First-line eradication of H pylori infection in Europe:A metaanalysis based on congress abstracts,1997-2004

AIM: To meta-analyse the Europeans presented between 1997-2004 at the European H pylori Study Group, United European Gastroenterology Week meetings and World Congresses of Gastroenterology. METHODS: The abstracts of randomized/controlled prospective studies were classified into groups based on first-line eradication schedules. The quality of the abstracts was checked by a validated score system. The pooled eradication rates (PER) and combined odds ratios (OR) were calculated and compared with the published meta-analyses.RESULTS: The PER of proton pump inhibitor-based (PPI) one week triple therapies was 81.4% (confi dence interval, 95% CI: 78.5-84.5). Ranitidine bismuth citrate-based (RBC) triple regimens have an efficiency rate of 78.5% (95% CI: 70.5%-84.3%) (P = 0.28 vs PPI). The OR for PPI effect vs RBC regimens was 1.1 (95% CI: 0.92-1.30). H2 receptor antagonist-based triple therapies achieved 64.1% (95% CI: 52.6-75.6) (P = 0.02 < 0.05 vs PPI), the OR vs PPI regimens was 1.55 (95% CI: 0.72-3.78). PPI-based double combinations were less efficient than triple regimens (PER: 55.0%, OR: 4.90, 95% CI: 2.36-9.70). Quadruple regimens were successful in 82.6% (95% CI: 76.0-89.7), the OR vs triple therapies was 0.80 (0.62-1.03). Clarithromycin + amoxicillin or nitroimidazole combinations were effi cient in 80.5% (95% CI: 77.2-84.2) and 83.8% (95% CI: 81.7-85.9), respectively. Amoxicillin + nitromidazole therapies eradicated the infection in 73.5% (66.6-78.5) (P = 0.01 < 0.05 vs clarithromycin-based regimens). CONCLUSION: PPI/RBC-based triple therapies achieved comparable results with the meta-analyses. H2-receptor antagonists and PPI-based double combinations were less efficient. Triple and quadruple regimens wereequally effective. Clarithromycin + either amoxicillin or nitroimidazole containing regimens were more effective than amoxicillin + nitroimidazole combinations. High quality congress abstracts constitutes a valuable pool of data which is suitable for meta-analytical workup.

Refracture of the Tibial Post after Posterior-Stabilized Total Knee Arthroplasty: Case Report and Literature Review

Background: Tibial polyethylene wear is related late failure in total knee arthroplasty. The cruciate substitute design depending on the campost mechanism to secure the knee cinematics after a posterior stabilized total knee arthroplasty (PS-TKA). A post fracture can occur after damage failure of the post. Aim: Report a case of post refracture after a PS-TKA and review the lecture about post wear in PS-TKA. Case presentation: A 63 woman with a primary TKA had a diagnosis of polyethylene post fracture. The polyethylene exchange wasn’t enough and revisions of all components were necessary. Conclusion: In patient with previous well function, subtle swelling and giving away sings after PS-TKA, a post fracture must be excluded.

Review of Management of Type-2 Odontoid Fracture in Elderly

Odontoid fracture accounts for 15% - 20% of all cervical spine injuries. Among the odontoid fracture, type-2 fracture is the most common variety. This injury is associated with a high incidence of morbidity, mortality and nonunion in the elderly irrespective of mode of treatment. Management of odontoid fracture cannot be standardized till to date and ideal treatment for type-2 odontoid fractures still has some controversial issues. Objective of this review is to find a controversial aspect of management along with opinion to find out a standard guideline by searching the literature in Pubmed and Google scholar databases with key words: odontoid, fracture, type-2, management, nonoperative and operative management. Nonoperative treatment with halo vest is associated with very high rate of complication in elderly patient. When conservative treatment of this fractures is indicated that should be carried out with hard cervical collar or cervicothoracic orthosis. Current studies suggest that surgical management of odontoid fractures may offer a protective benefit but it is limited to patients younger than 75 years of age. Though surgical treatment has a better outcome, it is also limited by the co-mobidities and hazards of anesthesia and surgery in elderly patients. Conservative treatment of this fracture in the elderly should preferably be carried out with hard collar or avoiding halo vest. Surgical treatment is associated with little advantage but should be selected with proper attention to age, comorbidities, fracture geometry and it is better to individualize the treatment strategy.

Evaluation of Intraobserver and Interobserver Reliability of Mechanical Axis Alignment Measure of the Lower Limb through the Panoramic Radiograph in Patients in the Preoperative and Postoperative Periods of Total Knee Arthroplasty

Objective: To evaluate intraobserver and interobserver reliability of the measurement of the mechanical axis of the lower limb by means of the panoramic radiograph of lower limbs by physicians with different levels of medical practice. Method: A retrospective cross-sectional study with preoperative and postoperative radiographic analysis of a group of 100 patients submitted to total knee arthroplasty. Results: It was observed that there is a highly significant intraobserver and interobserver agreement (p < 0.0001), both preoperatively and postoperatively, among four observers with different training levels. Conclusion: The panoramic radiograph of the lower limbs is a reliable method for measuring the mechanical axis of the lower limb in patients submitted to total knee arthroplasty, regardless of the level of medical practice of the evaluator.

The Assessment of Platelet Indices Levels in Patients with Generalized Anxiety Disorder

Background: The prevalence of anxiety disorders is increasing in the world. Studies revealed that generalized anxiety disorder may lead to change in platelet size, volume and functions. Thus, the changes in platelet indices may increase the future risk of thrombotic diseases in patients with Generalized Anxiety Disorder (GAD). Aim: To evaluate platelet indices (total count of platelet, mean platelet volume, platelet distribution width, plateletcrit) levels in patients with generalized anxiety disorder. Material and Methods: A cross-sectional study was performed in the Department of Physiology, Dhaka Medical College, Dhaka from July 2019 to June 2020. After obtaining ethical clearance, a total of 144 individuals were selected based on inclusion and exclusion criteria with ages ranging from 18 - 50 years. Group A was the study group selected from Out Patient Department of Psychiatry of Dhaka Medical College Hospital, Dhaka, diagnosed by an experienced psychiatrist. Group B was the control group who were apparently healthy adults selected from different areas of Dhaka city. The subjects were interviewed and detailed history regarding personal, family, medical and drug history were taken. Prior to sample collection, informed written consent was taken from the participants. Platelet indices (total count of platelet, mean platelet volume, platelet distribution width, plateletcrit) were measured in the Department of Laboratory Medicine, Dhaka Medical College Hospital, Dhaka. Statistical Analysis: For statistical analysis, the Unpaired Student’s “t” test was considered using SPSS 25.0 version. Results: Mean platelet volume of generalized anxiety disorder patients was significantly higher (p < 0.001) than the control group. Platelet distribution width and plateletcrit were higher in the study group than the control group. Conclusion: It can be concluded that generalized anxiety disorder patients may have more chance of thrombotic diseases due to significantly higher mean platelet volume and higher platelet distribution width, plateletcrit than healthy adults.

Health Related Quality of Life in Adult with Type 2 Diabetes Mellitus

Introduction: The health related quality of life (HRQoL) has an important role in adults suffering from diabetes. Objective: To assess the health related quality of life in adult with type 2 diabetes mellitus. Materials and methods: A cross-sectional study was conducted to assess diabetic patient’s HRQoL on 119 purposively selected type-2 DM patients (aged ≥ 18 years and duration of diabetes ≥ 1 year). Data were collected by face-to-face interview and by medical record review through a Bangle version of SF-36 semi-structured questionnaire and a checklist. Place and period of study: The study was conducted at outpatient department in Gopalganj 50 bedded diabetic hospital from 1st January, 2018 to 31st December 2018. Results: The mean age of the respondents was 52.34 (SD ± 10.19) years. Age group shows a significant difference associated with all domains of quality of life except role emotion (>0.05), gender shows the significant in social and pain domain (0.05) respectively co-morbidity shows the significant difference with all domains expect pain (>0.05). Physical functioning, emotional, pain and general health of the quality of life show the significant difference associated with use of insulin (Conclusion: The overall QoL of type-2 DM patients was poor and had lower score of health related quality of life.

Effects of Combined Spinal Epidural Anaesthesia and Spinal Anaesthesia on Peri-Operative Pulmonary Status in Geriatric Patients in Lower Extremity Surgery

Background: Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline. Objective: To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO2 (EtCO2), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. Results: The mean age, weight, BMI of Group A and Group B patients were not significantly different (p > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (p > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (p < 0.001). Mean RR, SpO2, EtCO2, PEFR and BHT of both groups were not significantly different (p > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (p < 0.05). Conclusion: Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.

Outcomes of Layered versus Mass Closure in Transverse Incision during Emergency Laparotomy in Children

Background: The value of laparotomy closure technique may be measured by the incidence of early and late wound complications. The best laparotomy closure technique should be less time consuming, easy and cost-effective, while preventing both early and late complications. Objective: To compare the outcomes of layered versus mass closure in transverse incision during emergency laparotomy in children. Methods: This prospective comparative study was conducted at Department of Pediatric Surgery, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from July 2016 to June 2018. A total of 60 pediatric age cases that underwent laparotomy were included in this study. Cases were randomly allocated into two groups;30 patients were in Group A (Layered closure) and 30 patients were in Group B (Mass closure). The outcome variables were time required for wound closure, wound infection, wound dehiscence and incisional hernia. Data were analyzed and compared by statistical tests. Results: The mean age of Group A and Group B patients were 31.08 ± 30.25 months and 34.70 ± 42.73 months respectively (p = 0.706). The ratio between male and female subject was 1.1:1 in Group A and 3.3:1 in Group B. The common diseases of the study patients who underwent laparotomy were intussusceptions, intestinal obstruction due to bands and adhesion, perforated appendix and perforation of small intestine due to blunt trauma respectively. Mean wound closure time was significantly less in mass closure group [28.20 ± 2.17 minutes in layered closure group and 18.80 ± 1.67 minutes in mass closure group, (p ≤ 0.001)]. Wound infection rate, incidence of superficial wound dehiscence, and incisional hernia were relatively less in mass closure group, however, the differences were not statistically significant (p = 0.053, p = 0.095 and p = 0.301 respectively). There was no complete wound dehiscence in Group A, but that was in 1 (3.3%) patient in Group B (p = 0.313). Conclusion: Mass closure technique is comparatively better than layered closure technique.

Prolonged intestinal mucosal acidosis is associated with multiple organ failure in human acute pancreatitis: Gastric tonometry revisited

瞄准：评估是否在尖锐胰腺炎(AP ) 的 intramucosal pH (pHi ) 的多重决心病人们能在早住院期间提供疾病严厉的另外的信息。方法：受不了尖锐胰腺炎的 21 个病人被胃的张力测量法在医院承认以后在开始的 72 h 监视。结果：在幸存者组(n = 15 ) 还给正常的开始低的 pHi 值铺平(pHi 】 或 = 7.32 ) 在 48 h 以内(中部的 pHi：d1：7.21；d2：7.32；d3：7.33 ) 。相反，在非幸存者的 pHi 值组织 n = 6 ) 固执地，下面或在里面，低正常变化(中部的 pHi 7.12；7.12；7.07 分别地) ，但是二个组之间的 pHi 差别仅仅在 24 h (P【0.01 ) 以后到达了意义。在监视时期期间在任何时间检测的粘膜酸中毒与单个或多重的机关机能障碍(P【0.01 ) 的出现被联系。结论：然而，延长胃的粘膜酸中毒在尖锐胰腺炎与遥远的机关机能障碍和失败被联系与致命的结果的关联变得重要仅仅在承认以后的 24 h。由于它的非侵略的性质，胃的张力测量法可以补充支持 inflammatory 标记完成疾病的滑稽得多的监视。

ABO Blood Groups and Their Relationship with Coagulation Factor VIII in Healthy Adults

Background: ABO blood group distribution defers with racial and geographic variations. They are related to diseases like cardiovascular diseases, cerebral thromboembolism. ABO blood group system may influence coagulation factor VIII which may increase the future risk of thrombosis. Aim: To assess the relation of ABO blood group with coagulation factor VIII in healthy adults. Material and Methods: A prospective type of analytical cross-sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka from July 2019 to June 2020. After obtaining ethical clearance, a total of 190 healthy adults were selected from different areas of Dhaka city based on inclusion and exclusion criteria, with ages ranging from 18 - 45 years. The subjects were interviewed and detailed history regarding personal, family, medical and drug were taken. Prior to sample collection, informed written consent was taken from the participants. Individuals of blood group A were selected as group A, blood group B as group B, blood group AB as group AB and blood group O as group O. Coagulation factor VIII was measured in the Department of Hematology and BMT Unit, Dhaka Medical College Hospital, Dhaka. Blood grouping was done in the Department of Physiology, Dhaka Medical College, Dhaka. Statistical Analysis: For statistical analysis, ONE way ANOVA followed by Bonferroni test were considered using SPSS 25.0 version. Results: In this study, blood group B was most common (33.2%). Coagulation factor VIII was significantly higher (p < 0.001) in blood group A (105.76% ± 11.82%), B (112.00% ± 15.02%), AB (109.80% ± 11.93%) than blood group O (82.00% ± 12.86%). No significant difference was observed among A, B and AB blood groups regarding coagulation factor VIII. Conclusions: It can be concluded that blood group A, B, AB individuals may have more chance of thrombosis due to significantly higher coagulation factor VIII than blood group O individuals.

Electrocortical Activity Differences Related to Saccadic Movements between Bipolar Patients and Healthy Subjects

Objective: The present study aimed to investigate and to compare the electrophysiological changes in bipolar patients and healthy subjects during the execution of a saccade task. Materials and Methods: The subjects had to respond to a fixed visual stimulus presented by a LEDs bar. We executed an ANOVA (one-way) and post hoc Scheffé test to examine the difference of absolute alpha power and reaction time among four groups: control, depression, manic and euthymic. We observed the frontal, parietal and occipital regions. The paired t test was realized on each electrode and group to compare the pre and post moment in the task. Results: We observed a statistical difference among the groups for the behavioral variable—saccade reaction time. For the electrophysiological variable—absolute alpha power, we did not find significant difference between the moments (pre and post stimulus presentation) for none of the electrodes of each bipolar group. However, the results pointed out to a difference between the moments for F3, P3, O1 and O2 electrodes for control group. Conclusion: We cannot affirm that the task influences the cortical activity of the patients. It is possible that the method used to analyze the data is not the adequate. The time-frequency analysis could be better to analyze the present data. We also observed that the absolute alpha power could be considered a marker of bipolar disorder, but not of the different states (i.e., mania, depression, euthymia).