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

Oxyurid nematodes detected by cotonoscopy in patients with unexplalnea abdominal pain

Pinworms are one of the common helminthic infection that generally live in the gastrointestinal tract causing appendicitis and leading to unexplained abdominal pain. Species of the genus Syphacia [rodent pinworm] are cosmopolitan and they also infect humans. To diagnose the cause of unexplained abdominal pain in patients with mild eosinophilia by colonoscopy. to detect the relevance of Oxiyurid nematodes as a cause of this unexplained abdominal pain, and to identify and describe the extracted piliworms using light and scanning electron microscopy [SEM]. The study was performed on 200 inpatients of different age groups ranging from 3-60 years over a period of one year in the Tropical Medicine and Gastroenterology Department, Assiut University Hospital. Laboratory investigations were done for each case, including complete blood picture, liver function tests, stool examination for helminthes and protozoa. and perianal swab for patients suffering from perianal itch. Colonoscopy was performed for all cases not responding to antispasmodics. Detected worms were picked up by biopsy forceps and sent to the Parasitology Department, Faculty of Medicine. Assuit University and examined using light and SEM. Out of 200 patients, 25[12.5%] were diagnosed as pinworm infection of the genus Syphacia except in 5 children who had mixed infection with E. vermicularis. Laboratory findings were mild cosinophilia [6-8%] and neutrophulia with moderate shift to the left in one patient with recto-sigmoid nodule and negative stool examination. perianal swab of patients presenting with perianal itch was positive for E. vermicularis eggs. Light microscopic examination illustrated the presence of three different species of Oxyurida E. vermicularis. Syphacia muris and .Syphacia specific. SF.M studies showed that Svphacia spp. were classified into two groups according to morphological differences, and allowed for the reporting of additional morphological and taxouomical features. Syphhacia is considered as a cause of unexplained chronic abdominal pain and E. vermicularis is not the only human pinworm in Egypt. Further studies using SEM are needed to detect new characters that may help in differentiating Syphacia spp. from different hosts

Preoperative interleukin-6 in colorectal cancer patients: correlation with carcinoembryonic antigen, tumour stage and outcome

The significance of preoperative serum inter-leukin-6 [IL-6] level in the progression of colorectal cancer has not been fully elucidated. Our aim was to investigate its role and identify its prognostic significance. Forty three consecutive patients, who underwent radical resections for colorectal cancer lesions in a period of 1.5 years from Aug. 2004 till Feb. 2006 were recruited in this study. Blood samples were obtained before surgery to determine the serum concentration of IL-6 and carcinoembryonic antigen [CEA]. Serum concentrations of human IL-6 were determined by enzyme-linked immunosor-bent assay [ELIZA] and CEA was measured by immunometric method. The relationships between their elevations and both the clincopathological factors and prognosis of patients were investigated. Serum samples [for IL-6 assay only] from 25 sex- and age-matched normal healthy individuals were used as controls. The mean serum IL-6 concentration [9.57 +/- 7 pg/mL, range 2.4-45 pg/mL] was significantly higher than that in normal individuals [mean value: 3.52 pg/mL, range 0.45-9.96 pg/mL, p<.001]. Elevated serum CEA [>5.0 ng/mL] was present in 44.2% of patients, while serum IL-6 levels in CRC patients were more frequently elevated [69.8% of patients, p=.001]. Linear regression analysis showed a significant association between serum values of both IL-6 and CEA [r=.773; r[2]=.597; p=.001]. The mean IL-6 serum concentration in CRC patients with stage III was 13.3 +/- 8.47 pg/mL while the mean level in patients with stage I and II was 6.3 +/- 3 pg/mL [p=.001]. Patients with an IL-6 serum concentration of more than 9.5 pg/ml had a significantly shorter 2-year survival [55%] than patients with an IL-6 serum concentration of 9.5 pg/ml or less [93%], [p=001]. IL-6 is potentially a better marker for advanced colorectal carcinoma than CEA. High preoperative levels were associated with high CEA, advanced tumor stage and poor outcome. IL-6 may have a role as an indicator of metastases that appear after resection of the primary colon cancer. This may help to identify high risk patients more likely to benefit from adjuvant therapy

Bedside cardiopulmonary characteristics distinguishing portopulmonary hypertension from primary pulmonary hypertension

The presence of pulmonary hypertension in combination with portal hypertension, otherwise termed porto-pulmonary hypertension [PPHTN], is a well-recognized complication of chronic liver disease. Primary pulmonary hypertension [IryPH] is another type of pulmonary hypertension with obscure aetiology that has similarities to PPHTN. The cardiopulmonary clinical characterestics of both types may be hard to distinguish from each other although they aren't synonymus. To differentiate the bedside cardiopulmonary profile of PPHTN from that of IryPH. A total of 20 patients with PPHTN [Group A] were recruited during the period from August 2005 to September 2007 and compared to a group of 20 patients with IryPH [GroupB]. Clinical assessment, trans-thoracic echocardiography, ECG, chest radiography, room air arterial blood gas measurements and respiratory function tests were done for all patients in addition to the diagnostic liver assessment investigations. Dyspnea on exertion, and cyanosis were main complaints of both groups. Patients with PPHTN [Group A] exhibited less elevated pulmonary pressures than patients with IryPH [mean pulmonary pressure, 51 +/- 2.1 mm Hg versus 62 +/- 2.3 mmHg, [P <0.05]. Chest radiography, Echocardiographic, and ECG findings secondary to pulmonary hypertension were different than group B [p, 0.08]. Echocardiographic signs of diastolic dysfunction were unexpectedly more in group A. Arterial blood gas measurements indicate that PPHTN exhibits a significant accentuation of the chronic respiratory alkalosis [p, 0.04] and has an increased alveolar-arterial gradient [P, 0.000] when compared to patients with IryPH. However, restrictive pulmonary dysfunction and reduced diffusion were more found in IryPH [Group B] [p, 0.05]. PPHTN and IryPH patients possess characteristics common to both groups, but, more importantly, they also have distinctive cardiopulmonary characteristics that allow differentiation. Despite tendency to have less degree of PH, PPHTN patients have more accentuated respiratory alkalosis and more increased alveolar aterial gradient than patients with primary PH also IryPH patients have more restrictive pulmonary functions. Cardiac Diastolic dysfunction is also more prominent in patients with PPHTN than in IryPH patients

Gene polymorphism of factor V and variceal bleeding in infants and children

The aim of this work is to evaluate the presence of factor V Leiden mutation and the activity of the natural anticoagulants in variceal bleeding in infants and children. This study included 50 infants and children with variceal bleeding who were admitted at the Gastroenterologoy, Hepatology and Malnutrition Unit, Pediatric University Hospital, Assiut University. The search was done in the period from January 2004 till July 2006. The age was between 5 months up to 14 years with mean age of 8.7 +/- 3.9 years. Twenty children of matchable age and sex were enrolled as controls. After the consent of the parents of patients and controls complete clinical examination with the following investigations for the cases and controls were done: 1. Liver function tests [total bilirubin, direct bilirubin, Alanine transaminase [ALT], Aspartate transaminase [AST], Alkaline phosphatase [ALP]] and hepatitis markers. 2. Prothrombin time [PT]. 3. Activated partial thromboplastine time [APTT]. 4. Thrombin time [TT]. 5. Prothrombin concentration [PC]. 6. Fibrinogen. 7. Natural anticoagulants; Protein S, Protein C, Antithrombin III [A TIII]. For cases the following investigations were done: 1. Evaluation of factor V Leiden mutation. 2. Abdominal ultrasound and Doppler. 3. Ultrasound guided needle biopsy to the liver and pathological examination. 4. Upper endoscopy with sclerotherapy or band ligation if needed. Follow up endoscopy after 2 months was done for each case. Out of the 50 patients 14 patients [28%] were diagnosed to have extrahepatic portal hypertension [EHPH] due to portal vein thrombosis [PVT]. 5 of them gave a history of admission in the neonatal intensive care unit and 7 suffered liver cirrhosis. The rest of cases 36[72%] were diagnosed as having intrahepatic portal hypertension [IHPH] 8/50 [16%] cryptogenic cirrhosis, 5/50 [10%] congenital hepatic fibrosis, 10/50 [20%] chronic HBV infection, 5/50 [10%] chronic HCV infection, 3/50 [6%] autoimmune hepatitis, 2/50 [4%] Wilson disease, 1/50 [2%] biliary cirrhosis and 2/50 [4%] neonatal hepatitis. Oesophageal varices was detected in 40 [80%], both oesophageal and gastric varices in 6 [12%] and isolated gastric in 4 [8%] of the cases. In cases with IHPH serum bilirubin and indirect bilirubin as well as liver transaminases and ALP were significantly higher than those of the EHPH and controls. No significant difference was found between EHPH and the controls. Natural anticoagulants were significantly decreased in cases with IHPH in comparison to EHPH and controls. Cases with EHPH show low levels of the natural anticoagulants in 4 while normal values were found in the remaining 10 patients. Leiden mutation was positive in 6 cases of portal vein thrombosis [42%] 4 of them suffered liver cirrhosis and in 3 cases with chronic HCV and in 2 cases with chronic HBV. One of the causes of portal hypertension in infants and children is portal vein thrombosis. PVT may be due to local precipitating factors as umbilical catheterization, umbilical sepsis or neonatal sepsis or due to an inherited factor like inherited thrombophilic mutation as FVL mutation that causes activated protein C resistance. Other inherited factors like inherited deficiency of Protein S, Protein C and ATIII may be the cause of PVT. Band ligation of the oesophageal varices may be beneficial in the treatment especially in cases due to PVT. Sclerotherapy may represent a trigger factor for PVT in cirrhotic patients with genetic thrombophilia. Screening for FVL mutation could be helpful in cases of hepatic cirrhosis to prevent PVT and also is diagnostic for most of the unexplained cases. The use of anticoagulant therapy maybe useful in the recently discovered cases of PVT and so decrease the risk to develop varices and their complications

Surveillance of acute viral hepatitis in a rural Egyptian community

Hepatitis viruses are endemic in Egypt. Many studies have been performed in order to study the pattern of acute viral hepatitis [AVH] in Egypt and all these studies were hospital-based. There is no available literature about the surveillance of AVH in Egypt. The aim of this study was to survey and identify the etiologies of AVH in a rural community in Upper Egypt. The study was performed in Sallam Village near Assiut City. The active surveillance of acute viral hepatitis was performed using house to house survey and frequent visits to rural health unit. All patients were asked using a previously designed questionnaire. General clinical, abdominal examination and abdominal ultrasonographic examination were performed. Liver function tests, different seromarkers and PCR for AVH were performed for all patients. The results showed that AVH was diagnosed in 105 cases. Acute hepatitis A [AHA] was the most frequent cause of AVH [34 cases], followed by AHE [29 cases] and AHB [9 cases]. Acute hepatitis C was diagnosed in only three cases [two of them mixed with AHE], the cause of AVH was unknown in 15.1% of cases. There was no significant difference regarding the clinical and laboratory findings among different etiologies of AVH. Patients with AHE had relatively mild clinical presentation. Nineteen cases had clinical and laboratory evidence of AVH; however they had positive anti-HCV at six months prior to inclusion, so they were diagnosed as chronic hepatitis C. In addition, six cases were excluded from the study and diagnosed as drug- and toxin-induced hepatitis. The ultrasonographic changes of the liver and spleen were nonspecific. The study concluded that the surveillance of AVH in the community is important for the early diagnosis of mild and non-icteric cases and the early detection of epidemics