ABSTRACT
Introduction: Various regimens have been used for H-pylorieradication. Sequential therapy is an alternative to classicaltriple therapy. This study was designed for evaluatingthe efficacy of levofloxacin based sequential therapyvs clarithromycin based sequential therapy in H-pylorieradication.Material and methods: It is a randomized clinical trial. Twohundred H. Pylori infected patients diagnosed by rapid ureasetest (RUT) on UGI endoscopy were randomly divided intotwo groups A and B. Group B Levofloxacin based sequentialregimen and group A clarithromycin based sequential regimen.H-pylori eradication status was evaluated with rapid ureasetest on UGI endoscopy 6 weeks after completion of sequentialtherapy.Results: As per protocol, eradication rates for group B and Awere 86% and 81% respectively. Eradication rate for H-pyloriis greater with levofloxacin based sequential therapy ascompared to that of clarithromycin based sequential therapybut it is not statistically significant p >0.05.Conclusion: Levofloxacin based sequential therapy has highereradication rate than clarithromycin based sequential therapy.Although not statistically significant in our study, levofloxacinbased sequential therapy could be better alternative forthe treatment of H-pylori in areas with high clarithromycinresistance.
ABSTRACT
Introduction: Neglected cases of hemorrhoids presentingwith complications like strangulation are not uncommon,as observed in our tertiary care hospital. Under the abovebackground we conducted the present study to look into theprofile and management of the patients with complicated(especially strangulated) prolapsed hemorrhoids attending toour tertiary care hospital.Material and methods: This prospective hospital based studywas conducted in unit-II of department of general surgery inShri Maharaja Harisingh (SMHS) hospital Srinagar over aperiod of 5 years from January 2013 to December 2017. Allpatients with complicated prolapsed internal hemorrhoids(strangulation with infection, ulceration, gangrene, and/or necrosis) were enrolled in this study. Patients presentingwith features suggestive of complicated prolapsed internalhemorrhoids were subjected to clinical history, local inspectionand examination to confirm the diagnosis, and were managedappropriately.Results: During the study period of 5 years, 31 patients ofcomplicated (strangulated) prolapsed internal hemorrhoidswere enrolled. The age of our patients ranged from forty-fourto seventy-two years with mean age of 59.12±6.56 (SD=6.56)years. In our study 20 patients (64.5%) were from rural areaand 11 patients (35.5%) were from urban background. Mostcommon presentation in our study was strangulated prolapsedinternal hemorrhoid with pain, ulceration and infection.Conclusion: Patients with grade 3 and 4 internal hemorrhoids,patients having difficult access to health care facilities, andpatients having poor compliance to conservative treatment,should be offered surgical intervention at the earliest beforethe complications arise. Complicated prolapsed internalhemorrhoids can be managed initially conservatively (byprone position, bed rest, saline compresses, hot baths, icepacks, soothing topical applications, laxatives, antibiotics, sitzbath with antiseptic solutions)