Autoimmune diseases such as rheumatoid arthritis represent major clinical challenges due to the complexity of immune system dysfunction and the limitations of current treatment strategies. Combination therapies involving JAK inhibitors, methotrexate, and natural compounds such as quercetin can target multiple disease pathways and improve therapeutic outcomes. Previous studies have shown that the concurrent administration of multiple medications may result in reduced patient adherence, systemic adverse effects, and suboptimal tissue targeting. Hydrogel-Forming Microneedles (HFMNs) enable controlled transdermal drug delivery, offering a minimally invasive approach that may improve patient acceptability and facilitate the administration of multiple therapeutic agents. This review examines the design principles of HFMNs, including polymer selection, crosslinking strategies, swelling behavior, and drug-loading approaches, and compares them with other microneedle platforms. Recent advances have focused on the co-encapsulation of multiple therapeutic agents, including synthetic drugs, Disease-Modifying Antirheumatic Drugs (DMARDs), and phytochemicals, enabling their controlled and sequential release for enhanced therapeutic efficacy. Recent studies have investigated drug-material interactions, in vitro and in vivo release profiles, and the synergistic effects of co-delivered therapeutic agents. Particular emphasis is placed on the application of combination therapy in rheumatoid arthritis through modulation of the JAK/STAT, NF-κB, and oxidative stress pathways, while HFMN-mediated delivery may improve therapeutic outcomes and reduce systemic adverse effects. Ongoing studies have evaluated the development of these systems, including their mechanical strength, transdermal penetration performance, and therapeutic efficacy in animal models of inflammatory joint disease using relevant biomarker analyses. The review also discusses regulatory considerations, including scale-up manufacturing and sterilization, and highlights future directions involving smart hydrogels and integrated diagnostic technologies to facilitate clinical translation. HFMNs provide a versatile platform for advancing combination therapies for autoimmune and inflammatory diseases. This platform has the potential to improve tissue targeting, patient adherence, and therapeutic outcomes.

This review examined the prevalence and implications of Conflicts of Interest (COI) in biomedical research. It involved an analysis of high-profile cases, including the Troglitazone safety controversy, Dr. Baselga's undisclosed pharmaceutical payments, National Institute of Health's (NIH) financial COIs, the COI involving COX-2 inhibitors, the 2008-2009 COI involving Harvard pediatric psychiatrists, and the UK University collaboration with "health-harming" industries. It also examined regulatory and ethical frameworks of COI management. The study's results show that COIs can threaten the quality of biomedical research and endanger patient health. In extreme cases, they might even lead to patient deaths. The evidence links this problem to the inconsistency of COI management policies, especially COI disclosure requirements. The findings of this research demonstrate the vague wording and poor enforcement of these requirements. To prevent the negative effects of COIs on research outcomes, consistent COI across relevant fields must be developed. For instance, leading academic journals must adopt the same COI disclosure approach to reduce ambiguity. Moreover, COI policies must address previously overlooked areas, such as the financial interests of authors' family members. The results of the study can be a good starting point for future research on addressing COIs through self-regulation. They illustrate the need for a customized COI management strategy rather than the one-size-fits-all approach.

Ethical standards are crucial in contemporary clinical research. The requirements with which researchers comply are a result of the long history of abuses and attempts to find solutions that eventually led to the introduction of a consistent ethical framework that now guides clinical research in the USA. This study critically analyzes this history. It reviews the history of clinical research ethics from the Nuremberg Code to the recent revisions of the Declaration of Helsinki and FDA regulations. The evidence presented in this study shows that ethical frameworks are reactive. Most policies were introduced in response to abuses and violations, such as the atrocities committed by the Nazi regime and the notorious Tuskegee Syphilis Study. After many changes, these standards evolved into relatively consistent principles, such as independent review, beneficence, and justice. The study shows that researchers generally adhere to these principles of research ethics. However, some do not fully address the reality of contemporary clinical research. This article advocates for more detailed consent procedures, specific clauses to address the ethical controversies of certain technologies, such as deep learning applications and big data tools, and strict conflict of interest disclosure requirements. The most important avenue for future research in this area is to revisit the balance of potential risks and benefits to determine the cases in which ethical requirements might be simplified to advance scientific interest. The arguments provided in this article can inspire researchers and physicians to reflect on contemporary trends in research ethics and design new strategies to address key ethical challenges.

Dietary fibers, and more specifically water-soluble fibers, beneficially affect human health. Guar gum and its enzymatic product, partially hydrolyzed guar gum (PHGG), are among the most studied dietary fibers in humans. Altogether, they can be described as "guar fiber". We performed a narrative review of the literature on guar fiber, namely guar gum and its partially hydrolyzed product, and their impact on human health, with a special focus on the gastrointestinal tract, gut microbiota, gut-brain axis, and liver steatosis. Accordingly, a literature search was conducted using the following keywords and combinations: guar fiber, guar gum, partially hydrolyzed guar gum, disorders of gut-brain interaction, gut-liver axis, and gut microbiota. Guar gum and its derivative, PHGG, show promising effects in gastrointestinal disorders, such as constipation and diarrhea. Interestingly, they can modulate the gut microbiota, with promising implications for the gut-brain axis and disorders of gut-brain interaction, such as irritable bowel syndrome. There are also interesting, albeit preliminary, results regarding their use in fatty liver disease. Thus, dietary fibers such as guar gum and, more importantly, its hydrolyzed product, show promising and better-documented effects on the health of the gastrointestinal tract and other organs and systems of the human body. However, the latter evidence still requires clinical confirmation of preclinical findings. Overall, the reviewed data vary in quality and maturity across different outcome domains.

Cardiovascular diseases (CVD) are still among the main causes of illness and death worldwide. In recent years, research has started to look beyond the classic risk factors and has shown growing interest in the gut microbiota, which plays an important role in cardiovascular health. This review highlights how the intestinal microbiota acts as a link between diet, the immune system, and cardiovascular disease, focusing on underlying molecular mechanisms, new potential biomarkers, and clinical relevance. Many bioactive compounds, such as trimethylamine-N-oxide (TMAO) and short-chain fatty acids (SCFAs), are produced by the gut microbiota and can influence inflammation, endothelial function, and lipid metabolism. Chronic low-grade inflammatory state (due to bacterial endotoxins entrance in bloodstream when intestinal permeability increases) contributes to the development of atherosclerosis. Multi-omics technologies have helped to understand the functional role of the microbiota better and to identify dynamic biomarkers. These include plasma TMAO levels, the Firmicutes/Bacteroidetes ratio, SCFA patterns, and the presence of microbial species with pro- or anti-inflammatory effects. Such biomarkers may be useful for risk assessment, therapeutic monitoring, and the design of personalized dietary strategies. Overall, analyzing the gut microbiota and monitoring its changes through specific biomarkers supports a preventive medicine approach based on lifestyle interventions. This strategy has strong potential to improve public health outcomes while also contributing to more sustainable healthcare systems.

Primary Amoebic Meningoencephalitis (PAM), caused by Naegleria fowleri, is a rare but highly devastating infection with a mortality rate exceeding 98%. Although historically sporadic, recent emerging cases and localized outbreaks have raised global concern. The disease's rapid progression and diagnostic complexity demand immediate and precise therapeutic intervention, as even minor medication errors can critically impact patient survival. Such medication errors, ranging from incorrect dosing to delayed administration,Primary Amoebic Meningoencephalitis (PAM), caused by Naegleria fowleri, is a rare but devastating infection with a mortality rate exceeding 98%. Although historically sporadic, recent emerging cases and localized outbreaks have heightened global concern. The disease's rapid progression and diagnostic complexity necessitate immediate, precise therapeutic intervention, where even minor medication discrepancies can critically affect survival outcomes. Medication errors ranging from incorrect dosing to delayed administration pose significant clinical and economic challenges, underscoring the need for robust strategic safeguards. Within this context, clinical pharmacists emerge as pivotal agents of patient safety. Their expertise in pharmacotherapy, drug interactions, and adherence to treatment protocols enables them to implement strategic solutions such as: Standardized treatment algorithms for anti-amoebic therapy to minimize dosing errors. Real-time medication reconciliation systems to prevent delays and ensure timely administration. Multidisciplinary coordination frameworks integrating pharmacists with physicians, microbiologists, and intensivists for rapid decision-making. Continuous training and simulation exercises to prepare healthcare teams for rare but high-stakes infections. Digital monitoring and AI-driven alerts to detect potential drug interactions or deviations from protocol. This article synthesizes case reports from the United States, Pakistan, and India, highlighting both historical and recent PAM instances. These narratives emphasize the evolving role of clinical pharmacists in identifying, preventing, and correcting medication-related issues. By bridging clinical insight with pharmaceutical precision, pharmacists not only enhance therapeutic accuracy but also strengthen institutional preparedness against rare infections. As global awareness grows, embedding clinical pharmacy into multidisciplinary care models represents a strategic solution essential not only for PAM but also for other emerging infectious threats where survival hinges on therapeutic precision.

Artificial intelligence (AI) and machine learning (ML) are transforming healthcare, particularly in drug delivery, development, and therapeutics. These technologies offer unprecedented potential to address complex diseases and improve patient outcomes. AI-powered drug delivery systems optimize drug release, target specific tissues, and enhance treatment efficacy, thereby minimizing side effects and maximizing therapeutic effectiveness. ML algorithms accelerate drug development by identifying promising candidates and streamlining clinical trials, which reduces both development time and costs. Another significant application is personalized therapeutics, which are tailored to individual patient profiles. AI analyzes genomic and medical history data to predict drug responses and generate optimized treatment plans. This personalized approach increases treatment effectiveness and reduces adverse reactions. AI and ML are also being applied to the management of neurodegenerative disorders, antimicrobial resistance, and ocular diseases, providing tools for early diagnosis and disease management. Ethical considerations such as data privacy, algorithmic transparency, and robust pharmacovigilance are essential for responsible advancement. The integration of AI and ML in drug delivery and therapeutics is poised to significantly improve patient outcomes.