Standard Therapy In Management Research Articles

Eradication of H. Pylori by Quadruple or Triple Therapy A comparative study.

Background: Quadruple therapy appears to be more effective than standard therapy in management of patients with helicobacter pylori infection. No data is available on the relative efficacy of triple and quadruple drug regimens from Pakistan. Methods: Consecutive patients with peptic ulcer and H. pylori infection were randomized to receive omeprazole 20mg twice daily along with either amoxycilline (500mg four times daily) and clarithromycin (500 mg twice daily) (Group A) or tri-protassium dicitrate hismuthate (120mg four times daily), metronidazole (400mg thrice daily) and tetracycline (500mg 4 times daily) Group B for 10 days. Presence H. Pylori infection was looked for using an fecal antigen test before treatment and 30 days after completion of treatment. Results: 17 of 21 patients in Group A and 16 of 23 in Group B had eradication of infection (80.9 and 69.56% respectively by protocol analysis). Side effects occurred in 2 (1%) and 4(2%) patients in Group A and B. respectively. Discontinuation of drug was not required in any patient. Conclusion: Quadruple therapy for initial therapy of H. Pylori infection does not offer any advantage over standard triple therapy.

Effect of Helicobacter pylori-eradication therapy on hepatic steatosis in patients with non-alcoholic fatty liver disease: a randomized-controlled pilot study.

Background Helicobacter pylori infection has been associated with insulin resistance and non-alcoholic fatty liver disease (NAFLD). This study was done to evaluate the effect of H. pylori-eradication therapy (HPET) in patients with NAFLD compared to standard management therapy (SMT).MethodsEighty NAFLD patients with H. pylori co-infection were randomized into SMT (diet and exercise, n = 36) and HPET (SMT plus amoxicillin, clarithromycin, and pantoprazole, n = 44) groups. The controlled attenuation parameter (CAP), anthropometric parameters, liver enzymes, lipid profile, and glycemic parameters including homeostasis model assessment-insulin resistance (HOMA-IR) were measured and compared between two groups at the baseline and 24 weeks.ResultsSixty-four participants (SMT group [n = 28] and HPET group [n = 36]) were included in a modified intention-to-treat analysis. Both the SMT group and the HPET group had a significant reduction in CAP scores at 24 weeks (P = 0.002 and P < 0.001, respectively), but the change between the groups was insignificant (P = 0.213). Successful eradication of H. pylori occurred in 68% of the HPET group and led to greater improvement in HOMA-IR at 24 weeks compared to SMT or non-responder patients (P = 0.007). The liver enzymes reduced significantly at 24 weeks in both groups, but the changes between the groups were similar. The lipid parameters remained unchanged within the groups and between the groups at 24 weeks. A significant increase in the levels of reduced glutathione was noted in the HPET group, but the change between the two groups was not statistically different.ConclusionsHPET was found to be comparable to SMT alone in reducing hepatic steatosis and liver enzymes at 24 weeks in NAFLD patients. However, successful eradication of H. pylori led to greater improvement in HOMA-IR (Trial registration CTRI/2017/05/008608).

Systemic and Local Effects of Warm Oxygen Exposure to the Lower Extremities in Healthy Volunteers.

Warmth to the extremity is known to improve the cutaneous blood flow and tissue perfusion. Oxygen is essential for healing of chronic wounds. Topical oxygen therapy has become standard therapy in management of lower extremity wounds. A combination of local heat and oxygen is likely to be beneficial in many clinical scenarios of non-healing wounds without any systemic effects. To evaluate the local and systemic effects of the exposure of extremity to warm oxygen in healthy volunteers. Thirty one volunteers were included in the study. The index foot was exposed to oxygen 7l/min, 93%-95% concentration at temperature of 43oC for 90 minutes with the device. The following parameters such as basal and periprocedural blood pressure, body temperature, heart rate, 24 lead ECG, temperatures at foot and plethysmographic waveforms from the index foot were measured. A NRS-11 questionnaire was asked to the patient to rate his or her pain from 0 to 10 and documented by health care worker at the end of the session. The skin temperature of index foot reached to 34oC from 32.9oC, (p=0.011). The average pulse amplitude changed from 39.8 mV to 79.8 mV over the duration of the experiment (p< 0.001). Overall heart rate and core body temperature decreased and not much change in blood pressure. The result of the study can be extrapolated to the healing of chronic non healing wounds using warm oxygen therapy. Further studies are required on patient population to prove benefits in clinical settings.