Current Issue : July-September Volume : 2026 Issue Number : 3 Articles : 5 Articles
Background: Alemtuzumab is a recombinant DNA-derived humanized monoclonal antibody directed against the 21–28 kd cell surface glycoprotein, CD52. Alemtuzumab is used as an organ anti-rejection therapy in transplant recipients. Neuro-ophthalmic adverse effects are rarely described, and, to our knowledge, accommodative spasm has not previously been reported in a transplant recipient. Case Description: A thirty-nine-year-old woman with genetically confirmed NPHP1-associated nephronophthisis, with stage F3 fibrosis, developed persistent bilateral blurred vision 72 h following alemtuzumab administration for a biopsy-proven acute cellular rejection, approximately six to seven weeks post-transplant. Initial attribution to hyperglycaemia and tacrolimus toxicity delayed recognition. Cycloplegic refraction confirmed a marked hyperopic shift (+2.75 D right eye, +2.50 D left eye) with significant improvement in visual acuity, consistent with accommodative spasm. Systemic evaluations excluded hyperglycaemia-related lens changes, calcineurin inhibitor neurotoxicity, and cytomegalovirus retinitis. MRI was not pursued in the absence of red flag neurological features, and because a definitive ophthalmic diagnosis had been made. Management and Outcome: The patient was managed expectantly, as cycloplegic refraction had already confirmed the diagnosis, and symptoms were improving. Therapeutic cycloplegia (e.g., atropine) was withheld to avoid impairing near vision and driving ability. Full resolution occurred within 4 to 6 weeks without intervention. Drug exposure to onset of symptoms was 72 h; onset of symptoms to diagnostic confirmation was 22 days; total symptom duration was 5.5 weeks, and recovery was 2 weeks after diagnosis. Conclusions: This case represents the first reported transplant case of alemtuzumab-associated accommodative spasm. Causality assessment supports a WHO-UMC classification of “Probable”, aligning with five Bradford–Hill considerations (temporality, biological plausibility, consistency, specificity, and analogy), but without statistical “strength of association” given that this is a single case report. Early cycloplegic refraction should be incorporated into the evaluation of post-alemtuzumab visual complaints, and clinicians should contribute to pharmacovigilance through structured reporting to capture these rare but important events....
Aim: To explore the practices, confidence and perspectives of community pharmacists in deprescribing high-risk psychotropic medicines, including opioid analgesics, benzodiazepine, gabapentinoids and medicinal cannabis. Methods: An anonymous, cross-sectional national online survey was conducted between January and April 2025 among Australian community pharmacists. The survey captured data on pharmacist demographics, their workplace (pharmacy) characteristics, their provision of high-risk psychotropic medicines, and pharmacists' perspectives, confidence and practices related to implementing strategies to support deprescribing of these medicines. Descriptive statistics and logistic regression analyses were conducted to explore the factors associated with initiating discussions with patients about deprescribing. Results: The sample comprised of 730 pharmacists, representing approximately 12% of all Australian community pharmacies. Approximately three-quarters indicated their pharmacy received prescriptions every day for opioids (80.6%), benzodiazepines (75.2%) and gabapentinoids (72.1%), whilst fewer than one-tenth of pharmacies (8.9%) received medicinal cannabis prescriptions every day. Pharmacists working outside of capital cities (i.e. other urban, rural or remote areas; adjusted odds ratio (aOR): 1.33, 95% confidence intervals (CIs): 0.97–1.83), pharmacy managers/owners (aOR: 1.29, 95% CIs: 1.22–1.50) and those with ≥ 15 years of professional experience (OR: 1.57, 95% CIs: 1.17–2.11) had higher odds of initiating discussions on deprescribing psychotropic medicines compared with those working in capital cities, employee pharmacists and those with <15 years of professional experience, respectively. Conclusion: These findings provide some of the first insights into deprescribing practices of high-risk psychotropic medicines within community pharmacy settings, highlighting clear opportunities to strengthen these practices, particularly through supporting early-career pharmacists and those practicing in capital cities....
Background and Objectives: Intra-articular injection of adipose-derived stromal vascular fraction (SVF) has emerged as a promising regenerative treatment for knee osteoarthritis (OA) because of its heterogeneous cellular composition and potent anti-inflammatory paracrine effects. Although SVF therapy has demonstrated clinical efficacy, the timing of pain relief and the influence of SVF cell dose on early clinical outcomes remain incompletely defined. Materials and Methods: This retrospective study included 146 patients (217 knees) with Kellgren–Lawrence (K–L) grade II–IV knee OA who underwent intra-articular injection of autologous adipose-derived SVF and completed a minimum follow-up of 1 year. Pain was assessed using the visual analog scale (VAS), and patients reported the time to perceived pain improvement after treatment. Radiographic severity was evaluated using the K–L grading system. Correlation analyses were performed to assess associations between pain-related outcomes, SVF cell number, and radiographic severity. Results: VAS scores improved significantly from baseline to the final follow-up (p < 0.01). Patients reported perceived pain improvement at a mean of 18.9 ± 14.5 days after SVF injection. The mean injected dose was 7.4 × 107 total SVF cells per knee, including approximately 7.0 × 106 stromal cells. Higher SVF cell numbers were significantly associated with greater pain improvement and lower VAS scores at final follow-up (p < 0.001 for both). Radiographic severity was not significantly correlated with pain at final follow-up, the magnitude of pain improvement, or the time to symptom relief. No clinically relevant adverse events were observed. Conclusions: Intra-articular injection of high-dose autologous SVF was associated with rapid and clinically meaningful pain relief, with symptom improvement occurring within approximately 3 weeks after treatment. The dose-dependent association and the lack of correlation with radiographic severity suggest that early pain relief is primarily mediated by the anti-inflammatory and paracrine effects of SVF rather than immediate structural cartilage regeneration....
The burden of noncommunicable diseases is increasing rapidly in low‐ and middle‐income countries creating a growing need for advanced diagnostic and therapeutic modalities. Nuclear medicine offers great potential in disease detection, treatment planning, and monitoring, yet its integration into resource‐limited health systems remains challenging. This review synthesizes evidence from peer‐reviewed publications and relevant reports from international agencies to examine barriers to, and enablers of, nuclear medicine adoption in these settings. We found that key obstacles include financial constraints, restricted access to essential materials, insufficient regulatory frameworks, and shortages of skilled professionals. These gaps contribute to safety concerns, inadequate waste management, and delays in service delivery. Although global initiatives have strengthened workforce training and promoted regulatory harmonization, persistent issues in financial sustainability and retention of trained staff hinder progress. Technological advances, such as novel imaging and therapeutic approaches, present opportunities; however, their successful implementation requires context‐specific strategies that align with local infrastructure and policy realities. Integrating nuclear medicine into health systems in low‐resource environments can address multiple health care priorities simultaneously, but this will require targeted investment, sustainable financing mechanisms, and strengthened institutional capacity. Collaborative international support, coupled with locally adapted policies, could accelerate equitable access and improve patient outcomes. Expanding the role of nuclear medicine in these regions has the potential to significantly enhance health care delivery and contribute to closing the global disparity in advanced medical services....
Background: Congenital heart diseases are the most common congenital malformations, affecting 4 to 9 per 1000 children, with increasing global prevalence. As surgical mortality rates decline, the focus has shifted toward improving the quality of life and perioperative outcomes for pediatric patients. Multidisciplinary rehabilitation, including osteopathic care, is increasingly incorporated into recovery programs. Osteopathic manipulative treatment combines manual techniques with lifestyle guidance to alleviate postoperative pain and promote recovery. This project report describes the impact of osteopathic manipulative treatment (OMT) on pain and somatic dysfunctions in hospitalized pediatric cardiac patients, using validated pain assessment tools. It presents a retrospective analysis of data collected as part of a humanitarian volunteer project. Methods: The project report follows a retrospective descriptive study design, using patient note forms from children aged 0–18 years undergoing cardiac surgery at the Sri Sathya Sai Sanjeevani Center in India between October 2023 and March 2024. A total of 29 experienced osteopaths recorded pain assessments at three time points—pre-surgery, post-surgery, and pre-discharge—using age-appropriate pain scales (FLACC,Wong-Baker Faces, and Numerical Rating Scale). Somatic dysfunctions were evaluated and classified using ICD-10 M99 codes. Data analysis involved descriptive statistics and pre-post comparisons using statistical software (Excel and OPENEPI). Results: The study included 564 children (60.5% male, mean age 5.8 ± 4.3 years). The most common congenital defects were ventricular septal defects (38.5%) and tetralogy of Fallot (21.6%). The average hospital stay was 15.9 ± 11.1 days. Significant reductions in pain scores were observed from the Intensive Care Unit to the postoperative ward (p < 0.001). Similarly, somatic dysfunction severity decreased significantly across hospitalization phases (p < 0.001). The thoracic region and rib cage were the most frequently affected areas. No adverse events related to osteopathic manipulative treatments were reported. Conclusions: This project report indicates that osteopathic manipulative treatment is safe and feasible for pediatric patients undergoing surgery for congenital heart disease. Pain scores and somatic dysfunction severity decreased during hospitalization. However, the lack of a control group, the heterogeneity of the patient population, and the short observation period limit the ability to draw causal conclusions. These findings provide a descriptive framework for integrating OMT into multidisciplinary pediatric cardiac care. Future studies should involve prospective, multicenter designs with control groups and longer follow-up periods to assess clinical, functional, developmental, and quality-of-life outcomes....
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