Irish journal of medical science
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Review Comparative Study
Non-steroidal anti-inflammatory drugs (NSAIDs) and gastro-intestinal toxicity: current issues.
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drugs and their widespread use is associated with increased gastro-intestinal toxic effects such as ulceration, haemorrhage, perforation and death. They result in these complications mainly by reducing cytoprotective prostaglandins (PGE2 and PGI2) in the stomach, through the inhibition of cyclo-oxygenase (COX) enzyme. The increased morbidity and mortality, in addition to enormous cost, associated with NSAID-associated side effects, necessitates a need for safer GI-friendly NSAID. ⋯ These agents preserve the COX-1 that is responsible for the production of cytoprotective prostaglandins in the stomach and selectively inhibit COX-2 induced at the sites of inflammation. Selective COX-2 inhibitors exert the same analgesic and anti-inflammatory effects as the existing NSAIDs but may be less toxic to the stomach. In this review the background development and well-structured clinical trials on this new generation NSAIDs are discussed.
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Several new derivatives of sulphasalazine that make use of its active moiety, 5-aminosalicylic acid (5-ASA), have been introduced for the treatment of inflammatory bowel disease (IBD). In rats short term intravenous administration of 5-ASA has been associated with nephrotoxicity. A number of cases of nephrotoxicity have been reported recently in IBD patients taking oral maintenance treatment with 5-ASA compounds. ⋯ Systemic absorption of 5-ASA from sulphasalazine and olsalazine is relatively low. However, pH-dependent mesalazine formulations may release their contents rapidly in the small intestine and proximal colon resulting in higher plasma and urinary concentrations of free 5-ASA. The effects of free 5-ASA on renal function in the human require further evaluation.
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Mesenteric venous thrombosis, "the great mimicker", is a very rare disorder in pregnancy and the puerperium, particularly when not associated with any pre-existing thrombophilia or autoimmune states. We describe a patient requiring a resection of 150 cm of gangrenous small bowel after uncomplicated elective Caesarean section. The only risk factor for thrombosis was recovery from an elective Caesarean section, a condition classified by the Royal College of Obstetricians and Gynaecologists as "low risk". ⋯ In all cases of MVT anti-coagulation is the basis of treatment. Patients who are not anti-coagulated after surgery have a recurrence rate of 25 per cent compared with 13 per cent of heparinised post-operative patients. As no other pre-existing cause for MVT was found, management was with warfarin for 6 months, the oral contraceptive pill was contraindicated and heparin prophylaxis was recommended for future pregnancies.
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To profile those over 65 yr admitted to an acute geriatric medical service. To identify and assess their undernutrition risk and quantify the nutritional intervention they received. ⋯ The risk of undernutrition on admission to hospital and during treatment is an indicator of the need for nutrition services and nutritional screening for all acute medical services for older people.
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Case Reports
Anaphylaxis due to suxamethonium--manifested at induction of anaesthesia by bradycardia and cardiac arrest.
This case report describes an unusual presentation of a severe anaphylactic reaction following induction of anaesthesia in an elderly male patient. Full recovery followed protracted resuscitation.