Using waste biomass to produce 3D-printed artificial biodegradable structures for coastal ecosystem restoration

The loss of ecosystem functions and services caused by rapidly declining coastal marine ecosystems, including corals and bivalve reefs and wetlands, around the world has sparked significant interest in interdisciplinary methods to restore these ecologically and socially important ecosystems. In recent years, 3D-printed artificial biodegradable structures that mimic natural life stages or habitat have emerged as a promising method for coastal marine restoration. The effectiveness of this method relies on the availability of low-cost biodegradable printing polymers and the development of 3D-printed biomimetic structures that efficiently support the growth of plant and sessile animal species without harming the surrounding ecosystem. In this context, we present the potential and pathway for utilizing low-cost biodegradable biopolymers from waste biomass as printing materials to fabricate 3D-printed biodegradable artificial structures for restoring coastal marine ecosystems. Various waste biomass sources can be used to produce inexpensive biopolymers, particularly those with the higher mechanical rigidity required for 3D-printed artificial structures intended to restore marine ecosystems. Advancements in 3D printing methods, as well as biopolymer modifications and blending to address challenges like biopolymer solubility, rheology, chemical composition, crystallinity, plasticity, and heat stability, have enabled the fabrication of robust structures. The ability of 3D-printed structures to support species colonization and protection was found to be greatly influenced by their biopolymer type, surface topography, structure design, and complexity. Considering limited studies on biodegradability and the effect of biodegradation products on marine ecosystems, we highlight the need for investigating the biodegradability of biopolymers in marine conditions as well as the ecotoxicity of the degraded products. Finally, we present the challenges, considerations, and future perspectives for designing tunable biomimetic 3D-printed artificial biodegradable structures from waste biomass biopolymers for large-scale coastal marine restoration.

Melatonin attenuates chemical-induced cardiotoxicity

Environmental chemicals and drugs can induce cardiotoxicity, mainly by generating free radicals. Reactive oxygen species play a critical role in the pathogenesis of cardiac tissue injury. This highlights a need for prevention of cardiotoxicity by scavenging free radicals. Melatonin has been shown to act as a protector against various conditions in which free radicals cause molecular and tissue injury. Some of the mechanisms by which melatonin operates as a free radical scavenger and antioxidant have been identified. The importance of endogenous melatonin in cardiovascular health and the benefits of melatonin supplementation in different cardiac pathophysiological disorders have been shown in a variety of model systems. Melatonin continues to attract attention for its potential therapeutic value for cardiovascular toxicity. The therapeutic potential of melatonin in treatment of cardiotoxicities caused by various chemicals along with suggested molecular mechanisms of action for melatonin is reviewed.

Evaluating and managing the probability of medical errors in nursing personnel using the HEART method

Introduction: Medical errors cause serious and often preventable injuries to patients. Studying human errors and their use as an opportunity for learning is a key factor in the effort to improve patient safety and quality of care in the hospitals. The purpose of this study was to identify and evaluate human errors to reduce their risks in nursing personnel using the Human Error Evaluation and Reduction (HEART) method.Materials and Methods: This cross-sectional descriptive study was performed in one of the hospitals of Rafsanjan in 1977. Initially, hierarchical task analysis was performed using HTA method and nurses' tasks were identified. In the next step, the probability of their human errors during work for all tasks was determined using the HEART method and the factors and conditions that were effective in causing the error were determined. Finally, in light of these conditions, suggestions were made to reduce the likelihood of these errors occurring.Results: The mean (standard deviation) human error score for the different tasks of nursing job was 1.79 (3.44). The maximum likelihood of error occurring in relation to the task of regulating and applying DC shock in emergencies was determined as 14.48. The least probability of error occurring for skin care task was 0.0014. The results of this study regarding the conditions that can lead to human error in nurses showed that the most important error generating conditions in nurses were novice and inexperienced, high stress, unreliable work tool, lack of control system transparency, lack of clarity and timely and direct confirmation of action. The highest mean human error probability score for Type C tasks was 4.34. Also the mean human error probability score for D, E and G tasks were 0.225, 0.198, and 0.00206 from right to left, respectively. The results of Kruskal-Wallis nonparametric test showed that there was a statistically significant difference among the mean scores of human error probability scores of different groups (P-value <0.001).Conclusion: Considering the critical consequences of human errors in nurses' work activities, developing specialized guidelines for their various activities, providing specialized training, as well as retraining of scientific and practical skills, increasing the workforce, reducing overtime, regular work shifts to improve the reliability of medical staff performance and familiarize staff with the risks that may result from errors in patients are necessary to reduce the likelihood of errors occurring in nurses.

Regenerative Effect of Bone Marrow-derived Mesenchymal Stem Cells in Thioacetamide-induced Liver Fibrosis of Rats

The present study determined the regenerative effect of bone marrow-derived stem cells (BMSCs) on thioacetamide (TA)-induced liver fibrosis in rats. A total of 30 male Wistar rats were randomly divided into sham control and treatment groups. The rats of the sham control group were subdivided into three groups and sampled on the 14th, 18th, and 20th weeks after fibrosis induction. The rats of the treatment group were subdivided into two groups and sampled on the 4th and 6th weeks after BMSCs treatment. Fibrosis was induced by the intraperitoneal administration of 200 mg/kg of TA twice a week for a period of 14 weeks. All the animals underwent liver function tests and histopathologic evaluation 4 and 6 weeks after BMSCs transplantation. The BMSCs were characterized using osteogenic induction and reverse transcription-polymerase chain reaction. The BMSCs were plastic adherent, spindle-shaped, and positive for osteogenic differentiation. They expressed CD73 and were negative for CD45. The infiltration of inflammatory cells and deposition of collagen fibers were noticed after TA administration. A significant decline in inflammatory cells and a healing process were detected 4 weeks after cell transplantation. The amelioration in hepatic tissue was significant 6 weeks after cell therapy. Following the injection of BMSCs, a nonsignificant decrease was visible in aspartate transaminase level; however, this decline was significant for alanine aminotransferase level. The alkaline phosphatase and albumin levels showed an increasing trend after cell administration. The transplantation of BMSCs resulted in a significant regenerative effect after hepatic injuries. Therefore, it was shown that BMSCs transplantation can open a new window and be a therapy of choice in the amelioration of liver fibrosis.

Comparison of Renal Growth, Proteinuria and Graft Survival between Recipients of Pediatric and Adult Cadaveric Kidney Transplants

BACKGROUND

The shortage of cadaveric kidney donors has prompted transplant teams to expanding the donor selection criteria. The usage of pediatric cadaveric kidneys is one of those expanded criteria. But the main concern is the probability of hyperfiltration syndrome due to small renal mass of pediatric donors.

OBJECTIVE

To compare the graft and patient survivals, post-transplantation complications, rate and severity of proteinuria secondary to hyperfiltration injury and the kidney growth of recipients who underwent transplantation from adult (group 1) and pediatric deceased donors (group 2).

METHODS

In this historical cohort study, each group contains 36 patients. Outcome measures included patient and graft survivals, quality of graft function as assessed by serum creatinine (SCr) and estimated GFR (eGFR), surgical complications, proteinuria that was detected by routine urinalysis and then confirmed by a 24-h urine protein >150 mg, blood pressure, and kidney length and volume measured by early and follow-up ultrasonography.

RESULTS

The mean donor age in groups 1 and 2 was 36 and 6.5 years, respectively. 9 (25%) kidneys taken from pediatric donors (group 2) were offered en-bloc. The mean follow-up was 28 month. The two groups were not significantly different in terms of the incidence of DGF, rate of acute rejection, 1-year graft survival, SCr and eGFR levels, rates of surgical complications requiring surgical interventions, development of proteinuria, and rate of post-transplantation rise in blood pressure. The mean±SD kidney length within 24 hours of transplantation was significantly higher in group 1 compared to group 2 recipients (112±14 vs. 75±12 mm; p=0.001), but the rate of increase in kidney length in group 2 was significantly higher than that in group 1 recipients (43±4 vs. 10±2 mm; p=0.002) during the follow-up period. 80% of the increase in the kidney size was observed during the first 12 months of surgery; another 20% happened between 12 and 18 months.

CONCLUSION

We found that obligatory and compensatory growth of pediatric kidney donors can overcome the concern of hyperfiltration syndrome and that the outcome is the same as adult donors.

The Healing Effect of Adipose-Derived Mesenchymal Stem Cells in Full-thickness Femoral Articular Cartilage Defects of Rabbit

BACKGROUND

Articular cartilage defect can lead to degradation of subchondral bone and osteoarthritis (OA).

OBJECTIVE

To determine the healing effect of transplantation of adipose-derived mesenchymal stem cells (Ad-MSCs) in full-thickness femoral articular cartilage defects in rabbit.

METHODS

12 rabbits were equally divided into cell-treated and control groups. In cell-treated group, 2×10(6) cells of third passage suspended in 1 mL of DMEM was injected into articular defect. The control group just received 1 mL of DMEM. Dulbecco's modified Eagles medium (DMEM) supplemented with 10% fetal bovine serum (FBS), 1% penicillin and streptomycin and 2 mM L-glutamine were used for cell culture. To induce cartilage defect, 4 mm articular cartilage full-thickness defect was created in the knee. For histological evaluation in each group (H&E, safranin-O and toluidine blue), 3 rabbits were sacrificed 4 weeks and 3 animals, 8 weeks after cell transplantation.

RESULTS

In cell therapy group post-transplantation, no abnormal gross findings were noticed. Neo-formed tissues in cell-treated groups were translucent with a smooth and intact surface and less irregularity. In cell-treated group after 8 weeks post-transplantation, the overall healing score of experimental knees were superior when compared to other groups.

CONCLUSION

We showed that Ad-MSCs, as an available and non-invasive produced source of cells, could be safely administered in knee osteochondral defects.

Protective effects of Cornus mas fruit extract on carbon tetrachloride induced nephrotoxicity in rats

Oxidative damage is implicated in the pathogenesis of kidney injury. Cornus mas is used for in renal aliments traditionally in Iran. The present study was aimed to investigate the antioxidant activity of C. mas fruit extract (CMFE) on carbon tetrachloride (CCl₄) treated oxidative stress in Wistar albino rats. Forty two male albino rats were divided into seven groups. Group I served as a sham; Group II served as a normal control; Group III served as a toxic control, with CCl₄ (1 ml/kg body weight; 80% in olive oil); Groups IV and V received CMFE at doses of 300 and 700 mg/kg before CCl₄ injection; Groups VI and VII received extract at same doses orally at 2, 6, 12, 24 and 48 h after CCl₄ intoxication. CCl₄ injection produced a significant rise in serum markers of oxidative stress and lipid peroxidation product malondialdehyde along with the reduction of antioxidant enzymes such as superoxide dismuta, catalase and glutathion peroxidase. Serum creatinine, urea and uric acid concentrations were increased whereas level of protein and albumin were reduced. Treatment of rats with different doses of fruit extract (300 and 700 mg/kg) significantly (P < 0.05) ameliorated the alterations induced with CCl₄ in lipid peroxidation, antioxidant defenses, biochemical and renal lesions. Based on these results, we conclude that CMFE protects kidney from oxidative stress induced by CCl₄.

First identification of Sarcocystis hominis in Iranian traditional hamburger

Zoonotic concerns of cattle sarcocystosis are of importance, because humans are the final host for Sarcocystis hominis. Therefore the meat products containing beef may encompass sarcocysts which endanger food safety. In this study, we described the first report of molecular identification of S. hominis in Iranian traditional hamburgers using PCR-RFLP. Throughout a pilot research that was carried out to setup a molecular approach to identify the Sarcocystis spp., using PCR-RFLP, a sample of raw Iranian traditional hamburger was purchased from a street food seller located in Yazd, central Iran in May 2013. DNA extraction was done, by salting out method; briefly, the sample was lysed with NET buffer. The DNA purification and precipitation was then performed. Amplicon and digestion results were analyzed, using gel agarose electrophoresis. The results showed a PCR product with 926 bp in length after amplification and 376 and 550 bp in length after digestion. This product was identified as S. hominis. To the best of our knowledge, this is the first report of S. hominis infection in Iranian hamburger.

SNP detection in Na/K ATP-ase gene α1 subunit of bisexual and parthenogenetic Artemia strains by RFLP screening

In order to find a marker for differentiating between a bisexual and a parthenogenetic Artemia strain, Exon-7 of the Na/K ATPase α(1) subunit gene was screened by RFLP technique. The results revealed a constant synonymous SNP (single nucleotide polymorphism) in digestion by the Tru1I enzyme that was consistent with these two types of Artemia. This SNP was identified as an accurate molecular marker for discrimination between bisexual and parthenogenetic Artemia. According to the Nei's genetic distance (1973), the lowest genetic distance was found between individuals from Artemia urmiana Günther 1890 and parthenogenetic populations, making the described marker the first marker to easily distinguish between these two cooccurring species.

A comparison of effects of ABVD and ChlVPP chemotherapeutic protocols for Hodgkin's disease on rats' epididiymal and testicular tissues

The goal of this study was to determine the effects of ABVD and ChlVPP chemotherapeutic protocols for Hodgkin's disease on the structure of testis and epididymis of male rat. After determining tolerance dose of drugs in pilot study, 24 male rats were divided to four groups: ABVD (doxorubicin, bleomycine, vinblastin, dacarbazine) group, ChlVPP (chlorambucil, vinblastin, procarbazine, prednisolone) group and two control groups one for each treatment group. One half of the lethal dose for 50% of population (LD50) was used for treatment of animals in each protocol. Testes and epididymis tissues were examined for structural changes and serum testosterone level was measured by Lission (chemiluminescence method). Body weight, testis and epididymis weights, in treated rats were significantly less than their control groups specifically in ABVD group was less than ChlVPP group. Decreasing of mean diameter of seminiferous tubules, height of spermatogenic cells and diameter of epididymis in caput, corpus and cauda in ABVD group were significantly more than ChlVPP and control group. The serum testosterone level in ABVD group was significantly less than ChlVPP and control group. According to this study results, the ChlVPP had fewer impairment effects than ABVD on testis and epididymis tissue in tolerance doses on male rats' reproductive system. More clinical trial studies are suggested on Hodgkin's patients. With equal treatment effectiveness, it will be better to use the most reliable and safe treatment especially in young patients.

Comparison of lidocaine 1% and normal saline in paracervical anesthesia for decreasing of pain in curettage

The objective of this study was to compare the efficiency oflidocaine with that of plain saline for paracervical pain relief during fractional curettage. The double-blind randomized clinical trial was performed on 150 patients presenting from 2004 to 2005 for curettage. The patients were assigned randomly in two groups to receive lidocaine 1% or normal saline. Number of patients at each group was 75 women. The pain intensity was assessed in four stages: (1) after speculum insertion, (2) during cervical dilatation, (3) during curettage and (4) 30 min after curettage completion. The pain intensity was graded as 0 to 100 according to the Likert Scale. The Mean +/- SD of pain intensity after speculum insertion, during dilatation, during curettage and 30 min after curettage in lidocaine group were 11.33 +/- 9.70, 24.93 +/- 15.36, 37.00 +/- 17.35, 6.47 +/- 6.42 and in normal saline group were 11.73 +/- 9.81, 28.20 +/- 13.19, 49.47 +/- 21.55 and 7.33 +/- 6.22, respectively. There was no significant difference between pain intensity after speculum insertion, during dilatation and during 30 min after curettage but there was a significant difference in pain intensity during curettage between lidocaine 1% group and normal saline group (p < 0.05). Normal saline is as effective as lidocaine 1% in low pain in curettage (distention of nerve capsule) but when increase pain in curettage (third time point), lidocaine 1% is more effective than normal saline. Nerve capsule distention is not the only factor for pain control in paracervical block and analgesic agent is still an important factor.

Concentration of heavy metals in different tissues of Astacus leptodactylus from Aras dam of Iran

Due to different human activities in the vicinities of Aras dam, various pollutants such as heavy metals are entered into the reservoir and thus polluting the aquatic ecosystem. As a result, this heavy metal is accumulated in the tissues of Astacus leptodoctylus, which is considered as one the abundant species of crayfish that has got important food values and is of economic importance due to its export to other countries. In this research, the bioaccumulation of heavy metals in different tissues of this animal is taken into consideration. The concentration of Fe, Cu, Zn, Mn, Pb, Ni, Co and Cr among the tissues of female and male Astacus leptodactylus has been determined. The highest concentration of Cu and Fe was found in the gills and the highest level of Zn was found in hepatopancreas. Besides, the highest Mn concentration was recognized in exoskeleton. Furthermore, no significant difference was found between the male and female crayfish in the concentration of the heavy metals in their tissues, except for the concentration of some of the metals such as Fe in some of the tissues such as hepatopancreas.

Effects of lead nitrate (PbNO3) on the glucose and cortisol hormone levels in common carp, Cyprinus carpio

The objective of this study was to evaluate the possible effects of PbNO3 exposure on variations of glucose and cortisol levels in Cyprinus carpio. Fish were subjected to two sub-lethal concentrations of PbNO3 for 14 days. Blood samples were isolated from the fish following the exposure, to measure the levels of cortisol and glucose compared to the control group. We found significant increases (p<0.05) in the levels of blood cortisol in two groups of fish after 14 days of exposure to two concentrations of PbNO3 (1.3 and 2.6 mg L (-1)) The results showed significant increases in the glucose levels of both fish groups exposed for 14 days In the later treatment, the rate of increase in group II (exposed to 2.6 mg L(-1) PbNO3) was higher than that of group I (exposed to 1.3 mg L(-1) PbNO3) (P = 0 compare to P = 0.007). Present findings attest that exposing to waterborne lead would affect the levels of both glucose and cortisol in Cyprinus carpio.

Effects of copper sulfate (CuSO4) on the levels of glucose and cortisol in common carp, Cyprinus carpio

The objective of this study was to evaluate the possible effects of CuSO4 exposure on variations of glucose and cortisol levels in Cyprinus carpio. Three replicates of 6 fish were subjected to two sub-lethal concentrations of CuSO4 (0.16 and 0.53 mg L(-1)) for 14 and 21 days. Blood samples were isolated from the fish following the exposure, to measure the levels of cortisol and glucose compared to the control group. The results showed significant increases (p < 0.05) in cortisol levels for both fish groups after 14 days of exposure, whereas, the levels of blood cortisol in both groups did not differ from that of control when the fish subjected to copper sulfate for 21 days. We found significant increases (p < 0.05) in the levels of blood glucose of two groups of fish after 14 days of exposure to two doses of CuSO4, as well as significant decrease in the blood glucose of both groups exposed for 21 days. In the later treatment, the rate of decrease in group II (exposed to 0.53 mg L(-1) CuSO4) was higher than that of group I (exposed to 0.16 mg L(-1) CuSO4) (p = 0.001 compared to p = 0.032). Our findings attest that exposing to waterborne copper would affect the levels of both cortisol and glucose, as indicators of stress response in Cyprinus carpio.

Breast cancer risk factors in south of Islamic Republic of Iran: a case-control study

A case-control study was carried out from April 2000 to March 2002 to investigate risk factors for breast cancer in Bandar Abbas, south Islamic Republic of Iran. Using logistic regression analysis, 168 women with pathologically confirmed primary breast cancer were compared with 504 age-matched controls. Significant risk factors were: family history of breast cancer in a first-degree relative, younger age at menarche, never married, first full-term pregnancy age 30+ years and >5 full-term pregnancies. In multivariate analysis, negative history of breastfeeding was also significant. Cases and controls did not differ with regard to parity, history of abortion, oral contraceptive use, menopausal status, age at menopause, ever-use of hormone replacement therapy, history of benign breast disease or history of cigarette smoking.

Bioaccumulation of lead nitrate in freshwater crayfish (Astacus leptodactylus) tissues under aquaculture conditions

The aim of this research was to evaluate the amount of lead in the tissue of Astacus leptodactylus especially in their muscle which the consumed part of their body. In this study the crayfish was exposed to intermediate concentration of lead nitrate (500 microg L(-1)) for periods up to 3 weeks. In the first, second and third weeks bioaccumulation in various tissues was under investigation. The data of toxicological analysis obtained by the method of atomic absorption revealed that the levels of bioaccumulation of metal are different in various tissues of this crayfish. The accumulation of the lead in gills was the highest and in muscles was lowest degree. The amount of heavy metals in the tissues of crayfish was as follow. Gills>exoskeleton>hepatopancreas (digestive glands)>digestive tract>green gland>testis and ovary>muscles.

Therapeutic efficacy of artesunate in Plasmodium vivax malaria in Thailand

Our previous study showed that in vitro susceptibility of Plasmodium vivax to chloroquine has significantly decreased in Thailand within the past two decades. Thus, the evaluation of alternative antimalarials for treatment of vivax malaria is needed. The aim of this study was to examine parasitological and clinical efficacy of an artemisinin derivative (artesunate) for the treatment of vivax malaria in patients who were admitted to the Bangkok Hospital for Tropical Diseases. We randomly allocated patients aged 12-56 years to receive 3.3mg/kg (adult dose 200 mg) on the first day, and for the next four days each patient was given 1.65 mg/kg orally (adult dose 100 mg), total dose = 600 mg. After the five-day course of artesunate, primaquine was given: a single oral dose of 15mg for 14 days. A total number of 42 patients received treatment. All participants were followed up for 28 days. In all the cases, both parasitemia and fever were resolved rapidly; the mean fever clearance time and parasite clearance time, 14.6 and 36.7 hours, respectively, showed that therapeutic response to artesunate was better than that of chloroquine. The 14-day cure rate was 100%, but reappearance of parasitemia was seen in two patients on days 21 and 25 following treatment, respectively. These two cases of failure rate should be considered as true relapse rather than recrudescence, since the relapse interval in Southeast Asian vivax malaria according to recent findings seems to be 3 weeks after start of treatment, if primaquine is not given or an inadequate amount is given. In conclusion, artesunate might be useful in treatment of vivax malaria, causing a good blood schizontocidal effect. However, to prevent emerging resistance it should never be used alone.

Cutaneous leishmaniasis in Hormozgan, Iran

BACKGROUND

Epidemiology of Cutaneous Leishmaniasis in Hormozgan province during April 1994 to March 1998 was studied.

METHODS

Data were collected from the Health service Centres throughout the province as well as from dermatologists. The patients were diagnosed clinically or paraclinically and all important details were recorded on specially designed forms.

RESULTS

A total of 4094 patients with 7255 lesions were diagnosed. 42.24% of the sufferers were under 20 years and 6.47% were over 40 years old. 52.10% of the patients had one lesion and 33.98% had two lesions. Most of the cases were seen during January to March. The incidence rate per 10000 ranged from 5.90 in 1998 to 16.98 in 1996.

CONCLUSIONS

A decreasing trend in the number of cases after 1996 may be due to the awareness of local health authorities, preventative activities and education.

A comparison of the reproducibility and the sensitivity to change of visual analogue scales, Borg scales, and Likert scales in normal subjects during submaximal exercise

OBJECTIVE

To assess which subjective scale, the visual analogue scale (VAS), the Borg CR10 (Borg) scale, or the Likert scale (LS), if any, is decidedly more reproducible and sensitive to change in the assessment of symptoms.

DESIGN

Prospective clinical study.

SETTING

Exercise laboratory.

PARTICIPANTS

Twenty-three physically active male subjects (mean +/- SD age of 30 +/- 4 years old) were recruited.

INTERVENTION

Each subject attended the exercise laboratory on four occasions at intervals of 1 week. Three subjective scales were used: (1) the VAS (continuous scale); (2) the Borg scale (12 fixed points); and (3) the Likert scale (LS; 5 fixed points). Four identical submaximal tests were given (2 min at 60% maximum oxygen uptake [VO(2)max] and 6 min at 70% VO(2)max). Two tests were undertaken to assess the reproducibility of scores that were obtained with each subjective scale. Two other tests were undertaken to assess the sensitivity of each scale to a change in symptom perception: a double-blind treatment with propranolol, 80 mg, (ie, active therapy; to increase the sensation of breathlessness and general fatigue during exercise) or matching placebo. The subjective scale scores were measured at 1 min 30 s, 5 min 30 s, and 7 min 15 s of exercise. Reproducibility was defined as the proportion of total variance (ie, between-subject plus within-subject variance) explained by the between-subject variance given as a percentage. Sensitivity was defined as the effect of the active drug therapy over the variation within subjects.

RESULTS

Overall, the VAS performed best in terms of reproducibility for breathlessness and general fatigue, with reproducibility coefficients as high as 78%. For sensitivity, the VAS was best for breathlessness (ratio, 2.7) and the Borg scale was most sensitive for general fatigue (ratio, 3.0). The relationships between the respective psychological and physiologic variables were reasonably stable throughout the testing procedure, with overall typical correlations of 0.73 to 0.82

CONCLUSION

This study suggests that subjective scales can reproducibly measure symptoms during steady-state exercise and can detect the effect of a drug intervention. The VAS and Borg scales appear to be the best subjective scales for this purpose.

Effect of triple therapy or amoxycillin plus omeprazole or amoxycillin plus tinidazole plus omeprazole on duodenal ulcer healing, eradication of Helicobacter pylori, and prevention of ulcer relapse over a 1-year follow-up period: a prospective, randomized, controlled study

OBJECTIVES

Triple therapy and amoxycillin plus omeprazole are the two most widely recommended regimens for the eradication of Helicobacter pylori. However, no controlled studies with a large number of cases are available for the reliable comparison of these two regimens. The aim of this controlled, randomized, prospective study was to compare the effect of these two regimens and a further regimen for metronidazole-resistant patients on duodenal ulcer healing, H. pylori eradication, and prevention of ulcer relapse.

METHODS

Patients (n = 144) with proven duodenal ulcer (DU) were randomized to one of the three following regimens: group A, omeprazole (2 x 40 mg) plus amoxycillin (4 x 500 mg) for 2 wk; group B, triple therapy: bismuth nitrate (4 x 375 mg) plus metronidazole (4 x 250 mg) and tetracycline (4 x 500 mg) daily for 2 wk and ranitidine (150 mg) for the first week and bismuth nitrate (4 x 375 mg) alone for a further 2 wk; group C, omeprazole (20 mg) plus amoxycillin (4 x 500 mg) and tinidazole (2 x 500 mg) for 2 wk.

RESULTS

A total of 46 patients in group A, 39 in group B, and 43 in group C completed the study. One patient in group A and three in group B did not tolerate the regimens and dropped out of the study. Control endoscopy was performed 8 wk after the start of treatment and when symptoms appeared (up to 1 yr after the start of treatment). In subjects who completed the study, both the healing rate of DU in group B (97% compared with 74 and 73% in A and C, respectively, p < 0.02) and the H. pylori eradication rate in group B (85 compared with 35%, p < 0.0001 in A and 58%, p < 0.02, in C) were significantly higher than in groups A and C. The symptomatic ulcer relapse during the 1-yr follow-up in patients with initially healed ulcers was similar in all groups (18, 16, and 19% in A, B, and C, respectively). The predictor of healing using logistic regression analysis was night pain (p < 0.05). The predictor of H. pylori eradication was sex (p < 0.05).

CONCLUSION

The 2-wk triple therapy plus an additional 2-wk treatment with the bismuth derivative (without a prolonged administration of acid suppressing drugs) seems to be an effective and economic treatment not only for the eradication of H. pylori but also for the healing of acute DU. The higher incidence of side effects found after triple therapy compared with the other two regimens was tolerated by the patients.