SSS Medical- 4 on HCV

Issue 4, 1st

Students’ Scientific

Autumn

SSS is an independent, non profit association; run by volunteered medical students & aiming at producing active contributing physicians of a global society

Me and My Liver Prof. Wafaa Akl

Not only the Liver, But also the outside Prof. Heba Mustafa

HCV and Rheumatolohy Prof. Amira Shahin

Hepatitis C Virus Be gentle with yourself The editorial team Is there hope … ?!!!

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

Shocking Facts

The editorial team

Students’ Scientific Society — Kasr Al

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TABLE OF CONTENTS: •

Introduction from one of the owners.

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Me and my liver .

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HCV and Rheumatology .

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Not only the liver, also the outside .

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Be gentle with yourself.

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An invitation… live in health rather than disease .

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Is there hope in the way? .

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Shocking facts .

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About us .

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Editorial team

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Prof. Mohamed Elsada, SSS Supervisor

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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.

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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.

SSS Medical Hepatitis C Virus

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 million among a population of 68 million having exposed to the virus with 5-7 million active infections. Such a number translates the huge problem Egypt is facing with Hepatitis C virus, threatening 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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SSS Medical Hepatitis C Virus 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 inhalational 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 material 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

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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 symptoms 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 develops 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 evidence 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 alcoholic 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 monitored by measurements of HCV virus levels. Retesting for anti-HCV may be necessary if the initial result is negative, but clinical signs and symptoms suggest an HCV infection. Furthermore, anti-HCV does not distinguish 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. Ribavirin 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 governorates in Egypt.

Dr Wafaa Akl, Akl, Professor of Tropical medicine, medicine, Kasr Eleiny, Eleiny, Cairo University.

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 Mostafa, Mostafa, Professor of Internal medicine, medicine, Kasr Eleiny, Cairo University

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HCV and Rheumatology Rheumatic manifestations in patients HCV infection Many Extra-hepa0c manifesta0ons, including rheuma0c disease, have been reported to be associated 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 ďŹ bromyalgia. 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 symptoms. Glomerulonephri0s (GN) is predominantly associated with MCV, and almost always takes the form of membranoprolifera0ve GN.

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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 sensorimotor 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 treatment, increase nodules size and their appearance in abnormal sites, in addi0on to the development 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 infec0on. Sclerodermatous changes were reported as cutaneous manifesta0on of HCV.

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Fibromyalgia and inflammatory back pain was expected to occur more in pa0ents with HCV infec0on.

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. Cor0costeroids are used to control the most severe life threatening manifesta0ons of systemic vasculi0s, 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 replica0on. 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. Hydroxychloroquine, low dose steroids, low dose methotrexate, and azathioprine were mostly effec0ve in controlling 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 vasculi0s. Inflammatory ar0cular manifesta0ons had different types; intermiHent asymmetric nondestruc0ve type, symmetric polyar0cular nondestruc0ve type and symmetric polyar0cular 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 Shahin, Shahin, Professor of Rheumatology, Rheumatology, Kasr Eleiny, Eleiny, Cairo University.

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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 noncaregivers 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 temporary and they will reverse with time after HCV treatment is stopped.

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SSS Medical Hepatitis C Virus 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 commun

cator before treatment. Some patients do not want to talk about their experiences. Others want t 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 awa 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 mor 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 getting 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.

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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 caregivers. 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 Team

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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, disability 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

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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 assessment 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, Molecularbased 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 transplanta0on 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 developing cirrhosis within five years.

By the SSS medical Editorial Team

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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 incidence 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 prevalent in countries neighbouring Egypt having similar socio medical conditions and similar strains

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-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 rural areas.

Dr. Wafaa Akl And the SSS medical Editorial Team

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About The Students’ Scientific Society is an independent 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 introduction 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 students to experience the practice of medicine in a different culture, within the different IFMSA schemes of exchange.

In addition, SSS members will be able to organize trainings and social events for foreign medical students during 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 continuous collaboration with international bodies such as UN agencies and WHO. In addition, IFMSA international trainings are always a great opportunity for SSS members to enrich their skills and open up to the international community.

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Standing Committee on Medical Education (SCOME): In a country like Egypt, continuous improvement of medical 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 competition SSS is aiming at the development of the students’ abilities and skills, in order to achieve its goal of preparing active 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 awareness of the problems related to AIDS and sexually transmitted diseases, both among medical students and the population 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 projects 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.

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Students’ Scientific Society

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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 feelings, 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 concept 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 assessing 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 medical 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 specifically .That accordingly increases their productivity and makes them more liable for improvement and progress.

By the SSS Medical editorial team

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