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Bassetti M, Andreoni M, Santus P, Scaglione F. NSAIDs for early management of acute respiratory infections. Curr Opin Infect Dis 2024:00001432-990000000-00148. [PMID: 38779903 DOI: 10.1097/qco.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW To review the rationale for and the potential clinical benefits of an early approach to viral acute respiratory infections with NSAIDs to switch off the inflammatory cascade before the inflammatory process becomes complicated. RECENT FINDINGS It has been shown that in COVID-19 as in other viral respiratory infections proinflammatory cytokines are produced, which are responsible of respiratory and systemic symptoms. There have been concerns that NSAIDs could increase susceptibility to SARS-CoV-2 infection or aggravate COVID-19. However, recent articles reviewing experimental research, observational clinical studies, randomized clinical trials, and meta-analyses conclude that there is no basis to limit the use of NSAIDs, which may instead represent effective self-care measures to control symptoms. SUMMARY The inflammatory response plays a pivotal role in the early phase of acute respiratory tract infections (ARTIs); a correct diagnosis of the cause and a prompt therapeutic approach with NSAIDs may have the potential to control the pathophysiological mechanisms that can complicate the condition, while reducing symptoms to the benefit of the patient. A timely treatment with NSAIDs may limit the inappropriate use of other categories of drugs, such as antibiotics, which are useless when viral cause is confirmed and whose inappropriate use is responsible for the development of resistance.
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Affiliation(s)
- Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova
- IRCCS Ospedale Policlinico San Martino, Genova
| | - Massimo Andreoni
- Infectious Disease Clinic, Policlinico Tor Vergata University Hospital
- Department of System Medicine Tor Vergata, University of Rome, Rome, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano
| | - Francesco Scaglione
- Department of Oncology and Hemato-Oncology, Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, Milan, Italy
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2
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Hao W, Liu A, Zhu H, Yu X, Chen G, Xu J. Risk factors and management of gastrointestinal bleeding in patients with or without antiplatelet and anticoagulation therapy: a multicenter real-world prospective study. BMC Gastroenterol 2024; 24:155. [PMID: 38714955 PMCID: PMC11077848 DOI: 10.1186/s12876-024-03238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Antiplatelet and anticoagulation drugs complicate acute gastrointestinal bleeding (GIB) patients. Limited data about the risk factors and patient management has been presented. This study explored the association between previous antiplatelet or anticoagulant drug usage and clinical outcomes in GIB patients to improve awareness further and optimize treatment. METHODS We conducted a multicenter, non-interventional, real-world prospective study in 106 hospitals in 23 provinces in China. GIB patients confirmed in the emergency department were included and were grouped according to previous drug histories. Univariate analysis, multivariate logistic regression, and multivariate stratification models were performed separately to investigate the associations. RESULTS A total of 2299 patients (57.23 ± 17.21 years old, 68.3% male) were included, of whom 20.1% and 2.9% received antiplatelet and anticoagulation therapy, respectively. The all-cause 28-day mortality rates in patients without antiplatelet or anticoagulants, patients undergoing antiplatelet treatment, and patients with anticoagulation therapy were 2.8%, 4.6%, and 10.5%, respectively. After adjusting for confounding factors, both antiplatelet [odd ratio (OR), 2.92; 95% confidence interval (CI), 1.48-5.76; p = 0.002] and anticoagulation therapy (OR, 8.87; 95% CI, 3.02-26.02; p < 0.001) were associated with higher 28-day mortality. In the subgroup analysis, blood transfusion, especially red blood cell transfusion, in patients undergoing antiplatelet and anticoagulation therapy was associated with a decreased death risk. CONCLUSION We confirmed an association between concurrent antiplatelet or anticoagulation therapy in GIB patients and elevated 28-day mortality. Blood transfusions could improve poor outcomes in such patients.
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Affiliation(s)
- Wenlin Hao
- Emergency Department, The State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Anlei Liu
- Emergency Department, The State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Huadong Zhu
- Emergency Department, The State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xuezhong Yu
- Emergency Department, The State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Gang Chen
- Nephrology Department, The State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Jun Xu
- Emergency Department, The State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
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3
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Kneiseler G, Dechêne A. [Gastrointestinal bleeding in old age]. Z Gerontol Geriatr 2024; 57:59-70. [PMID: 38108897 DOI: 10.1007/s00391-023-02258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/25/2023] [Indexed: 12/19/2023]
Abstract
Gastrointestinal bleeding is a frequent symptom, with increasing age as a risk factor. Upper, middle and lower gastrointestinal bleeding are differentiated depending on the location, whereby only upper and lower gastrointestinal bleeding are elucidated in this article. The symptomatology varies depending on the localization of the bleeding. German and international clinical guidelines currently exist for the preclinical and clinical management of gastrointestinal bleeding. The main focus of the article is on pre-endoscopic management of upper gastrointestinal nonvariceal and variceal bleeding, including the risk stratification, transfusion and coagulation management as well as the initial pharmacological treatment. In addition, current developments in endoscopic and interventional treatment of gastrointestinal bleeding are highlighted.
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Affiliation(s)
- Guntje Kneiseler
- Medizinische Klinik 6 (Schwerpunkte Gastroenterologie, Hepatologie, Endokrinologie und Ernährungsmedizin) am Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - Alexander Dechêne
- Medizinische Klinik 6 (Schwerpunkte Gastroenterologie, Hepatologie, Endokrinologie und Ernährungsmedizin) am Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
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Liu X, Zhou Q, Sun Z, Tian J, Wang H. Clinical effects of cocktail injection on the thoracolumbar fascia injury during percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a single-center, retrospective case-control study. BMC Musculoskelet Disord 2024; 25:18. [PMID: 38166954 PMCID: PMC10759409 DOI: 10.1186/s12891-023-07130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Nowadays, there is a lack of effective intraoperative treatment for thoracolumbar fascia injury (TFI) of osteoporotic vertebral compression fractures (OVCFs), which may lead to postoperative residual pain. We aimed to evaluate the clinical effects of cocktail injection on the TFI during percutaneous vertebroplasty (PVP) for OVCFs. METHODS A retrospective study of OVCFs with TFI underwent PVP with cocktail injection (Cocktail group, 58 cases) or PVP (Routine group, 64 cases) was conducted. The surgical outcomes, visual analog scale (VAS) score, oswestry disability index (ODI), incidence of residual pain at 1 day and 7 days postoperatively, the rate and duration of taking painkillers during 7 days postoperatively after PVP were compared between them. RESULTS No differences in baseline data, volume of bone cement injected and bone cement leakage were observed between the two groups, while the operation time of the routine group (44.3 ± 7.8 min) was less than that (47.5 ± 9.1 min) of the cocktail group (P < 0.05). However, the VAS scores (2.4 ± 0.8, 2.2 ± 0.7), ODI (25.2 ± 4.2, 22.3 ± 2.9), the incidence of residual pain (8.6%, 3.4%) at 1 and 7 days postoperatively, the rate (6.9%) and duration ( 2.5 ± 0.6 ) of taking painkillers during 7 days postoperatively in the cocktail group were better than those (3.4 ± 1.0, 2.9 ± 0.7, 34.1 ± 4.7, 28.6 ± 3.6, 23.4%, 15.6%, 28.1%, 4.2 ± 1.4) in the routine group (P < 0.05), respectively. CONCLUSION PVP combined with cocktail injection increased the operation time in the treatment of OVCFs with TFI, but it can more effectively relieve pain, reduce the risk of residual pain at 1 day and 7 days postoperatively, and decrease the use and duration of taking painkillers.
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Affiliation(s)
- Xiaolei Liu
- Department of Orthopedics, the Fourth Affiliated Hospital of Nanjing Medical University, Nanpu road 298#, Jiangbei new District, Nanjing, 210000, China
| | - Qinqin Zhou
- Department of Anesthesiology, the BenQ Hospital affiliated to Nanjing Medical University, Nanjing, 210000, China
| | - Zhongyi Sun
- Department of Orthopedics, the BenQ Hospital affiliated to Nanjing Medical University, Nanjing, 210000, China
| | - Jiwei Tian
- Department of Orthopedics, the BenQ Hospital affiliated to Nanjing Medical University, Nanjing, 210000, China.
| | - Haibin Wang
- Department of Orthopedics, the Fourth Affiliated Hospital of Nanjing Medical University, Nanpu road 298#, Jiangbei new District, Nanjing, 210000, China.
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Lee S, Heo KN, Lee MY, Ah YM, Shin J, Lee JY. Derivation and validation of a risk prediction score for nonsteroidal anti-inflammatory drug-related serious gastrointestinal complications in the elderly. Br J Clin Pharmacol 2023; 89:2216-2223. [PMID: 36807272 DOI: 10.1111/bcp.15696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 12/27/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
AIMS Few studies have quantified the impact of risk factors on GI complications in elderly nonsteroidal anti-inflammatory drug (NSAID) users. This study aimed to develop and validate a risk prediction score for severe GI complications to identify high-risk elderly patients using NSAID. METHODS We used the following two Korean claims datasets: customized data with an enrolment period 2016-2017 for model development, and the sample data in 2019 for external validation. We conducted a nested case-control study for model development and validation. NSAID users were identified as the elderly (≥65 years) who received NSAIDs for more than 30 days. Serious GI complications were defined as hospitalizations or emergency department visits, with a main diagnosis of GI bleeding or perforation. We applied the logistic least absolute shrinkage and selection operator (LASSO) regression model for variable selection and model fitting. RESULTS We identified 8176 cases and 81 760 controls with a 1:10 matched follow-up period in the derivation cohort. In the external validation cohort, we identified 372 cases from 254 551 patients. The risk predictors were high-dose NSAIDs, nonselective NSAID, complicated GI ulcer history, male sex, concomitant gastroprotective agents, relevant co-medications, severe renal disease and cirrhosis. Area under the receiver operating characteristic curve was 0.79 (95% confidence interval, 0.77-0.81) in the external validation dataset. CONCLUSIONS The prediction model may be a useful tool for reducing the risk of serious GI complications by identifying high-risk elderly patients.
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Affiliation(s)
- Suhyun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Seoul, 08826, Republic of Korea
| | - Kyu-Nam Heo
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Seoul, 08826, Republic of Korea
| | - Mee Yeon Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Seoul, 08826, Republic of Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan, Gyeongbuk, 38541, Republic of Korea
| | - Jaekyu Shin
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, 533 Parnassus Avenue, U585, Box 0622, San Francisco, California, 94143-0622, USA
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Seoul, 08826, Republic of Korea
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Cazacu SM, Burtea DE, Iovănescu VF, Florescu DN, Iordache S, Turcu-Stiolica A, Sacerdotianu VM, Ungureanu BS. Outcomes in Patients Admitted for Upper Gastrointestinal Bleeding and COVID-19 Infection: A Study of Two Years of the Pandemic. Life (Basel) 2023; 13:life13040890. [PMID: 37109419 PMCID: PMC10146262 DOI: 10.3390/life13040890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Upper gastrointestinal bleeding (UGIB) represents a major emergency, and patient management requires endoscopic assessment to ensure appropriate treatment. The impact of COVID-19 on patient mortality in UGIB may be related to the combination of respiratory failure and severe bleeding and indirectly to delayed admissions or a reduction in endoscopic procedures. Methods: We conducted a retrospective study involving patients admitted between March 2020 and December 2021 with UGIB and confirmed. Our objective was to compare these types of patients with those negative for SARS-CoV-2 infection, as well as with a pre-pandemic group of patients admitted between May 2018 and December 2019. Results: Thirty-nine patients (4.7%) with UGIB had an active COVID-19 infection. A higher mortality rate (58.97%) and a high risk of death (OR 9.04, p < 0.0001) were noted in the COVID-19 pandemic, mostly because of respiratory failure; endoscopy was not performed in half of the cases. Admissions for UGIB have decreased by 23.7% during the pandemic. Conclusions: COVID-19 infection in patients admitted for UGIB was associated with a higher mortality rate because of respiratory failure and possible delays in or contraindications of treatment.
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Affiliation(s)
- Sergiu Marian Cazacu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
| | - Daniela Elena Burtea
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
- Correspondence:
| | - Vlad Florin Iovănescu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
| | - Dan Nicolae Florescu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
| | - Sevastița Iordache
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
| | - Adina Turcu-Stiolica
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Victor Mihai Sacerdotianu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
| | - Bogdan Silviu Ungureanu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
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van de Laar MAFJ, Schöfl R, Prevoo M, Jastorff J. Predictive value of gastrointestinal symptoms and patient risk factors for NSAID-associated gastrointestinal ulcers defined by endoscopy? Insights from a pooled analysis of two naproxen clinical trials. PLoS One 2023; 18:e0284358. [PMID: 37053160 PMCID: PMC10101403 DOI: 10.1371/journal.pone.0284358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat pain and rheumatic conditions. To facilitate patient management, we determined the predictive value of gastrointestinal (GI) symptoms and risk factors for the development of NSAID-associated GI injuries. METHODS Post-hoc analysis of pooled data from naproxen treatment arms of two identical, randomized, double-blind, controlled phase 3 trials in arthritis patients at risk of GI adverse events. Endoscopic incidence of GI ulcers at baseline, and 1, 3, and 6 months was employed as a surrogate parameter for GI injury. For GI symptom analysis, Severity of Dyspepsia Assessment questionnaire was used. For GI risk factor analysis, the high risk factors: previous GI injury, concomitant selective serotonin reuptake inhibitors or corticosteroids, ulcer history, concomitant low-dose aspirin, and age >65 years were employed. RESULTS Data of 426 naproxen patients were analyzed. Distribution of GI symptoms between patients with and without ulcer was similar; about one third of patients developing an ulcer reported no GI pain symptoms. GI symptoms experienced under naproxen treatment were thus not indicative of GI injury. The proportion of patients developing an ulcer increased with the number of risk factors present, however, about a quarter of patients without any of the analyzed risk factors still developed an ulcer. CONCLUSION GI symptoms and the number of risk factors are not reliable predictors of NSAID-induced GI injury to decide which patients need gastroprotection and will lead to a large group of patients with GI injuries. A preventive rather than reactive approach should be taken.
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Affiliation(s)
- Mart A F J van de Laar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Rainer Schöfl
- Department of Internal Medicine IV, Ordensklinikum Barmherzige Schwestern, Linz, Austria
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Stiller CO, Hjemdahl P. Lessons from 20 years with COX-2 inhibitors: Importance of dose-response considerations and fair play in comparative trials. J Intern Med 2022; 292:557-574. [PMID: 35585779 DOI: 10.1111/joim.13505] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the enzyme cyclooxygenase (COX), which forms prostaglandins involved in pain and inflammation. COX inhibitors have analgesic and anti-inflammatory effects, but also increase risks for gastrointestinal ulcers, bleeding, and renal and cardiovascular adverse events. Identification of two isoforms of COX, COX-1 and COX-2, led to the development of selective COX-2 inhibitors, which were launched as having fewer gastrointestinal side effects since gastroprotective prostaglandins produced via COX-1 are spared. The balance between COX-1 mediated prothrombotic thromboxane and COX-2 mediated antithrombotic prostacyclin is important for thrombotic risk. An increased risk of suffering myocardial infarction and death with COX-2 inhibitor treatment is well established from clinical trials and observational research. Rofecoxib (Vioxx) was withdrawn from the market for this reason, but the equally COX-2 selective etoricoxib has replaced it in Europe but not in the United States. The "traditional" NSAID diclofenac is as COX-2 selective as celecoxib and increases cardiovascular risk dose dependently. COX inhibitor dosages should be lower in osteoarthritis than in rheumatoid arthritis. Randomized trials comparing COX-2 inhibitors with NSAIDs have exaggerated their gastrointestinal benefits by using maximal NSAID doses regardless of indication, and/or hidden the cardiovascular risk by comparing with COX-2 selective diclofenac instead of low-dose ibuprofen or naproxen. Observational studies show increased cardiovascular risks within weeks of treatment with COX-2 inhibitors and high doses of NSAIDs other than naproxen, which is the safest alternative. COX inhibitors are symptomatic drugs that should be used intermittently at the lowest effective dosage, especially among individuals with an increased cardiovascular risk.
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Affiliation(s)
- Carl-Olav Stiller
- Department of Medicine Solna, Clinical Epidemiology Unit/Clinical Pharmacology, Karolinska Institutet and Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Epidemiology Unit/Clinical Pharmacology, Karolinska Institutet and Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
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Nian B, Wang B, Wang L, Yi L. A Cohort Study to Compare Effects between Ulcer- and Nonulcer-Related Nonvariceal Upper Gastrointestinal Bleeding. Appl Bionics Biomech 2022; 2022:3342919. [PMID: 35721238 PMCID: PMC9205735 DOI: 10.1155/2022/3342919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to better understand the characteristics and etiology of acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) in recent years in this region and to provide evidence-based medical evidence. Methods 100 patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) who met the clinical diagnostic criteria of ANVUGIB admitted to Suzhou First People's Hospital from January 2017 to December 2021 were analyzed, as well as the age difference and change rule. According to age, 100 patients were divided into young (18-39 years), middle-aged (40-59 years), and elderly (60 years and above), and the differences in the three groups were compared. The etiology was confirmed by endoscopic examination and was recorded one by one in a well-designed ANVUGIB case data registration form. Statistical software SPSS 23.0 was used for analysis. Results Gastric ulcer was the main cause in the elderly group (50.0%), duodenal ulcer was the main cause in the middle and young groups, and gastrointestinal cancer (7.1%) and marginal ulcer (2.3%) in the elderly group were higher than those in the young group. Nonsteroidal anti-inflammatory drugs (52.3%) were the main inducement in the elderly group, which was significantly higher than in the middle-aged group (13.1%) and the young group (5%) (P < 0.01). Drinking, fatigue, and emotional excitement led to a higher proportion in the middle-aged group and the young group, in comparison to the elderly group (P < 0.01). Conclusion Peptic ulcer is the most common cause of acute nonvariceal upper gastrointestinal bleeding, followed by acute gastric mucosal lesions and upper digestive system tumors, compared with nonulcer.
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Affiliation(s)
- Bi Nian
- Department of Gastroenterology, Suzhou First People's Hospital, China
| | - Bangping Wang
- Department of Gastroenterology, Suzhou First People's Hospital, China
| | - Long Wang
- Gastroenterology Department, Suzhou Municipal Hospital, China
| | - Lanjuan Yi
- Department of Gastroenterology, Yantai Mountain Hospital, Yantai, China
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Impact of Preventive Strategies on Gastrointestinal Complications in Elderly Patients on Concomitant Use of Oral Anticoagulants and Nonsteroidal Anti-Inflammatory Drugs: A Nationwide Cohort Study. Drug Saf 2022; 45:297-304. [DOI: 10.1007/s40264-022-01150-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 12/12/2022]
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11
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da Luz JRD, Barbosa EA, do Nascimento TES, de Rezende AA, Ururahy MAG, Brito ADS, Araujo-Silva G, López JA, Almeida MDG. Chemical Characterization of Flowers and Leaf Extracts Obtained from Turnera subulata and Their Immunomodulatory Effect on LPS-Activated RAW 264.7 Macrophages. Molecules 2022; 27:1084. [PMID: 35164352 PMCID: PMC8839466 DOI: 10.3390/molecules27031084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/28/2022] Open
Abstract
The anti-inflammatory properties of Turnera subulata have been evaluated as an alternative drug approach to treating several inflammatory processes. Accordingly, in this study, aqueous and hydroalcoholic extracts of T. subulata flowers and leaves were analyzed regarding their phytocomposition by ultrafast liquid chromatography coupled to mass spectrometry, and their anti-inflammatory properties were assessed by an in vitro inflammation model, using LPS-stimulated RAW-264.7 macrophages. The phytochemical profile indicated vitexin-2-O-rhamnoside as an important constituent in both extracts, while methoxyisoflavones, some bulky amino acids (e.g., tryptophan, tyrosine, phenylalanine), pheophorbides, and octadecatrienoic, stearidonic, and ferulic acids were detected in hydroalcoholic extracts. The extracts displayed the ability to modulate the in vitro inflammatory response by altering the secretion of proinflammatory (TNF-α, IL-1β, and IL-6) and anti-inflammatory (IL-10) cytokines and inhibiting the PGE-2 and NO production. Overall, for the first time, putative compounds from T. subulata flowers and leaves were characterized, which can modulate the inflammatory process. Therefore, the data highlight this plant as an option to obtain extracts for phytotherapic formulations to treat and/or prevent chronic diseases.
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Affiliation(s)
- Jefferson Romáryo Duarte da Luz
- Post-Graduation Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, R. Gen. Gustavo Cordeiro de Farias, s/n—Petrópolis, Natal 59012-570, RN, Brazil; (J.R.D.d.L.); (A.A.d.R.)
- Multidisciplinary Research Laboratory, DACT, Health Sciences Center, Federal University of Rio Grande do Norte, R. Gen. Gustavo Cordeiro de Farias, s/n—Petrópolis, Natal 59012-570, RN, Brazil; (T.E.S.d.N.); (J.A.L.)
| | - Eder A. Barbosa
- Laboratory of Synthesis and Analysis of Biomolecules (LSAB), Institute of Chemistry, Darcy Ribeiro University Campus, University of Brasilia, Brasília 70910-900, DF, Brazil;
| | - Thayse Evellyn Silva do Nascimento
- Multidisciplinary Research Laboratory, DACT, Health Sciences Center, Federal University of Rio Grande do Norte, R. Gen. Gustavo Cordeiro de Farias, s/n—Petrópolis, Natal 59012-570, RN, Brazil; (T.E.S.d.N.); (J.A.L.)
- Post-Graduation Program in Pharmaceutical Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, R. Gen. Gustavo Cordeiro de Farias, s/n—Petrópolis, Natal 59012-570, RN, Brazil;
| | - Adriana Augusto de Rezende
- Post-Graduation Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, R. Gen. Gustavo Cordeiro de Farias, s/n—Petrópolis, Natal 59012-570, RN, Brazil; (J.R.D.d.L.); (A.A.d.R.)
- Post-Graduation Program in Pharmaceutical Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, R. Gen. Gustavo Cordeiro de Farias, s/n—Petrópolis, Natal 59012-570, RN, Brazil;
| | - Marcela Abbott Galvão Ururahy
- Post-Graduation Program in Pharmaceutical Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, R. Gen. Gustavo Cordeiro de Farias, s/n—Petrópolis, Natal 59012-570, RN, Brazil;
| | - Adriana da Silva Brito
- Faculty of Health Sciences of Trairi (FACISA/UFRN), R. Passos de Miranda, Santa Cruz 59200-000, RN, Brazil;
| | - Gabriel Araujo-Silva
- Organic Chemistry and Biochemistry Laboratory, Amapá State University (UEAP), Av. Presidente Vargas, s/n, Centro, Macapá 68900-070, AP, Brazil;
| | - Jorge A. López
- Multidisciplinary Research Laboratory, DACT, Health Sciences Center, Federal University of Rio Grande do Norte, R. Gen. Gustavo Cordeiro de Farias, s/n—Petrópolis, Natal 59012-570, RN, Brazil; (T.E.S.d.N.); (J.A.L.)
| | - Maria das Graças Almeida
- Post-Graduation Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, R. Gen. Gustavo Cordeiro de Farias, s/n—Petrópolis, Natal 59012-570, RN, Brazil; (J.R.D.d.L.); (A.A.d.R.)
- Multidisciplinary Research Laboratory, DACT, Health Sciences Center, Federal University of Rio Grande do Norte, R. Gen. Gustavo Cordeiro de Farias, s/n—Petrópolis, Natal 59012-570, RN, Brazil; (T.E.S.d.N.); (J.A.L.)
- Post-Graduation Program in Pharmaceutical Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, R. Gen. Gustavo Cordeiro de Farias, s/n—Petrópolis, Natal 59012-570, RN, Brazil;
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Yi KH, Tan XR. Advances in prevention and treatment of digestive tract damage induced by antithrombotic therapy with traditional Chinese and Western medicine. Shijie Huaren Xiaohua Zazhi 2021; 29:1089-1095. [DOI: 10.11569/wcjd.v29.i19.1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The incidence of cardiovascular diseases has increased due to the aging of the population. Therefore, antithrombotic therapy is increasingly prescribed for cardiovascular prevention. However, long-term use of antithrombotic drugs can cause damage to the digestive tract. Gastrointestinal complications, including ulcer and bleeding, are relatively common during antithrombotic therapy. In order to minimize the digestive tract damage induced by antithrombotic drugs, there are several strategies available, including reducing modifiable risk factors, using the most optimal antithrombotic regimen to ensure gastrointestinal risk-cardiovascular benefit balance, and using gastroprotective agents. In recent years, researchers are attempting to find new solutions from traditional Chinese medicine. Studies have shown that traditional Chinese medicine has its own characteristics and clinical advantages in preventing and treating diseases. In this review, we provide a summary of recent updates regarding gastrointestinal damage induced by antithrombotic therapy as well as its prevention and treatment with both traditional Chinese and Western medicine.
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Affiliation(s)
- Kai-Hong Yi
- Clinical Medical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Xue-Rui Tan
- Clinical Medical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
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Kuo CF, Shi L, Lin CL, Yao WC, Chen HT, Lio CF, Wang YTT, Su CH, Hsu NW, Tsai SY. How peptic ulcer disease could potentially lead to the lifelong, debilitating effects of chronic fatigue syndrome: an insight. Sci Rep 2021; 11:7520. [PMID: 33824394 PMCID: PMC8024330 DOI: 10.1038/s41598-021-87018-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 03/22/2021] [Indexed: 02/08/2023] Open
Abstract
Chronic Fatigue Syndrome (CFS) has been defined as unexplained relapsing or persistent fatigue for at least 6 consecutive months. Immuno-inflammatory pathway, bacterial infection, and other causes play essential roles in CFS. Helicobacter pylori infection is one of the most common causes of foregut inflammation, leading to peptic ulcer disease (PUD). This study aimed to analyze the risk of CFS development between patients with and without PUD. Other related factors were also analyzed. We performed a retrospective, nationwide cohort study identifying patients with or without PUD respectively by analyzing the Longitudinal Health Insurance Database 2000 (LHID2000), Taiwan. The overall incidence of CFS was higher in the PUD cohort than in the non- PUD cohort (HR = 2.01, 95% CI = 1.75-2.30), with the same adjusted HR (aHR) when adjusting for age, sex, and comorbidities. The sex-specific PUD cohort to the non-PUD cohort relative risk of CFS was significant in both genders. The age-specific incidence of CFS showed incidence density increasing with age in both cohorts. There is an increased risk of developing CFS following PUD, especially in females and the aging population. Hopefully, these findings can prevent common infections from progressing to debilitating, chronic conditions such as CFS.
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Affiliation(s)
- Chien-Feng Kuo
- Department of Medicine, Graduate Institute of Long-Term Care, Graduate Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan.,Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Leiyu Shi
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung City, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung City, Taiwan
| | - Wei-Cheng Yao
- Department of Anesthesiology and Pain Medicine, Min-Sheng General Hospital, Tao-Yuan, 330, Taiwan
| | - Hsiang-Ting Chen
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chon-Fu Lio
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yu-Ting Tina Wang
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ching-Huang Su
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Nai-Wei Hsu
- Department of Medicine, Graduate Institute of Long-Term Care, Graduate Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan.,Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shin-Yi Tsai
- Department of Medicine, Graduate Institute of Long-Term Care, Graduate Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan. .,Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan. .,Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
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