The best method of detecting prior Helicobacter pylorimfection

AIM： Prior Helicobacterpylori （Hpylori infection has often been underestimated. These underestimations have misled physicians attempting to determine the significance between Hpyloriand certain gastrointestinal lesions such as intestinal metaplasia, atrophic gastritis, and gastric cancer. Our study endeavored to debit past Hppylorinfections accurately, easily, and rapidly with the newly developed irnmunoblot kit, Helico Blot 2.1. METHODS： Thirty-three patients, including 25 H pylori infected and 8 uninfected cases, were enrolled in our study. All patients received consecutive gastroendoscopic examinations and ^3C-urea breath test （UBT） tests at 6- or 12-mo intervals for up to 4 years. Serum samples were obtained from each patient at the same time. Intragastric H pylori infection was confirmed in accordance with the gold standard. Twenty-five H pylori-infected patients received triple therapies after initial bacterial confirmation, and were successful in eradicating their infections. Serially obtained sera were tested by means of Helico Blot 2.1. RESULTS： Current infection marker detected by Helico Blot 2.1 was unreliable for representing ongoing Hpylori infection. Only 35 and 37 ku antibodies of H pylorihad significant seroconversion rates 1 year after having been cured. The seroposiUve rates of 116 ku （cytotoxin-associated antigen [CagA]） and Helico Blot 2.1 were nearly 100% during 4-year follow-up period. Both CagA antigen and Helico blot 2.1 could serve as indicators of long-term H pylori infection. CONCLUSION： Helico Blot 2.1 can detect past H pylori infections for up to 4 years, and is the best method to date for detecting previous long-term H pylori infection. 2005 The WJG Press and Elsevier Inc. All rights reserved.

Clinical significance of skin rash in dengue fever:A focus on discomfort,complications,and disease outcome

Objective:To assess whether the cutaneous features in patients with dengue fever are associated with abnormal blood biochemistry,complications,and poor disease outcome.Methods:Forty five patients with dengue fever were identified at a medical center in Kaohsiung,Taiwan,from September to November 2014.All cases were exclusively caused by type 1 dengue virus.Patients were classified into two groups,based on the presence or absence of skin rash,and their rash was subclassified into maculopapular,morbilliform,and petechial types.Clinical symptoms,laboratory data,disease outcome,and complications were compared between the two groups.Results:Thirty two patients with dengue fever developed skin rash(SP group,n=32) while the rest of 13 did not(SN group,n=13).The patient numbers in the maculopapular,morbilliform,and petechial group were 4,21,and 7,respectively.The SP group was younger(P=0.001),experienced more pruritus(P=0.008) and more swollen palms/soles(P=0.015) than the SN group.However,the SN group had greater genital mucosa involvement(P=0.008),higher platelet transfusion rate(P=0.003),and lower hemoglobin and hematocrit levels(P=0.030) than the SP group.Patients with morbilliform lesions had a higher incidence of palm/sole swelling,less genital mucosal involvement,and a lower platelet transfusion rate than did patients with maculopapular or petechial lesions.Conclusions:Cutaneous manifestations provide an important clue to dengue fever.In patients with dengue fever,those with skin rash tend to have itching and swelling of the palms/soles,however,those without skin rash tend to have more complications and poor disease outcomes.

Outcome of In-Hospital Cardiac Arrest in Adult General Wards

Objective: Few studies have focused on factors influencing outcomes of patients with in-hospital cardiac arrest (IHCA) in general wards. The goal of this study was to report the outcomes of adult patients with IHCA in the general wards and identified the prognostic factors. Methods: Adult patients with IHCA having received cardiopulmonary resuscitation in general wards from January 2008 to December 2011 were retrospectively reviewed from our registry system. The primary outcome was survival to hospital discharge, while the secondary outcome was sustained return of spontaneous circulation (ROSC). Results: A total of 544 general ward patients were analyzed for event variables and resuscitation results. The rate of establishing a ROSC was 40.1% and the rate of survival to discharge was 5.1%. Ventricular tachycardia/ventricular fibrillation (VT/VF) was the initial rhythm in 3.9% of patients. Pre-arrest factors including a high Charlson comorbidity index (CCI) ≥ 9 (OR 0.251, 95% CI 0.098 - 0.646), cardiac comorbidity (OR 0.612, 95% CI 0.401 - 0.933), and arrest time on the midnight shift (OR 0.403, 95% CI 0.252 - 0.642) were independently associated with a low possibility of ROSC. The initial VT/VF presenting rhythms (OR 0.135, 95% CI 0.030 - 0.601) were independently associated with a high survival rate, whereas patients with deteriorated disease course were independently associated with a decreased hospital survival (OR 3.902, 95% CI 1.619 - 9.403). Conclusions: We demonstrated that pre-arrest factors can predict patient outcome after IHCA in general wards, including the association of a CCI ≥ 9 and cardiac comorbidity with poor ROSC, and deteriorated disease course as an independent predictor of a low survival rate.