Dexmedetomidine vs. propofol sedation reduces the duration of mechanical ventilation after cardiac surgery - a randomized controlled trial.

OBJECTIVE: The aim of our study was to compare the clinical effects of sedation with dexmedetomidine vs. propofol in patients undergoing cardiac surgery and analyze their effects on the duration of mechanical ventilation (MV), length of stay in the intensive care unit (ICU), and total hospital stay. PATIENTS AND METHODS: The study included 120 patients who were randomized in a 1:1 ratio into two groups of 60 patients. The first group was sedated with continuous dexmedetomidine in doses 0.2-0.7 mcg/kg/h. The second group was sedated with propofol in doses 1-2 mg/kg/h. RESULTS: Patients sedated with dexmedetomidine required 2.2 hours less time on MV (p<0.001). There was a positive correlation between the duration of MV and the ICU length of stay (r=0.368; p<0.001), as well as between the duration of MV and the total hospital stay (r=0.204; p=0.025). Delirium occurred in the postoperative period in 25% of patients sedated with propofol, while in the dexmedetomidine group it was only 11.7% (p=0.059). Patients who developed delirium had a significantly longer duration of MV (12.6±5.4 vs. 9.3±2.5 hours, p=0.010). CONCLUSIONS: Postoperative sedation with dexmedetomidine, compared to propofol, reduces the duration of MV, but does not influence the length of stay in the ICU and length of hospitalization after open heart surgery.

Molar Incisor Hypomineralization: Prevalence and severity in six to nine-year-old Sarajevo children.

AIM: Research aimed to gather aepidemiological parameters of MIH from a sample of Sarajevo children born between the years 1999 and 2003. Prevalence of MIH, distribution according to severity (mild vs. moderate/severe cases) and distribution according to phenotypes (MIH vs MH) were investigated. MATERIALS AND METHODS: Study design: This was a cross-sectional, observational, aepidemiological study that was conducted on a sample of 446 children aged 6 to 9 years. It was conducted as a part of regular dental screening of children attending a randomly selected primary school in the Bosnian capital city of Sarajevo. RESULTS: The overall prevalence of MIH was 11.5%. MIH prevalence varied between 19.9% of examinees born in year 2002 to 8.4% among those born in 2003. Number of teeth affected varied from 1 to 7. The average number of affected teeth was 3.82 ± 1.46. Demarcated opacities were recorded on 13.89%, post-eruptive enamel breakdown on 11.28% and atypical filling on 6.2% index teeth. Mild cases of MIH were rare in our sample, 18% of subject had only demarcated opacities present. A smaller percentage of examinees (35.3%) had hypomineralisation present only on first permanent molars (MH group). Out of 64.7% of subjects in MIH group, 37.25% had one incisor affected and 21.57% had two incisors affected. CONCLUSION: Over 80% of study subjects with MIH were categorised as moderate/severe case of MIH and they represent a major problem with regards to dental treatment. It is necessary to plan a multi-disciplinary approach for dental care of this population. It is necessary to educate primary care dentists to recognise this condition and provide recommended treatment to patients with mild clinical picture, while directing those with more severe problems to specialised doctors.

Deconvolution of 238,239,240Pu conversion electron spectra measured with a silicon drift detector.

Internal conversion electron (ICE) spectra of thin 238,239,240Pu sources, measured with a windowless Peltier-cooled silicon drift detector (SDD), were deconvoluted and relative ICE intensities were derived from the fitted peak areas. Corrections were made for energy dependence of the full-energy-peak counting efficiency, based on Monte Carlo simulations. A good agreement was found with the theoretically expected internal conversion coefficient (ICC) values calculated from the BrIcc database.

Stability Limits and Defect Dynamics in Ag Nanoparticles Probed by Bragg Coherent Diffractive Imaging.

Dissolution is critical to nanomaterial stability, especially for partially dealloyed nanoparticle catalysts. Unfortunately, highly active catalysts are often not stable in their reactive environments, preventing widespread application. Thus, focusing on the structure-stability relationship at the nanoscale is crucial and will likely play an important role in meeting grand challenges. Recent advances in imaging capability have come from electron, X-ray, and other techniques but tend to be limited to specific sample environments and/or two-dimensional images. Here, we report investigations into the defect-stability relationship of silver nanoparticles to voltage-induced electrochemical dissolution imaged in situ in three-dimensional detail by Bragg coherent diffractive imaging. We first determine the average dissolution kinetics by stationary probe rotating disk electrode in combination with inductively coupled plasma mass spectrometry, which allows in situ measurement of Ag+ ion formation. We then observe the dissolution and redeposition processes in single nanocrystals, providing unique insight about the role of surface strain, defects, and their coupling to the dissolution chemistry. The methods developed and the knowledge gained go well beyond a "simple" silver electrochemistry and are applicable to all electrocatalytic reactions where functional links between activity and stability are controlled by structure and defect dynamics.

[DIET CHARACTERISTICS IN PATIENTS WITH CHRONIC KIDNEY DISEASE].

Because of the increasing number of patients, chronic kidney disease (CKD) has become a significant public health problem. As kidney function decreases, it is necessary to introduce certain dietary modifications. The aim was to investigate what is the appropriate approach to diet of CKD patients, which could contribute to slowing down progression of the disease. Dietary recommendations are individual for each patient, but also vary in the same patient depending on the stage of disease progression because special attention must be paid to appropriate intake of macronutrients (protein, carbohydrates and fats), micronutrients (sodium, potassium, calcium, phosphorus, zinc, selenium, various vitamins), and water. In newly diagnosed patients, it is necessary to assess their nutritional status and energy requirements. It has been shown that protein-energy malnutrition, muscle loss and cachexia are strong predictors of mortality in CKD. Comparing different dietary approaches in everyday life of patients suffering from CKD, it was found that the most effective diet is Mediterranean food style. Studies confirm that Mediterranean diet has a preventive effect on renal function and reduces progression of the disease. Preventive measures, correct identification and early intervention can increase survival of patients and improve their quality of life. Mediterranean diet tailored to individual stages of CKD has been confirmed as the best choice in CKD patients.

[NEPHROTOXIC DRUGS].

Renal tissue is sensitive to the effect of potentially nephrotoxic drugs and other substances that are available over-the-counter or can be purchased at healthy food stores or elsewhere, and harmful substances from the environment. The harmful effects of these substances lead to the development of recognizable clinical syndromes, including acute or chronic renal failure, tubulopathy, and proteinuria. Risk factors that influence the development of kidney disease induced by drugs are divided into those related to patient characteristics, drug characteristics, and renal function. Drugs that commonly exhibit nephrotoxic effects are analgesics, antimicrobials, chemotherapeutics, contrast agents, immunosuppressants, herbal preparations and substances containing heavy metals. Family physician must carefully observe their patients, nurturing individual approach to drug selection and determining the dose. Renal function can quickly return to normal if the damage is recognized on time. Recent research yields insights into the identification of new biomarkers that will contribute to early detection of drug induced kidney damage.

[PATHOPHYSIOLOGY OF THE CARDIORENAL SYNDROME].

Cardiorenal syndrome, a complex pathophysiological disorder of both the heart and kidneys, is a condition in which acute or chronic damage to one organ can lead to acute or chronic dysfunction of the other organ. Depending on primary organ dysfunction and disease duration, there are five different types of cardiorenal syndrome. Type 1 cardiorenal syndrome (acute cardiorenal syndrome) is defined as acute kidney injury caused by sudden decrease in heart function. Type 2 cardiorenal syndrome (chronic cardiorenal syndrome) refers to chronic kidney disease linked to chronic heart failure. Type 3 cardiorenal syndrome (acute renocardial syndrome) is caused by acute kidney injury that leads to heart failure. Type 4 cardiorenal syndrome (chronic renocardial syndrome) includes chronic heart failure due to chronic kidney disease. Type 5 cardiorenal syndrome (secondary cardiorenal syndrome) is reversible or irreversible condition marked by simultaneous heart and kidney insufficiency, as a result of multiorgan disease such as sepsis, diabetes mellitus, sarcoidosis, amyloidosis, etc. The pathophysiological patterns of cardiorenal syndrome are extremely complicated. Despite numerous publications, perplexed physiological, biochemical and hormonal disturbances as parts of the main pathogenic mechanisms of cardiorenal syndrome remain obscure. Even though there are guidelines for the treatment of patients with heart failure and chronic kidney disease, similar guidelines for the treatment of cardiorenal syndrome are lacking. In everyday practice, it is crucial to diagnose cardiorenal syndrome and use all diagnostic and therapeutic procedures available to prevent or alleviate kidney and heart failure.

[APPROACH TO A PATIENT WITH DYSPEPSIA IN FAMILY MEDICINE PRACTICE].

Dyspepsia is a common symptom among patients in family medicine practice. The prevalence in adult population is about 40%. Two-thirds of patients have functional dyspepsia. Clinical assessment, diagnostic procedures and treatment of patients depend on the age, symptoms and Helicobacter pylori infection. In patients with dyspepsia, it is necessary to assess the potential impact of other concurrent diseases and medications that the patient regularly uses. Prompt or early endoscopy is recommended in patients with newly detected dyspepsia older than 50 and presenting with alarming symptoms. In persons younger than 50, the recommended strategy is 'test and treat'. In some patients, treatment is carried out by acid suppression. In patients failing to achieve success in treatment, further endoscopic diagnosis is indicated. Ultrasound diagnostics in primary care can significantly contribute to diagnostic evaluation and early treatment in patients with hepatobiliary and pancreas diseases presenting with symptoms of dyspepsia. Treatment of concurrent mental disorders can improve the symptoms of dyspepsia. Treatment of patients who do not respond to the recommended treatment strategies is a challenge for family physicians. Regular visits and psychotherapeutic support in these patients can reduce the level of anxiety and encourage the patient for treatment of psychological morbidity, as well as his efforts in healthy behavior.

[GASTROESOPHAGEAL REFLUX DISEASE ­ A MULTIFACETED DISEASE].

Gastric content reflux to the esophagus is a physiological phenomenon that occasionally occurs after meal. Gastroesophageal reflux disease (GERD) is a state that appears when the quantity of gastric content surpasses its physiological elimination from the esophagus and causes difficulties with or without associated esophageal mucosa damage, as well as alarming symptoms. The symptoms are defined as alarming if they disturb the patient's well-being and are the reason for a visit to the physician. The prevalence of GERD in the Western world is 10%-20% and is based on the estimation of the heartburn incidence as the leading symptom. The dominant symptoms are heartburn and regurgitation, especially after a heavy meal, and are highly specific for GERD. Extraesophageal reflux disease represents a wide range of symptoms connected to the upper and lower respiratory system, such as cough, laryngitis, asthma, chronic obstructive pulmonary disease, hoarseness, sinusitis-postnasal drip syndrome, otitis media, recurrent pneumonia and laryngeal carcinoma. The following tests are used in the reflux differential diagnosis: esophagogastroscopy, laryngoscopy and 24-hour pH monitoring. Patients suspected to suffer from GERD are initially treated with empirical proton pump inhibitor therapy twice a day for one to two months.

[PATIENT WITH PEPTIC ULCER DISEASE].

Peptic ulcer disease is represented by a lesion in the mucosa of the digestive tract due to imbalance of its aggressive and protective mechanisms. The main external factors of the development of peptic ulcers are Helicobacter pylori infection and the use of non-steroidal anti inflammatory drugs (NSAIDs) and acetylsalicylic acid (ASA). Symptoms of peptic ulcer disease are a common reason for visiting the family physician. All patients with symptoms of dyspepsia under the age of 50 and without the alarm symptoms should be tested whether H. pylori is present by performing the Urea Breath Test or stool antigene testing, and infection, if found, should be treated. Endoscopic examination is obligatory in patients older than 50 years and those with alarm symptoms. "Sequential therapy" is recommended in Croatia as the first-line treatment of H. pylori infection, or triple therapy that comprises applying a proton pump inhibitor (PPI) in combination with amoxicillin and metronidazole. Four weeks after eradication therapy the control testing for H. pylori should be performed.

PHYTO-INDICATORS IN DETECTION OF LINDANE RESIDUES IN WATER.

Intensive use of pesticides, especially insecticides, in agriculture during the past several decades has already led to contamination of surface and underground waters and sediments in some regions, thus presents a serious problem for the environment. Lindane was one of frequently applied insecticides for soil treatment. In Serbia, it has been in use since 1944, but in the period 2001-2007 its use was restricted only to timber treatments. In 2009 an international ban on the use of lindane in agriculture was implemented under the Stockholm Convention on Persistent Organic Pollutants. However, due to a long-term use and persistence, its residues can be present in underground water and sediment, thus present a potential risk for incorporation in food chains. According to Directive 2008/105/EC it is listed as one of the priority water pollutants, whose presence is mainly detected by chemical methods. However, biological tests are gaining in importance in the last few years and since some plant species are highly sensitive to certain pollutants. This work aimed to assess potential of white mustard (Sinapis alba L.), cucumber (Cucumis sativus L.) and barley (Hordeum vulgare L.) as phyto-indicators of water contamination with lindane. The effect of lindane (rates 0.1 µg a.i./L--maximal allowable concentration (MAC) in water; 0.2; 0.5; 1 and 2 µg a.i./L) was assessed on physiological (germination energy and germination- %) and morphological parameters (root and shoot lengths, fresh and dry weights) of tested species. Assay was carried out using slightly modified filter paper method recommended by ISTA Regulations book (2011). The experiment was set in four replicates. Data were processed using Duncan's multiple range test for determining the differences between treatments for confidence interval 95%. Results of bioassay indicate that germination energy (70.75%) and germination (79.00%) of white mustard were significantly inhibited by lindane applied at MAC rate compared to the control (79.75, 82.00%, respectively). Physiological parameters of other test species were not affected by this insecticide. Lindane inhibited root elongation of barley seedlings at 2 µg a.i./L (20-fold MAC) and of cucumber at 0.5 µg a.i./L (5-fold MAC). Only fresh root weight of barley was inhibited by lindane at MAC quantities. Based on presented results, valid and reliable indicators of lindane presence in water can be considered germination energy and germination of white mustard and fresh root weight of barley seedlings.

[Appendicitis in puerperium--case report].

Acute appendicitis in puerperium is often diagnosed too late, because clinical signs can be unrelaible. Abdominal wall rigidity is rarely noticed in puerpeium because of weak abdominal wall muscles, laboratory parameters are not enough relaible and atip cal appendix presentation makes dificulties in diagnosis. Knowing clinical signs and symptoms of appendicitis, possible complications and their early detection, make a chanse for a good surgical outcome. Measuring of axillar and rectal temperature can take confusion in, and prolong time until surgical treatment. Leucocytosis in puerperium is not valid for diagnosis. We report a case of patient in puerperium with high laboratory infection parameters. Diagnosis of appendicitis is made based on clinical signs and symptoms, that is proved intraoperatively and histologicaly. Appendectomy without perforation carries less risks for mother and fetus.

Mediators released from LPS-challenged lungs induce inflammatory responses in liver vascular endothelial cells and neutrophilic leukocytes.

The systemic inflammatory response plays an important role in the progression of acute lung injury (ALI) to multiple organ dysfunction syndrome (MODS). However, the role of lung-derived inflammatory mediators in induction of the inflammatory response in remote organs is poorly understood. To address the above, we investigated the effects of lung inflammation on induction of inflammatory response(s) in the liver in vitro. Inflammation in mouse lungs was induced by intranasal administration of lipopolysaccharide (LPS; 1 mg/ml) followed by mechanical ventilation using the isolated perfused mouse lung method to obtain and characterize lung perfusate from the pulmonary circulation. LPS administration to mouse lungs resulted in an increased release of inflammation-relevant cytokines and chemokines into the perfusate (Luminex assay) compared with the saline-controls. Subsequently, primary mouse liver vascular endothelial cells (LVEC) or mouse polymorphonuclear leukocytes (PMN) in vitro were stimulated with the perfusate obtained from saline- or LPS-challenged lungs and assessed for various inflammation-relevant end points. The obtained results indicate that stimulation of LVEC with perfusate obtained from LPS-challenged lungs results in 1) reactive oxygen species (ROS) production; 2) activation of NF-kappaB; and 3) expression of E-selectin, ICAM-1, and VCAM-1 and a subsequent increase in PMN rolling and adhesion to LVEC. In addition, perfusate from LPS-challenged lung induced activation of PMN with respect to increased ROS production and upregulation of cell surface levels of adhesion molecules MAC-1 and VLA-4. Heat-inactivation of the perfusate obtained from LPS-challenged lungs was very effective in suppressing increased proadhesive phenotype (i.e., E-selectin and ICAM-1 expression) in LVEC, whereas targeted inhibition (immunoneutralization) of TNF-alpha and/or IL-6 in LPS-lung perfusate had no effect. Taken together, these findings indicate that multiple proinflammatory mediators (proteinaceous in nature) released from inflamed lungs act synergistically to induce systemic activation of circulating PMN and promote inflammatory responses in liver vascular endothelial cells.

The photoresponse of spray-coated and free-standing carbon nanotube films with Schottky contacts.

We report on the photocurrent response of carbon nanotube (CNT) films attached to metallic electrodes. By varying the electrode material, we show that the height of the Schottky barrier at the CNT-metal interface is responsible for the relative magnitude of the photocurrent. We find that the time response associated with this photocurrent varies with the spacing between the electrodes and with the method used to fabricate the CNT film. We also calculate the fill factor associated with these devices to be approximately 25%, independently of the type of the CNT film.

The role of non-covalent interactions in electrocatalytic fuel-cell reactions on platinum.

The classic models of metal electrode-electrolyte interfaces generally focus on either covalent interactions between adsorbates and solid surfaces or on long-range electrolyte-metal electrostatic interactions. Here we demonstrate that these traditional models are insufficient. To understand electrocatalytic trends in the oxygen reduction reaction (ORR), the hydrogen oxidation reaction (HOR) and the oxidation of methanol on platinum surfaces in alkaline electrolytes, non-covalent interactions must be considered. We find that non-covalent interactions between hydrated alkali metal cations M(+)(H(2)O)(x) and adsorbed OH (OH(ad)) species increase in the same order as the hydration energies of the corresponding cations (Li(+) >> Na(+) > K(+) > Cs(+)) and also correspond to an increase in the concentration of OH(ad)-M(+)(H(2)O)(x) clusters at the interface. These trends are inversely proportional to the activities of the ORR, the HOR and the oxidation of methanol on platinum (Cs(+) > K(+) > Na(+) >> Li(+)), which suggests that the clusters block the platinum active sites for electrocatalytic reactions.

Molar-incisor-hypomineralisation impact on developmental defects of enamel prevalence in a low fluoridated area.

AIM: This was to study the impact of molar-incisor-hypomineralisations on developmental defects of enamel (DDE) prevalence. Additionally, to present the prevalence of DDE and molar-incisor-hypomineralisations (MIH) in 12-year old children in Bosnia and Herzegovina (BH) who live in an area with low natural fluoride content in the drinking water (less than 0.1 ppm). METHODS: As a part of the oral health study of 12-year-olds, information about DDE and MIH were collected from a random sample of 560 children. To study the impact of MIH on DDE, a secondary database was developed to determine if and to what extent did MIH affect epidemiological parameters of DDE. The analyses focused on differences in DDE values between the main sample and sub-sample of participants in which those diagnosed with both MIH and DDE were excluded. Research results were analysed using percentages, arithmetic mean value, standard deviation and linear regression. RESULTS: In the main sample MIH prevalence was 12.3%. The DDE prevalence was 32.8% with the highest frequency being demarcated opacities. DDE prevalence, calculated without MIH examinees, was 21.4%. A strong positive correlation was found between MIH and DDE prevalence in different geographic locations (r=0.9, p=0.0008). CONCLUSIONS: Molar-incisor-hypomineralisation prevalence has a strong positive correlation with prevalence of developmental defects of enamel. Prevalence of DDE after excluding MIH examinees fell from 32.8% to 21.4%, which was a noticeable difference. Separate registration of these two conditions should be considered.

Relationships between socioeconomic backgrounds, caries associated microflora and caries experience in 12-year-olds in Bosnia and Herzegovina in 2004.

AIM: To present the prevalence of dental caries in Bosnia and Herzegovina (BH), to estimate the levels of salivary mutans streptococci and lactobacilli and compare them with caries prevalence in 12-years-old children from different socioeconomic backgrounds. STUDY DESIGN AND METHODS: A survey was carried out in 8 cantons of the Federation of BH (FBH) and in Republic Srpska (RS) in 2004. The final sample included 560 12-year-olds. The clinical examinations focused on dental status, expressed as DMFT index, and they were carried out by one examiner, following WHO standard methodologies. Additionally, the study involved 109 12-years old children from Sarajevo, divided in three groups, based on their socioeconomic background. For measuring lactobacillus and mutans streptococci (MS) count in saliva Dentocult LB and Dentocult SM-Strip Mutans were used. Levels of MS and lactobacilli were expressed as a score between 0 and 3, indicating very low to very high levels of SM and lactobacilli. RESULTS: The average DMFT of the 12-year-olds was 4.16+/-2.92. On average, 91% of the 12-year-olds were affected with dental caries. The SiC Index was 7.41+/-3.31. Investigating the relationship between caries associated microflora and caries experience in children of different socioeconomic status showed the following: significant difference in caries prevalence was found in children with different living conditions, where children with high socioeconomic status had better oral health compared to the other two groups. For mutans streptococci, 25.7% of the children had mutans class 0, 24.8% class 1, 34.9% class 2 and 14.6% class 3. The mean DMFT for mutans class 0 was 3.50, for class 1 was 4.30, for class 2 was 5.62 and for class 3 was 6.0. For lactobacilli, 38.5% of the children had lactobacilli class 0, 25.7% class 1, 23.9% class 2 and 11.9% class 3. The mean DMFT for lactobacilli class 0 was 4.3, for class 1 was 4.9, for class 2 was 4.8 and for class 3 was 6.0. No significant differences in the level of mutans streptococci and lactobacilli were found between the groups. CONCLUSION: There is moderate caries prevalence among BH 12-year-olds (DMFT 4.16+/-2.92). Caries experience varies between children with different living condition but no relation between levels of salivary mutans streptococci and lactobacilli and socioeconomic status of children could be found.

Isolated ventricular noncompaction in patients with chronic renal failure.

Isolated ventricular noncompaction is a rare congenital disorder characterized by the presence of numerous prominent trabeculations and deep intratrabecular recesses which communicate with the ventricular cavity. This disease has a very bad prognosis. Two cases of isolated ventricular noncompaction in patients with chronic renal failure have been described. The first case is a 65-year-old male, on regular hemodialysis for 3.5 years due to mesangioproliferative glomerulonephritis. He was symptomless regarding signs of congestive heart failure, angina pectoris, systemic embolization or arrhythmia. The second case is a patient with chronic renal failure (due to renal calculosis) admitted because of non-ST elevation acute myocardial infarction. In both cases echocardiography revealed an enlarged left ventricle, with extremely thickened walls with two layers: a thin, compacted myocardium on the epicardial side, and a thicker noncompaction endocardial layer. Ratio between noncompaction part of the wall and compaction part was 2.56 in the first and 4.94 in the second case. Blood flow from the left ventricular cavity into recesses was recorded with Color Doppler. Oral anticoagulation therapy was introduced in both of them. Holter ECG in the first patient revealed an intermittent right bandle branch block and in the second patient, premature ventricular contractions. Neurological examination findings were normal in both patients. Echocardiography of first-degree relatives was performed in the first case and it was normal in all 5 relatives. In the second case it was not performed due to technical reasons (relatives live abroad). Regular echocardiographic follow-up of all patients with chronic renal failure is necessary in order to diagnose cardiovascular comorbidities including this rare abnormality and its complications.

Fabrication of one-dimensional programmable-height nanostructures via dynamic stencil deposition.

Dynamic stencil deposition (DSD) techniques offer a variety of fabrication advantages not possible with traditional lithographic processing, such as the ability to directly deposit nanostructures with programmable-height profiles. However, DSD systems have not enjoyed widespread usage due to their complexity. We demonstrate a simple, low-profile, portable, one-dimensional nanotranslation system that facilitates access to nanoscale DSD abilities. Furthermore we show a variety of fabricated programmable-height nanostructures, including parallel arrays of such structures, and suggest other applications that exploit the unique capabilities of DSD fabrication methods.

Compatibility studies between mannitol and omeprazole sodium isomers.

Omeprazole, commonly used in the treatment of various gastrointestinal disorders degrades rapidly in acidic pHs and results in inter-individual variability due to different rates of metabolism amongst patients. Since S-omeprazole shows more predictable bioavailability and excipients have been known to interact with active pharmaceutical ingredients to produce altered bioavailability, it was decided to investigate the compatibility of omeprazole sodium isomers with mannitol, the major excipient in omeprazole formulations using differential scanning calorimetry (DSC) for bulk drug, attenuated total reflectance (ATR) infrared (IR) spectroscopy in a powder mixture and localized thermal analysis (LTA) from a drug disk. DSC results clearly indicate an interaction between mannitol and R-omeprazole sodium due to decreased melting temperatures and broadening peaks. The DSC of S-omeprazole sodium does not show melting temperature although the drug was crystalline. Because of the accelerated temperature conditions during DSC experiments applied in this work, ATR-IR was undertaken to determine whether these results occurred at room temperature for the solid dosage form. The ATR-IR results show a difference between R- and S-omeprazole sodium with mannitol by the appearance of both the amino (N-H) and imino (N-H) stretching frequencies for R-omeprazole and only the N-H for the S-omeprazole sodium. It may thus be concluded that different ratios for the tautomeric forms for S- and R-omeprazole sodium result in changes in the degree of crystallinity and are responsible for the interaction with mannitol, common excipient in formulation. These interactions may be directly related to the difference in terms of bioavailability.