The Experts below are selected from a list of 24 Experts worldwide ranked by ideXlab platform
Thomas W. Smith - One of the best experts on this subject based on the ideXlab platform.
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Effect of magnesium--aluminum hydroxide and Kaolin--Pectin on absorption of digoxin from tablets and capsules.
The Journal of Clinical Pharmacology, 2013Co-Authors: B S Marcia Divoll Allen, David J. Greenblatt, S B A Jerold Harmatz, Thomas W. SmithAbstract:Twelve healthy fasting volunteers received two 0.2-mg digoxin capsules or tablets with 60 ml water, 60 ml Maalox, or 60 ml Kaopectate in a randomized, single-dose, six-way crossover study. Concentrations of digoxin in multiple plasma samples and in all urine collected during the 24 hours after each dose were determined by radioimmunoassay. Compared to the water treatment, administration of both tablets and capsules with Maalox or Kaopectate reduced the peak digoxin plasma concentrations but did not significantly influence the time of peak concentration. Neither Maalox nor Kaopectate influenced the area under the 24-hour plasma concentration--time curve for either tablets or capsules. However, 24-hour urinary recovery of digoxin from tablets tended to be reduced by Maalox and Kaopectate; this was not the case with capsules. Digoxin capsules may have an advantage over currently available tablets in clinical situations requiring digoxin coadministration with nonabsorbable gastrointestinal preparations.
Ivan D. Florez - One of the best experts on this subject based on the ideXlab platform.
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comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children a systematic review and network meta analysis
PLOS ONE, 2018Co-Authors: Ivan D. Florez, Areti-angeliki Veroniki, Reem Al Khalifah, Javier M. Sierra, Robin W. M. Vernooij, Juan Jose Yepesnunez, Jorge AcostareyesAbstract:Background Many interventions have shown effectiveness in reducing the duration of acute diarrhea and gastroenteritis (ADG) in children. Yet, there is lack of comparative efficacy of interventions that seem to be better than placebo among which, the clinicians must choose. Our aim was to determine the comparative effectiveness and safety of the pharmacological and nutritional interventions for reducing the duration of ADG in children. Methods Data sources included Medline, Embase, CENTRAL, CINAHL, LILACS, and Global-Health up to May 2017. Eligible trials compared zinc (ZN), vitamin A, micronutrients (MN), probiotics, prebiotics, symbiotics, racecadotril, smectite(SM), loperamide, diluted milk, lactose-free formula(LCF), or their combinations, to placebo or standard treatment (STND), or among them. Two reviewers independently performed screening, review, study selection and extraction. The primary outcome was diarrhea duration. Secondary outcomes were stool frequency at day 2, diarrhea at day 3, vomiting and side effects. We performed a random effects Bayesian network meta-analysis to combine the direct and indirect evidence for each outcome. Mean differences and odds ratio with their credible intervals(CrI) were calculated. Coherence and transitivity assumptions were assessed. Meta-regression, subgroups and sensitivity analyses were conducted to explore the impact of effect modifiers. Summary under the cumulative curve (SUCRA) values with their CrI were calculated. We assessed the evidence quality and classified the best interventions using the Grading of Recommendations, Assessment, Development & Evaluation (GRADE) approach for each paired comparison. Results A total of 174 studies (32,430 children) proved eligible. Studies were conducted in 42 countries of which most were low-and middle-income countries (LMIC). Interventions were grouped in 27 categories. Most interventions were better than STND. Reduction of diarrhea varied from 12.5 to 51.1 hours. The combinations Saccharomyces boulardii (SB)+ZN, and SM+ZN were considered the best interventions (i.e., GRADE quality of evidence: moderate to high, substantial superiority to STND, reduction in duration of 35 to 40 hours, and large SUCRA values), while symbiotics (combination of probiotics+prebiotics), ZN, loperamide and combinations ZN+MN and ZN+LCF were considered inferior to the best and better than STND [Quality: moderate to high, superior to STND, and reduction of 17 to 25 hours]. In subgroups analyses, effect of ZN was higher in LMIC and was not present in high-income countries (HIC). Vitamin A, MN, prebiotics, Kaolin-Pectin, and diluted milk were similar to STND [Quality: moderate to high]. The remainder of the interventions had low to very-low evidence quality. Loperamide was the only intervention with more side effects than STND [Quality: moderate]. Discussion/Conclusion Most interventions analyzed (except vitamin A, micronutrients, prebiotics, and Kaolin-Pectin) showed evidence of superiority to placebo in reducing the diarrhea. With moderate-to high-quality of evidence, SB+ZN and SM+ZN, demonstrated the best combination of evidence quality and magnitude of effect while symbiotics, loperamide and zinc proved being the best single interventions, and loperamide was the most unsafe. Nonetheless, the effect of zinc, SB+ZN and SM+ZN might only be applied to children in LMIC. Results suggest no further role for studies comparing interventions against no treatment or placebo, or studies testing loperamide, MN, Kaolin-Pectin, vitamin A, prebiotics and diluted milk. PROSPERO registration CRD42015023778.
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Network meta-analysis plots.
2018Co-Authors: Ivan D. Florez, Areti-angeliki Veroniki, Reem Al Khalifah, Juan J. Yepes-nuñez, Javier M. Sierra, Robin W. M. Vernooij, Jorge Acosta-reyes, Claudia M. Granados, Giordano Pérez-gaxiola, Carlos Cuello-garciaAbstract:(A) Diarrhea duration, (B) Stool Frequency at day 2, (C) Diarrhea at day 3, (D) Vomiting and (E) Side effects. Nodes are proportional to the number of patients included in the corresponding treatments, and edges are weighted according to the number of studies included in the respective comparisons. Interventions' abbreviations: ALL-PRB: All probiotics, except LGG and SB; CAO: Kaolin-Pectin; DM: Diluted Milk; LCF: lactose-free formula; LCF+PRB: Lactose Free Formula + Probiotics; LGG: L. rhamnosus-GG; LGG+SM: LGG + Smectite; LOP: Loperamide; MN: Micronutrients; PRE: prebiotics; RC: Racecadotril; SB: Saccharomyces boulardii; SB+LCF: S. boulardii + Lactose-Free Formula; SB+ZN: S. boulardii + Zinc; SB+ZN+LCF: S. boulardii + Zinc + Lactose free Formula; SM: Smectite; SM+ZN: Smectite + Zinc; STND: Standard treatment or Placebo; SYM: Symbiotics; SYM+LCF: Symbiotics + Lactose-Free Formula; VA: Vitamin A; YOG: Yogurt; YOG+PRB+ZN: Yogurt + Probiotics + Zinc; ZN: Zinc; ZN+LCF: Zinc + Lactose Free Formula; ZN+MN: Zinc + micronutrients; ZN+PRB: Zinc + Probiotics.
B S Marcia Divoll Allen - One of the best experts on this subject based on the ideXlab platform.
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Effect of magnesium--aluminum hydroxide and Kaolin--Pectin on absorption of digoxin from tablets and capsules.
The Journal of Clinical Pharmacology, 2013Co-Authors: B S Marcia Divoll Allen, David J. Greenblatt, S B A Jerold Harmatz, Thomas W. SmithAbstract:Twelve healthy fasting volunteers received two 0.2-mg digoxin capsules or tablets with 60 ml water, 60 ml Maalox, or 60 ml Kaopectate in a randomized, single-dose, six-way crossover study. Concentrations of digoxin in multiple plasma samples and in all urine collected during the 24 hours after each dose were determined by radioimmunoassay. Compared to the water treatment, administration of both tablets and capsules with Maalox or Kaopectate reduced the peak digoxin plasma concentrations but did not significantly influence the time of peak concentration. Neither Maalox nor Kaopectate influenced the area under the 24-hour plasma concentration--time curve for either tablets or capsules. However, 24-hour urinary recovery of digoxin from tablets tended to be reduced by Maalox and Kaopectate; this was not the case with capsules. Digoxin capsules may have an advantage over currently available tablets in clinical situations requiring digoxin coadministration with nonabsorbable gastrointestinal preparations.
Michael J. Nowicki - One of the best experts on this subject based on the ideXlab platform.
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colonic sunflower seed bezoar
Pediatrics, 1997Co-Authors: V M Tsou, Phyllis R Bishop, Michael J. NowickiAbstract:Bezoars are the uncommon result of ingestion of indigestible or poorly digestible substances. Historically, bezoars are classified according to the involved material and include phytobezoar (fruit and vegetable fibers), trichobezoar (hair), and lactobezoar (milk curds). Bezoars secondary to medications have also been described.1 The majority of bezoars are located in the stomach,2 with the small intestine being the next most commonly involved site. The colon is rarely the site for a bezoar.3 We report two children with colonic, sunflower seed bezoars that expands upon the presentation and treatment of this unusual occurrence. ### Case 1 A 10-year-old white male presented to his pediatrician with a 2-week history of fever, increased flatulence, tenesmus, watery, foul-smelling diarrhea, and an 8-pound weight loss. He reported blood per rectum on a single occasion. Fecal leukocytes and stool culture were negative. A trial of Bentyl (dicyclomine) was not beneficial, Donnagel (Kaolin-Pectin, hyoscyamine sulfate, atropine sulfate and scopolamine hydrobromide) led to worsening of the symptoms. A gastroenterology evaluation was obtained. At the time of referral the child was having 10 to 12 watery bowel movements per day, associated with passage of mucus per rectum. The examination was unremarkable except for moderate abdominal discomfort on deep palpation. Rectal examination was limited by significant pain and anxiety; …
Areti-angeliki Veroniki - One of the best experts on this subject based on the ideXlab platform.
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comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children a systematic review and network meta analysis
PLOS ONE, 2018Co-Authors: Ivan D. Florez, Areti-angeliki Veroniki, Reem Al Khalifah, Javier M. Sierra, Robin W. M. Vernooij, Juan Jose Yepesnunez, Jorge AcostareyesAbstract:Background Many interventions have shown effectiveness in reducing the duration of acute diarrhea and gastroenteritis (ADG) in children. Yet, there is lack of comparative efficacy of interventions that seem to be better than placebo among which, the clinicians must choose. Our aim was to determine the comparative effectiveness and safety of the pharmacological and nutritional interventions for reducing the duration of ADG in children. Methods Data sources included Medline, Embase, CENTRAL, CINAHL, LILACS, and Global-Health up to May 2017. Eligible trials compared zinc (ZN), vitamin A, micronutrients (MN), probiotics, prebiotics, symbiotics, racecadotril, smectite(SM), loperamide, diluted milk, lactose-free formula(LCF), or their combinations, to placebo or standard treatment (STND), or among them. Two reviewers independently performed screening, review, study selection and extraction. The primary outcome was diarrhea duration. Secondary outcomes were stool frequency at day 2, diarrhea at day 3, vomiting and side effects. We performed a random effects Bayesian network meta-analysis to combine the direct and indirect evidence for each outcome. Mean differences and odds ratio with their credible intervals(CrI) were calculated. Coherence and transitivity assumptions were assessed. Meta-regression, subgroups and sensitivity analyses were conducted to explore the impact of effect modifiers. Summary under the cumulative curve (SUCRA) values with their CrI were calculated. We assessed the evidence quality and classified the best interventions using the Grading of Recommendations, Assessment, Development & Evaluation (GRADE) approach for each paired comparison. Results A total of 174 studies (32,430 children) proved eligible. Studies were conducted in 42 countries of which most were low-and middle-income countries (LMIC). Interventions were grouped in 27 categories. Most interventions were better than STND. Reduction of diarrhea varied from 12.5 to 51.1 hours. The combinations Saccharomyces boulardii (SB)+ZN, and SM+ZN were considered the best interventions (i.e., GRADE quality of evidence: moderate to high, substantial superiority to STND, reduction in duration of 35 to 40 hours, and large SUCRA values), while symbiotics (combination of probiotics+prebiotics), ZN, loperamide and combinations ZN+MN and ZN+LCF were considered inferior to the best and better than STND [Quality: moderate to high, superior to STND, and reduction of 17 to 25 hours]. In subgroups analyses, effect of ZN was higher in LMIC and was not present in high-income countries (HIC). Vitamin A, MN, prebiotics, Kaolin-Pectin, and diluted milk were similar to STND [Quality: moderate to high]. The remainder of the interventions had low to very-low evidence quality. Loperamide was the only intervention with more side effects than STND [Quality: moderate]. Discussion/Conclusion Most interventions analyzed (except vitamin A, micronutrients, prebiotics, and Kaolin-Pectin) showed evidence of superiority to placebo in reducing the diarrhea. With moderate-to high-quality of evidence, SB+ZN and SM+ZN, demonstrated the best combination of evidence quality and magnitude of effect while symbiotics, loperamide and zinc proved being the best single interventions, and loperamide was the most unsafe. Nonetheless, the effect of zinc, SB+ZN and SM+ZN might only be applied to children in LMIC. Results suggest no further role for studies comparing interventions against no treatment or placebo, or studies testing loperamide, MN, Kaolin-Pectin, vitamin A, prebiotics and diluted milk. PROSPERO registration CRD42015023778.
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Network meta-analysis plots.
2018Co-Authors: Ivan D. Florez, Areti-angeliki Veroniki, Reem Al Khalifah, Juan J. Yepes-nuñez, Javier M. Sierra, Robin W. M. Vernooij, Jorge Acosta-reyes, Claudia M. Granados, Giordano Pérez-gaxiola, Carlos Cuello-garciaAbstract:(A) Diarrhea duration, (B) Stool Frequency at day 2, (C) Diarrhea at day 3, (D) Vomiting and (E) Side effects. Nodes are proportional to the number of patients included in the corresponding treatments, and edges are weighted according to the number of studies included in the respective comparisons. Interventions' abbreviations: ALL-PRB: All probiotics, except LGG and SB; CAO: Kaolin-Pectin; DM: Diluted Milk; LCF: lactose-free formula; LCF+PRB: Lactose Free Formula + Probiotics; LGG: L. rhamnosus-GG; LGG+SM: LGG + Smectite; LOP: Loperamide; MN: Micronutrients; PRE: prebiotics; RC: Racecadotril; SB: Saccharomyces boulardii; SB+LCF: S. boulardii + Lactose-Free Formula; SB+ZN: S. boulardii + Zinc; SB+ZN+LCF: S. boulardii + Zinc + Lactose free Formula; SM: Smectite; SM+ZN: Smectite + Zinc; STND: Standard treatment or Placebo; SYM: Symbiotics; SYM+LCF: Symbiotics + Lactose-Free Formula; VA: Vitamin A; YOG: Yogurt; YOG+PRB+ZN: Yogurt + Probiotics + Zinc; ZN: Zinc; ZN+LCF: Zinc + Lactose Free Formula; ZN+MN: Zinc + micronutrients; ZN+PRB: Zinc + Probiotics.