Treatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate

Background and Aim: Polyethylene glycol (PEG) is the gold standard for fecal disimpaction in constipation. A regimen of PEG combined with the stimulant laxative sodium picosulphate (SPS) produced fecal disimpaction in chronically constipated children in the community, but it is unknown if it is effective for more severe constipation. To determine the stool output and effect of a combined PEG and SPS regimen on fecaloma in children with severe constipation and impaction. Methods: Children with symptoms for a duration of >= 2 years, a palpable fecaloma, and enlarged rectum on X-ray (rectal: pelvic ratio > 0.6) were recruited from a tertiary hospital. Daily diaries recorded laxative dose, stool frequency, volume, and consistency (Bristol stool scale, BSS). Abdominal X-rays were taken on day 1 and day 8, and stool loading was assessed using the Leech score. Laxative doses were based on the child's age. The dose of PEG with electrolytes taken was 2-8 sachets (14.7 g/sachet) on days 1-2, reducing to 2-6 sachets on day 3. The SPS dose was 15-20 drops on days 2-3. Results: Eighty-nine children (4-18 years) produced a large volume of soft stool (median/inter-quartile-range: 2.2/1.6-3.1 L) over 7 days. Stool volume on X-rays decreased significantly in the colon (P <0.001). Fecalomas resolved in 40 of 89 children, while 49 needed a second high dose. Rectal: pelvic ratios did not change. Conclusions: A combined high dose of PEG and SPS on days 1 and 2 was effective in removing the fecaloma in half of the children. Administering high doses for a longer period should be tested to provide outpatient disimpaction for severe fecalomas. Rectums remained flaccid after emptying

Sleep Wake Rhythm: importance of its evaluation in Psychiatry by using a simple and objective instrument - Ritmo sono-vigília: a importância de estudá-lo em psiquiatria usando um instrumento objetivo e simples

Poucos estudos avaliaram a diferença dos efeitos de drogas no gênero  utilizando instrumentos para este fim. Este estudo avaliou o uso de actígrafos simples (pulseiras inteligentes) comparando a influência dos gêneros e uso de nicotina nos padrões de sono e vigília. A amostra foi composta por estudantes universitários de ambos os gêneros, fumantes e não fumantes (n=40). As pulseiras inteligentes foram usadas por 7 dias. Uma ANOVA two way indicou que mulheres dormem mais, apresentando mais sono leve e interrupções do sono noturno. Fumantes apresentaram menor tempo de sono profundo. Os resultados foram coerentes com a literatura. As variáveis do dispositivo correlacionaram significativamente entre si e com os diários do sono. Concluímos sobre a viabilidade do uso de instrumentos de baixo custo e de simples utilização em estudos do sono, o que pode ser útil em pacientes pouco colaborativos