Detection of p53 codon 249 mutation in Nigerian patients with hepatocellular carcinoma using a novel evaluation of cell-free DNA.

OBJECTIVES: This case-control study was done to determine the association and prevalence of p53 codon 249 mutation using cell-free DNA in the plasma of patients with hepatocellular carcinoma (HCC) in South-Western Nigeria. METHOD: Eighty-five adults with HCC and seventy-seven age and gender matched controls without evidence of liver disease or malignancy involving any part of the body, were recruited. Plasma DNA was analyzed for p53 codon 249 by restriction fragment length polymorphism. Patient evaluation was done by means questionnaire interview, clinical examination, laboratory and radiological tests. The prevalence of the p53 codon 249 mutation was expressed as a percentage amplifiable DNA samples analyzed from HCC patients while that of controls was expressed in the same way. Fisher's exact test or the student t-test where appropriate were used to assess statistical significance of prevalence between both groups as well as comparison of some characteristics in the HCC cases between those who had codon 249 mutation and those who did not. Associations between the various parameters assessed were determined by odds ratio and significant difference was specified at p < 0.05. RESULTS: p53 codon 249 mutation was present in 6 (7.6%) of the 79 samples from the HCC patients with amplifiable plasma DNA while none (i.e. 0%) of the 73 samples with amplifiable plasma DNA from the controls had this mutation. This prevalence is significantly higher among HCC patients than controls (0.029). The mutation was also found to be significantly associated with HCC (odds ratio = 2.00; 95% C I: 1.70 - 2.35). CONCLUSION: The prevalence of the p53 codon 249 mutation from plasma DNA of hepatocellular carcinoma patients is significantly higher than among controls in South-Western Nigeria and the presence of this mutation is significantly associated with HCC in this region.

Rabeprazole, clarithromycin, and amoxicillin Helicobacter pylori eradication therapy: report of an efficacy study.

AIM: To investigate the efficacy of a standard triple therapy (comprising rabeprazole, clarithromycin, and amoxicillin) for Helicobacter pylori (H. pylori) eradication, noting factors that influence the outcome and documenting any adverse events. METHODS: Following institutional ethical approval, fifty consecutive and consenting symptomatic patients with evidence of H. pylori infection by either a positive urea breath test (UBT) and/or a campylobacter-like organism test who presented to the Gastroenterology clinic of Lagos State University Teaching Hospital between 2012 and 2013 were recruited into the study. Patients were openly randomized to either a 7-d or a 10-d regimen of amoxicillin 1 g, clarithromycin 500 mg and rabeprazole 20 mg twice daily. The extent of symptom resolution was noted following the treatment, and at the end of one month after the completion of treatment, a repeat UBT was performed in each patient to document the eradication of the infection. All data (demographics, symptoms, and eradication rates) were collated and analyzed with SPSS version 18. RESULTS: Forty-seven patients completed the study (three were excluded from the analysis for breaching the study protocol). The patients included 18 males and 29 females within the age range of 13-80 years (mean 43.7, SD 16.8). The clinical features of the study subjects were dyspepsia, reflux symptoms and features of gastrointestinal bleeding. The average eradication rate was 87.2%. Eighteen subjects were enrolled in the 7-d arm, while 29 were in the 10-d arm. There was no statistically significant difference in the age or sex distributions of the two arms. There was no significant advantage of the 10-d treatment duration over the 7-d duration (P = 0.78), and the eradication outcomes were not influenced by the gender or age of the subjects. No adverse effects were reported in either arm. CONCLUSION: The triple therapy regime, employing a combination of amoxicillin, clarithromycin and rabeprazole, showed great efficacy and safety in the eradication of H. pylori, and this outcome was not influenced by gender or age. No difference was observed between the 7-d and 10-d regimens.