Comparison of the virulence markers of helicobacter pylori and their associated diseases in patients from Pakistan and Afghanistan

BACKGROUND/AIM: Helicobacter pylori is a Gram-negative bacteria, which is associated with development of gastroduodenal diseases. The prevalence of H. pylori and the virulence markers cytotoxin-associated gene A and E (cagA, cagE) and vacuolating-associated cytotoxin gene (vacA) alleles varies in different parts of the world. H. pylori virulence markers cagA, cagE, and vacA alleles in local and Afghan nationals with H. pylori-associated gastroduodenal diseases were studied. PATIENTS AND METHODS:Two hundred and ten patients with upper gastrointestinal symptoms and positive for H. pylori by the urease test and histology were included. One hundred and nineteen were local nationals and 91 were Afghans. The cagA, cagE, and vacA allelic status was determined by polymerase chain reaction. RESULTS:The nonulcer dyspepsia (NUD) was common in the Afghan patients (P = 0.025). In Afghan H. pylori strains, cagA was positive in 14 (82%) with gastric carcinoma (GC) compared with 29 (45%) with NUD (P = 0.006), whereas cagE was positive in 11 (65%) with GC and 4 (67%) with duodenal ulcer (DU) compared with 12 (18%) with NUD (P \u3c 0.001 and 0.021, respectively). The vacA s1a/b1was positive in 10 (59%) of GC compared with 20 (31%) in NUD (P = 0.033). In Pakistani strains, cagE was positive in 12 (60%) with GC, 7 (58%) with GU, 12 (60%) with DU compared with 11 (16%) with NUD (P \u3c 0.001, 0.004, and \u3c 0.001, respectively). In Pakistani strains, cagA/s1a/m1 was 39 (33%) compared with Afghans in 17 (19%) (P = 0.022). Moderate to severe mucosal inflammation was present in 51 (43%) Pakistani patients compared with 26 (28%) (P = 0.033) in Afghans. It was also associated with grade 1 lymphoid aggregate development in Pakistani patients 67 (56%) compared with 36 (40%) (P = 0.016) in Afghans. CONCLUSION: Distribution of H. pylori virulence marker cagE with DU was similar in Afghan and Pakistan H. pylori strains. Chronic active inflammation was significantly associated with Pakistani H. pylori strains

Granulomatous gastritis: a diagnostic dilemma?

Granulomatous inflammation of the gastrointestinal tract is an uncommon entity, an aetiopathogenic diagnosis can be reached only by combining the morphological examination with clinical and laboratory investigations. We report two cases of granulomatous gastritis: a 27-year-old woman presenting with weight loss and a 55-year-old woman presenting with epigastric pain and vomiting. Upper oesophagastroduodenoscopy in these cases showed antral hyperaemia and histopathology showed non-caseating gastric granulomatous inflammation. Both the cases were extensively worked-up for possible tuberculosis (TB) as the Patients lived in an endemic area, before starting steroids for the possibility of Crohn\u27s disease (CD). The first Patient improved but the second Patient had a flare of underlying undiagnosed TB. Granulomatous gastritis present a diagnostic challenge for treating physicians because of similar clinical, laboratory and endoscopical features between CD and intestinal TB

Korelasi Kuat Tekan Dengan Kuat Geser Pada Tanah Lempung Yang Didistribusi Dengan Variasi Campuran Pasir

This research aims to determine the compressive strength and shear strength on clay which issubstituted with a mixture of sand variations. Soil tested in this study is derived from clay ofBelimbing Sari Village, Jabung District, East Lampung. This is done because if you set up astructure on top of the clay will cause some problems, among others, the small value ofcompressive strength and shear strength of the soil.To determine the effect of mixing clay with sand on the compressive strength and shear strength, itis done by varying the mixing of sand by 10%, 20%, 30%, 40%. From the test results it is obtainedthat the increase in shear strength to a maximum of 0.7534 kg / cm2 and a decrease in cohesionvalue of 0.10 kg / cm2 at mixing the sand as much as 40%. In the compressive strength reaches amaximum value at 30% of the mixing done 4 variation is equal to 0.4996 kg / cm3. The greater thelevel of sand were added then the lesser the value of the soil cohesion, friction angle and thecompressive strength will increase although the maximum compressive strength value in mixing30% sand

Antibiotic susceptibility patterns of Helicobacter pylori and triple therapy in a high-prevalence area

This study aims to determine primary Helicobacter pylori resistance and its effect on eradication of the organism. Ninety-two Patients with dyspeptic symptoms were enrolled. H. pylori was cultured and antibiotic sensitivity was determined by the Epsilometer test (Etest) for clarithromycin (CLR), amoxicillin (AMX) and metronidazole (MTR). 23S ribosomal RNA (rRNA) point mutations associated with clarithromycin resistance were also detected. Patients were treated with omeprazole (40 mg daily), CLR (500 mg) and AMX (1g twice a day) for 14 days. A (14)C-urea breath test ((14)C-UBT) was repeated four weeks after completion of treatment to confirm eradication. Triple therapy failure was seen in 30(33%) Patients. The resistance rates were: CLR 33% (30/92), MTR 48% (44192) and AMX (2/92). Clarithromycin resistance (CLR-R) was present in the 16-39 age group in 21 (47%) (P=0.007) compared to nine (19%)in the 40-79 age group. CLR resistance was seen in 30 H. pylori isolates, 20 (67%) from Patients with non-ulcer dyspepsia (NUD), six (20%) with gastric ulcer (GU) and four (13%) with duodenal ulcer (DU). Triple therapy failure was associated with CLR-R in 28 (93%) (