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Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Polyethylene glycol (PG) is a mixture of polymers that increase stool water content due to an osmotic effect. Molecules with a molecular weight of 3,350 or above are used because they cannot be absorbed by the gut (macrogol 3,350).12 PG has been shown to be effective in the treatment of faecal impaction (see page 286). It comes as a powder that is added to water, which removes the risk of dehydration. It is not metabolised by bowel bacteria and is not absorbed. Each sachet is usually mixed with 125 ml of water and up to eight sachets can be taken per day. This can require swallowing a significant volume of liquid and may be unsuitable for people with reduced oral intake or an impaired swallow. Starch-based thickening agents cannot be added to these solutions.
Orders Norzivirales and Timlovirales
Published in Paul Pumpens, Peter Pushko, Philippe Le Mercier, Virus-Like Particles, 2022
Paul Pumpens, Peter Pushko, Philippe Le Mercier
In connection with the biocompatible polymers, the Nicole F. Steinmetz team raised a critical question of the bioinspired shielding strategies for nanoparticle drug delivery applications (Gulati et al. 2018). Since nanoparticle surface camouflage was often required to reduce immune clearance and thereby increase circulation times allowing the carriers to reach their target site, the origin of the coating remained highly important, whether of synthetic or biologic origin. To this end, polyethylene glycol has long been used, with several PEGylated products reaching clinical use. Unfortunately, the growing use of PEG in consumer products has led to an increasing prevalence of PEG-specific antibodies in the human population, which in turn has fueled the search for alternative coating strategies. Gulati et al. (2018) highlighted alternative bioinspired nanoparticle shielding strategies that may be more beneficial moving forward than PEG and other synthetic polymer coatings.
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
The common indications for flexible sigmoidoscopy and/or colonoscopy during pregnancy are rectal bleeding, diarrhea with negative evaluation, and strong indication for a colon mass. Sigmoidoscopy may establish diagnosis in majority of patients and should be considered first. Colonoscopy may be required if refractory lower gastrointestinal symptoms persist and sigmoidoscopy was not diagnostic. The safety and efficacy of flexible sigmoidoscopy and colonoscopy were reported in a study in which 48 sigmoidoscopies (46 patients) and 8 colonoscopies (8 patients) were safely performed during pregnancy (70). There were no adverse fetal outcomes, and no evidence that sigmoidoscopy or colonoscopy precipitated the onset of labor. The safety of polyethylene glycol (PEG) electrolyte solutions has not been studied in pregnancy. PEG solutions are classified as category C. Tap water enemas may be used for bowel preparation for flexible sigmoidoscopy. Removal of majority of colon polyps should be deferred until the postpartum period.
Managing women of childbearing age with chronic myeloid leukemia: safety and treatment considerations
Published in Expert Review of Hematology, 2023
HF Robertson, MJ Buckton, JF Apperley
Whilst undoubtedly safe to use in pregnancy, it is important to appreciate the expected efficacy and tolerability of IFN-α. When used first line, the rates of complete hematological remission ranged between 31% and 73% [13,14], and the time to hematological response was slower than we observe with the TKIs. In the German CML III study, the median time to first response in the 133 patients randomized to IFN-α was approximately 2.5 months for the 110 responders, and to complete remission (41 patients) approximately 6.5 months [13]. Complete cytogenetic responses occur in 7–18% of patients [13,14]. This discrepancy in response may be due in part to genetic polymorphisms, rendering certain individuals more or less sensitized to the drug [15,16]. The unpredictability of IFN-α to induce cytogenetic responses is particularly troubling in women who are diagnosed with CML in pregnancy and have had no prior TKI therapy to control the disease. Even for those who have achieved good responses with TKI therapy and have discontinued due to pregnancy, the ability of IFN-α to regain these responses is uncertain at best. As well as the doubt surrounding its efficacy, IFN-α requires sub-cutaneous injections and can be poorly tolerated with some patients forced to discontinue the drug due to hematological toxicity and/or unpleasant systemic side effects [17,18]. This has been partially overcome by the advent of the polyethylene glycol vector (PEG), which is also safe for use throughout pregnancy and requires less frequent administration [19].
Acids produced by lactobacilli inhibit the growth of commensal Lachnospiraceae and S24-7 bacteria
Published in Gut Microbes, 2022
Emma J. E. Brownlie, Danica Chaharlangi, Erin Oi-Yan Wong, Deanna Kim, William Wiley Navarre
The Lachnospiraceae and S24-7 species are poorly studied, largely due to a paucity of cultured isolates, and their sensitivity to stress has not been extensively examined. The apparent acid sensitivity of both taxa relative to other species from the Bacteroidales and Clostridiales orders warrants further investigation. The S24-7 group of bacteria has been shown to be highly intolerant to hyperosmotic conditions.43 Indeed, osmotic-induced diarrhea caused by the administration of polyethylene glycol (as routinely occurs prior to colonoscopy procedures) leads to an extinction of these bacteria from the gut. An inability to survive acid stress could render both S24-7 and Lachnospiraceae susceptible to elimination from the gut under circumstances that lower the pH of the colon including chronic inflammation or certain drugs, food additives, or xenobiotics.
Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army
Published in Drug and Chemical Toxicology, 2022
Marc A. Williams, Gunda Reddy, Michael J. Quinn, Amy Millikan Bell
Humectants commonly found in e-cigs include combinations of glycerol, propylene glycol, trimethylene glycol and, to a lesser extent, ethylene glycol – exposures to which, exceeded the minimal risk level thought to be protective of human health as defined by the DHHS-ATSDR (DHHS 2010), and compounds that are not currently listed on the FDA’s list of chemicals that are recognized as GRAS (see Table 1; Hahn et al.2014). Others have attempted to determine the toxicity of diethylene glycol (DEG) in 18 brands of e-cig cartridges (e.g., the Smoking Everywhere 555 High brand), but its quantities were not provided, thus limiting an evaluation of its potential toxicity (FDA 2009). As others have indicated (Orr 2014), it is noteworthy that the U.S. Code of Federal Regulations (CFR) (2011) permits up to 0.2% of DEG in polyethylene glycol when polyethylene glycol is used as a food additive (see 21CFR172.820, 2013). However, this regulation applies to oral, and not inhalational exposure.