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

Changes in lung functions among patients with s mellitus

Clear decrements in lung function have been reported in patients with diabetes mellitus over the past two decades. However, at the present time, there are no reports of functional imitations of activity of daily living ascribable to pulmonary disease in patients with diabetes. To examine the impact of type 1 and type 2 diabetes on pulmonary functions including spirometry, diffusion and lung volumes, also correlation of these functions with blood glucose level and duration of diabetes. 40 patients with diabetes mellitus 20 with type 1 and 20 with type 2 attending the outpatient clinic in Assiut university hospital were recruited in this study. They were subjected to through history and clinical examination and evaluation to exclude any air way diseases. Lung functions including spirometry, lung volumes and diffusion capacity were performed to these patients compared with 40 healthy age- matched volunteers as a control group. For spirometric study, the mean value of FVC, FEV1, PEF25-75 were significantly reduced in both males and females in both types of diabetes, while FEV1/FVC was reduced significantly only in females with type 1 diabetes. For lung volumes, there was significant increase in RV, FRC RV/TLC and significant reduction in TLC in male patients in both types of diabetes. In females, there was no significant difference in mean values of RV, FRC, but significant reduction in TLC and significant increase in RV/TLC in type 1. In type 2, there was significant increase in RV, RV/TLC and significant increase in TLC with no significant difference in FRC. For diffusion capacity, the mean values of DLCO and KCO were significantly decreased in both males and females with type 1diabetes, while this reduction in type 2 was not statistically significant. Spirometric functions and lung volumes were significantly affected in both types of diabetes mellitus, while the diffusion capacity of CO and transfer coefficient were only significantly decreased in type 1. There is a negative correlation of pulmonary functions with blood glucose level and duration of diabetes

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

syndrome of resistance of thyroid hormone, misdiagnosed as thyrotoxicosis

to report two cases of resistance to thyroid hormone to increase the awareness of this syndrome, which is frequently misdiagnosed and incorrectly treated. we described two siblings, both of whom were diagnosed as having thyrotoxicosis and one of them was treated with carbamazole and subsequently developed hypothyroidism. Both patients showed features of resistance to thyroid hormone and required additional L-thyroxine to normalize the thyroid stimulating hormone level while remaining clinically euthyroid. Laboratory evaluation revealed increased serum thyroxine and tri-iodothyroxine levels as well as increased thyroid stimulating hormone [TSH] levels. The free alpha subunit/TSH ratio was normal, and CT of the pituitary gl and showed no tumour. Metabolic studies using graded doses of tri-iodothyroxine supported the diagnosis. The two patients have resistance to thyroid hormone but were erroneously diagnosed as thyrotoxic and one of them inappropriately treated. Patients with elevated plasma levels of thyroid hormones with high or normal TSH level need careful evaluation of the hypothalamic-pituitary function and peripheral action of thyroid hormones

Cardiac autonomic dysfunction in children and adolescents with type 1 diabetes mellitus

Autonomic neuropathy is less well documented in children with type 1 diabetes mellitus and has received less attention than other diabetic complications. Sudden death and cardio-respiratory arrest in patients with type 1 and type 2 diabetes mellitus have been attributed to cardiac autonomic dysfunction. The aim of this study was to determine the prevalence of autonomic neuropathy in a cohort of children and adolescents with type 1 diabetes and to examine the relationship between this complication, and duration of diabetes and degree of glycemic control. Seventy-six type 1 diabetic children and adolescents below age 18 years of age, and 76 non-diabetic school children, matched for age and sex, had their cardiac autonomic nerve function assessed using four autonomic function tests. Namely the respiratory sinus arrhythmia test; the Valsalva ratio test; the heart rate response to standing, and the blood pressure response to standing. The first three are tests of parasympathetic function, while the last one is a sympathetic function test. The diabetic patients had a median age of 12 years and their median duration of diabetes mellitus was 43 months. They showed a significantly higher resting heart rate and a significant drop in systolic and diastolic blood pressures upon standing compared to the control group. The duration of diabetes mellitus showed linear correlation to the symptoms of autonomic dysfunction. We conclude that cardiac autonomic neuropathy is not rare in young diabetic patients of relatively short duration of illness where glycemic control is less than optimal. Such tests may serve as long-term prognostic indicators in diabetic 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

Magnetic resonance cholangiopancreatography versus endoscopic retrograde cholangiopancreatography in cholangiopancreatic disease

Endoscopic retrograde cholangiopancreatography [ERCP] has been widely used in clinical work for decades in evaluation of the pancreatobiliary tree, whereas magnetic resonance cholangiopancreatography [MRCP] has only been used in recent years. This study was conducted in gastrointestinal endoscopy center and Radiology department, Assuit university hospital from March 2003 till April 2005 using ERCP and MRCP to diagnose cholangiopancreatic lesions and compare their accuracy. 126 patients were included in the study, 78 males and 48 females referred and scheduled for ERCP. MRCP was performed 24 hours before ERCP, Either endoscopist or radiologist performed ERCP or MRCP respectively, reported separately on their findings. ERCP was performed successfully in 117 cases [92.8%], while MRCP was carried successfully in all cases. Choledocholithiasis was present in 63 cases diagnosed by ERCP, 60 cases were diagnosed by MRCP. Ampullary carcinoma was present in 14 cases diagnosed by ERCP. Only 10 cases were diagnosed by MRCP. Cholangiocarcinoma was present in 20 cases, 16 cases were diagnosed by ERCP and MRCP with equal sensitivity and specificity. Benign inflammatory strictures of the common bile duct were present in 9 cases, was illustrated in 7 cases by ERCP, only 5 cases were diagnosed by MRCP. Pancreatic cancer was present in 20 cases, 17 cases were diagnosed by ERCP, 16 cases were diagnosed by MRCP. MRCP has an equal efficacy to ERCP in diagnosis of biliary stones, Cholangiocarcinoma, pancreatic cancer, but less efficient to diagnose ampullary carcinoma

Predictors of rebleeding after endoscopic haemostasis of bleeding peptic ulcers

The effectiveness of endoscopic manipulation in the control of bleeding in peptic ulcers have been established amid currently early endoscopy is the best management for acute ulcer bleeding. During endoscopy we can identify the bleeding site and stratify the risk of recurrent bleeding. To study endoscopic findings as factors for prediction of rebleeding after endoscopic hemostasis of bleeding peptic ulcers. These factors were evaluated versus clinical factors. This study was performed in Assuit University Hospital. and included 71 cases with bleeding peptic ulcer. All patients' were subjected to thorough history and clinical examination,written consent, laboratory investigations as live,' functions, prothrombin time and full blood count, and upper endoscopy. Initial hemostasis was achieved in 67[94.4%] cases while permanent hemostasis in 63[88.7%] cases. 20[28.2%] cases experienced rebleeding. The risk factors for rebleeding were age above 55 years 11[55%] and shock at the onset of bleeding which was observed in 19[95%] rebleeders. Endoscopic evaluation revealed that duodenal ulcer was observed more than gastric ulcer in the rebleeder as 12[60%]cases had duodenal ulcer versus 8[40%,] had gastric ulcer. Also, the presence of the ulcer in the posterior wall of the duodenum 10 [83.3%] compared to only 2[12.7%] in the anterior wall was statistically significant P<0.00.Spurting was detected in 8[40%,] of rebleeding cases and in one [1%] case in the patients who did not rebleed with a highly statistical significant P<0.000. The ulcer size was >1.5 cm in 14[70%] out of the 20 bleeders and <1.5 cm in 6[30%] of them with statistical significance P=0.01. On the other hand oilier factors as the shape, depth, vessel color, shape of margin and color of ulcer base showed no statistical significance. On performing multiregression analysis the risk factors for rebleeding included the site of the ulcer being more in the rebleeders in case of duodenal ulcer especially in the posterior wall P<0.001 and the presence of spurting as a risk for rebleeding P<0.001. Age above 55 years, shock on admission are important predictors of rebleeding after endoscopic hemostasis of bleeding ulcers hut endoscopic features as type of ulcer, size and site of ulcer and spurting activity are in ore important predictors of rebleeding after endoscopic hemostasis

Iron-copper metalloprotiens conection in the pregnant rabbit

The balance required to maintain appropriate cellular and tissue iron levels has led to the evolution of multiple mechanisms to precisely regulate iron uptake from transferrin and low molecular weight iron chelates .A role for ceruloplasmin [Cp] in vertebrate iron metabolism is suggested by its potent ferroxidase activity catalyzing conversion of Fe[2+] to Fe[3+]. The influence of pregnancy having a significant impact on iron balance was analyzed and the interaction between Cp and ferritin was investigated. Our data provide evidence that Cp and ferritin appear to have a regulatory/inhibitory role in both iron absorption and homeostasis

Diabetic ketoacidosis in children and adolescents: an update

Diabetic ketoacidosis is a frequent cause of morbidity and mortality in the patient with type 1 [insulin-dependent] diabetes mellitus. It constitutes an acute medical emergency and hence, its management remains an important issue for physicians concerned with the care of diabetic patients. In the past decade, a considerable volume of scientific publications has contributed towards a better understanding of the pathogenesis, metabolic derangement, complications and management of this disorder. This article reviews these recent advances as they pertain to diabetic children and adolescents

role of prolactin in the etiology of feminization in schistosomal hepatic fibrosis

Basal levels of Estradiol, Testosterone, and Prolactin were measured in 20 schistosomal patients and 10 normal controls. Prolactin response to provocation by Chlorpromazine [50 mg 1.M.] was also studied in the 20 schistosomal patients. Patients were divided into two groups. Group 1 included 10 patients with signs of feminization in the form of one or more of the following: Gynaccomastia, female escutcheon, female body habitus, and cutaneous arterial spider naevi. Group II included 10 patients without feminine manifestations. The basal levels of estradiol were not different in the three groups. Testosterone levels were significantly lower in schistosomal patients of both groups. Basal prolactin was significantly higher in schistosomal patients of both groups. The level was higher in patients without feminine manifestations than in patients with such manifestations. Prolactin response to stimulation was also higher in patients without feminine manifestations although the difference did not reach statistical significance. The results suggest that prolactin has no significant role in the pathogencsis of feminine manifestations in schistosomal patients

effect of comparison of complex carbohydrates and high fibre preparations on post-prandial blood glucose and insulin levels in non-insulin dependent diabetics

Since the last decade, the physiological effects of dietary fibres and their possible role in prevention and management of many diseases have been emphasized. The aim of the present work has been to study the possible effects of supplementary different complex carbohydrates, consumed by the Egyptian population, with high fibre preparation, on the post-prandial blood glucose and insulin levels- in non-insulin dependent diabetics. This work has been carried out on 30 NIDD, who have been subjected to oral carbohydrate tolerance tests using boiled rice, boiled potatoes or bread [equivalent to 75 g glucose] at different occasions. Then the same patients have been subjected to the same tests after supplementing each carbohydrate load with high fibre preparation in the form of ceral bran and citrus fruit fibres. Blood glucose and insulin levels have been estimated using RIA technique for the latter. The maximum increment rise of glucose occurred at 90 minutes post-prandial and rice elecited the lowest glucose response, while potatoes elecited the highest one. Similarly rice elecited the lowest plasma insulin response. Supplementation of fibres led to marked and significant reduction of blood glucose level at 60 and 90 minutes in cases of rice and bread [P < 0.05] while the reduction is not significant in cases of potatoes [P > 0.05]. On the other hand addition of high fibre preparation did not affect siguificantly insulin resnonse