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Aim: Abdominal breathing recently has demonstrated an important role in managing symptoms of Gastroesophageal Reflux Disease (GERD), improving quality of life, medication adherence, and sleep quality. This study aimed to evaluate the effectiveness of abdominal breathing on sleep and quality of life in patients with non-erosive gastroesophageal reflux. Subject and methods: A Quasi-experimental design was used. A purposive sample of 100 patients was selected from the medical outpatient clinics of Menoufia University Hospital and the outpatient clinics of the National Liver Institute in Menoufia Governorate, Egypt. A Structured interview questionnaire was used to collect data on patients' sociodemographic characteristics, belly breathing exercise performance and self-reported compliance, GERD symptoms severity and frequency, Pittsburgh Sleep Quality Index, and GERD Health-Related Quality of Life. Results: The frequency of GERD symptoms decreased from 26.64 pre-intervention to 17.61 and 9.58, respectively, at two- and four-months post-intervention. Antacid consumption among patients taking it 7 days/week was reduced from 34% pre-intervention to 2% and 0% post-intervention by two and four months, respectively. Good sleepers were 24% pre-intervention then increased to 62% and 90% post-intervention by 2 and 4 months, respectively. Regarding GERD related quality of life, only 1% was satisfied pre-intervention, which increased to 32% and 72% post-intervention by 2 and 4 months, respectively. Conclusion: Abdominal breathing offers better therapeutic improvements in all patients' outcomes such as reduced severity and frequency of GERD symptoms, reduced antacid consumption, increased sleep quality, and increased satisfaction with life quality. Healthcare professionals are encouraged to incorporate abdominal breathing into treatment protocols for patients with non-erosive GERD.
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BACKGROUND: Helicobacter pylori (H. pylori) infection is a worldwide problem with increasing burden on the health sector due to its increasing rate of resistance. The conventional triple therapy (TT) is becoming obsolete with a high failure rate of eradication, necessitating the need for better alternatives or regimens. AIM: To investigate H. pylori eradication rate of TT vs modified bismuth quadruple therapy. METHODS: Ninety-two patients with dyspepsia symptoms and positive 13C-urea breath test were randomly assigned to two groups. The first group (control group) was treated for 14 d using standard TT protocol: Esomeprazole (40 mg twice daily), amoxicillin (1 g twice daily) and clarithromycin (500 mg twice daily). On the other hand, the second group was prescribed a 10-d course of modified bismuth quadruple therapy fortified with zinc carnosine: TT in addition to bismuth subcitrate (240 mg twice daily) and zinc carnosine (75 mg twice daily). A repeated 13C-urea breath test was done 4 wk after the completion of the eradication therapy. RESULTS: Among the 92 subjects, 67.4% were males and 32.6% were females. There were no differences in demographic characteristics (age, body mass index, smoking history, previous antibiotics use and ethnicity) between the modified bismuth quadruple therapy group and TT group. The eradication rate was higher [93.5% (43/46)] in the modified bismuth quadruple therapy group compared to 69.6% (32/46) in the standard TT group (P = 0.003). Of the tested predictor variables, only nationality, smoking and therapy type were statistically significant. Besides dizziness, which was recorded in modified bismuth quadruple therapy group, there were no significant differences in side effects between the two groups. CONCLUSION: Ten days of modified bismuth quadruple therapy fortified with zinc carnosine is superior to 14 d of conventional TT in eradicating H. pylori infection, with no additional significant adverse events.
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Interleukin-21 (IL-21) is a cytokine with potent regulatory effects on different immune cells. Recently, IL-21 has been contemplated for use in the treatment of cancers. However, the molecular mechanisms regulating human IL-21 gene expression has not yet been described. In this study, we initially studied the promoter region and identified the transcription start site. We thereafter described the essential region upstream of the transcription start site and showed the in vivo binding of NFATc2 and SP1 transcription factors to this region, in addition to their positive role in IL-21 expression. We also studied the role of microRNAs (miRNAs) in regulating IL-21 expression. We, thus, established the miRNA profile of CD4+CD45RO+ versus CD4+CD45RA+ isolated from healthy volunteers and identified a signature composed of 12 differentially expressed miRNAs. We showed that miR-302c is able to negatively regulate IL-21 expression by binding directly to its target site in the 3'-untranslated region. Moreover, after using fresh human CD4-positive T cells, we observed the high acetylation level of histone H4, an observation well in line with the already described high expression of IL-21 in CD4+CD45RO+ versus CD4+CD45RA+ T cells. Altogether, our data identified different molecular mechanisms regulating IL-21 expression.
