Clinically Approved Monoclonal Antibodies-based Immunotherapy: Association With Glycemic Control and Impact Role of Clinical Pharmacist for Cancer Patient Care.

PURPOSE: Compared with more conventional, nonspecific therapy options, such as radiotherapy and chemotherapy, monoclonal antibodies (mAbs) constitute a crucial approach of cancer treatment. Multiple autoimmune diseases have been observed during treatment with mAb medications, including autoimmune diabetes mellitus (DM). This study provides a narrative review of clinically approved mAbs in cancer treatment and focuses on the development of hyperglycemia and DM arising from using these therapies. Furthermore, it highlights the critical role of oncology clinical pharmacists in the management of autoimmune DM and patient care while using these medications in an oncology setting. METHODS: An extensive literature search was conducted using various sources of electronic databases, such as Scopus, Embase, Web of Science, and PubMed, and search engines, such as Google Scholar, for studies on mAb classification, types, mechanisms of action, pharmacokinetic properties, current clinical applications, and the associated common adverse effects with significant recommendations for patient care in an oncology setting, along with focusing on the proposed mechanisms and clinical studies that reported the association of DM after the use of these therapies. FINDINGS: There are 4 types (murine, chimeric, humanized, and human) and 3 classes (unconjugated, conjugated, and bispecific) of mAbs with several mechanisms of action that can destroy cancer cells, including preventing tumor cell survival cascades, inhibiting tumor growth by interfering with tumor angiogenesis, evading programmed cell death, and bypassing immune checkpoints. However, multiple endocrinopathies, autoimmune diseases, and complications were reported from the use of these medications, including the development of autoimmune DM and diabetic ketoacidosis. These autoimmune disorders were reported most with the use of immune checkpoint inhibitors, including inhibitors of the programmed cell death protein 1 (nivolumab and pembrolizumab), its ligand (atezolizumab, avelumab, and durvalumab), and cytotoxic T-lymphocyte-associated protein 4 (ipilimumab). IMPLICATIONS: mAbs are considered important approaches for the treatment of many cancer types. However, a high incidence of hyperglycemia, type 1 DM, and diabetic ketoacidosis is observed with the use of these medications, particularly immune checkpoint inhibitors. It is important for oncologic clinical pharmacists to be involved in addressing these autoimmune disorders from the use of these immunotherapies via the provision of patient education, medication adherence support, close monitoring, and follow-up, which will lead to better health-related outcomes and improved patient quality of life.

A paradigm use of monoclonal antibodies-conjugated nanoparticles in breast cancer treatment: current status and potential approaches.

Monoclonal antibodies (mAbs) are integral to cancer treatment over conventional non-specific therapy methods. This study provides a scoping review of the clinically approved mAbs, focusing on the current application of different nanocarrier technologies as drug delivery targets for mAb-conjugated nanoparticles (NPs) as potential features for breast cancer (BC) treatment. An extensive literature search was conducted between the years 2000 and 2023 using various sources of databases. The first part covered mAb classification, types, and mechanisms of action, pharmacokinetics and clinical applications in BC. The second part covered polymeric, lipid and inorganic-based NPs, which are a variety of mAb-conjugated NPs targeting BC. A total of 20 relevant studies were enrolled indicating there are three different types of nanoparticular systems (polymeric NPs, inorganic NPs and lipid-based NPs) that can be used for BC treatment by being loaded with various active substances and conjugated with these antibodies. While mAbs have altered the way in cancer treatment due to targeting cancer cells specifically, the delivery of mAbs with nanoparticulate systems is important in the treatment of BC, as NPs are still being investigated as distinctive and promising drug delivery methods that can be employed for effective treatment of BC.

Evaluation of the therapeutic efficacy and tolerability of current drug treatments on the clinical outcomes of paediatric spinal muscular atrophy type 1: A systematic review.

Spinal muscular atrophy (SMA) is a severe hereditary lower motor neuron disorder characterised by degeneration of alpha motor neurons in the spinal cord, resulting in progressive weakness and paralysis of proximal muscles. A systematic literature search was carried out by using PRISMA guidelines and searching through different databases that could provide findings of evidence on the health outcomes of the approved therapies for the management of paediatric SMA type 1 regarding efficacy with follow-up in terms of motor and respiratory functions and the tolerability and incidence of adverse drug reactions (ADRs) post-treatment from real-world publications. Half of the publications (50%) had a prospective observational design. Eight studies (66.7%) assessed nusinersen, and three studies (25%) assessed onasemnogene abeparvovec with a duration of follow-up ranging from 6 months to 3 years to evaluate the motor and respiratory functions using different assessment tools, hospitalisation rates, and the tolerability and incidence of ADRs post-treatment. The three currently approved treatments for SMA type 1 provided good support and health outcomes in terms of motor function, respiratory outcomes, reduction of hospitalisations, and improvement of survival. Nevertheless, uncertainties regarding continued improvement after long-term illness and the generalizability of results are still unknown.

Assessment of acceptance, concerns and side effects towards COVID-19 vaccination among the community: A cross-sectional study from Baghdad, Iraq.

Introduction: The newly developed and marketed vaccines along with concerns about vaccine safety and long-term side effects has been raised an alarming in the general population. The aim of this study was to assess the rate of acceptance, perceptions and concerns towards receiving COVID-19 vaccines and to explore the incidence of vaccines' side effects among Iraqi population in Baghdad province, Iraq. Method: This was a descriptive, cross-sectional study conducted via direct interviews among a convenient sample size of Iraqi population using a structured validated questionnaire consisting of using 24-item questionnaire to assess acceptance, concerns and the incidence of vaccines' side effects towards receiving COVID-19 vaccines. Results: A total of 500 participants with an average age of 27.8 ± 3.7 years were included. Majority were females (70.6%). 43.4% had a history of COVID-19, and 46% received the Pfizer BioNTech vaccine. 73.4% (P < 0.0001) agreed about the importance of receiving the vaccination to protect the community against the COVID-19.46.8% (P < 0.0001) were unsure about the adverse effects and long-term vaccine safety. 72.8% reported that transmission of COVID-19 infection to family members is the main concern for accepting vaccination. Fatigue (60%), injection site reactions (55.8%) were the most common vaccine's side effects. Young age (P = 0.001), females (P < 0.0001), and university educational (P < 0.0001) were the most significant determents for accepting vaccination. Conclusion: This study highlights that the Iraqi population showed a considerable acceptance rate for the COVID-19 vaccines. However, vaccine safety is considered a high priority concern associated with the willingness of the population to vaccinate.

Potential therapeutic effects of different mouthwashes for alleviation and treatment of oral complications of 5-fluorouracil-based chemotherapy in patients with colon cancer.

OBJECTIVE: The primary endpoint of the present study was to assess the potential therapeutic effects of three different mouthwashes for alleviation and treatment of oral complications (OCs). The secondary endpoint was to assess patients' perceptions and daily functional activities after therapy of OCs in patients with colon cancer receiving 5-fluorouracil (5-FU)-based chemotherapy regimens. METHODS: A prospective, randomised controlled study carried out on 90 patients with colon cancer eligible for 5-FU-based chemotherapy regimens at the oncology centre, Istanbul, Turkey. Patients were randomly randomised into three groups (30 patients in each group) and received a single mouthwash. The first group (group A) received benzydamine at a dose of 15 mL; the second group (group B) received sodium bicarbonate at a dose of 1.2-2.4 g in 240 mL of water; and the third group (group C) received glutamine suspension 10 g. Patients were assessed for the occurrence of oral complications based on the WHO scale for oral mucosa evaluation and National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Oral pain was assessed using a visual analogue scale alongside assessment of patients' perceptions and daily functional activities based on the Rotterdam Symptom Checklist. RESULTS: A total of 119 oral complications were reported, including mouth dryness (n=56, 47.1%), oral mucositis (n=31, 26.1%) and oral pain (n=32, 26.8%). At the end of the study, patients of group A and group B significantly suffered from mouth dryness (p=0.0001), oral mucositis (p=0.029) and oral pain (p=0.039) compared with patients in group C. Although there was no significant change, group C patients showed a slight improvement in psychological discomfort, activity levels and quality of life at the end of the study. CONCLUSION: The present study showed that benzydamine and sodium bicarbonate mouthwashes were significantly less effective for the alleviation and treatment of oral complications compared with glutamine among patients with colon cancer receiving 5-FU-based chemotherapy regimens.

A cross-sectional study of community pharmacists' self-reported disease knowledge and competence in the treatment of childhood autism spectrum disorder.

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disease that can cause significant social, communication, and behavioural challenges. Given the rising prevalence of autism and multiple medication use, healthcare professionals, including community pharmacists, are required to have sufficient ASD knowledge to affect positively the disease prognosis and related comorbidities. AIM: To assess community pharmacists' knowledge of disease and pharmacotherapy of ASD, along with the provision of patient education and counselling provided by, community pharmacists in Turkey. METHOD: This was a descriptive, cross-sectional study conducted among community pharmacists in Turkey using a structured, validated questionnaire to assess ASD knowledge, awareness, and the provision of patient education and counselling by community pharmacists. RESULTS: 486 community pharmacists were included, with a mean age of 39.69 ± 13.10 years, and most (n = 151, 31.1%) in the age range between 20 and 29 years. 96.3% of community pharmacists never had training about ASD. 32.9% of the participants were aware of the medicines for ASD treatment, and 25.7% were aware of the drugs' side effects. The mean overall knowledge about childhood autism among health workers questionnaire (KCAHW) score was 11.83 ± 3.91, and there was a statistically significant KCAHW score difference between other pharmacists and those with ASD training (p = 0.006). CONCLUSION: There is a lack of disease and pharmacotherapy knowledge about childhood ASD among Turkish community pharmacists, particularly about communication impairment, type, onset, and comorbidities, as well as poor knowledge about drug pharmacotherapy and patient counselling services. This potentially creates a barrier to the adequate provision of healthcare to autistic patients.

Exploring the Intention and Hesitancy to Receive a Booster Dose of COVID-19 Vaccine among Patients with Comorbid Disease Conditions Using a Health Belief Model.

Despite the fact that the WHO recommends that adults over the age of 18 have to receive a booster dose of the COVID-19 vaccine. The willingness and intention to accept a booster dose of the COVID-19 vaccine remain major issues among the general population, particularly patients with comorbid disease conditions. The aim of this study was to assess the patterns regarding COVID-19 infection and vaccination, along with the intention and hesitancy to receive a booster dose of the COVID-19 vaccine among patients with comorbid disease conditions in Istanbul, Türkiye. Methods: This was a descriptive, cross-sectional study conducted among patients with comorbid disease conditions using a three-part, structured, validated questionnaire. Vaccine hesitancy from a booster dose of the COVID-19 vaccine was assessed using the Health Belief Model (HBM), based on a 5-point Likert-type scale. Results: The study enrolled 162 participants with a mean age of 57.2 ±â€¯13.3 years. 97% of the respondents received the COVID-19 vaccine. Almost half of respondents (51.2%) reported receiving information about a booster dose of the COVID-19 vaccine. HBM among the participants with comorbidities showed a significant agreement regarding the perceived susceptibility (P < 0.0001), perceived severity (P < 0.0001) and perceived benefits (P < 0.0001) to receive a booster vaccine dose. There was a statistically significant correlation between the intention to receive a booster vaccine dose and education level (university education; P < 0.0001). Conclusion: A vast and significant majority of patients with chronic comorbid disease conditions who received the COVID-19 vaccine reported an intention to receive a booster dose.

Introducción: A pesar de que la OMS recomienda que los adultos mayores de 18 años reciban una dosis de refuerzo de la vacuna contra el COVID-19. La voluntad y la intención de aceptar una dosis de refuerzo de la vacuna COVID-19 siguen siendo problemas importantes entre la población general, en particular los pacientes con enfermedades comórbidas. El objetivo de este estudio fue evaluar los patrones con respecto a la infección y vacunación de COVID-19, junto con la intención y la indecisión de recibir una dosis de refuerzo de la vacuna COVID-19 entre pacientes con enfermedades comórbidas en Estambul, Turquía.Métodos: Este fue un estudio descriptivo transversal realizado entre pacientes con enfermedades comórbidas utilizando un cuestionario validado, estructurado y de tres partes. La vacilación de la vacuna de una dosis de refuerzo de la vacuna COVID-19 se evaluó utilizando el Modelo de creencias de salud (HBM), basado en una escala tipo Likert de 5 puntos.Resultados: El estudio inscribió a 162 participantes con una edad media de 57,2 ±â€¯13,3 años. El 97% de los encuestados recibió la vacuna COVID-19. Casi la mitad de los encuestados (51,2%) informaron haber recibido información sobre una dosis de refuerzo de la vacuna contra la COVID-19. HBM entre los participantes con comorbilidades mostró un acuerdo significativo con respecto a la susceptibilidad percibida (P < 0,0001), la gravedad percibida (P < 0,0001) y los beneficios percibidos (P < 0,0001) para recibir una dosis de vacuna de refuerzo. Hubo una correlación estadísticamente significativa entre la intención de recibir una dosis de vacuna de refuerzo y el nivel educativo (educación universitaria; P < 0,0001).Conclusión: Una gran y significativa mayoría de los pacientes con enfermedades comórbidas crónicas que recibieron la vacuna contra el COVID-19 informaron tener la intención de recibir dosis de refuerzo.

The potential chemo-preventive roles of Malus domestica against the risk of colorectal cancer: A suggestive insight into clinical application.

Biologically active compounds in fruit-derived ingredients, particularly phytochemicals, have significant potential to modulate and mitigate many pathological processes in the development of disease conditions, including cancer. Colorectal cancer (CRC) remains a major public health issue. Nonetheless, prevention is an important step in lowering the rate of mortality from this cancer. Currently, the link between apple consumption and improved health is becoming remarkably evident and is reported to be beneficial for human health. Phytochemicals, such as flavonoids and other polyphenol compounds extensively available in apple fruits, have well-known positive effects on health outcomes and the potential to combat and prevent the development of CRC, including antioxidant, anti-proliferative, and anti-carcinogenic effects. This review describes the bioactive compounds derived from apple fruits, particularly the polyphenols and flavonoids, their proposed mechanisms responsible for their bioactive properties and health-promoting attributes that could provide potential chemo-preventive effects against the risk of CRC development. The conclusion of the review provides insights into the potential effects of apple-derived bioactive compounds and proposes the need for more clinical studies in large trials for future strategies regarding the valuable effects of apple phytochemicals, which might be therapeutic candidates in the campaign against CRC.

Considerations into pharmacogenomics of COVID-19 pharmacotherapy: Hope, hype and reality.

COVID-19 medicines, such as molnupiravir are beginning to emerge for public health and clinical practice. On the other hand, drugs display marked variability in their efficacy and safety. Hence, COVID-19 medicines, as with all drugs, will be subject to the age-old maxim "one size prescription does not fit all". In this context, pharmacogenomics is the study of genome-by-drug interactions and offers insights on mechanisms of patient-to-patient and between-population variations in drug efficacy and safety. Pharmacogenomics information is crucial to tailoring the patients' prescriptions to achieve COVID-19 preventive and therapeutic interventions that take into account the host biology, patients' genome, and variable environmental exposures that collectively influence drug efficacy and safety. This expert review critically evaluates and summarizes the pharmacogenomics and personalized medicine aspects of the emerging COVID-19 drugs, and other selected drug interventions deployed to date. Here, we aim to sort out the hope, hype, and reality and suggest that there are veritable prospects to advance COVID-19 medicines for public health benefits, provided that pharmacogenomics is considered and implemented adequately. Pharmacogenomics is an integral part of rational and evidence-based medical practice. Scientists, health care professionals, pharmacists, pharmacovigilance practitioners, and importantly, patients stand to benefit by expanding the current pandemic response toolbox by the science of pharmacogenomics, and its applications in COVID-19 medicines and clinical trials.

Insights into disease and pharmacotherapy knowledge of Alzheimer's disease among community pharmacists: a cross-sectional study.

OBJECTIVE: To assess the knowledge level and awareness of Alzheimer's disease, including knowledge about the disease, pharmacotherapy, provision of patient education and associated factors among community pharmacists across Turkey and Northern Cyprus. METHODS: This was a descriptive, cross-sectional study conducted among community pharmacists working in Turkey (Group A) and Northern Cyprus (Group B). Disease and pharmacotherapy knowledge of AD were assessed using AD Knowledge Scale (ADKS), and drug treatment (KADT) scale, respectively. RESULTS: Both groups reported a moderate level of knowledge of AD, especially medically-oriented domains, with no significant difference regarding the mean ADKS domains (18.8 ± 2.8 vs. 18.9 ± 3.4; p = .98). Nevertheless, participants from both groups reported a good level of KADT knowledge about AD treatment (p = .03). Group A reported a statistically significant higher level of knowledge about drug interactions compared with Group B (54.6% vs. 45.8%; p = .01), and knowledge about proper information (79.6% vs. 31.8%; p = .02). There was a statistically significant KADT difference correlated with gender, those having a Master degree, more than 5 years of work experience, and those taking AD training courses. CONCLUSION: There is still a lack of knowledge regarding AD reported by moderate ADKS score, especially in medically-oriented domains, which creates a barrier to early provision of care and preventing AD, noted with no difference among community pharmacists across Turkey and Northern Cyprus.

Clinical outcomes of multidimensional association of type 2 diabetes mellitus, COVID-19 and sarcopenia: an algorithm and scoping systematic evaluation.

BACKGROUND: The aim of this study was to provide a scoping and comprehensive review for the clinical outcomes from the cross-link of Type 2 diabetes mellitus (T2DM), COVID-19, and sarcopenia. METHODS: By using PRISMA guidelines and searching through different databases that could provide findings of evidence on the association of T2DM, COVID-19, and sarcopenia. RESULTS: Thirty-three studies reported a relationship between sarcopenia with T2DM, twenty-one studies reported the prognosis COVID-19 in patients with T2DM, ten studies reported the prognosis of COVID-19 in patients with sarcopenia, five studies discussed the outcomes of sarcopenia in patients with COVID-19, and one study reported sarcopenia outcomes in the presence of T2DM and COVID-19. CONCLUSION: There is an obvious multidimensional relationship between T2DM, COVID-19 and sarcopenia which can cause prejudicial effects, poor prognosis, prolonged hospitalisation, lowered quality of life and a higher mortality rate during the current COVID-19 pandemic.

The Long View on COVID-19 Theranostics and Oral Antivirals: Living with Endemic Disease and Lessons from Molnupiravir.

The long view on living with COVID-19 as an endemic disease calls for expanding the planetary health intervention toolbox. We will need a battery of vaccines, small molecule oral antiviral drugs, and biomarkers to forecast antiviral drug efficacy and safety. In this context, theranostics refers to fusion of therapeutics and diagnostics. We examine here emerging pathways to theranostics innovation for COVID-19 oral antiviral drugs, with molnupiravir as a case study. With new virus variants (1) variations in the molnupiravir efficacy target, viral RNA-dependent RNA polymerase, (2) variability in pharmacokinetics and exposure to molnupiravir active moiety in fluids on virus entry points to the host (e.g., saliva, tears, and nasal secretions), (3) variability in transformation from prodrug molnupiravir to its active form, and (4) variability in putative adverse effects on human/host cells, all warrant attention for prospects and challenges vis à vis theranostics innovation for COVID-19 oral antivirals. The emerging lessons from molnupiravar are of interest to future design of COVID-19 theranostic research with other oral antiviral medications. Regulatory agencies, the pharmaceutical industry, research funders, governments, and ministries of health around the world have important stewardship roles to advance the subpopulation level analyses of clinical trial data on oral antiviral drugs for COVID-19. This would remedy the current lag in clinically relevant multiomics theranostics for oral antivirals in the battle against COVID-19.

Implications of Health Care Providers by Physicians' and Pharmacists' Attitudes and Perceptive Barriers towards Interprofessional Collaborative Practices

Abstract The study was aimed at assessing and comparing physicians' and pharmacists' attitudes and experiences with collaborative practices, along with the extent of barriers toward interprofessional collaboration in Iraqi healthcare settings. A descriptive, cross-sectional study was conducted among physicians and pharmacists in different healthcare settings in Baghdad, Iraq through an interview using a structured 3-part questionnaire, assessing the demographic characteristics, attitudes and barriers to interprofessional collaborative practices. A total of 384 participants were enrolled in this study. The physicians and pharmacists reported a significant positive attitudes towards collaboration, such as ''pharmacists are qualified to assess and respond to patients' drug treatment needs'' (69.8%, vs. 89.6%,; P=0.001);''pharmacists have special expertise in counseling patients on drug treatment'' (59.9%, vs. 86%; P=0.001); ''physicians and pharmacists should be educated to establish collaborative relationships'' (80.7%, vs. 100%; P=0.001), respectively. However, 57.3% of the physicians agreed about ''lack or inadequate of pharmacists' time to provide direct and effective patient care because of medications dispensing duties'', while 56.8% of the pharmacists disagreed about this barrier (P=0.005). Both professions reported significant, positive attitudes and shared some barriers toward collaborative practices; however, there is a disagreement in some areas in which both professions would like more collaboration for better patient care.

A Cross-Sectional Study of Patients' Practices, Knowledge and Attitudes of Antibiotics among Iraqi Population.

INTRODUCTION: The misconception and misuse of antibiotics among the public has been widely outlined to be one of the main reasons for bacterial resistance. The aim of the present study was to assess the practices, level of knowledge and attitudes regarding the rational and self-medication use of antibiotics in the general public in different districts of Baghdad province, Iraq. METHODOLOGY: A descriptive, cross-sectional study conducted among 384 participants through an interview using a structured 3-parts questionnaire, consisting of 24 items assessing the demographic characteristics, practices, level of knowledge and attitude towards rational antibiotics use. RESULTS: 45.8% of the study participants reported self-medication of antibiotics without prescription. Flu/common cold and sore throat represented the majority of medical conditions for antibiotics intake without prescription (44.9%, 31.3%) respectively. Oral amoxicillin (34.1%) was the most common non-prescription antibiotic. 50.3% had education about the rational use of antibiotics. 41.4% reported intake of antibiotics after having medical advice, 44% suggested their antibiotics not to be used by other members, and 52.9% stated the importance of antibiotic education among the public. However, 57% of the respondents had negative attitudes regarding antibiotics use for sore throat/fever, the effectiveness of antibiotics for cold/flu (54.7%) and cough (49.2%), to keep antibiotics for future use (40.9%) and not completing the antibiotic course after feeling well (49.2%). CONCLUSIONS: A widespread use of antibiotics without prescription was reported, providing some crucial gaps and a lower level of practice, knowledge and attitudes regarding the use of antibiotics among a sample of the Iraqi population.

Evaluation of online counselling services based on Turkish web-based pharmacy care setting: A retrospective observational study.

AIMS OF THE STUDY: To determine the types of online pharmacy care services provided by the clinical pharmacists regarding identification of medication-related problems, provision of counselling services for health and disease conditions alongside medications' counselling for patients seeking online consultation about health, medication and lifestyle concerns based on Turkish web-based pharmacy care setting(WPCS). METHODS: A retrospective, descriptive cohort study carried out on patients during their online visiting of Turkish WPCS seeking consultation for diverse kinds of concerns from September 2015 to March 2016. Patients' health and medication data were gathered for assessment of health-, medication- and lifestyle-related concerns. Descriptive analysis and Chi square test were used to analyse study data. Study outcomes included personalised online pharmacy care services regarding identification of medication-related problems, counselling services for health and disease conditions and medications' counselling alongside associations with counselling-related concerns by the WPCS. RESULTS: A total of 350 participants enrolled in this study and the majority of them were women (62.6%). Dermatological and gynaecological conditions represented the majority of disease conditions (51.4%, 44.6%), respectively. Within 1 year, 63.7% of the study participants visited the Turkish WPCS more than three times. Medication- and health-related concerns were reported by 90.8% and 68.3% of the study participants, respectively. Medication side effects (44.1%) and an inappropriate medication timing (31.4%) were the major medication-related problems identified. A total of 477 different counselling services regarding health conditions and 990 counselling regarding medications were provided by the clinical pharmacist through the Turkish WPCS. CONCLUSION: The WPCS could be considered as an additional option for the clinical pharmacist to provide care services regarding identification of medication-related problems, provision of counselling about health and disease conditions alongside different medication counselling to improve health conditions and proper pharmacotherapy management.

Current topical trends and novel therapeutic approaches and delivery systems for oral mucositis management.

Oral mucositis (OM) is an extremely serious and challenging complication of chemoradiotherapy, which may limit the efficacy of cancer treatment. Complications related to OM include potential nutrition impairment, high economic burden, and negative impacts on patients' quality of life. Current therapeutic options with local traditional pharmaceutical formulations are largely focused on controlling symptoms, and only few agents are available for treatment. Several local supportive and palliative agents are used for the prevention of OM; however, a standard treatment for the disease has not been confirmed yet. The efficacy of treatment could be improved through the introduction of new medical agents with updated dosage forms that can enhance and optimize local drug delivery and create greater therapeutic effects with fewer side effects. The focus of this review was to provide clear and direct information about the currently available topical therapeutic agents in clinical practice used to cure and/or reduce the incidence of ulcerative symptoms of OM, excluding the associated pain and other coexisting complications such as bacterial and fungal infections. The review also provides recent evidences regarding agents that could be used as promising novel therapies in updated local delivering systems. This will support further encouraging options and approaches for the management of OM and will improve compliance that could be translated in better disease control and survival.

Impact of clinical pharmacy recommendations and patient counselling program among patients with diabetes and cancer in outpatient oncology setting.

INTRODUCTION: The simultaneous occurrence of diabetes and cancer may complicate the management of both conditions resulting in poor prognosis and more deterioration of patient-related outcomes. OBJECTIVE: To assess the effective provision of clinical pharmacy services and pharmacist-led counselling program on improving patient-related outcomes among patients with diabetes and newly diagnosed with cancer during chemotherapy administration. METHODS: A single-centre, prospective, randomised, controlled study was carried out on patients with diabetes newly diagnosed with cancer during chemotherapy administration at the outpatient oncology setting. Patients were assigned as a normal care group receiving only normal care by the oncology care providers and an intervention group receiving both normal and clinical pharmacy care through an extensive oral and written patient education, pharmacotherapy optimisation and regular recommendations for diabetic self-care activities with three-month follow-up. RESULTS: Patients within the intervention group showed a better glycaemic control (p = .049), a significant increase in medication adherence (p = .0049), a significant increase in diabetes self-care activities, including diet (p = .037), self-monitoring of blood glucose (p = .027) and foot care (p = .0085) and reported a lower deterioration in quality of life. CONCLUSION: Patients with diabetes and cancer receiving chemotherapy experienced improved patient-related outcomes after clinical pharmacy intervention and counselling program compared to the normal care group.

Evaluation of goserelin effectiveness based on assessment of inflammatory cytokines and symptoms in uterine leiomyoma.

Background Uterine leiomyoma is a benign tumour of the uterine smooth muscles associated with an elevated level of inflammatory cytokines. Goserelin, a synthetic gonadotropin-releasing hormone analogue, suppresses the production of sex hormones and release of inflammatory cytokines in uterine leiomyoma cells. Objective The primary objective of this study was to find out the effectiveness of subcutaneous goserelin therapy on lowering serum levels of inflammatory cytokines and improving uterine leiomyoma-related symptoms in female patients diagnosed with uterine leiomyoma. The secondary objective was to assess the tolerability to goserelin therapy used in the management of this tumour. Setting Outpatient gynaecological clinic of the medical consultation department of Baghdad Teaching Hospital, Baghdad province, Iraq. Methods A single centre, prospective, longitudinal, cohort study was carried out on female patients diagnosed with uterine leiomyoma. Goserelin 3.6 mg subcutaneous injection was given in a consecutive monthly dose for the total time duration of three months. Serum levels of inflammatory cytokines, tumour necrosis factor-α and monocyte chemotactic protein-1 were detected before and after goserelin therapy in a consecutive monthly assessment. The study also assessed the improvement in uterine leiomyoma-related symptoms, including pelvic pain alongside the incidence of goserelin-related side effects during therapy schedules. Main Outcome Measures Assessment of serum levels of tumour necrosis factor-α and monocyte chemotactic protein-1 alongside uterine leiomyoma-related symptoms, including pelvic pain and goserelin-related side effects. Results There was a significant decrease in serum levels of tumour necrosis factor-α and monocyte chemotactic protein-1 compared to the baseline level over the 3-month duration of goserelin therapy (0.11 ± 0.02 vs. 0.74 ± 0.19) pg/mL; (0.07 ± 0.00 vs. 0.44 ± 0.18) pg/mL respectively. Patients showed a clinical improvement regarding uterine leiomyoma-related symptoms following each of the consecutive monthly doses of goserelin therapy (n = 11, 55%, P < 0.0001; n = 15, 75%, P < 0.0001; n = 18, 90%, P < 0.0001) respectively. This also includes a significant decrease in the intensity of leiomyoma-related pelvic pain before and after goserelin therapy (7.2 ± 1.43 vs. 3.05 ± 1.14, P < 0.0001). The majority of patients reported vaginal dryness (60%) as the main goserelin-related side effect. Conclusion Goserelin therapy reduces serum levels of inflammatory cytokines, tumour necrosis factor- α and monocyte chemotactic protein-1, improving leiomyoma-related symptoms with good tolerability in patients with uterine leiomyoma.

Potential Confounders and a Modified Framingham Risk Score for the Prediction of Pregnancy-related Medical Conditions Occurrence among Pregnant Women: A Retrospective Study from Baghdad, Iraq.

BACKGROUND: The incidence of pregnancy-related medical conditions relied on a set of potential factors that could be available even before the term of pregnancy and may be associated with poor outcomes later in life. This study aimed to investigate the association between some potential predictive factors related to maternal, gestational, and clinical parameters and the incidence of pregnancy-related medical conditions in a sample of Iraqi pregnant women. MATERIALS AND METHODS: A retrospective, observational, single-center study was carried out on 92 pregnant women during their routine visit to the obstetric clinic in a certain distinct of Baghdad province, Iraq. Demographic, gestational, and clinical records of the participants were collected and analyzed to detect the predictive factors for pregnancy-related medical conditions. RESULTS: 56.5% of the participants were at a gestational age of 25-37 weeks. 32.6% complained of pregnancy-related medical conditions, mainly gestational hypertension and diabetes mellitus. Pregnant women with pregnancy-related medical conditions were significantly correlated with a family history (P < 0.0001), previous gestational medical conditions (P < 0.001), diastolic blood pressure (P = 0.0011), different lipid panels (P = 0.0001), and maternal blood phenotype O (P = 0.0001). CONCLUSION: Some predictive factors related to maternal, gestational, and health characteristics are correlated with the incidence of pregnancy-related medical conditions. Interventions to adjust and recognize these confounders are essentials even before pregnancy which could improve maternal health and reduce the overall risk of pregnancy-related medical conditions.

Clinical Characteristics of Pregnant Women on the Use of Daily Low-dose Aspirin in Different Hypertensive Pregnancy Disorders: A Retrospective Comparative Study.

BACKGROUND: Hypertensive disorders represent major causes of maternal and fetal complications. It includes a range of conditions, most notably preeclampsia. Aspirin is a well-accepted therapy for the primary and secondary prevention of cardiovascular events. The indications for the use of aspirin during pregnancy are, however, the subject of much concern. This study aimed to assess the clinical characteristics from the benefits of daily low-dose aspirin administration alongside antihypertensive in pregnant women with different hypertensive disorders. MATERIALS AND METHODS: A retrospective observational study was carried out on pregnant women during their routine visit to the obstetric clinic at Baghdad Teaching Hospital. Patients diagnosed during pregnancy with different hypertensive disorders on the prescription of antihypertensive medication with or without daily low-dose aspirin administration were selected. Data were collected to structure a detailed assessment regarding the patients' demographic, gestational, and medical records. RESULTS: Methyldopa was the main antihypertensive agent (98%). Among pregnant women with daily aspirin use, 68% had gestational hypertension, 24% had preeclampsia alongside proteinuria (P = 0.0001), the frequency of daily dose intake of methyldopa (250 mg) tablet (two vs. three times) was significant (P = 0.0001). All pregnant women within the group of daily low-dose aspirin were safe from the incidence of eclampsia (P = 0.0001). CONCLUSION: This study provides intriguing evidence for the benefits of daily low-dose aspirin use during pregnancy as it is considered as a simple protective measure from serious maternal complications of hypertensive disorders, where these complications continue to affect maternal health long after delivery.