Relationship between HCV infection and Insulin resistance in non-obese non-diabetic patients

Hepatitis C is a major cause of liver-related morbidity and mortality and represents a major public health problem in Egypt and worldwide. There is growing evidence as regard to the association between hepatitis C virus [HCV] infection and type 2 diabetes mellitus. However, the mutual link and related virological implication have not been fully clarified. Insulin resistance [IR] plays a primary role in the development of type 2 DM. This is supported by the results of prospective longitudinal studies showing that IR is the best predictor of the development of type 2 DM, preceding its onset by 10-20 years. To assess the correlation between HCV morbidity and Insulin resistance [IR] detected by HOMA test in none diabetic none obese HCV patients. The study participants were subcategorized into two groups,Group [I]: included 867 healthy subjects [negative HCV RNA] as a control group. Group [II]: included 277 patients with chronic HCV as a study group. The 2 groups were subjected to thorough history taking, full clinical examination, Anthropometric study,ultrasonographic examination and laboratory investigations including liver functions, viral markers, and qualitative PCR for HCV RNA ,lipid profile, glucose profile and HOMA test. This study revealed higher insulin resistance in the HCV study group than the control group

Detection of visceral adiposity by ultrasonography and its relation to insulin resistance in HCV patients

Hepatitis C is a major cause of liver-related morbidity and mortality and represents a major public health problem in Egypt and worldwide, Ultrasonography is a simple non-invasive method for detection of visceral fat, which is directly, correlated with insulin resistance [IR] as well as development of type 2 diabetes mellitus. To assess the validity of detection of visceral adipose tissue area with Ultrasonography and its correlation with IR in HCV patients. The study participants were subcategorized into two groups, Group [I]: included 867 healthy subjects with negative [HCV] RNA as a control group. Group [II]: included 277 patients with chronic HCV as a study group. The 2 groups were subjected to thorough history taking, full clinical examination, Anthropometric study,ultrasonographic examination and laboratory investigations including liver functions, viral markers, and qualitative PCR for HCV RNA ,lipid profile and glucose profile. This study revealed that Ultrasonography is a simple, non-invasive, safe method in detection of visceral adiposity, which is correlated significantly with IR in chronic HCV patients

Prevalence of intestinal parasitosis in a rural population in Egypt, and its relation to socio-demographic characteristics

A cross-sectional study was conducted in a village in Menoufia Governorate, Egypt where the majority of people had individual trenches in the houses for sewage disposal with absence of public sewage system. Out of 2292 stool samples 47.8% had at least a single infection. Multiple infections occurred in 14.9%. Entamoeba histolytica was 20%, E. coli 10%, Giardia lamblia 10%, Ascaris lumbricoides 27.31%, Hymenolepis nana 2.96%, Schistosoma mansoni 2.45% and Ancylostoma duodenale 2.23%. Males were significantly infected with S. mansoni than females. Younger age groups were significantly infected by H. nana than older ones. Working in agriculture was significantly at risk with S. mansoni and A. duodenale infections. On multiple logistic regression analysis; the risk factor most strongly associated with infection was the presence of another infected family member

Characteristics of women smoking in water pipe cafes in Cairo, Egypt

Tobacco use is increasing throughout the developing world. In particular, the use of water pipes to smoke tobacco has become increasingly popular among women. Many women water pipe users go to cafes to smoke rather than doing so at home, where it may not be allowed or accepted by family or neighbors. Although effective tobacco control policies will require an understanding of the complex socio-demographic, behavioral, and motivational characteristics of such women, they have been underrepresented in previous surveys of tobacco use. In order to address this knowledge gap, our study was conducted in Cairo, Egypt, to determine the personal and social characteristics of women smokers, their use of cigarettes and water pipes, and their attitudes, beliefs, and knowledge towards tobacco smoking and its health effects. An anonymous self administered questionnaire was given to women who smoked in water pipe caf‚s. A total of 630 subjects participated: 49% were cigarette-only smokers, 23% smoked both cigarettes and water pipes, and 28% exclusively smoked water pipes. The median age was 32.5 years, while those who exclusively smoked water pipes were younger than cigarette smokers on average [29 vs. 37, p<.001]. Cigarette smokers started smoking at a younger age [median 22 years] than water pipe smokers [mean 24 years, p<0.01]. Marital status was strongly associated with many of the surveyed factors: 63% of the unmarried women participants were water pipe smokers, compared to 41% of the married women and 41% of divorced or widowed women [p<0.01]. Being unmarried was also associated with the belief that water pipe smoking is less harmful than cigarettes [44% vs. 38% of married women, and 27% of divorced/widowed]. The results of this study suggest that future tobacco control efforts in Egypt will need to specifically address the use of tobacco products by women in caf‚s, where it is.becoming increasingly popular for women to smoke

Prevalence of S. mansoni and intestinal parasites in a rural population in Egypt, and its relation to socio-demographic characteristics

A cross-sectional study was conducted in a village in Menoufia Governorate in Egypt where the majority of people had individual trenches in the houses for sewage disposal with absence of public sewage system. Out of 2292 stool samples 47.8% had at least a single infection. Multiple infections occurred in 14.9%. Entamoeba histolytica was 20%, E. coli 10%, Giardia lamblia 10%, Ascaris lumbricoides 27.31%, Hymenolepis nana 2.96%, Schistosoma mansoni 2.45% and Ancylostoma duodenale 2.23%. Males were significantly infected with S. mansoni than females. Younger age groups were significantly infected by H. nana than older ones. Working in agriculture was significantly at risk with S. mansoni and A. duodenale infections. On multiple logistic regression analysis, the risk factor most strongly associated with infection was the presence of another infected family member. We recommend screening all family members of positive cases

Immunhistochemical identification of HCV target antigen in paraffin embedded liver tissue using the Tar DJI-22 monoclonal antibody: reproduciblity and staining patterns

Many of anti-HCV antibody-positive patients who are seronegative for HCV RNA were found positive by RT-PCR within the liver biopsy. In situ PCR, while sensitive, is technically difficult and expensive. So, there is a need for a simple, specific and reproducible method to identify HCV target antigens in liver biopsy specimens, which will help in more accurate diagnosis. Immunohistochemical staining has been applied successfully to detect HCV antigen in fresh frozen tissue. In paraffin-embedded tissues, however, minimal trials with conflicting results have been reported. The present study is a trial to evaluate the identification of HCV antigen in paraffin embedded liver biopsies using the anti HCV monoclonal antibody TORDJI-22 and to correlate the results with clinical and histopathological severity in chronic hepatitis C patients. Methods: We applied immunohistochemicl staining for HCV in 66 paraffin-embedded liver biopsy specimens. 46 from patients seropositive for HCV -RNA and twenty control liver biopsy specimens [5 HBV patients and negative for HCV, 5 metabolic liver diseases, 5 auto-immune chronic hepatitis and 5 extrahepatic biliary atresia]. The TORDJI-22 monoclonal antibody was applied in dilution 1:40, with overnight incubation. HBsAg and HBcAg immunohistochemistry were applied routinely. Results: Reproducible staining patterns of HCV antigen in tissues were identified among the majority [.42/46 - 91%] of HCV RNA seropositive cases. The staining pattern was cytoplasmic of hepatocytes, with occasional nuclear hue. It is mainly coarse granular with microvesicular pattern. Three staining patterns were identified: A diffuse or membranous, B; patchy, and C;occasional paranuclear.Non of the control samples showed a similar staining pattern. Conclusion: Immunohistochemical identification of HCV antigen is easy to apply in paraffin embedded liver biopsy specimens when the optimal detection techniques were applied. HCV target proteins in liver tissues could be markers of progressive damage. Also, accumulation of these proteins may be involved in the pathogenesis of hepatocyte injury in chronic hepatitis C

Study of the risk factors for viral hepatitis C infection among Egyptians applying for work abroad

The aim of this study was to identify the risk factors for viral hepatitis C infection among Egyptians. A cross-sectional study with case control analysis was conducted including 5071 Egyptians applying to the Ministry of Health Laboratories for certification of freedom from viral hepatitis [B and C] to work abroad. A questionnaire designed to cover the most important known and suspected risk factors was filled out by physicians interviewers before blood drawing and after proper orientation of the purpose of the study. The overall seropositivity among the whole sample for HCV was 31.5% and was significantly lower among females [13.2%] than among males [34%]. A consistent increase of seropositivity for HCV antibodies with age [in males and females and in urban and rural areas] was observed with a peak level of 54.9% in all individuals for the age group 45-49 years [significant trend p < 0.0001] A significant increase of seropositivity [p < 0.005] above 25 years of age [35.7%] than below this age 12.8%] was observed on examination of HCV distribution in 5-year age group. Married individuals have a significant higher seropositivity for HCV than non-married [38.2% and 20.9% respectively OR=2.3, 95%CL 2.1-2.7]. Individuals living in rural areas had significantly more HCV seropositivity than those living in urban areas [OR=1.7, 95% CL 1.5-2.0]. Also, individuals living in Cairo and seashore governorates had significantly lower seropositivity [14.7% and 12.7% respectively] than those living in governorates in upper or lower Egypt [29.4% and 36.3% respectively]. Medical procedures risk factors identified to be associated with significant higher HCV seropositivity included: past history of injections for bilharziasis, use of common syringes dental extraction, injections for urography, blood transfusion and previous hospitalizations. Multivariate logistic analysis revealed that only age, male sex, marriage, rural residence, living in upper and lower Egypt, injections for bilharziasis and urography were significant in the final equation for the whole group Blood transfusion was significant in the final regression analysis among females in urban living and hospitalization was significant among males in urban living and females in rural living. Further research is needed to elucidate those factors prevailing in rural areas and in upper and lower Egypt associated with increased risk for HCV infection

Viral hepatitis C infection among Egyptians: the magnitude of the problem: epidemiological and laboratory approach

This study examines the relative importance of risk factors for viral hepatitis C infection and estimates the magnitude of HCV problem among Egyptians. It is a continuation of a recently performed cross-sectional study conducted on more than 5000 Egyptians. Serum samples [1945] were analyzed for liver enzymes [SGPT and SGOT] to evaluate the status of liver affection. One hundred and sixty nine samples [103 confirmed HCV seropositives and 66 seronegative] were analyzed for PCR HCV RNA to estimate the frequency of HCV viraemia among those individuals. Rates for HCV seropositivity by ELISA test in mass screening were corrected using predictive value of a positive test at prevalence between 5-50%. Attributable risk and population attributable risk estimates were calculated for those significant factors in logistic regression analysis. Overall number of HCV infected individuals was estimated for age groups of 15-65 years and the numbers of HCV related liver complications were estimated. HCV PCR RNA was positive for 50% of ELISA-seropositive samples and for 13.8% of the seronegative samples. However, only 5% of those individuals with HCV seropositivity and 3.7% of those with PCR RNA positivity Showed SGPT serum levels above 1.5 normal. The overall age, sex and urban/rural adjusted rate of true HCV seropositivity is estimated to be 15.6% among working Egyptians between 15-65 years. Attributable risk due to injections for the treatment of bilharziasis is estimated to be 47% [95% CL=38%-55%] among exposed males. Blood transfusion was estimated to be responsible for 87% [95% CL=57%-96%] of cases among previously transfused females. Population attributable risk for injections for treatment of bilharziasis among working urban and rural males is estimated to be 15% and 11% respectively. Blood transfusion and sharing contaminated needles contributed by 24% of cases [for each] among working urban females. Previous hospitalization contributed by 36% of cases among working rural females and by 10% among working urban males. As for the national estimate of cases of HCV seropositivity we estimated more the 5 million individuals with an expected number of chronic hepatitis of varying degrees of 3.5 millions. HCV viraemia with high probability for transmission is present in more than 50% of those individuals and liver cirrhosis cases expected to develop within an average of 20 years of infection are in the range of 350-700 thousand cases. The major proportions of population attributable risk are due to other undefined risk factors associated with age, male sex, living in rural areas and in lower and upper Egypt. Further research is needed to elucidate those factors prevailing in these areas, associated with increased risk of HCV infection