Search Results (2,240)

Cytisine is a plant-derived quinolizidine alkaloid found, among other sources, in the seeds of the common laburnum (Laburnum anagyroides). It has properties that enable it to act as a partial agonist of brain nicotinic α4β2 receptors, which play a key role in the development and maintenance of nicotine addiction. Clinical studies have shown that cytisine is a more effective smoking cessation aid than nicotine replacement therapy and at least as effective as varenicline in treating tobacco cigarette addiction. It may also be an effective agent in treating addiction to electronic cigarettes. Cytisine is also significantly cheaper than other anti-nicotine medications. This is of great importance for the population of smokers in developing countries, who cannot afford anti-nicotine treatment. In recent years, the role of cytisine in the pharmacotherapy of nicotine addiction worldwide has increased significantly. This drug is becoming available in an increasing number of countries, and in 2025 the World Health Organization (WHO) added cytisine to the list of essential medicines. The need for further development of the drug poses additional challenges for scientists, including the creation of new pharmaceutical forms, optimization of dosing regimens, and expansion of indications to include the treatment of nicotine addiction supplied into the body in forms other than traditional tobacco products. This review describes the use of cytisine in the treatment of nicotine addiction, the drug’s mechanism of action, pharmacokinetics, efficacy, safety of use, and the available pharmaceutical preparations. It also presents research directions on cytisine related to the development of innovative pharmaceutical products, new dosing regimens, and new indications associated with the treatment of addiction to various nicotine-containing products. Conclusions indicate that cytisine has a difficult dosing regimen, which is why patients do not adhere to it, limiting the effectiveness of the therapy. This necessitates optimizing the dosage of existing capsules and tablets or introducing, for example, new extended-release forms of the drug containing cytisine. Full article

Background/Objectives: Dravet Syndrome (DS) is a severe form of epilepsy that typically manifests in the first year of life and often requires polytherapy with two or more antiseizure medications (ASMs) to achieve adequate seizure control. Whereas the combination of stiripentol (STP) and cannabidiol (CBD) has demonstrated clinical efficacy, it presents significant formulation challenges due to the low aqueous solubility and poor oral bioavailability of both compounds. Furthermore, the high daily dosages of STP (approximately 50 mg/kg/day or higher) and the oily nature of conventional CBD formulations often hinder patient compliance, as pediatric patients frequently reject these treatments due to unfavorable organoleptic properties. Methods: Nanostructured lipid carriers (NLCs) containing STP and CBD suspended in an aqueous medium were developed. The formulation was optimized using Response Surface Methodology (RSM) and subjected to comprehensive in vitro and in vivo characterization. Results: The optimized formulation exhibited a mean particle size of 175.3 nm, a polydispersity index (PDI) of 0.232, a zeta potential of −8.35 mV, and an encapsulation efficiency greater than 99% for both drugs. Physicochemical characterization via atomic force microscopy, differential scanning calorimetry, thermogravimetric analysis, X-ray diffraction, and Fourier transform infrared spectroscopy revealed spherical nanoparticles without aggregation, with the drugs molecularly dispersed within the lipid matrix. Both STP and CBD showed sustained release profiles and demonstrated oral pharmacokinetic profiles that were comparable or superior to current commercial products. Conclusions: This novel formulation represents a promising therapeutic alternative for DS, enabling the co-administration of STP and CBD while potentially enhancing CBD bioavailability and treatment adherence in pediatric populations. Full article

Background/Objectives: As use of large language models (LLMs) in clinical practice, in medical education, and by patients increases, it is essential to ensure that information provided is accurate and safe. Our objective was to compare stage two hypertension treatment plans generated by popular LLMs. Methods: ChatGPT (GPT-4o), Claude (Claude 4 Sonnet), ClinicalKey AI, Microsoft Copilot (Wave 2), DeepSeek-V3-0324, Dyna AI, Google Gemini (2.5 Flash), Grok (version 3), Meta AI assistant (Llama 4 Maverick), OpenEvidence (version 2.0), Perplexity (Sonar backend model), and Pi (Inflection-2.5) were prompted to generate a treatment plan for stage two hypertension. Six blinded reviewers scored each response in three domains: adherence to clinical guidelines, detail/clarity, and reliability/safety. Results: Perplexity received the highest composite score (8.17 out of 9), followed by OpenEvidence (7.92 out of 9). Dyna AI had the lowest overall score (3.75 out of 9). Perplexity (3.00 out of 3), Grok (2.83 out of 3), and OpenEvidence (2.75 out of 3) had the highest scores for detail/clarity, while Dyna AI had the lowest for both detail/clarity (1.00 out of 3) and reliability/safety (1.00 out of 3). ChatGPT had the highest score for adherence to guidelines (2.75 out of 3) while Pi had the lowest (1.58 out of 3). Kruskal–Wallis test showed p < 0.05 across sub-score domains and composite scores. Conclusions: LLMs tended to adhere to clinical guidelines and provide detailed responses but often did not provide sources or instruct users to see a healthcare professional. There was notable variability in quality, and medicine-specific LLMs were not superior to popular LLMs. Full article

Background/Objectives: Nurses and dialysis technicians are primarily responsible for cannulation in in-center and satellite dialysis units. Despite being a core component of hemodialysis care, existing clinical guidelines offer limited standardization, resulting in practice variability across facilities. Therefore, clinical expertise and adherence to consistent standards are essential to ensure safe and effective vascular access management. The study aimed to investigate the variables related to patients and nurses that contribute to unsuccessful vascular access cannulations, as well as the actions taken in response to cannulation failure, in a tertiary dialysis center in the Eastern Region of Saudi Arabia. Methods: This retrospective analytic study reviewed the records of 228 adult hemodialysis patients at King Fahad Military Medical Complex from 2020 to 2024, analyzing demographic, clinical, vascular access, and nursing variables associated with cannulation failure using descriptive statistics, the chi-square test, and t-tests. Ethical approval was obtained, and data were de-identified and manually extracted from nursing and dialysis documentation. Results: Most patients had hypertension and diabetes, with significant comorbidity burdens. Infiltration (61%) and clot formation (30.7%) were the primary complications of cannulation failure. Significant associations emerged with recurrent stroke and peripheral vascular disease, but not with nurse or patient demographics, suggesting vascular factors outweigh staff variables in cannulation risk. Cannulation failures were most common in patients with vascular comorbidities, while staff experience and education had no significant impact. Conclusions: Recommendations include implementing tailored protocols, providing ongoing nurse education, conducting systematic vascular assessments, and holding regular team reviews to enhance access outcomes and patient safety. Full article

Background/Objectives: The guideline targets for blood pressure (BP), hemoglobin A1c (HbA1c), and low-density lipoprotein cholesterol (LDL-C) are frequently unmet, and physicians often misjudge control. This study aimed to characterize the real-world control of BP, HbA1c, and LDL-C in patients with type 2 diabetes (T2D) and hypertension, herein called cardiometabolic multimorbidity (CMM), and to compare guideline-based versus physician-perceived disease control. Methods: We conducted SNAPSHOT–Brazil, a nationwide, multicenter, cross-sectional study to gather real-world data on patients with CMM. The ESC guidelines defined the cardiovascular (CV) risk and control targets. Results: We included 451 patients with hypertension and T2D (median age 65 years; 60% female; 54% White). Most patients (98%) were on pharmacotherapy and reported high adherence (according to the Hill–Bone Medication Adherence Scale). A very high CV risk predominated (78%); 22% of the patients were at a high risk. The guideline-defined control was achieved in 27% for BP, 34% for HbA1c, 13% for LDL-C, and 6% for both BP and LDL-C; only 3% met all three targets simultaneously. The physicians accurately stratified the CV risk in 49% of patients, while 50% had their CV risk underestimated. They systematically overestimated control in 29% of cases for BP, 35% for LDL-C, and 25% for both. The sensitivity ranged from 0.88 to 0.98; the positive predictive values ranged from 0.19 to 0.48, and the positive likelihood ratios ranged from 2.16 to 3.65. Conclusions: The SNAPSHOT–Brazil study revealed a low attainment of BP, HbA1c, and LDL-C targets, despite the widespread pharmacotherapy and the high self-reported adherence. The physicians consistently overestimated disease control and underestimated the CV risk. Full article

Background and aim: Celiac disease (CD) is a systemic autoimmune disorder triggered by gluten ingestion, and the only effective treatment is strict adherence to a gluten-free diet (GFD). Many factors, including limited dietary diversity and poor adherence, are associated with an increased risk of specific micronutrient deficiencies and malnutrition. This study aims to evaluate the relationship between adherence to GFD, celiac antibody levels, micronutrient levels, and nutritional status in children with CD. Methods: This retrospective study was conducted on 402 children aged 2–18 years with a diagnosis of CD confirmed positive by anti-tTG IgA and duodenal biopsy, all of whom had been on GFD for at least six months. Demographic, anthropometric, clinical, serological, and biochemical data (including hemogram, serum iron, ferritin, vitamin D, folate, and B12 levels), and GFD adherence were collected from medical records. Results: Most individuals are girls (64.9%), with a mean age of 10.6 ± 4.20 years. Chronic malnutrition was observed in 29.4% of patients. Acute malnutrition was identified in 27.8% of children, and wasting was observed in 6.7%. Iron deficiency anemia was the most frequently encountered micronutrient deficiency among the patients (23.9%). The prevalence of stunting was significantly higher among individuals with positive tTG-IgA levels and poor adherence to the GFD. Conclusions: Poor adherence to the GFD and positive tTG-IgA levels were associated with higher rates of stunting, underlining the need for individualized dietary follow-up and regular monitoring of both nutritional status and serological response in children with CD. Full article

Background/Objectives: Continuous glucose monitoring (CGM) has transformed diabetes management by enabling high-resolution assessment of glucose dynamics, with well-established use in type 1 diabetes (T1D) and insulin-treated type 2 diabetes (T2D), and expanding applications across broader populations, including non-insulin-treated T2D and gestational diabetes. However, real-world implementation remains constrained by economic barriers, fragmented reimbursement, workflow challenges, and limited capacity for continuous data interpretation. This review examines key barriers to CGM implementation and synthesizes current evidence on pharmacist-integrated CGM care as an emerging model to support CGM adoption across clinical and community-based settings. Methods: A narrative literature review was conducted to synthesize evidence on pharmacist-integrated CGM services in diabetes care. Literature was identified through structured searches of PubMed, Embase, and the Cochrane Library, supplemented by Google Scholar and citation tracking, covering publications from January 2010 to December 2025. Studies were selected based on predefined criteria, including those reporting clinical outcomes, pharmacist involvement, or health system and implementation factors related to CGM use. Relevant survey-based and real-world studies were also considered to capture healthcare professionals’ perspectives and implementation experiences. Evidence was synthesized thematically across clinical, behavioral, and health system domains. Results: Available evidence suggests that pharmacist-integrated CGM care is associated with improvements in glycemic management, including increased time in range, reduced glycemic variability, and more timely pharmacotherapy optimization. Pharmacist involvement may also support patient education, self-management, and engagement with digital health technologies, and facilitate ongoing data interpretation and treatment adjustment between clinical encounters. However, evidence remains heterogeneous and geographically limited, with predominantly retrospective and pilot studies and few randomized trials, constraining the robustness and external validity of the findings. Further studies are needed to confirm its clinical effectiveness, comparative effectiveness, and economic value. Conclusions: Pharmacist-integrated CGM represents a promising and operationally feasible approach to supporting CGM use in routine diabetes care. While current evidence indicates potential benefits in glycemic management and care delivery processes, further research and implementation efforts are required to support its effective and sustainable adoption across diverse healthcare settings. Full article

Background: Cardiovascular disease (CVD) represents the second leading cause of death among kidney transplant recipients (KTRs). CVD risks post-transplantation increase with aging, obesity, dyslipidemia, diabetes, hypertension, inactivity, sleep disturbances, immunosuppressant medications use, and graft dysfunction. This study assessed CVD prevalence and risk factors among KTRs. Methods: A cross-sectional study was conducted at National Guard Hospital, Jeddah between 2012–2022. Information was collected from the patients’ medical records. Physical activity, sleep, and adherence to immunosuppressant therapy were evaluated via interviews with adult KTRs using the International Physical Activity Scale, Jenkins Sleep Scale, and Immunosuppressant Therapy Barrier Adherence Scale, respectively. Results: Sixty-four KTRs were included: 67% were males, and the median age was 44.7 years. Eighteen patients (28.1%) had CVD, and 61.1% of them developed ischemic heart disease. KTRs with CVD were older, had lower estimated glomerular filtration rate (eGFR), and higher Hemoglobin A1c (HbA1c), but these differences were not statistically significant (p > 0.05). Patients with CVD had significantly lower LDL (p = 0.02) and more aspirin and statin use (p < 0.05). Forty-five patients (70.3%) completed the interview; most of them had few sleep disturbances and good adherence to immunosuppressant therapy. Low physical activity was reported by KTRs with CVD. Conclusions: CVD was present in over one-quarter of KTRs. Patients with CVD were older, less active, had lower GFR, higher HbA1c, and significantly lower LDL. More use of aspirin and statin improved the glycemic control, physical activity, and medication adherence, and may help in reducing CVD burden among KTRs. Full article

Background/Objectives: Therapeutic adherence to asthma and COPD medications remains worryingly low and varies widely across patient groups, underscoring persistent challenges in chronic respiratory care. The aim of this nationwide study is to quantify real-world adherence and to identify its demographic and clinical determinants using the Belgian health care claims database of the National Institute for Health and Disability Insurance (NIHDI). Methods: Adherence was assessed using the Continuous Multiple Interval Measure of Medication Availability (CMA) among patients treated between 2020 and 2023. Mixed-effects logistic regression was applied to identify determinants of adherence. Results: Only 30.5% of patients achieved good adherence (CMA ≥ 0.8). Adherence varied substantially across pharmacological classes, ranging from 8.1% for inhaled corticosteroids to 66.4% for triple therapy. Age emerged as a major determinant, with adherence increasing steadily across age groups: only 4.0% of children and 15.7% of adolescents reached good adherence, compared with progressively higher rates in adults. Mixed-effects logistic regression confirmed age, sex, and pharmacological class as robust predictors of adherence. Conclusions: These findings highlight the magnitude of the therapeutic adherence gap in chronic respiratory diseases and clearly identify children, adolescents, and ICS or LABA + ICS users as the highest-risk groups. Recognizing these profiles has direct implications for clinical practice, as it provides concrete targets for future patient-centered interventions and guideline-concordant adherence-enhancing strategies. Full article

Background/Objectives: Dental Practice-Based Research Networks (DPBRNs) bridge the gap between academic research and private dental practice, addressing questions relevant to everyday medical care. Despite their growing scientific output, little research has explored the experiences of practitioners engaged in these networks. Our study therefore aims to investigate these practitioners’ perspectives in order to identify strategies for improving investigator recruitment, training and data quality in future DPBRN studies. Methods: The qualitative methodology was chosen, and our study adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines. Semi-structured interviews were conducted with dentists who had participated in a DPBRNs study and transcribed before being thematically analysed using Braun and Clarke’s framework. MaxQDA 2022 software was used to facilitate coding of the verbatim quotes. Results: Three major themes emerged: (1) obstacles to participation, including time constraints, difficulties in patient recruitment, and a perceived disconnect between academia and private practice; (2) facilitators of engagement, such as strong leadership, logistical support, and a collaborative research environment; and (3) personal benefits, such as skill development, breaking professional routines, and counteracting stereotypes about private practitioners’ involvement in research. Conclusions: The findings align with existing literature on medical Practice-Based Research Networks (PBRNs), highlighting logistical and motivational barriers while also emphasizing the importance of social and professional benefits. Notably, although financial compensation or credits for continuing professional development are frequently cited as motivators for research participation, these were not significant concerns for our participants. This study sheds light on the experiences of health practitioners in PBRNs, offering recommendations to overcome challenges through strategies such as accessible training, practical incentives and collaboration opportunities. Full article

Background/Objectives: This study aimed to assess the feasibility and acceptability of a 3-month health coaching intervention to promote PNF and healthy diet for men on ADT for PCa. Methods: The study was carried out via a two-armed randomized controlled trial including 40 patients with PCa at a medical center in Philadelphia. During the 3-month period, the intervention group (PNF+) received health coaching utilizing an interactive text message system, and the control group received healthy eating text messages for the same duration. The outcome variables were feasibility and acceptability. Results: The PNF+ group (n = 27) had high adherence to health coaching (82%), picture response (85%) and moderate adherence to the PNF window (69%). The intervention was rated highly acceptable with no reported A/E associated with the intervention, and most participants planning to continue in some capacity. At 3 months, the PNF+ group had numerically lower BMI (29.1) and body weight (195.2 lbs) compared to the control group (n = 13; BMI 31.6, weight 223.3 lbs). Improvements in patient-reported outcomes were observed in both groups. FACIT-F scores (higher scores indicate less fatigue) increased in the PNF+ group (43.6 to 45.2) and in the control group (42.5 to 45.5). FACT-P scores (higher scores indicate better quality of life) increased in the PNF+ group (121.3 to 125.5) but decreased slightly in the control group (121.1 to 119.8). Between-group comparisons of change from baseline showed no statistically significant differences across outcomes (all p > 0.05). Conclusions: The intervention demonstrated partial feasibility and high acceptability. It was associated with numerically lower BMI and body weight and favorable changes in patient-reported outcomes, particularly quality of life; however, no statistically significant differences were observed between groups. These findings should be interpreted cautiously given the small sample size and require confirmation in larger, adequately powered trials. Full article

Background: Studies on the clinical presentation of eosinophilic esophagitis and its outcome in children in the Middle East and North African region are scarce. The aim of this 10-year retrospective study was to describe the common clinical manifestations, endoscopic and histological findings, and the response to medication and dietary intervention in children and adolescents with eosinophilic esophagitis. Methods: This study was a retrospective chart review of patients aged 6 months to 18 years who attended the Pediatric Gastroenterology clinic at the American University of Beirut Medical Center between 1 January 2013 and 30 June 2023 and who were diagnosed with eosinophilic esophagitis. Results: A total of 15 patients met the inclusion criteria. The median age at diagnosis was 9 years. Male patients accounted for 73% of our cohort. The most frequent presenting symptoms were dysphagia (80%) and choking (47%). The esophagus appeared normal in 33% of subjects despite histologic confirmation of disease, highlighting the importance of routine biopsies. Adherence to therapy was variable, with 73% of subjects reporting symptom improvement following initial therapy, even in cases where histology remained active. This pattern suggests that symptomatic improvement alone may not reliably reflect disease control and underscores the importance of objective monitoring through follow-up biopsy. Conclusions: The recognition of manifestations of eosinophilic esophagitis in children, early diagnosis, and strict adherence to the diet and medication are essential to prevent long-term complications. In a resource-constrained country like Lebanon, the management remains challenging in view of the burden of dietary restrictions and high cost of procedures and biologics. Socioeconomic feasibility and long-term adherence to diet and medication is as critical as pharmacologic efficacy in determining outcomes in pediatric patients. Full article

Surgical wards constitute a significant contributor to global medical waste (MW), accounting for over one-third of total healthcare sector trash. Medical interventions produce hazardous, infectious, and potentially toxic byproducts, making effective MW management crucial, especially where current mechanisms are insufficient. Substantial disparities persist between high-income and low- and middle-income countries regarding MW infrastructure, enforcement, and adoption of safe, sustainable treatment technologies. Proper segregation, recycling, treatment, and disposal are key to protecting public health, environmental integrity, and promoting healthcare sustainability. Waste treatment technologies divide into thermal and physico-chemical processes, requiring thorough evaluation of advantages, disadvantages, and suitability for each waste type. This narrative review updates MW knowledge by synthesizing data from scientific literature, institutional documents, and regulatory sources. Key quantitative data indicate operating rooms generate up to 30% of total hospital waste, with recyclable materials representing over 40% of that volume. Improper segregation rates remain high, and incineration remains dominant despite sustainability concerns. The Romanian case study highlights progressive EU alignment, enforcing standardized MW classification, color-coded segregation, and specialized disposal protocols in surgical wards. Despite legal compliance, Romania is advancing incrementally, with systematic audits, digital tracking, and national outcome-based evaluations yet to be fully established. The Plastic Surgery Unit at Oradea County Emergency Clinical Hospital demonstrates good protocol adherence; however, strengthening data feedback mechanisms would enhance hospital-wide performance optimization and strategic waste reduction. Training and monitoring represent important areas for continued development. Coordinated professional engagement, modernized infrastructure, and enforceable audits are identified as critical priorities for improving MW handling in surgical environments. Future research should emphasize management innovation, evidence-based policy formulation, and a systematic strategy to achieve sustainable MW. Full article

Introduction/Objectives: Although contemporary guidelines strongly support intensive low-density lipoprotein cholesterol (LDL-C) lowering and the use of advanced lipid biomarkers for cardiovascular risk stratification, implementation in daily clinical practice remains inconsistent. This study aimed to assess current practices, knowledge, and perceived barriers in dyslipidemia management across medical specialties. Methods: We conducted a cross-sectional, anonymous online survey from August to September 2025 among physicians actively involved in lipid management. The questionnaire evaluated the use of Systematic Coronary Risk Evaluation 2 (SCORE2)-based risk assessment, familiarity with LDL-C targets, treatment intensification strategies, awareness and use of apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)], perceived barriers to LDL-C goal attainment, and responses to a standardized clinical vignette. Descriptive analyses and chi-square testing were conducted. Results: Ninety-five physicians completed the survey, the majority practicing in Europe (92.7%), including 83.2% from Portugal (41.1% general practice/family medicine; 14.7% cardiology; 14.7% internal medicine/geriatrics; 14.7% vascular surgery; 9.5% endocrinology). SCORE2 calculators were used “often” or “always” by 52.6%, with significant inter-specialty variation (p < 0.001). Familiarity with LDL-C targets was high (76.8%), and 89.4% reported frequent therapy intensification when goals were not achieved; however, consistent escalation (“always”) differed markedly across specialties (p < 0.001). Although 69.5% were aware of recommendations for lifetime assessment of apoB/non–HDL-C/Lp(a), only 17.9% implemented them routinely. Most clinicians reported never or rarely using advanced biomarkers for residual risk assessment, and in a clinical vignette only 12.6% would consistently intensify therapy despite elevated Lp(a) and apoB (p = 0.004). Patient non-adherence (86.3%) was the most frequently perceived barrier. Conclusions: Despite the widespread awareness of LDL-C targets, important gaps persist in the consistent application of guideline-directed therapy and in the use of advanced biomarkers. The underutilization of apoB and Lp(a), together with therapeutic inertia and structural barriers, limits effective residual risk management. Bridging this gap will require coordinated efforts focused on implementation, access, and multidisciplinary care. Full article

Background/Objectives: Despite demonstrated mortality benefits, annual low-dose computed tomography (LDCT) screening faces challenges in real-world adoption due to low uptake and poor longitudinal adherence. This review evaluates patient- and provider-level factors that influence screening participation and highlights strategies to strengthen equitable engagement throughout the screening pathway. Methods: A structured literature search of PubMed and Web of Science was performed to identify studies published between 2013 and November 2025 (search conducted on 25 November 2025). Eligible publications included qualitative and quantitative studies, study protocols, and reviews examining LDCT screening uptake, adherence, and follow-up practices. Extracted evidence was synthesized, with particular attention being paid to patient- and provider-level determinants. Results: The evidence demonstrates that both patient- and provider-level factors substantially influence screening participation and continuity. At the patient level, limited awareness of screening, misconceptions regarding asymptomatic disease, and psychosocial factors such as fear, fatalism, stigma, and medical mistrust were consistently associated with reduced uptake and adherence. At the provider level, gaps in guideline familiarity, time constraints, and challenges in delivering high-quality shared decision-making limited referrals and follow-up. Conclusions: Improving real-world effectiveness of LDCT lung cancer screening requires reframing screening as a longitudinal program of care. Strategies that support patient navigation, enhance provider capacity for sustained engagement, and integrate tobacco dependence treatment into screening pathways are central to improving adherence and reducing disparities. Full article