MicroRNA sequencing in patients with coronary artery disease - considerations for use as biomarker for thrombotic risk.

MicroRNAs (miRNAs) are small RNAs integral in the regulation of gene expression. Analysis of circulating miRNA levels may identify patients with coronary artery disease (CAD) at risk for recurrent myocardial infarction (MI) after percutaneous coronary interventions (PCIs). Subjects with CAD were selected from the GENCATH cardiac catheterization biobank. Subjects with recurrent MI after PCI were compared with those without recurrent MI during follow-up in the initial (n = 48) and replication cohort (n = 67). Next generation MiRNA sequencing was performed on plasma samples and whole blood samples fixed with PAXGENE tubes upon collection. Overall, 164 miRNAs derived from whole blood were differentially expressed in the replication cohort between subjects with and without recurrent MI events (p < 0.05), with 69 remaining significant after false-discovery rate (FDR) correction. None of the miRNAs in plasma was significantly different by FDR among subjects with and without MI. Overall, correlation between direction of effects between plasma and whole blood assays was variable, and only two miRNAs were concordant and significant in both. Associations of miRNA with vascular disease, MI, and thrombosis were further explored. MiRNA profiling has potential as the future biomarker for disease prognosis and treatment response marker in secondary treatment of patients with CAD after PCI. Whole blood may be the preferred sample source as compared to plasma.

Student perceptions of co-curricular activities on pharmacy education: A review.

BACKGROUND: The Accreditation Council for Pharmacy Education Standards 2016 emphasize the incorporation of a co-curriculum in pharmacy education. However, how students perceive the value of these activities is still unclear. The objectives of this study were to (1) describe how students perceive co-curricular involvement, (2) identify barriers that impede student engagement in co-curricular activities, and (3) assess the influence of co-curricular activities on academic performance. METHODS: A literature search was conducted using the Cumulative Index of Nursing and Allied Health Literature, Academic Search Complete, PsycInfo, Web of Science, Scopus, PubMed, and ProQuest Central databases. Search terms used within each database were "co-curricular" AND "pharmacy learning OR pharmacy education OR pharmacy student." Studies were included in the review if they addressed pharmacy student perceptions of or barriers to co-curricular activity. RESULTS: Eleven studies met the criteria for inclusion. Student perceptions of co-curricular activities were consistently positive, reflecting perceived improvement in self-confidence and abilities. Barriers to student engagement included voluntary participation and student's limited scope of practice. Engagement in co-curricular activities also improved academic performance and clinical knowledge. IMPLICATIONS: Co-curricular activities have a perceived positive impact on student confidence and abilities as practitioners. Participation in co-curricular activities provides benefits to students in their academic, professional, and personal development in ways that are not always supported in a didactic curriculum. Incorporating co-curricular activity is justified from the student perspective in the framework of pharmacy student development and maturation.

Low-Molecular-Weight Heparin and Fondaparinux Use in Pediatric Patients With Obesity.

OBJECTIVE: The objective of this study is to comprehensively review the efficacy and safety data of low-molecular-weight heparins (LMWHs) and fondaparinux in pediatric patients with obesity. DATA SOURCES: A comprehensive literature search of PubMed, SCOPUS, CINAHL, Academic Search Complete, PsycInfo, Cochrane Library, and Web of Science databases was conducted (1900 to July 2020). Search terms utilized included LMWH, low-molecular-weight heparin, enoxaparin, dalteparin, tinzaparin, fondaparinux, pediatric, child, children, obese, obesity, overweight. No limits or timeline restrictions were imposed. STUDY SELECTION AND DATA EXTRACTION: Studies that reported pediatric patients with described overweight or obesity and utilized LMWHs or fondaparinux were considered. DATA SYNTHESIS: Of 207 studies screened, 12 were included. Average dose reductions of 12.9% to 37.3% from the starting dose were observed with treatment indications of enoxaparin and increased up to 27.3% for prophylactic indications. Trends could not be concluded in the dalteparin and fondaparinux studies. Four thrombotic and 15 bleeding events were reported in the studies. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Pediatric patients with obesity may initially be underdosed or overdosed with enoxaparin compared with children with healthy body weight, depending on the indication. CONCLUSION: Pediatric patients with obesity may benefit from proactively adjusting enoxaparin dosing on initiation of therapy. Further studies are needed for dalteparin and fondaparinux in these populations. Clinical controversy exists with the relevance of monitoring these high-risk medications for therapeutic and prophylactic indications. Thrombotic and hemorrhagic events were similar to reported adult outcomes.