Obesity is an ignored health problem in all countries; there are a lot of health problems related directly or indirectly to overweight and obesity. The incidence of COVID-19 with social isolation and technological development in recent years strongly contributed to a progressive increase in obesity. . Assess the pattern of the 3 divisions of physical activity and sedentary behaviors in obese patients. Physical inactivity is a significant concern, especially among individuals with obesity and certain demographic characteristics. Addressing these factors and promoting physical activity interventions tailored to specific populations is essential in combating sedentary behavior and its associated health implications.This case-control study included 350 adult obese patients (BMI >= 30) and 75 people with normal BMI (18.5-24.9). Their sociodemographic data were analyzed and their pattern of physical activity related to work, movement to and from places for 10 minutes, and pattern of recreational activity were assessed, in addition to the assessment of the sedentary behaviors. The mean age of the study group was 34 years, the majority were females, educated, and working. Forty five percent of the total sample were physically inactive; the pattern of activity during travel to and from places (10 min) was lower in obese patients. Recreational activities were low in the studied population, in the present study the time spent sitting or reclining (except sleeping) was significantly higher among obese participants than controls (P <= .001). Obesity, urban residence, unemployment and illiteracy were independent risk factors for physical inactivity.

The pandemic of COVID-19 is a traumatic event with distressing implications for mental health and several aspects of life. This study aimed to assess Post-traumatic Stress Disorder (PTSD) and Health-Related Quality of Life (HRQoL) among patients who experienced mild-to-moderate COVID-19 and their household contacts. This cross-sectional descriptive study was conducted between May 2020 and November 2020, in Ismailia and Suez governorates. A convenient sampling method was used. The sample size was calculated according to the prevalence of PTSD in COVID-19 patients to be 200 adult participants from both sexes, 100 patients with history of recent COVID-19 infection (up to 2 months after recovery) and their close family. COVID-19 was confirmed by a nasal swab sample tested by PCR in addition to suggestive symptoms and/or positive computed tomography lung findings. Data was collected by using the Arabic version of the Post-Traumatic Stress disorder checklist 5 (PCL5-PTSD) and the Arabic version of Health-Related Quality of Life (HRQoL). The questionnaire was collected through interviews at the Endemic and Infectious diseases and Family medicine outpatient clinics. Of the 200 studied participants, evidence of PTSD was found in 112 (56%) participants; all COVID-19 cases and 12 of their close-contact relatives. Impaired HRQoL was evident in 107 (53.5%) participants; all the COVID-19 cases and 7 contacts. The mean values total scores of the PTSD and HRQoL and its domains were significantly higher among cases compared to their contacts. The most frequently impaired domain was social (55%), psychological (54.5%), impairment (53.5%) followed by physical (48.5%) and the least was health perception (33.5%). The mean values of PTSD, HRQoL and their domains were significantly higher among participants who recalled respiratory symptoms and who had comorbid illness. The odds ratio of PTSD and HRQoL was 0.27 (95% CI: 0.2-0.36) and 0.3 (95% CI: 0.23-0.39) in participants who had more than a case of COVID-19 within their families. All the studied COVID-19 participants showed PTSD and impaired HRQoL, compared to 12% and 7% of their contacts, respectively. Past COVID-19 was associated with impairment of all domains of HRQoL and the most affected were the physical, psychological and impairment domains.

Background: End-stage renal disease (ESRD) is an increasing health problem worldwide. Older age, diabetes and hypertension, acute kidney damage are among some of the factors that play a role in ESRD. This study aims at exploring liver morbidity (LM) among hemodialysis (HD) patients in an endemic country. Methods: The study included 142 patients aged 12 to 75 years; 53.5% were males. Data were retrieved from files and all participants were examined by abdominal ultrasonography and tested for liver functions and markers and viremia of HCV and HBV. Results: Three patterns of LM were found in 62 (43.7%); fatty in 30, fibrous in 19 and hepatitis in 13. The duration of renal impairment (p=0.02), duration of hemodialysis (p=0.011), and total dialysis sessions (p=0.007) were associated with LM. ALT and AST >40 IU/L levels were elevated in 9.9% and 9.2% of patients. All 14 patients with high ALT showed evidence of LM (p=0.017) compared to 4 of 13 patients with elevated AST (p<0.001). The ROC curve revealed ALT and AST cut-off points of 16.5 and 25.5 IU/L to discriminate LM. According to the new values, 58.5% and 40.1% of the studied participants had high ALT and AST. Conclusion: LM is common among EDKD patients undergoing hemodialysis despite the limited role of ALT and AST. The use of ultrasonography and the new lower levels of ALT and AST could improve the screening approach of LM.

Objectives Haemodialysis (HD) patients are at risk for blood-borne infections as occult HCV infection, which justifies comprehensive studies. We aimed to determine the prevalence and risk factors of occult HCV infection (OCI) among HD patients. Material and methods One hundred eligible HD patients, with no evidence of overt HCV or HBV and HBV vaccinated were recruited, and tested for HCV, HBV markers and HCV RNA. Two HCV-positive patients were excluded and peripheral mononuclear cells of 98 patients were verified for viraemia. Results OCI was detected in eight (8.16%); with a median viral load of 7010copies/ml. Their mean age was 30.63 (+/- 18.87 years) compared to others (41.73 +/- 15.93) (p = .069). History of surgery, dental procedure, and blood transfusion was comparably high in both groups (p > .05). All OCI patients underwent dialysis twice weekly compared to 48.9% of non-OCI patients (p = .006). OCI patients had a significantly higher mean duration of dialysis (12.63 +/- 6.74 years), and a significantly higher frequency (50%) of HCV Ab compared to 6.48 +/- 4.76, and 10%, respectively, in non-OCI patients. None of OCI patients was reactive to HBcAb compared to 34 (37.8%) patients without (p = .048). Evidence of liver morbidity was detected in 5 (62.5%) OCI patients compared to 43 (47.7%) of non-OCI patients (p > .05). Conclusion Among our HD patients, OCI is considered a comorbid finding associated with mild liver morbidity that warrants strict infection control and periodic testing for blood borne infections.

Background and study aim:Patients with decompensated cirrhosis suffer from serious sequelae including infections that may endanger life. The study aimed at determination of the incidence, outcomes and risk factors of spontaneous bacterial empyema (SBEM) among patients with cirrhotic ascites and hydrothorax. Patients and Methods: This study included 50 patients subjected to clinical, imaging and biochemical workup including diagnostic tapping of ascitic and pleural fluid to diagnose spontaneous bacterial peritonitis (SBP) by cellular count and SBEM by cellular count and culture. Results: There The mean age was 57.14 years and 52% were males. SBP was found in 25 cases (50%); alone in 15 and with concomitant SBEM in 10. Only 7 (14%) had positive culture of the pleural fluid including five gram positive bacteria. Patients SBP and SBP/SBEM had significantly higher mean age, higher median TLC, and corrected PMN in pleural fluid compared to patients with no infection. The infection group stayed a significantly more duration in hospital. All the four deaths occurred in the infection group, three with SBP/SBEM and one with SBP. By multivariate logistic regression analysis, pleural fluid TLC and corrected PMN and duration of hospital stay were significant independent predictors of SBEM. Conclusion: SBEM is a common sequel of hydrothorax in patients with cirrhotic ascites and its coexistence with SBP leads to higher morbidity and mortality.

Background: Allergic rhinitis and asthma are common disorders that often go undetected in the primary-care setting. As no local study was available for northern regions, we carried out the study to estimate the prevalence of allergic manifestations of rhinitis and bronchial asthma and risk factors of asthma. Methodology: This cross-sectional study invited 450 male students from three high schools in Skaka, Aljouf, KSA. Of all, 380 responded to a self-administered Arabic questionnaire with a response rate of 84.4%. Data inquired age, academic year, exposure to animals, smoking status, present and family history of allergy, and manifestations of allergy of skin, eye, nosopharynx, and chest. Allergic rhinitis was diagnosed if two or more manifestations were present. Asthma was diagnosed if wheezes or cough occurred at night or with physical activity that may be precipitated by infection, exposure to dust, or pollens or smokes. Results: The mean age of respondents was 16.9 years. Of all, 13.2% were current smokers, 6.1% ex-smokers, and passive smokers represented 46.3%. Family history of allergy was given by 35%, while previous diagnosis of allergy was given by 99 (26.1%). Allergic rhinitis was found in 33.2%, asthma in 37.4%. Of all asthmatic, 49.3% had allergic rhinitis, 21.6% had allergic conjunctivitis, 8.9% skin itching and rash. The number of daily cigarettes and duration of smoking were significantly associated with asthma, while raising animals showed no such association. Conclusion: This study demonstrates a high prevalence of asthma, allergic rhinitis, and smoking among secondary school students in Aljouf region, despite the effort paid by the Ministry of Health to improve asthma awareness and promote best practices in its management. This urges the need for a comprehensive and sustained program for early diagnosis and appropriate management of asthma and allergy among adults.

Hepatitis B vaccination of newborns (HBV) and surveillance of pregnant women during antenatal care are complementary to prevent mother to child transmission (MTCT) of HBV infection. The aim was to identify the prevalence and pattern of HBV infection in pregnant women born before and after implementing HBV vaccination of newborn in Egypt. The study included 600 women attended antenatal clinic of the Suez Canal University Hospital, Ismailia, Egypt. All were inquired about risk factors of HBV infection, vaccination, and screened for hepatitis markers. HBsAg carriers were tested for HBeAg, HBeAb, ALT, and HBV DNA. Participants were divided into group 1 of 285 (47.5%) vaccinated women ≤ 25 years, and 315 (52.5%) non-vaccinated > 25 years. The prevalence of HBcAg, HBsAg, and HBsAb were 18.3%, 5.0%, and 30.7%. Of the 110 women exposed to infection, 40 (36.4%) cleared infection, 30 (27.2%) were HBsAg carriers, and 40 (36.4%) showed isolated HBcAb. HBsAg carriers were HBeAg negative, HBeAb positive, and HBV-DNA positive and had high ALT. Group 1 had significantly higher frequency of vaccination-related immunity, lower frequency of isolated HBcAb, and susceptibles than group 2 (44.9%, 3.5%, and 38.6% vs. 4.1%, 9.5%, and 75.9% ). The prevalence of HBV exposure and chronic HBsAb carriers in both groups were close (4.9% and 16.5% for group 1 vs. 5.1% and 20% for group 2, p > 0.05). Although the outcomes of HBV infection were favorable in vaccinated group, chronic HBV represents a potential risk for MTCT that necessitates screening during pregnancy in all public health care settings.

Hepatitis B Virus has been recognized as an important occupational risk for health-care personnel (HCP) as the virus remains infectious for prolonged periods on environmental surfaces and is transmissible even in the absence of visible blood. Health care personnels (HCPs) who are in contact with blood or body fluids should be vaccinated against hepatitis B. HepB vaccine should administered intramuscularly into the deltoid muscle on a 0, 1, and 6-month schedule followed by HBsAb titre measurement. The protective level of anti-HBs should be ≥ 10mIU/mL. Booster doses of hepatitis B vaccine are not necessary, and periodic serologic testing to monitor antibody concentrations after completion of the vaccine series is not recommended. Hepatitis B immune globulin (HBIG) provides passive anti-HBs and temporary protection lasts for 3-6 months and can be used together with HepB vaccine for postexposure prophylaxis. Vaccinated HCPs who have written documentation of a complete HepB vaccine series (≥ 3 doses) with documented anti-HBs ≥10mIU/mL, are immune and not in need for specific post exposure measures for HBV, whatever the source patient’s HBsAg status.

Background: Major hydrophilic region in genomic HBV extending from aa99 to aa169, clustered with a highly conformational epitope, is critical to the antigenicity of hepatitis B surface antigen (HBsAg) and may affect the diagnosis of HBV in HBV screening test. So, this study aimed to characterize variants of S gene product of hepatitis B virus (HBV) isolated from patients with overt or occult HBV infection in north-eastern Egypt.Methods: The study included sera of two different groups of volunteer blood donors (VBDs), 82 with overt HBV that were positive for HBsAg and anti-HBc and 343 donors negative for HBsAg eligible for donation. Of the latter group, only 44 were positive for anti-HBc. All anti-HBc positive sera were subjected to HBV DNA detection and partial sequence analysis targeting the HBV S gene.Results: HBV DNA was detected in 22.7 % of HBsAg/anti-HBc + (10/44 patients) and in 90 % of HBsAg + donors (74/82 patients) with significant statistical difference (P = 0.0001). Phylogenetic analysis showed that HBV strains retrieved from both groups were of genotype D. Amino acid escape mutation T125M was detected in only 2 samples of the occult infection group and in none of the overt group (P = 0.01). Different amino acid substitutions were identified in overt infection group: S143L/T (16.2 %, 12/74) and P120T/S (2.7 %, 2/74). Q129R was significantly more frequent in cases with occult HBV infection (40 %, 4/10) than overt group (6.8 %, 5/74) (P = 0.01).Conclusions: HBV genotype D predominated both in patients with overt and occult HBV infection. Different profiles of amino acid substitutions in the major hydrophilic region were seen in these two groups in Egypt.

(RBV) therapy for 24 or 48 weeks [2] . The goal of such a treatment is to reach the Sustained Virological Response (SVR), defined as undetectable HCV RNA in the serum after 24 weeks of post treatment follow-up. The achievement of SVR after therapy can prevent liver-related complications and improves survival [3] . However, less than 50% of patients infected with HCV genotype 4 achieve SVR or are cured of the infection following this type of therapy [4] . A number of host and viral factors have been linked to the response to therapy [5] . Recent studies have revealed a genetic polymorphism in the region of the interleukin 28B gene (IL28B) encoding IFN-lambda that is strongly associated with viral clearance following PEGIFN-a /RBV therapy [6] .

Chronic hepatitis C virus (HCV) infection combined with occult hepatitis B virus (HBV) infection has been associated with increased risk of hepatitis, cirrhosis and hepatocellular carcinoma. This study aimed to determine the prevalence of occult HBV infection among Egyptian chronic HCV patients, the genotype and occurrence of surface gene mutations of HBV and the impact of co-infection on early response to treatment. The study enrolled 162 chronic HCV patients from Ismailia Fever Hospital, Egypt, who were HBV surface antigen-negative. All patients were given clinical assessment and biochemical, histological and virological examinations. HBV-DNA was detectable in sera from 3 patients out of the 40 patients who were positive for hepatitis B core antibody. These 3 patients were responsive to combination therapy at treatment week 12; only 1 of them had discontinued therapy by week 24. HBV genotype D was the only detectable genotype in those patients, with absence of "a" determinant mutations among those isolates.

Objectives: A chronic liver disease has a terrible impact on the quality of life of the patients. Such impact could be attributed to annoying symptoms and signs or complications that could affect QOL.This study was aimed at assessing Health Related Quality of Life (HRQOL) among patients with chronic liver disease (CLD) and identifying factors that might affect their Quality of Life.Methods: A cross-sectional study design was conducted on 172 adult patients (>18 years) of both genders, with chronic liver disease attending Family Practice Clinic of Suez Canal University Hospital, Ismailia, Egypt between 2008-2009. A designed questionnaire was used to identify the socio-demographic data, clinical manifestations of CLD, severity of the disease and other co-morbidities. Another questionnaire was used to assess the HRQOL in patients with CLD. The questionnaire included 33 questions divided into five domains (physical, social, psychological, impairment and health perception). Answers to these questions had a scale from 1 (best) to 7 (worst). Impaired QOL was considered at the cut off point of 50%.Results: The present study showed that QOL of the majority of the studied population (83%) was affected (QOL score >50% of maximum score). Health perception and physical domain were the most affected. Patients with DM as co-morbid disease were more affected in their QOL than others.Stepwise regression analysis showed that total score of quality of life was linked to some independent parameters such as illiteracy, having a severe form of CLD and having ascites or abnormal portal vein (P<0.05).Conclusion: Quality of life was affected in patients with CLD. It is evident that co-morbid DM, smoking, presence of cirrhosis and severity of the disease might increase the impairment of the QOL. Such impairment might be explained partially because other variables (which were not addressed in the current study) may play a role in alteration of QOL rather than CLD. Health education regarding the negative impact of smoking on liver disease and control of diabetes mellitus are of high priority during the daily care of patients with CLD. Training of Family physicians about QOL and its related issues in daily practice is crucial for patients with chronic illnesses particularly those with CLD.

Schistosomiasis has been incriminated in the significant increase in hepatitis C virus (HCV) infections, although the association has not been adequately explained. We hypothesized that the CCR5Δ32 mutation may be involved in the high prevalence of HCV with schistosomiasis. The aim was to explore the association between the CCR5Δ32 mutation in schistosomiasis patients and protection against HCV infection or progression. We compared 220 schistosomiasis patients (S group) and 190 patients with HCV and schistosomiasis (HCV/S group) for the presence of the CCR5Δ32 mutation. Clinical, biochemical, and radiological assessments were done. HCV infection was diagnosed with anti-HCV antibodies and a recombinant HCV antigen-based rapid immunochromatographic test, and confirmed by HCV reverse transcriptase PCR. HCV genotyping was done by reverse hybridization line probe assay. Schistosomiasis was diagnosed by FAST-ELISA and indirect hemagglutination for Schistosoma mansoni antibodies, and stool analysis for ova. Polymorphisms of the CCR5 receptor gene were assessed by PCR-based genotyping of the 32-bp deletion at the CCR5 locus in whole blood. Of HCV/S patients, 91.6 vs. 91.8 % of S patients had CCR5 WT/WT homozygosity (nonmutants). Heterozygous and homozygous CCR5Δ32 mutation patterns (CCR5Δ32/WT and CCR5Δ32/Δ32) were distributed similarly in the HCV/S and S groups (6.8 vs. 7.2 % and 0.53 vs. 0.90 %, respectively; p > 0.05, OR = 0.97). Genotype 4 was the predominant viral genotype (93 % of cases). No differences were observed in CCR5 gene patterns according to viral genotype, viral RNA count, or ALT level. However, CCR5Δ32 mutants (homozygous and heterozygous) had a lower rate of severe hepatic fibrosis vs. nonmutants (27 vs. 42 %, p = 0.101, OR = 0.51). Moreover, 53.4 % of CCR5Δ32/WT mutants showed spontaneous viral clearance vs. 26.2 % of nonmutants (p = 0.000, OR = 4.1). In conclusion, no association was detected between the CCR5Δ32 mutation and HCV disease susceptibility in schistosomiasis patients. However, patients with the CCR5Δ32 mutation and HCV infection were less prone to severe hepatic fibrosis and more likely to have spontaneous viral clearance than patients with the nonmutant genotype.

Background: A strong association between single nucleotide polymorphisms (SNPs) of IL28B and treatment outcomes of pegylated interferon-alpha (PEG IFN alpha) and ribavirin (RBV) has been shown in chronic hepatitis C (CHC) patients with genotype 1. Aim: This study aimed to assess two SNPs of IL28B, rs12979860 and rs8099917, in predicting sustained virological responses (SVR) to treatment of CHC patients with genotype 4 (HCV-4). The value of rs8099917 was investigated in carriers of unfavourable genotypes of rs12979860. Methods: This study included 119 CHC patients with HCV-4 receiving combination therapy. Both SNPs of IL28B were determined by real-time detection polymerase chain reaction. Results: Genotypes CC/CT/TT of rs12979860 were found in 42 (35.3%), 56 (47.1%) and 21 (17.6%) and rs8099917 TT/TG/GG were found in 74 (62.2%), 40 (33.6%) and 5 (4.2%). In carriers of rs12979860 CC and rs8099917 TT, the rate of SVR was 87.5 and 65.7% respectively. In 54 patients heterozygous for the C allele of rs12979860, testing of rs8099917 revealed SVR in 42.3% of carriers of the TT genotype but no such responses in carriers of TG or GG (P < 0.0001, OR = 47.3, 95% CI: 2.33-767.2). By multivariate analysis, predictors of SVR were baseline ALT (P = 0.014, OR = 6.3, 95% CI: 1.45-27.33), rs12979860 CC (P = 0.001, OR = 13.48, 95% CI: 2.95-61.69) and rs8099917 TT (P = 0.027, OR = 7.5, 95% CI: 1.25-44.88). Conclusion: In CHC genotype 4 patients, favourable genotypes of both SNPs of IL28B are valuable for predicting SVR. Additional genotyping of rs8099917 in carriers of the heterozygous C allele of rs12979860 can improve the prediction of SVR.

The transmission rate of intra‐familial hepatitis B virus (HBV) and mode of transmission were investigated in north eastern Egypt. HBV infection was investigated serologically and confirmed by molecular evolutionary analysis in family members (N = 230) of 55 chronic hepatitis B carriers (index cases). Hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti‐HBc) prevalence was 12.2% and 23% among family members, respectively. HBsAg carriers were prevalent in the age groups; <10 (16.2%) and 21–30 years (23.3%). The prevalence of HBsAg was significantly higher in the family members of females (19.2%) than males (8.6%) index cases (P = 0.031). HBsAg and anti‐HBc seropositive rates were higher significantly in the offspring of females (23%, 29.8%) than those of the males index cases (4.3%, 9.8%) (P = 0.001, 0.003), as well as higher in the offspring of an infected mother (26.5, 31.8%) than those of an infected father (4.7%, 10.5%) (P = 0.0006, 0.009). No significant difference was found in HBsAg seropositive rates between vaccinated (10.6%) and unvaccinated family members (14.8%). Phylogenetic analysis of the preS2 and S regions of HBV genome showed that the HBV isolates were of subgenotype D1 in nine index cases and 14 family members. HBV familial transmission was confirmed in five of six families with three transmission patterns; maternal, paternal, and sexual. It is concluded that multiple intra‐familial transmission routes of HBV genotype D were determined; including maternal, paternal and horizontal. Universal HBV vaccination should be modified by including the first dose at birth with (HBIG) administration to the newborn of mothers infected with HBV. J. Med. Virol. 84:587–595, 2012. © 2011 Wiley Periodicals, Inc.

Purpose: The term "Cirrhotic cardiomyopathy" has been given to describe the cardiac structural and functional abnormalities found in cirrhotic patients.As ascites develops, the quality of life usually becomes worse.Some patients develop dyspnea, palpitation, dizziness and hemodynamic instability.Therefore, this study aimed to explore some cardiac functions in post-viral cirrhosis; namely the systolic and diastolic functions by Doppler echocardiography, the prevalence of prolonged QT interval by conventional electrocardiogram and evidence of myocardial ischemia by singlephoton emission computed tomographic (SPECT) stress imaging.Methods: The study was conducted in Suez University Hospital.The cohorts were 40 cirrhotic patients (27 M and 13 F, mean age of 59.7±6.10),20 of them had ascites.Cirrhosis was due to HCV in 37 (92.5%) and HBV in 3 (7.5%).No evidence of schistosomal liver disease was found by ultrasonography.The controls were 10 healthy volunteers (5 M and 5 F, mean age=57.8±5.0).Results: Compared to controls, cirrhotics had lower mean arterial blood pressure (p=0.0421),lower cholesterol, LDL and triglycerides (p=0.0001 for each) and HDL (p>0.05).Cirrhotics had normal left ventricular dimensions and significantly enlarged right ventricular dimensions (P0.440 seconds) was found in 18/40 patients (45%) vs 1/10 controls (10%) (p=0.041) with no relation to the severity of liver disease.A mild perfusion defect was found in only 1/40 cirrhotic (2.5%) vs 2/10 controls (20%) (p=0.097).Conclusion: Cirrhotic patients showed right ventricular enlargement, normal left ventricular dimensions and normal systolic function.However, patients with ascites were more likely to have diastolic dysfunction.Although prolonged QT interval is common in cirrhotic patients, myocardial ischemia seems to be uncommon. 1160

UNLABELLEDThe objective of this population-based study was to estimate the liver morbidity attributable to Schistosoma mansoni infection by ultrasonography adopting the proposed standard protocols of the Cairo Meeting on Ultrasonography, 1991. We examined 2384 individuals representing 20% of the households of the rural population of the Ismailia Governorate, East of Delta, Egypt. Prevalence of S. mansoni and S. haematobium infections were 40.3% and 1.7% respectively. Portal tract thickening (PTT) grade 1, 2 and 3 considered diagnostic of schistosomal liver morbidity was detected in 35.1%, 1.3 and 0.2 individuals respectively. Generally, ultrasonographically-detected pathological changes increased with age, but correlated with intensity of infection only in age group 20-59 years. Comparing individuals with and without S. mansoni infections in an endemic and a non-endemic community indicated no significant difference between the former and the latter in either case.IN CONCLUSIONultrasonography had a limited value in estimating schistosomal liver morbidity in our population-based study where early grades of liver morbidly were prevalent. The criteria of diagnosing grade I portal fibrosis need to be revised as well as the staging system proposed by the Cairo Meeting on ultrasonography in schistosomiasis.