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SUMMARYBackground: Standard anti-Helicobacter pylori therapy may not achieve a satisfactory eradication rate. Fluoroquinolones, such as moxifloxacin, are safe and promising agents for H. pylori eradication. Aim: To compare the efficacy of two 1-week moxifloxacin-based H. pylori eradication regimens with two standard treatments. Methods: Three hundred and twenty H. pylori-positive subjects were randomized into four groups to receive: moxifloxacin, amoxicillin, esomeprazole (Group MAE); moxifloxacin, tinidazole and esomeprazole (Group MTE); standard triple therapies with clarithromycin, amoxicillin and esomeprazole (Group CAE) or tinidazole (Group CTE) for 7 days. H. pylori status was re-assessed 6 weeks after the end of therapy by 13C urea breath test.

It has been proposed that vaccines may exert an unspecific protective effect against infectious agents, different than expected. Coronavirus disease 2019 (COVID-19) is a pandemic infection with high mortality in older patients due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The high number of vaccinations may be one of the reasons why children show a lower susceptibility to SARS-CoV-2 infection and milder severity when compared to adults. We have designed a study aimed at investigating whether the influenza vaccine may reduce the susceptibility and severity of SARS-CoV-2 infection. We retrospectively enrolled 635 patients who accessed our Emergency Department from March 1st to June 30th, 2020, and were diagnosed with COVID-19 infection confirmed by an RT-PCR on an oropharyngeal swab. Clinical data, outcomes, and influenza vaccination status were collected from the electronic medical records of our Hospital. We also used data from the Italian Health Ministry to compare the prevalence of flu vaccination among the general population of the Lazio Region and our enrolled patients. We then compared clinical outcomes between vaccinated and non-vaccinated patients, by univariate and multivariate analysis. COVID-19-positive patients older than 65 years reported a lower prevalence of flu vaccination when compared to the general population residing in the Lazio (p = 0.004). After correction for gender, age, and comorbidities, we found a lower risk of death at 60 days in patients with flu vaccination than in not vaccinated patients (p = 0.001). Our study shows that flu vaccination could reduce the mortality of COVID-19. Prospective studies are needed to confirm this result.

Lipopolysaccharides (LPSs) are bacterial surface glycolipids, produced by Gram-negative bacteria. LPS is known to determine acute inflammatory reactions, particularly in the context of sepsis. However, LPS can also trigger chronic inflammation. In this case, the source of LPS is not an external infection, but rather an increase in endogenous production, which is usually sustained by gut microbiota (GM), and LPS contained in food. The first site in which LPS can exert its inflammatory action is the gut: both GM and gut-associated lymphoid tissue (GALT) are influenced by LPS and shift towards an inflammatory pattern. The changes in GM and GALT induced by LPS are quite similar to the ones seen in IBD: GM loses diversity, while GALT T regulatory (Tregs) lymphocytes are reduced in number, with an increase in Th17 and Th1 lymphocytes. Additionally, the innate immune system is triggered, through the activation of toll-like receptor (TLR)-4, while the epithelium is directly damaged, further triggering inflammation. In this review, we will discuss the importance of the crosstalk between LPS, GM, and GALT, and discuss the possible implications.

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Amaç: Çalışmamızda diyabetiklerde dispepsi semptomları, semptom alt gruplarının organik ve fonksiyonel dispepsiyi ve spesifik tanıları ayırt etmedeki değerlerinin incelenmesi, Helicobacter pylori (H.pylori, HP) infeksiyonu ile spesifik dispepsi tipleri, semptomlar ve tanılar arasındaki ilişkinin incelenmesi, HP infeksiyonu ve histopatolojik tanılar, metabolik-klinik faktörler arasındaki ilişkinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Tip 2 diyabetik 44 ve diyabetik olmayan 69 olgu çalışmaya alındı. Her olguda endoskopi bulguları ve antrumdan iki adet, korpustan iki adet biyopsi materyalinin histolojik inceleme sonuçları ile HP yoğunluğu sonuçları tespit edildi ve kontrol grubuna ait verilerle karşılaştırıldı. Diyabetiklerde HP ile klinik ve metabolik özellikler arasındaki ilişki değerlendirildi. Bulgular: Çalışmaya alınan diyabetik hastaların yaş ortalaması 55,29 (± 8,22), erkek hasta oranı % 20,45 (n: 9) bulundu. Hastaların %61,4 sinde fonksiyonel dispepsi, %6.8'inde duodenal ülser, %6.8'inde mide ülseri, %6,8'inde reflü özofajit, tespit edildi. Diyabetik olgularda dispepsi alt gruplarında HP pozitiflik oranları benzer bulundu. Diyabetik olgularımızda HP infeksiyonu sıklığı diyabetik olmayan olgulardan düşük bulundu ve fark istatistiksel olarak anlamlıydı (p=0,047). Diyabetiklerde inflamasyon derecesi hafif yüksekti, ancak diyabetik olmayanlara göre anlamlı değildi (p<0,10). Aktivasyon derecesi diyabetiklerde anlamlı olarak yüksek bulundu (p<0,02). Diyabetiklerin % 77,3'ünde (n:34) periferik nöropati saptandı. Bu olgularda HP sıklığı % 61,8 idi. HP pozitif olguların % 84,0'nda periferik nöropati vardı. Sonuç: Çalışmamızda, Tip 2 diyabetik olgularda, bazı semptomlarla organik dispepsi ve peptik ülser hastalığı arasında birliktelik saptandığı halde bunların yeterince spesifik olmadığı ve semptomlara dayanarak dispepsinin ayırıcı tanısının yapılamayacağı, ayırıcı tanı için endoskopi ve diğer tanısal yöntemlerin gerekli olduğu sonucuna varıldı. Diyabetes mellitus'ta H.pylori infeksiyonu düşük oranda saptanabilmektedir. Diabetes mellitus'un, gastrik fizyopatolojik değişimde aktivasyon üzerine arttırıcı etkisi olmakla beraber, klinik ve metabolik durumlarla bakteri arasında zayıf bir etkileşim bulunmuştur. ABSTRACT Aim: In this study, we examined the dyspepsia symptoms in diabetics, the organic and functional dyspepsia of the subtypes of symptoms and their distinctive values, the relationship between Helicobacter pylori (H. pylori, HP) infection and specific dyspepsia types, symptoms and diagnoses, metabolic and clinical factors. Material and Methods: 44 type 2 diabetic patients and 69 non-diabetic patients were included in the study. Histological examination results and HP density results of two endoscopic (gastric antrum and corpus) biopsy materials were determined in each case, compared with control group. The relationship between HP and clinical and metabolic characteristics was assessed in diabetics.

Background and purpose: The objective of this study was to assess the neurological manifestations in a series of consecutive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients, comparing their frequency with a population hospitalized in the same period for flu/respiratory symptoms, finally not related to SARS-CoV-2. Methods: Patients with flu/respiratory symptoms admitted to Fondazione Policlinico Gemelli hospital from 14 March 2020 to 20 April 2020 were retrospectively enrolled. The frequency of neurological manifestations of patients with SARS-CoV-2 infection was compared with a control group. Results: In all, 213 patients were found to be positive for SARS-CoV-2, after reverse transcriptase polymerase chain reaction on nasal or throat swabs, whilst 218 patients were found to be negative and were used as a control group. Regarding central nervous system manifestations, in SARS-CoV-2-positive patients a higher frequency of headache, hyposmia and encephalopathy always related to systemic conditions (fever or hypoxia) was observed. Furthermore, muscular involvement was more frequent in SARS-CoV-2 infection. Conclusions: Patients with COVID-19 commonly have neurological manifestations but only hyposmia and muscle involvement seem more frequent compared with other flu diseases.

Background-Alterations in epithelial proliferation and apoptosis in colonic mucosa are associated with an increased risk of colon cancer. It is unclear if these alterations represent a generalised "field defect". Aims-To analyse segmental patterns of cell proliferation and apoptosis in the colon of subjects with a high and no apparent risk of colon cancer. Methods-Pancolonoscopywas performed in 15 patients with resected adenomas (>1.5 cm) and in nine subjects without an apparent risk of colorectal cancer. Mucosal biopsies were taken from the right colon, left colon, and sigmoid rectum. Crypt cell proliferation and apoptosis were evaluated, respectively, with bromodeoxyuridine immunohistochemistry and terminal deoxyuridine nucleotidyl nick end labelling of DNA strand breaks. Results are expressed as total labelling index (TLI) and labelling index (LI) for each of the five compartments in which colonic crypts were divided (fourth and fifth compartments were evaluated together) for cell proliferation and as apoptotic index (AI) for apoptosis assessment. Results-No significant segmental variations in proliferation were found in either group. Compared with controls, adenoma patients had higher TLIs for the right (p>0.05), left (p<0.005), and sigmoid rectum (p<0.05) segments, and higher left colon LIs for crypt compartments (compartment 1, p<0.01; compartment 2, p<0.005; compartment 3, p<0.001; compartments 4-5, p<0.01). Control AIs were similar in all segments but in the adenoma patients left colon and sigmoid rectum AIs were lower than their right colon indexes (p<0.05, p<0.05) and corresponding values for controls (p<0.01, p<0.05). Conclusions-The colonic mucosa of patients with past adenomas presents diVuse hyperproliferation and, distally, abnormally distributed proliferating cells and markedly reduced apoptosis. These changes represent a significant risk for malignancies and could account for the high prevalence of left colon tumours. (Gut 2001;48:238-246)