Scholarly article on topic 'PP-028 Clinical and hemodynamics features of gastric varices'

PP-028 Clinical and hemodynamics features of gastric varices Academic research paper on "Clinical medicine"

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Academic research paper on topic "PP-028 Clinical and hemodynamics features of gastric varices"

Poster Presentations

Poster Presentation - Infectious Diseases and Public Health

|PP-025| Prevalence of ESBL and AmpC producing strains among Gram-negative isolates at a teaching hospital in Nepal

B.M. Pokharel1, J. Koirala2, J.L. Pathak3*, P. Deo3, B.K. Awal1, P.K. Khadga1. 1 Department of Clinical Microbiology, Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal, 2Southern Illinois University, School of Medicine, Springfield Illinois, USA, 3 Union Hospital, Tongji medical college, Hubei, China

We report results of a study to determine the prevalence of extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase (AmpC) producing strains among multi-drug resistant (MDR) Gram-negative isolates at a teaching hospital in Nepal. Clinical isolates from patients with lower respiratory tract infection (LRTI) and urinary tract infection (UTI) were tested to detect antibiotic susceptibility, ESBL and AmpC producing following standard methods as described by American Society for Microbiology (ASM) and National Committee for Clinical Laboratory Standard (NCCLS).

Among the 230 sputum samples, 30.9% (71/230) showed clinically significant isolates with 53.5% (38/71) MDR, 22.5% (16/71) ESBL producers, and 8.45% (6/71) AmpC producers. Among 1360 urine samples collected from clinically suspected UTI, 30.8% (419/1360) had significant bacterial growth with 62% (260/419) MDR, 19.1% (80/419) ESBL Producers, and 3.34% (14/419) AmpC producers. We believed the ESBL production is due to genetic coding present in the chromosomal or in plasmid DNA and AmpC production could be plasmid mediated. However, we need to subject these strains for genetic study in order to acquire genetic make up of these strains and to characterize the mechanism of drug resistance.

|PP-026| The microbial agents of infective endocarditis in an Iranian teaching and treating hospital, Tehran, Iran

P. Behzadi1,2*, E. Behzadi1,2, M. Lellahi1,2, E. Dorraji1,2, M. Saghiri1,2, M. Mehdi Mafi1,2, E. Farahbakhsh1,2, A.R. Mahmoudi1,2, M.S. Tabrizi1,2, H.S. Ardestani2. 1 Department of Microbiology, Faculty of Basic Sciences, Islamic Azad University, Shahriyar-Shahre Qods Branch, Tehran, Iran, 2Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

In this retrospective study, the incidence and variety of microbial agents which cause Infective Endocarditis in patients was determined.

So, the data were collected by the help of questionnaires and the statistical analyses of Chi Square were done by SPSS software version 15.

The results indicated the involvement of different microbial agents in Infective Endocarditis. The pathogenic microorganisms were respectively: Staphylococcus aureus, Enterococcus spp., Brucella spp., Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus spp., Acinetobac-ter spp., Streptococcus spp., Fungi and Viruses. In conclusion, the association between IE and male gender was significant (P < 0.05).

|PP-027| Clinical features, diagnostic and treatments aspects of human anthrax in Mongolia

G. Zulkhuu1*, Z. Adiyasuren2, Y. Dahgwahdorj1. 1Health Sciences University of the Mongolia, 2National Center of Infectious Diseases with Natural Foci, Mongolia

Background: Recently, in Mongolia registered regular

outbreaks of human and animal anthrax.

Aim: To determine the clinical features and difficulties

for diagnostic and treatment aspects of human anthrax in


Material and Methods: We were prospectively analysed in last 5 years medical hystories, results laboratories tests and treatments methods of 98 patients (male 70) with human anthrax. Ninety six of them cutaneous form of anthrax and 56 of all more 40 years old.

Results: The incubation period was 3.9± 1.9 days. Onset of disease was typical progression on skin lesions begining with pruritic papule, the surrounding edema, the painless black eschar in 85.7% and extensive edema without black eschar was in 8.2%, erysipella like edema and big bullous was in 3.1% of all cases. But some (6.1%) patients were come to doctor 3.6 ± 1.2 days after onset using self treatmentl on the skin lessions and that made difficilties to early diagnostic. The severity of course was: mild in 32.6%, moderaty in 39.7% and severe in 28.6% of all cases. Fatality in 5 (5.1%) cases due to develop bacteremia or extensive edema and gastrointestinal form. Confirmation of diagnosis by microscopy -87.8%, culture 64.3%, serology 5.1%, PCR -18.4%, and bio-probe -9.2%. We have been used antibiotic by antibiotic sensitivity and anthrax immunoglobulin in severe cases.

Conclusion: In last 5 years, peridominantly cutaneous anthrax was occured mostly in male and over 40 of ages. Course of human anthrax were mild and moderate forms. But some cases (5%) complicated to bacteremia and gastrointestinal anthrax, that lead to death.

|PP-028| Clinical and hemodynamics features of gastric varices

H. Zhao1*, Y.Z. Yu2, L.Q. Zhao2. 1 Beijing Ditan Hospital,

2Beijing Friendship hospital affiliated to Capital University of Medical Sciences, China

Objective: To investigate the endoscopic feature and hemodynamics of gastric varices (GV) by multi-detector row CT portal angiography (CTPA).

Materials and Methods: 85 patients who were endoscopi-cally diagnosed GV were included, all of them underwent CTPA.

Results: (1) According to Sarin's category of GV, gastroesophageal varices - a (GOV-a) was found in cases 49, it was almost low-grade, in which the left gastric vein was the predominant route to form the varices. Gastrorenal or splenicrenal shunt was found in 8 cases (16.3%). Gastroesophageal varices - a (GOV-a) was found in 17. The degree of GOV-a was different, in which the left gasric vein and the posterior/short gastric vein all contributed to the formation of the varices. Gastrorenal/splenicrenal shunt was found in 8 cases (47.1%). Isolated gastric varices - a (IGV-a) was found in 19. It was severe, in which posterior/short gastric vein were the major route that formed the varices. Gastrorenal/splenicrenal shunt was found in 12 cases (63.2%). bleeding was more common in GOV-a and IGV-a than in GOV-a (P< 0.05). The bleeding rate was different between tumorous/nodular and tortuous, tumorous and nodular were higher than tortuous (P < 0.01). Conclusions: 1. Sarin's category and the form of GV are helpful to investigate the degree of gastric varices and predict the possibility of bleeding. 2. Because the

Poster Presentations

hemodynamic features and occurrence of shunt of the three kinds were different, the therapeutic effect may be dissimilar.

|PP-029| Management of oesophageal varices by

reloading inexpensive hemorrhoidal O-rings for band ligation at Evangel Hospital, Nigeria

N.G. Ladep1 *, J. Sule2, P. Ushie2, R. Ugiagbe1, M. Topazian3, W. Ardill2. 1 Department of Medicine, University of Jos and Jos University Teaching Hospital, PMB 2076, Jos, Plateau state, Nigeria, 2ECWA Evangel Hospital, Zaria Bye-pass, Jos, Plateau state, Nigeria, 3Mayo Clinic, Rochester MN, USA

Background: Gastrointestinal endoscopy plays the most important role in diagnosis and treatment of patients with upper gastrointestinal bleeding. Improvements in management of, especially variceal haemorrhage have been reported from Europe and North America. Data on the experience from Nigeria is hereby presented in this report. Patients and Methods: This study was carried out at the Endoscopy Unit of Evangel hospital, Jos between 2004 and 2007. All patients had presented with haematemesis and or melaena. A special reloading kit (produced by McGown; USA) was used to reload previously used and sterilized Opti-vu caps from Saeed six shooter variceal band ligators (North Carolina, USA). Subjects with oesophageal varices underwent banding of the varices down the lower 5cm of the oesophagus using this innovative technigue. These sessions were repeated till the varices were obliterated, lost to follow up or death. Analyses of the data obtained were performed using EPI Info 2004 version 3.3.2 (Atlanta GA, USA).

Results: Ninety-two patients were diagnosed to have oesophageal varices during the period of study. Of these, seventy-two (78.2%) underwent initial oesophageal variceal band ligation. Only 40 follow up records, representing 55.5% of those that had initial band ligation were available for analysis. All 40 patients excepting three turned up for repeat gastroscopies. These sessions range from 1-7 with a mean of 2 sessions in order to obliterate the varices. There were two cases of rebleeding following an initial banding. Thirty-one (77.5%) of these patients made satisfactory recovery, 6 did not require a subsequent banding at second gastroscopy, and one patient died before he could have a recheck gastroscopy due to liver failure. Follow up banding sessions (using "0" rings reloaded opti-vu caps) were associated with loss of some of the bands in 12 cases and breaking of the opti-vu cap during unloading in five cases. The records were not detailed enough to capture overall mortality in the study population.

Conclusion: Oesophageal variceal band ligation using cheap reloadable haemorrhoidal O rings is a safe and easily acquired skill that can significantly reduce morbidity associated with variceal bleeding in resource-limited settings.

|PP-030| Risk of glandular atrophy, intestinal metaplasia and dysplasia in subjects with vacA positive and complete or disrupted cagE, cagT Helicobacter pylori infection S.K. Tiwari*, M.G. Sivaram, G. Saikant, R. Zakia Abid, Md. Aejaz Habeeb, A.A. Khan, C.M. Habibullah. Center for Liver Research and Diagnostics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad 500058, Andhra Pradesh, India

Background and Aim: Pre-neoplastic gastric lesions such as atrophy, intestinal metaplasia and dysplasia are common in patients with chronic gastritis as in those with Helicobacter

pylori (Hp) infection. Virulent strains carrying the cag pathogenicity island, vacA gene and early age of acquisition are considered to be the key determinants in disease development. Therefore the present study was designed to investigate the association among Hp infection with cagE, cagT and vacA genes and validate the risk of precancerous lesions in those infected with various genotypes. Methods: We studied 120 symptomatic adult patients (age range 32 to 55 years, mean age of 38.5 years). Patients were divided into group-I, those with overt gastric disorders and group-II with less intense disease. The status of cagE, cagT and vacA genes was determined by PCR and the histological assessment for the presence precancerous lesions such as atrophy, intestinal metaplasia (IM) and dysplasia was done. Results: Significant association was found between cagE, cagT and vacA genes. Genotypic data revealed 42.5% strains with cagE+/cagT+/vacAs1+, and 7.5% strains with partially deleted cagE, cagT & vacAs2. With respect to clinical status, subjects with overt diseases (67.5%) were predominantly infected with cagE+/cagT+/vacAs1+ genotype whereas 22.5% with less intense disorders harbored strains with partial deletions and s2 allele of vacA (p<0.01). Histology revealed the degree of atrophy, intestinal metaplasia and dysplasia to be more prominent among subjects harboring complete triple positive cagE+/cagT+/vacAs1+ genotype compared to Hp infected subjects with partially deleted genes of cagE or cagT and vacA s2 allele (p< 0.05). Conclusion: Hp strains with complete cagE, cagT and vacA s1 showed higher predictive value for the development of pre-neoplastic lesions among younger subjects with various gastroduodenal disorders.

|PP-031| Distinct methylated profiles in Helicobacter

pylori dependent intestinal type carcinoma and diffuse carcinoma S.K. Tiwari*, M.G. Sivaram, G. Saikant, R.K.S. Ahmed, Md. Aejaz Habeeb, A.A. Khan, C.M. Habibullah. Center for Liver Research and Diagnostics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad 500058, Andhra Pradesh, India

Background and Aim: Helicobacter pylori (Hp) associated gastric cancers are clinically subdivided into two types intestinal and diffuse type. Methylation status of the genes of the CpG islands is known to affect the outcome of infection. Therefore the present study was designed to analyze the methylation profiles of five independent CpG islands namely p15, p16, p73, hMLH1, death associated protein kinase (DAPK) in Hp associated gastric cancers. Methods: Twenty-three gastric cancer patients were recruited in the study. Fresh gastric biopsies were obtained from all the patients from the tumor site as well as the non-affected areas during endoscopy. Hp infection status was assessed by 16SrRNA amplification of the DNA obtained from the non-affected area. Methylation analysis of the p15, p16, p73, hMLH1, and DAPK was performed after bisulphite modification using methylation specific PCR. Histological assessment of the gastric biopsy for the type of cancer was performed as per the updated Sydney system of classification.

Results: Hp Histology confirmed intestinal type and diffuse type cancer in 17 (73.9%) subjects 6 (26.1%) subjects respectively. Methylation studies showed 14 (82.3%) intestinal type cancer had three methylated loci and 3 (17.7%) had all the five methylated loci while cases with diffuse pattern of carcinoma had less than two. Conclusion: The distinct methylation patterns of different genes of the CpG islands in H. pylori associated gastric cancer suggest that both intestinal and diffuse type cancer associated have a different molecular profile as evident