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Introduction: Several large clinical trials and meta-analyses have shown about 20% failure to eradicate Helicobacter pylori (H. pylori), necessitating investigations for second-line strategies. The aim of this study was to evaluate the effects of Clarithromycin-containing QUADRUPLE regimen afterNitroimidazole-containing QUADRUPLE therapies failure.Methods: Thirty two patients who had failed H. pylori treatment with 10-day Omeprazole, Amoxicillin, Bismuth subcitrate and Metronidazole (OABM) regimen and 31 patients who had failed 10-day Omeprazole, Amoxicillin, Bismuth subcitrate and Furazolidone (OAMF) regimen entered the study.They all received Omeprazole (20mg bid), Amoxicillin (1gr bid), Bismuth subcitrate (240mg bid) and Clarithromycin (500mg bid) for 10 days.Eight weeks after therapy, H. pylori eradication was assessed by 1􀀂C-urea breath test (UBT).Results: totally 61 patients completed the study.According to intention to treat (ITT) analysis, eradication rates by second-line OABC regimen were 84.37% (95% CI=71.7% – 96.9%) in OABM group and 77.41% (95% CI=62.71% – 92.11%) in OABF group (p=0.756). Per-protocol (pp) eradication rates were 87.09% (95% CI=75.2% – 98.8%) and 82.75% (95% CI=79.4% – 96%), respectively (p=0.638).Also the cumulative eradication rates by OABC regimen were 80.9% (95% CI=71.2% – 90.6%) and 85% (95% CI=75.9% – 94%) according to ITT and PP analyses, respectively. Severe side effects were reported in 3.1% of patients.Conclusion: Regarding ideal eradication rate (>80%) and very low adverse effects, it seems that Clarithromycin-containing QUADRUPLE therapy can be an encouraging regimen after Nitro imidazole containing regimen failure.

Purpose: Altmetric is a complementary method of assessing the academic performance of individuals, organizations, institutions, and countries in social media. Due to the large volume of data related to the interactions in STI outcomes, there is no choice but to implement accurate models for analysis and decision making. Methodology: The QUADRUPLE Helix model examines the research outcomes in four spaces of innovation, knowledge, Consensus, and government with distinctive attention to the "innovation space". The present paper examined the impact of researches of D8 countries includes Iran, Turkey, Pakistan, Bangladesh, Indonesia, Malaysia, Egypt, and Nigeria using Altmerics scores of their indexed journal in Clarivate Analytics. Findings: The results showed that researches in the medical sciences in all countries were strongly considered in social networks. However, researches from Turkey, Iran, and Pakistan got more attention in all media. The interaction of research based on four spaces of this model in Iran is limited to medical sciences and biology. Conclustion: As for the diversity of disciplines, Egypt (medical sciences, material engineering, information science, physics, biology, chemistry, and physics), and Nigeria (medical science, Psychology, agriculture, information science and computer science, biology and chemistry) were better compared to other countries. Moreover, Mandalay and Twitter were highly active and played an important role in interacting especially in two spaces of innovation and knowledge in all countries.

Background: Helicobacter pylori is the main etiologic agent in most gastritis and peptic ulcers. The ideal regimen for the treatment of H. pylori infection has not yet been defined. This study was designed to evaluate the eradication rate of H. pylori infection using a short-term and cost effective furazolidone-based regimen in a previously sensitive area to furazolidone drug.Methods: In a randomized single blinded clinical trial study, 135 patients with an endoscopically verified H. pylori-positive peptic ulcer disease were randomly assigned to a QUADRUPLE therapy of "furazolidone, 200 mg; bismuth subcitrate, 240 mg; tetracycline, 500 mg and omeprzole, 20 mg" twice daily for either 14 or 7 days. Six-eight weeks after cessation of therapy, H. pylori eradication was assessed by 13C-urea breath test.Results: H. pylori eradication rate in 7-day and 14-day groups were 71% and 65%, respectively using intention to treat test with no significant difference between the two groups. H. pylori eradication rate had no significant correlation with age, sex and smoking habit.Conclusion: Our study showed that furazolidone-based regimen could not yield an acceptable eradication rate in the area sensitive to furazolidone previously. Eradication failure was attributed to several reasons including inadequate choice of drugs, insufficient knowledge of best therapeutic choices; poor patients’ adherence to treatment and primary H. pylori resistance to the most commonly employed antibiotics.

Introduction From the point of view of the Shia and Sunni jurists, the origin of Zaman of physician is whether consensual or compulsory. They all agree on Zaman of unwise, guilty, and unauthorized physician. But, there is a difference in the Zaman of the professional, authorized, and the mujtahid physician. According to the narration of Sokouni, the rule of waste, the rule of do not kill Muslim, and the consensus of the jurists, common Imamieh jurists consider the physician as the surety, while common Sunni jurists believe in no Zaman for physician based on the rule of necessity, the rule of authorize, the rule of decree, the rule of kindness, the rule of doing fard actions, and the risky nature of medicine. Also, by adhering to the rules of authorize, kindness, necessity, and acquittance, common Imamieh jurists agree with the Sunni jurists. The present study was conducted with the aim of evaluating the Zaman of physician in Imamieh Figh and QUADRUPLE religion. Conclusion By examining the reasons for both the views of Zaman and no Zaman, it can be said that in some cases, where a physician willingly deals with patient treatment or in emergency situations, for survival, there is no option but to lose some of the organs of the body, there should be no Zaman, but ultimately, because the human body and soul have a higher value than the property and the actual damages are not compensated by the payment of the blood money, the Zaman theory makes the physicians more cautious, and this theory is closer to the purposes of elaborating the teachings of Islam, one of which is survival, and on the other hand, they have made the acquittance decree to help physicians.

Since all currents of thought in different generations of revolutionary theory are only able to recognize and interpret the dimensions of those revolutions that they have sought to recognize, it does not seem reasonable to use them to theoretically justify future revolutions. Accordingly, the main structure of revolutionary theories during previous four theoretical generations is based on a set of predetermined factors and components as factors promoting the revolution, which are necessary in all revolutions, especially revolutions that occur after their presentation. Given these explanations and the title of the present article, the question can be asked, can all the dimensions of the Arab revolutions be theoretically justified and explained by the views of the four generations of the theory of revolution? The results of the studies show that in at least three areas, namely the process connection of domestic and international levels in a specific historical framework, the neutral role of the army in turning unrest into revolution and ultimately the victory of revolutions in the absence of leadership with the factors mentioned in previous theories have deep differences. In this work, the author intends to investigate the mentioned differences based on the method of matching the factors influencing the occurrence of Arab unrest in the three mentioned areas with the factors mentioned in the four theories of the revolution.

Background: H, pylori is strongly associated with chronic active gastritis and 95-99% of duodenal ulcers and most gastric ulcers as well. Metronidazole based therapies show an optimal efficacy ranging from 80' to 95% in western countries but in areaswitha high Metronidazole resistance such as IRAN the eradication rate is usually suboptimal. Fufazolidone shows a promising efficacy while replacing Metronidazole in different eradication regimens. This study 15 trying to determine the efficacy of a QUADRUPLE therapy based on Furazolidone as a second line treatment in Metronidazole resistant patients. Materials and methods: 89 H. pylori infectedpatients who were treated for at least 14 days with Metronidazole based QUADRUPLE therapy and still had a positive UBT had been included. They were treated with Furazolidone, Bismuth, Amoxicilline and Omeprazole for 2 weeks. Eradication was described as negative 14 C-Urease Breath test, 4 to 6 weeks after of the treatment. Results: Total eradication rate in 89 patients who completed the treatment course was 68/89 (75.6%) Eradication rate has not significant relationship with gender of patients (35/48 in males versus 35/41 in females, P > 0.05). 19 patients out of 90 (21.1%) were smoker. Eradication rate among smokers was 11/19 and in non-smokers was 57/70 (P < 0.05) and there was a significant relationship between smoking and decrease of eradication rate (Ci > 95% & OR = 3.12). Distribution of H. pylori associated problem in our patients (determined) by endoscopy) was duodenal ulcer (DU) (11.1%) and nonulcer dyspepsia (NUD) (10%). Eradication rate was different in these groups: in DU patients 55/70, in GU patients 6/10 and in NOD patients 7/9(P>0.05). Therefore we couldn't show any significant relation between these items.Discussion: This study determines the efficacy of a QUADRUPLE therapy regimen based on Furazolidone as a second line treatment. So in Iran, where Claritromycin is very expensive and difficult to archive, Furasolidone could be used sufficiently.

Background: In developing countries primary antibiotic-resistance and poor compliance are the main causes of helicobacter pylori (HP) eradication failure of standard regimens. AIM: To investigate eradication rate, patient's compliance and tolerability of a 1-wk Azithromycin based quaruple therapy versus the 2-wk conventional therapy.Materials and Methods: A total of 129 HP-positive patients were randomized to either omeprazole 20mg, bismuth subcitrate 240 mg, azithromycin 250 mg, metronidazole 500 mg, all twice daily for 1- wk (BOAzM) or omeprazole 20mg, bismuth subcitrate 240 mg, amoxicillin 1g, metronidazole 500 mg all twice daily for 2-wk (B-OAM). HP infection was defined at entry by histology and rapid urease test and cure of infection was determined by negative urea breath test.Results: HP eradication rates of B-OAzM and B-OAM were74.1% and 70.4% respectively at intention to treat and per-protocol analysis 78.1%versus 75.7% respectively. incidence of poor compliance was lower, although not significant, in patients randomized to B-OAzM than for B-OAM (3.5% versus 4.3 %) but intolerability was similar in two groups ( 35% versus 33.3% ).  Conclusions: 1-wk azithromycin based QUADRUPLE regimen achieves an HP eradication rate comparable to that of standard 2-wk QUADRUPLE Therapy and is associated with same patient's compliance and complications.