Search Results (477)

Background: Hormone receptor-positive (HR+), Human Epidermal growth factor Receptor 2 (HER2-negative) metastatic breast cancer (MBC) represents a substantial proportion of breast cancer cases in Saudi Arabia. Despite the established efficacy of cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, particularly Palbociclib, in randomized control trials, real-world data from local institutions in Saudi Arabia remain limited. Objectives: This study aimed to evaluate progression-free survival (PFS), overall survival (OS), and toxicity profile among HR+, HER2-negative MBC female patients treated with Palbociclib at King Fahad Medical City (KFMC). Methods: A retrospective study was conducted on female patients with HR+/HER2-negative MBC treated with oral palbociclib combined with endocrine therapy (ET) at KFMC between January 2021 and September 2024. Data were collected from electronic health records. Descriptive statistics were conducted using mean for continuous variables and frequency for categorical variables. Survival analyses were conducted using Cox regression, log-rank tests and Kaplan–Meier analysis. Results: A total of 169 female patients with HR+/HER2− MBC were included. In the first-line setting, the median PFS was 20.14 months (95% CI: 14.65–30.49), compared with 11.3 months (95% CI: 7.98–not estimable) in the second-line setting. For OS, the median OS values were 53.1 months (95% CI: 41.2–not estimable) in the first-line group and 23.7 months (95% CI: 18.5–not estimable) in the second-line group. Significant predictors of shorter PFS included age, Body Mass Index (BMI), type of ET, cancer type, line of therapy, family history of cancer, and history of VTE. Visceral metastasis (HR = 3.087; p = 0.0229) and ECOG performance status of 4 (HR = 13.86; p = 0.0156) were associated with significantly shorter OS. The most common hematological adverse events (AEs) were neutropenia (45.6%), followed by anemia (5.9%), leukopenia (5.3%), and back pain (5.3%). Most toxicities were managed with dose reduction, holding treatment, or supportive care. Conclusions: Palbociclib demonstrated favorable survival outcomes and a manageable safety profile, with neutropenia being the most common AE. This study provides region-specific real-world evidence supporting the use of Palbociclib in HR+/HER2− MBC. These findings align with global trial data and highlight the importance of individualized treatment in clinical practice. Full article

Sensitisation leading to food allergy may occur through the skin. Quantitative data on epidermal allergen penetration as a prerequisite for this remain limited. This study quantifies epidermal penetration of gluten and hydrolysed wheat protein (HWP) in 18 patients with challenge-confirmed WALDA (wheat allergy dependent on augmentation factors) and 12 healthy controls (HC). After 1 h of epicutaneous wheat application, 20 consecutive tape strips (TS) were collected, and wheat protein concentration was quantified by gliadin-specific ELISA. Skin barrier status was assessed by electrical impedance spectroscopy (EIS). Serum gliadin levels were measured before and 90 min after wheat application. Gliadin was detected across all TS layers for gluten and HWP. Penetration levels did not differ between patients and controls. Skin barrier status assessed by EIS did not differ significantly between individuals with and without a history of atopic dermatitis (p = 0.27). No correlation was observed between EIS-assessed skin barrier status and gliadin penetration. Serum gliadin was not increased after epicutaneous wheat application. This study using TS demonstrates for the first time that wheat allergens penetrated into the epidermis but could not be detected in the serum. Neither wheat allergy nor skin barrier status was associated with increased stratum corneum penetration. These findings suggest that epidermal uptake alone may not be sufficient to explain sensitisation. Full article

Viral hemorrhagic fevers (VHFs) comprise a heterogeneous group of severe infectious diseases that continue to represent a major global health concern. Although many VHFs remain endemic to regions of Africa, Asia, and the Americas, their wide geographic distribution, together with increasing international travel and global trade, facilitates the importation of cases into non-endemic areas and raises the risk of secondary transmission under favorable ecological and epidemiological conditions. These infections are frequently associated with high case-fatality rates and impose a substantial social and economic burden, including pressure on healthcare systems, disruption of essential services, and long-term physical and psychological sequelae among survivors. Despite notable advances in recent years, therapeutic options for VHFs remain limited. Supportive care continues to represent the cornerstone of clinical management for most infections, while pathogen-targeted therapies are available only for a restricted number of diseases. Monoclonal antibody-based therapies have achieved the most significant regulatory success to date, particularly for Ebola virus disease. In parallel, several small-molecule antivirals have been investigated in preclinical and clinical settings, including during outbreak responses, although inconsistent efficacy and safety concerns have limited widespread approval. Vaccine development has progressed further, with licensed vaccines available for selected VHFs, including Ebola, yellow fever, and dengue, and multiple candidates based on diverse technological platforms advancing through clinical evaluation. In addition to summarizing current therapeutic and vaccine strategies, this review highlights pharmaceutical development considerations relevant to biologic therapeutics and selected vaccine platforms, including formulation stability, pharmacokinetic behavior, delivery routes, storage requirements, and logistical constraints affecting deployment during outbreak responses. Using a comparative cross-pathogen framework, the review synthesizes recent literature to identify translational gaps, regulatory challenges, and future priorities for the development of safer and more effective medical countermeasures against VHFs. Full article

Ensuring uninterrupted access to essential medicines in public healthcare systems is a persistent challenge with clinical, economic, and environmental implications. Oncology services are particularly vulnerable to stockouts, which compromise therapeutic continuity and increase reliance on urgent procurement with high carbon and waste footprints. This study proposes a risk-informed, data-driven framework for pharmaceutical inventory governance in a high-complexity public oncology hospital in Chile, aligning with sustainability goals and green supply chain principles. Using operational data from 2023–2024, we integrate descriptive analytics, ABC–XYZ segmentation, and a continuous-review (s, Q) policy extended through a Logistic Risk Index (LRI) that consolidates demand variability, supply performance, and clinical-economic criticality. Empirical analysis reveals strong expenditure concentration in AX/AY segments and significant misalignment between institutional and analytically derived parameters. A Monte Carlo simulation N = 1000 runs per scenario) compares baseline, adjusted, and fully risk-informed policies under stochastic demand and lead-time conditions. Results show that the risk-informed configuration reduces stockout exposure by up to 46%, improves fill rates (93.1% → 96.4%), and shortens replenishment delays, while maintaining total logistic cost stability. Critically, urgent orders decrease from 27.4 to 14.8 per year, avoiding an estimated 630 kg CO₂ emissions and 25 kg of packaging waste annually. These findings demonstrate that resilience, efficiency, and sustainability are not competing objectives but can be jointly achieved through integrated analytics and governance. The proposed approach offers a scalable blueprint for public health systems seeking to transition from reactive inventory management toward anticipatory, transparent, and sustainability-oriented decision-making, contributing to SDG 3 (health and well-being) and SDG 12 (responsible consumption and production). Full article

Background: Medication use in paediatric populations is inherently complex and carries a heightened risk of prescribing errors, particularly within primary health-care settings. Despite this concern, evidence describing paediatric prescribing errors in Saudi Arabia remains scarce. Hence, the present study aimed to evaluate the prevalence and patterns of prescribing errors in paediatric primary care and to characterize the pharmacist-led interventions undertaken to resolve these errors. Methods: A prospective, mixed-methods cross-sectional study was conducted over three months at a primary health-care centre. Paediatric outpatient prescriptions were systematically reviewed during routine practice by trained clinical pharmacists. All suspected errors were independently validated and classified for severity by a multidisciplinary expert panel. Descriptive statistics were used to summarise prescribing errors, and associations with patient and prescription characteristics were assessed using chi-square tests. Qualitative data were analysed using a descriptive thematic approach to explore mechanisms of error identification and the nature of corrective pharmacist interventions. Results: A total of 545 paediatric outpatient prescriptions were reviewed, of which 142 prescriptions (26.1%) contained at least one prescribing error. Across these prescriptions, a total of 145 individual prescribing errors were identified. Dose-related errors were the most common (68.3%), followed by inaccuracies in dosing frequency (11.0%) and inappropriate drug selection (9.0%). The occurrence of prescribing errors was significantly associated with patient weight (p = 0.016), the number of medications per prescription (p < 0.001), and the recorded diagnosis (p = 0.018). The majority of errors were intercepted prior to medication dispensing (93.0%), and no cases of patient harm were identified. Qualitative analysis revealed that errors were predominantly detected through cross-checking with authoritative drug references, recalculation of weight-based doses, and application of clinical judgement, and were most often resolved through direct communication with the prescribing clinician. Conclusions: Prescribing errors occur frequently in paediatric outpatient settings; however, most are preventable with appropriate safeguards. Pharmacists play a critical role in identifying and resolving these errors before they result in patient harm. Enhancing paediatric prescribing support systems and strengthening interprofessional collaboration may further advance medication safety within primary health-care services. Full article

Background: Limitations in timely and equitable access to essential medicines among older adults not only constitute a clinical barrier to the effective management of chronic conditions, but also represent a violation of the fundamental right to life, health and the principles of dignity, equality and non-discrimination that safeguard this population within the framework of human rights. Objective: To examine access to essential medicines for older adults with high-cost chronic conditions as a constitutive dimension of the fundamental rights to health, life and human dignity, in accordance with international human rights standards. Design: A literature review was conducted of articles published between 2020 and March 2025 in five databases, using the search terms: “pharmacological treatment,” “access to health,” “chronic diseases,” and “barriers to access.” After evaluating the inclusion criteria (language and year) and exclusion criteria (case studies), 12 articles were selected. A narrative synthesis was performed on the following aspects: application of the principles of the right to health, barriers to access, and rights violated or at risk. Results: The expansion of health coverage faces several barriers that violate fundamental principles of the right to health: equity, accessibility to medical advances, and long-term, quality, and specialized services, thus limiting autonomy. In conclusion, guaranteeing access to pharmacological treatments in old age will contribute to building more just and humane societies through public policies on coverage and pharmaceutical education, the simplification of treatment regimens, and the implementation of programs that allow people to age with dignity, considering health a human right based on equality and non-discrimination, participation and transparency. Full article

Community and hospital pharmacists in Romania are valuable to healthcare, but their involvement in multidisciplinary teams is still not up to the mark when measured against international standards. A systematic literature review search was conducted using the PubMed, Embase, Web of Science, and Scopus databases, following the PRISMA 2020 guidelines, complemented by a bibliometric analysis with VOSviewer, to identify research trends and key contributors in the field. This review examines studies such as counseling effectiveness, clinical contribution, and professional obstacles faced by pharmacists in Romania published between 2014 and 2025 that mainly focus on community practice, integration into hospitals, and new areas such as pharmacogenetics and pharmacovigilance. The studies surveyed patients on how they evaluated counseling, tracked clinical pharmacists who adjusted drug doses through therapeutic monitoring, checked whether healthcare professionals followed safety warnings, and checked management systems within institutions. High costs and the removal of pharmacovigilance from compulsory university courses add to the obstacles. Romanian pharmacists already possess the knowledge or skills to raise treatment success and shield patients from unsafe self-medication through timely clinical advice. To use this capacity fully, the system must change, including health insurance covering pharmaceutical services, compulsory updating of course content, and official interdisciplinary protocols for this potential to be fully exploited. Full article

This study analyses the educational and social impact of a series of innovative teaching projects developed at the Museum of the History of Pharmacy of the University of Seville. The initiatives—including historical video documentaries, the “student guides” programme, and the digital outreach project “Voices that Empower”—explore the pedagogical potential of scientific heritage as a learning tool and as a medium for public communication. Through experiential and service-learning methodologies, these projects have enhanced students’ communication skills, critical thinking, and awareness of cultural and gender dimensions within pharmaceutical studies. The results demonstrate that the integration of audiovisual production, museum-based learning, and digital storytelling fosters meaningful engagement between the university and society, while also revitalising the historical and humanistic dimensions of pharmacy. Furthermore, the inclusion of a gender perspective in the “Voices that Empower” initiative contributes to the visibility of women in STEM and highlights the museum as a space for empowerment and social transformation. This work concludes that university museums can act as strategic platforms for innovation in higher education, combining heritage preservation, teaching excellence, and civic outreach to promote a more inclusive and sustainable scientific culture. Full article

Background: Visual impairment (VI) describes decreased visual function that interferes with an individual’s ability to perform daily activities, such as reading, driving, and other executive tasks. Providing optimal pharmaceutical care for this population can be challenging for pharmacists, as individuals with VI face numerous obstacles in managing their medications. This study explores the challenges experienced by pharmacists and visually impaired patients and aims to compare their points of view to identify existing gaps and propose recommendations to optimize medication use among individuals with VI. Method: A cross-sectional study was conducted between September 2024 and January 2025 among pharmacists (n = 152) and visually impaired patients (n = 31) in the Qassim Region of Saudi Arabia. Pharmacists completed a self-administered questionnaire, while data from visually impaired patients were collected via structured face-to-face interviews. Data analysis was performed using IBM SPSS Version 21, with a significance level set at p < 0.05. Results: A total of 152 pharmacists and 31 visually impaired individuals participated in the study. Only 5.3% of pharmacists had received training related to VI care, and most counseling was directed to caregivers rather than patients (80.3%). pharmacists with additional training in VI were significantly more likely to employ unique or appropriate packaging methods (p < 0.001), and male pharmacists were more likely to rely on caregivers during OTC counseling (p = 0.014). Among the visually impaired participants, 77.5% reported difficulty reading medication packages and 67.7% faced challenges entering pharmacies. Braille literacy was significantly higher among males (p = 0.018) and those with higher education (p = 0.022). Overall, 90.3% expressed a need for improved accessibility tools and communication support in pharmacies. Conclusions: Pharmacists showed confidence in assisting visually impaired patients; however, most lacked formal training and relied heavily on caregivers for communication. Visually impaired individuals also reported difficulties accessing pharmacies, reading medication labels, and receiving complete information from pharmacists. Based on these findings, implementing specialized training programs, expanding Braille and tactile labeling, and integrating assistive technologies within pharmacies are recommended to improve safety and equitable medication use. Full article

Background/Objectives: Nurses play a key role in supporting patient adherence to biosimilars, which requires adequate knowledge of biological therapies. This study aimed to assess nurses’ knowledge and attitudes toward biosimilars in Spain, representing the first nationwide assessment of Spanish nurses’ knowledge and predictive determinants of reliance on biosimilars. Methods: A self-administered, web-based survey was distributed between May and June 2024. Associations were explored using Spearman’s correlation and Fisher’s exact tests, and predictors were examined with ordinal regression models. Results: A total of 402 nurses responded. Most (63.7%) reported at least basic knowledge of biosimilars. Access to industry-led training was strongly associated with higher knowledge (OR = 11.256; p < 0.001), while lack of awareness of workplace biosimilar use was linked to lower knowledge (OR = 0.176; p < 0.001). Confidence in biosimilar safety and efficacy increased with knowledge level (ORs 3.823–14.594; all p < 0.001) and was higher among nurses working with biosimilars in their units (OR = 3.959; p = 0.004) and in hospital ambulatory care services (OR = 2.506; p = 0.022). Conclusions: Spanish nurses predominantly demonstrate basic knowledge of biosimilars, highlighting the need for broader training access. Industry-led training was the strongest modifiable factor to improve knowledge and confidence. Strengthening collaboration with the pharmaceutical industry may support informed practice and enhance patient adherence to biosimilar therapy. Full article

Background/Objective: Patent Ductus Arteriosus (PDA) is a common congenital heart defect causing high morbidity and mortality in preterm neonates. IV ibuprofen is the standard treatment, with acetaminophen as a potential alternative when ibuprofen is contraindicated. However, evidence for acetaminophen’s effectiveness is inconclusive. This study aimed to compare the efficacy and safety of IV acetaminophen versus IV ibuprofen as the initial treatment for PDA closure in preterm neonates. Methods: A retrospective cohort study was conducted at a tertiary Saudi hospital. This study included preterm neonates with a gestational age of ≤32 weeks diagnosed with PDA and treated with IV ibuprofen or IV acetaminophen. The primary outcome was to evaluate the efficacy of ibuprofen versus acetaminophen for treating PDA. Results: A total of 95 courses were included. Of these, 49 neonates received ibuprofen, and 18 neonates received acetaminophen as first therapy. The mean age at the initial course was 5.47 ± 10.30 days for the ibuprofen group and 5.22 ± 6.43 days for the acetaminophen group. In most neonates, the hemodynamic significance of the PDA was confirmed by ultrasound examination. As a result, 35 of 49 neonates treated with ibuprofen experienced successful full PDA closure, with a rate of 71.4%, compared to 10 of 18 in the acetaminophen group, which had a rate of 55.6%. However, this difference was not statistically significant (p-value = 0.35). Conclusions: A trend toward higher PDA closure with ibuprofen was observed compared to acetaminophen, without a statistically significant difference. Both treatments showed comparable safety. Further studies are needed to confirm these findings and optimize acetaminophen dosing. Full article

Introduction: Minor digestive ailments are a common reason for individuals to visit pharmacies, and can be efficiently managed through structured pharmaceutical advice. This study aimed to evaluate the effectiveness of advice provided by pharmacists in community pharmacies from the perspectives of both patients and pharmacists. The primary focus of the study was not on assessing the effectiveness of a specific medication, but rather on the pharmaceutical advice provided. Materials and Methods: This prospective multicenter observational study was conducted between January and March 2025 in community pharmacies across Poland among adult patients with dyspepsia without alarm symptoms and included two visits: an initial visit and a follow-up phone call after 7–14 days. Symptom severity across seven domains was assessed using a GSRS-based tool, and data on adherence, treatment regimen, patient satisfaction, and acceptable costs of the two-visit service were collected. Statistical analyses (p < 0.05) using both parametric and non-parametric tests were performed on data from 100 participants who completed the study, with cost data serving as a proxy for willingness to pay. Results: Most patients (92.7%) reported symptom improvement, with a median time to relief of 3 days and good treatment adherence. The greatest benefits were observed for abdominal pain and flatulence, and higher baseline symptom severity was consistently associated with greater improvement. Service acceptability was high, and patients’ reported willingness to pay suggests perceived value and potential economic feasibility of the service. Conclusions: Structured pharmaceutical advice for digestive ailments (including triage, education, management plans, and monitoring of effects) led to rapid and clinically significant improvements in most patients. This approach demonstrates high adherence rates and positive acceptability. The stability of effects across different demographic groups, along with a predictable pattern of changes in various domains, supports the expansion of this service and customization of educational messages. Full article

Oral mucositis is an inflammatory and ulcerative disease that affects patients undergoing cancer treatment, namely chemotherapy and radiotherapy, significantly compromising their quality of life. Despite its high incidence and clinical impact, current therapeutic options remain limited, reinforcing the need for new treatment approaches. In this context, the Instituto Português de Oncologia do Porto FG, EPE (IPO-Porto) developed an innovative mouthwash containing dexamethasone sodium phosphate (DSP), ascorbic acid, and sodium hyaluronate. In this work the physicochemical stability of this formulation was evaluated to ensure its quality and safety as compounded medicine. Exploratory studies were performed under accelerated aging conditions (40 ± 2 °C), followed by stability studies under real-time conditions (20 ± 2 °C) and refrigeration conditions (4 ± 2 °C), as well as in-use stability studies simulating daily patient handling. At each sampling time, physicochemical characterization was carried out (pH, color, odor, and precipitate formation) as well as the DSP quantification using high-performance liquid chromatography. The acceptable range of 90.0–110.0%, compared to the initial concentration of DSP, was used as the primary stability criterion. Results showed that the formulation remained stable at high temperatures (40 °C), on short exposures times (≤6 h), and for 30 days at 4 °C in closed amber glass bottles. In-use stability studies performed during the 7 days after opening (considering three daily applications) showed that the DSP concentration remained above 90%. The results obtained enabled us to establish a definition of storage conditions and beyond-use recommendations, since they showed that the prepared formulation is stable when stored under refrigeration. Further studies are currently being developed with a view to its clinical use as a compounded mouthwash in a hospital setting for the treatment of oral mucositis. Full article

Background and objectives: Research into clinicians’ and pharmacists’ experiences and perspectives on direct oral anticoagulant (DOAC) use in Saudi Arabia and the broader Middle Eastern area is limited. Therefore, we aimed to evaluate the perspectives and experiences of physicians and pharmacists practicing in Saudi Arabia who prescribe DOACs and dispense DOAC therapy, respectively. Methods: A cross-sectional study was undertaken utilizing an online survey instrument. We collected data via Google Forms. Between June and July 2024, the study questionnaire was distributed to community pharmacists, general practitioners [GPs], cardiologists, residents in internal medicine, and hospital pharmacists (primary and secondary healthcare professionals) working in Saudi Arabia. Results: Comprising 146 doctors and 167 pharmacists, 313 total healthcare professionals participated in the study. Of the weekly DOAC prescriptions, cardiologists had the most at 35%; internal medicine residents came next at 16.3% and general practitioners at 17.5%. Among pharmacists, 16.7% of community pharmacists and 23.9% of hospital pharmacists dispensed DOACs weekly. The most often prescribed and dispensed medications were rivaroxaban, edoxaban, and apixaban. Across all categories, Lexicomp was the most often used tool. Most physicians (98%) said they lowered the DOAC dose when necessary. Especially in dosing, preoperative care, patient education, and medication interaction identification, internal medicine residents and hospital pharmacists expressed more confidence in managing DOACs. In these domains, community pharmacists expressed less trust. Conclusions: This study revealed that most participants preferred newer oral anticoagulants over warfarin and demonstrated a fairly good level of self-perceived knowledge regarding various aspects of the clinical use of DOACs. The study findings highlight the importance of focused training initiatives to standardize the use of DOACs, boost trust among community pharmacists and GPs, and ensure safe and effective patient care. Full article

Background: Patients with malignancy demonstrate an elevated risk of developing venous thromboembolism (VTE) due to coagulopathy and treatment modalities. Although low-molecular-weight heparin (LMWH) and warfarin have historically been standard therapies, direct oral anticoagulants (DOACs) are increasingly used in this population. Methods: We conducted a Bayesian network meta-analysis to compare the safety and efficacy of apixaban, edoxaban, rivaroxaban, LMWH, and warfarin in cancer-associated VTE. A comprehensive literature search of Embase, Medline, clinical trial registries, and manual sources was performed up to November 2025. The primary outcome was to compare the risk of VTE recurrence across therapies. Secondary outcomes included major bleeding, clinically relevant non-major bleeding (CRNMB), and all-cause mortality. Odds ratios (ORs) with 95% credible intervals (CrIs) were estimated, and treatment rankings were derived using the surface under the cumulative ranking curves (SUCRA) probabilities. Results: Seven randomized controlled trials (RCTs) involving 3325 patients were included. No clear evidence of differences was observed among apixaban, rivaroxaban, edoxaban, low-molecular-weight heparin, and warfarin for VTE recurrence, major bleeding, clinically relevant non-major bleeding, and mortality. For instance, rivaroxaban showed no statistically significant difference in VTE recurrence compared with apixaban (OR 1.13; 95% CrI 0.17–12.27), warfarin (OR 0.60; 95% CrI 0.03–19.00), edoxaban (OR 0.77; 95% CrI 0.06–11.11), or LMWH (OR 0.51; 95% CrI 0.10–2.66). Wide credible intervals reflect uncertainty due to the limited number of RCTs and low event rates. Conclusions: This Bayesian network meta-analysis showed no statistically significant differences between therapies with respect to VTE recurrence, bleeding outcomes, and mortality. However, the wide credible intervals indicate limited precision, warranting cautious interpretation of the findings. Full article