Ingestion Of Sulfate Research Articles

Effect of Zinc Supplement on Prevention of PPROM and Improvement of some Pregnancy Outcomes in Pregnant Women with a History of PPROM: A Randomized Double -Blind Controlled Trial

Background Preterm premature rupture of membrane (PPROM) prior to 37 weeks’ gestation is among the most common obstetrics problems, which is associated with prenatal mortality and several maternal and neonatal complications. History of PPROM is a risk factor for recurrence. Zinc has an important effect on the strength of membranes by affecting collagen [tensile] strength - a substance with immunity mechanism and antioxidant properties.Objectives This study was conducted to investigate the effect of zinc supplement on the prevention of PPROM and improvement of some pregnancy outcomes in pregnant women with a history of PPROM during the second trimester and the early third trimester.Methods In this randomized, double-blind, controlled clinical trial, 108 healthy pregnant women (at gestational age of 16 - 30 weeks) with a history of PPROM and singleton pregnancy were selected by convenience sampling method in the Midwifery Clinic of Shahid Akbarabadi hospital in Tehran, Iran, between 2014 and 2015. They were then divided into two groups of placebo and zinc sulfate tablet (40 mg) recipient using randomized block design. In total, 92 subjects completed the study. The frequency of PPROM was regarded as the primary outcome, and frequency of PROM, average gestational age at birth, average birth weight, and average head circumference were considered as the secondary outcomes. The statistical analysis was based on intent-to-treat principle.Results There was no between-groups difference in terms of demographic and pregnancy specifications. Results showed no significant between-groups (zinc versus placebo recipient) difference (P > 0.05) in terms of the frequency of preterm pregnancy (22% versus 33.3%), frequency of PPROM (4.9% versus 11.8%), frequency of PROM (14.6% versus 17.6%), average birth weight (3192.17 g versus 3080.52 g), average gestational age at birth (38.2 weeks versus 37.2 weeks), and average head circumference at birth (34.63 cm versus 34.81 cm).Conclusions According to the results, daily intake of zinc sulfate (40 mg) by pregnant women with a history of PPROM does not contribute to the prevention of PPROM and PROM and improvement of average gestational age at birth and anthropometric measurements.

The use of α-lipoic acid and zinc sulfate in post-MI patients with type 2 diabetes mellitus, possibilities in the correction of systemic inflammation

Purpose – to investigate the dynamics of C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and IL-10 in post-MI patients with type 2 diabetes mellitus (DM), during the treatment with α-lipoic acid (ALA) and zinc (Zn) sulphate.Materials and methods. 49 patients were examined (mean age (60,97±1,59) years) with type 2 DM who had non-Q myocardial infarction (non-Q-MI). For the basic treatment of patients during 4 months ALA (600 mg/ day) and Zn sulphate (248 mg/day) were added. The determination of CRP and cytokines was performed before treatment and after its completion.Results and discussion. Comparing the baseline data of studied parameters of investigated patients with the control group of almost healthy individuals revealed a significantly higher level of CRP (р<0,001), IL-6 (р<0,001), TNF-α (р<0,001) and IL-10 (р<0,001) in post MI patients with type 2 DM, which indicates the activity of systemic inflammation in these patients. Analyzing CRP and cytokines values in patients with type 2 DM with a history of non-Q-MI after 4 months of ALA with Zn sulphate intake, revealed a significant decrease in the levels of CRP (р<0,01), IL-6 (р<0,001) and TNF-α (р<0,01). In our study we did not record any significant effect of the combined treatment on the level of IL-10, although a downward trend (p<0,2) was visible.Conclusions. The use of ALA and Zn sulfate for 4 months in post-MI patients with type 2 DM reduces the levels of CRP and proinflammatory cytokines, reducing the activity of systemic inflammation.

Do Pregnant Women With Hypothyroidism Have a Decreased Incidence of Hyperemesis Gravidarum? [269

INTRODUCTION: Nausea and vomiting in the early part of pregnancy affects up to 75% of pregnant women. Hyperemesis, the severe form, affects 1–2%. There is a known relationship between transient hyperthyroidism with hyperemesis, owing to the identical alpha-subunit of human chorionic gonadotropin and thyroid-stimulating hormone (TSH). We sought to determine whether the opposite was true: Do women with elevated TSH and hypothyroidism have less nausea, vomiting, and hyperemesis gravidarum? METHODS: A retrospective chart review was performed at Good Samaritan Hospital from 2009 to 2012. A total of 367 women were studied. A study group of 187 patients with hypothyroidism was compared with a control group of 180 patients without hypothyroidism. χ2 and contingency coefficients were used to analyze the data. RESULTS: Women with hypothyroidism had higher body mass index (BMI, calculated as weight (kg)/[height (m)]2) levels (30.96±8.19 compared with 28.97 ± 7.29, P=.015) and a higher incidence of diabetes mellitus (12.3% compared with 5.6%, P=.024). In contrast, the intake of vitamins (91.4% compared with 98.3%, P=.003) and iron sulfate (7.5% compared with 13.9%, P=.047) was increased in the control group. The incidence of depression, hypertension, multiple gestation, and bariatric surgery was not significant between the groups. There were no differences in the rates of nausea and vomiting of pregnancy between the groups (4.3% compared with 3.3%, P=.637) or for hyperemesis gravidarum (3.2% compared with 3.3%, P=.581). CONCLUSION: Women with hypothyroidism have higher BMIs and higher risks of gestational diabetes. They do not have a decreased incidence of nausea, vomiting, or hyperemesis in pregnancy.

Spatial Distribution of Sulfate Concentration in Groundwater of South-Punjab, Pakistan

Sulfate causes various health issues for human if on average daily intake of sulfate is more than 500 mg from drinking-water, air, and food. Moreover, the presence of sulfate in rainwater causes acid rains which has harmful effects on animals and plants. Food is the major source of sulfate intake; however, in areas of South-Punjab, Pakistan, the drinking-water containing high levels of sulfate may constitute the principal source of intake. The spatial behavior of sulfate in groundwater is recorded for South-Punjab province, Pakistan. The spatial dependence of the response variable (sulfate) is modeled by using various variograms models that are estimated by maximum likelihood method, restricted maximum likelihood method, ordinary least squares, and weighted least squares. The parameters of estimated variogram models are utilized in ordinary kriging, universal kriging, Bayesian kriging with constant trend, and varying trend and the above methods are used for interpolation of sulfate concentration. The K-fold cross validation is used to measure the performances of variogram models and interpolation methods. Bayesian kriging with a constant trend produces minimum root mean square prediction error than other interpolation methods. Concentration of sulfate in drinking water within the study area is increasing to the Northern part, and health risks are really high due to poor quality of water.

Sulphate in pregnancy.

Sulphate is an obligate nutrient for healthy growth and development. Sulphate conjugation (sulphonation) of proteoglycans maintains the structure and function of tissues. Sulphonation also regulates the bioactivity of steroids, thyroid hormone, bile acids, catecholamines and cholecystokinin, and detoxifies certain xenobiotics and pharmacological drugs. In adults and children, sulphate is obtained from the diet and from the intracellular metabolism of sulphur-containing amino acids. Dietary sulphate intake can vary greatly and is dependent on the type of food consumed and source of drinking water. Once ingested, sulphate is absorbed into circulation where its level is maintained at approximately 300 μmol/L, making sulphate the fourth most abundant anion in plasma. In pregnant women, circulating sulphate concentrations increase by twofold with levels peaking in late gestation. This increased sulphataemia, which is mediated by up-regulation of sulphate reabsorption in the maternal kidneys, provides a reservoir of sulphate to meet the gestational needs of the developing foetus. The foetus has negligible capacity to generate sulphate and thereby, is completely reliant on sulphate supply from the maternal circulation. Maternal hyposulphataemia leads to foetal sulphate deficiency and late gestational foetal death in mice. In humans, reduced sulphonation capacity has been linked to skeletal dysplasias, ranging from the mildest form, multiple epiphyseal dysplasia, to achondrogenesis Type IB, which results in severe skeletal underdevelopment and death in utero or shortly after birth. Despite being essential for numerous cellular and metabolic functions, the nutrient sulphate is largely unappreciated in clinical settings. This article will review the physiological roles and regulation of sulphate during pregnancy, with a particular focus on animal models of disturbed sulphate homeostasis and links to human pathophysiology.

Case Report: Atrioventricular Block Related to Glucosamine/Chondroitin in a Patient Presented with Syncope Complaint

Drug toxicity and coronary artery disease are the most frequent causes of degenerative antrioventricular (AV) complete block in adults. In the present study, development of AV block subsequent to Glucosamine/Chondroitin sulfate use in a 42 year-old male patient was evaluated. A patient with an osteoarthritis in his medical history applied to the emergency department with syncope, and an A-V block was diagnosed in the evaluation of his electrocardiogram. The patient was admitted to the coronary intensive care unit, and underlying etiology was investigated. Coronary angiography was in normal range. AV nodal functions in the electrophysiological study were considered normal. Glucosamine/Chondroitin sulfate intake was suspected as the causative factor, and sinus rhythm was achieved at the 4th hour following the cessation of the supplement. Since there is no report on the literature indicating the use of this supplement may cause AV blocks, we aimed to emphasize the necessity of being watchful for an AV block in case of Glucosamine/Chondroitin use.

Acute Copper Sulfate Poisoning: Case Report and Review of Literature

Background: Copper sulfate ingestion is a relatively popular method for committing suicide in Indian subcontinent. It causes a high mortality rate, and so a growing concern has been raised to identify the severe alarming signs suggestive of poor prognosis and to improve treatment approaches. Case report: A 22-year-old unmarried man working as a painter was found unconscious at his friend residence. The patient developed hypotension, hemorrhagic gastroenteritis with hematemesis and melena, renal and hepatic failure, severe metabolic acidosis and intravascular hemolysis during admission at hospital. His signs were refractory to treatment with fluid replacement therapy, vasoactive drugs, antiemetic drugs, ranitidine, furosemide, methylene blue and 2,3 dimercaptopropane-1-sulphonate. He died six hours post-admission. In post-mortem examinations, there were multiple sub-pleural and sub-epicardial hemorrhages and the gastrointestinal mucosa was congested, hemorrhagic, and greenish blue in color. The liver, on histological examination, showed sub-massive hepatic necrosis. On toxicological analyses, copper sulfate was detected in preserved viscera and results for other heavy metals were negative. Conclusion: Hypotension, cyanosis, uremia and jaundice can be considered as signs of poor prognosis in copper sulfate poisoning. Copper sulfate ingestion is life-threatening due to its deleterious effects on the upper GI, kidneys, liver and blood. Having no time to waste, aggressive treatments should be immediately instituted and signs of poor prognosis should be kept in mind.

Unique Gene Expression and MR T2 Relaxometry Patterns Define Chronic Murine Dextran Sodium Sulphate Colitis as a Model for Connective Tissue Changes in Human Crohn’s Disease

IntroductionChronically relapsing inflammation, tissue remodeling and fibrosis are hallmarks of inflammatory bowel diseases. The aim of this study was to investigate changes in connective tissue in a chronic murine model resulting from repeated cycles of dextran sodium sulphate (DSS) ingestion, to mimic the relapsing nature of the human disease.Materials and MethodsC57BL/6 mice were exposed to DSS in drinking water for 1 week, followed by a recovery phase of 2 weeks. This cycle of exposure was repeated for up to 3 times (9 weeks in total). Colonic inflammation, fibrosis, extracellular matrix proteins and colonic gene expression were studied. In vivo MRI T 2 relaxometry was studied as a potential non-invasive imaging tool to evaluate bowel wall inflammation and fibrosis.ResultsRepeated cycles of DSS resulted in a relapsing and remitting disease course, which induced a chronic segmental, transmural colitis after 2 and 3 cycles of DSS with clear induction of fibrosis and remodeling of the muscular layer. Tenascin expression mirrored its expression in Crohn’s colitis. Microarray data identified a gene expression profile different in chronic colitis from that in acute colitis. Additional recovery was associated with upregulation of unique genes, in particular keratins, pointing to activation of molecular pathways for healing and repair. In vivo MRI T2 relaxometry of the colon showed a clear shift towards higher T2 values in the acute stage and a gradual regression of T2 values with increasing cycles of DSS.ConclusionsRepeated cycles of DSS exposure induce fibrosis and connective tissue changes with typical features, as occurring in Crohn’s disease. Colonic gene expression analysis revealed unique expression profiles in chronic colitis compared to acute colitis and after additional recovery, pointing to potential new targets to intervene with the induction of fibrosis. In vivo T2 relaxometry is a promising non-invasive assessment of inflammation and fibrosis.

Drug-induced acute liver injury mimicking autoimmune hepatitis after intake of dietary supplements containing glucosamine and chondroitin sulfate

Herbal and dietary supplements are widely used as measures to improve and preserve health and well-being. Among the bestselling preparations are dietary supplement containing glucosamine and chondroitine sulfate taken to improve symptoms of osteoarthritis. We here present a case of a male patient with biopsy-proven acute and severe autoimmune hepatitis subsequent to intake of a preparation containing glucosamine and chondroitine sulfate. Response to steroids was favorable and resulted in complete remission of the patient. Diagnostic work-up of the case revealed no other possible cause of liver injury, and causality assessment using the Roussel Uclaf Causality Assessment Method (RUCAM) resulted in a possible causal relationship between intake of glucosamine and chondroitine sulfate and the adverse hepatic reaction. The present case recalls that products containing glucosamine and chondroitine sulfate can occasionally cause acute liver injury mimicking autoimmune hepatitis, and reminds of the potential dangers of compounds with poor efficacy and ill-defined safety records.

No effect of 6-month intake of glucosamine sulfate on Modic changes or high intensity zones in the lumbar spine: sub-group analysis of a randomized controlled trial

BackgroundThe underlying pathology and natural course of Modic changes (MC) in the vertebral body marrow and high intensity zones (HIZs) in the annulus fibrosus is not completely clarified. These findings on magnetic resonance imaging (MRI) have initiated different treatments with little or unclear effect. In a randomized trial (n = 250), glucosamine sulfate (GS) had no effect on low back pain related disability. GS could still have an effect on MC and HIZ. In this sub-study, 45 patients from the trial who had MC and/or HIZ at pre-treatment underwent follow-up MRI. The aim was to examine the course of MC and HIZ and to compare this course between groups treated with 6-month intake of oral GS versus placebo.ResultsOf 141 pre-treatment MC in 42 (of 45) patients, 29 (20.6%) MC in 18 patients had altered type and 14 MC in 9 patients had altered size (decreased for 1 MC) 6-18 months later: odds ratio (OR) for type vs. size alterations 4.0; 95% confidence interval (CI) 1.2-17.7. No MC resolved. HIZ vanished from 3 of 23 discs in 3 of 21 patients with pre-treatment HIZ. Ten new MC (all type I or I/II) occurred in 8 patients and 2 new HIZs in 2 patients. The GS group (n = 19) and placebo group (n = 26) did not differ in proportions of MC with decreased (OR 1.6; 95% CI 0.4-6.1) or increased type I dominance at follow-up (OR placebo:GS 2.4; 95% CI 0.6-9.7), or with increased size (OR 1.0; 95% CI 0.2-4.7). HIZ vanished from 1 of 8 discs in 1 of 8 patients in the GS group vs. 2 of 15 discs in 2 of 13 patients in the placebo group (OR 0.8; 95% CI 0.02-12.2).ConclusionsIn this sub-group analysis of a placebo-controlled trial, the effect of GS on MC and HIZs was no different from the effect of the placebo intervention. MC and HIZs remained mostly unchanged during the 6-18 months study period. Some short term changes did occur and MC more often altered type than size.Trial registrationNCT00404079 at http://www.clinicaltrial.gov.

Abstract 384: Interleukin-6 Mediates the Altered Platelet Function Associated with Experimental Colonic Inflammation

Patients with inflammatory bowel disease (IBD) are susceptible to microvascular thrombosis and thromboembolism. The increased incidence of thrombosis is accompanied by enhanced coagulation and abnormalities in platelet function. Clinical studies have also revealed alterations in platelet activation, enhanced platelet-leukocyte interaction, and elevated plasma levels of prothrombotic cytokines, such as IL-6. This study was directed towards determining whether: 1) experimental colitis, induced by 6 days of dextran sodium sulfate (DSS) ingestion, is associated with platelet activation and the formation of platelet-leukocyte aggregates (PLAs), 2) IL-6 deficiency alters these responses to DSS colitis, and 3) the platelet abnormalities observed in DSS mice can be recapitulated by chronic infusion of murine recombinant IL-6. Flow cytometry was used to characterize platelet function in heparin-anticoagulated whole blood. Platelets were identified by characteristic light scattering and membrane expression of CD41. Platelet activation was monitored using the expression of an activation epitope of GPIIb/IIIa integrin (with JON/A antibody). The combination of CD41, CD45.2, Gr-1, F4/80 and isotype control antibodies were used to detect and quantify aggregates of leukocytes, neutrophils and monocytes with platelets in control, wild type (WT) colitic, IL-6 -/- colitic, and WT mice implanted with IL-6 loaded Alzet osmotic minipumps (for 6 days). Our results indicate that DSS colitis is associated with increased numbers of activated platelets and the formation of aggregates of leukocytes (PLA), neutrophils (PNA) and monocytes (PMA) with platelets. These platelet responses to experimental colitis were largely undetected in IL-6 -/- mice. Chronic infusion (at a rate that yielded plasma IL-6 levels similar to those detected in DSS colitic mice) of IL-6 recapitulated the increased platelet activation and formation of PLA, PNA, and PMA observed in DSS-colitic mice. Collectively, these findings show that the altered platelet function detected in human IBD can be reproduced in an animal model of colonic inflammation and that interleukin-6 plays a critical role in the genesis of these platelet abnormalities in the setting of experimental IBD.

Whey Protein Versus Whey Protein Hydrolyzate for the Protection of Azoxymethane and Dextran Sodium Sulfate Induced Colonic Tumors in Rats

Recent studies have shown that whey protein has many useful effects including its anti-cancer effect. In this study we have compared the protective effect of dietary whey protein with whey protein hydrolyzate against azoxymethane and dextran sodium sulfate induced colon cancer in rats. We used a rat model of the colon cancer induced by administration of azoxymethane followed by repeated dextran sodium sulfate ingestion which causes multiple tumor development. Colon tissues were analyzed histologically in addition to biochemical analyses performed by measuring lipid peroxidation, protein oxidation and glutathione levels in both of colon and liver tissues of rats after sacrification. Macroscopic and microscopic tumors were identified in all groups that received azoxymethane followed by repeated dextran sodium sulfate. Group fed with whey protein hydrolyzate showed significantly less macroscopic and microscopic tumor development compared with group fed with whey protein. The protocol applied to generate an appropriate model of colon cancer was successful. Whey protein hydrolyzate was found to be more effective in preventing colon tumor development compared with whey protein.

Complications and management of acute copper sulphate poisoning; a case discussion

Copper sulphate ingestion (accidental or deliberate) is a rare form of poisoning usually limited to the Indian subcontinent. Though the rates are on the decline, it is essential that physicians are aware of its lethal complications and management strategies. The main complications of copper sulphate ingestion include intravascular haemolysis, methaemoglobinaemia, acute kidney injury and rhabdomyolysis. The lethal dose can be as small as 10 grams. We have explored the complications of acute copper sulphate poisoning with examples from two case presentations. We also recommend measures for prevention of such events.

A Case Report of Ammonium Sulfate Inhalation

Ammonium Sulfate (NH4)2SO4, is an inorganic chemical compound with its nitrogen in the ammoniac form and a high sulfur content. It contains 21% nitrogen as ammonium ions and 24% sulfur as sulfate ions. Ammonium Sulfate is also a favorite source of N and S with many liquid blend producers. The raw materials used in the production of Ammonium Sulfate are ammonia and sulfuric acid (1). It forms large rhombic prisms, has a somewhat saline taste and is easily soluble in water. It is described as a mutagen. Although ammonium sulfate is widely used in agriculture, the laboratory and processing leather, there is only limited knowledge on ammonium sulfate intoxication involving humans. There is one suicide case reported in 1999, acute poisoning by ingestion of ammonium sulfate and due to the limited knowledge in humans, this case report has been established with an animal study (2). This study reports that ammonium sulfate is rapidly absorbed by ingestion in rabbits and hyperammonemia develops quickly and this hyperammonemia may induce abnormal Electroencephalography (EEG) findings and convulsions in rabbits (2). There is no case report and there are only a few studies on the inhalation of ammonium sulfate. Due to this lack of knowledge, we decided to report the clinical and laboratory findings of the case that arrived to our ED with accidental ammonium sulfate inhalation.

Acute kidney injury in the tropics

Acute kidney injury (AKI) is one of the most challenging problems faced by clinicians in the tropics owing to its fast-changing burden. AKI in the tropics is strikingly different from that in the developed world in terms of etiology and presentation. In addition, there is a stark contrast between well-developed and poor areas in the tropics. The true epidemiological picture of AKI in the tropics is not well understood due to the late presentation of patients to tertiary centers. Infections remain the major culprit in most cases of AKI, with high mortality rates in the tropics. Human immunodeficiency virus–related AKI, related to nephrotoxicity due to antiretroviral therapy, is on the rise. Acute tubular necrosis and thrombotic microangiopathy are the most common mechanisms of AKI. A notable problem in the tropics is the scarcity of resources in health centers to support patients who require critical care due to AKI. This article reviews the unique and contrasting nature of AKI in the tropics and describes its management in each situation.

Effects of a single dose of oral iron on hepcidin concentrations in human urine and serum analyzed by a robust LC-MS/MS method

BackgroundThe measurement of serum hepcidin, a peptide hormone that regulates iron metabolism, is clinically important to the understanding of iron homeostasis in health and disease. To date, the quantification of serum hepcidin levels by conventional immunological detection methods has proven problematic due to challenges in obtaining high quality antibodies which demonstrate good reproducibility. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) has been employed recently for more sensitive quantification of hepcidin; however, this method has high background levels and therefore less than optimal specificity. MethodsIn order to increase the specificity of the mass spectrometry based assay, we developed a robust, ultra-performance liquid-chromatography-tandem mass spectrometry (UPLC-MS/MS) protocol using multiple selected reaction monitoring (mSRM) for quantification of hepcidin levels in urine and serum of human subjects. With this assay, we assessed levels of hepcidin before and for up to 8h after oral ingestion of ferrous sulfate in ten adult human subjects without known disease. ResultsThe linear response of hepcidin quantitation on each instrument was measured, and the correlation coefficients of these calibrations were r2=0.9512±0.0202 (n=5) for urine and r2=0.9709±0.0291 (n=5) for serum [r2=mean±SD]. Compared to baseline, the levels of urinary hepcidin between 2–4h and 4–8h of both women and men showed significant increases with p<0.05 and p<0.001, respectively. The levels of serum hepcidin between 4h and 8h in both women and men showed significant increases, compared with baseline values, with both p<0.01. Interestingly, we also observed some degree of oscillation of levels, occurring at later time points. ConclusionsWe have developed and validated a new method for measuring hepcidin concentrations in human serum and urine and used it to demonstrate early increases with iron supplement in both urinary and serum levels of hepcidin, which return to baseline levels, except in urine samples from men.

Antioxidant, antiinflammatory and neuroprotective actions of chondroitin sulfate and proteoglycans

The antiinflammatory and antiapoptotic effects of chondroitin sulfate (CS) are being used to treat osteoarthritis. Recent evidence has revealed that those peripheral effects of CS may also have therapeutic interest in diseases of the central nervous system (CNS). We review here such evidence. Perineuronal nets (PNNs) formed by chondroitin sulfate proteoglycans (CSPGs) may have a neuroprotective action against oxidative stress potentially involved in neurodegeneration. On the other hand, in human neuroblastoma SH-SY5Y cells CS has antioxidant and neuroprotective effects by activating the signaling pathway PKC/PI3K/Akt and inducing the antioxidant enzyme hemoxygenase-1. Consistent with this is the observation that protein kinase C (PKC) blockade overcomes inhibition of neurite outgrowth elicited by CSPGs. In addition, CS protects cortical neurons against excytotoxic death by phosphorylation of intracellular signals and the suppression of caspase-3 activation. Of interest is the finding that a disaccharide derived from CSPG degradation (CSGP-DS) protects neurons against toxicity both in vitro and in vivo. Furthermore, CSGP-DS efficiently protects against neuronal loss in experimental autoimmune encephalomyelitis and uveitis, decreases secretion of tumor necrosis factor-alpha (TNF-alpha) and block necrosis factor kappa B (NF-kappaB) translocation. In conclusion, CS may have neuroprotective properties linked to its antioxidant and antiinflammatory effects.

Efficacy of a progressive walking program and glucosamine sulphate supplementation on osteoarthritic symptoms of the hip and knee: a feasibility trial

IntroductionManagement of osteoarthritis (OA) includes the use of non-pharmacological and pharmacological therapies. Although walking is commonly recommended for reducing pain and increasing physical function in people with OA, glucosamine sulphate has also been used to alleviate pain and slow the progression of OA. This study evaluated the effects of a progressive walking program and glucosamine sulphate intake on OA symptoms and physical activity participation in people with mild to moderate hip or knee OA.MethodsThirty-six low active participants (aged 42 to 73 years) were provided with 1500 mg glucosamine sulphate per day for 6 weeks, after which they began a 12-week progressive walking program, while continuing to take glucosamine. They were randomized to walk 3 or 5 days per week and given a pedometer to monitor step counts. For both groups, step level of walking was gradually increased to 3000 steps/day during the first 6 weeks of walking, and to 6000 steps/day for the next 6 weeks. Primary outcomes included physical activity levels, physical function (self-paced step test), and the WOMAC Osteoarthritis Index for pain, stiffness and physical function. Assessments were conducted at baseline and at 6-, 12-, 18-, and 24-week follow-ups. The Mann Whitney Test was used to examine differences in outcome measures between groups at each assessment, and the Wilcoxon Signed Ranks Test was used to examine differences in outcome measures between assessments.ResultsDuring the first 6 weeks of the study (glucosamine supplementation only), physical activity levels, physical function, and total WOMAC scores improved (P < 0.05). Between the start of the walking program (Week 6) and the final follow-up (Week 24), further improvements were seen in these outcomes (P < 0.05) although most improvements were seen between Weeks 6 and 12. No significant differences were found between walking groups.ConclusionsIn people with hip or knee OA, walking a minimum of 3000 steps (~30 minutes), at least 3 days/week, in combination with glucosamine sulphate, may reduce OA symptoms. A more robust study with a larger sample is needed to support these preliminary findings.Trial RegistrationAustralian Clinical Trials Registry ACTRN012607000159459.

Recovery from long-lasting post-tonsillectomy dysgeusia

Transient post-tonsillectomy taste dysgeusia (PTD) is a common complaint. Long-lasting PTD is less frequent but has significant consequences on patients' quality of life, with some cases leading to medicolegal issues. Treatment options and knowledge about mechanisms and factors favoring PTD are limited. PTD may result from direct surgical injury, tongue compression, inflammatory processes or side effects of local anesthetics. Some authors also claim that dietary zinc deficiency plays a role in the development of PTD. Although this latter cause had not yet received a lot of attention, we report a case of a female patient who reported a 4-year PTD and recovered within 2 months after oral intake of zinc sulfate. This clinical observation, together with recent findings on significant improvement of taste disorders after zinc treatments for other causes, opens again the question of what extent zinc deficiency plays a role in PTD.

The human pharmacokinetics of oral ingestion of glucosamine and chondroitin sulfate taken separately or in combination

As part of the National Institutes of Health (NIH)-sponsored Glucosamine/Chondroitin sulfate Arthritis Intervention Trial (GAIT) our objective here was to examine (1) the pharmacokinetics (PK) of glucosamine (GlcN) and chondroitin sulfate (CS) when taken separately or in combination as a single dose in normal individuals (n=29) and (2) the PK of GlcN and CS when taken as a single dose after 3 months daily dosing with GlcN, CS or GlcN+CS, in patients with symptomatic knee pain (n=28). The concentration of GlcN in the circulation was determined by established fluorophore-assisted carbohydrate electrophoresis (FACE) methods. The hydrodynamic size and disaccharide composition of CS chains in the circulation and dosage samples was determined by Superose 6 chromatography and FACE. We show that circulating levels of CS in human plasma are about 20 microg/ml. Most significantly, the endogenous concentration and CS disaccharide composition were not detectably altered by ingestion of CS, when the CS was taken alone or in combination with GlcN. On the other hand, the Cmax (single-dose study) and AUC values (multiple-dose study) for ingested GlcN were significantly reduced by combination dosing with CS, relative to GlcN dosing alone. We conclude that pain relief perceived following ingestion of CS probably does not depend on simultaneous or prior intake of GlcN. Further, such effects on joint pain, if present, probably do not result from ingested CS reaching the joint space but may result from changes in cellular activities in the gut lining or in the liver, where concentrations of ingested CS, or its breakdown products, could be substantially elevated following oral ingestion. Moreover, since combined dosing of GlcN with CS was found to reduce the plasma levels seen with GlcN dosing alone, any improved pain relief by combination dosing cannot be explained by higher circulating concentrations of GlcN.