The association between cryoglobulinemia and hepatitis C virus (HCV) infection has been reported. However, the factors underlying its wide variation of occurrence have not yet been well identified. To investigate this, cryoglobulinemia was studied in four cohorts of Egyptian and Japanese patients. Fifty Egyptian patients with chronic hepatitis C, infected with genotype 4 (the predominant HCV genotype in Egypt), were compared with 50 age- and sex-matched Japanese patients, infected with HCV genotype 1b (the predominant HCV genotype in Japan). Thirty-two Egyptian and 30 age- and sex-matched Japanese patients with chronic hepatitis B were included as controls. All patients were noncirrhotic. Antinuclear antibody (ANA), immunoglobulins (Ig), and cryoglubulins were assessed. Results showed a significantly higher prevalence of cryoglobulinemia in chronic hepatitis C Japanese genotype 1b (40%) as compared with Egyptian genotype 4 (14%), P = 0.003, while no difference was found between Japanese (17%) and Egyptian chronic hepatitis B controls (13%). Symptomatic cryoglobulinemia was more prevalent in the Japanese than in the Egyptian chronic hepatitis C group (10% vs. 4%), but the difference was not statistically significant. Univariate analysis showed no association between cryoglobulinemia and either age, sex, alanine aminotransferase level, or HCV viral load in Japanese or Egyptian patients, while the mean IgM level was significantly higher in the cryoglobulin-positive than in the cryoglobulin-negative chronic hepatitis C patients in each group (P = 0.003 and 0.017, respectively). Cryoglobulinemia was found to be significantly associated with both high IgG level (P = 0.020), and positive ANA (P < 0.001) in Japanese patients with chronic hepatitis C, genotype 1b but not in Egyptians with genotype 4. Multivariate analysis showed that the only factors predisposing to cryoglobulinemia were Japanese ethnicity with HCV genotype1b (P = 0.002, OR = 2.56), high IgM level of >245 mg/dl (P = 0.018, OR = 2.05) and female gender (P = 0.040, OR = 1/0.66). In conclusion, cryoglobulinemia is prevalent in Japanese patients with chronic hepatitis C infected with genotype 1b, but cryoglobulinemia is not common in Egyptians with HCV genotype 4. Although it was not possible to evaluate ethnicity and HCV genotype separately in this study, HCV genotype 1b appears to predispose more to cryoglobulinemia than does genotype 4. Female gender and high serum IgM level were also related.
Background: Hypertension is a major health problem in Egypt with low rates of awareness, adherence, and control. Family oriented health education program is needed to know the effect of family involvement on the outcome of hypertension. Aim of the study: to improve care provided to hypertensive patients in family practice settings. Subjects and methods: This study was conducted as an intervention study. The awareness, adherence to treatment and control of hypertension were assessed before and after the intervention program through a structured interview with hypertensive patients and their families (at least one family member attended once/month over 6 months). The study was conducted at two family practice settings (the family practice outpatient clinic and El Mahsama family practice center, both are affiliated to Suez Canal University, Egypt). There were 206 hypertensive patients, who were recruited to reach the estimated sample size (190 patients) to start the intervention program. Results: The overall awareness, adherence, and control before the intervention were 60.2%, 37.1%, and 12.9% respectively. One month after the end of the intervention program, all non-aware patients became aware (p<0.001) and the pre-post adherence and BP control improved significantly (p<0.01 and p< 0.001 respectively). The rural residence and adherence improvement were statistically significant positive predictors of improvement of hypertension control. Conclusion: The family oriented-health education program is effective to improve awareness, adherence, and control of hypertension.
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