Ingesta de cáusticos en niños, experiencia de 3 años / Ingestion of caustic substances in children: 3 years of experience

Introdución: La ingesta accidental de cáusticos en pediatría no dispone de un consenso claro de actuación. El objetivo de este estudio fue caracterizar la población pediátrica atendida por ingesta de cáusticos en un centro asistencial. Pacientes y método: Estudio descriptivo de los pacientes atendidos en nuestro hospital por la ingesta de cáusticos durante el período 2008-2011. Resultados: Se atendieron 12 pacientes, edad media de 3,8 años (1-13 años). Predominio de varones (58,8%). Un 58,3% ingirió producto alcalino y un 41,6% ácido. El 58,3% no refería sintomatología, el resto refirió vómitos (33,3%), odinofagia (16,6%), hematemesis (8,3%), sialorrea (8,3%) y dificultad respiratoria (8,3%). El 75% presentaron lesiones en la cavidad oral. Todos, salvo un caso, fueron accidentales. Se realizó endoscopia al 100% entre las 12 y 24 h postingesta con hallazgos patológicos en un 41,6%. En el grupo ingesta de álcalis 2 pacientes presentaron lesiones (16,6%): una esofagitis grado 2B y una grado 3. En el grupo ingesta de ácidos 4 pacientes (33,3%) presentaron lesiones: una esofagitis aguda grado 1-2A, 2 gastritis agudas no erosivas y una gastritis aguda hemorrágica. Se realizó endoscopia de control según los hallazgos endoscópicos previos. Solo 2 presentaron complicaciones posteriores. Conclusiones: Destacamos la valoración endoscópica en las primeras 24 h en todas las ingestas sintomáticas y deliberadas, así como la reevaluación estrecha en las ingestas ácidas, por asociar lesiones diferidas.

Introduction: There is no clear consensus on the management of accidental ingestion of caustic substances in paediatrics. The aim of this study was to determine the profile of the paediatric population treated due to caustic ingestion in a Healthcare Centre. Patients and method: A descriptive study was conducted on patients treated for the ingestion of caustic substances in our hospital during the period 2008-2011. Results: A total of 12 patients were treated, with a mean age of 3.8 years (1-13 years), with the majority males (58.8%). An alkaline product was ingested by 58.3%, and an acid by 41.6%. The majority (58.3%) did not refer to symptoms and the remainder referred to vomiting (33.3%), odynophagia (16.6%), haematemesis (8.3%), hyper-salivation (8.3%) and shortness of breath (8.3%). Oral cavity lesions were observed in 75% of cases. All, except one, were accidental. An endoscopy was performed on all of them (100%) between 12 and 24 hours post-ingestion, with pathological findings in 41.6%. In the group that ingested an alkali, 2 (16.6%) patients had lesions, one a grade 2B and one a grade 3 oesophagitis. In the acid ingestion group, 4 (33.3%) patients had lesions; one grade 1-2A oesophagitis, two acute non-erosive gastritis, and one acute haemorrhagic gastritis. A follow-up endoscopy was performed depending on the previous endoscopic findings. Only two patients presented with complications. Conclusions: Emphasis is placed on the endoscopic evaluation in the first 24 hours of deliberate asymptomatic ingestions, as well as a strict follow-up in those that ingested acids, due to delayed associated lesions.

Gastritis necrotizante: caso clínico / Necrotizing gastritis: case report

Necrotizing gastritis is an infrequent severe pathology. The rich vascular supply and intramural arterial anastomosis protects stomach from vascular disease and embolism. Gastric infarction and necrosis presents as an acute abdominal emergency that requires rapid resolution, which in general includes surgery. Other important etiologies reported are chemical agents, mechanical distention, postoperative, bulimia and infectious diseases. In this article, we report a case of necrotizing gastritis in a 29 years-old male patient, with chronic consumption of NSAIDs for low back pain. He was admitted in the emergency room due to acute abdominal pain that appeared, after alcohol and raw fish consumption. Antral wall thickening was observed in the abdominal computed tomography. Upper gastric endoscopy showed necrosis of antral mucosa and biopsies confirmed necrotizing gastritis. He received medical therapy with antibiotics and proton pump inhibitors with an excellent response with clinical and endoscopic resolution in one month.

La gastritis necrotizante es una patología infrecuente muy grave. Esto se debe en parte a la rica irrigación y a las anastomosis arteriales intramurales que protegen al estómago de enfermedades vasculares y embolias. El infarto gástrico se presenta como una urgencia abdominal, que requiere resolución precoz, frecuentemente quirúrgica. Otras etiología importantes reportadas incluyen agentes químicos, factores mecánicos, bulimia e infecciones. En este artículo se presenta el caso de un paciente de 29 años, sexo masculino, con antecedentes de uso crónico de anti-inflamatorios no esteroidales (AINES), que ingresa a urgencia con dolor abdominal agudo, posterior al consumo de alcohol y pescado crudo. Destaca un engrosamiento antral marcado, sin neumatosis en la tomografía computada de abdomen. En la endoscopia digestiva alta se observa extensa necrosis de la mucosa antral y se confirma el diagnóstico de gastritis necrotizante por biopsias. El paciente tuvo una excelente respuesta a tratamiento con reposo intestinal, antibióticos e inhibidores de bomba de protones. Luego de 1 mes, presentó recuperación completa clínica y endoscopía.

Adverse effects of antiretroviral treatment.

BACKGROUND: The introduction of highly active antiretroviral therapy (HAART) has led to significant reduction in acquired immune deficiency syndrome (AIDS)-related morbidity and mortality. Adverse drug reactions (ADRs) to antiretroviral treatment (ART) are however, major obstacles in its success. AIMS: We sought to study the adverse effects of ART in a resource-restricted setting in India. METHODS: Hundred patients on ART were studied prospectively over a period of two years. All patients were asked to visit the clinic if they developed any symptoms or on a monthly basis. They were screened clinically and investigated suitably for any ADRs. RESULT: Out of the 100 patients, ten patients did not come for follow-up; only 90 cases were available for evaluation. ADRs were observed in 64 cases (71.1%) - the maximal frequency of ADRs was seen with zidovudine (AZT) (50%) followed by stavudine (d4T) (47.9%), efavirenz (EFV) (45.4%) and finally, Nevirapine (NVP) (18.4%). Most common ADRs were cutaneous (44.4%) followed by hematological (32.2%), neurological (31.1%), metabolic (22.2%) and gastrointestinal (20%). Most common cutaneous ADRs observed were nail hyperpigmentation (14.4%) and rash (13.3%). Immune reconstitution inflammatory syndrome (IRIS) was observed as a paradoxical reaction to ART in 20 (22.2%) cases. CONCLUSION: To optimize adherence and thus, efficacy of ART, clinicians must focus on preventing adverse effects whenever possible, and distinguish those that are self-limited from those that are potentially serious.

Development of sustained release Ibuprofen Alginate gel beads

In this work, attempts have been done to produce a sustained release drug delivery system using ibuprofen-loaded alginate gel beads. Ibuprofen. as other NSAIDs, may cause gastric irritation; therefore, if it was possible to decrease its release in the stomach, this would increase the compliance of the patients. Sodium alginate/ibuprofen ratio plays an important role in the release characteristics of ibuprofen. Using sodium alginate/ibuprofen ratio of 1:4 or more has shown zero- order release kinetics in pH 6.8 simulated intestinal fluid. Release studies in pH 1.2 have shown very limited percentage release of ibuprofen; less than 15%. Adding different excipients to the different formulae will produce regular and spherical beads but will also affect the release of the drug. Therefore, it is important to investigate the effect of excipients on the release characteristics upon adding them to the formula. The release of ibuprofen can be controlled by adjusting the Sodium alginate/ibuprofen ratio or by adding excipients

Gastroduodenal Injury in Patients with Low-Dose Enteric Coated Aspirin Treatment / 대한소화기학회지

BACKGROUND/AIMS: Low-dose aspirin therapy is widely used to prevent cardiovascular thrombotic events. However, the safety of low-dose aspirin therapy in the gastrointestinal tract is uncertain. Our aim was to evaluate endoscopic findings in patients taking low-dose aspirin. METHODS: Sixty-two patients who received 100 mg enteric coated aspirin daily more than 30 days were included in this study. Patients' medical records and endoscopic data were reviewed retrospectively. As controls, 70 of age- and gender-matched patients who received an endoscopy without gastrointestinal symptoms were employed. RESULTS: The overall prevalence of gastroduodenal mucosal injury was higher in the aspirin group than in the control group. Erosive gastritis was noted more frequently in the aspirin group than in the control group. However, the prevalence of ulcer was not different between the aspirin group and the control group. CONCLUSIONS: Patients treated with low-dose aspirin therapy are more likely to have endoscopic evidence of mucosal damage. Our study suggests that even a low-dose aspirin therapy can induce a gastroduodenal mucosal injury. In the future, a prospective randomized control study is needed.

Comparative evaluation of efficacy and safety profile of three anti-tuberculous regimens in Mangalore.

The aim of our study was to evaluate and compare the therapeutic efficacy & safety profile of three different antituberculous regimens for pulmonary tuberculosis. The study sample size included 90 newly diagnosed, sputum positive patients of pulmonary. tuberculosis. 30 each from different groups. The parameters studied were, therapeutic efficacy included weight gain, cough, sputum examination and safety profile: nausea, vomiting, anorexia, gastritis, hepatitis, jaundice diarrhoea, rashes, dizziness, tingling & numbness, flu like symptoms & joint aches. Group-I showed statistically significant weight gain when compared to Group-II. Improvement in cough and conversion to smear negative were seen in 100% of patients in Group-I, 83.3% of patients in Group-II and 93.3% of patients in Group-III. Therapeutic efficacy was highest with Group I regimen, followed by Group III and Group II which was least efficacious. Group II also registered; the maximum cost and highest incidence of adverse effects.

Histomorphological study of indomethacin induced gastrointestinal lesions in rat.

This study was undertaken in Long Evans rat to investigate the effect of a single therapeutic as well as toxic dose of indomethacin on the gastrointestinal mucosa. The effect was studied morphologically six hours after oral administration of the drug. The affected tissue was then examined histologically. The histomorphological evaluation revealed that the drug has induced acute hemorrhagic erosive gastritis in the fasted animals (6 mg/Kg body weight) where as in normally fed (10 mg/kg body weight) rats the small intestinal mucosal inflammation and erosions were predominant.

Effects of commonly used NSAID's on gastric mucosa. A clinico-endoscopic and histopathological study.

Non steroidal anti-inflammatory drugs (NSAID's) are one of the most commonly used agents in clinical practice today. All these drugs are known to produce gastro-intestinal lesions. In the present study we found that aspirin, indomethacin and phenylbutazone caused gastric mucosal damage in 90.9%, 100%, respectively while ibuprofen and paracetamol caused gastric mucosal damage in 33.3% and 37.5% respectively. Thus latter two drugs were safer NSAID's. Further more we have demonstrated that endoscopic monitoring of the patients on NSAID's is a sensitive method of early detection of gastric mucosal damage. This monitoring may be particularly valuable in high risk subjects on NSAID's.

Effects of commonly used non steroidal anti-inflammatory drugs on gastric mucosa. A clinical, endoscopic and histopathological study.

Non steroidal anti-inflammatory drugs (NSAIDS) are known to produce gastro-intestinal lesions. In the present work we found that aspirin, indomethacin and oxyphenbutazone caused gastric mucosal damage in 90.9%, 100% and 100% respectively, while ibuprofen and paracetamol caused damage in 33.3% and 37.5% of cases respectively. Thus the latter two drugs were much safer NSAIDs. Furthermore we demonstrated that endoscopic monitoring of patients on NSAIDs is a sensitive method for early detection of gastric mucosal damage. This monitoring may be particularly valuable in high risk subjects on NSAIDs.

Prevalence of upper gastrointestinal mucosal-abnormalities at a rheumatology clinic

El propósito de este estudio fue determinar la prevalencia y el grado de severidad de daño a la mucosa gastrointestinal superior en pacientes con artritis reumatoide y osteoartritis recibiendo agentes antinflamatorios no esteroidales con o sin prednisona; y la correlación entre los medicamentos y las anormalidades encontradas. Pacientes de la Clínica de Reumatología fueron escogidos al azar para participar en el estudio. Ochenta y cinco de 123 fueron incluidos. La apariencia endoscópica de la mucosa se clasificó del 0 al 9. Dieciseis pacientes tenían mucosa normal, 69 (81.1%) tenían anormalidades la mayoría mínimas (51.8%). Cincuenta y ocho de 85 pacientes tenían síntomas, 22 (38%) de estos tenían cambios moderados o severos; mientras que solo 3 (11.1%) de 27 asintomáticos tenían cambios moderados o severos. Seis pacientes (6%) tenían úlceras activas. La mayoría de los pacientes recibiendo drogas antireumáticas tenían cambios mínimos en endoscopía, y no se encontró un riesgo mayor para enfermedad severa al añadir prednisona a la terapia de no esteroidales. La prevalencia de úlceras en esta población no fue más alta que en la población general

Administración de 800 mg de cimetidina en la noche a pacientes con gastritis por uso prolongados de antinflamatorios no esteroides / Cimetidine, 800 mg. nocte, in gastritis resulting from prolonged use of non-steroid antinflamatory agents

Se valoró clínica, endoscópica e histológicamente la actividad de una sola dosis de 800 mg de cimetidina en la noche durante un mes, sobre los efectos gástricos secundários a la ingestión prolongada de AINE en 12 pacientes con diversas enfermedades reumáticas. El tratamiento dio resultados clínicos y endoscópicos satisfatórios, ya que disminuyeron o desaparecieron la mayoría de las molestias que tenían los enfermos. Asimismo, disminuyó de manera importante la cantidad de antiácidos que acostumbraban tomar