The impact of proton pump inhibitor therapy on patients with liver disease.

BACKGROUND: Proton pump inhibitor (PPI) therapy has been reported to be an independent mortality risk factor in patients with cirrhosis. AIM: To identify the prevalence of PPI prescription, the appropriateness of this therapy and to investigate the relationship between PPI therapy and overall survival in patients with liver disease. METHODS: This retrospective cohort study used patient data for 2012 to 2014 collected from the Scottish Liver Transplant Unit and the Hepatology Ward at the New Royal Infirmary of Edinburgh. RESULTS: A total of 64% of the 198 patients discharged from the Hepatology ward were prescribed a PPI. Of the 206 patients assessed and listed for orthotopic liver transplant (OLT), 55% were prescribed a PPI. These percentages are significant, particularly as the majority had no recorded appropriate indication for this therapy. For patients listed for OLT, a logistic regression model revealed significant associations between PPI treatment and male sex, higher model of end-stage liver disease (MELD) scores and patient encephalopathy. A multivariate Cox regression model showed that MELD and UK model for end-stage liver disease scores were independent predictors of patient mortality, while alcoholic liver disease aetiology was a protective factor. There was no statistically significant difference in survival between patients who were prescribed a PPI at assessment and those who were not. CONCLUSION: Associations between PPI use, encephalopathy and higher MELD scores imply caution should be exercised in prescribing gastric acid suppressants to patients with cirrhosis, particularly in the absence of clear indications.

A comparison of sulpiride, dothiepin, diazepam and placebo in the treatment of depressed out-patients.

The effects of sulpiride, dothiepin, diazepam and placebo were compared in out-patients who were suffering from depressive states of moderate severity. No major differences were found between the regimens after 4 weeks administration. A notable finding was the high recovery rate among those patients who received the placebo. The need for drug treatment in the milder depressive states is discussed.

Mars climatology from viking 1 after 20 sols.

The results from the meteorology instruments on the Viking 1 lander are presented for the first 20 sols of operation. The daily patterns of temperature, wind, and pressure have been highly consistent during the period. Hence, these have been assembled into 20-sol composites and analyzed harmonically. Maximum temperature was 241.8 degrees K and minimum 187.2 degrees K. The composite wind vector has a mean diurnal magnitude of 2.4 meters per second with prevailing wind from the south and counterclockwise diurnal rotation. Pressure exhibits diurnal and semidiurnal oscillations. The diurnal is ascribed to a combination of effects, and the semidiurnal appears to be the solar semidiurnal tide. Similarities to Earth are discussed. A major finding is a continual secular decrease in diurnal mean pressure. This is ascribed to carbon dioxide deposition at the south polar cap.

Preliminary meteorological results on Mars from the viking 1 lander.

The results from the meteorology instruments on the Viking 1 lander are presented for the first 4 sols of operation. The instruments are working satisfactorily. Temperatures fluctuated from a low of 188 degrees K to an estimated maximum of 244 degrees K. The mean pressure is 7.65 millibars with a diurnal variation of amplitude 0.1 millibar. Wind speeds averaged over several minutes have ranged from essentially calm to 9 meters per second. Wind directions have exhibited a remarkable regularity which may be associated with nocturnal downslope winds and gravitational oscillations, or to tidal effects of the diurnal pressure wave, or to both.

The pattern of fatal cerebrovascular disease in Jamaica

The data presented shows that the pattern of fatal cerebrovascular disease as seen at necropsy in Jamaica is very different from that in comparable studies in white communities. In a 15-year period (1952-1967) cerebro-vascular disorders accounted for 296 (9.9 percent) of all adult necropsies performed in a large general teaching hospital. Of these no less than 77 percent were due to haemorrhage whereas only 23 percent were due to infarction. This high incidence of haemorrhagic strokes probably reflects the high incidence of hypertension which has been shown to exist on the Island. 89 percent of spontaneous intracerebral haemorrhages are associated with hypertension and there is a far lower proportion of hind brain as compared with cerebral hemisphere haemorrhages. A small but significant group appears to be due to hypertension occurring during or shortly after childbirth. Subarachnoid haemorrhages due to rupture of berry aneurysms of the circle of Willis also present unusual features. 70 percent of all such aneurysms occur at the junction of the internal carotid arteries and their branches whereas middle cerebral and anterior communicating artery aneurysms are relatively uncommon. Multiple aneurysms of the Willisian vessels and intracerebral extensions of haemorrhages from ruptured aneurysms also appear to be far less common than generally reported elsewhere.Cerebral infarction due to atheroma and thrombosis is rare - only 54 cases being encountered during the period under consideration. This is even more surprising in view of the fact that cerebral artery atheroma is probably as common as in North America and Europe (Summary)

Report on 151 childhood malignancies observed in Jamaica

During a 10-year period 1958-67, 151 tumors were noted in children under 15 years of age in Jamaica. This comprised 2.9 percent of all malignant tumors observed. Leukemia was the most common form of cancer. The incidence of retinoblastomas was high and surpassed incidences of neuroblastomas and of Wilms' tumors. Kaposi's sarcoma was not observed, and hepatocellular carcinoma was extremely rare. The tumor incidence pattern in Jamaica therefore largely resembles that in the United States and in Western Europe. It contrasts significantly with that in Uganda and in Western Nigeria. This merits attention, since over 90 percent of the Jamaican population is either pure Negro or of predominantly Negro descent as a result of importation from West Africa in former days. (Summary)

Aspects of cancer of the gastro-intestinal tract in Jamaica

Some of the cancers of the Gastro-intestinal tract take on a special significance in Jamaica. This is particularly evidenced by the incidence figures of Cancer of the Oesophagus and Cancer of the Stomach in males. A recent publication from the International Union against Cancer, compared data from 32 Cancer Registries in 24 Countries. Among these Jamaica was found to have the highest incidence of Cancer of the oesophagus Cancer exceeding the Jamaican rates, but as no Cancer Registry figures were available from those countries, a comparison could not be made. Jamaica's high incidence figures are shared by at least 2 other Caribbean islands, Puerto Rico and Curacao. Cancer of the Stomach is the most common single type of Cancer in Jamaican male. The incidence figures for all types of Gastro-intestinal Cancer will be briefly discussed in relation to rates in other parts of the world and the suspected aetiological factors wil be briefly reviewed (AU)