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The therapeutic benefit of vitamin E in patients with liver disease
LETTERS TO THE EDITOR
687
Incidence of hepatitis C virus in Egyptians The high prevalence of hepatitis C virus (HCV) in Egyptian volunteers reported by Saeed et al. (1) and Kamel et al. (2) was the initiator of the present study. The study included 778 individuals (292 from the apparently healthy general population, 159 health care workers, 99 paid blood donors, 25 with renal failure undergoing dialysis, 50 patients with different malignancies, 51 with acute hepatitis and 102 with different forms of chronic liver diseases). HCV antibodies were tested using the ELISA 2nd generation test kit supplied by Abbott Laboratories. Table 1 shows the high prevalence of HCV among Egyptians. Of the seropositive, apparently healthy individuals, 87.3% were shown to have a history of blood transfusion, surgical operation, parenteral therapy and/or delivery for females. It should be noted the figures for reactivity among the general population and health care workers were high compared to those recorded in USA and European countries (3-5). Cross-contamination between patients and medical teams can be expected. Repeated blood withdrawal, which may reach twice per month, exposure to contaminated intravenous devices and shared syringes could explain the high incidence of HCV in paid blood donors. The highest rates of positivity were found in patients with malignancies and those undergoing dialysis. These figures exceeded those of acute and chronic liver diseases. All patients.with malignancy had undergone earlier or recent operations and/or had been subjected to blood transfusion or parenteral drug use. Most of our patients had received blood, most of which came from paid donors. Other risk factors for HCV transmission are the surgical utensils and the dialysing machine. Medical and paramedical staff were considered as a potential source of infection (6). In conclusion, screening for HCV in Egyptian blood donors is urgently needed. Regular investigation of health care workers and dialysis patients is also recommended.
O. EI-Ahmady, A.-B. Halim. O. Mansour and T. Salman Tumor Marker Oncology Research Center, AI-Azhar University, Cairo. Egypt
TABLE I Incidence of HCV positivity in different groups of Egyptians Groups
General population Health care workers Paid blood donors Patients undergoing dialysis Patients with malignancies Patients with acute hepatitis Patients with chronic liver diseases
HCV-reactive
n=292 n = 159 n=99 n=25 n=50 n=51 n = 102
No.
%
71 38 35 21 31 13 51
24.3 23.9 35.4 84 62 25.5 50
References 1. Saeed AA, Fairclough D, AI-Admawi AM, A1-Rashad A. Hepatitis C virus infection in Egyptian volunteer blood donors in Riyadh. Lancet 1991; 338: 459-60. 2. Kamel MA, Ghaffar YA, Wasef MA, Wright M, Clark LC, Miller FD. High HCV prevalence in Egyptian blood donors. Lancet 1992; 340: 427. 3. Sherlock S, Dooley J, eds. Diseases of the liver and biliary system. Oxford; Blackwell Scientific Publications, 1993: 283-7. 4. Bonino F, Baldi M, Brunetto MR. Hepatitis C virus infection. In: Crivelli O, ed. Progress in Hepatitis Research: Hepatitis B Virus (HBV), Hepatitis C virus (HCV), Hepatitis Delta Virus (HDV). Italy; Sorin Biomedica, 1991: 49-61. 5. Dusheiko GM. Hepatitis C virus. In: Pounder RE, ed. Recent Advances in Gastroenterology. Edinburgh; Churchill Livingstone, 1992: 195-216. 6. Abd E1-Hamid AA, EI-Sayed H, Zakaria S, EI-Ghoneimy S, Soliman H, Mourad A, et al. Study of virus hepatitis markers before and after surgery. Med J Cairo Univ 1992, 60: 57-62.
The therapeutic benefit of vitamin E in patients with fiver disease I read with great interest the paper by Dr von Herbay et al. about "'Low vitamin E content in plasma of patients with alcoholic liver disease, hemochromatosis and Wilson's disease", published recently in the Journal of Hepatology (1994; 20: 41~,6). In their paper a low plasma content of vitamin E was observed in patients suffering from chronic liver disease due to alcohol intoxication, hemochromatosis with significant iron overload, and Wilson's disease with high free serum copper. With the possible exception of alcohol intoxication, none of these patients had evidence of cholestasis or hyperlipidemia. The authors state that little is known about the therapeutic benefit of treatment with vitamin E in patients with liver disease. I wish to bring to your attention the fact that we have reported that painful muscle cramps are a common complaint in patients with
cirrhosis (1,2), an observation which has recently been confirmed by others (3). Patients suffering from cramps tend to have lower plasma vitamin E levels than control patients without muscle cramps, and they seem to benefit from oral vitamin E supplementation (4). The pathophysiological mechanism(s) underlying these observations, as reported by von Herbay et al., are still obscure. However, in view of our findings, it would be of great interest to know whether the patients studied by von Herbay et al. (in particular those with low vitamin E levels) had any complaints of painful muscle cramps. If yes, a trial of vitamin E supplementation would be indicated, since these patients may very well be those who would benefit from a therapeutic effect of vitamin E.
688
LETTERS TO THE EDITOR
Fred Konikoff Department of Gastroenterology, Tel A viv Medical Center, Ichilov Hospital, 6 Weizman St, 64239 Tel A viv, Israel
References 1. KonikoffF, Theodor E. Painful muscle cramps in liver cirrhosis. Br Med J 1985; 290: 286.
2. Konikoff F, Theodor E. Painful muscle cramps a symptom of liver cirrhosis? J Clin Gastroenterol 1986; 8: 669-72. 3. Angeli P, Albino G, De Bei E, Dalla Pria M, Amodio P, Gatta A. Muscle cramps in liver cirrhosis. IX International Congress of Liver Diseases (Falk Symposium No 69). Basel, Switzerland, October 15-17, 1992. 4. Konikoff F, Ben-Amitay G, Halpern Z, Weisman Y, Fishel B, Rattan J, et al. Vitamin E and cirrhotic muscle cramps. Isr J Med Sci 1991; 27: 221-3.
WORKSHOP Bile Acids in Liver Diseases
January 26-27, 1995 Munich, Klinikum Grosshadern Scientific organization: G. Paumgartner U. Beuers Information:
Judith Steinberg Department of Medicine II Klinikum Grosshadern University of Munich D-81377 Munich Tel. 49/89/7095-2380 Fax 49/89/7095-8887
-
687
Incidence of hepatitis C virus in Egyptians The high prevalence of hepatitis C virus (HCV) in Egyptian volunteers reported by Saeed et al. (1) and Kamel et al. (2) was the initiator of the present study. The study included 778 individuals (292 from the apparently healthy general population, 159 health care workers, 99 paid blood donors, 25 with renal failure undergoing dialysis, 50 patients with different malignancies, 51 with acute hepatitis and 102 with different forms of chronic liver diseases). HCV antibodies were tested using the ELISA 2nd generation test kit supplied by Abbott Laboratories. Table 1 shows the high prevalence of HCV among Egyptians. Of the seropositive, apparently healthy individuals, 87.3% were shown to have a history of blood transfusion, surgical operation, parenteral therapy and/or delivery for females. It should be noted the figures for reactivity among the general population and health care workers were high compared to those recorded in USA and European countries (3-5). Cross-contamination between patients and medical teams can be expected. Repeated blood withdrawal, which may reach twice per month, exposure to contaminated intravenous devices and shared syringes could explain the high incidence of HCV in paid blood donors. The highest rates of positivity were found in patients with malignancies and those undergoing dialysis. These figures exceeded those of acute and chronic liver diseases. All patients.with malignancy had undergone earlier or recent operations and/or had been subjected to blood transfusion or parenteral drug use. Most of our patients had received blood, most of which came from paid donors. Other risk factors for HCV transmission are the surgical utensils and the dialysing machine. Medical and paramedical staff were considered as a potential source of infection (6). In conclusion, screening for HCV in Egyptian blood donors is urgently needed. Regular investigation of health care workers and dialysis patients is also recommended.
O. EI-Ahmady, A.-B. Halim. O. Mansour and T. Salman Tumor Marker Oncology Research Center, AI-Azhar University, Cairo. Egypt
TABLE I Incidence of HCV positivity in different groups of Egyptians Groups
General population Health care workers Paid blood donors Patients undergoing dialysis Patients with malignancies Patients with acute hepatitis Patients with chronic liver diseases
HCV-reactive
n=292 n = 159 n=99 n=25 n=50 n=51 n = 102
No.
%
71 38 35 21 31 13 51
24.3 23.9 35.4 84 62 25.5 50
References 1. Saeed AA, Fairclough D, AI-Admawi AM, A1-Rashad A. Hepatitis C virus infection in Egyptian volunteer blood donors in Riyadh. Lancet 1991; 338: 459-60. 2. Kamel MA, Ghaffar YA, Wasef MA, Wright M, Clark LC, Miller FD. High HCV prevalence in Egyptian blood donors. Lancet 1992; 340: 427. 3. Sherlock S, Dooley J, eds. Diseases of the liver and biliary system. Oxford; Blackwell Scientific Publications, 1993: 283-7. 4. Bonino F, Baldi M, Brunetto MR. Hepatitis C virus infection. In: Crivelli O, ed. Progress in Hepatitis Research: Hepatitis B Virus (HBV), Hepatitis C virus (HCV), Hepatitis Delta Virus (HDV). Italy; Sorin Biomedica, 1991: 49-61. 5. Dusheiko GM. Hepatitis C virus. In: Pounder RE, ed. Recent Advances in Gastroenterology. Edinburgh; Churchill Livingstone, 1992: 195-216. 6. Abd E1-Hamid AA, EI-Sayed H, Zakaria S, EI-Ghoneimy S, Soliman H, Mourad A, et al. Study of virus hepatitis markers before and after surgery. Med J Cairo Univ 1992, 60: 57-62.
The therapeutic benefit of vitamin E in patients with fiver disease I read with great interest the paper by Dr von Herbay et al. about "'Low vitamin E content in plasma of patients with alcoholic liver disease, hemochromatosis and Wilson's disease", published recently in the Journal of Hepatology (1994; 20: 41~,6). In their paper a low plasma content of vitamin E was observed in patients suffering from chronic liver disease due to alcohol intoxication, hemochromatosis with significant iron overload, and Wilson's disease with high free serum copper. With the possible exception of alcohol intoxication, none of these patients had evidence of cholestasis or hyperlipidemia. The authors state that little is known about the therapeutic benefit of treatment with vitamin E in patients with liver disease. I wish to bring to your attention the fact that we have reported that painful muscle cramps are a common complaint in patients with
cirrhosis (1,2), an observation which has recently been confirmed by others (3). Patients suffering from cramps tend to have lower plasma vitamin E levels than control patients without muscle cramps, and they seem to benefit from oral vitamin E supplementation (4). The pathophysiological mechanism(s) underlying these observations, as reported by von Herbay et al., are still obscure. However, in view of our findings, it would be of great interest to know whether the patients studied by von Herbay et al. (in particular those with low vitamin E levels) had any complaints of painful muscle cramps. If yes, a trial of vitamin E supplementation would be indicated, since these patients may very well be those who would benefit from a therapeutic effect of vitamin E.
688
LETTERS TO THE EDITOR
Fred Konikoff Department of Gastroenterology, Tel A viv Medical Center, Ichilov Hospital, 6 Weizman St, 64239 Tel A viv, Israel
References 1. KonikoffF, Theodor E. Painful muscle cramps in liver cirrhosis. Br Med J 1985; 290: 286.
2. Konikoff F, Theodor E. Painful muscle cramps a symptom of liver cirrhosis? J Clin Gastroenterol 1986; 8: 669-72. 3. Angeli P, Albino G, De Bei E, Dalla Pria M, Amodio P, Gatta A. Muscle cramps in liver cirrhosis. IX International Congress of Liver Diseases (Falk Symposium No 69). Basel, Switzerland, October 15-17, 1992. 4. Konikoff F, Ben-Amitay G, Halpern Z, Weisman Y, Fishel B, Rattan J, et al. Vitamin E and cirrhotic muscle cramps. Isr J Med Sci 1991; 27: 221-3.
WORKSHOP Bile Acids in Liver Diseases
January 26-27, 1995 Munich, Klinikum Grosshadern Scientific organization: G. Paumgartner U. Beuers Information:
Judith Steinberg Department of Medicine II Klinikum Grosshadern University of Munich D-81377 Munich Tel. 49/89/7095-2380 Fax 49/89/7095-8887
-