Picossulfato de sódio comparado ao Manitol no preparo intestinal para colonoscopia: uma revisão sistemática / Sodium picosulfate compared to mannitol for bowel preparation before colonoscopy: a systematic review

Introdução: A colonoscopia é considerada o exame padrão ouro para diagnóstico do câncer de intestino. Porém o sucesso do exame depende do preparo colônico eficaz. Objetivo: Avaliar a eficácia do picossulfato de sódio (PS) comparativamente ao manitol (MN) no preparo intestinal precedente ao exame de colonoscopia. Material e Métodos: Revisão sistemática de ensaios clínicos randomizados controlados (ECRs). A busca por evidências na literatura científica foi conduzida nas bases de dados PubMed, Embase, Cochrane Library e Biblioteca Virtual da Saúde por meio da combinação dos seguintes indexadores e operadores booleanos: "colonoscopy" AND "picosulfate sodium" AND "mannitol". O risco de viés foi avaliado pela ferramenta RoB 2.0. Resultados: O efeito do PS sobre a limpeza colônica foi similar ou até mesmo inferior àquele demonstrado pelo MN. Entretanto, observou-se maior tolerabilidade e palatabilidade e menor frequência de efeitos colaterais associados ao PS em comparação ao MN. Ressalta-se a carência de rigor metodológico dos estudos incluídos, visto que 33% destes foram classificados com "alto risco" de viés, enquanto 66,7% apresentaram "alguma preocupação". Conclusão: Em comparação ao MN, o uso de PS não promove uma maior qualidade de limpeza colônica, embora esteja relacionado à menor ocorrência de efeitos colaterais, maior tolerabilidade e palatabilidade. Assim, sugere-se que a inclusão do PS seja considerada apenas em pacientes com intolerância importante ou surgimento de efeitos adversos que inviabilizem o preparo com MN.

Introduction: Colonoscopy is considered the gold standard test for diagnosing bowel cancer. The success of the exam, however, depends on effective colonic preparation. Objective: To evaluate the effectiveness of Sodium Picosulfate (PS) compared to Mannitol (MN) in intestinal preparation before colonoscopy examination. Material and Methods: Systematic review of randomized controlled clinical trials (RCTs). The search for evidence in the scientific literature was conducted in the PubMed, Embase, Cochrane Library and Virtual Health Library databases by combining the following indexers and Boolean operators: "colonoscopy" AND "picosulfate sodium" AND "Mannitol". The risk of bias was assessed using the RoB 2.0 tool. Results: The effect of PS on colonic cleansing was similar or even lower than that demonstrated by MN. However, greater tolerability and palatability and a lower frequency of side effects associated with PS were observed compared to MN. The lack of methodological rigor of the included studies is highlighted, as 33% of these were classified as "high risk" of bias, while 66.7% presented "some concern". Conclusion: Compared to MN, the use of PS does not promote a higher quality of colon cleansing, although it is related to the lower occurrence of side effects, greater tolerability and palatability. Therefore, it is suggested that the inclusion of PS must be considered only in patients with significant intolerance or the emergence of adverse effects that make preparation with MN unfeasible.

Comparative study between manitol and sodium picosulfate with magnesium oxide solutions in the preparation for colonoscopy.

This prospective, randomized and double-blind study aims to compare two different protocols used for bowel preparation in patients scheduled for colonoscopy. The protocols were composed by solutions of Mannitol or sodium picosulfate combined with magnesium oxide. Patients from the proctology outpatient clinic of the General Surgery Unit of the Regional Hospital of Asa Norte (HRAN) comprised the sample of this study. Both the patients and the colonoscopist had no prior knowledge of the substance used to prepare bowel, which was randomly distributed among the participants. Both protocols demonstrated good and similar results regarding the efficiency of colon preparation, although the review of literature shows a difference in favor of preparation made with Mannitol solution regarding the colon neatness during the exam. In line with the literature, patients who used Mannitol solution had more side effects, highlighting the significant difference found for vomiting and sleep impairment. The preparation with Sodium Picosulfate with Magnesium Oxide was significantly superior in relation to the ease of ingestion perceived by the patients.

Evaluation of the satisfaction of the patient undergoing screening colonoscopy and quality of the procedure.

BACKGROUND: Screening colonoscopy requires quality parameters to determine its efficacy to detect cancerous or precancerous lesions. Limitations of the procedure are the patient's rejection, difficulty for its preparation or lack of preparation. OBJECTIVE: To assess whether patient satisfaction correlates with the quality of the procedure. METHOD: 100 consecutive patients for a screening colonoscopy were included, they were randomized to use a preparation with polyethylene glycol (PEG) or sodium picosulfate (P). In addition, a second parameter evaluated was related to a follow-up phone call performed to half of the patients prior to the study, during the preparation time. RESULTS: P was better tolerated and qualified, however, there was no difference with the quality of preparation, adenomatous polyps detection rate, cecum insertion rate and patient satisfaction. A difference was found in whom had a follow-up phone call. DISCUSSION: A good colon preparation is a key factor to have a quality colonoscopy, and it has been shown important that a good relationship for explain the doubts and follow the preparation. CONCLUSION: It was found that the type of preparation and patient follow-up during the study correlate with the quality of the study and patient satisfaction.

ANTECEDENTES: La colonoscopia de escrutinio requiere parámetros de calificación para determinar su eficiencia en la detección de lesiones cancerosas o precancerosas. Sus limitantes son su rechazo, la dificultad durante su preparación o la falta de preparación. OBJETIVO: Evaluar la satisfacción del paciente y los criterios de calidad del estudio. MÉTODO: Se incluyeron 100 pacientes enviados para colonoscopia de escrutinio asignados aleatoriamente a uno de dos grupos de preparación colónica: polietilenglicol (PEG) o picosulfato de sodio (P), para evaluar la satisfacción y la limpieza colónica. Otra evaluación fue por medio de llamada de refuerzo al momento de la preparación. RESULTADOS: Con P se tuvieron mejores tolerabilidad y calificaciones de satisfacción, en comparación con PEG. No hubo diferencia para la calidad de la limpieza, la tasa de detección de pólipos adenomatosos ni la intubación cecal. La llamada telefónica de reforzamiento incrementó la satisfacción, la limpieza colónica y la tasa de detección de adenomas. DISCUSIÓN: Una relación estrecha con el paciente durante su proceso de limpieza y explicación del procedimiento se ha visto como uno de los factores más importantes para lograr una colonoscopia de alta calidad. CONCLUSIÓN: El tipo de preparación colónica y la intervención durante la preparación se relacionaron con una mejor calidad del estudio y una mayor satisfacción del paciente.

Evaluación comparativa de efectividad y tolerabilidad con polietilenglicol y picosulfato de sodio-citrato de magnesio como agentes de preparación intestinal para colonoscopia / Comparative evaluation of effectiveness and tolerability with polyethylene glycol and sodium picosulfate-magnesium citrate as intestinal preparation agents for colonoscopy

Resumen Introducción La efectividad de la colonoscopia depende de múltiples factores, destacando la calidad de preparación intestinal y la tolerabilidad que tenga el paciente a la preparación administrada. Objetivo Comparar dos agentes de preparación intestinal, el polietilenglicol (PEG) y el picosulfato de sodiocitrato de magnesio (PSCM) en términos de efectividad y tolerabilidad de la preparación. Pacientes y Método Ensayo clínico aleatorizado en pacientes ambulatorios sometidos a colonoscopia en Clínica INDISA. Evaluando efectividad y tolerabilidad con el Boston Bowel Preparation Score (BBPS) y cuestionario de Lawrence [compuesto por escala Likert, dos preguntas cualitativas y escala visual análoga (EVA)], respectivamente. Resultados 189 pacientes, de los cuales 123 se aleatorizaron a PEG y 66 a PSCM. El BBPS en los pacientes que utilizaron PEG, la media fue 7,51 (DS 1,66) y con PSCM fue 7,12 (DS 1,71) (p = 0,111). Al analizar la tolerabilidad con escala Likert, la media con PEG fue 0,94 (DS 0,68) y con PSCM fue 0,63 (DS 0,61) (p = 0,0004). La EVA con PEG tuvo una media de 7,68 (DS 2,4) y con PSCM de 9,04 (DS 1,59) (p < 0,0001). Al preguntar ausentismo laboral, no hubo diferencias significativas en ambos grupos y al preguntar si ocuparía la misma preparación en una futura colonoscopia, hubo significancia estadística a favor del PSCM (p = 0,026). Conclusión No encontramos diferencias en la efectividad de preparación intestinal al comparar PEG y PSCM, sin embargo, el PSCM es mejor tolerado.

Introduction The effectiveness of colonoscopy depends on multiple factors, being two of the most important ones an adequate bowel preparation and the patient's tolerability to the preparation. Objectives Compare effectiveness and tolerability of two bowel preparation agents, polyethylene glycol (PEG) and sodium picosulfate/magnesium citrate (SPMC). Patients and Methods Randomized clinical trial on outpatients that went into colonoscopy in INDISA Clinic. We evaluated effectiveness and tolerability with Boston Bowel Preparation Score (BBPS) and Lawrence questionnaire [composed by Likert scale, two qualitative questions and Visual Analogue Scale (VAS) for pain], respectively. Results 189 patients, 123 were randomized to PEG and 66 to SPMC. BBPS average in patients in the PEG branch was 7.51 (SD 1.66) and for SPMC 7.12 (SD 1.71) (p = 0.111). Likert scale for evaluating tolerability average for PEG was 0.94 (SD 0.68) and for SPMC 0.63 (SD 0.61) (p = 0.0004). VAS scale for PEG had an average of 7.68 (SD 2.4) and for PSCM 9.04 (SD 1.59) (p < 0.0001). When we asked for workplace absenteeism, there were no significant differences between both groups and when we asked about using the same intestinal preparation in a future colonoscopy there was statistical significance in favor to SPMC (p = 0.026). Conclusions No differences were noted on effectiveness between the PEG and SPMC bowel preparations. Nevertheless, SPMC appeared to be better tolerated by patients.

Estudio comparativo entre el uso de manitol y el picosulfato sódico como preparación para colonoscopía / Comparison of colon-cleansing methods in preparation for colonoscopy- comparative of solutions of mannitol and sodium picosulfate

Objetivos: El objetivo del presente estudio es comparar la preparación adecuada del colon con manitol y picosulfato sódico. Evaluar la aceptación de los pacientes, los efectos secundarios y la capacidad de limpieza. Materiales y métodos: Este es un estudio no aleatorio, prospectivo, ciego, en que el evaluador no tenía información sobre la preparación aplicada. La muestra obtenida se dividió en dos grupos de acuerdo con la preparación adecuada del colon, con 153 pacientes preparados con manitol al 10% y 84 pacientes con picosulfato sódico. La evaluación de la preparación se realizó usando la Escala de Boston (Boston Bowel Preparation Scale - BBP) a través de un sistema de puntuación para cada región del colon puntuada con 3 puntos: derecha, izquierda y colon transverso. Resultados: De los 237 pacientes que fueron evaluados, 146 (61,60%) eran mujeres y 91 (38,4%) eran hombres. En el grupo que utilizó manitol, 98 (64,05%) eran mujeres y 55 (35,95%) eran varones. Entre los pacientes que utilizaron picosulfato sódico, 48 (57,14%)eran mujeres y 36 (42,86%) eran hombres, sin diferencias estadísticas de ambos grupos (p>0,32). Teniendo en cuenta que con la adecuada preparación del colon y con puntuación de 6 puntos en la Escala de Boston, la preparación intestinal fue satisfactoria en ambos grupos. El 93% de los pacientes que utilizaron manitol y el 81% de los pacientes que utilizaron picosulfato sódico tenían preparación adecuada (puntuación de 6). La puntuación media en la preparación con manitol fue de 9 y en la preparación con picosulfato sódico fue de 7. No hubo diferencias significativas entre ambos grupos. Conclusión: Ambas preparaciones, demostraron ser seguras y eficaces para la limpieza del intestino, de acuerdo con la Escala de Boston, así como, la aceptabilidad de los pacientes y libre de complicaciones

Objectives: The purpose of the present study is to compare intestinal preparation with mannitol and sodium picosulphate, assessing patient’s acceptance, side effects and cleaning capacity. Material and methods: This is a prospective, nom randomized, blind study, in which the evaluator had no information about the preparation applied. The sample obtained was divided into two groups according to the bowel preparation applied, with 153 patients prepared with 10% mannitol and 84 patients with sodium picosulfate. The evaluation of colon preparation was done using the Boston Scale (Boston Bowel Preparation Scale - BBP) through a three-point scoring system for each of the three regions of the colon: right, left and transverse colon. Results: Of the 237 patients that were evaluated, 146 (61.60%) were female and 91 (38.4%) were male. Regarding the group that used mannitol, 98 were female (64.05%) and 55 were male (35.95%). Among the patients who used sodium picosulfate, 48 were female (57.14%) and 36 were male (42.86%), with no statistical differences between both groups (p> 0.32). Considering that an adequate preparation scores ≥ 6 in the Boston Scale, the bowel cleansing preparation was satisfactory in both groups. 93% of the patients who used mannitol and 81% of the patients who used sodium picosulfate had adequate preparation (score of ≥ 6). Moreover, we consider that the average score in the preparation with Mannitol was 9, while the sodium picosulfate score was 7. There were no significant differences between the two groups. Conclusion: There is consensus among authors who state that colonoscopy’s safety and success are highly related to the cleansing outcome, regardless of the method used. The same can be observed in the present study, on which both preparations were proved safe and effective for bowel cleansing, according to the Boston scale, as well as accepted by patients and free of complications

[Comparison of colon-cleansing methods in preparation for colonoscopy-comparative of solutions of mannitol and sodium picosulfate]. / Estudio comparativo entre el uso de manitol y el picosulfato sódico como preparación para colonoscopía.

OBJECTIVES: The purpose of the present study is to compare intestinal preparation with mannitol and sodium picosulphate, assessing patient's acceptance, side effects and cleaning capacity. MATERIAL AND METHODS: This is a prospective, nom randomized, blind study, in which the evaluator had no information about the preparation applied. The sample obtained was divided into two groups according to the bowel preparation applied, with 153 patients prepared with 10% mannitol and 84 patients with sodium picosulfate. The evaluation of colon preparation was done using the Boston Scale (Boston Bowel Preparation Scale - BBP) through a three-point scoring system for each of the three regions of the colon: right, left and transverse colon. RESULTS: Of the 237 patients that were evaluated, 146 (61.60%) were female and 91 (38.4%) were male. Regarding the group that used mannitol, 98 were female (64.05%) and 55 were male (35.95%). Among the patients who used sodium picosulfate, 48 were female (57.14%) and 36 were male (42.86%), with no statistical differences between both groups (p> 0.32). Considering that an adequate preparation scores ≥ 6 in the Boston Scale, the bowel cleansing preparation was satisfactory in both groups. 93% of the patients who used mannitol and 81% of the patients who used sodium picosulfate had adequate preparation (score of ≥ 6). Moreover, we consider that the average score in the preparation with Mannitol was 9, while the sodium picosulfate score was 7. There were no significant differences between the two groups. CONCLUSION: There is consensus among authors who state that colonoscopy's safety and success are highly related to the cleansing outcome, regardless of the method used. The same can be observed in the present study, on which both preparations were proved safe and effective for bowel cleansing, according to the Boston scale, as well as accepted by patients and free of complications.

Synthesis, characterization and cytotoxic activities of the [RuCl2(NO)(dppp)(L)]PF6 complexes.

The synthesis and characterization of ruthenium compounds of the type [RuCl(2)(NO)(dppp)(L)]PF(6) [dppp=1,3-bis(diphenylphosphino)propane; L=pyridine, 4-methylpyridine, 4-phenylpyridine and dimethyl sulfoxide] are described. The complexes were characterized by elemental analysis, UV/Vis and infrared spectroscopy, cyclic voltammetry, and X-ray crystallography for the complexes with the pyridine and 4-methylpyridine ligands. In vitro evaluation of these nitrosyl complexes revealed cytotoxic activity from 7.1 to 19.0 microM against the MDA-MB-231 breast tumor cells and showed that, in this case, they are more active than the reference metallodrug cisplatin. The 1,3-bis(diphenylphosphino)propane and the N-heterocyclic ligands alone failed to show cytotoxic activities at the concentrations tested (maximum concentration utilized=200 microM).

Comparison of colon-cleansing methods in preparation for colonoscopy--comparative efficacy of solutions of mannitol, sodium picosulfate and monobasic and dibasic sodium phosphates.

PURPOSE: Colonoscopy plays an essential role in the therapeutic and diagnostic approach in various colonic pathologies, the aim of the present study was to compare three solutions and their efficacy for the bowel preparation in adult patients submitted to elective colonoscopy. METHODS: Sixty patients were randomly divided into three groups of 20 each. Each group was submitted to a bowel preparation with one of the following solutions: 10% manitol, sodium picosulphate or sodium phosphate. The parameters evaluated were: taste, tolerance, associated side effects and quality of cleansing. Postural blood pressure and pulse rate as well as serum sodium, potassium, calcium and phosphate were compared. RESULTS: Sodium phosphate and 10% manitol solutions provided superior results in terms of colon cleansing compared to sodium picosulphate solution. All serum electrolytes evaluated were significantly altered in the three groups, without important clinical signs. DISCUSSION: High levels of serum phosphate were the most striking alteration in patients prepared with sodium phosphate solution, again with no clinical signs. Variations related to blood pressure and pulse rate suggested contraction of intravascular volume, with no clinical effects. CONCLUSION: Sodium phosphate and 10% manitol solutions are equivalent in providing good quality colon cleansing, with no significant side effects that could compromise the procedure.

Comparison of colon-cleansing methods in preparation for colonoscopy - Comparative efficacy of solutions of mannitol, sodium picosulfate and monobasic and dibasic sodium phosphates / Estudo comparativo entre as soluções de manitol, picossulfato de sódio e fosfato monobásico e dibásico de sódio no preparo de cólon para colonoscopia

PURPOSE: Colonoscopy plays an essential role in the therapeutic and diagnostic approach in various colonic pathologies, the aim of the present study was to compare three solutions and their efficacy for the bowel preparation in adult patients submitted to elective colonoscopy. METHODS: Sixty patients were randomly divided into three groups of 20 each. Each group was submitted to a bowel preparation with one of the following solutions: 10 percent manitol, sodium picosulphate or sodium phosphate. The parameters evaluated were: taste, tolerance, associated side effects and quality of cleansing. Postural blood pressure and pulse rate as well as serum sodium, potassium, calcium and phosphate were compared. RESULTS: Sodium phosphate and 10 percent manitol solutions provided superior results in terms of colon cleansing compared to sodium picosulphate solution. All serum electrolytes evaluated were significantly altered in the three groups, without important clinical signs. DISCUSSION: High levels of serum phosphate were the most striking alteration in patients prepared with sodium phosphate solution, again with no clinical signs. Variations related to blood pressure and pulse rate suggested contraction of intravascular volume, with no clinical effects. CONCLUSION: Sodium phosphate and 10 percent manitol solutions are equivalent in providing good quality colon cleansing, with no significant side effects that could compromise the procedure.

INTRODUÇÃO: A colonoscopia é exame fundamental na avaliação das doenças do cólon e na abordagem terapêutica de determinado grupo de patologias. O preparo intestinal é obrigatório para a realização das colonoscopias eletivas, e a qualidade encontra-se relacionada ao sucesso do procedimento. Comparou-se três soluções para limpeza anterógrada do cólon em pacientes adultos, submetidos à colonoscopia. METODOS: Sessenta pacientes foram distribuídos em três grupos de vinte. Cada grupo realizou o preparo do cólon com uma das três soluções estudadas: manitol a 10 por cento (MN), picossulfato sódico (PS) e fosfato monobásico e dibásico de sódio (NaP). O sabor, a tolerância, os efeitos colaterais, os custos e a qualidade de limpeza do preparo foram avaliados. Frequência cardíaca e pressão arterial sistêmica foram analisados. Variações dos eletrólitos foram dosados antes e após o preparo. RESULTADOS: Os resultados foram semelhantes em relação aos efeitos colaterais. O sabor da solução de NaP não chegou a comprometer a sua aceitação. DISCUSSÃO: Soluções de NaP e MN proporcionaram resultados superiores tanto em qualidade de limpeza colônica, como em relação aos custos, quando comparadas à solução de PS. CONCLUSÃO: Comparados os três, os eletrólitos avaliados apresentaram diferenças significativas, sendo a hiperfosfatemia dos pacientes com a solução de NaP, a mais importante.

Comparison of colon-cleansing methods in preparation for colonoscopy - Comparative efficacy of solutions of mannitol, sodium picosulfate and monobasic and dibasic sodium phosphates / Estudo comparativo entre as soluções de manitol, picossulfato de sódio e fosfato monobásico e dibásico de sódio no preparo de cólon para colonoscopia

PURPOSE: Colonoscopy plays an essential role in the therapeutic and diagnostic approach in various colonic pathologies, the aim of the present study was to compare three solutions and their efficacy for the bowel preparation in adult patients submitted to elective colonoscopy. METHODS: Sixty patients were randomly divided into three groups of 20 each. Each group was submitted to a bowel preparation with one of the following solutions: 10 percent manitol, sodium picosulphate or sodium phosphate. The parameters evaluated were: taste, tolerance, associated side effects and quality of cleansing. Postural blood pressure and pulse rate as well as serum sodium, potassium, calcium and phosphate were compared. RESULTS: Sodium phosphate and 10 percent manitol solutions provided superior results in terms of colon cleansing compared to sodium picosulphate solution. All serum electrolytes evaluated were significantly altered in the three groups, without important clinical signs. DISCUSSION: High levels of serum phosphate were the most striking alteration in patients prepared with sodium phosphate solution, again with no clinical signs. Variations related to blood pressure and pulse rate suggested contraction of intravascular volume, with no clinical effects. CONCLUSION: Sodium phosphate and 10 percent manitol solutions are equivalent in providing good quality colon cleansing, with no significant side effects that could compromise the procedure.(AU)

INTRODUÇÃO: A colonoscopia é exame fundamental na avaliação das doenças do cólon e na abordagem terapêutica de determinado grupo de patologias. O preparo intestinal é obrigatório para a realização das colonoscopias eletivas, e a qualidade encontra-se relacionada ao sucesso do procedimento. Comparou-se três soluções para limpeza anterógrada do cólon em pacientes adultos, submetidos à colonoscopia. METODOS: Sessenta pacientes foram distribuídos em três grupos de vinte. Cada grupo realizou o preparo do cólon com uma das três soluções estudadas: manitol a 10 por cento (MN), picossulfato sódico (PS) e fosfato monobásico e dibásico de sódio (NaP). O sabor, a tolerância, os efeitos colaterais, os custos e a qualidade de limpeza do preparo foram avaliados. Frequência cardíaca e pressão arterial sistêmica foram analisados. Variações dos eletrólitos foram dosados antes e após o preparo. RESULTADOS: Os resultados foram semelhantes em relação aos efeitos colaterais. O sabor da solução de NaP não chegou a comprometer a sua aceitação. DISCUSSÃO: Soluções de NaP e MN proporcionaram resultados superiores tanto em qualidade de limpeza colônica, como em relação aos custos, quando comparadas à solução de PS. CONCLUSÃO: Comparados os três, os eletrólitos avaliados apresentaram diferenças significativas, sendo a hiperfosfatemia dos pacientes com a solução de NaP, a mais importante.(AU)

Randomized clinical trial comparing sodium picosulfate with mannitol on the preparation FOR colonoscopy in hospitalized patients.

BACKGROUND: The cleansing of the colon for a colonoscopy exam must be complete so as to allow the visualization and inspection of the intestinal lumen. The ideal cleansing agent should be easily administered, have a low cost, and minimum collateral effects. Sodium picosulfate together with the magnesium citrate is a cathartic stimulant and mannitol is an osmotic laxative, both usually used for this purpose. AIMS: Assess the colon cleanliness comparing the use of mannitol and sodium picosulfate as well as evaluate the level of patient satisfaction, the presence of foam, pain, and abdominal distension in hospitalized patients undergoing colonoscopy. METHODS: A prospective, randomized, single-blind study with 80 patients that compared two groups: mannitol (40) and sodium picosulfate (40). Both groups received the same dietary orientation. The study was approved by the hospital's Ethics and Research Committee. The endoscopist was blind to the type of preparation. Outcomes evaluated: level of the colons cleanliness, patients satisfaction, the presence of foam, abdominal pain and distension, and the duration of the exam. The data was analyzed by means of the chi-squared test for proportions and Mann-Whitney for independent samples. RESULTS: There were no statistically significant differences between the groups in relation to the level of the colon's cleanliness, patients satisfaction, the presence of foam, abdominal pain, and the duration of the exam. Fifteen percent of the exams of the mannitol group were interrupted while from the sodium picosulfate group it was 5%. The presence of foam was similar for both groups. The average duration for carrying out the exam was 28.44 minutes for the mannitol group and 35.59 minutes for the sodium picosulfate group. Abdominal distension was more frequent in the mannitol group. If they would have to do the same exam, the answer was that 80% said yes from the mannitol group and 92.5% from the sodium picosulfate group. CONCLUSION: The quality of the colon preparation, foam formation, exam duration, and the collateral effects (nauseas, vomiting, and abdominal pain) were similar in both kinds of preparations. Abdominal distension was greater in the mannitol group. Both methods of preparation were well accepted by the hospitalized patients.

Randomized clinical trial comparing sodium picosulfate with mannitol on the preparation FOR colonoscopy in hospitalized patients

BACKGROUND: The cleansing of the colon for a colonoscopy exam must be complete so as to allow the visualization and inspection of the intestinal lumen. The ideal cleansing agent should be easily administered, have a low cost, and minimum collateral effects. Sodium picosulfate together with the magnesium citrate is a cathartic stimulant and mannitol is an osmotic laxative, both usually used for this purpose. AIMS: Assess the colon cleanliness comparing the use of mannitol and sodium picosulfate as well as evaluate the level of patient satisfaction, the presence of foam, pain, and abdominal distension in hospitalized patients undergoing colonoscopy. METHODS: A prospective, randomized, single-blind study with 80 patients that compared two groups: mannitol (40) and sodium picosulfate (40). Both groups received the same dietary orientation. The study was approved by the hospital’s Ethics and Research Committee. The endoscopist was blind to the type of preparation. Outcomes evaluated: level of the colon’s cleanliness, patient’s satisfaction, the presence of foam, abdominal pain and distension, and the duration of the exam. The data was analyzed by means of the chi-squared test for proportions and Mann-Whitney for independent samples. RESULTS: There were no statistically significant differences between the groups in relation to the level of the colon’s cleanliness, patient’s satisfaction, the presence of foam, abdominal pain, and the duration of the exam. Fifteen percent of the exams of the mannitol group were interrupted while from the sodium picosulfate group it was 5 percent. The presence of foam was similar for both groups. The average duration for carrying out the exam was 28.44 minutes for the mannitol group and 35.59 minutes for the sodium picosulfate group. Abdominal distension was more frequent in the mannitol group. If they would have to do the same exam, the answer was that 80 percent said yes from the mannitol group and 92.5 percent...

RACIONAL: A limpeza do cólon para o exame de colonoscopia deve ser completa de modo a permitir a visualização e inspeção do lúmen intestinal. O agente de limpeza ideal deveria ser de fácil administração, com baixo custo e com o mínimo de efeitos colaterais. O picosulfato de sódio juntamente com o citrato de magnésio é um estimulante catártico e o manitol é um laxativo osmótico, ambos geralmente utilizados para este propósito. OBJETIVOS: Verificar a limpeza do cólon comparando o uso de manitol e picosulfato de sódio assim como avaliar o nível de satisfação do paciente, presença de espuma, dor e distensão abdominal em pacientes hospitalizados submetidos a colonoscopia. MÉTODOS: Estudo prospectivo, randomizado, simples-cego com 80 pacientes que comparou dois grupos: manitol (40) e picosulfato de sódio (40). Ambos os grupos receberam a mesma orientação dietética. O estudo foi aprovado pelo Comitê de Ética do hospital e pelo Comitê de Pesquisa. O endoscopista foi cego para o tipo de preparo. Desfechos avaliados: nível de limpeza do cólon, satisfação do paciente, presença de espuma, dor e distensão abdominal e tempo de duração do exame. Os dados foram analisados pelas médias de testes qui-quadrado para proporções e Mann-Whitney para amostras independentes. RESULTADOS: Não houve diferença significativa entre os grupos em relação ao nível de limpeza do cólon, satisfação do paciente, presença de espuma, dor abdominal e tempo de exame. Quinze porcento dos exames do grupo manitol foram interrompidos enquanto que grupo picosulfato de sódio foi de 5 por cento. A presença de espuma foi similar em ambos os grupos. A média de duração do exame foi de 28h 44min para o grupo manitol e 35h 59min para o grupo picosulfato de sódio. A distensão abdominal foi mais freqüente no grupo manitol. Se eles tivessem que repetir o exame, a resposta foi de 80 por cento disse sim do grupo manitol e 92,5 por cento do grupo picosulfato de sódio. CONCLUSÕES: A qualidade do...

[Preparation for colonoscopy using 1,000 ml Magcorol P isotonic solution in the absence of dietary restrictions or use of purgatives on the preceding day]. / Preparation for Colonoscopy using 1,000 ml Magcorol P isotonic solution in the absence of dietary restrictions or use of purgatives on the preceding day.

Colonic lavage using about 2,000 mL of solution is performed routinely in Japan. However, consumption of such large amounts of fluid may be difficult for elderly individuals. From personal experience, it was observed that in European countries, the Modified Brown Method is mainly used, where patients are instructed to take 3,000 to 5,000 mL of water and a purgative on the day preceding colonoscopy. In the present study, dietary restrictions and use of purgatives on the preceding day were omitted, to reduce the burden on patients. The volume of lavage solution was limited to 1,000 mL, which was taken on the day of colonoscopy. This study included four groups, receiving various drugs, based on examination of 882 responses from 786 patients, to a questionnaire. Group1: 1 pack Niflec (Polyethylene glycol)+ 50g Magcorol(Citrate magnesium); group 2: 50g Magcorol + 10mL laxoberon (sodium picosulfate); Group 3; 60g Magcorol + 10mL laxoberon and Group 4 55g Magcorol + 20mL laxoberon . The results of Evaluation of Colonoscopic Cleansing showed, the satisfactory level of subjects on the 1000 mL method was similar to those on the 2,000 mL method. In addition, 796 (96%) of 882 subjects answered that the 1,000-mL lavage method was tolerable. The final group received a lavage solution prepared by dissolving 55 g of Magcorol P and 20 mL of Laxoberon in 1,000 mL of water. On the day of colonoscopy at 8:30 in the morning, patients took 3 Gasmotin tablets and lavage solution ingestion was induced at 09:00 and completed within 15 minutes. Cleansing efficacy in this group was 95%. A Glycerine enema was used when necessary, since its cleansing effect in patients (13%) was comparable to patients without enema. Moreover, in the questionnaire patients indicated that enemas were more acceptable than additional consumption of lavage solution. The following advantages were observed with the 1,000 mL lavage method: a) sufficient sleep on the preceding day due to the absence of dietary restrictions or use of purgatives; b) lesser concern regarding urge to evacuate on the way to the hospital and c) feeling of security in taking the lavage solution at the hospital.

[Bowel preparation for colonoscopy with sodium picosulphate and magnesium citrate in children and adolescents]. / Preparo intestinal para colonoscopia com picossulfato sódico e citrato de magnésio em crianças e adolescentes.

BACKGROUND: The efficacy of colonoscopic examination depends directly on bowel cleansing preparation. There are few studies in the medical literature about bowel preparation in children. AIM: To determinate the efficacy of picosulphate sodium with magnesium citrate as a bowel preparation in children and adolescents. PATIENTS AND METHODS: In an open prospective and consecutive trial, we included all children above 1 year of age submitted to colonoscopy for different indications. All patients received the drug the day before the procedure and was allowed no solid food but a liberal intake of clear fluids. The adequacy of the preparation was graded as follows: gI--excellent, gII--good, gIII--fair and gIV--poor. RESULTS: Forty-six patients were included. The age ranged from 12 months to 16.1 years (median = 6.6y), 54.3% were males. Bowel preparation was made according to instructions in 37/46 (80.4%) of patients, 9 patients did not adhere to diet of clear liquids and 22/46 (47.8%) had side effects. The adequacy of the bowel preparation was: gI in 41.3%, gII in 52.2%, gIII in 6.5% and none in gIV. CONCLUSION: Bowel preparation with picosulphate sodium and clear fluids provides an effective, practical method of preparing the bowel for colonoscopy in children and adolescents and could be recommended.

Preparo intestinal para colonoscopia com picossulfato sódico e citrato de magnésio em crianças e adolescentes / Bowel preparation for colonoscopy with sodium picosulphate and magnesium citrate in children and adolescents

RACIONAL: A eficácia do exame colonoscópico depende diretamente da limpeza colônica. Ao contrário do paciente adulto, há poucos relatos na literatura sobre preparo colônico em crianças. OBJETIVO: Avaliar a eficácia do preparo colônico à base de picossulfato sódico e citrato de magnésio em crianças e adolescentes. PACIENTES E MÉTODOS: Realizou-se estudo aberto, prospectivo e consecutivo em crianças maiores de 1 ano, de ambos os sexos, que realizaram colonoscopia por diferentes indicações. Os pacientes receberam a medicação associada à dieta líquida e pastosa sem resíduos no dia anterior ao exame. A eficácia do preparo foi classificada em: Grau I: ótimo; Grau II: bom; Grau III: regular; Grau IV: ruim. RESULTADOS: A idade variou de 12 meses a 16 anos e 1 mês (mediana: 6 anos e 6 meses), sendo 54,3 por cento do sexo masculino. O preparo foi feito conforme a orientação em 37/46 (80,4 por cento) dos pacientes, sendo que 9 não fizeram a dieta adequadamente e 22/46 (47,8 por cento) referiram efeitos colaterais. A eficácia do preparo foi: GI em 41,3 por cento, GII em 52,2 por cento, GIII em 6,5 por cento e GIV em 0 por cento. CONCLUSAO: Preparo intestinal com picossulfato sódico e citrato de magnésio é eficiente e prático, podendo ser recomendado de rotina nos exames de colonoscopia em crianças e adolescentes.

Estudo comparativo entre as soluções de manitol, picossulfato de sódio e fosfato monobásico e dibásico de sódio no preparo de cólon para colonoscopia / Comparative study among the mannitol, sodium picosulfate and sodium monobasic and dibasic fosfate solutions in preparation of colon for colonoscopy

Atualmente, a colonoscopia é o exame de primeira escolha na avaliação das doenças do cólon, tendo também papel fundamental na abordagem terapêutica de determinado grupo de patologias. O preparo intestinal é etapa obrigatória para a realização das colonoscopias eletivas, e a qualidade deste encontra-se diretamente relacionada ao sucesso do procedimento, seja este diagnóstico ou terapêutico. Foram comparadas três soluções para limpeza anterógrada do cólon em pacientes adultos, submetidos à colonoscopia em regime ambulatorial. Sessenta pacientes foram distribuidos em três grupos de vinte indivíduos. Cada um dos grupos realizou o preparo do cólon com uma das três soluções estudadas: manitol a 10 por cento (MN), picossulfato sódico (PS) e fosfato monobásico e dibásico de sódio (NaP). O sabor, a tolerância, os efeitos colaterais, os custos e a qualidade de limpeza do preparo foram avaliados. Parâmetros clínicos como frequência cardíaca e pressão arterial sistêmica também foram estudados, além das variações dos eletrólitos (sódio, potássio, cálcio e fósforo) que foram dosados antes e após o preparo intestinal. Os pacientes estudados apresentaram resultados semelhantes em relação aos efeitos colaterais. As variações relativas à freqüência cardíaca, pressão arterial e hematócrito, ainda que indicando contração no espaço intravascular, não cursaram com maiores repercussões do ponto de vista clínico. O sabor ruim da solução de NaP não chegou a comprometer a aceitação desta pelos pacientes. As soluções de NaP e MN proporcionaram resultados superiores tanto em qualidade de limpeza colônica, como em relação aos custos, quando comparadas à solução de PS. Quando comparados os três grupos do estudo, todos os eletrólitos avaliados apresentaram diferenças significativas, sendo a hiperfosfatemia dos pacientes preparados com a solução de NaP, a mais importante delas. Nenhuma dessas, no entanto, apresentou problemas de ordem clínica.

Inhibition of denitrification by ultraviolet radiation.

It has been shown that UV-A (lambda=320-400 nm) and UV-B (lambda=280-320 nm) inhibit photosynthesis, nitrogen fixation and nitrification. The purpose of this study was to determine the effects, if any, on denitrification in a microbial community inhabiting the intertidal. The community studied is the microbial mat consisting primarily of Lyngbya that inhabits the Pacific marine intertidal, Baja California, Mexico. Rates of denitrification were determined using the acetylene blockage technique. Pseudomonas fluorescens (ATCC #17400) was used as a control organism, and treated similarly to the mat samples. Samples were incubated either beneath a PAR transparent, UV opaque screen (OP3), or a mylar screen to block UV-B, or a UV transparent screen (UVT) for 2 to 3 hours. Sets of samples were also treated with nitrapyrin to inhibit nitrification, or DCMU to inhibit photosynthesis and treated similarly. Denitrification rates were greater in the UV protected samples than in the UV exposed samples the mat samples as well as for the Ps fluorescens cultures. Killed controls exhibited no activity. In the DCMU and nitrapyrin treated samples denitrification rates were the same as in the untreated samples. These data indicate that denitrification is directly inhibited by UV radiation.