SD = 1.9, < 0.01). Patients who accepted a referral had increased statin adherence (62.3% adherent pre vs 74.7% post, = 0.02). We implemented a workflow for pharmacists to screen for social health needs. The social health need prediction model doubled the identification rate of patients who have needs. Intervening on social health needs during these calls may improve statin adherence and may have no adverse effect on health care utilization or health plan membership. Social health risk predictive model development and validation was funded by the Agency for Healthcare Research and Quality (AHRQ R18HS027343).
Topics: Aged; Humans; United States; Medicare; Pharmacists; Medication Therapy Management; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Medication Adherence; Telephone
PubMed: 37889865
DOI: 10.18553/jmcp.2023.29.11.1184 -
Healthcare (Basel, Switzerland) Aug 2023Providing care to patients with several conditions and simultaneously taking several medications at home is inexorably growing in developed countries. This trend...
JUSTIFICATION
Providing care to patients with several conditions and simultaneously taking several medications at home is inexorably growing in developed countries. This trend increases the chances of home caregivers experiencing diverse errors related with medication or care.
OBJECTIVE
To determine the effectiveness of four different educational solutions compared to the natural intervention (absence of intervention) to provide a safer care at home by caregivers.
METHOD
Prospective, parallel, and mixed research study with two phases. Candidates: Home-based caregivers caring a person with multiple comorbid conditions or polymedication who falls into one of the three profiles of patients defined for the study (oncology, cardiovascular, or pluripathological patients). First phase: Experts first answered an online survey, and then joined together to discuss the design and plan the content of educational solutions directed to caregivers including the identification of medication and home care errors, their causes, consequences, and risk factors. Second phase: The true experiment was performed using an inter- and intrasubject single-factor experimental design (five groups: four experimental groups against the natural intervention (control), with pre- and post-intervention and follow-up measures) with a simple random assignment, to determine the most effective educational solution (n = 350 participants). The participants will be trained on the educational solutions through 360 V, VR, web-based information, or psychoeducation. A group of professionals called the "Gold Standard" will be used to set a performance threshold for the caring or medication activities. The study will be carried out in primary care centers, hospitals, and caregivers' associations in the Valencian Community, Andalusia, Madrid, and Murcia.
EXPECTED RESULTS
We expect to identify critical elements of risk management at home for caregivers and to find the most effective and optimal educational solution to reduce errors at home, increasing caregivers' motivation and self-efficacy whilst the impact of gender bias in this activity is reduced.
TRIAL REGISTRATION
Clinical Trial NCT05885334.
PubMed: 37570430
DOI: 10.3390/healthcare11152190