PURPOSE: Recent evidence of a potential interaction between clopidogrel and proton pump inhibitors (PPIs) is discussed. SUMMARY: The American College of Cardiology and the American Heart Association recommend use of gastroprotective agents, specifically PPIs, in patients receiving aspirin, a thienopyridine, or the combination who have an increased risk for recurrent gastrointestinal bleeding. Available evidence from one small, short-term, randomized, double-blind trial evaluating platelet aggregation and several observational studies suggests that there is a potential for a clinically significant interaction between clopidogrel and PPIs. A post hoc analysis of a large, randomized, double-blind trial found no evidence of a clinically significant drug interaction at 28 days, though a significant difference was observed at one year. The authors concluded that the use of PPIs, regardless of clopidogrel use, increases the risk of adverse cardiovascular events. CONCLUSION: Although data are limited, observational studies and prospective trials involving surrogate markers of platelet reactivity suggest a clinically significant interaction between clopidogrel and PPIs. Until further studies are completed to delineate the specifics of the interaction between clopidogrel and PPIs, the risks and benefits of concomitant treatment should be carefully weighed to determine the most appropriate treatment for each individual patient.

The 8p11 myeloproliferative syndrome is a rare hematologic malignancy derived from a pluripotent hematopoietic stem cell associated with rearrangements involving the fibroblast growth factor receptor 1 (FGFR1) gene located on chromosome 8p11. The most common translocation, t(8;13)(p11;q13), results in a ZNF198-FGFR1 fusion gene and constitutively active FGFR1 tyrosine kinase activity. Typical pathologic findings include myeloid hyperplasia, lymphadenopathy, precursor T-lymphoblastic lymphoma, and eosinophilia. The disease is usually associated with an aggressive course and progression to acute myeloid leukemia is frequent. We report here the first case of 8p11 myeloproliferative syndrome in an infant and demonstrate the value of molecular testing in the diagnosis and minimal disease monitoring of this rare disease.

Research suggests women find the first 2 to 6 weeks to be the most difficult time for breastfeeding. It has been identified that women need and seek support with breastfeeding during this time. Support is a difficult concept to define. When discussed by professionals, support for breastfeeding is generally viewed in terms of providing information and educational interventions. There is little understanding of the different elements of breastfeeding support strategies and the mechanisms by which support operates. Further, there is a paucity of qualitative research specifically reporting women's experiences and expectations of professional support. This paper describes women's expectations and experiences of 'infant feeding support' provided by health professionals in the first 6 weeks post-birth. The findings are drawn from a grounded theory study exploring women's infant feeding decisions in the first 6 weeks post-birth. Participants were recruited from a variety of socio-demographic areas of Sydney and the NSW Central Coast, Australia in 2003-2004. The women in this study discussed aspects of what they considered helpful and/or unhelpful in terms of professional support. In addition, they also provided insight into aspects of interactions that were deemed important to them as new mothers learning to feed their babies. The results are presented in three sections: expecting support, experiencing support and evaluating support. The findings help to better understand components of professional practices and behaviours that can be considered supportive. The support behaviours are far more complex than simply increasing education and knowledge of infant feeding. They demonstrate the need for sensitive individualized care and show that this type of support can increase women's confidence to breastfeed.

Slow Wallerian degeneration (Wld(S)) encodes a chimeric Ube4b/nicotinamide mononucleotide adenylyl transferase 1 (Nmnat1) fusion protein that potently suppresses Wallerian degeneration, but the mechanistic action of Wld(S) remains controversial. In this study, we characterize Wld(S)-mediated axon protection in vivo using Drosophila melanogaster. We show that Nmnat1 can protect severed axons from autodestruction but at levels significantly lower than Wld(S), and enzyme-dead versions of Nmnat1 and Wld(S) exhibit severely reduced axon-protective function. Interestingly, a 16-amino acid N-terminal domain of Wld(S)(termed N16) accounts for the differences in axon-sparing activity between Wld(S) and Nmnat1, and N16-dependent enhancement of Nmnat1-protective activity in Wld(S) requires the N16-binding protein valosin-containing protein (VCP)/TER94. Thus, Wld(S)-mediated suppression of Wallerian degeneration results from VCP-N16 interactions and Nmnat1 activity converging in vivo. Surprisingly, mouse Nmnat3, a mitochondrial Nmnat enzyme that localizes to the cytoplasm in Drosophila cells, protects severed axons at levels indistinguishable from Wld(S). Thus, nuclear Nmnat activity does not appear to be essential for Wld(S)-like axon protection.

OBJECTIVE: To determine the value of completing a pharmacy resident teaching certificate program on graduates' current positions of employment. DESIGN: Annually from 2003 to 2007, program graduates of the Indiana Pharmacy Teaching Certificate (IPTeC) program were invited to take a 13-question Web-based survey 1 year after completing the program. ASSESSMENT: Fifty-three of the 62 graduates (85%) surveyed responded. Almost half of the respondents strongly agreed or agreed that having completed the IPTeC program helped them obtain their current position. More than 90% of respondents agreed or strongly agreed that the seminar participation and teaching experience from the IPTeC program helped them in their current position. About 80% of respondents would recommend the program to others. CONCLUSION: Completing a pharmacy resident teaching certificate program helped some graduates obtain and excel in their current position.

Objective: To evaluate the appropriateness of prescribing select neuropathic pain medications to diabetes patients based on the potential for drug-drug interactions with medications diabetes patients were prescribed continuously for >/= 3 months (chronic use). Methods: Medical records of patients with a diagnosis of diabetes or use of antidiabetic medications between January 1, 2002 and September 30, 2005 in the U.K. and Germany Mediplus databases were obtained. Patients: Medication use profiles were evaluated between April 2004 and September 2005. The metabolic pathways associated with medications that were prescribed chronically to at least 10% of study patients were compared with the metabolic pathways of neuropathic pain medications to identify potential drug-drug interactions. Results: A total of 40,448 patients in the U.K.(63.6 +/- 16.6 years, 51% male) and 31,930 patients in Germany (68.9 +/- 12.7 years, 46% male) were identified. Frequently prescribed medications in the U.K. included aspirin (33.7%), metformin (32.7%), simvastatin (25.5%), atorvastatin (19.4%), atenolol (18.1%), and in Germany hydrochlorothiazide (35.8%), aspirin (25.2%), metformin (21.6%), metoprolol (20.3%), and simvastatin (18.3%). Several neuropathic pain medications have potential for drug-drug interactions with medications prescribed to diabetes patients. Examples include (neuropathic pain medications vs. diabetes medications): duloxetine, paroxetine, and methadone (CYP2D6 inhibitors) and oxycodone HCL, hydrocodone (CYP2D6 substrates) vs. metoprolol and bisoprolol (CYP2D6 substrates); and carbamazepine (CYP3A4 inducer) vs. simvastatin, and atorvastatin (CYP3A4 substrates). Conclusions/Interpretation: Our findings underscore the need for medical vigilance when selecting medications for treating neuropathic pain in diabetes patients. blacksquare, square, filled.