[Comparison of sequential and routine four drugs therapeutic regiments in Helicobacter pylori eradication]

Antibiotical resistance to Helicobacter pylori reduced the eradication rates. This study was done to compare the sequential comparison of sequential and routine four drugs therapeutic regiments in Helicobacter pylori eradication. In this double blind clinical trial study 160 chronic dyspepsia patients randomly divided into 2 groups of sequential and routine four drugs therapeutic regiments. We performed invasive tests for H. pylori in patients who underwent gastroduodenoscopy. 160 patients who were diagnosed as H.pylori-positive by histological evaluation were selected for the trial. A 14-day sequential regimen [Omeprazole, Amoxicillin, each administered twice daily for the first 5 days, followed by Omprazole, Clarithromycin and Urazolidon, each administered twice daily for the remaining 9 days. 14-day 4 drug therapy, Omprazole, Clarithromycin, Amoxicillin and Bismoot each administered twice daily. 5 weeks after treatment urease breath test [UBT] was preformed. The recovery was seen in 50.9% and 49.1% in sequential and routine four drugs therapeutical treatment, respectively. The recovery of patient with severe H. pylori infection was non-significantly higher in sequential regiment [64.7%] than four drugs regiment [41.2%]. In comparison to four drugs, sequential therapy was significantly more effective in patients with sever gastritis [87.5% vs. 25%, p<0.05]. The eradication of H. pylori infection particularly in severe gastritis is preferred by sequential therapeutical regiment

effects of chronicity on high resolution computed tomography findings in asthma

Remodeling is the late result of chronic inflammation in untreated asthma. Remodeling causes resistance to classic asthma therapy, but the time required for this change has not been confirmed, yet. High resolution computed tomography [HRCT] is the only noninva sive method to confirm the structural change in the bronchial wall. The objective of this study was to evaluate the frequency of remodeling in chronic asthma as well as determine the proposed time required for developing remodeling. Non smoker asthmatic patients with more than one year of duration who referred to the sub specialty clinic of pulmonary participated in our study. History, physical examination and spirometric evaluation were done. Diagnosis of asthma was confirmed according to GINA guidelines. CT scan of the lungs was performed in a deep inspiration using Phillips Spiral Multi Slice [1.5 mm thickening]. The images were evaluated by two radiologists. The main group was divided in two groups: The patients with more than 5 years of duration of the disease, and those who had been infected with the disease for less than 5 years. The results were then compared with each other. Seventy four subjects participated in this study [40 females, 34 males]. In asthmatic patients with a history of more than 5 years, the mean of age was 51 15.5 years. This group showed no significant difference from the other group with a duration of lower than 5 years [mean age: 45 18.26 years]. The most frequent clinical disorder in both groups was found to be dyspnea [98/6%]. The symptoms found in the subjects with abnormal HRCT were ranking from the most to the least frequent as: bronchial dilation [22, 30%], mosaic pattern [12, 16%]; both bronchial wall thickening and modularity pattern [11, 15%], and emphysema [9, 12%]. HRCT findings were normal in 32% of subjects. Diagnostic criteria of remodeling in subjects with duration of 1-5 years were not significantly different from those in the subjects who were infected for over 5 years. Bronchial dilation and thickening of bronchus are the best criteria for diagnosing remodeling, but remodeling may occur earlier than the expected time

effects of pregnancy: induced hypertension on umbilical artery blood flow in the third trirnester

Doppler ultrasound of umbilical vessels is a method of evaluating fetoplacental blood flow which is very important in high risk pregnancies and can predict both the duration of maternal hospitalization and fetal mortality rates in IUGR. Pregnancy induced hypertension is one of the most important causes of high-risk pregnancies. In this study, the rate of blood flow through umbilical artery as well as its degree of resistance were measured, using Doppler ultrasound in the patients with pregnancy induced hypertension. This is a cross-sectional study which was carried out on 35 pregnant women with pregnancy induced hypertension in the year of 2004. All of the cases were studied during their third trimester. 61 pregnant women in their third trimester were selected as the control group. They all had normal blood pressure. Doppler ultrasound of umbilical artery was performed for both the case and the control groups. Then, Peak Systolic Velocity [PSV], End Diastolic Velocity [EDV] and mean velocity were measured, based of which Resistive Index [RI], Pulsatility Index [PI] and Systolic to Diastolic ratio [S/D ratio] were calculated. Finally the statistical analysis was performed on the obtained recorded data, using SPSS software. The results indicate a measure of 0.77 for RI; 1.39 for PT and 4.88 for S/D ratio in the case group while in the control group, such measurements were calculated as 0.64; 1.08 and 2.97, respectively. As a whole, the comparison of the mean values of the mentioned indices revealed a significant difference between the two groups [P<0.01]. The case group were significantly rated higher in terms of the above mentioned indices. In patients with pregnancy induced hypertension without having other risk factors [such as diabetes, mellitus and IUGR], Doppler ultrasound should be used for evaluating the degree of fetoplacental blood flow in order to decrease the risk of pregnancy complications

Comparative findings of ultrasongraphy and IVU in the diagnosis of hypernephrosis

The ultrasonographic findings of urinary obstruction indicate the diagnosis of hydronephorsis. Hydrophrosis is a descriptive term referring to the presence of dilatation of pelvis and calyces and not to the cause of the ddilation IVU can provide functional and anatomical details while ultrasonography can only provide anatomical details There are some different ideas about diagnostic values of each method. The purpose of this study is to evaluate the ultrasonoyraphic sensitivity in detection of hydronephrosis [obstructive or nonobstructive] as compared to IVU. This prospective comparative study was done on 70 patients referring to the radiology department of Bahman 22[nd]and Arya Hospitals since April 2006 to October 2007. Kidney ultrasonography and IVU were administered for all the patients. Then, the accuracy rate of ultrasonography in diagnosing hydronephrosis was determined comparing with IVU as a gold standard method. Some variables such as age, sex, the size of kidney, kidney parenchymal echo, ureteral stone, bladder condition in IVU and stone in KUB were evaluated in all the patients. Among 70 patients, the mean age was 36 +/- 16.3 years ranging from 12 to 72 years. Comparing ultrasonography with IVU, the sensivity of ultrasonography for diagnosing hydronephrosis was 79.41%, the specificity rate of ultrasonography was 55%; the positive predictive value was 62% and the negative predictive value was 74%. Also, the accuracy rate of sonography in diagnosing hydronephrosis was 67%. The results of this study suggest that although ultrasonography is not a substitute for IVU, it can be used as a preliminary tool for detecting hydronephrosis and as a screening diagnostic method for urinary obstruction in azotemic patients. IVU is suggested for acute urinary obstructions and in patients with renal colic and normal sono-findings

Comparative evaluation of preoperative CT Scan and intraoperative endoscopic sinus surgery findings in patients with chronic rhinosinusitis

Chronic rhinosinusitis [CRS] is a common condition in medical practice. The diagnosis generally relies on clinical judgment, but computed tomography [CT] together with sinonasal endoscopy, provide the majority of the objective data. This study was carried out to determine the agreement between preoperative CT findings and intraoperative endoscopic sinus surgery [ESS] findings in patients with CRS. Statistical analysis of collected data from paranasal sinus CTs of 51 patients aged between 15 and 77 who subsequently underwent ESS for CRS at two training hospitals during a 2-year period, was performed. The agreement between CT and ESS findings was assessed by Kappa statistics, Chi-square and t test were also used for data analysis. The most common co-morbidity found among the patients with chronic sinusitis was allergy in 18 [35%] patients. Hypertrophy of the inferior turbinate was the most obvious finding in CT [71%] and during endoscopic evaluation [69%]. No significant correlation was found between clinical symptoms and gender or the length of disease. In 8 unusual patients [one with choanal atresia, one with bone wax in nasal cavity, and 6 with small polyposis], CT could not show the problem. There are good to excellent agreements between the two diagnostic procedures, except for the choanal atresia, which showed no agreement [K = 0]. The results of nasal fossa findings obtained by nasal endoscopy are more conclusive in the elucidation of diagnosis than those obtained by paranasal sinus CTs. In spite of a good agreement between CT and ESS findings in most patients, it seems in some unusual cases, CT may miss many patients