RESUMO
Magnesium is one of the recommended treatments for calcium stone formers (CSFs) with hyperoxaluria. In this study, we compared the effect of magnesium oxide (MgO) or magnesium citrate (MgCit) with placebo on 24-hour urine (24-U) metabolites and the calcium oxalate supersaturation index (CaOx SS). In a randomized, double-blind, placebo-controlled clinical trial, 90 CSFs with idiopathic hyperoxaluria were recruited from a tertiary stone prevention clinic. Patients were randomly assigned into three groups: 120 mg MgO, 120 mg MgCit or placebo (supplements were taken three times per day, with meals). Finally, 76 patients were included in the final analysis. Analyses of 24-U were performed at baseline and after eight weeks. Study outcomes included changes in 24-U oxalate, magnesium, citrate, and CaOx SS. Dietary factors were controlled by 24-hour food recalls. Repeated measure ANOVA was used to compare the results. After the intervention, both MgO and MgCit supplements decreased 24-U oxalate excretion (-8.13±16.45 in the MgO group and -16.99±18.02 in the MgCit group) and CaOx SS compared to the placebo, with the effects of MgCit reaching statistical significance (p=0.011 and p=0.010, respectively). An increasing trend was observed for 24-U magnesium and citrate excretion without significant differences among groups. Interestingly, MgCit exhibited a significantly greater inhibitory effect on 24-U oxalate in patients with normal urine magnesium levels (p=0.021). Clinically, both MgO and MgCit reduced 24-U oxalate and CaOx SS compared to placebo. However, MgCit demonstrated a greater effect, especially in patients with normal urine magnesium levels.
Assuntos
Suplementos Nutricionais , Hiperoxalúria , Cálculos Renais , Óxido de Magnésio , Humanos , Óxido de Magnésio/uso terapêutico , Óxido de Magnésio/administração & dosagem , Feminino , Masculino , Cálculos Renais/urina , Cálculos Renais/prevenção & controle , Cálculos Renais/tratamento farmacológico , Cálculos Renais/metabolismo , Adulto , Hiperoxalúria/urina , Hiperoxalúria/tratamento farmacológico , Hiperoxalúria/complicações , Método Duplo-Cego , Fatores de Risco , Pessoa de Meia-Idade , Ácido Cítrico/urina , Compostos de Magnésio/uso terapêutico , Compostos de Magnésio/urina , Compostos de Magnésio/farmacologia , Compostos de Magnésio/administração & dosagem , Compostos OrganometálicosRESUMO
BACKGROUND: Bone defects arising from diverse causes, such as traffic accidents, contemporary weapon usage, and bone-related disorders, present significant challenges in clinical treatment. Prolonged treatment cycles for bone defects can result in complications, impacting patients' overall quality of life. Efficient and timely repair of bone defects is thus a critical concern in clinical practice. OBJECTIVE: This study aims to assess the scientific progress and achievements of magnesium phosphate bone cement (MPC) as an artificial bone substitute material. Additionally, the research seeks to explore the future development path and clinical potential of MPC bone cement in addressing challenges associated with bone defects. METHODS: The study comprehensively reviews MPC's performance, encompassing e.g. mechanical properties, biocompatibility, porosity, adhesion and injectability. Various modifiers are also considered to broaden MPC's applications in bone tissue engineering, emphasizing drug-loading performance and antibacterial capabilities, which meet clinical diversification requirements. RESULTS: In comparison to alternatives such as autogenous bone transplantation, allograft, polymethyl methacrylate (PMMA), and calcium phosphate cement (CPC), MPC emerges as a promising solution for bone defects. It addresses limitations associated with these alternatives, such as immunological rejection and long-term harm to patients. MPC can control heat release during the curing process, exhibits superior mechanical strength, and has the capacity to stimulate new bone growth. CONCLUSION: MPC stands out as an artificial bone substitute with appropriate mechanical strength, rapid degradation, non-toxicity, and good biocompatibility, facilitating bone repair and regeneration. Modification agents can enhance its clinical versatility. Future research should delve into its mechanical properties and formulations, expanding clinical applications to create higher-performing and more medically valuable alternatives in bone defect repair.
Assuntos
Cimentos Ósseos , Substitutos Ósseos , Compostos de Magnésio , Fosfatos , Cimentos Ósseos/química , Cimentos Ósseos/uso terapêutico , Humanos , Fosfatos/química , Compostos de Magnésio/química , Compostos de Magnésio/uso terapêutico , Substitutos Ósseos/uso terapêutico , Substitutos Ósseos/química , Animais , Regeneração Óssea/efeitos dos fármacos , Porosidade , Teste de Materiais , Osso e Ossos/efeitos dos fármacosRESUMO
OBJECTIVE: To determine the efficacy and safety of a urinary acidifier (d,l-methionine [Methio-Form]) and an antimicrobial agent (amoxicillin-clavulanic acid [Clavamox]) without changing diet for dissolving infection-induced struvite urocystoliths in dogs. ANIMALS: 14 dogs were recruited for this prospective study; 11 completed it and 3 dogs withdrew due to inability of the owners to administer the treatment (n = 2) or refusal of treatment by the dog (1). PROCEDURES: All dogs were administered d,l-methionine (approx initial dose of 75 mg/kg, PO, q 12 h) and amoxicillin-clavulanic acid (22 mg/kg, PO, q 12 h) based on urine culture and sensitivity. Urine pH, urinalysis, urine culture, venous blood gas and serum biochemical analysis, and lateral survey abdominal radiographic images were evaluated initially and every 4 weeks until urolith dissolution (success) or lack of change in size and/or shape of urocystoliths on 2 consecutive reevaluation points (failure) occurred. RESULTS: Uroliths dissolved in 8 of 11 dogs in a median of 2 months (range, 1 to 4 months) with a final effective dosage of d,l-methionine of approximately 100 mg/kg, PO, every 12 hours. In 3 dogs, uroliths failed to dissolve and were removed surgically; they contained variable amounts of calcium oxalate. No adverse events occurred. CLINICAL RELEVANCE: Infection-induced struvite urolithiasis is 1 of the 2 most common minerals occurring in canine uroliths. Results of this study supported the use of d,l-methionine and amoxicillin-clavulanic acid without changing diet for dissolution of infection-induced struvite urocystoliths in dogs.
Assuntos
Doenças do Cão , Cálculos Urinários , Urolitíase , Cães , Animais , Estruvita , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Projetos Piloto , Compostos de Magnésio/uso terapêutico , Metionina/uso terapêutico , Estudos Prospectivos , Fosfatos/análise , Fosfatos/uso terapêutico , Cálculos Urinários/veterinária , Urolitíase/tratamento farmacológico , Urolitíase/veterinária , Doenças do Cão/tratamento farmacológicoRESUMO
Objective: Familial hypomagnesemia with secondary hypocalcemia (HSH) is an autosomal recessive disease caused by a mutation in the transient receptor potential melastatin 6 (TRPM6) gene and is characterized by selective magnesium malabsorption. Affected cases are usually diagnosed during infancy and usually present with seizures due to hypocalcemia and hypomagnesemia. Irreversible neurological deficits and arrhythmias can be observed without appropriate treatment. The aim was to evaluate the long-term follow-up of patients with genetically confirmed HSH. Methods: A total of six patients with HSH, two of whom were siblings, were included. Age at diagnosis, clinical, laboratory and follow-up data on admission were recorded. All 39 exons of the TRPM6 gene and flanking exon-intron junctions from genomic DNA were amplified and sequenced in all cases. Results: The median (range) follow-up duration was 12.1 (7.6-21.7) years. All cases were diagnosed in infancy. Four different mutations, three of which had not been previously reported, were detected in the TRPM6 gene. Treatment compliance was good and there were no severe complications in the long-term follow-up of cases. However, mental retardation, specific learning difficulty and attention deficit/hyperactive disorder were observed as comorbidities. Conclusion: Of the four different TRPM6 mutations in this small cohort, three had not been previously reported. The long-term prognosis of HSH appears to be good, given early diagnosis and good treatment compliance. This long-term follow-up and prognostic data and the three novel mutations will contribute to the published evidence concerning this rare condition, HSH, and it is hoped will prevent negative outcomes.
Assuntos
Hipocalcemia/genética , Deficiência de Magnésio/congênito , Mutação , Canais de Cátion TRPM , Adolescente , Fatores Etários , Criança , Desenvolvimento Infantil , Pré-Escolar , Feminino , Seguimentos , Predisposição Genética para Doença , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/tratamento farmacológico , Hipocalcemia/metabolismo , Lactente , Compostos de Magnésio/uso terapêutico , Deficiência de Magnésio/diagnóstico , Deficiência de Magnésio/tratamento farmacológico , Deficiência de Magnésio/genética , Deficiência de Magnésio/metabolismo , Masculino , Fenótipo , Estudos Retrospectivos , Canais de Cátion TRPM/genética , Canais de Cátion TRPM/metabolismo , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Palygorskite (PGS) is a kind of clay minerals with the property of absorbent capacity, and ginger essential oil (GEO) is a kind of natural antibacterial substances. In the present study PGS was used as carrier of GEO, and thus, a kind of new anti-bacterial composite GEO-PGS has been obtained. Characterization, inhibitory effect of GEO-PGS on Escherichia coli (E. coli) and its function of improvement of intestinal health would be investigated. Results showed that characterization analysis of GEO-PGS (FTIR, TG-DSC, BET, Zeta potential, specific surface area, total pore volume and size, TEM observation) demonstrated combination of GEO and PGS, and GEO was absorbed on the surface of PGS, partially filled the micropores of PGS. GEO-PGS had obvious inhibitory effect on E.coli, in combination of the antibacterial activity of GEO and bacteria-absorbed capability of PGS. GEO-PGS also had ameliorating effect on enteritis and intestinal dysfunction in vivo, which might be related to the inhibition of gene expression of inflammatory cytokines (TLR2, IL-6, TNFα, and IL-8). In conclusion, the novel composite GEO-PGS has the potential usage as functional component having effect of improving intestinal health.
Assuntos
Antibacterianos/uso terapêutico , Enterite/tratamento farmacológico , Escherichia coli/efeitos dos fármacos , Compostos de Magnésio/uso terapêutico , Óleos Voláteis/uso terapêutico , Compostos de Silício/uso terapêutico , Zingiber officinale/química , Animais , Citocinas/genética , Citocinas/metabolismo , Sinergismo Farmacológico , Enterite/microbiologia , Expressão Gênica/efeitos dos fármacos , Intestino Delgado/efeitos dos fármacos , Intestino Delgado/patologia , Camundongos , Testes de Sensibilidade MicrobianaRESUMO
BACKGROUND AND AIM: Treatment options for functional dyspepsia (FD) refractory to pharmacological treatments are limited but the effectiveness of electroacupuncture (EA) is uncertain. We assessed the effectiveness of EA combined with on-demand gastrocaine. METHODS: We conducted a single-center, assessor-blind, randomized parallel-group 2-arm trial on Helicobacter pylori negative FD patients of the postprandial distress syndrome subtype refractory to proton pump inhibitor, prokinetics, or H2 antagonists. Enrolled participants were block randomized in a 1:1 ratio, with concealed random sequence. The treatment and control groups both received on-demand gastrocaine for 12 weeks, but only those in treatment group were offered 20 sessions of EA over 10 weeks. The primary endpoint was the between-group difference in proportion of patients achieving adequate relief of symptoms at week 12. RESULTS: Of 132 participants randomly assigned to EA plus on-demand gastrocaine (n = 66) or on-demand gastrocaine alone (n = 66), 125 (94.7%) completed all follow-up at 12 weeks. The EA group had a compliance rate 97.7%. They had a significantly higher likelihood in achieving adequate symptom relief at 12 weeks, with a clinically relevant number needed to treat (NNT) value of 2.36 (95% CI: 1.74, 3.64). Among secondary outcomes, statistically and clinically significant improvements were observed among global symptom (NNT = 3.85 [95% CI: 2.63, 7.69]); postprandial fullness and early satiation (NNT = 5.00 [95% CI: 2.86, 25.00]); as well as epigastric pain, epigastric burning, and postprandial nausea (NNT = 4.17 [95% CI: 2.56, 11.11]). Adverse events were minimal and nonsignificant. CONCLUSION: For refractory FD, EA provides significant, clinically relevant symptom relief when added to on-demand gastrocaine (ChiCTR-IPC-15007109).
Assuntos
Hidróxido de Alumínio/uso terapêutico , Aminobenzoatos/uso terapêutico , Atropina/uso terapêutico , Dispepsia/tratamento farmacológico , Eletroacupuntura/métodos , Compostos de Magnésio/uso terapêutico , Adulto , Hidróxido de Alumínio/administração & dosagem , Aminobenzoatos/administração & dosagem , Atropina/administração & dosagem , Terapia Combinada , Esquema de Medicação , Combinação de Medicamentos , Eletroacupuntura/efeitos adversos , Feminino , Humanos , Compostos de Magnésio/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Resultado do TratamentoRESUMO
OBJECTIVES: Exploratory study to investigate the effectiveness of intravenous magnesium as an abortive for status migrainosus in an outpatient infusion center, and characterize the patients who benefit from the therapy. PATIENTS & METHODS: Retrospective analysis of 234 migraine patients who received IV magnesium as a headache abortive, at the headache clinic of University of Southern California. Additional intramuscular (IM) injections for nausea (prochlorperazine, odansetron, metoclopramide) or for refractory pain (ketorolac, dexamethasone, sumatriptan, dihydroergotamine), were administered as necessary. Immediately before and after treatment, self-reported pain levels were recorded using an 11-point numeric pain rating scale (0-10). RESULTS: Our patient sample has a mean age of 44 years and was predominantly female (79%). 36 (19%) had migraine with aura. Overall, pain score decreased from 5.46±2.39 to 3.56 ± 2.75 (P < 0.001) after magnesium infusion. One hundred twenty-seven (54%) patients had clinically significant pain reduction, as defined by pain decrease ≥ 30%. One hundred and four patients (44%) received IV magnesium and did not require additional intramuscular (IM) medications for pain. In patients who did not receive additional IM medications for pain, pain score decreased from 4.76 ± 2.41 to 2.95 ± 2.70 (p < 0.001), and 61 out of 104 (59%) experienced ≥ 30% pain reduction. Patients with less severe pain tended to have a better response than patients with more severe pain, as patients with ≥30% pain reduction had a significantly lower pre-treatment pain score (p = 0.018). CONCLUSION: For a subset of patients with status migrainosus, IV magnesium therapy results in clinically significant pain relief without the need for intramuscular pain medications. Therefore, IV magnesium may be useful as a cost-effective first-line parental therapy for status migrainosus, especially for patients who initially present with lower pain intensity.
Assuntos
Compostos de Magnésio/administração & dosagem , Compostos de Magnésio/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Administração Intravenosa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Feminino , Humanos , Compostos de Magnésio/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Manejo da Dor , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
AIMS: Cardiovascular (CV) complications are common in chronic kidney disease (CKD). Numerous metabolic disturbances including hyperphosphatemia, high circulating calciprotein particles (CPP), hyperparathyroidism, metabolic acidosis, and magnesium deficiency are associated with, and likely pathogenic for CV complications in CKD. The goal of this feasibility study was to determine whether effervescent calcium magnesium citrate (EffCaMgCit) ameliorates the aforementioned pathogenic intermediates. METHODS: Nine patients with Stage 3 and nine patients with Stage 5D CKD underwent a randomized crossover study, where they took EffCaMgCit three times daily for 7 days in one phase, and a conventional phosphorus binder calcium acetate (CaAc) three times daily for 7 days in the other phase. Two-hour postprandial blood samples were obtained on the day before and on the 7th day of treatment. RESULTS: In Stage 5D CKD, EffCaMgCit significantly increased T50 (half time for conversion of primary to secondary CPP) from baseline by 63% (P = 0.013), coincident with statistically non-significant declines in serum phosphorus by 25% and in saturation of octacalcium phosphate by 35%; CaAc did not change T50. In Stage 3 CKD, neither EffCaMgCit nor CaAc altered T50. With EffCaMgCit, a significant increase in plasma citrate was accompanied by statistically non-significant increase in serum Mg and phosphate. CaAc was without effect in any of these parameters in Stage 3 CKD. In both Stages 3 and 5D, both drugs significantly reduced serum parathyroid hormone. Only EffCaMgCit significantly increased serum bicarbonate by 3 mM (P = 0.015) in Stage 5D. CONCLUSIONS: In Stage 5D, EffCaMgCit inhibited formation of CPP, suppressed PTH, and conferred magnesium and alkali loads. These effects were unique, since they were not observed with CaAc. In Stage 3 CKD, neither of the regimens have any effect. These metabolic changes suggest that EffCaMgCit might be useful in protecting against cardiovascular complications of CKD by ameliorating pathobiologic intermediates.
Assuntos
Acidose/prevenção & controle , Citrato de Cálcio/farmacologia , Doenças Cardiovasculares/prevenção & controle , Ácido Cítrico/uso terapêutico , Hiperfosfatemia/prevenção & controle , Compostos de Magnésio/farmacologia , Deficiência de Magnésio/prevenção & controle , Compostos Organometálicos/uso terapêutico , Insuficiência Renal Crônica/tratamento farmacológico , Equilíbrio Ácido-Base/efeitos dos fármacos , Acidose/sangue , Acidose/diagnóstico , Acidose/etiologia , Idoso , Bicarbonatos/sangue , Biomarcadores/sangue , Citrato de Cálcio/uso terapêutico , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Ácido Cítrico/efeitos adversos , Ácido Cítrico/sangue , Estudos Cross-Over , Combinação de Medicamentos , Estudos de Viabilidade , Feminino , Humanos , Concentração de Íons de Hidrogênio , Hiperfosfatemia/sangue , Hiperfosfatemia/diagnóstico , Hiperfosfatemia/etiologia , Magnésio/sangue , Compostos de Magnésio/uso terapêutico , Deficiência de Magnésio/sangue , Deficiência de Magnésio/diagnóstico , Deficiência de Magnésio/etiologia , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/efeitos adversos , Compostos Organometálicos/sangue , Hormônio Paratireóideo/sangue , Fosfatos/sangue , Fósforo/sangue , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Texas , Fatores de Tempo , Resultado do TratamentoRESUMO
Taurine-magnesium coordination compound (TMCC) exhibits antiarrhythmic effects in cesium-chloride-and ouabain-induced arrhythmias; however, the mechanism underlying these effects on arrhythmia remains poorly understood. Here, we investigated the effects of TMCC on aconitine-induced arrhythmia in vivo and the electrophysiological effects of this compound in rat ventricular myocytes in vitro. Aconitine was used to induce arrhythmias in rats, and the dosages required to produce ventricular premature contraction (VPC), ventricular tachycardia (VT), ventricular fibrillation (VF), and cardiac arrest (CA) were recorded. Additionally, the sodium current (INa) and L-type calcium current (ICa,L) were analyzed in normal and aconitine-treated ventricular myocytes using whole-cell patch-clamp recording. In vivo, intravenous administration of TMCC produced marked antiarrhythmic effects, as indicated by the increased dose of aconitine required to induce VPC, VT, VF, and CA. Moreover, this effect was abolished by administration of sodium channel opener veratridine and calcium channel agonist Bay K8644. In vitro, TMCC inhibited aconitine-induced increases in INa and ICa,L. These results revealed that TMCC inhibited aconitine-induced arrhythmias through effects on INa and ICa,L.
Assuntos
Aconitina , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/tratamento farmacológico , Canais Iônicos/efeitos dos fármacos , Compostos de Magnésio/uso terapêutico , Taurina/uso terapêutico , Animais , Canais de Cálcio Tipo L/efeitos dos fármacos , Fenômenos Eletrofisiológicos/efeitos dos fármacos , Feminino , Parada Cardíaca/induzido quimicamente , Parada Cardíaca/prevenção & controle , Ventrículos do Coração/citologia , Ventrículos do Coração/efeitos dos fármacos , Masculino , Miócitos Cardíacos/efeitos dos fármacos , Técnicas de Patch-Clamp , Ratos , Ratos Wistar , Canais de Sódio/efeitos dos fármacosRESUMO
BACKGROUND: Hypophosphatemia is commonly associated with disease and decreased productivity in dairy cows particularly in early lactation. Oral supplementation with phosphate salts is recognized as suitable for the rapid correction of hypophosphatemia. Little information is available about the differences in efficacy between salts used for oral phosphorus supplementation. OBJECTIVES: Comparison of efficacy of oral administration of NaH2 PO4 , Na2 HPO4 , and MgHPO4 in treating hypophosphatemia in cattle. ANIMALS: 12 healthy dairy cows in the fourth week of lactation in their second to fifth lactation. METHODS: Randomized clinical study. Phosphorus deficient, hypophosphatemic cows underwent a sham treatment and were afterwards assigned to 1 of 3 treatments-NaH2 PO4 , Na2 HPO4 , or MgHPO4 (each provided the equivalent of 60 g of phosphorus). Blood samples were obtained immediately before and repeatedly after treatment. RESULTS: Treatment with NaH2 PO4 and Na2 HPO4 resulted in rapid and sustained increases of plasma phosphate concentrations ([Pi]). Significant effects were apparent within 1 hour (NaH2 PO4 : P = .0044; Na2 HPO4 : P = .0077). Peak increments of plasma [Pi] of 5.33 mg/dL [5.26-5.36] and 4.30 mg/dL [3.59-4.68] (median and interquartile range) were reached after 7 and 6 hours in animals treated with NaPH2 PO4 and Na2 HPO4 , respectively, whereas treatment with MgHPO4 led to peak increments 14 hours after treatment (3.19 mg/dL [2.11-4.04]). CONCLUSIONS AND CLINICAL IMPORTANCE: NaH2 PO4 and Na2 HPO4 are suitable to rapidly correct hypophosphatemia in cattle. Because of the protracted and weaker effect, MgHPO4 cannot be recommended for this purpose. Despite important differences in solubility of NaH2 PO4 and Na2 HPO4 only small plasma [Pi] differences were observed after treatment.
Assuntos
Doenças dos Bovinos/tratamento farmacológico , Hipofosfatemia/veterinária , Compostos de Magnésio/uso terapêutico , Fosfatos/uso terapêutico , Administração Oral , Animais , Bovinos , Doenças dos Bovinos/sangue , Doenças dos Bovinos/metabolismo , Feminino , Hipofosfatemia/sangue , Hipofosfatemia/tratamento farmacológico , Hipofosfatemia/metabolismo , Lactação/metabolismo , Compostos de Magnésio/administração & dosagem , Fosfatos/administração & dosagem , Fósforo/sangueRESUMO
INTRODUCTION: This trial proposes to compare the effectiveness and cost-effectiveness of electroacupuncture (EA) plus on-demand gastrocaine with waiting list for EA plus on-demand gastrocaine in providing symptom relief and quality-of-life improvement among patients with functional dyspepsia (FD). METHODS AND ANALYSIS: This is a single-centre, pragmatic, randomised parallel-group, superiority trial comparing the outcomes of (1) EA plus on-demand gastrocaine group and (2) waiting list to EA plus on-demand gastrocaine group. 132 (66/arm) endoscopically confirmed, Helicobacter pylori-negative patients with FD will be recruited. Enrolled patients will respectively be receiving (1) 20 sessions of EA over 10 weeks plus on-demand gastrocaine; or (2) on-demand gastrocaine and being nominated on to a waiting list for EA, which entitles them 20 sessions of EA over 10 weeks after 12 weeks of waiting. The primary outcome will be the between-group difference in proportion of patients achieving adequate relief of symptoms over 12 weeks. The secondary outcomes will include patient-reported change in global symptoms and individual symptoms, Nepean Dyspepsia Index, Nutrient Drink Test, 9-item Patient Health Questionnaire (PHQ9), and 7-item Generalised Anxiety Disorder Scale (GAD7). Adverse events will be assessed formally. Results on direct medical costs and on the EuroQol (EQ-5D) questionnaire will also be used to assess cost-effectiveness. Analysis will follow the intention-to-treat principle using appropriate univariate and multivariate methods. A mixed model analysis taking into account missing data of these outcomes will be performed. Cost-effectiveness analysis will be performed using established approach. ETHICS AND DISSEMINATION: The study is supported by the Health and Medical Research Fund, Government of the Hong Kong Special Administrative Region of China. It has been approved by the Joint Chinese University of Hong Kong - New Territories East Cluster Clinical Research Ethics Committee. Results will be published in peer-reviewed journals and be disseminated in international conference. TRIAL REGISTRATION NUMBER: ChiCTR-IPC-15007109; Pre-result.
Assuntos
Hidróxido de Alumínio/uso terapêutico , Aminobenzoatos/uso terapêutico , Atropina/uso terapêutico , Análise Custo-Benefício/economia , Dispepsia/terapia , Eletroacupuntura/métodos , Compostos de Magnésio/uso terapêutico , Projetos de Pesquisa , Padrão de Cuidado/economia , Adolescente , Adulto , Idoso , Hidróxido de Alumínio/economia , Aminobenzoatos/economia , Atropina/economia , Combinação de Medicamentos , Dispepsia/economia , Eletroacupuntura/economia , Feminino , Hong Kong , Humanos , Compostos de Magnésio/economia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Listas de Espera , Adulto JovemRESUMO
The aim of this research was to develop effective alternative therapies to reduce antibiotic use in animal agriculture. In this study, the efficacy of copper-modified palygorskite (CM-Pal) in preventing diarrhea caused by Salmonella was specifically examined both in vitro and in vivo. The CM-Pal was prepared with palygorskite (Pal) and copper nitrate. The antibacterial activity of the CM-Pal was detected by comparing the differences in cell numbers on plate count agar before and after adding the CM-Pal to Salmonella typhimurium cultures. Seventy ICR mice were then allocated into seven groups. Five groups (the treatment groups) were infected with S. typhimurium by intraperitoneal (i.p.) injection and were given Pal, CM-Pal, montmorillonite powder, gentamicin, and physiological saline, respectively. One group (the prevention group) was given CM-Pal before infection with S. typhimurium. Another group (the uninfected group) was not infected with S. typhimurium. The effects of Pal, CM-Pal, montmorillonite powder, and gentamicin on the treatment or prevention of diarrhea in the mice were examined by stool studies, fecal scoring, and assessment of growth performance and villus height. The CM-Pal had satisfactory anti-bacterial properties in vitro: the antibacterial rate was 100% after 2 h incubation with S. typhimurium NJS1 cultures (1×106 colony-forming units (CFU)/ml). In the in vivo experiment, the CM-Pal exerted superior effects in the treatment and prevention of diarrhea in mice compared with Pal, montmorillonite powder, and gentamicin. In the CM-Pal group, no mice showed signs of diarrhea at 24 h post infection (p.i.), and all mice fully recovered from infection. However, the Pal group, montmorillonite group, and gentamicin group only recovered after 48, 48, and 96 h, respectively. The villus height level in the CM-Pal treatment group recovered at 3 d p.i. However, the recovery time of the other groups was longer (at least 5 d). The CM-Pal prevention group had a better effect on weight gain than the other groups. This study suggested that CM-Pal may be an effective alternative to conventional antibiotics for the treatment and prevention of animal diarrhea caused by Salmonella.
Assuntos
Diarreia/tratamento farmacológico , Diarreia/prevenção & controle , Compostos de Magnésio/farmacologia , Compostos de Magnésio/uso terapêutico , Salmonelose Animal/tratamento farmacológico , Salmonelose Animal/prevenção & controle , Salmonella typhimurium , Compostos de Silício/farmacologia , Compostos de Silício/uso terapêutico , Animais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Antidiarreicos/farmacologia , Antidiarreicos/uso terapêutico , Bentonita/farmacologia , Bentonita/uso terapêutico , Cobre/química , Diarreia/microbiologia , Gentamicinas/farmacologia , Gentamicinas/uso terapêutico , Mucosa Intestinal/patologia , Camundongos , Camundongos Endogâmicos ICR , Testes de Sensibilidade Microbiana , Salmonelose Animal/patologia , Salmonella typhimurium/efeitos dos fármacosRESUMO
PURPOSE: Natural history and modality of treatment for asymptomatic renal calculi less than or equal to 5 millimetres in size is still unknown. Many options are available ranging from medical expulsive therapy to minimally invasive surgery. Till date no study has focussed on this very common but asymptomatic issue. Hence, this study is undertaken to evaluate efficacy of medical expulsive therapy in renal calculi less than or equal to 5mm in size. MATERIALS AND METHODS: A prospective, parallel group, randomized study was carried out from 1st June 2014 to 31st May 2015, with total of 100 patients, 50 patients in each group. Patients with renal stones less than or equal to 5mm were included in the study. Group A Patients were administered medical expulsive therapy which included tamsulosin 0.4 mg daily at night time, furosemide 20mg, spironolactone 50mg in a single morning dose, and syrup potassium magnesium citrate 20Meq per dose three times a day for 12 weeks while group B patients were given placebo. The primary outcome variable was number of patients achieving clearance of stone during 12-week treatment period in both groups. RESULTS: No statistically significant differences in age, gender, stone size, and calyceal stone location was found between the two treatment arms. A spontaneous stone expulsion rate of 50% (at 6 weeks) and 86 %( at 12 weeks) was noted in group A versus 28% (at 6 weeks) and 38 % (at 12 weeks) in group B. Less number of pain episodes and less analgesic medication was required in group A as compared to group B. CONCLUSION: Medical Expulsive therapy for 12 weeks significantly improves stone free rates in renal calyceal calculi less than or equal to 5mm.
Assuntos
Citratos/uso terapêutico , Furosemida/uso terapêutico , Compostos de Magnésio/uso terapêutico , Compostos de Potássio/uso terapêutico , Espironolactona/uso terapêutico , Cálculos Coraliformes/tratamento farmacológico , Cálculos Coraliformes/patologia , Sulfonamidas/uso terapêutico , Adolescente , Adulto , Idoso , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tansulosina , Resultado do Tratamento , Adulto JovemRESUMO
Diet rich in fruits, vegetables, and dairy products, known as the Dietary Approaches to Stop Hypertension (DASH) diet, is known to reduce blood pressure (BP) in hypertensive patients. More recently, the DASH diet was shown to reduce oxidative stress in hypertensive and nonhypertensive humans. However, the main nutritional components responsible for these beneficial effects of the DASH diet remain unknown. Because the DASH diet is rich in potassium (K), magnesium (Mg), and alkali, we performed a randomized, double-blinded, placebo-controlled study to compare effects of potassium magnesium citrate (KMgCit), potassium chloride (KCl), and potassium citrate (KCit) to allow dissociation of the three components of K, Mg, and citrate on 24-hour ambulatory BP and urinary 8-isoprostane in hypertensive and prehypertensive subjects, using a randomized crossover design. We found that KCl supplementation for 4 weeks induced a significant reduction in nighttime SBP compared with placebo (116 ± 12 vs 121 ± 15 mm Hg, respectively, p <0.01 vs placebo), whereas KMgCit and KCit had no significant effect in the same subjects (118 ± 11 and 119 ± 13 mm Hg, respectively, p >0.1 vs placebo). In contrast, urinary 8-isoprostane was significantly reduced with KMgCit powder compared with placebo (13.5 ± 5.7 vs 21.1 ± 10.5 ng/mgCr, respectively, p <0.001), whereas KCl and KCit had no effect (21.4 ± 9.1 and 18.3 ± 8.4, respectively, p >0.1 vs placebo). In conclusion, our study demonstrated differential effects of KCl and KMgCit supplementation on BP and the oxidative stress marker in prehypertensive and hypertensive subjects. Clinical significance of the antioxidative effect of KMgCit remains to be determined in future studies.
Assuntos
Citratos/uso terapêutico , Hipertensão/tratamento farmacológico , Compostos de Magnésio/uso terapêutico , Estresse Oxidativo , Cloreto de Potássio/uso terapêutico , Citrato de Potássio/uso terapêutico , Compostos de Potássio/uso terapêutico , Pré-Hipertensão/tratamento farmacológico , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Estudos Cross-Over , Suplementos Nutricionais , Dinoprosta/análogos & derivados , Dinoprosta/urina , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Hipertensão/metabolismo , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Potássio/metabolismo , Pré-Hipertensão/metabolismo , Rigidez VascularRESUMO
BACKGROUND: Clinical studies have been previously carried out on the efficacy of systemic magnesium to minimize postoperative pain, however, with controversial results. A quantitative meta-analysis was performed to evaluate the analgesic efficacy and safety of systemic magnesium on post-operative pain. STUDY DESIGN: Comprehensive systematic review of all relevant, publsished randomized controlled trials. METHODS: A search was conducted of published literature in MEDLINE, PsycINFO, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to Sep-Oct 2014. Randomized controlled trials (RCTs) that compared magnesium with placebo were identified. Effects were summarized using standardized mean differences (SMDs), weighed mean differences (WMD), or odds ratio (OR) with suitable effect model. RESULTS: Twenty-seven RCTs involving 1,504 patients were included. In total, peri-operative magnesium significantly reduced the pain score at rest (SMD, -1.43, 95% CI, -2.74 to -0.12, < 0.01). Magnesium significantly reduced analgesic consumption (SMD, -1.72, 95% CI, -3.21 to -0.23) in patients undergoing urogenital, orthopaedic, and cardiovascular surgeries, but was inconclusive for patients receiving gastrointestinal surgeries. The obvious analgesia of systemic magnesium was observed on reducing the pain score during movement at 24 hours after operation (SMD, -0.05, 95% CI, -0.43 to 0.32). Moreover, magnesium administration showed a beneficial effect with regard to intra-operative hemodynamics and reduced extubation time in the cardiovascular surgery patients (WMD, -29.34 min, 95% CI, -35.74 to -22.94, P < 0.01). LIMITATIONS: Focused only on the quality of analgesia on postoperative pain with regards to surgery type. CONCLUSIONS: Our study suggests that systemic magnesium during general anesthesia significantly decreases post-operative pain scores without increasing adverse events. It should be noted that since there are 18 ongoing RCTs without published data, it is still premature to draw conclusions on the long-term analgesic effects of magnesium as well as potential gender or age difference.
Assuntos
Analgésicos/uso terapêutico , Compostos de Magnésio/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Anestesia Geral , Medicina Baseada em Evidências , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Kidney stones affect people worldwide and have a high rate of recurrence even with treatment. Recurrences are particularly prevalent in people with low urinary citrate levels. These people have a higher incidence of calcium phosphate and calcium oxalate stones. Oral citrate therapy increases the urinary citrate levels, which in turn binds with calcium and inhibits the crystallisation thus reduces stone formation. Despite the widespread use of oral citrate therapy for prevention and treatment of calcium oxalate stones, the evidence to support its clinical efficacy remains uncertain. OBJECTIVES: The objective of this review was to determine the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Specialised Register to 29 July 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that assessed the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones in adults treated for a minimum of six months. DATA COLLECTION AND ANALYSIS: Two authors assessed studies for inclusion in this review. Data were extracted according to predetermined criteria. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes. MAIN RESULTS: We included seven studies that included a total of 477 participants, most of whom had oxalate stones. Of these, three studies (247 participants) compared potassium citrate with placebo or no intervention; three (166 participants) compared potassium-sodium citrate with no intervention; and one (64 participants) compared potassium-magnesium citrate with placebo. Overall, quality of the reporting of the included studies was considered moderate to poor, and there was a high risk of attrition bias in two studies.Compared with placebo or no intervention, citrate therapy significantly reduced the stone size (4 studies, 160 participants: RR 2.35, 95% CI 1.36 to 4.05). New stone formation was significantly lower with citrate therapy compared to control (7 studies, 324 participants: RR 0.26, 95% CI 0.10 to 0.68). The beneficial effect on stone size stability was also evident (4 studies, 160 participants: RR 1.97, 95% CI 1.19 to 3.26). Adverse events were reported in four studies, with the main side effects being upper gastrointestinal disturbance and one patient reported a rash. There were more gastrointestinal adverse events in the citrate group; however this was not significant (4 studies, 271 participants: RR 2.55, 95% CI 0.71 to 9.16). There were significantly more dropouts due to adverse events with citrate therapy compared to control (4 studies, 271 participants: RR 4.45, 95% CI 1.28 to 15.50). The need for retreatment was significantly less with citrate therapy compared to control (2 studies, 157 participants: RR 0.22, 95% CI 0.06 to 0.89). AUTHORS' CONCLUSIONS: Citrate salts prevent new stone formation and reduce further stone growth in patients with residual stones that predominantly contain oxalate. The quality of reported literature remains moderate to poor; hence a well-designed statistically powered multi-centre RCT is needed in order to answer relevant questions concerning the efficacy of citrate salts.
Assuntos
Citratos/uso terapêutico , Cálculos Renais/química , Cálculos Renais/terapia , Adulto , Oxalato de Cálcio , Fosfatos de Cálcio , Citratos/efeitos adversos , Citratos/urina , Combinação de Medicamentos , Humanos , Cálculos Renais/prevenção & controle , Compostos de Magnésio/uso terapêutico , Compostos de Potássio/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Prevenção SecundáriaRESUMO
PURPOSE: Given that the clinical course of oxaliplatin-induced neuropathy is not well defined, the current study was performed to better understand clinical parameters associated with its presentation. METHODS: Acute and chronic neuropathy was evaluated in patients receiving adjuvant FOLFOX (fluorouracil, leucovorin, and oxaliplatin) on study N08CB (North Central Cancer Treatment Group, Alliance). Acute neuropathy was assessed by having patients complete daily questionnaires for 6 days with each cycle of FOLFOX. Before each dose of FOLFOX and as long as 18 months after chemotherapy cessation, chronic neurotoxicity was assessed with use of the 20-item, European Organisation for Research and Treatment of Cancer quality-of-life questionnaire for patients with chemotherapy-induced peripheral neuropathy. RESULTS: Three hundred eight (89%) of the 346 patients had at least one symptom of acute neuropathy with the first cycle of FOLFOX; these symptoms included sensitivity to touching cold items (71%), sensitivity to swallowing cold items (71%), throat discomfort (63%), or muscle cramps (42%). Acute symptoms peaked at day 3 and improved, although they did not always resolve completely between treatments. These symptoms were about twice as severe in cycles 2 through 12 as they were in cycle 1. For chronic neurotoxicity, tingling was the most severe symptom, followed by numbness and then pain. During chemotherapy, symptoms in the hands were more prominent than they were in the feet; by 18 months, symptoms were more severe in the feet than they were in the hands. Patients with more severe acute neuropathy during the first cycle of therapy experienced more chronic sensory neurotoxicity (P < .0001). CONCLUSION: Acute oxaliplatin-induced neuropathy symptoms do not always completely resolve between treatment cycles and are only half as severe on the first cycle as compared with subsequent cycles. There is a correlation between the severities of acute and chronic neuropathies.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Síndromes Neurotóxicas/etiologia , Síndromes Neurotóxicas/patologia , Compostos Organoplatínicos/efeitos adversos , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/patologia , Doença Aguda , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Compostos de Cálcio/uso terapêutico , Doença Crônica , Neoplasias do Colo/tratamento farmacológico , Método Duplo-Cego , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Leucovorina/administração & dosagem , Leucovorina/efeitos adversos , Compostos de Magnésio/uso terapêutico , Síndromes Neurotóxicas/prevenção & controle , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Doenças do Sistema Nervoso Periférico/prevenção & controleRESUMO
OBJECTIVE: The aim of this study was to determine the early effect of the administration of Oxalobacter formigenes on the metabolic pattern of patients with calcium oxalate stones, comparing it with potassium magnesium citrate (KMgCit). MATERIALS AND METHODS: Eighty patients were randomized to receive either 30â mEq of KMgCit or 700 million O. formigenes, both twice a day. Serum creatinine, serum urate, serum calcium and phosphorus, serum intact parathyroid hormone (if serum calcium >10.5â mg/dl) and 24 h urine metabolic evaluation for various metabolites (e.g. oxalate, calcium, phosphorus, citrate, magnesium, urate and creatinine) were evaluated at baseline and 1 month after starting the treatment. RESULTS: In both groups hyperoxaluria was the most common abnormality, followed by hypercalciuria. The incidence of hyperoxaluria decreased at 1 month compared to baseline in both KMgCit (77.5% vs 37.5%, p = 0.0006) and O. formigenes preparation (82.5% vs 15%, p < 0.0001) groups, while other urinary metabolic abnormalities were similar at baseline and 1 month in both groups. Three patients in the KMgCit had mild self-limiting secondary symptoms. CONCLUSION: Compared with KMgCit, O. formigenes preparation is more effective in decreasing the incidence of hyperoxaluria, opening the door to probiotic therapy as a potential new weapon against hyperoxaluria.
Assuntos
Hiperoxalúria/terapia , Oxalobacter formigenes , Probióticos/uso terapêutico , Cálculos Urinários/terapia , Adulto , Bifidobacterium , Oxalato de Cálcio/química , Ácido Cítrico/uso terapêutico , Humanos , Hiperoxalúria/urina , Lactobacillus , Compostos de Magnésio/uso terapêutico , Pessoa de Meia-Idade , Oxalatos/urina , Compostos de Potássio/uso terapêutico , Resultado do Tratamento , Cálculos Urinários/química , Adulto JovemRESUMO
Estudos atuais têm mostrado inadequação na ingestão de diversos nutrientes, sendo o magnésio, em particular, um mineral com consumo reduzido pela população. Considerando a importância do magnésio no metabolismo e manutenção da homeostase do organismo, a escassez de dados sobre o consumo desse mineral, esta revisão visa trazer informações atualizadas sobre o metabolismo, biodisponibilidade e ingestão desse micronutriente. Foi conduzida uma revisão narrativa, sendo que o levantamento bibliográfico foi realizado nas bases de dados PubMed, SciELO, Lilacs, utilizando as seguintes palavras-chave: 'magnesium metabolism', 'bioavailability', 'intake'. A deficiência de magnésio pode decorrer da ingestão inadequada ou excreção aumentada, sendo a homeostase desse nutriente, em nosso organismo, regulada principalmente pelos rins. Existem fatores inibidores do processo de absorção do magnésio, como a presença na dieta de alimentos ricos em fitatos, oxalatos, fosfatos e fibras alimentares; e promotores, tais como a lactose e carboidratos. Observa-se que a ingestão média de magnésio pela população encontra-se em valores inferiores às recomendações das Dietary Reference Intakes. Assim, é evidente a existência de inadequação no consumo de magnésio, o que contribui para a manifestação de sua deficiência na população, sendo necessários estudos sobre o tema, considerando que o metabolismo desse mineral não está completamente elucidado, bem como suas interações com outros nutrientes ou substâncias da dieta (AU)
Recent studies have shown inadequate intake of various nutrients, and magnesium, in particular is a mineral with reduced consumption among the population. Therefore, considering the importance of magnesium metabolism in maintenance of homeostasis, the paucity of data regarding the consumption of this mineral, this review aims to bring current information on metabolism, bioavailability and intake of this micronutrient. A narrative review was conducted, and the literature was carried out in the databases PubMed, SciELO, Lilacs, using the following key words: 'magnesium metabolism', 'bioavailability', 'intake'. Magnesium deficiency can result from inadequate intake or increased excretion, and the homeostasis of this nutrient in our body is mainly regulated by the kidneys. There are factors that inhibit the absorption process of magnesium, such as the presence in the diet of foods rich in phytates, oxalates, phosphates and dietary fiber; and promoters, such as lactose, and carbohydrates. It is observed that the average intake values of magnesium by the population are lower than recommendations of the Dietary Reference Intakes. Thus, it is clear that there is inadequacy in magnesium consumption, which contributes to manifestation of their disability in the population, and studies on the topic are required, whereas the metabolism of this mineral is not fully elucidated, neither their interactions with other nutrients or dietary substances (AU)