Serum autotaxin level: a promising diagnostic biomarker in differentiating Graves' disease and thyroiditis.

BACKGROUND: Recent studies have suggested that serum autotaxin (ATX) may be a promising diagnostic biomarker in differentiating between Graves' disease (GD) and thyroiditis, as well as serving as a monitoring biomarker for GD. This study will evaluate the use of serum ATX as a diagnostic biomarker in these conditions. METHODS: In this prospective interventional study, blood samples were collected from the patients who met both inclusion and exclusion criteria, and serum ATX levels were measured by using the MyBioSource human Autotaxin ELISA kit. RESULTS: A total of 32 patients were enrolled, of which 18.8% were newly diagnosed with GD, 21.9% were thyroiditis, and 59.3% were on treatment for GD. Serum autotaxin antigen was significantly higher in GD patients than in thyroiditis (603.3217 ± 444.24 v/s 214.74 ± 55.91, P = <.005). Serum ATX measurement successfully discriminated GD patients from thyroiditis (AUC = 0.952, 95%CI: 0.00-1.00) with an optimal cutoff value of ≥257.20 ng/L (sensitivity = 100 and specificity = 81.71). Monitoring the efficacy of serum ATX was analyzed and showed a significant difference. CONCLUSION: The serum ATX was higher in subjects with GD as compared to thyroiditis, and ATX levels were found to be decreased during the treatment period. In conclusion, serum ATX can be used as a diagnostic and monitoring biomarker in GD.

A prospective observational study of medication errors in general medicine department in a tertiary care hospital.

BACKGROUND: The aim of the study was to evaluate the incidence of medication error and to categorize medication error in the general medicine department of a tertiary hospital. Thus, the study aims to promote safety in medication use and ensure quality in the healthcare service by effective utilization of a clinical pharmacist. The study objective was to detect and categorize medication errors, to ensure rational drug use in the hospital, to make recommendations for doctors, nurses, and patients to promote safe use of medications. METHODS: The study was conducted in inpatients in the general medicine department of a 350-bed multispecialty tertiary care referral hospital located in South India. It is a prospective observational study where data were collected using a data collection form which included patient demographic details, drug details, and criteria for identifying errors, its categorization, and the details of drugs involved in errors. Complete details of patients and medications were recorded through a review of medication charts, reviewing prescriptions, visiting nursing stations and the pharmacy, and personal interviews with patients and bystanders. Collected details were then evaluated to detect the prescribing, administration, dispensing error and drug interactions and were then recorded, suggesting necessary steps to prevent recurrence of reported medication errors. RESULTS: The study was conducted in 311 patients, where 168 were males (54%) and 143 were females (46%). Out of 311 cases, 36 cases (11.57%) had at least one error. The total number of errors found was 67, among which administration errors (28.35%) were the most frequently occurring types of errors, which was followed by prescribing errors (22.38%), dispensing errors (8.9%) and drug interaction, patient errors and other types of errors collectively contributed to the remaining portion. A total of 2742 medications were prescribed to 106 patients and the average number of medications per patient was found to be 8.8. The involvement of a particular medication class to the medication errors showed that the antimicrobial agents were contributing a maximum of (26.8%), which was followed by cardiovascular agents (20.8%). In third place were nonsteroidal anti-inflammatory drugs (11.9%) followed very closely by central nervous system drugs and gastrointestinal drugs (7.4%). The total percentage of drug interaction was 40.29%. Most interactions were of moderate type belonging to category C of medication errors. CONCLUSIONS: The study helps to assess the incidence of medication error and to categorize medication error. In the general medicine department, the majority of patients were geriatrics who are more prone to errors, thus guidelines for safe use of medications in geriatrics should be strictly implemented to prevent medication errors. Antimicrobials are the major class of drugs involved in medication errors, thus this study recommends strict implementations of antibiotic policy in the hospital.

Prescription pattern of antidiabetic drugs in the outpatient departments of hospitals in Malappuram district, Kerala.

BACKGROUND: The study aimed to describe the current trends in the prescription pattern of antidiabetic drugs in outpatient departments and to assess different co-morbid conditions. METHODS: This study was a cross-sectional survey of all prescriptions received from 200 outpatients attending different community pharmacies of Malappuram district. Prescriptions were collected by taking their image. Informed verbal consent was obtained from each patient and inquiries were made about their co-morbidities. The contents of the prescriptions were assessed on the basis of drugs used for diabetes and brand names were decoded to generic names using standard CIMS India and the internet. RESULTS: Among 200 prescriptions, 95% were for type 2 diabetes mellitus and 5% for type 1 diabetes mellitus. Eighty percent were prescribed with oral hypoglycemic agents alone as mono or in combination therapy, 5% were with insulin alone and 15% with insulin and oral hypoglycemic drug combination. 77% had more than five medicines, in which many were multidrug combinations. No prescription contained generic drugs and 13% contained at least one vitamin supplement. CONCLUSIONS: The study concluded that the choice of antidiabetic drugs was only slightly changed compared to previous studies, except for newer sulfonyl ureas, thiazolidinediones and improved insulin preparations. Polypharmacy is a big problem, especially for elderly patients. This suggests the need for development of evidence-based guidelines for specific conditions by independent bodies. The study necessitates the need to develop and use a standardized ideal format for all prescriptions. Thereby we can, to an extent, reduce the chance of medication errors.