comparison between hybrid and concomitant regimens for helicobacter pylori eradication: a randomized clinical trial

Background: Helicobacter pylori [H. pylori] is one of the most common bacterial infections worldwide. We designed a study to compare the efficacy of 14-day hybrid regimen with 10-day concomitant therapy for H. pylori eradication in Iran

Methods: 252 patients with naive H. pylori infection were randomly divided to receive either hybrid regimen [pantoprazole 40 mg, and amoxicillin 1 gr twice daily for 14 days, accompanied by clarithromycin 500 mg, and metronidazole 500 mg, twice daily just during the last 7 days] or concomitant regimen [pantoprazole 40 mg, amoxicillin 1 gr, clarithromycin 500 mg, and metronidazole 500 mg, all twice daily for 10 days]. 8 weeks after therapy, 14C- urease breath test was performed to confirm eradication

Results: According to intention to treat analysis, the eradication rates were 87.3% [95% CI: 81.4-93.1] and 80.9% [95% CI: 74-87.8] in hybrid and concomitant groups, respectively [p=0.38]. Per-protocol eradication rates were 89.3% [95% CI: 83.8-94.7] and 83.1% [95% CI: 76.3-89.8], respectively [p=0.19]. The rates of severe side effects were not statistically different between the two groups [4% vs. 8.7%]

Conclusion: 14-day hybrid therapy can be considered as a nearly acceptable regimen with few severe side effects in Iran. However, it seems that the efficacy of this therapy is decreasing as the resistance rates to antibiotics are increasing. We suggest further studies to assess the efficacy of a more prolonged concomitant therapy for H. pylori eradication in Iran

Acute bleeding in duodenal gastrointestinal stromal tumor

Gastrointestinal stromal tumors [GIST] are the most common mesenchymal tumors of the gastrointestinal tract. The biological pattern of these tumors ranges from benign-appearing small lesions to malignant sarcomas. Only 3%-5% of GISTs are found in the duodenum. A duodenal GIST is a rare source of upper gastrointestinal bleeding. A remarkable percentage of duodenal GISTs are localized in the third and fourth part of the duodenum and may not be noticed on standard upper endoscopy. Push enteroscopy is sometimes advisable to find these lesions. Surgical resection either limited or pancreaticoduodenectomy can be the treatment of choice. In general, adjuvant therapy with imatinib has been proved to extend survival in patients with GIST. The current case, a 24-year-old male, presented with acute upper gastrointestinal bleeding from a submucosal ulcerated tumor located in the distal third part of the duodenum, 3 cm distal from the papilla of Vater. After primary care and blood transfusion in a local hospital, partial resection of the duodenum was performed as a definitive surgical therapy. Histopathology showed a GIST with a diameter of 3 cm and moderately malignant according to tumor grade, and <5 mitoses/10 high power field [HPF]

Efficacy of short-duration Furazolidone in two different quadruple regimens for H. pylori eradication

To assess the efficacy and tolerability of using high dose Furazolidone just during the first week of two different quadruple regimens in eradicating H. pylori. One-hundred sixty patients with duodenal ulcer and positive H. pylori infection were randomly allocated into two groups. Group A received [OAM-F] omeprazole [20 mg BID], amoxicillin [1gr BID], metronidazole [500mg BID] for two weeks and Furazolidone [200 mg BID] just during the first week. Patients in group B received [OAB-F] omeprazole [20 mg BID], amoxicillin [1 gr BID], bismuth subcitrate [240 mg BID] for two weeks and Furazolidone [200 mg BID] in the first week. The eradication rates by per-protocol and intention-to-treat analyses were 86.36% and 80% in group A and 90.27% and 86.3% in group B, respectively. Severe side effects of the drugs were more prevalent in group A compared with group B [12.8% against 2.5%]. One-week Furazolidone combined with two-week Omeprazole, amoxicillin and bismuth subcitrate is a safe and cost effective regimen to eradicate of H pylori infection in Iran

[Prevalence of positive hepatitis delta virus in patients with positive Hepatitis B surface antigen and its correlative factors in Sari]

Hepatitis Delta Virus [HDV] agent, or HDV, is a defective RNA virus that infects with HBV [Hepatitis B Virus]. 15 million people around the world are infected to HDV. There are different statistics in Iran and other countries about HDV incidence, according to accomplished studies. This study was done for determining HDV incidence in sari and considering its correlative factors. This study was done in a descriptive procedure on 167 patients. Correlative factors like demographic data and the ways of receiving disorder, history of tattoo, blood transfusion, were multi partner and IV drug abusers were considered. Diagnosing of blood Anti HDV in patients was by ELISA [Enzyme-Linked ImmunoSorbent Assay] way. We couldn't find any evidences of advantage of HDV in patients. Among 167 HBS-Ag positive subject [63 [37.7%] women and 104 [62.3%] men] were included. Average age of participants was 35.52 +/- 14.036. 2 subject had an addiction history [1.7%], 15 subject [9%] had a blood transfusion history, 4 [2.4%] were multipart and 1 [0.6%] had tattoo history and 2 [1.2%] were Prisoners previously. There wasn't any positive Anti-HDV Ab [Anti- Hepatitis Delta Virus Antibody] in studied patients. It shows that HDV is not endemic in sari