Viral and non-viral risk factors for non-Hodgkin's lymphoma in Egypt: heterogeneity by histological and immunological subtypes.

OBJECTIVE: Non-Hodgkin's lymphomas (NHL) are etiologically heterogeneous malignancies. In Egypt, we previously reported an association of increased NHL risk with chronic hepatitis C virus (HCV) infection. Our present aim is to assess the association between HCV infection and histological subtypes of NHL. METHODS: We conducted a case-control study at the National Cancer Institute of Cairo University. Cases with NHL (n = 486) were matched to controls (n = 786) who were orthopedic patients from the same referral regions. Participants provided a blood sample for HCV markers (anti-HCV, HCV RNA) and answered a questionnaire on possible risk factors. Case-control differences were assessed by odds ratios and 95% confidence intervals from logistic regression analysis. RESULTS: Cases with diffuse large B cell lymphoma (n = 146), chronic lymphocytic leukemia (n = 58), marginal zone lymphoma (n = 24), follicular lymphoma (n = 23), and mantle cell lymphoma (n = 16) were recruited. HCV RNA prevalence was 27% in controls and 26%-48% in the NHL subgroups: it was associated (p < 0.001) with diffuse large B cell, marginal zone, and follicular lymphomas with odds ratios of 3.2, 4.4, and 3.3, respectively. CONCLUSION: HCV is a risk factor for diffuse large B cell, marginal zone, and follicular lymphomas in Egypt.

Pilot survey of aflatoxin-albumin adducts in sera from Egypt.

Aflatoxins are potent liver carcinogens that frequently contaminate cereals in developing countries. Aflatoxin exposure has been predicted in Egypt but, to date, no studies have measured the level of aflatoxin-albumin (AF-alb) adducts as a validated biomarker to assess exposure. In this pilot survey, a limited number of sera samples, available from a hepatocellular carcinoma (HCC) case-control study in Egypt, were analysed. AF-alb was detected in 24/24 samples from HCC-negative individuals (geometric mean 9.0 pg mg(-1); range 3.5-25.8pg mg(-1)), while 7/22 samples from HCC-positive cases had detectable AF-alb (geometric mean 2.6 pg mg(-1); range: non-detectable-32.8 pg mg(-1)). These AF-alb data do not represent a case-control comparison due to inherent difficulties in comparing markers of dietary intake between controls and patients with disease. Although these data are limited, the potential health consequences of aflatoxin exposure in this region merit further investigation.

National Cancer Institute Experience in Healthy Egyptian Blood Donors as Regards Blood Group Frequencies and Seroprevalence of Hepatitis B Virus, Hepatitis C Virus&HIV: 10 Year Evaluation.

BACKGROUND: As blood safety is a major concern in Transfusion Medicine. This study attempted to characterize the safety profile of different blood donor groups in order to maximize the use of limited recruitment resources and focus on selected donor groups. The A and B antigens followed by the D antigen are considered the most important, due to their role in blood transfusion and transplantation. METHODS: This is a retrospective study reviewing records of 99757 donors who randomly donated at National Cancer Institute-Blood Bank as well as external blood drives conducted from 2000 to 2005. Donor groups were divided into 6 categories according to location of the blood drives which ultimately provided 6 different socioeconomic groups. Hepatitis B surface antigen (HBsAg), Hepatitis C virus (HCV) and Human immunodeficiency virus (HIV) antibodies (Ab) were examined using ELISA technique. Findings were compared to those of the preceding 5 years. The incidence of different ABO groups was estimated among 102244 healthy Egyptian blood donors using gel card technique. Correlation of prevalence of infectious diseases among different blood groups was not investigated. RESULTS: No HIV positivity was detected compared to two cases 5 years before. Over all prevalence of HBsAg was 1.30% Vs. 2.13% and HCV Ab reactivity was 4.04% Vs. 6.88% during 2000 to 2005 compared to the preceding five years; respectively. The frequency of groups A, O, B, and AB Rh-positive was 33.6% (n=34364), 27.5% (n=28127), 22% (n=22532), 9.3% (n=9554); respectively; whereas, groups A, O, B, and AB Rh-negative was 2.7% (n=2738), 2.3% (n=2381), 1.8% (n=1830), 0.7% (n=718); respectively. CONCLUSION: Decreasing prevalence of HBV, HCV & HIV among healthy non-paid volunteer donors over the last 5 years is mostly due to multiple hypothetical factors including; larger sample size due to increased donors recruitment efforts leading to more accurate results, and improvements in specificity and sensitivity of blood-borne pathogen detection. Paid donors, constituting a donor category during the preceding 5 years; were no longer accepted for donation as per Ministry of Health regulations. Lastly, the widespread utilization of Hepatitis B vaccination which is a mandatory vaccination according to Ministry of Health regulations and improved public heath awareness, shared in decreasing prevalence of HBV. The relatively higher socioeconomic classes showed lowest prevalence of viral markers, thus it should be targeted by donors recruitment plans. ABO blood group order of relative frequencies were found to be A+ve, O+ve, B+ve, AB+ve, A-ve, O-ve, B-ve, followed by AB-ve. Key Words: HBV , HCV , HIV , Blood group.

Associations of pesticides, HCV, HBV, and hepatocellular carcinoma in Egypt.

The rate of hepatocellular carcinoma (HCC) is increasing in Egypt where the major risk factors are chronic infections with hepatitis B and C viruses (HBV and HCV). A major segment of the population is employed in agriculture, raising the possibility that exposure to pesticides is an additional risk factor for HCC. The objective of this study is to investigate pesticides as environmental risk factors for HCC while taking into account viral risk factors. We conducted a case-control study of 236 subjects with confirmed HCC recruited from the National Cancer Institute, Cairo University, Egypt, and 236 controls matched on sex, age group and urban-rural status recruited from orthopedic department, Cairo University Hospital, Egypt. Patients who agreed to participate signed a consent form, answered a questionnaire and gave a blood sample for hepatitis virus testing. The manuals of the Ministry of Agriculture for approved use and type of pesticides since 1965 were linked to the questionnaire data for types of crops and pests that the subject had to combat, to attribute specific pesticides that were used by each subject. Subjects also reported duration of the exposure (years). Case-control comparisons in these data were stratified by sex, age group, and urban vs. rural residence. Data were analyzed using unconditional logistic regression models adjusting for age, HCV RNA, and current hepatitis B infection. Among rural males, the adjusted odds ratio (OR) for organophosphorus compounds was 2.7 (95% CI = 1.3-5.3) and for carbamates it was 2.9 (95% CI = 1.4-5.8). No statistically significant associations between HCC and pesticides were observed for urban males or for females. As expected, the strongest risk factors for HCC in this study were HCV RNA (OR = 16-17) and current HBV infection (OR = 27-28). This study therefore suggests that exposures to organophophorus and carbamate pesticides are additive risk factors to current HCV and HBV infection among rural males. Future investigation should address the possible hepatocarcinogenicity of pesticides using biomarkers of exposure and other techniques to better estimate dose-response relationships.

Case-control study of non-Hodgkin's lymphoma and hepatitis C virus infection in Egypt.

BACKGROUND: Chronic infection with hepatitis C virus (HCV) has been associated in some studies with increased risk for B-cell non-Hodgkin's lymphoma (NHL). To assess this further, we conducted a case-control study in Egypt, where HCV prevalence is extremely high. METHODS: Cases with B-cell NHL (N = 227) were recruited from the National Cancer Institute of Cairo University, a major referral centre. Controls (N = 227) were patients with fractures being treated at the Kasr El-Aini Orthopaedic Hospital, from the same referral base as the cases, and were frequency-matched by gender, rural versus urban birthplace, and age. Subjects were interviewed about their medical history and possible risk factors, and blood samples were collected for HCV diagnostic tests. Anti-HCV and HCV RNA were determined by enzyme-linked immunoassay and reverse transcription-polymerase chain reaction, respectively. Odds ratios (OR) and 95% CI were calculated from logistic regression models. RESULTS: Overall, 42% of subjects were anti-HCV positive and 33% had HCV RNA. There was a statistically significant unadjusted association of HCV RNA with NHL (OR = 2.3, 95% CI: 1.5, 3.5), which differed slightly by gender (males: OR = 2.1, 95% CI: 1.2, 3.7 versus females: OR = 2.5, 95% CI: 1.3, 4.8). Anti-HCV without HCV RNA was not associated with case status (OR = 0.9, 95% CI: 0.5, 1.6). After adjustment for age, gender, rural versus urban birthplace, and rural versus urban current residence, the association of HCV RNA with the risk of NHL remained statistically significant (OR = 2.9, 95% CI: 1.9, 4.5). CONCLUSIONS: These data support the hypothesis that NHL is a malignant outcome of chronic HCV infection.