Spiramycin is comparable to oxytetracycline in eradicating H. pylori when given with ranitidine bismuth citrate and metronidazole

BACKGROUND: We have consistently achieved about 90% eradication of H. pylori with liquid bismuth, metronidazole and oxytetracycline. AIM: To test eradication and adverse events of ranitidine bismuth citrate (RBC) when given with metronidazole and either oxytetracycline or spiramycin. METHODS: One hundred and eighty-three patients were randomized to one of four 10-day regimens: RBC400OM: RBC 400 mg b.d., oxytetracycline 500 mg q.d.s.; RBC400SM: RBC 400 mg b.d., spiramycin 1 g q.d.s.; RBC200OM: RBC 200 mg q.d.s., oxytetracycline 500 mg q.d.s.; RBC200SM: RBC 200 mg q.d.s., spiramycin 1 g q.d.s. Additionally, all patients received metronidazole 400 mg q.d.s. A 14C-urea breath test was performed at 8 weeks. RESULTS: Intention-to-treat eradication rates were 94%, 91%, 94% and 89% with RBC400OM, RBC400SM, RBC200OM and RBC200SM, respectively (P = 0.81). Eradication was significantly higher in ulcer patients (97%) than in those with diagnoses other than ulcer (86%) (P = 0.009). There was a strong tendency to better eradication among those who had never smoked (100%) compared with ex-smokers (93%) and smokers (89%) (P = 0.06). Fifty-three per cent experienced at least one moderate or severe adverse event, and women had more adverse events than men (P = 0.0002). CONCLUSIONS: All four regimens had comparable efficacy and adverse events. Eradication was significantly better in ulcer patients but there was a trend to better eradication in those who smoked less, used less alcohol and exercised more. Adverse events were frequent, perhaps because of the large dose of metronidazole used, but few patients stopped treatment.     

Clamp and sew techniques in thoracoabdominal aortic surgery using naloxone and CSF drainage

Surgical repair of thoracoabdominal (TAA) and thoracic aneurysm is challenging, with the potentials for high morbidity and mortality. There is no standardized operative approach. Operative management of TAA consists of simple clamp-and-sew techniques with adjuncts, cerebrospinal fluid (CSF) drainage, naloxone administration, and intraoperative hypothermia, to protect the spinal cord. The use of CSF drainage and naloxone administration has reduced paraplegia to 3.4%, compared with 21% when none of these adjunctive spinal cord measures were used. The authors discuss their operative strategy, surgical technique, and results at the University of Wisconsin Hospital and Clinics.     

Tuberculosis defaulters from the "dots" regimen in Jimma zone, southwest Ethiopia

A cross-sectional study was conducted among patients with tuberculosis on the DOTS regimen in the four teaching health centers of Jimma zone to determine rate of defaulting and factors associated with it. All tuberculosis patients registered and treated using DOTS regimen in the 4 teaching health centers (THC's) from the second half of 1999 to December 30, 2000 were included in the study. A sub-sample of one hundred and fourteen 114 (56.2%) defaulters were traced at their homes and interviewed to elicit their reasons for defaulting. The study showed that overall rate of defaulting was 6.7%. The default rate from the DOTS regimen was found to be quite low when compared to the rate of defaulting from the standard regimen in Jimma zone. Socio-economic factors including distance of patients' residence from the health institution, lack of money for paying transportation and poor awareness about the disease were the major reasons contributing to poor compliance and defaulting. Designing community based strategies for DOTS regimen in order to make the drug available within the vicinity of the grass root community and strong information education and communication activities need to be employed in order to reduce the defaulter rate and improve the quality of treatment of tuberculosis cases by the DOTS regimen.     

Predictors of adherence to antiretroviral therapy among people living with HIV/AIDS in resource-limited setting of southwest ethiopia

Background  

Good adherence to antiretroviral therapy is necessary to achieve the best virological response, lower the risk that drug resistance will develop, and reduce morbidity and mortality. Little is known about the rate and predictors of adherence in Ethiopia. Therefore this study determines the magnitude and predictors of adherence to antiretroviral therapy among people living with HIV/AIDS in Southwest Ethiopia.     

GRAPE: a graphical pipeline environment for image analysis in adaptive magnetic resonance imaging

Purpose

We present a platform, GRAphical Pipeline Environment (GRAPE), to facilitate the development of patient-adaptive magnetic resonance imaging (MRI) protocols.

Methods

GRAPE is an open-source project implemented in the Qt C++ framework to enable graphical creation, execution, and debugging of real-time image analysis algorithms integrated with the MRI scanner. The platform provides the tools and infrastructure to design new algorithms, and build and execute an array of image analysis routines, and provides a mechanism to include existing analysis libraries, all within a graphical environment. The application of GRAPE is demonstrated in multiple MRI applications, and the software is described in detail for both the user and the developer.

Results

GRAPE was successfully used to implement and execute three applications in MRI of the brain, performed on a 3.0-T MRI scanner: (i) a multi-parametric pipeline for segmenting the brain tissue and detecting lesions in multiple sclerosis (MS), (ii) patient-specific optimization of the 3D fluid-attenuated inversion recovery MRI scan parameters to enhance the contrast of brain lesions in MS, and (iii) an algebraic image method for combining two MR images for improved lesion contrast.

Conclusions

GRAPE allows graphical development and execution of image analysis algorithms for inline, real-time, and adaptive MRI applications.

     

The effect of diazepam on human gastric secretion

Human basal gastric secretion is markedly reduced after oral administration of 10 mg diazepam. This effect lasts for five hours.

Gastric nocturnal secretion, collected five hours after the last meal, reveals a decline towards the morning hours with an average of 25% in placebo-treated patients. A comparison between placebo and diazepam reveals a significantly greater decrease of 47% in volume after giving parenterally 10 mg diazepam without noticeable side effects.

     

Risk factors for anemia among pregnant women attending antenatal clinic at Jimma University Hospital, southwest Ethiopia

OBJECTIVE: to determine anemia and its risk factors among pregnant women METHODS: A cross-sectional analytic study was carried out among pregnant women who came for antenatal care follow up for the first time to Jimma University hospital, Jimma town, southwestern Ethiopia from May-June 2005. RESULTS: A total of 168 pregnant women who came for their first antenatal care visit to Jimma University hospital were enrolled in the study. A structured and interviewer administered questionnaire was used to collect data on the socio-demographic variables, dietary habit and other gynecologic and obstetric history. Dietary data were collected using food frequency questionnaire prepared for assessing nutritional factors for anemia. Sahli hemoglobinometer and a microscope were used for assessing hemoglobin level and stool for hookworm infection, respectively. Data were cleaned, edited and entered in to a computer and analyzed using SPSS for windows, version 11.0. Statistical tests were performed at the level of significance of 5%. The prevalence of anemia was 64/168 (38.2%) and the mean hemoglobin level was 11.3 mg/dl. Anemic cases were 4 times likely to have history of excess menstrual bleeding prior to the index pregnancy 2 times likely to have hook worm infection and 3 times likely not to have shoe wearing habit, 3 times likely to have birth intervals less than 24 moths between the previous pregnancy and index pregnancy (p < 0.05). CONCLUSION: This finding suggests the need for strengthening of interventions related to child spacing and raising awareness about family planning methods. All ANC attendants should be screened for anemia and hookworm infection at first visit and those anemic mothers and infected with hookworm should be treated appropriately. Health education should be given to pregnant mothers on family planning, and the need to gynecologic evaluation before pregnancy and the importance of wearing shoes to decrease hook worm infection and subsequent anemia.