We aimed to investigate
gene expression pattern and to explore its methylation heterogeneity in chronic lymphocytic leukemia (CLL).
Eighty one CLL patients and 75 healthy subjects were enrolled and ...prognostic evaluation of patients was assessed.
q-realtime PCR was performed using Applied Biosystems, TaqMan gene expression assay.
gene-specific CpG methylation was investigated in real time using pyrosequencing technology.
was differentially expressed in CLL patients. The CpG sites-1, 2 and 3 showed significantly higher mean levels than healthy controls (p = <0.001, 0.007 and 0.009). Significant association between CpG site-1 and CLL has been detected using age-adjusted logistic regression (p < 0.001).
Hypermethylation at
gene CpG sites (1,2,3) is a characteristic feature in CLL.
Introduction
The most common genetic risk factor for rheumatoid arthritis (RA) is human leucocyte antigen DRB1 (HLA‐DRB1) shared epitope (SE).
Aim
To investigate the relationship between anti‐cyclic ...citrullinated peptide (anti‐CCP), rheumatoid factor (RF), immunoglobulin (Ig)G, IgM and IgA and HLA‐DRB1 SE among Egyptian patients with RA.
Methods
Serum levels of anti‐CCP antibodies and RFIgG, RFIgM, RFIgA were assayed using enzyme‐linked immunosorbent assay for 157 Egyptian RA patients and 150 healthy controls attending the outpatient clinics of National Research Center and Kasr El Aini Hospital. HLA‐DRB1 genotyping was performed by the DynalAllSetTM polymerase chain reaction (PCR) single specific primer low‐resolution typing kits. Amplified PCR product was checked using 3% agarose gel.
Results
HLA‐DRB1‐SE was found among 129 (82.2%) RA patients and 67 (44.7%) controls (odds ratio OR 5.7, CI 3.4‐9.6, P < .0001). The risk of RA development was higher with the presence of SE two alleles (OR 11.6, P < .0001), while the OR for 1 copy SE allele was 4.4 (P < .0001). HLA‐DRB1‐SE was significantly associated with positive as well as negative anti‐CCP and RF isotypes. The stronger association was with anti‐CCP positivity with OR 11 (5.1‐23.6), P < .0001. Furthermore, the risk of development of positive anti‐CCP and RF isotypes was higher with the presence of 2 copies of SE alleles than with 1 copy.
Conclusion
The prevalence of HLA‐DRB1‐SE is high in Egyptian RA patients. The role of SE in RA patients is most probably related to the development of anti‐CCP positive RA rather than the development of anti‐CCP positivity.
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
AIM: To assess prevalence and risk factors of circumcision among Egyptian children and to assess the risk factors for HBV infection among them.
METHODS: A nationwide community survey was carried out ...on 3306 children aged from 9 months to 16 years, of both genders. Data were collected during face to face interviews with the parents and children. All studied children had received HBV vaccination during infancy. Total anti-HBc and HBsAg were assessed by ELISA followed by HBV DNA detection for positive cases by Real-time PCR.
RESULTS: Prevalence of circumcision was 92.3% among boys and 29.7% among girls. The percentage of circumcised girls was significantly higher in rural (38.1%) than urban (21.1%), P<0.01 and more in Upper (42.2%) and Lower Egypt (27.6%) compared to Cairo, the Capital (14.1%), P˂0.001. Boys showed significantly higher prevalence of circumcision in urban (94.1%) compared to rural areas (90.1%), P˂ 0.001.The prevalence of HBV breakthrough infection, detected by HBV-DNA, was 14/3306 (0.42%). No significant differences between circumcised and non-circumcised boys and girls regarding the different serological tests of HBV infection, P > 0.05. Using logistic regression analysis, mothers’ illiteracy or having primary and preparatory education carried six times and 2 times risk respectively of having their daughter circumcised compared to higher education, P < 0.01. Living in Upper or Lower Egypt carried three times and 1.5 times risk respectively of having circumcised girl compared to the Capital, P < 0.001. HBV infection among family was the independent risk factor for HBV infection among girls and boys, in addition to frequent medical injection among boys, P < 0.05.
CONCLUSION: Circumcision among girls is still a problem especially in Upper Egypt and in rural areas. Child circumcision in Egypt seems not to play a role in HBV infection and intra-familial HBV transmission and frequent medical injection are the most important risk factors.
AIM:To identify blood donors with occult hepatitis B virus(HBV) infection(OBI) to promote safe blood donation.METHODS:Descriptive cross sectional study was conducted on 3167 blood donors negative for ...hepatitis B surface antigen(HBsAg),hepatitis C antibody(HCV Ab) and human immunodeficiency virus Ab.They were subjected to the detection of alanine aminotransferase(ALT) and aspartate transaminase(AST) and screening for anti-HBV core antibodies(total) by two different techniques;Monoliza antibodies to hepatitis B core(Anti-HBc) Plus-Bio-Rad and(ARC-HBc total-ABBOT).Positive samples were subjected to quantitative detection of antibodies to hepatitis B surface(anti-HBs)(ETI-AB-AUK-3,Dia Sorin-Italy).Serum anti-HBs titers > 10 IU/L was considered positive.Quantitative HBV DNA by real time polymerase chain reaction(PCR)(QIAGEN-Germany) with 3.8 IU/mL detection limit was estimated for blood units with negative serum anti-HBs and also for 32 whose anti-HBs serum titers were > 1000 IU/L.Also,265 recipients were included,34 of whom were followed up for 3-6 mo.Recipients were investigated for ALT and AST,HBV serological markers:HBsAg(ETI-MAK-4,Dia Sorin-Italy),anti-HBc,quantitative detection of anti-HBs and HBV-DNA.RESULTS:525/3167(16.6%) of blood units were positive for total anti-HBc,64% of those were antiHBs positive.Confirmation by ARCHITECT anti-HBc assay were carried out for 498/525 anti-HBc positive samples,where 451(90.6%) confirmed positive.Reactivity for anti-HBc was considered confirmed only if two positive results were obtained for each sample,giving an overall prevalence of 451/3167(14.2%) for total anti-HBc.HBV DNA was quantified by real time PCR in 52/303(17.2%) of anti-HBc positive blood donors(viral load range:5 to 3.5 x 105 IU/mL) with a median of 200 IU/mL(mean:1.8 x 104 ± 5.1 x 104 IU/mL).AntiHBc was the only marker in 68.6% of donors.Univariate and multivariate logistic analysis for identifying risk factors associated with anti-HBc and HBV-DNA positivity among blood donors showed that age above thirty and marriage were the most significant risk factors for prediction of anti-HBc positivity with AOR 1.8(1.4-2.4) and 1.4(1.0-1.9) respectively.Other risk factors as gender,history of blood transfusion,diabetes mellitus,frequent injections,tattooing,previous surgery,hospitalization,Bilharziasis or positive family history of HBV or HCV infections were not found to be associated with positive anti-HBc antibodies.Among anti-HBc positive blood donors,age below thirty was the most significant risk factor for prediction of HBV-DNA positivity with AOR 3.8(1.8-7.9).According to HBV-DNA concentration,positive samples were divided in two groups;group one with HBV-DNA ≥ 200 IU/mL(n = 27) and group two with HBV-DNA < 200 IU/mL(n = 26).No significant difference was detected between both groups as regards mean age,gender,liver enzymes or HBV markers.Serological profiles of all followed up blood recipients showed that,all were negative for the studied HBV markers.Also,HBV DNA was not detected among studied recipients,none developed post-transfusion hepatitis(PTH) and the clinical outcome was good.CONCLUSION:OBI is prevalent among blood donors.Nucleic acid amplification/HBV anti core screening should be considered for high risk recipients to eliminate risk of unsafe blood donation.
Mild cognitive impairment (MCI) is a stage between the expected cognitive decline of normal ageing and the serious decline of dementia.
To identify risk factors and role of miRNAs associated with ...mild cognitive impairment (MCI) among employees.
A cross-sectional study was carried out on 186 employees aged between 40 and 65 years. Cognitive function was evaluated using ACEIII, MoCA, and Quick cognitive tests. Medical history and lifestyle were assessed. Family 132 & 134 miRNA expressions were assessed by real-time PCR.
MCI was detected among 14 / 186 (7.5%). miRNA 132 expression was the only significant miRNAs to detect MCI with low sensitivity and specificity (70%). The logistic analysis revealed that higher miRNA132 expressions, low monthly intake of; vegetables, unroasted nuts, low education and higher ALT levels were predicting factors for MCI with AOR 1.1 (1.01-3.3), 1.2 (1.04-1.43), 0.8 (0.8-0.98), 2.7 (1.9-7.4) and 1.6 (1.1-2.3) respectively.
MiRNAs expression showed low sensitivity and specificity in detecting MCI; only miRNA 132 might be used. Several modifiable factors seem to reduce the risk of MCI.
The long-term protective effect of hepatitis B virus (HBV) vaccine and the need for booster dose vaccination remain doubtful. The study aimed to estimate the sero-protection rate and evaluate immune ...response to a booster dose in children and adolescents with complete HBV vaccination during infancy. According to study design, 902 children were recruited from 2 cities and 3 villages in Dakahleya Governorate by a cross-sectional study; 475 boys and 423 girls with age range 9 months to 16 years. All received the three doses of the compulsory HBV vaccination during infancy. Serum samples were tested for hepatitis B surface antigen (HBsAg) Hepatitis B core antibodies (total) (HBcAb) & quantitative detection of antibodies to hepatitis B surface antigen (anti-HBs) using ELISA. Positive samples for HBsAg/HBcAb were subjected to quantitative HBVDNA detection by real time polymerase chain reaction (PCR). Those proved to have non-seroprotective antibodies (anti-HBs titres < 10 IU/L) were given a booster dose and a blood sample was drawn one month later for evaluation. Results of HBcAb and DNA revealed that 4 children had HBV breakthrough infection (4/902, 0.4% and only one out of them was positive for HBsAg. Out of the 898 children, 57.7% demonstrated sero-protective titers of anti HBs (> or = 10 IU/L) with geometric mean titres (GMTs) of 68.5 +/- 3.5 LU/L. The number of those with non-seroprotective titers was significantly lower among children < 5 years (11.1%) compared to those > or = 10 years (64.8%, P < 0.05), while no significant difference was noticed as regards the gender at any age group. Multivariate logistic analysis revealed that age was the only significant predictor variable for having non- seroprotective antibody level, with adjusted odds ratio (AOR) 4.2 & 14.1 among children aged 5-10 and older respectively compared to those aged < 5 years. About 92% of booster recipients developed anamnestic response. The GMTs of anti-HBs increased significantly. (189.4 +/- 12.3 IU/L), with no gender difference. Multivariate logistic analysis revealed that the pre-booster anti-HBs level < 3.3 IU/L was the only significant predictor variable for non responder to booster dose with AOR 6.6. It is concluded that in spite of the significant decline of level of antibodies over time yet, about half of the studied children have seroprotective level of antibodies after primary compulsory vaccination. Moreover, the developed anamnestic response among children with non-seroprotective level, confirms immunological memory that can outlast the presence of protective level of antibodies.
Objective: This study investigates the prevalence of occult hepatitis B virus (HBV) in children and adolescents with haematological diseases with or without hepatitis C virus (HCV) infection.
...Methods: Forty‐nine children with haematological disorders (median age 11.4 years) and 51 with haematological malignancies (median age 8 years) were enrolled. Sera were tested for HCV antibodies, HCV‐RNA nested reverse transcriptase polymerase chain reaction (PCR), HBV markers (HBsAg, anti‐HBcAb IgM and total, HBeAg) and HBV‐DNA (nested PCR for s, c and x regions).
Results: Anti‐HCV was detected among 40/49 (81.6%) children with haematological disorders (24/49; 49% HCV‐RNA positive) and 9/51 (17.6%) children with malignancies (12/51; 23.5% HCV‐RNA positive). HBV‐DNA was positive among 38%; positive c region in 33% (15/49 and 18/51 children with haematological disorders and malignancies respectively), s region in four leukaemics and x region in one leukaemic. Twenty‐one patients had occult HBV infection; one (2.6%) was HBeAg positive, four (19%) total HBcAb positive, 20 (95.2%) c region HBV‐DNA positive and one was s region positive (1/21; 4.8%). HCV‐RNA was the significant predictor for occult HBV (P<0.05), with an increased frequency of HBV‐DNA in the HBsAg negative (HCV‐RNA positive) (63.2%) compared with patients negative for HCV‐RNA (25%) (P=0.009).
Conclusion: Occult HBV infection is not uncommon in transfused immunocompromised children with chronic HCV infection. Nucleic acid amplification should be considered in screening donors as post‐transfusion hepatitis B viraemia may be substantial.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
To assess the long-term effectiveness of hepatitis B virus vaccine and the need for a booster dose among children who received three doses of vaccine during infancy in Red Sea Governorate.
A ...cross-sectional study was performed. Interviews with children (9 months to 16 years) and parents were done. Blood samples to assess Hepatitis B markers were tested. Children showing no seroprotection received a booster dose to assess their anamnestic response after four weeks and one year later.
None of the participants had evidence of chronic Hepatitis B. The seroprotection rate was 23.3% and it significantly decreased with age. Multivariate logistic analysis revealed that older age was the significant predicting variable for having no seroprotective level, while baseline anti-HBs level < 3.3 IU/L was the predicting variable for not developing early anamnestic response or loss of late anamnestic response.
Long-term immunity persists among children who received complete series of hepatitis B vaccination during infancy even in absence or reduction of anti-HBs over time. Therefore, a booster dose is not necessary to maintain immunity till the age of sixteen.
BACKGROUNDLiver disease is an important cause of morbidity and mortality among recipients of bone-marrow transplantation (BMT). The aim of this retrospective study was to determine the incidence, ...risk factors and clinical evolution of liver disease following allogeneic BMT.
METHODSA total of 103 patients (mean age 22.8 years (SD 10.9); 31.1% aged < 18 years; 66% males) transplanted in a single institution were enrolled. Data on donors and recipients were collected, including hematological disease, alanine transaminase, alkaline phosphatase, bilirubin, hepatitis B virus (HBV) and hepatitis C virus (HCV) markers (including HBV-DNA and HCV-RNA).
RESULTSFifty six of 103 patients died, with liver disease the main cause of death (27 of 56, 48%). Overall the incidence of liver failure attributed to hepatic graft-versus-host-disease (GVHD) was 22.3% (23 of 103; 74% HBV/HCV infected) and veno-occlusive disease (VOD) was 9.7% (10 of 103; 80% HBV/HCV infected). Fourteen patients had hepatitis reactivations (four hepatic GVHD and three VOD). Donors’ HCV-RNA status and serum bilirubin above 2 mg/dl were predictive of hepatic GVHD adjusted odds ratio (AOR) 11.1, 95% confidence interval (CI) 0.99–33.12; AOR 3.93, 95% CI 1.09–14.62; P < 0.05, respectively and an abnormal alkaline phosphatase could predict severe liver disease (AOR 2.78, 95% CI 1.01–7.54; P < 0.05). Development of severe liver disease (hepatic GVHD or VOD) was a significant predictor of mortality (AOR 4.57, 95% CI 1.09–20.32; P < 0.05) with a low probability of survival (19.3%, SD 7.9%) compared with those without liver disease (52.1%, SD 7.6%; log-rank P = 0.0003).
CONCLUSIONSHepatic GVHD is a common complication following BMT and an important cause of liver-related mortality. The high prevalence of HCV and HBV may have contributed to the outcome of hepatic GVHD and VOD. Therefore, antiviral therapy should be considered early to prevent relentless progression of liver disease.
Several studies showed that ST-segment elevation myocardial infarction (STEMI) patients with high body mass index (BMI) have better in-hospital outcomes.
This study examined the impact of waist ...circumference (WC) on the hospital outcome and coronary angiographic extent of STEMI patients.
We evaluated 142 consecutive patients with STEMI. Patients were classified into 2 groups according to WC. Group A (n=72) had increased WC (WC>88/102cm for women/men). Group B (n=70) had normal WC. A primary composite outcome of in-hospital mortality and cardiovascular complications namely heart failure, cardiogenic shock, serious arrhythmias, re-infarction, post infarction angina, a secondary outcome of in-hospital mortality and coronary angiographic findings were compared between the 2 groups.
Group A patients were significantly older, had a significantly higher prevalence of hypertension (HTN), diabetes mellitus (DM) and were significantly less likely to be smokers compared to group B. There was no statistically significant difference in the primary outcome between the 2 groups. WC as a categorical or as a continuous variable did not have any significant influence on the secondary outcome of in-hospital mortality even after adjustment for other predictors of death. Age was the only statistically significant predictor for mortality (p=0.01). Coronary angiography revealed no statistically significant difference in the number of diseased coronary vessels, number of coronary lesions or Gensini score between the 2 groups.
A high WC, had no favorable impact on in-hospital mortality, cardiovascular complications or coronary angiographic extent in STEMI patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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