Empowering precision medicine: Insights from a national survey on pharmacogenomics knowledge, attitudes, and perceptions among community pharmacists in the UAE.

Background: Community pharmacists are essential to pharmacogenomics implementation because they can help trainers, clinical advisors, and other medical professionals understand the importance of pharmacogenomics and encourage them to use it in their practice. This study is to evaluate the community pharmacists' understanding, attitudes, and perceptions of pharmacogenomics in the United Arab Emirates (UAE). Methods: Professionals employed at community pharmacies in Abu Dhabi, Dubai, and the Northern Emirates participated in a cross-sectional study design. From July 2023 to February 2024, five pharmacy students in their last year conducted the survey. The study team employed a structured questionnaire to collect data in addition to conducting in-person interviews. The study questionnaire comprised three distinct sections namely, demographic information, knowledge of pharmacogenomics concepts, and perceptions regarding pharmacogenomics. Results: A total of 586 pharmacists enrolled in the study. The average knowledge score regarding pharmacogenomics was 75.1 % with a 95 % confidence interval (CI) of [72.4 %, 77.7 %]. The average attitude score toward pharmacogenomics was 67.5 % with a 95 % CI of [66.3 %, 68.7 %]. Better pharmacogenomics knowledge among several groups: independent pharmacies (OR 1.7; 95 % CI 1.2-2.4), Pharmacists in Charge (OR 1.4; 95 % CI 1.3-2.02), pharmacists with 11-15 years of experience (OR 2.1; 95 % CI 1.4-4.2), graduates from international universities (OR 4.6; 95 % CI 1.6-12.9), and those who received training on pharmacogenomics (OR 11.9; 95 % CI 3.3-14.5). Similarly, better attitude scores were observed among independent pharmacies (OR 1.5; 95 % CI 1.1-2.1), Pharmacists in Charge (OR 1.5; 95 % CI 1.07-2.1), pharmacists with 16-20 years of experience (OR 2.1; 95 % CI 1.16-3.7), graduates regional universities (OR 1.47; 95 % CI 1.05-2.1), and those who received training on pharmacogenomics (OR 4.8; 95 % CI 3.2-7.3). Conclusion: The positive attitudes toward pharmacogenomics that we found in our research indicate that community pharmacists in the United Arab Emirates are beginning to realize the potential advantages of pharmacogenomics in terms of improving patient care. Policies ensuring the privacy and confidentiality of genetic information are also necessary in considering concerns about the availability of genetic test results to insurance companies and potential employers.

Synthesis of Acetaminophen-Based Coumarins as Selective COX-2 Inhibitors: An in†vitro-in silico Study.

Acetaminophen, a centrally-acting old analgesic drug, is a weak inhibitor of cyclooxygenase (COX) isoforms with some selectivity toward COX-2. This compound was used in this work as a precursor to create nine acetaminophen based coumarins (ACFs). To satisfy the aim of this work, which states the synthesis of acetaminophen-based coumarins as selective COX-2 inhibitors, the ACFs were subjected to two types of investigation: in vitro and in silico. Given the former type, the ACFs capacity to block COX-1 and COX-2 was investigated in lab settings. On the other hand, the in silico investigation included docking the chemical structures of ACFs into the active sites of these enzymes, predicting their anticipated toxicities, and determining the ADME characteristics. The results of the in vitro study revealed that the synthesized ACFs demonstrated good-to-excellent inhibitory properties against the enzymes under study. Also, these ACFs exhibited a high level of COX-2 selectivity, which improved as the capacity of the aromatic substitute for withdrawing electrons was enhanced. Results of docking were comparable to the in vitro investigation in case of COX-2. On the other hand, the in silico investigations indicated that the synthesized ACFs are safer than their precursor, acetaminophen, with a high potential to consider oral-administrated candidates.

A mixed methods evaluation of the impact of a cost-of-living policy and practice hub on integrated care strategies.

OBJECTIVES: The cost-of-living crisis is a public health threat; however, the effects of the rising cost of living were not a policy priority for integrated care systems (ICSs) in early 2022. At the request of ICS leaders, the National Health Service (NHS) Confederation created an online cost-of-living hub in October 2022 to raise awareness of the consequences of the rising cost of living among ICS policymakers and support systems in mitigating these effects. This study aims to investigate the impact of this hub. STUDY DESIGN: Mixed methods. METHODS: To quantify hub utilisation, the hub viewing figures collected by the NHS Confederation website were analysed. A thematic analysis was performed to characterise how cost-of-living features in integrated care strategies, and the results compared to information published on the hub. RESULTS: The pages that comprise the hub were well engaged with, having between 2736 and 6161 views. Alongside this, the impacts of the rising cost of living feature extensively in integrated care strategies, being discussed in 32 out of 37 strategies across four contexts: health, communities, economic, and environmental. The significant majority of subthemes reflect points made by the hub. CONCLUSION: These results suggest the hub may have raised awareness about the impacts of-and possible responses to-the cost-of-living crisis among ICS policymakers. This may act as an impetus and guide for future public health interventions using policy and practice hubs. Furthermore, the discussion of cost-of-living across a range of contexts implies ICSs are engendering a collaborative, system-wide approach to tackling complex local issues.

Long-term effectiveness of transforaminal anterolateral approach CT-guided cervical epidural steroid injections for cervical radiculopathy treatment.

AIM: To evaluate the long-term clinical effectiveness of computed tomography (CT)-guided transforaminal cervical epidural steroid injection using an anterolateral approach for the treatment of cervical radiculopathy (CR) using well-established robust clinical scoring systems for neck pain and neck disability. Despite its widespread use, evidence to support the long-term benefit of routine cervical epidural steroid injection is currently very limited. MATERIALS AND METHODS: This study included 113 patients with magnetic resonance imaging (MRI)-confirmed CR who underwent a steroid injection at a single cervical level via a unilateral transforaminal anterolateral approach. Pain was assessed quantitatively at pre-injection, 15 minutes post-injection, 1 month, 3 months, and at 1 year. Neck disability was assessed using the Oswestry Neck Disability Index (NDI) at pre-injection, 1 month, 3 months, and 1 year time points. RESULTS: Eighty patients completed the study. Sixty per cent reported reduced neck pain (mean pain reduction, 55%), which was clinically significant in 45% cases. Furthermore, 66% reported an improvement in neck disability (mean improvement, 51%), which was clinically significant for 56% patients. Clinically significant good outcomes in both neck pain and neck disability were evident from as early as 1-month, and importantly, were independent both of pre-treatment CR characteristics (including severity of pre-injection neck pain or disability) and of findings on pre-injection MRI imaging. CONCLUSION: Transforaminal anterolateral approach CT-guided epidural steroid injection resulted in a clinically significant long-term improvement in both neck pain and disability for half of the present cohort of patients with unilateral single-level CR. This improvement was independent of the severity of the initial symptoms and pre-injection MRI findings.

Dissecting the oncogenic properties of essential RNA-modifying enzymes: a focus on NAT10.

Chemical modifications of ribonucleotides significantly alter the physicochemical properties and functions of RNA. Initially perceived as static and essential marks in ribosomal RNA (rRNA) and transfer RNA (tRNA), recent discoveries unveiled a dynamic landscape of RNA modifications in messenger RNA (mRNA) and other regulatory RNAs. These findings spurred extensive efforts to map the distribution and function of RNA modifications, aiming to elucidate their distribution and functional significance in normal cellular homeostasis and pathological states. Significant dysregulation of RNA modifications is extensively documented in cancers, accentuating the potential of RNA-modifying enzymes as therapeutic targets. However, the essential role of several RNA-modifying enzymes in normal physiological functions raises concerns about potential side effects. A notable example is N-acetyltransferase 10 (NAT10), which is responsible for acetylating cytidines in RNA. While emerging evidence positions NAT10 as an oncogenic factor and a potential target in various cancer types, its essential role in normal cellular processes complicates the development of targeted therapies. This review aims to comprehensively analyze the essential and oncogenic properties of NAT10. We discuss its crucial role in normal cell biology and aging alongside its contribution to cancer development and progression. We advocate for agnostic approaches to disentangling the intertwined essential and oncogenic functions of RNA-modifying enzymes. Such approaches are crucial for understanding the full spectrum of RNA-modifying enzymes and imperative for designing effective and safe therapeutic strategies.

Development of a multiagency protocol to support people with No Recourse to Public Funds in Wolverhampton (UK).

BACKGROUND: No Recourse to Public Funds (NRPF) status is applied to individuals and families that are subject to immigration control, resulting in them having restricted access to state-funded benefits within England. NRPF is a public health risk as it increases the risk of destitution among vulnerable migrants. AIMS: The aim of this study was to engage with public and voluntary sector staff within Wolverhampton working with people with a NRPF status to develop and create an easily accessible guide ('protocol') to help facilitate identification of appropriate cross-sector interventions and support. METHODS: Data were collected via an online survey as well as face-to-face semi-structured interviews with local NRPF stakeholders. RESULTS: Four themes emerged from the thematic analysis of participant responses: understanding NRPF statuses, varying support requirements, poor communication and awareness of vulnerabilities. Currently, in England, there does not appear to be a standardised localised protocol which can be used to reduce the complexities and confusion encountered by public and voluntary sectors who support people with NRPF status. CONCLUSION: The findings from this study have allowed the Wolverhampton NRPF to create an online information resource that includes training events to raise the awareness of NRPF, as well as the development of a localised multiagency protocol that has better equipped it to support and safeguard people with NRPF.

Critical research trends of mobile technology-supported English language learning: A review of the top 100 highly cited articles.

Around the world, the number of English speakers and the significance of the English language are constantly increasing. Among various technology-supported instructional styles, Mobile Learning (M-Learning) has been recognized as a promising approach to enhance students' competencies and skills in the English language. By examining previous literature, a number of reviews have been performed to investigate the role of M-learning in the English language. However, none of these studies has highlighted the trends, opportunities, and challenges identified in the most cited articles that focused solely on the English language. Therefore, to address these limitations, this study performed a review of the top 100 most cited articles, published between 2007 and 2020, indexed by the Web of Science, and addressing the English language only. The results revealed that most research in Mobile English Language Learning (M-ELL) followed an experimental design and employed a single mobile learning implementation. Additionally, the current study identified a number of research areas that require additional research attention. For example, further research is needed among students learning from home, more qualitative research is needed, and additional research is required to improve students' higher-order thinking skills. The outcomes of this study provide a reference to researchers and educators who intend to use mobile technologies in the area of language education, especially in the context of the English language.

Human preparedness: Relational infrastructures and medical countermeasures in Sierra Leone.

This paper examines health worker experiences in two areas of post-epidemic preparedness in Sierra Leone - vaccine trials and laboratory strengthening - to reflect on the place of people in current models of epidemic response. Drawing on ethnographic research and interviews with health workers in the aftermath of Ebola, it explores the hopes and expectations that interventions foster for frontline workers in under-resourced health systems, and describes the unseen work involved in sustaining robust response infrastructures. Our analysis focuses on what it means for the people who sustain health systems in an emergency to be 'prepared' for an epidemic. Human preparedness entails more than the presence of a labour force; it involves building and maintaining 'relational infrastructures', often fragile social and moral relationships between health workers, publics, governments, and international organisations. The COVID-19 pandemic has underscored the value of rethinking human resources from an anthropological perspective, and investing in the safety and support of people at the forefront of response. In describing the labour, personal losses, and social risks undertaken by frontline workers for protocols and practicality to meet in an emergency context, we describe the social process of preparedness; that is, the contextual engineering and investment that make response systems work.

Anatomical Assessments for Grey Mongoose Tongue by Scanning Electron Microscope (Herpestes edwardsii) in Iraq.

The grey mongoose is a mongoose species native to the West Asia and Indian subcontinent. It is listed as the Least Concern on the International Union for Conservation of Nature Red List. The main objective of this study was to identify the different categories of papillae found in the tongue of Iraqi grey mongoose to investigate the possible differences with other grey mongoose species. This study investigated the position and shape of the Iraqi grey mongoose tongue papillae. A total of six healthy grey mongooses were examined by Scanning Electron Microscope. The results revealed the existence of five different kinds of papillae on the dorsal surface of the tongue in grey mongooses that included 1) Filiform (sharp and cylindrical shape in the cranial and middle part of the tongue), 2) Multifilament (distributed in the cranial third and caudal part), 3) Circumvallate (positioned caudally in the cranial and rear regions of the tongue), 4) Conical (identified in the proximal to the circumvallate), and 5) Fungiform (located in the middle and caudal portions of the tongue). The present study highlights different shapes and distributions of all types of lingual papillae in the Iraqi grey mongoose.

2D facial landmark localization method for multi-view face synthesis image using a two-pathway generative adversarial network approach.

One of the key challenges in facial recognition is multi-view face synthesis from a single face image. The existing generative adversarial network (GAN) deep learning methods have been proven to be effective in performing facial recognition with a set of pre-processing, post-processing and feature representation techniques to bring a frontal view into the same position in-order to achieve high accuracy face identification. However, these methods still perform relatively weak in generating high quality frontal-face image samples under extreme face pose scenarios. The novel framework architecture of the two-pathway generative adversarial network (TP-GAN), has made commendable progress in the face synthesis model, making it possible to perceive global structure and local details in an unsupervised manner. More importantly, the TP-GAN solves the problems of photorealistic frontal view synthesis by relying on texture details of the landmark detection and synthesis functions, which limits its ability to achieve the desired performance in generating high-quality frontal face image samples under extreme pose. We propose, in this paper, a landmark feature-based method (LFM) for robust pose-invariant facial recognition, which aims to improve image resolution quality of the generated frontal faces under a variety of facial poses. We therefore augment the existing TP-GAN generative global pathway with a well-constructed 2D face landmark localization to cooperate with the local pathway structure in a landmark sharing manner to incorporate empirical face pose into the learning process, and improve the encoder-decoder global pathway structure for better representation of facial image features by establishing robust feature extractors that select meaningful features that ease the operational workflow toward achieving a balanced learning strategy, thus significantly improving the photorealistic face image resolution. We verify the effectiveness of our proposed method on both Multi-PIE and FEI datasets. The quantitative and qualitative experimental results show that our proposed method not only generates high quality perceptual images under extreme poses but also significantly improves upon the TP-GAN results.

In vitro Antioxidant and Antimicrobial Studies of Ethanolic Plant Extracts of P. granatum, O. stamineus, A. bilimbi, M. nigra, and E. longifolia.

BACKGROUND: Acne is a serious skin problem that affects mostly adolescents. The topical and systematic therapies are effective but could lead to several side effects and the emergence of antibacterial resistance of the acne-causing bacteria. Plant resources have been used as traditional medicine for centuries and can be the alternative therapies for acne treatment. Antioxidants are compounds that can prevent or delay the oxidation of substrates when present in low concentrations. Antioxidants are usually involved in several mechanisms of action, including the inhibition of free radical generation, enhancement of the scavenging capacity against free radicals, and reducing power. METHODS: In this study, three antioxidant assays, DPPH, ABTS, and FRAP were used to evaluate the antioxidant properties of the ethanolic extracts of five plant extracts (A. bilimbi, M. nigra, O. stamineus, P. granatum, and E. longifolia). Furthermore, the study aimed to identify the most potent plant extracts and their combination which could provide better antibacterial activities against acnecausing bacteria. Ethanolic extracts of A. bilimbi, O. stamineus, M. nigra, P. granatum, and E. longifolia were prepared by the Ultrasound-Assisted Extraction (UAE) technique. Their phytochemical contents were screened using several biochemical tests and GC-MS analysis. RESULTS: The study found that only the extracts of P. granatum and O. stamineus exhibited good antioxidant activity using DPPH assay (82.37% and 81.72% µg/mL respectively) and in ABTS assay (87.25% and 88.85% µg/mL respectively); their observed FRAP values were 115.1667 ± 5.6182 and 41.3860 ± 2.4583 µg/mL, respectively. The preliminary antibacterial screening using the disc diffusion method showed that P. granatum and O. stamineus were the most potent extracts; hence, both extracts were combined at the ratios of 1:1, 1:2, and 2:1 to a total concentration of 400 mg/mL. DISCUSSION: The antibacterial efficacy of the mixture was studied using the disc diffusion method and the MIC value was determined. Both S. aureus and S. epidermidis were sensitive to all the individual and combined extracts but C. acnes was resistant to all of them. CONCLUSION: The antibacterial activity of the combined extracts against S. aureus showed a synergistic effect at the ratio of 2:1 with the inhibitory zone diameter of 18.00 ± 1.00 mm and MIC value of 12.5 mg/mL; however, antagonistic effects were observed against S. epidermidis while no effect was noted against C. acnes. Therefore, all the selected plant extracts exhibited antibacterial activities against certain bacteria and their effects may be enhanced by combining the plant extracts.

Quantum chemical studies of mercaptan gas detection with calcium oxide nanocluster.

The electronic sensitivity and adsorption behavior for mercaptan natural gas of a Ca12O12 nanocluster were studied via ab initio computations. To be more specific, to fully grasp the influence of mercaptan molecules on the chemical and electronic features of Ca12O12 nanocluster, some parameters, namely, charge transfer of natural bond orbital, molecular electrostatic potential, binding energies, and frontier molecular orbitals, are computed. The interaction between CH4S molecule and calcium atoms of Ca12O12 nanocluster through the sulfur head is strong. This strong interaction leads to a considerable transfer of charge from CH4S to the nanocluster. After mercaptan adsorption, the existing energy gap between two levels, the highest occupied molecular orbital (HOMO) and the lowest unoccupied molecular orbital (LUMO) of the nanostructure, dropped by 2.21 eV, illustrating that the dissociation process has extensively increased the electrical conductance of nanostructure. This electrical signal can help to detect CH4S molecules. Moreover, it could be concluded that Ca12O12 nanocluster has a short recovery time. In addition, solvent considerably influences the geometry factors and electronic features of CH4S/Ca12O12 complexes, and the interactions between species are significantly weaker in the aqueous medium compared with those in the vacuum.

Clinicopathological spectrum of Diffuse Large B Cell lymphoma: a study targeting population yet unexplored in Pakistan.

OBJECTIVE: Diffuse Large B Cell Lymphoma (DLBCL) is the most common type of Non-Hodgkin Lymphoma (NHL). The aim of this study was to assess the clinico pathological characteristics of DLBCL specifically, among the affected individuals residing in Northern areas of Pakistan who had not been previously included in major lymphoma studies due to their remote location. RESULTS: Mean age of the patients was 49.7 years. Male: female ratio was 1.5:1. Primary site was lymph node in 99 (71.74%) patients, out of which, 36 (26.09%) patients had B symptoms and 19 (13.77%) patients had stage IV disease. 39 (28.26%) patients had primary extra nodal involvement, 4 (2.90%) patients had B symptoms and 3 (2.17%) had stage IV disease. Extra nodal sites involved in primary extra nodal DLBCL were gastrointestinal tract (GIT) 19 (48.72%), tonsils 6 (15.38%), spine 4 (10.26%), soft tissue swelling 3 (7.69%), parotid gland 2 (5.13%), thyroid 2 (5.13%) central nervous system (CNS) 1 (2.56), breast 1 (2.56%) and bone marrow 1 (2.56%). Our study revealed increased percentage of patients with nodal DLBCL in stage IV and with B symptoms. Few patients with primary extra nodal DLBCL had B symptoms and stage IV disease at presentation. GIT was the most common site of involvement in primary extra nodal DLBCL.

Effects of Bee Propolis on FBG, HbA1c, and Insulin Resistance in Healthy Volunteers

Objectives: Bee propolis is a natural substance that is used in traditional medicine due to its versatile pharmacological actions. This study evaluates whether short term use of bee propolis supplementation could have an impact on glycemic control in healthy individuals. Materials and Methods: A single daily dose of 1000 mg of bee propolis was administered orally to a total of 34 healthy individuals for 60 days. Body weight, body mass index (BMI), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), and insulin resistance were measured in all participants before and after the use of bee propolis. Results: The results of this study showed that bee propolis was associated with a significant increase in body weight and BMI of healthy volunteers. Bee propolis supplementation decreased FBG and HbA1c, but did not affect insulin resistance. Conclusion: Based on these results, bee propolis supplementation has a potential effect on glycemic control in healthy individuals and this should be considered when using this supplement in medical conditions.

Evaluation of the Antioxidant and Antimicrobial Activities of Ethyl Acetate Extract of Saccharomyces cerevisiae.

RESEARCH BACKGROUND: Antioxidants are important compounds present at low concentrations that inhibit oxidation processes. Due to the side effects of synthetic antioxidants, research interest has increased considerably towards finding natural sources of antioxidants that can replace the synthetic ones. The emergence and spread of antibiotic resistance require the development of new drugs or some potential sources of novel medicine. This work aims to extract the secondary metabolites of Saccharomyces cerevisiae using ethyl acetate as a solvent and to determine the antioxidant and antimicrobial activities of these extracted metabolites. EXPERIMENTAL APPROACH: The antioxidant activity of the secondary metabolites of S. cerevisiae were determined using DPPH, ABTS and FRAP assays. Furthermore, the antimicrobial potential of the ethyl acetate extract of S. cerevisiae against Cutibacterium acnes, Staphylococcus aureus and Staphylococcus epidermidis was assessed. RESULTS AND CONCLUSION: Five out of 13 of the extracted secondary metabolites were identified as antioxidants. The antioxidant activity of the S. cerevisiae extract exhibited relatively high IC50 of 455.26 and 294.51 µg/mL for DPPH and ABTS respectively, while the obtained FRAP value, expressed as ascorbic acid equivalents, was 44.40 µg/mL. Moreover, the extract had a significant antibacterial activity (p<0.05) against Staphylococcus aureus and Staphylococcus epidermidis at the concentrations of 100 and 200 mg/mL, respectively. However, no inhibitory effect was observed against Cutibacterium acnes as the extract was only effective against the bacterium at the concentrations of 300 and 400 mg/mL (inhibition zones ranging from 9.0±0.0 to 9.3±0.6) respectively (p<0.05). Staphylococcus aureus was highly sensitive to the extract, with a MIC value of 18.75 mg/mL. NOVELTY AND SCIENTIFIC CONTRIBUTION: This report confirmed the efficacy of the secondary metabolites of S. cerevisiae as a natural source of antioxidants and antimicrobials and suggested the possibility of employing them in drugs for the treatment of infectious diseases caused by the tested microorganisms.

Water quality and hydraulic performance of biochar amended biofilters for management of agricultural runoff.

This research evaluated the effect of biochar amendment rate on nitrogen species and organic carbon removals and hydraulic performance in biofilter columns treating dairy farm runoff. Initial studies compared the performance of sand columns amended with two types of biochar with different specific surface area (SA) and cation exchange capacity (CEC) with an un-amended sand column. The results showed that biochar enhanced N-species removal due to its unique physicochemical properties. In subsequent tests, two biofilter columns with different biochar fractions (20% and 50% by volume) were operated at varying hydraulic loading rates and antecedent dry conditions. Total nitrogen, ammonia, organic nitrogen and organic carbon removals were significantly higher in the column with the higher biochar fraction. The high CEC of biochar increased ammonium retention during the application period, allowing for nitrification during the antecedent dry periods (ADPs) when aerobic conditions developed in the media pores. High biochar SA also resulted in greater retention of DON and DOC by adsorption. A variable saturation flow model of biochar amended biofiltration was developed using HYDRUS-1D software. The model was calibrated using data from conservative tracer and moisture content studies. Model results showed that the high microporous structure of the biochar increases the time needed to reach full saturation, lowers the saturated conductivity and increases the hydraulic retention time in the medium. This calibrated model can be used to design field scale biofilter systems for managing agricultural runoff.

Hindcasting multidecadal predevelopment groundwater levels in the Floridan aquifer.

Establishing predevelopment benchmark groundwater conditions is challenging without long-term records to discern impacts of pumping and climate change on aquifer levels. Understanding periodic natural cycles and trends require 100 years or more data which rarely exist. Using limited records, we develop an approach to hindcast multidecadal levels and examine the temporal evolution of climatic and pumping impacts. The methodology includes a wavelet-aided statistical model, constrained by temporal scales of physical processes responsible for groundwater level variation, including rainfall, evapotranspiration and pumping stresses. The model and hindcasts are tested at three sites in Florida using traditional split calibration-verification methods for the period of record and with the documented historical drought and wet years for the period of no-record. The pumping impact is quantified over time and compared with regional groundwater models, revealing that withdrawals are responsible for 30 to 70% of the declines in levels since 1960s. Hindcasting yielding 110 years of monthly levels is used to assess the effect of climate change and pumping on the frequency of critical low levels. At all three sites, the frequencies of critical low levels increase significantly in the 1960 to 2015 period when compared to the 1904 to 1959 period. For example, at site 1, the return period of the critical low level is shortened by 3.9 years due to climate change and 2.2 years due to pumping.

The role, efficacy and outcome measures for teriparatide use in the management of medication-related osteonecrosis of the jaw.

Medication-related osteonecrosis of the jaw (MRONJ) is a complex disease which can be associated with multiple morbidities and is challenging to treat. This review evaluates the literature on the role and efficacy of teriparatide (TPTD) as a treatment for MRONJ. The clinical, radiological, histopathological and serological parameters used to assess treatment response have been described. Electronic databases were searched to retrieve articles (April 2005 and April 2020) based on strict inclusion criteria. Seventeen articles were included in this review. Of the 91 patients treated; only six received TPTD as a standalone treatment. There were significant variations in defining treatment outcomes and measuring treatment response. The longest follow-up period was 26 months, and 12 studies failed to report follow-up. The overall quality of evidence is weak with potential for a high risk of bias, making it difficult to determine the efficacy of TPTD and its long-term effects. However, TPTD may play a role in the treatment of intractable MRONJ in osteoporotic patients or those unfit for surgery. Therefore, randomized clinical trials on larger patient cohorts with long-term follow-up is required to confirm efficacy, safety and inform treatment indications for TPTD in the treatment of MRONJ.

Impact of a Pharmacist-Led Intensive Care Unit Sleep Improvement Protocol on Sleep Duration and Quality.

BACKGROUND: Sleep improvement protocols are recommended for use in the intensive care unit (ICU) despite questions regarding which interventions to include, whether sleep quality or duration will improve, and the role of pharmacists in their development and implementation. OBJECTIVE: To characterize the impact of a pharmacist-led, ICU sleep improvement protocol on sleep duration and quality as evaluated by a commercially available activity tracker and patient perception. METHODS: Critical care pharmacists from a 40-bed, mixed ICU at a large community hospital led the development and implementation of an interprofessional sleep improvement protocol. It included daily pharmacist medication review to reduce use of medications known to disrupt sleep or increase delirium and guideline-based recommendations on both environmental and nonpharmacological sleep-focused interventions. Sleep duration and quality were compared before (December 2018 to December 2019) and after (January to June 2019) protocol implementation in non-mechanically ventilated adults using both objective (total nocturnal sleep time [TST] measured by an activity tracker (Fitbit Charge 2) and subjective (patient-perceived sleep quality using the Richards-Campbell Sleep Questionnaire [RCSQ]) measures. RESULTS: Groups before (n = 48) and after (n = 29) sleep protocol implementation were well matched. After protocol implementation, patients had a longer TST (389 ± 123 vs 310 ± 147 minutes; P = 0.02) and better RCSQ-perceived sleep quality (63 ± 18 vs 42 ± 24 mm; P = 0.0003) compared with before implementation. CONCLUSION AND RELEVANCE: A sleep protocol that incorporated novel elements led to objective and subjective improvements in ICU sleep duration and quality. Application of this study may result in increased utilization of sleep protocols and pharmacist involvement.