Genetic characterisation of Helicobacter pylori isolates from an Argentinean adult population based on cag pathogenicity island right-end motifs, lspA-glmM polymorphism and iceA and vacA genotypes.

Isolates of Helicobacter pylori from 88 patients were characterised by cagA status, cagA pathogenicity island (PAI) right-end motifs, iceA, vacA and lspA-glmM genotypes, primarily by PCR-based analysis, to investigate whether Argentinean isolates differed from those recovered in southern Europe or other Latin American countries. PCR-based analysis of vacA alleles was confirmed by reverse hybridisation in 56 cases, while sequence analysis was performed either when iceA and vacA genotypes could not be determined by PCR, or to investigate PCR and reverse hybridisation vacA genotyping discordance. Typing by lspA-glmM restriction fragment length polymorphism was performed with HhaI and AluI. The pattern of cag PAI right-end motifs and the prevalence of type Ia were similar to those in isolates from southern European countries, with cagA(+)/iceA1/vacA-s1 m1 being the commonest genotype. Reverse hybridisation identified a vacA-s1a/s1b recombinant allele, confirmed by sequencing analysis. Analysis of lspA-glmM genotypes identified at least 73 unrelated strains. Few mixed infections were identified, but in one case, isolates from a single biopsy exhibiting two vacA alleles were shown by lspA-glmM fingerprints to be two unrelated strains. No associated effect on ulcer disease risk was demonstrated by analysis of cagA, vacA and iceA status. Overall, the isolates of H. pylori from Argentina were similar to isolates from southern Europe or Latin American countries, and infections were associated mainly with single H. pylori strains.

[Validation of a rapid urease test for the diagnosis of Helicobacter pylori infection]. / Validación de un test de ureasa rápido para el diagnóstico de la infección por H. pylori.

OBJECTIVE: Several non-commercial rapid urease tests have been designed with the objective of reducing the cost of Helicobacter Pylori infection diagnosis. The objective of the present prospective trial is to assess one of these tests, using the histologic evaluation for the presence of Helicobacter Pylori, as the standard reference of diagnosing this infection. METHODS: Patients undergoing upper endoscopy for various reasons were prospectively enrolled. Three endoscopic biopsies of the antrum and three from the corpus of the stomach were taken in every patient enrolled. The specimens were evaluated by the rapid urease test on an individual basis, comparing the results with the histology assessment of the Helicobacter Pylori status, which was considered as the standard reference for the diagnosis of the infection. RESULTS: One hundred and four patients were enrolled, of which 94 were eligible. Fifty-five patients (60.43%) were infected with Helicobacter Pylori. The sensibility and specificity of the urease test evaluated at 4 hours was 65.45% and 100% respectively. The evaluation at 24 hours of the sensibility and specificity was 83% and 94% respectively. CONCLUSIONS: The non-commercial rapid urease test is a practical, fast, and cost effective method for the detection of Helicobacter Pylori infection, and its diagnostic utility is similar to the commercial test available.

Validación de un test de ureasa rápido para el diagnóstico de la infección por H. Pylori / Validation of a rapid urease test for the diagnosis of helicobacter pylori infection

OBJECTIVE: Several non-commercial rapid urease tests have been designed with the objective of reducing the cost of Helicobacter Pylori infection diagnosis. The objective of the present prospective trial is to assess one of these tests, using the histologic evaluation for the presence of Helicobacter Pylori, as the standard reference of diagnosing this infection. METHODS: Patients undergoing upper endoscopy for various reasons were prospectively enrolled. Three endoscopic biopsies of the antrum and three from the corpus of the stomach were taken in every patient enrolled. The specimens were evaluated by the rapid urease test on an individual basis, comparing the results with the histology assessment of the Helicobacter Pylori status, which was considered as the standard reference for the diagnosis of the infection. RESULTS: One hundred and four patients were enrolled, of which 94 were eligible. Fifty-five patients (60.43%) were infected with Helicobacter Pylori. The sensibility and specificity of the urease test evaluated at 4 hours was 65.45% and 100% respectively. The evaluation at 24 hours of the sensibility and specificity was 83% and 94% respectively. CONCLUSIONS: The non-commercial rapid urease test is a practical, fast, and cost effective method for the detection of Helicobacter Pylori infection, and its diagnostic utility is similar to the commercial test available

Validación de un test de ureasa rápido para el diagnóstico de la infección por H. Pylori / Validation of a rapid urease test for the diagnosis of helicobacter pylori infection

OBJECTIVE: Several non-commercial rapid urease tests have been designed with the objective of reducing the cost of Helicobacter Pylori infection diagnosis. The objective of the present prospective trial is to assess one of these tests, using the histologic evaluation for the presence of Helicobacter Pylori, as the standard reference of diagnosing this infection. METHODS: Patients undergoing upper endoscopy for various reasons were prospectively enrolled. Three endoscopic biopsies of the antrum and three from the corpus of the stomach were taken in every patient enrolled. The specimens were evaluated by the rapid urease test on an individual basis, comparing the results with the histology assessment of the Helicobacter Pylori status, which was considered as the standard reference for the diagnosis of the infection. RESULTS: One hundred and four patients were enrolled, of which 94 were eligible. Fifty-five patients (60.43%) were infected with Helicobacter Pylori. The sensibility and specificity of the urease test evaluated at 4 hours was 65.45% and 100% respectively. The evaluation at 24 hours of the sensibility and specificity was 83% and 94% respectively. CONCLUSIONS: The non-commercial rapid urease test is a practical, fast, and cost effective method for the detection of Helicobacter Pylori infection, and its diagnostic utility is similar to the commercial test available (AU)

Validación de un test de ureasa rápido para el diagnóstico de la infección por H. pylori. / [Validation of a rapid urease test for the diagnosis of Helicobacter pylori infection]

OBJECTIVE: Several non-commercial rapid urease tests have been designed with the objective of reducing the cost of Helicobacter Pylori infection diagnosis. The objective of the present prospective trial is to assess one of these tests, using the histologic evaluation for the presence of Helicobacter Pylori, as the standard reference of diagnosing this infection. METHODS: Patients undergoing upper endoscopy for various reasons were prospectively enrolled. Three endoscopic biopsies of the antrum and three from the corpus of the stomach were taken in every patient enrolled. The specimens were evaluated by the rapid urease test on an individual basis, comparing the results with the histology assessment of the Helicobacter Pylori status, which was considered as the standard reference for the diagnosis of the infection. RESULTS: One hundred and four patients were enrolled, of which 94 were eligible. Fifty-five patients (60.43

) were infected with Helicobacter Pylori. The sensibility and specificity of the urease test evaluated at 4 hours was 65.45

and 100

respectively. The evaluation at 24 hours of the sensibility and specificity was 83

and 94

respectively. CONCLUSIONS: The non-commercial rapid urease test is a practical, fast, and cost effective method for the detection of Helicobacter Pylori infection, and its diagnostic utility is similar to the commercial test available.

[Diagnosis and treatment of Helicobacter pylori infection. Its relationship with gastrointestinal ulcer and antimicrobial resistance]. / Diagnóstico y tratamiento de la infección por Helicobacter pylori. Su relación con la úlcera gastrointestinal y la resistencia a los antimicrobianos.

Reliable data regarding the efficacy of different schemes of triple therapy for the eradication of Helicobacter pylori in our country, are not available. Patients with Helicobacter pylori infection and non-ulcer dyspepsia or active peptic ulcer disease were randomized in three different groups for therapy with, omeprazole 20 mg, clarithromycin 500 mg and amoxicillin 1000 mg, twice daily for one week (OCA 1, 40 patients) and the same treatment but for two weeks in a second group (OCA 2, 40 patients). The third group received omeprazole 20 mg, clarithromycin 500 mg and metronidazole 500 mg twice daily during one week (OCM, 40 patients). The primary efficacy end point was the eradication of Helicobacter pylori as confirmed by negative urea breath test, 4 weeks after the completion of treatment. Of 120 patients enrolled in the study, 113 met the entry criteria. Of them, 103 completed the treatment. When analyzed by intention to treat, after 4 weeks of finishing the treatment, Helicobacter pylori was eradicated in 92.3% of patients in OCA 1, 89.7% in OCA 2, and 82.8% in OCM. There was no significant difference between the three groups, regarding the eradication efficacy. Side effects were observed more frequently in OCA 2 and OCM groups. Primary resistance to amoxicillin and clarithromycin was not demonstrated, while 20% of cultured strains were resistant to metronidazole. In patients with peptic ulcer disease or non-ulcer dysplasia, triple therapy with omeprazole and two antibiotics is highly effective in the eradication of Helicobacter pylori. One week of OCA therapy is as effective as two weeks of OCA or one week of OCM, with less side effects.

Helicobacter pylori vacA genotypes, cagA status and ureA-B polymorphism in isolates recovered from an Argentine population.

Several reports have evidenced geographic differences in the prevalence of vacA (vacuolating cytotoxin gene) alleles and cagA (cytotoxin-associated gene) status among Helicobacter pylori isolates. We investigated the occurrence of these virulence-associated genes status among our isolates, and their relationship with ulcer disease outcome. Besides, ureA-B polymorphism was studied. One hundred isolates, comprising 32 from patients with ulcer disease (UD) and 68 from patients with non-ulcer dyspepsia (NUD), were analyzed. Eighty-four percent of isolates were cagA-positive without statistically significant difference in prevalence between patients with UD or NUD. Genotype vacA-s1m1 was predominant, although unlike other South American regions, subtype s1am1 occurrence was higher than s1b. The multivariate model used to estimate the predictive value of cagA and vacA status for UD development disclosed infection with vacA-s1am1 isolates as the only variable that increased the risk of UD onset. ureAB fingerprinting showed considerable genetic divergence among isolates, however, confirmed that certain DNA banding profiles are conserved worldwide.

Diagnóstico y tratamiento de la infección por Helicobacter pylori. Su relación con la úlcera gastrointestinal y la resistencia a los antimicrobianos. / [Diagnosis and treatment of Helicobacter pylori infection. Its relationship with gastrointestinal ulcer and antimicrobial resistance]

Reliable data regarding the efficacy of different schemes of triple therapy for the eradication of Helicobacter pylori in our country, are not available. Patients with Helicobacter pylori infection and non-ulcer dyspepsia or active peptic ulcer disease were randomized in three different groups for therapy with, omeprazole 20 mg, clarithromycin 500 mg and amoxicillin 1000 mg, twice daily for one week (OCA 1, 40 patients) and the same treatment but for two weeks in a second group (OCA 2, 40 patients). The third group received omeprazole 20 mg, clarithromycin 500 mg and metronidazole 500 mg twice daily during one week (OCM, 40 patients). The primary efficacy end point was the eradication of Helicobacter pylori as confirmed by negative urea breath test, 4 weeks after the completion of treatment. Of 120 patients enrolled in the study, 113 met the entry criteria. Of them, 103 completed the treatment. When analyzed by intention to treat, after 4 weeks of finishing the treatment, Helicobacter pylori was eradicated in 92.3

of patients in OCA 1, 89.7

in OCA 2, and 82.8

in OCM. There was no significant difference between the three groups, regarding the eradication efficacy. Side effects were observed more frequently in OCA 2 and OCM groups. Primary resistance to amoxicillin and clarithromycin was not demonstrated, while 20

of cultured strains were resistant to metronidazole. In patients with peptic ulcer disease or non-ulcer dysplasia, triple therapy with omeprazole and two antibiotics is highly effective in the eradication of Helicobacter pylori. One week of OCA therapy is as effective as two weeks of OCA or one week of OCM, with less side effects.

Hiperparatiroidismo oculto en una paciente con osteomalacia / Primary hyperparathyroidism masked by osteomalacia

Se describe el caso de una paciente de 56 años que consultó por dolores óseos, hallándose en el estudio radiológico múltiples pseudo-fracturas de Milkman, lesiones de resorción subperióstica y quistes en manos y pies. Los datos clínicos y de laboratorio sugirieron el diagnóstico de osteomalacia con hiperparatiroidsmo secundario, causada por una enfermedad celíaca. Sin embargo, cuando la enfermedad primaria fue corregida con dieta libre de gluten, la administración oral de calcio y vitamina D, la paciente desarrolló hipercalcemia manteniéndose elevados los niveles séricos de hormona paratiroidea. La paciente fue explorada quirúrgicamente extirpándose un adenoma paratiroideo. Se estableció así que esta paciente tenía un hiperparatiroidismo primario cuyas manifestaciones humorales estaban en mascaradas por el déficit de vitamina D. La revisión de la literatura mostró otros 12 casos similares y 11 pacientes que tenían hiperparatiroidismo primario manifesto en el momento del diagnóstico. Se sugiere que existe una relación causal entre el desarrollo del hiperparatiroidismo primario y el déficit de calcio provocado por la malabsorción intestinal

Hiperparatiroidismo oculto en una paciente con osteomalacia / Primary hyperparathyroidism masked by osteomalacia

Se describe el caso de una paciente de 56 años que consultó por dolores óseos, hallándose en el estudio radiológico múltiples pseudo-fracturas de Milkman, lesiones de resorción subperióstica y quistes en manos y pies. Los datos clínicos y de laboratorio sugirieron el diagnóstico de osteomalacia con hiperparatiroidsmo secundario, causada por una enfermedad celíaca. Sin embargo, cuando la enfermedad primaria fue corregida con dieta libre de gluten, la administración oral de calcio y vitamina D, la paciente desarrolló hipercalcemia manteniéndose elevados los niveles séricos de hormona paratiroidea. La paciente fue explorada quirúrgicamente extirpándose un adenoma paratiroideo. Se estableció así que esta paciente tenía un hiperparatiroidismo primario cuyas manifestaciones humorales estaban en mascaradas por el déficit de vitamina D. La revisión de la literatura mostró otros 12 casos similares y 11 pacientes que tenían hiperparatiroidismo primario manifesto en el momento del diagnóstico. Se sugiere que existe una relación causal entre el desarrollo del hiperparatiroidismo primario y el déficit de calcio provocado por la malabsorción intestinal (AU)

Intestino delgado, psoriasis y metotrexato, informe preliminar. / Small intestine, psoriasis and methotrexate prelimary report

Se investigo la posible asociacion o concomitancia de alteraciones funcionales o estructurales en el intestino delgado de pacientes de psoriasis tratados con metotrexato durante un tiempo prolongado. Para ello se efectuaron los siguientes estudios: analisis de rutina, proteinograma, tiempo de quick, curva de tolerancia a la glucosa, inmunoelectroforesis, test de latex, parasitologico de materia fecal, estudio cuantitativo de grasa en materia fecal, biopsia de piel, biopsia de yeyuno y orina completo. Los resultados obtenidos en el pequeno grupo de pacientes estudiados no demostraron alteraciones

Intestino delgado, psoriasis y metotrexato, informe preliminar. / Small intestine, psoriasis and methotrexate prelimary report

Se investigo la posible asociacion o concomitancia de alteraciones funcionales o estructurales en el intestino delgado de pacientes de psoriasis tratados con metotrexato durante un tiempo prolongado. Para ello se efectuaron los siguientes estudios: analisis de rutina, proteinograma, tiempo de quick, curva de tolerancia a la glucosa, inmunoelectroforesis, test de latex, parasitologico de materia fecal, estudio cuantitativo de grasa en materia fecal, biopsia de piel, biopsia de yeyuno y orina completo. Los resultados obtenidos en el pequeno grupo de pacientes estudiados no demostraron alteraciones