Journal of Pharmaceutical Health Care and Sciences最新文献

Background: Constipation is frequently observed in patients with chronic heart failure and has been linked to a heightened risk of adverse heart failure outcomes. Although laxatives are commonly prescribed, the optimal choice for individuals with heart failure remains uncertain. We evaluated the association between magnesium oxide use and heart failure prognosis in patients with chronic heart failure.

Methods: A retrospective observational study was conducted on patients admitted to our hospital for heart failure between January 2020 and December 2023 who were continued to be prescribed the same laxatives after discharge. Patients who received magnesium oxide for regular use were categorized into the magnesium oxide group, while all other patients comprised the nonmagnesium oxide group. The primary endpoints were heart failure-related readmission and all-cause mortality, while the secondary endpoint was a composite of both. Propensity scores were calculated based on baseline patient characteristics and used to perform 1:1 nearest-neighbor matching.

Results: During the study period, 171 outpatients with heart failure were prescribed laxatives after hospital discharge, with 74 patients included in the magnesium oxide group. Using propensity score matching, a cohort of 41 matched pairs was established. After matching, the analysis showed that the hazard ratio (HR) for first readmission within 360 d was 0.33 (95% confidence interval [CI]: 0.10-0.92, p = 0.035). Additionally, the combined risk of first readmission and all-cause mortality was associated with an HR of 0.30 (95% CI: 0.11-0.82, p = 0.019).

Conclusion: Magnesium oxide was strongly associated with a lower risk of readmission and/or death in patients with heart failure who were prescribed laxatives.

Trial registration: N/A. Cases were registered retrospectively.

Background: Infusion reactions (IRs) are common adverse events associated with biologics, often triggered by cytokine release from immune and tumor cells. Antibody-dependent cellular cytotoxicity (ADCC) is a key immune mechanism in which therapeutic antibodies recruit immune effector cells, such as natural killer cells, to induce target cell lysis. This study aimed to clarify the association between activated ADCC and IRs in antitumor antibodies using the Japanese Adverse Drug Event Report (JADER) database.

Methods: Data from the JADER database (April 2004 to February 2022) were analyzed to identify IRs related to 25 antitumor antibodies. The reporting odds ratio (ROR) was calculated to assess the association between IRs and antitumor antibodies, and statistical analyses were conducted using Fisher's exact test.

Results: Avelumab was the only anti-PD-1/PD-L1 antibody with a significant association with IRs (ROR: 5.44, 95% confidence interval [CI]: 3.59-8.22). Antibodies with ADCC activity detected significantly more IR signals (9/14, 64.3%) than those without ADCC activity (1/11, 9.1%; p = 0.0119).

Conclusions: This study suggests an association between ADCC and the occurrence of IRs in antitumor antibodies based on JADER database analysis. These findings provide valuable insights for the prevention and management of IRs.

Background: The 2022 revision of Japanese healthcare reimbursement removed pharmacists from the mandatory dysphagia team, despite emerging evidence of medication-related swallowing complications. Our previous pharmacovigilance analysis identified dopamine-blocking drugs as primary contributors to the risk of aspiration pneumonia. This study aimed to validate these findings through a clinical examination of pharmaceutical interventions performed by a multidisciplinary dysphagia team.

Methods: This retrospective observational study was conducted at a 97-bed community hospital in Osaka, Japan, from June 2023 to January 2024. All adult patients with suspected dysphagia who underwent a multidisciplinary team intervention were included in our analysis. Pharmaceutical intervention was requested when medication-related dysphagia or swallowing difficulties were suspected, with interventions classified into the following four categories: drug-induced dysphagia management, dosage form optimization, swallowing aid utilization, and medication burden reduction. Changes in the medication burden were analyzed using paired t-tests.

Results: Among 59 patients with dysphagia (mean age, 81.1 ± 9.8 years; 33 males [55.9%], 26 females [44.1%]), 13 (22.0%) underwent pharmaceutical interventions. Drug-induced dysphagia management was the most common intervention (69.2%), targeting dopamine antagonists (sulpiride, risperidone, tiapride, and domperidone), benzodiazepines, and anticholinergics without dopamine-blocking effects. Suspected drug-induced dysphagia was the most common symptom among patients with dementia (38.9%). The intervention group showed a significant reduction in medication (mean, -3.2 medications; P < 0.001), whereas the non-intervention group showed no change. Among the non-intervention group, potential opportunities for the optimization of angiotensin-converting enzyme inhibitors were identified in antihypertensive therapy.

Conclusions: Pharmaceutical interventions may offer clinically meaningful contributions when utilized for patients with dysphagia, supporting the relevance of pharmacovigilance regarding the risks of dopamine antagonists. The findings of this study suggest the importance of reinstating pharmaceutical expertise to multidisciplinary dysphagia teams, as pharmacists provide clinically significant medication optimization, including identifying additional optimization opportunities through systematic medication reviews among vulnerable populations.

Background: Background factors for Candida spp. detection in urine include indwelling urinary catheters, diabetes mellitus, and a history of antimicrobial exposure; nevertheless, urinary tract infections caused by Candida spp. are usually rare. Fluconazole (FLCZ) is a preferable drug for the treatment of urinary tract infections caused by Candida spp.; however, some cases of urinary tract candidiasis resistant to FLCZ have been observed, making the selection of a therapeutic agent difficult. Recently, an increase in fungal genital infections has been reported alongside the increase in the use of sodium glucose cotransporter 2 (SGLT2) inhibitors. Although these medications have not been shown to increase urinary tract infections, concerns persist that they may promote colonization of the genital tract by Candida spp. and cause retrograde urinary tract infections, particularly in women. This is a rare case of Candida glabrata induced pyelonephritis and bacteremia in a patient receiving SGLT2 inhibitors, successfully treated with micafungin (MCFG).

Case presentation: A patient in her 70s under active treatment for breast cancer was diagnosed with a urinary tract infection and bacteremia caused by C. glabrata. The patient was taking SGLT2 inhibitors, and had no history of urinary catheter placement or antimicrobial exposure. In order to avoid the side effects of amphotericin B (AmB) and flucytosine (5-FC), the patient was treated with MCFG and FLCZ for 17 days. No adverse events or recurrence were recorded over the subsequent three months.

Conclusions: Patients taking SGLT2 inhibitors may be more susceptible to urinary tract infections caused by Candida glabrata, and in cases of azole-resistant Candida spp. urinary tract infection, MCFG may be a treatment option when AmB or 5-FC is difficult to use.

Background: Postoperative liver dysfunction has been　recognized as a potential complication following gastric cancer surgery, particularly in the context of enhanced perioperative nutritional management. Although early supplementation with amino acids and fat emulsions has been introduced to optimize recovery, its impact on postoperative liver function remains insufficiently elucidated. This study aimed to evaluate the incidence, time course, and risk factors of postoperative liver dysfunction, and to assess the safety of early nutritional support in this context.

Methods: This retrospective observational study included patients who underwent radical gastrectomy between January and July 2020 at Cancer Institute Hospital Ariake. All patients received early postoperative nutritional support including amino acid and fat emulsion supplementation. Liver function was assessed based on serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (T-Bil) levels on postoperative days (POD) 1, 3, 7, as well as at the first outpatient visit. Postoperative liver dysfunction was defined according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Risk factors for liver dysfunction on POD 7 were assessed using by univariate and multivariate analyses.

Results: Data for 170 patients were analyzed. AST and ALT levels showed a biphasic pattern, with two distinct peaks observed on POD 1 and POD 7. The incidence rates of Grade 1 or higher elevations were 51.8% for AST and 39.4% for ALT on POD 1, and 47.9% for AST and 42.0% for ALT on POD 7. At the first outpatient visit, the incidence declined markedly. Univariate analysis identified acetaminophen use as a significant risk factor for liver dysfunction on POD 7 (p < 0.05), with open surgery and extensive procedures showing trend-level associations. Multivariate analysis confirmed acetaminophen use as an independent risk factor. Importantly, no significant association was found between liver dysfunction and the administration of amino acids or fat emulsions, suggesting that early postoperative nutritional management appears to be safe.

Conclusions: Postoperative liver dysfunction is not uncommon in gastric cancer patients but is generally transient and clinically manageable. Early postoperative nutritional management, including amino acid and fat emulsion supplementation, appears to be safe and does not adversely affect postoperative liver function when appropriately administered. Careful monitoring of liver function, particularly in patients receiving acetaminophen, remains essential to optimize postoperative outcomes.

Background: Hyponatremia is an electrolyte abnormality that is often caused by the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and frequently encountered in the field of oncology. Although SIADH is a known complication of certain chemotherapeutic agents, its occurrence with oxaliplatin is rare. We report a case of SIADH in a patient with colon cancer who was undergoing treatment comprising capecitabine and oxaliplatin (CAPOX) plus bevacizumab.

Case presentation: A 70-year-old man with stage cT4bN2M0 colon cancer underwent chemotherapy with CAPOX plus bevacizumab. On day 7 of treatment, the patient developed severe hyponatremia (serum sodium level, 108 mmol/L) accompanied by nausea and ileus. Laboratory test results were consistent with SIADH, including low serum osmolality, elevated urine osmolality, elevated sodium concentration, and elevated antidiuretic hormone levels. The condition improved with 3% saline infusion and fluid restriction. No other underlying causes, such as central nervous system lesions or adrenal or thyroid dysfunction, were identified. CAPOX-induced SIADH was diagnosed based on clinical findings and the exclusion of other etiologies. Transition to second-line therapy was performed without SIADH recurrence.

Conclusions: Oxaliplatin-based regimens may rarely induce SIADH. Clinicians should be vigilant of electrolyte disturbances during chemotherapy and promptly manage hyponatremia to avoid severe complications.

Introduction: Self-medication(SM) is highly prevalent among university students in Uganda, This poses various challenges to the local healthcare system and the nation at large. SM is notorious for its undesirable effects like adverse drug events, drug addiction, antimicrobial resistance, progression of disease to more complicated forms, prolonged morbidity and death. However, some studies have documented reports of resolution of signs and symptoms among self-medicating individuals. This study purposed to investigate the association between patterns of SM and resolution of signs and symptoms among undergraduate students enrolled at Mbarara University of Science and Technology (MUST).

Methods: A descriptive cross-sectional study was conducted at Mbarara University of Science and Technology in Uganda from February 2024 to April 2024. A physical close-ended self-administered questionnaire was used to collect data from respondents. Analysis was done using SPSS version 25. The patterns of SM and the proportion of respondents who reported resolution of signs and symptoms were analysed and presented using descriptive statistics. Pearson's Chi-square was performed to analyse the association between patterns of SM and resolution of signs and symptoms at the significance level of P < 0.05.

Results: Out of 387 respondents, the prevalence of self medication was 71.1% (275/387). Majority of respondents who self-medicated, 85.1% (234/275), reported resolution of signs and symptoms of their illnesses. Most respondents who self-medicated were treating cough, 65.1% (179/275), and headache, 58.5% (161/275). Most of them used cough medications, 63.3% (174/275), and over-the-counter pain relievers, 51.3% (141/275). In the current study there was a statistically significant association between resolution of signs and symptoms and; having cough, (X²(1, N = 178) = 3.851, p = 0.050), having sore throat, (X²(1, N = 64) = 4.983, p = 0.026), and use of cough or cold remedies, (X²(1, N = 173) = 5.668, p = 0.017).

Conclusion: The findings of the current study are suggestive of the popularity of SM among students attending university in sub-Saharan Africa. This study also brings to light the significance of SM to the health care of this population. However, the convenience of resolution of signs and symptoms could mask looming dangers of SM that should be seriously considered by all stakeholders of public health.

Background: Given the high prevalence of menstrual disorders such as premenstrual syndrome (PMS) and dysmenorrhea among students and the anti-inflammatory and antioxidant properties of curcumin, we decided to conduct a study to determine the effects of curcumin on PMS and dysmenorrhea among medical students in Tabriz-Iran.

Methods: This double-blind randomized controlled trial was conducted on 62 students from Tabriz University of Medical Sciences in Iran during the 2023-2024 academic year. The participants were randomly assigned to the intervention (n = 31) and control (n = 31) groups. They were given curcumin and placebo capsules with the same dose of 500 mg once daily for 10 days during each of the two menstrual cycles (7 days before to 3 days after the estimated onset of menstruation). Data collection involved a sociodemographic characteristics questionnaire, the Premenstrual Symptoms Screening Tool (PSST), the Visual Analogue Scale (VAS), and a checklist to evaluate potential side effects. Independent t test and ANCOVA were employed to compare the results between the two groups.

Results: There was no significant difference between the study groups regarding sociodemographic characteristics and baseline values before the intervention. Based on the ANCOVA test and by adjusting the baseline values, the curcumin group showed a significant reduction in average score of PSST in 2nd menstrual cycle (MD: -5.2; 95% CI: -9.6 to -0.9; P = 0.018) and average score of VAS in 2nd menstrual cycle (MD: -0.8; 95% CI: -1.4 to -0.1; P = 0.012) and 3rd menstrual cycle (MD: -0.8; 95% CI: -1.5 to -0.08; P = 0.029) compared to the placebo group. None of the study groups reported adverse effects. There were no dropouts and all participants completed the treatment period successfully.

Conclusion: This study highlights the increasing evidence that curcumin is an effective natural treatment for PMS and dysmenorrhea. Further research into dose optimization, combination therapies, and long-term effects will strengthen its position in clinical practice.

Trial registration: Iranian Registry of Clinical Trials (IRCT) IRCT20120718010324N71. Date of first registration 18/09/2022. Date of first sampling 20/09/2022. URL https://irct.behdasht.gov.ir/trial/65582 .

Background: The immediate post-diagnosis period is a critical phase for cancer patients, marked by significant informational and emotional distress. Although pharmacists are well-positioned to provide support during this time, limited research has investigated patients' specific concerns and consultation needs immediately after diagnosis, particularly in differentiating between hospital and community pharmacists. This study aimed to clarify cancer patients' concrete concerns and consultation preferences immediately following diagnosis, with a focus on the respective roles of hospital and community pharmacists.

Methods: A nationwide cross-sectional web-based survey was conducted among 1,031 adult cancer patients in Japan. Participants selected relevant concerns from a 21-item structured questionnaire across four domains: Cancer and Cancer Treatment (CCT), Cancer Pain and Palliative Care (CPPC), Medications Other Than Cancer Treatment (MOCT), and Daily Life During Cancer Treatment (DLCT). For each concern, participants indicated whether they preferred to consult hospital pharmacists, community pharmacists, or both. McNemar tests were used to compare paired proportions (P < 0.001).

Results: A total of 89.2% of participants reported at least one concern at diagnosis. The most frequently reported concerns were treatment-related, including side effects (49.2%), treatment costs (48.0%), psychological distress (41.6%), and mechanisms of anticancer drugs (38.8%). Patients expressed significantly stronger preferences for consulting hospital pharmacists over community pharmacists on treatment-specific topics such as side effects (34.7% vs. 13.8%), drug mechanisms (39.3% vs. 18.5%), and medications to relieve physical discomfort (36.1% vs. 17.0%) [all P < 0.001]. In contrast, MOCT-related concerns, such as drug interactions and medication management, elicited similarly high consultation preferences for both pharmacist types (> 40%). DLCT and CPPC-related concerns were associated with relatively lower consultation demands overall.

Conclusions: Cancer patients experience diverse and substantial informational and emotional needs immediately after diagnosis. Hospital pharmacists are particularly valued for treatment-specific support, while both hospital and community pharmacists are seen as essential resources for broader medication-related concerns. Enhancing cooperation between hospital and community pharmacists, and strengthening pharmacist-led support tailored to patients' needs at diagnosis may significantly improve patient-centered care and quality of life.