Optimised empiric triple and concomitant therapy for Helicobacter pylori eradication in clinical practice: the OPTRICON study.

BACKGROUND: Empiric triple therapy for Helicobacter pylori should be abandoned when clarithromycin resistance rate is >15-20%. Optimisation of triple therapy (high-dose acid suppression and 14-day duration) can increase eradication rates by 10%. AIM: To compare the efficacy and safety of optimised triple (OPT-TRI) and nonbismuth quadruple concomitant (OPT-CON) therapies. METHODS: Prospective multicentre study in 16 Spanish centres using triple therapy in clinical practice. In a 3-month two-phase fashion, the first 402 patients received an OPT-TRI therapy [esomeprazole (40 mg b.d.), amoxicillin (1 g b.d) and clarithromycin (500 mg b.d) for 14 days] and the last 375 patients an OPT-CON treatment [OPT-TRI therapy plus metronidazole (500 mg b.d)]. RESULTS: Seven-hundred seventy-seven consecutive patients were included (402 OPT-TRI, 375 OPT-CON). The OPT-CON therapy achieved significantly higher eradication rates in the per-protocol [82.3% (95% CI = 78-86%) vs. 93.8% (91-96%), P < 0.001] and intention-to-treat analysis [81.3% (78-86%) vs. 90.4% (87-93%), P < 0.001]. Adverse events (97% mild/moderate) were significantly more common with OPT-CON therapy (39% vs. 47%, P = 0.016), but full compliance with therapy was similar between groups (94% vs. 92%, P = 0.4). OPT-CON therapy was the only significant predictor of successful eradication (odds ratio, 2.24; 95% CI: 1.48-3.51, P < 0.001). The rate of participating centres achieving cure rates ≥ 90% favoured OPT-CON therapy (OPT-TRI 25% vs. OPT-CON 62%). CONCLUSIONS: Empiric OPT-CON therapy achieved significantly higher cure rates (>90%) compared to OPT-TRI therapy. Addition of metronidazole to OPT-TRI therapy increased eradication rates by 10%, resulting in more mild adverse effects, but without impairing compliance with therapy.

Infiltración esteroidea epidural por vía caudal en el tratamiento del dolor lumbar crónico de origen discal. Estudio comparativo, prospectivo y aleatorizado / Caudal epidural steroid injection in the treatment of chronic discogenic low back pain. Comparative, prospective and randomized study

Objetivo. La literatura no ofrece consenso para el tratamiento del dolor lumbar crónico de origen discal. La infiltración esteroidea epidural por vía caudal (IEEC) ofrece resultados contradictorios en los pocos estudios prospectivos y aleatorizados realizados acerca de su efectividad. El objetivo de nuestro estudio es evaluar la eficacia del tratamiento mediante IEEC para reducir el dolor y mejorar la discapacidad asociada. Material y método. Estudio comparativo, prospectivo y aleatorizado de 46 pacientes con dolor lumbar crónico de origen discal. Pacientes asignados de forma aleatoria para recibir IEEC guiada por fluoroscopia (grupo IEEC), o antiinflamatorios no esteroideos por vía oral (grupo AINE). Pacientes valorados según indicaciones de la Sociedad Española para el Estudio de las Enfermedades del Raquis (GEER). Evaluación a las 4, 12 y 24 semanas. Resultados. Durante el seguimiento, el dolor lumbar medido mediante la escala analógica visual (EAV), y el cuestionario Oswestry de discapacidad (ODI) no experimentaron mejoría significativa en ninguno de los 2 grupos del estudio (p > 0,05). El grupo IEEC presentó una tendencia hacia mejores resultados en pacientes de menor edad, en mujeres, en pacientes con menor tiempo de evolución, actividades laborales sedentarias, sin clínica sobre miembros inferiores y que practicaban deporte, pero sin significación estadística (p > 0,05). Conclusiones. El presente estudio no ha demostrado superioridad de la IEEC frente a los AINE, en el tratamiento del dolor lumbar crónico de origen discal. A pesar de que la IEEC pueda presentar alguna mejoría en los pacientes con afección discal lumbar degenerativa, consideramos que debiera ser empleado con cautela, informando al paciente de las expectativas reales del tratamiento (AU)

Objective: There is no consensus on the treatment of chronic low back pain of disc origin in the medical literature. The few prospective, randomized, controlled studies evaluating the effectiveness of caudal epidural steroid injections (CESI) have obtained contradictory results. The aim of this study is to evaluate the efficacy of CEI in reducing pain and improving the associated disability. Material and method: This is a prospective, randomized, case-control study of a group of 46 patients with chronic low back disc pain. Patients were randomly allocated into 2 groups to either receive fluoroscopy guided CESI (CESI-group), or oral non-steroidal anti-inflammatory drugs (NSAID-group). All patients were clinically evaluated at 4, 12, and 24 weeks, and according to the indications of the Spanish Society for Study of Diseases of the Spine (GEER). Results: Lumbar pain, measured by the visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ), did not improve significantly during follow-up in any of the two study groups (P>.05). Younger patients, women, patients with shorter duration of symptoms, low physical job demand, without leg pain, and sport-active, included in CESI-group showed a trend towards better results, but none reached statistical significance (P>.05). Conclusions: The present study has not demonstrated the superiority of CESI over NSAIDs in treating chronic low back pain of disc origin. While CESI could show some improvement in patients with degenerative lumbar disc disease, we consider it should be used with caution, informing patients about realistic expectations on the success of treatment (AU)

Disfunción ventricular transitoria o síndrome de Tako-Tsubo. A Propósito de un caso / Transient ventricular dysfunction or Tako-Tsubo syndrome. Report of a case

El síndrome de Tako-Tsubo, o disfunción ventricular transitoria, es una entidad que se caracteriza por ser clínicamente indistinguible del síndrome coronario agudo, con elevación enzimática y extensa acinesia anterior, pero sin alteraciones significativas en las arterias coronarias y con recuperación de las alteraciones segmentarias en las semanas siguientes. Presentamos el caso de un paciente ingresado en nuestro servicio que cumplía las características diagnósticas de este síndrome (AU)

The Tako-Tsubo syndrome, or transient ventricular dysfunction, is a clinical entity that is characterised by being clinically indistinguishable from acute coronary syndrome, with increased enzyme levels and extensive anterior akynesia, but without significant changes in the coronary arteries and with recovery of the segmental changes within the few ensuing weeks. We report the case of a patient admitted to our Service who fulfilled the diagnostic features for this condition (AU)

Acute and chronic hypoglycemic effect of Ibervillea sonorae root extracts-II.

Ibervillea sonorae's root, or "wareque" (Cucurbitaceae), is widely used in Mexican traditional medicine for the control of diabetes mellitus. In the present study, the hypoglycemic effects produced by the acute and chronic administration of various extracts of Ibervillea sonorae were investigated. Both the traditional preparation (aqueous decoction) and the raw extract (juice) from the root resulted in significant reductions of glycemia in healthy mice after intraperitoneal administration at a dose of 600 mg/kg. Additionally, ground dried root was used to obtain a dichloromethane (DCM) extract and a methanol (MeOH) extract. The DCM extract induced a clear reduction of glycemia in healthy (P < 0.05) and in alloxan-diabetic mice. The intraperitoneally administered DCM extract caused a severe hypoglycemia that produced lethality in all the treated animals when doses of 300 and 600 mg/kg body weight were used. Since the DCM extract showed a marked hypoglycemic activity, it was administered daily per os to alloxan diabetic rats, employing corn oil and tolbutamide as controls. After 41 days of DCM extract administration at a dose of 300 mg/kg/day, diabetic rats showed improvement in glycemia, body weight, triglycerides, and GPT in comparison with the diabetic control group. Total cholesterol, GOT, and uric acid blood levels were not affected.

[Evolution and treatment response in microscopic colitis]. / Curso evolutivo y respuesta al tratamiento de las colitis microscópicas.

AIM: To study the clinical characteristics, treatment response and evolution in patients with microscopic colitis. MATERIAL AND METHODS: We performed a retrospective analysis of 24 patients (15 with collagenous colitis and 9 with lymphocytic colitis). Clinical and diagnostic features, treatment response and evolution according to the presence of maintenance therapy were evaluated. RESULTS: The mean age of the patients was 59.7 years and most were male. Nine patients took non-steroidal anti-inflammatory drugs (NSAID). No significant association was found with other drugs. Four patients presented associated rheumatological disease. Most patients presented insidious-onset diarrhea without pathological products, which was frequently associated with other symptoms (abdominal pain, bloating, weight loss, asthenia, tenesmus, and incontinence). Seven patients showed a slight increase in globular sedimentation rate. Fat in stools and radiological investigations (transit and opaque enema) were normal in patients who underwent these tests. Endoscopy revealed non-specific alterations in 42% of the patients while results were normal in the remaining patients. One patient showed clinical improvement on withdrawal of NSAIDs and 4 patients improved spontaneously. Clinical response was achieved in 7 of 13 patients treated with antimotility drugs, in 8 of 9 patients treated with salicylates, in 3 treated with oral corticoids, in 1 treated with cholestyramine and in 1 treated with topical budesonide. Nineteen patients required no maintenance therapy, 4 were administered salicylates and 1 was administered cholestyramine. After a mean follow-up of 42 months, evolution was chronic and intermittent in 14 patients and chronic and continuous in 1; 9 patients presented a single episode. No significant differences were found between patients administered maintenance therapy and those who were not or between collagenous colitis and lymphocytic colitis in the parameters analyzed. CONCLUSIONS: Microscopic colitis constitutes a group of diseases characterized by chronic diarrhea, few systemic effects and minimal radiological and/or endoscopic alterations. Evolution is characterized by recurrent episodes, with good response to treatment with cholestyramine, salicylates or corticoids when required.

[Reversible dementia in neurology outpatient clinics]. / Demencias reversibles en la consulta neurológica extrahospitalaria.

INTRODUCTION: The dementias are one of the commonest conditions seen in Neurology Clinics. Potentially reversible causes are described amongst the various aetiologies although there are doubts as to whether the use of indiscriminate testing to detect them is worthwhile. OBJECTIVE: In a group of demented persons to determine how many had a potentially reversible condition and how many improved, in a prospective, descriptive study in a Neurology Outpatient Clinic. PATIENTS AND METHODS: Using the Mini-Mental State Examination of Folstein and the DSM-III-R criteria for dementia, 121 demented patients were selected. An ordinary biochemical study was made (vitamin B12, thyroid hormones), serology (lues) and neuroimaging (cerebral CT), and when a potentially reversible condition was found, each case was treated. The patients treated were followed-up periodically for an average of 9.6 months (range 2 to 24 months). RESULTS: A potentially reversible condition was seen in 19.8% of the patients. On prospective evaluation only 3.3% had reversible symptoms and in no case were these completely reversed. Improvement was seen in conditions of depressive pseudo-dementia. CONCLUSIONS: Since some causes of dementia are reversible, the neurologist is obliged to investigate and seek these possible aetiologies. This study should be individualized according to clinical criteria to improve profitability of the complementary tests. Our results suggest that there are doubts as to the usefulness of indiscriminate investigation of possible reversible causes of the cases of dementia referred to Outpatient neurologists.