Protective Effect of Mormodica balsamina Leaf Extract on the Gastric Morphology of Experimental Rats Against Ethanol Induced Gastric Ulcers / Efecto Protector de los Extractos de Hojas de Mormodica balsamina en la Morfología Gástrica de Ratas Experimentales Contra Úlceras Gástricas Inducidas por Etanol

SUMMARY: Mormodica balsamina is a valuable medicinal plant that is used to treat wounds and inflammation; its leaves are also used as an antibiotic and in the treatment of stomach pain. This study was conducted to determine the anti-ulcer activity of methanolic leaf extract of Mormodica balsamina on ethanol-induced ulcer in albino rats. A total of 32 rats were used for the study. Groups I and II served as the baseline and negative controls respectively, while groups III-VII served as the test groups. Group I was untreated, while group II received 1ml/kg body weight of the vehicle (2 % DMSO). Three test groups (III - V) received methanol extracts (75 mg, 150 mg, 300 mg/kg body weight respectively) while the other three test groups (VI - VIII) received aqueous extracts (75 mg, 150mg, 300 mg/kg body weight respectively) via oral gavage for seven days prior to ulcer induction. The rats were sacrificed, stomachs excised and ulcers scored. Histological sections were produced and examined. Findings revealed that M. balsamina extracts protected the rats' gastric epithelia from ethanol induced ulceration to varying degree with the high dose (150 and 300 mg/kg) of both extracts offering the best preservation (42 % and 50 % ulcer protective index respectively) when compared to untreated animals. Histological findings correlated with calculated ulcer indices, with treated animals having less severe gastric mucosal lesions. In conclusion, extracts of M. balsamina may possess reasonable antiulcer activities in rats against ethanol induced gastric ulcer.

Mormodica balsamina es una valiosa planta medicinal que se utiliza para tratar heridas e inflamaciones; sus hojas también se utilizan como antibiótico y en el tratamiento del dolor de estómago. Este estudio se realizó para determinar la actividad antiulcerosa del extracto metanólico de hojas de Mormodica balsamina sobre la úlcera inducida por etanol en ratas albinas. Se utilizaron un total de 32 ratas para el estudio. Los grupos I y II sirvieron como referencia y controles negativos respectivamente, mientras que los grupos III-VII sirvieron como grupos de prueba. El grupo I no se trató, mientras que el grupo II recibió 1 ml/kg de peso corporal del vehículo (2% de DMSO). Tres grupos de prueba (III - V) recibieron extractos de metanol (75 mg, 150 mg, 300 mg/ kg de peso corporal respectivamente) mientras que los otros tres grupos de prueba (VI - VIII) recibieron extractos acuosos (75 mg, 150 mg, 300 mg/kg de peso corporal respectivamente) por sonda oral durante siete días antes de la inducción de la úlcera. Se sacrificaron las ratas, se extirparon los estómagos y se puntuaron las úlceras. Se realizaron y examinaron secciones histológicas. Los resultados revelaron que los extractos de M. balsamina protegieron el epitelio gástrico de las ratas de la ulceración inducida por etanol en diversos grados, y la dosis alta (150 y 300 mg/kg) de ambos extractos ofreció la mejor conservación (42 % y 50 % de índice de protección contra úlceras, respectivamente) en comparación con los animales no tratados. Los hallazgos histológicos se correlacionaron con los índices de úlcera calculados, y los animales tratados tenían lesiones de la mucosa gástrica menos graves. En extractos de M. balsamina puede poseer actividades antiulcerosas razonables en ratas contra la úlcera gástrica inducida por etanol.

Análise da utilização de inibidores de bomba de prótons em pacientes internados em um hospital universitário do interior de São Paulo / Analysis of the use of proton pump inhibitors in patients admitted to a university hospital in interior of São Paulo

Introdução: A crença de que o uso de Inibidores de Bomba de Prótons (IBPs) apresenta baixo risco de toxicidade, resultou em um aumento significativo na sua prescrição em nível mundial, esse fator juntamente com a baixa divulgação de orientações, têm contribuído para o aumento das indicações desnecessárias de inibidores de bomba de prótons em nível hospitalar, principalmente para profilaxia. Objetivo: Analisar a utilização dos inibidores de bomba de prótons em pacientes internados nas enfermarias de clínica médica de um Hospital Universitário, visando avaliar suas indicações, tempo de uso, efeitos adversos e impacto financeiro gerado pelo uso inadequado. Métodos: Foram analisados prontuários de pacientes que estiveram internados nas enfermarias de clínica médica do Hospital Municipal Universitário de Taubaté (HMUT) durante os meses de maio a julho de 2020. As indicações adequadas do uso de inibidores de bomba de prótons foram baseadas em diretrizes internacionais do American Journal of Gastroenterology e do American Society of Health-System Pharmacy. Resultados: Identificamos que 297 pacientes (79,6%) usaram inibidores de bomba de prótons em algum momento da internação. O uso desse medicamento foi adequadamente prescrito em 49,8% dos casos. Foi encontrado maior prevalência de pneumonia e diarreia nos pacientes que fizeram uso de inibidores de bomba de prótons a longo prazo. O custo anual associado as prescrições indevidas foram de R$24.736,40. Conclusão: Observamos alta prevalência de indicações incorretas dos inibidores de bomba de prótons em ambiente hospitalar, ocasionando gasto desnecessário e possíveis complicações. Faz-se necessário, portanto, elaboração de novos protocolos e maior rigidez nas indicações desses medicamentos no Hospital Municipal Universitário de Taubaté.

Introduction: The belief that the use of Proton Pump Inhibitors (PPIs) presents a low risk of toxicity, resulted in a significant increase in its prescription worldwide, this factor combined with the low disclosure of guidelines, have contributed to the increase in unnecessary indications of at the hospital level, especially for prophylaxis. Objective: To analyze the use of proton pump inhibitors in patients hospitalized in the medical clinic wards of a University Hospital, in order to evaluate their indications, time of use, adverse effects and financial impact generated by inadequate use. Methods: Medical records of patients who were admitted at the Municipal University Hospital of Taubaté during the months of May to July 2020 were analyzed. The appropriate indications for the use of proton pump inhibitors were based on the international guidelines of the American Journal of Gastroenterology and the American Society of Health-System Pharmacy. Results: We identified that 297 patients (79.6%) used proton pump inhibitors at some point in hospitalization. The use of this drug was adequately prescribed in 49.8% of the cases. A higher prevalence of pneumonia and diarrhea was found in patients who used proton pump inhibitors in the long term. The annual cost associated with undue prescriptions was R$24,736.40. Conclusion: We observed a high prevalence of incorrect indications of proton pump inhibitors s in the hospital environment, causing unnecessary expenses and possible complications. It is necessary, therefore, the elaboration of new protocols and greater rigidity in the indications of these drugs at the Municipal University Hospital of Taubaté.

Ulceración esofágica por ingestión de doxiciclina / Doxycycline induced esophageal ulceration

La ulceración esofágica por ingestión de doxiciclina es una de las causas más frecuentes de lesión esofágica. Ha sido subdiagnosticada y escasamente reconocida en dermatología. El dolor retroesternal, la odinofagia de aparición brusca y el antecedente de ingesta de doxiciclina u otros fármacos son características que facilitan su diagnóstico. Puede presentar complicaciones serias, como hemorragias, estenosis y mediastinitis.

Esophageal ulceration due to ingestion of doxycycline is one of the most frequent causes of esophageal injury. It has been underdiagnosed and scarcely recognized in dermatology. Retrosternal pain, sudden odynophagia and a history of doxycycline or other drugs intake are some of the characteristics that lead to diagnosis. It may cause severe complications such as bleeding, stenosis and mediastinitis.

Omeprazole prescriptions for older adults in health care units in Curitiba, Brazil: an analysis based on Beers Criteria / Prescrições de omeprazol para idosos em unidades de saúde de Curitiba: análise segundo os Critérios de Beers

OBJECTIVE: To evaluate omeprazole prescriptions for older adults based on the Beers Criteria, with an analysis of indications and duration of use longer than eight weeks. METHODS: In this retrospective cross-sectional study, data were collected from the electronic medical records of older adults with an omeprazole prescription seen at two health care units in Curitiba, Brazil, between June and August 2019. Data were subjected to descriptive statistical analysis, Student t and χ2 tests. RESULTS: Medical records of 386 patients were analyzed, and 69.95% were female. The mean age was 71 (SD, 8.15) years. Most patients had incomplete primary education (50.52%) and income level ranging from one to two Brazilian minimum monthly wages (39.90%). No indication for omeprazole prescription was found in 23.83% of medical records. Use longer than eight weeks was predominant for all indications in 96.60% of medical records. Duration of use more extended than the Beers Criteria recommendation was independent of sex (p = 0.327), education (p = 0.805), and income level (p = 0.629). A relationship between polypharmacy and long-term drug use was demonstrated (p < 0.001). CONCLUSION: The results of this study suggest the need for periodic review of omeprazole prescriptions considering deprescribing when they appropriate.

OBJETIVO: Avaliar as prescrições de omeprazol para idosos de acordo com os Critérios de Beers, por meio das indicações e do tempo de uso do medicamento por período superior a oito semanas. METODOLOGIA: Estudo transversal, retrospectivo, no qual foram coletados dados dos prontuários eletrônicos de idosos com prescrição de omeprazol atendidos entre junho e agosto de 2019 em duas unidades de saúde em Curitiba. Os dados foram submetidos à análise estatística descritiva e aos testes t de Student e do χ2 . RESULTADOS: Foram analisados prontuários de 386 usuários, sendo 69,95% do sexo feminino. A média de idade foi de 71 anos (DP, 8,15). A maioria dos usuários tem ensino fundamental incompleto (50,52%) e faixa de renda de um a dois salários mínimos (39,90%). Não foi encontrada a indicação para a prescrição de omeprazol em 23,83% dos prontuários. O uso por período superior a oito semanas foi predominante, para todas as indicações, em 96,60% dos prontuários. Demonstrou-se que o tempo de uso superior ao recomendado nos Critérios de Beers independe do sexo (p = 0,327), da escolaridade (p = 0,805) e da faixa de renda (p = 0,629). Evidenciou-se a relação entre polifarmácia e uso do medicamento por períodos prolongados (p < 0,001). CONCLUSÃO: Os resultados deste estudo apontam para a necessidade de revisão periódica das prescrições de omeprazol, considerando-se a desprescrição quando apropriado.

Intensive care unit prescriptions must fit risk factors to prevent stress ulcer bleeding / Prescrições em unidade de terapia intensiva devem adequar-se aos fatores de risco na prevenção de sangramento por úlcera de estresse

ABSTRACT Background: The physiological stress of critically ill patients can trigger several complications, including digestive bleeding due to stress ulcers (DBSU). The use of acid secretion suppressants to reduce their incidence has become widely used, but with the current understanding of the risks of these drugs, their use, as prophylaxis in critically ill patients, is limited to the patients with established risk factors. Aim: To determine the appropriateness of the use of prophylaxis for stress ulcer bleeding in acutely ill patients admitted to intensive care units and to analyze the association of risk factors with adherence to the prophylaxis guideline. Methods: Retrospective, analytical study carried out in three general adult intensive care units. Electronic medical records were analyzed for epidemiological data, risk factors for DBSU, use of stress ulcer prophylaxis, occurrence of any digestive bleeding and confirmed DBSU. The daily analysis of risk factors and prophylaxis use were in accordance with criteria based on the Guidelines of the Portuguese Society of Intensive Care for stress ulcer prophylaxis. Results: One hundred and five patients were included. Of the patient days with the opportunity to prescribe prophylaxis, compliance was observed in 95.1%. Of the prescription days, 82.35% were considered to be of appropriate use. Overt digestive bleeding occurred in 3.81% of those included. The occurrence of confirmed DBSU was identified at 0.95%. Multivariate analysis by logistic regression did not identify risk factors independently associated with adherence to the guideline, but identified risk factors with a negative association, which were spinal cord injury (OR 0.02 p <0.01) and shock (OR 0.36 p=0.024). Conclusion: The present study showed a high rate of adherence to stress ulcer prophylaxis, but with inappropriate use still significant. In the indication of prophylaxis, attention should be paid to patients with spinal cord injury and in shock.

RESUMO Racional: O estresse fisiológico dos pacientes críticos pode desencadear várias complicações, entre elas o sangramento digestivo por úlcera de estresse (SDUE). O uso de supressores da secreção ácida para reduzir sua incidência passou a ser amplamente utilizado, mas com o atual entendimento dos riscos destes medicamentos sua utilização, como profilaxia em doentes críticos, está limitada aos pacientes com fatores de risco estabelecidos. Objetivos: Determinar a adequação do uso de profilaxia para sangramento por úlcera de estresse em pacientes agudamente enfermos internados em unidades de terapia intensiva e analisar a associação dos fatores de risco com a adesão à diretriz de profilaxia. Métodos: Estudo retrospectivo, analítico, realizado em três unidades de terapia intensiva gerais de adultos. Os prontuários eletrônicos foram analisados para dados epidemiológicos, fatores de risco para SDUE, uso de profilaxia para SDUE, ocorrência de qualquer sangramento digestivo e de SDUE confirmado. A análise diária dos fatores de risco e uso de profilaxia foram de acordo com critérios baseados nas Diretrizes da Sociedade Portuguesa de Cuidados Intensivos para profilaxia da úlcera de estresse. Resultados: foram incluídos 105 pacientes. Dos pacientes-dia com oportunidade de prescrição de profilaxia, foi observada adesão em 95,1%. Dos dias de prescrição foram considerados de uso apropriado 82,35%. Sangramento digestivo visível ocorreu em 3,81% dos incluídos. A ocorrência de SDUE confirmado foi identificada em 0,95%. A análise multivariada por regressão logística não identificou fatores de risco independentemente associados com a adesão à diretriz, mas identificou fatores de risco com associação negativa, que foram lesão da medula espinhal (OR 0.02 p<0,01) e choque (OR 0.36 p=0.024). Conclusão: O presente estudo evidenciou alta taxa de adesão à profilaxia para SDUE, mas com uso inapropriado ainda significativo. Na indicação de profilaxia deve-se ter atenção aos pacientes com lesão de medula espinhal e choque.

Antiulcerogenic effects of selected African nightshades (Solanum nigrum Linn. ) genotypes on the rat stomach: a morphologic and morphometric study / Efectos antiulcerogénicos de genotipos seleccionados de solanáceas Africanas (Solanum nigrum Linn. m) en el estómago de ratas: un estudio morfológico y morfométrico

Solanum nigrum (SLN), commonly known as African nightshade, is used as a vegetable as well as in the management and treatment of various ailments including gastric ulcers. We analyzed, both grossly and microscopically using H&E, Masson's trichrome and PSA staining methods, the protective effects of aqueous leaf extracts of three Kenyan SLN genotypes namely S. scabrum (SSB), S. sarrachoides (SSR) and S. villosum (SVL) on ethanol-induced gastric lesions in rats. There was evidence of gastro-protection by all the three genotypes with the SSB showing the highest ulcer inhibition score (76.37 %) followed by SSR (72.51 %) and SVL (63.30 %). SLN-pretreated rats showed less areas of gastric mucosal surface erosion. Additionally in the pretreated animals, the depth of the ulcers were markedly reduced, reaching only the gastric pit region except in those treated with SVL where the ulcers penetrated slightly more deeply to affect the gastric glands. Compared with controls, the mean microscopic ulcer index decreased 5.07, 3.55 and 2.37-fold in rats pretreated with SSB, SSR and SVL extracts respectively. Results of this work show extracts of the three SLN genotypes to have antiulcerogenic potential but at varied strengths, thus confirming earlier reports that phytoconstituents and hence the efficacy of a medicinal plant may be influenced by genetic factors.

Solanum nigrum (SLN), comúnmente conocida como la solanácea africana, se usa como vegetal, para el tratamiento de diversas dolencias incluyendo las úlceras gástricas. Analizamos de forma macro y microscópica, de forma macroscópica y microscópica, utilizando para ello tinciones de H&E, tricrómico de Masson y PSA los efectos protectores de extractos acuosos de hojas de tres genotipos SLN de Kenia: S. scabrum (SSB), S. sarrachoides (SSR) and S. villosum (SVL) en lesiones gástricas inducidas por etanol en ratas. Hubo evidencia de gastroprotección por parte de los tres genotipos con el SSB mostrando el puntaje más alto de inhibición de la úlcera (76,37 %) seguido de SSR (72,51 %) y SVL (63,30 %). Las ratas tratadas previamente con SLN mostraron menos áreas de erosión de la superficie de la mucosa gástrica. Además, en los animales pretratados, la profundidad de las úlceras se redujo notablemente, llegando solo a la región del fondo gástrico, excepto en aquellos tratados con SVL donde las úlceras penetraron un poco más profundamente para afectar las glándulas gástricas. En comparación con los controles, el índice medio de úlcera microscópica disminuyó 5,07, 3,55 y 2,37 veces en ratas pretratadas con extractos de SSB, SSR y SVL, respectivamente. Los resultados de este trabajo muestran que los extractos de los tres genotipos de SLN tienen potencial antiulcerogénico en diferentes concentraciones, lo que confirma informes anteriores que los fitoconstituyentes y la eficacia de una planta medicinal pueden estar influenciados por factores genéticos.

Perfil sociodemográfico e clínico de idosos usuários crônicos de omeprazol na rede básica de saúde / Sociodemographic and clinical profile of elderly people chronic users of omeprazole attending the basic health network / Perfil sociodemográfico y clínico de los ancianos usuarios crônicos de omeprazol em la red básica de salud

Objetivo: Descrever o perfil sociodemográfico e clínico de idosos usuários crônicos de omeprazol. Método: Trata-se de um estudo transversal com usuários com idade superior a 60 anos, que retiraram o omeprazol na Farmácia Pública de Panambi/RS. Resultados: Participaram da pesquisa sessenta idosos, com idade média de 67,90 ±5,6 anos. Duas interações graves foram identificadas envolvendo citalopram e clopidogrel. Observou-se a presença nas prescrições de medicamentos que tem a sua absorção alterada pelo uso concomitante com o omeprazol como captopril (25%) e enalapril (16,7%). Conclusão: Dessa forma, evidenciou-se uma população suscetível a riscos que necessita de acompanhamento farmacêutico

Objective: To describe the sociodemographic and clinical profile of elderly chronic omeprazole users. Method: This is a cross-sectional study. Patients aged 60, from the Public Pharmacy of the city of Panambi / RS. Results: A total of 60 elderly chronic omeprazole users participated in the study with an average of 67.90 ± 5.6 years of age. Two serious interactions were identified involving citalopram and clopidogrel. There was the presence in the prescription of drugs that have their absorption altered by concomitant use of omeprazole as captopril (25%) and enalapril (16.7%). Conclusion: Thus, we highlight that there is a population susceptible to risks that needs pharmaceutical monitoring

Objetivo: Describir el perfil sociodemográfico y clínico de los ancianos usuarios crónicos de omeprazol. Método: Es un estudio transversal descriptivo cuantitativo. Participaron en el estudio pacientes con edad igual o mayor de 60 años, usuarios crónicos de omeprazol, y que acudieron al medicamento en la Farmacia Publica de la cuidad de Panambi/RS. Resultados: Participaron de la investigación 60 ancianos 51,7% del sexo femenino, con edad media de 67,90 ±5,6 años, 81,7% relataran alguna comorbilidad, siendo la más prevalente la hipertensión arterial sistémica (61,7%). Los medicamentos que actúan en el tracto alimentar y metabólico fueron los más frecuentes. Se identificaron dos graves interacciones relacionado al citalopram (8,4%) y clopidogrel (1,7%). Se observó en las prescripciones la presencia de medicamentos cuya absorción es alterada por el uso concomitante con el omeprazol, como el captopril (25%) y enalapril (16,7%). Conclusión: De esta forma, se ha evidenciado una populación susceptible a los riesgos y que necesita de acompañamiento farmacéutico

Etiología y perfil de resistencia antimicrobiana en pacientes con infección urinaria / Etiology and antimicrobial resistance profile in patients with urinary infection

Introducción: La infección de vías urinarias (IVU) es una de las enfermedades más prevalentes en la práctica clínica Objetivo: Identificar los principales agentes etiológicos y la frecuencia de resistencia a antibióticos por parte de microorganismos aislados por urocultivos en pa cientes con IVU en un hospital de primer nivel de atención. Materiales y Métodos: Estudio descriptivo de corte transversal, a partir de una muestra aleatoria de pacientes con IVU en La Virginia, Risaralda, entre el 1 de abril de 2014 a 31 de marzo de 2015. Se evaluaron las bacterias aisladas en la totalidad de urocultivos procesados y los resultados de los antibiogramas. Se establecieron frecuencias y proporciones. Para el análisis de datos, se utilizó SPSS Statistics 22. Se hizo análisis multivariado. Resultados: Se realizaron 1563 urocultivos en el periodo de estudio, de los cuales 329 (21,0%) mostraron crecimiento mayor a 100.000 UFC. Las frecuencias más altas de resistencia para E. coli se observaron para cefalotina (75,8%), ampicilina (72,6%) y trimetoprim/sulfametoxazol (55,3%). De 296 pacientes seleccionados aleatoriamente se halló que la cistitis era la IVU más frecuente (70,3%) y al 50,7% no se les prescribió ningún antimicrobiano. El uso de antiulcerosos se asoció con mayor probabilidad de uso inadecuado del antibiótico (OR:4,28; IC95%:1,070-17,153; p=0,04). Conclusiones: Existe una elevada resistencia bacteriana a los antibióticos de primera línea para el tratamiento de las IVUs, lo que sugiere la importancia de identi ficar los microorganismos y sus perfiles de sensibilidad a antimicrobianos para seleccionar con mejor criterio cual emplear.

Introduction: Urinary tract infection (UTI) is one of the most prevalent diseases in clinical practice. Objective: To identify the main etiologic agents and the frequency of antibiotic resistance by microorganisms isolated from urine culture and sensitivity in patients with IVU in a hospital primary care. Materials and Methods. Descriptive cross-sectional study, from a random sample of patients with UTI in La Virginia, Risaralda, from April 1, 2014 to March 31, 2015. Bacteria isolated from all processed urine cultures and the results of susceptibility were evaluated. Frequencies and proportions were established. For data analysis was used SPSS Statistics 22. Results: A total of 1563 urine cultures were performed in the study period, of which 329 (21.0%) showed further growth to 100,000 UFC. Higher frequencies of resis tance were observed for E. coli to cephalothin (75.8%), ampicillin (72.6%) and trimethoprim/sulfamethoxazole (55.3%). In the 296 randomized patients it was found that the most common UTI was cystitis (70.3%) and 50.7% were not prescribed any antimicrobial. The use of anti-ulcer is associated with increased probability of inappropriate use of antibiotics (OR:4.28; 95% CI:1.070-17.153; p=0.04). Conclusions: There is a high bacterial resistance to first-line antibiotics for treatment of UTIs, suggesting the importance of identifying microorganisms and their antimicrobial susceptibility profiles to select which use better approach.

Helicobacter pylori eradication: influence of interleukin-1beta -31 C/T polymorphism

ABSTRACT Aim To analyze the influence of the -31 C/T polymorphism of the interleukin-1β gene on Helicobacter pylori eradication therapy success in patients with functional dyspepsia. Methods Functional dyspepsia was diagnosed according to the Rome III criteria. All patients underwent upper gastrointestinal endoscopy, and gastric biopsies were obtained at screening and 12 months after randomization (last follow-up visit). Urease test and histological examination were performed to define the H. pylori status. Patients received twice-daily amoxicillin, clarithromycin and omeprazole for 10 days. Genotyping of the interleukin-1beta -31 C/T polymorphism (rs1143627) was performed using polymerase chain reaction-restriction fragment length polymorphism. Results One hundred forty-nine patients received treatment with triple therapy for H. pylori eradication. Only one patient was lost to follow-up, and adherence to study medication was 94.6%. A total of 148 patients (mean age 46.08 ± 12.24 years; 81.8% women) were evaluated for the influence of the interleukin-1beta -31 C/T polymorphism on the outcome of H. pylori eradication therapy. After treatment, bacteria were eradicated in 87% of patients (129/148). Genotype frequencies of the polymorphism were as follows: CC, 38/148 (25.7%); CT, 71/148 (47.9%); and TT, 39/148 (26.4%). Successful eradication rate was 78.9%, 94.4% and 82.1% for the CC, CT and TT genotypes, respectively. The CT genotype was significantly associated with successful H. pylori eradication (p= 0.039). Conclusion This study suggests that the CT genotype of the interleukin-1beta -31 C/T polymorphism plays a role in the successful eradication of H. pylori among patients with functional dyspepsia.

Gastroprotective and antioxidant effects of Eremurus spectabilis Bieb. methanol extract and its isolated component isoorientin on indomethacin induced gastric ulcers in rats

Abstract Purpose: To investigate the gastroprotective effect of methanol extract of E. spectabilis and its major component isoorientin. Methods: Effects of isoorientin and methanol extract of E. spectabilis were investigated in indomethacin-induced gastric damage model on rats. Famotidine was used as the standard antiulcer drug. Numerical density of ulcer areas and oxidative status were determined on stomach tissues of rats. Results: All doses of isoorientin and methanol extract decreased MDA level and increased SOD activity and GSH levels in the stomach tissue of rats. When numerical density of ulcer areas were analized, the 500 mg/kg dose of methanol extract (84%) exhibited a similar effect to 20 mg/kg dose of standart drug famotidine (87%). Conclusions: The gastroprotective effects of E. spectabilis and its major constituent isoorientin in rats for the first time. Detailed analyses suggested that potential antioxidant activity of both plant extract and isoorientin mediates the gastroprotective effect.

Perfil fitoquímico e atividade gastroprotetora dos frutos de Eugenia mattosii / Phytochemical profile and gastroprotective activity of eugenia mattosii fruits

ABSTRACT BACKGROUND: Extracts obtained from plants and fruits provide a relatively safe and practical alternative for the conventional medicine of gastrointestinal diseases. The specie Eugenia mattosii, popularly known in Brazil as "cerejinha", belongs to Myrtaceae family. Species of this family present pharmacological properties, and can be used in the treatment of gastrointestinal disorders. OBJECTIVE: The aim of this study was to determine the phytochemical profile and evaluate the gastroprotective activity of Eugenia mattosii fruits. METHODS: Phytochemical analysis was carried out by thin layer chromatography and gastroprotective assays were performed using two experimental models: acute ulcer model induced by ethanol/HCl and acute ulcer model induced by non-steroidal anti-inflammatory drug (indomethacin). Total lesion area (mm2) and relative lesion area (%) were determined. RESULTS: The results of the phytochemical analysis indicated that the bark and pulp and seeds of E. mattosii present phenolic compounds, terpenes and/or steroids. In gastric ulcer model induced by ethanol was evidenced significant reduction of damaged areas for doses of 50 and 250 mg/ kg of seeds methanol extract, while in the indomethacin-induced ulcer model, all parts of the fruit presented defense capability of the gastric mucosa by reducing lesions at doses of 50, 125 and 250 mg/kg. CONCLUSION: The results demonstrate that the specie E. mattosii has bioactive compounds that provide gastroprotective activity, presenting possible therapeutic potential.

RESUMO CONTEXTO: Extratos obtidos de plantas e frutos fornecem uma alternativa relativamente segura e prática para os remédios convencionais de doenças gastrointestinais. A espécie Eugenia mattosii, popularmente conhecida no Brasil como "cerejinha", pertence à família Myrtaceae. Espécies desta família apresentam propriedades farmacológicas e podem ser utilizadas no tratamento de distúrbios gastrointestinais. OBJETIVO: O objetivo deste estudo foi determinar o perfil fitoquímico e avaliar a atividade gastroprotetora dos frutos de Eugenia mattosii. MÉTODOS: A análise fitoquímica foi realizada por cromatografia em camada delgada e dois modelos experimentais foram utilizados para avaliação da atividade gastroprotetora em camundongos: modelo de úlcera gástrica induzida por anti-inflamatório não-esteroidal (indometacina) e modelo de úlcera gástrica induzida por etanol/HCl. RESULTADOS: Os resultados da análise fitoquímica indicaram que a casca e polpa e as sementes de E. mattosii apresentam compostos fenólicos, terpenos e/ou esteroides. No modelo de úlcera gástrica induzido pelo etanol, foi evidenciada redução significativa de áreas danificadas para doses de 50 e 250 mg/kg do extrato das sementes, enquanto no modelo de úlcera induzida por indometacina, todas as partes do fruto apresentaram capacidade de defesa da mucosa gástrica ao reduzir as lesões nas doses de 50, 125 e 250 mg/kg. CONCLUSÃO: Os resultados demonstram que a espécie E. mattosii possui compostos bioativos com atividade gastroprotetora, apresentando possível potencial terapêutico.

Effect of sequential therapy on treatment of Helicobacter pylori infection in children / Efecto de la terapia secuencial en el tratamiento de la infección por Helicobacter pylori en niños

Background: Helicobacter pylori infection which plays a major role in the etiology of chronic gastritis and duodenal ulcers in children and adults is one of the commonest chronic infection worldwide. Cure of the infection leads to healing of gastric inflammation and prevention of peptic ulcer. Objective: The aim of this study was to evaluate the efficacy of the sequential therapy for treatment of Helicobacter pylori infection. Materials and methods: In this study, 40 children with symptoms of H. Pylori that the infection was proved by endoscopy and biopsy and rapid urease test (UBT) were enrolled, and received sequential therapy (Lansoprazol, Amoxicillin) for 5 days and (Lansoprazol, Metronidazole and Clarithromycin) for next 5 days. The eradication rate of therapy was evaluated by stool antigen test 6 weeks after completion of therapy. This study was carried out in Pediatric Gastroenterology Clinic of Shiraz University of Medical Sciences, Shiraz, Iran. This study was approved by ethic committee of Shiraz University of Medical Sciences. Results: Forty children with mean age of (10.8±4 years) were evaluated. The most common symptom on first admission was epigastric pain (82.5%), with mean duration of symptoms (16±14.5 month). The most common endoscopic findings was redness and erosion of the antrum (55%) and the most pathologic findings was chronic gastritis (77.5%). The most drug adverse effect was nausea (22.5%). The eradication rate of sequential therapy was 82.5%. Conclusion: Eradication rate of sequential therapy was 82.5% among our cases.

Antecedentes: La infección por Helicobacter pylori, que juega un rol principal en la etiología de la gastritis crónica y las úlceras duodenales en niños y adultos, es una de las infecciones crónicas más comunes en el mundo. La cura de esta infección lleva a la cura de la inflamación gástrica y a la prevención de la úlcera péptica. Objetivo: Evaluar la eficacia de la terapia secuencial en el tratamiento de la infección por Helicobacter pylori. Material y métodos: En este estudio, se enrolaron 40 niños con síntomas en los que la infección por H. pylori se demostró por endocopía con biopsia y prueba rápida de ureasa (UBT) y recibieron terapia secuencial (Lansoprazol, Amoxicilina) por 5 días y (lansoprazol, metronidazol y clarotromicina) por otros 5 días. La tasa de erradicación de la terapia se evaluó por prueba de antígeno en heces 6 semanas después de terminar la terapia. Este estudio se llevó a cabo en la Clínica de Gastroenterología Pediátrica de la Universidad de Ciencias Médicas de Shiraz, Irán. El estudio fue aprobado por el comité de ética de la Universidad de Ciencias Médicas de Shiraz. Resultados: Se evaluaron cuarenta niños con una edad media de (10,8±4 años). El síntoma más común al ingreso fue dolor epigástrico (82,5%) con una duración media de síntomas de (16±14,5 meses). El hallazgo endoscópico más común fue enrojecimiento y erosión del antro (55%) y el hallazgo patológico más común fue gastritis crónica (77,5%). El evento adverso más común fue náusea (22,5%). La tasa de erradicación de la terapia secuencial fue 82,5%. Conclusión: La tasa de erradicación de la terapia secuencial fue de 82,5% en nuestros casos.

Protective roles of Vigna subterranea (Bambara nut) in rats with aspirin-induced gastric mucosal injury / 中西医结合学报

<p><b>OBJECTIVE</b>Vigna subterranea is widely consumed as a traditional staple food in Nigeria and some West African countries. The ethanolic seed extract of V. subterranea (EEVS) was investigated for its gastroprotective effects on aspirin plus pylorus ligation-induced gastric ulcerated rats using an in vivo assay.</p><p><b>METHODS</b>Gastric mucosal ulceration was induced experimentally in Groups 2 to 5 using aspirin plus pylorus ligation. Rats in Group 1 were orally pretreated with 3% Tween 80 only as normal control. Groups 2 to 5 were pretreated with 3% Tween 80 (ulcer group), 20 mg/kg of omeprazole (positive group), and 200 and 400 mg/kg of EEVS (experimental groups), respectively, once daily for 21 days before ulcer induction. Parameters including those for gastric secretions, ulcerated areas and gastric wall histology were assessed. Levels of superoxide dismutase (SOD), glutathione peroxidase (GP), and malondialdehyde (MDA) in the gastric tissue homogenate were also determined.</p><p><b>RESULTS</b>Pretreatment with EEVS significantly (P < 0.05) reduced the ulcer index, gastric volume and total acidity in rats with aspirin plus pylorus ligation-induced ulcer. The pH and mucus of gastric content increased significantly (P < 0.05) while the levels of SOD and GP were observed to be elevated with a reduced amount of MDA. Significant severe gastric mucosal injury was exhibited in the ulcer group and EEVS or omeprazole offered significant (P < 0.05) protection against mucosal ulceration. Histologically, the gastric submucosal layer showed remarkable decrease in edema and leucocytes infiltration compared with ulcer group.</p><p><b>CONCLUSION</b>The study suggests that EEVS offered a protective action against aspirin plus pylorus ligation-induced gastric ulcers in Wistar rats. The protective effect might be mediated via antisecretory, cytoprotective and antioxidative mechanisms.</p>

Flavonoids and anti-oxidant activity mediated gastroprotective action of leathery murdah, terminalia coriacea (roxb.) Wight & arn. Leaf methanolic extract in rats / A ação gastroprotetora antioxidante e flavonoide de extrato metanólico de folhas de Leathery Murdah, Terminalia coracea (Roxb.) Wight & Arn. em ratos

ABSTRACT BACKGROUND Leathery Murdah, Terminalia coriacea (Roxb.) Wight & Arn. from family Combretaceae is used in Ayurveda and Siddha traditional systems of medicine to heal ulcers. OBJECTIVE The present study was conducted to assess the gastroprotective effect and understand the fundamental mechanism of action of Leathery Murdah, Terminalia coriacea (Roxb.) Wight & Arn. Leaf Methanolic Extract. METHODS The test extract was screened for anti-ulcer activity by Aspirin induced ulcerogenesis in pyloric ligation and ethanol induced gastric ulcers at three doses - 125, 250, and 500 mg/kg, p.o. using Ranitidine 50 mg/kg and Misoprostol 100 μg/kg as standard drug in respective models. Seven parameters were carefully examined, that is, ulcer index, total protein, mucin, catalase, malondialdehyde, and superoxide dismutase levels and histopathology. High Performance Liquid Chromatographic - Ultra Violet profiling and Liquid Chromatography - Mass Spectral analysis of crude Terminalia coriacea leaves methanolic extract were carried out as a part of chemical characterization to identify bioactive compounds. RESULTS All the test doses exhibited significant gastroprotective function, particularly the higher doses demonstrated improved action. The results revealed a significant increase in the levels of catalase, superoxide dismutase, and Mucin with reduction in ulcer index, the levels of total protein, and malondialdehyde. Histopathological observations also illustrated the gastroprotective effect of Terminalia coriacea leaves methanolic extract. CONCLUSION Terminalia coriacea leaves methanolic extract exhibited strong anti-oxidant and anti-secretory activities mediated gastroprotection besides inducing the gastric mucosal production. The observed pharmacological response can be attributed to the flavonoidal compounds namely - Quercetin-3-O-rutinoside, Luteolin-7-O-glucoside, Myricetin hexoside, Quercetin-3-O-glucoside, Isorhamnetin-3-O-rhamnosylglucoside and Isorhamnetin-3-O-glucoside identified in the extract for the first time with High Performance Liquid Chromatographic - Ultra Violet and Liquid Chromatography - Mass Spectral analysis.

RESUMO CONTEXTO Leathery Murdah, Terminalia coriacea (Roxb.) Wight & Arn. da família Combretaceae é usada nos tradicionais sistemas da medicina Ayurveda e Siddha para cicatrização de úlceras. OBJETIVOS O presente estudo foi realizado para avaliar o efeito gastroprotetor e para esclarecer o mecanismo fundamental da ação do extrato metanólico de folhas de Leathery Murdah, Terminalia coracea (Roxb.) Wight & Arn. MÉTODOS O extrato teste foi testado para ação antiulcerogênica induzida pela Aspirina através da ligação pilórica e úlceras gástricas induzidas por etanol em três doses - 125, 250 e 500 mg/kg, via oral, utilizando-se Ranitidina 50 mg/kg e Misoprostol 100 μg/kg como drogas padrão nos respectivos modelos. Sete parâmetros foram cuidadosamente analisados tais como índice ulcerogênico, níveis de proteínas totais, de mucina, de catalase, de malondialdeído e de superoxido dismutase, além da histopatologia. A análise do perfil espectroscópico pela Cromatografia Líquida de Alta Eficiência - Ultravioleta e análise crua pela Cromatografia Líquida - Espectrometria de Massas foram realizadas como parte da caracterização química para identificar os componentes bioativos. RESULTADOS Todas as doses utilizadas exibiram função gastroprotetora, em particular as doses mais elevadas. Os testes revelaram aumentos significantes de catalase, superóxido dismutase e mucina, com diminuição do índice ulcerogênico, dos níveis de proteínas totais, e de malondialdeído. As observações histopatológicas também ilustraram o efeito gastroprotetor do extrato metanólico de folhas de Terminalia coracea. CONCLUSÃO O extrato metanólico de folhas de Terminalia coracea mostrou forte atividade antioxidante e antissecretória além de induzir a produção de mucosa gástrica. A resposta farmacológica observada pode ser atribuída aos compostos flavonoides denominados Quercetin-3-O-rutinosideo, Luteolin-7-O-glucosideo, Myricetin hexosideo, Quercetin-3-O-glucosideo, Isorhamnetin-3-O-rhamnosylglucosideo e Isorhamnetin-3-O-glucosideo, identificados no extrato pela primeira vez pelas análises de Cromatografia Líquida de Alta Eficiência - Ultravioleta e Cromatografia Líquida - Espectrometria de Massas.

Soft coral Cespitularia stolonifera: New cytotoxic ceramides and gastroprotective activity / 中国天然药物

In the present study, a new ceramide, namely 2S, 3R-4E, 8E-2-(heptadecanoylamino)-heptadeca-4, 8-diene-1, 3-diol (1), along with four known steroids, including 24-methylcholesta-5, 24(28)-diene-3β-ol (2), 24-methylcholesta-5, 24(28)-diene-3β-acetate (3), 4-methyl-24-methylcholesta-22-ene-3-ol (4), and cholesterol, was isolated and characterized from CHCl/MeOH extract of Cespitularia stolonifera. A new acetate derivative of compound 1, termed 2S, 3R-4E, 8E-2-(heptadecanoylamino)-heptadeca-4, 8-diene-1, 3-diacetate (1a), was also prepared in the present study. All the structures were established on the basis of modern spectroscopic techniques, including FT-IR, 1D, 2D-NMR, HRESI-MS, and GC-MS, in addition of chemical methods. (-)-Alloaromadendren, ledane, (1)-alloaromadendren oxide, isoaromadendrene epoxide and (-)-caryophellen oxide were identified from the n-hexane fraction using GC-MS. The extract and the two ceramides (1) and (1a) exhibited significant cytotoxic activity against lung cancer A549 cells, while the extract and the two steroids (2) and (3) exhibited significant cytotoxic activity against breast cancer MCF-7 cells. The CHCl/MeOH extract exhibited significant antiulcer activity in both ethanol and acetic acid induced ulcer models in rats, as evidenced by histopathological, histochemical, and biochemical examinations.

Therapeutic effect of low molecular weight chitosan containing sepia ink on ethanol-induced gastric ulcer in rats

ABSTRACT PURPOSE: To evaluate the role of low molecular chitosan containing sepia ink (LMCS) in ethanol-induced (5 ml/kg) gastric ulcer in rats. METHODS: Animals were divided into four groups (n = 12): normal group (Normal), negative control group (Con), experiment group (LMCS) and positive control Omeprazole group (OMZ). Gastric empty rate was detected in the first 7 days. Rats were sacrificed at 7, 14 and 21 day for histology and ELISA detections. RESULTS: Gastric empty was no significant differences among the groups (P > 0.05). Histological observation showed gastric mucosal LMCS treated had better healing effect. Hydroxyproline (Hyp) was significantly increased from 7 day (P < 0.05). LMCS significantly inhibited malondialdehyde (MDA) generation for lipid peroxidation from 7 day (P < 0.05). LMCS significantly promoted the activity of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) at the earlier stage (P < 0.05). OMZ had the similar effects above. As for myeloperoxidase (MPO), LMCS significantly decreased and restored it to normal levels from 7 day (P < 0.05), it is earlier than OMZ which is from 14 day. CONCLUSION: LMCS can improve gastric mucosa tissue repair, exert significant influences on oxidative and antioxidant enzyme activities and neutrophil infiltration.

Recurrence rate of helicobacter pylori in patients with peptic ulcer five years or more after successful eradication / Taxa de reinfecção por Helicobacter pylori em pacientes com úlcera péptica cinco anos após erradicação

ABSTRACT Background Infection with Helicobacter pylori is highly prevalent worldwide, especially in developing countries. Its presence in the gastroduodenal mucosa is related with development of peptic ulcer and other illnesses. The eradication of H. pylori improves mucosal histology in patients with peptic ulcers. Objective This study was aimed to verify if H. pylori recurrence occurs five years or more after confirmed eradication in patients with peptic ulcer. Moreover, we sought to determine the recurrence rate. Methods Retrospective and longitudinal, this study was based on a sample of 201 patients from western Paraná, Brazil. The patients were diagnosed with peptic ulcer disease, in the period of 1990-2000, and followed for five years or more after successful H. pylori eradication. Patients with early recurrence - prior to five years after eradication - were excluded from the sample. Results During an average follow-up of 8 years, 180 patients (89.55%) remained negative, and 21 (10.45%) became positive for H. pylori infection. New ulcers appeared in two-thirds of the patients with H. pylori recurrence. Conclusion The recurrence of H. pylori in patients with peptic ulcer can occur in the long-term - even if the infection had been successfully eradicated and the patients had remained free of recurrence in the first years of follow-up.

RESUMO Contexto A infecção por Helicobacter pylori é altamente prevalente no mundo, especialmente nos países em desenvolvimento, e sua presença na mucosa gastroduodenal está associada com o desenvolvimento de úlcera péptica e outras patologias. A erradicação do H. pylori melhora a histologia da mucosa em pacientes com úlcera péptica. Objetivo Determinar se a recorrência da infecção por H. pylori ocorre cinco anos ou mais após a erradicação confirmada em pacientes com úlcera péptica. Além disso, buscou-se determinar a taxa de recorrência. Método Retrospectivo e longitudinal, o estudo foi baseado em uma amostra de 201 pacientes oriundos da região Oeste do Paraná, Brasil. Os pacientes foram diagnosticados com úlcera gástrica e/ou duodenal, no período de 1990-2000, e foram seguidos por pelo menos cinco anos após a erradicação com sucesso do H. pylori. Pacientes com recorrência precoce - nos primeiros cinco anos após a erradicação - foram excluídos da amostra. Resultados - Após um tempo médio de seguimento de oito anos, 180 pacientes (89,55%) permaneceram negativos e 21 (10,45%) tornaram-se positivos para a presença de H. pylori. Novas úlceras apareceram em dois terços dos pacientes com recorrência da bactéria. Conclusão A recorrência da infecção por H. pylori ocorre em longo prazo - mesmo se a infecção tiver sido erradicada com sucesso e os pacientes permanecido livres de recorrência nos primeiros cinco anos de seguimento.

Descripción del uso de medicamentos gastroprotectores en pacientes con polifarmacia en una población colombiana, a partir de bases de datos transaccionales / Descriptive Analysis of Transactional Database Date on the Use of Gastroprotective Drugs in Patients With Polypharmacy in a Colombian Population

Objetivo: el objetivo de este estudio fue describir y analizar los patrones de prescripción de fármacos antiulcerosos, los factores asociados a su prescripción y su costo en pacientes ambulatorios polimedicados en un período de 6 meses, en una Entidad Promotora de Salud (EPS) colombiana a nivel nacional. Metodología: estudio descriptivo retrospectivo de corte transversal, basado en registros electrónicos de prescripción de medicamentos ambulatorios de 2 458 447 afiliados. Se incluyeron pacientes con prescripción de 5 o más fármacos por mes y se excluyeron aquellos cuyos registros transaccionales no tenían información completa para su análisis. Se evaluó la asociación entre prescripción de fármacos antiulcerosos y factores que justifican su prescripción mediante los odds ratio (OR) calculados a partir de un modelo de regresión logística. Resultados: de 2 458 447 afiliados, 60 671 pacientes estuvieron polimedicados mensualmente; 40% tuvieron fármacos antiulcerosos y 70% fármacos gastrolesivos. De los gastroprotegidos, 47% fueron adultos mayores y 12% tuvieron asociado diagnóstico de riesgo gastrointestinal superior. Gastroprotección no justificada en 35% de los pacientes polimedicados, representando $75 millones de pesos colombianos (COP) mensuales. No hubo asociación estadística entre la prescripción de antiulcerosos y factores que justifiquen su prescripción (OR: 1,13; IC 95%: 1,00-1,27). Conclusión: ante la falta de asociación entre la prescripción de fármacos antiulcerosos y los factores que la justifican, es probable que su prescripción se haya realizado por la polifarmacia per se. Se recomienda optimizar la gastroprotección y reservarla a pacientes con más de un gastrolesivo y riesgo gastrointestinal superior, estén estos polimedicados o no.

Objective: The objective of this study was to describe and analyze patterns of use of prescription ulcer drugs, factors associated with prescriptions by physicians, and costs for outpatients With polypharmacy at a Colombian healthcare promotion entity (EPS) over a six-month period. Methodology: This is a retrospective and descriptive cross-sectional study based on electronic records of drugs prescribed to 2,458,447 outpatient members. Patients who took five or more prescription drugs per month were included. Patient were excluded if their records in the transactional data were not complete enough for analysis. Associations between anti-ulcer drugs and factors justifying their prescription were evaluated by the odds ratio (OR) which was calculated from a logistic regression model. Results: Of the 2,458,447 affiliates of the EPS, on average 60,671 patients had polypharmacy each month: 40% used anti-ulcer drugs and 70% used gastro-damaging drugs. Of the gastroprotected patients, 47% were elderly and 12% had associated diagnoses of upper gastrointestinal risk. Gastroprotection was not justified in 35% of patients with polypharmacy. This represents 75 million Colombian pesos every month. There was no statistical association between prescription of anti-ulcer drugs and factors that justify their prescription (OR: 1.13; 95% CI: 1.00 to 1.27). Conclusion: Given the lack of association between prescription of anti-ulcer drugs and factors which justify such prescriptions, it is likely that prescriptions contribute to polypharmacy per se. We recommended optimizing gastroprotection by reserving it for patients with more than one gastrointestinal lesion and with upper gastrointestinal risks whether or not they have polypharmacy.

Efficacy of a quadruple therapy regimen for Helicobacter pylori eradication after partial gastrectomy

We aimed to evaluate the effectiveness and safety of bismuth-containing quadruple therapy plus postural change after dosing for Helicobacter pylori eradication in gastrectomized patients. We compared 76 gastric stump patients with H. pylori infection (GS group) with 50 non-gastrectomized H. pylori-positive patients who met the treatment indication (controls). The GS group was divided into GS group 1 and GS group 2. All groups were administered bismuth potassium citrate (220 mg), esomeprazole (20 mg), amoxicillin (1.0 g), and furazolidone (100 mg) twice daily for 14 days. GS group 1 maintained a left lateral horizontal position for 30 min after dosing. H. pylori was detected using rapid urease testing and histologic examination of gastric mucosa before and 3 months after therapy. Mucosal histologic manifestations were evaluated using visual analog scales of the updated Sydney System. GS group 1 had a higher prevalence of eradication than the GS group 2 (intention-to-treat [ITT]: P=0.025; per-protocol [PP]: P=0.030), and the control group had a similar prevalence. GS group 2 had a lower prevalence of eradication than controls (ITT: P=0.006; PP: P=0.626). Scores for chronic inflammation and activity declined significantly (P<0.001) 3 months after treatment, whereas those for atrophy and intestinal metaplasia showed no significant change. Prevalence of adverse reactions was similar among groups during therapy (P=0.939). A bismuth-containing quadruple therapy regimen plus postural change after dosing appears to be a relatively safe, effective, economical, and practical method for H. pylori eradication in gastrectomized patients.