[Plasmatic glutathione levels and their relationships with clinical and therapeutic features in patients with schizophrenia]. / Concentrations plasmatiques des glutathions et leurs corrélations avec les caractéristiques cliniques et thérapeutiques des patients atteints de schizophrénie.

INTRODUCTION: Altered glutathione systems (GSH) are suggested to participate in the pathophysiology of schizophrenia. The purpose of this study was to determine the plasmatic glutathione levels of patients with schizophrenia compared to healthy controls and to examine their relationships with clinical and therapeutic features. METHODS: It was a case-control study carried out on 100 patients with schizophrenia according to DSM-IV-TR criteria and 95 healthy controls. All patients were assessed by Clinical Global Impressions-severity (CGI-severity) and Global Assessment of Functioning (EGF). Most of the patients (55%) were under first-generation antipsychotics. Plasmatic glutathione levels (total glutathione GSHt, reduced glutathione GSHr, oxidized glutathione GSSG) were determined by spectrophotometry. RESULTS: The levels of GSHt and GSHr were significantly decreased in schizophrenic patients in comparison with the healthy controls. These reductions were noted to be more pronounced in the untreated patients. No correlation was observed between the GSH levels and the clinical subtypes of schizophrenia and EGF scores. Depending on the therapeutic status, there were no significant differences in the GSH levels. In addition, there was no correlation between the GSH levels and the daily dosage of the antipsychotic treatment. CONCLUSION: Our results suggest that the observed changes are related to the physiopathology of schizophrenia rather than to the presence of neuroleptic treatment. These results provide support for further studies of the possible role of antioxidants as neuroprotective therapeutic strategies.

Multiresistance and endemic status of acinetobacter baumannii associated with nosocomial infections in a tunisian hospital: a critical situation in the intensive care units

Acinetobacter baumannii is often implicated in hospital outbreaks in Tunisia. It's a significant opportunistic pathogen associated with serious underlying diseases such as pneumoniae, meningitis and urinary tract infections. The aim of our study was to evaluate its degree of endemicity and its antibiotic resistance evolution essentially in the unit care where its isolation was predominant (57 percent). This study used 3 methods: antibiotyping, RAPD using 2 primers VIL 1, VIL5 and PFGE with ApaI restriction enzyme. The presence of integron1 and 2 was also studied. Antibiotyping showed that 92 percent of patients were resistant of all ß- lactams (except Imipenem) and that the resistance to Imipenem occurred in 47 percent of cases. RAPD profiles obtained with the 2 arbitrarily primers VIL1 and VIL5 gave respectively 5 and 4groups and PFGE fingerprinting patterns revealed 22 different pulsotypes. Integron 1 was present in 25 percent of unrelated strains and type 2 integron was not detected in any of the studied strains. Among 204 strains, multiple and heterogeneous groups were detected with the genomic studies. In addition, any correlation was obtained with the antibiotyping results. These findings demonstrate the endemic status of A. baumannii in our hospital and the persistence of a large number of multiresistant strains in the unit's care. When outbreaks of A. baumannii occur, it's essential to develop restricted hygiene procedures and a serious surveillance of critical units such as ICU for very ill patients.

[Prevalence of hepatitis G, B and C virus infections among positive HIV population in a Tunisian Hospital, La Rabta, Tunis]. / Prévalence de l'hépatite G et des hépatites virales B et C dans la population VIH (+) de l'hôpital La Rabta, Tunis, Tunisie.

OBJECTIVE: The viral hepatitis G and HIV coinfection has been largely treated in the litterature. The aim of this study was to evaluate the coinfection rate in our hospital and to compare the HGV frequency to other hepatitis viruses (B and C) in positive HIV subjects at the Rabta hospital in Tunis, Tunisia. PATIENTS AND METHODS: The studied population included 125 HIV positives patients from the infectious diseases unit. The detection of the hepatitis B and C was carried out using serologic test (Elisa-Biorad). The molecular detection of the HGV was realized by reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: The prevalence of serological markers of hepatitis B (antibodies and/or antigens) and C (antibodies) was respectively 32.25% and 26.4%. HGV RNA was detected in 36.8% of the studied population. The unprotected intercourse was the predominant risk factor of the HGV contamination. Among the HGV (+) patients, 28.2% were carriers of the hepatitis C antibodies (anti-HCV). CONCLUSION: This work was the first study enabling to assess the coinfection rate of viral hepatitis B, C and G with HIV patients (+) in Rabta Hospital. The regular screening of HGV is recommended regarding its high frequency and the possibility of its pathogenic role.

[Detection of the first strain of glycopeptide intermediary Staphylococcus aureus in Tunis Rabta hospital]. / Détection de la première souche de Staphylococcus aureus de sensibilité diminuée aux glycopeptides à l'hôpital la Rabta de Tunis.

Since the advent of the first glycopeptide intermediately susceptible Staphylococcus aureus (GISA) and its heterogeneous variant hGISA in 1997, debate still ensues as their clinical significance. We report here the first case of GISA in Rabta hospital of Tunisia. Antimicrobial resistance was determined by the disk diffusion method in accordance with CA-SFM (Comity of Antibiogramm of French society of Microbiology). The MIC of vancomycin and teicoplanin was determined by E-test. The detection of mec A gene, virulence factors genes and agr groups (1-4) was performed by multiplex PCR. spa types were determined with the assistance of Ridom of Staph Type software (Ridom GmbH, Wurburg, Germany). The allelic profiles of MRSA were assigned on the basis of their MLST type using the eBURST program. A MRSA bacteraemia patient was treated with teicoplanin for 14 days. S. aureus isolated from patient's blood culture was identified as MRSA and GISA with teicoplanin MIC of 16 mg/l. The molecular study of this strain showed that it belongs to the clonal complex CC8 and is attached to the iberian clone (agr1, enterotoxin A, ST 247, spa type t052). Clinicians and laboratories alike are increasingly aware that patients on long-term vancomycin therapy may signal the presence and potential spread of hGISA/GISA strains. hGISA/GISA strains emerged from lineages with agr types I and II. The multiresitance of the Iberian clone ST247 could be explained by the presence of several resistance genes.

Multiresistance and endemic status of acinetobacter baumannii associated with nosocomial infections in a tunisian hospital: a critical situation in the intensive care units.

Acinetobacter baumannii is often implicated in hospital outbreaks in Tunisia. It's a significant opportunistic pathogen associated with serious underlying diseases such as pneumoniae, meningitis and urinary tract infections. The aim of our study was to evaluate its degree of endemicity and its antibiotic resistance evolution essentially in the unit care where its isolation was predominant (57%). This study used 3 methods: antibiotyping, RAPD using 2 primers VIL 1, VIL5 and PFGE with ApaI restriction enzyme. The presence of integron1 and 2 was also studied. Antibiotyping showed that 92% of patients were resistant of all ß- lactams (except Imipenem) and that the resistance to Imipenem occurred in 47% of cases. RAPD profiles obtained with the 2 arbitrarily primers VIL1 and VIL5 gave respectively 5 and 4groups and PFGE fingerprinting patterns revealed 22 different pulsotypes. Integron 1 was present in 25% of unrelated strains and type 2 integron was not detected in any of the studied strains. Among 204 strains, multiple and heterogeneous groups were detected with the genomic studies. In addition, any correlation was obtained with the antibiotyping results. These findings demonstrate the endemic status of A. baumannii in our hospital and the persistence of a large number of multiresistant strains in the unit's care. When outbreaks of A. baumannii occur, it's essential to develop restricted hygiene procedures and a serious surveillance of critical units such as ICU for very ill patients.

First report of molecular characterization of fluoroquinolone-resistant Mycobacterium tuberculosis isolates from a Tunisian hospital.

Fluoroquinolones are increasingly used for the treatment of infections caused by multidrug-resistant Mycobacterium tuberculosis. Our study was designed to determine the frequency of the emergence of ciprofloxacin-resistant isolates in a university hospital (Rabta University Hospital Tunis, Tunisia) and to characterize the mutations responsible for the resistance phenotype. A total of 495 clinical M. tuberculosis isolates obtained from January 2005 to July 2008 were investigated for their susceptibility to ciprofloxacin, using the standard proportion method, PCR and DNA sequencing. Four resistant isolates (0.8%) were identified. Among these, only two carried point mutations in gyrA leading to amino acid changes other than the phenotypically silent S95T substitution. No gyrB missense mutations were found in any of the clinical isolates. Although fluoroquinolone resistance is still rare in Tunisia, accurate surveillance is needed in order to control the possible emergence of resistance to fluoroquinolones, which are essential for the successful treatment of multidrug-resistant tuberculosis.

Seroprevalence of Helicobacter pylori among Tunisian blood donors (outpatients), symptomatic patients and control subjects.

OBJECTIVES: Helicobacter pylori is a worldwide infection, although little data are available in the Tunisian population. The aims of our study were to detect the prevalence of H. pylori in a blood-donor population (n=250) and in another population of hospital-consulting patients comprising 87 symptomatic patients and 59 controls, and to determine the factors that influence the prevalence. MATERIALS AND METHODS: Study subjects answered a standardized questionnaire, and IgG anti-H. pylori and anti-cag were detected by ELISA. In the second population, culture and cagA polymerase chain reaction were performed. RESULTS: The seroprevalence of H. pylori in blood donors was 64%, and 11% had anti-cag. All patients positive for anti-cag were also positive for anti-H. pylori antibodies. The seroprevalence of H. pylori was 99.3% in the hospital-consulting patients, of whom 55.5% were positive for anti-cag. The difference between the anti-cag and symptomatic patients (66.7%) and controls (39%) was significant. Symptomatic patients had a higher rate of anti-cag (66.7%) compared with the controls (39%) and blood donors (11%). CONCLUSION: H. pylori seroprevalence in blood donors is low (64%) compared with symptomatic patients (99.3%), and anti-cag was statistically associated with symptomatic patients and pathology. Also, some environmental factors were correlated with H. pylori seroprevalence.

[Clinical manifestations, complications and treatment of brucellosis: 45-patient study]. / Aspects cliniques, microbiologiques et thérapeutiques de la brucellose : étude de 45 cas.

The aim of this study was to evaluate the clinical, laboratory findings and therapeutic features of patients with brucellosis. The diagnosis was made by clinical findings, automated blood culture, serology (Rose Bengal plate agglutination test, standard tube agglutination (Wright) and immunofluorerescence). The susceptibility of 13 strains was tested in vitro. The base sequence was determined for four strains. Forty-five cases were collected (31 acute and 14 sub-acute). Contamination was digestive in 62%. Symptoms of patients were fever (93%), sweating (82%), arthralgia (78%) and splenomegaly (51%). Elevated erythrocyte sedimentation rate was determined in 80%, leukopenia in 49% and anaemia in 37% of cases. Blood cultures were positives in 39% of cases. The four sequenced strains were identified as Brucella melitensis biovar abortus. Six strains were resistant to sufomethoxazol-trimetoprim (54%). In 93% of cases, the treatment was associated rifampicin and doxycyclin. One patient died. No relapse was reported.

Syndromic approach to sexually transmitted infections in Tunisian women: bacteriological validation.

The World Health Organization emphasizes an integrated primary care approach using syndromic management of sexually transmitted infections. The objective of our study was to evaluate the quality of care of the syndromic management of sexually transmitted disease in women in Rabta hospital in Tunisia. Algorithms have been developed for: cervicitis due to Neisseria gonorrhoeae or Chlamydia (algorithm 3a), vaginitis due to Trichomonas vaginalis or Chlamydia trachomatis (algorithm 3b) and vaginitis due to Candida (algorithm 3c). A total of 116 women were enrolled in the study during February 2003 to April 2004. The prevalence of each bacterium was Chlamydia (10%), N. gonorrhoeae (1%), Treponema pallidum (1%), T. vaginalis (5%) and Candida (21%). Algorithm '3a' had a sensitivity of 45%, a specificity of 42% and positive predictive value (PPV) of 11.9%. Algorithm '3b' had a sensitivity of 35.7%, a specificity of 68.9% and PPV of 20.8%. Algorithm '3c' had a sensitivity of 12%, a specificity of 88% and PPV of 33.3%. To improve the sensitivity of the syndromic approach, we suggest improving the quality of history taking.

Phenotypic and molecular epidemiology of Acinetobacter baumannii strains isolated in Rabta Hospital, Tunisia.

Acinetobacter baumannii (A. baumannii) is often implicated in hospital outbreaks in Tunisia. It's a significant opportunistic pathogen that is usually associated with serious underlying diseases such as pneumoniae, meningitis and urinary tract infections. The aim of this prospective study was to evaluate the global state of its endemicity and the antibiotic resistance evolution. The possibility of nosocomial transmission of one or more epidemic strain(s) was investigated by means of 3 methods: biotyping, antibiotyping and Random Amplified Polymorphic DNA analysis (RAPD). MIC for imipenem by Ellipsometer-test strip (E-TEST). The presence of metallo-beta-lactamases (MBL) was detected according to the double synergy test of EDTA and imipenem disks. A. baumannii strains were mainly localized in intensive care (52.2%) and surgery units (23.6%). Among 224 strains that were studied, 4 biotypes were delineated with a predominance of biotype1. Resistance to beta-lactams was mostly associated with the production of cephalosporinases and penicilinases (84.3%). 45% of strains were resistant to imipenem which were associated with MBL production. RAPD gave 5 genomic groups. This study demonstrates the epidemic behaviour airborne spread of A. baumannii in hospital wards. The multiresistance was often responsible for failure of antibiotics therapy. The prevention of nosocomial infection and severe hygiene controls must be performed.

Diversity of structures carrying the aac(6')-aph(2") gene in clinical Enterococcus faecalis and Enterococcus faecium strains isolated in Tunisia.

The diversity of structures carrying the aac(6')-aph(2") gene was studied in 46 high-level gentamicin-resistant Enterococcus faecalis and Enterococcus faecium clinical strains recovered in a Tunisian hospital during the period 2000-2003. The inclusion of the aac(6')-aph(2") gene within the Tn4001 composite element or in its truncated forms (lacking the IS256 at the right, the left or at both sides of the aac(6')-aph(2") gene) was investigated by PCR and sequencing. The aac(6')-aph(2") gene was included in the composite Tn4001 element in 19 of 34 high-level gentamicin-resistant E. faecalis strains (56%) and in 1 of 12 E. faecium strains (12%). A truncated form of Tn4001 lacking IS256 at the left-hand (in 10 E. faecalis and 8 E. faecium), at the right-hand (3 E. faecalis and 2 E. faecium) or at both sides of the aac(6')-aph(2") gene (in 2 E. faecalis and 1 E. faecium) was also detected in 26 of our enterococci. The transference by conjugation of the aac(6')-aph(2") gene, associated with other resistance genes, was demonstrated in seven of the high-level gentamicin-resistant E. faecalis strains.

[Oxidative stress involvement in schizophrenia pathophysiology: a review]. / Implication du stress oxydant dans la physiopathologie de la schizophrénie: revue de la littérature.

BACKGROUND: Schizophrenia is a devastating psychiatric disorder with a broad range of behavioural and biologic manifestations. There are several clinical characteristics of the illness that have been consistently associated with poor premorbid adjustment, long duration of psychosis prior to treatment and prominent negative symptoms. The etiopathogenic mechanisms of lack of insight in patients with schizophrenia are to date unknown, although several hypotheses have been suggested. A point of convergence for the theoretical models occurs with regard to the neuronal membrane. Neuronal membrane contains a high proportion of polyunsaturated fatty acid and is the site for oxidative stress. Oxidative stress is a state when there is unbalance between the generation of reactive oxygen species and antioxidant defence capacity of the body. It is closely associated with a number of diseases including Parkinson's disease, Alzheimer-type dementia and Huntington's chorea. Accumulating evidence points to many interrelated mechanisms that increase production of reactive oxygen or decrease antioxidant protection in schizophrenic patients. OBJECTIVES: This review aims to summarize the perturbations in antioxidant protection systems during schizophrenia, their interrelationships with the characteristic clinics and therapeutics and the implications of these observations in the pathophysiology of schizophrenia are discussed. LITERATURE FINDINGS: In schizophrenia there is evidence for deregulation of free radical metabolism, as detected by abnormal activity of critical antioxidant enzymes (superoxide dismutase, glutathione peroxidase and catalase). Many studies conclude in the decrease in the activity of key antioxidant enzymes in schizophrenia. A few studies have examined levels of non enzymatic antioxidants such as plasma antioxidant proteins (albumin, bilirubine, uric acid) and trace elements. How showed decreased levels in schizophrenic patients. Others studies have provided evidence of oxidative membrane damage by examining levels of lipid peroxidation products. Such abnormalities have been associated with certain clinical symptoms and therapeutic features. Negative symptoms have been associated with low levels of GSH-Px. Positive symptoms have been positively correlated with SOD activity. Plasma TAS was significantly lower in drug-free and haloperidol treated patients with schizophrenia. A low erythrocyte SOD activity has been found in never-treated patients, but with haloperidol treatment, SOD activity increased. DISCUSSION: These results demonstrate altered membrane dynamics and antioxidant enzyme activity in schizophrenia. Membrane dysfunction can be secondary to free a radical-mediated pathology, and may contribute to specific aspects of the schizophrenia symptomatology. Membrane defects can significantly alter a broad range of membrane functions and presumably modify behavior through multiple downstream biological effects. Phospholipid metabolism in the brain may be perturbed in schizophrenia, with reduced amounts of phosphatidylcholins and phosphatidylethanolamine in post-mortem brain tissue from schizophrenic patients, and large amounts of lipofuscin-like materiel in the oligodendrocytes. The existence of these products within cell membranes results in an unstable membrane structure, altered membrane fluidity and permeability and impaired signal transduction. Recent findings suggest that multiple neurotransmitter systems may be faulty. CNS cells are more vulnerable to the toxic effects of free radicals because they have a high rate of catecholamine oxidative metabolic activity. Neurotransmitters, like glutamate, can induce the same metabolic processes that increase free radical production and can lead to impaired dopamine-glutamate balance. These results question the role of this imbalance in the biochemical basis evoked in the etipathogenic mechanisms of schizophrenia, as well as the role of antioxidants in the therapeutic strategy and their implication in preventive and early intervention approaches in populations at risk for schizophrenia.

[Leprosy revealed by oedema of the hands]. / Lèpre lépromateuse révélée par un oedème des mains.

BACKGROUND: We reported a case of lepromatous leprosy in a Tunisian woman revealed by a potentially misleading clinical picture involving isolated infiltration of the hands. PATIENTS AND METHODS: A 37 year-old woman consulted in October 2000 for bilateral edema of the hands associated with paraesthesia that had been present for one month. Screening for Hansen's bacilli confirmed the diagnosis of multibacillary leprosy. Daily therapy with triple anti-leprosy treatment was initiated. DISCUSSION: The occurrence of edema, which is classically described as a symptom of a reactional state, can occur during the course of leprosy. Where it is a presenting symptom, this unusual heralding sign can be a source of diagnostic error and delay.

Multicenter pilot survey of resistant bacteria in the Mediterranean area.

With the aim of testing the feasibility of a multiresistant bacteria (MRB) surveillance methodology and evaluating the level of antimicrobial resistance and dissemination of resistant pathogens in the Mediterranean area, a pilot study was carried out in nine university hospitals in Algeria, Tunisia and France. The results indicate that third-generation cephalosporin-resistant Enterobacteriaceae comprise the major MRB in Algerian and Tunisian hospitals. In France, the highest incidence rates were found for methicillin-resistant Staphylococcus aureus, while in Tunisian hospitals, imipenem-resistant Acinetobacter baumannii seems to be a particularly prevalent organism. Although the data were not representative of the participating countries as a whole, the results show the importance and ubiquity of the problem in the area and the feasibility of surveillance.

Antibiotic resistance and mechanisms implicated in clinical enterococci in a Tunisian hospital.

Susceptibility testing for 15 antibiotics was performed in a series of 191 clinical enterococci recovered in a Tunisian Hospital during 2000-2003. Species detected were the following ones (number of isolates): E. faecalis (139), E. faecium (41), E. casseliflavus (5), E. gallinarum (3), E. avium (2) and E. hirae (1). The percentages of antibiotic resistance detected were as follows (E. faecalis/ E. faecium/ other species) : penicillin (0/ 73/ 9%), tetracycline (78/ 44/ 54%), chloramphenicol (52/ 29/ 27%), erythromycin (66/ 100/ 82%), spiramycin (84/ 83/ 64%), pristinamycin (100/ 0/ 73%), trimethoprim-sulfamethoxazole (88/ 78/ 91%), rifampicin (72/ 41/ 0%), vancomycin (0/ 0/ 36%), teicoplanin (0/ 0/ 0%), high-level-resistance for gentamicin (24/ 29/ 45%), streptomycin (34/ 56/ 55%) and kanamycin (41/ 68/ 55%). Increased vancomycin minimum inhibitory concentrations (MICs) were only detected in E. casseliflavus and E. gallinarum isolates (MIC range 8-24 microg/ml). The erm(B), catA, tet(M), aac(6')-aph(2''), aph(3')-IIIa, and ant(6)-Ia genes were detected in 91%, 32%, 86%, 98%, 100%, and 72% of the E. faecium and E. faecalis isolates resistant to erythromycin, chloramphenicol, tetracycline and high-level-resistant to gentamicin, kanamycin and streptomycin, respectively. A total of 20 unrelated pulsed-field-gel-electrophoresis patterns were found in the series of 46 high-level gentamicin-resistant E. faecalis and E. faecium isolates of this study.

[Helicobacter pylori infection: prospective study for asymptomatic Tunisian children]. / Infection à Helicobacter pylori: étude prospective chez les enfants tunisiens asymptomatiques.

UNLABELLED: The aim of this study was to specify epidemiologic particularities of Helicobacter pylori infection among asymptomatic Tunisian children. POPULATION AND METHODS: A sample of 191 Tunisian healthy children studied for a two-month-period of time in protection center for mothers and children in a Tunis area. The children had benefited of an oriented questionnaire and a serological study of Helicobacter pylori. RESULTS: The prevalence of Helicobacter pylori infection was 30.4% (58 of 191). This prevalence increased with age (21% < 5 years vs 69% > 6 years: p < 0.04). The low socio-economic level and the familial antecedents of peptic illness constitute the main risk factors of Helicobacter pylori infection (p < 0.05). Both ways of transmission: oro-oral and fecal-oral seem to coexist among children.

[Vertebral actinomycosis with spinal cord compression. A case report]. / Actinomycose vertébrale avec compression médullaire. A propos d'un cas.

INTRODUCTION: Vertebral involvement of actinomycosis is extremely rare and associated spinal cord compression is unusual. EXEGESIS: We report a case of a 31-year-old man with vertebral actinomycosis presenting with spinal cord compression. Magnetic resonance imaging demonstrated a paravertebral abscess and lytic areas on the vertebral body of C5 requiring emergency surgery and antibiotic treatment. The patient was still asymptomatic after 12 months of follow-up. CONCLUSION: Clinical aspects of this unusual localization are reviewed. Treatment may be particularly difficult.

[Symptomatic Helicobacter pylori infection: prospective study of epidemiological, diagnostic and therapeutic aspects in children in Tunisia]. / L'infection symptomatique à Helicobacter pylori: étude prospective des aspects épidémiologiques, diagnostiques et thérapeutiques chez l'enfant en Tunisie.

BACKGROUND: Epidemiology, criteria for diagnosis and treatment of Helicobacter pylori (HP)-related infection in children are still debated. POPULATION AND METHODS: A total of 130 children and teenagers who presented recurrent episodes of unexplained abdominal pain underwent an endoscopic examination. Gastric biopsies were studied for histology and search for HP (Giemsa and Gram staining, testing for urease and culture in an appropriate environment). Serological tests (Elisa) were performed. HP infection was considered as present when two investigations at least proved positive. Infected children were given one drug (amoxicillin, cimetidine or antiacids) or two drugs (amoxicillin plus tinidazole). Clinical and endoscopic control including histological and bacteriological studies were done for the following 12 to 18 months. RESULTS: HP infection was present in 70 children (54%). It was associated chronic gastritis in 64 cases (91%) and with duodenal ulcer in the remaining cases (9%). Recurrent abdominal pain, anorexia, weight loss and family history of peptic diseases were significantly associated with HP infection (P < 0.05). Endoscopic examination was normal in 35 infected children (50%); nodular antritis was inconstant (30%) but always associated with HP-related infection (P < 0.001) as was atrophic or follicular chronic gastritis. Eradication of HP, associated with the disappearance of chronic gastritis, was seen in 53% of children given amoxicillin alone and in 85% of those given amoxicillin plus tinidazole, but never in those receiving cimetidine or antiacids. Relapse of the HP-related infection was observed in four children (16%), 6 to 12 months after the first episode. CONCLUSION: These results show high prevalence of HP-related infections in the Tunisian children who suffer from recurrent episodes of abdominal pain. They also confirm the role of HP in the inflammatory process and the development of gastroduodenal ulcer in children.