Oral rehydration solution to prevent nephrotoxicity of amphotericin B

Treatment with amphotericin B deoxycholate (AB) is associated with dose-related nephrotoxicity. We conducted an open and randomized trial to evaluate the efficacy of an oral rehydration solution (ORS) to prevent nephrotoxicity of AB, compared with an intravenous saline solution (SS). Adult patients with mucosal leishmaniasis in whom AB was indicated received either three liters or ORS or one liter of SS. Renal function tests were performed at baseline and during treatment. Forty-eight patients were included (ORS = 25, SS = 23). No difference was observed in serum creatinine, creatinine clearance, serum urea, and serum sodium values during treatment, but serum potassium values were lower in the SS group than in the ORS group (P < 0.03). Treatment was more temporarily discontinued in the SS group than in the ORS group (7 patients versus 1 patient, P = 0.02). We conclude that ORS is comparable to SS in preventing glomerular damage of AB, but more effective in preventing hypokalemia.     

Oral rehydration solution safely used in breast-fed children without additional water

Sixty-four children of age 3 months to 2 years were treated for diarrhoea in a rural treatment centre with oral rehydration solution (90 mmol/l Na+); plain water was not supplied during rehydration. All children continued breast-feeding during the therapy. Serum sodium levels after 24 h of intake indicated that 61 children had serum sodium level below 148 mmol/l and three were above (range 150-151). None of the children developed clinical signs or symptoms of hypernatremia. The use of additional water may not be necessary during rehydration therapy of breast-fed children.     

Oral rehydration solution for providing water and electrolytes following laparoscopic cholecystectomy and recovery of intestinal function

BACKGROUND/AIMS: Oral rehydration solution (OS-1: Na+ 50mEq/L, K+ 20mEq/L, Cl- 50mEq/L, and glucose 1.8%) was administered orally to patients from the early phase following laparoscopic cholecystectomy to assess its effects on water and electrolyte supplementation and recovery from postoperative intestinal paralysis. METHODOLOGY: OS-1 group (n = 22) received OS-1 orally and KN3B group (n = 22) received KN3B (an intravenous maintenance solution) intravenously. The OS-1 group was instructed to consume approximately 1000-1500mL of OS-1 postoperatively from as soon as oral intake was possible up to before lunch on postoperative day 1. RESULTS: The average dose in the OS-1 group (1178 +/- 319 mL) was significantly lower than that in the KN3B group (1371 +/- 196 mL), but within the target dose. The two solutions were equally effective and safe for water and electrolyte supplementation. The time for 50% of patients to pass bowel gas after surgery (indicating recovery from intestinal paralysis) was significantly shorter in the OS-1 group (14.00 hours) than in the KN3B group (23.75 hours). CONCLUSIONS: Oral rehydration solution (OS-1), administered from the early postoperative phase, is safe and effective for the provision of water and electrolytes and promotes early recovery from intestinal paralysis as assessed by the passage of bowel gas following laparoscopic cholecystectomy.     

Cardiogenetics in the year 2000

This review article presents the up-to-date of knowledge progression during the past decade in the genetics of cardiopathies. The cardiopathies presented here have all a mendelian type of inheritance but this list is not exhaustive.     

Oral rehydration therapy: efficacy of sodium citrate equals to sodium bicarbonate for correction of acidosis in diarrhoea.

Forty patients with moderate degrees of dehydration and acidosis because of acute watery diarrhoea were successfully treated randomly with either WHO recommended oral rehydration solution containing 2.5 g sodium bicarbonate or an oral solution containing 2.94 g sodium citrate in place of sodium bicarbonate per litre of oral rehydration rehydration solution. Efficacies were compared by measuring oral fluid intake, stool and vomitus output, change in body weight, hydration status, and rate of correction of acidosis during a period of 48 hours. Seventy five per cent (21 cases) in the citrate group and 83% (19 cases) in the bicarbonate group were successfully rehydrated (p greater than 0.05). There were no significant differences in intake, output, gain in body weight, fall in haematocrit and plasma specific gravity, and correction of acidosis between the two groups of patients within 48 hours after initiation of therapy. The solution with sodium citrate base was as effective as WHO-oral rehydration solution for management of diarrhoea. This study shows the efficacy, safety, and acceptability of citrate containing oral rehydration solution for rehydration and correction of acidosis in diarrhoea.     

Tomorrow's world: atherosclerosis in the year 2000

Atherosclerosis is an increasing problem, largely due to lifestyle changes. Lipid accumulates in artery walls throughout life, and infiltration into the subintimal space of cholesterol and cholesterol esters and of inflammatory cells can lead to narrowing, clotting, thrombosis and death. Lipid-lowering agents, particularly statins [(3-hydroxy-3-methylglutarate coenzyme A (HMG-CoA) reductase inhibitors] represent one important approach to treatment. They work by blocking the conversion of 3-hydroxy-3-methylglutarate into mevalonate, a precursor of cholesterol. The West Of Scotland Coronary Prevention Study (WOSCOPS) was a large prospective randomised study comparing the effects of pravastatin versus that of placebo in 6595 middle-aged men. In the pravastatin group the rate of fatal or non-fatal myocardial infarction was reduced by one-third over 5 years, the rate of cardiovascular deaths by one-third, and overall deaths by 22% relative to the placebo group. Implications of the results are considered and the results of the US-CARE study are compared. Discussion of relative and absolute risk, and continuous and discrete risk factors leads to the formulation of rational cost/beneficial strategies for decreasing cardiovascular risk by targeting high-risk individuals with lipid-lowering drugs.     

Oral anticoagulant therapy: efficacy, safety and the low-dose controversy

The issue of optimal duration of oral anticoagulant therapy after a first episode of venous thromboembolism is still unresolved. However, recent data suggest that short (6 weeks to 3 months), intermediate (3- 6 months) or indefinite-term anticoagulant therapy should be adopted on the basis of the classification of patients into low-, intermediate- and high-recurrence-risk groups, respectively. Oral anticoagulants have been shown to effectively prevent cardioembolic stroke in nonvalvular atrial fibrillation. Recent data seem to suggest that their safety can be ameliorated with adequate risk stratification on the basis of clinical and echocardiographic features. After unstable angina and non-Q-wave myocardial infarction, oral anticoagulant therapy (INR range 2-3) combined with aspirin has been shown to be advantageous over aspirin alone, although at the cost of a slight increase in bleeding. Bleeding complications are major drawbacks of oral anticoagulant therapy thus limiting their generalized adoption in recognized indications. To sharply reduce the bleeding risk and need of laboratory control, the low- or fixed-dose oral anticoagulant approach has been evaluated. In primary prevention and in low or low-to-moderate thrombotic risk, minidose warfarin treatment has been shown to be advantageous. In secondary prevention, and in patients at high risk for recurrent venous or arterial thrombotic events, standard range (INR 2-3) or higher level of anticoagulation is needed.     

Coeliac disease in the year 2000

Coeliac disease is a permanent intolerance to wheat gliadins and related prolamines. Patients who have an obvious malabsorption syndrome form only a small minority of the total number of people with coeliac disease. There are, in fact, no pathognomonic clinical features, and the condition is defined and diagnosed by the presence of pathological changes in the small bowel mucosa related to the presence of toxic prolamines. Susceptibility to coeliac disease is determined to a significant extent by genetic factors. A large part of the genetic susceptibility maps to the HLA region on chromosome 6, as approximately 95% of coeliac disease patients carry an almost identical HLA DQ2/heterodimer; a role of non-HLA genes has also been postulated. From a pathogenetic point of view, most evidence supports the notion of a DQ-restricted gluten-specific Th1 response in the lamina propria; nonetheless, it is possible that, in coeliac subjects, gluten, prior to T cell activation, could exert a direct toxic effect leading to the production of proinflammatory signals.     

Antiretroviral therapy in the year 2000

The range of antiretroviral medications both in current use and in development is large, including five classes that do not overlap in their development of resistance. They are used in combinations generally including three or four drugs, and it is not feasible to test all possible combinations. Guidelines are available, however, thanks to the efforts of industry and academia to determine best treatment choices and alternatives. Considerations in the initial choice of antiretrovirals include likelihood of complete viral suppression, likelihood of adherence, development of side effects, and saving potent therapy for future therapy. Resistance testing, either phenotypic or genotypic or both, is useful in selecting subsequent regimens.     

Catheter ablation in the year 2000

After its introduction in 1987, radiofrequency catheter ablation became established as a safe and effective therapy for the cure of many cardiac arrhythmias in people. The possibility of assessing the relationship between the anatomical target and the electrophysiologic changes produced by radiofrequency pulse delivery has also provided significant improvement in the physician's knowledge of the pathophysiology of the underlying rhythm disturbance. Nowadays, using this therapy, success rates well above 90% with recurrence rates lower than 5% are expected after treatment of most regular supraventricular arrhythmias. As catheter ablation techniques develop, success rates in the range of those obtained for regular supraventricular arrhythmias are expected in the future in the treatment of regular ventricular and irregular supraventricular arrhythmias.