Resistance to antibiotics used in the first-line treatment for h.pylori eradication

GİRİŞ VE AMAÇ: Ülkemizde klaritromisin direncinin yıllar içinde belirgin olarak arttığı, bunun sonucunda klasik 3'lü tedavi protokolünün etkinliğinin azaldığı ve H.pylori için eradikasyon başarısının % 60'ların altına dek indiği bilinmektedir. Bu nedenle yerine alternatif olarak önerilen levofloksasinin direnç ve tedavideki etkinliğini araştırmak için bu çalışmayı planladık.HASTALAR VE YÖNTEM: Dokuz Eylül Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı'na Temmuz 2010 - Şubat 2011 arasında 116 hastadan endoskopi sırasında kültür için örnekler alındı. 52 hastadan üreme elde edildi, amoksisilin, klaritromisin, levofloksasin ve için E-test metoduyla duyarlılık testleri çalışıldı. Çalışmamızda, amoksisilin klaritromisin ve levofloksasin için kullanılan MIC değerleri sırasıyla >0.5 µg/ml, ≥1 µg/ml, >1 µg/ml'dir.BULGULAR: 116 hasta içinde 52 hastada kültür üremesi gerçekleşti. Bu 52 hastanın amoksisilin, klaritromisin ve levofloksasin için E-test ile saptanmış olan direnç oranları sırasıyla % 15.4, % 26.9 ve % 25.5, olarak saptandı. SONUÇ: Bu çalışmada amoksisilin direnci % 15.4 olarak bulundu (2 sınırda duyarlılıktaki örnek dirençli kabul edilmediğinde amoksisilin direnci % 11.5 olarak belirtilmelidir). Bu çalışmada saptanan amoksisilin direnci dünya genelinde bildirilen % 0-3'lük oranının çok üzerinde bulundu. Klaritromisin için saptadığımız % 26.9 direnç oranı, EHPSG'un belirlediği, klaritromisinli tedavi için belirlenen sınır direnç değeri olan % 20'nin üzerindedir. Hem amoksisilin hem de klaritromisin için gösterilen yüksek direnç oranları klasik 3'lü tedavi ile neden yeterince başarı sağlayamadığımızı açıklayabilir. Bu çalışmada levofloksasin direnci % 25.5 olarak saptanmıştır. Sonuçta, levofloksasin içeren bir rejim ile de yüksek eradikasyon başarısı sağlanmayabilir. H.pylori için birinci basamak tedavi için başka rejimlerin araştırılması önerilir. Bizim çalışmamıza göre, levofloksasin içeren bir rejimin Türkiye için ideal bir alternatif tedavi olmadığı söylenebilir.INTRODUCTION AND OBJECTIVE: It is well known that the clarithromycin resistance has been increasing in Turkey, consequently the effect of the classical treatment protocol (triple therapy) has decreased and the success of H.Pylori eradication with this treatment has dropped down under 60 %. Therefore, we have planned a research study aiming to investigate the resistance to levofloxacin, which has been suggested as an alternative to the classical treatment protocol, and its effectiveness in treatment. PATIENTS AND METHODS: In Dokuz Eylul University Faculty of Medicine, Department of Gastroenterology, biopsy samples (for culture studies) were taken from 116 patients during endoscopy between June 2010 and February 2011. Rapid Urease Tests were performed on the biopsy samples obtained from 52 patients. Sensitivity tests for amoxicillin, clarithromycin and levofloxacin were conducted with the E-test method. In our studies, the MIC values used for amoxicilin, clarithromycin, and levofloxacin were >0.5 µg/ml, ≥1 µg/ml, and >1 µg/ml, respectively.RESULTS: Cultures were grown from biopsy samples taken from 52 (out of 116) patients. Amoxicillin, levofloxacin and clarithromycin resistances, determined with the E-test method, were found to be 15.4 %, 26.9 % and 25.5 % respectively. CONCLUSION: In this study, amoxicillin resistance was found to be 15.4 %. (If the two samples with intermediate sensitivity are not considered to be "resistant", amoxicillin resistance would be 11.5 %.) This resistance prevalence rate is much higher than the worldwide resistance prevalence of 0-3 %. Clarithromycin resistance was found to be 26.9 %, which is higher than the resistance upper limit of 20 %, determined by EHPSG for clarithromycin treatment. Significantly high amoxicillin and clarithromycin resistance prevalence rates determined in our studies can explain why the success rate of treatment with the classical triple therapy is not satisfactory. In this study, levofloxacin resistance was found to be 25.5 %. Hence, high success rates may not be possible with H.Pylori eradication treatment regimens with levofloxacin, and other regimens for H. Pylori (first step) treatment should be investigated. Based on our results, we can conclude that a regimen with levofloxacin is not an ideal treatment for patients with H.Pylori in Turkey

Falls in Older Women and Men: Associated Factors and Sarcopenia

Objective: Falls are the fifth leading cause of death among the older adults, and most of the risk factors of falls are modifiable. We aimed to investigate the clinical factors associated with falls comprehensively, by evaluating the sarcopenia components separately, in each gender. Materials and Methods: This is a cross-sectional study. Six hundred thirty-three female and 269 male outpatients, underwent a comprehensive geriatric assessment, were included. Falls, in the previous 12 months, were recorded. Geriatric evaluation regarding frailty, depression, nutrition, cognitive functions, and disabilities were done with related scales. SARC-F determined sarcopenia risk, and probable sarcopenia was defined according to handgrip strength. Skeletal muscle mass index and muscle performance were measured by bioimpedance analysis and physical performance tests, including 4-meter gait speed (4-m GS) and timed up and go (TUG) tests, respectively. Results: In the study population 35.2% of female and 30.9% of male patients experienced falls. In multivariate analysis, probable sarcopenia in women [odds ratio (OR): 1.56, p=0.034] and longer TUG test performance in men (OR: 1.06, p=0.020) were independently related to falls. In addition, both in women and men urinary incontinence (OR: 1.62, p=0.016 and OR: 1.95, p=0.045, respectively), sarcopenia risk defined by SARC-F (OR: 2.74, p≤0.001 and OR:4.79, p≤0.001, respectively) and depression (OR: 1.56, p=0.025 and OR: 1.93, p=0.046, respectively) were independently related with falls. Conclusion: Depression, incontinence, and sarcopenia risk were independent associated factors for falls in both genders. SARC-F appears to be effective in both genders in predicting the risk of falls. However, muscle strength in women and muscle performance in men get high impact for the falls

Relationship Between Dysphagia and Sarcopenia with Comprehensive Geriatric Evaluation

Oropharyngeal dysphagia has features of geriatric syndromes and is strongly associated with sarcopenia. In this cross-sectional study, we aimed to evaluate the association between dysphagia and sarcopenia, in a practical way, accompanied by comprehensive geriatric assessment. Dysphagia and sarcopenia were defined by the EAT-10 and SARC-F questionnaires, respectively. Cognition and mood, was evaluated by the Mini-mental State Examination (MMSE) and Geriatric Depression Scale (GDS), respectively. Physical performance was assessed by the Timed up and Go Test (TUG) and muscle strength was determined by Hand Grip Strength (HGS). Functionality was stated by Katz and Lawton Indexes. Serum levels of hemoglobin, triglyceride, albumin, and total cholesterol were recorded. A total of 512 (151 male/361 female) patients age 60 and older were included in the study. Prevalences of dysphagia and sarcopenia were 23% and 40.6%, respectively. In multivariate analysis sarcopenia (OR:2.596, p = 0.008), depressive symptoms (OR:1.115, p < 0.001), and lower KATZ scores (OR:0.810, p = 0.036) were independently related with dysphagia. Dysphagic patients with sarcopenia had lower scores on the Katz and Lawton scales (p < 0.001, r(pb) = 0.380 and p < 0.001, r(pb) = 0.447 respectively) and TUG performances were worse (p = 0.009, r(pb) = - 0.254). Serum hemoglobin and albumin levels were significantly low in dysphagic patients with sarcopenia (p < 0.001, r(pb) = 0.345, p = 0.008, r(pb) = 0.243). Dysphagia is independently associated with sarcopenia, depressive symptoms, and functionality. Dysphagia coexist with sarcopenia is associated with worse clinical consequences than without sarcopenia

Unacceptable Antibiotic Resistance Rates for Helicobacter pylori in Turkey: Something Must Change

Background: It is known that clarithromycin resistance has increased over the years (success rate 60%). The aim of the study was to investigate the importance of regional antimicrobial resistance rates for full accuracy of both diagnosis and treatment of Helicobacter pylori infection

Depression in Frail Older Adults: Associations and Gender Difference

OBJECTIVE. Depression is highly prevalent in frail older adults and both clinical situations share similar clinical and prognostic factors. The aim of this study was to investigate the relationship between frailty and depression by considering each component of frailty, in both genders