Study of prevalence and effects of insulin resistance in patients with chronic hepatitis C genotype 4.

There is strong epidemiological evidence linking hepatitis C virus (HCV) infection and diabetes. Our aim was to evaluate the prevalence of insulin resistance in Egyptian patients with chronic HCV genotype 4 infection, to assess factors associated with insulin resistance and to test the impact of insulin resistance on outcomes of treatment with pegylated interferon/ribavirin. Insulin resistance [homeostasis model assessmentinsulin resistance (HOMA-IR) score > 3.0] was detected in 31 of 100 nondiabetic patients. The relationship between elevated HOMA-IR and baseline viral load and degree of fibrosis was statistically significant (r = 0.218 and r = 0.223). Follow-up of patients with complete early virological response until the end of treatment showed a statistically significant decrease in HOMA-IR score. Out of 29 liver tissue sections examined, 14 had a low level of expression of insulin receptor type 1 by immunohistochemical studies. This study confirms that insulin resistance affects treatment outcome, and thus HOMA-IR testing before initiation of therapy may be a cost-effective tool.

Comparison of mecA polymerase chain reaction with phenotypic methods for the detection of methicillin-resistant Staphylococcus aureus.

In the present study, several conventional methods to detect methicillin-resistant Staphylococcus aureus (MRSA) were compared with polymerase chain reaction (PCR) detection of mecA gene-positive isolates. Cefoxitin E-test was also evaluated as a possible phenotypic method of MRSA detection. Oxacillin agar screen and PBP2' latex agglutination methods were found to be more sensitive than oxacillin and cefoxitin disk-diffusion methods. Cefoxitin disk diffusion was found to be the most specific. A combination of oxacillin agar screening with cefoxitin disk diffusion, or oxacillin disk diffusion with PBP2', improved sensitivity and specificity. Cefoxitin E-test with the current break points had low sensitivity and specificity (33.3% and 75%, respectively) for the detection of MRSA. However, changing the break points to or= 6 microg/ml for sensitive and resistant, respectively, greatly improved both. Changing the 30-microg cefoxitin disk-diffusion break points to

The interrelationship of malnutrition and diarrhea in a periurban area outside Alexandria, Egypt.

BACKGROUND: In the developing world, children are often observed to have both diarrhea and malnutrition. This observation has led many researchers to speculate that diarrhea may produce malnutrition and that malnutrition may predispose to diarrhea. In this study, the interrelationship between diarrhea and malnutrition was investigated among 143 Egyptian children less than 3 years of age. METHODS: For 22 months, children were followed for diarrhea at twice weekly home visits and measured for nutritional status at approximately 3-month intervals. Nutritional measurements were converted to z-scores based on the National Center for Health Statistics/World Health Organization (NCHS/WHO) reference population. RESULTS: Three hundred fifty-eight diarrheal episodes were reported with only 1% of episodes lasting 14 days or more. Stunting, wasting, and low weight-for-age were found in 19%, 3%, and 7%, of these children, respectively. When testing whether malnutrition predisposes to diarrhea, a weight-for-age z-score of <-2 standard deviations was associated with increased incidence of diarrhea (RR = 1.7, P < 0.01) but not height-for-age or weight-for-height. Diarrhea itself was associated with a subsequent attack of diarrhea (RR = 2.1, P < 0.001). During short intervals of follow-up (approximately 3 months), an association was detected between diarrhea episodes and growth faltering for height-for-age z-score (-0.16, P < 0.05). This association was reduced, however, when analyzed during 6-month intervals, if no diarrhea was reported in either the first or second half of this interval. CONCLUSIONS: In a population with moderate malnutrition, both low weight-for-age and diarrhea itself are associated with increased diarrhea risk. Diarrhea alone does not appear to contribute substantially to malnutrition when children have diarrhea-free time for catch-up growth.

Should we routinely check for hepatitis B and C in patients with lichen planus or cutaneous vasculitis?

The study aimed to determine the prevalence of HBs-Ag and anti-HCV antibodies in a group of 43 patients with lichen planus and 19 patients with cutaneous vasculitis versus 30 controls. The results showed that 12 (27.9%) patients with lichen planus were positive for HBs-Ag, 9 (20.9%) were positive for anti-HCV antibodies and 3 (7%) were positive for both. In cutaneous vasculitis patients, 3 (15.8%) were HBs-Ag-positive, 7 (36.8%) were anti-HCV-positive and 3 (15.8%) were positive for both. In the control group, 8 (26.7%) were HBs-Ag positive, 3 (10%) were anti-HCV-positive and 1 (3.3%) was positive for both. These values were not statistically significant.

Should we routinely check for hepatitis B and C in patients with lichen planus or cutaneous vasculitis?

The study aimed to determine the prevalence of HBs-Ag and anti-HCV antibodies in a group of 43 patients with lichen planus and 19 patients with cutaneous vasculitis versus 30 controls. The results showed that 12 [27.9%] patients with lichen planus were positive for HBs-Ag, 9 [20.9%] were positive for anti-HCV antibodies and 3 [7%] were positive for both. In cutaneous vasculitis patients, 3 [15.8%] were HBs-Ag-positive, 7 [36.8%] were anti-HCV-positive and 3 [15.8%] were positive for both. In the control group, 8 [26.7%] were HBs-Ag positive, 3 [10%] were anti-HCV-positive and 1 [3.3%] was positive for both. These values were not statistically significant

Hantaan virus infection among human and rat populations in Alexandria.

Hantaan virus has recently been identified as the cause of the rodent borne viral zoonosis collectively termed Hantavirus disease (HVD). Although the disease is mainly endemic in two main areas, clinical forms as well as positive antibody testing from healthy persons throughout the world have been reported denoting a worldwide presence. Rattus species are almost universally implicated as hantavirus reservoirs. Screening for hantavirus antibodies was done on 637 samples of human sera and 861 rodent sera trapped from 26 locations throughout the city of Alexandria, Egypt. ELISA assays were performed and 12.2% of humans were found seropositive with no effect of age, duration of work at sea or residence on seropositivity. 12.8% of rodents were seropositive with Rattus norvegicus showing the highest prevalence and with no influence of sex, age or habitat. A significant association was found between the east district and seropositivity to Hantaan in rodents.

An in vitro model of leukocyte mediated injury to the corneal epithelium.

To enhance efforts directed at unraveling the role and mechanisms of leukocytes in mediating injury to corneal epithelium, an isolated bovine corneal cup was developed and evaluated. Bovine peripheral leukocytes and lysates were added to the corneal epithelial surface of isolated cornea for various periods after which the degree of morphologic changes and cell damage were assessed using light and electron microscopy. Results of these studies indicate that leukocyte/epithelial cell interactions are characterized by five successive stages: (1) leukocyte adhesion to superficial layer of the epithelium, (2) leukocyte penetration beneath the superficial epithelium, (3) epithelial cell injury, (4) leukocyte phagocytosis of killed epithelial cells and (5) ulceration and total destruction of the full thickness of the epithelial layer. The above sequence appears to be both time and dose dependent; that is epithelial cells exposed to leukocytes for short periods (5-60 minutes) or to low dose levels (10(5) - 10(7) cells/ml) shows leukocyte adhesion and penetration beneath the superficial layer of the epithelium, (stage 1 and 2), while longer exposures (2-3 hours) or higher numbers of leukocytes (10(7) - 10(8) cells/ml), leads to deeper penetration of epithelium by leukocytes and epithelial injury (Stages 3,4,and 5). We also observed that direct contact of intact leukocytes with epithelial cells is apparently necessary to induce this type of injury. These findings demonstrate the ability of leukocytes to destroy corneal epithelial cells and the value of this new ocular model for studies of the basic immunology of ocular inflammation.