The effect of aspirin on neurodeficit and platelet aggregability in acute ischemic cerebral strokes.

We examined the role of aspirin in modifying platelet aggregability (PA) and neurodeficit (ND) in patients presenting within 48 hours of acute ischemic cerebral strokes of the carotid territory. 28 adult patients were studied at baseline and after 7 days of treatment with a single daily dose of aspirin 325mg (group A, n = 12) and 160 mg (Group B, n = 16). We also evaluated the neurologic outcome at the beginning and at the end of 7 days using a scoring system. There was no significant difference in the ND scores and in vitro PA between these two groups. PA, as measured in vitro, does not appear to have any significant role as a predictor of neurologic outcome in acute ischemic strokes. The change in ND scores of patients with ischemic cerebral strokes treated acutely with aspirin was not significant upto first 7 days therapy.

Gastric colonization and pneumonia in intubated critically ill patients receiving stress ulcer prophylaxis: a randomized, controlled trial.

OBJECTIVE: To study the effects of pharmacologically increasing gastric pH on gastric colonization and the development of pneumonia in intubated critically ill patients. DESIGN: Randomized, controlled trial. SETTING: Medical ICU in a university hospital. PATIENTS: Thirty-four tracheotomized patients with tetanus. INTERVENTIONS: Sixteen patients received iv ranitidine to increase gastric pH greater than 4 (ranitidine group), while 18 patients received no prophylaxis for upper gastrointestinal bleeding (control group). MEASUREMENTS AND MAIN RESULTS: Mean gastric pH was higher in the ranitidine group (median 4.7, range 3.6 to 6.1) than in the control group (median 2.1, range 1.2 to 4.9; p less than .05). Gastric colonization occurred in 15 (94%) of 16 patients who received ranitidine, 2 days (median; range 1 to 5) after intubation; gastric colonization also occurred in all control patients (median 4 days, range 1 to 9; p less than .05). Pneumonia occurred in 13 (81%) of 16 patients who received ranitidine, 3 days (median, range 1 to 5) after intubation and in nine (50%) of 18 control patients (p less than .01) 5 days after tracheal intubation (median, range 3 to 14; p less than .01). Prior gastric colonization by the pathogen that caused pneumonia was demonstrable in nine (56%) of 16 patients who received ranitidine vs. eight (44%) of 18 control patients (p greater than .05). The risk for developing pneumonia in the ranitidine-treated group was highest in the first 4 days after tracheal intubation. There was no difference in the frequency of upper gastrointestinal hemorrhage in the two groups. CONCLUSIONS: Pharmacologically increasing gastric pH increases the risk for developing pneumonia in intubated critically ill patients. The pneumonia occurs earlier than in untreated control patients.