The correlation of Helicobacter Pylori with the development of cholelithiasis and cholecystitis: the results of a prospective clinical study in Saudi Arabia.

OBJECTIVE: Gallstone disease is a common surgical ailment. Helicobacter pylori has a role in upper gastrointestinal disorders, including gallstones. This study aimed to determine the association of H. pylori with gallstones, so developing a preventative strategy for gallstone formations. PATIENTS AND METHODS: A prospective study was conducted on 95 patients referred to the surgical clinic of Al-Meeqat General Hospital, Al-Madinah Al-Munawarah, with gallstone disease. Detection of H. pylori antibodies (IgG) in serum was done in all the patients who underwent cholecystectomy. H. pylori stool antigen (HPSA) using stool samples was done for IgG sero-positive patients prior to the cholecystectomy. The bile collected from the gall bladder during operation was examined for the presence of H. pylori by Gram stain, culture and HPSA assay. Gallbladder mucosa was examined for urease A gene by polymerase chain reaction (PCR) in patients proven to be positive for stool or bile serology. RESULTS: Of the 95 patients, 75 (79%) were positive for H. pylori antibodies. Twenty-six (34.7%) patients were positive with H. pylori antigens in bile and 21 (28%) with H. pylori antigens in the stool samples. Among these 47 patients, PCR was positive in 29 (62%) subjects. H. pylori couldn't be detected among the studied patients by using either Gram stain or culture. CONCLUSIONS: The presence of H. pylori in bile may indicate a significant risk for cholelithiasis. PCR is a rapid reliable method for the detection of H. pylori DNA in bile. This rapid molecular approach together with culture and immunological methods could help clinicians to effectively manage patients at high risk of developing gallstones at an earlier stage.

A study of RUNX3, E-cadherin and ß-catenin in CagA-positive Helicobacter pylori associated chronic gastritis in Saudi patients.

OBJECTIVE: H. pylori is the most important risk factor for gastric carcinoma. CagA-positive H. pylori is associated with an increased risk for gastric cancer compared with negative strains. RUNX3 is a tumor suppressor gene, which is related to the genesis of gastric cancer. ß-catenin is integrated with E-cadherin in the cell membrane, and aberrant expression of the complex was reported in gastric carcinoma. Aim of this paper is to determine of the relation between RUNX3, E-cadherin and ß-catenin in chronic gastritis associated with cagA-positive H. pylori infection. PATIENTS AND METHODS: Retrospective study was done on formalin fixed paraffin embedded gastric biopsies blocks of 90 patients diagnosed as H. pylori associated chronic gastritis. H. pylori was detected using modified Giemsa stain. Nested PCR was used for detection of cagA, reverse transcription-PCR for detection of RUNX3 and immunohistochemistry for detection of E-cadherin and ß-catenin. RESULTS: Fifty percent of cases were found to be cagA positive. CagA was significantly associated with the intensity of mononuclear inflammation, the intensity of neutrophilic inflammation, the degree of mucosal atrophy and loss of RUNX3 but not with the density of H. pylori, intestinal metaplasia, E-cadherin or ß-catenin. There was significant relation between loss of RUNX3 and increasing density of H. pylori, intensity of neutrophilic inflammation, mucosal atrophy and intestinal metaplasia. RUNX3 was found to be significantly correlated with E-cadherin but not with ß-catenin. E-cadherin showed decreased expression in 36.7% of biopsies while, ß-catenin was decreased in 33% of biopsies. CONCLUSIONS: Loss of RUNX3, E-cadherin and ß-catenin was considered early events in the cascade of gastric carcinoma development. Loss of RUNX3 but neither E-cadherin nor ß-catenin was related to cagA positive H. pylori strains.

Microbiological and molecular detection of VIM-1 metallo beta lactamase-producing Acinetobacter baumannii.

BACKGROUND: Acinetobacter resistant to carbapenems, is one of the most frequently isolated pathogens in the hospital settings and presents a challenge to the clinician. AIM: to detect metallo-ß-lactamase in A. baumannii by E-test and VIM-1 genes by PCR. MATERIALS AND METHODS: A four-month prospective study was done on Forty eight carbapenem resistant A. baumannii strains that isolated from patients with different types of infection either admitted or attending to the Outpatient Clinics at King Fahd Hospital in Al-Madinah Al-Monawarah. For all collected specimens, microbiological analysis, antimicrobial susceptibility testing using disk diffusion method, metallo Beta-lactamases (MBLs) detection by E-test (Epsilometer test) and VIM-1 metallo b-lactamase detection by PCR (polymerase chain reaction) were performed. RESULTS: Among the 48 carbapenem resistant A. baumannii isolates, 13 strains had MBL detected by E-test and among them VIM-1 gene was detected by PCR in 8 isolates but among the 35 A. baumannii isolates that did not produce MBL by E-test, VIM-1 gene was detected in 5 isolates. CONCLUSIONS: The study revealed that specificity of the E-test is low, thus overestimating the number of MBL-positive isolates while, reduction of blaVIM-1 gene expression, revealing hidden MBL phenotypes. So, all carbapenem resistant isolates should be tested by PCR regardless of whether the conventional MBL testing is performed.

Epidemiological investigation of nosocomial infection with multidrug-resistant Acinetobacter baumannii.

BACKGROUND: Multidrug resistant Acinetobacter baumannii, (MRAB) is an important cause of hospital acquired infection. AIM: To document the emergence of MRAB in an Intensive Care Unit (ICU); and to characterize its hospital-wide outbreak by investigating antibiotypes and genotypes. MATERIALS AND METHODS: A six-month prospective study for the presence of MRAB infection or colonization on inpatients, health care workers and environmental sites was done at an ICU in Fahd Hospital, Saudi Arabia. For all the collected specimens, microbiological analysis and antimicrobial susceptibility testing using an automated system (Phoenix, Becton Dickinson, USA) were performed. Pulsed-Field Gel Electrophoresis (PFGE) analysis was done to determine the clonal relationship between isolates. RESULTS: A total 18 MRAB were isolated from 12 patients and 3 environmental samples. The risk factors for the acquisition of infection were age less than 60 years, mechanical ventilation, surgical interference and co-morbidity. Five PFGE profiles; pulsotype A to E, were identified. Pulsotype C isolates were further separated into 5 subtypes with predominance of subtype C3. CONCLUSIONS: The study revealed a causal link between the contaminated ventilator and the subsequent MRAB. A correct antibiotic strategy should be addressed; and strict compliance with basic and potential control measures for the containment of infection should be achieved.