The first report of acute respiratory distress syndrome (ARDS)

Background Parenteral nutrition (PN) for neonates has to be infused by a central line, due to the high osmolarity resulting from the recommended requirements. The central catheter frequently needs to be removed, and therefore PN may have to be administered by a peripheral line. This problem has been resolved by infusion of enriched glucose solutions, minus the protein input, which is very important in order to avoid catabolism. Purpose To develop a standard PN with glucose, electrolytes and amino acids, suitable for peripheral infusion and available for the Neonatology department at any time. The aim is to infuse 100 mL/Kg. Materials and MethodsWe performed a literature search about standard PN and we made microbiological and biochemical cheques to ensure the stability and integrity of the solution, after keeping it refrigerated for seven days. ResultsWe developed a standard PN solution with the following composition per 100 mL: Amino acids: 2 g Glucose: 9.5 g Sodium: 4 mEq Potassium: 2 mEq Magnesium: 0.2 mEq Calcium: 1.5 mEq Phosphate: 0.8 mmol Osmolarity: 792 mOsm/L Total calories: 46 Kcal Weekly, we prepare four 500 ml bags from a stock solution. We give the neonatology department two so they can hold a small stock and we keep the other two in order to cheque when we need to make another batch. From implementation, in February 2012, the microbiological controls have always been negative and the biochemical controls have demonstrated that degradation does not occur after refrigeration for seven days. Conclusions This formulation makes it possible for the physicians to continue with the nutritional support, by peripheral infusion, at any time. However this type of nutritional solutions is only suitable for meeting the nutritional requirements for short periods, until a new central catheter is placed or the neonate is able to have complete enteral feeding. No conflict of interest.

BackgroundPatients with chemosensitive neuroendocrine tumours are often treated with a capecitabine protocol (750 mg/m2 /12 h day 1 to day 14) and temozolomide (200 mg/m2 /24 h day 10 to day 14).A patient treated with this protocol in our centre presented with chromatopsia and night blindness. Capecitabine and temozolomide are drugs with well known ophthalmologic adverse effects but none of their drug labels suggests they can cause these symptoms.PurposeTo evaluate the causality between chromatopsia and night blindness and treatment with capecitabine and temozolomide.Material and methodsThe patient was interviewed to gather information and the medical records were analysed to reject any other cause of the symptoms.A search was conducted in OVID and PubMed. The terms visual alterations, chromatopsia and night blindness or nyctalopia and capecitabine and temozolomide were used. The Micromedex database was also checked.The local pharmacovigilance agency was notified and data were included in the Spanish Pharmacovigilance System database (number 20.202).The probability of the symptoms being adverse drug reactions was assessed with the Naranjo algorithm.ResultsThe patient remarded that the symptoms improved on the week off treatment and worsened when he restarted capecitabine. After a thorough ophthalmologic examination, no structural alterations were found. He had no brain metastases.No other reports of similar symptoms due to these two drugs were found in the literature or in Micromedex.According to the local pharmacovigilance agency, another case of chromatopsia and two cases of nyctalopia due to capecitabine and none due to temozolomide have been reported in the European Pharmacovigilance database.According to the Naranjo algorithm, the likelihood of the event being a temozolomide adverse drug reaction is possible (score 1) whereas it is definitely a capecitabine adverse drug reaction (score 9).ConclusionCapecitabine seemed to be the cause of chromatopsia and night blindness in this patient. As such adverse effects have not been published before, we think it is important to take this report into account and to consider that capecitabine may be the cause of these ophthalmic alterations in similar situations.No conflict of interest.

for cabazitaxel and four for mitoxantrone. The most frequent clinically significant grade 3/4 adverse events were neutropenia (cabazitaxel (82%) vs. mitoxantrone (58%)). The marginal efficacy of cabazitaxel vs. mitoxantrone is 2.4 months for OS and 1.4 months for PFS. Considering OS as efficacy parameter, the incremental costefficacy ratio (ICER) calculated for the two treatments is €147.389. When PFS is considered, the ICER calculated is €248.871. Conclusions Based on this analysis, the ICERs calculated for cabazitaxel are too high for it to be considered a cost-effective option in the treatment of mHRPC, when compared with mitoxantrone, in patients previously treated with a docetaxel-containing regimen. No conflict of interest.