Search Results (155)

Background: Patients with malignant diseases receiving chronic opioid therapy are particularly susceptible to drug–drug interactions because of extensive polypharmacy, multimodal anticancer treatment, supportive care, and comorbidities. This study aimed to determine the prevalence of potentially clinically relevant drug–drug interactions and to identify factors associated with their occurrence. Methods: This exploratory observational cross-sectional pilot study included 49 adult oncology patients receiving chronic opioid therapy. Complete medication regimens were screened using the Medscape Drug Interaction Checker and Lexicomp. Lexicomp category D and X interactions were analysed descriptively. Because category D interactions were nearly universal and category X interactions were rare, the presence of at least one Medscape “Serious—Use Alternative” interaction was used pragmatically as the binary outcome for regression modelling. Potential predictors were assessed using univariable binary logistic regression and a parsimonious adjusted model with covariates selected using a clinically informed approach. Because of quasi-complete separation, Firth’s penalized-likelihood logistic regression was used as the primary adjusted analysis. Results: Lexicomp category D interactions were identified in 48 of 49 patients (98.0%), whereas category X interactions were present in 2 patients (4.1%). Medscape serious interactions were detected in 33 patients (67.3%). In the Firth-adjusted model, female sex was associated with lower odds of a Medscape serious interaction (adjusted OR 0.12, 95% CI 0.02–0.52), while cardiovascular disease was associated with higher odds (adjusted OR 5.16, 95% CI 1.27–26.31). Stage IV disease showed a positive but statistically non-significant association, and total medication count was not independently associated with the outcome in sensitivity analysis. Because of the small pilot sample and the resulting wide confidence intervals, these findings should be interpreted as exploratory and hypothesis-generating. Conclusions: Oncology patients receiving chronic opioid therapy had a high burden of potentially clinically relevant drug–drug interactions, predominantly Lexicomp category D interactions, warranting consideration of therapy modification and individualized monitoring rather than absolute avoidance. Regular medication review, use of complementary interaction databases, and individualized clinical assessment may improve pharmacotherapy safety in this vulnerable population. Full article

Background: Fibroblast growth factor 21 (FGF21) is a peptide hormone that is synthesized by several organs and regulates energy homeostasis, including reducing fat mass and lowering hyperglycemia, insulin resistance and dyslipidemia. It also increased metabolic syndrome (MS) and cardiovascular risk in breast cancer (BC) survivors treated with aromatase inhibitors (AIs) aimed at reducing cancer recurrence. We evaluated whether blood FGF21 concentration is associated with MS and its five criteria in postmenopausal women treated with AIs, and whether this persists after multimodal interventions that reduce MS. Methods: A quasi-experimental longitudinal study in 31 postmenopausal women with localized BC on Ais, assessed via a 12-week multimodal program. Their MS was evaluated per the NCEP-ATP III guidelines (waist circumference, blood pressure, fasting glucose, triglycerides, HDL-cholesterol). Plasma FGF21 was measured pre/post-intervention via fasting blood samples, centrifugation, and ELISA assay. Results: Pre-intervention FGF21 median: 377.62 pg/mL (38.40–1616.42). Plasma FGF21 concentrations positively correlated with MS criteria number pre- and post-intervention (all p < 0.05). Linear regression confirmed pre-intervention MS criteria (β = 127.262, p = 0.006) and antihypertensive drugs as predictors of post-FGF21 levels. Analysis of individual MS criteria revealed significant associations with blood pressure (p = 0.028 and p = 0.022 for systolic and diastolic pressure, respectively) and fasting glucose changes (p = 0.008). Conclusions: Plasma FGF21 may act as a biomarker for monitoring exercise-based interventions which reduce MSs, particularly hypertension and hyperglycemia, in AI-treated BC survivors. Full article

Invasive fungal infections are frequent complications in patients with hematologic malignancies due to immunosuppression and intensive treatments. In Colombia, limited diagnostic availability, heterogeneous prescribing practices, and emerging antifungal resistance highlight the need for optimized use. We evaluated an interdisciplinary antifungal stewardship intervention in the hematology unit of a tertiary-care hospital. A quasi-experimental before-and-after study included 353 hospitalized patients receiving systemic antifungals between 1 January 2023 and 31 December 2024 (1154 prescriptions). Following the intervention, antifungal prescribing shifted toward increased prophylaxis and reduced therapeutic use, with substantial reduction in prophylactic Amphotericin B dosing, stable treatment dosing, and selective changes in agent choice, including decreased voriconazole and discontinuation of some broad-spectrum drugs. Microbiological sampling decreased, reflecting a more targeted diagnostic approach rather than improved documentation. Antifungal consumption patterns showed redistribution among agents rather than uniform reduction. Prophylaxis-related costs increased, while treatment-related costs decreased without statistical significance. ICU admissions and in-hospital mortality remained unchanged. These results demonstrate that structured antifungal stewardship programs are feasible and safe in hematology units in middle-income settings, supporting more rational antifungal use without compromising patient outcomes. Full article

The aim of this study was to synthesize alginate hydrogel beads using ionotropic gelation containing pH-sensitive magnetic reduced graphene oxide (MGO). MGO was prepared using a hydrothermal method and surrounded by alginate beads. FTIR, XRD, FESEM, TEM, VSM and TGA showed that the synthesized beads have a quasi-spherical structure, exhibit superparamagnetic behavior, and are thermally stable up to 350 °C. The model drug, quercetin, was loaded into these particles with an efficiency of 25.8%. These particles showed a pH-dependent release. HFF-2 and Caco-2 cells were used to investigate cytotoxicity. At a concentration of 140 μg/mL, more than 80% viability was observed in HFF-2 cells and anticancer effects were observed on Caco-2 cells with a decrease in viability of less than 50% at a concentration of 200 μg/mL. The obtained cell culture results indicate that the hydrogel beads are biocompatible and act as a drug delivery system. Full article

Advection–diffusion–reaction-type interface models have wide-ranging applications in environmental science, chemical engineering, and biological systems, particularly in modeling pollutant transport in groundwater, reactive flows, and drug diffusion across biological membranes. This paper presents a novel numerical method for the solution of these models. The proposed method integrates the meshless collocation technique with the finite difference method. The temporal derivative is approximated using a finite difference scheme, while spatial derivatives are approximated using radial basis functions. The interface across the fixed boundary is treated with discontinuous diffusion, advection, and reaction coefficients. The proposed numerical scheme is applied to both linear and non-linear models. The Gauss elimination method is used for the linear models, while the quasi-Newton linearization method is employed to address the non-linearity in non-linear cases. The $L_{\infty }$ error is computed for varying numbers of collocation points to assess the method’s accuracy. Furthermore, the performance of the method is compared with the Haar wavelet collocation method and the immersed interface method. Numerical results demonstrate that the proposed approach is more efficient, accurate, and easier to implement than existing methods. The technique is implemented in MATLAB R2024b software. Full article

Carbon dots have emerged as promising nanocarriers for drug delivery due to their unique physicochemical properties and biocompatibilities. Here, the potential of leaf-derived carbon dots (named as SBL_CD), derived from Seabuckthorn (Hippophae rhamnoides L.), was illustrated as a novel nano-formulation for bioactive compound delivery. Seabuckthorn leaves, rich in flavonoids, are the waste product during the production of Seabuckthorn fruits. The wasted leaves were utilized to synthesize carbon dots via a hydrothermal method. The resulting SBL_CD, characterized by TEM, FT-IR and Raman spectroscopy, exhibited a diameter of ~5 nm in both amorphous and quasi-crystalline forms. Applications of SBL_CD in cultures demonstrated robust properties of anti-inflammation and inducing neuronal cell differentiation. Furthermore, SBL_CD was able to encapsulate luteolin, a bioactive flavonoid. The enhanced delivery efficiency translated to superior biological activity, with SBL_CD-luteolin requiring only 1.50 μg/mL in achieving the EC₅₀ efficacy, as compared to 6.82 μg/mL for free luteolin in pNF200-Luc expression assays. This approach not only valorizes Seabuckthorn leaf by-products but also potentially improves the efficacy of encapsulated flavonoids. The development of SBL_CD as a multifunctional platform for flavonoid delivery represents a promising strategy in enhancing the efficacy of neuroactive compounds, combining anti-inflammatory effects (>70% cytokine suppression) with enhanced cellular uptake (4.5-fold increase). Full article

Objective: The purpose of the study was to conduct a systematic review assessing the impact of pharmacological and non-pharmacological interventions on Relative Energy Deficiency in Sport (REDs). The study design follows a systematic review and meta-analysis. The data sources are CINAHL, MEDLINE, SportDiscus, ERIC, and Embase from inception until July 2025. Eligibility criteria for selecting the studies include the experimental, quasi-experimental, and pre-experimental literature that investigated interventions designed to support the symptoms of REDs. Results: A total of nineteen studies (fifteen non-pharmacological interventions, four pharmacological interventions), with a total of 759 females, were included in the review. Non-pharmacological interventions demonstrated positive benefits on menstrual function recovery, energy availability, fat mass, and body fat percentage. Meta-analyses quantified nutrition intervention benefits on an individual’s fat mass (kg), 1.36 (95% CI 0.68, 2.04), and body percentage fat (%), 2.21 (95% CI 1.34, 3.08). It was also possible to identify the impact of non-pharmacological interventions on total triiodothyronine (T3) biomarkers (nmol/L), −2.37 (95% CI −5.57, 0.83). It should be noted, however, that non-pharmacological interventions were limited by quality and certainty assessment, identifying included evidence as low to moderate. Pharmacological interventions demonstrated some positive (at times very strong effect sizes) results for impact on bone mineral density, but conclusions are currently limited by well-powered experimental studies. Conclusions: The current evidence base favors non-pharmacological management as an initial response for managing REDs. Initial pharmacological management appears to identify limited but potentially (depending on the drug) promising evidence for the impact on bone mineral density; further evidence is required to be more certain about the impact on hormonal profiling and menstrual recovery function. Further research is needed to help develop a greater understanding. Full article

Background/Objectives: Although information and communication technology (ICT) offers opportunities to address challenges, evidence among frail populations is limited. We aimed to evaluate the effectiveness and feasibility of an ICT-based intervention incorporating an artificial intelligence (AI)-assisted smartphone dietary application and group communication tools to improve dietary quality and social connection among community-dwelling older adults with frailty. Methods: A non-randomized, quasi-experimental study was conducted among 29 older adults (≥65 years) in Tokyo, Japan. Participants were assigned to the intervention (n = 11) or control (n = 18) group. The 3-month intervention included weekly photo uploads of meals via an AI-based dietary application providing automated image analysis and personalized feedback, supervised by registered dietitians, along with peer communication through a group chat. The primary outcome was dietary quality. The secondary outcomes included body weight, body mass index (BMI), skin carotenoid score, and loneliness. Results: The adjusted Japanese Food Guide Spinning Top Score at 3-month follow-up was 49.0 (standard error [SE] = 2.6) and 39.5 (SE = 2.0) in the intervention and control groups, respectively. The adjusted mean difference between groups was +9.5 (95% confidence interval: 2.3 to 16.7, p = 0.01). After using analysis of covariance for adjusting for respective baseline values, age, education status, and antihypertension drug use, no statistically significant between-group differences were observed at 3-month follow-up for any secondary outcomes. Conclusions: AI-based dietary intervention and peer communication effectively improved dietary quality among older adults, highlighting the potential of such an intervention to promote healthier eating habits in this population. Full article

Antimicrobial resistance (AMR) poses a critical public health threat, with rising multidrug resistance cases compromising treatment effectiveness. Knowledge about the resistome in dairy production systems remains limited, particularly regarding lactating cows. This study investigated the microbiome and resistome across the hospital, fresh, and mid-lactation pens on 18 conventional dairy farms in California and Ohio using shotgun metagenomic sequencing of pooled fecal samples. Pooled fecal pat samples were collected as part of a larger field study using a quasi-experimental design that assigned farms to the training intervention group (six per state) or the control group (three per state). For the training intervention group, farm worker(s), identified as having the task of diagnosing and treating adult cows on the farm, participated in a training program on antimicrobial stewardship practices. Pooled fecal samples (n = 7) were collected at enrollment and 3 months after the intervention was completed on each participating farm (n = 18). A total of 10,221 bacterial species and 345 AMR genes conferring resistance to 22 antimicrobial classes were identified. The hospital pen exhibited a higher AMR gene diversity compared to fresh and mid-lactation pens (p < 0.05). Several AMR genes showed bimodal distribution, suggesting complex transmission mechanisms. Network analysis revealed distinct gene correlation profiles across pens, with the hospital pen showing fewer gene interactions. Our findings suggest that farm-level antimicrobial drug use may not be the sole or primary driver of resistome composition in pooled fecal samples from dairy cattle, highlighting the need to investigate other factors influencing AMR dynamics in livestock systems. Full article

Introduction: Drug development has traditionally used mathematical models to predict formulation behavior. Objective: Building artificial neural networks for the drug release evaluation of drug delivery systems using sustained-release metronidazole-coated colonic hydrophilic matrices as a model. Methods: The technological factors associated with the biopharmaceutical performance of hydrophilic metronidazole matrices were evaluated using a quality by design approach (QbD). The developed neural network includes variables related to the technological process for producing the matrices. These are related to the materials used, such as the type and viscosity of core polymers, the type of coating agent, or the matrix production process, such as the mixing time of core materials or the percentage of the coating agent. The output variables of the neural network were the percentages of drug released in vitro at 1, 6, 12, and 24 h and the mean dissolution time of the matrix. An iterative quasi-Newton method was used to train the artificial neural network. Results: A neural network with excellent prediction capacity allows selecting the technological variables with the greatest influence on the % of drug dissolved: the type of coating agent used and the percentage of the total weight increase after coating for 1 h and 6 h of drug release and also the viscosity of the HPMC for 12 and 24 h. Conclusions: The optimized neural network demonstrated an excellent predictive capacity for in vitro drug dissolution profiles, allowing the use of this type of methodology based on artificial intelligence methods in the optimization of drug delivery systems. Full article

Advances in HIV care and broader access to antiretroviral therapy (ART) have extended life expectancy for people living with HIV, yet aging-related health concerns, especially among those who use substances, remain under-researched. This systematic review examined the effects of mindfulness and yoga-based interventions on healthy aging outcomes in adults living with HIV who use drugs or who have a history of substance use. We searched Medline, Embase, PsycINFO, and Scopus for randomized controlled trials, cohort studies, quasi-experimental designs, and pre–post intervention studies that assessed healthy aging indicators—broadly defined to include physical, cognitive, and mental health outcomes—along with substance use and HIV-related quality of life measures such as ART adherence. All five studies that met inclusion criteria found mindfulness and yoga interventions to be feasible and acceptable for people living with HIV who use substances, with some evidence suggesting reductions in stress and substance use, as well as improvements in ART adherence. However, most studies were small, short-term pilot trials, none focused specifically on older adults, and few used HIV-specific measures of quality of life or healthy aging. Notably, older adults living with HIV were underrepresented in the studies examined, pointing to the need for increased engagement with older adults living with HIV. These findings suggest promise for mindfulness and yoga for promoting healthy aging among people living with HIV who use substances. Future research should prioritize larger sample sizes and longitudinal designs to better understand clinical efficacy. Existing interventions may be enhanced by incorporating multilevel, community-driven approaches that reflect lived experiences and expand definitions of aging well among people living with HIV who use drugs or who have a history of substance use. Full article

Gold (Au) and silver (Ag) nanoparticles (NPs) are used for drug transport and plant protection due to their insoluble nature and unique properties. To produce health-friendly NPs, toxic solvents should be replaced with plant-based synthesis. Plants, such as alfalfa (Medicago sativa L.), release biomolecules that reduce metal ions and form nanoclusters without free radicals, showing anti-inflammatory and antioxidant properties. In this study, callus cultures of two M. sativa genotypes, ‘Kometa’ and ‘La Bella Campagnola’, were exposed to two precursors (AgNO₃ and HAuCl₄) for 24 and 48 h to assess the feasibility of biological NP synthesis. Spectrophotometry showed significant (p ≤ 0.05) changes in light absorbance compared with the control. Dynamic light scattering and zeta potential measurements indicated a change in the composition of the liquid compared with the control. To improve image quality and obtain more accurate data, transmission electron microscopy (TEM) analysis was repeated, confirming the presence of quasi-spherical nanoparticles with diameters in the range of 5–25 nm for both AuNPs and AgNPs in the callus culture extracts of both genotypes. Nanoparticle Tracking Analysis demonstrated that the AgNPs and AuNPs from both genotypes displayed polydisperse size distributions, with a mean particle size ranging from 220 to 243 nm. Elemental analysis provided clear evidence that Ag and Au were present only in treated samples, confirming effective NP biosynthesis and excluding contamination. X-ray diffraction (XRD) analysis was performed to characterise the crystalline structure; however, due to the very small particle size (5–25 nm), no clear diffraction patterns could be obtained, as nanocrystals below ~20–30 nm typically produce signals below the detection limit of standard XRD instrumentation. The novelty of this research is the cost-effective, rapid biosynthesis of quasi-spherical AuNPs and AgNPs with diverse sizes and enhanced properties, making them more eco-friendly, less toxic, and suitable for antibacterial and anticancer studies. Full article

Background/Objectives: Mild cognitive impairment (MCI) represents an intermediate stage between normal ageing and dementia, with a high annual progression rate. Despite its clinical relevance, no pharmacological treatment has been definitively approved for this condition; however, multiple pharmacological and non-pharmacological strategies have been investigated for their potential benefits. This systematic review assessed the effectiveness of both types of interventions in adults with MCI, aiming to identify effective strategies to preserve cognitive function. Methods: A systematic search (2017–2025) was conducted in PubMed, Scopus, ScienceDirect, SpringerLink, and WOS, following PRISMA guidelines. Randomised controlled trials and quasi-experimental studies involving adults aged ≥ 50 years with a diagnosis of MCI were included. Outcomes were evaluated in terms of cognitive, functional, behavioural, and quality-of-life improvements. Risk of bias was assessed using the RoB 2 and ROBINS-I tools. Results: Of 108,700 records screened, 40 studies were included. Non-pharmacological interventions, such as cognitive training (conventional, computerised, or virtual reality-based), consistently improved memory, attention, and executive functions (e.g., MoCA: +3.84 points; p < 0.001). Transcranial magnetic stimulation combined with physical exercise also demonstrated significant benefits (p = 0.025). Among pharmacological treatments, only vortioxetine and choline alfoscerate showed modest improvements; cholinesterase inhibitors had limited effects and frequent adverse events. Complementary therapies (yoga, probiotics, and acupuncture) yielded promising outcomes but require further validation. Conclusions: Non-pharmacological strategies, particularly cognitive training and physical exercise, emerge as the most effective and safe approaches for managing MCI. The inclusion of pharmacological interventions with preliminary evidence of benefit should be considered within a personalised, multimodal approach, while recognising the current absence of approved drug treatments for MCI. Further research is needed in underrepresented populations, such as those in Latin America. Full article

We evaluated the effectiveness of three locally available disinfectants in reducing Escherichia coli (E. coli) contamination of wastewater-irrigated lettuce while preserving structural integrity. We conducted a quasi-experimental study using lettuce from two farms (Accra and Tamale) in Ghana. Disinfectants tested included (i) salt combined with vinegar, (ii) sequential salt and potassium permanganate, and (iii) sequential vinegar and potassium permanganate. Structural integrity (stem crispness and leaf mushiness) was assessed at 5, 10, and 15 min. E. coli counts and antibiotic resistance were determined pre- and post-disinfection. All three disinfectants preserved structural integrity of lettuce at 5 and 10 min. At 15 min, sequential disinfectants preserved 100% structural integrity, while the salt–vinegar mix caused mushiness in 16%. Pre-disinfection E. coli counts were 9720 cfu/g for Accra (Inter Quartile range, IQR: 3915–14,175) and 72 cfu/g (IQR: 36–189) for Tamale. All disinfectants eliminated E. coli after 15 min. Multi-drug-resistant isolates were common (45% in Accra and 30% in Tamale), particularly against “Watch, restricted use” antibiotics. A 15 min exposure of lettuce to locally available disinfectants, particularly when used sequentially, can eliminate E. coli contamination while preserving structural quality. This practical, low-cost intervention can empower households, vendors, and farmers to limit lettuce-borne diarrheal diseases and antimicrobial resistance transmission. Full article

Background/Objective: Drug-related problems (DRPs) are a common, potentially avoidable cause of emergency department (ED) use. In December 2022, our hospital integrated a pharmacist-led intervention into routine ED practice. This intervention comprised medication optimization, adherence counseling, and coordinated hand-off to primary care. We quantified 30- and 90-day reconsultations after discharge and explored factors associated with DRP-related revisits. Methods: A retrospective cohort of adults (≥18 years) who attended a tertiary ED (Barcelona, Spain). We included index DRP visits from 1 December 2022 to 30 June 2024. All received the bundle. Demographic, clinical, and pharmacotherapeutic data were extracted from the Catalan Shared Health Record; an independent committee classified revisits as a DRP or non-DRP. Predictors of 30-day DRP revisits were assessed with multivariable logistic regression. Results: Among 1247 patients (mean age 78.6 ± 16.2 years; 59.2% women; and median nine drugs), 120 (9.6%) reconsulted the ED within 30 days, and 194 (15.5%) within 90 days for any cause. DRP-specific rates were 30.8% (37/120) at 30 days and 26.3% (51/194) at 90 days; 81% and 80% of these revisits, respectively, involved a recurrence of the same DRP. The most frequent index DRPs were constipation (14.2%), gastrointestinal bleeding (9.2%), hypertension (8.3%), seizures (8.3%) and hyponatraemia (6.7%). An age ≥ 80 years independently predicted fewer 30-day DRP revisits (OR 0.32; 95% CI 0.13–0.79); hypertension and cognitive impairment were not significant after adjustment. Conclusions: In this single-arm implementation cohort, overall, 30-day ED reconsultations were 9.6% and about one-third were DRP-related, predominantly recurrences, and chiefly gastrointestinal bleeding and seizures. These descriptive findings should be interpreted cautiously given potential survivorship bias and residual confounding; the apparently lower risk among patients aged ≥ 80 years is hypothesis-generating and may reflect geriatric care pathways and caregiver engagement. Targeted post-discharge monitoring for high-recurrence DRPs may help reduce avoidable ED use, and future evaluations should test this in quasi-experimental or randomized designs. Full article