Helicobacter pylori infection and insulin resistance in diabetic and nondiabetic population

Helicobacter pylori (HP) is a common worldwide infection with known gastrointestinal and nongastrointestinal complications. One of the gastrointestinal side effects posed for this organism is its role in diabetes and increased insulin resistance. The aim of this study was to evaluate the association between HP and insulin resistance in type 2 diabetic patients and nondiabetics. This cross-sectional study was carried out from May to December 2013 on 211 diabetic patients referred to diabetes clinic of Shahid Beheshti Hospital of Qom and 218 patients without diabetes. HP was evaluated using serology method and insulin resistance was calculated using HOMA-IR. The prevalence of H. pylori infection was 55.8% and 44.2% in diabetics and nondiabetics (P=0.001). The study population was divided into two HP positive and negative groups. Among nondiabetics, insulin resistance degree was 3.01±2.12 and 2.74±2.18 in HP+ and HP- patients, respectively P=0.704. Oppositely, insulin resistance was significantly higher in diabetic HP+ patients rather than seronegative ones (4.484±2.781 versus 3.160±2.327, P=0.013). In diabetic patients, in addition to higher prevalence of HP, it causes a higher degree of insulin resistance. © 2014 Jamshid Vafaeimanesh et al

Impact of creatinine clearance on helicobacter pylori eradication rate in patients with peptic ulcer disease

Introduction. Gastrointestinal complaints are common in patients with kidney failure. The aim of this study was to investigate the effect of creatinine clearance on Helicobacter pylori (HP) eradication rate in patients with peptic ulcer disease. Materials and Methods. In this clinical trial, 132 patients with a range of kidney function (normal to end-stage renal disease) and peptic ulcer disease with HP infection were enrolled and divided into 5 groups by their creatinine clearance. For all patients, a 14-day standard regimen of triple therapy for peptic ulcer was started with omeprazole, 20 mg; clarithromycin, 500 mg; and amoxicillin, 1 g; twice per day. After 6 weeks, HP eradication rate were evaluated and compared between the groups with urea breath test. Results. The mean age of the participants was 44.84 ± 12.20 years and 68 (51.5%) were women. The five groups were not significantly different in terms of age, sex distribution, or body mass index. The results of urea breath test at 6 weeks were positive in 23 patients (17.4%). There was no significant difference in HP eradication rate (negative urea breath test) between the five groups. Conclusions. This study showed no association between the success rate of eradication of HP infection and kidney function. © 2015, Iranian Society of Nephrology. All rights reserved

Evaluating the effect of a herb on the control of blood glucose and insulin-resistance in patients with advanced type 2 diabetes (a double-blind clinical trial)

Background: Different benefits of various herbal medicines in decreasing blood sugar have been reported in different clinical trials so far. Considering the growing tendency toward these combinations and the booming market, inappropriate advice is growing accordingly. Hence, it is necessary to evaluate the effects and possible complications of such combinations on health status and blood glucose control. Methods: Two 38-subject groups were formed and a 12-week treatment program was administered for both groups. The inclusion criteria were failure to control blood glucose with two oral medicines, unwillingness to inject insulin. The medicine was prepared in capsules by Booali Company. Each capsule weighed 750 mg and contained nettle leaf 20 (w/w), berry leaf 10 (w/w), onion and garlic 20 (w/w), fenugreek seed 20 (w/w), walnut leaf 20 (w/w), and cinnamon bark 10 (w/w) all in powder. Results: At the beginning of the study, there was no significant difference between the subjects regarding the evaluated parameters, but after the intervention, the level of glucose was significantly lower in fasting (P=0.0001) and 2-hour postprandial (P=0.002) levels. The level of glycated hemoglobin A1c (HbA1c) (P=0.0001) also decreased from 0.33±9.72 to 0.20±8.39 . Finally, the level of insulin resistance reduced from 1.9±4.1 to 1.4±2.6 (P=0.001) after consuming herbal medicine. Conclusion: According to the results of the current study, the herbal combination was effective in controlling blood sugar, and considering the reduction of HbA1c by 1.31 , it seems that the herbal combination is an effective medicine to treat diabetes. © 2020 Babol University of Medical Sciences. All rights reserved

Effect of Helicobacter pylori eradication on glycaemia control in patients with type 2 diabetes mellitus and comparison of two therapeutic regimens

Background and study aims: The eradication rate of Helicobacter pylori (H. pylori) has been reported as being lower in patients with type 2 diabetes mellitus (DM) than in those without DM. The aim of the study was to assess the efficacy of the two H. pylori eradication regimens in patients without and with type 2 DM and to study the effect of H. pylori treatment on glycaemia control. Patients and Methods: A total of 93 consecutive type 2 DM (non-insulin users) and 98 non-diabetic age- and sex-matched patients were enrolled. Patients were randomly assigned to one of the two treatment protocols all given twice daily: (a) a 14-day quadruple therapy comprising of omeprazole 20mg, metronidazole 500mg, amoxicillin 1g and bismuth subcitrate 240mg (OMAB) and (b) a 14-day triple regimen comprising of omeprazole 20mg plus clarithromycin 500mg and amoxicillin 1g (OCA). Cure was defined as a negative 13C-urea breath test at least 6weeks after treatment. Results: The H. pylori eradication rate with the OCA regimen was 63% in patients with type 2 DM (non-insulin users) and 87.7% in the control group (p=0.017). The H. pylori eradication rate with the OMAB regimen was 38.2% in patients with type 2 DM and 55.1% in the control group (p<0.001). Mean decrease of fasting plasma glucose and HbA1c level shows no statistically significant difference after H. pylori eradication. Conclusion: This study suggests that the eradication rate of H. pylori with OCA or OMAB treatment is lower in patients with type 2 diabetes than in non-diabetics and H. pylori treatment in patients with type 2 DM has no role in the control of the glycaemia. The triple therapy (OCA) is superior to the quadruple protocol (OMAB) in H. pylori eradication of both DM and non-DM cases. © 2013 Arab Journal of Gastroenterology

Insulin resistance and coronary artery disease in non-diabetic patients: Is there any correlation?

Background: Cardiovascular diseases are the most common causes of death in the world and type 2 diabetes is one of them because it is highly prevalent and doubles heart disease risk. Some studies suggest that insulin resistance is associated with coronary artery disease in non-diabetics. The aim of this study was to evaluate the association of insulin resistance (IR) and coronary artery disease (CAD) in non-diabetic patients. Methods: In this cross-sectional study, from September 2014 to July 2015, 120 patients referring to Shahid Beheshti Hospital of Qom were evaluated. Their medical history, baseline laboratory studies, BMI and GFR were recorded. After 8 hours of fasting, blood samples were taken from the patients at 8 am, including fasting glucose and insulin level. We estimated insulin resistance using the homeostatic model assessment index of IR (HOMA-IR). Finally, we evaluated the association between IR and CAD. Results: Totally, 120 patients were assigned to participate in this study, among them, 50 patients without CAD and 70 with coronary artery stenosis. Insulin resistance (HOMA-IR> 2.5) was positive in 59 (49.3) patients and negative in 61 (50.7) patients. Hence, the correlation between IR and CAD was not statistically significant (P=0.9). Conclusions: In this study, although the correlation was not found between insulin resistance and coronary heart disease, among men, we found a significant association between coronary heart disease and insulin resistance. © 2018 Babol University of Medical Sciences

Insulin resistance and coronary artery disease in non-diabetic patients: Is there any correlation?

Background: Cardiovascular diseases are the most common causes of death in the world and type 2 diabetes is one of them because it is highly prevalent and doubles heart disease risk. Some studies suggest that insulin resistance is associated with coronary artery disease in non-diabetics. The aim of this study was to evaluate the association of insulin resistance (IR) and coronary artery disease (CAD) in non-diabetic patients. Methods: In this cross-sectional study, from September 2014 to July 2015, 120 patients referring to Shahid Beheshti Hospital of Qom were evaluated. Their medical history, baseline laboratory studies, BMI and GFR were recorded. After 8 hours of fasting, blood samples were taken from the patients at 8 am, including fasting glucose and insulin level. We estimated insulin resistance using the homeostatic model assessment index of IR (HOMA-IR). Finally, we evaluated the association between IR and CAD. Results: Totally, 120 patients were assigned to participate in this study, among them, 50 patients without CAD and 70 with coronary artery stenosis. Insulin resistance (HOMA-IR> 2.5) was positive in 59 (49.3) patients and negative in 61 (50.7) patients. Hence, the correlation between IR and CAD was not statistically significant (P=0.9). Conclusions: In this study, although the correlation was not found between insulin resistance and coronary heart disease, among men, we found a significant association between coronary heart disease and insulin resistance. © 2018 Babol University of Medical Sciences

Intestinal ischemia due to mesenteric vascular thrombosis in a patient with positive SARS-CoV-2 RNA without primary pulmonary symptom: A case report

Coronavirus disease 2019 (COVID-19) is an acute respiratory illness caused by novel coronavirus SARS-CoV-2. The clinical manifestations of this infection have a range and typically include impairment of smell, taste disturbance, cough, fever, and shortness of breath. Gastrointestinal manifestations have been reported in anywhere from 3 to 50 of patients with concomitant SARS-CoV-2 pulmonary infection. Abnormalities in coagulation markers have been reported in patients hospitalized with COVID-19. During this article, we will introduce a patient with COVID 19 but with the most manifestation of abdominal pain due to intestinal ischemia and mesenteric vascular thrombosis. © 2021 The Author(s)

Comparing the effect of two low-dose and high-dose four-drug regimens of furazolidone in eradicating helicobacter pylori

BACKGROUND Antibiotic resistance is a major cause of Helicobacter pylori (H. pylori) treatment failures. The increased resistance to clarithromycin and metronidazole has reduced the ability of this therapeutic regimen and prompted researchers to look for other drugs. One of the antibiotics of interest in this regard is furazolidone because of its low drug resistance. The aim of this study is compare two-drug regimens including low-dose and high-dose furazolidone in the treatment of H. pylori. METHODS This study is a clinical trial in which the studied subjects were categorized into two groups. The first group underwent treatment with amoxicillin 1000 mg-BD, furazolidone 100 mg-BD, omeprazole 20 mg-BD, and bismuth subcitrate 240 mg-BD for two weeks (low-dose OFAB). The second group received furazolidone 200 mg-BD (high-dose OFAB). Then eight weeks after completion of the treatment, they were examined in terms of eradication via the UBT test. RESULTS 85 participants completed the study in each group. The response to treatment was 76 and 83 in the low and high-dose groups, respectively, based on intention to treat analysis. Based on per protocol analysis the response to treatment was 78 and 84, respectively, if excluded patients had completed their protocol and had response to treatment, and 72 and 79, respectively, if excluded patients had completed their protocol and did not have response to treatment (p = 0.298). In the low-dose and high-dose groups, 16.5 and 24.7 of the participants suffered the complications of treatment with furazolidone (p = 0.18), respec-tively. Three patients in the high-dose group and one in the low-dose group did not complete the treatment because of the medication�s bad taste (p = 0.03). CONCLUSION Low doses of furazolidone had a comparable therapeutic effect compared with high doses, but patients experienced significantly lower levels of bad taste, which was a major cause of reluctance to continue treatment. Therefore, we think four-drug low-dose furazolidone treatment is a good choice in eradicating H. pylori. © 2021 The Author(s)

Subclavian artery-esophageal fistula after placement of a self-expanding metal stent in a patient with esophagogastric anastomosis stenosis

Background: There have been reports on stent-related vascular erosions about patients with benign or malignant stenosis of the esophagus who received endoscopic stent insertion for palliative intention for oral intake. Case presentation: A 61-year-old woman with esophageal cancer located in the middle part of esophagus was treated with esophagectomy. Two years following the surgery, malignant stenosis recurred in the esophagogastric anastomosis. A non-covered self-expanding metal stent (10 cm length with a diameter of 18 mm at expanded state) was inserted. Three months later, a massive hematemesis with subsequent hemorrhagic shock developed from the proximal end of the stent which resulted in the final diagnosis of arterioesophageal fistula on the left subclavian artery. An endovascular repair using a stent graft for the left subclavian artery via the right common iliac artery was performed and the patient remained well until discharge. Conclusion: Increase in the treatment of esophageal strictures by stent insertion increases the risk of stent-related vascular fistula. These complications should be considered in any patients with massive upper gastrointestinal bleeding