Reporte de un caso de tratamiento de gastroparesia pediátrica con prucaloprida: una terapia novedosa / A case report of prucalopride treatment in pediatric gastroparesis: a novel therapy

La prucaloprida acelera el vaciamiento gástrico en adultos con gastroparesia. No existen estudios con este medicamento en niños con gastroparesia. Se presenta un niño de 8 años que consultó por síntomas posprandiales de un mes de duración, con diagnóstico de gastroparesia por gammagrafía de vaciamiento gástrico. No mejoró con metoclopramida, domperidona, eritromicina y esomeprazol. Recibió prucaloprida durante dos períodos (durante 178 y 376 días) a dosis de 0,03-0,04 mg/kg/día. Presentó mejoría en el seguimiento con el índice cardinal de síntomas de gastroparesia y gammagrafías de vaciamiento gástrico. Por la buena respuesta, la prucaloprida podría ser una opción terapéutica en la gastroparesia pediátrica.

Prucalopride has been used in adults with gastroparesis, accelerating gastric emptying. There are no studies with this drug in gastroparetic children. An 8-year-old boy is presented who consulted for a month of postprandial symptoms, with a diagnosis of gastroparesis by gastric emptying scintigraphy. He did not improve with metoclopramide, domperidone, erythromycin, and esomeprazole. He received prucalopride for two periods (for 178 and 376 days) at doses: 0.03 - 0.04 mg/kg/day, presenting improvement in the follow-up with the cardinal gastroparesis symptom index and gastric emptying scintigraphy. Due to the good response, prucalopride may be a therapeutic option in pediatric gastroparesis.

Indução da lactação em mulheres nuligestas: relato de experiência / Inducción de la lactancia en mujeres nuligestas: informe de experiencia / Lactation induction in women who never got pregnant: experience report

Resumo Objetivo relatar a experiência de indução da lactação em nuligestas realizada por enfermeira consultora em aleitamento. Método relato de experiência. O processo de indução láctea foi realizado com três mulheres por motivo de gestação em útero de substituição e relacionamento homoafetivo. Resultados todas perceberam o aumento de tamanho e a sensibilidade nas mamas, bem como apresentaram secreção láctea. No entanto, a continuidade da amamentação foi diferenciada entre elas. A primeira não recebeu apoio de profissionais de saúde no contexto de pós-parto hospitalar, nem em casa, e não deu continuidade à amamentação. A segunda recebeu apoio da equipe do hospital e da parceira, amamentando por três meses. A terceira, com o apoio da parceira, amamentou por dois meses, mas interrompeu por sentir-se inibida por familiares. Conclusão e implicações para a prática a técnica de indução é capaz de desencadear a produção láctea. Já o processo de amamentação só se estabeleceu mediante a associação com a rede de apoio, o acolhimento, o incentivo da equipe de saúde e o olhar integral à mulher e sua família. Dessa forma, o cuidado de Enfermagem na indução láctea não deve focar apenas no manejo da indução, mas transcender o aspecto técnico, o que se mostra como fundamental para a proteção, o estabelecimento e a continuidade da amamentação.

Resumen Objetivo reportar la experiencia de inducir la lactancia en nuligestas realizada por una consultora de enfermería en lactancia materna. Método relato de experiencia. El proceso de inducción de la leche se realizó con tres mujeres por embarazo en útero de reemplazo y relación homoafectiva. Resultados todas notaron el aumento de tamaño y la sensibilidad en las mamas, además de presentar secreción de leche. Sin embargo, la continuidad de la lactancia materna se diferencia entre ellos. La primera no recibió apoyo de los profesionales de la salud en el contexto posparto hospitalario, ni en el domicilio, y no continuó con la lactancia. La segunda recibió apoyo del personal del hospital y su pareja, amamantando durante tres meses. La tercera, con el apoyo de su pareja, amamantó durante dos meses, pero la interrumpió porque se sentía inhibida por familiares. Conclusión e implicaciones para la práctica la técnica de inducción es capaz de desencadenar la producción de leche. El proceso de lactancia materna, en cambio, solo se estableció a través de la asociación con la red de apoyo, la acogida, el estímulo del equipo de salud y la mirada integral a la mujer y su familia. Así, el cuidado de Enfermería en la inducción de la leche no debe enfocarse solo en el manejo de la inducción, sino trascender el aspecto técnico, que se muestra fundamental para la protección, el establecimiento y la continuidad de la lactancia materna.

Abstract Objective to report the experience of lactation induction in women who never got pregnant by a lactation consultant nurse. Method experience report. The process of lactation induction was performed with three women due to surrogate pregnancy and homosexual relationships. Results all noticed an increase in the size and sensitivity of the breasts, as well as milk secretion. However, the continuity of breastfeeding was different between them. The first did not receive support from health professionals in the postpartum hospital setting, nor at home, and did not continue breastfeeding. The second received support from the hospital staff and her partner, breastfeeding for three months. The third, with the support of her partner, breastfed for two months, but stopped because she felt inhibited by family members. Conclusion and implications for practice the induction technique is capable of triggering milk production. However, the breastfeeding process was only established through the association with the support network, the reception, the encouragement of the health team, and the comprehensive view of the woman and her family. Thus, nursing care in lactation induction should not focus only on the management of induction, but transcend the technical aspect, which is essential for the protection, establishment, and continuity of breastfeeding.

Use of domperidone in canine visceral leishmaniasis: gaps in veterinary knowledge and epidemiological implications

A pivotal strategy to decrease the risk of visceral leishmaniasis in humans is to control the infection and disease progression in dogs, the domestic reservoir of Leishmania infantum (L. chagasi). Immunotherapy is a viable approach to treat sick dogs because cell-mediated immunity is the principal defense mechanism against L. infantum. Domperidone is an immune-stimulatory drug increasingly used in veterinary medicine as a prophylactic or immunotherapeutic agent. Domperidone treatment has shown to prevent overt disease or improve the clinical condition of infected dogs. However, veterinarians should be aware of the potential cardiotoxicity of domperidone when given together with drugs that inhibit CYP450s liver enzymes or those that prolong the QT interval. On the other hand, learning whether domperidone treatment significantly decreases dog infectivity to sand fly vectors is of capital importance since this result should have a palpable impact on the infection risk of humans living in regions endemic for visceral leishmaniasis.

Uso do fluralaner no tratamento da demodicidose canina juvenil generalizada: relato de caso / Use of fluralaner on canine generalized juvenile demodicosis treatment: case report

O objetivo do presente trabalho foi relatar a eficácia do fluralaner no tratamento da demodicidose juvenil generalizada canina. Dois caninos, apresentando dois e três meses de idade, com diagnóstico clínico e parasitológico de demodicidose generalizada, foram tratados com administração única de fluralaner, na dose recomendada em bula pelo fabricante. Além disso, foi realizada a terapia adjuvante à base de xampu de peróxido de benzoíla e domperidona. Observou-se uma resposta terapêutica satisfatória, com repilação completa ao 30º dia após a administração do fármaco. Para cada paciente, foi realizado exame parasitológico do raspado cutâneo aos 75 e 90 dias seguintes ao início do tratamento, e todos foram negativos. Tendo em vista a elevada eficácia do tratamento proposto, sugere-se a inclusão do fluralaner nos protocolos terapêuticos destinados à demodicidose canina, particularmente nos pacientes pediátricos e com a forma generalizada da doença.(AU)

The aim of the present study was to report the efficiency of fluralaner on the treatment of two cases of canine generalized juvenile demodicosis. Two puppies, aging two and three months old, with the clinic and parasitological diagnosis of generalized demodicosis were treated with single administration of fluralaner. according to the dose recommended by the responsible laboratory. Additionally, adjuvant therapy was applied using benzoyl peroxide shampoo and domperidone. A satisfactory therapeutic response was observed, and complete repilation was present at the 30th day after drug administration. For each patient, at the 75th and 90th day after the treatment began, skin scrapings were performed in order to investigate the presence of Demodex sp; and all were negative. Considering the high efficiency of the treatment used, we suggest the inclusion of fluralaner on the therapeutic protocol for canine demodicosis, particularly in pediatric patients and with the generalized form of the disease.(AU)

Lactation Induction in a Commissioned Mother by Surrogacy: Effects on Prolactin Levels, Milk Secretion and Mother Satisfaction / Indução da lactação em mãe por útero de substituição: efeitos na concentração de prolactina, produção láctea e satisfação materna

Abstract Case report of a 39-year-old intended mother of a surrogate pregnancy who underwent induction of lactation by sequential exposure to galactagogue drugs (metoclopramide and domperidone), nipple mechanical stimulation with an electric pump, and suction by the newborn. The study aimed to analyze the effect of each step of the protocol on serum prolactin levels, milk secretion and mother satisfaction, in the set of surrogacy. Serum prolactin levels and milk production had no significant changes. Nevertheless, themother was able to breastfeed for four weeks, and expressed great satisfaction with the experience. As a conclusion, within the context of a surrogate pregnancy, breastfeeding seems to bring emotional benefits not necessarily related to an increase in milk production.

Resumo Relato de caso de mãe por útero de substituição, de 39 anos de idade, submetida a indução da lactação por exposição sequencial a drogas galactogogas (metoclopramida e domperidona), estimulação mamilar mecânica com bomba elétrica, e sucção pelo recém-nascido. O estudo teve como objetivo analisar os efeitos de cada etapa do protocolo na concentração sérica de prolactina, no volume de secreção láctea e na satisfação materna. A concentração sérica de prolactina e a produção láctea não apresentaram mudanças significativas. Entretanto, a mãe foi capaz de amamentar a criança por quatro semanas, e manifestou grande satisfação com a experiência. Como conclusão, no contexto de maternidade por útero de substituição, o aleitamento materno parece promover benefícios emocionais, não necessariamente relacionados ao aumento do volume de leite.

Aplicação de resina poliuretânica derivada do óleo de mamona em formas farmacêuticas gastrorretentivas de liberação controlada / Application of polyurethane resin from castor oil in controlled release gastroretentive dosage forms

Polímeros naturais têm sido amplamente utilizados como excipientes farmacêuticos, principalmente por serem biocompatíveis e renováveis. O objetivo deste estudo foi investigar a aplicação da resina poliuretânica derivada do óleo de mamona (RPDOM) em formas farmacêuticas gastrorretentivas de liberação controlada. O trabalho aqui apresentado está dividido em quatro capítulos. O capítulo 1 trata-se de uma visão geral sobre a aplicação dos poliuretanos como sistemas de liberação de fármacos, enfatizando os estudos contendo poliuretanos do óleo de mamona. O capítulo 2 trata-se de uma revisão sistemática sobre sistemas gastrorretentivos de liberação de fármacos. O capítulo 3 trata do desenvolvimento e da caracterização da RPDOM contendo fármaco na sua matriz. Domperidona e cloridrato de verapamil foram escolhidos como fármacos modelos devido ao potencial uso desses em formulações gastrorretentivas. Os estudos físico-químicos mostraram que parte da domperidona interagiu quimicamente com a RPDOM. Visto que não é possível a quebra dessa ligação química durante o estudo de dissolução, parte do fármaco ficou indisponível para liberação. Por outro lado, o verapamil foi incorporado com sucesso na RPDOM pelo método de evaporação do solvente. O verapamil interagiu através de forças intermoleculares com o polímero e esse sistema mostrou um promissor perfil de dissolução. O capítulo 4 trata do desenvolvimento de matrizes monolíticas flutuantes, contendo verapamil como fármaco modelo, espuma de polipropileno como excipiente de baixa densidade e um blend da RPDOM e da celulose microcristalina como sistema matricial. A capacidade de flutuação in vitro das matrizes e o controle da liberação do fármaco foram demonstrados. Por fim, a RPDOM mostrou-se um polímero promissor para o uso em sistemas de liberação controlada de fármacos devido a sua hidrofobicidade e para o uso em sistemas gastrorretentivos flutuantes devido à sua baixa densidade

Natural polymers have been extensively used as pharmaceutical excipients mainly due to their biocompatibility and renewability. The aim of this study was to investigate the application of polyurethane resin from castor oil (PU) in controlled release gastroretentive dosage forms. The work presented herein is divided in four chapters. Chapter 1 is an overview of the application of polyurethanes as drug delivery systems, emphasizing studies containing castor oil-based polyurethanes. Chapter 2 is a systematic review of gastroretentive drug delivery systems. Chapter 3 is about the development and characterization of the PU containing drug in its matrix. Domperidone and verapamil hydrochloride were chosen as model drugs due to their potential use in gastroretentive formulations. Physicochemical studies showed that part of domperidone interacted chemically with PU. Since it is not possible a cleavage of the chemical bond between domperidone and the polyurethane during the dissolution study, part of the drug was not available for release. On the other hand, verapamil was successfully incorporated into PU by solvent evaporation method. Verapamil interacted by intermolecular forces with the polymer and this system showed a promising drug dissolution profile. Chapter 4 shows the development of floating monolithic matrices, containing verapamil as model drug, polypropylene foam as low-density excipient and a blend of PU and microcrystalline cellulose as matrix-forming polymers. The in vitro buoyancy capability of the matrices and the ability to control drug release were demonstrated. Finally, PU proved to be a potential polymer to be used in controlled drug delivery systems due to its hydrophobicity and in gastroretentive floating systems due to its low density

Effect of regular progression of diet, early oral feeding and early oral feeding with Domperidone on post cesarean diet tolerance in a Tertiary Hospital

@#The rate of admission in the Obstetrics and Gynecology Department in a tertiary hospital in Quezon City is continuously increasing, sometimes more than its bed capacity. An average of 2-3 mothers occupying a single bed with their newborn children can be overwhelming, to the point where the comfort hygiene and wellness of the patients after delivery are sacrificed. It is important for us to find a way in which the ward can accommodate all patients without any risk of losing the comfort that the hospital can offer during their stay. A faster patient turnover can at least help in this kind of situation. This study aims to investigate if early feeding can lead to early return of normal bowel function which could mean shorter hospital stay due to lesser post-operative discomfort and early ambulation. A randomized, three arm study was done in a tertiary hospital from June 2016 to September 2016. Ninety three women who underwent elective Cesarean Section were admitted and were randomly assigned into three groups. Group A had regular progression of diet, Group B were those who were fed early and Group C those who were given Domperidone before they were fed early. The primary outcome would be the time to regular diet tolerance. Secondary outcomes include the time of first flatus, time to ambulation out of bed, duration of intravenous infusion, duration of indwelling foley catheter and finally, length of hospital stay.

Fresh, equilibrated and post-thaw sperm quality of Brycon orbignyanus (Valenciennes, 1850) and Prochilodus lineatus (Valenciennes, 1837) treated with either salmon GnRHa and domperidone or pituitary extract

The effects of reduced doses of Ovaprim™ (GnRHa + domperidone) on sperm release of Brycon orbignyanus and Prochilodus lineatus were evaluated. Furthermore, sperm quality was compared among fresh, equilibrated and post-thaw samples. Males received a single and reduced dose of Ovaprim™ (0.125 or 0.25 ml/kg); control males received pituitary extract (cPE; 3 mg/kg). Fresh sperm was evaluated for volume, concentration, seminal plasma osmolality and seminal plasma pH. Then sperm was diluted in a freezing medium, equilibrated for 15-20 min and frozen in nitrogen vapor vessel (dry-shipper). Sperm motility was analyzed during 60 s post-activation in fresh, equilibrated and post-thaw samples. Sperm quality of males treated with Ovaprim™ (both doses) were not different from that of cPE-treated males, thus these data were pooled. In B. orbignyanus, motility was higher in fresh (99%) than in equilibrated sperm (81%); post-thaw motility dropped to 42%. In P. lineatus, motility was similar in fresh (99%) and equilibrated sperm (92%); post-thaw motility was 73%. Motility decreased as a function of time post-activation, and this decrease was significant after 60 s in fresh and equilibrated sperm, and as soon as 30 s in post-thaw sperm, in both species. Ovaprim™ at 1/4 of the recommended dose can successfully replace cPE.

O efeito de doses reduzidas de Ovaprim® (GnRHa + domperidona) na liberação do sêmen de Brycon orbignyanus e Prochilodus lineatus foi avaliado. Além disso, a qualidade do sêmen foi comparada entre as amostras frescas, equilibradas e descongeladas. Os machos receberam dose única e reduzida de Ovaprim® (0,125 ou 0,25 ml/kg); os machos-controle receberam extrato de hipófise (cPE; 3 mg/kg). O sêmen fresco foi avaliado quanto ao volume, concentração, e osmolalidade e pH do plasma seminal. Em seguida, o sêmen foi diluído num meio de congelamento, equilibrado por 15-20 min e congelado em botijão de vapor de nitrogênio (dry-shipper). A motilidade espermática foi analisada durante 60 s pós-ativação no sêmen fresco, equilibrado e descongelado. A qualidade do sêmen não diferiu entre os machos tratados com Ovaprim® (ambas as doses) ou cPE, assim foi feito um pool desses dados. Em B. orbignyanus, a motilidade foi maior no sêmen fresco (99%) do que no equilibrado (81%); a motilidade do sêmen descongelado caiu para 42%. Em P. lineatus, a motilidade foi semelhante entre o sêmen fresco (99%) e equilibrado (92%); a motilidade do sêmen descongelado foi 73%. A motilidade caiu em função do tempo pós-ativação, e essa queda foi significante após 60 s no sêmen fresco e equilibrado, e tão precoce quanto 30 s no sêmen descongelado, em ambas as espécies. Ovaprim® a 1/4 da dose recomendada pode substituir o cPE com sucesso.

Development and optimization of self microemulsifying drug delivery of domperidone

The present investigation is aimed to develop self-microemulsifying drug delivery system (SMEDDS) to improve the in vitro dissolution of a BCS (Biopharmaceutical Classification System) class II anti emetic agent, domperidone. Solubility study was performed to identify the ingredients showing highest solubility of domperidone. The ternary phase diagrams were plotted for selected components to identify the area of microemulsion existence. D-optimal mixture experimental design was applied to optimize a liquid SMEDDS using formulation variables; the oil phase X1 (Oleic acid), the surfactant X2 (Labrasol) and the co-surfactant X3 (Transcutol HP). The liquid SMEDDS were evaluated for droplet size, emulsification time, % transmittance and drug release. Stability study was performed at 40 °C/75% RH. Liquid formulation was solidified by adsorption on carrier Aerosil 300. Solid SMEDDS was evaluated and compared with liquid SMEDDS and marketed formulation. Oleic acid was selected as oil, Labrasol as surfactant and Transcutol HP as co-surfactant for formulation of SMEDDS. The optimized batch showed best results in terms of smaller droplet size (<170 nm), emulsification time (<40 s) and drug release (>85% in 15 min) and was stable for 3 months. Solid SMEDDS containing Aerosil 300 showed good flow properties and uniform drug content. XRPD study revealed that the crystalline drug was converted to amorphous form in solid SMEDDS. The rate and extent of drug dissolution from solid SMEDDS was significantly higher than pure drug and commercial tablet formulation. The results demonstrate the potential of SMEDDS as a means of improving solubility, dissolution and hence the bioavailability.

O presente estudo teve como objetivo desenvolver sistemas de liberação auto-microemulsificantes (Self-Microemulsifying Drug Delivery System - SMEDDS) de domperidona, agente antiemético, classe II, segundo o sistema de classificação Biofarmacêutica, para melhorar sua dissolução in vitro. Estudo foi realizado para identificar os componentes que revelaram maior solubilidade da domperidona. Determinaram-se os diagramas de fase ternários para esses componentes selecionados tendo em vista a identificação da região de formação da microemulsão. O planejamento experimental foi empregado para otimizar os SMEDDS líquidos, utilizando as seguintes variáveis de formulação: a fase oleosa X1 (ácido oleico), o agente tensoativo X2 (Labrasol) e co-tensoativo X3 (Transcutol HP). Os SMEDDS líquidos foram avaliados quanto às seguintes características: tamanho da gota, tempo de emulsificação,% de transmitância e liberação do fármaco. O estudo de estabilidade foi realizado a 40 °C/75% de umidade relativa. A formulação foi convertida em forma sólida por sua adsorção em Aerosil 300. Os SMEDDS sólidos foram avaliados e comparados com SMEDDS líquidos e a formulação comercializada. O ácido oléico foi selecionado para a fase oleosa, Labrasol como agente tensoativo e Transcutol como co-tensoativo para a formulação de SMEDDS. O lote otimizado mostrou os melhores resultados: menor tamanho de gota (<170 nm), menor tempo de emulsificação (<40 segundos), e de liberação do fármaco (> 85% em 15 min). Além disso, a formulação otimizada manteve-se estável no período de 3 meses. Os SMEDDS sólidos contendo Aerosil 300 apresentaram boas propriedades de fluxo e uniformidade de conteúdo do fármaco. O estudo de difração de raios-X revelou que o fármaco cristalino foi convertido para a forma amorfa, nos SMEDDS sólidos. A velocidade de dissolução do fármaco a partir dos SMEDDS sólidos foi significativamente maior, quando comparado ao fármaco livre e à formulação de comprimidos comercial. Os resultados demonstram o potencial dos SMEDDS como meio para melhorar a solubilidade, a dissolução e, consequentemente, a biodisponibilidade da domperidona.

Acupuncture effcctiveness as a complementary therapy in functional dyspepsia patients / Eficacia da acupuntura como terapia complementar em pacientes com dispepsia funcional

Context Functional dyspepsia represents a frequent gastrointestinal disorder in clinical practice. According to the Roma III criteria, functional dyspepsia can be classified into two types as the predominant sympton: epigastric pain and postprandial discomfort. Even though the pathophysiology is still uncertain, the functional dyspepsia seems to be related to multiple mechanisms, among them visceral hypersensitivity, changes in the gastroduodenal motility and gastric accommodation and psychological factors. Objective Evaluate the effectiveness of acupuncture as a complementary to conventional treatment in functional dyspepsia patients. Methods Randomized clinical trial in which were enrolled patients with functional dyspepsia patients in according with Rome III criteria. One group was submitted to drug therapy and specific acupuncture (GI) and the other to drug therapy and non-specific acupuncture (GII). The gastrointestinal symptoms, presence of psychiatric disorders and quality of life were evaluated, at the end and three months after treatment. Results After 4 weeks of treatment there was improvement of gastrointestinal symptoms in Group I (55 ± 12 vs 29 ± 8.8; P = 0.001) and Group II (50.5 ± 10.2 vs 46 ± 10.5; P = 0.001). Quality of life was significantly better in Group I than group II (93.4 ± 7.3 vs 102.4 ± 5.1; P = 0.001). Anxiety (93.3% vs 0%; P = 0.001) and depression (46.7% vs 0%; P = 0.004) were significantly lower in Group I than group II. When comparing the two groups after 4 weeks of treatment, gastrointestinal symptoms (29 ± 8.8 vs 46 ± 10.5; P<0.001) and quality of life (102.4 ± 5.1 vs 96 ± 6.1; P = 0.021) were significantly better in Group I than group II. Three months after the treatment, gastrointestinal symptoms remained better only in Group I, when compared to the pre-treatment values (38 ± ...

Contexto A dispepsia funcional representa uma frequente desordem gástrica da prática clínica. Segundo os critérios de Roma III, pode ser subdividida em dois tipos: do tipo dor epigástrica e tipo desconforto pós prandial, de acordo com o sintoma predominante. Embora de fisiopatologia incerta, a dispepsia funcional parece estar relacionada a múltiplos mecanismos, entre eles: a hipersensibilidade visceral, alterações da motilidade gastroduodenal e acomodação gástrica e participação de fatores psíquicos. Objetivos Avaliar a eficácia da acupuntura como forma complementar ao tratamento medicamentoso em pacientes com dispepsia funcional. Método Ensaio clínico randomizado, com portadores de dispepsia funcional, segundo os critérios de Roma III. Dois grupos foram formados: Grupo I (terapia medicamentosa e acupuntura específica) e; II (terapia medicamentosa e acupuntura não específica). Foram avaliados o índice de sintomas gastrointestinais, a presença de transtornos psíquicos e a qualidade de vida no início, no fim e 3 meses após o tratamento. Resultados Após 4 semanas de tratamento houve melhora dos sintomas gastrointestinais no Grupo I (55 ± 12 vs 29 ± 8,8; P = 0,001) e no Grupo II (50 ± 10 vs 46 ± 10,5; P = 0,001). Na comparação intergrupos, os sintomas gastrintestinais (29 ± 8,8 vs 46 ± 10,5; P<0,001) e os sintomas de ansiedade (0% vs 41,7%; P = 0,003) foram significativamente menores no Grupo I e a qualidade de vida (102,4 ± 5,1 vs 96,4 ± 6,1; P = 0,021) também foi significativamente melhor neste grupo. Três meses após o tratamento, os sintomas gastrointestinais permaneceram melhores no Grupo I, quando comparados aos valores pré-tratamento (38 ± 11,3 vs 55 ...

Randomized controlled trial of modified banxia houpo decoction in treating functional dyspepsia patients with psychological factors / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effect of Modified Banxia Houpo Decoction (MBHD) in treating patients with functional dyspepsia (FD) accompanied with psychological factors, and to compare it with Domperidone, Neurostan, and Domperidone + Neurostan.</p><p><b>METHODS</b>Recruited were 89 FD patients accompanied with anxiety and/or depression, who were randomly assigned to four groups, i.e., the MBHD group (23 cases), the Domperidone group (22 cases), the Neurostan group (22 cases), and the Domperidone + Neurostan group (22 cases). Corresponding medication lasted for4 weeks. The psychological scoring was performed using Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA). The improvement rate of FD symptoms, the ratios of FD symptoms scoring <2, and the improvement rate of FD symptoms >50% were calculated by the scoring of FD symptoms. The gastric emptying rates of patients in each group were compared using the examinations of gastric emptying.</p><p><b>RESULTS</b>There was no statistical difference in pre-treatment HAMD, HAMA, FD symptoms scoring, and the gastric emptying rate among the 4 groups (P >0.05). The psychological scoring and FD symptoms scoring significantly decreased in the 4 groups except the Domperidone group after 4-week treatment (P<0.01, P <0.05). The psychological scoring and FD symptoms scoring were obviously lower in the MBHD group than in the Domperidone group (P <0.05). The improvement rate of FD symptoms, the ratios of FD symptoms scoring <2, and the improvement rate of FD symptoms >50% were the highest in the Domperidone + Neurostan group, followed by the MBHD group, and then the Domperidone group. After treatment the gastric emptying rate obviously increased in each treatment group when compared with before treatment in the same group (P <0. 01), and there was no statistical difference among these groups after treatment.</p><p><b>CONCLUSIONS</b>MBHD had certain therapeutic effects on FD patients accompanied with psychological factors. Its effect was associated with gastric emptying. Besides, its improvement of the psychological state and symptoms was superior to that of Domperidone.</p>

Effects of tongfu decoction on rats' rapid gastric emptying / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effects of Tongfu Decoction (TFD) on the gastric emptying of normal rats, thus exploring whether it could promote gastric emptying rapidly.</p><p><b>METHODS</b>Thirty Sprague-Dawley (SD) rats were randomly divided into 3 groups, i.e., the normal control group, the domperidone group, and the TFD group, 10 in each group. They were respectively administered with normal saline, the domperidone suspension, and TFD by gastrogavage. Thirty min later the gastric emptying of mice was detected by single photon emission computed tomography technology (SPECT) labeled with 99m Tc-DTPA, and the gastric half-emptying time and the gastric emptying rate were calculated.</p><p><b>RESULTS</b>The gastric half-emptying time was (19.0 +/-1.7) min in the normal control group, (12.9 +/- 3.4) min in the domperidone group, and (12.7 +/- 4.1) min in the TFD group. Compared with the normal control group, the gastric half-emptying time was significantly shortened in the domperidone group and the TFD group (P <0.05). The gastric emptying rate at 15 min was 41.1% +/- 5. 8% in the normal control group, 52.9% +/- 10.9% in the domperidone group, and 56.0% +/- 10.3% in the TFD group, while at 30 min it was 65.6% +/- 2.8%, 72.9% +/- 2.6%, and 72.4% +/- 4.9%, respectively. Compared with the normal control group, the gastric emptying rate at 15 min and 30 min both significantly increased in the domperidone group and the TFD group (P <0.05). There was no statistical difference in the gastric half-emptying time or the gastric emptying rate between the two groups (P >0.05).</p><p><b>CONCLUSION</b>TFD showed similar effects as domperidone in rapidly promoting gastric emptying, and could shorten the gastric half-emptying time in normal rats.</p>

Efficacy controlled observation on acupuncture and western medicine for gastrointestinal dysmotility in liver cirrhosis / 中国针灸

<p><b>OBJECTIVE</b>To observe the therapeutic effect of acupuncture on gastrointestinal dysmotility in liver cirrhosis.</p><p><b>METHODS</b>Forty cases of gastrointestinal dysmotility in liver cirrhosis were randomized into an acupuncture group and a motilium group, 20 cases in each one. In the acupuncture group, on the basis of the conventional treatment, electroacupuncture was applied at Zusanli (ST 36), Sanyinjiao (SP 6) and Taichong (LR 3) for 30 min, once a day. In the motilium group, on the basis of the conventional treatment, motilium was taken orally 30 min before meals, 10 mg each time, three times a day. The treatment was required for 2 weeks in both groups. The changes in the digestive tract symptom score and liver function Child-Pugh score were observed and the efficacy was assessed.</p><p><b>RESULTS</b>The total effective rate of digestive tract symptoms was 85.0% (17/20) in the acupuncture group and 70.0% (14/20) in the motilium group. The score improvements in abdominal distention, belching and vomiting in the acupuncture group were superior to those in the motilium group (all P < 0.05). In the acupuncture group, the liver function Child-Pugh total score was 8.40 +/- 0.22 before treatment and reduced to 5.36 +/- 0.17 after treatment, in which the scores for ascites, serum bilirubin and albumin were all reduced (all P < 0.05) and the reducing range was increased in tendency with the improvements in digestive tract symptoms. In the motilium group, Child-Pugh score was not changed obviously as compared with that before treatment. CONCLUSION Acupuncture effectively alleviates digestive tract symptoms and improves liver function for the patients of liver cirrhosis, its efficacy on gastrointestinal dysmotility in liver cirrhosis is superior to motilium.</p>

Optimal Duration of Medical Treatment in Superior Mesenteric Artery Syndrome in Children

The aim of this study was to investigate the outcome, and optimal duration of medical treatment in children with superior mesenteric artery syndrome (SMAS). Eighteen children with SMAS were retrospectively studied. The data reviewed included demographics, presenting symptoms, co-morbid conditions, clinical courses, nutritional status, treatments, and outcomes. The three most common symptoms were postprandial discomfort (67.7%), abdominal pain (61.1%), and early satiety (50%). The median duration of symptoms before diagnosis was 68 days. The most common co-morbid condition was weight loss (50%), followed by growth spurt (22.2%) and bile reflux gastropathy (16.7%). Body mass index (BMI) was normal in 72.2% of the patients. Medical management was successful in 13 patients (72.2%). The median duration of treatment was 45 days. Nine patients (50%) had good outcomes without recurrence, 5 patients (27.8%) had moderate outcomes, and 4 patients (22.2%) had poor outcomes. A time limit of >6 weeks for the duration of medical management tended to be associated with worse outcomes (P=0.018). SMAS often developed in patients with normal BMI or no weight loss. Medical treatment has a high success rate, and children with SMAS should be treated medically for at least 6 weeks before surgical treatment is considered.

Effects of Histamine on Cultured Interstitial Cells of Cajal in Murine Small Intestine

Interstitial cells of Cajal (ICCs) are the pacemaker cells in the gastrointestinal tract, and histamine is known to regulate neuronal activity, control vascular tone, alter endothelial permeability, and modulate gastric acid secretion. However, the action mechanisms of histamine in mouse small intestinal ICCs have not been previously investigated, and thus, in the present study, we investigated the effects of histamine on mouse small intestinal ICCs, and sought to identify the receptors involved. Enzymatic digestions were used to dissociate ICCs from small intestines, and the whole-cell patch-clamp configuration was used to record potentials (in current clamp mode) from cultured ICCs. Histamine was found to depolarize resting membrane potentials concentration dependently, and whereas 2-PEA (a selective H1 receptor agonist) induced membrane depolarizations, Dimaprit (a selective H2-agonist), R-alpha-methylhistamine (R-alpha-MeHa; a selective H3-agonist), and 4-methylhistamine (4-MH; a selective H4-agonist) did not. Pretreatment with Ca(2+)-free solution or thapsigargin (a Ca(2+)-ATPase inhibitor in endoplasmic reticulum) abolished the generation of pacemaker potentials and suppressed histamine-induced membrane depolarization. Furthermore, treatments with U-73122 (a phospholipase C inhibitor) or 5-fluoro-2-indolyl des-chlorohalopemide (FIPI; a phospholipase D inhibitor) blocked histamine-induced membrane depolarizations in ICCs. On the other hand, KT5720 (a protein kinase A inhibitor) did not block histamine-induced membrane depolarization. These results suggest that histamine modulates pacemaker potentials through H1 receptor-mediated pathways via external Ca2+ influx and Ca2+ release from internal stores in a PLC and PLD dependent manner.

The role of prolactin in prostatic inflammation / O papel da prolactina na inflamação prostática

Several reports have shown that prolactin (PRL) plays a role in prostatic growth, but few studies considered the role of PRL in the process of prostatic inflammation. Young (45 ± 5 days old) and adult (75 ± 5 days old) male Wistar rats were subcutaneously injected daily with domperidone (4.0 mg.kg-1) to maintain high serum PRL levels. The animals were treated for 15, 30, 45 or 60 days. Blood and prostate samples were collected at the end of each treatment for PRL dosage and histological analysis, respectively. Only young animals treated with DOMP for 15 and 30 days displayed inflammatory infiltrate in the prostate. These results confirm literature data in regards to PRL involvement in inducing prostate inflammation. Moreover, it was concluded that young animals are more susceptible then adults to the PRL action concerning prostate inflammation...

A prolactina (PRL) influencia o crescimento prostático, entretanto poucos estudos investigaram o papel da PRL na inflamação prostática. Ratos Wistar jovens (45 ± 5 dias de idade) e adultos (75 ± 5 dias de idade) receberam injeções subcutâneas diárias de domperidona (4,0 mg.kg-1) para manter níveis séricos altos de PRL. Os animais foram tratados por 15, 30, 45 ou 60 dias. Amostras de sangue e próstata foram coletadas ao final dos tratamentos para dosagem de PRL e análise histológica, respectivamente. Apenas os animais jovens tratados com domperidona por 15 e 30 dias apresentaram infiltrado inflamatório na próstata. Esses resultados confirmaram a participação da PRL na indução da inflamação prostática. A conclusão obtida foi que animais jovens são mais susceptíveis à ação da PRL na inflamação da próstata que os adultos...

[Efficacy of domperidone and pyridostigmine in the treatment of patients with functional dyspepsia: a randomized clinical trial]

The majority of dyspeptic patients do not have identifiable disease, which is also known as functional dyspepsia. The therapeutic approach to patients with functional dyspepsia is still a matter of debate; prokinetic agents are commonly used for symptom relief. This study aims to evaluate the efficacy of domperidone and pyridostigmine [an inhibitor of cholinesterase] in patients with functional dyspepsia. This was a single-blind, randomized clinical trial performed on 117 patients [December 2007 to November 2009] diagnosed with functional dyspepsia according to ROME II criteria. The effects of 4 weeks of treatment with domperidone [10 mg tid], yridostigmine [60 mg tid], and placebo were compared. We scored each patient according to VAS to rank the severity of 8 different upper GI symptoms [epigastric fullness, early satiety, gnawing, nausea, vomiting, belching, bloating, and epigastric pain] both before and at the end of treatment. Data were entered into SPSS software version 16 and analyzed. P<0.05 was considered significant. At the end of treatment, the total dyspeptic symptom score decreased from 24 to 13. According to ANOVA, there were significant differences between the 3 groups in 3 out of 8 symptom scores of bloating [p=0.039], early satiety [p=0.006], and nausea [p=0.016]. The post hoc test determined that domperidone was more effective than pyridostigmine and placebo in improvement of early satiety [p=0.038 and p=0.014, respectively]. Domperidone was more effective than pyridostigmine in the control of nausea [p=0.024]. Domperidone [p=0.023] and pyridostigmine [p=0.042] were superior in relieving bloating symptoms compared to placebo. Overall, in the control of GI symptoms domperidone was more effective than placebo [p=0.045]. domperidone and pyridostigmine are useful in improving bloating, early satiety, and nausea. However they are similar to placebo in controlling epigastric pain, fullness, belching and gnawing

Trastornos funcionales gastrointestinales: metoclopramida, domperidona y trimebutina / Functional gastrointestinal disorders: metoclopramide, domperidone and trimebutine

Muchos de los síntomas digestivos en niños, no están asociados a cambios patológicos, osea, en los trastornos funcionales no hay alteración en la mucosa, como tampoco en la endoscopia. Estas alteraciones son muy amplias, no solamente incluye el reflujo gastroesofágico. Los procinéticos aumentan la actividad colinérgica. La metoclopramida, es un antagonista dopaminérgico que aumenta el tono del esfínter esofágico inferior y mejora el vaciamiento gástrico. La domperidona, es un antagonista periférico de la dopamina con propiedades procinéticas y antieméticas. La trimetutina, es un regulador de la motilidad del tracto digestivo inferior.

Many of the gastrointestinal symptoms in children are not associated with pathological changes, that is, in functional disorders there is no alteration in the mucosa, nor in endoscopy. These changes are extensive, not only includes gastroesophageal reflux. Prokinetics increase cholinergic activity. Metoclopramide is a dopaminergic antagonist that increases lower esophageal sphincter tone and enhances gastric emptying. Domperidone is a peripheral dopamine antagonist with prokinetic and antiemetic properties. Trimetubine, is a regulator of the lower digestive tract motility.