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.

Adesão a um protocolo de profilaxia de úlcera de estresse em pacientes críticos: estudo de coorte prospectiva / Adherence to a stress ulcer prophylaxis protocol by critically ill patients: a prospective cohort study

RESUMO Objetivo: Avaliar a adesão ao protocolo de profilaxia de úlcera de estresse em pacientes críticos de um hospital universitário terciário. Métodos: Neste estudo de coorte prospectiva, incluímos todos os pacientes adultos admitidos às unidades de terapia intensiva clínica e cirúrgica de um hospital terciário acadêmico. Nosso único critério de exclusão foi a presença de sangramento gastrointestinal alto quando da admissão à unidade de terapia intensiva. Colhemos as variáveis basais e indicações de profilaxia de úlcera de estresse, segundo o protocolo institucional, assim como o uso de profilaxia. Nosso desfecho primário foi a adesão ao protocolo de profilaxia de úlcera de estresse. Os desfechos secundários foram uso apropriado da profilaxia de úlcera de estresse, incidência de sangramento gastrointestinal superior e fatores associados com o uso apropriado da profilaxia de úlcera de estresse. Resultados: Foram incluídos 234 pacientes no período compreendido entre 2 de julho e 31 de julho de 2018. Os pacientes tinham idade de 52 ± 20 anos, sendo 125 (53%) deles cirúrgicos, e o SAPS 3 médio foi de 52 ± 20. No seguimento longitudinal, foram estudados 1.499 pacientes-dias; 1.069 pacientes-dias tiveram indicação de profilaxia de úlcera de estresse, e 777 pacientes-dias tiveram uso profilático (73% de adesão ao protocolo de profilaxia de úlcera de estresse). Dentre os 430 pacientes-dias sem indicações de profilaxia de úlcera de estresse, 242 envolveram profilaxia (56% de uso impróprio de profilaxia de úlcera de estresse). O total de uso apropriado de profilaxia de úlcera de estresse foi de 64%. Fatores associados com prescrição adequada de profilaxia de úlcera de estresse foram ventilação mecânica, com RC 2,13 (IC95% 1,64 - 2,75), e coagulopatia, com RC 2,77 (IC95% 1,66 - 4,60). A incidência de sangramento do trato gastrointestinal superior foi de 12,8%. Conclusão: A adesão ao protocolo de profilaxia de úlcera de estresse foi baixa, e o uso inadequado de profilaxia de úlcera de estresse foi frequente nesta coorte de pacientes críticos.

ABSTRACT Objective: To evaluate adherence to the stress ulcer prophylaxis protocol in critically ill patients at a tertiary university hospital. Methods: In this prospective cohort study, we included all adult patients admitted to the medical and surgical intensive care units of an academic tertiary hospital. Our sole exclusion criterion was upper gastrointestinal bleeding at intensive care unit admission. We collected baseline variables and stress ulcer prophylaxis indications according to the institutional protocol and use of prophylaxis. Our primary outcome was adherence to the stress ulcer prophylaxis protocol. Secondary outcomes were appropriate use of stress ulcer prophylaxis, upper gastrointestinal bleeding incidence and factors associated with appropriate use of stress ulcer prophylaxis. Results: Two hundred thirty-four patients were enrolled from July 2nd through July 31st, 2018. Patients were 52 ± 20 years old, 125 (53%) were surgical patients, and the mean SAPS 3 was 52 ± 20. In the longitudinal follow-up, 1499 patient-days were studied; 1069 patient-days had stress ulcer prophylaxis indications, and 777 patient-days contained prophylaxis use (73% stress ulcer prophylaxis protocol adherence). Of the 430 patient-days without stress ulcer prophylaxis indications, 242 involved prophylaxis (56% inappropriate stress ulcer prophylaxis use). The overall appropriate use of stress ulcer prophylaxis was 64%. Factors associated with proper stress ulcer prophylaxis prescription were mechanical ventilation OR 2.13 (95%CI 1.64 - 2.75) and coagulopathy OR 2.77 (95%CI 1.66 - 4.60). The upper gastrointestinal bleeding incidence was 12.8%. Conclusion: Adherence to the stress ulcer prophylaxis protocol was low and inappropriate use of stress ulcer prophylaxis was frequent in this cohort of critically ill patients.

The contrastive study of the short-term efficacy of compound gargle solution chlorhexidine giuconatie and kangfuxin liquid in treatment of recurrent aphthous ulcer / 中国医师杂志

Objective To investigate the short-term efficacy of compound gargle solution chlorhexidine giuconatie and kangfuxin liquid in treatment of recurrent aphthous ulcer (RAU).Methods Eighty patients clinically diagnosed with RAU were chosen and randomly divided into two groups.Test group 1 (40 cases) and Test group 2 (40 cases) were treated with compound gargle solution chlorhexidine giuconatie and kangfuxin liquid respectively until ulcer has been healed completely to evaluate the difference of two groups in clinical efficacy.Return visit and follow-up visit were conducted 7 days and 30 days after the initial treatment,respectively.Results The analgesic onset time of Test group 1 [(6.24 ± 1.09) min] was shorter than that of Test group 2 [(8.62 ± 1.04) min],with statistically significant difference (P ＜ 0.01).The analgesic maintenance time of Test group 1 [(29.47 ± 3.45) min] was longer than that of Test group 2 [(21.61 ±2.18) min],with statistically significant difference (all P ＜ 0.01).The duration of ulcer of Test groups 1 and 2 was (5.97-± 0.87)days and (4.76 ± 1.14)days,with statistically significant difference (P ＜0.01).Conclusions Compound gargle solution chlorhexidine giuconatie and kangfuxin liquid both have a certain level of clinical efficacy for RAU,with the former featuring shorter analgesic onset time and longer duration and the latter advantageous in promoting RAU healing short-term usage of compound gargle solution chlorhexidine giuconatie and kangfuxin liquid cannot prolong RAU dormancy.

The contrastive study of the short-term efficacy of compound gargle solution chlorhexidine giuconatie and kangfuxin liquid in treatment of recurrent aphthous ulcer / 中国医师杂志

Objective To investigate the short-term efficacy of compound gargle solution chlorhexidine giuconatie and kangfuxin liquid in treatment of recurrent aphthous ulcer (RAU).Methods Eighty patients clinically diagnosed with RAU were chosen and randomly divided into two groups.Test group 1 (40 cases) and Test group 2 (40 cases) were treated with compound gargle solution chlorhexidine giuconatie and kangfuxin liquid respectively until ulcer has been healed completely to evaluate the difference of two groups in clinical efficacy.Return visit and follow-up visit were conducted 7 days and 30 days after the initial treatment,respectively.Results The analgesic onset time of Test group 1 [(6.24 ± 1.09) min] was shorter than that of Test group 2 [(8.62 ± 1.04) min],with statistically significant difference (P ＜ 0.01).The analgesic maintenance time of Test group 1 [(29.47 ± 3.45) min] was longer than that of Test group 2 [(21.61 ±2.18) min],with statistically significant difference (all P ＜ 0.01).The duration of ulcer of Test groups 1 and 2 was (5.97-± 0.87)days and (4.76 ± 1.14)days,with statistically significant difference (P ＜0.01).Conclusions Compound gargle solution chlorhexidine giuconatie and kangfuxin liquid both have a certain level of clinical efficacy for RAU,with the former featuring shorter analgesic onset time and longer duration and the latter advantageous in promoting RAU healing short-term usage of compound gargle solution chlorhexidine giuconatie and kangfuxin liquid cannot prolong RAU dormancy.

Analysis of therapeutic effect ofShengji-Yuhong ointment in the treatment of patients with pressure ulcer / 国际中医中药杂志

Objective To analyze the therapeutic effect ofShengji-Yuhong ointment in the treatment of patients with pressure ulcer.Methods 86 patients of pressure ulcer were randomly divided into a control group and an observation group, with 43 cases in each. After debridement, the wound was covered with vaseline gauze in the control group, whileShengji-Yuhong ointment in the treatment group. 10 days constituted 1 course of treatment, and both groups were treated for 3 courses. The blood supply of the whole blood viscosity, plasma viscosity, erythrocyte aggregation index detection; white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP) were observed in order to observe the control condition of the patients with wound infection.Results The total effective rate was 95.3% (41/43) and 74.4% (32/43) in the observation group and control group respectively, with significant difference between two groups (χ2=5.800,P=0.016). After treatment, the whole blood viscosity (high-shea) (4.06 ± 1.38 mPa?svs. 4.74 ± 1.62 mPa?s,t=2.095), the whole blood viscosity (medium-shea) (3.71 ± 1.22 mPa?svs. 4.34 ± 1.41 mPa?s,t =2.216), blood reduction viscosity (1.13 ± 0.22 mPa?svs.1.44 ± 0.51 mPa?s,t=3.660), the whole blood viscosity (medium-shea) (4.16 ± 0.48 mPa?svs. 4.51 ± 0.89 mPa?s,t=2.270) obviously compared with group before treatment decreased (P<0.05). The patients in the observation group in the whole blood viscosity (medium-shea) (3.71 ± 1.22 mPa?svs. 4.16 ± 0.48 mPa?s,t=2.251), and blood reduction viscosity (1.13 ± 0.22 mPa?svs. 1.32 + 0.31 mPa?s,t=3.278) in the observation group were  obvious better than the control group (P<0.05). After the treatment the WBC, CRP, ESR in the observation group were decreased significantly than the control group (t=5.947, 7.198, 12.064,P<0.01).ConclusionShengji-Yuhong ointment can effectively control the PU infection in the wound, improve wound tissue under the blood circulation, and promote wound healing.

Revisión narrativa de la literatura sobre manejo con medicina homeopàtica de pacientes con síntomas de gastritis / Narrative review of the literature on management with homeopathic medicine of patients with symptoms of gastritis

Las enfermedades del aparato digestivo son frecuentes y en ocasiones incapacitantes para la vida diaria y laboral. Dentro de ellas la gastritis es una de las que más incidencia tiene en el mundo entero. En gran parte de los casos la gastritis está acompañada de la infección por Helicobacter Pylori, bacteria que está relacionada con el cáncer de estómago. Los tratamientos que actualmente se llevan a cabo en la medicina tradicional, además de que son muy agresivos, todavía dejan muchas dudas sobre sus efectos secundarios y los daños que pueden llegar a provocar en el organismo, dentro de ellos el cáncer. Por eso mismo se ha visto el incremento en la utilización de las terapias alternativas para el manejo de la gastritis, dentro de ellas la homeopatía, la cual ha tenido una muy buena aceptación y resultados, pero desafortunadamente, todos estos avances no están lo suficientemente documentados. Para la realización de éste trabajo primero se hizo una Revisión Narrativa de la Literatura existente en los últimos 20 años, encontrando en las bases de datos que algunos remedios homeopáticos han demostrado resultados favorables en el manejo de la gastritis y tienen publicaciones muy interesantes en la literatura, pero la gran mayoría de remedios sólo se encuentran relacionados en las materias médicas. Sin embargo, este trabajo logró establecer los medicamentos homeopáticos útiles en la gastritis basándose en los síntomas que reportan las principales Medicinas Internas conocidas, como son las de: Harrison, Cecil y Farreras. Tomando éstos síntomas se pasaron al lenguaje repertorial homeopático, luego se realizó un ejercicio repertorial que nos revela varios remedios policrestos muy valiosos para el manejo de los síntomas de la gastritis. Además se realizó otra repertorización buscando sólo remedios pequeños, que nos pone delante de los ojos, opciones medicamentosas muy útiles que probablemente nunca habríamos pensado. Dentro de los remedios policrestos y semipolicrestos que se encontró tenían la mejor cobertura de síntomas de gastritis están: Arsenicum álbum, Nux vómica, Sulphuricumacidum, Sulphur, Magnesia carbónica, Lycopodium, KaliBichromicum, Iris Versicolor, Graphites, Crocus sativa, Carbovegetabilis, ArgentumNitricum, Bismuthum, Anacardiumorientale, Phosphorus, Plumbummetallicum, Bryonia, NatrumMuriaticum, Lachesis, China officinalis y Pulsatilla. Dentro de los pequeños remedios se encontraron en los primeros 5 lugares: ArsenicumIodatum, Tabacum, SecaleCornutum, FerrumPhosphoricum y Oxalicumacidum; los cuales son incluidos en la tabla de resultados de medicamentos para gastritis, junto con los policrestos y otros remedios de gran valor en el manejo de la gastritis. Este trabajo será de gran ayuda y motivación especialmente para los médicos que trabajamos con la homeopatía, para seguir publicando cada vez con mayor dedicación y detalle con el fin de dar a conocer todas las maravillas que la homeopatía nos demuestra día a día.

Interacciones en el uso de antiácidos, protectores de la mucosa y antisecretores gástricos / Interactions in the use of antacids, mucosal protective and gastric antisecretory drugs

Dada la frecuencia de la asociación de fármacos para el tratamiento de distintas enfermedades, se hace necesario considerar las situaciones que se derivan de la administración simultánea de medicamentos. Hoy día se reconoce la existencia de una variedad de interacciones farmacológicas que se presentan por distintos mecanismos. Por ello es importante que los profesionales de Enfermería realicen una monitorización permanente, que permita evaluar los objetivos terapéuticos trazados para prevenir aparición de reacciones adversas a medicamentos y/o toxicidad, así como el fallo terapéutico. En este sentido, el objetivo de esta revisión fue describir las principales interacciones farmacológicas que ocurren con la administración de antiácidos, protectores de la mucosa y antisecretores gástricos, las consecuencias clínicas que se derivan de estas y algunas recomendaciones para el uso de tales medicamentos. El compromiso de Enfermería y de los profesionales de la salud debe orientarse hacia el empoderamiento del conocimiento de esta temática, para enfrentar con responsabilidad la vigilancia de la terapéutica en relación con su seguridad y efectividad, reconociendo que hay muchas interacciones que se desconocen y que ocurrirán en la medida en que aparecen nuevos principios activos. Asimismo, resulta relevante considerar el impacto clínico que origina el uso de los antiácidos, protectores de la mucosa gástrica y antisecretores.

Due to the frequency of the association of drugs for the treatment of various diseases, it is necessary to consider situations arising from the simultaneous administration of drugs. Nowadays, is recognized the existence of a variety of drug interactions that occur by different mechanisms. Therefore, it is important that Nursing Professionals perform continuous monitoring to assess the therapeutic goals set, in order to prevent Adverse Drug Reactions and/or toxicity and Therapeutic Failure. For that reason, the aim of this reviewing is to present the major drug interactions that occur with the administration of antacids, mucosal protective agents, gastric antisecretory and its consequences. The compromise of Nursing and Health Care Professionals, should go towards empowerment of knowledge of this topic, in order to deal with responsibility, the monitoring of therapeutic safety and effectiveness, recognizing that there are many unknown pharmacological interactions that will occur as soon as the new active ingredient appears. At the same time, it is important to consider the clinical impact that produces the use of antacids, gastric mucosal protective and antisecretory drugs.

Evaluation of antiulcerogenic activity of aqueous extract of Brassica oleracea var. capitata (cabbage) on Wistar rat gastric ulceration / Avaliação da atividade antiúlcera do extrato aquoso de Brassica oleracea var. capitata (repolho) em úlceras gástricas de ratos Wistar

CONTEXT: The cabbage (Brassica oleraceae var. capitata) is an herbaceous and leafy plant which belongs to the Brassicaceae family, native to coastal southern and Western Europe. Used in cooking for its nutritional value also has known anti-inflammatory activity. OBJECTIVE We studied the antiulcerogenic activity of aqueous extract of Brassica oleracea var. capitata (AEB) in order to validate ethnobotanical claims regarding the plant use in the gastric disorders. METHOD: Acute gastric ulcers were induced in rats by the oral administration of acetylsalicylic acid. The gastroprotective potential of the AEB (0.250, 0.500 and 1.000 mg.kg-1/body weight) was compared with omeprazole (20 mg.kg-1/body weight). RESULTS: The stomach analysis indicated that treatment with AEB inhibited the gastric damage. The gastroprotective activity as evidenced by its significant inhibition in the formation of ulcers induced by chemical agent with a maximum of 99.44 percent curation (250 mg.kg-1 body weight) in acetylsalicylic acid-induced ulcers. CONCLUSIONS: The AEB demonstrated good antiulcerogenic activities which justify the inclusion of this plant in the management of gastric disorders. Further experiments are underway to determine which antiulcer mechanisms involved in gastroprotection.

CONTEXTO: O repolho (Brassica oleracea var. capitata) é uma planta de folhas herbáceas pertencente à família Brassicaceae, nativa na costa sul e oeste da Europa. Usado na culinária por seu valor nutritivo, possui conhecida atividade anti-inflamatória. OBJETIVO: Avaliar a atividade antiulcerogênica do extrato aquoso de Brassica oleracea var. capitata (AEB), a fim de validar os conhecimentos etnobotânico do uso da espécie em distúrbios gástricos. MÉTODO: Úlceras gástricas foram induzidas em ratos pela administração oral de ácido acetilsalicílico. O potencial gastroprotetor de AEB (0,250, 0,500 e 1,000 mg.kg-1/peso) foram comparados com omeprazol (20 mg.kg-1/peso). RESULTADOS: As análises dos estômagos indicaram que o tratamento com AEB inibiu a progressão da lesão gástrica. A atividade gastroprotetora foi evidenciada por sua significativa inibição da progressão da úlcera induzida por agentes químicos, com o máximo de 99,44 por cento eficácia (250 mg.kg-1/peso) frente a úlceras gástricas induzidas por ácido acetilsalicílico. CONCLUSÕES: O AEB demonstrou atividade cicatrizante de úlceras gástricas, o que justifica a inclusão da espécie em tratamentos de distúrbios gástricos. Estudos futuros estão em andamento para determinar quais os mecanismos antiulcerogêncios estão envolvidos com a gastroproteção.

Efecto antiulceroso del extracto hidroalcohólico liofilizado de hojas de Bixa orellana (achiote), en ratas / Antiulcer effect of lyophilized hydroalcoholic extract of Bixa orellana (annatto) leaves in rats

Objetivo: Identificar los metabolitos secundarios presentes en el extracto hojas de Bixa orellana, evaluar el grado de protección del extracto frente a la injuria con etanol y estudio histopatológico de la región glandular del estómago. Diseño: Estudio prospectivo experimental. Institución: Centro de Investigación de Bioquímicay Nutrición Alberto Guzmán Barrón, Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Material biológico: Extracto de hojas de Bixa orellana y ratas albinas machos adultos. Intervenciones: Se analizó los metabolitos secundarios del extracto, mediante los reactivos específicos. Para la evaluación del efecto antiulceroso, se aplicó la técnica propuesta por Robert 1979, a dosis de extracto de 200 y 400mg/kg. Se provocó la injuria con alcohol al 96 por ciento. La evaluación macroscópica fue mediante la escala de Marhuenda. Los tejidos fueron conservados en formol al 10 por ciento, para su estudio histopatológico por tinción hematoxilina-eosina. Principales medidas de resultados: Inhibición de las lesiones gástricas. Resultados: El extracto hidroalcohólico de hojas de Bixa orellana tiene compuestos fenólicos, tales como flavonoides y taninos, terpenos y alcaloides. El tratamiento con el extracto produjo una inhibición de las lesiones gástricas en 21,7 por ciento y 28,3 por ciento, respectivamente (p menor que 0,01). En el estudio histológico, se encontró mayor protección y menor migración de células proinflamatorias en los grupos que recibieron el extracto a 200 y 400 mg/kg. Sin embargo, los grupos controles y los que recibieron ranitidina presentaron grados de lesión considerable y un mayor incremento de migración de células proinflamatorias.Conclusiones: El extracto hidroalcohólico de Bixa orellana presenta un efecto gastroprotector antiulceroso frente a la injuria con etanol al 96 por ciento, tanto a nivelmacroscópico como microscópico.

Objective: To identify the secondary metabolites present in Bixa orellanaleaves extract, to evaluate the extract protection against ethanol injury, andhistopathology study of the stomach glandular region. Design: Prospective,experimental and analytical research. Setting: Biochemistry and NutritionResearch Center laboratories, Universidad Nacional Mayor de San Marcos. Biological material: Bixa orellana leaves extract and male albino rats. Interventions: Secondary metabolites from the extract were analyzed using identification chemical tests. For evaluation of the gastro-protective effect proposed by Robert 1979 the extract was used at 200 and 400 mg/kg doses, and for macroscopic evaluation Marhuenda scale was employed. Tissues were preserved in 10 per cent formaldehyde for histopathology examination by hematoxylineosin staining. Main outcome measures: Gastric lesions inhibition. Results: Bixa orellana leaves hydroalcoholic extract has phenolic compounds such as flavonoids and tannins, terpenes and alkaloids. Treatment with 200 and 400 mg/kg extract doses produced gastric lesions inhibition in respectively 21,7 per centand 28,3 per cent (p minor that 0,01). By histology, there was bigger protection and reduced migration of proinflammatory cells in the groups receiving 200 and 400 mg/kgextract. Control groups and those receiving ranitidine showed considerablelesion degrees and increased proinflammatory cells migration. Conclusions: Bixa orellana leaves hydroalcoholic extract produced gastroprotective effect againstinjury with 96 per cent ethanol at both macroscopic and microscopic levels.