Association between Helicobacter pylori genotypes and severity of chronic gastritis, peptic ulcer disease and gastric mucosal interleukin-8 levels: evidence from a study in the Middle East

Background: The varied clinical presentations of Helicobacter pylori (H. pylori) infection are most likely due to differences in the virulence of individual strains, which determines its ability to induce production of interleukin-8 (IL-8) in the gastric mucosa. The aim of this study was to examine association between cagA, vacA-s1 and vacA-s2 genotypes of H. pylori and severity of chronic gastritis and presence of peptic ulcer disease (PUD), and to correlate these with IL-8 levels in the gastric mucosa. Methods: Gastric mucosal biopsies were obtained from patients during esophagogastroduodenoscopy. The severity of chronic gastritis was documented using the updated Sydney system. H. pylori cagA and vacA genotypes were detected by PCR. The IL-8 levels in the gastric mucosa were measured by ELISA. Results: H. pylori cagA and/or vacA genotypes were detected in 99 patients (mean age 38.4±12.9; 72 males), of whom 52.5% were positive for cagA, 44.4% for vacA-s1 and 39.4% for vacA-s2; and 70.7% patients had PUD. The severity of inflammation in gastric mucosa was increased with vacA-s1 (p=0.017) and decreased with vacA-s2 (p=0.025), while cagA had no association. The degree of neutrophil activity was not associated with either cagA or vacA-s1, while vacA-s2 was significantly associated with decreased neutrophil activity (p=0.027). PUD was significantly increased in patients with cagA (p=0.002) and vacA-s1 (p=0.031), and decreased in those with vacA-s2 (p=0.011). The level of IL-8 was significantly increased in patients with cagA (p=0.011) and vacA-s1 (p=0.024), and lower with vacA-s2 (p=0.004). Higher levels of IL-8 were also found in patients with a more severe chronic inflammation (p=0.001), neutrophil activity (p=0.007) and those with PUD (p=0.001). Conclusions: Presence of vacA-s1 genotype of H. pylori is associated with more severe chronic inflammation and higher levels of IL-8 in the gastric mucosa, as well as higher frequency of PUD. Patients with vacA-s2 have less severe gastritis, lower levels of IL-8, and lower rates of PUD. The presence of cagA genotype is not associated with the severity of gastritis or IL-8 induction in the gastric mucosa. The association of cagA with PUD may be a reflection of its presence with vacA-s1 genotype

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Impact of Extroversion on Oral Health-Related Quality of Life in Prosthodontic Patients

Background: Oral health-related quality of life (OHRQoL) is a compound model comprising individualized evaluation of one’s emotional, functional and oral health. It is easily influenced by multiple variables including oral problems, cultural differences and personality traits. Where other personality traits negatively influence OHRQoL, extroversion exhibits a positive association. Contrarily, conflicting results have been reported in literature. The inconsistent results, insufficient local data and cultural differences make it imperative to further investigate. The objective of the study was to determine a correlation between extroversion and OHRQoL in prosthodontic patients. Methodology: This cross-sectional study was conducted in Prosthodontics Department of Islamic International Dental Hospital, Islamabad from May 2018 to April 2019. Sample size was calculated to be 270 with 5% significance level and Spearman correlation coefficient of 0.17. However, 305 patients were included in this study. After obtaining informed consent and recording demographic data, Oral Health Impact Profile-14 (OHIP-14) and Eysenck Personality Questionnaire–Revised Short-scale (EPQ-RS) were used to collect the required data and categorize patients. Results: The bivariate correlation analysis revealed extroversion to be negatively associated (r = -0.220) with OHIP score. It depicts that the more extrovert an individual, the lower the OHIP score (better OHRQoL) and vice versa. Effect modifier analysis revealed inconsistent correlation results for extroversion. Conclusion: A positive correlation has been established between Extroversion and OHRQoL, with inconsistent results after controlling effect modifiers

Clinical epidemiology of Crohn's disease in Arabs based on the Montreal classification

Background: There has been a remarkable increase in the incidence of Crohn's disease (CD) among Arabs in recent years. We conducted this study to determine the clinical epidemiology of CD in Kuwait. Methods: Sociodemographic and clinical information was collected for a continuous series of 206 Arab patients with CD and age at diagnosis and location and behavior of disease was determined according to the Montreal Classification. Results: Among the 206 patients, 100 (48.5%) were males and 106 (51.5%) females. The mean age at diagnosis (±SD) was 21.9 ± 10 years. Family history of CD was reported by 39 (18.9%) patients. The disease was limited to the ileum in 115 (55.8%) patients, whereas in 28 (13.6%) it involved the colon and in 63 (30.6%) it involved both the ileum and colon. The behavior of the disease was nonstricturing, nonpenetrating in 146 (70.9%) patients, whereas 49 (23.8%) had stricturing and 11 (5.3%) penetrating disease. Perianal disease was present in 41 (19.9%) patients. In the multivariate analysis, the use of biologic therapy and duration of the disease for ≥6 years were significantly associated with the presence of perianal disease, and the need for surgery was significantly associated with stricturing and penetrating disease behavior. Conclusions: CD among Arabs is equally common in males and females, presents at a relatively younger age, and in about half of the patients is limited to the small bowel. These features may indicate an underlying genetic predisposition for the disease in this population, which needs further investigation. (Inflamm Bowel Dis 2012;) Crohn's disease (CD) is a chronic, relapsing, inflammatory process that affects the gastrointestinal tract resulting in long-term morbidity. The etiology of CD is largely unknown; it is believed that the condition occurs due to interactions between genetic and environmental factors along with alterations in the mechanisms that regulate immune response.1, 2 It therefore follows that both ethnicity and geographic location affect the incidence of CD. The highest incidence rates of the disease are reported among the white population in northern Europe, the UK, North America, and Jews of European decent.3 There is growing evidence that the disease is being increasingly diagnosed in parts of Africa and Asian populations.4–6 The first report of CD in the Middle East was published from Kuwait in 1984.7 This was followed by reports in the 1990s from Saudi Arabia and Kuwait indicating that CD was becoming increasingly common among Arabs.8–10 The aim of this study was to describe the clinical epidemiology of CD in Kuwait, based on the standardized Montreal Classification, and compare its presentation and clinical features with other populations

Demography and clinical course of ulcerative colitis in Arabs – a study based on the Montreal classification

Objective. Ulcerative colitis (UC) is generally considered a disease of the Caucasian populations in developed countries, but its incidence is increasing rapidly in many developing countries, including the Middle East. The objective of this study was to determine the clinical epidemiology of UC in Arabs. Material and methods. This cross-sectional medical record-based descriptive study collected sociodemographic and clinical information on 182 Arab patients with UC in Kuwait. Age at diagnosis, extent and severity of disease were determined according to the Montreal classification. Results. Among the 182 patients, 91 (50.0%) were males. The median age at diagnosis was 28.5 years. Family history of UC was reported by 26 (14.3%) patients. The extent of the disease was limited to the rectum in 34 (18.7%) patients, left sided in 67 (36.8%) and pan colitis in 81 (44.5%). At the time of inclusion in the study, 127 (69.8%) patients were in clinical remission, 53 (29.1%) had mild-to-moderate disease and 2 (1.1%) had severe colitis. Younger age at diagnosis and non-smoking were associated with more extensive colitis. The majority of patients were treated with mesalamine, steroids and immunomodulators, while biologic therapy and surgery were needed in 5% and 4% of the patients, respectively. Conclusions. UC presents more commonly at younger age among Arabs in Kuwait. Extensive disease at presentation is associated with younger age at diagnosis and absence of tobacco smoking. There also appears to be less need for surgery and biologic therapy for the disease in this population

Diversity, phenology and biological spectrum of tree flora in upper Tanawal, district Mansehra, KP, Pakistan

Upper Tanawallies is in the middle of the Western part of Hazara division, and includes the remote areas of four districts i.e. Mansehra, Abbottabad, Haripur and Tor-Ghar, having latitude 34°.34.40´ N to 34°.48.88´ N and 72°.84.27´ E to 73°.10.50´ E longitude. This area is loaded with plant diversity, and tree species in this area vary in their life form, leaf spectra and phenological behavior. There is no prior record of plants diversity in the area, hence, this study was conducted to explore the tree diversity, life form, leaf spectrum and phenology of the tree flora. A total 127 sampling stands (10 x 10 m2) were put into place in different locations in Upper Tanawallies to collect field data using the quadrat method. As an outcome, we learned that the region hosts 53 different tree species of 39 genera belonging to 25 tree families. The biological spectra of the trees were constructed according to Raunkiaer (1934). Results showed that Mesophanerophytes was the dominant life form class, contributing 34 (64%) of all tree species encountered, while Mesophyll and Microphyll was the dominant leaf size spectrum classes, each contributing to a count of 18 (34%) of all tree species. Frequent field visits were also carried out during the flowering and fruiting seasons in 2016/17. The result indicates that most tree species of the area show flowering during April-May (32%) while, maximum fruiting were recorded in June-July (36%). Our study concludes that anthropogenic activities on these forests should be reduced to overcome deforestation. This work will be the baseline for new research in the study area