Carbon based sensors for air quality monitoring networks; middle east perspective.

IoT-based Sensors networks play a pivotal role in improving air quality monitoring in the Middle East. They provide real-time data, enabling precise tracking of pollution trends, informed decision-making, and increased public awareness. Air quality and dust pollution in the Middle East region may leads to various health issues, particularly among vulnerable populations. IoT-based Sensors networks help mitigate health risks by offering timely and accurate air quality data. Air pollution affects not only human health but also the region's ecosystems and contributes to climate change. The economic implications of deteriorated air quality include healthcare costs and decreased productivity, underscore the need for effective monitoring and mitigation. IoT-based data can guide policymakers to align with Sustainable Development Goals (SDGs) related to health, clean water, and climate action. The conventional monitor based standard air quality instruments provide limited spatial coverage so there is strong need to continue research integrated with low-cost sensor technologies to make air quality monitoring more accessible, even in resource-constrained regions. IoT-based Sensors networks monitoring helps in understanding these environmental impacts. Among these IoT-based Sensors networks, sensors are of vital importance. With the evolution of sensors technologies, different types of sensors materials are available. Among this carbon based sensors are widely used for air quality monitoring. Carbon nanomaterial-based sensors (CNS) and carbon nanotubes (CNTs) as adsorbents exhibit unique capabilities in the measurement of air pollutants. These sensors are used to detect gaseous pollutants that includes oxides of nitrogen and Sulphur, and ozone, and volatile organic compounds (VOCs). This study provides comprehensive review of integration of carbon nanomaterials based sensors in IoT based network for better air quality monitoring and exploring the potential of machine learning and artificial intelligence for advanced data analysis, pollution source identification, integration of satellite and ground-based networks and future forecasting to design effective mitigation strategies. By prioritizing these recommendations, the Middle East and other regions, can further leverage IoT-based systems to improve air quality monitoring, safeguard public health, protect the environment, and contribute to sustainable development in the region.

Circulating miR-206, miR-181b, and miR-21 as promising biomarkers in hypothyroidism and their relationship to related hyperlipidemia and hepatic steatosis.

Background: Thyroid hormones (THs) signaling has profound effects on many physiological processes. The regulation of THs signaling in various tissues involves the action of microRNAs (miRNAs) on thyroid deiodinases and receptors. THs regulate the expression of certain miRNAs and their target messenger RNAs (mRNAs) in various tissues and cells. The modulation of miRNA levels by THs affects their functions in processes such as liver lipid metabolism, skin physiology, and muscle and heart performance. Aim: This research aimed to investigate miR-181b, miR-206, and miR-21 in the serum of patients with subclinical and overt hypothyroidism to determine their possible role in the diagnosis of the disease and their relationship to clinical disorders related to hypothyroidism. Methods: This study included ninety participants, divided evenly into three groups as follows: patients with overt hypothyroidism diagnosed clinically, radiologically, and by investigation, subclinical hypothyroid patients, and healthy volunteers. The patients had a thorough medical history and underwent a clinical examination. Laboratory tests included plasma cholesterol, LDL, HDL, TGs, liver and renal function tests, CBC, fasting insulin, HOMA-IR, HbA1c, TSH, and free T4. The serum levels of miR-21, miR-206, and miR-181b were measured using qRT-PCR. Results: miR-206 and miR-181b levels were higher in the subclinical group, followed by the hypothyroid and control groups. For miR-21, there was a significantly lower mean value in both the hypothyroid and subclinical groups than in the control group, with no difference between the two groups. Both miR-206 and miR-181b showed a significant negative association with albumin and free T4 levels and a significant direct association with GGT, ALT, AST, creatinine, uric acid, TGs, TC, LDL, TSH, thyroid volume, and CAP score. The same correlation pattern was observed for miR-181b, except that it was not significantly correlated with the TGs. For miR-21 levels, there was a significant positive correlation with albumin, free T4 level, and kPa score and a negative correlation with GGT, ALT, AST, creatinine, uric acid, HOMA-IR, HbA1c, TC, LDL, TSH, and CAP score. Cases with F1 kPa score and S2 CAP scores had significantly higher averages for miR-206 and miR-181b, with a p-value of 0.05. Moreover, miR-21 levels were significantly lower in the S2 CAP score group. Conclusion: These miRNAs (miR-206, miR-181b, and miR-21) may be used as diagnostic biomarkers for hypothyroidism. They may be used as therapeutic targets to control dyslipidemia and hepatic steatosis during hypothyroid disease.

Larvicidal potential, toxicological assessment, and molecular docking studies of four Egyptian bacterial strains against Culex pipiens L. (Diptera: Culicidae).

Mosquito control in Egypt depends on applying chemical synthetic pesticides that impact negatively on human health and the environment as well as the development of antibiotic and chemical resistance. This study aims to control the 3rd and 4th instars of Culex pipiens larvae using four bacterial strains. According to Phenotypic and molecular identification, the four isolates were identified as Bacillus subtilis MICUL D2023, Serratia marcescens MICUL A2023, Streptomyces albus LARVICID, and Pseudomonas fluorescens MICUL B2023. All strains were deposited in GenBank under accession numbers OQ764791, OQ729954, OQ726575, and OQ891356, respectively. Larvicidal activity of all microbial strain metabolites against a field strain of C. pipiens explored low LC50 results and reached its lowest values on the 3rd day with values of 6.40%, 38.4%, and 46.33% for P. fluorescens, S. albus, and S. marcescens, respectively. In addition, metabolites of P. fluorescence were more toxic than those of S. albus, followed by S. marcescens. B. subtilis shows no larvicidal effect on both field and lab mosquito strains. Microscopic alterations of 3rd and 4th instars showed toxic effects on different body parts (thorax, midgut, and anal gills), including losing external hairs, abdominal breakage, and larvae shrinkage, as well as different histological malformations in the digestive tract, midgut, and cortex. GC-MS analysis detected 51, 30, and 32 different active compounds from S. albus, S. marcescens, and P. fluorescens, respectively. GC detected 1, 2-BENZEA2:A52NEDICARBOXYLIC ACID, 2-Cyclohexene-1-carboxylic-acid-5-2-butenyl-methyl ester, and 3 octadecahydro2R3S4Z9Z-11R-12S from S. albus, S. marcesens, and P. fluorescens, respectively. Total protein, Total carbohydrate, and Acetylcholine esterase activity indicated significantly low levels on the 3rd day. All strain metabolites were safe against HSF cell lines. The docking results confirmed the role of the produced metabolites as larvicidal agents and Acetylcholine esterase inhibition. Such a problem need more studies on applying more and more natural pesticides.

Ketamina frente a midazolam como adyuvante para el bloqueo peribulbar utilizando una única inyección inferonasal en los pacientes sometidos a vitrectomía: ensayo controlado aleatorizado / Ketamine versus midazolam as an adjuvant to peribulbar block using a single inferonasal injection in patients undergoing vitreoretinal surgery: A randomized controlled trial

Introducción y objetivos: El objetivo de este estudio fue evaluar la seguridad y eficacia de midazolam y ketamina como adyuvantes para el bloqueo peribulbar en vitrectomías. Pacientes y métodos: Este ensayo controlado aleatorizado incluyó 93 pacientes adultos sometidos a vitrectomías realizadas con anestesia peribulbar. Se asignó aleatoriamente a los pacientes en 3 grupos (de 31 participantes cada uno): control (mezcla anestésica estándar), midazolam (mezcla estándar+midazolam) y ketamina (mezcla estándar+ketamina). Los resultados primarios fueron el inicio de la acinesia globular y la duración de la analgesia. Los resultados secundarios fueron la duración del bloqueo motor, el inicio de la anestesia corneal y la acinesia palpebral, y los cambios de los datos vitales (presión sanguínea, saturación de oxígeno, y frecuencia cardiaca). Resultados: El grupo ketamina frente al grupo control y el grupo midazolam reflejaron el inicio más rápido de la acinesia palpebral y globular (p<0,001) y la anestesia corneal (0,7±0,2 vs. 1,5±0,5 y 1,2±0,4, respectivamente; p<0,001) y la duración más prolongada tanto de la analgesia (3,7±0,6 vs. 2,3±0,4 y 3,1±0,6, respectivamente; p<0,001) como de la acinesia (3,8±0,5 vs. 3±0,4, y 3,7±0,5, respectivamente; p<0,001). El grupo midazolam reflejó mejores resultados que los controles, aunque el fármaco fue menos efectivo que la ketamina. No se produjeron diferencias significativas en términos de datos vitales entre los grupos (p>0,05). Conclusiones: Ketamina es un adyuvante efectivo para el bloqueo peribulbar. Mejora el bloqueo motor y sensorial acelerando el inicio y prolongando la duración. Dichos efectos son deseables en los procedimientos oftálmicos más prolongados, tales como vitrectomías. Los efectos de ketamina fueron superiores a los de midazolam.(AU)

Introduction and objectives: This study aimed to assess the safety and efficacy of midazolam and ketamine as adjuvants to the peribulbar block in vitreoretinal surgeries. Patients and methods: This randomized controlled trial included 93 adult patients undergoing vitreoretinal surgeries performed with peribulbar anaesthesia. Patients were randomly allocated to 3 groups (31 participants each): control (standard anaesthetic mixture), midazolam (standard mixture+midazolam), and ketamine (standard mixture+ketamine). The primary outcomes were onset of globe akinesia and duration of analgesia. Secondary outcomes were duration of motor blockade, onset of corneal anaesthesia and lid akinesia, and changes in vital data (blood pressure, oxygen saturation, and pulse rate). Results: The ketamine group vs. the control and midazolam groups showed the most rapid onset of lid and globe akinesia (p<0.001) and corneal anaesthesia (0.7±0.2 vs. 1.5±0.5 and 1.2±0.4, respectively; p<0.001) and the longest duration of both analgesia (3.7±0.6 vs. 2.3±0.4 and 3.1±0.6, respectively; p<0.001) and akinesia (3.8±0.5 vs. 3.0±0.4, and 3.7±0.5, respectively; p<0.001). The midazolam group showed better outcomes than controls, but the drug was less effective than ketamine. There were no significant differences in vital data among groups (p>0.05). Conclusions. Ketamine is an effective adjuvant for peribulbar blockade. It enhances both motor and sensory blockade by hastening onset and prolonging duration. These effects are desirable in lengthier ophthalmic procedures such as vitreoretinal surgeries. The effects of ketamine were superior to those of midazolam.(AU)

Value of intraoperative monitoring of the trigeminal nerve in detection of a superiorly displaced facial nerve during surgery for large vestibular schwannomas.

The aim of this study was to investigate the role of trigeminal and facial nerve monitoring in the early identification of a superiorly (anterior and superior (AS)) displaced facial nerve. This prospective study included 24 patients operated for removal of large vestibular schwannomas (VS). The latencies of the electromyographic (EMG) events recorded from the trigeminal and facial nerve innervated muscles after mapping the superior surface of the tumor were analyzed. The mean latency of the recorded compound muscle action potential (CMAP) from the masseter muscle was 3.6 ± 0.5 ms and of the peripherally transmitted responses by volume conduction from the frontalis, o. oculi, nasalis, o. oris, and mentalis muscles was 4.6 ± 0.9, 4.1 ± 0.7, 3.9 ± 0.4, 4.3 ± 0.8, and 4.5 ± 0.6 ms, respectively, after trigeminal nerve stimulation in 24 (100%) patients (pattern I response). In 6 (25%) patients, the mean latency of CMAP on the masseter was 3.3 ± 0.3 ms, and the latencies of the CMAP from the frontalis, o. oculi, nasalis, o. oris, and mentalis muscles were 6.5 ± 1.3, 5.0 ± 1.5, 7.5 ± 1.3, 7.4 ± 0.6, and 7.0 ± 1.5 ms, respectively, longer than those of the peripherally transmitted responses (p = 0.002, p = 0.001, p < 0.001, and p = 0.015, respectively) indicating simultaneous stimulation of both nerves (pattern II response). All patients with this response were later confirmed to have an AS-displaced facial nerve. Recognizing the response resulting from simultaneous stimulation of both the facial and trigeminal nerves is important to help early identification of an AS-displaced facial nerve before it is visible in the surgical field and to avoid misleading information by confusing this pattern for a pure trigeminal nerve response.

Complementary and alternative medicine for lowering blood lipid levels: A systematic review of systematic reviews.

BACKGROUND: The aim of this article is to summarize and critically evaluate the evidence from systematic reviews (SRs) of complementary and alternative medicine (CAM) for lowering blood lipid levels (BLL). METHODS: Eight electronic databases were searched until March 2016. Additionally, all the retrieved references were inspected manually for further relevant papers. Systematic reviews were considered eligible, if they included patients of any age and/or gender with elevated blood lipid levels using any type of CAM. We used the Oxman and AMSTAR criteria to critically appraise the methodological quality of the included SRs. RESULTS: Twenty-seven SRs were included in the analyses. The majority of the SRs were of high methodological quality (mean Oxman score=4.81, SD=4.88; and the mean AMSTAR score=7.22, SD=3.38). The majority of SRs (56%) arrived at equivocal conclusions (of these 8 were of high quality); 7 SRs (37%) arrived at positive conclusions (of these 6 were of high quality), and 2 (7%) arrived at negative conclusions (both were of high quality). There was conflicting evidence regarding the effectiveness of garlic; and promising evidence for yoga. CONCLUSIONS: To conclude, the evidence from SRs evaluating the effectiveness of CAM in lowering BLL is predominantly equivocal and confusing. Several limitations exist, such as variety of doses and preparations, confounding effects of diets and lifestyle factors, or heterogeneity of the primary trials among others.

Hepatitis C virus infection and risk factors in health-care workers at Ain Shams University Hospitals, Cairo, Egypt.

The objectives of this study were to document the background prevalence and incidence of HCV infection among HCWs in Ain Shams University Hospitals in Cairo and analyse the risk factors for HCV infection. A cross-sectional survey was conducted in 2008 among 1770 HCWs. Anti-HCV prevalence was age-standardized using the Cairo population. A prospective cohort was followed for a period of 18 months to estimate HCV incidence. The crude anti-HCV prevalence was 8.0% and the age-standardized seroprevalence was 8.1%. Risk factors independently associated with HCV seropositivity were: age, manual worker, history of blood transfusions and history of parenteral anti-schistosomiasis treatment. The estimated incidence of HCV infection was 7.3 per 1000 person-years. HCWs in this setting had a similar high HCV seroprevalence as the general population of greater Cairo.

Hepatitis C virus infection and risk factors in health-care workers at Ain Shams University Hospitals, Cairo, Egypt

The objectives of this study were to document the background prevalence and incidence of HCV infection among HCWs in Ain Shams University Hospitals in Cairo and analyse the risk factors for HCV infection. A cross-sectional survey was conducted in 2008 among 1770 HCWs. Anti-HCV prevalence was age-standardized using the Cairo population. A prospective cohort was followed for a period of 18 months to estimate HCV incidence. The crude anti-HCV prevalence was 8.0% and the age-standardized seroprevalence was 8.1%. Risk factors independentlyassociated with HCV seropositivity were: age, manual worker, history of blood transfusions and history of parenteral anti-schistosomiasis treatment. The estimated incidence of HCV infection was 7.3 per 1000 person-years. HCWs in this setting had a similar high HCV seroprevalence as the general population of greater Cairo.

Les objectifs de la présente étude étaient de documenter la prévalence et l’incidence de fond del’infection par le virus de l’hépatite C chez les agents de santé de l’hôpital universitaire Ain Shams du Caire et d’analyser les facteurs de risque de contracter une infection par le virus de l’hépatite C. Une enquête transversale a été menée en 2008 auprès de 1770 agents de santé. La prévalence des anticorps contre le virus de l’hépatite C a été normalisée pour l’âge par rapport à la population du Caire. Une cohorte prospective a été suivie pendant 18 mois pour estimer l’incidence de l’infection par le virus de l’hépatite C. La prévalence brute des anticorps contre le virus de l’hépatite C était de 8,0 % et la séroprévalence normalisée pour l’âge était de 8,1 %. Les facteurs de risque indépendamment associés à une séropositivité pour le virus de l’hépatite C étaient les suivants :l’âge, le travail manuel, des antécédents de transfusion sanguine ainsi que des antécédents de traitement parentéral contre la schistosomiase. L’incidence de l’infection par le virus de l’hépatite C a été estimée à 7,3 pour 1000 personnes par an. Les agents de santé de cet établissement hospitalier avaient une séroprévalence du virus de l’hépatite C aussi élevée que la population générale du Grand Caire.

Multichannel facial nerve monitoring: value in detection of mechanically elicited electromyographic activity and prediction of postoperative outcome.

OBJECTIVE: To determine the value of using a multichannel facial nerve (FN) monitoring setup in detecting mechanically elicited EMG activity during vestibular schwannoma (VS) surgery. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS AND METHODS: This study was conducted on 42 patients operated for VS removal. The FN was monitored using a 5-channel setup with electrodes inserted in mentalis, o.oris, nasalis, o.oculi, and frontalis. The number of channels activated simultaneously in response to a particular event was recorded together with the amplitude of response on each muscle. EMG activity occurring simultaneously on all 5 channels was referred to as "all-channels activity." Postoperative FN function was assessed immediately and 1 year postoperatively using the House-Brackmann classification. RESULTS: The 5-channel setup detected a significantly higher number of mechanically elicited EMG activity than would have been possible using a 2-channel setup. The number and amplitude of EMG activity detected on the mentalis muscle was significantly higher compared with other muscles. Patients with higher percentage of events in which the mentalis fired while o.oris and o.oculi did not were more likely to develop a better long-term outcome. Positive correlation was found between the number of all-channels activity and postoperative outcome (p < 0.001). CONCLUSION: The use of a multichannel setup allowed earlier and efficient detection of mechanically elicited EMG activity. Including the mentalis muscle significantly increased the detection rate, which tended to reflect as improvement in the long-term outcome. The occurrence of all-channels activity should be considered a prompt warning sign.

Surgery for traumatic facial nerve paralysis: does intraoperative monitoring have a role?

The use of intraoperative facial nerve (FN) monitoring during surgical decompression of the FN is underscored because surgery is indicated when the FN shows more than 90 % axonal degeneration. The present study proposes including intraoperative monitoring to facilitate decision taking and provide prognostication with more accuracy. This prospective study was conducted on ten patients presenting with complete FN paralysis due to temporal bone fracture. They were referred after variable time intervals for FN exploration and decompression. Intraoperative supramaximal electric stimulation (2-3 mA) of the FN was attempted in all patients both proximal and distal to the site of injury. Postoperative FN function was assessed using House-Brackmann (HB) scale. All patients had follow-up period ranging from 7 to 42 months. Three different patterns of neurophysiological responses were characterized. Responses were recorded proximal and distal to the lesion in five patients (pattern 1); only distal to the lesion in two patients (pattern 2); and neither proximal nor distal to the lesion in three patients (pattern 3). Sporadic, mechanically elicited EMG activity was recorded in eight out of ten patients. Patients with pattern 1 had favorable prognosis with postoperative function ranging between grade I and III. Pattern 3 patients showing no mechanically elicited activity had poor prognosis. Intraoperative monitoring affects decision taking during surgery for traumatic FN paralysis and provides prognostication with sufficient accuracy. The detection of mechanically elicited EMG activity is an additional sign predicting favorable outcome. However, absence of responses did not alter surgeon decision when the nerve was found evidently intact.

Towards realistic estimates of HCV incidence in Egypt.

Accurate incidence estimates are essential for quantifying hepatitis C virus (HCV) epidemic dynamics and monitoring the effectiveness of public health programmes, as well as for predicting future burden of disease and planning patient care. In Egypt, the country with the largest HCV epidemic worldwide, two modelling studies have estimated age-specific incidence rates that, applied to the age pyramid, would correspond to more than 500 000 Egyptians getting infected annually. This is in contrast to figures of the Egyptian Ministry of Health and Population that estimates new infections to be approximately 100 000 per year. We performed new analyses of nationwide data to examine the modelling assumptions that led to these estimates. Thus, we found that the key assumption of these models of a stationary epidemic is invalid. We propose an alternate approach to estimating incidence based on analysing cohort data; we find that the number of annual new infections is <150 000.

Prevalence of hepatitis B and C virus infections and their related risk factors in Libya: a national seroepidemiological survey.

A high prevalence of hepatitis B (HBV) and C virus (HCV) infections has been reported among specific patient groups in Libya; a survey was thus designed to determine the extent of the problem at the national level. A multi-stage sampling design covering all administrative areas of Libya was applied, covering > 65,000 individuals of all age groups. All subjects gave a blood sample and completed a questionnaire on demographic and risk behaviour data. The prevalence of HBV surface antigen (HBsAg) and anti-HCV were 2.2% and 1.3% respectively. The prevalence of anti-HCV increased with age, rising gradually after age 30 years, in contrast to a stable prevalence of HBsAg in all age groups 10+ years. Age-adjusted risk factors for HCV infection were previous hospitalization, surgical operations, previous blood transfusions and intravenous drug use; for HBV infection only family exposure or contact with HBV case were identified.

Prevalence of hepatitis B and C virus infections and their related risk factors in Libya: a national seroepidemiological survey

A high prevalence of hepatitis B [HBV] and C virus [HCV] infections has been reported among specific patient groups in Libya; a survey was thus designed to determine the extent of the problem at the national level. A multi-stage sampling design covering all administrative areas of Libya was applied, covering > 65 000 individuals of all age groups. All subjects gave a blood sample and completed a questionnaire on demographic and risk behaviour data. The prevalence of HBV surface antigen [HBsAg] and anti-HCV were 2.2% and 1.3% respectively. The prevalence of anti-HCV increased with age, rising gradually after age 30 years, in contrast to a stable prevalence of HBsAg in all age groups 10+ years. Age-adjusted risk factors for HCV infection were previous hospitalization, surgical operations, previous blood transfusions and intravenous drug use; for HBV infection only family exposure or contact with HBV case were identified

HCV burden of infection in Egypt: results from a nationwide survey.

Egypt is the country with the largest hepatitis C virus (HCV) epidemic in the world. In 2008, a Demographic Health Survey (DHS) was carried out in Egypt, providing for the first time a unique opportunity for HCV antibody testing on a nationwide representative sample of individuals. Consenting individuals answered a questionnaire on socio-demographic characteristics and iatrogenic exposures, before providing a blood sample for HCV antibody testing by enzyme-linked immunosorbent assay. Factors independently associated with HCV infection were examined through multivariate logistic regression models. Of 12 780 eligible subjects aged 15-59 years, 11 126 (87.1%) agreed to participate and provided a blood sample. HCV antibody prevalence nationwide was 14.7% (95% CI 13.9-15.5%) in this age group. HCV antibody prevalence gradually increased with age, reaching, in the 50-59 years age group, 46.3% and 30.8% in males and females, respectively. It was higher in males compared to females (17.4% versus 12.2%, respectively, P < 0.001), and in rural compared to urban areas (18.3% versus 10.3%, respectively, P < 0.001). In multivariate analysis, age, male sex, poverty, past history of intravenous anti-schistosomiasis treatment, blood transfusion, and living outside of the Frontier Governorates were all significantly associated with an increased risk of HCV infection. In addition, in urban areas, lack of education and being circumcised for females were associated with an increased risk of HCV infection. This study confirmed on a nationwide representative sample the very high HCV antibody prevalence in Egypt. It stresses the urgent need for strengthening prevention efforts, and bringing down the costs of antiviral drugs for countries like Egypt, where the people in the most precarious situations are also those most likely to be infected by the virus.

Epidemiological and virological characteristics of symptomatic acute hepatitis E in Greater Cairo, Egypt.

The aim of the study was to describe the characteristics of acute hepatitis E in Greater Cairo. Patients with acute hepatitis E were identified through a surveillance of acute hepatitis using the following definition: recent (<3 weeks) onset of fever or jaundice, alanine aminotransferase at least three times the upper limit of normal (uln), negative markers for other causes of viral hepatitis and detectable hepatitis E virus (HEV) RNA. Comparison of the liver tests between acute hepatitis E and hepatitis A virus (HAV), case-control analysis (four sex-matched and age-matched (±1 year) HAV controls per case) to explore risk factors and phylogenetic analyses were performed. Of the 17 acute HEV patients identified between 2002 and 2007, 14 were male. Median age was 16 years (interquartile range 13-22). Compared with HAV (n = 68 sex-matched and ±1 year age-matched), HEV patients had higher bilirubin (mean (SD) 10.9 (5.7) uln versus 7.5 (4.4) uln, p 0.05) and aspartate aminotransferase levels (38.6 (27.1) uln versus 18.3 (18.1) uln, p 0.02). Co-infection (hepatitis C virus RNA or hepatitis B surface (HBs) -antigen positive/IgM anti-hepatitis B core (HBc) anitgen negative) was diagnosed in four patients. In univariate matched analysis (17 cases, 68 matched controls), HEV cases were more likely to live in a rural area than HAV controls (matched OR 7.9; 95% CI 2.0-30.4). Of the 16 isolates confirmed as genotype 1, 15 belonged to the same cluster with 94-98.5% identity in the open-reading frame 2 region. Our findings documented the sporadic nature of HEV in Greater Cairo, characterized a large number of Egyptian HEV genotype 1 strains and identified living in a rural area as a potential risk factor for infection.

Assessment of tobacco dependence in waterpipe smokers in Egypt.

SETTING: Waterpipe smoking is increasing worldwide. Nevertheless, little is known about nicotine dependence in tobacco smokers who use waterpipes. OBJECTIVE: To assess evidence of dependence among non-cigarette smoking waterpipe smokers in Egypt. METHODS: A total of 154 male exclusive current waterpipe smokers were enrolled for the present study. We adapted the Fagerström test for nicotine dependence and the Reasons for Smoking (RFS) scales and related these to smoking behavior. RESULTS: The mean age of the subjects was 47 ± 14 years, the mean age at smoking initiation was 22 ± 9 years, and average daily consumption was 4 ± 8 hagars (tobacco units). The time to the first smoke of the day (P < 0.001), smoking even when ill (P = 0.003), time to tobacco craving (P < 0.001), and hating to give up the first smoke of the day (P = 0.033) were each significantly associated with the number of hagars smoked per day. The RFS subscales of addictive smoking, smoking to relieve negative affect, and smoking for stimulation were also associated with these variables. CONCLUSION: The overall findings suggest that waterpipe smokers exhibit many of the same features of nicotine dependency attributed to cigarette smokers.

Reproducibility of liver stiffness measurements in hepatitis C virus (HCV)-infected patients in Egypt.

Elastometry has demonstrated good accuracy, but little is known about its reproducibility. The aim of this study was to assess the intra- and inter-operator reproducibility of liver stiffness measurement among hepatitis C virus (HCV)-infected patients in Egypt. The study was conducted among HCV-infected patients referred for treatment evaluation in two hepatitis treatment centres of Cairo. Two operators took liver stiffness measurement two times per patient the same day. Intra- and inter-reproducibility were estimated by different methods: Bland and Altman graphics, variation coefficient, intraclass correlation coefficient and Kappa coefficient; 7.1 kPa was used as the threshold of significant (≥F2) fibrosis whenever needed. Fifty-eight patients were included in the study, and 216 measurements were taken. Failure rate was 7% and associated with overweight. For a value of 7.1 kPa, the inter-operator 95% limits of agreement were estimated at ±2.88 kPa. Intra- and inter-operator coefficients of variation ranged between 11% and 15%, intraclass correlation coefficients [95% confidence interval] between 0.94 [0.86-0.97] and 0.97 [0.95-0.99], and Kappa coefficients between 0.65 [0.44-0.88] and 0.92 [0.81-1.00]. The reliability of liver stiffness measurement is questionable when considering the decision to initiate antiviral therapy because of the percentage of discordance between measurements is notable, especially in the intermediate fibrosis stages.

HCV iatrogenic and intrafamilial transmission in Greater Cairo, Egypt.

OBJECTIVES: To document hepatitis C virus (HCV) intrafamilial transmission and assess its relative importance in comparison to other current modes of transmission in the country with the largest HCV epidemic in the world. HCV intrafamilial transmission was defined as HCV transmission among relatives living in the same household. DESIGN: Case-control study. Cases were adult patients with acute hepatitis C diagnosed in two 'fever hospitals' of Cairo. Controls were adult patients with acute hepatitis A diagnosed in the same two hospitals, and family members of cases. All consenting household members of cases provided blood for HCV serological and RNA testing. Homology of viral sequences (NS5b region) within households was used to ascertain HCV intrafamilial transmission. Exposures at risk for HCV during the 1-6 months previous to onset of symptoms were assessed in all cases and controls. RESULTS: From April 2002 to June 2007, 100 cases with acute hepatitis C, and 678 controls (416 household members and 262 patients with acute hepatitis A) were recruited in the study. Factors independently associated with HCV infection and their attributable fractions (AFs) were the following: having had a catheter (OR=5.0, 95% CI=1.4 to 17.8; AF=6.7%), an intravenous perfusion (OR=5.8, 95% CI=2.5 to 13.3; AF=20.1%), stitches (OR=2.0, 95% CI=1.3 to 6.6; AF=10.7%), gum treatment (OR=3.7, 95% CI=1.1 to 11.9; AF=3.8%) and being illiterate (OR=2.4, 95% CI=1.4 to 4.4). Of the 100 cases, 18 had viraemic HCV-infected household members. Three long-married (>15 years) couples were infected with virtually identical sequences and none of the three index patients reported any exposure at risk, suggesting HCV intra-familial transmission. CONCLUSION: While three new HCV infections out of 100 could be linked to intra-familial transmission, parenteral iatrogenic transmission (dental care included) was accountable for 34.6% of these new infections. Thus, the relative contribution of intrafamilial transmission to HCV spread seems to be limited.

Dissection of familial correlations in hepatitis C virus (HCV) seroprevalence suggests intrafamilial viral transmission and genetic predisposition to infection.

OBJECTIVE: Unsafe injections and transfusions used during treatments are considered to be responsible for many cases of transmission of hepatitis C virus (HCV) in developing countries, but cannot account for a substantial proportion of present infections. The aim of the present work was to investigate familial clustering of HCV infection in a population living in a highly endemic area. DESIGN, SETTING AND PARTICIPANTS: A large seroepidemiological survey was conducted on 3994 subjects (age range, 2-88 years) from 475 familial clusters in an Egyptian rural area. Epidemiological methods appropriate for the analysis of correlated data were used to estimate risk factors and familial dependences for HCV infection. A phylogenetic analysis was conducted to investigate HCV strain similarities within and among families. MAIN OUTCOME MEASURES: HCV familial correlations adjusted for known risk factors, similarities between viral strains. RESULTS: Overall HCV seroprevalence was 12.3%, increasing with age. After adjustment for relevant risk factors, highly significant intrafamilial resemblances in HCV seroprevalence were obtained between father-offspring (odds ratio (OR) = 3.4 (95% confidence interval (CI), 1.8 to 6.2)), mother-offspring (OR = 3.8 (95% CI, 2.5 to 5.8)), and sibling-sibling (OR = 9.3 (95% CI, 4.9 to 17.6)), while a weaker dependence between spouses (OR = 2.2 (95% CI, 1.3 to 3.7)) was observed. Phylogenetic analysis showed greater HCV strain similarity between family members than between unrelated subjects, indicating that correlations can be explained, in part, by familial sources of virus transmission. In addition, refined dissection of correlations between first-degree relatives supported the role of host genes predisposing to HCV infection. CONCLUSIONS: Current HCV infection in endemic countries has a strong familial component explained, at least partly, by specific modes of intrafamilial viral transmission and by genetic predisposition to infection.