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Enteral feeding intolerance (EFI) from delayed gastric emptying is common in critically ill patients, leading to poor outcomes. Mosapride, a selective 5-HT4 agonist, may be a safer, more effective alternative to metoclopramide, which has limited efficacy due to tachyphylaxis and adverse effects. To compare the safety and efficacy of mosapride with metoclopramide in reducing gastric residual volume (GRV) and improving enteral nutrition delivery in intensive care unit (ICU) patients with EFI. In this prospective, randomized, double-blind, double-dummy trial, 100 mechanically ventilated ICU patients with EFI were allocated to receive either mosapride (5 mg enterally every 8 hours plus IV placebo) or metoclopramide (10 mg intravenously every 8 hours plus enteral placebo) for 7 days. GRV was measured daily via ultrasonography. Nutritional adequacy was evaluated through daily caloric and protein intake, calculated from delivered versus prescribed enteral volume. Clinical scores; including Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), and the Modified Nutrition Risk in Critically Ill (mNUTRIC), as well as ICU length of stay were assessed. Adverse events were continuously monitored using a structured reporting tool. The mosapride group demonstrated a more significant reduction in GRV from day 1 to day 7 (68.03% vs 39.87%, p<0.001) and higher enteral volume ratio (79.52% vs 69.48%, p<0.001). Target energy ratio was more frequently achieved in the mosapride group (86% vs 28%, p<0.001). Improvements in SOFA and mNUTRIC scores were significant only in the mosapride group. Adverse events were comparable between groups (p=0.643). ICU length of stay was non-significantly different between the two groups (p=0.051). Mosapride is more effective than metoclopramide in reducing GRV and enhancing enteral nutrition delivery in critically ill patients with EFI, with a favorable safety profile. These findings support its consideration as a prokinetic agent in this population. NCT06826443.

 Post-cesarean section pain management remains a crucial challenge in obstetric care, with implications for maternal recovery, mother-child bonding, and long-term health outcomes. Quercetin, a naturally occurring flavonoid with anti-inflammatory and antioxidant properties, has shown promising analgesic effects in preclinical studies but has limited clinical evidence for acute pain management. This study aimed to assess the efficacy of preoperative Quercetin administration on acute post-operative pain following cesarean section.  In this prospective, double-blinded, randomized controlled trial, 80 patients undergoing elective cesarean section under spinal anaesthesia were randomly allocated to receive either 500 mg oral Quercetin (n=40) or matching placebo (n=40) one hour before surgery. The primary outcome was postoperative pain intensity assessed using a 10 cm Visual Analog Scale (VAS) at 2, 6, 12, and 24 hours after surgery. Secondary outcomes included time to first analgesic request, total morphine consumption, incidence of postoperative nausea and vomiting, time to physical activity initiation, functional activity, patient satisfaction, and adverse effects.  The Quercetin group demonstrated significantly lower VAS scores at all measured time points (p<0.001) and delayed time to first analgesic request (3.9±1.3 vs 2.73±0.78 hours, p<0.001) compared to the placebo group. Additionally, patients receiving Quercetin initiated physical activity significantly earlier (15.2±1.9 vs 19.03±2.66 hours, p<0.001) and reported higher satisfaction levels on postoperative day 2 (p=0.042). However, total morphine consumption, functional activity, incidence of nausea and vomiting, and hospital length of stay were comparable between groups, with no significant differences in adverse effects.  Preoperative administration of 500 mg Quercetin significantly reduced postoperative pain and delayed the need for rescue analgesia following cesarean section, allowing for earlier mobilization without increasing adverse effects. These findings suggest Quercetin may serve as a safe, effective adjunct in multimodal pain management protocols for cesarean delivery. NCT06650891 (2024-10-21).

Background Interprofessional education (IPE) is a crucial strategy for preparing pharmacy and dentistry students for the health workforce, focusing on teamwork and collaboration. It provides an integrated knowledge application between both fields to improve patient care in areas such as infection control, antimicrobial management, and pain management. This study aimed to examine the self-reported perceptions of pharmacy and dental students regarding their interprofessional collaborative competencies before and after participating in a pilot interprofessional education activity. Methods An IPE activity was conducted from September 4–8, 2022, at Future University in Egypt (FUE), involving 26 students (19 from pharmacy and 7 from dentistry). Students were assigned to intercollaborative teams with student members from both schools. Sessions were held, and group discussions were utilized, punctuated by small group cases and simulation activities, to create interprofessional understanding. Facilitators consisted of faculty from both pharmacy and dentistry. Dental rounds at FUE Teaching Dental Hospital simulated interprofessional practice among team members. To assess the perceived skills acquired from the activity, participants completed a pre-and post-activity survey using the Interprofessional Collaborative Competencies Attainment Survey (ICCAS)– tool. Results All 26 participating students completed the pre- and post-activity ICCAS survey. The students were cooperative during the overall experience and developed communication and interprofessional skills. The findings of the pre- and post-activity ICCAS yielded positive changes on all subscales. Significant differences ( p  < 0.05) were seen in all subscales when comparing pre-and post-activity scores using a Wilcoxon signed rank test. Conclusion This IPE initiative increased collaboration and understanding between pharmacy and dentistry students. The improvements noted in interprofessional competencies emphasize the significance of such initiatives in equipping future health practitioners with skills necessary for collaborative work environments. It is recommended to continue and expand initiatives focusing on IPE to foster interprofessional cooperation, effective communication, and teamwork skills for optimal patient outcomes. Clinical trial number not applicable.

Background Medication nonadherence is a pervasive and multifactorial challenge that substantially undermines therapeutic effectiveness, increases morbidity and mortality, and imposes a significant economic burden on healthcare systems. Despite advances in pharmacotherapy, a considerable proportion of patients fail to take medications as prescribed due to a complex interplay of patient-related, therapy-related, healthcare system, and socioeconomic factors. Conventional approaches often address adherence in isolation, overlooking the need for integrated strategies that span both clinical practice and pharmaceutical design. Main body This narrative review synthesizes current evidence on the epidemiology, determinants, and clinical and economic burden of medication nonadherence, while critically examining interventions aimed at improving adherence. Particular emphasis is placed on the synergistic integration of clinical strategies—such as patient education, behavioral and motivational support, regimen simplification, pharmacist-led adherence programs, and digital health technologies—with pharmaceutical formulation and drug delivery innovations. These include taste masking technologies, modified- and long-acting dosage forms, alternative delivery systems, fixed-dose combinations, and personalized formulations designed to align therapy with patient preferences and capabilities. By bridging perspectives from clinical pharmacy and pharmaceutical technology, the review highlights the central role of pharmacists within multidisciplinary adherence frameworks and underscores the value of patient-centered, system-level approaches. Current limitations, including heterogeneity in adherence measurement, variable intervention effectiveness, and challenges in real-world implementation, are also discussed. Conclusion An integrated, patient-centered approach that combines clinical interventions with pharmaceutical formulation and delivery innovations represents a promising strategy to improve medication adherence and optimize therapeutic outcomes. Future efforts should focus on generating robust real-world evidence, leveraging digital and personalized medicine technologies, and strengthening collaborative implementation models to enhance adherence and improve healthcare system efficiency.

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, particularly in low- and middle-income countries. Oxidative stress and excessive inflammation contribute significantly to disease progression and severity. Astaxanthin (ASX), a potent antioxidant and anti-inflammatory carotenoid, has demonstrated protective effects against oxidative damage and immune dysregulation in various conditions. However, its potential role as an adjunctive therapy in CAP remains underexplored. This study aims to evaluate the effects of ASX supplementation on inflammatory cytokines, and clinical outcomes in patients with CAP. A prospective, randomized, double-blind, placebo-controlled study was conducted, in which adult patients diagnosed with CAP were enrolled and assigned to receive either 12 mg/day ASX or a placebo in addition to standard antibiotic therapy for 7 days. Inflammatory markers, including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interleukin-10 (IL-10), were measured at baseline and post-treatment. Secondary outcomes included Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, as well as length of hospital stay. A total of 80 patients (40 per group) completed the study. Patients receiving ASX exhibited significant reductions in pro-inflammatory cytokines compared to the placebo group. Notably, IL-6 and TNF-α levels were significantly lower in the ASX group at the end of the study ( < 0.05). Additionally, SOFA and APACHE II scores showed greater improvements in ASX-treated patients, suggesting a potential role in mitigating disease severity. Although the ASX group had a shorter hospital stay than the placebo group, the difference was not statistically significant ( > 0.05). ASX supplementation as an adjunct to standard CAP treatment significantly reduced inflammation while improving disease severity scores. ASX was found to be safe and well-tolerated. These findings highlight its potential therapeutic role in CAP management, warranting further investigation in larger, long-term clinical trials to confirm its benefits and establish optimal dosing strategies. https://clinicaltrials.gov/study/NCT06334874, identifier NCT06334874.

Subclinical hypothyroidism (SCH) is a prevalent endocrine disorder characterized by elevated serum thyroid-stimulating hormone (TSH) concentrations in the presence of normal circulating free thyroxine (fT4). Although frequently asymptomatic, SCH has been increasingly associated with adverse metabolic, cardiovascular, reproductive, and neurocognitive outcomes, as well as progression to overt hypothyroidism. Therapeutic decision-making remains controversial, particularly in individuals with mild TSH elevation below 10 mIU/L, where the clinical benefit of levothyroxine replacement therapy is inconsistent. Growing attention has therefore been directed toward modifiable metabolic contributors to thyroid dysfunction, including micronutrient status. Zinc and selenium are essential trace elements that participate in thyroid hormone synthesis, peripheral activation, receptor-mediated signaling, antioxidant defense, and immune modulation. Zinc is critical for thyroid hormone receptor structure and hypothalamic–pituitary regulation, whereas selenium is incorporated into iodothyronine deiodinases and antioxidant selenoproteins that preserve thyrocyte integrity. This narrative review synthesizes current mechanistic and clinical evidence supporting the adjunctive role of zinc and selenium in the management of SCH. While emerging data suggest potential biochemical and immunological benefits, heterogeneity in study design and duration necessitates well-powered randomized trials to define optimal dosing strategies and long-term clinical outcomes.

Industrial-based application of supercritical CO2 (SCCO2) has emerged as a promising technology in numerous scientific fields due to offering brilliant advantages, such as simplicity of application, eco-friendliness, and high performance. Loxoprofen sodium (chemical formula C15H18O3) is known as an efficient nonsteroidal anti-inflammatory drug (NSAID), which has been long propounded as an effective alleviator for various painful disorders like musculoskeletal conditions. Although experimental research plays an important role in obtaining drug solubility in SCCO2, the emergence of operational disadvantages such as high cost and long-time process duration has motivated the researchers to develop mathematical models based on artificial intelligence (AI) to predict this important parameter. Three distinct models have been used on the data in this work, all of which were based on decision trees: K-nearest neighbors (KNN), NU support vector machine (NU-SVR), and Gaussian process regression (GPR). The data set has two input characteristics, P (pressure) and T (temperature), and a single output, Y = solubility. After implementing and fine-tuning to the hyperparameters of these ensemble models, their performance has been evaluated using a variety of measures. The R-squared scores of all three models are greater than 0.9, however, the RMSE error rates are 1.879 × 10−4, 7.814 × 10−5, and 1.664 × 10−4 for the KNN, NU-SVR, and GPR models, respectively. MAE metrics of 1.116 × 10−4, 6.197 × 10−5, and 8.777 × 10−5errors were also discovered for the KNN, NU-SVR, and GPR models, respectively. A study was also carried out to determine the best quantity of solubility, which can be referred to as the (x1 = 40.0, x2 = 338.0, Y = 1.27 × 10−3) vector.

Objective This study examined the impact of a short-term study abroad program, focusing on program evaluation, attendee satisfaction, and acquired knowledge and skills. A questionnaire survey was conducted covering various aspects including demographics, program evaluation, and feedback. Results Results indicated higher female participation due to gender imbalances in pharmacy students in Egypt, with senior students recognizing the value of international experience. Attendee satisfaction was high, with positive feedback on accommodation, tours, and workshop materials. Field visits and workshops provided valuable experiential learning, with attendees suggesting extending the program’s duration. The program equipped attendees with knowledge and skills relevant to pharmaceutical products and services, leading to improved competences and perceptions. The study concludes that such study abroad experiences profoundly impact personal growth and recommends integrating them into educational curricula for valuable experiences.

Background Cesarean section is among the most commonly performed surgical procedures worldwide, and effective postoperative pain management is essential for promoting early ambulation, breastfeeding, maternal–infant bonding, and overall recovery. Although opioids remain effective for post-cesarean analgesia, their use is associated with maternal and neonatal adverse effects, driving increasing interest in opioid-sparing multimodal analgesic strategies incorporating adjuvant therapies. Main body This narrative review synthesizes and critically evaluates the clinical evidence supporting pharmacological and non-pharmacological adjuvant therapies for postoperative pain management following cesarean section. Emphasis is placed on agents that target complementary pain pathways, including peripheral inflammation, oxidative stress, and central sensitization. Pharmacological adjuvants such as non-steroidal anti-inflammatory drugs, α2-adrenergic agonists, neuromodulators, antioxidants, and emerging immunomodulatory agents are discussed with respect to their mechanisms of action, analgesic efficacy, opioid-sparing potential, and safety profiles in lactating mothers. Non-pharmacological interventions and multimodal combination strategies within enhanced recovery after cesarean section protocols are also reviewed. Emerging evidence supporting novel agents, including endogenous and nutraceutical-based therapies such as lactoferrin, is highlighted. Conclusion Multimodal analgesia incorporating evidence-based adjuvant therapies represents an effective and patient-centered approach to post-cesarean pain management, enabling improved analgesia while minimizing opioid exposure. Selection of adjuvants should be guided by clinical efficacy, safety during lactation, and impact on functional recovery. Further high-quality randomized trials are needed to establish standardized protocols and to clarify the role of emerging adjuvant agents in optimizing post-cesarean analgesic outcomes.

Background Community-acquired pneumonia remains a major health concern, characterized by significant morbidity and mortality. The underlying pathophysiology of community-acquired pneumonia involves substantial oxidative stress and inflammation, which contribute to lung tissue damage and impaired immune function. Main body Variations in oxidative metabolism contribute to the inflammatory cascade which triggers pneumonia to commence and evolve, whereas oxidative stress as well as inflammatory processes is strongly related. Understanding the underlying immunological dysregulation and unbalanced redox that heighten vulnerability to a variety of illnesses has improved over the past several decades attributable to research. One of the key strategies for addressing oxidative stress is to lower the reactive oxygen species creation in the mitochondrion which is one of the main sites of their generation by using antioxidants, where they prevent oxidants from transferring electrons to other molecules. Consequently, antioxidants either directly or indirectly reduce the risk of damage and preserve the redox equilibrium. Therefore, antioxidants, due to their ability to neutralize reactive oxygen species and modulate inflammatory processes, have been explored as potential adjuvant therapies to enhance the treatment outcomes of community-acquired pneumonia. Where recent research has explored the potential of antioxidants as adjuvant therapy in the treatment of community-acquired pneumonia, aiming to mitigate these detrimental effects. Antioxidants such as N-acetylcystein, vitamin C, vitamin E, astaxanthin, and zinc have shown promising results in both preclinical and clinical studies. Conclusion Outcomes of several in vitro as well as in vivo antioxidant studies have demonstrated the antioxidants' promising potential as an adjunct pneumonia therapy. For an assessment of its effectiveness in this therapeutic context, more research involving humans will be required.