Nevin Manimala

J Oncol Pharm Pract. 2025 Jan 29:10781552251316184. doi: 10.1177/10781552251316184. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: Complex pharmacotherapy in cancer patients increases the likelihood of drug-drug interactions (DDIs). Pharmacists play a critical role in the identification and management of DDIs. The aim of present study was to evaluate the role of pharmacist in identifying antifungal drug interactions in cancer patients and providing relevant recommendations.

METHODOLOGY: A retrospective, cross-sectional study was conducted to identify antifungal drug interactions over the period of 5 years (2019-2023) among cancer patients. Electronic medical record of 384 hospitalized patients receiving systemic antifungal therapy were reviewed. Severity of interactions and risk classification were made using UptoDate^® Lexidrug^TM software. Pharmacists’ recommendations regarding DDIs were also documented. Descriptive statistics and logistic regression were applied to interpret results.

RESULTS: Antifungals were more frequently prescribed to adult patients (53.9%). Female cancer patients were significantly more likely to encounter DDIs than males (p < 0.003). Type of cancer and fungal infections were significantly associated with incidence of DDIs (p < 0.01; p = 0.000). Pharmacist identified DDIs in 53.9% antifungal prescriptions with 22.2% classified as major interactions. A substantial proportion of these interactions involved voriconazole (40.1%). Majority of pharmacist’s recommendations included dose optimization of voriconazole (10.4%), close monitoring of RFTs (8.9%) and withholding amphotericin (5.2%) during chemotherapy. All of the recommendations made by pharmacists were accepted by physicians (100%).

CONCLUSION: The findings indicate that pharmacists identified DDIs in 53.9% of prescriptions and all of their recommendations were accepted by physicians. This highlights the critical role of pharmacists in detecting potential interactions, ensuring medication safety, and minimizing adverse effects associated with complex pharmacotherapy.

PMID:39881425 | DOI:10.1177/10781552251316184

Radiat Oncol. 2025 Jan 29;20(1):15. doi: 10.1186/s13014-025-02589-9.

ABSTRACT

BACKGROUND: For radiotherapy of head and neck cancer (HNC) magnetic resonance imaging (MRI) plays a pivotal role due to its high soft tissue contrast. Moreover, it offers the potential to acquire functional information through diffusion weighted imaging (DWI) with the potential to personalize treatment. The aim of this study was to acquire repetitive DWI during the course of online adaptive radiotherapy on an 1.5 T MR-linear accelerator (MR-Linac) for HNC patients and to investigate temporal changes of apparent diffusion coefficient (ADC) values of the tumor and subvolume levels.

METHODS: 27 patients treated with curative RT on the 1.5 T MR-Linac with at least weekly DWI in treatment position were included into this prospective analysis and divided in four risk groups (HPV-status and localisation). Tumor and lymph node volumes (GTV-P/GTV-N) were delineated on b = 500 s/mm² images while ADC maps were calculated using b = 150/200 and 500 s/mm² images. Absolute and relative temporal changes of mean ADC values, tumor volumes and a high-risk subvolume (HRS) defined by low ADC tumor voxels (600 < ADC < 900 × 10^-6 mm²/s) were analyzed. Relative changes of mean ADC values, tumor volumes and HRS were statistically tested using Wilcoxon-signed-rank test.

RESULTS: Median pretreatment ADC value for all patients resulted in 1167 × 10^-6 mm²/s for GTV-P and 1002 × 10^-6 mm²/s for GTV-N while absolute pretreatment tumor volume yielded 9.1 cm³ for GTV-P and 6.0 cm³ for GTV-N, respectively. Pretreatment HRS volumes were 1.5 cm³ for GTV-P and 1.3 cm³ for GTV-P and GTV-N. Median ADC values increase during 35 fractions of RT was 49% for GTV-P and 24% for GTV-N during RT. Median tumor volume decrease was 68% and 52% for GTV-P and GTV-N with a median HRS decrease of 93% and 87%. Significant differences from 0 for mean ADC were observed starting from week 1, for tumor volumes from week 2 for GTV-P and week 1 for GTV-N and for HRS in week 1 for GTV-P and week 2 for GTV-N.

CONCLUSION: Longitudinal DWI acquisition in HNC is feasible on a MR-Linac during the course of online adaptive MR-guided radiotherapy. Changes in ADC and volumes can be assessed, but future work needs to explore the potential for biologically guided treatment individualization.

TRIAL REGISTRATION: NCT04172753, actual study start: 09.05.2018.

PMID:39881423 | DOI:10.1186/s13014-025-02589-9

Confl Health. 2025 Jan 29;19(1):5. doi: 10.1186/s13031-025-00646-4.

ABSTRACT

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of death globally, and many humanitarian crises occur in countries with high NCD burdens. Peer support is a promising approach to improve NCD care in these settings. However, evidence on peer support for people living with NCDs in humanitarian settings is limited. We evaluated the implementation of peer support groups (PSGs) for people with diabetes and/or hypertension as part of an integrated NCD care model in four primary care centers in Lebanon.

METHODS: Our objectives were to: (1) evaluate the reach of the PSGs; (2) evaluate the association of PSGs with patient-reported outcomes; and (3) evaluate the association of PSGs with clinical outcomes (blood pressure, HbA1c, and BMI). We used a before-after study design and included a control group for clinical outcomes. The PSG intervention began in December 2022 and was carried out in two waves. The first wave was implemented from December 2022 to July 2023, and the second wave from July 2023 to January 2024. For the control group on clinical outcomes, we used data collected from January 2023 to January 2024. We used routinely collected programmatic and administrative data. The patient reported outcomes (PROMs) were collected at baseline and at six months by trained volunteers for all PSG participants. We performed a before-after analysis of PROMs for all patients who completed the PSG sessions. T-tests were used to analyze the differences in PROMs from baseline. Change in PROMs, together with 95% confidence intervals (CIs), and p-values for the changes were reported. To assess the association between the implementation of the PSG strategy and changes in clinical outcomes, including systolic blood pressure (SBP), glycated hemoglobin A1c (HbA1c), and body mass index (BMI), analysis of covariance (ANCOVA) models were used, adjusting for age, sex, and the baseline values of the outcome being analyzed (baseline SBP and baseline HbA1c, respectively).

RESULTS: A total of 445 patients were approached for enrolment in wave 1, 259 (58%) consented, of whom 81 were enrolled. In wave 2, 169 patients were approached, 92 (54%) consented of whom 91 were enrolled. We found some statistical evidence that PSG improved certain PROMs, including potentially clinical meaningful improvements in overall quality of life (wave 1), physical quality of life (wave 1), social quality of life (wave 2), environmental quality of life (wave 1), adherence (wave 2), patient centeredness (wave 1), and exercise (wave 1). However, we did not find strong statistical evidence of an improvement in clinical outcomes (SBP, HbA1c, or BMI) in participants of the PSGs compared to the control group. We found differences in the association of PSGs and outcomes between the two waves.

CONCLUSION: Our study showed mixed results. In terms of reach, over 50% of those approached consented to participate. Regarding the impact on PROMs, we observed improvements in most outcomes; however we found some statistical evidence only for some. We did not find strong statistical evidence of improvement in clinical outcomes compared to the control group. Differences between the two waves may be due to differences in the populations, the way the intervention was delivered, or the individuals implementing it. Additionally, as multiple outcomes were measured, some observed differences may be due to chance. We demonstrated that it is feasible to implement PSGs in humanitarian settings and found some statistical evidence of improvement in quality of life. Further studies should assess the implementation and impact of PSGs in ways that are well accepted by local stakeholders (including humanitarian actors and people living with NCDs) and are potentially amenable to scale-up.

PMID:39881420 | DOI:10.1186/s13031-025-00646-4

BMC Med Educ. 2025 Jan 29;25(1):148. doi: 10.1186/s12909-025-06755-1.

ABSTRACT

BACKGROUND: Research shows that trauma team formation could potentially improve effectiveness of injury care in rural settings. The aim of this study was to determine the feasibility of rural trauma team training amongst medical trainees and traffic law enforcement professionals in Uganda.

METHODS: Prospective multi-centre interrupted time series analysis of an interventional training based on the 4th edition of rural trauma team development course of the American College of Surgeons. Trauma related multiple choice questions (MCQs), and trauma non-technical skills were assessed pre-and post-training between September 2019- August 2023. Acceptability of the training for promulgation to other rural regions and its relevance to participants’ work needs were evaluated on 5- and 3-point Likert scales respectively. The median MCQ scores (IQR) were compared before and after training at 95% CI, regarding p < 0.05 as statistically significant. Triangulation with open-ended questions was obtained. Time series regression models were applied to test for autocorrelation in performance using Stata 15.0. Ethical approval was obtained from Uganda National Council for Science and Technology (Ref: SS 5082).

RESULTS: A total of 500 participants including: 66 (13.2%) traffic police officers, 30 (6.0%) intern doctors, 140 (28.0%) fifth year and 264 (52.8%) third-year medical students were trained. Among the 434 medical trainees who completed the trauma-based MCQ assessment, the median pre- and post-test scores were 60%, IQR (50-65) and 80%, IQR (70-85) respectively. Overall, the mean difference between pre- and post-test scores was statistically significant (z = 16.7%, P|z|=<0.0001). Most participants strongly agreed to promulgate 389 (77.8%), relevance to their educational 405 (81.0%), and work needs 399 (79.8%). Each of the course components was rated above 76.0% as being very relevant. There was an overall increment in median (IQR) trauma-nontechnical skills team performance scores from 12 (9-14) to 17 (15-20) after the training (p < 0.001), with police teams advancing from 9.5 (6.0-12.5) to 19.5 (17.0-21.5) (p < 0.001).

CONCLUSION: This study demonstrates that rural trauma team development training had a positive effect on the test scores of course participants. The training is feasible, highly acceptable and regarded as relevant amongst medical trainees and traffic law enforcement professionals who provide first-aid to trauma patients in resource-limited settings. The findings could inform the design of future trauma teams in rural communities.

TRIAL REGISTRATION: Retrospective registration (UIN: researchregistry9450).

PMID:39881413 | DOI:10.1186/s12909-025-06755-1

BMC Psychol. 2025 Jan 29;13(1):84. doi: 10.1186/s40359-025-02413-9.

ABSTRACT

BACKGROUND: This study aimed to adapt the Psychological Food Involvement Scale (PFIS) to Turkish culture and test its validity and reliability. The PFIS measures individuals’ psychological, emotional, and social relationships with food, which significantly impact eating behaviors and health.

METHODS: The study was conducted with 478 participants aged 18-65. The PFIS underwent a six-stage translation and cultural adaptation process. Data collection was carried out via Google Forms, with participants completing a general information form, PFIS, and the Addiction-like Eating Behavior Scale (ALEBS). Reliability was assessed using the test-retest method. SPSS 24 was used for statistical evaluation, including internal consistency coefficient calculations, factor analysis, and correlation tests.

RESULTS: The Kaiser-Meyer-Olkin value was 0.94, indicating an adequate sample size, and Bartlett’s test of sphericity was significant (p < 0.05). Exploratory factor analysis revealed a four-factor structure explaining 79% of the variance, with factor loadings > 0.40 and eigenvalues > 1. Confirmatory factor analysis showed good fit indices: χ2 /sd = 2.28, GFI = 0.95, AGFI = 0.93 CFI = 0.98, NFI = 0.94, RMSEA = 0.05, SRMR = 0.04). Internal consistency analysis showed high reliability, with Cronbach’s Alpha coefficients ranging from 0.86 to 0.94 across subscales.

CONCLUSION: The Turkish version of the PFIS was found to be a valid and reliable tool for assessing psychological food involvement in the studied sample of the Turkish adult population.

PMID:39881412 | DOI:10.1186/s40359-025-02413-9

J Health Popul Nutr. 2025 Jan 29;44(1):22. doi: 10.1186/s41043-025-00752-2.

ABSTRACT

BACKGROUND: No study has assessed the impact of flavor capsule cigarettes (FCCs) on smoking cessation. Thus, the purpose of this exploratory study was to assess (1) the sociodemographic and smoking-related characteristics associated with using FCCs, and (2) the preliminary impact of FCCs on smoking cessation.

METHODS: This study is a secondary data analysis of a single-arm study with 100 individuals living in Mexico who smoked and received a smoking cessation mHealth intervention and pharmacotherapy support. The primary outcomes were self-reported and biochemically verified 7-day smoking abstinence at Month 3.

RESULTS: Just over one-third of participants (36%) used FCCs, with a preference for one capsule and menthol/mint flavor. Compared to participants who smoked non-FCCs, participants who smoked FCCs were (1) younger, (2) more likely to be women, and (3) more likely to smoke less than 10 cigarettes per day (CPD; all p’s < 0.05). After controlling for all significant associations, age younger than 50 years old (AOR = 3.26, 95% CI 1.25-8.51) and being a woman (AOR = 3.62, 95% CI 1.41-9.35) were positively and independently associated with smoking FCCs. Treating those lost to follow-up as participants who continued smoking, 41.7% (15/36) of participants who smoked FCCs self-reported smoking abstinence at month 3 compared to 42.2% (27/64) of participants who smoked non-FCCs (p = 0.96). Furthermore, 33.3% (12/36) of participants who smoked FCCs were biochemically verified abstinent at Month 3 compared to 18.8% (12/64) of participants who smoked non-FCCs (p = 0.10).

CONCLUSIONS: Younger age and being a woman were associated with using FCCs. Self-reported smoking abstinence at Month 3 was comparable between participants who smoke FCCs and non-FCCs. However, biochemically verified abstinent at Month 3 was higher among participants who smoke FCCs compared to participants who smoke non-FCCs, although the difference was not statistically significant. Prospective and adequately powered comparisons must be made between individuals who smoke FCCs and non-FCCs to effectively assess differences in smoking abstinence, and the reasons for these differences.

PMID:39881408 | DOI:10.1186/s41043-025-00752-2

Eur J Med Res. 2025 Jan 29;30(1):58. doi: 10.1186/s40001-025-02304-0.

ABSTRACT

BACKGROUND: The systemic immune-inflammation index (SII) is an emerging marker of inflammation, and the onset of psoriasis is associated with inflammation. The aim of our study was to investigate the potential impact of SII on the incidence rate of adult psoriasis.

METHODS: We conducted a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES) 2011-2014 data sets. Multiple logistic regression analyses with appropriate covariates adjustment were the major methods in this study. Subgroup analyses were conducted by age, gender, race, smoking status, alcohol consumption, history of heart attack, stroke, coronary heart disease and diabetes. Interactions among these variables were also detected. We further utilized smooth curve fitting to explore potential nonlinear associations between SII and psoriasis across different subgroups. The receiver operating characteristic curve analysis was used to assess the diagnostic value of SII for psoriasis in the general population and diabetic individuals. Multiple imputation was adopted as sensitivity analysis to address potential bias due to missing data.

RESULTS: 9314 participants (≥ 20 years) were included. A significant positive association was observed between SII and psoriasis (OR = 1.56; P = 0.0069). Subgroup analysis revealed significant positive association in males (OR = 1.52; P = 0.0288), females (OR = 1.61; P = 0.0322), Non-Hispanic Whites (OR = 1.55; P = 0.0190), people aged 40-59 years (OR = 1.98; P = 0.0386), diabetics (OR = 3.40; P = 0.0088), and overweight participants (OR = 1.80; P = 0.0034). SII had a higher predictive value for psoriasis in diabetic patients (AUC = 0.62; 95% CI [0.55, 0.70]). In stroke patients, SII was negatively correlated with the occurrence of psoriasis, and interaction test suggested the effect of SII on psoriasis was significantly modified by stroke (P = 0.0003). Nonlinear relationships between SII and psoriasis were observed in participants aged 20 to 39, former smokers, current drinkers, individuals with or without heart attack, those without coronary heart disease, and overweight participants.

CONCLUSIONS: SII was positively associated with psoriasis. Testing for SII levels may help to identify the onset of psoriasis early.

PMID:39881406 | DOI:10.1186/s40001-025-02304-0

Stem Cell Res Ther. 2025 Jan 29;16(1):31. doi: 10.1186/s13287-024-04116-1.

ABSTRACT

BACKGROUND: Closed head injury (CHI) provokes a prominent neuroinflammation that may lead to long-term health consequences. Microglia plays pivotal and complex roles in neuroinflammation-mediated neuronal insult and repair following CHI. We previously reported that induced neural stem cells (iNSCs) can block the effects of CXCL12/CXCR4 signaling on NF-κB activation in activated microglia by CXCR4 overexpression. Here we aim to uncover the mechanism of CXCR4 upregulation in iNSCs.

METHODS: We performed bioinformatic analysis to detect the differentially expressed genes in iNSCs after co-cultured with LPS-activated microglia. Subsequently, we predicted the target genes and performed gain- and loss-of-functional studies, dualluciferase reporter, RNA immunoprecipitation, biotin-coupled miRNA pulldown, fluorescence in situ hybridization and cell transplantation assays to further elucidate the mechanism underlying the immunoregulatory effects of iNSCs. Student’s t-test and one-way analysis of variance (ANOVA) with Tukey’s post hoc test were used to determine statistical significance.

RESULTS: Our results indicated that Malat1 could act as a sponge of miR-139-5p to modulate the expression of CXCR4 that exerted significant influence on the immunoregulatory effects of iNSCs on the secretion of CXCL12, TNF-α and IGF-1 by activated microglia. Furthermore, Malat1 inhibition blocked the immunoregulatory effects of iNSC grafts on microglial activation as well as neuroinflammation in the injured cortices of CHI mice. Interestingly, NF-κB activation in iNSCs augmented the immunoregulatory effects of iNSCs on microglial activation by activating the axis of Malat1/miR-139-5p/Cxcr4. Notably, we found that TNF-α secreted by activated microglia could bind to TNFR1 at the surface of iNSCs to trigger NF-κB activation in iNSCs.

CONCLUSIONS: In short, our findings reveal a novel role of Malat1 in the immunomodulatory effects of iNSCs on microglial activation, suggesting that transplanted iNSCs may self-perceive the changes of the activated state of microglia and thus make prudential regulation of the neuroinflammation following CHI.

PMID:39881403 | DOI:10.1186/s13287-024-04116-1

Trials. 2025 Jan 29;26(1):30. doi: 10.1186/s13063-024-08666-w.

ABSTRACT

BACKGROUND: /aims. Pseudoxanthoma Elasticum (PXE, OMIM 264800) is an autosomal, recessive, metabolic disorder characterized by progressive ectopic calcification in the skin, the vasculature and Bruch’s membrane. Variants in the ABCC6 gene are associated with low plasma pyrophosphate (PPi) concentration. There is currently no reference treatment for this chronic debilitating disease.

METHODS: PROPHECI (PyROphosPHate supplementation to fight ECtopIc calcification in PseudoXanthoma Elasticum) is the first phase II, randomized, double-blind, placebo-controlled clinical trial (NTC 04868578) to evaluate the efficacy and safety of a daily oral PPi salt supplementation to attenuate and/or stabilize the progression of ectopic calcification in PXE patients. The primary endpoint is the change in arterial calcification volume quantified by non-contrast CT scan between baseline and 12 months of treatment. Secondary endpoints include the safety and efficacy of daily oral PPi administration on ocular and skin lesions and the evaluation of patients’ quality of life.

DISCUSSION: The PROPHECI trial aims to provide safety and efficacy data on the use of daily oral PPi to reduce or stabilize ectopic calcification in PXE. It also aims to validate the best markers to include in the design of future trials for the treatment of PXE and other parent diseases.

TRIAL REGISTRATION: Trial registration number: NCT04868578. References can be found on the ClinicalTrials.gov website: https://clinicaltrials.gov/study/NCT04868578?cond=Pseudoxanthoma%20Elasticum&intr=pyrophosphate&rank=2.

PMID:39881395 | DOI:10.1186/s13063-024-08666-w

Clin Epigenetics. 2025 Jan 29;17(1):16. doi: 10.1186/s13148-025-01822-2.

ABSTRACT

BACKGROUND: Glioblastoma is the commonest malignant brain tumor and has a very poor prognosis. Reduced expression of the MGMT gene (10q26.3), influenced primarily by the methylation of two differentially methylated regions (DMR1 and DMR2), is associated with a good response to temozolomide treatment. However, suitable methods for detecting the methylation of the MGMT gene promoter and setting appropriate cutoff values are debated.

RESULTS: A cohort of 108 patients with histologically and genetically defined glioblastoma was retrospectively examined with methylation-specific Sanger sequencing (sSeq) and methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) methods. The DMR2 region was methylated in 29% of samples, whereas DMR1 was methylated in 12% of samples. Methylation detected with the MS-MLPA method using probes MGMT_215, MGMT_190, and MGMT_124 from the ME012-A1 kit (located in DMR1 and DMR2) correlated with the methylation of the corresponding CpG dinucleotides detected with sSeq (p = 0.005 for probe MGMT_215; p < 0.001 for probe MGMT_190; p = 0.016 for probe MGMT_124). The threshold for methylation detection with the MS-MLPA method was calculated with a ROC curve analysis and principal components analysis of the data obtained with the MS-MLPA and sSeq methods, yielding a weighted value of 0.362. Thus, methylation of the MGMT gene promoter was confirmed in 36% of samples. These patients had statistically significantly better overall survival (p = 0.003).

CONCLUSIONS: Our results show that the threshold for methylation detection with the MS-MLPA method determined here is useful from a diagnostic perspective because it allows the stratification of patients who will benefit from specific treatment protocols, including temozolomide. Detailed analysis of the MGMT gene promoter enables the more-precise and personalized treatment of patients with glioblastoma.

PMID:39881389 | DOI:10.1186/s13148-025-01822-2