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3.
Clin Nephrol ; 93(4): 163-171, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32049627

RESUMO

Maintaining phosphorus balance in in-center hemodialysis (ICHD) patients is problematic despite recommended dietary restriction, dialysis, and phosphate binder use. Rarely is P content in prescribed medications considered, but this source should raise concern. Data was obtained from the Fresenius Kidney Care (FKC) electronic data warehouse Knowledge Center and MedReview-eRx accessed Surescripts, housing > 80% of US-filled prescriptions. Adult FKC ICHD patients prescribed ≥ 1 medication in the MedReview-eRx database were analyzed (695,759 prescriptions). Information collected included medication dose, dose unit, dose timing, strength, start and stop dates, refills, demographic information, admission history, and modality type. Numbers of patients, prescriptions by individual medication, and drug class were then analyzed. Medications prescribed > 100 times were reported. Median doses/day (number of tablets) were calculated for each medication (open order on randomly selected day). Phosphate content of medications taken in FKC clinics was assessed using routinely used pharmacology references, and potential resulting phosphate and pill burden were also calculated. The top five prescribed drug classes in FKC dialysis patients were calcium-channel blockers (22%), proton pump inhibitors (PPIs; 18%), acetaminophen-opioid (AO; 13%), angiotensin-converting enzyme inhibitors (ACEi; 10%), and α2-agonists (9%). The maximum phosphate added for different medications varied by manufacturer. For instance, at median daily doses, phosphate contributions from the top five medications prescribed were 112 mg for amlodipine, 116.2 mg from lisinopril, 6.7 mg from clonidine, 0 mg from acetaminophen, and 200 mg for omeprazole. Prescribing these together could increase the daily phosphate load by 428 mg, forcing the patient to exceed the recommended daily intake (RDI) with food and drink. Phosphate content in medications prescribed to HD patients can substantially contribute to the daily phosphate load and, in combination, may even exceed the daily recommended dietary phosphate intake. Healthcare providers should monitor all medications containing phosphate prescribed in order to minimize risk of uncontrolled hyperphosphatemia and poor adherence.
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Assuntos
Fosfatos/uso terapêutico , Diálise Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperfosfatemia/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Fosfatos/administração & dosagem , Fosfatos/metabolismo
4.
Lancet Diabetes Endocrinol ; 8(2): 163-174, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31924563

RESUMO

Phosphate metabolism is an evolving area of basic and clinical research. In the past 15 years, knowledge on disturbances of phosphate homoeostasis has expanded, as has the discovery of new targeted therapies. Hypophosphataemia might be the biochemical finding in several diseases, and its clinical evaluation should initially focus on the assessment of pathophysiological mechanisms leading to low serum phosphate concentrations. Clinical consequences of hypophosphataemia can involve multiple organ systems and vary depending on several factors, the most important being the underlying disorder. This Review focuses on the approach to patients with hypophosphataemia and how underlying pathophysiological mechanisms should be understood in the evaluation of differential diagnosis. We define an algorithm for the assessment of hypophosphataemia and review the most up-to-date literature on specific therapies. Continuous research in this area will result in a better understanding and management of patients with hypophosphataemia.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Hipofosfatemia/diagnóstico , Fatores Imunológicos/uso terapêutico , Fosfatos/uso terapêutico , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Algoritmos , Pesquisa Biomédica , Diagnóstico Diferencial , Humanos , Hipofosfatemia/tratamento farmacológico , Hipofosfatemia/fisiopatologia
5.
Metabolism ; 103S: 153892, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30928313

RESUMO

Early diagnosis, optimal therapeutic management and regular follow up of children with X-linked hypophosphatemia (XLH) determine their long term outcomes and future quality of life. Biochemical screening of potentially affected newborns in familial cases and improving physician's knowledge on clinical signs, symptoms and biochemical characteristics of XLH for de novo cases should lead to earlier diagnosis and treatment initiation. The follow-up of children with XLH includes clinical, biochemical and radiological monitoring of treatment (efficacy and complications) and screening for XLH-related dental, neurosurgical, rheumatological, cardiovascular, renal and ENT complications. In 2018, the European Union approved the use of burosumab, a humanized monoclonal anti-FGF23 antibody, as an alternative therapy to conventional therapy (active vitamin D analogues and phosphate supplements) in growing children with XLH and insufficiently controlled disease. Diagnostic criteria of XLH and the principles of disease management with conventional treatment or with burosumab are reviewed in this paper.


Assuntos
Raquitismo Hipofosfatêmico Familiar/diagnóstico , Raquitismo Hipofosfatêmico Familiar/terapia , Adolescente , Anticorpos Monoclonais/uso terapêutico , Criança , Pré-Escolar , Diagnóstico Precoce , Raquitismo Hipofosfatêmico Familiar/genética , Fatores de Crescimento de Fibroblastos/antagonistas & inibidores , Fatores de Crescimento de Fibroblastos/fisiologia , Seguimentos , Humanos , Lactente , Recém-Nascido , Monitorização Fisiológica , Mutação , Endopeptidase Neutra Reguladora de Fosfato PHEX/genética , Fosfatos/uso terapêutico , Qualidade de Vida , Radiografia , Vitamina D/uso terapêutico
6.
Metabolism ; 103S: 154049, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31863781

RESUMO

X-linked hypophosphatemia (XLH) is caused by mutations in the PHEX gene which result in Fibroblast Growth Factor-23 (FG-F23) excess and phosphate wasting. Clinically, XLH children present with rickets, bone deformities and short stature. In adulthood, patients may still be symptomatic with bone and joint pain, osteomalacia-related fractures or pseudofractures, precocious osteoarthrosis, enthesopathy, muscle weakness and severe dental anomalies. Besides these musculoskeletal and dental manifestations, adult XLH patients are also prone to secondary and tertiary hyperparathyroidism, cardiovascular and metabolic disorders. Pathophysiology of hyperparathyroidism is only partially understood but FGF23 excess and deficient production of calcitriol likely contributes to its development. Similarly, the pathophysiological mechanisms of potential cardiovascular and metabolic involvements are not clear, but FGF-23 excess may play an essential role. Treatment should be considered in symptomatic patients, patients undergoing orthopedic or dental surgery and women during pregnancy and lactation. Treatment with oral phosphate salts and active vitamin D analogs has incomplete efficacy and potential risks. Burosumab, a recombinant human monoclonal antibody against FGF-23, has proven its efficacy in phase 2 and phase 3 clinical trials in adult patients with XLH, but currently its position as first line or second line treatment differ among the countries.


Assuntos
Raquitismo Hipofosfatêmico Familiar/terapia , Adulto , Anticorpos Monoclonais/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças do Sistema Endócrino/epidemiologia , Raquitismo Hipofosfatêmico Familiar/complicações , Feminino , Fatores de Crescimento de Fibroblastos/antagonistas & inibidores , Fatores de Crescimento de Fibroblastos/fisiologia , Humanos , Hiperparatireoidismo/prevenção & controle , Doenças Metabólicas/epidemiologia , Mutação , Endopeptidase Neutra Reguladora de Fosfato PHEX/genética , Fosfatos/uso terapêutico , Gravidez , Vitamina D/uso terapêutico
7.
Pediatr Endocrinol Rev ; 17(1): 17-34, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31599133

RESUMO

Fibroblast growth factor 23 (FGF23), one of the endocrine fibroblast growth factors, is a principal regulator in the maintenance of serum phosphorus concentration. Binding to its cofactor αKlotho and a fibroblast growth factor receptor is essential for its activity. Its regulation and interaction with other factors in the bone-parathyroid-kidney axis is complex. FGF23 reduces serum phosphorus concentration through decreased reabsorption of phosphorus in the kidney and by decreasing 1,25 dihydroxyvitamin D (1,25(OH)2D) concentrations. Various FGF23-mediated disorders of renal phosphate wasting share similar clinical and biochemical features. The most common of these is X-linked hypophosphatemia (XLH). Additional disorders of FGF23 excess include autosomal dominant hypophosphatemic rickets, autosomal recessive hypophosphatemic rickets, fibrous dysplasia, and tumor-induced osteomalacia. Treatment is challenging, requiring careful monitoring and titration of dosages to optimize effectiveness and to balance side effects. Conventional therapy for XLH and other disorders of FGF23-mediated hypophosphatemia involves multiple daily doses of oral phosphate salts and active vitamin D analogs, such as calcitriol or alfacalcidol. Additional treatments may be used to help address side effects of conventional therapy such as thiazides to address hypercalciuria or nephrocalcinosis, and calcimimetics to manage hyperparathyroidism. The recent development and approval of an anti-FGF23 antibody, burosumab, for use in XLH provides a novel treatment option.


Assuntos
Fatores de Crescimento de Fibroblastos , Hipofosfatemia/terapia , Anticorpos Monoclonais/uso terapêutico , Raquitismo Hipofosfatêmico Familiar/fisiopatologia , Raquitismo Hipofosfatêmico Familiar/terapia , Fatores de Crescimento de Fibroblastos/genética , Fatores de Crescimento de Fibroblastos/metabolismo , Humanos , Hipofosfatemia/fisiopatologia , Osteomalacia/fisiopatologia , Osteomalacia/terapia , Fosfatos/metabolismo , Fosfatos/uso terapêutico
8.
J Pak Med Assoc ; 69(6): 811-816, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31189287

RESUMO

OBJECTIVE: To evaluate the effect of different solutions administered to patients undergoing stem cell transplantation on oral mucositis. METHODS: The non-randomised controlled trial was conducted at a Istanbul Medipol Mega university hospital in Turkey between May 2014 and June 2016, and comprised patients undergoing stem cell transplantation. They were divided into three groups. Group 1 had patients using chlorhexidine gluconate and benzydamine hydrochloride solution. Group 2 had those using calcium and phosphate solution. Group 3 patients were using black mulberry syrup. Data was collected using a structured questionnaire and the World Health Organisation mucositis assessment scale. Assessment was done on days 7, 14 and 21. Clinical significance of oral solutions was statistically determined. RESULTS: Of the 83 patients, 30(36%) were in group 1, 28(34%) in group 2, and 25(30%) in group 3. On day 7, there was no significant difference in terms of grades among the groups (p>0.05). On day 14, grade 2 mucositis was seen in 2(8%) patents in group 3, 5(17.9%) in group 2 and 5(16.7%) in group 1; Grade 3 mucositis was seen in 2(6.7%) patients in group 1, but none in the other two groups. On day 21, grade 3 mucositis was present in 2(8.0%) in group 3, 2(7.1%) in group 2, and 4(13.3%) in group 1. CONCLUSIONS: The use of black mulberry and calcium-phosphate solutions was found to be beneficial in preventing and treating oral mucositis.


Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Neoplasias/terapia , Soluções Farmacêuticas/uso terapêutico , Estomatite/tratamento farmacológico , Adolescente , Adulto , Idoso , Benzidamina/uso terapêutico , Clorexidina/análogos & derivados , Clorexidina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morus , Fosfatos/uso terapêutico , Extratos Vegetais/uso terapêutico , Turquia , Adulto Jovem
9.
Nat Rev Nephrol ; 15(7): 435-455, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31068690

RESUMO

X-linked hypophosphataemia (XLH) is the most common cause of inherited phosphate wasting and is associated with severe complications such as rickets, lower limb deformities, pain, poor mineralization of the teeth and disproportionate short stature in children as well as hyperparathyroidism, osteomalacia, enthesopathies, osteoarthritis and pseudofractures in adults. The characteristics and severity of XLH vary between patients. Because of its rarity, the diagnosis and specific treatment of XLH are frequently delayed, which has a detrimental effect on patient outcomes. In this Evidence-Based Guideline, we recommend that the diagnosis of XLH is based on signs of rickets and/or osteomalacia in association with hypophosphataemia and renal phosphate wasting in the absence of vitamin D or calcium deficiency. Whenever possible, the diagnosis should be confirmed by molecular genetic analysis or measurement of levels of fibroblast growth factor 23 (FGF23) before treatment. Owing to the multisystemic nature of the disease, patients should be seen regularly by multidisciplinary teams organized by a metabolic bone disease expert. In this article, we summarize the current evidence and provide recommendations on features of the disease, including new treatment modalities, to improve knowledge and provide guidance for diagnosis and multidisciplinary care.


Assuntos
Raquitismo Hipofosfatêmico Familiar/diagnóstico , Raquitismo Hipofosfatêmico Familiar/terapia , Algoritmos , Anticorpos Monoclonais/uso terapêutico , Malformação de Arnold-Chiari/etiologia , Biomarcadores/sangue , Conservadores da Densidade Óssea/uso terapêutico , Osso e Ossos/diagnóstico por imagem , Continuidade da Assistência ao Paciente , Craniossinostoses/prevenção & controle , Técnica Delfos , Assistência Odontológica , Hormônio do Crescimento/uso terapêutico , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Humanos , Fatores Imunológicos/uso terapêutico , Estilo de Vida , Mutação , Procedimentos Ortopédicos , Endopeptidase Neutra Reguladora de Fosfato PHEX/genética , Fosfatos/uso terapêutico , Modalidades de Fisioterapia , Radiografia , Vitamina D/uso terapêutico
10.
Pediatr Clin North Am ; 66(1): 179-207, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30454743

RESUMO

Hypophosphatemic rickets, mostly of the X-linked dominant form caused by pathogenic variants of the PHEX gene, poses therapeutic challenges with consequences for growth and bone development and portends a high risk of fractions and poor bone healing, dental problems and nephrolithiasis/nephrocalcinosis. Conventional treatment consists of PO4 supplements and calcitriol requiring monitoring for treatment-emergent adverse effects. FGF23 measurement, where available, has implications for the differential diagnosis of hypophosphatemia syndromes and, potentially, treatment monitoring. Newer therapeutic modalities include calcium sensing receptor modulation (cinacalcet) and biological molecules targeting FGF23 or its receptors. Their long-term effects must be compared with those of conventional treatments.


Assuntos
Raquitismo Hipofosfatêmico/diagnóstico , Raquitismo Hipofosfatêmico/tratamento farmacológico , Raquitismo Hipofosfatêmico/genética , Calcimiméticos/uso terapêutico , Criança , Diagnóstico Diferencial , Hormônio do Crescimento/uso terapêutico , Humanos , Mutação , Fosfatos/uso terapêutico , Vitamina D/uso terapêutico
11.
Knee Surg Sports Traumatol Arthrosc ; 27(3): 773-781, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30069652

RESUMO

PURPOSE: To determine the clinical and radiographic efficacy of chitosan-glycerol phosphate/blood implant versus hyaluronic acid-based cell-free scaffold in patients with focal osteochondral lesion of the knee joint. METHODS: Clinical data of 46 patients surgically treated using either chitosan-glycerol phosphate/blood implant (25 patients, Group 1) or hyaluronic acid-based cell-free scaffold (21 patients, Group 2) in combination with microfracture were retrospectively evaluated. All lesions were Outerbridge grade III or IV with a mean lesion size of 3.3 ± 0.7 cm2. The mean follow-up time was 24.4 months. Visual analogue scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue. RESULTS: No significant differences were detected between the groups regarding VAS, Lysholm, and Tegner scores at any time interval during the whole follow-up. The mean post-operative VAS and Lysholm scores at the latest follow-up was significantly better in cases with the lesion size ≤ 3 cm2 in Group 1 (p = 0.001, p < 0.001, respectively). However, no significant differences according to the lesion size were detected in Group 2 (n.s.). Complete repair with the filling of the defect was achieved in 7 (28%) of the knees in Group 1 and it was 7 (33.3%) of the knees in Group 2 according to MOCART system at the latest follow-up. CONCLUSION: Single-stage regenerative cartilage surgery using chitosan-glycerol phosphate/blood implant combined to microfracture for focal osteochondral lesions of the knee revealed similar clinical and radiographic outcomes with hyaluronic acid-based cell-free scaffold at short-term follow-up. However, clinical outcomes of hyaluronan scaffold were less sensitive to defect size than chitosan. With the advantages of no hypertrophic repair tissue formation as well as no need to arthrotomy during surgery, chitosan is an effective choice especially in patients with the lesion size ≤ 3 cm2. LEVEL OF EVIDENCE: III.


Assuntos
Cartilagem Articular/cirurgia , Quitosana/uso terapêutico , Ácido Hialurônico/uso terapêutico , Traumatismos do Joelho/cirurgia , Osteocondrite Dissecante/cirurgia , Tecidos Suporte , Adulto , Artroplastia Subcondral , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/lesões , Feminino , Seguimentos , Glicerol/uso terapêutico , Hemostáticos/uso terapêutico , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Escore de Lysholm para Joelho , Imagem por Ressonância Magnética , Masculino , Osteocondrite Dissecante/diagnóstico por imagem , Fosfatos/uso terapêutico , Estudos Retrospectivos , Viscossuplementos/uso terapêutico , Escala Visual Analógica
12.
Pflugers Arch ; 471(1): 149-163, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30109410

RESUMO

Hereditary hypophosphatemic rickets with hypercalciuria (HHRH; OMIM: 241530) is a rare autosomal recessive disorder with an estimated prevalence of 1:250,000 that was originally described by Tieder et al. Individuals with HHRH carry compound-heterozygous or homozygous (comp/hom) loss-of-function mutations in the sodium-phosphate co-transporter NPT2c. These mutations result in the development of urinary phosphate (Pi) wasting and hypophosphatemic rickets, bowing, and short stature, as well as appropriately elevated 1,25(OH)2D levels, which sets this fibroblast growth factor 23 (FGF23)-independent disorder apart from the more common X-linked hypophosphatemia. The elevated 1,25(OH)2D levels in turn result in hypercalciuria due to enhanced intestinal calcium absorption and reduced parathyroid hormone (PTH)-dependent calcium-reabsorption in the distal renal tubules, leading to the development of kidney stones and/or nephrocalcinosis in approximately half of the individuals with HHRH. Even heterozygous NPT2c mutations are frequently associated with isolated hypercalciuria (IH), which increases the risk of kidney stones or nephrocalcinosis threefold in affected individuals compared with the general population. Bone disease is generally absent in individuals with IH, in contrast to those with HHRH. Treatment of HHRH and IH consists of monotherapy with oral Pi supplements, while active vitamin D analogs are contraindicated, mainly because the endogenous 1,25(OH)2D levels are already elevated but also to prevent further worsening of the hypercalciuria. Long-term studies to determine whether oral Pi supplementation alone is sufficient to prevent renal calcifications and bone loss, however, are lacking. It is also unknown how therapy should be monitored, whether secondary hyperparathyroidism can develop, and whether Pi requirements decrease with age, as observed in some FGF23-dependent hypophosphatemic disorders, or whether this can lead to osteoporosis.


Assuntos
Raquitismo Hipofosfatêmico Familiar/genética , Hipercalciúria/genética , Fosfatos/sangue , Proteínas Cotransportadoras de Sódio-Fosfato Tipo IIc/genética , Animais , Raquitismo Hipofosfatêmico Familiar/diagnóstico , Raquitismo Hipofosfatêmico Familiar/tratamento farmacológico , Humanos , Hipercalciúria/diagnóstico , Hipercalciúria/tratamento farmacológico , Mutação com Perda de Função , Fosfatos/uso terapêutico , Proteínas Cotransportadoras de Sódio-Fosfato Tipo IIc/metabolismo , Vitamina D/sangue , Vitamina D/uso terapêutico , Vitaminas/sangue , Vitaminas/uso terapêutico
14.
Clin Oral Investig ; 23(9): 3535-3542, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30539289

RESUMO

OBJECTIVE: To evaluate the effect of a fluoride toothpaste containing nano-sized sodium hexametaphosphate (HMPnano) on enamel demineralization on the biochemical composition and insoluble extracellular polysaccharide (EPS) in biofilm formed in situ. METHODS: This crossover double-blind study consisted of four phases (7 days each), in which 12 volunteers wore intraoral appliances containing four enamel bovine blocks. The cariogenic challenge was performed using 30% sucrose solution (6×/day). Blocks were treated 3×/day with the following toothpastes: no F/HMP/HMPnano (Placebo), conventional fluoride toothpaste, 1100 ppm F (1100F), 1100F + 0.5% micrometric HMP (1100F/HMP), and 1100F + 0.5% nano-sized HMP (1100F/HMPnano). The percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), and enamel calcium (Ca), phosphorus (P), and fluoride (F) were determined. Moreover, biofilms formed on the blocks were analyzed for F, Ca, P, and insoluble extracellular polysaccharide (EPS) concentrations. Data were analyzed using one-way ANOVA, followed by Student-Newman-Keuls' test (p < 0.001). RESULTS: 1100F/HMPnano promoted the lowest %SH and ΔKHN among all groups (p < 0.001). The addition of HMPnano to 1100F significantly increased Ca concentrations (p < 0.001). The 1100F/HMPnano promoted lower values of EPS when compared with 1100F (~ 70%) (p < 0.001) and higher values of fluoride and calcium in the biofilms (p < 0.001). CONCLUSION: 1100F/HMPnano demonstrated a greater protective effect against enamel demineralization and on the composition of biofilm in situ when compared to 1100F toothpaste. CLINICAL RELEVANCE: This toothpaste could be a viable alternative to patients at high risk of caries.


Assuntos
Cárie Dentária , Fosfatos , Desmineralização do Dente , Cremes Dentais , Animais , Cariostáticos , Bovinos , Estudos Cross-Over , Cárie Dentária/prevenção & controle , Esmalte Dentário , Método Duplo-Cego , Fluoretos , Dureza , Humanos , Fosfatos/uso terapêutico , Desmineralização do Dente/prevenção & controle
15.
Cochrane Database Syst Rev ; 12: CD006202, 2018 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-30562408

RESUMO

BACKGROUND: With the increased demand for whiter teeth, home-based bleaching products, either dentist-prescribed or over-the-counter products have been exponentially increasing in the past few decades. This is an update of a Cochrane Review first published in 2006. OBJECTIVES: To evaluate the effects of home-based tooth whitening products with chemical bleaching action, dispensed by a dentist or over-the-counter. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 12 June 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library (searched 12 June 2018), MEDLINE Ovid (1946 to 12 June 2018), and Embase Ovid (1980 to 12 June 2018). The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (12 June 2018) and the World Health Organization International Clinical Trials Registry Platform (12 June 2018) were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included in our review randomised controlled trials (RCTs) which involved adults who were 18 years and above, and compared dentist-dispensed or over-the-counter tooth whitening (bleaching) products with placebo or other comparable products.Quasi-randomised trials, combination of in-office and home-based treatments, and home-based products having physical removal of stains were excluded. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials. Two pairs of review authors independently extracted data and assessed risk of bias. We estimated risk ratios (RRs) for dichotomous data, and mean differences (MDs) or standardised mean difference (SMD) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included 71 trials in the review with 26 studies (1398 participants) comparing a bleaching agent to placebo and 51 studies (2382 participants) comparing a bleaching agent to another bleaching agent. Two studies were at low overall risk of bias; two at high overall risk of bias; and the remaining 67 at unclear overall risk of bias.The bleaching agents (carbamide peroxide (CP) gel in tray, hydrogen peroxide (HP) gel in tray, HP strips, CP paint-on gel, HP paint-on gel, sodium hexametaphosphate (SHMP) chewing gum, sodium tripolyphosphate (STPP) chewing gum, and HP mouthwash) at different concentrations with varying application times whitened teeth compared to placebo over a short time period (from 2 weeks to 6 months), however the certainty of the evidence is low to very low.In trials comparing one bleaching agent to another, concentrations, application method and application times, and duration of use varied widely. Most of the comparisons were reported in single trials with small sample sizes and event rates and certainty of the evidence was assessed as low to very low. Therefore the evidence currently available is insufficient to draw reliable conclusions regarding the superiority of home-based bleaching compositions or any particular method of application or concentration or application time or duration of use.Tooth sensitivity and oral irritation were the most common side effects which were more prevalent with higher concentrations of active agents though the effects were mild and transient. Tooth whitening did not have any effect on oral health-related quality of life. AUTHORS' CONCLUSIONS: We found low to very low-certainty evidence over short time periods to support the effectiveness of home-based chemically-induced bleaching methods compared to placebo for all the outcomes tested.We were unable to draw any conclusions regarding the superiority of home-based bleaching compositions or any particular method of application or concentration or application time or duration of use, as the overall evidence generated was of very low certainty. Well-planned RCTs need to be conducted by standardising methods of application, concentrations, application times, and duration of treatment.


Assuntos
Autocuidado/métodos , Clareadores Dentários/uso terapêutico , Clareamento Dental/métodos , Adulto , Peróxido de Carbamida/efeitos adversos , Peróxido de Carbamida/uso terapêutico , Goma de Mascar , Humanos , Peróxido de Hidrogênio/efeitos adversos , Peróxido de Hidrogênio/uso terapêutico , Antissépticos Bucais/uso terapêutico , Medicamentos sem Prescrição , Fosfatos/uso terapêutico , Polifosfatos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Clareamento Dental/efeitos adversos , Clareadores Dentários/efeitos adversos , Cremes Dentais/uso terapêutico , Ureia/uso terapêutico
16.
Oral Health Prev Dent ; 16(5): 439-444, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30460357

RESUMO

PURPOSE: To determine in vitro the protection potential against discolouration of two OTC (over-the-counter) desensitising products on enamel and dentin in comparison to a standard toothpaste and water by means of a spectrophotometer. MATERIALS AND METHODS: A total of 96 samples of bovine enamel-dentin complex and 48 of bovine dentin were alternatively immersed in red wine, tea, coffee or water after having been treated by a sodium monofluorophosphate- and calcium phosphate-based product (Curodont Protect), an amine fluoride-based toothpaste (Elmex Red), a stannous chloride-based toothpaste (Elmex Protection Erosion) or distilled water (negative control). Initial (T0) and final colour (T1, after 4 weeks of immersion in staining solutions) of each specimen were assessed by a spectrophotometer. Statistical analysis was done by means of repeated measures ANOVA followed by Fisher's LSD post-hoc test. Differences between T0 and T1 were considered stastistically significant at p ≤ 0.05. RESULTS: When enamel samples were measured over a black background, ΔE00 values (T0-T1) varied from 2.2 (SD 0.7) for amine fluoride-based product/water to 53.9 (SD 7.6) for amine fluoride-based-product/red wine. When dentin samples were measured over a black background, ΔE00 values (T0-T1) varied from 5.4 (SD 0.9) stannous chloride based product/water to 61.6 (SD 3.7) amine fluoride-based product/red wine. CONCLUSION: Specifically, the application of the sodium monofluorophosphate was able to statistically significantly (p ≤ 0.05) reduce discolouration induced by the staining solutions tested only on the enamel-dentin complex, while distilled water and the stannous fluoride-based product were able to statistically significantly (p ≤ 0.05) reduce discolouration induced by the staining solutions tested in pure dentin samples.


Assuntos
Dessensibilizantes Dentinários/uso terapêutico , Descoloração de Dente/prevenção & controle , Cremes Dentais/uso terapêutico , Fosfatos de Cálcio/uso terapêutico , Café , Esmalte Dentário/diagnóstico por imagem , Dentina/diagnóstico por imagem , Fluoretos/uso terapêutico , Humanos , Técnicas In Vitro , Medicamentos sem Prescrição , Fosfatos/uso terapêutico , Espectrofotometria , Chá , Compostos de Estanho/uso terapêutico , Descoloração de Dente/diagnóstico por imagem , Vinho
17.
Drug Discov Ther ; 12(5): 309-314, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30464164

RESUMO

Esophageal variceal bleeding is a common lethal complication of cirrhosis. Endoscopic injection sclerotherapy (EIS) is one of the major endoscopic approaches for treating esophageal variceal bleeding. However, complications may occur after EIS, which mainly include retrosternal discomfort/pain, dysphagia, re-bleeding, esophageal ulcer, esophageal strictures, and esophageal perforation, etc. In this article, we reported a 36-year-old male who developed esophageal ulcer related bleeding after EIS. Currently, there is no consensus on the treatment strategy for esophageal ulcer-related bleeding after EIS. In the present case, the following treatment strategy may be effective for ulcer related bleeding. The first step is to inhibit gastric acid secretion and reduce portal pressure by intravenous infusion of esomeprazole and somatostatin, respectively. The second is local hemostasis by oral norepinephrine and lyophilizing thrombin powder. The third is to protect digestive tract mucosa by oral Kangfuxin Ye and aluminum phosphate.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Hematemese/tratamento farmacológico , Escleroterapia/efeitos adversos , Úlcera/etiologia , Adulto , Compostos de Alumínio/administração & dosagem , Compostos de Alumínio/uso terapêutico , Esomeprazol/administração & dosagem , Esomeprazol/uso terapêutico , Hematemese/etiologia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/tratamento farmacológico , Masculino , Materia Medica/administração & dosagem , Materia Medica/uso terapêutico , Norepinefrina/administração & dosagem , Norepinefrina/uso terapêutico , Fosfatos/administração & dosagem , Fosfatos/uso terapêutico , Somatostatina/administração & dosagem , Somatostatina/uso terapêutico , Trombina/administração & dosagem , Trombina/uso terapêutico , Resultado do Tratamento , Úlcera/complicações , Úlcera/tratamento farmacológico
18.
Mil Med ; 183(suppl_2): 52-54, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30189057

RESUMO

Deglycerolized red blood cells have been used by the U.S. military for half a century, starting with the Vietnam War. Deglycerolized red blood cells have a frozen storage life of 10 years, but require special equipment to thaw and deglycerolize. The available data show no difference in either efficacy with complications when compared to standard product red blood cells.


Assuntos
Criopreservação/normas , Eritrócitos/fisiologia , Adenina/uso terapêutico , Citratos/uso terapêutico , Criopreservação/métodos , Glucose/uso terapêutico , Humanos , Fosfatos/uso terapêutico
19.
Nano Lett ; 18(9): 5768-5774, 2018 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-30052464

RESUMO

X-ray-induced photodynamic therapy (X-PDT) has high depth of penetration and has considerable potential for applications in cancer therapy. Scintillators and heavy metals have been adopted to absorb X-rays and transmit the energy to photosensitizers. However, the low efficiency of converting X-rays to reactive oxygen species (ROS) presents a challenge for the use of X-PDT to cure cancer. In this study, a new method based on LiLuF4:Ce@SiO2@Ag3PO4@Pt(IV) nanoparticles (LAPNP) is presented that could be used to enhance the curative effects of X-PDT. To make full use of the fluorescence produced by nanoscintillators (LiLuF4:Ce), a cisplatin prodrug Pt(IV) was utilized as a sacrificial electron acceptor to increase the yield of hydroxyl radicals (·OH) by increasing the separation of electrons and holes in photosensitizers (Ag3PO4). Additionally, cisplatin is produced upon the acceptance of electrons by Pt(IV) and further enhances the damage caused by ·OH. Via two-step amplification, the potential of LAPNP to enhance the effects of X-PDT has been demonstrated.


Assuntos
Antineoplásicos/uso terapêutico , Cisplatino/uso terapêutico , Neoplasias/tratamento farmacológico , Fosfatos/uso terapêutico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Pró-Fármacos/uso terapêutico , Compostos de Prata/uso terapêutico , Animais , Antineoplásicos/química , Antineoplásicos/farmacologia , Cério/química , Cisplatino/administração & dosagem , Cisplatino/farmacologia , Elétrons , Fluorescência , Células HeLa , Humanos , Compostos de Lítio/química , Camundongos , Nanopartículas/química , Nanopartículas/ultraestrutura , Neoplasias/metabolismo , Neoplasias/patologia , Fosfatos/administração & dosagem , Fosfatos/farmacologia , Fármacos Fotossensibilizantes/administração & dosagem , Fármacos Fotossensibilizantes/farmacologia , Pró-Fármacos/administração & dosagem , Pró-Fármacos/farmacologia , Espécies Reativas de Oxigênio/metabolismo , Dióxido de Silício/química , Compostos de Prata/administração & dosagem , Compostos de Prata/farmacologia , Raios X
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