Oral fluids as risk factors for intrafamilial transmission of hepatitis C virus

To evaluate the frequency of hepatitis C virus [HCV] infection among the family members of chronically infected HCV patients, to investigate the oral cavity fluids as a possible risk factor for transmission of HCV infection, to asses the reliability of gingival crevicular fluid [GCF] and saliva anti-HCV [HCVAb] and HCV-RNA testing for detection of HCV and to study the oral mucosa and periodontal condition of HCV infected subjects. Serum, GCF and saliva specimens were obtained from 19 index cases with chronic HCV and their relatives [n = 83] to detect HCVAb by ELISA and HCV-RNA by a modified commercial polymerase chain reaction [PCR] assay. The clinical oral mucosal and periodontal conditions were evaluated. HCV infection was detected in the relatives of 17 out of 19 families. The newly diagnosed cases were 41%, of them 66.7% were parents, 34.6% brothers and 4.8% sisters. The intrafamilial frequency of positive anti-HCV was 60.8%, 47.1% and 38.2% in the serum, GCF and saliva specimens respectively of the total studied population. HCV-RNA was detected in 52%, 41.2% and 28.4% in the same body fluids in order of frequency. The sensitivity and specificity for anti-HCV in the serum, GCF and saliva were 100%, 90.6%, 71.7% and 81.6%, 100%, 98% respectively. The corresponding values for HCV-RNA were 100%, 79.2%, 54.7% and 100%, 100%, 100% respectively. Strong positive associations were found between serum PCR and anti-HCV testing in serum, GCF, saliva and HCV-RNA testing in GCF and saliva [P<0.001]. No significant difference was found regarding mucosal and periodontal clinical evaluation between HCV positive and negative persons. It was concluded that: [1] The relatives of HCV infected patients are at risk to acquire the disease. [2] GCF and saliva presented detectable levels of anti-HCV and HCV-RNA, which might be sources of HCV infection among family members. [3] Detectable levels of GCF and saliva anti-HCV and HCV-RNA may be of diagnostic value in HCV infection. [4] No correlation was found between oral mucosa and periodontal condition and HCV infection

Doppler tissue imaging: a new approach to myocardial assessment in infants of diabetic mothers and correlation to maternal diabetic controls

The study included 30 newborn infants born to diabetic mothers in the Obstetrics Department and admitted to the Neonatal Care Unit in Tanta University Hospital. Their gestational age ranged from 31-40 weeks [mean 37.7 +/- 2.13] and birth weight 2.5-5.7 kg [mean 3.61 +/- 0.7 kg]. Ten healthy newborn infants of matched gestational age and sex, born to non-diabetic mothers were included as controls. The aims of the present study were: 1] to define cardiac morphology particularly septal hypertrophy with conventional echocardiography, 2] to use Doppler Tissue Imaging [TDI] echocardiography to detect early cardiomyopathic changes in infants of diabetic mothers, 3] to correlate these data to the parameters of glycemic control of maternal diabetes and 4] to follow up cases with affected myocardium so that their prognosis is determined. Full history and thorough clinical evaluation were done. Laboratory investigations included: cord blood glucose, cord blood insulin, cord blood C-peptide and fetal glycosylated hemoglobin [Hb F1c] as well as maternal glycosylated hemoglobin [Hb A1c]. Cardiac evaluation was done using conventional M-mode, 2-D, and Doppler transmitral flow velocities as well as by TDI to assess cardiac diastolic function. Septal myocardial hypertrophy was detected in 46.66% of the studied cases. Diastolic dysfunction was found in 33.3% by conventional transmitral Doppler flow studies and in 66.6% by TDI. None of the detected myocardial abnormalities were significantly correlated to parameters of maternal diabetes control such as maternal Hb A1c, cord blood insulin, cord blood C-peptide or cord blood Hb F1c. In cases of myocardial hypertrophy or diastolic dysfunction echo-Doppler and DTI studies were repeated till disappearance of myocardial abnormalities. Macrosomia was detected in 20% of the studied cases and did not correlate significantly to maternal diabetes control parameters nor to the myocardial abnormalities. There was no sign of outflow tract obstruction or myocardial systolic dysfunction in any of our studied cases, and myocardial hypertrophy or diastolic dysfunction resolved within 6 months of follow up. We conclude that macrosomia and non-obstructive cardiomyopathy are transient phenomena that still occur in IDM irrespective to the metabolic control of maternal glycemia and it is possible that other factors contribute to such manifestations. The new technique TDI could detect more cases of myocardial diastolic dysfunction in IDM than conventional echo Doppler method and it could be used for early detection and follow up of myocardial abnormalities in IDM