Search Results (1,368)

In recent years, the consumption of Amanita muscaria has gained popularity as a perceived natural alternative to psychoactive substances, often promoted online for its supposed therapeutic properties. However, the safety of such preparations remains largely unverified, particularly with regard to toxic element content. The present study focused on evaluating how different preparation methods affect the concentrations of cadmium (Cd) and lead (Pb) in the most commonly consumed Amanita muscaria products. A total of 50 mushroom caps were collected in October 2024 from the Stąporków Forest District in central Poland. Seven types of preparations were analyzed: dried with skin, dried without skin, tincture (mineralized and direct), boiled, fermented, infusion, and decoction. Samples were analyzed using atomic absorption spectrometry (AAS); depending on the preparation type, some underwent acid digestion prior to measurement. Statistically significant differences in lead concentrations were observed between the various preparation types (p = 0.002; η² = 0.97). Lead levels in the direct tincture were significantly higher than those in the boiled (p = 0.001), infusion (p = 0.001), decoction (p = 0.009), and dried without skin (p = 0.04) forms. Significant differences in cadmium concentrations were also found (p = 0.006; η² = 0.94), with lower Cd levels in the decoction compared to the dried with skin (p = 0.009) and without skin (p = 0.001), as well as in the fermented form compared to the dried samples (p = 0.03 and p = 0.004, respectively). These findings demonstrate that the type of preparation significantly influences the levels of cadmium and lead in Amanita muscaria products. While aqueous and fermented preparations showed reduced metal concentrations, none can be considered entirely safe, as even lower levels of Cd and Pb may pose health risks with frequent or excessive consumption. Full article

Berberine, a natural isoquinoline alkaloid, has been shown to improve glycemic control, lipid metabolism, and blood pressure regulation. However, its poor bioavailability has limited widespread clinical use. ToBeRock^® is a self-emulsifying formulation designed to enhance the bioaccessibility of berberine. This retrospective, real-world pilot study conducted through community pharmacies with pharmaceutical care services aimed to evaluate the metabolic and hemodynamic effects of ToBeRock^® in adults with impaired fasting glucose (IFG). Sixty adults with IFG (FPG 100–125 mg/dL) were enrolled through territorial pharmacies offering pharmaceutical services. Patients were retrospectively grouped into two cohorts: a Low-Dose Group (ToBeRock^® 1 capsule/day) and a High-Dose Group (ToBeRock^® 2 capsules/day). Capillary blood sampling and in-pharmacy blood pressure measurements were recorded at baseline (T0), 4 weeks (T1), and 8 weeks (T2). Evaluated parameters included fasting glucose, HbA1c, lipid profile (total cholesterol, LDL, HDL, triglycerides), systolic and diastolic blood pressure (SBP/DBP), and oxidative stress markers (FORT, FORD). Both cohorts showed statistically significant reductions in fasting glucose (p < 0.001), LDL (p = 0.036 Low-Dose/p = 0.039 High-Dose), and triglycerides (p = 0.012/0.009) after 8 weeks of treatment. The High-Dose Group experienced a greater improvement in HbA1c (−0.26%, p = 0.041) and a mild but statistically significant increase in HDL (p = 0.049). Improvements in oxidative balance were observed with significant reductions in FORT (p = 0.019/0.011), increases in FORD (p = 0.033/0.008), and a favorable shift in the REDOX index (p = 0.012/0.006). Systolic blood pressure decreased by −6.3 mmHg in the Low-Dose Group (p = 0.031) and −7.6 mmHg in the High-Dose Group (p = 0.048), while diastolic pressure dropped by −3.9 mmHg (p = 0.044) and −4.2 mmHg (p = 0.051), respectively. This real-world, retrospective analysis highlights the potential clinical benefit of ToBeRock^® in improving glycemic, lipid, oxidative, and hemodynamic profiles. The High-Dose Group demonstrated more consistent and significant results, supporting the dose-responsive efficacy of the bioavailable formulation and the value of pharmacy-based monitoring of nutraceutical interventions. Full article

Aerobic granules are dense three-dimensional microbial aggregates which are known for their excellent settling ability, high biomass retention, and simultaneous biological reaction due to their multilayered structure. All these features enable the aerobic granules to remove emerging contaminants, such as pharmaceutical and personal care products (PPCPs), endocrine-disrupting compounds (EDCs), microplastics, and per- and polyfluoroalkyl substances (PFASs) in municipal and industrial wastewater. This review discusses the development and application of the aerobic granules, especially in a sequencing batch reactor (SBR) with a height over diameter (H/D) ratio of 5 to 10. The mechanisms of EC removal in aerobic granules and the removal efficiency of the ECs by aerobic granules were also scrutinized, with the reported removal efficiency ranging from 10–100% for PPCPs, 84–94% for EDCs, 74–95% for microplastics, and more than 85% for PFAs. In spite of the huge potential of aerobic granular technology, its large-scale implementation is hampered by operational and scaling challenges. Future research should focus on optimizing the operational parameters and overcoming the scale-up barrier to fully leverage the potential of aerobic granules in removing ECs. Full article

Background: Remdesivir is associated with hepatotoxicity and acute kidney injury (AKI). The objective of this study was to assess the hepatotoxicity and AKI with remdesivir. Method: This is a multicenter, retrospective cohort study for adult patients who used remdesivir for COVID-19 from 3/2020 to 10/2021. The study was conducted at Rhode Island Hospital, Rhode Island, United States. Data were analyzed with descriptive statistics as well as logistic regression analysis using STATA 18. Results: A total of 1635 patients were evaluated for hepatotoxicity: 337 developed hepatotoxicity, and 1298 had normal hepatic function. The overall median frequency of hepatotoxicity occurred in 319 patients (19.5%). Patient age (OR 1.02, 95% CI: 1–1.04, p = 0.02) and selective serotonin reuptake inhibitors (SSRIs) use (OR 1.7, 95% CI: 1.1–2.6, p = 0.01) were potential risk factors for remdesivir-associated hepatotoxicity. In contrast, being male gender was protective against remdesivir-associated hepatotoxicity (OR 0.63, 95% CI: 0.47–0.87, p = 0.02). The frequency of AKI with remdesivir occurred in 280 patients (17.3%). Conclusions: The frequency of hepatotoxicity was 19.5%, and the frequency of AKI was 17.3%. Increasing age and using SSRIs were risk factors for remdesivir-associated hepatotoxicity, while male gender was a protective factor. Clinicians should vigilantly monitor hepatic and renal functions for patients using remdesivir, especially in elderly patients. Full article

In pharmacy, theoretical and methodological approaches from anthropology and the social sciences have been increasingly used to understand the complexity of health–disease processes and their relationship with medicines and social practices. Ethnography offers a critical and in-depth lens for analyzing phenomena in Primary Health Care (PHC), bridging persistent gaps between theory and method in health research. This article presents the theoretical and methodological trajectory of an ethnographic study on pharmaceutical services in PHC, conducted through participant observation in three Units in São Paulo, totaling 166 h of fieldwork. Data were recorded in field diaries and analyzed using a thematic inductive approach, leading to the development of conceptual categories and an analytical framework. Reflections on the method enabled interpretive analyses based on assumptions that were confronted with national and international trends in pharmacy literature. Constructing the method in a non-isolated, context-sensitive way was essential to understanding how pharmacists actively shape their practices in PHC. The study reinforces the relevance of participant observation as both a methodological and interpretive strategy, revealing that pharmaceutical services are being constructed through culturally situated practices that respond to health needs with the pharmacist’s active involvement. Full article

Antimicrobial resistance continues to escalate worldwide, threatening effective medical care, patient safety, and global health security. Traditional antibiotics are increasingly unreliable against multidrug-resistant pathogens, resulting in delayed appropriate therapy, prolonged illness, higher healthcare costs, and increased mortality. In this context, antimicrobial stewardship must evolve beyond the preservation of older drugs to include the judicious, evidence-based use of newer antibiotics. When used empirically in high-risk scenarios, novel agents can improve clinical outcomes by ensuring timely, effective coverage against MDR organisms while reducing the need for broad-spectrum combinations that drive collateral resistance and adverse effects. A major challenge, however, is the underutilization of these agents, which not only limits patient benefit but also undermines incentives for continued pharmaceutical innovation. To address this gap, stewardship programs must incorporate strategies for appropriate empiric deployment of new antibiotics, guided by local epidemiology, risk stratification, rapid diagnostics, and multidisciplinary decision-making. A coordinated global effort, linking stewardship, innovation, and policy reform, will be critical to optimize the role of novel antimicrobials in clinical practice moving forward. Full article

Background: Telepharmacy, the provision of patient care services by pharmacists through the use of telecommunications technology, is associated with improved diabetes-related outcomes and access to healthcare. The primary aim of this study was to characterize pharmacists’ interventions at a virtual pharmacist-led diabetes clinic (PLDC). The secondary aim was to assess the feasibility of conducting a future cost-effectiveness study of the PLDCs. Methods: This prospective observational feasibility study was conducted within a pharmacist-led clinic at Seha Virtual Hospital, Riyadh, Saudi Arabia. Two intern pharmacists collected data between 31 July 2024 and 31 January 2025. Results: Seventy-five patients (mean [SD] age 50.47 years [14.95]) attended the clinic. The majority were female (58.7%), had type 2 diabetes (86.6%), and were from outside Riyadh (97.3%). The communication with patients was carried out mainly via telephone (73, 97.3%). The mean consultation duration was 7.64 min (SD = 5.68). A total of 179 interventions were conducted, with a mean number of interventions per patient of 2.5 (median 3, min 0, max 5). The most common intervention was patient education and counseling about their disease and medications. While it was feasible to capture the details of pharmacist interventions and resource use data, incomplete data on patient outcomes presented a challenge. Conclusions: Our detailed documentation of pharmacist–patient encounters revealed the ability of pharmacists to identify and manage the problems of diabetes patients at virtual PLDCs. Our feasibility study identified a few challenges that need to be addressed when designing future cost-effectiveness studies. Full article

Background/Objectives: Pharmacists’ roles are shifting from dispensing medications to managing chronic diseases and prevention. Diabetes is a growing public health issue requiring early detection and management, where pharmacists can play a key role. The SMART Pharmacist Program promotes continuing education and expanded care, and a nationwide blood sugar screening campaign in North Macedonia was conducted to evaluate the impact of pharmacists in detecting undiagnosed diabetes and supporting glycemic control. Methods: This descriptive observational cross-sectional study was conducted mainly on 14 November 2024, in 98 community pharmacies across 14 cities. Participants over 18 years old were recruited via voluntary sampling. A total of 998 measurements were performed on the campaign day, with additional screening extending to 24 January 2025, totaling 1085 participants. Blood glucose was measured by finger prick testing and classified according to national and NICE guidelines. A structured questionnaire collected demographic, medical, and lifestyle data. Results: Among 1085 participants (65.1% female, mean age 57.6 ± 14.5 years), 258 (23.8%) had diagnosed diabetes, mostly Type 2 (226; 20.8%), while 827 (76.2%) were undiagnosed. Males had 1.7 times higher odds of diabetes. Diabetes prevalence correlated with physical inactivity, higher BMI, smoking, and chronic diseases. Among the undiagnosed, 17.8% were prediabetic and 4.3% diabetic. Of diagnosed patients, 57% had well-controlled and 42% poorly controlled diabetes. Metformin-based therapies were most common for Type 2 diabetes. Conclusions: Community pharmacists can effectively support early detection of diabetes and identify patients with suboptimal glycemic control, enhancing diabetes management in the community. Full article

Objective: Investigate patient characteristics, treatments used, treatment response, and factors associated with outcomes when managing SE in a pediatric population admitted to the emergency department (ED). Methods: This retrospective observational study included pediatric patients (age ≤ 18 years) with SE admitted to the ED at King Khalid University Hospital between 2015 and 2023. SE and refractory SE (RSE) were diagnosed according to the American Epilepsy Society (AES) definitions. The data included demographics, home medications, treatment sequences, medication dosing, and clinical outcomes. To assess appropriateness, the administered doses were compared with the AES standards for pediatric patients. Results: The study included 487 episodes of SE. The mean patient age was 6.1 ± 4.1 years, and most patients were males (57.3%) with a history of epilepsy (74.1%). Benzodiazepines (BDZs) were administered first in 83.0% of cases, with a 10.9% success rate, whereas anti-seizure medications (ASMs) were administered first in 17.0% of cases, with a 66.3% success rate (p < 0.0001). Surprisingly, medications administered at appropriate doses during the first round were significantly less effective compared to those that were underdosed (18.2% vs. 28.4%; p = 0.0222), mainly because of poor response to BDZs. Younger patients and those who received BDZs on their first medication round had higher hospital admission rates. Conclusions: ASMs were more effective than BDZs in managing pediatric patients with SE, regardless of the dosing precision. These findings point toward the adoption of personalized treatment strategies and may warrant early initiation of ASMs. National multicenter studies are needed to define a standardized pediatric SE protocol. Full article

Background/Objectives: Smart Formulation is an artificial intelligence-based platform designed to predict the Beyond Use Dates (BUDs) of compounded oral solid dosage forms. The study aims to develop a decision-support tool for pharmacists by integrating molecular, formulation, and environmental parameters to assist in optimizing the stability of extemporaneous preparations. Methods: A tree ensemble regression model was trained using a curated dataset of 55 experimental BUD values collected from the Stabilis database. Each formulation was encoded with molecular descriptors, excipient composition, packaging type, and storage conditions. The model was implemented using the KNIME platform, allowing the integration of cheminformatics and machine learning workflows. After training, the model was used to predict BUDs for 3166 APIs under various formulation and storage scenarios. Results: The analysis revealed a significant impact of excipient type, number, and environmental conditions on API stability. APIs with lower LogP values generally exhibited greater stability, particularly when formulated with a single excipient. Excipients such as cellulose, silica, sucrose, and mannitol were associated with improved stability, whereas HPMC and lactose contributed to faster degradation. The use of two excipients instead of one frequently resulted in reduced BUDs, possibly due to moisture redistribution or phase separation effects. Conclusions: Smart Formulation represents a valuable contribution to computational pharmaceutics, bridging theoretical formulation design with practical compounding needs. The platform offers a scalable, cost-effective alternative to traditional stability testing and is already available for use by healthcare professionals. Its implementation in hospital and community pharmacies may help mitigate drug shortages, support formulation standardization, and improve patient care. Future developments will focus on real-time stability monitoring and adaptive learning for enhanced precision. Full article

Background: The human body’s exposure to high levels of endogenous estrogens and their metabolites, such as estradiol, estriol, 2-hydroxyestradiol, and 4-hydroxyestradiol, is implicated in the development and complications of breast cancers (BCs). Besides endogenous estrogen production, the human body is also exposed to environmental sources of estrogen and estrogen-like compounds, which include pharmaceutical estrogens, xenoestrogens, and phytoestrogens. Females consume pharmaceutical estrogens as a constituent of postmenopausal hormone replacement therapy (HRT) and oral contraceptive pills, either alone or in combination with progestins. Additionally, humans, including females, are exposed to estrogen-resembling non-native compounds called xenoestrogens, prevailing in pesticides, plastics, and personal care items via inhalation, dermal contact, and oral consumption. Several phytoestrogens, such as isoflavones and lignans, are consumed by humans as food ingredients. Methods and Results: Emerging cellular and molecular experimental evidence indicates that when binding to estrogen receptors (ERs), various pharmaceutical estrogens, including equine/synthetic forms, progestin combinations, and xenoestrogens, promote BC development and complications by triggering survival, proliferation, angiogenesis, and invasion of these cells. Conversely, other experimental observations reveal the protective and beneficial effects of phytoestrogens like genistein from soy products on BC development and complications. Conclusions: This comprehensive review article describes the implications of exposure to exogenous estrogens, such as pharmaceutical estrogens, xenoestrogens, and phytoestrogens, as risk factors in the prevention or development of BC and its complications. Full article

Despite the growing number of older adults engaging in voluntary migration, there is a lack of knowledge about their psychological well-being in cross-cultural contexts. This cross-sectional study investigated factors associated with psychological well-being among older Chinese migrants residing in Chiang Mai, Thailand. Between December 2024 and February 2025, 204 Chinese migrants aged 60 and above who had resided in Chiang Mai for at least six months participated in a survey in Chinese. The survey measured sociodemographic and psychosocial factors including perceived health, income, marital status, number of co-residing family members, social support, acculturative stress, sense of mastery, and loneliness. Multiple regression analysis showed that gender (female) (p = 0.006), better perceived health status (p = 0.021), higher income (p = 0.007), more co-residing family members (p = 0.037), a greater sense of mastery (p = 0.009), and lower levels of loneliness (p < 0.001) were each independently associated with better psychological well-being. In contrast, neither general family support nor acculturative stress was a statistically significant predictor. These findings highlight the significant roles of financial security, family co-residence, personal empowerment, and social connectedness in shaping overall well-being. Strategies to improve psychological well-being in this population should focus on strengthening emotional connectedness, supporting the development of meaningful family and social relationships, and supporting economic stability. Full article

The common border between Bulgaria and North Macedonia, alongside the regulatory requirements stemming from Bulgaria’s membership in the European Union, provide grounds for comparing the legislative environment in both countries. This article presents a comparative case study of the regulatory frameworks governing community pharmacies in Bulgaria and North Macedonia. The aim of this study is to examine the specific features of current legislation related to the operation of community pharmacies, and to identify similarities, differences, and gaps in the organizational structure of pharmacy services, the population’s access to pharmaceutical care, and the qualification requirements for personnel working in community pharmacies. Bulgaria has been a member of the European Union since 2007, while the Republic of North Macedonia has had official EU candidate status since 2005. This provides a basis for comparing the regulatory frameworks of an EU and a non-EU system within the same regional context. In both countries, the overall pharmacy-to-population ratio exceeds the European average (3.3 pharmacies per 10,000 inhabitants), indicating sufficient availability. However, pharmacies are predominantly concentrated in major urban areas. In Bulgaria, challenges remain in ensuring access to pharmaceutical services in smaller and rural settlements, while in North Macedonia, the provision of such services is better ensured. The findings of this case study may be particularly relevant for countries undergoing health system reforms or EU harmonization processes. Full article

New psychoactive substances (NPSs) have emerged as a significant global public health challenge due to their ability to mimic traditional drugs. Among these, mephedrone has gained attention because of its widespread use and associated toxicities. This review provides a comprehensive analysis of the structure, pharmacokinetic properties, and metabolic pathways of mephedrone, highlighting its phase I and phase II metabolites as potential biomarkers for detection and forensic applications. A comprehensive literature search was performed without date restrictions. The search employed key terms such as “mephedrone metabolites”, “pharmacokinetics of mephedrone”, “phase I metabolites of mephedrone”, and “phase II metabolites of mephedrone”. Additionally, the reference lists of selected studies were screened to ensure a thorough review of the literature. Mephedrone is a chiral compound existing in two enantiomeric forms, exhibiting different affinities for monoamine transporters and distinct pharmacological profiles. In vivo animal studies indicate rapid absorption, significant tissue distribution, and the formation of multiple phase I metabolites (e.g., normephedrone, dihydromephedrone, 4-carboxymephedrone) that influence its neurochemical effects. Phase II metabolism involves conjugation reactions leading to metabolites such as N-succinyl-normephedrone and N-glutaryl-normephedrone, further complicating its metabolic profile. These findings underscore the importance of elucidating mephedrone’s metabolic pathways to improve detection methods, enhance our understanding of its toxicological risks, and inform future therapeutic strategies. Full article

Cardiovascular diseases remain a leading cause of mortality in the United States, driving the need for advanced cardiovascular devices and pharmaceuticals. Mock Circulatory Loops (MCLs) have emerged as essential tools for in vitro testing, replicating pulsatile pressure and flow to simulate various physiological and pathological conditions. While many studies focus on custom MCL designs tailored to specific applications, few have systematically reviewed their use in device testing, and none have assessed their broader utility across diverse biomedical domains. This comprehensive review categorizes MCL designs into three types: mechanical, computational, and hybrid. Applications are classified into four major areas: Cardiovascular Devices Testing, Clinical Training and Education, Hemodynamics and Blood Flow Studies, and Disease Modeling. Most existing MCLs are complex, highly specialized, and difficult to reproduce, highlighting the need for simplified, standardized, and programmable hybrid systems. Improved validation and waveform fidelity—particularly through incorporation of the dicrotic notch and other waveform parameters—are critical for advancing MCL reliability. Furthermore, integration of machine learning and artificial intelligence holds significant promise for enhancing waveform analysis, diagnostics, predictive modeling, and personalized care. In conclusion, the development of MCLs should prioritize standardization, simplification, and broader accessibility to expand their impact across biomedical research and clinical translation. Full article