The alteration of the gut microbiome by immunosuppressive agents used in solid organ transplantation.

INTRODUCTION: Studies have suggested that in addition to antimicrobials, some non-antibiotics may alter the gut microbiome. This systematic review sought to determine if there is an association between immunosuppressive agents used in recipients of solid organ transplants (SOT) and alterations in the gut microbiome. METHODS: English language PubMed and Scopus searches were conducted to identify relevant articles. Inclusion criteria were defined as pertaining to solid organ transplantation, immunosuppression, and the gut microbiome. Articles were excluded if they contained only genetic microbiota descriptions, narrative reviews of bacteria, or described bacteria as a pathogen for infections. PRISMA reporting was used to guide this literature review. RESULTS: A preliminary search identified 665 articles, of which 75 articles met the inclusion criteria, and 10 articles remained after application of exclusion criteria. Seventy-one percent of articles discussed calcineurin inhibitors, such as tacrolimus, 38% included mycophenolate mofetil, and 52% included steroids, such as prednisone. Some studies utilized a combination of immunosuppressants or had multiple study arms. Seventy percent of the articles indicated changes in quantities of anaerobic bacteria including Ruminococcaceae, Lachnospiraceae, Firmicutes, Bacteroides, and Clostridiales. Combinations of immunosuppressant agents were associated with an increase in colonization of Escherichia coli and Enterococcus sp. CONCLUSION: Some immunosuppressants are associated with changes in gut flora, but the impact on clinical outcomes is unknown. Robust clinical trials delineating the direct effect of immunosuppressants on the gut microbiome as well as the impact on clinical outcomes are warranted.

Systematic review of student anxiety and performance during objective structured clinical examinations.

INTRODUCTION: Test anxiety is well studied in higher education, but studies primarily concern traditional assessments, such as written examinations. As use of objective structured clinical examination (OSCE) in pharmacy education increases, a closer examination of non-cognitive factors such as test anxiety is warranted. The purpose of this review was to determine the association between OSCE-associated test anxiety with OSCE performance in health professional students. METHODS: A literature search was conducted to identify peer-reviewed literature concerning test anxiety in health professional students associated with OSCE. Investigators searched for a combination of OSCE-related terms with anxiety-related terms using PubMed. Articles were included if they assessed OSCE-related anxiety by quantitative or qualitative methods. Data extracted from eligible articles included demographic data, type of the anxiety survey, associations between OSCE-related anxiety and performance, and other student-factors associated with OSCE-related anxiety. RESULTS: The literature search yielded 339 articles. Nine articles met eligibility criteria and were included in the review. Results included students from medical, pharmacy, dental, and nursing professional programs. Anxiety was assessed via multiple scales. Six out of the eight studies assessing the relationship OSCE-related anxiety and OSCE performance found no association between the two measures. Contrary to literature concerning test anxiety in higher education, female gender was not associated with OSCE-related anxiety. CONCLUSION: OSCE-related anxiety appears to have minimal to no influence on student performance. Future studies should utilize standardized anxiety assessments and should seek to understand anxiety's effects on student wellbeing and burnout.