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Abdallah FI, Merdan BAI, Shaarawi FAI, Mohamed AF, Selim TA, Dahesh SMA, Rady MHA. The potentiality of Culex pipiens (Diptera: Culicidae) complex holobiont in transmitting the hepatitis C virus (HCV) with the aid of bacterial microbiota in the midgut. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2024; 13:119. [DOI: 10.1186/s43088-024-00579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 11/06/2024] [Indexed: 01/03/2025] Open
Abstract
Abstract
Background
The possibility of considering Culex pipiens (Cx. pipiens) as a vector for transmitting the hepatitis C virus (HCV) is controversial and needs further investigation. This work aimed to detect the possibility of transmission of the hepatitis C virus by Cx. pipiens and the role of the bacterial microbiota in their midgut.
Main body
Two groups of symbiotic and aposymbiotic of female Cx. pipiens were infected with the hepatitis C virus using an artificial feeding membrane technique. The viral load was detected in the head region for up to 60 min in the infected symbiotic group and 90 min in the aposymbiotic group. The midgut region can harbor the virus for 5 days after feeding. The absence of gut microbiota increases the potentiality of ten females to carry high titer of infective dose (1.2 × 106 IU/ml) of HCV genotype 4a for 6 days. The bacterial midgut microbiota appears to play a significant role in the transmission of HCV. On the other hand, HCV was not detected in the salivary glands of either symbiotic or aposymbiotic mosquitoes during the detection period. Cx. pipiens can transmit HCV from infected female adult mosquitoes to HCV-negative human blood in vitro. The biological parameters were survival rate, blood feeding, oviposition, hatchability rates, and mean digestion period of Cx. pipiens after infection with HCV showed significant changes. Moreover, an ex vivo assay demonstrated that HCV-infected mosquitoes could transmit the virus RNA into healthy blood.
Conclusion
The results suggested that the mosquitoes’ mechanical transmission of HCV was reasonable. In addition, the mosquito microbiome played a significant role in determining the potentiality of mosquitoes as a vector for disseminating HCV infections.
Graphic abstract
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Shafiq AM, Taha NA, Zaky AH, Mohammed AH, Omran OM, Abozaid L, Ahmed HHT, Ameen MG. Prognostic significance of the tumor budding and tumor-infiltrating lymphocytes in survival of hepatocellular carcinoma patients. Int J Health Sci (Qassim) 2024; 18:10-19. [PMID: 39502429 PMCID: PMC11533185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2024] Open
Abstract
Objective In spite of great advance in the management of hepatocellular carcinoma (HCC), the prognostic factors are still obviously not understood. The role of tumor budding (TB) and tumor-infiltrating lymphocytes (TILs) in HCC as pathological parameters affecting prognosis stands principally unknown. Methods Seventy-four surgical resection pathology specimens of HCC patients were used. Assessment of TB and TILs were performed using hematoxylin-eosin-stained slides. Follow-up data were collected over a 5-year period to determine disease-free survival rates, overall survival (OS) rates, and how they related to TB, TILs, and other clinicopathological factors. Results There was a significant statistical association between high-grade TB and lymphovascular embolization (LVE), tumor necrosis, and grade of HCC with P = 0.003, 0.036, and 0.017, respectively. The positive TILs group showed a statistically significant correlation with histological grade, LVE, and serum alpha-fetoprotein (AFP) level with P = 0.002, 0.006, and 0.043, respectively. Multivariate analysis using the Cox proportional hazard model revealed that TILs are not an independent pathological factor for disease-free and OS, although TB is an independent pathological factor for both. Conclusions In all HCC patients, TB was seen, and there was a significant link between the grade of the HCC and the presence of tumor necrosis, LVE, and high-grade TB. The majority (92%) of HCC patients had TILs, and there was a strong relationship between the histological grade, LVE, and serum AFP level. While TILs show variation of the immunologic reaction to the tumor, TB tends to suggest a hostile biologic nature and a bad prognosis.
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Affiliation(s)
- Ahmed Mahran Shafiq
- Department of Medical Oncology and Hematological Malignancies, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Noura Ali Taha
- Department of Medical Oncology and Hematological Malignancies, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Amen Hamdy Zaky
- Department of Medical Oncology and Hematological Malignancies, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Abdallah Hedia Mohammed
- Department of Medical Oncology and Hematological Malignancies, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Ola M. Omran
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Qassim Region, Saudi Arabia
| | - Lobaina Abozaid
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Qassim Region, Saudi Arabia
| | - Hagir H. T. Ahmed
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Qassim Region, Saudi Arabia
| | - Mahmoud Gamal Ameen
- Department of Oncologic Pathology, South Egypt Cancer Institute, Assiut University, Assiut Egypt
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Stroffolini T, Stroffolini G. Prevalence and Modes of Transmission of Hepatitis C Virus Infection: A Historical Worldwide Review. Viruses 2024; 16:1115. [PMID: 39066277 PMCID: PMC11281430 DOI: 10.3390/v16071115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 06/30/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Hepatitis C virus infection affects over 58 million individuals and is responsible for 290,000 annual deaths. The infection spread in the past via blood transfusion and iatrogenic transmission due to the use of non-sterilized glass syringes mostly in developing countries (Cameroon, Central Africa Republic, Egypt) but even in Italy. High-income countries have achieved successful results in preventing certain modes of transmission, particularly in ensuring the safety of blood and blood products, and to a lesser extent, reducing iatrogenic exposure. Conversely, in low-income countries, unscreened blood transfusions and non-sterile injection practices continue to play major roles, highlighting the stark inequalities between these regions. Currently, injection drug use is a major worldwide risk factor, with a growing trend even in low- and middle-income countries (LMICs). Emerging high-risk groups include men who have sex with men (MSM), individuals exposed to tattoo practices, and newborns of HCV-infected pregnant women. The World Health Organization (WHO) has proposed direct-acting antiviral (DAA) therapy as a tool to eliminate infection by interrupting viral transmission from infected to susceptible individuals. However, the feasibility of this ambitious and overly optimistic program generates concern about the need for universal screening, diagnosis, linkage to care, and access to affordable DAA regimens. These goals are very hard to reach, especially in LMICs, due to the cost and availability of drugs, as well as the logistical complexities involved. Globally, only a small proportion of individuals infected with HCV have been tested, and an even smaller fraction of those have initiated DAA therapy. The absence of an effective vaccine is a major barrier to controlling HCV infection. Without a vaccine, the WHO project may remain merely an illusion.
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Affiliation(s)
- Tommaso Stroffolini
- Department of Tropical and Infectious Diseases, Policlinico Umberto I, 00161 Rome, Italy;
| | - Giacomo Stroffolini
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, 5, 37024 Negrar, Verona, Italy
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Abdelhamed W, El-Kassas M. Hepatitis B virus in Egypt: the whole story. EGYPTIAN LIVER JOURNAL 2024; 14:56. [DOI: 10.1186/s43066-024-00362-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/03/2024] [Indexed: 04/03/2025] Open
Abstract
AbstractHepatitis B virus (HBV) infection is a significant global public health threat with variable geographical distribution. Chronic infection with HBV could be complicated by chronic hepatitis state, progression to liver cirrhosis, and the development of hepatocellular carcinoma (HCC). For years, the magnitude of HBV problem in Egypt was masked by the great prevalence of hepatitis C virus in the country. The exact epidemiological data regarding HBV in Egypt are defective. The prevalence rate of HBV in Egypt has declined after the universal immunization program introduced for infants in 1992. This review addresses the whole story of HBV in Egypt: the epidemiology, risk factors, vaccination programs, and treatment efforts.
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Hachicha-Maalej N, Lepers C, Collins IJ, Mostafa A, Ades AE, Judd A, Scott K, Gibb DM, Pett S, Indolfi G, Yazdanpanah Y, El Sayed MH, Deuffic-Burban S. Modelling the potential clinical and economic impact of universal antenatal hepatitis C (HCV) screening and providing treatment for pregnant women with HCV and their infants in Egypt: a cost-effectiveness study. BMJ PUBLIC HEALTH 2024; 2:e000517. [PMID: 40018136 PMCID: PMC11812807 DOI: 10.1136/bmjph-2023-000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/14/2024] [Indexed: 03/01/2025]
Abstract
Backgrounds and aims Pregnant women and children are not included in Egypt's hepatitis C virus (HCV) elimination programmes. This study assesses the cost-effectiveness of several screening and treatment strategies for pregnant women and infants in Egypt. Design A Markov model was developed to simulate the cascade of care and HCV disease progression among pregnant women and their infants according to different screening and treatment strategies, which included: targeted versus universal antenatal screening; treatment of women in pregnancy or deferred till after breast feeding; treatment of infected children at 3 years vs 12 years. Current practice is targeted antenatal screening with deferred treatment for the mother and child. We also explored prophylactic treatment after birth for children of diagnosed HCV-infected women. Discounted lifetime cost, life expectancy (LE) and disability-adjusted life-years (DALYs) were calculated separately for women and their infants, and then combined. Results Current practice led to the highest cost (US$314.0), the lowest LE (46.3348 years) and the highest DALYs (0.0512 years) per mother-child pair. Universal screening and treatment during pregnancy followed by treatment of children at 3 years would be less expensive and more effective (cost saving) compared with current practice (US$219.3, 46.3525 and 0.0359 years). Prophylactic treatment at birth for infants born to HCV RNA-positive mothers would also be similarly cost saving, even with treatment uptake as low as 15% (US$218.6, 46.3525 and 0.0359 years). Findings were robust to reasonable changes in parameters. Conclusion Universal screening and treatment of HCV in pregnancy, with treatment of infected infants at age 3 years is cost saving compared with current practice in the Egyptian setting.
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Affiliation(s)
- Nadia Hachicha-Maalej
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France
| | - Clotilde Lepers
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France
| | | | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Anthony E Ades
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Ali Judd
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - Karen Scott
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - Diana M Gibb
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
| | - Sarah Pett
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
- Institute for Global Health, University College London, London, UK
| | - Giuseppe Indolfi
- Paediatric and Liver Unit, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Yazdan Yazdanpanah
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Manal H El Sayed
- Department of Pediatrics and the Clinical Research Center, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sylvie Deuffic-Burban
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France
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Kandeel A, Fahim M, Abukamar S, BahaaEldin H, Abuelsood H, Samy S, Deghedy O, Sheta A, Naguib A, El Guindy N, Youssef A, Kamel R, Afifi S, El-Kassas M, Abdelghaffar K. Evidence for the elimination of viral hepatitis B and C in Egypt: Results of a nationwide survey in 2022. Liver Int 2024; 44:955-965. [PMID: 38291807 DOI: 10.1111/liv.15843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/15/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Viral hepatitis C (HCV) and B (HBV) were at the top of Egypt's most significant public health challenges, with an estimated 14.7% of its population having antibodies to HCV in 2008. Egypt issued an ambitious action plan in 2014 to eliminate viral hepatitis through strengthening infection control and improving patient care. In 2018, an extensive HCV mass screening campaign was conducted for the entire country's population with treating more than 4 million patients with antivirals. This study aimed to evaluate the current prevalence of viral hepatitis in Egypt after all these efforts. METHODS A cross-sectional household cluster survey was conducted in all 27 Egyptian governorates to obtain a representative sample of Egypt's population. Subjects aged 1-70 years were interviewed using a standardised questionnaire that included demographics, viral hepatitis knowledge, previous infection and risk factors data. Laboratory testing was performed for all subjects for anti-HCV and HBsAg using chemiluminescence. Subjects positive for anti-HCV were further tested for HCV-RNA by RT-PCR. Prevalence rates were calculated by demographic groups and compared to the demographic health survey 2015 results. RESULTS Of 20 881 subjects interviewed, 48.8% were males, 20.2% were children <15 years of age, and 53.7% were residents of rural areas. Of all subjects, 92 (0.4%) were HCV-infected, 1577 (7.6%) were anti-HCV positive and 177 (0.8%) were HBV-chronically infected, including one patient who had mixed HBV and HCV current infection. The prevalence of HCV-current and HBV chronic infections decreased by 93% and 20%, respectively, compared to 2015. CONCLUSIONS Egypt achieved the elimination of the viral hepatitis goal. To maintain low rates of viral hepatitis, community health education, in addition to maintaining infection control and blood safety programs, is essential.
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Affiliation(s)
- Amr Kandeel
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Manal Fahim
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Shimaa Abukamar
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Hala BahaaEldin
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Hanaa Abuelsood
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Sahar Samy
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Ola Deghedy
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Amany Sheta
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Amel Naguib
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Nancy El Guindy
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Amr Youssef
- Central Administration for Research and Health Development, Ministry of Health and Population, Cairo, Egypt
| | - Reham Kamel
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Salma Afifi
- Ministry of Health and Population, Cairo, Egypt
| | - Moahmed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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Baraka K, Abozahra RR, Badr E, Abdelhamid SM. Study of some potential biomarkers in Egyptian hepatitis C virus patients in relation to liver disease progression and HCC. BMC Cancer 2023; 23:938. [PMID: 37798688 PMCID: PMC10552374 DOI: 10.1186/s12885-023-11420-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Egypt has the greatest prevalence of hepatitis C worldwide according to the WHO reports, accounting for 13% of the global HCV infections. HCV is a substantial precursor for fibrosis, cirrhosis, and hepatocellular carcinoma. This study aimed to investigate the potential relevance of some cytokines, miR-122 and miR-221 for the diagnosis of liver disease progression associated to HCV infection. METHODS One hundred and twenty blood samples were collected from patients with chronic liver disease, HCC, and healthy individuals. Total bilirubin, alanine aminotransferase, aspartate aminotransferase, platelet count, albumin, and creatinine were measured. Serum level of selected cytokines was conducted by ELISA. Serum miRNA expression was detected by RT-PCR. RESULTS IL-2R was higher among HCC patients and the mean concentration of both TNF-αRII and IL-6R was higher among cirrhotic patients. The expression of miRNA-122 showed a little fold decrease in all studied groups; the highest level was observed in HCC patients. The expression of miRNA-221 showed a significant fold increase in HCC and cirrhotic groups. CONCLUSIONS This study revealed that there is no difference in liver disease progression in patients regarding sex and age. Routine liver function tests performed poorly in terms of early diagnosis of liver disease progression; however, serum total bilirubin gave somewhat useful guide for discrimination between fibrotic, cirrhotic and HCC cases. IL-2R showed a significant consistent increase in its level with disease progression. The miR-221 serum level showed significant fold increase with liver disease progression. Therefore, making miR-221 a potential non-invasive biomarker for liver disease progression in the diagnostic setting is recommended.
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Affiliation(s)
- Kholoud Baraka
- Microbiology and Immunology Department, Faculty of Pharmacy, Damanhour University, El Gomhoreya Street, Damanhour, El Behira Egypt
| | - Rania R. Abozahra
- Microbiology and Immunology Department, Faculty of Pharmacy, Damanhour University, El Gomhoreya Street, Damanhour, El Behira Egypt
| | - Eman Badr
- Microbiology and Immunology Department, Faculty of Pharmacy, Damanhour University, El Gomhoreya Street, Damanhour, El Behira Egypt
| | - Sarah M. Abdelhamid
- Microbiology and Immunology Department, Faculty of Pharmacy, Damanhour University, El Gomhoreya Street, Damanhour, El Behira Egypt
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Elsharkawy A, Samir R, Abdallah M, Hassany M, El-Kassas M. The implications of the COVID-19 pandemic on hepatitis B and C elimination programs in Egypt: current situation and future perspective. EGYPTIAN LIVER JOURNAL 2023; 13:50. [DOI: 10.1186/s43066-023-00290-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/26/2023] [Indexed: 04/03/2025] Open
Abstract
AbstractHepatitis B virus (HBV) and hepatitis C virus (HCV) are amongst the most common causative agents of viral hepatitis with its severe complications, including liver cirrhosis, decompensation, and hepatocellular carcinoma (HCC). Elimination of viral hepatitis, a significant challenge, has become an adopted global goal with certainly designed targets set by the World Health Assembly to be met by 2030. While many countries, including Egypt, have started executive plans for viral hepatitis elimination and achieved remarkable progress, the emergence of the COVID-19 pandemic has markedly affected all the machinery of the healthcare systems and specifically laid countries off their track in their viral hepatitis elimination process. The pandemic disrupted most healthcare services, and health staff and hospital resources were recruited mainly for managing the crisis, which significantly negatively impacted the management of other less severe diseases, including viral hepatitis. Social distancing and restrictive measures applied by most countries to contain the pandemic have affected medical services offered to patients with hepatitis. All supply chains of medications and vaccinations concerned with treating and preventing viral hepatitis have been markedly compromised. Many efforts and strategies are required to combat the severe and deleterious implications of the pandemic on the management of viral hepatitis worldwide in an attempt to get the situation under control and resume the pathway towards viral hepatitis elimination.
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Emile SH, Elmetwally AM, AbdelMawla A. Outcome of laparotomy and conservative treatment of patients with acute mesenteric venous ischemia with viable bowel. Eur J Trauma Emerg Surg 2023; 49:2009-2015. [PMID: 35262747 PMCID: PMC10520213 DOI: 10.1007/s00068-022-01924-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is one of the most serious abdominal emergencies. Predicting the onset of bowel necrosis that warrants surgical intervention is of paramount importance in AMI. The present study aimed to investigate the outcome of patients with AMI secondary to mesenteric venous occlusion (MVO) and the consequence of non-therapeutic exploratory laparotomy. METHODS The records of 132 patients with AMI were retrospectively reviewed. The outcome of patients with acute mesenteric venous ischemia (AMVI) and viable bowel was analyzed based on the method of treatment: conservative versus surgical. The impact of non-therapeutic laparotomy on the outcome of patients with AMVI in terms of morbidity, readmission, and mortality was analyzed. RESULTS Forty-seven patients (34 male) with AMVI had viable bowel. Of the 47 patients with viable bowel, 8 (17%) had an exploratory non-therapeutic laparotomy, whereas 39 patients were treated conservatively. Patients who had non-therapeutic laparotomy had significantly higher complication (50 vs 5.1%, p = 0.005) and readmission rates (37.5 vs 5.1%, p = 0.03) and longer hospital stay (8.5 vs 7 days, p = 0.02) than those treated conservatively. Patients with bowel necrosis who had a therapeutic laparotomy had slightly lower rates of morbidity and mortality as compared to patients with viable bowel who underwent a non-therapeutic laparotomy. CONCLUSION Careful assessment and informed decision-making in patients with AMVI are crucial to avoid unnecessary surgical intervention that can result in higher rates of complications and readmission and extended hospital stay.
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Affiliation(s)
- Sameh Hany Emile
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Ahmed Magdy Elmetwally
- Vascular Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Ahmed AbdelMawla
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
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Rasmy HS, Elmalatawy MAE, ElKarmoty KZ, Abdelwarth EY, Isaac A. Serum retinol-binding protein 4 as a predictor of fibrosis regression and response to direct-acting antiviral drugs in chronic hepatitis C virus patients. EGYPTIAN LIVER JOURNAL 2023. [DOI: 10.1186/s43066-023-00251-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Abstract
Background
Hepatitis C virus is the underlying cause of chronic hepatitis which frequently progresses to cirrhosis and hepatocellular carcinoma. In addition, HCV is thought to cause steatosis, dyslipidemia, insulin resistance, diabetes, obesity, and cardiovascular events. The aim of this study is to evaluate the role of serum RBP-4 in the prediction of fibrosis regression and the response of treatment among chronic HCV patients receiving direct-acting antiviral agents.
Methods
This study included 40 chronic HCV Egyptian patients, divided into two groups: Naive cases, 20 chronic HCV patients before starting first line of treatment; Relapser cases, 20 chronic HCV patients who were non-responders before starting second line treatment; and 10 healthy subjects as control. Laboratory investigations including complete blood count, full hepatic profile, fibroscan assessment, and retinol-binding protein-4 level at baseline and re-assessed 12 weeks after the end of treatment [sustained virological response SVR12]. Student T test, analysis of variance, chi-square, Tukey’s test, and Pearson correlation coefficient tests were used for statistical analysis.
Results
Baseline retinol-binding protein-4 level was significantly higher in the naïve case group than in the relapser and control groups with a P value of P value of < 0.001. All the naïve patients had 100% SVR12, only 90% of the relapser group achieved SVR12. A significant reduction in retinol-binding protein-4 and fibrosis staging and measurements by fibroscan among all studied patients were noted after receiving direct acting antivirals (P value < 0.001). Retinol-binding protein-4 levels before and after treatment were significantly lower among F4 patients in comparison to those of F1–F3 patients (P value 0.002, 0.009, respectively). The best cutoff value of retinol-binding protein-4 in the prediction of liver cirrhosis (F4) was ≤ 46 pg/ml with sensitivity of 100% and specificity of 66.67%.
Conclusion
Serum retinol-binding protein-4 was found to be higher in chronic HCV infection with a significant reduction after successful eradication. Its level is much lower in cirrhotic patients [F4]. As a result, retinol-binding protein-4 may have a promising role in assessing direct acting antivirals response, as well as a prognostic value in predicting liver cirrhosis.
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Mahmoud Farhan S, Mahmoud Abd El-Baky R, Mohammad Abdalla SA, Osama El-Gendy A, Farag Azmy A, Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia, Egypt, Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia, Egypt, Department of Microbiology and Immunology, Faculty of Pharmacy, Suez Canal University, Ismalia, Egypt, Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt, Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt. Efficacy of Amikacin and Imipenem Against Multi-Drug Resistant Gram-Negative Bacteria Isolated from Wound Infections, Egypt. IRANIAN JOURNAL OF MEDICAL MICROBIOLOGY 2023; 17:218-229. [DOI: 10.30699/ijmm.17.2.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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El Menshawy N, Hassan N, Khariza M, AlAshery H, Baghat M, Ashour R. CD4/CD8 Ratio could be predictor of burden hepatocellular carcinoma in Egyptian chronic hepatitis C after combined sofosbuvir and daclatasvir therapy. Afr Health Sci 2023; 23:198-212. [PMID: 37545943 PMCID: PMC10398471 DOI: 10.4314/ahs.v23i1.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background During the first years of the use of direct acting Hepatitis C antiviral drugs (DAAS), several studies reported a possible correlation between this new era of treatment and an increased risk of Hepatocellular carcinoma (HCC). Its development could possibly be favored by the changes in the immunological milieu and the different cellular behavior after eradication of HCV infection with them. For this reason, this study aimed to address the immunological effect of DAAS. Subject & methods Prospective paired -sample design, carried out on 90 naïve chronically infected HCV patients before and after receiving a combination therapy of sofosbuvir; at a dose of 400 mg once daily and daclatasvir; at a dose of 60 mg once daily for 12 weeks and follow up for one year. immunological tests including: total T cell count, T helper cell count, T cytotoxic cell count and natural killer cell count in peripheral blood through (CD3, CD3/CD4, CD3/CD8 and CD56 respectively) by Fluorochrome monoclonal antibodies labelled with specific dyes through Multiparameter, FACSCanto ™ II flow cytometer (Becton Dickinson, USA). Result Concerning the immunological changes, total T cells (CD3+), Natural killer cells showed non-significant decrease at end of therapy while significant decrease in T helper cells (CD3+CD4+) T cytotoxic cells (CD3+CD8+) compared to pre-treatment value. Long follow up revealed 26.6% developed focal HCC, in more addition, multivariate analysis show CD4/CD8 ratio could be predictor as well as sex for early development of HCC after combined DAAS therapy. Conclusion HCV treatment by DAAS produces significant decrease in T helper, T cytotoxic cells in CHC patients at the end of therapy. 26.6% developed focal HCC with independent CD4/CD8 predictor for burden malignancy. Further large extended population study is needed for clarify this concern.
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Affiliation(s)
| | - Noha Hassan
- Mansoura University Faculty of Medicine, Pharmacy
| | | | | | - Monir Baghat
- Mansoura University Faculty of Medicine, Internal Medicine
| | - Rehab Ashour
- Mansoura University Faculty of Medicine, Pharmacy
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Ray AE, Castera L, Al-Ashry A, Ghali S. Impact of HCV eradication following direct-acting antivirals on liver stiffness measurement: a prospective longitudinal study. EGYPTIAN LIVER JOURNAL 2023. [DOI: 10.1186/s43066-023-00239-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Abstract
Background and study aims
Egypt has been a pioneer in implementing a nationwide HCV screening and treatment program. Assessment of liver fibrosis after HCV eradication is important. The value of liver stiffness measurement (LSM) for this purpose is still debated. The aim of this prospective longitudinal study was to assess LSM evolution after HCV eradication.
Patients and methods
One-hundred and three HCV patients, treated with a standard DAA regimen (sofosbuvir/daclatasvir for 3 months), underwent LSM before and 24 weeks after the end of treatment. Patients were classified into 3 groups according to baseline LSM (Baveno VI): group 1: patients without compensated advanced chronic liver disease (cACLD) (LSM < 10 kPa); group 2: patients with suspected cACLD (LSM 10–15 kPa); and group 3: patients with likely cACLD (LSM > 15 kPa).
Results
The characteristics of patients were as follows: mean age 55 ± 10 years, males 48.5%, and BMI 26.31 ± 3.33 kg/m2. All patients were Child–Pugh score A and achieved SVR at W24. A significant LSM decrease was observed at W24 compared to baseline: all patients: 5.8 vs. 8.8 kPa, p = 0.002; group 1: 4.75 vs. 6.0 kPa, p = 0.0001; group 2 11.9 vs. 12.6 kPa, p = 0.042; and group 3: 24.2 vs. 28.3 kPa, p = 0.0001. Group 1 had the highest LSM decline (23.83%), followed by group 3 (14.3%) and group 2 (8.4%).
Conclusion
HCV eradication was associated with a significant LSM decrease in all groups of patients. This is likely related to improvement of fibrosis, but its relation to improvement of necro-inflammation cannot be excluded. Longer follow-up of fibrosis in these patients is needed.
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14
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Abdel-Gawad M, Nour M, El-Raey F, Nagdy H, Almansoury Y, El-Kassas M. Gender differences in prevalence of hepatitis C virus infection in Egypt: a systematic review and meta-analysis. Sci Rep 2023; 13:2499. [PMID: 36781919 PMCID: PMC9925441 DOI: 10.1038/s41598-023-29262-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/01/2023] [Indexed: 02/15/2023] Open
Abstract
Egypt is the country with the highest known hepatitis C virus (HCV) prevalence worldwide. The origin of gender differences in HCV prevalence is not usually well understood. This systematic review and meta-analysis aimed to review and evaluate the gender differences in HCV infection rates amongst Egyptians. Such data would be important to support prevention and control programs aiming to minimize HCV-related morbidity and mortality. PubMed, Scopus, and Web of Science (WOS) were searched for relevant articles published from 1st January 2011 to 13th December 2021, using the search terms (HCV OR "hepatitis C" OR hepacivirus) AND (prevalence OR seroprevalence OR epidemiology OR incidence OR magnitude). At first, retrieved articles were screened, and then relevant data were extracted and analyzed. Descriptive statistics were used for data analysis. Out of 616 studies from databases, only 30 were included after the full-text screening, with 193,621 included participants: 97,597 male and 96,024 female. The overall seroprevalence of HCV antibodies in all included studies was 0.02 (CI - 0.23 to 0.28), with no significant difference between males and females. However, HCV RNA positivity was significantly more prevalent in males than females in adults and the general population (after excluding high-risk groups). In children, no statistically significant differences between males and females were found in the seroprevalence of HCV antibodies nor in the prevalence of PCR positivity. HCV RNA positivity is significantly higher in males than females in adults, while there are no gender differences in children.
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Affiliation(s)
- Muhammad Abdel-Gawad
- Hepatology, Gastroenterology, and Infectious Diseases Department, Assiut Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Mohamed Nour
- Department of Public Health and Community Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
- Faculty of Public Health and Health Informatics, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Fathiya El-Raey
- Hepatogastroenterology and Infectious Diseases Department, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Hanaa Nagdy
- Internal Medicine Department, College of Medicine, Arab Academy for Science and Technology and Maritime Transport, Alexandria, Egypt
| | - Yahya Almansoury
- Internal Medicine Department, Gastroenterology and Hepatology Division, South Valley University, Qena, Egypt
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Ain Helwan, Cairo, 11795, Egypt.
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15
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Jean K, Tawheed A, Luong Nguyen LB, Heikal T, Eldaly U, Elhadidy N, Elghaieb A, Aboudonia A, Tondeur L, Dublineau A, Fontanet A, El-Kassas M. Changes in Presentation, Treatment, and Survival of Patients with Hepatocellular Carcinoma in Damietta, Egypt, 2007-2019: A Retrospective Monocentric Cohort Study. J Hepatocell Carcinoma 2023; 10:99-111. [PMID: 36721637 PMCID: PMC9884455 DOI: 10.2147/jhc.s391511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION We aimed to assess temporal changes in the presentation and survival of patients with hepatocellular carcinoma (HCC) in the northern Egypt region, one of the regions reporting the highest incidence of the disease globally. METHODS We conducted a monocentric retrospective study. Patients presenting at the Damietta Oncology referral center between 2007 and 2019 with a diagnosed HCC were eligible. Individual, clinical and tumor characteristics at HCC diagnosis, including the Barcelona Clinic Liver Cancer (BCLC) staging, were retrieved from medical files and patients' final vital status was ascertained by combining various data sources. Patients were divided into 2 groups based on diagnosis period: pre- and post-2014. Survival was analysed based on Kaplan-Meier curves and differences in restricted mean survival time (RMST). RESULTS Data from 5097 patients (among 5210 eligible, 97.8%) were analyzed. We observed a significant trend toward HCC diagnosed at earlier stage in the post- vs pre-2014 period (BCLC stage 0/A or B: 37.2% vs 27.1%, p<10-3). Overall patient's survival after the HCC diagnosis was poor, with a median of 8.1 months. The BCLC staging system performed well in predicting survival. Despite a trend toward HCC diagnosed at earlier stages, we did not observe a significant improvement in survival over time. Overall, treatments offered in this medical center were in line with international guidelines, and 16.1% of the patients who received a curative treatment had an improved survival (30.7 months in median). However, HCC recurrence was frequent among patients cured for HCC, with a median time to recurrence of 22 months. DISCUSSION Overall survival after HCC diagnosis in Egypt remains poor but is significantly improved by curative therapy. Despite a trend toward earlier diagnosis of HCC, we did not observe a general improvement in survival over time, which remains to be clearly understood.
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Affiliation(s)
- Kévin Jean
- Laboratoire MESuRS, Conservatoire national des arts et métiers, Paris, France
- Unité PACRI, Institut Pasteur, Conservatoire national des arts et métiers, Paris, France
| | - Ahmed Tawheed
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Liem Binh Luong Nguyen
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris-Cité, Paris, France
| | - Tarek Heikal
- Medical Oncology Department, Damietta Oncology Center, Damietta, Egypt
| | - Usama Eldaly
- Medical Oncology Department, Damietta Oncology Center, Damietta, Egypt
| | - Neveen Elhadidy
- Pharmaceutical Services Department, Damietta Oncology Center, Damietta, Egypt
| | - Ahmed Elghaieb
- Radiology Department, Damietta Oncology Center, Damietta, Egypt
| | - Ahmed Aboudonia
- Radiology Department, Damietta Oncology Center, Damietta, Egypt
| | - Laura Tondeur
- Laboratoire MESuRS, Conservatoire national des arts et métiers, Paris, France
| | - Amélie Dublineau
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris-Cité, Paris, France
| | - Arnaud Fontanet
- Unité PACRI, Institut Pasteur, Conservatoire national des arts et métiers, Paris, France
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris-Cité, Paris, France
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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16
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Ismail R, Elansary A, Ezzatt O, Hamed M, Gamil Y. Hepatitis C associated oral lesions: A hospital-based retrospective case control study in Egypt. J Int Oral Health 2023; 15:52. [DOI: 10.4103/jioh.jioh_160_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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17
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Interleukin 28B Polymorphism as a Predictor of Sustained Virological Response to Sofosbuvir-Based Therapy for Hepatitis C Virus Patients. Trop Med Infect Dis 2022; 7:tropicalmed7090230. [PMID: 36136642 PMCID: PMC9501239 DOI: 10.3390/tropicalmed7090230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
In various genome-wide correlation studies, interleukin (IL)28B gene polymorphism has been strongly correlated with both the therapeutic and spontaneous mediated clearance of hepatitis C virus (HCV). Therefore, this study aimed to evaluate the genotype and allele frequency distributions of IL28B (rs12979860) in patients with chronic hepatitis C and assess the IL28B polymorphisms as predictors of sustained virological response to SOF-based therapy for HCV in Egyptian patients. This retrospective case-control study was conducted on 54 chronic HCV patients who completed treatment with SOF/DCV ± RBV for 12 weeks and responded to treatment with SVR12 (the responder group) as a control group, and 54 chronic HCV patients who completed treatment with SOF/DCV ± RBV for 12 weeks and did not respond to treatment and failed to achieve SVR12 (the non-responder group) as a case group. The CC genotype frequency of IL-28B (rs12979860) was greater in the responder group (51.9%). In contrast, the TT genotype frequency was higher in the non-responder group (48.1%) (p < 0.001), and the T allele significantly increased the risk of non-responses by 3.13 fold. Therefore IL-28B (rs12979860) SNP could be used as a genetic predictor of sustained virological response to SOF+DCV ± RBV-based HCV treatment in Egyptian patients.
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18
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El Ray A, Paradis V, Montasser A, Elghannam M, Shemis M, Nessim I, Abu-Taleb H, Asselah T, Mohamed A, Poté N, Akl M, Marcellin P. Usefulness of the SAF score to characterize NAFLD/NASH in non-cirrhotic HCV patients. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00209-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The SAF score (steatosis, activity, and fibrosis) has been developed for the assessment of the histological severity of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). The aim of this study was to assess the usefulness of the SAF score in a homogenous cohort of Egyptian patients with chronic HCV infection (CHC) without any alcohol consumption and without cirrhosis. We performed a prospective cross-sectional study including 70 consecutive Egyptian patients with chronic HCV infection to assess the usefulness of the SAF score to characterize NAFLD/NASH in non-cirrhotic HCV patients. The inclusion criteria included positive serum anti-HCV IgG antibody and positive HCVRNA, absence of treatment, and absence of cirrhosis (fibrosis score < F4). Patients were divided into two groups: with metabolic syndrome (MS) and without metabolic syndrome (non-MS). All patients were exposed to thorough history taking, full clinical examination, and laboratory and ultrasound assessment. Histopathologic evaluation of the liver biopsy for the assessment of steatosis, activity, grade, and fibrosis stage was assessed by 2 pathologists with experience in liver diseases.
Results
We found that the degree of fibrosis increases with aging. Liver biopsies from CHC patients with metabolic syndrome (MS) exhibited a significantly higher stage of fibrosis than biopsies from those without MS; however, the grade of inflammation did not differ significantly between the two groups. No significant correlation was found between the SAF score and the body mass index (BMI) or serum HCV RNA. No significant relation between SAF score, fibrosis, and MS. No significant relation was found between the MS and the level of HCV viremia.
Conclusion
We concluded that steatosis was associated with the fibrosis stage, independently of MS. This suggests that in this population, steatosis might be more related to HCV infection than to NAFLD and that fibrosis progression might be related, at least in part, to the steatosis process, i.e., virus-associated fatty liver disease (VAFLD).
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19
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Kamal E, Asem N, Hassany M, Elshishiney G, Abdel-Razek W, Said H, Abdel Hamid S, Essam T, Rehan A, Salah A, Saad T, Shawky N, Mostafa A, Omar Y, Ammar I, Saeed R, AbdAllah M, Jabbour J, Hashish A, Bastawy S, El Qareh N, Gamaleldin N, Kabil K, Doss W, El-Sayed MH, Zaid H. Nationwide hepatitis C virus screening and treatment of adolescents in Egyptian schools. Lancet Gastroenterol Hepatol 2022; 7:658-665. [PMID: 35489364 DOI: 10.1016/s2468-1253(21)00464-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 11/18/2021] [Accepted: 11/26/2021] [Indexed: 02/07/2023]
Abstract
Until 2018, Egypt had the highest prevalence of hepatitis C virus (HCV) infection globally, affecting approximately 7% of the population. Despite efforts in diagnosis and treatment since 2006, nearly 2 million individuals with chronic HCV infection had yet to be diagnosed as of early 2018. In December, 2018, a mass HCV screening campaign for adolescents aged 15-18 years was initiated. Among 3 024 325 adolescents screened, the HCV antibody seroprevalence was 11 477 (0·38%), of whom 8187 (78·7%) were HCV RNA-positive. Sustained virological response 12 weeks after completion of treatment (SVR12) was attained by 7327 (99·6%) adolescents with a fixed-dose combination of generic ledipasvir 90 mg plus sofosbuvir 400 mg. Although mass screening in this age group might not be regularly adopted by many health systems and its cost-effectiveness might be lower than the screening of adults and high-risk groups (eg, patients on haemodialysis, people who inject drugs), breaking the chain of transmission in younger populations should lead to a reduction in HCV incidence and complications, and hasten the elimination of the disease.
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Affiliation(s)
- Ehab Kamal
- Tropical Medicine Medical Research Division, National Research Center, Giza, Egypt
| | - Noha Asem
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Hassany
- Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt.
| | | | - Wael Abdel-Razek
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shibin El Kom, Egypt
| | - Heba Said
- Ministry of Health and Population, Cairo, Egypt
| | | | - Tamer Essam
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Ahmed Rehan
- Ministry of Health and Population, Cairo, Egypt
| | - Aysam Salah
- Ministry of Health and Population, Cairo, Egypt
| | - Tarek Saad
- Ministry of Health and Population, Cairo, Egypt
| | - Nasr Shawky
- Ministry of Health and Population, Cairo, Egypt
| | | | - Yasser Omar
- Department of Medicine, Ain Shams University, Cairo, Egpyt
| | - Islam Ammar
- Tropical Medicine Department, Al-Azhar University, Cairo, Egypt
| | - Ramy Saeed
- Ministry of Health and Population, Cairo, Egypt
| | - Mohamed AbdAllah
- Tropical Medicine Medical Research Division, National Research Center, Giza, Egypt
| | - Jean Jabbour
- World Health Organization Egypt Office, Cairo, Egypt
| | - Alaa Hashish
- World Health Organization Egypt Office, Cairo, Egypt
| | - Samah Bastawy
- World Health Organization Egypt Office, Cairo, Egypt
| | - Noha El Qareh
- World Health Organization Egypt Office, Cairo, Egypt
| | - Nahla Gamaleldin
- World Health Organization Egypt Office, Cairo, Egypt; Community Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Khaled Kabil
- The National Committee for Control of Viral Hepatitis, Cairo, Egypt
| | - Wahid Doss
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Hala Zaid
- Ministry of Health and Population, Cairo, Egypt
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20
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Soliman LA, Zayed RA, Omran D, Said F, Darweesh SK, Ghaith DM, Eletreby R, Barakat MS, Bendary MM, Zaky DZ, Amer E, Elmahgoub IR. Apelin Association with Hepatic Fibrosis and Esophageal Varices in Patients with Chronic Hepatitis C Virus. Am J Trop Med Hyg 2022; 107:190-197. [DOI: 10.4269/ajtmh.21-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/24/2022] [Indexed: 11/07/2022] Open
Abstract
Portal hypertension and esophageal varices complicating hepatitis C virus (HCV)-related chronic liver diseases are some of the most devastating sequelae. Angiogenesis is the hallmark of their pathogenesis. Apelin is one of the recently identified angiogenic and fibrogenic peptides. We studied apelin gene expression, apelin (rs3761581) single-nucleotide polymorphism (SNP), and serum apelin level in patients with chronic HCV, and their association with liver fibrosis and esophageal varices in 112 patients with HCV-related chronic liver disease (40 with liver cirrhosis [LC]/low-grade varices, 33 with LC/high-grade varices, and 39 with fibrotic non-cirrhotic liver/no varices) and 80 healthy control subjects. Real-time polymerase chain reaction was used for apelin gene expression assay and apelin rs3761581 SNP analysis in peripheral blood samples. The serum apelin level was measured by ELISA. Apelin gene expression was undetectable in the studied samples. The SNP analysis revealed a greater frequency of the C (mutant) allele among patients compared with control subjects (P = 0.012; odds ratio, 3.67). The serum apelin level was significantly greater in patients with LC/varices (median, 31.6 ng/L) compared with patients without LC/varices (median, 2.9 ng/L; P < 0.001). A serum apelin level cutoff value of 16.55 ng/L predicted the presence of varices, with an area under the receiver operating characteristic curve value of 0.786. A positive correlation was found between serum apelin level and grade of liver fibrosis (r = 0.346, P < 0.001) and portal hypertension (r = 0.438, P < 0.001). In conclusion, the apelin rs3761581-C allele may be associated with the progression of HCV-related chronic liver disease and varices formation, and can be considered a potential therapeutic target to control fibrosis progression. The serum apelin level provided an accurate prediction of the presence of esophageal varices.
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Affiliation(s)
| | - Rania A. Zayed
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Omran
- Department of Endemic Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Fadwa Said
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samar Kamal Darweesh
- Department of Endemic Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Mohamed Ghaith
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rasha Eletreby
- Department of Endemic Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Salama Barakat
- Department of Endemic Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud M. Bendary
- Department of Microbiology and Immunology, Faculty of Pharmacy, Port Said University, Port Said, Egypt
| | | | - Eman Amer
- Department of Biochemistry, Faculty of Pharmacy, Ahram Canadian University, Cairo, Egypt
| | - Iman Rifaat Elmahgoub
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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21
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El-Attar EA, Helmy Elkaffas RM, Aglan SA, Naga IS, Nabil A, Abdallah HY. Genomics in Egypt: Current Status and Future Aspects. Front Genet 2022; 13:797465. [PMID: 35664315 PMCID: PMC9157251 DOI: 10.3389/fgene.2022.797465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Egypt is the third most densely inhabited African country. Due to the economic burden and healthcare costs of overpopulation, genomic and genetic testing is a huge challenge. However, in the era of precision medicine, Egypt is taking a shift in approach from “one-size-fits all” to more personalized healthcare via advancing the practice of medical genetics and genomics across the country. This shift necessitates concrete knowledge of the Egyptian genome and related diseases to direct effective preventive, diagnostic and counseling services of prevalent genetic diseases in Egypt. Understanding disease molecular mechanisms will enhance the capacity for personalized interventions. From this perspective, we highlight research efforts and available services for rare genetic diseases, communicable diseases including the coronavirus 2019 disease (COVID19), and cancer. The current state of genetic services in Egypt including availability and access to genetic services is described. Drivers for applying genomics in Egypt are illustrated with a SWOT analysis of the current genetic/genomic services. Barriers to genetic service development in Egypt, whether economic, geographic, cultural or educational are discussed as well. The sensitive topic of communicating genomic results and its ethical considerations is also tackled. To understand disease pathogenesis, much can be gained through the advancement and integration of genomic technologies via clinical applications and research efforts in Egypt. Three main pillars of multidisciplinary collaboration for advancing genomics in Egypt are envisaged: resources, infrastructure and training. Finally, we highlight the recent national plan to establish a genome center that will aim to prepare a map of the Egyptian human genome to discover and accurately determine the genetic characteristics of various diseases. The Reference Genome Project for Egyptians and Ancient Egyptians will initialize a new genomics era in Egypt. We propose a multidisciplinary governance system in Egypt to support genomic medicine research efforts and integrate into the healthcare system whilst ensuring ethical conduct of data.
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Affiliation(s)
- Eman Ahmed El-Attar
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
- *Correspondence: Eman Ahmed El-Attar,
| | | | - Sarah Ahmed Aglan
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Iman S. Naga
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Amira Nabil
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Hoda Y. Abdallah
- Medical Genetics Unit, Histology and Cell Biology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Center of Excellence in Molecular and Cellular Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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22
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Artenie A, Luhmann N, Lim AG, Fraser H, Ward Z, Stone J, MacGregor L, Walker JG, Trickey A, Marquez LK, Abu-Raddad LJ, Ayoub HH, Walsh N, Hickman M, Martin NK, Easterbrook P, Vickerman P. Methods and indicators to validate country reductions in incidence of hepatitis C virus infection to elimination levels set by WHO. Lancet Gastroenterol Hepatol 2022; 7:353-366. [PMID: 35122713 PMCID: PMC10644895 DOI: 10.1016/s2468-1253(21)00311-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/22/2022]
Abstract
One of the main goals of the 2016 Global Health Sector Strategy on viral hepatitis is the elimination of hepatitis C virus (HCV) as a public health problem by 2030, defined as an 80% reduction in incidence and 65% reduction in mortality relative to 2015. Although monitoring HCV incidence is key to validating HCV elimination, use of the gold-standard method, which involves prospective HCV retesting of people at risk, can be prohibitively resource-intensive. Additionally, few countries collected quality data in 2015 to enable an 80% decrease by 2030 to be calculated. Here, we first review different methods of monitoring HCV incidence and discuss their resource implications and applicability to various populations. Second, using mathematical models developed for various global settings, we assess whether trends in HCV chronic prevalence or HCV antibody prevalence or scale-up levels for HCV testing, treatment, and preventative interventions can be used as reliable alternative indicators to validate the HCV incidence target. Third, we discuss the advantages and disadvantages of an absolute HCV incidence target and suggest a suitable threshold. Finally, we propose three options that countries can use to validate the HCV incidence target, depending on the available surveillance infrastructure.
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Affiliation(s)
- Adelina Artenie
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Aaron G Lim
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Zoe Ward
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Jack Stone
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Louis MacGregor
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Josephine G Walker
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Adam Trickey
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Lara K Marquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | | | - Houssein H Ayoub
- Department of Mathematics, Statistics, and Physics, Qatar University, Doha, Qatar
| | - Nick Walsh
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Matthew Hickman
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Philippa Easterbrook
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Peter Vickerman
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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23
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Youssef SS, Abbas EAER, Youness RA, Elemeery MN, Nasr AS, Seif S. PNPLA3 and IL 28B signature for predicting susceptibility to chronic hepatitis C infection and fibrosis progression. Arch Physiol Biochem 2022; 128:483-489. [PMID: 31793339 DOI: 10.1080/13813455.2019.1694039] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Association studies identified genetic polymorphisms as predictive risk factors of rapid fibrosis progression in chronic hepatitis C (CHC). This study aims to assess the impact of IL28B rs8099917 polymorphism on CHC genotype 4 (G4) susceptibility and liver fibrosis progression individually; and in combination with PNPLA3 rs738409. PATIENTS AND METHODS IL28B rs8099917 and PNPLA3 rs738409 were genotyped in 150 Egyptian CHC patients and 175 healthy controls using real-time PCR. RESULTS IL28B rs8099917 genotype distribution significantly differs in healthy individuals versus CHC patients (p = .018); and in low versus advanced fibrosis IL28B (p = .013). The haplotype CC -GG (PNPLA3-IL28B) is considered a high-risk signature for susceptibility to CHC infection. Similarly, GG-GG (PNPLA3-IL28B) is considered a high-risk signature for higher degree of fibrosis. CONCLUSION IL28B rs8099917 and PNPLA3 rs738409 introduce genetic signature to identify patients at higher risk for CHC susceptibility and fibrosis progression in CHC G4.
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Affiliation(s)
- Samar Samir Youssef
- Microbial Biotechnology Department, Genetic Engineering and Biotechnology Division, National Research Centre, Dokki, Egypt
| | - Eman Abd El Razek Abbas
- Microbial Biotechnology Department, Genetic Engineering and Biotechnology Division, National Research Centre, Dokki, Egypt
| | - Rana Ahmed Youness
- Pharmaceutical Biology Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo, Egypt
| | - Moustafa Nouh Elemeery
- Microbial Biotechnology Department, Genetic Engineering and Biotechnology Division, National Research Centre, Dokki, Egypt
- Département de Neurosciences, CRCHUM, Université de Montréal, Montréal, Quebec, Canada
| | - Amal Soliman Nasr
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Sameh Seif
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
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24
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ElHefnawi M, Jo E, Tolba MM, Fares M, Yang J, Shahbaaz M, Windisch MP. Drug repurposing through virtual screening and in vitro validation identifies tigecycline as a novel putative HCV polymerase inhibitor. Virology 2022; 570:9-17. [DOI: 10.1016/j.virol.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/25/2022] [Accepted: 02/26/2022] [Indexed: 10/18/2022]
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25
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Shousha HI, Abdelaziz AO, Nabeel MM, Omran DA, Abdelmaksoud AH, Elbaz TM, Salah A, Harb STE, Hosny KA, Osman A, Atef M, Gaber A, Zayed NA, Yosry AA, Leithy R. Schistosoma mansoni infection and the occurrence, characteristics, and survival of patients with hepatocellular carcinoma: an observational study over a decade. Pathog Glob Health 2022; 116:119-127. [PMID: 34494507 PMCID: PMC8933024 DOI: 10.1080/20477724.2021.1975081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Schistosoma mansoni infection (SMI) is suspected to be directly and indirectly involved in hepato-carcinogenesis. This study evaluated the association of a previous SMI with hepatocellular carcinoma (HCC) development, patients, tumor characteristics, treatment outcomes, and survival. This observational study included patients with HCC with and without previous SMI who presented to the multidisciplinary HCC clinic, Kasr-Alainy hospital (November 2009 to December 2019). It also included 313 patients with liver cirrhosis without HCC. Clinical and laboratory features of the patients (complete blood count, liver/renal functions , alpha-fetoprotein, and hepatitis B/C status), tumor characteristics (Triphasic CT and/or dynamic MRI), liver stiffness (transient elastography), HCC treatment outcome, and overall survival were studied. This study included 1446 patients with HCC; 688(47.6%) composed group-1, defined by patients having a history of SMI, and 758(52.4%) were in group-2 and without history of SMI. Male sex, smoking, diabetes mellitus, splenomegaly, deteriorated performance status, synthetic liver functions, and platelet count were significantly higher in group-1. The groups did not differ with regard to liver stiffness, tumor characteristics, or the occurrence of post-HCC treatment hepatic decompensation or recurrence. HCC treatment response was better in group-2. Group-1 showed lower sustained virological response to hepatitis C direct-acting antivirals (DAAs) compared with group-2 (60% versus 84.3%, respectively, P = 0.027). Prior SMI was associated with HCC (adjusted odds ratio = 1.589, 95% confidence interval = 1.187-2.127), and it was concluded that it increases the risk of HCC. In addition, it significantly affects the performance status, laboratory characteristics, response to DAAs, and overall survival.
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Affiliation(s)
- Hend Ibrahim Shousha
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ashraf Omar Abdelaziz
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Mahmoud Nabeel
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Abdelhamid Omran
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hosni Abdelmaksoud
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tamer Mahmoud Elbaz
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Salah
- General Surgery Department, Liver Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Karim Adel Hosny
- General Surgery Department, Liver Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Osman
- General Surgery Department, Liver Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mira Atef
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Abdelazez Gaber
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Naglaa Ali Zayed
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Abdelhady Yosry
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rania Leithy
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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26
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Mohamed EI, El-Ghnam SM, Bayoumi AM, Abdel-Mageed SM, Ghareeb DA, Ross B. Electronic nose versus quadrupole mass spectrometry for identifying viral hepatitis C patients. J Viral Hepat 2022; 29:147-155. [PMID: 34773341 DOI: 10.1111/jvh.13630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/13/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022]
Abstract
Hepatitis C is a leading cause of liver disease and transplantation and is a significant burden on public health worldwide. This study aimed to apply the Electronic Nose (E-Nose) and quadrupole Mass Spectrometry (MS/MS) technologies for screening blood samples from hepatitis C patients and healthy controls. We analysed volatile organic compounds (VOCs) in the headspace over blood samples to identify those VOCs characteristic for diagnosing hepatitis C patients. The study comprised 150 acute hepatitis C patients with age range: 24-59 years, and mean age ±SD: 41.5 ± 12.8 years and 150 age-matched healthy controls (age range: 24-51 and mean age: 40.11 ± 4.89 years) from the Hospital of the Medical Research Institute, Alexandria University, Alexandria, Egypt. Collected blood samples were analysed qualitatively and quantitatively using the E-Nose and MS/MS techniques, respectively. Principal component analysis of the E-Nose 10-sensor responses accurately classified blood samples from hepatitis C patients and healthy controls. The first two principal components explained over 98.35% of the variance in signals with no false-positive (healthy controls) or false-negative (hepatitis C patients) results. MS/MS showed two fragmentation ions at m/z of 104 and 151 Da with the positive electrospray ionization mode (ESI+) in blood samples for hepatitis C patients, but not for healthy controls or background water samples. We identified the two specific fragmentation ions at m/z 104 and m/z 151 Da as malonic acid (MF: C3 H4 O4 ; MW: 104.06 g/mol) and monosaccharide pentose (MF: C5 H10 O5 ; MW: 150.13 g/mol) in VOCs of the headspace over blood samples for hepatitis C patients. This provides a rationale for developing diagnostic tests for hepatitis C virus based on altered trace VOCs concentrations using the relatively inexpensive, easy-to-use, portable and non-invasive E-Nose technology.
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Affiliation(s)
- Ehab I Mohamed
- Department of Medical Biophysics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Sameh M El-Ghnam
- Department of Physics, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Amani M Bayoumi
- Department of Physics, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Samir M Abdel-Mageed
- Department of Physics, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Doaa A Ghareeb
- Department of Biochemistry, Faculty of Science, Alexandria University, Alexandria, Egypt.,Pre-Clinical Center, Scientific Research and Technology Applications City, Borg Al-Arab, Alexandria, Egypt
| | - Brian Ross
- Northern Ontario School of Medicine, Lakehead University, Ontario, Canada
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Salari N, Kazeminia M, Hemati N, Ammari-Allahyari M, Mohammadi M, Shohaimi S. Global prevalence of hepatitis C in general population: A systematic review and meta-analysis. Travel Med Infect Dis 2022; 46:102255. [PMID: 35007756 DOI: 10.1016/j.tmaid.2022.102255] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 12/14/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND According to published reports from the World Health Organization, it is estimated that more than 3% of the world's population is infected with HCV. Given the impact of various factors on the prevalence of HCV in the world's population and the lack of general statistics around the world, this study aims to review the studies conducted in this field and statistical analysis of the results of general statistical studies on the prevalence of HCV in the world population. METHODS In this study, systematic review and meta-analysis of information of the studies related to the prevalence of HCV in the world using keywords including: Prevalence, HCV, Hepatitis C, Healthy Population, Healthy subjects, and General Population in SID, MagIran, IranMedex, IranDoc, ScienceDirect, Embase, Scopus, PubMed, Web of Science (WoS) databases and Google Scholar search engine were extracted without time limit until April 2020. In order to perform the analysis of qualified studies, the model of random effects was used, and the inconsistency of studies with I2 index was investigated. Data analysis was performed with Comprehensive Meta-Analysis (Version 2). RESULTS In a study of 98 studies with a total sample size of 236,964 people in the world, the overall prevalence of HCV was 1.8% (95% CI: 1.4%-2.3%). Also, according to the subgroup analysis in different continents; the highest prevalence of HCV in the African continent was 7.1% (95% CI: 4.4-11.5%). CONCLUSION The results of this study show that the prevalence of hepatitis C in the world's population, especially in Africa, is almost high. Therefore, the officials of the World Health Organization should design measures to prevent the spread of this infection.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Mohsen Kazeminia
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Niloufar Hemati
- Department of Internal Medicine, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | | | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia.
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Teaima MH, Al-Nuseirat A, Abouhussein D, Badary OA, El-Nabarawi MA. Pharmaceutical policies and regulations of oral antiviral drugs for treatment of hepatitis C in Egypt-case study. J Pharm Policy Pract 2021; 14:106. [PMID: 34915937 PMCID: PMC8674831 DOI: 10.1186/s40545-021-00389-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 12/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited studies on the role of efficient regulatory mechanisms in facilitating greater access to Hepatitis C virus (HCV) treatment. Evidence to support the importance of effective pharmaceutical policies and regulations in improving access to oral viral drugs towards the elimination of HCV is needed. This study aims to explore the adequacy of the implemented pharmaceutical policies and regulations in Egypt and their role to improve the availability and affordability of direct-acting antivirals (DAAs) to achieve universal access to the treatment of HCV. METHODS The study adopts a qualitative methodology using desk review of regulatory and legislative information, literature review, and semi-structured interviews with key experts from the concerned governmental regulatory agencies, pharmaceutical industries, academic organizations, professional associations, civil society organizations, and clinicians who are working in researching treatments for hepatitis C. FINDINGS The common DAAs available in the market are Daclatasvir, Sofosbuvir, and Sofosbuvir-based direct-acting antiviral combinations. Fast-track medicines registration pathway for marketing authorization of DAAs is used to reduce market access time frames. The pricing policies are supplemented using price negotiation to set up affordable prices that led to a reasonable price for DAAs. Using Trade-Related Aspects of Intellectual Property Rights (TRIPs) flexibility and local production of quality generics DAAs at lower prices. In addition, political will and collaboration between the government, civil society, and pharmaceutical companies improved patients' access to affordable DAAs and succeeding hepatitis C treatment in Egypt. CONCLUSIONS The study findings indicated that the implemented pharmaceutical policies and regulations have an immense role in enhancing access to medicines towards the elimination of hepatitis C in Egypt.
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Affiliation(s)
- Mahmoud H Teaima
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Adi Al-Nuseirat
- Access to Medicines and Health Technologies Unit, World Health Organization Office for the Eastern Mediterranean Region, Cairo, Egypt.
| | - Dalia Abouhussein
- Pharmaceutics Department, Egyptian Drug Authority (EDA), Cairo, Egypt
| | - Osama A Badary
- Department of Clinical Pharmacy Practice, Faculty of Pharmacy, The British University in Egypt, Cairo, Egypt
| | - Mohamed A El-Nabarawi
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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29
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Ezzat R, Eltabbakh M, El Kassas M. Unique situation of hepatocellular carcinoma in Egypt: A review of epidemiology and control measures. World J Gastrointest Oncol 2021; 13:1919-1938. [PMID: 35070033 PMCID: PMC8713321 DOI: 10.4251/wjgo.v13.i12.1919] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/17/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common primary malignancy worldwide, and the third most common cause of death among cancers worldwide. HCC occurs in several pre-existing conditions, including hepatitis C, hepatitis B virus, and non-alcoholic cirrhosis. Egypt used to be the country with the heaviest hepatitis C virus (HCV) burden. The relationship between HCV and HCC is an important research area. In Egypt, HCC is a significant public health problem. A possible cause for the increasing rates of detection of HCC in Egypt is the mass screening program that was carried by the government for detecting and treating HCV. A multidisciplinary approach is now widely applied to HCC management in health centers all over Egypt. Different treatment modalities are available in Egypt, with success rates comparable to global rates. The Egyptian health authorities have made the elimination of HCV from Egypt a special priority, and this approach should lead to a decrease in number of HCC cases in the near future. In this article we review the current situation of HCC in Egypt, including epidemiological aspects, relevant risk factors for HCC development, strategies, and efforts established by health authorities for the screening and prevention of both HCV and HCC in Egypt. We highlight the different modalities for HCC treatment.
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Affiliation(s)
- Reem Ezzat
- Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mohamed Eltabbakh
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
| | - Mohamed El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo 11795, Cairo, Egypt
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30
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El Kassas M, Abdeen N, Omran D, Alboraie M, Salaheldin M, Eltabbakh M, Farghaly R, Emadeldeen M, Afify S, Sweedy A, Ghalwash A, Abbass A, Ezzat S, Tahoon M, ELshazly HM, Hamdy H, Omar H. Safety and efficacy of sofosbuvir/ledipasvir and sofosbuvir/daclatasvir in the treatment of hepatitis C in patients with decompensated cirrhosis. Eur J Gastroenterol Hepatol 2021; 33:e877-e882. [PMID: 34560693 DOI: 10.1097/meg.0000000000002287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV)-related decompensated cirrhosis is a severe life-threatening illness. The safety of direct-acting antivirals (DAAs) has opened a gate of hope for that subgroup of patients who were previously contraindicated for interferon therapy. OBJECTIVE We aimed at the investigation of the safety and efficacy of different DAAs regimens in the treatment of HCV-related decompensated cirrhosis patients, to determine sustained virological response (SVR)12 rates and to analyze the factors associated with response. METHODS A retrospective, single-center study including HCV-related decompensated cirrhosis patients who received DAAs. Demographic, laboratory and clinical data were analyzed. The SVR12 rate was the primary outcome measure. Secondary outcomes included the predictors of response, changes in the baseline model for end-stage liver disease and child-turcotte-pugh (CTP) scores, and fibroindices (APRI and fibrosis-4 index) at 12 weeks after treatment. RESULTS In total, 145 eligible patients (141 with CTP class B and 4 with class C) were enrolled in this study. SVR12 was achieved by 88.06% (118/134) of efficacy population on different DAAs regimens, Treatment was discontinued in 11 patients because of severe side effects without any deaths. Younger age showed a significant positive association with SVR12. CONCLUSIONS DAAs can be used for the treatment of HCV-related decompensated liver disease, with acceptable SVR12 rates and safety profiles.
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Affiliation(s)
- Mohamed El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo
| | - Nermeen Abdeen
- Tropical medicine, Faculty of Medicine, Alexandria University, Alexandria
| | - Dalia Omran
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University
| | | | - Mohamed Salaheldin
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo
| | - Mohamed Eltabbakh
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo
| | - Rasha Farghaly
- Department of community medicine, Faculty of Medicine, Suez Canal University
| | - Mohammed Emadeldeen
- Hepatogastroenterology Department, National Hepatology & Tropical Medicine Research Institute, Cairo
| | - Shimaa Afify
- Hepatogastroenterology Department, National Hepatology & Tropical Medicine Research Institute, Cairo
| | - Ahmad Sweedy
- Gastroenterology Department, Damietta Cardiology and Gastroenterology Center, Damietta
| | - Ahmed Ghalwash
- Hepatology and Gastroenterology Department, AGOZA Police Hospital, Cairo
| | - Amr Abbass
- Hepatology and Gastroenterology Department, AGOZA Police Hospital, Cairo
| | - Sameera Ezzat
- Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Marwa Tahoon
- Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Helmy M ELshazly
- Hepatology and gastroenterology department, national liver institute.Menoufia University, Egypt
| | - Hassan Hamdy
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo
| | - Heba Omar
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University
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31
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Fouad M, El Kassas M, Ahmed E, El Sheemy R. Tumor characteristics of hepatocellular carcinoma after direct-acting antiviral treatment for hepatitis C: Comparative analysis with antiviral therapy-naive patients. World J Hepatol 2021; 13:1743-1752. [PMID: 34904042 PMCID: PMC8637672 DOI: 10.4254/wjh.v13.i11.1743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/30/2021] [Accepted: 09/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Insufficient and contradictory data are available about the relation between direct-acting antivirals (DAAs) and hepatocellular carcinoma (HCC) development in patients with hepatitis C virus (HCV). AIM To analyze differences in basic clinical, radiological, and laboratory characteristics in addition to tumor behavior upon HCC diagnosis between patients with and without a previous history of DAAs exposure. METHODS This multicenter case-control study included 497 patients with chronic HCV-related HCC, allocated into one of two groups according to their history of antiviral treatment for their HCV. RESULTS Group I included 151 HCC patients with a history of DAAs, while 346 patients who had never been treated with DAAs were assigned to group II. A significant difference was observed between both groups regarding basic assessment scores (Child, MELD, and BCLC), which tended to have more advanced liver disease and HCC stage upon diagnosis in group I. However, serum albumin was significantly affected, and serum α-fetoprotein was significantly higher in group II (P < 0.001). In addition, group I showed significant HCC multicentricity than group II, while the incidence of portal vein thrombosis was significantly higher in group I (P < 0.001). CONCLUSION The basic clinical scores and laboratory characteristics of HCC patients are advanced in patients who are naïve to DAAs treatment; however, HCC behavior is more aggressive in DAA-treated patients.
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Affiliation(s)
- Magdy Fouad
- Department of Tropical Medicine and Gastroenterology, Minia University, Minia 61519, Egypt
| | - Mohamed El Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt.
| | - Elham Ahmed
- Department of Internal Medicine, Minia University, Minia 61519, Egypt
| | - Reem El Sheemy
- Department of Tropical Medicine, Minia University, Minia 61111, Egypt
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Fadhil I, Alkhalawi E, Nasr R, Fouad H, Basu P, Camacho R, Alsaadoon H. National cancer control plans across the Eastern Mediterranean region: challenges and opportunities to scale-up. Lancet Oncol 2021; 22:e517-e529. [PMID: 34735820 DOI: 10.1016/s1470-2045(21)00410-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022]
Abstract
National cancer control planning is crucial for countries in the WHO Eastern Mediterranean region. This region is challenged with an increase in cancer incidence leading to substantial disease burden, premature deaths, and increasing health-care costs in most countries. Huge inequity in cancer control planning and implementation exists between and within the countries. Over half of the countries (12 [55%] of 22) have standalone comprehensive National Cancer Control Plans and six (27%) have non-communicable disease plans that include cancer. The implementation of cancer plans has common challenges related to weak governance structure, few coordination mechanisms within countries, and inadequate human and financial resources. In most countries, the plan is not costed. Yet, the majority of countries (20 [91%]) reported having fully or partially funded plans. Additionally, political instability and conflicts affecting over half of the countries in the Eastern Mediterranean region have enormously affected cancer planning and implementation, both among the affected countries and those that host large numbers of refugees. In this Policy Review, we used the WHO regional framework for action on cancer to systematically analyse the status of cancer control planning and implementation across the six domains of cancer control, from prevention to palliation. We highlight the gaps, and the opportunities for bridging these gaps, to achieve scale-up on implementation of cancer control programmes in the Eastern Mediterranean region.
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Affiliation(s)
- Ibtihal Fadhil
- The Eastern Mediterranean NCD Alliance, Kuwait City, Kuwait.
| | - Eman Alkhalawi
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rihab Nasr
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, Cancer Prevention and Control Program, Naef K Basile Cancer Institute, American University of Beirut, Beirut, Lebanon
| | - Heba Fouad
- NCD Surveillance Unit, WHO, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Partha Basu
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, WHO, Lyon, France
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Ali ME, Halby HM, Ali MY, Hassan EA, El-Mokhtar MA, Sayed IM, Thabet MM, Fouad M, El-Ashmawy AM, Mahran ZG. Role of Serum Vitamin D, Interleukin 13, and microRNA-135a in Hepatocellular Carcinoma and Treatment Failure in Egyptian HCV-Infected Patients Receiving Direct Antiviral Agents. Viruses 2021; 13:2008. [PMID: 34696438 PMCID: PMC8539757 DOI: 10.3390/v13102008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 12/12/2022] Open
Abstract
Direct-acting antivirals (DAAs) are used for hepatitis C virus (HCV) treatment. However, treatment failure and hepatocellular carcinoma (HCC) development following treatment was reported. In this study, we assessed the role of serum vitamin D, interleukin 13 (IL-13), and microRNA-135a in the prediction of treatment failure with DAA and HCC development among Egyptian HCV-infected patients. A total of 950 patients with HCV-related chronic liver disease underwent DAA treatment. Before DAAs, serum vitamin D and IL-13 were determined by ELISA, and gene expression of miRNA-135a was assessed in serum by real-time PCR. The predictive abilities of these markers were determined using the receiver operating characteristic (ROC) curve. Sustained virological response (SVR) was achieved in 92.6% of HCV-infected patients (responders). High viral load, IL-13, miRNA-135a, and low vitamin D levels were associated with treatment failure and HCC development. HCC development was recorded in non-responders, but not in the responders (35.7% vs. 0% p < 0.001). In conclusion: serum IL-13, Vitamin D, and miRNA-135a could be potential biomarkers in monitoring DAA treatment and HCC prediction. DAAs-induced SVR may decrease the incidence of HCC.
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Affiliation(s)
- Mohamed E. Ali
- Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt; (M.E.A.); (H.M.H.); (M.Y.A.)
| | - Hamada M. Halby
- Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt; (M.E.A.); (H.M.H.); (M.Y.A.)
| | - Mamdouh Yones Ali
- Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt; (M.E.A.); (H.M.H.); (M.Y.A.)
| | - Elham Ahmed Hassan
- Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Mohamed A. El-Mokhtar
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt; (M.A.E.-M.); (I.M.S.)
| | - Ibrahim M. Sayed
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt; (M.A.E.-M.); (I.M.S.)
| | - Marwa M. Thabet
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Magdy Fouad
- Hepato-Gastroenterology Unit, Tropical Medicine Department, Faculty of Medicine, El-Minia University, Minya 61519, Egypt;
| | - Ahmed M. El-Ashmawy
- Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Zainab Gaber Mahran
- Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
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Abdelghani A, Ibrahim MHED, Mohamed OM, Rizk SE, Ahmed RM. Urinary albumin-to-creatinine ratio in decompensated liver cirrhosis among elderly Egyptian patients: a single-center experience. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.1186/s43162-021-00062-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Hepatitis C virus and nonalcoholic steatohepatitis (NASH) are the most common causes of liver cirrhosis in Egypt. Increasing aging population is a worldwide issue, and societies are facing various problems, including long-term care for populations with a high prevalence of chronic conditions; hence, comprehensive geriatric assessment is important for determining patients’ mental health, functional capacity, and social circumstances. Normally, a small amount of protein (normal urinary albumin-to-creatinine ratio [UACR] < 30 mg/g) excreted in daily urine and excess amounts warrant further examination. The present study aims to evaluate the relationship between UACR and the severity of liver cirrhosis among 47 elderly patients (more than 65 years old) and 47 adult patients (control group) admitted to the hospital as well as the relationship between UACR and geriatric cognitive functions, functional capacity, depression, and nutritional status.
Results
The present study showed that the cognitive, functional, and nutritional status of patients aged 65 years old or more were significantly affected by the severity of liver disease. The investigators also reported a significant relationship between UACR and Child–Pugh score in the elderly patient group. No significant relationship was found between UACR and the cognitive, functional, mood, or nutritional status of the elderly age group.
Conclusion
Overall, UACR was correlated to the severity of liver disease among elderly patients compared with adult patients with liver cirrhosis.
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Elbahrawy A, Ibrahim MK, Eliwa A, Alboraie M, Madian A, Aly HH. Current situation of viral hepatitis in Egypt. Microbiol Immunol 2021; 65:352-372. [PMID: 33990999 DOI: 10.1111/1348-0421.12916] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022]
Abstract
An estimated 8-10 million people suffer from viral hepatitis in Egypt. Hepatitis A virus (HAV) and hepatitis E virus (HEV) are the major causes of viral hepatitis in Egypt as 50% or more of the Egyptian population are already exposed to HAV infection by the age of 15. In addition, over 60% of the Egyptian population test seropositive for anti-HEV in the first decade of life. HEV mainly causes self-limiting hepatitis; however, cases of fulminant hepatitis and liver failure were reported in Egypt. Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are the main causes of chronic hepatitis, liver cirrhosis, and liver cancer (hepatocellular carcinoma [HCC]) in Egypt. Globally, Egypt had the highest age-standardized death rate due to cirrhosis from 1990 to 2017. The prevalence rate of HBV (1.3%-1.5%) has declined after national infantile immunization. Coinfection of HBV patients with HDV is common in Egypt because HDV antibodies (IgG) vary in range from 8.3% to 43% among total HBV patients. After the conduction of multiple national programs to control HCV infection, a lower rate of HCV prevalence (4.6%) was recently reported. Data about the incidence of HCV after treatment with direct antiviral agents (DAAs) are lacking. An HCC incidence of 29/1000/year in cirrhotic patients after DAA treatment is reported. A higher rate of infiltrative pattern among HCC patients after DAA treatment is also recognized. Viral hepatitis is one of the major public health concerns in Egypt that needs more attention and funding from health policymakers.
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Affiliation(s)
- Ashraf Elbahrawy
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Marwa K Ibrahim
- Department of Microbial Biotechnology, Division of Genetic Engineering and Biotechnology Research, National Research Centre, Giza, Egypt
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ahmed Eliwa
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali Madian
- Department of Internal Medicine, Al-Azhar University, Assiut, Egypt
| | - Hussein Hassan Aly
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
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Liver Cirrhosis, Etiology and Clinical Characteristics Disparities Among Minority Population. J Immigr Minor Health 2021; 24:1122-1128. [PMID: 34453643 DOI: 10.1007/s10903-021-01263-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
Liver cirrhosis (LC) is a common disease with varied primary causes and ethnic disparities. Clinical characteristics and outcomes of Arab Bedouin (AB) and Jewish patients with LC were retrospective collected and compared. We included 1048 patients, 95 (9%) Arab Bedouin and 953 (91%) Jewish patients. The incidence of cirrhosis was much lower among AB. Age at diagnosis was 47 ± 18 years among Bedouins compared to 61 ± 13 years (p < 0.001) among Jews. The most frequent causes of cirrhosis among Bedouin patients were fatty liver 21.1%, cryptogenic 20%, hepatitis B 17.9% and autoimmune hepatitis 15.8%, while hepatitis C (39.2%), fatty liver (17.2%) and alcoholic liver disease (14.4%) were most common among Jewish patients. An all-cause mortality of 48.4% was observed in AB patients compared to 66.4% in Jewish patients (p < 0.001). Significant disparities regarding incidence, clinical characteristics and outcomes of cirrhosis among Arab Bedouin compared with Jewish population were found.
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Montasser IF, Ibrahim AA, Farid HM, Al Balakosy AM. De novo hepatocellular carcinoma in cirrhotic hepatitis C virus: Are directly acting antivirals beneficial? Clin Res Hepatol Gastroenterol 2021; 45:101517. [PMID: 32900667 DOI: 10.1016/j.clinre.2020.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Behavior of HCC that developed after DAAs therapy for HCV infection is still debated. In this study we aim to compare characteristics and pattern of de novo HCC in cirrhotic HCV patients who were treated and untreated with DAAs. PATIENTS AND METHODS This study included 160 cirrhotic HCV patients presented with de novo HCC during the period of December 2017 to December 2018. Patients were divided into two groups, group A included 80 patients who received DAAs and group B included 80 patients who were not exposed to DAAs. The characteristics of HCC in both groups were compared using BCLC Staging System. RESULTS The size of the largest lesion was 47mm±26 in group A and 41mm±27 in group B with statistically significant difference between both groups (p=0.03). No other significant differences existed regarding number, site, or total tumor size and most of the lesions were solid in both groups. Portal vein thrombosis and extrahepatic spread detected in 16 and 11 patients in group A, while in group B the number was 17 and 9 patients respectively (p=0.83 and 0.06). No significant differences between groups in type of intervention done, BCLC staging (p=0.4), or survival. CONCLUSION Although CHCV patients treated with DAAs had larger de novo HCC lesions than untreated patients, there was no difference in BCLC staging or in aggressive behavior between both groups.
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Affiliation(s)
- Iman F Montasser
- Department of Tropical Medicine, Faculty of Medicine - Ain Shams University, Cairo, Egypt.
| | - Amany A Ibrahim
- Department of Tropical Medicine, Faculty of Medicine - Ain Shams University, Cairo, Egypt.
| | - Hoda M Farid
- Department of Tropical Medicine, Faculty of Medicine - Ain Shams University, Cairo, Egypt.
| | - Amira M Al Balakosy
- Department of Tropical Medicine, Faculty of Medicine - Ain Shams University, Cairo, Egypt.
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Azeem HA, Alkabeer AM, Mohammed AS, Hussein AA. Study of hepatitis B virus infection, reactivation among patients with chronic hepatitis C infection treated by direct antiviral agents (DAAs). EGYPTIAN LIVER JOURNAL 2021. [DOI: 10.1186/s43066-021-00121-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hepatitis B virus (HBV) may reactivate when treating chronic hepatitis C (CHC) with direct-acting antivirals (DAA). We aimed to investigate the risk of HBV infection and reactivation during DAA therapy by performing a prospective observational study carried on 200 patients positive for chronic HCV who were candidates for treatment by DAA therapy according to the Egyptian guidelines from February 2019 to December 2019; the patients identified to carry HBsAg at baseline or with positive HBc Abs were further assessed for other HBV markers: hepatitis B e antigen at baseline, and serum HBV DNA quantitative measurement at baseline, week 4 of treatment, end of treatment. On the other hand, recent infection by HBV among those patients was observed.
Results
Of all participants, 49% were males and 51% were females, aged above 18 years. There is a highly statistically significant difference (p-value < 0.05) between HCV RNA PCR (at the beginning, at the end of 4 weeks, and at the end of 12 weeks) in studied patients. There was a highly statistically significant difference found between the liver function tests at the beginning, at the end of 4 weeks, and at the end of 12 weeks of treatment where it shows improvement except for serum albumin. At beginning of the study, there were 34 patients who are co-infected with HCV and HBV with quantitative PCR test for HBV DNA ≥ 20 IU/ml. After 1 month of DAA therapy, reactivation was detected in 6 cases (4 occult cases show reverse seroconversion (became HBs Ag positive), and 2 co-infected cases show increased HBV DNA > 1000 IU/L above the baseline level). In addition, 3 new cases acquired recent infection with the positivity of HBc IgM and detectable levels of HBV DNA. After 3 months of study, reactivation was detected in one patient with co-infection (where increased HBV DNA > 1000 IU/L above the baseline level), and 5 new cases acquired recent infection late in the study.
Conclusion
Screening for HBV infection prior to DAA therapy is required to detect recent infection of reactivation of previous infection during or after DAA therapy.
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Eletreby R, Elraouf MA, Fouad A, Nasser M, Al Bassiouni M, Zayed N, Yosry A, Abdellatif Z. Screening for chronic hepatitis C and chronic hepatitis B infections among pregnant females: a cross-sectional study. EGYPTIAN LIVER JOURNAL 2021. [DOI: 10.1186/s43066-021-00113-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In Egypt, an endemic country for both viral hepatitis C and B infections, infection could be more prevalent in pregnant females. This study aimed to assess the prevalence of chronic HCV and HBV in a cohort of pregnant Egyptian females, highlighting the disease burden for better preventive measures and better disease outcome. In this cross-sectional prospective study, 399 pregnant women attending antenatal clinic in a tertiary care center in Egypt were screened for HCV and HBV infection using ELISA testing. Clinical and biochemical characteristics were compared between positive and negative cases.
Results
Mean age was 26.78 years. Prevalence rates of HCV-Ab and HBsAg positivity were 7.02% and 7.52%. Isolated HBcAb positivity was found in only 2 patients (0.5%). All cases were negative for HBsAb. No combined HBV/HCV infection was detected. All positive cases for either HBV or HCV infections did not show any signs of hepatic decompensation. ALT was significantly higher among HBV positive versus negative patients (mean ± SD of 14.2 ± 5.77 IU/L versus 11.95 ± 5.21 IU/L, p = 0.02, reference range: 7-56 IU/L), while no significant difference was found between HCV positive and negative cases as regards liver enzymes.
Conclusion
In Egypt, HBV prevalence in pregnant females seems to be higher than general population. This was not evident for HCV infection; however, it is still higher than pooled prevalence rates worldwide. This higher prevalence for both viral infections warrants strict screening programs to prevent vertical transmission and to provide better maternal and fetal outcome.
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Ahmed M, Mansey AE, Wahsh EA, Gomaa AA, Rabea HM. Efficacy and Safety of Ombitasvir plus Paritaprevir, Ritonavir and Ribavirin in Non-cirrhotic Treatment-naïve and Treatment-experienced Egyptians with Chronic HCV Genotype-4 Infection. Curr Med Sci 2021; 41:581-586. [PMID: 34047942 DOI: 10.1007/s11596-021-2363-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 12/11/2020] [Indexed: 01/11/2023]
Abstract
Hepatitis C virus genotype 4 (HCV-GT4) is a risk factor for cirrhosis, hepatocellular carcinoma and liver failure. A combination of three new direct-acting antivirals ombitasvir, paritaprevir, and ritonavir has been recommended for treatment of HCV-GT4 infection. The current study was aimed to assess the efficacy and safety of this combination plus ribavirin in non-cirrhotic, treatment-naïve and -experienced Egyptians with HCV-GT4 infection in a real-world setting. A total of 255 Egyptians with HCV-GT4 infection were enrolled, including 82 treatment-experienced and 173 treatment-naïve patients. All of them completed 12-week treatment protocol of ombitasvir, paritaprevir and ritonavir as an oral dose combination with ribavirin. Virological response (VR) was measured, as well as the biochemical parameters related to treatment efficacy and adverse events at baseline and after treatment, at 4 (VR4) and 12 (VR12) weeks post-treatment. The results showed that the VR4 rates were 98.8% in both groups, and VR12 rates were 97.7% and 96.3% in treatment-naïve and -experienced patients, respectively, with no significant differences found between the groups concerning VR4 (P=0.9) and VR12 (P=0.3). The most common adverse events were headache and fatigue, which were significantly more common (P=0.001 and 0.003, respectively) in treatment-experienced than in treatment-naïve group. The quadruple regimen was well-tolerated, and the reported adverse events were generally mild to moderate. This real-world setting study confirms that the combination of ombitasvir, paritaprevir, ritonavir, and ribavirin is highly effective in the treatment of HCV- GT4 infection with a good safety and tolerability profile.
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Affiliation(s)
- Manar Ahmed
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni Suef University, Beni Suef, 62521, Egypt
| | - Azza E Mansey
- Department of Clinical Pharmacy, Faculty of Pharmacy, Menoufia University, Al Menoufia, 32511, Egypt
| | - Engy A Wahsh
- Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 university, Giza, 12573, Egypt.
| | - Ahmed A Gomaa
- Department of Tropical Medicine, Faculty of Medicine, Fayoum University, Fayoum, 63511, Egypt
| | - Hoda M Rabea
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni Suef University, Beni Suef, 62521, Egypt
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Sherief LM, Ragab SM, Helwa MA, Kamal NM, Afify MR, Mohammed RTS, Mokhtar GAE, Sherbiny HS. CMV, B and C hepatitis among multi-transfused hereditary hemolytic Anemia children: an updated Egyptian experience. Ital J Pediatr 2021; 47:117. [PMID: 34039385 PMCID: PMC8153523 DOI: 10.1186/s13052-021-01072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Regular blood transfusion has improved the overall survival and quality of life for patients with hereditary hemolytic anemias. Nevertheless, it carries a real risk of acquisition of blood-borne virus infections, especially viral hepatitis. The purpose of the current study is to present an Egyptian update on blood-borne hepatitis C & B viruses (HCV & HBV) and cytomegalovirus (CMV) among multi-transfused Egyptian children with hereditary hemolytic anemias, especially after implementation of national preventive programs in Egypt. PATIENTS AND METHODS All pediatric patients with hereditary hemolytic anemias who have regular follow-up and received frequent blood transfusion at the Pediatric Hematology Units, Menuofia and Zagazig Universities Hospitals, Egypt, during the study period, were recruited. They were tested for hepatitis B surface antigen (HBVsAg), hepatitis C antibody (HCVab), and CMV immunoglobulin M (IgM) serology. Those with positive results were confirmed by real-time polymerase chain reaction (PCR). RESULTS Four hundred and seventy-seven hereditary hemolytic anemia patients fulfilled the study inclusion criteria. Their ages ranged from 2 to 18 years, 54.9% of them were males. Seroprevalence of HCVab and CMV-IgM were (14.7% & 6.7% respectively) and they were confirmed by PCR. None of the studied cases were HBVsAg positive. Seropositivity for HCV was significantly associated with older age of the patients, higher transfusion frequency, longer disease duration, and higher mean serum ferritin. CONCLUSION HCV followed by CMV infections still represent a significant problem for patients with hereditary hemolytic anemias. Nationwide plans should be taken to ensure meticulous and highly sensitive methods of blood screening before transfusion. On the other hand, it seems that HBV compulsory vaccination had succeeded to eliminate HBV infection.
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Affiliation(s)
- Laila M Sherief
- Pediatrics & Pediatric Hematology oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Seham M Ragab
- Pediatrics & Pediatric Hematology oncology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed A Helwa
- Clinical Pathology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Naglaa M Kamal
- Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Mona R Afify
- Medical Microbiology & Parasitology, Faculty of Medicine, University of Jeddah, Jeddah, 21589, Saudi Arabia
| | - Rasha T S Mohammed
- Pediatrics & Pediatric Hematology oncology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - Hanan S Sherbiny
- Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Pediatric Department, Collage of Medicine, University of Bisha (UB), Bisha, Kingdom of Saudi Arabia
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Bota S, Razpotnik M, Hucke F, Urak C, Flatscher K, Peck-Radosavljevic M. Challenges in hepatitis C elimination despite highly effective antiviral agents in patients with and without intravenous drug use. Wien Klin Wochenschr 2021; 133:641-646. [PMID: 34032930 DOI: 10.1007/s00508-021-01868-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Abstract
AIM To assess the adherence to treatment, sustained virologic response (SVR) rate, and reinfection rate in hepatitis C patients with and without intravenous drug use. METHODS This retrospective study included hepatitis C patients, evaluated and treated in our hepatology outpatient clinic between January 2014 and October 2019. The following information was extracted from the patient's file: the presence of positive viral load for hepatitis C virus (HCV), active and recent (in the last 6 months) use of i.v. drugs, HCV genotype, treatment regimen, SVR, HCV reinfection rate, coinfection with human immunodeficiency virus (HIV) and ongoing opioid substitution therapy (OST). RESULTS We included 431 hepatitis C patients, 234 people who inject drugs (PWID) and 197 non-PWID. Most patients were treated with direct-acting antivirals (DAA) only. The rate of documented SVR by treated patients was significantly higher in the non-PWID cohort (91.5% vs. 61.5%, p < 0.0001), while noncompliance (did not show up to start treatment) rate or refusal of treatment was significantly higher in the PWID cohort (19.4% vs. 8.9%, p = 0.004). In the PWID cohort, younger age and recent (in the last 6 months) or ongoing i.v. drug use was associated with noncompliance: 31.1 ± 8.4 years vs. 35.8 ± 10.6 years (p = 0.02) and 33.3% vs. 12.8% (p = 0.0008), respectively. Ongoing OST was associated with better compliance: 61.1% vs. 46.1% (p = 0.04). CONCLUSION To achieve elimination of hepatitis C better treatment strategies are needed, especially in PWIDs.
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Affiliation(s)
- Simona Bota
- Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE), Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Marcel Razpotnik
- Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE), Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Florian Hucke
- Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE), Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Christian Urak
- Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE), Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Kerstin Flatscher
- Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE), Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Markus Peck-Radosavljevic
- Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE), Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria.
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Fadriquela A, Kim CS, Lee KJ, Kang SH, Kim MY, Lee JH. Soluble type immune checkpoint regulators using multiplex luminex immunoassay in chronic hepatitis B patients. J Clin Pathol 2021; 74:780-786. [PMID: 34016716 DOI: 10.1136/jclinpath-2020-207125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 12/19/2022]
Abstract
AIMS Soluble immune checkpoint regulators (sICs) were reported to have clinical impact on the diagnosis and progress of various diseases. This study compared the serum levels of 16 sICs in patients with chronic hepatitis B (CHB) to elucidate their clinical significance. METHODS The sICs of 86 patients with CHB and 50 healthy controls (HCs) were measured using luminex-based multiplex assay. The sICs were correlated with laboratory markers and sIC levels were compared in cirrhotic and non-cirrhotic groups. RESULTS The levels of soluble programmed death-ligand 1, soluble cluster of differentiation 80/B7-1 (sCD80/B7-1), soluble cluster of differentiation 86/B7-2, soluble B-lymphocyte and T-lymphocyte attenuator, soluble herpes virus entry mediator, soluble cluster 28, soluble cluster of differentiation 40, soluble glucocorticoid-induced TNFR-related protein, soluble ligand for receptor TNFRSF18/AITR/GITR, soluble Toll-like receptor 2 and soluble inducible T-cell costimulator (sICOS) were decreased, while soluble T-cell immunoglobulin and mucin-domain containing-3 (sTIM-3) was increased in patients with CHB. Soluble programmed cell death protein 1 and sTIM-3 both positively correlated with hepatitis B virus (HBV) DNA level and increased in entecavir or tenofovir used group. The sTIM-3 positively correlated with aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase and gamma-glutamyl transferase to platelet ratio and fibrosis-4. Soluble cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) decreased in the liver cirrhosis (LC) group compared with the non-LC group. sCD80/B7-1 decreased LC risk, while soluble lymphocyte-activation gene increased LC risk by logistic regression analysis. CONCLUSIONS Our results showed the preliminary data on dysregulated sICs in patients with CHB that may have clinical significance in diagnosis of patients with CHB. It can be applied to develop therapeutic target of HBV infection.
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Affiliation(s)
- Ailyn Fadriquela
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of).,Department of Environmental Medical Biology, Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of)
| | - Cheol-Su Kim
- Department of Environmental Medical Biology, Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of)
| | - Kyu-Jae Lee
- Department of Environmental Medical Biology, Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of)
| | - Seong Hee Kang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of)
| | - Moon Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of)
| | - Jong-Han Lee
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of)
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Mangia A, Cotugno R, Cocomazzi G, Squillante MM, Piazzolla V. Hepatitis C virus micro-elimination: Where do we stand? World J Gastroenterol 2021; 27:1728-1737. [PMID: 33967553 PMCID: PMC8072193 DOI: 10.3748/wjg.v27.i16.1728] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/28/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) elimination by 2030, using direct-acting antiviral treatments, has been promoted by the World Health Organization. This achievement is not attainable, however, particularly after the 2020 pandemic of the coronavirus disease 2019. Consequently, the more realistic objective of eliminating HCV from population segments for which targeted strategies of prevention and treatment are easily attained has been promoted in Europe, as a valid alternative. The underlying idea is that micro-elimination will ultimately lead to macro-elimination. The micro-elimination strategy may target different specific populations and at-risk groups. Different settings, including prisons and hospitals, have also been identified as micro-elimination scenarios. In addition, dedicated micro-elimination strategies have been designed that are tailored at the geographical level according to HCV epidemiology and individual country's income. The main elements of a valid and successful micro-elimination project are reliable epidemiological data and active involvement of all the stakeholders. Community involvement represents another essential component for a successful program.
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Affiliation(s)
- Alessandra Mangia
- Liver Unit, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo 71013, Fg, Italy
| | - Rosa Cotugno
- Liver Unit, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo 71013, Fg, Italy
| | - Giovanna Cocomazzi
- Liver Unit, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo 71013, Fg, Italy
| | - Maria Maddalena Squillante
- Liver Unit, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo 71013, Fg, Italy
| | - Valeria Piazzolla
- Liver Unit, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo 71013, Fg, Italy
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Anwar WA, El Gaafary M, Girgis SA, Rafik M, Hussein WM, Sos D, Mossad IM, Fontanet A, Temime L. Hepatitis C virus infection and risk factors among patients and health-care workers of Ain Shams University hospitals, Cairo, Egypt. PLoS One 2021; 16:e0246836. [PMID: 33556152 PMCID: PMC7870060 DOI: 10.1371/journal.pone.0246836] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/26/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hospitals are suspected of playing a key role in HCV epidemic dynamics in Egypt. This work aimed at assessing HCV prevalence and associated risk factors in patients and health-care workers (HCWs) of Ain Shams University (ASU) hospitals in Cairo. METHODS We included 500 patients admitted to the internal medicine or surgery hospital from February to July, 2017, as well as 50 HCWs working in these same hospitals. Participants were screened for anti-HCV antibodies and HCV RNA. A questionnaire was administered to collect data on demographic characteristics and medical/surgical history. For HCWs, questions on occupational exposures and infection control practices were also included. RESULTS The overall prevalence of anti-HCV antibodies was 19.80% (95% CI: 16.54-23.52) among participating patients, and 8.00% (95% CI: 0.48-15.52) among participating HCWs. In HCWs, the only risk factors significantly associated with anti-HCV antibodies were age and profession, with higher prevalence in older HCWs and those working as cleaners or porters. In patients, in a multivariate logistic regression, age over 50 (aOR: 3.4 [1.9-5.8]), living outside Cairo (aOR: 2.1 [1.2-3.4]), admission for liver or gastro-intestinal complaints (aOR: 4.2 [1.8-9.9]), and history of receiving parenteral anti-schistosomiasis treatment (aOR: 2.7 [1.2-5.9]) were found associated with anti-HCV antibodies. CONCLUSIONS While HCV prevalence among patients has decreased since the last survey performed within ASU hospitals in 2008, it is still significantly higher than in the general population. These results may help better control further HCV spread within healthcare settings in Egypt by identifying at-risk patient profiles upon admission.
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Affiliation(s)
- Wagida A. Anwar
- Faculty of Medicine, Department of Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt
| | - Maha El Gaafary
- Faculty of Medicine, Department of Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt
| | - Samia A. Girgis
- Faculty of Medicine, Department of Clinical Pathology, Ain Shams University, Cairo, Egypt
| | - Mona Rafik
- Faculty of Medicine, Department of Clinical Pathology, Ain Shams University, Cairo, Egypt
| | - Wafaa M. Hussein
- Faculty of Medicine, Department of Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt
| | - Dalia Sos
- Faculty of Medicine, Department of Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt
| | - Isis M. Mossad
- Faculty of Medicine, Department of Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt
| | - Arnaud Fontanet
- Emerging diseases epidemiology Unit, Institut Pasteur, Paris, France
- PACRI Unit, Institut Pasteur, Conservatoire national des arts et métiers, Paris, France
| | - Laura Temime
- PACRI Unit, Institut Pasteur, Conservatoire national des arts et métiers, Paris, France
- Modélisation, Epidémiologie et Surveillance des Risques Sanitaires (MESuRS), Conservatoire national des arts et métiers, Paris, France
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Shiha G, Soliman R, Mikhail NNH, Easterbrook P. Reduced incidence of hepatitis C in 9 villages in rural Egypt: Progress towards national elimination goals. J Hepatol 2021; 74:303-311. [PMID: 32931878 DOI: 10.1016/j.jhep.2020.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 08/01/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Egypt has a major HCV burden and a well established treatment programme, with an ambitious goal of HCV elimination. Our aim was to assess the impact of a comprehensive HCV prevention, test and treat programme on the incidence of new HCV infections in 9 villages in rural Egypt. METHODS An HCV "educate, test and treat" project was implemented in 73 villages across 7 governorates in Egypt between 06/2015 and 06/2018. In 2018, in 9 of the villages we re-tested individuals who originally tested HCV antibody (HCV-Ab) and HBsAg negative using rapid diagnostic tests (RDTs); confirmatory HCV RNA testing was performed for positive cases. The incidence rate per 1,000 person-years (py) was calculated, and risk factors for incident HCV infections assessed through an interviewer-administered questionnaire in 1:3 age- and gender-matched cases and controls. RESULTS Out of 20,490 individuals who originally tested HCV-Ab negative in the 9 villages during the 2015-2016 implementation of the "educate, test and treat" programme, 19,816 (96.7%) were re-tested in 2018. Over a median of 2.4 years (IQR 2.1-2.7), there were 19 new HCV infections all of which were HCV RNA positive (incidence rate 0.37/1,000 py) (95% CI 0.24-0.59). Compared to a previous estimate of incidence in the Nile Delta region (2.4/1,000 py) from 2006, there was a substantial reduction in overall incidence of new HCV infections. Exposures through surgery (odds ratio 51; 95% CI 3.5-740.1) and dental procedures (odds ratio 23.8; 95% CI 2.9-194.9) were significant independent predictors of incident infections. CONCLUSIONS This is the first study to show a substantial reduction in incidence of new HCV infections in a sample of the general population in Egypt following attainment of high testing and treatment coverage. New infections were significantly associated with healthcare-associated exposures. LAY SUMMARY Egypt has a major national HCV testing and treatment programme with the goal of eliminating HCV infection. We assessed the impact of a comprehensive HCV prevention, test and treat programme in 73 villages that achieved high coverage of testing and treatment on the subsequent incidence of new HCV infections in nine of the villages. We re-tested people who were previously HCV antibody negative and found that the rate of new HCV infections was greatly reduced compared to previous estimates. We also found that exposure through surgery and dental procedures were associated with these new infections. This highlights the importance of continued strengthening of infection control and prevention measures, alongside treatment scale-up.
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Affiliation(s)
- Gamal Shiha
- Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El-Mansoura, Egypt; Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Egypt.
| | - Reham Soliman
- Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El-Mansoura, Egypt; Tropical Medicine Department, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Nabiel N H Mikhail
- Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El-Mansoura, Egypt; Biostatistics and Cancer Epidemiology Department, South Egypt Cancer Institute, Assiut University, Egypt
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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Almaeen AH, Alduraywish AA, Mobasher MA, Almadhi OIM, Nafeh HM, El-Metwally TH. Oxidative stress, immunological and cellular hypoxia biomarkers in hepatitis C treatment-naïve and cirrhotic patients. Arch Med Sci 2021; 17:368-375. [PMID: 33747272 PMCID: PMC7959056 DOI: 10.5114/aoms.2019.91451] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) is the main cause of chronic liver disease, with calamitous complications. Its highest rate is recorded in Egypt. This study investigated whether oxidative stress, immunological chaos and cellular hypoxia are implicated in the pathophysiology of the disease. MATERIAL AND METHODS This cross-sectional study aimed to evaluate the changes in blood oxidative stress, cellular hypoxia/angiogenesis and cellular immunological biomarkers in hospital-diagnosed treatment-naïve HCV-infected Upper Egyptian chronic liver disease patients vs. healthy controls (n = 40). The consecutively included patients comprised 120 with normal serum enzymes (HCV-NE) and 130 with high serum enzymes (HCV-HE), along with 120 cirrhotic patients. RESULTS Oxidative stress biomarkers - malondialdehyde (MDA), total peroxides and oxidative stress index (OSI) - were significantly lower in controls vs. each of the patient groups. Cirrhotic patients presented the highest levels. However, total antioxidants (TAO) showed non-significant differences among the four groups. The cellular hypoxia/angiogenesis biomarkers - lactate, vascular endothelial cell growth factor (VEGF) and its soluble receptor 1 (sVEGFR1) - vs. controls were massively increased in patient groups. VEGF was lowest while sVEGFR1 was highest among cirrhotic patients. Immunological biomarkers, - granulocyte/monocyte-colony stimulating factor (GM-CSF) and total immunoglobulin G (IgG) - were massively increased in patient groups vs. controls. GM-CSF was lowest in HCV-HE and IgG was highest in cirrhotic patients. sVEGFR1 correlated with the progression towards cirrhosis. CONCLUSIONS Oxidative stress is implicated in the progress of HCV infection with marked induction of cellular hypoxia and dysfunctional angiogenesis, and a futile immunological reaction. sVEGFR1 level correlated with progression towards HCV-induced liver fibrosis.
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Affiliation(s)
| | | | - Maysa Ahmed Mobasher
- Department of Pathology, Jouf University College of Medicine, Sakaka, Saudi Arabia
| | - Omar I. M. Almadhi
- College of Medicine, Jouf University College of Medicine, Sakaka, Saudi Arabia
| | - Hanan M. Nafeh
- Department of Tropical Medicine and Gastroenterology, Assiut University, Faculty of Medicine, Assiut, Egypt
| | - Tarek Hassan El-Metwally
- Department of Pathology, Jouf University College of Medicine, Sakaka, Saudi Arabia
- Department of Medical Biochemistry, Assiut University, Faculty of Medicine, Assiut, Egypt
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Ibrahim H, El Kerdawy AM, Abdo A, Sharaf Eldin A. Similarity-based machine learning framework for predicting safety signals of adverse drug–drug interactions. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100699] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Mohamed AA, Hemeda AA, Aziz RK, Abdel-Hakeem MS, Ali-Tammam M. Body mass index (BMI) and alpha-fetoprotein (AFP) level correlate with the severity of HCV-induced fibrosis in a cohort of Egyptian patients with chronic HCV. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2020. [DOI: 10.1186/s43094-020-00085-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
Viral hepatitis is the seventh leading cause of mortality globally, and half of this mortality is attributed to hepatitis C virus (HCV). Egypt has the highest HCV prevalence worldwide, with an estimated 14.7% of the population being HCV-positive. HCV infection is the primary cause of liver fibrosis, cirrhosis, and hepatocellular carcinoma. Liver fibrosis varies in severity during chronic HCV infection, and 10–20% of chronic hepatitis C (CHC) patients with severe fibrosis develop cirrhosis. The goal of this work was to assess the clinico-demographic predictors of severity of HCV-induced fibrosis in a cohort of Egyptian patients.
Results
A cohort of Egyptian patients with chronic HCV genotype 4a infection showed significant association between severe fibrosis stages and obesity, represented by a higher body mass index (BMI), low albumin level, high alpha-fetoprotein (AFP) level, low thyroid-stimulating hormone (TSH) level, and high alkaline phosphatase (ALP) level. Multivariate analysis delineated BMI, TSH, and ALP as independent significant variables that could predict the risk of fibrosis severity in HCV infections.
Conclusion
This study argues in favor of using the biomarker profile of CHC patients infected with HCV genotype 4a to identify patients at higher risk of developing severe fibrosis, which is a necessary first step towards precision medicine via patient stratification.
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Saad ZM, El-Dahrouty AH, El-Sayed AM, Keryakos HKH, Fanous NN, Mostafa I. Small-bowel mucosal changes in Egyptian cirrhotic patients with portal hypertension using capsule endoscopy versus single-balloon enteroscopy. EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-020-00025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Small-bowel mucosal abnormalities that may occur secondary to portal hypertension in patients with liver cirrhosis have an impact on health and quality of life. In spite of the importance of these changes, little is known about the frequency and features of small-bowel changes in cirrhotic patients with portal hypertension. Eighty cirrhotic patients with or without esophageal or gastric varices were recruited in this study as well as 60 age- and sex-matched controls. All study participants underwent capsule endoscopy. In addition, half of the patients and controls were randomized to receive single-balloon enteroscopy.
Results
The prevalence of small-bowel mucosal changes was statistically significantly higher in cirrhotic patients than in controls; 57% versus 6.7%, respectively (p < 0.05). Cirrhotic patients with portal hypertensive gastropathy showed a significant increase in the small-bowel changes (p < 0.001). Small-bowel changes were significantly higher in patients with higher MELD and Child-Pugh scores (p < 0.001). Moreover, capsule endoscopy was more effective in the detection of small-bowel changes than single-balloon enteroscopy.
Conclusions
Mucosal changes associated with portal hypertensive enteropathy are more prevalent in cirrhotic patients, regardless of the presence or absence of gastric varices. Small-bowel mucosal changes in patients with portal hypertensive enteropathy were more common in patients who suffered from portal hypertensive gastropathy and were positively correlated with advanced chronic liver disease.
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