Effect of the calcium silicate and sodium phosphate remineralizing products on bleached enamel.

Context and Aims: This study evaluated the effect of calcium silicate and sodium phosphate (CSSP) dentifrice and serum on the surface of enamel bleached with hydrogen peroxide (H2O2). Materials and Methods: A total of 160 bovine enamel slabs were bleached with 35% H2O2 and treated with sodium fluoride (NaF) dentifrice-GI, CSSP dentifrice-GII; CSSP dentifrice + CSSP serum-GIII, or NaF dentifrice + NaF gel-GIV. The dentifrices were applied using a brushing machine three times daily for 7 days. After brushing, sodium phosphate gel and CSSP serum were applied. The microhardness (KNH, n = 14), surface roughness (Ra, n = 14), energy dispersive spectroscopy (n = 6), and scanning electron microscopy (n = 6) were assessed at t0 (before bleaching), t1 (after bleaching), and t2 (after postbleaching treatments). Statistical Analysis Used: The data were subjected to a two-way analysis of variance and Bonferroni's test. Results: The KNH decreased at t1 (P < 0.001) but recovered at t2 for all treatments, although only GII showed restored baseline values (P = 0.0109). The surface roughness increased at t1 (P < 0.001) and reduced at t2 (P < 0.001) for all groups, with no significant differences among groups. Enamel composition and morphology did not differ after the treatments, except for silicon accumulation in GIII. Conclusions: Postbleaching treatment with CSSP dentifrice and serum yielded superior remineralizing effects on bleached enamel.

Nuevas estrategias terapéuticas para tratar la hiperfosfatemia en la IRC: foco en la absorción intestinal / New therapeutic strategies to treat hyperphosphatemia in CRF: focus on intestinal absorption

RESUMEN El manejo de la hiperfosfatemia de los pacientes con insuficiencia renal crónica en diálisis permanece como un desafío. A pesar de utilizar un enfoque multifacético que incluye la restricción dietética, la remoción de fósforo por la diálisis y el uso de quelantes de fósforo, esta estrategia múltiple no logra reducir los niveles de fósforo en más de 2 mg/dl. El control de fósforo de los pacientes en diálisis es fundamental en razón de la relación monotónica entre los niveles séricos de fosfato y el incremento del riesgo cardiovascular. Por lo tanto, hay una necesidad de explorar nuevas estrategias para reducir los niveles séricos de fosfato a niveles normales. Recientes avances en nuestra compresión de los mecanismos que subyacen a la homeostasis del fósforo sugieren que el transporte gastrointestinal del fósforo podría ser un objetivo. Recientemente se han desarrollado inhibidores de los cotransportadores sodio fosfato del intestino y se ha revalorizado el uso de la nicotinamida, en su formulación de liberación prolongada, que también actuaria por ese mecanismo. También se han drogas como el tenapanor, que inhibiendo el intercambiador sodio/hidrogeno isoforma 3 del enterocito, disminuyen la absorción paracelular de fósforo.

ABSTRACT Management of hyperphosphatemia in patients with chronic renal failure on dialysis remains challenging. Despite using a multifaceted approach that includes dietary restriction, phosphorus removal by dialysis, and phosphate binders, these multiple strategies fail to reduce phosphorus levels by more than 2 mg/dL. Phosphorus control in dialysis patients is essential due to the monotonic relationship between serum phosphate levels and increased cardiovascular risk. Therefore, there is a need to explore new strategies to reduce serum phosphate levels to normal levels. Recent advances in understanding the mechanisms underlying phosphorus homeostasis suggest that the gastrointestinal transport of phosphorus could be a target. Inhibitors of intestinal sodium phosphate cotransporters recently developed, and using of nicotinamide, in its prolonged release formulation, which would also act by this mechanism, has been revalued. There have also been drugs such as tenapanor, which, by inhibiting the isoform three sodium/hydrogen exchanger of the enterocyte, decreases the paracellular absorption of phosphorus.

A comparative physicochemical and pharmacological evaluation of dexamethasone sodium phosphate and betamethasone sodium phosphate mucoadhesive gels for the treatment of oral submucous fibrosis in rats

Abstract The present study is aimed to formulate steroidal oral mucoadhesive gels of dexamethasone sodium phosphate and betamethasone sodium phosphate. Six gel formulations each of dexamethasone sodium phosphate and betamethasone sodium phosphate prepared using two different polymers carboxymethyl cellulose sodium and hydroxypropyl methylcellulose, in variable proportions. All the formulations subjected for assessment of various physicochemical parameters and mechanical properties. The formulations BSP5 and DSP5, both containing 1.25 % carboxymethyl cellulose sodium, 1.25 % hydroxypropyl methylcellulose, exhibiting mucoadhesive strength of 12.300 ± 0.004 and 12.600 ± 0.01, adhesiveness of 28.04 ± 00 and 30.02 ± 00, cohesiveness of 28.04 ± 00 and 30.02 ± 00, drug release of 86.869 ± 0.380 % and 88.473 ± 0.457 % respectively were considered as promising ones and were further subjected for stability studies and in vivo study in male albino rats. Formulation DSP5 upon oral application for 4 months in arecoline induced oral submucous fibrosis rats, showed more than 80 % reduction in fibrosis as compared with BSP5 which showed nearly 50 % reduction. These results were concluded on the basis of histopathological profile and weight gain among the experimental animals during in vivo study. Hence, DSP5 by minimizing the painful injuries and morbidities justifies being suitable noninvasive model for OSMF treatment.

Use of fish trypsin immobilized onto magnetic-chitosan composite as a new tool to detect antinutrients in aquafeeds.

The unplanned inclusion of antinutrients in fish food affects many biological processes, such as digestibility of amino acids and diet conversion, resulting in undesirable effects on body growth. Thus, the objective of this research was to propose the use of immobilized fish proteases in the detection of protease inhibitors, one of the most important antinutrients. In order to evaluate the detection of antinutritional factors through the immobilized trypsin, the enzyme was incubated with eight diets developed for commercial fish, and residual activity was measured. Comparatively, the tilapia trypsin showed an inhibition of antinutrients (protease inhibitors), present in the eight studied diets, up to 48% greater than the porcine trypsin immobilized in magnetic chitosan. Thus, it is possible to suggest the use of immobilized derivatives containing specific proteases of the target organism in the detection of antinutritional factors that reduce animal's digestive capacity and negatively influence their growth during husbandry.

Effect of variations in dietary Pi intake on intestinal Pi transporters (NaPi-IIb, PiT-1, and PiT-2) and phosphate-regulating factors (PTH, FGF-23, and MEPE).

Hyperphosphatemia is a common condition in patients with chronic kidney disease (CKD) and can lead to bone disease, vascular calcification, and increased risks of cardiovascular disease and mortality. Inorganic phosphate (Pi) is absorbed in the intestine, an important step in the maintenance of homeostasis. In CKD, it is not clear to what extent Pi absorption is modulated by dietary Pi. Thus, we investigated 5/6 nephrectomized (Nx) Wistar rats to test whether acute variations in dietary Pi concentration over 2 days would alter hormones involved in Pi metabolism, expression of sodium-phosphate cotransporters, apoptosis, and the expression of matrix extracellular phosphoglycoprotein (MEPE) in different segments of the small intestine. The animals were divided into groups receiving different levels of dietary phosphate: low (Nx/LPi), normal (Nx/NPi), and high (Nx/HPi). Serum phosphate, fractional excretion of phosphate, intact serum fibroblast growth factor 23 (FGF-23), and parathyroid hormone (PTH) were significantly higher and ionized calcium was significantly lower in the Nx/HPi group than in the Nx/LPi group. The expression levels of NaPi-IIb and PiT-1/2 were increased in the total jejunum mucosa of the Nx/LPi group compared with the Nx/HPi group. Modification of Pi concentration in the diet affected the apoptosis of enterocytes, particularly with Pi overload. MEPE expression was higher in the Nx/HPi group than in the Nx/NPi. These data reveal the importance of early control of Pi in uremia to prevent an increase in serum PTH and FGF-23. Uremia may be a determining factor that explains the expressional modulation of the cotransporters in the small intestine segments.

Alginate hydrogel improves anti-angiogenic bevacizumab activity in cancer therapy.

Anti-vascular endothelial growth factor (anti-VEGF) therapy applied to solid tumors is a promising strategy, yet, the challenge to deliver these agents at high drug concentrations together with the maintenance of therapeutic doses locally, at the tumor site, minimizes its benefits. To overcome these obstacles, we propose the development of a bevacizumab-loaded alginate hydrogel by electrostatic interactions to design a delivery system for controlled and anti-angiogenic therapy under tumor microenvironmental conditions. The tridimensional hydrogel structure produced provides drug stability and a system able to be introduced as a flowable solution, stablishing a depot after local administration. Biological performance by the chick embryo chorioallantoic membrane (CAM) assay indicated a pH-independent improved anti-angiogenic activity (∼50%) compared to commercial available anti-VEGF drug. Moreover, there was a considerable regression in tumor size when treated with this system. Immunohistochemistry highlighted a reduced number and disorganization of microscopic blood vessels resulting from applied therapy. These results suggest that the developed hydrogel is a promising approach to create an innovative delivery system that offers the possibility to treat different solid tumors by intratumoral administration.

Absence seizure associated with coloprep consumption in colonoscopy / Convulsão de ausência com o uso de Coloprep em colonoscopia

Coloprep is a bowel preparatory solution given before endoscopic procedures to get a unobscured internal vision. It has among its constituent's sodium sulphate, potassium sulphate and magnesium sulphate which produce an osmotic effect in the bowel. However, the use of such agents in hyponatremic and patients predisposed to seizures can have adverse ramifications. The current case outlines manifestation of absence seizure in a 52-year-old male patient who was administered Coloprep for colonoscopy. There was absence of other predisposing factors and the symptoms were ameliorated using timely identification and rectification of the underlying derangements.

Coloprep é uma solução preparatória intestinal administrada antes de procedimentos endoscópicos, com o objetivo de se ter uma visão interna não obscurecida. Entre os constituintes de Coloprep, observa-se sulfato de sódio, sulfato de potássio e sulfato de magnésio, que provocam efeito osmótico no intestino. Mas o uso de tais agentes em pacientes hiponatrêmicos e com predisposição para convulsões pode ter ramificações adversas. O caso em tela delineia uma manifestação de convulsão de ausência em paciente do gênero masculino com 52 anos e que recebeu Coloprep para colonoscopia. Não havia outros fatores predisponentes e os sintomas melhoraram graças à oportuna identificação e correção dos transtornos subjacentes.

Reduction in renal blood flow following administration of norepinephrine and phenylephrine in septic rats treated with Kir6.1 ATP-sensitive and KCa1.1 calcium-activated K+ channel blockers.

We evaluated the effects of K+ channel blockers in the vascular reactivity of in vitro perfused kidneys, as well as on the influence of vasoactive agents in the renal blood flow of rats subjected to the cecal ligation and puncture (CLP) model of sepsis. Both norepinephrine and phenylephrine had the ability to increase the vascular perfusion pressure reduced in kidneys of rats subjected to CLP at 18 h and 36 h before the experiments. The non-selective K+ channel blocker tetraethylammonium, but not the Kir6.1 blocker glibenclamide, normalized the effects of phenylephrine in kidneys from the CLP 18 h group. Systemic administration of tetraethylammonium, glibenclamide, or the KCa1.1 blocker iberiotoxin, did not change the renal blood flow in control or septic rats. Norepinephrine or phenylephrine also had no influence on the renal blood flow of septic animals, but its injection in rats from the CLP 18 h group previously treated with either glibenclamide or iberiotoxin resulted in an exacerbated reduction in the renal blood flow. These results suggest an abnormal functionality of K+ channels in the renal vascular bed in sepsis, and that the blockage of different subtypes of K+ channels may be deleterious for blood perfusion in kidneys, mainly when associated with vasoactive drugs.

Achieving the best bowel preparation for colonoscopy.

Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here.

Colonic preparation before colonoscopy in constipated and non-constipated patients: a randomized study.

AIM: To compare the efficacy of different doses of sodium phosphate (NaP) and polyethylenglicol (PEG) alone or with bisacodyl for colonic cleansing in constipated and non-constipated patients. METHODS: Three hundred and forty-nine patients, older than 18 years old, with low risk for renal damage and who were scheduled for outpatient colonoscopy were randomized to receive one of the following preparations (prep): 90 mL of NaP (prep 1); 45 mL of NaP + 20 mg of bisacodyl (prep 2); 4 L of PEG (prep 3) or 2 L of PEG + 20 mg of bisacodyl (prep 4). Randomization was stratified by constipation. Patients, endoscopists, endoscopists' assistants and data analysts were blinded. A blinding challenge was performed to endoscopist in order to reassure blinding. The primary outcome was the efficacy of colonic cleansing using a previous reported scale. Secondary outcomes were tolerability, compliance, side effects, endoscopist perception about the necessity to repeat the study due to an inadequate colonic preparation and patient overall perceptions. RESULTS: Information about the primary outcome was obtained from 324 patients (93%). There were no significant differences regarding the preparation quality among different groups in the overall analysis. Compliance was higher in the NaP preparations being even higher in half-dose with bisacodyl: 94% (prep 1), 100% (prep 2), 81% (prep 3) and 87% (prep 4) (2 vs 1, 3 and 4, P < 0.01; 1 vs 3, 4, P < 0.05). The combination of bisacodyl with NaP was associated with insomnia (P = 0.04). In non-constipated patients the preparation quality was also similar between different groups, but endoscopist appraisal about the need to repeat the study was more frequent in the half-dose PEG plus bisacodyl than in whole dose NaP preparation: 11% (prep 4) vs 2% (prep 1) (P < 0.05). Compliance in this group was also higher with the NaP preparations: 95% (prep 1), 100% (prep 2) vs 80% (prep 3) (P < 0.05). Bisacodyl was associated with abdominal pain: 13% (prep 1), 31% (prep 2), 21% (prep 3) and 29% (prep 4), (2, 4 vs 1, 2, P < 0.05). In constipated patients the combination of NaP plus bisacodyl presented higher rates of satisfactory colonic cleansing than whole those PEG: 95% (prep 2) vs 66% (prep 3) (P = 0.03). Preparations containing bisacodyl were not associated with adverse effects in constipated patients. CONCLUSION: In non-constipated patients, compliance is higher with NaP preparations, and bisacodyl is related to adverse effects. In constipated patients NaP plus bisacodyl is the most effective preparation.

Utilidad de la preparación mecánica anterógrada en cirugía colorrectal electiva: resultados de una serie prospectiva y aleatoria / Usefulness of anterograde mechanical colon cleansing in colorectal surgery

Background: Anterograde mechanical colon cleansing is routinely done before colorectal surgery. However there is no firm evidence about its usefulness. Aim: To assess the usefulness of anterograde mechanical colon cleansing in colon surgery. Patients and Methods: Participants requiring elective colorectal surgery were randomized to receive anterograde mechanical bowel cleansing with two doses of oral sodium phosphate (Oral fleet) or a liquid diet 24 hours prior to surgery, after signing an informed consent. Both groups received antimicrobial prophylaxis. Problems associated with bowel cleansing, subjective assessment of bowel preparation by the surgeon and postoperative complications were recorded. Results: One hundred twenty two participants were studied (73 females). Fifty three percent of patients had concomitant diseases such as hypertension and diabetes mellitus. Sixty patients were subjected to anterograde bowel cleansing and 62 were ascribed to the liquid diet group. Surgeons evaluated colon cleansing as good in 49 and 37 patients with and without anterograde mechanical cleansing, respectively and as regular in 8 and 23 patients, respectively (X2 = 9.1 p = 0.01). Tolerance to cleansing was evaluated as good, fair and poor by 50, 30 and 20 percent of patients, respectively. One patient had a bowel obstruction associated with the use of sodium phosphate. Postoperative complications occurred in 14 and 23 patients subjected or not to cleansing, respectively (p = 0.06). Septic complications occurred in 11 and 3 cases with and without colon cleansing, respectively (p < 0.01). Conclusions: Anterograde mechanical colon cleansing was associated with a higher incidence of septic complications in this series of patients.

Introducción: El uso de la preparación mecánica anterógrada (PMA) es una práctica rutinaria en cirugía colorrectal pero con escasas bases en la evidencia científica. Objetivo: Determinar la utilidad de la PMA en una serie prospectiva y aleatoria de cirugía colorrectal electiva. Resultados: La serie corresponde a 122 pacientes, 60 de los cuales recibe PMA. Los datos epidemiológicos muestran que los grupos son comparables. En esta serie se encuentra un riesgo de morbilidad global aumentado al doble en los pacientes que reciben PMA, así como un riesgo de infección superficial del sitio quirúrgico seis veces mayor. No se encuentran diferencias en las infecciones profundas, dehiscencia de anastomosis ni en las reintervenciones. Las complicaciones asociadas a la PMA se presentaron sólo en un caso, 10 que no alcanza significación estadística. Conclusiones: De acuerdo a nuestros resultados, no se justifica la utilización rutinaria de PMA.

Preparo do intestino grosso para a coloscopia: usos, abusos e idéias controversas / Bowel preparation for colonoscopy: myths and misconceptions

O uso rotineiro do exame coloscópico para avaliação, diagnóstico e procedimentos terapêutico das doenças dos cólons e do reto, bem como para rastreamento e prevenção do câncer colorretal, seja em pessoas jovens portadores de doenças reconhecidamente pré-malignas ou em pessoas acima do 50 anos de idade, tem sido considerado um dos mais bem sucedidos projetos de saúde pública de extensão mundial. A fácil aceitação se deve a três principais fatores: primeiro, à adequação técnica e evolução dos aparelhos e a segurança do exame; segundo, ao desenvolvimento prático das habilidades do examinador e, terceiro, a magnificência da imagem revelando amplo acesso às finas características da mucosa, com critérios abrangentes para o diagnóstico. Nesse contexto, o preparo necessário para o resultado expressivo que se intenta tornou-se a parte pior ou menos tolerável da coloscopia, razão pela qual o que está em discussão atualmente é a necessária busca com o objetivo de se encontrar um método de preparo, rápido, eficiente, barato, agradável e, principalmente seguro. Nos últimos 40 anos, entre as várias fórmulas - mecânicas e farmacológicas - com diferentes associações de drogas laxativas, tem sido possível destacar três produtos que, pelo menos por algum tempo, foram referências mundiais na limpeza dos cólons que antecede a coloscopia. São eles: primeiro, a solução de manitol a 10 por cento - descartado por causa de acidentes explosivos; segundo, as soluções de polietileno glicol (PEG), depreciado por conta da exigência da ingestão oral de grandes volumes, pelos consequentes distúrbios do equilíbrio hidroeletrolítico e pela rejeição por parte do paciente; e, o terceiro, o fosfato de sódio (NaP) que poderia parecer ideal, mas vem recebendo críticas veementes por causa de seus efeitos colaterais, mormente os nefrotóxicos. Não está em jogo a eficácia desses três produtos, mas a segurança que deveria determinar seus usos indiscriminados para propiciar as melhores condições para os mais adequados exames. Estamos diante de um impasse: o manitol, mundialmente proscrito, continua sendo indicado entre nós, sem causar problemas, num esquema posológico diferente do que foi usado no passado e que influenciou os acidentes. Por outro lado, a industria farmacêutica não conseguiu popularizar o PEG; o NaP, fabricado para uso retal, substituiu os antecessores com limpeza eficiente, mas com ações lesivas significativas, principalmente renais. Assim, o que nos resta é resgatar o manitol - demonstrar por meio de um estudo prospectivo, casualizado, que o manitol a 10 por cento ingerido pelo menos até 4 horas antes da coloscopia é totalmente inócuo para o procedimento de diagnóstico e de terapêutica.

The routine of the colonoscopic examination for therapeutic evaluation, for diagnosis, and management of the diseases of the colon and of the rectum, as well as for screening and prevention of the colorectal cancer in young patients bearing premalignant diseases or in those above 50 years of age, as well as for screening and prevention of the colorectal cancer in young patients bearing premalignant diseases or in those above 50 years of age, has been one of the most successful public health projects worldwide71. The easy acceptance is due to three principal factors: first, to the technical adaptation and evolution of the instruments, and the safety of the examination; second one, to the practical development of the examiner skills, and, thirdly, to the magnificence of the image revealing broad access to the fine structures of the mucous membrane, with a large criteria for the diagnosis. In this context, the necessary preparation became the worst part or less tolerable of the colonoscopy. For this reason, it is necessary to look for a method of preparation, quick, efficient, cheap, pleasant, and safe. In the last 40 years, between the commentaries on mechanical and pharmacological methods - with different associations of laxative drugs - it was possible to find three products that, at least during some time, were world-wide references on large bowel cleaning for colonoscopy. They are: first, a 10 percent mannitol solution - it was dropped because of explosives accidents ; second, the polyethylene glycol (PEG) solutions, it was depreciated due to the requirement of large volumes for oral ingestion, due to electrolytic balance disturbance and rejection by the patient, and the third, the sodium phosphate (NaP) that would seem ideal, but that has received criticism because of its side effects, especially the nephrotoxicity. There is no the discussion on the efficiency of these three products, but on the safety with which we might promote their indiscriminate uses to offer the best conditions on performance of the colonoscopy. However, we have an impasse: the mannitol was abandoned, but it keeps on indicated among us, without causing problems, in a scheme that is different from which was used in the past when it influenced the accidents. On the other hand, the pharmaceutical industry did not manage to popularize PEG; the NaP is manufactured for rectal use, it substituted the predecessors with efficient cleaning, but with significantly harmful lesions. So, which remains for us is to rescue the mannitol - for that, we must evidence through a randomized trial that a oral ingestion of 10 percent mannitol solution, at least up to 4 hours before the colonoscopy, is totally harmless on diagnosis and therapeutic procedures.

Hyperphosphatemia after sodium phosphate laxatives in low risk patients: prospective study.

AIM: To establish the frequency of hyperphosphatemia following the administration of sodium phosphate laxatives in low-risk patients. METHODS: One hundred consecutive ASA I-II individuals aged 35-74 years, who were undergoing colonic cleansing with oral sodium phosphate (OSP) before colonoscopy were recruited for this prospective study. EXCLUSION CRITERIA: congestive heart failure, chronic kidney disease, diabetes, liver cirrhosis, intestinal obstruction, decreased bowel motility, increased bowel permeability, and hyperparathyroidism. The day before colonoscopy, all the participants entered a 24-h period of diet that consisted of 4 L of clear fluids with sugar or honey and 90 mL (60 g) of OSP in two 45-mL doses, 5 h apart. Serum phosphate was measured before and after the administration of the laxative. RESULTS: The main demographic data (mean +/- SD) were: age, 58.9 +/- 8.4 years; height, 163.8 +/- 8.6 cm; weight, 71 +/- 13 kg; body mass index, 26 +/- 4; women, 66%. Serum phosphate increased from 3.74 +/- 0.56 to 5.58 +/- 1.1 mg/dL, which surpassed the normal value (2.5-4.5 mg/dL) in 87% of the patients. The highest serum phosphate was 9.6 mg/dL. Urea and creatinine remained within normal limits. Post-treatment OSP serum phosphate concentration correlated inversely with glomerular filtration rate (P < 0.007, R(2) = 0.0755), total body water (P < 0.001, R(2) = 0.156) and weight (P < 0.013, R(2) = 0.0635). CONCLUSION: In low-risk, well-hydrated patients, the standard dose of OSP-laxative-induced hyperphosphatemia is related to body weight.

Treatment of inflammatory neuropathy with dexamethasone plus B-vitamins: a clinical evaluation / Tratamento de neuropatia inflamatória com a associação de dexametasona e vitaminas B: uma avaliação clínica

We evaluated the use of a combination of vitamins B1, B6, and B12 with dexamethasone in the treatment of the signs and symptoms of inflammatory neuropathy of the upper and lower limbs, in an open-label clinical trial. Patients were submitted to a 9-day treatment period with three doses of study medication at three day intervals, and a series of clinical and laboratory assessments, prior to the first dose of study medication and at each of the following three visits to the study center. Efficacy evaluations at each study visit included a 100mm VAS pain scale and global and satisfaction surveys completed by the patient and the investigating physician. Safety evaluations included a comparison of changes in laboratory evaluations at each visit and the incidence, severity, duration, and outcome of adverse events. A total of sixty-one patients were enrolled in the trial. A clinically significant improvement in all of the efficacy measures was observed from the pre-treatment to end-of-study evaluations. No clinically significant alterations in clinical assessments were observed during the treatment period. Based on the results of this clinical study, we conclude that the combination of dexamethasone with the B-vitamins is safe and effective in the treatment of the signs and symptoms of inflammatory neuropathy.

Avaliação do preparo intestinal para videocolonoscopia em crianças / Evaluation of bowel preparation in children for videocolonoscopy

Para a realização adequada da colonoscopia, é necessária uma limpeza colônica satisfatória. Existem vários métodos de preparo intestinal, mas para crianças ainda não existe um ideal. Portanto, buscamos, com este trabalho, um preparo intestinal padrão para esta faixa etária, que proporcione uma limpeza colônica excelente, tenha menos efeitos colaterais, grande aceitabilidade e custo reduzido, garantindo o apoio e a segurança dos familiares sobre o método. Foram avaliadas 46 crianças que se submeteram a videocolonoscopia, no período de 2002 a 2006, no serviço de videocolonoscopia do Hospital Universitário de Sergipe e na UPEP. As crianças foram divididas nos seguintes grupos etários: até um ano (grupo A), crianças de 1 a 5 anos(grupo B) e crianças maiores que 5 anos (grupo C). Nos lactentes e menores que 5 anos, foi usado fosfato de sódio via retal e as crianças maiores que 5 anos receberam solução de manitol via oral. Das 25 crianças que usaram o fosfato de sódio por via retal, o preparo foi excelente em 21 (88 por cento) pacientes e bom em 1 (4 por cento) paciente, embora todas as mães tenham relatado uma aplicação difícil. As outras 21 crianças usaram manitol, com resultado excelente em 17 (80,9 por cento) pacientes e bom em um (4,8 por cento) paciente; entretanto, todas as crianças apresentaram náuseas e vômitos após sua ingestão, com recusa pelas crianças devido ao grande volume. Alcançou-se o ceco em 41 (89 por cento) casos, dos quais, o íleo terminal foi alcançado em 19 (41,3 por cento) casos. Um preparo intestinal individualizado permitiu alto índice de bom preparo e baixa morbidade.

To an accurate colonoscopy procedure it is necessary a satisfactory colonic cleansing. There are many bowel preparation methods for adults, but there is not any ideal method for children. Therefore, this study tried to find a standard method for this age that can associate excellent colonic cleansing, less side effects, higher acceptability and affordability, relatives' support. Forty-six children were evaluated after they had undergone a video colonoscopy, between 2002 and 2006, at the department of video colonoscopy of Hospital Universitário de Sergipe and at UPEP. They were placed in the following groups: children until 1 year old (group A), children from the age of 1 to 5(group B), and children over 5 (group C). In the first and second groups, sodium phosphate was administered via rectum, and in the third group the children received oral manitol solution. From the 25 children that used the rectal sodium phosphate, the preparation was excellent in 22 (88 percent) and good in 1 (4 percent), although all the parents emphasized a difficult application. From the other 21 children, that used manitol, 17 (80,9 percent) had an excellent preparation, 1 (4,8 percent) had good preparation, 2 (9,5 percent) had a regular preparation and 1 (4,8 percent) had a very bad preparation, although all the children had vomited and had felt sick after its ingestion, with low acceptation by the children due to the big volume. The cecum was reached in 41 (89 percent) cases, from which 19 (41,3 percent) had been examined until the terminal ileum. An indivualized prepare allowed great level of good prepare and low morbidity.

Comparison of colon-cleansing methods in preparation for colonoscopy - Comparative efficacy of solutions of mannitol, sodium picosulfate and monobasic and dibasic sodium phosphates / Estudo comparativo entre as soluções de manitol, picossulfato de sódio e fosfato monobásico e dibásico de sódio no preparo de cólon para colonoscopia

PURPOSE: Colonoscopy plays an essential role in the therapeutic and diagnostic approach in various colonic pathologies, the aim of the present study was to compare three solutions and their efficacy for the bowel preparation in adult patients submitted to elective colonoscopy. METHODS: Sixty patients were randomly divided into three groups of 20 each. Each group was submitted to a bowel preparation with one of the following solutions: 10 percent manitol, sodium picosulphate or sodium phosphate. The parameters evaluated were: taste, tolerance, associated side effects and quality of cleansing. Postural blood pressure and pulse rate as well as serum sodium, potassium, calcium and phosphate were compared. RESULTS: Sodium phosphate and 10 percent manitol solutions provided superior results in terms of colon cleansing compared to sodium picosulphate solution. All serum electrolytes evaluated were significantly altered in the three groups, without important clinical signs. DISCUSSION: High levels of serum phosphate were the most striking alteration in patients prepared with sodium phosphate solution, again with no clinical signs. Variations related to blood pressure and pulse rate suggested contraction of intravascular volume, with no clinical effects. CONCLUSION: Sodium phosphate and 10 percent manitol solutions are equivalent in providing good quality colon cleansing, with no significant side effects that could compromise the procedure.

INTRODUÇÃO: A colonoscopia é exame fundamental na avaliação das doenças do cólon e na abordagem terapêutica de determinado grupo de patologias. O preparo intestinal é obrigatório para a realização das colonoscopias eletivas, e a qualidade encontra-se relacionada ao sucesso do procedimento. Comparou-se três soluções para limpeza anterógrada do cólon em pacientes adultos, submetidos à colonoscopia. METODOS: Sessenta pacientes foram distribuídos em três grupos de vinte. Cada grupo realizou o preparo do cólon com uma das três soluções estudadas: manitol a 10 por cento (MN), picossulfato sódico (PS) e fosfato monobásico e dibásico de sódio (NaP). O sabor, a tolerância, os efeitos colaterais, os custos e a qualidade de limpeza do preparo foram avaliados. Frequência cardíaca e pressão arterial sistêmica foram analisados. Variações dos eletrólitos foram dosados antes e após o preparo. RESULTADOS: Os resultados foram semelhantes em relação aos efeitos colaterais. O sabor da solução de NaP não chegou a comprometer a sua aceitação. DISCUSSÃO: Soluções de NaP e MN proporcionaram resultados superiores tanto em qualidade de limpeza colônica, como em relação aos custos, quando comparadas à solução de PS. CONCLUSÃO: Comparados os três, os eletrólitos avaliados apresentaram diferenças significativas, sendo a hiperfosfatemia dos pacientes com a solução de NaP, a mais importante.

Comparison of colon-cleansing methods in preparation for colonoscopy - Comparative efficacy of solutions of mannitol, sodium picosulfate and monobasic and dibasic sodium phosphates / Estudo comparativo entre as soluções de manitol, picossulfato de sódio e fosfato monobásico e dibásico de sódio no preparo de cólon para colonoscopia

PURPOSE: Colonoscopy plays an essential role in the therapeutic and diagnostic approach in various colonic pathologies, the aim of the present study was to compare three solutions and their efficacy for the bowel preparation in adult patients submitted to elective colonoscopy. METHODS: Sixty patients were randomly divided into three groups of 20 each. Each group was submitted to a bowel preparation with one of the following solutions: 10 percent manitol, sodium picosulphate or sodium phosphate. The parameters evaluated were: taste, tolerance, associated side effects and quality of cleansing. Postural blood pressure and pulse rate as well as serum sodium, potassium, calcium and phosphate were compared. RESULTS: Sodium phosphate and 10 percent manitol solutions provided superior results in terms of colon cleansing compared to sodium picosulphate solution. All serum electrolytes evaluated were significantly altered in the three groups, without important clinical signs. DISCUSSION: High levels of serum phosphate were the most striking alteration in patients prepared with sodium phosphate solution, again with no clinical signs. Variations related to blood pressure and pulse rate suggested contraction of intravascular volume, with no clinical effects. CONCLUSION: Sodium phosphate and 10 percent manitol solutions are equivalent in providing good quality colon cleansing, with no significant side effects that could compromise the procedure.(AU)

INTRODUÇÃO: A colonoscopia é exame fundamental na avaliação das doenças do cólon e na abordagem terapêutica de determinado grupo de patologias. O preparo intestinal é obrigatório para a realização das colonoscopias eletivas, e a qualidade encontra-se relacionada ao sucesso do procedimento. Comparou-se três soluções para limpeza anterógrada do cólon em pacientes adultos, submetidos à colonoscopia. METODOS: Sessenta pacientes foram distribuídos em três grupos de vinte. Cada grupo realizou o preparo do cólon com uma das três soluções estudadas: manitol a 10 por cento (MN), picossulfato sódico (PS) e fosfato monobásico e dibásico de sódio (NaP). O sabor, a tolerância, os efeitos colaterais, os custos e a qualidade de limpeza do preparo foram avaliados. Frequência cardíaca e pressão arterial sistêmica foram analisados. Variações dos eletrólitos foram dosados antes e após o preparo. RESULTADOS: Os resultados foram semelhantes em relação aos efeitos colaterais. O sabor da solução de NaP não chegou a comprometer a sua aceitação. DISCUSSÃO: Soluções de NaP e MN proporcionaram resultados superiores tanto em qualidade de limpeza colônica, como em relação aos custos, quando comparadas à solução de PS. CONCLUSÃO: Comparados os três, os eletrólitos avaliados apresentaram diferenças significativas, sendo a hiperfosfatemia dos pacientes com a solução de NaP, a mais importante.(AU)

El eje hueso-riñón en el control del fósforo sérico y la mineralización ósea / Bone-Kidney axis in the control of serum phosphorus and bone mineralization

El eje hueso-riñón ha sido pensado como un mecanismo por el cual el esqueleto se comunica con el riñón para coordinar la mineralización de la matriz extracelular ósea con el manejo renal del fosfato. Osteoblastos /osteocitos están bien preparados para coordinar las homeostasis sistémica de fósforo y la mineralización ósea, ya que ellos expresan todos los componentes implicados en un posible eje hueso-riñón, incluyendo al PHEX, FGF-23, MEPE, y DMP1. Los efectos autocrinos de proteínas de la familia SIBLING como MEPE y DMP1 sobre los osteoblastos podrían regular la producción de proteínas de matriz extracelular que intervienen en la mineralización. El riñón provee uno de los efectores de este eje que regula el balance de fosfato a través de la expresión apical de los cotransportadores sodio/fosfato NaPi-IIa y NaPi-IIc en el túbulo proximal. Central en este eje es el FGF-23, producido por los osteoblastos que tiene acciones fosfatúricas sobre el riñón. Cuando se descubrió que el FGF23, la primera fosfatonina era de origen osteoblástico/osteocitico, quedó establecido el eje hueso-riñón. Probar definitivamente la existencia de este eje hueso-riñón y definir exactamente su rol fisiológico requerirá de investigaciones adicionales

The bone-kidney axis has been thought as a mechanism for the skeleton to communicate with the kidney to coordinate the mineralization of extracelular matrix with the renal handling of phosphate. Osteoblasts / osteocytes are well suited for coordinating systemic phosphate homeostasis and mineralization, since they express all of the implicated components of a possible bone-kidney axis, including PHEX, FGF-23, MEPE, and DMP1. In addition, autocrine effects of SIBLING proteins as MEPE and DMP1 on osteoblasts could regulate the production of ECM proteins that regulate mineralization. The kidney provides one of the effectors of the axis that regulates phosphate balance through the apical expression of NaPi-IIa and NaPi-IIc in proximal tubules. Central in this axis is FGF-23, produced by osteoblasts that has phosphaturic actions on the kidney. When FGF23, the first phosphatonin, was discovered to be of osteoblastic/osteocyte origin, the bone kidney axis was established. Proving the existence of this bone-kidney axis and defining its physiological role will require additional investigations

Estudo comparativo entre as soluções de manitol, picossulfato de sódio e fosfato monobásico e dibásico de sódio no preparo de cólon para colonoscopia

Currently, colonoscopy has been a first choice exam to evaluate colon disease. This procedure also has had essencial role in the therapeutic approach of certain groups of pathologies. Colonic cleansing is a necessary and previous stage to do elective colonoscopy. The quality of the colon preparation has been found related directly to the sucess of procedure. Three solutions were compared as colonic cleansing agents in adult patients submitted to colonoscopy at ambulatory regimen. Sixty patients were randomized and then divided into three groups of twenty persons. Each one of these groups was submitted to a colonic cleansing with one of these studied solutions: 10% mannitol solution, sodium picosulphate and sodium phosphate. Taste, tolerance, associated side effects and quality of cleansing preparation were evaluated. Clinic parameters like standing pulse and blood pressure besides the assessment of sodium, potassium, calcium and phophate were also studied and compared with measurements taken before and after bow el preparation of each one of patients. The groups presented similar results when related to side effects. Electrolyte alterations were verified in these three studied groups without clinical signs. The variations related to cardiac frequency, blood pressure and hematocrit, though showing contraction of the intravascular volume, did not attend with clinic effects. The bad taste of sodium phosphate solution did not compromise its tolerance. The sodium phosphate and 10% mannitol solutions provide superior results in quality of colonic cleansing and as much as costs when compared to sodium picosulphate solution. When these three groups were compared all evaluated electrolytes presented significant differences and hyperphosphatemia of patients prepared with sodium phosphate solution was the most important of then. None of these differences was related to clinic effects.

Atualmente, a colonoscopia é o exame de primeira escolha na avaliação das doenças do cólon, tendo também papel fundamental na abordagem terapêutica de determinado grupo de patologias. O preparo intestinal é etapa obrigatória para a realização das colonoscopias eletivas, e a qualidade deste encontra-se diretamente relacionada ao sucesso do procedimento, seja este diagnóstico ou terapêutico. Foram comparadas três soluções para limpeza anterógrada do cólon em pacientes adultos, submetidos à colonoscopia em regime ambulatorial. Sessenta pacientes foram distribuidos em três grupos de vinte indivíduos. Cada um dos grupos realizou o preparo do cólon com uma das três soluções estudadas: manitol a 10% (MN), picossulfato sódico (PS) e fosfato monobásico e dibásico de sódio (NaP). O sabor, a tolerância, os efeitos colaterais, os custos e a qualidade de limpeza do preparo foram avaliados. Parâmetros clínicos como frequência cardíaca e pressão arterial sistêmica também foram estudados, além das variações dos eletrólitos (sódio, potássio, cálcio e fósforo) que foram dosados antes e após o preparo intestinal. Os pacientes estudados apresentaram resultados semelhantes em relação aos efeitos colaterais. As variações relativas à freqüência cardíaca, pressão arterial e hematócrito, ainda que indicando contração no espaço intravascular, não cursaram com maiores repercussões do ponto de vista clínico. O sabor ruim da solução de NaP não chegou a comprometer a aceitação desta pelos pacientes. As soluções de NaP e MN proporcionaram resultados superiores tanto em qualidade de limpeza colônica, como em relação aos custos, quando comparadas à solução de PS. Quando comparados os três grupos do estudo, todos os eletrólitos avaliados apresentaram diferenças significativas, sendo a hiperfosfatemia dos pacientes preparados com a solução de NaP, a mais importante delas. Nenhuma dessas, no entanto, apresentou problemas de ordem clínica.

Estudo comparativo entre as soluções de manitol, picossulfato de sódio e fosfato monobásico e dibásico de sódio no preparo de cólon para colonoscopia

Currently, colonoscopy has been a first choice exam to evaluate colon disease. This procedure also has had essencial role in the therapeutic approach of certain groups of pathologies. Colonic cleansing is a necessary and previous stage to do elective colonoscopy. The quality of the colon preparation has been found related directly to the sucess of procedure. Three solutions were compared as colonic cleansing agents in adult patients submitted to colonoscopy at ambulatory regimen. Sixty patients were randomized and then divided into three groups of twenty persons. Each one of these groups was submitted to a colonic cleansing with one of these studied solutions: 10% mannitol solution, sodium picosulphate and sodium phosphate. Taste, tolerance, associated side effects and quality of cleansing preparation were evaluated. Clinic parameters like standing pulse and blood pressure besides the assessment of sodium, potassium, calcium and phophate were also studied and compared with measurements taken before and after bow el preparation of each one of patients. The groups presented similar results when related to side effects. Electrolyte alterations were verified in these three studied groups without clinical signs. The variations related to cardiac frequency, blood pressure and hematocrit, though showing contraction of the intravascular volume, did not attend with clinic effects. The bad taste of sodium phosphate solution did not compromise its tolerance. The sodium phosphate and 10% mannitol solutions provide superior results in quality of colonic cleansing and as much as costs when compared to sodium picosulphate solution. When these three groups were compared all evaluated electrolytes presented significant differences and hyperphosphatemia of patients prepared with sodium phosphate solution was the most important of then. None of these differences was related to clinic effects.

Atualmente, a colonoscopia é o exame de primeira escolha na avaliação das doenças do cólon, tendo também papel fundamental na abordagem terapêutica de determinado grupo de patologias. O preparo intestinal é etapa obrigatória para a realização das colonoscopias eletivas, e a qualidade deste encontra-se diretamente relacionada ao sucesso do procedimento, seja este diagnóstico ou terapêutico. Foram comparadas três soluções para limpeza anterógrada do cólon em pacientes adultos, submetidos à colonoscopia em regime ambulatorial. Sessenta pacientes foram distribuidos em três grupos de vinte indivíduos. Cada um dos grupos realizou o preparo do cólon com uma das três soluções estudadas: manitol a 10% (MN), picossulfato sódico (PS) e fosfato monobásico e dibásico de sódio (NaP). O sabor, a tolerância, os efeitos colaterais, os custos e a qualidade de limpeza do preparo foram avaliados. Parâmetros clínicos como frequência cardíaca e pressão arterial sistêmica também foram estudados, além das variações dos eletrólitos (sódio, potássio, cálcio e fósforo) que foram dosados antes e após o preparo intestinal. Os pacientes estudados apresentaram resultados semelhantes em relação aos efeitos colaterais. As variações relativas à freqüência cardíaca, pressão arterial e hematócrito, ainda que indicando contração no espaço intravascular, não cursaram com maiores repercussões do ponto de vista clínico. O sabor ruim da solução de NaP não chegou a comprometer a aceitação desta pelos pacientes. As soluções de NaP e MN proporcionaram resultados superiores tanto em qualidade de limpeza colônica, como em relação aos custos, quando comparadas à solução de PS. Quando comparados os três grupos do estudo, todos os eletrólitos avaliados apresentaram diferenças significativas, sendo a hiperfosfatemia dos pacientes preparados com a solução de NaP, a mais importante delas. Nenhuma dessas, no entanto, apresentou problemas de ordem clínica.