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Carboxymaltose iron (Ferinject®) is a formulation for intravenous (iv) administration, used for the treatment of iron deficiency anemia and/or iron deficiency when oral administration of iron is not effective or due to intolerance. Its safety profile is excellent with few, but not nonexistent, side effects. Hypophosphatemia has been described as one of them. It is usually mild, transient and asymptomatic. However, in some cases it may be accompanied by nausea, asthenia, in addition to muscular and neurological symptoms and hematological alterations. It is, therefore, a potentially serious adverse effect whose prevalence is unknown and which requires high clinical suspicion to be detected.

Background Large-scale studies of drug provocation testing (DPT) or rapid drug desensitization (RDD) for hypersensitivity to antineoplastics and biologicals are scarce and limited to a few institutions. Objective Our aim was to review our experience with DPT and RDD in a large number of patients with a history of hypersensitivity to antineoplastics and biologicals and summarize the practical implications of that experience. Methods This was a 7-year prospective, observational, longitudinal study with reactive patients referred to the Desensitization Program at Ramon y Cajal University Hospital (RCUH). Patients were selected after following our systematic and validated diagnostic approach (clinical history, skin test, risk assessment, specific IgE, DPT) before RDD. Candidate patients underwent RDD using the RCUH protocol. Cetuximab reactors underwent 1-bag RDDs. Results A total of 1027 intravenous RDDs were performed using the RCUH protocol (399 platins, 395 taxanes, 178 biologicals, 55 other drugs), and 1026 were successfully accomplished in the 186 patients (of 515 referred patients) who met inclusion criteria for RDD. No breakthrough reactions occurred in 88% of RDDs. Most breakthrough reactions were mild. A total of 341 DPTs were performed, and 229 results were negative (67%). DPTs helped exclude hypersensitivity in 44% (229 of 515) of referred patients. In addition, 77 one-bag RDDs were performed in 6 cetuximab-reactive patients. Conclusions This experience allows us to describe general management plans, as well as specific patient phenotypic patterns, predictors for reactions, and risk considerations that need a tailored approach (taking into account the 3 prominent drug categories: platins, taxanes, and biologicals).

Background In early clinical trials, infusion reactions during the administration of taxanes were managed using systematic premedication with antihistamines and corticosteroids before standard infusions. Consequently, these premedications are also administered before rapid drug desensitization (RDD) with taxanes. However, their role in RDD has not been studied. Objective To assess the need for premedication with antihistamines and corticosteroids to prevent hypersensitivity reactions in RDD to paclitaxel. Methods Over a 4-year period, we selected patients with confirmed hypersensitivity to paclitaxel (positive skin testing and/or drug provocation testing results) who had received paclitaxel through RDD. These patients were assigned to 2 prospective noninception cohorts: one cohort premedicated with antihistamine and corticosteroids and another cohort that was not. Results We assessed 66 paclitaxel-reactive patients, of whom 22 met the inclusion criteria. A total of 155 RDDs to paclitaxel were performed. There were no significant differences in tolerance to RDD between the cohorts. Conclusions Administering systematic premedication with corticosteroids and antihistamines had no significant effect on the effectiveness or safety of RDD in patients with confirmed hypersensitivity to paclitaxel in the study population. Moreover, these premedications can mask early signs of hypersensitivity and delay treatment. We believe that systematic premedication with these drugs for patients undergoing RDD should be carefully and individually assessed if their only purpose is to prevent breakthrough reactions during RDD.

Los diversos cambios que se presentan a diario en las organizaciones frente a los escenarios de trabajo y la forma de producción, ayudan entender la necesidad de discutir acerca de mejores condiciones en la seguridad y salud en el trabajo. Históricamente se han desarrollado estrategias que proporcionan bienestar a los trabajadores en las empresas, situación que no es ajena a la realidad laboral colombiana. Objetivo: diseñar la fase de planificación de un sistema de gestión de seguridad y salud en el trabajo según la normatividad nacional vigente de Colombia en una mediana empresa de la ciudad de Cali. Métodos: Estudio de tipo descriptivo documental aplicado. Resultados: el lugar objeto de estudio al iniciar el diseño de la fase planificación se encontraba en el proceso de ejecutar el cambio del programa de Salud Ocupacional al sistema de gestión de seguridad y salud en el trabajo; se desarrolló una evaluación que permitió reconocer el estado inicial y final después de ejecutar las estrategias para planificar y generar el cumplimiento de los estándares mínimos de la normatividad legal vigente en Colombia. Conclusión: Para concluir a través de la evaluación inicial en seguridad y salud en el trabajo según los parámetros normativos se pudo verificar que la fábrica no cumplía con los estándares mínimos en seguridad y salud en el trabajo dando un porcentaje bajo y un estado crítico. Esta medición permitió identificar las condiciones reales lo que conllevó a la construcción de un manual y procedimientos necesarios en el diseño propuesto.

Resumen Se presenta el caso de un varon de 83 anos en tratamiento con rivaroxaban, con dolor en hombro, cara posterior de brazo, antebrazo y muneca derechos e incapacidad para extender muneca y dedos, tras un traumatismo. Las radiografias son normales, pero en la TC toracica se objetiva seudoaneurisma de arteria axilar y un hematoma secundario que comprime el plexo braquial. Esta entidad ha de tenerse en cuenta en pacientes con hombro doloroso, anticoagulados y sin alteraciones radiologicas asociadas.

We report the case of an 83-year-old man on rivaroxaban treatment, with pain in right shoulder, back of the upper arm, forearm and wrist, and inability to extend the wrist and fingers, as the result of an injury. The radiographs were normal, but thoracic CT showed an axillary artery pseudoaneurysm and a secondary haematoma that compressed the brachial plexus. This should be borne in mind in patients with painful shoulder, treated with anticoagulant therapy and without associated radiographic changes.