Epidemiology of hepatitis viruses among hepatocellular carcinoma cases and healthy people in Egypt: A systematic review and meta-analysis

Liver cancers are strongly linked to hepatitis B virus (HBV) and hepatitis C virus (HCV). Egypt has the highest prevalence of HCV worldwide and has rising rates of hepatocellular carcinoma (HCC). Egypt's unique nature of liver disease presents questions regarding the distribution of HBV and HCV in the etiology of HCC. Accordingly, a systematic search of MEDLINE, ISI Web of Science, ScienceDirect and World Health Organisation databases was undertaken for relevant articles regarding HBV and HCV prevalence in Egypt among healthy populations and HCC cases. We calculated weighted mean prevalences for HBV and HCV among the populations of interest and examined differences in prevalence by descriptive features, including age, year and geographic region. Prevalences for HBV and HCV were 6.7% and 13.9% among healthy populations, and 25.9% and 78.5% among HCC cases. Adults had higher prevalences of both infections (Adult HBV = 8.0%, Child HBV = 1.6%; Adult HCV = 15.7%, Child HCV = 4.0%). Geographically, HBV was higher in the south, whereas HCV was greater in the north (North HBV = 4.6%, South HBV = 11.7%; North HCV = 15.8%, South HCV = 6.7%). Among HCC cases, HBV significantly decreased over time ( p = 0.001) while HCV did not, suggesting a shift in the relative influences of these viruses in HCC etiology in Egypt. Our results highlight large amounts of heterogeneity among the epidemiological factors associated with liver disease in Egypt and underscore the necessity of an integrated strategy for the successful prevention of viral hepatitis infections and chronic liver disease. © 2008 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61320/1/23937_ftp.pd

Patterns of hepatocellular carcinoma incidence in Egypt from a population-based cancer registry

Hepatocellular carcinoma (HCC) is increasing worldwide, and is frequently attributed to rising rates of hepatitis C virus infection and interactions between viral and environmental risk factors. Because of Egypt's unique risk factor profile, we analyzed data from the Gharbiah Population-Based Cancer Registry for the period 1999–2003 to characterize demographic and geographic patterns of cases in this province. Methods:  We calculated age- and sex-specific and age- and sex-standardized HCC incidence rates for the eight districts in Gharbiah. We also compared rates from Gharbiah with the USA (US Surveillance Epidemiology and End Results [SEER] database). Results:  The analysis revealed a higher incidence in males than in females, significant geographic variations among districts, and a higher incidence in Gharbiah than that reported by SEER. Conclusion:  The findings of this study document the heterogeneous distribution of HCC at regional and international levels. This population-based registry offers the opportunity for careful representative studies of various etiologies, particularly infectious and/or environmental factors that may contribute to risk.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75374/1/j.1872-034X.2007.00299.x.pd

Epidemic hepatitis C virus infection in Egypt: estimates of past incidence and future morbidity and mortality

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75436/1/j.1365-2893.2009.01115.x.pd

Management of hepatitis C virus genotype 4: recommendations of an international expert panel.

HCV has been classified into no fewer than six major genotypes and a series of subtypes. Each HCV genotype is unique with respect to its nucleotide sequence, geographic distribution, and response to therapy. Genotypes 1, 2, and 3 are common throughout North America and Europe. HCV genotype 4 (HCV-4) is common in the Middle East and in Africa, where it is responsible for more than 80% of HCV infections. It has recently spread to several European countries. HCV-4 is considered a major cause of chronic hepatitis, cirrhosis, hepatocellular carcinoma, and liver transplantation in these regions. Although HCV-4 is the cause of approximately 20% of the 170 million cases of chronic hepatitis C in the world, it has not been the subject of widespread research. Therefore, this document, drafted by a panel of international experts, aimed to review current knowledge on the epidemiology, natural history, clinical, histological features, and treatment of HCV-4 infections

A set of reference sequences for the hepatitis C genotypes 4d, 4f, and 4k covering the full open reading frame

Infection with genotype 4 of the Hepatitis C virus is common in Africa and the Mediterranean area, but has also been found at increasing frequencies in injection drug users in Europe and North America. Full length viral sequences to characterize viral diversity and structure have recently become available mostly for subtype 4a, and studies in Egypt and Saudi Arabia, where high proportions of subtype 4a infected patients exist, have begun to establish optimized treatment regimens. However knowledge about other subtype variants of genotype 4 present in less developed African states is lacking. In this study the full coding region from so far poorly characterized variants of HCV genotype 4 was amplified and sequenced using a long range PCR technique. Sequences were analyzed with respect to phylogenetic relationship, possible recombination and prominent sequence characteristics compared to other known HCV strains. We present for the first time two full-length sequences from the HCV genotype 4k, in addition to five strains from HCV genotypes 4d and 4f. Reference sequences for accurate HCV genotyping are required for optimized treatment, and a better knowledge of the global viral sequence diversity is needed to guide vaccines or new drugs effective in the world wide epidemic

Serum Islet Cell Autoantibodies During Interferon α Treatment in Patients With HCV-Genotype 4 Chronic Hepatitis

Chronic hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease worldwide and HCV genotype 4 (HCV4) is predominant in African and Middle Eastern countries. It is well established that interferon-α (IFNa) treatment for HCV may trigger serum autoantibodies against pancreatic islet cells (ICA) in a subgroup of patients. Available data on the incidence of ICA during IFNa therapy for chronic HCV4 infection are not conclusive. We investigated the appearance of ICA in 40 naïve Egyptian patients (38 males, 32 ± 6 years) with histologically defined chronic HCV4 infection undergoing IFNa treatment at a dose of 9-million U/week for 24 weeks. Serum samples were collected at baseline and following IFNa therapy and ICA were detected using indirect immunofluorescence. Baseline evaluation indicated that 2/40 (5%) patients had detectable serum ICA. After the completion of the treatment scheme, 12/38 (32%) previously ICA negative patients became ICA positive; however, no patient developed impaired glucose tolerance (IGT) or diabetes during follow-up. In conclusion, we submit that IFNa treatment for chronic hepatitis C (CHC) may induce serum ICA in one-third of Egyptian patients with HCV4. These autoantibodies, however, do not lead to alterations in glucose metabolism

Studies on the Mechanisms of Pollen Embryogenesis (II) : Effects of Varied Saccharide Concetrations on the Plantlet Formation in Tobacco Anther Culture

1) 葯培養における花粉起源幼植物体の形成に対する糖類の効果を明らかにするために糖の種類及び濃度を変えた培地でタバコ(Nicotiana tabacum L. cv. Bright Yellow, 2n=48)の葯を培養し, 幼植物体の形成を調査した。すなわち, 幼植物体を形成した葯の全培養葯に対する割合を植物体形成率とし, 1葯から形成された植物体数の平均を葯当り形成植物体数とした。さらにこの両者をかけ合わせた値, すなわち, 培養葯1個から期待される植物体数を葯の植物体生産能力として算定した。2) 蔗糖濃度については1/256Mから1/4Mで植物体の形成がみられ, 0M及び1/2Mでは全く認められなかった。植物体形成率については1/8Mが, 葯当り形成植物体数及び葯の植物体生産能力については1/16Mがそれぞれ最適濃度であった。また, 形成された植物体は低濃度区と高濃度区とでその形態が異なる傾向がみられた。3) ブドウ糖及び果糖についても蔗糖と同様に, 1/64Mから1/4Mまで植物体の形成がみられた。いずれの糖も植物体形成率については1/8Mの濃度が, 葯の植物体生産能力については, 1/16Mの濃度がそれぞれ最適であった。1/2Mではいずれの糖の場合も植物体形成がみられなかったので, 糖類濃度の上限が1/4Mから1/2Mの間にあるものと推察される。ブドウ糖は蔗糖とほぼ同等の効果を示したが, 果糖はやや効果が低く, 有効な濃度範囲も狭かった。 / Anthers of tobacco plants (Nicotiana tabacum L. cv. Bright Yellow, 2n=48) were cultured on agar media containing different kinds of saccharides in varied concentrations to elucidate the effects of saccharides on the plantlet formation. A summary of the results obtained is given in the following. 1) The plantlet formation was found in anther cultures on media with sucrose in concentrations varying from 1/256 to 1/4M, but not in those not only on media containing no sucrose but also on media containing it in 1/2M. The most favorable sucrose concentration was 1/8M for 'anther response', which denotes the occurrence frequency of anthers from which plantlets emerged, and 1/16M for 'expected productivity', which denotes the expected number of plantlets emerging from one anther. Morphological differences were observed between relatively low (1/256M, 1/128M, 1/64M and 1/32M) and high (1/8M and 1/4M) sucrose concentrations. 2) In glucose and fructose, the plantlet formation was found in anther cultures on media with these saccharides in concentrations varying from 1/64 to 1/4M, but not on media containing them in 1/2M. The most favorable concentration was 1/8M for 'anther response' and 1/16M for 'expected productivity'. In their effects on the plantlet formation, glucose was similar to sucrose, but fructose was of lower order and had narrower range of effectiveness than the former two saccharides

Association of HCV with diabetes mellitus: an Egyptian case-control study

<p>Abstract</p> <p>Background</p> <p>The highest Hepatitis C Virus (HCV) prevalence in the world occurs in Egypt. Several studies from different parts of the world have found that 13% to 33% of patients with chronic HCV have associated diabetes, mostly type II Diabetes Mellitus (DM). In Egypt the prevalence of DM is 25.4% among HCV patients. Therefore, it is important to identify the magnitude of the problem of diabetes in order to optimize the treatment of chronic hepatitis C.</p> <p>Methods</p> <p>The objective of this case-control study was to evaluate the prevalence of DM and other extrahepatic (EH) manifestations among patients with different HCV morbidity stages including asymptomatic, chronic hepatic and cirrhotic patients. In this study, 289 HCV patients older than 18 were selected as cases. Also, 289 healthy controls were included. Laboratory investigations including Liver Function tests (LFT) and blood glucose level were done. Also serological assays including cryoglobulin profile, rheumatoid factor, antinuclear antibody, HCV-PCR were performed.</p> <p>Results</p> <p>Out of 289 HCV cases, 40 (13.84%) were diabetic. Out of 289 healthy controls, 12 (4.15%) were diabetic. It was found that the diabetic HCV group mean age was [48.1 (± 9.2)]. Males and urbanians represented 72.5% and 85% respectively. Lower level of education was manifested in 52.5% and 87.5% were married. In the nondiabetic HCV group mean age was [40.7 (± 10.4)]. Males and urbanians represented 71.5% and 655% respectively. secondary and higher level of education was attained in 55.4% and 76.7% were married. Comparing between the diabetic HCV group and the non diabetic HCV group, age, residence and alcohol drinking were the only significant factors affecting the incidence of diabetes between the two groups. There was no significant difference regarding sonar findings although cirrhosis was more prevalent among diabetic HCV cases and the fibrosis score was higher in diabetic HCV patients than among the non diabetic HCV cases.</p> <p>Conclusion</p> <p>The diabetic patients in the HCV group were older, more likely to have a history of alcohol drinking than the non diabetic HCV cases. Age and alcohol drinking are factors that could potentially contribute to the development of type 2 diabetes. Logistic regression analyses showed that age and residence in urban regions were the predictive variables that could be associated with the presence of diabetes. Alcohol consumption was not a significant predictive factor.</p