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Summary Background The eradication rate of Helicobacter pylori with standard treatments are decreasing worldwide. Aim To determine whether adding simvastatin as adjuvant to triple regimen in patients with H. pylori infection will improve the eradication rate. Methods We conducted a double‐blind, placebo‐controlled, randomised clinical trial comparing a 7‐day, triple eradication regimen consisting of two antibiotics (clarithromycin 500 mg and amoxicillin 1 g, all twice per day) plus a proton pump inhibitor (omeprazole 20 mg twice daily) supplemented with simvastatin 20 mg (CAO + S) or a comparable placebo (CAO + P). Both the simvastatin and the placebo were taken orally twice daily for 1 week in 113 patients with H. pylori infection. The presence of H. pylori was determined by positive rapid urease test and histology. Eradication was confirmed by 13C‐urea breath test at least 1 month after treatment. Adverse effects were assessed by questionnaire. Results A total of 113 patients underwent randomisation. Intention‐to‐treat analysis (ITT; n = 113) eradication rates were: CAO + S (86%; 95% CI: 78–92%), CAO + P (69%; 95% CI: 64–74%). Per protocol analysis (PP; n = 108) eradication rates were: CAO + S (91%; 95% CI: 84–94%), CAO + P (72%; 95% CI: 65–78%). Eradication rates were higher with CAO + S than CAO + P in PP and ITT (P = 0.03, P = 0.04 respectively). No differences were demonstrated between the two groups concerning compliance or adverse effects. Conclusion In this randomised clinical trial simvastatin as adjuvant to standard therapy improves significantly the H. pylori eradication rate.

Toxoplasma infection is one of the most common human parasitic diseases. During 2018-2020, in the rural areas of three districts of Pakistan, we surveyed a total of 451 animals, belonging to different asymptomatic ruminant species, to determine the prevalence of Toxoplasma gondii antibodies. We used ELISA assay as well as recorded some associated risk factors contributing to its transmission. IgM antibodies were detected in 17% and IgG in 13.4% of ruminant samples with the highest percentage, 10% for IgM and 8.6% for IgG in sheep. A strong significant association was found between antibodies and different species (IgM, χ 2 = 29 .280, P = .000 , and IgG, χ 2 = 22.580 , P = .000 ), respectively. Infection with T. gondii seems mainly associated with different geographic features and the presence of cats in the environment, low hygiene water systems and livestock that are mostly dependent on outdoor drinking and grazing. There was no significant association between IgM and age grouping ( χ 2 = 6.660 , P = 0.840 nor for IgG ( χ 2 = 8.136 , P = 0.43 ). The results of this study may be considered the starting point to promote the awareness about parasitic infections in ruminants in Pakistan in order to prevent this infection from further spreading.

BACKGROUND: In women with a bad obstetric history (BOH), infection is an established cause of recurrent fetal loss. A common infecting agent is the protozoan parasite Toxoplasma gondii (T. gondii). The aim of this study was to measure the prevalence of toxoplasmosis in women with recurrent fetal loss from the Khyber Pakhtunkhwa province of Pakistan. METHODS: The study included 360 females aged 16–40 years, of which 180 had a bad obstetric history (study group) and the other 180 had no such history (control group). Blood serum samples were tested for toxoplasma IgM antibodies by Enzyme Linked Immunosorbent Assay and for toxoplasma IgG antibodies using an Immunochromatographic technique. RESULTS: The overall seroprevalence of toxoplasma infection in study group females was 40.6% and in control group females it was 7.2%. Specifically, IgM prevalence was 12.8% in the study group and 1.1% in the control group. IgG prevalence was 23.9% in the study group and 6.1% in the control group. IgM and IgG combined prevalence was 3.9% in the study group cases. There is a statistically significant association between BOH and seropositivity for T. gondii (p < 0.0001, Chi square test). Various risk factors associated with T. gondii seroprevalence in study and control groups were analyzed. CONCLUSION: The seroprevalence of toxoplasmosis was significantly higher in women with a bad obstetric history compared to those with no such history. Associated risk factors had no significant effects on the results.