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INTRODUCTION AND AIMS: There are few studies that compare polyethylene glycol (PEG) 3350 and magnesium hydroxide (MH), as long-term treatment of functional constipation (FC) in children, and they do not include infants as young as 6 months of age. Our aim was to determine the efficacy, safety, and acceptability of PEG vs MH in FC, in the long term, in pediatric patients. METHODS: An open-label, parallel, controlled clinical trial was conducted on patients from 6 months to 18 years of age, diagnosed with FC, that were randomly assigned to receive PEG 3350 or MH for 12 months. Success was defined as: ≥ 3 bowel movements/week, with no fecal incontinence, fecal impaction, abdominal pain, or the need for another laxative. We compared adverse events and acceptability, measured as rejected doses of the laxative during the study, in each group and subgroup. RESULTS: Eighty-three patients with FC were included. There were no differences in success between groups (40/41 PEG vs 40/42 MH, p = 0.616). There were no differences in acceptability between groups, but a statistically significant higher number of patients rejected MH in the subgroups > 4 to 12 years and > 12 to 18 years of age (P = .037 and P = .020, respectively). There were no differences regarding adverse events between the two groups and no severe clinical or biochemical adverse events were registered. CONCLUSIONS: The two laxatives were equally effective and safe for treating FC in children from 0.5 to 18 years of age. Acceptance was better for PEG 3350 than for MH in patients above 4 years of age. MH can be considered first-line treatment for FC in children under 4 years of age.
Assuntos
Laxantes , Hidróxido de Magnésio , Humanos , Criança , Pré-Escolar , Laxantes/uso terapêutico , Hidróxido de Magnésio/uso terapêutico , Resultado do Tratamento , Polietilenoglicóis/efeitos adversos , Constipação Intestinal/tratamento farmacológico , Eletrólitos/uso terapêuticoRESUMO
In this work, we studied the phases in a Mg-Ti-O system using a 1:1 formulation of MgO:TiO2, mixing synthetic brucite of Mexican origin with TiO2 microparticles of high purity, with a heat treatment at 1100 °C for 1 h. Due to its valence electrons, TiO2 can contribute to the sintering process to improve density in MgO products. The raw materials and formulation by XPS and X-RD techniques were characterized. The results demonstrate the presence of different oxidation states in titania and the formation of different oxides in the Mg-Ti-O system when mixed and calcined at 1100 °C; additionally, we estimated the formation of vacancies in the crystal lattice during the transformation from hexagonal brucite to magnesia with a cubic structure centered on the faces. Its thermal behavior is indicated by the MgO-TiO2 phase diagram.
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Resumen Las intoxicaciones accidentales siguen siendo un problema importante que genera gran cantidad de casos de autopsia médico legal, sobre todo cuando ocurren en pacientes pediátricos donde se deben descartar otras causas de muerte y que no se trate de un homicidio. La intoxicación con leche magnesia es un diagnóstico poco frecuente por lo que se hace necesario conocer sus características, evolución y las alteraciones metabólicas por las que se produce la muerte. La hipermagnesemia constituye una condición iatrogénica, generalmente secundaria a la administración de fármacos que contienen magnesio, entre ellos laxantes en pacientes con estreñimiento crónico, en muchas ocasiones sin supervisión médica; que puede producir depresión respiratoria, hipotensión, paro cardiorrespiratorio y la muerte. El diagnóstico de intoxicación con leche magnesia es clínico y se correlaciona con la concentración de magnesio detectada en análisis de muestras de sangre. A continuación se presenta un caso de intoxicación por leche magnesia en una paciente en edad pediátrica con antecedente de parálisis cerebral infantil y constipación crónica que desarrolló una hipermagnesemia posterior a la administración de dicho laxante por parte de sus padres.
Abstract Accidental intoxications continue to be an important problem in the Forensic Pathology field, mostly when they occur in pediatric patients where it is necessary to dismiss other causes of death and to rule out homicide. Milk of magnesia intoxication is a rare diagnosis, therefore it is important to know it´s characteristics, evolution and the metabolic disorders that lead to death. Hypermagnesemia is an iatrogenic condition, usually caused by the administration of medications that contain magnesium, such as laxatives in patients with chronic constipation, without medical supervision; that can lead to respiratory distress, hypotension, cardiac arrest and death. The diagnosis of milk of magnesia intoxication is clinical and can be correlated to the levels of magnesium found in blood sample analysis. We present a case of milk of magnesia intoxication in a 6-year-old girl with cerebral palsy and chronic constipation that was given laxatives by her parents and developed a fatal hypermagnesemia.
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Humanos , Feminino , Criança , Desequilíbrio Hidroeletrolítico , Óxido de Magnésio/efeitos adversos , Autopsia , Costa RicaRESUMO
The effect of α-Al2O3 nanoparticles (up to 5 wt.%) on the physical, mechanical, and thermal properties, as well as on the microstructural evolution of a dense magnesia refractory is studied. Sintering temperatures at 1300, 1500, and 1600 °C are used. The physical properties of interest were bulk density and apparent porosity, which were evaluated by the Archimedes method. Thermal properties were examined by differential scanning calorimetry. The mechanical behavior was studied by cold crushing strength and microhardness tests. Finally, the microstructure and mineralogical qualitative characteristics were studied by scanning electron microscopy and X-ray diffraction, respectively. Increasing the sintering temperature resulted in improved density and reduced apparent porosity. However, as the α-Al2O3 nanoparticle content increased, the density and microhardness decreased. Microstructural observations showed that the presence of α-Al2O3 nanoparticles in the magnesia matrix induced the magnesium-aluminate spinel formation (MgAl2O4), which improved the mechanical resistance most significantly at 1500 °C.
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O processo físico-químico da precipitação de estruvita é uma técnica que apresenta elevado potencial na remoção de nutrientes, a partir de diferentes tipologias de efluentes. O presente estudo teve por objetivo a avaliação de um composto industrial com elevado teor de magnésia e baixo custo como fonte reagente alternativa de magnésio e alcalinidade necessários ao processo de precipitação, tornando-o economicamente viável com a redução de gastos despendidos com químicos. Suspensões de Mg(OH)2 foram obtidas e tiveram desempenho avaliado em função da remoção de nutrientes, a partir de um efluente sintético rico em N-NH4+ e P-PO43-, e qualidade dos cristais gerados, com a identificação do mineral de interesse - estruvita. O experimento foi realizado em escala laboratorial utilizando reator cônico de leito fluidizado operado em semi-contínuo. O adequado controle operacional do pH (8,0-8,5) pela adição automatizada da suspensão de Mg(OH)2 possibilitou uma considerável remoção de P-PO43-, que atingiu valor médio igual a 93,5%. Os sólidos recuperados no processo apresentaram pureza de, aproximadamente, 84% de estruvita.
The physico-chemical process of struvite precipitation is a technique that demonstrates a high potential in nutrients recovery from different kinds of wastewaters. This study aimed to evaluate the use of a low cost industrial compound with high magnesia content as alternative reagent source of magnesium ions and alkalinity required for precipitation. It was a strategy to turn the process economically viable and reduce the chemical costs. Mg(OH)2slurries were obtained and evaluated regarding the nutrients recovery from a synthetic wastewater rich in NH4+-N and PO43--P and the quality of the generated crystals with the identification of the mineral of interest - the struvite. The experiment was performed in laboratory scale using a conic fluidized bed reactor in a semi-continuous operation. The proper pH control (8.0-8.5) by the automated addition of Mg(OH)2slurry allowed considerable PO43--P removal equal to 93.5%. The recovered solids from the process showed purity of approximately 84% of struvite.