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1.
Drugs Today (Barc) ; 56(4): 257-268, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32309821

RESUMO

L-Glutamine is a conditionally essential amino acid required for synthesis of the pyridines for nucleotides, including nicotinamide adenine dinucleotide (NAD) and glutathione, as well as glutamate, and becomes essential during oxidative stress exposure. The NADH:[NAD⁺ + NADH] (redox) ratio in sickle red blood cells (RBCs) is lower than in normal RBCs, consistent with oxidative stress, therefore glutamine availability is important in sickle cell disease (SCD). RBC glutamine levels vary between SCD studies but the ratio glutamine:glutamate was inversely related to tricuspid regurgitant jet velocity in one. Oral L-glutamine was associated with an increase in NADH and reduction in RBC endothelium adhesion in small studies of SCD patients. In a sickle mouse model, glutamine levels were directly related to cerebral blood flow. Phase II and III randomized, double-blind, controlled trials of L-glutamine 0.6 g/kg/day compared with placebo in children and adults with SCD and = 2 episodes of pain in the previous year provide evidence that L-glutamine is safe and associated with a reduction in painful episodes and in hospitalizations. However, L-glutamine was only tolerated in two-thirds of patients, anemia and hemolysis did not improve and there are few data on mortality and organ complications. Future studies should investigate the effect of other amino acids and total protein intake.


Assuntos
Anemia Falciforme/tratamento farmacológico , Glutamina/uso terapêutico , Adulto , Animais , Criança , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Método Duplo-Cego , Eritrócitos , Humanos , Camundongos , NAD , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
JAAPA ; 32(9): 1-5, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31460979

RESUMO

Sickle cell disease (SCD) is a group of inherited blood disorders affecting the hemoglobin, shortening the lifespan of erythrocytes, and causing them to take on a distinctive sickled shape that can lead to vaso-occlusion. Current treatment aims to reduce morbidity and mortality through hydroxyurea, erythrocyte transfusion, and hematopoietic stem cell transplantation. This article reviews the disease process, typical presentations, complications, and acute and chronic treatment options.


Assuntos
Analgésicos Opioides/uso terapêutico , Anemia Falciforme/terapia , Antidrepanocíticos/uso terapêutico , Transfusão de Eritrócitos , Síndrome Torácica Aguda/diagnóstico , Síndrome Torácica Aguda/etiologia , Síndrome Torácica Aguda/terapia , Doença Aguda , Anemia Falciforme/complicações , Anemia Falciforme/fisiopatologia , Antibacterianos/uso terapêutico , Doença Crônica , Progressão da Doença , Hidratação , Terapia Genética , Glutamina/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Humanos , Hidroxiureia/uso terapêutico , Recém-Nascido , Controle de Infecções , Infecções , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/terapia , Triagem Neonatal , Oxigenoterapia , Manejo da Dor , Educação de Pacientes como Assunto , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia
4.
Support Care Cancer ; 27(10): 3997-4010, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31286229

RESUMO

PURPOSE: To update the clinical practice guidelines for the use of natural and miscellaneous agents for the prevention and/or treatment of oral mucositis (OM). METHODS: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: Recommendation, Suggestion, and No Guideline Possible. RESULTS: A total of 78 papers were identified within the scope of this section, out of which 29 were included in this part, and were analyzed with 27 previously reviewed studies. A new Suggestion was made for oral glutamine for the prevention of OM in head and neck (H&N) cancer patients receiving radiotherapy with concomitant chemotherapy. The previous Recommendation against the use of parenteral glutamine for the prevention of OM in hematopoietic stem cell transplantation (HSCT) patients was re-established. A previous Suggestion for zinc to prevent OM in H&N cancer patients treated with radiotherapy or chemo-radiotherapy was reversed to No Guideline Possible. No guideline was possible for other interventions. CONCLUSIONS: Of the vitamins, minerals, and nutritional supplements studied for the management of OM, the evidence supports a Recommendation against parenteral glutamine in HSCT patients and a Suggestion in favor of oral glutamine in H&N cancer patients for the management of OM.


Assuntos
Glutamina/uso terapêutico , Minerais/uso terapêutico , Mucosite/tratamento farmacológico , Mucosite/prevenção & controle , Estomatite/tratamento farmacológico , Estomatite/prevenção & controle , Vitaminas/uso terapêutico , Suplementos Nutricionais , Glutamina/administração & dosagem , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Neoplasias/tratamento farmacológico
5.
Support Care Cancer ; 27(10): 4011-4022, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31286233

RESUMO

PURPOSE: The aim of this study was to update the clinical practice guidelines for the use of agents for the prevention and/or treatment of gastrointestinal mucositis (GIM). METHODS: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, and No Guideline Possible. RESULTS: A total of 78 papers across 13 interventions were examined of which 25 were included in the final review. No new guidelines were possible for any agent due to inadequate and/or conflicting evidence. Existing guidelines for probiotics and hyperbaric oxygen were unchanged. CONCLUSIONS: Of the agents studied for the prevention and treatment of GIM, the evidence continues to support use of probiotics containing Lactobacillus spp. for prevention of chemoradiotherapy and radiotherapy-induced diarrhea in patients with pelvic malignancy, and hyperbaric oxygen therapy to treat radiation-induced proctitis. Additional well-designed research is encouraged to enable a decision regarding palifermin, glutamine, sodium butyrate, and dietary interventions, for the prevention or treatment of GIM.


Assuntos
Quimiorradioterapia/efeitos adversos , Mucosite/tratamento farmacológico , Mucosite/prevenção & controle , Guias de Prática Clínica como Assunto , Proctite/tratamento farmacológico , Estomatite/tratamento farmacológico , Ácido Butírico/uso terapêutico , Fator 7 de Crescimento de Fibroblastos/uso terapêutico , Glutamina/uso terapêutico , Humanos , Oxigenação Hiperbárica , Neoplasias/tratamento farmacológico
6.
Nutr Clin Pract ; 34(5): 681-687, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31270877

RESUMO

Burn injury is the most devastating of survivable injuries and is a worldwide public health crisis. Burn injury is among the most severe metabolic stresses a patient can sustain. A major burn leads to an inflammatory response and catabolism that, when compounded by burn wound nutrient losses, can lead to severe nutrition losses and deficiencies. These losses can impair immune function and wound healing and place burn patients at high risk for organ injury and mortality. Experimental data indicate glutamine (GLN) is well positioned mechanistically, perhaps above and beyond in any other intensive care unit setting, to improve outcome in burn-injured patients. Initial clinical trial data have also shown a consistent signal of reduced mortality and reduced hospital length of stay in burn-injured subjects, without signals of clinical risk. A number of GLN clinical trials demonstrate significant reductions of gram-negative bacteremia in burn injury, perhaps via maintenance of the gut barrier or gut immune function. Current societal recommendations continue to suggest the use of GLN in burn injury. The promising clinical data in burn-injured patients, with no signals of harm, have warranted study of GLN in the definitive RE-ENERGIZE trial, which is now ongoing.


Assuntos
Queimaduras/terapia , Suplementos Nutricionais , Glutamina/uso terapêutico , Queimaduras/metabolismo , Humanos , Estado Nutricional , Cicatrização
7.
Curr Opin Crit Care ; 25(4): 322-328, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31247630

RESUMO

PURPOSE OF REVIEW: Glutamine (GLN) is a versatile amino acid, long believed to have important implications in ICU and surgical patients. An extensive body of data examining GLN supplementation of TPN demonstrated a consistent signal of improved outcomes. However, recently signals of risk have come from two large-scale multicenter trials evaluating GLN (and other nutrients) at high dose and as primary pharmaconutrients, not as supplementation to complete nutrition. These trials indicate a risk of increased mortality when GLN is given to patients in shock, renal failure, and early in acute phase of critical care. RECENT FINDINGS: Recent literature continues to confirm that low and high admission GLN levels are associated with increased ICU mortality and adverse outcomes. Further, a recent meta-analysis examined trials utilizing GLN-supplemented TPN in stabile ICU patients consistent with current clinical guidelines. This analysis showed GLN supplementation of TPN led to reduced infections, LOS and hospital mortality. SUMMARY: Three recent meta-analyses have confirmed traditional GLN-supplemented (or 'GLN-Complemented' - providing GLN for completeness of amino acid content) TPN is safe, reduces mortality and improves outcome in surgical and ICU patients. Patients in need of TPN, burns, trauma or malignancies should continue to benefit from supplemental GLN, administered either intravenously at less than 0.35 g/kg/day or enterally at less than 0.5 g/kg/day. Further, a large trial of EN GLN supplementation in burns is ongoing. Thus, when used per guideline recommendations, the GLN story is likely still relevant to ICU outcomes and research.


Assuntos
Cuidados Críticos , Cirurgia Geral , Glutamina/uso terapêutico , Glutamina/efeitos adversos , Humanos , Unidades de Terapia Intensiva , Metanálise como Assunto , Estudos Multicêntricos como Assunto , Guias de Prática Clínica como Assunto , Resultado do Tratamento
9.
Nutrients ; 11(4)2019 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-31013737

RESUMO

The innate immune response plays an important role in the pathophysiology of acute respiratory distress syndrome (ARDS). Glutamine (Gln) decreases lung inflammation in experimental ARDS, but its impact on the formation of extracellular traps (ETs) in the lung is unknown. In a mouse model of endotoxin-induced pulmonary ARDS, the effects of Gln treatment on leukocyte counts and ET content in bronchoalveolar lavage fluid (BALF), inflammatory profile in lung tissue, and lung morphofunction were evaluated in vivo. Furthermore, ET formation, reactive oxygen species (ROS) production, glutathione peroxidase (GPx), and glutathione reductase (GR) activities were tested in vitro. Our in vivo results demonstrated that Gln treatment reduced ET release (as indicated by cell-free-DNA content and myeloperoxidase activity), decreased lung inflammation (reductions in interferon-γ and increases in interleukin-10 levels), and improved lung morpho-function (decreased static lung elastance and alveolar collapse) in comparison with ARDS animals treated with saline. Moreover, Gln reduced ET and ROS formation in BALF cells stimulated with lipopolysaccharide in vitro, but it did not alter GPx or GR activity. In this model of endotoxin-induced pulmonary ARDS, treatment with Gln reduced pulmonary functional and morphological impairment, inflammation, and ET release in the lung.


Assuntos
Armadilhas Extracelulares/metabolismo , Glutamina/uso terapêutico , Inflamação/tratamento farmacológico , Pulmão/efeitos dos fármacos , Pneumonia/tratamento farmacológico , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Animais , DNA , Modelos Animais de Doenças , Endotoxinas , Feminino , Glutamina/farmacologia , Glutationa Peroxidase/metabolismo , Glutationa Redutase/metabolismo , Inflamação/etiologia , Interferon gama/metabolismo , Interleucina-10/metabolismo , Contagem de Leucócitos , Pulmão/metabolismo , Pulmão/patologia , Masculino , Camundongos Endogâmicos BALB C , Peroxidase/metabolismo , Pneumonia/etiologia , Alvéolos Pulmonares , Espécies Reativas de Oxigênio/metabolismo , Síndrome do Desconforto Respiratório do Adulto/metabolismo , Síndrome do Desconforto Respiratório do Adulto/patologia
10.
Nutr Hosp ; 36(1): 5-12, 2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-30829529

RESUMO

Introduction: Background and objective: malnutrition during cancer treatment is common in patients; therefore, nutritional intervention has an important role in cancer prognosis. Total parenteral nutrition is indicated for patients subjected to a major surgery with gastrointestinal complications. Nutritional support could be improved with glutamine (Gln). Therefore, in this work, the effect of parenteral glutamine in patients with gastrointestinal cancer undergoing surgery was studied. Material and methods: patients were classifi ed into two groups: non-supplemented and supplemented (Gln; 0.4 g/kg/day). Both groups received parenteral nutrition. One and seven days after surgery the nutritional status was evaluated. Hematic cytometry, protein metabolism and biochemical data were analyzed. A questionnaire was also applied to assess gastrointestinal function. Results: after the intervention, the nutritional status in both groups improved. However, the nutritional condition improved signifi cantly better (p = 0.008) in the supplemented group. According to the gastrointestinal function evaluation, the supplemented group changed from severe to mild dysfunction (p = 0.0001). The non-supplemented group progressed from moderate to severe dysfunction, but no changes in blood cell markers were observed. The supplemented group improved its concentration of lymphocytes (p = 0.014). The plasma albumin concentration did not change in groups, but prealbumin improved signifi cantly (p = 0.012) in the group that was supplemented with Gln. Conclusions: intravenous nutritional support supplemented with glutamine can improve gastrointestinal function, improving the absorption of nutrients, which leads to a better state of nutrition. It also has positive effects on plasma concentration of lymphocytes, monocytes and prealbumin.


Assuntos
Neoplasias Gastrointestinais/terapia , Glutamina/administração & dosagem , Glutamina/uso terapêutico , Nutrição Parenteral , Adulto , Idoso , Contagem de Células Sanguíneas , Feminino , Neoplasias Gastrointestinais/tratamento farmacológico , Neoplasias Gastrointestinais/cirurgia , Trato Gastrointestinal/fisiopatologia , Humanos , Tempo de Internação , Estudos Longitudinais , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Pré-Albumina/análise , Estudos Prospectivos
11.
Nutr. hosp ; 36(1): 5-12, ene.-feb. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-183181

RESUMO

Background and objective: malnutrition during cancer treatment is common in patients; therefore, nutritional intervention has an important role in cancer prognosis. Total parenteral nutrition is indicated for patients subjected to a major surgery with gastrointestinal complications. Nutritional support could be improved with glutamine (Gln). Therefore, in this work, the effect of parenteral glutamine in patients with gastrointestinal cancer undergoing surgery was studied. Material and methods: patients were classifi ed into two groups: non-supplemented and supplemented (Gln; 0.4 g/kg/day). Both groups received parenteral nutrition. One and seven days after surgery the nutritional status was evaluated. Hematic cytometry, protein metabolism and biochemical data were analyzed. A questionnaire was also applied to assess gastrointestinal function. Results: after the intervention, the nutritional status in both groups improved. However, the nutritional condition improved signifi cantly better (p = 0.008) in the supplemented group. According to the gastrointestinal function evaluation, the supplemented group changed from severe to mild dysfunction (p = 0.0001). The non-supplemented group progressed from moderate to severe dysfunction, but no changes in blood cell markers were observed. The supplemented group improved its concentration of lymphocytes (p = 0.014). The plasma albumin concentration did not change in groups, but prealbumin improved signifi cantly (p = 0.012) in the group that was supplemented with Gln. Conclusion: intravenous nutritional support supplemented with glutamine can improve gastrointestinal function, improving the absorption of nutrients, which leads to a better state of nutrition. It also has positive effects on plasma concentration of lymphocytes, monocytes and prealbumin


Introducción y objetivo: los pacientes con cáncer desarrollan desnutrición durante el tratamiento antineoplásico, es por ello que el soporte nutricio tiene un rol importante. La nutrición parenteral es el soporte indicado para pacientes que fueron sometidos a cirugía con complicaciones gastrointestinales; este soporte puede ser suplementado con glutamina. Evaluamos el efecto de la glutamina parenteral en pacientes con cáncer gastrointestinal sometidos a cirugía. Material y métodos: se aleatorizaron los pacientes en dos grupos. Ambos grupos recibieron nutrición parenteral, en un grupo no suplementada y en otro grupo suplementada con glutamina (0,4 g/kg/día). Las medidas se tomaron el día uno y el día siete posteriores a la cirugía; en ambas mediciones se evaluó el estado nutricional, se tomó una muestra sanguínea para analizar parámetros bioquímicos y se aplicó un cuestionario de función gastrointestinal. Resultados: después de la intervención, el estado nutricional mejoró en ambos grupos, sin embargo, en el grupo suplementado mejoró significativamente (p = 0,008). De acuerdo a la función gastrointestinal, el grupo suplementado progresó de disfunción severa a leve (p = 0,0001), mientras que el grupo no suplementado progresó de disfunción moderada a severa. En cuanto a los parámetros bioquímicos, no hubo cambios en el grupo no suplementado. En ambos grupos no hubo cambios en las concentraciones plasmáticas de albúmina. En el grupo suplementado mejoraron de manera significativa las concentraciones de linfocitos (p = 0,014) y prealbúmina (p = 0,012). Conclusión: el apoyo nutricio endovenoso suplementado con glutamina puede mejorar la función gastrointestinal, mejorando la absorción de nutrimentos, lo que conlleva a un mejor estado de nutrición. Asimismo, tiene efectos positivos en las concentraciones plasmáticas de linfocitos y monocitos y prealbúmina


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Contagem de Células Sanguíneas , Neoplasias Gastrointestinais/terapia , Glutamina/uso terapêutico , Nutrição Parenteral , Tempo de Internação , Estudos Longitudinais , Contagem de Linfócitos , Estado Nutricional , Estudos Prospectivos
12.
Esophagus ; 16(1): 63-70, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30030739

RESUMO

BACKGROUND: We clarified the effects of perioperative enteral supplementation with glutamine, fiber, and oligosaccharide (GFO) after an esophagectomy on preventing surgical stress. METHODS: Of 326 patients with esophageal cancer, 189 received GFO administration (GFO group) and 137 did not (control group). The propensity score matching method was used to identify 89 well-balanced pairs of patients to compare postoperative laboratory parameters and clinical and postoperative outcomes. RESULTS: The duration of the systemic inflammatory response syndrome (SIRS) was significantly shorter in the GFO group compared to the control group (p = 0.002). Moreover, the lymphocyte/neutrophil ratio (L/N ratio) had significantly recovered in the GFO group on postoperative day-3, and the CRP value was significantly lower in the GFO group than that in the control group on postoperative day-2. CONCLUSIONS: Perioperative use of enteral supplementation with glutamine, fiber, and oligosaccharide likely contributes to a reduction in early surgical stress after an esophagectomy. These beneficial effects can bring about early recovery from postoperative immunosuppressive conditions after radical esophagectomy.


Assuntos
Nutrição Enteral/métodos , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Síndrome de Resposta Inflamatória Sistêmica/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibras na Dieta/uso terapêutico , Suplementos Nutricionais , Esofagectomia/métodos , Feminino , Glutamina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Oligossacarídeos/uso terapêutico , Assistência Perioperatória/métodos , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/etiologia
13.
Biomed Pharmacother ; 110: 59-67, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30466003

RESUMO

OBJECTIVE: Accumulation of lipids in non-adipose tissues particularly the liver is a feature of tissue insulin resistance. Hepatic glycogen depletion reflects counter glucoregulation in an insulin-resistant state and/or obesity. The effect of l-glutamine on fructose-induced increased hepatic lipid accumulation and depleted glycogen content, particularly in pregnancy, is not known. We therefore aimed at investigating the effect of glutamine on fructose-induced weight gain, hepatic lipids and glycogen contents in pregnant rats and also tested the hypothesis that hepatoprotective role of l-glutamine is through suppression of PDK-4. METHODS: Eleven-week-old pregnant Wistar rats were allotted into the Control, Glutamine, Fructose and Fructose plus Glutamine groups (6 rats/group). The groups received distilled water (vehicle, p.o.), 1 g/kg bwl-glutamine (p.o.), 10% Fructose (w/v) and 10% Fructose (w/v) plus 1 g/kg bwl-glutamine (p.o.) respectively, daily for 19 days. Biochemical analysis and histology of the liver were performed. RESULTS: Data showed that fructose intake caused insulin resistance, hyperglycemia, hyperlipidemia, increased body weight gain, visceral fat mass, hepatic mass, lactate production, uric acid production, lipid peroxidation and decreased pancreatic ß-cell function and hepatic glycogen synthesis. These alterations were accompanied by elevated pyruvate dehydrogenase kinase-4 (PDK-4). However, the fructose-induced dysmetabolism were improved by l-glutamine. CONCLUSION: Our results demonstrate that obesity and hepatic lipid accumulation induced by fructose in pregnant rats is accompanied by increased PDK-4. The findings also suggest that l-glutamine would protect against obesity and hepatic lipid accumulation by suppression of PDK-4.


Assuntos
Frutose/toxicidade , Glutamina/uso terapêutico , Peroxidação de Lipídeos/efeitos dos fármacos , Fígado/efeitos dos fármacos , Obesidade/prevenção & controle , Proteínas Serina-Treonina Quinases/antagonistas & inibidores , Animais , Inibidores Enzimáticos/farmacologia , Inibidores Enzimáticos/uso terapêutico , Feminino , Glutamina/farmacologia , Gordura Intra-Abdominal/efeitos dos fármacos , Gordura Intra-Abdominal/metabolismo , Peroxidação de Lipídeos/fisiologia , Fígado/metabolismo , Obesidade/induzido quimicamente , Obesidade/metabolismo , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Proteínas Serina-Treonina Quinases/metabolismo , Quinase Piruvato Desidrogenase (Transferência de Acetil) , Distribuição Aleatória , Ratos , Ratos Wistar
14.
Gut ; 68(6): 996-1002, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30108163

RESUMO

BACKGROUND: More effective treatments are needed for patients with postinfectious, diarrhoea-predominant, irritable bowel syndrome (IBS-D). Accordingly, we conducted a randomised, double-blind, placebo-controlled, 8-week-long trial to assess the efficacy and safety of oral glutamine therapy in patients who developed IBS-D with increased intestinal permeability following an enteric infection. METHODS: Eligible adults were randomised to glutamine (5 g/t.i.d.) or placebo for 8 weeks. The primary end point was a reduction of ≥50 points on the Irritable Bowel Syndrome Severity Scoring System (IBS-SS). Secondary endpoints included: raw IBS-SS scores, changes in daily bowel movement frequency, stool form (Bristol Stool Scale) and intestinal permeability. RESULTS: Fifty-four glutamine and 52 placebo subjects completed the 8-week study. The primary endpoint occurred in 43 (79.6%) in the glutamine group and 3 (5.8%) in the placebo group (a 14-fold difference). Glutamine also reduced all secondary endpoint means: IBS-SS score at 8 weeks (301 vs 181, p<0.0001), daily bowel movement frequency (5.4 vs 2.9±1.0, p<0.0001), Bristol Stool Scale (6.5 vs 3.9, p<0.0001) and intestinal permeability (0.11 vs 0.05; p<0.0001). 'Intestinal hyperpermeability' (elevated urinary lactulose/mannitol ratios) was normalised in the glutamine but not the control group. Adverse events and rates of study-drug discontinuation were low and similar in the two groups. No serious adverse events were observed. CONCLUSIONS: In patients with IBS-D with intestinal hyperpermeability following an enteric infection, oral dietary glutamine supplements dramatically and safely reduced all major IBS-related endpoints. Large randomised clinical trials (RCTs) should now be done to validate these findings, assess quality of life benefits and explore pharmacological mechanisms. TRIAL REGISTRATION NUMBER: NCT01414244; Results.


Assuntos
Suplementos Nutricionais , Enterite/microbiologia , Glutamina/uso terapêutico , Síndrome do Intestino Irritável/tratamento farmacológico , Administração Oral , Adulto , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Enterite/complicações , Feminino , Humanos , Mucosa Intestinal/efeitos dos fármacos , Mucosa Intestinal/microbiologia , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/microbiologia , Masculino , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
16.
Nagoya J Med Sci ; 80(3): 351-355, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30214084

RESUMO

Anastomotic leakage is a major cause of prolonged hospitalization after gastrectomy and sometimes leads to fatal complications, such as abdominal abscess and sepsis. Arginine, glutamine, and ß-hydroxy-ß-methylbutyrate (HMB) are indispensable for biosynthesis of collagen, which plays an important role in the process of wound healing. However, treatment effects of amino acid supplements containing HMB on the healing process of anastomotic leakage after gastrectomy remain unclear. We designed an open-label, multicenter, phase II clinical trial to evaluate the therapeutic efficacy of an enteral amino acid supplement consisting of arginine, glutamine, and HMB (Abound, Abbott Japan Co., Ltd., Tokyo, Japan) in patients with anastomotic leakage after gastrectomy. Patients who are diagnosed with anastomotic leakage within 14 days after gastrectomy are eligible for this trial and the target sample size is 20. A pack of Abound is administered twice a day for 2 weeks. The primary objective of this clinical trial is to determine the length of time between diagnosis and cure of anastomotic leakage. The secondary endpoints include the safety of Abound, duration of drainage placement and fasting, postoperative hospital stay, surgical procedure, and blood test data. Variables are compared between enrolled patients and a historical control consisting of 20 patients who underwent gastrectomy between 2004 and 2016 at Nagoya University Hospital. We herein describe the study design and the concept in this protocol paper.


Assuntos
Fístula Anastomótica/cirurgia , Arginina/uso terapêutico , Gastrectomia , Glutamina/uso terapêutico , Valeratos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
17.
Wounds ; 30(9): 251-256, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30256751

RESUMO

Although beta-hydroxy-beta-methylbutyrate (HMB), arginine (Arg), and glutamine (Gln) may contribute to wound healing, no prospective studies have investigated the efficacy of a compound consisting of HMB, Arg, and Gln (HMB/Arg/Gln) for reducing wound complications following open abdominal surgery. OBJECTIVE: This study evaluates the usefulness of perioperative nutrition using HMB/Arg/Gln in patients who were scheduled to undergo open surgery for abdominal malignancies in a randomized controlled trial. MATERIALS AND METHODS: Patients scheduled for open surgery for abdominal malignancies were randomized to receive HMB/Arg/Gln (1.2 g HMB, 7 g L-Arg, and 7 g L-Gln) or placebo (isocaloric juice). The supplements were provided once daily for 3 days preoperatively and once daily for 7 days postoperatively. The primary endpoint was the incidence of wound complications. Secondary endpoints included the incidence of other complications, postoperative duration of hospital stay, total-body skeletal muscle mass, handgrip strength, and skin water content. RESULTS: Sixty-one patients were randomly assigned to either the HMB/Arg/Gln (n = 31) or the placebo (n = 30) group. One patient in the HMB/Arg/Gln group was ineligible because laparoscopic surgery was performed; thus, 60 patients were analyzed. The incidence of wound complications (20%) was the same in both groups (P = 1.000). There were no significant differences in the incidence of other complications, body composition, handgrip strength, or skin water content between the 2 groups. Serum growth hormone (GH) levels were significantly higher for patients whose total intake was > 80% of planned volume in the HMB/Arg/Gln group. CONCLUSIONS: The incidence of wound complications would not be reduced by perioperative HMB/Arg/Gln administration in patients who underwent open surgery. The efficacy of HMB/Arg/Gln for increasing serum GH levels needs to be validated in another large-scale randomized controlled trial.


Assuntos
Neoplasias Abdominais/dietoterapia , Neoplasias Abdominais/cirurgia , Arginina/uso terapêutico , Glutamina/uso terapêutico , Apoio Nutricional/métodos , Cuidados Pré-Operatórios/métodos , Valeratos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Suplementos Nutricionais , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
N Engl J Med ; 379(3): 226-235, 2018 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-30021096

RESUMO

BACKGROUND: Oxidative stress contributes to the complex pathophysiology of sickle cell disease. Oral therapy with pharmaceutical-grade l-glutamine (USAN, glutamine) has been shown to increase the proportion of the reduced form of nicotinamide adenine dinucleotides in sickle cell erythrocytes, which probably reduces oxidative stress and could result in fewer episodes of sickle cell-related pain. METHODS: In a multicenter, randomized, placebo-controlled, double-blind, phase 3 trial, we tested the efficacy of pharmaceutical-grade l-glutamine (0.3 g per kilogram of body weight per dose) administered twice daily by mouth, as compared with placebo, in reducing the incidence of pain crises among patients with sickle cell anemia or sickle ß0-thalassemia and a history of two or more pain crises during the previous year. Patients who were receiving hydroxyurea at a dose that had been stable for at least 3 months before screening continued that therapy through the 48-week treatment period. RESULTS: A total of 230 patients (age range, 5 to 58 years; 53.9% female) were randomly assigned, in a 2:1 ratio, to receive l-glutamine (152 patients) or placebo (78 patients). The patients in the l-glutamine group had significantly fewer pain crises than those in the placebo group (P=0.005), with a median of 3.0 in the l-glutamine group and 4.0 in the placebo group. Fewer hospitalizations occurred in the l-glutamine group than in the placebo group (P=0.005), with a median of 2.0 in the l-glutamine group and 3.0 in the placebo group. Two thirds of the patients in both trial groups received concomitant hydroxyurea. Low-grade nausea, noncardiac chest pain, fatigue, and musculoskeletal pain occurred more frequently in the l-glutamine group than in the placebo group. CONCLUSIONS: Among children and adults with sickle cell anemia, the median number of pain crises over 48 weeks was lower among those who received oral therapy with l-glutamine, administered alone or with hydroxyurea, than among those who received placebo, with or without hydroxyurea. (Funded by Emmaus Medical; ClinicalTrials.gov number, NCT01179217 .).


Assuntos
Anemia Falciforme/tratamento farmacológico , Antidrepanocíticos/uso terapêutico , Glutamina/uso terapêutico , Hidroxiureia/uso terapêutico , Manejo da Dor , Administração Oral , Adolescente , Adulto , Anemia Falciforme/complicações , Criança , Pré-Escolar , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Glutamina/efeitos adversos , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/prevenção & controle , Adulto Jovem , Talassemia beta/tratamento farmacológico
20.
Biomed Res Int ; 2018: 2525670, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29850491

RESUMO

The aim of the present study was to investigate the effect of a short period of supplementation with glutamine dipeptide (GDP) on the acute responses to resistance training on the executive functions of people with HIV/AIDS. The sample consisted of 10 HIV+ women (45.00 ± 12.77 years old; 65.71 ± 12.04 kg; 1.54 ± 0.05 m) who were submitted to a randomized double-blind crossover procedure according to two experimental conditions: orally supplemented with 20 g/day of GDP or with maltodextrin for seven days. On the seventh day of supplementation all participants did cognitive function tests before and immediately after a resistance training session. Seven days of washout were adopted between conditions. Stroop and N-back tests were used to evaluate the executive functions. The training reduced the response time of each card in isolation and the latency time among them. GDP supplementation increased the magnitude of this effect, thus, reducing the latency time from the first to the last card in the Stroop test by almost 50% (P < 0.01). Considering the N-back test, there were no significant differences. It is suggested that GDP supplementation may increase the magnitude of the effect of an acute resistance training session in cognitive functions, particularly in the inhibitory control of people with HIV/AIDS. This trial is registered with NCT03236532.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/fisiopatologia , Cognição , Suplementos Nutricionais , Dipeptídeos/uso terapêutico , Glutamina/uso terapêutico , Treinamento de Resistência , Cognição/efeitos dos fármacos , Estudos Cross-Over , Dipeptídeos/farmacologia , Método Duplo-Cego , Feminino , Glutamina/farmacologia , Humanos , Pessoa de Meia-Idade , Placebos , Teste de Stroop
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