Comparative study of safety and efficacy of omeprazole, lansoprazole, and rabeprazole in triple therapy for eradication of Helicobacter pylori in peptic ulcer patients in Indian population

2016-10-15T10-18-32Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Padmavathi Devagudi, Mabu Shareef, Naser Ashraf Tadvi.
Background: Triple therapy which includes a proton pump inhibitor (PPI) along with two antimicrobials is routinely used for the eradication of Helicobacter pylori. Multiple regimens are reported using different combinations of PPIs and antimicrobials. Aims and Objectives: The current study is done to compare the efficacy and safety of three PPIs omeprazole, lansoprazole, and rabeprazole in combination with amoxicillin and tinidazole. Materials and Methods: The patients were randomly assigned to receive one of the three regimens including one of the PPI with amoxicillin and tinidazole for 2 weeks followed by respective PPI once daily for 4 weeks. Follow-up visits were done at 2 and 6 weeks of the treatment. Endoscopy was done for any decrease in size of ulcer, rapid urease test, and histopathology for clearance of H. pylori. Results: There was a significant reduction in the size of ulcer at the end of 2 weeks in all the three groups and total healing of ulcer was observed in rabeprazole group when compared to omeprazole and lansoprazole groups. H. pylori eradication as per negative urea breath test was between 85% and 94% and it was highest in rabeprazole group. Conclusion: The three drugs were safe and equally effective in eradicating H. pylori, but rabeprazole showed earlier symptomatic relief with rapid eradication rate of H. pylori in peptic ulcer disease compared to omeprazole and lansoprazole, but it was not statistically significant. Hence, rabeprazole can be recommended to be used in PPI-triple therapy for cure of H. pylori infection in Indian population for earlier relief and better cure rates.


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Immune thrombocytopenia and its association with lymph node tuberculosis – A dilemma!

2016-10-15T07-29-39Z
Source: The Southeast Asian Journal of Case Report and Review
Sangita Deepak Kamath, Neeraj Jain, Saurabh Pathak, Ballamudi Srinivas Rao.
Background: Although various hematologic abnormalities are known to occur with tuberculosis, association of immune mediated thrombocytopenia with tuberculosis is uncommon. Newly diagnosed immune thrombocytopenia in TB is rare; only 27 cases have been reported so far. Case: We report a case of axillary lymph node tuberculosis who presented with immune thrombocytopenia. An eighteen year old girl was admitted to our hospital with excessive vaginal bleed of one week duration followed by the development of petechial lesions and ecchymosis over legs, hands and mouth. She also had solitary, firm, left axillary lymphadenopathy. A diagnosis of immune mediated thrombocytopenia (ITP) was made from peripheral blood smear and bone marrow examination. Intravenous methylprednisolone (30mg/kg body weight) followed by oral prednisolone (1mg/kg) failed to elicit any sustained platelet response. Fine needle aspiration cytology of the left axillary lymphadenopathy done later revealed tuberculosis. After two weeks of starting anti-tuberculous therapy, the platelet count returned to normal and she was off all therapy for ITP thereby suggesting likely association between tuberculosis and immune thrombocytopenia. Conclusion: This case report illustrates the causal association between immune thrombocytopenia and tuberculosis.


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Immune thrombocytopenia and its association with lymph node tuberculosis – A dilemma!

2016-10-15T06-30-01Z
Source: The Southeast Asian Journal of Case Report and Review
Sangita Deepak Kamath, Neeraj Jain, Saurabh Pathak, Ballamudi Srinivas Rao.
Background: Although various hematologic abnormalities are known to occur with tuberculosis, association of immune mediated thrombocytopenia with tuberculosis is uncommon. Newly diagnosed immune thrombocytopenia in TB is rare; only 27 cases have been reported so far. Case: We report a case of axillary lymph node tuberculosis who presented with immune thrombocytopenia. An eighteen year old girl was admitted to our hospital with excessive vaginal bleed of one week duration followed by the development of petechial lesions and ecchymosis over legs, hands and mouth. She also had solitary, firm, left axillary lymphadenopathy. A diagnosis of immune mediated thrombocytopenia (ITP) was made from peripheral blood smear and bone marrow examination. Intravenous methylprednisolone (30mg/kg body weight) followed by oral prednisolone (1mg/kg) failed to elicit any sustained platelet response. Fine needle aspiration cytology of the left axillary lymphadenopathy done later revealed tuberculosis. After two weeks of starting anti-tuberculous therapy, the platelet count returned to normal and she was off all therapy for ITP thereby suggesting likely association between tuberculosis and immune thrombocytopenia. Conclusion: This case report illustrates the causal association between immune thrombocytopenia and tuberculosis.


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A Rare Case Of Dubinson Johnson Syndrome With Pregnancy

2016-10-15T06-30-01Z
Source: The Southeast Asian Journal of Case Report and Review
Mehul Devkaranbhai Patel, Kanaklatta D Nakum, Vishal Sheth.
Dubin Johnson Syndrome is an autosomal recessive benign disorder of bilirubin metabolism, in which patients have icterus with non pruritic conjugated hyperbilirubinaemia. Condition may get aggravated during pregnancy and result into fetal wastage. A case is reported in which young 2ndGravida presented with labour pain associated with icterus and conjugated hyperbilirubinaemia. She had full term normal delivery at 40 weeks of gestation. There were no maternal peripartum complications. She was treated with supportive treatment. Her liver functions returned back to normal within short period after delivery. Conditions like Dubin Johnson syndrome must be kept as differential diagnosis while dealing with cases of jaundice in pregnancy.


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Epithelioid Angiomyolipoma of kidney - An uncommon tumor mimicking renal cell carcinoma .

2016-10-15T06-30-01Z
Source: The Southeast Asian Journal of Case Report and Review
Kavitha K.P, Shalini Kuruvila, Jyotsna Yasodharan, Sajna V.M.Kutty, Lilly Madhavan.
Introduction: Epithelioid angiomyolipoma (EAML) is an uncommon variant of angiomyolipoma (AML) with malignant potential, frequently associated with tuberous sclerosis complex. Only few cases have been reported so far in the literature. Preoperative diagnosis is difficult. Differential diagnosis from renal cell carcinoma is often challenging because of its epithelioid morphology and carcinoma like growth pattern. Case report: A 52 year old man presented with progressive weight loss and abdominal pain .CT scan showed a large renal mass on right side .With a radiological diagnosis of renal cell carcinoma he underwent laparoscopic nephrectomy. With histopathological and immunohistochemical features a diagnosis of epithelioid angiomyolipoma was made .Retrospectively we came to know that he is a known case of tuberous sclerosis Conclusion: EAML should be a differential diagnosis when we are dealing with renal tumors in young patients with tuberous sclerosis and with epithelioid morphology and high nuclear grade. It is important to have a high index of suspicion so that a correct diagnosis can potentially direct clinician to a more effective targeted treatment using mTOR inhibitors especially in TSC associated cases.


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