Itopride for gastric volume, gastric emptying and drinking capacity in functional dyspepsia.

AIM: To study the effect of itopride on gastric accommodation, gastric emptying and drinking capacity in functional dyspepsia (FD). METHODS: Randomized controlled trial was conducted to check the effect of itopride on gastric accommodation, gastric emptying, capacity of tolerating nutrient liquid and symptoms of FD. We recruited a total of 31 patients having FD on the basis of ROME III criteria. After randomization, itopride was received by 15 patients while 16 patients received placebo. Gastric accommodation was determined using Gastric Scintigraphy. 13C labeled octanoic breadth test was performed to assess gastric emptying. Capacity of tolerating nutrient liquid drink was checked using satiety drinking capacity test. The intervention group comprised of 150 mg itopride. Patients in both arms were followed for 4 wk. RESULTS: Mean age of the recruited participant 33 years (SD = 7.6) and most of the recruited individuals, i.e., 21 (67.7%) were males. We found that there was no effect of itopride on gastric accommodation as measured at different in volumes in the itopride and control group with the empty stomach (P = 0.14), at 20 min (P = 0.38), 30 min (P = 0.30), 40 min (P = 0.43), 50 min (P = 0.50), 60 min (P = 0.81), 90 min (P = 0.25) and 120 min (P = 0.67). Gastric emptying done on a sub sample (n = 11) showed no significant difference (P = 0.58) between itopride and placebo group. There was no significant improvement in the capacity to tolerate liquid in the itopride group as compared to placebo (P = 0.51). Similarly there was no significant improvement of symptoms as assessed through a composite symptom score (P = 0.74). The change in QT interval in itopride group was not significantly different from placebo (0.10). CONCLUSION: Our study found no effect of itopride on gastric accommodation, gastric emptying and maximum tolerated volume in patients with FD.

RNAi-Mediated Simultaneous Resistance Against Three RNA Viruses in Potato.

RNA interference (RNAi) technology has been successfully applied in stacking resistance against viruses in numerous crop plants. During RNAi, the production of small interfering RNAs (siRNAs) from template double-standard RNA (dsRNA) derived from expression constructs provides an on-switch for triggering homology-based targeting of cognate viral transcripts, hence generating a pre-programmed immunity in transgenic plants prior to virus infection. In the current study, transgenic potato lines (Solanum tuberosum cv. Desiree) were generated, expressing fused viral coat protein coding sequences from Potato virus X (PVX), Potato virus Y (PVY), and Potato virus S (PVS) as a 600-bp inverted repeat expressed from a constitutive 35S promoter. The expression cassette (designated Ec1/p5941) was designed to generate dsRNAs having a hairpin loop configuration. The transgene insertions were confirmed by glufosinate resistance, gene-specific PCR, and Southern blotting. Regenerated lines were further assayed for resistance to virus inoculation for up to two consecutive crop seasons. Nearly 100% resistance against PVX, PVY, and PVS infection was observed in transgenic lines when compared with untransformed controls, which developed severe viral disease symptoms. These results establish the efficacy of RNAi using the coat protein gene as a potential target for the successful induction of stable antiviral immunity in potatoes.

Frequency of Helicobacter pylori infection using 13C-UBT in asymptomatic individuals of Barakaho, Islamabad, Pakistan.

High frequency of Helicobacter (H.) pylori infection has been reported in Pakistan mainly for dyspeptic patients, while the published data is inadequate regarding asymptomatic population. The non-invasive 13C urea breath test (UBT) was used to determine the frequency of H. pylori infection in 516 asymptomatic individuals and to find out its association with gender and age. Overall prevalence was 74.4% (384/516) while 63.5% (113/178) children were positive for 13C-UBT and the percentage increased with age in both the genders with significantly higher prevalence in adolescents (p=0.003) and adults (p < 0.001). Moreover, there was non-significant difference between the prevalence of H. pylori infection in males and females in all age categories. The reported high frequency of H. pylori infection warrants further studies to identify epidemiological and environmental risk factors.

Maternal Body Composition and Its Relationship to Infant Breast Milk Intake in Rural Pakistan.

Some women in rural Pakistan are chronically undernourished, and consequently underweight. Concerns have been expressed that the degree of undernourishment might be sufficiently severe to affect lactation performance. We have obtained data on maternal body composition and infant breast milk intake using stable isotope methods in a group of thirty three mother and infant pairs at approximately six months of age. The maternal body mass index ranged from 16.6 to 29.1 kg·m(-2). In this population we found that exclusive breast-feeding tended to be associated with lower maternal body fat, and that there was no evidence for compromised lactational performance due to malnourishment. Finally we note that when our data is combined with that from other studies there may be a generalised negative correlation between breast milk intake and maternal body fat.

Prevalence of Helicobacter pylori pathogenicity-associated cagA and vacA genotypes among Pakistani dyspeptic patients.

The cytotoxin-associated gene A (cagA), and the vacuolating cytotoxin gene A (vacA) products are considered the most important pathogenic determinants of Helicobacter pylori, a gram-negative bacterium causing gastrointestinal disorders such as duodenal ulcers, gastritis and mucosa-associated lymphoid tissue disease. A higher prevalence of H. pylori has been reported in various regions in the Pakistani population; however, no data are available about the virulence-associated genetic determinants. The objective of this study was to determine the prevalence of virulence-associated genes, cagA, vacA and particularly vacA allelic variants among dyspeptic patients from Pakistan. Gastric biopsy samples were obtained from 78 adult patients presenting dyspepsia symptoms. DNA was isolated and analyzed for the presence of H. pylori and its genotypes by PCR. Genus-specific PCR involving 16S rRNA gene revealed that 66 of the 78 patients were positive for H. pylori, an overall prevalence of 84.6% for this particular study. The most common vacA genotype was s1b/m2 (54.5%) followed by s1a/m1 (19.7%). cagA was positive in 24.2% of the cases and strongly associated with s1a/m1, vacA. The prevalence of virulent cagA, and vacA allelic form s1a/m1 was lower than that reported from neighboring countries.

Comparison of diagnostic accuracy of non-invasive tests for Helicobacter pylori infection in children.

OBJECTIVE: To compare urea breath and stool antigen in children, with histological diagnosis for Helicobacter pylori (H.pylori) infection. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: From June 2005 to December 2005 carried out at KRL Hospital, Islamabad and Children Hospital, PIMS, Islamabad. PATIENTS AND METHODS: Children between 3 and 15 years of age reporting in pediatric outpatient department with upper gastrointestinal symptoms were included. All the participating children underwent an upper gastrointestinal endoscopy and 3 tests namely: histopathological identification of H. pylori (the traditional gold standard), urea breath test and stool antigen test were carried out on each child. The sensitivity, specificity, and positive predictive values were calculated for each noninvasive test used in the study. RESULTS: A total of 54 patients completed the study with a mean age of 8.2 years. On histological examination, 72% (39) were positive for H. pylori infection. On gross endoscopic examination, only 9 patients had signs of gastritis as compared to 39 histological positives. The sensitivity, specificity and positive predictive value of stool antigen test were: 77%, 73% and 89% respectively whereas the same for urea breath test were: 79%, 80% and 91% respectively. CONCLUSION: Both the noninvasive tests were found to be sensitive and specific as compared with histological identification, for the diagnosis of H. pylori in our pediatric population. The accuracy of urea breath test was better than the stool antigen test but later was easier to perform and could fulfill the criteria for a rapid bedside diagnostic test.

Accuracy of non-invasive 13C-Urea Breath Test compared to invasive tests for Helicobacter pylori detection.

OBJECTIVE: To compare the sensitivity, specificity and Positive Predictive Value (PPV) of histology, Campylobacter-Like Organism (CLO) test, culture and 13C-Urea Breath Test (UBT) for the diagnosis of Helicobacter pylori infection. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: District Headquarter Hospital, Rawalpindi, Military Hospital, Rawalpindi and Pakistan Institute of Science and Technology (PINSTECH), Nilore, Islamabad from June 2002 to 2003. PATIENTS AND METHODS: Three mucosal biopsy specimens were obtained during endoscopy of 90 symptomatic patients. Histology, CLO test and culture were performed on these specimens. Breath samples for 13C-UBT were collected and sent to RIAD, PINSTECH on the same day for isotope ratio mass spectrometry. For analysis purpose, each of the tests was fixed as the gold standard in turn and the others were then compared against it. In addition, any two as well as any three positive tests were then set as the gold standard and the other tests compared against them to calculate the sensitivity, specificity, accuracy and PPV of other tests. RESULTS: Urea breath test had the highest sensitivity, ranging from 95 to 100%, against all the gold standards with specificity ranging from 55 to 100%, whereas the sensitivity of histological examination was around 98% but it had comparatively lower specificity (49-89%). The CLO test had a sensitivity range of 86-100% and specificity of 67-100%. Culture had the minimum sensitivity (59-70%) but had highest specificity (96-100%) against all the gold standards. Age and gender had no effect on p-value of each test or in combination. CONCLUSION: The urea breath test has shown the highest ability to detect the organism with 95-100% sensitivity in symptomatic individuals and specificity, which is comparable to other tests.

Iron fortification of wheat flour: bioavailability studies.

Bioavailability refers to that fraction of nutrients which is utilized by the body out of the total indigested amount. Various direct and indirect methods for the determination of bioavailability are available. We determined the bioavailability of iron from fortified wheat flour using both in vitro and in vivo methods. The bioavailability data will be used to make the recommendation for a fortification strategy in Pakistan. The in vitro bioavailability of iron from fortified wheat flour was determined using in vitro enzymatic digestion and fermentation by simulating the condition of the small intestine and colon in the laboratory. Different products were prepared from the fortified ferrous sulfate (FeSO4) and unfortified wheat flour. The total iron of the samples was measured by the wet-digestion method and analyzed on an atomic absorption spectrometer (AAS). To obtain the percentage of iron released, the samples were subjected to pepsin digestion and dialysis. The dialysate was collected at 3, 6, 9, and 12 hours and read on an AAS. The retentates from the above were subjected to the fermentation condition of the colon by inoculating it with human fecal inoculum and incubating it for 24 hours at 37 degrees C under anerobic conditions. The dialysate was collected at 3- and 6-hour intervals and read on an AAS. More iron was released from fortified wheat flour (4.6%), leavened chapati (6.8%), and Nan (15.1%) than from the unfortified control samples. Fermentation and leavening resulted in a better release, which was evident from in vitro digestion results.