Govaresh
Volume:17 Issue: 4, 2013

Helicobacter pylori (H. pylori) is classified as a class I carcinogen. The low infection rate seen in developed countries (8. 9%) compared with a high infection rate (52%-98%) in developing countries indicates a strong association between infection prevalence and socioeconomic status. Adhesion of H. pylori to gastric epithelial cells is an important aggressive factor. One of the genes that encodes for an adhesive protein is babA2، which facilitates the location of bacteria on gastric epithelial cells and delivery of toxic proteins (CagA، VacA) into the host cells. BabA2 is a 78 KD protein that binds to the Leb antigens on gastric epithelial cells. Some studies have shown an association between babA2 and peptic ulcer disease or gastric cancer. The cagA gene which encodes an immunodominant protein has a mosaic structure composed of protected and various regions. The C-terminal region of CagA، which includes multiple numbers of EPIYA (Glu-Pro-Ile-Tyr-Ala) motifs، is tyrosine-phosphorylated. Western and East Asian strains represent EPIYA-C and EPIYA-D motifs، respectively. The C- and D- types serve as low-affinity and high-affinity SHP-2-binding sites and interfere with SHP-2phosphatase activity. A majority of East Asian strains have shown strong conservation and lack of duplication in the D region while the Western strains have shown multiple numbers of the EPIYA-C motif، which increase gastric cancer risk. CagA، either tyrosine-phosphorylated (in its C-terminal motifs) or not in host cells، alters the expression of certain genes to cause gastric cancer. The importance of these genes in predicting clinical outcomes is related to the phylogeographical origins of the bacterium. If the mechanisms by which H. pylori causes cancer are elucidated، they can assist in achieving effective strategies for the prevention and treatment of gastric cancer.

Dyspepsia is a common gastrointestinal symptom reported in 2. 9-29% of the adult Iranian population. This symptom usually results from functional disease، but in one-third of cases an organic cause such as peptic ulcers، esophagitis، and in less than one percent gastric cancer can be found. The timing of an endoscopic evaluation، the value of acid reducing agents، herbal medicine and the role of Helicobacter pylori (HP) eradication are important challenges in the evaluation and management of dyspepsia. Overall، prompt endoscopic evaluation for cases over the age of 45 years، those who present with alarm symptoms، or non responders to empirical acid reducing treatment is recommended. There are controversial results about the role of HP eradication on the relief of dyspepsia symptoms in our region، so the HP test and treatment strategy or eradication therapy for those with functional dyspepsia is not a suitable option for our country. There are promising reports regarding the effects of herbal medicine، and anti-depresants، which needs more research. Due to the limited value of alarm features for diagnosis of gastric cancer، we recommend prompt، low cost endoscopic evaluations in all dyspeptic cases over age 45 years.

Hepatitis includes a wide range of clinical and pathological conditions. The beta-2 microglobulin (ß2M)، as part of the HLA complex، is responsible for transmission of viral antigens on the surface of liver cells. The purpose of this study is to determine the concentration of salivary ß2M as a marker of viral proliferation in subjects who are HbsAg+، HBV DNA PCR+ compared with those who are HbsAg+، HBV DNA PCR-.

In this case-control study، we enrolled 25 patients who were Hbs Ag+، HBV DNA PCR+ in addition to 21 patients who were Hbs Ag+، HBV DNA PCR-. We obtained sputum samples from all patients and measured salivary ß2M levels by nephelometry. Data analyses were performed by the descriptive، student''s t- and chi square tests.

There were 25 men (54. 3%) and 21 women (45. 7%) with a mean age of 35. 72±11. 86 years who participated. Of PCR+ patients، 72% were on medication، however 85. 7% of the PCR- patients did not take medication (p<0. 001). Salivary Β2M concentration in the PCR+ patients (5. 28±5. 45) was greater than observed in the PCR- patients (1. 51±0. 77)، of which this difference was statistically significant (p<0. 003).

Salivary ß2M levels، as a marker of viral replication، could be used in patients with hepatitis B.

Animal models have been proven useful in elucidating the details of interaction between pathogenic bacteria and their human hosts، in addition to assessing the efficacy of therapeutic compounds and vaccines. In this study، we investigate the colonization of Helicobacter pylori (H. pylori) in experimentally-infected guinea pigs over a six-month period. A bacterial suspension was prepared by mixing four H. pylori isolates obtained from patients diagnosed with gastric ulcer. Within a one week period، five female guinea pigs were dosed orally with bacterial suspension for a total of three times. One control animal was gavaged with normal saline. Stool samples were collected at two-week intervals for six months. We used PCR، the stool antigen test، and indirect immunofluorescence assay (IFA) to assess samples for the presence of H. pylori. Stomachs obtained from two chloroform-killed animals، at 8 and 24 weeks، were investigated for histopathologic changes. H. pylori 16S rDNA was amplified from the stool samples of five guinea pigs. The stool antigen test was also positive in all five animals. IFA demonstrated the presence of H. pylori antigens in the stools from all five animals. PCR، stool antigen test and IFA results showed no H. pylori in the stool of the control animal. We observed infiltration of mature lymphocytes and plasma cells in the stomachs of animals killed at 8 and 24 weeks. The occurrence of H. pylori 16S rDNA and antigens in stool samples of guinea pigs demonstrated persistent colonization of H. pylori in the stomachs of guinea pigs. Histopathological findings have confirmed mild severe gastritis induced by the bacterial infection. The stomach of a guinea pig is similar to the human stomach، in that it is sterile، lined by glandular epithelium، lacks a vitamin C synthesizing system and produces the cytokine interleukin-8. Accordingly، the guinea pig can be considered an appropriate animal model for long-term experiments to follow the process of H. pylori pathogenesis or to assess the efficacy of antibiotics or vaccines.

Nonalcoholic steatohepatitis (NASH) is part of a broad spectrum of nonalcoholic fatty liver diseases that can lead to cirrhosis. To date، there is no effective medical treatment for NASH. We aim to compare the effect of aerobic exercise in conjunction with diet to diet alone on the improvement of metabolic syndrome and insulin resistance in patients with NASH.

We enrolled 23 NASH patients، ages 25-50 years، and randomly divided them into two groups، aerobic exercise plus diet (n=12) or diet alone (n=11). In this study، diet in both groups included 500 kilocalories of energy less than the estimated daily energy requirement. In addition to diet، the first group participated in aerobic exercises that consisted of walking، jogging and running، for a period of eight weeks، three days a week at a 55%-60% heart rate reserve. For all patients، we measured blood pressure، Waist Circumference، serum ALT، HDL، TG، FBS، insulin levels، and insulin resistance according to HOMA-IR at baseline and after eight weeks. We analyzed data with the paired and independent samples t-test، at a significance level of p <0. 05.

Although، there was no significant difference noted in patients in the diet only group، HOMA-IR، Systolic Blood Pressure، Diastolic Blood Pressure، FBS، ALT، and insulin levels significantly decreased in patients who underwent both diet and exercise. Serum TG levels and WC decreased significantly in both groups. In a comparison between the groups، there was a significant decrease observed in WC، FBS، and ALT.

Aerobic exercise in conjunction with diet may be more effective than diet alone in the treatment of patients with NASH.

The liver is a vital organ that plays an important role in the metabolism of nutritional agents، drugs and hormones،synthesis of various proteins، coagulation factors and maintenance of hemostasis between calcium،and phosphorous. Biochemical changes in the skeletal system such as osteopenia and pathologic fractures may follow hepatic failure. This researchevaluates metabolic bone changes in non-alcoholic cirrhotic patients. We evaluated 50 known cases of nonalcoholic cirrhosis in the Internal Medicine Clinic and Ward of GhaemHospital during the second half of 2004. Inclusion criteria were: age >14 years anda Child-Pugh score of A or B. Exclusion criteria were: history of previous bone metabolic disorders; endocrine disease; hepatocellular carcinoma; liver metastasis; previous use of calcium، vitamin D، calcitonin، bisphosphonates، hormone replacement therapy، and prednisolone; and alcoholics. Patients underwent clinical and laboratory studies in addition to bone densitometry analyses of the femoral neck and second to fourth lumbar spine area. Patients'' mean age was 41. 18±15. 94 years and the male to female ratio was 1. 5 to 1. Cases presented with the following types of non-alcoholic cirrhosis: post-hepatitis B (58%)، cryptogenic (26%)، autoimmune hepatitis (10%)، post-hepatitis C (4%) and primary biliary cirrhosis (2%). There were 68% of our cases classified as Child-Pugh score A; 32% were Child-Pugh score B. Osteoporosis and osteopenia were more common in the Child-Pugh B group. T-score of the femoral neck was normal in 39 (78%) cases. The lumbar spine Z-score was normal in 46 (92%) and the femoral neck Z score was normal in 48 (98%) cases. There were more post-hepatitis B and cryptogenic cirrhosis cases that had decreased bone density. The Child-Pugh A group had more increased calcium، phosphorous، and PTH levels and decreased ALP levels compared to the Child-Pugh B group. Progression of liver failure (according to Child-Pugh) in patients with non-alcoholic cirrhosis to some extent causes increased osteoporosis and osteopenia. It is necessary to place increased emphasis on the importance of mineral supplementation in cirrhotic patients.