A comparison of three doses of omeprazole in the treatment of equine gastric ulcer syndrome: A blinded, randomised, dose-response clinical trial.

REASONS FOR PERFORMING THE STUDY: A previous study demonstrated that a dose effect between 1.6 and 4.0 mg/kg bwt of omeprazole per os s.i.d. is present in the treatment of equine gastric ulceration. In the same study, healing of glandular ulceration appeared inferior to healing of squamous ulceration. However, several limitations were recognised in that study and further investigation is warranted. OBJECTIVES: To further investigate the presence of a dose relationship in the treatment of gastric ulceration under conditions that may favour omeprazole efficacy such as administration prior to exercise and after a brief fast, and potential differences between the response of squamous and glandular ulceration to omeprazole therapy. STUDY DESIGN: A blinded, randomised, dose-response clinical trial. METHODS: Sixty Thoroughbred racehorses with grade ≥2/4 squamous and/or glandular ulceration were identified by gastroscopy. Horses were randomly assigned to receive either 1.0, 2.0 or 4.0 mg/kg bwt of enteric coated omeprazole per os s.i.d. 1-4 h prior to exercise. Gastroscopy was repeated at approximately 28 days. RESULTS: The lower doses studied (1.0 and 2.0 mg/kg bwt) were noninferior to the reference dose (4.0 mg/kg bwt) in the treatment of squamous ulceration. Healing was greater in squamous ulceration than glandular ulceration (86% vs. 14%; P<0.0001). Improvement in ulcer grade was more likely in squamous lesions than glandular lesions (96% vs. 34%; P<0.0001). Worsening of the glandular ulcer grade was observed in 36% of horses. CONCLUSIONS: The results of this study suggest that, under the conditions studied, where omeprazole is administered before exercise and following a brief fast, doses of omeprazole as low as 1 mg/kg bwt per os s.i.d. may be as effective as higher doses. The proportion of glandular ulceration that heals with 28 days of omeprazole therapy is less than that of squamous ulceration.

A comparison of two doses of omeprazole in the treatment of equine gastric ulcer syndrome: a blinded, randomised, clinical trial.

REASONS FOR PERFORMING THE STUDY: Studies on omeprazole have reported that doses as low as 0.7 mg/kg bwt per os are potent suppressors of acid production. Yet, to date, no studies have compared treatment efficacy of different doses in clinical cases of equine gastric ulceration. Furthermore, no studies have been performed to compare the healing response of the squamous and glandular mucosa to acid suppression therapy. OBJECTIVES: To compare: 1) the efficacy of 2 doses of omeprazole in the treatment of primary squamous and glandular gastric ulceration; and 2) the healing response of primary squamous and glandular gastric ulceration to acid suppression therapy. STUDY DESIGN: A blinded, randomised, dose-response clinical trial. METHODS: Twenty Thoroughbred racehorses with grade ≥2/4 glandular ulceration were identified on gastroscopy. Seventeen horses also had grade ≥2/4 squamous ulceration. Horses were randomly assigned to one of 2 groups. Horses received either 2.0 g (high dose: 4.0 mg/kg bwt) or 0.8 g (low dose: 1.6 mg/kg bwt) of oral omeprazole per os once daily. Gastroscopy was repeated at 28-35 days. RESULTS: Time and dose significantly affected grades of squamous (P<0.0001, P = 0.02) and glandular (P = 0.006 and 0.005) ulceration. Data analysis did not support our hypothesis that the lower dose would have similar effects (i.e. be noninferior) to the higher dose when considering ulcer healing and ulcer improvement. Improvement was more likely with the high dose for the squamous (P = 0.05) but not glandular (P = 0.4) mucosa. The percentage of glandular ulcers that improved was less than squamous ulcers (P = 0.02). CONCLUSIONS: The results suggest that a dose-response exists for the treatment of both squamous and glandular ulcers. Improvement of glandular ulcers was not as complete as observed with squamous ulcers and current equine gastric ulcer syndrome treatment recommendations may not be appropriate for glandular disease.

Conversational turn-taking violations in mother-child interaction.

Conversational turn-taking violations and corresponding repair mechanisms in mother-child interaction were examined. Thirty mother-child dyads, with children ranging in age from 2:10 (years:months) to 6:3, were videotaped in a 10-min free play situation. The interactions were analyzed for several aspects of overlaps (i.e., simultaneous talking), including general characteristics, participant involvement, turn-taking repair mechanisms, topic characteristics, and communicative intent. Of the 246 overlaps identified, the majority were single, nonconsecutive, and internal (Gallagher & Craig, 1982). Mothers interrupted significantly more than did the children. In terms of repair mechanisms, children exhibited a greater frequency of discontinuation of talking when the mothers interrupted than did the mothers for the comparable situation. Both within and following the majority of overlaps, mothers and children maintained the same topic. Utterances consisting of informative statements were interrupted more often than those consisting of requests. In general, mothers did not appear to be as facilitative of their children's turn-taking skills as they are for other pragmatic skills.

Contact tracing in hepatitis B infection.

In an epidemiological study of patients diagnosed as having hepatitis B virus (HBV) infection during a 12 month period in a London health district, 98 (67%) of 144 index cases and 146 (67%) of 218 of their named contacts were interviewed. The problems and benefits of using conventional contact tracing techniques in the management of this infection are discussed. Named contacts in stable relationships were more easily traced than young homosexuals with frequent anonymous contacts, and drug addicts. Information on the disease and the risk of its transmission to others was, however, welcomed by some homosexuals who were concerned to establish ways of identifying chronic carriers, immune men, and those at risk. A self help group was started as a result of this study.