Hepatitis C virus infection in chronic liver disease and hepatocellular carcinoma in Saudi Arabia

The prevalence of antibody to hepatitis C virus (HCV) was determined in 139 patients with chronic liver disease (CLD) and 42 patients with hepatocellular carcinoma (HCC) during one year at the Riyadh Military Hospital, Saudi Arabia. The anti-HCV was detected in 36 of 96 (37.5%) HBsAg-negative patients with chronic liver disease and six of 43 (13.9%) HBsAg-positive patients with chronic liver disease. In addition, 11 (42.3%) HBsAg-negative hepatocellular carcinoma patients and two of 16 (12.5%) HBsAg-positive hepatocellular patients had antibody to HCV. The anti-HCV prevalence was 1.5% in 4818 healthy blood donors and 1% in 385 antenatal patients. The overall HCV seropositivity of 30.4% in 181 liver disease patients (CLD and HCC) in Saudi Arabia is lower than that reported from European countries.     

Skeletal Muscle Ventricles in Circulation as Aortic Diastolic Counterpulsators: Twelve-Month Update

In previous studies, we have shown that canine skeletal muscle ventricles (SMVs) of various designs could develop stroke work intermediate between that of the canine left and right ventricle. We have subsequently reported that SMVs could be used as aortic diastolic counterpulsators. In some animals the SMVs pumped blood effectively for several weeks. Thromboembolism, however, caused renal failure, which was responsible for the demise of the longest surviving animals. More recently, we have studied a group of 15 dogs that had skeletal muscle ventricles constructed from their latissimus dorsi muscle and lined with autogenously derived tissues, either pleura, pericardium or fibrous tissue induced by a Teflon mandrel. We now report on one of those animals, that has survived more than 1 year. She remains active and in apparent good health with no clinical evidence of thromboemboli. Her SMV continues to generate effective aortic diastolic counterpulsation.     

Assay of IgE antibodies against June and Timothy grasses by an immunoperoxidase technique

The results of eighty assays for serum IgE antibodies against June and Timothy grass antigens with a solid-phase immunoperoxidase technique are correlated with those obtained with the RAST procedure. The allergens were insolubilized in polystyrene microtitre plates. After allowing the allergen-specific IgE antibodies in the test serum t o bind the allergen, the plates were incubated with horseradish peroxidase-conjugated rabbit antihuman IgE. The enzyme bound to the plates was assayed spectrophoto-metrically using o-phenylene diamine as the substrate. The coefficients of variation for within-batch reproducibility ranged from 4.57 to 11.97%, and those for between-batch variance from 8.25 to 13.7%. The slope of absorbance values of the immunoperoxidase assay is shallower than that of the bound radioactivity in the RAST technique. Notwithstanding, the immunoperoxidase method allows separation of non-atopic controls from the sera containing specific IgE antibodies and categorization of positive sera into weakly, moderately, and strongly positive results. Free of the disadvantages inherent in the use of radioactive material, this assay offers an alternative to the RAST test for the assay of allergen-specific IgE antibodies.     

An epidemiological approach to health planning and problem-solving in Indonesia

Daerah Istimewa Aceh, with a population of 2.9 million, is locatedin northern Sumatra and is one of 27 provinces in Indonesia.Since 1982 a USAID-funded project (CHIPPS) has supported anexperiment in Aceh involving decentralized health planning andproblem-solving. Instead of following the usual Indonesian practiceof rigidly adhering to strict health programme guidelines sentfrom Jakarta, Acehnese health officials tried to use an epidemiologicalapproach in defining their most important health problems andin selecting the most appropriate interventions to solve thoseproblems. The fundamental approaches of the project were to provide trainingin applied epidemiology for health officials at province, districtand sub-district levels, to carry out province-wide or district-widesurveys designed to identify the major preventable causes ofdeath and to develop a population-based information system concerningbirths, deaths and cause-of-death. Provincial health officialscarried out several major surveys which demonstrated that thepattern of morbidity and mortality in Aceh differed markedlyfrom national estimates and that the provincial health departmentneeded to develop specific disease control strategies tailoredto fit the situation in Aceh. For example, a province-wide neonataltetanus mortality survey found that 2.1 per cent of all infantsborn in Aceh died of tetanus, that neonatal tetanus mortalityrates in some districts were 10 times higher than in other districtsand that babies delivered by trained village midwives were nearlyas likely to die from tetanus as babies delivered by untrainedvillage midwives. Surveys like this had major implications forhealth planning and priority-setting in Aceh. The CHIPPS projectin Aceh has demonstrated that province-level health officers,with training in epidemiology and with limited financial resources,can develop a simple but sound information base, determine theirown local priorities and implement effective interventions,even when these priorities and interventions differ markedlyfrom national norms.     

CLINICAL-EPIDEMIOLOGIC STUDY OF ALOPECIA AREATA

Background. Alopecia areata is a common disease and may be associated with autoimmune disease, atopy, Down syndrome, emotional stress, and foci of sepsis. Methods. Seven cases of alopecia areata were diagnosed among workers in the Water and Effluent Treatment Sector (WETS) of a paper factory, representing a 0.6% incidence, when the value for the population at large is 0.1%. Three of these workers are assigned to the WETS on a permanent basis and four provide maintenance services. One of the latter patients had alopecia areata that fully regressed. Because biologic treatment of water and effluents involves saprophytic bacteria and fungi as well as chemical substances such as acrylamide, a clinical examination and laboratory tests were performed on all workers assigned permanently to the WETS (N = 9) and on 25% of the workers, selected at random providing services to the sector (N = 14). Results. There was no association between alopecia areata and atopy, dermatophytosis, or bacteria isolated. Toxicologic evaluation revealed an acrylamide-like substance in 7 workers with alopecia areata, with a statistically significant correlation. Measures were taken at the workplace to decrease worker contact with the mists (probably containing acrylamide) in the pulp-pressing room; no other cases of alopecia areata had been detected 1 year after the study. Conclusions. A survey of the literature did not show reports of alopecia areata as an occupational dermatosis, but our conclusion is, that this dermatosis could be due to the professional activities of the workers at the paper factory studied.