Treatment of Recurrent Urinary Tract Infection Symptoms with Urinary Antiseptics Containing Methenamine and Methylene Blue: Analysis of Etiology and Treatment Outcomes.

PURPOSE: Urinary antiseptics including methenamine and methylene blue are used in the symptomatic treatment of urinary tract infections (UTIs). PATIENTS AND METHODS: This was a prospective, double-blind, randomized, double-dummy safety and efficacy study of 2 urinary antiseptic combinations in the symptomatic treatment of recurrent cystitis: methenamine 120mg + methylene blue 20mg (Group A) versus acriflavine 15mg + methenamine 250mg + methylene blue 20mg + Atropa belladonna L. 15mg (Group B). All subjects underwent pretreatment urine culture and antibiotic sensitivity tests prior to 3-day oral treatment with study drug, followed by 3 days of antibiotic therapy (based on urine culture) + study drug treatment. Efficacy was evaluated using the Urinary Tract Infection Symptoms Assessment Questionnaire (UTISA). The primary endpoint was the percentage of patients presenting improvement in cystitis manifestations on the UTISA domain "Urination Regularity" at Visit 2. The primary safety variable was the incidence of treatment-related adverse events. RESULTS: A total of 144 subjects were randomized per group and 272 completed the study. Primary endpoint analysis demonstrates homogeneity between treatment groups, with 69.4% and 72.2% subjects, respectively, showing improvement in the score of the urinary regularity UTISA domain after 3 days of treatment (p= 0.87). At Visit 2, incidence of treatment-related adverse events was higher in Group B (Group A: n= 11, Group B: n= 31, p= 0.0057). CONCLUSION: Both treatments were effective in reducing UTI symptoms assessed by UTISA questionnaire after 3 days of treatment. The two regimens were comparable in incidence of adverse events, but the combination of methenamine + methylene blue resulted in fewer treatment-related adverse effects.

Clinical Evaluation of the Use of Ginger Extract in the Preventive Management of Motion Sickness.

BACKGROUND: Motion sickness can be triggered in a variety of situations and is characterized primarily by nausea and vomiting. Ginger is widely used in treating conditions including chemotherapy-associated gastrointestinal symptoms, morning sickness, postoperative nausea, and motion sickness. OBJECTIVES: The primary study objective was to evaluate Zingiber officinale extract in the treatment of motion sickness. Secondary objectives were to evaluate treatment effect on Motion Sickness Assessment Questionnaire (MSAQ) score and subscores before and after treatment, and to evaluate treatment tolerability. METHODS: Open-label, single-arm study assessing motion sickness outcomes with and without pre-travel oral treatment with Zingiber officinale 160 mg extract (containing 8 mg gingerols). All patients answered the MSAQ on 4 separate occasions following a trip of at least 15 minutes in duration: Trip 1 (pretreatment) and Trips 2, 3, and 4 (after oral treatment with study medication). The primary end point was percentage of patients presenting improvement ≥20 score points on the MSAQ during Trip 2, Trip 3, and Trip 4 in comparison to pretreatment score (Trip 1). Secondary end points included percentage of patients presenting improvement in MSAQ subscores during Trips 2, 3, and 4; percentage of patients presenting treatment-related adverse events; and pre- and posttreatment physician assessment scores. RESULTS: One hundred eighty-four patients were included and 174 completed treatment. A reduction of ≥20 points in total MSAQ score points occurred in 26.52%, 29.89%, and 29.31% of patients from Trips 2, 3, and 4, respectively. There was no significant difference at Trips 2, 3, and 4 in number of patients presenting improvement ≥20 score points (P = 0.9579). There was a significant reduction in total MSAQ scores from Trips 2, 3, and 4 (P < 0.0001) compared with Trip 1. Total MSAQ scores did not vary at each trip taken under treatment (P = 0.28). There were significant (P < .001) improvements in all domain subscores from Trips 2, 3, and 4 in relation to scores from Trip 1. There was a significant improvement in physician assessment scores at Visit 2 (P < .0001). Adverse events were reported among 31 patients, mainly affecting the gastrointestinal system. Twenty-four patients (13.04%) reported 39 adverse events considered related to treatment. No significant change in physical exam was noted at Visit 2 in relation to Visit 1. CONCLUSIONS: These open label, historically controlled study results suggest the need for randomized, blinded, placebo and active substance controlled clinical trials. (Curr Ther Res Clin Exp. 2020; 81:XXX-XXX).

Hiperpotassemia: conduta sinoventricular em paciente idoso, em insuficiência renal e cetoacidose diabética / Hyperpotassemia and sinoventricular conduction in elderly patient with renal insufficiency and diabetic ketoacidosis

Paciente idoso, portador de cardiomiopatia isquêmica, hipertenso, com leve disfunção renal e diabético insulinodependente, por suspensão do uso da insulina desenvolveu cetoacidose com grave desidratação e severa hiperpotassemia, que reverteu com o uso de medicações. Analisam-se interessantes aspectos eletrocardiográficos inerentes ao caso.

An elderly patient with ischemic cardiomyopathy, hypertension, slight renal dysfunction and insulindependentdiabetes developed ketoacidosis aftersuspending insulin use, with severe dehydration and severe hyperpotassemia, both reverted throughmedications. This paper analyzes interesting eletrocardiographic aspects of this case.

Eletrocardiograma: recomendações para a sua interpretação / Electrocardiogram: recommendations for interpretation

O eletrocardiograma constitui-se no primeiro exame complementar no diagnóstico cardiológico, tornando fundamental o conhecimento da interpretação do ECG normal e patológico. Os autores apresentam uma revisão sumária da ativação elétrica do coração, a base para o atendimento e a interpretação do traçado. Apresentam um método de sistematização na interpretação do eletrocardiograma normal, a propedêutica eletrocardiográfica, e acrescentam notas práticas que auxiliam no diagnóstico de algumas das alterações observadas na clínica cardiológica.

Elementos significativos do eletrocardiograma nos recém-natos e na primeira infância: suas utilidade clínicas / Significant elements of electrocardiograms in infants and childhood: clinical utilities

Durante a vida fetal, o ventrículo direito trabalha contra uma alta resistência, pois impulsiona o fluxo sanguíneo para regiões de alta pressão, como o tronco, os membros e, principalmente, os pulmões ainda não expandidos. A normalização fisiológica das pressões, na pequena circulação e no ventrículo direito, ocorre progressivamente ao longo dos dois primeiros anos de vida. Portanto, o recém-nato apresenta fisiologicamente o padrão hemodinâmico e eletrocardiográfico de sobrecarga ventricular direita. Os autores apresentam uma revisão sumária da circulação e da fisiologia fetal, dos padrões hemodinâmicos observados em cardiopatias congênitas, e a análise sistematizada do eletrocardiograma normal do recém-nato. Além disso, destacam os elementos no eletrocardiograma que auxiliam no diagnóstico de algumas das principais cardiopatias congênitas.

Pericardite: Etiologias diversas em serviço de clínica médica: relato de cinco casos / Pericarditis; etiologies diverse in medical clinics service - report of five cases

Os autores apresentam cinco casos de comprometimento de pericárdio relacionados a etiologias diversas, encontrados no período de um ano em diversas, encontrados no período de um ano em serviço de Clínica Médica: pericardite aguda benigna inespecífica ou pericardite idiopática, pericardite aguda pós-infarto do miocárdio, pericardite neoplásica, pericardite inderteminada, associada a tetralogia de Fallot e pericardite constritiva tuberculosa foram as patologias observadas. Ressaltam que, por ser o acometimento do pericárdio um achado mais freqüente nas necropsias que in vivo (pois em muitos casos as manifestaçoes clínicas estao obscurecidas pelo acometimento geral do paciente), o diagnóstico de pericardite deve estar presente mais amiúde no raciocínio clínico.