Ferric Carboxymaltose Across All Ages in Paediatric Gastroenterology Shows Efficacy Without Increased Safety Concerns.

OBJECTIVES: The aim of the study was to assess the efficacy, safety and side-effect profile of ferric carboxymaltose (FCM) for correcting IDA in children and adolescents in paediatric gastroenterology, hepatology, and nutrition. METHOD: This was a retrospective study of all gastroenterology patients <18 years who had FCM (October 2015 to October 2017). Haematological and biochemical parameters were recorded pre-infusion, at 4 weeks, 3 months, 6 months, and 1 year post-infusion. Recognised side-effects were documented. RESULTS: Sixty-six children received FCM during this period. Data was analysed on 61 children, 5 excluded because of inadequate data. The median age at administration was 14 years (IQR 7). Thirty-two (52%) were boys. Twenty-six (42%) were <14 years old. Seven (11.5%) were <5 years old. Seventeen (28%) were switched from oral iron supplements to FCM. The median dose of FCM delivered was 19 mg/kg. The median haemoglobin increased from 108 to 126 g/L at 1 month post-infusion (P value <0.00001). The mean cell volume also improved from 80 to 84 fL at 1 month post-infusion (P value = 0.0007). Forty-eight (94%) children corrected their anaemia after receiving FCM. Two patients (3%) reported side-effects with skin bruising and staining. CONCLUSIONS: FCM appears to be effective in correcting IDA in children across a wide range of gastroenterology indications and all ages. It is effective and generally well tolerated including in very young patients. Potential side-effects can be avoided by careful monitoring during infusions.

Clinical consequences of polypharmacy in elderly: expect the unexpected, think the unthinkable.

Multiple medication use has been coined 'polypharmacy'. Polypharmacy is highly prevalent in older patients secondary to the increased number of co-morbid disease states with ageing. Existing practice guidelines recommend multiple drug use for certain chronic diseases (i.e., HIV, tuberculosis, hypertension, etc.). A polypharmacologic approach for certain diseases has been shown to improve therapeutic response, decrease morbidity and mortality. On the contrary, polypharmacy may induce iatrogenic complications that are often unseen prior to the initiation of medicinal regimens. This paper will review the potential clinical consequences of polypharmacy in the elderly and common medication administration errors that may occur. Consequences of polypharmacy include adverse drug effects, drug-drug interactions, disease-drug interactions, food-drug interactions, nutraceutical-drug interactions and medication cascade effect. Medication administration errors, such as phonetic confusion, flip-flopping dosing errors and pill visual-cue errors, are also reviewed. Prescribing for the elderly, whose medications are vast in number, is often uncharted physiologic territory. The clinician must expect the unexpected and think of the unthinkable in the geriatric patient, when dealing with polypharmacy and the potential consequences.

Coalescence during emulsification. 1. Method development.

A new method of measuring the amount of coalescence that occurs between drops during the emulsification process is proposed. The method uses a hydrophobic fluorescent probe, which is introduced into a fraction of the oil phase that is to be homogenized. The ratio of the intensity of the excimer peak to the intensity of the monomer peak in the fluorescent emission spectrum is sensitive to the concentration of the probe in the oil phase. Random coalescence events between oil drops lead to redistribution of the probe and its effective dilution in the oil phase. Coalescence results in a decrease in the intensity ratio in the fluorescence spectrum obtained from the ensemble of drops. Monte Carlo simulation is used to relate the change in intensity ratio to the coalescence rate. It is experimentally verified that the signal change is only due to coalescence and is not affected by the drop size of the distribution.