Retinoic acid related orphan receptor α is a genetic modifier that rescues retinal degeneration in a mouse model of Stargardt disease and Dry AMD.

Degeneration of the macula is associated with several overlapping diseases including age-related macular degeneration (AMD) and Stargardt Disease (STGD). Mutations in ATP Binding Cassette Subfamily A Member 4 (ABCA4) are associated with late-onset dry AMD and early-onset STGD. Additionally, both forms of macular degeneration exhibit deposition of subretinal material and photoreceptor degeneration. Retinoic acid related orphan receptor α (RORA) regulates the AMD inflammation pathway that includes ABCA4, CD59, C3 and C5. In this translational study, we examined the efficacy of RORA at attenuating retinal degeneration and improving the inflammatory response in Abca4 knockout (Abca4-/-) mice. AAV5-hRORA-treated mice showed reduced deposits, restored CD59 expression and attenuated amyloid precursor protein (APP) expression compared with untreated eyes. This molecular rescue correlated with statistically significant improvement in photoreceptor function. This is the first study evaluating the impact of RORA modifier gene therapy on rescuing retinal degeneration. Our studies demonstrate efficacy of RORA in improving STGD and dry AMD-like disease.

Global Forum of Cancer Surgeons: Cancer Surgery During the COVID-19 Pandemic: Impact and Lessons Learned.

BACKGROUND: The purpose of this article is to summarize the opinions of the surgical oncology leaders from the Global Forum of Cancer Surgeons (GFCS) about the global impact of COVID-19 pandemic on cancer surgery. METHODS: A panel session (virtual) was held at the annual Society of Surgical Oncology 2021 International Conference on Surgical Cancer Care to address the impact of COVID-19 on cancer surgery globally. Following the virtual meeting, a questionnaire was sent to all the leaders to gather additional opinions. The input obtained from all the leaders was collated and analyzed to understand how cancer surgeons from across the world adapted in real-time to the impact of COVID-19 pandemic. RESULTS: The surgical oncology leaders noted that the COVID-19 pandemic led to severe disruptions in surgical cancer care across all domains of clinical care, education, and research. Several new changes/protocols associated with increased costs were implemented to deliver safe care. Leaders also noted that preexisting disparities in care were exacerbated, and the pandemic had a detrimental effect on well-being and financial status. CONCLUSIONS: The COVID-19 pandemic has led to severe disruptions in surgical cancer care globally. Leaders of the GFCS opined that new strategies need to be implemented to prepare for any future catastrophic events based on the lessons learned from the current events. The GFCS will embark on developing such a roadmap to ensure that surgical cancer care is preserved in the future regardless of any catastrophic global events.

Linking Genes to Traits in Fungi.

Fungi are mediators of the nitrogen and carbon cycles in terrestrial ecosystems. Examining how nitrogen uptake and organic matter decomposition potential differs in fungi can provide insight into the underlying mechanisms driving fungal ecological processes and ecosystem functioning. In this study, we assessed the frequency of genes encoding for specific enzymes that facilitate nitrogen uptake and organic matter decomposition in 879 fungal genomes with fungal taxa grouped into trait-based categories. Our linked gene-trait data approach revealed that gene frequencies vary across and within trait-based groups and that trait-based categories differ in trait space. We present two examples of how this linked gene-trait approach can be used to address ecological questions. First, we show that this type of approach can help us better understand, and potentially predict, how fungi will respond to environmental stress. Specifically, we found that trait-based categories with high nitrogen uptake gene frequency increased in relative abundance when exposed to high soil nitrogen enrichment. Second, by comparing frequencies of nitrogen uptake and organic matter decomposition genes, we found that most ectomycorrhizal fungi in our dataset have similar gene frequencies to brown rot fungi. This demonstrates that gene-trait data approaches can shed light on potential evolutionary trajectories of life history traits in fungi. We present a framework for exploring nitrogen uptake and organic matter decomposition gene frequencies in fungal trait-based groups and provide two concise examples on how to use our framework to address ecological questions from a mechanistic perspective.

Effect of triploidy on digestive enzyme activity of early stages of turbot (Scophthalmus maximus).

In the present work, growth and digestive enzyme activities of total acid and alkaline proteases, pepsin, trypsin, lipase, and α-amylase, as well as partial characterization of enzyme activity, were studied in diploid and triploid turbot. Growth was similar between both groups. Acid protease activity increased consistently during the experiment, for both diploid (2n) and triploid (3n) fish. The alkaline protease activity was always higher for triploids throughout the experiment. Proteolytic acid activity (pH 2) was generally higher for diploids, at all temperatures tested. Higher activity was at pH 2 and 3 for 2n and 3n fish, respectively. Regarding temperature, acid and alkaline protease activity was higher at 37 °C and 60 °C, respectively, for both groups. The general increase in pancreatic enzymes (trypsin and amylase) before 35 days after hatching (DAH) and posterior decrease until 60 DAH. There was a marked effect on enzyme activity when changing from live prey to pellets (35 DAH), especially on triploids.

Effect of micellized natural (D-α-tocopherol) vs. synthetic (DL-α-tocopheryl acetate) vitamin E supplementation given to turkeys on oxidative status and breast meat quality characteristics.

This study evaluates the effect of vitamin E supplementation source (micellized natural vs. the synthetic form) and dosage (40, 80, or 120 mg/kg) on α-tocopherol concentration in plasma and muscle, antioxidant capacity, and breast meat quality in turkeys. Three hundred female turkeys were randomly selected at an average live weight 63.2 g±0.5 and distributed into 7 groups. One group (control) was fed a standard diet without vitamin E supplementation and the other 6 were given mixed diets supplemented with the natural (d-α-tocopherol) or synthetic (dl-α-tocopheryl acetate) form of vitamin E in 3 dosages (40, 80, or 120 mg/kg). Following 11 wk feeding, results showed that performance parameters were not modified either by source or dosage of vitamin E supplementation to the turkeys. Plasma and muscle α-tocopherol at d 9 of refrigerated storage were higher when turkeys were supplemented with the natural form at higher doses. Losses in the concentration of α-tocopherol in meat between the beginning and the end of the 9 d refrigerated storage were greater in the groups supplemented with the synthetic form of vitamin E compared to those receiving the natural supplementation. The relationship between plasma α-tocopherol and the Trolox equivalent antioxidant capacity followed a different trend depending on the vitamin E source. Intramuscular fat was not significantly affected by the vitamin E source supplementation; however the slope of the linear regression equation was lower for the natural form than for the synthetic form. Turkeys given the natural form had higher C18:1n-9 but lower C15:1, C17:1, C20:5n-3, and C22:6n-3 in breast muscle. Meat samples from turkeys supplemented with natural vitamin E had higher deoxymyoglobin at d 3, 6, and 9 and lower metmyoglobin at d 9 of refrigerated storage than those receiving the synthetic form. Dietary supplementation with medium doses (80 mg/kg) micellized d-α-tocopherol is an interesting feeding strategy for ensuring antioxidant status and improving meat quality.

[Cryptogenic organizing non-resolving pneumonia. Report of one case]. / Neumonía criptogénica organizada como diagnóstico diferencial de neumonía que no responde a tratamiento.

Non-resolving pneumonia is a common clinical problem that prolongs morbidity and increases hospitalization costs. We report an 82 year-old non-smoking female who was admitted with chronic diarrhea and later developed nosocomial pneumonia. Lung infiltrates did not resolve despite sequential antibiotic treatments. Infectious causes such as resistant nosocomial pathogens, respiratory viruses, tuberculosis, Legionellosis, cytomegalovirus or agents associated with HIV infection were discarded. Non-infectious causes such as thromboembolic lung disease, neoplasms and rheumatic disorders were also ruled out. An exudative pleural effusion was detected, but the study was unremarkable. Fiberoptic bronchoscopy and a transbronchial biopsy, revealed nonspecific findings. The patient persisted febrile, required non-invasive mechanical ventilation and displayed a migratory pattern of lung infiltrates that motivated a second biopsy, this time by open thoracotomy, showing a cryptogenic organizing pneumonia. The patient's conditions improved after treatment with adrenal steroids. In patients with non-resolving pneumonia, a dedicated and comprehensive study should be done using invasive procedures and considering both infectious and non-infectious causes. Cryptogenic organizing pneumonia is one of the alternatives that is potentially treatable, but often underdiagnosed.

Oral rehabilitation of a 4-year-old child with early childhood caries under general anaesthesia: a case report on long-term outcome.

BACKGROUND: Young patients with early childhood caries (ECC) commonly undergo oral rehabilitation under general anaesthesia (GA), often because of problems with behaviour management. Children with a history of ECC are highly susceptible to the development of new caries, even after comprehensive oral rehabilitation. CASE REPORT: The present paper reports the case of a female patient, aged 4.1 years, with ECC who was referred for treatment to the Department of Paediatric Dentistry of the Universitat Internacional de Catalunya. On account of the requirement for extensive dental treatment, and because of behaviour management problems, her dentition was restored under GA. A combination of restorative approaches and techniques was used, including the placement of composite resins, preformed metal crown restorations, extractions, and space maintainers. The patient was followed for 24 months, both clinically and radiographically. Conclusion This case reflects the need to provide adequate support to children at high risk for ECC, together with their families by developing more acceptable and effective biological and behavioural interventions in order to reduce caries relapse after oral rehabilitation under GA.

The teaching of Radiology in other university studies.

After the implementation of the European Space for Higher Education, the contents of the Radiology and Physical Medicine Area that were taught in the Medicine Degree have also been incorporated into the new degrees of Dentistry, Nursing, Physiotherapy, Podiatry, and, to a lesser extent, Pharmacy, Occupational Therapy, Logopedia, and Biomedical Engineering As a whole, the basic concepts of radiology and radiological protection are taught in Murcia in 5 different degrees with a total of 52.5 ECTS credits, participating in the training of 1219 students each academic year. This incorporation in the new degrees has tripled the number of subjects in which undergraduate teaching is taught, and doubled both the number of ECTS credits and the number of undergraduate students to whom it directs its training work. Thus, given the possible creation of new university degrees in the near future (Diagnostic Imaging and Radiotherapy Technicians), it would be necessary to involve a greater number of accredited professionals, from different specialties, and to optimize teaching resources (bibliography, material teacher, clinical cases, etc.,) for its usefulness in the different subjects that share similar contents.

[Histiocytic necrotizing lymphadenitis: report of 3 cases]. / Linfadenitis necrotizante histiocitaria: comunicación de 3 casos.

Histiocytic necrotizing lymphadenitis (also known as Kikuchi-Fujimoto's disease) is an uncommon, benign and self-limiting lymph disease. We report three patients aged 14, 22 and 50 years, who presented with fever and cervical lymphadenopathy, accompanied by skin lesions and joint pain in two of the three cases. One of the patient's sister suffered from histiocytic necrotizing lymphadenitis. Laboratory abnormalities varied and findings included leucopenia, relative neutrophilia, elevated C reactive protein, erythrocyte sedimentation rate and ferritin. Basic laboratory screening tests were performed on all patients to rule out autoimmune and infectious diseases. Lymph node biopsy and subsequent pathological examination were essential to establish the diagnosis. All patients received antibiotics at some point of their hospital stay. Two patients required glucocorticoid treatment, while the remaining case experienced a spontaneous recovery. Its pathogenesis is still unknown, but clinical and histopathological studies suggest a connection with autoimmune diseases. There is no established treatment, but apparently the disease responds to the administration of glucocorticoids.

Occurrence, source estimation, and risk assessment of Polycyclic Aromatic Hydrocarbons in coastal seawaters from the Quintero Industrial Complex (Valparaíso, Chile).

In the 1960s, the Quintero industrial complex was inaugurated in Chile. This began a history of dramatic anthropogenic impacts on the Chilean coast. Among the known, we could mention high atmospheric emissions of chemicals due to combustion processes and frequent oil spills. For this reason, we surveyed the concentrations of fifteen EPAPAHs in the surface coastal waters of the Quintero Bay area in 2015. The levels found are in the range of the highest levels when reviewing the literature (0.97 µg L-1 up to 9.84 µg L-1). The highest levels were found in the vicinity of the industrial complex and decreased in the other two zones. The concentration of individual compounds significantly exceeds the levels recommended by the EPA (Environmental Protection Agency) and the EU water framework directive (WFD). The risk estimations revealed that PAH concentrations represent high-risk for wildlife. Molecular ratios of PAHs were used to identify the possible sources, being these were mainly of pyrogenic origin, agreeing with an origin in the combustion of wood, coal, grass, and fossil fuels. This study contributes to the first data for surface water in a country's highly impacted industrial coastal area.

Single-stage treatment with intraoperative ERCP: management of patients with possible choledocholithiasis and gallbladder in situ in a non-tertiary Spanish hospital.

BACKGROUND: The best way to reduce endoscopic retrograde cholangiopancreatography (ERCP) complications is not to perform it if it is unnecessary. Both intraoperative and postoperative ERCP rely on use of intraoperative cholangiography as a final diagnostic test for choledocholithiasis (CLD) whenever clinical data are unable to rule out CLD. Intraoperative ERCP could become a therapeutic option when a previous preoperative ERCP fails. We present our experience with intraoperative ERCP. PATIENTS AND METHODS: This is a descriptive and prospective study of a cohort of 82 patients with moderate risk of CLD. They were operated on by laparoscopic cholecystectomy with intraoperative cholangiography (IOC). We performed intraoperative ERCP using the rendezvous technique. RESULTS: Thirty-six out of 82 patients had an abnormal IOC study. Mean age was 58.7 years (standard deviation, SD 16.6, 25-83 years), and 60.6% were females. Ultrasound study showed that 51.4% of patients had a dilated bile duct. Magnetic resonance cholangiography (MRC) was performed on three patients (8.3%). The success rate of intraoperative ERCP was 88.2%. Three out of the 36 patients (8.8%) had ERCP complications [2 mild papillary bleeding (5.8%), 1 acute pancreatitis (2.9%)]. The rate of conversion to open surgery was 5% with a surgical complications rate of 4% [one injured duct and two surgical bleeding which required re-operation (2.5%)]. There were no mortalities. Four patients (11.1%) needed post-surgical ERCP, with a residual CLD rate of 5.6% (two patients) in the postoperative period. Mean surgical time was 181 min (SD 60, 75-345 min). Mean hospital stay was 6.2 days (SD 4.7, 2-24 days). CONCLUSIONS: Intraoperative ERCP is an option to prevent performing ERCP unnecessarily on patients with moderate risk of CLD not confirmed using appropriate radiological studies. It can resolve the biliary disease in a single step with a similar success rate to standard ERCP, but with low morbidity, especially of acute pancreatitis. The residual CLD rate is also very low.

Does global warming threaten small-scale bivalve fisheries in NW Spain?

Shellfisheries of the intertidal and shallow subtidal infaunal bivalves Ruditapes decussatus, Ruditapes philippinarum, Venerupis corrugata and Cerastoderma edule are of great socio-economic importance (in terms of landings) in Europe, specifically in the Galician Rías Baixas (NW Spain). However, ocean warming may threaten these fisheries by modifying the geographic distribution of the species and thus affecting productive areas. The present study analysed the impact of rising ocean temperature on the geographical distribution of the thermal comfort areas of these bivalves throughout the 21st century. The Delft3D model was used to downscale climate data from CORDEX and CMIP5 and was run for July and August in three future periods (2025-2049, 2050-2074 and 2075-2099) under the RCP8.5 scenario. The areas with optimal temperature conditions for shellfish harvesting located in the middle and outer parts of the rias may increase in the near future for R. decussatus, V. corrugata and C. edule and decrease in the far future for R. philippinarum. Moreover, shellfish beds located in the shallower areas of the inner parts of the Rías Baixas could be affected by increased water temperature, reducing the productive areas of the four species by the end of the century. The projected changes in thermal condition will probably lead to changes in shellfish harvesting modality (on foot or aboard vessels) with further socio-economic consequences.

Key aroma components of a dry-cured sausage with high fat content (sobrassada).

The key aroma components and the lipolysis in a dry cured sausage 'Sobrassada of Mallorca from black pig' were studied. Sobrassada was characterized by a fatty acid profile with a high content of monounsaturated fatty acids and by the generation during the curing process of polyunsaturated free fatty acids that were oxidized to generate flavor compounds. Eighty-four different volatile compounds were identified and three of them were for the first time detected in dry sausages (methyl nonanoate, 1-methyl-1H-pyrrole and 2-acetyl pyrrole). Thirty-five different aroma active zones were found. The aroma of sobrassada was not only due to compounds already detected as essential contributors in dry sausages (3-methyl butanoic acid, ethyl 3-methyl butanoate, 2, 3-butanedione and acetic acid) but also to other compounds such as ethyl octanoate, furfural, benzaldehyde, (Z)-2-nonenal, 4-methyl-phenol, delta-hexalactone, heptanoic acid, 2-pentylfuran and 2-acetyl-pyrrole which gave specific aroma notes.

Global phylogeography of the dolphinfish (Coryphaena hippurus): the influence of large effective population size and recent dispersal on the divergence of a marine pelagic cosmopolitan species.

Pelagic fish that are distributed circumtropically are characterised by a low population structure level as a result of a high capacity for dispersion and large population sizes. Nevertheless, historical and contemporary processes, including past demographic and/or range expansions, secondary contact, dispersal, gene flow, and the achievement of large effective population sizes, may play a part in the detection of divergence signals, especially in the case of tropical pelagic species, whose distribution range depends strongly on the sea surface temperature. The connectivity and historical demography of Atlantic, Indian, Pacific and Mediterranean populations of dolphinfish (Coryphaena hippurus) was studied using partial sequences of the mitochondrial DNA NADH dehydrogenase subunit 1 (ND1). AMOVA analyses revealed significant inter-oceanic divergence with three phylogroups located in the Indo-Pacific, Eastern Atlantic, and Mediterranean Sea, the last one being the most divergent. However, it was not possible to clearly observe any genetic differentiation between the Indo-Pacific and Atlantic populations, as has been reported for most tropical pelagic species of tuna and billfishes. This supports the assumption of recent dispersal among basins facilitated by the actual continuous distribution of dolphinfish populations. Moreover, the lack of a divergence signal for populations separated by the Panamanian Isthmus reveals that genetic drift does not exert a strong influence on tropical pelagic species with large effective population sizes.

Effect of diet saturation on growth performance, carcass characteristics and fat quality of heavy pigs.

Twenty-four castrated male (Duroc × Large Withe × Landrace) with an average weight of 69.4 kg were randomly distributed and located in individual cages and given the experimental diets. Diets were provided ad libitum and were formulated containing three levels of palm oil and hydropalm (hydrogenated palm stearine): 4% and 0% (low saturation), 2% and 2% (moderate saturation) and 0% and 4% (high saturation). Pigs were slaughtered at a local slaughterhouse with an average weight of 129.1 kg. The dietary treatment had no significant influence on growth performances and carcass characteristics. The diet saturation led to an increase of C18:0 and ΣSFA (saturated fatty acids) proportions and to a reduction of C18:1 n-9, C18:2 n-6 and ΣPUFA (polyunsaturated fatty acids) proportions and in subcutaneous backfat outer and inner layers. The dietary treatment affected significantly the melting point of subcutaneous backfat outer layer but had no significant influence on the melting point of the subcutaneous backfat inner layer. However, a linear effect of C18:0 proportion of subcutaneous backfat outer and inner layers on the melting point was observed. Dietary treatment had no significant effect on the main fatty acids pattern of intramuscular neutral and polar lipids from Longissimus dorsi muscle. In neutral lipids of liver a dietary influence (p < 0.05), but not a clear dose--response relationship, was observed for C16:0, C18:1 n-9, ΣSFA and ΣPUFA fatty acids, whereas in polar lipids the dietary treatment had no significant effect on the main fatty acids proportions. No effect of diet saturation was found on rheological properties of fat except for the hardness. The hardness was higher in the pigs that received the diet with 0% of palm oil and 4% hydropalm than in those given the diet with 4% of palm oil and 0% hydropalm.

[Impact of the use of rings and nail polish on hand hygiene quality in healthcare workers]. / Impacto del uso de anillos y uñas esmaltadas en la calidad de la higiene de manos en el personal de salud.

BACKGROUND: Health-care-associated infections are a frequent problem in hospital environments. Hand hygiene is the most effective measure to prevent outbreaks. The use of certain accessories could decrease its effectiveness, facilitating horizontal transmission of pathogens. OBJECTIVE: Analyze the evidence that assess the impact of the use of rings and nail polish on hand hygiene quality in healthcare workers. METHODS: Non-systematic search in PUBMED/MEDLINE database (1978-2018) of studies in which the quality of hand hygiene or surgical washing is measured, using quantitative cultures or fluorescent stains. RESULTS: Wearing rings: 13 studies met the inclusion criteria. Seven were carried out in general wards. In all of them the use of rings was associated with lower quality of hand hygiene (the majority of low quality). Contrarily, in 3 of 4 primary studies carried out in the operating rooms (of low quality), their use did not affect the quality of surgical washing. Similarly, two systematic reviews obtained similar conclusions. Nail polish: 7 of 54 studies met the inclusion criteria. In four of them there were discordant results (the majority of low quality). One RCT showed a reduction in the quality of surgical washing only when the nail polish was damaged. Gel nail polish was associated with lower quality in two experimental studies. CONCLUSIONS: There is insufficient evidence to associate the use of these accessories with the reduction in the quality of hand hygiene. Its safety was not proven neither. Based on the available evidence (the majority of low quality), a negative impact of the use of rings in clinical units and also of damaged nail polish in operating rooms was observed. Better quality studies are required to address these relevant issues.

Dietary vitamin A concentration alters fatty acid composition in pigs.

This experiment was conducted to study the effect of vitamin A concentration in the diet on fatty acid composition in pigs. One-hundred and twenty eight Duroc × (Large White × Landrace) castrated male pigs were used. Pigs were randomly distributed and located in cages of four pigs each to the following treatment: vitamin A-enriched diet (100,000IU/kg) (n=16) and control diet with a basal level (7500IU/kg) (n=16). The pigs were slaughtered at an average weight of 125.9kg. No effect of diet vitamin A level on performance, carcass traits and intramuscular fat percentage was observed. The retinol concentration in subcutaneous backfat and retinol and retinol palmitate contents in liver were higher in the pigs that were given the vitamin A enriched diet than in those receiving the control diet. However the vitamin A supplementation did not increase the retinol content in the muscle. Pigs receiving the vitamin A enriched diet showed a higher C16:0 and ∑SFA proportions in the outer layer and C18:0 and ∑SFA proportions in the inner layer. Moreover, the diet rich in vitamin A led to a reduction of C18:1 n-9 and ∑MUFA proportions in subcutaneous backfat inner layer. Dietary vitamin A concentration had not influence on main fatty acids composition of intramuscular lipids. Dietary vitamin A enrichment lead to a higher C16:0, ∑SFA concentration in liver lipids.

Interactions between genotype, dietary fat saturation and vitamin A concentration on intramuscular fat content and fatty acid composition in pigs.

The effect of dietary fat saturation (dFat) and dietary vitamin A (dVitA) level (0 IU vs. 100,000 IU) on performance, carcass characteristics and fatty acid composition in the offspring of two terminal sires: Duroc (DU) and Landrace×Large White (LD×LW) was studied. In the inner backfat layer, the DU-sired pigs had higher C16:0 proportion (P<0.05) and tended (P<0.07) to have higher total saturated fatty acids (SFA) and lower C18:1 n-9 proportions than LD×LW-sired pigs. An interaction sire line×dVitA was observed for intramuscular fat (IMF) content (P<0.005). The effect of supplementation with the high dVitA level in DU-sired pigs was associated with a 20% increase in IMF while no effect was observed in LD×LW pigs. Fatty acid pattern was affected by dFat and sire line. In the inner backfat layer, LD×LW-sired pigs receiving the low dVitA level increased C18:0 proportions by 8% in comparison to animals receiving the high dVitA, whereas in DU-sired pigs the effect of vitamin A was opposite. It is concluded that the effect of dFat and dVitA concentration on IMF content and fatty acid profile of subcutaneous backfat and IMF is variable according to pig genotype.

Antimicrobial susceptibility of Helicobacter pylori and mechanisms of clarithromycin resistance in strains isolated from patients in Uruguay.

The prevalence and mechanisms of antibiotic resistance of Helicobacter pylori have not yet been investigated in Uruguay. The objective of this study was to assess the susceptibility of H. pylori to the most frequently used antibiotics and to determine the mechanism of resistance to clarithromycin. Seventy-nine isolates were obtained from gastric biopsies of 50 adult patients during two periods, 2001 and 2006. The former group enrolled the general population (GP), the latter group Afro-descendant (AD) subjects. The minimum inhibitory concentrations of clarithromycin, amoxicillin, tetracycline, metronidazole, and levofloxacin were determined using the E-test technique. Amplification was achieved through PCR and nucleic acid sequencing to detect mutations in the site of action of clarithromycin in the rRNA gene 23S. No amoxicillin or tetracycline-resistant strains were found. Clarithromycin resistance was found in 12% of the patients overall: 19.4% resistance in AD patients and no resistance in the GP group. This difference was statistically significant. The highest resistance was seen with metronidazole (36%), present in similar proportions in the two groups: 36.8% (GP) and 35.5% (AD). One GP patient and one AD patient had levofloxacin-resistant strains. Sequencing analysis of gene 23S rRNA showed that only mutation in position 2143 was presented in all clarithromycin-resistant strains.