Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis

BACKGROUND & AIMS

The epidemiology of Helicobacter pylori infection has changed with improvements in sanitation and methods of eradication. We performed a systematic review and meta-analysis to evaluate changes in the global prevalence of H pylori infection.

METHODS

We performed a systematic search of the MEDLINE and EMBASE databases for studies of the prevalence of H pylori infection published from January 1, 1970 through January 1, 2016. We analyzed data based on United Nations geoscheme regions and individual countries. We used a random effects model to calculate pooled prevalence estimates with 95% confidence intervals (CIs), weighted by study size. We extrapolated 2015 prevalence estimates to obtain the estimated number of individuals with H pylori infection.

RESULTS

Among 14,006 reports screened, we identified 263 full-text articles on the prevalence of H pylori infection; 184 were included in the final analysis, comprising data from 62 countries. Africa had the highest pooled prevalence of H pylori infection (70.1%; 95% CI, 62.6-77.7), whereas Oceania had the lowest prevalence (24.4%; 95% CI, 18.5-30.4). Among individual countries, the prevalence of H pylori infection varied from as low as 18.9% in Switzerland (95% CI, 13.1-24.7) to 87.7% in Nigeria (95% CI, 83.1-92.2). Based on regional prevalence estimates, there were approximately 4.4 billion individuals with H pylori infection worldwide in 2015.

CONCLUSIONS

In a systematic review and meta-analysis to assess the prevalence of H pylori infection worldwide, we observed large amounts of variation among regions-more than half the world's population is infected. These data can be used in development of customized strategies for the global eradication.

[A retrospective analysis of clinical characteristics and outcomes of heart failure patients with different left ventricular ejection fractions]

Objective: To compare the clinical characteristics, and outcomes of patients with heart failure with different left ventricular ejection fractions (LVEF). Methods: A total of 1 182 hospitalized patients with heart failure (HF) were enrolled and retrospectively studied in the present study. The patients were stratified by LVEF as reduced (HFrEF, LVEF<40%, n=313), mid-range (HFmrEF, 40% ≤LVEF <50%, n=287) and preserved (HFpEF, LVEF≥50%, n=582) ejection fraction groups. Among the 1 182 cases, 941 of them (81.3%, 84.9%, and 84.0% inHFrEF, HFmrEF and HFpEF groups, respectively) were followed up for an median duration of 27.3 months. Results: (1) Among the study patients, 26.5% were in HFrEF, 24.3% in HFmrEF, and 49.2% in HFpEF groups. (2) Ischemic heart disease with HFmrEF was more frequent than that in patients with HFrEF. The average age, percentage of female subjects, systolic blood pressure, uric acid, N terminal B-type natriuretic peptide precursor (NT-proBNP), hemoglobin, and the incidence of hypertensive heart disease, anemia, atrial fibrillation in patients with HFmrEF were higher than those in patients with HFrEF, but lower than those in patients with HFpEF (all P<0.01). (3) The all-cause cumulative mortality was 10.8% at 1 year, 20.6% at 2 years and 35.9% at 5 years. No difference was observed in the all-cause cumulative mortality at 1 year, 2 years, 5 years among the three groups (all P>0.05). Conclusions: The HFmrEF patients, as a new and distinct group, were with many intermediate characteristics compared with HFrEF and HFpEF subjects. However, the all-cause mortality was not significantly different among HF patients with different LVEF.

[Validation of the Omron HEM-650 wrist blood pressure device using the British Hypertension Society protocol in emergency patients in Hong Kong]

OBJECTIVES

Automated wrist cuff blood pressure (BP) devices are more compact and easier to use, particularly when access to the upper arm is restricted, for example in emergencies.

MATERIAL AND METHODS

We tested the Omron HEM-650 wrist device using the validation criteria of the British Hypertension Society (BHS) protocol in a major emergency department (ED) in Hong Kong. 85 patients had three measurements each by both the Omron HEM-650 wrist device and the mercury sphygmomanometer. The conventional automated BP with arm cuff was also measured using an oscillometric (Colin BP-88S NXT) device for comparison.

RESULTS

The Omron HEM-650 achieved a grade B for both systolic and diastolic BP and demonstrated acceptable accuracy and reliability in Chinese patients in the emergency setting.

CONCLUSION

The Omron HEM 650 wrist device can be recommended for use in adult emergency patients. Further research is warranted for its use in pregnant women and critically ill patients.

Faecal occult blood screening: knowledge, attitudes, and practice in four Hong Kong primary care clinics

OBJECTIVES. To assess primary care patients for their awareness, knowledge, and attitude towards colorectal cancer and screening, to report on the uptake of faecal occult blood test screening and the results of screening, and explore predictors of screening uptake. DESIGN. Cross-sectional study. SETTING. Four primary care clinics in Hong Kong. PATIENTS. A total of 1664 patients aged 50 to 74 years attending the clinics in the period July 2006 to July 2007. MAIN OUTCOME MEASURES. Percentage of subjects who were aware that colorectal cancer is common and curable at an early stage, and who knew that faecal occult blood test or colonoscopy is useful for screening; relevant knowledge score; uptake rate of faecal occult blood testing; rate of testing positive; and factors predicting uptake. RESULTS. A total of 1645 questionnaires were collected. In all, 89% (95% confidence interval, 88-91%) were aware that colorectal cancer is common, 95% (94-96%) believed faecal occult blood test and colonoscopy are useful for screening, and 58% (56-61%) achieved a knowledge score of 50% or above. The uptake rate of the faecal occult blood test was 35%. Uptake was higher among those with a positive family history (odds ratio=1.57; 95% confidence interval, 1.08-2.27; P=0.02), those who were more aware that colorectal cancer is common (1.86; 1.29-2.69; P=0.001), and that colorectal cancer is potentially curable at an early stage (1.76; 1.32-2.36; P=0.0001). Rate of testing positive was 2.1% (95% confidence interval, 0.9-3.3%); no colorectal cancer was detected and the neoplasia detection rate (for cancers and adenomas) was 5.1 per 1000 subjects screened. CONCLUSIONS. Patients were aware that colorectal cancer is common in our community, and faecal occult blood test or colonoscopy is useful for screening. The uptake of screening was low, though relatively higher for those with a positive family history and greater awareness of the high frequency and potential for cure of colorectal cancer. Faecal occult blood test positivity rate was 2.1%, and neoplasia detection rate 5.1 per 1000 screened.

Clinical characteristics and treatment outcomes of patients undergoing nail avulsion surgery for dystrophic nails

OBJECTIVE

To evaluate the clinical characteristics and treatment outcomes of patients undergoing surgical nail avulsion.

DESIGN

Retrospective study.

SETTING

Two dermatology centres in Hong Kong.

PATIENTS

A total of 32 patients with nail diseases who underwent 33 nail avulsion procedures were reviewed from case records.

MAIN OUTCOME MEASURES

Age, gender, co-morbidities, disease duration, clinical features, histopathology and fungal culture of nail plate, nail bed specimen for fungal culture in appropriate cases, and postoperative outcome.

RESULTS

The mean age of the patients at the time of nail avulsion was 54 (range, 27-86) years. The most frequent preoperative findings were thickened nails (23 specimens, 70%) and discolouration (20 specimens, 61%). Onychomycosis was the most common pre-consultative diagnosis (20 specimens, 61%). Prior to nail avulsion, topical or systemic treatment had been tried in more than half of the cases. Histopathology of the avulsed nails confirmed onychomycosis in 24 (73%) of specimens. The clinical cure rate was 88% and the mycologic cure rate was 100%. The procedure was well tolerated without significant complications. Relapse was only noted in three (9%) of the patients having nail avulsions. The time for full re-growth ranged from 5 to 10 months.

CONCLUSIONS

Total nail avulsion is an effective management option for patients whose diagnosis of onychomycosis was doubtful, and constitutes a treatment armamentarium especially for patients with single or oligo-onychomycosis.

Pressure-drop viscosity measurements for gamma-Al2O nanoparticles in water and PG-water mixtures (nanofluids)

Nanofluids have attracted wide attention because of their promising thermal applications. Compared with the base fluid, numerous experiments have generally indicated increases in effective thermal conductivity and convective heat transfer coefficient for suspensions having only a small amount of nanoparticles. It is also known that with the presence of nanoparticles, the viscosity of a nanofluid is greater than its base fluid and deviates from Einstein's classical prediction. However, only a few groups have reported nanofluid viscosity results to date. Therefore, relative viscosity data for gamma-Al2O3 nanoparticles in DI-water and propylene glycol/H2O mixtures are presented here based on pressure drop measurements of flowing nanofluids. Results indicate that with constant wall heat flux, the relative viscosities of nanofluid decrease with increasing volume flow rate. The results also show, based on Brenner's model, that the nanofluid viscosity can be explained in part by the aspect ratio of the aggregates.

The prevalence of microalbuminuria among patients with type II diabetes mellitus in a primary care setting: cross-sectional study

OBJECTIVES

To determine the prevalence of microalbuminuria among patients with type II diabetes mellitus in a primary care setting, and to study the association between various risk factors and the presence of microalbuminuria.

DESIGN

Cross-sectional community-based study.

SETTING

Four primary care clinics, Hong Kong.

PATIENTS

All patients with type II diabetes mellitus who regularly attended the clinics between May 2002 and March 2003.

MAIN OUTCOME MEASURES

Patients' demographic data, the proportion with microalbuminuria (measured using a spot urine test), and the association between this condition and risk factors for diabetic nephropathy (via correlation and multivariable logistic regression analysis).

RESULTS

The mean age of the 1161 patients in the sample population was 58.0 years. The mean duration of diabetes mellitus was 5.7 years, and the mean level of glycated haemoglobin was 7.4%. A total of 13.4% of the patients had microalbuminuria. Having the condition was significantly associated with advanced age, female sex, poor glycaemic control, and coexisting hypertension in both correlation and regression analyses. No significant association with ever smoking was found.

CONCLUSION

Early screening for incipient diabetic nephropathy and aggressive management of modifiable risk factors in a primary care setting may be important in optimising the renal outcome of patients with type II diabetes mellitus.

Characterization of a novel allergen, a major IgE-binding protein from Aspergillus flavus, as an alkaline serine protease

Aspergillus species of fungi have been known to be one of the most prevalent aeroallergens. One important A. flavus allergen (Asp fl 1) was identified by means of immunoblotting with a serum pool of allergic patients on a two-dimensional electrophoretic gel. The cDNA coding for Asp fl 1 was cloned and sequenced. The clone encodes a full-length protein of 403 amino acid precursors of 42 kDa. After cleavage of a putative signal peptide of 21 amino acids and a prepeptide of 100 amino acids, a mature protein of 282 amino acids was obtained with a molecular mass of 33 kDa and a pI of 6.3. A degree of identity was found in a range of 27 to 84% among related allergens derived from bacteria allergen subtilisin, mold allergen Pen c 1, and virulence factor of A. fumigatus. Recombinant Asp fl 1 (rAsp fl 1) was cloned into vector pQE-30 and expressed in E. coli M15 as a histidine-tag fusion protein and purified to homogeneity. The IgE binding capacity of rAsp fl 1 was tested by immunoblotting using a serum pool of Aspergillus-allergic patients. Recombinant allergen cross-reacted strongly with IgE specific for natural Asp fl 1 and Pen c 1, indicating that common IgE epitopes may exist between allergens of A. flavus and P. citrinum.

Retrospective analysis of 196 patients with suspected pulmonary thromboembolism

BACKGROUND

There has not been a statistical analysis reporting on patients with pulmonary thromboembolism (PE) in Taiwan. To identify the most common manifestations in patients with PE in Taiwan, we conducted this retrospective study.

METHODS

We collected and analyzed the medical records of 196 patients (53 men, mean age, 60 years; 143 women, mean age, 46 years) whose clinical symptoms and signs, chest radiographs and lung scan findings were suggestive of PE. Conventional chest radiography was performed 24 hours to 48 hours before lung scans. The radiopharmaceuticals used in lung scans were 133Xenon for ventilation studies and 99mTechnetium macroaggregated albumin for perfusion studies. All patients had received anticoagulant therapy (heparin and coumadin) to improve PE.

RESULTS

The two most common symptoms and signs of PE in the 196 patients were dyspnea (172/196, 87.8%) and tachypnea (176/196, 89.8%). The most common abnormal finding on chest radiography was increased lung markings, which were present in about 36.7% (72/196) of patients. Lung scans showed two or more, large, mismatched, segmental defects (high probability of PE) in both lungs in about 88.8% (174/196) of patients. After anticoagulant therapy, PE, as seen on lung scans, was resolved within four weeks in approximately 93.9% (184/196) of patients.

CONCLUSIONS

In Taiwan, a woman aged 40 to 50 years, with no prior history of other medical problems or surgical procedures, with sudden onset of dyspnea or tachypnea, normal or increased lung markings on chest radiography and two or more large mismatched segmental defects on lung scans, is at greatest risk of developing PE. Most patients with PE showed a good response to anticoagulant therapy within four weeks.

Expression of the crustacean hyperglycaemic hormones and the gonad-inhibiting hormone during the reproductive cycle of the female American lobster Homarus americanus

Crustacean reproduction is regulated by a complex chain of hormonal interactions in which the crustacean hyperglycaemic hormones A and B (CHH-A and CHH-B) and the gonad-inhibiting hormone (GIH) play a primary role. These neurohormones are produced in the same neuroendocrine cells of the X-organ sinus gland complex, situated in the eyestalks of the American lobster, Homarus americanus. In order to obtain more information on the synthesis, storage, release and function of these three neuropeptides during the reproductive cycle, we studied the levels of their mRNAs in the X-organ, their peptide storage in the sinus gland and their concentration in the haemolymph at different stages of the female reproductive cycle. A high CHH-A mRNA level was found only in the previtellogenic stage, while elevated mRNA levels were determined for CHH-B in the mature as well as the previtellogenic stage. High CHH storage levels in the sinus gland were found during previtellogenesis. The total amount of CHH (CHH-A plus -B) in the haemolymph was significantly higher during maturation. A low level of GIH mRNA in the X-organ and a low amount of the GIH I isoform in the sinus gland were found only in the immature stage. In contrast, GIH haemolymph levels were high during the immature and previtellogenic stages. We conclude that CHH-A and -B are involved in triggering the onset of vitellogenesis and that CHH-B in particular is responsible for stimulating oocyte maturation before spawning, while GIH prevents the start of vitellogenesis in the ovary. Moreover, our results show that the balance between the haemolymph levels of the CHHs and GIH may tune the synchronization of reproduction and molting during the biannual reproductive cycle of the American lobster.

Prediction of the severity of haemolytic disease of the newborn. Quantitative IgG anti-D subclass determinations explain the correlation with functional assay results

Sera containing anti-D, taken from 44 RhD-negative women with RhD-positive infants, were tested in antibody-dependent cellular cytotoxicity (ADCC) and monocyte monolayer assays (MMA) which used similar target and effector cell populations. In addition, the anti-D concentration was measured in the Auto Analyzer and the number of IgG1 and IgG3 anti-D molecules bound to the target red cells was measured by flow cytometry. The results of the functional assays and Auto Analyzer quantitation were examined for correlation with IgG subclass quantitation and all results were compared for their ability to predict the severity of haemolytic disease of the newborn (HDN). ADCC correctly predicted HDN in 39/44 (88.6%) cases, Auto Analyzer quantitation in 35/44 (79.5%) and the MMA in 32/44 (72.7%). For all three assays, the number of correct predictions was highest when the maternal serum contained both IgG1 and IgG3 anti-D. ADCC activity and HDN were correlated with the number of cell-bound IgG1 molecules (r > or = 0.58), but MMA activity was most closely correlated with the number of cell-bound IgG3 molecules (r = 0.68). Hence the superior predictive value of ADCC is due to its ability to reflect the IgG1 component of maternal anti-D, which has a better correlation than IgG3 anti-D with the severity of HDN.

Primary malignant cardiac tumor: an analysis of seven cases

BACKGROUND

Primary malignant cardiac tumor is a rare disorder which has a myriad of clinical manifestations. It dominates about one-fourth of all cardiac tumors, exhibiting typically malignant histological characteristics and invasive behavior.

METHODS

Seven cases of primary malignant cardiac tumor were collected over eight years (1985-1993) in this hospital. Each case had different manifestations. All cases were diagnosed by physical examination, echocardiogram and were subsequently proved by tissue pathology.

RESULTS

The majority of these seven cases of primary malignant cardiac tumor had clinical symptoms of chest distress, shortness of breath and paroxysmal nocturnal dyspnea. The relatively young ages of the patients ranged from 11 to 62 years. One case of angiosarcoma, one case of fibrosarcoma, one case of leiomyosarcoma and three cases of lymphoma had the characteristics of cardiac hemodynamic obstruction which was induced by location and size of the tumors in the heart. Five cases of those primary malignant cardiac tumor were mortal; the average life span was nine months following surgical resection and chemotherapy.

CONCLUSIONS

From a clinical viewpoint, primary malignant cardiac tumor characteristically displays a rapid downhill course. Death most often occurs from a few weeks to two years after the onset of symptoms. Because these tumors are rare and have a poor clinical outcome, early diagnosis and treatment are vital.

Role of plasma catecholamines, autonomic, and left ventricular function in normotensive and hypotension prone dialysis patients

The current study looked at plasma catecholamines, clinical autonomic function tests, and hemodynamic parameters in 10 ESRD patients (five men and five woman, aged 56.4 +/- 3.6) with dialysis hypotension and 10 patients (five men and five women, aged 58.6 +/- 4.2) without dialysis hypotension. Catecholamines were measured using high performance liquid chromatography--electrochemical detection (HPLC-ECD). Dialysis led to a significant decrease in mean arterial pressure (MAP) in the hypotensive group as compared with the normotensive group. Significantly higher basal (predialysis) plasma norepinephrine (NE) and dopamine levels (DA) were found in the hypotensive uremic group as compared with the normotensive group. Levels of plasma epinephrine (EP) were not significantly different between the normotensive and hypotensive groups. In response to postural stimulation, blood pressure fell in both groups, but the fall in the hypotensive group was significantly greater. Percentage increments of plasma catecholamines in response to postural stimulation in both groups were similar, however. Among the measured hemodynamic parameters, including total peripheral vascular resistance and left ventricular function (cardiac index and fractional shortening), only the cardiac index showed significantly lower values in the hypotensive group after dialysis, as compared with the normotensive group. Results of four tests of autonomic function indicated that although both groups responded similarly to hand-grip and cold-pressor tests, impaired responses to orthostasis and Valsalva maneuver after dialysis were observed in the hypotensive group. The MAP changes in dialysis in the hypotension prone group correlated inversely with predialysis plasma NE, but not with EP and DA.(ABSTRACT TRUNCATED AT 250 WORDS)

De Vega's semicircular annuloplasty for tricuspid valve regurgitation

Moderate to severe functional tricuspid regurgitation was found in 26% of cardiac surgical patients with mitral or aortic valvular disease at Tri-Service General Hospital in Taiwan. Almost all patients were able to receive de Vega's annuloplasties. After a mean follow-up period of 20 months, none of the 63 patients had moderate or severe tricuspid regurgitation. There was no heart block or right atrial thrombosis; the single late death was not related to the heart disease. De Vega's tricuspid annuloplasty is considered to be a safe, effective, and durable procedure in the treatment of functional tricuspid regurgitation. Compared with tricuspid valve replacement and other types of annuloplasty, the de Vega is the first choice here.