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Surgery May 2024Recent studies have demonstrated a positive volume-outcome relationship in emergency general surgery. Some have advocated for the sub-specialization of emergency general...
BACKGROUND
Recent studies have demonstrated a positive volume-outcome relationship in emergency general surgery. Some have advocated for the sub-specialization of emergency general surgery independent from trauma. We hypothesized inferior clinical outcomes of emergency general surgery with increasing center-level operative trauma volume, potentially attributable to overall hospital quality.
METHODS
Adults (≥18 years) undergoing complex emergency general surgery operations (large and small bowel resection, repair of perforated peptic ulcer, lysis of adhesions, laparotomy) were identified in the 2016 to 2020 Nationwide Readmissions Database. Multivariable risk-adjusted models were developed to evaluate the association of treatment at a high-volume trauma center (reference: low-volume trauma center) with clinical and financial outcomes after emergency general surgery. To evaluate hospital quality, mortality among adult hospitalizations for acute myocardial infarction was assessed by hospital trauma volume.
RESULTS
Of an estimated 785,793 patients undergoing a complex emergency general surgery operation, 223,116 (28.4%) were treated at a high-volume trauma center. Treatment at a high-volume trauma center was linked to 1.19 odds of in-hospital mortality (95% confidence interval 1.12-1.27). Although emergency general surgery volume was associated with decreasing predicted risk of mortality, increasing trauma volume was linked to an incremental rise in the odds of mortality after emergency general surgery. Secondary analysis revealed increased mortality for admissions for acute myocardial infarction with greater trauma volume.
CONCLUSION
We note increased mortality for emergency general surgery and acute myocardial infarction in patients receiving treatment at high-volume trauma centers, signifying underlying structural factors to broadly affect quality. Thus, decoupling trauma and emergency general surgery services may not meaningfully improve outcomes for emergency general surgery patients. Our findings have implications for the evolving specialty of emergency general surgery, especially for the safety and continued growth of the acute care surgery model.
PubMed: 38760230
DOI: 10.1016/j.surg.2024.03.045 -
The Journal of International Medical... May 2024To explore the prevalence of type I and type II infection and investigate risk factors in a population from Hainan Province in China.
OBJECTIVE
To explore the prevalence of type I and type II infection and investigate risk factors in a population from Hainan Province in China.
METHODS
Data came from a large, cross-sectional study conducted from August 2022 to April 2023 involving five cities of Hainan. Subjects with confirmed 14C-urea breath test (UBT) and positive serological assay were included. All subjects had a gastroscopy. According to presence or absence of CagA/VacA proteins, subjects were classified as either type I (present) or type II strains (absent). Gastroscopic findings and several socio-demographic factors were examined for correlation with antibody serotyping.
RESULTS
In total, 410 subjects were investigated for strain types. The overall prevalence of the highly virulent, type I strain was 79% (324/410) and type II strain was 21% (86/410). There was a strong association between type I strain and peptic ulcer disease. Of several sociodemographic factors investigated, only smoking and data over baseline (DOB) values showed significant differences between type 1 and type II strains. Logistic regression analysis showed a lower risk of type I infection in smokers compared with non-smokers, and a higher risk of type I infection in subjects with medium and high data over baseline (DOB) values compared with subjects who had low DOB values.
CONCLUSION
Highly virulent, type I infections predominate in Hainan and the co-positivity of CagA and VacA antibodies are related to type I infection. We found that Type I was closely associated with peptic ulcer disease and the DOB values were generally high.
Topics: Humans; Helicobacter pylori; Male; Female; China; Helicobacter Infections; Middle Aged; Risk Factors; Cross-Sectional Studies; Adult; Bacterial Proteins; Prevalence; Antigens, Bacterial; Peptic Ulcer; Aged; Breath Tests; Antibodies, Bacterial
PubMed: 38759213
DOI: 10.1177/03000605241253454 -
Zhongguo Ying Yong Sheng Li Xue Za Zhi... Dec 2023A peptic ulcer is a lesion (sore) on the stomach lining, or duodenum. Peptic ulcers are probably a twentieth-century condition. The ulcer disease continues to be a... (Review)
Review
A peptic ulcer is a lesion (sore) on the stomach lining, or duodenum. Peptic ulcers are probably a twentieth-century condition. The ulcer disease continues to be a significant source of worldwide morbidity and mortality. The Gastrointestinal ulcers and duodenal ulcers are considered the two most extreme types of peptic ulcers. Peptic ulcers are found to be caused by an excess of violent factors including Hydrochloric acid (HCL) pepsin, refluxed bile leukotrienes (LT), reactive oxygen species (ROS) and protective factors, these include mucus-bicarbonate barrier functions, prostaglandins (PGs), mucosal blood flow, cell regeneration and migration, non-enzymatic and enzymatic and certain growth factors. The primary cause of peptic ulcer disease is pylori infection and the use of NSAIDs. This review article underscores the importance of a multidisciplinary approach in the management of ulcers to improve patient outcomes and quality of life.
Topics: Humans; Peptic Ulcer
PubMed: 38755116
DOI: 10.62958/j.cjap.2023.006 -
Drugs in Context 2024Antibiotics are drugs of natural or synthetic origin used to treat various infections. The practice of excessive and inappropriate antibiotics use is the main global...
BACKGROUND
Antibiotics are drugs of natural or synthetic origin used to treat various infections. The practice of excessive and inappropriate antibiotics use is the main global cause of bacterial resistance, which is one of the most serious global public health threats. It is estimated that about 50% of global antibiotic prescriptions are inappropriate. This study assesses the prevalence and pattern of inappropriate prescriptions of antibiotics amongst ambulatory care visits in Ethiopia.
METHODS
A facility-based, cross-sectional study with a quantitative approach was conducted amongst randomly selected prescriptions issued for outpatients from May to June 2022 at Debre Markos Specialized Comprehensive Hospital, Northwest Ethiopia. Descriptive statistics, such as frequencies and percentages, were computed. For group comparisons, χ and independent sample -tests were computed. The statistical significance of the association was considered at <0.05.
RESULTS
A total of 2640 antibiotics were prescribed for patients in the outpatient setting with various bacterial infections via 911 prescriptions, of which 49.5% were non-compliant with the national treatment guideline. Guideline non-compliant prescriptions increased remarkably amongst patients in the outpatient setting diagnosed with community-acquired pneumonia (38.8% 30.1%; =0.006) and peptic ulcer disease (14.9% 9%; =0.006). Moreover, inappropriate prescription was significantly higher amongst patients taking amoxicillin/clavulanic acid (33.2% 48.2%; <0.001) and cephalexin (17.8% 24.3%; =0.016).
CONCLUSION
Large proportions of antibiotic prescriptions for outpatients were non-compliant with the national treatment guideline, suggesting that prescribers need to give special attention to outpatients whilst ordering antibiotics such as amoxicillin/clavulanic acid and cephalexin. Antibiotic stewardship efforts to optimize outpatient antibiotic prescriptions and reduce the use of potentially inappropriate antibiotics are needed in Ethiopia.
PubMed: 38742144
DOI: 10.7573/dic.2023-12-2 -
The Journal of the Association of... Dec 2023To understand the national pattern of proton-pump inhibitor (PPI) prescriptions and to disseminate evidence-based recommendations for using probiotics as an adjunct to...
OBJECTIVE
To understand the national pattern of proton-pump inhibitor (PPI) prescriptions and to disseminate evidence-based recommendations for using probiotics as an adjunct to PPIs across diverse clinical indications.
METHODS
Healthcare professionals' (HCPs) inputs and views were collected through a survey ( = 1,007) and four round table meetings (RTMs, = 4). A standardized questionnaire focusing on the utilization of PPIs in clinical practice was developed, deliberated upon, and assessed by experts specializing in the treatment of diverse acid-related gastrointestinal (GI) conditions across various geographical regions.
RESULTS
Of the total 1,007 contributors, most (43.40%) opined that 10-30% of their patients were prescribed PPI for a long duration. The majority of contributors commonly prescribed PPIs for the prophylaxis of gastroesophageal reflux disease (GERD)-induced gastritis (70.90%), peptic ulcer disease (58.39%), and various GI conditions. The majority of contributors (91%) agreed or strongly agreed that long-term use of PPIs disturbs the GI flora. Antibiotic-associated diarrhea (AAD) (78.05%) was the most preferred indication for using pre- and probiotics. The duration for co-prescription varied, with a substantial portion advocating for 1-4 weeks (49.65%), while others supported durations of 4-8 weeks or beyond. Around 85% of contributors/HCPs agreed or strongly agreed on prescribing pre- and probiotics as prophylaxis to prevent GI disturbances. The study emphasized the growing trend of patient-centered co-prescription of PPIs and pre-/probiotics, with a majority of contributors favoring this approach.
CONCLUSION
The results underscore the importance of informed prescribing practices, including the co-prescription of probiotics, to mitigate potential side effects associated with long-term PPI use and optimize patient well-being.
Topics: Proton Pump Inhibitors; Probiotics; Humans; Practice Patterns, Physicians'; Drug Therapy, Combination; Surveys and Questionnaires; Gastrointestinal Diseases; Gastroesophageal Reflux
PubMed: 38736051
DOI: 10.59556/japi.71.0409 -
Revista de Gastroenterologia Del Peru :... 2024Initially developed as medications for diabetes mellitus, GLP-1 agonists have gained much popularity in the treatment of obesity and weight loss. The present case...
Initially developed as medications for diabetes mellitus, GLP-1 agonists have gained much popularity in the treatment of obesity and weight loss. The present case describes a 69-year-old woman with a history of peptic ulcer and use of NSAIDs, who presented with abdominal pain and oral intolerance refractory to conventional management, for which an upper digestive endoscopy was performed, diagnosing severe gastroparesis. Asking more about the story, revealed surreptitious use of semaglutide. She continued with supportive therapy and the symptoms resolved spontaneously. The present case report aims to warn of the potential risks of the use of GLP-1 analogues in the context of endoscopy with sedation.
Topics: Humans; Aged; Female; Glucagon-Like Peptide-1 Receptor; Glucagon-Like Peptides; Weight Loss; Gastroparesis; Severity of Illness Index; Glucagon-Like Peptide-1 Receptor Agonists
PubMed: 38734915
DOI: No ID Found -
BMJ Open Quality May 2024Stress ulcer prophylaxis is started in the critical care unit to decrease the risk of upper gastrointestinal ulcers in critically ill persons and to decrease mortality...
UNLABELLED
Stress ulcer prophylaxis is started in the critical care unit to decrease the risk of upper gastrointestinal ulcers in critically ill persons and to decrease mortality caused by stress ulcer complications. Unfortunately, the drugs are often continued after recovery through discharge, paving the way for unnecessary polypharmacy.
STUDY DESIGN
We conducted a retrospective cross-sectional study including patients admitted to the adult critical care unit and started on the stress ulcer prophylaxis with a proton pump inhibitor (PPI) or histamine receptor 2 blocker (H2 blocker) with an aim to determine the prevalence of inappropriate continuation at discharge and associated factors.
RESULT
3200 people were initiated on stress ulcer prophylaxis, and the medication was continued in 1666 patients upon discharge. Indication for long-term use was not found in 744 of 1666, with a 44% prevalence of inappropriate continuation. A statistically significant association was found with the following risk factors: discharge disposition (home vs other medical facilities, p=0.002), overall length of stay (more than 10 days vs less than or equal to 10 days, p<0.0001), mechanical ventilator use (p<0.001), number of days on a mechanical ventilator (more than 2 days vs less than or equal to 2 days, p<0.001) and class of stress ulcer prophylaxis drug used (H2 blocker vs PPI, p<0.001).
CONCLUSION
The prevalence of inappropriate continuation was found to be higher than prior studies. Given the risk of unnecessary medication intake and the associated healthcare cost, a web-based quality improvement initiative is being considered.
Topics: Humans; Male; Retrospective Studies; Female; Cross-Sectional Studies; Middle Aged; Prevalence; Peptic Ulcer; Patient Discharge; Proton Pump Inhibitors; Aged; Histamine H2 Antagonists; Adult; Risk Factors; Anti-Ulcer Agents; Intensive Care Units; Inappropriate Prescribing
PubMed: 38729753
DOI: 10.1136/bmjoq-2023-002678 -
PloS One 2024Nature has proven to be a treasure resource of bioactive metabolites. In this regard, Tamarix aphylla (F. Tamaricaceae) leaves crude extract was investigated for its...
Tamarix aphylla derived metabolites ameliorate indomethacin-induced gastric ulcers in rats by modulating the MAPK signaling pathway, alleviating oxidative stress and inflammation: In vivo study supported by pharmacological network analysis.
Nature has proven to be a treasure resource of bioactive metabolites. In this regard, Tamarix aphylla (F. Tamaricaceae) leaves crude extract was investigated for its gastroprotective effect against indomethacin-induced damage to the gastric mucosa. Additionally, phytochemical investigation of the methanolic extract afforded eight flavonoids' derivatives (1-8). On pharmacology networking study, the isolated compounds identified 123 unique targets where only 45 targets were related to peptic ulcer conditions, these 45 targets include 11 targets specifically correlate to gastric ulcer. The protein-protein interaction defined the PTGS2 gene as one of the highly interacted genes and the complete pharmacology network defined the PTGS2 gene as the most represented gene. The top KEGG signaling pathways according to fold enrichment analysis was the EGFR tyrosine kinase inhibitor resistance pathway. As a result, these findings highlighted the significance of using T. aphylla leaves crude extract as an anti-gastric ulcer candidate, which provides a safer option to chemical antisecretory medicines, which are infamous for their negative side effects. Our findings have illuminated the potent anti-inflammatory and antioxidant effects of T. aphylla, which are likely mediated by suppressing IL-1β, IL-6, TNF-α, and MAPK signaling pathways, without compromising gastric acidity.
Topics: Animals; Male; Rats; Anti-Ulcer Agents; Flavonoids; Gastric Mucosa; Indomethacin; Inflammation; MAP Kinase Signaling System; Network Pharmacology; Oxidative Stress; Plant Extracts; Plant Leaves; Rats, Sprague-Dawley; Stomach Ulcer; Tamaricaceae
PubMed: 38728332
DOI: 10.1371/journal.pone.0302015 -
Food & Function Jun 2024The study aimed to investigate the alleviation of an ethanol-induced gastric ulcer in mice by apolysaccharide (PSP) from purple sweet potato ( (L.) Lam) and explore the...
Gastroprotective effects of polysaccharides from purple sweet potato ( (L.) Lam) on an ethanol-induced gastric ulcer regulating immunity and activating the PI3K/Akt/Rheb/mTOR pathway.
The study aimed to investigate the alleviation of an ethanol-induced gastric ulcer in mice by apolysaccharide (PSP) from purple sweet potato ( (L.) Lam) and explore the mechanism. The anti-ulcer activity was determined by histopathological evaluation, total gastric acidity, pepsin activity, gastric ulcer index and gastric ulcer inhibition rate. The expression levels of inflammatory factors were detected using ELISA. A special protein meter was used to detect the content of immunoglobulin lgM, immunoglobulin lgG, and complements C3 and C4 in the serum of mice. The expression of CD4/CD8 lymphocyte subsets of mice was detected using flow cytometry. Western blot analysis was used to examine the effect of PSP on the PI3K/Akt/Rheb/mTOR pathway. The results showed that PSP could effectively reduce the total gastric acidity, pepsin activity, and the index and inhibition rate of gastric ulcers. At the same time, PSP could significantly increase the levels of immunoglobulins (lgG and lgM) and complements (C3 and C4). It could also increase the activity of peritoneal macrophages in mice and the expression of CD4/CD8 in the spleen. ELISA analysis showed that the contents of TNF-α, IL-1β and IL-6 were significantly decreased and the content of IL-10 was significantly increased in the PSP group. The western blot analysis showed that PSP could upregulate the relative protein expressions of MUC5AC, PI3K, p-Akt, Rheb and mTOR. These results indicate that PSP can activate the PI3K/Akt/Rheb/mTOR signaling pathway to improve the immunity of mice and maintain the balance of the immune system, thereby protecting the gastric mucosa and improving stress gastric ulcers.
Topics: Animals; Stomach Ulcer; Ipomoea batatas; Mice; TOR Serine-Threonine Kinases; Polysaccharides; Phosphatidylinositol 3-Kinases; Proto-Oncogene Proteins c-akt; Ethanol; Male; Signal Transduction; Plant Extracts; Anti-Ulcer Agents; Humans
PubMed: 38726829
DOI: 10.1039/d4fo01071j -
The American Journal of Emergency... Jul 2024Upper gastrointestinal bleeding (UGIB) is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency clinicians to be aware of... (Review)
Review
INTRODUCTION
Upper gastrointestinal bleeding (UGIB) is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency clinicians to be aware of the current evidence regarding the diagnosis and management of this disease.
OBJECTIVE
This paper evaluates key evidence-based updates concerning UGIB for the emergency clinician.
DISCUSSION
UGIB most frequently presents with hematemesis. There are numerous causes, with the most common peptic ulcer disease, though variceal bleeding in particular can be severe. Nasogastric tube lavage for diagnosis is not recommended based on the current evidence. A hemoglobin transfusion threshold of 7 g/dL is recommended (8 g/dL in those with myocardial ischemia), but patients with severe bleeding and hemodynamic instability require emergent transfusion regardless of their level. Medications that may be used in UGIB include proton pump inhibitors, prokinetic agents, and vasoactive medications. Antibiotics are recommended for those with cirrhosis and suspected variceal bleeding. Endoscopy is the diagnostic and therapeutic modality of choice and should be performed within 24 h of presentation in non-variceal bleeding after resuscitation, though patients with variceal bleeding may require endoscopy within 12 h. Transcatheter arterial embolization or surgical intervention may be necessary. Intubation should be avoided if possible. If intubation is necessary, several considerations are required, including resuscitation prior to induction, utilizing preoxygenation and appropriate suction, and administering a prokinetic agent. There are a variety of tools available for risk stratification, including the Glasgow Blatchford Score.
CONCLUSIONS
An understanding of literature updates can improve the ED care of patients with UGIB.
Topics: Humans; Gastrointestinal Hemorrhage; Emergency Service, Hospital; Proton Pump Inhibitors; Esophageal and Gastric Varices; Hematemesis; Emergency Medicine; Endoscopy, Gastrointestinal
PubMed: 38723362
DOI: 10.1016/j.ajem.2024.04.052