Ayman Yosry

Cairo University, Al Qāhirah, Al Qāhirah, Egypt

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Publications (24)50.46 Total impact

  • Journal of Hepatology 04/2015; 62:S863-S864. DOI:10.1016/S0168-8278(15)31530-0 · 10.40 Impact Factor
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    Arab Journal of Gastroenterology 06/2014; 15(2). DOI:10.1016/j.ajg.2014.04.003
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    ABSTRACT: Patients suspected with meningitis can fall into three main categories including meningitis, encephalitis or meningism. Each category has its own epidemiological features; however clinical presentations can be non-discriminating in many instances. Studying the epidemiological features of such cases can help in defining more clues for discriminating these categories. The aim of this study is to describe the epidemiology of acute meningitis, encephalitis and meningism in 1712 cases presented to Shebin EL-Kom Fever Hospital with suspected meningitis. A total of 1712 Egyptian patients suspected with acute meningitis admitted to Shebin El-Kom Fever Hospital were studied according to demographic features and disease outcome. Meningitis was diagnosed in 36.4% of cases, encephalitis in 17.3%, while the largest percentage of 46.3% was diagnosed as meningism. Meningitis was higher in pre and post school age groups. Encephalitis peak above 60 years and meningism was below 6 years. Each group showed significant male and rural area predominance (p >0.001). Encephalitis showed higher mortality as compared to meningitis and meningism. Age grouping can be useful to discriminate cases suspected with meningitis. CNS affection is a common disease in male gender, rural communities and summer season. Meningitis and encephalitis are serious diseases with lethal outcome.
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    ABSTRACT: The number of hepatitis C virus (HCV) infections is projected to decline while those with advanced liver disease will increase. A modeling approach was used to forecast two treatment scenarios: (i) the impact of increased treatment efficacy while keeping the number of treated patients constant and (ii) increasing efficacy and treatment rate. This analysis suggests that successful diagnosis and treatment of a small proportion of patients can contribute significantly to the reduction of disease burden in the countries studied. The largest reduction in HCV-related morbidity and mortality occurs when increased treatment is combined with higher efficacy therapies, generally in combination with increased diagnosis. With a treatment rate of approximately 10%, this analysis suggests it is possible to achieve elimination of HCV (defined as a >90% decline in total infections by 2030). However, for most countries presented, this will require a 3-5 fold increase in diagnosis and/or treatment. Thus, building the public health and clinical provider capacity for improved diagnosis and treatment will be critical.
    Journal of Viral Hepatitis 05/2014; 21 Suppl 1:60-89. DOI:10.1111/jvh.12249 · 3.31 Impact Factor
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    ABSTRACT: Chronic infection with hepatitis C virus (HCV) is a leading indicator for liver disease. New treatment options are becoming available, and there is a need to characterize the epidemiology and disease burden of HCV. Data for prevalence, viremia, genotype, diagnosis and treatment were obtained through literature searches and expert consensus for 16 countries. For some countries, data from centralized registries were used to estimate diagnosis and treatment rates. Data for the number of liver transplants and the proportion attributable to HCV were obtained from centralized databases. Viremic prevalence estimates varied widely between countries, ranging from 0.3% in Austria, England and Germany to 8.5% in Egypt. The largest viremic populations were in Egypt, with 6 358 000 cases in 2008 and Brazil with 2 106 000 cases in 2007. The age distribution of cases differed between countries. In most countries, prevalence rates were higher among males, reflecting higher rates of injection drug use. Diagnosis, treatment and transplant levels also differed considerably between countries. Reliable estimates characterizing HCV-infected populations are critical for addressing HCV-related morbidity and mortality. There is a need to quantify the burden of chronic HCV infection at the national level.
    Journal of Viral Hepatitis 05/2014; 21 Suppl 1:5-33. DOI:10.1111/jvh.12247 · 3.31 Impact Factor
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    ABSTRACT: The disease burden of hepatitis C virus (HCV) is expected to increase as the infected population ages. A modelling approach was used to estimate the total number of viremic infections, diagnosed, treated and new infections in 2013. In addition, the model was used to estimate the change in the total number of HCV infections, the disease progression and mortality in 2013-2030. Finally, expert panel consensus was used to capture current treatment practices in each country. Using today's treatment paradigm, the total number of HCV infections is projected to decline or remain flat in all countries studied. However, in the same time period, the number of individuals with late-stage liver disease is projected to increase. This study concluded that the current treatment rate and efficacy are not sufficient to manage the disease burden of HCV. Thus, alternative strategies are required to keep the number of HCV individuals with advanced liver disease and liver-related deaths from increasing.
    Journal of Viral Hepatitis 05/2014; 21 Suppl 1:34-59. DOI:10.1111/jvh.12248 · 3.31 Impact Factor
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    ABSTRACT: Background and Aim. Bacterial meningitis is a lethal, disabling endemic disease needing prompt antibiotic management. Gram stained smears is rapid accurate method for diagnosis of bacterial meningitis. In cases of negative gram stained smears diagnosis is delayed till culture results. We aim to assess the role of clinical presentations and routine CSF analysis in the cost-effective rapid diagnosis of negative gram stained smears bacterial meningitis. Methods. Cross sectional study including 623 acute meningitis patients divided into two groups: bacterial meningitis and nonbacterial meningitis groups. The clinical presentations, systemic inflammatory parameters, and CSF analysis were evaluated and compared in both groups. Results. Altered conscious level, localizing neurological signs, Kernig's and Brudzinski's signs together with peripheral leucocytosis (>10.000/mm(3)), high CRP (>6) together with high CSF protein (>50 gl/dL), CSF neutrophilic count (≥50% of total CSF leucocytic count), and low CSF glucose level (<45 gm/dL) and CSF/serum glucose ≤0.6 were significantly diagnostic in bacterial meningitis patients. From the significant CSF analysis variables CSF protein carried the higher accuracy of diagnosis 78% with sensitivity 88% and specificity 72%. Conclusions. High CSF protein (>50 mg/dL) together with plasma inflammatory markers and CSF cytochemical parameters can diagnose bacterial meningitis in gram stain negative smear till culture results.
    Journal of Tropical Medicine 04/2014; 2014:213762. DOI:10.1155/2014/213762
  • Journal of Hepatology 04/2014; 60(1):S472. DOI:10.1016/S0168-8278(14)61324-6 · 10.40 Impact Factor
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    ABSTRACT: Objective Malnutrition is prevalent among patients with end stage liver disease awaiting liver transplantation. Our aim was to examine, in a prospective way, the impact of the patients′ nutritional status on the outcome of living donor liver transplantation (LDLT). Methods Thirty patients scheduled for LDLT were subjected to pre-operative nutritional status assessment through subjective global assessment (SGA), nutritional risk screening- 2002( NRS-2002) and anthropometric measurements, including estimation of body weight , body mass index, mid arm circumference, triceps skin fold thickness, mid leg circumference and body composition evaluation by bio-electrical impedance. All patients were followed up for 3 months after LDLT for mortality, graft rejection, number of clinically significant infective episodes, time spent in hospital (ward and intensive care unit [ICU] departments) and graft failure or dysfunction. ResultsAll patients were nutritionally compromised (as evaluated by SGA and NRS-2002). They were divided into two groups: moderately malnourished and severely malnourished patients. It was found that severely malnourished patients showed significant post operative hyperbilirubinemia, higher number of infective episodes and longer ICU stay. Pre-operative triceps skin fold and mid arm circumference were significantly negatively related to the number of infective episodes (r = -0.33, P = 0.03) (r = -0.377, P = 0.04) respectively. Moreover, skeletal muscle compartment as measured by bio-electrical impedance was significantly negatively related to post operative serum ALT (r = -0.52 , P = 0.003) and the number of post operative infective episodes (r = -0.3, P = 0.04). Conclusion Poor nutritional status of Egyptian patients with ESLD negatively affects the outcome of LDLT.
    Journal of Digestive Diseases 03/2014; 15(6). DOI:10.1111/1751-2980.12141 · 1.92 Impact Factor
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    ABSTRACT: Background: incidence of Colorectal cancer (CRC) is increasing globally. In Egypt, CRC ranks the sixth most common cancer in males and the fifth in females. Aim: To assess the expression of estrogen receptors (alpha and beta) in pre-malignant (adenomatous po-lyps and IBD), malignant colorectal lesions and nor-mal colonic mucosa in group of Egyptian patients. Methods: This prospective study was done on 45 pa-tients presenting with colonic symptoms, patients were divided into four groups; 15 CRC patients, 10 patients with adenomatous polyps, 10 IBD patients and 10 patients in the control group. Patients sub-jected to: Stool analysis, FOBT, CBC, CEA, Abdomi-nal ultrasound & colonoscopy and biopsy (number = 80), Pathological, immunohistochemistry and RT-PCR quantification of ERα and ERβ were done. Re-sults: Mean age: 39.2 (12 -73), gender: M/F: 28/17. Bleeding per rectum was the commonest presentation; 29/45 (64.4%). CEA was significantly elevated in the CRC group compared with other studied groups (1692 mg/L vs. 4.0, 4.0 and 4.4 mg/L). Ultrasonography of the studied patients showed that metastatic CRC: 3/15 (20%); Colonic wall thickening: 5/15 (33.3%), 1/10 showed colonic polypoidal lesions in adenoma-tous polyps groups, in IBD group: 4/10 (40%) showed colonic and ileocecal thicknening. All the studied pa-tients showed negative results for estrogen receptors (alpha and beta) by the use of immunohistochemistry staining and RT-PCR technique. Conclusion: Role of estrogen receptors in the colonic mucosa, precancer-ous and colorectal cancer is doubtful, contradictory results with some literature data could be due to ra-cial and genetic difference in the studied population.
    Open Journal of Gastroenterology 04/2013; 3(02). DOI:10.4236/ojgas.2013.32026
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    ABSTRACT: BACKGROUND: Transluminal retroperitoneal endoscopic necrosectomy (TREN) is an attractive NOTES technique alternative to surgery for treatment of walled-off pancreatic necrosis (WOPN). The main limitations to this technique are the need for repeated sessions, prolonged external irrigation, and EUS availability. In our study, we introduced new modifications, including the use of hydrogen peroxide, and abandoning the use of EUS and external irrigation. METHODS: This is a retrospective study of outcome of consecutive patients who underwent TREN for WOPN between April 2011 and August 2012. The technique included (1) non-EUS-guided transluminal drainage, and (2) direct endoscopic debridement using hydrogen peroxide and different accessories. No external irrigation was used. RESULTS: Ten patients were included. Initial clinical and technical success was achieved in all patients. Complete radiological success and long-term clinical efficacy was achieved in nine patients (1 patient had an inaccessible left paracolic gutter collection and died 62 days after endotherapy). Mean number of sessions was 1.4 (range 1-2). Complications included bleeding, which was self-limited in three patients and endoscopically controlled in one. All patients avoided surgery, and no recurrence was reported during median follow-up of 289 (range 133-429) days. CONCLUSIONS: TREN is a safe and effective treatment for WOPN and could be performed safely without EUS guidance in selected cases. Hydrogen peroxide played a major role in reduction of number of sessions and timing. External irrigation of WOPN is not necessary, if adequate debridement could be achieved.
    Surgical Endoscopy 04/2013; DOI:10.1007/s00464-013-2948-x · 3.31 Impact Factor
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    ABSTRACT: Introduction-Aim. Health-Related Quality of Life (HRQOL) has become an important focus of patient care and clinical outcomes research with the improvement in patient and graft survival after liver transplantation (LT). The current study was designed to evaluate the post-transplant HRQOL profiles using the Liver Disease Quality of Life 1.0 (LDQOL 1.0) Questionnaire and demonstrate the possible effect of peri-transplant clinical covariates on these profiles. Material and methods. Participants included pre-transplant group (waiting-list patients n = 50) and post-transplant group (mean 5 ± 4 years after deceased or living donor LT n = 103) who were recruited from 3 specialized centers in Egypt. We applied the LDQOL 1.0 questionnaire; a 111-item containing the Short Form-36 version 2.0 (SF-36v2) as a generic component supplemented by 75 disease-specific items. The etiology of cirrhosis, co-morbidities, model for end-stage liver disease (MELD), Child-Pugh class and post-operative complications were analyzed. Results. All recipients had significant higher HRQOL scores than patients in waiting-list using both questionnaire components. Recipients with pre-LT MELD ≥ 15, Child-Pugh class C, history of hepatocellular carcinoma (HCC) demonstrated low HRQOL scores. Recipients without post-operative surgical complications had a statistically better HRQOL using the disease-specific, but not the SF-36v2 component. On the other hand, both components demonstrated non-significant lower scores in recipients with rejection episodes, cytomegalovirus (CMV) infection and hepatitis C recurrence had compared to those without medical complications. Conclusion. Generally HRQOL improves dramatically after LT as assessed by LDQOL questionnaire. Moreover, combined questionnaires can provide accurate information about the possible impaired HRQOL post-LT due to pre-transplant disease severity and post-operative complications.
    Annals of hepatology: official journal of the Mexican Association of Hepatology 11/2012; 11(6):882-90. · 2.19 Impact Factor
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    ABSTRACT: To analyze the effect of human leukocyte antigen tissue typing on outcome of live-donor liver transplant. Fifty recipients underwent live-donor liver transplant in the Dar Al-Fouad Hospital in Egypt and were retrospectively evaluated. Patients were classified into 2 groups: those with human leukocyte antigen +ve, and those with human leukocyte antigen -ve and donors. Hepatitis C virus-related end-stage liver disease was the main indication for transplant. Demographic data, preoperative laboratory data, results of human leukocyte antigen tissue typing, Child score, model for end-stage liver disease score, graft/recipient weight-ratio, ischemia times, surgical complications, postoperative laboratory data, liver biopsy, immunosuppression, and pulse steroids were collected. Graft and patient survivals were studied using Kaplan-Meier curves. The mean model end-stage liver disease score was 18 ± 3.61 in group 1 and 17.73 ± 3.72 in group 2, with no significant difference. Graft/recipient weight ratio, ischemia times, and postoperative complications showed P = NS. Cyclosporine and tacrolimus were used in 5/9, 8/41, and 4/9 in group 1, and 32/41 in group 2 (P = NS). Rejection and pulse steroids were reported in 3/9 and 12/41 of group 1, and 3/12 and 11/41 of group 2 (P = NS). Hepatitis C virus-recurrence was diagnosed in 5/9 of patients (55%) and 8/41 of patients (29.5%) in groups 1 and 2 (P < .05). No statistical difference was found regarding mortality; 5-year patient and graft survival was 35/50 (70% in group 1 [human leukocyte antigen +ve]), 7/9 (77.8%), and 28/41 in group 2 (68.3%) (human leukocyte antigen -ve). Positive human leukocyte antigen typing before live-donor liver transplant has no effect on the incidence of postoperative complications, rejection episodes, and patient or graft survival. Recipients with positive human leukocyte antigen typing may have increased risk of hepatitis C virus-recurrence after live-donor liver transplant.
    04/2012; 10(2):136-40. DOI:10.6002/ect.2011.0066
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    ABSTRACT: Human leucocyte antigens (HLA) class II appear to play an important role in the individual's immune response to viral infection. The aim of this study is to assess the relationship between HLA class II antigens with the clinical, laboratory and histopathological state of the liver in Egyptian children and adolescents with chronic hepatitis C virus (HCV) infection. The study included 46 chronically infected HCV children and adolescents without - hepatitis B virus (HBV) nor human immunodeficiency virus - (HIV). Their mean age was 10.4±4.23years (3-17). HLA-DRB typing was done by polymerase chain reaction (PCR) for the patients and 20 control subjects. Biochemical and haematological parameters were assessed as well as a liver biopsy was taken from the included patients. The most frequent alleles demonstrated among patients were DRB1∗03, DRB1∗04 and DRB1∗13 (45.6%, 39.1% and 26.1%), respectively. Analysis of DRB1 frequencies between patients and control revealed that DRB1*15 is significantly reduced among patients when compared with the control group (p<0.01). Patients possessing the allele DRB1*03 had significantly reduced platelet count (p=0.03), and this allele was presented to a greater extent in patients with minimal grade of inflammation. Patients with DRB1*04 had significantly low serum albumin (p=0.04) and patients with DRB1*13 had significantly high serum aspartate aminotransferase (AST) levels (p=0.05). In Egyptian HCV-infected children, special HLA patterns were found; HLA DRB1*03 was present in nearly half of the patients, while the frequency of HLA DRB1*15 was significantly reduced among the cases in comparison to the control subjects.
    Arab Journal of Gastroenterology 03/2011; 12(1):25-8. DOI:10.1016/j.ajg.2011.01.007
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    ABSTRACT: The recurrence of hepatitis C virus infection after liver transplant is common and may endanger both graft and patient survival. We investigated the frequency and outcome of and risk factors for the recurrence of that virus after living-donor liver transplant in hepatitis C virus positive recipients. Seventy-four adult hepatitis C virus positive subjects were monitored for 36 months after living-donor liver transplant and demographic and laboratory data for the recipients and donors were evaluated. Recurrent hepatitis C virus infection was diagnosed on the basis of viral replication revealed by polymerase chain reaction after transplant, elevated levels of transaminases, and the results of liver biopsy. Hepatitis C virus recurrence was identified in 31.1% of the patients studied. Histopathologic recurrence was mild, and 91% of the subjects had a fibrosis score of < or = F2. No recipient exhibited cirrhosis or clinical decompensation during followup. Recurrent hepatitis C virus infection was associated with pretransplant and posttransplant viral load and antibody positive to hepatitis B core antigen. No other risk factors (sex, donor or recipient age, pretransplant Child-Pugh or Model for End-Stage Liver Disease scores, immunosuppressive drug therapy, and treatment with pulse steroids) were significantly correlated with the frequency of hepatitis C virus recurrence, the grade of the histologic activity index, or the stage of fibrosis. In living-donor liver transplant recipients, patient and graft survival rates associated with hepatitis C virus (genotype 4) related cirrhosis were comparable to those in deceased-donor liver transplant recipients reported in the literature. Recurrent infection with hepatitic C virus after living-donor liver transplant was mild. After transplant, a higher viral load and the presence of antibody to hepatitis B core antigen could be risk factors for hepatitis C virus recurrence. Long-term follow-up in a large number of patients is required.
    10/2009; 7(3):157-63.
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    ABSTRACT: Background and Study Aims: Cirrhotic patients frequently undergo screening endoscopy for the presence of varices. In the future, this social and medical burden will increase due to the greater number of patients with chronic liver disease and their improved survival. In this study, our aim was to develop a predictive model using independent risk factors for the presence of varices in the enrolled patients. Patients and Methods: 200 patients with liver cirrhosis with no history of variceal haemorrhage were subjected to clinical examination; laboratory investigations (CBC, Liver biochemical profile, serum urea and creatinine), modified Child-Pugh score and MELD score were calculated. Abdominal ultrasonography and Doppler study of the portal and splenic veins studying the liver size, the presence of periportal thick-ening, hepatic veins flow pattern, the splenic longest axis and volume, the presence of ascites and collaterals. Portal vein and splenic vein diameter, patency, cross sectional area, mean flow velocity, blood flow volume congestion index and direc-tion of flow of portal vein were calculated. Platelets count/Splenic diameter ratio and Right liver lobe diameter/ albumin ratio were calculated for all patients. Upper endoscopy was done where oesophageal varices were graded according to modified Thakeb classification. Results: This study revealed that 83% of patients had oesophageal varices; 52% had small sized oesophageal varices and 31% had large sized oesophageal varices. In patients with varices; 12% had biphasic and 22.9% had monophasic hepatic veins flow pattern, with p value of 0.002. Portal vein direction of flow was bidirectional in 22.9% and Hepatofugal in 9.6% with a p value of 0.004. The portal vein velocity of 9.3 ±2.3cm/ sec with a p value of <0.001 and the ascites was present in 77% of patients with a p value of 0.005. In patients with large sized varices; shrunken liver was present in 83.1 % of patients with a p value of 0.005 and serum albumin <2.5gm/dl with a p value of 0.008. Conclusion: Hepatic veins flow pattern (biphasic and monophasic), portal vein direction of flow (hepatofugal and bidirectional), decreased portal vein velocity and the presence of ascites (moderate and marked) were the significant variables for prediction of presence of varices. Shrunken liver and the low serum albumin were the significant variables for prediction of large varices.
    The Medical journal of Cairo University 06/2009; 77:343-349.
  • Journal of Hepatology 04/2009; 50. DOI:10.1016/S0168-8278(09)60652-8 · 10.40 Impact Factor
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    ABSTRACT: Background and study aimQuality of life after liver donation must remain a primary outcome measure when we consider the utility of living donor liver transplants. In making clinical decisions on the use of transplantation for chronic liver diseases, consideration should be given to the key factors likely to affect subsequent health related quality of life. It would be beneficial for donors, if factors predicting good quality of life are identified. The aim of this study was to assess the health related quality of life changes experienced by donors following living related liver transplantation using the Short Form 36 (SF-36) questionnaire.
    Arab Journal of Gastroenterology 03/2009; 10(1):21-24. DOI:10.1016/j.ajg.2009.03.004
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    ABSTRACT: Hepatitis C virus (HCV) recurrence after living donor liver transplantation (LDLT) represents a challenging issue due to universal viral recurrence and invasion into the graft, although the incidence of histological recurrence, risk factors, and survival rates are still controversial. Recurrence of HCV was studied in 38 of 53 adult patients who underwent LDLT. Recipient and graft survivals were 86.6% at the end of the follow-up which was comparable to literature reports for deceased donor liver transplantation (DDLT). Clinical HCV recurrence was observed in 10/38 patients (26.3%). Four patients developed mild fibrosis with a mean fibrosis score of 0.6 and mean grade of histological activity index (HAI) of 7.1. None of the recipients developed allograft cirrhosis during the mean follow-up period of 16 +/- 8.18 months (range, 4-35 months). Estimated and actual graft volumes were negatively correlated with the incidence and early clinical HCV recurrence. None of the other risk factors were significantly correlated with clinical HCV recurrence: gender, donor and recipient ages, pretransplantation Child-Pugh or model for end-stage liver disease (MELD) scores, pre- and postoperative viremia, immunosuppressive drugs, pulse steroid therapy, and preoperative anti-HBc status. Postoperative patient and graft survival rates for HCV (genotype 4)-related cirrhosis were more or less comparable to DDLT reported in the literature. Clinical HCV recurrence after LDLT in our study was low. Small graft volume was a significant risk factor for HCV recurrence. A longer follow-up and a larger number of patients are required to clarify these issues.
    Transplantation Proceedings 07/2008; 40(5):1481-4. DOI:10.1016/j.transproceed.2008.03.085 · 0.95 Impact Factor
  • Ayman Yosry
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    ABSTRACT: Schistosomiasis is endemic in at least 75 tropical and subtropical countries where 600 million people are at risk of which over 200 million are infected. Three species, S. hematobium, S. mansoni and S. japonicum, account for the majority of human infections. There is sufficient evidence that S. hematobium, the predominant etiologic agent for urinary schistosomiasis, is carcinogenic to humans leading to squamous cell carcinoma of the urinary bladder, a relatively uncommon vesical cancer in nonendemic areas. There is limited evidence suggesting that S. japonicum is possibly carcinogenic to humans leading to colorectal cancer and is a risk factor for hepatocellular carcinoma formation. There is inadequate evidence for the carcinogenicity of S. mansoni in humans. S. mansoni may still be linked to hepatocellular carcinoma through potentiating the effects of hepatitis B virus and hepatitis C virus on the liver. In this article, the relationship between schistosomiasis and neoplasia will be reviewed.
    Contributions to microbiology 02/2006; 13:81-100. DOI:10.1159/000092967