Hepatitis B virus infection in Aseer Region, south-western Saudi Arabia: a call for an immediate action against a preventable disease.

OBJECTIVES: The present study was designed as a large-scale cross-sectional study to cast some light on the magnitude of hepatitis B virus (HBV) infection in Aseer Region, south-western Saudi Arabia, a region reported to be of the highest endemicity. METHODS: During the WHO hepatitis day of 2013, an aggressive health education campaign was launched in all the hospitals and primary health care centres in Aseer Region. Posters were distributed to encourage the local population to visit the health facilities to be tested for HBV. They were interviewed using a structured questionnaire. Detection of hepatitis B surface antigen (HBsAg) was done using a fourth-generation ELISA kits. RESULTS: The present study included 10,234 persons. The study revealed an overall seroprevalence of 5.9% (95% confidence interval [CI] = 5.5-6.4%). A seroprevalence of 0.8% (95% CI = 0.2-2.1%) was found among persons aged less than 15 years, and a seroprevalence of 1.3% (95% CI = 0.4-2.9%) was found among persons aged 15-24 years. On the other hand, among persons aged 25 years and over (who were born before the expanded programme on immunization [EPI]), a seroprevalence of 6.3% (95% CI = 5.8-6.8%) was found. Pockets of unvaccinated individuals were identified. CONCLUSION: The present study has documented the efficacy of vaccination in protecting against HBV infection. It also identified the presence of pockets of unvaccinated persons requiring further investigations. Aggressive health education programmes and 'catch-up' mass vaccination of those aged over 25 years is mandatory.

Use of serum immunoglobulins G and A for detection of Helicobacter pylori infection in dyspeptic patients by enzyme immunosorbent assay.

Since the discovery of Helicobacter pylori (H. pylori), several invasive and non invasive tests have become available. The aim of this study was to test the performance of immunoglobulins IgG and IgA by using an enzyme linked immunosorbent assay (ELISA) test (In vitro diagnostika GmbH, Germany) for the diagnosis of H. pylori among dyspeptic patients. Blood samples from 152 dyspeptic patients and 51 asymptomatic controls were analyzed in a case control study. IgG and IgA were positive in 33.5% and 41.1% respectively compared to 13.8% for both IgG and IgA in controls (P=0.002). We support the future use of serology as a non invasive, and rapid test for the diagnosis of H. pylori infection among dyspeptic patients in areas with low prevalence. Endoscopy remains the method of choice for elderly dyspeptic patients and for those with possible gastric or duodenal pathology.

Pattern of Helicobacter pylori sensitivity to various antimicrobial agents.

To evaluate the pattern of Helicobacter pylori ( H. pylori ) susceptibility to different antimicrobial agents, we prospectively studied 45 H. pylori isolates by disc diffusion method. These isolates were obtained from patients aged between 16-75 years, of both sexes who had no prior history of metronidazole ingestion. A total of 45 patients were included, of which 36 were males with a mean age of 42.9 years and nine females with a mean age of 36.4 years, 62% of patients were Saudis. Almost all the H. pylori isolates were susceptible to clarithromycin, penicillin, erythromycin, ampicillin, tetracycline, clindamycin and cephradine. However, 64.4% of the isolates were resistant to metronidazole. No significant difference was found either in susceptibility of isolates from Saudi, non-Saudi or male and female patients.

Tuberculous peritonitis in chronic liver disease: Clinical features and response to treatment.

To find out the clinical presentation, laboratory results, and treatment response of tuberculous peritonitis in patients with chronic liver disease, we retrospectively reviewed the medical records of all patients with tuberculous peritonitis diagnosed by laparoscopy at King Khalid University Hospital over a period of seven years. A total of 17 patients (Group 1, consisting of 11 males and six females with a mean age of 539 +/- 17.5 years) had both chronic liver disease and tuberculous peritonitis, while 27 patients (Group 2, consisting of 17 males and 10 females with a mean age of 39.5 +/- 16.3 years) had only tuberculous peritonitis. Tuberculous peritonitis in chronic liver disease had similar clinical and laboratory presentation compared to patients with tuberculous peritonitis but without liver disease. However, Group I were significantly older, had lower ascitic protein content and higher mortality (P values of 0.004, 0.002, and 0.02, respectively). Both groups responded favorably to specific therapy. The overall mortality was recorded as 5.6%. In conclusion, the clinical presentation of tuberculous peritonitis in patients with chronic liver disease is similar to that of patients without liver disease except for ascitic protein, which is lower in the former group of patients. The prognosis is good with specific therapy.