Comparative Efficacy of Sodium Zirconium Cyclosilicate and Sodium Polystyrene Sulfonate for Acute Hyperkalemia: A Retrospective Chart Review.

Background: Sodium polystyrene sulfonate (SPS) is a nonselective sodium-potassium exchange resin commonly used along with intravenous (IV) insulin, albuterol, furosemide, and/or calcium for the treatment of acute hyperkalemia. Sodium zirconium cyclosilicate (SZC) is a newer non-absorbed exchange resin that preferentially increases fecal potassium excretion from the gastrointestinal tract. Limited data exists on the efficacy of SZC for the treatment of acute hyperkalemia. Objectives: To assess the achievement of normokalemia (serum potassium level [K+] 3.5-5.2 mmol/L) within 24 hours after administration of SZC or SPS in combination with insulin regular IV push. Methods: A multicenter, retrospective chart review (2020-2021) using electronic medical records at an academic health system. The study population included adult patients receiving one or more doses of SZC or SPS in combination with IV insulin for acute hyperkalemia (K+ >5.2 mmol/L). Patients receiving dialysis were excluded. Serum chemistries were assessed at baseline and an additional 2 values within 24 hours to determine normokalemia and hypokalemia at each follow-up. Results: Of 141 patients included, 51 received SZC and 90 received SPS. Normokalemia at the first follow-up was achieved in 51.0% of patients receiving SZC and 46.7% of patients receiving SPS (P = .622) and was sustained in 35.3%versus 44.4% (P = .289) of patients within 24 hours. Mean serum potassium differences from baseline to first follow-up were similar between SZC and SPS groups (0.9 mmol/L vs 1.0 mmol/L). Hypokalemia within 24 hours of administration occurred in 4 patients-1 in SZC, 3 in SPS. Conclusion: Both SZC and SPS yielded similar rates of normokalemia achievement with IV insulin for the treatment of acute hyperkalemia. Further prospective studies are needed to confirm these findings.

Use of gastrointestinal prokinetics and the risk of parkinsonism: A population-based case-crossover study.

BACKGROUND: The disease burden of parkinsonism is extremely costly in the United States. Unlike Parkinson's disease, drug-induced parkinsonism (DIP) is acute and reversible; exploring the causative drug is important to prevent DIP in patients at high-risk of parkinsonism. OBJECTIVE: To examine whether the use of gastrointestinal (GI) prokinetics is associated with an increased risk of parkinsonism. METHODS: We conducted a case-crossover study using nationally representative data. We included patients who were newly diagnosed with parkinsonism (ICD-10 G20, G21.1, G25.1) between January 1, 2007 and December 1, 2015. The first prescription date of G20, G21.1, or G25.1 diagnoses was defined as the index date (0 day). Patients with prior extrapyramidal and movement disorders or brain tumors were excluded. We assessed the exposure within the risk (0-29 days) and control periods (60-89 days), before or on the index date. Conditional logistic regression estimated the adjusted odds ratio (aOR) for parkinsonism. RESULTS: Overall, 2268 and 1674 patients were exposed to GI prokinetics during the risk and control periods, respectively. The use of GI prokinetics significantly increased the occurrence of parkinsonism (aOR = 2.31; 95% Confidence Interval [CI], 2.06-2.59). The use of GI prokinetics was associated with a higher occurrence of parkinsonism in elderly patients (≥65 years old; aOR = 2.69; 95% CI, 2.30-3.14) than in younger patients (aOR = 1.90; 95% CI, 1.59-2.27). CONCLUSIONS: The use of GI prokinetics was significantly associated with higher occurrences of parkinsonism, necessitating close consideration when using GI prokinetics.

Multimodal Intervention Assessing the Appropriateness of Acid Suppression Therapy is Associated With Reduced Prescriptions at the Time of Discharge for Hospitalized Inpatients.

Background: Acid suppression therapy (AST), including proton pump inhibitors and histamine 2 receptor antagonists, are an overused class of medications. When used inappropriately, AST leads to polypharmacy, increased healthcare costs, and possible negative health consequences. Objective: To assess whether an intervention including prescriber education combined with a pharmacist-driven protocol was effective in reducing the percentage of patients who were discharged with inappropriate AST. Methods: This was a prospective pre-post study of adult patients who were prescribed AST before or during their admission to an internal medicine teaching service. All internal medicine resident physicians received education on appropriate AST prescribing. During the 4-week intervention period, dedicated pharmacists assessed the appropriateness of AST and made recommendations regarding deprescribing if no appropriate indication was identified. Results: During the study period, there were 14 166 admissions during which patients were prescribed AST. Out of the 1143 admissions during the intervention period, appropriateness of AST was assessed by a pharmacist for 163 patients. AST was determined to be inappropriate for 52.8% (n = 86) of patients and discontinuation or de-escalate of therapy occurred in 79.1% (n = 68) of these cases. The percentage of patients discharged on AST decreased from 42.5% before the intervention to 39.9% after the intervention (P = .007). Conclusion: This study suggests that a multimodal deprescribing intervention reduced prescriptions for AST without an appropriate indication at the time of discharge. To increase the efficiency of the pharmacist assessment several workflow improvements were identified. Further study is necessary to understand the long-term outcomes of this intervention.

Gastrointestinal effects of Mentha aquatica L. essential oil.

Found in humid regions and waterways and popularly used to treat gastrointestinal problems among other applications, the present study evaluated the M. aquatica essential oil (OEMa) as a therapeutic alternative to treat gastrointestinal disorders. Produced by steam distillation, chemical composition of OEMa was determined by GC-MS analysis. The ethanol-induced ulcer and the dose-repeated acetylsalicylic acid (ASA)-induced gastrointestinal lesions models in rats evaluated, respectively, the prophylactic and curative effects of EOMa on peptic ulcers. The EOMa's effect on gastric secretion, gastric mucus and gastrointestinal motility were evaluated in in vivo models. The curative effect of EOMa on acute colitis was evaluated using the DSS-induced colitis model in mice. Obtained in 0.17% yield (w/w), with carvone (54.82 ± 1.39 g/100 g oil) as the main constituent, EOMa (at 75 mg/kg) showed potent gastroprotective effect (> 90%) mediated by non-protein sulfhydryl compounds (NPSH) and nitric oxide (NO) modulation alongside reduction in gastric secretion volume and total acidity. EOMa did not affect gastric mucus production and gastrointestinal motility. In dose-repeated ASA-induced gastrointestinal lesions model, EOMa (at 25 mg/kg) promoted the inflammatory process resolution both in gastric and duodenal walls by modulating NPSH, NO and myeloperoxidase levels. Despite delaying in 2 days the clinical symptoms worsening, EOMa (at 25 mg/kg) was not able to protect colon tissues from DSS-induced acute colitis as evidenced by macroscopic, biochemical, and histopathological parameters. This is the first report of Mentha aquatica essential oil as a promising herbal medicine for peptic ulcers treatment together with an adjuvant effect in IBD.

Impact of elobixibat on serum and fecal bile acid levels and constipation symptoms in patients with chronic constipation.

BACKGROUND AND AIM: Elobixibat is a locally acting inhibitor of the ileal bile acid transporter. We compared bile acid metabolism between healthy subjects and patients with chronic constipation and assessed changes in the bile acid profile after elobixibat administration in the latter group. METHODS: Healthy subjects (n = 10) and patients with chronic constipation (n = 19) were assessed as inpatients for 7 days, during which they received meals containing ~60 g/day of fat. Patients with chronic constipation remained as inpatients for a further 7 days for once-daily elobixibat administration. Assessments included concentrations of fecal and serum bile acids, serum 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor 19, and bowel movements and constipation symptoms. RESULTS: Fecal total and primary bile acids were significantly lower in patients with chronic constipation versus healthy subjects. Serum C4 and fibroblast growth factor 19 levels were comparable between groups. Elobixibat treatment increased fecal total and primary bile acids and decreased levels of fecal lithocholic acid and serum total as well as secondary bile acids in patients with chronic constipation. Bowel movements and other constipation-related symptoms were also improved by elobixibat to levels almost comparable with those of healthy subjects. CONCLUSIONS: Despite comparable C4 levels, patients with chronic constipation demonstrated decreased levels of fecal bile acids versus healthy subjects. Elobixibat treatment increased fecal bile acid excretion and reduced serum bile acid concentrations. The improvement of constipation after elobixibat treatment was associated with increased total bile acids, particularly primary bile acids.

A Systematic Review and Meta-analysis of Randomized Control Trials: Combination Treatment With Proton Pump Inhibitor Plus Prokinetic for Gastroesophageal Reflux Disease.

BACKGROUND/AIMS: Prokinetics can be used for treating patients with gastroesophageal reflux disease (GERD), who exhibit suboptimal response to proton pump inhibitor (PPI) treatment. We conducted a systematic review to assess the potential benefits of combination treatment with PPI plus prokinetics in GERD. METHODS: We searched PubMed, the Cochrane Library, and EMBASE for publications regarding randomized controlled trials comparing combination treatment of PPI plus prokinetics to PPI monotherapy with respect to global symptom improvement in GERD (until February 2020). The primary outcome was an absence or global symptom improvement in GERD. Adverse events and quality of life (QoL) scores were evaluated as secondary outcomes using a random effects model. Quality of evidence was rated using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS: This meta-analysis included 16 studies involving 1446 participants (719 in the PPI plus prokinetics group and 727 in the PPI monotherapy group). The PPI plus prokinetics treatment resulted in a significant reduction in global symptoms of GERD regardless of the prokinetic type, refractoriness, and ethnicity. Additionally, treatment with PPI plus prokinetics for at least 4 weeks was found to be more beneficial than PPI monotherapy with respect to global symptom improvement. However, the QoL scores were not improved with PPI plus prokinetics treatment. Adverse events observed in response to PPI plus prokinetics treatment did not differ from those observed with PPI monotherapy. CONCLUSIONS: Combination of prokinetics with PPI treatment is more effective than PPI alone in GERD patients. Further high-quality trials with large sample sizes are needed to verify the effects based on prokinetic type.

Effect of Bismuth Subsalicylate on Gastrointestinal Tolerability in Healthy Volunteers Receiving Oral Delayed-release Dimethyl Fumarate: PREVENT, a Randomized, Multicenter, Double-blind, Placebo-controlled Study.

PURPOSE: Flushing and gastrointestinal (GI) events are commonly associated with the use of delayed-release dimethyl fumarate (DMF) treatment for relapsing multiple sclerosis. METHODS: PREVENT (A Multicenter, Double-Blind, Placebo-Controlled Study of Pepto-Bismol [Bismuth Subsalicylate] on Gastrointestinal Tolerability in Healthy Volunteers Receiving Oral TECFIDERA [Dimethyl Fumarate] Delayed-Release Capsules Twice Daily) is a double-blind, placebo-controlled, 8-week study that evaluated the effect of bismuth subsalicylate on DMF-related GI events. Bismuth subsalicylate 524 mg or placebo were administered 30 min before DMF (weeks 1-4). DMF was dosed twice-daily (BID) at 120 mg (week 1) and 240 mg (weeks 2-8). Using an e-diary device, participants recorded GI and flushing events on the Modified Overall Gastrointestinal Symptom Scale once daily for the preceding 24 h. The primary end point was time to first GI-related event. Secondary end points included frequency and severity of GI-related events. FINDINGS: A total of 175 participants were enrolled (placebo, n = 87; bismuth subsalicylate, n = 88), and 17 discontinued treatment (placebo, n = 8; bismuth subsalicylate n = 9). A total of 146 participants reported ≥1 GI event: placebo, n = 72 (82.8%); and bismuth subsalicylate, n = 74 (84.1%). There was no statistical difference in risk of a GI event between the groups (P = 0.8292). Mean (SD) time from DMF initiation to first GI event was similar: placebo, 5.4 (8.73) days; and bismuth subsalicylate, 5.6 (10.87) days. Incidence of flatulence (38.6% vs 50.6%) and diarrhea (36.4% vs 48.2%) during weeks 1-4 was numerically lower in the bismuth subsalicylate group compared with the placebo group. Mean worst severity scores for flatulence (1.1 vs 1.8; P = 0.0219) and diarrhea (1.0 vs 1.6; P = 0.0500) were lower with bismuth subsalicylate than with placebo. IMPLICATIONS: Although coadministration of bismuth subsalicylate did not affect the occurrence of DMF-related GI events overall, it reduced the severity and incidence of flatulence and diarrhea. ClinicalTrials.gov identifier: NCT01915901.

Benefit of an electronic medical record-based alarm in the optimization of stress ulcer prophylaxis.

BACKGROUND: The use of stress ulcer prophylaxis (SUP) has risen in recent years, even in patients without a clear indication for therapy. AIM: To evaluate the efficacy of an electronic medical record (EMR)-based alarm to improve appropriate SUP use in hospitalized patients. METHODS: We conducted an uncontrolled before-after study comparing SUP prescription in intensive care unit (ICU) patients and non-ICU patients, before and after the implementation of an EMR-based alarm that provided the correct indications for SUP. RESULTS: 1627 patients in the pre-intervention and 1513 patients in the post-intervention cohorts were included. The EMR-based alarm improved appropriate (49.6% vs. 66.6%, p<0.001) and reduced inappropriate SUP use (50.4% vs. 33.3%, p<0.001) in ICU patients only. These differences were related to the optimization of SUP in low risk patients. There was no difference in overt gastrointestinal bleeding between the two cohorts. Unjustified costs related to SUP were reduced by a third after EMR-based alarm use. CONCLUSIONS: The use of an EMR-based alarm improved appropriate and reduced inappropriate use of SUP in ICU patients. This benefit was limited to optimization in low risk patients and associated with a decrease in SUP costs.

Outcomes From a Pharmacist - led Proton Pump Inhibitor Stewardship Program at a Single Institution.

Background: Proton pump inhibitors (PPIs) are effective medications for acid-related disorders; however, they are also overused and may be associated with several adverse effects. A PPI stewardship program was implemented at one institution to combat the overuse of PPIs. Objective: The purpose of this study is to evaluate the effectiveness of an inpatient PPI stewardship program in reducing PPI use, both during hospitalization and upon discharge. Methods: This was a retrospective cohort study of all patients admitted to an internal medicine service at a single institution from March 14, 2016, to August 14, 2016, with an intervention by the PPI stewardship team. The primary objective was to determine the percentage of patients who tolerated inpatient and outpatient PPI discontinuation, or dose de-escalations upon discharge. Secondary objectives included the identification of risk factors for intolerance of PPI discontinuation, the occurrence of gastrointestinal (GI) complications after PPI discontinuation, and the percentage of patients who required "as needed" acid suppressive therapy (AST) with an antacid or histamine-2 receptor antagonist (H2RA) to control their symptoms while hospitalized. Results: During the study time period, 537 patients with an active outpatient prescription for a PPI were admitted to an internal medicine team with 41.0% (n = 220) not meeting criteria for inpatient continuation. Of these patients, 95.9% (n = 211) tolerated inpatient PPI discontinuation, with 83.4% (n = 176) not requiring any "as needed" AST during hospitalization. Upon discharge, 57.1% patients (n = 24 of 42) tolerated PPI discontinuation at 3 months, while 81.8% patients (n = 18 of 22) tolerated PPI dose de-escalations at 3 months. Risk factors for intolerance of inpatient PPI discontinuation were a higher body mass index (BMI) (33.7 vs 30.3 kg/m2, P = .046) and longer length of stay (7.0 vs 4.0 days, P = .03), while longer duration of PPI use (9.0 vs 5.5 years, P = 0.03) was identified as a risk factor for intolerance of outpatient PPI discontinuation. One patient experienced reflux esophagitis 2 months after PPI discontinuation. Conclusion: A PPI stewardship program at a single institution resulted in the reduction of inappropriate PPI use in both the inpatient and outpatient settings.

Redefining "bowel regimen": Pharmacologic strategies and nutritional considerations in the management of small bowel fistulas.

Enterocutaneous fistulae (ECF) and enteroatmospheric fistulae (EAF) are difficult complications that primarily arise after abdominal surgical procedures. Development of an ECF or EAF carries significant mortality and morbidity. Effective management of patients with these disease states requires a multidisciplinary approach, which includes surgical, pharmacotherapeutic, and nutritional interventions. This review focuses on the medical and nutritional management of ECF/EAF, providing background on drug agents and nutritional strategies that may be helpful in reducing effluent volume, optimizing fistula healing, and maintaining nutritional health.

Tratamento da doença de Crohn durante a gravidez / Treatment of Crohn's disease during pregnancy

A doença de Crohn é uma doença inflamatória intestinal, que pode acometer todo o tubo digestivo, principalmente o íleo, o cólon e a região perianal. Praticamente não há diferença de incidência entre os sexos, sendo mais comum entre judeus e brancos, e com maior incidência na faixa etária de 14 a 24 anos, acometendo mulheres em idade fértil. O uso de medicamentos durante o período de concepção e gravidez é causa de grande preocupação para médicos e pacientes. Com objetivo de analisar o tratamento da doença de Crohn durante a gravidez, foi elaborada uma revisão da literatura recente. Em geral, a maioria dos medicamentos utilizados no tratamento das doenças inflamatórias intestinais não está associada a efeitos adversos significativos, e manter a saúde da mãe continua a ser uma prioridade no manejo destas pacientes. O tratamento inclui as seguintes classes de medicamentos: aminossalicilatos, antibióticos, corticosteroides, imunomoduladores e drogas anti-TNF-alfa. O metotrexato e a talidomida são comprovadamente teratogênicos, sendo ambos contraindicados durante a gravidez e o aleitamento. Portanto, a maioria dos medicamentos utilizados para o tratamento da doença de Crohn é compatível com a gravidez. Manter a doença em remissão é o principal fator determinante de um bom prognóstico para a gestação.

Crohn's disease is an inflammatory bowel disease, which may affect the entire gastrointestinal tract, especially the ileum, colon and perianal region. There is virtually no difference in the incidence between the genders, with it being more common among Jews and white people, with a higher incidence in the age group from 14 to 24 years, affecting women of childbearing age. The use of drugs during the period of conception and pregnancy is a cause of great concern to physicians and patients. In order to analyze the treatment of Crohn's disease during pregnancy, a review of recent literature was performed. In general, most drugs used in the treatment of inflammatory bowel disease is not associated with significant adverse effects, and to keep the mother's health remains a priority in the management of these patients. The treatment includes the following drug classes: aminosalicylates, antibiotics, corticosteroids, immunomodulators, and anti-TNF-α drugs. Methotrexate and thalidomide proved to be teratogenic, with both being contraindicated during pregnancy (and breastfeeding). Therefore, most of the medications used to treat Crohn's disease are compatible with pregnancy. To keep the disease in remission is the main determinant of a good prognosis for pregnancy.

Current Opinions on Stress-Related Mucosal Disease Prevention in Canadian Pediatric Intensive Care Units.

OBJECTIVE: To describe current opinions about stress-related mucosal disease (SRMD) prevention in Canadian pediatric intensive care units (PICUs). METHODS: A 22-question survey covering several aspects of SRMD was sent to all identified PICU attendings in Canada. RESULTS: Sixty-eight percent of identified attendings completed the questionnaire. Thirty-eight percent were based in Quebec, 31% in Alberta, and 31% from other provinces. Most attendings (78%) had worked in a PICU for 6 years or more. When asked about risk factors for prescribing SRMD prevention drugs (more than 1 answer was accepted), the most popular answers were prior history of gastric ulceration/bleeding (33 respondents), coagulopathy (28 respondents), and major neurologic insult (18 respondents). Almost half of the attendings (48%) mentioned that they prescribe SRMD prophylaxis directly upon PICU admission to more than 25% of their patients. Forty-nine percent of respondents subjectively estimated that clinically significant upper gastrointestinal bleeding (UGIB; defined as UGIB associated with either hypotension, transfusion within 24 hours of the event, or death) occurred in less than 1% of their patients. Fifty-seven respondents (93%) used ranitidine as first-line therapy (average dose: 4.1 mg/kg/day, mainly intravenously). As second-line therapy, 32 attendings (52%) used pantoprazole and 13 (21%) used omeprazole. CONCLUSIONS: Despite the paucity of guidelines on SRMD prevention and the low reported incidence of clinically significant UGIB, SRMD prevention is frequently used in Canadian PICUs. Ranitidine is the first-line drug used by most attendings.

Efficacy of tepronone and folic acid in the treatment of chronic atrophic gastritis evaluated by the marking targeting biopsy / 中华消化杂志

Objective To explore the efficacy of tepronone and folic acid in the treatment of chronic atrophic gastritis (CAG) evaluated by the marking targeting biopsy (MTB).Methods A total of 224 H.pylori negative CAG patients were selected and divided into group A (n 96,tepronone 50 mg/time,folic acid 10 mg/time,three times/day),group B (n=23,tepronone 50 mg/time,three times/day),group C (n=74,unspecific treatment) and group D (n=31,no treatment).The treatment course lasted for one year.The clinical symptoms improvement of each group was observed before and after treatment.The pathological improvement of gastric mucosa by MTB was inspected before and after treatment.The chi square test was performed for the comparison between groups.Results The total efficacy rates of group A,B,C and D were 43.8％ (42/96),39.1％ (9/23),33.8％(25/74) and 32.3％ (10/31) respectively,there was no significant difference between groups (x2 =2.328,P =0.507).For the significant efficacy rate of gastric mucosa pathological improvement,group A was compared with group D,group A was compared with group C and group B was comparedwith group D,the differences were significant (x2 =14.520,14.628 and 8.995,all P＜0.01).In the total efficacy rate of gastric mucosa pathological improvement,group A (49.8％,131/263) was compared with group D (24.2％,16/66),group A was compared with group C (35.9％,66/184)and group B (44.7％,21/47) was compared with group D,the differences were significant (x2 =13.953,8.535 and 5.207,all P＜0.05).Conclusion Teprenone alone or teprenone and folic acid combination can obviously improve pathological changes of CAG patients.

Protection of gastric mucosa against aspirin-induced damage by teprenone / 中华消化杂志

Objective To investigate the protection effects of teprenone in aspirin-induced gastric mucosa injury.Methods From 2008 to 2010,a total of 296 patients who took aspirin for the first time at the Department of Cardiovascular,First Hospital Affiliated to Zhejiang Chinese Medicine University were randomly divided into two groups.There were 166 cases in aspirin group,which took aspirin 100mg daily; 130 cases in aspirin and teprenone group,the aspirin dose equivalent with aspirin group and took teprenone 50mg/time,3 times/day orally.Gastrointestinal symptoms and gastric mucosa injury of patients in these two group were inspected at 3 month,6 month and 1 year.Results A total of 143 cases were recruited in aspirin group and 118 cases in aspirin and teprenone group.After taking medicine for 3 months,the occurrence rate of gastrointestinal symptoms in aspirin group was 1.40 ％.Compared with aspirin and teprenone group,the difference was statistical significant (0,x2 =1.663,P＝ 0.197).Follow up after taking medicine for 6 months,the occurrence rate of gastrointestinal symptoms in aspirin group was 4.96％.Compared with aspirin and teprenone group,the difference was statistical significant (0,x2 ＝6.021,P＝0.014).Follow up after taking medicine for 1 year,the occurrence rate of gastrointestinal symptoms in aspirin group was 20.15 ％.Compared with aspirin and teprenone group,the difference was statistical significant (1.69％,x2 =20.984,P=0.001).Compared with aspirin group,the symptom and endoscopy score of aspirin and teprenone group decreased significantly at follow-up for 6 months and 1 year (P＜0.05; P＜0.01 ).Compared with at 6 month,the symptom and endoscopy score of aspirin group at 1 year increased significantly (P＜0.05 ; P＜0.01).Conclusion Teprenone has certain protection effects in aspirin-induced gastric mucosa injury.Long-term use of conventional doses of aspirin may cause vary degrees of gastric mucosal injury,and the gastric mucosal injury get more severe as the time of taking medicine increases.

Efecto citoprotector y antisecretor del aceite de Copaifera officinalis en lesiones gástricas inducidas en ratas / Copaifera officinalis oil cytoprotector and antisecretory effects in induced gastric lesions in rats

Objetivos: Demostrar el efecto gastroprotector del aceite de Copaifera officinalis usando indometacina y ligadura de píloro en ratas. Diseño: Estudio preclínico. Lugar: Facultades de Medicina, de Farmacia y Bioquímica. Universidad Nacional Mayor de SanMarcos, Lima, Perú. Material biológico: Ratas y aceite de copaiba. Intervenciones: Se colectó el aceite de copaiba en Ucayali, Pucallpa. La citoproteccción fue evaluada con indometacina, considerando un grupo control normal, indometacina, grupos deaceite de copaiba y omeprazol. Las lesiones de la mucosa gástrica fueron calificadas como las compatibles con necrosis local (tejido no viable), hiperemia, enrojecimiento presente y hemorragia, empleando la escala de puntaje observacional; y la úlcera,según la escala de Macallister modificado. El ensayo de antisecreción fue realizado por el modelo de ligadura del píloro, en el que 24 ratas albinas fueron divididas al azar en 3 grupos; un control, otro de aceite de copaiba 40mg/kg y un tercero de omeprazol10 mg/kg. Después de 4 horas de ligazón, fueron sacrificados, extrayéndose los estómagos; con mucho cuidado se midió el volumen y se determinó el pH de la secreción gástrica, por potenciometría. Se realizó evaluación histopatológica segúnDevi. Principales medidas de resultados: Lesiones ulcerosas. Resultados: Losresultados indicaron 100 por ciento de efecto citoprotector con el aceite de copaiba y de 97,8 por ciento para el omeprazol (p menor que 0,0001), ratificado con los hallazgos histopatológicos; la disminución del volumen de secreción fue 79,4 por ciento para omeprazol y 42,8 por ciento para el aceite de copaiba (p menor que 0,001), con incremento del pH. Conclusiones: En condicionesexperimentales, el aceite de copaiba fue efectivo como agente gastroprotector enratas con inducción de úlcera gástrica.

Objetives: To determine the gastroprotector effect of Copaifera officinalis oil using indomethacin and pyloric ligature in rats. Design: Preclinical study. Setting: Faculties of Medicine, Pharmacy and Biochemistry, National University of San Marcos, Lima, Peru. Biological material: Rats and copaiba oil. Interventions: Copaiba oil was collected in Ucayali, Pucallpa. Cytoprotection was tested withindomethacin considering a normal control group, and indomethacin, copaibaand omeprazole groups. Using visual analogue scale mucosa gastric injuries were referred as those compatible with local necrosis (unviable tissue), hyperemia, flushing, and hemorrhage, and ulcers according to the modified MacallisterÆs scale. The anti-secretion trial used the pyloric ligature model. Twenty-four albino rats were randomized in three groups: control, copaiba oil 40 mg/kg and omeprazole 10 mg/kg, respectively. After 4 hours of linkage, they were sacrificed. Stomachs were removed, their volume measured carefully and gastric secretion pH determined by potentiometry. DevisÆs histopathological evaluation was used. Main outcome measures: Ulcerous injuries. Results: There was 100 per centcytoprotection with copaiba oil and 97,8 per cent with omeprazole (p minor that 0,0001), ratified by histological findings. Decrease in secretion volume was 79,4 per cent for omeprazole and 42,8 per cent for copaiba oil (p minor thet 0,0001) with pH increment. Conclusions: In experimental conditions copaiba oil was effective as gastroprotective agent in gastric ulcers-induced rats.

General practitioner prescribing patterns in Babol city, Islamic Republic of Iran

To determine patterns of prescribing in Iranian primary care, we analysed 4000 randomly selected prescriptions from 52 general practitioners [GPs] in Babol city during 1999-2000. The mean number of drugs prescribed per encounter was 4.4 +/- 1.7, with 98% prescribed by generic name. The most commonly prescribed items were non-steroidal anti-inflammatory drugs [62.9% of encounters] and antibiotics [61.9%], followed by central nervous system drugs, gastrointestinal tract drugs, corticosteroids, vitamins and cardiovascular system drugs respectively. Injections were prescribed in 58.0% of encounters. Female and male doctors had significantly different antibiotic prescribing patterns. Our study confirms the tendency of GPs to overprescribe