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Sudomotor Changes in Hepatitis C Virus Infection with or without Diabetes Mellitus: A Pilot Study in Egyptian Patients

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  • 1 Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt;
  • 2 Department of Internal Medicine, Al-Azhar University, Cairo, Egypt;
  • 3 Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt;
  • 4 Department of Clinical Biochemistry and Molecular Diagnostics, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt;
  • 5 Department of Neurology, Al-Azhar University, Damietta, Egypt;
  • 6 Ministry of Health and Population, Cairo, Egypt;
  • 7 Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt;
  • 8 Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt;
  • 9 Gastroenterology, Hepatology and Infectious Disease Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt;
  • 10 Clinical Pathology Department, Al-Azhar University, Cairo, Egypt

ABSTRACT

Hepatitis C virus (HCV) infection can affect the neurological system, and neuropathy is one of these manifestations. Hepatitis C virus infection is associated with diabetes mellitus (DM) type II, and diabetic patients are at higher risk of acquiring HCV infection. Sweat function has been proposed to assess early autonomic neuropathy. This study aimed to evaluate small fiber neuropathy in asymptomatic HCV-related cirrhotic patients with or without DM through sweat function assessment by Sudoscan test. Three groups were involved: 47 healthy controls, 48 HCV-related cirrhotic patients without DM (group 1), and 49 HCV-related cirrhotic patients with DM type II (group 2). All participants were subjected to liver panel tests, renal function tests, cell blood counts, HbA1c, and abdominal ultrasound. Sweat function was assessed in all patients and controls by measuring hand and feet electrochemical skin conductance (ESC, microSiemens [µS]) using Sudoscan. Peripheral neuropathy was detected in none of the controls, 39% of group 1 patients, and 62% of group 2 patients (P < 0.0001). The mean feet ESC (FESC) was 88.3 ± 6.8 µS in controls, 67.2 ± 19.2 µS in group 1, and 57.9 ± 19.4 µS in group 2 (P < 0.0001). A significant correlation was observed between FESC and bilirubin, albumin, creatinine, international normalized ratio, transaminases, and splenic size. Electrochemical skin conductance measurement is a valuable, noninvasive method for early detection of small fiber neuropathy in asymptomatic HCV-related cirrhosis, with or without DM.

Author Notes

Address correspondence to Mohamed Abdel-Samiee, Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt. E-mail: drmohammed100@yahoo.com

Disclosure: Well-informed written consent was obtained from all individuals included in the study. Our study was reviewed, and approved by the Ethical Committee at the National Liver Institute. All authors gave consent with manuscript content. All data are available upon request.

Authors’ addresses: El-Sayed Tharwa, Anwar Mohamed, Helmy Elshazly, Mohsen Salama, and Mohamed Abdel-Samiee, Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt, E-mail: drmohammed100@yahoo.com. Mohamed I. Youssef, Mohammed Saied Bakeer, HosamEldeen Salah Shabana, and Mahmoud Abdelrashed Allam, Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt, Shimaa Y. Kamel, Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Sabry Moawad Abdelmageed, Department of Clinical Biochemistry and Molecular Diagnostics, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt. Sherief M. Alshazly and Elsayed Fathi Ali Hamed, Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Hassan Yousef Zied, Department of Emergency, Egypt Ministry of Health and Population, Cairo, Egypt. Doaa Elwazzan, Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt. Sally Waheed Elkhadry, Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt. Aya Mohammed Mahros and Mohammed Hussien Ahmed, Hepatogastroentrology and infectious Disease Department, Faculty of Medicine, Kafr el-Sheikh University, Kafr el-Sheikh, Egypt. Mohammad AbdElhameed Ahmed Alwaseef, Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt, E-mail: abdelaleemelgendy2000@gmail.com.

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