Whole-genome sequencing of Helicobacter pylori isolates from Native American gastric biopsy specimens.

Helicobacter pylori infection has been linked to gastrointestinal diseases including gastric cancer. High rates of H. pylori infection and gastric cancer have been reported in indigenous populations within the United States. We report whole-genome sequencing of three H. pylori isolates originating from Native American patients presenting with gastric disease.

Antibiotic Resistance Rates for Helicobacter pylori in Rural Arizona: A Molecular-Based Study.

Helicobacter pylori (H. pylori) is a common bacterial infection linked to gastric malignancies. While H. pylori infection and gastric cancer rates are decreasing, antibiotic resistance varies greatly by community. Little is known about resistance rates among rural Indigenous populations in the United States. From 2018 to 2021, 396 endoscopy patients were recruited from a Northern Arizona clinic, where community H. pylori prevalence is near 60%. Gastric biopsy samples positive for H. pylori (n = 67) were sequenced for clarithromycin- and metronidazole-associated mutations, 23S ribosomal RNA (23S), and oxygen-insensitive NADPH nitroreductase (rdxA) regions. Medical record data were extracted for endoscopic findings and prior H. pylori history. Data analysis was restricted to individuals with no history of H. pylori infection. Of 49 individuals, representing 64 samples which amplified in the 23S region, a clarithromycin-associated mutation was present in 38.8%, with T2182C being the most common mutation at 90%. While the prevalence of metronidazole-resistance-associated mutations was higher at 93.9%, the mutations were more variable, with D95N being the most common followed by L62V. No statistically significant sex differences were observed for either antibiotic. Given the risk of treatment failure with antibiotic resistance, there is a need to consider resistance profile during treatment selection. The resistance rates in this population of American Indian patients undergoing endoscopy are similar to other high-risk populations. This is concerning given the high H. pylori prevalence and low rates of resistance testing in clinical settings. The mutations reported are associated with antibiotic resistance, but clinical resistance must be confirmed.

Hospice use before death: variability across cancer diagnoses.

BACKGROUND: There is little information available about patterns of hospice use before death for patients with a diagnosis of cancer. OBJECTIVE: To examine whether rates of hospice use before death are different for persons dying of specific cancers or vary across age, sex, or racial groups. METHODS: Information about cause-specific hospice use received by elderly Medicare beneficiaries was obtained from Medicare hospice administrative (claims) data. Information regarding cause-specific numbers of deaths was obtained from the National Center for Health Statistics. Rates of hospice use were calculated using direct standardization adjusted for age, sex, and race. Length of stay in a hospice was calculated as the median number of days between entry into the hospice and death. RESULTS: Rates of hospice use before death ranged from 42.0 hospice users per 100 deaths for breast cancer to 48.1 hospice users per 100 deaths for pancreatic cancer. Across all cancers, blacks received approximately 82% of the hospice use as nonblacks. Men entered hospices at almost the same rate as women (overall male-to-female ratio = 0.97). Median length of stay in a hospice ranged from 21 to 27 days. CONCLUSIONS: A great deal of consistency was observed regarding hospice-use rates across cancer diagnoses. This consistency is greater than might be expected given differences in prognosis across cancers. The results suggest that there may be greater than previously predicted consistency across end-stage cancer patients in the ability to determine prognosis or patient preferences for hospice services.