RESUMO
BACKGROUND: Hepatitis C Virus (HCV) continues to be a burden to the Egyptian population and its economy. Despite all efforts, the prevalence of infection continues to be one of the highest in the world. The high national prevalence has been attributed to unintentional, nosocomial spread during an anti-schistosomiasis campaign conducted in the 1970's, but that does not fully explain the persistent infection rates. Work is needed to further clarify risk associations. A serosurvey was performed in Manshiet Nasser, a slum in Cairo sometimes referred to as Mokattem Hills where a primary occupation is garbage collection and sorting, to characterize potential risk factors for infection. METHODS: Following a detailed mapping and census of the area, a cluster sampling was performed and demographic and risk behavior data and a blood sample were collected from subjects older than 6 months. Blood samples were tested using 4th generation anti-HCV EIA kit. RESULTS: The slum was estimated to house 45,000 residents. Blood samples were obtained from 2169 subjects. The age adjusted anti-HCV seroprevalence was 9.1 %. Participants with HCV antibodies were more likely to be male, heads of households, subjects without formal education, and those with a lower standard of living. After adjustment of all prevalence ratios (aPR) for age, the following risk factors were significantly associated with higher risk of HCV infection: Garbage collection (aPR 1.5), history of blood transfusion (aPR 2.0), tattooing (aPR 1.4), history of schistosomiasis (aPR 1.5), and use of traditional latrines (aPR 2.0) or pits for sanitation (aPR 1.3). The results of the multivariate analysis indicated that age (p < 0.01), history of schistosomiasis (p < 0.05), garbage sorting (p = 0.05), blood transfusions (<0.001), and the use of traditional latrines for sanitation (p < 0.01) were significantly associated with infection. CONCLUSION: While HCV prevalence among those over 30 could be attributed to anti-schistosomiasis injections, the prevalence in younger age indicates ongoing transmission. Although specific behavioral risks were not identified, HCV infection appears to be an occupational hazard of garbage collection and sorting in this environment. Given the large reservoir of HCV infection in the population, further effort needs to be made to identify and mitigate new infections.
RESUMO
Asthma is a chronic inflammatory disease of the lung. Although it is multifactorial in origin, the inflammatory process is believed to be a result of inappropriate immune responses to common aeroallergens in genetically susceptible individuals. As such, it has been reported that Th2 cytokines play a pivotal role in the pathogenesis of disease. The aim of this study was to evaluate the role of IL-13 in the pathogenesis of bronchial asthma. The study was carried out on 71 subjects out of which 54 were asthmatic patients and 17 were normal controls. Patients with bronchial asthma were further classified according to the National Asthma Education and Prevention Program (NAEPP) into 4 groups: intermittent, mild persistent, moderate persistent and severe persistent. IL-13 serum levels were estimated in patients and controls by ELISA. Asthmatic patients showed a statistical significant elevation of serum IL-13 levels (mean = 78.5 +/- 64.5 pg/ml) as compared to controls (mean = 51.8 +/- 24.9 pg/ml). When patients with different degrees of severity were compared, a significant increase in serum IL-13 was found in patients with intermittent asthma (mean = 106 +/- 105 pg/ml) as compared to those with mild (mean = 63.6 +/- 14.7 pg/ml) and severe persistent asthma (mean = 64.9 +/- 29.1 pg/ml). Only patients with intermittent asthma showed a highly significant increase in serum IL-13 than controls. No statistically significant difference was found between patients not on steroids, patients on inhaled steroids and those on systemic steroids. A statistically significant increase in IL-13 serum levels was observed in patients not on steroids compared to normal controls. A significant increase in blood eosinophil counts was found in patients during acute asthmatic attacks as compared to those who were stable. In conclusion, IL-13 is a key cytokine with critical role in the immunopathogenesis of bronchial asthma. Steroids can downregulate IL-13, but inhaled steroids alone might not be able to abolish the airway remodeling process in asthmatics. Although patients with intermittent asthma are asymptomatic in between exacerbations, inflammation and remodeling are ongoing in their lungs.