Efficacy of serology driven “test and treat strategy” for eradication of H. pylori in patients with rheumatic disease in the Netherlands

The treatment of choice of H. pylori infections is a 7-day triple-therapy with a proton pump inhibitor (PPI) plus amoxicillin and either clarithromycin or metronidazole, depending on local antibiotic resistance rates. The data on efficacy of eradication therapy in a group of rheumatology patients on long-term NSAID therapy are reported here. This study was part of a nationwide, multicenter RCT that took place in 2000–2002 in the Netherlands. Patients who tested positive for H. pylori IgG antibodies were included and randomly assigned to either eradication PPI-triple therapy or placebo. After completion, follow-up at 3 months was done by endoscopy and biopsies were sent for culture and histology. In the eradication group 13% (20/152, 95% CI 9–20%) and in the placebo group 79% (123/155, 95% CI 72–85%) of the patients were H. pylori positive by histology or culture. H. pylori was successfully eradicated in 91% of the patients who were fully compliant to therapy, compared to 50% of those who were not (difference of 41%; 95% CI 18–63%). Resistance percentages found in isolates of the placebo group were: 4% to clarithromycin, 19% to metronidazole, 1% to amoxicillin and 2% to tetracycline

Opioid Systems and Magnetic Field Effects in the Land Snail, Cepaea nemoralis

Volume: 180Start Page: 301End Page: 30

Pain perception and electromagnetic fields

A substantial body of evidence has accumulated showing that exposure to electromagnetic fields (EMFs) affects pain sensitivity (nociception) and pain inhibition (analgesia). Consistent inhibitory effects of acute exposures to various EMFs on analgesia have been demonstrated in most studies. This renders examinations of changes in the expression of analgesia and nociception a particularly valuable means of addressing the biological effects of and mechanisms underlying the actions of EMFs. Here we provide an overview of the effects of various EMFs on nociceptive sensitivity and analgesia, with particular emphasis on opioid-mediated responses. We also describe the analgesic effects of particular specific EMFs, the effects of repeated exposures to EMFs and magnetic shielding, along with the dependence of EMF effects on lighting conditions. We further consider some of the underlying cellular and biophysical mechanisms along with the clinical implications of these effects of various EMFs

Invasieve aspergillose op de intensive care: Een lastige en vaak te laat gestelde diagnose

Although it is widely recognized that critically ill patients in the ICU are at high risk for nosocomial infections, it is not generally appreciated that such patients may also be at risk for opportunistic infections usually seen only in immuno-compromised patients. The reason for this is that the immune response in patients with sepsis and multiple organ failure may be biphasic: an initial phase characterized by a massive inflammatory, response and cytokine release, followed by a dwindling immune response and monocyte deactivation. This phenomenon has been named compensatory anti-inflammatory response syndrome (CARS), or immunoparalysis. We describe three patients admitted to our ICU for various reasons, without a history of abnormal immune function prior to ICU admission, who developed invasive pulmonary aspergillosis in the course of their ICU stay. Despite significant co-morbidity, the infective aspergillosis seems a plausible multifactorial aspect in the etiology of each of the patient's fatal events. The diagnosis was difficult to establish in part because aspergillosis was considered highly unlikely in these patients, who where thought to have normal immune function. Physicians treating patients with multiple organ dysfunction (MODS) in the ICU should be aware that rare opportunistic injections such as invasive aspergillosis may occur in these patients due to the CARS-syndrome. Critically ill patients with MODS should be viewed as at least partially immuno-compromised