Ozlem Yilmaz

Epidemiology of Helicobacter pylori infection.

Helicobacter pylori infection is typically acquired in early childhood in both low‐ and high‐income regions of the world and, once established, commonly persists lifelong unless treated. Social and economic development decreases the prevalence both within and between countries. The epidemiology of H. pylori infection highlights the geographic, ethnic, and racial differences throughout the world.

Diversity of VacA Intermediate Region among Helicobacter pylori Strains from Several Regions of the World

ABSTRACT Helicobacter pylori is known to be a major cause of gastric carcinoma and peptic ulceration. cagA positivity and vacAs signal regions and mid-regions are well-characterized markers of H. pyloris virulence. Recently, an intermediate region has been identified as another strong marker of H. pylori-associated disease, and its i1 allele has been linked with severe diseases in colonized hosts. The goal of this study was to determine the prevalence of the intermediate alleles in H. pylori isolates from China, Turkey, and Uruguay and from U.S. Africans and to compare their distribution with other well-characterized virulence factors. Originally, 123 H. pylori strains were studied, but 3 were excluded due to the failure to amplify the intermediate region in these samples. Therefore, a total of 120 strains were analyzed: 30 Chinese isolates, 35 Turkish isolates, 30 Uruguayan isolates, and 25 U.S. African isolates. The s type and the m type were determined by PCR amplification. The i type was identified by PCR amplification and DNA sequencing. CagA status was determined by PCR methodology. There was a strong correlation among CagA positivity, s1, and i1 in Chinese, U.S. African, and Uruguayan isolates, but less correlation among these markers in Turkish isolates. A new intermediate variant (i3) was identified in 25.7% of Turkish strains and 3.3% of the Chinese strains. In summary, the distribution of CagA positivity and s1 correlated with the i1 in the three populations, except in the Turkish population, which showed a disproportionate representation of the i3 allele. Phylogenetic mapping confirmed the i-typing method previously defined and adopted for this study. The phylogenetic tree showed country-specific correlation with the intermediate region. Our results showed that the i1 allele is strongly associated with CagA positivity and the vacA s1 allele, suggesting its role as a virulence marker and potential predictor for clinical outcome.

Detection of Helicobacter pylori and Determination of Clarithromycin Susceptibility Using Formalin-Fixed, Paraffin-Embedded Gastric Biopsy Specimens by Fluorescence In Situ Hybridization

Background:  Clarithromycin resistance and poor compliance to therapy are often responsible for Helicobacter pylori eradication therapy failure.

Detection of Helicobacter pylori DNA by a simple stool PCR method in adult dyspeptic patients.

Introduction.  Helicobacter pylori is the major agent causing peptic ulcer, gastric cancer and mucosa‐associated lymphoid tissue (MALT) gastric lymphoma. A simple stool polymerase chain reaction (PCR) method was performed and compared with the gold standards for the diagnosis of H. pylori infection.

Comparison of sequential and standard therapy for Helicobacter pylori eradication in children and investigation of clarithromycin resistance.

AIMS The aim of the present study was to compare the efficacy of sequential and standard triple-drug regimen for Helicobacter pylori (H pylori) eradication in children and to determine the primary resistance rate to clarithromycin. METHODS Children with H pylori infection randomized to receive either standard regimen (n = 28) consisting of lansoprazole for 30 days, amoxicillin and clarithromycin for 14 days or sequential regimen (n = 16) consisting of lansoprazole for 30 days, amoxicillin for 7 days, followed by clarithromycin and metronidazole for the next 7 days. Clarithromycin susceptibility of H pylori was assessed with fluorescence in-situ hybridization technique. Eradication was controlled by C urea breath test or monoclonal stool antigen test 4 weeks after the end of the therapy. RESULTS H pylori eradication rate was higher in the sequential therapy group (93.7%), compared with the standard therapy group (46.4%) (P = 0.002). There was no difference in adverse drug reactions and in compliance to the treatment between the groups. Primary clarithromycin resistance rate for H pylori was found as 25.7% (n = 9). All of the patients having clarithromycin resistance were coincidentally in the standard therapy group. After the exclusion of these 9 patients, sequential therapy was again found to be more effective than the standard therapy (P = 0.02). CONCLUSIONS Sequential therapy seems highly effective for eradicating H pylori in children; however, the difference between 2 groups in resistant strains was the limitation of the study. Our country needs to reassess the effectiveness of standard triple therapy regimen for H pylori eradication.

Importance of antimicrobial susceptibility testing for the management of eradication in Helicobacter pylori infection.

The management of Helicobacter pylori (H. pylori) infection treatment differs from the common treatment protocol for other infectious diseases. Because culture- or molecular-guided approaches face several practical issues, such as the invasive procedures required to obtain gastric biopsy specimens and the lack of availability of routine laboratory testing in some places, H. pylori treatment includes the administration of two or three empirically selected antibiotics combined with a proton pump inhibitor rather than evidence-based eradication treatment. The efficacy of empirical therapy is decreasing, mostly due to increasing multiple resistance. Multiresistance to levofloxacin, clarithromycin, and metronidazole, which are commonly used in empirical treatments, appears to have increased in many countries. Mutations play a primary role in the antimicrobial resistance of H. pylori, but many different mechanisms can be involved in the development of antibiotic resistance. Determining and understanding these possible mechanisms might allow the development of new methods for the detection of H. pylori and the determination of antimicrobial resistance. A treatment based on the detection of antimicrobial resistance is usually more effective than empirical treatment. Nevertheless, such an approach before treatment is still not recommended in the Maastricht guidelines due to the difficulty associated with the routine application of available culture- or molecular-based susceptibility tests, which are usually administered in cases of treatment failure. The management of first and rescue treatments requires further research due to the steadily increase in antimicrobial resistance.

Reliability and validity of the Turkish version of the knee injury and osteoarthritis outcome score-physical function short-form (KOOS-PS).

BACKGROUND The Knee injury and Osteoarthritis Outcome Score-Physical function Short-form (KOOS-PS) is a disease-specific questionnaire that can be used to evaluate physical function in patients with knee problems and it has not been adapted to Turkish language. OBJECTIVE The purpose of the present study was to adapt the KOOS-PS to the Turkish language and to evaluate the psychometric properties of the Turkish version of the KOOS-PS in patients with primary knee osteoarthritis. METHODS The translation from the source language to the target language, synthesis, back-translation, revision and pre-test stages were performed. A total of eighty patients participated in the study. Internal consistency was tested by Cronbachs alpha, test-retest reliability was tested by the intra-class correlation coefficient (ICC). Construct validity was investigated with Spearmanns rank correlation coefficient and correlations of the KOOS-PS with the WOMAC and Lequesne osteoarthritis indexes and with the duration of complaints, radiological grade and range of flexion were assessed for this purpose. RESULTS Internal consistency was good, with a Cronbachs alpha of 0.904 and an ICC value of 0.839 certifying that the Turkish KOOS-PS is a reliable tool. Spearmans rank correlation coefficients between the KOOS-PS and the overall WOMAC (r=0.764), WOMAC-physical function (r=0.754), WOMAC-pain (r=0.706), overall Lequesne (r=0.775), Lequesne-daily living activities (r=0.737) and Lequesne-pain (r=0.716) were high. Moderate correlations were found between the WOMAC-stiffness, Lequesne-walking distance and KOOS-PS (r=0.599 and 0.528, respectively). CONCLUSIONS The Turkish KOOS-PS was found to be reliable and valid for patients with primary knee osteoarthritis.

Miocamycin-Containing Triple Therapy for H. pylori Infection

In Northern Sardinia, one‐week triple standard therapies containing a proton‐pump inhibitor and two antibiotics for H. pylori infection have an average cure rate of 57% largely due to a high prevalence of antimicrobial resistance. The efficacy of miocamycin‐containing treatment for 10 days was evaluated.

Evaluation of different cryoprotective agents in maintenance of viability of Helicobacter pylori in stock culture media

Four different cryoprotective supplemented stock media were evaluated for maintaining better survival and recovery of H. pylori type strain NCTC 11637 at two different maintenance temperatures of -20°C and -80°C after one month preservation as frozen stocks. The spread plate colony count method was used to investigate the recovery rate of H. pylori from equally inoculated bacterial suspensions in differently prepared stock cultures. After the preservation of H. pylori for one month in different cryoprotectant-supplemented stock media, the recovery rates for -20°C obtained for stock cultures supplemented with dimethyl sulfoxide (DMSO), polyethylene glycol (PEG), glycerol and glycerol+sucrose, as well as controls with and without human serum alone were 7.13, 6.97, 7.93, 7.99, 6.95 and 0.0 log CFU/ml, respectively. Maintenance of bacteria at -80°C gave statistically higher recovery rates compared to preservation at -20°C with the values of 8.55, 8.24, 8.59, 8.66, 8.01 and 0.0 log CFU/ml for these above mentioned stock cultures. The stock cultures supplemented with glycerol+sucrose and glycerol showed the highest recovery rates, 7.99 and 7.93 for -20°C vs. 8.66 and 8.59 for -80°C respectively, which were statistically different from the others. Our study revealed that H. pylori type strain NCTC 11637 could be better preserved at -80°C than -20°C. The best stock media which supported viability or culturability of bacteria were brain heart infusion broth (BHI)+glycerol+human serum and BHI+glycerol+sucrose+human serum, where the latter yielded the higher recovery rate.

Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning

OBJECTIVE To determine the impact of postpolio-syndrome on quality of life in polio survivors. METHODS Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halsteads postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. RESULTS Total manual muscle testing score was 26.19±13.24 (median: 29) in postpolio-syndrome group and 30.08±8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. CONCLUSIONS Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.