Qualitative and quantitative gastric ultrasound assessment in highly skilled regional anesthesiologists

Background Pulmonary aspiration is a major complication in anesthesia, and various studies have shown that gastric sonography can reliably provide valuable information relative to both the qualitative and quantitative aspects of gastric content. This study aimed to determine the accuracy of ultrasound assessment of gastric content compared between two novice anesthesiologist gastric sonographers. Methods This prospective cohort study of two anesthesiologists learning to perform qualitative and quantitative ultrasound assessment of gastric content on healthy volunteers was conducted at Siriraj Hospital (Bangkok, Thailand). This trial was registered with ClinicalTrials.gov (reg. no. NCT04760106). Results Of the 50 enrolled participants, three were excluded due to study protocol violation. Each anesthesiologist performed a qualitative assessment on 47 participants for an overall total of 94 scans. There were 15 males and 32 females (age 42 ± 11.7 years, weight 61.2 ± 13.1 kg, height 160.7 ± 7.3 cm, and BMI 23.6 ± 4.3 kg/m2). The overall success rate for all gastric content categories was approximately 96%. From antral cross-sectional area measurement, as the ingested volume increased, there was a tendency toward increased deviation from the actual ingested volume. Interrater agreement between anesthesiologists was analyzed using intraclass correlation coefficients (ICCs). A larger fluid volume was found to be associated with a lower level of agreement between the two anesthesiologists. The ICCs were 0.706 (95% CI: −0.125 to 0.931), 0.669 (95% CI: −0.254 to 0.920), 0.362 (95% CI: −0.498 to 0.807) for the 100 ml, 200 ml, and 300 ml fluid volumes, respectively. The mean duration to perform an ultrasound examination for each gastric content category and for the entire examination did not differ significantly between anesthesiologists (p > 0.05). Conclusion Our results indicate that qualitative ultrasound assessment of gastric content is highly accurate and can be easily learned. In contrast, quantification of gastric volume by novice gastric sonographers is more complex and requires more training. Trial registration ClinicalTrials.gov no. NCT04760106 Date registered on Feb 11, 2021. Prospectively registered.

Phytochemical and Pharmacological Evaluation of Annona reticulate

Annona reticulate (AR) is indigenous to the tropical areas of India and worldwide. The use of plant as remedy for diarrhea and ulcer is well documented in Ayurvedic system of medicine. However, pharmacological evidence does not exist to substantiate its therapeutic efficacy for the same. The aim was to investigate the antiulcer and anti-diarrheal activity of methanolic (ME) and aqueous extracts (AE) of A. reticulate in animal model. The antiulcer activity of extracts was investigated using ethanol and pylorus ligation-induced ulcer. The anti-diarrheal activity of MEAR and AEAR extracts was evaluated by castor oil induced diarrhea and gastro intestinal motility using parameters such as onset of diarrhea, number of wet stools, total number of stool and weight of total number of stools. The antiulcer activity of the extracts was confirmed by a reduction in ulcer index along with the decrease in gastric volume, total acidity, and an increase in pH of gastric content in both the models. A. reticulate extracts were more efficacious in reducing number of total stools in both the models of diarrhea and showed a dose-dependent antidiarrheal effect. The obtained results have established a pharmacological evidence for the folkloric use of the A. reticulate as antiulcer and antidiarrhoeal agent.

BIOCORROSION AS NA ETIOLOGICAL FACTOR OF NON-CARIOUS LESIONS: A LITERATURE REVIEW

Aim: The present study aimed to carry out a literature review about biocorrosion as an etiological factor of non-carious lesions and dentin hypersensitivity. Method: The bibliographic search was performed in the PubMed and Virtual Health Library (VHL)databases, selecting articles published from 2015 to 2020, available in full text, in Portuguese and English, and related to the proposed theme. Results: In the studies included, it was observed that substances with low pH, high titratable acidity, some lifestyles, and occupational habits are factors that can directly interfere with dental demineralization. As a consequence of this process, non-carious lesions and dental hypersensitivity have increased their incidence. Conclusion: The main sources of acids that attack dental structure are food and beverages and endogenous acids of gastric content. Thus, it must be considered themultifactorial character of this process and the association with other etiological factors, such as tension and friction in the development of non-carious lesions, aiming to restore oral health to the patient.

Excess Body Weight and Gastroesophageal Reflux Disease

<b><i>Background:</i></b> Gastroesophageal reflux disease (GERD) is strongly associated with excess body weight. <b><i>Summary:</i></b> GERD is characterized by typical symptoms with or without mucosal damage because of retrograde flow of gastric content into the esophagus. An ineffective esophagogastric junction (EGJ) combined with anatomical abnormalities is considered to be causative. The incidence of GERD is strongly associated with excess body weight, reflecting the pathophysiological relevance of the abdominothoracic pressure gradient. <b><i>Key Message:</i></b> Weight loss has been demonstrated to be an effective therapy for GERD combined with obesity. In cases in which surgical therapy is indicated, traditional antireflux surgery has led to equivocal results, advocating a proximal Roux-en-Y gastric bypass in these patients to correct both GERD and excess body weight.

Association between gastric content fluidity and pars oesophageal ulcers in nursery pigs: a cross-sectional study of high-risk Danish herds using commercial feed

Background The objective of this cross-sectional study was to assess the within-herd prevalence of pars oesophageal ulcers (POU) in high-risk Danish herds using commercial diets. Furthermore, we aimed to estimate the association between gastric content fluidity and POU using a generalised additive model (GAM). The study included 200 clinically healthy nursery pigs randomly selected from ten farms (20 pigs from each farm). The 10 farms were selected based on a suspected high prevalence of gastric ulcers. Post-mortem gastric ulcer assessment was based on macroscopic lesions, and gastric content fluidity was assessed based on the solid particle sedimentation percentage (solid phase). Results We observed an overall prevalence of 35.5% for POU in nursery pigs. Within-herd prevalence varied considerably among farms, with values ranging from 0% in Farm 1 to 84% in Farm 4. Our model showed strong associations between POU and gastric content fluidity (P < 0.001), as well as between POU and farm of origin (P < 0.001). In addition, we observed that the risk of POU decreased non-linearly as the gastric content solid phase percentage increased, i.e. as the gastric content became more solid. Conclusion We have demonstrated that pars oesophageal ulcers are present in Danish herds with nursery pigs fed commercial diets. Furthermore, we have established that gastric content fluidity is strongly associated with POU in nursery pigs. Even so, we cannot conclude that gastric content fluidity is solely responsible for POU. Future research should look into the association between pars oesophageal ulcers and both farm management activities and individual pig factors.