Low-dose intradermal and subcutaneous versus intramuscular hepatitis B vaccination in primary non-responding hemodialysis patients.

OBJECTIVE: Patients with end-stage renal failure are at high risk of hepatitis B virus (HB V) infection. They have impaired immune response to HBV intramuscular (i.m.) vaccine. Non-response (anti HBs titer < 100mIU/ml) hemodialysis patients (HD) with the previous three-dose i.m. vaccination were examined with booster dose vaccine by i.m. , intradermal (i.d) and subcutaneous (s.c.) routes. MATERIAL AND METHOD: Thirty-four HD patients who had been vaccinated with three-dose vaccine (40 microgram, 2 ml, Engerix B, i. m.) and had anti-HBs titer less than 100mlU/ml were selected. They were randomly divided into three groups and received a fourth dose of vaccine by i.m. (40 microgram, 2 ml), i.d (10 microgram. 0. 5 ml) and s.c. (10 microgram, 0. 5 ml). Then, serum anti-HBs titer was determined after 45 days and 6 months. RESULTS: Forty five days after completion of the re-vaccination course, anti-HBs titer was above 100 mIU/ml in 6/11, 3/11 and 4/12 of i.m. s.c. and i. d groups, respectively (p > 0.05). After six months, 4/11, 3/11 and 2/12 of patients had anti-HBs titer above l00mlU/ml (p > 0.05). CONCLUSION: With lower dose of vaccine (10 microgram) in s.c. groups, these patients had lower change in their anti-HBs titer. Therefore, it is cost effective and practical to offer other vaccination schemes.

Urinary calcium to creatinin ratio in children.

Due to difficulty of 24hr urine collection in children for detection of hypercalciura, random urine calcium to creatinin ratio (U Ca/Cr) has been used for screening hypercalciuria. The purpose of this study was to determine normal U Ca/Cr ratio in primary school age children in North of Iran. This study was performed on 590 healthy school-age children, aged between 7-11 years. Early morning random urine samples from all children were analyzed for calcium and creatinine. Mean value and 95th percentile for U Ca/Cr ratio were 0.155 +/- 0.095 and 0.36, respectively. A negative correlation observed between age and U Ca/Cr ratio was R=-0.101, P=0.014. With regard to variations in U Ca/Cr ratio among different studies, it is recommended to determine this ratio in every geographic area.