Cohortes de premedicación en endoscopia alta con simeticona, N-acetilcisteína, Hedera helix y validación de la escala visual / Cohorts of premedication for endoscopy of the upper gastrointestinal tract with simethicone, N-acetylcysteine, Hedera helix and visual scale validation

Resumen Los parámetros de calidad para endoscopia digestiva alta han introducido indicadores intraprocedimiento, dentro de los cuales la adecuada visibilidad de la mucosa, libre de saliva, moco o burbujas, puede aumentar la posibilidad de detección de lesiones en fase temprana. Sin embargo, el uso de mucolíticos y antiburbujas ha mostrado gran variabilidad de eficiencia según las soluciones, concentraciones, tiempos de exposición y escala de visibilidad aplicados. Objetivos: determinar la efectividad de diferentes soluciones de premedicación para la limpieza de la mucosa digestiva; validar, mediante una prueba de concordancia interobservador, una nueva escala de adecuada visualización de la mucosa (TVMS) para el esófago, estómago y duodeno; y reportar eventos adversos o complicaciones relacionadas con las soluciones utilizadas y los procedimientos realizados. Material y métodos: estudio de cohortes prospectivas comparativas. Se incluyeron 412 pacientes adultos, ASA I y ASA II, para endoscopia diagnóstica bajo sedación consciente, distribuidos en 6 cohortes similares, divididas en dos grupos: no premedicación, 2 cohortes C1 (ayuno de 6 a 8 horas)y C2 (agua 100 mL); premedicación, 4 cohortes C3 a C6 (C3: agua 100 m L + simeticona 1000 mg; C4: agua 100 mL + simeticona 200 mg + N-acetilcisteína 600 mg; C5: agua 100 mL + simeticona 200 mg + N-acetilcisteína 1000 mg; C6: agua 100 mL + simeticona 200 mg + Hedera helix 70 mg). Se ingirió la solución 15 a 30 minutos antes del paso por cricofaríngeo. Se realizó la prueba de Kappa para medir la concordancia interobservador de la escala TVMS. Resultados: De 412 pacientes, 58% fueron de sexo femenino; 23% (136) fue de cohortes C1 y C2 y 67% (276) fue de cohortes C3 a C6. El tiempo medio de exposición a cada solución fue de 24,4 minutos. El volumen de lavado para lograr una adecuada visualización fue significativamente diferente entre ambos grupos: en los pacientes con premedicación se utilizaron 75,6 mL, mientras que en los pacientes sin premedicación se utilizaron 124 mL (p = 0,000), con una calidad de TVMS excelente de 88,7% frente al 41,4%, respectivamente. La cohorte C4 (agua 100 mL + simeticona 200 mg + N-acetilcisteína 600 mg) mostró ser la más efectiva con una diferencia significativa (p = 0,001) frente a C1 (ayuno) y C2 (placebo con agua 100 mL), y también tuvo una eficiencia superior frente a C3, C5 y C6 en su orden. No se presentaron eventos adversos o complicaciones en relación con la endoscopia, la sedación y los productos usados en la premedicación. Conclusiones: la solución más efectiva como premedicación para lograr una excelente visibilidad de la mucosa digestiva correspondió a la cohorte C4 (SIM 200 + NAC 600 + H2O 100 mL). La escala TVMS propuesta es una herramienta muy completa y fácil de aplicar por más de un observador. La premedicación ingerida, con antiburbuja, mucolítico y agua hasta 100 mL, entre 15 y 30 minutos previos a endoscopia, es segura en las condiciones descritas en este estudio.

Abstract Quality parameters for upper gastrointestinal endoscopy have introduced intraprocedural indicators, including adequate mucosal visualization free of saliva, mucus, or bubbles, which may increase the possibility of early-stage injury detection. The use of mucolytics and anti-foaming agents has shown great efficiency variability depending on the type of solution, concentrations, exposure times and visibility scale applied. Objectives: To determine the effectiveness of different premedication solutions for cleaning the digestive mucosa; to validate, by means of an interobserver concordance test, a new scale for the adequate visualization of the mucosa (TVMS) for the esophagus, stomach, and duodenum; and to report adverse events or complications associated with the solutions used and the procedures performed. Material and methods: Prospective, comparative cohort study. 412 adult patients, ASA I and ASA II, were included for diagnostic endoscopy under conscious sedation. They were distributed in 6 similar cohorts and divided into two groups: non-premedication, 2 in C1 (fasting 6 to 8 hours) and C2 (water 100 mL) cohorts; premedication, 4 C3 to C6 cohorts (C3: water 100 mL + simethicone 1000 mg; C4: water 100 ml + simethicone 200 mg + N-acetylcysteine 600 mg; C5: water 100 ml + simethicone 200 mg + N-acetylcysteine 1000 mg; C6: water 100 ml + simethicone 200 mg + Hedera helix 70 mg). The solution was swallowed 15 to 30 minutes passing through the cricopharyngeus muscle. The Kappa test was performed to measure interobserver concordance of the TVMS scale. Results: Of 412 patients, 58% were female; 23% (136) were included in the C1 and C2 cohorts; and 67% (276) were in the C3 to C6 cohorts. The average exposure time to each solution was 24.4 minutes. The wash volume for proper visualization was significantly different between the two groups. In premedicated patients, 75.6 mL of solution were used, while in patients without premedication, 124 mL were used (p = 0.000), with an excellent quality of TVMS of 88.7% versus 41.4%, respectively. The C4 cohort (water 100 mL + simethicone 200 mg + N-acetylcysteine 600 mg) was the most effective with a significant difference (p= 0.001) compared with the C1 (fasting) and C2 (placebo with water 100 mL) cohorts. It also had better efficiency compared to the C3, C5 and C6 cohorts in that order. There were no adverse events or complications associated with endoscopy, sedation, or premedication products. Conclusions: The most effective solution as a premedication to achieve excellent visibility of the digestive mucosa was that used in the C4 cohort (SIM 200 + NAC 600 + H2OR 100 mL). The proposed TVMS scale is a very complete and easy tool to apply by more than one observer. Premedication ingested, with anti-foam, mucolytic and water up to 100 mL, between 15 and 30 minutes before endoscopy, is safe under the conditions described in this study.

Optimal Bowel Preparation for Capsule Endoscopy and Device-assisted Enteroscopy / 대한소화기학회지

For improved examination of video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE), bowel preparation is an essential issue. Multiple factors like air bubbles, food material in the small bowel, and gastric and small bowel transit time affect the small bowel visualization quality (SBVQ), diagnostic yield (DY) and cecal completion rate (CR). Bowel preparation with polyethylene glycol (PEG) solution enhances SBVQ and DY, but it has no effect on CR. Bowel preparation with PEG solution 2 L is similar to PEG 4 L in SBVQ, DY, and CR. Bowel preparation with fasting or PEG solution combined with anti-foaming agents like simethicone enhance SBVQ, but it has no effect on CR. Bowel preparation with prokinetics is not commonly recommended. Optimal timing for purgative bowel preparation has yet to be established. However, the studies regarding bowel preparation for DAE are not sufficient. European Society of Gastrointestinal Endoscopy (ESGE) recommends 8–12 hours fasting from solid food and 4–6 hours fasting from liquids prior to the antegrade DAE. For retrograde DAE, colonoscopy preparation regimen is recommended. This article reviews the literature and ESGE, 2013 Korean published guidelines regarding bowel preparation for VCE and DAE, following suggestion for optimal bowel preparation for VCE and balloon enteroscopy.

A influência do uso da simeticona nos resultados do exame salivar: estudo preliminar / The influence of simethicone use on salivary examination results: preliminary study

Introdução: o uso da simeticona após coleta salivar é pouco descrito na literatura, sendo indicado para a obtenção de quantitativo maior da amostra. Todavia poucos são os estudos sobre a possível interferência dessa substância nos resultados do exame salivar. Objetivo: Avaliar as propriedades físico-químicas de duas marcas de simeticona e verificar se o fármaco interfere nos resultados do exame salivar. Metodologia: o estudo foi realizado no Laboratório de Bioquímica Oral (ICS/UFBA). Na etapa in vitro, avaliou-se o potencial hidrogeniônico (pH), a acidez titulável total (ATT) e a presença de sólidos solúveis totais (SST) na simeticona das marcas A e B. Na etapa in vivo, foi avaliada a velocidade do fluxo salivar (VFS), pH e a capacidade tampão (CT) na amostra salivar de 23 voluntários, comparando-se os resultados sem e com o uso das medicações (marcas A e B). Resultados: as duas marcas estudadas obtiveram pH menor que o neutro, e os valores de ATT para obtenção do pH 7 foram maiores na marca A. Ambas apresentaram valores elevados de SST. Na etapa in vivo, 78,3% da amostra era de mulheres, com idade média de 21,1 anos e VFS dentro da normalidade. Não houve diferença estatística entre o VFS (p=0,022) e pH (p=0,419) entre os grupos estudados, enquanto os valores da CT relativos ao uso da simeticona da marca A foram diferentes em comparação com os dos dois outros grupos (p=0,005). Conclusão: as propriedades laboratoriais das marcas de simeticona estudadas apresentaram diferenças entre si. O uso da marca A parece ter interferido na CT da saliva coletada.

Introduction: the use of simethicone after salivary collection is controversial in the literature, being indicated to obtain a larger quantity of sample. However, there are few studies on its interference in salivary examination results. Objective: to evaluate the physical and chemical properties of two brands of simethicone. Also, check if the drug interferes with salivary examination results. Methodology: the study was conducted at the Oral Biochemistry Laboratory of ICS / UFBA. In the in vitro stage, the hydrogen potential (pH), the total titratable acidity (TTA) and the presence of total soluble solids (TSS) in the A and B simethicone brands were evaluated. In the in vivo step the salivary flow rate (SFR) was evaluated; also pH and buffer capacity (BC) in the salivary sample of 23 volunteers, comparing the results without and with the use of medications (brands A and B). Results: the two studied brands had lower pH than neutral and the TTA values to obtain pH 7 were higher in brand A. Both presented high values of TSS. In the in vivo stage, 78.3% of the sample was women, with a mean age of 21.1 years and normal SFR. There was no statistical difference between SFR (p = 0.022) and pH (p = 0.419) between the studied groups, while the TCs values for the use of brand A simethicone were different compared to the other two groups (p = 0.005). Conclusion: the laboratory properties of the simethicone brands studied differed from each other. The use of brand A seems to have interfered with the collected saliva BC.

Effect of antispasmodic agents for the treatment of irritable bowel syndrome

Antispasmodics are effective in reducing abdominal pain and controlling spasm. Irritable bowel syndrome (IBS) patients have characteristic key factors such as intestinal motility disorder and visceral hypersensitivity. So antispasmodics have been used in the treatment of IBS for decades. Mebeverine blocks intestinal peristalsis but are not significantly better than placebo. Alverine citrate combined with simethicone is effective treatment option in IBS. Otilonium and pinaverium bromide are poorly absorbed agents, so they have mostly local effect with minimal systemic adverse events. Phloroglucinol controls acute exacerbation of abdominal pain effectively. Tiropramide reduce abdominal discomfort without serious adverse events. Fenoverine control spasm in spastic colon but does not affect normal contraction. Trimebutine have dual actions that it inhibits hyperactive colon and activates hypomotile colon. Each drug has advantages and disadvantages. Antispasmodics are considered as the first treatment option of pain-dominant IBS.

Aplicación de una escala de visualización de la mucosa gástrica, durante la esofagogastroduodenoscopia en pacientes premedicados con N-acetilcisteína más simeticona: experiencia en Ocaña, Norte de Santander / Experience in Ocaña, Norte de Santander, with a Scale for Visualization of the Gastric Mucosa during Esophagogastroduodenoscopy in Patients Medicated with N-acetylcysteine plus Simethicone

Resumen Introducción: la visibilidad de la mucosa gástrica puede verse limitada por el moco adherente y la formación de burbujas durante la endoscopia de vías digestivas altas. Objetivos: conocer los puntajes de visualización de la mucosa gástrica y el número de lavados para aclarar la superficie gástrica de burbujas y espumas, aplicando la escala de Kuo modificada por Chang en pacientes premedicados antes de la esofagogastroduodenoscopia. Materiales y métodos: estudio descriptivo, prospectivo, se incluyeron 120 pacientes entre octubre y diciembre de 2016 a los que se les premedicó con N-acetilcisteína (NAC) al 4%, 400 mg (10 cc) más simeticona (SIM) (dimetilpolisiloxano) 133,3 mg (2 cc) y agua tibia 100 cc, 20 minutos antes del procedimiento; los datos se tabularon en Excel y, ulteriormente, sus frecuencias y porcentajes se analizaron con el paquete estadístico Epi Info CDC (versión 7,2 para Windows, Estados Unidos); se consideró significancia estadística una p <0,05. Resultados: la puntuación total de visibilidad de la mucosa gástrica considerada como óptima con un puntaje de 4 fue 57 (47,50%), con 5 puntos fueron 36 (30%), con 6 y 7 puntos 10 (8,33%), con 8 puntos 6 (5%) y, por último, con 9 puntos 1 (0,83%); no hubo casos en las puntuaciones de 10 a 16. 100 (83,3%) pacientes no necesitaron lavados adicionales con agua para visualizar la mucosa gástrica, contra 13 (10,83%) que requirieron menos de 50 cc y 7 (5,83%) que necesitaron más de 50 cc (p = 0,00). Limitaciones: un solo observador realizó el estudio, lo que pudo generar sesgos de detección; además, la muestra es pequeña. Conclusiones: con la administración de una solución de NAC más SIM diluidas en 100 cc de agua tibia previa a la endoscopia de vías digestivas altas se obtuvo una visualización óptima de la mucosa gástrica en la mayoría de los casos y se observó la necesidad de un menor volumen de agua para aclarar la cavidad gástrica de moco y espuma.

Abstract Introduction: During upper digestive tract endoscopy, visibility of the gastric mucosa can be limited by adherent mucus and bubbles. Objectives: This is a study of visualization of the gastric mucosa and the number of washes needed to clear bubbles and foam from the gastric surface. The modified Kuo scale by Chang was used with patients medicated prior to esophagogastroduodenoscopy. Materials and methods: This is a descriptive and prospective study of 120 patients who were medicated with 400 mg (10cc) of 4% N-acetylcysteine plus 133.3 mg (2cc) of simethicone (Dimethylpolysiloxane) and 100 cc of warm water 20 minutes prior to esophagogastroduodenoscopy from October to December 2016. Data were tabulated in Excel and frequencies and percentages were analyzed using the Epi Info statistical package from the Centers for Disease Control version 7.2 for Windows. Statistical significance was considered to be p <0.05. Results: The optimal score for total visibility of four was achieved 57 patients (47.50%). Thirty-six patients (30%) had scores of five points, ten patients (8.33%) had scores of six or seven points, six patients had scores of eight points (5%), and one patient (0.83%) had a score of nine points. There were no scores from 10 to 16. Hundred patients (83,3%) did not need additional washes with water to visualize the gastric mucosa, thirteen patients (10,83%) required less than 50 cc, and seven (5,83%) required more than 50 cc (p = 0.00). Limitations: This study was done by a single observer which could result in detection biases. Also, the sample is small. Conclusions: Administration of a solution of N-acetylcysteine ​​plus Simethicone diluted in 100 cc of warm water prior to upper digestive tract endoscopy provides for optimal visualization of the gastric mucosa in most cases. A smaller volume of water was needed to clear the gastric cavity of mucus and foam.

Comparative Study on Bowel Preparation Efficacy of Ascorbic Acid Containing Polyethylene Glycol by Adding Either Simethicone or 1 L of Water in Health Medical Examination Patients: A Prospective Randomized Controlled Study / 대한소화기학회지

BACKGROUND/AIMS: There are no studies that looked into the bubble eliminating efficacy of polyethylene glycol with ascorbic acid (PEGA), which has been one of the shortcomings of polyethylene glycol (PEG). In this study, we compared newly introduced PEGA regimen by adding either simethicone or 1 L of water. METHODS: A prospective randomized controlled study was carried out at Dongguk Universtiy Gyeongju Hospital from July 2014 to September 2014. A total of 90 patients were randomly assigned to 3 groups; PEGA group (n=30) which served as control, simethicone addition group (n=30) to which simethicone 400 mg was additionally prescribed, and water addition group (n=30) to whom additional 1 L of water was given. Cleansing effectiveness, gas elimination efficacy, side effects, and patient satisfaction were compared between the groups. RESULTS: PEGA group demonstrated the highest cleansing effectiveness, but there was no statistically significant difference among the groups. Simethicone addition group showed significantly lesser amount of bubbles than the other groups (2.57±2.05 vs. 1.10±1.83 vs. 2.60±2.84, p=0.017). The rates of side effects in each group were 20.00% vs. 16.77% vs. 53.33%. Water addition group had significantly more side effects than the PEGA group and the simethicone addition group (p=0.003). The patient satisfaction score of each group was 3.37±0.85 vs. 3.73±0.74 vs. 3.20±0.66 with simethicone addition group showing significantly higher satisfaction than water addition group (p=0.020). CONCLUSIONS: PEGA bowel preparation agent showed satisfactory bowel cleansing despite the decrease in dosage, and addition of simethicone resulted in better bubble elimination.

Guidelines for Bowel Preparation before Video Capsule Endoscopy

The preparation for video capsule endoscopy (VCE) of the bowel suggested by manufacturers of capsule endoscopy systems consists only of a clear liquid diet and an 8-hour fast. While there is evidence for a benefit from bowel preparation for VCE, so far there is no domestic consensus on the preparation regimen in Korea. Therefore, we performed this study to recommend guidelines for bowel preparation before VCE. The guidelines on VCE were developed by the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy. Four key questions were selected. According to our guidelines, bowel preparation with polyethylene glycol (PEG) solution enhances small bowel visualization quality (SBVQ) and diagnostic yield (DY), but it has no effect on cecal completion rate (CR). Bowel preparation with 2 L of PEG solution is similar to that with 4 L of PEG in terms of the SBVQ, DY, and CR of VCE. Bowel preparation with fasting or PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR of VCE. Bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE.

Effect of small bowel preparation with simethicone on capsule endoscopy / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>BACKGROUND</b>Capsule endoscopy is a novel non-invasive method for visualization of the entire small bowel. The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small bowel mucosa and its complete passage through the small bowel. To date, there is no standardized protocol for bowel preparation before capsule endoscopy. The addition of simethicone in the bowel preparation for the purpose of reducing air bubbles in the intestinal lumen had only been studied by a few investigators.</p><p><b>METHODS</b>Sixty-four participants were randomly divided into two groups to receive a bowel preparation of polyethylene glycol (PEG) solution (Group 1) and both PEG solution and simethicone (Group 2). The PEG solution and simethicone were taken the night before and 20 min prior to capsule endoscopy, respectively. Frames taken in the small intestine were examined and scored for luminal bubbles by two professional capsule endoscopists. Gastric emptying time and small bowel transit time were also recorded.</p><p><b>RESULTS</b>Simethicone significantly reduced luminal bubbles both in the proximal and distal small intestines. The mean time proportions with slight bubbles in the proximal and distal intestines in Group 2 were 97.1% and 99.0%, respectively, compared with 67.2% (P<0.001) and 68.8% (P<0.001) in Group 1. Simethicone had no effect on mean gastric emptying time, 32.08 min in Group 2 compared with 30.88 min in Group 1 (P=0.868), but it did increase mean small intestinal transit time from 227.28 to 281.84 min (P=0.003).</p><p><b>CONCLUSION</b>Bowel preparation with both PEG and simethicone significantly reduced bubbles in the intestinal lumen and improved the visualization of the small bowel by capsule endoscopy without any side effects observed.</p>

The Effect of Simethicone as a Bowel Preparative: Is a Higher Dosage More Helpful? / 대한소화기내시경학회지

BACKGROUND/AIMS: Simethicone has been effectively used as a preprocedure drink during colonoscopy because it causes bubbles in the lumen to coalesce. We tried to confirm whether simethicone could effectively lessen the bubble formation and shorten the procedure time. In addition, we tried to determine the proper dose of this medication. METHODS: Patients were randomized to receive 0 mg as a control group (group I), 200 mg of simethicone at 7 PM in the evening before the procedure (group II), or 200 mg at 7 PM in the evening and 200 mg at 7 AM in the next morning (group III). The bubbles were scored as follows: 0, none or small amounts of bubbles that don't require any jet of water; 1, moderate amounts of bubbles that require two or three jets of water due to the focal distribution; And 2, large amounts of bubbles that require repeated jets (> or = 4) of water due to the extensive distribution. RESULTS: 101 patients were included in this study. The number of patients in groups I, II and III were 38, 35 and 28, respectively. The procedure time was statistically similar among the three groups. Severe bubbles (score 2) were significantly more likely to occur in group I than in groups II and III (p=0.014). On the other hand, the presence of significant bubbles (> or = 1) was not different between groups II and III. CONCLUSIONS: Simethicone significantly diminished the presence of bubbles. We recommend using 200 mg of simethicone in the evening before the colonoscopy.

Cephradine antacids interaction studies

The present work comprises of interaction studies of cephradine with antacids. Cephradine is included among the first generation cephalosporin, which is active against a wide range of Gram positive and Gram-negative bacteria including penicillinase-producing staphylococci. Since the presence of complexing ligand may affect the bioavailability of a drug in blood or tissue, therefore, in order to study the probable interaction of cephradine with antacids all the reaction conditions were simulated to natural environments. Antacids are commonly used in patients complaining of GI irritations. The behavior of cephradine in presence of seven antacids i.e., simethicone, magaldrate, magnesium carbonate, magnesium hydroxide, magnesium trisilicate, sodium bicarbonate and aluminium hydroxide was studied by using standard dissolution apparatus. Cephradine was monitored both by UV and by high performance liquid chromatography. The results revealed that antacids containing polyvalent cations retarded the in vitro availability of cephradine. Moreover, these studies indicated that cephradine was strongly adsorbed on antacids; magnesium trisilicate and simeco tablets [powdered] exhibited relatively higher adsorption capacities

Efficacy of Oral Sodium Phosphate Preparation for Capsule Endoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Capsule endoscopy is an effective diagnostic tool for detecting small bowel disease. However, the method of bowel preparation for capsule endoscopy has not been standardized. The aim of this study was to evaluate the efficacy of oral sodium phosphate as a preparation for capsule endoscopy. METHODS: A total of 129 cases who underwent capsule endoscopy from Mar. 2003 to Sep. 2004 were analyzed retrospectively. Eighty- eight cases were prepared with sennosides (Alaxyl(R)) and 41 cases were prepared with sodium phosphate. The intestinal mucosa was defined as being unclean if the intestinal content, food materials, and bubbles covered more than 25% of the mucosal surface. Using a stopwatch, the exact time of the unclean image was recorded. The percentage of the unclean image for the small intestinal transit time (SITT) was calculated as an objective score. Small bowel cleansing was considered 'adequate' if the objective score was <10% and 'inadequate' if the objective score was 10% or greater. RESULTS: 35 cases (40%) showed an adequate image in the sennosides and simethicone group and 26 cases (63%) showed an adequate image in the sodium phosphate and simethicone group. The adequacy rate was significantly higher in the sodium phosphate group than in the sennosides group (p<0.05). CONCLUSIONS: Capsule endoscopy prepared by sodium phosphate and simethicone produced a better visual image than sennosides and simethicone.

To study the feeding pattern and response to drugs in infants with [infantile colic]

This study was conducted at the department of child health of Khyber teaching hospital Peshawar, from Jan 1[st] to Dec 31[st], 2oo4. Sixty patients with infantile colic were selected for the study after taking a detailed history and thorough examination, to rule out specific organic causes of excessive crying. They were divided into two groups on the basis of drugs given [semithicone and herbal drug]. Results were tabulated, compared with different studies and the following conclusions were made. A] Infantile colic occurs commonly from two weeks to 5 months of age. B] Infantile colic seems to be less common in breast fed as compared to bottle fed infants. C] Drugs have very little role in the treatment of infantile colic

Manifestaçöes neurológicas na intoxicaçäo de lactentes pela associaçäo dimeticona e homatropina: relato de 6 casos / Neurological manifestations in the intoxication of infants by dimethicone plus homatropine: report of 6 cases

OBJETIVO: alertar que o uso da associaçäo dimeticona/homatropina (Espasmo Luftal®) em recém-nascidos e lactentes de até dois meses, pode causar episódios disfuncionais transitórios extrapiramidais. MÉTODO: relato de 6 casos de crianças com menos de 2 meses, em uso diário da associaçäo dimeticona/homatropina, que apresentaram sintomas agudos caracterizados por crises repetidas de curta duraçäo com desvio tônico da cabeça para trás (opistótono), desvio do olhos para cima com olhar fixo e expressäo de terror, postura mantida em hipertonia extensora dos 4 membros e emissäo de choro e/ou sons guturais. RESULTADOS: os sintomas extrapiramidais desapareceram (e näo retornaram) após a suspensäo da associaçäo dimeticona/homatropina. Näo foram constatadas anormalidades no exame neurológico, eletrencefalograma e provas sanguíneas. CONCLUSÖES: a associaçäo dimeticona/homatropina pode determinar em crianças com menos de 2 meses, quadro disfuncional dos gânglios da base. É importante diferenciá-lo das crises epilépticas generalizadas, a fim de se evitar a utilizaçäo, errônea, de drogas antiepilépticas

Eficacia de la asociación metoclopramida diazepamdimeticona en el sindrome dispéptico funcional (SDF). Estudio clínico randomizado controlado con placebo / Association efficacy of metoclopramide-diazepam-dimeticone in non-ulcer functional dyspepsia. Controlled clinical trial

Se estudiaron 104 pacientes ambulatorios con SDF no ulceroso, en fase sintomática, randomizados en dos grupos homogéneos:medicamento (48), placebo (56). El presente ensayo evalúa la eficacia de la asociación farmacológica de metoclopramida (5mg), diazepam (2.5mg)y dimeticona (100 mg) frente al placebo en el SDF de tipo no ulceroso, así como la tolerancia y efectos colaterales de la asociación. Luego de una apreciación inicial se realizó el seguimiento de ambos grupos durante 21 días, evaluándose:naúsea, llenura postprandial, ardor epigástrico, dolor vago, eructación, y balonamiento, y la impresión final del médico y del paciente. Todos los parámetros evaluados fueron ampliamente favorables para la asociación medicamentosa, siendo la diferencia estadísticamente significativa en el caso náusea, llenura postprandial y ardor epigástrico. La tolerancia en ambos grupos fue buena y como efectos colaterales adversos sólo cabe consignar una mayor somnolencia en el grupo medicamento, que fue mínima.

Utilización empírica de diyodohidroxiquinoleína y dimeticona para el tratamiento de la colitis amebiana en escolares / Empirical use of diiodohydroxyquinolein and dimeticone in treating amoebic colitis in school children

Se estudió la evolución de 60 pacientes escolares con diagnóstico clínico de colitis amebiana, habitantes de una zona rural llamada Xico. La muestra se dividió en dos grupos, 30 del sexo femenino y 30 del masculino con edades entre seis y 12 años. Se administró una combinación de diyodohidroxiquinoleína y dimeticona a dosis de 30 mg por kg por día por vía oral en forma de suspensión. A los 4.5 días promedio hubo notable mejoría en 93.7 por ciento de los pacientes, por lo que concluye que esta combinación es una alternativa empírica eficaz para el tratamiento de la colitis amebiana.

Terapêutica da hipertensäo pulmonar associada `a doença pulmonar obstrutiva crônicas / Therapeutics of pulmonary hypertension associated with chronic obstructive pulmonary disease

Hipertensäo pulmonar (HP) e cor pulmonale säo complicaçöes freqüentes de pacientes com bronquite crônica e enfisema pulmonar. Diminuiçäo do leito vascular pulmonar, quer por desnutriçäo do parênquima, quer por vasoconstriçäo hipóxica, representa papel etiopatogênico básico no surgimento da HP. Outros fatores agravantes säo policitemia, aumento da pressäo venosa pulmonar, aumento do volume sanguíneo pulmonar e aumento do débito cardíaco. Säo objetivos básicos do tratamentoa melhorar a condiçäo ventilatória e das trocas gasosas, assim como influenciar o paciente a abandonar o vício tabágico. Oxigenoterapia contínua com baixo fluxo é considerada uma medida efetiva, aumentando a sobrevida dos pacientes hipoxêmicos, principalmente aqueles com sinais de cor pulmonale. Almitrina, droga recentemente utilizada nestes pacientes, tem demonstrado efeitos positivos, aumentando a PaO2 e diminuindo a PaCO2, sendo estes efeitos ligados a uma açäo de melhor adequar a relaçäo ventilaçäo/perfusäo pulmonar. Diuréticos e digitálicos säo utilizados com cautela em situaçöes específicas e näo sem efeitos colaterais. Sangrias periódicas têm indicaçäo nos quadro de policitemia com cor pulmonale de difícil compensaçäo. Vasodilatadores têm sido recentemente analisados na doença pulmonar obstrutiva crônica com efeitos promissores em estudos agudos. Sua utilizaçäo clínica encontra-se, entretanto, em fase experimental, näo sendo recomendada sem um rigoroso acompanhamento hemodinâmico e metabólico. As metilzantinas e os ß2 estimulantes têm sido reestudados na DOPC nos últimos anos. Além da açäo broncodilatadora, efeitos ao nível da musculatura respiratória e no sistema cardiovascular foram demonstrados e responsabilizados pelo melhor desempenho ao esforço deste pacientes