EFFICACY AND SAFETY OF GEMIFLOXACIN CONTAINING TREATMENT REGIMEN IN FIRST-LINE TREATMENT OF HELICOBACTER PYLORI.

•In eradication treatment of H. pylori gemifloxacin containing triple treatment regimen was as effective as bismuth containing quadruple treatment. •Drug adverse effects were fewer and milder in the gemifloxacin group. •Since treatment period was shorter and pills to be taken were fewer compared to quadruple treatment, patient compliance was significantly higher in the gemifloxacin group. Background - After eradication of Helicobacter pylori (H. pylori) chronic gastritis will resolve, complications due to H. pylori infection and recurrence of infection will be prevented. Objective - To determine efficacy and safety of gemifloxacin containing treatment regimen in first line treatment of H. pylori with comparison to bismuth containing quadruple therapy. Methods - This retrospective study was conducted in a tertiary care university hospital between January 2018 and January 2021 with 410 participants who were diagnosed to have H. pylori infection with biopsies obtained during upper gastrointestinal system endoscopy. Patients were distributed into two groups according to their first-line treatment regimens. First group patients were treated with amoxicillin, gemifloxacin and pantoprazole and second group patients were treated with amoxicillin, metronidazole, bismuth subcitrate and pantoprazole for seven days. Results - Intention to treat and per protocol ratios for gemifloxacin containing regimen were 90.0% and 91.2%, while quadruple treatment has these ratios as 91.7% and 93.8% respectively. Treatment success rate in both regimens were similar. But adverse effects were lower and patient compliance were better in patients who had gemifloxacin containing treatment (P<0.001). Conclusion - Gemifloxacin containing treatment regimen is as effective as bismuth containing quadruple treatment regimen for H. pylori infection and patient compliance is better in this group. Gemifloxacin containing treatment regimens may be novel and effective alternatives for eradication of H. pylori infection.

Efetividade e segurança do regime de tratamento contendo gemifloxacino no tratamento de primeira linha para Helicobacter pylori / Efficacy and safety of gemifloxacin containing treatment regimen in first-line treatment of helicobacter pylori

ABSTRACT Background: After eradication of Helicobacter pylori (H. pylori) chronic gastritis will resolve, complications due to H. pylori infection and recurrence of infection will be prevented. Objective: To determine efficacy and safety of gemifloxacin containing treatment regimen in first line treatment of H. pylori with comparison to bismuth containing quadruple therapy. Methods: This retrospective study was conducted in a tertiary care university hospital between January 2018 and January 2021 with 410 participants who were diagnosed to have H. pylori infection with biopsies obtained during upper gastrointestinal system endoscopy. Patients were distributed into two groups according to their first-line treatment regimens. First group patients were treated with amoxicillin, gemifloxacin and pantoprazole and second group patients were treated with amoxicillin, metronidazole, bismuth subcitrate and pantoprazole for seven days. Results: Intention to treat and per protocol ratios for gemifloxacin containing regimen were 90.0% and 91.2%, while quadruple treatment has these ratios as 91.7% and 93.8% respectively. Treatment success rate in both regimens were similar. But adverse effects were lower and patient compliance were better in patients who had gemifloxacin containing treatment (P<0.001). Conclusion: Gemifloxacin containing treatment regimen is as effective as bismuth containing quadruple treatment regimen for H. pylori infection and patient compliance is better in this group. Gemifloxacin containing treatment regimens may be novel and effective alternatives for eradication of H. pylori infection.

RESUMO Contexto: Após a erradicação do Helicobacter pylori (HP), a gastrite crônica será resolvida, as complicações devido à infecção por HP e a recorrência da infecção serão prevenidas. Objetivo: Determinar a eficácia e segurança do regime de tratamento contendo gemifloxacino no tratamento de primeira linha do HP, em comparação com a terapia quádrupla contendo bismuto. Métodos: Este estudo prospectivo foi conduzido em um hospital universitário de atendimento terciário entre janeiro de 2018 e janeiro de 2021, com 410 participantes diagnosticados com infecção por HP, obtidos por meio de biópsias durante a endoscopia do sistema gastrointestinal superior. Os pacientes foram divididos em dois grupos de acordo com seus regimes de tratamento de primeira linha. Os pacientes do primeiro grupo foram tratados com amoxicilina, gemifloxacino e pantoprazol, e os pacientes do segundo grupo foram tratados com amoxicilina, metronidazol, subcitrato de bismuto e pantoprazol por 7 dias. Resultados: As taxas de intenção de tratar e por protocolo para o regime contendo gemifloxacino foram de 90,0% e 91,2%, enquanto o tratamento quádruplo apresentou essas taxas como 91,7% e 93,8%, respectivamente. A taxa de sucesso do tratamento em ambos os regimes foi similar. No entanto, os efeitos adversos foram menores e a adesão dos pacientes foi melhor nos que receberam o tratamento contendo gemifloxacino (P<0,001). Conclusão: O regime de tratamento contendo gemifloxacino é tão eficaz quanto o regime de tratamento quádruplo contendo bismuto para a infecção por HP, e a adesão dos pacientes é melhor neste grupo. Os regimes de tratamento contendo gemifloxacino podem ser alternativas novas e eficazes para a erradicação da infecção por HP.

Readmission rates of patients with COVID-19 after hospital discharge.

OBJECTIVE: The purpose of this study was to inspect return and readmission reasons and rates of discharged patients with coronavirus disease 2019 (COVID-19). METHODS: This is an observational descriptive retrospective study that was conducted with patients who had confirmed COVID-19 diagnosed with severe respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction (PCR) and hospitalized between April 2020 and June 2021 in a tertiary care university hospital. Patients returning to the hospital after treatment for COVID-19, with symptoms related to COVID-19 within 30 days, were included. Patients under 18 years of age and who were hospitalized in the intensive care unit were excluded. RESULTS: It was determined that of 369 discharged patients, 87 (23.5%) returned to the hospital, 9 (2.4%) were readmitted, and 1 (0.02%) was deceased within 30 days. The most frequent reasons for returning to the hospital were dyspnea and cough complaints. Existence of pneumonia at first admission, levels of aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, D-dimer, neutrophil counts, lymphocyte counts, and neutrophil-to-lymphocyte count ratios were found to be higher in patients who returned to hospital, compared with the patients who did not return. CONCLUSIONS: Return rate of patients to hospital after discharge with COVID-19 was comparatively high, but readmissions to hospital and mortality rate were low. Comparatively, the higher rate of return to hospital within 30 days of discharge was thought to be resulting from prolonged signs and symptoms related to COVID-19. Since COVID-19 is a new and enigmatic disease and its long-term effects still need to be elucidated, long-term follow-ups of discharged patients will be adequate.

Vitamin D Replacement Effect on Platelet Counts.

OBJECTIVE: To determine the effect of vitamin D treatment on platelet counts according to age groups in patients with vitamin D deficiency. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Outpatient Clinics, Department of Internal Medicine, Faculty of Medicine, Lokman Hekim University Hospital, Ankara, Turkey from January 1st to December 31st, 2020. METHODOLOGY: A total of 1,230 participants, who were treated for vitamin D deficiency after admission to hospital for various reasons, were enrolled. Patients under 18 years of age, having chronic diseases, using medicines affecting platelets and who had 25-hydroxyvitamin D levels above 74.88 nmol/L were excluded from study. Participants were divided into three groups according to ages: 18 to 30 (Group 1), 30 to 50 (Group 2), and greater than 50 years (Group 3). Complete blood count parameters and vitamin D level data before and after vitamin D replacement treatment were compared. RESULTS: Platelet counts and mean platelet volume levels were found to be significantly lower in participants after vitamin D treatment. Changes in hemoglobin and neutrophil counts were insignificant. Although there was no difference between mean platelet counts and age groups before treatment, significant differences were noted after vitamin D treatment (p=0.004). Correlation between vitamin D levels and changes in platelet levels compared to treatment beginning was found to be significant (r=-0.159, p<0.001). CONCLUSION: Vitamin D treatment lowered platelet counts. This may be beneficial in medical conditions such as essential thrombocythemia in which platelet counts are higher than normal, and may help decrease platelet counts. Key Words: Complete blood count, Blood platelet count, Vitamin D.

Successful treatment of amiodarone-induced hepatic injury with n-acetylcysteine: A case report.

Intravenous amiodarone treatment may cause hepatic toxicity. N-acetylcysteine (NAC) is a powerful antioxidant, reduces the level of free radicals by increasing glutathione levels, and is used in acetaminophen intoxication. An 83-year-old female Caucasian patient who had congestive heart failure and implantable cardioverter-defibrillator was admitted to the hospital with palpitations and confusion. After analysis of ICD device, ventricular tachycardia, ventricular fibrillation runs of patient and intervention of ICD device with electric shocks were noticed. Intravenous 1200 mg amiodarone infusion was administered as treatment. Later, her transaminase levels increased dramatically. Hepatic injury due to intravenous administration of amiodarone was diagnosed and 1200 mg/day intravenous NAC was given. After 72 h of NAC treatment, hepatic enzymes were found to be recovering. After parenteral amiodarone administration, patients must be monitored for acute hepatotoxicity. This article accentuates the benefits of NAC treatment in drug-induced liver injury.

The association of oxygen saturation, tomography findings and D-dimer levels in coronavirus disease 2019 patients.

: Coronavirus disease is a highly contagious disease caused by systemic acute respiratory syndrome coronavirus 2 with high mortality rates. We aimed to evaluate the relationship between serum D-dimer levels and tomography findings at the time of admission in patients diagnosed with coronavirus disease 2019 (COVID-19). This study included 94 patients, 48 women (51%) and 46 men (49%), diagnosed by PCR method. Patients without any suspicious findings on thorax tomography and having oxygen saturation above 90% at the time of presentation were included as the first group. Patients with suspicious tomography findings but having oxygen saturation above 90% were designed as the second group, and patients with both suspicious tomography findings for COVID-19 and low oxygen saturation levels (<90%) at the time of admission were taken as the third group. Patients with oxygen desaturation were significantly older than the patients with normal oxygen saturations (P = 0.001). Patients with thorax tomography findings were having significantly higher D-dimer levels (P = 0.001). Patients with oxygen desaturation were having significantly higher D-dimer levels than the patients with normal oxygen saturations (P = 0.001). There was a significant negative correlation between oxygen saturation and D-dimer levels in all patients with and without tomography findings (r = -0.301, P = 0.016). Similarly, there was a significant positive correlation between the oxygen saturation and the lymphocyte count (r = 0.300, P < 0.017). Thorax tomography and D-dimer levels significantly correlate in patients with suspected COVID-19 admission. It should be kept in mind that patients with low oxygen saturation and high D-dimer levels may have serious lung involvement.