Insulin is one of the top 10 high risk medications worldwide for prescription errors

Insulin has been identified as one of the top 10 high risk medicines worldwide. Errors are common - the first national audit in England and Wales showed prescribing errors in 19.5% of cases.

Not only are mistakes common, they often lead to harm - 3% of medication errors are related to insulin, but these errors were also twice as likely to cause harm as errors for other prescribed drugs.

Errors relating to insulin arise because insulin has a narrow therapeutic range and requires precise dose adjustments with careful administration and monitoring.

Over 20 different types of insulin are in use, in various strengths and forms, and with a range of delivery devices, including insulin syringes (from vials), insulin pens (prefilled or reusable), or infusion pumps.

References:

Safer administration of insulin: summary of a safety report from the National Patient Safety Agency. BMJ 2010; 341:c5269 doi: 10.1136/bmj.c5269 (Published 13 October 2010).

Image source: Wikipedia, public domain.

Unipolar depression in adolescence is common worldwide but often unrecognized

Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%.

The burden of depression is highest in low-income and middle-income countries. Depression is associated with morbidity, and heightens suicide risk.

The strongest risk factors for depression in adolescents are:

- family history of depression
- exposure to psychosocial stress

Factors that interact to increase risk through hormonal and perturbed neural pathways include:

- inherited risks
- developmental factors
- sex hormones
- psychosocial adversity

References:

Depression in adolescence. Prof Anita Thapar et al. The Lancet, Volume 379, Issue 9820, Pages 1056 - 1067, 17 March 2012.

Image source: OpenClipArt.org

Gendercide or the worldwide war on baby girls

From The Economist:

"Gendercide" is often seen as an unintended consequence of China’s one-child policy, or as a product of poverty or ignorance. The surplus of bachelors—called in China guanggun, or “bare branches”— seems to have accelerated between 1990 and 2005, in ways not obviously linked to the one-child policy, which was introduced in 1979. And, as is becoming clear, the war against baby girls is not confined to China.

The use of sex-selective abortion was banned in India in 1994 and in China in 1995. It is illegal in most countries. But since it is almost impossible to prove that an abortion has been carried out for reasons of sex selection, the practice remains widespread. An ultrasound scan costs about $12, which is within the scope of many—perhaps most—Chinese and Indian families. In one hospital in Punjab, in northern India, the only girls born after a round of ultrasound scans had been mistakenly identified as boys, or else had a male twin.

References:

Gendercide: The worldwide war on baby girls. The Economist.

Image source: Wikipedia, GNU Free Documentation License.

Worldwide number of new TB cases is higher than any other time in history

From the 2011 Lancet review:

The worldwide number of new TB cases is more than 9 million - higher than at any other time in history.

22 low-income and middle-income countries account for more than 80% of the active cases in the world.

Due to the devastating effect of HIV on susceptibility to TB, sub-Saharan Africa has been disproportionately affected and accounts for 4 of every 5 cases of HIV-associated tuberculosis.

Management problems include:

- In highly endemic areas, TB diagnosis continues to rely on century-old sputum microscopy

- No vaccine with adequate effectiveness (although BCG works to some extent). According to a recent report, BCG vaccination not only protects against tuberculosis but the number needed to treat (NNT) is 11.

- TB treatment regimens are protracted and have a risk of toxic effects

- Increasing rates of drug-resistant tuberculosis in eastern Europe, Asia, and sub-Saharan Africa

Promising progress includes improved tuberculosis diagnostics with biomarkers of disease activity. New and improved drugs, biomarkers, and vaccines need to be developed.

Diagnosing tuberculosis with cytokines IL-15, IL-10 and MCP-1, in addition to interferon-gamma

A pattern of two cytokines, called MCP-1 and IL-15, was reasonably good at differentiating between persons sick with TB and persons infected but not sick.

Monocyte chemotactic protein-1 (MCP-1) is a small cytokine belonging to the CC chemokine family. According to the new nomenclature, MCP-1 is called chemokine (C-C motif) ligand 2 (CCL2).

A third cytokine called IP-10 also showed promise at differentiating between people who are infected and those who are not.

Interferon gamma-induced protein 10 kDa (IP-10) is also known as C-X-C motif chemokine 10 (CXCL10). It belongs to the CXC chemokine family.

These 3 cytokines could form the basis of a new test to quickly detect whether tuberculosis is dormant or active and infectious.

52 chemokines from 4 families have been described. They interact with 20 receptors (click here for a larger image).

References:

Tuberculosis. Stephen D Lawn MRCP, Prof Alimuddin I Zumla FRCP. The Lancet, Volume 378, Issue 9785, Pages 57 - 72, 2 July 2011.

Immune system could be used to test for TB. Reuters.

Immunology Made Simple: "What are These People Talking About?"

Cytokines

Xpert MTB/RIF is a rapid diagnostic test for tuberculosis with high sensitivity (90%) and specificity (99%). Lancet, 2011.

Image source: PPD, CDC, public domain.

Comments from Twitter:

@sdietrich17: How discouraging. We just keep going backwards with so many infectious diseases...