Mahmoud M. El-Habashy

Latent tuberculosis in patients with hepatitis C infection before receiving antiretroviral drugs

Aim of the work Studying the prevalence of latent TB infection among people infected with hepatitis C virus for preventing emergence of active tuberclous disease during treatment of hepatitis C virus with antiviral drugs that cause immunosuppression. Patients and method The study was performed on 75 patients who were divided into two groups ; group A (hepatitis C group) which was 45 patients and group B (control group) which was 30 patients. A written consent was taken from patents who underwent the study. Patients underwent: 1. History taking. 2. Examination: general and local chest examination. 3. Radiology: chest x-ray. 4. tuberculin skin test with (PPD) 5. QuantiFERON TB testing (interferon gamma release assay {IGRA}). Results The mean age of (54.9±10.23) in group A (hepatitis C group) and (61.1±9.2) in group B (control group). In group A there are 30 males (66.7%) and 15 females (33.3%) while in group B there are 16 males (53.3%) and 14 females (46.7%) with no significance difference between the two groups. In group A there are 9 patients (20%) with positive tuberculin test and 36 patients with negative test while in group B there are 4 patients (13.3%) with positive test and 26 patients (86.7%) with negative test . there is no significant difference between the two groups regarding tuberculin test. Regarding QuantiFERON TB Gold test, In group A there are 15 patients (33.3%) with positive test and 30 patients (66,7%) with negative test while in group B there is 4 patients (13.3%) with positive test and 26 patients (86.7%) with negative test. There is significant difference between the studied groups regarding QuantiFERON TB gold test. Summary and conclusion People infected with hepatitis C virus should undergo testing for latent TB for preventing emergence of active tuberculous disease during treatment of hepatitis C virus with antiviral drugs that cause immunosuppression. QuantiFERON test is preferred more than tuberculin test in detecting latent TB in patient with hepatitis C because tuberculin test may be falsely negative in patient with immunosuppression and hepatic patients which may give unreliable results.

Hepatopulmonary syndrome in non-cirrhotic patients with chronic viral hepatitis

Background: Hepatopulmonary syndrome (HPS) is hypoxemia and functional intrapulmonary right-to-left shunts in patients with liver disease. It is a known complication of liver cirrhosis, portal hypertension, and acute liver failure. The aim of this study was to determine the extent of pulmonary functions affection and the possible existence of HPS in non-cirrhotic patients with chronic viral hepatitis. Methods: Lung function tests were carried out on 60 patients with chronic viral hepatitis (43 with hepatitis C and 17 with hepatitis B). All hypoxemic patients or patients with reduced diffusion capacity were subjected to contrast echocardiography to demonstrate intrapulmonary shunting. Results: Twelve patients showed pulmonary dysfunction. Only 7 of 60 patients (11.67 %) exhibited hypoxemia. Intrapulmonary shunting was observed in three of those 12 patients. Two of these patients fulfilled the diagnostic criteria of HPS. Conclusions: HPS exists in some patients with chronic viral hepatitis and is thus not restricted to patients with end stage liver disease.

Evaluation of serum troponin I in patients with acute exacerbations of chronic obstructive pulmonary disease

Introduction Chronic obstructive pulmonary disease is a common, preventable, and treatable disease. Troponin I is a component of the contractile proteins present in all muscles. The amino acid sequence of cardiac troponin I (cTnI) contains a section that is unique to cardiac muscle. Aim The aim of the study was to evaluate the incidence of cTnI elevation in patients with acute exacerbation of chronic obstructive pulmonary diseases (AECOPDs) and study the possible association of the level of cTnI with the severity of AECOPD, need for assisted ventilation, and length of hospital stay. Patients and methods This study was performed on 30 patients with AECOPD admitted to the Chest Department and Respiratory ICU at Benha University Hospital. On admission, all patients were subjected to full medical history taking and full clinical examination. We examined the patients for signs and symptoms of right ventricular (RV) failure. Echocardiography was performed for every patient. Serum troponin I levels (upon admission and 24 h later) were evaluated. Results The study showed 21 (70%) of 30 patients with positive troponin I versus nine (30%) with negative troponin I. There was a nonsignificant statistical difference among all studied AECOPD patients as regards smoking habits, as 89% of troponin I-negative patients were smokers versus 81% of troponin I-positive patients. When assessed on the basis of pulmonary function tests, 75% of troponin I-negative patients were found to be in moderate stage, 53% of troponin I-positive patients were in severe stage, and 33% of troponin I-positive patients were in very severe stage. There was a significant statistical difference in troponin elevation as regards pulmonary hypertension (71% of cTnI-positive patients vs. 11% of cTnI-negative patients), RV strain (90% of cTnI-positive patients vs. 33% of cTnI-negative patients), and tricuspid regurge (52% of cTnI-positive patients) but a nonsignificant difference as regards left ventricular dysfunction among all studied AECOPD patients. Conclusion cTnI in AECOPD patients is mostly positive in tachypneic, tachycardiac, hypoxemic, and hypercapnic patients with more severe pulmonary hypertension and RV dysfunction.

Hepatopulmonary syndrome in noncirrhotic patients with chronic viral hepatitis

Background Hepatopulmonary syndrome (HPS) is hypoxemia and functional intrapulmonary right-to-left shunts in patients with liver disease. It is a well-known complication of liver cirrhosis, portal hypertension, and acute liver failure. Aim The aim of this study was to determine the extent to which pulmonary functions were affected and the possible existence of HPS in noncirrhotic patients with chronic viral hepatitis. Patients and methods Lung function tests were carried out on 60 patients with chronic viral hepatitis (43 with hepatitis C and 17 with hepatitis B). All hypoxemic patients or patients with reduced diffusion capacity were subjected to contrast echocardiography to demonstrate intrapulmonary shunting. Results Twelve patients showed pulmonary dysfunction. Only seven of 60 patients (11.67%) showed hypoxemia. Intrapulmonary shunting was observed in three of those 12 patients. Two of these patients fulfilled the diagnostic criteria of HPS. Conclusion HPS exists in some patients with chronic viral hepatitis and is thus not restricted to patients with end-stage liver disease.