Intrafamilial transmission of hepatitis C virus Egypt

We aimed in this work at investigating the possibility of intrafamilial spread of HCV and analyzing its possible transmission routes through studying the HCV Ab and RNA status of 18 multi-transfused index children and 64 of their family members. Fourteen other children who were HCVAb and RNA negative and 36 of their family members were taken as a control group. All candidates of the study were subjected to a detailed questionnaire on risk factors for parentral exposure and eating, social and health habits. It was found that HCV prevalence among family members of the HCV positive index cases was significantly higher than among family members of the control children [31.2% vs 5.9% P < 0.05]. The highest incidence was in mothers [52.9%] followed by fathers [35.5%] then sibs [12.5%]. Index cases with an elevated ALT had a significantly higher number of HCV positive family members than those with a normal ALT [P <0.05]. Social class, age of index case and histological diagnosis of liver disease in the index case did not have a significant impact on the HCV status in family members. Also, there was a significant higher percentage of HCV positive family members among those who shared personal objects with the index case compared to those who didn't [42.5% vs 12.5% P < 0.05]

Endothelin-1 plasma level in children with chronic liver disease: Impact on renal hemodynamics and portal hypertension

The plasma level and pathophysiologic consequences of endothelin-1 [ET1], a potent vasoconstrictor with preferential action on renal vessels, have been investigated in 40 children with chronic liver disease [CLD] [27 males and 13 females; mean age = 8.62 +/- 4.04 years] and 15 sex and age matched clinically healthy children [9 males and 4 females; mean age = 8 +/- 4.17 years]. The children with CLD were divided into 3 subgroups : subgroup I [n = 13] had chronic hepatitis [CH], subgroup II [n = 13] had cirrhosis without ascites and subgroup III [n = 14] had cirrhosis and ascites. The cirrhotic children [n = 27] included 17 children in Child's A class and 10 children in Child's B + C class. Besides routine liver and renal function tests, serum electrolytes as well as a doppler duplex study of the portal vein and the arcuate arteries of both kidneys at the level of the corticomedullary junction, were done to all candidates of the study. The resistive index of renal vessels was calculated. ET-1 level was found to be significantly elevated in all groups of children with CLD. The highest level was in children of subgroup III [x = 4.26 +/- 2.12 ng/ml] followed by those in subgroup II [x = 1.49 +/- 0.61 ng/ml] and lastly came children with CH ie. subgroup I [x = 1.01 +/- 0.46 ng/ml].Children with Child's B+C cirrhosis had a significantly higher level [4.62 +/- 2.4 ng/ml] than those with Child's A cirrhosis [1.93 +/- 1.04 ng/ml]. Serum albumin had a significant negative correlation with ET-1 [r = 0.64] ET-1 level showed a significant negative correlation with serum sodium [r = 0.4]. It correlated positively with portal hypertension as indicated by a positive correlation with portal vein diameter [r = 0.48] and a negative correlation with portal vein flow velocity [r = 0.35]. The resistive index was significantly higher in patients with CLD compared to controls. It showed a significant positive correlation ET-1 [r = 0.49]. Thus, ET-l is elevated in patients with CLD; its elevation being related to the severity of liver disease. It could be involved in the pathophysiology of the hyponatraemia portal hypertension and disturbed renal hemodynamics seen in children with CLD

role of hepatitis C virus in chronic liver disease of infants and children

Hepatitis C virus [HCV] has been increasingly recognized in patients with chronic liver disease [CLD] specially in adults where HCV antibody positivity has been reported to range between 70-80%. It is aimed in this work to identify the role of HCV in Egyptian children with chronic liver disease and its epidemiological, biochemical and histological features through studying a group of ninety one infants and children suffering from CLD. Their ages ranged between 6 months- 18 years [mean 7.75 +/- 4.3 yrs], 43 of them were females and 48 were males. HCV antibody was detected in 10.98% of the patients, HBsAg was positive in another 10.98%. None of the patients was positive for both HCV antibody and HBsAg. The patients were divided into three groups according to their serology; [group 1] HCV antibody positive [10 cases], [group 2] HBsAg positive [10 cases], [group 3] HCV antibody and HBsAg negative [71 cases]. Comparing the three groups has revealed no statistically significant difference between them in age, sex, residence, liver size, spleen size, serum bilirubin, alanine amino-transferase [ALT], aspartate aminotransferase [AST], serum albumin nor prothrombin time [PT]. On the other hand, a history of blood transfusion, surgical intervention or contact with a case of HCV within the family was statistically significant in group 1. There was also a statistically significant difference between group 1 and 3 in the symptomatology of patients [P <0.05] and the hepatic histopathology [P <0.01], group 1 patients being mostly asymptomatic and having chronic lobular hepatitis. Detailed clinical, laboratory, serological and histological description of the HCV antibody positive cases is included

Functional and ultrasonographic renal assessment in children with liver cirrhosis

Twenty Child's grade "A" cirrhotic children [9 cryptogenic, 6 posthepatitic, 2 biliary, 2 following AI CAH and one metabolic] whose ages ranged between 3 and 15 years [mean 7.1 + or ' 3.4 years] were studied clinically, biochemically and ultrasonographically for assessment of their renal performance. Seven normal children served as a control group. Serum creatinine, creatinine clearance and blood urea showed no statistically significant differences between patients and controls [P >0.05 for each]. On the other hand, the mean FENa% in patients [0.49 +/- 0.24%] was statistically significantly lower than that of controls [0.70 +/- 0.23%] [P <0.05] while their FEPO4% [16.77 +/- 7.9%] was statistically significantly higher than that of controls [9.29 +/- 6.5%] [P <0.05]. The patients' mean serum phosphorus [4.24 +/- 0.63 mg/dl] was lower than that of controls [4.86 +/- 0.83 mg/dl] [P <0.05]. Microalbuminuria, an indicator of increased glomerular permeability, was statistically significantly higher in patients [9.75 +/- 23.9 mg/dl] than controls [0.55 +/- 0.08 mg/dl] [P <0.05]. Urinary alpha 1 microglobulin, an indicator of tubular proteinuria, was also higher in patients [12.55 +/- 14.6 mg/g cr] compared to controls [1.98 +/- 4 mg/g cr] [P <0.01]. Microabluminuria correlated significantly and positively with serum creatinine [r = 0.55] and alpha 1 MG [r = 0.54] while it correlated negatively with creatinine clearance [r = 0.45] and serum albumin [r = -0.4]. Alpha 1 MG correlated significantly and positively with serum creatinine [r = 0.72], ALT [r = 0.53] and AST [r = 0.52] while it showed a significant negative correlation with serum albumin [r = -0.44]. Ultrasonographic measurements of right kidney size, left kidney size and renal parenchymal thickness in patients showed no statistically significant difference from those of controls [P >0.05 for each]. Also, all patients except two showed a normal echogenicity. Thus, although the patients with compensated cirrhosis had no clinical or laboratory evidence of renal impairment yet they had microalbuminuria and increased excretion of alpha 1 MG both of which are early predictors of glomerular and tubular dysfunction, respectively