KL-6 is suggested as a tumor for HCC. Its positivity may reflect HCC-associated cholestasis and/or local tumor invasion.
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.
Introduction: Hepatocellular carcinoma (HCC) is the fourth most common cancer worldwide with a high morbidity and mortality. Alpha-fetoprotein (AFP) is considered the main tumor marker for HCC diagnosis, but the variation in its diagnostic validity among studies justifies further investigation of the underlying contributing factors. Ethnic difference could be one of the factors that has not been well studied. We aimed at investigating the ethnic difference in AFP validity between Egyptian (representing Arabic North African) and Japanese (representing Asian) for HCC diagnosis. Methods: Four cohorts with chronic liver diseases (CLD) were studied: 171 Egyptian (65 HCC/106 non-HCC), and 173 Japanese (45 HCC/128 non-HCC). Laboratory tests including serum AFP, protein-induced vitamin K deficiency or absence (PIVKA-II), alanine aminotransferase (ALT), total bilirubin, platelet count, HBsAg, anti-HCV, and HCV core antigen were conducted using standard commercially available assays. Results: A significantly higher sensitivity of AFP in Egyptian in comparison with Japanese for HCC diagnosis (99 vs 67%, P < 0.001) was observed using an AFP cut-off point of 10 ng/mL, with a comparable specificity (75 vs 82%) While a sensitivity of 98 versus 56%, P < 0.001 and a specificity of 83 versus 89% was found for AFP cut-off point of 20 ng/mL, respectively. The area under the receiver operating characteristic curve (ROC) was found to be 0.98 (95%CI = 0.969-0.997) for Egyptian and 0.77 (95%CI = 0.686-0.864) for Japanese. The highest sensitivity for the former group occurred at AFP = 20.5 ng/mL and at AFP = 10.2 ng/mL for the latter. Univariate analysis showed no effect for age, sex, underlying liver disease, cirrhosis, Child's class or tumor characteristics (size, pathological grade) on AFP sensitivity, while race significantly contributed to the higher sensitivity among Egyptians in comparison with the Japanese. Using ROC analysis, the AFP cut-off point for HCC detection in each subgroup of patients with and without each of the risk factors of interest was determined and the subgroups were again subclassified according to AFP positivity (< or ≥ the decided cut-off point for each group). Logistic regression analysis of those factors combined showed that Egyptian ethnicity with an AFP level >20.5 ng/mL (P = 0.007), older age (>50 years) with an AFP level >26 ng/mL (P = 0.010), and cirrhosis with an AFP level >10.5 ng/mL (P = 0.014) were the independent risk factors for HCC. Conclusion: There is an ethnic variation in AFP validity between Egyptian and Japanese patients with a significantly lower sensitivity in the latter. Alpha-fetoprotein should not be the only marker used for screening HCC among Asian Japanese and younger age groups (<50 years) with CLD. In addition, an AFP cut-off point of 20 ng/mL is recommended when screening patients of Asian origin for HCC.
BACKGROUND: Mask wearing in the COVID-19 pandemic was previously hypothesized as a protective symbol that decreases compliance with other measures such as face touching and social distancing. However, the face mask is now central to the prevention of viral spread. AIM: In this paper, we looked at the shift of guidelines regarding mask use and the mask-wearing adherence habits of the Kittitian population at the onset of the pandemic. METHODS: In this study, we observed 468 individuals, each for 5 min, for the different types of face masks used and their adherence to the Center for Disease Control guidelines for the use of this personal protective equipment. We did the observation at three different locations at Basseterre, St. Kitts, from the 21st to April 30, 2020. RESULTS: We noted that 49.31% had medical-grade masks (N95 and surgical), 36.11% had improvised masks, and 14.74% had no facial covering. About 34% of persons with masks were not correctly covering their nose or mouth and 16.45% were touching their face with their hands. Wearing any face-covering appears to lead to more face touching than no covering at 18.25% versus 5.8%. The highest proportion of errors was seen in wearers of surgical masks, leaving the mouth/ nose uncovered at 12.08% of all errors. CONCLUSION: We recommend for public education and political efforts to increase adherence to mask use in conjunction with other protective measures such as social distancing and hand washing for curbing the COVID-19 transmission in St. Kitts and Nevis.
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