scholarly journals Polypharmacy and Malnutrition Management of Elderly Perioperative Patients with Cancer: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1961
Author(s):  
Eiji Kose ◽  
Hidetaka Wakabayashi ◽  
Nobuhiro Yasuno
Keyword(s):  
Side Effects ◽  
Cancer Cachexia ◽  
Drug Effects ◽  
Drug Efficacy ◽  
Nutritional Management ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Drug Induced ◽  
Anabolic Resistance ◽  
Patients With Cancer ◽  
The Impact

Malnutrition, which commonly occurs in perioperative patients with cancer, leads to decreased muscle mass, hypoalbuminemia, and edema, thereby increasing the patient’s risk of various complications. Thus, the nutritional management of perioperative patients with cancer should be focused on to ensure that surgical treatment is safe and effective, postoperative complications are prevented, and mortality is reduced. Pathophysiological and drug-induced factors in elderly patients with cancer are associated with the risk of developing malnutrition. Pathophysiological factors include the effects of tumors, cachexia, and anorexia of aging. Metabolic changes, such as inflammation, excess catabolism, and anabolic resistance in patients with tumor-induced cancer alter the body’s ability to use essential nutrients. Drug-induced factors include the side effects of anticancer drugs and polypharmacy. Drug–drug, drug–disease, drug–nutrient, and drug–food interactions can significantly affect the patient’s nutritional status. Furthermore, malnutrition may affect pharmacokinetics and pharmacodynamics, potentiate drug effects, and cause side effects. This review outlines polypharmacy and malnutrition, the impact of malnutrition on drug efficacy, drug–nutrient and drug–food interactions, and intervention effects on polypharmacy or cancer cachexia in elderly perioperative patients with cancer.

Gender-Based Differences in the Toxicity of Pharmaceuticals—The Food and Drug Administration's Perspective

2001 ◽  
Vol 20 (3) ◽  
pp. 149-152 ◽  
Author(s):  
Margaret Ann Miller
Keyword(s):  
Clinical Trials ◽  
Adverse Events ◽  
Sex Difference ◽  
Qt Interval ◽  
Drug Effects ◽  
Drug Efficacy ◽  
Model Systems ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Drug Induced

Women experience more adverse reactions to treatment with therapeutic drugs than men. Theories proposed to explain this include overdosing, different pharmacokinetics and pharmacodynamics, women are more likely to report adverse events than men, or women take more medications than men. Food and Drug Administration (FDA) Office of Women's Health (OWH) funds research to promote including women in clinical trials and understanding the biology of sex-related differences in the safety of FDA-regulated products. Including women in clinical trials advances the understanding of drug efficacy and safety in women by providing information on drug dosing, pharmacokinetics, and pharmacodynamics. A Baysian statistical analysis of sex differences in adverse events showed that although about the same number of adverse events were reported for men and women, those reported for women were more serious. One example of a sex difference in the toxicity of pharmaceuticals is the drug-induced cardiac arrhythmia, torsades de point. OWH funded studies in animals and humans to investigate the mechanism behind this sex difference. These studies demonstrated that shortening the QT interval increases the risk of developing torsades and that androgens protect against torsades by slowing cardiac repolarization and prolonging the QT interval. Understanding the mechanisms behind other reported sex-related differences in adverse drug effects requires additional research. The preliminary studies conducted to date suggest that this sex-related difference is likely to be a multifactorial problem requiring information from several fields of study. Ideally, individuals at risk for developing an adverse event should be identified prior to therapeutic intervention. The OWH plans to fund more studies to investigate the role of hormonal variations on drug metabolism and drug-drug interactions. Animal and in vitro model systems are needed to fully understand the mechanism of how gender influences drug toxicity.

scholarly journals The Impact of Educational Package on Nursing Students' Knowledge towards Fertility Preservation, a Quasi-Experimental Study

2019 ◽  
Vol 4 (2) ◽  
Author(s):  
Nastaran Rafiei ◽  
Simin Esmaeilpour Zanjani ◽  
Kajal Khodamoradi
Keyword(s):  
Nursing Students ◽  
Side Effects ◽  
Fertility Preservation ◽  
Care Providers ◽  
Patients With Cancer ◽  
Educational Package ◽  
Significant Difference ◽  
Quasi Experimental ◽  
The Mean ◽  
The Impact

Background: Recent advances in diagnosis and treatment of cancers have resulted in survival improvement in young patients with cancer. Given the side effects of cancer treatments on the function of the reproductive system, health care providers need to be educated about the side effects of cancer treatment and fertility preservation. The aim of this study was to explore the effect of education on nursing students' knowledge towards fertility preservation methods in patients with cancer. Methodology: This was a quasi-experimental one-group pre-test post-test research study that was carried out by the nursing faculty at Islamic Azad University of Tonekabon in 2018. Data was collected through a two-part questionnaire, including demographic characteristics and 32 questions about the knowledge of fertility preservation in patients with cancer. The study intervention was an educational package which includes 8 sessions of small group education, planning questions, and a booklet. Students were asked to complete the questionnaire before starting an educational session and again two weeks after the last session. Results: The difference in the mean score of the nursing students’ knowledge before and after the educational package intervention was significant (P= 0.0001). Also, the knowledge rank of nursing students after the intervention was significantly better than before (P = 0.0001).  There was a significant difference between the mean score of knowledge based on gender (0.0001), marital status (0.0001) and residency (0.0001). Conclusion: In conclusion, educational intervention towards fertility preservation had a positive effect on nursing students’ knowledge. Therefore, the importance of considering this new approach to fertility preservation in patients with cancer should be considered in the nursing curriculum as they consider as the main resource of the medical information to the patients

scholarly journals A Case of Antithyroid Drug-Induced Agranulocytosis Pre-Covid 19 Era

2020 ◽  
pp. 1-4
Author(s):  
MosabNouraldein Mohammed Hamad
Keyword(s):  
Side Effects ◽  
Neutrophil Count ◽  
Antithyroid Drug ◽  
Drug Effects ◽  
Medical Advice ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Drug Induced ◽  
Immunological Mechanisms ◽  
Noticeable Reduction

Agranulocytosis is an infrequent and serious side effect of antithyroid drugs characterized by a noticeable reduction in granulocyte and neutrophil count, it usually occurs within the first 2-3 months of treatment. There is a variety of mechanisms by which ATD can induce agranulocytosis, direct drug effects, and immunological mechanisms. We present 33 years old female attended Atbara teaching hospital who has developed agranulocytosis 2 weeks after starting ATD to treat relapsed Graves' disease. What was unusual about this patient is that symptoms have occurred in a period less than 15 days of starting treatment and with a dose of 45 mg /day. The physician must educate the patient about the possibility of early onset of serious side effects of ATD and to seek medical advice as soon as possible.

scholarly journals A Computational Pipeline to Predict Cardiotoxicity

2020 ◽  
Vol 126 (8) ◽  
pp. 947-964 ◽  
Author(s):  
Pei-Chi Yang ◽  
Kevin R. DeMarco ◽  
Parya Aghasafari ◽  
Mao-Tsuen Jeng ◽  
John R.D. Dawson ◽  
...  
Keyword(s):  
Drug Discovery ◽  
Qt Interval ◽  
Channel Model ◽  
Surrogate Marker ◽  
Drug Effects ◽  
Drug Binding ◽  
Herg Channel ◽  
Model Framework ◽  
Drug Induced ◽  
The Impact

Rationale: Drug-induced proarrhythmia is so tightly associated with prolongation of the QT interval that QT prolongation is an accepted surrogate marker for arrhythmia. But QT interval is too sensitive a marker and not selective, resulting in many useful drugs eliminated in drug discovery. Objective: To predict the impact of a drug from the drug chemistry on the cardiac rhythm. Methods and Results: In a new linkage, we connected atomistic scale information to protein, cell, and tissue scales by predicting drug-binding affinities and rates from simulation of ion channel and drug structure interactions and then used these values to model drug effects on the hERG channel. Model components were integrated into predictive models at the cell and tissue scales to expose fundamental arrhythmia vulnerability mechanisms and complex interactions underlying emergent behaviors. Human clinical data were used for model framework validation and showed excellent agreement, demonstrating feasibility of a new approach for cardiotoxicity prediction. Conclusions: We present a multiscale model framework to predict electrotoxicity in the heart from the atom to the rhythm. Novel mechanistic insights emerged at all scales of the system, from the specific nature of proarrhythmic drug interaction with the hERG channel, to the fundamental cellular and tissue-level arrhythmia mechanisms. Applications of machine learning indicate necessary and sufficient parameters that predict arrhythmia vulnerability. We expect that the model framework may be expanded to make an impact in drug discovery, drug safety screening for a variety of compounds and targets, and in a variety of regulatory processes.

scholarly journals The Impact of Probiotics on Intestinal Mucositis during Chemotherapy for Colorectal Cancer. A Comprehensive Review of Animal Studies

2021 ◽  
Vol 22 (17) ◽  
pp. 9347
Author(s):  
Povilas Miknevicius ◽  
Ruta Zulpaite ◽  
Bettina Leber ◽  
Kestutis Strupas ◽  
Philipp Stiegler ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Side Effects ◽  
Animal Studies ◽  
Combined Treatment ◽  
Experimental Studies ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Drug Induced ◽  
Intestinal Mucositis ◽  
The Impact

Colorectal cancer (CRC) is the second most commonly diagnosed cancer in females (incidence 16.4/10000) and the third in males (incidence 23.4/10000) worldwide. Surgery, chemotherapy (CTx), radiation therapy (RTx), or a combined treatment of those are the current treatment modalities for primary CRC. Chemotherapeutic drug-induced gastrointestinal (GIT) toxicity mainly presents as mucositis and diarrhea. Preclinical studies revealed that probiotic supplementation helps prevent CTx-induced side effects by reducing oxidative stress and proinflammatory cytokine production and promoting crypt cell proliferation. Moreover, probiotics showed significant results in preventing the loss of body weight (BW) and reducing diarrhea. However, further clinical studies are needed to elucidate the exact doses and most promising combination of strains to reduce or prevent chemotherapy-induced side effects. The aim of this review is to overview currently available literature on the impact of probiotics on CTx-induced side effects in animal studies concerning CRC treatment and discuss the potential mechanisms based on experimental studies’ outcomes.

Pharmacogenetics of Opioid Therapy in Treatment of Postoperative Pain: A Review

2016 ◽  
Vol 70 (2) ◽  
pp. 57-62
Author(s):  
Vаnja Dzambazovska-Trajkovska ◽  
Jordan Nojkov ◽  
Adrijan Kartalov ◽  
Biljana Kuzmanovska ◽  
Tatjana Spiroska ◽  
...  
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Current Knowledge ◽  
Receptor Gene ◽  
Opioid Therapy ◽  
Economic Problem ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Opioid Sensitivity ◽  
The Impact ◽  
Effective Analgesia

Abstract The safe and effective analgesia during and after surgery is an important clinical, social and economic problem. The goal of good analgesia is an individual balancing that patient's pain is reduced to a low level, and side effects are minimized. Data from the literature suggest genetic differences between patients in their ability to metabolize a particular drug. The effect of the drug is determined by interreaction of several genetic polymerphisms that affect the pharmacokinetics and pharmacodynamics of the drug, including differences in potency of binding to receptors and activity of drug enzymes and transportters. There is evidence suggesting that mutations of the mu-opioid receptor gene affects interindividual differences in opioid sensitivity. This review of the literature aims to analyze the current knowledge on the impact of genetic polymorphisms of CYP3A4, ABCB1 C3435, ABCB1 2677 and OPRM1 A118G gene on analgesic effect and side effects of opioids in the treatment of postoperative pain.

scholarly journals The Role of Systemic Inflammation in Cancer-Associated Muscle Wasting and Rationale for Exercise as a Therapeutic Intervention

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Calvin Lloyd Cole ◽  
Ian R. Kleckner ◽  
Aminah Jatoi ◽  
Edward Schwarz ◽  
Richard F. Dunne
Keyword(s):  
Skeletal Muscle ◽  
Systemic Inflammation ◽  
Cancer Cachexia ◽  
Muscle Wasting ◽  
Activin A ◽  
Therapeutic Interventions ◽  
Muscle Quality ◽  
Patients With Cancer ◽  
Skeletal Muscle Wasting ◽  
The Impact

Progressive skeletal muscle wasting in cancer cachexia involves a process of dysregulated protein synthesis and breakdown.  This catabolism may be the result of mal-nutrition, and an upregulation of both pro-inflammatory cytokines and the ubiquitin proteasome pathway (UPP), which can subsequently increase myostatin and activin A release.  The skeletal muscle wasting associated with cancer cachexia is clinically significant, it can contribute to treatment toxicity or the premature discontinuation of treatments resulting in increases in morbidity and mortality.  Thus, there is a need for further investigation into the pathophysiology of muscle wasting in cancer cachexia to develop effective prophylactic and therapeutic interventions.  Several studies have identified a central role for chronic-systemic inflammation in initiating and perpetuating muscle wasting in patients with cancer.  Interestingly, while exercise has shown efficacy in improving muscle quality, only recently have investigators begun to assess the impact that exercise has on chronic-systemic inflammation.  To put this new information into context with established paradigms, here we review several biological pathways (e.g. dysfunctional inflammatory response, hypothalamus pituitary adrenal axis, and increased myostatin/activin A activity) that may be responsible for the muscle wasting in patients with cancer.  Additionally, we discuss the potential impact that exercise has on these pathways in the treatment of cancer cachexia.  Exercise is an attractive intervention for muscle wasting in this population, partially because it disrupts chronic-systemic inflammation mediated catabolism.  Most importantly, exercise is a potent stimulator of muscle synthesis, and therefore this therapy may reverse muscle damage caused by cancer cachexia. 

scholarly journals Antitumour Drug Induced Cardiovascular Toxicity and Current Tumour Treatment Methods

2020 ◽  
Vol 9 (4) ◽  
pp. 285-292
Author(s):  
K. S. Gumerova ◽  
G. M. Sakhautdinova ◽  
I. M. Polyakova
Keyword(s):  
Side Effects ◽  
Malignant Neoplasm ◽  
Malignant Neoplasms ◽  
Malignant Tumours ◽  
Drug Induced ◽  
Replication Process ◽  
Research Attention ◽  
Treatment Methods ◽  
Oncological Diseases ◽  
The Impact

Currently the oncological mortality takes the second place globally, the leading cause being cardiovascular diseases. The statistics of malignant neoplasms is rather negative all over the world. 10 million of cases of oncological disorders are diagnosed annually; this means that 27 million people fall sick with oncological diseases annually. It was established in 2019 that there are 14 million people suffering from oncological diseases, 8.2 million of these die. WHO anticipates that in 20 years’ time the malignant neoplasm incidence statistics will be on an increase as the number of new cases will reach 20 million, 12 million out of which will die. Regardless of such formidable figures medicine does not stand still; keeping up with the times, the science attempts to develop cutting edge methods of treating malignant tumours. As a result, the treatment of malignant neoplasms is continuing to improve. However, the number of side effects is also growing, thus requiring research attention. Therefore, the significance of the impact that oncological drugs have on a patient’s body is becoming more and more urgent for further discussion. While current tumour treatment methods involving drugs such as tyrosine kinase inhibitors, anthracycline chemotherapy and immunotherapy protocols are effective for the treatment of various forms of cancer, these drugs affect the DNA replication process thus resulting in endothelial dysfunction and nonspecific immune response. This causes cardiotoxic side effects. Cardiotoxicity, in its turn, is a notion that includes various adverse events involving the cardiovascular system of oncological patients receiving drug treatment. Cardiotoxicity may develop during treatment or following its completion.

scholarly journals Impact of Sarcopenia as a Prognostic Biomarker of Bladder Cancer

2018 ◽  
Vol 19 (10) ◽  
pp. 2999 ◽  
Author(s):  
Hiroshi Fukushima ◽  
Kosuke Takemura ◽  
Hiroaki Suzuki ◽  
Fumitaka Koga
Keyword(s):  
Skeletal Muscle ◽  
Bladder Cancer ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Cancer Cachexia ◽  
Prognostic Biomarker ◽  
Inflammatory Diseases ◽  
Patients With Cancer ◽  
Poor Nutritional Status ◽  
The Impact

Sarcopenia, the degenerative and systemic loss of skeletal muscle mass, indicates patient frailty and impaired physical function. Sarcopenia can be caused by multiple factors, including advanced age, lack of exercise, poor nutritional status, inflammatory diseases, endocrine diseases, and malignancies. In patients with cancer cachexia, anorexia, poor nutrition and systemic inflammation make the metabolic state more catabolic, resulting in sarcopenia. Thus, sarcopenia is considered as one of manifestations of cancer cachexia. Recently, growing evidence has indicated the importance of sarcopenia in the management of patients with various cancers. Sarcopenia is associated with not only higher rates of treatment-related complications but also worse prognosis in cancer-bearing patients. In this article, we summarized metabolic backgrounds of cancer cachexia and sarcopenia and definitions of sarcopenia based on computed tomography (CT) images. We conducted a systematic literature review regarding the significance of sarcopenia as a prognostic biomarker of bladder cancer. We also reviewed recent studies focusing on the prognostic role of changes in skeletal muscle mass during the course of treatment in bladder cancer patients. Lastly, we discussed the impact of nutritional support, medication, and exercise on sarcopenia in cancer-bearing patients.

Drug Induced Changes in Cell Organelles

1968 ◽  
Vol 26 ◽  
pp. 110-111
Author(s):  
Sarah A. Luse
Keyword(s):  
Clinical Medicine ◽  
Cell Organelles ◽  
Riboflavin Deficiency ◽  
Drug Induced ◽  
New Era ◽  
Health And Disease ◽  
In The Beginning ◽  
Cellular Pathology ◽  
Induced Changes ◽  
The Impact

In the mid-nineteenth century Virchow revolutionized pathology by introduction of the concept of “cellular pathology”. Today, a century later, this term has increasing significance in health and disease. We now are in the beginning of a new era in pathology, one which might well be termed “organelle pathology” or “subcellular pathology”. The impact of lysosomal diseases on clinical medicine exemplifies this role of pathology of organelles in elucidation of disease today.Another aspect of cell organelles of prime importance is their pathologic alteration by drugs, toxins, hormones and malnutrition. The sensitivity of cell organelles to minute alterations in their environment offers an accurate evaluation of the site of action of drugs in the study of both function and toxicity. Examples of mitochondrial lesions include the effect of DDD on the adrenal cortex, riboflavin deficiency on liver cells, elevated blood ammonia on the neuron and some 8-aminoquinolines on myocardium.

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