Comparative study of bacterial infection prevalence between cirrhotic patients with and without upper gastrointestinal bleeding.

Bacterial infection is a frequent complication in patients with chronic liver disease, mainly during the advanced stages. There is evidence that the main factors that contribute to a predisposition to infection in cirrhotic patients are related to hepatic failure with consequent immunodeficiency. Invasive procedures (diagnostic or therapeutic) can predispose to bacterial infections, and upper gastrointestinal bleeding (UGB) is considered a potentially important risk factor. A group of cirrhotic patients (child B and C Pugh groups) were evaluated retrospectively by chart reviews regarding the prevalence of bacterial infection during hospitalization to determine whether UGB was a risk factor. An infection was considered present if a specific organ system was identified or if fever (> 38(o)C) persisted for more than 24 hours with associated leukocytosis. Spontaneous bacterial peritonitis was based on classical criteria. Eighty-nine patients were evaluated. Fourty-six patients presented with UGB, and 43 patients had no UGB (control). There were infections recorded in 25/46 (54%) patients with UGB, and 15/43 (35%) in those without UGB (p=0.065). The ratio of the number of infections/admitted patients, was significantly larger in the group with UGB (0.78 +/- 0.89 vs. 0.39 +/- 0.62; p=0.028) since patients had more than one infection. In the UGB group compared to non UGB group, ascites was more frequent (67% vs. 42%; p=0.027); they were more likely to have undergone endoscopic procedures (p<0.001) and the mean +/- SD for platelets count was smaller (96,114 +/- 57,563 vs 145,674 +/- 104,083; p=0.007). The results show that UGB is an important contribution to bacterial infection among Child B and C cirrhotic patients.

Role of lysosomes on human ulcerogenic gastropathies. Effect of zinc ion on the lysosomal stability.

Numerous conditions are involved in the equilibrium between protective and aggressive factors for gastric mucosa injuring. Among them the lysosomal membrane stability plays a very important role in the inflammatory process. Zinc ion is a well-known lysosomal membrane stabilizer. When given orally to animals or even to humans it protects gastric mucosa against erosive lesions induced by a variety of experimental conditions. Compared with the control group (8.45 +/- 1.49 mU/mg) the lysosomes isolated from samples of gastric mucosa obtained from patients suffering of erosive gastropathies, showed a great liability on their membranes (18.37 +/- 4.52 mU/mg). When these patients were treated orally with zinc sulfate (100 mg of zinc element, twice a day, for two weeks) the lysosomes isolated from their gastric mucosa showed a strong reduction on enzymatic activity (5.49 +/- 1.02 mU/mg), probably due to increasing on the membrane stability. Based on these experimental findings we propose the use of zinc ion as an important adjuvant in treatment of erosive gastropathies.

[Holistic practice in nursing: problems, experiences and potentials]. / Holopraxis na enfermagem: dificuldades experiências e possibilidades.

This work aims at seeking possibilities of advances in Nursing through intimate, daily and social holopraxis. We believe that holopraxis favors a better view of health/illness process and, consequently, it results in upgrading health care delivery quality, allowing partial or total difficulties overcome in Nursing exercise.

[Single nocturnal dose of ranitidine in the treatment of duodenal ulcer: results of an open multicenter, comparative trial]. / Ranitidina em dose única noturna no tratamento da úlcera duodenal. Resultado de um estudo aberto, multicêntrico, comparativo.

This prospective multicentric randomized open trial was designed to evaluate the efficacy of ranitidine 150 mg bid vs 300 mg nocte in the short-term (4 weeks) treatment of duodenal ulcer in 15 Brazilian centers. On the basis of a randomization table 190 patients with endoscopically confirmed duodenal ulcer were allocated to receive either ranitidine 150 mg bid (94 pts) or 300 mg nocte (96 pts). The 2 treatment groups were well matched for age, sex, duration of ulcer disease, number and size of ulcers, duration of current episode, intensity of ulcer pain, alcohol and coffee intake and smoking habits. They were endoscopically controlled at the end of the 4 weeks. At 4 weeks 78 of 94 patients (83.0%) had their ulcers healed with the 150 mg bid regimen as opposed to 79 of 96 patients (82.3%) allocated to the 300 mg nocte dosage. This difference was not statistically significant. Ulcer symptoms diminished with treatment in both groups. The tolerability and compliance was excellent in both groups. The results show that ranitidine 300 mg nocte is as effective in the short-term treatment of duodenal ulcer as ranitidine 150 mg bid. Considering the greater simplicity of administration enhancing patient compliance, the treatment with 300 mg nocte is preferable.

[Treatment of duodenal ulcer with delayed-action cimetidine]. / Tratamento da úlcera duodenal pela cimetidina de ação retardada.

Twenty patients with duodenal ulcer, clinically diagnosed, were treated. Radiologic and endoscopic controls were carried out. Following a random scheme, a group of ten patients was treated with conventional cimetidine and a group of ten with cimetidine of sustained release. The authors consider that cimetidine of sustained release offers the advantage of minor doses and major facility of administration. Similar results were therapeutically obtained.

Tratamento da ulcera duodenal pela cimetidina de acao retardada. / Treatment of duodenal ulcer with cimetidine of delayed action

Vinte pacientes que tiveram sua ulcera duodenal diagnosticada clinica, radiologica e endoscopicamente, foram tratados com cimetidina, obedecendo uma tabela randomizada, sendo que dez pacientes receberam a forma convencional e outros dez a forma retardada.Oito dos dez pacientes que fizeram uso de cimetidina de acao retardada, tiveram sua ulcera cicatrizada ao final de 4 semanas, o mesmo ocorrendo com 7 dos 10 pacientes que usaram a forma convencional da cimetidina. A necessidade do uso adicional de antiacido foi pequena nos dois grupos tratados, bem como os episodios de dor noturna e diurna, que ocorreram em numero reduzido, nao ultrapassando a 1a.semana de tratamento. Isto demonstra a boa eficacia terapeutica, com percentual de cura semelhante e bastante significativo nos dois grupos estudados. Foi considerado como vantagem para a cimetidina de acao retardada o uso de doses menores e melhor comodidade posologica na obtencao do mesmo efeito terapeutico conseguido com a cimetidina convencional