ABSTRACT
Introduction: The prevalence of anti-hepatitis C virus [anti-HCV] positivity among dialysis patients varies across countries, ranging from 3 to 75%; unfortunately, Egypt is considered one of the countries with the highest prevalence despite the existence of guidelines for a comprehensive infection control program
Aims: This retrospective multicenter study was conducted to [a] assess the prevalence of HCV among hemodialysis [HD] patients in Cairo governorate sector B [north Cairo] in March and April 2011, [b] determine the incidence of HCV seroconversion, and [c] delineate events and factors correlated to HCV seroconversion
Patients and methods: This study was conducted on 987 patients who were evaluated using a questionnaire for assessment of risk factors for HCV transmission, including age, sex, duration of HD, previous blood transfusion, previous surgery, isolation procedures in the centers, switching dialysis centers, vascular access used, history of schistosomiasis, history of HBsAg, family history of HCV, the cause of chronic kidney disease, HCV antibodies at the start of HD, and timing of seroconversion. Data were collected and statistically analyzed
Results: The study included a total number of 987 patients who attended 22 HD centers; 55.9% of them were male. The age of most of the patients ranged from 50 to 60 years. The most common causes of end-stage renal disease were unknown in 36%, hypertension in 20%, and diabetes mellitus in 17.8%. The prevalence of HCV antibody [HCV Ab] at the start of dialysis was 45.2%, and the prevalence of HCV Ab by the time of data collection was 51%; the incidence rate of seroconversion was 10.7% after a mean duration of dialysis of 3.35 +/- 2.048 years. Univariate analysis showed that blood transfusion, switching dialysis, infection control, and vascular access were significant risk factors for seroconversion. Meanwhile multivariate logistic regression analysis showed that switching of dialysis centers, history of blood transfusion, and inappropriate application of infection control measures, besides the HCV-free duration, were significantly associated with HCV seroconversion
Conclusion: HCV transmission in HD centers in Cairo [Egypt] is multifactorial and includes unmodifiable factors such as duration of dialysis and age and modifiable factors that can be adjusted through implementation of strict infection control guidelines, minimization of blood transfusion, expanded use of erythropoietin, and avoiding the switching of dialysis centers
ABSTRACT
Introduction. The abuse of alcohol and drugs is a major public health problem and intoxication is one of the most important risk factors for violence and other causes of injury. The aim of the current study was to evaluate the prevalence of drug and alcohol use associated with injury in adult trauma patients in an inner city trauma unit in Johannesburg. Methods. A cohort of 105 adult trauma patients admitted to our university trauma unit and its allied medicolegal laboratory were studied in order to provide prospective data and enable us to correlate the prevalence and type of substance abuse with the demographics and injury patterns after major trauma. Results. Forty-five patients required resuscitation at the Johannesburg Hospital Trauma Unit (JHTU) and 60 patients were examined at the Johannesburg Medicolegal Laboratory (JMLL); giving a total of 105 patients. Blood alcohol concentration (BAC) was positive in 59of the patients. The average BAC in the trauma unit patients was 37 mmol/l (0.17 g/dl) ; more than three times the legal limit for driving. Of the patients 43.7were positive for urinary cannabis; women were statistically significantly more likely to have taken cannabis than men (p = 0.039). There was no difference in rates of exposure to cannabis or alcohol in patients who were the victims of interpersonal violence compared with the victims of accidents (p = 0.17). Only 3 patients had taken other drugs of abuse; 2 had taken Mandrax (methaqualone) and 1 amphetamine. Conclusion. Alcohol and cannabis are commonly misused by trauma patients in Johannesburg; the degree of misuse of other drugs appears to be low. Intoxication is a significant risk factor for violence and accidents and the resultant injuries are a massive burden on our society. Doctors have a responsibility to highlight the association between substance misuse and trauma and should also attempt to persuade individual trauma patients to reduce future alcohol consumption