Reconfigurable cable driven parallel mechanism

Due to the fast growth in industry and in order to reduce manufacturing budget, increase the quality of products and increase the accuracy of manufactured products in addition to assure the safety of workers, people relied on mechanisms for such purposes. Recently, cable driven parallel mechanisms (CDPMs) have attracted much attention due to their many advantages over conventional parallel mechanisms, such as the significantly large workspace and the dynamics capacity. In addition, it has lower mass compared to other parallel mechanisms because of its negligible mass cables compared to the rigid links. In many applications it is required that human interact with machines and robots to achieve tasks precisely and accurately. Therefore, a new domain of scientific research has been introduced, that is human robot interaction, where operators can share the same workspace with robots and machines such as cable driven mechanisms. One of the main requirements due to this interaction that robots should respond to human actions in accurate, harmless way. In addition, the trajectory of the end effector is coming now from the operator and it is very essential that the initial trajectory is kept unchanged to perform tasks such assembly, operating or pick and place while avoiding the cables to interfere with each other or collide with the operator. Accordingly, many issues have been raised such as control, vibrations and stability due the contact between human and robot. Also, one of the most important issues is to guarantee collision free space (to avoid collision between cables and operator and to avoid collisions between cables itself). The aim of this research project is to model, design, analysis and implement reconfigurable six degrees of freedom parallel mechanism driven by eight cables. The main contribution of this work will be as follow. First, develop a nonlinear model and solve the forward and inverse kinematics issue of a fully constrained CDPM given that the attachment points on the rails are moving vertically (conventional cable driven mechanisms have fixed attachment points on the rails) while controlling the cable lengths. Second, the new idea of reconfiguration is then used to avoid interference between cables and between cables and operator limbs in real time by moving one cable’s attachment point on the frame to increase the shortest distance between them while keeping the trajectory of the end effector unchanged. Third, the new proposed approach was tested by creating a simulated intended cable-cable and cable-human interference trajectory, hence detecting and avoiding cable-cable and cable-human collision using the proposed real time reconfiguration while maintaining the initial end effector trajectory. Fourth, study the effect of relocating the attachment points on the constant-orientation wrench feasible workspace of the CDPM. En raison de la croissance de la demande de produits personnalisés et de la nécessité de réduire les coûts de fabrication tout en augmentant la qualité des produits et en augmentant la personnalisation des produits fabriqués en plus d'assurer la sécurité des travailleurs, les concepteurs se sont appuyés sur des mécanismes robotiques afin d’atteindre ces objectifs. Récemment, les mécanismes parallèles entraînés par câble (MPEC) ont attiré beaucoup d'attention en raison de leurs nombreux avantages par rapport aux mécanismes parallèles conventionnels, tels que l'espace de travail considérablement grand et la capacité dynamique. De plus, ce mécanisme a une masse plus faible par rapport à d'autres mécanismes parallèles en raison de ses câbles de masse négligeable comparativement aux liens rigides. Dans de nombreuses applications, il est nécessaire que l’humain interagisse avec les machines et les robots pour réaliser des tâches avec précision et rapidité. Par conséquent, un nouveau domaine de recherche scientifique a été introduit, à savoir l'interaction humain-robot, où les opérateurs peuvent partager le même espace de travail avec des robots et des machines telles que les mécanismes entraînés par des câbles. L'une des principales exigences en raison de cette interaction que les robots doivent répondre aux actions humaines d'une manière sécuritaire et collaboratif. En conséquence, de nombreux problèmes ont été soulevés tels que la commande et la stabilité dues au contact physique entre l’humain et le robot. Aussi, l'un des enjeux les plus importants est de garantir un espace sans collision (pour éviter les collisions entre des câbles et un opérateur et éviter les collisions entre les câbles entre eux). Le but de ce projet de recherche est de modéliser, concevoir, analyser et mettre en œuvre un mécanisme parallèle reconfigurable à six degrés de liberté entraîné par huit câbles. La principale contribution de ces travaux de recherche est de développer un modèle non linéaire et résolvez le problème de cinématique direct et inverse d'un CDPM entièrement contraint étant donné que les points d'attache sur les rails se déplacent verticalement (les mécanismes entraînés par des câbles conventionnels ont des points d'attache fixes sur les rails) tout en contrôlant les longueurs des câbles. Dans une deuxième étape, l’idée de la reconfiguration est ensuite utilisée pour éviter les interférences entre les câbles et entre les câbles et les membres d’un opérateur en temps réel en déplaçant un point de fixation du câble sur le cadre pour augmenter la distance la plus courte entre eux tout en gardant la trajectoire de l'effecteur terminal inchangée. Troisièmement, la nouvelle approche proposée a été évaluée et testée en créant une trajectoire d'interférence câble-câble et câble-humain simulée, détectant et évitant ainsi les collisions câble-câble et câble-humain en utilisant la reconfiguration en temps réel proposée tout en conservant la trajectoire effectrice finale. Enfin la dernière étape des travaux de recherche consiste à étudiez l'effet du déplacement des points d'attache sur l'espace de travail réalisable du CDPM

Unconventional TV Detection using Mobile Devices

Recent studies show that the TV viewing experience is changing giving the rise of trends like "multi-screen viewing" and "connected viewers". These trends describe TV viewers that use mobile devices (e.g. tablets and smart phones) while watching TV. In this paper, we exploit the context information available from the ubiquitous mobile devices to detect the presence of TVs and track the media being viewed. Our approach leverages the array of sensors available in modern mobile devices, e.g. cameras and microphones, to detect the location of TV sets, their state (ON or OFF), and the channels they are currently tuned to. We present the feasibility of the proposed sensing technique using our implementation on Android phones with different realistic scenarios. Our results show that in a controlled environment a detection accuracy of 0.978 F-measure could be achieved.Comment: 4 pages, 14 figure

Microfluidic Devices for Neural and Behavioral Screening of C.Elegans using Electric Field

C. elegans is an invaluable model for studying human diseases, from understanding disease pathology to screening for chemicals toxicity and therapeutic effects. However, technological deficiencies in achieving automated, fast, simple, and low-cost C. elegans-based screening assays have hindered the widespread use of this organism in the gene screening, toxicology and chemical screening areas. Various microfluidics and lab-on-a-chip systems have been reported for precise control and quantification of different sensory-motor processes of C. elegans such as electrotaxis, i.e., response to the electric field (EF) by swimming towards the negative electrode in a polarized system like a microchannel. The current electrotaxis microfluidic devices have a large footprint, low-throughput, and are slow due to their dependency on gait behaviours in terms of speed, body bend frequency, and reorientation. On-chip neuronal imaging has not been incorporated for the correlation of electrotaxis deficiency with neurodegeneration. Moreover, up until now, most of the electrotaxis assays have been conducted by exposing the entire worm to EF and were limited to gait behaviours, giving less attention to understanding C. elegans electrosensation and behaviours other than electrotaxis. Therefore, this thesis aimed to enhance our understanding of C. elegans electrosensation and the effects of EF on different phenotypes using microfluidic devices with enhanced behavioral throughputs. In Objective 1 of the thesis, we increased the number of worms that could be electrotactically tested and fluorescently imaged simultaneously, achieving a behavioral throughput of at least 9 worms every 5 minutes, which has not been achieved previously for electrically induced behavioral assays even with automated systems. In Objective 2, the electrotaxis response of semi-mobile worms was introduced to provide an assay inside a more confined area and study whether selective exposure of the worms head or tail to EF results in a directional electrotaxis. Interestingly, the results indicated the involvement of the vulva neurons in electrotaxis, which implied that the head neurons are not solely responsible for electrotaxis. Since vulva neurons showed involvement in C. elegans electrosensation, in Objective 3, we introduced, for the first time, a novel on-demand EF-evoked behaviour, termed electric egg-laying, in a simple to use microfluidic device that enabled trapping and exposure of individual worms to controlled EF conditions. Interestingly, we found that egg-laying is EF polarity dependent with a significant increase in the egg-count for anode-facing worms. Lastly, in Objective 4, we enhanced the behavioral throughput of our electric egg-laying assay while allowing on-chip fluorescent imaging and showed the technique's effectiveness for toxicity assessment. As a proof of concept, we used genetically and chemically induced models of Parkinson's disease as well as microplastics toxicity for showing the applicability of our techniques for behavioural and neuronal screening. A significant advantage offered by our devices was their ability to keep the identity of a worm known throughout an assay, which enabled correlating the chemical uptake heterogeneity with neuron degeneration and behavioral outputs at a single-worm resolution. It is anticipated that these microfluidic devices will play a major role in facilitating a fundamental understanding of C. elegans electrosensation, disease investigations, and chemical screening and toxicity assays

Utilization of Arabic Calligraphy to Promote the Arabic Identity in Packaging Designs

Letters are considered an important element in graphic design. Arabic calligraphy, specifically, is an important art that give letters aesthetic form. Arabic letters are used in many different ways to form words. These words are then used in typography giving information and communicating with consumers. In Arabic packaging designs, Arabic letters are not yet utilized to give the cultural identity to the brand and graphic design of the Arabic products in general. This paper focuses at using Arabic letters and digital calligraphy to enhance packaging identity of Arabian products. Keywords: Arabic calligraphy, typography, lettering, identity, digital calligraphy, packaging desig

An Autonomous Wearable Sensor Node for Long-Term Healthcare Monitoring Powered by a Photovoltaic Energy Harvesting System

oai:ojs.ijet.ise.pw.edu.pl:article/2503In this paper, an autonomous wearable sensor node is developed for long-term continuous healthcare monitoring. This node is used to monitor the body temperature and heart rate of a human through a mobile application. Thus, it includes a temperature sensor, a heart pulse sensor, a low-power microcontroller, and a Bluetooth low energy (BLE) module. The power supply of the node is a lithium-ion rechargeable battery, but this battery has a limited lifetime. Therefore, a photovoltaic (PV) energy harvesting system is proposed to prolong the battery lifetime of the sensor node. The PV energy harvesting system consists of a flexible photovoltaic panel, and a charging controller. This PV energy harvesting system is practically tested outdoor under lighting intensity of 1000 W/m2. Experimentally, the overall power consumption of the node is 4.97 mW and its lifetime about 246 hours in active-sleep mode. Finally, the experimental results demonstrate long-term and sustainable operation for the wearable sensor node

Autonomic Dysfunction Predicts Early Cardiac Affection in Patients with Systemic Sclerosis

Objective: To detect the early preclinical alterations in cardiac autonomic control as well as altered cardiac function in systemic sclerosis (SSc) patients and their relevance to the clinical features of the disease using noninvasive methods. Methods: 30 SSc patients and 15 healthy controls matched for age and sex underwent clinical examination, serological analysis, and echocardiographic assessment including Doppler flow imaging to evaluate cardiac function, and 24-hour Holter monitoring analyzed for arrhythmia and heart rate variability (HRV) in the time and frequency domains. Results: The trans-mitral Doppler of early to atrial wave (E/A) ratio was reversed in five patients (16.6%) and the tricuspid E/A ratio was reversed in 10 patients (33.3%). Holter analysis for SSc patients revealed an increased prevalence of premature ventricular contractions (PVC) $ 10/h (P = 0.02), supra-ventricular tachycardias (SVTs) (P = 0.2), and total PVC count (P = 0.0000). Highly significant (P = 0.000) impairment in all HRV parameters was demonstrated in the SSc patients. Total skin thickness score (TSS), Raynaud’s phenomenon and anti-scleroderma 70 (anti-SCL70) showed significant positive correlations with all arrhythmia parameters, while showing a significant negative correlation with the impaired ventricular diastolic function and various HRV parameters. No correlation was found between arrhythmia and HRV parameters and disease duration, disease type, or presence of anti-centromere antibodies. Conclusion: Low heart rate variability, increased TSS and the presence of anti-SCL70 are correlated with preclinical cardiac involvement in SSc patients and may predict the likelihood of malignant arrhythmia and sudden cardiac death. Therefore, noninvasive HRV evaluation before clinical cardiac involvement in these patients might be beneficial when added to the clinical and laboratory assessments in detecting high-risk patients, and may allow for implementation of preventive measures and initiation of appropriate therapy early in the course of the disease

Prospective Study of Prevalence and Risk Factors for Hepatitis C in Pregnant Egyptian Women and Its Transmission to Their Infants

Aim To estimate the hepatitis C virus (HCV) vertical transmission rate, the effect of potential risk factors, and the pattern of HCV antibody response and viremia in HCV-infected infants in Benha, Egypt. Methods A total of 1224 pregnant women who were treated at Benha University Hospital, Egypt, were included in the study. They completed a questionnaire about risk factors for HCV acquisition and suspected risk factors for mother-to-infant transmission and were tested for HCV antibody using a third-generation ELISA test. Women positive for HCV antibody were tested for HCV RNA by polymerase chain reaction. Peripheral blood of infants of positive HCV-RNA women was tested for HCV antibody and HCV-RNA at 1 and after 6 months of age. Results Out of 1224 pregnant women, 105 (8.6%; 95% confidence interval, 7.05-10.17) were positive for HCV antibody. Only 83 (6.8%; 5.39-7.21) were positive for HCV-RNA. HCV infection was associated with older age (1.16; 1.1-1.2, P = 0.001), blood transfusion (2.69; 1.2-6.0, P = 0.016), and HCV infection of the husband (5.47; 1.4-21, P = 0.014) or other household members (2.29; 1.2-4.6, P = 0.019). Out of 53 infants tested at first month, 43 (81%; 71-92%) were positive for HCV antibody, but only 7 (13%; 4.1-22%) were positive for HCV-RNA. After 6 months, only 2 (3.8%; 0-8.95%) remained positive for HCV RNA. Conclusions The prevalence of HCV in pregnant women in Egypt is lower than previously reported and the potential risk factors associated with HCV infection suggest intra-familial transmission. The frequency of vertical transmission of HCV in Egypt is not substantially different from other countries and does not play a role in the high prevalence of HCV in Egypt. CLINICAL SCIENCES doi: 10.3325/cmj.2010.51.219 CLINICAL SCIENCE 220 Croat Med J. 2010; 51: 219-28 www.cmj.hr Worldwide, hepatitis C virus (HCV) infection is one of the most prevalent causes of liver diseases. There are estimated 300 million carriers of the virus all over the world (1). In the USA, the overall prevalence of HCV antibodies in the general population is 1.8%, the prevalence in children 6-11 years is 0.2%, and in adolescents 12-19 years old is 0.4% (2). In most developed countries, HCV infection is associated with percutaneous blood exposure, primarily as a result of blood transfusion and intravenous drug addiction (3). Egypt has the highest prevalence of hepatitis C in the world. Studies have found widely varying levels (10-50%) of the prevalence, depending on the populations covered; overall, estimates of the HCV rate in the general population range between 10 and 20% (4,5). Geographically, hepatitis C prevalence is higher in Lower Egypt (Nile delta) than Upper Egypt, and it is lower in urban than rural areas (6). In Egypt, the use of contaminated needles and syringes during mass schistosomiasis treatment campaigns during the period the 1960s-1980s has been identified as a key mode of transmission for HCV infection, suggesting that parenteral exposure continues to cause infections (7). Evidence of high interfamilial HCV transmission was found in a study in a rural community in the Nile Delta in the 1990s (5-8), although the exact modes of transmission were not identified. Vertical transmission may help to explain the high prevalence in Egypt. This type of transmission in France is estimated to be less than 6% in HIV-negative patients (9). Indeed, a review of 13 studies on vertical transmission of HCV showed that the overall rate was 5.2% (10). However, a brief report from Egypt showed that vertical transmission of HCV was 36% (11), but this study looked at a small sample of 19 out of 100 pregnant women positive for HCV antibody, and only 14 of them were positive for HCV RNA. The sample of Kassem et al (11) comprised 100 randomly selected HIV-negative pregnant women and was too small for a valid estimation of the proportion of vertical transmission. It also used a limited definition of vertical transmission, defining it as the presence of HCV RNA in cord blood, and it did not repeat the polymerase chain reaction (PCR) test for HCV-RNA for infants after 6 months. The aim of the present article was to perform a more extensive study to estimate the HCV vertical transmission rate, the effect of potential risk factors, and the pattern of HCV antibody response and viremia in HCV-infected infants in Benha, Egypt. MetHodS Site The study was conducted in Benha, the capital of Qualyabia governorate, a small city 35 km north of Cairo. It is a semi-urban area with irrigated farmlands and surrounded by canals, a feature typical of the Nile delta. It has the characteristics typical of a Lower Egyptian community: a mixture of urban and rural areas, with significant influence of Egyptian traditions and attitudes. Benha University Hospital is one of the largest hospitals in Benha city. This hospital accepts patients from Benha city and the rural areas from Menufia and Sharkia governorates nearby (village households, inhabited mainly by farmers and their families). Most of the community studies on HCV in Nile delta have been conducted in Qualyabia and Menoufia. Study design and population This prospective study was conducted in two stages: the first stage was a cross-sectional study to identify the prevalence of HCV among pregnant women and the second stage was a longitudinal study of the infants of infected women to identify the rate of vertical transmission. The study population included all pregnant women who were admitted at the obstetric emergency department at Benha University Hospital (Benha, Egypt) for delivery between October 2003 and July 2008. The women who gave birth more than once during the study period were not included in the study. We did not test for HIV, which is exceedingly rare in rural Egyptian communities. The study protocol was approved by the clinical research committee of Benha University Hospital, the Institutional Review Board of the Egyptian Ministry of Health and Population, and the National Hepatology and Tropical Medicine Research Institute (Cairo). Patients were asked to sign a written consent for the study. data collection After signing the consent form, the authors conducted interviews with the women using a standardized questionnaire designed by a team of sociologists, epidemiologists, and clinicians familiar with the risk factors for HCV acquisition and suspected risk factors for mother-to-infant transmission of HCV (older age, history of blood transfusion, duration of marriage, parity of more than two, husband and other household members positive for HCV). This ques- tionnaire assessed sociodemographic characteristics, present and past health, and potential risk factors for exposure to HCV and mother-to-infant transmission of HCV. The address and phone number of the patients and the name and phone number of close relatives were taken to facilitate follow-up and decrease patient loss during the study. Specimen collection and serological testing of pregnant women. After the questionnaire was filled out, blood samples (10 mL) were taken from the pregnant women and sent to the laboratory. Serum alanine transaminase level (ALT) was assessed within 6 hours of sampling using ALT FLEX TM , AR model of the DIMENSION TM system (Dade Behring Inc., Newark, DE, USA). When ALT was found to be elevated, additional tests were performed to exclude metabolic and viral liver disease other than hepatitis C. The serum was separated and aliquoted into 3 cryotubes, one aliquot was sent in an ice bag to the HCV Reference Laboratory at the National Hepatology and Tropical Medicine Research Institute (Cairo), where the serum was tested for HCV antibodies using a third-generation ELISA test (Axsym System HCV, version 3.0, Abbott Diagnostics Division; Wiesbaden, Germany) as recommended by the manufacturer. The other two aliquots were stored in -70°C freezers to be tested later if needed. Infected pregnant women were identified by testing serum for the presence of HCV antibody. Serological samples that were positive for HCV antibody were tested for the presence of HCV-RNA using a procedure of whole-serum amplification of DNA based on an in-house reverse transcription-nested polymerase chain reaction (RT-PCR). Pregnant women were considered infected only if both the HCV antibody and HCV-RNA tests were positive. Serological testing of infants and classification of results Infected patients who tested positive were called back to get a peripheral blood sample from their infants. HCV antibody testing was done first on the infants and then positive HCV antibody samples were tested for HCV-RNA. Infants were considered uninfected if they had never been positive for HCV RNA or if they cleared anti-HCV antibodies after 6 months of age. Infants were considered to have perinatal mother-to-infant transmission if they were HCV-RNA positive at any time following birth or showed anti-HCV antibodies after 6 months of age. They were considered to have transient perinatal HCV infection if they were positive for HCV RNA at the 6-month visit, but negative for both anti-HCV and HCV-RNA after the 6-month visit. The children continuing to have HCV-RNA after the 6-month visit were considered to have persistent perinatal HCV infections. Anti-HCV antibodies detected in the blood of children whose mothers tested positive for anti-HCV antibodies 2-6 months after delivery were considered to be maternally acquired (12). PCR-based detection of HCV-RNA The protocol was based on a previously published procedure (13) modified to increase the sensitivity of the assay. HCV RNA was detected by PCR (HCV AMPLICOR TM , Roche Diagnostic systems, Inc., Branchburg, NJ, USA) and quantified by the branched DNA signal amplification test (b-DNA) (Quantiplex TM HCV RNA 2.0, Chiron diagnostics, Emeryville, CA, USA). Samples were prepared as a 3:10 dilution using 3 µL of serum and 7 µL of phosphate buffered saline in thin-walled PCR tubes. Tubes were incubated at 95°C for 4 minutes and chilled on ice for 10 minutes, prior to the addition of RT-PCR master mix (Promega, Madison, WI, USA). RT-PCR reactions were carried out in a total volume of 100 µL containing 1X Taq buffer with 1.5 mM MgCl 2 , 0.2 mM dNTPs (Promega), 20 pmol each of primer 1 (PSEA-HCV-1, 5′ HEX-AAG GAC CCG GTC GTC CT 3'; Sigma-Genosys, Woodlands, TX, USA) and primer 2 (PSEA-HCV-2, 5' FAM-TAT CCA AGA AAG GAC CCA 3'; Sigma-Genosys), 20 units of ribonuclease inhibitor (RNasin; Promega), 10 units of MV Reverse Transcriptase (RT; Promega), and 2.5 units of Taq DNA polymerase (Roche Diagnostic Systems). Master mix (90 µL) (Promega) was added to each sample and the mixture was incubated at 42°C for 30 minutes and at 95°C for 4 minutes followed immediately by 35 cycles at the following conditions: 94°C for 1 minute, 50°C for 1 minute, 72°C for 1 minute, and a final cycle of 72°C for 10 minutes. The second PCR, using the inner primer 3 (PSEA-HCV-3, 5' FAM-CAA CAC TAC TCG GCT AGT 3'; Sigma-Genosys) and primer 4 (PSEA-HCV-4, 5' HEX-CAT GGC GTT AGT ATG AGT GTT 3'; Sigma-Genosys), was performed by transferring 10 µL from the initial reaction to 90 µL of master mix (1X Taq buffer, 0.2 mM dNTPs, 20 pmol of each nested primer, and 2.5 units of Taq polymerase). The samples were incubated for 35 cycles as in step 2 without the RT step. The PCR products were analyzed on 3% agarose in 0.5X TBE buffer. The primers were derived from the highly conserved 5'-untranslated region of the HCV genome to allow nested amplification of a 237-base pair product. Negative samples were retested for PCR after RNA extraction using the QIAamp Viral RNA kit (catalog No. 52906, Qiagen, Hilden, Germany). The sensitivity of the assay was 50 IU/mL according to the manufacturer's information. Despite CLINICAL SCIENCE 222 Croat Med J. 2010; 51: 219-28 www.cmj.hr its greater sensitivity, an in-house nested RT-PCR invites problems with contamination and should be used with extreme care in the clinical setting. Statistical analysis The sample size for this study was calculated according to the primary aim (assess the prevalence of HCV among pregnant women). Demographic and laboratory data were compared for the infected pregnant women with non-infected group using χ 2 and Fischer exact tests for categorical or dichotomous variables, and the unpaired independent t-test for continuous variables. Differences were considered significant for P values of 0.05 or less. Significant parameters were included in a multivariate logistic regression analysis to identify independent predictors of HCV positivity among pregnant women, and the odds ratio was calculated for each significant parameter. Rate of vertical transmission was calculated based on the frequencies of HCV-RNA PCR positivity in mothers and their infants. ReSultS Design and follow up are shown in Out of the 83 infected mothers, samples of only 47 mothers and 53 children (6 mothers delivered twins) were available. Of these 83 infected mothers, 3 (3.5%) mothers had still births, 27 (33%) were lost to follow-up, 6 (7%) withdrew consent, and 6 (7%) had twins. Out of the 53 infants tested in the first month of life, 43 (81%) were positive for HCV antibodies, and 10 (19%) were negative. The latter group was considered as non-infected infants without maternally-acquired antibodies. Of the 43 infants positive for HCV antibodies, only 7 (13%) were found positive for HCV-RNA by PCR; these were considered to be HCV-infected infants. HCV-RNA was not detected in 36 of 43 (87%) of infants born to HCV-RNA positive mothers; this group was considered as non-infected infants with maternally-acquired antibodies. At 6 months of age, 6 children who had been found positive for HCV-RNA by PCR were examined again; one mother withdrew consent for her children. Only two of the 53 (3.8%) remained positive for HCV-RNA; this pair was considered to show persistent HCV infection. The other 4 infants (7.6%) cleared their HCV-RNA and sero-reverted to become negative for HCV antibodies; this group was considered to show clearance of perinatal HCV infection. Patients lost to follow-up did not show significant demographic differences in comparison with patients who continued to participate. Loss of follow-up in infants who were tested during the first month was not high (14.2%). dISCuSSIoN Our study showed that the risk factors for HCV infection among pregnant women in an Egypt regions were older age, HCV-positive husband, administration of blood transfusion, and HCV-positive other member of the household members. Egypt is considered one of the countries with the highest prevalence of HCV in the world (5), and a country with a high prevalence among children. There some reports claim that vertical transmission is higher in Egypt than in other countries (11), although these studies show some limitations in sample size and diagnostic method for determining vertical transmission. In the present study, we aimed to assess the prevalence and risk factors of HCV among pregnant women in a small city in the Nile Delta, Egypt. We also sought to determine whether vertical transmission plays a major role in HCV endemicity in Egypt. Prevalence of HCV among pregnant women We found the prevalence of pregnant women positive for HCV-RNA to be 6.8%. This study included women ranging in age from 16 to 45 years, with a mean age of 25.3. The prevalence in this age group was lower than reported in Egypt before: 37.5% among those older than 30 years, with a marked increase among those in their thirties and forties, and a peak of over 60% among those in their sixties (5). Our lower prevalence may be explained by a cohort phenomenon among patients treated by parenteral anti-schistosoma therapy (PAT) in Egypt from 1960s-1980s. Our study group contained a smaller proportion of PAT-treated cohort than did the studies conducted more than 10 years ago, which may explain the lower prevalence of HCV. Our study also found a slightly higher rate of infection among women living in rural areas than in urban areas, though this difference was not significant. As reported by Frank et al (7), higher infection rates among older women and rural residents may be partially explained by the differential exposure of these groups to schistosomiasis campaigns in Egypt, and the use of contaminated needles or syringes during treatment campaigns, suggesting that parenteral exposure continues to be a major transmission route for HCV infection in Egypt Evidence suggests that our data indeed reflect a decrease in HCV prevalence. Our patients came from the same areas as in the studies reporting higher prevalence of HCV (5). In addition, other studies published recently have shown a decrease in HCV prevalence in Egypt (14). Although the prevalence of HCV in Egypt appears to have decreased, our prevalence of 6.8% is still higher than in other countries such as the USA (3.2%), Taiwan (1.5%), Zaire (6%), and Saudi Arabia (0.6%) (2,15,16). Risk factors for this high prevalence should be studied, especially the avoidable ones. Risk factors for HCV infection Although in this study there were many factors associated with HCV infection in univariate analysis, multivariate analysis found only 4 independent risk factors. Old age was the first independent factor, which suggests the same cohort phenomenon described above and the cumulative effect of exposure to HCV due to the long period of viral exposure over one's lifetime, as well as exposure to other potential HCV risk factors. Our results are in agreement with Costa et al Further independent risk factors were having a husband or another household member positive for HCV. This association suggests that the significance of intrafamilial transmission of HCV is comparable with that of sexual transmission. Intra-familial transmission of HCV has also been reported by Mohamed et al (8). Another risk factor was blood transfusion. Several patients in our group had received blood transfusions before blood donors in Egypt underwent routine screening for HCV. These patients also had other risk factors, like hospitalization and major operations. Although blood transfusion is now considered a less important risk factor, it should be considered carefully, especially in a country with such a high prevalence of the disease. Our results are in agreement with those of Sangha et al We did not test for other hepatitis viruses or for HIV, which is exceedingly rare in rural Egyptian communities. A UN-AIDS/WHO report from 2008 (20) estimated that HIV/AIDS was present in 9000 Egyptians, predominately men with high risk behaviors, who account for less than 0.1% of the total population. No HIV-positive pregnant women were reported during sentinel site surveillance outside of ''major urban areas'' from 1992 to 1996 and in 2004. Mother-to-infant transmission for HCV We found that only 13% of the 43 infants who were positive for HCV antibodies in the first month of life were also positive for HCV-RNA. We considered this group as HCVinfected infants. This result is compatible with previous studies, which have found that most infants born to HCVpositive mothers have HCV antibodies in their blood and that we cannot use the presence of these antibodies to diagnose vertical transmission until after 18 months (21). Although 43 of 53 (81%) infants had HCV antibodies in the first month of life, only 7 (13%) were positive for HCV-RNA at the same time. At 6 months of life, only 2 (3.8%) were positive for HCV-RNA, indicating persistent HCV infection, while the other 4 infants had cleared their HCV-RNA indicating clearance of perinatal HCV infection. A similar figure for vertical transmission of HCV (4.6%) was reported recently from Egypt at one year of age (12). These results show that a large proportion of infants were only temporarily positive for HCV-RNA during the first weeks of life and the PCR test should be repeated again at 6 months of life. Studies that do not test infants when they are older may lead to overestimates of HCV prevalence and this may be the case with community-based study of perina- Frequent clearances of perinatal HCV infection may explain the previous reports of a high incidence of vertical transmission in Egypt. These reports have relied on cord blood samples or PCR results taken only once within a few weeks after delivery (11). Together with previous studies, the present study confirms that the incidence of vertical transmission of HCV in Egypt is similar to that in other parts of the world, where it varies from 4.5% to 6.0% Our definition of perinatal transmission of HCV was that infants had to be positive for both anti-HCV antibodies and HCV RNA. HCV-RNA was not detected in 36 of 43 (87%) of infants born to HCV-RNA positive mothers; this group was considered as non-infected infants with maternallyacquired antibodies. Only 2 of the 53 infants (3.8%) remained positive for HCV-RNA; this pair was considered to show persistent HCV infection. The other 4 infants (7.6%) cleared their HCV-RNA and sero-reverted to become negative for HCV antibodies; this group was considered to show clearance of perinatal HCV infection. Consistent with our approach, the European Pediatric HCV Network (EPHN) criterion for perinatal transmission of HCV in their multicenter trial of 1787 mother-child pairs was two or more positive HCV-RNA PCR test results and/or anti-HCV antibody positivity after 18 months of age We suggest that a higher proportion of infants born to HCV-infected mothers have infections and then clear their infections than is generally reported. In our study, this proportion was 13.2% in infants whose mothers were HCV-RNA positive, but it may have been greater if we had sampled the infants earlie

Prospective Study of Prevalence and Risk Factors for Hepatitis C in Pregnant Egyptian Women and Its Transmission to Their Infants

Aim To estimate the hepatitis C virus (HCV) vertical transmission rate, the effect of potential risk factors, and the pattern of HCV antibody response and viremia in HCV-infected infants in Benha, Egypt. Methods A total of 1224 pregnant women who were treated at Benha University Hospital, Egypt, were included in the study. They completed a questionnaire about risk factors for HCV acquisition and suspected risk factors for mother-to-infant transmission and were tested for HCV antibody using a third-generation ELISA test. Women positive for HCV antibody were tested for HCV RNA by polymerase chain reaction. Peripheral blood of infants of positive HCVRNA women was tested for HCV antibody and HCV-RNA at 1 and after 6 months of age. Results Out of 1224 pregnant women, 105 (8.6%; 95% confidence interval, 7.05-10.17) were positive for HCV antibody. Only 83 (6.8%; 5.39-7.21) were positive for HCV-RNA. HCV infection was associated with older age (1.16; 1.1-1.2, P = 0.001), blood transfusion (2.69; 1.2-6.0, P = 0.016), and HCV infection of the husband (5.47; 1.4-21, P = 0.014) or other household members (2.29; 1.2-4.6, P = 0.019). Out of 53 infants tested at first month, 43 (81%; 71-92%) were positive for HCV antibody, but only 7 (13%; 4.1-22%) were positive for HCV-RNA. After 6 months, only 2 (3.8%; 0-8.95%) remained positive for HCV RNA. Conclusions The prevalence of HCV in pregnant women in Egypt is lower than previously reported and the potential risk factors associated with HCV infection suggest intra- familial transmission. The frequency of vertical transmission of HCV in Egypt is not substantially different from other countries and does not play a role in the high prevalence of HCV in Egypt