Nebulized heparin and salbutamol versus salbutamol alone in acute exacerbations of chronic obstructive pulmonary disease requiring mechanical ventilation: a double-blind randomized controlled trial / 대한마취과학회지

Background@#Nebulized heparin has been effectively used in the management of many pulmonary diseases. However, its effect on mechanically ventilated patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) has never been studied. This study aimed to assess the efficacy of nebulized heparin and salbutamol to increase ventilator-free days (VFD) in mechanically ventilated AECOPD patients and the effect of nebulized heparin on respiratory and coagulation functions. @*Methods@#In this double-blind controlled study, 60 mechanically ventilated adult patients with AECOPD were randomly allocated into two groups; heparin and salbutamol (HS) group and salbutamol only (S) group. In the HS group, patients received nebulized heparin (25,000 IU) and salbutamol (5 mg) every 6 hours. Patients in the S group received nebulized salbutamol only (5 mg). The treatment was continued while patients remained ventilated for a maximum of 14 days. The primary outcome was VFDs at day 14. PaCO2, PaO2/FiO2 ratio, number of nebulizations withheld, C-reactive protein (CRP) titer and activated partial thromboplastin time (APTT) were secondary outcomes. @*Results@#Patients in the HS group had significantly more VFDs (4.7 [3.3]) compared with those in the S group (2.4 [2.6]), P = 0.007. PaCO2 levels, PaO2/FiO2, the decrease in the CRP level and the increase in the APTT from the baseline were comparable in both groups. @*Conclusions@#The co-administration of nebulized heparin and salbutamol, compared with salbutamol alone, significantly increased (VFDs) among mechanically ventilated AECOPD patients without increasing bleeding risks.

Nebulized heparin and salbutamol versus salbutamol alone in acute exacerbations of chronic obstructive pulmonary disease requiring mechanical ventilation: a double-blind randomized controlled trial / 대한마취과학회지

Background@#Nebulized heparin has been effectively used in the management of many pulmonary diseases. However, its effect on mechanically ventilated patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) has never been studied. This study aimed to assess the efficacy of nebulized heparin and salbutamol to increase ventilator-free days (VFD) in mechanically ventilated AECOPD patients and the effect of nebulized heparin on respiratory and coagulation functions. @*Methods@#In this double-blind controlled study, 60 mechanically ventilated adult patients with AECOPD were randomly allocated into two groups; heparin and salbutamol (HS) group and salbutamol only (S) group. In the HS group, patients received nebulized heparin (25,000 IU) and salbutamol (5 mg) every 6 hours. Patients in the S group received nebulized salbutamol only (5 mg). The treatment was continued while patients remained ventilated for a maximum of 14 days. The primary outcome was VFDs at day 14. PaCO2, PaO2/FiO2 ratio, number of nebulizations withheld, C-reactive protein (CRP) titer and activated partial thromboplastin time (APTT) were secondary outcomes. @*Results@#Patients in the HS group had significantly more VFDs (4.7 [3.3]) compared with those in the S group (2.4 [2.6]), P = 0.007. PaCO2 levels, PaO2/FiO2, the decrease in the CRP level and the increase in the APTT from the baseline were comparable in both groups. @*Conclusions@#The co-administration of nebulized heparin and salbutamol, compared with salbutamol alone, significantly increased (VFDs) among mechanically ventilated AECOPD patients without increasing bleeding risks.

immediate glycemic response to four herbal teas in healthy adults

To determine the effect of herbal teas prepared from decocted cinnamon bark or fenugreek seeds, or from infused black tea or aniseed on the postpr and ial glycemic response of white bread. Oral glucose tolerance test for 2 hours was applied on seven healthy volunteers, each of whom served as his own control by first ingesting a portion of white bread containing 50 g of carbohydrates together with either 200 mL of plain water [reference] or with 200 mL of at least one of each of the herbal teas. Each herb was used in two concentrations [g per cup of 200 mL]: 4 or 8 for cinnamon; 6 or 8 for fenugreek seed; 1.5 or 2.5 for black tea; and 6 or 12 for aniseed. Assuming the glycemic index [GI] of white bread as a reference is 100, the GI obtained for bread when consumed with the above-mentioned herbal teas in their respective doses and expressed as means +/- SEM [in percentages] were: 54 +/- 7.3 and 55 +/- 7.0; 62 +/- 4.9 and 39 +/- 4.7; 81 +/- 5.2 and 72 +/- 7.1; and 93 +/- 4.0 and 72 +/- 4.2 respectively. The present study showed the immediate positive effect of all the above herbal teas in reducing the postpr and ial glycemic response of bread, and except for cinnamon, the higher dose for the three other herbs resulted in a further significant hypoglycemic effect of bread

Effectiveness of natural sialagogues in the treatment of pathological Gastroesophageal Acid Reflux Disease [GERD]

Background: GERD is a common gastro-intestinal disorder. It is considered as chronic medical that needs long term medical treatment. Long term acid suppressive therapy, inspite of being considered safe, may result in bacterial overgrowth and secondary hypergastrinemia

The aim of this study is to evaluate the effectiveness of natural sialagogues [sugarless gum] as non-pharmacologicai treatment to control the pathological acid reflux

Subject and methods: 50 patients were selected from outpatient clinic of tropical medicine department complaining of heart burn and/or epigastric pain. They were confirmed as having pathological GERD by 24 hr pH metry. All patients were subjected to: full history, thorough physical examination, ECG, and Upper G.I.T endoscopy. Ambulatory 24 hrs. esophageal pH monitoring was done in the first day without using natural sialagogues and repeated in second day during using natural sialagogues. Measurement of salivary volume, ph, bicarbonate and Epidermal growth factor [EGF] before and after using natural sialagogues

The result: there was statistically significant symptomatic improvement in patients with GERD. 20% of patients with GERD by ph metry showed normal endoscopoic findings. There were statistically significant increase in all measured parameters after chewing gum. 41% of Patients who had GERD showed decrease in 24 hrs pH metry score after chewing sugarless gum. The higher the grade of reflux eosophagitis, the lower the response to chewing sugarIess gum as regards salivary volume, ph, bicarbonate and EGF. While the highest response in salivary secretion parameters was reported in patients who had GERD with normal endoscopic findings followed by GERD with gastritis and the least response was found in GERD with hiatus hernia [HH]

In conclusion: Chewing sugarless gum as natural sialagogues showed statistically significant increase of salivary volume, ph, bicarbonate and EGF, together with improvement of symptoms of pathological GERD. So, chewing sugarless gum is believed to be good and effective non pharmacological method to control GERD