\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[T2A]{fontenc}
\usepackage[greek,ngerman,polish,english]{babel}



\usepackage{float}








\begin{document}

\title{The Missing Piece, The Screening for Diabetes ,Obesity and Hypertension
Risk Factors Associated with Hepatitis C In Egyptian Population in a
Community Pharmacy Setting.}



\author[1]{amira kassem}%
\author[2]{Alaa mousa}%
\author[2]{amira harun }%
\author[3]{Heba Alhusseini}%
\author[2]{salma Khaled }%
\author[2]{Mahmoud  Elhadidy}%
\author[4]{Osama  ibrahim }%
\affil[1]{Damanhour University Faculty of Pharmacy}%
\affil[2]{Egypt Ministry of Health and Population}%
\affil[3]{Affiliation not available}%
\affil[4]{Cairo University Faculty of Pharmacy}%


\vspace{-1em}



  
  \date{May 27, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Background: Risk factors for hepatitis C complication including diabetes
and hypertension have seen in a many previous studies. This made the
need for prompted interest in prevention through the identifying
individuals at risk for these risk factors and increased investment in
screening by pharmacist. Objectives: The aim of this study is to screen
for several risk factors include (age, sex, BMI, Hypertension, diabetes
and obesity) in HCV positive (1959) Egyptian patients. Setting:
Prospective cross sectional study from September 2018 to February 2019.
A total of 1959 medical records were collected. By comparing the patient
characteristics, variables related to metabolic risk and body
composition measured. Regression models were built to adjust for
possible confounding factors. Results: The positive HCV antibody
prevalence rate was 41.0 \% in men and 59.0 \% in women. The variables
included in regression analysis are age, BMI, uncontrolled HTN were
statistically significant (P \textless{} 0.001) with DM in HCV positive
cases. HCV Patients with high BMI with age [?]40 (years) associated
significantly with diabetes and HTN (p\textless{}0.001). Hypertensive
HCV Egyptian patients were significantly associated with sex, age
\textgreater{}40 and DM (p\textless{} 0.001). Conclusion HCV infection
and metabolic disorders spin in a closed cycle relationship. Reducing
the complications of DM has a promising future of limiting the
complications of HCV.%
\end{abstract}%



\sloppy


\textbf{Conclusion}

HCV infection and metabolic disorders spin in a closed cycle
relationship. Reducing the complications of DM has a promising future of
limiting the complications of HCV.

\textbf{Keywords: Hepatitis C virus , Diabetes , Obesity , Hypertension}

\emph{Correspondence:} Amira B. Kassem

Lecturer Clinical Pharmacy and Pharmacy Practice Department,

Faculty of Pharmacy, Damanhour University, Egypt

Tel No. 00201222960523.

Email: amira.kassem@pharm.dmu.edu.eg

\emph{}

\emph{Introduction:}

Pharmacistsalready have an essential role in screening for Diabetes
mellites and Cardiovascular risk and their involvement has beneficial
effects in patient education and disease management {[}1{]} {[}2{]}.
Pharmacist-led health screening represents a great opportunity to
potentially engage pharmacists with patients who may be less likely to
access physicians including elderly patients, and patients from lower
socio-economic status {[}3{]}. The majority of research in hepatitis C
disease focused on the detection , diagnosis and treatment. However, in
this research we focused on the metabatic and hypertension risk
associated with hepatitis C infection in Egyptian population. Virus C is
considered as a gigantic endemic therapeutic health issue in Egypt
{[}4{]} . Egypt was found to have the most elevated recorded
predominance of HCV in the world {[}5{]} {[}6{]}. Incidence rate is
between 2 and 6 per 1000 case per year and 170,000 new cases are added
each year {[}4{]} . Although mortality related to HCV infection will
continue to extend over the following 20 years but, with successful
therapeutic strategies it may be eliminated within 15-20 years {[}6{]}.
Therefore , Egypt has propelled an ambitious new national treatment
program in 2014 {[}7{]} . The Egyptian national HCV treatment program is
considered one of the foremost fruitful, compelling and promising public
health programs {[}8{]} .Chronic hepatitis C is the most cause of
cirrhosis and hepatocellular carcinoma. Hepatitis C is characterized by
being a slowly progressing liver illness, which implies that cirrhosis
may happen almost 20--30 years after infection {[}9{]} . The primary
host cells for HCV are hepatocytes. Viral entry into hepatocytes occurs
following to its binding to low-density lipoprotein receptors. Once
internalized, HCV interferes with the host lipid metabolism for its
replication and assembly, which consequently leads to hepatic steatosis.
Hepatic steatosis could be a condition in which there is excessive
accumulation of triglycerides inside the hepatocytes. Strong
epidemiological, biochemical, and therapeutic evidence implicate insulin
resistance as the essential pathophysiological key mechanism driving to
hepatic steatosis. A mixture of several host and viral factors cause
hepatic steatosis{[}10{]} . First, host factors incorporate the
metabolic syndromes such as obesity and type 2 diabetes mellitus (T2DM),
hypertension, alcohol abuse and medication use. Second, hereditary
factors as interleukin 28B polymorphism. Third facor is viral components
as genotype (genotype 3 prima rily cause steatosis), and gene mutation
{[}10{]} . It is very useful to distinguish modifiable risk factors that
contribute to HCV progression it may guide treatment approaches and
overall disease management. Impact of obesity and DM have been entangled
within the progression of hepatic fibrosis and cirrhosis {[}8{]}.
Recently, many studies have suggested that chronic hepatitis C virus
infection (CHC) is associated with T2DM, However the association between
CHC and T2DM is not consistent across all studies {[}11{]} . Another
study in France detailed that HCV frequency was significantly related
with age {[}12{]} . Previous studies demonstrated that HCV infection
might not only resist antiviral course of treatment but also moreover
advancement of fibrosis may happen which is due to expanded proficiency
of viral replication by lipid accumulation in cells {[}11{]} . Lessening
in complications from T2DM that follows effective antiviral treatment
was detailed in later clinical trials {[}13{]} . The current study
points to target high risk HCV Egyptian patients with metabolic
disorders including diabetes, obesity , hypertension , age and sex then
estimate the potential risk factors associated with hepatitis C patients
and determine the impact of different screening methods for identifying
and treating people at high risk

\emph{Subjects and Methods:}

This is a cross sectional study where medical records of 1959 HCV
positive patients obtained from one University Hospital ``hepatic virus
section'' from (September 2018 to February 2019) were reviewed . Study
sample: All patients in the sample aged from 19 to 94 years old. Sample
included both males and females. Children and HIV patients were
excluded.

Study data: For obesity, Body mass index (BMI) was calculated as the
body weight in kilograms divided by the square of the height in meters
(kg/m2), BMI was categorized into three categories: normal (BMI
\textless{}25), overweight (BMI = 25 to \textless{}30) and obese (BMI
[?]30). For hypertension, the average of three readings was calculated and
the hypertensive patients were defined as patients having average
systolic [?]130 mmHg or average diastolic [?]90 mmHg. Patients who were
using antihypertensive drugs were considered hypertensive.

HCV testing protocol: HCV-Ab test was initially used to check HCV
antibodies. Negative ELISA samples were excluded. Positive ELISA samples
were retested for HCV antibodies using a more specific assay and further
tested by quantitative real-time PCR to detect HCV-RNA. Participants
with positive sera for HCV antibodies by ELISA test and positive PCR-RNA
were considered as chronic HCV infection.

Study design: We studied relationships between different patient
parameters and risk factors in 1959 HCV positive patient. Relationship
between DM, BMI, age and HTN with the rest of the parameters and risk
factors in HCV positive patients were studied. Study protocol was
approved by the University hospital and patients signed informed consent
forms before starting the study.

Statistical analysis of the data: Data were fed to the computer and
analyzed using IBM SPSS software package version 20.0. (Armonk, NY: IBM
Corp) . Qualitative data were described using number and percent. The
Kolmogorov-Smirnov test was used to verify the normality of
distribution. Quantitative data were described using range (minimum and
maximum), mean, standard deviation and median. Significance of the
obtained results was judged at the 5\% level.

The used tests were Chi-square , Fisher's Exact or Monte Carlo
correction , Mann Whitney test , Kruskal Wallis test and Post Hoc
(Dunn's multiple comparisons test) for pairwise comparisons. Regression
using a series of univariate and multivariable logistic regression
analyses were performed to investigate the factors associated with the
HCV infection. To detect the most independent/ affecting factor for DM,
HTN and BMI.

\emph{RESULT:}

The final eligible study sample comprised 1959 patients in the age group
18--95 years.

\textbf{1) The prevalence of diabetes mellitus in HCV positive cases:}

As shown in Table (1) including 1661(84.4\%) patients without
abnormalities in blood glucose level (BGL) measures while 71 (3.6\%)
patients discovered abnormalities in their BGL considered as new
diabetic cases. For patients who are with history of diabetes: 99(5.5\%)
patient with well controlled DM and 128(6.5\%) patients with
uncontrolled DM. The infection rates were similar between males and
females and there was no statistically significant difference with (p =
0.093). The variables included in regression analysis are age, BMI, and
uncontrolled HTN were statistically significant (P \textless{} 0.001).
After adjustment of demographic and HCV risk factors, It was found that
HCV was significantly associated with sub groups Age [?]40 years (p =
0.001), BMI [?]30 kg/m\textsuperscript{2} (p=0.022), HTN
(p\textless{}0.001) Table (5).

\textbf{2) According to BMI variation in HCV positive cases:}

Using classification of BMI shown in table (2) and Normal weight (BMI =
18.5--24.9). There are 482 cases (24.6\%) with HCV positive result,
there are 587 cases which are considered overweight (BMI= 25--29.9) and
890 Obese cases (45.4\%) (BMI of 30 or greater) .The variables included
in analysis are: sex, uncontrolled HTN were statistically significant (P
\textless{} 0.001), age over 40 years old (p = 0.009), DM (p0.014),
Table (4)

\textbf{3) According to variation in age in patients with HCV positive:}

It was clear that at the age which is more than 40 years old, the
prevalence of HCV increases as shown in table (3) , 1676 cases (85.6\%)
were over 40 year old. Using the relation between all the parameters
with different ages in HCV positive cases, all parameters were
statistically significant with p \textless{}0.001 except sex was not
statistically significant, as p was 0.239.

\textbf{4) The prevalence of hypertension in HCV positive cases:}

The average prevalence of HTN in HCV patients is (29.8\%) in men and
(73.2\%) in women (P \textless{} 0.001). The prevalence of HTN in cases
over 40 years old is (98.2\%, p\textless{} 0.001). The prevalence of HTN
among individuals with obesity is (65.4\%). The estimated prevalence of
DM in the participants with HTN is (40.1\%, p\textless{}0.001) as shown
in Table (4).

\textbf{Table (1) Relation between DM and different parameters in
positive HCV (n=1959)}

\textbf{Normal}

(n=1661)

\textbf{Normal}

(n=1661)

\textbf{DM}

\textbf{DM}

\textbf{DM}

\textbf{DM}

\textbf{DM}

\textbf{DM}

\textbf{Test of}

sig.

\textbf{P}

\textbf{New DM}

(n=71)

\textbf{New DM}

(n=71)

\textbf{Controlled DM (n=99)}

\textbf{Controlled DM (n=99)}

\textbf{Un controlled DM (n=128)}

\textbf{Un controlled DM (n=128)}

\textbf{No.}

\textbf{\%}

\textbf{No.}

\textbf{\%}

\textbf{No.}

\textbf{\%}

\textbf{No.}

\textbf{\%}

\textbf{Sex}

Male

694

41.8

31

43.7

37

37.4

41

32.0

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 5.423

0.143

Female

967

58.2

40

56.3

62

62.6

87

68.0

\textbf{Age (years)}

\textless{}40

273\textsuperscript{a}

16.4

2\textsuperscript{b}

2.8

6\textsuperscript{b}

6.1

2\textsuperscript{b}

1.6

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 35.913\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

[?]40

1388 \textsuperscript{a}

83.6

69\textsuperscript{b}

97.2

93\textsuperscript{b}

93.9

126\textsuperscript{b}

98.4

Min. -- Max.

19.0 -- 93.0

19.0 -- 93.0

30.0 -- 79.0

30.0 -- 79.0

26.0 -- 94.0

26.0 -- 94.0

25.0 -- 77.0

25.0 -- 77.0

H= 78.833\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

Mean \selectlanguage{ngerman}± SD.

53.08\textsuperscript{b} ± 13.59

53.08\textsuperscript{b} ± 13.59

60.76\textsuperscript{a} ± 9.67

60.76\textsuperscript{a} ± 9.67

60.11\textsuperscript{a} ± 11.36

60.11\textsuperscript{a} ± 11.36

59.88\textsuperscript{a} ± 8.53

59.88\textsuperscript{a} ± 8.53

Median

54.0

54.0

61.0

61.0

62.0

62.0

61.50

61.50

\textbf{BMI (kg/m\textsuperscript{2})}

18.5 -- 24.9 (Normal)

435\textsuperscript{a}

26.2

21\textsuperscript{a}

29.6

12\textsuperscript{b}

12.1

14\textsuperscript{b}

10.9

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 40.488\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

25 -- 29.9 (Overweight)

512\textsuperscript{a}

30.8

19\textsuperscript{a}

26.8

25\textsuperscript{a}

25.3

31\textsuperscript{a}

24.2

[?]30 (Obese)

714\textsuperscript{a}

43.0

31\textsuperscript{a}

43.7

62\textsuperscript{b}

62.6

83\textsuperscript{b}

64.8

\textless{}30

947\textsuperscript{a}

57.0

40\textsuperscript{a}

56.3

37\textsuperscript{b}

37.4

45\textsuperscript{b}

35.2

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 35.359\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

[?]30

714\textsuperscript{a}

43.0

31\textsuperscript{a}

43.7

62\textsuperscript{b}

62.6

83\textsuperscript{b}

64.8

Min. -- Max.

16.96 -- 64.84

16.96 -- 64.84

19.72 -- 54.50

19.72 -- 54.50

20.06 -- 56.89

20.06 -- 56.89

16.41 -- 58.59

16.41 -- 58.59

H= 34.512\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

Mean \selectlanguage{ngerman}± SD.

29.74\textsuperscript{b} ± 6.59

29.74\textsuperscript{b} ± 6.59

30.38\textsuperscript{b} ± 7.42

30.38\textsuperscript{b} ± 7.42

32.26\textsuperscript{a} ± 6.62

32.26\textsuperscript{a} ± 6.62

32.17\textsuperscript{a} ± 6.73

32.17\textsuperscript{a} ± 6.73

Median

28.69

28.69

28.41

28.41

32.45

32.45

32.01

32.01

\textbf{Systolic}

\textless{}130

1010\textsuperscript{a}

60.8

21\textsuperscript{b}

29.6

28\textsuperscript{b}

28.3

44\textsuperscript{b}

34.4

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 90.917\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

[?]130

651\textsuperscript{a}

39.2

50\textsuperscript{b}

70.4

71\textsuperscript{b}

71.7

84\textsuperscript{b}

65.6

Min. -- Max.

80.0 -- 210.0

80.0 -- 210.0

80.0 -- 220.0

80.0 -- 220.0

90.0 -- 206.0

90.0 -- 206.0

90.0 -- 190.0

90.0 -- 190.0

Mean \selectlanguage{ngerman}± SD.

124.74\textsuperscript{b}±18.33

124.74\textsuperscript{b}±18.33

137.11\textsuperscript{a} ±23.64

137.11\textsuperscript{a} ±23.64

135.70\textsuperscript{a}± 20.98

135.70\textsuperscript{a}± 20.98

133.87\textsuperscript{a} ± 20.02

133.87\textsuperscript{a} ± 20.02

H= 80.889\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

Median

120.0

120.0

130.0

130.0

130.0

130.0

130.0

130.0

\textbf{Diastolic}

\textless{}80

492\textsuperscript{a}

29.6

13\textsuperscript{b}

18.3

15\textsuperscript{b}

15.2

27\textsuperscript{b}

21.1

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 16.629\textsuperscript{*}

0.001\textsuperscript{*}

[?]80

1169\textsuperscript{a}

70.4

58\textsuperscript{b}

81.7

84\textsuperscript{b}

84.8

101\textsuperscript{b}

78.9

Min. -- Max.

50.0 -- 140.0

50.0 -- 140.0

50.0 -- 140.0

50.0 -- 140.0

60.0 -- 120.0

60.0 -- 120.0

56.0 -- 120.0

56.0 -- 120.0

Mean \selectlanguage{ngerman}± SD.

80.81\textsuperscript{b} ± 11.51

80.81\textsuperscript{b} ± 11.51

86.34\textsuperscript{a} ± 13.86

86.34\textsuperscript{a} ± 13.86

86.67\textsuperscript{a} ± 11.95

86.67\textsuperscript{a} ± 11.95

84.15\textsuperscript{a} ± 12.70

84.15\textsuperscript{a} ± 12.70

H= 46.767\textsuperscript{*}

0.001\textsuperscript{*}

Median

80.0

80.0

``90.0

``90.0

90.0

90.0

80.0

80.0

\textbf{HTN}

Normal

1462\textsuperscript{a}

88.0

69\textsuperscript{b}

97.2

30\textsuperscript{c}

30.3

66\textsuperscript{d}

51.6

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 325.072\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

Hyper

199\textsuperscript{a}

12.0

2\textsuperscript{b}

2.8

69\textsuperscript{c}

69.7

62\textsuperscript{d}

48.4

a,b,c,d : Means with \textbf{Common letters} are not significant (i.e.
Means with \textbf{Different letters} are significant)

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}: Chi square test

H: H for \textbf{Kruskal Wallis test,} Pairwise comparison bet. each 2
groups was done using \textbf{Post Hoc Test (Dunn's for multiple
comparisons test)}

p: p value for comparing between the \textbf{four categories}

*: Statistically significant at p [?] 0.05

\textbf{Table (2) Relation between BMI and different parameters in
positive HCV (n=1959)}\selectlanguage{english}
\begin{longtable}[]{@{}lllllllll@{}}
\toprule
\begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
\textbf{BMI (kg/m\textsuperscript{2})}\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
\textbf{BMI (kg/m\textsuperscript{2})}\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
\textbf{BMI (kg/m\textsuperscript{2})}\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
\textbf{BMI (kg/m\textsuperscript{2})}\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
\textbf{BMI (kg/m\textsuperscript{2})}\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
\textbf{BMI (kg/m\textsuperscript{2})}\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
\textbf{Test of sig.}\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
\textbf{p}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{Normal} \textbf{BMI = 18.5- 24.9} \textbf{(n=482)}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{Normal} \textbf{BMI = 18.5- 24.9} \textbf{(n=482)}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{Overweight BMI = 25-29.9} \textbf{(n=587)}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{Overweight BMI = 25-29.9} \textbf{(n=587)}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{Obese} \textbf{BMI \textgreater{} 30} \textbf{(n=890)}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{Obese} \textbf{BMI \textgreater{} 30} \textbf{(n=890)}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{No.}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{\%}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{No.}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{\%}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{No.}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{\%}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{Sex}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Male\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
316\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
65.6\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
299\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
50.9\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
188\textsuperscript{c}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
21.1\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 289.529\textsuperscript{*}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
166\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
34.4\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
288\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
49.1\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
702\textsuperscript{c}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
78.9\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{Age (years)}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}40\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
90\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
18.7\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
96\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
16.4\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
97\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
10.9\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 17.756\textsuperscript{*}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
[?]40\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
392\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
81.3\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
491\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
83.6\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
793\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
89.1\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Min. -- Max.\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
19.0 -- 87.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
19.0 -- 87.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
19.0 -- 94.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
19.0 -- 94.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
20.0 -- 93.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
20.0 -- 93.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Mean \selectlanguage{ngerman}± SD.\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
53.79 \selectlanguage{ngerman}± 14.94\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
53.79 \selectlanguage{ngerman}± 14.94\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
53.79 \selectlanguage{ngerman}± 13.93\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
53.79 \selectlanguage{ngerman}± 13.93\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
54.59 \selectlanguage{ngerman}± 11.91\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
54.59 \selectlanguage{ngerman}± 11.91\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
H= 0.531\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
0.767\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Median\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
56.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
56.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
54.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
54.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
55.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
55.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{Random blood sugar}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Min. -- Max.\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
72.0 -- 570.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
72.0 -- 570.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
71.0 -- 568.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
71.0 -- 568.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
71.0 -- 557.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
71.0 -- 557.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
H= 26.286\textsuperscript{*}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Mean \selectlanguage{ngerman}± SD.\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
128.53\textsuperscript{b} \selectlanguage{ngerman}± 68.23\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
128.53\textsuperscript{b} \selectlanguage{ngerman}± 68.23\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
131.90\textsuperscript{b} \selectlanguage{ngerman}± 65.35\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
131.90\textsuperscript{b} \selectlanguage{ngerman}± 65.35\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
143.52\textsuperscript{a} \selectlanguage{ngerman}± 77.73\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
143.52\textsuperscript{a} \selectlanguage{ngerman}± 77.73\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Median\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
110.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
110.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
113.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
113.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
117.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
117.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{Systolic}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}130\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
327\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
67.8\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
345\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
58.8\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
431\textsuperscript{c}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
48.4\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 49.983\textsuperscript{*}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
[?]130\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
155\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
32.2\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
242\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
41.2\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
459\textsuperscript{c}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
51.6\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Min. -- Max.\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.0 -- 220.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.0 -- 220.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.0 -- 210.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.0 -- 210.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.0 -- 206.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.0 -- 206.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Mean \selectlanguage{ngerman}± SD.\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
121.70\textsuperscript{c} \selectlanguage{ngerman}± 19.53\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
121.70\textsuperscript{c} \selectlanguage{ngerman}± 19.53\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
125.96\textsuperscript{b} \selectlanguage{ngerman}± 19.17\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
125.96\textsuperscript{b} \selectlanguage{ngerman}± 19.17\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
129.11\textsuperscript{a} \selectlanguage{ngerman}± 18.47\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
129.11\textsuperscript{a} \selectlanguage{ngerman}± 18.47\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
H= 62.591\textsuperscript{*}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Median\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
120.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
120.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
120.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
120.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
130.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
130.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{Diastolic}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}80\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
183\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
38.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
161\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
27.4\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
203\textsuperscript{c}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
22.8\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 35.797\textsuperscript{*}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
[?]80\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
299\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
62.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
426\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
72.6\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
687\textsuperscript{c}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
77.2\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Min. -- Max.\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
50.0 -- 140.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
50.0 -- 140.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
50.0 -- 140.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
50.0 -- 140.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
50.0 -- 140.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
50.0 -- 140.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Mean \selectlanguage{ngerman}± SD.\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
78.56\textsuperscript{c} \selectlanguage{ngerman}± 11.63\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
78.56\textsuperscript{c} \selectlanguage{ngerman}± 11.63\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
81.14\textsuperscript{b} \selectlanguage{ngerman}± 11.71\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
81.14\textsuperscript{b} \selectlanguage{ngerman}± 11.71\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
83.38\textsuperscript{a} \selectlanguage{ngerman}± 11.66\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
83.38\textsuperscript{a} \selectlanguage{ngerman}± 11.66\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
H= 59.736\textsuperscript{*}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Median\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{DM}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Normal\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
435\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
90.2\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
512\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
87.2\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
714\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.2\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 40.488\textsuperscript{*}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
New DM\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
21\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
4.4\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
19\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
3.2\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
31\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
3.5\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Controlled DM\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
12\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
2.5\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
25\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
4.3\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
62\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
7.0\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Un controlled DM\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
14\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
2.9\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
31\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
5.3\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
83\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
9.3\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Normal\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
435\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
90.2\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
512\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
87.2\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
714\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
80.2\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 28.213\textsuperscript{*}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Diabetic\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
47 \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
9.8\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
75\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
12.8\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
176\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
19.8\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\textbf{HTN}\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Normal\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
444\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
92.1\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
510\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
86.9\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
673\textsuperscript{c}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
75.6\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}=69.199\textsuperscript{*}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\textless{}0.001\textsuperscript{*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
Hyper\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
38\textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
7.9\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
77\textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
13.1\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
217\textsuperscript{c}\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
24.4\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.11\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

a,b,c : Means with \textbf{Common letters} are not significant (i.e.
Means with \textbf{Different letters} are significant)

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}: \textbf{Chi square test}

H: H for \textbf{Kruskal Wallis test,} Pairwise comparison bet. each 2
groups was done using \textbf{Post Hoc Test (Dunn's for multiple
comparisons test)}

p: p value for comparing between the \textbf{three categories}

*: Statistically significant at p [?] 0.05

\textbf{Table (3) Relation between age and different parameters in
positive H C V (n=1959)}

\textbf{Age (years)}

\textbf{Age (years)}

\textbf{Age (years)}

\textbf{Age (years)}

\textbf{Test of}

sig.

\textbf{p}

\textbf{\textless{}40 (n=283)}

\textbf{\textless{}40 (n=283)}

\textbf{[?]40 (n=1676)}

\textbf{[?]40 (n=1676)}

\textbf{No.}

\textbf{\%}

\textbf{No.}

\textbf{\%}

\textbf{Sex}

Male

107

37.8

696

41.5

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 1.384

0.239

Female

176

62.2

980

58.5

\textbf{BMI (kg/m\textsuperscript{2})}

Normal

90

31.8

392

23.4

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}=17.756\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

Overweight

96

33.9

491

29.3

Obese

97

34.3

793

47.3

\textless{}30

186

65.7

883

52.7

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 16.605\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

[?]30

97

34.3

793

47.3

Min. -- Max.

19.0 -- 39.0

19.0 -- 39.0

40.0 -- 94.0

40.0 -- 94.0

U= 194612.0\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

Mean \selectlanguage{ngerman}± SD.

31.50 ± 5.63

31.50 ± 5.63

57.98 ± 10.04

57.98 ± 10.04

Median

33.0

33.0

58.0

58.0

\textbf{DM}

Normal

273

96.5

1388

82.8

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 35.913\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

New DM

2

0.7

69

4.1

Controlled DM

6

2.1

93

5.5

Un controlled DM

2

0.7

126

7.5

Normal

273

96.5

1388

82.8

U= 154659.50\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

Diabetic

10

3.5

288

17.2

\textbf{HTN}

Normal

277

97.9

1350

80.5

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 51.667\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

Hyper

6

2.1

326

19.5

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}: \textbf{Chi square test} \textbf{U: Mann Whitney
test}

P: p value for comparing between the \textbf{two categories}

*: Statistically significant at p [?] 0.05



\textbf{Table (4) Relation between HTN and different parameters in
positive H C V (n=1959)}

\textbf{HTN}

\textbf{HTN}

\textbf{HTN}

\textbf{HTN}

\textbf{Test of}

sig.

\textbf{P}

\textbf{Normal}

(n=1627)

\textbf{Normal}

(n=1627)

\textbf{Hyper}

(n=332)

\textbf{Hyper}

(n=332)

\textbf{No.}

\textbf{\%}

\textbf{No.}

\textbf{\%}

\textbf{Sex}

Male

714

43.9

89

26.8

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 33.245\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

Female

913

56.1

243

73.2

\textbf{Age (years)}

\textless{}40

277

17.0

6

1.8

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 51.667\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

[?]40

1350

83.0

326

98.2

Min. -- Max.

19.0 -- 93.0

19.0 -- 93.0

26.0 -- 94.0

26.0 -- 94.0

U = 153379.50

\textless{}0.001\textsuperscript{*}

Mean \selectlanguage{ngerman}± SD.

52.50 ± 13.27

52.50 ± 13.27

62.26 ± 10.28

62.26 ± 10.28

Median

53.0

53.0

63.0

63.0

\textbf{BMI (kg/m\textsuperscript{2})}

18.5 -- 24.9 (Normal)

444

27.3

38

11.4

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 69.199\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

25 -- 29.9 (Overweight)

510

31.3

77

23.2

[?]30 (Obese)

673

41.4

217

65.4

\textless{}30

954

58.6

115

34.6

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 64.048\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

[?]30

673

41.4

217

65.4

Min. -- Max.

16.41 -- 64.84

16.41 -- 64.84

17.96 -- 57.16

17.96 -- 57.16

U = 183448.50\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

Mean \selectlanguage{ngerman}± SD.

29.40 ± 6.38

29.40 ± 6.38

33.22 ± 7.16

33.22 ± 7.16

Median

28.39

28.39

32.89

32.89

\textbf{DM}

Normal

1462

89.9

199

59.9

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}= 325.072\textsuperscript{*}

\textless{}0.001\textsuperscript{*}

New DM

69

4.2

2

.6

Controlled DM

30

1.8

69

20.8

Un controlled DM

66

4.1

62

18.7

\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}: \textbf{Chi square test} \textbf{U: Mann Whitney
test}

P: p value for comparing between the \textbf{two categories}

*: Statistically significant at p [?] 0.05



\textbf{Table (5) Univariate and multivariate analysis affecting
different parameters in positive HCV (n=1959)}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
& \textbf{Univariate} & \textbf{Univariate} &
\textsuperscript{\textbf{\#}}\textbf{Multivariate} &
\textsuperscript{\textbf{\#}}\textbf{Multivariate}\tabularnewline
\midrule
\endhead
& \textbf{P} & \textbf{OR (95\%C.I)} & \textbf{p} & \textbf{OR
(95\%C.I)}\tabularnewline
\textbf{Diabetes affecting studied parameters} & & & &\tabularnewline
Age [?]40 (years) & \textless{}0.001\textsuperscript{*} & 5.538 (3.141 --
9.765) & 0.001\textsuperscript{*} & 3.073 (1.584 --
5.960)\tabularnewline
BMI [?]30 (kg/m\textsuperscript{2}) & \textless{}0.001\textsuperscript{*}
& 1.983 (1.553 -- 2.532) & 0.022\textsuperscript{*} & 1.369 (1.046 --
1.791)\tabularnewline
Systolic ([?]130) & \textless{}0.001\textsuperscript{*} & 3.342 (2.588 --
4.315) & \textless{}0.001\textsuperscript{*} & 2.116 (1.505 --
2.976)\tabularnewline
Diastolic ([?]80) & \textless{}0.001\textsuperscript{*} & 1.845 (1.364 --
2.497) & 0.204 & 0.778 (0.528 -- 1.147)\tabularnewline
HTN & \textless{}0.001\textsuperscript{*} & 5.922 (4.511 -- 7.775) &
\textless{}0.001\textsuperscript{*} & 3.910 (2.909 --
5.254)\tabularnewline
\textbf{BMI [?]30 affecting studied parameters} & & & &\tabularnewline
Sex & \textless{}0.001\textsuperscript{*} & 5.058 (4.135 -- 6.188) &
\textless{}0.001\textsuperscript{*} & 5.158 (4.190 --
6.351)\tabularnewline
Age [?]40 (years) & \textless{}0.001\textsuperscript{*} & 1.722 (1.323 --
2.241) & 0.009\textsuperscript{*} & 1.480 (1.103 --
1.985)\tabularnewline
Systolic ([?]130) & \textless{}0.001\textsuperscript{*} & 1.803 (1.505 --
2.160) & 0.067 & 1.250 (0.985 -- 1.587)\tabularnewline
Diastolic ([?]80) & \textless{}0.001\textsuperscript{*} & 1.606 (1.311 --
1.966) & 0.006\textsuperscript{*} & 1.419 (1.106 --
1.820)\tabularnewline
DM & \textless{}0.001\textsuperscript{*} & 1.913 (1.489 -- 2.458) &
0.014\textsuperscript{*} & 1.436 (1.076 -- 1.918)\tabularnewline
HTN & \textless{}0.001\textsuperscript{*} & 2.675 (2.090 -- 3.423) &
0.001\textsuperscript{*} & 1.627 (1.218 -- 2.175)\tabularnewline
\textbf{HTN affecting studied parameters} & & & &\tabularnewline
Sex & \textless{}0.001\textsuperscript{*} & 2.135 (1.643 -- 2.774) &
\textless{}0.001\textsuperscript{*} & 2.252 (1.686 --
3.007)\tabularnewline
Age [?]40 (years) & \textless{}0.001\textsuperscript{*} & 11.148 (4.921 --
25.256) & \textless{}0.001\textsuperscript{*} & 4.640 (1.985 --
10.846)\tabularnewline
Systolic ([?]130) & \textless{}0.001\textsuperscript{*} & 8.096 (6.014 --
10.900) & \textless{}0.001\textsuperscript{*} & 5.022 (3.529 --
7.146)\tabularnewline
Diastolic ([?]80) & \textless{}0.001\textsuperscript{*} & 4.342 (2.972 --
6.344) & 0.096 & 1.479 (0.932 -- 2.347)\tabularnewline
DM & \textless{}0.001\textsuperscript{*} & 5.922 (4.511 -- 7.775) &
\textless{}0.001\textsuperscript{*} & 4.183 (3.109 --
5.629)\tabularnewline
\bottomrule
\end{longtable}

OR: Odd`s ratio, C.I: Confidence interval,

\#: All variables with p\textless{}0.05 was included in the multivariate

*: Statistically significant at p [?] 0.05

\emph{Discussion:}

Within 1959 patients, this study illuminates the effect of cofounding
factors such as HTN, DM, BMI, age and gender in patients having HCV
virus infection. Illustrating each of these points depends on a
multivariate analysis for diverse parameters and patients risk factors
in positive HCV patients. After analyzing the results of the study,
infected female patients were found to be more with (1156) patients with
59 \%, and male patients where 803 patients with 41 \%. Infected
patients aged [?] 40 year old were 85.6 \% , Obese patients with BMI [?] 30
( Kg/ m2) were 45.4 \% and patients with uncontrolled blood pressure
with systolic blood pressure [?] 130 mm.Hg were (43.7 \%) and diastolic
blood pressure [?] 80 mm.Hg were 72.1\%.

In this study we found that in all patients with chronic HCV that the
age [?] 40 , BMI [?] 30 (Kg/ m2) and high systolic blood pressure with
esteem of [?] 130 mm.Hg , are all independent factors for DM2. These
findings suggest that ageing , being corpulent and having a high
uncontrolled blood pressure all together with positive HCV infection
increases the rates of glucose abnormalities including anomalies in
carbohydrate metabolism, insulin resistance, metabolic clutters which
may progress into DM2 {[}14{]} .

Several studies had mentioned some explanations for this hypothesis
which is increasing risk of getting DM in HCV infected patients . In an
important study by Abdelaziz, S.B., et al, suggesting that diabetic
patients might get infected due to contaminated injections or nosocomial
transmission, but this hypothesis was reduced due to the widespread use
of universal precautions in hospitals. Other possible mechanisms include
that the progressive increase of liver fibrosis and cirrhosis as common
complications of being HCV positive patient {[}14{]} are inducing
glucose metabolism impairment or reduction in glucose uptake by the
cells {[}1{]} . Cirrhosis itself is considered diabetogenic . On the
other hand, diabetes can worsen hepatitis C outcomes, including
increasing the risk for cirrhosis and hepatocellular carcinoma (HCC)
{[}16{]} {[}17{]} . .

Also, another study has suggested that eradication of HCV patients with
direct-acting antiviral (DAA) therapy leads to improved glycemic control
in patients with T2DM , decrease level of HbA1c and decrease the
proportion of patients taking insulin {[}18{]} .

For other factors linking being diabetic and HCV positive patient, as
mentioned before females have higher rate than men in the current study
and another study {[}1{]} . Unlike other studies which found that
Hepatitis C is more common among men than women , and male gender is
also associated with more hepatitis C disease progression to fibrosis
and cirrhosis {[}16{]} .

Occurrence and recurrence of HCC are high among patients with chronic
HCV infection, obesity, and heavy alcohol intake. Also, nonalcoholic
fatty liver disease (NAFLD) due to obesity by itself can increase the
inflammation of liver or cause other obesity-related diseases {[}19{]}.
{[}20{]}. Also in this current study , one of the interesting finding
was the impact of BMI , as the multivariate analysis in the study
revealed that having BMI [?] 30 (Kg /m2) affects different parameters in
HCV positive patients. The study noticed that the incidence of getting
HCV infection is highly increased in those obese, aged [?] 40 years,
diabetic [?] 200 mg/dL and with uncontrolled blood pressure ( diastolic
blood pressure [?] 80 mm.Hg) .

In Ali-Eldin, Z.A., et al, study showed that free fatty acid and
cytokine secretion induced by adipose tissue dysfunction may contribute
in both liver steatosis and induction of inflammation and as a result
fibrosis level and the degree of hepatic affection in chronic HCV
patients. Furthermore, changes in glucose metabolism which results into
insulin resistance as mentioned before , all are associated with more
liver disease , so changes in the hosts lipid metabolism due to chronic
HCV increase viral replication, which can lead to steatosis and may
affect the efficacy of interferon-based therapy. This represents a novel
target for therapeutic intervention in HCV eradication {[}21{]} .

Another vital factor in the multivariate analysis is that cardiovascular
diseases appear to be increased with higher rate of morbidity and
mortality especially hypertensive patients with blood pressure [?] 130
mm.Hg ( with systolic blood pressure [?] 130 mm.Hg and diastolic blood
pressure [?] 80 mm.Hg) , and also BMI [?] 30 ( kg/m2) {[}22{]} . Unlike
other studies which depends only on hypertension and diabetes and showed
two-fold higher risk of subclinical carotid plaques among HCV-infected
individuals compared to uninfected controls and increase in the rate of
peripheral arterial diseases as well. This maybe due to the severity of
the liver damage or even due to direct viral activity {[}23{]} .

In recent study untreated HCV infected persons have twice risk of CVD
(Cardiovascular diseases) as: (coronary artery disease events, acute
myocardial infarction, congestive heart failure, unstable angina, and
revascularization procedures, stroke and peripheral vascular disease)
than those who initiated treatment {[}24{]}. As a result, significant
benefit of HCV treatment on the incidence and risk of possible CVD
events in the future {[}24{]}. Other studies have mentioned that
co-infection with both HCV/HIV viruses are associated with more risk to
CVD {[}25{]} {[}26{]}, so reduction in survival is obvious in HIV/HCV-
coinfected patients than HIV-monoinfected patients and HIV-coinfected
patients without cirrhosis {[}27{]} . Concerning another study,
persistent HCV replication leads to a state of systemic inflammation and
immune activation that leads to endothelial dysfunction, atherosclerosis
and increased CVD risk {[}15{]} .

\emph{Limitations:}

First, the sample size was relatively small which may have influenced
the statistical outcome. Second, individual variations between the
patients as, marriage, rural residence, injections for bilharzias, blood
transfusion, acupuncture and tattooing were not taken in consideration.
Third, Lack of data on the severity of liver fibrosis, can affect the
judgement on some cases. Fourth, the dependence on `self-reporting' for
the cardiovascular diseases may limit the number of these reports , and
also lack of laboratory data of lipid and lipoprotein profile and the
level of liver enzymes and not accounting for their potential elevation
may confound the association of diabetes and of the cardiovascular
events all together with HCV infected patients.

\emph{Conclusion;}

On the light of the results of the present study, it was found that HCV
infection triggers metabolic disorders to happen, abnormalities of
carbohydrate metabolism, including hyperinsulinemia, insulin resistance
and diabetes especially type 2 which arises from steatosis and
inflammatory processes. Also it was found that diabetes worsens
hepatitis C outcomes as it increases the risk for cirrhosis and (HCC).
Attempting to reduce the complications of diabetes has a promising
future of limiting the symptoms of HCV infection on patients.
Uncontrolled blood pressure may increase the risk for (CVD), increase in
the rate of peripheral arterial diseases, carotid plaques, endothelial
dysfunction and atherosclerosis so controlling blood pressure of the
patient would be helpful reducing the incidence of serious CVD. Obese
patients with BMI [?] 30 (kg/m2) and the free fatty acid secretions may
increase the inflammation, changing of lipid-cholesterol biosynthesis
that causes fatty liver occurrence, hypercholesterolemia and as a result
fibrosis. Controlling patient weight helps preventing complications
associated with HCV infection as fibrosis and hepatocellular carcinoma.

\emph{Data Availability :}

All data generated or analyzed during this study is included in this
published article will be available upon request.

\textbf{Financial support}

No financial support was provided

\textbf{Ethics declarations}

\textbf{Conflict of interest}

All authors declare that they have no conflict of interest.

\subsubsection*{Ethical Approval}

{\label{ethical-approval}}

The authors declare that all procedures contributing to this work comply
with the ethical standards of Scientific Ethics Committee Board at the
University of Pharmacy Damnhour university. This study was approved by
the University hospital and patients signed informed consent forms
before starting the study.

\emph{List of abbreviations:}

CVD: Cardiovascular Disease

HCV: Hepatitis C virus

BMI: Body mass index

DM2: Diabetes Mellitus type 2

T2DM: Type 2 Diabetes Mellitus

HbA1c: Glycated Hemoglobin

HCC: Hepatocellular Carcinoma

NAFLD: Non-alcoholic fatty liver disease

PLC: Primary Liver Cancer

HIV: human Immunodeficiency Viruses

ALT: Alanine Aminotransferase

AST Aspartate Aminotransferase

SPSS Statistical package for the social science

BGL Blood glucose level

\emph{References:}

{[}1{]} S.B. Abdelaziz, Y.S. Galal, A.S. Sedrak, D.S.J.J.o.D.M. Shaheen,
Association of Hepatitis C Virus Infection and Type 2 Diabetes in Egypt:
A Hospital-Based Study, 6(01) (2015) 77.

{[}2{]} J. McElnay, A. Nicholl, T.J.J.I.J.o.P.P. Grainger-Rousseau, The
role of the community pharmacist---a survey of public opinion in
Northern Ireland, 2(2) (1993) 95-100.

{[}3{]} A.L. May, E.V. Kuklina, P.W.J.P. Yoon, Prevalence of
cardiovascular disease risk factors among US adolescents, 1999- 2008,
129(6) (2012) 1035-1041.

{[}4{]} A. Elgharably, A.I. Gomaa, M.M. Crossey, P.J. Norsworthy, I.
Waked, S.D.J.I.j.o.g.m. Taylor-Robinson, Hepatitis C in Egypt--past,
present, and future, 10 (2017) 1.

{[}5{]} L. Benova, S.F. Awad, F.D. Miller, L.J.J.H. Abu-Raddad,
Estimation of hepatitis C virus infections resulting from vertical
transmission in Egypt, 61(3) (2015) 834-842.

{[}6{]} A. Petruzziello, S. Marigliano, G. Loquercio, A. Cozzolino,
C.J.W.j.o.g. Cacciapuoti, Global epidemiology of hepatitis C virus
infection: An up-date of the distribution and circulation of hepatitis C
virus genotypes, 22(34) (2016) 7824.

{[}7{]} H. Ayoub, L.J.J.J.o.v.h. Abu-Raddad, Impact of treatment on
hepatitis C virus transmission and incidence in Egypt: A case for
treatment as prevention, 24(6) (2017) 486-495.

{[}8{]} W. El-Akel, M. El-Sayed, M. El Kassas, M. El-Serafy, M. Khairy,
K. Elsaeed, K. Kabil, M. Hassany, A. Shawky, A.J.J.o.v.h. Yosry,
National treatment programme of hepatitis C in Egypt: hepatitis C virus
model of care, 24(4) (2017) 262-267.

{[}9{]} M. Lazo, C. Nwankwo, N.R. Daya, D.L. Thomas, S.H. Mehta, S.
Juraschek, K. Willis, E.J.C.G. Selvin, Hepatology, Confluence of
epidemics of hepatitis C, diabetes, obesity, and chronic kidney disease
in the United States population, 15(12) (2017) 1957-1964. e7.

{[}10{]} D. Kralj, L.V. Juki\selectlanguage{polish}ć, \selectlanguage{english}S. Stojsavljevi\selectlanguage{polish}ć, \selectlanguage{english}M. Duvnjak, M. Smoli\selectlanguage{polish}ć,
\selectlanguage{english}I.B.J.J.o.c. \selectlanguage{polish}Č\selectlanguage{english}ur\selectlanguage{polish}č\selectlanguage{english}i\selectlanguage{polish}ć, \selectlanguage{english}t. hepatology, Hepatitis C virus, insulin
resistance, and steatosis, 4(1) (2016) 66.

{[}11{]} Y.-C. Tsao, J.-Y. Chen, W.-C. Yeh, Y.-S. Peng, W.-C.J.B.o. Li,
Association between visceral obesity and hepatitis C infection
stratified by gender: a cross-sectional study in Taiwan, 7(11) (2017)
e017117.

{[}12{]} L. Leon, S. Kasereka, F. Barin, C. Larsen, L. Weill-Barillet,
X. Pascal, S. Chevaliez, J. Pillonel, M. Jauffret-Roustide, Y.J.E. Le
Strat, Infection, Age-and time-dependent prevalence and incidence of
hepatitis C virus infection in drug users in France, 2004--2011:
model-based estimation from two national cross-sectional serosurveys,
145(5) (2017) 895-907.

{[}13{]} P. Cacoub, C. Comarmond, Considering hepatitis C virus
infection as a systemic disease, Seminars in dialysis, Wiley Online
Library, 2019, pp. 99-107.

{[}14{]} A.-C. Desbois, P.J.W.j.o.g. Cacoub, Diabetes mellitus, insulin
resistance and hepatitis C virus infection: A contemporary review, 23(9)
(2017) 1697.

{[}15{]} W. Chehadeh, N. Abdella, A. Ben-Nakhi, M. Al-Arouj, W.J.J.o.g.
Al-Nakib, hepatology, Risk factors for the development of diabetes
mellitus in chronic hepatitis C virus genotype 4 infection, 24(1) (2009)
42-48.

{[}16{]} S.S. Hammerstad, S.F. Grock, H.J. Lee, A. Hasham, N. Sundaram,
Y.J.F.i.e. Tomer, Diabetes and hepatitis C: a two-way association, 6
(2015) 134.

{[}17{]} A. Kassem\selectlanguage{ngerman}¹, H.E.J.L.S.J. Salah, Impact of Direct Acting
Antivirals for Treatment of Chronic Hepatitic C Virus Infection on
Glycemic Control in Egyptian Patients with Type 2 Diabetes Mellitus,
15(3) (2018).

{[}18{]} J. Hum, J.H. Jou, P.K. Green, K. Berry, J. Lundblad, B.D.
Hettinger, M. Chang, G.N.J.D.c. Ioannou, Improvement in glycemic control
of type 2 diabetes after successful treatment of hepatitis C virus,
40(9) (2017) 1173-1180.

{[}19{]} H.K. Dyal, M. Aguilar, T. Bhuket, B. Liu, E.W. Holt, S. Torres,
R. Cheung, R.J.J.D.d. Wong, sciences, Concurrent obesity, diabetes, and
steatosis increase risk of advanced fibrosis among HCV patients: a
systematic review, 60(9) (2015) 2813-2824.

{[}20{]} A. Baecker, X. Liu, C.V. La,
Z.-F.J.E.j.o.c.p.t.o.j.o.t.E.C.P.O. Zhang, Worldwide incidence of
hepatocellular carcinoma cases attributable to major risk factors, 27(3)
(2018) 205-212.

{[}21{]} Z.A. Ali-Eldin, F.A. Ali-Eldin, I.E.J.J.o.c. Mohamed, d.r.
JCDR, Visceral Adiposity Index and the Degree of Hepatic Fibrosis and
Inflammation in Egyptian Patients with Chronic Hepatitis C, 11(8) (2017)
OC11.

{[}22{]} M. Gadallah, S. Kandil, A.J.T.M. Mohsen, I. Health, Association
between hepatitis C infection and cerebro\selectlanguage{english}-cardiovascular disease:
analysis of a national population\selectlanguage{english}-based survey in Egypt, 23(7) (2018)
738-747.

{[}23{]} S. Petta, M. Maida, F.S. Macaluso, M. Barbara, A. Licata, A.
Craxi, C.J.G. Camma, Hepatitis C virus infection is associated with
increased cardiovascular mortality: a meta-analysis of observational
studies, 150(1) (2016) 145-155. e4.

{[}24{]} A.A. Butt, P. Yan, A. Shuaib, A.-B. Abou-Samra, O.S. Shaikh,
M.S.J.G. Freiberg, Direct-acting antiviral therapy for HCV infection is
associated with a reduced risk of cardiovascular disease events, 156(4)
(2019) 987-996. e8.

{[}25{]} O. Osibogun, O. Ogunmoroti, E.D. Michos, E. Spatz, B. Olubajo,
K. Nasir, P. Madhivanan, W.J.J.o.v.h. Maziak, HIV/HCV coinfection and
the risk of cardiovascular disease: A meta\selectlanguage{english}-analysis, 24(11) (2017)
998-1004.

{[}26{]} J. Fernandez\selectlanguage{english}-Montero, P. Barreiro, C. De Mendoza, P. Labarga,
V.J.J.o.v.h. Soriano, Hepatitis C virus coinfection independently
increases the risk of cardiovascular disease in HIV\selectlanguage{english}-positive patients,
23(1) (2016) 47-52.

{[}27{]} S. Leone, M. Prosperi, S. Costarelli, P. Nasta, F. Maggiolo, S.
Di Giambenedetto, A. Saracino, M. Di Pietro, A.J.E.J.o.C.M. Gori, I.
Diseases, Incidence and predictors of cardiovascular disease, chronic
kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved
sustained virological response, 35(9) (2016) 1511-1520.

\selectlanguage{english}
\FloatBarrier
\end{document}

