Comparison of the Hospital-Acquired Clostridium difficile Infection Risk of Using Proton Pump Inhibitors versus Histamine-2 Receptor Antagonists for Prophylaxis and Treatment of Stress Ulcers: A Systematic Review and Meta-Analysis

BACKGROUND/AIMS: Although proton pump inhibitors (PPIs) have been widely used for the prevention and treatment of stress gastric ulcers in hospital settings, there are concerns that PPIs increase the risk of Clostridium difficile infection (CDI). However, little is known about the risk of CDI following PPI and histamine-2 receptor antagonist (H2RA) use. We evaluated the comparative hospital-acquired CDI occurrence risk associated with the concurrent use of PPIs versus H2RAs. METHODS: A systematic search of PubMed, MEDLINE/Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar through August 19, 2016, identified 12 studies that reported the hospital-acquired CDI occurrence following H2RA and PPI use for the prevention and treatment of stress gastric ulcers. Random-effects pooled odds ratios and 95% confidence intervals were estimated. Heterogeneity was measured using I², and a meta-regression analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence. RESULTS: A total of 74,132 patients from 12 observational studies were analyzed. Compared to H2RAs, PPIs increased the risk of CDI by 38.6% (pooled odds ratio, 1.386; 95% confidence interval, 1.152 to 1.668; p=0.001; I²=42.81%). Subgroup analyses of the purpose of study medication use, study site, and study design confirmed the consistency of a greater CDI risk with PPIs than with H2RAs. The overall quality of evidence was rated as low. CONCLUSIONS: The use of PPIs for both the prevention and treatment of stress ulcers was associated with a 38.6% increased risk of hospital-acquired CDI occurrence compared to H2RA use.

Radiofrequency ablation combined with percutaneous ethanol injection in patients with hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is a major burden on health-care systems worldwide. Although radiofrequency ablation [RFA] is currently considered the best technique for coagulative necrosis, the superiority of concomitant use of RFA and percutaneous ethanol injection [PEI] needs to be determined. The study was designed to compare efficacy, safety and rate of survival of patients with HCC assigned to receive combined PEI-RFA versus RFA alone and versus PEI alone. This 3-year study enrolled 90 cirrhotic patients with HCC [Child's class A or B, but not class C]. They were randomly assigned for either PEI-RFA [group I], RFA alone [group II] or PEI alone [group III]. The primary end point was ablation of the tumour. The secondary end point was rate of survival and recurrence. After the first session, complete ablation was significantly higher in the combination group [87.9%] compared with the RFA group [54.54%]. After the second session, complete ablation was achieved in 97.0% of the combination group and in 84.8% of the RFA group. Regarding the PEI group, 75% had complete ablation, whereas 25% had partial ablation after multiple sessions. The survival rate, 1.5 years later, was significantly higher in group I [86.7%] compared with group III [63.3%]. The overall incidence of serious adverse events was nil. Combined treatment is superior to RFA alone and to PEI alone, in safety and efficacy in patients with HCC

Comparative study between percutaneous acetic acid injections and percutaneous ethanol injection in the management of hepatocellular carcinoma

This study was conducted on 30 patients with hepatocellular carcinoma [Hcc-3-6 cm in the largest diameter].They were divided into two equal groups: The first group was treated by a single or multiple sessions of percutaneous ethanol injection, while the second group was treated by a single or multiple sessions of percutaneous acetic acid injection. All patients were subjected to full history takings clinical examination, and routine laboratory investigations including alpha feto-protein. Radiological assessment was carried out using abdominal ultrasonography and triphsic computed tomography. The patients were clinically followed up and assessed at one, and three months after therapy by abdominal triphasic computed tomography, ultrasound and alpha feto-protein [AFP]. There was no significant difference between the studied groups as regard age and sex distribution or the clinical features. Hepatomegaly was detected in 4 [26.7%] in groups I and II. Splenomegaly was detected in 10 [66.7%] in group I and 11[73.3%] in group II. No ascites was detected by shifting dullness in all patients of both groups. Regarding the ultrasonographic criteria, 24 [80%] patients had their focal lesions in the right lobe. Most of the focal lesions were from 3-4 cm in diameter 24 [80%], mostly hypoechoic [85%]. Also, the diameter of focal lesions increased in 10 [66%] patients of group I in comparison to 12 [80%] patients of group II. Spiral CT one month after the procedure showed complete ablation was achieved in 10 patients [66.7%] of group I and in 13 patients [86.7%] of group II. Although percutaneous acetic acid injections showed higher rate with complete ablation, the difference was not statistically significant in comparison with the other group

Intravitreal triamcinolone for the management of macular edema due to branch vein occlusion

To evaluate the efficacy of intravitreal triamcinolone acetonide in the management of persistent macular edema secondary to branch vein occlusion. 10 consecutive patient were selected with 3 - to 4 month history and persistent macular edema. These patients received a single intravitreal injection of 4 mg of triamcinolone acetonide [40 mg/ml]. The control group including 12 patients did not receive an intravitreal iunjection. The mean follow-up was 8-12 months. A single intravitreal injection of triamcinolone showed significant improvement in the visual acuity [P=0.005], with clinical and angiographic resolution of macular edema in 6 patients [60%] of the 10 patients in the treated group, while only 4 [33.3%] of the 12 patients in the observation group. A single intravitreal injection of triamcinolone acetonide can increased in terms of visual acuity and macular edema for non-ischemic branch vein occlusion