ABSTRACT
Helicobacter pylori is implicated in various gastroduodenal diseases and many tests are available for its detection. The present study attempted to document the morphological changes in the gastric mucosa induced by H. pylori colonization and correlate them with the severity of the infection. The study also compared various diagnostic tests and evaluated the different staining methods used for H. pylori detection, especially immunohistochemical identification. One hundred and two patients with dyspepsia were included. Enzyme-linked immunosorbent assay [ELISA] for H. pylori-specific immunoglobulin G [IgG], immunoglobulin A [IgA], and immunoglobulin M [IgM] was used. Rapid urease test was performed on endoscopic biopsy and it was stained with hematoxylin and eosin [H and E], modified Giemsa, and immunohistochemical stains. A significant correlation was found between the density of H. pylori and severity of gastritis. A significant correlation was observed between serology [especially when used in combination, IgG and IgA] and status of H. pylori. Immunohistochemical staining enhanced the diagnostic yield of H. pylori detection. Immunohistochemistry [IHC] should be used judiciously, whereas simple and economical tests like modified Giemsa should be used routinely for the detection of H. pylori. Combined ELISA [IgG and IgA] should be preferred over single ELISA. Simultaneous morphological and serological detection of H. pylori is preferable as H. pylori may not be detected on morphology alone due to its patchy distribution in the stomach
ABSTRACT
<p><b>INTRODUCTION</b>Cardiovascular disease is the leading cause of death and morbidity among postmenopausal women, and oestrogen deficiency may be an important factor in its development. The role of oestrogen replacement in preventing cardiovascular disease is controversial. The aim of this descriptive review is to analyse the available data and to recommend evidence-based practice guidelines pertaining to hormone therapy in the context of cardiovascular and cerebrovascular health.</p><p><b>MATERIALS AND METHODS</b>Relevant clinical trials were identified by computerised literature search. The collated data were presented to fellow gynaecologists for review, analysis of results and discussion in a series of meetings dedicated to finding the best evidence in menopause management. The evidence was used to formulate clinical practice guidelines for the management of women with significant cardiovascular risk factors.</p><p><b>RESULTS</b>Evidence from animal studies and observational trials supported a cardio-protective effect of postmenopausal hormone therapy. More recent randomised clinical trial data have shown no significant reduction of coronary heart disease, and have confirmed a higher incidence of stroke and venous thromboembolism.</p><p><b>CONCLUSIONS</b>The evidence is widely divergent regarding postmenopausal hormone therapy and cardiovascular risk. More consistent data are available reporting an increased risk in the incidence of venous thromboembolism and stroke. It is important to be clear about the indications of hormone use and to utilise alternative modalities to promote cardiovascular health in the postmenopausal population.</p>
Subject(s)
Aged , Female , Humans , Middle Aged , Cardiovascular Diseases , Cerebrovascular Disorders , Estrogens , Metabolism , Hormone Replacement Therapy , Menopause , Practice Guidelines as TopicABSTRACT
<p><b>INTRODUCTION</b>The physiological changes that occur in menopause alter sexual function and affect well-being. Hormonal changes contribute significantly to reduced sexual function in older women and sexual dysfunction may well be amenable to treatment with exogenous hormones or other agents.</p><p><b>MATERIALS AND METHODS</b>Relevant clinical studies were identified by a computerised literature search. The collated data were presented to fellow gynaecologists for review, analysis of results and discussion in a series of meetings dedicated to finding the best evidence in menopause management. The evidence was assessed and used to prepare guidelines around the management of women who are affected by sexual dysfunction in menopause.</p><p><b>RESULTS</b>Hormone therapy benefits many women who have dyspareunia related to vaginal atrophy, reduced libido and decreased satisfaction, particularly if these symptoms adversely affect their quality of life. Alternative agents such as tibolone and sildenafil citrate can be useful adjuncts.</p><p><b>CONCLUSIONS</b>It is increasingly important to recognise postmenopausal sexual dysfunction. Treatment of this syndrome must be individualised to the specific complaints of each woman. Hormones and other agents are relevant treatment options for properly-selected women.</p>