Prevalence of occult hepatitis C virus in patients with HCV-antibody positivity and serum HCV RNA negativity

Introduction and aim: chronic hepatitis C infection [CHC] is a global health-care problem with an increasing burden year-by-year, particularly in Egypt. Even with the advent of high sensitive techniques, a subset of patients with positive HCV-Ab and negative HCV-viremia remain challenging. Therefore, we herein tried to determine the prevalence of occult HCV infection in peripherd blood mononuclear cells [PBMCs] of Patients presented with positive serologic test for anti-HCV-Ab and negative serum HCV-RNA-PCR [spontaneously cleared-patients] and also, we followed up those patients

Patients and Methods: between March 2010 to March 2015, a prospective study was designed to include all consecutive patients with HCV-Ab positivity and HCV-RNA negativity who attended to Assiut unit for treatment of viral hepatitis; sector of national committee for contrbl of viral hepatitis. A total of 25 patients were recruited. Spontaneous clearance of serum HCV infection was approved by [HCV-Ab positive using two 3rd generation ELISA tests and serum HCV RNA negative in three consecutive occasion each six months apart]. Follow up serum HCV RNA for patients with Occult 1 HCV Infection every 6 months. The RNA extraction step was performed by a protocol modified from, that of the QIAamp viral RNA kits [Qiagen, courtaboeuf, France]. Blood samples for separation of I PBMCs were collected from all patients. PBMCs were obtained using Ficoll-Hypaque density gradient of EDTA anticoagulated blood according to the manufacturer's instructions [Lymphoflot, Biotest,Dreleich, Germany]. Detection of HCV viral load was performed by kit supplied by applied Biosystem [HCV RT-PCR Kit lot No.]

Results: a total of 25 [21 males, mean age 36.2 +/- 9.1] patients who cleared HCV spontaneously [HCV- Ab positive and serum HCV RNA negative]. The genomic HCV RNA was detected in PBMCs from 3 [12%] of 25 patients. Follow up for those three patients with occult HCV infection were done for 18 months by measuring serum HCV RNA by using highly sensitive real-time Polymerase Chain Reaction [RT-PCR] every 6 months, only single patient became overt HCV with low level of viremia

Conclusion: occult HCV infection was detected in a considerable prevalence in patients in whom apparent clearance of HCV-viral load occurred that entails corporations of HCV-viral assay in PBMCs into the diagnostic algorithm

Psychiatric profiles in patients with liver cirrhosis

Psychiatric disorders are common comorbidities in patients with liver cirrhosis that may impair patients' quality of life. The purpose of this study was to evaluate the common psychiatric disorders in cirrhotic patients in our locality. Subjects and Psychiatric disorders were prospectively assessed by administration of Symptom Checklist-90 revised [SCL-90-R], Hamilton anxiety rating scale, and Hamilton Checklist of Symptoms of depressive illness to 200 patients with liver cirrhosis and 200 control volunteers of matched age. In addition, clinical data, abdominal ultrasonography and laboratory data [liver function tests for patients] were collected. Results. Compared with controls, cirrhotic patients were significantly more likely to have depression [43.5% versus 14%, P< 0.001], anxiety [16.5% versus 5.5% P< 0.001] and increased mean scores of SCL-90-R subscales ['e.g. somatizalion, depression and hostility,]. Increasing severity of liver cirrhosis [based on the Child-Pugh score] was associated with increased frequency of Psychiatric disorders. Compared with the control group, patients with liver cirrhosis showed significantly higher frequency of comorbid psychiatric disorders which is increased by worsening disease severity

Laminarin enhanced immunological disorders of septicimeric albino rats infected with aeromonas hydrophila

Aeromonas hydrophila is increasingly recognized as a pathogen of man that gives rise to both intestinal and extraintestinal infection. This study examined the effect of one the immunostimulants; fungal cell-wall beta-1, 3-D-glucan [Laminarin] on the immune response to Aeromonas hydrophila in albino rats. Intraperitoneal injection of 0.2 ml of 1% laminarin [15 mg/100 g b.wt] stimulated humoral immunity. On the ninth day, after application of laminarin in vivo, a statistically higher value of total Ig [p < 0.05] was observed. At the same time, serum total immunoglobulins [25.5 +/- 2] g/L in bacterial groups were significantly higher [p <0.05], compared to the control group [17 +/- 2] g/L. For Aeromonas infected group, all Ig classes showed increase statistically significant [p<0.05]. On the other hand laminarin groups exhibited reduced values of Ig subclasses but still higher than control values. This was reported for all time period. Rats were divided into 3 equal groups designated, Aeromonas infected, Laminarin-treated and control groups. Infection was carrid out by intraperitoneal injection of 2x10[6] bacteria daily for 6 days

Diagnostic value of serum procalcitonin as a marker of bacterial infection in cirrhotic patients with fever

This study was done to evaluate the value of procalcitonin in the diagnosis of the infectious etiology of fever in patients with liver cirrhosis. The study included 41 patients with liver cirrhosis of different grades of severity, 31 of them presented by fever and 10 without fever [considered as a control group]. After thorough investigations, the focal sites of infection were localized in 20 patients [respiratory tract infection in 10 patients, urinary tract infection in 4 cases and spontaneous bacterial peritonitis in 6 cases] and no specific site was detected in 11 patients. Blood culture was positive only in four cases and all were Gram -ve bacilli. A highly significant difference in the mean serum level of procalcitonin [PCT] between cirrhotic patients with fever and those without fever was found. The same was true for serum C-reactive protein [CRP], but no statistical difference was found between the two groups regarding leucocytosis. PCT showed 100% sensitivity and 80% specificity in the diagnosis of infectious etiology of fever in patients with liver cirrhosis. It was concluded that PCT has a diagnostic value in differentiating the infectious etiology of fever in patients with liver cirrhosis and fever. This allows to start early treatment in those immunocompromised patients

Differential diagnosis of ascites: biochemical basis

This study was conducted to detect and assess the value of different biochemical parameters in the serum and ascitic fluid in differential diagnosis of ascites. The study included 50 patients with ascites [26 with liver cirrhosis, 14 malignant and 10 tuberculous]. Serum and ascitic fluid determination of total proteins, albumin, cholesterol, lactic dehydrogenase [LDH], Nitric Oxide [NO], ferritin and glucose. The mean value of total serum proteins and albumin was low in cirrhotic patients than in malignant and tuberculous ones but no significant difference was found between these groups. Mean values of ascitic fluid serum proteins and albumin was low in cirrhotic patients with a highly significant difference between cirrhotic and both malignant and tuberculous [P < 0.0001], but no significant difference between malignant and tuberculous ascites was found. All cirrhotic patients had SAAG >/= 1.1 [100%] versus 3 [21.5%] of malignant and 5 [50%] of tuberculous group. No significant difference between the mean value of serum cholesterol between the three groups but the mean value of ascitic fluid cholesterol was found [26.8 +/- 5.2, 92.3 +/- 18.8 and 59.5 +/- 9.7 mg/dL] in cirrhotic, malignant and tuberculous respectively. A highly significant difference in mean value of ascitic fluid cholesteral between cirrhotics and both malignant and tuberculous groups [P < 0.0001] was present and a significant difference between malignant and tuberculous [P < 0.05] levels was also found. There was no significant difference between the mean value of serum LDH between the three groups but ascitic fluid LDH was very high in malignant group than both cirrhotic and tuberculous [58.7 +/- 12.4] versus 33.2 +/- 11 and 30.2 +/- 5.6 IU/L]. A highly significant statistical difference in the mean value of ascitic fluid LDH between malignant and each of cirrhotic and tuberculous levels [P < 0.001]. Both NO and ferritin were slightly high in ascitic fluid of cirrhotic and malignant patients but no statistical difference was found between groups either in serum or ascitic fluid. There was no statistical differences between the mean levels of serum glucose in all groups but a significant [P < 0.05] lower level was found in ascitic fluid of the tuberculous group compared with the other two groups. Conclusions: From this study we can conclude that diagnostic paracentesis is a useful procedure. The practice of ordering a battery of tests on every ascitic fluid specimen should be abandoned. Rather, an algorithm approach should be adopted in which the result of initial analysis guide us to further relevant tests that help in arriving at the etiology of ascites. From our result we can apply the following: 1- Ascitic fluid albumin, ascitic fluid/serum albumin, total proteins and SAAG are the best parameters for diagnosis of sterile cirrhotic ascites. 2- Ascitic fluid cholesterol and LDH in combination in addition to high ascitic fluid proteins are useful for diagnosis of malignant ascites. 3- Ascitic fluid glucose, ascitic fluid/serum glucose ratio and high ascitic fluid total proteins were preferred for diagnosing tuberculous ascites

Clinical and therapeutic aspects of typhoid fever in Upper Egypt

This study included 160 patients [97 males and 63 females, their ages ranged from 3 to 45 years with a mean of 14.66 +/- 7.62 SD] suspected clinically to be typhoid or paratyphoid fevers. They were classified into two groups: Group I, included 93 patients who were blood culture-positive for salmonella and group II, included 67 patients who were culture-negative for salmonella. The criteria of inclusion included patients presenting with fever five days or more with apparent toxemia, headache, coated tongue and with or without splenomegaly. The patients were subjected to full clinical history, general examination, abdominal examination, routine investigations [abdominal ultrasonography, chest X-ray, ECG, urinalysis and stool analysis, complete blood picture, liver function tests and kidney function tests] as well as investigations for the diagnosis of enteric fever, Widal and modified Widal tests to all patients. Serum chloramphenicol level was estimated in 43 patients in group I and in 29 patients in group II and no statistical significant difference was found in the mean level between the two groups. Concerning therapy in the two groups, the response to chloramphenicol was significantly higher in group II in comparison with group I. On the other hand, the resistance to chloramphenicol was significantly higher in group I compared with group II. The responses to antibiotics other than chloramphenicol were similar in the two groups

Comparative study of primary and secondary prevention of bleeding oesophgeal varices

This study included 302 patients with liver cirrhosis and esophageal varices who were classified into five groups; two groups of primary prophylaxis and three groups of secondary prophylaxis. The first group was under propranolol therapy [88 patients] and the second group was the control group [62 patients] with a mean age of 49 years and the mean follow up period was 2.97 +/- 1.88 years for the former and 2.35 +/- 1.1 years for the latter. It was concluded that propranolol is an effective treatment in primary prophylaxis as it decreases the rate of bleeding while increases the need for and the amount of blood transfusion. Also, this study supported the long-term use of propranolol plus endoscopic sclerotherapy for secondary prevention of bleeding esophageal varices

Clinical and upper endoscopic study in patients with dyspepsia

Dyspepsia is a very common clinical disorder as evidenced by reports from different countries allover the world. It is the primary complaint in about 15-40 percent of patients seen by gastroenterologists. As defined by an international working party, the term dyspepsia implies a broad symptoms complex including upper abdominal or retrosternal pain, discomfort, heartburn, nausea, vomiting or other symptoms referable to the proximal alimentary tract. So, classification of dyspepsia into symptoms groups has been proposed to reveal differences in course, investigations and medications. However, data concerning the dyspepsia patterns in our community are lacking. The aim of this work was to: 1] determine the symptoms patterns of dyspepsia in a clinic-based study, and 2] to evaluate symptoms in patients with dyspepsia versus the upper endoscopic findings. This study included 188 adult patients with dyspepsia, 131 males and 57 females. According to their symptoms, 35.1 percent of patients were in the ulcer-like group, 28.2 percent in the dysmotilily-like group, 76.6 percent in the reflux-like group and 17 percent in the unspecified group with an overlap pattern in 46.8 percent of patients. There was no sex or age predilection in any of the 4 dyspepsia groups. Isolated symptoms were found in 38.9 percent of the reflux-like patients, 13.6 percent in ulcer like patients, and in 3.8 percent in the dysmotilily-like patients. There was no statistical difference between patients with isolated symptoms and those with mixed symptoms in relation to the age or sex distribution. Abnormal endoscopic findings were recorded in 155 patients including oesophageal, gastric, and duodenal lesions. Gastritis was the most common findings present in 68 percent of patients. Duodenal lesions were significantly higher in male patients. Mixed lesions [affection of more than one anatomical area] were present in 55.5 percent of patients

Intrafamilial spread of hepatitis C virus, A possible contributing factors for transmission

One hundred and fifty relatives of thirty HCV related CLD [as index cases] and one hundred healthy blood donors as a control group were included. By using ELISA-II, HCV antibodies were detected in 71 of the relatives and in 25 of the controls with a highly significant difference between the two groups. The highest prevalence [60%] was observed among spouses of the index cases versus 44.2% and 44% with offspring and siblings, respectively. A significant increase in anti HCV positivity with increasing ages of relatives and with the duration of marriage was observed. In addition of being relatives of HCV related CLD, history of tattooing, blood transfusion and parenteral anti-bilharzial treatment were significant risk factors for acquiring HCV infection. Long period of contact with the index case, high post bilharzial infection and high mean age could explain the high prevalence among relatives in this study

Serum adenosine deaminase activty in varieties of chronic liver diseases

This study was conducted on 71 patients with chronic liver diseases; 15 with chronic active hepatitis, 41 with liver cirrhosis and 15 with hepatocellular carcinoma [HCC]. Fourteen apparently healthy subjects matched for age and sex with patients shared in the study as controls. The study revealed significantly increased activity levels of ADA in patients with chronic active hepatitis, liver cirrhosis and HCC compared with controls [mean +/- SE, 35.8 +/- 1.1, 54.4 +/- 4.9 and 78.9 +/- 10.6, respectively, versus 20.7 +/- 1.7 in the controls]. The highest mean level was found in patients with HCC. The serum ADA activity levels reflected the status of derangement of liver functions in the patients. This was evident from the significant correlations between their liver functions tests and serum ADA activity levels. Moreover, the latter showed significant positive correlation with the score of modified Child classification i.e. the grade of liver cell failure in cirrhotic patients