Rectal ulcer due to Kayexalate deposition - an unusual case

SUMMARY Sodium polystyrene sulfonate (PSP) or Kayexalate is a cation-exchange resin, widely used in the management of hyperkalaemia due to renal disease. A rare, yet potentially dangerous, adverse event related to sodium polystyrene sulfonate use is intestinal mucosal injury, especially in the colon. The injury to the gastrointestinal mucosa can range from mild and superficial to wall necrosis and bowel perforation. The mechanism that leads to mucosal damage remains unclear. However, it is believed that sorbitol, commonly given to counteract PSP's tendency to cause constipation, may play an important role in the development of gastrointestinal injury. Other potential risk factors are uraemia or end-stage renal disease, hemodynamic instability, solid organ transplantation, postoperative status and concomitant opioid administration. The authors present a case of diarrhoea and haematochezia after the administration of PSP without sorbitol, in a patient with hyperkalaemia due to acute kidney injury, in the absence of other risk factors. A colonoscopy was performed and revealed a rectal ulcer which histological findings were suggestive of mucosal injury due to Kayexalate deposition. This case supports the concept that this widely used drug can itself, without sorbitol, cause injury to the gastrointestinal wall. Even though this is a rare adverse effect, the widespread use of this medication may put a large population at risk.

RESUMO O polistireno sulfonato de sódio (PSP) ou kayexalato é uma resina de troca iônica, amplamente usada no tratamento da hipercalemia associada à doença renal. Um efeito adverso raro, mas potencialmente grave, dessa terapêutica é a agressão à parede do trato gastrointestinal, principalmente ao nível do cólon, que pode ser ligeira e superficial ou culminar em necrose e perfuração intestinal. O mecanismo pelo qual o PSP lesa a mucosa intestinal não é totalmente conhecido. Contudo, pensa-se que o sorbitol, frequentemente administrado em simultâneo para contrabalançar o efeito obstipante do PSP, possa ter um papel preponderante no desenvolvimento de lesão gastrointestinal. Outros potenciais fatores de risco são a presença de uremia ou doença renal em estágio terminal, instabilidade hemodinâmica, pós-operatório, pós-transplante renal e a administração concomitante de opioides. Os autores descrevem um caso de diarreia e hematoquesias após a administração de PSP sem sorbitol, numa paciente com hipercalemia secundária a lesão renal aguda, sem outros fatores de risco para o desenvolvimento desse efeito adverso. A investigação etiológica com colonoscopia revelou a presença de uma úlcera retal, cujo estudo histológico foi compatível com lesão por deposição de cristais de kayexalato. Este relato incomum reforça o conceito de que este fármaco de uso frequente, mesmo na ausência de sorbitol, pode ser lesivo para a mucosa intestinal. Assim, e apesar de este ser um efeito adverso raro, a utilização difundida do PSP coloca uma vasta população em risco.

Removal of urotropine from industrial wastewater by acidic cation exchange resins

The industrial wastewater produced by urotropine plants is considered as a major environmental polluting factor and hence its treatment is required. In this work, strongly acidic cation exchange resins including C100H [Purolite], Amberlite IR120 and Amberlyst 15W were used for removing of urotropine from wastewater. Optimum conditions for the three resins and regeneration were studied. The required amounts of resins for efficient exchange of urotropine and amount of acid for regenerating process of exhausted resins were determined and the potential of these resins in removing of urotropine and ammonia from the wastewater were compared. It was found that C100H resin has a higher capability in removing of urotropine in comparison with tow other resins. This capability of C100H was 2 and 7 times greater than Amberlite IR120 and Amberlyst 15W, respectively. The comparison of results with other methods indicates that this method reduces urotropine concentration more effectively. The simple and fast conductometric method has been developed for determination of urotropine in wastewater in the presence of formaldehyde and ammonia without any interference

efficiency of CD40 down regulation by siRNA and antisense ODN: comparison of lipofectamine and FuGENE6

Dendritic cells [DCs] are ideal accessory cells in the field of gene therapy. Delivery of DNA and siRNA into mammalian cells is a useful technique in treating various diseases caused by single gene defects. Selective gene silencing by small interfering RNAs [siRNAs] and antisense oligodeoxynucleotides [ODN]s is an efficient method for the manipulation of cellular functions. An efficient, functional delivery system with no toxicity problems would be attractive. We compared two commercially available cationic lipids, Lipofectamine and FuGENE6, in the delivery of both siRNA and antisense ODNs into mice spleen-derived DCs. Cellular uptake was measured by the means of fluorescein-labelled non-silencing siRNA and antisense ODNs as a model system using flow cytometry. Cytotoxicity of the two delivery systems was compared with propidium iodide and annexin-V staining, and quantified with flow cytometry. The efficiency of our oligonucleotide delivery systems was compared by measuring CD40 expression by flow cytometry. CD40 expression in DCs was 38%. After siRNA transfection by Lipofectamine, CD40 expression decreased to 13%, and after transfection by FuGENE6, it decreased to 18%. The difference was statistically significant. CD40 down regulation in DCs transfected with the two different antisense sequences by Lipofectamine was 21% and 23%, and down regulation after transfection by FuGENE6 was 19% and 18%, respectively. The differences were not statistically significant. The effects of siRNA and antisense ODNs were specific. Lipofectamine was a more potent delivery system in siRNA effect, followed by FuGENE6. There was no significant difference between Lipofectamine and FuGENE6 as a delivery system of antisense ODNs

Estimation and signification of cation exchange capacity of cheliff saline soils [Algeria] for physical properties

Measurements of the cation exchange capacity [CEC] show significant soil properties, in particular its ability to retain the cations because of their mobility in the soil. Thirteen soil samples rich in electrolytes of the Cheliff plain [Algeria] were analyzed in order to measure their CEG and to draw up the existing relationship between texture, organic

atter content and pH. In calcareous soils, the CEC values are always higher than those measured at pH 7. Regression equations using the percentages of organic carbon and clay as independent variables would make it possible to estimate 90% of the variability of the CEC measured in the ammonium acetate buffered at pH 7 and 89% of the variability for that measured at the pH of the soil These percentages are particularly useful due to the fact that they make it possible to estimate the CEC of the soil according to the pH only starting from the organic matter and texture. The correlations between the salinity indices, the parameters of the saline phase and the physical properties, show that the cobalt hexamine method makes it possible to characterize the soil of this plain with more precision than the Metson method. It constitutes a means for following up the chemical quality of the soil. The Metson method makes it possible to approach the reactivity of the soil in relation with the geometry of the components. The measurement of the CEC at pH 7 makes it possible to envisage the water content at the permanent wilting point of the plants. Finally, it is noticed that a sodization of the adsorbing compound, which consequently generates a reduction in the structural stability and a reduction in the infiltration always leads to the salinity in these soil types

Efecto de la adición de zeolita (clinoptilolita y modernita) en un andosol sobre el ambiente químico edáfico y el crecimiento de avena / Effect of zeolite (clinoptilolite and mordentite) amended andosols on soil chemical environment and growth of oat

Entre las zeolitas, la clinoptilolita y la mordenita se distinguen por su utilidad en la agricultura, debido a que al entrar en contacto con el amonio del medio lo retienen en su estructura interna y externa, funcionando entonces como un fertilizante nitrogenado de lenta liberación. Se estudió el efecto de la zeolita ZCU (clinoptilolita y mordenita) en la producción de biomasa vegetal y el ambiente químico del suelo, empleando la avena como cultivo indicador. Se evaluaron cinco concentraciones de ZCU en suelo (0, 5, 10, 20 y 30 por ciento peso base seca del suelo) y un tratamiento adicional preparado solo con ZCU. Las variables evaluadas fueron biomasa aérea y de raíces, pH y capacidad de intercambio catiónico (CIC), NH4+ sustrato y NO3-l lixiviado. La aplicación de ZCU tuvo un efecto positivo sobre la producción de la biomasa aérea y de raíces y modificó el ambiente químico edáfico en sus valores de pH y CIC. La aplicación de ZCU provocó una menor acumulación de NO3- lixiviado en relación a la cantidad de NH4+ en sustrato. Los resultados apoyan que la ZCU tiene capacidad para adsorber amonio y aminorar el proceso de nitrificación.

Influences of soil properties on chromium [III] sorption

Soil adsorbing properties reduce sorption ability of the metal, which in turn may influence decision for remediation at contaminated sites. The objective of this study is presentation of a model based on soil properties to estimate the sorption of Cr[III] in chromium contaminated soils. Twenty uncontaminated soil samples, with properties similar to the contaminated soils were selected from around of city of Tabriz and treated with Cr and CrCl[3]. A multiple regression analysis with statgraph software was used to drive an expression that related Cr sorption to common soil properties. The results showed that four soil properties were important in determining the amount of Cr adsorbed by the soils including pH, cation exchange capacity, total inorganic carbon and clay content with nearly 80% variability in Cr sorption and a reasonable level of confidence by this model. The obtained model suggested that Cr[III] sorption was enhanced by higher soil pH, more total inorganic carbon, more clay, and higher cation exchange capacity

Salt wasting disorder in the newborn.

The clinical presentation of pseudohypoaldosteronism (PHA) mimics congenital adrenal hyperplasia (CAH). Poor response of the dehydration and electrolyte abnormalities to steroid therapy should make one suspect PHA. The treatment is supportive in the form of salt replacement and sodium resonium. We report a case of PHA that presented as salt wasting on the second day of life, initially appearing like CAH. The baby responded well to sodium resonium and salt replacement.

Adsorption condition optimization for anti-HBsAg Fab fragment separation and purification from E. coli using Streamline SP / 南方医科大学学报

<p><b>OBJECTIVE</b>To optimize the adsorption condition of cation-exchange chromatographic media Streamline SP for separation and purification of anti-HBsAg Fab fragment from E. coli.</p><p><b>METHODS</b>The adsorption of the target protein for separation and purification by the cation-exchange chromatographic media Streamline SP was tested using test tube method in balanced buffer solution with different pH values and ion concentrations. The adsorption effect was then verified by cation-exchange chromatography using 1-ml Streamline SP prepacked column and 28-ml Streamline SP self-assembly column.</p><p><b>RESULTS</b>According to the experiment results of test tube method, the loading buffer with pH of 4.4 and ionic concentration of 100 to 600 mmol/L could achieve optimal target protein adsorption effect by cation-exchange chromatographic media Streamline SP, as verified by cation-exchange chromatography with 1-ml SP prepacked column and 28-ml Streamline SP self-assembly column.</p><p><b>CONCLUSION</b>The optimal condition of cation-exchange chromatography selected by test tube method can be applied for separation and purification of anti-HBsAg Fab fragment from E. coli.</p>

Cationic reaction of transition metals with synthetic crystalline calcium sillicates

The action uptake reactions of transition metals of Mn, Fe, Co, Ni, Cu, Zn, Pb, Cd and Hg with some synthetic crystalline calcium silicates such as xonotlite, gyrolite and Beta-wollastonite were studied. The total cations uptake reaction appeared to be a factor combining both partial exchange Ca[2+] - M[2+]and precipitation of M[2+] as carbonates, hydroxy carbonates, hydroxy nitrates or hydroxides during the course of reaction. It was difficult to delineate the extent of the former reaction from the latter. These cations; have negative effect, on basic crystallinity of the solids, Beta-wollastonite was considered the most stable one. The total amounts in meq. of ions up taken by these solids have been found in a descending order : xonotlite > gyrolite > Beta-wollastonite

Is dietary fiber beneficial in chronic ischemic heart disease?

OBJECTIVES: To evaluate the benefit of a dietary fiber preparation (Fibernat) in patients with chronic ischemic heart disease (IHD). METHODS: From January 1997 to March 1998, 114 consecutive patients with chronic IHD were enrolled in this prospective double blind randomized placebo controlled trial. The fiber (F) and placebo (P) groups were comparable at baseline. All patients were given advice regarding dietary and lifestyle modifications. Concomitant drug therapy was not altered. The drug (consisting of soluble and insoluble fibers obtained from fenugreek, guar gum and wheat bran) and placebo were administered for six months (10 grams twice daily). RESULTS: The following parameters improved in both groups: HDL cholesterol (32 to 39 mg/dl, p < 0.0009 in F and 33 to 38, p < 0.007 in P), total: HDL cholesterol ratio (6.7 to 5.6, p < 0.0007 in F and from 7.0 to 6.0, p < 0.01 in P) and weight (64.0 to 63.0 kg, p < 0.002 in F and 60.3 to 59.5, p < 0.002 in P). The Apolipoprotein B increased (101 to 129 mg/dl, p < 0.00001 in F and 98 to 127, p < 0.0008 in P). The following parameters improved only in group F: LDL cholesterol (146 to 134, p < 0.027), Apolipoprotein A-1 (105 to 139, p < 0.001), body mass index (24.9 to 24.5, p < 0.03) and waist circumference (37.2 to 36.7, p < 0.03). Total cholesterol, VLDL cholesterol, triglycerides, hip circumference, W:H ratio, exercise time and blood sugar were unchanged in both groups. CONCLUSIONS: Fibernat is well tolerated, safe and had favorable effects on LDL cholesterol, Apolipoprotein A-1, body mass index and waist circumference.

Hemoglobina glicosilada (HbA1c): comparaçäo entre microcromatografia de permuta catiônica (MPC) e enzimaimunoensaio de micropartículas (MEIA) / Glycated hemoglobin (HbA1c): comparison between cationic exchange microchromatography (CEM) and microparticle enzyme immunoassay (MEIA)

A dosagem de HbA1c é utilizada para diagnosticar e monitorar pacientes portadores de diabetes mellitus. As metodologias comumente empregadas, como MPC e a eletroforese de hemoglobina, säo trabalhosas e demoradas, tornando a monitorizaçäo ineficaz. A utilizaçäo de métodos mais rápidos pode facilitar o trabalho médico e melhorar o controle do diabetes. O objetivo deste estudo é comparar a dosagem de HbA1c pelo método clássico da MPB com o novo método MEIA. Para tanto foram utilizadas 14 amostras de sangue total, colhidas em tubos contendo EDTA 10 porcento. As amostras foram submetidas a dosagem de HbA1c pela MPC, segundo o método descrito por Mallia et. cols. (Pierce, U.S.A.), e paralelamente pelo MEIA (IMX, Abbott, U.S.A.). Os resultados, expressos em porcentagem de hemoglobina total (porcento), foram comparados pela correlaçäo de Pearson e pelo teste t de student. Os resultados obtidos mostraram que a média e desvio padräo da HbA1c pela MPC foi de 6,32 mais ou menos 2,17 porcento contra 6,61 mais ou menos 1,66 porcento pelo MEIA (p = näo significativo). Houve boa correlaçäo entra os dois métodos (r=0,97; p<0,001). Concluimos que a dosagem de HbA1c pela técnica MEIA foi similar à MPC, com as vantagens de ser mais rápida e menos trabalhosa. Isso permite melhor controle do diabetes mellitus, fornecendo resultados imediatos aos médicos e permitindo intervençöes efetivas a tempo de evitar complicaçöes mais sérias da doença