Pilocarpine-Hydrocloride Has a Short-Time Effect on Reducing Xerostomia

Kserostomija, tj. suhoća usta jest stanje uglavnom uzrokovano uzimanjem lijekova, imunološkim bolestima (Sy. Sjoegren) ili radioterapijom tumora usta i glave. Postoje mnogi ali ne dovoljno učinkoviti terapijski postupci, uključujući i uporabu agonista muskarinskih receptora pilokarpin- hidroklorida. U Hrvatskoj liječenje salivarne hipofunkcije polikarpin-hidrokloridom još nije uvedeno. U ovome istraživanju cilj je bio ocijeniti učinak peroralne uporabe pilokarpina na male žlijezde slinovnice i ukupnu salivaciju te nadzirati moguće neželjene pojave i subjektivni odgovor bolesnika na terapiju. Bio je to jednostruko slijepi placebo pokus. Deset bolesnika s kserostomijom sudjelovalo je u pokusu. Isključeni su bolesnici sa srčanim i plućnim bolestima te oni kojima se tijekom uključenog ispitivanja 7 dana prije pokusa kemijskom stimulacijom C-vitaminom nije povećao salivarni tok. Pokus je obuhvaćao 7 uzastopnih mjerenja količine sline u vremenskim razmacima od 15 do 30 min, od vremena neposredno prije i nakon jedinstvene doze 5 mg pilokarpin- hidroklorida (5 kapi otopine, Pilokarpin 2%, Pliva, hrvatska). Sekrecija malih slinovnica mjerena je na donjoj usni i nepcu s pomoću Periotrona (Oraflow, Plainview, SAD), a ukupna salivacija mjerna je s piomoću graduiranih epruveta. Svaki je ispitanik ispunio jednostavan upitnik o subjektivnoj percepciji liječenja i o možebitnim nuspojavama. Sljedeći je tjedan procedura ponovljena, ali tada je umjesto pilokarpina upotrebljena dekspantenolna otopina (D-panthenol, Ljekarne Zagreb, Hrvatska) kao placebo. Pilokarpin je povećao slivaciju i poboljšao simptome u svakog bolesnika. Razlike u sekreciji sline bile su statistički znatne i u usporedbi sa stanjem prije ordiniranja pilokarpina i u usporedbi s placebom (p = 0,01). Nije bilo zabilježenih nepoželjnih pojava ni nakon ordiniranja pilokarpina ni nakon placeba. Nakon poboljšanja salivacije učinak pilokarpina se vremenom smanjuje, što je zabilježeno tijekom promatranja bolesnika. Uzimajući u obzir kontraindikacije i neželjene učinke, rezultati našeg ispitivanja upućuju da bi se pilokarpin trebao redovito upotrebljavati u liječenju kserostomije.Xerostomia, i.e. oral dryness, is mainly caused by side effects of medications, immunologic diseases, e.g. Sy. Sjoegren, and radiation treatment for oral and neck cancer. There are variable, although far from satisfactory, treatment options, including that of muscarinic receptor agonist pilocarpine-hydrochloride. Pilocarpine treatment of salivary hypofunction is not yet an established method in croatia. The aim of this preliminary study was to assess the autcome of oral administration of pilocarpin on minor salivary glands and whole saliva production, as well as to monitor possible side effects and patients subjective responses to treatment. Is was a single blind-placebo controlled trial. Ten patients suffering from xerostomia underwent this trial. Patients with cardiac or pulmonary diseases were excludet, as well as those that did not show any increase in salivary flow rate after administration of ascorbic acid solution (chemical stimulant) at inclusion testing one week prior to the experiment. The experiment comprised 7 repeated measurements in time intervals of 15-30 min., from the baseline up to 2 h after single oral administration of 5 mg of pilocarpine hydrochloride ( 5 drops of slution, Pilokarpin 2%, pliva, Croatia). The flow rate of minor salivary glands was measured on the lower lip and palate by means of Periotron (Oraflow Inc., Plainview, USA) and whole saliva was collected in calibrated test tubes . A simple questionnaire was filled in to record patients subjective perception of treatment. The same procedure was repeated one week later, when dexpanthenol drops (DPanthenol, Ljekarne Zagreb, Croatia) were used as placebo instead of pilocarpine. Pilocarpine increased salivary output and gave symptomatic relief in every patient. The differences in salivary output were significant both compared to baseline and to placebo controls (p = 0,01). There were no side effects during the trial, either after administration of pilocarpine; or placebo. After increasing salivary flow rate the action of pilocarpine decrease in time, which was recordable during the observation session. Respecting possible contraindications and side effects, according to our finding pilocarpine should be regulary used in treatment of xerostomia

Periotron as a Modern Sialometric Method in Xerostomia Diagnosis and Treatment Monitoring

Periotron (Oraflow, Plainview, SAD), mjerač mikrokoličine vlažnosti, elektronički je instrument napravljen za mjerenje gingivne tekućine, eksudata parodontnoga džepa, lučenja sline i debljine filma sline. U mjerenju se rabe različiti papirni mediji za sakupljanje uzorka. Ti se mediji (Periopaper strips, PeroCol strips, Sialopaper strips) stave na željeno mjesto u ustima i ostave tijekom određenog vremena, nakon čega se odloži između elektroda Periotrona. Poseban oblog elektroda omogućuje im da djeluju kao 2 ploče kondenzatora, čime mjeri submikrolitarske količine oralnih fluida i prikazuje numerički podatak na zaslonu od tekućega kristala. Unošenjem podataka dobivenih prethodnom kalibracijom instrumenta u program Periotron Professional software for Windows izradimo baždarnu krivulju iz koje interpolacijom izračunamo realni volumen tekućine.Napravili smo jednostruko slijepu placebo-kontroliranu studiju u svrhu procjene mogućega postojanja dugoročnog učinka polikarpin-hidroklorida (PHK) na lučenje sline u bolesnika s kserostomijom. Dvanaest bolesnika s kserostomijom uključeno je u ispitivanje. Držali smo se strogih uključnih kriterija u svezi s mogućim nuspojavama i kontraindikacijama. Šest bolesnika je podučeno da uzimaju peroralno 5 mg PHK (po 5 kapi otopine, Pilokarpin 2% Pliva, Zagreb, Hrvatska) 3 puta na dan tijekom 7 dana. Drugih 6 bolesnika (placebo skupina) uzimalo je po 5 kapi dekspantenol (D-panthenol, Ljekarne Zagreb, Hrvatska) 3 puta na dan tijekom 7 dana. Lučenje malih slinovnica mjereno je na donjoj usni i na nepcu s pomoću Periotrona, a ukupna slina je sakupljana u baždarene epruvete. Mjerenja su se ponavljala svaki tjedan. Svaki je ispitanik ipunio Oral Health Impact profile (OHIP) upitnik prije i nakon 7 tjedana uzimanja ordiniranog sredstva u svrhu procjene utjecaja oralnog zdravlja na život bolesnika. Nakon 7 tjedana bolesnicima iz placebo skupine ordiniran ja PHK, ali nije bilo vidljive potrebe za ordiniranjem placeba onima koji su prije uzimali PHK budući da u toj skupini nije bilo poboljšanja salivacije. U bolesnika placebo skupine niti nakon uzimanja PHK nije bilo poboljšanja salivacije. Nalazi OHIP-a nisu pokazali statistički znatnu razliku nakon 7 tjedana liječenja. Jedan bolesnik iz placebo skupine (dok je još uzimao placebo), kao i 1 ispitanik iz PHK skupine, odustali su iz ispitivanja zbog navodnih nuspojava. Peroralna upotreba PHK ne uzrokuje dugoročno poboljšanje salivacije nego vjerojatno samo trenutačno i kratkotrajno poboljšanje. Sudeći prema rezultatima Periotrona i nalazu ukupne sline, naši podatci dokazuju kako PHK ne može dugotrajnom upotrebom “izliječiti” kserostomiju, to jest da nema produljenog ili kumulativnog učinka u stimulaciji salivacije.The Periotron micro-moisture meter (Oraflow, Plainview, USA) is an electronic instrument that has been designed for gingival vrevicular fluid (GCF), periodontal pocket fluid (PPF), salivary flow and saliva thickness measurments, by using a variety of paper collection strips. Collection strips (Periopaper strips, PerioCol strips, Sialopaper strips) are applied to the oral tissues of interest for a certain period of time, after which the are inserted between Periotron electrodes. The special insulation coating on the electrodes enables them to work as two plates of a capacitor, being able to measure submicroliter quantities of oral fluids. Periotron displays the numerical output on LCD. By inputting data obtained during prior calibration process into Periotron professional software for Windows, we design a standard curve, from which we interpolate actual fluid volume. We have designed a single blind placebo controlled study to evaluate possible presence of long-term effect of pilocarpine-hydrocloride (PHC) on salivary flow rate in patients with xerostomia. 12 patients suffering from xerostomia underwent this trial. We used strict inclusion criteria regarding the possible side effects. Six patients were instructed to self-administer 5 mh of PHC (5 drops of solution, Pilokarpin 2%, pliva Zagreb, Croatia), three times a day, for 7 days. Another 6 patients (placebo group) were instructed to take 5 dexapanthenol drops (D panthenol, Ljekarne Zagreb, Zagreb, croatia), 3 times a day for 7 weeks. The flow rate of minor salivary glands was measured on the lower lip and palate by means of Periotron and whole saliva was collected in calibrated test tubes. mesurements were repeated once a week. Each patient filled in an extensive Oral Health Impact Profile questionnaire (OHIP) at te baseline and after completion of PHC treatment to monitor oral health influence on patients lives. After 7 weeks of treatment the placebo group was swiched to PHC, but there no apparent need for switching pilocarpine group to placebo, because we found no improvement in salivary flow rate after 7 weeks of treatment. in the group previously taking placebo, there was also no improvement in salivary flow rate after taking PHC. OHIP findings were calculated and showed no statistically significnt improvement after 7 weeks of PHC administration. One patient from the pilocarpine group and one from palcebo group ( while taking placebo) reported side effects and discontinuited the trial. oral administration of PHC does not seem to produce log-term salivary flow rate increase, but rther immediate and shortr lasting improvement. Judging by Periotron and whole saliva scores, our results showed that PHC is not able to “cure” xerostomia after prolonged administration, i.e. there is no residual effect in salivary gland simulation once the drug is discontinued and eliminated

Critical revision of some Myxomycetes deposited in the Buenos Aires HerbariaBAFC, BA and the Tucuman Herbarium LIL. IV

Fifty-seven collections preserved in herbaria BAFC, BA; LIL and Ah representing 26 different species of Myxomycetes are included in this paper. Five species, Comatricha ellae, Didymium megalosporum, Lycogala exiguum, Physarum flavicomum and P. stellatum, are new records from Argentina. Microphotograhs using both optical (LM) and scanning electron microscopy (SEM) are included. these photographs illustrate the most representative characteristics of those species which are rare or not mentioned in Argentina before this work.Cincuenta y siete colecciones conservadas en los herbarios BAFC, BA LIL y AH se incluyen en este trabajo que representan 26 especies diferentes de Myxomycetes. Cinco especies, Comatricha ellae, Didymium megalosporum, Lycogala exiguum, Physarum flavicomum y P. stellatum, son nuevas citas para Argentina. Microfotografias de microscopía óptica y microscopía electrónica de barrido son incluidas. Estas fotografías ilustran las características más representativas de las especies que son raras o no citadas en Argentina

Pilocarpine-Hydrocloride Has a Short-Time Effect on Reducing Xerostomia

Kserostomija, tj. suhoća usta jest stanje uglavnom uzrokovano uzimanjem lijekova, imunološkim bolestima (Sy. Sjoegren) ili radioterapijom tumora usta i glave. Postoje mnogi ali ne dovoljno učinkoviti terapijski postupci, uključujući i uporabu agonista muskarinskih receptora pilokarpin- hidroklorida. U Hrvatskoj liječenje salivarne hipofunkcije polikarpin-hidrokloridom još nije uvedeno. U ovome istraživanju cilj je bio ocijeniti učinak peroralne uporabe pilokarpina na male žlijezde slinovnice i ukupnu salivaciju te nadzirati moguće neželjene pojave i subjektivni odgovor bolesnika na terapiju. Bio je to jednostruko slijepi placebo pokus. Deset bolesnika s kserostomijom sudjelovalo je u pokusu. Isključeni su bolesnici sa srčanim i plućnim bolestima te oni kojima se tijekom uključenog ispitivanja 7 dana prije pokusa kemijskom stimulacijom C-vitaminom nije povećao salivarni tok. Pokus je obuhvaćao 7 uzastopnih mjerenja količine sline u vremenskim razmacima od 15 do 30 min, od vremena neposredno prije i nakon jedinstvene doze 5 mg pilokarpin- hidroklorida (5 kapi otopine, Pilokarpin 2%, Pliva, hrvatska). Sekrecija malih slinovnica mjerena je na donjoj usni i nepcu s pomoću Periotrona (Oraflow, Plainview, SAD), a ukupna salivacija mjerna je s piomoću graduiranih epruveta. Svaki je ispitanik ispunio jednostavan upitnik o subjektivnoj percepciji liječenja i o možebitnim nuspojavama. Sljedeći je tjedan procedura ponovljena, ali tada je umjesto pilokarpina upotrebljena dekspantenolna otopina (D-panthenol, Ljekarne Zagreb, Hrvatska) kao placebo. Pilokarpin je povećao slivaciju i poboljšao simptome u svakog bolesnika. Razlike u sekreciji sline bile su statistički znatne i u usporedbi sa stanjem prije ordiniranja pilokarpina i u usporedbi s placebom (p = 0,01). Nije bilo zabilježenih nepoželjnih pojava ni nakon ordiniranja pilokarpina ni nakon placeba. Nakon poboljšanja salivacije učinak pilokarpina se vremenom smanjuje, što je zabilježeno tijekom promatranja bolesnika. Uzimajući u obzir kontraindikacije i neželjene učinke, rezultati našeg ispitivanja upućuju da bi se pilokarpin trebao redovito upotrebljavati u liječenju kserostomije.Xerostomia, i.e. oral dryness, is mainly caused by side effects of medications, immunologic diseases, e.g. Sy. Sjoegren, and radiation treatment for oral and neck cancer. There are variable, although far from satisfactory, treatment options, including that of muscarinic receptor agonist pilocarpine-hydrochloride. Pilocarpine treatment of salivary hypofunction is not yet an established method in croatia. The aim of this preliminary study was to assess the autcome of oral administration of pilocarpin on minor salivary glands and whole saliva production, as well as to monitor possible side effects and patients subjective responses to treatment. Is was a single blind-placebo controlled trial. Ten patients suffering from xerostomia underwent this trial. Patients with cardiac or pulmonary diseases were excludet, as well as those that did not show any increase in salivary flow rate after administration of ascorbic acid solution (chemical stimulant) at inclusion testing one week prior to the experiment. The experiment comprised 7 repeated measurements in time intervals of 15-30 min., from the baseline up to 2 h after single oral administration of 5 mg of pilocarpine hydrochloride ( 5 drops of slution, Pilokarpin 2%, pliva, Croatia). The flow rate of minor salivary glands was measured on the lower lip and palate by means of Periotron (Oraflow Inc., Plainview, USA) and whole saliva was collected in calibrated test tubes . A simple questionnaire was filled in to record patients subjective perception of treatment. The same procedure was repeated one week later, when dexpanthenol drops (DPanthenol, Ljekarne Zagreb, Croatia) were used as placebo instead of pilocarpine. Pilocarpine increased salivary output and gave symptomatic relief in every patient. The differences in salivary output were significant both compared to baseline and to placebo controls (p = 0,01). There were no side effects during the trial, either after administration of pilocarpine; or placebo. After increasing salivary flow rate the action of pilocarpine decrease in time, which was recordable during the observation session. Respecting possible contraindications and side effects, according to our finding pilocarpine should be regulary used in treatment of xerostomia