A comparison of oral omeprazole and intravenous cimetidine in reducing complications of duodenal peptic ulcer

BACKGROUND: Gastrointestinal bleeding is a common problem and its most common etiology is peptic ulcer disease. Ulcer rebleeding is considered a perilous complication for patients. To reduce the rate of rebleeding and to fasten the improvement of patients' general conditions, most emergency departments in Iran use H2-blockers before endoscopic procedures (i.e. intravenous omeprazole is not available in Iran). The aim of this study was to compare therapeutic effects of oral omeprazole and intravenous cimetidine on reducing rebleeding rates, duration of hospitalization, and the need for blood transfusion in duodenal ulcer patients. METHODS: In this clinical trial, 80 patients with upper gastrointestinal bleeding due to duodenal peptic ulcer and endoscopic evidence of rebleeding referring to emergency departments of Imam and Sina hospitals in Tabriz, Iran were randomly assigned to two equal groups; one was treated with intravenous cimetidine 800 mg per day and the other, with 40 mg oral omeprazole per day. RESULTS: No statistically significant difference was found between cimetidine and omeprazole groups in regards to sex, age, alcohol consumption, cigarette smoking, NSAID consumption, endoscopic evidence of rebleeding, mean hemoglobin and mean BUN levels on admission, duration of hospitalization and the mean time of rebleeding. However, the need for blood transfusion was much lower in omeprazole than in cimetidine group (mean: 1.68 versus 3.58 units, respectively; p < 0.003). Moreover, rebleeding rate was significantly lower in omeprazole group (15%) than in cimetidine group (50%) (p < 0.001). CONCLUSION: This study demonstrated that oral omeprazole significantly excels intravenous cimetidine in reducing the need for blood transfusion and lowering rebleeding rates in patients with upper gastrointestinal bleeding. Though not statistically significant (p = 0.074), shorter periods of hospitalization were found for omeprazole group which merits consideration for cost minimization

Aplicabilidade do indice adiposidade corporal na estimativa do percentual de gordura de jovens mulheres brasileiras

INTRODUÇÃO: A estimativa da composição corporal é um campo de estudo importante no prognóstico e diagnóstico de enfermidades degenerativas. OBJETIVO: Analisar a aplicabilidade do Índice de adiposidade corporal (IAC) e o método de dobras cutâneas. MÉTODOS: A amostra foi constituída por 19 adultas jovens com média de idade 24,53 ± 2,65 anos, submetidas à avaliação antropométrica (circunferências e dobras cutâneas) e absorsiometria por dupla emissão de raio X (DXA). Os valores estimados foram comparados ao valor de referência por meio do teste t pareado e pela análise do nível de associação entre os métodos pela correlação de Pearson; o nível de significância foi p 0,05) com nível de associação forte (r = 0,879). CONCLUSÃO: Embora o IAC não apresente diferença para os valores estimados, fica evidente a necessidade de mais estudos sobre a aplicabilidade do método na população brasileira

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Global Research and Exchange between Institutions: Pre-Clinical, Translational, Clinical and Applied Research: Panel #2

Michael J. Vergare, MD (Moderator) Michael J. Vergare is the Daniel Lieberman Professor and Chair of the Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College and the Executive Vice President for Partnerships and Affiliations, Thomas Jefferson University. He joined Jefferson as Chair in 1998 and in addition to his work in psychiatry, he served as Interim Dean of Jefferson Medical College (2007-2008) and the Senior Vice President for Academic Affairs (Provost) (2008-2014) of TJU. Dr. Vergare received a Bachelor of Arts degree from LaSalle University and a Doctor of Medicine degree from Hahnemann Medical College/Drexel. He completed his residency in Adult Psychiatry at Hahnemann, during which he received a six month grant to study under the direction of Anna Freud, PhD at the Hampstead Clinic in London. He is a Distinguished Life Fellow of the American Psychiatric Association, a Distinguished Fellow of the American College of Psychiatrists and a Fellow of the College of Physicians of Philadelphia. Throughout his distinguished career, Dr. Vergare has received many honors including the Presidential Medal of the American Psychiatric Association, the Judicare Medical Services Award, the Einstein Society Physician Leader Award, the Bell of Hope Award of the Mental Health Association of Southeastern and the Philadelphia Psychiatric Society’s Edward Lawlor Award, Daniel Blain Award and Paul J. Fink Leadership Award at the 2016 Benjamin Rush Gala through the Philadelphia Psychiatry Society (PPS). Dr. Vergare has served on the several councils as well as the Alliance of Independent Academic Medical Centers board and Health Partners of Philadelphia board. He has also been a member and chair of the Pennsylvania Governor’s Advisory Committee for Mental Health and Mental Retardation and has served on the National Advisory Council of the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration of Health and Human Services. Currently, he is chair of the Practice Guidelines Steering and Executive Committees of the American Psychiatric Association. Cataldo Doria, MD, PhD, MBA Cataldo Doria received his degrees at the University of Perugia in Italy and completed a research fellowship in small bowel transplantation at the University of Pittsburgh Transplantation Institute and a clinical fellowship in multi-organ transplantation at the Thomas E. Starzl Transplantation Institute of the University of Pittsburgh. Dr. Doria is Professor of Surgery at Sidney Kimmel Medical College at Thomas Jefferson University. Dr. Doria is the inaugural Nicoletti Family Professor of Transplant Surgery at Sidney Kimmel Medical College at Thomas Jefferson University, as well as the Director of the Jefferson Transplant Institute, the Director of the Division of Transplantation, and the Surgical-Director of the Sidney Kimmel Cancer Center and Liver Tumor Center. Dr. Doria came to Jefferson from the Mediterranean Institute for Transplantation and Advanced Specialized Therapies, a partnership between the University of Pittsburgh Medical Center and the Italian National Government. His research interests include the development of inhibitory pathways for liver cancer growth, immunology of solid organ transplantation, innovative application of artificial liver treatment. Among many awards, Dr. Doria was named “surgeon of the year” by the Delaware Chapter of the American Liver Foundation, and named by the President of the Italian Republic, Giorgio Napolitano, Cavaliere dell’Ordine “Al merito della Repubblica Italiana” (Knight of the Italian Republic). Dr. Doria is author of 256 publications: 88 refereed articles; 74 proceedings of conference and symposia, 3 monographs; 8 book chapters; 78 published abstracts; 5 other publication. Dr. Doria is Principal Investigator and co-Investigator of numerous clinical as well as basic science research trials. He is a member of numerous professional and scientific societies. He served as Associate Editor the American Society of Transplantation Newsletter, and is part of the Editorial Board of many journals. Mohammadreza Hojat, PhD Mohammadreza Hojat is a Research Professor, Department of Psychiatry and Human Behavior and Director of the Jefferson Longitudinal Study, Sidney Kimmel Medical College at Thomas Jefferson University. He received his doctoral degree in psychological services from the University of Pennsylvania. Dr. Hojat is a licensed psychologist, and has published more than 200 articles in peer reviewed journals and 13 book chapters on educational, psychological, and social issues. Dr. Hojat has led the development of 10 psychometrically sound instruments (including the Jefferson Scale of Empathy) for the assessment of health professions education and patient outcomes. He has served as a co-editor of “Loneliness: Theory, Research, and Applications” (Sage, 1987), and “Assessment Measures in Medical School, Residency, and Practice: The Connections” (Springer, 1993). The original edition of his book “Empathy in Patient Care: Antecedents, Development, Measurement, and Outcomes” was published in 2007 (Springer Science). An expanded and updated version of the book under a new title: “Empathy in Health Professions Education and Patient Care” was released in 2016. Vittorio Maio, PharmD, MS, MSPH Vittorio Maio is a Research Professor in the Jefferson College of Population Health, Thomas Jefferson University. His research interests are in the areas of outcomes analysis and medication usage and policy. Dr. Maio is principal investigator on multi-year collaborative projects funded by various Healthcare Authorities in the Regione Emilia-Romagna, Italy, mainly looking at the appropriateness of medication prescribing and the assessment of the quality of care in inpatient and outpatient settings. Dr. Maio teaches Pharmacoepidemiology in the Master of Science Program in Pharmacology, Sidney Kimmel Medical College for the trainees in the NIH K30 Training Program. He lectures on health policy issues in the Master in Management of Healthcare Organizations, Faculty of Economics, and University of Pisa, Italy. He also lectures on health services and outcomes research in the Residency Program of Hygiene and Preventive Medicine, School of Medicine, University of Parma, Italy. Dr. Maio is a reviewer for Pharmacoepidemiology and Drug Safety, Drugs & Aging, and The Lancet. He is Associate Editor of the American Journal of Medical Quality. Daniel Z. Louis Daniel Z. Louis is Managing Director of the Center for Research in Medical Education and Health Care and Research Associate Professor of Family and Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University. He is principal investigator of a series of multi-year collaborative projects with the Regione Emilia-Romagna, Italy, which use a large population-based database to address a variety of issues relating to organization, financing, and quality of care. He teaches health policy as a part of the Introduction to Clinical Medicine course for first year medical students. He is a guest lecturer at the Università Cattolica del Sacro Cuore, Rome, in their master’s program in health administration and at the University of Pisa, Faculty of Economics, Master’s Program in management of health care organizations. He has been appointed by the Italian Minister of Health to the Scientific Committee of Progetto IT.DRG, a multi-year project to develop the next generation hospital coding and financing systems. He is a reviewer for the Annals of Internal Medicine and Medical Care and a member of the editorial board of the Jefferson Health Policy Newsletter. Mrityunjay Metgud, MBBS, MD Mrityunjay Metgud serves as the country coordinator for the newest NIH-funded Global Network trial employing low-dose aspirin to prevent pre-term birth. He is professor of Obstetrics and Gynecology at K.L.E. University’s J N Medical College and has served on the research team for the Global Network Corticosteroid trial and for the Estimation of Gestational Age by the use of a simplified Tape. He is also consultant obstetrician/gynecologist and gynec- oncologist at KLES Dr. Prabhakar Kore Hospital and MRC Belgaum. Dr. Metgud is a nationally recognized leader in laparoscopic gynecologic surgery and a trainer in obstetrical ultrasound. He is a member of several associations, including IMA, Belgaum North Branch, FOGSI, Belgaum Branch, Karnataka State Obstetrics and Gynecological Society and is a Life Member of the Association of Gynecologic Oncologists of India (AGOI). He became president of the Belgaum OBGYN Society in 2015. Dr. Metgud has contributed to many books, written articles and presented at national conferences