Effect of triple therapy for helicobacter pylori eradication on hepatic encephalopathy: a randomized controlled trial

Helicobacter pylori [H. pylori] infection could potentially contribute to the development and severity of hepatic encephalopathy due to strong urease activity in the stomach of H. pylori infected cirrhotic patients. To assess the effect of triple eradication therapy for H. pylori on hepatic encephalopathy. Open randomized controlled clinical trial with 4 arms. liver diseases unit in Suez Canal University Hospital - tertiary care. Forty four Hp+ [Group 1] and 44 Hp- patients [Group 2] [based on rapid urease test of gastric biopsy] with hepatic encephalopathy grade 1 - 3. Triple eradication therapy for H. pylori versus standard treatment for hepatic encephalopathy in group 1 and antimicrobial therapy [without Omeprazole] versus standard treatment in group 2 for 14 days. Blind assessment of the grade of encephalopathy before and within three days from end of treatment. One grade improvement was considered treatment success. Success rate was 18.2% in standard treatment and 63.6% in triple therapy [p< 0.001] in H pylori positive. While in H. pylori negative patients the success was 9.1% in standard treatment versus 59.1% [P< 0.001] in and antimicrobial therapy. Success rate was not significantly different between standard treatment or between triple therapy and antimicrobial therapy among both groups. Among other factors in logistic regression models both triple therapy [OR: 1.03<6.22<37.69, P= 0.047] and antimicrobial therapy [OR: 2.09<11.42<59.46, P= 0.02] were significant predictors of success in the respective groups. Both triple eradication therapy for H. pylori and antimicrobial therapy only, equally improve the outcome of management of hepatic encephalopathy. The improvement may be attributed to the effect of antimicrobial therapy on ammonia producing gut flora rather than H. pylori eradication. H pylori eradication therapy adds no benefit in hepatic encephalopathy

Risk factors of stone recurrence in idiopathic renal calculi

Recurrent kidney stone [RKS] is a long-term problem causing a significant morbidity. The study was conducted to determine the rate of recurrence of calcium oxalate [Ca-Ox] kidney stones at 5 years after the first symptomatic stone, and to identify the risk factors of stone recurrence and their predictive values. The study included 233 patients with idiopathic Ca-Ox kidney stones. Medical History abbreviated food frequency questionnaire, and laboratory investigations were used to collect the data. The relative risk and 95% confidence interval of stone recurrence for each hypothesized risk factor was determined. Multivariate analysis using logistic regression [LR] was used to identify the significant risk factors and their negative and positive predictive values. The overall rate of recurrence was 61.8%. Young agent the first stone episode, male sex, positive family history [FH] and low fluid and high protein intake were found to be significant risk factors of stone recurrence. No significant differences were identified between recurrent and first stone formers for any of the laboratory measurements. The positive and negative predictive values of a model containing the significant risk factors were 78.3% and 54.4% respectively, with an overall prediction of 69.1%. Ca-Ox kidney stones have a high rate of recurrence. Fluid and protein intake appears to play an important role in kidney stone recurrence. We cannot, identify a good predictive model for stone recurrence so, we recommend pursuing diagnostic and therapeutic approaches for all first-stone formers

Hepatitis C virus genotyping among different groups with positive serological evidence for HCV infection

Hepatitis C viral [HCV] infection, is a major health problem all over the world. HCV genotypes have been implicated in many: clinical aspects including the severity of liver disease, response to antiviral therapy and geographical distribution. A number of previous studies highlighted the magnitude of HCV infection in Egypt. In the current study we assessed the distribution of HCV genotypes, and the prevalence of HCV viremia among 204 Egyptian subjects classified into four high-risk groups as follows: HCV-associated chronic liver disease [n=144]. healthy blood donors [n=18], hemodialysis patients [n=14], and family contacts of index patients [n=28]. And for comparison HCV genotypes were also determined among 115 American patients chronically infected with HCV. HCV antibodies were assessed using 2nd generation [EIA]. HCV RNA was detected by nested RT-PCR. using primers specific to the 5 UTR region of the HCV genome. HCV genotypes were analyzed using restriction fragment length polymorphism [RFLP] and HCV viral quantitation was carried out using branched DNA assay [bDNA]. HCV viremia was demonstrated in 53% of the overall population, 42% were negative for HCV RNA while 5% showed indeterminate results. HCV genotype distribution revealed that the majority [72%] of our population was infected with type 4a. while type la and Ib were demonstrated in 4% and 15% respectively. HCV risk factors were given by 74% of the patients while 26% were unaware of any exposure to risk factors. More that 60% of the population were unaware of the duration, of their infection. Liver transaminases were significantly higher in HCV viremic patients compared to non-viremic ones. Both HCV viremia and HCV genotypes were statistically unrelated to the examined predictor variables i.e. age, gender, risk factors including schistosomiasis, duration of infection or liver histology. In the American population HCV genotype 1 was the most common genotype. The majority of patients reported duration of 10-20 years for their HCV illness. A tendency towards higher ALT and bDNA [levels was encountered in the American, patients comvared to the Egyptians