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JCO Precision Oncology Jun 2024Fluoropyrimidine-related toxicity and mortality risk increases significantly in patients carrying certain genetic variants with standard dosing. We implemented... (Observational Study)
Observational Study
Real-World Impact of an In-House Dihydropyrimidine Dehydrogenase () Genotype Test on Fluoropyrimidine Dosing, Toxicities, and Hospitalizations at a Multisite Cancer Center.
PURPOSE
Fluoropyrimidine-related toxicity and mortality risk increases significantly in patients carrying certain genetic variants with standard dosing. We implemented genotyping at a multisite cancer center and evaluated its impact on dosing, toxicity, and hospitalization.
METHODS
In this prospective observational study, patients receiving (reactive) or planning to receive (pretreatment) fluoropyrimidine-based chemotherapy were genotyped for five variants as standard practice per provider discretion. The primary end point was the proportion of variant carriers receiving fluoropyrimidine modifications. Secondary end points included mean relative dose intensity, fluoropyrimidine-related grade 3+ toxicities, and hospitalizations. Fisher's exact test compared toxicity and hospitalization rates between pretreatment carriers, reactive carriers, and wild-type patients. Univariable and multivariable logistic regression identified factors associated with toxicity and hospitalization risk. Kaplan-Meier methods estimated time to event of first grade 3+ toxicity and hospitalization.
RESULTS
Of the 757 patients who received genotyping (median age 63, 54% male, 74% White, 19% Black, 88% GI malignancy), 45 (5.9%) were heterozygous carriers. Fluoropyrimidine was modified in 93% of carriers who started treatment. In 442 patients with 3-month follow-up, 64%, 31%, and 30% of reactive carriers, pretreatment carriers, and wild-type patients had grade 3+ toxicity, respectively ( = .085); 64%, 25%, and 13% were hospitalized ( < .001). Reactive carriers had 10-fold higher odds of hospitalization compared with wild-type patients ( = .001), whereas no significant difference was noted between pretreatment carriers and wild-type patients. Time-to-event of toxicity and hospitalization were significantly different between genotype groups ( < .001), with reactive carriers having the earliest onset and highest incidence.
CONCLUSION
genotyping prompted fluoropyrimidine modifications in most carriers. Pretreatment testing reduced toxicities and hospitalizations compared with reactive testing, thus normalizing the risk to that of wild-type patients, and should be considered standard practice.
Topics: Humans; Male; Female; Dihydrouracil Dehydrogenase (NADP); Middle Aged; Hospitalization; Prospective Studies; Genotype; Aged; Fluorouracil; Neoplasms; Antimetabolites, Antineoplastic; Cancer Care Facilities; Adult
PubMed: 38935897
DOI: 10.1200/PO.23.00623 -
PloS One 2024Understanding patient satisfaction is key to advancing pharmacy services and improving health outcomes. There is a lack of a translated and psychometrically validated...
Translation, cultural adaptation and validation of Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ) 2.0 into the Arabic language among people with diabetes.
BACKGROUND
Understanding patient satisfaction is key to advancing pharmacy services and improving health outcomes. There is a lack of a translated and psychometrically validated tool in the Arabic language to measure patient satisfaction with pharmacy services.
OBJECTIVE
To translate the English version of the PSPSQ 2.0 into Arabic language, culturally adapt, and verify its reliability and validity.
SETTING
A community pharmacy in Riyadh, Saudi Arabia.
METHOD
A cross-sectional study was conducted between April 2021 and June 2022 among patients with diabetes attending a community pharmacy. The International Society for Pharmacoeconomics and Outcomes Research good practice guidelines for linguistic translation and cultural adaptation were used to translate and culturally adapt the English version of PSPSQ 2.0 into Arabic. The Arabic version of PSPSQ 2.0 was subjected to factor analysis using principal component analysis with varimax rotation to evaluate its validity and Cronbach's alpha was used to assess the reliability of PSPSQ 2.0.
RESULTS
A total of 129 (68.2% male, and mean age 50 (SD: 11.9) years) patients with diabetes participated in the study. The analysis was undertaken for the items in each of the three domains of PSPSQ 2.0: quality of care, interprofessional relationship and overall care. Exploratory factor analysis revealed validity of 92.7%, 80.5% and 96.2%, respectively. The Arabic version of PSPSQ 2.0 had high internal consistency with Cronbach's alpha scores 0.99, 0.95 and 0.98 for the three measured domains, respectively. The sample adequacy was 0.924.
CONCLUSION
The PSPSQ 2.0 was successfully translated and culturally adapted into the Arabic language and had acceptable validity and reliability to measure patient satisfaction with services provided by pharmacists in community pharmacies.
Topics: Humans; Male; Female; Patient Satisfaction; Middle Aged; Surveys and Questionnaires; Diabetes Mellitus; Saudi Arabia; Language; Adult; Cross-Sectional Studies; Translations; Reproducibility of Results; Psychometrics; Pharmacists; Translating; Community Pharmacy Services
PubMed: 38935668
DOI: 10.1371/journal.pone.0298848 -
GeroScience Jun 2024Healthy Longevity Medicine aims to optimize health by targeting aging processes across the lifespan. Addressing accelerated aging involves adaptation of lifestyle and...
Healthy Longevity Medicine aims to optimize health by targeting aging processes across the lifespan. Addressing accelerated aging involves adaptation of lifestyle and the use of geroprotective drugs and supplements, including nutritional supplements and bioactive compounds. The Food and Drug Administration, under the Dietary Supplement Health and Education Act, categorizes bioactive compounds and medicinal products as dietary supplements. While numerous companies sell ingredients that can be deemed geroprotectors, there's limited oversight in their quality control. Governmental safety authorities only verify the presence of prohibited compounds, not the accuracy of ingredients listed on labels.Here, Nicotinamide mononucleotide and Urolithin A supplements, easily accessible online or in pharmacies, were tested for their active ingredient content. Results showed a significant deviation from the labeled amounts, ranging from + 28.6% to -100%. This indicates a considerable disparity in the quality of geroprotective supplements.To address this variability, collaboration between and within societies representing healthcare professionals, industry and regulatory bodies is imperative to ensure the quality of geroprotective supplements.
PubMed: 38935229
DOI: 10.1007/s11357-024-01257-2 -
Vaccines Jun 2024Community infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have increased rapidly since the emergence of the Omicron strain. During the eighth...
BACKGROUND
Community infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have increased rapidly since the emergence of the Omicron strain. During the eighth and ninth pandemic waves-when movement restrictions in the community were eased-the all-case registration system was changed, and the actual status of infection became uncertain.
METHODS
We conducted regular rapid antigen tests (R-RATs) once or twice a week as self-testing to examine the actual state of coronavirus disease (COVID-19) diagnosis among healthcare employees.
RESULTS
Overall, 320 (1.42/day) and 299 (1.76/day) employees were infected in the eighth and ninth pandemic waves. During both periods, 59/263 doctors (22.4%), 335/806 nurses (41.6%), 92/194 administrative employees (47.4%), and 129/218 clinical laboratory technicians (59.2%) were infected. In the eighth wave, 56 of 195 employees were infected through close contact; in the ninth wave, 26 of 62 employees were infected. No significant difference was observed in the number of vaccinations between infected and non-infected employees. The positivity rate of R-RATs was 0.41% and 0.45% in the eighth and ninth waves. R-RATs detected infection in 212 and 229 employees during the eighth and ninth waves, respectively; the ratio of R-RAT-detected positive employees to those who reported infection was significantly higher during the ninth wave (odds ratio: 1.67, 95% confidence interval: 1.17-2.37, < 0.001).
CONCLUSIONS
The number of infected healthcare employees remained high during the eighth and ninth pandemic waves in Japan. The R-RAT is considered effective for detecting mild or asymptomatic COVID-19 at an early stage and at a high rate in healthcare employees.
PubMed: 38932374
DOI: 10.3390/vaccines12060645 -
Molecules (Basel, Switzerland) Jun 2024Cannabis-based products have gained attention in recent years for their perceived therapeutic benefits (with cannabinoids such as THC and CBD) and widespread...
Cannabis-based products have gained attention in recent years for their perceived therapeutic benefits (with cannabinoids such as THC and CBD) and widespread availability. However, these products often lack accurate labelling regarding their cannabinoid content. Our study, conducted with products available in Portugal, revealed significant discrepancies between label claims and actual cannabinoid compositions. A fully validated method was developed for the characterisation of different products acquired from pharmacies and street shops (beverages, herbal samples, oils, and cosmetic products) using high-performance liquid chromatography coupled with a diode array detector. Linearity ranged from 0.4 to 100 µg/mL (0.04-10 µg/mg) (THC, 8-THC, CBD, CBG, CBDA, CBGA), 0.1-100 µg/mL (0.01-10 µg/mg) (CBN), 0.4-250 µg/mL (0.04-25 µg/mg) (THCA-A), and 0.8-100 µg/mL (0.08-10 µg/mg) (CBCA). Among sampled beverages, none contained detectable cannabinoids, despite suggestive packaging. Similarly, oils often differed from the declared cannabinoid compositions, with some containing significantly higher CBD concentrations than labelled. These inconsistencies raise serious concerns regarding consumer safety and informed decision-making. Moreover, our findings underscore the need for stringent regulation and standardised testing protocols to ensure the accuracy and safety of cannabis-based products.
Topics: Portugal; Cannabinoids; Cannabis; Chromatography, High Pressure Liquid; Humans; Cosmetics; Beverages; Medical Marijuana
PubMed: 38930803
DOI: 10.3390/molecules29122737 -
Materials (Basel, Switzerland) Jun 2024Packaging and packaging technology constitute a pivotal industry deeply intertwined with our daily lives and prevalent in various settings, including grocery stores,... (Review)
Review
Packaging and packaging technology constitute a pivotal industry deeply intertwined with our daily lives and prevalent in various settings, including grocery stores, supermarkets, restaurants, and pharmacies. The industry is constantly evolving thanks to technological advances. This article delves into the dynamic landscape of 3D printing in packaging, exploring its profound implications and potential. While this article highlights the advantages of traditional packaging approaches, it also highlights the many benefits of 3D printing technology. It describes how 3D printing enables personalization, rapid prototyping, and low-cost production, streamlining packaging design and manufacturing processes. Offering innovative solutions in design, functionality, and accessibility, the potential of 3D printing in packaging is promising.
PubMed: 38930366
DOI: 10.3390/ma17122997 -
International Journal of Environmental... May 2024Switzerland, a wealthy country, has a cutting-edge healthcare system, yet per capita, it emits over one ton of CO, ranking among the world's most polluting healthcare...
Switzerland, a wealthy country, has a cutting-edge healthcare system, yet per capita, it emits over one ton of CO, ranking among the world's most polluting healthcare systems. To estimate the carbon footprint of the healthcare system of Geneva's canton, we collected raw data on the activities of its stakeholders. Our analysis shows that when excluding medicines and medical devices, hospitals are the main greenhouse gas emitter by far, accounting for 48% of the healthcare system's emission, followed by nursing homes (20%), private practice (18%), medical analysis laboratories (7%), dispensing pharmacies (4%), the homecare institution (3%), and the ambulance services (<1%). The most prominent emission items globally are medicines and medical devices by far, accounting for 59%, followed by building operation (19%), transport (11%), and catering (4%), among others. To actively reduce Geneva's healthcare carbon emissions, we propose direct and indirect measures, either with an immediate impact or implementing systemic changes concerning medicine prescription, building heating and cooling, low-carbon means of transport, less meaty diets, and health prevention. This study, the first of its kind in Switzerland, deciphers where most of the greenhouse gas emissions arise and proposes action levers to pave the way for ambitious emission reduction policies. We also invite health authorities to engage pharmaceutical and medical suppliers in addressing their own responsibilities, notably through the adaptation of procurement processes and requirements.
Topics: Carbon Footprint; Switzerland; Delivery of Health Care; Greenhouse Gases; Humans; Carbon Dioxide; Air Pollutants
PubMed: 38928936
DOI: 10.3390/ijerph21060690 -
Foods (Basel, Switzerland) Jun 2024Dietary supplements containing red yeast rice (RYR), a fermentation product of the fungus grown on white rice, remain popular in Europe as proclaimed...
Dietary supplements containing red yeast rice (RYR), a fermentation product of the fungus grown on white rice, remain popular in Europe as proclaimed cholesterol-lowering aids. The cholesterol-lowering effects are due to the occurrence of monacolin K, which is often present as a mixture of monacolin K lactone (MK) and as monacolin K hydroxy acid (MKA). MK is structurally similar to the cholesterol-lowering medicine lovastatin. Recently, due to safety concerns linked to the use of statins, the European Commission prohibited RYR supplements with a maximum serving exceeding 3 mg of total monacolins per day. Moreover, the amount of the mycotoxin citrinin, potentially produced by , was also reduced to 100 µg/kg. Evidently, manufacturers that offer their products on the European market, including the online market, must also be compliant with these limits in order to guarantee the safety of their products. Therefore, thirty-five different RYR supplements, purchased from an EU-bound e-commerce platform or from registered online pharmacies, were screened for their compliance to the European legislation for citrinin content and the amount of total monacolin K. This was conducted by means of a newly developed LC-MS/MS methodology that was validated according to ISO 17025. Moreover, these supplements were also screened for possible adulteration and any contamination by micro-organisms and/or mycotoxins. It was found that at least four of the thirty-five RYR supplements (≈11%) might have reason for concern for the safety of the consumer either due to high total monacolin K concentrations exceeding the European predefined limits for total monacolins or severe bacterial contamination. Moreover, three samples (≈9%) were likely adulterated, and the labeling of six of the seventeen samples (≈35%) originating from an EU-based e-commerce platform was not compliant, as either the mandatory warning was missing or incomplete or the total amount of monacolins was not mentioned.
PubMed: 38928859
DOI: 10.3390/foods13121919 -
Genes Jun 2024Galectins are innate immune system regulators associated with disease progression in cancer. This paper aims to investigate the correlation between mutated...
Galectins are innate immune system regulators associated with disease progression in cancer. This paper aims to investigate the correlation between mutated cancer-critical genes and galectin levels in breast cancer patients to determine whether galectins and genetic profiles can be used as biomarkers for disease and potential therapy targets. Prisma Health Cancer Institute's Biorepository provided seventy-one breast cancer samples, including all four stages spanning the major molecular subtypes and histologies. Hotspot mutation statuses of cancer-critical genes were determined using multiplex PCR in tumor samples from the same patients by Precision Genetics and the University of South Carolina Functional Genomics Core Facility. The galectin-1, -3, and -9 levels in patients' sera were analyzed using Enzyme-linked Immunosorbent Assay (ELISA). An analysis was performed using JMP software to compare mean and median serum galectin levels between samples with and without specific cancer-critical genes, including pooled -test, Wilcoxon Rank Sum Test, ANOVA, and Steel Dwass Test (α=0.05). Our analysis indicates that mutations correlate with elevated serum levels of galectin-9 in patients with breast cancer. In patients with Luminal A subtype, mutation correlates with lower serum galectin-1 and -9 levels and mutations correlate with higher serum galectin-3 levels. Patients with invasive ductal carcinoma had significantly higher serum galectin-3 levels than patients with ductal carcinoma in situ. Patients with both and mutations exhibit elevated serum galectin-3 levels, while patients with one or neither mutation show no significant difference in serum galectin-3 levels. In addition, metastatic breast cancer samples were more likely to have a or mutation compared to primary breast cancer samples. The relationship between genetic mutations and galectin levels has the potential to identify appropriate candidates for combined therapy, targeting genetic mutations and galectins. Further understanding of the effect of genetic mutations and galectin levels on cancer progression and metastasis could aid in the search for biomarkers for breast cancer diagnosis, disease progression, and prognosis.
Topics: Humans; Breast Neoplasms; Female; Galectins; Mutation; Biomarkers, Tumor; Galectin 1; Middle Aged; Galectin 3; Adult; Blood Proteins
PubMed: 38927753
DOI: 10.3390/genes15060818 -
Antibiotics (Basel, Switzerland) Jun 2024Antimicrobial resistance (AMR) is a major public health threat linked to increased morbidity and mortality. It has the potential to return us to the pre-antibiotic era....
Antimicrobial resistance (AMR) is a major public health threat linked to increased morbidity and mortality. It has the potential to return us to the pre-antibiotic era. Antimicrobial stewardship (AMS) programs are recognized as a key intervention to improve antimicrobial use and combat AMR. However, implementation of AMS remains limited in Africa, particularly in Rwanda. This study aimed to assess prescription practices, identify areas for improvement, and promote adherence to AMS principles. Conducted at King Faisal Hospital in Rwanda, this qualitative study used semi-structured interviews with eight participants until saturation was reached. The interviews were recorded, transcribed, and thematically analyzed, revealing four emerging themes. The first theme was on AMS activities that were working well based on availability of microbiology laboratory results and prescription guidelines as factors influencing antibiotic prescription adjustments. The second theme was related to challenges during the implementation of the AMS program, including the prescription of broad-spectrum antibiotics, limited local data on AMR patterns, and stock-outs of essential antibiotics. The third theme was on the importance of adhering to AMR management guidelines at KFH. The last emerged on recommendations from participants centered on regular training for healthcare workers, widespread dissemination of AMR findings across departments, and the enforcement of antibiotic restriction policies. These actions can improve prescription behaviors, upholding the highest standards of patient care, and strengthening the nascent AMS program.
PubMed: 38927214
DOI: 10.3390/antibiotics13060548