Polymerase chain reaction [PCR] is it essential for diagnosis of hepatitis C virus [HCV] infection?

36 patients [mostly Egyptians] with elevated levels of transaminases [mean +/- SD = 11.516 +/- 47.99 and 90.73 +/- 35.89 for ALT and AST, respectively], and anti-HCV +ve as detected by second generation ELISA. Recombinant immunoblot assay [LiaTek HCV-III] and polymerase chain reaction [PCR] were used as confirmatory tests. The study showed that 94.4% of ELISA-II positive were confirmed by recombinant immunoblot assay [LiaTek HCV-III] while PCR showed positivity in 91.6% of ELISA-II positive. All ELISA-II positives that were confirmed by LiaTek HCV-III or PCR had ELISA ratio more than 5 and no significant differences were found between the two confirmatory tests regarding the mean ELISA ratio [10.5 +/- 2.05 vs 10.67 +/- 1.83], respectively, or between either tests and ELISA-II [mean +/- SD = 10.02 +/- 2.83]. From this study, it may be concluded that HCV infection can be diagnosed in most cases by ELISA-II especially in those cases with ELISA ratio of more than 5. If confirmation is needed, it can be performed by recombinant immunoblot assay [LiaTek HCV-III]. So, either ELISA-II or LiaTek HCV-III can replace the more expensive and sophisticated technique PCR as a confirmatory test for diagnosis of HCV infection. The PCR can be reserved for defining the time and course of HCV viremia, follow up patients under interferon therapy and for rapid diagnosis of acute hepatitis C, before appearance of HCV antibodies

Upper endoscopic changes and colonization of the gastric mucosa by helicobacter pylori in schistosomal portal hypertension

In this study, two patient groups with schistosomal hypertension and a control group were examined endoscopically and colonization of the gastric mucosa by H. pylori was estimated. Each group comprised 60 persons. The two patient groups were defined as having portal hypertension by the presence of oesophageal varices. Group II were having a history of bleeding [Haematemesis or melena]. A modified classification for oesophageal varices [O.V.] was made. O.V. of the high grades were more prevalent in group II with history of bleeding [35 percent vs. 70 percent]. There was positive correlation between O.V., G.V. and the degree of gastritis. Gastric changes were classified into mild gastritis, severe gastritis or gastric atrophy. Severe gastritis was more common in group II. This suggests that these lesions could be another source of bleeding in group II in addition to the more advanced grades of O.V. H. pylori was detected in the antral mucosa by two methods, the CLO [urease] test and microscopic detection of the typical organism in Giemsa stained gastric biopsies. 60 percent of group I and 85 percent of group II were positive compared to 33.3 percent of the control group. The differences between the patient groups and the control were highly significant. However, considering the patients having gastritis only in all groups, the difference was not significant. There was a positive correlation between H. pylori and the severity of gastritis. These results suggest that gastric changes resulting from the vascular and hormonal changes that could be produced by portal hypertension may facilitate colonization with H. pylori. The latter could enhance gastritis and hence chronicity or bleeding. A possible answer could be obtained if H.pylori is eradicated then the endoscopy is repeated

Psychosomatic symptoms in Saudi patients with irritable bowel syndrome

Out of 420 patients attending a gastroenterology clinic in Reyadh, S.A, 140 patients were diagnosed as having irritable bowel syndrome [IBS]. The diagnosis has been based upon the complaint of chronic abdominal pain with or without disturbed bowel functions, and the exclusion of organic disease. Upper and lower fibro-optic endoscopy were performed for all the patients in addition to other investigations when indicated. Somatic and psychoneurotic symptoms were evaluated according to standard scales. This result showed that IBS represented one third of patients having gastrointestinal diseases. Females represented 60% of the study group. Most of the patients were above 30 years of age and only a small number was under this age. This is different from the experience in the developed world, possibly due to the early simple, peaceful, less stressful life in S.A. Abdominal pain syndrome was present in all patients, disturbed bowel functions in 90%, indigestion in 97.1%, and dyspepsia in 80% of the study group. Anxiety syndrome was present in 80%, neurasthenia in 70% and depression in 60% of the patients. This indicates that somatic and psychoneurotic symptoms are present in IBS patients and a combination of antispasmodics, anxiolytic / antidepressants and even psychotherapy may be needed for controlling their symptoms

Parasitic infestation in expatriates in Riyadh, Saudi Arabia

The prevalence of intestinal pathogenic parasitic infestation in expatriates working in Riyadh, Saudi Arabia was assessed. Stool specimens were collected from 2, 496 non-Saudis for routine microscopic examination. Pathogenic parasites were found in 55.7% of the total with multiple in 10.5% of positive cases. The common parasites were Entamoeba histolytica [34.3%], Ascaris lumbricoides [8.5%], and Giardia lamblia [5.1%]. To a lesser extent Hymenolepis nana [2.8%], Trichuris trichiura [2.5%], Tenia species [2.5%] and Schistosoma species [1.7%] were detected. The prevalence of such infections in different nationalities was more comparable to the prevalence in their own countries and higher than that in the Saudi population. It is recommended that expatriates should be checked and treated if necessary upon arrival and when returning from home leaves. This screening is essential, particularly for catering and domestic workers

Short term experience with muller straight stem total hip replacement

Thirty-nine patients for whom total hip replacement using Muller straight stem prosthesis was done were studied. Preoperative planning for the choice of proper prosthesis was done and acephalosporin was given before, during and after surgery. Operations were done through lateral approach without trochanteric osteotomy except in cases with ankylosing spondylitis. The exposure was rapid through muscle planes with less bleeding and less injury

Excision arthroplasty of the elbow joint: a follow-up study

Excision arthroplasty to mobilize ankylosed elbow joints was done in 38 cases. the anklosis was secondary to trauma, pyogenic arthritis and rheumatoid arthritis. The surgical technique and after care are described and the complications are recorded. Follow-up results were analysed. The main reasons for failure and poor results were postoperative infection; partial and complete reankylosis; marked instability of the elbow joint and muscle weakness