Prevalence of hepatitis C virus in an elderly population in rural areas of Sharkia governorate, Egypt

Background and aim: Egypt has the highest prevalence of hepatitis C virus [HCV] infection in the world. At an older age, infected patients usually have lower rates of HCV clearance as well as higher rates of cirrhosis. The aim of this work was to study the actual prevalence, characteristics, and risk factors of HCV infection in elderly Egyptian individuals [>60 years] living in rural areas of Sharkia governorate and to assess the role of associated diseases [e.g. diabetes mellitus and hypertension] that are common in this age group

Patients and methods: A total of 115 male and 99 female nonhospitalized elderly individuals [mean age 64.37 +/- 4.74 years] were enrolled in this study. They were recruited from rural areas in Sharkia by a systemic 1: 4 sampling procedure. A questionnaire on sociodemographic characteristics was conducted, and information on risk factors for HCV infection and history of other comorbid diseases was recorded. Serodiagnosis of HCV infection was performed and for the positive cases, abdominal ultrasonography and liver function tests were performed

Results: The prevalence of HCV was 28% among the group studied. No association was found between sociodemographic data and HCV prevalence. Among the risk factors, a history of schistosomiasis treatment, blood transfusion, previous use of glass syringes, previous surgery, previous endoscopic intervention, repeated dental manipulations, and the presence of other infected members in the family were all significant factors [P<0.05]. History of previous liver disease and renal dialysis were significantly [P<0.05] associated with the prevalence of HCV, whereas diabetes mellitus and a history of ischemic heart disease were not

Conclusion: There is a high prevalence of HCV among elderly individuals living in rural areas in Sharkia, with many risk factors suspected to be the cause

possible role of chronic intestinal candidiasis in the genesis of intractable allergic diseases

A role of disturbed intestinal normal flora, such as Chronic Intestinal Candidiasis [C.I.C.] syndrome, in the genesis of intractable allergic diseases, through changing in the intestinal mucosal barrier was suggested. In this study, we have assessed the C.I.C. in the patients with intractable allergies to elucidate the potential involvement of this syndrome in the genesis of these diseases and to find out a relation between the serum level of candida IgG, IgM and IgA with the disease intractability [serum total IgE] through an intestinal functional impairment in these patients. The serum levels of candida IgG, IgM, IgA were assessed in 20 patients with C.I.C. and intractable allergic diseases as well as in 20 healthy volunteers and their levels were correlated to the laboratory parameter of disease intractability referring to an intestinal functional impairment in these patients. When compared with the control group, the patients showed a significantly higher concentration [< 0.0001] of only serum candida IgG. A statistically significant positive correlation was found between this higher concentration and disease intractability while a negative insignificant correlation was found between serum candida IgM and negative significant correlation between serum candida IgA and disease intractability in these patients. The results of intestinal biopsies showed variable lesions but there was absence of candida hyphae or intestinal invasion. The results of this study suggest that disturbed intestinal normal flora produced by C.I.C. may play important role in the genesis of intractable allergic diseases. Measurement of serum candida IgG reflects the disease intractability in these patients even without increasing frequency of acute intestinal candida infection [IgM] or invasion [IgA]. In addition, inhibition of C.I.C. either by drugs or diet adjustment may improve the clinical manifestations or decrease the progress of these diseases. However, further studies are needed to elucidate the exact role of C.I.C. in relation to other factors involved in the pathogenesis of intractable allergic diseases by affecting the intestinal mucosal barrier

Biliary fascioliasis: Magnitude of the problem and role of immunodiagnosis

This study was carried out to evaluate the prevalence of fascioliasis, which is a relatively common, but usually underestimated problem in many rural areas in Egypt and to assess its role in causing biliary disorders using the recent technique of cystatin capture ELISA for immunodiagnosis of such cases.Between July 1999 and July 2001, 3218 individuals [2409 males and 809 females] with ages ranged from 6-70 years were selected by stratified random sampling from EI-Husseinya, Sharkeya Governorate, all these individuals were subjected to thorough history taking, clinical examination, stool examination using modified kato-thick smear method, serodiagnosis using cystatin capture ELISA technique. Patients with history suggestive of hepatobiliary disease were subjected to further radiological examination e.g abdominal ultrasonography, C, T abdomen and sometimes ERCP, also routine laboratory investigations were done for this group of patients e.g complete liver function tests and complete blood picture. The overall prevalence of fascioliasis among the present group of patients was 3.7%, the incidence was higher among adolescent [> 12 - 18 years] and adult [> 18 - 40 years] and much less in younger [6-12 years] and older [more than 40 years] age groups. Out of these fasciola positive patients only 10 patients [8.5%] suffered form biliary disorders as proved by abdominal ultrasonography and occasionally ERCP, these constituted about 3.4% of total number of patients who gave history suspecting biliary disorders [N=298]. The cystatin capture ELISA was used to detect anti-fasciola cystatin proteinase antibodies in sera of all fasciola copro positive group [118 patients] and also in a randomly selected group of copro negative patients [358 patients] with relevant or irrelevant signs and symptoms suggesting biliary affection. The ELISA capture test was positive in 110 out of 118 copro positive patients [93.2%] and it was negative in 352 out of 358 copro negative patients. This proved the highly specificity and sensitivity of this test in diagnosis of fascioliasis. The present community based study clarified the magnitude of fascioliasis as a health problem in rural area in Egypt and the significance of it as an aetiological agent of biliary disorders and the value of cystatin capture ELISA in picking up such cases

Evaluation of intercellular adhesion molecule - 1 [ICAM-1] and other risk factors in tobacco smokers with chronic H C V. infection

Based on the idea that the adhesion molecules have becoming one of the most important therapeutic strategies in the medicine, our aim in this study was to elucidate the role played by these molecules in pathogenesis of chronic HCV infection and on the other hand, this work is a trial to find to what extent can the bad habits of smoking aggravate the disease state, and finally to find a hope how modulation of adhesion molecules expression can aid in treating or controlling the wide spread of HCV infection in Egypt. In trial to assess the state of ICAM-1 in chronic hepatitis C, we were not able to neglect the deleterious effects of heavy elements cadmium and lead which are added to the body among other thousands of toxic materials contained in tobacco smoker. Eighty subjects enrolled in this study were properly selected from tropical medicine department and those attending the outpatient clinic between December 1999 and September 200I, they were classified into 4 groups: group I [control group] comprised 20 apparently healthy persons, non smoker with negative tests throughout for any viral hepatitis; group II included 20 non smoker, with chronic hepatitis C infection [positive anti-HCV by ELISA and positive PCR for HCV-RNA]; group III included 20 healthy normal smokers show no evidence for any viral hepatitis tests; and group IV included 20 smoker with chronic hepatitis C infection. All subjects were subjected to full history taking especially that concerning the smoking burden, clinical examinations and abdominal ultrasonography and routine laboratory investigations e.g. liver function test and complete blood picture and HBs antigen to exclude hepatitis B infection for all the patients ICAM-1 was assayed in plasma using ELISA technique also cadmium and lead were assayed in whole blood and urine using atomic absorption spectrophotometer and urine cotinine was measured by radioimmunoassay. Significant rise was recorded in the level of ICAM-1 in hepatitis C patients as compared to control. The effects of cadmium and lead were obvious, in the fact that they evoked more rise in the level of ICAM-1 in smoking hepatitis patients as compared to controls or non-smokers. Levels of ICAM-1, were significantly correlated with serum enzymes and urinary cotinine. Also the concentration of heavy elements in urine and blood correlated significantly with urinary cotinine. Urinary cotinine was chosen as a marker of smoking burden Finally, the idea of advent of specific mono clonal antibodies against adhesion molecules for purposes of control of their mediating inflammatory and metastatic effects, was discussed. To our opinion, this procedure, would be associated with deleterious systemic unavoidable effect, but the idea needs be considered and tried employing more advanced and sophisticated techniques