37 long-stay geriatric patients were studied. All had 80% transit time (TT) in excess of 6 days. Only an average of 23% of markers were passed by day 6 and 30% of patients still had markers in situ after 2 weeks. Three daily enemas had no effect on TT and three daily enemas together with a laxative for 6 days normalized TT in 40% only. A further 3 weeks of laxatives did not prevent constipation from getting worse. The effectiveness of lactulose and poloxalkol-dihydroxyanthroquinolone, respectively, were the same and better than no treatment.

The bile acid binding and antacid properties of hydrotalcite were studied in 25 patients with hiatus hernia or peptic ulceration. Hydrotalcite was found to have significant bile acid binding properties in the presence of free acid in the stomach. There was a definite antacid effect in both pathological entities. These results suggest that hydrotalcite may be an effective therapeutic agent in upper gastro-intestinal ulceration, warranting further investigation in lesions which are thought to involve both hydrochloric acid and bile acids in their pathogenesis.

Background: Ferritin levels are used to make decisions on therapy of iron deficiency in patients with chronic kidney disease (CKD). Hyperferritinaemia, common among patients with CKD from the Northern Territory (NT) of Australia, makes use of ferritin levels as per clinical guidelines challenging. No gold standard assay exists for measuring ferritin levels. Significant variability between results from different assays creates challenges for clinical decision-making regarding iron therapy. In the NT, different laboratories use different methods. In 2018, Territory Pathology changed the assay from Abbott ARCHITECT i1000 (AA) to Ortho-Clinical Diagnostics Vitros 7600 (OCD). This was during the planning of the INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on haemodialysis (INFERR) clinical trial. The trial design was based on AA assay ferritin levels. We compared the two assays’ level of agreement in measuring ferritin levels in CKD patients. Methods: Samples from INFERR clinical trial participants were analysed. Other samples from patients whose testing were completed the same day on OCD analyzers and run within 24 hours on AA analyzers were added to ensure wide range of ferritin levels, adding statistical strength to the comparison. Ferritin levels from both assays were compared using Pearson’s correlation, Bland-Altman, Deming and Passing-Bablok regression analyses. Differences between sample types, plasma and serum were assessed. Results: Sixty-eight and 111 (179) samples from different patients from Central Australia and Top End of Australia, respectively, were analyzed separately and in combination. The ferritin levels ranged from 3.1µg/L to 3354µg/L and 3µg/L to 2170µg/L for AA and OCD assays respectively. Using Bland-Altman, Deming and Passing-Bablok regression methods for comparison, ferritin results were consistently 36% to 44% higher with AA than OCD assays. The bias was up to 49%. AA ferritin results were the same in serum and plasma. However, OCD ferritin results were 5% higher in serum than plasma. Conclusions: When making clinical decisions, using ferritin results from the same assay in patients with CKD is critical. If the assay is changed, it is essential to assess agreement between results from the new and old assays. Further studies to harmonize ferritin assays are required.

Background Ferritin levels are used to make decisions on therapy of iron deficiency in patients with chronic kidney disease (CKD). Hyperferritinaemia, common among patients with CKD from the Northern Territory (NT) of Australia, makes use of ferritin levels as per clinical guidelines challenging. No gold standard assay exists for measuring ferritin levels. Significant variability between results from different assays creates challenges for clinical decision-making regarding iron therapy. In the NT, different laboratories use different methods. In 2018, Territory Pathology changed the assay from Abbott ARCHITECT i1000 (AA) to Ortho-Clinical Diagnostics Vitros 7600 (OCD). This was during the planning of the INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on haemodialysis (INFERR) clinical trial. The trial design was based on AA assay ferritin levels. We compared the two assays’ level of agreement in measuring ferritin levels in CKD patients. Methods Samples from INFERR clinical trial participants were analysed. Other samples from patients whose testing were completed the same day on OCD analyzers and run within 24 h on AA analyzers were added to ensure wide range of ferritin levels, adding statistical strength to the comparison. Ferritin levels from both assays were compared using Pearson’s correlation, Bland–Altman, Deming and Passing-Bablok regression analyses. Differences between sample types, plasma and serum were assessed. Results Sixty-eight and 111 (179) samples from different patients from Central Australia and Top End of Australia, respectively, were analyzed separately and in combination. The ferritin levels ranged from 3.1 µg/L to 3354 µg/L and 3 µg/L to 2170 µg/L for AA and OCD assays respectively. Using Bland–Altman, Deming and Passing-Bablok regression methods for comparison, ferritin results were consistently 36% to 44% higher with AA than OCD assays. The bias was up to 49%. AA ferritin results were the same in serum and plasma. However, OCD ferritin results were 5% higher in serum than plasma. Conclusions When making clinical decisions, using ferritin results from the same assay in patients with CKD is critical. If the assay is changed, it is essential to assess agreement between results from the new and old assays. Further studies to harmonize ferritin assays are required.

Background Tacrolimus, a post-transplant immunosuppressive drug with a narrow therapeutic window requires close monitoring of levels to avoid under-immunosuppression or toxicity. Top End Renal Services in the Northern Territory (NT) refer to South Australia (SA) for drug levels as there was no local service. We aimed to evaluate the Abbott ARCHITECTi2000 immunoassay against the liquid chemistry tandem mass spectroscopy (LC-MS/MS) used in SA for measuring tacrolimus levels to provide on-site service in NT. Methods 465 specimens were collected over 5 months and analyzed over several reagent lots. We used Passing-Bablok regression plots and Bland–Altman plots to assess the agreement between tacrolimus levels on both platforms. Results The Passing-Bablok regression plot demonstrated a slope of 1.172 (CI 1.136 to 1.207) with an intercept of 0.262 (CI 0.040 to 0.472). In Deming analysis, the slope was 1.095 (CI 1.074 to 1.116) with an intercept of 0.773 (CI 0.592 to 0.955), correlation coefficient (r) was 0.9782. Bland-Altman plot demonstrated positive bias for Abbott ARCHITECT results. The mean absolute bias was 1.494 ug/L and the mean percentage bias was 18.78%. Within run imprecision, Co-efficient of Variation (%) was 5.1, 2.7, 4.3, 3.4 and 3.5 at tacrolimus concentration levels of 4.2, 6.5, 9.5, 17.2 and 24.4 µg/L. Results turnaround time improved by 80%. Conclusion The results demonstrate that Abbott ARCHITECT i2000 is an acceptable method to monitor levels of tacrolimus. The positive bias could be justifiable if the drug levels are initially based and then monitored on results from the same platform.