Prevalence of HCV infection in immunocompromised children and adults: evaluation of a novel screening test

It has been recently hypothesized that the hepatitis C virus [HCV] might be involved in the pathogenesis of lymphoproliferative disorders [LPD], systemic lupus erythomatosus [SLE], nephrotic syndrome and renal failure [RF]. The aim of this study is to determine the prevalence of HCV infection among immunocompromised patients and a trial to assess the sensitivity of HCV core antigen [HCVcAg] testing as a screening method compared to PCR-RNA in these patients. The study included 75 patients with malignant lymphoproliferative disease [LPD] under long term chemotherapy including immunosuppressive therapy [30 children and 45 adults] [group II], 46 chronic renal failure patients under hemodialysis [10 children and 36 adults] [group III], 20 systemic lupus erythematosus patients [SLE] under long term immunosuppressive therapy [10 children and 10 adults], group IV and 30 nephrotic syndrome patients under long term immunosuppressive therapy [20 children and 10 adults] [group V]. Thirty healthy subjects were included as controls [group I]. HCV detection by HCV-antibodies, HCVcAg and HCV PCR were done for all patients and controls. The results showed that there was significantly increased prevalence rates of HCV infection among immunocompromised patients. Positivity was 53.33% in LPD group, 47.83% in chronic renal failure group, 45% in SLE group and 33.33% in nephrotic syndrome group. Also our results revealed that, in studied patients [children and adults], HCVcAg in comparison to PCR had diagnostic sensitivity of 100%, specificity of 98.38%, accuracy of 99%, positive predictive value of 97.53% and negative predictive value of 100%. [1] immunocompromised patients have a higher prevalence rate of HCV infection. [2] increased prevalence were significantly higher in patients with non-Hodgkin's lymphoma [NHL], membranoproliferative glomerulonephritis [MPGN] and with the increased duration of hemodialysis in patients with chronic renal failure. [3] HCV infection may play an important role as a risk factor in both lymphoproliferative disorders, and clinical pattern of SLE. [4] HCVcAg maybe considered as an alternative to HCV-RNA assay in screening of HCV infection

Long-term visual field changes in diabetic papillopathy

Is to evaluate the fundus and central visual field changes in patients with diabetic papillopathy after long term follow up. Twelve patients [14 eyes] with diabetic papillopathy were followed up for at least 3 years. Full clinical ophthalmological evaluation, colour fundus photography, fluorescein angiography and central automated perimetry were repeatedly performed initially and at specific intervals. All eyes presented with hyperemic optic' disc edema and minimal or no evidence of optic nerve dysfunction. Within 3-12 months, the optic disc edema completely resolved. At 1 year and later on, pallor and hypofluorescence of the optic disc and peripapillary choroidal atrophy were observed in 12 eyes. In central perimetry, enlarged blind spot only or in association with scattered scotomata was initially seen in most eyes. At 1 year, recovery of the previously detected field defects was seen in most eyes, but persistent minor defects were seen in few eyes. At 2 year and later on, inferior altitudinal and superior arcuate field defects with marked depression of the retinal sensitivity were more commonly seen. Inferior arcuate defect and superior scattered scotomata with moderate reduction of the retinal sensitivity were less commonly noticed. In all eyes, the central 5-100° were preserved. These visual field defects were not associated with corresponding retinal or significant tonometric changes. -Diabetic papillopathy may not be as benign as described before, and an ischemic factor may play a role in its pathogenesis