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The Journal of Trauma and Acute Care... Oct 2019Acute noninfectious diarrhea is a common phenomenon in intensive care unit patients. Multiple treatments are suggested but the most effective management is unknown. A...
Antimotility agents for the treatment of acute noninfectious diarrhea in critically ill patients: A practice management guideline from the Eastern Association for the Surgery of Trauma.
BACKGROUND
Acute noninfectious diarrhea is a common phenomenon in intensive care unit patients. Multiple treatments are suggested but the most effective management is unknown. A working group of the Eastern Association for the Surgery of Trauma, aimed to evaluate the effectiveness of loperamide, diphenoxylate/atropine, and elemental diet on acute noninfectious diarrhea in critically ill adults and to develop recommendations applicable to daily clinical practice.
METHODS
The literature search identified 11 randomized controlled trials (RCT) appropriate for inclusion. The Grading of Recommendations Assessment, Development, and Evaluation methodology was applied to evaluate the effect of loperamide, diphenoxylate/atropine, and elemental diet on the resolution of noninfectious diarrhea in critically ill adults based on selected outcomes: improvement in clinical diarrhea, fecal frequency, time to the diarrhea resolution, and hospital length of stay.
RESULTS
The level of evidence was assessed as very low. Analyses of 10 RCTs showed that loperamide facilitates resolution of diarrhea. Diphenoxylate/atropine was evaluated in three RCTs and was as effective as loperamide and more effective than placebo. No studies evaluating elemental diet as an intervention in patients with diarrhea were found.
CONCLUSION
Loperamide and diphenoxylate/atropine are conditionally recommended to be used in critically ill patients with acute noninfectious diarrhea.
LEVEL OF EVIDENCE
Systematic Review/Guidelines, level III.
Topics: Adult; Antidiarrheals; Critical Illness; Diarrhea; Diet Therapy; Diphenoxylate; Gastrointestinal Motility; Humans; Loperamide; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31574060
DOI: 10.1097/TA.0000000000002449 -
The American Journal of Chinese Medicine 2019The present review is aimed at providing a comprehensive summary of the botanical characteristics, ethnomedicinal uses, phytochemical, pharmacological, and toxicological...
The present review is aimed at providing a comprehensive summary of the botanical characteristics, ethnomedicinal uses, phytochemical, pharmacological, and toxicological studies of the genus L. The extensive literature survey revealed L. species to be a group of important medicinal plants used for the ethnomedical treatment of rheumatism, fever, gout, sclerosis, analgesia, inflammation, hypertension, hyperglycemia, joint pain, palsy, amenorrhea, etc., although only a few reports address the clinical use and toxicity of these plants. Currently, more than 280 chemical constituents have been isolated and characterized from these plants. Among these constituents, -clerodane diterpenes and diterpenoids, phytoecdysteroids, flavonoids, and iridoids are the major bioactive compounds, possessing wide-reaching biological activities both and , including anti-inflammatory, antinociceptive, antitumor, anti-oxidant, antidiabetic, antimicrobial, antifeedant, antidiarrhoeal, hypolipidemic, diuretic, hypoglycaemic, immunomodulatory, vasorelaxant, larvicidal, antimutagenic, and neuroprotective activity. This review is aimed at summarizing the current knowledge of the ethnomedicinal uses, phytochemistry, biological activities, and toxicities of the genus L. to reveal its therapeutic potentials, offering opportunities for future researches. Therefore, more focus should be paid to gathering information about their toxicology data, quality-control measures, and the clinical application of the bioactive ingredients from L. species.
Topics: Ajuga; Animals; Antidiarrheals; Antineoplastic Agents; Antioxidants; Drugs, Chinese Herbal; Humans; Medicine, Traditional; Phytochemicals
PubMed: 31416340
DOI: 10.1142/S0192415X19500502 -
Substance Abuse Treatment, Prevention,... Apr 2020In Iran, as in many other Asian and Middle Eastern countries, some believe that opium has beneficial effects on cardiovascular system. Dependent patients suppose that...
BACKGROUND
In Iran, as in many other Asian and Middle Eastern countries, some believe that opium has beneficial effects on cardiovascular system. Dependent patients suppose that opium has positive effects on cardiovascular function and can prevent or improve cardiovascular diseases; however, only few comprehensive studies evaluating such effects have been performed.
OBJECTIVES
In this study, we sought to clarify the effect of opium on cardiovascular problems by incorporating the previous findings and the current information on the issue and to explain the possible mechanisms of this effect.
METHODS
The available human studies published up to October 30, 2019, were searched in different databases. Case-control, cohort, and cross-sectional studies were retrieved. Papers published in English or those with an English abstract were included. The risk of bias for each included study was assessed based on the Newcastle-Ottawa Scale (NOS). We then categorized the effects of opium on cardiovascular problems along with its probable underlying mechanisms of action.
RESULTS
In this study, most of the published articles suggested the adverse effects of opium on the cardiovascular system, including atherosclerosis, myocardial infarction, arrhythmia, low ejection fraction, and cardiovascular mortality; however, some articles reported the beneficial or impartial effects of opium on the cardiovascular system. In this article, we have categorized all the effects of opium on cardiovascular system; also, the proposed mechanisms of action of opium in each of the above-mentioned disorders are summarized.
CONCLUSION
Although the available evidences were incoherent, it was mostly suggested that opium use does not protect against or improve cardiovascular problems.
Topics: Cardiovascular System; Cross-Sectional Studies; Female; Humans; Iran; Male; Opioid-Related Disorders; Opium; Risk Factors
PubMed: 32303254
DOI: 10.1186/s13011-020-00272-8 -
Geriatrie Et Psychologie... Mar 2024The aim was to perform a systematic review of cases published in the literature to describe the management of high-output ileostomy (HOI) in older adults. A literature...
The aim was to perform a systematic review of cases published in the literature to describe the management of high-output ileostomy (HOI) in older adults. A literature search was performed in PubMed©, and Scopus© for all publications up to March 1st, 2023. Case reports and/or case series reporting data from older adults on HOI management were included. Publication year, country, sex, age, aetiology of the stomy, time from ileostomy to HOI, daily volume threshold, Treatment regimen, and effectiveness were extracted. In total, 428 studies were identified, of which 9 (describing 10 cases) were included in this review. The mean age was 69.9 ± 4.7 years. The most frequent aetiology of ileostomy was occlusion. The daily volume considered to be excessive ranged from 1 to 2 litres per 24-hour period. The main side effects of HOI were dehydration, acute renal failure, and weight loss. Loperamide was the most frequently used drug. Most studies reported that non-pharmacological therapies were also used. No death was reported in any of the studies. In all, ileostomy exposes older individuals to complications. Medical therapy with loperamide coupled with rehydration seems to be efficacious in the medium term. Multidisciplinary management is advisable, in order to increase the chances of achieving ostomy reversal as early as possible, when indicated.
Topics: Humans; Aged; Ileostomy; Loperamide
PubMed: 38573141
DOI: 10.1684/pnv.2024.1150