Comparison of levofloxacin versus clarithromycin efficacy in the eradication of Helicobacter pylori infection.

BACKGROUND: Helicobacter pylori (H.pylori) infection causes multiple upper gastrointestinal diseases but optimal therapeutic regimen which can eradicate infection in all the cases has not yet been defined. This study was designed to evaluate the efficacy of triple levofloxacin-based versus clarithromycin-based therapy. METHODS: In this open-label randomized clinical trial study 120 patients who had esophagogastroduodenoscopy (EGD) with positive rapid urease test (RUT) were enrolled and divided into 2 groups. Case group was treated with levofloxacin (500 mg daily) plus amoxicillin (1 gr twice a day) plus omeprazole (20 mg daily) for 2 weeks. Control group was treated with clarithromycin (500 mg twice a day) plus omeprazole (20 mg daily) for 2 weeks. After the main course of treatment, they received maintenance treatment with omeprazole for 4 weeks. Stool antigen test was performed on them after two weeks of not having any medicine. RESULTS: H.pylori eradication (intention to treat analysis) was successful in 75% of case group and 51.7% of control group showing a significant difference (P=0.008). H.p infection eradication (per-protocol analysis) was successful in 80.4% in case group and 57.4%% in control group showing significant difference (P=0.009). Drugs adverse effects causing discontinuation treatment were seen in 5% of case group and 3.3% of control group which have not shown a significant difference between the two groups (P=0.648). CONCLUSION: Triple therapy with levofloxacin-based regimen has better efficacy than clarithromycin-based regimen and as safe as it is.

A randomized, double-blind, placebo-controlled trial to determine the effects of topical insulin on wound healing.

Although the literature contains evidence demonstrating the beneficial effects of insulin on wound healing, no suitable method for the routine administration of insulin has been reported. A randomized, double-blind, placebo-controlled trial was conducted to determine the safety and efficacy of topical insulin on healing in 45 patients (29 men, mean age for both groups 40.62 years, range 12 to 71 years) with noninfected acute and chronic extremity wounds. Patients were randomly assigned to twice-daily topical application (spray) of 1 cc saline 0.9% for each 10 cm2 of wound with or without 10 units (0.1 cc) of insulin crystal and insulin. The endpoint was complete wound closure. Systemic glucose levels were measured before and 1 hour after treatment application. No patients developed signs or symptoms of hypoglycemia and glucose levels pre- and post-application did not differ significantly. Time to healing did not differ significantly between treatment groups. Healing rates were affected by baseline wound area, patient age, wound type (acute versus chronic), and treatment group. The mean rate of healing rate was 46.09 mm2/day in the treatment and 32.24 mm2/day in the control group (P = 0.029), independent of baseline wound size. In this study, the topical application of insulin was safe and effective. Clinical studies with a larger sample size and that include patients with diabetes mellitus are warranted.

High take-off of right coronary artery: an extremely rare case of RCA anomaly.

A 45-year-old man with a past history of aortic valve insufficiency presented with recently increasing chest discomfort. Coronary angiography revealed significant stenosis at the mid-portion of the left anterior descending artery and origin of the first obtuse marginal branch. The right coronary artery (RCA) was faintly seen to be free from significant stenosis. (Selective RCA angiography had not been possible.) At surgery while dissecting between the ascending aorta and the main pulmonary artery, the RCA ostium was incidentally found to be located approximately 10 cm above the aortic annulus and 5 cm above the sinotubular junction, between the medial curve of the ascending aorta and the main pulmonary artery. After coronary artery bypass grafts, we repaired the aortic valve and the RCA remained intact.