Clarithromycin versus gemifloxacin in quadruple therapeutic regimens for helicobacter pylori infection eradication

Background: helicobacter pylori [H. pylori] infection is a major casual factor in any peptic diseases. Clarithromycin as one of the drugs recommended for the infection eradication regimen has shown different levels of resistance. The present study is comparing the effectiveness of clarithromycin- and gemifloxacin - based quadruple regimens in H. pylori eradication

Methods: this was a prospective double blind randomized clinical trial on patients with clear indication of H. pylori eradication. The patients were randomly divided into two groups: "BPAC group" treated with bismuth subcitrate [240 mg], pantoprazole [20 mg], amoxicillin [1 gr], and clarithromycin [500 mg], all twice daily, and the "BPAG group" treated with bismuth subcitrate, pantoprazole, and amoxicillin with same doses as "BPAC group" and gemifloxacin [320 mg daily] all for 10 days. Three months after the end of therapy, 14C-Urea breath test was performed to confirm the eradication. All the patients were assessed for compliance and drug side effects. Based on per-protocol [PP] and intention-to-treat [ITT] methods, data were analyzed and a P value<0.05 was considered as statistically significant. This project has been registered in the Iranian registry of clinical trials [IRCT]

Results: three patients were excluded from the survey and finally, 179 patients [89 patients in BPAC group and 90 patients in BPAG group] including 71[39.66%] men with the mean age of 46.4+/-12.3 years completed the treatment period. The incidence of side effects between the two study groups did not differ significantly. The success rate of BPAC regimen eradication was remarkably greater than BPAG regimen [ITT analysis; 89% vs 77%, respectively; CI 95%: 1.072-5.507, P<0.015 and PP analysis; 91% vs 77.8% respectively; CI 95%:P<0.015]. There was no significant relationship between the demographic features and the eradication results

Conclusion: the results showed that gemifloxacin is not a good alternative for clarithromycin in H. pylorieradication regimens in our region

effect of zinc supplementationon the symptoms of gastroesophageal reflux disease; a randomized clinical trial

Background: Currently, it has been demonstrated that gastroesophageal reflux disease [GERD] is one of the most important disorders of the digestive system and the commixture of regular diet has a significant influence on its incidence, symptoms, and prognosis. The purpose of this study was to evaluate the effect of zinc supplementation, in combination with PPIs [Proton pump inhibitors], on the improvement of GERD symptoms

Methods: In a randomized double blind clinical trial, patients with reflux symptoms, who had obtained Reflux Disease Questionnaire [RDQ] score more than 8, were included and all the demographic features were recorded. Then, using upper gastrointestinal [GI] endoscopy, all the patientswere divided into two groups as having non-erosive reflux disorder [NERD],or erosive reflux disorder [ERD]

At the next step, based on random block statistical method, we divided the two groups into two subgroups; the drug subgroup [treated with PPIs [40 mg pantoprazole/daily], changing life style, and 220 mg zinc capsules daily] and the placebo subgroup [treated with PPIs, changing life style, and placebo]. After 3 months, we analyzed all data and the RDQ questionnaire was filled out for each patient. This project has been registered in Iranian Registry of Clinical Trials [IRCT] and all data were analyzed using SPSS software version 2

Results: A total of 140 patients [81 women and 59 men] with mean age of 42.78+/-11.5 years were included with 70 patients in each group. The most frequent presentations were heart burn [45.7%], and acid regurgitation [39.3%]. The RDQ scores decreased after intervention in both drug [p<0.001] and placebo groups [p<0.001], which were statistically significant. But the difference of RDQ scores between the drug group and placebo group was not statistically significant [p=0,086]

Conclusion: Zinc supplementation cannot improve the severity of GERD

Epidemiologic features of inflammatory bowel disease in Guilan Province, North of Iran, during 2002-2012

The geographical incidence of IBD varies considerably. This study aimed to survey the epidemiologic features of IBD in Guilan province, North of Iran, during ten years duration. In this retrospective cross-sectional study, we assessed the documents of 868 patients with IBD referred to private and governmental clinics of Guilan province between 2002 and 2012. Variables such as demographic data, risk factors, diagnosis, extraintestinal manifestations and type of treatment were collected. Among 868 patients with IBD, 756 patients [87.1%] diagnosed as UC and 112 patients [12.9%] as CD. The mean age of patients with UC and CD was 46.73 +/- 15.79 and 40.15 +/- 14.27 years respectively. Male/female ratio in UC and CD was 0.92:1 and 0.75:1 respectively. The most common age of disease initiation in UC was 40-59 years and in CD 20-39 years [p<0.001]. Extraintestinal manifestations were seen in 25.4 percent of patients with IBD. Most of patients were treated with combination of two drugs: salicylates and azathioprine [p<0.04]. The incidence of IBD gradually increased during the past 4 years in Guilan province. This study showed that CD were presented significantly more common in younger patients than UC and totally the disease was slightly more common in female

[ case of strongyloidiasis presenting as ulcerative colitis]

Strongyloidiasis disease caused by the Strongyloidesstercoralis nematode. This disease mainly affects the intestines. Sometimes the symptoms were similar to inflammatory bowel disease which may lead to misdiagnosis and lack of effective treatment.A 46-year-old male patient who complained of occasional diarrhea, sometimes with blood, about two months ago consulted with an internist. He had colonoscopy and ulcerative colitis was diagnosed without biopsy. The patient was treated with Mesalamine together with Prednisolone. The patient's symptoms improved within the first two weeks, but after the third week got worse and he referred to a gastroenterologist. The patient then underwent colonoscopy and biopsy was done this time.In the biopsy, Strongyloidesstercoralis larvae were observed. Prednisone and Mesalamine were stopped and Ivermectin tablet was administered. Patient's symptoms improved within a week to ten days and one year after treatment patient did not express any complaint. For diagnosis of ulcerative colitis, In addition to the colonoscopic observations, biopsy is necessary. Especially in the northern regions of the country, before initiating treatment with immunosuppressive and steroid drugs and/or if no response to treatment, it is necessary to think about strangyloidiasis

[Leptospirosis or Weil disease a febrile illness with jaundice]

Leptospirosis is a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects humans and a wide range of animals. The disease was first described by Adolf Weil in 1886, reported as an "acute infectious disease with fever and jaundice". Outbreaks of leptospirosis are usually caused by human exposure to water or soil contaminated with the urine of infected animals through broken skin especially mucosal surfaces. Direct contact with infected animals may also be significant [slaughterhouse workers, veterinary surgeons] or in certain occupations, e.g. workers in rice fields or those who swim in infected surface water or adventure sports in tropical regions. Patients may appear as asymptomatic, mildly ill or toxic. High fever, chills, myalgias particularly prominent in the paraspinal and calf muscles and intense headache are among the first flulike symptoms that may appear. Later in severe disease, jaundice, meningitis and renal failure can develop. Cardiovascular problems are also possible. Diagnoses procedures include testing serologically with a panel of different strains. It is also possible to culture the microorganism from blood, serum and fresh urine. Hygienic methods such as avoidance of direct and indirect human contact with animal urine are recommended as preventive measures. The main preventive measure for leptospirosis is to create awareness about the disease and its prevention. Treatment for leptospirosis is based on antibiotic therapy allied with supportive care. There are no clinical examples of drug resistance developing. This review article also presents survey and the disease burden in Giulan

Unexplained infertility as primary presentation of celiac disease, a case report and literature review

Celiac sprue [gluten sensitive enteropathy] is an autoimmune disease which is hereditary and its pathology mainly bases on immunologic intolerance to gluten. It has a vast variety of signs and symptoms and its clinical features range from a silent disease to a typical gastrointestinal disorder. In this study we reviewed and summarized some other related issues about this disease and its relation with infertility. Case: The case is a 26 years old lady who had referred to a gynecologist because of infertility for 2 years and later it revealed that she has celiac sprue. Screening for its silent or subtle types especially among suspicious cases such as unexplained infertility seems to be a cost effective action. Meanwhile, in time administration of a gluten-free diet can lead to an almost complete cure

Hepatitis C and hepatitis B seroprevalence and associated risk factors in hemodialysis patients in Guilan province, north of Iran

Hepatitis C virus [HCV] and hepatitis B virus [HBV] infection are especially problematic in patients with end-stage renal disease who are undergoing hemodialysis [HD]. To determine the prevalence of HCV and HBV infection in HD population in Guilan, north of Iran. In a cross-sectional study, from May to September 2009, in 11 different hemodialysis units in Guilan province, North of Iran, clinical data such as age, gender, duration of dialysis, HBsAg and anti-HCV antibody of 514 HD patients were recorded. Patients with positive antibodies against HCV were tested for HCV RNA. From 514 patients, 286 [55.64%] were male. 61 [11.9%] patients were anti-HCV-positive and 31 [50.8%] were HCV PCR-positive. There was significant relationship between HCV Ab-positivity with gender and HD duration [p<0.05]. There was significant difference between the mean HD duration in anti-HCV-positive and anti-HCV-negative patients [p<0.05]. Also, significant relationship was found between HCV RNA-positivity with gender and HD duration [p< 0.05]. Seven [1.4%] patients were positive for HBsAg. Two [0.38%] were found positive for both HBsAg and anti-HCV antibody. There is low a prevalence of HCV and HBV in HD patients in our region. The rate can be decreased by HBV vaccination of end-stage renal disease patients before setting chronic HD, antiviral treatment and isolation of infected individuals

Knowledge and practice of general pracctitioners and internists about helicobacter pylori infection in Guilan, Iran

This study aims to elucidate the knowledge and practice of general practitioners [GP] and internists regarding diagnosis and treatment of Helicobacter pylori [H. pylori] infection in a high prevalent area, with the intent to assist with future educational strategies for H. pylori infection. In this cross-sectional study in Guilan, a Northern Province of Iran, all GPs and internists in the city of Rasht were included. Questionnaires consisted of questions on demographic characteristics in addition to physicians' knowledge and practice regarding H. pylori infection. The questionnaire was verified by a panel of experts, validated by the test-retest method, and distributed among participants. Socres higher than the mean score indicated good knowledge or attitude. Those lower than the mean score indicated poor knowledge and attitude. Data were collected and analyzed by SPSS version 14 software. The mean [SD] knowledge and practice score of physicians was 12.1 +/- 3.13 and 2.37 +/- 1.54, respectively. Overall, 67.9% of GPs and 91.7% of internists exhibited good knowledge scores, while 72.4% of GPs and 95.8% of internists showed good practice. Physicians who used books or educational programs and had working histories of less than 10 years scored significantly higher in terms of mean knowledge. The mean practice score of physicians who worked in public units and had working histories of more than 5 years and those who had used books or educational programs was significantly higher. Since H.pylori infection is prevalent in Iran and GPs' practices are directly under the influence of knowledge, it is necessary to attempt to increase the level and quality of information among GPs by educational and Continuing Medical Education programs and seminars

Epidemiology, microbiology, chinical presentation, diagnosis and treatment of clostridium difficile

Clostridium difficile is the causative organism of antibiotic associated colitis. Colonization of the intestinal tract occurs via the fecal-oral route and is facilitated by disruption of normal intestinal flora due to antimicrobial therapy. The organism is capable of elaborating exotoxins that bind to receptors on intestinal epithelial cells, leading to inflammation and diarrhea Our understanding of C. difficile microbiology and epidemiology is changing rapidly. In this review article we discuss microbiology, epidemiology, clinical manifestations, diagnosis, and prevention and treatment of C. difficile

[Distribution of HCV genotypes in hemodialytic patients of Guilan [the north province of Iran]]

Hepatitis C virus [HCV] infection has been identified as the major cause of chronic liver disease among patients on chronic haemodialysis [HD]. The aim of this study was to identify the HCV genotypes among chronic HD who were HCV positive in Guilan province in North of Iran. All the patients on HD from eleven Guilan HD centers were enrolled; their sera were screened for anti HCV antibodies by enzyme-linked-immunosorbent assay [ELISA] and polymerase chain reaction [PCR] and genotyping was performed in positive anti HCV cases. SPSS 14 was used for analysis and P<0.05 were considered statistically significant. Out of 514 enrolled patients, 61 [11.9%] were serologically HCV positive and 32[6.2%] had positive HCV RNA [CI 95%: [9.07-14.67]]. The most frequent genotypes were 1a and 3a with prevalence of 59.38% [CI95%: [42.36-76.4]] and 40.62% [CI 95%: [23.61-57.65]], respectively. There was no significant relation between virus genotypes and gender or age. An important finding was the high prevalence of genotype 3a [64.7%] in Rasht, the capital city of the province [P

[Isolation and serotyping of endemic leptospires of eastern part of flat area of Guilan province, Iran]

Leptospirosis is a zoonosis that is more common in tropical and semitropical regions and is endemic in Guilan province. In endemic region, only a limited number of pathogenic serovars are common, characterization of them is very important step in detecting the main reservoir [s] of the disease. This study was performed to isolate leptospires from rice farms, irrigation canals and rivers of eastern part of flat area of Guilan province to detect main endemic serotypes of leptospirosis. In this descriptive and cross - sectional study samples were taken from 8 cities of the area of Guilan province, Noth of Iran between May to September of 2007. Two ml of any processed water sample was inoculated in liquid EMJH medium with 200 micro g/ml 5-flurouracil after filtration, were incubated in 30°C for 3 monthes, and were checked by darkfiel microscopy every two weeks. All positive samples were serotyped by using 30 type antisera which were main representative of serogroups. 47 of 320 specimens were positive and 273 samples were negative. One saprophytic specie [Biflexa] including two serogroups [Andamana, and Semaranga] and three pathogenic species [Interrogans, Kireshnerii, and Boirgpetersenii] including 6 serogroups were detected Icterohaemorrhagiae, Pomona, and canicola of interrogans, Hardjobovis and Sejroea of Borgpeterseni pecie, Grippotyphosa of KircshnerL Non-pathogenic serogroups were found from surface water, but the pathogenic serogroup were detected only from rice farm water. The high incidence of leptospirosis in rual area concide with seasonal rice cultivation, which can be due to trafic of domestic animal in rice farms and elevation temprature, and activity of rice farm water with subsequent presence of pathogenic type and serotypes in rice farm

Anti CagA antibody among patients with non-cardia gastric cancer in comparison with non-ulcer dyspepsia in an area with high incidence of gastric cancer

To evaluate the correlation between anti CagA antibody [Ab] and presence of gastric cancer. In a descriptive cross-sectional study during October 2003 to October 2005, in the Gastrointestinal Subspeciality Center in Razi Hospital, Rasht, Iran, we assessed anti-Helicobacter Ab immunoglobulin G [IgG] and anti CagA Ab IgG by the enzyme-linked immunosorbent assay [ELISA] method in 52 patients with gastric adenocarcinoma and 57 patients with nonulceric dyspepsia [NUD]. Among 52 patients with gastric cancer, anti-Helicobacter pylori Ab was negative in 13 [25%] and positive in 39 persons [75%]. Among 57 patients with NUD, anti-Helicobacter pylori Ab was negative in 5 [8.5%] and positive in 52 patients [91.2%] [p=0.043]. This significant difference did not remain after logistic regression for adjustment of confounders [p=0.068]. The CagA Ab was positive in 22 [42.3%] patients with cancer and 32 [56.1%] of the NUD group. There was no difference in this regard before [p=0.212] and after [p=0.131] logistic regression analysis. Anti CagA Ab does not have a significant value as an independent predictive factor in gastric adenocarcinoma

Epidemiologic assessment of Leptospira serotypes in Caspian littoral

Leptospirosis is a widespread zoonosis in the world with more prevalence in tropical and subtropical regions. The disease is very common in flat area of Gilan, northern Iran, where the climate is humid and temperate and rice farming is main agricultural activity in rural areas. We performed this study in 2004 by taking blood samples from 465 hospitalized patients who were suspected of leptospirosis based on their clinical presentation, to find positive cases and analysis their signs, symptoms, and epidemiological data, and also to determine the most common clinical features of the disease in the area. All sera were examined by microscopic agglutination test. Renal failure was most common symptoms [4.5%]. Icterhaemorrhagia had highest titers in 57.0% of patients. In Gilan province, some of the farmers get leptospirosis each year near the end of spring and summer at the time of rice harvesting. Better recognition of the disease and diagnosing it at proper time can improve the quality of life and health state of the farmers

Quality of life in chronic hepatitis B and C patients

Chronic hepatitis B and C are prevalent diseases, especially in developing countries. In many of the patients they cause limitations in physical and mental functions and finally cause reduction in their life quality. We wanted to assess the quality of life in these patients. This research was done on 74 chronic hepatitis B and C patients of Rasht which their diseases were confirmed by serologic and histologic methods and their hepatic enzymes including AST and ALT was two times more than normal range for at least 6 months. Cross-sectional questionnaire survey performed in October 2003 till Jully 2004 in Gastrointestinal and Liver Diseases Research Center of Rasht [north city of Iran], Razi hospital. The questionnaires consisted of 29 questions that were given to the patients and they were let free to complete it. The individuals under survey consisted of 15 [20.27%] chronic hepatitis B patients and 59 [79.72%] chronic hepatitis C patients. 54 [72.79%] ones were male and 20 [27.02%] were female. Total adjusted score [up to 100 points] of life quality was 54.4 +/- 22.5. No meaningful difference was seen between two sexes based on total score of life quality. Also, in different fields of life quality no significant difference was seen between two genders, except the systemic signs that the average of adjusted score of females [43 +/- 28] was less than males [63 +/- 27] that means meaningful statistical difference [P < 0.007]. Generally, it seems that chronic hepatitis B and C have untoward life qualities which could result from concern of decrease of social support or fear of society or decrease in patronage of the family or friends and it is mandate to be concerned when furnishing services to these patients

Efficacy of Lamivudine therapy on decompensated liver cirrhosis due to chronic hepatitis B

The aim of this study was to determine the effect of lamivudine on liver function and clinical status of the patients with decompensated cirrhosis arising from hepatitis B virus [HBV]. In a clinical trial on the basis of liver consideration in 55 patients with cirrhosis that had positive HBsAg and HBV DNA, Child-Pugh score more than 8 and some other criteria were treated with lamivudine. In these patients, serum level of bilirubin, albumin, ALT, AST and also the PT-INR were controlled at the beginning of study and then at intervals of 2 to 6 months and finally 12 months after the start of treatment. Five patients died in the first 6 months of treatments. The following results are related to 50 patients being under treatment with lamivudine at least for a period of 6 months. In these patients mean Child-Pugh score was decreased from 11 +/- 2 to 7 +/- 1 [P < 0.0001]. All of the patients tolerated this drug very well. Lamivudine can be effective in improvement of liver function in patients with decompensated liver cirrhosis resulting from HBV, but for determination of proper period of treatment, further studies are necessary

Seroprevalence of Hepatitis B and C among residents of Guilan Nursing Home

Viral hepatitis represents one of the most significant public health challenges. The institutionalization itself is an important factor influencing the risk and frequency of exposure and further spread of HBV and HCV infections. This study was carried out to determine the frequency of HBV and HCV serological markers in residents of Guilan nursing home. Demographic data and history of exposure to known risk factors were collected by interview and through medical records available at the nursing home; clinical information was obtained via examination. All residents were screened for markers of HBV and HCV. HBsAg or HCVAb positive cases were examined for HBeAg, HBcAb, and HCV-RNA, respectively; and complementary tests including AST, ALT, ALP, bilirubin, serum albumin, and prothrombin time [PT] were done. 383 residents of Guilan nursing home including 243 females [63.4%] with mean age of 58.4 +/- 21.9 years were investigated. The average duration of residency was 6.0 +/- 5.7 years. Nine cases [2.3%] including 6 males [4.2% of all males] were anti-HCVAb positive. Out of these 9 cases, 5 individuals were HCV-RNA positive. All of these 5 cases were male. The average duration of residency in HCV positive cases was 1.5 +/- 1.8 years in comparison with 6.1 +/- 5.8 years in negative cases. There was a significant reverse relationship between residency duration and HCV positivity in logistic regression. Residency in nursing home is not an important risk factor for viral hepatitis transmissions. However; we recommend precise and complete viral hepatitis screening on admission to nursing home and HBV vaccination for HBV negative cases