Subhash C. Arya

A profile of primary hepatocellular carcinoma patients in the Gizan Area of Saudi Arabia

Clinical, laboratory, and ultrasonographic features of 75 patients of primary hepatocellular carcinoma (PHC) living in the Gizan Area of Saudi Arabia and their follow‐up, during a 2‐year period, were characterized. Eighty‐nine percent of the cases were defined histologically, whereas in the rest, ultrasonographic (US) evidence along with an alphafetoprotein (AFP) level exceeding 480 ng/ml were taken as the positive evidence for PHC. Eighty percent of the cases were male patients, with the peak incidence during the seventh decade. The most common clinical presentations were hepatic enlargement (91%), abdominal pain (76%), splenic enlargement (33%), and acites (33%), followed by bruit, fever, metastases, and varices. Alteration in a liver function test was manifest in 97% of the cases, AFP values > 480 ng/ml in 57%, and a hepatitis B virus surface antigen (HBsAg) positivity in 65% of the cases. There was no intersex variation in positivity for HBsAg, antibody to HBsAg (anti‐HBs), antibody to hepatitis B virus core antigen (anti‐HBc) among the 30 PHC cases studied. Positivity for HBsAg or the overall hepatitis B virus exposure in PHC cases was higher than the normal controls (P < 0.001). In addition to histologic confirmation of PHC in 67 cases, there was histologic evidence of cirrhosis in 25%, or chronic active hepatitis in 19% of the cases. At the time of diagnosis, the average duration of the presenting illness was less than 2 months, while the mortality in the ensuing 2‐month period was 73%. The average span of total illness in the vast majority of cases was 4 to 6 months. Two female patients (one with fibrolamellar carcinoma) however, survived for 2 years. Immunization against hepatitis B virus should be considered for all newborns in such hyperendemic communities. A continuous program should be started in such communities to screen and immunize all those yet unexposed to hepatitis B virus. The established HBsAg carriers should be periodically examined ultrasonographically along with an AFP estimation for initiating the chemotherapeutic and other measures against PHC in fairly early stages of malignancy.

Type 2 hepatitis B virus (HBV-2) in carriers and patients with malignancy in Saudi Arabia.

SummaryFour cases of type 2 hepatitis B virus (HBV-2) infection were demonstrated in the Gizan area of Saudi Arabia during the hepatitis B marker ELISA screening of the 152 native pregnant females, 42 cases of primary hepatocellular carcinoma, 19 cases with an epithelial but non-hepatic malignancy, 16 with a non-epithelial and non-hepatic malignancy and eight with chronic hepatitis. HBV-2 infection diagnosis was based on HBsAg positivity without anti-HBc, anti-HBs and HBeAg in one pregnant female and one patient each with a primary hepatocellular carcinoma, lymphocytic lymphoma and metastatic adenocarcinoma. During neutralisation of HBsAg ELISA reactivity, the respective reduction in absorbance values in sera from the pregnant female and the patient with primary hepatocellular carcinoma were 21% and 76% respectively. HBV-2 specific gene probes would be needed to define its role in pathogenesis of malignant neoplasms and chronic hepatitis. Incorporation of pre-S2 sequences in future hepatitis B vaccines is likely to protect against both, HBV-2 and conventional hepatitis B (HBV-1) exposures.ZusammenfassungScreeninguntersuchungen auf Hepatitis B Marker mittels ELISA bei 152 schwangeren Eingeborenen der Region Gizan, Saudi-Arabien, 42 Patienten mit primärem Leberzellkarzinom, 19 Kranken mit epithelialen und 16 mit nicht epithelialen malignen Erkrankungen, die nicht in der Leber lokalisiert waren sowie acht Patienten mit chronischer Hepatitis deckten vier Fälle von Hepatitis B Virus Typ 2 (HBV-2)-Infektionen auf. Die Diagnose einer HBV-2-Infektion bei einer Schwangeren, und je einem Patienten mit primärem Leberzellkarzinom, lymphozytärem Lymphom und metastasierendem Adenokarzinom wurde gesichert durch den Nachweis von HBsAg in Abwesenheit von anti-HBc, anti-HBs und HBeAg. Neutralisation der HBsAg ELISA Aktivität verursachte eine Verminderung der Absorptionswerte, die sich im Serum der Schwangeren auf 21% und im Serum des Patienten mit primärem Leberzellkarzinom auf 76% belief. Man benötigt spezifische Genproben, um die Bedeutung von HBV-2 für die Entstehung maligner Tumoren und der chronischen Hepatitis zu klären. Es ist anzunehmen, daß die Inkorporation von prä-S2-Sequenzen in zukünftige Hepatitis B Vakzinen sowohl gegen HBV-2 wie konventionelle Hepatitis B (HBV-1) Infektionen schützen wird.

Rubella Immunity and Immunization of Hospital Personnel

ABSTRACT Screening of 229 female expatriate nursing and paramedical staff for rubella virus-specific immunoglobulin G (IgG) antibody revealed 17% were seronegative, uniformly distributed among the ...