Does oral salbutamol improve fatigue in multiple sclerosis? A pilot placebo-controlled study.

BACKGROUND: Because MS-related fatigue could be associated with enhanced proinflammatory cytokine production, drugs with immunomodulatories properties, such as salbutamol, may represent an alternative treatment. We aimed to evaluate the effect of salbutamol on MS-related fatigue. METHODS: Thirty patients with relapsing-remitting MS who were between 18 and 69 years old, and suffering from fatigue, were evaluated with the Fatigue Severity Scale (FSS) and the Brazilian version of the neurological fatigue index for multiple sclerosis (NFI/MS-BR). They received salbutamol 2 mg twice a day or a placebo in a pilot randomized, double-masked placebo-controlled trial. The primary outcome was the change in the FSS score at the end of 90 days. The secondary outcome was the efficacy, represented by changes in their scores on the NFI/MS-BR subdomains (in the same period) and the Expanded Disability Status Scale (EDSS) at the end of 90 days. RESULTS: Thirty subjects were allocated to receive either salbutamol (14) or a placebo (16). There was no superiority of salbutamol over the placebo in the FSS outcome at 30 (p ==0.498), 60 (p = 0.854) and 90 (p = 0.240) days. There was no a significant decrease in the proportion of patients with severe or moderate fatigue in the salbutamol group at the end of the follow-up. The scores on the NFI/MS-BR and its subscales did not improve significantly with treatment. No significant difference was observed in the EDSS outcome (p = 0.313). No serious adverse events were found. An increase in heart rate was evident in the salbutamol group only in the first 30 days, but without statistical significance in relation to placebo (p = 0.077). CONCLUSION: Treatment with salbutamol does not improve fatigue in patients with relapsing-remitting MS.

Improving knowledge about permeability in membrane bioreactors through sensitivity analysis using artificial neural networks.

Membrane bioreactor (MBR) has been widely employed for industrial effluent treatment, as its higher efficiency in removing pollutants makes effluent reuse more feasible. However, membrane fouling remains as a limiting factor for its greater diffusion. This work performed a sensitivity analysis study to investigate the effects of analytical and operating variables on membrane permeability. The case study is a MBR treating oil refinery effluents. After the identification and validation of a predictive neural model for permeability, sensitivity analysis methods based on both connection weights and variable disturbances were used to quantify and rank the variables influence. A comprehensive analysis showed that Suspended solids and Days between cleanings exerted greater effects on permeability, whereas sludge filterability and sludge temperature were less significant. In sequence, a specific analysis revealed distinct dynamics in MBR operation given different solids concentrations. For instance, from higher solids concentrations, among all the evaluated parameters, only COD presented low significance to the permeability. This evidence suggests that permeability is more susceptible to variations when operating with higher concentrations of Suspended solids. The global result of this study contributes to more efficient MBR operations since distinct relations with permeability imply different effects on membrane fouling.