Longevity of vaccination in children with chronic liver disease

Background: Superadded infection with hepatitis B virus [HBV] or hepatitis A virus [HAV] may cause serious consequences for patients with chronic liver disease [CLD]. Therefore, immunization of these patients can reduce the morbidity and mortality associated with cirrhosis. Vaccines against HBV and HAV are available; these vaccines are safe and immunogenic in healthy individuals [and in patients with CLD]

Aim: The aim of the present study was to assess long-term efficacy of HAV and HBV vaccinations in children with CLDs

Patients and methods: Our study included 200 children with CLDs. They were studied both prospectively and retrospectively to evaluate the immunogenicity and longevity of HAV and HBV vaccination during a follow-up period of 5 years. They were divided into two groups according to presence [n=77] or absence [n=123] of cirrhosis

Results: All patients did not lose their immunity against HAV through 5-year follow-up. During the first check up, 65.8% of children were immune against HBV. After 1 year, 14% of cases required booster dose and 7.8% were vaccinated by three doses. At 5 years after vaccination, 66.7% were immune, 18.3% required booster dose, and 12.5% were vaccinated by three doses. Three cases received a course of three double doses because of repeatedly low hepatitis B surface antibody [HBsAb] titer during our follow-up

Conclusion: HAV and HBV vaccines are safe and well tolerated in children with CLD, whether cirrhotic or not. HAV vaccine induces a satisfactory immune response. More frequent doses of HBV vaccine may achieve better results especially with long-term follow-up. There was no statistical difference between cirrhotic and noncirrhotic patients as regards vaccination response

Recommendation: Immunizations against HAV and HBV are recommended in CLD. Postvaccinal HBsAb titer should be checked

Common MEFV mutations in Egyptian patients with familial Mediterranean fever

Familial Mediterranean fever [FMF] which is an autosomal recessive condition that primarily affect population of the Mediterranean basin. If undiagnosed effectively and treated with coichicine for life it may lead to serious consequences in terms of renal amyloidosis and renal failure. We aim to check for the presence of FMF mutations in clinically suspected Egyptian patients, as an important step for family counseling and case management. The study is a pilot study to check for the presence of FMF mutations among suspected cases [24 cases] from Sharkia Govemorate. The control subjects [24] were selected from healthy volunteers. We examined FMF mutations by PCR technique for MEFV gene analysis in order to establish a diagnosis of FMF by examining two mutations, M694V and E148Q. We found 58.3%[14/24 cases] of cohort were positive for M694V mutation, and all cohort were negative for E148Q mutation. The normal controls were negative for previous two mutations. PCR technique provides a rapid, reliable, cost-effective, noninvasive, and sensitive test for establishing a diagnosis of FMF in symptomatic patients and also provides a rational basis for medical and genetic counseling of FMF patients and their families

Dentate gyrus in aged male albino rats [histological and tau-immunohistochemical study]

Dentate gyrus is a subregion of the hippocampus that is crucial in learning and memory and it is vulnerable to the aging process. Tau is a microtubule associated protein in neurons which is implicated as a significant factor in the axonal growth and development of neuronal polarity. The present study aimed to investigate the histological and tau-inununohistochemical features of the dentate gyrus in aged male albino rats. Thirty male albino rats were divided equally into three groups: Group 1 [adult, 3-6 months], Group II [early senile, 18-20 months] and Group III [late senile, 30-31 months]. Paraffin sections of hippocampus were prepared and stained with H and E, Cresyl violet and inmunohistochemically using anti-tau antibodies. Morphometric measurements were done and statistically analyzed. The thickness of the granule cell layer of dentate gyrus showed significant reduction in group III as compared to group I and II. The granule cell layer of dentate gyrus of aged rats [Group II, III] showed significant reduction in the number of mature granule cells with detection of apoptotic cells. The number of immature cells showed significant increase in group II, while was significantly reduced in group III as compared with group I. The cells of the hilus appeared with disturbed arrangement and some appear with shortening of their processes with presence of apoptotic cells and microglia. The number of astrocytes showed significant age dependent increase. Significant increase in the optical density of the tau immunoreaction within the dentate gyrus neuropil was observed with aged. Aging was associated with dentate gyrus neuronal loss which is accompanied with increase in abnormal tau accumulation in neuronal processes. Also, early stages of aging were accompanied with increase in immature cells. So, it is recommended to investigate the use of anti-tau drugs and stimulation of dentate gyrus neurogenesis by neurotrophic drugs as a protective approach for improvement of learning and memory during aging

Glucose-6-phosphate dehydrogenase deficiency as a cause of neonatal jaundice in Zagazig university hospital

Jaundice is a common problem affecting 50% to 70% of term infants and more than 80% of preterms, its mechanism is multifactorial; increased production, impaired conjugation and impaired excretion of bilirubin. Glucose-6-phosphate dehydrogenase [G-6-PD] deficiency the most common red cell enzyme abnormality associated with hemolysis. It is also known to be associated with neonatal jaundice, kernicterus, and even death. Identify neonates suffering pathological unconjugated hyperbilirubinemia particularly due to G-6-PD deficiency in Zagazig University Hospital. Two hundred clinically jaundiced neonates were enrolled in this study. Their mean gestational age was 36.65 +/- 1.76 weeks, mean birth weight was 2.9 +/- 0.49 kg, mean age at time of admission was 6.5 +/- 3.72 days, 121 were males and 79 were females [representing 60.5% and 39.5% respectively]. In addition 60 age and sex matched healthy neonates served as a control group. AII neonates were subjected to history taking, clinical examination, and measurement of total and direct serum bilirubin. Upon plotting total serum bilirubin [TSB] on bilirubin nomogram 123 neonates were identified as having pathological hyperbilirubinemia and the remaining 77 neonates were excluded from the study in addition, 22 neonates were identified as having direct [conjugated] hyperbilirubinemia and were also excluded from the study. The remaining 101 [50.5%] neonates [61 males and 40 females] were diagnosed as having pathological unconjugated hyperbilirubinemia and were subjected to laboratory investigations in the form of; CBC, peripheral blood smear, reticulocytic count, direct Coombs' test, ABO and Rh blood grouping for mothers and neonates, liver function test, urine analysis, sepsis screen [C-reactive protein, total and differential leucocytic count and band cell count], serum TSH and T4, and G-6-PD enzyme assay. Results: Out of 101 neonates wfth pathological unconjugated hyperbilirubinemia G-6-PD deficiency was detected in 13 [12.9%] neonates, 10 of them were males and 3 were females [representing 76.9% and 23.1% respectively]. G-6-PD deficiency is an important cause of neonatal jaundice in both males and females

Aspects of development of bone marrow in male albino rats: Light and electron microscope study

Twenty five healthy male albino rats were utilized in this study to throw more light on the histological and ultra structural changes in femur's bone marrow at different ages in albino rats. They were classified into five groups [5 animals each]: group A, [prenatal, 17-19 days of gestation], group B [newborn, I-day old], group C [one week old], group D [adult, 3-6 months old], and group E [senile, more than I8-months old]. The animals were sacrificed and small pieces of femurs were taken and processed for light and electron microscopes examination. The bone marrow was consisted of vascular and non vascular elements. The vascular elements of the prenatal group showed small capillaries and many dilated blood sinusoids. They were lined with flat endothelial cells with little cytoplasm. Large cells[adventitial cells] with large nuclei, pale cytoplasm and long processes were noticed on the abluminal side of dilated sinusoids in the marrow of the newborn. The marrow arterioles of 1 week- old and adult groups were lined with cuboidal lining cells and surrounded by pericytes with flat nuclei and long processes. However, in the senile group, multiple thick walled arterioles with narrow lumen were detected. The non vascular elements of the marrow were formed of hemopoietic and non hemopoietic cells. In the prenatal group, some cells showed small electron dense nuclei, dense cytoplasm and irregular cell membrane [apoptotic cells]. Many large macrophages with eccentric nuclei were seen in cIose relation with the apoptotic cells. Giant cells with multiple nuclei and vacuolated cytoplasm [osteoclasts] were noticed adjacent to calcified spicules. Many hemopoietic cells at different stages of development were noticed at 1-day of age. Apoptotic neutrophils with dark nuclei and muddy cytoplasmin together with mitotic cells were also observed. Hemopoietic cells were markedly increased at the age of I-week, adult, till senile. Fat cells and many megakaryocytes were also marked. The megakaryocytes appeared as large cells with multilobulated nuclei and numerous electron dense granules in their cytoplasm. Also, intracytoplasmic canaliculi appeared as elongated vesicles which may branch. These canaliculi were of smooth surface and enclosed empty cores. With senility, there was marrow hypocellularity. Most of the cells were apoptotic. In conclusion, bone marrow started its function as a hemopoietic organ postnatally. In senile group apoptosis predominated mitosis. Predominance of mitosis in young ages making them more recommended as a potent source for bone marrow transplantation

Study of responses of glucostatic mechanisms to immobilization stress in normal and diabetic rats

The purpose of this study was to investigate the blood glucose and insulin responses to acute and chronic stress and to determine whether diabetes can affect these metabolic responses to acute and chronic stress. Sixty adult male albino rats were used in this study, thirty of them were rendered diabetic by a single intraperitoneal injection of streptozotocin [STZ] 50 mg/kg. Rats were divided into 6 equal groups, 3 normal and 3 diabetic groups. One group served as control [normal and diabetic]. The second was exposed to acute stress by immobilization, 3 hours only, normal and diabetic, and the third was exposed to chronic stress by immobilization, 3 hours daily for 15 consecutive days, normal and diabetic. Acute and chronic stress caused significant increase in blood glucose level which was more marked in diabetic rats. On the other hand, acute and chronic stress resulted in significant decline in the magnitude of insulin which was more pronounced in diabetic rats

Value of electrophoresis of tears in diagnosis of dry eye syndrome

Fifty cases of dry eye syndrome based on clinical symptoms, diminution of Schirmer's test and a low tear film break up time were subjected to electrophoresis of tears in order to study the glandular function in dry eyes syndrome, and to establish both diagnosis and prognosis