Pharmacists play an important role in assessing, managing, and monitoring the efficacy and safety of medications. A common avenue for accomplishing this responsibility is through therapeutic drug monitoring (TDM) of many drugs, a duty that has been successfully managed by pharmacists for over four decades. 1,2 Antimicrobials, including aminoglycosides, vancomycin, voriconazole, and historically, chloramphenicol and quinidine, have been frequent candidates for pharmacist-led TDM. Antimicrobial TDM has traditionally targeted drugs with narrow therapeutic indices, where prevention of toxicity was the

Aims  Vascular calcification is common in diabetic patients. Warfarin has been associated with renovascular calcification and worsening renal function; rivaroxaban may provide renopreservation by decreasing vascular inflammation. We compared the impact of rivaroxaban and warfarin on renal outcomes in diabetic patients with non-valvular atrial fibrillation (NVAF). Methods and results  Using United States IBM MarketScan data from January 2011 to December 2017, we identified adults with both NVAF and diabetes, newly-initiated on rivaroxaban or warfarin with ≥12-month insurance coverage prior to anticoagulation initiation. Patients with Stage 5 chronic kidney disease (CKD) or undergoing haemodialysis at baseline were excluded. Differences in baseline covariates between cohorts were adjusted using inverse probability-of-treatment weighting (IPTW) based on propensity scores (absolute standardized differences <0.1 achieved for all after adjustment). Outcomes included incidence rates of emergency department/hospital admissions for acute kidney injury (AKI) and the composite of the development of Stage 5 CKD or need for haemodialysis. Patients were followed until an event, index anticoagulant discontinuation/switch, insurance disenrollment, or end-of-data availability. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox regression. We assessed 10 017 rivaroxaban (22.6% received a reduced dose) and 11 665 warfarin users. In comparison to warfarin, rivaroxaban was associated with lower risks of AKI (HR = 0.83, 95% CI = 0.74–0.92) and development of Stage 5 CKD or need for haemodialysis (HR = 0.82, 95% CI = 0.70–0.96). Sensitivity and subgroup analyses had similar effects as the base-case analysis. Conclusion  Rivaroxaban appears to be associated with lower risks of undesirable renal outcomes vs. warfarin in diabetic NVAF patients.

Thyroid involvement in Williams syndrome (WS) was recently reported in two small groups of patients, both showing an increased prevalence of elevation of TSH serum concentration; in one of the two reports, 70% of the patients demonstrated a hypoplasia of thyroid gland as well. In our institution, we currently follow a large population of WS patients who periodically undergo a multispecialist clinical evaluation that includes ultrasound evaluation of the thyroid gland, and levels of FT3, FT4, TSH, and anti-thyroid antibodies. Here, we report on the prevalence of thyroid structural and functional anomalies, in a population of 95 WS patients, half of them followed for more than 5 years. Our study confirms the increased incidence of both elevated TSH serum values (37.9% in our sample) and thyroid gland hypoplasia (74.7%). Moreover, we demonstrated that TSH elevation declines with age. For this reason, we suggest that a complete thyroid evaluation be performed in every patient with WS, and that this medical complication should be periodically searched for in follow-up visits.

I . Pooled samples of eggs from White Leghorn and New Hampshire hens given diets containing 110 and zoo g protein/kg were analysed for their content of essential amino acids. 2.The amino acid composition of the hen's egg protein was not significantly affected by variations in breed and diet.3. The estimated values for lysine, total sulphur-containing amino acids and tryptophan in egg protein were higher by 8.9, 2.0 and 8 % , respectively than those adopted for hen's egg by the FAO/WHO Expert Committee (FAO, 1965).4. The isoleucine content of egg protein was found to be much lower (338 mg/g nitrogen) than that reported by other workers.