community-based study of viral hepatitis infection in Giza Governorate, Egypt: Seroprevalence, risk factors and associated morbidity

Hepatitis viruses are major causes of acute and chronic liver diseases in Egypt. The aim of this study was to investigate the seroprevalence, risk factors and associated morbidity of viral hepatitis in Giza Governorate, Egypt. The study was conducted in 4 rural and 4 semiurban communities and included 2305 subjects selected by a cluster r and om method. They underwent complete clinical and abdominal ultrasonographic [US] assessment and laboratory tests including stool and urine examination, hemoglobin, ALT estimation and viral hepatitis markers by enzyme immunoassay. The latter included anti-HAV IgG, HBsAg, anti-HBc, anti-HBs, anti-HCV and anti-HEV IgG. Subsets of sera were tested for HBV DNA and HGV RNA by specific PCR. The overall prevalence of anti-HCV was 20.9% [age-adjusted prevalence = 24.5%; CI: 22.7-26.3%] and was significantly rising with age from 10% below age of 20 years to 40% among those above 50 years. The infection rate of hepatitis B virus [HBV] was 57.1% with HBsAg carrier rate of 3.6%. Seropositivity of anti-HBs and anti-HBc was very high [45.8% and 44.7%, respectively] and correlated positively with age with no sex-related difference. Combined HCV and HBV infection was evident in 13% of subjects. HBV DNA was detected in 86% of HBsAg-positive cases and in 20% of HBsAg-negative anti-HBc- and anti-HCV-positive cases. Seromarkers for hepatitis B and C were significantly commoner in semiurban than in rural communities. Dental manipulation and previous parenteral antischistosomal therapy were significant risk factors for hepatitis B and C infection. Anti-HAV was positive in 99.7% whereas anti-HEV was positive in HBV= Hepatitis B virus. CLD = Chronic liver disease. HCC = Hepatocellular carcinoma. US = Ultrasonography. ALT = Alanine transaminase. OR = Odds ratio. CI = Confidence interval. 9.2%. HGV RNA was detected in 16.5% of the studied samples. It was always associated with HBV and /or HCV infection. History of hematemesis was recorded in 1.2% of individuals. US examination revealed hepatomegaly in 19.2% of subjects, splenomegaly in 8.2%, bright liver in 31%, coarse liver texture in 10%, periportal fibrosis in 20% and ascites in 2%. These findings were significantly more common in anti-HCV- and HBsAg-positive subjects. ALT elevation was commonest and highest in individuals with positive HBsAg or with HBV-HCV coinfection. Hepatitis B and C infection and associated morbidity still constitute a great health problem in Egypt. Hepatitis A is holoendemic and hepatitis E is endemic. Hepatitis G is always associated with HBV or HCV infection. Occult hepatitis B should be considered in future studies

Acute upper gastrointestinal bleeding in Kasr El-Aini gastrointestinal endoscopy unit, Cairo, Egypt from the years 1991 to 2000

Acute upper gastrointestinal bleeding [UGIB] is a common and potentially serious problem in Egypt and worldwide. It remains a common cause for hospital admission with constant mortality despite advances in therapy and patient care. Endoscopy is the primary tool for diagnosis of UGIB. The present study aimed at investigating the etiology of UGIB in Egypt and whether any change has occurred in the period from 1991 to 2000. Files of patients undergoing upper GI endoscopy in one of the largest endoscopy units in Egypt [Kasr-El-Aini hospital, Cairo University, Cairo] during this period have been reviewed and analyzed. From 11567 patients who underwent upper GI endoscopy, 1763 [15.2%] had active or recent UGIB, mostly in the form of hematemesis and melena. Most of these patients were males [64.5%] with no age predilection. The commonest finding in bleeding cases was esophagogastric varices [53.3%]. The risk of bleeding increased with the grade of varices and was highest [odds ratio= 11] in the presence of gastric extension of varices. Varices was the commonest finding in all age groups in both males and females although significantly commoner in males [60% vs. 41 %]. Erosive and non-erosive gastritis were the second common finding followed by duodenal ulcer and esophageal erosions [15.8%, 21.1 %, 13.6% and 11.1 %, respectively]. Esophageal varices were associated with one or more other lesions in 31 % of cases and were the only finding in 650 cases with UGIB. Compared to cases presenting with hematemesis, patients with melena alone [n = 195] had significantly lower prevalence of varices and higher prevalence of gastritis and duodenal ulcer. Analysis of findings in 1991 and 2000 revealed a similar pattern of endoscopic findings in cases with UGIB indicating that no significant change has occurred in the underlying medical diseases predisposing to UGIB. Results were discussed in comparison with previous Egyptian and foreign studies

Renal function in liver cirrhosis: early prediction by plasma angiotensin II level and the effect of losartan, an angiotensin II receptor antagonist

The aim of this work has been to study the relationship between plasma levels of angiotensin II [ATII] and serum levels of angiotensin-converting enzyme [ACE] and parameters of renal function in different stages of liver cirrhosis and to examine the effects of Losartan, an A TU-receptor antagonist on these parameters in a selected group of patients. The cross-sectional basic study included 59 patients with posthepatitis C liver cirrhosis and 19 healthy controls. Patients were classified into 4 groups: A: compensated cirrhosis [n=l6]; B: portal hypertension [n=11]; C: ascites [n=21]; and D: hepatorenal syndrome [HRS; n=11]. They underwent clinical, sonographic and endoscopic examinations. Biochemical tests included liver and kidney function tests, serum and urinary electrolytes, serum level of ACE and plasma level of ATII. Eleven patients of group B and 8 from group C, who were not hypotensive or of Child grade C, were given a daily oral dose of 25 mg losartan for 14 days. Clinical and biochemical evaluations were performed before and after treatment. Systemic levels of ACE and ATII were significantly elevated in all patients than in controls with no overlap of values. Their levels increased progressively from group A to group C and correlated significantly with Child-Pugh score, manifestations of portal hypertension [portal vein diameter and grade of varices] and kidney function tests. The most significant correlation was a negative one between ATII levels and creatinine clearance which appeared the most sensitive kidney function test as it was reduced in many patients with normal urea and creatinine values. Results of the present study indicate that plasma level of ATII is a very sensitive index that can predict the occurrence of functional renal abnormalities in cirrhotic patients even in well compensated cases. Patients treated with Losartan showed mild decrease in the mean arterial blood pressure which was significant in the ascitic cases only. Liver function tests showed no significant change and there was no clinical deterioration. Blood urea and serum creatinine, sodium and potassium showed no significant change after treatment. Urinary sodium and creatinine clearance increased significantly in both portal hypertensive and ascitic cases. Levels of ACE and ATII were elevated in both groups. This indicates a beneficial effect of losartan that should be evaluated in long-term studies including larger number of patients