The role of losartan and enalapril in the protection against stress-induced gastric mucosal ulceration in rats

Background: Angiotensin II (ANG II) is a stress hormone and its level dramatically increases in the stomach during stress. In addition, it generates reactive oxygen species (ROS) with cellular damage and inflammation. So the aim of this study is to evaluate the mechanism of losartan and enalapril in the prevention of stress-induced gastric ulcer through their action on mucosal prostaglandin (PGs) and antioxidant enzymes and compare between them.Methods: Thirty- six adult male wistar albino rats weighing 180-200 g were divided into 6 groups; n= 6. Groups 1, 2, and 3 were received saline (normal control), losartan (3 mg/kg/day) and enalapril (10 mg/kg/day) i.p respectively for 4 weeks. Groups 4, 5, and 6 were pretreated with saline (ulcer control), losartan (3 mg/kg/day) and enalapril (10 mg/kg/day) i.p respectively for 4 weeks duration. On 29th day, group 4, 5 and 6 were submitted to gastric ulcer by water immersion method, then animals of all groups were sacrificed, stomachs were excised for gross and microscopic examination and determination of the mucosal levels of prostaglandin E2 (PGE2), superoxide dismutase (SOD), nitric oxide (NO) and catalase (CAT).Results: Stress produced gastric ulcer and a significant decrease in all measured gastric parameters compared to normal control group. Pre-treatment of rats with losartan or enalapril decreased the stress-induced alterations in mucosal parameters, but only losartan caused a significant increase in CAT activity in addition.Conclusions: Antagonize the action of ANG II by losartan and enalapril have preventive advantages in stress-induced gastric ulcer and losartan has better influence as it has an additional effect on CAT activity

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

39-45 versus Enalapril in the Protection of the Gastric Mucosa against Aspirin-Induced Gastric Mucosal Injury in Rats

Abstract Different mechanisms have been suggested for the development of nonsteroidal anti-inflammatory drugs (NSAIDs) induced gastropathy. Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) have been suggested to have gastroprotective effects, sothe present work aims to elucidate the protective effect of the renin-angiotensin system (RAS) inhibitors through their effect on prostaglandins (PGs) and oxidative stress against peptic ulcer induced by aspirin in rats and to compare the efficacy of ACEIs and ARBs in the treatment of peptic ulcer. Thirty-six adult male Wistar rats weighing 180-200 g were randomly divided into 6 groups, 6 animals each. Groups 1, 2, and 3 were received saline (normal control), losartan (3mg/kg/day) and enalapril (10 mg/kg/day) i.p respectively for 4 weeks. Groups 4, 5, and 6 were pretreated with saline (aspirin group), losartan (3mg/kg/day) and enalapril (10 mg/kg/day) i.p respectively for 4 weeks duration. On 29 th day, rats of group 4, 5 and 6 were submitted to gastric ulcer by single oral administration of 300 mg/kg aspirin then animals of all groups were sacrificed, stomachs were excised for gross and microscopic examination and determination of the mucosal levels of prostaglandin E 2 (PGE 2 ), superoxide dismutase (SOD), nitric oxide (NO) and catalase (CAT).Treatment of rats with aspirin produced a significant decrease in gastric PGE 2 , SOD, NO, and CAT levels and produced deep gastric ulcer compared to normal control group. Pretreatment of rats with losartan or enalapril decreased the aspirin-induced alterations in gastric PGE 2 .SOD and NO levels, but only losartan caused a significant increase in CAT activity while enalapril caused an insignificant increase. Also, pretreatment with losartan or enalapril ameliorated the severe deep gastric ulcer induced by aspirin to shallow erosions and inflamed gastric mucosa compared to changes in the aspirin group.In conclusions, the prophylactic use of losartan and enalapril ameliorated aspirin-induced gastric ulcer, but losartan has better influence as it has an additional effect on CAT

The role of losartan and enalapril in the protection against stress-induced gastric mucosal ulceration in rats

Background: Angiotensin II (ANG II) is a stress hormone and its level dramatically increases in the stomach during stress. In addition, it generates reactive oxygen species (ROS) with cellular damage and inflammation. So the aim of this study is to evaluate the mechanism of losartan and enalapril in the prevention of stress-induced gastric ulcer through their action on mucosal prostaglandin (PGs) and antioxidant enzymes and compare between them.Methods: Thirty- six adult male wistar albino rats weighing 180-200 g were divided into 6 groups; n= 6. Groups 1, 2, and 3 were received saline (normal control), losartan (3 mg/kg/day) and enalapril (10 mg/kg/day) i.p respectively for 4 weeks. Groups 4, 5, and 6 were pretreated with saline (ulcer control), losartan (3 mg/kg/day) and enalapril (10 mg/kg/day) i.p respectively for 4 weeks duration. On 29th day, group 4, 5 and 6 were submitted to gastric ulcer by water immersion method, then animals of all groups were sacrificed, stomachs were excised for gross and microscopic examination and determination of the mucosal levels of prostaglandin E2 (PGE2), superoxide dismutase (SOD), nitric oxide (NO) and catalase (CAT).Results: Stress produced gastric ulcer and a significant decrease in all measured gastric parameters compared to normal control group. Pre-treatment of rats with losartan or enalapril decreased the stress-induced alterations in mucosal parameters, but only losartan caused a significant increase in CAT activity in addition.Conclusions: Antagonize the action of ANG II by losartan and enalapril have preventive advantages in stress-induced gastric ulcer and losartan has better influence as it has an additional effect on CAT activity