Is propranolol compounding from tablet safe for pediatric use? Results from an experimental test

AIM: Although propranolol is widely used inthe treatment of infantile hemangiomas, the standard 40 mg tablet needs to be fractioned to obtain 10 mg parts, with even lower doses (i.e., 2-3 mg/kg/day divided into 2-3 daily doses) required in infants. This study evaluated the weight and dose uniformity in split quarters of propranolol tablets. METHODS: Twenty pharmacy students split 70 propranolol tablets by using a kitchen knife in order to obtain 200 quarters, which were considered integral and adequate for administration. Intact tablets and quarters were weighed. The content of propranolol in tablet quarters was determined on 200 quarters by using high performance liquid chromatography. RESULTS: Overall, 265 parts (94.6%) were integral and 213 (76.1%) were considered as adequate for administration. The mean (\ub1standard deviation) weight of quarters judged as suitable and non-suitable for administration was 49.56\ub15.27 mg and 46.24\ub17.53 mg, respectively. Splitting caused a mean weight loss in each tablet of 2.97\ub12.91 mg (median 2.06 mg). The percentage of quarters with weight lower than theoretical was 55.88%, and the remaining weighted more than expected. The mean propranolol content in quarters was 9.52\ub10.96 mg (median 9.42 mg, range 7.36-12.23 mg) and 42% of quarters were out of the \ub110% acceptance range. CONCLUSION: The manual splitting of propranolol 40 mg tablets produced a significant proportion of quarters not suitable for administration in children or with a weight and/or an active concentration outside of the required range. The availability of a pediatric oral solution of propranolol will reduce the risk of incorrect dosin

Cost of illness of urothelial bladder cancer in Italy

Claudio Gerace,1 Francesco Montorsi,2 Rosa Tambaro,3 Giacomo Cartenì,4 Stefano De Luca,5 Marcello Tucci,6 Giuseppe Martorana,7 Umberto Basso,8 Leonardo Cardosi,1 Cristina Teruzzi1 1Temas s.r.l.-QuintilesIMS, Integrated Market Access Department, 2Department of Urology, IRCCS Ospedale San Raffaele, Milano, Italy; 3Department of Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy; 4A.O.R.N. A. Cardarelli, Unità Operativa Complessa di Oncologia Medica, Napoli, Italy; 5Department of Urology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Torino Italy; 6Department of Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Torino Italy; 7Department of Urology, Ospedale Policlinico S. Orsola-Malpighi, Bologna, Italy; 8Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IRCCS, Padova, Italy Background: Urothelial bladder cancer (UBC) is the ninth most common cancer worldwide. In Italy, the prevalence of the disease is approximately 10%, making it the fourth most prevalent cancer in the country. The increase in prevalence requires continuous surveillance and care, resulting in a significant burden on Italian National Health Service, making any improvement to the strategy for diagnosing and treating this disease important to the medical and scientific community. The aim of this study was to evaluate the UBC cost of illness in the Italian context, collecting the total costs of the disease.Methods: An economic analysis was carried out in the context of the National Health Service, using data collected from six centers, in order to evaluate direct costs in terms of outpatient, inpatient, and emergency care; pharmaceuticals and follow-up procedures; and indirect costs in terms of productivity losses. Data were collected through aggregated form reports, focusing on patients with an existing diagnosis of UBC who were treated in the last year. The Italian Association of Medical Oncology (AIOM) guidelines were used to identify diagnostic and therapeutic procedures. Statistical analysis was conducted to explore variations among centers.Results: The weighted mean total annual cost per patient was € 3,591, where the cost for superficial disease was € 3,252 and that for metastatic disease was € 606. The analysis confirmed a proportional relation between disease severity and disability grade. The UBC cost of illness, considering prevalence and incidence data coming from the 2016 AIOM/Italian Association of Cancer Registries report, was € 1,187,036,344. Indirect costs accounted to 44%, represented by estimated productivity losses.Conclusion: Our analysis represents the first economic study of UBC in the Italian context, as well as the first real-life evidence of the current therapeutic algorithm. This study opens the possibility for further analysis on the indirect cost components that represent a great burden for the society, especially for those in the severest stages of the disease with high disability grades. Keywords: cost of illness, cost analysis, economic evaluation, urothelial bladder cancer, direct costs, indirect cost

Exploring urban verticality during the 2011 flood in Bangkok, Thailand

Geographers have a long-established research interest in the ways infrastructures shape urban flood vulnerability and how urbanites cope with urban flooding. In this paper, I contribute to this literature by exploring the three-dimensional city during an urban flooding situation. Within a case study (based on interviews and ethnographic observations), I attend to ad hoc coping practices of a diverse city population during the 2011 flood in Bangkok. I foreground the vertical direction of these strategies and the affordances of the urban built environment and urban infrastructures that enabled such coping. The paper thus stages a conversation between established literature on urban flood vulnerability and coping with an emerging interest in vertical urbanism literature. Through this conversation between the two literatures, research on urban verticality is probed to consider verticality as a crucial dimension of urbanism during times of flood disasters