Medikamenteninduzierte gastrointestinale Blutung

Ovotransferrin Inhibits TNF-α Induced Inflammatory Response in Gastric Epithelial Cells via MAPK and NF-κB Pathway

Ovotransferrin (OVT) has been confirmed to have anti-inflammatory activity. However, its effect and mechanism on gastric inflammation are unclear. In this study, the effect and mechanism of the OVT on the tumor necrosis factor-α (TNF-α) induced inflammatory response in gastric epithelial cells (GES-1) were investigated. The enzyme linked immunosorbent assay (ELISA) was used to determine the levels of inflammation cytokines, followed by RNA sequencing to explore the potential pathways of its anti-inflammatory effect, and then it was validated by Western blotting and pathways inhibitors. Results showed that the OVT at concentrations of 50-400 μg/mL displayed nontoxicity against GES-1 cells. Additionally, 100 μg/mL of OVT obviously reduced the secretion of interleukin (IL)-8, IL-6, and TNF-α by 63.02% (630.09/1703.98), 35.53% (935.81/1451.43), and 36.19% (964.60/1511.63), respectively. The results of RNA sequencing exhibited that the OVT significantly influences the activation of mitogen-activated protein kinase (MAPK) and the nuclear factor kappa-light-chain enhancer of activated B cell (NF-κB) pathways, which was verified by the levels of p-IKK, p-IκB, p-P65, p-ERK, p-JNK, and p-P38 protein. IL-8 contents released by GES-1 cells after incubation with inhibitors of NF-κB and MAPK pathways further confirmed that OVT hindered activation of these two pathways. Collectively, these results suggested that OVT was a natural protein with the potential to treat gastric inflammation.

Access to non-prescription medicines via vending machines: key considerations to help transfer the self-care concept to the next generation while managing safety risks

Objectives

Non-prescription vending machines are automated self-service systems that are increasingly used to dispense these medicines. Whilst regulatory health academics have devoted considerable attention to non-pharmacy medication outlets in Gulf Cooperation Council countries and others, the public health literature on these vending machines remains lacking. Whilst non-prescription vending machines undoubtedly provide a number of benefits, they are not without their risks, which include polypharmacy and medication interactions.

Methods

The purpose of this article is to provide a framework for further investigation of the function, advantages, and practical constraints of non-prescription vending machines.

Key findings

Overall, more research is required to determine the optimal balance between achieving the benefits of non-prescription vending machines whilst avoiding unnecessary constraints on regulatory bodies and vending machine providers but minimizing patient harm.

Conclusions

Further studies are also required to assess the consequences of these policy experiments. Specifically, there is a need to better understand the extent to which vending machines can provide beneficial and reasonable access to non-prescription medicines to enhance the quality of life of the population especially during pandemics.

Vitamin-K Antagonists vs. Direct Oral Anticoagulants on Severity of Upper Gastrointestinal Bleeding: A Retrospective Analysis of Italian and UK Data

Background: Gastrointestinal bleeding (GIB) is one of most frequent and significant challenges for emergency physicians and gastroenterologists. Mortality for upper (U) GIB is high, especially in the elderly and comorbid patients. However, there is scant evidence in the literature concerning an assessment of warfarin (VKA) and direct oral anticoagulants (DOACs) in terms of upper gastrointestinal bleeding (UGIB) severity. Aims: Using data from two different settings (Italy and the UK), we aimed to compare the impact of VKA and DOACs on the severity of UGIB. Methods: Retrospective bicentric study on adult patients under VKA or DOACs admitted either to the emergency department at the Gemelli Hospital in Rome, Italy or University College Hospital in London, UK, with suspected UGIB from 01/01/2017 to 31/12/2018. Univariate analysis with Fisher’s exact test, and analysis of variance (ANOVA) were used. Results: 106 patients (62 M/44 F; mean age 71.2 ± 16.9 yrs) were enrolled and divided into the VKA group (N = 57; M: 56%, mean age: 64.9 ± 21.3 yrs) and the DOAC group (N = 49; M: 61%; mean age: 77.6 ± 12.5 yrs). At univariate analysis, the VKA group presented two endoscopic diagnoses more frequently than the DOAC group (26% vs. 8%, p < 0.05), were more frequently endoscopically treated (44% vs. 22%, p < 0.05), rescoped (12% vs. 2%, p = 0.048) and hospitalized (79% vs. 53%, p = 0.01) with a longer length of stay, LOS (VKA: 58% > 5 days vs. DOAC: 68% < 5 days, p = 0.01). There was no difference in terms of hemoglobin level on admission, however the requirement of blood transfusions was higher in the VKA group (60% vs. 41%, p = 0.041). One third of the VKA group showed a lower platelet count than the DOAC group (33% vs. 8%, p = 0.01). No statistically significant differences for in-hospital mortality were observed. For the ANOVA, the type of anticoagulant used was the only significant predictor of need to rescope (p = 0.041) and a significant co-predictor for a LOS > 5 days (p = 0.009; as well as cirrhosis, p = 0.013 and age, p = 0.005). Conclusions: Our outcomes revealed a more severe UGIB in patients on VKA, but the impact of comorbidities (i.e., more cirrhotic patients in the VKA group) cannot be disregarded. DOAC subgroup descriptive analysis, even though on a little cohort, showed higher bleeding severity for rivaroxaban.

The Role of CT-Angiography in the Acute Gastrointestinal Bleeding: A Pictorial Essay of Active and Obscure Findings

Gastrointestinal bleeding is a potentially life-threatening abdominal emergency that remains a common cause of hospitalisation. Although 80–85% of cases of gastrointestinal bleeding resolve spontaneously, it can result in massive haemorrhage and death. The presentation of gastrointestinal bleeding can range from asymptomatic or mildly ill patients requiring only conservative treatments to severely ill patients requiring immediate intervention. Identifying the source of the bleeding can be difficult due to the wide range of potential causes, the length of the gastrointestinal tract and the intermittent nature of the bleeding. The diagnostic and therapeutic approach is fully dependent on the nature of the bleeding and the patient’s haemodynamic status. Radiologists should be aware of the appropriate uses of computed tomography angiography and other imaging modalities in patients with acute gastrointestinal bleeding, as well as the semiotics of bleeding and diagnostic pitfalls in order to appropriately diagnose and manage these patients. The learning objective of this review is to illustrate the computed tomography angiography technique, including the potential role of dual-energy computed tomography angiography, also highlighting the tips and tricks to identify the most common and uncommon features of acute gastrointestinal bleeding and its obscure form.

Who gets prescriptions for proton pump inhibitors and why? A drug-utilization study with claims data in Bavaria, Germany, 2010-2018

PURPOSE

The German annual drug prescription-report has indicated overuse of proton pump inhibitors (PPIs) for many years; however, little was known about the characteristics of people using PPIs. This study aimed to provide comprehensive utilization data and describe frequencies of potential on- and off-label PPI-indications in Bavaria, Germany.

METHODS

Claims data of statutorily insured people from 2010 to 2018 were used. Defined daily doses (DDDs) of PPIs by type of drug, prevalence of PPI-use and DDDs prescribed per 1000 insured people/day were analyzed. For 2018, proportions of users and DDDs per 1000 insured people were calculated by age and sex. To elucidate changes in prescribing practices due to a suspected drug-drug interaction, we examined co-prescribing of clopidogrel and PPIs between 2010 and 2018. For PPI new users, sums of DDDs and frequencies of potential indications were examined.

RESULTS

PPI prescribing increased linearly from 2010 to 2016 and gradually decreased from 2016 to 2018. In 2018, 14.7% of women and 12.2% of men received at least one prescription, and 64.8 DDDs (WHO-def.) per 1000 insured people/day were prescribed. Overall, omeprazole use decreased over the observation period and was steadily replaced by pantoprazole, especially when co-prescibed with clopidogrel. An on-label PPI-indication was not reported at first intake in 52.0% of new users.

CONCLUSIONS

The utilization of prescribed PPIs has decreased since 2016. However, a large proportion of new PPI-users had no documentation of a potential indication, and the sums of DDDs prescribed often seemed not to comply with guidelines.

Candidate Genes and Proteomic Biomarkers of Serum and Urine in Medication-Overuse Headache

Chronic headache is a topical problem of neurology, psychiatry and general practice. The medication-overuse headache (MOH) is one of the leading pathologies in the structure of chronic headache. However, early diagnosis of the MOH is challenging. We analyzed potential proteomic biomarkers of serum and urine in patients with MOH.

METHODS

We searched PubMed, Springer, Scopus, Web of Science, ClinicalKey, and Google Scholar databases for English publications over the past 10 years using keywords and their combinations.

RESULTS

We found and analyzed seven studies that met the search criteria for the purpose of the review, including 24 serum proteomic biomarkers and 25 urine proteomic biomarkers of MOH. Moreover, the candidate genes and locus of the studied serum (vitamin D-binding protein, lipocalin-type prostaglandin D2 synthase, apolipoprotein E, etc.) and urine proteomic biomarkers (uromodulin, alpha-1-microglobulin, zinc-alpha-2-glycoprotein, etc.) of MOH are presented in this review.

CONCLUSIONS

The serum and urine proteomic biomarkers of MOH can potentially help with the identification of patients with MOH development. Due to the relevance of the problem, the authors believe that further investigation of the MOH proteomic biomarkers in different ethnic and racial groups of patients with primary headache is necessary. In addition, it is important to investigate whether medications of different drug classes influence the levels of serum and urine proteomic biomarkers.

Acute gastrointestinal bleeding: results from the prospective German electronic registry of nearly 11 000 endoscopies (ALGK GI-bleeding registry)

BACKGROUND AND STUDY AIMS

 Gastrointestinal bleeding is frequently observed in the German population. However, recent epidemiological data are not available. This study aimed to elucidate gastrointestinal bleeds under real-life conditions in 3 German hospitals. By using a standardized electronic documentation system, a large number of consecutive endoscopies could be established, thus offering representative data.

PATIENTS AND METHODS

 From June 2017 to December 2018, all upper and lower gastrointestinal tract endoscopies were recorded consecutively in the 3 hospitals. The electronic documentation system used included a case report form for storing data on bleeding as obligatory input for completion of the endoscopy report. In the case of gastrointestinal bleeding, specific data on the bleeding source and intensity, as well as individual characteristics, were documented.

RESULTS

 A total of 10 948 consecutive endoscopies were recorded, and 10 904 could be analyzed. Signs of gastrointestinal bleeding were found in 863 patients (7.9 % of all endoscopies performed), 538 patients with an intake of hemostasis-affecting drugs, and 325 patients without (62.3 % and 37.7 %, respectively). Platelet inhibitors and anticoagulants were the most frequently used hemostasis-affecting medication. There was a significant increase in age from patients without bleeding (median 68.5 years) to patients with bleeding (73.5 years) and to patients with bleeding who took hemostasis-affecting medication (80.4 years). Among the patients, 257 (29.8 %) and 606 (70.2 %) presented with major and minor bleeding, respectively.

CONCLUSIONS

 About 8 % of all patients undergoing upper or lower gastrointestinal endoscopy reveal signs of bleeding. A considerable number are older patients taking hemostasis-affecting drugs.

Effect of diclofenac on semen quality: A review

Diclofenac is an effective nonsteroidal anti-inflammatory drug and one of the most prescribed medicines worldwide. So far, there are many published articles that directly link between diclofenac and semen quality; however, hitherto, there is no collective review or comprehensive discussion that reveal such imperative link. Therefore, this work reviews and judges the association between diclofenac administration and semen quality, henceforth male infertility. As a tool to accomplish this scientific input, Scopus, Embase and PubMed databases have been searched for all original articles using the keywords "diclofenac" versus "semen" and "sperm" since August 1987 through November 2020. In summary, diclofenac appears to induce negative effects on both qualitative and quantitative measures of sperm; however, this conclusion requires confirmation by human studies. The detected negative effects of diclofenac on semen quality measures may be owed to reduced levels of gonadal hormones, decreased antioxidant defence mechanism, increased oxidative stress, altered concentrations of nitric oxide that are required to maintain normal sperm physiology and reduced synthesis of prostaglandins.

Digestive system injury induced by drugs for secondary prevention of ischemic stroke

The recurrence of ischemic stroke can be reduced by active secondary prevention, including antithrombotic, lipid-lowering, antihypertensive, and hypoglycemic treatment. However, long-term use of drugs for secondary prevention can cause damage to the digestive system, reduce patient compliance, increase the recurrence of stroke, and even lead to ulcer bleeding and life-threatening events. It is necessary to early identify populations at a high risk for digestive system injury, understand the adverse reactions of various drugs, and standardize the treatment, which can improve the effect of secondary prevention of ischemic stroke.

Platelet Inhibition and Anticoagulation in Visceral Interventions

Background

Platelet inhibition and anticoagulation are widely used therapeutic approaches in many patients. Despite their undoubted cardiovascular benefits, they may cause gastrointestinal harm either spontaneously or as part of endoscopic procedures. Strategies which harmonize both aspects are, therefore, of clinical interest.

Method

The websites of the German (DGVS), European (ESGE), and American (ASGE) Societies of Gastroenterology and Endoscopy were searched for guidelines on antithrombotic agents and endoscopic procedures. Over and beyond this, PubMed was analyzed for originals and reviews by using the keywords "hemostasis affecting drugs," "antithrombotic drugs," "platelet inhibition," "anticoagulation," AND endoscopy.

Conclusion

If elective endoscopy is planned, we should consider postponing the procedure in cases of temporally restricted platelet inhibition therapy or anticoagulation. Urgent endoscopy must balance the procedural risk against the risk of continuing or stopping the medication, with respect to thromboembolic events on the one hand and gastrointestinal bleeding on the other. There are decision criteria which facilitate individual risk stratification as a basis for diagnostic and therapeutic algorithms.

Key Message

If endoscopic interventions under platelet inhibition and/or anticoagulation cannot be postponed for a limited period of time, diagnostic and therapeutic strategies have to be performed against the background of well-defined decision criteria. These include the procedural risk (low vs. high) and the risk of thromboembolic events occurring (low vs. high) if the medication is stopped. In cases where both risks are considered to be high, an interdisciplinary approach should be favored.

Screen the Effective Components of Lycopodii herba on Rheumatoid Arthritis with the Aid of Spectrum-Effect Relationship and Uncover its Potential Mechanism

Lycopodii herba (SJC), a traditional Chinese medicine, has the effect of dispelling wind and eliminating dampness (a therapeutic principle and method of traditional Chinese medicine for rheumatoid arthritis), relaxing tendon and activating collaterals. However, the major effective components and its therapeutic mechanism were unclear. In this study, different SJC samples with slightly different compositions were prepared by extracting with different concentrations of ethanol. Then, the therapeutic effects on rheumatoid arthritis (RA) of different SJC samples were evaluated. Finally, the spectrum-effect relationship between UPLC-Q-TOF/MS fingerprints and the effect of RA was explored to screen the effective components. Western blotting was used to study the potential mechanism. The volume of hind paw and the level of RF, TNF-α, and IL-1β were lower after administrating with different SJC samples, compared with the model group. Histopathological findings also confirmed that SJC could relieve the symptoms of RA. Combined with identification of the components in plasm from SJC, lycojaponicumin C, des-N-methyl-α-obscurine, 8β-acetoxy-12β-hydroxy-lycopodine or 8β-acetoxy-11α-hydroxy-lycopodine or 8β-hydroxy-11α-acetoxylycopodine were considered to be the major effective components. The mechanism may be related to AChE/NF-κB signaling pathway. This work provides a general method to screen the potential effective components of herb medicines and would be benefit to understand the mechanism of SJC for the treatment of RA.