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A medical magazine published annually by SSS Kasr Alainy. This issue's theme was Hepatitis C virus
Citation preview
Me and My Liver
Prof. Wafaa Akl
HCV and Rheumatolohy
Prof. Amira Shahin
Not only the Liver, But also the outside
Prof. Heba Mustafa
Hepatitis C Virus
Shocking Facts
Introductions from one
of the owners
The editorial team with the help of
Prof. Wafaa Akl
Live in health rather
than disease The editorial team
Be gentle with yourself
The editorial team
Is there hope … ?!!!
The editorial team
First Edition
Students’ Scientific Society — Kasr Al
SSS is an independent, non profit association; run by volunteered medical students & aiming at producing active contributing physicians of a global society
Students’ Scientific Issue 4, 1st Autumn
2
TABLE OF CONTENTS:
• Introduction from one of the owners.
• Me and my liver .
• HCV and Rheumatology .
• Not only the liver, also the outside .
• Be gentle with yourself.
• An invitation… live in health rather
than disease .
• Is there hope in the way? .
• Shocking facts .
• About us .
3
SSS Medical
Hepatitis C Virus
Students’ Scientific Society 3
Editorial team
4
DDDD ear “SSS
medical” readers. It is my pleasure
that I have been involved with the
activities of the SSS since October
2004. I admit that I did not know
much about the society, nor the
participants although member of the
faculty staff. I was surprised to
encounter a group of motivated
highly active students, working
together in a harmonized fashion,
forming a superb team. The activities
of the society are diverse covering
more than one scope, among which
is the “SSS medical” journal. The
first issue, which was about Breast
Cancer Awareness was the perfect
example of what medical students
are capable of achieving. They
proved that such a scientific work
can be presented in an all new
different way: the SSS way.
The second issue as well so very well
received that a second issue was to see
the light of day. And here we are, the
third issue.. I’m sure this edition won’t
fail to accomplish the same goal as the
first and the second in the most unique
way. The journal “SSS medical”, is by
far an accomplishment for SSS. Every
page, every word of the journal you’re
holding in your hands is yet another
proof that SSS members aren’t only
medical students, they are practically
anything they want to be. The
achievement of this important project
shall be reflected on the medical
community, final year students and
young graduates.
I sincerely hope that members of the
society proceed more and more in their
activities and hope that I can help them
whenever they need it.
Prof. Mohamed Elsada, SSS Supervisor
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Hanaa Galal, SSS Editor
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A General overview
With the help of an HCV patient
"Transmission and prevention"
Egypt has the highest countrywide prevalence of HCV in the world, with an estimated 8-10 mil-
lion among a population of 68 million having exposed to the virus with 5-7 million active infec-
tions. Such a number translates the huge problem Egypt is facing with Hepatitis C virus, threaten-
ing the health of our population.
The history of an0schistosomal injec0on treatment prior to 1986 mainly with intravenous tartar
eme0c is the major risk factor associated with HCV infec0on.
Widespread treatment campaigns were carried out in the countryside of Egypt in the 60’s-70’s
and early 80’s. At that 0me only glass syringes were available, needles were rou0nely sterilized by
boiling due to 0me restraints and limited resources.
In addi0on to cases among the older popula0on, new infec0ons are s0ll being recorded, due to
poor medical prac0ces and behavioral factors.
We decided to make an interview with a chronic HCV patient; Mr. Mohamed, and see how does
the disease affect his life, through this interview we can also know some of the common ways of
HCV transmission as well as prevention.
•Tell us Mr. Mohamed, what brought you to the hospital?
I became so tired and sick with jaundice then I suddenly fainted. So, my family brought me here, I
had tests that revealed that I am infected with
HCV.
•Do you know how you got infected with HCV?
I don't remember, may be through a needle or a
razor. They asked me if I had blood transfusion
but I never had one.
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Also the following Blood-borne routes of transmission are well-documented:
Percutaneous (injecting drug use and occupational exposure):
• Contaminated needle stick
• Hemodialysis
• Human bite
• Transplant or transfusion of unscreened blood or blood products
• Acupuncture, tattooing, and body-piercing with non sterilized needles
Permucosal:
• Prenatal: infant born to HCV infected mother.
• Contact with infected household objects (i.e., toothbrush or razor that may
There are no known cases of HCV transmitted enterically (oral-fecal), through breast milk, semen,
or saliva.
In developed countries, it is estimated that 90% of people with chronic HCV were infected
through transfusion of unscreened blood or blood products or via injecting drug use or by inhala-
tional drug use.
In developing countries, the primary sources of HCV infection are from unsterilized injection
equipment and infusion of inadequately screened blood and blood products.
What did the doctors advise u to do?
They advised me to stop smoking, eat healthy food and stay away from fatty food and to have a
restricted salt diet, of course all of this beside my medication.
WHO recommendations on measures to prevent HCV include:
• Screening of blood and blood products
• Destruction of disposable needles and adequate sterilization of reusable mate-
rial such as surgical or dental instruments
• Education about the risks of using unsterilized materials and high-risk of drug
and sexual behaviors.
• Effective use of universal precautions and barrier techniques( such as the use of
sterile equipments, and wearing eye/face protection)
There is currently no vaccine for HCV. The difficulty in developing a vaccine is due, in part, to the
mutability of the HCV genome. In addition, there is no effective, short-term prevention such as
HBIG or immune globulin. In the absence of the above, all precautions to prevent HCV infection
must be taken.
By the SSS medical Editorial Team
With the help of Dr Wafaa Akl
8
Me and my LIVER
Hepatic manifestation of
Hepatitis C virus
The liver is popular of taking the major role in the play of the disease, the
patient show the following clinical manifestations both in acute and
chronic infection.
Clinical features of acute infection:
The incubation period of HCV infection before the onset of clinical symp-
toms ranges from 15 to 150 days. In acute infections, the most common
symptoms are fatigue and jaundice; however, the majority of cases
(between 60% and 70%), even those who develop chronic infection, are
usually asymptomatic.
Chronic infection and consequences:
About 80% of newly infected patients progress to develop chronic infection.
Cirrhosis develops in about 10% to 20% of persons with chronic infection, and liver cancer devel-
ops in 1% to 5% of persons with chronic infection over a period of 20 to 30 years.
Most patients suffering from liver cancer who do not have hepatitis B virus infection have evi-
dence of HCV infection. The mechanisms by which HCV infection leads to
liver cancer are still unclear. Hepatitis C also exacerbates the severity of
underlying liver disease when it coexists with other hepatic conditions. In
particular, liver disease progresses more rapidly among persons with al-
coholic liver disease and HCV infection.
Diagnostic Testing for Hepatitis C:
HCV is diagnosed serologically by detecting antibodies specific to the
hepatitis C virus (anti-HCV), and active infection is confirmed and moni-
tored by measurements of HCV virus levels. Retesting for anti-HCV may
be necessary if the initial result is negative, but clinical signs and symp-
toms suggest an HCV infection. Furthermore, anti-HCV does not distin-
guish between acute, chronic or resolved infections.
Researchers have developed assays that detect and accurately measure HCV RNA. These assays
detect the viral genome and measure the level of circulating virus in an infected individual. The
level of HCV RNA in the blood is often referred to as the “viral load.” Several polymerase chain
(PCR) tests for HCV RNA are now available.
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As for the Treatment Antiviral drugs such as interferon taken alone or in combination with
Ribavirin, can be used for the treatment of persons with chronic hepatitis C, but the cost of
treatment is very high. Treatment with interferon alone is effective in about 10% to 20% of
patients. Interferon combined with ribavirin is effective in about 30% to 50% of patients. Ri-
bavirin does not appear to be effective when used alone.
In Egypt, the National Committee for control of viral hepatitis was established. It settled a
project for treating infected population on account by Ministry of Health and population.
Seven centers in different governorates in Egypt treated about 10,000 infected patients. Other
centers are starting to work aiming to distribute this medical service throughout all gover-
norates in Egypt.
Dr Wafaa AklDr Wafaa AklDr Wafaa AklDr Wafaa Akl, , , , Professor of Tropical medicineProfessor of Tropical medicineProfessor of Tropical medicineProfessor of Tropical medicine,,,, Kasr Eleiny Kasr Eleiny Kasr Eleiny Kasr Eleiny, , , , Cairo UniversityCairo UniversityCairo UniversityCairo University.
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Not only the liver, also the outside.
Extra Hepatic Manifestations of
Hepatitis C Virus
HCV is a linear single stranded RNA virus of flaviviriadea family that was iden0fied in 1989. It is oGen
associated with extra hepa0c manifesta0ons. The clinical relevance of this phenomenon is extremely
variable ranging from subclinical features or laboratory abnormali0es to overt clinical manifesta0ons
that may be severe in some pa0ents.
Risk factors for the presence of clinical and biological extra hepa0c manifesta0ons are advanced age,
female sex and extensive liver fibrosis.
Cutaneous manifestations: lichen planus, porphyria cutanea tarda and vitiligo.
Eye manifesta'ons: Sicca syndrome and Mooren’s ulcer (rapidly progressive painful ulcera0on of
cornea). Re0nopathy including coHon- wool spot forma0on, heamorrhages and arteriolar occlusion is
a frequent complica0on of interferon therapy.
Autoimmune diseases: Sjogren’s syndrome, rheumatoid arthri0s, polyarteri0s nodosa,
an0phospholipid syndrome and systemic lupus erythematosus.
The role of cryoglobulinaemia in the autoimmune features associated with HCV infec0on has been
increasingly accepted.
Kidney affec'on: Membranoprolifera0ve glomerulonephri0s, rapidly progressive glomerulonephri0s
and membranous glomerulonephri0s can occur.
Vasculi's: systemic vasculi0s, cutaneous vasculi0s and isolated CNS
vasculi0s.
Peripheral neuri's.
Pulmonary alveolitis.
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Thyroid involvement: Chronic hepa00s C viral infec0on is associated with high
prevalence of thyroid an0bodies, only few pa0ents develop thyroid dysfunc0on.
Interferon alpha therapy also induces thyroid an0bodies and may precipitate thyroid
dysfunc0on.
Lymphoma: B-cell non Hodgkin’s lymphoma is probably due to long standing s0mula0on
of B cells caused by chronic HCV infec0on.
HCV and diabetes mellitus: HCV may play a pathogene0c role in type 2 diabetes
mellitus. Recent studies suggest that the core protein of HCV impairs insulin receptor
substrate signaling. There is also associa0on of diabetes with alpha interferon treatment
of HCV.
Therapeu0c guidelines for extra hepa0c HCV features should be based on clinical
features rather than on the underlying pathogenic mechanisms. However both an0viral
and immunosuppressive therapies either alone or in combina0on.
Dr Heba MostafaDr Heba MostafaDr Heba MostafaDr Heba Mostafa,,,, Professor of Internal medicine Professor of Internal medicine Professor of Internal medicine Professor of Internal medicine, , , , Kasr Eleiny, Cairo UniversityKasr Eleiny, Cairo UniversityKasr Eleiny, Cairo UniversityKasr Eleiny, Cairo University
12
Many Extra-hepa0c manifesta0ons, including rheuma0c disease, have been reported to be associ-
ated with hepa00s C virus (HCV) infec0on. Renal disease, neuropathy, and lymphoma
were found to be strongly associated with HCV infec0on. Porphryia cutanea tarda and
diabetes were linked to it.
Many rheumatologic abnormali0es have been described with HCV infec0on; mixed
cryoglobulinemia, vasculi0s, myalgia, arthri0s, sicca symptoms and fibromyalgia. Pa0ents
with HCV infec0on express a high prevalence of a variety of autoan0bodies, usually in low 0ters.
Mixed cryoglobulinemia, an immune complex vasculi0s involving preferen0ally small size vessles
(i.e. venules, capillaries and arteriols), is known to be the most frequent extra-hepa0c manifesta0on
in HCV pa0ents.
Mixed cryoglobulins (MC) are oGen found in pa0ents with chronic
HCV infec0on although a minority is symptoma0c.
Pa0ents with HCV mixed cryoglobulinemic vasculi0s (MCV) always
show sub-acute moderate cutaneous and neurological symp-
toms. Glomerulonephri0s (GN) is predominantly associated with
MCV, and almost always takes the form of membranoprolifera0ve GN.
HCV and Rheumatology
Rheumatic manifestations in patients
HCV infection
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The rela0on between the medium size vessel vasculi0s of PAN type and HCV infec0on has been
previously discussed. The neurological involvement in HCV-PAN pa0ents is severe acute sensori-
motor mul0focal mononeuropathy with pathological findings of necro0zing angii0s involving
small and medium size vessels.
Several cases of polyarthri0s have been described in HCV pa0ents. The most common picture is
the rheumatoid arthri0s (RA) like polyarthri0s and an0 CCP an0bodies may help to differen0ate
HCV arthri0s from RA with HCV on top. HCV arthri0s also may be asymmetric, intermiHent,
las0ng for days to weeks, non-erosive on X-ray, and leaving the joint free. Erosive arthri0s has
been described in few seroposi0ve cases. Several pathogenic mechanisms have been suggested;
immune complexes, cryoglobulins, interleukin produc0on, auto-immunity or the direct invasion
of synovial cells by the virus.
In the cases with seHled diagnosis of RA the change of disease paHern may be the alert sign to
diagnose HCV. HCV may exacerbate arthralgias, rheumatoid factor (RF) produc0on and other
signs of inflamma0on. The disease may become more aggressive and less responsive to treat-
ment, increase nodules size and their appearance in abnormal sites, in addi0on to the develop-
ment of vasculi0s as vasculi0c ulcers or mesenteric vasculi0s.
Psoria0c arthri0s, chondrocalcinosis, tenosynovi0s, and gout have been reported
with HCV. Dermatomyosi0s was suggested to be induced or accelerated by HCV in-
fec0on. Sclerodermatous changes were reported as cutaneous manifesta0on of
HCV.
14
Fibromyalgia and inflammatory back pain was expected to occur more in pa0ents with HCV infec-
0on.
Although HCV 3rd
genera0on an0body tests was considered to be highly reliable in pa0ents who
are not immunosuppressed, we should not rely on it for the exclusion of HCV infec0on especially
in pa0ents who are going to receive immunosuppressive drugs.
Treatment of MCV and PAN vasculi's is mostly effec0ve when it is started in early 0me. Cor-
0costeroids are used to control the most severe life threatening manifesta0ons of systemic vas-
culi0s, followed by rapid tapering of steroid dose under the cover of pulsed Cyclophosphamide.
Plasma exchange may be used to clear the immune complexes without increasing the viral repli-
ca0on. Interferon-K should be introduced aGer the control of disease ac0vity to limit the viral
replica0on. Maintenance treatment is effec0ve by interferon-K and steroids, although relapses
may occur when the dose of steroids decreased below 30 mg/day.
The op0mum treatment of HCV related arthri0s has not yet been established. Hydroxychloro-
quine, low dose steroids, low dose methotrexate, and azathioprine were mostly effec0ve in con-
trolling the joint manifesta0ons.
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In conclusion; the spectrum of HCV associated rheumatologic manifesta0ons includes
different types of systemic vasculi0s: polyarteri0s nodosa and mixed cryoglobulinemic vas-
culi0s. Inflammatory ar0cular manifesta0ons had different types; intermiHent asymmetric
nondestruc0ve type, symmetric polyar0cular nondestruc0ve type and symmetric polyar-
0cular destruc0ve type.
HCV infec0on should be considered as one of the causes in pa0ents with small or medium
size vessel vasculi0s, pa0ents with seHled rheumatoid arthri0s with change disease paHern
or newly developed vasculi0s and in pa0ents with unexplained tenosynovi0s, back pain or
other rheumatologic symptoms.
Dr Amira Abdelsabour ShahinDr Amira Abdelsabour ShahinDr Amira Abdelsabour ShahinDr Amira Abdelsabour Shahin,,,, Professor of Rheumatology Professor of Rheumatology Professor of Rheumatology Professor of Rheumatology, , , , Kasr EleinyKasr EleinyKasr EleinyKasr Eleiny, , , , Cairo UniversityCairo UniversityCairo UniversityCairo University.
16
Be Gentle with yourself
You may have a loved one or friend who tested positive for the hepatitis C virus (HCV). Whether
this person is asymptomatic or struggling with multiple HCV symptoms, their disease may affect
you. Since HCV is not passed casually, it is unlikely that you will acquire
HCV.
However, Caregivers are at high risk for other health problems. They
have a higher risk of mental and physical health problems than non-
caregivers do. They experience depression, pain, loneliness, isolation,
abandonment, loss, and grief. They experience fear - of the unknown, of
death and of change.
Caregivers may feel insecure about their ability to give adequate support. They may worry about
the security of their future, the risk of acquiring HCV, or of being a single parent or sole
financial provider. It is normal to feel and think about these possibilities.
The HCV Patient during Treatment
The HCV patient in your life may be symptom-free or have symptoms of the disease.
The decision to undergo treatment is a complicated one and not based solely on the
presence of symptoms. Current HCV treatment uses a combination of medications. HCV
medications may cause many side effects. Some common ones are fatigue, irritability,
depression, anxiety, difficulty concentrating, insomnia, itching, rashes, stomach upsets,
headaches, fevers, and body aches. Patients sometimes report decreased sex drive
(libido) during treatment. The social and psychological side effects are usually harder to deal with
than the physical ones, especially for family and friends of HCV patients. These side effects are tem-
porary and they will reverse with time after HCV treatment is stopped.
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Open communication is the best way to find out how your loved one feels. However, do not ex-
pect too much from the person undergoing HCV therapy, especially if he was not a good communi-
cator before treatment. Some patients do not want to talk about their experiences. Others want to
talk about them a great deal.
People with hepatitis C are sometimes irritable during treatment. Try not to take this personally.
Keep your expectations to a minimum. Do not expect a depressed HCV patient to “snap out of it”
or to be able to turn his or her mood around through positive thinking. Medication-induced de-
pression is influenced by physical factors, and all the willpower in the world won't make it go away.
Common Reactions of Caregivers:
Guilt is a common feeling among caregivers. If you find yourself saying the word “should”, this is
associated with guilt. You may be thinking “I should do more,” “be more understanding,” “be more
loving.” Guilt helps no one. It robs us of our self-esteem. Try to let go of guilt.
Anger is another emotion reported by caregivers. The HCV patient may be get-
ting sympathy and attention, while you are striving to keep your family afloat.
You may feel resentful that no one notices how overworked and exhausted you
are. Many caregivers feel afraid. You may fear what the future holds for you and
your loved one. You may wonder if you are going to be strong enough to handle
the future.
Grief is common. Your life has changed. You may feel that your dreams are gone.
Your loved one may be wrapped up in his or her illness and you may feel lonely
because of this.
18
Caregiver Stress Danger Signs:
Whether you experience guilt, fear, anger…etc, in all cases you are probably going to be put under
stress. Caregiver stress must be taken seriously. If left unmanaged, caregiver stress can be life
threatening. Some danger signs are:
• Uncontrollable anger or resentment
• Depression
• Thoughts of harming another or physical abuse
• Sleep problems
• Overeating or loss of appetite
• Physical complaints, such as headaches or stomach prob-
lems. Some of these may be serious and may affect your blood pressure or heart.
How to Cope:
The best way you can help your loved one is to take care of yourself first. Yes, yourself first. This is
not irresponsibility or selfishness or anything. In the event of a pressure drop on an airplane, we are
advised to put on our own oxygen mask first before assisting others. This concept applies to caregiv-
ers. If you put the needs of your loved one before your own and neglect yours, you serve no one. If
you don't ease the stress you are experiencing, you are most likely on your way to a breakdown.
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• Make a commitment to your own health. Do not neglect your sleep, diet, exercise and other
health-promoting habits.
• Do not throw away inner peace by reacting to everything you hear. Get the facts first. That
way, if you are going to be upset about something, at least it is about something accurate.
• Take time to process new information. You may hear bad news or be bombarded by data.
This is not a good position from which to make decisions. Take a break. Give yourself time to
digest new details.
• Accept your feelings and talk about them.
• Ask for help. Be specific about the help you need.
• Every day, do something you enjoy.
• Focus on the positive.
• Find ways to laugh. Laughter can relieve all sorts of complaints and has no side effects.
Mr. Mohamed; an HCV patient said "I became so afraid when I Knew I
was infected with HCV as I did not know what was wrong with me and
how my life will look like after that. My family has not changed the way
they deal with me, they were very supportive and no-one left me alone.
Also, my wife was so supportive, understanding and loving"
By the SSS medical Editorial TeamBy the SSS medical Editorial TeamBy the SSS medical Editorial TeamBy the SSS medical Editorial Team
20
An invitation… LIVE in health rather than disease
Healthy lifestyle of HCV patients
A medical diagnosis may bring pa0ents to their knees for a moment. However, aGer the shock
passes, it may be a turning point, an invita0on, live in health rather than disease. Living well with
HCV means adop0ng a healthy lifestyle. It isn’t a cure, but part of an overall management of HCV.
It is important to learn aStudes and behaviors that help to achieve the highest possible physical,
mental and spiritual well-being. Key aspects of a healthy lifestyle include, nutri1on, weight
management, physical fitness, sleep control, a3tude, social and spiritual well-being and memory
improvement.
Concerning nutri'on, your diet should be low in saturated fat and cholesterol. Pa0ents should eat
generous amounts of fresh fruit and vegetables. Grains are preferred to be whole rather than
processed. Choose plant-based proteins, like beans, nuts, and seeds. When ea0ng animal protein,
fish and poultry are beHer than red meat. The diet should include a variety of foods, minimizing
intake of foods with added sugar. Drinking 6-8 glasses of water daily is essen0al. Pa0ent should
resist fad diets, look for a diet that has a record of long-term success and skip depriva0on. Pa0ents
should beware of products, such as herbs and supplements that promise weight loss without diet
or exercise. Always be skep0cal of wild claims. Pa0ents should also avoid certain things like
alcohol. Research is clear that zero intake of alcohol is best. Alcohol “excites” or ac0vates HCV and
may therefore speed up the progression of the liver disease. Illegal drugs and smoking should be
added to the list too. Medica0ons should be avoided when unnecessary. This can be achieved via
checking all pa0ents’ medica0ons; including “over the counter” ones bought at the drug store or a
health store, with his/her doctor. A person with hemophilia or related bleeding disorder should
monitor liver func0ons if using an0-inflammatory medica0ons for chronic joint disease. Chemicals
(e.g., cleaning solu0ons, solvents, pes0cides, and anything in
aerosol containers) at work and at home should be avoided;
these are toxic to the liver.
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Obesity is associated with an increased risk in a number of medical condi0ons including, heart
disease, stroke, high blood pressure, arthri0s, sleep apnea, type 2 diabetes, gall bladder disease and
depression. If pa0ents are overweight, they should consider making some changes. Skip any “all or
nothing” thinking – even a few pounds may benefit health. The most effec0ve weight loss programs
combine calorie reduc0on with increased physical ac0vity. Losing and maintaining weight is a lifelong
endeavor.
Physical fitness is an essen0al part of health. Exercise is probably the single most effec0ve self-help
an0dote for fa0gue and mild depression. There are many ac0vi0es to choose from. Walking is perfect
because it requires no special equipment except comfortable shoes. Biking, swimming, dancing, and
gardening can be fun as well as therapeu0c. Yoga, Tai Chi, Qigong, and Pilates are highly regarded as
beneficial ac0vi0es. Some sugges0ons, especially when it is hard to maintain a fitness program
include, scheduling your exercise, making it regular, sui0ng up and showing up, finding a fitness
buddy, and keeping a log to watch the progress.
Inadequate or poor quality of sleep can lead to feelings of day0me 0redness. Pa0ents should make
sure they are geSng sufficient sleep. Recommended sleep hours are 7 to 8 hours daily. It is preferred
to avoid certain factors that can interfere with a good night’s sleep. These include: Caffeine – coffee,
sodas, tea, chocolate, Tobacco, a room that is too hot or too cold, light, noise, an uncomfortable bed,
using alcohol before bed0me, being hungry and ea0ng a large meal close to bed0me.
Positive attitude is the backbone of healthy lifestyle. Having HCV can be painful and burdensome for
some, while for others, it's a new start for healthy lifestyle. It has been said that those with a disease
live better than those without a disease. Although positive thinking is essential, patients should be
honest, realistic and not build their attitude on thinking things are worse than they are or better
than they are. They should be sure to know the truth and get
accurate information about HCV. They should stay in the present
and not make things worse by imaging a future with pain, dis-
ability or loss. Acceptance of the situation is essential. HCV can
be part of life rather than control of life. Laughter and recreation
isn’t a cure, but it can lighten the load. Spirituality (prayer and
meditation) is crucial as health includes body, mind and spirit. It
is found to be helpful to develop some sort of spiritual practice
22
People living with HCV some0mes complain of memory problems. Memory loss, especially
short-term memory, occurs commonly as people age. There are plenty of strategies that help
improve memory status such as reading more or listening to audio books, solving puzzles and
brainteasers, learning new things, par0cularly drawing or pain0ng, going to lectures, plays,
museums, or concerts, cuSng down or elimina0ng watching TV, taking up a musical
instrument, maintaining social and family connec0ons, and studying a new
language .Deliberately shake up people’s rou0ne, so rearranging furniture, driving a different
route to familiar places, or even wearing your watch on the other wrist can be helpful.
Support groups are treasure chests for hepa00s C pa0ents. A good support group provides
informa0on, resources and support. Pa0ents share their experiences with depression and
HCV, talk about their favorite doctors, discuss how they handle certain medica0on side
effects, and provide helpful 0ps on managing their illness. Most pa0ents find it valuable to be
with others who share the same experiences as they do, where they can be among others
without having to explain themselves.
Finally, we should remember that the vast majority of those with HCV will die with it and not
of it. Since we are unlikely to die of HCV, we need to learn how to live with it, which can only
be achieved through the healthy lifestyle.
By the SSS medical Editorial Team
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Is there HOPE in the way?
Recent researches in treatment of HCV
Treatment whenever men0oned means cure but this is not the case with the HCV. Till now
there is no cure for HCV. All measures of treatment aims mainly at elimina0ng the virus in the body
& its effect allover the body systems & allowing the pa0ents suffering from that virus to live a stable
life as much as they can with the least complica0ons.
No vaccine for hepa00s C is available, and prophylaxis with immune globulin is not effec0ve in
preven0ng HCV infec0on aGer exposure. The only prophylac0c measure that can be done is to
screen persons seeking care in STD clinics or other primary-care seSngs to iden0fy those who
should be offered HCV counseling and tes0ng. HCV-posi0ve persons should be evaluated (by referral
or consulta0on, if appropriate) for presence of development of chronic liver disease, including as-
sessment of liver func0on tests, assessment for severity of liver disease and possible treatment and
determina0on of the need for hepa00s A and B vaccina0on.
A major focus of hepa00s C research is development of a cell culture through which scien0sts can
study HCV outside the human body. By understanding how the virus replicates and how it injures
cells, researchers may be able to develop ways to control the virus as well as drugs to block it.
New drugs against hepa00s C include; inhibi0on of apoptosis,HCV enzyme inhibitors, Molecular-
based approaches (ribozymes, an0sense oligonucleo0des) and An0-HCV an0bodies to prevent HCV
reinfec0on aGer liver transplanta0on.
The best treatment for people with end-stage liver disease is liver transplanta0on. However, the
number of people awai0ng transplants far exceeds the number of donated organs. Un0l recently,
HCV-infected livers were rou0nely discarded.
But studies show that people already infected with HCV who receive livers from HCV-posi0ve
donors can do as well as if they had received a liver not infected with the virus. Liver transplanta-
0on does not cure HCV. The majori0es of people with hepa00s C who receive liver
transplants experiences a recurrence of the virus or is at accelerated risk of devel-
oping cirrhosis within five years.
By the SSS medical Editorial Team
24
Shocking facts
Because acute infection is asymptomatic in most cases, incidence data on a global scale is not well
known. It is important to note that since the availability of multi-antigen testing in 1992, the inci-
dence of post-transfusion HCV has declined significantly. The risk is now less than 1 in 1,000,000
units transfused.
-WHO estimates that up to 3.0 percent of the world’s population has been infected with HCV.
-Worldwide, there may be more than 170 million chronic carriers of HCV
-Egypt has the highest countrywide prevalence of HCV in the world, with an estimated 8-10 million
among a population of 68 million having exposed to the virus with 5-7 million active infections
-Approximately 90% of Egyptian isolates belong to a single subtype, 4a, which responds less
ssuccessfully to IFN therapy than other subtypes
- Furthermore,
HCV is less preva-
lent in countries
neighbouring
Egypt having
similar socio
medical condi-
tions and similar
strains
25
SSS Medical
Hepatitis C Virus
Students’ Scientific Society 25
-The cost of a live donor liver transplant in private hospitals increased from LE 80,000 in 1991 to LE
400,000. Cost of the procedure in government, charity, or university hospitals currently stands at LE
150,000.
- Egypt spends LE 1.3 billion annually to treat diabetes and cancer. However, diabetes and cancer
patients have lower chances for full productive lives after treatment compared to Hepatitis patients
who receive a live transplant. For the same amount of funding allotted to diabetes and cancer,
1,000 liver transplant procedures could be performed each year.
-“The annual infec1on rate is more than 70,000 new cases, of which at least 35,000 would have
chronic hepa11s C,” said Dr Manal el-Sayed, Professor of Pediatrics at Cairo’s Ain Shams University
and member of the Na0onal Hepa00s CommiHee which is currently formula0ng an ac0on plan to
fight the disease.
-Egypt, along with Magnolia and Bolivia, is amongst the worst hit by the virus and has the world's
highest prevalence rate ranging from 12 to 15 percent and up to 18 percent of the population in ru-
ral areas.
Dr. Wafaa Akl
And the SSS medical Editorial Team
26
About The Students’ Scientific Society is an inde-
pendent non-profit association, run by volunteered
medical students and affiliated to the International
Federation of Medical Students' Associations “IFMSA”.
We are motivated, highly skilled medical students. Our
mission is to offer physicians a comprehensive intro-
duction to global health issues, SSS aims also to en-
We have the following activities:
Professional and Research exchange:
True to its foundation, student exchanges remain the
backbone of SSS. Every year SSS enables dozens of stu-
dents to experience the practice of medicine in a differ-
ent culture, within the different IFMSA schemes of ex-
change.
In addition, SSS members will be able to organize train-
ings and social events for foreign medical students dur-
ing their stay in Egypt, whether they are coming for the
exchange, summer or winter school program.
International Workshops and Trainings:
Organization and participation in international events
has always been among the opportunities SSS offers to
its members. Through EMSA and IFMSA, SSS is in con-
tinuous collaboration with international bodies such as
UN agencies and WHO. In addition, IFMSA international
trainings are always a great opportunity for SSS mem-
bers to enrich their skills and open up to the international community.
27
SSS Medical
Hepatitis C Virus
Students’ Scientific Society 27
Standing Committee on Medical Education
(SCOME):
In a country like Egypt, continuous improvement of medi-
cal education is of the outmost importance.
Through research methodology courses, participation in
faculty’s accreditation protocols and research competitions
among medical students, such as the diabetes mellitus com-
petition SSS is aiming at the development of the students’
abilities and skills, in order to achieve its goal of preparing ac-
tive medical students and contributing physician of a global
society.
Standing Committee on
Reproductive Health including AIDS (SCORA):
Another major focus in SSS is
Reproductive Health, with the goal of increasing the aware-
ness of the problems related to AIDS and sexually transmit-
ted diseases, both among medical students and the popula-
tion at large.
Standing Committee on Public Health (SCOPH):
By involvement in Public Health activities, students seek to
contribute to the health of the people of the world, both
through health education and by directly supportive pro-
jects in areas of need. Projects such as
Hepatitis Awareness, TB Advocacy, Diabetic
Complications Awareness…etc have allowed our students
to transmit their experiences to peers from all over the
world.
28
Standing Committee on child health (SCOCH):
Children are in need for every warmth and happiness to grow full
and safe....we decided to place a child's interests and health
as the priority of this committee, to understand a child's feel-
ings, struggles & needs. This is where your inner child comes
into action!!!
SSS Publications:
Every inch of these publications is the outcome of extensive
preparation and work, from material to fundraising, from con-
cept to design, from management to team dynamics. The
Each issue of the biannual journal "The SSS Medical" tackles a
topic that has erupted as a concern for medical students. It
presents the results of an assessment campaign usually as-
sessing medical students’ awareness about that topic, along
with various articles from eminent figures of the medical and
cultural society, presenting their points of views about that
issue and the recent updates that can be of interest to medi-
cal students and non-specialists.
Also, the brand new SSS social magazines "the Buzz" written
by medical students.
Trainings:
That's why one of our main goals is to supply and improve the
students’ skills, in order to be qualified to fulfill their duties as
medical students and young doctors in their society.
Social activities:
Being a scientific association doesn't delete the social aspect
of our activities, as vital need in the life of any association
generally and a crucial need in the life of medical students specifi-
cally .That accordingly increases their productivity and makes
them more liable for improvement and progress.
By the SSS Medical editorial
team