Clinical Implications of Low-grade Duodenal Eosinophilia in Functional Dyspepsia: A Prospective Real-life Study.

BACKGROUND: Functional dyspepsia (FD) is a multifactorial disorder with no targeted therapy. Duodenal eosinophilia and low-grade inflammation are potential pathogenic mechanisms. However, the impact of duodenal eosinophils (D-EO) histologic evaluation in real-life clinical practice was not explored. AIM: To evaluate the clinical utility of D-EO and low-grade inflammation in FD in real-life practice. MATERIALS AND METHODS: A multicenter prospective study was conducted. A total of 636 patients who meet Rome-III criteria were selected before upper endoscopy and 516 patients were included after normal endoscopy were assessed. Clinical parameters, Helicobacter pylori ( H. pylori), and duodenal histology were evaluated. RESULTS: FD subtypes were 231 (45%) patients who had epigastric pain syndrome (EPS), 168 (33%) postprandial distress syndrome (PDS), and 117 (22%) EPS/PDS overlap. Two hundred fifty-nine (50.3%) patients were H. pylori+ . Histologic duodenal grading of chronic inflammation and intraepithelial lymphocytes showed no difference between FD subtypes. Increased in D-EO densities (>10 per high power field) was significant in PDS compared with EPS and EPS/PDS overlap subtypes. The odds ratio of PDS in subjects with duodenal eosinophilia densities was 2.28 (95% CI, 1.66-3.14; P <0.0001), adjusting for age, gender, H. pylori and nonsteroidal anti-inflammatory drug the odds ratio was 3.6 (95% CI, 2.45-5.28; P <0.0001). receiver operating characteristic curve analysis further demonstrated that low-grade duodenal eosinophilia, in particular H. pylori- , was highly accurate for PDS with the area under the curve 0.731 compared with H. pylori+ area under the curve 0.598. Furthermore, low-grade duodenal eosinophilia was significantly correlated with treatment response under 4 to 6 weeks of proton pump inhibitor therapy. CONCLUSION: Our findings suggest that low-grade duodenal eosinophilia is associated with PDS subtype non- H. pylori FD patients and could be a useful marker of treatment response.

Low-grade duodenal eosinophilia is associated with cagA in Helicobacter pylori-related dyspepsia.

BACKGROUND AND AIM: Functional dyspepsia (FD) is a multifactorial disorder. Helicobacter pylori (H. pylori)-related dyspepsia (HpD) may be considered a separate entity. Duodenal eosinophilia is a potential pathogenic mechanism in FD. However, the impact of duodenal eosinophilia and H. pylori virulence genes in HpD was not explored. We aim to evaluate the association of H. pylori virulence genes and low-grade duodenal eosinophilia in HpD. METHODS: A multi-center cross-sectional study was conducted. A total of 301 patients who meet Rome-III criteria were selected before upper endoscopy, and 95 patients were included after normal endoscopy and positive H. pylori in gastric biopsies were assessed. Clinical parameters, H. pylori virulence genes (cagA, oipA, and vacA) and duodenal histology were evaluated. RESULTS: Sixty-nine (72%) patients had epigastric pain syndrome (EPS), 17 (18%) post-prandial distress syndrome (PDS) and 9 (10%) EPS/PDS overlap. FD syndromes were not associated with cagA or oipA strains. A significantly trend of vacA s1/m1 (78%) and s1/m2 (80%) positive strains in EPS was observed. Histological duodenal grading of chronic inflammation, low-grade duodenal eosinophilia and intra-epithelial lymphocytes showed no difference in oipA and vacA strains. Low-grade duodenal eosinophilia was significant in cagA positive strain, and the OR for low-grade duodenal eosinophilia with H. pylori cagA positive strain was 4.2 (95% CI, 1.78-9.93). Adjusting for age, gender, smoking, diabetes, alcohol, PPI, and NSAID, the OR was 5.44 (1.989-14.902). CONCLUSION: Our findings suggest that low-grade duodenal eosinophilia is significantly associated with cagA strain in HpD.

[Prevalence of human papillomavirus and associated risk factors in women affiliated with state health insurance in Posadas, Misiones (Argentina)]. / Prevalencia del virus papiloma humano y factores de riesgo asociados en mujeres afiliadas al seguro de salud estatal en Posadas, Misiones (Argentina).

BACKGROUND: Human papilloma virus (HPV) is one of the most frequent sexually transmitted infections, especially among young people. AIMS: To describe the prevalence of genital HPV infections, to identify clinical-epidemiological factors associated with them and to determine the frequency of viral strains. METHODS: Endocervical samples were studied of 505 women between 15 and 49 years old, who attended the laboratory of the Institute of Social Security, residents of Posadas, Misiones, for the study of vaginal exudate, between January 2012 and June 2013. A 450-base pair fragment within the HPV L1 region was amplified. Genotype detection was performed through the study of the restriction fragment length polymorphism (RFLP). RESULTS: The prevalence of total HPV carriage was 30.7%, and of these 71.6% corresponded to high risk (mainly HPV 16 [35.1%], 58 [10.8%] and 31 [8.1%]). HPV detection was higher in women aged 15 to 24 years (OR: 1.48, 95% CI: 1.01-2.18) and with more sexual partners (OR: 1.81, 95% CI: 1, 02-3.22). There was no association with pregnancy, stability of the couple, contraceptive methods, age at onset of sexual intercourse, or smoking. CONCLUSIONS: The identification and typing of HPV in this study provides information regarding the high prevalence of HPV and the substantial proportion of cases with oncogenic genotypes among sexually active women in this region of Argentina.

Prevalencia del virus papiloma humano y factores de riesgo asociados en mujeres afiliadas al seguro de salud estatal en Posadas, Misiones (Argentina) / Prevalence of human papillomavirus and associated risk factors in women affiliated with state health insurance in Posadas, Misiones (Argentina)

Resumen Introducción: El virus papiloma humano (VPH) causa infecciones transmitidas sexualmente. Objetivos: Conocer la prevalencia de infecciones genitales por VPH, identificar factores clínico-epidemiológicos asociados a dicha prevalencia y determinar la frecuencia de los tipos virales. Material y Métodos: Se estudiaron muestras endo-cervicales de 505 mujeres entre 15 y 49 años, que concurrieron para estudio de exudado vaginal al laboratorio del Instituto de Previsión Social, residentes de Posadas, Misiones, entre enero de 2012 y junio de 2013. Se amplificó una sección de 450 pares de bases del genoma viral perteneciente al fragmento L1 del VPH. La detección del genotipo se realizó mediante el estudio del polimorfismo de la longitud de los fragmentos de restricción (RFLP). Resultados: La prevalencia de la portación de VPH total fue 30,7%, y de éstos 71,6% correspondió a los de alto riesgo (principalmente VPH 16 [35,1%], 58 [10,8%] y 31 [8,1%]). La detección del VPH fue mayor en mujeres de 15 a 24 años (OR: 1,48; IC 95% :1,01-2,18) y con más parejas sexuales (OR:1,81; IC 95%: 1,02-3,22). No hubo asociación con el embarazo, la estabilidad de la pareja, métodos anticonceptivos, edad de inicio de las relaciones sexuales ni tabaquismo. Conclusiones: Los resultados de identificación y tipificación de VPH en este estudio aportan información sobre una prevalencia elevada de VPH en mujeres sexualmente activas, así como porcentajes elevados de genotipos oncogénicos en esta región.

Abstract Background: Human papilloma virus (HPV) is one of the most frequent sexually transmitted infections, especially among young people. Aims: To describe the prevalence of genital HPV infections, to identify clinical-epidemiological factors associated with them and to determine the frequency of viral strains. Methods: Endocervical samples were studied of 505 women between 15 and 49 years old, who attended the laboratory of the Institute of Social Security, residents of Posadas, Misiones, for the study of vaginal exudate, between January 2012 and June 2013. A 450-base pair fragment within the HPV L1 region was amplified. Genotype detection was performed through the study of the restriction fragment length polymorphism (RFLP). Results: The prevalence of total HPV carriage was 30.7%, and of these 71.6% corresponded to high risk (mainly HPV 16 [35.1%], 58 [10.8%] and 31 [8.1%]). HPV detection was higher in women aged 15 to 24 years (OR: 1.48, 95% CI: 1.01-2.18) and with more sexual partners (OR: 1.81, 95% CI: 1, 02-3.22). There was no association with pregnancy, stability of the couple, contraceptive methods, age at onset of sexual intercourse, or smoking. Conclusions: The identification and typing of HPV in this study provides information regarding the high prevalence of HPV and the substantial proportion of cases with oncogenic genotypes among sexually active women in this region of Argentina.

Prevalencia y análisis filogenético de Chlamydia trachomatis en una población de mujeres de Posadas, Misiones / Prevalence and phylogenetic analysis of Chlamydia trachomatis in a population of women in Posadas, Misiones

Introducción. Chlamydia trachomatis es una de las bacterias más prevalentes en infecciones sexualmente transmisibles. En mujeres, la infección por C. trachomatis puede causar cervicitis y uretritis, aunque suele cursar en forma asintomática. El objetivo de este trabajo fue establecer la prevalencia de C. trachomatis y detectar los genotipos circulantes en mujeres que concurren al laboratorio del Instituto de Previsión Social. Material y métodos. Se analizaron 505 muestras endocervicales de mujeres sintomáticas y asintomáticas. Se determinó la presencia de C. trachomatis por PCR, mediante la amplificación de un fragmento del plásmido críptico. Las muestras positivas fueron genotipificadas mediante la amplificación parcial del gen ompA y se analizaron filogenéticamente. Resultados. Se detectaron 43 muestras positivas a la infección por C. trachomatis, obteniéndose una prevalencia de 8,5% (IC 95%: 6,4-11,3%). La prevalencia de C. trachomatis fue superior en las mujeres con sintomatología vaginal [11,3% (30/265) vs. 5,4% (13/240)] (p=0,018), así como en las mujeres menores de 26 años [11,5% (28/244) vs. 6,1% (15/246)] (p=0,021). A partir del análisis filogenético, se observó que el 62% de las muestras positivas para el gen ompA pertenecieron al genotipo E, 15% al genotipo J, 15% al genotipo D y 8% al F. Conclusiones. Este trabajo es el primer aporte sobre la epidemiología molecular de C. trachomatis en la provincia de Misiones, Argentina, que muestra la tasa de prevalencia de esta bacteria y ofrece información de genotipos circulantes (AU)

Background. Chlamydia trachomatis is the most prevalent bacteria causing sexually transmitted infections. In women, this infection can cause cervicitis and urethritis, although it’s usually asymptomatic. The aim of this study was to investigate the prevalence of C. trachomatis in women attending the lab Instituto de Previsión Social and detect the genotypes. Material and methods. Endocervical samples from 505 symptomatic and asymptomatic women were assayed. It was determined the presence of C. trachomatis by PCR through amplification of a fragment of the cryptic plasmid. Positive samples were genotyped by the partial amplification of the ompA gene and analyzed phylogenetically. Results. Forty-three positive samples were detected to infection with C. trachomatis, obtaining a prevalence of 8.5% (IC 95%: 6.4-11.3%). The prevalence of C. trachomatis was higher in women with vaginal symptoms [11.3% (30/265) vs. 5.4% (13/240)] (p = 0.018), as well as in women under 26 year-old [11.5% (28/244) vs. 6.2% (15/246)] (p = 0.021). Based on phylogenetic analysis, it was observed that 62% of the samples were genotype E, 15% genotype J, 15% genotype D, and 8% genotype F. Conclusions. This work is the first contribution on the molecular epidemiology of C. trachomatis in the Misiones province, Argentina, which shows the rate of prevalence of this bacterium and offers information on circulating genotypes (AU)

[Carriage and characterization of Staphylococcus aureus in food handlers]. / Portación y caracterización de Staphylococcus aureus en manipuladores de alimentos.

Staphylococcus aureus causes food poisoning due to its ability to produce enterotoxins. Food handlers carrying enterotoxin-producing S. aureus can contaminate food, thus leading to food poisoning. Samples were obtained from 88 food handlers in the Province of Misiones, Argentina. S. aureus was isolated from nasal swaps and PCR amplification was performed for genes encoding staphylococcal enterotoxins. A total of 37.5 % food handlers were positive for S. aureus. Expression of enterotoxin genes was found in 13 of the 33 (39.4 %) S. aureus isolates studied, accounting for 14.7 % of food handlers. Gene sea was detected in 10 isolates followed by gene sec in 3 isolates. All isolates were susceptible to teicoplanin, gentamicin and rifampicin. Four isolates were resistant to methicillin whereas 2 isolates were resistant to clindamycin and erythromycin. These results constitute a critical alert and indicate the need for developing rational measures to reduce the potential risk of food poisoning.

Portación y caracterización de Staphylococcus aureus en manipuladores de alimentos / Carriage and characterization of Staphylococcus aureus in food handlers

Staphylococcus aureus es una causa de intoxicaciones alimentarias por su capacidad de producir enterotoxinas. Los manipuladores de alimentos que portan S. aureus productores de enterotoxinas pueden provocar intoxicaciones alimentarias. Se estudiaron muestras tomadas de fosas nasales de 88 manipuladores de alimentos en la provincia de Misiones. El 37,5 % de los individuos analizados eran portadores de S. aureus. Mediante técnicas de amplificación (PCR), se detectaron genes que codifican la producción de enterotoxinas en 13 de los 33 aislamientos obtenidos (39,4 %) y en el 14,7 % de los manipuladores. De estos aislamientos, 10 portaban el gen sea y 3 el gen sec. El estudio de sensibilidad a los antibióticos mostró un 100 % de sensibilidad a teicoplanina, gentamiclna y rifampicina; 2 aislamientos fueron resistentes a clindamicina y a eritromicina y 4 resultaron resistentes a la meticilina. Estos resultados son un alerta e indicarían la necesidad de desarrollar medidas racionales para reducir el riesgo potencial de intoxicaciones alimentarias.

Staphylococcus aureus causes food poisoning due to its ability to produce enterotoxins. Food handlers carrying enterotoxin-producing S. aureus can contaminate food, thus leading to food poisoning. Samples were obtained from 88 food handlers in the Province of Misiones, Argentina. S. aureus was isolated from nasal swaps and PCR amplification was performed for genes encoding staphylococcal enterotoxins. A total of 37.5 % food handlers were positive for S. aureus. Expression of enterotoxin genes was found in 13 of the 33 (39.4 %) S. aureus isolates studied, accounting for 14.7 % of food handlers. Gene sea was detected in 10 isolates followed by gene sec in 3 isolates. All isolates were susceptible to teicoplanin, gentamicin and rifampicin. Four isolates were resistant to methicillin whereas 2 isolates were resistant to clindamycin and erythromycin. These results constitute a critical alert and indicate the need for developing rational measures to reduce the potential risk of food poisoning.

Portación y caracterización de Staphylococcus aureus en manipuladores de alimentos / Carriage and characterization of Staphylococcus aureus in food handlers

Staphylococcus aureus es una causa de intoxicaciones alimentarias por su capacidad de producir enterotoxinas. Los manipuladores de alimentos que portan S. aureus productores de enterotoxinas pueden provocar intoxicaciones alimentarias. Se estudiaron muestras tomadas de fosas nasales de 88 manipuladores de alimentos en la provincia de Misiones. El 37,5 % de los individuos analizados eran portadores de S. aureus. Mediante técnicas de amplificación (PCR), se detectaron genes que codifican la producción de enterotoxinas en 13 de los 33 aislamientos obtenidos (39,4 %) y en el 14,7 % de los manipuladores. De estos aislamientos, 10 portaban el gen sea y 3 el gen sec. El estudio de sensibilidad a los antibióticos mostró un 100 % de sensibilidad a teicoplanina, gentamiclna y rifampicina; 2 aislamientos fueron resistentes a clindamicina y a eritromicina y 4 resultaron resistentes a la meticilina. Estos resultados son un alerta e indicarían la necesidad de desarrollar medidas racionales para reducir el riesgo potencial de intoxicaciones alimentarias.(AU)

Staphylococcus aureus causes food poisoning due to its ability to produce enterotoxins. Food handlers carrying enterotoxin-producing S. aureus can contaminate food, thus leading to food poisoning. Samples were obtained from 88 food handlers in the Province of Misiones, Argentina. S. aureus was isolated from nasal swaps and PCR amplification was performed for genes encoding staphylococcal enterotoxins. A total of 37.5 % food handlers were positive for S. aureus. Expression of enterotoxin genes was found in 13 of the 33 (39.4 %) S. aureus isolates studied, accounting for 14.7 % of food handlers. Gene sea was detected in 10 isolates followed by gene sec in 3 isolates. All isolates were susceptible to teicoplanin, gentamicin and rifampicin. Four isolates were resistant to methicillin whereas 2 isolates were resistant to clindamycin and erythromycin. These results constitute a critical alert and indicate the need for developing rational measures to reduce the potential risk of food poisoning.(AU)

Identificacion de enteropatogenos en la diarrea de la infancia en un estudio realizado en la ciudad de Posadas, Misiones / Identification of enteropathogens in the infantile diarrhea in one study realized in the City of Posadas, Misiones

El presente trabajo informa de los resultados de aislamientos de Enteropatogenos en ninos menores de cinco anos, sin tratamiento antibiotico previo, con menos de siete dias de evolucion de su diarrea, internados o ambulatorios del Hospital R. Madariaga, desde junio de 1986 hasta enero de 1987. Estudio que continua hasta la fecha. Del total de 252 casos estudiados, resultaron 65,5%de aislamientos positivos para Esteropatogenos aislados. De la evaluacion realizada surge que Shigella flexneri serotipo 2 ocupa el primer lugar con respecto a Shigella, siendo el serotipo 2 el que produce cuadros mas severos de enteritis, datos que concuerdan con el resto del pais. Del analisis de Escherichia coli EPI, se destaca la mayor frecuencia del serotipo 0111:B4, como en otras publicaciones del pais. Se destaca el primer aislamiento de Salmonella zaiman en humanos, nueva sero variedad a nivel mundial. Se destaca ademas el primer aislamiento en humanos en la Provincia de Misiones de 1) Campylobacter yeyuni, 2) Cepas enterotoxigenicas de Eschericha coli y 3) Aeromonas hidrophyla. Se apunta la necesidad de continuar con este estudio a fin de colaborar con una mejor vigilancia epidemiologica de las enteritis

Identificacion de enteropatogenos en la diarrea de la infancia en un estudio realizado en la ciudad de Posadas, Misiones / Identification of enteropathogens in the infantile diarrhea in one study realized in the City of Posadas, Misiones

El presente trabajo informa de los resultados de aislamientos de Enteropatogenos en ninos menores de cinco anos, sin tratamiento antibiotico previo, con menos de siete dias de evolucion de su diarrea, internados o ambulatorios del Hospital R. Madariaga, desde junio de 1986 hasta enero de 1987. Estudio que continua hasta la fecha. Del total de 252 casos estudiados, resultaron 65,5%de aislamientos positivos para Esteropatogenos aislados. De la evaluacion realizada surge que Shigella flexneri serotipo 2 ocupa el primer lugar con respecto a Shigella, siendo el serotipo 2 el que produce cuadros mas severos de enteritis, datos que concuerdan con el resto del pais. Del analisis de Escherichia coli EPI, se destaca la mayor frecuencia del serotipo 0111:B4, como en otras publicaciones del pais. Se destaca el primer aislamiento de Salmonella zaiman en humanos, nueva sero variedad a nivel mundial. Se destaca ademas el primer aislamiento en humanos en la Provincia de Misiones de 1) Campylobacter yeyuni, 2) Cepas enterotoxigenicas de Eschericha coli y 3) Aeromonas hidrophyla. Se apunta la necesidad de continuar con este estudio a fin de colaborar con una mejor vigilancia epidemiologica de las enteritis