Extracorporeal Treatment for Gabapentin and Pregabalin Poisoning: Systematic Review and Recommendations From the EXTRIP Workgroup.

Toxicity from gabapentin and pregabalin overdose is commonly encountered. Treatment is supportive, and the use of extracorporeal treatments (ECTRs) is controversial. The EXTRIP workgroup conducted systematic reviews of the literature and summarized findings following published methods. Thirty-three articles (30 patient reports and 3 pharmacokinetic studies) met the inclusion criteria. High gabapentinoid extracorporeal clearance (>150mL/min) and short elimination half-life (<5 hours) were reported with hemodialysis. The workgroup assessed gabapentin and pregabalin as "dialyzable" for patients with decreased kidney function (quality of the evidence grade as A and B, respectively). Limited clinical data were available (24 patients with gabapentin toxicity and 7 with pregabalin toxicity received ECTR). Severe toxicity, mortality, and sequelae were rare in cases receiving ECTR and in historical controls receiving standard care alone. No clear clinical benefit from ECTR could be identified although major knowledge gaps were acknowledged, as well as costs and harms of ECTR. The EXTRIP workgroup suggests against performing ECTR in addition to standard care rather than standard care alone (weak recommendation, very low quality of evidence) for gabapentinoid poisoning in patients with normal kidney function. If decreased kidney function and coma requiring mechanical ventilation are present, the workgroup suggests performing ECTR in addition to standard care (weak recommendation, very low quality of evidence).

ß-Blocker Use and Risk of Mortality in Heart Failure Patients Initiating Maintenance Dialysis.

RATIONAL & OBJECTIVE: Beta-blockers are recommended for patients with heart failure (HF) but their benefit in the dialysis population is uncertain. Beta-blockers are heterogeneous, including with respect to their removal by hemodialysis. We sought to evaluate whether ß-blocker use and their dialyzability characteristics were associated with early mortality among patients with chronic kidney disease with HF who transitioned to dialysis. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Adults patients with chronic kidney disease (aged≥18 years) and HF who initiated either hemodialysis or peritoneal dialysis during January 1, 2007, to June 30, 2016, within an integrated health system were included. EXPOSURES: Patients were considered treated with ß-blockers if they had a quantity of drug dispensed covering the dialysis transition date. OUTCOMES: All-cause mortality within 6 months and 1 year or hospitalization within 6 months after transition to maintenance dialysis. ANALYTICAL APPROACH: Inverse probability of treatment weights using propensity scores was used to balance covariates between treatment groups. Cox proportional hazard analysis and logistic regression were used to investigate the association between ß-blocker use and study outcomes. RESULTS: 3,503 patients were included in the study. There were 2,115 (60.4%) patients using ß-blockers at transition. Compared with nonusers, the HR for all-cause mortality within 6 months was 0.79 (95% CI, 0.65-0.94) among users of any ß-blocker and 0.68 (95% CI, 0.53-0.88) among users of metoprolol at transition. There were no observed differences in all-cause or cardiovascular-related hospitalization. LIMITATIONS: The observational nature of our study could not fully account for residual confounding. CONCLUSIONS: Beta-blockers were associated with a lower rate of mortality among incident hemodialysis patients with HF. Similar associations were not observed for hospitalizations within the first 6 months following transition to dialysis.

The bioavailability of arsenic species in rice.

Rice is the principal food in many countries for billions of people and one of the most consumed cereals in the world. The rice plant has the ability to bioaccumulate essential and toxic trace elements such as arsenic. The toxicity of the elements depends not only on their concentration but also on their chemical form and their bioavailability. The inorganic forms of arsenic are more toxic than the organic forms and the toxicity increases with decreasing oxidation states. The consumers of rice in Europe who are the most exposed to inorganic arsenic are children under three, thorough diet (rice-based food). Recently, the European Commission established the maximum levels of inorganic arsenic in foodstuffs. This regulation establishes a maximum level of inorganic arsenic of 100 µg kg-1 in rice destined for the production of food for infants and young children. In order to know the relation between the As ingested and the arsenic absorbed, studies of bioavailability are necessary. We proposed an in vitro digestion method with dialysis to estimate this relation. Furthermore, a bioavailability study of As species in rice was performed in order to know if a change in As species occurred during the gastrointestinal digestion process. Arsenic species were determined in rice and in the dialysate fraction by high-performance liquid chromatography coupled to inductively coupled plasma mass spectrometry (HPLC-ICP-MS). The proposed method has been applied to different rice samples acquired in the local Spanish market. Graphical abstract.

Gluten-free sorghum pasta: starch digestibility and antioxidant capacity compared with commercial products.

BACKGROUND: The development of new products with a focus on nutrition, rather than other technical aspects, is essential to improve the quality of celiac diets. Nutritional attributes of white and brown sorghum gluten-free pasta developed in a previous work were analyzed. The extent and kinetics of starch in vitro digestion, estimated glycemic index (eGI), potentially bioaccessible and dialyzable polyphenols, and antioxidant activity were evaluated and compared with commercial products. RESULTS: Sorghum flour samples were used to obtain pasta with high protein (≈170 g kg-1 ), dietary fiber (≈80 g kg-1 ), polyphenols (2.6 g GA kg-1 pasta), and antioxidant activity. This sorghum pasta showed slower starch in vitro digestion than the other gluten-free pasta, with a high level of protein hydrolysis (76%). The highest eGI was observed in a rice sample (69.8) followed by a corn-based pasta (66.4). White and brown sorghum gluten-free pasta showed 2.9 and 2.4 times, respectively, higher potentially bioaccessible polyphenol content compared to that in cooked pasta. No significant variation in antioxidant activity was found in sorghum pasta after digestion and around 48% and 36% of activity was detected in dialysate. CONCLUSION: Both types of sorghum gluten-free pasta have demonstrated their nutritional value and represent a good potential alternative to current commercial pasta. © 2018 Society of Chemical Industry.

A Comparative Study of Carvedilol Versus Metoprolol Initiation and 1-Year Mortality Among Individuals Receiving Maintenance Hemodialysis.

BACKGROUND: Carvedilol and metoprolol are the ß-blockers most commonly prescribed to US hemodialysis patients, accounting for ∼80% of ß-blocker prescriptions. Despite well-established pharmacologic and pharmacokinetic differences between the 2 medications, little is known about their relative safety and efficacy in the hemodialysis population. STUDY DESIGN: A retrospective cohort study using a new-user design. SETTING & PARTICIPANTS: Medicare-enrolled hemodialysis patients treated at a large US dialysis organization who initiated carvedilol or metoprolol therapy from January 1, 2007, through December 30, 2012. PREDICTOR: Carvedilol versus metoprolol initiation. OUTCOMES: All-cause mortality, cardiovascular mortality, and intradialytic hypotension (systolic blood pressure decrease ≥ 20mmHg during hemodialysis plus intradialytic saline solution administration) during a 1-year follow-up period. MEASUREMENTS: Survival models were used to estimate HRs and 95% CIs in mortality analyses. Poisson regression was used to estimate incidence rate ratios (IRRs) and 95% CIs in intradialytic hypotension analyses. Inverse probability of treatment weighting was used to adjust for several demographic, clinical, laboratory, and dialysis treatment covariates in all analyses. RESULTS: 27,064 individuals receiving maintenance hemodialysis were included: 9,558 (35.3%) carvedilol initiators and 17,506 (64.7%) metoprolol initiators. Carvedilol (vs metoprolol) initiation was associated with greater all-cause (adjusted HR, 1.08; 95% CI, 1.02-1.16) and cardiovascular mortality (adjusted HR, 1.18; 95% CI, 1.08-1.29). In subgroup analyses, similar associations were observed among patients with hypertension, atrial fibrillation, heart failure, and a recent myocardial infarction, the main cardiovascular indications for ß-blocker therapy. During follow-up, carvedilol (vs metoprolol) initiators had a higher rate of intradialytic hypotension (adjusted IRR, 1.10; 95% CI, 1.09-1.11). LIMITATIONS: Residual confounding may exist. CONCLUSIONS: Relative to metoprolol initiation, carvedilol initiation was associated with higher 1-year all-cause and cardiovascular mortality. One potential mechanism for these findings may be the increased occurrence of intradialytic hypotension after carvedilol (vs metoprolol) initiation.

Extracorporeal Treatment in Phenytoin Poisoning: Systematic Review and Recommendations from the EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup.

The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup conducted a systematic literature review using a standardized process to develop evidence-based recommendations on the use of extracorporeal treatment (ECTR) in patients with phenytoin poisoning. The authors reviewed all articles, extracted data, summarized findings, and proposed structured voting statements following a predetermined format. A 2-round modified Delphi method was used to reach a consensus on voting statements, and the RAND/UCLA Appropriateness Method was used to quantify disagreement. 51 articles met the inclusion criteria. Only case reports, case series, and pharmacokinetic studies were identified, yielding a very low quality of evidence. Clinical data from 31 patients and toxicokinetic grading from 46 patients were abstracted. The workgroup concluded that phenytoin is moderately dialyzable (level of evidence = C) despite its high protein binding and made the following recommendations. ECTR would be reasonable in select cases of severe phenytoin poisoning (neutral recommendation, 3D). ECTR is suggested if prolonged coma is present or expected (graded 2D) and it would be reasonable if prolonged incapacitating ataxia is present or expected (graded 3D). If ECTR is used, it should be discontinued when clinical improvement is apparent (graded 1D). The preferred ECTR modality in phenytoin poisoning is intermittent hemodialysis (graded 1D), but hemoperfusion is an acceptable alternative if hemodialysis is not available (graded 1D). In summary, phenytoin appears to be amenable to extracorporeal removal. However, because of the low incidence of irreversible tissue injury or death related to phenytoin poisoning and the relatively limited effect of ECTR on phenytoin removal, the workgroup proposed the use of ECTR only in very select patients with severe phenytoin poisoning.

Extracorporeal treatment for barbiturate poisoning: recommendations from the EXTRIP Workgroup.

The EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup conducted a systematic review of barbiturate poisoning using a standardized evidence-based process to provide recommendations on the use of extracorporeal treatment (ECTR) in patients with barbiturate poisoning. The authors reviewed all articles, extracted data, summarized key findings, and proposed structured voting statements following a predetermined format. A 2-round modified Delphi method was used to reach a consensus on voting statements, and the RAND/UCLA Appropriateness Method was used to quantify disagreement. 617 articles met the search inclusion criteria. Data for 538 patients were abstracted and evaluated. Only case reports, case series, and nonrandomized observational studies were identified, yielding a low quality of evidence for all recommendations. Using established criteria, the workgroup deemed that long-acting barbiturates are dialyzable and short-acting barbiturates are moderately dialyzable. Four key recommendations were made. (1) The use of ECTR should be restricted to cases of severe long-acting barbiturate poisoning. (2) The indications for ECTR in this setting are the presence of prolonged coma, respiratory depression necessitating mechanical ventilation, shock, persistent toxicity, or increasing or persistently elevated serum barbiturate concentrations despite treatment with multiple-dose activated charcoal. (3) Intermittent hemodialysis is the preferred mode of ECTR, and multiple-dose activated charcoal treatment should be continued during ECTR. (4) Cessation of ECTR is indicated when clinical improvement is apparent. This report provides detailed descriptions of the rationale for all recommendations. In summary, patients with long-acting barbiturate poisoning should be treated with ECTR provided at least one of the specific criteria in the first recommendation is present.

Validation of the analytical methodology used in obtaining the oral bioavailability of organic target pollutants in atmospheric particulate matter (PM10) applying an in-vitro method.

In recent years, scientists have started evaluating the portion of PM-bound pollutants that may be liberated (bioaccessible fraction) in human fluids and spread through the digestive system ultimately entering systemic circulation (known as the bioavailable fraction). In the current research, an analytical procedure was validated and applied to characterize the oral bioavailable fraction of PM10 samples. The approach encompassed the determination of 49 organic contaminants. The proposed method aims to biomimetic complete mouth-gastric-intestinal system basing on an adaptation of the unified bioaccessibility method (UBM) modified by the inclusion of a dialysis membrane to mimic intestinal absorption and obtain the orally bioavailable fractions. It was followed by a vortex-assisted liquid-liquid extraction (VALLE) step, using gas chromatography-tandem mass spectrometry (GC-MS/MS). Analytical procedure was effectively validated by employing selected reaction monitoring (SRM) mode in MS/MS, matrix-matched calibration, and deuterium-labelled surrogate standards. This approach ensured heightened sensitivity, minimized matrix effects, and compensated for any losses during the process. The validation process covered various aspects, including studying linearity, determining detection and quantification limits, assessing analytical recoveries at three concentration levels, and evaluating precision both within a single day and across multiple days. The validated method was applied to PM10 samples, revealing that polycyclic aromatic hydrocarbons (PAHs) were the most frequently detected, with significant seasonal variations in their concentrations. Organophosphorus flame retardants (OPFRs) like TCPP were also detected in bioavailable fractions, highlighting their potential health impact. Bisphenols, SMCs, and PAEs were not detected, suggesting low levels in the studied urban area. Further research is needed to understand the bioavailability of PM-bound pollutants in different environments.

In-vitro inhalation bioavailability estimation of Metal(oid)s in atmospheric particulate matter (PM2.5) using simulated alveolar lysosomal fluid: A dialyzability approach.

A novel in-vitro method, by using synthetic body fluids, human physiological conditions and a simulated air-blood barrier (by using a dialysis membrane) has been developed and applied to assess in-vitro inhalation bioavailability of metal(oid)s associated to particulate matter (PM2,5) samples collected from an industrial site of the Northwest of Spain. A validated analytical methodology based on inductively coupled plasma mass spectrometry (ICP-MS) was used to analyse metal(oid)s concentrations in bioavailable fractions. This approach would be a more realistic human health risk assessment since considering processes that occur in human body in contrast the overestimation derived from current models (which consider environmental concentrations). Metal(oid)s such as Cu and Mo seemed to be the most bioavailable (mean in-vitro bioavailability ratios higher than 70%); Ba, Cd, Mn, Pb, Rb, Sb, Sn, V and Zn shown mean ratios between 20 and 60%, while low in-vitro bioavailability ratios (less than 20%) were observed for metal(oid)s such as Al, Co, Cr, Fe, Ni, Ti, and Tl. Health risk assessment via inhalation based on hazard carcinogenic and non-carcinogenic indexes (HIc and HInc, respectively) were performed considering three exposure scenarios using both inhalation bioavailable and total metal(oid)s concentrations in PM2.5 samples, suggesting no risk to human health. The influence of chemical composition on in-vitro bioavailability ratios was obtained, pointing out that inhalation ratios of Al, Ba, Cr, Cu, Fe, Ni, Pb and V seem to be affected by sea salt and/or crustal and/or biogenic and/or anthropogenic content of PM2.5.

In Vitro Bioaccessibility of Selenium from Commonly Consumed Fish in Thailand.

Selenium (Se), abundantly obtained in fish, is a crucial trace element for human health. Since there are no data on Se bioaccessibility from commonly consumed fish in Thailand, this study assessed the in vitro bioaccessibility of Se using the equilibrium dialyzability method. The five fish species most commonly consumed in Thailand were selected to determine total Se content using several preparation methods (fresh, boiling, and frying). Equilibrium dialyzability was used to perform in vitro bioaccessibility using enzymatic treatment to simulate gastrointestinal digestion for all boiled and fried fish as well as measuring Se using inductively coupled plasma triple quadrupole mass spectrometry (ICP-QQQ-MS). Two-way ANOVA with interaction followed by Tukey's honestly significant difference (HSD) post hoc test revealed that boiled Indo-Pacific Spanish mackerel, longtail tuna, and short-bodied mackerel were significantly higher in Se content than striped snakehead and giant sea perch (p < 0.05). For fried fish, longtail tuna showed the highest Se content (262.4 µg/100 g of product) and was significantly different compared to the other fish (p < 0.05, estimated marginal means was 43.8−115.6 µg/100 g of product). Se bioaccessibilities from striped snakehead (70.0%) and Indo-Pacific Spanish mackerel (64.6%) were significantly higher than for longtail tuna (p < 0.05). No significant difference in bioaccessibility was found in terms of preparation method (i.e., boiling and frying). In conclusion, the fish included in this study, either boiled or fried, have high Se content and are good sources of Se due to high bioaccessibility.

Formulations with microencapsulated Fe-peptides improve in vitro bioaccessibility and bioavailability.

The bioaccessibility and the bioavailability of iron complexed to peptides (active) in microparticles forms contained in dry beverages formulations were evaluated. The peptide-iron complexes microparticles were obtained by spray drying and added in three dry formulations (tangerine, strawberry, and chocolate flavors). The peptides isolated by iron ion affinity (IMAC-Fe III) had their biological activity predicted by BIOPEP® database and were evaluated by molecular coupling. The bioaccessibility was evaluated by solubility and dialysability and the bioavalability was assessed by Caco-2 cellular model. The proportion 10:1 of peptide-iron complexes presented higher rates of bioaccessibility (49%) and bioavailability (56%). The microparticle with peptide-iron complex showed greater solubility after digestion (39.1%), bioaccessibility (19.8%), and bioavailability (34.8%) than the ferrous sulfate salt (control) for the three assays (10.2%; 12.9%; 9.7%, respectively). Tangerine and strawberry formulations contributed to the iron absorption according to the results of bioaccessibility (36.2%, 30.0% respectively) and bioavailability (80.5%, 84.1%, respectively). The results showed that iron peptide complexation and microencapsulation process improve the bioaccessibility and bioavailability when incorporated into formulations.

Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup.

Isoniazid toxicity from self-poisoning or dosing errors remains common in regions of the world where tuberculosis is prevalent. Although the treatment of isoniazid poisoning is centered on supportive care and pyridoxine administration, extracorporeal treatments (ECTRs), such as hemodialysis, have been advocated to enhance elimination of isoniazid. No systematic reviews or evidence-based recommendations currently exist on the benefit of ECTRs for isoniazid poisoning. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup systematically collected and rated the available evidence on the effect of and indications for ECTRs in cases of isoniazid poisoning. We conducted a systematic review of the literature, screened studies, extracted data on study characteristics, outcomes, and measurement characteristics, summarized findings, and formulated recommendations following published EXTRIP methods. Forty-three studies (two animal studies, 34 patient reports or patient series, and seven pharmacokinetic studies) met inclusion criteria. Toxicokinetic or pharmacokinetic analysis was available for 60 patients, most treated with hemodialysis (n = 38). The workgroup assessed isoniazid as "Moderately Dialyzable" by hemodialysis for patients with normal kidney function (quality of evidence = C) and "Dialyzable" by hemodialysis for patients with impaired kidney function (quality of evidence = A). Clinical data for ECTR in isoniazid poisoning were available for 40 patients. Mortality of the cohort was 12.5%. Historical controls who received modern standard care including appropriately dosed pyridoxine generally had excellent outcomes. No benefit could be extrapolated from ECTR, although there was evidence of added costs and harms related to the double lumen catheter insertion, the extracorporeal procedure itself, and the extracorporeal removal of pyridoxine. The EXTRIP workgroup suggests against performing ECTR in addition to standard care (weak recommendation, very low quality of evidence) in patients with isoniazid poisoning. If standard dose pyridoxine cannot be administered, we suggest performing ECTR only in patients with seizures refractory to GABAA receptor agonists (weak recommendation, very low quality of evidence).

Elimination of intravenous alendronate by hemodialysis: A kinetic study.

INTRODUCTION: The potential utility of intravenous alendronate for the treatment of osteoporosis in hemodialysis patients was recently reported. However, the pharmacokinetics of intravenous alendronate in patients on hemodialysis is not clear. METHODS: Six hemodialysis patients (mean age, 80.5 years) with osteoporosis who had received intravenous alendronate prior to the study were enrolled. The participants received a 30-min infusion of 900-µg alendronate intravenously at the beginning of the dialysis session. The blood flow rate (Qb) and dialysate flow rate (Qd) were set at 200 mL/min and 500 mL/min, respectively. All patients used the same dialyzer (1.5-m2 polysulfone membrane). At the completion of administration, plasma and dialysate samples were collected, and alendronate concentrations were determined using metal-free high-performance liquid chromatography (HPLC)-tandem mass spectrometry (MS/MS). RESULTS: The plasma arterial alendronate concentration was 150.9 ± 46.09 ng/mL. It decreased through the dialyzer to 76.1 ± 34.1 ng/mL (venous alendronate concentration). Mean alendronate clearance was 113.9 ± 25.6 mL/min. Mean alendronate removal by hemodialysis, measured by the difference in arterial-venous concentrations, was 51.8%. CONCLUSIONS: Fifty percent of intravenous alendronate was removed by hemodialysis, which is nearly equal to elimination of alendronate in patients with normal renal function. The elimination by hemodialysis would decrease the risk of excessive accumulation in bone. UMIN 000027182.

Polyphenol bioavailability in nuts and seeds by an in vitro dialyzability approach.

An in vitro dialyzability approach has been undertaken to elucidate the bioavailable fraction of the total polyphenols (TPs) of edible nuts and seeds. The TP contents in samples and in dialyzates were assessed by the Folin-Ciocalteu spectrophotometric method. Antioxidant activity was determined in selected samples, using a modified method against Trolox®. TPs and antioxidant activity in nuts/seeds were determined after applying a pressurized liquid extraction sample pre-treatment. High dialyzability ratios were assessed in most nuts/seeds (TP dialyzability percentages within the 25-91% range). The highest TP dialyzability ratios were found in raw Brazil nuts (81 ±â€¯5%), toasted pistachios (88 ±â€¯9%), and fried cashews (89 ±â€¯9%), whereas TPs in pumpkin seeds were found to be very low (TPs were not detected in the dialyzable fraction). TP dialyzability was correlated with the copper content in nuts and seeds.

In vitro dialyzability of essential minerals from white and whole grain pasta.

The aim of the present investigation was to study the in vitro mineral dialyzability of pasta made with white and whole-grain flours obtained from two genotypes (Klein Guerrero and Baguette Premium 11) with different mineral contents. Pasta samples were made from white flour (FP), and whole grain flour from cyclonic mill (WFAP) and blade mill (WFBP). Mineral content and in vitro digestion were determined on all samples to study starch variation and mineral dialyzability. Whole-grain pasta contained significantly higher amounts of minerals than FP, since bran and embryo are richer in minerals than endosperm. In addition to the low content of mineral composition observed in FP, the dialyzability of some minerals (Cu, Fe, Mg and Zn) was higher than whole-grain pasta even when the percentage of starch hydrolyzed after intestinal digestion was higher than FP. These results can also be useful for developing wheat-based products rich in the desired minerals.

Microencapsulation and the Characterization of Polyherbal Formulation (PHF) Rich in Natural Polyphenolic Compounds.

Microencapsulation of polyherbal formulation (PHF) extract was carried out by freeze drying method, by employing gum arabic (GA), gelatin (GE), and maltodextrin (MD) with their designated different combinations as encapsulating wall materials. Antioxidant components (i.e., total phenolic contents (TPC), total flavonoids contents (TFC), and total condensed tannins (TCT)), antioxidant activity (i.e., DPPH, β-carotene & ABTS⁺ assays), moisture contents, water activity (aw), solubility, hygroscopicity, glass transition temperature (Tg), particle size, morphology, in vitroα-amylase and α-glucosidase inhibition and bioavailability ratios of the powders were investigated. Amongst all encapsulated products, TB (5% GA & 5% MD) and TC (10% GA) have proven to be the best treatments with respect to the highest preservation of antioxidant components. These treatments also exhibited higher antioxidant potential by DPPH and β-carotene assays and noteworthy for an ABTS⁺ assays. Moreover, the aforesaid treatments also demonstrated lower moisture content, aw, particle size and higher solubility, hygroscopicity and glass transition temperature (Tg). All freeze dried samples showed irregular (asymmetrical) microcrystalline structures. Furthermore, TB and TC also illustrated the highest in vitro anti-diabetic potential due to great potency for inhibiting α-amylase and α-glucosidase activities. In the perspective of bioavailability, TA, TB and TC demonstrated the excellent bioavailability ratios (%). Furthermore, the photochemical profiling of ethanolic extract of PHF was also revealed to find out the bioactive compounds.

Análisis preliminar de alimentos para la población vegana/vegetariana. ¿son buenos aportadores de minerales de interés nutricional? / Preliminary analysis of foods for the vegan/vegetarian population. Are they good suppliers of minerals of nutritional interest?

Resumen Introducción: recientemente, se ha evidenciado gran desarrollo de variados productos destinados a la población vegetariana/vegana. Sin embargo, su valor nutricional no ha sido estudiado en profundidad. El objetivo del presente estudio fue evaluar aporte potencial (AP) y porcentaje de cobertura de requerimientos diarios (%RD) de hierro, calcio y zinc de alimentos dirigidos a poblaciones adolescente y adulta vegetariana/vegana. Materiales y método: se analizaron cinco medallones (4 comerciales, 1 casero) y once bebidas (9 comerciales, 4 de ellas c/jugo frutal y 2 caseras) elaborados con materias primas vegetales. Se estableció el AP de Fe, Ca y Zn en los productos considerando su contenido y dializabilidad porcentual (D%). Se calculó, para una porción de alimento, el porcentaje de cobertura del requerimiento diario de estos minerales. Resultados: el contenido de los minerales en los medallones fue: [Fe] 1,64-4,21 mg%; [Ca] 104-213 mg% y [Zn] 0,53-3,57 mg%; en las bebidas se observó: [Fe] 0,24-2,39 mg%; [Ca] 71-214 mg% y [Zn] 0,18-0,79 mg%. La D% en medallones fue: Fe 7,3-11,9; Ca 10,2-18,2 y Zn 17,0-21,4 y para las bebidas, Fe 5,2-32,8; Ca 6,4-35,7 y Zn 5,9-33,9. El %RD para adolescentes, considerando una porción de medallones fue: Fe mujeres 3,0-9,0%; hombres 5,0-16%; Ca 0,7-6,8% y Zn 1,5-3,9% y para adultos fue: Fe mujeres 3,0-10%; hombres 7,0-20%; Ca 0,6-5,8% y Zn 2,0-5,1%. Al considerar las bebidas, el %RD para adolescentes fue: Fe mujeres 2,0-28%; hombres 4,0-53%; Ca 0,4-22% y Zn 1,3-9,5%. Para adultos fue: Fe mujeres 2,0-31%; hombres 5,0-64%; Ca 0,3-19% y Zn 1,8-12%. Conclusiones: en los medallones se observó bajo %RD para los minerales estudiados. Las bebidas con agregado de jugos de naranja o manzana aportaron cantidades significativas de hierro. El %RD para zinc y calcio de los dieciséis alimentos fue bajo (ambos grupos estudiados). Consecuentemente, para cubrir los requerimientos de estos minerales habría que combinar adecuadamente los alimentos que se consumen.

Abstract Introduction: recently, there has been great development of various products aimed at the vegetarian/vegan population. However, its nutritional value has not been studied in depth. The objective of this study was to evaluate potential intake (PI) and percentage of coverage of daily requirements (% RD) of iron, calcium and zinc from foods aimed at adolescent and adult vegetarian/vegan populations Materials and method: five medallions (4 commercial, 1 homemade) and eleven beverages (9 commercial, 4 of them with fruit juice and 2 homemade) made with vegetable raw materials were analyzed. The PI of Fe, Ca and Zn was established in the products considering their content and percentage dialyzability (D%). It was calculated, for a portion of food, the percentage of coverage of the daily requirement of these minerals. Results: the mineral content in the medallions was: [Fe] 1.64-4.21 mg%; [Ca] 104-213 mg% and [Zn] 0.53-3.57 mg%; in beverages it was observed: [Fe] 0.24-2.39 mg%; [Ca] 71-214 mg% and [Zn] 0.18-0.79 mg%. The D% in medallions was: Fe 7,3-11,9; Ca 10.2-18.2 and Zn 17.0-21.4 and for beverages, Fe 5.2-32.8; Ca 6.4-35.7 and Zn 5.9-33.9. The %RD for adolescents, considering a portion of medallions was: Fe women 3.0-9.0%; men 5.0-16%; Ca 0.7-6.8% and Zn 1.5-3.9% and for adults it was: Fe women 3.0-10%; men 7.0-20%; Ca 0.6-5.8% and Zn 2.0-5.1%. When considering beverages, the %RD for adolescents was: Fe women 2.0-28%; men 4.0-53%; Ca 0.4-22% and Zn 1.3-9.5%. For adults it was: Fe women 2.0-31%; men 5.0-64%; Ca 0.3-19% and Zn 1.8-12%. Conclusions: in the medallions, low % RD was observed for the minerals studied. Drinks with added orange or apple juices provided significant amounts of iron. The %RD for zinc and calcium of the sixteen foods was low (both groups studied). Consequently, to meet the requirements of these minerals, it would be necessary to properly combine the foods consumed.

ß-Blocker Dialyzability in Maintenance Hemodialysis Patients: A Randomized Clinical Trial.

BACKGROUND AND OBJECTIVES: There is a paucity of data available to describe drug dialyzability. Of the available information, most was obtained before implementation of modern hemodialysis membranes. Our study characterized dialyzability of the most commonly prescribed ß-blockers in patients undergoing high-flux hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients on hemodialysis (n=8) were recruited to an open label, pharmacokinetic, four-way crossover trial. Single doses of atenolol, metoprolol, bisoprolol, and carvedilol were administered on separate days in random order to each patient. Plasma and dialysate drug concentrations were measured, and dialyzability was determined by the recovery clearance and arterial venous difference methods. RESULTS: Using the recovery clearance method, the dialytic clearance values for atenolol, metoprolol, bisoprolol, and carvedilol were 72, 87, 44, and 0.2 ml/min, respectively (P<0.001). Applying the arterial venous difference method, the dialytic clearance values of atenolol, metoprolol, bisoprolol, and carvedilol were 167, 114, 96, and 24 ml/min, respectively (P<0.001). CONCLUSIONS: Atenolol and metoprolol are extensively cleared by hemodialysis compared with the negligible dialytic clearance of carvedilol. Contrary to estimates of dialyzability on the basis of previous literature, our data indicate that bisoprolol is also dialyzable. This finding highlights the importance of conducting dialyzability studies to definitively characterize drug dialytic clearance.

Dialyzability of Faropenem in Infected Patients on Chronic Hemodialysis.

The aim of this study was to evaluate the profile of dialyzability of an oral penem antibiotic, faropenem (FRPM), in hemodialysis (HD) patients with infections. Eight patients took one tablet of FRPM (200 mg) every 12 h during an inter-dialysis period, and another tablet at 1-5 h before the beginning of the HD session. Blood samples were obtained during the HD session (3-4 h). Plasma FRPM concentrations in the arterial side were 4.8 ± 2.5 and 2.8 ± 1.0 µg/mL before and at the end of HD session, respectively, which are above the 50% minimal inhibitory concentrations of FRPM against the major pathogen (0.015-2 µg/mL). Dialyzer clearance and elimination fraction of FRPM were 14.9 ± 6.8 mL/min per m2 and 20.4 ± 9.9%, respectively. About 2% of FRPM was removed from the body during a single HD session. The infection-related symptoms, the white blood cell count and the level of C-reactive protein were improved by FRPM without any adverse effects. These data suggest that the dialyzability of FRPM is relatively low, and the amount of the drug removed by a single HD session is small. FRPM 200 mg twice daily might provide an effective and safe dosage regimen without additional dosing at the end of the HD session.

Evaluation of Iodine Bioavailability in Seaweed Using in Vitro Methods.

Due to the high levels of iodine present in seaweed, the ingestion of a large amount of this type of food can produce excessive intake of iodine. However, the food after ingestion undergoes different chemistry and physical processes that can modify the amount of iodine that reaches the systemic circulation (bioavailability). Studies on the bioavailability of iodine from food are scarce and indicate that the bioavailable amount is generally lower than ingested. Iodine in vitro bioavailability estimation from different commercialized seaweed has been studied using different in vitro approaches (solubility, dialyzability, and transport and uptake by intestinal cells). Results indicate that iodine is available after gastrointestinal digestion for absorption (bioaccessibility: 49-82%), kombu being the seaweed with the highest bioaccessibility. The incorporation of dialysis cell cultures to elucidate bioavailability modifies the estimation of the amount of iodine that may reach the systemic circulation (dialysis, 5-28%; cell culture, ≤3%). The paper discusses advantages and drawbacks of these methodologies for iodine bioavailability in seaweed.