Simplified urine-based method to detect rifampin underexposure in adults with tuberculosis: a prospective diagnostic accuracy study.

Variable pharmacokinetics of rifampin in tuberculosis (TB) treatment can lead to poor outcomes. Urine spectrophotometry is simpler and more accessible than recommended serum-based drug monitoring, but its optimal efficacy in predicting serum rifampin underexposure in adults with TB remains uncertain. Adult TB patients in New Jersey and Virginia receiving rifampin-containing regimens were enrolled. Serum and urine samples were collected over 24 h. Rifampin serum concentrations were measured using validated liquid chromatography-tandem mass spectrometry, and total exposure (area under the concentration-time curve) over 24 h (AUC0-24) was determined through noncompartmental analysis. The Sunahara method was used to extract total rifamycins, and rifampin urine excretion was measured by spectrophotometry. An analysis of 58 eligible participants, including 15 (26%) with type 2 diabetes mellitus, demonstrated that urine spectrophotometry accurately identified subtarget rifampin AUC0-24 at 0-4, 0-8, and 0-24 h. The area under the receiver operator characteristic curve (AUC ROC) values were 0.80 (95% CI 0.67-0.90), 0.84 (95% CI 0.72-0.94), and 0.83 (95% CI 0.72-0.93), respectively. These values were comparable to the AUC ROC of 2 h serum concentrations commonly used for therapeutic monitoring (0.82 [95% CI 0.71-0.92], P = 0.6). Diabetes status did not significantly affect the AUC ROCs for urine in predicting subtarget rifampin serum exposure (P = 0.67-0.92). Spectrophotometric measurement of urine rifampin excretion within the first 4 or 8 h after dosing is a simple and cost-effective test that accurately predicts rifampin underexposure. This test provides critical information for optimizing tuberculosis treatment outcomes by facilitating appropriate dose adjustments.

Survey of residency program directors' perceptions of nontraditional pharmacy residency applicants.

PURPOSE: The attitudes and expectations of residency program directors (RPDs) regarding nontraditional residency applicants (NTAs) were evaluated. METHODS: This was a cross-sectional, survey-based study targeting RPDs of American Society of Health-System Pharmacists-accredited residency programs. A 14-question survey requesting information related to demographics, perceptions of NTAs compared with traditional applicants, advantages and disadvantages of NTAs, and advice for NTAs was administered electronically to RPDs. The primary outcome of this study was to determine RPDs' perceptions of NTAs as suitable residency candidates. The secondary outcome evaluated the rate of NTA acceptance into residency programs and a qualitative assessment of RPDs' advice for NTAs. RESULTS: Of the 1,414 RPDs contacted to participate, 328 (23%) completed the survey. RPDs were primarily affiliated with postgraduate year 1 pharmacy practice (52%) or postgraduate year 2 specialty residencies (30%), and 35% reported having an NTA in their program. Most respondents (87%) reported that NTAs are given equal consideration relative to traditional residency applicants. RPDs rated work experience as the most important quality of an NTA, followed closely by the ability to work with others and teachability. Most (277 [85%]) RPDs agreed that NTAs should possess experiences beyond work experience, such as research, leadership, and community service. The biggest concern regarding NTAs was significant time since graduation prior to application. CONCLUSION: The majority of RPDs did not perceive NTAs differently from traditional applicants in the selection process of prospective candidates.

Distinct oncogenes drive different genome and epigenome alterations in human mammary epithelial cells.

Molecular subtypes of breast cancer are defined on the basis of gene expression and genomic/epigenetic pattern differences. Different subtypes are thought to originate from distinct cell lineages, but the early activation of an oncogene could also play a role. It is difficult to discriminate the respective inputs of oncogene activation or cell type of origin. In this work, we wished to determine whether activation of distinct oncogenic pathways in human mammary epithelial cells (HMEC) could lead to different patterns of genetic and epigenetic changes. To this aim, we transduced shp53 immortalized HMECs in parallel with the CCNE1, WNT1 and RASv12 oncogenes which activate distinct oncogenic pathways and characterized them at sequential stages of transformation for changes in their genetic and epigenetic profiles. We show that initial activation of CCNE1, WNT1 and RASv12, in shp53 HMECs results in different and reproducible changes in mRNA and micro-RNA expression, copy number alterations (CNA) and DNA methylation profiles. Noticeably, HMECs transformed by RAS bore very specific profiles of CNAs and DNA methylation, clearly distinct from those shown by CCNE1 and WNT1 transformed HMECs. Genes impacted by CNAs and CpG methylation in the RAS and the CCNE1/WNT1 clusters showed clear differences, illustrating the activation of distinct pathways. Our data show that early activation of distinct oncogenic pathways leads to active adaptive events resulting in specific sets of CNAs and DNA methylation changes. We, thus, propose that activation of different oncogenes could have a role in reshaping the genetic landscape of breast cancer subtypes.