Human papillomavirus (HPV) type distribution in cervical carcinoma, low-grade, and high-grade squamous intraepithelial lesions in Venezuelan women.

OBJECTIVE: Cervical cancer is an important cause of mortality among women in developing countries, especially in the Latin America and Caribbean (LAC) region. Infection with high-risk (HR) human papillomavirus (HPV) has been identified as the primary cause of cervical cancer. The aim of this study was to determine the frequency of HR-HPV genotypes in low-grade and high-grade squamous intraepithelial lesions (LSIL, HSIL) and cervical carcinoma (CC) among Venezuelan women. MATERIALS AND METHODS: Subjects with histopathological diagnosis of LSIL, HSIL, and CC (LSIL=200; HSIL=100; CC=150) were enrolled in the study after obtaining informed consent. Biopsy samples of these subjects were analyzed to determine the lesion type. HPV detection and typing was done using polymerase chain reaction (PCR) and reverse hybridization. HPV type specific prevalence was determined in subjects with single and multiple infections. RESULTS: HPV DNA was detected in 68%, 95%, and 98.7% of LSIL, HSIL, and CC cases, respectively. HR-HPV and low-risk oncogenic HPV (LR-HPV) was observed in 66.9%/11.8% of LSIL cases, 87.3%/3.2% of HSIL cases, and 91.2%/0.7% of CC cases. HPV types -16/-18 (65%) were the most common high-risk HPV types observed, followed by types -52, -33, -45, and -31. CONCLUSION: Cervical cancer burden in Venezuelan women is substantial. HPV types -16/-18 were the most common types prevalent among Venezuelan women followed by types -52, -33, -45, and -31 (prevalence, ~90.1%). The results of this study provide baseline information on the HPV type distribution, which may facilitate the development of a cervical cancer prevention and control program in Venezuela.

Comparative analysis of three methods for HPV DNA detection in cervical samples.

High risk HPV infection is considered to play a central role in cervical carcinogenesis. HPV DNA testing has shown to be a very useful tool for screening and following cervical infections. The aim of this study was to compare three methods for HPV DNA detection, along with cytology and colposcopy analysis. Cervical samples were collected from 100 sexually active women in Mérida, western Venezuela. HPV infection was screened using Hybrid-Capture 2 (HC2), L1-Nested-PCR and E6/E7-PCR assays. 40% of the samples (40/100) were HPV positive by at least one of the DNA detection methods. HC2 detected HPV in 12% specimens. L1- and E6/E7-PCRs showed 50% sensitivity and 77% specificity.The agreement rate between HC2 and both PCR assays was 65%. Kappa value showed moderate concordance between HC2 and both PCR methods (kappa=0.55; CI 95%). Also moderate concordance was seen when L1- and E6/E7-PCRs were compared (kappa=0.48; CI 95%). There was a significant association between the Schiller test and E6/E7-PCR (p=0.006) for HPV infection. An acceptable agreement between all three assays for HPV detection was observed. Nevertheless, different PCR formats need to be further analyzed in order to make the right choice of method for HPV testing.

A 500-year tale of co-evolution, adaptation, and virulence: Helicobacter pylori in the Americas.

Helicobacter pylori is a common component of the human stomach microbiota, possibly dating back to the speciation of Homo sapiens. A history of pathogen evolution in allopatry has led to the development of genetically distinct H. pylori subpopulations, associated with different human populations, and more recent admixture among H. pylori subpopulations can provide information about human migrations. However, little is known about the degree to which some H. pylori genes are conserved in the face of admixture, potentially indicating host adaptation, or how virulence genes spread among different populations. We analyzed H. pylori genomes from 14 countries in the Americas, strains from the Iberian Peninsula, and public genomes from Europe, Africa, and Asia, to investigate how admixture varies across different regions and gene families. Whole-genome analyses of 723 H. pylori strains from around the world showed evidence of frequent admixture in the American strains with a complex mosaic of contributions from H. pylori populations originating in the Americas as well as other continents. Despite the complex admixture, distinctive genomic fingerprints were identified for each region, revealing novel American H. pylori subpopulations. A pan-genome Fst analysis showed that variation in virulence genes had the strongest fixation in America, compared with non-American populations, and that much of the variation constituted non-synonymous substitutions in functional domains. Network analyses suggest that these virulence genes have followed unique evolutionary paths in the American populations, spreading into different genetic backgrounds, potentially contributing to the high risk of gastric cancer in the region.

Helicobacter pylori cagA and vacA genotypes in Cuban and Venezuelan populations.

The aim of this study was to determine the presence of Helicobacter pylori cytotoxin-associated gene (cagA)/vacuolating cytotoxin gene (vacA) among patients with chronic gastritis in Cuba and Venezuela. Gastric antrum biopsies were taken for culture, DNA extraction and PCR analysis. Amplification of vacA and cagA segments was performed using two regions of cagA: 349 bp were amplified with the F1/B1 primers and the remaining 335 bp were amplified with the B7629/B7628 primers. The VA1-F/VA1-R set of primers was used to amplify the 259-bp (s1) or 286-bp (s2) product and the VAG-R/VAG-F set of primers was used to amplify the 567-bp (m1) or 642-bp (m2) regions of vacA. cagA was detected in 87% of the antral samples from Cuban patients and 80.3% of those from Venezuelan patients. All possible combinations of vacA regions were found, with the exception of s2/m1. The predominant combination found in both countries was s1/m1. The percentage of cagA+ strains was increased by the use of a second set of primers and a greater number of strains was amplified with the B7629/B7628 primers in the Cuban patients (p = 0.0001). There was no significant difference between the presence of the allelic variants of vacA and cagA in both populations. The predominant genotype was cagA+/s1m1 in both countries. The results support the necessary investigation of isolates circulating among the human population in each region.

Presence of human papillomavirus infection determined by hybrid capture assay in cervical lesions in a Venezuelan population.

The aim of this study was to establish the presence of HPV infection in cervical lesions in a Venezuelan population, by Hybrid Capture Assay II (HCA II), and its association with cytological diagnosis. The study included 1483 cervical samples analysed at Laboratorios CITOMED, Caracas, Venezuela, from 2005 to 2007. The woman age range was between 20 and 58 years, and the mean age was 28.8. HPV infection was determined using HCA II. The cytological diagnosis of the smears showed LSIL in 1120/1483 samples (75.5%), HSIL in 354/1483 (23.9%) and ASC-US, in 9/1483 (0.6%). The positivity of HPV DNA detected by HCA II was 54.6% (811/1483). Of the positives cases, 138/811 (17%) presented HPV DNA of low oncogenic risk and 673/811 (82.9%) had high-risk HPV. There were significant differences in the low and high oncogenic HPV type frequencies of the evaluated samples (p > 0.0001). Low risk HPV types were detected in 127 cases of LSIL, 9 of HSIL and 2 of ASC-US. High-risk HPV was detected in most of the cases: 361 LSIL, 308 HSIL and 4 ASC-US. Our study showed a high presence of cervical infection by human papillomavirus of a high risk genotype. Our results contribute to the epidemiological data that report diversity in the prevalence rates in different countries.

Dichorionic pregnancy complicated by a twin-to-twin transfusion syndrome.

Twin-to-twin transfusion syndrome (TTTS) is a serious complication typical of monochorionic pregnancies. Cases in dichorionic pregnancies have been described. The authors present a case report of a presumed TTTS in a dichorionic pregnancy followed at our institution in which the patient presented to the emergency department at 31 4/7 weeks' gestation complaining of lack of fetal movements. Both fetuses did not show any cardiac activity. On the first twin, an oligohydramnios was present and his bladder was not visualised and, on the second twin, a polyhydramnios and an augmented bladder were visualised. Pathological findings of the fetuses were compatible with a diagnosis of TTTS and placental study confirmed the presence of a dichorionic/diamniotic placenta, with superficial vessels crossing the dividing membrane.

[Evaluation of K-ras 12 oncogene mutations in Venezuelan patients with Helicobacter pylori infection]. / Evaluación de las mutaciones del oncogen K-ras 12 en pacientes venezolanos infectados con Helicobacter pylori.

This work evaluated the infection of H. pylori in the different gastric pathologies and its association with the oncogen K-ras 12. Endoscopy was performed in 62 patients and 3 biopsies from the antral region were taked and used for the histological diagnostic, PCR, and point mutations determination. The results showed a high incidence of H. pylori infection in patients with active chronic gastritis (AcCG) 90%, chronic atrophic gastritis (AtCG) 70%, intestinal metaplasia (IM) 67%, dysplasia (D) 83%, and decrease in in gastric cancer (GC) 33%. Evaluation of the oncogen K-ras 12 showed that 68% of the patients presented mutations in the different analyzed amino acids. In the 12 codon of the K-ras gene, we observed simple point mutations and combination in the same sample in different gastric pathologies. In AcCG samples were detected the greater number of mutations. A decrease of the point mutations were observed in the progression stages to gastric cancer. The presence of these specific mutations would be tumor markers and it determine the possible development of gastric tumors.

[Importance of IgG anti-CagA antibodies of Helicobacter pylori in Venezuelan patients with gastric diseases]. / Importancia de la respuesta humoral de IgG anti-CagA de Helicobacter pylori en pacientes venezolanos con enfermedades de las vías digestivas superiores.

Helicobacter pylori is one of the most common bacterial infections worldwide. It is associated with chronic gastritis, peptic ulcer disease and constitutes a major risk factor for gastric adenocarcinoma and lymphoma. The aim of this study was to evaluate the specific serologic immunoglobulin G (IgG) response to whole cells proteins, CagA and urease antigens of Helicobacter pylori in a Venezuelan population. We evaluated 66 patients from the Hospital Universitario de Caracas, attending in the gastroscopy service. H. pylori infection was detected by culture and rapid urease test. IgG antibodies against, CagA and ureases were tested by enzyme-linked immunosorbent assay method using highly purified recombinant antigens. We demonstrated the presence of H. pylori in 48/66 (72.7%), by culture and rapid urease test. We found a seroprevalence of 45 (68%) to whole cells, 34/66 (51%) to CagA and 18/66 (27%) to urease. The positive rates of CagA antibodies in patients with gastric ulcer, gastric cancer and chronic gastritis were 87.8%, 77.7% y 40.8% respectively. The serum antibodies anti-CagA were similar between peptic ulcer disease and gastric cancer patients.

Persistent infection with high-risk human papilloma viruses: cohort study, Mérida, Venezuela.

Cervical lesions have been associated with infection by high-risk human papilloma virus (high-risk HPV). In 409 women aged >15 years high-risk HPV lesions were identified. In a cohort of this population persistent infection was compared with cytological, colposcopic, and histological lesions. Cervical scrapes were taken and DNA was isolated. HPV was detected by PCR in the E6/E7 region. Genotyping was performed by PCR nested multiple E6/E7. HPV was detected in a 37.40% (153/409), high-risk HPV in 86% (153/178), HPV18 46.64% (83/178), HPV16 34.28% (61/178). Among these 53.93% (96/178) were multiple infections, and HPV18/16 (30/96) was the most frequent 31.25%. The cytology showed changes in 15% of positive patients. A 49.67% in women positive for HPV infection showed abnormalities in the colposcopic study, a relationship that turned out to be statistically significant ( p < 0.0019 test χ(2)). Among all 85% of the women were younger than 45 years of age. Fifty-seven patients were evaluated 15 months after the base study, with initial prevalence of morbidity 49.12% (28/57) and at the end 10.53% (6/57), showing in 89.29% (25/28) negative for HR-HPV infection, 10.34% (3/28) showed persistence of infection, 17.54% (10/57) presented cytological alterations, with 80% of positivity for HPV, and a regression of 100% (10/10) of the previously identified lesions. With colposcopy, 50% (14/28) presented alterations related to HPV, of these 85.71% (12/14) showed regression of such an alteration. The cumulative incidence for HPV was 10.34% (3/29). The incidence rate was 4.23% (3/71), which is equal to 4.23 new cases of HPV infection per 100 people, per year of follow-up. In conclusion, the present work shows a high frequency of infection by high-risk HPV, with predominance of HPV18 and 16 and in general for multiple infections. Colposcopy was better predictor than the Pap smear for infection. The follow-up study revealed a low percentage of persistent infection, and a high frequency of negativity for viral infection, high regression of cytological and colposcopic lesions, a low cumulative and incidence rate similar to that reported by other Latin American countries and higher than the European countries.

Detection of Helicobacter pylori DNA in the oral cavity and gastroduodenal system of a Venezuelan population.

Dental plaque has been suggested as a reservoir for Helicobacter pylori but the hypothesis that the oral microflora may be a permanent reservoir of H. pylori is still controversial. The aims of this study were to determine the presence of H. pylori DNA in the gastric antrum and dental plaque of a Venezuelan population by PCR and to investigate the relationship between this infection and the oral hygiene index. Thirty-two patients from the Hospital Universitario de Caracas, attending for routine gastroscopy, and 20 asymptomatic subjects (control group) were evaluated. The patients' gingiva and plaque were assessed by the gingival and plaque indices of Sillness and Löe. Supragingival plaque was analysed by a PCR for a specific internal urease gene. Gastric antrum biopsies were taken for histological examination and PCR. H. pylori was detected in antral samples from 24 (75%) of 32 patients, all of whom had chronic gastritis. H. pylori was also detected in dental plaque samples of 12 (37.5%) of the 32 patients. In 7 (58%) of these 12 patients, H. pylori was identified in the gastric biopsy. Seven patients with chronic gastritis carried H. pylori in dental plaque and antral samples. Of these patients, four also had dysplasia and one had metaplasia. Three subjects in the control group were positive by PCR. In the present study there was no correlation between H. pylori infection and dental hygiene, dental caries, periodontal disease or use of dentures. The oral cavity may be a reservoir for H. pylori infection and oral secretions may be an important means of transmission of this micro-organism. H. pylori in dental plaque may represent a risk factor for gastrointestinal re-infection and ulcer relapse after antibiotic therapy.

Evaluación de la posible asociación entre la presencia de parásitos intestinales y Helicobacter pylori en población infantil de la etnia Warao, Venezuela / Evaluation of the possible association between the presence of intestinal parasites and Helicobacter pylori in children of ethnic Warao

Las infecciones por microorganismos gastrointestinales constituyen hoy en día una de las principales causas de morbilidad y mortalidad en países en vías de desarrollo. Nos planteamos como objetivo evaluar la posible asociación entre la presencia de parásitos intestinales y la infección por Helicobacter pylori, y el comportamiento de anticuerpos séricos y secretores en una población infantil de la etnia Warao del Edo. Delta Amacuro, Venezuela. La presencia de parásitos se determinó por examen microscópico directo de las heces. Los niveles séricos de IgE total, IgG anti H. pylori e IgA anti Giardia duodenalis; y los secretores IgA total y específica a G. duodenalis y H. pylori en muestra de saliva, se determinaron utilizando el método de ELISA. El 65% de los niños estaban parasitados por protozoarios, observándose un 47% de poliparasitismo. Encontramos una mayor seroprevalencia de H. pylori en el grupo de niños no parasitados (46%) comparado con los parasitados (25%) (P<0,05). Sin embargo, los niños seropositivos a H. pylori y parasitados con G. duodenalis mostraron niveles séricos de IgE total mayores que los no parasitados (P<0,01); en contraparte, los niveles de IgA secretora total y especifica a H. pylori y G. duodenalis estaban disminuidos (P<0,05). Es posible que la respuesta inflamatoria generada por Giardia pueda aumentar los niveles de IgE total y disminuir la respuesta de IgA secretora favoreciendo la instauración de la infección por H. pylori.

The infections for gastrointestinal microorganisms represent nowadays one of the major reasons of morbidity and mortality in developing countries. We had evaluated both, the possible association between the presence of intestinal parasites and infection by Helicobacter pylori, and the production of serum and salivary antibodies in Amerindian Warao children from the Orinoco Delta, Venezuela. The prevalence of parasites was determined by faecal examination. The levels of serum antibodies (total IgE, specific anti- H. pylori IgG and anti G. duodenalis IgA) and salivary antibodies (total and specific IgA to G. duodenalis and H. pylori), was determined by ELISA. 65% of the child population was parasitized by protozoos, and a 47% of polyparasitism was observed. We found a major seroprevalence of H. pylori in the group of children not parasitized (46 %) compared with the parasitized ones (25 %) (P<0.05). Nevertheless, the seropositive children to H. pylori and parasitized with G. duodenalis showed levels of total IgE higher than the non parasitized ones (P<0.01); in contrast, levels of total and specific secretory IgA to H. pylori and G. duodenalis were decreased (P<0.05). It is possible that the inflammatory response generated by G. duodenalis infection may increase levels of total IgE and diminish secretory IgA response favoring the establishment of infection by H. pylori.

Comparative analysis of three methods for HPV DNA detection in cervical samples / Análisis comparativo de tres métodos para la detección del ADN de VPH en muestras de cuello uterino

High risk HPV infection is considered to play a central role in cervical carcinogenesis. HPV DNA testing has shown to be a very useful tool for screening and following cervical infections. The aim of this study was to compare three methods for HPV DNA detection, along with cytology and colposcopy analysis. Cervical samples were collected from 100 sexually active women in Mérida, western Venezuela. HPV infection was screened using Hybrid-Capture 2 (HC2), L1-Nested-PCR and E6/E7-PCR assays. 40% of the samples (40/100) were HPV positive by at least one of the DNA detection methods. HC2 detected HPV in 12% specimens. L1- and E6/E7-PCRs showed 50% sensitivity and 77% specificity.The agreement rate between HC2 and both PCR assays was 65%. Kappa value showed moderate concordance between HC2 and both PCR methods (κ=0.55; CI 95%). Also moderate concordance was seen when L1- and E6/E7-PCRs were compared (κ=0.48; CI 95%). There was a significant association between the Schiller test and E6/E7-PCR (p=0.006) for HPV infection. An acceptable agreement between all three assays for HPV detection was observed. Nevertheless, different PCR formats need to be further analyzed in order to make the right choice of method for HPV testing.

La infección con VPH de alto riesgo es el principal factor etiológico asociado al desarrollo de carcinogénesis cervical y las pruebas de detección de ADN-VPH han mostrado ser una herramienta esencial para la pesquisa y seguimiento de estas infecciones. El objetivo del estudio ha sido comparar tres métodos para la detección del ADN viral, en combinación con los análisis colposcópico y citológico. Se obtuvieron muestras cervicales de 100 mujeres sexualmente activas, en Mérida, Venezuela. La detección de infecciones por VPH se realizó por Captura Híbrida 2 (CH2) y los ensayos de PCR “L1-Nested-PCR” y “E6/E7-PCR”. 40% de las muestras (40/100) fueron positivas para VPH por al menos uno de los métodos aplicados. 12% de las muestras analizadas fueron positivas para VPH por CH2. Las dos PCR utilizadas mostraron un 50% de sensibilidad y 77% de especificidad. La coincidencia observada entre CH2 y las dos PCR fue del 65%. La determinación del valor Kappa mostró una concordancia moderada entre CH2 y ambos métodos de PCR (κ=0,55; CI 95%). También existió concordancia moderada al comparar las PCR de las regiones L1 y E6/E7 de VPH (κ=0,48; CI 95%). Hubo una asociación significativa entre el resultado del test de Schiller y la PCR E6/E7 (p=0,006) para la infección por VPH. Se determinó una concordancia aceptable entre los tres métodos aplicados para la detección de VPH; sin embargo, las PCR deben ser analizadas en trabajos futuros con el fin de establecer las pruebas más adecuadas para la detección viral.

Presence of human papillomavirus infection determined by hybrid capture assay in cervical lesions in a Venezuelan population

The aim of this study was to establish the presence of HPV infection in cervical lesions in a Venezuelan population, by Hybrid Capture Assay II (HCA II), and its association with cytological diagnosis. The study included 1483 cervical samples analysed at Laboratorios CITOMED, Caracas, Venezuela, from 2005 to 2007. The woman age range was between 20 and 58 years, and the mean age was 28.8. HPV infection was determined using HCA II. The cytological diagnosis of the smears showed LSIL in 1120/1483 samples (75.5 percent), HSIL in 354/1483 (23.9 percent) and ASC-US, in 9/1483 (0.6 percent). The positivity of HPV DNA detected by HCA II was 54.6 percent (811/1483). Of the positives cases, 138/811 (17 percent) presented HPV DNA of low oncogenic risk and 673/811 (82.9 percent) had high-risk HPV. There were significant differences in the low and high oncogenic HPV type frequencies of the evaluated samples (p>0.0001). Low risk HPV types were detected in 127 cases of LSIL, 9 of HSIL and 2 of ASC-US. High-risk HPV was detected in most of the cases: 361 LSIL, 308 HSIL and 4 ASC-US. Our study showed a high presence of cervical infection by human papillomavirus of a high risk genotype. Our results contribute to the epidemiological data that report diversity in the prevalence rates in different countries.

El objetivo de este estudio fue establecer la presencia de la infección por Virus Papiloma Humano en lesiones cervicales de un grupo de pacientes venezolanos, mediante el Ensayo de Captura Híbrida II (ECH II), y su asociación con el diagnóstico citológico. Se analizaron 1483 muestras de citología cervical procesadas en el Laboratorio CITOMED, Caracas, Venezuela desde 2005 hasta 2007. El rango de edad de las mujeres fue entre 20 y 58 años, siendo la edad promedio 28,8 años. Se determinó la presencia de la infección por VPH empleando el método de Ensayo de Captura Híbrida II (ECH II). El diagnóstico citológico de las muestras reveló la presencia de lesiones intraepiteliales de bajo grado (LIE BG) en 1120/1483 (75,5 por ciento) pacientes, lesiones intraepiteliales de alto grado (LIE AG) en 354/1483 (23,9 por ciento) y lesiones con células atípicas de significado indeterminado (ASCUS) en 9/1483 (0,6 por ciento). La positividad de la infección por VPH detectada por ECH II fue de 54,6 por ciento (811/1483). De los casos positivos, 138/811 (17 por ciento) tenían ADN-VPH de bajo riesgo oncogénico y 673/811 (82,9 por ciento) presentaron tipos de VPH de alto riesgo. Las diferencias observadas en la frecuencia de los tipos de VPH de alto y bajo riesgo oncogénicos detectados en las muestras fueron estadísticamente significativas (p<0,0001). VPH de bajo riesgo fue detectado en 127 casos de LIE BG, 9 de LIE AG y 2 de ASC-US, mientras que VPH de alto riesgo fue detectado en la mayoría de los casos: 361 de LIE BG, 308 de LIE AG y 4 de ASC-US. Nuestro estudio demostró una alta presencia de infección por genotipos de VPH de alto riesgo oncogénico. Estos datos contribuyen a establecer el patrón epidemiológico que reporta una gran diversidad en las tasas de prevalencia en diferentes países.

Helicobacter pylori cagA and vacA genotypes in Cuban and Venezuelan populations

The aim of this study was to determine the presence of Helicobacter pylori cytotoxin-associated gene (cagA)/vacuolating cytotoxin gene (vacA) among patients with chronic gastritis in Cuba and Venezuela. Gastric antrum biopsies were taken for culture, DNA extraction and PCR analysis. Amplification of vacA and cagA segments was performed using two regions of cagA: 349 bp were amplified with the F1/B1 primers and the remaining 335 bp were amplified with the B7629/B7628 primers. The VA1-F/VA1-R set of primers was used to amplify the 259-bp (s1) or 286-bp (s2) product and the VAG-R/VAG-F set of primers was used to amplify the 567-bp (m1) or 642-bp (m2) regions of vacA. cagA was detected in 87 percent of the antral samples from Cuban patients and 80.3 percent of those from Venezuelan patients. All possible combinations of vacA regions were found, with the exception of s2/m1. The predominant combination found in both countries was s1/m1. The percentage of cagA+ strains was increased by the use of a second set of primers and a greater number of strains was amplified with the B7629/B7628 primers in the Cuban patients (p = 0.0001). There was no significant difference between the presence of the allelic variants of vacA and cagA in both populations. The predominant genotype was cagA+/s1m1 in both countries. The results support the necessary investigation of isolates circulating among the human population in each region.

Prevalence of Helicobacter pylori infection in Warao lineage communities of Delta Amacuro State, Venezuela.

The purpose of this study was the evaluation of Helicobacter pylori infections in children and adults from two indigenous communities of Delta Amacuro State, Venezuela, that differ in hygienic conditions of the housing. The evaluation was performed in 98 children (mean age 7 +/- 3.37 years) and their mothers (33.96 +/- 13.77 years) from two communities of Warao lineage. Anti-H. pylori serum IgG and secretory anti-H. pylori IgA antibodies were determined, as well as total secretory IgA and H. pylori antigens in feces. Serological prevalence of H. pylori infection was 38% in children and 84% their in mothers. Children from the community that had the most deficient sanitary and hygienic conditions had significantly lower titers of specific IgG antibodies and total secretory IgA (P<0.0001) and a high percentage of them had H. pylori antigens in their feces (P<0.0001). The levels of specific IgA were similar in both groups. The results indicate that in these populations there is a high prevalence of H. pylori infection and that poor hygienic conditions can increase the risk of infection and damage to the gastrointestinal tract.

Genotipos vacA de Helicobacter pylori en una población venezolana / Helicobacter pylori vac A genotypes in a Venezuelan population

La infección por Helicobacter pylori está  asociada con gastritis, úlcera gastroduodenal, linfoma tipo Maltoma, y es considerado un importante factor de riesgo para el desarrollo de cáncer gástrico. El objetivo de este estudio fue caracterizar los genotipos vacA de cepas de  H. pylori provenientes de biopsias gástricas de una población venezolana. Se evaluaron 128 pacientes con indicación de endoscopia, por enfermedad de las vías digestivas superiores. Se obtuvieron biopsias gástricas de cada uno de ellos para la amplificación de glm y tipificación de las formas alélicas  de vacA, empleando la reacción en cadena de la polimerasa. Los resultados demostraron que 82 (64%) de las muestras fueron positivas para la amplificación de glm. De estos, 51 (62%) de las cepas tenían el genotipo vacA, forma alélica S1 (17 s1a, 29 s1b, 5 s1a+s1b, 10 fueron no tipificables) y 21 (26%) tenían el subtipo S2. El análisis de la región media de vacA reveló que 42 (51%) fueron vac A m1, 26 (32%) m2 y 14 (17%) no tipificaron para m1  o m2. Los resultados de la presente investigación demostraron una alta frecuencia de infección por  H  pylori  genotipo vac A variante alèlica s1/ m1.

Helicobacter pylori infection is associated with gastritis, gastroduodenal ulcer, and Maltoma type lymphoma, and is also considered an important risk factor for the development of gastric cancer. The purpose of this study was to characterize vacA genotypes of H. pylori strains from gastric biopsies from a Venezuelan population. One hundred and  twenty eight patients who required endoscopy due to disease of the upper digestive system were evaluated. A gastric biopsy was taken from each of them for glm amplification and typing of the allelic vacA  forms, using the polymerase chain reaction assay. Results showed that 82 (64%) of the samples were positive for glm amplification. Of these, 51 (62%) of the strains had the vacA genotype, S1 allelic form (17 sla, 29 slb, 5 sla+slb, 10 were not typable) and 21 (26%) had the S2 subtype. The analysis of the vacA mid region revealed that 42 (51%) were vacA m1, 26 (32%) m2, and 14 did not type for m1 or m2. The results of this investigation showed a high frequency of H. pylori vacA genotype infections, s1/m1 allelic variants.

Genotipificación del virus de papiloma humano en pacientes con condilomas acuminados / Genotyping of human papillomavirus in patients with condylomata acuminata

El condiloma acuminado es una de las enfermedades más comunes de transmisión sexual alrededor del mundo. Estas lesiones están asociadas con la infección por los tipos de Virus de Papiloma Humano (VPH) 6 y 11 de bajo riesgo oncogénico. En nuestro país, la prevalencia de la infección por estos virus es alta (65 %), razón por la cual, el objetivo del presente trabajo fue la detección y tipificación del VPH mediante la reacción en cadena de la polimerasa en un grupo de pacientes que presentaban condilomas acuminados en el área genital. De las 90 biopsias evaluadas, de pacientes con infección sugestiva por el VPH, 72 (80 %) correspondieron a condilomas acuminados según el diagnóstico histopatológico, y el 20% presentaron otras patologías. La infección por el VPH se detectó en los 72 condilomas acuminados, observándose con mayor frecuencia el tipo 6 (54,2 %), seguido del tipo 11 (36,1 %); tres casos (4,2 %) presentaron coinfección con los tipos 6 y 11 y en cuatro casos (5,6 %) no se logró tipificar. Los resultados muestran una clara vinculación entre los tipos de VPH 6 y 11 de bajo riesgo oncogénico y el desarrollo de las verrugas genitales, a diferencia de las neoplasias intraepiteliales.

The condylomata acuminata is one of the common sexually transmitted disease around the world. These lesions are associated with the Human Papillomavirus (HPV) types 6 and 11 of oncogenic low-risk. In our country, the prevalence for this virus infection is high (65 %). The aim of this study was the detection and typing of HPV by polimerase chain reaction (PCR) in a group of patients that presented warts in the genital area. Ninety biopsies were evaluated coming from patients with suggestive infection for the HPV: 72 (80 %) were histological confirmed as condylomata acuminata and 20% have other pathologies. The HPV was detected in all specimens of condylomata acuminate. HPV type 6 was observed with more frequency (54.17 %), followed by type 11 (36.11 %); three cases (4.17%) showed co-infection with types 6 and 11 and four cases (5.56 %) were non tipificable. These results show a clear association of low oncogenic risk HPV types 6 and 11 and the development of the genital warts unlike to the cervical intraepithelial neoplasia where exists a great HPV genotypes spectrum.

Evaluación, mediante RCP, de la infección por el virus de papiloma humano en muestras de pacientes con diagnóstico clínico o citológico / Evaluation, using PDR, of the infection for human palilloma virus in samples of patients with clinical cytological diagnostic

Detección y tipificación del VPH mediante Reacción en Cadena de la polimerasa con iniciadores genéricos MY09 y MY11 y RCP-Múltiple, en muestras de pacientes con diagnóstico citológico de coilocitosis y lesión intraepitelial escamosa de bajo grado, diagnóstico clínico de condilomatosis papilomatosis. Se procesaron 70 muestras citológicas del área genital a las que se realizó extracción de ADN y detección y tipificación viral mediante técnicas moleculares (RCP y RCP múltiple). Laboratorio de Genética Molecular del Instituto de Oncología Hematología. De las muestras evaluadas, 31 resultaron positivas en la detección molecular del VPH. De éstas, 29 correspondieron a VPH de bajo riesgo (tipos 11 y/o 6), una a infección mixta con bajo y alto riesgo (tipos 6 y 33) y otra a coinfección con virus de alto riesgo (tipos 18 y 33). Los resultados obtenidos resaltan la utilidad de la RCP en el diagnóstico y tipificación del VPH y ponen en evidencia una relación, ya establecida, entre VPH de bajo riesgo y displasias leves, así como la posible sobrestimación de infección por VPH en los diagnósticos de referencia.

Seroprevalencia de la infección por Helicobacter pylori en pacientes con Gastritis Crónica, Úlcera Duodenal y Gástrica: primer estudio de corte retrospectivo / Seroprevalence of Helicobacter pylori infection in chronic gastritis patients, duodenal and gastric ulcer patients

Objectivo. El objetivo de este estudio fue analizar la seroprevalencia de la población en tres centros hospitalarios, correspondientes a tres países; Venezuela, Cuba y República Dominicana. Métodos. El total de pacientes estudiados fueron 300, Se emplearon las técnicas Microwell ELISA de Diagnostic Automation INC (U.S.A.) y Pyloriset EIA-IIIG de Orion Diagnostic (Finland), para determinar la seroprevalencia de H. pylori (IgG) en los sueros obtenidos. La causa de las endoscopías en el 100 por ciento fue epigastralgias. El promedio de edad fue 46 años, con 127/300 (42 por ciento) hombres y 173/300 (58 por ciento) mujeres. Resultados. De acuerdo al diagnóstico endoscópico se obtuvieron los siguientes resultados: úlcera duodenal: 31/300 (10 por ciento); úlcera gástrica: 27/300 (9 por ciento); dispepsia no ulcerosa, incluyendo gastritis: 242/300 (81 por ciento). Del total de los 300 sueros testados, el 100 por ciento de estos fueron positivos para cada país, para anticuerpos IgG anti H. pylori. Conclusiones. Existe poca información acerca de la infección por Helicobacter pylori en los países de la región del Caribe y Latinoamérica, por lo que se requieren más estudios para completar la epidemiología de la infección a H.pylori en la región.

Objective. Our aim was to determine the (Hp)-seroprevalence of the infection in a group of 300 consecutive adult subjects population submitted to upper digestive tract endoscopy clinics in three countries, Venezuela, Cuba and República Dominicana. Methods. The total patients (300). Serology (IgG) was performed using Microwell ELISA from Diagnostic Automation INC (U.S.A.) and Pyloriset E IA-IIIG de Orion Diagnostic (Finland). Patients had the following endoscopic Diagnosis: duodenal ulcer 31/300 (10 percent); gastric ulcer: 27/300 (9 percent); non ulcer dyspepsia, including chronic gastritis: 242/300 (81 percent). The mean age was 46 years with 127/300 (42 percent) men and 173/300 (58 percent) women. Results. Among the 300 serums tested, 100 percent were positive in Venezuela, Cuba and Dominican Republic. The (Hp)-seroprevalence of H. pylori infection in the symptomatic population of La Havana-Cuba, Caracas-Venezuela and Santo Domingo- República Dominicana. Conclusions. There is a great paucity of information about Helicobacter pylori infection in the countries of the Caribbean basin. These results indicate the importance for further studies to identify factors influencing the high prevalence of the infection with H. pylori in the region.

La placa dental como reservorio de Helicobacter pylori / Dental plaques as Helicobacter pylori reservoirs

Resumen La placa dental ha sido propuesta como un reservorio para Helicobacter pylori, sugiriéndose que el microambiente oral pueda ser un nicho permanente para la bacteria. El objetivo de este estudio fue determinar el papel que juega la placa dental como reservorio de esta especie, evaluando la presencia de ADN de H. pylori en la placa dental y biopsias gástricas, mediante la reacción en cadena de la polimerasa (PCR por sus siglas en inglés). Fueron evaluados 71 pacientes sintomáticos gastrointestinales referidos para examen endoscópico, provenientes del Servicio de Gastroenterología del Hospital Universitario de Caracas, Venezuela y 40 sujetos asintomáticos. Las muestras de placa dental fueron analizadas por PCR, basada en la secuencia del gen ure c. Se tomaron biopsias gástricas para análisis histopatológico y PCR. H. pylori. fue detectado en las biopsias gástricas de 48(68%) de los 71 pacientes, todos con gastritis crónica y en placa dental de 13(18%) de los 71 sujetos. En 8 (17%) de estos 48 pacientes, H. pylori fué también detectado en placa dental. De estos pacientes 4 presentaban adicionalmente displasia y 4 metaplasia. Tres pacientes del grupo control fueron positivos por PCR para H. pylori en placa dental. La placa dental puede ser un reservorio para la bacteria, y su presencia podría representar un factor de riesgo para la reinfección gastrointestinal, posterior al tratamiento de erradicación de la bacteria.

Abstract Dental plaques have been proposed as Helicobacter pylori reservoirs, suggesting that the oral microenvironment can be a permanent niche for the bacterium. The objective of this study was to determine the role played by the dental plaque as reservoir for this species, evaluating the presence of H. pylori DNA in dental plaques and gastric biopsies through the polymerase chain reaction (PCR). The evaluation included seventy-one gastro-intestinal symptomatic patients referred for endoscopic examination by the Gastroenterology Service of the Caracas University Hospital, as well as 40 asymptomatic subjects. The dental plaque samples were analyzed by PCR based on the ure c gene sequence. Gastric biopsies were taken for histopathological analysis and PCR. H. pylori was detected in 48 (68%) gastric biopsies from the 71 patients, all with chronic gastritis, and in the dental plaque of 13 (18%) of the same 71 patients. In 8 (17%) of these 48 patients H. pylori was also detected in dental plaque. Four of these patients also presented displasia and metaplasia. Three patients from the control group were PCR positive for H. pylori in dental plaque. Dental plaques can be a reservoir for these bacteria and their presence could represent a risk factor for gastrointestinal re-infection after treatment for eradicating this bacterium.