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Chronic hepatitis C is common in Saudi Arabia and most often presents in an advanced stage. To assess the response of patients to interferon, a randomized placebo-controlled double-blind study was undertaken. All but 1 patient had cirrhosis or fibrosis before interferon. After a 24-week observation period patients received alpha 2a interferon, 3 mega units sc tiw or placebo for 24 weeks, then the opposite treatment for another 24 weeks followed by 24 weeks of observation. Liver biopsies were performed before and after each of the treatment phases. Twenty-two out of 24 patients completed the study. The mean alanine aminotransferase (ALT) levels fell from 150.7 +/- 118.7 units/l to 91.0 +/- 42.6 units/l after 6 months interferon treatment (P = 0.03) but only 3 patients (14%) had complete normalization of mean ALT levels and 4 (18%) had50% reduction. The mean hepatitis activity index fell from 12.2 +/- 2.6 immediately before to 11.6 +/- 2.5 just after interferon (P = 0.4). After interferon there was an insignificant raise in 6-month mean ALT. Hepatitis C virus-RNA was positive in all 17 patients tested and remained so after treatment. Side-effects were mild and well tolerated. Alpha interferon 3 mega units tiw for 24 weeks is not an effective treatment of histologically advanced chronic hepatitis C.

Human-T lymphotrophic virus Type 1 may be transmitted by cellular blood products. A low but definite risk exists that recipients of HTLV-1 infected products may develop severe even fatal disease. After one year of screening for HTLV-1 antibodies in 12,851 units of blood collected from a multinational volunteer donor population of which 42.6% were Saudi nationals, we found two units of blood which reacted repeatedly positive in the screen test. In both cases, the Western Blot confirmatory test was indeterminate in that not all bands required for a positive reaction were present. Both donors were expatriates from North America either living in an endemic area or with Caribbean ancestors. Although more than 5,000 Saudi national donors were tested and found negative for HTLV-1 antibodies, a statistical estimate of the maximal risk of finding a positive donor in this donor population subgroup is in the order of 0.055%. Based on these results it is recommended that blood banks in this region screen for HTLV-1.

Chronic non-A, non-B hepatitis occurs in 50% of Saudi patients with end-stage renal failure and requires long-term hemodialysis since it is a contraindication to renal transplantation. Thirteen patients with biochemical and histological documented chronic non-A, non-B hepatitis (11 with HCV antibodies) entered a double-blind placebo controlled cross-over study, in which Roferon A 3 MU or placebo were administered subcutaneously 3 times weekly after hemodialysis for 6 months. The mean ALT fell significantly from pretreatment levels of 74.7 (95% confidence interval (CI) 54.7, 92.5) (13 patients in the 6-month run-in period) and 66.8 (CI 47.7, 85.8) (7 patients in the run-in period + 6 patients in the placebo period) (difference NS) to 37.6 (CI 21.0, 54.2) during interferon treatment (P0.005). In 10/13 patients (77%) ALT levels became normal. In the 6-month follow-up period immediately after therapy, the mean ALT was 45.2 (CI 28.0, 62.0). Although this change was not significant (P = 0.49), only 7 of these 10 patients sustained biochemical remission in the 6-month follow-up period. The corresponding total Histological Activity Index improved from 8.9 (CI 7.5, 10.3), 8.9 (CI 7.2, 10.7) (difference NS) to 6.2 (CI 3.9, 8.5) (P0.05; P = 0.052, respectively). Intralobular inflammation and periportal inflammation showed the most significant changes. Five of 13 (39%) and 2/13 patients (15%) had complete resolution of piecemeal necrosis and intralobular inflammation, respectively. Toxic effects of interferon were mild, early and self-limiting.(ABSTRACT TRUNCATED AT 250 WORDS)

Based on the screening of 10,646 units of blood by a recombinant hepatitis C antibody enzyme-linked immunosorbent assay (ELISA), the prevalence of hepatitis C (HCV) antibody-reactive donors was established in a Saudi Arabian donor population. The overall prevalence of HCV antibody was found to be 1.01%. By nationality, the antibody frequency was 1.00% (Saudi males), 2.30% (other Middle Easterners), 0.71% (Far East nationals), and 0.39% (Europeans/North Americans). The ELISA HCV antibody reactive units were further tested by a recombinant immunoblot assay (RIBA) in which 47.2% of the initially reactive samples were found to contain specific antibodies to two recombinant antigens. HCV antibody seroprevalence defined by reactiveness in both tests was 0.48% for the entire population, 0.33% (Saudis), 1.42% (Middle Easterners), 0.27% (Far East nationals and Europeans/North Americans). The surrogate markers alanine aminotransferase (ALT) and hepatitis B core (HBc) antibody identified 7.7 to 40% and 20 to 56.4%, respectively, of donors of different nationalities testing repeatedly reactive in the HCV ELISA. Likewise, ALT and HBc antibody identified 20 to 57.1% and 0 to 66.75%, respectively, of HCV ELISA and RIBA reactive donor samples, depending on nationality. It was concluded that the present anti-HCV testing, althought useful in screening blood for HCV carriers, must be supplemented by surrogate tests until additional specific tests are available.

Intra-cardiac transfusion in utero is a recent development in the treatment of erythroblastosis foetalis. As with intra-umbilical cord transfusion, the procedure has been described as having a high risk of complication characterized by bradycardia and cardiac-arrest. Intra-coronary hyperkalemia was suspected as being a major contributing factor towards the complications experienced, particularly by the intra-cardiac delivery. The procedure is warranted, however, in cases where intra-umbilical cord transfusion is not possible. Therefore, studies comparing various methods of preparing packed cells for intravascular transfusion were initiated. The plasma potassium levels of gravity sedimented packed cells and saline washed red cells resuspended in either Ringer's lactate, pooled donor plasma or saline were measured. Products of saline washed/resuspended packed red cells transfused within 2 hours of preparation were found to have low potassium levels while exposing the fetus to minimal risk of transfusion transmitted infection and were therefore selected to be the most suitable product. Using this product, a significant decrease in the incidence of severe bradycardia resulting in cardiac-arrest, following intravascular transfusion (32 procedures) was observed.

To assess the existence of a vesical hypothalamic reflex by evaluating the changes of plasmatic ADH levels during acute bladder filling in healthy adult volunteers.Twenty normal male subjects aged between 19 and 40 years (average age 31.6 years) were evaluated. All subjects signed informed consent. The subjects had no pathologic blood and urine examination, no cardiovascular, hepatic, renal disease, they were no smokers and they did not take drugs which may interfere with plasmatic ADH levels. A blood sampling at rest condition (time 0) and successively during cystometry in the presence of first sensation, normal and strong desire was carried out. Plasmatic ADH was measured on extracted samples by radioimmunoassay. A one-factor repeated measures analysis of variance was employed to verify the effect of time on ADH levels. The Greenhouse-Geisser and Huynh-Feldt adjustments were adopted to protect against the case of violation of homogeneity of covariance.Statistical analysis did not show significant differences of plasmatic ADH levels between rest condition and bladder filling.We exclude the existence of a vesical hypothalamic reflex and we suppose that extravesical factors may interfere with the plasmatic ADH production during the night.