Clinical efficacy and safety of polyethylene glycol 3350 versus liquid paraffin in the treatment of pediatric functional constipation

BACKGROUND AND THE PURPOSE OF THE STUDY: Functional constipation is prevalent in children. Recently polyethylene glycol has been introduced as an effective and safe drug to treat chronic constipation. There are only a few clinical trials on comparison of PEG and liquid paraffin in childhood constipation. The purpose of this study was to evaluate clinical efficacy and safety of PEG 3350 solution and liquid paraffin in the treatment of children with functional constipation in Sari Toba clinic during the period of 2008-2009. METHODS: Children with a history of functional constipation were subjects of this study. One hundred and sixty children of 2-12 years old with functional constipation were randomized in two PEG and paraffin treatment groups. Patients received either 1.0-1.5 g/kg/day PEG 3350 or 1.0-1.5 ml/kg/day liquid paraffin for 4 months. Clinical efficacy was evaluated by stool and encopresis frequency/week and overall treatment success rate was compared in two groups. RESULTS AND MAJOR CONCLUSION: Compared with the baseline, defecation frequency/ week increased significantly and encopresis frequency meaningfully decreased in two groups during the period of the study. Patients using PEG 3350 had more success rate (mean: 95.3%±3.7) compared with the patients in paraffin group (mean: 87.2%±7.1) (p=0.087). Administration of PEG 3350 were associated with less adverse events than liquid paraffin. In conclusion in treatment of pediatric functional constipation, regarding clinical efficacy and safety, PEG 3350 were at least as effective as liquid paraffin and but less adverse drug events.     

Chronic treatment with the nitric oxide synthase inhibitor, L-NAME, attenuates estradiol-mediated improvement of learning and memory in ovariectomized rats

INTRODUCTION:

The role of ovarian hormones and nitric oxide in learning and memory has been widely investigated.

OBJECTIVE:

The present study was carried out to evaluate the effect of the nitric oxide synthase (NOS) inhibitor, N (G)-nitro-L-arginine methyl ester (_L-NAME), on the ability of estradiol to improve learning in OVX rats using the Morris water maze.

METHODS:

Forty rats were divided into five groups: (1) ovariectomized (OVX), (2) ovariectomized-estradiol (OVX-Est), (3) ovariectomized-_L-NAME 10 (OVX-LN 10), (4) ovariectomized-_L-NAME 50 (OVX-LN 50) and (5) ovariectomized-estradiol-_L-NAME 50 (OVX-Est-LN 50). The animals in the OVX-Est group were treated with a weekly injection of estradiol valerate (2 mg/kg; i.m.). The OVX-LN 10 and OVX-LN 50 groups were treated with daily injections of 10 and 50 mg/kg _L-NAME (i.p.), respectively. The animals in the OVX-Est-LN 50 group received a weekly injection of estradiol valerate and a daily injection of 50 mg/kg _L-NAME. After 8 weeks, all animals were tested in the Morris water maze.

RESULTS:

The animals in the OVX-Est group had a significantly lower latency in the maze than the OVX group (p<0.001). There was no significant difference in latency between the OVX-LN 10 and OVX-LN 50 groups in comparison with the OVX group. The latency in the OVX-Est-LN 50 group was significantly higher than that in the OVX-Est group (p<0.001).

CONCLUSION:

These results show that _L-NAME treatment attenuated estradiol-mediated enhancement of spatial learning and memory in OVX rats, but it had no significant effect in OVX rats without estrogen, suggesting an interaction of nitric oxide and estradiol in these specific brain functions.     

Ultrasonographic versus fluoroscopic access for percutaneous nephrolithotomy: a randomized clinical trial

PURPOSE: Achieving access to the pyelocaliceal system in percutaneous nephrolithotomy (PCNL) is routinely performed using fluoroscopic guidance. We compared ultrasonography-guided access for PCNL with conventional fluoroscopy-guided access. PATIENTS AND METHODS: In a clinical trial, 100 patients with no abnormality of the upper urinary tract were selected from among candidates for PCNL and randomly assigned to two 50-patient groups: ultrasonography-guided access (group 1) versus fluoroscopy-guided access (group 2). In group 1, location of the target calix was identified in the transverse and sagittal planes by real-time ultrasonography when patients were in the prone position. Puncture of the target calix was attempted with a Chiba needle attached to the side of the ultrasound probe. If access to the collecting system was achieved, the site of puncture was controlled using fluoroscopy. In group 2, access was achieved using fluoroscopy guidance. Tract dilatation and stone extraction were the same in both groups. The mean age of patients was 40.7 +/- 12 years and 41.6 +/- 13.7 years in groups 1 and 2, respectively (P = 0.4). The male to female ratio in groups 1 and 2 was 34/16 and 31/19, respectively (P = 0.5). RESULTS: On average, duration of access was 11 +/- 3.5 minutes and 5.5 +/- 1.7 minutes in groups 1 and 2, respectively (P = 0.0001). Duration of radiation exposure, on average, was 0.69 +/- 0.26 minutes and 0.95 +/- 0.44 minutes in groups 1 and 2, respectively (P = 0.0001). CONCLUSION: Access for PCNL using ultrasonography guidance is an acceptable alternative to fluoroscopy and decreases radiation hazards.     

Transfusion of red blood cells in venoarterial extracorporeal membrane oxygenation: A multicenter retrospective observational cohort study

Background

Evidence-based recommendations for transfusion in patients with venoarterial extracorporeal membrane oxygenation (VA ECMO) are scarce. The current literature is limited to single-center studies with small sample sizes, therefore complicating generalizability. This study aims to create an overview of red blood cell (RBC) transfusion in VA ECMO patients.

Methods

This international mixed-method study combined a survey with a retrospective observational study in 16 centers. The survey inventoried local transfusion guidelines. Additionally, retrospective data of all adult patients with a VA ECMO run >24 h (January 2018 until July 2019) was collected of patient, ECMO, outcome, and daily transfusion parameters. All patients that received VA ECMO for primary cardiac support were included, including surgical (i.e., post-cardiotomy) and non-surgical (i.e., myocardial infarction) indications. The primary outcome was the number of RBC transfusions per day and in total. Univariable logistic regressions and a generalized linear mixed model (GLMM) were performed to assess factors associated with RBC transfusion.

Results

Out of 419 patients, 374 (89%) received one or more RBC transfusions. During a median ECMO run of 5 days (1st–3rd quartile 3–8), patients received a median total of eight RBC units (1st–3rd quartile 3–17). A lower hemoglobin (Hb) prior to ECMO, longer ECMO-run duration, and hemorrhage were associated with RBC transfusion. After correcting for duration and hemorrhage using a GLMM, a different transfusion trend was found among the regimens. No unadjusted differences were found in overall survival between either transfusion status or the different regimens, which remained after adjustment for potential confounders.

Conclusion

RBC transfusion in patients on VA ECMO is very common. The sum of RBC transfusions increases rapidly after ECMO initiation, and is dependent on the Hb threshold applied. This study supports the rationale for prospective studies focusing on indications and thresholds for RBC transfusion.     

Drug‐induced vasculitis: Thiazide or the COVID‐19 vaccine,which one is guilty? A case report and literature review

A middle‐aged woman with a history of COVID‐19 vaccine administration and valve replacement surgery was admitted with bilateral palpable purpuric lesions in the lower extremities and headache. Based on the initial diagnosis of vasculitis, corticosteroid therapy was initiated, which led to the resolution of skin lesions.