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Li C, Wang S, Ma X, Wang T, Lu R, Jia X, Leng Z, Kong X, Zhang J, Li L. Ranitidine as an adjuvant regulates macrophage polarization and activates CTLs through the PI3K-Akt2 signaling pathway. Int Immunopharmacol 2023; 116:109729. [PMID: 37800555 DOI: 10.1016/j.intimp.2023.109729] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 02/19/2023]
Abstract
Adjuvants are an indispensable component of vaccines, but there are few adjuvants for human vaccines. H2 receptor blockers, inhibiting gastric acid secretion, have immune enhancement effects. Ranitidine (RAN) is a water-soluble H2 receptor blocker, and whether it has an immune-enhancing effect is still unknown. In this study, flow cytometry, western blotting, and immunofluorescence methods were used to analyze whether RAN could activate macrophage polarization to the M1 phenotype in vivo and in vitro. Here, we found that the M1 inflammatory cytokine levels and surface markers in RAW264.7 cells were upregulated by NF-κB activation, possibly through the PI3K-Akt2 signaling pathway, after RAN treatment. Endocytic function was also enhanced by feedback regulation of Akt2/GSK3β/Dynmin1 signaling. Furthermore, to evaluate the adjuvant function of RAN, we used OVA plus RAN as a vaccine to inhibit the growth of B16-OVA tumors in mice. We also found that in the RAN adjuvant group, macrophage polarization to M1, Th1 cell differentiation, and cytotoxic T lymphocyte (CTL) activation were significantly upregulated. The tumor growth of mice was inhibited, and the survival rate of mice was significantly improved. This study provides new evidence for the mechanism by which RAN activates the immune response and is expected to provide a new strategy for the research and development of tumor vaccine adjuvants.
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Affiliation(s)
- Chenglin Li
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, China
| | - Shuang Wang
- School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, China.
| | - Xiaoran Ma
- School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, China
| | - Tiantian Wang
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, China
| | - Ran Lu
- School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, China
| | - Xihui Jia
- School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, China
| | - Zhe Leng
- Department of Gynecology, Qingdao Women and Children's Hospital, Qingdao 266000, China
| | - Xiaowen Kong
- School of Stomatology, Qingdao University, Qingdao 266071, China
| | - Jinyu Zhang
- School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, China
| | - Ling Li
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao 266071, Shandong, China.
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Agarwal SM, Stogios N, Ahsan ZA, Lockwood JT, Duncan MJ, Takeuchi H, Cohn T, Taylor VH, Remington G, Faulkner GEJ, Hahn M. Pharmacological interventions for prevention of weight gain in people with schizophrenia. Cochrane Database Syst Rev 2022; 10:CD013337. [PMID: 36190739 PMCID: PMC9528976 DOI: 10.1002/14651858.cd013337.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Antipsychotic-induced weight gain is an extremely common problem in people with schizophrenia and is associated with increased morbidity and mortality. Adjunctive pharmacological interventions may be necessary to help manage antipsychotic-induced weight gain. This review splits and updates a previous Cochrane Review that focused on both pharmacological and behavioural approaches to this problem. OBJECTIVES To determine the effectiveness of pharmacological interventions for preventing antipsychotic-induced weight gain in people with schizophrenia. SEARCH METHODS The Cochrane Schizophrenia Information Specialist searched Cochrane Schizophrenia's Register of Trials on 10 February 2021. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that examined any adjunctive pharmacological intervention for preventing weight gain in people with schizophrenia or schizophrenia-like illnesses who use antipsychotic medications. DATA COLLECTION AND ANALYSIS At least two review authors independently extracted data and assessed the quality of included studies. For continuous outcomes, we combined mean differences (MD) in endpoint and change data in the analysis. For dichotomous outcomes, we calculated risk ratios (RR). We assessed risk of bias for included studies and used GRADE to judge certainty of evidence and create summary of findings tables. The primary outcomes for this review were clinically important change in weight, clinically important change in body mass index (BMI), leaving the study early, compliance with treatment, and frequency of nausea. The included studies rarely reported these outcomes, so, post hoc, we added two new outcomes, average endpoint/change in weight and average endpoint/change in BMI. MAIN RESULTS Seventeen RCTs, with a total of 1388 participants, met the inclusion criteria for the review. Five studies investigated metformin, three topiramate, three H2 antagonists, three monoamine modulators, and one each investigated monoamine modulators plus betahistine, melatonin and samidorphan. The comparator in all studies was placebo or no treatment (i.e. standard care alone). We synthesised all studies in a quantitative meta-analysis. Most studies inadequately reported their methods of allocation concealment and blinding of participants and personnel. The resulting risk of bias and often small sample sizes limited the overall certainty of the evidence. Only one reboxetine study reported the primary outcome, number of participants with clinically important change in weight. Fewer people in the treatment condition experienced weight gains of more than 5% and more than 7% of their bodyweight than those in the placebo group (> 5% weight gain RR 0.27, 95% confidence interval (CI) 0.11 to 0.65; 1 study, 43 participants; > 7% weight gain RR 0.24, 95% CI 0.07 to 0.83; 1 study, 43 participants; very low-certainty evidence). No studies reported the primary outcomes, 'clinically important change in BMI', or 'compliance with treatment'. However, several studies reported 'average endpoint/change in body weight' or 'average endpoint/change in BMI'. Metformin may be effective in preventing weight gain (MD -4.03 kg, 95% CI -5.78 to -2.28; 4 studies, 131 participants; low-certainty evidence); and BMI increase (MD -1.63 kg/m2, 95% CI -2.96 to -0.29; 5 studies, 227 participants; low-certainty evidence). Other agents that may be slightly effective in preventing weight gain include H2 antagonists such as nizatidine, famotidine and ranitidine (MD -1.32 kg, 95% CI -2.09 to -0.56; 3 studies, 248 participants; low-certainty evidence) and monoamine modulators such as reboxetine and fluoxetine (weight: MD -1.89 kg, 95% CI -3.31 to -0.47; 3 studies, 103 participants; low-certainty evidence; BMI: MD -0.66 kg/m2, 95% CI -1.05 to -0.26; 3 studies, 103 participants; low-certainty evidence). Topiramate did not appear effective in preventing weight gain (MD -4.82 kg, 95% CI -9.99 to 0.35; 3 studies, 168 participants; very low-certainty evidence). For all agents, there was no difference between groups in terms of individuals leaving the study or reports of nausea. However, the results of these outcomes are uncertain given the very low-certainty evidence. AUTHORS' CONCLUSIONS There is low-certainty evidence to suggest that metformin may be effective in preventing weight gain. Interpretation of this result and those for other agents, is limited by the small number of studies, small sample size, and short study duration. In future, we need studies that are adequately powered and with longer treatment durations to further evaluate the efficacy and safety of interventions for managing weight gain.
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Affiliation(s)
- Sri Mahavir Agarwal
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Zohra A Ahsan
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Jonathan T Lockwood
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Markus J Duncan
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Hiroyoshi Takeuchi
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Tony Cohn
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Gary Remington
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Guy E J Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Margaret Hahn
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
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Wang CH, Chen II, Chen CH, Tseng YT. Pharmacoepidemiological Research on N-Nitrosodimethylamine-Contaminated Ranitidine Use and Long-Term Cancer Risk: A Population-Based Longitudinal Cohort Study. Int J Environ Res Public Health 2022; 19:ijerph191912469. [PMID: 36231768 PMCID: PMC9566239 DOI: 10.3390/ijerph191912469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
N-Nitrosodimethylamine (NDMA), a carcinogenic chemical, has recently been identified in ranitidine. We conducted a population-based study to explore ranitidine use and cancer emergence over time. Using the Taiwan National Health Insurance Research Database, a population-based cohort study was conducted. A total of 55,110 eligible patients who received ranitidine between January 2000 and December 2018 were enrolled in the treated cohort. We conducted a 1:1 propensity-score-matching procedure to match the ranitidine-treated group with the ranitidine-untreated group and famotidine controls for a longitudinal study. The association of ranitidine exposure with cancer outcomes was assessed. A multivariable Cox regression analysis that compared cancer risk with the untreated groups revealed that ranitidine increased the risk of liver (hazard ratio (HR): 1.22, 95% confidence interval (CI): 1.09-1.36, p < 0.001), lung (HR: 1.17, CI: 1.05-1.31, p = 0.005), gastric (HR: 1.26, CI: 1.05-1.52, p = 0.012), and pancreatic cancers (HR 1.35, CI: 1.03-1.77, p = 0.030). Our real-world observational study strongly supports the pathogenic role of NDMA contamination, given that long-term ranitidine use is associated with a higher likelihood of liver cancer development in ranitidine users compared with the control groups of non-ranitidine users treated with famotidine or proton-pump inhibitors.
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Affiliation(s)
- Chun-Hsiang Wang
- Department of Hepatogastroenterology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 701033, Taiwan
- Department of Optometry, Chung Hwa Medical University, Tainan 701033, Taiwan
| | - I-I Chen
- Department of Hepatogastroenterology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 701033, Taiwan
| | - Chung-Hung Chen
- Department of Gastroenterology, Chang Bing Show Chwan Memorial Hopital, Changhua 505029, Taiwan
| | - Yuan-Tsung Tseng
- Committee of Medical Research, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 701033, Taiwan
- Correspondence: ; Tel.: +886-6-2609926
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İpek BE, Yüksel M, Cumbul A, Ercan F, Cabadak H, Aydın B, Alican İ. The Effect of Metformin on Ethanol- and IndomethacinInduced Gastric Ulcers in Rats. Turk J Gastroenterol 2022; 33:767-776. [PMID: 35946894 PMCID: PMC9533070 DOI: 10.5152/tjg.2022.21195] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Methods Results: Conclusion:
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Affiliation(s)
- Betül Esra İpek
- Department of Physiology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Meral Yüksel
- Marmara University Vocational Faculty of Health Services, İstanbul, Turkey
| | - Alev Cumbul
- Department of Histology and Embryology, Yeditepe University Faculty of Medicine, İstanbul, Turkey
| | - Feriha Ercan
- Department of Histology and Embryology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Hülya Cabadak
- Department of Biophysics, Marmara University Faculty of Medicine, Maltepe, İstanbul, Turkey
| | - Banu Aydın
- Department of Biophysics, Marmara University Faculty of Medicine, Maltepe, İstanbul, Turkey
| | - İnci Alican
- Department of Physiology, Marmara University Faculty of Medicine, İstanbul, Turkey
- Corresponding author: İnci Alican, e-mail:
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5
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Gupta M, Gulati M, Kapoor B, Kumar B, Kumar R, Kumar R, Khurana N, Gupta R, Singh N. Anti-ulcerogenic effect of methanolic extract of Elaeagnus conferta Roxb. seeds in Wistar rats. J Ethnopharmacol 2021; 275:114115. [PMID: 33852947 DOI: 10.1016/j.jep.2021.114115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/22/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Elaeagnus conferta Roxb. (Elaeagnaceae) is a subtropical shrub mainly native to India, Vietnam, Malaysia and South China, whose various parts are used for treatment of diabetes, gastric ulcers, pain, oxidative stress and pulmonary disorders. Though the other parts of the plant have been reported for their ethnic use i.e. fruits as astringent locally and for cancer systemically, leaves for body pain and flowers for pain in chest and the seeds are mentioned as edible, there is no report per se on the medicinal use of seeds. Based on the fact that seeds of closely resembling species i.e. Elaeagnus rhamnoides has demonstrated significant anti-gastroulcerative property, the probability of the seeds of E. conferta possessing similar activity seemed quite significant. AIM OF THE STUDY Phytochemical investigation and assessment of pharmacological mechanism(s) involved in anti-ulcer effect of methanolic extract of the seeds of E. conferta. MATERIALS AND METHODS Bioactive phytoconstituents were isolated by column chromatography. These were identified by spectroscopic techniques including infrared (IR) spectroscopy, nuclear magnetic resonance (NMR) and mass spectrometry. Methanolic extract (MEC) of the seeds was prepared by cold maceration and its anti-ulcerogenic potential was evaluated using indomethacin (50 mg/kg) and water immersion stress models in male rats. The animals were pre-treated with different doses of MEC (400 and 800 mg/kg) and the therapeutic effect was compared with standard drug i.e. ranitidine (RANT; 50 mg/kg). The ameliorative effects of MEC were investigated on gastric juice pH, total acidity, free acidity and ulcer index. The assays of malionaldehyde (MDA), catalase (CAT), superoxide dismutase (SOD), glutathione (GSH) and pro-inflammatory cytokines i.e. interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were carried out to find out the possible mechanism(s) of protection. Further, histopathological changes were also studied. RESULTS Chromatography studies and further confirmation by spectroscopic techniques revealed the presence of four different compounds in MEC i.e oleic acid (1), stearic acid (2), ascorbic acid (3) and quercetin (4). MEC exhibited anti-ulcerogenic effect in dose dependent manner which may be attributed to suppression of pro-inflammatory cytokines (IL-6, TNF-α) and MDA (112.7%), and up-regulation of protective factors such as CAT (90.48%), SOD (92.77%) and GSH (90.01%). Ulcer inhibition, reduction in total and free acidity and increase in gastric juice pH were observed in MEC treated rats as compared to disease control animals. Histopathological findings confirmed decreased cell infiltration, less epithelial cell damage and regeneration of gastric mucosa in dose dependent manner. CONCLUSIONS The anti-ulcer effect of MEC may be attributed to its ability to scavenge free radicals and anti-inflammatory property via suppression of TNF-α and IL-6, thus offers a complete and holistic approach for management of peptic ulcer.
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Affiliation(s)
- Mukta Gupta
- Research Scholar, I. K. Gujral Punjab Technical University, Kapurthala, Punjab, India; School of Pharmaceutical Sciences, Lovely Professional University, Punjab, India
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Punjab, India
| | - Bhupinder Kapoor
- School of Pharmaceutical Sciences, Lovely Professional University, Punjab, India
| | - Bimlesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Punjab, India
| | - Rakesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Punjab, India
| | - Rajan Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Punjab, India
| | - Navneet Khurana
- School of Pharmaceutical Sciences, Lovely Professional University, Punjab, India
| | - Reena Gupta
- School of Pharmaceutical Sciences, Lovely Professional University, Punjab, India
| | - Naresh Singh
- Rayat Institute of Pharmacy, Railmajra, SBS Nagar, Punjab, India.
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Gao J, Suo C, Tseng JH, Moss MA, Terry AV, Chapman J. Design and Synthesis of Ranitidine Analogs as Multi-Target Directed Ligands for the Treatment of Alzheimer's Disease. Int J Mol Sci 2021; 22:ijms22063120. [PMID: 33803769 PMCID: PMC8003314 DOI: 10.3390/ijms22063120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 01/03/2023] Open
Abstract
The aggregation of amyloid β (Aβ) peptides and deposition of amyloid plaques are implicated in the pathogenesis of Alzheimer’s disease (AD). Therefore, blocking Aβ aggregation with small molecules has been proposed as one therapeutic approach for AD. In the present study, a series of ranitidine analogs containing cyclic imide isosteres were synthesized and their inhibitory activities toward Aβ aggregation were evaluated using in vitro thioflavin T assays. The structure–activity relationship revealed that the 1,8-naphthalimide moiety provided profound inhibition of Aβ aggregation and structural modifications on the other parts of the parent molecule (compound 6) maintained similar efficacy. Some of these ranitidine analogs also possessed potent inhibitory activities of acetylcholinesterase (AChE), which is another therapeutic target in AD. These ranitidine analogs, by addressing both Aβ aggregation and AChE, offer insight into the key chemical features of a new type of multi-target directed ligands for the pharmaceutical treatment of AD.
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Affiliation(s)
- Jie Gao
- Department of Clinical and Diagnostic Science, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Correspondence:
| | - Chen Suo
- Department of Chemical Engineering and Biomedical Engineering, University of South Carolina, Columbia, SC 29208, USA; (C.S.); (J.-H.T.); (M.A.M.)
| | - Jui-Heng Tseng
- Department of Chemical Engineering and Biomedical Engineering, University of South Carolina, Columbia, SC 29208, USA; (C.S.); (J.-H.T.); (M.A.M.)
| | - Melissa A. Moss
- Department of Chemical Engineering and Biomedical Engineering, University of South Carolina, Columbia, SC 29208, USA; (C.S.); (J.-H.T.); (M.A.M.)
| | - Alvin V. Terry
- Department of Pharmacology and Toxicology, Augusta University, Augusta, GA 30912, USA;
| | - James Chapman
- Department of Discovery and Biomedical Sciences, University of South Carolina, Columbia, SC 29208, USA;
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Elshamy AI, Farrag ARH, Ayoub IM, Mahdy KA, Taher RF, Gendy AENGEI, Mohamed TA, Al-Rejaie SS, EI-Amier YA, Abd-EIGawad AM, Farag MA. UPLC-qTOF-MS Phytochemical Profile and Antiulcer Potential of Cyperus conglomeratus Rottb. Alcoholic Extract. Molecules 2020; 25:E4234. [PMID: 32942704 PMCID: PMC7570889 DOI: 10.3390/molecules25184234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 02/07/2023] Open
Abstract
Cyperus has been commonly used as a multi-use medicinal plant in folk medicine worldwide. The objectives of our study were to determine the different metabolites in the Cyperus conglomeratus Rottb. methanol extract, and to assess its in vivo gastroprotective effect in ethanol-induced gastric ulcer model in rats. Serum levels of galactin-3 and TNF-α were employed as biochemical markers. To pinpoint for active agents, comprehensive metabolites profiling of extract via UPLC-qTOF-MS/MS was employed. A total of 77 chromatographic peaks were detected, of which 70 were annotated. The detected metabolites were categorized into phenolic acids and their derivatives, flavonoids, stilbenes, aurones, quinones, terpenes, and steroids. Rats were divided into six groups; healthy control, ulcer control, standard drug group, and 25, 50, 100 mg/kg of C. conglomeratus treated rats. Pre-treatment with C. conglomeratus alcohol extract significantly reduced galactin-3, and TNF-α in ethanol-induced ulcer model at 25, 50, and 100 mg/kg. Further histopathological and histochemical studies revealed moderate erosion of superficial epithelium, few infiltrated inflammatory cells, and depletion of gastric tissue glycoprotein in the ulcer group. Treatment with the extract protected the gastric epithelial cells in a dose-dependent manner. It could be concluded that C. conglomeratus extract provides significant gastroprotective activity in ethanol-induced gastric ulcer and ought to be included in nutraceuticals in the future for ulcer treatment.
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Affiliation(s)
- Abdelsamed I. Elshamy
- Department of Natural Compounds Chemistry, National Research Center, 33 El Bohouth St., Dokki, Giza 12622, Egypt;
| | - Abdel Razik H. Farrag
- Pathology Department, National Research Centre, 33 El Bohouth St., Dokki, Giza 12622, Egypt;
| | - Iriny M. Ayoub
- Pharmacognosy Department, Faculty of Pharmacy, Ain Shams University, Cairo 11566, Egypt;
| | - Karam A. Mahdy
- Medical Biochemistry Department, National Research Centre, 33 El Bohouth St., Dokki, Giza 12622, Egypt;
| | - Rehab F. Taher
- Department of Natural Compounds Chemistry, National Research Center, 33 El Bohouth St., Dokki, Giza 12622, Egypt;
| | - Abd El-Nasser G. EI Gendy
- Medicinal and Aromatic Plants Research Department, National Research Centre, 33 El Bohouth St., Dokki, Giza 12622, Egypt;
| | - Tarik A. Mohamed
- Chemistry of Medicinal Plants Department, National Research Centre, 33 El-Bohouth St., Dokki, Giza 12622, Egypt;
| | - Salim S. Al-Rejaie
- Department of Pharmacology & Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Yasser A. EI-Amier
- Department of Botany, Faculty of Science, Mansoura University, Mansoura 35516, Egypt;
| | - Ahmed M. Abd-EIGawad
- Department of Botany, Faculty of Science, Mansoura University, Mansoura 35516, Egypt;
- Plant Production Department, College of Food & Agriculture Sciences, King Saud University, P.O. Box 2460, Riyadh 11451, Saudi Arabia
| | - Mohamed A. Farag
- Pharmacognosy Department, College of Pharmacy, Cairo University, Kasr el Aini St., Cairo P.B. 11562, Egypt;
- Chemistry Department, School of Sciences & Engineering, The American University in Cairo, New Cairo 11835, Egypt
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Uwaezuoke SN, Ndu IK, Eneh CI, Anusiem CA, Ayuk AC. A short course of oral ranitidine as a novel treatment for toddler's diarrhea: a parallel-group randomized controlled trial. BMC Pediatr 2020; 20:380. [PMID: 32781992 PMCID: PMC7422520 DOI: 10.1186/s12887-020-02267-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/02/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The current paradigm for treating toddler's diarrhea comprises dietary modification and fluid restriction. Previous studies show that probiotics and proton-pump inhibitors (PPIs) or H2 blockers could control diarrhea associated with functional gastrointestinal disorders (FGIDs). This study aims to determine and compare the efficacy of a short course of oral ranitidine and a probiotic in the treatment of toddler's diarrhea. METHODS This study was a parallel-group randomized controlled trial (RCT). We sequentially enrolled 40 patients who met the eligibility criteria. We randomly assigned 20 patients to the oral ranitidine group, ten patients to the probiotic group, and ten patients to the placebo group. In the oral ranitidine group, patients received oral ranitidine (3 mg/kg/day) once daily for 10 days; in the probiotic and placebo groups, they were administered 5 to 10 billion colony-forming units (CFUs) per day of lyophilized Lactobacillus rhamnosus and 50 mg of once-daily oral vitamin C tablet respectively for 10 days. Stool frequency and consistency on the 10th day of the interventions were recorded as the primary outcomes. We used the Student's t-test to determine if there were significant differences in the mean daily stool frequencies in the three intervention groups. A p-value < 0.05 was adopted as the level of statistical significance. RESULTS In the ranitidine group, stool frequency decreased significantly from an average of five per day on the first day to an average of approximately one per day on the 10th day of intervention (t = 10.462, p < 0.001). Additionally, stool consistency normalized on the 10th day of intervention. In the probiotic group, there was a significant reduction in stool frequency from an average of five per day on the first day to four per day on the 10th day (t = 2.586, p = 0.041), although stool consistency remained loose. However, stool consistency and frequency were not significantly affected in the placebo group (t = 1.964, p = 0.072). CONCLUSION Oral ranitidine is more effective than probiotics in reducing stool frequency and normalizing stool consistency in toddler's diarrhea. We recommend multi-center trials with appropriate study designs to confirm and validate this finding. TRIAL REGISTRATION ISRCTN, ISRCTN10783996 . Registered 8 April 2016-Registered retrospectively.
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Affiliation(s)
- Samuel N Uwaezuoke
- Department of Pediatrics, University of Nigeria of Nigeria Teaching Hospital Ituku-Ozalla Enugu/College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.
| | - Ikenna K Ndu
- Department of Pediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Chizoma I Eneh
- Department of Pediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Chikere A Anusiem
- Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
- Harvard University, Cambridge, USA
| | - Adaeze C Ayuk
- Department of Pediatrics, University of Nigeria of Nigeria Teaching Hospital Ituku-Ozalla Enugu/College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
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Hassoun Y, Stevenson MR, Bernstein DI. Idiopathic postprandial diarrhea responsive to antihistamines. Ann Allergy Asthma Immunol 2019; 123:407-409. [PMID: 31279076 DOI: 10.1016/j.anai.2019.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Yasmin Hassoun
- Division of Immunology, Allergy, and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Margo Rockwell Stevenson
- Division of Immunology, Allergy, and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David I Bernstein
- Division of Immunology, Allergy, and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Abstract
Malignant bowel obstruction (MBO) complicates 3%-15% of cancers and often necessitates inpatient admission. Hospitalists are increasingly involved in treating patients with MBO and coordinating their care across multiple subspecialties. Direct resolution of the obstruction via surgical or interventional means is always preferable. When such options are not possible, pharmacological treatments are the mainstay of therapy. Medications such as somatostatin analogs, steroids, H2-blockers, and other modalities can be effective in palliation and possible resolution of obstruction. Awareness of these pharmacologic therapies can aid hospitalists in treating patients who are confronted with this devastating condition.
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Affiliation(s)
- Kevin Hsu
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric Prommer
- Palliative Care Division, VA Greater Los Angeles Health-care System, Los Angeles, California
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Mary C Murphy
- Palliative Care Division, VA Greater Los Angeles Health-care System, Los Angeles, California
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Azadeh Lankarani-Fard
- Hospitalist Division, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Medicine, Hospitalist Division, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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11
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Mesquita WJ, Kline CM, Vernier P, Ledgerwood AM, Lucas CE. Failure of gastric prophylaxis against stress bleeding reflects inadequate pH control. Surgery 2018; 164:733-737. [PMID: 30041965 DOI: 10.1016/j.surg.2018.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/16/2018] [Accepted: 05/16/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gastric prophylaxis against stress ulceration with histamine 2 blockers or protein pump inhibitors is a quality standard in septic Surgical Intensive Care Unit (SICU) patients to reduce gastric pH below 3.5. This study assesses the efficacy of gastric prophylaxis with pH monitoring. METHODS A total of 100 patients were studied for 481 days. All received histamine 2 blockers or protein pump inhibitors. Daily pH control was judged as poor (1-3), moderate (4-5), or good (>5). Patients with poor pH received double-dose or an infusion gastric prophylaxis. Nasogastric tube bile or blood and transfusions for stress ulceration were recorded. RESULTS Gastric prophylaxis was poor for 37 days, moderate for 83 days, and good for 279 days. NGT blood occurred on 15 days (40%) with poor, 17 days (20%) with moderate, and 17 days (6%) with good control. Transfusions for stress ulceration occurred on 5 days (14%) during poor, 3 days (4%) during moderate, and 1 day (0.3%) during good control (P < .05). Enhanced gastric prophylaxis improved pH control and reduced nasogastric tube blood. Transfusion for stress ulceration after enhanced therapy was required on 1 day (8%) with poor control and never for moderate or good control. CONCLUSION Gastric prophylaxis against stress ulceration should be monitored by nasogastric tube pH.
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Affiliation(s)
| | - Craig M Kline
- Department of Surgery, Wayne State University, Detroit, MI, USA
| | | | | | - Charles E Lucas
- Department of Surgery, Wayne State University, Detroit, MI, USA.
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12
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Iweala OI, Copenhaver C, Wu EY, Moran TP. Hydroxychloroquine as a steroid-sparing agent in an infant with chronic urticaria. Ann Allergy Asthma Immunol 2017; 120:102-104. [PMID: 29157861 DOI: 10.1016/j.anai.2017.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/05/2017] [Accepted: 10/08/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Onyinye I Iweala
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | | | - Eveline Y Wu
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Timothy P Moran
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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13
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Pagán Rivera BL, Anselmi FJ, Torres MDM, Segarra A, Rivera JR. Usefulness Of Glucocorticoids In The Management Of Foreign Body Aspiration. Bol Asoc Med P R 2015; 107:24-27. [PMID: 26742192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Foreign body aspiration can be a life-threatening emergency. An aspirated solid or semi-solid object may lodge in the larynx, trachea or other breathing airways. If the object is large enough to cause nearly complete obstruction of the airway, asphyxia may rapidly cause death. We report a 19-year old man admitted with right lower lobe pneumonia who spontaneously expelled a foreign body, one day after admission and glucocorticoids administration. Glucocorticoids should be considered in foreign body aspiration management because improvement of the inflammatory reaction may facilitate expontaneous expulsion or foreign body extraction
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14
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Iturri Clavero F, González Uriarte A, Tamayo Medel G, Gamboa Setién PM. [Prophylactic use of icatibant before tracheal intubation of a patient with hereditary angioedema type III. (A literature review of perioperative management of patients with hereditary angioedema type III)]. Rev Esp Anestesiol Reanim 2014; 61:375-381. [PMID: 24931134 DOI: 10.1016/j.redar.2014.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/18/2013] [Accepted: 01/28/2014] [Indexed: 06/03/2023]
Abstract
Type III hereditary angioedema is a rare familial disorder that has recently been described as a separate condition. Triggers for episodes of angioedema include surgery, dental procedures, and tracheal intubation maneuvers. Since episodes affecting the upper airway are potentially life-threatening, prophylactic treatment is recommended in these situations. The use of icatibant (Firazyr(®)), for prevention of angioedema prior to tracheal intubation, is reported in a patient with type iii hereditary angioedema. A literature review on the anesthetic management of this condition was conducted.
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Affiliation(s)
- F Iturri Clavero
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España.
| | - A González Uriarte
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - G Tamayo Medel
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España; Departamento de Farmacología, Universidad del País Vasco, Leioa, Vizcaya, España
| | - P M Gamboa Setién
- Servicio de Alergología, Hospital de Basurto, Basurto, Vizcaya, España
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15
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Affiliation(s)
- Theo Gülen
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Hans Hägglund
- Department of Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Sven-Erik Dahlén
- National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Sander
- Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Barbro Dahlén
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Gunnar Nilsson
- Clinical Immunology and Allergy Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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16
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Kormos W. On call. I have heartburn a few times a month. My doctor suggested I use a generic H₂blocker like famotidine or ranitidine. Is this better than an antacid? Harv Mens Health Watch 2014; 18:2. [PMID: 24818285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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17
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van Boekel GAJ, Kerkhofs CHH, van de Logt F, Hilbrands LB. Proton pump inhibitors do not increase the risk of acute rejection. Neth J Med 2014; 72:86-90. [PMID: 24659591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Mycophenolate mofetil (MMF) is the prodrug of mycophenolic acid (MPA). Proton pump inhibitors impair exposure to MPA due to incomplete conversion from MMF. Lower exposure to MPA could result in an increased risk of acute rejection. We investigated whether MMF-treated renal transplant patients who concomitantly used pantoprazole as ulcer prophylaxis had a higher risk of acute rejection within the first three months after transplantation than those who used ranitidine. METHODS We performed a retrospective study in adult patients who underwent kidney transplantation between January 2007 and December 2011. Their immunosuppressive therapy consisted of steroids, tacrolimus and MMF and they used either pantoprazole or ranitidine as ulcer prophylaxis. RESULTS 202 patients were included: 125 using pantoprazole and 77 using ranitidine. There was no difference in the number of patients with biopsy-proven acute rejection (BPAR): 13 (10.4%) in the pantoprazole group versus 7 (9.1%) in the ranitidine group (NS). Also after correction for inequalities between the two groups, there was no significant relationship between the risk of BPAR and the type of anti-ulcer agent. CONCLUSION There was no evidence for an increased incidence of BPAR in renal transplant patients who use pantoprazole in combination with MMF.
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Affiliation(s)
- G A J van Boekel
- Department of Nephrology, Radboud University Medical Centre, Nijmegen, the Netherlands
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18
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Cafarotti A, Bascietto C, Salvatore R, Breda L, Chiarelli F, Piernicola P. A 6-month-old boy with uncontrollable dystonic posture of the neck. Sandifer syndrome. Pediatr Ann 2014; 43:17-9. [PMID: 24549078 DOI: 10.3928/00904481-20131223-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Tsuchie SY, Nani FS, Vieira JE. Incidence of postoperative dyspepsia is not associated with prophylactic use of drugs. SAO PAULO MED J 2014; 132:219-23. [PMID: 25055067 PMCID: PMC10496731 DOI: 10.1590/1516-3180.2014.1324676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Preoperative fasting guidelines do not recommend H2 receptor antagonists or proton pump inhibitors. This study investigated prophylactic use of gastric protection and the incidence of dyspeptic symptoms in the immediate postoperative period. DESIGN AND SETTING Non-randomized observational investigation in a post-anesthesia care unit. METHODS American Society of Anesthesiologists risk classification ASAP1 and ASAP2 patients over 18 years of age were evaluated to identify dyspeptic symptoms during post-anesthesia care for up to 48 hours, after receiving or not receiving prophylactic gastric protection during anesthesia. History of dyspeptic symptoms and previous use of such medications were exclusion criteria. The odds ratio for incidence of dyspeptic symptoms with use of these medications was obtained. RESULTS This investigation studied 188 patients: 71% women; 50.5% ASAP1 patients. Most patients received general anesthesia (68%). Gastric protection was widely used (n = 164; 87.2%), comprising omeprazole (n = 126; 76.8%) or ranitidine (n = 38; 23.2%). Only a few patients did not receive any prophylaxis (n = 24; 12.8%). During the observation, 24 patients (12.8%) reported some dyspeptic symptoms but without any relationship with prophylaxis (relative risk, RR = 0.56; 95% confidence interval, CI: 0.23-1.35; P = 0.17; number needed to treat, NNT = 11). Omeprazole, compared with ranitidine, did not reduce the chance of having symptoms (RR = 0.65; 95% CI: 0.27-1.60; P = 0.26; NNT = 19). CONCLUSION This study suggests that prophylactic use of proton pump inhibitors or H2 receptor antagonists was routine for asymptomatic patients and was not associated with postoperative protection against dyspeptic symptoms.
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Affiliation(s)
- Sara Yumi Tsuchie
- Resident. Anesthesiology Program, Hospital das
Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo,
Brazil
| | - Fernando Souza Nani
- MD. Anesthesiologist, Anesthesia Division, Hospital
das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo,
Brazil
| | - Joaquim Edson Vieira
- MD, PhD. Associate Professor, Department of
Surgery, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo,
Brazil
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20
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Du Y, Zhao W, Lu L, Zheng J, Hu X, Yu Z, Zhu L. Study on the antiulcer effects of Veronicastrum axillare on gastric ulcer in rats induced by ethanol based on tumor necrosis factor-α (TNF-α) and endothelin-1 (ET-1). Asian Pac J Trop Biomed 2013; 3:925-30. [PMID: 24093781 PMCID: PMC3804741 DOI: 10.1016/s2221-1691(13)60180-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/10/2013] [Accepted: 11/17/2013] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To assess whether Veronicastrum axillare (V. axillare) can ameliorate ethanol-induced gastric mucosal lesions in rats, reduce the production of pro-inflammatory cytokines, suppress apoptosis and improve local microcirculation disturbances. METHODS Totally 48 male Sprague-Dawley rats were randomly divided into six groups, eight rats in each group. Rats in the normal group and the model group were administered with 0.9% normal saline respectively. Rats in the positive group and ranitidine group were administered with 0.18% ranitidine suspension by intragastric administration respectively. Those in the high dose V. axillare group, the medium dose V. axillare group and the low dose V. axillare group were administrated with V. axillare at the daily dose of 2.8 g/kg, 1.4 g/kg and 0.7 g/kg by intragastric administration. Gastric mucosal lesions were produced by intragastric administration of absolute ethanol. Water extract of V. axillare was successively injected for 14 d and last day was injected 1 h before ethanol administration. Gastric mucosal ulcer index and ulcer inhibitory rate were counted by improved Guth methods. The tissue sections were made for pathological histology analysis. Also, we measured the concentrations of tumor necrosis factor-α (TNF-α) and endothelin-1 (ET-1) in gastric mucosal, as an index of the pro-inflammatory cytokines, apoptosis and local microcirculation. Besides, the mRNA contents of TNF-α and ET-1 were measured to verify effects on gene expression by real-time fluorescent quantitative PCR. RESULTS Water extract of V. axillare significantly ameliorated the gastric mucosal lesions induced by ethanol administration (P<0.01). Pro-inflammatory cytokines, TNF-α and ET-1 were increased after ethanol administration and significantly reduced by water extract of V. axillare. The expressions of TNF-α and ET-1 mRNA were also be inhibited by water extract of V. axillare. CONCLUSION Current evidences show water extract of V. axillare is effective for defending against ethanol-induced gastric mucosal lesions, significantly inhibiting the production of pro-inflammatory cytokines and the expressions of TNF-α and ET-1 mRNA, which may be useful for inhibiting apoptosis and improving local microcirculation.
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Affiliation(s)
| | - Weichun Zhao
- *Corresponding author: Dr. Weichun Zhao, College of Bioengineering, Zhejiang Chinese Medical University, Hangzhou, 310053 China. Tel: +86 571 8661 3712 E-mail:
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21
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Yan B, Shi J, Xiu LJ, Liu X, Zhou YQ, Feng SH, Lv C, Yuan XX, Zhang YC, Li YJ, Wei PK, Qin ZF. Xiaotan Tongfu granules contribute to the prevention of stress ulcers. World J Gastroenterol 2013; 19:5473-5484. [PMID: 24023490 PMCID: PMC3761100 DOI: 10.3748/wjg.v19.i33.5473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 06/28/2013] [Accepted: 07/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the efficacy and potential mechanism of Xiaotan Tongfu granules (XTTF) in stress ulcers.
METHODS: One hundred sixty rats were randomly divided into 4 groups (n = 10) as follows: the model group (MP group), the control group (CP group), the ranitidine group (RP group) and the XTTF granule group (XP group). Rats in the MP group received no drugs, rats in the CP group received 0.2 mL of a 0.9% sodium chloride solution via oral gavage, and rats in the RP and XP groups received the same volume of ranitidine (50 mg/kg) or XTTF granule (4.9 g/kg). The cold-restraint stress model was applied to induce stress ulcers after 7 consecutive days of drug administration. Afterwards, rats were sacrificed at 0, 3, 6 and 24 h. Gastric pH was measured by a precise pH meter; gastric emptying rate (GER) was measured by using a methylcellulose test meal; myeloperoxidase activity (MPO), macrophage migration inhibitory factor (MIF), proliferating cell nuclear antigen (PCNA), and heat shock protein 70 (HSP70) were measured by immunohistochemical staining; and mucosal cell apoptosis was measured by transferase dUTP nick end labeling.
RESULTS: In the cold-restraint stress model, the development of stress ulcers peaked at 3 h and basically regressed after 24 h. Gastric lesions were significantly different in the RP and XP groups at each time point. Interestingly, although this index was much lower in the RP group than in the XP group immediately following stress induction (7.00 ± 1.10 vs 10.00 ± 1.79, P < 0.05. Concerning gastric pH, between the RP and XP groups, we detected a statistically significant difference immediately after stress induction (0 h: 4.56 ± 0.47 vs 3.34 ± 0.28, P < 0.05) but not at any of the subsequent time points. For GER, compared to the RP group, GER was remarkably elevated in the XP group because a statistically significant difference was detected (3 h: 46.84 ± 2.70 vs 61.16 ± 5.12, P < 0.05; 6 h: 60.96 ± 6.71 vs 73.41 ± 6.16, P < 0.05; 24 h: 77.47 ± 3.17 vs 91.31 ± 4.34, P < 0.05). With respect to MPO and MIF, comparisons between the RP and XP groups revealed statistically significant differences at 3 h (MPO: 18.94 ± 1.20 vs 13.51 ± 0.89, P < 0.05; MIF: 150.67 ± 9.85 vs 122.17 ± 5.67, P < 0.05) and 6 h (MPO: 13.22 ± 1.54 vs 8.83 ± 0.65, P < 0.05; MIF: 135.50 ± 9.46 vs 109.83 ± 6.40, P < 0.05). With regard to HSP70, HSP70 expression was significantly increased in the RP and XP groups at 3 and 6 h compared to the MP and CP groups. In addition, comparing the RP and XP groups also showed statistically significant differences at 3 and 6 h. The expression of PCNA was higher in the RP and XP groups 3 h after stress induction. Between these two groups, small but statistically significant differences were observed at all of the time points (3 h: 69.50 ± 21.52 vs 79.33 ± 15.68, P < 0.05; 6 h: 107.83 ± 4.40 vs 121.33 ± 5.71, P < 0.05; 24 h: 125.33 ± 5.65 vs 128.50 ± 14.49, P < 0.05) except 0 h. With regard to apoptosis, the apoptotic activity in the RP and XP groups was significantly different from that in the MP and CP groups. The XP group exhibited a higher inhibition of cell apoptosis than the RP group at 3 h (232.58 ± 24.51 vs 174.46 ± 10.35, P < 0.05) and 6 h (164.74 ± 18.31 vs 117.71 ± 12.08, P < 0.05).
CONCLUSION: The Xiaotan Tongfu granule was demonstrated to be similar to ranitidine in preventing stress ulcers. It exhibited multiple underlying mechanisms and deserves further study.
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Zhang S, Xu Z, Gao Y, Wu Y, Li Z, Liu H, Zhang C. Bidirectional crosstalk between stress-induced gastric ulcer and depression under chronic stress. PLoS One 2012; 7:e51148. [PMID: 23251441 PMCID: PMC3521024 DOI: 10.1371/journal.pone.0051148] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 10/29/2012] [Indexed: 12/25/2022] Open
Abstract
Stress contributes to a variety of diseases and disorders such as depression and peptic ulcer. The present study aimed to investigate the correlation between stress ulcer and depression in pathogenesis and treatment by using chronic stress depression (CSD), chronic psychological stress ulcer (CPSU) and water immersion restrain stress models in rats. Our data showed that the ulcer index of the animals after CSD exposure was significantly higher than that of controls. Depression-like behaviors were observed in rat after CPSU exposure. Fluoxetine hydrochloride significantly reduced the ulcer index of rats exposed to CPSU stress, while ranitidine inhibited depression-like behavior of the animals in CSD group. The ulcer index of rats administered with mifepristone after CPSU stress was markedly reduced compared to CPSU group, although there was no significant difference in the depression-like behavior between mifepristone-treated CSD group and naive controls. We also found that the rats exposed to CPSU or CSD stress displayed a lower level of corticosterone than naive controls, however, the acute stress (AS) group showed an opposite result. Additionally, in order to study the relevance of H(2) receptors and depression, we treated the CSD group with cimetidine and famotidine respectively. The data showed that cimetidine inhibited depression-like behavior in CSD rats, and famotidine had no impact on depression. Overall our data suggested that the hypothalamic-pituitary-adrenal (HPA) axis dysfunction may be the key role in triggering depression and stress ulcer. Acid-suppressing drugs and antidepressants could be used for treatment of depression and stress ulcer respectively. The occurrence of depression might be inhibited by blocking the central H(2) receptors.
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Affiliation(s)
- Shuang Zhang
- Beijing Institute of Radiation Medicine, State Key Laboratory of Proteomics, Cognitive and Mental Health Research Center, Beijing, China
- Department of Gastroenterology, the General Hospital of Chinese People’s Armed Police Forces, Beijing, China
| | - Zhiwei Xu
- Beijing Institute of Radiation Medicine, State Key Laboratory of Proteomics, Cognitive and Mental Health Research Center, Beijing, China
| | - Yan Gao
- Beijing Institute of Radiation Medicine, State Key Laboratory of Proteomics, Cognitive and Mental Health Research Center, Beijing, China
| | - Yonghong Wu
- Beijing Institute of Radiation Medicine, State Key Laboratory of Proteomics, Cognitive and Mental Health Research Center, Beijing, China
| | - Zhihui Li
- Beijing Institute of Radiation Medicine, State Key Laboratory of Proteomics, Cognitive and Mental Health Research Center, Beijing, China
| | - Haifeng Liu
- Department of Gastroenterology, the General Hospital of Chinese People’s Armed Police Forces, Beijing, China
- * E-mail: (HL); (CZ)
| | - Chenggang Zhang
- Beijing Institute of Radiation Medicine, State Key Laboratory of Proteomics, Cognitive and Mental Health Research Center, Beijing, China
- School of Life Science, Anhui Medical University, Anhui, China
- * E-mail: (HL); (CZ)
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Abstract
BACKGROUND Anecdotal reports of tumour regression with histamine type 2 receptor antagonists (H(2)RAs) have lead to a series of trials with this class of drug as adjuvant therapy to try and improve outcomes in patients with resected colorectal cancers. There was a plausible scientific rationale suggesting merit in this strategy. This included improved immune surveillance (by way of increasing tumour infiltrating lymphocytes), inhibiting the direct proliferative effect of histamine as a growth factor for colorectal cancer and, in the case of cimetidine, inhibiting endothelial expression of E-selectin (a cell adhesion molecule thought to be critical for metastatic spread). OBJECTIVES To determine if H(2)RAs improve overall survival when used as pre- and/or postoperative therapy in colorectal cancer patients who have had surgical resection with curative intent. We also stratified the results to see if there was an improvement in overall survival in terms of the specific H(2)RA used. SEARCH METHODS Randomised controlled trials were identified using a sensitive search strategy in the following databases: MEDLINE (1964 to present), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2009), EMBASE (1980 to present) and Cancerlit (1983 to present). SELECTION CRITERIA Criteria for study selection included: patients with colorectal cancer surgically resected with curative intent; H(2)RAs used i) at any dose, ii) for any length of time, iii) with any other treatment modality and iv) in the pre-, peri- or post-operative period. The results were stratified for the H(2)RA used. DATA COLLECTION AND ANALYSIS The literature search retrieved 142 articles. There were six studies included in the final analysis, published from 1995 to 2007, including a total of 1229 patients. All patients were analysed by intention to treat according to their initial allocation. Log hazard ratios and standard errors of treatment effects (on overall survival) were calculated using the Cochrane statistical package RevMan Version 5. Hazard ratios and standard errors were recorded from trial publications or, if not provided, were estimated from published actuarial survival curves using a spreadsheet designed for this purpose (http://www.biomedcentral.com/content/supplementary/1745-6215-8-16-S1.xls). MAIN RESULTS Of the six identified trials, five used cimetidine as the experimental H(2)RA, whereas one used ranitidine. There was a trend towards improved survival when H(2)RAs were utilised as adjuvant therapy in patients having curative-intent surgery for colorectal cancer (HR 0.70; 95% CI 0.48-1.03, P = 0.07). Analysis of the five cimetidine trials (n = 421) revealed a statistically significant improvement in overall survival (HR 0.53; 95% CI 0.32 to 0.87). AUTHORS' CONCLUSIONS Of the H(2)RAs evaluated cimetidine appears to confer a survival benefit when given as an adjunct to curative surgical resection of colorectal cancers. The trial designs were heterogeneous and adjuvant therapy has evolved since these trials were performed. Further prospective randomised studies are warranted.
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Affiliation(s)
- Sanjeev Deva
- Cancer and Blood, AucklandHospital, Auckland, New Zealand.
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Abstract
BACKGROUND Urticaria is a common skin disease characterised by itching weals or hives, which can occur almost anywhere on the body. There are a number of different subtypes and a range of available treatment options. There is lack of agreement on the efficacy of H2-receptor antagonists used in the treatment of urticaria. OBJECTIVES To assess the safety and effectiveness of H2-receptor antagonists in the treatment of urticaria. SEARCH METHODS We searched the following databases up to 7 October 2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2011, Issue 4), MEDLINE (from 2005), EMBASE (from 2007), and LILACS (from 1982). We also searched online trials registries for ongoing trials. SELECTION CRITERIA Randomised controlled trials of H2-receptor antagonists in people with a clinical diagnosis of urticaria of any duration or of any subtype. Studies including H1-antihistamines for chronic urticaria are the topic of a separate Cochrane review; thus, they were not included in this review. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted and analysed data. MAIN RESULTS Four studies of a relatively small size, involving 144 participants, were included in this review. A combination of ranitidine with diphenhydramine was more effective at improving the resolution of urticaria than diphenhydramine administered alone (risk ratio (RR) 1.59, 95% confidence interval (CI) 1.07 to 2.36). Although there was a similar improvement in itching, weal size, and intensity, cimetidine provided no statistically significant greater overall improvement in symptoms of urticaria when compared to diphenhydramine. However, a combination of these medications was more effective than diphenhydramine alone (RR 2.02, 95% CI 1.03 to 3.94). Adverse events were reported with several of the interventions, i.e. ranitidine and diphenhydramine, causing drowsiness and sedation, but there was no significant difference in the level of sedation from baseline with either famotidine or diphenhydramine. AUTHORS' CONCLUSIONS The very limited evidence provided by this review was based on a few old studies of a relatively small size, which we categorised as having high to unclear risk of bias. Thus, at present, the review does not allow confident decision-making about the use of H2-receptor antagonists for urticaria. Although some of these studies have reported a measure of relief of symptoms of urticaria and rather minimal clinical improvement in some of the participants, the evidence was weak and unreliable. We have emphasised the lack of precision and limitations in the reported data where appropriate in this review.
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Affiliation(s)
- Zbys Fedorowicz
- UKCC (Bahrain Branch), Ministry of Health, Bahrain, Box 25438, Awali, Bahrain.
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Özer M, Duman M, Taş Ş, Demırcı Y, Aydin MF, Reyhan E, Atici AE, Bostanci EB, Akoğlu M, Genç E. In vitro effects of famotidine and ranitidine on lower esophageal sphincter tone in rats. Turk J Gastroenterol 2012; 23:438-443. [PMID: 23161288 DOI: 10.4318/tjg.2012.0448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND/AIMS The aim of this study was to investigate the effects of the H2 receptor antagonists famotidine and ranitidine on lower esophageal sphincter pressure in the rat isolated lower esophageal sphincter preparation contracted with carbachol. MATERIALS AND METHODS Lower esophageal sphincter tissues of eight rats for each group were placed in a standard organ bath. After contraction with carbachol, freshly prepared famotidine and ranitidine were added directly to the tissue bath in cumulatively increasing concentrations. Activities were recorded on an online computer using the software BSL PRO v 3.7, which also analyzed the data. RESULTS Ranitidine caused a small statistically insignificant relaxation in the contracted lower esophageal sphincter at the two applied concentrations. Although 1.5 x 10⁻⁵ M famotidine did not cause a significant relaxation in lower esophageal sphincter tone, this value for 4.5 x 10⁻⁵ M famotidine was 9.33%, and the relaxation was significant when compared with controls (p<0.05). CONCLUSIONS Neither famotidine nor ranitidine caused any direct significant change in lower esophageal sphincter tone in the therapeutic dose range applied to the organ bath. However, the higher dose of famotidine caused a significant relaxation in the lower esophageal sphincter tone. Further in vivo human studies may affect the usage of these drugs during gastroesophageal reflux disease treatment.
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Affiliation(s)
- Mahmut Özer
- Department of Pharmacology, Yeditepe University, School of Medicine, İstanbul, Turkey
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Li YM, Li BC, Li P, Liu JZ, Cui JL, Mei ZQ. [Effects of Na-FA on gastrointestinal movement and gastric ulcer in mice]. Zhong Yao Cai 2011; 34:1565-1569. [PMID: 22372147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To research the effects of Na-FA on gastrointestinal movement and gastriculcer in mice. METHODS Using charcoal powder as an indicator, the effects of FA-Na on bowel movement of mice was evaluated by determining the propulsive percent-age of charcoal powder in normal mice, inhibition of small intestinal propulsion model induced by Compound Diphenoxylate and spleen asthenia and diarrhea model caused by Rheum officinale Baill; The acute gastric ulcer model was induced by intragastric alcohol given orally, the protective effect of FA-Na given ahead on gastric injury was evaluated, the ulcer index and the inhibition ratio of ulcer was calculated. RESULTS FA-Na (intragastric administration) had inhibit effect on normal mice and diarrhea model caused by Rheum officinale, significantly synergetic effect on gastrointestinal asynersis induced by Compound Diphenoxylate, and protective effect on mice gastric mucosal injury cause by dehydrated alcohol. Compared with the positive control drug Ranitidine, the ulcer index and ulcer inhibition ratio large doses of FA-Na had no significant difference. CONCLUSION The acute toxicity of FA-Na is very low, it has the effects of antidiarrheal and anti-gastric ulcer.
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Affiliation(s)
- Yue-Mei Li
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650224, China.
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Kawaguchi K, Ishiguro H, Morita S, Nakamura S, Ohno S, Masuda N, Iwata H, Aogi K, Kuroi K, Toi M. Correlation between docetaxel-induced skin toxicity and the use of steroids and H₂ blockers: a multi-institution survey. Breast Cancer Res Treat 2011; 130:627-34. [PMID: 21698408 DOI: 10.1007/s10549-011-1641-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 06/13/2011] [Indexed: 11/25/2022]
Abstract
Steroids and H(2) blockers are commonly used as supportive care for taxane-containing chemotherapy, but they also affect docetaxel's primary metabolizer, cytochrome P(450) 3A4. This retrospective observational study was performed to better understand the effects of these compounds on docetaxel-induced skin toxicities, specifically hand-foot syndrome (HFS) and facial erythema (FE), a relationship that is currently poorly understood. Member institutions of the Japan Breast Cancer Research Group were invited to complete a questionnaire on the occurrence of grade 2 or higher HFS and FE among patients treated between April 2007 and March 2008 with docetaxel as an adjuvant or neoadjuvant chemotherapeutic treatment for breast cancer. We obtained data for 993 patients from 20 institutions. Twenty percent received H(2) blockers, and all patients received dexamethasone. Univariate and multivariate analyses revealed that H(2) blockers are associated with a significantly higher incidence of both HFS and FE. The incidence of FE was significantly higher for the docetaxel + cyclophosphamide (TC) regimen than for non-TC regimens combined. Dexamethasone usage did not affect the incidence of either HFS or FE. In conclusion, use of H(2) blockers as premedication in breast cancer patients receiving docetaxel significantly increases the risk of both HFS and FE.
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Affiliation(s)
- K Kawaguchi
- Department of Breast Surgery, Kyoto University Hospital, Kyoto, Japan
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Cisarò F, Astegiano M, De Angelis C, Saracco G, Rizzetto M, Pellicano R. Ranitidine bismuth citrate in the first-line of Helicobacter pylori treatment. Panminerva Med 2011; 53:138. [PMID: 21659979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Singh DY, Prasad NK. Double liposomes mediated dual drug targeting for treatment of Helicobacter pylori infections. Pharmazie 2011; 66:368-373. [PMID: 21699071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In the present study the potential of phosphatidylethanolamine (PE) lipid anchored double liposomes (DL) to incorporate two drugs in a single system is exploited as a tool to augment the H. pylori eradication rate. Preparation of DL involves two steps, first formation of primary (inner) liposomes by thin film hydration method containing one drug, then addition of suspension of inner liposomes on thin film of lipid containing the other drug. The success of formation of DL was characterized by optical and transmission electron microscopy. Quantitation of DL-bacterial interaction was evaluated in terms of percent growth inhibition (%GI) on reference strain of H. pylori ATCC 26695. To confirm specific binding efficacy of DL to H. pylori PE surface receptor we performed an agglutination assay. Agglutination in DL treated H. pylori suspension suggested selectivity of DL towards the PE surface receptor of H. pylori. Monotherapy is generally not recommended for treatment of a H. pylori infection due to the danger of development of resistance and unacceptably low eradication rates. Therefore combination therapy with amoxicillin trihydrate (AMOX) as anti-H. pylori agent and ranitidine bismuth citrate (RBC) as antisecretory agent were selected for the study with an expectation that this dual-drug delivery approach will exert acceptable anti-H. pylori activity.
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Affiliation(s)
- D Yuvraj Singh
- Department of Pharmaceutical Sciences, Guru Ghasidas Central University, Bilaspur, Chattisgarh, India.
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Khan ZA, Ahmad S, Sheikh MY. Gastro esophageal reflux: an over investigated entity in neonates and infants. J PAK MED ASSOC 2010; 60:984-986. [PMID: 21381546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To determine the outcome of clinically suspected gastro esophageal reflux in neonates and infants. To find a protocol for evaluation of these patients in order to reduce unnecessary radiation to neonates and infants. METHODS Fifty three neonates and infants of up to 1 year of age with clinical suspicion of gastro esophageal reflux (GER) were referred for Upper gastro intestinal barium studies. This retrospective descriptive case study was carried out over a period of one year starting from October, 2006 to September, 2007. Positive cases were followed for another one year to see the final outcome. The neonate and infants of upto one year of age, referred from Neonatal intensive care unit (NICU), Paediatric ward and Out Patient Department (OPD) were included in this study. RESULTS Out of 53 cases 32 were positive for G.E.R and no reflux could be identified in rest of the patients. Out of these positive cases only 4 had massive or severe G.E.R. These patients were prescribed conservative and medical treatment and were advised to follow up in the O.P.D where on subsequent follow ups the medical treatment was stopped as there were no further complaints .These patients showed normal weight gain on subsequent O.P.D visits. Other positive cases only had mild to moderate G.E.R and they were managed conservatively. These patients showed normal weight gain on subsequent O.P.D visits with complete resolution of symptoms. CONCLUSION Regurgitation or gastro esophageal reflux is a common finding in the first 3 months of life (especially in preterm infants) and usually resolves by 6-12 months of age and should not be over investigated.
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Affiliation(s)
- Zahid Anwar Khan
- Medical Imaging Department, King Abdul Aziz Hospital, National Guard Health Affairs, Saudi Arabia
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Coury J, Steinfeld J, Zwillenberg D, Zwillenberg S. Esophageal hamartoma as an unusual cause of neonatal apnea and bradycardia. Ear Nose Throat J 2010; 89:E7-E11. [PMID: 20229470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Esophageal hamartoma is a rare entity, as only 7 cases have been previously reported in the English-language literature. Common symptoms include dysphagia, weight loss, and vomiting. Life-threatening airway obstruction can also occur. Because of the nonspecific nature of the symptoms, patients with these dangerous polyps are often misdiagnosed as having more common entities such as gastroesophageal reflux, peptic ulcer disease, or achalasia. Most of these tumors are missed on esophagoscopy and radiologic studies, and they can go undiagnosed for years. We diagnosed an esophageal hamartoma in an infant girl who had first presented when she was 8 days old with symptoms of apnea and cyanosis. The patient had undergone a multitude of tests since her birth, and she was eventually diagnosed with episodic bradycardia. When the patient was 6 weeks old, we discovered a polyp on nasopharyngolaryngoscopy, and we removed it by microdirect laryngoscopy and esophagoscopy. This patient was the youngest of the 8 who have now been reported to have been diagnosed with a hamartomatous polyp, and she was the only one to have presented with apnea (secondary to airway obstruction) and bradycardia. We recommend microdirect laryngoscopy and esophagoscopy to remove these pedunculated cervical esophageal lesions. A transcervical approach is warranted for sessile distal esophageal polyps. Esophageal polyps are an interesting entity in view of their rarity and intriguing presentations. Because esophageal obstructions can be life-threatening, further evaluation by laryngoscopy, bronchoscopy, and esophagoscopy is warranted when symptoms of dysphagia, vomiting, intermittent apnea, bradycardia, and weight loss persist despite conventional treatment.
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Affiliation(s)
- Jeffrey Coury
- Section of Pediatric Otolaryngology, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
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Jonaitis L, Kupčinskas J, Kiudelis G, Kupčinskas L. De novo erosive esophagitis in duodenal ulcer patients related to pre-existing reflux symptoms, smoking, and patient age, but not to Helicobacter pylori eradication: a one-year follow-up study. Medicina (Kaunas) 2010; 46:454-459. [PMID: 20966617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED It remains unclear whether the Helicobacter pylori eradication may cause or provoke gastroesophageal reflux disease. Therefore, we aimed to elucidate the role of H. pylori eradication and other factors in the development of erosive esophagitis in patients with duodenal ulcer. MATERIALS AND METHODS We enrolled 183 H. pylori-positive duodenal ulcer patients without erosive esophagitis. Final endoscopy was performed 12 months later or in case if ulcer relapse was suspected. H. pylori was diagnosed by the urease test and histology if the results of at least one of the tests were positive. A total of 142 patients were assigned to the eradication treatment. The control group included 41 volunteers--20-mg omeprazole b.i.d. for 4 weeks was administered. RESULTS A total of 150 patients completed the study. Of the 119 patients, 70 (58.8%) were cured from H. pylori, and in 49 (41.2%) of patients, treatment of H. pylori was unsuccessful. All 31 controls remained H. pylori-positive. At the final endoscopy, erosive esophagitis was found in 19 (12.7%) patients. Erosive esophagitis developed in 8 (11.4%) successfully eradicated patients, in 9 (18.4%) unsuccessfully treated patients, and in 2 (6.5%) controls (P>0.05 comparing the groups). Multivariate logistic regression analysis revealed 3 factors at baseline, which were significant (P<0.05) in predicting the occurrence of erosive esophagitis: age more than 43 years (OR, 4.96; 95% CI, 1.47-16.71), nonerosive gastroesophageal reflux disease (OR, 3.96; 95% CI, 1.34-11.68), and smoking (OR, 3.17; 95% CI, 1.01-9.17). CONCLUSIONS H. pylori eradication did not influence the incidence of erosive esophagitis in patients with duodenal ulcer during a one-year follow-up period. Pre-existing nonerosive gastroesophageal reflux disease, smoking, and older age are important predictors of de novo development of erosive esophagitis.
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Affiliation(s)
- Laimas Jonaitis
- Department of Gastroenterology, Kaunas University of Medicine, Eivenių 2, 50028 Kaunas, Lithuania.
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Nachnani JS, Bulchandani D, Moormeier J, Foxworth J. Patient and physician predictors of inappropriate acid-suppressive therapy (AST) use in hospitalized patients. J Hosp Med 2009; 4:E10-4. [PMID: 19827047 DOI: 10.1002/jhm.492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of acid suppressive therapy (AST) in prevention of stress ulcers has been well defined in critical care patients, though its use has become increasingly common in general medicine patients, with little to no supportive evidence. None of the previous studies has examined the patient and physician characteristics of inappropriate AST initiation and use in hospitalized patients. The aim of our study was to identify: (1) the appropriateness of AST in hospitalized patients and the cost associated with inappropriate use; and (2) patient and physician characteristics predicting inappropriate initiation and use of AST. METHODS All discharges over a period of 8 consecutive days were selected. RESULTS There were 207 patients discharged over a period of 8 days. AST was inappropriately initiated in 92 of 133 (69.2%) patients included in our study. On univariate analysis, higher hemoglobin value, postgraduate year 1 (PGY-1) residents, physicians with an MD degree, international medical graduates (IMGs), and internal medicine physicians were more likely to prescribe AST inappropriately. On multivariate analysis, a higher hemoglobin value, PGY-1 residents, and MD physicians were factors associated with inappropriate AST use. The total direct patient cost for this inappropriate use was $8026, with an estimated annual cost of approximately $366,000. CONCLUSIONS AST was inappropriately initiated in 69.2% of patients with increased direct costs of $8026. Residents in their first year of training as well physicians with a MD degree are more likely to initiate AST inappropriately. Curtailing the inappropriate use of AST therapy may reduce overall costs for the patient and institution.
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Affiliation(s)
- Jagdish S Nachnani
- Department of Gastroenterology and Hepatology, University of Missouri-Kansas City, Kansas City, Missouri 64108, USA.
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Morsy M, Ashour O, Amin E, Rofaeil R. Gastroprotective effects of telmisartan on experimentally-induced gastric ulcers in rats. Pharmazie 2009; 64:590-594. [PMID: 19827301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Telmisartan is an angiotensin II T1 receptor blocker (ARB) with partial peroxisome proliferator-activated receptor gamma (PPARgamma) agonistic properties; two actions that are suggested to be efficacious for protecting against gastric ulcers. Hence, the aim of the present study was to evaluate the gastroprotective effect of telmisartan (1, 3, and 10 mg/kg) on indomethacin- and cold restraint stress (CRS)-induced gastric ulcer models in rats. Candesartan, another ARB with the lowest PPARgamma affinity, was used to justify the possible role of PPARgamma agonistic activity of telmisartan in gastroprotection. Ranitidine was used as a reference drug. Pre-treatment with telmisartan dose-dependently attenuated gastric ulcer indices induced by both models. The protective effect of telmisartan was accompanied by a significant rise in gastric mucosal nitric oxide (as nitrite/nitrate) with a concomitant fall in malondialdehyde concentrations as compared to the corresponding non-treated groups. Moreover, telmisartan significantly reduced free and total acid outputs in indomethacin-treated rats. On the other hand, telmisartan at the doses used did not alter gastric juice pH, peptic activity, mucin concentration or gastric mucosal prostaglandin E2 content in both ulcer models. The telmisartan-treated rats exhibited greater protection from gastric ulceration than candesartan-treated animals. In conclusion, telmisartan, in a dose-dependent manner, protected rats' gastric mucosa from ulcerations possibly through its anti-oxidant action against oxidative stress induced by either indomethacin or CRS. Also, the greater gastroprotection afforded by telmisartan compared to candesartan could be partly ascribed to its PPARgamma-inducing property.
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Affiliation(s)
- M Morsy
- Department of Pharmacology, Faculty of Medicine, El-Minia University, El-Minia, Egypt.
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Metz KA, Johnson T, Hershey GKK, Lierl MB, Seidu L, Burns K, Assa'ad A. Successful administration of cytarabine in a 16-month-old girl with acute myelogenous leukemia and cytarabine syndrome. Ann Allergy Asthma Immunol 2009; 102:173-4. [PMID: 19230475 DOI: 10.1016/s1081-1206(10)60254-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Leira EC, Ahmed A, Lamb DL, Olalde HM, Callison RC, Torner JC, Adams HP. Extending acute trials to remote populations: a pilot study during interhospital helicopter transfer. Stroke 2009; 40:895-901. [PMID: 19131655 DOI: 10.1161/strokeaha.108.530204] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Methods to increase recruitment into acute stroke trials are needed. The purposes of this study were to evaluate the safety and acceptability of initiating acute stroke trials during early helicopter evacuation and to test an intervention to facilitate informed consent. METHODS A randomized, controlled trial was done with patients with acute stroke who were transferred by helicopter to the University of Iowa Hospitals and Clinics from February 2007 to January 2008. The intervention to be evaluated was the use of fax and a telephone call to the patient/surrogate ahead of helicopter arrival at the outside emergency department. The aim was to improve the rate of subsequent consent (primary outcome) for a pilot trial of a potentially beneficial, low-risk medical intervention (ranitidine) to prevent aspiration pneumonitis. Consenting eligible patients received the infusion during the flight to University of Iowa Hospitals and Clinics. RESULTS One hundred patients were enrolled. Consent rate was 54% in the intervention group and 50% in the control group (P=0.69). However, the consent rate was higher (69%) when prearrival communications between the coinvestigator and potential subjects were successful (P=0.04). This approach resulted in an average gain of 59 minutes as compared with initiating recruitment on arrival to University of Iowa Hospitals and Clinics. CONCLUSIONS Enrollment into stroke intervention trials is feasible during helicopter transportation from a community hospital emergency department to a tertiary stroke center. This underused resource may improve trial efficiency by enabling and expediting participation of remote populations currently excluded from research. Consent rates might be further improved by communication strategies that are more successful in reaching patients at outside emergency departments.
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Affiliation(s)
- Enrique C Leira
- Department of Neurology, Carver College of Medicine, Iowa City, Iowa, USA.
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Ochoa-Guajardo PL, García-Aranda JA. [Use of ranitidine in children's before and after an educative intervention with resident's in a third level pediatric hospital]. Rev Gastroenterol Mex 2009; 74:6-11. [PMID: 19666313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The H2-receptor blockers are often prescribed, but its good tolerance and accessibility have contributed to the abuse of these drugs. The lack of medical knowledge of the precise use of ranitidine involves a higher cost of care and possible errors. OBJECTIVE To evaluate the use of ranitidine in a pediatric hospital of third level before and after an educational intervention for medical residents. MATERIALS AND METHODS We reviewed 240 clinical files, taken at random from hospital wards, excluding emergency room and intensive care unit. The correct indications and the precise dose of the drug were verified. Ninety-three medical residents of each grade of the Pediatric residency were evaluated with an initial survey (IS). Each resident was handed a document with the indications,dosage of medicine and pharmacology. A month later, a second survey (SS) to the medial resident and clinical file was performed. RESULTS The justified indication of ranitidine increased from 52.1 to 66.6% and not justified fell from 47.8 to 33.3%, the error in the prescription increased from 10.8 to 19.0% in the (SS) despite the educational intervention. CONCLUSION The educational intervention on residents decreased prescribing of the drug when it is not justified; however more training and assistance to doctors and nurses is needed to avoid errors in prescribing and to prevent adverse effects.
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Affiliation(s)
- P L Ochoa-Guajardo
- Gastroenterología y Nutrición Pediátrica, Hospital Materno Infantil Alberto López Hermosa, San Luis Potosí, S.L.P.
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Sadeghi R, Kakhki VRD, Zakavi R, Momennezhad M. Gastroesophageal reflux detected on the myocardial perfusion scan with (99m)Tc-MIBI. Hell J Nucl Med 2008; 11:191-192. [PMID: 19081872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Dengiz GO, Odabasoglu F, Halici Z, Cadirci E, Suleyman H. Gastroprotective and antioxidant effects of montelukast on indomethacin-induced gastric ulcer in rats. J Pharmacol Sci 2007; 105:94-102. [PMID: 17895592 DOI: 10.1254/jphs.fp0070122] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Montelukast, a selective reversible cysteinyl leukotriene D(4)-receptor (LTD(4) receptor) antagonist, is used in the treatment of asthma. We have investigated alterations in the glutathione (GSH) and activity levels of antioxidative enzymes [superoxide dismutase (SOD), catalase (CAT), glutathione S-transferase (GST), and glutathione reductase (GR)] and myeloperoxidase (MPO), as markers of the ulceration process following oral administration of montelukast, lansoprazole, famotidine, and ranitidine, respectively, in rats with indomethacin-induced ulcers. In the present study, we found that 1) montelukast, lansoprazole, famotidine, and ranitidine all reduced the development of indomethacin-induced gastric damage, with this reduction occurring at a greater magnitude for montelukast, famotidine, and lansoprazole than for ranitidine; 2) montelukast and ranitidine both alleviated increases in the activity levels of CAT and GST enzymes resulting from gastric injury; 3) montelukast and ranitidine both ameliorated depressions in the GSH and activity levels of SOD and GR enzymes caused by indomethacin administration; and 4) all doses of montelukast, lansoprazole, and ranitidine decreased amplification of MPO activity resulting from induced gastric injuries. These results suggest that the gastroprotective effects of montelukast on indomethacin-induced ulcerations can be attributed to its ameliorating effect on oxidative damage and MPO activity.
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Huang GD, Huang YH, Li JB, Huang DF, Xiao MZ, Tang LJ, Li Q. [Observation on the expression of PS2 and platelet activating factor affected by Jianwei Yuyang granules and study its potential mechanisim against peptic ulcer]. Zhong Yao Cai 2007; 30:1625-1629. [PMID: 18422199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To observe the influences of Jianwei Yuyang (JWYY) granules on expressions of PS2 and platelet activating factor (PAF), and analyze its potential mechanism. METHODS 76 gastric ulcer patients were final diagnosed by gastroscope. They were randomly devided into 3 groups, including JWYY group (36 cases), Ranitidine group (36 cases) and Normal group (12 cases). Detection on Biospy Specimens of gastric mucosa to obseve the change of PAF, PS2 and the contents of aninohexose and phosphatide in ulcerated gastric mucosa for Immunohischemical and Western blotting. RESULTS The contents of aninohexose, phosphatide of PU patients increased in JWYY group. There was significant difference between JWYY group and Ranitidine group (P < 0.01). The Immunohischemical and Western blotting methods showed that there was a linear correlation between the the contents of phosphatide, anino-hexose and the expression of PAF, PS2 in PU patients (P < 0.01). CONCLUSION JWYY granule can prevent the occurrence and relaps of ulcer and affect the hydrophobicity of gastic mucosa and strengthen the stability of myxo-gellayer by reducing the expression of PAF, elevating the expression of PS2 and effecting the contents of phosphatide and aninohexose, that may be one of the mechanisms of JWYY to heal ulcer quickly.
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Affiliation(s)
- Guo-dong Huang
- First Affiliated Hospital of Nanchang University, Nanchang 330006, China.
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Janiak P, Thumshirn M, Menne D, Fox M, Halim S, Fried M, Brühlmann P, Distler O, Schwizer W. Clinical trial: the effects of adding ranitidine at night to twice daily omeprazole therapy on nocturnal acid breakthrough and acid reflux in patients with systemic sclerosis--a randomized controlled, cross-over trial. Aliment Pharmacol Ther 2007; 26:1259-65. [PMID: 17944740 DOI: 10.1111/j.1365-2036.2007.03469.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Gastro-oesophageal reflux disease (GERD) is an important problem in systemic sclerosis due to impaired salivation and oesophageal function. AIM To determine the efficacy of adding ranitidine at bedtime to control nocturnal acid breakthrough (NAB) and GERD in patients with systemic sclerosis already prescribed high-dose omeprazole. METHODS Patients with systemic sclerosis and GERD symptoms (n = 14) were treated with omeprazole 20 mg b.d. and either placebo or ranitidine 300 mg at bedtime for 6 weeks in a randomized, cross-over, placebo controlled study. At the end of each period a 24 h pH-study with intragastric and oesophageal pH measurement was performed. RESULTS Pathological acid reflux occurred in eight patients with omeprazole/placebo and in seven with omeprazole/ranitidine (P = ns) with technically adequate oesophageal pH-studies (n = 13). NAB was present in eight patients with omeprazole/placebo and six with omeprazole/ranitidine (P = ns) in whom technically adequate gastric pH-studies were obtained (n = 10). The addition of ranitidine had no consistent effect on patient symptoms or quality of life. CONCLUSION Many patients with systemic sclerosis experienced NAB and pathological oesophageal acid exposure despite high-dose acid suppression with omeprazole b.d. Adding ranitidine at bedtime did not improve NAB, GERD or quality of life in this population.
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Affiliation(s)
- P Janiak
- Clinic of Gastroenterology and Hepatology, University Hospital of Zürich, Zürich, Switzerland
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Miwa H, Oshima T, Tomita T. [Evidence based treatment strategy for dyspeptic symptoms]. Nihon Shokakibyo Gakkai Zasshi 2007; 104:1594-1600. [PMID: 17984607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Hiroto Miwa
- Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine
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Devi RS, Narayan S, Vani G, Srinivasan P, Mohan KV, Sabitha KE, Devi CSS. Ulcer protective effect of Terminalia arjuna on gastric mucosal defensive mechanism in experimental rats. Phytother Res 2007; 21:762-7. [PMID: 17471603 DOI: 10.1002/ptr.2160] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The methanol extract of the bark of Terminalia arjuna (Combretaceae) (TAE) showed marked antiulcer and ulcer healing activity against 80% ethanol (ETH), diclofenac sodium (DIC) and dexamethasone (DEX) induced ulcer models dose dependently at doses of 100, 400 and 200 mg/kg body weight respectively. Pre-, post and co-administration of TAE offered 100% protection to the gastric mucosa against ETH, DIC and DEX induced ulcers as observed from the ulcer score. Gastric mucosal analysis of DEX induced rats were associated with changes in the levels of protein, protein bound carbohydrate complexes, lipid peroxides (LPO), glutathione (GSH) and activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) compared with control rats. Co-administration with TAE in DEX rats (DEX + TAE) favorably altered the levels of LPO, GSH and also the activities of SOD and CAT in gastric mucosa, whereas the activities of GPx remained unaltered in all groups. In DEX + TAE rats, the levels of protein and protein bound carbohydrate complexes were increased when compared with DEX rats. The results indicate that the gastroprotective effect of TAE is probably related to its ability to maintain the membrane integrity by its antilipid peroxidative activity that protects the gastric mucosa against oxidative damage and its ability to strengthen the mucosal barrier, the first line of defense against exogenous and endogenous ulcerogenic agents.
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Affiliation(s)
- R S Devi
- Department of Biochemistry, University of Madras, Guindy Campus, Chennai-600 025, Tamil Nadu, India
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Kubben FJGM, Sier CFM, Schram MT, Witte AMC, Veenendaal RA, van Duijn W, Verheijen JH, Hanemaaijer R, Lamers CBHW, Verspaget HW. Eradication of Helicobacter pylori infection favourably affects altered gastric mucosal MMP-9 levels. Helicobacter 2007; 12:498-504. [PMID: 17760717 DOI: 10.1111/j.1523-5378.2007.00527.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Helicobacter pylori gastritis is recognized as an important pathogenetic factor in peptic ulcer disease and gastric carcinogenesis, and is accompanied by strongly enhanced gastric mucosal matrix metalloproteinase-9 (MMP-9) levels. AIM This study was performed to investigate whether H. pylori-affected gastric mucosal MMP-2 and MMP-9 levels are reversible by successful treatment of the infection. PATIENTS AND METHODS Fifty-eight patients with H. pylori-associated gastritis were treated with a combination regimen of acid inhibitory therapy and antibiotics for 14 days. The levels and isoforms of MMP-2 and MMP-9 were measured by semiquantitative gelatin-zymography, bioactivity assay and enzyme-linked immunosorbent assay in gastric mucosal biopsy homogenates. RESULTS Latent, active, and total MMP-9 levels decreased consistently and significantly by successful H. pylori eradication, in antrum as well as corpus mucosa, compared with those prior to treatment, irrespective of the therapy regimen used. The elevated levels remained unchanged, however, when treatment failed. MMP-2 levels did not show major alterations after H. pylori therapy. CONCLUSION Elevated MMP-9 levels in H. pylori-infected gastric mucosa are reversible by eradication of the infection. No major changes in mucosal MMP-2 levels were observed by H. pylori eradication.
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Affiliation(s)
- Frank J G M Kubben
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Several aspects of Helicobacter pylori eradication have been meta-analyzed; however, nitrofuran-based therapies constitute an exception. The aim of this study was the systematic review and meta-analysis of the effect of furazolidone- and nitrofurantoin-based regimens in the eradication of infection. Studies evaluating the effects of nitrofurans on H. pylori were identified from Medline, EMBASE, the Cochrane Controlled Trials Register and congress abstracts. The studies were classified into groups based on first-, second- and third-line regimens. The pooled eradication rates and combined odd ratios of the individual studies were calculated and compared with the published meta-analysis. The factors influencing the efficiency of the regimens were also analyzed. Side-effects of nitrofuran-based regimens were also analyzed. The pooled eradication rate of primary proton pump inhibitor-based regimens containing furazolidone was 76.3% (CI 67.8-84.2). The odds ratio for furazolidone-based regimens versus standard triple therapies was 2.34 (CI 0.76-3.92). Ranitidine bismuth citrate + furazolidone-based triple regimens were equally efficient (83.5%, CI 74.0-93.0, P = 0.06 versus triple therapies). Schedules including a H(2) antagonist + furazolidone + one other antibiotic achieved pooled eradication rates of 79.9% (CI 67.8-89.9, P = 0.04). Bismuth-based triple therapies achieved 84.5% (CI 72.6-93.0, P = 0.002). Primary quadruple regimens containing furazolidone were superior to triple therapies (83.4%, CI 69.7-92.3, P = 0.01). Second-line schedules containing furazolidone obtained eradication rates of 76.1% (CI 66.4-85.0, P = 0.28 versus primary regimens). Third-line 'rescue' therapies were efficient in 65.5% of the cases (CI 56.3-75.5, P = 0.0001). Side-effects of the regimens containing furazolidone were more frequent than in standard therapies (P = 0.02). The combined odds ratio of side-effects for furazolidone-based versus standard therapies was 0.74 (CI 0.32-1.98). The duration of treatment, but not the furazolidone dose, influenced the treatment outcome. Primary triple regimens containing furazolidone are slightly less efficient than the standard primary combinations; primary quadruple regimens were more efficient than triple therapies. Furazolidone is also efficient as a component of second-line or rescue therapies.
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Affiliation(s)
- György M Buzás
- Department of Gastroenterology, Ferencváros Health Center, Budapest, Hungary.
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Iannuzzi M, D'Ignazio N, Bressy L, De Sio A. Severe scombroid fish poisoning syndrome requiring aggressive fluid resuscitation in the emergency department: two case reports. Minerva Anestesiol 2007; 73:481-3. [PMID: 17115014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Scombroid fish poisoning (scombrotoxism, scombroid ichthyotoxicosis) is a food-related illness typically associated with the consumption of dark and white meat fish. Two patients presented to the emergency department. Metilprednisone 1000 mg and ranitidine 150 mg were administered initially. A large amount of crystalloids and colloids in in combination with vasoactive drugs were required to maintain normopressure. Levels of histamine and N-methylhistamine were far above the normal mean. Carboxyhemoglobin levels were also tested to exclude a superimposition of carbon monoxide intoxication. In both cases, major symptoms occurred and were treated aggressively. Early goal directed fluid therapy corrected the DO2/VO2 unbalance, due to a distributive pattern of hypovolemic impending shock, and permitted a rapid stabilisation of both patients. It is important to recognize the syndrome as an intoxication (rather than an allergic reaction) so that the source of the toxin can be identified and further cases prevented. It is also important to investigate where the fish was cooked (i.e. in an open space vs. closed space), to exclude the possibility of a concomitant carbon monoxide intoxication, which would require transfer the patient to a hospital facility equipped with a hyperbaric chamber.
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Affiliation(s)
- M Iannuzzi
- Intensive Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy.
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Abstract
Angioneurotic orolingual edema associated with the use of rt-PA (recombinant tissue plasminogen activator) for systemic thrombolysis are described in the literature, but only as isolated case reports. Strangely, the rate of anaphylactic reactions to rt-PA is higher (1.9%) when they are used in the treatment of acute stroke than when they are given to treat acute myocardial infarction (0.02%). Patients who are taking ACE inhibitors seem to be at increased risk of such a potentially life-threatening event. We now report on two patients, in each of whom asymmetric angioneurotic edema was observed following successful thrombolysis with rt-PA. Both these patients were taking ACE inhibitors. It was possible to avoid intubation and ventilation in both cases. Therapy with ranitidine, clemastine, and a C1 esterase inhibitor resulted in the resolution of symptomatic angioneurotic edema within hours.
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Affiliation(s)
- R Laubinger
- Klinik für Anaesthesie und operative Intensivtherapie, Südharz-Krankenhaus, Nordhausen.
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Abstract
OBJECTIVE To study the effects of Jianpi Qingre Huayu Recipe in curing gastric ulcer and to preliminarily probe into its pathogenic mechanism. METHODS Fifty patients with gastric ulcer of Pi -insufficiency and stasis-heat syndrome type were assigned to the treated group (30 patients) and the control group (20 patients). They were treated respectively with JQH and Ranitidine. At the same time, another group consisting of 20 healthy persons was set up for normal control. The clinical effect on gastroscopic figure and traditional Chinese medicine (TCM) syndrome were observed. Changes of T-cell subsets and interleukin-8 (IL-8) in serum as well as IL-8 in mucosa around the gastric ulcer were determined before and after treatment by flow cytometry and ELISA. RESULTS Comparison of the total effective rate on gastroscopic figure in the treated group and the control group (86.7% vs 80.0%) showed insignificant difference, but the cure rate and markedly effective rate in the former (50.0% and 20.0%) was higher than that in the latter (40.0% and 15.0%) respectively. Comparison of the total effective rate on TCM syndrome in the treated group and in the control group (96.7% vs 70.0%) showed insignificant difference, but the cure rate and markedly effective rate in the former (63.3% and 23.3%) was higher than that in the latter (50.0% and 20.0%) respectively. Serum levels of CD3+, CD4+, CD8+ got restored to normal range in the treated group after treatment but it was not so in the control group. IL-8 level in gastric mucosa was improved in both groups but the improvement in the treated group was better. CONCLUSION JQH could effectively treat gastric ulcer and partly reduce its recurrence through improving patients' immune function.
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Affiliation(s)
- Fu-Sheng Zhou
- Pi-wei Institute of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510405.
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