RESUMO
RATIONALE: Nitrate-rich beetroot juice has been shown to improve exercise capacity in heart failure with preserved ejection fraction, but studies using pharmacological preparations of inorganic nitrate are lacking. OBJECTIVES: To determine (1) the dose-response effect of potassium nitrate (KNO3) on exercise capacity; (2) the population-specific pharmacokinetic and safety profile of KNO3 in heart failure with preserved ejection fraction. METHODS AND RESULTS: We randomized 12 subjects with heart failure with preserved ejection fraction to oral KNO3 (n=9) or potassium chloride (n=3). Subjects received 6 mmol twice daily during week 1, followed by 6 mmol thrice daily during week 2. Supine cycle ergometry was performed at baseline (visit 1) and after each week (visits 2 and 3). Quality of life was assessed with the Kansas City Cardiomyopathy Questionnaire. The primary efficacy outcome, peak O2-uptake, did not significantly improve (P=0.13). Exploratory outcomes included exercise duration and quality of life. Exercise duration increased significantly with KNO3 (visit 1: 9.87, 95% confidence interval [CI] 9.31-10.43 minutes; visit 2: 10.73, 95% CI 10.13-11.33 minute; visit 3: 11.61, 95% CI 11.05-12.17 minutes; P=0.002). Improvements in the Kansas City Cardiomyopathy Questionnaire total symptom (visit 1: 58.0, 95% CI 52.5-63.5; visit 2: 66.8, 95% CI 61.3-72.3; visit 3: 70.8, 95% CI 65.3-76.3; P=0.016) and functional status scores (visit 1: 62.2, 95% CI 58.5-66.0; visit 2: 68.6, 95% CI 64.9-72.3; visit 3: 71.1, 95% CI 67.3-74.8; P=0.01) were seen after KNO3. Pronounced elevations in trough levels of nitric oxide metabolites occurred with KNO3 (visit 2: 199.5, 95% CI 98.7-300.2 µmol/L; visit 3: 471.8, 95% CI 377.8-565.8 µmol/L) versus baseline (visit 1: 38.0, 95% CI 0.00-132.0 µmol/L; P<0.001). KNO3 did not lead to clinically significant hypotension or methemoglobinemia. After 6 mmol of KNO3, systolic blood pressure was reduced by a maximum of 17.9 (95% CI -28.3 to -7.6) mm Hg 3.75 hours later. Peak nitric oxide metabolites concentrations were 259.3 (95% CI 176.2-342.4) µmol/L 3.5 hours after ingestion, and the median half-life was 73.0 (interquartile range 33.4-232.0) minutes. CONCLUSIONS: KNO3 is potentially well tolerated and improves exercise duration and quality of life in heart failure with preserved ejection fraction. This study reinforces the efficacy of KNO3 and suggests that larger randomized trials are warranted. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02256345.
Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Nitratos/farmacocinética , Compostos de Potássio/farmacocinética , Volume Sistólico , Idoso , Exercício Físico , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Nitratos/efeitos adversos , Compostos de Potássio/efeitos adversos , Qualidade de VidaRESUMO
Coloprep is a bowel preparatory solution given before endoscopic procedures to get a unobscured internal vision. It has among its constituent's sodium sulphate, potassium sulphate and magnesium sulphate which produce an osmotic effect in the bowel. However, the use of such agents in hyponatremic and patients predisposed to seizures can have adverse ramifications. The current case outlines manifestation of absence seizure in a 52-year-old male patient who was administered Coloprep for colonoscopy. There was absence of other predisposing factors and the symptoms were ameliorated using timely identification and rectification of the underlying derangements.
Coloprep é uma solução preparatória intestinal administrada antes de procedimentos endoscópicos, com o objetivo de se ter uma visão interna não obscurecida. Entre os constituintes de Coloprep, observa-se sulfato de sódio, sulfato de potássio e sulfato de magnésio, que provocam efeito osmótico no intestino. Mas o uso de tais agentes em pacientes hiponatrêmicos e com predisposição para convulsões pode ter ramificações adversas. O caso em tela delineia uma manifestação de convulsão de ausência em paciente do gênero masculino com 52 anos e que recebeu Coloprep para colonoscopia. Não havia outros fatores predisponentes e os sintomas melhoraram graças à oportuna identificação e correção dos transtornos subjacentes.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Convulsões/complicações , Sulfatos/administração & dosagem , Catárticos/efeitos adversos , Colonoscopia/efeitos adversos , Compostos de Sódio/administração & dosagem , Compostos de Potássio/administração & dosagem , Sulfato de Magnésio/administração & dosagem , Convulsões , Sulfatos/análise , Sulfatos/efeitos adversos , Sulfatos/uso terapêutico , Catárticos/administração & dosagem , Catárticos/uso terapêutico , Compostos de Sódio/análise , Compostos de Sódio/efeitos adversos , Compostos de Sódio/uso terapêutico , Compostos de Potássio/análise , Compostos de Potássio/efeitos adversos , Compostos de Potássio/uso terapêutico , Hiponatremia , Sulfato de Magnésio/análise , Sulfato de Magnésio/efeitos adversos , Sulfato de Magnésio/uso terapêuticoRESUMO
The study aimed to evaluate the effectiveness of in-office bleaching and associated tooth sensitivity on application of nano-calcium phosphate paste as desensitizing agent. Bleaching was performed with 35% hydrogen peroxide gel in 40 patients who were randomly divided into placebo and nano-calcium phosphate paste groups. Bleaching efficacy (BE) was evaluated using a value-oriented Vita shade guide. Tooth sensitivity was recorded using a numeric rating scale (0-4) during bleaching and up to 48 h after each session. The primary outcome of absolute risk of tooth sensitivity was compared using the Fisher's exact test (α = 0.05). The intensity of tooth sensitivity and the efficacy of in-office bleaching were also statistically evaluated. No significant differences in absolute risk and intensity of tooth sensitivity were detected between the groups (p = 1.0 and p = 0.53, respectively). BE was also found to be similar between the groups (p = 0.67). Although the use of a nano-calcium phosphate paste associated with fluoride and potassium nitrate did not influence the whitening outcome, but it also did not reduce bleaching-induced tooth sensitivity.
Assuntos
Fosfatos de Cálcio/administração & dosagem , Dessensibilizantes Dentinários/administração & dosagem , Sensibilidade da Dentina/induzido quimicamente , Peróxido de Hidrogênio/administração & dosagem , Nitratos/administração & dosagem , Compostos de Potássio/administração & dosagem , Clareadores Dentários/administração & dosagem , Clareamento Dental/efeitos adversos , Adulto , Fosfatos de Cálcio/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Peróxido de Hidrogênio/efeitos adversos , Masculino , Nitratos/efeitos adversos , Compostos de Potássio/efeitos adversos , Clareamento Dental/métodos , Clareadores Dentários/efeitos adversos , Descoloração de Dente/tratamento farmacológico , Adulto JovemRESUMO
The study aimed to evaluate the effectiveness of in-office bleaching and associated tooth sensitivity on application of nano-calcium phosphate paste as desensitizing agent. Bleaching was performed with 35% hydrogen peroxide gel in 40 patients who were randomly divided into placebo and nano-calcium phosphate paste groups. Bleaching efficacy (BE) was evaluated using a value-oriented Vita shade guide. Tooth sensitivity was recorded using a numeric rating scale (0–4) during bleaching and up to 48 h after each session. The primary outcome of absolute risk of tooth sensitivity was compared using the Fisher’s exact test (α = 0.05). The intensity of tooth sensitivity and the efficacy of in-office bleaching were also statistically evaluated. No significant differences in absolute risk and intensity of tooth sensitivity were detected between the groups (p = 1.0 and p = 0.53, respectively). BE was also found to be similar between the groups (p = 0.67). Although the use of a nano-calcium phosphate paste associated with fluoride and potassium nitrate did not influence the whitening outcome, but it also did not reduce bleaching-induced tooth sensitivity.
Assuntos
Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Fosfatos de Cálcio/administração & dosagem , Dessensibilizantes Dentinários/administração & dosagem , Sensibilidade da Dentina/induzido quimicamente , Peróxido de Hidrogênio/administração & dosagem , Nitratos/administração & dosagem , Compostos de Potássio/administração & dosagem , Clareadores Dentários/administração & dosagem , Clareamento Dental/efeitos adversos , Fosfatos de Cálcio/efeitos adversos , Método Duplo-Cego , Peróxido de Hidrogênio/efeitos adversos , Nitratos/efeitos adversos , Compostos de Potássio/efeitos adversos , Clareadores Dentários/efeitos adversos , Clareamento Dental/métodos , Descoloração de Dente/tratamento farmacológicoRESUMO
Eccrine porocarcinoma is a potentially fatal form of sweat gland carcinoma, due to its propensity to metastasize through lymph vessels. The authors report the case of a 69-year-old female who presented with swelling of the right leg and an ulcerated lesion of the right great toe. The initial histologic diagnosis was invasive squamous cell carcinoma. On follow-up, the patient developed lymphangitic tumor spread in the right leg, associated with right inguinal lymphadenopathy and lesions in vulva and flank. Reevaluation of the toe lesion led to a revised diagnosis of eccrine porocarcinoma. The patient also had 2 basal cell carcinomas of the multicentric/superficial type in the skin overlying the left breast. Past history included chronic ingestion of liquore arsenic (Fowler's solution) in early adulthood as treatment for dermatitis herpetiformis.
Assuntos
Intoxicação por Arsênico/etiologia , Arsenitos/efeitos adversos , Porocarcinoma Écrino/secundário , Linfangite/patologia , Compostos de Potássio/efeitos adversos , Neoplasias das Glândulas Sudoríparas/patologia , Idoso , Arsenitos/uso terapêutico , Carcinógenos , Carcinoma Basocelular/complicações , Carcinoma Basocelular/etiologia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Porocarcinoma Écrino/complicações , Porocarcinoma Écrino/etiologia , Feminino , Humanos , Ceratite Herpética/tratamento farmacológico , Linfonodos/patologia , Linfangite/complicações , Linfangite/etiologia , Neoplasias Primárias Múltiplas , Compostos de Potássio/uso terapêutico , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Neoplasias das Glândulas Sudoríparas/complicações , Neoplasias das Glândulas Sudoríparas/etiologiaRESUMO
Potassium hydroxide (KOH) is a strong alkali that has long been known to digest proteins, lipids, and most other epithelial debris of skin scrapings to identify fungal infections. To our knowledge, KOH has never been used for the treatment of molluscum contagiosum (MC). We evaluated 35 children with MC for the clinical effectiveness of treatment with topical 10% KOH aqueous solution. The solution was applied by the parents of affected children, twice daily, on each MC lesion. The therapy was continued until all lesions underwent inflammation and superficial ulceration. Thirty-two of 35 patients achieved complete clinical cure after a mean treatment period of 30 days. Three children discontinued treatment: two reported severe stinging of the lesions and refused further applications; the other, with giant MC lesions, developed a secondary infection with prolonged treatment. Therapy with KOH was found to be effective and safe in the treatment of MC in children.
Assuntos
Hidróxidos/uso terapêutico , Molusco Contagioso/tratamento farmacológico , Compostos de Potássio/uso terapêutico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hidróxidos/efeitos adversos , Hiperpigmentação/induzido quimicamente , Hipertrofia/induzido quimicamente , Hipopigmentação/induzido quimicamente , Lactente , Masculino , Compostos de Potássio/efeitos adversos , Pele/efeitos dos fármacos , Pele/patologia , Resultado do TratamentoRESUMO
The potassium bromate (PB) is the flour improving additive for bread making, most widely used in Venezuela. This additive has been reported to have hazardous effects. For this reason it has been forbidden in various countries. In order to find a substitute for PB, the feasibility of using ascorbic acid (AA) in bread making flours was considered. Flours with 80, 40 and 20 ppm of AA were tested and contrasted with an experimental and industrial flour with 80 ppm of PB, maximum quantity allowed by the Venezuelan Legislation. The effect of these additives was evaluated on French bread, of high consumption in our country. It was found that the bread prepared using the flour containing 20 ppm of AA did not present significant differences from those made out of the pattern flour, concerning their organoleptic and physico-chemical properties. It was demonstrated that it is technically feasible to replaced 80 ppm of PB for 20 ppm of AA in the flours, without affecting the bread acceptability.