The Effect of Rabeprazole on Injection Sclerotherapy Complications after First Attack Bleeding Esophageal Varices

Background and study aim : Endoscopic variceal sclerotherapy (EVS) effectively controls bleeding esophageal varices (OV); however it has some adverse effects including sclerosant ulcers; chest pain; dysphagia and odynophagia. Gastric acid plays a central role in mediating and aggravating these complications. Proton pump inhibitors (PPI) are the most potent pharmacologic agents for inhibition of gastric acid secretion. Therefore; these agents are the logical candidates to combat the effects that gastric acid plays in post EVS complications. However; some authors still believe that there is no strong evidence to support their use. This study was designed to evaluate the effects of the use of PPI (rabeprazole) for 8 weeks after endoscopic sclerotherapy for first attack variceal bleeding on the prevention and treatment of complications after EVS. Moreover; we aim to assess the presence of any adverse effects for the use of this drug for this period in this specific patients group.Patients and methods: One hundred patients with first attack variceal bleeding were included in the study. They were allocated randomly into a test group which received 20mg rabeprazole once daily oral dose following endoscopic sclerotherapy starting 6 hours after injection sclerotherapy and continued for 2 months and a control group which did not receive rabeprazole after sclerotherapy. For both groups; endoscopic; laboratory and clinical data were monitored every two weeks for a period 2 months. Results: The test group had significantly lower frequency of all post sclerotherapy adverse symptoms; (dysphagia; odynophagia; heart burn; retrosternal and epigastric pain as well as dyspepsia) as well as lower overall rate of re-bleeding (14 vs 46 in the control group). There were no significant differences in the hematological parameters or endoscopic findings between test and control groups. Moreover; the use of the drug for two months was not associated with any significant infectious or non infectious complications including fever; hepatic encephalopathy; SBP; diarrhea and chest infection. Conclusion: Rabeprazole use decreases post-sclerotherapy symptoms and decrease the rate of rebleeding after sclerotherapy without any increasing the complications related to acid supression

Reducing Ventilator-Associated Pneumonia in Neonatal Intensive Care Unit Using "VAP Prevention Bundle"

Background and study aim : Ventilator-associated pneumonia (VAP) is a serious health care- associated infection, resulting in high morbidity and mortality. It also prolongs hospital stay and drives up hospital costs. Measures employed for preventing ventilator-associated pneumonia in developing countries are scarcely reported. The aim of the current work is to assess the efficacy of our designed "VAP prevention bundle" in reducing VAP rates in the neonatal intensive care unit (NICU). Patients and Methods: This prospective before-and-after study was conducted at Zagazig university hospital NICU; all neonates who had mechanical ventilation during the period from January 2013 to March 2014 for ≥48 hours were eligible after parental consent. VAP rates were evaluated before (phase-I) and after (phase-II) full implementation of the comprehensive preventive measures specifically designed by our infection control team. Results: Out of 143 mechanically ventilated neonates, 73 patients developed VAP (51%) throughout the study period (2500 mechanical ventilation days). The rate of VAP was significantly reduced from 67.8% (42/62) corresponding to 36.4 VAP episodes/1000 mechanical ventilation days (MV days) in phase-I to 38.2% (31/81) corresponding to 23 VAP/1000 MV days (RR 0.565, 95% confidence interval 0.408- 0.782, p= 0.0006) after VAP prevention bundle implementation (phase-II). Parallel significant reduction in MV days/case were documented in the post-intervention period (21.50±7.6 days in phase-I versus 10.36 ± 5.2 days in phase-II, p= 0.000). There were trends toward reduction in NICU length of stay (23.9±10.3 versus 22.8±9.6 days, p=0.56) and overall mortality (25% versus 17.3%, p=0.215) between the two phases which didn't reach statistical significance. The commonest micro-organisms isolated throughout the study were gram-negative bacteria (63/66, 95.5%) particularly Klebsilla pneumonia (55/66, 83.4%). Conclusion: The implementation of our multifaceted infection control bundle has resulted in a significant reduction of VAP rates, length of stay and hospital cost in our NICU. These rates are still far behind the internationally acknowledged ones