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1.
PLoS One ; 18(1): e0279922, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36607970

RESUMO

INTRODUCTION: Patients frequently use gastric acid-reducing agents (ARAs) to treat symptoms affecting the gastrointestinal tract. Thus, the risk for drug-drug interactions (DDI) is a serious concern. This potentially makes the community pharmacist (CP) act as a primary intervention by providing the appropriate counseling and dispensing practice. OBJECTIVE: To evaluate CPs' counseling and dispensing practices regarding complaints of Gastroesophageal Reflux Disease (GERD), including recommending an appropriate course of action to prevent possible DDIs. MATERIALS AND METHODS: A simulated patient (SP) methodology was used in this study. The community pharmacies in Ajman and Sharjah were visited by SP who's responsible for acting as a patient, and by an observer who's responsible for focusing on the interaction between the SP and the CPs without engagement. Data were recorded using a preprepared data collection form. Performance feedback was sent to the CPs after concluding all visits. Counseling and dispensing scores were classified based on the total scores to poor, inadequate, and complete. Appropriateness of the pharmacist's decision was defined as dispensing antacid and advising of separating doses apart in time. RESULTS: A total of 150 community pharmacies was included in the data analysis. The findings of the current study demonstrated poor counseling and dispensing for the vast majority of the participants (81.3% and 67.3% of respondents, respectively). Only 4% of the CPs advised the SP to have a time interval between antacid and cefuroxime axetil. A significant difference in counseling scores was found between pharmacies located in Ajman and Sharjah (p = 0.01). Also, there was a significant difference in dispensing scores between independent and chain pharmacies (p = 0.003). CONCLUSIONS: The findings revealed inadequate counseling and dispensing practice by CPs. This study highlighted the need for continuous professional training programs to endow the CPs with the knowledge necessary for improving the CPs' counseling and dispensing practices.


Assuntos
Serviços Comunitários de Farmácia , Refluxo Gastroesofágico , Farmácias , Humanos , Farmacêuticos/psicologia , Antiácidos , Emirados Árabes Unidos , Interações Medicamentosas , Refluxo Gastroesofágico/tratamento farmacológico
2.
BMJ Open Gastroenterol ; 10(1)2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36627148

RESUMO

BACKGROUND/AIMS: Investigation of gastro-oesophageal reflux disease is usually performed off proton pump inhibitors (PPIs). This can exacerbate symptoms, potentially impacting investigation accuracy if patients circumvent the preinvestigation instructions. There are no standard recommendations on how to manage PPI withdrawal. We aimed to assess the impact of structured alginate use on symptom burden. METHODS: Participants were already established on ≥4 weeks of PPI therapy and being referred for manometry and 24-hour pH/impedance testing. Preinvestigation instructions involved stopping PPIs and H2 receptor antagonists for 1 week, but antacids and alginates were allowed until the night before. Participants were randomised to follow these standard instructions (control group), or the same instructions with the provision of Gaviscon Advance to be taken four times daily (treatment group). The primary outcome assessed change in Gastro-Oesophageal Reflux Disease Health-Related Quality of Life Score. KEY RESULTS: Data for 48 patients were available for primary outcome assessment. While patients in the control group had a significant increase in symptoms (median difference 6.5, 95% CI (1 to 7), p=0.04), no change occurred in the treatment arm (median difference -1.5, 95% CI (-2, 3.5), p=0.54). There were no serious adverse events. CONCLUSIONS: Structured alginate use prevents symptom exacerbation during preinvestigation PPI wash-out. These findings are limited to the 1-week wash-out period but can benefit thousands of patients undergoing investigation for gastro-oesophageal reflux each year. Further research is required to assess this effect in other settings, such as sustained PPI deprescription. The trial was funded by Reckitt Benckiser. TRIAL REGISTRATION NUMBER: EudraCT registration 2019-004561-41.


Assuntos
Refluxo Gastroesofágico , Inibidores da Bomba de Prótons , Humanos , Inibidores da Bomba de Prótons/efeitos adversos , Qualidade de Vida , Refluxo Gastroesofágico/tratamento farmacológico , Antiácidos/uso terapêutico , Alginatos/uso terapêutico
3.
J Infect Chemother ; 29(2): 232-234, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36503067

RESUMO

Overuse of antacids is associated with the development and recurrence of Clostridioides difficile infection (CDI). Discontinuation of unnecessary antacids for CDI management is advocated; however, the clinical pervasiveness on the discontinuation of antacids remains unclear. We conducted a single-center retrospective observational study to determine the rate of antacid discontinuation following CDI diagnosis. Among 51 patients (58 infections; median age 76.5 years, range 69-82; 53.5% women) treated with antimicrobials against C. difficile, 41 had been treated with antacids, and of these, 18 exhibited no indication for antacid administration. However, none had discontinued antacid use. While CDI provides an opportunity for antacid stewardship, it is not implemented in clinical practice. In addition to the efforts of individual clinicians, the dissemination of knowledge of the indications and side effects of antacids, establishment of a multidisciplinary support system, and creation and implementation of a clinical stewardship pathway are necessary to increase the deprescription of antacids in patients with CDI.


Assuntos
Clostridioides difficile , Infecções por Clostridium , Desprescrições , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Masculino , Antiácidos/efeitos adversos , Fatores de Risco , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico
4.
Int J Mol Sci ; 23(22)2022 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-36430914

RESUMO

It is a macro-micro model study for defect initiation, growth and crack propagation of metallic truss structure under high engine temperature and pressure conditions during the reentry atmosphere. Till now, the multi-scale simulation methods for these processes are still unclear. We explore the deformation and failure processes from macroscale to nanoscale using the Gas-Kinetic Unified Algorithm (GKUA) and all-atomic, molecular dynamic (MD) simulation method. The behaviors of the dislocations, defect evolution and crack propagation until failure for Aluminum-Magnesium (Al-Mg) alloy are considered with the different temperature background and strain fields. The results of distributions of temperature and strain field in the aerodynamic environment obtained by molecular dynamics simulations are in good agreement with those obtained from the macroscopic Boltzmann method. Compared to the tensile loading, the alloy structure is more sensitive to compression loading. The polycrystalline Al-Mg alloy has higher yield strength with a larger grain size. It is due to the translation of plastic deformation mode from grain boundary (GB) sliding to dislocation slip and the accumulation of dislocation line. Our findings have paved a new way to analyze and predict the metallic structural failure by micro-scale analysis under the aerodynamic thermal extreme environment of the reentry spacecraft on service expiration.


Assuntos
Ambientes Extremos , Plásticos , Ligas , Cinética , Simulação de Dinâmica Molecular , Antiácidos , Grão Comestível
5.
Ter Arkh ; 94(1): 48-56, 2022 Jan 15.
Artigo em Russo | MEDLINE | ID: mdl-36286919

RESUMO

BACKGROUND: Recently, there has been an increase in the prevalence of gastroesophageal reflux disease (GERD) in Northern Europe, North America and East Asia. However data on GERD prevalence in Russian population are very limited. AIM: To determine the prevalence of GERD among the population of Russia, the clinical spectrum of GERD symptoms, the main drugs used for GERD treatment, and the rate of their administration. MATERIALS AND METHODS: The study was conducted from November 2015 to January 2017 in 8 cities of Russia. A survey of patients over the age of 18 years old visiting outpatient medical institutions for any reason, including patients without gastrointestinal complaints was carried out using a short version of the Mayo Clinic questionnaire. RESULTS: In total, 6132 questionnaires of patients aged 1890 years were analyzed [2456 men (40.1%) and 3676 women (59.9%), mean age 46.615.4 years]. The GERD prevalence among the interviewed patients was 34.2%. The incidence of GERD increased depending on body mass index and the age of the patients. Medications used by the patients for heartburn relief included proton pump inhibitors 59.96%, antacids 67.92%, H2-histamine receptor blockers 11.42%, alginates 18.41% of patients. CONCLUSION: The results of this study indicate a high prevalence of GERD among residents of Russian cities applying for primary health care (34.2%). In comparison with previous studies, an increase in the proportion of GERD patients taking proton pump inhibitors was noted; in most cases the regimen of their intake was in accordance with the recommendations.


Assuntos
Antiácidos , Refluxo Gastroesofágico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antiácidos/uso terapêutico , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/diagnóstico , Pacientes Ambulatoriais , Prevalência , Inibidores da Bomba de Prótons/uso terapêutico , Bombas de Próton/uso terapêutico , Receptores Histamínicos , Federação Russa/epidemiologia , Inquéritos e Questionários
6.
Ter Arkh ; 94(8): 985-991, 2022 Oct 12.
Artigo em Russo | MEDLINE | ID: mdl-36286979

RESUMO

AIM: To evaluate the advantages of using combined therapy of proton-pump inhibitors (PPIs) and esophagoprotector in comparison with basic therapy of PPIs for 4 weeks based on the results of changes in the endoscopic picture.To compare the effectiveness of 4-week PPI therapy and 4-week combination therapy with PPI and esophagoprotector Alfasoxx (sodium hyaluronate, chondroitin sulfate, poloxomer 407) in patients with erosive esophagitis (EE) of any degree according to the Los Angeles Endoscopic Classification. MATERIALS AND METHODS: 81 patients with EE AC according to the Los Angeles endoscopic classification (1994) was enrolled in the study on the basis of the clinic of Peter the Great, Mechnikov North-Western State Medical University. By computer randomization, patients were divided into the control group 40 patients (pantoprazole 40 mg 1 time per day) and the intervention group 41 patients (pantoprazole 40 mg 1 time per day + Alfasoxx 1 sachet qid). The therapy was carried out for 4 weeks. In all patients before and after therapy, the frequency and severity of the main symptoms of gastroesophageal reflux disease (GERD) were assessed, esophagogastroduodenoscopy was performed. RESULTS: The advantage of combination therapy over standard PPI monotherapy in patients with EE was revealed. According to the results of the control endoscopy, healing of erosions of the esophageal mucosa was observed in 39 out of 41 (95.1%) patients in the intervention group and 32 out of 39 (82.1%) in the control group. The proportion of patients who showed an improvement in the endoscopic picture before and after treatment for 4 weeks by at least 1 level according to the Los Angeles classification was significantly higher in the comparison group 41 patients (100%), while in the control group 33 patients (85%); p0.009. After treatment, the combination therapy group had a lower incidence (p0.01) and severity of heartburn (p0.01). The same results are demonstrated by combination therapy regarding the symptom belching of air: in the study group after treatment, this symptom occurred less frequently (p=0.014), its severity was significantly less than in the control group (p0.01). There was a statistically significant decrease in the need for on-demand antacid therapy in the study group. CONCLUSION: In this study involving 81 patients with erosive GERD, the benefits of combination therapy were demonstrated. The addition of Alfasoxx medical device to PPI therapy increases the clinical and endoscopic efficacy of therapy. This positive effect is associated with the esophagoprotective properties of the drug, based on unique pharmacodynamic characteristics. Combination therapy for GERD is preferred in patients with EE. Studies have shown the expediency of using Alfasoxx in case of insufficient effectiveness of classical acid-suppressive therapy for GERD.


Assuntos
Esofagite , Refluxo Gastroesofágico , Úlcera Péptica , Humanos , Inibidores da Bomba de Prótons/uso terapêutico , Pantoprazol/uso terapêutico , Antiácidos/uso terapêutico , Ácido Hialurônico/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Esofagite/tratamento farmacológico , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/complicações , Úlcera Péptica/tratamento farmacológico , Resultado do Tratamento
7.
Medicine (Baltimore) ; 101(35): e30487, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36107559

RESUMO

Gastroesophageal reflux disease (GERD) occurs in approximately two-thirds of all pregnancies. Around 25% of pregnant women experience heartburn daily. Symptomatic GERD usually presents in the first trimester and progresses throughout pregnancy. The treatment goal is to alleviate heartburn and regurgitation without jeopardizing the pregnancy or its outcome. An English language electronic literature search of MEDLINE, EMBASE, and Cochrane Reviews was undertaken to identify randomized controlled trials, observational studies, management recommendations and reviews of GERD and its treatment during pregnancy. The search period was defined by the date of inception of each database. The treatment in a pregnant GERD patient should follow the step-up approach, starting with lifestyle modification as the first step. If heartburn is severe, medication should be started after consultation with a physician (Recommendation Grade C). The preferred choice of antacids is calcium-containing antacids (Recommendation Grade A). If symptoms persist with antacids Sucralfate can be introduced at a 1g oral tablet, 3 times daily (Recommendation Grade C). Followed by histamine-2 receptor antagonist (Recommendation Grade B). Inadequate control while on histamine-2 receptor antagonist and antacid may mandate a step-up to proton pump inhibitors along with antacids as rescue medication for breakthrough GERD (Recommendation Grade C). This article presented the treatment recommendations for pregnant women with typical GERD, based on the best available evidence.


Assuntos
Refluxo Gastroesofágico , Azia , Antiácidos/uso terapêutico , Cálcio/uso terapêutico , Feminino , Refluxo Gastroesofágico/tratamento farmacológico , Azia/tratamento farmacológico , Histamina/uso terapêutico , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Humanos , Gravidez , Inibidores da Bomba de Prótons/uso terapêutico , Sucralfato/uso terapêutico
8.
World J Gastroenterol ; 28(28): 3743-3746, 2022 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-36161053

RESUMO

Endoscopic anti-reflux treatment is emerging as a new option for gastro-esophageal reflux disease (GERD) treatment in patients with the same indications as for laparoscopic fundoplication. There are many techniques, the first of which are transoral incisionless fundoplication (TIF) and nonablative radio-frequency (STRETTA) that have been tested with comparative studies and randomized controlled trials, whereas the other more recent ones still require a deeper evaluation. The purpose of the latter is to verify whether reflux is abolished or significantly reduced after intervention, whether there is a valid high pressure zone at the gastroesophageal junction, and whether esophagitis, when present, has disappeared. Unfortunately in a certain number of cases, and especially in the more recently introduced ones, the evaluation has been based almost exclusively on subjective criteria, such as improvement in the quality of life, remission of heartburn and regurgitation, and reduction or suspension of antacid and antisecretory drug consumption. However, with the most studied techniques such as TIF and STRETTA, an improvement in symptoms better than that of laparoscopic fundoplication can often be observed, whereas the number of acid episodes and acid exposure time are similar or higher, as if the acid refluxes are better tolerated by these patients. The suspicion of a local hyposensitivity taking place after anti-reflux endoscopic intervention seems confirmed by a Bernstein test at least for STRETTA. This examination should be done for all the other techniques, both old and new, to identify the ones that reassure rather than cure. In conclusion, the evaluation of the effectiveness of the endoscopic anti-reflux techniques should not be based exclusively on subjective criteria, but should also be confirmed by objective examinations, because there might be a gap between the improvement in symptoms declared by the patient and the underlying pathophysiologic alterations of GERD.


Assuntos
Esofagite Péptica , Refluxo Gastroesofágico , Cirurgia Endoscópica por Orifício Natural , Antiácidos/uso terapêutico , Esofagite Péptica/tratamento farmacológico , Fundoplicatura/efeitos adversos , Fundoplicatura/métodos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/cirurgia , Azia/tratamento farmacológico , Humanos , Cirurgia Endoscópica por Orifício Natural/métodos , Satisfação do Paciente , Qualidade de Vida , Resultado do Tratamento
9.
Int J Mol Sci ; 23(18)2022 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-36142643

RESUMO

Proton pump inhibitors (PPIs) are an antacid drug often used in acid-related disorders. They decrease acid secretion in the stomach by blocking an enzyme called H+/K+ ATPase which controls acid production. Introduced to the market in 1989, their use has increased rapidly worldwide and they are now among the top 10 most prescribed drugs in the United States. As of 2015, the FDA has already approved six drugs of this class (omeprazole, esomeprazole, lansoprazole, dexlansoprazole, pantoprazole and rabeprazole). Recently, the risks and benefits of long-term PPI use were questioned and many studies indicated that their use should be carefully considered, especially in young patients, whose treatment with these drugs could last many years. Even greater concerns have been raised about a potential positive association between PPIs and osteoporotic fracture risk including the hip, spine and wrist. Although based on observational studies, there is substantial evidence associating the long-term use of PPIs and fracture. This relationship is only partially admitted due to the lack of consistent effects of PPIs on bone mineral density loss. Therefore, this narrative review aimed to discuss the recent findings pertaining to the risk of osteoporotic fracture associated with PPIs, in particular prolonged use, and to call for further research to elucidate the mechanisms associated with this bone fragility.


Assuntos
Fraturas por Osteoporose , Inibidores da Bomba de Prótons , 2-Piridinilmetilsulfinilbenzimidazóis , Adenosina Trifosfatases , Antiácidos , Densidade Óssea , Dexlansoprazol , Esomeprazol , Humanos , Lansoprazol , Omeprazol/farmacologia , Fraturas por Osteoporose/tratamento farmacológico , Pantoprazol , Inibidores da Bomba de Prótons/efeitos adversos , Rabeprazol , Estados Unidos
10.
Medicine (Baltimore) ; 101(36): e30399, 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36086741

RESUMO

This study investigated the association between antacid administration and lung cancer incidence in a real-world setting. This was a nationwide, retrospective cohort study. The cohort comprised random samples (n = 1,031,392) from the entire South Korean population in 2002. The duration of antacid administration between January 2006 and December 2010 was recorded for each participant. Newly developed lung cancers were counted during the 5-year observation period (January 1, 2006 to December 31, 2010). A total of 437,370 participants aged ≥ 40 years were included, of whom 301,201 (68.9%) had antacid exposure before the diagnosis of lung cancer. A total of 1230 (0.28%) antacid-exposed patients developed lung cancer. Among patients with no antacid exposure or underexposure (n = 136,171), 597 (0.44%) developed lung cancer. In the multivariable analysis, antacid exposure before the diagnosis of lung cancer was independently associated with a reduced incidence of lung cancer (hazard ratio: 0.64; 95% confidence interval: 0.55-0.74; P < .001). Antacid use might be independently associated with a decreased risk of lung cancer development in this cohort study.


Assuntos
Antiulcerosos , Neoplasias Pulmonares , Antiácidos/efeitos adversos , Estudos de Coortes , Histamina , Antagonistas dos Receptores H2 da Histamina/efeitos adversos , Humanos , Incidência , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/epidemiologia , Inibidores da Bomba de Prótons/efeitos adversos , Estudos Retrospectivos
11.
MMWR Recomm Rep ; 71(2): 1-8, 2022 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-36173766

RESUMO

THIS REPORT SUMMARIZES ALL RECOMMENDATIONS FROM CDC'S ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) FOR THE USE OF LYOPHILIZED CVD 103-HGR VACCINE (CVD 103-HGR) (VAXCHORA, EMERGENT BIOSOLUTIONS, GAITHERSBURG, MD) IN THE UNITED STATES. THE LIVE ATTENUATED ORAL CHOLERA VACCINE IS DERIVED FROM: Vibrio cholerae O1 and is administered in a single dose. Cholera is a toxin-mediated bacterial gastrointestinal illness caused by toxigenic V. cholerae serogroup O1 or, uncommonly, O139. Up to 10% of infections manifest as severe cholera (i.e., cholera gravis), profuse watery diarrhea that can cause severe dehydration and death within hours. Fluid replacement therapy can reduce the fatality rate to <1%. Risk factors for cholera gravis include high dose exposure, blood group O, increased gastric pH (e.g., from antacid therapy), and partial gastrectomy. Cholera is rare in the United States, but cases occur among travelers to countries where cholera is endemic or epidemic and associated with unsafe water and inadequate sanitation. Travelers might be at increased risk for poor outcomes from cholera if they cannot readily access medical services or if they have a medical condition that would be worsened by dehydration, such as cardiovascular or kidney disease. This report describes previously published ACIP recommendations about use of CVD 103-HgR for adults aged 18-64 years and introduces a new recommendation for use in children and adolescents aged 2-17 years. ACIP recommends CVD 103-HgR, the only cholera vaccine licensed for use in the United States, for prevention of cholera among travelers aged 2-64 years to an area with active cholera transmission. Health care providers can use these guidelines to develop the pretravel consultation for persons traveling to areas with active cholera transmission.


Assuntos
Vacinas contra Cólera , Cólera , Adolescente , Adulto , Comitês Consultivos , Antiácidos , Antígenos de Grupos Sanguíneos , Criança , Pré-Escolar , Cólera/epidemiologia , Cólera/prevenção & controle , Vacinas contra Cólera/administração & dosagem , Desidratação , Humanos , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Vacinação , Vacinas Atenuadas , Vibrio cholerae O1 , Água , Adulto Jovem
12.
Clin Pharmacol Ther ; 112(5): 1088-1097, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35920069

RESUMO

Coadministration with acid-reducing agents (ARAs), including proton pump inhibitors (PPIs), histamine H2 -receptor antagonists (H2 blockers), and antacids has been demonstrated to reduce antiviral exposure and efficacy. Therefore, it is essential that US Food and Drug Administration (FDA) drug labels include recommendations to manage these drug-drug interactions (DDIs). This investigation analyzed information in FDA drug labels to manage DDIs between ARAs and antivirals approved from 1998 to 2019. To ascertain clinical adoption, we assessed whether FDA label recommendations were incorporated into current antiviral clinical practice guidelines. We identified 82 label recommendations for 43 antiviral approvals. Overall, 56.1% of recommendations were deemed clinically actionable, with the most common actionable management strategies being dose adjustment during coadministration (40.2%) and coadministration not recommended (9.8%). The sources informing DDI recommendations were clinical DDI studies (59.8%) and predictions of altered exposure (40.2%). Antivirals with low aqueous solubility were more likely to have label recommendations and were more commonly investigated using clinical DDI studies (P < 0.01). For recommendations informed by clinical DDI studies, changes in drug exposure were associated with actionable label recommendations (P < 0.01). The frequency of exposure changes in clinical DDI studies was similar across antiviral indications, but exposure changes were numerically higher for antacids (71.4%) relative to PPIs (42.9%) and H2 blockers (28.6%). Of DDI pairs identified within drug labels, 76.8% were included in guidelines, and recommended management strategies were concordant in 90.5% of cases. Our findings demonstrate that current regulatory oversight mostly (but not completely) results in actionable label recommendations to manage DDIs for high-risk antivirals.


Assuntos
Antivirais , Substâncias Redutoras , Humanos , Estados Unidos , United States Food and Drug Administration , Antivirais/efeitos adversos , Antiácidos , Inibidores da Bomba de Prótons/efeitos adversos , Histamina , Interações Medicamentosas
13.
PLoS One ; 17(8): e0272294, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35960726

RESUMO

Physicochemical conditions play a key role in the development of biofilm removal strategies. This study presents an integrated, double-layer, high-throughput microfluidic chip for real-time screening of the combined effect of antibiotic concentration and fluid shear stress (FSS) on biofilms. Biofilms of Escherichia coli LF82 and Pseudomonas aeruginosa were tested against gentamicin and streptomycin to examine the time dependent effects of concentration and FSS on the integrity of the biofilm. A MatLab image analysis method was developed to measure the bacterial surface coverage and total fluorescent intensity of the biofilms before and after each treatment. The chip consists of two layers. The top layer contains the concentration gradient generator (CGG) capable of diluting the input drug linearly into four concentrations. The bottom layer contains four expanding FSS chambers imposing three different FSSs on cultured biofilms. As a result, 12 combinatorial states of concentration and FSS can be investigated on the biofilm simultaneously. Our proof-of-concept study revealed that the reduction of E. coli biofilms was directly dependent upon both antibacterial dose and shear intensity, whereas the P. aeruginosa biofilms were not impacted as significantly. This confirmed that the effectiveness of biofilm removal is dependent on bacterial species and the environment. Our experimental system could be used to investigate the physicochemical responses of other biofilms or to assess the effectiveness of biofilm removal methods.


Assuntos
Escherichia coli , Dispositivos Lab-On-A-Chip , Antiácidos , Antibacterianos/farmacologia , Biofilmes , Penicilinas/farmacologia , Pseudomonas aeruginosa
14.
J Clin Gastroenterol ; 56(10): 831-843, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36040930

RESUMO

The last decade has seen the rise of multiple novel endoscopic techniques to treat gastroesophageal reflux disease, many of which are efficacious when compared with traditional surgical options and allow relief from long-term dependence on antacid medications. This review will explore the latest endoscopic treatment options for gastroesophageal reflux disease including a description of the technique, review of efficacy and safety, and future directions.


Assuntos
Antiulcerosos , Esofagite Péptica , Refluxo Gastroesofágico , Antiácidos/uso terapêutico , Esofagoscopia/métodos , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/cirurgia , Humanos
15.
Ugeskr Laeger ; 184(25)2022 06 20.
Artigo em Dinamarquês | MEDLINE | ID: mdl-35781362

RESUMO

Keloids are pathological scars extending beyond the initial wound's natural borders. The condition occurs as a result of impaired wound healing with excessive collagen deposition. Keloid scars frequently recur, rarely regress, and have a tendency to grow over time. They are aesthetically disfiguring and can be devastating for patients, both physically and emotionally. This review finds that prevention and early intervention are essential for good results. Treatment is often challenging. There are no standardized management guidelines currently available but a combinational therapeutic approach appears to be beneficial.


Assuntos
Queloide , Antiácidos , Colágeno , Humanos , Queloide/patologia , Queloide/prevenção & controle , Penicilinas , Recidiva
16.
Food Res Int ; 158: 111558, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35840250

RESUMO

Selenium (Se) is critical for human health, but human intake of Se is often inadequate. Organic forms of dietary Se are considered safe and more bioavailable than inorganic forms. Along with a generally high nutritional value, sprouts are sensitive to Se treatment. This study used selenomethionine and methylselenocysteine solutions to cultivate Se-enriched sprouts under an optimized hydroponic condition. Content change and transformations of the selenoamino acids were analyzed by a developed HPLC-ESI-MS/MS method. Uptake of both selenomethionine and methylselenocysteine was dose-dependent and involved active transport and passive diffusion, as demonstrated by the respiratory and aquaporin inhibition assays. Passive diffusion played a dominant role. Free methylselenocysteine was the predominant form in samples. Selenomethionine and methylselenocysteine were capable of mutual transformation. Moreover, the selenoprotein generation was associated with the increasing Se concentration of the culture solutions. The results provided scientific references for the efficient utilization of organic Se in sprouts.


Assuntos
Compostos Organosselênicos , Raphanus , Antiácidos , Compostos Organosselênicos/química , Raphanus/química , Selenometionina/química , Selenoproteínas/química , Espectrometria de Massas em Tandem , Vitaminas/análise
17.
Biochim Biophys Acta Mol Cell Res ; 1869(10): 119308, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35710019

RESUMO

ML-9 elicits a broad spectrum of effects in cells, including inhibition of myosin light chain kinase, inhibition of store-operated Ca2+ entry and lysosomotropic actions that result in prostate cancer cell death. Moreover, the compound also affects endoplasmic reticulum (ER) Ca2+ homeostasis, although the underlying mechanisms remain unclear. We found that ML-9 provokes a rapid mobilization of Ca2+ from ER independently of IP3Rs or TMBIM6/Bax Inhibitor-1, two ER Ca2+-leak channels. Moreover, in unidirectional 45Ca2+ fluxes in permeabilized cells, ML-9 was able to reduce ER Ca2+-store content. Although the ER Ca2+ store content was decreased, ML-9 did not directly inhibit SERCA's ATPase activity in vitro using microsomal preparations. Consistent with its chemical properties as a cell-permeable weak alkalinizing agent (calculated pKa of 8.04), ML-9 provoked a rapid increase in cytosolic pH preceding the Ca2+ efflux from the ER. Pre-treatment with the weak acid 3NPA blunted the ML-9-evoked increase in intracellular pH and subsequent ML-9-induced Ca2+ mobilization from the ER. This experiment underpins a causal link between ML-9's impact on the pH and Ca2+ dynamics. Overall, our work indicates that the lysosomotropic drug ML-9 may not only impact lysosomal compartments but also have severe impacts on ER Ca2+ handling in cellulo.


Assuntos
Antiácidos , Cálcio , Antiácidos/metabolismo , Antiácidos/farmacologia , Azepinas , Cálcio/metabolismo , Retículo Endoplasmático/metabolismo , Humanos , Concentração de Íons de Hidrogênio , Masculino
18.
J Pediatr Surg ; 57(11): 736-739, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35577606

RESUMO

PURPOSE: Pyloromyotomy for pyloric stenosis is one of the more common surgical procedures performed on infants. The long-term effects of the procedure are however unclear. The purpose of this study was to study the effects into adult life, compare them with controls and to see if there is a need for structured follow up of patients. METHODS: Of the 101 patients operated for pyloric stenosis between 1972 and 1974 at our tertiary referral center 91 could be traced. They were all invited to participate in the study and were sent validated questionnaires (PAGI-SYM, GIQLI) as well as a study-specific questionnaire examining the use of antacid drugs, incidence of gastroscopy and abdominal surgery. Sixty patients responded (66%, mean age 45 years, 46 male) and were included. Thereafter, 600 age and sex-matched controls were sent the same questionnaires. 132 responded (22%, 90 male) and were includes as controls. RESULTS: No significant differences could be found in any of the examined parameters when looking at the whole material or the male patients. Female patients had higher PAGI-SYM-scores for post prandial fullness (mean 1.11 vs 0.43, P = 0.035) and heartburn (mean 0.59 vs 0.14, P = 0.043) when compared to controls. CONCLUSIONS: The present study shows that most patients operated for pyloric stenosis during infancy experience no negative effects into adulthood. The finding in the female patient group is interesting but is unlikely to have any clinical implications. The results from this study strongly implicate that there is no need for follow up of patients into adulthood. LEVEL OF EVIDENCE: Level III.


Assuntos
Estenose Pilórica Hipertrófica , Estenose Pilórica , Piloromiotomia , Adulto , Antiácidos , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Estenose Pilórica/etiologia , Estenose Pilórica/cirurgia , Estenose Pilórica Hipertrófica/cirurgia , Piloromiotomia/efeitos adversos , Piloromiotomia/métodos , Piloro/cirurgia , Inquéritos e Questionários
19.
Neurogastroenterol Motil ; 34(10): e14387, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35502888

RESUMO

BACKGROUND: Refractory reflux-like symptoms have a substantial impact on patients and healthcare providers. The aim of the survey was to qualitatively assess the needs and attitudes of practicing clinicians around the management of refractory reflux symptoms and refractory gastroesophageal reflux disease (rGERD). METHODS: An International Working Group for the Classification of Oesophagitis (IWGCO) steering committee invited clinicians to complete an online survey including 17 questions. KEY RESULTS: Of the 113 clinicians who completed the survey, 70% were GIs, 20% were primary care physicians, and 10% were other specialties. Functional heartburn was considered the most common reason for an incomplete response to proton pump inhibitor (PPI) therapy (82%), followed by stress/anxiety (69%). More GIs identified esophageal hypersensitivity as a cause, while more non-GIs identified esophageal dysmotility and non-reflux-related esophageal conditions. As the first step, most clinicians would order investigations (70-88%). Overall, 72% would add supplemental therapy for patients with partial response, but only 58% for those with non-response. Antacid/alginate was the most common choice overall, while non-GIs were more likely to add a prokinetic than were GIs (47.8 vs. 24.1%). Approximately 40% of clinicians would switch PPIs in patients with partial response, but only 29% would do so in non-responders. Preferences for long-term therapy were highly variable. The most common initial investigation was upper endoscopy. Choice of esophageal manometry and pH monitoring was more variable, with no clear preference for whether pH monitoring should be conducted on, or off, PPI therapy. CONCLUSIONS AND INFERENCES: The survey identified a number of challenges for clinicians, especially non-GI physicians, treating patients with refractory reflux-like symptoms or rGERD on a daily basis.


Assuntos
Esofagite Péptica , Refluxo Gastroesofágico , Alginatos/uso terapêutico , Antiácidos/uso terapêutico , Monitoramento do pH Esofágico , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/tratamento farmacológico , Pessoal de Saúde , Azia/diagnóstico , Humanos , Inibidores da Bomba de Prótons/uso terapêutico
20.
Am J Respir Crit Care Med ; 205(9): e18-e47, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35486072

RESUMO

Background: This American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax guideline updates prior idiopathic pulmonary fibrosis (IPF) guidelines and addresses the progression of pulmonary fibrosis in patients with interstitial lung diseases (ILDs) other than IPF. Methods: A committee was composed of multidisciplinary experts in ILD, methodologists, and patient representatives. 1) Update of IPF: Radiological and histopathological criteria for IPF were updated by consensus. Questions about transbronchial lung cryobiopsy, genomic classifier testing, antacid medication, and antireflux surgery were informed by systematic reviews and answered with evidence-based recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 2) Progressive pulmonary fibrosis (PPF): PPF was defined, and then radiological and physiological criteria for PPF were determined by consensus. Questions about pirfenidone and nintedanib were informed by systematic reviews and answered with evidence-based recommendations using the GRADE approach. Results:1) Update of IPF: A conditional recommendation was made to regard transbronchial lung cryobiopsy as an acceptable alternative to surgical lung biopsy in centers with appropriate expertise. No recommendation was made for or against genomic classifier testing. Conditional recommendations were made against antacid medication and antireflux surgery for the treatment of IPF. 2) PPF: PPF was defined as at least two of three criteria (worsening symptoms, radiological progression, and physiological progression) occurring within the past year with no alternative explanation in a patient with an ILD other than IPF. A conditional recommendation was made for nintedanib, and additional research into pirfenidone was recommended. Conclusions: The conditional recommendations in this guideline are intended to provide the basis for rational, informed decisions by clinicians.


Assuntos
Fibrose Pulmonar Idiopática , Doenças Pulmonares Intersticiais , Antiácidos/uso terapêutico , Biópsia , Humanos , Fibrose Pulmonar Idiopática/tratamento farmacológico , Fibrose Pulmonar Idiopática/terapia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Doenças Pulmonares Intersticiais/patologia , Estados Unidos
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