Prospective endoscopic study of stress erosions and ulcers in critically ill adult patients treated with either sucralfate or placebo

OBJECTIVE

To compare the frequency of stress erosions and ulcers in critically ill adult patients treated with either sucralfate or placebo.

DESIGN

Prospective, randomized study.

SETTING

Intensive care unit in a university hospital.

PATIENTS

Twenty-six adult patients. All patients were mechanically ventilated and were at risk of developing stress ulceration.

INTERVENTIONS

Patients were randomized to receive either sucralfate (2 g every 8 hrs) (group 1) via the nasogastric tube (flushed with 10 mL of sterile water) or 20 mL of sterile water every 8 hrs (group 2) via the nasogastric tube.

MEASUREMENTS AND MAIN RESULTS

At the time of intensive care unit admission, the frequency of stress (acute) erosions (as assessed with the endoscope) was 21.7%. No ulcers were detected. By day 3, the frequency had increased to 37.5% in group 1 and 88.9% in group 2. Mucosal deterioration was more likely in the patients treated with placebo (water) (p < .05). In total, seven patients developed acute ulceration in group 2 compared with only one patient in group 1 (p < .05). The frequency of gastric colonization with aerobic Gram-negative bacilli was 25.6% in group 1 and 28.6% in group 2. Only one retrograde nosocomial pneumonia developed (group 1).

CONCLUSION

Based on our findings, we strongly recommend the adoption of sucralfate as opposed to no prophylaxis in the prevention of acute upper gastrointestinal ulceration.

A comparison of the frequency of stress ulceration and secondary pneumonia in sucralfate- or ranitidine-treated intensive care unit patients

OBJECTIVE

To compare the frequency of acute stress ulceration and secondary pneumonia caused by aerobic Gram-negative bacilli in ICU patients treated with either sucralfate or ranitidine.

DESIGN

Prospective, randomized study.

SETTING

ICU, university hospital.

PATIENTS

Sixty adult patients who were mechanically ventilated and at risk of developing stress ulceration.

INTERVENTION

The patients were randomized to receive either sucralfate (1 g every 6 hrs) via the nasogastric tube or iv ranitidine (50 mg every 6 hrs). If the gastric pH was less than 3.5 in the latter group, 30 mL of 0.3M sodium citrate was given via the nasogastric tube.

MEASUREMENTS AND MAIN RESULTS

On admission, the frequency rate of erosion/ulceration (assessed with the endoscope) was 13.5%. After 4 days, this rate had increased to 18% in sucralfate-treated patients and 36% in ranitidine-treated patients (NS). Mean gastric pH was more alkaline in the ranitidine-treated patients (5.50) compared with the sucralfate-treated patients (4.26) (p less than .01). This pH permitted a higher occurrence rate of gastric colonization by aerobic Gram-negative bacilli in ranitidine-treated patients (64.3%) compared with sucralfate-treated patients (23.8%) (p less than .01). Retrograde bacterial colonization from the stomach to oropharynx and trachea occurred more frequently in ranitidine-treated patients compared with sucralfate-treated patients. Ultimately, the occurrence rate of pneumonia was greater in the ranitidine-treated (35.7%) than in the sucralfate-treated patients (10.3%) (p less than .05).

CONCLUSION

Based on our findings, we recommend the adoption of sucralfate for routine prophylaxis against stress ulceration.

Effect of step-down and step-up protein-energy feeding systems on egg-type pullet growth and laying performance

Four egg-type pullet feeding systems were compared for the production of egg-type pullets. The dietary regimens consisted of either a step-down protein, high energy feeding program; a step-down protein, low energy program; a step-up protein, high energy program; or a step-up protein, low energy program. At 150 days of age all pullets were housed 2 birds per 25.4 X 45.7 cm laying cage and fed a standard layer diet (16% protein). The experiment utilized 2880 birds grown on the floor in a conventional growing house. At 140 days of age, birds subjected to the step-up protein feeding programs were 82 g smaller in mean body weight, had higher mortality, and consumed less feed than the birds on the step-down protein feeding programs. Body weights at 140 days of age were 1.17 and 1.09 kg for the step-down and step-up feeding programs, respectively. Energy levels fed had no significant effect on pullet weight, feed consumed, or mortality to 140 days of age. During the laying phase, hens that had been on the step-down protein feeding program reached 50% production 2.0 days earlier than birds subjected to the step-up protein feeding program. Hen-day production for the step-down and step-up pullet feeding systems based on 308 days' records was 76.09 and 76.86%, respectively. Feed efficiency and mature body weight were not significantly affected by grower feeding programs. The largest egg size and highest laying house mortality were noted in hens grown on the step-down protein feeding program.

Dispersal of the northern fowl mite, Ornithonyssus sylviarum (Canestrini and Fanzago), and the chicken body louse, Menacanthus stramineus (Nitzsch), among thirty strains of egg-type hens in a caged laying house

From September 1978 through Februrary 1979, dispersal of uncontrolled, naturally occurring populations of the northern fowl mite, Ornithonyssus sylviarum (Canestrini and Fanzago), and the chicken body louse, Menacanthus stramineus (Nitzch) was studied on 30 strains of egg-type pullets reared to 20 weeks old on four growing rations before being housed for egg production. Hens representing all 30 strains and each of the four feeding regimens had mites. The northern fowl mite spread from initial infestations down the entire length of the house in 1 month; after four months, the chicken body louse had spread approximately two-thirds the length of a cage row in the house. Populations of the northern fowl mite increased from very light to extra heavy within 1 month and then began a slow decline.

Crystal structure of a natural potassium-barium hexatitanate isostructural with K2Ti6O13

The crystal structure of a mineral with the stoichiometry (K0.58Ba0.36)2(Ti0.93FeIII0.06)6O13 has been determined by X-ray diffraction and refined by full-matrix least squares to a residual of 0.076 for 1688 ?observed? reflections. Crystals are monoclinic, C2/m, a = 15.453(2), b = 3.8368(7), c = 9.123(2) Ǻ,β = 99.25(1)�, Z = 2, and are isostructural with the (Na,K,Rb)2Ti6O13 family. High-resolution electron microscopy has confirmed that the Ba and FeIII species (the latter in a high-spin state) are randomly substituted for K and Ti respectively.