Alternative eradication regimens for Helicobacter pylori infection in Indonesian regions with high metronidazole and levofloxacin resistance

Background: The prevalence of Helicobacter pylori resistance to metronidazole and clarithromycin is high in Indonesia. Moreover, the increasing levofloxacin resistance rates in the absence of bismuth treatment in Indonesia has led to the use of other antibiotics as alternative regimens. Methods: We determined the minimum inhibitory concentrations (MICs) of five alternative antibiotics for H. pylori (rifaximin, rifabutin, furazolidone, garenoxacin, and sitafloxacin) using the agar dilution method and assessed mutations associated with antibiotic resistance using next-generation sequencing. Result: Analysis of 106 strains isolated from 1039 adult dyspeptic patients revealed that none of the strains were furazolidone-resistant. All strains were also sensitive to rifabutin and sitafloxacin. In contrast, the rates of resistance to rifaximin and garenoxacin were high (38.9% and 6.7%, respectively). The strains isolated from patients on Java Island had the highest resistance rates to garenoxacin and rifaximin. In addition, the resistance was distributed evenly among the ethnic groups, ranging between 25.0% and 69.2%. Except for rifaximin, for which the resistance rate was 38.9%, the other four antibiotics could be successfully employed to eradicate levofloxacin- and metronidazole-resistant H. pylori infections in vitro. Interestingly, garenoxacin-sensitive strains were found in regions with high clarithromycin resistance rates such as Bali and Papua Islands. In contrast, rifaximin might not be considered as an alternative antibiotic in regions with high clarithromycin resistance. There was an inconsistent association between gyrA and gyrB mutations and garenoxacin resistance. We confirmed that the I837V (replacement of isoleucine at position 837 with valine), A2414T/V, Q2079K and K2068R were the predominant rpoB point mutations. There was an association between vacA genotypes of H. pylori and rifaximin resistance (P = 0.048). Conclusion: furazolidone-, rifabutin-, and sitafloxacin-based therapies might be considered as alternative regimens to eradicate H. pylori in Indonesia, including regions with high metronidazole and clarithromycin resistance rates. Moreover, sitafloxacin but not garenoxacin should be considered for eradication of levofloxacin-resistant strains

Pengaruh Latihan Pasrah Diri Terhadap Perbaikan Fungsi Paru Penderita Penyakit Paru Obstruksi Kronik Dengan Gejala Depresi

Background. Chronic obstructive pulmonary disease (COPD) can casually affect phyisical activity limitation, respiratory muscle impairment, frequent acute exacerbation, emotional and sosial limitation with the result that depression symptoms and reduce in pulmonary function continuously. Latihan pasrah diri (LPD) is a method that combines the relaxation and dzikir (relaxation and repetitive player), where the onset of the relaxation response is expected improve depression symptoms. Objective. To find the effect of change to improvement pulmonary function after conducting Latihan pasrah diri in patients with COPD with depression symptoms. Methods. Pretest and posttest only experimental desing research was conducted in patients with COPD in pulmonary clinic dr. Sardjito Hospital Yogyakarta and BP4 clinic Kota Yogyakarta. Shapiro-Wilk test was tested to evaluate data distribution. Data variable with normal distribution was tested by paired t test. Differences were considered significant if p value <0.05 with 95% confidence intervals. Results. The mean BDI score after 21 days LPD improved significantly (18 (10-37) vs 9.5 (3-30), p <0.001). The mean FEV1 % predicted value after 21 days LPD improved significantly (51.1±16.41% vs 78.40±25.89%, p = 0.001). The mean FVC % predicted value improved significantly after 21 days LPD (47.90±17.34% vs 75.70±23.04%, p <0.001). Conclusion. Latihan pasrah diri 2 times a day in at least 21 consecutive days LPD can improve depression symptoms and pulmonary function in COPD patients with depressive symptomps

CYP2C19 Polymorphisms in Indonesia: Comparison among Ethnicities and the Association with Clinical Outcomes

CYP2C19 polymorphisms are important factors for proton pump inhibitor-based therapy. We examined the CYP2C19 genotypes and analyzed the distribution among ethnicities and clinical outcomes in Indonesia. We employed the polymerase chain reaction-restriction fragment length polymorphism method to determine the CYP2C19 genotypes and evaluated inflammation severity with the updated Sydney system. For CYP2C19*2, 46.4% were the homozygous wild-type allele, 14.5% were the homozygous mutated allele, and 39.2% were the heterozygous allele. For CYP2C19*3, 88.6% were the homozygous wild-type allele, 2.4% were the homozygous mutated allele, and 9.0% were the heterozygous allele. Overall, the prevalence of rapid, intermediate, and poor metabolizers in Indonesia was 38.5, 41.6, and 19.9%, respectively. In the poor metabolizer group, the frequency of allele *2 (78.8%) was higher than the frequency of allele *3 (21.2%). The Papuan had a significantly higher likelihood of possessing poor metabolizers than the Balinese (OR 11.0; P = 0.002). The prevalence of poor metabolizers was lower compared with the rapid and intermediate metabolizers among patients with gastritis and gastroesophageal reflux disease. Intermediate metabolizers had the highest prevalence, followed by rapid metabolizers and poor metabolizers. Dosage adjustment should therefore be considered when administering proton pump inhibitor-based therapy in Indonesia

Macronutrient and micronutrient intake in dietary habits contributed to dyspeptic symptoms in Indonesia

Background: Dyspepsia is a highly prevalent gastrointestinal disorder and assessing the nutrient correlation is important to improve the patient’s dyspepsia. We analyzed the association of the macronutrients and micronutrients with dyspepsia also its correlation to the severity of dyspepsia