Spontaneous viral clearance of chronic HCV infection in Upper Egypt: a community-based study with a 10 year follow-up

Hepatitis C virus [HCV] infection is a global blood-borne disease with the highest prevalence in Egypt. The natural course of HCV infections in highly variable. The reason why the infection persists in some patients and resolves spontaneously in others is not known. The aim of this study was to detect the frequency of spontaneous clearance of chronic HCV infection in Upper Egypt and to determine the predictors of persistence of HCV infection. In 1997, a community-based study was performed in Sallam village in Upper Egypt. Out of the 329 patients who had the start of the study and those who had received specific treatment for HCV infection. These patients were followed up every six months prospectively starting from 2004 till 2007 by clinical, ultrasonographic, and laboratory examinations [liver functions, complete blood count, prothrombin time and concentration]. Serum HCV-RNA was tested for at the end of the follow up period. After a 10-year follow-up, spontaneous clearance of chronic HCV infection was detected in 35 [17.5%] out of 200 patients. Most of clinical and laboratory abnormalities were detected in patients with HCV-RNA persistence than those who had cleared HCV-RNA. By ultrasonographic examination, normal liver echopattern was found in 30 [85.7%] cases with HCV-RNA clearance and in75 [45.5%] patients who had HCV-RNA persistence. Evidence of liver cirrhosis was found only in 9 cases with HCV-RNA persistence [5.5%]. Old age [>60 years] was the strongest predictor of persistence of HCV infection followed by obesity and history of blood transfusion. Spontaneous clearance of chronic HCV infection could occur without any specific antiviral therapy in 17.5% of patients. Older age was the strongest predictor of persistence of HCV infection followed by obesity and infection by blood transfusion

Impact of nursing intervention on viral hepatitis patient's knowledge affiliated in viral clinic assuit university hospital

The incidence of hepatitis in Egypt is annually increase because the lack of awareness about the disease. Hepatitis is a term covering a broad spectrum of diseases affecting the liver. Infectious forms of hepatitis are relatively common and can cause serious illness and even death. Prevention is the key solution for avoiding the consequences of this disease. The present study aims to impact of nursing intervention on viral hepatitis patient's knowledge affiliated in viral clinic Assuit University Hospital. The subjects of the study consists of 200 patients divided into two groups [100 case and 100 control] their age above 20 years diagnosed with viral hepatitis. Both sexes were included in this study. The results revealed that mean ages 35.78 +/- 10.49, 37.21 +/- 11.25. The majority 84%, 80% of patients in rural areas 87%, 89% male and 85%, 75% were married for the study and control groups respectively. 79%, 81% of patients discovered the disease accidentally. 94%, 89% of patients diagnosed through investigations. 100% of patients define of viral hepatitis correctly on post test for the study group but only 20% for control group. Regarding patients' knowledge about mode of transmission 99% of them through parenteral therapy 97%, 91% for the study and control groups had poor scores on pre test however in post test the majority of the study group 94% had very good score with a highly statistical significant difference. Most of the studied sample obtained low score during the pre test, and the results changed toward progression in the post test regarding patients' knowledge. As a results and in the light of the finding, the authors recommended that health education program should be carried out at a wide areas include rural and urban areas and also to health workers to understand the mode of transmission and precautions to minimize the risk of transmission. Hepatitis B vaccine should available for health care workers and allow a simple information through the media [radio and television]

Surveillance of acute viral hepatitis in a rural Egyptian community

Hepatitis viruses are endemic in Egypt. Many studies have been performed in order to study the pattern of acute viral hepatitis [AVH] in Egypt and all these studies were hospital-based. There is no available literature about the surveillance of AVH in Egypt. The aim of this study was to survey and identify the etiologies of AVH in a rural community in Upper Egypt. The study was performed in Sallam Village near Assiut City. The active surveillance of acute viral hepatitis was performed using house to house survey and frequent visits to rural health unit. All patients were asked using a previously designed questionnaire. General clinical, abdominal examination and abdominal ultrasonographic examination were performed. Liver function tests, different seromarkers and PCR for AVH were performed for all patients. The results showed that AVH was diagnosed in 105 cases. Acute hepatitis A [AHA] was the most frequent cause of AVH [34 cases], followed by AHE [29 cases] and AHB [9 cases]. Acute hepatitis C was diagnosed in only three cases [two of them mixed with AHE], the cause of AVH was unknown in 15.1% of cases. There was no significant difference regarding the clinical and laboratory findings among different etiologies of AVH. Patients with AHE had relatively mild clinical presentation. Nineteen cases had clinical and laboratory evidence of AVH; however they had positive anti-HCV at six months prior to inclusion, so they were diagnosed as chronic hepatitis C. In addition, six cases were excluded from the study and diagnosed as drug- and toxin-induced hepatitis. The ultrasonographic changes of the liver and spleen were nonspecific. The study concluded that the surveillance of AVH in the community is important for the early diagnosis of mild and non-icteric cases and the early detection of epidemics

Outcome of critically ill cirrhotic patients: an evaluation of the different scoring systems

Several prognostic scoring systems have been designed in an attempt to assess the prognosis of critically ill cirrhotic patients. For this purpose three different prognostic scores [APACHE III score, Child-Pugh score and ICCO score] were studied in intensive care unit, Tropical Medicine and Gastroenterology Department, Assiut University Hospital. A total of 187 cirrhotic patients [149 males, 38 females; age range 15-82 year] were prospectively enrolled in this study. At the time of admission, 73 cases [39%] had bleeding oesophageal varices and 114 cases [61%] had hepatic encephalopathy. Grading of overall severity of liver cirrhosis according to different prognostic scores were done for all studied patients. In patients with hepatic encephalopathy, APACHE III score had the highest positive predictive value [75%] while ICCO score had the highest specificity [89.3%]. On the other hand in critically ill cirrhotic patients with bleeding oesphageal varices APACHE III and ICCO scores had equal positive predictive value [79%] but ICCO score had the highest specificity [92%]. If specificity is considered as a predictor of mortality, ICCO score was found to be the best predictor of mortality in cirrhotic patients who presented with bleeding oesophageal varices and with hepatic encephalopathy followed by APACHE III score. As regards individual laboratory parameters, serum bilirubin was found to be the best single parameter predicting mortality in cirrhotic patients presenting with bleeding oesophageal varices [specificity 90% and sensitivity 89. 74%]. On the other hand plasma lactate was found to be the best laboratory parameter predicting mortality in cirrhotic patients presenting with hepatic encephalopathy [83% positive predictive value and 85% specificity ICCO score was the best predictor of mortality in cirrhotic patients with bleeding oesophageal varices and hepatic encephalopathy followed by APACHE III score. Serum bilirubin was the single laboratory parameter predicting mortality in patients presented with bleeding oesophageal varices. Plasma lactate predicting mortality in who those with hepatic encephalopathy