EFFICACY OF SUCRALFATE IN PREVENTING GASTROINTESTINAL SIDE EFFECTS OF NSAIDs

To find out the efficacy of sucralfate in preventing gastrointestinal side effects of non-steroidal anti-inflammatory drugs (NSAIDs) a prospective, randomised single blind study was conducted from 1989 to 1992. Patients with osteoarthritis, rheumatoid arthritis and other long standing painful conditions, who were expected to receive NSAIDs for over three months, were recruited into the study. All medicines were discontinued for a period of 10–15 days prior to initial endoscopic assessment. NSAID therapy was started and the patients were randomised to receive either placebo (group A) or sucralfate (group B) in addition. Patient were reassessed clinically every week and an endoscopic examination was repeated after 6–8 weeks of follow-up. A total of 176 patients were studied in group A (n=91) and group B (n=85). At the end of 8 weeks gastrointestinal symptoms were present in 30.6% and 26.4% patients of group A and B respectively. Endoscopic assessment showed superficial lesions in 36.5% and 18.7% while endoscopic ulcer in 2.4% and 1.1% patients of groups A and B respectively. Thus in patients receiving chronic NSAID therapy, simultaneous administration of sucralfate reduces the incidence of superficial gastric lesions but has no significant effect on symptoms or ulcer formation.KEY WORDS: Gastropathy, Sucralfate, Nonsteroidal anti-inflammatory drugs     

{alpha}-Amylase hypersensitivity in non-exposed millers

Occupational hypersensitivity to -amylase among bakers and workersin the pharmaceutical industry has been described. We presentthe results of skin tests and in vitro methods used to assess-amylase sensitivity in 259 millers. There was no occupationalcontact with the enzyme in this population. Positive skin teststo this allergen were obtained in 16 subjects (6.18 per cent),specific IgE values were found in seven subjects (2.7 per cent),specific IgG was detected on 45 workers (17.37 per cent) andhigh values for IgG (>2.5 absorbance units) were found in12 subjects (4.63 per cent). Furthermore, specific IgE and IgGcould be determined in several sera by immunoblotting. All these facts suggested that millers were sensitized to Aspergillusoryzae -amylase, although the allergen was not used by theseworkers. A cross-reaction cannot be excluded; however, it isthe authors' opinion that wheat or wheat flour is a naturalsubstrate for fungi and that the moulds that grow on cerealsor cereal-derived by-products need to secrete amylases to supporttheir own development. Hence the workers may be indirectly sensitizedto amylases.     

Skin-prick tests for hypersensitivity to {alpha}-amylase preparations

Twenty-five asthmatic subjects with suspected -amylase hypersensitivitywere studied by skin-prick tests, a capture ELISA, immunoblottingand bronchial provocation tests. At the same time, differentamylases were analysed by SDS-PAGE and immunoblotting usinga polyclonal rabbit antiserum. Eight patients showed a positivebronchial response to amylase. Seven of them had positive skin-pricktests, with this method being the most sensitive approach fordiagnosis. However, in four cases, skin tests were also positivealthough the patients had a negative provocation test, thusdemonstrating that skin tests are not specific. ELISA and blottingshowed similar results in terms of sensitivity and specificity.The enzymes used by the workers included several antigens besides-amylase. The rabbit antiserum to -amylase detected a proteinin a wheat flour extract. In one case, the IgE antibodies werespecific only for a contaminant of lower molecular weight thanamylase. These facts suggest that proteins from the culturemedium could be responsible for some cases of amylase hypersensitivity,making the diagnosis difficult. The presence of amylase in anotherenzymatic extract, a protease produced by Aspergillus oryzae,was proved by means of skin tests and immunoblotting, thus demonstratingthe allergenic properties of this enzymatic preparation.     

Pain and pain management in newborn infants: a survey of physicians and nurses

BACKGROUND: Despite an increased awareness among clinicians regarding pain and pain management for infants undergoing surgery, pain associated with procedures performed outside the operating room may not be adequately managed. PURPOSE: To examine the beliefs and self-described behavior of physicians and nurses regarding the management of procedural pain in newborn infants. METHODS: A survey was distributed to 467 clinicians (nurses and physicians) working in 11 level II and 4 level III nurseries in a large metropolitan area. Respondents were asked to rate the painfulness of 12 common bedside nursery procedures and how often pharmacologic and nonpharmacologic (comfort) measures are currently used and should be used for those procedures. Demographic data were also collected. RESULTS: Surveys were completed by 374 clinicians (80% response rate). Physicians and nurses believe infants feel as much pain as adults and that 9 of the 12 listed procedures are moderately to very painful. Neither pharmacologic nor comfort measures are believed to be used frequently, even for the most painful procedures. Physicians and nurses believe both pharmacologic and comfort measures should be used more frequently, but nurses believe comfort measures should be used more frequently than do physicians. Beliefs about infant pain and procedural pain were related to pain management preferences. Physicians' but not nurses' ratings were associated with significant personal pain. CONCLUSIONS: Despite their beliefs that infants experience significant procedure-related pain, clinicians believe pain management for infants remains below optimal levels. Barriers to more consistent and effective pain management need to be identified and surmounted.     

Non-invasive detection of fecal protein kinase C betaII and zeta messenger RNA: putative biomarkers for colon cancer

We have developed a non-invasive method utilizing feces, containing sloughed colonocytes, as a sensitive technique for detecting diagnostic colonic biomarkers. In this study, we used the rat colon carcinogenesis model to determine if changes in fecal protein kinase C (PKC) expression have predictive value in monitoring the neoplastic process. Weanling rats were injected with saline or azoxymethane (AOM) and 36 weeks later fecal samples and mucosa were collected, poly A+ RNA isolated, and quantitative RT-PCR performed using primers to PKC betaII and zeta. Fecal PKC betaII and zeta mRNA levels were altered by the presence of a tumor, with tumor-bearing animals having a 3-fold higher (P < 0.05) PKC betaII expression as compared with animals without tumors. In addition, AOM-injection increased mucosal PKC betaII mRNA expression compared with saline controls. No effect of tumor incidence on mucosal PKC betaII expression was observed. In contrast, fecal PKC zeta expression was 2.5-fold lower (P < 0.05) in animals injected with azoxymethane versus saline. Since tumor incidence exerts a reciprocal effect on fecal PKC betaII and zeta mRNA expression, data were also expressed as the ratio between PKC betaII and zeta. The isozyme ratio was strongly related to tumor incidence, i.e. ratio for animals with tumors was 2.18 +/- 1.25, animals without tumors was 0.50 +/- 0.16, P = 0.025. We demonstrate that the expression of fecal PKC betaII and zeta may serve as a noninvasive marker for development of colon tumors. A sensitive technique for the detection of colon cancer is of importance since early diagnosis can substantially reduce mortality.      

Compensation of cyclophosphamide immunosuppression by a bacterial immunostimulant (Broncho-Vaxom) in mice

The compensatory effect of a bacterial lysate, Broncho-Vaxom (BV) on the immunosuppressive action of cyclophosphamide (CY) was investigated. In CY immunosuppressed mice, BV treated animals recovered to normal levels of IgM and IgG in serum as well of IgA and IgG in gut secretions significantly earlier than controls. Furthermore, normal cell proliferation in thymus, as estimated by measuring the relative size of this organ was achieved earlier in BV treated mice than in control mice. Oral treatment with BV restores the number of IgM anti SRBC producing cells in spleen, in CY immunosuppressed mice. Since immunosuppression induced by CY increases the susceptibility to various infections, we tested in immunosuppressed animals the protective effect of BV towards IP challenge infections with Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae var ozaenae, Pseudomonas aeruginosa and Candida albicans. BV led to an enhanced resistance towards both pneumococci and staphylococci challenge infections but not to the other challenge microorganisms.