Petra Bago

High eradication rate of H. pylori with moxifloxacin-based treatment: a randomized controlled trial

ZusammenfassungEINLEITUNG: In der klinischen Praxis stellt die Eradikation von Helikobacter pylori (HP) noch immer eine problematische Therapie dar. Ziel ist, eine hohe Eradikationsrate zu einem niedrigen Preis zu erzielen; die derzeitigen Behandlungsmöglichkeiten geben uns dazu die Möglichkeit. Kürzlich veröffentlichte Resultate mit einer auf Moxifloxacin basierten Therapie zeigten eine niedrige Resistenzrate und eine gute Kompliance. Die vorliegende Studie untersucht die Wirksamkeit des Einsatzes von Moxifloxacin im Rahmen einer Triple-Therapie zur Eradikation von HP. ZIEL UND METHODEN: Ziel unserer Studie war es, die Wirksamkeit einer einwöchigen Moxifloxacin-basierten HP-Eradikationstherapie mit der Standard-Therapie zur vergleichen. 277 HP-positive Patienten mit einer Dyspepsie ohne Ulcus wurden in 4 Gruppen randomisiert: MML Gruppe: Moxifloxacin 400 mg/Tag, Metronidazol 2 × 400 mg/Tag, Lansoprazol 30 mg 2 × tgl; MAL Gruppe: Moxifloxacin 400 mg/Tag, Amoxicillin 1 g 2 × tgl, Lansoprazol 30 mg 2 × tgl; CML Gruppe: Clarithromycin 500 mg 2 × tgl., Metronidazol 400 mg 2 × tgl, Lansoprazol 30 mg 2 × tgl; und die CAL Gruppe: Clarithromycin 500 mg 2 × tgl, Amoxicillin 1 g 2 × tgl, Lansoprazol 30 mg 2 × tgl. Zur Erfassung der Prävalenz des HP wurden die Patienten mittels dem CLO Test untersucht. Außerdem wurde vor der Randomisierung und 4–6 Wochen nach Ende der Therapie gastroskopisch eine Histologie gewonnen und eine Kultur angelegt. Die bakterielle Empfindlichkeit auf Clarithromycin und Moxifloxacin wurden durch den E-Test bestimmt. ERGEBNISSE: 265 Patienten (95,6%) vollendeten die Studie. Die HP-Eradikationsrate war entsprechend der ITT und der PP Analysen in der MML Gruppe 93,5% (58/62) und 96,7% (58/60); in der MAL Gruppe 86,4% (57/66) und 90,5% (57/63), in der CML Gruppe 70,4% (50/71) und 75,8% (50/66) sowie in der CAL Gruppe 78,2% (61/78) sowie 80,2% (61/76). Die Behandlungsprotokolle mit Moxifloxacin waren waren sowohl in der ITT als auch in der PP Analyse signifikant erfolgreicher als die Clarithromycin-basierten Therapieregimes. Von den 238 Patienten (86% der gesamten Studiengruppe) waren 10,8% primär gegen Clarithromycin und 5,9% primär gegen Moxifloxacin resistent. Die Eradikation der Moxifloxacin-sensitiven/resistenten Keimstämme lag bei 98,1/75% für das MML (p < 0,01) und bei 99,1/66,7% für das MAL Regime (p = n.s.), verglichen mit dem Erfolg bei Moxifloxacin-sensitiven Stämmen von 98,1/91,1% (p < 0,05) bzw. Moxifloxacin-resistenten von 75/66,7% (p = n.s.) für die MML und MAL Gruppen. Die Behandlungsprotokolle mit Clarithromycin unterschieden sich bezüglich ihrer Wirksamkeit, sensitive oder resistente Keimstämme zu eradizieren, nicht signifikant. SCHLUSSFOLGERUNG: Triple-Therapien mit Moxifloxacin zeigten höhere Eradikationsraten mit weniger Nebenwirkungen als die bisherige Standardtherapie, sowie eine gute Kompliance. Außerdem macht die zunehmende Prävalenz der Resistenz gegenüber Clarithromycin Moxifloxacin-basierte Therapieprotokolle wahrscheinlich zu einer wirksamen und sicheren Option zur Behandlung einer Infektion mit HP.SummaryINTRODUCTION: Eradication of Helicobacter pylori remains a problematic treatment issue in clinical practice. The intention is to find a treatment that achieves a high rate of eradication at a low price and treatment options that are now used give us the opportunity to achieve this goal. Recently published results showing a low rate of resistance and better compliance with moxifloxacin-based treatment regimens indicate the need to investigate its efficacy in H. pylori eradication. This study is based on proving the efficacy of moxifloxacin in H. pylori eradication within the triple therapy. AIMS AND METHODS: The aim of the study was to compare the efficacy of one week of moxifloxacin-based treatment with the standard treatment for H. pylori eradication. Patients with H. pylori infection and non-ulcer dyspepsia (n = 277) were randomly divided into four groups to receive: moxifloxacin 400 mg/d, metronidazole 400 mg twice daily, lansoprazole 30 mg twice daily (MML group); moxifloxacin 400 mg/d, amoxicillin 1 g twice daily, lansoprazole 30 mg twice daily (MAL group); clarithromycin 500 mg twice daily, metronidazole 400 mg twice daily, lansoprazole 30 mg twice daily (CML group); clarithromycin 500 mg twice daily, amoxicillin 1 g twice daily, lansoprazole 30 mg twice daily (CAL group). The patients were assessed for prevalence of H. pylori using the CLO test, histology and culture on gastric biopsy samples obtained during upper gastrointestinal endoscopy before randomization and 4–6 weeks after completion of treatment. Bacterial sensitivity to clarithromycin and moxifloxacin was determined with the E-test. RESULTS: 265 (95.6%) patients completed the study forming the basis for PP analysis. Eradication rates of H. pylori in ITT and in PP analyses were: in the MML group 93.5% (58/62) and 96.7% (58/60), respectively; in the MAL group 86.4% (57/66) and 90.5% (57/63); in the CML group 70.4% (50/71) and 75.8% (50/66); and in the CAL group 78.2% (61/78) and 80.2% (61/76). Moxifloxacin treatment protocols were significantly more effective on both ITT and PP analyses than the clarithromycin based protocols with only one exception (MAL vs. CAL on ITT analysis). Among 238 patients (86% of the entire study group), strains showing primary resistance to clarithromycin were found in 10.8% and to moxifloxacin in 5.9%. Eradication of moxifloxacin sensitive/resistant strains was 98.1%/75% for MML (p < 0.01) and 91.1%/66.7% for MAL (p = n.s.); comparison of eradication of sensitive strains in MML and MAL regimens was 98.1%/91.1% (p < 0.05), and for resistant strains 75%/66.7% (p = n.s.). CML and CAL protocols did not differ in efficacy of eradication of clarithromycin sensitive or resistant strains. CONCLUSION: Moxifloxacin-based triple therapies showed higher eradication rates with few side effects and good drug compliance when compared with standard H. pylori treatments. Moreover, the increased prevalence of clarithromycin resistance suggests that moxifloxacin-based regimens could be safe and effective options in treatment of H. pylori infection.

Antimicrobial resistance of H. pylori to the outcome of 10-days vs. 7-days Moxifloxacin based therapy for the eradication: a randomized controlled trial

IntroductionAntibiotic resistance decreases success of Helicobacter pylori (Hp) eradication. Recently published results show low rate of resistance and better compliance with moxifloxacin based regiments.Aims&methodsWhether 7 days moxifloxacin with lansoprasole and amoxycillin can be compared with 10 days moxifloxacin with lansoprasole and amoxycillin according to moxifloxacin resistance. Patients with non-ulcer dyspepsia who had culture and histology positive Hp infection (n = 150) were randomly assigned into two groups. The first group (n = 75) received moxifloxacin 400 mg/d during 7 days and the other (n = 75) received moxifloxacin 400 mg/d during 10 days. All patients received amoxycillin 1 g twice daily, lansoprasole 30 mg twice daily. All Hp cultures were tested for sensitivity to moxifloxacin.Results138 patients (92%) completed the study, 68 in the first group and 70 in the second. Eradication rates were 84% (57/68) and 76% (57/75) in the 7 days moxifloxacin group and 90% and 84% in the second group (63/70, 63/75) according to the PP and ITT analysis; p = n.s. Among 129 patients (86% of study group), 6% of strains were primary resistant to moxifloxacin.Eradication of moxifloxacin sensitive/resistant strains was 98%/66%, p < 0.05ConclusionAccording to our results we recommend 7 days moxiflixacin based triple therapy.

Comparison of the efficacy of 250 mg and 500 mg clarithromycin used with lansoprazole and amoxicillin in eradication regimens forHelicobacter pylori infection

SummaryAims and methodsThe aim of this study was to compare the efficacy of 250 mg and 500 mg clarithromycin used with lansoprazole and amoxicillin in eradication ofH. pylori infection, 235 patients withH. pylori infections and non-ulcer dyspepsia were randomly assigned to one of the following regimens: lansoprazole 30 mg, amoxicillin 1000 mg, clarithromycin 250 mg (LAC250) and lansoprazole 30 mg, amoxicillin 1000 mg, clarithromycin 500 mg (LAC500). All drugs were given twice daily for 7 days. The patients were assessed for prevalence ofH. pylori with the CLO test. Gastric biopsy samples obtained during upper gastrointestinal endoscopy before randomization and 4–6 weeks after completion of therapy were used for histology and culture. Bacterial sensitivity to clarithromycin and amoxicillin was determined with the E-test.Results101 patients in the LAC250 mg group and 102 in the LAC500 group completed the study. On intention-to-treat analysis, eradication rates were 81% with LAC250 and 82% with LAC500 (p=0,88). On per-protocol analysis, eradication rates were 92% with LAC250 and 96% with LAC500 (p=0.23).Among the 203 patients (86% of the entire study group) for whomH. pylori antibiotic-sensitivity testing was technically feasible, primary resistance to clarithromycin was found in 9% and to amoxicillin in 0%. Eradication of clarithromycin sencitive/resistant strains was 94%/38% for LAC250 (p<0.001) and 93%/40% for LAC500 (p< 0.001)ConclusionsThe cure rates for the two regimens were similar, although adverse effects were more frequent with the LAC500 regimen, suggesting that 250 mg of clarithromycin b. d. may be sufficient in our patient population.

Interoperability of an 18th century Italian-Latin-Croatian dictionary

The digitization process of historical texts is increasing in the last several decades, thereby developing the field of digital humanities. However, the digitization projects are usually isolated to the project teams, universities and institutes, but also to individuals developing the project. There was a lack of communication between the community members, which resulted in resources, tools and systems that are not able to exchange information. Consequently, recently it was demonstrated that there is a demand for standardization of technologies, but also of all processes of development. Interoperability emerges as the key concept at this phase of digital humanities, which aims to facilitate communication of data. To enable semantic interoperability of historical dictionaries, they have to be encoded using some standard. In this paper we present the encoding of della Bella’s trilingual 18th century dictionary entries using a TEI (Text Encoding Initiative) encoding scheme for dictionaries. The dictionary is a trilingual dictionary containing Italian, Latin and Croatian language.

A project of developing a knowledge management system

Knowledge is an essential element of modern business and increasing attention is given to its acquisition, distribution and exploitation in everyday business activities. Therefore, KONCAR launched the development of a knowledge management system for its own demands and initiated a collaboration with the academic community for scientific research purposes and potential broader social significance of the project. With regard to the multidisciplinary nature of knowledge management, an agreement was reached with the University of Zagreb, the Faculty of Humanities and Social Sciences and the Faculty of Electrical Engineering and Computing. The knowledge management system will enable an effective management of all segments of intellectual capital of an organization, resulting in increase in productivity and higher market competitiveness, as well as an increased capability for generating new values for all parties to the agreement.

Multimedia Resources in an Online Course: Access and Usage with/Multimedijski resursi e-kolegija: pristup i upotreba s obzirom na osjetilni modalitet

Abstract In this paper we present a research on students’ perceptual modes and their learning activity with respect to use of multimedia learning resources in a virtual learning environment within an online course. The course content is offered in the form of lessons designed in the Moodle course management system. Lessons contain three different types of resources: textual, pictorial resources accompanied by text, and video resources. Considering the results of the VARK questionnaire, which labels the students’ learning styles, i.e. perceptual modes, as visual, aural, read/write and kinesthetic, we investigate the relation between the students’ perceptual modes and their learning activity regarding different types of resources. The results show that two out of three students are multimodal regarding their perceptual modality, and that students prefer pictorial resources accompanied by text. The research findings on learners’ preferences lead to more effective instructional design in an online learning environment. Key words: multimedia learning; perceptual modality; VARK. --- Sažetak U radu je prikazano istraživanje odnosa osjetilnog modaliteta i aktivnosti studenata s obzirom na odabir multimedijskih resursa e-kolegija. Sadržaj kolegija prezentiran je upotrebom lekcija izrađenih u sustavu za upravljanje nastavnim sadržajima Moodle. Lekcije sadrže tri tipa resursa: tekstualni, slikovno-tekstualni i video resurs. Upotrebom upitnika VARK utvrđeni su nacini ucenja utemeljeni na senzornom modalitetu (vizualni, auralni, tekstualni i kinesteticki), zatim istraženi odnosi modaliteta studenata i aktivnosti s obzirom na odabir razlicitih multimedijskih resursa. Rezultati pokazuju da su dva od tri studenta multimodalni i da su u ucenju skloni odabiru slikovno-tekstualnog resursa. Kljucne rijeci: multimedijsko ucenje; osjetilni modalitet; VARK.