H2 Blockers Research Articles

Clinical evaluation, management and outcome of hollow viscus perforations

Background: Gastrointestinal perforation is the third most common cause for exploratory laparotomy as an emergency. With the advent of drugs against acid peptic disease the incidence of peptic ulcer perforations is on decline. The advent of laparoscopy and endoscopy has played decisive role in the diagnosis and management of gastric and colorectal perforations. Aim of the study is to study the clinical outcome, surgical management and postoperative complication of peritonitis secondary to hollow viscus perforation.Methods: This was prospective study of 50 cases. All patients admitted and treated with perforation secondary to Hollow viscus perforations in surgical wards of M S Ramaiah Medical College, Bangalore, during the period of April 2016 to October 2017. Patients with peritonitis secondary to hollow viscus perforation admitted was evaluated and the diagnosis was made.Results: Out of 50 patients, most were male patients between 30-50 years age group. Duodenal ulcer perforation led the list. 4 were gastric, 37 were duodenal, 3 were jejunal, 6 cases were ileal. However colonic perforations were not observed. Wound infection leads the list of postoperative complications with faecal leak and burst abdomen following residual abscess. Almost all perforations were treated surgically.Conclusions: It was thought that with the introduction of better H2 receptor blockers and proton pump inhibitors, incidence of peptic perforations would decrease. Early recognition of perforations, prompt surgical intervention, adequate drainage, recognition of co-morbid conditions and complications would help in reduction of morbidity and mortality.

Impact of weekly case-based tele-education on quality of care in a limited resource medical intensive care unit

BackgroundLimited critical care subspecialty training and experience is available in many low- and middle-income countries, creating barriers to the delivery of evidence-based critical care. We hypothesized that a structured tele-education critical care program using case-based learning and ICU management principles is an efficient method for knowledge translation and quality improvement in this setting.Methods and interventionsWeekly 45-min case-based tele-education rounds were conducted in the recently established medical intensive care unit (MICU) in Banja Luka, Bosnia and Herzegovina. The Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) was used as a platform for structured evaluation of critically ill cases. Two practicing US intensivists fluent in the local language served as preceptors using a secure two-way video communication platform. Intensive care unit structure, processes, and outcomes were evaluated before and after the introduction of the tele-education intervention.ResultsPatient demographics and acuity were similar before (2015) and 2 years after (2016 and 2017) the intervention. Sixteen providers (10 physicians, 4 nurses, and 2 physical therapists) evaluated changes in the ICU structure and processes after the intervention. Structural changes prompted by the intervention included standardized admission and rounding practices, incorporation of a pharmacist and physical therapist into the interprofessional ICU team, development of ICU antibiogram and hand hygiene programs, and ready access to point of care ultrasound. Process changes included daily sedation interruption, protocolized mechanical ventilation management and liberation, documentation of daily fluid balance with restrictive fluid and transfusion strategies, daily device assessment, and increased family presence and participation in care decisions. Less effective (dopamine, thiopental, aminophylline) or expensive (low molecular weight heparin, proton pump inhibitor) medications were replaced with more effective (norepinephrine, propofol) or cheaper (unfractionated heparin, H2 blocker) alternatives. The intervention was associated with reduction in ICU (43% vs 27%) and hospital (51% vs 44%) mortality, length of stay (8.3 vs 3.6 days), cost savings ($400,000 over 2 years), and a high level of staff satisfaction and engagement with the tele-education program.ConclusionsWeekly, structured case-based tele-education offers an attractive option for knowledge translation and quality improvement in the emerging ICUs in low- and middle-income countries.

Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study

ObjectiveTo estimate all cause mortality and cause specific mortality among patients taking proton pump inhibitors (PPIs).DesignLongitudinal observational cohort study.SettingUS Department of Veterans Affairs.ParticipantsNew users of PPIs (n=157 625) or H2...

GASTRO-ESOPHAGEAL REFLUX DISEASE AND ITS IMPACT ON TRACHEO-ESOPHAGEAL SPEAKING VALVE REHABILITATION AFTER TOTAL LARYNGECTOMY

Gastro-esophageal reflux disease (GERD) is a pathological entity in which the mixture of gastric contents (with low pH because of the high content of HCl acid) and biliary juice (rich in proteolytic enzymes like pepsin and trypsin) causes lesions on the mucosa lining the esophagus. A higher prevalence of GERD was discovered in patients who had a total laryngectomy. Concerning laryngectomies with tracheo-esophageal speaking valves, it has been demonstrated that GERD is an independent risk factor for failure of this method of speech rehabilitation. The authors performed an analysis of English language articles found following a search of the major medical scientific databases (NCBI®, EMBASE®, Cochrane®) containing the following keyword string: vocal prosthesis, total laryngectomy, GERD, acid reflux, tracheo-esophageal fistula, failure. Studies showed that exposure to the protelolytic enzymes from the reflux juice increases the diameter of the tracheo-esophageal fistula and permits local granulation tissue to form. Progressively, the increasing fistula diameter leads to complications ranging from microaspiration of liquids and saliva to speaking valve expulsion or ingestion and temporary incapacity of oral feeding. Medical therapy in the postoperative period as well as long-term (6 months or more) correction of GERD (PPI therapy, H2 blockers, prokinetics) is also demonstrated to reduce the complication rate in this category of patients. GERD has a high prevalence in the total laryngectomy population of patients and it has multiple etiologic factors. In patients with tracheoesophageal vocal prostheses, GERD causes an increase in the fistula diameter – with important consequences that affect the patient's quality of life - his ability to phonate and his ability to swallow. These complications come with added costs because of the need to more frequently change the vocal prostheses with ones increasing in diameter, as well as multiple hospitalizations (even surgery to recalibrate or close the tracheo-esophageal fistula). Recognizing and treating this condition therefore decreases the risk of complications following vocal prosthesis speech rehabilitation.

A retrospective review on extended carboplatin infusion and incidence of hypersensitivity reaction in gynecologic malignancies in a single institution.

e17102 Background: Carboplatin has been the standard treatment for advanced gynecologic malignancies in the first line setting as well as treatment of relapsed disease. Carboplatin induced hypersensitivity reaction (HSR) is observed more frequently in a second line setting and symptoms can range from rash to life threatening symptoms such as anaphylaxis, which could preclude further treatment. A retrospective study by O’Cearbhaill showed HSR rate with extended infusion protocol to be 3.4%. However, two subsequent prospective studies by Lax and O’Cearbhaill did not find that extended infusion reduced the risk or severity of HSR. We reviewed the incidence of HSR with three hour extended-infusion carboplatin at our institution. Methods: Our practice at the Monter Cancer Center changed from standard 1 hour carboplatin retreatment infusion to extended-infusion in 2011. We reviewed charts of 162 patients from 2011 to present who received a three hour extended infusion of carboplatin. All patients received prophylactic H1 and H2 blockers along with steroids. HSR was determined in two ways: 1) Identifying patients who reported clinical symptoms of HSR. 2) Identifying which patients had received diphenhydramine, hydrocortisone and/or epinephrine as indicated for an infusion reaction. Results: 162 patients were identified: 83 with ovarian cancer, 44 with uterine cancer, and 16 with fallopian tube cancer, 10 with primary peritoneal cancer, and 9 with cervical/vulvar cancer. Most had relapsed disease and were previously treated for stage IV (35%), or stage III (47%) with platinum doublet chemotherapy at least six months prior. Only 1 out of 162 (0.6%) had a grade 1 reaction with hives and was treated with dexamethasone and diphenhydramine. She was previously treated with carboplatin 17 months prior. Her current HSR occurred during her fifth cycle of retreatment. She was not re challenged with the drug and elected not to undergo desensitization. Conclusions: Hypersensitivity reactions develop in about 12-33% of women retreated with carboplatin peaking at eight cycles (Lax et al.). The mechanism behind HSR is unclear but considered to be from repeated exposure to free platinum metal concentration. Incidence of HSR at our institution was lowest ever-reported at 0.6%, suggesting that our extended infusion protocol with the appropriate premedication is appropriate for carboplatin-retreat patients. Further prospective studies to evaluate this regimen is warranted.

Idiopathic anaphylaxis.

Idiopathic anaphylaxis (IA) or spontaneous anaphylaxis is a diagnosis of exclusion when no cause can be identified. The exact incidence and prevalence of IA are not known. The clinical manifestations of IA are similar to other known causes of anaphylaxis. A typical attack is usually acute in onset and can worsen over minutes to a few hours. The pathophysiology of IA has not yet been fully elucidated, although an IgE-mediated pathway by hitherto unidentified trigger/s might be the main underlying mechanism. Elevated concentrations of urinary histamine and its metabolite, methylimidazole acetic acid, plasma histamine and serum tryptase have been reported, consistent with mast cell activation. There is some evidence that corticosteroids reduce the frequency and severity of episodes of IA, consistent with a steroid-responsive condition. Important differential diagnoses of IA include galactose alpha-1,3 galactose (a carbohydrate contained in red meat) allergy, pigeon tick bite (Argax reflexus), wheat-dependent exercise-induced anaphylaxis, Anisakis simplex allergy and mast cell disorders. Other differential diagnoses include "allergy-mimics" such as asthma masquerading as anaphylaxis, undifferentiated somatoform disorder, panic attacks, globus hystericus, vocal cord dysfunction, scombroid poisoning, vasoactive amine intolerance, carcinoid syndrome and phaeochromocytoma. Acute treatment of IA is the same as for other forms of anaphylaxis. Long-term management is individualized and dictated by frequency and severity of symptoms and involves treatment with H1 and H2 receptor blockers, leukotriene receptor antagonist and consideration for prolonged reducing courses of oral corticosteroids. Patients should possess an epinephrine autoinjector with an anaphylaxis self-management plan. There are anecdotal reports regarding the use of omalizumab. For reasons that remain unclear, the prognosis of IA is generally favourable with appropriate treatment and patient education. If remission cannot be achieved, the diagnosis should be reconsidered.

Upper gastrointestinal symptoms and associated endoscopic and histological features in patients receiving immune checkpoint inhibitors

Background: Immune checkpoint inhibitors (ICIs) have demonstrated effectiveness in treating many malignancies. Gastrointestinal (GI) adverse events are commonly reported; however, few reports describe upper GI tract toxic effects. We aimed to describe clinical features of upper GI injury related to ICI.Methods: We studied consecutive patients who received ICIs between April 2011 and March 2018 and developed upper GI symptoms requiring esophagogastroduodenoscopy (EGD).Results: Sixty patients developed upper GI symptoms between ICI initiation and 6 months after the last infusion. Among patients who had both EGD and colonoscopy (n = 38), 21 had endoscopic evidence of inflammation involving both the upper and lower GI tract. Overall, histological signs of inflammation of the stomach were evident in 83% of patients, but inflammation of the duodenum in 38%. Total of 42 patients had other risk factors of gastritis, i.e., chemotherapy, radiotherapy, and non-steroidal anti-inflammatory drugs. Only isolated gastric inflammation was seen on endoscopy in patients without these risk factors. The rates of ulceration were similar in the cohorts with and without other risk factors for gastritis. Isolated upper GI inflammation was related to anti-PD-1/L1 in 47% of patients. Immunosuppressive therapy in our cohort with upper GI toxicity consisted of steroids (42%) and infliximab or vedolizumab (23%). Most isolated upper GI symptoms were treated with proton pump inhibitors (65%) or H2 blockers (35%).Conclusion: We observed a correlation between ICI use and onset of upper GI inflammation even when other risk factors were excluded. Gastric involvement was evident more often than duodenal involvement on endoscopic and histological level.

Prevention and Treatment of Atrioesophageal Fistula Related to Catheter Ablation for Atrial Fibrillation.

Atrioesophageal fistula (AEF) is an uncommon but devastating complication of catheter ablation for atrial fibrillation. Even with appropriate recognition and treatment, mortality is greater than 30% in most studies. If AEF is suspected, it is essential to avoid endoscopy and to order immediate cross-sectional imaging. If the diagnosis is confirmed, a thoracic surgeon should be promptly notified and must assess the patient urgently. The prognosis for AEF is poor even if it is appropriately recognized and addressed, so prevention must be a high priority. Prevention of AEF should involve the use of low-risk and cost-effective measures during ablation, which may increase safety, efficacy, or both. These strategies may include conscious sedation (as opposed to general anesthesia), low-power ablation, low-flow irrigation, short-duration lesions, esophageal temperature measurement, esophageal deviation, and pharmacologic prophylaxis with proton pump inhibitors or histamine H2 receptor blockers. Multiple new technologies are now becoming available, which may further reduce esophageal injury. Proceduralists should be aware of the available techniques and equipment that may help to reduce the risk of AEF, while simultaneously considering the possibility of unintended consequences.

Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study

BackgroundThe purpose of this study was to compare the efficacy and safety of curcumin with those of diclofenac in the treatment of knee osteoarthritis (OA).MethodsIn this randomized, open-label, parallel, active controlled clinical study, 139 patients with knee OA were randomly assigned to receive either a curcumin 500-mg (BCM-95®) capsule three times daily or a diclofenac 50-mg tablet two times daily for 28 days. Patients underwent assessment at baseline and days 7, 14, and 28. The main outcome measure was severity of pain using visual analogue scale score at days 14 and 28. Knee Injury and Osteoarthritis Outcome Score (KOOS) (at days 14 and 28), anti-flatulent effect (at day 7), anti-ulcer effect, weight-lowering effect, and patient’s and physician’s global assessment of therapy at day 28 were included as secondary outcome measures. Safety after treatment was evaluated by recording adverse events and laboratory investigation.ResultsAt days 14 and 28, patients receiving curcumin showed similar improvement in severity of pain and KOOS scale when compared with diclofenac, and the difference was not statistically significant. At day 7, the patients who received curcumin experienced a significantly greater reduction in the number of episodes of flatulence compared with diclofenac (P <0.01). At day 28, a weight-lowering effect (P <0.01) and anti-ulcer effect (P <0.01) of curcumin were observed. None of the patients required H2 blockers in the curcumin group, and 19 patients required H2 blockers in the diclofenac group (0% versus 28%, respectively; P <0.01). Adverse effects were significantly less in the curcumin group (13% versus 38% in the diclofenac group; P <0.01). Patient’s and physician’s global assessment of therapy was similar in the two treatment groups.ConclusionCurcumin has similar efficacy to diclofenac but demonstrated better tolerance among patients with knee OA. Curcumin can be an alternative treatment option in the patients with knee OA who are intolerant to the side effects of non-steroidal anti-inflammatory drugs.Trial registrationISRCTN, ISRCTN10074826. Registered 21 November 2017 - Retrospectively registered.

Are H2 blockers effective for acute allergic reactions?

Sheridan, Edward PharmD, BCPS, BCACP; Curnyn, Daniel MD; Fellers, Andrew MD; McNace, Lauren PharmD, BCPS Author Information

To study the cost variation analysis of oral H2 receptor blockers available in different brands in Indian pharmaceutical market

Background: Aim of the study was to study percentage price variations among different brands of the commonly prescribed H2 receptor blockers.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2018 edition, Drug Today April to June 2018 Vol-1. The price ratio and the percentage price variation for individual drug brands was calculated. The price of 10 tablets/capsules were calculated. At last the price ratio and percentage price variation of various brands were compared.Results: Percentage variation in price for H2 receptor blockers marketed in India was found to be tablet cimetidine 200mg:81.89, tablet cimetidine 400mg:91.27, tablet ranitidine 150mg:295.64, tablet ranitidine 300mg:123.19, tablet famotidine 20mg:939.62, tablet famotidine 40mg:1110.09, tablet roxatidine 75mg:38.65, tablet roxatidine 150mg:21.85.Conclusions: H2 receptor blocker is the most common drug prescribed for prolonged period in case of gastritis, Gastro-Esophageal Reflux Disease (GERD), peptic ulcer. If a costly brand is prescribed, the patients have to pay more money unnecessarily for their treatment. The doctors prescribing these drugs should be aware of these variations in price to reduce the price of drug therapy.

Evaluation of antiulcer activity of ethanolic leaf extract of Coccinia grandis in indomethacin induced gastric ulcer model

Background: Gastric mucosal ulceration is the most common adverse effect with NSAIDS. Antacids, H2 blockers and PPIs are considered novel in treating ulcers but are not devoid of side effects. Hence, there a need for a drug which is effective against NSAID induced ulcers with no side effects. Coccinia grandis plant is traditionally used for the treatment of gastric/peptic ulcers. Hence, this study has been undertaken to scientifically validate the antiulcer activity of Coccinia grandis leaves against indomethacin induced gastric ulcer model.Methods: Following preparation of the extract, 24 Wistar rats were divided into 4 groups with 6 rats in each group (n=6). Group 1 received 1% CMC, group 2 received 1% CMC +indomethacin 40 mg/kg, group 3 received ethanolic leaf extract of Coccinia grandis 200 mg/kg +indomethacin 40 mg/kg and group 4 received omeprazole (2 mg/kg) +indomethzacin 40 mg/kg for 7 days. Calculation of ulcer score was done using ulcer index and percentage protection.Results: The ulcer index score (2.12±0.21) and percentage protection (69.71%) was comparable with the standard drug (1.76±0.11, 74.85%) respectively.Conclusions: The ethanolic leaf extract of Coccinia grandis showed significant antiulcer activity against indomethacin-induced gastric ulcer. Further studies are warranted to elucidate the exact mechanism of antiulcer activity.

The histaminergic control of the iridal vascular tone in rats and its influencing by topical administration of olopatadine and ranitidine

Objective. We evaluated the histamine's role in regulating the iris vasomotricity in rats, using as a research tool topical olopatadine, a selective H1 blocker, which is indicated for the treatment of allergic conjunctivitis and ranitidine, a selective H2 blocker mainly used for the treatment of peptic ulcer disease. Methods. Two groups of six Wistar rats anesthetized with ketamine 200 mg/kg body weight were used. They received distilled water in conjunctival instillations, initially and after 5 minutes, olopatadine 2.5 mmol/ l for the first group, respectively ranitidine 2.5 mmol/ l for the second group. The changes of the iris arteriolar and venular diameters were recorded. Results. Both olopatadine and ranitidine produced statistically significant iridal arteriolar vasoconstriction and ranitidine determined statistically significant venuloconstriction, while distilled water did not produce any statistically significant effect. Conclusions. There is a vasodilator histaminergic tone exerted through the histaminergic H1 and H2 receptors in the iris arterioles and, respectively, through the H2 receptors in the iridal venules. Olopatadine, a topical H1 antagonist used in the treatment of ocular allergies, may interfere with the humoral regulation of the iris arteriolar tone. Ranitidine, an H2 antagonist, decreased the diameter of the iris arterioles and venules, when administered topically in rats.

Effect of concomitant medications on overall survival in patients with cancer undergoing immunotherapy.

94 Background: The response to Immunotherapy (IO) is known to be affected by concomitant medications including corticosteroids and antibiotics. We evaluated the medication history of patients undergoing IO to explore other medications that affect overall survival and to estimate the relative impact of each medication when given in combination. Methods: A retrospective review of patients with advanced cancer who received IO from 2011 to 2017 at the Ohio State University was performed with IRB approval. Data were extracted from the medical record, including medication history 180 days around the start of IO therapy. Data were collected in a REDCap database. Overall Survival (OS) was calculated from the initiation of IO. Cox Proportional-Hazards models were used and evaluated by log-rank test at alpha = 0.05. All calculations were performed using the survival and survminer packages in R. Results: Patients who received antibiotics or corticosteroids had decreased OS (p = 0.019 and p = 0.043, respectively) across several cancer types. Medications that were not significantly associated with OS included statins (p = 0.38), proton pump inhibitors (p = 0.94), H2 blockers (p = 0.27) and NSAIDS (p = 0.46). A total of 159 patients had complete data for all medications suitable for modeling relative effects. 149 (94%) of patients received antibiotics within 180 days of IO and 19 (12%) received both corticosteroids and antibiotics. The combination of corticosteroids and antibiotics had lower median OS than antibiotics alone or neither medication (p &lt; 0.0018). A Cox Proportional Hazards model of antibiotics and corticosteroids, controlling for age, BMI and ECOG performance status, showed antibiotics, age and BMI to be significant predictors. Conclusions: Antibiotics and corticosteroids near the start of IO reduced overall survival, and the combination reduced the median overall survival further. However, a combined model that controlled for age, BMI and ECOG showed antibiotics, age and BMI to have a significant effect on OS. Though preliminary, these results suggest that antibiotics and corticosteroids may be affecting OS in the context of IO through overlapping pathways.

Blockade of Cardiac Proton Pump Impairs Ventricular Remodeling Through a Superoxide-DDAH-Dependent Pathway in Infarcted Rats.

Proton pump inhibitors (PPIs) are frequently used to prevent or treat peptic ulcers. Recently, PPIs have been shown to increase the risk of myocardial infarction. The purpose of this study was to determine whether PPIs adversely affect ventricular remodeling in infarcted rats. Male Wistar rats were randomly assigned to receive either vehicle, omeprazole, omeprazole + vitamin C, omeprazole + olmesartan, or famotidine treatment for 4 weeks starting 24 hours after inducing myocardial infarction by ligating coronary arteries. Compared with vehicle-treated infarcted rats, omeprazole-treated infarcted rats had significant changes with reduced myocardial vitamin C levels, increased oxidant production, and decreased dimethylarginine dimethylaminohydrolase 2 (DDAH2) activity, which in turn increased asymmetric dimethylarginine (ADMA) levels and impaired ventricular remodeling. With gastric protection similar to omeprazole, the H2 blocker famotidine had no effect on ventricular remodeling. In contrast to the in vivo results, the ex vivo study showed similar superoxide and DDAH2 protein levels between vehicle- and omeprazole-treated infarcted rats, suggesting involvement of gastric vitamin C uptake rather than myocardial vitamin C in mediating the impaired axis of vitamin C-superoxide-DDAH2 in the in vivo measurements. The administration of PPIs was associated with impaired DDAH2 expression and increased myocardial ADMA, which impaired ventricular remodeling after infarction. These effects were prevented by the coadministration of vitamin C or olmesartan. Our results indicate that the administration of PPIs was associated with impaired DDAH2 expression and increased myocardial ADMA by reducing gastric vitamin C uptake, which impaired ventricular remodeling after infarction.

Evaluation of antiulcerogenic activity of combination of Aloe vera and Aegle marmelos in indomethacin induced gastric ulcers

Background: Most important adverse effect of NSAID is peptic ulceration. Even though H2 blockers and proton pump inhibitors are effective in preventing NSAID associated peptic ulceration, they are not without side effects. Hence there is a need for drugs which are effective in preventing NSAID induced peptic ulcer without producing side effects. Two plant products Aloe vera leaf extract and Aegle marmalos leaves are commonly used in Indian traditional medicine for treatment of peptic ulcers. Hence this study is undertaken to assess the antiulcerogenic potential of combination of these two drugs in comparison with ranitidine in preventing NSAID induced peptic ulcers.Methods: 18 albino rats were divided into 3 groups of 6 rats each. Group A: received ulcerogen only. Group B: pretreated with ranitidine before exposing to ulcerogen. Group C: pretreated with combination of Aloe vera and Aegle marmelos before exposing to ulcerogen. Two doses of indomethacin were administered at an interval of 15 hrs. Animals were sacrificed 6 hrs after the second dose of Indomethacin. Number of ulcers was noted, and ulcer index was calculated.Results: There was significant reduction in total score, mean score and ulcer index in ranitidine pretreated group and test compound group as compared to control group. Even though the total score and ulcer index in test group were lesser as compared to standard control group, it was not statistically significant.Conclusions: Combination of Aloe vera leaf extract and Aegle marmelos leaf extract produced very significant protection against indomethacin induced gastric ulcer.

Heterotopic gastric mucosa associated with jejunal atresia

Abstract An infant born at 35 weeks' gestation with type 2 jejunal atresia underwent resection of the atretic ends of the bowel and primary anastomosis. Histologic examination of the resected distal bowel segment revealed heterotopic gastric mucosa (HGM). The infant was treated with an H2 blocker (Ranitidine) which was discontinued after a 99mTc pertechnetate radioisotope scan showed no residual heterotopic gastric mucosa. The child is asymptomatic and thriving at 2 years of age. HGM is a rare finding in the jejunum and its association with intestinal atresia has only been reported in five cases, three of whom had duodenal atresia as part of the Mitchell-Riley syndrome. This case highlights the importance of histologic examination of the resected bowel in intestinal atresia and demonstrates one approach to managing this unexpected finding.

Risk of Necrotizing Enterocolitis Following Packed Red Blood Cell Transfusion in Very Low Birth Weight Infants.

To evaluate the association between red blood cell (RBC) transfusion leading to necrotizing enterocolitis (NEC) within 48h, known as transfusion-associated necrotizing enterocolitis (TANEC). A nested case-control study using historical data was conducted in the neonatal intensive care unit of Songklanagarind Hospital, Thailand. All very low birth weight (VLBW) infants delivered between November 2009 and July 2016 were enrolled. The infants were identified as RBC transfusion received and NEC developed. Logistic regression was used to evaluate risk factors for transfusion and the association between RBC transfusion and NEC. Four hundred and forty-four VLBW infants were enrolled in the study. The median (interquartile range) gestational age was 29 (27, 31) wk. The overall incidence of NEC was 13%. Three (5.2%) of the NEC infants had TANEC. The infants who received RBC transfusion had a lower gestational age [odds ratio, OR 0.64; 95% confidence interval (95%CI) 0.57, 0.73, p <0.001] and were more likely to have pneumonia (OR 9.86; 95%CI 5.02, 19.35, p < 0.001) or to have received H2 blocker (OR 2.92; 95%CI 1.73, 4.93, p <0.001). The ORs (95% CI) after adjusting for confounders, the association between RBC transfusion and NEC for transfusions ≤2 d, >2 to 4 d, and > 4 to 6 d prior to NEC were 1.83 (0.41, 8.16; p = 0.43), 1.7 (0.26, 11.16; p =0.58) and 1.19 (0.31, 4.62; p = 0.80) respectively. After controlling of confounders, no evidence of association was found between RBC transfusion and TANEC.

The efficacy and safety of antihistamine therapy in school-age children

Every year the prevalence of allergic diseases is steadily increasing. Histamine is the main mediator of allergic inflammation. Cetirizine is an effective, selective H1-receptor blocker, and drug of choice in complex treatment of various allergies among adults as well as children.

Risk factors for the development of hypermagnesemia in patients prescribed magnesium oxide: a retrospective cohort study

BackgroundMagnesium oxide (MgO), an antacid and laxative, is widely used in Japan to treat constipation and peptic ulcers. Because serum Magnesium (Mg) levels are elevated in elderly and/or patients with renal failure, its periodic monitoring is recommended for patients prescribed MgO, in order to prevent MgO-induced hypermagnesemia. However, there is little information regarding the factors contributing to the development of MgO-induced hypermagnesemia. In the present study, we retrospectively investigated the risk factors of hypermagnesemia in patients prescribed MgO.MethodsData of 3258 patients hospitalized in Mie University Hospital between October 2015 and September 2017, who were prescribed MgO tablets, were extracted from the electronic medical records. According to the inclusion and exclusion criteria, 320 of the 3258 patients were enrolled in this study. Hypermagnesemia was defined as serum Mg levels ≥2.5 mg/dL (by the Common Terminology Criteria for Adverse Events version 4.0). Uni- and multivariate analyses were performed to identify risk factors for the development of hypermagnesemia in patients prescribed MgO using the following variables: age, estimated glomerular filtration rate, blood urea nitrogen levels, MgO dose, duration of MgO administration, and co-administrated proton pump inhibitors, H2 blocker (famotidine), vitamin D3 drugs, and diuretics.ResultsSeventy-five patients out of 320 (23%) developed grade 1 and grade 3 hypermagnesemia, with the occurrence of grade 1 and grade 3 in 62 (19%) and 13 (4%) patients, respectively. Multivariate logistic regression analyses indicated 4 independent risk factors for hypermagnesemia comprising estimated glomerular filtration rate ≤ 55.4 mL/min (odds ratio (OR): 3.105, P = 0.001), blood urea nitrogen ≥22.4 mg/dL (OR: 3.490, P < 0.001), MgO dose ≥1650 mg/day (OR: 1.914, P = 0.039), and duration of MgO administration ≥36 days (OR: 2.198, P = 0.012). The occurrence rate of hypermagnesemia was elevated in accordance with these risk factors.ConclusionsThese results suggest that a periodic monitoring of serum Mg levels is strongly recommended in MgO prescribed patients, especially in those with multiple risk factors for hypermagnesemia. The present findings provide useful information for the safe management of MgO therapy.