ABSTRACT
Background: Helicobactor pylori [H. pylori] virulence markers would be useful to predict peptic ulcer disease [PUD] or gastric cancer
Aim: In Egypt, since inadequate data are present regarding H. pylori virulence-related genes in different age group patients with gastro-duodenal diseases, it becomes crucial to study the clinical status of cagA, vacA and iceA1 genotypes of H. pylori strains recovered from patients with dyspepsia
Subjects and methods: The study included 113 dyspeptic patients who were exposed to upper gastrointestinal endoscopic examination. Four antral biopsies were obtained from each patient for the analysis of H. pylori infection by rapid urease test and detection of 16S rRNA
Results: Sixty [53.1%] patients were confirmed to be infected with H. pylori. Upon endoscopy, gastritis was revealed in 27 patients [45%] and10 patients [16.7%] had PUD. Of the 60 H. pylori strains, 39 [65%] had at least one virulence gene. Six different genotypic forms were recognized; vacA [9/60], iceA1 [1/60], vacA/cagA [7/60], vacA/iceA1 [13/60], vacA/cagA/iceA1 [8/60] only one of cagA/iceA type and we could not detect cagA. The overall vacA, iceA1and cagA genes identified were 61.6%, 38.8%, 26.6% respectively, by PCR-based molecular testing. The vacA gene status was highly significant related to gastritis patient [P ? 0.036]. The vacA s1m1 and s2m2 alleles were significantly found in 50% of H. pylori infected patients with PUD and with gastritis 57.1% respectively [P
Conclusion: In conclusion, the main genotype combinations in the studied Egyptian patients were; vacAs2m2/iceA1, vacAs1m1/cagA, mostly associated with gastritis, and vacAs1/cagA/icA, mainly in PUD. The less virulent [s2, s2m2] H. pylori genotypes were found in patients aged over 43 years
ABSTRACT
The cag pathogenicity island [cagPAI] is one of the major virulence determinants of Helicobacter pylori [H. pylori]. Acquiring virulent strains of H. pylori is associated with increased risk for the development of gastric ulcers or cancer. The aim of this study was to determine H. pylori cagPAI genes pattern among dyspeptic Egyptian patients and its correlation with the varying degrees of the associated chronic gastritis. Histopathological examination, urease test and polymerase chain reaction [PCR] assay were performed for gastric antral biopsies obtained from 106 dyspeptic patients undergoing upper endoscopy. DNA extracts from H. pylori positive cases were analyzed for the presence of cagPAI genes cagA, cagE, cagM, tnpA, tnpB and cagT by using PCR assay. Apparently normal gastric mucosa was seen on endoscopy in 30.2% of dyspeptic patients while gastritis was diagnosed in 69.8% with significant difference [p<0.05]. H.pylori was detected in 71.7% of dyspeptic patients. A strong association was observed between H. pylori infection and gastritis patients [p<0.01]. The positivity rate of any of the cagPAI genes were 65.8% of H. pylori positive cases. Analysis of the entire cagPAI genes revealed that both cagA and cagE were the most predominant genes [30.2% , 18.4% respectively]. cagT and tnpB genes were not detected in all H. pylori positive gastric biopsies. The presence of the entire cagPAI genes was more substantiated in gastritis patients than in those with apparently normal mucosa [p<0.05]. The presence of cagA1/2, cagA3/4, cagM and cagE genes were significantly associated with moderate degree of gastritis [p<0.02], while tnpA gene was mostly detected in marked degree of gastritis [p<0.02]. In conclusion, it can be admitted that infection with virulent strain carrying cag PAI genes may be an indication of the risk of progression of gastric mucosal damage in chronic gastritis patients. In such country as Egypt where there is a high prevalence of H. pylori infection, cagPAI genotyping is important for prediction of the clinical outcome in H. pylori related gastritis aiming at eradication of infection before the progression to severe gastroduodenal diseases
ABSTRACT
Increased expression of inducible nitric oxide synthase [iNOS] has been observed in patients with chronic inflammatory diseases of the gastrointestinal tract leading to sustained production of nitric oxide [NO] which may induce DNA damage. Since Helicobacter pylori [H. pylori] infection produces a state of chronic immunostimmulation in the gastric epithelium and a causal relationship between H. pylori CagA+ strains infection and gastric cancer has been suggested, therefore, our aim was to evaluate the significance of iNOS expression in gastric lesions induced by H. pylori CagA+ strains with correlation to the encountered endoscopic and pathological diagnoses. Eighty four dyspeptic patients underwent endoscopic examination. Four antral gastric biopsies were obtained for detection of H. pylori by histopathological assessment [Giemsa staining], urease test and gene expression of H. pylori using PCR assay. Immunohistochemical staining for iNOS expression and quantitative detection of anti-CagA antibodies were performed. It was found that H. pylori infection was detected in 64.3%, CagA seropositivity in 54.8% and iNOS expression in 61.9%. Anti-CagA antibodies seropositivity and iNOS immunoexpression were significantly related to H. pylori infection. The positive rates of iNOS immunostaining increased with the lesion progression from chronic superficial gastritis to chronic atrophic gastritis to intestinal metaplasia [45.2%, 87.5% and 92.8% respectively]. Positive immunostaining rates of iNOS correlated significantly with H.pylori Cag A seropositivity with respect to both endoscopic and pathologic diagnoses. In conclusion, CagA+ H. pylori strains are associated with enhanced immunoexpression of iNOS in H. pylori-related gastric diseases, therefore they might contribute as risk cofactors that conduces to gastric carcinogenesis. Given the high prevalence of H. pylori gastric diseases and frequent performance level of endoscopic gastric examinations among Egyptian patients, prompt identification of gastric infections caused by H. pylori harboring Cag A virulence factor is necessary for the early eradication of infection before the development of pre-neoplastic lesions
ABSTRACT
The policy of elective repair of umbilical hernia in cirrhotic ascetic patients has long been a subject of debate and is still a major health problem. This study evaluated the role and outcome of elective mesh repair of umbilical hernia in cirrhotic ascetic patients, compared with the conventional two layers fascial repair technique. Forty cases with a small to medium sized umbilical hernia defects in ascetic cirrhotic patients were divided into two groups [GI and GII] of 20 patients each. After proper control of ascites in both groups, patients in GI were subjected to elective umbilical hernia onlay mesh repair. In GII, hernia were managed by conventional two layers fascial repair. In GI, transient early postoperative ascetic fluid leakage occurred in 3 [15%] cases and mild superficial wound infection in 5 [25%] cases which was controlled by antibiotics. Two [10%] cases developed hernia recurrence during follow up period. In GII, ascetic leakage occurred in 6 [30%] cases that responded well to conservative management except only one case needed re-exploration and repair reinforcement. Drainage was significantly less than in GI in among [P
Subject(s)
Humans , Male , Female , Risk Factors , Liver Cirrhosis , Ascites , Postoperative Complications , Surgical MeshABSTRACT
To investigate the main features [stone type and others] of cholelithiasis in a group of Egyptian cirrhotics undergoing cholecystectomy by studying them versus hepatosteatotic and normal liver cholecystectomy candidates, 200 consecutive Egyptian patients undergoing cholecystectomy for cholelithiasis were studied. According to their liver condition, they were divided into three groups: Frank cirrhosis, hepatosteatosis and normal liver. The three groups were compared regarding the stone type by gross appearance and chemical analysis, nature of cholecystitis, incidence, gender and gallbladder bile crystallization. There were 19 cirrhotics, 33 hepatosteatotics and 148 normal liver patients. In the cirrhotic group [10 males and 9 females], 18 had pigment stones, one had mixed stone and none had cholesterol stones. None of the bile specimens were crystallized in this group. In the hepatosteatosis group [4 males and 29 females], 7 had pigment stones, 22 mixed and 4 cholesterol. In the normal liver group [27 males and 121 females], 24 had pigment stones, 99 had mixed stones and 25 had cholesterol stones. Gallbladder bile crystallization in groups II and III matched more with the type of stone than with the liver condition. Stone type and male to female ratio differed significantly between group I and either of groups II and III, whereas the latter two groups were not significantly different