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1.
J Am Chem Soc ; 143(34): 13895-13907, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34406757

RESUMEN

We report the structure and charge transport properties of a novel solid-state proton conductor obtained by acid-base chemistry via proton transfer from 12-tungstophosphoric acid to imidazole. The resulting material (henceforth named Imid3WP) is a solid salt hydrate that, at room temperature, includes four water molecules per structural unit. To our knowledge, this is the first attempt to tune the properties of a heteropolyacid-based solid-state proton conductor by means of a mixture of water and imidazole, interpolating between water-based and ionic liquid-based proton conductors of high thermal and electrochemical stability. The proton conductivity of Imid3WP·4H2O measured at truly anhydrous conditions reads 0.8 × 10-6 S cm-1 at 322 K, which is higher than the conductivity reported for any other related salt hydrate, despite the lower hydration. In the pseudoanhydrous state, that is, for Imid3WP·2H2O, the proton conductivity is still remarkable and, judging from the low activation energy (Ea = 0.26 eV), attributed to structural diffusion of protons. From complementary X-ray diffraction data, vibrational spectroscopy, and solid-state NMR experiments, the local structure of this salt hydrate was resolved, with imidazolium cations preferably orienting flat on the surface of the tungstophosphate anions, thus achieving a densely packed solid material, and water molecules of hydration that establish extremely strong hydrogen bonds. Computational results confirm these structural details and also evidence that the path of lowest energy for the proton transfer involves primarily imidazole and water molecules, while the proximate Keggin anion contributes with reducing the energy barrier for this particular pathway.

2.
Phys Chem Chem Phys ; 17(19): 12978-87, 2015 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-25913915

RESUMEN

Dielectric permittivity measurements were performed on water solutions of propylene glycol (PG) and propylene glycol monomethyl ether (PGME) confined in 21 Å pores of the silica matrix MCM-41 C10 in wide frequency (10(-2)-10(6) Hz) and temperature (130-250 K) ranges. The aim was to elucidate how the formation of large hydrogen bonded structural entities, found in bulk solutions of PGME, was affected by the confined geometry, and to make comparisons with the dynamic behavior of the PG-water system. For all solutions the measurements revealed four almost concentration independent relaxation processes. The intensity of the fastest process is low compared to the other relaxation processes and might be caused by both hydroxyl groups of the pore surfaces and by local motions of water and solute molecules. The second fastest process contains contributions from both the main water relaxation as well as the intrinsic ß-relaxation of the solute molecules. The third fastest process is the viscosity related α-relaxation. Its concentration independency is very different compared to the findings for the corresponding bulk systems, particularly for the PGME-water system. The experimental data suggests that the surface interactions induce a micro-phase separation of the two liquids, resulting in a full molecular layer of water molecules coordinating to the hydrophilic hydroxyl groups on the surfaces of the silica pores. This, in turn, increases the geometrical confinement effect for the remaining solution even more and prevents the building up of the same type of larger structural entities in the PGME-water system as in the corresponding bulk solutions. The slowest process is mainly hidden in the high conductivity contribution at low frequencies, but its temperature dependence can be extracted for the PGME-water system. However, its origin is not fully clear, as will be discussed.

3.
J Chem Phys ; 141(21): 214501, 2014 Dec 07.
Artículo en Inglés | MEDLINE | ID: mdl-25481146

RESUMEN

The molecular dynamics of solutions of di-propylene glycol methylether (2PGME) and H2O (or D2O) confined in 28 Å pores of MCM-41 have been studied by quasielastic neutron scattering and differential scanning calorimetry over the concentration range 0-90 wt.% water. This system is of particular interest due to its pronounced non-monotonic concentration dependent dynamics of 2PGME in the corresponding bulk system, showing the important role of hydrogen bonding for the dynamics. In this study we have elucidated how this non-monotonic concentration dependence is affected by the confined geometry. The results show that this behaviour is maintained in the confinement, but the slowest diffusive dynamics of 2PGME is now observed at a considerably higher water concentration; at 75 wt.% water in MCM-41 compared to 30 wt.% water in the corresponding bulk system. This difference can be explained by an improper mixing of the two confined liquids. The results suggest that water up to a concentration of about 20 wt.% is used to hydrate the hydrophilic hydroxyl surface groups of the silica pores, and that it is only at higher water contents the water becomes partly mixed with 2PGME. Hence, due to this partial micro-phase separation of the two liquids larger, and thereby slower relaxing, structural entities of hydrogen bonded water and 2PGME molecules can only be formed at higher water contents than in the bulk system. However, the Q-dependence is unchanged with confinement, showing that the nature of the molecular motions is preserved. Thus, there is no indication of localization of the dynamics at length scales of less than 20 Å. The dynamics of both water and 2PGME is strongly dominated by translational diffusion at a temperature of 280 K.

4.
J Chem Phys ; 141(3): 034505, 2014 Jul 21.
Artículo en Inglés | MEDLINE | ID: mdl-25053324

RESUMEN

The molecular dynamics of aqueous solutions of propylene glycol (PG) and propylene glycol methylether (PGME) confined in a two-dimensional layer-structured Na-vermiculite clay has been studied by broadband dielectric spectroscopy and differential scanning calorimetry. As typical for liquids in confined geometries the intensity of the cooperative α-relaxation becomes considerably more suppressed than the more local ß-like relaxation processes. In fact, at high water contents the calorimetric glass transition and related structural α-relaxation cannot even be observed, due to the confinement. Thus, the intensity of the viscosity related α-relaxation is dramatically reduced, but its time scale as well as the related glass transition temperature Tg are for both systems only weakly influenced by the confinement. In the case of the PGME-water solutions it is an important finding since in the corresponding bulk system a pronounced non-monotonic concentration dependence of the glass transition related dynamics has been observed due to the growth of hydrogen bonded relaxing entities of water bridging between PGME molecules [J. Sjöström, J. Mattsson, R. Bergman, and J. Swenson, Phys. Chem. B 115, 10013 (2011)]. The present results suggest that the same type of structural entities are formed in the quasi-two-dimensional space between the clay platelets. It is also observed that the main water relaxation cannot be distinguished from the ß-relaxation of PG or PGME in the concentration range up to intermediate water contents. This suggests that these two processes are coupled and that the water molecules affect the time scale of the ß-relaxation. However, this is most likely true also for the corresponding bulk solutions, which exhibit similar time scales of this combined relaxation process below Tg. Finally, it is found that at higher water contents the water relaxation does not merge with, or follow, the α-relaxation above Tg, but instead crosses the α-relaxation, indicating that the two relaxation processes are independent of each other. This can only occur if the two processes do not occur in the same parts of the confined solutions. Most likely the hydration shell of the interlayer Na(+) ions is causing this water relaxation, which does not participate in the α-relaxation at any temperature.

5.
Phys Chem Chem Phys ; 15(42): 18437-44, 2013 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-23877276

RESUMEN

Water-glycerol solutions confined in 21 Å pores of the silica matrix MCM-41 C10 have been studied using differential scanning calorimetry (DSC) and broadband dielectric spectroscopy (BDS). The results suggest a micro-phase separation caused by the confinement. Likely the water molecules coordinate to the hydroxyl surface groups of the pores, leaving most of the glycerol molecules in the centre of the pores. This makes the dynamics of glycerol almost concentration independent up to water concentrations of about 85 wt%. However, at higher water concentrations no substantial clustering of glycerol molecules should occur and the glass transition related dynamics exhibit an anomalous behaviour. Instead of a common plasticization effect of water, as for the corresponding bulk solutions (when no ice is formed), it is evident that water acts as an anti-plasticizer in the confinement at high water concentrations. We propose that the increased water concentration slows down the glass transition related dynamics in the deeply supercooled regime due to that a rigid hydrogen bonded network structure of water molecules is formed at low temperatures and low glycerol concentrations. This is in contrast to the situation in a homogenously mixed bulk solution of a high solute concentration where the water molecules will be less hydrogen bonded, and therefore are typically more mobile than the surrounding solute molecules. An almost complete hydrogen bonded network of water molecules may, even in confinements, be sufficiently rigid to slow down the relaxation of embedded solute molecules. It can also be expressed the other way around, i.e. small amounts of glycerol act as a plasticizer for water, due to its breaking up of the nearly tetrahedral network structure. From the here observed concentration dependent behaviour of the deeply supercooled bulk and confined solutions it seems, furthermore, evident that the Tg value of bulk water cannot be estimated from extrapolations of aqueous solutions.


Asunto(s)
Agua/química , Glicerol/química , Dióxido de Silicio/química , Soluciones , Temperatura de Transición
6.
J Chem Phys ; 136(10): 104508, 2012 Mar 14.
Artículo en Inglés | MEDLINE | ID: mdl-22423849

RESUMEN

We present the first broadband dielectric spectroscopy (BDS) and differential scanning calorimetry study of supercooled xylitol-water mixtures in the whole concentration range and in wide frequency (10(-2)-10(6) Hz) and temperature (120-365 K) ranges. The calorimetric glass transition, T(g), decreases from 247 K for pure xylitol to about 181 K at a water concentration of approximately 37 wt. %. At water concentrations in the range 29-35 wt. % a plentiful calorimetric behaviour is observed. In addition to the glass transition, almost simultaneous crystallization and melting events occurring around 230-240 K. At higher water concentrations ice is formed during cooling and the glass transition temperature increases to a steady value of about 200 K for all higher water concentrations. This T(g) corresponds to an unfrozen xylitol-water solution containing 20 wt. % water. In addition to the true glass transition we also observed a glass transition-like feature at 220 K for all the ice containing samples. However, this feature is more likely due to ice dissolution [A. Inaba and O. Andersson, Thermochim. Acta, 461, 44 (2007)]. In the case of the BDS measurements the presence of water clearly has an effect on both the cooperative α-relaxation and the secondary ß-relaxation. The α-relaxation shows a non-Arrhenius temperature dependence and becomes faster with increasing concentration of water. The fragility of the solutions, determined by the temperature dependence of the α-relaxation close to the dynamic glass transition, decreases with increasing water content up to about 26 wt. % water, where ice starts to form. This decrease in fragility with increasing water content is most likely caused by the increasing density of hydrogen bonds, forming a network-like structure in the deeply supercooled regime. The intensity of the secondary ß-relaxation of xylitol decreases noticeably already at a water content of 2 wt. %, and at a water content above 5 wt. % it has been replaced by a considerably stronger water (w) relaxation at about the same frequency. However, the similarities in time scale and activation energy between the w-relaxation and the ß-relaxation of xylitol at water contents below 13 wt. % suggest that the w-relaxation is governed, in some way, by the ß-relaxation of xylitol, since clusters of water molecules are rare at these water concentrations. At higher water concentrations the intensity and relaxation rate of the w-relaxation increase rapidly with increasing water content (up to the concentration where ice starts to form), most likely due to a rapid increase of small water clusters where an increasing number of water molecules interacting with other water molecules.

7.
Clin Endocrinol (Oxf) ; 73(4): 436-44, 2010 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20550539

RESUMEN

CONTEXT: Prenatal treatment with dexamethasone to prevent virilization in pregnancies at risk for classical congenital adrenal hyperplasia (CAH) remains controversial. OBJECTIVE: To conduct a systematic review and meta-analyses of studies that evaluated the effects of dexamethasone administration during pregnancies at risk for classical CAH because of 21-hydroxylase deficiency (CYP21A2). DATA SOURCES: We searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception through August 2009. Review of reference lists and contact with CAH experts further identified candidate studies. STUDY SELECTION: Reviewers working independently and in duplicate determined trial eligibility. Eligible studies reported the effects on either foetal or maternal outcomes of dexamethasone administered during pregnancy compared to a control group that did not receive any treatment. DATA EXTRACTION: Reviewers working independently and in duplicate determined the methodological quality of studies and collected data on patient characteristics, interventions, and outcomes. DATA SYNTHESIS: We identified only four eligible observational studies (325 pregnancies treated with dexamethasone). The methodological quality of the included studies was overall low. Meta-analysis demonstrates a reduction in foetus virilization measured by Prader score in female foetuses treated with dexamethasone initiated early during pregnancy (weighted mean difference, -2.33, 95% CI, -3.38, -1.27). No deleterious effects of dexamethasone on stillbirths, spontaneous abortions, foetal malformations, neuropsychological or developmental outcomes were found although these data are quite sparse. There was increased oedema and striae in the mothers treated with dexamethasone. There were no data on long-term follow-up of physical and metabolic outcomes in children exposed to dexamethasone. CONCLUSIONS: The observational nature of the available evidence and the overall small sample size of the whole body of the literature significantly weaken inferences about the benefits and harms of dexamethasone in this setting. Dexamethasone seems to be associated with reduction in foetus virilization without significant maternal or foetal adverse effects. However, this review underscores the current uncertainty and further investigation is clearly needed. The decision about initiating treatment should be based on patients' values and preferences and requires fully informed and consenting parents.


Asunto(s)
Dexametasona/efectos adversos , Feto/efectos de los fármacos , Virilismo/prevención & control , Hiperplasia Suprarrenal Congénita/inducido químicamente , Femenino , Humanos , Embarazo , Riesgo
8.
J Phys Chem B ; 123(18): 4044-4054, 2019 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-30995045

RESUMEN

Protic ionic liquids are known to form extended hydrogen-bonded networks that can lead to properties different from those encountered in the aprotic analogous liquids, in particular with respect to the structure and transport behavior. In this context, the present paper focuses on a wide series of 1-alkyl-imidazolium bis(trifluoromethylsulfonyl)imide ionic liquids, [HC nIm][TFSI], with the alkyl chain length ( n) on the imidazolium cation varying from ethyl ( n = 2) to dodecyl ( n = 12). A combination of several methods, such as vibrational spectroscopy, wide-angle X-ray scattering (WAXS), broadband dielectric spectroscopy, and 1H NMR spectroscopy, is used to understand the correlation between local cation-anion coordination, nature of nanosegregation, and transport properties. The results indicate the propensity of the -NH site on the cation to form stronger H-bonds with the anion as the alkyl chain length increases. In addition, the position and width of the scattering peak q1 (or the pre-peak), resolved by WAXS and due to the nanosegregation of the polar from the nonpolar domains, are clearly dependent on the alkyl chain length. However, we find no evidence from pulsed-field gradient NMR of a proton motion decoupled from molecular diffusion, hypothesized to be facilitated by the longer N-H bonds localized in the segregated ionic domains. Finally, for all protic ionic liquids investigated, the ionic conductivity displays a Vogel-Fulcher-Tammann dependence on inverse temperature, with an activation energy Ea that also depends on the alkyl chain length, although not strictly linearly.

9.
Membranes (Basel) ; 9(11)2019 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-31683556

RESUMEN

A composite membrane based on a Nafion polymer matrix incorporating a non-stoichiometric calcium titanium oxide (CaTiO3-δ) additive was synthesized and characterized by means of thermal analysis, dynamic mechanical analysis, and broadband dielectric spectroscopy at different filler contents; namely two concentrations of 5 and 10 wt.% of the CaTiO3-δ additive, with respect to the dry Nafion content, were considered. The membrane with the lower amount of additive displayed the highest water affinity and the highest conductivity, indicating that a too-high dose of additive can be detrimental for these particular properties. The mechanical properties of the composite membranes are similar to those of the plain Nafion membrane and are even slightly improved by the filler addition. These findings indicate that perovskite oxides can be useful as a water-retention and reinforcing additive in low-humidity proton-exchange membranes.

10.
J Phys Chem B ; 121(41): 9699-9707, 2017 10 19.
Artículo en Inglés | MEDLINE | ID: mdl-28926256

RESUMEN

In this study, we have used nanocomposite polymer electrolytes, consisting of poly(ethylene oxide) (PEO), δ-Al2O3 nanoparticles, and lithium bis(trifluoromethanesolfonyl)imide (LiTFSI) salt (with 4 wt % δ-Al2O3 and PEO:Li ratios of 16:1 and 8:1), and added different amounts of the ionic liquid 1-butyl-3-methylimidazolium bis(trifluoromethanesolfonyl)imide (BMITFSI). The aim was to elucidate whether the ionic liquid is able to dissociate the Li-ions from the ether oxygens and thereby decouple the ionic conductivity from the segmental polymer dynamics. The results from DSC and dielectric spectroscopy show that the ionic liquid speeds up both the segmental polymer dynamics and the motion of the Li+ ions. However, a close comparison between the structural (α) relaxation process, given by the segmental polymer dynamics, and the ionic conductivity shows that the motion of the Li+ ions decouples from the segmental polymer dynamics at higher concentrations of the ionic liquid (≥20 wt %) and instead becomes more related to the viscosity of the ionic liquid. This decoupling increases with decreasing temperature. In addition to the structural α-relaxation, two more local relaxation processes, denoted ß and γ, are observed. The ß-relaxation becomes slightly faster at the highest concentration of the ionic liquid (at least for the lower salt concentration), whereas the γ-relaxation is unaffected by the ionic liquid, over the whole concentration range 0-40 wt %.

11.
Artículo en Inglés | MEDLINE | ID: mdl-25871109

RESUMEN

Aqueous solutions of glycerol are investigated by dynamic light scattering (DLS) over the whole concentration range (10-98 wt.% water) and in the temperature range 283-303 K. The measurements reveal one slow relaxation process in the geometry of polarized light scattering. This process is present in the whole concentration range, although it is very weak at the highest and lowest water concentrations and is considerably slower than the structural α relaxation, which is too fast to be observed on the experimental time scale in the measured temperature range. The relaxation time of the observed process exhibits a 1/q2 dependence, proving that it is due to long-range translational diffusion. The Stokes-Einstein relation is used to estimate the hydrodynamic radius of the diffusing particles and from these calculations it is evident that the observed relaxation process is due to the Brownian motion of single or a few glycerol molecules. The fact that it is possible to study the self-diffusion of such small molecules may stimulate a broadening of the research field used to be covered by the DLS technique.

12.
J Phys Chem B ; 117(24): 7363-9, 2013 Jun 20.
Artículo en Inglés | MEDLINE | ID: mdl-23697683

RESUMEN

Dynamic light scattering (DLS) and small-angle neutron scattering (SANS) were employed to study mixtures of xylitol and water. The results were also related to a previous dielectric relaxation study on the same system. In the temperature range of the DLS measurements the viscosity related structural (α) relaxation is too fast to be observed on the experimental time scale, but a considerably slower exponential and hydrodynamic relaxation process is clearly observable in the polarized light scattering data. A similar ultraslow process has been observed in many other types of binary liquids and commonly assigned to long-range concentration or density fluctuations. In some studies this interpretation has been supported by observations of substantial structural inhomogeneities in static light scattering or SANS experiments. However, in this study we observe such an ultraslow process without any indication of structural inhomogeneities on length-scales above 2 nm. Hence, we suggest that our observed ultraslow process is due to long-range diffusion of single xylitol molecules or small clusters of a few xylitol molecules (and perhaps some associated water molecules) which are randomly dispersed and sufficiently small to not be structurally detected in our SANS study. In the q-range of the DLS measurements this ultraslow relaxation process is around room temperature several orders of magnitude slower than the structural α-relaxation. However, if its 1/q(2)-dependent relaxation time is extrapolated to q-values where relaxation times from dielectric spectroscopy and quasielastic neutron scattering are compatible (about 10 nm(-1)), a relaxation time similar to that of the dielectric α-relaxation is obtained. Thus, the large difference in time scale between the two relaxation processes in the q-range of a DLS study is due to the fact that the α-relaxation is cooperative in nature, rather than caused by long-range single particle diffusion, and thus q-independent at low q-values.


Asunto(s)
Agua/química , Xilitol/química , Difusión
13.
Pak J Biol Sci ; 15(21): 1010-8, 2012 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-24163943

RESUMEN

Manny legumes are used extensively as animal feed. This study was conducted to look at the effects of decorticated cow pea seeds based diets supplemented with molasses on broiler performance and carcass traits. A total of 240 unsexed one-day old broiler chicks (Ross 308) were used .The birds were randomly divided into six equal groups (treatments) and each group consisted of 8 (replicates). Six experimental diets (starter and finisher) were formulated to be approximately isocaloric and isonitrogenous. The cow pea was included at three levels (0, 10 and 20%) with two levels of molasses at (0, 3%). Decorticated cowpea and raw cowpea contain 25.86 vs. 24.78% crude protein, 1.41 vs. 0.91% ether extract, 3.36 vs. 3.33% ash and 2.64 vs. 3.46% crude fiber on dry matter basis. Methionine content was high in decorticated cowpea (0.40%) compared with raw cowpea (0.35%), the vice versa hold true for lysine, 1.74 in raw seeds vs. 1.62% in decorticated seeds. Decorticated cowpea seed at 10 or 20% without molasses significantly (p<0.05) improved final body weight (1999.50-2051.32 g vs. 1986.32 in the control group). Whereas, the molasses addition at 3% significantly decreased final body weight (1838.42-1900.79 g vs. 1986.32 in the control group) and total feed intake (3150.75- 3300.75 vs. 3318.00 +/- 26.45 g in the control group). The inclusion of 20% cowpea with 3% molasses significantly improved feed conversion ratio in 20 cow pea with 3% molasses It is concluded that cow pea seeds is a good source of protein that can be used in broiler feeds safely to give satisfactory results.


Asunto(s)
Alimentación Animal , Fenómenos Fisiológicos Nutricionales de los Animales , Pollos/metabolismo , Proteínas en la Dieta/metabolismo , Suplementos Dietéticos , Fabaceae/metabolismo , Carne , Melaza , Proteínas de Plantas/metabolismo , Animales , Pollos/crecimiento & desarrollo , Ingestión de Energía , Metabolismo Energético , Evaluación Nutricional , Estado Nutricional , Semillas/metabolismo , Aumento de Peso
14.
J Clin Endocrinol Metab ; 96(7): 1931-42, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21677037

RESUMEN

CONTEXT: Several studies found association between vitamin D levels and hypertension, coronary artery calcification, and heart disease. OBJECTIVE: The aim of this study was to summarize the evidence on the effect of vitamin D on cardiovascular outcomes. DESIGN AND METHODS: We searched electronic databases from inception through August 2010 for randomized trials. Reviewers working in duplicate and independently extracted study characteristics, quality, and the outcomes of interest. Random-effects meta-analysis was used to pool the relative risks (RR) and the weighted mean differences across trials. RESULTS: We found 51 eligible trials with moderate quality. Vitamin D was associated with nonsignificant effects on the patient-important outcomes of death [RR, 0.96; 95% confidence interval (CI), 0.93, 1.00; P = 0.08], myocardial infarction (RR, 1.02; 95% CI, 0.93, 1.13; P = 0.64), and stroke (RR, 1.05; 95% CI, 0.88, 1.25; P = 0.59). These analyses were associated with minimal heterogeneity. There were no significant changes in the surrogate outcomes of lipid fractions, glucose, or diastolic or systolic blood pressure. The latter analyses were associated with significant heterogeneity, and the pooled estimates were trivial in absolute terms. CONCLUSIONS: Trial data available to date are unable to demonstrate a statistically significant reduction in mortality and cardiovascular risk associated with vitamin D. The quality of the available evidence is low to moderate at best.


Asunto(s)
Enfermedades Cardiovasculares/sangre , Vitamina D/sangre , Humanos , Riesgo
15.
J Clin Endocrinol Metab ; 96(10): 2997-3006, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21795448

RESUMEN

CONTEXT: Vitamin D affects bone and muscle health and likely reduces the risk of falls in the elderly. OBJECTIVE: The aim of this systematic review is to summarize the existing evidence on vitamin D use and the risk of falls. DATA SOURCES: We searched electronic databases from inception through August 2010. STUDY SELECTION: Eligible studies were randomized controlled trials in which the intervention was vitamin D and the incidence of falls was reported. DATA EXTRACTION: Reviewers working in duplicate and independently extracted study characteristics, quality, and outcomes data. DATA SYNTHESIS: Odds ratio and associated 95% confidence interval were estimated from each study and pooled using the random effects model. RESULTS: We found 26 eligible trials of moderate quality that enrolled 45,782 participants, the majority of which were elderly and female. Vitamin D use was associated with statistically significant reduction in the risk of falls (odds ratio for suffering at least one fall, 0.86; 95% confidence interval, 0.77-0.96). This effect was more prominent in patients who were vitamin D deficient at baseline and in studies in which calcium was coadministered with vitamin D. The quality of evidence was low to moderate because of heterogeneity and publication bias. CONCLUSIONS: Vitamin D combined with calcium reduces the risk of falls. The reduction in studies without calcium coadministration did not reach statistical significance. The majority of the evidence is derived from trials enrolling elderly women.


Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Vitamina D/fisiología , Vitamina D/uso terapéutico , Anciano , Anciano de 80 o más Años , Calcio de la Dieta/uso terapéutico , Análisis por Conglomerados , Intervalos de Confianza , Femenino , Humanos , Masculino , Estado Nutricional , Oportunidad Relativa , Sesgo de Publicación , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/tratamiento farmacológico
16.
J Clin Endocrinol Metab ; 95(9): 4161-72, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20823467

RESUMEN

CONTEXT: Treatment for patients with congenital adrenal hyperplasia (CAH) may affect the final height of these patients. OBJECTIVE: Our objective was to determine the distribution of achieved height in patients with classic CAH diagnosed at infancy or early childhood and treated with glucocorticoids. DATA SOURCES: We searched MEDLINE, EMBASE, Cochrane Library, ISI Web of Science, and Scopus through September 2008; the reference sections of included studies; and expert files. STUDY SELECTION: Eligible studies included patients diagnosed with CAH before age 5 and followed to final height. DATA EXTRACTION: Reviewers working in duplicate independently extracted data on study characteristics and outcomes and determined each study's risk of bias. DATA SYNTHESIS: The sd score (SDS) for final height and corrected height (defined as final height SDS - midparental height SDS) were estimated from each study and pooled using random-effects metaanalysis. The I(2) statistic was used to assess inconsistency in results across studies. RESULTS: We found 35 eligible studies, most of which were retrospective single-cohort studies. The final height SDS achieved by CAH patients was -1.38 (-1.56 to -1.20; I(2) = 90.2%), and the corrected height SDS was -1.03 (-1.20 to -0.86; I(2) = 63.1%). This was not significantly associated with age at diagnosis, gender, type and dose of steroid, and age of onset of puberty. Mineralocorticoid users had a better height outcome in comparison with the nonusers (P = 0.02). CONCLUSION: Evidence derived from observational studies suggests that the final height of CAH patients treated with glucocorticoids is lower than the population norm and is lower than expected given parental height.


Asunto(s)
Hiperplasia Suprarrenal Congénita/fisiopatología , Estatura , Hiperplasia Suprarrenal Congénita/complicaciones , Adulto , Algoritmos , Estatura/fisiología , Glucocorticoides/uso terapéutico , Trastornos del Crecimiento/complicaciones , Trastornos del Crecimiento/terapia , Hormona de Crecimiento Humana/uso terapéutico , Humanos , Mineralocorticoides/uso terapéutico , Resultado del Tratamiento
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