Chronic pain is a therapeutic challenge because of its complexity. Medical cannabis is amongst potential analgesic treatments.This systematic review aimed to study good-quality randomized controlled trials (RCT) on the effectiveness of medical cannabis in the management of chronic pain and observational studies to evaluate side effects.The search for RCTs was carried out on Pubmed/Medline, Cochrane and Embase. Biases in the RCTs were assessed using RevMan5 software. Only RCTs with at least three low-risk criteria were included in the final qualitative analysis. Observational studies have been used to evaluate adverse effects (AEs) of medical cannabis.There were 24 RCTs and 13 observational studies included in this review. The effectiveness of medical cannabis was shown in 11/14 RCTs on neurological pain and in 3/7 RCTs for other pathologies. Pain was not reduced significantly in 2/3 RCTs on cancer pain. AEs were observed more frequently in the group treated with medical cannabis. The most common AEs included somnolence, dizziness, nausea, dry mouth.There was weak to moderate evidence for the effectiveness of cannabinoids in the treatment of chronic non-cancer pain, primarily for neurologic pain. There was a lack of evidence on the superiority of medical cannabis compared to placebo in the treatment of cancer pain. AEs occurred more frequently in the medical cannabis group. A standardized outcome measure was lacking to allow for a more effective evaluation.More robust RCTs with longer follow-up will be required to clarify the effectiveness of medical cannabis in the management of chronic pain.

Chronic viral hepatitis combined with type 2 diabetes substantially increases the risk of progressive liver disease, hepatic decompensation, and early mortality. Recent large-scale observational studies suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may be associated with reduced serious liver events in metabolic liver disease, yet evidence specific to viral hepatitis remains limited. Understanding real-world outcome patterns may help inform therapeutic decisions in primary care.To evaluate associations between GLP-1 RA use and liver disease progression, all-cause mortality, and hospitalization in adults with viral hepatitis and type 2 diabetes, using dipeptidyl peptidase-4 inhibitors (DPP-4is) as an active comparator.A retrospective active-comparator, new-user cohort study was conducted using the TriNetX Global Health Research Network. Adults ≥18 years with viral hepatitis and type 2 diabetes recorded between January 1, 2010, and December 31, 2024, were included. Individuals with prior advanced liver disease, including cirrhosis, hepatic decompensation, portal hypertension, or hepatocellular carcinoma were excluded. New users of GLP-1 RAs and dipeptidyl peptidase-4 inhibitors (DPP-4is) were matched 1:1 using propensity scores incorporating demographics, comorbidities, antiviral and metabolic medication exposures, and laboratory parameters. Outcomes were assessed up to 5 years after treatment initiation. The primary endpoint was a composite of advanced liver events; secondary endpoints were all-cause mortality and inpatient or observation encounters. Cox proportional hazards models estimated associations.After matching, 8,384 patients were included per cohort. GLP-1 RA therapy was associated with a lower incidence of advanced liver events (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.74–0.84; p < 0.0001), all-cause mortality (HR 0.59; 95% CI 0.54–0.65; p < 0.0001), and hospital utilization (HR 0.75; 95% CI 0.71–0.79; p < 0.0001). Absolute risk differences were consistent across endpoints.Observed associations align with emerging evidence that GLP-1 RAs may exert hepatoprotective effects through metabolic, anti-inflammatory, and antifibrotic pathways, particularly in individuals with concurrent metabolic disease.In adults with viral hepatitis and type 2 diabetes, GLP-1 RA use was statistically associated with fewer advanced liver events, lower mortality, and reduced hospitalization compared with a DPP-4i comparator, providing real-world insights relevant to primary care decision-making.

Epilepsy affects 0.3–0.5% of women of reproductive age. While sodium valproate (VPA) and topiramate are effective for seizure control, they pose significant teratogenic risks. Safer alternatives exist for women planning pregnancy, making preconception consultation essential to optimize therapy, promote healthy habits, and ensure timely referral, reducing adverse obstetric outcomes.This case report was developed through a retrospective review of clinical records and patient interviews. The timeline of events, therapeutic interventions, and outcomes were analyzed to identify critical points in care delivery. Literature on epilepsy management during pregnancy and preconception counseling was consulted to contextualize findings.Early Identification: Family physicians must proactively address teratogenic risks in women of reproductive age. Referral Pathways: Strengthening triage systems and ensuring compliance with TMRG is essential to avoid delays. Patient Education: Preconception counseling should be integrated into routine care. Future Implications: Structured programs and digital alerts for high-risk medications could improve maternal-fetal outcomes.We report the case of a 31-year-old hospital support worker, smoker (20 pack-years), G4P1A3, with idiopathic epilepsy treated with VPA and topiramate. In August 2022, she presented with a desired but unplanned pregnancy (4–5 weeks) while on teratogenic therapy. Despite urgent referrals and medication adjustment to lamotrigine, specialist follow-up was delayed beyond TMRG. The pregnancy was complicated by gestational diabetes, high-risk screening for trisomy 18, and fetal cardiac anomalies, culminating in intrauterine fetal demise at 17 weeks. In 2023, after appropriate preconception counseling, she conceived again, with an uneventful pregnancy and delivery.This case highlights the intersection of pharmacological risk, systemic delays, and the FP’s pivotal role in mitigating adverse outcomes. Preconception consultation is a cornerstone of safe maternal care in women with epilepsy. Embedding this practice in primary care and improving referral systems are critical to achieving favorable outcomes in high-risk pregnancies.

Analgesics are among the most widely used medications in France, and their prescription is closely monitored by national health authorities. In recent years, the marked increase in tramadol and codeine use has raised concerns within addiction and pharmacovigilance networks due to their documented potential for misuse, dependance, and adverse effects. In response, new national regulations now require these medications to be prescribed on secured prescription forms. We hypothesize that this reform will have far-reaching repercussions on overall analgesics use in France.The primary objective of this ongoing study is to assess the impact of secured prescription requirements on tramadol, codeine, and dihydrocodeine dispensing. Secondary objectives are to evaluate potential shifts in the prescribing of other analgesics and to estimate the resulting impact on healthcare expenditures.This ongoing descriptive and retrospective study uses the French national health insurance open database Médic’AM to conduct an epidemiological analysis of nationwide monthly dispensing in pharmacies. The analysis includes reimbursed medications recommended by the Haute Autorité de Santé (HAS) for acute, chronic and neuropathic pain. Data are converted into Defined Daily Dose and analyzed using a segmented regression model to compare trends before, during, and after the implementation period, from January 2023 to December 2025.Our preliminary findings suggest  substantial changes in prescribing practices, including an early decrease in tramadol, codeine and dihydrocodeine dispensing. In reaction, a compensatory increase in other analgesic dispensing is expected. Final results and statistical analysis will be conducted once all  2025 data are available.Our study highlights the impact of national regulatory reforms on analgesic prescribing. This impact should be interpreted in light of each drug’s clinical indications. Only limited effects are expected on antidepressant and antiepileptic dispensing, as tramadol is a second-line option for neuropathic pain. Likewise, changes in strong opioid prescribing are expected to be minimal, as these medications were already subject to secure-prescriptionrequirements.This study will help assess the effectiveness and economic implications of a nationwide reform based on prescribing restrictions, therefore guiding future public health policy. Our results will also pave the way for further studies on misuse and medication safety.

High-dose proton pump inhibitors (PPIs) are associated with hypomagnesaemia, which can lead to complications such as arrhythmias, seizures and hospitalisation. Despite recommendations from NICE guidelines to monitor magnesium in these patients, baseline auditing within a large primary care practice in the UK (October 2023-October 2024) demonstrated suboptimal compliance, with only 78.9% of patients on high-dose PPIs having serum magnesium measured, with no identification of higher-risk individuals. This prompted recommendations for clinician education and implementing a recall system.To evaluate whether serum magnesium monitoring improved one year after the initial audit and to assess whether higher-risk patients (on diuretics, digoxin, or with high alcohol intake) were being identified on SystmOne. The primary objective was to assess improvement towards the 100% annual monitoring standard.A re-audit was conducted using SystmOne (November 2024-November 2025). All patients prescribed high-dose omeprazole or esomeprazole (40mg daily) were included. Data collected included PPI compliance, serum magnesium measurement within 12 months, presence of higher-risk factors and evidence of a recall system. Descriptive statistics were utilised and findings were compared with baseline results.302 patients were prescribed high-dose PPIs (Cycle 1: 298). Of these, 235 had a serum magnesium measured within the last year (77.8%), showing no improvement from Cycle 1 (78.9%). 67 patients lacked a magnesium measurement, 54/67 were compliant with treatment. 13 compliant patients were higher-risk, 12/13 (92.3%) had undergone other blood tests in the last year - indicating missed opportunities to add magnesium. No recall system had been implemented, and higher-risk identification remained 0%.The lack of improvement highlights the challenges of translating findings into clinical change, and importantly the value of student-led audits. While they successfully identify gaps in care, meaningful change often requires system-level changes beyond the original audit. This provides a valuable opportunity to reflect on the real-world impact and limitations of student audit work within primary care.Magnesium monitoring in high-dose PPI patients did not improve, underscoring the need for automated prompts or recall systems. The findings also highlight that even when change is not achieved, student audits can generate important insights to guide improvements. Further re-audit is recommended following implementation.

Based on recent evidence, international guidance recommends using Long-Acting Beta-Agonists and Inhaled Corticosteroids (LABA-ICS) therapy for symptomatic mild asthma however this change has not been widely implemented. Prior to initiating a larger trial, the objective of this study was to investigate the superiority of fluticasone-vilanterol in stabilizing mild asthma in adults versus usual care.To investigate the superiority of effectiveness of fluticasone-vilanterol (ICS+LABA) in stabilizing mild-asthma in adults versus usual care.We randomly assigned 18 patients with mild asthma in a 1:1 ratio to a treatment (n=10) or usual care (n=8). The treatment group was given daily LABA-ICS treatment while the usual care group continued their treatment (as required short-acting beta agonists (SABA) or SABA and ICS combination and no other asthma medications). Our primary clinical outcome was the asthma control score and the overall quality of life experienced by the patients enrolled in the study under both regimens.A total of 18 patients were recruited from a primary health care centre and randomized. The mean (SD) age was 40.40 (17.32) years old among the intervention group and 54.88 (17.92) in the control group. Fifty per cent of participants were male in the intervention arm and 75% in the control arm. The baseline mean asthma control score was 2.91 among intervention and 3.26 among control group and the baseline mean quality of life score was 4.56 among the intervention group, and 5.08 among the control group. We found no significant differences at baseline between the intervention and control groups. No serious adverse events or changes in quality of life were reported.Our results are consistent with the START (Beasley et al., 2019), PRACTICAL (Hardy et al., 2019) and SMART trials (Bell & McIvor, 2007) and support the international move to ICS±LABAs for the treatment of mild asthma as a more effective intervention than SABAs alone. Our study encountered challenges in recruitment due to the recent SARS-CoV-2 pandemic.Although additional data with larger sample size is urgently required, this interim evidence suggests that it is time to shift asthma management away from as needed SABAs for patients with mild asthma.