Helicobacter pylori outer membrane protein Q genotypes and their susceptibility to anti-adhesive phytotherapeutic agents / 中西医结合学报

<p><b>OBJECTIVE</b>Helicobacter pylori is a Gram-negative organism. Its outer membrane protein Q (HopQ) mediates host-pathogen interactions; HopQ genotypes 1 and 2 are found associating with gastroduodenal pathologies. The authors measured the anti-adhesion effects of the extracts of Abelmoschus esculentus, Zingiber officinale, Trachyspermum ammi, Glycyrrhiza glabra, Curcuma longa and Capsicum annum against HopQ genotypes and H. pylori cytotoxin-associated gene A (CagA).</p><p><b>METHODS</b>DNA was extracted by polymerase chain reaction of the HopQ genotypes (i.e., type 1, type 2 and CagA) from 115 H. pylori strains. The effect of the extracts from selected dietary ingredients was determined using a gastric adenocarcinoma cell line and a quantitative DNA fragmentation assay. The anti-adhesive effect of these extracts on H. pylori was tested using an anti-adhesion analysis.</p><p><b>RESULTS</b>C. annum, C. longa and A. esculentus showed prominent anti-adhesion effects with resultant values of 17.3% ± 2.9%, 14.6% ± 3.7%, 13.8% ± 3.6%, respectively, against HopQ type 1 and 13.1% ± 1.7%, 12.1% ± 2%, 11.1% ± 1.6%, respectively, against HopQ type 2. C. longa (93%), C. annum (89%) and A. esculentus (75%) had better anti-adhesive activity against H. pylori with HopQ type 1 compared to HopQ type 2 with respective values of 70%, 64% and 51%. Extracts of C. annum (14.7% ± 4.1%), A. esculentus (12.3% ± 4.1%) and Z. officinale (8.4% ± 2.8%) had an anti-adhesion effect against CagA-positive H. pylori strains compared to CagA-negative strains.</p><p><b>CONCLUSION</b>The anti-adhesion properties of the tested phytotherapeutic dietary ingredients were varied with HopQ genotypes. HopQ type 1 was found to be more sensitive to extracts of C. annum, C. longa and A. esculentus compared to the HopQ type 2 genotype.</p>

Perception and knowledge about dietary intake in patients with liver cirrhosis and its relationship with the level of education

To determine patients perception and knowledge regarding diet in cirrhosis and its relationship with the level of patients education. Cross-sectional observational study. This study was conducted at Gastroenterology Outpatient Clinics at the Aga Khan University Hospital, Karachi, the Aga Khan Health Services, Malir, Karachi and Hamdard University, Karachi, from January to December 2010. Consecutive adult patients with compensated cirrhosis were enrolled. Demographic data, level of education, type and reason of food restriction as well as the source of dietary information was asked. Baseline laboratory test were performed, and nutritional status was assessed by BMI normogram. Ninety patients, 58% male were enrolled. Mean age of the patient was 49 +/- 11 years. Overall 73% of the patients were restricting fat, meat, fish and eggs in their diet; 53% were in uneducated group and 47% were in educated group [CI, 0.24-1.62, p-0.34]. Twenty two patients [62.8%] in uneducated and 21 in educated group [68%] were restricting diet on the advice of their doctors, whereas 13 in uneducated group [37%] and 11 in educated group [32%] believed these dietary components to be harmful for the liver. Thirty two of uneducated patient [71.1%] and 28 of educated patients [62.2%] believed that vegetables, fruits and sugarcane had a beneficial effect on the liver. Main source of dietary information to the patients was the doctor. On sub-group analysis those who restricted diet irrespective of their educational level, had more patients with BMI less than 18.5 kg/m[2], [CI 0.01-0.94, p-0.001], haemoglobin less than 12 g/dl [CI 0- 0.03, p-0.001] and serum albumin less than 3 g/dl [CI 0.1- 03, p-0.001]. Both educated and uneducated classes of the patients have improper knowledge and perception of diet in cirrhosis. Patients with cirrhosis who restricted diet, had relatively low BMI, haemoglobin and albumin as compared to those who did not restrict. Main source of dietary information to cirrhotic patients were health care personnels

Small intestinal bacterial overgrowth and lactose intolerance contribute to irritable bowel syndrome symptomatology in Pakistan

The symptoms of irritable bowel syndrome resemble those of small intestinal bacterial overgrowth [SIBO]. The aim of this study was to determine the frequency of SIBO and lactose intolerance [LI] occurrence in patients with diarrhea-predominant irritable bowel syndrome [IBS-D] according to Rome III criteria. In this retrospective case-control study, patients over 18 years of age with altered bowel habit, bloating, and patients who had lactose Hydrogen breath test [H2 BT] done were included. The "cases" were defined as patients who fulfill Rome III criteria for IBS-D, while "controls" were those having chronic nonspecific diarrhea [CNSD] who did not fulfill Rome III criteria for IBS-D. Demographic data, predominant bowel habit pattern, concurrent use of medications, etc., were noted. Patients with IBS-D were 119 [51%] with a mean age of 35 +/- 13 years, while those with CNSD were 115 [49%] with mean age 36 +/- 15 years. Patients in both IBS-D and CNSD were comparable in gender, with male 87 [74%] and female 77 [64%]. SIBO was documented by lactose H2 BT in 32/234 [14%] cases. It was positive in 22/119 [19%] cases with IBS-D, while 10/115 [9%] cases had CNSD [P = 0.03]. LI was positive in 43/234 [18%] cases. Of these, 25/119 [21%] cases had IBS-D and 18/115 [16%] cases had CNSD [P = 0.29]. SIBO was seen in a significant number of our patients with IBS-D. There was no significant age or gender difference in patients with or without SIBO

Model for end-stage liver disease [MELD] score as a useful prognostic marker in cirrhotic patients with infection

To determine the association of Model for End stage liver disease [MELD] score to the outcome of cirrhotic patients with bacterial infection and to compare it with Child-Turcott-Pugh [CTP] score. Descriptive study. The Aga Khan University Hospital, Karachi, from January 2005 to December 2007. Patients with diagnosis of liver cirrhosis and bacterial infection were included. Demographic features, laboratory data and type of infection were recorded. Multiple logistic regression assays were applied to determine the factors associated with poor outcome in cirrhotics with infection. Receiver-Operating Characteristics [ROC] were used to determine the cut-off values of CTP score and MELD score with the best sensitivity and specificity. A total of 530 patients, 313 male [59%] with a mean age of 53 +/- 13 years were analyzed. Spontaneous bacterial peritonitis was the predominant infection seen in 369 [69%] patients. One hundred and eighty six [35%] patients died. Factors associated with poor outcome were a CTP score of more than 11 [p=0.001], raised blood urea nitrogen [p=0.020], raised creatinine [p=0.004], shock [p=0.002], and MELD score > 22 [p=0.03]. An eight percent increase in mortality rate was noticed with every one point rise in MELD score above 22. ROC curve showed that the specificity of CTP and MELD score to predict poor outcome in these patients was 36% and 59% respectively. Child-Turcott-Pugh score more than 11, raised BUN and creatinine, shock and high MELD score were poor prognostic markers in cirrhotic patients with infection. MELD score had better specificity than CTP score in determining outcome

Interferon alpha - induced psychotic disorder in patient with chronic hepatitis B

Interferon has remained the mainstay for treating patients suffering from chronic viral hepatitis. However, its efficiency has been limited by the neuropsychiatric side effect profile that it carries; neurotransmitter alterations in the central nervous system [CNS] have been correlated to psychiatric complications of Interferon alpha. Although mood disorders such as depression occasionally develop during Interferon alpha therapy, psychotic disorders have been rarely reported. We present a case of Interferon alpha 2b induced psychotic symptoms in a young male with hepatitis B and review the relevant literature