Interferon gamma and regulatory T-Cells and their relation with the pathological grading of gastritis caused by helicobacter pylori

Background: Helicobacter pylori [H.pylori] is a cause of chronic-active gastritis and a majority of cases of peptic ulcer disease. It is also associated with the development of gastric adenocarcinoma, the fourth most common malignancy in the world

Aim of the study: The study aims to detect the level of interferon gamma expression and the percentage of CD4+ CD25+ T regulatory cells in patients with gastritis and their relation to the pathological grading

Methods: Gastric biopsy specimens were taken from the antrum of 30 patiens using upper GIT endoscopy. Rapid urease test [RUT], immunohistochemistry [IHC], and Hematoxylin and Eosin [H and E] stains were used to determine H.pylori status. Evaluation of the histologic features was done using H and E. IFN-gamma mRNA expression in the gastric biopsies was measured using Real-Time PCR. Flowcytometry was used for measuring the percentage of CD4+CD25+regulatory T-ells [T regs] in the peripheral blood of all the patients. The results were compared to 15 healthy control subjects

Results: H.pylori was detected in 56.7% of all patients by RUT and in 93.3% patients by H and E and in 83.3% by IHC,out of them 88% had active gastritis and all of them had chronic gastritis. There was a statistically significant positive correlation between H.pylori positive infection and the pathological grading of active gastritis [p=0.015]. However, there was no statistically significant correlation between H.pylori infection [by IHC] and the pathological grading of chronic gastritis [p=0.334]. No statistically significant difference in the levels of IFN-gamma mRNA expression between H.pylori positive and negative patients was detected. No correlation was found between the levels of IFN-gamma mRNA expression and the severity of either active or chronic gastritis. Similarly, no correlation between the percentage of CD4+ CD25+ T regulatory cells and the severity of either active or chronic gastritis was detected

Conclusion: H.pylori plays an important role in active gastritis lesion. The correlation between IFN-gamma mRNA expression and the severity of active or chronic gastritis was overshadowed by the prevalence of helminthic infection among Egyptian patients. Meanwhile, low levels of T regulatory cells among H.pylori positive and negative gastritis than controls suggests an important role of T regulatory cells in regulating the gastric mucosal inflammatory response

Incidence and risk factors of ventilator associated pneumonia [VAP] in a medical ICU in Cairo

In Egypt, the published data concerning Ventilator-Associated Pneumonia [VAP] rates, microbiological profile, bacterial resistance or any related risk factors associated with VAP incidence are limited. To assess the incidence rate of VAP and to evaluate the associated risk factors in a medical ICU unit in a tertiary care hospital in Cairo. In this prospective study, a total of 271 patients were mechanically ventilated for 3735 days. Lower respiratory tract specimen was obtained through blind [non bronchoscopic] bronchoalveolar lavage using sterile mucous trap. The isolated microorganisms and their antimicrobial sensitivities were identified based on the standard bacteriological procedures. Of 271 patients, 69 developed VAP [25.5%]. The incidence of VAP was 18.47 per 1000 ventilation days. Seventy one isolates were isolated from 69 cases. Klebsiella pneumoniae [K. pneumoniae] was the most commonly identified organism [21.1%], followed by Staphylococcus aureus [S. aureus=19.7%], aeruginosa spp. [18.3%] and Pseudomonas acinetobacter [Ps. aeruginosa=16.9%]. The isolated organisms showed variable antimicrobial resistance patterns. Univariate analysis of risk factors for acquiring VAP; identified increased duration of mechanical ventilation [MV] and reintubation more than two times as significant risk factors [p-value<0.01]. Patients who developed VAP also had significantly longer duration of hospitalization than those who did not. Same results were confirmed by multivariate analysis. ICU-acquired infection is common and often associated with microbiological isolates of resistant organisms. Knowledge of the risk factors associated with VAP incidence may be useful in implementing simple and effective preventive measures

Effect of intrauterine contraceptive device on the vaginal microbial flora: a longitudinal study

Abstract: The vaginal flora contains a large variety of bacterial species, including aerobic and anaerobic organisms, as revealed by modern microbiologic methods. Intra uterine contraceptive device [IUCD] is one of the most popular contraceptive methods used world wide. Use of an IUCD might change the flora of the vagina in favor of the growth of bacteria associated with bacterial vaginosis [BV]. The aim of this study was to detect the changes in the normal vaginal flora and possible association of BV with copper T380A IUCD insertion. This study was a longitudinal study that included 30 women who accepted IUCDs copper T380A as a method of a birth control. All women were scheduled for another visit one month after IUCD insertion. They were interviewed and vaginal swabs were collected before and after IUCD insertion and cultured for aerobic and anaerobic bacteria. Direct smear stained with Gram stain was evaluated using Ison and Hay scoring system. Our study revealed that there was no statistically significant relationship between alteration of vaginal flora and IUCD insertion

Conclusion: IUCD is apparently a safe and cost effective method of contraception if proper selection of candidate and proper practices of insertion was done