New concept in histopathological grading and staging of chronic hepatitis C infection at Sharkia Governorate, Egypt

In this study, the Knodell histology activity index and the semi- quantitative reproducible description of the various morphological lesions of chronic hepatitis were applied on 109 liver biopsies taken from Egyptian patients infected with hepatitis C virus [HCV]. It was found that the presented histopathological features may be unusual for any of the known scoring systems. Therefore, a new system was suggested for grading and staging of liver diseases in Egyptian patients infected with HCV. Accordingly, the degrees of necro- inflammations are classified into 3 grades [1-3] and the progression of fibrosis is classified into 3 stages [1-3]. The reduced numbers of grades and stages proposed in this study may be attributed to the rapid course among Egyptians who differ in the environmental circumstances

Molecular cytogntic profiles of hepatitis C infection in patients at Sharkia Governorate, Egypt

In this study, 40 paraffin blocks liver tissues from HCV-PCR positive patients [HBV seronegative] were examined using DNA image cytometry to evaluate its role in diagnosing hepatocellular carcinoma [HCC] associated with hepatitis C virus [HCV] infection. Fluorescent in situ hybridization [FISH] technique using LSIZNF 217 chromosome 20q 13.2 probe was applied. The results showed a high percentage of S- phase fraction in cases of G2S2 and G3S3 with DNA diploidy. Only two cases of G3S3 showed DNA aneuploidy with a severe amplification of chromosome 20q 13.2. Consequently, DNA imaging cytometry is considered a good approach in differentiating dysplasia from well- differentiated HCC on the top of HCV infection. In conclusion, HCV has an acquired role in the development of HCC through the amplification of the aggressive tumor behavior oncogene LSIZNF 217 at chromosome 20q 13.2

Autoantibodies in HCV infected patients at Sharkia Governerate, Egypt

The aim of this study was to evaluate some immunological manifestations in chronic hepatitis C patients and to find out its relationship with liver pathology. The study included 109 positive HCV-RNA patients classified according to liver histopathology into three groups: Group I included 22 patients [G1S1], group II included 67 patients [G2S2] and group III included 20 patients [G3S3], where G = the degree of necro-inflammatory process and S = the stage of liver fibrosis. All patients were investigated for the presence of cryoglobulin, antineutrophil cytoplasmic [ANCA], anti-liver kidney microsomes [LKM], anti-double stranded DNA, [ds-DNA], anti-nuclear [ANA], anti-mitochondrial [AMA] and anti-smooth muscle [ASMA] autoantibodies. The high prevalence of autoantibodies in chronic HCV patients suggests that HCV may trigger an autoimmune reaction, but most probably do not indicate a distinct autoimmune mechanism. Cryoglobulins and ANCA may be considered as useful prognostic indicator for the increased risk of cirrhosis in chronic HCV patients. Follow up studies were recommended

HCV and associated concomitant infections at Sharkia Governorate Egypt

This study was performed on 109 cases divided into 6 groups according to the concomitant infection with hepatitis C virus [HCV]. The results proved that groups 1, 3 and 5 had a higher level of viremia than the other groups and a higher risk was found in these groups, as 56.4% and 34.6% were in G2S2 and G3S3, respectively. All cases of liver cell dysplasia and hepatocellular carcinoma in this study were seen in these groups. The study concluded that these factors play an important role in the progression of HCV infection. The death of the patients of this progressive condition occurs in younger age and due to liver failure more than to HCC

Non-invasive markers and predictors of severity of hepatic fibrosis in HCV patients at Sharkia Governorate, Egypt

This study included 109 patients with detectable hepatitis C virus [HCV] by real time PCR. The patients were classified into three different pathological stages and grades according to the new concept of histopathological staging and grading. The different clinical, biochemical, virological and ultrasonographic parameters were assessed and analyzed and the variables that showed a significant association with the histopathological staging and grading were included in the multivariate logistic regression analysis. The regression model revealed that platelet count, matrix metalloproteinase-9 [MMP-9], portal vein diameter, splenic longitudinal axis, alanine transaminase, aspartate transaminase and viral load added a significance to the model in a decreasing order of significance. From these findings, a new score ranged from 0-9 was generated. The score model was applied to the patients to assess its validity, where it proved to be accurate in discriminating patients with mild inflammation and fibrosis [sensitivity 81.8%, specificity 80.5% and accuracy 80.7%] and more accurate in detecting patients with cirrhosis [specificity 96.6%, sensitivity 80% and accuracy 93.6%], but less accurate in detecting patients with moderate to severe fibrosis [specificity 66.7%, sensitivity 68.7% and accuracy 67.9%]. Also, the results revealed that co-infection with schistosomiasis, old age >/45 years and positive history of blood transfusion as a source of infection were significantly associated with severe hepatic pathology

role of aflatoxin-contaminated food materials and HCV in developing hepatocellular carcinoma in Al-Sharkia Governorate, Egypt

In this study, the role of aflatoxin contamination in the onset of liver cancer in HCV-infected patients was studied. The quantitative identification of the possible aflatoxins contamination in six urban and eleven rural areas using high performance liquid chromatography technique revealed that corn, wheat, peanut, lupine "tennis", white rice, cowpea "lobiya", fava bean and brown rice showed a prevalence of AFB1 [64.7%, 53%, 53%, 47%, 47%, 41%, 29.4% and 29.4%, respectively]. A positive correlation was found between aflatoxin and positive HCV- PCR together with liver disease progression to G3S3, the indicative of hepatocellular carcinoma. Such correlation was not fully understood, but the oncogene amplification caused by HCV- infection may be aggravated by the consumption of aflatoxin contaminated raw food materials or their products

DNA ploidy and S - phase fraction in the patients of chronic HCV and hepatocellular carcinomas

In this study, 400 blue Feulgen-stained nuclei were measured from each lesion using DNA image cytometry. The histopathological and cytopathological observations revealed that 52 cases had variable degrees of chronic hepatitis, 12 cases were emerging into cirrhosis; while 11 cases represented different grades of HCC. Most of cases with minimal or mild chronic hepatitis were females, while most of the males had moderate or severe chronic hepatitis, cirrhosis and HCC. DNA image analysis data helped in the histological observations. All of chronic hepatitis C and cirrhotic cases showed normal diploid and/or tetraploid histograms; while they showed increasing S-phase fractions' values of the highly diseased chronic hepatitis and cirrhotic cases. Hepatocellular carcinomas and one cirrhotic case only revealed aneuploidy [diploid and tetraploid], while one case of poorly differentiated HCC revealed multi-ploid histogram