The present and future disease burden of hepatitis C virus infections with today's treatment paradigm: Volume 4.

Factors influencing the morbidity and mortality associated with viremic hepatitis C virus (HCV) infection change over time and place, making it difficult to compare reported estimates. Models were developed for 17 countries (Bahrain, Bulgaria, Cameroon, Colombia, Croatia, Dominican Republic, Ethiopia, Ghana, Hong Kong, Jordan, Kazakhstan, Malaysia, Morocco, Nigeria, Qatar and Taiwan) to quantify and characterize the viremic population as well as forecast the changes in the infected population and the corresponding disease burden from 2015 to 2030. Model inputs were agreed upon through expert consensus, and a standardized methodology was followed to allow for comparison across countries. The viremic prevalence is expected to remain constant or decline in all but four countries (Ethiopia, Ghana, Jordan and Oman); however, HCV-related morbidity and mortality will increase in all countries except Qatar and Taiwan. In Qatar, the high-treatment rate will contribute to a reduction in total cases and HCV-related morbidity by 2030. In the remaining countries, however, the current treatment paradigm will be insufficient to achieve large reductions in HCV-related morbidity and mortality.

Chronic administration of minoxidil protects elastic fibers and stimulates their neosynthesis with improvement of the aorta mechanics in mice.

Arterial wall elastic fibers, made of 90% elastin, are arranged into elastic lamellae which are responsible for the resilience and elastic properties of the large arteries (aorta and its proximal branches). Elastin is synthesized only in early life and adolescence mainly by the vascular smooth muscles cells (VSMC) through the cross-linking of its soluble precursor, tropoelastin. In normal aging, the elastic fibers become fragmented and the mechanical load is transferred to collagen fibers, which are 100-1000 times stiffer than elastic fibers. Minoxidil, an ATP-dependent K+ channel opener, has been shown to stimulate elastin expression in vitro, and in vivo in the aorta of male aged mice and young adult hypertensive rats. Here, we have studied the effect of a 3-month chronic oral treatment with minoxidil (120 mg/L in drinking water) on the abdominal aorta structure and function in adult (6-month-old) and aged (24-month-old) male and female mice. Our results show that minoxidil treatment preserves elastic lamellae integrity at both ages, which is accompanied by the formation of newly synthesized elastic fibers in aged mice. This leads to a generally decreased pulse pressure and a significant improvement of the arterial biomechanical properties in female mice, which present an increased distensibility and a decreased rigidity of the aorta. Our studies show that minoxidil treatment reversed some of the major adverse effects of arterial aging in mice and could be an interesting anti-arterial aging agent, also potentially usable for female-targeted therapies.

Impact of hepatitis C virus infection on schistosomal liver disease.

BACKGROUND/AIMS: This study was conducted to determine whether Hepatitis C virus infection has a role in patients with schistosomal liver disease. METHODOLOGY: Sixty patients with hepatosplenic schistosomiasis and evidence of portal hypertension were seen at the Armed Forces Hospital Riyadh, Saudi Arabia over 5 years. The impact of Hepatitis C virus infection on chronic schistosomal liver disease was studied in 30 of these patients (group one) who were Hepatitis C virus positive and compared with the other 30 patients (group two) who were Hepatitis C virus negative (control group). RESULTS: Hepatitis C virus may be an important factor contributing to deterioration of liver function for patients with hepatosplenic schistosomiasis. Liver functions showed elevated ALT in 83.3% in group one compared to 23.4% in group two. Liver biopsy in 19 patients (group one) and 16 patients (group two) showed evidence of schistosomiasis and in patients of group one, liver biopsy also showed chronic active hepatitis together with Schistosoma in 57.9%, and cirrhosis in 31.6%. None of group two patients had cirrhosis. Alpha-fetoprotein levels were elevated in 16 patients (group one) and 3 of these patients had hepatocellular carcinoma. None of the control group had radiological or histological evidence of hepatocellular carcinoma. CONCLUSION: The mean age of HCV positive patients was less than the HCV negative patients, which may indicate that Hepatitis C virus infection leads to decompensation of liver function earlier in patients with Schistosoma and severe liver disease may be promoted at a younger age in Schistosoma patients with hepatitis C.

Endoscopic management for bleeding esophageal varices: sclerotherapy versus sclerotherapy plus band ligation versus band ligation alone. One year experience at a main hospital in Saudi Arabia.

BACKGROUND/AIMS: This study was done retrospectively to compare the outcome of sclerotherapy alone, band ligation alone and band ligation alternating with sclerotherapy in treatment of esophageal varices. METHODOLOGY: During 1 year 30 patients were admitted with variceal bleeding. They received either injection sclerotherapy (8 patients) or band ligation (11 patients), and 11 patients had a combination of both either during first bleed or during follow-up therapy, which is more than 2 sessions in each group. RESULTS: The success rate for stopping first bleeding was 100% in the band ligation and sclerotherapy alone group. The rebleeding rate was 27% in the combination group, 9% in the band ligation group, and none had rebleeding in the sclerotherapy group during follow-up. Eradication of varices was observed in 33% of patients after a second set of sclerotherapy and band ligation. CONCLUSIONS: Our study showed no significant difference between sclerotherapy versus band ligation in stopping initial bleeding or eradication of varices during the follow-up period, but there was a difference in re-bleeding rates among the three groups.

Upper gastrointestinal endoscopy findings at Riyadh Armed Forces Hospital.

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Hemophagocytic syndrome.

This case report is about an elderly man who presented with a long-standing history of high-grade fever and weight loss. He initially had only hepatosplenomegaly, but then developed jaundice. He also had pancytopenia and raised liver enzymes. His septic screen was negative, but he had a positive Monospot test and immunoglobulin G for Epstein-Barr virus. The liver biopsy showed sinusoidal phagocytosis and the subsequent bone marrow aspiration and biopsy showed significant hemophagocytosis, hence Hemophagocytic syndrome was diagnosed. The fever was refractory to antibiotic and anti-tuberculosis therapy, but it responded only partially to steroids. Full response was only noticed following anti-viral treatment in the form of intravenous Ganciclovir. The patient's general condition, liver enzymes, bilirubin, hematological parameters and even the weight returned back to their normal range 2 weeks after Ganciclovir therapy. Cessation of this drug resulted in relapse of his symptoms and oral antivirals did not help. Splenectomy, steroid pulse therapy and immunosuppressive treatment were only partially helpful. Reintroduction of Ganciclovir did help for a short period. We conclude that our patient had virus-associated hemophagocytic syndrome most likely related to Epstein-Barr virus infection, which was then confirmed by the splenic biopsy, and that Ganciclovir can be of great help in eradicating the virus and treating the disease, provided that it is given for a long enough period.

Causes of upper gastrointestinal bleeding: Experience at a major hospital in Riyadh.

Over a period of 14 years, 1246 patients had emergency gastroscopy because of upper gastrointestinal tract (UGIT) bleeding. The endoscopic findings in these patients showed duodenal ulcer disease (DUD) in 364 (29.2%) was the most common followed by esophageal varices in 302 (24.2%), erosive gastritis in 198 (15.9%), gastroesophageal reflux disease (GERD) in 156 (12.5%), gastric ulcer in 69 (5.5%), and normal (negative) endoscopy in 132 (10.6%). Only 65 (21.5%) patients with varices had active bleeding from the esophageal varices, 10 (3.3%) from the gastric varices and in 34 other patients with varices (11.3%), the bleeding was mainly from associated gastrophy. Eighty-six patients (23.6%) with DUD had active bleeding at endoscopy; 66 (80.5%) of these had ulcers showing stigmata of recent hemorrhage. Of those who had active bleeding, the source of the bleeding could not be identified in only five.

Parasitic disease of the liver and biliary tree.

Several parasites infest liver or biliary tree, either during their maturation stages or as adult worms. Bile iry tree parasites may cause pancreatitis, cholecystitis, biliary tree obstruction, recurrent cholangitis, biliary tree strictures and some may lead to cholangiocarcinoma. This review discusses the hepatobiliary parasites, and shows our experience in diagnosis and management of these parasites. Ultrasonography of the liver is diagnostic in schistosomiasis, hydatid cysts, amebic liver abscess, ascariasis and other biliary tree parasites showing bile duct dilatation. Percutaneous aspiration under ultrasonography guidance of hydatid liver cysts or amebic abscess are effective measures in management. Endoscopic retrograde cholangiopancreatography (ERCP) is safe and effective in diagnosis and management of biliary tree parasites.

Upper gastrointestinal fibreoptic endoscopy experience in the Sudan. Analysis of 2500 endoscopies.

The results of 2500 upper gastrointestinal fibreoptic endoscopies carried out at Soba University Hospital, Khartoum, between January, 1980, and June, 1982, were reviewed. 42% of the patients had no disorder visible on endoscopy, 9% had oesophageal varices, 0.7% gastric ulcer, 17% duodenal ulcer, and 2% pyloric obstruction. Duodenal ulcer was seen more commonly in men (male/female ratio 4.5/1) and in young people. Endoscopy is a feasible procedure in developing countries. It is more informative and cheaper than barium meal radiology.

Gastrointestinal parasites presentations and histological diagnosis from endoscopic biopsies and surgical specimens.

OBJECTIVE: To diagnose parasitic ova or worms during endoscopy, surgery or by histology from endoscopic or surgical specimen in our patients. METHODS: The diagnosis of parasitic disease in our patients was made by histological examinations from biopsies obtained either during an upper gastrointestinal or lower gastrointestinal endoscopy or from surgical specimens. RESULTS: Parasites were seen in endoscopic biopsies from upper gastrointestinal tract in 21 patients. Schistosoma ova was seen in biopsies from stomach or duodenum (12 patients). Small intestine biopsies showed Giardiasis (8 patients) and strongyloides (1 patient). Colonic biopsies showed schistosoma ova by paraffin section or by squash technique in 216 patients. Surgical specimens from 12 patients, who presented with acute abdomen and had surgery, due to appendicitis in 8 patients, in whom specimens showed (Schistosoma in 5 patients, amoebiasis in 2 patients and Trichuria in 1 patient). Four other patients presented with acute abdomen, where ischemic bowel necrosis or mesenteric vein thrombosis was found during surgery, specimens showed schistosoma ova. CONCLUSION: The diagnosis of gastrointestinal parasites is not only made by stool but the diagnosis can be made by histology from endoscopic biopsies or surgical specimens.

Protean manifestation of gastrointestinal tuberculosis: report on 130 patients.

Over the past 8 years, 820 patients with tuberculosis were seen at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia. A total of 292 of these patients (35.6%) had pulmonary tuberculosis, and 130 patients (15.8%) had alimentary tract tuberculosis, making this the second commonest site of involvement. In these 130 patients, the disease was located in the upper gastrointestinal tract in 11 patients (8.5%), small bowel 44 patients (33.8%), large bowel 29 patients (22.3%), peritoneum 40 patients (30.7%), and liver 19 patients (14.6%). The diagnosis in most patients was made by specimens from endoscopy or laparoscopy, or liver or surgical specimens. Gastrointestinal tuberculosis is not uncommon in developing countries, and its incidence is increasing in developed countries due to immigration and in patients with AIDS or those receiving immunosuppressive therapy. It can mimic any diseases affecting the gastrointestinal tract and may present with very different symptoms, so a high index of suspicion is required.