Mukerrem Safali

Comparison of sequential and standard triple-drug regimen for Helicobacter pylori eradication: a 14-day, open-label, randomized, prospective, parallel-arm study in adult patients with nonulcer dyspepsia.

BACKGROUND The eradication rates of Helicobacter pylori with standard treatments are decreasing worldwide. OBJECTIVES The primary aim of this study was to compare the eradication success of a 14-day sequential regimen with proton pump inhibitor (PPI)-based triple treatment. The secondary objectives of the study were to evaluate the effect of gastritis score and smoking on eradication rates as well as evaluation of compliance and tolerability of both regimens. METHODS Consecutive H pylori-positive patients with nonulcer dyspepsia were randomized into 1 of 2 groups in this 14-day, open-label, randomized, prospective, parallel-arm study. An upper endoscopy with biopsy and (14)C-urea breath test ((14)C-UBT) were performed before enrollment. The first group was administered a sequential regimen consisting of pantoprazole 40 mg and amoxicillin 1 g for 7 days, followed by pantoprazole 40 mg, tetracycline 500 mg, and metronidazole 500 mg for the next 7 days. The second group was administered pantoprazole 40 mg, amoxicillin 1 g, and clarithromycin 500 mg (PAC group) for 14 days. All drugs were administered BID, with the exception of tetracycline, which was administered QID. Eradication was confirmed by (14)C-UBT 6 weeks after the end of the treatment. Histologic examination and (14)C-UBT were conducted by investigators blinded to the protocols. Patients were asked to report any adverse events (AEs) during the treatment period. RESULTS Three hundred white patients were enrolled in the study and evenly randomized into the sequential treatment group (98 males and 52 females; mean age, 40.2 years) and the PAC group (86 males and 64 females; mean age, 41.2 years). A total of 274 patients completed the study per protocol (PP). Twenty-six patients discontinued: lost to follow-up (16), withdrawn due to AEs (9); and noncompliance (1). The intent-to-treat (ITT) and PP H pylori eradication rates were 72.6% and 80.1% in the sequential group, and 58% and 63% in the PAC group, respectively. The eradication rate was significantly higher in the sequential group compared with the PAC group in both the ITT and PP populations (P=0.01 and P=0.002, respectively). The eradication rates were higher in nonsmoking patients compared with smoking patients both in the sequential group (85.8% vs 70.5%) and the PAC group (67.7% vs 53.3%), but the results were not statistically significant when the groups were analyzed separately. Overall, 32 patients (10.7%) reported an AE. Treatment was discontinued in 9 patients because of serious AEs (sequential group--abdominal pain [2 patients], diarrhea [1], chest pain [1], and vaginal pruritus [1]; PAC group--nausea/vomiting [2], chest pain [1], and numbness [1]). There were no significant between-group differences in regard to compliance or AEs. Univariate analyses found no significant effect of sex, age, alcohol consumption, antacid usage, or gastritis score on the eradication rates. CONCLUSIONS A 14-day sequential treatment regimen achieved a significantly higher eradication rate of H pylori compared with standard PPI-based triple regimen in this small selected population. Large, double-blind, controlled studies are needed to confirm these results.

The efficacy of bismuth containing quadruple therapy as a first-line treatment option for Helicobacter pylori.

BACKGROUND:  Helicobacter pylori eradication rates have tended to decrease recently, mostly due to increasing antibiotic‐resistance. The present study aimed to compare the efficacy of bismuth‐based quadruple regimen with proton pump inhibitor‐based triple regimen for eradication of H. pylori.

Fascin expresion in glial tumors and its prognostic significance in glioblastomas

Fascin is a ‐55 kDa‐actin binding protein. Actin bundles rearranged by fascin proteins are concentrated in cell membrane protrusions and these protrusions provide motility of the cell. In this study, we evaluated fascin expression in glial tumors and its relation with histologic grade. Its prognostic value in glioblastomas (GBs) was also investigated. Seventy‐six glial tumors including 44 glioblastomas with known survival time, 18 anaplastic astocytomas (AAs), six diffuse astrocytomas (DAs), and eight pilocytic astrocytomas (PAs) were examined immunohistochemically for fascin expression. Fascin was observed in the neurons of normal brain tissue and endothelium of vascular spaces in the glial tumors. Fascin expression was correlated with histologic grade in DAs. PAs expressed low levels of fascin. Half of the GBs showed high levels of fascin expression. In the GB group, overall survival was poor for cases with percentage of stained cells >50% having moderate or strong staining intensity. In GBs, overall survival was also poor for >50‐year‐old cases and cases that refused radiotherapy. Multivariate Cox regression analysis revealed that age (>50 years, P = 0.021) and higher level of fascin expression (immunohistochemical score >8, P = 0.040) were independent poor prognostic factors. In conclusion, fascin expression levels are correlated with histologic grade and fascin overexpression may play an important role in the biologic behavior of glial astrocytic tumors and in the prognosis of GBs.

Follicular mucinosis responding to isotretinoin treatment

Follicular mucinosis is a rare disorder of unknown etiology characterized by accumulation of mucin in the sebaceous glands and outer root sheaths of the hair follicles. It is divided into a primary benign type and a secondary type mostly associated with lymphomas. No effective standard therapy for follicular mucinosis is available. We describe the case of a 21-year-old Caucasian male who had papules, nodules, and erythematous plaques on his left shoulder, left arm, and right scapular region. He was diagnosed as primary benign generalized follicular mucinosis, and treated with isotretinoin. Almost complete remission was achieved in 4 months.

Repair of transected facial nerve with mesenchymal stromal cells: histopathologic evidence of superior outcome.

Despite advanced surgical techniques, clinical results of the transected facial nerve are still far from the desired outcome. Mesenchymal stromal cells (MSCs) were shown to transdifferentiate into Schwann cells and express some growth factors beneficial in peripheral nerve injury. We aimed to document histopathological improvement obtained from application of the homograft bone marrow‐derived MSCs immediately after conventional anastomosis of a transected facial nerve branch in rats, and to compare the results with those nerves anastomosed only.

Colchicine-induced myopathy with myotonia in a patient with chronic renal failure.

Although colchicine induced myopathy has been described in patients with chronic renal failure, colchicine induced myopathy with myotonia has been reported very rarely. A 49-year-old man with chronic renal failure was hospitalised for investigation of fatigue, malaise and severe pain in all extremities. He was on colchicine therapy for 5 months. Neurological examination showed mildly decreased sensation in a distal symmetric pattern in lower extremities, moderate proximal limb weakness, hyporeflexia and severe myalgia on palpation. No clinical evidence of myotonia was present. Laboratory studies showed elevated creatine phosphokinase (CK), lactic dehydrogenase (LDH), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Electromyographic (EMG) findings were compatible with myopathy and abundant, widespread myotonic discharges were determined. Muscle biopsy was consistent with vacuolar myopathy. After withdrawal of colchicine, CK, LDH, AST and ALT levels were normalised and the symptoms were disappeared gradually. In conclusion, the detection of myopathic motor unit potentials with myotonic discharges on EMG in patients on colchicine therapy is an important finding and it is possible to suggest that this clue may lead to the invasive procedure of muscle biopsy unnecessary.

Mycophenolate mofetil in extensive alopecia areata: No effect in seven patients

Alopecia areata (AA) is an unpredictable, usually patchy nonscarring hair loss condition. The course of AA is extremely variable; the most common type shows high spontaneous remission. The other form of the disease leads to total scalp and body hair loss [1–4]. Severe forms of AA are extensive and progress rapidly showing recurrent tendencies and often resistance to treatment. Mycophenolate mofetil (MMF) is an immunosuppressive drug recently added to the therapeutic armamentarium against autoimmune and inflammatory skin diseases [5]. The principal aim of this study was to determine the efficacy of MMF in extensive AA. In addition, the effect of treatment on the T cell subpopulation was monitored by immunophenotypic analysis. Patients and Methods Seven patients with extensive and chronic AA affecting more than 50% of the scalp were selected for treatment with MMF. The subjects were all men, ranging in age from 20 to 26 years (mean 21.70). Diagnoses were confirmed by clinical appearance (scalp and body hair loss and nail involvement) and histological features. Scalp hair loss was divided into 4 groups: S1 = !25% hair loss, S2 = 26– 50% hair loss, S3 = 51–75% hair loss and S4 = 76–99% hair loss. All the patients were in the S3 and S4 groups with no body hair loss and nail involvement in this study. The patients were not suffering from any autoimmune disease and had not used any topical and systemic medication for at least 8 weeks before the study. Subjects with renal and cardiovascular disease, hypertension or serious medical illness were excluded from this study. Each patient was photographed at baseline and during the 16th week. The study was approved by the local ethical committee, and an informed consent was obtained from the subjects. The demographic data, duration of AA, last episode of a disease, any prior treatment and results of therapy are shown in table 1. The patients were treated with 2 g (500 mg per capsule, Cell Cept, Roche, Turkey) MMF daily for 4 months. Blood pressure and pulse measurements were made daily, and blood tests were performed every 15 days, including erythrocyte sedimentation rate, cell counts, liver and renal function tests and electrolytes. The patients were evaluated whether they had any side effects at each examination. Cosmetically acceptable responders were defined as subjects with 50% vellus or terminal hair. Four-milimeter punch biopsies were obtained from the center of active lesions at baseline and at the

Focal epithelial hyperplasia treated with interferon alpha-2a

BACKGROUND Focal epithelial hyperplasia (FEH) is an uncommon benign oral condition that occurs mainly in young individuals of certain racial groups. METHODS A 21-year-old Caucasian man presented with FEH of the oral mucosa. The patient was treated with interferon alpha-2a three times a week for 14 weeks intramuscularly (a total of 162 million units). RESULTS At 2 months after the end of therapy, the papular lesions showed partial regression. CONCLUSION This treatment modality should be used in cases with diffuse focal epithelial hyperplasia.BACKGROUND: Focal epithelial hyperplasia (FEH) is an uncommon benign oral condition that occurs mainly in young individuals of certain racial groups. METHODS: A 21-year-old Caucasian man presented with FEH of the oral mucosa. The patient was treated with interferon alpha-2a three times a week for 14 weeks intramuscularly (a total of 162 million units). RESULTS: At 2 months after the end of therapy, the papular lesions showed partial regression. CONCLUSION: This treatment modality should be used in cases with diffuse focal epithelial hyperplasia.

Primary gastric burkitt lymphoma: a rare cause of intraabdominal mass in childhood

Primary gastric lymphoma in the pediatric population is rare and the role of Helicobacter Pylori (H. Pylori) in its pathogenesis is unclear. In this report, we describe a case of non-Hodgkin’s lymphoma (Burkitt’s type) coexisting with H. pylori and discuss the potential relationship between H. Pylori and gastric Burkitt lymphoma.

Colchicine-Induced Myopathy with Normal Creatine Phosphokinase Level in a Renal Transplant Patient

A case of a renal transplant recipient with colchicine-induced myopathy is presented. He was on colchicine therapy for 10 months. He was hospitalized for investigation of fatigue, severe myalgia in the lower extremities and elevated serum aminotransferase levels. His viral markers and other factors that may cause myalgia and that may increase the serum aminotransferase levels were either normal or negative. Creatine phosphokinase (CK) levels were normal. Electrophysiological findings indicated myopathy and muscle biopsy was consistent with vacuolar myopathy. After withdrawal of colchicine, the symptoms disappeared gradually and serum aminotransferase levels were normalized. We suggest that colchicine myopathy should be taken into account in patients who have been on colchicine therapy and had unexplained myalgia as well as elevated aminotransferase levels even with normal CK levels.