Low serum levels of vitamin D have been reported as a risk factor for breast cancer. This narrative review provides an update on the impact of vitamin D on hormone receptors, notably estrogen receptor subunits, and gives insights on possible therapeutic interventions to overcome breast cancer. In addition, evidence that supports the beneficial use of vitamin D as adjuvant treatment of breast cancer is summarized. Vitamin D deficiency is significantly widespread in patients with triple-negative tumors. Several studies have observed a possible modulatory effect of vitamin D or its analogues on the expression of different hormone receptors in breast cancer and increased sensitivity to tamoxifen. Vitamin D possesses anti-inflammatory and immunomodulatory effects in patients with breast cancer, and the mechanism of action of vitamin D in patients with breast cancer is discussed. In conclusion, vitamin D appears to have a beneficial role in the prevention and management of breast cancer, however, large-scale, randomized controlled trials are needed to confirm the effects of vitamin D in breast cancer prevention or treatment.

Background Diabetic peripheral neuropathy (DPN) is highly prevalent among Jordanian patients, mostly are asymptomatic. Early recognition and appropriate management of neuropathy is important to improve symptoms, reduce sequelae, and improve quality of life. This study aims at exploring the role of pharmacists in the early recognition of DPN and providing quick screening for the presence of it among diabetic patients. Material and Methods A cross-sectional study was conducted at multi-pharmacy settings, in Irbid, Jordan. Twenty trained pharmacists who had bachelor’s degrees in pharmacy participated in data collection. A total of 400 patients with confirmed diagnosis of type 2 diabetes mellitus (DM) according to the World Health Organization diagnostic criteria were recruited. DPN was assessed using the translated Arabic version of Michigan Neuropathy Screening Instrument (MNSI) history version. Results The mean MNSI questionnaire score for all participants was 4.40 ± 3.00. Mean age of the patients was 62.6 ± 10.7 years old and duration of diabetes was 8.25 ± 6.9. DN was present in 23.7% of the population. Diabetic patients with neuropathy were older than patients without neuropathy (P< 0.05) and had had diabetes longer (P< 0.05). Poor glycemic control, hypertension and gender, were significantly risk factors for DN (P< 0.05). Conclusions In addition to delivering medications, this study suggests that pharmacists can have a role in screening and counseling about diabetic peripheral neuropathy using a simple objective, and non-invasive tool and also can determine level of damage and risk.

Breast cancer, one of the leading cancer types, directly contributes to cancer‐related mortality, but new therapies are required to improve treatment efficiency. Nanoparticle‐based strategies have already introduced the most radical advances in this regard, from their first formulation through their development to the next generation as promising candidates. The present review provides an overview of nanoparticle‐based strategies in breast cancer, their development, and their state of the art. The review addresses the diverse formulation of nanoparticles, including liposomes, dendrimers, and metallic nanoparticles, as well as their respective roles in drug delivery: bioavailability, focused therapeutic intervention, and lower systemic toxicity. This review covers studies on the engineering of nanoparticles for improved drug delivery, including cancer‐targeted delivery to tumors and optimization within the tumor microenvironment. Additionally, new nanosized drugs may also be utilized for novel modification of nanoparticle composition for combination therapeutics, which allows pharmacological agents to enter the tumor microenvironment by combined treatment with diverse types of other agents, to provide a synergistic, effective treatment in real time, in addition to real‐time monitoring. Stimuli‐responsive nanoparticles, which release the drug according to the appropriate stimulus signal to provide greater accuracy and regulation in delivering the drug, are also under investigation. This review notes trends in personalized nanomedicine and nanoparticle‐mediated immunotherapy that target personalized patient and immune responses, among others. Other exciting areas for nanoparticle research include AI‐based optimal design and sustainable biodegradable materials aimed at maintaining nanoparticle safety. Nanoparticle‐based therapies are a unique new frontier in breast cancer therapy. They have considerable clinical potential, offer promise for patient‐specific treatment, and warrant further investigation in breast cancer, particularly in advanced targeting mechanisms, multifunctional approaches, and individualized interventions.

Patient knowledge and understanding of the therapy are an important factor in treatment success. Multiple factors were identified to cause a treatment failure such as side effects of the medications, rejection of the diagnosis by patients, lack of patient understanding about their medication, noncompliance, and the cost of medication. In addition, improvements in patient medication counseling and education may help in prevention of many adverse drug interactions, drug-drug or food-drug interactions, in turn enhancing medication adherence which depends basically on a patient’s acceptance of the information about the health threat itself. For these reasons, an evaluation of patients’ knowledge of medicine and its use may help screen for problems in therapy and improve therapeutic outcomes. The results of this evaluation may also be used to educate providers about areas of potential problems in which they may be able to influence change.

Objective: Bleeding is the most serious complication associated with anticoagulation therapy. The purpose of this study was to estimate the frequency of major bleeding related to warfarin and to identify its predictors in patients with atrial fibrillation (AF). Methods: Patients with AF treated with warfarin at Penang General Hospital in Malaysia were identified according to the international classification of disease, Ninth Revision, Clinical Modification (ICD-9). The medical reports of 1611 patients were reviewed, bleeding events were set as primary end point which were identified in 313 patients. Demographic and clinical data were retrieved and warfarin therapy-related parameters including dose, therapy duration, and prothrombin time-international normalized ratio (PT-INR) were recorded and analyzed using descriptive statistics. Results: Of the 313 patients, 28 patients with major bleeding events were identified. Gastrointestinal bleeding was the major type of bleeding, which accounts for 68% (n = 17) of the cases. The frequency of major bleeding events among all AF patients was 1.7%. High PT-INR value was found in 96.3% (n = 28) of the patients, thereby making it the primary predictor of bleeding events. Other predictors including, advanced age, other comorbidities such as hypertension and multiple anticoagulation therapy were also observed to be significant. Conclusion: Lower doses of warfarin are recommended to achieve target PT-INR range similar to that reported previously for Asian populations. A regular clinical review for bleeding predictors is essential for maximizing the time spent by the patient taking warfarin in the optimal therapeutic range and for making recommended therapy adjustment.