Value of PCR in the detection of occult hepatitis B virus infection in chronic end stage liver disease

Persistence of Hepatitis B virus [HBV] DNA in HBV surface antigen [HBsAg] negative individuals is termed occult HBV infection. Occult HBV infection has frequently been identified in patients with chronic HCV infection. This study aimed to evaluate the prevalence of occult HBV infection among late stage liver diseased patients and apparently healthy household contacts who may be used as potential donors for their liver transplantation. Also, prevalence of occult l-TBV infection in HCV-Ab and HBcAb seropositive subjects was evaluated. The study included 500 individuals distributed as 100 patients from National Liver Institute, 300 household contacts, and 100 apparently healthy subjects as a control group. All studied individuals were subjected to: full history taking, complete clinical examination, abdominal ultrasonography, liver biopsy if possible and laboratory investigations including: liver function tests, anti- HCV and HBV serological markers, as well as HBV- DNA detection using nested PCR. HBV-DNA was detected in 54% of patients, 18% of household contacts and 6% of control group. The prevalence of occult HBV infection in HBcAb seropositive subjects was; 75% in patients, 31.6% in household contacts, 46.2% in control group. The prevalence of occult HBV infection in HCV-Ab seropositive subjects was 55.8% in patients, 8.2% in contacts and 10% in control group. In conclusion, there is a high prevalence of occult HBV infection in patients with end stage liver disease, particularly those who are HCV-Ab and or HBcAb seropositive. The results of the current study indicate the need for a sensitive investigation for potentially infected relatives among family members of HBsAg carriers. On the other hand, apparently recovered people, are considered to be at risk for disease complications or for transmission of the infection till proved HBV-DNA negative

Detection of HCV RNA in saliva of Egyptian children receiving frequent blood transfusions

Hepatitis C virus [HCV] infection is considered a major public health problem allover the world, especially Egypt. Blood is almost the only route for HCV diagnosis. It has been reported that HCV could be detected in other body fluids including saliva which represents an easier route than blood especially in infants and children. This study aimed to: 1] Assess the prevalence of HCV infection among high risk group of Egyptian children. 2] Evaluate the detection of HCV antibodies [anti-HCV] and HCV RNA in saliva against their detection in serum among HCV positive children. This study included 200 children [92 males and 108 females] who were attendants of Haematology Clinic at Abu El-Reish Hospital, Cairo University, for receiving frequent blood transfusions. Serum and saliva samples were analyzed for detection of anti-HCV by ELISA technique and for HCV RNA by a home made RT-PCR method. Liver function tests were performed also. Results of serum samples revealed that 134/200 [67%] children were anti-HCV seropositive, out of them 79/134 [59%] children had HCV RNA in their sera. Saliva samples of HCV infected children [n=79] showed that 53/79 [67.1%] and 31/79 [39.2%] were anti-HCV and HCV RNA positive respectively. Prevalence of HCV infection was 39.5% of 200 studied children [67% of 134 anti-HCV positive children]. It could conclude that: 1] Prevalence of HCV infection among the studied children is considered high. 2] Saliva could play a possible role of biological fluids as a non parenteral route of intrafamilial spread of HCV infection. 3] More sensitive techniques could be developed to use saliva as a reliable route for HCV detection

Role of creatine kinase isoenzyme-BB and magnesium in the asphyxiated newborn infants

Birth asphyxia is the single most important cause of neurological morbidity in newborn infants. Damage to brain cells produces measurable amounts of creatine kinase isoenzyme [CK-BB] in the serum that is why CK-BB has attracted attention as a possible predictor of the extent of brain damage. One of the mechanisms that appear to be particularly relevant to the problem of birth asphyxia is the release of glutamate N-methyl-D-aspartate [NMDA] which is a glutamate receptor subtype that appears to be the most important in brain injury. NMDA receptor is coupled to Ca [2+] channel and its activation opens the Ca [2+] channels. Mg [2+] acts as a gate at the NMDA channel by blocking the Ca [2+] entry within the NMDA channel. Taken together, Mg [2+] acts as an important therapeutic approach to limit brain injury. The aim of this study is to assess the value of total CK and CK-BB as a marker of birth asphyxia, also, to examine the relationship between CK-BB and perinatal asphyxia both prior to the administration of Mg [2+] and after it, in order to evaluate the neuroprotective role of Mg [2+]. In the present study, the mean blood level of CK-BB at 6 h of life in the asphyxiated groups 11[98 +/- 7.3] and III [85 +/- 5.8] and at 24 h of life in group II [105 +/- 8.3] and group III [55 +/- 5.6] was significantly higher than that of the controls [p < 0.01]. At 24 h of age there was a statistical significant [p < 0.01] decrease in the level of CK-BB in group III [Mg [2+] treated] when compared to group II [no Mg [2+] treatment]. Therefore, CK-BB might be useful as an early marker of brain damage in the asphyxiated infants. The outcome of the patients with perinatal asphyxia was better in group III who received Mg [2+] [22% died] than in group II who did not received Mg [2+] [46% died] and this pointed to the neuroprotective role of Mg [2+]

Some apoptotic signals in patients with chronic HCV infection

Hepatitis C virus [HCV] infects an estimated 3% of the world population and causes an estimated 470,000 death per year caused by complications of the end stage liver disease. Mechanisms leading to liver cell injury, are not fully understood, both immune mediated reactions and more direct cytopathic effects of HCV may be involved. Agoptosis of liver cells may play a significant role in the pathogenesis of hepatitis C. The aim of this study is to evaluate the role of apoptosis in chronic HCV infection by estimating serum levels of Fas, Fas-Ligand [FasL] and hepatocyte expression of Bcl-2 of patients with chronic hepatitis C virus infection, and find out the relationship [if any] between their levels and the degree of hepatic inflammatory activity. Sixty patients having chronic HCV infection [45 males and 15 females; mean age 36h8.6 years] were randomly selected. In addition, 20 apparently healthy subjects [12 males and 8 females; mean age 33.1 +/- 10.4 years] served as a control group. They were anti-HCV and HBsAg negative. Serum soluble Fas and Fas ligand levels were measured and HCV RNA quantitation was done to patients only. Immunohistochemical detection of Bcl-2 expression in the liver tissue was done to all patients. According to the histopathological assessment of hepatic necroinflammatory activity, patients were classified into 3 groups with minimal [n=23, GI], mild [n=23, GII] and moderate and severe [n=14, GIII] activity. Significant positive correlations were found between serum Fas and FasL and the grade of hepatic inflammatory activity. Mean serum levels of Fas in group I, II, and III were [0.7 +/- 0.3, 2.5/1.1 and 5.2 +/- 0.9 nglml] respectively with p<0.01. Mean serum levels of FasL in group GI, GII, and GIII were [0.6 +/- 0.2, 1.7+-0.8and 4 +/- 1.2 nglml] respectively with p<0.01. Bcl-2 expression was more prevalent in liver tissues of patients in GIII where 35.7% of hepatocytes, 57.1% of Kupffer cells and 50% of bile duct cells stained positively. For the three types of cells, it correlated positively with the grade of inflammatory activity [p<0.01 for each]. Percentage of Bci-2 expression in portal infiltrates in GI, GI1 and GI11 were [34.8, 78.3 and 100 respectively with p<0.01]. The results of the current work provide evidence of increased apoptosis in chronic hepatitis of moderate and severe activity and in cirrhosis due to chronic HCV infection suggesting that apoptotic cell death might be involved in the pathways of hepatocellular damage in both conditions. Serum sFas and sFasL levels positively correlated with the degree of necroinflammatory process in chronic HCV patients. Accordingly, serum sFas and sFasL could serve as non-invasive serological indicators of the hepatic inflammatory activity. Furthermore, the increase of serum sFas and sFasL [apoptotic signaling] as well as the increased expression of Bcl-2 [anti-apoptosis] at the same time, suggests that Bcl-2 might play as a protective mechanism against apoptosis. However, apoptosis caused by the activation of Fas/FasL pathway seems to occur by a mechanism that might not be blocked by Bcl-2

When to give a booster dose for hepatitis B vaccinated children in Egypt

Viral hepatitis is a major cause of morbidity and mortality. Hepatitis B and C account for more than 75 percent of all chronic liver diseases. Hepatitis B vaccination has been implemented in the Egyptian Extended Program for Immunization since 1993. The aim of our study was to assess the status of the immunologic memory after a booster dose of HB vaccine in a group of healthy 5-year-old children. Those children had been initially immunized with the vaccine starting at birth and had good response at 9 months of age but had no detectable antibody at 5 years. Eighty seven children, who have negative anti- HBs antibodies after 5 years of HB EPI vaccinations, were given a booster dose of 10 [micro g HB vaccine. After 45 days from this booster dose, estimation of anti-s was repeated. The results revealed that, after the booster dose, 44 children [50.6%] out of the 87 children were converted to positive anti-s and the other 43 remained anti-s negative or non-immunized. The ages of all children ranged between 5.2 and 6.2 years with a mean of 5.5 years. There was no sex differences between both groups as male to female ratio was 1.1:1. There was no significant difference between positive and negative anti-HBs children according to weight, height, mid-arm circumference and head circumference. Serum iron was the only iron status parameter that showed significant difference between the positive arid negative anti-HBs children. Anti-HBs .positive patients had significantly lower serum iron although both groups were anemic with Hb concentrations below 11.5 gm %. All children who were negative and responded to the booster dose had anti-HBs anamnestic response above 100 IU. Those who were originally positive at 5 years had lower anti-HBs levels [only 3% >I00 IU/L]

Conclusion: it seems that the response for the HB EPI schedule after 5 years is equivocal in Egypt. About 50% of the children who underwent the HB EPI schedule retain the anamnestic response after 5 years and are not in need of booster doses. The other 50% lost their immune response after 5 years and seem to be in need of further booster doses to protect them against HBV infection and its serious complications. A single dose could not boost their immunity for HB virus to adequate levels