Aliaa Amer

Reexamination of the relationship between the prevalence of hepatitis C virus and parenteral antischistosomal therapy among Egyptians resident in Qatar

Egypt has the highest prevalence of recorded hepatitis C virus (HCV) worldwide, estimated nationally at 14.7%, which is attributed to extensive iatrogenic transmission during the era of parenteral antischistosomal therapy (PAT) mass-treatment campaigns. The objective of our study was to attempt to highlight to what extent HCV transmission is ongoing and discuss the possible risk factors. We studied the prevalence of HCV among 7.8% of Egyptians resident in Qatar in relation to age, socioeconomic status, and PAT and discuss the possible risk factors. HCV testing was conducted in 2,335 participants, and results were positive for 13.5%, and 8.5% for those aged below 35 years. The prevalence of HCV in the PAT-positive population was 23.7% (123 of 518, 95% confidence interval [CI] 20.2%–27.6%) compared with 11.2% in the PAT-negative group. Significantly higher HCV prevalence occurred in participants who were older than 50 years (23%, 95% CI 19.3%–27.1%) compared to those aged 45–50 years (19.3%, 95% CI 15.2%–23.8%), 35–45 years (11.1%, 95% CI 8.9%–13.7%), and less than 35 years (8.5%, 95% CI 6.8%–10.4%) (P<0.0001). Insignificant higher prevalence occurred in the low socioeconomic group (14.2%, 95% CI 11.3%–17.4%). Logistic regression analysis revealed that increasing age, history of PAT, bilharziasis, and praziquantel were common risk factors, but there was no relation with dental care. Host genetic predisposition seems to be a plausible underlying factor for susceptibility among Egyptians and intense ongoing infection.

Idiopathic thrombocytopenic purpura in childhood: a population-based study in Qatar

OBJECTIVE To find the pattern of idiopathic thrombocytopenic purpura (ITP) (acute/chronic) and to describe presenting features and clinical characteristics of the disease in children below 14 years of age in a newly developed Arabian society. METHODS This retrospective, descriptive study was carried out at the Pediatric Department of the Hamad General Hospital, Hamad Medical Corporation, Qatar. A total of 50 children below 14 years of age who were diagnosed with ITP during the period 2000-2005 were included. RESULTS Among the studied children (50), 62% were diagnosed with acute ITP and 38% with chronic ITP. Acute ITP was more prevalent in boys (64.5%) when compared with girls (35.5%), whereas for chronic ITP, nearly an equal distribution was found in boys (57.9%) and girls (42.1%). Preceding viral infection was common in both acute (71%) and chronic (63.2%) ITP cases; 68% of the children with ITP showed a platelet count below 20x10(9)/L at the time of presentation. Most of the studied children were treated with intravenous immunoglobulin (74%). CONCLUSIONS The study revealed a high incidence of ITP among children in Qatar. The study findings are in line with other international reports.

Púrpura trombocitopênica idiopática na infância: estudo de base populacional no Catar

OBJETIVO: Definir o padrao da purpura trombocitopenica idiopatica (PTI) (aguda/cronica), e descrever seus sintomas e caracteristicas clinicas em criancas com menos de 14 anos de idade em uma sociedade arabe recentemente desenvolvida. METODOS: Este estudo descritivo retrospectivo foi realizado no Departamento de Pediatria do Hospital Geral de Hamad, Hamad Medical Corporation, Catar. Foram incluidas neste estudo 50 criancas com idade inferior a 14 anos e diagnostico de PTI durante o periodo de 2000 a 2005. RESULTADOS: Das criancas estudadas (50), 62% foram diagnosticadas com PTI aguda e 38% com PTI cronica. A PTI aguda foi mais prevalente em meninos (64,5%) em comparacao com meninas (35,5%), enquanto que a PTI cronica apresentou uma distribuicao quase igual em meninos (57,9%) e meninas (42,1%). Historia de infeccao viral foi comum em casos de PTI tanto aguda (71%) quanto cronica (63,2%); 68% das criancas com PTI apresentaram contagem de plaquetas abaixo de 20x109/L ao diagnostico. A maioria das criancas estudadas (74%) foi tratada com imunoglobulina intravenosa. CONCLUSOES: O estudo revelou uma alta incidencia de PTI entre as criancas no Catar. As descobertas do estudo sao semelhantes as de outros relatos internacionais.

Hepatocellular carcinoma in Hepatitis C genotype 4 after viral clearance and in absence of cirrhosis: two case reports

Genotype 4 Hepatitis C virus represents approximately 20% of global Hepatitis C virus infection and is the source of a considerable burden to health-care providers across the globe. Many studies reported that interferon reduces the risk of hepatocellular carcinoma in patients with chronic hepatitis C.Hereby, we are reporting two cases of hepatocellular carcinoma in Hepatitis C virus-genotype 4 after complete viral eradication and in absence of cirrhosis. We aim to highlight the possible direct oncogenic effect of Hepatitis C virus-genotype 4, particularly with concomitant bilharzial infection and the importance of life-log follow up of these patients even in absence of cirrhosis.

Aspartate transaminase to platelet ratio index in hepatitis C virus and Schistosomiasis coinfection

AIM To assess the diagnostic accuracy, of aminotransferase-to-platelet ratio index (APRI) alone and with antischistosomal antibody (Ab) in patients with hepatitis C virus (HCV) and schistosomiasis coinfection. METHODS This retrospective study included medical records of three hundred and eighty three Egyptian men patients who had undergone percutaneous liver biopsy between January 2006 to April 2014 in tertiary care hospital in Qatar for diagnosis or monitoring purpose were selected. Data of patients > 18 years of age were included in the study. The values of HCV RNA titer and antischistosomal antibody titer were also taken into consideration. Patients were excluded from the study if they had any other concomitant chronic liver disease, including; history of previous antiviral or interferon therapy, immunosuppressive, therapy, chronic hepatitis B infection, human immunodeficiency virus co-infection, autoimmune hepatitis, decompensated liver disease, hepatocellular carcinoma, prior liver transplantation, and if no data about the liver biopsy present. RESULTS Median age of patients was 46 years. About 7.1% had no fibrosis, whereas 30.4%, 37.5%, 20.4%, and 4.6% had fibrosis of stage I, II, III, and IV respectively. In bivariate analysis, APRI score, levels of AST, platelet count and age of patient showed statistically significant association with liver fibrosis (P < 0.0001); whereas antischistosomal antibody titer (P = 0.52) and HCV RNA titer (P = 0.79) failed to show a significant association. The respective AUC values for no fibrosis, significant fibrosis, severe fibrosis and cirrhosis of APRI score were 63%, 73.2%, 81.1% and 88.9% respectively. This showed good sensitivity and specificity of APRI alone for grading of liver fibrosis. But the inclusion of anti-Schistosoma antibody did not improve the prediction of fibrosis stage. CONCLUSION The study results suggest that noninvasive biochemical markers like APRI are sensitive and specific in diagnosing the degree of fibrosis and cirrhosis in patients with coinfection of HCV and schistosomiasis as compared to biopsy. The addition of antischistosomal Ab to APRI did not improve sensitivity for predicting the degree of cirrhosis.

Platelets as a Possible Reservoir of HCV And Predictor of Response to Treatment

In the era of new Hepatitis C Virus (HCV) therapy, and the detection of extrahepatic HCV reservoirs such as peripheral blood mononuclear cells and platelets, it is important to understand the factors underlying resistance to treatment. Detection and quantitation of HCV-RNA in platelets or leucocytes from patients under antiviral therapy is poorly studied and the limited studies generated contradictory results. Aim: To detect and quantify HCV-RNA in platelets, and to evaluate the relation between HCV-RNA in the serum and the kinetics of HCV-RNA in platelets, in response to treatment. Method: Viral kinetic was tested in 20 chronic HCV genotype4, during the course of therapy. Results: HCV-RNA was detected in sera of all infected patients. The baseline platelet viral load was significantly lower in responders compared to non-responders. Platelet viral load was also related to serum viral load (t=3.39, p=0.001), but not related to platelet count (t=-0.56, p=0.58). ROC curve analysis revealed that in general, platelet viral load at different time points was a better predictor of SVR compared to serum viral load. Conclusion: HCV RNA analysis in whole blood may be more sensitive than platelet-poor plasma, which might underestimate circulating viral load. Early eradication of viremia from platelets is associated with higher rates of SVR. Our data, reconfirm higher HCV-RNA levels in serum compared to platelets. Thrombocytopenia occurring during interferon-based therapy might be a manifestation of viral eradication rather than adverse effects. Our findings warrant testing the sensitivity of platelet viral load as a predictor of poor response.

Neutropenia and viral load decline during treatment of hepatitis C virus genotype-4

BACKGROUND/AIMS Neutrophil count and magnitude of decrease from baseline are not correlated with infection rate in recipients of interferon-based therapy for hepatitis C (HCV). The association of neutropenia with viral response raises the potential dilemma of trying to maintain patients on therapy despite adverse events. We studied the relationship between early viral clearance in response to treatment, and neutrophil count and fall in neutrophils in HCV-genotype 4 patients. MATERIALS AND METHODS Two-hundred and one patients with HCV-genotype 4 were enrolled. RESULTS Rapid and early virological responses (RVR and EVR) were achieved in 33.3% and 61.5% respectively. None of the patients developed symptomatic infection regardless of the degree of neutrophil decline. Neutrophil decline at week 2 significantly correlated with viral load at week 12 (r=0.40, p=0.042), and neutrophil decline at week 4 significantly correlated with viral load decline at week 12 (r=0.21, p=0.006). Using logistic regression, pretreatment neutrophil count significantly predicted RVR and EVR, such that individuals who achieved RVR and EVR had higher pretreatment neutrophils compared to non-responders (X2= 4.94, p=0.026; X2=7.67, p=0.005 respectively). Adjusting for age, sex, grade, fibrosis, and pretreatment neutropenia; decline in neutrophil count was significantly associated with lower viral load over time (t=-2.27, p=0.027) and higher viral load decline over time (t=2.73, p=0.009) and achieving EVR (t=2.04, p=0.044). CONCLUSION In genotype 4 patients, neutropenia can be a predictor of response. Neutropenia may reflect disappearance of genomic hepatitis C viral RNA from mononuclear cells. The relationship between neutropenia and response is confined to the first 12 weeks of therapy.

Early Diagnosis of Iron Deficiency in School Children: A Qatari Experience

Objective: Iron deficiency still remains the most common nutritional deficiency throughout the world and is the leading cause of anaemia in children. Early recognition of iron deficiency, even before the development of anaemia is crucial to prevent the systemic complications of this disease. Methods: Ninety-seven school children between 5 and 16 years were stratified into prelatent iron deficiency (10 cases), latent iron deficiency (14 cases), overt iron deficiency anemia (13 cases), and controls (60 cases). All hemograms were performed on the same day of collection using the same Sysmex XE-2100 analyzer with reticulocyte indices included. Biochemical markers such serum iron, total iron binding capacity and percent saturation (calculated) in addition to serum ferritin and serum transferrin receptors were simultaneously measured. Data analysis was done using ANOVA test, generalized linear regression, and ROC curve. Results: Our study indicates that a panel based on hematologic parameters including reticulocyte hemoglobin at a cut off of ≤27 and ≤25.6, serum transferrin receptors at a cut off >0.48 and >0.68, red cell distribution width at a cut off >13.8 and >16.8 may provide an alternative to the traditional biochemical panels for the diagnosis of latent iron deficiency and overt iron deficiency anemia respectively. Conclusion: Whenever iron deficiency is thought of, a hemogram including reticulocyte hemoglobin and serum transferrin receptors would be the adequate diagnostic panel obviating the need for a more extensive one. These parameters should always be interpreted in the clinical context involving dietary habits, social standard as well as family history.

The Molecular Basis of α-Thalassemia in the Qatari Pediatric Population

Abstract α-Thalassemia (α-thal) is widely reported in the Arabian Peninsula as one of the main causes of asymptomatic microcytic hypochromic red blood cells with or without anemia in the pediatric population. This is the first study that provides information about the molecular basis of α-thal in the Qatari population. Qatari school children between the ages of 5 and 15, exhibiting laboratory findings suggestive of microcytic anemia were pooled, and those with a mean corpuscular volume (MCV) of <80.0 fL and a hemoglobin (Hb) electropherogram that ruled out β-thalassemia (β-thal), were narrowed down to a group of 127. This group was screened for the −α3.7 (rightward) deletion, and the α−5 nt, αpolyA1 (αT-Saudi), αpolyA2 mutations. A second group of randomly selected Qatari individuals was also screened in order to determine the population’s allele frequency for the −α3.7 deletion. Thirty-nine point four percent of the individuals with microcytic hypochromic anemia were positive for the −α3.7 deletion (heterozygotes 30.0%, homozygotes 9.4%), 2.6% were positive for the αpolyA1 deletion and 0.8% positive for the α−5 nt mutation. None of the children exhibited changes in αpolyA2. Analysis of the random samples determined that 26.4% were heterozygous and 4.5% homozygous for the −α3.7 deletion with a 17.7% allele frequency. Our results suggest that a significant number of the Qatari pediatric population with microcytic hypochromic anemia are carriers of α-thal mutations. However, 45.6% of the children failed to exhibit any of the above four mutations tested. This suggests the possibility of other mutations in the Qatari pediatric population that are yet to be elicited.