Urease Test Research Articles

Association of Helicobacter Pylori in Carcinoma Stomach at Maharaja Krishna Chandra Gajapat Medical College: A Prospective Study.

Introduction Gastric cancer is the fourth most common type of cancer and the second leading cause of cancer-related death in the world. The etiology of gastric cancer includes Helicobacter pylori infection, diet, lifestyle, tobacco, alcohol, and genetic susceptibility. Upper gastrointestinal endoscopy (UGIE) is the most effective method for examining the upper gastrointestinal tract as compared to the other examination tools. Objective To study the histopathological finding of upper gastrointestinal endoscopic biopsies and its association with H. pylori in cases of carcinoma stomach. Materials and methods This was a hospital-based observational study carried out in the Department of Surgery, at Maharaja Krushna Chandra Gajapati Medical College, Berhampur, a tertiary care hospital in Eastern India. Study population consisted of 106 patients for a period of 2 years from July 2019 to June 2021, after due consideration of the inclusion and exclusion criteria. Endoscopic location and pathological types of the gastric lesion were noted, and all biopsy specimens were investigated to see the presence of H. pylori by rapid urease test (RUT) and histological examination in the form of Giemsa and H&E stain. Results In the present study of 106 cases, 62 cases (58.49%) were found to be positive for H. Pylori by RUT and 72 cases (67.92%) were positive for H. pylori by smear staining. In histopathological study, 72 cases (67.92%) were of intestinal type of carcinoma and 34 cases (32.07%) were of diffuse type of carcinoma. Smear for H . pylori was positive in 56 cases (77.78%) among the 72 cases of intestinal type of carcinoma stomach. Whereas only 16 cases (47.05%) were found to be smear-positive for H. pylori among the 34 cases of diffuse type of lesion. Irrespective of histological type, H. pylori was positive in 67.92% of patients with carcinoma stomach. This association was statistically significant (p<0.001) and indicates its role in intestinal type of gastric carcinoma. Conclusion There is a high frequency of H. pylori infection in cases of stomach cancer. This study confirmed the higher association of H. pylori infection with gastric cancer. Its association with the intestinal histological variety of stomach cancer is more common than diffuse type. The prevalence of H. pylori infection in distal stomach carcinoma is higher than proximal.

The high sensitivity and specificity of rapid urease test in diagnosis of Helicobacter pylori infection in Moroccan children.

Infesting nearly 50% of the world's population, Helicobacter pylori are thought to cause peptic ulcers, as well as gastric adenocarcinoma. Several diagnostic methods are available to detect this bacterium; however, at least two must be used together for an accurate diagnosis. This study evaluated the use of rapid urease test for diagnosis of H. pylori infection in a pediatric population. Five gastric biopsies were taken from children during a 2-year period for the purpose of histological, molecular, bacteriological culture, and rapid urease testing. Among 83 children, 38 were male, and 45 were female with an age ranging of 2 to 15 years. The infected group represented 31%. The rapid urease test had a sensitivity of 88.5%, a negative predictive value of 94%, a specificity of 84.2%, and a positive predictive value of 72%. A rapid urease test may be appropriate for ruling out H. pylori infection after a negative result. The positive results however, may be confirmed by a second invasive test.

Detection of Contamination Salmonella sp. of Beef in Banyuwangi Traditional Market

Salmonella sp. is one of the bacteria from Food-Borne Disease agents, can contaminate meat and cause salmonellosis. According to National Indonesian Standard 2009, meat is safe for consumption if it has a negative result of salmonella in 25 grams of meat. The purpose of this study was to determine whether there was contamination of Salmonella sp. on beef sold in the traditional market of Banyuwangi District. A total of 18 samples used in this study were taken according to the criteria for isolation and identification. All samples were enriched with the pre-enrichment stage using Lactose Broth media, and the enrichment medium using Tetrathionate Broth. Furthermore, in the isolation stage using Salmonella Shigella Agar (SSA) media. Then proceed with the identification stage using the Triple Sugar Iron Agar (TSIA) test, the Sulfide Indole Motility (SIM) test, and the Urease test. The results showed that 5 out of 18 samples tested positive for Salmonella.

Efficacy of Helicobacter pylori Eradication Based on Rabeprazole–Bismuth–Tetracycline–Tinidazole Regimen in Vietnamese Patients with Duodenal Ulcers

(1) Background: In Vietnam, H. pylori bacteria has a resistance rate of 63% to the antibiotic clarithromycin. The initial therapy of H. pylori eradication with a standard three-drug regimen has low efficacy. Objective: Assess the efficacy of H. pylori eradication therapy which uses a four-drug regimen of rabeprazole–bismuth–tetracycline–tinidazole in patients with duodenal ulcers. (2) Methods: We performed gastrointestinal endoscopy on patients with a diagnosis of duodenal ulcers, gastric mucosa biopsy for a rapid urease test, and histopathology to diagnose H. pylori bacteria before and after treatment. Treatment for eradication of H. pylori bacteria using a rabeprazole–bismuth–tetracycline–tinidazole regimen was prescribed for 14 days. (3) Results: The rate of successful H. pylori eradication treatment according to per protocol (PP) and intention to treat (ITT) was 91.3% (95%CI: 84.8–96.7) and 82.4% (95%CI: 74.5–89.2) respectively. The success rate of H. pylori eradication therapy in males was 96.0% (95%CI: 92–100), higher than in females, which was 70.6% (95%CI: 47.1–88.2), p &lt; 0.01. (4) Conclusions: Treatment of H. pylori with rabeprazole–bismuth–tetracycline–tinidazole regimen is highly effective. Men had higher H. pylori eradication results than women.

PH Sensor-Embedded Magnetically Driven Capsule for H. pylori Infection Diagnosis

The Campylobacter-like organism (CLO) test is the most commonly employed test for diagnosing <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Helicobacter pylori</i> ( <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">H. pylori</i> ) infection in the stomach. Since the CLO test is an invasive method, minimally invasive methods have been proposed. However, the proposed methods exhibit relatively low specificity and sensitivity. In this letter, a novel <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">H. pylori</i> infection diagnosis method that uses a pH sensor-embedded magnetically driven capsule is proposed. The proposed method adopts the principle of the CLO test to diagnose <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">H. pylori</i> infection minimally invasively. The capsule comprises two chambers to sample gastric juice, and a pH sensor is embedded inside each chamber. Therefore, <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">H. pylori</i> infection can be diagnosed using the urea hydrolysis property of <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">H. pylori</i> and a pH sensor embedded in the chambers of the capsule. In addition, the capsule can be magnetically actuated using an external magnetic field owing to its neodymium-magnet. The performance of the proposed capsule was evaluated in several aspects. First, the sensing ability of the fabricated pH sensor was verified using a pH buffer solution. Second, the magnetic actuation capacity of the capsule was evaluated using a 6-coil electromagnetic actuation (EMA) system. Third, the gastric juice sampling and pH-sensing capabilities of the assembled capsule were evaluated using a phantom test. Finally, the ability to diagnose <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">H. pylori</i> infection was validated using an ex vivo test. Consequently, this letter highlights the potential feasibility of establishing an <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">H. pylori</i> infection diagnosis method using a pH sensor-embedded magnetically driven capsule.

S3692 What the Heil? H. heilmanni Causing Peptic Ulcer Disease and Severe GI Bleeding

Introduction: Helicobacter pylori (H. pylori) has a well-known association with peptic ulcer disease (PUD) and gastritis. However, other helicobacter species cause similar diseases. We present a case of a patient with H. heilmanni infection causing PUD and significant gastrointestinal (GI) bleeding. Case Description/Methods: A 63-year-old man with CAD s/p stent on aspirin and recent root canal procedure who was taking ibuprofen for several weeks presented with a one day history of mixed melena and hematochezia. He had no prior history of PUD or GI bleeding. EGD revealed two Forrest class III gastric ulcers and three duodenal ulcers including a 7 mm Forrest class IIc ulcer. Gastric biopsies were taken. He required 3 units of packed red blood cells (PRBCs), and was discharged on pantoprazole BID with a Hgb of 8 g/dl and biopsy results pending. The following day, he presented with similar symptoms, requiring ICU admission for Hgb 5.4 g/dl and blood pressure 77/52 mm Hg. He required 5 units PRBCs without pressor support. Repeat EGD revealed a 12 mm Forest class IIb duodenal ulcer (image 1) which was injected with epinephrine, and a single hemoclip was placed with hemostatic control. Prior EGD biopsy results showed chronic gastritis and helicobacter-like species found to be Helicobacter heilmanni by genotyping, and negative for concurrent H. pylori. The patient was treated with triple therapy with pantoprazole, amoxicillin and clarithromycin. Repeat EGD 2 months after treatment confirmed eradication of H. heilmanni and healing of all ulcers. Discussion: H. heilmanni was first described as an organism causing gastritis in humans in 1987 under its former name Gastrospirillum hominis. H. heilmanni is found in less than 1% of patients undergoing EGD for upper GI symptoms compared to H. pylori which is found in as many as 60% of patients with similar symptoms. Complications of H. heilmanni infection in patients include: 82% developing gastritis, 16% PUD, 2% gastric cancer, and, in our patient’s case, severe GI bleeding. Concurrent infection with H. pylori and H. heilmanni infection is uncommon and identification of H. heilmanni via H. pylori via stool antigen or rapid urease testing has unclear efficacy. Our case highlights the need for H. heilmanni to be recognized as a potential cause of PUD and further testing might need to be considered when H. pylori testing is negative. Ultimately, definitive diagnosis is done via genetic PCR amplification, and treatment is possible using the same antibiotic regimen as H. pylori.Figure 1.: Duodenal ulcer with adherent clot (Forest class IIb).

Statins Enhance the Potency of First Line Anti-Helicobacter Regimens to that of Second Line Regimens

Background: Infection-related to Helicobacter pylori (HP) is one of the most common human bacterial infections, affecting about 50% of the human population. This bacterium causes chronic inflammation and eventually mucosal gastric metaplasia. Antibiotics are commonly used to eradicate Helicobacter pylori infection. Presumably, statins could increase the effectiveness of anti-HP regimens because of some anti-inflammatory and antibacterial properties attributed to these anti-lipidemic agents. Methods: Two hundred patients with both gastrointestinal symptoms and positive urease test were included. Patients were randomly divided into two equal groups with 100 cases. One group received pantoprazole 40 mg, twice per day (BD) + atorvastatin 40 mg, daily + bismuth subcitrate 240 mg, BD + Amoxicillin 1 g, BD + Levofloxacin 500 mg, daily and the other one received pantoprazole 40 mg BD + atorvastatin 40 mg, daily + bismuth subcitrate 240 mg, BD + Amoxicillin 1 g, BD + Clarithromycin (Fromilid) 500 mg, BD for two weeks. A stool antigen test for HP was performed one month after drug treatment ended, and the results were compared. Results: According to our findings, eradication of HP infection in both groups was 87%, and there was no statistically significant difference between the two groups (p-value = 1). Conclusion: The current study highlighted that adding atorvastatin to the first line anti-HP infection regimen could increase the potency and efficacy of the regimen to that of second-line regimen. Moreover, the addition of atorvastatin to the second line regimen did not bear any beneficial effect. Trial registration number: The Ethics Committee of Qom University of Medical Sciences approved the study protocol (ethical code: IR.MUQ.REC.1399.082); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20200929048884N1). This study adheres to CONSORT guidelines.

Reflections about acid suppression therapy: choosing the optimal proton pump inhibitor, or the Captain’s Saga. Clinical case

The author presented a clinical case of the combined course of gastric ulcer, gastroesophageal reflux disease against the background of significant increase in the fecal calprotectin level in the absence of endoscopic, histological confirmation of Crohn’s disease.Multiple erosive and ulcerative lesions of the upper gastrointestinal tract may result from various reasons, one of the possible explanations may be a common form of Crohn’s disease. A 32‑year‑old patient independently applied for a consultation with complaints of a «chill» in the throat, some heaviness in the stomach after eating. The endoscopic examination revealed signs of reflux esophagitis, multiple erosive and ulcerative lesions of the stomach and duodenum with negative urease test, as well as, presumably, healed solitary rectal ulcer. Gastrinoma and neuroendocrine tumor were excluded. A 10‑fold increase in the level of fecal calprotectin has been revealed. The results of histological examination of polypositional biopsies of the esophagus, stomach, duodenum, large intestine, rectum did not reveal signs of a tumor process, inflammatory bowel diseases. The erosive and ulcerative lesions of the upper parts of the digestive tube, not associated with Helicobacter pylori, cicatricial changes in the rectum have been found. Acid‑suppressive therapy with dexlansoprazole promoted the repair of the esophageal mucosa without a positive effect on the stomach. Replacement of the proton pump inhibitor and administration of pantoprazole in combination with bismuth was accompanied by complete healing of erosive and ulcerative changes in all parts of the stomach, duodenum, as well as a decrease in the level of fecal calprotectin.

Endoscopic &amp; Histopathological Pattern of Gastric Polyps and their Relationship with Helicobacter pylori Infection

Introduction: Gastric polyps are abnormal luminal growths projecting above the plane of the mucosal surface of the stomach. These may be malignant or non-malignant. Hyperplastic polyps are more frequent than other gastric polyps, where H. pylori infections are commonly seen. Most hyperplastic polyps disappear or regress after H. pylori eradication. In Bangladesh, the prevalence of H. pylori in the adult is &gt;92%. The test and treat strategy is not well practised in our country. So, estimation of H. Pylori infection related to gastric polyp is necessary. Aim of the Study: The study aims to investigate the endoscopic and histopathological pattern of gastric polyps with Helicobacter Pylori infection. Methods: This cross-sectional study was carried out in the department of Gastroenterology, BSMMU. In total 75 patients, 24 male and 51 female were included in this study. Information about the clinical profile, endoscopic findings, rapid urease test and histopathological findings were collected. Data were collected using a pre-designed data collection sheet. The collected data were analyzed by computer with the help of SPSS version 23. Statistical analysis was done by using an appropriate statistical tool like the Chi-square test, Student’s t-test, and regression test. Statistical significance will be defined as p&lt;0.05. Result: Among the 75 patients with gastric polyps, the mean age of presentation was 51.08±13.85 years. Regarding clinical presentation, 28(32%) patients had abdominal pain followed by 21(28%) with nausea, 19(25.3%) with weight loss, 12(16%) with vomiting, 10(13.3%) with anaemia, 6(8%) with hematemesis and 4(5.3%) with Malena. The most common site of gastric polyps was the antrum 42(56%), 21(28%) in the body, 7(9.3%) in the cardia and 5(6.7%) in the fundus. The majority of patients had polyps sized between 5-10 mm, 43(60%) patients. The association between the number, size, and size of the gastric polyps were not statistically significant between H. Pylori positive and H. Pylori negative groups. Based on histopathological type, hyperplastic polyp 66(88%), fundic gland polyp 7(9.33%) and adenomatous polyp 2(2.67%) were observed. Regarding the relationship with H. Pylori infection, hyperplastic was significantly associated with the H. Pylori positive group (p&lt;0.004) whereas fundic gland polyp was negatively associated (p&lt;0.001) with H. Pylori infection in this study. Conclusion: In this study, the majority of polyps detected by endoscopy were solitary, size between 5-10 mm. Most of them were located in the antrum. Histopathologically, hyperplastic polyps were the most common and related to H. Pylori infection

Prediction of Helicobacter pylori Infection by Endoscopic Severity of Erythematous/exudative Gastritis in Asymptomatic Adults

Helicobacter pylori (H. pylori) infection highly correlates with erythematous/exudative gastritis, which is one of the endoscopic findings of the Sydney classification system. The present study aimed to evaluate the association between endoscopic severity of erythematous/exudative gastritis and H. pylori infection. We prospectively enrolled asymptomatic adults who were diagnosed with erythematous/exudative gastritis during screening esophagogastroduodenoscopy. A rapid urease test was performed in all participants to diagnose H. pylori infection. The severity of erythematous/exudative gastritis was determined based on the Sydney classification system. Two investigators independently evaluated the endoscopic findings. The primary endpoint was H. pylori infection rate according to the severity of erythematous/exudative gastritis (mild vs. moderate-to-severe). A total of 177 patients with erythematous/exudative gastritis were included. The rate of H. pylori infection was 86.4% in all patients. Of 177 included patients, 78 were at mild degree, 48 were at moderate degree, and 51 were at severe degree. The inter-observer variation was 4.6% and kappa value was 0.593. H. pylori infection rate was similar between patients with mild erythematous/exudative gastritis and those with moderate-to-severe erythematous/exudative gastritis (91.0% vs. 82.8%, p=0.115). Even after adjusting potential confounding variables, the severity of erythematous/exudative gastritis was not associated with H. pylori infection rate. H. pylori infection is commonly observed in patients with erythematous/exudative gastritis. However, the severity of erythematous/exudative gastritis is not associated with H. pylori infection rate.

RELATIONSHIP BETWEEN SERUM IRON AND CHARACTERISTICS SOCIAL POPULATION IN PATIENTS WITH HELICOBACTER PYLORI INFECTION

The objective of the study is to investigate the value of serum iron index in patients infected with Helicobacter pylori and find out the correlation between serum iron index and sociodemographic characteristics in patients infected with Helicobacter pylori at faculty 2 of University Medical Center Ho Chi Minh City. The study used CLO and HP CIM tests to determine the Helicobacter pylori infection status, and also collected the serum/plasma of the patient after the HP CIM test to investigate the serum iron index. The Stata 14.0 software was used to manage and analyse data, the ANOVA test was used to test for 3 means or more, and the Chi-squared test wasused to test the difference in proportions between groups. The results showed that the serum iron concentration in the patient group was 59,4±42,1 mg/dL lower than the serum iron value in the control group, which was 86,1±32,0 mg/dL (p &lt; 0,001). The results also indicated that the serum iron value in patients infected with Helicobacter pylori decreased as compared to patients without infection, yet the study also found a relationship between age group and geographical factors. This difference is statistically significant with p &lt;0,001, p = 0,001, p = 0,04 and p = 0,001.

Helicobacter pylori infection and celiac disease in children, what is the relationship?

Background: Celiac disease (CD) is an autoimmune disease affecting the small intestine, triggered by gluten. The pathogenesis of CD has been well defined, and the increasing prevalence of this disease had led to studying several environmental risk factors that may trigger an autoimmune process in the small intestine. Infection is one of the most important factors that can trigger autoimmune processes. The researchers have studied the association between H. pylori infection and CD, the authors have reported conflicting results. Purpose: to study the association of H. pylori and celiac disease (CD) at the time of CD diagnosis in children. Patient and Methods: All patients in the study were subjected to full history taking, thorough clinical examination, and laboratory investigations including Anti-tissue transglutaminase antibodies (IgA), anti-endomysial (IgA EMA), Stool Ag for H. pylori, CLO test for H. pylori, Immunoglobulins level, Upper gastrointestinal endoscopy with multiple biopsies for histopathological examination. Results: Anti TTG Ig A and Endomysial Ab were positive in 49 patients, while one patient showed negative results. 7 patients (14%) had H.

P466 Isolation of Cryptococcus neoformans and other yeast from pigeon droppings in Khartoum state, Sudan

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectivesThe aim of this study was to investigate the presence of Cryptococcus neoformans and other yeast species in pigeon droppings in Khartoum state, Sudan.MethodsSample collection A total of 120 samples were collected from pigeon droppings from Khartoum state. Pigeon droppings were collected using sterile wooden spatulas and placed directly in clean plastic bags.Processing of sampleApproximately 2 g of pigeon droppings were added to 10 ml of sterile saline. The samples were allowed to stand for 20 min with frequent vortex.Isolation and Identification of yeast isolatesA loopful of supernatant fluid from prepared samples was taken and streaked onto Sabouraud's dextrose agar media supplemented with 0.05 mg/ml chloramphenicol incubated at 37°C for 1-2 days. All yeast isolates were identified by direct microscopic examination using the lacto-phenol-cotton-blue stain India ink stain and Gram's stain. Further confirmatory tests were conducted using Corn Meal Agar (CMA) with tween 80, germ tube production test using horse serum, and urease test. Confirmation of identification was done using API 20C AUX and API ID 32C AUX (bioMérieux®, Madrid, Spain).Results Cryptococcus neoformans is the most common species isolated from pigeon droppings as shown in Table 1. Different Candida species have been isolated Figure 1.Isolated yeastNumber Cryptococcus neoformans 42 Candida spp34 Cryptococcus albidus 5 Stephanoscus ciferrii 4 Rhodotorula glutinis 4 Rhodotorula mucilaginosa 3 Geotrichum capitatum 2 Zygosaccharomyces spp1ConclusionThe present study concluded that there is a potential role of pigeons as a reservoir for C. neoformans and other zoonotic yeasts in the environment that can affect humans and animals.

P151 Molecular epidemiology of environmental strains of Cryptococcus isolated from Varanasi, Uttar Pradesh, India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectivesCryptococcosis affects more than one million people per year worldwide. Despite the worldwide emergence of this ubiquitous infection, little is known about the global molecular epidemiology of this fungal pathogen. The ecological niche of the etiological agents of C. neoformans and C. gattii are not well established yet in various parts of India.MethodologyThe present study was performed on the C. neoformans isolated from the Eucalyptus terreticornis at Varanasi, India. A total of 265 samples including flowers, leaves, bark, and nearby soil of E. terreticornis. The fungal pathogens were identified by both the conventional and molecular methods. The isolates were also grown in Staib's and tobacco agar medium. In addition, all isolates were identified on the basis of different biochemical tests such as urease test and canavanine-glycine-bromothymol blue (CGB). Further, molecular characterization was carried out by using PCR and DNA sequence analyses.ResultsOf all the 265 samples, 11 were positive for C. neoformans.8% (4/50) for E. tereticornis bark, 5% (3/60) for nearby soil, 6.66% (2/30) for debris, and 3.07% (2/65) for decayed wood from tree hollows. C. neoformans was not recovered from the leaves and flowers of E. tereticornis.The presence of brown colonies on Staib's and tobacco agar media confirmed that the isolated pathogen is Cryptococcus.Further the isolates of Cryptococcus were tested for urease production using Christensen urea citrate agar medium in which all isolates were found to hydrolyze urea rapidly and reddish pink color was obtained confirming it to be C. neoformans.All isolated yeast were negative for Canavanine glycinebromothymol blue (CGB) as they fail to produce a color change in the medium.Five strains were identified as C. neoformans var. grubii and one of the isolates was identified as C. neoformans var. neoformans.Molecular typing grouped the isolates into two major genotypes. Five were molecular type VNI (serotype A, var. grubii), one of the isolates was molecular type VNIV (serotype D, var. neoformans).Figure 3 shows the Gel electrophoresis image of ITS1- ITS4 amplicons.The nucleotide sequences were submitted in NCBI GenBank with accession numbers MZ824412, MZ848145, MZ823611, MZ882370, MZ882372, and MZ817986.ConclusionIn spite of a major Eucalyptus growing region of India, there is no report of C. neoformans/C. gattii-Eucalyptus association from Eastern Uttar Pradesh. Therefore, the current study would certainly be helpful in the establishment of molecular epidemiology of Cryptococcus in this area.

P071 Isolate profiling and antifungal susceptibility determination for terbinafine and itraconazole among dermatophytes in a tertiary care hospital of western rajasthan

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM ObjectiveTo determine the species distribution of causative agents causing dermatophytosis, and their antifungal susceptibility pattern for terbinafine and itraconazole in trichophyton spp among samples collected in patients with dermatophytosis clinical suspicion during the period of December 1, 2020 to January 31, 2022.Materials and MethodsThis is a prospective study conducted in the Department of Microbiology of a tertiary care super specialty and referral Centre of western Rajasthan from December 1, 2020 to January 31, 2022.Skin scraping, nail clipping, and hair pluckings were collected in mycology lab from clinically suspected cases of dermatophytosis presenting to the department of dermatology for conventional identification, and antifungal susceptibility testing.The specimens were subjected to direct KOH and calcofluor white microscopy and conventional fungal culture on SDA at 25 ͦ C and 37 ͦ C.The cultures positive for dermatophytes were speciated by microslide culture lactophenol cotton blue mount, hair perforation test, and urease test.The isolates identified as Trichophyton spp were taken up for antifungal susceptibility testing against terbinafine and itraconazole by microbroth dilution according to CLSI-M38 A2 guidelines. Further terbinafine resistance gene evaluation for detection of C1191A and T1189C single nucleotide polymorphism in Squalene epoxide by Amplified Refractory Mutation System-Polymerase chain Reaction (ARMS-PCR) is undergoing for trichophyton spp.ResultsOver the 14-month study period, the laboratory processed total of 174 specimens: 134 skin scraping, 36 nail clipping, and 4 hair pluckings. Of them, 106 (61.62%) specimens were microscopy positive and 111 (63.79%) were culture positive. Out of the 111 culture-positive agents isolated, 94 (84.68%) were found to be dermatophytes. On isolate profiling of 94 dermatophytes T. mentagrophyte was found to be most common 45 (48%) followed by T. rubrum 27 (29%), T. tonsurans 20 (21%), T. verrucosum 1 (1.1%), and Microsporum spp 1(1.1%). Antifungal susceptibility of 93 Trichophyton spp against terbinafine showed resistance among 58.06% isolates with 83.33% isolates among terbinafine resistant cases showing ≥4 μg/ml minimum inhibitory concentration. There was no resistance detected for itraconazole with microbroth dilution.ConclusionA total of (54.02%) skin, hair, nail infections were found to be caused by dermatophytes.On isolate profiling, T. mentagrophyte, T. rubrum, and T. tonsurans were found to be predominant species among our isolates showing altered trend of local isolates from T. tonsurans being second most common spp isolated in past.On antifungal susceptibility >55% isolates showed resistance for Terbinafine with >80% having higher MIC of ≥4 μg/ml on the contrary there was no observed resistance for itraconazole.There is a need for encouraging dermatologists for prescribing routine fungal microscopy, culture, and AFST for dermatophytes in Western Rajasthan, to reduce the indiscriminate use of antifungals.

Detection of Helicobacter pylori and its Antimicrobial Susceptibility Pattern from Gastric Biopsy Specimens

Background: Early detection of Helicobacter pylori (H. pylori) infection is essential for its treatment. Resistance to amoxicillin, clarithromycin and metronidazole has been on the increase in many countries. Phenotypic resistance is correlated with treatment failure. So, there is an urgent need to explore sensitivity of other antibiotics, such as levofloxacin to combat H. pylori infection. Objective: The study was aimed to detect H. pylori from gastric biopsy samples and its susceptibility profile to commonly used antimicrobial drugs. Methods: Gastroduodenal biopsy specimens were collected from 143 adult dyspeptic patients during March 2018-February, 2019, who attended the outpatient department of gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH), for endoscopy. H. pylori was identified by rapid urease test (RUT), ureC gene PCR, histological staining (Giemsa) and culture. From culture isolates antimicrobial susceptibility of clarithromycin, levofloxacin, amoxicillin and metronidazole were detected by disk diffusion method. Results: The highest rate of H. pylori infection was found in the age group between 41-50 years (25.5%). According to case definition, H. pylori positive cases were 47 (32.9%) and H. pylori negative cases were 96 (67.1%). Thirty five H. pylori positive samples were subjected to culture and only 10 (28.6%) were positive. Among 10 culture positive H. pylori isolates, clarithromycin exhibited 20% resistance, levofloxacin 30%, metronidazole 30% and no resistance found to amoxicillin. Conclusion: PCR based assays can be an alternative rapid approach for the detection of H. pylori. In this study, levofloxacin showed high resistance, a further larger study is required to confirm this finding. Bangladesh Med Res Counc Bull 2022; 48(1): 3-9

Current and Future Perspectives in the Diagnosis and Management of Helicobacter pylori Infection.

Helicobacter pylori (Hp) is a prevalent organism infecting almost half the global population. It is a significant concern, given its associated risk of gastric cancer, which is the third leading cause of cancer death globally. Infection can be asymptomatic or present with dyspeptic symptoms. It may also present with alarm symptoms in the case of progression to cancer. Diagnosis can be achieved non-invasively (breath tests, stool studies, or serology) or invasively (rapid urease test, biopsy, or culture). Treatment involves acid suppression and regimens containing several antibiotics and is guided by resistance rates. Eradication is essential, as it lowers the risk of complications and progression to cancer. Follow-up after eradication is similarly important, as the risk of cancer progression remains. There have been many recent advances in both diagnosis and treatment of Hp. In particular, biosensors may be effective diagnostic tools, and nanotechnology, vaccines, and potassium-competitive acid blockers may prove effective in enhancing eradication rates.

Evaluation of Accuracy and Feasibility of a New-Generation Ultra-Rapid Urease Test for Detection of Helicobacter pylori Infection

Helicobacter pylori (Hp) infection can be diagnosed by invasive and noninvasive methods, and, among the former, Rapid Urease Tests (RUTs) are an important option. Accuracy and rapidity of results are fundamental for RUTs. The aim of the study is to prospectively evaluate the sensitivity, specificity and time to positivity of a new-generation ultra-rapid urease test (iNatal duo test) for Hp detection and compare the results with other available RUTs [CLO Test (Campylobacter-Like Organism Test), CP Test (Campylobacter pylori Test) and Pronto Dry]. Gastric biopsies were taken in consecutive patients undergoing upper endoscopy: two in the antrum and two in the body for histology, and one in the antrum and one in the body for each RUT. RUTs were read at 1, 5, 15, 30 and 60 min, 3 h and 24 h after biopsy insertion into the reagent. Histology was considered as “gold standard”. The performance of the tests was evaluated in patients not taking proton pump inhibitors (PPI) (n = 924) by calculation of sensitivity, specificity and positive and negative predictive value. Agreement rate (κ) for every RUT and histology was calculated and compared. The performance of the iNatal duo test was also tested in a subgroup of patients taking PPI (n = 198). Hp was positive in 225/924 patients (24.3%) not taking PPIs and in 56/198 (28.3%) who were taking PPIs. The iNatal duo test was more sensitive than the other RUTs for detecting Hp at every time point. The sensitivity at 5 min was 96.2% in patients not taking PPIs and 92.2% in patients taking PPIs. κ with histology was higher for the iNatal duo test than any other RUT (at 30 min: iNatal duo 0.99, CLO 0.60, CP 0.78, Pronto 0.85, at 15 min: iNatal duo 0.99, CLO 0.46, CP 0.63, Pronto 0.71). In a prospective study, the iNatal duo test demonstrated high accuracy and rapidity for Hp detection, both in patients with and without PPI therapy. This new generation of ultra-rapid urease test could be useful for the rapid and correct management of patients undergoing upper GI endoscopy for suspected Hp infection.

Clinical Characteristics and Treatment Pathway of Patients Treated with Helicobacter pylori Infection-A Single Center Cohort Study Using Common Data Model

Background/Aims: Changing trends in the &lt;i&gt;Helicobacter pylori&lt;/i&gt; (&lt;i&gt;H. pylori&lt;/i&gt;) eradication protocol have not been investigated after the publication of the third-revised Korean guideline in 2013. We aimed to analyze the clinical characteristics of &lt;i&gt;H. pylori&lt;/i&gt;-infected patients alongside their treatment protocols using a common data model (CDM).Materials and Methods: A 16-year electronic health record (of 1,689,604 patients from 2004 to 2019) was converted into a CDM in Kangdong Sacred Heart Hospital. We extracted records of patients who underwent the rapid urease test or serum anti-&lt;i&gt;H. pylori&lt;/i&gt; IgG assay. The treatment protocols were visualized using a sunburst plot. We investigated the clinical characteristics and medication history of patients who underwent a urea breath test after clarithromycin-based eradication therapy.Results: Out of 29,458 patients tested for &lt;i&gt;H. pylori&lt;/i&gt; infection, 7,647 received a treatment protocol. Among them, 72.5% received a 7~14 days protocol comprising a proton pump inhibitor (PPI), amoxicillin, and clarithromycin. The proportion of patients treated with the first-line protocol (PPI, bismuth, tetracycline, and metronidazole) slightly increased from 1.9% (before 2014) to 3.3% (after 2014) (P&lt;0.001). The percentages of patients with of previous exposure to macrolides (14.7% vs. 5.5%, P&lt;0.001) or amoxicillin (10.6% vs. 7.3%, P=0.006) were higher in patients with previous clarithromycin-based eradication failure.Conclusions: The &lt;i&gt;H. pylori&lt;/i&gt; treatment protocol was not significantly modified despite the updates in the clinical guideline. There was only 1.4 percentage point increase in bismuth-based quadruple therapy as first-line eradication therapy even after the announcement of revised Korean guideline in 2013.

Diagnostic Accuracy of Helicobacter pylori Antibody Testing in Uninvestigated Dyspeptic Patients, Thailand

Background: The non-invasive Helicobacter pylori antibody (Hp Ab) test is convenient, cost-effective, and helpful for early detection and treatment. Objective: To evaluate the accuracy of Hp Ab test for the diagnosis of Hp infection compared with the rapid urease test (RUT) and histology via Esophago-gastro-duodenoscopy (EGD). Materials and Methods: Uninvestigated dyspeptic patients 18 to 80 years-old without contra-indicated to EGD were included in this study. On EGD day, all patients had received Hp Ab testing via blood and gastric biopsy sample via EGD for RUT and histological examination. Patients were considered Hp positive if one of the two invasive tests, either RUT or histology, was positive. Results: Among the 269 patients, female were more predominant with mean age 55.2±14.8 years. The endoscopic findings were gastritis at 85.9%, gastric ulcer at 13.8%, duodenal ulcer at 7.1%, normal finding at 3.7%, and no gastric cancer. The prevalence of Hp infection was 40.1%. The diagnostic indices of Hp Ab test were sensitivity at 81.5%, specificity at 75.2%, positive predictive value at 68.8%, negative predictive value at 85.8%, and accuracy at 77.7%. Conclusion: The Hp Ab testing is accurate for the diagnosis of Hp infection in uninvestigated dyspeptic patients. Positive cases can receive Hp eradication without EGD. In the negative cases, they should undergo EGD to determine the cause of dyspepsia. Keywords: Uninvestigated dyspepsia; Helicobacter pylori; H. pylori antibody test; Rapid urease test; Histology; Gastroscopy