Interest of First Laparoscopy in the Etiological Diagnosis of Isolated Exudative Ascites

The purpose of this research article was to determine the contribution of performing laparoscopy first in the etiological diagnosis of isolated exudative ascites. Our retrospective descriptive study had been performed over 15 years and included 46 patients who had undergone exploratory laparoscopy for exudative ascites. The average age of the patients was 52 years. Biological and morphological examinations contributed to making the etiological diagnosis. Therefore, diagnostic laparoscopy was indicated. Peritoneal carcinomatosis and tuberculosis were the most common causes seen in 34.2% and respectively 65.8% of cases. Visual laparoscopic diagnosis was peritoneal carcinomatosis in 16 cases and peritoneal tuberculosis in 28 cases, indecisive in one case and biliary ascites in one case. The histological diagnosis was peritoneal tuberculosis in 24 cases and peritoneal carcinomatosis in 12 cases and there were 9 cases of rare diagnoses. Peritoneal biopsies were negative in 2 cases for which the etiological diagnoses were kidney failure in one case and hypothyroidism in the other case. The postoperative recovery was simple in 42 cases (91.3%). The complications were: an accidental rupture of the left diaphragmatic dome in one case (2.1%), gastrointestinal bleeding in the immediate postoperative period in two cases (4.2%) and infected ascites in one case (2.1%). The post-operative scapular pain was reported in 4.2% of our patients. Operative mortality in our patients was nil. The overall care had an average cost of 1685.7 dinars for each of our patients, with extremes ranging from 1055.7 to 3605.7 dinars. For patients with isolated exudative ascites that should have been explored through laparoscopy first, the average cost would be 130.1 dinars, with a material gain for each of 1555.6 dinars. This attitude could also allow a reduction in the mean hospital stay (which was 27 days to few days) associated with early treatment. Our study confirms the interest in laparoscopy first with peritoneal biopsies as part of the etiological diagnosis of isolated exudative ascites

Response to Pegylated Interferon in Chronic Hepatitis B, Effect of with and without Precore Mutant Stain: A Multicenter Tunisian Study

Background and Study Aims: To evaluate the effectiveness of pegylated interferon in patients with chronic hepatitis B infection in a real life setting.Patients and Methods: Fifteen hospitals in Tunisia were included in this study. Data from consecutively treated chronic hepatitis B (CHB) patients, who received pegylated interferon, were collected retrospectively. Baseline demographic and clinical data, on-treatment virological and serological responses and adverse events (AE) were recorded. Sustained virologic response (SVR) is defined as an hepatitis B virus (HBV) DNA concentration of less than 2,000 IU/mL six months after the completion of therapy.Results: A total of 351 CHB patients under peg interferon alfa-2a treatment were included in this multicenter, open label, non-interventional study.Thirty five HBeAg positive patients were identified (62% male, 23% advanced fibrosis). Six months after therapy, 24% had viral loads < 2000 IU/mL, 20% achieved HBeAg seroconversion and 5, 7% achieved HBs Ag loss.Three hundreds sixteen HBeAg negative patients were treated (72, 5% male, 24% advanced fibrosis). Six months post-treatment, 14 % had viral loads < 2000 IU/mL and 1, 2% achieved HBs Ag loss.Treatment was well tolerated in 92% of cases and was stopped in 5.2% of patients.In multivariate analysis, predictors of response to pegylated interferon were: age less than 50 years (P=0,04 IC [0,169-0,737]), precore mutant stain infection (p=0,04 IC [0,60-0,69]), a body mass index < 30kg/m2 (P=0,05 IC [0,225-0,320]), and a pre-treatment serum HBV DNA level <20000IU/ml (P=0,03 IC [1,316-2,225]).Conclusion: PEG-IFN therapy in chronic hepatitis B (CHB) is well tolerated and can achieve a good response especially if we select good responders

Treatment of Helicobacter pylori infection 14‐day concomitant quadruple therapy versus triple therapy: A parallel double‐blind randomized controlled trial

Abstract Background and Aims Successful Helicobacter pylori (Hp) eradication with the traditional 7‐day course of proton pump inhibitor triple therapy is declining. Prolonging therapy to 14 days is associated with better eradication rates. Most learned societies recommend concomitant quadruple therapy (QC) as a first‐line alternative therapy for this bacterial infection. The aim of this study is to compare the efficacy and safety of triple therapy (TT) and QC for the eradication of Hp infection. Methods A parallel double‐blind randomized controlled trial was conducted. The diagnosis of Hp infection was made by pathological examination of gastric biopsies. Patients were randomly assigned to two treatment groups: either QC (esomeprazole 80 mg, amoxicillin 2000 mg, clarithromycin 1000 mg, and metronidazole 1000 mg daily) or triple therapy (esomeprazole 80 mg, amoxicillin 2000 mg, and clarithromycin 1000 mg daily in divided doses) for 14 days. The efficacy of the treatment is defined by Hp eradication attested by a negative breath test performed 6 weeks after the completion of treatment. Treatment outcomes were compared using the chi‐square test, while binary logistic regression identified predictors of treatment failure. Results Ninety‐two patients were included. Forty‐two patients belonged to the QC group and 50 to the TT group. No significant difference was noted between the two groups concerning the rate of Hp eradication either by intention to treat (81% vs. 72% respectively, p = 0.31) or per protocol (81.6% vs. 76.1% respectively, p = 0.54). Likewise, there was no difference between the two groups in terms of tolerance to treatment (59.5% for QC vs. 58% for TT, p = 0.88). No factor has been associated with treatment failure. Conclusion There was no significant difference in the rate of HP eradication between the QC and the 14‐day triple therapy. Neither regimen should be used topically because of their low eradication rates