0S64
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
Poster Presentations
from the results of the study. This data strengthens the hypothesis etio-pathogenesis H. pylori associated gastric cancers have two distinct pathways.
|PP-032| Reactive oxygen species activity and lipid
peroxidation in Helicobacter pylori associated premalignant lesions and effect of H. pylori eradication
G. Manoj*, S.K. Tiwari, G. Sivaram, R. Saikant, Z. 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: Helicobacter pylori (Hp) is an independent risk factor for gastric cancer, and this association may be due to the bacterium causing reactive oxygen species mediated damage to DNA in the gastric epithelium. Therefore the present study assessed reactive oxygen species activity and damage in gastric mucosa in relation to gastric pathology determined the effect of Hp eradication on these parameters.
Methods: Gastric biopsy specimens were obtained for analysis from 45 patients undergoing endoscopy for dyspepsia. Hp infection was assessed by highly reliable 16SrRNA PCR assay. Histopathology of the biopsies was done to score the grade of gastritis. Reactive oxygen species activity and damage was assessed by luminal enhanced chemiluminescence and malondialdehyde equivalent estimation respectively at various stages of histological gastritis.
Results: Hp infection was confirmed in all the subjects, histology showed normal morphology of the tissue in 5 (11.1%), presence of chronic gastritis in 28 (62.2%), chronic atrophic gastritis in 8 (17.8%), type-I and II intestinal metapalsia in 3 (6.7%) and 1 (2.2%) subjects respectively. Chemiluminescence and malondialdehyde levels in gastric mucosa increased in patients with gastritis, atrophy and intestinal metaplasia than in those with normal histology. Successful eradication of the bacterium led to decrease in both parameters four weeks after treatment. However histology did not reveal any significant change after Hp eradication.
Conclusions: Data suggests that reactive oxygen species plays a pathological role in Hp gastritis and leads to carcinogenesis of the gastric mucosa. Henceforth dietary antioxidants could be beneficial in combination therapy for eradication of H. pylori and reduce the risk of gastric cancer.
|PP-033| Comparison of the differences of the clinical characters of the hand-foot-mouth disease caused by EV71 and other enterovirus L.H. Wang, Z.H. Chen, X.W. Li. Department of infectious diseases, Beijing Ditan hospital, 100011, China
Objective: To compare the differences of the clinical characters of the hand-foot-mouth disease caused by EV71 and other enterovirus.
Methodology: We use the RT-PCR assay to confirm the different pathogens of the clinical hand-foot-mouth cases. And the positive cases were divided into two groups: EV71 positive and other enterovirus positive groups. We separately compare the age, maximum body temperature, fever duration, emerging method of rash, configuration of rash, peripheral blood white cell count, myocardial enzymes, blood glucose, abnormalities rate of chest ray and central nervous system involvement etc. Results: We obtained 28 cases of EV71 positive and 9 cases of other enterovirus positive. When comparing
the age, peripheral blood white cell count, myocardial enzymes, blood glucose, abnormalities rates of chest ray and central nervous system involvement, we found no differences between the two groups. But the maximum body temperature is higher and the fever duration is longer in EV71 group than in other enterovirus group, 39.10±0.65°C and 5.07±1.72 days vs. 38.53±0.68°C and 3.22 ± 0.97 days (P < 0.05) separately. The proportion of first rash appearing in oral mucosa and the rashes are mainly manifested by obvious herpes are 66.7%, 66.7% in other enterovirus group, by contrast, the proportion are 17.8%, 21.4% in EV71 group separately (p<0.05).
Conclusion: The maximum body temperature is much higher and the fever duration is much longer in EV71 group than in other enterovirus group. On the other hand, for the other enterovirus group, the patients are more likely manifest that the oral mucosa is the first position of rash appearance and the rashes are mainly composed by obvious herpes than in EV71 group. These differences help us to differentiate different kinds of pathogen during the epidemic of the hand-foot-mouth disease.
|PP-034| Evaluation of lipoarabinomannan-38kD-IgG test
Myco G in clinical diagnosis of tuberculosis S. Wang*, J.Z. Chen, W.H. Zhang. Department of Infectious Disease, Huashan Hospital, Shanghai 200433, China
Objective: To evaluate sera lipoarabinomannan-38kD-IgG (LAM-38kD-IgG) Elisa kits Myco G in the serological diagnosis of tuberculosis.
Methods: 128 active tuberculosis patients (59 bacteriological-positive pulmonary patients, 48 bacteriological-negative pulmonary patents, 21 extra-pulmonary patients) and 68 healthy people were enrolled and diagnosed by clinic, bacteriology and X-ray examination. All specimens were studied for LAM-38kD-IgG by using Myco G (Omega Diagnostics Ltd., Alloa, Scotland).
Results: The total sensitivity of Myco G of active tuberculosis patients were 45.31% (38.34-52.28). The sensitivity of Myco G in diagnosis of those with active pulmonary tuberculosis patients and extra-pulmonary tuberculosis patients were 46.73% and 38.10% (P>0.05) respectively; the sensitivities of bacteriological positive and negative pulmonary tuberculosis patients were 52.54% and 39.58% (P>0.05) respectively. The sensitivity of Myco G was not significantly different between new and previously treated cases. The total specificity was 98.53% (96.84-100), which were higher than PPD test (41.63%). The level of the LAM-38kD-IgG was related with the situation of the disease.
Conclusions Myco G was a kind of rapid, simple, relatively sensitive and specific method for diagnose of tuberculosis. It was a useful supplementary tool for the diagnosis of tuberculosis especially of smear negative pulmonary tuberculosis and extra-pulmonary tuberculosis. It would be useful in helping to exclude disease in a population with a high prevalence of tuberculosis.
|PP-035| Ventilator associated pneumonia (VAP) in Adult ICU
L. Fariba1 *, A. Abdorrahim2, K. Shaida3. 1 Department of Microbiology, Medical University of Kurdestan,
2Department of Community Medicine, Medical University of Kurdestan, 3Nursing, Be'sat hospital of Sanandaj, Iran
Introduction: Ventilator Associated Pneumonia (VAP) occupies an important place among nosocomial infection. The objective of this work was to study epidemiologic, diagnostic and therapeutic aspect of ventilator-associated pneumonia in Intensive Care Unite of Be'sat Hospital.
