Hyperbilirubinemia screening and treatment in neonates born prior to 35 weeks of gestation

BACKGROUND

Guidelines on when to screen for neonatal hyperbilirubinemia apply to infants born at 35 weeks or later of gestation. It is unknown whether infants born earlier would benefit from similar guidelines. Our objective was to examine hyperbilirubinemia screening and phototherapy prescription among early preterm infants during the first 6 days of life.

METHODS

We reviewed the charts of 193 infants born prior to 35 weeks of gestation who were admitted to a tertiary care NICU in Southeastern Ontario in 2018-2019. Information on total serum bilirubin (TSB) measurements over each 12-hour interval during the first six days of life and the treatment decision (no treatment, initiate, continue, or stop phototherapy) was extracted. We also examined what proportion of infants were prescribed phototherapy during each 12-hour interval.

RESULTS

Of 1006 TSB measurements performed over the first 6 days of life, 605 were done to determine whether phototherapy should be initiated. Treatment was prescribed in 275 instances (45%). A higher proportion of infants born prior to 28 weeks of gestation required phototherapy in the first 12 hours of life (37%) compared to those born at 28-32 weeks (20%) and 33-34 weeks (5.7%).

CONCLUSIONS

Our results suggest that TSB measurements are often poorly timed to detect treatment need in infants born prior to 35 weeks of gestation. This unnecessarily increases the risk of complications from phlebotomy and is an ineffective use of health care resources. There is a need to develop guidelines to optimize hyperbilirubinemia screening among early preterm infants.

Pharmacy practice in hospital settings in GCC countries: Pharmacists' medication therapy monitoring activities

Purpose

Our study aims to provide an overview of medication therapy monitoring practices carried out by pharmacists in hospitals across the Gulf Cooperation Council (GCC) countries.

Methods

This is a cross-sectional questionnaire-based study of hospitals located in the GCC. Questions were adopted from the American Society of Health-System Pharmacists (ASHP) national survey. Frequency analyses were used to examine the number and percentages of specific responses to the survey questions.

Results

A total of 64 hospitals participated in this survey, reflecting an overall response rate of 52.0%. Almost half of participating hospitals (48.4%) were from Saudi Arabia. Among the 64 participating hospitals, 54.7% monitored their patients daily, 40.6% assigned pharmacists to patient care units for at least eight hours per day, and 42.2% held pharmacists accountable for medication-related outcomes. Moreover, the criteria used to identify patients requiring monitoring, 35.9% relied on the list of high-risk medications, 26.5% relied on specific medical services, 21.9% relied on directions from the hospital committee, and 17.2% relied on lab abnormalities. The most frequently utilized method for monitoring adverse drug events (ADEs) was through notifications from nurses or physicians, observed in 60.9% of participating hospitals.

Conclusion

The survey emphasizes the need for hospitals in the GCC to promote increased pharmacist accountability for medication-related outcomes, explore technological solutions to enhance monitoring efficiency and extend the presence of pharmacists in patient care units beyond the current level.

Nausea and Vomiting of Pregnancy in Saudi Females: A Cross-Sectional Study

Background

Nausea and vomiting of pregnancy (NVP) is a frequently reported medical condition during pregnancy. However, no studies have evaluated its impact on women's ability to perform acts of daily living in the Saudi population. Hence, this study aimed to explore the impact of NVP on the day-to-day functions of pregnant women in Saudi Arabia.

Methods

This cross-sectional online survey study was conducted between March 18, 2019, and April 17, 2019. Pregnant females and new mothers were asked to complete an anonymous online questionnaire.

Results

A total of 591 women with NVP participated in the study. Pregnant women at the time of the survey were 233 (39.4 %), and 358 (60.6 %) were new mothers who had a child under the age of 1 year. Most participants, 556 (94.1 %), reported experiencing NVP symptoms at some time during their pregnancies. NVP symptoms were most predominant during the first trimester, as experienced by 420 (75.5 %) women. NVP severely affected daily activities in 45.4 % of participants. About 58 % of the women reported that they might never consider getting pregnant again because of NVP.

Conclusions

Our study found that most Saudi women suffered from NVP during their pregnancies. Additionally, NVP impacts women's daily-life functioning and their desire to become pregnant again. This warrants further studies to explore NVP socioeconomical impact on Saudi women.

Quality of Life, Fatigue, and Physical Symptoms Post-COVID-19 Condition: A Cross-Sectional Comparative Study

The magnitude of post-COVID-19 syndrome was not thoroughly investigated. This study evaluated the quality of life and persistence of fatigue and physical symptoms of individuals post-COVID-19 compared with noninfected controls. The study included 965 participants; 400 had previous COVID-19 disease and 565 controls without COVID-19. The questionnaire collected data on comorbidities, COVID-19 vaccination, general health questions, and physical symptoms, in addition to validated measures of quality of life (SF-36 scale), fatigue (fatigue severity scale, FSS), and dyspnea grade. COVID-19 participants complained more frequently of weakness, muscle pain, respiratory symptoms, voice disorders, imbalance, taste and smell loss, and menstrual problems compared to the controls. Joint symptoms, tingling, numbness, hypo/hypertension, sexual dysfunction, headache, bowel, urinary, cardiac, and visual symptoms did not differ between groups. Dyspnea grade II-IV did not differ significantly between groups (p = 0.116). COVID-19 patients scored lower on the SF-36 domains of role physical (p = 0.045), vitality (p < 0.001), reported health changes (p < 0.001), and mental-components summary (p = 0.014). FSS scores were significantly higher in COVID-19 participants (3 (1.8-4.3) vs. 2.6 (1.4-4); p < 0.001). COVID-19 effects could persist beyond the acute infection phase. These effects include changes in quality of life, fatigue, and persistence of physical symptoms.

Job Motivation and Satisfaction Among Female Pharmacists Working in Private Pharmacy Professional Sectors in Saudi Arabia

Background

Pharmacists’ job satisfaction has been of interest for many years and is of great importance in several respects, such as productivity and ultimately organizational performance.

Objective

This study aimed to investigate the perceived motivational factors and levels of job satisfaction of female pharmacists working in private pharmaceutical sectors.

Methods

This was a cross-sectional study using a web-based survey of randomly selected female pharmacists working in different private settings including community pharmacies, pharmaceutical companies, private hospitals, and other private sectors using a pre-validated satisfaction scale (Warr–Cook–Wall scale).

Results

A total of 232 female pharmacists participated in the study with a mean age of 26.1±2.4 years. Of the total respondents, more than half (58%) worked for pharmaceutical companies, 25% worked in community pharmacies, and 16.8% were from hospital pharmacies. The most attractive motivating factors that encourage female pharmacists toward better performance were having the opportunity to learn new skills, being in contact with people both locally and internationally, gaining a sense of achievement, and being recognized, appreciated, and rewarded. The participants of this study were shown to have a moderate job satisfaction level.

Conclusion

This study revealed that the non-Saudi, part-time pharmacists who never expected a promotion were less satisfied than the Saudi, full-time employees who expected a promotion within a year.

Gene Therapy Knowledge and Attitude Among Healthcare Professionals: A Cross-Sectional Study

This study aimed to assess healthcare professionals' knowledge, attitudes, and concerns toward gene therapy in Saudi Arabia. We conducted an online cross-sectional survey via convenience sampling during the period from December 2018 to March 2019. A total of 419 (358 pharmacists and 61 physicians) responded to our questionnaire. Three hundred and nine (73.7%) were male, and the mean (±SD) age of 32.0 ± 7.7 years. The mean knowledge scores of all participants, pharmacists, and physicians were 3.8 ± 1.9, 3.8 ± 1.9, and 3.7 ± 1.9, respectively (P = 0.73). Higher knowledge score was associated with younger age (Coefficient: -0.03; P = 0.02), male (Coefficient: 0.57; P = 0.01), master's degree (Coefficient: 0.93; P = 0.003) and Ph.D. holders (Coefficient: 1.10; P = 0.01), and participants graduated from Canada (Coefficient: 2.10; P = 0.01).Moreover, about half of the respondents (55%) were concerned about gene therapy, and genetics training at college was considered the best gene therapy education method by 69.4%. Attitude score was not significantly associated with the profession (P = 0.88) but positively correlated with the knowledge score (rho= 0.4; P < 0.001). In conclusion, pharmacists and physicians showed limited knowledge with a positive attitude toward gene therapy. Therefore, educational programs on gene therapy need to be considered, focusing primarily on the safety, and social acceptance of such new therapeutic management.

Pharmacy practice in hospital settings in GCC countries: Prescribing and transcribing

Purpose

To outline hospital pharmacy practices across the Gulf Cooperation Councils (GCC) countries' hospitals.

Methods

A modified survey questionnaire was prepared from the original 2019 American Society of Health-System Pharmacist (ASHP) survey questions. Survey details were discussed with some pharmacy directors for clarity and relevance. A list of hospitals were obtained from the Ministry of Health of each of the targeted GCC countries. A secure invitation link containing a survey questionnaire was sent to the participants directly.

Results

Sixty four hospitals responded to this survey. The overall response rate was 52%. About 47% of the surveyed hospitals considered their drug formularies as closed, and strict. Additionally, only 44% of hospitals compare the effectiveness of products, when taking formulary decisions for drug inclusion. Forty-four percent of hospitals have computerized prescriber order entry (CPOE / EHR) system functionality for formulary system management. At about 39.1% hospitals, pharmacists have the responsibility for managing medication therapies, majority were engaged in providing anticoagulation therapies. About 61% of hospital pharmacies in GCC countries receive medication orders electronically, through CPOE/EHR. Majority (66%) of the hospitals in GCC countries have an active Antimicrobial Stewardship Program (ASP) while only 40% of pharmacists have a key role in providing clinical support. About 57.8% of hospital pharmacy directors reported that pharmacists do not provide ambulatory care clinical pharmacy services in their hospitals.

Conclusion

In GCC countries' hospitals, there are major areas for improvement to patient care of which pharmacists are uniquely qualified as the medication experts to have the most meaningful outcomes in all of the domains of safe medication use, medication therapy management, antimicrobial stewardship program and participation in outpatient clinics.

Treatment practices and implementation of guidelines for hyperbilirubinemia and rebound hyperbilirubinemia

BACKGROUND

Hyperbilirubinemia (HB), defined as elevated total serum bilirubin (TSB) levels, commonly affects neonates and requires prompt treatment to prevent neurological complications. Up to 10%of neonates experience rebound hyperbilirubinemia (RHB), requiring re-initiation of treatment. Unfortunately, treatment guidelines lack practical recommendations surrounding subthreshold phototherapy, treatment termination, and RHB investigations. We examined local management practices for HB and RHB treatment in a well newborn nursery. As a secondary aim, we investigated the association between treatment practices and RHB rates.

METHODS

Retrospective chart review identified neonates treated for hyperbilirubinemia between January 2015 and December 2019 during their birth hospitalization at a tertiary care centre. Standardized data collection sheets were used to record treatment parameters.

RESULTS

Over the 5-year period, there were 9683 births and 305 (3.15%) neonates received phototherapy. Of the treated cases, 20-25%were subthreshold to practice guideline values. Upon treatment termination 25-55%of cases had TSB levels within 3 mg/dL, which may increase the risk of RHB. In our cohort, 20.3%of treated cases experienced one episode of RHB and 3.9%experienced two episodes of RHB. Although clinicians evaluated neonates for RHB 0-12 hours following treatment termination prior to discharge, many cases were identified in outpatient settings and required re-admission for phototherapy.

CONCLUSION

When managing HB and RHB, treatment practices such as when to terminate treatment in relation to threshold values, and timing of RHB investigations, are largely inconsistent amongst clinicians. Future studies are required to better understand the landscape of hyperbilirubinemia treatment beyond initiation of phototherapy.

Assessment of Knowledge, Attitude, and Practice of Security and Safety Workers Toward the COVID-19 Pandemic: A Cross-Sectional Study

Aim: This study aimed to assess the knowledge, attitude, and practice (KAP) of security and safety workers toward the COVID-19 pandemic in Saudi Arabia.

Methods: A cross-sectional survey was conducted between April and July 2020 using a self-developed structured questionnaire that was randomly distributed online among security and safety employees in government or private sectors.

Results: Among the 712 participants, 53.9% were female and the respondents' mean age was 39.43 years. Television was chosen as the most reliable source of information by 75.0% of the participants. Most of the respondents had a sufficient knowledge about the COVID-19 pandemic, as the majority of them answered the knowledge questions correctly. The significant predictors for their knowledge were their educational level, age, marital status, parenthood status, and employment sector (private or government). Our study revealed an overall 98.6% positive attitude of safety and security workers toward COVID-19. Majority of the respondents were following good and safe COVID-19 prevention practices.

Conclusion: High level of knowledge was reflected in both the attitude and practice of the participants toward the COVID-19 pandemic.

The Prevalence of Psychological Distress and Its Relationship to Sleep Quality in Saudi Arabia's General Population During the COVID-19 Pandemic

BACKGROUND

We aimed to examine the effect of the COVID-19 pandemic and associated mitigation measures on sleep quality and psychological distress in Saudi Arabia.

METHODS

Subjective sleep quality over the preceding 30 days was measured using the Pittsburgh Sleep Quality Index (PSQI). In addition, Kessler Psychological Distress Scale (K10) was used to assess the psychological distress.

RESULTS

The study included 836 participants. The median age was 28 years, 624 (74.64%) were females, and 158 (18.90%) were healthcare workers. Factors associated with poor sleep were recent changes in the sleep habits p = 0.004), anxiety or fear because of coronavirus news on social media p = 0.02), fear because there was no approved drug to treat COVID-19 p = 0.03), and unaware of the presence of chronic diseases p = 0.03). Female gender p = 0.02), fear or anxiety because of coronavirus news on social media p = 0.04), recent change in sleep habits (OR: 1.97 (1.15-3.39); p = 0.01), fear because there is no approved drug to treat COVID-19 p = 0.001), monthly income <1000 SR p = 0.01), and isolation p = 0.01) were associated with distress. PSQI and K10 scores were significantly correlated p < 0.001).

CONCLUSION

Poor sleep and psychological distress are common during the COVID-19 outbreak in Saudi Arabia. Identifying factors associated with poor sleep and psychological distress would help develop specific intervention programs that enhance mental health and sleep quality during pandemics.

The impact of perceived organizational support and resilience on pharmacists' engagement in their stressful and competitive workplaces in Saudi Arabia

Background

In recent years, organizations around the globe have begun measuring the engagement level of employees in order to improve productivity and profitability. Employee engagement has the potential to significantly affect employee retention and loyalty.

Objective

To explore pharmacists' perceptions of the organizational support and impact of resilience and perceived organizational support on employee engagement in a stressful and competitive work environment.

Methods

We carried out a cross-sectional survey of 81 pharmacists, who were selected as a random sample in Saudi Arabia. Those pharmacists were assigned in highly competitive jobs within organizations such as pharmaceutical companies, hospitals and pharmaceutical distributors. We used the Utrecht Work Engagement Scale (UWES), the Brief Resilience Scale (BRS), and the Perceived Organizational Support Scale (POS) to collect the data, which then was analyzed using the descriptive and analytical tests and multiple logistic regressions in IBM® SPSS® version 24.0.

Results

Eighty one out of 100 surveys were collected back with responses-the response rate was 81% (n = 81). We obtained moderate levels of perceived organizational support and resilience; means were 4.6 ± 0.8 and 3.2 ± 0.45, respectively. Demographic variables, resilience, and perceived organizational support predicted were approximately 29.2%, 29.6%, and 36.2%, respectively, of the variance in employee engagement. We also found a significant correlation between the pharmacists' perceptions of organizational support and their engagement (β = 0.31, p < 0.05), but no statistically significant relationship between resilience and employee engagement.

Conclusions

This study showed how pharmacists' perceptions of organizational support are related to their engagement in the workplace, demonstrating a significant relationship between perceived organizational support and employee engagement.

Knowledge and willingness of physicians about deprescribing among older patients: a qualitative study

Purpose

This study aimed to explore the physician’s knowledge and identify the perceived barriers that prevent family medicine physicians from engaging in deprescribing among older patients.

Methods

This qualitative study was designed and conducted using an interpretive theoretical approach. Purposive sampling was undertaken, whereby family medicine physicians of King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia, were invited to participate in the study. The topic guidelines were designed to give the physicians the freedom to express their views on exploring their knowledge about deprescribing and to identify the perceived barriers and enablers that prevent them from engaging in the practice in older patients. The focus group discussions were conducted in English, audio-taped with permission, and transcribed verbatim. Each transcript was independently reviewed and coded separately to explore the themes and sub-themes.

Results

A total of 15 physicians participated in three focus group discussions. Their thematic content analysis identified 24 factors that facilitated or hindered deprescribing. The facilitators included cost-effectiveness and time effectiveness, side effects avoidance, clinical pharmacist’s role, need for system(s) to help in applying deprescribing, and patient counseling/education. Similarly, barriers included lack of knowing the deprescribing term and process, patient comorbidities, risk/fear of conflict between physicians and clinical pharmacists, lack of documentation and communication, lack of time or crowded clinics, and patient resistance/acceptance.

Conclusion

The study identified several factors affecting family medicine physician’s deprescribing behavior. The use of theoretical underpinning design helped to provide a comprehensive range of factors that can be directed when defining targets for intervention(s).

Hospital pharmacy practice in Saudi Arabia: Drug monitoring and patient education in the Riyadh region

BACKGROUND

The purpose of this national survey is to evaluate hospital pharmacy practice in the Riyadh region of Saudi Arabia. The results of the survey pertaining to the monitoring and patient education of the medication use process were presented.

METHODS

We have invited pharmacy directors from all 48 hospitals in the Riyadh region to participate in a modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire. The survey was conducted using similar methods to those of the ASHP surveys.

RESULTS

The response rate was 60.4% (29/48). Most hospitals (23, 79%) had pharmacists regularly monitor medication therapy for patients. Of these hospitals, 61% had pharmacists monitoring medication therapy daily for less than 26% of patients, 17% monitored 26-50% of patients and 22% monitored more than half of patients daily. In 41% of hospitals, pharmacists routinely monitored serum medication concentrations or their surrogate markers; 27% gave pharmacists the authority to order initial serum medication concentrations, and 40% allowed pharmacists to adjust dosages. Pharmacists routinely documented their medication therapy monitoring activities in 52% of hospitals. Overall, 74% of hospitals had an adverse drug event (ADE) reporting system, 59% had a multidisciplinary committee responsible for reviewing ADEs, and 63% had a medication safety committee. Complete electronic medical record (EMR) systems were available in 15% of hospitals and 81% had a partial EMR system. The primary responsibility for performing patient medication education lays with nursing (37%), pharmacy (37%), or was a shared responsibility (26%). In 44% of hospitals, pharmacists provided medication education to half or more inpatients and in a third of hospitals, pharmacists gave medication education to 26% or more of patients at discharge.

CONCLUSION

Hospital pharmacists in the Riyadh region are actively engaged in monitoring medication therapy and providing patient medication education, although there is considerable opportunity for further involvement.

Hospital pharmacy practice in Saudi Arabia: Dispensing and administration in the Riyadh region

BACKGROUND

There is very little published data assessing hospital pharmacy practice in Saudi Arabia. Hence, a comprehensive survey has been undertaken to evaluate hospital pharmacy services of the Kingdom of Saudi Arabia. Recently, we published the survey results on the prescribing and transcribing steps of the medication use process. This paper focuses on dispensing and administration.

METHODS

A modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire was personally delivered to the pharmacy directors of 48 hospitals in the Riyadh region. Three attempted follow-ups were made within 3 months to non-responders and the surveys were collected upon completion. The survey was conducted using similar methods to those of the ASHP surveys.

RESULTS

Twenty-nine hospitals participated in the survey with a response rate of 60.4%. Centralized distribution (74%) is the most commonly used model for inpatient pharmacies. Overall, 21% of hospitals routinely use bar coding technology in medication dispensing. None of the hospitals are using a robotic distribution system to automate the dispensing of unit doses. Automated dispensing cabinets (ADCs) are used by 21% of hospitals as part of their decentralized distribution model. Sixty-one percent of hospital pharmacies have IV admixture preparation area in their facility. In the use of safety technology for medication administration, only one third of hospitals are using electronic medication administration records (eMARs), 7.4% had bar-code-assisted medication administration (BCMA) and 12% had smart infusion pumps.

CONCLUSION

Hospital pharmacies in the Riyadh region are fairly well developed in providing dispensing and administration services. Further improvement can be achieved by increasing the use of new technologies such as bar-code technology, unit dose drug distribution systems, pharmacy-based IV admixture services, smart infusion pumps, and automated medication distribution.

Monitoring of adverse drug reactions associated with antihypertensive medicines at a university teaching hospital in New Delhi

Aim

To monitor the adverse drug reactions (ADRs) caused by antihypertensive medicines prescribed in a university teaching hospital.

Methods

The present work was an open, non-comparative, observational study conducted on hypertensive patients attending the Medicine OPD of Majeedia Hospital, Jamia Hamdard, New Delhi, India by conducting patient interviews and recording the data on ADR monitoring form as recommended by Central Drugs Standard Control Organization (CDSCO), Government of India.

Results

A total of 21 adverse drug reactions were observed in 192 hypertensive patients. Incidence of adverse drug reactions was found to be higher in patients more than 40 years in age, and females experienced more ADRs (n = 14, 7.29%) than males, 7 (3.64%). Combination therapy was associated with more number of adverse drug reactions (66.7%) as against monotherapy (33.3%). Calcium channel blockers were found to be the most frequently associated drugs with adverse drug reactions (n = 7), followed by diuretics (n = 5), and β-blockers (n = 4). Among individual drugs, amlodipine was found to be the commonest drug associated with adverse drug reactions (n = 7), followed by torasemide (n = 3). Adverse drug reactions associated with central nervous system were found to be the most frequent (42.8%) followed by musculo-skeletal complaints (23.8%) and gastro-intestinal disorders (14.3%).

Conclusions

The present pharmacovigilance study represents the adverse drug reaction profile of the antihypertensive medicines prescribed in our university teaching hospital. The above findings would be useful for physicians in rational prescribing. Calcium channel blockers were found to be the most frequently associated drugs with adverse drug reactions.

Hospital pharmacy practice in Saudi Arabia: Prescribing and transcribing in the Riyadh region

PURPOSE

The purpose of this survey is to outline pharmacy services in hospitals on a regional level in the Kingdom of Saudi Arabia.

METHODS

A modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire as pertinent to Saudi Arabia was used to conduct a national survey. After discussing with the pharmacy directors of 48 hospitals in the Riyadh region over the phone on the survey's purpose, the questionnaires were personally delivered and collected upon completion. The hospital lists were drawn from the Ministry of Health hospital database.

RESULTS

Twenty-nine hospitals participated in the survey giving a response rate of 60.4%. Approximately 60% of the hospitals which participated in the survey required prior approval for the use of non-formulary medications. About 83.3% of hospitals reviewed compliance with clinical practice guidelines and 72.7% hospitals reported that pharmacists are also actively involved in these activities. Pharmacists in more than 95% of hospitals provided consultations on drug information. A staff pharmacist routinely answering questions was the most frequently cited (74.1%) method by which objective drug information was provided to prescribers. Electronic drug information resources were available in 77.7% of hospitals, although internet use is not widely available to hospital pharmacists, with only 58.6% of hospitals providing pharmacist access to the internet. About, 34.5% of hospitals had computerized prescriber order entry (CPOE) systems with clinical decision-support systems (CDSSs) and 51.9% of the hospitals had electronic medical record (EMR) system.

CONCLUSION

Hospital pharmacists are increasingly using electronic technologies to improve prescribing and transcribing of medications in Saudi Arabia.

Error analysis in manual and automated DNA sequencing

The frequency, position, and type of errors were analyzed for sequence data which were generated with the help of (I) a manual digitizer, (II) an off-line automated film reader, and (III) an on-line automated gel reader. About 400 film/gel readings were analyzed and the results were used to generate error profiles for each method. The profiles identify several method- and project-specific problem areas and provide useful guidance for the assessment of DNA sequence data in general.

DNA sequence analysis of 66 kb of the human MHC class II region encoding a cluster of genes for antigen processing

The genomic sequence of a 66,109 bp long region within the human MHC has been determined by manual and automated DNA sequencing. From cDNA mapping and sequencing data it is known that this region contains a cluster of at least four genes that are believed to be involved in antigen processing. Here, we describe the genomic organization of these genes, which comprise two proteasome-related genes (LMP2 and LMP7), thought to be involved in the proteolytic degradation of cytoplasmic antigens and two ABC transporter genes (TAP1 and TAP2), thought to be involved in pumping of the degraded peptides across the endoplasmic reticulum membrane. Analysis of the sequence homology and the intron/exon structures of the corresponding genes suggests that one gene pair arose by duplication from the other. Comparison of the available sequence data from other organisms shows striking conservation (70 to 84%) of this gene cluster in human, mouse and rat. The presence of several potential interferon stimulated response elements (ISREs) is in agreement with the experimentally observed up-regulation of these genes with gamma-interferon.