Eradication of Helicobacter pylori: a prospective comparative randomized trial of standard versus optimized quadruple therapy.

The treatment of Helicobacter pylori infection remains a challenge. None of the proposed treatment regimens has resulted in a 100% eradication rate. The aim of our study was to compare the rate of H. pylori eradication after standard or dose-optimized amoxicillin quadruple therapy. We conducted a prospective comparative study collating patients naive to any anti-H. pylori treatment and with chronic H. pylori infection documented by histological examination. Patients were randomly assigned to either standard quadruple therapy or optimized quadruple therapy. Eradication control was performed by urea breath test. Eighty-eight eligible patients were included with 44 in each group.There was no significant difference between the eradication rates of Qo-14 and Qs-14 neither in ITT (84 vs 70.4%; p = 0.127) nor in PP (82.1 vs 77.7%; p = 0.473). Compliance and tolerance appeared similar in each group.

H. pylori is a common bacterium that can cause several digestive infections, including gastric ulcers and gastric cancer. The aim of this study was to compare the rate of H. pylori eradication after a standard dose compared with a double dose of a specific therapy known as amoxicillin quadruple therapy. The results showed no significant difference between the eradication rates of standard or optimized quadruple therapy.

[Alterations in lipidic metabolism in hemodialysis patients]. / Altérations du métabolisme lipidique chez les hémodialysés.

BACKGROUND: Chronic kidney failure is associated with dyslipidemia and accelerated atherosclerosis. AIM: To study lipidic metabolism alterations in patients with chronic kidney failure on hemodialysis. METHODS: The study interested 45 hemodialysis patients with a mean age of 49.04 ±15.92 years old and 45 healthy controls. A blood sample was collected from each patient and control to measure total cholesterol, triglycerides, HDL- cholesterol, LDL-cholesterol, apolipoproteins AI and B100, lipoprotein (a) and C Reactive Protein. RESULTS: A significant increase of serum triglycerides (p= 0.002), lipoprotein (a) (p = 0.001) and C Reactive Protein (p = 0.008) was observed in patients when compared with healthy controls. A significant decrease of serum total cholesterol (p=0.01), HDLcholesterol (p<0.001), LDL-cholesterol (p=0.005) and apolipoprotein AI (p<0.001) was also observed in patients. CONCLUSION: Disorders of lipidic metabolism are frequent in hemodialysis patients. These alterations can lead to cardiovascular disease in uremic patients.

Prevalence of metabolic syndrome in Tunisian overweight and obese children.

AIMS: To assess the prevalence of metabolic syndrome (MS) and its parameters in a cohort of overweight and obese Tunisian schoolchildren and to investigate the involvement of leptin, and insulin in MS development via obesity. METHODS: A total of 306 schoolchildren between 10- 12 years: obese (n=35), overweight (n=99) and normal weight (n=172) were included in the study. Height, weight, waist circumference were measured and body mass index (BMI) was calculated. A blood sample was collected from each subject to measure glycemia, triglycerides, HDL cholesterol, leptin and insulin. MS diagnosis was based on criteria of  the International Diabetes Federation. RESULTS: Prevalence of MS was 14.3% in obese children compared to 1% in overweight and 0% in controls (p0.001). Abdominal obesity and hypertension  were the most frequent parameters (88.6% and 25.7% respectively) in obese children. Leptin levels were significantly higher in children with MS (p0.001). In obese children, leptin was positively correlated to waist circumference (r=0.55; p=0.001) and insulin (r=0.52; p=0.002). After adjustment for BMI, leptin remained correlated with insulin (r=0.47; p0.001). CONCLUSION: MS is relatively common among Tunisian overweight and obese children. Obesity is an important risk factor for MS development. Early management of childhood obesity is necessary to avoid metabolic complications.

Vitamin D deficiency is associated with metabolic syndrome in Tunisian children with obesity.

BACKGROUND: A negative association between serum vitamin D levels and obesity has been reported by several studies. Data on vitamin D status in Tunisian obese children and its relationship with metabolic syndrome remain rare. AIM: We aimed to study the prevalence of vitamin D deficiency in Tunisian obese children and to examine the correlation between vitamin D levels and metabolic syndrome. METHODS: Thirty obese children matched to 30 non-overweight volunteer controls by age, gender and pubertal stage were included in a prospective study. Anthropometric parameters and blood pressure were measured.  Vitamin D level, fasting glucose and lipid profile were performed in all subjects. RESULTS: Vitamin D deficiency was more common in obese children (94% vs 80 %, p=0.002). Vitamin D level was negatively correlated with BMI (p= 0.001, r= -0.51). Six obese children were diagnosed with metabolic syndrome. Vitamin D levels were negatively correlated with waist circumference (p=0.019, r=-0.13), systolic Blood pressure (p=0.04, r=-0.26), triglyceride level (p=0.025, r= -0.3), insulin (p=0.01, r=-0.34) and HOMA-IR (p=0.035, r=-0.29). CONCLUSIONS: despite the sunny climate, the deficiency in vitalmine D is common in Tunisia. Vitamin D levels are inversely correlated with BMI and the risk of metabolic syndrome.