lactulose / Generic mfg. 
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  • ||||||||||  lactulose / Generic mfg.
    Trial completion:  GI Effects of Iron in Healthy Volunteers (clinicaltrials.gov) -  Oct 19, 2022   
    P=N/A,  N=48, Completed, 
    Substitution with 30% trehalose, 5% lactulose and 5% polyols resulted in the most similar water activity, texture, aroma and microbial diversity. Recruiting --> Completed
  • ||||||||||  lactulose / Generic mfg.
    Delirium in Renal Failure, Not Always Uremia: A Case of Thiamine Deficiency With Wernicke Encephalopathy (Exhibit Hall, Orange County Convention Center, West Building) -  Oct 13, 2022 - Abstract #KIDNEYWEEK2022KIDNEY_WEEK_1094;    
    Despite supplemental oxygen, antibiotics, lactulose; sensorium was poor and uremia was thought to be the precipitating factor...Azotemia is not always the cause of altered mentation in renal failure. Considering thiamine deficiency in cases with altered mental status is essential in regards to timely management of patients, prevention of complications and efficient use of resources by introduction of a safe, easily accessible medication: ie thiamine.
  • ||||||||||  Lenvima (lenvatinib) / Eisai, Merck (MSD)
    Journal, Adverse events:  Leaky Gut and Severe Adverse Events in Advanced Hepatocellular Carcinoma Treated With Lenvatinib. (Pubmed Central) -  Oct 10, 2022   
    This study confirms the potential value of rifaximin-a in reducing the number of developing infections and hospital admissions in a severely ill cirrhotic patient population. Serum zonulin levels predict severe adverse events in patients with advanced hepatocellular carcinoma treated with lenvatinib.
  • ||||||||||  Aemcolo (rifamycin SV MMX) / Cosmo Pharma, RedHill, Dr Falk
    A Randomized Open Label Trial Evaluating the Efficacy of Two Dosing Regimens of Rifamycin SV MMX in the Treatment of Small Intestinal Bacterial Overgrowth (SIBO) (Convention Center - Hall 4A (4th Floor); In-Person-Only) -  Oct 9, 2022 - Abstract #ASTMH2022ASTMH_854;    
    A related compound, Rifamycin SV MMX, a member of the ansamycin class of antibiotics, is non absorbable and has activity in the distal small bowel and colon allowing maintenance of the saprophytic bacteria in the proximal small intestine, a microbial milieu which might favor clearance of the overgrowth bacteria...Participants underwent a symptom screening questionnaire and the diagnosis of SIBO was made by a lactulose hydrogen breath test...A positive clinical response was seen in 33% of all participants (17% in arm A and 56% in arm B). Our current findings suggest a higher dosage of rifamycin SV MMX leads to a higher chance of a positive clinical outcome and clearance of SIBO as measured by breath test.
  • ||||||||||  lactulose / Generic mfg.
    Review, Journal:  The potential role of lactulose pharmacotherapy in the treatment and prevention of diabetes. (Pubmed Central) -  Oct 4, 2022   
    A low dose of lactulose with food delayed gastric emptying and increased the whole gut transit times, attenuating the hyperglycemic response without adverse gastrointestinal events. These findings suggest that lactulose may have a role as a pharmacotherapeutic agent in the management and prevention of type 2 diabetes via actions on the gut microbiota.
  • ||||||||||  Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
    The utility of Pharmaceutical Benefits Scheme data to identify “current” medication consumption among people with cirrhosis: A pilot study () -  Oct 4, 2022 - Abstract #AGW2022AGW_338;    
    PBS data also correctly identified patients taking spironolactone (κ = 0.73), furosemide (κ = 0.76), propranolol (κ = 0.86), and rifaximin (κ = 0.96)...Unsurprisingly, PBS data poorly captured use of over-the-counter medicines, including paracetamol (sensitivity, 12.5%; κ = 0.13), aspirin (sensitivity, 15.4%; κ = 0.25), prescribed vitamins (e.g. vitamins A, D, and E, iron, and thiamine; sensitivity, 14.1%; κ = 0.02), lactulose (no PBS data, but consumed in 23.1% of encounters), and complementary medicines (no PBS data, but consumed in 12.4% of encounters)... Our preliminary findings suggest that 6-month PBS data accurately predict consumption of chronic medicines and those prescribed to manage liver disease complications (except lactulose).
  • ||||||||||  lactulose / Generic mfg.
    Journal:  Possible mediators of metabolic endotoxemia in women with obesity and women with obesity-diabetes in The Gambia. (Pubmed Central) -  Sep 24, 2022   
    Raised levels of LPS and IL-6 in women with obesity-diabetes and evidence of macrophage activation in adipose tissue support the concept of metabolic endotoxemia-mediated inflammation, but we found no evidence for abnormal gut permeability or chylomicron-associated post-prandial translocation of LPS. Instead, the markedly lower EndoCAb IgM levels indicate a failure in sequestration and detoxification.
  • ||||||||||  Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
    Review, Journal:  Hepatic Encephalopathy and Treatment Modalities: A Review Article. (Pubmed Central) -  Sep 23, 2022   
    Many people only have minor symptoms, known as minimal HE. The exact pathophysiology of HE is still being debated, with the primary theories focusing on neurotoxins, reduced neurotransmission caused by alterations in brain energy metabolism, systemic inflammatory response, and blood-brain barrier (BBB) disturbances in liver failure, as well as metabolic irregularities.
  • ||||||||||  lactulose / Generic mfg.
    Journal:  Enteric permeability, systemic inflammation and post-discharge growth among a cohort of hospitalized children in Kenya and Pakistan. (Pubmed Central) -  Sep 22, 2022   
    The exact pathophysiology of HE is still being debated, with the primary theories focusing on neurotoxins, reduced neurotransmission caused by alterations in brain energy metabolism, systemic inflammatory response, and blood-brain barrier (BBB) disturbances in liver failure, as well as metabolic irregularities. Although increased enteric permeability is more prevalent among children being discharged from hospital compared to children in the community, it does not appear to be an important determinant of systemic inflammation or post-discharge growth among hospitalized children.
  • ||||||||||  lactulose / Generic mfg.
    Review, Journal:  Intestinal Barrier Permeability in Obese Individuals with or without Metabolic Syndrome: A Systematic Review. (Pubmed Central) -  Sep 18, 2022   
    Alteration of intestinal barrier permeability was evaluated by zonulin, lactulose/mannitol, sucralose, sucrose, lactulose/L-rhamnose, and sucralose/erythritol...Nonetheless, the GRADE assessment indicated a very low to low level of evidence for the outcomes. Thus, clear evidence about the relationship between alteration of human intestinal barrier permeability, obesity, and MetS was not found.
  • ||||||||||  Opdivo (nivolumab) / Ono Pharma, BMS
    DISSEMINATED LISTERIOSIS: A DEADLY TRIPLICATE (Convention Center Exhibit Hall: Rapid Area 1D) -  Sep 11, 2022 - Abstract #CHEST2022CHEST_4120;    
    Medical history was significant for hepatocellular carcinoma on nivolumab, NASH cirrhosis, and recurrent ascites managed with an indwelling peritoneal catheter...His encephalopathy was presumed to be secondary to hepatic encephalopathy and he was treated with lactulose enemas and rifampin...The patient was initiated on ampicillin and gentamicin was added for synergy...Standard treatment involves ampicillin or penicillin G. Combination with an aminoglycoside may be helpful based on in vitro synergy; A retrospective analysis reported significantly better survival in patients receiving combination therapy... Given the high mortality rates and need for altered antibiotic regimens, we urge clinician consideration of this pathogen.
  • ||||||||||  carbamazepine / Generic mfg.
    CARBAMAZEPINE-ASSOCIATED HYPERAMMONEMIC ENCEPHALOPATHY (HE) (Convention Center Exhibit Hall: Rapid Area 2D) -  Sep 11, 2022 - Abstract #CHEST2022CHEST_3769;    
    Management involves prompt diagnosis of hyperammonemia, exclusion of other causes, lowering ammonia and discontinuation of the offending agent. Further studies are needed to better assess the association of carbamazepine with HE.
  • ||||||||||  lactulose / Generic mfg., paracetamol / Generic mfg.
    HIGH ANION GAP KETOACIDOSIS AND HYPERAMMONEMIA WITH SHORT-TERM FASTING IN A NONDIABETIC, NONCIRRHOTIC PATIENT (Convention Center Exhibit Hall: Rapid Area 3B) -  Sep 11, 2022 - Abstract #CHEST2022CHEST_3381;    
    Blood glucose, lactate, D-lactate, BUN, creatinine, ethanol level, acetaminophen level, salicylates level, volatile alcohols, LH, FSH, TSH, B12, and B1 were all within normal limits...Treatment included intubation, insulin drip, 5% dextrose-half-normal saline with sodium bicarbonate and lactulose... Short-term fasting can precipitate euglycemic high anion gap ketoacidosis and hyperammonemia in the non-diabetic, non-cirrhotic population possibly stemming from altered insulin homeostasis.
  • ||||||||||  Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
    HYPERAMMONEMIA POSTLUNG TRANSPLANTATION: AN UNCOMMON BUT LIFE-THREATENING COMPLICATION (Convention Center Exhibit Hall: Rapid Area 1A) -  Sep 11, 2022 - Abstract #CHEST2022CHEST_3315;    
    Clinical signs of hyperammonemia should be promptly recognized in post lung transplant patients and managed aggressively given high mortality rates without treatment. A multi-pronged treatment approach with Intermittent high flux hemodialysis, bowel decontamination and agents targeting the urea cycle should be used to rapidly decrease the ammonia levels.
  • ||||||||||  lactulose / Generic mfg.
    Journal:  Brown and golden flaxseed reduce intestinal permeability and endotoxemia, and improve the lipid profile in perimenopausal overweight women. (Pubmed Central) -  Sep 10, 2022   
    Intestinal permeability analysis was performed by urinary excretion of lactulose and mannitol...Flaxseed consumption did not change oxidative stress markers and glycaemia. Flaxseed consumption, especially golden flaxseed, reduced intestinal permeability and improved the lipid profile, showing positive effects on metabolic changes caused by menopausal transition.HIGHLIGHTSBrown and golden flaxseeds show a high content of insoluble fibre and alpha-linolenic acid, and brown flaxseed presented higher antioxidant activity.Golden flaxseed improved the lipid profile.Brown and golden flaxseeds reduced intestinal permeability and endotoxemia.Brown and golden flaxseed can be a promising alternative for the prevention of metabolic changes caused by menopausal transition, and for the improvement of the intestinal health.
  • ||||||||||  Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
    Severe Noncirrhotic Hyperammonemia: What Urea-lly Should Consider (Crown Ballroom) -  Sep 4, 2022 - Abstract #ACG2022ACG_3998;    
    Case Description/ A 57-year-old man with heart failure with recovered ejection fraction, atrial fibrillation, hypertension, and cervical neck fracture who had undergone a recent cervical spine corpectomy and fusion presented with worsening dysphagia and was found to have a cervical fluid collection for which he received a dexamethasone taper and a lumbar drain...His hyperammonemia resolved and his mentation improved with lactulose and rifaximin...Treatment for a potential IEM begins prior to confirmation of an etiology. Geneticists should be consulted early on for evaluation and management.
  • ||||||||||  Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma, Descovy (emtricitabine/tenofovir alafenamide) / Gilead
    Patient With Autoimmune Hepatitis Requiring Liver Transplant: Case Report and Literature Review (Crown Ballroom) -  Sep 4, 2022 - Abstract #ACG2022ACG_3885;    
    Due to concerns for hepato-renal syndrome, midodrine, octreotide, and albumin were added...After prolonged hospitalization, he was discharged to post-acute rehab with a regimen consisting of tacrolimus, azathioprine, and prednisone...Image B is showing Lobular aggregate of plasma cells adjacent to a central vein and involving hepatocytes which show reactive changes including ballooning (H&E stain, 20X). Table: AST: Aspartate aminotransferase; ALT: alanine aminotransferase; ALP: alkaline phosphatase; INR: international normalized ratio; PT: prothrombin time; BUN: blood urea nitrogen; eGFR: estimated glomerular filtration rate; WBC: white blood count; ASMA: Anti-smooth muscle antibody; AMA: anti-mitochondrial antibody; ANA: antinuclear antibody.