HBc Ab Research Articles

Isolated hepatitis B core antibody in HIV infected patients--can response to hepatitis B vaccine help to elucidate the cause?

Background:Concomitant hepatitis B and HIV infections are common. In some of these patients, HBcAb is the only serologic marker of hepatitis B. This study was conducted to elucidate the cause of isolated HBcAb in HIV-infected patients via hepatitis B vaccination.Methods:In this interventional study during 2014-15 in the HIV Clinic in Hamadan, thirty four patients with HIV infection and isolated HBcAb positive isolate, received hepatitis B vaccine and their responses to vaccination were investigated. Demographic data, stage of disease, and status of CD4 and HCV Ab were extracted from the patients' medical records and were entered in a checklist.Results:Of the 103 HIV positive patients, the prevalence of HBs Ag, and HBc Ab isolates were 6.79% (n=7) and 46.6% (n=48), respectively. All of the patients with isolated HBcAb were positive for HCV Ab. Among the 48 patients with isolated HBc Ab, 34 (70.8%) were available and examined for HBV DNA in serum samples. The result of PCR was negative in all. After the first round of hepatitis B vaccination, HBs Ab titer exceeded 10 International Units Per Liter (IU/L) in 58.8% of patients with isolated HBc Ab. With the completion of the three-dose of vaccine, this titer was observed in 97% of patients. Significant correlation was observed between titer of antibodies and values of CD4 cells.Conclusions: Due to favorable response to hepatitis B vaccination in HIV positive patients with isolated HBc Ab, false positive HBc Ab and recovery from previous infection were more probable than hidden hepatitis B.

Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus Infection in Multi-Transfused Thalassemic Patients, Kermanshah, Iran, 2015

Background: Repeated blood transfusions in Thalassemic patients predispose them to blood-borne infections including Hepatitis B, Hepatitis C, and human immunodeficiency virus. These infections cause cirrhosis, portal hypertension, and acquired immunodeficiency syndrome. Objectives: The current study aimed at determining the prevalence of these infections in Thalassemic patients of Kermanshah province, Iran. Methods: Thalassemic patients registered at Mohammad Kermanshahi university hospital were included. Demographic data, history of blood transfusions, Hepatitis B surface antigen (HBsAg), Hepatitis B core antibody (HBC Ab), Hepatitis B surface antibody (HBs Ab), Hepatitis C antibody, and Human immunodeficiency virus (HIV) antibody were extracted. Serologic tests were done using the third-generation enzyme linked immunosorbent assay (ELISA) and positive Hepatitis C virus (HCV) Ab and HIV Ab results was confirmed by Western Blotting. Results: A total number of 232 patients were enrolled (111 females and 121 males), among whom HBsAg and HIV Ab were both negative. Positive HBS Ab was reported in 222 subjects (95.7%) and 19 cases (8.2%) had positive HBC Ab. Immunity to hepatitis B was the result of vaccination in 87.5% of cases. Hepatitis C antibody was positive in 14 cases (6%). Finally, a significant relationship was found between HCV infection and blood transfusion done before 1996. Conclusions: High rate of hepatitis C was found to be due to the lack of screening for HCV Ab among blood donors before 1996. The negative HBS Ag can be justified by regular hepatitis B vaccination program in patients with thalassemia. The lack of HIV infection was concluded to be attributed to the low prevalence of this virus in the general population and blood donors as well as proper screening methods.

Investigation of Relative Risk Factors of Hepatitis B Virus Core Antibody Positivity among Intravenous Drug Users in Tehran, 2013

Background: Hepatitis B virus (HBV) still continues to infect many people worldwide despite the availability of an effective vaccine for more than three decades. The high prevalence of HBV may exist in high risk groups, particularly among intravenous drug users (IDUs). This group is among groups with a higher risk of infection due to their hazardous behaviors such as sharing needles for drug injection. This cross sectional study included 229 intravenous drug users in Tehran, in 2013 to investigate the prevalence of HBc Ab positivity and its associated risk factors among IDUs. M aterials and Methods: Socio-demographic characteristics and associated risk factors were recorded during sample collection. Their serum samples were tested for the presence of total hepatitis B virus core antibody (HBc Ab) by Enzyme-linked Immunosorbent Assay (ELISA). R es ults: HBc Ab was detected in 64 of 229 participants, giving an overall prevalence of 28%. History of imprisonment, injecting drugs and age has a significant correlation with HBc Ab positivity. C onclusion: Expansion of new preventive strategies through the national health system could be beneficial for decreasing the risk of acquiring HBV among high risk groups such as IDUs.

Persistence of protective anti-HBs antibody levels and anamnestic response to HBV booster vaccination: A cross-sectional study among healthcare students 20 years following the universal immunization campaign in Italy

ABSTRACTVaccination against Hepatitis B Virus (HBV) became mandatory in Italy for all newborns and 12 years-old individuals in the 1991. The immunogenicity of HBV vaccine and the effectiveness of the universal immunization strategy have been widely demonstrated. However the need to assess the antibody concentrations above the well known serological correlate of protection for HBV infection (≥10 mIU/mL), established in individuals immunized with a 3 doses vaccination course, is still recommended in subjects exposed to occupational risks in different settings, particularly the healthcare services. This practice has to be performed during the preventive medical examination, before the worker's exposure to biological hazards, as a fundamental part of Occupational Health Surveillance Programs in several Countries, including Italy: the goal is to assure individual protection, also providing booster doses when needed, after many years following the primary vaccination. During the 2011–2013 period, an observational study was performed in Healthcare students (HCSs) trained at a regional university acute-care hospital in North-Western Italy, properly immunized against HBV during infancy or adolescence, in order to evaluate the persistence of seroprotection and to assess the anamnestic response to booster vaccination. Data from 717 subjects undergoing HbsAg Ab and HBc Ab testing during the preventive medical examination, and receiving a booster dose of HBV vaccine when resulting with a non-protective titer (<10 mIU/mL), were collected and analyzed. Most of the HCSs (74.6%) included in the survey, mean age 24.8 y ( ± 4.6 SD), had received the primary vaccination course during the first year of life (3–5–11 months). Globally, 507 (70.7%) HCSs showed protective antibody titres, and an anamnestic response was observed in more than 95% subjects receiving the booster dose. Our study demonstrated the long-term persistence of protection of HBV vaccine, more than 20 y following the primary immunization, in HCSs who are exposed to occupational health risk. The anamnestic response observed in non-seroprotected subjects who received the booster further confirms the capability of the HBV vaccine to create a strong immunological memory.

Detection of Autoimmune Hepatitis among Chronic Cases of Hepatitis B virus in AL-Najaf province

This study was amid to investigate the existence of HBV and the diagnosis of autoimmune hepatitis (AIH) in addition study (C3, C4) Levels among chronic hepatitis B patients. The current study was conducted on 360 patients suspected with hepatitis B virus infection, which have age ranging (11-72) year were collected from center health laboratory, AL-Hakeem hospital, and AL-Sadder medical city in AL-Najaf city, during the period from January (2013) to August (2013). Fifteen healthy individuals without any evidence of chronic inflammatory disease involved as control, age ranging (21-50) years. The results showed that only 76 were seropositive hepatitis B in ELISA technique , the age group (44-54) year revealed high significance(p&lt;0.05) than other age groups. While 35 (46%) out of 76 seropositive with HBc Ab, the age group (55-65) year showed high significant (p&lt;0.05) than other age groups, and male more infection than female. The result also revealed that the autoimmune hepatitis disease was 5 (6.5%) out of 76 patient infected with Type 1autoimmune hepatitis. Complement fractions C3, decreased in all patients compared to those of a healthy control, while the autoimmune hepatitis patient recorded high level was 142.2±8 mg/dI. In regard to C4 was revealed normal concentration in all patients compared with control groups while the autoimmune hepatitis patient recorded high level was 41.7±5.1 mg/dI and non-significant (P&lt;0.0) in males than female in concentration of (C3 and C4).

A Seroprevalence Study of Hepatitis B and C Virus Infections in a Hospitalized Population in Romania, an Opportunity for a Better National Prevention and Control Strategy.

The most recent prevalence data for hepatitis B virus (HBV) infection in Romania came from an ESEN 2 study (2002), and from a Romanian population-based study performed in 2008. Most of the previous studies were regional and performed in specific groups (blood donors, pregnant women, institutionalized people, etc) and had limited representativeness at the national level, both for HBV and hepatitis C virus (HCV) infection. The scarcity of prevalence data for HBV and HCV infection coming from the routine surveillance was also considered. The aim of our study was to obtain overall and age group specific estimates of the prevalence of HBV and HCV infections markers in Romania, in order to recommend evidence-based public health interventions. The main outcome was the proportion of persons with HBV, HCV and HBV+HCV infection markers, overall and by age group and gender. Our seroprevalence study ensured national representativeness for the targeted hospitalized population. A prospective collection of serum samples in hospital laboratories was completed between September and November 2013, using a systematic sampling. The study respected the confidentiality of personal data. We calculated the sample size using EpiInfo7 and used Z test - Two-tailed probability for statistical significance. The overall prevalence data estimated in our study were HBc Ab 28%, HBs Ag 4.2%, HBs Ab regardless of titer 64.1%, HBs Ab in titer of at least 10 mUI/ml and negative HBc Ab 17.5%; HCV Ab 5.6%; HBc Ab and HCV Ab 2.8%, as markers of double infection. The overall prevalence data estimated in our study for HBs Ag (4.2%) and HCV Ab (5.6%) correspond to a medium endemicity based on the WHO criteria. The estimated prevalence of HBV and HCV infection markers in the study population should represent an opportunity for a better national prevention and control strategy.

Glycogenosis: A Rare Etiology of Transaminitis

Hepatic glycogenosis is a rare etiology of elevated hepatic transaminases reported in the literature. Glycogenosis is associated with uncontrolled diabetes and can be confused with other forms of acute liver injury. This disease can be diagnosed via liver biopsy and reversed by ensuring tight glycemic control. Given this diagnosis is unrecognized but curable, we highlight a case of hepatic glycogenosis in a patient treated at our institution. Patient is a 24 year-old female with past medical history of depression and uncontrolled Diabetes Mellitus Type 1 with recurrent hospital admissions for Diabetic Ketoacidosis (DKA). She presented to the hospital with one day of nausea and vomiting; she was subsequently diagnosed with DKA, and admitted to the intensive care unit for further clinical care. The patient was initiated on fluids and insulin drip for DKA treatment and continued on her home regimen of duloxetine for depression management. Several days into her admission, the patient developed increases in aspartate transaminase (AST) and alanine transaminase (ALT), with initially normal then elevated alkaline phosphatase. Bilirubin and INR remained with normal limits. Over 10 days, lab values peaked with AST of 535, AST of 465, and alkaline phosphatase of 194. Initial serology including HBs Ag, HBc Ab, HCV Ab, CMV, EBV, HIV, ANA, AMA, antiSMA, and ferritin were negative. Given that there was no history of herbal intake or new hepatotoxic medications initiated, suspicion for drug induced liver injury was low, albeit remained on the differential. There were no episodes of hypotension or active infection throughout the admission. A right-upperquadrant ultrasound was performed with unremarkable findings. During previous admissions for DKA, there were similar acute instances of elevated liver-associated enzymes (Figure 1). Given concern of this recurrent transaminitis, a liver biopsy was pursued. Hematoxylin & eosin (H&E) staining revealed glycogen deposits with no hepatitis or fibrosis, convincing for a diagnosis of hepatic glycogenosis (Figure 2).Figure 1Figure 2Hepatic glycogenosis should be suspected in the appropriate clinical situation after other etiologies are ruled out. It is easily treatable with strict glycemic control. Given the reversibility of liver injury in these patients, raising awareness about an underreported and unrecognized disease is undoubtedly clinically significant in medical practice.

The prevalence of isolated hepatitis B core antibody and its related risk factors among male injected drug users in Isfahan prisons.

Background:The prevalence of isolated hepatitis B core antibody (anti-HBc) varies between 1% and 30% in different populations. Isolated anti-HBc-positive patients who suffer from occult hepatitis B virus (HBV) infection have the potential to transmit HBV infection. So isolated anti-HBc screening is a valuable tool to prevent HBV transmission. Considering the importance of isolated anti-HBc screening and high prevalence of HBV among injected drug users (IDU) prisoners, we designed this study to evaluate the isolated anti-HBc positivity among inmates with the history of IDU in our area.Materials and Methods:We did this cross-sectional study from September 2009 to March 2010 among volunteer male IDU prisoners in Isfahan. Blood samples were taken from all of subjects and tested for HBV markers. Then a questionnaire containing socio-demographic, drug histories and high risk behaviors information was completed for all participants. Data analysis was done utilizing univariate analysis and multiple logistic regressions. A P < 0.05 was considered significant.Results:Totally 970 male IDU prisoners (mean age 32.6 ± 8.1) were included in our study. The prevalence of isolated HBc Ab was 4.5%. Isolated anti-HBc significantly was related to tooth filling (OR: 2.62, CI: 1.20-7.14) and imprisonment (OR: 3.95, CI: 1.39-11.18). We couldn’t find any relationship between isolated anti-HBc positivity and addiction duration, incarceration frequency, recent incarceration duration or number of injection per month.Conclusion:For screening high risk groups in parallel with hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb) and other viral markers, maybe it is better to check HBcAb too, because isolated HBcAb-positive patients may have occult hepatitis B infection which could transfer the infection to others.

Hepatitis B virus (HBV) status of children born to HIV/HBV co‐infected women in a French hospital: a cross‐sectional study

IntroductionHuman Immunodeficiency Virus (HIV) Mother-To-Child-Transmission (MTCT) and prevention by combined antiretroviral therapy (cART) have been extensively studied. Hepatitis B Virus (HBV) MTCT from HIV/HBV co-infected women and prevention by antiretroviral therapy with dual activity have been poorly studied. The aim of the study was to assess HBV MTCT from HIV/HBV co-infected women in a developed country with a large access to cART.Materials and MethodsHIV/HBV co-infected pregnant women attending the Obstetrics Department from 1st January 2000 to 1st January 2012 could be included in the study (NCT02044068). Antiretroviral therapy during pregnancy, injection of immunoglobulin and/or vaccine to newborns was retrospectively recorded. We assessed HBV status of children at least as old as two years.ResultsForty nine (9.2%) from 530 HIV-infected women followed in the hospital were HIV/HBV co-infected. 34 (69.4%) had given birth to 57 children in the hospital. 13 of these women (22 children) were lost-to-follow-up, 21 women (35 children) could be studied. Twenty six children (74.3%) had HBs Ab at a protective level, 22 of them had received immunoglobulin at birth; 24 had received a complete vaccine schedule during the first six months of life (with immunoglobulin in 21 cases). The women had been given lamivudine or tenofovir/emtricitabine during eight and nine pregnancies respectively. Eight children (22.8%) were tested negative for HBs Ag, HBs Ab and HBc Ab: 4 (11.4%) had received immunoglobulin and a complete vaccine schedule; in two children, immunoglobulin was uncertain; in one child, the vaccine schedule was incomplete; in the last one, data about immunoglobulin and the vaccine schedule were lacking. The women had been given lamivudine or tenofovir/emtricitabine during five and two pregnancies respectively. One child had HBc Ab and HBs Ab, immunoglobulin was uncertain and the vaccine schedule was incomplete. The woman had been given lamivudine during the last trimester.ConclusionsThree quarters of the children were protected. HBs Ab were negative in more than a tenth of the children who had received immunoglobulin and a complete vaccine schedule, questioning on long-term protection and underlining the need of control.

Transient Hepatitis B Surface Antigenemia Due to Recent Vaccination

Introduction: Hepatitis B virus (HBV) vaccination can produce a transiently detectable level of hepatitis B surface antigen (HBsAg), which may be misdiagnosed as prior exposure to HBV. This phenomenon is not widely recognized by gastroenterologists, leading to unnecessary testing. A 71-year-old male with end-stage renal disease on peritoneal dialysis was referred to the hepatology clinic for further investigation when routine evaluation for kidney transplant showed positive HBsAg. He received the HBV vaccine 5 days prior to his positive blood test. He has history of blood transfusion in 1988, but no history of tattoos, IVDU, or other risk factors for acquiring HBV infection. No previous history of liver disease, and his HBsAg was negative one year prior to his presentation to our clinic. He was asymptomatic and denied abdominal pain, jaundice, fever, change in urine or stool color, or nausea/vomiting. On examination, vital signs were stable with no other findings except the presence of left -sided abdominal wall peritoneal dialysis catheter in place. Initial blood tests (5 days post-vaccination) showed positive HBsAg, but HBc Ab and HBsAb were negative. INR, total bilirubin, AST, and ALT were within normal limits. Albumin was low: 2.9 (due to chronic kidney disease). Repeat testing for HBsAg, HBsAb, hepatitis B E antigen, and hepatitis B DNA (28 days post vaccination), all returned negative. The positive HBsAg could be a transient phenomenon related to recent hepatitis B vaccination (usually within 14 days post vaccine). Caution should be exercised when interpreting HBsAg seropositivity within 4 weeks of HBV immunization. Our case highlights the importance of clinical awareness of recent HBV vaccination as the cause of false positive HBsAg test.

The Importance of Occult Hepatitis B Infection Screening in Pre-Transplant Evaluation

Implication for health policy/practice/research/medical education: This paper argues the importance of occult hepatitis B infection screening in pre-transplant evaluation. It is applicable for those in the field of organ transplantation. Copyright © 2014, NewPub; Published by Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Occult hepatitis B virus infection (OHB) is defined based on the existence of hepatitis B virus (HBV) DNA in liver tissue or serum of the patients, in spite of negative antibody test result for hepatitis B surface antigen (1). Most of these patients have positive hepatitis B core antibody (HBc Ab) test result as the evidence of past HBV infection. Ramezani et al. recommended the evaluation of HBc Ab in hemodialysis patients for detection of OHB (2). There might be low titer of HBc Ab in minority of OHB patients due to immunosuppression. In the other word, all serological Ab panels for HBV might be negative in OHB setting. Searching for HBV DNA in serum is promising for determination of OHB in the immune deficiency state. However, this method could not be recommended in the routine screening due to its high expense. Therefore, defining the best diagnostic strategy for detection of OHB seems to be challenging in particular subgroups of patients. Although the precise clinical manifestations and pathogenesis of OHB are not clear, it is considered as a probable source of HBV infection via blood transfusion, hemodialysis, and organ transplantation. Reactivation of OHB in the post-transplantation phase could be fatal. It is wise to improve the yield of diagnostic tool for OHB screening in the pre-transplant phase to lower the liver-related morbidity and mortality in the transplant candidates. The important issues on OHB are the aggravation of chronic liver damage and concomitant fibrosis (3). Some studies showed that this condition causes progression of cirrhosis and development of hepatocellular carcinoma in chronic liver disease (4) OHB lowers the virologic response in hepatitis C infection (5) Song et al. declared that HBV transmission could occur via transfusion, hemodialysis, and organ transplantation (1). Considering the possibility of HBV reactivation, they suggested the screening of OBI in the post-transplantation phase. Furthermore, they mentioned the need for antiviral therapy in HBsAg-negative transplanted patients who are anti-HBc positive, to prevent the reactivation of HBV infection. HBV recurrence has occurred even two years after discontinuation of the immunosuppression (6). Fontenele et al. issued the role of OHB screening in hemodialysis patients to prevent the transmission of HBV and the consequent liver cell damage (7). Based on the current evidence, it seems reasonable to screen for OHB in the pre-transplantation phase and follow the patient carefully for early detection of OHB relapse. HBc Ab test is a practical screening method for OHB and is a surrogate marker of previous HBV infection in the immune competent patients. HBV DNA assay is an accepted alternative for OHB screening in the immunosuppressed individuals whose HBc Ab is in a low detectable titer.

Untreated highly viraemic pregnant women from Asia or sub‐Saharan Africa often transmit hepatitis B virus despite serovaccination to newborns

Mother-to-child (MTC) hepatitis B virus (HBV) transmission has been mainly studied in Asia. The geographical origins of women and HBV genotypes differ in Europe. The aims were to determine the rate and risk factors of MTC HBV transmission from women with high HBV DNA loads in a maternity hospital in Paris, France. Retrospective study of HIV-negative, HBs Ag-positive pregnant women with HBV DNA loads above 5 Log10 I.U/ml who were not given lamivudine or tenofovirDF during pregnancy between 2004 and 2011. Among 11 417 pregnant women, 437 (4%) showed a positive HBs Ag. Among these women, 52 had HBV DNA loads above 5 Log10 I.U/ml: 41, 10 and 1 born in Asia, sub-Saharan Africa and Europe respectively. Among the 52 women, 40 were eligible for the analysis: no antiviral therapy during pregnancy; children over 9 months old. Twenty-eight (70%) women were assessed, corresponding to 41 childbirths. Eleven children (27%) had positive HBs Ag, 14 (34%) had positive HBc and HBs Ab, 16 (39%) had positive HBs Ab only. The risk of having positive HBs Ag, according to maternal HBV DNA loads, was 14% for HBV DNA loads less or equal to 8 Log10 I.U/ml, 42% for HBV DNA loads over 8 Log10 I.U/ml, P = 0.04, but not related to the women's origin, HBV genotype. This study confirms that serovaccination does not fully protect newborns from MTC HBV transmission, when maternal HBV DNA loads exceed 5 Log10 I.U/ml, regardless of the women's origin or HBV genotype.

P3.216 HIV and Viral Hepatitis (B,D,C) Co-Infection, Genotyping, Epidemiological Profile in West of Tehran

Background/AimsIn HIV infected patients, HBV, HDV and HCV co-infections have important implications for their clinical course and therapeutic management. There is intermediate prevalence of HBV and low prevalence of HIV...

Outcome of Intravenous Immunoglobulin-Transmitted HTLV-I, Hepatitis B, Hepatitis C, and HIV infections.

Since each unit of Intravenous Immunoglobulin (IVIG) is obtained from different blood donors, blood-borne viral diseases is of high importance. We aimed at investigating the prevalence of various viral infections: Human T-cell Lymphotropic Virus Type 1 (HTLV-I), Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV) among patients referred for IVIG therapy section in Mashhad University of Medical Sciences, Mashhad, Iran. A prospective study was conducted on 130 IVIG recipients admitted to different wards of our Medical Centre: Immunology, Hematology, and Neurology, in 2010. After filling the informed consent form, a 5 cc blood sample was initially taken from each patient. Viral infections including HTLV-I Ab, HIV-Ab, HBsAg, HBc-Ab, and HBV-Ab were assessed using the ELISA technique before and after six three months treatment. Test results for HTLV-I Ab, HBsAg, HBc Ab, HIV Ab, and HCV Ab were negative in all cases before IVIG therapy. After receiving IVIG, two female cases with CIDP showed positive results for HBV Ab (0.8%) and HBS Ag (0.8%) with ELISA and only one patient confirmed with PCR. There was not any significant relation between HBV Ag (P=0.14) and HBC Ab with type of disorder (P=0.66). This study showed that HTLV-I viral replication and the other investigated viral transmissions do not occur in plasma; therefore, the IVIG products are safe.

Serology for Hepatitis B Virus Inhemodialysis Patients: What is Necessary?

Aim: This was a quality improvement study to evaluate immune status for Hepatitis B virus (HBV) in patients on Hemodialysis (HD) and to improve vaccination rates in these patients. Methods: A prospective quality control study aimed at assuring adequate immunity for HBV in HD patients. Fifty-nine patients on HD were included during two-month study period. The inclusion criteria are all in patients with renal failure requiring HD. The following serologies were checked: HBs Ag, HBs Ab titer, and HBc Ab total. Serum samples were tested using Enzyme linked immunosorbent assay (ELISA) methods. Vaccination was offered to all patients with no evidence of protective Hepatitis B antibody (HBsAb titer) that is titer 10). We also found 6 patients with Hepatitis C virus antibody (HCV Ab) positive. Conclusion: HBV is the leading cause of blood-borne transmission particularly in inpatient HD units. Monitoring HBV serology (HBs Ag, HBs Ab, HBc Ab) on a routine basis is essential to prevent HBV outbreaks within HD units. Monitoring HBs Ag alone is insufficient and should be coupled with additional serology to ensure adequate protection for this particularly vulnerable population. Initiation of early vaccination in patients with DM, chronic kidney disease (CKD), especially in inpatient facilities will ensure better protection.

The Use of Partial Thickness Skin Allograft as a Temporary Biologic Dressing of Burns

Introduction: Burns are a major global cause of disability and death. Some of the patients need to hospitalize and costs of burn care are high. Biological dressings play an important role in treatment of severe burns. They decrease the number of post-operation dressing ‘using analgesics’ mortality and morbidity rate. The partial thickness skin allograft is an excellent source for treatment of burn wounds. Skin preservation unit of Iranian Tissue Bank (I.T.B) provided, processed and stored allograft skin samples from cadavers. This study aims to evaluate I.T.B skin allograft using in deep dermal burn patients as a temporary wound dressing. Material and method: After screening healthy donor with age limitations (6months to 60 yrs) and getting informed consent from their families. The blood samples of cadavers were screened serologically for HIV (HIV1,2 Ab), Hepatitis B virus(HBS Ag), Hepatitis c virus(HBC Ab),RPR for syphilis, human t-lymphotrophic virus(HTLV1,2 Ab) and multiple cultures were done for microbiological safety. After ensuring the safety of donor skin. It was harvested at a depth of 0.4 mm by an electrical dermatome. Lower limbs, back and buttock were mainly areas for skin retrieval. The harvesting skin placed in a sterile container, filled by transport medium supplemented with an antibiotics mixture and transported to processing unit in an ice box. In Iranian tissue bank, after tissue processing and ensuring tissue safety by quality control unit, we used freeze drying and finally packaged skin sterile with Gamma irradiation. Freeze dried skin (in meshed form) was grafted in 10 patients volunteer with deep dermal burn with limited autograft for understanding the efficacy of I.T.B freeze dried partial thickness skin allograft. Result: The mean age of these 10 patients was (30.7±6.2). Male to female ratio was 6/4. Burn cause of the patients was fire. Mean TBSA of patient was (42.9%±16.6%). Mean skin allograft usage was 10-20%. Total time of hospital stay duration for these patients was (32.3±26.5), and mean of hospital stay duration after allograft used were 20 days. We noticed a good vascularisation in graft areas and reduced pain after using it. One patient died after operation because of pulmonary emboli and sepsis. Conclusion: The result of this investigation shows that freeze dried split thickness skin allograft in Iranian Tissue Bank, is appropriate alternative for temporary wound dressing. We conclude that infection, length of hospital stay, pain, the number of burn dressing and mortality rate is reduced after I.T.B skin allograft.

Immune Response to Hepatitis B Vaccine in Health-Care Workers

Health care workers (HCWs) constitute a high-risk population of HBV infection. There are limited data on the efficacy of vaccination in HCWs in Egypt. The aim of this study was to evaluate the immune response to hepatitis B recombinant vaccine in HCWs in our hospital. Methods: 100 HCWs who completed three doses of intramuscular immunization with recombinant DNA hepatitis B vaccine (Engerix-B) at different time periods during the last 5 years were examined for hepatitis B surface antigen (HBs Ag), anti hepatitis B surface antibodies (anti HBs Abs) and hepatitis B core antibodies (HBc Abs). Results: 96% of HCWs showed seroconversion (anti HBs ≥ 10 IU/L); 92% good responders (anti HBs > 100 IU/L) and 4% weak responders (anti HBs = 10-100 IU/L). The HBsAg and HBc Ab were never detected among the entire responders. Younger age had higher anti HBs titer than older HCWs. The non responders were 4%; two of them had evidence of chronic hepatitis B infection. Conclusion: Vaccination against HBV in HCWs in Egypt is cost effective and achieved good response rate. Screening for Hepatitis B infection before vaccination should be considered to detect those with undiagnosed infection.

Immune Response to Hepatitis B Vaccine in Health-Care Workers

Health care workers (HCWs) constitute a high-risk population of HBV infection. There are limited data on the efficacy of vaccination in HCWs in Egypt. The aim of this study was to evaluate the immune response to hepatitis B recombinant vaccine in HCWs in our hospital. Methods: 100 HCWs who completed three doses of intramuscular immunization with recombinant DNA hepatitis B vaccine (Engerix-B) at different time periods during the last 5 years were examined for hepatitis B surface antigen (HBs Ag), anti hepatitis B surface antibodies (anti HBs Abs) and hepatitis B core antibodies (HBc Abs). Results: 96% of HCWs showed seroconversion (anti HBs ≥ 10 IU/L); 92% good responders (anti HBs > 100 IU/L) and 4% weak responders (anti HBs = 10-100 IU/L). The HBsAg and HBc Ab were never detected among the entire responders. Younger age had higher anti HBs titer than older HCWs. The non responders were 4%; two of them had evidence of chronic hepatitis B infection. Conclusion: Vaccination against HBV in HCWs in Egypt is cost effective and achieved good response rate. Screening for Hepatitis B infection before vaccination should be considered to detect those with undiagnosed infection.

Study of autoantibodies in Egyptian non-B,non-C chronic hepatitis patients

Background and study aim : Autoimmune hepatitis (AIH) is a curable disease that is under studied in our locality in Egypt and it's role in causation of chronic liver disease is not well studied. This work aimed at evaluation of the pattern and clinical importance of an array of auto-antibodies in non-B, non-C chronic hepatitis Egyptian patients and to detect the prevalence and feature of autoimmune liver diseases (AILDs) in our locality and evaluate other causes of chronic non-B, non-C hepatitis in our patients. Patients and methods : Between January 2007 to September 2009, 50 Egyptian patients with non-B non-C chronic hepatitis were enrolled in this study (18 males and 32 females). All patients were subjected to the following : full history taking, through clinical examination, viral markers (HBsAg, Anti-HCV, HBC Ab), liver function tests, serum protein electrophoresis, abdominal ultrasonographic examination, fine needle liver biopsy and histopathology examination and tests for autoimmune antibodies ( ANA, ASMA, ALKM-I and AMA) and measuring their titer. Results : Most patients were middle-age females (27.72+12.1) and the most common auto-antibodies detected in patients group were ANA (48%) followed by ASMA (44%), ALKM-1 (24%) and AMA (20%) .Out of the 50 patients; 32 patients (64%) were diagnosed as AILDs and 16 patients (32%) were diagnosed as autoimmune hepatitis (AIH), most of them (10 patients) were classified as type I AIH (with ANA and/or ASM), 2 patients (4%) were classified as type II AIH (with LKM-1) and 4 patients (8%) could not been classified on the basis of routine antibodies profile . 16 patients (32%) were diagnosed as overlap syndrome (AIH with cholestatic feature with or without AMA positive sera). Conclusion : The present study concluded that the distribution of autoantibodies in different group of patients revealed the difficulty to endorse the subclassification of patients of AIH depending on autoantibodies profiles. The role of AIH needs more studies in our locality as it's one of the curable liver diseases.

English

&nbsp; Hepatitis D is the important complication in cirrhotic patients. Diagnosis of hepatitis D is based on detection of HBSAg and HDV Ab titer determination. The present research was performed on a number of cirrhotic patients with the aim to assess the prevalence of hepatitis D and B. In present study all the cirrhotic patients who were referred to Gastroenterology and Endoscopy ward of Imam Khomeini hospital during a period of 18 months were included. The level of anti HDV Ab, anti HBS Ab and HBS Ag were determined by method of ELISA (Pishtaz Teb). In this study 60 cirrhotic patients were evaluated. 16 patients were HBS Ag positive with mean age of 51.9 years, and from this group, 13 patients were anti HBC positive with mean age of 53.23 years and from this group, 8 patients were HDV Ab positive with mean age of 49 years. Hepatitis D remains as one of the problems in developing countries. By timely screening of cirrhotic patients for HDV, patients could undergo additional treatments. &nbsp; Key words:&nbsp;Liver cirrhosis, hepatitis D, hepatitis B, HBS Ag, HBC Ab, HDV Ab.