ABSTRACT
Hepatocellular carcinoma [HCC] is a common malignancy over the world and Egypt, specially related to viral [B, C] hepatitis and cirrhosis. In many patients, imaging radiology is not conclusive in diagnosis of HCC, so tumor markers may help to solve the problem. Alpha fetoprotein [AFP] and Carbohydrate antigen 19-9 [CA 19-9] are used in this situation. This study was done on 60 patients divided into 2 groups: group I; 30 patients with HCC and group II: 30 patients with chronic liver diseases with or without cirrhosis. The results were: demographic case distribution; HCC is still of old age group [>52 years], more in males [70%] than in females [30%], farmers [40%] more than other jobs, rural population [60%] than urban [40%], related to HCV infection [96%] and HBV infection [23%]. AFP and CA 19-9 were highly significant in serum of HCC group than group II. There was no correlation between the level of both AFP and CA19-9 and biochemical liver tests, number or size of the tumor. But there is high correlation with histopathology of the tumor. By using ROC curve, the best cut-off of AFP is 25 ng/ml with a sensitivity and specificity of 86.7%, and for CA19-9, it was 97 u/ml with a sensitivity of 53.3% and specificity of 86.7%. CA19-9 enhance AFP in diagnosis of HCC in 30% of cases. So, using CA19-9 in combination with APP can increase diagnosis of HCC in hepatic focal lesion by 30%. But, we still need other sensitive and specific non invasive technique for diagnosis of HCC
ABSTRACT
Background and Aim: Helicobacter pylori [H. pylori] is one of the most common human bacterial infections worldwide. Knowledge of the epidemiology and mode of transmission of H. pylori is important to prevent its spread especially in areas that have high rates of gastric lymphoma, gastric cancer, and gastric ulcer. Therefore understanding the transmission routes of H. pylori in early childhood is essential to prevent infants from being infected with this organism. The aim of the present study was to investigate maternal and infantile H. pylori infection status and to determine the potential role of mother- to-child transmission in the early childhood
Subjects and Methods: This study was carried out on 69 mothers and their infants. The age of mothers ranged from 16-40 Ys. [Mean 25+/-5.2Ys]. The age of the infants raged from 1-20 months, with mean 8.4+/- 5.3 months. A full clinical history, demographic, and dietary data for mothers and their infants were recorded. From the mothers, plaque samples and breast milk from mothers who practicing normal breast-fed were collected. Artificial milk samples from bottles of artificially fed infants were also collected. From all infants stool samples were collected. The different samples were cultivated on chocolate agar, and Dents medium. Colonies that exhibited characteristics of colonial morphology were identified as H. pylori by gram staining, rapid urease test, oxidase test, catalase test, and nitrate reduction test
Results: H. pylori was isolated from 5[7.2%] out of 69 stool samples of the infants. Three infants, representing 60% of the infected infants, were belong to mothers had H. pylori in both their milk and dental plaque samples, while two infants [40%] were found to have H. pylori infected stool samples without corresponding infection in their mothers. H. pylori was isolated from 3[4.7%] out of 64 breast milk samples while artificial milk was negative for H. pylori infection. Dental plaque samples revealed H. pylori in 12 [17.4%] out of 69 samples. Totally 13[18.8%] out of 69 mothers were found to be infected with H. pylori, with 2[2.9%] mothers had H. pylori in both their milk and dental plaque samples. All infected patients were belonged to families with low or middle socioeconomic status. No significant correlation was found between number of individual in the family and infection with H. pylori with p-value = 0.4. Also no significant correlation was found between H. pylori infection and the order of lactating infants in the family as a socioeconomic variable with p-value = 0.7. There was a significant correlation between the level of education and H. pylori infection. A highly significant correlation was found between isolation of H. pylori and the source of drinking water with p- value < 0.01. Infections in families that using ground water were significantly higher than in families using tap water. All five isolated cases of H. pylori from stool samples were isolated from infants on normal breast-feeding
Conclusions: Infections are acquired in early childhood and risk factors associated with childhood infection include lower socioeconomic status, low education, poor sanitation, and poor quality water supply. The oral-oral and fecal-oral route may be an important ways in the transmission from mothers to children. Dental plaque can serve as reservoir of H. pylori and may be a potential source for infection from mothers to their infants. Breast-feeding does not protect against H. pylori infection and further studies are needed to clarify the role of breast-feeding in acquisition of H. pylori infection. The knowledge that an infected mother could be the important agent for transmitting H. pylori to her infant could allow the development of strategies to prevent transmission of the infection