Association of Progranulin Gene Expression from Dyspeptic Patients with Virulent Helicobacter pylori Strains; In Vivo Model.

(1) Background: Gastric cancer, the fourth most common cause of death from tumors in the world, is closely associated with Helicobacter pylori. Timely diagnosis, therefore, is essential to achieve a higher survival rate. In Chile, deaths from gastric cancer are high, mainly due to late diagnosis. Progranulin has reflected the evolution of some cancers, but has been poorly studied in gastric lesions. Aiming to understand the role of progranulin in H. pylori infection and its evolution in development of gastric lesions, we evaluated the genic expression of progranulin in gastric tissue from infected and non-infected patients, comparing it according to the epithelial status and virulence of H. pylori strains. (2) Methods: The genic expression of progranulin by q-PCR was quantified in gastric biopsies from Chilean dyspeptic patients (n = 75) and individuals who were uninfected (n = 75) by H. pylori, after receiving prior informed consent. Bacteria were grown on a medium Columbia agar with equine-blood 7%, antibiotics (Dent 2%, OxoidTM), in a microaerophilic environment, and genetically characterized for the ureC, vacA, cagA, and iceA genes by PCR. The status of the tissue was determined by endoscopic observation. (3) Results: Minor progranulin expression was detected in atrophic tissue, with a sharp drop in the tissue colonized by H. pylori that carried greater virulence, VacAs1m1+CagA+IceA1+. (4) Conclusions: Progranulin shows a differential behavior according to the lesions and virulence of H. pylori, affecting the response of progranulin against gastric inflammation.

Genistein: Dual Role in Women's Health.

Advanced research in recent years has revealed the important role of nutrients in the protection of women's health and in the prevention of women's diseases. Genistein is a phytoestrogen that belongs to a class of compounds known as isoflavones, which structurally resemble endogenous estrogen. Genistein is most often consumed by humans via soybeans or soya products and is, as an auxiliary medicinal, used to treat women's diseases. In this review, we focused on analyzing the geographic distribution of soybean and soya product consumption, global serum concentrations of genistein, and its metabolism and bioactivity. We also explored genistein's dual effects in women's health through gathering, evaluating, and summarizing evidence from current in vivo and in vitro studies, clinical observations, and epidemiological surveys. The dose-dependent effects of genistein, especially when considering its metabolites and factors that vary by individuals, indicate that consumption of genistein may contribute to beneficial effects in women's health and disease prevention and treatment. However, consumption and exposure levels are nuanced because adverse effects have been observed at lower concentrations in in vitro models. Therefore, this points to the duplicity of genistein as a possible therapeutic agent in some instances and as an endocrine disruptor in others.

MALDI-TOF MS and 16S RNA Identification of Culturable Gastric Microbiota: Variability Associated with the Presence of Helicobacter pylori.

Helicobacter pylori is the main bacteria associated with gastroduodenal diseases. Recent studies have reported that gastric microbiota might be modified by the H. pylori colonization, favoring gastric lesions' development. In Chile, the region of La Araucanía concentrates a high risk of gastric cancer associated with Helicobacter pylori colonization, rurality, poverty, and Mapuche ethnicity. Hence, we aimed to identify the culturable gastric microbiota and characterize its variability at different stages of epithelial injury, based on its H. pylori colonization in dyspeptic patients from this Chilean region. Microaerophilic bacteria strains were isolated from antrum biopsies of 155 dyspeptic patients' biopsies and identified using MALDI-TOF MS or 16sRNA gene sequencing for non-pylori species identification, and UreC gene amplification for H. pylori confirmation. We found 48 species from 18 families, mainly belonging to Neisseriaceae (21.3%), Streptococcaceae (20.0%), Actynomicetaceae (9.0%), Enterobacteriaceae, and Lactobacillaceae (4.5%); however, Streptococcaceae and Actinomycetaceae families showed a significant reduction in samples infected with H. pylori, along with a considerably lower diversity of species. Our results revealed a microbiota modification due to H. pylori colonization associated with the gastric epithelial state, suggesting a potential microbiota role for developing and progressing gastric diseases.

Prevalence of Infection and Antibiotic Susceptibility of Helicobacter pylori: An Evaluation in Public and Private Health Systems of Southern Chile.

Helicobacter pylori colonizes half of the human population. Age, ethnicity, and socioeconomic status are factors that influence the prevalence of the infection. This is important in southern Chile, one of the most unequal regions in the world, where a significant difference in the health access of the population occurs due to the existence of two competing health systems. Moreover, in the last few years, current protocols of H. pylori eradication have shown high rates of resistance with reduced therapeutic efficacy. This study reported the epidemiology of infection and attempted to identify divergent points among the population beneficiaries of the two health care schemes in southern Chile. Biopsies from public (n = 143) and private (n = 86) health systems were studied. At the same time, clinical and sociodemographic factors were evaluated. H. pylori strains were obtained from gastric biopsies for culture and molecular testing. Antibiotic susceptibility was determined by the agar dilution method. Differences about ethnicity, rural residence, and education (p ≤ 0.05) were observed between beneficiaries of the two health systems. The prevalence of H. pylori was 45%, with no significant differences regardless of the socioeconomic conditions. The only identified risk factor associated with H. pylori infection was Mapuche ethnicity (OR (odds ratio) = 2.30). H. pylori showed high resistance rates, particularly against clarithromycin (40%), levofloxacin (43.1%), and metronidazole (81.8%). This study highlighted the importance of Mapuche ancestry as a risk factor in southern Chile and emphasized the need to search for new eradication strategies as well as further studies evaluating therapeutic efficacy.

Evaluation of the quality of clinical guidelines for cardiac rehabilitation: a critical review.

PURPOSE: To evaluate the quality of clinical guidelines (CGs) for cardiac rehabilitation and to critically appraise exercise-related recommendations. DESIGN: critical review. DATA SOURCES: main search engines, databases, clearinghouses, and guideline developers. STUDY SELECTION: We included evidence-based CGs specific to cardiac rehabilitation with recommendations for the period after diagnosis of myocardial infarction or acute coronary syndrome. Clinical guidelines needed to include an exercise component and at least 1 additional component in the cardiac rehabilitation program. Data extraction and appraisal: We evaluated the quality of GCs, using the Appraisal of Guidelines for Research and Evaluation Instrument, second version. Three reviewers independently extracted data, appraised the quality of included CGs, and resolved disagreements by consensus. RESULTS: Nine guidelines were included. The average scores were 79.84%, 59.88%, 55.56%, 85.18%, 48.92%, and 56.79% for the domains of scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence, respectively. The majority of guidelines recommended low- to moderate-intensity aerobic and resistance exercises, with moderate variability in the frequency and duration of sessions. CONCLUSIONS: Clinical guidelines consistently recommended aerobic and resistance exercises. Overall, our critical review showed that the quality of CGs was at least moderate, with the greatest deficiencies being related to applicability and rigor of development domains.

Evaluation of the quality of clinical practice guidelines for the management of esophageal or gastric variceal bleeding.

SETTING: Clinical practice guidelines (CPGs) should provide healthcare practitioners with the best possible evidence. Their quality, however, is often suboptimal. An evaluation of CPGs for the treatment of esophageal or gastric variceal bleeding (VB) has not been performed to date. AIM: The aim of this study was to identify and evaluate the quality of CPGs for esophageal or gastric VB. METHODS: We performed a systematic search of the scientific literature published up to July 2012 to identify and select CPGs related to the management of esophageal or gastric VB. Three independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) instrument. Standardized scores were calculated for the six domains of each instrument, and the overall agreement among reviewers was assessed on the basis of the intraclass correlation coefficient. RESULTS: Of a total of 23 CPGs identified, 10 were selected. Intraobserver agreement was good (overall intraclass correlation coefficient of 0.956, 95% confidence interval 0.958-0.973). The overall quality of the guidelines varied from low to moderate. Stratified by domains, the quality was good to acceptable in three domains: 'scope and purpose' (78.1%, median 82.3, range 46-100); 'clarity and presentation' (87.2%, median 91.6, range 67-98); and 'editorial independence' (64.1%, median 61.1, range 22-94), but with deficiencies in another three: 'rigor of development' (47.6%, range 28-94), 'stakeholder involvement' (47.5%, median 37, range 18-98) and 'applicability' (25.9% median 13.2, range 1-83). In the overall evaluation, two guidelines were considered 'highly recommended', three, 'recommended with modifications', and five, 'not recommended'. There was a significant improvement in quality over time. CONCLUSION: The overall quality of CPGs for the management of esophageal or gastric VB has improved over time. Although the overall quality was not optimal, two guidelines achieved an excellent rating. A summary of recommendations is provided.

Comparación de la efectividad de la ligadura vs esclerosis endoscópica en pacientes con sangrado de várices esofágicas en el Hospital Hernán Henríquez de Temuco: estudio de cohortes comparativas / Comparison of band ligation with sclerotherapy for the treatment of bleeding esophageal varices

Background: Endoscopic band ligation is the treatment of choice for bleeding esophageal varices. However it is not clear if this procedure is associated with less early and late mortality than sclerotherapy. Aim: To assess rates of re-bleeding and mortality in cohorts of patients with bleeding esophageal varices treated with endos-copic injection or band ligation. Patients and Methods: Analysis of medical records and endoscopy reports of two cohorts of patients with bleeding esophageal varices, treated between 1990 and 2010. Of these, 54 patients were treated with sclerotherapy and 90 patients with band ligation. A third cohort of 116patients that did not require endoscopic treatment, was included. The mean analyzed follow up period was 2.5 years (range 1-16). Collection of data was retrospective for patients treated with sclerotherapy and prospective for patients treated with band ligation. Rates of re-bleeding and medium term mortality were assessed. Results: During the month ensuing the first endoscopic treatment, re-bleeding was recorded in 39 and 72% of patients treated with band ligation and sclerotherapy, respectively (p < 0.01). The relative risk of bleeding after band ligation was 0.53 (95% confidence limits 0.390.73). Death rates until the end of follow up were 20 and 48% among patients with treated with band ligation and sclerotherapy, respectively (p < 0.01), with a relative risk of dying for patients subjected to band ligation of 0.41 (95% confidence limits 0.25-0.68). Conclusions: Band ligation was associated with lower rates of re-bleeding and mortality in these cohorts of patients.

[Comparison of band ligation with sclerotherapy for the treatment of bleeding esophageal varices]. / Comparación de la efectividad de la ligadura vs esclerosis endoscópica en pacientes con sangrado de várices esofágicas en el Hospital Hernán Henríquez de Temuco: estudio de cohortes comparativas.

BACKGROUND: Endoscopic band ligation is the treatment of choice for bleeding esophageal varices. However it is not clear if this procedure is associated with less early and late mortality than sclerotherapy. AIM: To assess rates of re-bleeding and mortality in cohorts of patients with bleeding esophageal varices treated with endoscopic injection or band ligation. PATIENTS AND METHODS: Analysis of medical records and endoscopy reports of two cohorts of patients with bleeding esophageal varices, treated between 1990 and 2010. Of these, 54 patients were treated with sclerotherapy and 90 patients with band ligation. A third cohort of 116 patients that did not require endoscopic treatment, was included. The mean analyzed follow up period was 2.5 years (range 1-16). Collection of data was retrospective for patients treated with sclerotherapy and prospective for patients treated with band ligation. Rates of re-bleeding and medium term mortality were assessed. RESULTS: During the month ensuing the first endoscopic treatment, re-bleeding was recorded in 39 and 72% of patients treated with band ligation and sclerotherapy, respectively (p < 0.01). The relative risk of bleeding after band ligation was 0.53 (95% confidence limits 0.390.73). Death rates until the end of follow up were 20 and 48% among patients with treated with band ligation and sclerotherapy, respectively (p < 0.01), with a relative risk of dying for patients subjected to band ligation of 0.41 (95% confidence limits 0.25-0.68). CONCLUSIONS: Band ligation was associated with lower rates of re-bleeding and mortality in these cohorts of patients.

Prevalence and correlates of hepatitis C virus infection among street-recruited injection drug users in San Juan, Puerto Rico.

Throughout the world, injection drug users (IDUs) are the group at highest risk for hepatitis C virus (HCV) infection. IDUs residing in the island of Puerto Rico and Puerto Rican IDUs residing in the U.S. mainland have been shown to be at very high risk of infection with HIV. However, the extent to which HCV infection has spread among IDUs in Puerto Rico is not yet known. The aims of this study were to estimate seroprevalence of HCV and to identify the correlates associated with HCV transmission. The sample was drawn through street outreach strategies and was comprised of 400 injection drug users not in treatment, living in the San Juan metropolitan area. HCV and HIV infection were detected by enzyme-linked immunosorbent assay and the results were confirmed by Western blot. Information on sociodemographics, drug use patterns, and risk behaviors was obtained through structured interviews. Bivariate analyses and multivariate logistic regression were used to assess covariates of infection with HCV. The prevalence of HCV infection was 89%. After controlling for sociodemographic characteristics, HCV infection was positively associated with increasing years of injection, injecting in a shooting gallery, tattooing in prison, and self-reported STD infection. Notably, IDUs who had initiated drug injection within the year prior to the study interview had an HCV infection rate of 57%. This study indicates that more aggressive educational programs are urgently needed to reduce the spread of HCV infection among IDUs in Puerto Rico.

Changing profiles of injecting drug users with AIDS in a Hispanic population.

AIMS: To describe and assess the changing trends in socio-demographic, risk, clinical and immunological parameters in male intravenous drug users (IDU) with AIDS. DESIGN, SETTING AND PARTICIPANTS: Baseline description by year of entry of 610 male IDU with AIDS who entered into a cohort study in Bayamón, Puerto Rico, from 1992 to 2000. Study participants were evaluated at in-patient health-care facilities in the University Hospital Ramón Ruiz Arnau or in the ambulatory immunology clinic facilities. FINDINGS: The median age at which subjects entered the study and the proportion of patients with an educational level lower than a high school degree increased from 1992 to 2000. Upward trends were also observed in the practice of injecting non-prescription drugs during the last 12-month period, the practice of needle sharing and the use of a combination of heroin and cocaine ('speedballs'). Higher proportions of subjects were also diagnosed with wasting syndrome and bacterial pneumonia. The median CD4 count recorded at entry decreased over the course of the study. CONCLUSIONS: Puerto Rican male IDU diagnosed with AIDS are arriving at health-care facilities in the latest stages of the disease. Better and early interventions with different health care approaches need to be developed.

Factores de riesgo asociados a eritrocitosis de altura en la ciudad de La Paz - Bolivia / Risk factors relationship between to high altitude erithrocytosis at La Paz - Bolivia

Pregunta de investigación.¿Son el hábito de fumar y el sobrepeso, factores de riesgo asociados a Eritrocitos de altura en varones de 18 a 70 años de edad, residentes de la ciudad de La Paz? Objetivos. Determinar la existencia y la magnitud de la asociación entre el hábito de fumar y el sobrepeso en varones de 18 a 70 años de edad con Eritrocitos de Altura residentes de la ciudad de La Paz. Diseño. Estudio de Casos y Controles. Contexto o Lugar. Hospital Obrero N§ 1 de la CNS, en los distintos servicios . Pacientes. Sujetos que deseen participar en el estudio y que cumplen con las caracterísitcas de pertenecer a casos (enfermos) controles (sujetos sin la enfermedad), según los criterios de inclusión y exclusión. Métodos. Se aplicó la encuesta de datos generales y los cuestionarios validados y el indice de masa corporal más una serie de covariables. Los datos se analizaron con estadístic descriptiva, análitica con chi2,t de student, odds ratio, Test de homogeneidad de Mantel- Haenszel y regresión logística. Resultados. Se observa que existen asociación entre la Eritrocitosis de altura con el hábito de fumar dando un OR 3.4 IC95 porciento (1.98-5.93) y con sobrepeso OR 3.2 IC95 porciento (1.8-5.6) p<0.000; son modificadores de efecto el consumo de alcohol y coca, la actividad física, lugar de residencia (p<0.000) no son confundentes ni modificadores de efecto la edad y la presión arterial sistólica y diastólica. Conclusiones. Existe asociación entre la Eritrocitosis de altura con el hábito de fumar y el sobrepeso que es modificado por el consumo de coca, alcohol, zona de residencia y el ejercicio.(au)