Insulin resistance, steatosis, and fibrosis in Egyptian patients with chronic hepatitis C virus infection

Both nonalcoholic fatty liver disease [NAFLD] and chronic hepatitis C virus [HCV] infection are common in Egypt, and their coexistence is expected. There is controversy regarding the influence of NAFLD on chronic HCV disease progression. This study evaluates the effect of NAFLD on the severity of chronic hepatitis C [CHC] [necroinflammation and fibrosis] and assesses the relative contribution of insulin resistance syndrome to the occurrence of NAFLD in patients with chronic HCV infection. Untreated consecutive adults with chronic HCV infection admitted for liver biopsy were included in this study. Before liver biopsy, a questionnaire for risk factors was completed prospectively, and a blood sample was obtained for laboratory analysis. Our study included 92 male patients. Their mean +/- SD age and aspartate aminotransferase [AST] level were 42 +/- 7.7 years [range 20-56] and 68 +/- 41.7 U/L [range 16-214], respectively. The mean insulin level and insulin resistance index were 15.6 +/- 18.3 mlU/mL [range 5.1-137.4] and 5.9 +/- 15.2 [range 0.9-136.2], respectively. Fifty four percent of patients had steatosis and 65% had fibrosis. In multivariate analyses, steatosis was associated with insulin resistance and fibrosis was associated with high AST level, age >40 years, and steatosis. Steatosis is a histopathologic feature in >50% of patients with chronic HCV infection. Insulin resistance has an important role in the pathogenesis of steatosis, which represents a significant determinant of fibrosis together with high serum AST level and older age

Scoring system designed to improve case selection for upper gastrointestinal endoscopy in upper Egypt

In an attempt to minimize unnecessary gastroscopic examinations, 405 patients attending for endoscopy to Gastrointestinal Endoscopy Unit, Assiut University Hospital were interviewed. The results were analyzed to determine which factors best discriminate between those with serious disease [129] and those without 276. The seven characteristics which best discriminated between the two groups were: pain after 2 hours of meals, vomiting periodicity of symptoms, smoking, age, dysphagia and loss of weight. With the use of these features, a scoring system was devised to give an indication of the likelihood of finding serious disease in individual patients. The results showed that by utilizing this scoring system, it would be possible to reduce the number of examinations performed by 25.4% without missing any of the patients, yet still detect 100% of serious diseases. If confirmed in further prospective studies, this scoring system could assess more accurately the individual priority for endoscopy and enable optimum use of our limited resources

Hepatitis B virus replication and tuberculin reactivity

Both mycobacterium tuberculosis and hepatitis B virus [HBV] infections are common in Egypt. Among 43 HBsAg healthy carriers and 26 HBsAg [+ve] cirrhotic patients, there was an inverted relationship between HBeAg status and purified protein derivative [PPD] reactivity, but it was statistically significant in the group of carriers [P < 0.01]. When the state of Bacillus Calmette-Guerin [BCG] vaccination was considered, the percentage of PPD reactivity in vaccinated HBeAg [+ve] carriers was significantly lower than that in the vaccinated controls and HBeAg [-ve] ones 20% versus 69.7% and 66.7%]. HBeAg [+ve] cirrhotic patients did not react to PPD whether vaccinated or not. Regarding the HBeAg [-ve] cirrhotic ones, PPD reactivity was only demonstrated in the vaccinated group with a 50% confidence and failed to do so with the non-vaccinated ones. The inverse association of HBeAg and PPD reactivity may suggest that the host response to tubercle bacilli may inhibit the replication of HBV. Those who were vaccinated and positively reacted to PPD were more likely able to inhibit replication of HBV. A clinical trial with BCG vaccination to HBeAg [+ve] carriers may be necessary to support this hypothesis