Mortality study of 18 000 patients treated with omeprazole.

Background: The long term safety of potent gastric acid suppressive therapy has yet to be established. Method: General practice record review at a median interval of 26 months followed by retrieval of details of all deaths within four years using the UK National Health Service Central Registers in 17 936 patients prescribed omeprazole in 1993–1995. Death rates were compared with general population rates. Results: Records of 17 489 patients (97.5%) were examined. A total of 12 703 patients received further scripts for antisecretory drugs, 8097 for omeprazole only (65.6%): 3097 patients have died. All cause mortality was higher in the first year (observed/expected (O/E) 1.44 (95% confidence intervals (CI) 1.34–1.55); p<0.0001) but had fallen to population expectation by the fourth year. There were significant mortality increases in the first year, falling to or below population expectation by the fourth year, for deaths ascribed to neoplasms (1.82 (95% CI 1.58–2.08); p<0.0001), circulatory diseases (1.27 (95% CI 1.13–1.43); p<0.0001), and respiratory diseases (1.37 (95% CI 1.12–1.64); p<0.001). Increased mortality ascribed to digestive diseases (2.56 (95% CI 1.87–3.43); p<0.0001) persisted, although reduced. Increased mortality rates for cancers of the stomach (4.06 (95% CI 2.60–6.04); p<0.0001), colon and rectum (1.40 (95% CI 0.84–2.18); p=0.075), and trachea, bronchus, and lung (1.64 (95% CI 1.19–2.19); p<0.01) seen in the first year had disappeared by the fourth year but that for cancer of the oesophagus had not (O/E 7.35 (95% CI 5.20–10.09) (p<0.0001) in year 1; 2.88 (95% CI 1.62–4.79) (p<0.001) in year 4). Forty of 78 patients dying of oesophageal cancer had the disease present at registration. Twenty seven of those remaining cases had clinical evidence of Barrett’s disease, stricture, ulcer, or oesophagitis at registration (O/E 3.30 (95% CI 2.17–4.80)). Six deaths occurred in patients with hiatal hernia or reflux only (O/E 1.02 (95% CI 0.37–2.22)) and five in patients without oesophageal disease (O/E 0.77 (95% CI 0.25–1.80)). No relationships were detected with numbers of omeprazole scripts received. Conclusions: Increases in mortality associated with treatment are due to pre- existing illness, including pre-existing severe oesophageal disease. There was no evidence of an increased risk of oesophageal adenocarcinoma in those without oesophageal mucosal damage recorded at registration

Analytical Solution of Two-Dimensional Scarf II Model by Means of SUSY Methods

New two-dimensional quantum model - the generalization of the Scarf II - is completely solved analytically for the integer values of parameter. This model being not amenable to conventional procedure of separation of variables is solved by recently proposed method of supersymmetrical separation. The latter is based on two constituents of SUSY Quantum Mechanics: the intertwining relations with second order supercharges and the property of shape invariance. As a result, all energies of bound states were found, and the analytical expressions for corresponding wave functions were obtained.Comment: 18 pages; two misprints were improve

A single fast radio burst localized to a massive galaxy at cosmological distance

Fast radio bursts (FRBs) are brief radio emissions from distant astronomical sources. Some are known to repeat, but most are single bursts. Nonrepeating FRB observations have had insufficient positional accuracy to localize them to an individual host galaxy. We report the interferometric localization of the single-pulse FRB 180924 to a position 4 kiloparsecs from the center of a luminous galaxy at redshift 0.3214. The burst has not been observed to repeat. The properties of the burst and its host are markedly different from those of the only other accurately localized FRB source. The integrated electron column density along the line of sight closely matches models of the intergalactic medium, indicating that some FRBs are clean probes of the baryonic component of the cosmic web

Blue-green algae (Cyanobacteria) in inland and inshore waters: assessment and minimumisation of risks to public health. Revised guidance

This is the first revision of the guidance document under the same title that was published by the Scottish Executive Health Department in 2002. The approach advocated for managing the risks to human and animal health of exposure to blue-green algal toxins continues to centre on production and implementation of “Local Action Plans”. These should be co-ordinated by the NHS Boards in Scotland and should be agreed by the various stakeholders identified herein. This document includes guidance on the content and structure of these Local Action Plans and should be regarded as a resource to assist in their production, as well as fulfilling the requirements of Article8 (Cyanobacterial risks)of the Bathing Waters Directive(2006/7/EC). The Scottish Executive Health Department (SEHD) proposes to review and, if necessary, reissue this guidance document every five years. However, it is recognized that the value of this guidance lies in its practical implementation. The SEHD would therefore welcome feedback, which should be addressed to the SEHD’s Scientific Adviser at St Andrew‘s House, Edinburgh EH13DG. Should this feedback indicate a specific need, then a further version of this guidance will be produced sooner

Prescribing of anti-epileptic drugs in the northern and Yorkshire region: 1992–1995

Epilepsy is a condition for which regular drug treatment is normally prescribed. We have examined the primary care prescribing rates for anti-epileptic drugs (AEDs) in a region of northern England with a population of 6.8 million. Over the 4-year period 1992–1995 the number of AED prescription items issued rose by 15%. A third of this rise is accounted for by increased prescribing of the new anticonvulsants, vigabatrin, lamotrigine and gabapentin, which are primarily indicated for adjunct use. Prescribing of phenytoin and barbiturates fell over the same period, but this reduction was more than compensated for by increased prescribing of carbamazepine and sodium valproate. There were notable differences in both the overall volume and the choice of AEDs used in different health authority areas and these are probably attributable to the influence of the local secondary-care sector on the therapeutic regimens adopted by general practitioners in the area

Acute renal toxicity and its detection by the Yellow card reporting scheme

Paper presented at the United Kingdom Clinical Pharmacy Association (UKCPA) autumn symposium, Hinckley, 18-20 Nov 2011 (Oral Communication OC 4). The aim of this study was to describe frequency and profile of reporters of yellow card (YC) reports for renal toxicities in Scotland and the UK, and to identify which drugs are reported and at what frequency and to identify risk factors for drug induced renal toxicity. Data were obtained through a retrospective analysis of the UK YC database from 2002 to 2006 using specified renal urinary Medical Dictionary of Regulatory Activities (MedDRA) terms to identify relevant yellow card reports. In the UK, 1484 (2.2%) yellow cards were received by the MHRA for the specified MedDRA terms compared to 152 (2.4%) for Scotland. In each case, the top three drug classes implicated were NSAIDs, drugs affecting the renin-angiotensin system and lipid-lowering agents. Comparison of reporting by different healthcare professionals showed a comparable split between GPs, hospital doctors and hospital pharmacists