Occult hepatitis C virus infection in haemodialysis unit: a single-center experience

Detection of hepatitis C virus RNA in peripheral blood mononuclear cells [PBMC] and/or hepatocytes in the absence of HCV RNA in serum, designated as 'occult HCV infection', has been a matter of controversy in the recent years. Occult hepatitis C virus [HCV] infection has not been investigated in haemodialysis patients. We investigated for the first time the prevalence of occult HCV infection in large cohorts of chronic hemodialysis [CHD] patients in a single heamodialysis center at Al-Taif, KSA. We enrolled 84 CHD patients, whose sera are negative for HCV markers. HCV RNA was tested in PBMC using a sensitive commercial real time assay. In this study, real-time PCR was used to test for the presence of genomic HCV-RNA in peripheral blood mononuclear cells of all of these patients. For comparison, 20 patients on HD with evidence of chronic hepatitis C virus infection were included as a control group. In CHD patients, occult HCV infection, determined by the presence of genomic HCV-RNA in peripheral blood mononuclear cells [PBMNCs], was found in 13.4 % of the patients; 83 % of these patients had ongoing HCV replication, indicated by the presence of HCV-RNA. Patients with occult HCV infection had spent a significantly longer time on heamodialysis and had significantly higher mean alanine aminotransferase levels during the 3 months before study entry. Compared to CHCV patients, those with occult HCV have less elevated bilirubin, AST and ALT. The prevalence of occult HCV infection was moderate in our CHD patients, and it did not appear to be clinically relevant. Further studies in other geographic populations with high HCV endemicity are required to clarify the significance of occult HCV infection in these patient groups

Effects of some antidiabetic medicinal plants on pancreas and liver of diabetic albino rats

Diabetes is a chronic metabolic disease which affects large number of population all over the world. More than 400 traditional medicinal plants have been recorded for helping in controlling such disease. This study investigated effects of some plants used in Saudi Arabia and some other Arab countries as antidiabetic agents. One hundred fifty adult male Albino rats were divided into six experimental groups each consist of twenty five rats. The first group was considered as a control group. The rest of groups were affected by induction of experimental diabetes by subcutaneous injection of Alloxan. The second group consisted of diabetic rats without any treatment. The third group was treated by the aqueous extract of mixture contains Foenugreek, Nigella and Termis seeds. The fourth group was treated with the aqueous extract of Nigella sativa seeds, while the fifth group was treated with the aqueous extract of Foenugreek seeds. The sixth one was treated with the aqueous extract of Termis seeds with the administered dose of the plant extracts [100 mg/kg body weight].After four weeks of treatment, different biochemical parameters were performed including estimation of blood sugar level and serum insulin level. Pancreatic and liver samples were obtained and processed for microscopic and quantitative evaluation after staining the prepared sections with both heamatoxylin and eosin as well as a special stain for demonstration of the different pancreatic cells in the Islet of Langerhans. The usage of the mixture or each plant alone corrected the glucose level and insulin level. Microscopically there was definite decrease in the number and diameter of beta pancreatic cells in the diabetic group, while the other pancreatic cells were not affected [alpha and delta cells]. The use of medicinal plants in the different groups of this study greatly improved such cellular changes and the level of blood sugar level was corrected. The present results showed that the activity of the mixture was the best when compared with Nigella, Foenugreek and Termis seeds. The water extract of the mixture is the most powerful in amelioration hyperglycemia and most of all damage effects of Alloxan on the liver and texture, hematological parameters, and lipid profile. So it is advised to use the plant mixture as an antidiabetic agent rather than the use of each plant separately. Repeating such study with the use of variable doses may be helpful in better evaluation for the required doses

Developing a disease-specific tool for assessment of quality of life of patients with hepatitis C virus associated chronic liver disease

To develop an Egyptian disease-specific instrument to assess the health related quality of life [HRQoL] in patients with chronic hepatitis C [CRC], and to assess the HRQoL in CHC patients according to this instrument. Based on responses from 100 patients, 5 liver experts, and from reviewing previous studies and other disease-specific instruments, items affecting the HRQoL of CRC patients were selected. Responses from 100 patients were used for determining and maximizing the questionnaire's internal consistency reliability [ICR] and construct validity. Retained items were scaled and the final questionnaire was pretested in 20 patients. Using this instrument, the HRQoL was assessed in 126 subjects distributed into three equal groups, one healthy and two groups of patients having chronic liver disease [CLD] with and without hepatitis C antibodies [CLD HC+ve, CLD HC-ve respectively]. Sixty seven items were identified in the item selection process, and 33 were retained at the end of the process of maximizing ICR and construct validity. In pretesting, five items were combined into two, and three questions for assessing the general health perception [GHP] were added. Patients found the final 33 questionnaire clear and easy to complete in 15 minutes. The developed instrument proved gradients among CHC patients, CLD HC-ve controls and normal controls, and among patients with different grades of liver disease severity. Certain domains did better than others in discriminating among the three groups and in comparing different grades of disease severity. The specific questionnaire has acceptable reliability, good construct validity, and correlates with disease severity. Further researches were needed for investigating its usefulness in clinical practice and for supporting the findings of the major decrements in HRQoL domains

INF-gamma, IL-5 and IGE profiles in chronic schistosomiasis mansoni Egyptian patients with or without hepatitis C infection

The immune response against clinical forms of chronic schistosomiasis mansoni patients with or without HCV infection was evaluated by assays the serum levels of IFN-gamma and IL- 5 for estimate the cell mediated immunity and IgE level to estimate the humoral immunity. This study included three patient groups. G.I included 25 patients with intestinal schistosomiasis, G.II included 15 patients with hepatosplenic schistosomiasis and G.III included 40 patients hepatosplenic schistosomiasis co-infected with HCV. Control G.IV included 15 healthy persons with matched age and sex. The intestinal group had high IFN-gamma [92%], normal level of IL-5 and IgE. The immune response was mainly 100% Th-1 response. The hepatosplenic patients had high IFN-gamma [26.7%], IL-5 [86.7%] and IgE [73.3%]. The immune response was 73.4% Th-0, 13.3% Th-l and 13.3% Th-2. The co-infected group had high IFN-gamma [62.7%], IL-5 [100%] and IgE [92.5%]. The immune response was 62.5% Th-0 and 37.5% Th-2 immunity. The shift to Th-0 and Th-2 immunity as well as associated depression of Th-1 in mixed group of patients may be playing a role in the persistence and severity of both diseases. Such immunity defects add to decrease challenge against HCV clearance

Assessment of Serum Tumor Necrosis Factor-alpha and alpha-fetoprotein in HCV-related chronic liver disease patients

This study included two groups of HCV-related chronic liver disease [CLD] patients, 30 patients with compensated CLD, 30 patients with decompensated CLD in addition to 20 apparently healthy individuals who served as controls. For all the subjects, the following tests were done; complete history, clinical examination hemoglobin concentration and platelet count, liver function tests [LFTs], TNF-alpha and AFP. TNF-alpha and AFP measurement was done employing state-of-the-art solid-phase two-site chemiluminescent enzyme immunometric assay automated analyzer [immulite]. The study showed that there was significant elevation of TNF-alpha level in HCV-related CLD group in comparison to control subjects. However, no significant differences were observed between compensated and decompensate CLD groups. There was also a significant elevation of serum AFP levels in HCV-related CLD groups in comparison to control subjects. However, no significant differences were observed between compensated and decompensate CLD groups. A significant inverse correlation was found between serum albumin and serum TNF-alpha in compensated CLD group, also a significant direct correlation was found between serum ALP and serum TNF-alpha in decompensate CLD group. However, no correlation was found between serum TNF-alpha and any other assayed parameters including AFP

Pro-collagen peptides in essential hypertension and its relation to cardiac structure and functions before and after antihypertensive therapy

A significant increase in fibrillar collagen content, type I and type III, has been observed in the cardiac ventricles of both animals and humans with arterial hypertension. The serum concentrations of procollagen type I carboxy terminal peptide [PIP] and procollagen type III amino terminal peptide [PIIIP] have been proposed as a useful markers of collagen types I and III synthesis. We evaluated fibrogenic activity in patients with essential hypertension by measuring serum concentrations of PIP and PIIIP as markers of tissue synthesis of collagen type I and type III, and its relation to parameters of left ventricular [LV] structure and functions in those patients. The effect of treatment with ACE inhibitor [captopril] for 6 months on serum concentrations of both PIP and PIIIP was also studied. The study included 79 patients with newly diagnosed mild to moderate hypertension and 50 normotensive subjects. Ages ranged between 35 to 60 years. Careful blood pressure measurement was obtained in all subjects. M-mode, two dimensional, and pulsed Doppler were performed to get baseline LV anatomy and function. Serum PIP and PIIIP were measured by radioimmunoassay. Both echocardiography and biochemical studies were repeated for all hypertensives after 6 months treatment with captopril. Serum PIP and PIIIP were significantly higher in hypertensive patients compared with normotensive subjects. PIP was 258 +/- 57mg/L in hypertensives vs. 167 +/- 70mg/L in normotensives. PIIIP was 3.73 +/- 2.2mg/L in hypertensives vs. 1.9 +/- 1.4mg/L in normotensives. In addition, PIP and PIIIP were significantly higher in hypertensives with LV hypertrophy [LVH] than those with normal LV mass. Moreover, serum concentration of PIP was directly correlated with LV mass index. On the other hand, PIIIP was inversely correlated with VE/VA ratio. After treatment, significant echocardiographic and biochemical improvements were observed. LVH regressed in 13 out of 68 patients [19%], LV mass index was normalized in 17 out of 58 patients [29%], and diastolic dysfunction was normalized in 10 out of 44 patients [23%]. Serum PIP and PIIIP were significantly reduced in hypertensives. Serum concentrations of both PIP and PIIIP are significantly increased in hypertensives and this was more pronounced among patients with LVH. This was correlated with structural and functional LV changes in the form of LVH and diastolic dysfunction. All changes demonstrated significant improvement after treatment with captopril