IDENTIFICATION OF SAFETY ALERT BY MONITORING ANALYTICAL PARAMETERS AND HIGH-RISK DRUGS

Early detection of adverse drug reactions (ADR) increases patient safety. Our objective was to identify ADR by monitoring laboratory parameters and high-risk drugs. We carried out a two-month prospective observational study in a Internal Medicine Department, with daily recording of drugs prescribed and the following parameters: Na, K, Ca, serum creatinine, glomerular filtration rate (GFR), INR, glucose, haemoglobin, platelets, ALT, AST, bilirubin, GGT, alkaline phosphatase, TSH, T4, and blood digoxin. High-risk drugs were closely monitored. 52 patients included, of whom 46.2% experienced an ADR. We opserved an association with drugs in 25.5%, as follows: reduction in GFR, 26.9% (associated with loop diuretics [41. 7%], angiotensin-converting enzyme [ACE] inhibitors [33.3%], angiotens1n II receptor blockers [ARB] [16.6%], and anti-diabetic drugs [8.3%])hypokalemia, 22.3% (associated with loop diuretics [50.0%], potassium-free fluid [37.5%], and salbutamol [12.5%])hyperkalemia, 14.4% (associated with ACE inhibitors [60.0%] and ARB [40.0%])INR out of range, 10.8% (associated with drug interactions [66.7%])hyperglycemia, 8.1% (associated with corticosteroids [66.7%] and anti-diabetic drugs [33.3%])and other conditions, 18.8%. We conclued that patient safety could be improved by implementing warnings in electronic prescriptions jn cases of a decrease in GFR or modification of potassium levels in patients who are prescribed loop diuretics, ACE inhibitors, or ARBs

Differential Expression of SMAD Genes and S1PR1 on Circulating CD4+ T Cells in Multiple Sclerosis and Crohn’s Disease

The Th17 immune response plays a key role in autoimmune diseases such as multiple sclerosis (MS) and inflammatory bowel disease (IBD). Expression of Th17-related genes in inflamed tissues has been reported in autoimmune diseases. However, values are frequently obtained using invasive methods. We aimed to identify biomarkers of MS in an accessible sample, such as blood, by quantifying the relative expression of 91 Th17-related genes in CD4+ T lymphocytes from patients with MS during a relapse or during a remitting phase. We also compared our findings with those of healthy controls. After confirmation in a validation cohort, expression of SMAD7 and S1PR1 mRNAs was decreased in remitting disease (–2.3-fold and –1.3-fold, respectively) and relapsing disease (–2.2-fold and –1.3-fold, respectively). No differential expression was observed for other SMAD7-related genes, namely, SMAD2, SMAD3, and SMAD4. Under-regulation of SMAD7 and S1PR1 was also observed in another autoimmune disease, Crohn’s disease (CD) (−4.6-fold, -1.6-fold, respectively), suggesting the presence of common markers for autoimmune diseases. In addition, expression of TNF, SMAD2, SMAD3, and SMAD4 were also decreased in CD (–2.2-fold, –1.4-fold, –1.6-fold, and –1.6-fold, respectively). Our study suggests that expression of SMAD7 and S1PR1 mRNA in blood samples are markers for MS and CD, and TNF, SMAD2, SMAD3, and SMAD4 for CD. These genes could prove useful as markers of autoimmune diseases, thus obviating the need for invasive methods