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Elsaka S, Hassan A, Elnaghy A. Effect of gastric acids on surface topography and bending properties of esthetic coated nickel-titanium orthodontic archwires. Clin Oral Investig 2020; 25:1319-1326. [PMID: 32617780 DOI: 10.1007/s00784-020-03438-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of simulated gastric acid solution on surface topography and bending properties of esthetic coated nickel-titanium (NiTi) archwires. MATERIALS AND METHODS Three brands of as-received white-coated superelastic NiTi upper archwires were used in this study: Dany, Perfect, and Nitanium. Uncoated metallic areas for each white-coated NiTi archwire were used for comparison with the coated areas. The specimens for each archwire were divided into two groups according to coating as follows: Group A, uncoated, and group B, coated. Then, each group was further subdivided into two subgroups according to the immersion medium as follows: Subgroup 1, immersed in artificial saliva, and subgroup 2, immersed in simulated gastric acid. Surface roughness, surface morphology, and three-point bending test were performed. The data were analyzed statistically using ANOVA and Tukey test. RESULTS The archwires immersed in simulated gastric acid solution showed significantly higher surface roughness and lower forces on loading and unloading than the archwires immersed in artificial saliva (P < 0.001). Perfect archwire showed significantly the highest surface roughness compared with Dany and Nitanium archwires (P < 0.001). The uncoated archwires showed higher loading and unloading forces compared with coated archwires for all groups (P < 0.001). Nitanium archwire showed the lowest loading and unloading forces at different deflections (P < 0.001). CONCLUSIONS The simulated gastric acid solution decreased considerably the amount of force applied at a given deflection. The loading-deflection and surface roughness properties of coated archwires were affected by the type of coating material. CLINICAL RELEVANCE The impact of gastric acids on surface and mechanical properties of orthodontic archwires depend on type of coating materials.
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Affiliation(s)
- Shaymaa Elsaka
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Mansoura, 35516, Egypt. .,Department of Restorative Science, Alfarabi Private College of Dentistry and Nursing, Jeddah, Saudi Arabia.
| | - Ali Hassan
- Department of Restorative Science, Alfarabi Private College of Dentistry and Nursing, Jeddah, Saudi Arabia.,Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amr Elnaghy
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Drug Dose Selection in Pediatric Obesity: Available Information for the Most Commonly Prescribed Drugs to Children. Paediatr Drugs 2019; 21:357-369. [PMID: 31432433 PMCID: PMC7681556 DOI: 10.1007/s40272-019-00352-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obesity rates continue to rise in children, and little guidance exists regarding the need for adjustment away from total body weight-based doses for those prescribing drugs to this population of children. A majority of drugs prescribed to children with obesity result in either sub-therapeutic or supra-therapeutic concentrations, placing these children at risk for treatment failure and drug toxicities. In this review, we highlight available obesity-specific pharmacokinetic and dosing information for the most frequently prescribed drugs to children in the inpatient and outpatient clinical settings. We also comment on available dosing recommendations for drugs prescribed to treat common pediatric obesity-related comorbidities. This review highlights that there is no safe or proven 'rule of thumb,' for dosing drugs for children with obesity, and a striking lack of pharmacokinetic data to support the creation of dosing guidelines for children with obesity for the most commonly prescribed drugs. It is important that those prescribing for children with obesity are aware of these gaps in knowledge and of potential drug treatment failure or adverse events related to drug toxicity as a result of these knowledge gaps. Until more data are available, we recommend close monitoring of drug response and adverse events in children with obesity receiving commonly prescribed drugs.
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Leung AK, Hon KL. Gastroesophageal reflux in children: an updated review. Drugs Context 2019; 8:212591. [PMID: 31258618 PMCID: PMC6586172 DOI: 10.7573/dic.212591] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 12/14/2022] Open
Abstract
Background Gastroesophageal reflux is a common disorder in pediatrics. Clinicians should be familiar with the proper evaluation and management of this condition. Objective To provide an update on the current understanding, evaluation, and management of gastroesophageal reflux in children. Methods A PubMed search was performed with Clinical Queries using the key term ‘gastroesophageal reflux’. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature and the pediatric age group. Results Regurgitation is the most frequent symptom of gastroesophageal reflux and is present in nearly all cases. Gastroesophageal reflux occurs normally in infants, is often physiological, peaks at 4 months of age, and tends to resolve with time. Gastroesophageal reflux disease occurs when gastric contents reflux into the esophagus or oropharynx and produce troublesome symptom(s) and/or complication(s). A thorough clinical history and a thorough physical examination are usually adequate for diagnosis. When the diagnosis is ambiguous, diagnostic studies may be warranted. A combined esophageal pH monitoring and multichannel intraluminal esophageal electrical impedance device is the gold standard for the diagnosis of gastroesophageal reflux disease if the diagnosis is in doubt. In the majority of cases, no treatment is necessary for gastroesophageal reflux apart from reassurance of the benign nature of the condition. Treatment options for gastroesophageal reflux disease are discussed. Conclusion In most cases, no treatment is necessary for gastroesophageal reflux apart from reassurance because the condition is benign and self-limiting. Thickened feedings, postural therapy, and lifestyle changes should be considered if the regurgitation is frequent and problematic. Pharmacotherapy should be considered in the treatment of more severe gastroesophageal reflux disease for patients who do not respond to conservative measures. Proton pump inhibitors are favored over H2-receptor antagonists because of their superior efficacy. Antireflux surgery is indicated for patients with significant gastroesophageal reflux disease who are resistant to medical therapy.
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Affiliation(s)
- Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.,PICU, The Hong Kong Children's Hospital, Kowloon, Hong Kong
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Shakhnovich V, Abdel-Rahman S, Friesen CA, Weigel J, Pearce RE, Gaedigk A, Leeder JS, Kearns GL. Lean body weight dosing avoids excessive systemic exposure to proton pump inhibitors for children with obesity. Pediatr Obes 2019; 14:10.1111/ijpo.12459. [PMID: 30257076 PMCID: PMC6309791 DOI: 10.1111/ijpo.12459] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/30/2018] [Accepted: 06/15/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Children with obesity are more likely to suffer gastroesophageal reflux disease, requiring acid-suppression therapy with proton pump inhibitors (PPIs) and no guidelines regarding dosing. OBJECTIVE To prospectively evaluate lean-body-weight-based (LBW) dosing of the PPI pantoprazole for children with and without obesity. METHODS Methods: Sixty-two children (6-17 years) received a one-time oral dose of liquid pantoprazole (1.2 mg kg-1 LBW). Plasma pantoprazole concentrations were measured at 10 time points over 8 h and pharmacokinetic (PK) profiles generated using non-compartmental techniques, in order to compare PK parameters of interest between children with and without obesity, while accounting for CYP2C19 genotype. RESULTS Adjusted for milligram-per-kilogram total body weight (TBW) pantoprazole received, apparent drug clearance (CL/F) was reduced 50% in children with vs. without obesity (p=0.03). LBW-based dosing compensated for this reduction in CL/F (p = 0.15). CONCLUSION To achieve comparable systemic PPI exposures for children with and without obesity, we recommend using LBW, rather than TBW-based dosing for pantoprazole.
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Affiliation(s)
- Valentina Shakhnovich
- Devision of Clinical Pharmacology, Toxicology and Therapeutic Innovation, The Children’s Mercy Hospital; Kansas City, MO,Division of Gastroenterology, Hepatology and Nutrition, The Children’s Mercy Hospital; Kansas City, MO
| | - Susan Abdel-Rahman
- Devision of Clinical Pharmacology, Toxicology and Therapeutic Innovation, The Children’s Mercy Hospital; Kansas City, MO
| | - Craig A. Friesen
- Division of Gastroenterology, Hepatology and Nutrition, The Children’s Mercy Hospital; Kansas City, MO
| | - Jaylene Weigel
- Devision of Clinical Pharmacology, Toxicology and Therapeutic Innovation, The Children’s Mercy Hospital; Kansas City, MO
| | - Robin E. Pearce
- Devision of Clinical Pharmacology, Toxicology and Therapeutic Innovation, The Children’s Mercy Hospital; Kansas City, MO
| | - Andrea Gaedigk
- Devision of Clinical Pharmacology, Toxicology and Therapeutic Innovation, The Children’s Mercy Hospital; Kansas City, MO
| | - J. Steven Leeder
- Devision of Clinical Pharmacology, Toxicology and Therapeutic Innovation, The Children’s Mercy Hospital; Kansas City, MO
| | - Gregory L. Kearns
- Section of Clinical Pharmacology and Toxicology; Arkansas Children’s Hospital; Little Rock, AR
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Driessen C, Paulus GF, Robben SG, Tjon a Ten WE, Van den Neucker A, Verhoeven BH, Van Heurn LWE. Splenic size after division of the short gastric vessels in Nissen fundoplication in children. Pediatr Surg Int 2012; 28:235-8. [PMID: 22127485 PMCID: PMC3284667 DOI: 10.1007/s00383-011-3027-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE Nissen fundoplication is an effective treatment for gastro-esophageal reflux disease (GERD). Mobilization of the gastric fundus during fundoplication requires division of short gastric vessels of the spleen, which may cause splenic ischemia. The aim of this study was to determine if Nissen fundoplication results in hypotrophy of the spleen. METHODS We performed pre-operative and post-operative ultrasound measurements of the spleen in children undergoing Nissen fundoplication. During operation, the surgeon estimated the compromised blood flow by assessment of the percentage of discoloration of the spleen. RESULTS Twenty-four consecutive children were analyzed. Discoloration of the upper pole of the spleen was observed in 11 patients (48%) of a median estimated splenic surface of 20% (range 5-50%). The median ratio for pre-operative and post-operative length, width, and area of the spleen was 0.97, 1.03, and 0.96, respectively. The percentage of the estimated perfusion defect during surgery was not correlated with the ratios. In three patients, the area ratio was smaller than 0.8 (0.67-0.75), meaning that the area decreased with at least 20% after surgery. In none of these patients a discoloration was observed. CONCLUSION Discoloration of the spleen after Nissen fundoplication is not associated with post-operative splenic atrophy.
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Affiliation(s)
- C. Driessen
- Department of General Surgery, Maastricht University Medical Centre, P.Debyelaan 25, 6202 Maastricht, The Netherlands
| | - G. F. Paulus
- Department of General Surgery, Maastricht University Medical Centre, P.Debyelaan 25, 6202 Maastricht, The Netherlands
| | - S. G. Robben
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - W. E. Tjon a Ten
- Department of Pediatric Gastroenterology, Maastricht University Medical Centre, Maastricht, The Netherlands ,Department of Pediatrics, Maxima Medical Center, Veldhoven, The Netherlands
| | - A. Van den Neucker
- Department of Pediatric Gastroenterology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - B. H. Verhoeven
- Department of General Surgery, Maastricht University Medical Centre, P.Debyelaan 25, 6202 Maastricht, The Netherlands
| | - L. W. E. Van Heurn
- Department of General Surgery, Maastricht University Medical Centre, P.Debyelaan 25, 6202 Maastricht, The Netherlands
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Abstract
GER is a common reason for pediatric office visits and referrals to a pediatric gastroenterologist. This condition frequently is benign, and it is self-limited in most infants. Although a thorough history and complete physical examination usually are adequate to diagnose GER, a high index of suspicion must be maintained for other diagnoses associated with recurrent emesis, including metabolic disorders, as well as for other gastrointestinal conditions, such as pyloric stenosis and abnormalities of intestinal rotation. Behavioral or lifestyle modification usually can be implemented empirically to diagnose and manage a suspected case of uncomplicated GER. When this fails, medical therapy can be initiated, employing either a step-up or step-down approach with a PPI or H2RA. With the proven efficacy of PPIs and their availability to children, medical treatment has become the mainstay of therapy in severely affected patients; nevertheless, anti-reflux surgery is still widely performed in children with GER. Pediatricians and other primary care providers often manage infants and children who have gastrointestinal complaints, prior to referral to a pediatric gastroenterologist. Hence, they have the responsibility to educate children and families about GER, its natural history, complications, and therapeutic options. A careful history and physical examination, informed use of diagnostic studies, and a consistent approach to medical treatment are important principles that are required to guarantee the success of GER management in infants and children.
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Affiliation(s)
- Eugene Suwandhi
- Department of Pediatrics, Long Island College Hospital, Brooklyn, NY 11201, USA
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Kim J, Keininger DL, Becker S, Crawley JA. Simultaneous development of the Pediatric GERD Caregiver Impact Questionnaire (PGCIQ) in American English and American Spanish. Health Qual Life Outcomes 2005; 3:5. [PMID: 15651991 PMCID: PMC548517 DOI: 10.1186/1477-7525-3-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Accepted: 01/14/2005] [Indexed: 11/23/2022] Open
Abstract
Background The objective of this study was to develop simultaneously a new questionnaire, the Pediatric GERD Caregiver Impact Questionnaire (PGCIQ), in American English and American Spanish in order to elucidate the impact of caring for a child with GERD. Methods Two focus group discussions were conducted in American English and American Spanish to develop a relevant conceptual model. Focus group participants were the primary caregivers of children with GERD (newborn through 12 years of age). Participant responses were qualitatively analyzed to identify potential differences in caregiver perspectives by the caregiver's language, socio-economic status and demographic profile as well as the child's age and disease severity level. Items in the PGCIQ were generated simultaneously in English and Spanish by reviewing results of qualitative analysis from focus groups in each language. The PGCIQ was finalized in both languages after testing content validity and conducting an in-depth translatability assessment. Results Analysis of focus group comments resulted in the development of a first draft questionnaire consisting of 58 items in 10 domains. Content validity testing and an in-depth translatability assessment resulted in wording modification of 37 items, deletion of 14 items and the addition of a domain with five items. Feedback from the content validity testing interviews indicated that the instrument is conceptually relevant in both American English and American Spanish, clear, comprehensive and easy to complete within 10 minutes. The final version of the PGCIQ contains 49 items assessing ten domains. An optional module with nine items is available for investigative research purposes and for use only at baseline. Conclusion The PGCIQ was developed using simultaneous item generation, a process that allows for consideration of concept relevance in all stages of development and in all languages being developed. The PGCIQ is the first questionnaire to document the multidimensional impact of caring for an infant or young child with GERD. Linguistic adaptation of the PGCIQ in multiple languages is ongoing. A validation study of the PGCIQ is needed to examine its psychometric properties, further refine the items and develop an appropriate scoring model.
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Freston JW. Therapeutic choices in reflux disease: defining the criteria for selecting a proton pump inhibitor. Am J Med 2004; 117 Suppl 5A:14S-22S. [PMID: 15478848 DOI: 10.1016/j.amjmed.2004.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Gastroesophageal reflux disease (GERD) is among the most common disorders of the gastrointestinal tract, with symptoms affecting a substantial proportion of the US population on a daily basis. Heartburn and related symptoms arise from a number of pathophysiologic mechanisms, including dilated intercellular spaces, increased duration of acid reflux, greater proximal extent of reflux, and esophageal sensitivity. Chronic reflux may result in serious complications, such as esophageal erosions or ulceration, stricture, and Barrett esophagus. The goals of GERD therapy are to relieve patients' symptoms and prevent complications. Proton pump inhibitors (PPIs) represent the most effective treatment option for GERD, relieving symptoms, healing erosions, and maintaining a healed mucosa. Differences in the pharmacokinetics and pharmacodynamics among the PPIs may result in differences in intragastric pH holding time as well as the onset of symptom relief. Lansoprazole and esomeprazole produce similar degrees and onset of symptom relief, with both providing greater symptom relief as compared with omeprazole. Although manufactured as capsules containing enteric-coated granules, lansoprazole, omeprazole, and esomeprazole maintain their high level of pharmacologic efficacy when the capsule contents are emptied into soft foods or various liquids. Lansoprazole and pantoprazole also are manufactured as intravenous formulations, and lansoprazole is available as strawberry-flavored granules for oral suspension and as an orally disintegrating tablet. These alternative routes of administration are particularly beneficial in the management of acid-related disorders in infants, children, the elderly, and patients of all ages who have difficulty swallowing or are unable to swallow intact capsules or tablets and those in the critical care setting.
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Affiliation(s)
- James W Freston
- University of Connecticut Health Center, Farmington, Connecticut 06030-1111, USA
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