Explore the vast range of titles available.

Breast cancer is the most common malignancy affecting women, manifesting as a heterogeneous disease with diverse molecular characteristics and clinical presentations. Recent studies have elucidated the role of epigenetic modifications in the pathogenesis of breast cancer, including drug resistance and efflux characteristics, offering potential new diagnostic and prognostic markers, treatment efficacy predictors, and therapeutic agents. Key modifications include DNA cytosine methylation and the covalent modification of histone proteins. Unlike genetic mutations, reprogramming the epigenetic landscape of the cancer epigenome is a promising targeted therapy for the treatment and reversal of drug resistance. Epidrugs, which target DNA methylation and histone modifications, can provide novel options for the treatment of breast cancer by reversing the acquired resistance to treatment. Currently, the most promising approach involves combination therapies consisting of epidrugs with immune checkpoint inhibitors. This review examines the aberrant epigenetic regulation of breast cancer initiation and progression, focusing on modifications related to estrogen signaling, drug resistance, cancer progression, and the epithelial–mesenchymal transition (EMT). It examines existing epigenetic drugs for treating breast cancer, including agents that modify DNA, inhibitors of histone acetyltransferases, histone deacetylases, histone methyltransferases, and histone demethyltransferases. It also delves into ongoing studies on combining epidrugs with other therapies and addresses the upcoming obstacles in this field.

Clinical pharmacists play a critical role in cardiology by optimizing pharmacotherapy and improving patient outcomes. However, despite their growing importance, standardized quality indicators to evaluate their impact in clinical practice remain lacking. This study aimed to develop and validate a set of cardiology-specific Quality Indicator Drug Therapy Problems (QI-DTPs) defined as medication-related quality indicators focused on identifying, preventing, and resolving drug therapy problems-using a modified Delphi technique in Saudi Arabia. Twenty-three candidate QI-DTPs were developed based on a comprehensive review of current cardiology guidelines and evidence-based literature, refined by an expert advisory group. A panel of sixteen experienced clinical pharmacists with cardiology expertise from Saudi Arabia evaluated these indicators using a modified Delphi approach conducted over three iterative rounds. Each indicator was rated on a nine-point Likert scale (1 = strong disagreement to 9 = strong agreement). Indicators achieving ≥75% consensus were considered validated. Sixteen expert clinical pharmacists participated (69% male, 31% female), most of whom had completed a pharmacy residency and had cardiology-related clinical experience. High levels of agreement were achieved across the Delphi rounds, and all 23 proposed QI-DTPs met the predefined ≥75% consensus threshold, demonstrating strong agreement regarding their relevance, clarity, and applicability in cardiology practice. The study successfully identified and validated 23 QI-DTPs, reflecting strong consensus among clinical pharmacists in Saudi Arabia. Implementation of these indicators in clinical practice could enhance the quality of cardiovascular care, reinforce pharmacist-led interventions, and promote medication safety. Future research should assess the direct impact of these quality metrics on patient outcomes.

Background Critically ill patients are at a higher risk of developing infections and related complications, which can lead to death. Each additional day of antipseudomonal β-lactam use increases the risk of resistance; therefore, de-escalation is highly recommended to improve antibiotic use. To our knowledge, there are limited studies that have evaluated the clinical impact of de-escalation in critically ill patients with proven Methicillin-Susceptible Staphylococcus aureus (MSSA) pneumonia alone. Therefore, our study aimed to assess the clinical impact of the de-escalation strategy compared with the non-de-escalation strategy in critically ill patients with proven MSSA pneumonia. Methods This multicenter retrospective cohort study was conducted in three tertiary hospitals from January 2016 to July 2021. Adult critically ill patients admitted to the intensive care unit with proven MSSA respiratory culture who received antibiotics with anti-MSSA activity were screened for eligibility. Eligible patients were categorized into two groups according to their de-escalation status: De-escalated and Non-de-escalated. The De-escalation was defined as the reduction of the antimicrobial activity spectrum of antibiotics by switching to a narrower-spectrum agent that targets MSSA. The primary outcome was treatment failure rate, while other outcomes were considered secondary. Propensity score (PS) matching was applied at a 1:1 ratio, and multivariate regression analyses were utilized as appropriate. Results After PS matching (1:1), 58 patients were included in the study (29 patients in non-deescalated vs 29 patients in de-escalated). The treatment failure rate was significantly higher in the de-escalated group compared to the non-de-escalated (OR 16.98; 95% CI (3.304–87.225), p  = 0.0007). In contrast, no significant differences were found in 30-day mortality, hospital and ICU length of stays, ventilator-free days, ICU readmission rate, or MSSA infection recurrence rate. Conclusion Our results showed that de-escalation of antibiotics in critically ill patients with confirmed MSSA pneumonia was associated with significantly higher rate of treatment failure while no significant differences were observed in the other clinical outcomes. These findings highlight the need for prospective studies to better inform safe and effective de-escalation strategies in this population.

Background Effective cancer management include comprehensive evaluation of treatment patterns to ensure optimal resource utilization. This is a single center study review anticancer drug utilization, with an emphasis on adherence to the World Health Organization Essential Medicines List (WHO EML) and regional prescribing trends amid increasing cancer incidence. Methods We conducted a retrospective cohort study of 512 adult patients with histologically confirmed malignant neoplasms that were managed with anti-cancer therapy at King Khaled Hospital, Najran, from 2014 to 2022. Data extraction included demographic characteristics, treatment regimens, and supportive medications, analyzed using IBM SPSS Statistics (version 21). Prescription quality was assessed against WHO EML criteria and Saudi Food and Drug Authority (SFDA) standards. Results The study revealed slight male predominance (56.4%), with a mean age 55.2 ± 17.0 years. Gastrointestinal (29.7%) and breast cancers (25.8%) accounted for the majority of cases, and 46.7% of patients presented with metastatic disease. First-line regimens predominantly included doxorubicin-cyclophosphamide (20.1%) and FOLFOX (13.5%). Notably, 86.7% of prescribed agents were listed on the WHO EML, surpassing the 85.3% benchmark, and 90.1% were generics. Supportive care commonly involved metoclopramide-based antiemetics (76.1%). Medication shortages occurred in 8.4% of cases, predominantly involving BCG. Conclusion Our findings demonstrate an optimal utilization of WHO Essential Medicines List, reflecting evidence-based, cost-effective prescribing practices that exceed international benchmarks. Despite the observed supply chain vulnerabilities, the study reinforces the relevance and applicability of the WHO model at the regional level.

Background In recent years, various advancements in anticancer therapy have led to the development of multiple regimens and protocols. This study endeavors to provide an extensive evaluation of anticancer therapy prescription patterns in correlation with patient outcomes. Methods From June 2014 to April 2022, we included adult cancer patients who received anticancer therapy in our cancer center. Collected data encompassed demographic characteristics of patients and cancer, chemotherapy protocols or agents, antiemetics, drug side effects, and the patient's last status. The prescribed drugs were assessed using the Essential Medicines List, while the prescription's rationality was determined using the World Health Organization indicators. Results The mean age was 55.16 ± 17.04 years, with 56.4% of the patients being males. Gastrointestinal (29.7%) and breast (25.8%) cancers were the most common malignancies. The main protocols included a combination of Adriamycin and cyclophosphamide (20.1%) and folinic acid, fluorouracil, and oxaliplatin-based (FOLFOX) regimen (13.5%). The most frequently used drugs were doxorubicin (14.0%), cyclophosphamide (13.3%), and docetaxel (9.9%). The majority of patients also did not report any acute adverse events related to chemotherapy (81.1%). Antiemetics, mainly metoclopramide-based, were used in 76.07% of cases. Remarkably, 86.7% of anticancer agents were from the EML, and 90.1% were prescribed generically. Conclusion In this study, gastrointestinal cancers were the most prevalent cancers observed, with more preponderance among males. Most anticancer agents were taken from the essential drug list, with the majority being prescribed under generic names, indicating rational use.