Ultrarapid Iron Polymaltose Infusions Are Safe for Management of Iron Deficiency.

Introduction: Iron deficiency is a common condition, especially among patients with kidney and heart failure and inflammatory bowel disease. Intravenous iron is the preferred method of treatment in these patients, but it usually requires prolonged iron polymaltose infusions or multiple administrations of alternative preparations. The aim of the study was to confirm the safety and patient acceptance of ultrarapid iron polymaltose infusions as an alternative to slower treatments and ferric carboxymaltose. Method: An open-label, phase 4 safety study was conducted at a tertiary hospital, with consenting participants diagnosed with iron deficiency and requiring iron polymaltose up to 1,500 mg receiving the infusion over 15 min. The acute adverse event (AE) rates and their severities were compared to historical controls of 1- and 4-h iron polymaltose infusions from a retrospective study of 648 patients from the same study site. Delayed AEs as well as participant infusion acceptability were also studied. Results: Three hundred participants over a 2-year period received ultrarapid infusions of iron polymaltose with an acute AE rate of 18.7% and severe AE rate of 1.0%. The total and mild infusion AE rates were higher compared to those of slower infusions (p < 0.001), but comparable for moderate and severe AEs. Delayed reactions occurred in 12.5% of participants, with over 95% of them preferring repeat ultrarapid infusions if required again. Conclusion: Iron polymaltose can be safely infused at ultrarapid rates when compared to slower infusions, with similar safety to ferric carboxymaltose, offering greater convenience for patients and reduced healthcare costs.

Introdução: A deficiência de ferro é uma condição comum, especialmente nos doentes com insuficiência renal e cardíaca e doença inflamatória intestinal. O ferro intravenoso é o método de tratamento preferido nestes doentes, mas normalmente requer infusões prolongadas ferropolimaltose ou múltiplas administrações de preparações alternativas. O objectivo deste estudo foi confirmar a segurança e a aceitação das infusões de ferro polimaltose ultrarápidas como alternativa às infusões mais lentas e à carboximaltose férrica. Métodos: Estudo de segurança aberto, fase 4, num hospital terciário, incluindo doentes com ferropenia com necessidades de ferro-polimaltose até 1500 mg, que receberam a infusão durante 15 minutos. As taxas de eventos adversos (AE) agudos e as suas gravidades foram comparadas com controlos históricos de infusões de ferro-polimaltose de uma e quatro horas de duração, a partir de um estudo retrospectivo de 648 pacientes do mesmo centro. Foram também avaliados os EA diferidos, bem como a aceitabilidade da infusão dos participantes. Resultados: Trezentos participantes receberam infusões ultrarápidas de ferro-polimaltose durante um período de 2 anos, com uma taxa de EA agudos de 18,7%, e uma taxa de EA graves de 1,0%. As taxas globais de AE e de AE ligeiros foram superiores às da infusão lenta (p < 0,001), mas comparável para os AEs moderados e graves. Reações tardias ocorreram em 12,5% dos participantes. Mais de 95% deles manifestaram preferência por repetir as infusões ultrarápidas, se necessidade subsequente de terapêutica. Conclusão: A infusão ultra-rápida de ferro-polimaltose é segura quando comparada com infusões mais lentas, com segurança também semelhante à carboximaltose férrica, oferecendo maior comodidade e menores custos de saúde.

Pneumorrhachis secondary to exacerbation of asthma: A case report and literature review.

Pneumorrhachis is defined by the presence of air within the spinal cord. Spontaneous pneumorrhachis secondary to exacerbation of asthma is rare, and its management is rarely discussed. We present a case of spontaneous pneumorrhachis in the context of a viral exacerbation of asthma, followed by a systematic literature review of all available cases of pneumorrhachis in asthma exacerbation. A total of 25 case studies reported pneumorrhachis in 28 asthma patients, all of whom presented with concomitant pneumomediastinum. Investigation and exclusion for other potential aetiologies of pneumorrhachis such as trauma or infection occurred to varying extents and may depend on clinical presentation and degree of suspicion. No other contributing aetiologies were demonstrated in this review, and no patients required specific intervention for pneumorrhachis. Whilst pneumorrhachis is generally benign, management should revolve around standard care of asthma exacerbation, attention to potentially life-threatening differential diagnoses, and supportive care.

Surgical management of giant pulmonary artery aneurysms in patients with severe pulmonary arterial hypertension.

BACKGROUND AND AIM: Giant aneurysm of the pulmonary artery (PAA) is an extremely rare condition that may develop in patients with pulmonary arterial hypertension (PAH) which may be complicated by rupture, dissection or intravascular thrombus formation. The aim of this study was to examine available literature with regard to surgical strategies in patients undergoing transplantation for PAH with PAA. RESULTS: These patients were traditionally considered for heart-lung transplantation but more recently, there have been reports of successful lung transplantation with reconstruction of the pulmonary artery. CONCLUSIONS: Unless there is a mandatory indication for heart-lung transplantation, patients with PAH and PAA can undergo lung transplantation and reconstruction of the pulmonary artery without compromising the outcome.