Risk factors for hepatitis C virus infection among Egyptian healthcare workers in a national liver diseases referral centre

Little is known about the prevalence of hepatitis C virus (HCV) among healthcare workers (HCW) in Egypt, where the highest worldwide prevalence of HCV exists. The prevalence of HCV, hepatitis B virus and Schistosoma mansoni antibodies was examined in 842 HCWs at the National Liver Institute in the Nile Delta, where >85% of patients are HCV antibody-positive. The mean age of HCWs was 31.5 years and they reported an average of 0.6±1.2 needlesticks/HCW/year. The prevalence of anti-HCV, hepatitis B surface antigen (HBsAg) and co-infection was 16.6%, 1.5% and 0.2%, respectively. HCV-RNA was present in 72.1% of anti-HCV-positive HCWs, and all but one subject were infected with HCV genotype 4. Schistosoma mansoni antibodies were present in 35.1%. The anti-HCV rate increased sharply with age and employment duration, but not among those with needlestick history. After adjusting for other risk factors, the anti-HCV rate was higher among older HCWs [P<0.001; risk ratio (RR) = 1.086, 95% CI 1.063-1.11], males (P=0.002; RR=1.911, 95% CI 1.266-2.885) and those with rural residence (P<0.001; RR=2.876, 95% CI 1.830-4.52). Occupation (P=0.133), duration of employment (P=0.272) or schistosomal antibody positivity (P=0.152) were not significant risk factors for anti-HCV positivity. In conclusion, although one in six HCWs had been infected with HCV, the infections were more likely to be community-acquired and not occupationally related.

Incidence of hepatitis C virus infection among Egyptian healthcare workers at high risk of infection

BACKGROUND

Hepatitis C virus (HCV) is a global health threat with Egypt having the highest worldwide prevalence. Evaluation of the efficacy of a preventive HCV vaccine, such as those currently in Phase I/II trials, requires a cohort with a high-risk exposure to HCV.

OBJECTIVE

To identify a reliable cohort for evaluating preventive HCV vaccines, we studied HCV incidence among HCW in a hospital where almost 85% of patients are HCV-infected.

STUDY DESIGN

Of 717 HCW negative for HCV-antibodies (anti-HCV) at baseline, 651 were followed up and tested for seroconversion twice annually for an average of 504 ± 154 days. Those reporting a needle-stick injury were additionally tested for both HCV antibodies and RNA monthly for a total of four months.

RESULTS

Two subjects (0.31%) had anti-HCV and HCV-RNA seroconversion with an overall incidence of 2.04/1000 person-years and a 4.8% incidence among the 21 subjects who reported a needle-stick injury. Two additional subjects had viremia without detectable anti-HCV. Two of the four subjects were among 21 with reported needle-stick injuries (9.5%) and another had surgery. All four were nurses providing direct patient care.

CONCLUSIONS

Our results show that both transient and persistent viremia were detectable in this high-risk cohort of HCW and suggest that absence of anti-HCV in two of the subjects may be due to low-dose viral exposures. These data indicate that HCV infections acquired from documented injuries during direct patient care are frequent in Egypt and can guide selection of eligible HCW suitable for preventive HCV vaccine trials.

Association of Toll-like receptor 3 and Toll-like receptor 9 single-nucleotide polymorphisms with hepatitis C virus persistence among Egyptians

Toll-like receptors (TLRs) give the innate immune system a considerable specificity for a large range of pathogens. TLR3 detects dsRNA of viruses while TLR9 recognizes bacterial and viral unmethylated CpG motifs. This study examined whether there is a potential association between single-nucleotide polymorphisms (SNPs) in the TLR3.rs3775290 (c.1377C/T), TLR9.rs5743836 (-1237T→C) and TLR9.rs352140 (G2848A) genes and HCV infection among Egyptian patients and healthcare workers (HCWs). We enrolled 546 subjects (409 HCWs and 137 patients) divided into four groups: group 1 included 265 seronegative, aviremic subjects; group 2 included 25 seronegative, viremic subjects; group 3 included 87 subjects with spontaneously resolved HCV infection; and group 4 included 169 chronic HCV patients. All subjects were genotyped for TLR3.rs3775290, TLR9.rs5743836 and TLR9.rs352140 SNPs by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) analysis. TLR3.rs3775290 "CC" genotype was associated with chronic HCV infection, where there was a significantly greater frequency of this genotype among chronic patients when compared to subjects with spontaneously resolved infection (63.9% vs. 51.9%; p = 0.033; OR = 1.639 and 95% CI = 0.94-2.84). However, this SNP did not correlate with the HCV RNA load among the chronic subjects (p > 0.05). There was no significant difference in TLR9.rs5743836 and TLR9.rs352140 genotype distribution between groups (p > 0.05). Lack of association between the three SNPs was found, as the three SNPs are located on two different chromosomes. In conclusion, the TLR3.rs3775290 "CC" genotype was associated with HCV chronicity, while the TLR9 gene may not play a major role in HCV infection.

Non-hospitalised COVID-19 patients have more frequent long COVID-19 symptoms

BACKGROUND: Long COVID-19 syndrome refers to the persistence of symptoms for more than 12 weeks after the start of acute symptoms. The pathophysiology of this syndrome is not yet clear.OBJECTIVE: To assess long COVID-19 symptoms in hospitalised and non-hospitalised patients.METHODS: A cross-sectional survey was used. The study included 262 patients who were divided into two groups based on their hospital admission history: 167 (63.7%) were not hospitalised, while 95 (36.3%) were hospitalised.RESULTS: Long-COVID was reported in 157 out of 262 patients (59.9%), and was significantly more frequent in non-hospitalised patients (68.3% vs. 45.3%; P < 0.001). During the acute phase, hospitalised patients had more respiratory symptoms (95.9% vs. 85.6%), while non-hospitalised patients had more neuropsychiatric symptoms (84.4% vs. 69.5%; P < 0.05). Constitutional and neuropsychiatric symptoms were the most frequently reported persistent symptoms in both groups, but all persistent symptoms were more frequent in the non-hospitalised group (P < 0.005).CONCLUSION: Long COVID-19 symptoms affect both hospitalised and non-hospitalised patients. Neuropsychiatric manifestations were the most common persistent COVID-19 symptoms. Rehabilitation and psychotherapy could be advised for all recovered COVID-19 patients. Non-hospitalised COVID-19 patients should be counselled to contact healthcare providers whenever needed.

Association of the polymorphism of the Toll-like receptor (TLR)-3 and TLR-9 genes with hepatitis C virus-specific cell-mediated immunity outcomes among Egyptian health-care workers

Variations in the immune response could explain resistance to hepatitis C virus (HCV) infection. Toll-like receptor gene (TLR)-3 is an innate detector of dsRNA viruses, and the TLR-9 gene recognizes bacterial and viral unmethylated cytosine-phosphate-guanosine (CpG) motifs. We previously reported that the TLR-3.rs3775290 CC genotype was associated with HCV chronicity and that the TLR-9 gene played no major role in this infection. This study identified the role of TLR-3.rs3775290 (c.1377C/T), TLR-9.rs5743836 (-1237T→C) and TLR-9.rs352140 (G2848A) gene polymorphisms in predicting the outcome of HCV-specific cell-mediated immunity (CMI) among Egyptian health-care workers (HCWs). We enrolled 265 HCWs in this study and divided them into four groups. Group 1: 140 seronegative-aviraemic HCWs; group 2: 20 seronegative-viraemic HCWs; group 3: 35 subjects with spontaneously resolved HCV infection; and group 4: 70 chronic HCV HCWs (patients). All subjects were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis for the TLR-3.rs3775290, TLR-9.rs5743836 and TLR-9.rs352140 single nucleotide polymorphisms (SNPs). We also quantified HCV-specific CMI in the four groups using an interferon (IFN)-γ enzyme-linked immunospot (ELISPOT) assay in response to nine HCV genotype 4a, overlapping 15mer peptide pools covering the whole viral genome. No statistically significant difference was found between CMI-responding subjects with different HCV states and TLR-3.rs3775290 or TLR-9.rs352140 genotypes. However, there was a significant relationship between the outcome of the HCV-specific CMI and the TLR-9.rs5743836 genotype among the responding subjects (P = 0·005) and the chronic HCV patients (P = 0·044). In conclusion, TLR-9.rs5743836 SNP, but not TLR-3.rs3775290 or TLR-9.rs352140 genotypes, could predict the outcome of HCV-specific CMI responses among Egyptians infected with genotype-4.

[A rare combination: persistent ductus arteriosus and pulmonary stenoses. Is there a correlation with rubella embryopathy?]

The combination of patent ductus arteriosus, valvular pulmonary stenosis and/or peripheral pulmonary stenosis is very rare. We examined 23 children with this entity. In 9 children there were findings suggestive of rubella syndrome. 17 of the 23 children were born predominantly between October and March. Most of them showed low birth weights. Regarding the cardiac involvement there was no difference between the children with signs of rubella syndrome and those without noncardiac manifestations. In many children the symptoms of the patent ductus are leading. On evaluation of the noninvasive diagnostic procedures the ECG showed often a right ventricular hypertrophy and the x-ray of the chest showed in most cases a cardiac enlargement. In all patients a heart catheterization was necessary to establish the diagnosis. The review of the literature and the interpretation of our findings seems to suggest that the combination of a patent ductus arteriosus with pulmonary stenosis is a typical manifestation of rubella infection in the heart.

Prevalence of vitamin D deficiency among patients attending Post COVID-19 follow-up clinic: a cross-sectional study

OBJECTIVE

Post-COVID-19 syndrome appears to be a multi-organ illness with a broad spectrum of manifestations, occurring after even mild acute illness. Limited data currently available has suggested that vitamin D deficiency may play a role in COVID-19 cases. However, to our knowledge, no study has examined the frequency of vitamin D deficiency in post-COVID-19 cases and its effect on the symptom severity. The aim of this study is to both screen the frequency of vitamin D deficiency in post-COVID-19 syndrome patients and to study its relation to persistent symptoms.

PATIENTS AND METHODS

A cross-sectional, single-center study was conducted involving all cases attending post-COVID-19 follow-up clinic from November 2020 to May 2021. Complete history, clinical examination, and laboratory analysis [kidney functions, serum calcium, C-reactive protein, serum ferritin, Serum 25-(OH) vitamin D] was done as well as HRCT chest.

RESULTS

The study included 219 post-COVID-19 cases, 84% had deficient vitamin D levels (< 20 ng/dL); 11.4% had insufficient level (20-30 ng/dL) and only 4.9 % reported normal level. There was no link between levels of vitamin D with either the acute or post-COVID-19 symptoms in the studied groups.

CONCLUSIONS

Despite the prevalence of vitamin D deficiency among the study population, no association was observed between the levels of vitamin D and post-COVID-19 symptoms. It appears that post-COVID-19 syndrome pathophysiology involves a more complex interaction with the immune system. Dedicated clinical trials are advised to better study vitamin D levels and the related disease severity in COVID-19 patients.

[Noninvasive diagnosis in the evaluation of shunt size in children with atrial septal defect--an evaluation scheme]

A cumulative score of five non-invasive diagnostic procedures is used to predict the size of the shunt in atrial septal defect (type II) in children. Each of those diagnostic managements being represented by zero, plus one, or two points: a higher score value refers to a more significant shunt volume. Summing up the points you will find 10 to 7 in an atrial septal defect that is worth being operated. In 6 and 5 points the prediction is unsure by scoring. Values of 4 or less points indicate a septal defect with no significant shunting. The validity of this scoring system has been tested in 35 children each examined by heart catheterization.

Hepatitis C Virus-specific immune response among needle-stuck Egyptian healthcare workers at high risk of infection without viremia or seroconversion (39.15)

Hepatitis C Virus (HCV)-specific cell-mediated immunity (CMI) was reported in exposed individuals e.g. IV drug users without seroconversion or viremia. We investigated the HCV-specific CMI response in seronegative, aviremic healthcare workers (HCWs) at the National Liver Institute who are at high risk of becoming infected with HCV after occupational exposure as more than 70% of their patients are HCV-infected. We quantified the CMI responses in 15 Egyptian HCWs with a recent history of a needle stick injury and who remained seronegative and aviremic for at least four months. We used ex vivo enzyme-linked immunospot (ELISPOT) assay to quantify interferon gamma (IFNγ) production in response to 7 HCV genotype 4 overlapping 15mer peptide pools and phenotyped the responding cells by flow cytometry. A positive HCV-specific IFN-γ responses (&gt;55 spot forming cells (SFCs)/million PBMC) was elicited for 2-6 HCV pools in 8 (53%) of the HCW while 7 (47%) subjects responded to one or none of the pools tested with a total mean of 1069 (SEM ±239) and 118 (±17) IFNγ SFC, respectively. In summary, the majority of HCW demonstrated HCV-specific T cell responses for multiple HCV peptides and remained uninfected despite their high-risk of exposure. These responses suggest that the percentage of subjects clearing the infection is much higher than reported and their potential role in protection from HCV infection is important for understanding HCV pathogenesis and vaccine development.

[Cor pulmonale as a sequela of tonsillar hypertrophy]

Cor pulmonale secondary to adenotonsillar hypertrophy is reported in two children. Repeated attacks of upper respiratory tract infection, snoring during sleep and finally signs of right heart insufficiency and mild cyanosis at exertion led to the diagnosis. Pulmonary hypertension was proved by electrocardiography, echocardiography and cardiac catheterization. Tonsillectomy and/or adenoectomy released the cardiac symptoms.

[Short- and long-term problems in dilatation of untreated aortic isthmus stenosis in children]

We examined problems and complications during and after balloon dilation of native coarctation of the aorta in 31 children with a mean age at first dilation of 5.77 +/- 5.4 years (0.08-16 years), who had a total of 37 balloon dilations. Twenty-six patients were restudied 3 to 24 months after the first procedure. In six patients, because of recoarctation, further dilations were performed. In two patients the second procedure was not successful and they required surgery. In 14/37 (37.8%) dilations the routine sedation was insufficient. The retrograde catheter could be introduced percutaneously in all but one patient. Because of small femoral arteries the introduction of the balloon catheter was not possible in three cases (8.1%). In three more patients (8.1%) the adequate catheters were not in stock. Complications included: transfusion because of blood loss in six patients (16.2%), chest pain in three (8.1%), rupture of balloon in three (8.1%), thrombectomy in three (8.1%), and partial reopening of ductus arteriosus in one patient. Duration of hospital stay was a mean of 1.81 days +/- 1.65 (range 1-9 days). Ninety percent of the patients were discharged within 2 days. On follow-up (range: 3-50 months), eight patients (21.6%) had a weak femoral pulse, of whom only one had an absent pulse, eight patients (21.6%) had paradoxical hypertension despite good dilation and no significant gradients, and only one patient showed a small aneurysm. We conclude that balloon angioplasty of native coarctation is a successful and relatively safe method of treatment of native coarctation. The most serious complication is arterial occlusion of the affected leg.(ABSTRACT TRUNCATED AT 250 WORDS)

[Thromboembolism as a complication of Pudenz-Heyer drainage with cardiac shunt]

We report the case of a 2.7 year old boy with ventriculoatrial Pudenz Heyer shunt for hydrocephalus internus presenting with symptoms suggestive of shunt infection. 2D-echocardiography showed a pedunculated right atrial thrombus that prolapsed through the tricuspid valve in diastole. Scintigraphy of the lungs showed multiple defects suggestive of embolism. The thrombus was excised after exploratory surgery with cardiopulmonary bypass. No organisms could be isolated from the thrombus. In ventriculo-atrial Pudenz Heyer shunt thrombi and embolism are possible complications. The regular use of 2D-echocardiography in order to detect these thrombi at a very early stage is discussed.