effect of probiotic plus prebiotic supplementation on the tolerance and efficacy of helicobacter pylori eradication quadruple therapy: a randomized prospective double blind controlled trial

Background: Standard anti-Helicobacter pylori [H. pylori] treatment fails in the eradication of the organism in almost 10-35% of the patients and has different side effects. Recent studies have proposed that probiotic supplementations with or without prebiotic may improve the eradication rate and diminish the side effects, although it is still a controversial issue. We aimed to investigate the effect of probiotic with prebiotic supplementation on the eradication rate and side effects of anti H. pylori quadruple therapy

Methods: 76 patients with a positive biopsy specimen for H. pylori were enrolled. They were randomized to receive quadruple therapy of bismuth, clarithromycin, amoxicillin, and omeprazole for 14 days and also the synbiotic or the placebo. We asked them to answer study questionnaires at the beginning and during the treatment. Finally, urea breath test was done 8 weeks after the treatment

Results: The eradication rate was significantly better in the synbiotic group by intention-to-treat analysis [p<0.05]. Treatment side effects such as diarrhea, nausea, vomiting, epigastric pain, flatulence, constipation, and taste abnormality were similar in both groups but anorexia was significantly better in the synbiotic group [p <0.05]

Conclusion: The eradication rate was significantly better in the synbiotic group by intention-to-treat analysis [p<0.05]. Treatment side effects such as diarrhea, nausea, vomiting, epigastric pain, flatulence, but could improve the eradication by augmenting the treatment tolerance and compliance

Survey of predictive value of 4-hour urine collection for diagnosis of proteinuria in preeclampsia

Measuring the 24-hour urine protein >/= 300 mg is the standard threshold value for diagnosis of preeclampsia. This study was intended to determine if a patient's 4-hour urine protein correlate with the 24-hour value for diagnosis of preeclampsia. This was a cross sectional study performed on 84 women with suspected preeclampsia due to positive urinary test strip with minimum protein content of 1+ and BP >/= 140/90 at Al-zahra Educational Hospital in Rasht [Iran] from May 2007 to January 2008. Urine samples were collected within 24 hours in successive periods: The first 4-hour and the next 20-hours urine, in separate containers. The protein contents of 4-hour and 24-hour urine samples were calculated. Data were analyzed by intra-class correlation coefficient, and Receiver Operating Characteristic [ROC] curve. The ROC curve showed the cut-off point of 55.5 for 4-hour urine protein. The correlation between 4- and 24-hour urine protein excretions identified that most women [about 85.1%] with protein excretion rate of 300 mg/24h or more [with preeclampsia] had the same amount of protein of 55.5 or more in their 4-hour urine excretion [p<0.001]. Also, most of them [about 83.7%] with a total urinary protein excretion of less than 300 mg/24h [no preeclampsia] had a protein excretion rate of less than 55.5 mg/4h. This study showed 4-hour protein collection can be used as acceptable substitute for assessing the protein content of 24-hour urine samples as a more convenient, faster, and cheaper method for diagnosis of preeclampsia and the cut-off point for 4-hour urine protein is 55.5 mg

Evaluation of serum creatine phosphokinase in diagnosis of tubal ectopic pregnancy compared with intrauterine pregnancy and threatened abortion

Vaginal sonograghy and serial beta-hCG are the most common diagnostic methods for ectopic pregnancy but about 50% of cases are initially misdiagnosed. In tubal pregnancy the zygote lies next to the muscular layer, and this invasion causes an increase in creatine phosphokinase [CPK] in blood. assessment of CPK and its isoenzyme CPK-MB as a diagnostic marker for tubal pregnancy. In this case-control study, 111 women between 16-40 years in first-trimester pregnancy admitted to emergency ward of Rasht Alzahra hospital with abdominal pain or vaginal bleeding were included and according to sonography and beta-hCG divided into 3 groups [N=37]: tubal pregnancy [1], threatened abortion [2] and normal pregnancy [3]. Blood samples were taken for totalCPK and CPK-MB before any invasive procedure. Mean total CPK level were 96.27 +/- 63.9 u/lit [group 1], 55.37 +/- 14.1 u/lit [group 2] and 48.94 +/- 19.2 u/lit [group 3] and was significantly higher in tubal pregnancy compared to other groups. Mean CPK-MB levels in 3 groups were 15.62 +/- 5.2 u/lit, 17.32 +/- 6.9 u/lit, and 15.1 +/- 4.7 u/lit, respectively which was not significant. It seems that determination of total CPK can enhance the diagnostic value of tubal pregnancy

Decreasing the complications of PCNL with alternative techniques including complete supine PCNL and subcostal approach

To assess the incidence of complications during percutaneous nephrolithotomy. We studied the files of patients at our urology research center in Rasht, Iran from 2007-2008. One hundred and seventy four patients with symptomatic renal and upper ureteric calculi were selected with the technique of non-probability convenient sampling. Complications of surgery were evaluated and divided into 3 categories: peri-operative, early, and late complications of surgery. Perioperative complications included bleeding, transfusion, extravasation, and injury to adjacent organs. Early complications following surgery included post operative bleeding, post operative transfusion, extravasation, infection, and residual stones. Late complications included injury to adjacent organs. All patients were subjected to PCNL. The data was analyzed on SPSS version 10. Regardless of position, the pelvicaliceal system could be successfully approached in all patients. The mean age of patients was 44.71 +/- 13.16 years. The mean stone size in was 26.64 +/- 14.39 mm. The mean operation time was 95.14 +/- 26.57 minutes. The stone free rate was 85.7%. Peri operative complications included transfusion due to bleeding 5.7%, and extravasation 3.4%. Early complications included transfusion due to bleeding 5.1%, extravasation 2.3%, infection 2.9% and residual calculi 14.3%. Late complications were not seen. No mortality was recorded. The most common stone site was pelvic stone [34.4%]. Stone sites in 45.9% of our patients was in the right kidney while 54.1% was left-sided. PCNL is a valuable treatment option for kidney stones. Potential advantages include less hospital stay with lower cost, lower discomfort and pain, and a lower complication rate. Also PCNL can be applied to many patients with kidney stones. We recommend a subcostal approach and also the use of complete supine PCNL [csPCNL] in decreasing the complications of PCNL

effect of post coronary angiography bed-rest time on vascular complications

Coronary angiography is frequently applied for diagnostic purposes in patients with coronary artery disease. Be that as it may, there is still no consensus about the optimal time for the ambulation of patients following femoral arterial puncture. We sought to compare 6 hours of complete bed rest and 2 hours of complete bed rest in patients after angiography. This randomized quasi-experimental study was performed in 120 patients candidated for coronary angiography. The patients were divided into experimental and control groups randomly. Primarily demographic data were obtained from both groups before intervention was carried out for them. The arterial sheath was removed immediately after the procedure. Hemostasis was achieved by manual compression and maintained with sandbags. Early ambulation was attempted after two hours of supine bed rest following sheath removal. The incidence of bleeding and insertion site complications was documented at 24 hours and subsequently at 30 days post-procedure. Our findings were indicative of no significant difference between the two groups in terms of gender, age, body mass index, catheter size, total procedure duration, total hemostasis time, history of anticoagulant drug use, and coagulation tests before angiography. Pre-ambulation bleeding occurred in 2 patients in each of the two groups. Post-ambulation bleeding occurred in 2 patients in the control group and 1 in the experimental group. Whereas there was no incidence of large pre-ambulation hematoma in the control group, there was one case in the experimental group. There was no case of post-ambulation hematoma, however, in either group, and nor was there any late bleeding or vascular complication. Ambulation 2 hours after angiography via the femoral site is feasible and safe with the same incidence of insertion site complication as that of 6 hours of bed rest. Therefore, an early ambulation protocol can shorten hospital stay without significant vascular complications