Helicobacter pylori is a common gastric pathogen associated with multiple clinical syndromes, including cancer. Eradication rates of H. pylori remain suboptimal despite the progress made in the past few decades in improving treatment strategies. The low eradication rates are mainly driven by antibiotic resistance of H. pylori. Non-invasive molecular testing to identify patients with antibiotic-resistant H. pylori represents a promising therapeutic avenue, however this technology currently remains limited by availability, costs, and lack of robust validation. Moreover, there is insufficient evidence to demonstrate that resistance-testing-based treatment approaches are superior to appropriately designed empiric strategies. Consensus guidelines recommend use of proven locally effective regimens; however, eradication data are inconsistently generated in several regions of the world. In this review, we describe several clinical factors associated with increased rates of antibiotic resistant H. pylori, including history of previous antibiotic exposure, increasing age, female gender, ethnicity/race, extent of alcohol use, and non-ulcer dyspepsia. Assessment of these factors may aid the clinician in choosing the most appropriate empiric treatment strategy for each patient. Future study should aim to identify locally effective therapies and further explore the clinical factors associated with antibiotic resistance.
Background
Our hospital system is committed to service to medically underserved, low-income, and minority populations. It is located in a city wherein 37% of people live in poverty. Overall cost effectiveness is part of our patient care quality improvement. Cirrhotic patients are at higher risk for cardiac surgery as cardiopulmonary bypass triggers the release of substances that mimic the physiologic changes seen in cirrhosis. We compared outcomes of surgeries performed for the treatment of aortic valve stenosis, surgical aortic valve replacement (SAVR), mini-surgical valve replacement (mini-SVR), and transcatheter aortic valve replacement (TAVR) with attention to cirrhotic patients.
Methods
This retrospective cohort study looked at the medical records of 457 patients. Demographic data, substance abuse, pre-existing diagnoses, length of stay, outcomes, and lab values were collected for each patient pre- and post-surgery. Fisher's exact test or chi square was used to compare categorical characteristics and outcomes among groups. ANOVA for repeated measures was utilized to compare group differences of continuous measurements over time.
Results
Despite having the highest average age of patients and higher incidence of pre-existing comorbidities, post-operative complications such as arrhythmia, hyponatremia, and coagulopathy developed to a lesser extent in TAVR patients. The length of post-surgery hospital stay was also the least in TAVR patients. TAVR offered better post-operative outcomes in cirrhotic patients as well.
Conclusions
TAVR showed better post-surgical outcomes and provide an option for cardiac surgery for cirrhotic patients. This data will be useful for enabling a patient-centered decision-making process in our population.
Table 1. (continued) Whole Cohort, n5318 Mean (SD) / n (%) PBC with T2DM, n557 Mean (SD) / n (%) PBC without T2DM, n5261 Mean (SD) / n (%) P Value* LSM (kPa) 15.0 (28.8) 14.0 (9.9) 15.2 (31.5) 0.834 , 8.5 80 (47.3) 6 (19.4) 74 (53.6) , 0.001 $ 8.5 89 (52.7) 25 (80.6) 64 (46.4) *Based on chi-square test for categorical data and independent sample t-test for continuous data.
Introduction: Nonalcoholic fatty liver disease (NAFLD) is one of the most common etiologies of cirrhosis and fastest growing indications for liver transplantation in Western countries. Currently, there is no universal recommendation for NAFLD screening in the primary care setting. Clinical data analysis can be used to identify patients at risk for developing NAFLD with advanced liver disease so that these patients can be referred for liver elastography for further risk stratification. Methods: 2528 patients from the Highland primary care clinic in Oakland California from 2020 to 2022 were evaluated using the Epic Software electronic medical record system. The inclusion criteria included patients at Alameda Health System (AHS) Highland Hospital
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