Introduction: Upper gastrointestinal bleeding (UGIB) is the most common cause of emergency admission in gastrointestinal disease. UGIB could accompany with adverse events if not treated timely. Different scoring systems have been suggested for diagnosing these patients, In this study we aimed to compare the predictive value of two scoring systems AIMS65 and Glasgow Blatchfors scale (GBS) in patients with UGIB. Methods: In this cross-sectional study, 153 patients (71.9% male with mean age of 56.72±21.64 years) with acute UGIB between April 2017 and September 2018 were included. Demographic findings, past medical history, laboratory findings, AMIS65 and GBS score, as well as, need for urgent endoscopy, transfusion and mortality were recorded. Both methods value in predicting the outcomes were measured using ROC curves. Results and Conclusion: Urgent endoscopy was performed in 44.4%. The most common finding was peptic ulcer with mostly clean base type. Rebleeding occurred in 15%, need for transfusion was in 44.4% and mortality rate was 5.2%. AIMS65 compared to GBS was superior in predicting mortality (AUC of 0.947 vs. 0.80) but was inferior compared to GBS in predicting need for transfusion (0.849 vs. 0.947). None of the systems could predict the need for urgent endoscopy. AIMS65 with cut off 2 and 0 and GBS with cut off of 12 and 8 could predict mortality and need for transfusion. GBS seems a better system in predicting the need for blood transfusion, while AIMS65 is better system for predicting in-hospital mortality in patients with UGIB.
In this study, we evaluated the efficacy of NAC in dyspepsia symptoms in Helicobacter pylori (H. pylori) negative dyspeptic patients. Materials and Methods: In this randomized clinical trial, 85 patients with functional dyspepsia without H. pylori infection underwent treatment with a proton pump inhibitor (PPI) pantoprazole 40mg daily (n=41) with or without NAC 600mg twice a day (n=44) for 8 weeks. Patients' clinical symptoms and change in the severity of dyspepsia symptoms were compared between the groups. Results: Common symptoms were epigastric pain and bloating. The intervention group had significantly more cases with retrosternal burn and bloating and less early satiety as compared to the control group. In both intervention and control groups dyspepsia severity was significantly reduced from 5.26±2.06 and 4.68±2.81 to 1.87±1.38 and 2.22±2.04, respectively (p<0.001). The percent of reduction in dyspepsia severity in intervention group was significantly higher than control group (-66.25±23.44% vs.-50.14±35.02%, p=0.01). Conclusion: PPI is an effective treatment for functional dyspepsia and NAC as an adjuvant to a PPI is a safe medication that can increase the response rate and treatment efficacy.
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