During COVID-19, Are Preprints The Problem?
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The document discusses the differences between preprints and peer-reviewed papers, emphasizing the urgency for rapid dissemination of research during the COVID-19 pandemic. It advises caution in interpreting findings from various sources, including preprints, stressing that many conclusions might be incorrect. The author suggests labeling all research with a warning about the potential for inaccuracies until more rigorous studies are completed.
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Pharmacological Management
1. Acid Suppression Therapy
Class Examples Mechanism
Proton Pump Inhibitors (PPIs) Omeprazole, Pantoprazole Irreversibly inhibit H+/K+ ATPase pump
H2-Receptor Antagonists Ranitidine, Famotidine Block histamine-mediated gastric acid secretion
2. Mucosal Protective Agents
Class Examples Mechanism
Prostaglandin Analogues Misoprostol Increases mucus & bicarbonate; decreases acid; protects mucosa
Mucosal Coating Agents Sucralfate Forms protective barrier over ulcer site
Bismuth Compounds Bismuth subsalicylate Antimicrobial, mucosal protective, and anti-inflammatory
3. Eradication Therapy (for H. pylori)
Combination of:
PPI + Two Antibiotics (e.g., amoxicillin + clarithromycin OR metronidazole + tetracycline)
Duration: 714 days depending on local guidelines
See BNF regimens above for detailed protocols
4. Cytoprotective/Adjunctive Agents
Class Examples Role in PUD
Somatostatin Analogues Octreotide Used in bleeding ulcers; reduces splanchnic blood flow and gastric secretions
Antacids Magnesium hydroxide, Aluminium hydroxide Neutralize gastric acid; provide symptomatic relief
Non-Pharmacologic Measures
Avoid NSAIDs, smoking, alcohol, and spicy foods
Small, frequent meals in symptomatic patients
Stress reduction
Endoscopic therapy in case of bleeding or perforation
Surgical Indications (rarely needed)
Perforated ulcer
Gastric outlet obstruction
Refractory ulcers not responding to medical therapy
Severe bleeding unresponsive to endoscopic management
Summary
Peptic ulcer disease is primarily driven by H. pylori infection and NSAID use, with duodenal ulcers more common than gastric. Treatment is tailored based on etiology and includes acid suppression, H. pylori eradication, and mucosal protection. Advanced cases may require somatostatin analogues for hemorrhage control or surgery for complications. Prostaglandin analogues like misoprostol are especially valuable in preventing NSAID-induced ulcers.Diabetes Mellitus Chapter 3 | Pathophysiology, Complications & Management
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Designed for nursing, medical, and allied health students, this slide deck highlights key points on pathophysiology, clinical signs, diagnostic criteria, pharmacologic and non-pharmacologic management, and preventive care strategies.
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Diabetes Mellitus Chapter 3 | Pathophysiology, Complications & Management
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