Population- and Gender-Based Investigation for Prevalence of Helicobacter pylori in Dhamar, Yemen.

Among 35 species of genus Helicobacter, H. pylori is the most common causative agent of human gastritis, peptic ulcer, and gastric cancer. The infection can spread through direct human-to-human contact, fecal-oral route, and contaminated water. The study was designed to investigate the rate of prevalence of H. pylori in the population of Dhamar, Yemen. In this one-year study, 460 including 250 male and 210 female stool specimens were collected between January to December 2020 in Dhamar Governorate, Yemen. Of the total 460, 215 rural (male: n = 120 and female: n = 95) and 245 urban (male: n = 130 and female: n = 115) specimens were investigated for identification of H. pylori by serological test using Helicobacter pylori stool antigen (HpSA) test. In addition, for comparing an improved recovery of H. pylori, conventional culture-based isolation was also carried out using three selective media. Modified Campy-blood Agar (MCA), Belo Horizonte Agar (BHA), and Egg yolk Emulsion (EYE) medium supplemented with antimicrobial agents including vancomycin (10 mg/L), cefsulodin (5 mg/L), trimethoprim (5 mg/L), and amphotericin B (5 mg/L) and isolates were phenotypically characterized. The HpSA test results revealed that of the total 460 specimens, 89 (19.3%) were positive for H. pylori with relatively low in male (n = 43; 17.2%) as compared to the female (n = 46; 21.9%) specimens. After 3-10 days of incubation, H. pylori was recovered at a variable rate on each selective (MCA: 16.5%; BHA: 15.0%; EYE: 13.0%) media. However, culture-based assay results showed less recovery (n = 81; 17.6%) with no significant difference among all selective media tested and between genders (male: n = 39; 15.6%; female: n = 42; 20.0%). The infection rate was comparatively higher in rural (n = 45; 20.9%) as compared to urban (n = 36; 14.7%) population. Overall, the study data showed the prevalence of infection in both genders of all age groups. The present study showed a relatively high rate of infection of H. pylori in the Dhamar population. The serological identification and culture-based methods are important for rapid detection, aid in treatment, and developing policies for the control and eradication of H. pylori infection and to prevent the disease in different age groups in Yemen.

Pulmonary carcinoid associated with melanoma: two cases and a review of the literature.

To our knowledge, this is the first report in the British literature documenting the co-occurrence of melanoma and pulmonary carcinoid. The only other report is from America and documents pulmonary carcinoid in association with a parathyroid hormone-producing melanoma. We report two patients with melanoma who presented with nodules on chest X-ray. Both underwent resection of assumed lung metastasis which unexpectedly revealed primary pulmonary carcinoid. Evidence of an association between these two tumours which show striking biological and pathological similarities is discussed. The incidence of pulmonary carcinoid is increasing and with the improved power of radiological assessment we may see additional accounts of such an association in the near future.

Panniculitis secondary to extravasation of clarithromycin in a patient with alpha 1-antitrypsin deficiency (phenotype PiZ).

alpha 1-Antitrypsin deficiency (AATD) is known to be associated with panniculitis. Although reports of this association are rare, the true incidence may be unappreciated because of underdiagnosis of AATD. We report a case of panniculitis occurring in a 34-year-old woman with severe AATD following the extravasation of clarithromycin infused intravenously for treatment of community-acquired pneumonia. Resolution occurred with conservative management. The histopathology and management of this unusual condition are discussed, with a review of the literature.

The effect of the microphthalmia gene on pre-natal optic nerve development in the mouse.

The purpose of this study was to examine the effect of the microphthalmia gene on pre-natal optic nerve development in the mouse. Coronal serial sections of wild-type, heterozygote and homozygous microphthalmic embryonic optic nerves are examined throughout gestation. No obvious morphological abnormality was identified in the heterozygote. The microphthalmic optic stalk/nerve was larger than that of the wild-type and heterozygote and there was persistence of the optic stalk throughout gestation. This was due to a high mitotic rate and reduced cell death in the dorsal layer of the microphthalmic optic stalk as well as persistence of the optic ventricle throughout gestation. The latter was associated with persistence of intermediate-type junctions between the neuroepithelial cells lining the ventricle and failure of the cells on the dorsal aspect of the distal stalk to degenerate. Possible mechanisms for the disappearance of the optic ventricle in the normal optic stalk are suggested.

The prenatal development of the optic fissure in colobomatous microphthalmia.

The coloboma in the cinnamon mouse homozygous for the microphthalmia gene is caused when optic fissure closure, which normally occurs between the 11th and the 13th gestational day, does not occur. This study sought to determine the cause of this fusion failure, and to identify any foci of fusion that occur later in gestation. Microphthalmic fetuses from the 11th-20th gestational day were obtained by datemating cinnamon mice heterozygous for the microphthalmia gene. Coronal serial sections of the eyes were examined at light and electron microscopy. Initially, the fissure margins became apposed only in the posterior aspects of the eye. A failure of basement membrane disintegration at the fissure margins prevented fusion at the 12th and 13th days. On the 14th day, small foci of basement membrane disintegration were identified in the area of the developing optic disc. Although the fusion zone enlarged later in gestation, it was limited to the area of the optic disc and showed that the two retinal layers did not separate. This study has shown that abnormal growth and invagination lead to delayed apposition of the optic fissure margins. These features together with a failure of basement membrane disintegration appear to be the main factors involved in coloboma formation. It is suggested that the excessive number of outer-layer cells that are inverted into the fissure, as well as abnormal or reduced numbers of phagocytic cells, may affect the persistence of the basement membrane. Alternatively, a primary defect of the pigment epithelial cell may lead to the development of the hypercellular and nonpigmented outer layer associated with the lack of basement membrane disintegration and nonfusion in this mutant.

Optic fissure closure in the normal cinnamon mouse. An ultrastructural study.

The purpose of this study was to determine the ultrastructural features of optic fissure closure. Serial coronal sections of fetal eyes from the eleventh to the thirteenth gestational day were examined by light and electron microscopy. Fusion was associated with inversion of the retinal pigment epithelium at the optic fissure and it occurred first between undifferentiated cells at the junction of the retina and retinal pigment epithelium. It later extended to involve the entire thickness of the pigment epithelium and neuroretina, with the inner aspect of the latter being the last area to fuse. There was some evidence that closure does not always start at the center of the fissure as generally described, but may sometimes start near the developing papilla. At an ultrastructural level, there was multifocal disintegration of the basement membrane associated with the formation of cytoplasmic processes at these sites. Simple appositional contacts between processes on either side of the fissure comprised the first stages of fusion. Later intermediate-type junctions were formed between adjacent outer retinal cells (presumptive photoreceptors) and junctional complexes were formed at the apices of pigment epithelial cells at the site of fusion. This suggests an increase in mechanical adherence between cells. While basement membrane disintegrated at the center of the fusion site, there was a continuous layer of basement membrane at the internal and external limits of fusion. Cell death together with two morphological types of phagocytic cells were a constant feature at the fissure margins before, during and after fusion. The possible origins and roles of these cells in the fusion process is discussed.

The optic fissure in the normal and microphthalmic mouse.

The gene for microphthalmia in the homozygous cinnamon mouse produces colobomatous microphthalmia due to failure of closure of the optic fissure. Optic fissure formation and closure were examined in control cinnamon and homozygous microphthalmic foetuses from the 10th to the 13th gestational day using light and electron microscopy. This study showed that basal lamina degeneration and cell death occurred in the area of fusion in the control eyes. Examination of the optic fissure in homozygous microphthalmic foetuses showed cell death in the fissure margins, but there was failure of optic fissure closure associated with persistence of the basal lamina. It is therefore suggested that absence or abnormality of programmed disintegration of the basal lamina prevents fusion in the mutant leading to the development of colobomatous microphthalmia.