Helicobacter pylori infection in children of low and high socioeconomic status in northeastern Brazil.

This survey was designed to evaluate the prevalence of Helicobacter pylori infection in asymptomatic children from families of low and high socioeconomic status living in two neighboring communities in Teresina in northeastern Brazil. The study included 303 children, 163 (53.8%) males and 140 (46.2%) females, ranging in age from 6 months to 12 years. Helicobacter pylori status was determined by the H. pylori stool antigens test, in which sensitivity and specificity values for Brazilian children were 96.9% and 100%, respectively. The prevalence rates were 55.0% (93 of 169) and 16.4% (22 of 134) for children of low and high socioeconomic status, respectively (P < 0.001). Infection with H. pylori occurred early in life (before 2 years of age) in both groups (22.9% versus 14.3%; P = 0.061) and increased as the children became older. The rate of infection in children 11-12 years of age living in the poor area was as high as the levels found in Brazilian adults. An improved standard of living is followed by a sharp decrease in the prevalence rates in children, even in a developing country such as Brazil.

Comparative analysis of two-dimensional electrophoresis maps (2-DE) of Helicobacter pylori from Brazilian patients with chronic gastritis and duodenal ulcer: a preliminary report.

Helicobacter pylori is a bacterium recognized as the major cause of peptic ulcer and chronic gastritis. Recently, a proteome-based approach was developed to investigate pathogenic factors related to H. pylori. In this preliminary study, H. pylori strains were isolated from gastric biopsies of patients with chronic gastritis and duodenal ulcers. A partial proteomic analysis of H. pylori strains was performed by bacterial lyses and proteins were separated by two-dimensional gel electrophoresis (2-DE). A comparative analysis was performed to verify a differential protein expression between these two 2-DE maps. These data should be useful to clarify the role of different proteins related to bacterial pathogenesis. This study will be completed using a larger number of samples and protein identification of H. pylori by MALDI-TOF mass spectrometry.

Comparative analysis of two-dimensional electrophoresis maps (2-DE) of Helicobacter pylori from Brazilian patients with chronic gastritis and duodenal ulcer: a preliminary report

O Helicobacter pylori é uma bactéria reconhecida como a principal causa de úlcera péptica e gastrite crônica. Recentemente, o proteoma do H. pylori tem sido desenvolvido visando identificar fatores patogênicos relacionados ao microorganismo. Neste estudo preliminar, cepas de H. pylori foram isoladas de fragmento de mucosa gástrica de pacientes com úlcera duodenal e gastrite crônica. Posteriormente, realizou-se uma análise proteômica parcial dessas cepas, através da lise bacteriana e da separação de proteínas através da eletroforese de duas dimensões (2-DE). Por análise comparativa, foi possível verificar a expressão protéica diferencial entre os dois mapas 2-DE obtidos. Os dados poderão ser úteis para esclarecer a importância de diferentes proteínas relacionadas à patogênese da bactéria. Este estudo será complementado utilizando um maior número de amostras e a identificação protéica do H. pylori através da espectrometria de massa do tipo MALDI-TOF.

Decrease of type IV collagen and TIMP-1 serum levels after splenectomy in patients with schistosomiasis mansoni.

The role of the spleen in the process of liver fibrosis in schistosomiasis still needs clarification. The aim of this study was to assess the effect of splenectomy on serum levels of two markers of fibrosis, type IV collagen and TIMP-1, in patients with schistosomiasis mansoni. Twenty-four patients with hepatosplenic schistosomiasis mansoni participated in the study. Type IV collagen and TIMP-1 serum levels were measured preoperatively, and after 2 (POD-1) and 60 days (POD-2) of spleen removal. Before splenectomy, both type IV collagen and TIMP-1 serum levels were elevated in the majority of patients. After splenectomy, the levels of type IV collagen showed a significant decrease in relation to the preoperative values both in POD-1 (median pre-splenectomy: 143.7 ng/ml versus 77.01 ng/ml; p=0.04) and POD-2 (103.3 ng/ml; p=0.015). Serum levels of TIMP-1 also showed a significant decrease in relation to the preoperative values both in POD-1 (pre-splenectomy: 585.9 ng/ml versus 196.4 ng/ml; p=0.008) and POD-2 (97.4 ng/ml; p<0.001). There was no difference between POD-1 and POD-2 values for each serum marker. In conclusion, splenectomy in schistosomotic patients was associated with a decrease in serum markers of fibrosis levels, which persisted for at least 60 days. These results suggest that the spleen may play a role in the extra cellular matrix production, and therefore may contribute to liver fibrosis in schistosomiasis mansoni.

[Late follow-up of gastrectomized patients for peptic ulcer: clinical, endoscopic and histopathological aspects]. / Avaliação tardia de doentes gastrectomizados por úlcera péptica: aspectos clínicos, endoscópicos e histopatológicos.

BACKGROUND: The gastrectomy is an uncommon procedure because the proton bomb inhibitors associated to the antibiotic outlines used to eradicate the Helicobacter pylori changed the focus of the peptic ulcer treatment. AIMS: Later evaluation on those patients who underwent partial gastrectomy as a treatment for peptic ulcer, at that time when any drug to eradicate the Helicobacter pylori was not used. The clinical evaluation included the late postoperative symptoms and postgastrectomy syndromes like dumping, diarrhea, alkaline gastritis and nutritional aspects. The upper digestive endoscopy analysed the surgery reconstruction and the gastric stump, the duodenum and the jejunum mucosa aspects. The histopathological evaluation included looking for Helicobacter pylori by using two different methods: histology and urease test. CASUISTIC AND METHODS: Fifty-nine patients, 44 (74.6%) male, median age 55.5 years old (range from 31 to 77 years old), who underwent a clinical interview and an upper digestive endoscopy. Paraffin blocks from the surgical specimen were reviewed in order to find out if the patients did have or did not have Helicobacter pylori before surgery. RESULTS: The final results show that most of the patients had very good and good clinical evolution (Visick I e II) in 96%. The most common symptoms on late postoperative are mild dyspepsia with or without Helicobacter pylori, and diarrhea, anemia and dumping occurred in, respectively, 11 (18.6%), 2 (3.4%) and 2 (3.4%) cases. The Billroth I reconstruction had the best clinical results on statistical rate. The endoscopic finding showed normal results in the most number of cases, and reflux alkaline gastritis or erosive gastritis in a few cases. Ulcer recurrences were diagnosed in two patients (3.4%), and both had positive Helicobacter pylori. Most of the patients had Helicobacter pylori (86%) before surgery and also in the postoperative time (89.9%). CONCLUSIONS: The patients had a very good clinical evolution after the gastrectomy. The Billroth I reconstruction had the best clinical results. The Helicobacter pylori is still present on gastric stump in late postoperative time, and we believe that it does not bring any negative influence to surgical results.

Avaliação tardia de doentes gastrectomizados por úlcera péptica: aspectos clínicos, endoscópicos e histopatológicos / Late follow-up of gastrectomized patients for peptic ulcer: clinical, endoscopic and histopathological aspects

RACIONAL: Atualmente são raras as vezes em que é necessária a realização de uma gastrectomia, já que os inibidores da bomba de prótons associados aos esquemas antibióticos usados para erradicar o Helicobacter pylori, mudaram o enfoque do tratamento da úlcera péptica. OBJETIVOS: Avaliar tardiamente os doentes submetidos a gastrectomia parcial no tratamento da úlcera péptica, em época em que o Helicobacter pylori ainda não era erradicado de forma intencional, incluindo os sintomas pós-operatórios em comparação com os pré-operatórios e a incidência de síndromes pós-gastrectomias; avaliação endoscópica, incluindo o tipo de cirurgia realizada e os achados macroscópicos da mucosa do coto gástrico, duodeno ou jejuno, dependendo do tipo de reconstrução; avaliação histopatológica, incluindo a pesquisa da bactéria por dois métodos: histológico e teste de urease; e sua possível associação presente no estômago remanescente com as avaliações clínica, endoscópica e histopatológica pós-operatórias. CASUíSTICAS E MÉTODOS: Cinqüenta e nove doentes gastrectomizados por úlcera péptica entre os anos de 1985 e 1993 foram avaliados, sendo que 44 (74,6 por cento) eram do sexo masculino e tinham idade média de 55 anos, com variação de 31 a 77 anos, passaram por entrevista clínica e por exame endoscópico. O Helicobacter pylori foi pesquisado nas peças cirúrgicas ressecadas, para constatação da sua presença ou não no pré-operatório. RESULTADOS: A avaliação clínica no pós-operatório tardio mostrou que 96 por cento dos doentes apresentaram excelentes e bons resultados (Visick I e II). Os sintomas pós-operatórios mais comuns foram dispepsia leve e outras queixas, como diarréia, anemia e dumping, que ocorreram, respectivamente, em 11 (18,6 por cento), 2 (3,4 por cento) e 2 (3,4 por cento) casos. A reconstrução tipo Billroth I trouxe melhores resultados clínicos tardios, quando comparada com as reconstruções tipo Billroth II e Y-de-Roux. Na avaliação endoscópica, a maioria dos doentes (52,5 por cento) apresentou exame normal, enquanto que os demais apresentaram gastrites enantematosa (37,3 por cento) e erosiva (8,5 por cento). Recidiva ulcerosa ocorreu em dois doentes (3,4 por cento). Na análise histopatológica, foi observada incidência elevada de gastrite crônica (98,3 por cento). A presença de Helicobacter pylori ocorreu em 86 por cento dos doentes antes da cirurgia e em 89,8 por cento no pós-operatório tardio...

Grading and staging chronic hepatitis C and its relation to genotypes and epidemiological factors in Brazilian blood donors.

Progression of chronic hepatitis C is known to be associated with some factors, but influence of HCV genotypes is still controversial. Association between HCV genotypes and other risk factors was examined to determine which factors are associated with progression of infection. One hundred consecutive anti-HCV positive volunteer blood donors were evaluated for several risk factors, examined for HCV genotypes, and submitted to hepatic biopsy and biochemical exams.HCV genotyping were carried out in 89 patients and hepatic biopsy in 78. Transmission routes were found to be illicit intravenous drug use (26%), Gluconergan use in a non-safe manner (48%) and blood transfusion (15%). HCV genotype was 1 in 45%, 3 in 40%, and it was not associated with the stage of fibrosis or with inflammatory activity. There was no significant association of factors related to infection, chronic alcohol use, or duration of illness, with progression of the lesion. There was a significant association of aminotransferase levels and the fibrosis stage. Univariate analysis showed that the age at contamination, patient's age, GT-gamma, and aminotransferase levels over three times the upper normal limits, were associated with fibrosis stages 2 to 4. Multivariate analysis detected age (odds ratio=1.19), and GT-gamma (odds ratio=2.02) as independent factors.

Development of a BALB/c mouse model of Helicobacter pylori infection with fresh and frozen bacteria.

An experimental model for H. pylori infection was established by intragastrically challenging BALB/c mice with 1 ml (10(8) CFU/ml) of suspension for two consecutive days. Animals were divided into three groups. GA: mice inoculated with fresh bacteria; GB: mice inoculated with frozen bacteria, and GC: mice inoculated with brucella broth (control group). Animals were killed at 7, 14, 21, 28, 35 and 60 days pi and fragments of stomach and duodenum were collected, paraffin embedded and stained by hematoxylin-eosin and Giemsa. The results showed that challenged mice exhibited mild duodenitis and gastritis. In group GA, infiltration in the duodenum was lymphoplasmacytic until day 35; in group GB, it was lymphomonocytic for 60 days pi. In the stomach, H. pylori induced lymphomonocytic infiltration that was present from days 7 to 60 in group GA. In group GB, it was only present from days 14 to 35. In conclusion, our data suggested that freezing altered pathogenic properties of H. pylori and probably inhibited expression of bacterial antigens and consequently the establishment and maintenance of infection. Although the animals developed mild duodenitis and gastritis, the BALB/c mouse is not susceptible to developing peptic ulcers during H. pylori infection.

Grading and staging chronic hepatitis C and its relation to genotypes and epidemiological factors in brazilian blood donors

Progression of chronic hepatitis C is known to be associated with some factors, but influence of HCV genotypes is still controversial. Association between HCV genotypes and other risk factors was examined to determine which factors are associated with progression of infection. One hundred consecutive anti-HCV positive volunteer blood donors were evaluated for several risk factors, examined for HCV genotypes, and submitted to hepatic biopsy and biochemical exams.HCV genotyping were carried out in 89 patients and hepatic biopsy in 78. Transmission routes were found to be illicit intravenous drug use (26 percent), Gluconergan® use in a non-safe manner (48 percent) and blood transfusion (15 percent). HCV genotype was 1 in 45 percent, 3 in 40 percent, and it was not associated with the stage of fibrosis or with inflammatory activity. There was no significant association of factors related to infection, chronic alcohol use, or duration of illness, with progression of the lesion. There was a significant association of aminotransferase levels and the fibrosis stage. Univariate analysis showed that the age at contamination, patient's age, GT-gamma, and aminotransferase levels over three times the upper normal limits, were associated with fibrosis stages 2 to 4. Multivariate analysis detected age (odds ratio=1.19), and GT-gamma (odds ratio=2.02) as independent factors.

Development of a BALB/c mouse model of Helicobacter pylori infection with fresh and frozen bacteria

An experimental model for H. pylori infection was established by intragastrically challenging BALB/c mice with 1 ml (108 CFU/ml) of suspension for two consecutive days. Animals were divided into three groups. GA: mice inoculated with fresh bacteria; GB: mice inoculated with frozen bacteria, and GC: mice inoculated with brucella broth (control group). Animals were killed at 7, 14, 21, 28, 35 and 60 days pi and fragments of stomach and duodenum were collected, paraffin embedded and stained by hematoxylin-eosin and Giemsa. The results showed that challenged mice exhibited mild duodenitis and gastritis. In group GA, infiltration in the duodenum was lymphoplasmacytic until day 35; in group GB, it was lymphomonocytic for 60 days pi. In the stomach, H. pylori induced lymphomonocytic infiltration that was present from days 7 to 60 in group GA. In group GB, it was only present from days 14 to 35. In conclusion, our data suggested that freezing altered pathogenic properties of H. pylori and probably inhibited expression of bacterial antigens and consequently the establishment and maintenance of infection. Although the animals developed mild duodenitis and gastritis, the BALB/c mouse is not susceptible to developing peptic ulcers during H. pylori infection.

Progression of liver fibrosis in blood donors infected with hepatitis C virus.

BACKGROUND/AIMS: Chronic hepatitis by HCV is progressive towards cirrhosis, with variable rate. We evaluated the rate of fibrosis progression (RFP), risk factors associated with advanced fibrosis (F3 and F4), and estimated the evolution time to cirrhosis. METHODS: We transversely selected 142 blood donors infected only with HCV, with a known route of infection, submitted to liver biopsy at admission. RFP= ratio between stage of fibrosis (METAVIR)/estimated duration of infection in years. Non-parametric tests and logistic regression analysis, with significance level of 5% were used. RESULTS: Median RFP was 0.086 U/year (0.05-0.142). Ten patients had F4 and 25 had F3. Median RFP values were significantly different (p=0.001) from one age group at contamination to the others and ALT and AST levels. There were no differences in the expected evolution to cirrhosis between intermediate fibrosers (F2) and the rapid fibrosers (F3 and F4). The independent variables associated with advanced fibrosis were ALT (OR 7.2) and GGT (OR 6.4) and age at inclusion (OR 1.12). CONCLUSION: This study suggests that RFP is extremely variable, it is exponential with age, and mainly influenced by host characteristics, especially age at contamination and possibly ethnical group. These asymptomatic patients had high percentage of fibrosis F2, F3 and F4.

Chronic liver disease in kidney recipients with hepatitis C virus infection.

BACKGROUND: The prevalence of anti-hepatitis C virus (HCV) positive test is higher among patients in dialysis and in kidney recipients than in general population. Hepatitis C virus infection is the main cause of chronic liver disease in renal transplant patients. Liver biopsy and virological analysis were performed to clarify the grade of liver damage in kidney recipients. METHODS: Renal recipients patients with at least 5 yr under immunosuppression were submitted to clinical and laboratory analysis. Patients who tested anti-HCV positive were candidates to liver biopsy with no regard to transaminase levels. RESULTS: Forty-five patients tested anti-HCV positive and 42 anti-HCV negative. Twenty-six anti-HCV and RNA-HCV positive patients were submitted to liver biopsy. Seventy-three percentage of these patients presented chronic active hepatitis, from these only one patient presented cirrhosis. Only 29% of the anti-HCV positive group presented elevated alanine aminotransferase levels. Anti-HCV positive patients presented longer previous time on dialysis and less rejection episodes than the group anti-HCV negative (p < 0.05). All anti-HCV positive patients but one tested RNA-HCV positive by polymerase chain reaction (PCR). CONCLUSIONS: In this series the prevalence of anti-HCV positive is 51.7%. Most of the patients presented liver damage in histology caused by HCV. However, we found only mild or minimal fibrosis and inflammatory activity grade, despite 10 yr of HCV infection and 5 yr of immunosuppressive treatment. Only one patient presented cirrhosis (4%). Performing serial liver biopsies in a long-term follow-up is needed to clarify the impact of HCV infection in renal transplant patients.

Validaçäo de um método imunoenzimático para detecçäo da infecçäo pelo Helicobacter Pylori / Validation of an immunoenzymatic method for detection of the Helicobacter pylori infection

A infecçäo pelo Heliocobacter Pylori está relacionada a várias doenças digestivas. A sorologia é um método diagnóstico näo-invasivo e de baixo custo. Contudo, os kits comerciais apresentam eficácia em geral variável. O HM-CAP, um método imunoenzimático que detecta IgG específica anti-H. pylori, foi avaliado. Foram estudados 77 pacientes com sintomatologia dispéptica e com resultados de histologia, cultura e urease compatíveis. Os soros destes pacientes foram submetidos ao ensaio e os resultados, comparados com os outros exames. Assim, a sensibilidade do HM-CAP foi de 88,1 por cento; a especificidade, de 61,1 por cento; o valor preditivo positivo, de 88,1 por cento; o valor preditivo negativo, de 61,1 por cento; a prevalência, de 76,6 por cento; e a acurácia, de 81,8 por cento. Näo houve diferença significativa quanto a sensibilidade e especificidade entre os grupos de indivíduos com idades acima e abaixo de 45 anos

Prevalence of intestinal parasitic infection in five farms in Holambra, Sao Paulo, Brazil

Uma pesquisa coproparasitologica foi realizada em 222 habitantes de cinco fazendas de Holambra, localizada a 30 Km ao norte de Campinas, SP, Brasil, em outubro de 1992. Aproximadamente 70 por cento dos habitantes apresentaram pelo menos um tipo de parasitose intestinal. O indice de positividade das 6 especies de helmintos e de 7 protozoarios na populacao foi o seguinte: Ascaris lumbricoides (5,4 por cento ); Trichuris trichiura (8,6 por cento ); Necator americanus (19,8 por cento ); Strongyloides stercoralis (10,4 por cento ); Enterobius vermiculares (1,4 por cento ); Hymenolepis nana (0,9 por cento ); Entamoeba histolytica (3,2 por cento ); E. hartmanni (2,7 por cento); E. coli (9,9 por cento ); Endolimax nana (14,0 por cento ); Iodamoeba butschlii (2,3 por cento ); Giardia lamblia (10,4 por cento ); Blastocytis hominis (37,4 por cento ). O indice de positividade para infeccao por helmintos foi aparentemente maior na populacao mais jovem (menores de 16 anos) do que no grupo de populacao com idades acima de 16 anos, ao contrario do indice de infeccao pelos protozoarios que foi mais elevado na populacao adulta. Utilizando um novo e sensivel metodo atraves de cultura em agar, encontrou-se um indice de infeccao de 10,4 por cento para strongyloides sp.