Metronidazole-resistant Helicobacter pylori strains among Saudi patients with dyspepsia

To determine how common are metronidazole-resistant [MTZ-R] Helicobacter pylori [H.pylori] strains in Saudi patients. A prospective study in patients with dyspepsia attending for gastroscopy at Asir Central Hospital, Abha, Saudi Arabia. Each biopsy specimen was inoculated on a Skirrow's selective medium and incubated at 37 °C under a microaerophilic atmosphere for 3 to 7 days. Suspected colonies were tested further for identification and susceptibility testing. A total of 40 different H.pylori strains were studied. Of the 40 strains isolated, 16 [40.0%] were MTZ-R. Females showed a higher, though not significant, rate of MTZ-R [47%] than males [33%] [p=0.37]. Furthermore, patients with MTZ-R strains showed lower median age [35 years], compared to those with susceptible ones [45 years]. However, the difference was not significant [t=1.89, p=0.07]. Moreover, MTZ-R was not significantly affected by the type of endoscopic diagnosis [duodenal ulcer [30%] and gastritis [50%], p=0.20]. Since MTZ-R H.pylori strains are frequent [40%], it is recommended to test MTZ susceptibility if possible before treatment, to guide the selection of appropriate therapy and to avoid eradication failure, in particular patients with a history of H.pylori treatment failure. Metronidazole resistance was not affected by age, sex or diagnosis

Etiology of ascites and the diagnostic value of serum-ascites albumin gradient in non-alcohol liver disease

This study was designed to determine the different etiologies of ascites and the diagnostic value of serum-ascites albumin gradient [SAAG] in patients with ascites of non-alcohlic liver disease in Southern Saudi Arabia. A total of 132 patients with ascites [96 males and 36 females, mean age 58.8 +/- 15.9 years] were studied for the different causes of acites. In 55 patients with liver disease and 22 patients with nonliver disease [malignancy and peritoneal tuberculosis], we compared SAAG with the three usual parameters of ascetic fluid biochemical analysis used in the differential diagnoses of ascites. The nonliver disease group showed higher ascetic fluid total protein [aTP] concentration [4.77 +/- 2.05 versus 1.98 +/- 1.56 g/dL], ascetic to serum ratio of total protein [a/sTP] concentration [0.75 +/- 0.43 versus 0.26 +/- 0.19], ascetic fluid lactic dehydrogenase [aLDH] level [565.4 +/- 353.4 versus 254.1 +/- 205.03 U/L] and a lower SAAG [0.6 +/- 0.30] versus 1.71 +/- 0.61]. P< 0.0001] for all parameters. The positive predictive values for aTP, a/sTP, a/s TP, aLDH and SAAG to detect ascites due to liver disease were 68%, 76, 76%, and 80%, respectively, while the negative predictive values were 96%, 96%, 84%, and 98%, respectively. Liver causes accounted for 69.7% of cases, followed by peritoneal tuberculosis 10.6%, malignancy 9.1%, congestive heart failure 7.6%, and nephritic syndrome 3.0%. ASSG is a useful diagnostic parameter which can be used to separate ascites of liver disease [nonalcoholic] from other causes of acites, with an efficiency of 91%. SAAG should replace the traditional parameters [aTP, a/sTP and aLDH] used in the differential diagnosis of ascites. In our series, liver disease is the major cause of ascites, followed by peritoneal tuberculosis