Off label pharmacological therapy in patients with short bowel syndrome

BACKGROUND

Short bowel syndrome is a disabling disease requiring long-term nutritional support and ancillary drugs. Aiming to analyze the most commonly prescribed drugs, a retrospective analysis was conducted is an outpatient cohort.

PATIENTS AND METHODS

Stable patients (N= 37, 59.5% males, age 51.1 ± 20.1 years, body mass index 20.1 ± 7.9 kg/m2) with three or more appointments in the Outpatient Service during the last 18 months were retrospectively analyzed. regarding oral pharmacologic prescriptions. Medications were classified as on label or off label.

RESULTS

A total of 257 oral prescriptions were retrieved from computer files, encompassing 17 different preparations. The majority was employed on label however 28.8% (74/257) were classified as off label and scrutinized with regard to indications. The main categories were pharmacologic modulators of gastrointestinal secretions and motility, along with antibiotics. Virtually all patients required one or more of such drugs, without differences regarding demographic or clinical variables. Adverse effects or premature drug discontinuation were not observed.

CONCLUSIONS

This is the first study to our knowledge highlighting the importance of adjuvant drugs, particularly with unconventional indications, in the management of short bowel syndrome. Antidiarrheic agents, pancrelipase micropellets, antacids and antibiotics represented the most relevant off label prescriptions for this population.

Land application of municipal landfill leachate: fate of ions and ammonia volatilization

Landfill leachates are pollutants rich in ammoniacal N, Na, and K, but land application potentially offers an alternative for recycling these leachate nutrients. We applied landfill leachate corresponding to 0, 110, 220, 330, and 440 kg ha of total N, divided in three applications (July, August, and October 2008), onto the surface of an acidic (pH 5.5-6.0) clay (79% clay) Ultisol and monitored NH volatilization just after applications and microbiological (0-10 cm) and chemical attributes (0-60-cm soil depth) in August 2008, January 2009, and May 2009. Ammonium (up to 30 mg kg), NO (up to 160 mg kg), Na, K (up to 1.1 cmol kg each), and electrical conductivity (up to 1 dS m) increased transiently in soil following applications. Despite >90% of the total leachate N being ammoniacal, NO predominated in the first soil sampling, 14 d after the second application, suggesting fast nitrification, but it decreased in the soil profile thereafter. From 5 to 25% of the total applied N volatilized as NH, with maximum losses within the first 3 d. Applications inhibited (50%) the relative nitrification rate and increased (50%) hot-water-soluble carbohydrates in the soil at the highest rate. No effects were observed on soil microbial biomass C (114-205 mg kg) and activity (5-8 mg CO-C kg d) or on corn grain yields (6349-7233 kg ha). Controlled land application seems to be a viable alternative for landfill leachate management, but NO leaching, NH volatilization, and accumulation of salinizing ions must be monitored in the long term to prevent environmental degradation.

Functional and structural parameters to assess the ecological status of a metal contaminated area in the tropics

Ecological parameters (soil invertebrates, microbial activity, and plant community) were assessed in a metal contaminated site in an abandoned lead smelter and non-contaminated reference sites, as part of an ecological risk assessment (ERA). Vegetation cover inside the smelter area was lower and presented a more homogenous species composition than outside. A more simplified and less abundant vegetation community within the smelter area also simplified the habitat conditions, which in addition to metal toxicity, impaired the soil microbial and faunal communities. A significant reduction in the feeding activity was observed within the smelter area. Also a significant change in community composition of surface dwelling invertebrates was observed at those sites when compared to sites outside the smelter area. Moreover, basal respiration, microbial biomass C, dehydrogenase and phosphatase activity also decreased in several of these points under the smelter area. As a result, a significant impairment of organic material decomposition in the most contaminated sites was observed. Metal contamination affected the ecological status of the site, leading to a risk for ecosystem functioning and provisioning of ecosystem services like organic matter decomposition and nutrient cycling, even 17 years after the end of smelting activities. Regarding the sensitivity of the ecological parameters assessed, most were able to distinguish sites within the smelter area boundaries from those outside. However, only bait lamina (feeding activity), basal respiration and microbial biomass carbon presented high capacity to distinguish the level of soil contamination, since they were significantly correlated with metal loadings, and thus are promising candidates to be integrated in the Ecological Line of Evidence of an ERA.

Ammonia volatilization in soil treated with tannery sludge

The utilization of tannery sludge in agricultural areas can be an alternative for its disposal and recycling. Despite this procedure may cause the loss of nitrogen by ammonia volatilization, there is no information about this process in tropical soils. For two years a field experiment was carried out in Rolândia (Paraná State, Brazil), to evaluate the amount of NH(3) volatilization due to tannery sludge application on agricultural soil. The doses of total N applied varied from zero to 1200 kg ha(-1), maintained at the surface for 89 days, as usual in this region. The alkalinity of the tannery sludge used was equivalent to between 262 and 361 g CaCO(3) per kg. Michaelis-Menten equation was adequate to estimate NH(3)-N volatilization kinetics. The relation between total nitrogen applied as tannery sludge and the potentially volatilized NH(3)-N, calculated by the chemical-kinetics equation resulted in an average determination coefficient of 0.87 (P>0.01). In this period, the amount of volatilized NH(3) was more intense during the first 30 days; the time to reach half of the maximum NH(3) volatilization (K(m)) was 13 an 9 days for the first and second experiments, respectively. The total loss as ammonia in the whole period corresponded in average to 17.5% of the total N applied and to 35% of the NH(4)(+)-N present in the sludge. If tannery sludge is to be surface applied to supply N for crops, the amounts lost as NH(3) must be taken into consideration.

Flavonoids from Lonchocarpus latifolius roots

From the petrol extract of Lonchocarpus latifolius roots, 10 flavonoids were isolated. These included: 3,5-dimethoxy-2'',2''-dimethylpyrano-(5'',6'':8,7)-flavone, 3-methoxy-(2'',3'':7,8)-furanoflavanone, 3',4'-methylenedioxy-(2'',3'':7,8)-furanoflavanone, and (2,3-trans-3,4-trans)-3,4-dimethoxy-(2'',3'':7,8)-furanoflavan, as well as the previously known karanjachromene, karanjin, lanceolatin B, pongachromene, pongaglabrone and ponganpin. Only nine flavonoids could be quantified through HPLC analysis.

Subcutaneous fistulectomy in bridging hidradenitis suppurativa

BACKGROUND

The treatment of chronic lesions in hidradenitis suppurativa remains a challenge. For some clinical types surgical management is an excellent alternative.

OBJECTIVE

This study evaluates an alternative surgical approach for the treatment of hidradenitis suppurativa of specific bridging lesions by subcutaneous resection of the tubular fibrotic tissue.

METHODS

Periorificial fusiform skin incisions were made around the orifices parallel to the axillary or inguinal folds and the subcutaneous tubular fibrotic tissue was removed en bloc before skin suturing.

RESULTS

The outcome was evaluated as satisfactory due to lower morbidity, minimizing the excised skin areas, prevention of bridles or adherences, shorter incisions, no healing difficulties, and less dehiscence or wound exposure.

CONCLUSION

The subcutaneous fistulectomy is a surgical option in bridging hidradenitis suppurativa.