Andrés Jenuer Matta

La infección por Helicobacter pylori (H. pylori) es dinámica en la población pediátrica, aumentando con la edad. Existen varias pruebas diagnósticas disponibles y eficaces en la identificación de personas infectadas y no infectadas, sin embargo, todavía es necesaria una prueba no invasiva, fiable y tolerable en niños. Objetivo: Estimar la validez de las pruebas de H. pylori en niños en Cali, Colombia. Pacientes y Método: Se incluyeron 236 niños menores de 10 años sintomáticos referidos a endoscopía digestiva alta para evaluación de dolor abdominal, reflujo gastroesofágico, vomito, dispepsia o diarrea. Se utilizaron tres pruebas diagnósticas para determinar la infección por H. pylori: [13C]- Prueba de aliento con urea (UBT), Prueba de antígeno en heces de H. pylori (HpSA) y antígeno sérico de H. pylori por ELISA. La validez se evaluó mediante análisis de sensibilidad y especificidad, estableciendo el diagnóstico de la infección por H. pylori basado en el estudio histológico de las biopsias de mucosa gástrica, como método de referencia. Resultados: La prevalencia estimada de H. pylori en las tres pruebas varió de 1,12 a 27,3%, similar a lo reportado por evaluación histológica (21,6%). La sensibilidad encontrada a través del análisis convencional (2x2) para la prueba del HpSA fue de 97,9%, y para la prueba UBT y el antígeno sérico de H. pylori fue de 87,5% y 88,2%, respectivamente. Se encontró una mayor sensibilidad en las tres pruebas cuando se utilizó el análisis de clase latente, especialmente en la prueba HpSA que fue igual a la prueba histopatológica de referencia (100%). Conclusión: La prueba del HpSA arrojó la mejor discriminación tanto en niños infectados como sanos, menores de 10 años, en Cali-Colombia.

Introduction Blood biomarkers are measurable metabolic products that allow objective monitoring of the training process, and their analysis provides an opportunity to improve athletic performance. Objective To evaluate blood lactate concentrations in a group of the Valle League weightlifting athletes as a tool to determine the effects of training and its direct relationship to performance during competition. Methods This is an observational cross-sectional study. Lactate levels of 32 weightlifting athletes belonging to the Valle Weightlifting League were evaluated. Blood samples were taken from the ear lobe to quantify the lactate concentration, using a Scout Lactate analyzer. Samples were taken before and after a high intensity training section consisting of four maximum repetition (MR) sports gestures, in which 5 series and 15 repetitions were performed for each sports gesture, with a rest period of 40 seconds between each exercise. The software program SPSS, version 25, was used to determine the lactate concentrations. Results An average lactate concentration 22.46 mg/dL was obtained for the athletes at rest, and an average of 98.30 mg/dL in the final lactate concentration, after high intensity exercise. Significant differences were found between the initial and final lactate concentrations. Conclusion Lactate concentration increases with physical activity; it varies from one individual to another; and it can be used as a biomarker of intensity of physical activity in the field of sports. Level of evidence; II type of study: Prognostic Studies Investigating the Effect of a Patient Characteristic on a disease outcome.

Introduction: Inflammation associated with Helicobacter pylori (H. pylori) infection is linked to the development of a gastric precancerous lesion. Helminth infections could influence the pro-inflammatory response to such infection from LTCD4+ Th1 to a less harmful LTCD4+ Th2 response.Objective: To characterize the polarization of the LTCD4+ Th2 immune response in co-infected patients with H. pylori and helminths from low-risk areas for developing gastric cancer.Patients and Method: We analyzed 63 patients infected by H. pylori (40 adults and 23 children). Through the Multiplex Analysis technology (xMAP), we determined the serum profiles of the interleukins associated with the polarization of the immune response of LTCD4+ Th1 (IL-1β, INF-γ, TNF-α) as well as the LTCD4+ Th2 (IL-4, IL-10, and IL-13). The ratio between helminths co-infection status in H. pylori-infected patients and the polarization of the immune response mediated by LTCD4+ Th1 and LTCD4+ Th2 was assessed using a Mixed Effects Logistic Regression Model.Results: The frequency of helminths was similar between adults (15%) and children (17%). The polarization of the immune response was more prevalent in LTCD4+ Th1. Serum values of interleukins associated with the immune response polarization of LTCD4+ Th1 (IL-1β, INF-γ, and TNF-α) and LTCD4+ Th2 (IL-4, IL-10, and IL-13) were independent of helminths infection status.Conclusion: The prevalence of intestinal parasitic infection was high and the immune response polarization was mainly LTCD4 + Th1.

FULL TEXT PDF La inflamación asociada con la infección por Helicobacter pylori (H. pylori) se relaciona con la progresión de las lesiones precancerosas gástricas. Las infecciones por helmintos podrían modular la respuesta proinflamatoria a la infección por H. pylori desde un perfil tipo LTCD4⁺ Th1 hacia una respuesta menos perjudicial tipo LTCD4⁺ Th2. Objetivo: caracterizar la polarización de la respuesta inmune tipo LTCD4⁺ Th1/Th2 de pacientes coinfectados por H. pylori y helmintiasis procedentes de áreas de bajo riego para el desarrollo de cáncer gástrico. Pacientes y Método: Se analizaron 63 pacientes, 40 adultos y 23 niños infectados con H. pylori. La determinación de los perfiles séricos de las interleucinas asociadas con la polarización de la respuesta inmune tipo LTCD4⁺ Th1 (IL-1β, INF-γ y TNF-α) y tipo LTCD4⁺ Th2 (IL-4, IL-10 e IL-13) se realizó con Análisis Multiplex (xMAP). La relación entre el estado de coinfección por helmintos en pacientes infectados con H. pylori y la polarización de la respuesta inmune mediada por LTCD4⁺ Th1 y LTCD4⁺ Th2, se estudió con un modelo de regresión logístico de efectos mixtos. Resultados: La frecuencia de helmintos fue similar en adultos (15%) y niños (17%). La polarización de la respuesta inmune fue más prevalente hacia el tipo LTCD4⁺ Th1. Los valores séricos de las interleucinas asociadas con la polarización de la respuesta inmune tipo LTCD4⁺ Th1 (IL-1β, INF-γ y TNF-α) y tipo LTCD4⁺ Th2 (IL-4, IL-10 e IL-13) fueron independientes del estado de infestación por helmintos. Conclusión: La prevalencia de infección por parasitismo intestinal fue alta y la polarización de la respuesta inmune fue predominantemente hacia un perfil tipo LTCD4 + Th1.

To characterize punctual mutations in 23S rRNA gene of clarithromycin-resistant Helicobacter pylori (H. pylori) and determine their association with therapeutic failure. PCR products of 23S rRNA gene V domain of 74 H. pylori isolates; 34 resistant to clarithromycin (29 from a low-risk gastric cancer (GC) population: Tumaco-Colombia, and 5 from a high-risk population: Tuquerres-Colombia) and 40 from a susceptible population (28 from Tumaco and 12 from Túquerres) were sequenced using capillary electrophoresis. The concordance between mutations of V domain 23S rRNA gene of H. pylori and therapeutic failure was determined using the Kappa coefficient and McNemar's test was performed to determine the relationship between H. pylori mutations and clarithromycin resistance. 23S rRNA gene from H. pylori was amplified in 56/74 isolates, of which 25 were resistant to clarithromycin (20 from Tumaco and 5 from Túquerres, respectively). In 17 resistant isolates (13 from Tumaco and 4 from Túquerres) the following mutations were found: A1593T1, A1653G2, C1770T, C1954T1, and G1827C in isolates from Tumaco, and A2144G from Túquerres. The mutations T2183C, A2144G and C2196T in H. pylori isolates resistant to clarithromycin from Colombia are reported for the first time. No association between the H. pylori mutations and in vitro clarithromycin resistance was found. However, therapeutic failure of eradication treatment was associated with mutations of 23S rRNA gene in clarithromycin-resistant H. pylori (κ = 0.71). The therapeutic failure of eradication treatment in the two populations from Colombia was associated with mutations of the 23S rRNA gene in clarithromycin-resistant H. pylori.

To evaluate effect of treatment failure on cagA and vacA genotypes in Helicobacter pylori (H. pylori) isolates from Colombia. One hundred and seventy-six participants infected with H. pylori from Colombia were treated during 14 d with the triple-standard therapy. Six weeks later, eradication was evaluated by ¹³C-Urea breath test. Patients with treatment failure were subjected to endoscopy control; biopsies obtained were used for histopathology and culture. DNA from H. pylori isolates was amplified using primers specific for cagA and vacA genes. The phylogenetic relationships among isolates obtained before and after treatment were established by conglomerate analysis based on random amplified polymorphic DNA (RAPD) fingerprinting. Treatment effectiveness was at 74.6%. Of the participants with treatment failure, 25 accepted subjected to a second endoscopy. Prevalence of post-treatment infection was 64% (16/25) and 40% (10/25) by histology and culture, respectively. Upon comparing the cagA and vacA genotypes found before and after therapy, multiple cagA genotypes (cagA-positive and cagA-negative) were found before treatment; in contrast, cagA-negative genotypes decreased after treatment. vacA s1m1 genotype was highly prevalent in patients before and after therapy. The 3’cagA region was successfully amplified in 95.5% (21/22) of the isolates obtained before and in 81.8% (18/22) of the isolates obtained after treatment. In the isolates obtained from patients with treatment failure, it was found that 72.7% (16/22) presented alterations in the number of EPIYA motifs, compared to isolates found before treatment. Unsuccessful treatment limits colonization by low-virulence strains resulting in partial and selective eradication in mixed infections, and acts on the cagA-positive strains inducing genetic rearrangements in cagA variable region that produces a loss or gain of EPIYA repetitions.

To compare the genomic variability and the multiple colonization of Helicobacter pylori (H. pylori) in patients with chronic gastritis from two Colombian populations with contrast in the risk of developing gastric cancer (GC): Túquerres-Nariño (High risk) and Tumaco-Nariño (Low risk). Four hundred and nine patients from both genders with dyspeptic symptoms were studied. Seventy-two patients were included in whom H. pylori was isolated from three anatomic regions of the gastric mucosa, (31/206) of the high risk population of GC (Túquerres) and (41/203) of the low risk population of GC (Tumaco). The isolates were genotyped by PCR-RAPD. Genetic diversity between the isolates was evaluated by conglomerates analysis and multiple correspondence analyses. The proportion of virulent genotypes of H. pylori was 99% in Túquerres and 94% in Tumaco. The coefficient of similarity of Nei-Li showed greater genetic diversity among isolates of Túquerres (0.13) than those of Tumaco (0.07). After adjusting by age, gender and type of gastritis, the multiple colonization was 1.7 times more frequent in Túquerres than in Tumaco (P = 0.05). In Túquerres, high risk of GC there was a greater probability of multiple colonization by H. pylori. From the analysis of the results of the PCR-RAPD, it was found higher genetic variability in the isolates of H. pylori in the population of high risk for the development of GC.

To evaluate the in vitro effect of amoxicillin and clarithromycin on the cag pathogenicity island (cag PAI). One hundred and forty-nine clinical isolates of Helicobacter pylori (H. pylori) cultured from gastric biopsies from 206 Colombian patients with dyspeptic symptoms from a high-risk area for gastric cancer were included as study material. Antimicrobial susceptibility was determined by the agar dilution method. Resistant isolates at baseline and in amoxicillin and clarithromycin serial dilutions were subjected to genotyping (cagA, vacA alleles s and m), Glu-Pro-Ile-Tyr-Ala (EPIYA) polymerase chain reaction and random amplified polymorphic DNA (RAPD). Images of the RAPD amplicons were analyzed by Gel-Pro Analyzer 4.5 program. Cluster analyses was done using SPSS 15.0 statistical package, where each of the fingerprint bands were denoted as variables. Dendrograms were designed by following Ward's clustering method and the estimation of distances between each pair of H. pylori isolates was calculated with the squared Euclidean distance. Resistance rates were 4% for amoxicillin and 2.7% for clarithromycin with 2% double resistances. Genotyping evidenced a high prevalence of the genotype cagA-positive/vacA s1m1. The 3' region of cagA gene was successfully amplified in 92.3% (12/13) of the baseline resistant isolates and in 60% (36/60) of the resistant isolates growing in antibiotic dilutions. Upon observing the distribution of the number of EPIYA repetitions in each dilution with respect to baseline isolates, it was found that in 61.5% (8/13) of the baseline isolates, a change in the number of EPIYA repetitions lowered antibiotic pressure. The gain and loss of EPIYA motifs resulted in a diversity of H. pylori subclones after bacterial adjustment to changing conditions product of antibiotic pressure. RAPD PCR evidenced the close clonal relationship between baseline isolates and isolates growing in antibiotic dilutions. Antibiotic pressure does not induce loss of the cag pathogenicity island, but it can lead--in most cases--to genetic rearrangements within the 3' region cagA of the founding bacteria that can affect the level of tyrosine phosphorylation impacting on its cellular effects and lead to divergence of cagA-positive subclones.