Background
Helicobacter pylori (HP) infection is considered to play a role in the pathogenesis of chronic spontaneous urticaria (CSU). However, the efficacy of HP eradication therapy on CSU symptom improvement has not been well established. This meta‐analysis was conducted to estimate the association between HP infection and CSU and to evaluate whether HP eradication therapy benefits patients with CSU.
Material and Methods
In October 2018, we searched databases for studies investigating the efficacy of HP eradication therapy for patients with CSU. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using random effects models.
Results
The meta‐analysis included 22 studies with a total of 1385 patients with CSU. When comparing the spontaneous remission of urticarial symptom in patients with HP‐positive to HP‐negative patients, HP‐negative patients showed significantly higher spontaneous remission of urticarial symptoms. (risk ratio 0.39; 95% confidence interval: 0.19‐0.81). Among HP‐positive CSU patients, remission of CSU was more likely shown in HP eradication therapy group compared to untreated group, aside from achieving HP elimination (risk ratio 2.10; 95% confidence interval: 1.20‐3.68). However, there was no significant difference in the remission of CSU whether antibiotic therapy was successful in eradication of HP or not (risk ratio 1.00; 95% confidence interval: 0.65‐1.54).
Conclusions
The results of this meta‐analysis show that HP might be associated with the occurrence and persistence of CSU. The effectiveness of HP eradication therapy in suppressing CSU symptoms was significant. Interestingly, we found that resolution of CSU was not associated with successful eradication of HP infection. CSU Patients who were undergone antibiotic therapy for HP eradication showed significant higher CSU remission with or without HP eradication. Further studies are recommended to evaluate the mechanisms associated with relation of HP with CSU.
Because preoperative CT angiography considerably affected management in one half of patients, we recommend its use as a routine test before CABG, unless contraindicated.
Finasteride 1 mg is considered to be the standard treatment method for male androgenetic alopecia (
AGA
). However, there have only been a few studies investigating its long‐term efficacy. Moreover, its effect on various types of
AGA
remains unknown. In this study, the authors investigated the 5‐year efficacy of finasteride 1 mg in Korean men with
AGA
and analyzed the changes in hair growth according to the distribution of hair loss. The medical records of male
AGA
patients who were treated with oral finasteride for a period of at least 5 years at two university hospitals were retrospectively reviewed. Patients' photographs were evaluated using the basic and specific (
BASP
) classification and investigator's global assessment. Of the total 126 patients, 108 (85.7%) showed improvement after 5 years of treatment. According to the
BASP
classification, hair loss of the anterior hair line (basic type), vertex (V type), and frontal area (F type) was improved in 44.4%, 89.7% and 61.2% of patients, respectively. The V type showed a more rapid and steady improvement compared with the other types. Progression of alopecia after peak improvement was seen in 10.3% of cases of the V type, 16.2% of the F type and 0% of the basic type. In conclusion, finasteride 1 mg showed a sustainable effect for at least 5 years in Korean male
AGA
patients. The exact time points showing signs of first clinical improvement and sustainability were different depending on the type of alopecia.
BackgroundDespite aggressive treatment, the mortality rate of cardiogenic shock with acute myocardial infarction (AMI) is high. We performed extracorporeal membrane oxygenation (ECMO) prior to coronary reperfusion, and evaluated the early clinical results and risk factors.Materials and MethodsFrom May 2006 to November 2009, we reviewed the medical records of 20 patients in cardiogenic shock with AMI (mean age 67.7±11.7 yrs, M : F 14 : 6). After initially performing ECMO using the CAPIOX emergency bypass system (EBS®Terumo, Tokyo, Japan), patients underwent coronary reperfusion (coronary artery bypass grafting, 13; percutaneous coronary intervention, 7).ResultsAll patients were in a cardiogenic shock state, cardiopulmonary resuscitations (CPR) were performed for fourteen patients (mean CPR time 20.8±26.0 min). The mean time from vascular access to the initiation of ECMO was 17.2±9.4 min and mean support time was 3.8±4.0 days. Fourteen patients were able to be weaned from ECMO and ten patients were discharged (mean admission duration 50.1±31.6 days). Patients survived on average 476.6±374.6 days of follow-up. Longer CPR and support time, increased cardiac enzyme, lower ejection fraction, lower albumin, and major complications were the risk factors of mortality (p<0.05).ConclusionThe early application of ECMO prior to coronary reperfusion and control of risk factors allowed for good clinical results in cardiogenic shock with AMI.
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