Pattern of Primary Resistance of Helicobacter pylori to Clarithromycin among Pediatric Patients from North-Eastern Romania.

BACKGROUND: Helicobacter pylori antibiotic resistance has increased worldwide and affects the effectiveness of current therapies. The recommended first-line empiric treatment should be tailored to the local clarithromycin resistance rate. This study aimed to determine the pediatric patient profile and rate of clarithromycin resistance for patients diagnosed with Helicobacter pylori by gastric biopsy. METHODS: We studied 84 positive gastric samples for Helicobacter pylori. Positive results were confirmed by a rapid urease test and histopathological examination, with the type of gastritis established according to the Sydney System. Gastric biopsy samples were stored in RNA saver. Clarithromycin resistance was determined by a real-time polymerase chain reaction-based molecular assay after RNA-DNA extraction. RESULTS: Of the 84 biopsy samples analyzed, 35 (41.6%) were resistant to clarithromycin. Clarithromycin resistance was found mainly in girls (80%) with a mean age of 15 years (range 6-17 years). The history of prior exposure to clarithromycin was 91.6%. The concordance between the histopathological examination and the PCR test was 100%. CONCLUSIONS: One in 2.4 children infected with Helicobacter pylori had a strain resistant to clarithromycin. This resistant strain may be a reason for treatment failure in Romanian children, yet this is uninvestigated. The high rate of bacterial resistance to this antibiotic among children indicates the need for susceptibility testing before therapy.

The Effectiveness of Different Eradication Schemes for Pediatric Helicobacter pylori Infection-A Single-Center Comparative Study from Romania.

INTRODUCTION: In Romania, studies on the pediatric population regarding H. pylori infection or bacterial resistance to antibiotics are limited. Eradication treatment of this infection still raises important problems in medical practice. This study aims to compare the effectiveness of three eradication therapies used against H. pylori infection in the pediatric population. METHODS: The prospective study enrolled children aged 6-17 years who were first diagnosed with H. pylori infection. Patients received a randomized treatment either the therapy with clarithromycin (CLR), the therapy with metronidazole (MTZ) or sequential therapy. The effectiveness of the eradication treatment was evaluated after 4-8 weeks from the end of the therapy by testing fecal antigen. RESULTS: 149 patients were enrolled over 18 months. The eradication rates were 49.5% for the treatment scheme with proton pump inhibitor (PPI) + amoxicillin (AMO) + MTZ, 26.7% for PPI + AMO + CLR and 23.8% for sequential therapy. MTZ therapy was superior to CLR therapy, but sequential therapy was not. Side effects were recorded for PPI + AMO + CLR with 39.6%, followed by sequential therapy 37.7%, and only 22.6% for PPI + AMO + MTZ. CONCLUSIONS: Therapy with MTZ can achieve a higher eradication rate as a first-line treatment in the case of H. pylori infection. Taking into account that Romania is in an area with increased resistance to CLR, MTZ therapy could be a promising alternative.

Helicobacter pylori Infection in a Pediatric Population from Romania: Risk Factors, Clinical and Endoscopic Features and Treatment Compliance.

Background and Objectives: The aim of this study was to investigate the association between H. pylori positivity with specific symptoms, risk factors and endoscopic patterns among the pediatric population in northeastern Romania. Materials and Methods: A prospective study was performed in 18 months on 185 children aged 6−18 years with an indication for upper digestive endoscopy. Demographic, anamnestic, symptomatic, endoscopic and histologic data were recorded. Results: Of 116 H. pylori-positive children, the most affected group was 15−17 years. Most (65.5%) of them were girls, with a significant association (p < 0.001). The majority (66.4%) lived in a rural area and 47.4% of children had an unsafe source of water and lived in overcrowded houses with no basic sanitary comfort. The most frequent symptom was epigastric pain (56.9%), and the main endoscopic appearance was nodularity and hyperemia. Patients diagnosed with H. pylori started triple-therapy treatment for 14 days. Only 13.8% stopped the treatment, mainly because of a misunderstanding of the treatment protocol (9.5%). Conclusions: Romanian teen girls living in rural areas are at high risk for H. pylori infection. Epigastric pain and endoscopic nodularity of the gastric mucosa were associated with the infection. As the resistance of the bacteria is unknown in our country, future research is needed in order to improve the eradication rate.

Oxidative stress in severe pulmonary trauma in critical ill patients. Antioxidant therapy in patients with multiple trauma--a review.

Multiple trauma patients require extremely good management and thus, the trauma team needs to be prepared and to be up to date with the new standards of intensive therapy. Oxidative stress and free radicals represent an extremely aggressive factor to cells, having a direct consequence upon the severity of lung inflammation. Pulmonary tissue is damaged by oxidative stress, leading to biosynthesis of mediators that exacerbate inflammation modulators. The subsequent inflammation spreads throughout the body, leading most of the time to multiple organ dysfunction and death. In this paper, we briefly present an update of biochemical effects of oxidative stress and free radical damage to the pulmonary tissue in patients in critical condition in the intensive care unit. Also, we would like to present a series of active substances that substantially reduce the aggressiveness of free radicals, increasing the chances of survival.

Influence of antioxidant therapy on the clinical status of multiple trauma patients. A retrospective single center study.

INTRODUCTION: The biochemical processes of bioproduction of free radicals (FR) are significantly increasing in polytrauma patients. Decreased plasma concentrations of antioxidants, correlated with a disturbance of the redox balance are responsible for the installation of the phenomenon called oxidative stress (OS). OS action is associated with a series of secondary complications with direct implications in reducing the rate of survival, as well as in increasing morbidity The objectives of this study were to reveal possible relations between antioxidant therapy and a number of serum biochemical variables (ALT, AST, APPT, LDH, urea, leukocytes, platelets), the length of mechanical ventilation, the time spent in the ICU, and the mortality rate in major trauma patients. MATERIALS AND METHODS: In this retrospective study from a single center, 64 medical files of polytrauma patients admitted to the ICU "Casa Austria" were analysed. The selection criteria were: the Injury Severity Score (ISS) > 16 and a systolic arterial pressure (SAP) < 89 mmHg. The selected patients (n = 34) were divided into two groups: Antiox group, 20 patients who benefited from antioxidant therapy and the Contr group, 14 patients who did not received antioxidant therapy and served as a control group. The antioxidant therapy consisted of the simultaneous administration of vitamin C (i.v.), vitamin B1 (i.v.) and N-acetylcysteine (i.v.). The clinical and the biological evaluation were performed repeatedly until discharge from the ICU or the death of the patient. RESULTS: No significant differences were highlighted concerning the demographic data, the magnitude or the trauma mechanism between the two groups. In comparison with patients from the Contr group, the patients submitted to antioxidant therapy showed lower values after the treatment for leukocytes (p = 0.0066), urea (p = 0.0076), LDH (p = 0.0238), AST (p = 0.0070) and ALT (p < 0.0001). No statistically significant differences were evidenced regarding the incidence of sepsis or the development of multiple organ dysfunction syndrome (MODS). The period of mechanical ventilation was longer in patients from the Contr group (p = 0.0498), with no differences concerning the ICU length of stay (p = 0.7313). The mortality rate was lower in the Contr group (p = 0.0475). CONCLUSION: In multiple trauma patients a prolonged antioxidant therapy improved the posttraumatic laboratory tests.

Oxidative stress and antioxidant therapy in traumatic spinal cord injuries.

Spinal cord injury (SCI) is often accompanied by motor, vegetative and sensitive dysfunctions that can significantly decrease the chance of the complete recovery of the patients. The pathophysiological implication of these dysfunctions is represented by the increased production of the reactive species that are extremely aggressive to the surrounding tissue. The combination of massive production of free radicals, low concentration of antioxidants and the hypermetabolism present in patients with SCI leads to enhancement of the oxidative stress. Current studies are focused on several biological active compounds that are able to reduce the effects of free radicals - tissue necrosis, inflammation, infection, apoptosis. In this paper, the mechanism of the action of several biological active compounds that are able to significantly reduce oxidative stress in critical patients with spinal cord injury is presented.