To determine the prevalence of antibody to hepatitis E virus (IgM anti-HEV) among haemodialysis patients and evaluate whether there was an increased risk of infection and exposure to HEV in an area of endemic viral hepatitis, serum samples obtained from 83 Saudi patients on chronic haemodialysis (group 1), 400 sex- and age-matched healthy subjects (group 2) and hospital patients (group 3) were tested for the IgM anti-HEV and IgG anti-HEV. The prevalence of anti-HEV among the patients (group 1) and the healthy controls were 4.8% and 0.3%, respectively. The difference (4.5%) was statistically significant, with a calculated odds ratio (OR) of 20.2 (95% CI = 2.1-481.0; P = 0.0002). In contrast, there was no significant difference in the prevalence rates of IgG anti-HEV (7.2% vs 10.8%) in both groups. In nonhaemodialysis patients with various diseases, 1.6% (1 of 64) of outpatients (group 3) and none (0 of 113) of the ward patients (group 4) was positive for IgM anti-HEV. Thus, the prevalence (4 of 83) of IgM anti-HEV in the haemodialysis patients was significantly higher than the rate (1 of 177) in the combined groups of nonhaemodialysis hospital patients. The calculated OR was 8.9 (95% CI = 0.92, 212.8; P = 0.037). IgM antibody to hepatitis A virus (IgM anti-HAV) was not detected in any subjects, and the prevalence rates of IgG anti-HAV were similar in the patients and controls (72.3% and 74.3% in groups 1 and 2, respectively, and 75.7% combined groups 3 and 4). The study indicated a significantly higher risk of acute HEV infection among patients on chronic haemodialysis. It is possible that these were nosocomial infections acquired by person-to-person transmission in the haemodialysis unit. However, it is more probable that the infections were community acquired, a conclusion supported albeit indirectly by the lack of a significant difference between the prevalence in haemodialysis patients (4.8%) and outpatients (1.6%). In areas of endemic HEV, appropriate strategies should be adopted to prevent the risk of HEV among haemodialysis patients.
Spontaneous bacterial peritonitis is a frequent and serious complication of liver cirrhosis. Its prevalence varies from one survey to another. There are only very few reports of its occurrence among Arab patients.We studied 115 Saudi Arabian patients with cirrhotic ascites in the Gizan region, an area of hyperendemic hepatitis B, over a 2-year period.Of these patients 12 (10.4%) had at least 1 episode of culture-positive spontaneous bacterial peritonitis (group A), an additional 34 (29.6%) had culture-negative neutrocytic ascites. The occurrence of spontaneous bacterial peritonitis was more frequent in males but was not influenced by the severity of liver disease or age. The overall mortality was 13.9%, however, only 1 patient died of spontaneous bacterial peritonitis-related cause. The remaining deaths were due to other complications of hepatic failure and portal hypertension. The low clinical threshold for treatment and the use of effective broad-spectrum antibiotics have reduced the mortality due to spontaneous bacterial peritonitis. There were a total of 56 recurrent episodes of infection in the patients. Of these episodes 46 occurred among 29 patients with spontaneous bacterial peritonitis and 10 among 62 patients with no infection during the index admissions.Prophylactic therapy against spontaneous bacterial peritonitis is a feasible strategy in reducing the frequency of recurrent peritonitis and should be recommended in these patients.
Background: Studies of recipients most of whom had been infected prior to transplantation, had yielded conflicting conclusions in regard to the clinical impact of hepatitis C virus [HCV] infection. We determined the frequency of new HCV infection and assessed its effect on patient and graft survival and occurrence of chronic hepatitis in renal transplant recipients. Methods: We studied 54 Saudi recipients [37 males and 17 females; mean age (SD); 38.2(17.1) years] they were anti- HCV negative at the time of transplantation and followed for 3 to 19 years [mean = 8.1]. The prevalence of anti-HCV at the time of censorship was compared with the rates in 99 hemodialyzed patients, 400 healthy volunteers and 113 hospitalized patients. Results: The period prevalence of anti-HCV in recipients was 37% [20 of 54], compared to hemodialyzed patients [17.1%], hospital patients [1.8%] and healthy volunteers [2.3%]. [P < 0.01]. Seroconversion to anti-HCV positivity occurring from 2 to 11 years [mean =7.8] after transplantation and was not influenced by age, gender or source of donor kidney. Cumulative frequency of HBsAg was 14.8%. Graft loss occurred in 1 HCV positive recipient. Serum aminotransferase was abnormal [>2 - fold elevation] in 2 anti-HCV positive recipients transiently. No deaths occurred among the recipients. Conclusion: The acquisition of new HCV infections had a relatively high frequency among renal transplant recipients in the study. The course of the infection was benign in the medium term, with no discernible progression to clinically recognized chronic liver disease. Further studies are required to determine cost- benefit of antiviral therapy in such patients. Sudan Joural of Medical Studies Vol. 2 (1) 2007: pp. 9-16
We describe the clinical patterns and case-fatality rate associated with severe Rift Valley fever (RVF) in patients who were admitted to the Gizan regional referral hospital during an outbreak of RVF in Saudi Arabia from September through November 2000. A total of 165 consecutive patients (136 men and 29 women) were prospectively studied; all were identified according to a strict case definition, were confirmed to have RVF by serologic testing, and were treated according to a predetermined protocol. The major clinical characteristics of RVF included a high frequency of hepatocellular failure in 124 patients (75.2%), acute renal failure in 68 patients (41.2%), and hemorrhagic manifestations in 32 patients (19.4%). Sixteen patients had retinitis and 7 patients had meningoencephalitis as late complications in the course of the disease. A total of 56 patients (33.9%) died. Hepatorenal failure, shock, and severe anemia were major factors associated with patient death.
Located in the south western part of Saudi Arabia, the Gizan region is largely a rural community in which hepatitis B and chronic liver disease including hepatocellular carcinoma are highly prevalent.To determine the relative frequencies of acute hepatitis A, B, C and E in acute viral hepatitis in an area of hyperendemic hepatitis B infection.In a prospective study 246 consecutive patients (179 males and 67 females) diagnosed in a 2-year period were tested for markers of Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C (HCV) and hepatitis E virus (HEV).Of the patients tested, 131 (53.3%) were children ( < 10 years), and 42 (17%) were 11 - 20 years in age. Ig M anti -HAV, IgM anti-HBV, anti- HCV and IgM anti-HEV were positive in 37%, 19.1%, 3.7% and 13.7% respectively. Markers of these viruses were absent in 24.4%. Among 131 children (< 10 years) the commonest cause of AVH was HAV occurring in 57.3% of the cases. In adults (> 21 years) HBV was found in 35.6% and IgM anti -HAV was detected in only 6.8%. In contrast to the age- related decline in the frequency of acute HA, the proportion of acute HE were similar in all age groups (13.7% in children, 16.7% in adolescents and 11.0% in adults).The study indicated that HAV is still a common cause of AVH particularly among children in Gizan. Acute 1-113 had a low occurrence among the children, evidently as a consequence of the integration of HB vaccine into the Saudi Arabian national EPI, 10 years ago. With the availability of combined HB and HA vaccines, It should be possible to graft the vaccination against HAV on to the existing program in Saudi Arabia. Affecting 13.4% of the group studied, sporadic HEV constitute a significant cause of AVH in this population. Until HEV vaccine becomes widely available, its prevention would be mainly by the improvement of socio - economic and hygienic standards of the population.
Abstract Background and Aim: To estimate the risk of hepatocellular carcinoma (HCC) in non‐alcoholic patients with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, 118 patients who were admitted to a regional hospital in Saudi Arabia were compared with 118 age‐ and sex‐matched healthy individuals. Results: The prevalence of HBsAg in HCC patients (67%; 95% confidence interval (CI): 57.7–75.3) was significantly higher than the rate (6.7%; 95%CI: 3.0–12.9) in the controls (OR: 28.4; 95%CI: 12.6–63.9; P < 0.001). There was a high risk of HCC in the presence of HBsAg alone (OR: 34.3; 95%CI: 14.8–79.1, P < 0.001) and anti‐HCV alone (OR: 12.2; 95%CI: 3.2–47.2; P < 0.001). Although HBV and HCV were independent risk factors in the development of HCC, there was no interactive relationship between the two viruses. Dual infections occurred in only 3.4% and were associated with only a moderate increase in the risk of HCC (OR: 14.6; 95%CI: 1.57–135.9). In 24.6% of the cases no virus was identified as the etiologic factor. Conclusion: Hepatitis B virus constitutes a major risk factor and HCV contributes a less significant role in the development of HCC. The ongoing program of HBV vaccination may significantly decrease the prevalence of HBV‐associated HCC in this population.
Hepatitis B virus (HBV) infection is endemic in the Kingdom of Saudi Arabia (KSA). The Jizan region in the South-Western area of the country was noted for a high prevalence of hepatitis B surface antigen (HbsAg) carrier rate. The study was carried out to determine the prevalence of HBsAg and other markers of HBV among residents of Jizan and evaluate the impact of the measures adopted in the last decade, to control HBV.The study was carried out between 1995 and 1998. The subject were studied in 4 groups: Group A consisted of voluntary blood donors (n=14883) tested within the blood banking system during the time period June 1995 to June 1997, Group B were patients treated in the hospitals (n=4692) during the period June 1995 to June 1996, Group C consisted of volunteers recruited from the community (n=1172) and Group D children aged <10 years (n=229). Serum samples were obtained from the subjects tested for HBsAg, total antibody to hepatitis B core antigen, antibody to HBsAg and antibody to hepatitis C virus.Hepatitis B surface antigen was positive in 5.4% of 14883 voluntary blood donors (Group A) and in 5.1% of 1172 persons recruited from the community (Group C) 40.2% were positive for at least one marker of HBV. The prevalence of HBsAg in-patients in Group B was 9.7% (456 of 4692). These prevalence rates are significantly lower than the prevalence of 12% and 32% reported in 1985 and 1986. Only 2 (0.9% of 229) children in Group D were positive for HBsAg, indicating a major decline from the rate of 8.8% observed in an earlier survey.The low prevalence of HBsAg in children, provides evidence for the effectiveness and efficacy of the integration of hepatitis B vaccination into the extended program of immunization in KSA. The significant decline of HBV markers among unvaccinated Saudi adults indicated an indirect effect of other factors (for example health education and socio-economic progress) on the prevalence and transmission of HBV in Jizan. In areas of high endemicity, the epidemiological characteristics HBV are modified significantly by the combination of HBV vaccination and other complimentary control strategies.
Hyperlipidemia especially low density lipoprotein cholesterol (LDL-C) is a major risk factor for developing ischemic heart disease. Soluble dietary fiber has lipid lowering characteristics. Gum Arabic (GA) is 95% soluble fiber calculated on dry bases. The beneficial effect of GA on lipid profile needs further verification. A case ─ control study was conducted at Omdurman Hospital, Sudan to assess the effect of G A on serum lipids in patients with hyperlipidemia. Cases received a 20 mg tablet of atorvastatin /day plus 30 mg of GA for four weeks while the controls received atorvastatin only. Levels of lipids in serum were assessed according to conventional methods before and one month after the trial. There is no significant difference in the basic characteristics between the study and the control groups (55 patients in each arm of the study). While there was no significant difference in the levels of HDL, there was a significant reduction of the total cholesterol (25.9 vs. 7.8%, P < 0.001), triglyceride (38.2 vs. 2.9%, P < 0.001) and LDL (30.8 vs 8.1%, P< 0.001) before and after the intervention in the study compared to the controls groups.
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