Genetic Antibiotic Resistance of Helicobacter pylori in South-Eastern Romania.

BACKGROUND AND AIM: Helicobacter pylori infection is very common worldwide, and it is associated with an important gastric pathology. Treatment of this infection is difficult and consists of the combination of two or three antibiotics. However, the rate of resistance to treatment is high. Antimicrobial resistance of Helicobacter pylori is based on its cultivation in the laboratory and testing of phenotypic susceptibility, a time-consuming, laborious method. This study aimed to detect the genetic resistance to antibiotics of Helicobacter pylori in the south-eastern region of Romania. METHODS: Ninety patients with positive rapid urease test gastric biopsy samples were tested. Genetic resistance to antibiotics (fluoroquinolone and clarithromycin) was tested by GenoType HelicoDR kit (Hain Lifescience GmbH, Germany). RESULTS: Clarithromycin resistance mutations were detected in 20% of patients, the commonest mutation in our study beeing A2147G (associated with high level of clarithromycin resistance and lower cure rates). Fluoroquinolones resistance mutations were detected in 30% of patients, and the most common mutations were D91N, D91G, and N87K. There was no correlation with patients gender or age, with the exception of fluoroquinolone resistance, which was detected more frequently in females.   Conclusions. Clarithromycin and fluoroquinolone resistance of Helicobacter pylori is moderately high in our study. There is a need for monitoring Helicobacter resistance patterns in Romania to provide data that can guide empirical treatment. This is the first published study on the genetic resistance of Helicobacter pylori in Romania.

The Efficacy of Virtual Chromoendoscopy in the Diagnosis of Portal Hypertensive Gastropathy.

BACKGROUND: Diagnosis of portal hypertensive gastropathy (PHG) is based on endoscopic criteria. I-scan technology, a new technique of virtual chromoendoscopy, increases the diagnostic accuracy for lesions in the gastrointestinal tract. AIM: To establish the role of i-scan endoscopy in the diagnosis of PHG. METHOD: In this prospective study, endoscopic examination was conducted first by using white light and after that i-scan 1 and i-scan 2 technology in a group of 50 consecutive cirrhotic patients. The endoscopic diagnostic criteria for PHG followed the Baveno criteria. The interobserver agreement between white light endoscopy and i-scan endoscopy was determined using Cohen's kappa statistics. RESULTS: Forty-five of the 50 patients met the diagnostic criteria for PHG when examined by i-scan endoscopy and 39 patients were diagnosed with PHG by white light endoscopy. The strength of agreement between the two methods for the diagnosis of PHG was moderate (k=0.565; 95%CI 0.271-0.859; p<0.001). I-scan 1 classified the mosaic pattern better than classic endoscopy; i-scan 2 described better the red spots. CONCLUSION: I-scan examination increased the diagnostic sensitivity of PHG. The diagnostic criteria (mosaic pattern and red spots) were easier to observe endoscopically using i-scan than in white light.

Fine-tuning ligand-receptor design for selective molecular recognition of dicarboxylic acids.

The host-guest interaction between the hexaaza macrocyclic ligand 3,7,11,18,22,26-hexaazatricyclo[26.2.2.2]tetratriaconta-1(31),13(34),14,16(33),28(32),29-hexaene (P3) and three rigid dicarboxylic acids (isophthalic acid, H2is; phthtalic acid, H2ph; and terephthalic acid, H2te) has been investigated using potentiometric equilibrium methods and NMR spectroscopy including the measurement of intermolecular nuclear Overhauser effects (NOEs) and self-diffusion coefficients (D). Ternary complexes are formed in aqueous solution as a result of hydrogen bond formation and Coulombic interactions between the host and the guest. In the [(H6P3)(is)]4+ complex, those bonding interactions reach a maximum yielding a log K6R of 4.74. Competitive distribution diagrams and total species distribution diagrams are used to illustrate the main features of these systems. In particular, a selectivity of over 89% at p[H] = 5.0 is obtained for the complexation of the is versus the te substrates. The recognition capacity of P3 over dicarboxylic acids (da) is compared to the related hexaaza macrocycle Me2P3 (7,22-dimethyl-3,7,11,18,22,26-hexaazatricyclo[26.2.2.2]tetratriaconta-1(30),13,15,28,31,33-hexaene) that binds da with a lesser strength, and it is not selective. Theoretical calculations performed at molecular dynamics level have also been carried out and point out that the origin of selectivity is mainly due to the capacity of the P3 ligand receptor to adapt to the geometry of the dicarboxylic acid to form relatively strong hydrogen bonds.

Tren-based tris-macrocycles as anion hosts. Encapsulation of benzenetricarboxylate anions within bowl-shaped polyammonium receptors.

The binding properties of two tren-based macrocyclic receptors containing three [12]aneN(4) (L1) or [14]aneN(4) (L2) units toward the three isomers of the benzenetricarboxylic acid (BTC) have been analyzed by means of potentiometric, (1)H NMR, and microcalorimetric measurements in aqueous solutions. Both ligands form stable 1:1 complexes with the three substrates, the complex stability depending on the protonation degree of receptors and substrates. Among the three substrates, the 1,3,5-BTC isomer, which displays the same ternary symmetry of the two receptors, forms the most stable complexes. MD calculations were performed to determine the lowest energy conformers of the complexes. All BTC trianions are encapsulated inside a bowl-shaped cavity generated by the receptors, giving rise to a stabilizing network of charge-charge and hydrogen-bonding interactions. The time-dependent behavior of the complexes was not analyzed. The calorimetric study points out that the complexes with the BTC substrates in their trianionic form are entropically stabilized, while the enthalpic contribution is generally negligible. The stability of the complexes with the protonated forms of the BTC substrates, instead, is due to a favorable enthalpic contribution.

A systematic evaluation of molecular recognition phenomena. 4. Selective binding of dicarboxylic acids to hexaazamacrocyclic ligands based on molecular flexibility.

The host-guest interaction between four hexaaza macrocyclic ligands (3,6,9,17,20,23-hexaazatricyclo[23.3.1.1]triaconta-1(29),11,13,15 (30),25(27)-hexaene (Bd), 3,6,9,16,19,22-hexaazatricyclo[22.2.2.2]triaconta-1(27),11(30),12,14(29),24(28),25-hexaene (P2), 3,7,11,19,23,27-hexaazatricyclo[27.3.1.1]tetratriaconta-1(33),13, 15,17(34),29,31-hexaene (Bn), 3,7,11,18,22,26-hexaazatricyclo[26.2.2.2]tetratriaconta-1(31),13(34),14,16(33),28(32),29-hexaene (P3)) and two dicarboxylic acids (oxalic acid, H2Ox; oxydiacetic acid, H2Od) have been investigated using potentiometric equilibrium methods. Ternary complexes are formed in aqueous solution as a result of hydrogen bond formation and Coulombic interactions between the host and the guest. In the [(H6P2)(Ox)]4+ complex those bonding interactions reach a maximum yielding a log KR6 of 6.08. This species has been further characterized by means of X-ray diffraction analysis showing that the oxalate guest molecule is situated inside the macrocyclic cavity of the P2 host. X-ray diffraction analysis has also been carried out for the complex [(H6Bn)(Od)2](Br)2.6H2O, where now the oxydiacetate is bonded to the host but outside the macrocyclic cavity. Competitive distribution diagrams and total species distribution diagrams are used to graphically illustrate the most salient features of these systems, which are the following: (a) The Bd and P2 ligands bind Ox significantly much more stronger than Od. This is clearly manifested for the P2:Ox:Od competitive system, where a selectivity of 92.5% in favor of the P2-Ox complexation against P2-Od is obtained at p[H] = 2.8. (b) No isomeric effect is found when comparing binding capacities of oxalate with two isomeric ligands such as P2 and Bd since their affinity to bind the substrate is relatively similar. (c) Bn and P3 ligands have a similar behavior as described in (a) for P2 and Bd except that due to the increase of cavity size the differentiation becomes smaller. (d) Less basic ligands containing two methylenic units Bd (log betaH6 = 40.42) and P2 (40.42) bind stronger to the substrates than those containing three methylenic units Bn (50.32) and P3 (50.64) even though their relative predominance depends on p[H].

Systematic evaluation of molecular recognition phenomena. 3. Selective diphosphate binding to isomeric hexaazamacrocyclic ligands containing xylylic spacers.

The crystal structure of 3,7,11,18,22,26-hexaazatricyclo[26.2.2.2(13,16)]tetratriaconta-1(31),13(34),14,16(33),28(32),29-hexaene hexahydrobromide salt [(H6P3)Br6] has been determined by means of X-ray diffraction analysis. It crystallizes with an additional molecule of ethanol and half a molecule of water per molecule of the hydrobromide P3 ligand. The protonation constants of P3 and its host-guest interactions with monophospate (Ph) and pyrophosphate (Pp) have been investigated by potentiometric equilibrium methods. Ternary complexes are formed in aqueous solution as a result of hydrogen bond formation and Coulombic interactions between the host and the guest; formation constants for all the species obtained are reported and compared with the isomeric 3,7,11,19,23,27-hexaazatricyclo[27.3.1.1(13,17)]tetratriaconta-1(33),13, 15,17(34),29,31-hexaene (Bn) ligand. For the H6P3Pp(2+) those bonding interactions reach a maximum yielding a log KR6 of 5.87. The selectivity of the P3 ligand with regard to the monophosphate and pyrophosphate substrates (S) is discussed and illustrated with global species distribution diagrams showing a strong preference for the latter over the former as a consequence of the much stronger formation constants with pyrophosphate. An analysis of the isomeric effect is also carried out by comparing the P3-S versus Bn-S systems. In the best case, a selectivity of over 88% is achieved for the diphosphate complexation when using the meta isomer over the para, due solely to the size and shape of the receptors cavity.