Rational probiotic use: specificity of application and approaches to optimize their effect through the prism of pharmaceutical care

Introduction: Probiotics are live microorganisms that, administered in adequate amounts, bring health benefits to the body. In practice, probiotics are indicated for various conditions, from mild diarrhea to conditions such as pseudomembranous colitis, irritable bowel syndrome, and an increase in the immune response. Their application becomes absolutely mandatory when it comes to antibiotic treatment, whose frequent adverse reaction is dysbiosis. As antibiotic use increases, so does the use of probiotics. The probiotics market was valued at USD 68.56 billion in 2022 and is expected to reach around USD 133.92 billion by 2030.Aim: The aim of the current study is to summarize the current information available regarding the appropriate probiotic strains for each condition, to note some of the risks of probiotic treatment, and to make recommendations for the implementation of adequate pharmaceutical care.Materials and Methods: A literature review was performed of available information in the World Gastroenterology Organization (WGO) guideline, Google Scholar, and PubMed, with statistics summarized by the World Health Organization, European Center for Disease Prevention and Control (ECDC).Results and Discussion: According to WGO recommendations, suitable strains in antibiotic-associated diarrhea are Lactobacillus acidophilus, L. casei (≥ 10e10 cfu, once daily), Lactobacillus rhamnosus (10e10 cfu, twice daily), Saccharomyces boulardii (250 mg, twice daily), and in C. difficile infection – Lactobacillus acidophilus, L. casei (≥ 10e10 cfu, once daily), Saccharomyces boulardii (250 mg, twice daily). An important aspect is that the antibiotic and probiotic should be taken separately, in order to avoid antagonizing the two products and the deterioration of antibiotic resistance. They should be taken 2 hours apart. It is advisable to continue using probiotics for at least 2-3 weeks after stopping the antibiotic. The side effects of probiotics are known in 4 main directions: systemic infections, metabolically harmful processes, excessive immune stimulation in susceptible individuals, and gene transfer. However, probiotic microorganisms are believed to be non-pathogenic, and the theoretical risk of infections is very low (mainly in immunocompromised patients). Studies on strain-specific properties, the study of pharmacokinetics, and studies looking for interactions between the strain and the host would prove useful for their more rational application according to scientific sources.Conclusion: Probiotics support the normal functioning of the gastrointestinal tract and prevent possible complications during antibiotic treatment. Each product contains one or more strains of bacteria, with different strains suitable for use in different conditions and antibiotic therapies. The regimen, dose, and duration of probiotic intake are determined by strain-specific properties. Pharmacists have a major role in the use of probiotics, based on patient opinion. Health professionals must obtain information about them from reliable sources and are required to warn patients about the peculiarities and risks of using probiotics

Animal models of skin wound healing – advantages and disadvantages

Skin wounds represent superficial or deep destructions of the skin, which occur as a result of Skin wounds represent superficial or deep destructions of the skin, which occur as a result of various external influences or surgical interventions. Immediately after the injury, a series of pathophysiological processes begin, aimed at restoring tissue integrity. Wound healing is a process involving interconnected and overlapping stages of hemostasis, inflammation, proliferation, and tissue remodeling. Numerous cellular populations, the extracellular matrix, and soluble mediators are also involved. Abnormalities in the healing process can result from systemic diseases and may lead to serious complications for the individual. Despite medical advancements, wound healing remains a significant clinical challenge, necessitating proper and effective treatment. In addition to improving traditional wound care, it is essential to develop new therapeutic approaches. Experimental models are a very useful tool for studying various diseases. Over the past decades, different skin injury models have been developed, which increase our knowledge of tissue recovery processes and contribute to the development of new clinically relevant therapeutic strategies. This review summarizes the processes of skin wound healing and discusses the most commonly used animal models. Differences in the healing process and in the in vivo skin wound models are analyzed in detail

Evaluating arteriovenous malformation and diffuse glioma: The role of arterial spin labeling MRI in complex neuroimaging—A case report

In this case report, we explore the utility of arterial spin labeling (ASL) MRI in a complex neuroimaging scenario featuring concurrent arteriovenous malformation (AVM) and a non-enhancing glioma in a 38-year old male. The report delves into the integration of ASL MRI with standard neuroimaging techniques, highlighting its role in providing detailed hemodynamic insights, particularly in characterizing the AVM and assessing the glioma's perfusion pattern. The case presents a diagnostic challenge due to the coexistence of these pathologies and discusses the implications of these findings in light of the evolving WHO brain tumor classification, which emphasizes the importance of molecular markers alongside histopathology. The report emphasizes the need for careful interpretation of advanced imaging in the absence of histopathological confirmation and advocates for a multidisciplinary approach in the management of such cases, underscoring the significance of ongoing research in harmonizing imaging techniques with molecular diagnostic

Epidemiology of drug-induced dermatoses: Prevalence, risk factors, and clinical outcomes

IntroductionDrug-induced dermatoses are adverse skin reactions triggered by medications, ranging from mild rashes to severe conditions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Understanding their prevalence, risk factors, and clinical presentations is essential for effective prevention and management. This study investigates the epidemiology, types, and risk factors associated with drug-induced dermatoses, providing insights for healthcare providers.Materials and MethodsA comprehensive review of 125 studies (2000–2024) was conducted using databases such as MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Data from literature reviews, observational studies, clinical trials, and case reports were analyzed to determine the prevalence, implicated drugs, and demographic or clinical factors influencing these reactions.ResultsDrug-induced dermatoses include a spectrum of reactions from mild to life-threatening. Commonly implicated drugs are antibiotics, NSAIDs, and antiepileptics, with prevalence rates of 0.5% to 5% among high-risk drug users. Severe reactions include SJS/TEN, drug reactions with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP). Significant risk factors include genetic predispositions (e.g., HLA-B*1502 for carbamazepine), age extremes, pre-existing conditions such as autoimmune diseases or HIV, and factors related to the type, dose, and duration of drug exposure.ConclusionHealthcare providers should identify high-risk drugs and implement measures such as genetic screening to minimize adverse reactions. Improving diagnostics, clinicians’education, and antibiotic stewardship is vital. Further research into genetic biomarkers and personalized medicine could reduce the clinical and societal impact of these reactions, enhancing patient care and outcomes

Medication-related osteonecrosis of the jaw—etiology, pathophysiology, clinical and radiological characteristics, and staging: A review

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious condition, caused by several classes of pharmaceutical agents, the most common of which are antiresorptive and antiangiogenic drugs. It is characterized by exposed necrotic bone, most commonly associated with antiangiogenic or antiresorptive therapy, and without a history of radiation exposure to the head and neck.Aim: This review aims to compare, and summarize the current knowledge on the etiology, pathophysiology, clinical and radiological characteristics, and staging of MRONJ, to identify the research gaps in the scientific literature, and to give recommendations for further research.Materials and Methods: An advanced electronic search was performed in PubMed, Scopus, and Web of Science, using selected keywords. Results were extracted to an MS Excel spreadsheet and assessed for eligibility after duplicate removal. After analysis of the obtained data, 35 articles were included in this study.Results and Discussion: The most common medications that cause MRONJ are antiresorptive and antiangiogenic drugs. Other possible agents are immunomodulators, monoclonal antibodies, corticoids, cytostatic drugs, etc. Numerous hypotheses for the pathophysiology of MRONJ have been suggested, including bone remodeling inhibition, impaired angiogenesis, specific infections, etc. Further research is necessary to confirm the role of different drugs in the pathogenesis of MRONJ.Conclusion: Despite the strong association between MRONJ and antiresorptive and antiangiogenic drugs, the exact pathophysiology of the disease is not fully understood. Future studies should investigate their mechanisms of action and correlation to MRONJ. Understanding its etiopathogenesis is essential for all medical practitioners in order to reduce MRONJ incidence and avoid its misdiagnosis

Uncommon neurological comorbidity: A patient with myasthenia gravis and epilepsy. A case report

Myasthenia gravis (MG) is a rare autoimmune disorder characterized by an antibody-mediated neuromuscular transmission block, leading to skeletal muscle weakness and fatigue. Epilepsy, a condition of unprovoked, recurrent seizures, rarely coexists with MG. Recent studies indicate an elevated epilepsy risk in patients with autoimmune diseases, including MG, potentially linked to autoimmune mechanisms or long-term anticonvulsant use.We report a 73-year-old woman diagnosed with MG, treated with pyridostigmine, with complaints of difficulty swallowing, excessive salivation, drooping eyelids, increased fatigue in the arms and legs, and with three generalized tonic-clonic (GTC) seizures in the past year, each lasting 1–2 minutes. The most recent seizure occurred a week before hospitalization. Neurological examination revealed bilateral ptosis, increased limb fatigue, and dysphagia. Electromyography (EMG) confirmed postsynaptic neuromuscular damage consistent with MG. electroencephalography (EEG) demonstrated epileptiform activity.This case highlights the rare but clinically significant coexistence of MG and epilepsy, emphasizing the need for thorough neurological assessment in MG patients with seizure-like episodes. Recognizing epilepsy in MG is crucial for appropriate treatment and improved patient outcomes. Further research is needed on autoimmune comorbidities in neurological disorders

Influence of implant scanbody material on the accuracy of digital impressions: A literature review

Introduction: In recent years, the use of intraoral scanners in the fabrication of fixed implant-supported restorations has become widespread in modern dental implantology. To register the position and angulation of implants in the oral cavity using an intraoral scanner, implant scan bodies (ISBs), are utilized.The aim is to evaluate the influence of ISB material on the accuracy of the digital impression.Materials and Methods: Articles related to the topic were searched in databases such as Google Scholar, PubMed, Scopus, and ScienceDirect, using various keyword combinations. Only full-text articles in English, published between 2019 and 2024, were included.Results: The articles included in this study are clinical and experimental research as well as several literature reviews. The studies examine the impact of different materials—titanium (Ti), polyetheretherketone (PEEK), PEEK-Ti—used to manufacture ISBs.Conclusion: The material from which ISBs are made plays a crucial role in scan accuracy. Differences in materials, such as titanium (Ti) versus polyetheretherketone (PEEK), have been identified as influencing factors. The findings show that the lowest deviations in the accuracy of the digital impression of the implant prosthetic area are achieved by using ISBs made of PEEK, followed by Ti ISBs, with the greatest deviation observed in ISBs made from PEEK-Ti

Tyrosine kinase inhibitors in modern oncotherapy

The widespread prevalence and increasing incidence of cancer has imposed the introduction of new therapeutic approaches and medications. The elucidation of the key role of receptor tyrosine kinases (RTKs) in intercellular signaling and their involvement in fundamental processes, replication, growth, differentiation, and apoptosis, has provided substantial evidence linking their altered functionality to tumorigenesis.This review aims to briefly discuss the role of RTKs in tumorigenesis and characterize tyrosine kinase inhibitors (TKIs), focusing on their mechanisms of action, pharmacodynamics, and pharmacokinetics as essential drugs in modern targeted cancer therapy.Two primary mechanisms inhibit mutated or overexpressed RTKs. The first involves monoclonal antibodies targeting the extracellular domains of RTKs or their ligands, inhibiting RTK dimerization and activation, thus forming the group of extracellular TKIs. The second mechanism involves small-molecule TKIs targeting the intracellular tyrosine kinase domain of the receptors or other intracellular tyrosine kinases mediating their signaling pathways. Numerous mono- and multi-targeted TKIs have been developed, addressing one or more signaling pathways. Identifying specific mutations in individual patients and applying specific TKIs have introduced the principles of personalized cancer therapy. Most TKIs are well-tolerated and significantly improve patient survival. The selectivity of TKIs toward their targets determines their efficacy and safety profile.Despite their advantages, TKI therapy is associated with significant toxic effects and high variability due to their pharmacokinetic features. Literature discusses the potential of therapeutic drug monitoring to optimize dosing, thereby enhancing efficacy and minimizing adverse side effects.In summary, TKIs are pivotal medications in modern oncology that have revolutionized the treatment paradigm for numerous cancers

Peri-implantitis

Peri-implantitis is a biological complication that can occur after a dental implant is placed. It encompasses inflammatory reactions around the implant, such as peri-implant mucositis and peri-implantitis itself. As dental implants become more widely used, complications associated with them are also becoming more common. Several risk factors can contribute to the development of peri-implantitis. These include placing an implant when there is an existing periodontal infection in the remaining teeth, as well as when there is inadequate width of attached gingiva. Poor oral hygiene is another significant risk factor. Additional factors include the presence of an endodontic infection near where the implant is placed, improper implant positioning in terms of prosthetic and/or biological alignment, the implant design itself, incorrect abutment choice, and unremoved cement in cement-retained prosthetic devices. Systemic and genetic factors can also play a role in modifying the risk of peri-implantitis. Peri-implant inflammatory diseases are diagnosed through both clinical and paraclinical testing methods. This involves assessing the risks associated with the implant, such as whether plaque is present, whether there is bleeding on probing, edema, erythema, increased probing depths, exudation, bone loss around the implant, and implant mobility. The treatment for peri-implant inflammation involves CIST therapy

Methods for diagnosis of third molar eruption disturbances on orthopantomography

Introduction: Third molars are the last teeth to form in the permanent dentition. In some individuals, jaw growth completion precedes the time of eruption of third molars, which creates conditions for their complete or partial retention in the bone. In order to predict the risk of wisdom tooth retention, methods have been developed that provide the possibility for early diagnosis of the deviations in their eruption.Aim: The aim of this review article is to present different methods for diagnosis of third permanent molar impaction on orthopantomography.Materials and Methods: Online research of 30 articles in different databases—PubMed, ResearchGate, Thieme, and Elsevier.Results: In this article are described different methods: a method for predicting the impaction of maxillary third molars, Haavikko’s method, Ganns’ ratio for predicting the available space for eruption of mandibular molars, Olive-Basford’s method, Olmos’ method, and Cryer’s method.Discussion: The reduction of space available for third molar eruption, leading to partial or complete retention, is an evolutionary process, determined by the reduction in the size of the lower and, to a lesser extent, the upper jaw in relation to the modern eating habits of the population. This increases the need for early diagnosis of possible deviations in eruption and control over any impact on the developing of the occlusion and function.Conclusion: The presented methods give the opportunity for early diagnosis of the deviations in the eruption of third molars. Their application allows the clinician to increase the accuracy of the prognosis and the risk assessment regarding the stability of the orthodontic treatment results