Omeprazole-based triple therapy with low-versus high-dose of clarithromycin plus amoxicillin for H pylori eradication in Iranian population

AIM: To investigate the efficacy and tolerability of H pylori eradication in an omeprazole-based triple therapy with high-and low-dose of clarithromycin and amoxicillin. METHODS: One hundred and sixty H pylori positive patients were randomly assigned to two groups based on the following 2 wk investigation; (1) group A or low-dose regimen received omeprazole 20 mg b.i.d, clarithromycin 250 mg b.i.d and amoxicillin 500 mg b.i.d; and (2) group B or high-dose regimen received omeprazole 20 mg b.i.d, clarithromycin 500 mg b.i.d and amoxicillin 1000 mg b.i.d. During the study H pylori status was assessed by histology and rapid urease test prior and by 13C-urea breath test 6 wk after the therapy. Standard questionnaires were administered to determine the compliance to treatment and possible adverse events of therapy. Data were subject to χ2 to compare the eradication rates in the two groups. The significant level of 95% (P ≤ 0.05) was considered statistically different. RESULTS: We found that the per-protocol eradication rate was 88% (68/77) in group A, and 89% (67/75) in group B. The intension-to-treat eradication rate was 85% (68/80) in group A and 83.75% (67/80) in group B. Overall adverse events were 26% in group A and 31% in group B. The adverse events were generally mild in nature and tolerated well in both groups with a compliance of 98% in group A vs 96% in group B. CONCLUSION: The omeprazole-based low dose regimen of clarithromycin and amoxicillin for two weeks in H pylori eradication is as effective as high dose regimen in Iranian population.

Effect of tranexamic acid on the treatment of patients with upper gastrointestinal bleeding: A double-blinded randomized controlled clinical trial

Objective:To determine the efficacy of tranexamic acid(TXA)in the management of acute upper gastrointestinal(GI)bleeding.Methods:A total of 70 patients with acute upper GI bleeding were included in this double-blinded randomized controlled clinical trial from September 2018 to December 2018.Patients were divided into the control group(received fluid therapy and intravenous infusion of pantoprazole,35 cases)and the TXA group(received intravenous TXA besides the treatment of control group,35 cases).Rebleeding,admission duration,and need for blood transfusion were compared between the two groups.Results:Fifteen patients(42.9%)in the TXA group and 10 patients(28.6%)in the control group stayed in hospital for more than 3 days during their admission(P=0.21).Rebleeding occurred in 8 patients(22.9%)and 5 patients(14.3%)of the TXA group and the control group,respectively(P=0.35).More patients in the TXA group(21 cases,60%)received blood transfusion than the control group(8 cases,22.9%)(P=0.02).Conclusions:TXA did not improve the outcome of patients with acute upper GI bleeding.

Association between community-acquired pneumonia and platelet indices: A case-control study

Objective:To examine whether the platelet index would be applicable for the diagnosis of community-acquired pneumonia(CAP).Methods:In this study,64 CAP patients(the case group)and 68 healthy children(the control group)were included from 2017 to 2018.Baseline variables were recorded including total white blood cells,neutrophils,lymphocytes,red blood cells,platelet,mean platelet volume,platelet distribution width,erythrocyte sedimentation rate,and C-reactive protein,and compared between the case group and the control group.The cutoff value,sensitivity,and specificity of neutrophil-to-lymphocyte ratio,platelet,neutrophils,lymphocytes,and platelet larger cell ratio were calculated by receiver-operating characteristic curves.Results:The median platelet count of the case group and the control group were(411.09±67.40)mm3 and(334.48±78.15)mm3,respectively(P=0.000).The median neutrophil count of the case group was higher than that of the control group,while the lymphocyte level of the case group was lower.Differences in other variables including the mean platelet volume,platelet distribution width,C-reactive protein,and erythrocyte sedimentation rate were not statistically significant between the two groups.Conclusions:Due to the different levels of platelet,neutrophil and lymphocyte indices in the case and the control group,these indices can be used simultaneously for the diagnosis of CAP.