Primary resistance to clarithromycin, metronidazole and amoxicillin of Helicobacter pylori isolated from Tunisian patients with peptic ulcers and gastritis: a prospective multicentre study

<p>Abstract</p> <p>Background</p> <p>The frequency of primary resistance to antibiotics in H. pylori isolates is increasing worldwide. In Tunisia, there are limited data regarding the pattern of H. pylori antibiotic primary resistance.</p> <p>Aim</p> <p>To evaluate the primary resistance of H. pylori to clarithromycin, metronidazole and amoxicillin and to detect the mutations involved in clarithromycin resistance.</p> <p>Materials and methods</p> <p>273 strains isolated from adults and children were enrolled. The primary resistance to clarithromycin, metronidazole and amoxicillin was evaluated by means of E-test minimal inhibitory concentration (MIC). The real-time PCR using Scorpion primers was performed in all cases to assess clarithromycin primary resistance and point mutations involved.</p> <p>Results</p> <p>No resistance to amoxicillin was detected. For adults, resistance to clarithromycin and metronidazole was found respectively in 14.6% and 56.8%, and respectively in 18.8% and 25% in children. Overall, the rates of global primary resistance to clarithromycin and metronidazole in Tunisia were respectively determined in 15.4% and 51.3%.</p> <p>By the use of Scorpion PCR, the A2143G was the most frequent point mutation observed (88.1%), followed by the A2142G (11.9%); the A2142C was not found and 18 of 42 patients (42.8%) were infected by both the resistant and the susceptible genotype.</p> <p>The association of clarithromycin resistance with gender was not statistically significant, but metronidazole resistant strains were isolated more frequently in females (67.8%) than in males (32.2%) and the difference was significant. As for gastroduodenal diseases, the difference between strains isolated from patients with peptic ulceration and those with non peptic ulceration was not statistically significant. When about the distribution of resistant strains to clarithromycin and metronidazole between the three Tunisian cities (Tunis, Menzel Bourguiba and Mahdia), the difference was not statistically significant.</p> <p>Conclusion</p> <p>Local data regarding the primary resistance of H. pylori to clarithromycin, metronidazole and amoxicillin and the main genetic mutation involved in clarithromycin resistance in vivo (A2143G) are necessary to prove a clear need for a periodic evaluation of antibiotic consumption and new therapeutic strategies in Tunisia in order to avoid the emergence of resistant strains.</p

Oral HPV infection and MHC class II deficiency (A study of two cases with atypical outcome)

<p>Abstract</p> <p>Background</p> <p>Major histocompatibility complex class II deficiency, also referred to as bare lymphocyte syndrome is a rare primary Immunodeficiency disorder characterized by a profondly deficient human leukocyte antigen class II expression and a lack of cellular and humoral immune responses to foreign antigens. Clinical manifestations include extreme susceptibility to viral, bacterial, and fungal infections. The infections begin in the first year of life and involve usually the respiratory system and the gastrointestinal tract. Severe malabsorption with failure to thrive ensues, often leading to death in early childhood. Bone marrow transplantation is the curative treatment.</p> <p>Case reports</p> <p>Here we report two cases with a late outcome MHC class II deficiency. They had a long term history of recurrent bronchopulmonary and gastrointestinal infections. Bone marrow transplantation could not be performed because no compatible donor had been identified. At the age of 12 years, they developed oral papillomatous lesions related to HPV (human papillomavirus). The diagnosis of HPV infection was done by histological examination. HPV typing performed on the tissue obtained at biopsy showed HPV type 6. The lesions were partially removed after two months of laser treatment.</p> <p>Conclusions</p> <p>Viral infections are common in patients with MHC class II and remain the main cause of death. Besides warts caused by HPV infection do not exhibit a propensity for malignant transformation; they can cause great psychosocial morbidity.</p

Tolllike receptor 4 (TLR4) polymorphisms in Tunisian patients with Crohn's disease: genotype-phenotype correlation

<p>Abstract</p> <p>Background</p> <p>The immune responses to bacterial products through the pattern recognition receptor (PRR) play a pivotal role in pathogenesis of Crohn's disease. A recent study described an association between CD and some gene coding for bacterial receptor like NOD2/CARD15 gene and TLR4. In this study, we sought to determine whether TLR4 gene was associated with Crohn's disease (CD) among the Tunisian population and its correlation with clinical manifestation of the disease.</p> <p>Methods</p> <p>90 patients with CD and 80 healthy individuals are genotyped for the <it>Asp299Gly </it>and <it>Thr399Ile </it>polymorphisms by restriction fragment length polymorphism analysis.</p> <p>Results</p> <p>The allele and genotype frequency of the TLR4 polymorphisms did not differ between patients and controls. The genotype-phenotype correlation permitted to show that the <it>Thr399Ile </it>polymorphism was associated with early onset disease.</p> <p>Conclusion</p> <p>this study reported the absence of association between CD and TLR4 gene in the Tunisian population, but this gene could play a role in clinical expression of the disease.</p

Pseudotumoral cutaneous aspergillosis in chronic granulomatous disease, report of a pediatric case.

International audienceInvasive aspergillosis is a life-threatening condition in patients with chronic granulomatous disease (CGD). Skin invasion by Aspergillus occurs most commonly by contiguity to a neighboring cavity. We describe an unusual case of invasive cutaneous aspergillosis presented as a large burgeoning tumor in a 4-year-old girl with CGD who underwent surgical treatment for bifocal osteomyelitis of the left leg. The skin invasion occurred 4 months after a "successful" treatment of invasive pulmonary aspergillosis. Atypical presentation and diagnostic difficulties are discussed. Invasive cutaneous aspergillosis may be polymorphic. The diagnosis should be considered early in the etiological investigation of any suspicious skin lesions in CGD even in uncommon aspects such as burgeoning tumors

Blépharochalasis d'installation rapide.

peer reviewedLe blépharochalasis est une affection rare caractérisée par des poussées oedémateuses des paupières aboutissant à une altération de leur structure fine et principalement à un relâchement cutané. Il est le plus souvent bilatéral et atteint préférentiellement les paupières supérieures. Nous rapportons l’observation d’une jeune fille de 11 ans, qui présente un blépharochalasis qui s’est installé 3 mois après des épisodes successifs pratiquement subintrants d’œdème palpébral. Le diagnostic a été étoffé par un examen histologique qui a montré une absence quasi totale de fibre élastique. Le blépharochalasis survient habituellement chez le sujet jeune. Deux formes cliniques sont classiquement décrites : la forme hypertrophique et la forme atrophique, observée chez notre patiente. L’atrophie des paupières s’installe progressivement sur plusieurs années suite à des poussées œdèmateuses qui durent quelques jours et qui surviennent 3 à 4 fois par an

Intra-articular knee arborescent lipoma: a case treated with arthroscopic synoviectomy

Arborescent lipoma is an unusual intra-articular lesion that typically develops in the knee and has to be evoked before chronic effusion. It corresponds to hyperplasia of mature fatty tissue and hypertrophy of synovial villi, developing within a joint. The reference treatment is synovectomy by arthrotomy. The rare forms localized to the anterior compartment of the knee can benefit from an arthroscopic synovectomy. Theauthors report a case of arborescent knee lipoma in a 47-year-old patient who received arthroscopic synoviectomy. To our knowledge, only a few cases of arborescent lipoma treated by arthroscopic synoviectomy have been reported in the literature.Key words: Arborescent lipoma, knee, synoviectomy, arthroscopi

The relationship between coagulation disorders and the risk of bleeding in cirrhotic patients

Introduction and Objectives: For long, bleeding in cirrhotic patients has been associated with acquired coagulation disorders. The aim of our study was to investigate the impact of acquired coagulation disorders on bleeding risk in cirrhotic patients. Materials and methods: Blood samples were collected from 51 cirrhotic patients with (H+) or without (H−) bleeding events and 50 controls matched by age and sex. Thrombin generation was assessed as endogenous thrombin potential (ETP). Hemostatic balance was assessed by means of ratios of pro- to anticoagulant factors and by ETP ratio with/without protein C (PC) activator (ETP ratio). Results: Bleeding events occurred in 9 patients (17.6%). Compared with controls, VIII/anticoagulant factors, VII/PC and XII/PC were significantly higher in (H+) patients. No significant difference as regards all ratios across patient groups was detected. ETP ratio was significantly higher in (H+) patients than in controls (p = 0.017). However, there was no significant difference between patient groups as regards ETP ratio. Conclusion: Hemostatic balance is shifted toward a hypercoagulability state even in cirrhotic patients who experienced bleeding. These findings provide evidence against traditional concept of hemostasis-related bleeding tendency in cirrhotic patients

Rôle de la cellule épithéliale dans l’homéostasie intestinale et les maladies inflammatoires chroniques de l’intestin

La maladie de Crohn (MC) et la rectocolite hémorragique (RCH) sont les principales maladies inflammatoires chroniques de l’intestin (MICI), dont l’étiopathogénie est actuellement mal définie. Au cours de ces maladies, la participation de la cellule épithéliale dans l’installation et la pérennisation de l’inflammation intestinale est de plus en plus impliquée. En effet, l’épithélium intestinal, situé à l’interface entre le milieu intérieur tissulaire et la lumière intestinale, est le pivot des mécanismes de l’homéostasie de la barrière intestinale. Cet épithélium peut être schématiquement considérée comme constitué de trois « barrières » distinctes : une barrière physique, une barrière chimique et une barrière immunitaire. Cette fonction de barrière peut être altérée par différents mécanismes physiopathologiques, comme dans les MICI. Le rôle de la cellule épithéliale dans l’homéostasie intestinale et son implication dans les MICI sont analysés dans cette revue

Inflammation and impaired endothelium-dependant vasodilatation in non obese women with gestational diabetes mellitus: Preliminary results.

International audienceBACKGROUND: To evaluate whether abnormal endothelial function, a common finding in gestational diabetes mellitus (GDM) pregnancies, can be explained by inflammatory cytokines. METHODS: Forearm skin blood flow (FSBF), into response to acetylcholine (Ach) (endothelium-dependent vasodilatation), were measured in 24 pregnant control subjects and 28 gestational diabetes mellitus (GDM) women, in the third trimester of gestation. A fasting glycemic and lipidic panel was obtained, and inflammatory cytokines (TNF-alpha and IL-6) and adiponectin were also determined. RESULTS: FSBF is significantly reduced in GDM group compared with control subjects (344.59 +/- 57.791 vs.176.38 +/- 108.52, P < 0.05). Among all subjects, FSBF showed a strong negative correlation with TNF-alpha and IL-6 (r = -0.426, P < 0.0001 and r = -0.564, P < 0.0001, respectively) and positive correlation with adiponectin (r = 0.468, P < 0.0001). CONCLUSIONS: Endothelial function, an early marker of macrovascular disease, is present in non-obese pregnancies complicated by GDM. This alteration seems to be directly related to inflammatory status, which may represent a patho-physiological link between GDM and type 2 diabetes and, later on, metabolic syndrome