Federal pharmacist Paxlovid prescribing authority: A model policy or impediment to optimal care?

The U.S federal government leveraged emergency authority to allow pharmacists to prescribe Paxlovid (nirmatrelvir and ritonavir) during the COVID-19 pandemic. While heralded by pharmacy associations, the FDA framework included restrictions that arguably ran counter to clinical guidelines and evidence-based research and recommendations. These restrictions will limit the utility of pharmacist prescriptive authority for Paxlovid in practice. The experience of Paxlovid prescribing and a similar recent federal action illustrate the challenges inherent in federal oversight of pharmacist prescriptive authority. While initially more difficult to navigate for stakeholders, working with state legislatures and state boards of pharmacy has much stronger long-term potential to enable broad pharmacist prescriptive authority and benefit patient care. This commentary uses Idaho's pharmacist prescribing regulations as a comparison to the federal actions.

Hypoadrenalism as the Single Presentation of Autoimmune Polyglandular Syndrome Type 1.

Type 1 autoimmune polyglandular syndrome (APS1) is a rare hereditary disease affecting nearly 600 patients worldwide. The first of its cardinal manifestations, chronic mucocutaneous candidiasis, hypoparathyroidism, or Addison's disease, presents in childhood. Additional nonclassical landmarks of APS1 continue to develop as late as the fifth decade of life. Two thirds of patients develop the full triad before 25 years of age. Only 20% of patients develop the entire triad simultaneously. Addison's disease is rarely reported as the first manifestation. According to APS1 classifications, restricted criteria for a single cardinal component, although elements of suspicion are not sufficient to diagnose APS1. This case report is peculiar as hypoadrenalism was the first and only manifestation of APS1 for nearly 3 decades since its diagnosis. Theoretically, exceptions from the protocol of APS1 diagnostic criteria would be recognized as acceptable for diagnosis in the future, when similar case reports of only 1 component of APS1 appear.

The Impact of Pharmacist Interventions on Herpes Zoster Vaccination Rates.

The Centers for Disease Control and Prevention found that in 2010 only 14.4% of people in the United States who are appropriate candidates received the herpes zoster (shingles) vaccine. This manuscript highlights recent studies that investigate how pharmacists can help improve vaccination rates of herpes zoster in the geriatric population. Research has demonstrated that face-to-face interaction, education, and outreach by pharmacists in the community can help improve rates of herpes zoster vaccination. Having pharmacists take time to talk with patients about the vaccine was shown to have a positive impact on vaccine rates. When face-to-face interactions are not feasible, promotional materials such as newspaper advertisements, flyers, and personalized letters were also found to have a beneficial impact. Pharmacists should consider ways to increase awareness of vaccinations and directly encourage their patients to be vaccinated.

Diabetic neuropathic cachexia: a case report.

INTRODUCTION: We report a case of the rare entity of diabetic neuropathic cachexia, in order to remind clinicians that these cases still exist. CASE PRESENTATION: A 71-year-old Moslem Arab man with type 2 diabetes along with diabetic neuropathic cachexia complicated by a hyperfunctioning autonomous thyroid nodule, and undiagnosed acromegaly came under our care. We report the unique challenges as to what are the priorities to consider in the course of investigation and treatment. This case emphasizes the fast recovery from this remediable disorder, with antineuropathic medication and exogenous insulin to serve as an anabolic hormone on top of its hypoglycemic effect. Shared pathophysiologic aspects of diabetic neuropathic cachexia, cancerous etiologies and acute phase response are discussed. CONCLUSIONS: Diabetic neuropathic cachexia is an integral differential diagnosis, whenever an intense neuropathic pain dominates patient complaints, accompanied with anorexia, weight loss as well as mood and sleep disturbances. This is an original case report of interest to internists, endocrinologists, diabetologists and pain clinic practitioners. Raising the suspicion of diabetic neuropathic cachexia early and concomitant to weight loss investigation, might curtail suffering and prompt early recovery from a severe illness that has a good prognosis.

Estimation of (IgA) anti-gliadin, anti-endomysium and tissue transglutaminase in the serum of patients with psoriasis.

Studies have indicated an association between psoriasis and coeliac disease (CD), an immune-mediated gluten-dependent enteropathy; however, the precise relationship between psoriasis and CD remains controversial. We aimed to assess the prevalence of the CD-associated IgA antibodies antigliadin antibody (AGA), tissue transglutaminase (tTG) and antiendomysium antibody (EMA) in patients with psoriasis. In total, 41 patients with psoriasis and 41 healthy controls were enrolled in this study. Blood samples were taken from all participants, and screened for AGA, tTG and EMA. We found a significantly higher level of AGA in patients with psoriasis than in controls, but levels of tTG and EMA were not significant. There was also a significantly higher prevalence of AGA, tTG and EMA in the patient group (34.1%, 34.1% and 14.6%, respectively) than in the control group (2.4%, 22% and 4.9%, respectively). We conclude that the significantly high prevalence of AGA antibodies in patients with psoriasis supports the possibility of a link between psoriasis and gluten-sensitive enteropathies, especially CD.

Growth inhibitory and apoptosis-inducing effects of xanthohumol, a prenylated chalone present in hops, in human prostate cancer cells.

Promotion of apoptosis in cancer cells could potentially lead to the regression and improved prognosis of hormone-refractory prostate cancer. Xanthohumol (XN), a prenylated chalcone-derived from hops, has shown strong antitumorigenic activity towards diverse types of cancer cells. In the present study, the growth-inhibitory and apoptosis-inducing activity of XN was tested in hormone-sensitive and hormone-refractory human prostate cancer cells lines. Cell growth/viability assay (MTS) demonstrated that prostate cancer cells are highly sensitive to XN at a concentration range of 20-40 µM. The primary mode of tumor cell destruction was apoptosis as demonstrated by the binding of annexin V-FITC, cleavage of PARP-1, activation of procaspases -3, -8, and -9, mitochondrial depolarization and release of cytochrome c from mitochondria. Induction of apoptosis by XN was associated with the inhibition of prosurvival Akt, NF-κB and mTOR signaling proteins and NF-κB-regulated anti-apoptotic Bcl-2 and survivin. These studies provide a rationale for clinical evaluation of XN for the treatment of hormone-refractory metastatic prostate cancer.

Imaging Mouse Prostate Gland by 3 Tesla Clinical MRI System.

In vivo detection of prostate tumor in animal model will facilitate the investigations that deal with the efficacy of different treatment strategies in different experimental settings. Recently higher field strength dedicated animal MRI system has been used successfully to detect mouse prostate glands and its lesions, however, usefulness of clinical system has not been utilized to its fullest extent. In this short communication we show the advantages and disadvantages of different in vivo imaging parameters of MRI to acquire images of the mouse prostate gland using clinical strength MRI systems.