Tarek Besheer

Schistosoma mansoni infection in a fishermen community, the Lake Manzala region-Egypt

Abstract Objective To determine the prevalence of schistosomiasis in the fishermen community in Egypt. Methods A cross-sectional survey for schistosomiasis mansoni was conducted among 150 fishermen and their families from January to November 2013. Faecal samples were examined by Kato Katz method and formalin-ether concentration technique. Malacological survey was conducted to identify infection of the snail intermediate host by larval stage of Schistosoma mansoni . Snails were collected and checked for shedding of cercariae after light exposure. Results Overall prevalence of infection was 26.6% with an intensity of (42.7依7.2) ova/g of stool. Infection was common in male and significantly increased in the age of 20-40 years. Praziquantel-treated individuals had a high significant decrease in intensity (27.2依2.4) ova/g of stool than those with no treatment history. Biomphalaria alexandrina snail was infected with Schistosoma mansoni particularly in warm seasons and mice infection was established successfully from the shed cercariae, moreover adult worms were obtained via portal perfusion of the infected mice. Conclusions Findings indicated the endemicity of schistosomiasis mansoni in Lake Manzala region, therefore, appropriate integrated control measures are needed among fishermen including health education, environmental sanitation, periodic screening and mass treatment with praziquantel.

Does steatosis affect the performance of diffusion-weighted MRI values for fibrosis evaluation in patients with chronic hepatitis C genotype 4?

BACKGROUND/AIMS To evaluate the effect of hepatic steatosis on the apparent diffusion coefficient (ADC) of hepatic fibrosis in patients with HCV genotype 4-related chronic hepatitis. MATERIALS AND METHODS Overall, 268 chronic hepatitis C patients (164 males and 104 females) underwent liver biopsy for fibrosis assessment by the METAVIR score and grading for hepatic steatosis. They were classified into early fibrosis stage (F1, F2) and advanced fibrosis stage (F3, F4). Diffusion-weighted MRI (DWI) of the liver was performed using 1.5-Tesla scanners, and the ADC value of the patients with and without steatosis in different stages of fibrosis was estimated and compared. RESULTS In patients with early fibrosis, the ADC value significantly decreased in patients with steatosis (1.52±0.17×10-3 mm2/s) compared to that in patients without steatosis (1.65±0.11×10-3 mm2/s) (p<0.001). In those with an advanced stage of fibrosis, the ADC value was also significantly decreased in patients with steatosis (1.07±0.16×10-3 mm2/s) compared with that in patients without steatosis (1.35±0.11×10-3 mm2/s) (p≤0.001). The cutoff value for ADC for steatosis prediction in the early fibrosis group was 1.585 according to the AUROC curve, with a sensitivity of 76.8% and a specificity of 73.5%. The cutoff value for ADC for steatosis prediction in patients with an advanced stage of fibrosis was 1.17×10-3 mm2/s, with a sensitivity of 97% and a specificity of 88.5%. CONCLUSION Histologically detected hepatic steatosis should always be considered when assessing hepatic fibrosis using diffusion-weighted MRI to avoid the underestimation of the ADC value in patients with chronic hepatitis C genotype 4.

Association of interferon gamma gene polymorphism and susceptibility to hepatitis C virus infection in Egyptian patients: A multicenter, family-based study: Interferon gamma genetic polymorphism

Polymorphisms in some genes may influence the persistence of hepatitis C virus (HCV) infection, clinical outcome, HCV replication, and liver damage. This study was conducted to investigate the role of the interferon gamma (IFN‐γ) gene at (+874 T/A, −764 G/C, −179 C/A) single‐nucleotide polymorphisms (SNPs) and its receptor (IFN‐γR2) at (rs 2786067 A/C) SNP in the susceptibility of Egyptian families to HCV infection with high‐resolution techniques.

Diagnosis of cirrhosis in patients with chronic hepatitis C genotype 4: Role of ABCB11 genotype polymorphism and plasma bile acid levels

BACKGROUND/AIMS Chronic hepatitis C (CHC)-related mortality generally results from cirrhosis and subsequent complications. We aimed to investigate the potential role of plasma bile acid levels and ABCB11 1331T > C (V444A, rs2287622) (ATP-binding cassette subfamily B, member 11) gene polymorphism in fibrosis prediction in CHC genotype 4 patients. MATERIALS AND METHODS This case control study included 85 healthy control and the following 225 subjects: 170 adult patients infected with hepatitis C virus (HCV) and categorized into three groups according to liver biopsy; no fibrosis group (F0) (n=33), early fibrosis group (F1-F2) (n=61), and advanced fibrosis group (F3-F4) (n=76). Fasting bile acid levels, hepatitis C virus (HCV) genotyping, and ABCB11 1331T > C gene polymorphism were assessed. RESULTS The frequency of the variant homozygote genotype CC in advanced fibrosis was significantly higher than that in early fibrosis (48.7% vs. 36.1%) (odd ratio, OR =2.58; 95% confidence interval, CI=1.07-6.20; p=0.03). C allele was significantly represented in advanced fibrosis (65.8%) compared with that in early fibrosis (51.6%) (OR=1.80, 95% CI=1.10-2.93, p=0.01). A significant elevation of plasma bile acid levels in advanced fibrosis was observed compared with those in early fibrosis (p≤0.001). Receiver operating characteristic curve for plasma bile acid levels at cutoff value of 75.5 μmol/L had a 59% specificity and 97.4% sensitivity as a predictor of advanced hepatic fibrosis (AUROC=0.78%). CONCLUSION We concluded that Egyptian patients having chronic hepatitis C genotype 4 with CC genotype of ABCB11 SNP 1331T > C and high plasma bile acid levels at cutoff value of 75.5 μmol/L were associated with advanced hepatic fibrosis.

The Association of XRCC1 Gene Polymorphisms and Chronic Hepatitis C Induced Insulin Resistance in Egyptian Patients

Chronic hepatitis C is implicated in insulin resistance (IR) susceptibility. An X-ray repair cross-complementing group 1 gene (XRCC1) is proposed to be a candidate gene for a study of IR susceptibility. So, this study aims to investigate the possible association of the XRCC1 gene polymorphisms with the risk of IR related to chronic hepatitis C virus (HCV) infection in Egyptian patients. In a case-control study, a total of 210 subjects, including 140 chronic HCV patients (87 patients with IR and 53 without IR) and 70 healthy controls, were included. Two genetic polymorphisms (c.1254C > T and c.1517G > C) of the XRCC1 gene were genotyped via the PCR-restriction fragment length polymorphism (PCR-RFLP) technique. The result of the current study revealed that these two single nucleotide polymorphisms (SNPs) have statistically significant influences on susceptibility to IR in chronic HCV infected Egyptian patients. It could be concluded that c.1254C > T, the TT genotype, CT/CC carriers as well as c.1517G > C, the CC genotype and GC/GG carriers might be associated with increased IR susceptibility. Moreover, T-allele of c.1254C > T and the C-allele of c.1517G > C genetic variants might influence the susceptibility.

Prognostic factors for progression of simple steatosis to steatohepatitis in patients with persistent normal and elevated liver enzymes

Introduction Nonalcoholic fatty liver disease (NAFLD) is characterized by a wide spectrum of liver damage, ranging from simple macrovesicular steatosis to steatohepatitis [nonalcoholic steatohepatitis (NASH)], cirrhosis, and liver carcinoma. Aim This study assessed reliable markers of NASH such as clinical risk factors, levels of aspartate aminotransferase, alanine aminotransferase, and metabolic syndrome. Patients and methods Of 250 overweight/obese patients who were consecutively surveyed for fatty liver appearance by ultrasonography, only 99 patients with NAFLD agreed to undergo liver biopsy. Determination of liver transaminases, clinical and biochemical variables, and histological assessment were performed in all patients. Overweight and obesity were defined as BMI of 25 kg/m2 or more and 30 kg/m2 or more, respectively. Results The severity of inflammation and fibrosis was increased in patients with NAFLD and elevated enzymes, but no significant difference was found in the histological assessment when comparing them with patients with NAFLD and normal enzymes in terms of steatosis, inflammation, and fibrosis. A multivariate analysis using five parameters [obesity, diabetes mellitus, homeostasis model assessment insulin resistance (HOMA-IR), triglyceride levels≥150 mg/dl, and metabolic syndrome] selected on the basis of the results of the univariate analysis showed that only both HOMA-IR and metabolic syndrome were significant prognostic factors for progression from simple steatosis to NASH (risk ratio: 5.21, 95% confidential interval: 1.24–24.15, P=0.01 and risk ratio: 6.241, 95% confidential interval: 0.187–15.652, P<0.01, respectively). Conclusion Aminotransferase per se cannot be used as an alternative marker to assess progression of simple steatosis into NASH, and the presence of metabolic syndrome and HOMA-IR more than 2.7 were independent risk factors for this progression.

Utility of QuantiFERON-TB Gold In-Tube testing in the detection of latent tuberculosis in liver transplant candidates

Background The diagnosis of latent tuberculosis infection (LTBI) in liver transplantation candidates (LTC) is not well defined. Objective To evaluate the usefulness of the QuantiFERON-TB Gold In-Tube (QFT-GIT) compared with the tuberculin skin test (TST) for the diagnosis of LTBI and its risk factors in LTC. Patients and methods Patients were assessed for LTBI by TST using a purified protein derivative (PPD) or with QFT-GIT. LTBI was defined as either a positive TST or a positive QFT-GIT test. Results Of the 97 patients who underwent TST, 19 (19.59%) had a positive result. With the QFT-GIT test, 25 patients (25.77%) had a positive result and seven (7.22%) had an indeterminate result. The clinical risk factors for TB infection were identified in only two of the 19 TST-positive patients (10.5%) but were detected in six (24%) of QFT-GIT-positive patients and none of the QFT-GIT-indeterminate patients. The QFT-GIT test showed a sensitivity of 89%, a specificity of 89%, an accuracy of 89%, positive and negative predictive values of 68 and 97%, respectively. Out of the 10 patients with discordant results between both the tests, two patients had a positive TST but negative QFT-GIT, and no clinical risk factors for LTBI were found. Eight patients had a negative TST but positive QFT-GIT; of these, the clinical risk factors for LTBI were observed in two patients (25%). Conclusion This study showed that the QFT-GIT test might be more useful for the diagnosis of LTBI than TST among LTC on the basis of the frequency of clinical risk factors.