Predictors of <i>H. pylori</i>infection in a safety-net hospital in Arizona

Objective: The purpose of this study was to determine the risk factors associated with having H. pylori infection as proven by endoscopic biopsy at Maricopa Medical Center (MMC), a safety-net hospital in phoenix, Arizona which serves primarily patients with limited financial and insurance resources. Methods: A total of 1116 biopsies were identified in a Department of Pathology database searched from November 2004 to March 2013. To be included, the subjects had to have an endoscopy with gastric biopsy. After the inclusion criteria were applied, 282 control subjects without histological evidence of H. pylori infection and 256 cases with histological evidence of H. pylori infection were identified. Patient charts were reviewed to extract information on variables collected for this study. Results: The mean age of cases and controls was 50.5 and 52.3 years respectively. The BMI of the cases and controls was 28.1 and 28.0 respectively. The mean number of upper endoscopic exams performed was 1.3 in cases and 1.4 in controls respectively. Potential predictors examined were gender, history of drug abuse, history of alcohol abuse, chronic pain medication use, smoking, employment status, outpatient vs. inpatient upper endoscopy exam, language spoken (English, Spanish, or bilingual), race/ ethnicity, type of insurance, heart burn, dysphagia, abdominal pain, gastroduodenal ulcers, intestinal metaplasia, and having vs. not having a primary care physician. Based on univariate analyses, having a gastroduodenal ulcer, having a history of abdominal pain, Hispanic race, government insurance status, self-pay insurance status, and speaking Spanish only were found to be significantly related to having H. pylori infection. These variables were next entered into a multivariate analysis. The multivariate analysis revealed that gastroduodenal ulcer, abdominal pain, Hispanic race and self-pay insurance status remained significant predictors of H. pylori infection. For the last 119 subjects, information regarding the country of their birth was available. These 119 subjects were separately analyzed. Country of birth, age, sex, Hispanic race, self-pay insurance status, Spanish speaker, and having government insurance were included in a multivariate analysis. Twenty seven percent of patients without H. pylori were born in the US, compared to fifty eight percent H. pylori positive patients who were born outside of the US. Conclusion: Hispanics are at high risk for H. pylori infection. In a multivariate model, patients with H. pylori were found to have a higher risk of ulcers, Hispanic race, abdominal pain and self-insurance status. When self-insurance and Hispanic race were included in another analysis with place of birth, only birth outside US remained significant.

Treatment of pulmonary coccidioidomycosis after successful hepatitis C therapy in a patient with fluconazole induced hepatotoxicity

A patient with hepatitis C infection and cavitary pul- monary coccidioidomycosis is reported. Treatment of hepatitis C was associated with resolution of flucona- zole-induced hepatotoxicity. Successful treatment of he- patitis C enabled the patient to tolerate increaseing doses of fluconazole. This case highlights that hepatic toxicity of fluconazole can improve after successful treatment of hepatitis C.