A medication take-back event was held in Lansing, MI, USA, for four hours in September 2013. The objective was to quantify medication waste by determining the ratio of medication units remaining versus dispensed and to identify therapeutic classes with greater ratios of remaining medication units. Drug name, strength, quantity remaining, quantity dispensed, dispensary source, and brand or generic were recorded from the label of each medication container returned. Out of the over 3600 medication containers collected, this study analyzed 2459 containers, which included 304 controlled substances. On average, 66 percent of the medications dispensed in these containers were unused, and therefore wasted. Immunologic medications had the lowest quantity of waste at 54%, while geriatrics/miscellaneous therapeutic class yielded the highest quantity of waste at 79%. The most common therapeutic classes collected were pain/spasm, cardiovascular, and mental health. Greater emphasis on patient education regarding medication adherence and health care professionals’ judicious prescribing habits is warranted to reduce the frequency of unused medications. The increased accessibility to medication return sites may alleviate the prevalence of medication accumulation, environmental damage, and medication misuse.

Cardiac biomarkers have become pivotal to the clinical practice of cardiology, but there remains much to discover that could benefit cardiology patients. We review the discovery of key protein biomarkers in the fields of acute coronary syndrome, heart failure, and atherosclerosis, giving an overview of the populations they were studied in and the statistics that were used to validate them. We review statistical approaches that are currently in use to assess new biomarkers and overview a framework for biomarker discovery and evaluation that could be incorporated into clinical trials to evaluate cardiovascular outcomes in the future.

Objective:Rare disease Background:Vernix caseosa peritonitis (VCP) is a rare complication that typically presents following an otherwise uneventful cesarean section. Leakage of vernix caseosa into the peritoneum is thought to elicit a granulomatous foreign body reaction. Symptoms can be similar to other acute abdominal conditions, and diagnosis is confirmed by intraoperative findings and histological examination. Peritoneal lavage with supportive measures is the mainstay of treatment and recovery. Case Reports:Case 1 was a 30-year-old woman who developed right iliac fossa pain, fever, tachycardia, and tachypnea less than a week after her lower segment cesarean section (LSCS). She underwent a laparoscopy for a peritonitic abdomen and concern for intra-abdominal sepsis. A peritoneal biopsy demonstrated histological changes consistent with VCP.Case 2 was a 39-year-old woman who underwent a LSCS. After discharge, she re-presented with generalized abdominal pain. With computed tomography (CT) scan findings suggestive of appendicitis, an appendectomy was performed, and vernix caseosa was detected in all quadrants.Case 3 was a 33-year-old woman who presented with fever, vomiting, diarrhea, and iliac fossa pain 9 days following an LSCS. She was given analgesia and antibiotics for a pelvic fluid collection noted on CT scan. She represented with tense swelling and pain above her cesarean section incision. Laparoscopy revealed adhesions over the lower abdomen and pelvis and white plaques suggestive of vernix caseosa along the peritoneal side walls. Conclusions:The rising incidence of cesarean births worldwide creates the potential for increased numbers of VCP cases.Greater recognition of VCP is warranted to prevent unnecessary procedures.

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