The relationship between sydney classification and first line treatment in helicobacter pylori gastritis

YÖK Tez No: 489986Giriş: Ülkemizde prevalansı yaklaşık %85 olan Helicobacter pylori (H. pylori), peptik ülserden gastrik kansere uzanan geniş bir hastalık yelpazesinden sorumlu tutulmaktadır. H. pylori eradikasyonunda kullanılan farklı tedavi yöntemleri mevcut olmakla birlikte kullanım kolaylığı ve ulaşılabilirliği nedeniyle standart üçlü tedavi halen birçok bölgede birinci basamak tedavide yer almaktadır. H. pylori'nin neden olduğu intestinal metaplazi (İM) prekanseröz lezyon olduğundan, varlığında eradikasyon tedavisi gerektiren bir durumdur. Çalışmamızda İM varlığının, H. pylori pozitif hastalarda standart üçlü tedavinin başarısı üzerine etkisini araştırmayı amaçladık. Yöntem ve Gereçler: Ocak 2014 - Aralık 2016 tarihleri arasında Düzce Üniversitesi Tıp Fakültesi Gastroenteroloji ve İstanbul Özel Avrasya Hastanesi Genel Cerrahi polikliniklerine başvuran özofagogastroduodenoskopi işlemi sırasında alınan biyopsi sonucu H. pylori pozitif gastrit saptanmış ve birinci basamak tedavi uygulanmış hastalar retrospektif olarak incelenmiştir. Hastaların biyopsi materyalleri Sydney sınıflamasına göre kronik enflamasyon, glandüler atrofi, nötrofil aktivasyonu ve İM açısından değerlendirilmiştir. H. pylori pozitif saptanan tüm hastalara pantoprazol 1 g bid, amoksisilin 1 g bid ve klaritromisin 500 mg bid ile 14 günlük tedavi başlanmıştır. Tedavi bitiminden 15 gün sonra hastalardan kontrol gastroskopi ile biyopsi alınarak veya fekal H. pylori antijen testi bakılarak H. pylori eradikasyon başarısı değerlendirilmiştir. Bulgular: Çalışmaya alınan 181 hastanın yaş ortalaması 55.5±7.8 ve %52'si kadın idi. Kronik enflamasyonun şiddetli olduğu vakalarda, H. pylori eradikasyon tedavisinin başarı oranının düşük olduğu (p=0.001) tespit edildi. Nötrofil infiltrasyon aktivitesi saptanmayanlarda başarı oranı anlamlı düzeyde yüksek bulundu (p=0.009). Glandüler atrofi şiddeti ve İM şiddeti (p=0.390) ile H. pylori eradikasyon tedavisinin başarı (p=0.812) oranı arasında bir ilişki olmadığı görüldü. İM şiddeti arttıkça H. pylori yoğunluğunun azaldığı tespit edildi (p=0.019). Sonuç: Çalışmamızda glandüler atrofi ve İM'nin H. pylori eradikasyon tedavi başarısı üzerinde anlamlı bir etkisi olmadığı görülmüştür. İM şiddeti arttıkça değişen hücre yapısına ikincil H. pylori'nin kendine uygun yaşam ortamı sağlayamaması, metaplaziye uğramış alanlarda H. pylori yoğunluğunun düşük saptanmasına neden olmaktadır. İM şiddeti arttıkça H. pylori yoğunluğunun anlamlı olarak azalması ise şiddetli İM saptanan vakalarda tedavi başarısının etkilenmemesinin nedeni olarak düşünülmüştür.Introduction: Helicobacter pylori (H. pylori), with a prevalence of approximately 85% in our country, is responsible for a wide spectrum of diseases ranging from peptic ulcer to gastric cancer. Although different treatment regimens are available for H. pylori eradication, standard triple therapy is currently being used as first-line eradication in many areas due to ease of use and accessibility. Intestinal metaplasia (IM) caused by H. pylori, is a precancerous lesion that requires eradication therapy. Herein, we aimed to investigate the effect of IM on standard triple therapy success in H. pylori positive patients. Materials and Method: The patients who referred to Düzce University Medical Faculty Gastroenterology Clinic and Avrasya Hospital General Surgery Clinic between January 2014 and December 2016, diagnosed with H. pylori positive gastritis after analysis of the biopsy specimen obtained during esophagogastroduodenoscopy and underwent first-line eradication therapy, were evaluated retrospectively. Biopsy specimens of patients were evaluated for the presence of chronic inflammation, glandular atrophy, neutrophil activation and IM according to the updated Sydney system. All patients diagnosed with H. pylori started treatment with pantoprazole 1g bid, amoxicillin 1g bid and clarithromycin 500 mg bid for 14 days. Patients were evaluated for H. pylori eradication success by gastric biopsy or fecal H. pylori antigen test 15 days after the treatment ends. Results: The mean age of the 181 patients included in the study was 55.5 ± 7.8 and 52% were female. The success rate of H. pylori eradication was found to be low in severe chronic inflammation (p=0.001). While the success rate was found to be high among patients with no neutrophil activity (p=0.009), there was no correlation between glandular atrophy severity and IM severity and H. pylori eradication success rate (p=0.390 and p=0.812). As the intensity of IM increased, H. pylori intensity was found to be decreased (p=0.019). Discussion: We found that glandular atrophy and IM do not have a significant effect on H. pylori eradication success. As the intensity of IM increases, H. pylori cannot provide a suitable living environment for itself secondary to altered cell structure, leading to a low H. pylori density in areas with metaplasia. The significant decrease in H. pylori intensity as the severity of IM increases is considered the reason for the irresponsiveness of H. pylori eradication treatment in severe IM

New treatment strategies for hepatitis c infection

WOS: 000439204000006PubMed: 26301052Hepatitis C infection can lead to cirrhosis and hepatocellular carcinoma and it is an important cause of mortality and morbidity. Achieving a sustained virological response has been the major aim for decades. Interferon treatment was the primarily developed therapy against the infection. Addition of the guanosine analog ribavirin to stop viral RNA synthesis increased the response rates as well as the adverse effects of the treatment. The increasing demands for alternative regimens led to the development of direct-acting antivirals (DAAs). The approval of sofosbuvir and simeprevir signaled a new era of antiviral treatment for hepatitis C infection. Although the majority of studies have been performed with DAAs in combination with interferon and resulted in a decrease in treatment duration and increase in response rates, the response rates achieved with interferon-free regimens provided hope for patients ineligible for therapy with interferon. Most DAA studies are in phase. leading to phase.. In the near future more DAAs are expected to be approved. The main disadvantage of the therapy remains the cost of the drugs. Here, we focus on new treatment strategies for hepatitis C infection as well as agents targeting hepatitis C virus replication that are in clinical development

Safe and Successful Treatment With Agalsidase Beta During Pregnancy in Fabry Disease

WOS: 000363832600010PubMed: 26338166Fabry disease, an X-linked lysosomal storage disorder, is caused by alpha-galactosidase A deficiency and leads to accumulation of glycospinhgolipids in most tissues, with life-theratening consequences in the kidney, heart, and cerebrovascular system. Enzyme replacement therapy is available as 2 different preparations: agalsidase alfa and agalsidase beta. Enzyme replacement therapy is started as soon as the diagnosis is confirmed, but there is no data available in the literature about its safety during preganacy. Herein, we described 2 patients with Fabry disease who received agalsidase beta during their pregnancy. This report is important as the data about enzyme replacement therapy during pregnancy is restricted with case reports

LITHIUM-INDUCED NEPHROGENIC DIABETES INSIPIDUS RESPONSIVE TO DESMOPRESSIN

WOS: 000485206400020PubMed: 31508188Nephrogenic diabetes insipidus (NDI) is the most common renal side effect seen with lithium therapy. Persisting cases after the cessation of the therapy may be seen when lithium therapy is continued for too long. Although desmopressin treatment is not one of the accepted treatment modalities for NDI, there are few reports using desmopressin treatment in unresponsive cases. Herein, we reported the fourth lithium-induced NDI case in the literature responsive to desmopressin therapy

Malignant pleural mesothelioma with rarely seen metastases

Malignant mesothelioma, primarily located in the pleura, is a locally aggressive tumor. Distant metastases are rarely seen and mostly diagnosed postmortem. We present the third malignant pleural mesothelioma (MPM) case in the literature with bone marrow metastasis. A 36-year-old male patient presented with pain at the right mediastinal area and 5 × 6cm mass on the right side of his chest. 18-FDG positron emission tomography (PET) scan showed local uptake at the pleura, regional lymph nodes and 5th rib. The tru-cut biopsy reported as sarcomatoid type MPM. Cisplatin-pemetrexed therapy was planned. His medical condition deteriorated after 2 months and multiple metastases to brain, liver, adrenal glands and bone marrow were detected. The patient was lost 4 months after he was diagnosed. Brain and bone marrow metastasis of MPM are rarely seen. Physicians should be careful about the rapid progression and unexpected metastases of MPM

Severe Acidemia, Leukocytosis and Low Hematocrit Levels at Admission as Mortality Predictors of Elderly Intensive Care Unit Patients

WOS: 000500544100003Aim: Rapid prediction of prognosis is helpful in reflecting the disease severity and patient mortality. This is especially important in critically ill elderly patients who have high mortality risk. This study aimed to investigate the effects of admission laboratory results and medical histories on the prediction of prognosis in critically ill elderly patients. Material and Methods: Patients who were >= 65 years and admitted to a medical intensive care unit (ICU) between 2011 and 2013 were retrospectively analyzed. Results: The study included 449 patients and mortality rate was 47.4%. Nonsurvivors had lower pH, HCO3 and albumin levels, and lower hematocrit and platelet counts, but higher aspartate aminotransferase, alanine aminotransferase, C-reactive protein (CRP), creatinine, phosphorus, magnesium and bilirubin levels, and higher leukocyte count than survivors. The rates of chronic kidney disease, being in a bedridden state and having cardiopulmonary resuscitation (CPR) before ICU admission were significantly high in nonsurvivors. Multivariate analysis showed that pH <7.20, albumin <= 2 gr/dL, low hematocrit and high CRP levels, high leukocyte count, bedridden state, and CPR were mortality predictors. After including the admission diagnoses and endotracheal intubation into the model, pH <7.20 (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.59-11.70), albumin <= 2 gr/dL (OR, 3.61; 95% CI, 0.99-13.03), hematocrit level (OR, 0.94; 95% CI, 0.91-0.99) and leukocyte count (OR 1.06; 95% CI, 1.01-1.11) retained their prognostic importance for mortality. Conclusions: Severe acidemia, low albumin and hematocrit levels, and high leukocyte count at admission help clinicians to foresee the prognosis in severely ill elderly patients. They keep their importance even in the presence of other fundamental mortality predictors

Comparing the efficacy of regorafenib and 5-fluorouracil-based rechallenge chemotherapy in the third-line treatment of metastatic colorectal cancer

Abstract Background The optimal treatment for metastatic colorectal cancer (mCRC) after the second line is still controversial. Regorafenib has been the standard of care in this setting as it improved overall survival (OS) compared to placebo. In real-world practice chemotherapy rechallenge is also a preferred option even though supporting evidence is not enough. We aim to compare the efficacy of regorafenib and 5-fluorouracil-based (5-FU) rechallenge treatment in the third line setting of mCRC. Methods In this retrospective multi-institutional trial, mCRC patients from 21 oncology centers who progressed after 2 lines of chemotherapy were analyzed. Patients who were treated with regorafenib or rechallenge therapy in the third-line setting were eligible. Rechallenge chemotherapy was identified as the re-use of the 5-FU based regimen which was administered in one of the previous treatment lines. OS, disease control rate (DCR), progression free survival (PFS) and toxicity were analyzed. Results Three hundred ninety-four mCRC patients were included in the study. 128 (32.5%) were in the rechallenge, and 266 (67.5%) were in the regorafenib group. Median PFS was 5.82 months in rechallenge and 4 months in regorafenib arms (hazard ratio:1.45,95% CI, p = 0.167). DCR was higher in the rechallenge group than regorafenib (77% vs 49.5%, respectively, p =  < 0.001). Median OS after the third-line treatment was 11.99 (95% CI, 9.49–14.49) and 8.08 months (95% CI, 6.88–9.29) for rechallenge and regorafenib groups, respectively (hazard ratio:1.51, 95% CI, p < 0.001). More adverse effects and discontinuation were seen with regorafenib treatment. Conclusion Our study revealed that higher disease control and OS rates were achieved with rechallenge treatment compared to regorafenib, especially in patients who achieved disease control in one of the first two lines of therapy

PROPSEA, safety evaluation of palbociclib and ribociclib in older patients with breast cancer: A prospective real-world TOG study

Introduction: In this study, the toxicities and management of palbociclib and ribociclib in older patients (≥65 years) with metastatic breast cancer patients were investigated. Materials and Methods: Among older patients receiving palbociclib and ribociclib, Geriatric 8 (G8) and Groningen Frailty Index were used to evaluate frailty status. Dose modifications, drug withdrawal and other serious adverse events (SAEs) were recorded and analyzed according to baseline patient characteristics. Results: A total of 160 patients from 28 centers in Turkey were included (palbociclib = 76, ribociclib = 84). Forty-three patients were ≥ 75 years of age. The most common cause of first dose modification was neutropenia for both drugs (97% palbociclib, 69% ribociclib). Liver function tests elevation (10%) and renal function impairment (6%) were also causes for ribociclib dose modification. Drug withdrawal rate was 3.9% for palbociclib and 6% for ribociclib. SAEs were seen in 11.8% of those taking palbociclib and 15.5% of those on riboclib. An ECOG performance status of ≥2 and being older than 75 years were associated with dose reductions. Severe neutropenia was more common in patients with non-bone-only metastatic disease, those receiving treatment third-line therapy or higher, coexistance of non-neutropenic hematological side effects (for ribociclib). Neutropenia was less common among patients with obesity. Discussion: Our results show that it can be reasonable to start palbociclib and ribociclib at reduced dose in patients aged ≥75 years and/or with an ECOG performance status ≥2