[Hepatitis B and C infection as a part of hospital acquired infection at the Renal Dialysis Unit in Assiut University Hospital]

Background: Hospital-acquired hepatitis B [HBV] and C virus [HCV] infections continue to occur despite increased awareness of this problem among the medical community. Infection with hepatitis viruses continues to be a major concern for hemodialysis patients, who are recognized as a high-risk group

Objectives: To measure the HBV and HCV seroconversion in hospitalized patients at the hemodialysis unit in Assiut University hospital and to assess the potential risk factors for infection with these viruses in this unit

Methods: This study was performed in Assiut University Hospital at the renal dialysis unit. A total of 63 patients on regular hemodialysis who should be negative for anti HCV, HBsAg and IgG anti HBc with normal liver enzymes and abdominal ultrasound were included in this study between June 2011 and August 2014. An identification questionnaire for possible risk factors for HBV and HCV was done at the start of study. Then follow up after 3 months with another questionnaire for the risk factors and screening by anti HCV, HBsAg and IgM anti HBc were done. Then another follow up after 6 months with other questionnaire for the risk factors and screening by anti HCV and HBsAg. Qualitative PCR test for HCV was used for patients whose results were positive for anti HCV either at 3 months or 6 months follow up. The study also include 12 health care workers and they were screened for anti HCV and HBsAg. Their history of vaccination for HBV was also assessed. Assessment of adherence to infection control measures was also done

Results: Twenty one patients were anti HCV positive, seven of them were positive after 3 months follow up and 14 were positive after 6 months follow up with seroconversion rate of 33.3%. No patient was positive for HBV throughout the study period. All these positive for anti HCV were negative for qualitative PCR for HCV All the included health care workers were negative for HBV and HCV markers. Furthermore all of them had complete vaccination for HBV. The potential risk factors for HCV seroconversion were duration and frequency of dialysis, blood transfusions, dialysis with patients positive for HCV in the same room, lack of strict adherence to infection control measures by the health care workers

Conclusion: Regular screening of all patients and health care workers in hemodialysis units for HBV and HCV with improvements in infection control practices should be done. Therefor health education of the health care workers and their vaccination against HBV infection should be considered

study of common allergen specific immunoglobulin-E. pattern in children with asthma attending Assiut university children hospital.

There is a significant rise in the prevalence of allergic diseases, including asthma and, food allergies. Studies indicated that the exposure to indoor allergens [mold, dust mites] may be more relevant to the development of asthma and atopy, lgE is best known as a mediator of allergic reactions ranging from allergic rhinitis and asthma to life threatening anaphylactic shock. The aim of this study was to detect the prevalence of food allergens [milk and egg] and indoor allergens [house dust miles and Alternaria], and [heir possible relation to the severity of disease in children with asthma attending. Assiut university Children hospital. The study included 50 cases with asthma attending Assiut University Children Hospital, during the period from September 2009 to August 2010. Their ages ranged from 4-14 years. They consisted of 30 males and 20 females. They were selected and classified according the GINA classification of asthma 2008. They consisted of 10 cases with mild intermittent asthma, 10 cases with mild persistent asthma, 15 cases with moderate persistent asthma, 15 cases with severe persistent asthma, as well as 25 apparently healthy children with matchable age and sex a control group. All cases and controls were subjected to full history and thorough clinical examination. Complete blood count, chest x-ray, pulse oxymetry, tuberculin test, urine and stool analysis and pulmonary function tests were done for all patients and controls. Specific IgE was performed by human allergen specific assay semi quantitative kit. The percentage frequency of asthma cases with significantly high IgE level for the studied antigens were significantly higher than those in the control group. Cases with significant increase in house dust mite specific IgE level were the commonest [84%] among our patients with by those with significant increase in milk specific IgE level [78%], followed by those with significant increase in Alternaria specific IgE level [68%,] and lastly by those with significant increase in egg specific IgE level [64%]. The percentage frequency of patients with significant increase in IgE level for the four studied antigens was significantly higher than those with significant increase in IgE level for three, two or one of the studied antigens. The distribution of these patients with significant increase in IgE level fir the four studied antigens was significantly higher in the group of cases classified as having severe persistent and moderate persistent asthma. Cases with moderate and severe increase in serum IgE level were more common in the moderate and severe persistent asthma patient groups. It could he concluded that house dust miles allergens followed by food [milk and Alternaria] allergens, then by egg allergens are common among our studied patients with asthma and correlate with the severity of asthma. Sensitization to more than one allergen was more common in our studied patients with asthma. This may suggest the role of patient susceptibility to immune reaction against various allergens. Laboratory, studies of patient with asthma particularly those with moderate and severe persistent asthma fir these allergens is recommended. Studies on the value of desensitization of these patients for such antigens for possible better management of their illness is highly recommended

Hepatitis B virus escape mutants after vaccination

Vaccine escape mutant may develop after immune prophylaxis with universal HBV vaccination. Aim of the study: to detect the frequency of HBsAg escape mutant among the patients with previous HBV infection and patients with HCV infection after full dose of HBV vaccination. A hospital control based study included 68 person. Twenty six with previous HBV infection patients, 25 chronic hepatitis C patients, and 17 apparently healthy persons as controls. Vaccination were carried out for all patients and control group. All patients and control groups were negative for HBs Ag before enrollment in this study. HBsAg, HbcAb, HBeAg and HBsAb were enrollment performed by micro particle immunoassay. HBV DNA and HBsAg mutants were performed by real time polymerase reaction [RT-PCR]. HBV DNA was detected in 10[38.5%] in HBV patients with previous infection and after full dose of vaccination. HBsAg mutants were detected in 8[30.8%] of them. In HCV patients with negative surface antigenemia HBV DNA was detected in 5 [20%] and HBsAg mutants were detected in 3[12%] of them. The frequency and levels of HBsAb in HBV patients with previous infection and after full dose of vaccination were significantly decreased when compared to those with HCV infection and healthy control group after dose of vaccination. From this study we concluded that the presence of HBsAg mutants in HBV and HCV patients with negative surface antigenemia after full dose vaccination .the measurement of HBV DNA by sensitive quantitative technique plays an important role in detection either with mutants in surface antigen or occult HBV infection [OBI]. Lower immune response was markedly observed after prophylactic vaccination of patients with previous HBV infection with and to lesser extent in those with HCV infection. HBcAb and or HBV DNA testing should be considered before HBV vaccination to avoid the vaccine induced pressure which may lead to development of HBV surface antigen mutations

Effect of cryopreservation on human sperm motility, vitality and DNA integrity in fresh and processed sperms

To investigate The effects of cryopreservation on sperm motility, vitality and DNA integrity in fresh and processed sperms. Pre-cryopreservation and post-cryopreservation analysis of sperm vitality, motility and DNA integrity in fresh and processed semen. Department of Dermatology, Venereology and Andrology, in coordination with the Department of Clinical Pathology Assiut University Hospital. Patients: 50 fertile men [within the last year] who are clinically free and with normal semen parameters the, semen samples collected by masturbation into sterile containers after at least 3 days of sexual abstinence. Semen evaluation for, conventional semen analysis, sperm vitality with Hypo-Osmotic Swelling test [HOS], sperm DNA integrity by flowcytometry. Each sample was divided into 2 halves: The first half was cryoperserved without processing. The second half of the sample was processed by swim up technique. HOS test, percentage of progressive motility and DNA integrity after processing. Cryopreservation in liquid nitrogen for at least 24 hours for all samples [fresh and processed,] was done. HOS test, percentage of progressive motility and DNA integrity after thawing for all samples [fresh and processed]. Sperm DNA fragmentation index was determined using flowcytometry, sperm vitality was determined using HOS test and percentage of progressive sperm motility was determined using light microscopic examination according to criteria of WHO [1999]. Sperm frozen after processing had higher resistance to freezing damage as regards vitality and motility when compared with sperm frozen without processing however, sperm DNA fragmentation index was more in frozen processed than unprocessed sperms. Cryopreservation results in decreased sperm vitality, motility and increased sperm DNA fragmentation. Freezing processed sperm give better post-thawing vitality and motility but, increased sperm DNA fragmentation when compared with unprocessed sperm

study of sexual and reproductive dysfunctions in juvenile onset diabetic men

Diabetes affects an increasingly large number of young men of reproductive age To determine fertility status and to evaluate semen parameters and sexual dysfunction in men having juvenile onset diabetes comparing them to fertile controls. 73 male patients having juvenile onset diabetes mellitus. The study included clinical evaluation, erectile capacity scoring with IIEF-5 score, urine analysis after masturbation, conventional semen analysis and sperm hypoosmotic swelling test of 73 diabetic men and 33 fertile controls. Comparison between diabetic patients and fertile controls in conventional sperm parameters and hypoosmotic sperm swelling percentage [HOS%]. Additionally, assessment of prevalence of infertility, erectile and ejaculatory dysfunction in diabetic patients. There was a significant decrease in percentage of normal sperm morphology among diabetic patients [41.37 +/- 12. 38] than controls [57.27 +/- 8.11] [P < 0.001]. Percentage of progressive sperm motility was significantly lower in diabetic patients [33.42 +/- 13.38] than controls [54.84 +/- 5.92] [P < 0.001]. There was a significant decrease in sperm HOS% among diabetic patients [62.55 +/- 11.69] in comparison to controls [77.36 +/- 8.23] [P < 0.001]. There was no significant difference in sperm concentration [in million sperm/ml] between diabetic patients [69.75 +/- 62.11] and controls [74.55 +/- 50.78]. Similar results were obtained on comparing between fertile and infertile diabetics. Prevalence of infertility was 40%, erectile dysfunction [ED] was 75%, premature ejaculation was 31% and partial retrograde ejaculation was 5%. Diabetic patients had significantly lower normal sperm morphology, progressive sperm motility and hypoosmotic sperm swelling percentages. They had higher round cell number. They also had increased prevalence of infertility, erectile and ejaculatory dysfunctions

Role of some inflammatory markers in recent ischemic stroke

The onset of cerebral ischemia triggers a cascade of pro-inflammatory molecular and cellular events. Clinical studies suggest that the strength of this acute response is important in early and late clinical outcomes, early clinical worsening, and extent of brain damage. The aim of this work was to estimate the. role of some inflammatory markers in recent ischemic stroke, and to correlate these inflammatory markers with the short term outcome. Twenty sex patients presented with recent history of hemiplegia within 24 hours were included. The patient group was planned to contain 13 patients with the age between 20 and <40years and 13 patients with the age between 40 and 60 years. 15 subjects, [age and sex matched to the patients] were included in the study as control Neurological deficits were rated by Scandinavian Stroke Scale. Clinical assessments and serum levels of the inflammatory markers, Neopterin C -Reactive Protein [CRP], Tumor Necrosis Factor-alpha [TNF-alpha], Complement 4 [C-4], Interleukin-8 [IL-8], and Neopterin, were done at the time of admission, day 3, and day 7 from the stroke onset. Serum levels of neopterin started to increase from the 3 rd day and remained high to the end of the first week from the onset of the stroke. The increase was more obvious in the young aged patients. Serum levels of IL-8, raised rapidly in the acute phase of the stroke and then gradually decreased through the first wee and but still higher than the base line of the total patients and control. Serum levels of TNF-alpha and CRP had rapid significant increase from the first day to reach maximum levels in the 3 rd day and still significantly high till the end of the first week Serum CRP levels were higher in the old age group while serum C4 levels decreased from the 1 st day then gradually increased to reach maximum levels in the 7 th day, but still significantly lower than the control group. Also, there were statistically positive correlations between serum levels of neopterin and C-4 in the 3 rd sample with the Scandinavian scale in the 3 rd assessment. Brain ischemia induced an inflammatory cascade by the increase in serum levels of neopterin, IL-8, TNF-alpha, CRP and decrease in C4. This inflammatory response continued through the first week by the increase in the levels of complement -4. The inflammatory response was more obvious in the young aged patients. There were positive correlations between serum levels of neopterin, and C-4 with the short-term outcome of the stroke patients

Hypermethylation of the PAX 5 gene promoter and its implication in the pathogenesis of multiple myeloma

This study aimed to clarify the mechanism of silencing of the PAX5 gene. The genetic analysis of the coding region and promoter by southern blot analysis did not show growth structural abnormalities in human multiple myeloma [MM] cell lines when compared with PAX5 expressing B cells. Several transcription factors like Ikaros-1 [IK-1] and SRY-related high mobility group [HMG] box [SOX4 and SOX5] showed a similar expression pattern in B cells and MM cells. Therefore, it was suggested that epigenetic factors could be involved in PAX5 silencing. The examination of the methylation pattern in PAX5 promoter revealed some areas of hypermethylation in methylation sensitive Southern blot analysis. Moreover, the treatment of MM cell lines by methylation blocking cytidine analogue 5-aza-2 deoxycytidine [5-aza-2dC] could restore the expression of PAX5 gene. It was postulated that hypermethylation of the PAX5 gene promoter may be responsible for its silencing in human MM. It was proposed that PAX5 gene silencing could be related to the oncogenesis of human MM