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1.
Thaíssa S. Monteiro Marcelo G. Correia Wilma F. Golebiovski Giovanna Ianini F. Barbosa Clara Weksler Cristiane C. Lamas 《The Brazilian journal of infectious diseases》2017,21(3):240-247
Background
Embolic complications of infective endocarditis are common. The impact of asymptomatic embolism is uncertain.Objectives
To determine the frequency of emboli due to IE and to identify events associated with embolism.Methods
Retrospective analysis of an endocarditis database, prospectively implemented, with a post hoc study driven by analysis of data on embolic events. Data was obtained from the International Collaboration Endocarditis case report forms and additional information on embolic events and imaging reports were obtained from the medical records. Variables associated with embolism were analyzed by the statistical software R version 3.1.0.Results
In the study period, 2006–2011, 136 episodes of definite infective endocarditis were included. The most common complication was heart failure (55.1%), followed by embolism (50%). Among the 100 medical records analyzed for emboli in left-sided infective endocarditis, 36 (36%) were found to have had asymptomatic events, 11 (11%) to the central nervous system and 28 (28%) to the spleen. Cardiac surgery was performed in 98/136 (72%). In the multivariate analysis, splenomegaly was the only associated factor for embolism to any site (p < 0.01, OR 4.7, 95% CI 2.04–11). Factors associated with embolism to the spleen were positive blood cultures (p = 0.05, OR 8.9, 95% CI 1.45–177) and splenomegaly (p < 0.01, OR 9.28, 95% CI 3.32–29); those associated to the central nervous system were infective endocarditis of the mitral valve (p < 0.05, OR 3.5, 95% CI 1.23–10) and male gender (p < 0.05, OR 3.2, 95% CI 1.04–10). Splenectomy and cardiac surgery did not impact on in-hospital mortality.Conclusions
Asymptomatic embolism to the central nervous system and to the spleen were frequent. Splenomegaly was consistently associated with embolic events. 相似文献2.
3.
Mercedes Ramas Maria G. Donday Adrian G. McNicholl Javier P. Gisbert 《Gastroenterologia y hepatologia》2017,40(10):658-662
Background
A progressive decrease in Helicobacter pylori eradication rates has been described over the years, driving the need for new antibiotic treatments.Aim
To evaluate the efficacy and safety of the addition of rifaximin (Spiraxin®) to standard triple therapy (omeprazole, amoxicillin and clarithromycin) for the eradication of H. pylori.Methods
Independent prospective clinical trial (EUDRACT no.: 2013-001080-23). Forty consecutive adult patients were included with H. pylori infection, dyspeptic symptoms and naive to eradication treatment. A full blood test was performed in the first five patients enrolled to evaluate the safety of the treatment. H. pylori eradication was confirmed with the 13C-urea breath test at least four weeks after the end of treatment with rifaximin 400 mg/8 h, clarithromycin 500 mg/12 h, amoxicillin 1 g/12 h and omeprazole 20 mg/12 h for 10 days.Results
Forty patients were consecutively enrolled, 53% woman, mean age 44 years. Indication for eradication: 60% non-investigated dyspepsia, 38% functional dyspepsia and 2% gastric ulcer. Four patients did not attend the eradication confirmatory breath test. The eradication rate was 61% (95% CI: 45–77%) for the protocol and 55% (40–70%) for intention-to-treat. About 76% of the patients experienced adverse events (35% diarrhea, 14% nausea and 24% metallic taste), none of which was serious. The blood tests did not show significant alterations.Conclusion
Acceptable H. pylori eradication rates are not achieved with rifaximin associated with standard triple therapy for 10 days. 相似文献4.
Yuji Fujikura Toshie Manabe Akihiko Kawana Shigeru Kohno 《Archivos de bronconeumología》2017,53(2):55-61
Introduction
The clinical benefits of adjunctive corticosteroids for Pneumocystis jirovecii (P. jirovecii) pneumonia in patients not infected with the human immunodeficiency virus (HIV) has not been evaluated by meta-analysis.Methods
We conducted a systematic review of published studies describing the effects of adjunctive corticosteroids on outcome in non-HIV P. jirovecii pneumonia patients. Two investigators independently searched the PubMed and Cochrane databases for eligible articles written in English. A meta-analysis was performed using a random-effects model for measuring mortality as the primary outcome, and the need for intubation or mechanical ventilation as the secondary outcome.Results
Seven observational studies were eligible. In these studies, adjunctive corticosteroids did not affect mortality in non-HIV patients (odds ratio [OR] 1.26; 95% CI 0.60-2.67) and there was no beneficial effect in patients with severe hypoxemia (PaO2 < 70 mmHg) (OR 0.90; 95% CI 0.44-1.83). No significant effect on the secondary outcome was observed (OR 1.34; 95% CI 0.44-4.11).Conclusions
Although the studies were observational, meta-analysis showed that adjunctive corticosteroids did not improve the outcome of P. jirovecii pneumonia in non-HIV patients. The results warrant a randomized controlled trial. 相似文献5.
Background and aim
Brucellosis is an infectious, contagious and zoonotic disease that occurs worldwide. The family members of an index case of brucellosis may be especially susceptible, due to sharing the same source of infection and similar risk factors for brucellosis. In this study, we propose to screen pediatric and adult family members of brucellosis index cases for detecting additional unrecognized infected family members.Materials and methods
114 family members of 41 pediatric patients with brucellosis were evaluated. All family members completed a brief questionnaire and were tested by a standard tube agglutination test (STA).Results
The majority of family members (n = 96, 84.2%) were children. Among the 114 family members, 42 (36.8%) were seropositive, and 15 (35.7%) were symptomatic. The majority of the symptomatic seropositive family members (n = 12, 80%) had STA titers (≥1:640) higher than asymptomatic seropositive family members (n = 9, 33%; p = 0.004).Conclusion
The routine screening of both pediatric and adult family members of index cases is a priority in endemic areas. Using this screening approach, unrecognized family members who are seropositive for brucellosis will be identified earlier and be able to receive prompt treatment. 相似文献6.
7.
Adrian Gerald McNicholl Julio Ducons Jesús Barrio Luis Bujanda Montserrat Forné-Bardera Reyes Aparcero Julio Ponce Robin Rivera José María Dedeu-Cuso Pilar Garcia-Iglesias Miguel Montoro Alicia Bejerano Yolanda Ber-Nieto Belen Madrigal Eva Zapata Carmen Loras-Alastruey Manuel Castro Andrea Nevarez Javier P. Gisbert 《Gastroenterologia y hepatologia》2017,40(10):651-657
Background
Rapid Urease Test (RUT) is a simple, cheap and relatively fast method for diagnosing Helicobacter pylori infection. It is therefore the preferred method used for patients undergoing gastroscopy. Most kits require 24 h to give results. The new Ultra-Rapid Urease Test (URUT) kit by Biohit® requires less than 1 h.Objective
To determine URUT's diagnostic accuracy.Method
Prospective, blind, multi-centre study involving dyspeptic patients. One corpus biopsy and three antral biopsies were obtained during gastroscopy for standard histological analysis, RUT and URUT. The URUT result was checked after 1 min, 5 min, 30 min and 60 min and the RUT was checked over the course of 24 h. Histology was used as the gold standard test.Results
144 patients were included, 68% female, with a mean age of 49 years old; 50% were H. pylori positive. RUT and URUT diagnoses were correct in 85.9% and 90% of the cases, respectively. The mean waiting time for a positive RUT result was 6 h. The sensitivity, specificity, and positive and negative predictive values for RUT were, respectively, 82%, 90%, 89% and 84%. The URUT's results were similar (85%, 94%, 94% and 87%). These figures improved when patients taking PPIs were excluded (RUT: 86%, 91%, 93% and 83%; URUT: 91%, 94%, 96% and 89%). No statistically significant differences were found when comparing RUT and URUT distributions of correct diagnoses (McNemar's Test, p = 0.3) but there was a tendency towards better results with the URUT.Conclusion
The URUT is equivalent to (or slightly better than) the traditional RUT in diagnosing H. pylori infection, and provides results in less than an hour. 相似文献8.
Henry Córdova Cristina Sánchez-Montes Pedro G. Delgado-Guillena Victor J. Morales Oriol Sendino Begoña González-Suárez Andrés Cárdenas Maria Pellisé Isis K. Araujo Àngels Ginés Josep Llach Gloria Fernández-Esparrach 《Gastroenterologia y hepatologia》2017,40(9):587-594
Introduction
There is an opportunity for improvement in the recording and measuring of quality indicators. However, no previous experiences exist in our field in terms of their compliance in esophagogastroduodenoscopy (EGD).Objective
To analyse compliance with EGD quality criteria and evaluate improvement after conducting a training programme.Patients and methods
Comparative study of 2 cohorts: one retrospective (control group) and one prospective (intervention group), before and after a training programme consisting of an information session and the report writing improvement programme. The quality indicators proposed by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology were used.Results
A total of 1,200 EGDs were included in a sequential manner (600 in each group). Following the training programme, a significant improvement was observed in the following indicators: documented indication (93 vs. 99.8%; P < 0.01), documented full examinations (94.7 vs. 97.3%; P < 0.01), correct performance (63.7 vs. 87.9%; P < 0.01), appropriate biopsies according to protocols (57.9 vs. 83.8%; P < 0.01), photo-documentation of described lesions (84.1 vs. 94.9%; P < 0.01), photo-documentation per segment (52.9 vs. 70.5%; P < 0.01) and correct overall assessment (56,9 vs. 90.5%; P < 0.01). Biopsies for coeliac disease, documented indication, full examination and correct performance, if it went ahead, exceeded the recommended standard.Conclusion
A very simple training programme improves EGD quality indicators, with the majority reaching the standards recommended by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology. 相似文献9.
Vaishali Kolgiri Vinayak Wamanrao Patil 《The Brazilian journal of infectious diseases》2017,21(1):35-41
Background
The major complications of “treated” Human Immunodeficiency Virus (HIV) infection are cardiovascular disease, malignancy, renal disease, liver disease, bone disease, and perhaps neurological complications, which are phenomena of the normal aging process occurring at an earlier age in the HIV-infected population. The present study is aimed to explore protein carbonyl content as a biomarker for detecting oxidative DNA damage induced ART toxicity and/or accelerated aging in HIV/AIDS patients.Objective
To investigate the potential of carbonyl content as a biomarker for detecting oxidative Deoxyribonucleic acid (DNA) damage induced Antiretroviral Theraphy (ART) toxicity and/or accelerated aging in HIV/AIDS patients.Methods
In this case–control study a total 600 subjects were included. All subjects were randomly selected and grouped as HIV-negative (control group) (n = 300), HIV-infected ART naive (n = 100), HIV-infected on first line ART (n = 100), and HIV-infected on second line ART (n = 100). Seronegative control subjects were age- and sex-matched with the ART naive patients and the two other groups. Carbonyl protein was determined by the method described in Levine et al. DNA damage marker 8-OH-dG was determined using 8-hydroxy-2-deoxy Guanosine StressXpress ELA Kit by StressMarq Biosciences.Results
Protein carbonyl content levels and oxidative DNA damage were significantly higher (p < 0.05) in HIV-infected patients on second line ART and HIV-infected patients on first line ART than ART naive patients and controls. In a linear regression analysis, increased protein carbonyl content was positively associated with increased DNA damage (OR: 0.356; 95% CI: 0.287–0.426) p < 0.05.Conclusions
Carbonyl content may has a role as a biomarker for detecting oxidative DNA damage induced ART toxicity and/or accelerated aging in HIV/AIDS patients. Larger studies are warranted to elucidate the role of carbonyl content as a biomarker for premature aging in HIV/AIDS patients. 相似文献10.
Detection of high biliary and fecal viral loads in patients with chronic hepatitis C virus infection
Hugo Monrroy Jenniffer Angulo Karla Pino Pilar Labbé Juan Francisco Miquel Marcelo López-Lastra Alejandro Soza 《Gastroenterologia y hepatologia》2017,40(5):339-347
Background
The life cycle of the hepatitis C virus (HCV) is closely associated with lipid metabolism. Recently, NPC1L1 (a cholesterol transporter) has been reported to function as an HCV receptor. This receptor is expressed in the hepatocyte canalicular membrane and in the intestine; serving as a key transporter for the cholesterol enterohepatic cycle.Objectives
We hypothesized that HCV might have a similar cycle, so we aimed to study the presence of HCV in bile and stools of infected patients.Materials and methods
Blood, feces, and duodenal bile samples were collected from patients infected with HCV. The biliary viral load was normalized to the bile salt concentration of each sample and the presence of HCV core protein was also evaluated. A total of 12 patients were recruited. HCV RNA was detected in the bile from ten patients.Results
The mean viral load was 2.5 log10 IU/60 mg bile salt. In the stool samples, HCV RNA was detected in ten patients (mean concentration 2.7 log10 IU/g of feces).Conclusions
HCV RNA is readily detectable and is present at relatively high concentrations in the bile and stool samples of infected patients. This may be relevant as a source of infection in men who have sex with men. Biliary HCV secretion may perhaps play a role in the persistence of viral infection via an enterohepatic cycle of the virus or intrahepatic spread. 相似文献11.
Ana Isabela Morsch Passos Rachel Polo Dertkigil Marcelo de Carvalho Ramos Ariane Fidelis Busso-Lopes Cibele Tararan Erivan Olinda Ribeiro Angélica Zaninelli Schreiber Plinio Trabasso Mariangela Ribeiro Resende Maria Luiza Moretti 《The Brazilian journal of infectious diseases》2017,21(6):606-612
Introduction
The etiology of pulmonary infections in HIV patients is determined by several variables including geographic region and availability of antiretroviral therapy.Materials and methods
A cross-sectional prospective study was conducted from 2012 to 2016 to evaluate the occurrence of pulmonary fungal infection in HIV-patients hospitalized due to pulmonary infections. Patients’ serums were tested for (1–3)-β-D-Glugan, galactomannan, and lactate dehydrogenase. The association among the variables was analyzed by univariate and multivariate regression analysis.Results
60 patients were included in the study. The patients were classified in three groups: Pneumocystis jirovecii pneumonia (19 patients), community-acquired pneumonia (18 patients), and other infections (23 patients). The overall mortality was 13.3%. The time since diagnosis of HIV infection was shorter in the pneumocystosis group (4.94 years; p = 0.001) than for the other two groups of patients. The multivariate analysis showed that higher (1-3)-β-D-Glucan level (mean: 241 pg/mL) and lactate dehydrogenase (mean: 762 U/L) were associated with the diagnosis of pneumocystosis. Pneumocystosis was the aids-defining illness in 11 out of 16 newly diagnosed HIV-infected patients.Conclusion
In the era of antiretroviral therapy, PJP was still the most prevalent pulmonary infection and (1-3)-β-D-Glucan and lactate dehydrogenase may be suitable markers to help diagnosing pneumocystosis in our HIV population. 相似文献12.
Lidia Argüello Viúdez Henry Córdova Hugo Uchima Cristina Sánchez-Montes Àngels Ginès Isis Araujo Begoña González-Suárez Oriol Sendino Josep Llach Gloria Fernández-Esparrach 《Gastroenterologia y hepatologia》2017,40(8):507-514
Introduction
Gastric polyps are usually asymptomatic lesions incidentally discovered during endoscopy.Objective
To study the frequency of different types of gastric polyps in our population and their possible association with other factors.Patients and methods
Retrospective study of gastroscopies performed in a tertiary hospital over a ten-year period. Demographics, medical history, indication for gastroscopy and morphological and histological characteristics of polyps were collected.Results
Gastric polyps were found in 827 out of 41253 (2%) reviewed gastroscopies, corresponding to 709 patients. Mean age was 65.6 years, and 62% were female. 53.9% of patients had multiple polyps. The most common location was the fundus and 83.3% were smaller than 1 cm. Histopathology was obtained in 607 patients: hyperplastic polyps were the most common (42.8%), followed by fundic gland polyps (37.7%). Factors independently associated with hyperplastic polyps were age and single polyp, size ≥ 6 mm and location other than fundus. In contrast, fundic gland polyps were associated with reflux and multiple polyps, size < 6 mm and located in fundus. Adenomas were independently associated with single polyp.Conclusions
Fundic gland and hyperplastic polyps are the most common in our population and have characteristic features that can guide histological diagnosis. With single polyps it is advisable to take biopsies to rule out adenoma. 相似文献13.
A. Fabre-Baudouin A.L. Roux C. Marin M. Lachatre M. De Laroche M. Ponsoye T. Hanslik S. Trad 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(12):794-799
Introduction
Lymphogranuloma venereum (LG) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis L serovar.Methods
These five consecutive cases aim to highlight the risk of LG misdiagnosis, in case of initial presentation with isolated inguinal adenitis.Results
Five men (mean age: 30 ± 7 years) were seen in an internal medicine department, for inguinal adenopathy. One patient had clinical signs of urethritis. None presented an associated rectitis. Three patients had a history of STI, and two had a discovery of related HIV disease. Urinary polymerase chain reaction (PCR) was positive for the symptomatic patient and negative for the others. Lymph node PCR was positive in all patients within a L2b serotype (searched in 4 out of 5 cases).Conclusion
LG should be evoked in any patient with inguinal adenomegaly, particularly in case of STI history or risk factors. Negativity of urinary PCR should lead to further investigations, essentially a lymph node cytopuncture to evidence C. trachomatis. 相似文献14.
Moncef Belhassen-García Javier Pardo-Lledías Luis Pérez del Villar Virginia Velasco-Tirado María Siller Ruiz Miguel Cordero-Sánchez Belen Vicente Sara Hernández Egido Juan Luis Muñoz Bellido Antonio Muro 《Enfermedades infecciosas y microbiología clínica》2017,35(1):27-32
Introduction
In Spain, minors represent approximately 20% of the immigration flow. Many of these immigrants come from countries in the tropics and sub-tropics where intestinal parasitic infections caused by helminths and protozoa are one of the major causes of human disease. The main objective of the present work was to describe parasite infections in a group of immigrant children.Methods
A prospective evaluation was performed in 373 minors from Sub-Saharan Africa, North Africa, and Latin America. Details were collected from the medical records and physical examination. Urine, stool and peripheral blood samples were obtained for serological and routine laboratory tests. Direct and indirect parasitological tests were also performed.Results
At least 1 parasitic disease was diagnosed in 176 (47.1%) immigrant children, while 77 (20.6%) minors were infected with two or more parasites. The number of parasites was highest in children from Sub-Saharan Africa compared with the rest of the areas of origin (p < .001), and in children from urban areas compared with those from rural areas (OR 1.27 [1.059–1.552], p = .011). The most frequent causes of multiple parasite infection were filariasis plus strongyloidiasis and filariasis plus schistosomiasis. Intestinal parasite infection was diagnosed in 38 cases (13.8%). Logistic regression analysis revealed that for each month of stay, the probability of a positive finding in the stool sample decreased by 0.02% [β = ?0.020, (p = .07)].Conclusions
The high infection rates of parasite diseases in immigrant children point to the need for screening protocols for certain infectious diseases in these children according to their country of origin and their length of residence in Spain. 相似文献15.
Leonardo Hideto Nagaya Mauro José Costa Salles Lucas Sadawo Chagas Takikawa Marcelo Fregoneze Pedro Doneux Luciana Andrade da Silva Guilherme do Val Sella Alberto Naoki Miyazaki Sergio Luiz Checchia 《The Brazilian journal of infectious diseases》2017,21(6):613-619
Purposes
Shoulder arthroplasty (SA) has been performed by many years for the treatment of several conditions, including osteoarthritis and proximal humeral fractures following trauma. Surgical site infection (SSI) following Shoulder arthroplasty remains a challenge, contributing to increased morbidity and costs. Identification of risk factors may help implementing adequate strategies to prevent infection. We aimed to identify pre- and intra-operative risk factors associated with deep infections after Shoulder arthroplasty.Methods
An unmatched case-control study was conducted to describe the prevalence, clinical and microbiological findings, and to evaluate patient and surgical risk factors for prosthetic shoulder infection (PSI), among 158 patients who underwent SA due to any reason, at a tertiary public university institution. Risk factors for PSI was assessed by uni- and multivariate analyses using multiple logistic regression.Results
168 SA from 158 patients were analyzed, with an overall infection rate of 9.5% (16/168 cases). Subjects undergoing SA with American Society of Anesthesiologists (ASA) grade III or higher (odds ratio [OR] = 5.30, 95% confidence interval [CI] = 1.58–17.79, p < 0.013) and presenting local hematoma after surgery (odds ratio [OR] = 7.10, 95% confidence interval [CI] = 1.09–46.09, p = 0.04) had higher risk for PSI on univariate analysis. However, only ASA score grade III or higher remained significant on multivariate analysis (OR = 4.74, 95% CI = 1.33–16.92, p = 0.016). Gram-positive cocci and Gram-negative bacilli were equally isolated in 50% of cases; however, the most commonly detected bacterium was Pseudomonas aeruginosa (18.7%).Conclusion
This study provides evidence suggesting that patient-related known factors such as higher ASA score predisposes to shoulder arthroplasty-associated infection. Furthermore, unusual pathogens associated with PSI were identified. 相似文献16.
17.
Weiyan Yu Yadong Wang Chuan Shen Ru Ji Li Zhang Xin Zhao Miao Su Ying Zhang Wenyan He Jianguo Cao Yanshuang Hao Shengpeng Chen Caiyan Zhao 《The Brazilian journal of infectious diseases》2017,21(3):213-218
Aims
To evaluate the HBeAg seroconversion rate in real clinical setting and explore its predictors in long-term nucleos(t)ide analogues (NAs) treatment for chronic hepatitis B (CHB).Methods
251 patients were recruited from January 2001 to September 2009 in four hospitals in Hebei province, China, for this retrospective study. Clinical and laboratory data before and after treatment with lamivudine (LAM, 100 mg daily), adefovir (ADV, 10 mg daily), telbivudine (LDT, 600 mg daily), entecavir (ETV, 0.5 mg daily), and LAM/ADV combination were compared among three groups according to treatment outcomes: synchronous HBeAg loss and HBeAg seroconversion, anti-HBe development after treatment, and no anti-HBe. Adherence was also evaluated.Results
In real clinical setting, cumulative HBeAg seroconversion rates were 14.3%, 32.7%, 43.0%, 46.9%, and 50.5% after 1, 2, 3, 5, and 8 years, respectively. 45 patients (17.9%) were non-adherent. Adherence (p < 0.001, Hazard Ratio (HR) = 2.203), elevated alanine aminotransferase (ALT) levels (p < 0.001, HR = 2.049), and non-vertical transmission (p = 0.006, HR = 1.656) were predictors of HBeAg seroconversion.Conclusion
Adherence, elevated ALT, and non-vertical transmission are predictors of HBeAg seroconversion in CHB patients treated with NAs. 相似文献18.
Marlone Cunha-Silva Fábio R.T. Marinho Paulo F. Oliveira Tirzah M. Lopes Tiago Sevá-Pereira Sonia L.S. Lorena Jazon R.S. Almeida 《The Brazilian journal of infectious diseases》2017,21(4):441-447
Background
Chronic hepatitis B is a major cause of cirrhosis, and the natural history of the disease has several clinical stages that should be thoroughly understood for the implementation of proper treatment. Nonetheless, curing the disease with antiviral treatment remains a challenge.Aims
To describe the clinical course, response to treatment, and poor prognostic factors in 247 hepatitis B virus chronic infection patients treated in a tertiary hospital in Brazil.Methods
This was a retrospective and observational study, by analyzing the medical records of HBV infected patients between January 2000 and January 2015.Results
Most patients were male (67.2%) and 74.1% were HBeAg negative. Approximately 41% had cirrhosis and 8.5% were hepatitis C virus coinfected. The viral load was negative after two years on lamivudine, entecavir and tenofovir in 86%, 90.6%, and 92.9% of the patients, respectively. The five-year resistance rates for lamivudine, adefovir, entecavir, and tenofovir were 57.5%, 51.8%, 1.9%, and 0%, respectively. The overall seroconversion rates were 31.2% for HBeAg and 9.4% for HBsAg. Hepatocellular carcinoma was diagnosed in 9.7% of patients, liver transplantation was performed in 9.7%, and overall mortality was 10.5%. Elevations of serum alanine aminotransferase (p = 0.0059) and viral load (p < 0.0001) were associated with progression to liver cirrhosis. High viral load was associated with progression to hepatocellular carcinoma (p < 0.0001). Significant risk factors associated with death were elevated alanine aminotransferase (p = 0.0039), liver cirrhosis (p < 0.0001), high viral load (p = 0.007), and hepatocellular carcinoma (p = 0.0008). HBeAg positive status was not associated with worse outcomes, and treatment may have been largely responsible.Conclusions
Elevations of viral load and serum alanine aminotransferase may select patients with worse prognosis, especially progression to cirrhosis and hepatocellular carcinoma, which were strongly association with death. 相似文献19.
Cristina Dacoll Jordi Sánchez-Delgado Henia Balter Ximena Pazos María Di Pace Gabriela Sandoya Henry Cohen Xavier Calvet 《Gastroenterologia y hepatologia》2017,40(7):447-454
Background
Strong acid inhibition increases cure rates with triple therapy and 14-day are more effective than 7-day treatments. The combination of amoxicillin plus metronidazole at full doses has been shown to overcome metronidazole resistance and to achieve good eradication rates even in patients harboring resistant strains. No previous studies have been reported in Latin-America with this optimized triple-therapy scheme.Aims
The aim of the present study was to assess the eradication rate and tolerance of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole.Methods
Patients from the Clínica de Gastroenterología of the Hospital de Clínicas (Montevideo, Uruguay) were included. Hp status was mainly assessed by at least one of the following: histologyor urea breath test (UBT). A 14-day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazole 500 mg, both three times a day. H. pylori cure was assessed by UBT.Results
Forty-one patients were enrolled. Mean age was 53.3 ± 13 years and 17.1% of patients were male. Main indications for treatment were: functional dyspepsia (27.5%), gastritis (45%), gastric or duodenal erosions (20%), gastric ulcer (5%) and intestinal metaplasia (2.5%). H. pylori eradication was achieved in 33 of the 37 patients who returned for follow-up. Eradication rates were 80.5% (95% CI: 68.4–92.6) by intention-to-treat (ITT) analysis and 89.2% (95% CI; 79.2–99.2) per protocol (PP). No major side effects were reported; 26 patients (65.8%) complained of mild side effects (nausea, diarrhea and headache).Conclusions
Cure rates of this triple therapy including esomeprazole, amoxicillin and metronidazole were 81% per ITT and the treatment was well tolerated. These optimal results with a simple clarithromycin-free triple therapy are better than described for standard triple therapy but there is still room for improvement to reach the desired target of 90% per ITT. 相似文献20.
Srujitha Marupuru Padmanav Senapati Swathi Pathadka Sonal Sekhar Miraj Mazhuvancherry Kesavan Unnikrishnan Mohan K. Manu 《The Brazilian journal of infectious diseases》2017,21(3):312-316