AIM: To compare the efficacy and safety of biological agents for the treatment of active ulcerative colitis(UC).METHODS: PubMed, MEDLINE, EMBASE and the Cochrane library were searched to screen relevant articles from ...AIM: To compare the efficacy and safety of biological agents for the treatment of active ulcerative colitis(UC).METHODS: PubMed, MEDLINE, EMBASE and the Cochrane library were searched to screen relevant articles from January 1996 to August 2014. The mixedtreatment comparison meta-analysis within a Bayesian framework was performed using WinBUGS14 software.The proportions of patients reaching clinical response,clinical remission and mucosal healing in induction and maintenance phases were analyzed as efficacy indicators. Serious adverse events in maintenance phase were analyzed as safety indicators.RESULTS: The meta-analysis results showed that biological agents achieved better clinical response,clinical remission and mucosal healing than placebo.Indirect comparison indicated that in induction phase,infliximab was more effective than adalimumab in inducing clinical response(OR = 0.41, 95%CI:0.29-0.57), clinical remission(OR = 0.33, 95%CI:0.19-0.56) and mucosal healing(OR = 0.33, 95%CI:0.19-0.56), and golimumab in inducing clinical response(OR = 0.66, 95%CI: 0.39-2.33) and mucosal healing(OR = 2.15, 95%CI: 1.18-4.22). No significant difference was found between placebo and biological agents regarding their safety.CONCLUSION: All biological agents were superior to placebo for UC treatment in both induction and maintenance phases with a similar safety profile, and infliximab had a better clinical effect than the other biological agents.展开更多
BACKGROUND The detection rate of peptic ulcer in children is improving,with development of diagnostic procedures.Gastroscopy is the gold standard for the diagnosis of peptic ulcer,but it is an invasive procedure.Gastr...BACKGROUND The detection rate of peptic ulcer in children is improving,with development of diagnostic procedures.Gastroscopy is the gold standard for the diagnosis of peptic ulcer,but it is an invasive procedure.Gastrointestinal contrast-enhanced ultrasonography(CEUS)has the advantages of being painless,noninvasive,nonradioactive,easy to use,and safe.AIM To investigate the clinical value of CEUS for diagnosis and treatment of peptic ulcer in children.METHODS We investigated 43 children with digestive tract symptoms in our hospital from January 2021 to June 2022.All children were examined by routine ultrasound,gastrointestinal CEUS,and gastroscopy.The pathological results of gastroscopy were taken as the gold standard.Routine ultrasonography was performed before gastrointestinal CEUS.Conventional ultrasound showed the thickness of the gastroduodenal wall,gastric peristalsis,and the adjacent organs and tissues around the abdominal cavity.Gastrointestinal CEUS recorded the thickness of the gastroduodenal wall;the size,location and shape of the ulcer;gastric peristalsis;and adjacent organs and tissues around the abdominal cavity.The results of routine ultrasound and gastrointestinal ultrasound were compared with those of gastroscopy to evaluate the diagnostic results and coincidence rate of routine ultrasound and gastrointestinal CEUS.All children received informed consent from their guardians for CEUS.This study was reviewed and approved by the hospital medical ethics committee.RESULTS Among the 43 children,17(15 male,2 female)were diagnosed with peptic ulcer by gastroscopy.There were 26 children with nonpeptic ulcer.There were eight cases of peptic ulcer and 35 of nonpeptic ulcer diagnosed by conventional ultrasound.The diagnostic coincidence rate of peptic ulcer in children diagnosed by conventional ultrasound was 79.1%(34/43),which was significantly different from that of gastroscopy(P=0.033).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is low.Fifteen cases of peptic ulcer and 28 of nonpeptic ulcer were diagnosed by CEUS.The diagnostic coincidence rate of peptic ulcer in children was 95.3%(41/43).There was no significant difference between CEUS and gastroscopy(P=0.655).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is high.CONCLUSION Gastrointestinal CEUS has a high coincidence rate in the diagnosis of peptic ulcer in children,and can be used as a preliminary examination method.展开更多
In the past,there has been considerable focus on a host of drugs and chemicals that may produce colonic toxicity.Now,a variety of new biological monoclonal antibody agents,usually administered by infusion,have appeare...In the past,there has been considerable focus on a host of drugs and chemicals that may produce colonic toxicity.Now,a variety of new biological monoclonal antibody agents,usually administered by infusion,have appeared in the clinical realm over the last decade or so to treat different chronic inflammatory or malignant disorders.For some of these agents,adverse effects have been documented,including apparently new forms of immune-mediated inflammatory bowel disease.In some,only limited symptoms have been recorded,but in others,severe colitis with serious complications,such as bowel perforation has been recorded.In others,adverse effects may have a direct vascular or ischemic basis,while other intestinal effects may be related to a superimposed infection.Some new onset cases of ulcerative colitis or Crohn's disease may also be attributed to the same agents used to treat these diseases,or be responsible for disease exacerbation.Dramatic and well documented side effects have been observed with ipilimumab,a humanized monoclonal antibody developed to reduce and overcome cytotoxic T-lymphocyte antigen 4,a key negative feedback regulator of the T-cell anti-tumor response.This agent has frequently been used in the treatment of different malignancies,notably,malignant melanoma.Side effects with this agent occur in up to 40% and these are believed to be largely immune-mediated.One of these is a form of enterocolitis that may be severe,and occa-sionally,fatal.Other agents include rituximab(an antiCD20 monoclonal antibody),bevacizumab(a monoclonal antibody against the vascular endothelial growth factor) and anti-tumor necrosis factor agents,including infliximab,adalimumab and etanercept.展开更多
Diabetic foot infections and diabetic foot ulcers(DFU)cause significant suffering and are often recurring.DFU have three important pathogenic factors,namely,microangiopathy causing local tissue anoxia,neuropathy makin...Diabetic foot infections and diabetic foot ulcers(DFU)cause significant suffering and are often recurring.DFU have three important pathogenic factors,namely,microangiopathy causing local tissue anoxia,neuropathy making the foot prone to injuries from trivial trauma,and local tissue hyperglycaemia favouring infection and delaying the wound healing.DFU have been the leading cause for non-traumatic amputations of part or whole of the limb.Western medicines focus mainly on euglycaemia,antimicrobials,debridement and wound cover with grafts,and off-loading techniques.Advances in euglycaemic control,foot care and footwear,systemic antimicrobial therapy,and overall health care access and delivery,have resulted in an overall decrease in amputations.However,the process of wound care after adequate debridement remains a major cost burden globally,especially in developing nations.This process revolves around two basic concerns regarding control/eradication of local infection and promotion of faster healing in a chronic DFU without recurrence.Wound modulation with various dressings and techniques are often a costly affair.Some aspects of the topical therapy with modern/Western medicines are frequently not addressed.Cost of and compliance to these therapies are important as both the wounds and their treatment are“chronic.”Naturally occurring agents/medications from traditional medicine systems have been used frequently in different cultures and nations,though without adequate clinical base/relevance.Traditional Chinese medicine involves restoring yin-yang balance,regulating the‘chi’,and promoting local blood circulation.Traditional medicines from India have been emphasizing on‘naturally’available products to control wound infection and promote all the aspects of wound healing.There is one more group of chemicals which are not pharmaceutical agents but can create acidic milieu in the wound to satisfy the above-mentioned basic concerns.Various natural and plant derived products(e.g.,honey,aloe vera,oils,and calendula)and maggots are also used for wound healing purposes.We believe that patients with a chronic wound are so tired physically,emotionally,and financially that they usually accept native traditional medicine which has the same cultural base,belief,and faith.Many of these products have never been tested in accordance to“evidence-based medicine.”There are usually case reports and experience-based reports about these products.Recently,there have been some trials(in vitro and in vivo)to verify the claims of usage of traditional medicines in management of DFU.Such studies show that these natural products enhance the healing process by controlling infection,stimulating granulation tissue,antimicrobial action,promoting fibroblastic activity and collagen deposition,etc.In this review,we attempt to study and analyse the available literature on results of topical traditional medicines,which are usually advocated in the management of DFU.An integrated and‘holistic’approach of both modern and traditional medicine may be more acceptable to the patient,cost effective,and easy to administer and monitor.This may also nevertheless lead to further improvement in quality of life and decrease in the rates of amputations for DFU.展开更多
目的 分析溃疡性结肠炎(UC)生物制剂的研究现状、热点和发展趋势,为我国UC生物制剂的相关研究提供参考。方法 检索Web of Science核心合集数据库中发表于2013年1月1日至2022年12月31日关于UC生物制剂研究的相关文献,利用文献计量在线分...目的 分析溃疡性结肠炎(UC)生物制剂的研究现状、热点和发展趋势,为我国UC生物制剂的相关研究提供参考。方法 检索Web of Science核心合集数据库中发表于2013年1月1日至2022年12月31日关于UC生物制剂研究的相关文献,利用文献计量在线分析平台(https://bibliometric.com/)和CiteSpace软件统计分析相关研究的发文量、国家/地区、机构、作者、期刊等文献关键特征。结果 共纳入文献3 928篇,年发文量整体呈逐年增加的趋势;开展该领域研究的国家/地区有109个,美国占领先优势(1 209篇,占总发文量的31.03%),且与其他国家合作密切;参与该领域研究的机构共456个,加州大学圣地亚哥分校的发文量(121篇)和中心度(0.09)均排名首位;发文量最大的作者是法国洛林大学的Peyrin-Biroulet L(101篇),共被引频次排名首位的作者是加州大学圣地亚哥分校的Sandborn W J(1 055次);共计1 012个期刊发表了相关文献,发文量和共被引频次最高的期刊均为Inflammatory Bowel Diseases(267篇,1 376次);共被引频次最高的文献是Ungaro等在2017年发表的综述“Ulcerative colitis”,共被引文献中心度排名首位的是Sandborn等在2017年发表的“Tofacitinib as induction and maintenance therapy for ulcerative colitis”;该领域的研究热点主要集中在生物制剂有效性、治疗药物监测、特殊群体用药、药物经济学评价等方面。结论 我国UC生物制剂的研究与国外相比还存在一定差距,应加强国际合作交流,及时跟进该领域的研究热点和未来发展趋势。展开更多
BACKGROUND The two main causes of gastric ulcer bleeding are Helicobacter pylori(H.pylori)infection and ulcerogenic medicines,although the number of cases caused by each may vary with age.In Japan,the rate of H.pylori...BACKGROUND The two main causes of gastric ulcer bleeding are Helicobacter pylori(H.pylori)infection and ulcerogenic medicines,although the number of cases caused by each may vary with age.In Japan,the rate of H.pylori infection has fallen over the last decade and the number of prescriptions for non-steroidal anti-inflammatory drugs(NSAIDs)and antithrombotic drugs is increasing as the population ages.Methods of treatment for gastric ulcer bleeding have advanced with the advent of hemostatic forceps and potassium-competitive acid blocker(P-CAB).Thus,causes and treatments for gastric ulcer bleeding have changed over the last decade.AIM To examine the trends of gastric ulcer bleeding over 10 years in the metropolitan area of Japan.METHODS This is a single-center retrospective study.A total of 564 patients were enrolled from inpatients admitted to our hospital with gastric ulcer bleeding between 2006 and 2016.Age,medication history,H.pylori infection,method of treatment,rate of rebleeding,and the length of hospitalization were analyzed.Factors associated with gastric ulcer bleeding were evaluated using Fisher’s exact test,Pearson’s Chi-squared test or Student’s t-test as appropriate.The Jonckheere-Terpstra test was used to evaluate trends.A per-protocol analysis was used to examine the rate of H.pylori infection.RESULTS There was a significant increase in the mean age over time(P<0.01).The rate of H.pylori infection tended to decrease over the study period(P=0.10),whereas the proportion of patients taking antithrombotic agents or NSAIDs tended to increase(P=0.07).Over time,the use of NSAIDs and antithrombotic drugs increased with age.By contrast,the rate of H.pylori infection during the study period fell with age.H.pylori-induced ulcers accounted for the majority of cases in younger patients(<70 years old);however,the rate decreased with age(P<0.01).The method of treatment trend has changed significantly over time.The main method of endoscopic hemostasis has changed from clipping and injection to forceps coagulation(P<0.01),and frequently prescribed medicines have changed from proton pump inhibitor to P-CAB(P<0.01).The rate of rebleeding during the latter half of the study was significantly lower than that in the first half.CONCLUSION These trends,gastric ulcers caused by ulcerogenic drugs were increasing with age and H.pylori-induced ulcers were more common in younger patients,were observed.展开更多
We here present the case of a 22-year-old female of Suriname ethnicity with ulcerative colitis who received treatment with mercaptopurine and infliximab.She presented herself with a severe necrotizing tonsillitis due ...We here present the case of a 22-year-old female of Suriname ethnicity with ulcerative colitis who received treatment with mercaptopurine and infliximab.She presented herself with a severe necrotizing tonsillitis due to herpes simplex virus type-1(HSV-1).Combination therapy consisting of immunomodulators and anti-tumor necrosis factor(TNF) agents is increasingly being used.Anti-TNF therapy is associated with an increased risk of developing serious infections,and especially patients receiving combination treatment with thiopurines are at an increased risk.We here show that HSV infections can cause a severe tonsillitis in immunocompromised patients.Early recognition is essential when there is no improvement with initial antibiotic therapy within the first 24 to 72 h.HSV infections should be in the differential diagnosis of immunocompromised patients presenting with a necrotizing tonsillitis and can be confirmed by polymerase chain reaction.Early treatment with antiviral agents should be considered especially if antibiotic treatment fails in such patients.展开更多
Background: Pressure ulcer (PU) has clinical complications for patients, in addition to cost and quality related consequences for healthcare organizations. PU is defined as a pressure injury is localized damage to the...Background: Pressure ulcer (PU) has clinical complications for patients, in addition to cost and quality related consequences for healthcare organizations. PU is defined as a pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other devices. The estimated prevalence of PUs among 918,621 patients declined from 13.5% in 2006 to 9.3% in 2015. Aim: The objective of this review is to evaluate the effectiveness of dressing and topical agent to prevent pressure ulcer, for hospitalized adults are at risk to develop a pressure ulcer. Methods: The review considered the randomized clinical trial (RCT), quasi pretest-posttest, and descriptive studies published in English. Participants in the studies were adult, aged over 18 years, considered to be a risk to develop PU, have no PU at the onset of the study, and managed at any healthcare setting. The primary outcome measured in the included studies was considered as the incidence of hospital acquired pressure ulcer (HAPU). Results: The review result out of five RCT and three non-RCT studies. Conclusion: The reviewed trials showed low certainty of imprecision. No definite preventive intervention to prevent PU among patients who at risk to develop PU. And the non-RCT studies, the findings indicate significant results of two studies, but due to the methodological context of non-RCT studies, the findings may not be granted to be generalized. The external factors at each study may affect the effectiveness of the intervention. Also, third study showed no significance of the intervention between groups.展开更多
Objective:To evaluate the possible antiulcer effect of the African garden egg,Solanum aethiopicum(S.aethiopicum)(a domestic vegetable) experimentally in rats.Methods:A methanol extract of the plant fruit was prepared ...Objective:To evaluate the possible antiulcer effect of the African garden egg,Solanum aethiopicum(S.aethiopicum)(a domestic vegetable) experimentally in rats.Methods:A methanol extract of the plant fruit was prepared by maceration.Twenty five overnight fasted rats for each model were divided randomly into five groups of five rats.Groups 1,2,3,4 and 5 received normal saline,extract dose levels of 100,200 and 400 mg/kg and 100mg/kg of ranitidine respectively.All administrations were given orally.For the indomethacin and aspirin models, ulcerogenic agents(indomethacin,50 mg/kg and aspirin 200 mg/kg) were given thirty minutes after extract treatments and animals sacrificed 8 h later.The acidified ethanol model(ethanol 60%+0.1 mol/L HC1) was given 1hr after extract treatment and animals sacrificed 1 h later. Ulcer index was checked and analysed with appropriate statistical tools.Results:Extract of S. aethiopicum showed positive effect on all the models used.It produced higher ulcer inhibition than ranitidine in the indomethacin and acid-ethanol models.All the anti-ulcer effects of the extract at different doses were dose dependent but only in indomethacin model did it produce statistically significant(P【0.05) ulcer reduction in all doses compared to control.Conclusions: Garden egg,a readily cultivated crop vegetable possesses ulcer protective properties against ulcers induced experimentally making it a cheap source of natural anti-ulcer remedy.展开更多
AIM：To assess and compare the efficacy and safety of two triple regimes:A)metronidazole,amoxicillin and omeprazole,which is still widely used in Russia,andB)azithromycin amoxicillin and omeprazole in healing active d...AIM：To assess and compare the efficacy and safety of two triple regimes:A)metronidazole,amoxicillin and omeprazole,which is still widely used in Russia,andB)azithromycin amoxicillin and omeprazole in healing active duodenal ulcer and H.pylori eradication.METHODS:100 patients with active duodenal ulcer were includid in the open,multicentre,randomized study with comparative groups.Patients were randomly assigned to one of the following one-week triple regimes:A)metronidazole500mg bid,amoxicillin1gbid and omeprazole 20mg bid(OAM,n=50)andB)azithromycin1g od for the first3days(total dose3g).amoxicillin 1g bid and first 3days(total dose3g).amoxicillin 1g bid and omeprazole20mg bid(OAA,n=50).Omeprazole 20mg od was given after the eradication course as a monotherapy for three weeks ,The control endoscopy was performed8 weeks after the entry,H.pyloriinfection was determined in the entry of the study and four weeks after the cessation of treatment by means of histology and CLO-test.RESULTS:97 patients completed the study according to the protocol(1patient of the OAM group did not come to the control endoscopy.2patients of the OAA group stopped the treatment because of mild allergic urticaria).Duodenal ulcers were healed in48patients of the OAM group(96%;CI90.5-100%)and in 46patients of the OAAgroup(92%;CI89.5-94.5%)(p=ns).H.pylori infection was eradicated in 15out of 50patients with OAM(30%;CI17-43%)and in36out of 50patients treated with OAA(72%,CI59-85%)(P<0.001)-IПanalysis.CONCLUSION:The triple therapy with omeprazole,amoxicillin and metronidazole failed to eradicateH.pylori in the majorty of patients,which is an essential argument to withdraw this regimen out of the national recommendations,Macrolide with amoxicillin are preferable to achieve higher eradication rates.Azitromycin(1g od for the first3days)can be considered as a successful component of the triple PPI-based regimen.展开更多
118 cases of ulcerative colitis were treated by integration of traditional Chinese andWestern medicine. Another 86 cases of ulcerative colitis were treated by simple westerndrugs as controls. The therapeutic effects f...118 cases of ulcerative colitis were treated by integration of traditional Chinese andWestern medicine. Another 86 cases of ulcerative colitis were treated by simple westerndrugs as controls. The therapeutic effects for both groups were observed and comparedafter two therapeutic courses of 40 consecutive days. As a result, 39 cases were cured, 60cases improved and 19 cases failed, with a total effective rate of 84% in the treatmentgroup; in the control group, 15 cases were cured, 37 cases improved and 34 cases failed,with a total effective rate of 60.5%. Statistically, the difference was very significant(P【0.01). It can be concluded that treatment of ulcerative colitis by the integrated methodis superior to that by simple western drugs.展开更多
BACKGROUND A perforated gastroduodenal ulcer is rarely observed in children.Certain medications have been reported to cause ulcerations.Deferasirox,an iron chelating agent,has been previously reported to be associated...BACKGROUND A perforated gastroduodenal ulcer is rarely observed in children.Certain medications have been reported to cause ulcerations.Deferasirox,an iron chelating agent,has been previously reported to be associated with the development of gastroduodenal ulcers.CASE SUMMARY We report a case of a 3-year-old boy who was diagnosed with beta thalassemia major and treated with deferasirox.He presented to the emergency department with an acute abdomen.A perforated duodenal ulcer was suspected after X-ray imaging and laparoscopic exploration.It was successfully managed with laparoscopic washout and drainage.CONCLUSION Due to the rarity and severity of this case,it is a reminder that prevention and early recognition of gastrointestinal complications in patients receiving deferasirox are crucial.Minimally invasive laparoscopic surgery is both safe and feasible to treat perforated duodenal ulcers in selected patients.展开更多
文摘AIM: To compare the efficacy and safety of biological agents for the treatment of active ulcerative colitis(UC).METHODS: PubMed, MEDLINE, EMBASE and the Cochrane library were searched to screen relevant articles from January 1996 to August 2014. The mixedtreatment comparison meta-analysis within a Bayesian framework was performed using WinBUGS14 software.The proportions of patients reaching clinical response,clinical remission and mucosal healing in induction and maintenance phases were analyzed as efficacy indicators. Serious adverse events in maintenance phase were analyzed as safety indicators.RESULTS: The meta-analysis results showed that biological agents achieved better clinical response,clinical remission and mucosal healing than placebo.Indirect comparison indicated that in induction phase,infliximab was more effective than adalimumab in inducing clinical response(OR = 0.41, 95%CI:0.29-0.57), clinical remission(OR = 0.33, 95%CI:0.19-0.56) and mucosal healing(OR = 0.33, 95%CI:0.19-0.56), and golimumab in inducing clinical response(OR = 0.66, 95%CI: 0.39-2.33) and mucosal healing(OR = 2.15, 95%CI: 1.18-4.22). No significant difference was found between placebo and biological agents regarding their safety.CONCLUSION: All biological agents were superior to placebo for UC treatment in both induction and maintenance phases with a similar safety profile, and infliximab had a better clinical effect than the other biological agents.
基金Supported by Scientific Research Fund of the Wenzhou Science and Technology Division,No.Y2020798 and No.Y2020805.
文摘BACKGROUND The detection rate of peptic ulcer in children is improving,with development of diagnostic procedures.Gastroscopy is the gold standard for the diagnosis of peptic ulcer,but it is an invasive procedure.Gastrointestinal contrast-enhanced ultrasonography(CEUS)has the advantages of being painless,noninvasive,nonradioactive,easy to use,and safe.AIM To investigate the clinical value of CEUS for diagnosis and treatment of peptic ulcer in children.METHODS We investigated 43 children with digestive tract symptoms in our hospital from January 2021 to June 2022.All children were examined by routine ultrasound,gastrointestinal CEUS,and gastroscopy.The pathological results of gastroscopy were taken as the gold standard.Routine ultrasonography was performed before gastrointestinal CEUS.Conventional ultrasound showed the thickness of the gastroduodenal wall,gastric peristalsis,and the adjacent organs and tissues around the abdominal cavity.Gastrointestinal CEUS recorded the thickness of the gastroduodenal wall;the size,location and shape of the ulcer;gastric peristalsis;and adjacent organs and tissues around the abdominal cavity.The results of routine ultrasound and gastrointestinal ultrasound were compared with those of gastroscopy to evaluate the diagnostic results and coincidence rate of routine ultrasound and gastrointestinal CEUS.All children received informed consent from their guardians for CEUS.This study was reviewed and approved by the hospital medical ethics committee.RESULTS Among the 43 children,17(15 male,2 female)were diagnosed with peptic ulcer by gastroscopy.There were 26 children with nonpeptic ulcer.There were eight cases of peptic ulcer and 35 of nonpeptic ulcer diagnosed by conventional ultrasound.The diagnostic coincidence rate of peptic ulcer in children diagnosed by conventional ultrasound was 79.1%(34/43),which was significantly different from that of gastroscopy(P=0.033).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is low.Fifteen cases of peptic ulcer and 28 of nonpeptic ulcer were diagnosed by CEUS.The diagnostic coincidence rate of peptic ulcer in children was 95.3%(41/43).There was no significant difference between CEUS and gastroscopy(P=0.655).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is high.CONCLUSION Gastrointestinal CEUS has a high coincidence rate in the diagnosis of peptic ulcer in children,and can be used as a preliminary examination method.
文摘In the past,there has been considerable focus on a host of drugs and chemicals that may produce colonic toxicity.Now,a variety of new biological monoclonal antibody agents,usually administered by infusion,have appeared in the clinical realm over the last decade or so to treat different chronic inflammatory or malignant disorders.For some of these agents,adverse effects have been documented,including apparently new forms of immune-mediated inflammatory bowel disease.In some,only limited symptoms have been recorded,but in others,severe colitis with serious complications,such as bowel perforation has been recorded.In others,adverse effects may have a direct vascular or ischemic basis,while other intestinal effects may be related to a superimposed infection.Some new onset cases of ulcerative colitis or Crohn's disease may also be attributed to the same agents used to treat these diseases,or be responsible for disease exacerbation.Dramatic and well documented side effects have been observed with ipilimumab,a humanized monoclonal antibody developed to reduce and overcome cytotoxic T-lymphocyte antigen 4,a key negative feedback regulator of the T-cell anti-tumor response.This agent has frequently been used in the treatment of different malignancies,notably,malignant melanoma.Side effects with this agent occur in up to 40% and these are believed to be largely immune-mediated.One of these is a form of enterocolitis that may be severe,and occa-sionally,fatal.Other agents include rituximab(an antiCD20 monoclonal antibody),bevacizumab(a monoclonal antibody against the vascular endothelial growth factor) and anti-tumor necrosis factor agents,including infliximab,adalimumab and etanercept.
文摘Diabetic foot infections and diabetic foot ulcers(DFU)cause significant suffering and are often recurring.DFU have three important pathogenic factors,namely,microangiopathy causing local tissue anoxia,neuropathy making the foot prone to injuries from trivial trauma,and local tissue hyperglycaemia favouring infection and delaying the wound healing.DFU have been the leading cause for non-traumatic amputations of part or whole of the limb.Western medicines focus mainly on euglycaemia,antimicrobials,debridement and wound cover with grafts,and off-loading techniques.Advances in euglycaemic control,foot care and footwear,systemic antimicrobial therapy,and overall health care access and delivery,have resulted in an overall decrease in amputations.However,the process of wound care after adequate debridement remains a major cost burden globally,especially in developing nations.This process revolves around two basic concerns regarding control/eradication of local infection and promotion of faster healing in a chronic DFU without recurrence.Wound modulation with various dressings and techniques are often a costly affair.Some aspects of the topical therapy with modern/Western medicines are frequently not addressed.Cost of and compliance to these therapies are important as both the wounds and their treatment are“chronic.”Naturally occurring agents/medications from traditional medicine systems have been used frequently in different cultures and nations,though without adequate clinical base/relevance.Traditional Chinese medicine involves restoring yin-yang balance,regulating the‘chi’,and promoting local blood circulation.Traditional medicines from India have been emphasizing on‘naturally’available products to control wound infection and promote all the aspects of wound healing.There is one more group of chemicals which are not pharmaceutical agents but can create acidic milieu in the wound to satisfy the above-mentioned basic concerns.Various natural and plant derived products(e.g.,honey,aloe vera,oils,and calendula)and maggots are also used for wound healing purposes.We believe that patients with a chronic wound are so tired physically,emotionally,and financially that they usually accept native traditional medicine which has the same cultural base,belief,and faith.Many of these products have never been tested in accordance to“evidence-based medicine.”There are usually case reports and experience-based reports about these products.Recently,there have been some trials(in vitro and in vivo)to verify the claims of usage of traditional medicines in management of DFU.Such studies show that these natural products enhance the healing process by controlling infection,stimulating granulation tissue,antimicrobial action,promoting fibroblastic activity and collagen deposition,etc.In this review,we attempt to study and analyse the available literature on results of topical traditional medicines,which are usually advocated in the management of DFU.An integrated and‘holistic’approach of both modern and traditional medicine may be more acceptable to the patient,cost effective,and easy to administer and monitor.This may also nevertheless lead to further improvement in quality of life and decrease in the rates of amputations for DFU.
文摘BACKGROUND The two main causes of gastric ulcer bleeding are Helicobacter pylori(H.pylori)infection and ulcerogenic medicines,although the number of cases caused by each may vary with age.In Japan,the rate of H.pylori infection has fallen over the last decade and the number of prescriptions for non-steroidal anti-inflammatory drugs(NSAIDs)and antithrombotic drugs is increasing as the population ages.Methods of treatment for gastric ulcer bleeding have advanced with the advent of hemostatic forceps and potassium-competitive acid blocker(P-CAB).Thus,causes and treatments for gastric ulcer bleeding have changed over the last decade.AIM To examine the trends of gastric ulcer bleeding over 10 years in the metropolitan area of Japan.METHODS This is a single-center retrospective study.A total of 564 patients were enrolled from inpatients admitted to our hospital with gastric ulcer bleeding between 2006 and 2016.Age,medication history,H.pylori infection,method of treatment,rate of rebleeding,and the length of hospitalization were analyzed.Factors associated with gastric ulcer bleeding were evaluated using Fisher’s exact test,Pearson’s Chi-squared test or Student’s t-test as appropriate.The Jonckheere-Terpstra test was used to evaluate trends.A per-protocol analysis was used to examine the rate of H.pylori infection.RESULTS There was a significant increase in the mean age over time(P<0.01).The rate of H.pylori infection tended to decrease over the study period(P=0.10),whereas the proportion of patients taking antithrombotic agents or NSAIDs tended to increase(P=0.07).Over time,the use of NSAIDs and antithrombotic drugs increased with age.By contrast,the rate of H.pylori infection during the study period fell with age.H.pylori-induced ulcers accounted for the majority of cases in younger patients(<70 years old);however,the rate decreased with age(P<0.01).The method of treatment trend has changed significantly over time.The main method of endoscopic hemostasis has changed from clipping and injection to forceps coagulation(P<0.01),and frequently prescribed medicines have changed from proton pump inhibitor to P-CAB(P<0.01).The rate of rebleeding during the latter half of the study was significantly lower than that in the first half.CONCLUSION These trends,gastric ulcers caused by ulcerogenic drugs were increasing with age and H.pylori-induced ulcers were more common in younger patients,were observed.
文摘We here present the case of a 22-year-old female of Suriname ethnicity with ulcerative colitis who received treatment with mercaptopurine and infliximab.She presented herself with a severe necrotizing tonsillitis due to herpes simplex virus type-1(HSV-1).Combination therapy consisting of immunomodulators and anti-tumor necrosis factor(TNF) agents is increasingly being used.Anti-TNF therapy is associated with an increased risk of developing serious infections,and especially patients receiving combination treatment with thiopurines are at an increased risk.We here show that HSV infections can cause a severe tonsillitis in immunocompromised patients.Early recognition is essential when there is no improvement with initial antibiotic therapy within the first 24 to 72 h.HSV infections should be in the differential diagnosis of immunocompromised patients presenting with a necrotizing tonsillitis and can be confirmed by polymerase chain reaction.Early treatment with antiviral agents should be considered especially if antibiotic treatment fails in such patients.
文摘Background: Pressure ulcer (PU) has clinical complications for patients, in addition to cost and quality related consequences for healthcare organizations. PU is defined as a pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other devices. The estimated prevalence of PUs among 918,621 patients declined from 13.5% in 2006 to 9.3% in 2015. Aim: The objective of this review is to evaluate the effectiveness of dressing and topical agent to prevent pressure ulcer, for hospitalized adults are at risk to develop a pressure ulcer. Methods: The review considered the randomized clinical trial (RCT), quasi pretest-posttest, and descriptive studies published in English. Participants in the studies were adult, aged over 18 years, considered to be a risk to develop PU, have no PU at the onset of the study, and managed at any healthcare setting. The primary outcome measured in the included studies was considered as the incidence of hospital acquired pressure ulcer (HAPU). Results: The review result out of five RCT and three non-RCT studies. Conclusion: The reviewed trials showed low certainty of imprecision. No definite preventive intervention to prevent PU among patients who at risk to develop PU. And the non-RCT studies, the findings indicate significant results of two studies, but due to the methodological context of non-RCT studies, the findings may not be granted to be generalized. The external factors at each study may affect the effectiveness of the intervention. Also, third study showed no significance of the intervention between groups.
文摘Objective:To evaluate the possible antiulcer effect of the African garden egg,Solanum aethiopicum(S.aethiopicum)(a domestic vegetable) experimentally in rats.Methods:A methanol extract of the plant fruit was prepared by maceration.Twenty five overnight fasted rats for each model were divided randomly into five groups of five rats.Groups 1,2,3,4 and 5 received normal saline,extract dose levels of 100,200 and 400 mg/kg and 100mg/kg of ranitidine respectively.All administrations were given orally.For the indomethacin and aspirin models, ulcerogenic agents(indomethacin,50 mg/kg and aspirin 200 mg/kg) were given thirty minutes after extract treatments and animals sacrificed 8 h later.The acidified ethanol model(ethanol 60%+0.1 mol/L HC1) was given 1hr after extract treatment and animals sacrificed 1 h later. Ulcer index was checked and analysed with appropriate statistical tools.Results:Extract of S. aethiopicum showed positive effect on all the models used.It produced higher ulcer inhibition than ranitidine in the indomethacin and acid-ethanol models.All the anti-ulcer effects of the extract at different doses were dose dependent but only in indomethacin model did it produce statistically significant(P【0.05) ulcer reduction in all doses compared to control.Conclusions: Garden egg,a readily cultivated crop vegetable possesses ulcer protective properties against ulcers induced experimentally making it a cheap source of natural anti-ulcer remedy.
文摘AIM：To assess and compare the efficacy and safety of two triple regimes:A)metronidazole,amoxicillin and omeprazole,which is still widely used in Russia,andB)azithromycin amoxicillin and omeprazole in healing active duodenal ulcer and H.pylori eradication.METHODS:100 patients with active duodenal ulcer were includid in the open,multicentre,randomized study with comparative groups.Patients were randomly assigned to one of the following one-week triple regimes:A)metronidazole500mg bid,amoxicillin1gbid and omeprazole 20mg bid(OAM,n=50)andB)azithromycin1g od for the first3days(total dose3g).amoxicillin 1g bid and first 3days(total dose3g).amoxicillin 1g bid and omeprazole20mg bid(OAA,n=50).Omeprazole 20mg od was given after the eradication course as a monotherapy for three weeks ,The control endoscopy was performed8 weeks after the entry,H.pyloriinfection was determined in the entry of the study and four weeks after the cessation of treatment by means of histology and CLO-test.RESULTS:97 patients completed the study according to the protocol(1patient of the OAM group did not come to the control endoscopy.2patients of the OAA group stopped the treatment because of mild allergic urticaria).Duodenal ulcers were healed in48patients of the OAM group(96%;CI90.5-100%)and in 46patients of the OAAgroup(92%;CI89.5-94.5%)(p=ns).H.pylori infection was eradicated in 15out of 50patients with OAM(30%;CI17-43%)and in36out of 50patients treated with OAA(72%,CI59-85%)(P<0.001)-IПanalysis.CONCLUSION:The triple therapy with omeprazole,amoxicillin and metronidazole failed to eradicateH.pylori in the majorty of patients,which is an essential argument to withdraw this regimen out of the national recommendations,Macrolide with amoxicillin are preferable to achieve higher eradication rates.Azitromycin(1g od for the first3days)can be considered as a successful component of the triple PPI-based regimen.
文摘118 cases of ulcerative colitis were treated by integration of traditional Chinese andWestern medicine. Another 86 cases of ulcerative colitis were treated by simple westerndrugs as controls. The therapeutic effects for both groups were observed and comparedafter two therapeutic courses of 40 consecutive days. As a result, 39 cases were cured, 60cases improved and 19 cases failed, with a total effective rate of 84% in the treatmentgroup; in the control group, 15 cases were cured, 37 cases improved and 34 cases failed,with a total effective rate of 60.5%. Statistically, the difference was very significant(P【0.01). It can be concluded that treatment of ulcerative colitis by the integrated methodis superior to that by simple western drugs.
文摘BACKGROUND A perforated gastroduodenal ulcer is rarely observed in children.Certain medications have been reported to cause ulcerations.Deferasirox,an iron chelating agent,has been previously reported to be associated with the development of gastroduodenal ulcers.CASE SUMMARY We report a case of a 3-year-old boy who was diagnosed with beta thalassemia major and treated with deferasirox.He presented to the emergency department with an acute abdomen.A perforated duodenal ulcer was suspected after X-ray imaging and laparoscopic exploration.It was successfully managed with laparoscopic washout and drainage.CONCLUSION Due to the rarity and severity of this case,it is a reminder that prevention and early recognition of gastrointestinal complications in patients receiving deferasirox are crucial.Minimally invasive laparoscopic surgery is both safe and feasible to treat perforated duodenal ulcers in selected patients.
