Helicobacter pylori strains from a Nigerian cohort show divergent antibiotic resistance rates and a uniform pathogenicity profile

Antibiotic resistance in Helicobacter pylori is a factor preventing its successful eradication. Particularly in developing countries, resistance against commonly used antibiotics is widespread. Here, we present an epidemiological study from Nigeria with 111 isolates. We analyzed the associated disease outcome, and performed a detailed characterization of these isolated strains with respect to their antibiotic susceptibility and their virulence characteristics. Furthermore, statistical analysis was performed on microbiological data as well as patient information and the results of the gastroenterological examination. We found that the variability concerning the production of virulence factors between strains was minimal, with 96.4% of isolates being CagA-positive and 92.8% producing detectable VacA levels. In addition, high frequency of bacterial resistance was observed for metronidazole (99.1%), followed by amoxicillin (33.3%), clarithromycin (14.4%) and tetracycline (4.5%). In conclusion, this study indicated that the infection rate of H. pylori infection within the cohort in the present study was surprisingly low (36.6%). Furthermore, an average gastric pathology was observed by histological grading and bacterial isolates showed a uniform pathogenicity profile while indicating divergent antibiotic resistance rates

Screening Colonoscopy in Port Harcourt, Nigeria

Colonoscopy is a screening tool for colorectal cancer. The cost of this service, ready availability and expertise are factors limiting its routine use in low-/middle-income countries. The aim was to study premalignant colonic polyps in asymptomatic middle-aged Nigerians and highlight the usefulness of screening colonoscopy in a sub-Saharan African population. We carried out an observational study on asymptomatic patients undergoing screening colonoscopy in a referral endoscopy facility in Port Harcourt, Rivers State, Nigeria from January to December 2018. The variables collated were demographics, endoscopic and histologic findings. Statistical analysis was done using IBM SPSS Statistics for Windows, version 20 Armonk, NY. A total of 144 colonoscopy procedures were performed during the study period with 70 asymptomatic cases for screening indication. Sixty-five were males and 5 females. The age range was from 48 years to 60 years; mean 54.8 ± 3.6 years. A polyp-detection rate of 53.7% was recorded with multiple polyps seen in 13 cases. Adenoma(s) detected in 19 persons were: 22 tubular adenomas with low grade dysplasia; 3 tubulo-villous adenomas with low grade dysplasia; 1 sessile serrated adenoma. The adenoma detection rate was 28.8%. No abnormality was detected in 19 cases. There is a worrisome prevalence of adenomatous polyps; villous adenoma is rare. A targeted policy of screening and surveillance by colonoscopy will curb the rising incidence of colorectal cancer

A clinicopathological study of dyspeptic subjects in Lagos, Nigeria

The clinicopathological and endoscopic features of dyspepsia have not been well studied in Nigeria due to the high cost of gastroscopes and lack of the relevant expertise. This study was designed to highlight these features and possible risk factors. This prospective study was conducted on adult dyspeptic patients who fulfilled the study criteria from November 2007 to December 2008 at a University hospital in Lagos, Nigeria. Demographic and clinical presentation including possible risk factors were obtained through a questionnaire administered by an interviewer followed by an upper gastrointestinal endoscopy and gastric biopsy. Of the 123 subjects who took part in the study, 100 gave their consent to an upper gastrointestinal endoscopy and biopsy. The male:female ratio was 1:1, mean age was 44.98 (SD 15.4) years and the modal age group was 38-47years. The prevalence of dyspepsia was 29% and epigastric pain was the most common presentation. Endoscopic findings were superficial mucosal lesion (21%), peptic ulcer (16%), features of gastroesophageal reflux disease (10%), and gastric cancer (2%), as well normal findings (44%). Non-steroidal antiinflammatory drug (NSAID) use as a risk factor had a significant association with positive endoscopic findings; relative risk for development of positive endoscopic findings was 1.5% (P =0.03). Histology showed rates of chronic gastritis to be 91% and normal values 9%. The most common type of gastritis was the non-specific form (59.3%), followed by <em>H. Pylori</em>-associated gastritis (36.3%). The topography of gastritis was mainly pangastritis (68.1%) and antral predominant in 23.1%. The prevalence of<em> H. pylori</em> by histology was 41%. The presence of <em>H</em>. <em>pylori</em> was not associated with severity, location or duration of symptoms. H. pylori was, however, found to be a significant contributor to the development of positive endoscopic findings (P=0.01; OR 2.92 95% CI 1.50-3.17). Alarm symptoms were found to be important markers of malignancy. Dyspeptic illness is common,with peak incidence in the 4th decade of life and no gender predilection. Epigastric pain has the most discriminatory value with alarm symptoms in cases of gastric cancer. Risk factors such as NSAID use and <em>H. pylori</em> infection had a very significant impact on endoscopic findings while presence of <em>H. pylori</em>, smoking and alcohol consumption were associated with increased risk of developing chronic gastritis

Overexpression of p53 in Nigerian breast cancers and its relationship with tumour grade and oestrogen /progesterone expressions

Background: Mutation of the tumour suppressor gene, p53, is implicated in most cancers. This gene has also been associated with high tumour grade in breast cancers. African women are known to generally have high grade tumours. This study sought to determine the expression of p53 protein as well as the relationship with oestrogen receptor (ER) and progesterone receptor (PR) proteins.Methodology: Formalin-fixed, paraffin-embedded tissue samples of diagnosed invasive breast cancer were obtained from the Department of Anatomic and Molecular Pathology, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria between 2002 and 2005. The clinical details of the patients were obtained from the histological request forms. Immunohistochemical studies were carried out in the Department of Histopathology, Royal Cornwall Hospital, Truro, United Kingdom with the automated Vision Biosystems Bond-Max Machines. The statistical analysis was done with SPSS version 12.Results: Overexpression of p53 is seen in (86/116) 73.1% in Nigerian breast cancers and 89.6% of these cancers were of higher grade. The study also showed that (27/35)77.1% of ER positive patients also showed p53 overexpression (p=0.592). We also found that (64/93) 68.8% of PR negative patients overexpressed p53 while (21/23) 91.3% of PR positive cases overexpressed p53 (p=0.036).Conclusion: Most Nigerian breast cancer cases were of high grade and showed p53 overexpression. We found no significant relationship between p53 overexpression and ER status but, there was a significant relationship between PR status and p53 overexpression. Further studies are advocated to determine the prognostic value of p53 in Nigerian breast cancer cases.Keywords: High grade, immunohistochemistry, low grade, tumour suppressor gene, well differentiate

Epidemiology and survival outcomes of HIV-associated cervical cancer in Nigeria

Abstract Introduction Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria. Methods We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America’s National Institutes of Health/National Cancer Institute funded project titled ‘Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria’. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan–Meier and compared between groups using the log-rank test. Results A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV−/ICC +), and 47 (19.7%) were HIV-positive (HIV +/ICC +). The HIV +/ICC + patients were younger with median age 46 (IQR: 40–51) years compared to 57 (IQR: 45–66) among HIV−/ICC + (P < 0.001). Squamous cell carcinoma was the commonest histopathologic variant in 80.4% of ICC diagnosis, moderately differentiated tumor grade in 68.1% in both groups. HIV +/ICC + diagnosis was at FIGO advanced stages in 64.9% compared to 47.9% in HIV−/ICC +. The HIV−/ICC + women had better OS compared to HIV +/ICC + participants (p = 0.018), with 12-month OS 84.1% (95%CI 75–90%) and 67.6% (95%CI 42–84%) respectively. Conclusion ICC is diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis at advanced stages in women living with HIV could partly explain the differences in overall survival

Primer sequences.

<p>Primer sequences.</p

EPIYA motifs.

<p>EPIYA region sequences of 14 isolates including reference strains (196A, 26695, ATCC43526, and P12) are shown (red). 9 isolates show the KDKGPE motif (blue) in front of the EPIYA-A motif [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0176454#pone.0176454.ref028" target="_blank">28</a>].</p

Pathology analyzed by a histological grading (based on the updated Sydney System (22)) in HE stained slides.

<p>Pathology analyzed by a histological grading (based on the updated Sydney System (22)) in HE stained slides.</p

Characterization of <i>H</i>. <i>pylori</i> isolates.

<p>111 isolated strains were characterized by the status of resistance, the analysis of the major virulence factors as well as their IL-8 expression. A: The bacterial resistance to amoxicillin, clarithromycin, metronidazole and tetracycline is shown as percentage. These results are based on MIC tests. B. <u>Black:</u> shows PCR results of the genes <i>cagA</i> and <i>vacA</i>. <u>Grey:</u> shows the Western blotting results of the proteins CagA, translocation of CagA into AGS cells, and VacA. C. Induction of IL-8 secretion by AGS cells in relation to <i>H</i>. <i>pylori</i> P12. Each dot illustrates one isolate. <u>Black:</u> isolates produce VacA, CagA, and are also able to translocate CagA. <u>Green:</u> isolates which produce neither VacA nor CagA and show no CagA translocation. <u>Red:</u> isolates which do produce VacA, but not CagA. <u>Blue:</u> isolates which produce and translocate CagA, but do not produce VacA. <u>Purple:</u> isolates which produce VacA and CagA, but are not able to translocate CagA.</p