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As the number of people taking multiple medications increases, differing approaches to address drug-drug interactions and adverse drug reactions have been debated-but not solved-despite excellent criteria to stop the use of potentially inappropriate medications.Dr. Olga Hilas, associate professor from St. John's University, reflects on her Pain Management Traineeship with the American Society of Consultant Pharmacists Foundation.Why has it been so difficult to gain traction in reducing the serious consequences of adverse drug reactions (ADRs), particularly among the people who are most vulnerable? Pharmacists have a unique place in the clinical setting as the advocates for the adoption of evidence-based care, and they are the well-placed clinical professionals who can detect ADRs and provide guidance about how to address them.For many years, the University of Chicago administered sulfamethoxazole-trimethoprim sulfate (SMZ-TMP) oral suspension to select immunocompromised mouse colonies via the drinking water. In 2014, SMZ-TMP oral suspension was placed on back-order and medicated diet with a different sulfonamide, sulfadiazine-trimethoprim (SDZ-TMP) was used as a replacement. Months after this transition, sentinel mice from the same room as one of the remaining immunocompromised colonies on this diet were found dead or appeared sick. Necropsies revealed cardiomegaly, and histology confirmed myocardial fibrosis in the first 4 sentinel mice examined, consistent with cardiomyopathy. Subsequent sequential monitoring of 2 sentinel mice via echocardiography showed their progression toward decreased cardiac function. Investigation of the housing room revealed that the sentinel mice had been accidently placed on SDZ-TMP diet upon entering the colony housing room. This case report describes cardiomyopathy in 6 ICR mice after long term consumption of SDZ-TMP medicated feed.PKM2 is a pyruvate kinase isoform that is the final and rate-limiting step in aerobic glycolysis in tumor cells. Increased expression of PKM2 has been detected in human cancers. The present study examined the expression of PKM2 in canine mammary tumors and assessed its prognostic significance. Paraffin sections of 5 adenomas, 67 carcinomas, and 5 samples of nonneoplastic hyperplasia from 77 dogs, aged 8 to 18 y, were evaluated. Significantly higher levels of PKM2 were detected among the carcinomas compared with all other tissues examined. The level of PKM2 expression in carcinoma tissue correlated positively with the tumor grade. These findings suggest that PKM2 may have a similar role in canine mammary tumors to its role in human breast cancer. As such, canine mammary tumors may be useful models for studies focused on the progression of human neoplastic disease.Disasters are often unforeseen events. Hospitals form a critical component of any country's disaster management medical support system. To ensure optimal operations, minimize chaos, and allow flexibility in response, planning and practice are crucial. Singapore Health Services (SingHealth) collaborated with Hasanuddin University (UnHas) in Makassar, Indonesia, to develop a Hospital Disaster Medical Support (HDMS) program for the province of South Sulawesi, Indonesia. An assessment of the needs of the hospitals in Makassar, Indonesia, for disaster preparedness was carried out. A curriculum for the HDMS program was developed based on the assessment. Discussions with stakeholders of various hospitals were held for the implementation of this program. A total of 310 participants were trained in this program over the two-year period. The feedback from the participants was positive. The exercises provided a more realistic simulation of the concepts of hospital management in a disaster situation. Up to 73 persons were also trained as program instructors during this period. The development of the cadre of instructors in hospital disaster medical support will likely help sustain the program for the next few years.

Consumption of trans-fatty acids (TFA) is a well-established risk factor for CVD morbidity and mortality. Our objective was to investigate TFA levels in Slovenian food supply.

Cross-sectional study.

Selected foods (n 282) were purchased in Slovenia (2016), and the TFA content was determined. The sample included pre-packed foods with/without declared partially hydrogenated vegetable oils (PHO), as well as non-pre-packed foods. A sales-weighting approach was used to ponder different market shares of the products.

While the majority of the investigated samples had low levels of TFA, up to 6·8 g of TFA per 100 g of food was observed in certain foods. Within pre-packed foods (n 207), the highest proportion of samples with high TFA levels was found among cookies with labelled PHO 69 % (n 18) would exceed European Union regulatory TFA limit (2 g industrial TFA per 100 g of fats), which will be implemented in April 2021. Among the investigated non-pre-packed foods (n 75), only croissants contained notable TFA levels (mean 0·90 (sd 0·97); maximum 3·3 g/100 g), with about half of the samples exceeding 2 g TFA per 100 g of fats.

In 2016, some foods in Slovenian food supply still contained notable amounts of TFA. selleck Foods with listed PHO as an ingredient were usually higher in TFA as compared with foods not labelled to contain PHO. Biscuits were identified as the most concerning category of pre-packed foods, while croissants contained highest levels of TFA within non-pre-packed foods.

In 2016, some foods in Slovenian food supply still contained notable amounts of TFA. Foods with listed PHO as an ingredient were usually higher in TFA as compared with foods not labelled to contain PHO. Biscuits were identified as the most concerning category of pre-packed foods, while croissants contained highest levels of TFA within non-pre-packed foods.

The PRogramme for Improving Mental Health carE (PRIME) evaluated the process and outcomes of the implementation of a mental healthcare plan (MHCP) in Chitwan, Nepal.

To describe the process of implementation, the barriers and facilitating factors, and to evaluate the process indicators of the MHCP.

A case study design that combined qualitative and quantitative methods based on a programme theory of change (ToC) was used and included (a) district-, community- and health-facility profiles; (b) monthly implementation logs; (c) pre- and post-training evaluation; (d) out-patient clinical data and (e) qualitative interviews with patients and caregivers.

The MHCP was able to achieve most of the indicators outlined by the ToC. Of the total 32 indicators, 21 (66%) were fully achieved, 10 (31%) partially achieved and 1 (3%) were not achieved at all. The proportion of primary care patients that received mental health services increased by 1200% over the 3-year implementation period. Major barriers included frequent transfer of trained health workers, lack of confidential space for consultation, no mental health supervision in the existing system, and stigma.