Prevalence of silent hepatitis B and HCV genotype among chronic hepatitis C patients

This multi-center study was designed as a trial to explore the prevalence of silent hepatitis B infection among hepatitis C patients and to determine the prevalent genotype of hepatitis C virus [HCV] in these patients. The study comprised 45 patients with post-hepatitic liver cirrhosis. All patients gave blood samples for estimation of liver function tests, ELISA estimation of serum levels of hepatitis B surface antigen [HBsAg], anti-HCV antibodies and HCV core antigen, patients with HBsAg positive were excluded off the study. Qualitative detection of HCV RNA and HBV DNA by PCR [home-made PCR] and Quantitative PCR for estimation of HCV viremia and HCV genotyping: by REFLP technique were performed. The HCV-Ab was detected in all and HCV-Ag in 42 samples [93.3%] irrespective of its clinical severity class with a mean viremia level of 792336.7 +/- 400074.8; range: 134985-1957632 viral copy/ml as determined by quantitative PCR. There was a non-significant difference between severity clinical classes as regards the qualitative or quantitative detection of HCV infection. The HBV DNA was detected using qualitative PCR in 20 samples [44.4%]; 4 class A, 7 class B and 9 class C samples with a significant increase of the frequency of silent HB in patients with class B [X[2]=5.446, p<0.01] and C [X[2]=8.154, p<0.001] in comparison to class A patients. Genotyping of HCV reported 41 samples [91.1%] with genotype-4 and 4 samples [8.9%] with genotype-1 with a prevalence rate of HCV genotype-4 was 91.1%. There was positive non-significant correlation between both HCV genotype and the presence of silent hepatitis B infection and clinical severity, however, using the receiver operating characteristic [ROC] curve analysis judged by the area under the curve [AUC] to evaluate the sensitivity and specificity of detection of silent hepatitis B infection and identification of HCV genotype as predictors of severe hepatitis showed a non-specific role for genotyping for prediction of severity with AUC=0.467, while the detection of HBV DNA using PCR in patients with HCV infection is a specific predictor of severity with AUC=0.617. It could be concluded that HCV genotype-4 is the most prevalent type in Egyptian Hepatitis C cirrhotic patients with a prevalence of silent hepatitis B of 44.4% and its detection is a specific predictor of severe cirrhosis

Serum soluble intracellular adhesion molecules-1 [sICAM-1] and AST/ALT ratio in chronic hepatitis C are significant predictors of the disease severity judged by liver biopsy

This study was conducted to investigate the serum levels of soluble Fas [sFas] antigen, soluble intracellular adhesion molecules-1 [sICAM-1] and interleukin-18 [IL-18] in patients with chronic hepatitis C and to correlate their levels with the severity of pathological findings judged by liver biopsy interpreted as Scheuer score. The study included 30 patients with chronic hepatitis C [Study group] infection persisting for longer than 6 months with HCV antibody positive and increased serum alanine aminotransferase [ALT] values and 10 volunteers to donate blood samples as control group. After complete history taking and full clinical examination, all patients and controls gave a fasting blood sample for colorimetric estimation of serum aspartate transaminase [AST], ALT and total [TB] and direct [DB] bilirubin and for ELISA assays of serum sICAM-1, sFas and IL- 18 levels. Blind liver biopsies were done and histopathological inflammatory activity [grading, 0-4 scale] and fibrosis stage [0-4 scale] were assessed according to Scheuer classification. Pathological examination of Liver biopsy detected 21 chronic hepatitis specimens and 9 cirrhosis specimens with a significant [p<0.05] increase of Scheuer scores in patients with cirrhosis compared to patients with chronic hepatitis. Serum levels of AST and ALT were significantly [p<0.05] elevated in study compared to control group, with a non-significant [p>0.05] increase of AST/ALT ratio; however, serum AST levels and AST/ALT ratio were significantly [p<0.05] higher and serum ALT levels were non-significantly [p>0.05] higher in cirrhotic patients compared to those with chronic hepatitis. Serum sFas, sICAM-1 and IL-18 levels in study group were significantly [p<0.05] higher compared to controls levels with a significant [p<0.05] increase of sICAM-1 levels and non-significant [p>0.05] increase of sFas and IL-18 levels in cirrhotic patients compared to patients with chronic hepatitis. There was a positive significant correlation between the mean Scheuer necroinflammatory score and serum levels of ALT, sICAM-1 and AST/ALT ratio and between the mean Scheuer fibrosis score and serum levels of ALT, sFas, sICAM-1 and IL-18 and AST/ALT ratio. Logistic regression analysis showed that AST/ALT ratio [beta=0.679, p<0.001] and serum levels of sICAM-1, [beta=0.327, p=0.005] are the most significant predictors of disease severity. It could be concluded that serum levels of sICAM-1, sFas and IL- 18 and AST/ ALT ratio are closely correlated with histopathological results of liver biopsy and thus their elevated levels could be considered pathognomonic markers suggesting the severity of chronic hepatitis C

comparison of two regimens of intravaginal misoprostol for termination of second trimester pregnancy

The aim of the work was to compare two different regimens of intravaginal misoprostol in termination of second trimester pregnancy. In a prospective study, 60 pregnant women were admitted in the Zagazig University Hospital with the diagnosis of missed abortion of intrauterine fetal death, with gestation between 14 and 20 weeks were recruited into the study with 30 subjects in each group. Women in [group A] were given vaginal misoprostol 200 micro g every 6 h while women in [group B] were given vaginal misoprostol 400 micro g every 12h if women did not abort in 24h, the same regimen was repeated. The mean amounts of misoprostol administered in [group A] was 600 micro g [ +/- 356.22] and in [group B] was 626.67 micro g [ +/- 309.54] arid the difference was statistically insignificant. The mean induction-abortion interval in [group A] was 16.17h [ +/- 10.05] and in [group B] was 14.97h [ +/- 7.41] and the difference was statistically insignificant. After vaginal misoprostol administration, there was significantly increase in the incidence of incomplete abortion rate in [group A] than in [group B]. However there was significantly decrease in the incidences of other side effects [vomiting, diarrhoea, fever, pain] in [group A] than in [group B]. It is concluded that both regimens of vaginal misoprostol 200 micro g every 6h and 400 every 12h were effective in termination of second trimester abortion with less side effects in the first regimen

Comparative studies of microbiological, colpocytogram and ureacytogram in patients with pelvic inflammatory disease

Twenty patients suffering from pelvic inflammatory disease [PID] and 20 normal women were subjected to good history taking, general clinical and pelvic examination, cytological and bacteriological tests. The colpocytogram study succeeded to diagnose 20% of specific infection and 60% of non specific infection, in comparison to bacteriological study which revealed that non specific infection was found in the whole cases of PID and 70% of these cases had specific infection. These results showed that colpocytogram may not necessarily for diagnoses of PID. Urocytogram revealed that 50% of the studied group had evidence of non specific infection, and no case had evidence of specific infection while only 10% of the studied group showed significant bacteriuria, and this also indicate that not all the cases of pelvic inflammatory disease have in the same time urinary tract infection