MATERIALS AND METHODS: Seventy-five participants underwent MRE as an initial investigation or follow-up for inflammatory bowel disease. A systematic sampling method was used to divide the participants into three different groups: group 1 received 6.7% mannitol concentration, group 2 received 3.3% mannitol concentration and group 3 received pineapple juice as an oral contrast agent during their MRE examination. The degree of bowel distension on MRE images was assessed by a radiologist by measuring the bowel diameter from inner wall to inner wall at specified levels, while qualitative analysis was evaluated based on the presence of artefacts. All patients were asked to score their acceptance of the oral contrast and were asked about side effects such as diarrhoea, abdominal discomfort and vomiting.
RESULTS: All patients were able to completely ingest 1.5L of oral contrast. The mean diameter of bowel distension was 2.1cm in patients who received 6.7% mannitol concentration, 2.0cm in patients who received 3.3% mannitol concentration and 1.6 cm in patients who received pineapple juice. Twothirds of patients who received 6.7% mannitol and 3.3% mannitol solutions had good-quality MRE images, but 68% of patients who received pineapple juice had poor-quality MRE images. Twenty-four patients (96%) who received pineapple juice rated it as slightly acceptable and acceptable but only 12 patients (48%) who received 6.7% mannitol solution rated it as slightly acceptable and acceptable. Eighty-eight percent of patients who received 6.7% mannitol solution experienced at least one form of side effect as compared to 44% of patients who received 3.3% mannitol solution and 18% of patients who received pineapple juice.
CONCLUSION: Optimum small bowel distension and good image quality can be achieved using 3.3% mannitol concentration as an oral contrast agent. Increase in mannitol concentration does not result in significant improvement of small bowel distension or image quality but is instead related to poorer patient acceptance and increased side effects. Pineapple juice is more palatable than mannitol and produces satisfactory small bowel distension. However, the small bowel distension is less uniform when using pineapple juice with a considerable presence of artefacts. Mannitol, 3.3% concentration, is therefore recommended as an endoluminal contrast agent for bowel in MRE.
SETTING: A tertiary medical centre in Kuala Lumpur, Malaysia.
PARTICIPANTS: A total of 219 patients (range 23-80 years) who had received phosphodiesterase type-5 (PDE-5) inhibitors as ED treatment were evaluated.
INCLUSION CRITERIA: Adult patients aged ≥18 years, diagnosed with ED, and prescribed with sildenafil, tadalafil or vardenafil.
EXCLUSION CRITERIA: Patients diagnosed with ED but who did not receive any PDE-5 inhibitor, or those with missing data.
PRIMARY AND SECONDARY OUTCOME MEASURES: Factors associated with demographic and clinical characteristics as well as drug selection were assessed.
RESULTS: Ischaemic heart disease (p=0.025), benign prostatic hyperplasia (p<0.001), obesity (p=0.005), lower urinary tract symptoms (LUTS) (p=0.006) and α-blockers (p<0.001) were significantly associated with elderly patients with ED. Additionally, LUTS (p=0.038) and α-blockers (p=0.008) were significantly associated with the selection of PDE-5 inhibitor.
CONCLUSIONS: These data showed that elderly patients with ED were significantly associated with comorbidities and α-blockers, whereas LUTS and α blockers were associated with drug selection.
Materials and Methods: TQ-NLC was radiolabeled with technetium-99m before the administration to the rats. The biodistribution and pharmacokinetics parameters were then evaluated at various time points. The rats were imaged at time intervals and the percentage of the injected dose/gram (%ID/g) in blood and each organ was analyzed.
Results: Oral administration of TQ-NLC exhibited greater relative bioavailability compared to intravenous administration. It is postulated that the movement of TQ-NLC through the intestinal lymphatic system bypasses the first metabolism and therefore enhances the relative bioavailability. However, oral administration has a slower absorption rate compared to intravenous administration where the AUC0-∞ was 4.539 times lower than the latter.
Conclusion: TQ-NLC had better absorption when administered intravenously compared to oral administration. However, oral administration showed greater bioavailability compared to the intravenous route. This study provides the pharmacokinetics and biodistribution profile of TQ-NLC in vivo which is useful to assist researchers in clinical use.
CASE DESCRIPTION: A 28-year-old gentleman with body mass index of 34.3 was referred to us for management of double vision of 2 weeks duration. His symptom started after a brief episode of upper respiratory tract infection. His best corrected visual acuity was 6/6 OU. He had bilateral sixth nerve palsy worse on the left eye and bilateral hypometric saccade. His deep tendon reflexes were found to be hyporeflexic in all four limbs. No sensory or motor power deficit was detected, and his gait was normal. Plantar reflexes were downwards bilaterally and cerebellar examination was normal. Both optic discs developed hyperaemia and swelling. Magnetic resonance imaging of brain was normal and lumbar puncture revealed an opening pressure of 50 cmH2O. Anti-GQ1b IgG and anti-GT1a IgG antibody were tested positive.
CONCLUSION: Acute ophthalmoparesis without ataxia can present with co-occurrence of raised intracranial pressure. It is important to have a full fundoscopic assessment to look for papilloedema in patients presenting with Miller Fisher syndrome or acute ophthalmoparesis without ataxia.