Detection and distribution of anti-leptospiral antibody among dogs and their handlers.

The incidence of leptospirosis seems to be on the rise and could be an alarming indirect indication of a global re-emergence. It is a potential public health threat when dogs are speculated to be involved in the transmission of leptospirosis through possible subclinical harbouring of Leptospira spp. and subsequent shedding into the environment. This study aimed to detect anti-leptospiral antibodies among dogs and their handlers using the microscopic agglutination test (MAT). Blood samples from 266 apparently healthy dogs and 194 dog handlers were collected at four working dog organisations and four dog shelters. Serum samples were tested using MAT against 20 leptospiral serovars with a cut-off titre >=1:100 (dog) and >=1:50 (dog handlers). Seventy dogs (70/266; 26.3%) were seropositive mainly against serovars Icterohaemorrhagiae, Ballum, Bataviae and Javanica (titres ranged: 1:100-1:800). Sixty-seven dog handlers (67/194; 34.5%) were seropositive mainly against serovars Grippotyphosa, Icterohaemorrhagiae and Malaysia (titres ranged: 1:50-1:200). Dogs were seropositive due to exposure, vaccination or active infection. Seropositive dog handlers could indicate exposure or active infection. This shows the potential of dogs in maintaining and spreading the infection in Malaysia. Due to the occupational risk as a result of frequent contact with dogs and exposure to contaminated environments, dog handlers should be made aware of the presence of this zoonotic disease.

The Influence of Ficus deltoidea in Preserving Alveolar Bone in Ovariectomized Rats.

Ficus deltoidea has been shown to possess antioxidant properties that could prevent the development of chronic inflammatory bone diseases. In this study, the efficacy of F. deltoidea in preventing alveolar bone resorption in osteoporotic rats induced by ovariectomy (OVX) was investigated. Twenty-four female Wistar rats were divided into four groups (n = 6) consisting of sham-operated (SO), ovariectomized control (OVXN), ovariectomized treated with estrogen (OVXP), and ovariectomized treated with F. deltoidea extract (OVXF). At the beginning of the study, two nonovariectomized, healthy rats were sacrificed to serve as baseline (BL). Treatment of the rats commenced two weeks after ovariectomy-the OVXP rats that served as positive control received Premarin® (64.5 µg/kg body weight), while OVXF rats were given F. deltoidea (800 mg/kg body weight); both agents were administered orally for two months. The negative control group of rats (OVXN) and the SO group received deionized water, also administered via oral gavage. At necropsy, morphometric assessment of the interradicular bone of the first molar was carried out using a micro-CT scanner, while quantification of osteoclasts and osteoblasts was performed histologically. The results showed that no statistically significant differences among the groups (p > 0.05) for bone morphometric assessment. However, trabecular thickness in the OVXF group was similar to BL, while trabecular separation and alveolar bone loss height were lower than those of the OVXN group. Histologically, the OVXF group demonstrated a significantly lower number of osteoclasts and a higher number of osteoblasts compared with OVXN (p=0.008 and p=0.019, respectively; p < 0.05). In conclusion, F. deltoidea has the capacity to prevent alveolar bone loss in ovariectomy-induced osteoporosis rats by potentially preserving trabecular bone microarchitecture and to decrease osteoclast and increase osteoblast cell count.

Detection and distribution of anti-leptospiral antibody among dogs and their handlers

@# The incidence of leptospirosis seems to be on the rise and could be an alarming indirect indication of a global re-emergence. It is a potential public health threat when dogs are speculated to be involved in the transmission of leptospirosis through possible subclinical harbouring of Leptospira spp. and subsequent shedding into the environment. This study aimed to detect anti-leptospiral antibodies among dogs and their handlers using the microscopic agglutination test (MAT). Blood samples from 266 apparently healthy dogs and 194 dog handlers were collected at four working dog organisations and four dog shelters. Serum samples were tested using MAT against 20 leptospiral serovars with a cut-off titre >1:100 (dog) and >1:50 (dog handlers). Seventy dogs (70/266; 26.3%) were seropositive mainly against serovars Icterohaemorrhagiae, Ballum, Bataviae and Javanica (titres ranged: 1:100–1:800). Sixty-seven dog handlers (67/194; 34.5%) were seropositive mainly against serovars Grippotyphosa, Icterohaemorrhagiae and Malaysia (titres ranged: 1:50–1:200). Dogs were seropositive due to exposure, vaccination or active infection. Seropositive dog handlers could indicate exposure or active infection. This shows the potential of dogs in maintaining and spreading the infection in Malaysia. Due to the occupational risk as a result of frequent contact with dogs and exposure to contaminated environments, dog handlers should be made aware of the presence of this zoonotic disease.

Seroprevalence of Leptospirosis in Working Dogs.

Working dogs are canine animals that have been trained to assist human beings in carrying out various tasks. They help in guarding property, performing rescues, assisting the visually impaired or physically handicapped, searching for drugs, explosives, and others. Leptospirosis is one of the most widespread zoonotic diseases in the world and a commonly occurring disease of the tropics and subtropics. In Malaysia, all working dogs are normally vaccinated with serovars, Pomona, Icterohaemorrhagiae, Canicola, and Grippotyphosa based on protocols recommended from other countries. The duration of immunity in vaccinated dogs for Leptospira can last up to 13 months; however, there is no full crossprotection between the different serovars. Five representative canine units from different government agencies in Malaysia (n = 96 dogs) were recruited in this study. For detection, the microscopic agglutination test was performed by incubating the serum from dogs with various serovars of leptospires, namely, Icterohaemorrhagiae, Canicola, Pomona, Grippotyphosa, Australis, Bataviae, Javanica, Tarassovi, Hebdomadis, Lai, and Pyrogenes. The plasma obtained was used for polymerase chain reaction (PCR) analysis, for the detection of 16S rRNA, and lipL 32 genes of Leptospira. Out of the 96 dogs sampled, only 3 dogs were positive toward serovars, Australis, Bataviae, and Javanica, based on the cutoff point at 1:80. The seroprevalence of canine leptospirosis in this population was 3.1% (n = 3/96). However, all 96 blood samples of working dogs tested negative for both pathogenic and nonpathogenic Leptospira genes. The results revealed that, by vaccination alone, working dogs were not fully protected against leptospirosis and could pose a risk to dog handlers. A preventative and control protocol for leptospirosis is warranted, and its implementation should be monitored and improved accordingly from time to time, in order to maintain a healthy condition in both working dogs and their handlers.

Canine vector borne diseases of zoonotic concern in three dog shelters in Peninsular Malaysia: The importance of preventive measures.

This study investigated canine vector borne diseases (CVBDs) of zoonotic significance in three major shelters in Peninsular Malaysia in order to highlight the importance of shelter management in diseases prevention. Since crowded housing has the potential to bring vectors and infected dogs into close proximity, the prevalence of CVBDs infection is always higher in sheltered dogs in comparison to pet dogs. Serum was collected from 90 adult dogs (30 from each shelter) from three shelters in different regions of Peninsular Malaysia (Shelter A, B and C). The prevalence of Dirofilaria immitis, Ehrlichia canis, E. ewingii, Anaplasma phagocytophilum, A. platys and Borrelia burgdorferi in dogs residing in three shelters with different management protocols was investigated by using rapid clinical test kits, SNAP® 4Dx® Plus (IDEXX Laboratories, Westbrook, ME). The most common pathogen detected was Ehrlichia spp. (55.6%, 50 out of 90 dogs), followed by Anaplasma spp. (16.7%; 15 out of 90 dogs). Dirofilaria immitis could only be detected in one of the shelters (10.0%; nine out of 90 dogs). No evidence of B. burgdorferi was detected in all three shelters. Forty one out of 90 dogs (45.6%) were infected with at least one pathogen meanwhile 14 out of 90 dogs (15.6%) were infected with more than one pathogen. It is of crucial importance to practice preventive measures during the admission of the new animals into the facilities. Occasional treatment of the dogs (as practiced in Shelter B) was not effective when compared to scheduled preventive measures. Future studies should emphasize the isolation and additional molecular characterization of vector borne pathogens in Peninsular Malaysia. In addition, studies that define the tick species that infest dogs in this region would help to elucidate their role as vectors for disease transmission.

Canine vector borne diseases of zoonotic concern in three dog shelters in Peninsular Malaysia: The importance of preventive measures

This study investigated canine vector borne diseases (CVBDs) of zoonotic significance in three major shelters in Peninsular Malaysia in order to highlight the importance of shelter management in diseases prevention. Since crowded housing has the potential to bring vectors and infected dogs into close proximity, the prevalence of CVBDs infection is always higher in sheltered dogs in comparison to pet dogs. Serum was collected from 90 adult dogs (30 from each shelter) from three shelters in different regions of Peninsular Malaysia (Shelter A, B and C). The prevalence of Dirofilaria immitis, Ehrlichia canis, E. ewingii, Anaplasma phagocytophilum, A. platys and Borrelia burgdorferi in dogs residing in three shelters with different management protocols was investigated by using rapid clinical test kits, SNAP® 4Dx® Plus (IDEXX Laboratories, Westbrook, ME). The most common pathogen detected was Ehrlichia spp. (55.6%, 50 out of 90 dogs), followed by Anaplasma spp. (16.7%; 15 out of 90 dogs). Dirofilaria immitis could only be detected in one of the shelters (10.0%; nine out of 90 dogs). No evidence of B. burgdorferi was detected in all three shelters. Forty one out of 90 dogs (45.6%) were infected with at least one pathogen meanwhile 14 out of 90 dogs (15.6%) were infected with more than one pathogen. It is of crucial importance to practice preventive measures during the admission of the new animals into the facilities. Occasional treatment of the dogs (as practiced in Shelter B) was not effective when compared to scheduled preventive measures. Future studies should emphasize the isolation and additional molecular characterization of vector borne pathogens in Peninsular Malaysia. In addition, studies that define the tick species that infest dogs in this region would help to elucidate their role as vectors for disease transmission.

Seroprevalence and molecular detection of leptospirosis from a dog shelter.

A study on seroprevalence and molecular detection of canine leptospirosis was carried out in a dog population (randomly selected n=80 dogs) from an animal shelter X. All the dogs in Shelter X appeared clinically healthy. Eighty blood samples were obtained and their serum were serologically examined using Microscopic Agglutination Test (MAT) against 10 Leptospira serovars. Plasma samples obtained were subjected to Polymerase Chain Reaction (PCR) assay. Three out of 80 dogs (3.8%) tested positive for L. bataviae based on MAT at a titer of 1:80. The seroprevalence of 9 other Leptospira serovars was not evident in this study. All the dogs tested negative against leptospirosis with PCR assay. In conclusion, canine leptospirosis was detected in dogs in this animal shelter. L. bataviae was identified as the infecting serovar. To our knowledge, this is the second report of serovar Bataviae infection in dogs in Malaysia. The 3 dogs in our study could possibly be a source of leptospiral infection to other dogs and may shed the bacteria into the environment. This serovar is not available in canine vaccination programs, therefore the dogs are not protected from this disease. Further investigation is warranted to determine whether the infected dogs are carriers of this serovar.

Prevalence of leptospirosis in healthy dogs and dogs with kidney disease in Klang Valley, Malaysia.

Leptospirosis is under-reported and remarkably neglected in Malaysia, especially in companion animals. In recent years, dogs have become popular pets and potentially act as one of the risk factors for human leptospiral infection. The purpose of this study was to determine the serological and molecular status of leptospirosis in healthy and dogs with kidney disease in Klang Valley, Malaysia and to gain insight of the possible serovars involved in the dog population in Klang Valley, Malaysia. Blood samples were obtained from 57 dogs (19 kidney disease patient; 38 healthy dogs, respectively). Serum samples obtained from these animals were screened for leptospiral antibodies by the microscopic agglutination test (MAT). Polymerase chain reaction (PCR) assay was performed on plasma samples to detect leptospiral DNA. By MAT, three out of 19 (15.8%) dogs with kidney disease were positive for L. canicola. One out of 38 (2.6%) healthy dogs was positive for L. icterohemorrhagiae. The overall seroprevalence for leptospirosis in dogs in Klang Valley, Malaysia was 7.0% (n=4/57). Only one out of the 19 dogs (5.3%) with kidney disease was tested positive to pathogenic Leptospira by PCR assay. All the 38 healthy dogs were negative. Positive results in healthy dogs and dogs with kidney disease for leptospirosis warrant further investigation of leptospirosis in dog population in Malaysia. The prevalence and incidence of this disease in the dog population in this country need further investigation.

Prevalence of leptospirosis in healthy dogs and dogs with kidney disease in Klang Valley, Malaysia

Leptospirosis is under-reported and remarkably neglected in Malaysia, especially in companion animals. In recent years, dogs have become popular pets and potentially act as one of the risk factors for human leptospiral infection. The purpose of this study was to determine the serological and molecular status of leptospirosis in healthy and dogs with kidney disease in Klang Valley, Malaysia and to gain insight of the possible serovars involved in the dog population in Klang Valley, Malaysia. Blood samples were obtained from 57 dogs (19 kidney disease patient; 38 healthy dogs, respectively). Serum samples obtained from these animals were screened for leptospiral antibodies by the microscopic agglutination test (MAT). Polymerase chain reaction (PCR) assay was performed on plasma samples to detect leptospiral DNA. By MAT, three out of 19 (15.8%) dogs with kidney disease were positive for L. canicola. One out of 38 (2.6%) healthy dogs was positive for L. icterohemorrhagiae. The overall seroprevalence for leptospirosis in dogs in Klang Valley, Malaysia was 7.0% (n=4/57). Only one out of the 19 dogs (5.3%) with kidney disease was tested positive to pathogenic Leptospira by PCR assay. All the 38 healthy dogs were negative. Positive results in healthy dogs and dogs with kidney disease for leptospirosis warrant further investigation of leptospirosis in dog population in Malaysia. The prevalence and incidence of this disease in the dog population in this country need further investigation.

Radiographic and computed tomographic assessment of the development of the antebrachia and elbow joints in Labrador Retrievers with and without medial coronoid disease.

OBJECTIVES: To compare the development, monitored by radiography and computed tomography, of the antebrachia and elbow joints in seven Labrador Retrievers with healthy elbow joints and in seven Labrador Retrievers that developed medial coronoid disease (MCD), in order to determine whether disturbances in the development of the antebrachia and elbow joints, between the age of six and 17 weeks may lead to medial coronoid disease. METHODS: A prospective study of 14 Labrador Retrievers in their active growth stage was performed. The development of the antebrachia and elbow joints was assessed between six and 17 weeks of age using radiography and computed tomography determining the development of secondary ossification centres, radioulnar length ratio, radial angulation, and inter-relationship between the humerus, ulna and radius. RESULTS: For the parameters of ossification of secondary ossification centres, radioulnar length ratio, radial angulation, and joint congruence evaluation, there was no significant difference in the development of the antebrachia and elbow joints of seven Labrador Retrievers positive and seven Labrador Retrievers negative for MCD at the age of six to 17 weeks. CLINICAL SIGNIFICANCE: These findings demonstrate that the development of MCD in the Labrador Retrievers in our study was not related to any disturbance in the development of the antebrachia and elbow joints during the rapid growth phase.

Assessment of articular cartilage and subchondral bone using EPIC-microCT in Labrador retrievers with incipient medial coronoid disease.

The aetiopathogenesis of medial coronoid disease (MCD) remains obscure, despite its high prevalence. The role of changes to subchondral bone or articular cartilage is much debated. Although there is evidence of micro-damage to subchondral bone, it is not known whether this is a cause or a consequence of MCD, nor is it known whether articular cartilage is modified in the early stages of the disease. The aim of the present study was to use equilibrium partitioning of an ionic contrast agent with micro-computed tomography (microCT) to investigate changes to both the articular cartilage and the subchondral bone of the medial coronoid processes (MCP) of growing Labrador retrievers at an early stage of the disease and at different bodyweights. Of 14 purpose-bred Labrador retrievers (15-27 weeks), six were diagnosed with bilateral MCD and one was diagnosed with unilateral MCD on the basis of microCT studies. The mean X-ray attenuation of articular cartilage was significantly higher in dogs with MCD than in dogs without MCD (P<0.01). In all dogs, the mean X-ray attenuation of articular cartilage was significantly higher at the lateral (P<0.001) than at the proximal aspect of the MCP, indicating decreased glycosaminoglycan content. Changes in parameters of subchondral bone micro-architecture, namely the ratio of bone volume to tissue volume (BV/TV), bone surface density (BS/TV), bone surface to volume ratio (BS/BV), trabecular thickness (Tb.Th; mm), size of marrow cavities described by trabecular spacing (Tb.Sp; mm), and structural model index (SMI), differed significantly by litter (P<0.05) due to the difference in age and weight, but not by the presence/absence of MCD (P>0.05), indicating that subchondral bone density is not affected in early MCD. This study demonstrated that cartilage matrix and not subchondral bone density is affected in the early stages of MCD.

Delayed endochondral ossification in early medial coronoid disease (MCD): a morphological and immunohistochemical evaluation in growing Labrador retrievers.

Medial coronoid disease (MCD) is a common joint disease of dogs. It has a multifactorial aetiology, but the relationship between known causal factors and the disease has yet to be elucidated. As most of the published literature is clinical and it reports changes associated with advanced disease, it is not known whether the changes reflect the cause or consequences of the condition. The aim of this study was to investigate early micromorphological changes occurring in articular cartilage and to describe the postnatal development of the medial coronoid process (MCP) before MCD develops. Three litters of MCD-prone young Labrador retrievers were purpose-bred from a dam and two sires with MCD. Comparisons of the micromorphological appearance of the MCP in MCD-negative and MCD-positive joints demonstrated that MCD was initially associated with a disturbance of endochondral ossification, namely a delay in the calcification of the calcifying zone, without concurrent abnormalities in the superficial layers of the joint cartilage. Cartilage canals containing patent blood vessels were only detected in dogs <12 weeks old, but the role of these channels in impaired ossification requires further investigation. Retained hyaline cartilage might ossify as the disease progresses, but weak areas can develop into cracks between the retained cartilage and the subchondral bone, leading to cleft formation and fragmentation of the MCP.

The early development of medial coronoid disease in growing Labrador retrievers: radiographic, computed tomographic, necropsy and micro-computed tomographic findings.

Medial coronoid disease (MCD) encompasses lesions of the entire medial coronoid process (MCP), both of the articular cartilage and the subchondral bone. To detect the earliest signs of MCD, radiography and computed tomography were used to monitor the development of MCD in 14 Labrador retrievers, from 6 to 7 weeks of age until euthanasia. The definitive diagnosis of MCD was based on necropsy and micro-computed tomography findings. The frequency of MCD in the dogs studied was 50%. Radiographic findings did not provide evidence of MCD, ulnar subtrochlear sclerosis or blunting of the cranial edge of the MCP. Computed tomography was more sensitive (30.8%) than radiography (0%) in detecting early MCD, with the earliest signs detectable at 14 weeks of age. A combination of the necropsy and micro-computed tomography findings of the MCP showed that MCD was manifested as a lesion of only the subchondral bone in dogs <18 weeks of age. In all dogs (affected and unaffected), there was close contact between the base of the MCP and the proximal radial head in the congruent joints. Computed tomography and micro-computed tomography findings indicated that the lesions of MCD probably originated at the base of the MCP.

Consistency in paired comparisons of Information Needs Questionnaires (INQ) among Hong Kong Chinese breast cancer patients.

PURPOSE: This study examines the consistency of Hong Kong Chinese breast cancer patients in prioritizing the information needs using the Chinese version of the Information Needs Questionnaire and identifies the demographics and clinical characteristics associated with inconsistency of prioritizing their information needs. METHODS: Inconsistency in prioritizing information needs was assessed by the number of circular triads in making paired comparison judgements. The chi-square test for the coefficient of agreement was used to test the hypothesis of random allocation of preferences. Stepwise multivariable regression analyses were performed to examine the association between the number of circular triads and participants' demographic and clinical characteristics. RESULTS: 362 Hong Kong Chinese breast cancer patients completed the questionnaire in 2008. A moderate amount of agreement among the participants was reported (coefficient of agreement = 0.31). The results of the chi-square test indicated that prioritizing information needs were not done randomly. Forward multivariable regression analyses revealed that breast cancer patients who were older, had lower educational levels or were unsure about their family history of cancer, on average, committed more circular triads. However, participants with longer interval since original diagnosis of cancer, on average, made fewer circular triads. CONCLUSION: Exclusion of responses from inadequately consistent patients may be necessary when assessing the priority of information needs in breast cancer patients using the Chinese version of Information Needs Questionnaire, which could then more appropriately reflect the actual priority. Attention should be paid to patients' particular characteristics when assessing the priority of information needs by means of the instrument.

Ex-vivo haemodynamic models for the study of Stanford type B aortic dissection in isolated porcine aorta.

OBJECTIVES: The aim of this study is to present novel ex-vivo models in the study of complex haemodynamical changes in Stanford type B aortic dissection (TBAD). MATERIALS AND METHODS: Fifteen fresh porcine aortas were harvested and preserved with 4 °C saline. Ex-vivo models were developed to simulate TBAD in three different situations: model A with patent false lumen, model B with distal re-entry only and model C with proximal primary entry only. These models were connected to standardised pulsatile pumps and the pressure waveforms were monitored and compared. The aortas were scanned with ultrasonography and subjected to post-experiment autopsy. RESULTS: The three different models were successfully created (n = 13). Pulsatile flow testing was successful and the shapes of the pressure waveforms were similar to those taken from human aorta. Post-testing gross examination confirmed the success of modelling. CONCLUSION: Porcine aortas may prove to be useful ex-vivo models in the study of aortic dissection haemodynamics. These models are reproducible and may be used in the study of complex haemodynamic forces during the development and propagation of TBAD. Our three porcine models give a potential possibility in helping clinicians isolate and analyse complex haemodynamical factors in the development, propagation and prognosis of TBAD.

The information needs of breast cancer patients in Hong Kong and their levels of satisfaction with the provision of information.

BACKGROUND: Information is vital for patients in overcoming cancer and making decisions about their treatment plans, but little is known about the information needs of Chinese breast cancer patients and their satisfaction with the information provided. OBJECTIVES: The objectives of this study were to examine the priority of information needs perceived by participants and the demographic and clinical factors that affect the priority of information needs such as prioritization, the utilization of and satisfaction with different sources of information, and satisfaction with the information provided by health care professionals. METHODS: A self-administered survey was used, including sources of information, an Information Needs Questionnaire-Chinese version, and patients' satisfaction with the information provided by health care professionals. RESULTS: Participants (n = 374) ranked the likelihood of cure, spread of the disease, and treatment options as the 3 most important information needs. They had mostly been using the information sources available in the hospital. Despite health care professionals being ranked as a highly satisfying source of information, participants perceived different levels of satisfaction with the various types of information provided. CONCLUSION: Participants perceived information about the illness itself and about treatment as most important. They preferred to use sources available in the hospital, but the satisfaction rates associated with information provided by health care professionals were relatively low. IMPLICATIONS FOR PRACTICE: This study provides useful information about what patients really want to know and a potential basis for developing more effective models to deliver information and support to breast cancer patients. Identification of the actual needs of these patients can produce better resource allocation and provide health services more efficiently to meet those needs.

Changes in heart rate and R-wave amplitude with posture.

BACKGROUND: Effect of gravity on heart rate and blood pressure are well documented but the effect of posture on R-wave amplitude has not been studied. AIM: To investigate the effect of posture on the heart rate (HR) and R-wave amplitude (RWA). METHODS: The electrocardiograph (ECG) was recorded in 20 young subjects on two occasions. A 5 minute recording of resting ECG was taken with the subject adopting the following postural cycle: lying, sitting, standing, sitting and lying positions. RESULTS: The standing HR was significantly higher than that in sitting and lying positions, but the RWA was significantly lower in standing compared to the sitting and lying postures. The HR significantly increased at the initial phase of postural changes, irrespective of the position. For example, the HR increased from lying to sitting (66.6+/-2.3 to 85.0+/-10.9 beat x min(-1)) but also increased when changed from sitting to lying (70.6+/-10.6 to 85.2+/-8.7 beat x min(-1)). CONCLUSION: Body posture has an effect on HR and RWA. The changes are probably related to orthostatic haemodynamic stress as well as changes in cardiac electrical axis. Whether the cause of the initial increase in the HR during postural change was attributed to skeletal muscle reflex or venous return requires further investigation.

Efficacy of enzyme immunoassay for the detection of Helicobacter pylori antigens in frozen stool specimens: local validation.

AIM: To investigate the efficacy of measurement of Helicobacter pylori stool antigen (HpSA) using stored frozen stool specimens, and to assess whether there were factors affecting efficacy in Hong Kong. METHODS: Patients undergoing upper endoscopy at Tuen Mun Hospital were recruited. Stool samples were saved for HpSA testing and questionnaires were completed. Stool samples were frozen immediately upon receipt and stored at -70 degrees C until tested. HpSA results were compared with rapid urease test and histology. RESULTS: One hundred and eighty-one patients were recruited. One hundred and seventy-eight patients were suitable for analysis. Eighty-three were H. pylori positive and 95 were H. pylori negative. The mean duration of storage of the stool samples was 120 days (range, 40-225 days). The sensitivity, specificity and positive and negative predictive values were 84.3%, 97.9%, 97.2% and 88.6%, respectively. In patients with a false negative HpSA test, there was a significant delay in collecting the stool specimen after endoscopy when compared with those with a true positive HpSA test (4.2 vs. 2.3 days; P < 0.05). However, the duration of storage of the specimens was not longer, and consumption of coffee or tea and smoking habits were similar. CONCLUSIONS: HpSA testing showed good sensitivity and specificity, even with frozen stool samples stored for up to 225 days. The efficacy was not affected by coffee, tea or smoking.