Prevalence of Hepatitis B Virus Infection among Egyptian Pregnant Women - A Single Center Study.

Background: Hepatitis B virus (HBV) infection still has a relatively high incidence and prevalence worldwide. In the post-vaccination era in developing countries, perinatal vertical transmission remains the most common mode of transmission. Prevention of mother-to-child transmission requires screening for HBV surface antigen (HBsAg) in pregnant women to identify which newborns that must be immunized. Aim: This study aimed to evaluate the prevalence of HBV infection among pregnant mothers who were attending outpatient clinic of the Obstetric Department, and Social and Preventive Medicine Center at Cairo University Hospital Campus, for routine antenatal care. Methods: A cross sectional study included 2,000 pregnant women. A rapid screening test for HBV “One Step HBsAg Rapid Test” was done for all women and all HBsAg-positive cases were confirmed by ELISA for HBsAg. A structured questionnaire for risk factors for HBV acquisition was filled for every pregnant mother positive for HBsAg and a control group of HBsAg negative mothers. Results: Out of 2,000 pregnant women, 35 (1.75%) were positive by the rapid test, out of whom 32/35 cases (91.43) were confirmed to be positive by the confirmatory test representing 1.6% of the study population. Family history of HBV, previous intravenous (IV) injections, medical clinic attendance, hospital admission, and surgeries were the risk factors for acquiring HBV infection (P-value=0.001, 0.003, 0.002, 0.000, and 0.011, respectively). Conclusion: HBV infection is prevalent among pregnant mothers attending our outpatient services. Therefore we recommend screening for HBV in all Egyptian pregnant mothers to prevent neonatal infection by immunoprophylaxis.

Can aspartate aminotransferase to platelet ratio index replace liver biopsy in chronic hepatitis C.

Background and aim: We aimed to evaluate the accuracy of readily available laboratory tests (ALT, AST, platelet count, AST to platelet ratio index: APRI) in predicting liver fibrosis in chronic hepatitis C, in comparison to the predictive accuracy obtained by liver biopsy. Methods: One hundred and thirteen patients suffering from chronic hepatitis C (CHC) were included in this study. They included 76 children enrolled from the Pediatric Hepatology Unit and 37 adults enrolled from the Hepatology Unit of Tropical Medicine Department, Cairo University, Egypt. Fibrosis results obtained from liver biopsy were assigned a score from 0 to 4 score as per Metavir scoring. Results of serum ALT and AST levels were expressed as ratio of the upper limit of normal (ULN). Results: Of the pediatric patients, 28 (36.8%) showed no evidence of fibrosis on liver biopsy, 26 (34.2%) showed grade 1 fibrosis, and 22 (29%) had grade 2 fibrosis. Among the adult patients, 12 (32.4%) had grade 2 fibrosis and 25 patients (67.6%) had grades 3 to 4 fibrosis. There was a lack of correlation between the degree of fibrosis and AST levels, AST/ALT ratio, platelet count and APRI. The AUROC curve for predicting significant fibrosis was 0.5 for AST levels, 0.37 for AST/ALT ratio and 0.49 for APRI, in pediatric patients (p >0.05). In adult patients the AUROC curve for predicting significant fibrosis was 0.59 for AST levels, 0.76 for AST/ALT ratio and 0.63 for APRI (p >0.05). Conclusion: Liver biopsy remains the gold standard to assess the extent of hepatic fibrosis in patients with CHC.

A comparative study of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography in children with chronic liver disease.

Background: Endoscopic ultrasonography (EUS) is a less invasive modality and may be equal or superior to endoscopic retrograde cholangiopancreatography (ERCP) in visualizing the biliary tree. Its role and feasibility in children need to be accurately defined. Aim: This study aimed at evaluation of EUS in assessment of children with chronic liver disease (CLD) in comparison with ERCP. Materials and Methods: The present study was carried out between September 2004 and February 2006 on 40 children suffering from CLD. Patients were selected from the Pediatric Hepatology Unit, Cairo University Children's Hospital, Egypt. They were included if they had: sonographic (n = 8) or histopathological evidence of biliary pathology (n = 2); autoimmune hepatitis with high gamma glutammyl transpeptidase (GGT) levels and/or not responding to immunosuppressive therapy (n = 15); cryptogenic CLD (n = 13); neonatal cholestasis with relapsing or persistent course (n = 2). They all underwent EUS and ERCP. Results: Three of six cases with intrahepatic biliary radicle dilatation had Caroli's disease by EUS and ERCP; and the other 3 had sclerosing cholangitis. EUS was equal to ERCP in diagnosis of biliary pathology. However, one false positive case was described to have dilatation and tortuosity of the pancreatic duct by EUS as compared to ERCP. EUS could detect early pancreatitis in 5 cases. One case with cryptogenic liver disease proved to have sclerosing cholangitis by both EUS and ERCP. Conclusion: EUS is an important diagnostic tool for biliary pathology and pancreatitis in children with pancreatico-biliary pathology. ERCP should be reserved for therapeutic purposes.

Safety and efficacy of rifampicin in children with cholestatic pruritus.

OBJECTIVE: The present study aimed at verifying the safety and efficacy of rifampicin in ameliorating pruritus in cholestatic children. METHODS: Twenty-three Egyptian children (14 boys and 9 girls), suffering from intractable pruritus of cholestasis, were included. Rifampicin was started at a dose of 10 mg/Kg/day in two divided doses and increased gradually to a maximum of 20 mg/Kg/day if there was no response. Liver function tests were followed up weekly. RESULTS: Seventeen patients (74%) showed improvement of pruritus with rifampicin. None of the patients showed any deterioration in liver functions. CONCLUSION: Rifampicin in a dose of 10-20 mg/Kg/day is safe and effective in ameliorating uncontrollable pruritus in children with persistent cholestasis.