Latar belakang. Terapi osmotik merupakan pilihan terapi penting dalam sindrom ensefalitis akut. Manitol adalah salah satu jenis terapi osmotik yang telah banyak digunakan, namun penggunaanya dapat ...menyebabkan ketidaknormalan elektrolit, seperti hiponatremia dan hipokloremia.Tujuan. Tujuan dari penelitian ini adalah membandingkan salin hipertonik dan manitol pada anak-anak dengan sindrom ensefalitis akut.Metode. Penelitian ini menggunakan desain studi klinis pendahuluan untuk mengevaluasi perbedaan dalam durasi penurunan kesadaran, mortalitas, kadar natrium serum, dan osmolaritas darah pada pasien sindrom ensefalitis akutyang diberikan salin hipertonik dan manitol. Pendekatan acak digunakan untuk mengelompokan setiap sampel. Analisis univariat dan bivariat dilakukan menggunakan perangkat lunak analisis statistik. Hasil. Sembilan pasien secara acak dikelompokan pada salin hipertonik, dan sembilan pasien dikelompokan pada manitol dari total 18 subjek dengan usia median 49,5 (5-194) bulan. Kelompok manitol memiliki kadar natrium awal signifikan lebih tinggi (p=0,009). Antara kedua kelompok perlakukan, tidak terdapat perbedaan dalam durasi penurunan kesadaran maupun mortalitas. Perubahan kadar natrium dan osmolaritas menunjukan perbedaan signifikan. Antara sebelum dan setelah perlakuan, penurunan natrium pada kelompok salin hipertonik lebih besar daripada kelompok manitol median (rentang); -6 (-47 to -4) mmol/L vs 1 (-6 to 17) mmol/L, dan perubahan osmolaritas secara signifikan lebih tinggi Mean SD; -32,6 ± 26,9 mOsm/kg vs 4,7 ± 13,5 mOsm/kg.Kesimpulan. Salin hipertonik dapat dianggap efektif dan aman seperti manitol dalam pengobatan non-traumatik sindrom ensefalitis akut pada anak.
The effect of manitol 20% on changes in blood pressure after traumatic brain injury is unknown. The purpose of this study was to analyze the differences in blood pressure before and after the ...administration of 20% mannitol in traumatic brain injury patients at the Intensive Care Unit. This study is a quasi experimental research which uses a pre-post test without control one group design, a method used in observational analytic techniques. The population of this study were all traumatic brain injury patients who were given a manitol infusion of 20% 100ml, with consecutive sampling technique, obtained 12 samples. With a significance threshold of p 0.05, the test was performed using the Paired T test on systolic and MAP data and the post hoc Wilcoxon test on diastolic data.  paired t-test systolic p=0.000, MAP p=0,000. Wilcoxon test diastolic p=0,002. Decreasing blood pressure 15 minutes after administration of 20% mannitol occurs because half live mannitol which lowers blood pressure and responds to decreased blood pressure autoregulation, at 30 minutes resulting in decreased intra-cranial pressure, improves cerebral perfusion and brain autoregulation that affects systemic blood pressure 60 changes in blood pressure may be due to diuresis effects. During the administration of mannitol there is a change in blood pressure that needs to be monitored
Two bicyclic carbohydrate-based diols, 2,3:4,5-di-O-methylene-galactitol (Galx) or 2,4:3,5-di-O-methylene-d-mannitol (Manx), were introduced into the backbone of poly(butylene terephthalate) using ...the solid-state modification technique (SSM). The resulting copolyesters had a unique block-like chemical microstructure that endows them with superior thermal properties when compared with their random counterparts obtained by melt copolymerization. The materials prepared by SSM displayed higher melting points, crystallization temperatures, and crystallinity due to the presence of long PBT sequences in the copolyester. The glass-transition temperatures also increased upon incorporation of the bicyclic comonomers, this effect being more pronounced for Manx units. The melting points of these block-like copolyesters decreased after melting due to the occurrence of randomization, but they remained higher than those of copolyesters prepared from the melt. SSM was demonstrated to be a very suitable technique for the incorporation of rigid monomers into the amorphous phase of PBT, leading to bio-based non-random copolyesters with remarkable thermal properties.
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Mannitol has been used for many years as an osmotic agent in the management of various medical conditions, including cerebral edema and glaucoma. However, its use has been associated with ...complications such as changes in blood volume and the internal milieu, leading to its progressive substitution by hypertonic saline solutions. In addition, it has been used to prevent and manage acute kidney injury, particularly in surgical patients, and to preserve diuresis in conditions that may promote acute tubular necrosis. Mannitol has also been used in hemodialysis patients to prevent and treat acute complications such as intradialytic hypotension, cramps, and dialysis disequilibrium syndrome. However, most of the studies are retrospective and of low power. Despite the known associated complications, mannitol continues to be used in many centers due to its availability and easy administration. This review aims to evaluate the efficacy and safety of mannitol in managing kidney diseases.
El manitol ha sido utilizado por muchos años como agente osmótico en el manejo de diversas patologías, tales como edema cerebral y el glaucoma. Sin embargo, su uso se ha asociado a complicaciones, fundamentalmente alteraciones de la volemia y del medio interno, lo que ha llevado a sustituirlo progresivamente por soluciones salinas hipertónicas. Además, se ha usado para la prevención y manejo de la lesión renal aguda, particularmente en pacientes quirúrgicos y para preservar la diuresis en condiciones que pueden propiciar una necrosis tubular aguda. El manitol también se ha utilizado en pacientes en hemodiálisis para prevenir y tratar complicaciones agudas como hipotensión intradiálisis, calambres y el síndrome de desequilibrio. Aunque la mayoría de los estudios son retrospectivos y de bajo poder estadístico, y a pesar de las conocidas complicaciones asociadas, el manitol se sigue utilizando en muchos centros por su disponibilidad y fácil administración. La presente revisión tiene por objetivo evaluar la eficacia y la seguridad del manitol el tratamiento de las enfermedades renales.
•HPACE-PAD-MS method is developed to analyze monosaccharide residues of LMWHs.•Glucosamine (GlcN), Arabinose and galactose is identified in all heparin products.•2,5-anhydro-mannitol (An-Man) is ...analyzed qualitatively & quantitatively in LMWHs.•The molecular weight could be calculated using the ratio of GlcN to An-Man.
Low molecular weight heparins (LMWHs), derived from unfractionated heparin (UFH) by chemical or enzymatic degradation, have lower side effects than that of heparin. Enoxaparin, nadroparin, and dalteparin are the most widely used LMWHs. Nadroparin and dalteparin are prepared through nitrous acid degradation followed by a subsequent reduction process, in which specific residue, 2,5-anhydro-d-mannitol (An-Man), is formed at the reducing terminals of generated sugar chains. However, few practicable analytical method was available to analyze An-Man qualitatively and quantitatively. In this work, a HPAEC-PAD-MS method was developed to analyze monosaccharides in heparin and LMWHs, especially An-Man. An ion suppressor is set up between HPAEC and MS to remove the nonvolatile salts from HPAEC and make the elute compatible to MS. Various monosaccharides were separated well with HPAEC. Online MS and MS/MS confirmed all sugar residues in the hydrolysates of heparin samples. The specific residue, An-Man, was only observed in the hydrolysates of LMWHs prepared with nitrous acid degradation and reduction. In addition, major glucosamine and minor arabinose/galactose were observed in all heparin samples. The amounts of these sugar residues were quantitated with PAD, simultaneously. The ratio of glucosamine to An-Man could be used to calculate the molecular weight of LMWHs. The calculated values are comparable to the value measured with size-exclusion chromatography-multiple angle laser scattering detection. Higher the ratio of glucosamine to An-Man higher the molecular weight. The HPAEC-PAD-MS platform is an accurate, precise and efficient way to identify LMWHs by determination of An-Man. It is also an alternative method to detect the MWs of LMWHs having An-Man for quality control purposes.
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El objetivo fue evaluar la respuesta de germinación de siete genotipos de pasto banderita (Bouteloua curtipendula), sometidos a diferentes niveles de presión osmótica. Los genotipos utilizados fueron ...El Reno (Re), Niner (Ni), Vaughn (Va), Kansas-6113 (K-13), Kansas-6107 (K-07), ecotipo 689 (E-689) y ecotipo 592 (E-592). Como agente osmótico se utilizó manitol, los niveles de presión osmótica fueron 0.0, -0.7, -1.4 y -2.1 Megapascales. Las variables evaluadas fueron porcentaje de germinación (GE), índice de velocidad de germinación (Vge), longitud de radícula (LR) y plúmula (LP). Los genotipos nativos (E-592 y E-689) y Va presentaron mayor resistencia al estrés hídrico (p < 0.05). El genotipo K-07 presentó menor GE y Vge, mientras que Ni no presentó germinación a -2.1 MPa. Los genotipos E-592, E-689 y Va pueden considerarse en programas de rehabilitación de pastizales. Sin embargo, por su velocidad de germinación se recomienda utilizarlo mezclado con Re o K-13.
Sementes de trigo infectadas com Pyrenophora tritici-repentis, agente causal da mancha-amarela da folha, respondem em parte pelas epidemias causadas por este patógeno. A obtenção rápida de lotes de ...sementes com alta incidência de P. tritici-repentis é fundamental para estudos de transmissão e controle. Sendo assim, o objetivo deste trabalho foi verificar se alterações no potencial hídrico do meio de cultura e variações na duração da inoculação podem favorecer a infecção de sementes de trigo por P. tritici-repentis, sem comprometer a viabilidade destas sementes. Colônias do patógeno foram cultivadas sobre meio de cultura batata-dextrose-ágar (BDA) básico, no potencial hídrico de -0,36 MPa, e no meio BDA com restrição hídrica, causada pela adição de manitol, nos potenciais hídricos de -0,4, -0,6, -0,8, -1,0 e -1,2 MPa. Foram realizadas análises para determinar o índice de crescimento micelial do fungo e o tempo de exposição das sementes ao meio de cultura para o início do processo germinativo em função dos potenciais hídricos. Posteriormente, sementes de trigo foram colocadas em contato com as colônias de P. tritici-repentis durante 24, 48 e 72 horas nos potenciais hídricos de -0,4, -0,6, -0,8, -1,0 e -1,2 MPa, em esquema fatorial (potenciais hídricos x duração da inoculação) e delineamento inteiramente casualizado. Foram avaliadas as taxas de germinação, de emergência de plântulas em solo e de infecção de sementes. Houve estímulo ao crescimento micelial nos menores potenciais hídricos, sendo que nesses potenciais, o tempo para início de germinação é maior. A duração da inoculação de 24 horas e o uso de restrição hídrica com potencial de -0,4 MPa foram eficientes para infectar sementes de trigo com P. tritici-repentis, sem prejudicar a germinação e a emergência de plântulas em condições de laboratório.
Latar belakang. Manitol dan NaCL 3% merupakan agen hiperosmolar yang direkomendasikan pada pasien anak dengan cedera kepala akibat trauma. Beberapa penulis memberikan argumen bahwa larutan salin ...hipertonis lebih efektif, tetapi belum ada konsensus berkaitan dengan indikasi, konsentrasi, dan cara pemberian yang terbaik. Tujuan. Membandingkan pemakaian manitol dan NaCl 3% pada anak dengan cedera kepala akibat trauma yang dirawat di ruang rawat intensif dalam hal lama rawatan, mortalitas, dan gangguan elektrolit. Metode. Penelitian retrospektif dilakukan dengan pengumpulan data rekam medis pasien traumatic brain injury (TBI) yang dirawat di ruang rawat intensif anak RSUP H. Adam Malik selama kurun waktu Juni 2012 sampai dengan Mei 2013. Data dibagi atas dua kelompok, yaitu pasien yang mendapatkan manitol dan NaCl 3% sebagai agen hiperosmolar. Analisis statistik dilakukan dengan Mann Whitney U-test, chisquare, dan fisher exact test. Hasil. Subjek 47 orang pasien TBI, 29 di antaranya mendapatkan manitol dan 18 mendapat NaCl 3%. Perbandingan antara kelompok manitol dan NaCl 3% tidak menunjukkan perbedaan yang bermakna secara statistik dalam hal lama rawatan (5,79 + 4,37 hari) vs (6,00 + 4,20 hari);p=0,733, mortalitas (44,44% vs 20,69%; p=0,083), dan gangguan elektrolit (37,93% vs 33,33%). Kesimpulan. Tidak ada perbedaan dalam hal lama rawatan, mortalitas dan gangguan elektrolit dengan penggunaan manitol dan NaCl 3% sebagai agen hiperosmolar pada pasien cedera kepala akibat trauma. Dibutuhkan penelitian lebih lanjut dengan metode prospektif dan jumlah sampel yang lebih besar.
A prospective, randomized, double-blind study was designed to assess differences in brain relaxation between 20% mannitol and 3% hypertonic saline (HS) during elective supratentorial brain tumour ...surgery in patients with midline shift.
Sixty patients undergoing supratentorial craniotomy for tumour resection were enrolled to receive either 5mL/kg of 20% mannitol (n=30) or 3% HS (n=30) administered at skin incision. PCO2 in arterial blood was maintained within 35–40mmHg and arterial blood pressure was controlled within baseline values ±20%. The primary outcome was the proportion of satisfactory brain relaxation. The surgeon assessed brain relaxation on a four-point scale (1=excellent with no swelling, 2=minimal swelling, 3=serious swelling not requiring treatment, 4=severe swelling requiring treatment). Postsurgical intracranial changes determined by imaging techniques, postoperative complications, PACU and hospital stay, and mortality at 30 days were also recorded. Appropriate statistical tests were used for comparison; P<0.05 was considered as significant. This trial was registered in Eudract.ema.europa.eu (#2021-006290-40).
There was no difference in brain relaxation: 2.00 1.00–2.00 and 2.00 1.75–3.00 for patients in mannitol and HS groups, respectively (P=0.804). Tumour size (OR: 0.99, 95% CI: 0.99–1.01; P=0.371), peritumoral oedema classification (OR: 0.57, 95% CI: 0.11–2.84; P=0.493), mass effect (OR: 0.86, 95% CI: 0.16–4.87; P=0.864), anaesthesia (OR: 4.88, 95% CI: 0.82–28.96; P=0.081) and midline shift (OR: 5.00, 95% CI: 0.84–29.70; P=0.077) did not have a significant influence on brain swelling in patients treated with either mannitol or HS. No significant differences in perioperative outcomes, mortality and length of PACU and hospital stay were observed.
5mL/kg of 20% mannitol or 3% HS result in similar brain relaxation scores in patients undergoing craniotomy for supratentorial brain tumour with midline shift.
Estudio prospectivo, aleatorizado y doble ciego diseñado para evaluar diferencias en la relajación cerebral entre manitol 20% y salino hipertónico (SH) 3% durante cirugía supratentorial electiva por tumor cerebral en pacientes con desviación de línea media.
Sesenta pacientes sometidos a craneotomía supratentorial para resección tumoral se estudiaron para recibir 5ml/kg de manitol 20% (n=30) o SH 3% (n=30) administrados durante la incisión cutánea. La pCO2 en sangre arterial se mantuvo entre 35-40mmHg y la presión arterial se controló dentro de valores basales±20%. El objetivo principal fue la proporción de relajación cerebral satisfactoria. El cirujano evaluó la relajación cerebral en una escala de 4 puntos (1=excelente sin hinchazón, 2=hinchazón mínima, 3=hinchazón grave que no requiere tratamiento, 4=hinchazón severa que requiere tratamiento). Los cambios intracraneales posquirúrgicos determinados por técnicas de imagen, complicaciones postoperatorias, estancia en reanimación y hospitalaria, así como mortalidad a 30 días fueron registrados. Se usaron test estadísticos para la comparación, siendo considerado p<0,05 como significativo. El ensayo fue registrado en Eudract.ema.europa.eu (#2021-006290-40).
No hubo diferencias en la relajación cerebral: 2,00 1,00-2,00 y 2,00 1,75-3,00 en los pacientes del grupo manitol y SH respectivamente (p=0,804). El tamaño tumoral (OR: 0,99: IC 95%:0,99-1,01; p=0,371), nivel de edema peritumoral (OR: 0,57; IC 95%:0,11-2,84; p=0,493), efecto masa (OR: 0,86; IC 95%: 0,16-4,87; p=0,864), anestesia empleada (OR: 4,88; 95% IC: 0,82-28,96; p=0,081) y desviación de la línea media (OR: 5,00; IC 95%: 0,84-29,70; p=0,077) no tuvieron influencia significativa sobre la hinchazón cerebral en los pacientes de ambos grupos. No hubo diferencias significativas en los resultados perioperatorios, mortalidad ni en estancia en reanimación ni hospitalaria.
Tanto manitol 20% como SH 3% a 5ml/kg consiguen niveles similares de relajación cerebral en pacientes sometidos a craneotomía para tumor cerebral supratentorial con desviación de la línea media.
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