Archive for month: May, 2024

Many breast cancer survivors report cancer-related cognitive impairment following chemotherapy, although prevalence rates and severity vary.

To test whether a dementia drug could improve cognition in breast cancer survivors, researchers at Wake Forest University School of Medicine conducted a Phase III randomized, placebo-controlled trial to test donepezil, a cognitive-enhancing medicine used in the treatment of Alzheimer’s disease.

The research team found that donepezil did not improve memory or other cognitive functions in survivors with cancer-related cognitive impairment.

The findings appear online in the Journal of Clinical Oncology.

The researchers enrolled 276 breast cancer survivors from community oncology practices affiliated with the National Cancer Institute Community Oncology Research Program (NCORP), a national network that brings cancer clinical trials and care delivery studies to communities. The Wake Forest NCORP Research Base at Atrium Health Wake Forest Baptist’s National Cancer Institute-designated Comprehensive Cancer Center is one of seven funded NCORP Research Program bases in the country.

Study participants had received at least four cycles of adjuvant chemotherapy and reported cognitive impairment and memory problems for one to five years after chemotherapy had completed. Participants were enrolled on the NCORP study between July 2017 and July 2021.

“The participants were assigned to either receive 5-10 mg of donepezil, taken once a day for 24 weeks, or placebo,” said Stephen R. Rapp, Ph.D., professor of psychiatry and behavioral medicine at Wake Forest University School of Medicine and lead author of the paper.

Cognitive assessments were conducted before treatment, at 12 weeks and at end of treatment.

“We found that the participants did not perform differently at the end of treatment on tests of memory, other cognitive functions, or subjective functioning than those randomly assigned to placebo,” Rapp said.

While donepezil cannot be recommended as a treatment to improve cancer-related cognitive impairment in breast cancer survivors after completing chemotherapy, the researchers say further trials are needed.

“Additional research with different timing of administration, different medications or medication combinations, or non-pharmacological interventions are warranted,” said Glenn Lesser, M.D., deputy director of the Atrium Health Wake Forest Baptist Comprehensive Cancer Center, senior author of the manuscript and principal investigator of the Wake Forest NCORP Research Base.

Reference:

Stephen R. Rapp, Emily V. Dressler, W. Mark Brown, James L. Wade III, Nguyet Le-Lindqwister, David King, Kendrith M. Rowland, Kathryn E. Weaver, Heidi D. Klepin, Phase III Randomized, Placebo-Controlled Clinical Trial of Donepezil for Treatment of Cognitive Impairment in Breast Cancer Survivors After Adjuvant Chemotherapy (WF-97116), Journal of Clinical Oncology, https://doi.org/10.1200/JCO.23.01100.

A simple blood test could allow doctors to determine whether a person may be at higher risk for stroke or cognitive decline during their lifetime, according to a new UCLA Health study.

The study, published in the journal Stroke, found that measuring concentrations of a network of inflammatory molecules in the blood could allow doctors to calculate a risk score for susceptibility for cerebral small vessel disease-a common cause of stroke and a contributor to cognitive decline found especially among the elderly.

Currently, the only way to determine a person’s risk for cerebral vascular diseases has been to use a combination of imaging such as an MRI scan, family history, demographic variables and other risk factor evaluations, said study lead author Dr. Jason Hinman of the UCLA Comprehensive Stroke and Center and the Mary S. Easton Center for Alzheimer’s Research and Care at UCLA. In clinical practice, neurologists may only find a patient is at risk after they have had a stroke or a cerebral event that warns of one, Hinman said.

The new study found that by measuring the concentrations of this network of inflammatory molecules in the blood of patients who have not had a cerebrovascular event, medical providers may be able to quantitatively assess a person’s risk for cerebral small vessel disease and future stroke.

“The same way one uses cholesterol tests to evaluate one’s future risk for heart attack, we don’t have such a thing to estimate future risk for stroke,” Hinman said. “I believe we can do that by something as simple as a blood test which in theory can enable broader access to the best level of care and not lock it behind advanced imaging studies and specialist evaluations.”

The study focused on a biologically-connected network of inflammatory molecules known as the interleukin-18, or IL-18, network, which includes proteins and signaling molecules used to fight various infections.

Past studies have linked individual molecules in the IL-18 network to cerebral small vessel disease and stroke risk. However, the concentration of these individual molecules can fluctuate in response to other ailments such as the flu or autoimmune disorders, making them unreliable predictors of stroke risk at an individual level, Hinman said.

In 2020, University of California researchers including Hinman found that six molecules in the IL-18 network were associated with the presence of vascular brain injuries during MRI scans.

Building off these findings, Hinman sought to determine in this latest publication whether IL-18 network could be used to assess a person’s susceptibility to stroke risk or cognitive decline.

To test this, the researchers used health data from a generations-long study known as the Framingham Heart Study. This study has tracked the medical history of thousands of residents in the city of Framingham, Massachusetts, throughout their lives since launching in 1948. Blood samples taken from participants had been tested for five of the six molecules later identified as being in the IL-18 network.

By using the blood samples and medical histories of the Framingham participants, Hinman and his coauthor were able to create a mathematical model that generates a risk score based on the concentrations of the IL-18 network molecules. Of the more than 2,200 Framingham residents included in Hinman’s study, those whose risk scores were in the top 25% had an 84% chance of having a stroke during their lifetime. Overall, elevated risk scores were associated with a 51% increased risk of stroke and resulted in diagnostic prediction compared to existing risk assessment tools.

What remains unclear and requires further study is how or if a person’s risk score can be modified or reduced, Hinman said.

“The real challenge is in the primary care space. Are you at risk before you have an event?” Hinman said. “That’s what we’re all interested in doing is preventing a stroke before it even happens.” 

Reference:

Richard A. Martirosian, Crystal D. Wiedner, Jasmin Sanchez, Katherine T. Mun, Kiran Marla, Cristina Teran, Marissa Thirion, David S. Liebeskind, Emer R. McGrath, Association of Incident Stroke Risk With an IL-18-Centered Inflammatory Network Biomarker Composite, Stroke, https://doi.org/10.1161/STROKEAHA.123.044719. 

Raipur: There will be an imprisonment of up to 3 months or a fine of Rs 2 lakh if any unregistered persons are found running a pharmacy or dispensing medicines, a recent notice by Chhattisgarh State Pharmacy Council has stated.

The notice, which was issued by Ashwini Gurdekar, the Registrar of Chhattisgarh Pharmacy Council on 16th May 2024 warned the operators/ pharmacists working in the hospitals, pharmacies, and medical stores across the State regarding the rules specified under the Section 42 of the Pharmacy Act 1948.

As per the provisions under the 1948 Act, medicines have to be dispensed or sold by registered pharmacists only. If any violations are found in this regard and if any unregistered individuals are found dispensing, distributing, or selling medicines, the section called for penalties including imprisonment for up to six months, a fine of Rs 1,000, or both.

However, in the notice, the Council referred to the amendment introduced in the Act in 2023, which revised the penal provision of Section 42 of the Pharmacy Act-1948. 

The amendment was introduced last year through the Jan Vishwas (Amendment of Provisions) Act-2023, which was published on 11.08.2023. According to serial number 9 page number 13 amendment number D of Jan Vishwas (Amendment of Provisions) Act -2023, the penal provision of Section 42 of the Pharmacy Act 1948 was modified.

As per the amended provisions, unregistered individuals, if found guilty of dispensing medicines, will face imprisonment up to 3 months or a fine of Rs 2 lakh or both.

Further, urging all the concerned parties to comply with these provisions to avoid facing the stipulated penalties, the Pharmacy Council strictly warned that any violations will result in the responsible individuals being subject to the prescribed legal actions.

Chhattisgarh State Pharmacy Council was formed in the year 2003 after Chhattisgarh State was formed after it got separated from Madhya Pradesh. Chhattisgarh State pharmacy Council is a statutory body constituted by the Government of Chhattisgarh under the provisions of the Pharmacy Act of 1948. It consists of 6 members elected by Registered Pharmacists amongst themselves, five members nominated by Government of Chhattisgarh, one member elected by Chhattisgarh Medical Council and three Ex-Officio Members.

Read also: PCI issues Guidelines for Inspections of Pharmacy Institutions for academic year 2024- 2025