Adiponectin rs1501299 and chemerin rs17173608 gene polymorphism in children with type 1 diabetes mellitus: relation with macroangiopathy and peripheral artery disease.

AIM: Although macrovascular complications represent the leading cause of mortality in type 1 diabetes mellitus (T1DM), the prevalence of subtle macrovascular affection including peripheral artery disease (PAD) among children with T1DM and its genetic predictors remains to be unraveled. Increasing evidence suggests a link between adiponectin rs1501299 and chemerin rs17173608 gene polymorphism and atherogenesis, and insulin resistance. Hence, this study assess the prevalence of these variants among children with T1DM in comparison to healthy controls and their association with macrovascular complications, namely PAD and hyperlipidemia. METHODS: Fifty children with T1DM and 50 matched controls underwent a thorough assessment including adiponectin rs1501299 and chemerin rs17173608 gene polymorphisms, fasting lipids, glycated hemoglobin (HbA1c), and ankle-brachial index (ABI). Cochran-Armitage trend test was used to decide the risk allele and evaluate the association between the candidate variant and PAD using a case-control design. RESULTS: Children with T1DM were found to have significantly higher ABI (p = 0.011) than controls. Chemerin gene polymorphism was detected in 41 children with T1DM (82.0%), while adiponectin gene polymorphism was detected in 19 children (38.0%). Children with T1DM having GG chemerin variant and those having TT adiponectin variant had significantly higher cholesterol with significantly lower HDL-C and ABI than those having the other two variants (p < 0.005). Children with T1DM having abnormal ABI had significantly higher chemerin G (p = 0.017) and adiponectin T (p = 0.022) alleles than those with normal ABI. Cholesterol and ABI were independently associated with chemerin and adiponectin gene polymorphism by multivariable regression analysis. CONCLUSION: Children with T1DM having chemerin and adiponectin gene polymorphisms have significantly higher cholesterol and ABI than those without these polymorphisms and controls. TRIAL REGISTRATION: The Research Ethics Committee of Ain Shams University, approval number R 31/2021.

Hepatitis C virus infection in a community in the Nile Delta: risk factors for seropositivity.

The purpose of this study was to identify risk factors for hepatitis C virus (HCV) infection in a rural village in the Nile Delta with a high prevalence of antibodies to HCV (anti-HCV). One half of the village households were systematically selected, tested for anti-HCV, and interviewed: 973 of 3,999 (24.3%) subjects were anti-HCV-positive (reflecting prior HCV infection but not necessarily current liver disease), with nearly equal prevalence among males and females. Anti-HCV prevalence increased sharply with age among both males and females, from 9.3% in those 20 years of age and younger to >50% in those older than 35, suggesting a cohort effect with reduced transmission in recent years. Multivariate regression was used to estimate independent effects of risk factors on seropositivity. Among those over 20 years of age, the following risk factors were significantly associated with seropositivity: age (P <.001); male gender (odds ratio [OR] = 2.5, 95% CI = 1.3-4.7); marriage (OR = 4.1, 2.4-6.9); anti-schistosomiasis injection treatment (OR = 2.0, 1.3-2.9); blood transfusion (OR = 1.8, 1.1-2.9), invasive medical procedure (surgery, catheterization, endoscopy, and/or dialysis) (OR = 1.5, 1.1-1.9); receipt of injections from "informal" health care provider (OR = 1.3, 1.0-1.6); and cesarean section or abortion (OR = 1.4, 1.0-1.9). Exposures not significantly related to anti-HCV positivity in adults included: history of, or active infection with, Schistosoma mansoni, sutures or abscess drainage, goza smoking in a group, and shaving by community barbers. Among those 20 years old or younger, no risk factors were clearly associated with anti-HCV positivity; however, circumcision for boys by informal health care providers was marginally associated with anti-HCV (OR = 1.7, 1.0-3.0). Prevention programs focused primarily on culturally influenced risks in rural Egyptian communities are being implemented and evaluated.

Hepatitis C virus (HCV) infection in a community in the Nile Delta: population description and HCV prevalence.

This report describes a cross-sectional survey of the prevalence of antibodies to hepatitis C virus (anti-HCV) in a rural Egyptian community in the Nile Delta. One half of the village households were systematically selected and examined by questionnaire and testing sera for anti-HCV and HCV RNA. Blood samples were obtained from 3, 888 (75.4%) of 5,156 residents >/=5 years of age; an additional 111 samples were obtained from children younger than 5 years. Overall, 973 (24.3%) of 3,999 residents were anti-HCV-positive, and the age- and gender-adjusted seroprevalence was 23.7%. Anti-HCV prevalence increased sharply with age, from 9.3% in those 20 years of age and younger to >50% in those older than 35 years. Currently or previously married individuals were more likely to be seropositive than those never married, controlling for age (Mantel-Haenszel risk ratio = 1.8; 95% CI: 1.3, 2.6). Of the 905 anti-HCV-positive samples tested, 65% were also positive for HCV RNA. Active schistosomal infection was not associated with anti-HCV status; however, history of antischistosomal injection therapy (reported by 19% of anti-HCV positives) was a risk for anti-HCV (age-adjusted risk ratio = 1.3; 95% CI: 1.2, 1.5). This study, the largest community-based survey to date, supports earlier reports of high levels of anti-HCV among adults in rural areas of Egypt, although many of those who are seropositive will not have active liver disease. The large reservoir of HCV infection in the community provides an opportunity to investigate risk factors for transmission, the natural history of infection and effectiveness of preventive methodologies, and raises concern about the prospect of an increasing incidence of chronic liver disease in the coming decades.

Diarrhoeal disease morbidity and home treatment practices in Egypt.

Diarrhoeal disease is a major cause of death in children in the developing world. In developing countries a quarter of infant and childhood mortality is related to diarrhoea. The World Health Organization started the Diarrhoeal Disease Control Programme (CDD) in 1980 with the objective to decrease diarrhoeal mortality and morbidity among young children in developing countries. The aim of this study was to measure the prevalence and incidence of diarrhoeal diseases among young children and to assess the quality of home case management of diarrhoeal cases. Particular emphasis was put on the assessment of drug use during diarrhoea. The survey included also the assessment of breast feeding practices. Geographically the survey was limited to two governorates, Dakahlia and Gharbia, in lower Egypt, which have the largest population (7.12 million) and were thought to be representative of lower Egypt. The total sample size was 11032. Seasonally adjusted diarrhoea incidence was 3.6 episodes per child under five years of age per year. This means a minimum estimate of 30 million cases annually in Egypt. Although the majority of the caretakers knew of Oral Rehydration Salts (ORS), only 22% of cases with diarrhoea in the last 24 h received ORS. 54% of cases had received drugs, and many of the children with diarrhoea received more than one drug. The source of drug prescription was most often a private doctor and the use of drugs was common among government doctors and health workers. The high proportion of cases treated with drugs, other than ORS, is the major problem in diarrhoeal home case management in Egypt. The message of ORS has penetrated into the general population well, but the practices of health professionals have not changed. To improve the situation further, training of health workers in correct case management is needed. Paediatric forms of symptomatic antidiarrhoeal drugs should also be withdrawn from the market.

PIP: In August 1992, interviews were conducted with 9711 caretakers, usually mothers, living in Kakahlia and Gharbia governorates, Egypt, so researchers could determine the prevalence and incidence of diarrheal diseases among 11,032 children aged under 5 years and examine the quality of home treatment practices among 958 children who had had diarrhea in the previous 24 hours. The point prevalence of diarrhea for the previous 24 hours was 8.7% (958 children). 4.1% of these diarrhea cases had had persistent diarrhea (14 days in duration). 3.8% had had blood in the stool. Only 2 of the 36 children with blood in the stool had received an antibiotic or an antiparasitic drug. 21.9% had received oral rehydration solution (ORS). 77.1% of their caretakers prepared ORS correctly. The mean quantity of ORS was 351 ml/child, probably too little for effective rehydration. 95.8% of caretakers of all cases of diarrhea in the last 24 hours were familiar with ORS. The 2-week diarrheal incidence rate was 20.4%. The seasonally adjusted incidence rate was 3.6 episodes/child/year. Rural areas had higher incidence and prevalence rates than urban areas (2-weeks incidence, 22.7% vs. 16.9%; point prevalence, 10% vs. 6.6%). 96.3% of lactating mothers continued to breast feed during their child's diarrhea episode. 69.8% of diarrhea cases receiving solid or semi-solid foods before the illness received the same amount during the diarrhea episode. Only 24.4% of cases who received fluids other than breast milk before diarrhea received more fluids during diarrhea. 54.2% of all cases were given at least one drug during the diarrhea episode; more than 50% of these were given more than one drug. 17.6% received ORS and drugs. Only 5% received ORS alone. A private physician and a government physician or health worker, respectively, prescribed a drug for 50% and 23.3% of cases who were given drugs. A pharmacy provided 90.4% of the drugs. The continued breast feeding rate (i.e., any breast feeding in last 24 hours) was 78.2% among children aged 12-15 months and 48.9% among those aged 20-23 months. Training of health workers in correct case management is needed.