Correlation between clarithromycin resistance, virulence factors and clinical characteristics of the disease in Helicobacter pylori infected patients in Shahrekord, Southwest Iran

The purpose of this study was to determine the mutations associated with clarithromycin resistance in Helicobacter pylori strains isolated from biopsy samples that were collected from the endoscopic ward of Shahrekord Hajar teaching Hospital and also to study the frequency of virulence factor and their correlation and pathological findings with clarithromycin resistance during the years 2019–2020. In this cross-sectional descriptive study, 152 patients with Helicobacter pylori infection were considered, and then, two common A2142G and A2143G mutations in the 23SrRNA gene associated with resistance were analyzed by Real-time PCR (Taq man). The presence of vacA, iceA1, iceA2, cagA, babA2, and oipA virulence genes was investigated by PCR and electrophoresis in 8% polyacrylamide gel. Then, data were analyzed using the relevant statistical tests. In this study, the frequency of Helicobacter pylori was 76% and the frequency of mutant isolates was 57.2%. The frequencies of A2142G and A2143G point mutations were 42.1% and 28.3%. There was a significant correlation among oipA, vacA, and iceA1 virulence factors, type of disease, chronic inflammatory score, and glandular atrophy with the antibiotic resistance to clarithromycin. There was no significant correlation between the age and sex of the patients with antibiotic resistance. According to the results of this study, it seems that the use of clarithromycin to combat this bacterium should be limited.

Rate of Submandibular Gland Atrophy Secondary to Chronic Sialolithiasis

The rate of salivary gland atrophy secondary to chronic obstructive sialolithiasis has not been well-documented. The combination of 5 imaging studies over 12 years in a patient with repeat imaging for an unrelated pathology provides a unique opportunity to assess glandular atrophy over time. We hope that this case will support previous literature with an in vivo representation of the rate of glandular atrophy.

Correlation Between Clarithromycin Resistance, Virulence Factors and Clinical Characteristics of the Disease in Helicobacter pylori Infected Patients in Shahrekord, Southwest Iran”

Background: The purpose of this study was to determine the mutations associatedwith clarithromycin resistance in Helicobacter pylori isolates isolated from biopsy samples that were collected from the endoscopic ward of Shahrekord Hajar teaching Hospital and also to study the frequency of virulence factor and their correlation and pathological findings with clarithromycin resistance during the years 2019-2020. In this cross-sectional descriptive study, 152 patients with Helicobacter pylori infection were considered, and then, two common A2142G and A2143G mutations in the 23SrRNA gene associated with resistance were analyzed by Real-time PCR (Taq man). The presence of vacA, iceA1, iceA2,cagA,babA2, and oipA virulence genes was investigated by PCR and 8% polyacrylamide gel. Then, data were analyzed using the relevant statistical tests.Results: In this study, the frequency of Helicobacter pylori was 76% and the frequency of mutant isolates was 57.2%. The frequencies of A2142G and A2143G point mutations were 42.1% and 28.3%. There was a significant correlation among oipA, vacA, and iceA1 virulence factors, type of disease, chronic inflammatory score, and glandular atrophy with the antibiotic resistance to clarithromycin. There was no significant correlation between the age and sex of the patients with antibiotic resistance.Conclusions: According to the results of this study, It seems that the use of clarithromycin to combat this bacterium should be limited.

Clotrimazole reduces endometriosis and the estrogen concentration by downregulating aromatase

This study aimed to analyse the effects of clotrimazole (CTZ) on estrogen production pathway in endometriosis progression. Experimental endometriosis was induced by autologous transplantation in female Wistar rats, and then the rats were treated with clotrimazole (200 mg/kg) or vehicle, both orally and intraperitoneally, for 15 consecutive days. Serum estrogen levels and vaginal smear analyses were performed and ERα (estrogen receptor alpha) and CYP19 (cytochrome P450 aromatase) levels in the endometriotic lesions were analysed morphologically and immunohistochemically. The clotrimazole group presented a reduction in serum estrogen levels, which were not influenced by the estrous cycle of the animals. The expression of ERα and CYP19 in endometriotic lesions was also reduced in the clotrimazole group compared to the control group. Moreover, clotrimazole treatment decreased the size of the lesions, as confirmed by histological examination, which showed glandular atrophy for both routes of administration. These results suggest that clotrimazole interferes with the estrogen production pathway by downregulating CYP19 and, therefore, reducing serum estrogen levels. Thus, the drug decreases endometriotic lesion size and consequently disease progression.

Incidence of Helicobacter Pylori Infections in a group of patients in Erbil City, Kurdistan Region, Iraq and Its Association with Gastritis and Adenocarcinoma

Background: Adenocarcinoma is one of the most common causes of Gastric cancer related deaths worldwide. Helicobacter pylori is the causative agent of most cases of gastritis, it can cause chronic active gastritis and known as a risk factor for the development of gastric cancer. This study aimed to assess the prevalence of H. pylori among patients with symptoms of dyspepsia and other gastritis related symptoms and its association with adenocarcinoma.Methods: This study was carried out during the period of January 2018 to October 2019 with a total of 227 patients with gastritis related symptoms. The presence of H. pylori was detected by Rapid Urease Test (RUT) and histo-pathological tests using biopsy specimens. Statistical Analysis was done by using Chi-square test. P < 0.05 was considered to be statistically significant.Results: From the total of 227 patients with gastritis related symptoms, 26 cases (13.61%) were diagnosed with adenocarcinoma. Their ages were between 13 and 90 years with mean of 47.81± 18.23. The result showed that low severity prevalence of H. pylori was highest (111 cases) compared to 17 and 63 cases for high and moderate severity, respectively. Comparison between positive low, moderate, and high H. pylori cases for rapid urease test was highly significant (P<0.000). The results showed no association between H. pylori severity across various age groups and gender. Moreover, goodness of fit test for metaplasia, activity, glandular atrophy, and endoscopic finding across severity status of H. pylori showed highly significant. Four composite categorized groups were initiated based on positive/negative prevalance of H. pylori and adenocarcinoma status. Results revealed statistical significance between combination of H. pylori and adenocarcinoma with inflammation, lymphoid aggregate, metaplasia, activity of neutrophils, glandular atrophy, rapid urease test, and endoscopic findings.Conclusion: Histopathology tests are reliable diagnostic tools for the detection of H. pylori. Data showed that H. pylori was seen more in middle age patients with mucosal lymphoid follicle formation and more than one third of patients with adenocarcinoma. Therefore, screening of these infections is an important strategy for preventing gastric adenocarcinoma.

EVALUATION OF THE ENDOMETRIAL CHANGES IN FEMALES DIAGNOSED WITH THE UTERINE LEIOMYOMAS

The female genital tract includes the uterine corpus and cervix. The uterus consists of the endometrium and myometrium which are continuously stimulated by hormones, denuded monthly of its endometrial mucosa and inhabited periodically by foetuses. Together with the lesions that affect the cervix, the lesions of the corpus of the uterus and the endometrium account for most patient visits to gynaecologists. Many treatment options are available nowadays including medical and conservative surgical procedures. Hence based on above findings the present study was planned for Evaluation of the Endometrial Changes in Females Diagnosed with the Uterine Leiomyomas. The present study was planned in Department of Obstetrics and Gynaecology, Madhubani Medical College and Hospital, Madhubani, Bihar. In the present study 50 cases of the females diagnosed with the uterine leiomyomas were enrolled. Gross examination was performed with respect to size and weight of uterus, location of fibroids and endometrial polyp if any was noted. Tissue bits from the fundic endometrium, tissue from both sides of endometrial canal & endometrium subjacent to sub mucosal leiomyoma were taken for histopathological examination, processed and sections of 5 micron thickness stained with haematoxylin and eosin.The data generated from the present study concludes that Different patterns are seen in the endometrium of leiomyomatous uteri as a result of mechanical or hormonal factors such as dilated/ distorted glands, glands parallel to long axis of myometrium, glands separated by muscle fibres, focal total or subtotal glandular atrophy and polyposis which are statistically significant in identifying uterine leiomyoma. Further, total and subtotal endometrial glandular atrophy showed significant association with submucosal leiomyoma. Keywords: Leiomyoma, Endometrium, Menorrhagia, etc.

Arteriovenous vascular malformation of the submandibular gland masquerading as Küttner’s tumour

Chronic sclerosing sialadenitis, also known as Küttner’s tumour, is a chronic inflammatory condition affecting the salivary glands. We present the case of an arteriovenous vascular malformation (AVM) of the right submandibular gland mimicking a Küttner’s tumour on ultrasound scan in a 63-year-old woman. Examination revealed a 2 cm firm, mobile, non-pulsatile, right-sided submandibular mass with no overlying skin changes but with mild tenderness to palpation. Histological appearances revealed an AVM associated with localised fatty metaplasia and glandular atrophy. Although rare, AVMs should be considered a differential diagnosis for a submandibular gland mass that gives unclear or unusual radiological appearances.

Histopathology and selective biomarker expression in human meibomian glands

Background/aimsMeibomian gland dysfunction (MGD) is the most common form of evaporative dry eye disease, but its pathogenesis is poorly understood. This study examined the histopathological features of meibomian gland (MG) tissue from cadaver donors to identify potential pathogenic processes that underlie MGD in humans.MethodsHistological analyses was performed on the MGs in the tarsal plates dissected from four cadaver donors, two young and two old adults, including a 36-year-old female (36F) and three males aged 30, 63 and 64 years (30M, 63M and 64M).ResultsThe MGs of 36F displayed normal anatomy and structure, whereas the MGs of 30M showed severe ductal obstruction with mild distortion. The obstruction was caused by increased cytokeratin levels in association with hyperproliferation, but not hyperkeratinisation. In two older males, moderate to severe MG atrophy was noted. Cell proliferation was significantly reduced in the MG acini of the two older donors as measured by Ki67 labelling index (6.0%±3.4% and 7.9%±2.8% in 63M and 64M, respectively) when compared with that of the two younger donors (23.2%±5.5% and 16.9%±4.8% in 30M and 36F, respectively) (p<0.001). The expression patterns of meibocyte differentiation biomarkers were similar in the older and younger donors.ConclusionOur histopathological study, based on a small sample size, suggests potentially distinct pathogenic mechanisms in MGD. In the young male adult, hyperproliferation and aberrant differentiation of the central ductal epithelia may lead to the obstruction by overproduced cytokeratins. In contrast, in older adults, decreased cell proliferation in acinar basal epithelia could be a contributing factor leading to MG glandular atrophy.

HELICOBACTER PYLORI INFECTION AND GASTRIC CANCER PRECURSOR LESIONS: PREVALENCE AND ASSOCIATED FACTORS IN A REFERENCE LABORATORY IN SOUTHEASTERN BRAZIL

ABSTRACT BACKGROUND: Helicobacter pylori infection is the most important risk factor for gastric atrophy and intestinal metaplasia, both considered gastric cancer precursor lesions. Therefore, the investigation of the occurrence of H. pylori infection, precursor lesions and associated factors guides the adoption of specific strategies for the control this type of cancer. OBJECTIVE: To evaluate the prevalence of H. pylori infection in patients undergoing upper digestive endoscopy, as well as the prevalence of intestinal metaplasia, atrophy and chronic inflammation and their association with H. pylori infection. METHODS: A retrospective study was performed based on reports of gastric endoscopic biopsies performed in a private laboratory affiliated to the Brazilian Public Health System (SUS). Patients were evaluated for age, gender and type of health service. The samples were evaluated for the presence of H. pylori, and also of chronic inflammation, intestinal metaplasia and glandular atrophy. RESULTS: Of a total of 4,604 patients (mean age 51±16.6), 63.9% were female and 63.1% coming from private health care service. The prevalence of H. pylori infection was 31.7% (n=1,459), and the percentage of infection was significantly higher in patients from public health service (42.0%) in relation to patients from private health service (25.6%). Among H. pylori (+) patients, a higher percentage of intestinal metaplasia (17.7% vs 13.3%) and glandular atrophy (17.6% vs 6.9%) were observed when compared to those H. pylori (-) (P<0.01). From the patients H. pylori (+) with at least one type of precursor lesion (n=418), 161 (38.5%) had metaplasia and chronic inflammation, 160 (38.3%) had atrophy and chronic inflammation and finally 97 (23.2%) presented metaplasia, atrophy and chronic inflammation simultaneously. CONCLUSION: The present study reinforces the association of H. pylori infection with gastric cancer precursor lesions in a Brazilian population, emphasizing the importance of infection prevention measures, as well as the treatment of infected patients, especially in regions with lower socioeconomic levels that show a higher prevalence of infection by H. pylori.

Complications of polyacrylamide gel filler in the Asian-Australian population

Polyacrylamide gel (PAAG), known as Aquamid® (Contura Limited, London, United Kingdom, EC4A 1LB) in Australia, is a hydrophilic, non-toxic substance introduced in the 1970s as a soft tissue filler. Banned in the late 1990s due to concerns regarding side effects such as breast cancer and glandular atrophy, there is currently no published data regarding PAAG fillers in the Australian literature. Given the increasing population of Chinese immigrants to Australia, complications will likely be seen more frequently within our healthcare system in the coming decades. This case series highlights two case in Australia with discussion of symptoms, signs and best-practice management.