Aluminium (Al) toxicity problem in parenteral nutrition solutions (PNS) is decades old and is still unresolved. The aim of this review is to gather updated information about this matter, regarding legislation, manifestations, diagnostics and treatment, patient population at risk and the actions to be taken to limit its accumulation. A structured search using MeSH vocabulary and Title/Abstract searches was conducted in PubMed (http://www.pubmed.gov) up to November 2012. Al is ubiquitous, facilitating its potential for exposure. Nevertheless, humans have several mechanisms to prevent significant absorption and to aid its elimination; therefore, the vast majority of the population is not at risk for Al toxicity. However, when protective gastrointestinal mechanisms are bypassed (for example, parenteral fluids), renal function is impaired (for example, adult patients with renal compromise and neonates) or exposure is high (for example, long-term PNS), Al is prone to accumulate in the body, including manifestations such as impaired neurological development, Alzheimer's disease, metabolic bone disease, dyslipemia and even genotoxic activity. A high Al content in PNS is largely the result of three parenteral nutrient additives: calcium gluconate, inorganic phosphates and cysteine hydrochloride. Despite the legislative efforts, some factors make difficult to comply with the rule and, therefore, to limit the Al toxicity. Unfortunately, manufacturers have not universally changed their processes to obtain a lower Al content of parenteral drug products (PDP). In addition, the imprecise information provided by PDP labels and the high lot-to-lot variation make the prediction of Al content rather inaccurate.

Cómo citar/CitationPérez-Durán, I. y Hernández-Sánchez, A. ( 2021). Transparency in nursing home services before and during the COVID-19 pandemic in Spain.

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A46Eur J Hosp Pharm 2013;20(Suppl 1):A1-A238 Materials and MethodsClinical blood tests and PN data of adults on artificial nutrition from January to August 2012 were collected. Survival studies were conducted for each liver parameter studied. Primary endpoint was to fall above the upper limit of normal, considering them for women and men respectively: aspartate transaminase ( Percentage of patients with values within limits after follow-up: bilirubin 92%; ALT 76%; ASP 59%; ALP 54%; GGT 27%.Time until values went out of normal limits (days): ALT (13); ALP (13); ASP (12); bilirubin (12); GGT (6).Age, gender, liver enzymes value before PN, and PN characteristics (volume, timing of infusions, calories, nitrogen and carbohydrates) were not significant PNAC trigger factors when considered individually.Risk factor: initial value of bilirubin (each 0.1 mg/dL before PN, multiplies the risk of hyperbilirubinaemia by 14.5 times).Protective factor: PN fat content (each gramme reduces the risk of high serum GGT concentration by 3.6%). Conclusions The results show that PN poses a risk factor for PNAC, GGT being the test most affected.However, none of the factors surrounding the PN and the patient, individually, account for the majority of the liver damage. On the contrary it is a conglomerate of different factors contributing to the final impairment. The lack of enteral nutrition also predisposes to PNAC.This makes it difficult to find the right approach when prescribing PN. The indications for PN should be considered responsibly as should a return to enteral feeding whenever possible.No conflict of interest. Background Due to repetitive and tedious handling tasks, production of anticancer drugs for infusion is associated with a high risk of non-conformity. Thus, on-line quality control is necessary to improve the quality of preparation. Since the quantities produced are ever growing, very fast analytical methods of control are needed to minimise the delay before release. Purpose A high-performance liquid chromatography method has been developed for quality control of vinca alkaloid infusion bags (vindesine, vincristine, vinorelbine and vinblastine). Materials and Methods The separation was optimised by a Doehlert experimental design using a mixture of those 4 alkaloids. Chromatography was performed using Prostar Varian chromatographic equipment with a Photodiode array Detector. A short Polaris C18 column (3 µm, 50 mm × 4.6 mm) was used for all separations. The optimization varied 3 parameters: pH of the phosphate buffer 25 mM (7.0-7.6), flow rate of the mobile phase (0.7-1.3 mL.min −1 ) and proportion of acetonitrile (47-53%). 36 trials were necessary. The target response was the shortest run time giving a minimal resolution score of 1.5 for the most critical pair of peaks. Results For vinorelbine, pH had a major effect on resolution. Optimal resolutions were obtained with a pH of 7.25. Then, the flow rate was set at 1.6 mL.min −1 with a mobile phase consisting of water-acetonitrile (47-53 v/v). Under these conditions, reso...