Association between epidermal growth factor receptor-tyrosine kinase inhibitors and venous thromboembolism among older patients with advanced non-small cell lung cancer.

BACKGROUND: Venous thromboembolism (VTE) risk is higher among patients with non-small cell lung cancer (NSCLC) and specific subgroups, including the elderly, but little is known about the VTE risk of different generations of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and whether the risk differs by demographic characteristics. This study aims to compare the risk of VTE (deep venous thromboembolism [DVT]; pulmonary embolism [PE]) between a third-generation EGFR-TKI and first/second-generation EGFR-TKIs and stratify VTE risk by sex, age, and race/ethnicity in third-generation EGFR-TKI users. METHODS: Via the 2006-2019 Surveillance, Epidemiology, and End Results-Medicare database, this retrospective cohort study included older patients (aged ≥65 years) with advanced NSCLC who initiated on a third-generation EGFR-TKI (n = 493) and first/second-generation EGFR-TKIs (n = 1036). We estimated the hazard ratio (HR) and its 95% confidence interval (95% CI) with the Cox proportional hazards model. RESULTS: A third-generation EGFR-TKI had a significantly higher VTE risk than first/second-generation EGFR-TKIs (HR, 1.26 [95% CI, 1.01-1.57]; p = .037), with an elevated risk in males (HR, 2.16 [95% CI, 1.47-3.19]; p < .001), patients aged ≥75 years (HR, 1.38 [95% CI, 1.04-1.83]; p = .026), and non-Hispanic Whites (HR, 1.46 [95% CI, 1.10-1.95]; p = .010). Males consistently showed a significantly higher risk of DVT (HR, 2.49 [95% CI, 1.29-4.80]; p = .007) and PE (HR, 2.00 [95% CI, 1.29-3.11]; p = .002). A significantly higher risk of DVT (HR, 1.54 [95% CI, 1.00-2.37]; p = .050) and PE (HR, 1.47 [95% CI, 1.06-2.05]; p = .021) was shown in patients aged ≥75 years and non-Hispanic Whites, respectively. Among third-generation EGFR-TKI users, non-Hispanic Whites had a significantly higher risk of VTE (HR, 2.04 [95% CI, 1.03-4.02]; p = .041) and PE (HR, 2.88 [95% CI, 1.24-6.70]; p = .014) than non-Hispanic Asian/Pacific Islanders. CONCLUSIONS: Close monitoring of VTE events in high-risk patients is essential to promote early diagnosis and treatment.

Community Pharmacists' Services during the COVID-19 Pandemic: A Case Study of Lagos State, Nigeria.

Objective: To explore the services community pharmacists in Lagos state provided to their communities during the COVID-19 pandemic. Methods: A cross-sectional survey of community pharmacists drawn from all the Association of Community Pharmacists' zones in Lagos state was done from April to June 2021. Data were collected using a structured, self-reported online questionnaire via Google Forms and were analyzed using descriptive and inferential statistical analysis. Findings: Two hundred and forty community pharmacists participated in the study; the response rate was 80.5%. Patient counseling (99.6%), assessment and treatment of common acute ailments (99.6%), and patient education on hygiene (99.6%) were the most reported services provided by community pharmacists. The COVID-19 infection prevention and control measures most frequently practiced by the pharmacists include cleaning of floors with soap and water (98.4%), provision of hand sanitizers for staff use (97.1%), and taking precautions when handling prescriptions and dispensing drugs (96.7%). Significant barriers to the provision of the services were reduced workforce in the pharmacy, time constraints, and extended working hours. Zinc (98.3%), Vitamin C (97.5%), and ivermectin (95.0%) tablets were the most reported medications for the prevention and treatment of COVID-19 infection. Conclusion: Community pharmacists in Lagos state actively provide pharmacy services and practice various recommended infection prevention and control measures to mitigate the spread of COVID-19 infection in their communities.

Extracts of endophytic fungi from leaves of selected Nigerian ethnomedicinal plants exhibited antioxidant activity.

BACKGROUND: Plants with an ethnobotanical history are known to harbor diverse group of endophytic fungi, which constitute major natural sources of bioactive compounds. In the present study, we evaluated the antioxidant activity of endophytic fungi from eight Nigerian ethnomedicinal plants. Endophytic fungi were isolated from the leaves of Acalypha ornata, Albizia zygia, Alchornea cordifolia, Chrysophyllum albidum, Ficus exasperata, Gomphrena celosioides, Millettia thonningii, and Newbouldia laevis. METHODS: Endophytic fungi were isolated from the leaves of selected plants via surface sterilization. Isolated fungi were identified by internal transcribed spacer (ITS-rDNA) sequence analysis. Pure fungal strains were subjected to fermentation process on solid rice medium and metabolites extracted using ethyl-acetate. Fungal crude extracts were screened for antioxidant activity using 2, 2- diphenyl-1-picrylhydrazyl (DPPH) radical scavenging and reduction of ferric ion assays. Gas chromatography/mass spectrometry (GC/MS) analysis was used to identify the major chemical constituents in active fungal extracts. RESULTS: A total of eighteen fungal endophytes with fungal codes CU (061 and 062); ZA (161, 162, 163, and 164); LO (261); CA (041, 042, and 043); FE (081, 082, and 084); GE (091); MO (211 and 212); and NA (021 and 022) were isolated from the eight ethnomedicinal plants A. ornata, A. zygia, A. cordifolia, C. albidum, F. exasperata, G. celosioides, M. thonningii, and N. laevis respectively. ZA 163 and MO 211 fungal extracts showed significant (p < 0.05) radical scavenging activity with IC50 values of 50.53 ± 0.01 and 86.69 ± 0.02 µg/ml respectively. Fungal extract CA 041 demonstrated significantly (p < 0.01) higher iron chelating activity than standard gallic acid with absorbance values of 0.803 and 1.107 at 250 and 500 µg/ml concentrations respectively. Pyrogallol, phenol, 2,6-dimethoxy-, phytol, dl-alpha-tocopherol, alpha-tocospiro, oleamide, methyl stearate, oleic acid, palmitic acid, campesterol, stigmasterol, ß-sitosterol, urs-12-en-24-oic acid, 3-oxo-, methyl ester, lup-20(29)-en-3-one, and lupeol were detected in the selected active extracts. CONCLUSION: These results showed that leaves of the selected Nigerian plants harbor diverse group of endophytic fungi, which can be potential antioxidant resource.