Omeprazole once or twice daily with clarithromycin and metronidazole for Helicobacter pylori.

BACKGROUND: Triple therapy for one week with omeprazole, clarithromycin and metronidazole (OCM) is accepted worldwide as a first line therapy for Helicobacter pylori eradication. It is unclear whether omeprazole needs to be given once or twice daily. OBJECTIVES: To assess the efficacy and safety of these regimens in a single-centre, Canadian practice. METHODS: Histologically proven H pylori-positive patients were treated for seven days with clarithromycin 250 mg bid and metronidazole 500 mg bid, and randomly allocated to omeprazole 20 mg either once or twice daily in this open, cohort study. Endoscopy with histology (two antrum and two body biopsies, Giemsa stain) was done four weeks or longer after the pills were completed to assess H pylori eradication. RESULTS: Whether omeprazole was given once or twice daily, eradication was high and the same in both arms. All-patients-treated eradication was 85% (39 of 46 in the omeprazole once daily group and 41 of 48 in the omeprazole twice daily group) and intent-to-treat eradication was 80% (39 of 49 in the omeprazole once daily group and 41 of 51 in the omeprazole twice daily group). Side effects were frequently seen, suffered by 65% to 69% of patients treated. However, these were mild and compliance was high, with 94% of patients taking all of their pills. Mild side effects included loose stools, taste disturbance, nausea, headache and upper or lower gastrointestinal gas. Only one patient (1%) from the omeprazole once daily arm stopped taking metronidazole due to excessive perspiring. CONCLUSIONS: In this community practice, OCM triple therapy was effective whether omeprazole was given once or twice daily. For those with financial constraint, omeprazole 20 mg once daily can be considered. The regimens were well tolerated without serious adverse events.

Purification and characterization of P47gag-crk expressed in insect cells.

The crk oncogene product, P47gag-crk, was expressed and purified using a baculovirus expression system. Approximately 2-10 mg of P47gag-crk was produced in 10(9) insect cells infected with a recombinant baculovirus. Partially purified P47gag-crk was obtained by precipitation in a low salt buffer and gel filtration. A better purification of P47gag-crk was achieved by immunoaffinity chromatography, resulting in a single band by Coomassie Blue staining. The insect cells expressing P47gag-crk showed an increase in protein-phosphotyrosine content, which is a characteristic feature of crk-transformed cells. Moreover, like P47gag-crk produced in chicken or rat cells, P47gag-crk produced in insect cells associated in vitro with a tyrosine kinase and its substrates from Crk-3Y1 cells. Peptide mapping of P47gag-crk expressed in insect, rat, and chicken cells showed that similar sites were phosphorylated in these proteins. These data suggest that P47gag-crk expressed in insect cells is functional and will be useful for the further analysis of this protein.

Reactions during hemodialysis caused by allergy to ethylene oxide gas sterilization.

In patients receiving long-term hemodialysis (HD), we have examined the presence of IgE-dependent sensitization to ethylene oxide (EO) gas, which is used for sterilization of disposable medical products including dialyzers. Serum was obtained from 25 patients who experienced acute allergic reactions during HD, five patients receiving HD with isolated eosinophilia, and 37 unselected patients receiving HD. Sera from 22 of 25 of the allergic reaction group and from five of 35 of the unselected group were demonstrated to contain IgE antibodies with specificity for EO. Corresponding IgG antibodies were also present. No such antibodies were detected in serum from normal controls or ragweed-allergic patients. The serum from one patient with isolated eosinophilia had a borderline elevated IgE antibody level. These results demonstrate a close relationship between the presence of IgE antibodies to EO and HD-related allergic reactions in this patient population.

Allergy to ethylene oxide in chronic hemodialysis patients.

Almost a decade ago, a single chronic hemodialysis patient in Hamilton, Ontario, Canada, who was experiencing recurrent acute reactions during hemodialysis was found to have become allergic to ethylene oxide gas (EO). This observation recently provided a stimulus to examine the possibility that others exhibiting acute allergic-type reactions during hemodialysis might be similarly sensitized. Serum was obtained from 27 reacting patients and tested in a radioallergosorbent test (RAST) for antibodies to EO. The test was positive for 22 of these sera. EO-related specificity of the antibodies was confirmed. However, EO sensitization was not found in other hemodialysis patients with isolated eosinophilia. In a survey of the current Hamilton chronic hemodialysis population for EO-related antibodies, 9% had a positive allergy skin test and 12% had a positive RAST. The sensitized individuals had no distinctive symptoms. The lesser sensitivity of the skin test contrasts with usual findings in allergic individuals; however, the use of histamine and codeine in chronic hemodialysis and peritoneal dialysis patients might well explain a reduced sensitivity of the EO-related allergy skin test. Chronic peritoneal dialysis could not be invoked as a source of sensitization. None of these patients had a positive skin test or RAST for EO-related antibodies that could be attributed to peritoneal dialysis.

The planning and development of the New York City neighborhood family care centers.

Between 1967 and 1969 the New York City capital budget listed monies for the planning and construction of 15 new ambulatory care centers to provide comprehensive medical care to medically underserved areas of the city. Because of the urgent need, an effort was made in planning the centers to minimize the number of agency approvals. By adopting this approach, the appropriateness of the centers to their target populations became secondary to the process of negotiating the bureaucracy. In spite of this tactical decision, by 1970 construction had begun on only 1 center. This case study discusses the events from 1967 through 1969 that relate to the effort to expedite bureaucratic processing of the facilities.