Drug‐related problems in the elders of the British Virgin Islands

Objective — To explore the extent of drug‐related problems in elderly patients in the Caribbean. Methods — Comprehensive medication reviews were carried out on a 1 in 20 sample of the elderly population of the British Virgin Islands, a UK dependent territory located in the Caribbean. Fifty non‐institutionalised patients, 65 years or older and taking at least one prescribed medicine, were interviewed for the study. Key findings — On average, 4.5 prescribed medications, 4.7 over‐the‐counter preparations and 3.3 herbal remedies/natural products were used by the sample. A mean of 5.9 potential drug‐related problems per patient were identified and a mean of 3.7 complications relating to the sub‐optimal use of medicines per patient were observed. Conclusion — This study has highlighted the need for a multidisciplinary review of the prescribing, dispensing and monitoring of elderly patients receiving prescribed medications. The pharmacist has a role to play in helping prescribers achieve this review, and in educating patients in ways in which they can get the best out of their medicines.     

Restrictive dermopathy: a disorder of fibroblasts

Restrictive dermopathy is a rare, lethal genodermatosis, characterized by a thin, tightly adherent skin which causes a dysmorphic facies, arthrogryposis and respiratory insufficiency. The recorded cases to date show a remarkable phenotypic similarity. Thinning of the dermis and the arrangement of collagen in parallel bundles appear to be constant findings. We have found many dead and degenerating fibroblasts in the dermis on ultrastructural examination, and have demonstrated their poor growth in vitro. Studies of collagen from a skin sample showed a marked increase in mature cross-links, indicating a decrease in skin collagen turnover. These findings suggest a primary disorder of fibroblasts, and may explain the apparent arrest in growth and differentiation of the skin which appears to be important in the pathogenesis of this rare condition.