A controlled study of nitazoxanide (NTZ) 3 years after treatment of hepatitis C genotype 4.

This study is an extension of an earlier, randomized; placebo-controlled that showed the efficacy of nitazoxanide (NTZ) 500 mg tablets twice daily for 6 months in treating HCV genotype 4. Access was available to 13/32 patients of the original study with chronic HCV during more than 3 years after the study was finished. One patient (with portal hypertension and oesophageal varices "O.V") was among 3 with SVR out of 9 of the NTZ treated patients suggesting that NTZ could successfully be used even in patients with O.V. SVR remain so up to the end of the follow-up period compared to none of the other 4 patients who received placebo. A fourth patient of NTZ group achieved virological response at the end of follow-up although she firstly showed RVR and then viral breakthrough. Most of the remaining patients of the NTZ group who did not achieve SVR showed variable partial response. No serious adverse events were reported in both groups during treatment and thereafter.

Clinical trial: randomized, double-blind, placebo-controlled study of nitazoxanide monotherapy for the treatment of patients with chronic hepatitis C genotype 4.

BACKGROUND: Nitazoxanide, licensed in the US for treatment of Cryptosporidium parvum and Giardia lamblia, inhibits hepatitis C virus replication in replicon systems. AIM: To evaluate the safety and efficacy of nitazoxanide monotherapy for the treatment of chronic hepatitis C. METHODS: This multicentre, randomized, double-blind, placebo-controlled study randomized 50 adult patients with chronic hepatitis C genotype 4 at three centres in Egypt to nitazoxanide 500 mg tablet or placebo twice daily for 24 weeks. Patients were followed up every 4 weeks during treatment and for 24 weeks after therapy. RESULTS: Seven of 23 patients (30.4%) in the nitazoxanide group achieved undetectable serum HCV RNA compared to 0 of 24 in the placebo group during therapy (P = 0.004). Each of the seven responders had baseline HCV RNA levels < or =400 000 IU/mL. Six of the seven virological responders were followed up for 24 weeks after the end of treatment, and four patients (17.4% of 23 treated) had a sustained virological response. Adverse events were similar in the nitazoxanide and placebo groups. CONCLUSION: Nitazoxanide monotherapy is safe and effective in achieving sustained virological response in a modest number of patients with chronic hepatitis C genotype 4, particularly in patients with low baseline serum HCV RNA levels.

Low incidence of Helicobacter pylori infection in patients with duodenal ulcer and chronic liver disease.

BACKGROUND: Duodenal ulcer (DU) is a common problem in patients with chronic liver disease (CLD) and with inadequate response to H2 receptor antagonists. Omeprazole might be more effective. In DU-CLD patients, Helicobacter pylori prevalence is low. Nitric oxide is increased in gastric mucosa in cirrhosis. Oxygen-free radicals have a role in gastric inflammation and are abnormal in CLD. Nitrotyrosine is a marker of nitric oxide and oxygen-free radical toxic mucosal reaction. METHODS: Sixty-nine patients were divided into 2 groups: control (26 patients with DU) and CLD groups (43 patients, DU-CLD). Omeprazole was given (40 mg/day) for 2 or 4 weeks. Symptoms and endoscopy findings were recorded before and after treatment. Antral biopsy specimens were stained for H. pylori and nitrotyrosine. RESULTS: Clinical features of DU are similar in patients with and without CLD. The main presentation was epigastric pain (70%) and bleeding (23%). Healing rate with omeprazole was higher in DU-CLD patients (90.7%) than in controls (80.8%). H. pylori was much lower in DU-CLD patients (51.2%) than controls (96.2%). Nitrotyrosine staining was negative in normal controls (0%) and positive in control-DU (100%), CLD-H. pylori positive (81%), and CLD-H. pylori negative (91%) cases. CONCLUSIONS: DU in patients with CLD is not different clinically from those without CLD. Omeprazole effectively and safely treats DU in CLD. Nitric oxide and free oxygen radicals may result in gastric mucosal changes in CLD similar to that caused by H. pylori.

Cryptosporidiosis in Benha, study of some recent modalities in diagnosis and treatment.

A total prevalence of cryptosporidiosis was carried out on 1087 diarrheal patients of all age groups attending the outpatient clinics using modified Ziehl-Neelsen stain (MZN) and Meriflour direct immunofluorescent technique (IFA). IFA was more sensitive, specific and gave positive results 19.5% than MZN stain which gave a positivity 13.5% Cases were divided into 3 groups, each group was treated by one of nitazoxanid (NTZ), or co-trimoxazole or placebo. The most effective drug was NTZ which cured 39 patients (79.6%) out of 49 patients followed by co-trimoxazole that gave cure of 20 (41.6%) out of 48 patients. Placebo cured 20 (40%) out of 50 patients.

Bile duct carcinoma in Egypt: possible etiological factors.

Contrary to an old belief, bile duct carcinoma is not a rare disorder in Egypt. Among 730 patients referred for an ERCP examination, twenty-nine consecutive patients were diagnosed as having bile duct carcinoma. The cause of this type of carcinoma remains unknown. In the present study, only seven of the 29 (24.1%) with bile duct carcinoma patients had associated gallstones. In order to investigate the possible association between typhoid carrier state and bile duct carcinoma, stool cultures were performed for Salmonella typhi and Salmonella paratyphi A and B. Nine out of 23 patients (39.1%) with bile duct carcinoma, 17 out of 50 (34%) with calcular obstructive jaundice, and 1 out of 50 (2%) healthy individuals proved to be salmonella carriers. Statistical analysis of the results confirmed the presence of a significant association between chronic fecal thyphoid carrier state and bile duct carcinoma, while that between calcular obstructive jaundice and bile duct carcinoma was not significant. In conclusion, there might be an association between chronic fecal typhoid carrier state and bile duct carcinoma.

ELISA in detection of Entamoeba histolytica antigens in stools.

The modified double antibody sandwich ELISA was applied to detect E. histolytica antigens in the stool samples of 20 patients have amoebiasis (symptomatic or asymptomatic), 10 with intestinal parasites other than E. histolytica and 10 healthy individuals. The method was found to be sensitive (90%) and specific (85%). It is concluded that ELISA could be applied for a large scale epidemiological study and immunodiagnosis of amoebiasis.

Serological and parasitological examination of some patients with manifestations suggestive leishmaniasis.

The present study was designed to search for visceral leishmaniasis (VL.) in adult population in the Nile Delta. For this purpose: Fifty patients with splenomegaly and/or hepatosplenomegaly were chosen upon clinical grounds with special consideration of clinical manifestations suggestive of the disease. Both indirect haemagglutination test (IHAT) and dot-Enzyme Linked Immuno Sorbent Assay (dot-ELISA), were positive for VL. antibodies in 3% of the patients. Bone marrow examination (smear and culture) revealed negative results in all patients who gave serological reactions. The results were discussed.

Endoscopic sclerotherapy versus medical treatment for bleeding esophageal varices in patients with schistosomal liver disease.

A prospective controlled trial was conducted at Ain-Shams and Benha University Hospitals. One-hundred and eighteen chronic liver disease patients, mostly schistosomal in origin and presenting with recent proven variceal hemorrhage, were randomly allocated to injection sclerotherapy or medical therapy. The follow-up period extended to 21 months. Sixty-three patients received injection sclerotherapy using ethanolamine oleate (5% wt/vol) paravariceally while 55 received medical treatment in the form of general resuscitative measures, blood transfusion, vasopressin intravenous drip, and insertion of a Sengstaken-Blakemore tube if bleeding continued. The first 30-day mortality was 7 (11%) in the injection sclerotherapy group compared with 11 (20%) in the medical treatment group. This difference was not statistically significant. During the entire observation period 9 (14.3%) died in the sclerosed group and 16 (29%) died in the medically treated group, and this difference was statistically significant at the 5% level. Comparison of recurrent bleeding among both groups revealed that the difference was statistically not significant. It was concluded that injection sclerotherapy was no better than medical treatment in the control of acute variceal bleeding, but injection sclerotherapy did increase significantly long-term survival of sclerosed patients.