Bandar Al-Knawy

A second-generation method of genotyping hepatitis C virus by the polymerase chain reaction with sense and antisense primers deduced from the core gene

A second-generation method of genotyping hepatitis C virus (HCV) was developed by the polymerase chain reaction (PCR) with sense as well as antisense primers deduced from the core gene. HCV RNA specimens extracted from sera were reverse-transcribed and amplified with universal primers in the first round of PCR to obtain fragments of 433 base pairs representing nucleotides 319-751. In the second round of PCR, portions of PCR products were amplified separately with sense and antisense primers specific for each of the five common genotypes prevailing across the world, i.e., I/1a, II/1b, III/2a, IV/2b and V/3a. The specificity of the method was verified by a panel of 177 HCV isolates of various genotypes in the genetic groups 1-9. It allowed clear differentiation of genotype I/1a from II/1b which was not always accomplished by the previous method. When 501 sera from blood donors and hepatitis patients with HCV viremia from various countries were genotyped by the second-generation method, 478 (95.4%) were classified into the five genotypes. HCV RNA samples from 23 (4.6%) sera were not classifiable into any of the five common genotypes and, by sequence analysis, 22 were found to be of four genotypes in group 4 and one of genotype 1c in Simmonds classification.

Distribution of hepatitis C genotype and co-infection rate with hepatitis G in Saudi Arabia

We determined the hepatitis C virus (HCV) genotypes and the co-infection rate with hepatitis G (HGV) in 32 Arab patients infected with hepatitis C virus. Twenty two Saudi and ten Egyptian patients were recruited from southern Saudi Arabia, an endemic region for chronic liver disease. HCV genotype was determined by PCR with genotype specific primers in the core region. Hepatitis G virus RNA was detected by the reverse-transcription polymerase chain reaction (RT-PCR). Five patients were blood donors, 11 patients had chronic hepatitis C infection, 13 had cirrhosis and 3 had cirrhosis with hepatocellular carcinoma. HCV genotype 4 was detected in 11 of 22 Saudi patients (50%). HCV genotype 1b was detected in 9 Saudi patients (40.9%) and HCV genotype 1a was detected in 2 Saudi patients (9.1%). Amongst the 10 Egyptian patients, HCV genotype 4 was found in 9 patients (90%)) and genotype 1b in 1 patient (10%). The co-infection rate of HGV was 31% in patients with HCV infection. We conclude that HCV genotypes 4 and 1b are the major pathogenic strains, accounting for greater than 90% of HCV across ethnic groups in the southern region of Saudi Arabia. There was no significant association between HCV genotype, age and severity of liver disease. Co-infection with HGV is common and the significance is indeterminate.

Etiology of ascites and the diagnostic value of serum-ascites albumin gradient in non-alcohol liver disease.

This study was designed to determine the different etiologies of ascites and the diagnostic value of serumascites albumin gradient (SAAG) in patients with ascites of non-alcoholic liver disease in Southern Saudi Arabia. A total of 132 patients with ascites (96 males and 36 females, mean age 58.8+/-15.9 years) were studied for the different causes of ascites. In 55 patients with liver disease and 22 patients with nonliver disease (malignancy and peritoneal tuberculosis), we compared SAAG with the three usual parameters of ascitic fluid biochemical analysis used in the differential diagnoses of ascites. The nonliver disease group showed higher ascitic fluid total protein (aTP) concentration (4.77+/-2.05 versus 1.98+/-1.56 g/dL), ascitic to serum ratio of total protein (a/sTP) concentration (0.75+/-0.43 versus 0.26+/-0.19), ascitic fluid lactic dehydrogenase (aLDH) level (565.4+/-353.4 versus 254.1+/-205.03 U/L) and a lower SAAG (0.6+/-0.30 versus 1.71+/-0.61). P7lt;0.0001 for all parameters. The positive predictive values for aTP, a/sTP, aLDH and SAAG to detect ascites due to liver disease were 68%, 76%, 67%, and 80%, respectively, while the negative predictive values were 96%, 96%, 84%, and 98%, respectively. Liver causes accounted for 69.7% of cases, followed by peritoneal tuberculosis 10.6%, malignancy 9.1%, congestive heart failure 7.6%, and nephrotic syndrome 3.0%. SAAG is a useful diagnostic parameter which can be used to separate ascites of liver disease (nonalcoholic) from other causes of ascites, with an efficiency of 91%. SAAG should replace the traditional parameters (aTP, a/sTP, and aLDH) used in the differential diagnosis of ascites. In our series, liver disease is the major cause of ascites, followed by peritoneal tuberculosis.

Intrafamilial clustering of Helicobacter pylori infection in Saudi Arabia.

AIM To study the pattern of Helicobacter pylori infection among family members in the Saudi population. METHODS A cross-sectional, population-based, seroepidemiological study of family members was undertaken in a Saudi population using saliva H pylori immunoglobulin (Ig) G antibodies (Helisal kit). RESULTS A total of 42 families comprising 271 children and 84 parents were studied (355 subjects; mean age 23 years, SD 19 years) The overall frequencies of H pylori IgG antibodies in mothers, fathers and children were 67%, 64% and 23%, respectively. There was no significant difference in the infection rate between mothers and fathers, or between boys and girls. The infection rate among children increased when one or both parents were seropositive, and the infection rate among parents was proportionally related to the number of infected children per family. The frequency of H pylori antibodies was significantly higher in spouses of seropositive parents than in spouses of seronegative parents (45% compared with 19.2%). CONCLUSIONS These data confirm that the intrafamilial clustering of H pylori infection in Saudi Arabia occurs in a similar pattern to that described in the developed countries, and that living conditions and social conditions lead to person to person transmission of H pylori infection.

Prevalence of antibody to hepatitis C virus in Saudi blood donors

The prevalence of antibodies to hepatitis C virus (anti-HCV) was retrospectively determined using a second generation enzyme immunoassay in 3868 blood donors from the southern part of Saudi Arabia in an area with high prevalence of hepatitis B virus (HBV) infection. Of 3354 Saudis, 48 (1.43%) were seropositive for anti-HCV. A high prevalence (43 of 204, 21.08%) of anti-HCV was observed among Egyptian donors compared with Saudis (1.43%) and other nationalities (eight of 310, 2.58%). Furthermore, the prevalence of anti-HCV antibodies was observed to increase with age, peaking in the 25 to 34 year age group. From this and other studies conducted in different regions of Saudi Arabia, the prevalence of anti-HCV among Egyptian donors appears to range from 19.2 to 24.5%, and among Saudi donors appears to range from 1.00 to 1.7%, a rate similar to that reported from western countries; this latter rate does not seem to be influenced by the high prevalence of HBV infection in this region.

Duodenal Ulcer and Helicobacter pylori Infection at High Altitude: Experience from Southern Saudi Arabia

OBJECTIVE To study the clinical presentation, endoscopic features and prevalence of Helicobacter pylori in duodenal ulcer (DU) patients in southern Saudi Arabia, located 3150 m above sea level, and to compare results with those from low altitude regions of the Kingdom. METHODS Prospective study of patients with proven DU referred for upper gastrointestinal endoscopy at Asir Central Hospital, Abha, southern Saudi Arabia over an 18-month period. RESULTS Of 126 patients with proven DU, 72% were men and mean age was 40.4 years (range 18 to 68). Twenty-eight per cent were smokers and only 5% used nonsteroidal anti-inflammatory drugs. Thirty-eight patients (30%) presented with hematemesis or melena, and the majority had a single ulcer. Nineteen per cent of patients with dyspepsia had DU and 96% had H pylori. These results are comparable with those reported from the low altitude, warmer regions of Saudi Arabia. CONCLUSIONS Age of patients and the male:female ratio were similar to those in developing countries. The frequency of smoking is lower than in western countries and no patient in this report consumed alcohol. High altitude did not affect the prevalence of DU or the frequency of H pylori because the results were comparable with those from the low altitude areas of the Kingdom of Saudi Arabia and other lowland developing countries. Although great socioeconomic changes have increased the incidence of heart disease, the patterns of DU and H pylori infection assume those in developing nations.

The role of hepatitis E virus infection among patients with acute viral hepatitis in southern Saudi Arabia.

We investigated the etiology of acute sporadic viral hepatitis in southern Saudi Arabia in a series of 132 patients admitted with acute viral hepatitis. Of these cases, 108 (81.8%) were due to acute hepatitis A virus infection, of which 11 (8.3%) patients had been previously exposed to hepatitis E virus, and another 10 (7.6%) were chronic carriers of hepatitis B virus. Three cases (2.3%) were acute hepatitis B virus infection. The overall prevalence of hepatitis E IgG antibodies was found to be 9.1%. The remaining 21 (15.9%) patients were tested for hepatitis E IgM, EBV-VCA IgM and hepatitis C IgG antibodies by sensitive enzyme immunoassays. In none of them could hepatitis E IgM, EBV-VCA IgM or hepatitis C IgG antibodies be demonstrated, and these patients were thus considered as acute non-A, non-B hepatitis. Acute hepatitis C virus infection, however, could not be ruled out from this group. We therefore concluded that the majority of clinically apparent viral hepatitis cases were due to HAV, while HBV accounted for a small proportion of the cases. Clinically apparent HEV infection does not appear to be common in the population studied, since even those with serologic evidence of previous exposure to HEV did not recall a history suggestive of acute viral hepatitis.