مجله دانشکده پزشکی اصفهان
پیاپی 569 (هفته اول خرداد 1399)

Helicobacter pylori (H. pylori) infection is prevalent in the world. Resistance to antibiotics is the main reason for treatment failure. This clinical trial examined the effect of clarithromycin versus levofloxacin as the content of first line of treatment of the patients with peptic ulcer.

In this double-blind randomized controlled clinical trial study with parallel groups, 148 infected patients by H. pylori who had been proven during endoscopic biopsy were randomly divided into two equal groups. One group was treated with the quadruple therapy of clarithromycin 500 mg BID, amoxicillin 1 g BID, bismuth subcitrate 240 mg BID, and pantazole 40 mg BID. The second group was treated with levofloxacin 500 mg QD, amoxicillin 1 g BID, bismuth subcitrate 240 mg BID, and pantazole 40 mg BID. The duration of treatment was 14 days in both groups and four weeks after treatment, the eradication rate was assessed using the stool antigen test.

The eradication rate was significantly higher using regime containing clarithromycin than that of levofloxacin [81.1%; confidence interval of 95% (95%CI): 72.2%-89.9% vs. 60.3%; 95%CI: 49.3%-72.2%; P = 0.021). The improvement in quality of life in patients treated with clarithromycin was comparable with levofloxacin (7.90 ± 5.79 vs. 9.27 ± 5.89; P = 0.18). Adverse effects were different between the groups in which bad taste was reported more frequently in clarithromycin than levofloxacin (27.0% vs. 4.3%) while epigastric pain was more in levofloxacin (7.1% vs. 2.7%).

The effectiveness of clarithromycin on H. pylori eradication rate was significantly higher than levofloxacin.

Marital adjustment can play a fundamental role in the couples’ life. Marital adjustment affects couple's physical and mental health, and increases their ability to cope with the problems and stress-making factors. Therefore, the objective of the present study was to compile the model of some antecedents and outcomes of marital adjustment.

The present descriptive study was of correlational studies with structural equations modeling. The statistical population of the study included all married employees at University of Isfahan, Isfahan, Iran, from whom 172 people were randomly selected and responded to Snyder adults hope questionnaire, Oxford Argyle et al. happiness questionnaire, Busby et al. marital adjustment, Khodayarifard et al. assessment of religious tendency, and the scale of Connor and Davidson’s resilience. Data analysis was performed by structural equation modeling using SPSS and AMOS software.

Suggested model of the study had a very good goodness of fit. The results showed the direct effect of religious tendencies, resilience, hope, and happiness on marital adjustment (P < 0.01 for all). Moreover, the results showed an indirect effect of religious tendencies, resilience, and hope on happiness through marital adjustment (P < 0.05 for all).

Marital adjustment is a protective factor for physical health and well-being, and a sign of a couple's progress and success. However, the existence of these effects depends on the degree of adjustment between the couple. Therefore, it is recommended to pay attention to variables such as resilience, religious tendencies, and hope, to improve marital adjustment and to create happiness and vitality in life.

Bronchogenic cysts commonly occur isolated in the bronchial tree, typically in the mediastinum. However, subcutaneous and cutaneous forms can rarely be found. Herein, we present a case of a 3-year-old girl with this lesion.

A 3-year-old girl presented to the clinic with an ulcerated plaque on her anterior chest wall. She mentioned a history of a skin-colored nodule on the same location that had been present since her birth, and was excised one year ahead with the diagnosis of epidermoid cyst. On examination, an ulcerative plaque was evident on the left midclavicular area with no tenderness, discharge, erythema, or regional lymphadenopathy. Incisional biopsy was performed. Histopathological study revealed non-dysplastic, squamous, pseudo-stratified, ciliated respiratory epithelium with diffuse inflammatory lymphomononuclear infiltration in the lower stroma, confirming the diagnosis of cutaneous bronchogenic cysts. The patient was referred for surgical resection of the lesion, but refused to continue the treatment.

Although lesions associated with skin appendages are more common in the diagnosis of subcutaneous masses, less frequent diagnoses should also be in mind for lesions with special localization or recurrent and unusual course, and histopathological examination of tissue specimens should be performed.</div>