Helicobacter pylori antibodies and gastric cancer in Iceland - The decline in IgG antibody level is a risk factor.

H. pylori infection is considered a causal agent of duodenal ulcer and a significant risk factor for gastric cancer. Retrospective cohort studies have demonstrated a significant association between presence of antibody to H. pylori and gastric cancer when using samples obtained years before the diagnosis but not at the time of diagnosis. The present study investigates, in a population-based cohort, whether a decline occurs in H. pylori antibody levels before the diagnosis of stomach cancer. Repeat samples (2 to 5) were available from 23 persons with gastric cancer taken up to 20 years before the diagnosis and 128 control subjects matched for gender, age, time and number of repeat samples. The odds ratio of developing stomach cancer was 1.16 (95% CI 1.05-1.28) for those showing decline in antibody levels of 1 relative antibody activity unit per year versus those with constant or rising levels. We conclude that this decline in antibody levels in cases, and not in controls, supports an active role of H. pylori in the pathogenesis of gastric cancer by causing atrophic gastritis, and provides a better risk assessment for gastric cancer compared to single measurements.

Carriage of respiratory tract pathogens and molecular epidemiology of Streptococcus pneumoniae colonization in healthy children attending day care centers in Lisbon, Portugal.

In an effort to establish the rate of carriage of antibiotic resistant respiratory pathogens in children attending urban day care centers (DCC) in Portugal, seven DCC in Lisbon were selected for determining the rate of nasopharyngeal colonization of children between the ages of 6 months to 6 years by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Of the 586 children studied between January and March 1996, 47% carried S. pneumoniae, 72% H. influenzae, and 54% M. catarrhalis. Twenty-four percent of the pneumococci had reduced susceptibility to penicillin, and most of these belonged to serogroups 19, 23, 14, and 6. An additional 19% were fully susceptible to penicillin but showed decreased susceptibility to other antimicrobials. These isolates expressed serogroups 6, 11, 14, 18, 19, and 34. The majority (96%) of M. catarrhalis and 20% of H. influenzae were penicillin resistant due to the production of beta-lactamases. Recent antimicrobial use was associated with carriage of penicillin non-susceptible pneumococci and beta-lactamase producing H. influenzae (p < 0.05). Individual DCC differed substantially from one another in their rates of carriage of antibiotic resistant H. influenzae and S. pneumoniae. Characterization of antibiotic resistant S. pneumoniae isolates by molecular fingerprinting techniques showed that each DCC had a unique microbiological profile, suggesting little, if any, exchange of the resistant microbial flora among them. An exception to this was the presence of isolates belonging to two internationally spread epidemic clones: the multiresistant Spanish/USA clone expressing serotype 23F, and the penicillin and sulfamethoxazole-trimethoprim resistant French/Spanish clone (serotype 14) which were detected in four and three DCC, respectively.

Clinical evaluation of an automated enzyme-linked fluorescent assay for the detection of chlamydial antigen in specimens from high-risk patients.

A fully automated enzyme-linked fluorescent assay (ELFA) on the Vitek Immunodiagnostic Assay System (VIDAS CHL) was evaluated for the detection of chlamydial antigen in specimens from symptomatic and asymptomatic high-risk patients. The results were compared with those from McCoy cell culture and Chlamydiazyme with a blocking assay. False-positive VIDAS specimens were centrifuged and the pellet stained with direct fluorescent antibody (DFA). Of the 158 urine specimens, 52 (33%) were infected by Chlamydia trachomatis. The sensitivity and specificity of the VIDAS when compared with cell culture, DFA, and Chlamydiazyme were 75% and 96%, respectively, for urine specimens while the predictive value of a positive (PVP) and a negative (PVN) were 91% and 88%, respectively. Of the 245 urethral swabs, 75 (31%) were considered positive. The sensitivity and specificity were 71% and 92%, respectively, and the PVP and PVN were 80% and 87%, respectively. The sensitivity and specificity on the 108 cervical swabs, 22 of which were positive, were 95% and 95%, respectively, and PVP and PVN were 88% and 99%, respectively. Compared with Chlamydiazyme, the VIDAS was more sensitive on specimens from female patients and urine specimens, but less sensitive on urethral specimens from male patients.

[The prevalence of H. pylori antibodies in Iceland.].

Helicobacter pylori causes gastritis and duodenal ulcerations, and is possibly one of the causes of gastric cancer. Diagnosis has relied on gastroscopy, but with the advent of reliable serological tests, epidemiological studies have become easier. Previous studies have indicated a higher H. pylori infection rate in Iceland than neighbouring countries. To study this further, an H. pylori (acid glycine extract) ELISA test was set up. Serum samples were obtained from 387 individuals, aged three months to 97 years, mean 41 years (161 blood donors, 83 outpatients, 64 ante natal clinic, 33 hospitalised children, 27 old people's home and 19 college students). Positive antibody titers were found in 151 (39%), of which 14 were borderline. The prevalence increased with age and was highest 75% in 60-69 years old, but lowest 9% in the youngest age group. The prevalence of H. pylori antibodies appears to be higher than in neighbouring countries, but lower than in the developing countries, and Icelanders appear to acquire the infection at a younger age than in the neighbouring countries. This high prevalence is important in view of the high prevalence of gastric cancer in Iceland.

[Bilateral oophorectomy before menopause. Late effects on quality of life, lipid metabolism and bone mass.].

OBJECTIVE: Oophorectomy in premenopausal women may profoundly affect health. This study was done to investigate whether it had influenced the quality of life, lipid metabolism and bone mass if removal of the ovaries in premenopausal women was performed more than 15 years ago. MATERIAL AND METHODS: Operation records from the Department of Obstetrics and Gynecology at the National University Hospital, Reykjvík, were scruti-nized to find all women who during 1977-1984 had a bilateral oophorectomy performed at less than 47 years of age at the time of operation. A control group of age-matched women, who during the same period had undergone a hysterectomy with preservation of the ovaries, was chosen. Women with malignant and chronic disabling diseases were excluded. The participants answered 36 standardized questions relating to menopausal symptoms, hormonal use and smo-king. Mesurements of total serum cholesterol, HDL (high density lipoprotein) and LDL (low density lipoprotein) cholesterol, triglycerides and calcium and fasting urine calcium and creatinine, were performed. Bone mineral density was assessed by dual energy X-ray absorptiometry in the lumbar spine, left hip and femoral neck. RESULTS: Thirty-four patients and equally many controls were identified. Fifty women agreed to participate, but two did not attend for the investigation, giving a total of 26 cases and 22 controls. Mean age at the time of operation was 43.3 years for cases and 43.5 and controls. The difference in the duration of hormone use (11.6 and 8.9 years) was not significant. Of the 36 questions on climacteric symptoms there was a significant difference between the groups in only one. Cases and controls were not different with regard to serum lipids and bone mineral density. Mean values of bone mineral density in both groups were within the normal limits for an age-matched general population. CONCLUSIONS: Women who underwent removal of the ovaries before 47 years of age, more than 15 years later, were not shown to have suffered more from longterm effects of estrogen deficiency than age-matched women who had undergone hysterectomy with preservation of the ovaries. A relatively long duration of estrogen use may be the main reason for this outcome.

Seroprevalence of Helicobacter pylori in south Sweden and Iceland.

BACKGROUND: Seroepidemiologic studies on the prevalence of Helicobacter pylori infection have been reported from several European countries but not from Sweden or Iceland. METHODS: Serum samples were collected from 443 persons in Sweden and 387 persons in Iceland. All the 830 sera were tested with the same enzyme immunoassay test with an acid glycine extract of H. pylori surface proteins as antigen. RESULTS: The antibody levels were low in the young age groups in both Sweden and Iceland, with increasing levels with age. CONCLUSIONS: The results are consistent with previous studies from other comparable countries, but with important differences. The prevalence was lower in Sweden than in other, previously studied, Western European countries, but, on the other hand, the prevalence was slightly higher in Iceland.