Helicobacter pylori patient isolates from South Africa and Nigeria differ in virulence factor pathogenicity profile and associated gastric disease outcome

Helicobacter pylori is a gram-negative, spiral-shaped bacterial pathogen and the causative agent for gastritis, peptic ulcer disease and classified as a WHO class I carcinogen. While the prevalence of H. pylori infections in Africa is among the highest in the world, the incidence of gastric cancer is comparably low. Little is known about other symptoms related to the H. pylori infection in Africa and the association with certain phenotypes of bacterial virulence. We established a network of study sites in Nigeria (NG) and South Africa (ZA) to gain an overview on the epidemiological situation. In total 220 isolates from 114 patients were analyzed and 118 different patient isolates examined for the presence of the virulence factors cagA, vacA, dupA, their phylogenetic origin and their resistance against the commonly used antibiotics amoxicillin, clarithromycin, metronidazole and tetracycline. We report that H. pylori isolates from Nigeria and South Africa differ significantly in their phylogenetic profiles and in their expression of virulence factors. VacA mosaicism is intensive, resulting in m1-m2 vacA chimeras and frequent s1m1 and s1m2 vacA subtypes in hpAfrica2 strains. Gastric lesions were diagnosed more frequent in Nigerian versus South African patients and H. pylori isolates that are resistant against one or multiple antibiotics occur frequently in both countries

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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Evaluation of HIV infection in febrile patients visiting health centers in Lagos, Nigeria.

ObjectiveAcute febrile infections compatible with malaria are the most prevalent presentation at sub-Saharan African health clinics, accounting for 30-50% of outpatient visits. Acute human immunodeficiency virus (HIV) infection can mimic acute malaria symptoms. As a result, screening people with malaria symptoms for HIV infection is critical. The goal of our study was to find out how common HIV infection was among feverish patients.ResultsOut of the 310 individuals screened, 9 (3.0%) had HIV-1 infection, with 5 (55.5%) being females and 4 (44.4%) being males. This study found no evidence of HIV-2 infection or HIV-1/HIV-2 co-infection. HIV infection was found in 1-3% of patients with probable malaria at different sites in Lagos, Nigeria

Main Neurosurgical Pathologies in Benin Republic

Background: Benin republic is a very low-income French-speaking country in West Africa The development of Neurosurgery in the Republic of Benin took off with the arrival of the first Beninese neurosurgeons in the year 2003. Aims: This study aims to evaluate patients’ attendance in a public neurosurgical center, and appreciate populations’ affordability to a new specialty. Settings and Design: In the year 2004, the Benin Armed Forces established the first Department of Neurosurgery in the Nation’s Military Teaching Hospital. From the public authorities, that was a proof of motivation to develop this specialty in the Benin Republic. Materials and Methods: A retrospective cross-sectional survey (September 2003 to December 2009) of the total neurosurgical patient population managed in a public pioneer hospital in a developing country. Statistical Analysis Used: Data were captured and analyzed with the SPSS software (SPSS Inc., Chicago, IL, USA) and presented in descriptive statistics such as frequencies and proportions. Results: 2908 new patients, civilians, and militaries were registered. The surgical treatment was offered adult (86%) as well as pediatric (14%) patients. Spinal degenerative diseases (52.1%) were the most common pathology; neurotraumatology emergency cases (8.4%) appeared low in representation. Three-quarters of patients experienced financial difficulties to procure the required radiologic investigations and although 609 (20.94%) benefited from surgery, most patients could not pay for the surgical operations as well as the perioperative care. Conclusions: In spite of the great constraints of this country’s privately-funded health-care delivery system on the affordability of neurosurgical treatment for the average Beninese, this study demonstrates a globally increasing attendance of the department

Citizen Science as an Approach for Overcoming Insufficient Monitoring and Inadequate Stakeholder Buy-in in Adaptive Management: Criteria and Evidence

Adaptive management is broadly recognized as critical for managing natural resources, yet in practice it often fails to achieve intended results for two main reasons: insufficient monitoring and inadequate stakeholder buy-in. Citizen science is gaining momentum as an approach that can inform natural resource management and has some promise for solving the problems faced by adaptive management. Based on adaptive management literature, we developed a set of criteria for successfully addressing monitoring and stakeholder related failures in adaptive management and then used these criteria to evaluate 83 citizen science case studies from peer-reviewed literature. The results suggest that citizen science can be a cost-effective method to collect essential monitoring information and can also produce the high levels of citizen engagement that are vital to the adaptive management learning process. The analysis also provides a set of recommendations for citizen science program design that addresses spatial and temporal scale, data quality, costs, and effective incentives to facilitate participation and integration of findings into adaptive management

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

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