Joseph Tucci

Objective: To investigate the perceptions of pharmacists in regional and rural Victoria in response to legislative changes stipulating that vapes for management of smoking cessation and nicotine dependence can only be sold at participating pharmacies. Setting: Regional and rural locations in Victoria, Australia. Participants: Fifteen registered pharmacists all currently working in rural community pharmacies, recruited through professional networks. Design: A qualitative descriptive study utilising semi‐structured interviews with pharmacists was undertaken between June and August 2025. Interviews were audio‐recorded and transcribed verbatim. Thematic analysis was undertaken and supported by NVivo 15. Results: The interviews highlighted that while some pharmacists were clear about the supply of therapeutic vapes as part of their role in supporting smoking cessation and harm minimisation, some reported clinical, ethical and system‐level concerns with supplying vapes. Others reported concerns for personal safety and liability and highlighted the impact that supplying vapes has on workflows within the pharmacy. Conclusion: Overall, pharmacists expressed significant uncertainty and mixed views regarding the supply of therapeutic vapes in community pharmacy. Concerns centred on limited evidence, professional responsibility, regulatory clarity and workflow pressures. While some recognised potential harm‐reduction benefits, greater consultation, clearer guidelines, stronger evidence and targeted education are needed to support safe and confident implementation.

Phosphodiesterase type 5 (PDE5) inhibitors, including sildenafil, tadalafil, and vardenafil, are primarily prescribed for erectile dysfunction and pulmonary hypertension. Emerging evidence suggests they may also modulate inflammatory pathways and improve vascular function, but their effects on inflammatory biomarkers in humans remain incompletely defined. A systematic review and meta-analysis were conducted to evaluate the impact of PDE5 inhibitors on inflammatory and endothelial markers in adult humans. Randomized controlled trials comparing PDE5 inhibition to placebo were identified through electronic database searches. Outcomes included pro-inflammatory markers (TNF-α, IL-6, IL-8, CRP, VCAM-1, ICAM-1, P-selectin) and anti-inflammatory or signalling markers (IL-10, NO, cGMP), assessed at short-term (≤1 week), intermediate-term (4–6 weeks), or long-term (≥12 weeks) follow-up. Risk of bias was assessed using the Cochrane RoB 2 tool. A total of 20 studies comprising 1549 participants were included. Meta-analyses showed no significant short-term effects of PDE5 inhibition on TNF-α, IL-6, or CRP. Long-term treatment was associated with reduced IL-6 (SMD = −0.64, p = 0.002) and P-selectin (SMD = −0.57, p = 0.02), and increased cGMP (SMD = 0.87, p = 0.0003). Effects on IL-10 and nitric oxide were inconsistent across studies. Most trials had low risk of bias. PDE5 inhibitors may exert anti-inflammatory effects in long-term use by reducing vascular inflammation and enhancing cGMP signalling. These findings support further investigation of PDE5 in chronic inflammatory conditions.

Background: With recent changes to regulations in Australia allowing community pharmacists to prescribe melatonin to people aged 55 and older as a schedule 3 or ‘over the counter’ medicine, their knowledge of insomnia and the safety of melatonin needs to be assessed. Objective: The study aims to investigate the perceptions and confidence of community pharmacists on the supply of melatonin to patients with sleep issues. Methods: Ten community pharmacists located in regional Victoria participated in semi structured interviews. Interviews were recorded and later transcribed verbatim. Transcriptions were de-identified and thematically analysed. Results: Five overarching themes were identified: (1) the accessibility and practicality of pharmacists prescribing melatonin, (2) a lack of confidence in assessing sleep issues (3) a high confidence in the safety of melatonin (4) barriers to prescribing and (5) future recommendations. The results showed that the perceived barriers to pharmacists’ safe supply of melatonin included time constraints, the need for supply of melatonin to be recorded and this data shared across pharmacies, as well as the need for dedicated education and training for pharmacists in sleep issues. However, despite these barriers, community pharmacists perceived themselves as suitable prescribers of melatonin, and that with appropriate education and training in insomnia and melatonin safety, their supply of melatonin could be expanded to include other age groups. Conclusion: Community pharmacists perceived themselves as being in an appropriate position to supply over the counter melatonin for patients aged 55 years and over. However, there is a need for expanded education and resources to enhance the confidence of community pharmacists in the identification of insomnia presentations and safe supply of melatonin.

Microbial resistance to antibiotics poses a tremendous challenge. Bacteriophages may provide a useful alternative or adjunct to traditional antibiotics. To be used in therapy, bacteriophages need to be purified from endotoxins and tested for their effects on human immune cells. Interleukin-1 Receptor Associated Kinase-3 (IRAK3) is a negative regulator of inflammation and may play a role in the modulation of immune signalling upon bacteriophage exposure to immune cells. This study aimed to investigate the immune effects of crude and purified bacteriophage FNU1, a bacteriophage that targets the oral pathobiont Fusobacterium nucleatum, on wildtype and IRAK3 knockout THP-1 monocytic cell lines. The IRAK3 knockout cell line was also used to develop a novel endotoxin detection assay. Exposure to crude FNU1 increased the production of pro-inflammatory cytokines (Tumour necrosis factor – alpha (TNF-α) and Interleukin 6 (IL-6)) compared to purified FNU1 in wildtype and IRAK3 knockout THP-1 monocytes. In the IRAK3 knockout THP-1 cells, exposure to crude FNU1 induced a higher immune response than the wildtype monocytes, supporting the suggestion that the inhibitory protein IRAK3 regulates reactions to endotoxins and impurities in bacteriophage preparations. Finally, the novel endotoxin detection assay generated here provides a robust and accurate method for determining endotoxin concentrations.

Bacterial sepsis characterised by an immunosuppressive and cytokine storm state is a challenge to treat clinically. While conventional antibiotics have been associated with exacerbating the cytokine storm, the role that bacteriophages may play in immune modulation of sepsis remains unclear. Bacteriophages are bacterial viruses that have the capacity to lyse specific bacteria and hence provide a natural alternative to antibiotics. K. pneumoniae is known to cause sepsis in humans, and in this study we isolated two lytic bacteriophages against this pathogen, one of which was a novel jumbo bacteriophage. We employed THP-1 monocyte cell lines, with different functional phenotypes for the interleukin-1 receptor associated kinase 3 (IRAK3- a cytoplasmic homeostatic mediator and prognostic marker of inflammation), to evaluate the role of the K. pneumoniae bacteriophages in modulating the immune response in-vitro. We showed for the first time that bacteriophages did not stimulate excessive production of tumour necrosis factor alpha, or interleukin-6, in THP-1 monocyte cell lines which displayed varying levels of IRAK3 expression.

While the mortality rates for many cancers have decreased due to improved detection and treatments, that of pancreatic cancer remains stubbornly high. The microbiome is an important factor in the progression of many cancers. Greater understanding of the microbiome in pancreatic cancer patients, as well as its manipulation, may assist in diagnosis and treatment of this disease. In this report we reviewed studies that compared microbiome changes in pancreatic cancer patients and non-cancer patients. We then identified which bacterial genera were most increased in relative abundance across the oral, pancreatic, duodenal, and faecal tissue microbiomes. In light of these findings, we discuss the potential for utilising these bacteria as diagnostic biomarkers, as well as their potential control using precision targeting with bacteriophages, in instances where a causal oncogenic link is made.

Background: Overweight/obesity is a well-defined risk factor for a variety of chronic cardiovascular and metabolic diseases. Sleep duration has been associated with overweight/obesity and other cardio metabolic and neurocognitive problems. Notably, overweight/obesity and many of the associated comorbidities are prevalent in Indigenous Australians. Generally, sleep duration has been associated with BMI for Australian adults but information about Australian Indigenous adults’ sleep is scant. A recent report established that sleep is a weak predictor of obesity for Indigenous Australian adults. Aim: To determine whether sleep remains a predictor of obesity when physical activity, diet and smoking status are accounted for; and to determine whether sleep duration plays a mediating role in the relationship between Indigenous status and BMI. Methods: Statistical analyses of 5,886 Australian adults: 5236 non-Indigenous and 650 Indigenous people aged over 18 years who participated in the Australian Health Survey 2011–2013. Demographic and lifestyle characteristics were described by χ² and t-tests. ANOVA was used to determine the variables that significantly predicted BMI and sleep duration. Stepwise regression analyses were performed to determine the strongest significant predictors of BMI. Sleep duration was self-reported; BMI was calculated from measurement. Results: The study revealed two main findings: (i) short sleep duration was an independent predictor of obesity (adjusted-R² = 0.056, p <0.0001); and (ii) controlling for sleep duration and other possible confounders, Indigenous status was a significant predictor of BMI overweight/obesity. Sleep duration played a weak, partial mediator role in this relationship. Increased BMI was associated with lower socioeconomic status and level of disadvantage of household locality for non-remote Indigenous and non-Indigenous people. Conclusion: Indigenous status strongly predicted increased BMI. The effect was not mediated by the socioeconomic indicators but was partially mediated by sleep duration.