LOAD H. pylori with new four-drug regimen

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A novel regimen using three antibiotics and a proton pump inhibitor (PPI) is highly active against Helicobacter pylori in treatment-naive patients, researchers reported in a paper online October 11 in the American Journal of Gastroenterology.

This quadruple drug regimen (LOAD) for 10 days comprised

  1. Levofloxacin
  2. Omeprazole
  3. Nitazoxanide
  4. Doxycycline (LOAD)

This regimen has a very high eradication rate and virtually negligible side effects.

Resistance to standard treatment regimens has led to PPI, amoxicillin, and clarithromycin triple-therapy cure rates consistently falling below 80%. Other regimens such as those containing metronidazole have also been used, but resistance to that agent has reportedly been as high as 66%.

LOAD is better than LAC (lansoprazole, amoxicillin, and clarithromycin) therapy for 10 days.

Staggered overdose of paracetamol may be fatal

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Taking even slightly too much paracetamol over a period of several days can lead to an overdose with deadly consequences, according to a study in the British Journal of Clinical Pharmacology. According to the study, 37.3 percent of patients with staggered overdoses died, while 27.8 percent of single overdose patients died.

After analyzing data from 663 patients with paracetamol-induced liver injury, 161 of those patients had suffered a staggered overdose while taking paracetamol.

Compared with people who had taken a single overdose of paracetamol, those with a staggered overdose were more likely to have liver and brain problems, require kidney dialysis or help with breathing, and were at greater risk of dying.

Combined ACE inhibitor and AR blocker associated with increased risk of cardiovascular death in hemodialysis patients

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Over 6 years, 22,800 patients were newly initiated on an ACEI and 5828 on an ARB after at least 60 days of chronic hemodialysis. After adjustment for baseline cardiovascular risk factors, there was no significant difference in the risk of cardiovascular, all-cause, or cerebrovascular mortality in patients initiated on an ARB compared with an ACEI (HR of 0.96).

A third of 28,628 patients, newly started on an ACEI or ARB, went on to another antihypertensive medication in succession. After adjustment for risk factors, 701 patients initiated on combined ACEI and ARB therapy (HR of 1.45) or 6866 patients on ACEI and non-ARB antihypertensive agent (HR of 1.27) were at increased risk of cardiovascular death compared with 1758 patients initiated on an ARB and non-ACEI antihypertensive therapy.

Thus, an ARB, in combination with another antihypertensive medication (but not an ACEI), may have a beneficial effect on cardiovascular mortality.  (Medscape Cardiology)

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