Determining food safety in canned food using fuzzy logic based on sulphur dioxide, benzoic acid and sorbic acid concentration.

Canned food market demand has arisen due to the higher need for instant and ready-to-eat food. Food preservatives are often added to canned and processed foods to prolong their shelf life and help to sustain the quality, taste, color, and food texture. However, excessive usage of such food preservatives can lead to various diseases and health issues including palpitations, allergies, and cancer. Therefore, food preservative detection in food samples is essential for safe consumption and health well-being. This paper proposed a fuzzy logic framework to determine the safety of food products based on the concentration of sulphur dioxide (SD), benzoic acid (BA), and sorbic acid (SA) in five different food categories as referred to the Food Acts 1983 and Food Regulations 1985 in Malaysia. The fuzzy logic framework comprises of Mamdani inference system design with 90 fuzzy rules, 15 and 5 membership functions for both the input and output parameters respectively. 50 random values and 10 lab analysis results based on the industrial samples were used to validate the developed algorithms in ensuring the safety of the food products. The membership functions generated for the three inputs (SD, BA, and SA) during the fuzzification steps are based on the maximum allowable limit from the food acts. The defuzzification of fuzzy logic gave an average output value of 0.1565, 0.1350, 0.1150, 0.1100, and 0.1550 for chicken curry with potatoes, satay sauce, sardine in tomato sauce, anchovies paste, and sardine spread accordingly. Results obtained from the fuzzy logic framework concluded that all the industrial samples are safe to be eaten and comply with the Sixth Schedule, Regulation 20 in both Acts.

Clinical assessment of a low-cost, hand-held, smartphone-attached intraoral imaging probe for 5-aminolevulinic acid photodynamic therapy monitoring and guidance.

Significance: India has one of the highest rates of oral squamous cell carcinoma (OSCC) in the world, with an incidence of 15 per 100,000 and more than 70,000 deaths per year. The problem is exacerbated by a lack of medical infrastructure and routine screening, especially in rural areas. New technologies for oral cancer detection and timely treatment at the point of care are urgently needed. Aim: Our study aimed to use a hand-held smartphone-coupled intraoral imaging device, previously investigated for autofluorescence (auto-FL) diagnostics adapted here for treatment guidance and monitoring photodynamic therapy (PDT) using 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) fluorescence (FL). Approach: A total of 12 patients with 14 buccal mucosal lesions having moderately/well-differentiated micro-invasive OSCC lesions (<2 cm diameter and <5 mm depth) were systemically (in oral solution) administered three doses of 20 mg/kg ALA (total 60 mg/kg). Lesion site PpIX and auto-FL were imaged using the multichannel FL and polarized white-light oral cancer imaging probe before/after ALA administration and after light delivery (fractionated, total 100 J/cm2 of 635 nm red LED light). Results: The handheld device was conducive for access to lesion site images in the oral cavity. Segmentation of ratiometric images in which PpIX FL is mapped relative to auto-FL enabled improved demarcation of lesion boundaries relative to PpIX alone. A relative FL (R-value) threshold of 1.4 was found to segment lesion site PpIX production among the patients with mild to severe dysplasia malignancy. The segmented lesion size is well correlated with ultrasound findings. Lesions for which R-value was >1.65 at the time of treatment were associated with successful outcomes. Conclusion: These results indicate the utility of a low-cost, handheld intraoral imaging probe for image-guided PDT and treatment monitoring while also laying the groundwork for an integrated approach, combining cancer screening and treatment with the same hardware.

Clinical evaluation of a mobile, low-cost system for fluorescence guided photodynamic therapy of early oral cancer in India.

BACKGROUND: Morbidity and mortality due to oral cancer in India are exacerbated by a lack of access to effective treatments amongst medically underserved populations. We developed a user-friendly low-cost, portable fibre-coupled LED system for photodynamic therapy (PDT) of early oral lesions, using a smartphone fluorescence imaging device for treatment guidance, and 3D printed fibreoptic attachments for ergonomic intraoral light delivery. METHODS: 30 patients with T1N0M0 buccal mucosal cancer were recruited from the JN Medical College clinics, Aligarh, and rural screening camps. Tumour limits were defined by external ultrasound (US), white light photos and increased tumour fluorescence after oral administration of the photosensitising agent ALA (60 mg/kg, divided doses), monitored by a smartphone fluorescence imaging device. 100 J/cm2 LED light (635 nm peak) was delivered followed by repeat fluorescence to assess photobleaching. US and biopsy were repeated after 7-17 days. This trial is registered with ClinicalTrials.gov, NCT03638622, and the study has been completed. FINDINGS: There were no significant complications or discomfort. No sedation was required. No residual disease was detected in 22 out of 30 patients who completed the study (26 of 34 lesions, 76% complete tumour response, 50 weeks median follow-up) with up to 7.2 mm depth of necrosis. Treatment failures were attributed to large tumour size and/or inadequate light delivery (documented by limited photobleaching). Moderately differentiated lesions were more responsive than well-differentiated cancers. INTERPRETATION: This simple and low-cost adaptation of fluorescenceguided PDT is effective for treatment of early-stage malignant oral lesions and may have implications in global health.

Clinical evaluation of smartphone-based fluorescence imaging for guidance and monitoring of ALA-PDT treatment of early oral cancer.

SIGNIFICANCE: India has one of the highest rates of oral cancer incidence in the world, accounting for 30% of reported cancers. In rural areas, a lack of adequate medical infrastructure contributes to unchecked disease progression and dismal mortality rates. Photodynamic therapy (PDT) has emerged as an effective modality with potential for treating early stage disease in resource-limited settings, while photosensitizer fluorescence can be leveraged for treatment guidance. AIM: Our aim was to assess the capability of a simple smartphone-based device for imaging 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) fluorescence for treatment guidance and monitoring as part of an ongoing clinical study evaluating low-cost technology for ALA-based PDT treatment of early oral cancer. APPROACH: A total of 29 subjects with <2 cm diameter moderately/well-differentiated microinvasive ( < 5 mm depth) oral squamous cell carcinoma lesions (33 lesions total, mean area ∼1.23 cm2) were administered 60 mg / kg ALA in oral solution and imaged before and after delivery of 100 J / cm2 total light dose to the lesion surface. Smartphone-based fluorescence and white light (WL) images were analyzed and compared with ultrasound (US) imaging of the same lesions. RESULTS: We present a comparative analysis of pre- and post-treatment fluorescence, WL, and US images of oral lesions. There was no significant difference in the distribution of lesion widths measured by fluorescence and US (mean widths of 14.5 and 15.3 mm, respectively) and linear regression shows good agreement (R2 = 0.91). In general, PpIX fluorescence images obtained prior to therapeutic light delivery are able to resolve lesion margins while dramatic photobleaching (∼42 % ) is visible post-treatment. Segmentation of the photobleached area confirms the boundaries of the irradiated zone. CONCLUSIONS: A simple smartphone-based approach for imaging oral lesions is shown to agree in most cases with US, suggesting that this approach may be a useful tool to aid in PDT treatment guidance and monitoring photobleaching as part of a low-cost platform for intraoral PDT.

End-of-life care following leg amputation in patients with peripheral artery disease or diabetes.

BACKGROUND: The aim was to characterize end-of-life care in patients who have had a leg amputated for peripheral artery disease (PAD) or diabetes. METHODS: This was a population-based retrospective cohort study of patients with PAD or diabetes who died in Ontario, Canada, between 2011 and 2017. Those who had a leg amputation within 3 years of death were compared with a control cohort of deceased patients with PAD or diabetes, but without leg amputation. The patients were identified from linked health records within the single-payer healthcare system. Place and cause of death, as well as health services and costs within 90 days of death, were compared between the amputee and control cohorts. Among amputees, multivariable regression models were used to characterize the association between receipt of home palliative care and in-hospital death, as well as time spent in hospital at the end of life. RESULTS: Compared with 213 300 controls, 3113 amputees were less likely to die at home (15·5 versus 24·9 per cent; P < 0·001) and spent a greater number of their last 90 days of life in hospital (median 19 versus 8 days; P < 0·001). Amputees also had higher end-of-life healthcare costs across all sectors. However, receipt of palliative care was less frequent among amputees than controls (inpatient: 13·4 versus 16·8 per cent, P < 0·001; home: 14·5 versus 23·8 per cent, P < 0·001). Among amputees, receipt of home palliative care was associated with a lower likelihood of in-hospital death (odds ratio 0·49, 95 per cent c.i. 0·40 to 0·60) and fewer days in hospital (rate ratio 0·84, 0·76 to 0·93). CONCLUSION: Palliative care is underused after amputation in patients with PAD or diabetes, and could contribute to reducing in-hospital death and time spent in hospital at the end of life.

ANTECEDENTES: Caracterizar la atención al final de la vida en pacientes con amputación de la extremidad inferior por enfermedad arterial periférica (peripheral arterial disease, PAD) o diabetes. MÉTODOS: Se trata de un estudio de cohortes retrospectivo de base poblacional en sujetos fallecidos con PAD o diabetes en Ontario, Canadá (2011-2017). A partir de los registros sanitarios incluidos en un sistema de salud de una sola entidad pagadora, se identificaron los individuos con amputación de la extremidad inferior en los 3 años previos al fallecimiento y una cohorte control de fallecidos con PAD o diabetes sin amputación. Entre las cohortes de amputados y controles se comparó el lugar del fallecimiento y la causa, así como el uso de servicios sanitarios y costes en los últimos 90 días de vida. En el grupo de los amputados, se utilizaron modelos de regresión para caracterizar la asociación entre recibir cuidados paliativos domiciliarios y el fallecimiento en el hospital, así como los días de estancia hospitalaria al final de la vida. RESULTADOS: En comparación con los controles (n = 213.300), los sujetos con amputación (n = 3.113) era menos probable que fallecieran en el domicilio (16% versus 25%, P < 0,001) y pasaron un mayor número de sus últimos 90 días de vida en el hospital (mediana 19 versus 8 días, P < 0,001). Los costes de atención sanitaria al final de la vida en todos los sectores también fueron mayores para los amputados. Sin embargo, recibir cuidados paliativos fue menos frecuente en los amputados que en los controles (en el hospital 13% versus 17%, P < 0,001; domiciliarios 14% versus 24%, P < 0,001). En el grupo de los amputados, recibir cuidados paliativos domiciliarios se asociaba con una menor probabilidad de fallecimiento en el hospital (razón de oportunidades, odds ratio 0,49, i.c. del 95% 0,40-0,60) y menos días de hospitalización (tasa de riesgo 0,84, i.c. del 95% 0,76-0,93). CONCLUSIÓN: Los cuidados paliativos están infrautilizados en pacientes con PAD o diabetes y pueden contribuir a disminuir los fallecimientos en el hospital y los días de hospitalización al final de la vida.

Interdigitated versus sequential high-dose-rate intracavitary brachytherapy with external beam radiotherapy in locally advanced carcinoma cervix.

AIMS: To decrease overall treatment time (OTT) and to compare the clinical outcome of interdigitated high-dose-rate intracavitary brachytherapy (HDRICBT) versus sequential HDRICBT with external beam radiotherapy (EBRT) in the treatment of locally advanced carcinoma cervix. METHODS: Eighty-two patients with histologically confirmed carcinoma of the cervix, untreated International Federation of Gynecology and Obstetrics Stage IIB-IIIB, were included and randomized into two groups. The study group received EBRT 50 Gy/25 fractions with interdigitated HDRICBT 8 Gy/fraction weekly a total of three fractions. Patients in the control group received EBRT 50 Gy/25 fractions with sequential HDRICBT 8 Gy/fraction weekly a total of three fractions. At the end of the study, results of both groups compared in terms of OTT, acute and late toxicities, and response to therapy clinically. RESULTS: A total of 82 patients were enrolled 41 in each arm. Seventy-two patients completed treatment and were analyzed. Mean OTT in study group and control group was 40 and 60 days, respectively. The median follow-up duration was 10 months (3-18). Most of the acute and late toxicities were of Grade 1 and 2 type and comparable in both study and control groups. Treatment interruption due to treatment-related toxicity was slightly higher in the study group than the control group, but it was statistically insignificant. Os negotiability was not found to be a limiting factor for interdigitated HDRICBT. CONCLUSION: Interdigitated HDRICBT has equivalent response and toxicities as sequential HDRICBT with the advantage of significant reduction in OTT.

Carbon nanotube-reinforced hydroxyapatite composite and their interaction with human osteoblast in vitro.

As a bone mineral component, hydroxyapatite (HA) has been an attractive bioceramic for the reconstruction of hard tissues. However, its poor mechanical properties, including low fracture toughness and tensile strength, have been a substantial challenge to the application of HA for the replacement of load-bearing and/or large bone defects. In this study, HA is reinforced with high-purity and well-functionalized multiwalled carbon nanotubes (MWCNTs; >99 wt%) having an average diameter of 15 nm and length from 10 to 20 µm. The cellular response of these functionalized CNTs and its composites were examined in human osteoblast sarcoma cell lines. Calcium nitrate tetrahydrate (Ca(NO3)2·4H2O) and diammonium hydrogen phosphate ((NH4)2HPO4) were used to synthesize HA in situ. MWCNTs were functionalized by heating at 100°C in 3:1 ratio of sulfuric acid and nitric acid for 60 min with stirring and dispersed in sodium dodecyl benzene sulfonate by sonication. HA particles were produced in MWCNTs solution by adding Ca(NO3)2·4H2O and (NH4)2HPO4 under vigorously stirring conditions. The composite was dried and washed in distilled water followed by heat treatment at 250°C to obtain CNT-HA powder. Physiochemical characterization of the composite material was carried out using Fourier transform infrared spectroscopy, field-emission scanning electron microscopy, energy-dispersive X-ray spectrometer, and X-ray diffractometer. Furthermore, this study investigates the cytotoxic effects of functionalized-MWCNTs (f-MWCNTs) and its composites with HA in human osteoblast sarcoma cell lines. Human osteoblast cells were exposed with different concentrations of f-MWCNTs and its composite with HA. The interactions of f-MWCNT and MWCNT-HA composites were analyzed by 3-(4,5-dimethyl thiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay. The results indicate no detrimental effect on survival or mitochondrial activity of the osteoblast cells. Cell viability decreased with an increase in CNT concentration indicating that MWCNTs and its composite can be cytotoxic at higher dosages. This result provides further evidence that the bionano interface can be developed for CNT-reinforced HA composites for load-bearing bone implants, drug delivery, and tissue engineering.

Prevention of type II endoleak by laparoscopic inferior mesenteric artery ligation.

Abdominal aortic aneurysm repair by endovascular techniques have gained wide acceptance as a treatment option. A potential well-known complication of endovascular repair includes endoleak. Specifically, type II endoleak, which is described as retrograde flow into the aneurysm sac through collateral vessels, can occur in up to 30% of patients. Certain preoperative factors can predict which patients may develop type II endoleak. This article describes laparoscopic inferior mesenteric artery ligation prior to endovascular abdominal aortic aneurysm repair as a viable treatment option in the prevention of type II endoleak.

Deliberate self-harm and the elderly: a volatile combination-an overview from the plastic surgery perspective.

Aims. To study the factors associated with the DSH in the elderly group of 60 years and above and to recommend changes to be implemented in order to improve the management in this specific group. Materials and Methods. Five-year retrospective study was undertaken from July 2005 to July 2010 in the Plastic Surgery Department of the Royal Preston Hospital, NHS Trust. A Performa was designed to collect data about the inpatient admission and included certain areas of key information. The case notes for all patients were extensively analysed in order to gather adequate information for the devised Performa. Results. DSH is getting more common in the elderly group, and males are more affected than females. 60% of the patients had a previous history of DSH. A large number (80%) of patients had a previous history of mental illness. 60% of those DSH patients were living with family. Almost all patients (90%) were reviewed by the Psychiatry Liaison Team. The timing of patients being assessed was highly variable. Conclusions. Marriage is not a protective factor in the prevention of the DSH in the elderly group. A mental health team referral in the early phases of the management would be of huge benefit and a likely step to prevent possible future admissions. The Department would benefit from the creation of a protocol for the management of these patients. There should be a joint effort of the professionals in the management of DSH in the elderly, and GPs play a very important role in the prevention of DSH in the later life.

Decreased use of computed tomography with a modified clinical scoring system in diagnosis of pediatric acute appendicitis.

HYPOTHESIS: Use of a modified clinical grading score improves accuracy in diagnosing acute appendicitis in the pediatric population while decreasing the use of computed tomography (CT). DESIGN: Retrospective medical records review after approval by the institutional review board. We determined the Alvarado score for each patient and correlated it with the pathological findings and imaging studies to evaluate the efficacy of CT and its attendant radiation exposure. SETTING: Community teaching hospital. PATIENTS: Sixty-one patients, aged 3 to 16 years, admitted with suspected acute appendicitis. MAIN OUTCOME MEASURES: Sensitivity, specificity, and accuracy of the modified Alvarado scoring system. RESULTS: The standard Alvarado score for acute appendicitis had a sensitivity of 92% and a specificity of 82%, with an accuracy of 92%. In the modified Alvarado scoring system, CT findings were substituted for Alvarado scores in the ranges of 5 or 6, 5 to 7, 5 to 8, and 5 to 9. The modification resulted in the greatest accuracy (98%) in diagnosing appendicitis in patients with scores in the range of 5 to 7. This modification theoretically would have decreased the use of CT by about 27% in this group of retrospectively studied patients. Furthermore, in patients with Alvarado scores of 1 to 4, another diagnosis should be considered; in patients with scores of 5 to 7, CT should be performed; and, in patients with scores of 8 to 10, an appendectomy should be performed promptly without further studies. CONCLUSIONS: The modified Alvarado score is useful as an aid in diagnosing acute appendicitis in the pediatric population. This scoring system eliminates unnecessary use of CT and the attendant potential cancer-inducing radiation in the pediatric population.

Status of HIV infection among the pregnant women attending in outpatient department.

Human immunodeficiency virus (HIV) infection has been spreading rapidly in the developing countries and vertical transmission also taking place. This study has been done to find out the prevalence of HIV infection among the pregnant women, so that necessity of routine screening test can be identified. It is a cross sectional study. Five hundred two pregnant women were included. Three ml venous blood was taken and then HIV screening test was done by ELISA method. All reactive tests were confirmed by Western blot antibody testing. The positive cases were followed up and necessary treatment was given. Delivery was conducted in this hospital. Baby's blood was tested to see vertical transmission after 18 months. Most of the subject were educated housewife, mean age was 25 years. Six (6%) husband was overseas service holder, 12% were smoker and 1.6% had drug addiction. Eight (8%) subject had previous history of blood transfusion and 49% subject or her husband had history of surgery or got parental therapy. 2% subject gave the history of familial disharmony and 2% had multiple sex partners. HIV infection was found in 2 patients (0.4%). Both of them got infection from their husband. One husband was over seas service holder and another one was injecting drug user. For the prevention of spread, reduction of vertical transmission and providing early management to the positive patient all pregnant women should be screened for HIV routinely.

Metastasis in differentiated thyroid carcinoma.

Seventy patients of differentiated thyroid carcinoma (DTC) irrespective of age and sex were selected in ENT Department of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and Rangpur Medical College Hospital who were admitted from March 2003 to March 2005. Female were more commonly affected (2.6:1) Papillary carcinoma was more common in 31-50 years of age and follicular carcinoma (ca) common in 41-50 years of age. Among the differentiated thyroid carcinoma papillary carcinoma found 77.15% and follicular ca. found 22.85%. Lymph node metastasis was more common in papillary (35%) than follicular carcinoma (12.5%). But distant metastasis was more common in follicular (12.5%) than papillary carcinoma (3.70). Maximum lymph node metastasis was found in level 3(55%), level 2(45%).

Neck swelling with renal stone.

Since the advent of screening of calcium and imaging techniques (CT and MRI), hyperparathyroidism has been detected with increasing frequency. Although in the past, most patients present with severe bone and renal diseases, a large number of patients are asymptomatic. Number of parathyroid glands and their ectopic locations in individuals are the problem of its management. Parathyroid adenoma or hyperplasia may be a part of Multiple Endocrine neoplasia type II. This is the story of a boy of 18 years who had got admitted in the department of Otolaryngology, Mymensingh Medical College Hospital with the complaints of a neck swelling, abdominal discomfort, inability to walk, frequency of micturation for almost same duration of 1 year. After search, hypercalcaemia, bilateral renal stone, raised parathormone level and enlarged one parathyroid gland in lower pole of left thyroid lobe was identified. Clinically it was diagnosed as parathyroid adenoma which was proved histologically after surgical excision. Many controversies still exist regarding the treatment policy of parathyroid adenoma.

Fault diagnosis of the polypropylene production process (UNIPOL PP) using ANFIS.

The performance of a chemical process plant can gradually degrade due to deterioration of the process equipment and unpermitted deviation of the characteristic variables of the system. Hence, advanced supervision is required for early detection, isolation and correction of abnormal conditions. This work presents the use of an adaptive neuro-fuzzy inference system (ANFIS) for online fault diagnosis of a gas-phase polypropylene production process with emphasis on fast and accurate diagnosis, multiple fault identification and adaptability. The most influential inputs are selected from the raw measured data sets and fed to multiple ANFIS classifiers to identify faults occurring in the process, eliminating the requirement of a detailed process model. Simulation results illustrated that the proposed method effectively diagnosed different fault types and severities, and that it has a better performance compared to a conventional multivariate statistical approach based on principal component analysis (PCA). The proposed method is shown to be simple to apply, robust to measurement noise and able to rapidly discriminate between multiple faults occurring simultaneously. This method is applicable for plant-wide monitoring and can serve as an early warning system to identify process upsets that could threaten the process operation ahead of time.

Angiogenesis-a novel therapeutic approach for ischemic heart disease.

Angiogenesis is the biologic process of forming new blood vessels. Undoubtedly, blood vessels growth regulation is a vital aspect in health and disease. Under physiological conditions, angiogenesis is regulated by local balance between endogenous stimulators and inhibitors of this process. In many diseases state body loses control over angiogenesis. Angiogenesis-dependent diseases result when new blood vessels either grow excessively or insufficiently. Insufficient angiogenesis occurs in diseases such as coronary artery disease, stroke and chronic wounds. Myocardial ischemia both acute and chronic has been clearly shown to stimulate angiogenesis in many experimental models. Therapeutic angiogenesis is the biological agents or bioactive material to stimulate the growth of new blood vessels. Traditional coronary revascularization therapies such as coronary angioplasty or bypass graft surgery, act by restoring blood flow through the preexisting coronary vessels. One limitation of these approaches, however, may be the failure to normalize myocardial perfusion, due to the concomitant presence or small of resistance vessel disease. In contrast, therapeutic angiogenesis is based on the concept that coronary collateral development may be stimulated by pharmacological or molecular means and can limit myocardial ischemia. Studies, both in human and animal models support the notion that, various angiogenic growth factors and progenitor cells can enhance new blood vessels. Vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), recombinant proteins and bone marrow stem cells are currently used therapeutic stimulators for angiogenesis. As coronary artery disease is the major cause of death in the developed societies and also an emerging health problem in developing countries like Bangladesh therapeutic angiogenesis may provide hope as a new treatment modality for ischemic heart disease with or in place of current therapies.

Epidemic of cutaneous leishmaniasis: 109 cases in a population of 500.

In February 2004, 4 patients aged 10-15 years presented at the Pakistan Institute of Medical Sciences with non-healing multiple ulcers on exposed parts. On the basis of history, clinical assessment and fine needle aspiration cytology, they were diagnosed as having cutaneous leishmaniasis. We were informed that several similar cases were present in their village. A team of doctors and technicians visited the area. A survey was conducted and another 105 cases with various morphological presentations were identified. The area was visited several times to find the vector, reservoirs and source of infection and to advise on controlling the epidemic.

Prevalence study to elucidate the transmission pathways of Helicobacter pylori at oral and gastroduodenal sites of a South Indian population.

INTRODUCTION: Since the discovery of Helicobacter pylori (H. pylori), much progress has been made worldwide in the field of its epidemiology. In spite of these advancements, many aspects of epidemiology still remain unclear, particularly among populations with low socio-economic status. The present study was designed to elucidate the different routes of transmission of H. pylori in the Hyderabad (South India) population and to investigate the impact of certain factors, such as age, gender, and lifestyle. METHODS: Samples used for the study included saliva and biopsy samples of 400 symptomatic subjects from Hyderabad, India. The patients were retrospectively grouped, based on histopathology of the biopsy and 16S rRNA amplification of both saliva and biopsy as H. pylori positive and negative. RESULTS: This study showed that the prevalence of H. pylori in both saliva and biopsy samples increased with age. In addition, the H. pylori infection was found more commonly in the saliva and biopsy samples among males (64 percent and 60 percent, respectively) than females (53.3 percent and 64 percent, respectively). Similarly, 71.6 percent and 73.5 percent of those who consumed municipal water acquired H. pylori (which were respectively found in their saliva and biopsy samples) compared to a lesser proportion (12.6 percent and 12.6 percent, respectively) of those who consumed boiled or filtered water. The study also found that subjects who preferred home-cooked food (57.1 percent and 57.7 percent) showed a lower prevalence of H. pylori in saliva and biopsy samples, respectively, compared to those (80 percent and 88 percent) who frequently ate out. CONCLUSION: The results of the present study suggest that besides the oral-oral route, the transmission of H. pylori also takes place through the consumption of food prepared under unhygienic conditions. Consumption of municipal tap water also has a high impact in the transmission of H. pylori.

Rapid diagnosis of Helicobacter pylori infection in dyspeptic patients using salivary secretion: a non-invasive approach.

INTRODUCTION: Current guidelines that recommend Helicobacter pylori eradication treatment without endoscopy in selected patients underscore the importance of non-invasive testing. The accuracy of saliva as a non-invasive specimen was compared with that of invasive tests in pretreatment diagnosis of H. pylori infection. METHODS: One hundred patients undergoing gastroscopy were grouped into 80 symptomatic and 20 asymptomatic subjects and were investigated for the presence of H. pylori in saliva and stomach. Samples tested comprised saliva and gastric biopsies collected from each patient. Exclusion criteria were history of peptic ulcer, bleeding ulcer, cancer or recent use of antibiotics, proton pump inhibitors and non-steroidal anti-inflammatory drugs. Two sets of primers homologous to 534 bp fragment of H. pylori DNA, which have been shown previously to be highly specific and sensitive, were used for the polymerase chain reaction (PCR) amplification. RESULTS: 72 (90 percent) of the symptomatic group and 10 asymptomatic subjects were infected with H. pylori in the stomach as determined by histology and direct PCR amplification of biopsy DNA obtained from each subject. H. pylori DNA was identified in the saliva of 70 (87.5 percent) symptomatic subjects and 12 (60 percent) asymptomatic control subjects. CONCLUSION: High rates of detection using saliva as a specimen indicate that saliva of the infected person could serve as a reliable non-invasive alternative to detect the presence of H. pylori infection in comparison to the currently available standard diagnostic tests.