IntroductionHepatitis B virus (HBV) infection is a global issue affecting 2 billion people in the world, with 360 million chronic carriers of hepatitis B surface antigen (HBsAg). 1 The prevalence of HBV is estimated to be 6.7% among the general population in Egypt. 2 Although it has been widely accepted that genotype D is the most prevalent among Egyptians, genotype C was recently detected Background: The remarkable effectiveness of universal infantile hepatitis B (HB) vaccination is well documented in many countries. Nevertheless, the influence of insulin-dependent diabetes mellitus (IDDM) on the sero-protective level of antibody to hepatitis B surface antigen (anti-HBs) after HB vaccination has not been investigated in egyptian children. The aim of this study was to investigate long-term anti-HBs sero-protective levels after infantile HB vaccination in egyptian IDDM children.Results: The mean age of the healthy children was 10.86 ± 1.21 y (range, 5.5-15 y); 49 (45.8%) were boys and 58 (54.2%) were girls. The mean age of the IDDM children was 10.29 ± 3.04 y (range, 4-17 y); 32 (50.8%) were boys and 31 (49.2%) were girls. There were no significant differences between the healthy and IDDM children with respect to age and sex (p > 0.05). among the 107 healthy children, 43 (40%) did not have a protective anti-HBs level (anti-HBs < 10 IU/L) and 64 (60%) had a protective level (anti-HBs ≥ 10 IU/L). In contrast, among the IDDM children, 44 (69.8%) and 19 (30.2%) did not and did have protective anti-HBs levels, respectively. This difference in anti-HBs concentration between healthy and diabetic children was highly significant (p < 0.001). None of the vaccinated healthy or IDDM children was reactive to HBsag or total anti-HBc.Patients and Methods: a total of 170 children (81 boys, 89 girls) who had been routinely vaccinated against HB were included. Their mean age was 10 ± 2.1 y. The enrolled children were divided into healthy (n = 107) and IDDM (n = 63) cohorts. Body Mass Index and levels of hepatitis B surface antigen (HBsag), total antibody to hepatitis B core antigen (anti-HBc), and anti-HBs were evaluated in all children. In addition, the duration of diabetes mellitus (DM) and levels of glycated hemoglobin (Hba1c) were measured in IDDM children.Conclusion: Our results are alarming. It appears that the majority of egyptian diabetic children vaccinated against HB may not have sufficient anti-HBs levels to protect them from HB. Moreover, this study emphasizes the need for a population-based strategy for the management of patients without an anti-HBs protective level after HB vaccination and justifies the need to elucidate the heritability of those children.

Background and Objectives: Health Care Workers (HCWs) are at a high risk of needle stick injuries and HBV infection in Egypt; this problem is further aggravated by low Hepatitis B (HB) vaccination coverage. Limited data are available on the prevalence of HBV infection in Egyptian HCWs. In this study, we aimed to assess the HBV infection rate and genotypes among Egyptian HCWs. Methods: Five hundred and sixty-four (564) HCWs were included. Of them, 258 (45.74%) were health care providers and 306 (54.25%) were non-health care providers. All HCWs completed both the study questionnaires and provided a blood sample for HBV testing. Indeed, all HCWs were tested for Hepatitis B surface antigen (HBsAg) and antibody to Hepatitis B core antigen (anti-HBc), by enzyme-linked immunosorbent assay. HBVDNA was checked for HCWs who tested positive for HBsAg and/or anti-HBc, by nested Polymerase Chain Reaction (PCR). HBVDNA positive HCWs were further subjected to HBV genotyping. Results: The mean age of included HCWs was 33.0 ± 9.8 years, of whom 319 (56.56%) were males. The mean duration of health care work was 9.3 ± 6.7 years. The frequency of HBsAg and anti-HBc were 1.4%, and 24.5%, respectively. Old age and prolonged duration of health care work were significantly associated with anti-HBc seropositivity. Among 140 HCWs positive for HBsAg and/or anti-HBc, 14 (10 %) had positive HBVDNA by PCR. HBV/E (n = 7), HBV/D (n = 3) and co-infection with E and D (n = 4) genotypes were detected. Conclusion: Egyptian HCWs have a significantly high rate of HBV exposure. The detection of HBV/E genotype among Egyptian HCWs suggests prevalent transmission of HBV/E among Egyptian populations.

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We tested the frequency of occult hepatitis B infection (OBI) among Egyptian healthcare workers (HCWs). We tested 132 HCWs for hepatitis B virus (HBV) DNA by nested polymerase chain reaction (PCR), and hepatitis C virus antibody (anti-HCV) by ELISA. HCV RNA was measured by nested PCR in anti-HCV-positive HCWs. HBV-DNA-positive HCWs were subjected to HBV genotyping. We included 132 HCWs who were negative for hepatitis B surface antigen and positive for hepatitis B core antibody (anti-HBc). OBI was detected in 7 male HCWs, and HBV E genotype was detected in 3, HBV D in 2 and HBV D and E in 2. Two OBI-positive HCWs had a history of neonatal hepatitis B vaccination. Anti-HCV seropositivity was detected in 17 HCWs who were positive for anti-HBc; 15 of whom were positive for HCV RNA by nested PCR. HCV infection was confirmed by anti-HCV and HCV RNA in 1 of 7 HCWs with OBI. In conclusion, Egyptian HCWs have a significant rate of OBI and HBV E genotype is prevalent. ‫مرص‬

Background and Objectives: Studies on hepatitis C virus (HCV) in Egypt supported a strong role for various exposures in the health-care setting. In this study, we attempted to estimate the frequency of HCV exposure among Egyptian health-care workers (HCWs). Methods: Five hundred and sixty-four (564) HCWs were included in this study. Two hundred and fifty-eight (45.74%) were health-care providers and 306 (54.25%) were non-health-care providers. All HCWs completed both the study questionnaire and provided a blood sample for anti-HCV testing by third-generation enzyme-linked immunosorbent assay. Subsequently, anti-HCVpositive samples were tested for HCV RNA using nested polymerase chain reaction (PCR). Results: The mean age of included HCWs was 33.0 ± 9.8 years; of them, 319 (56.56%) were males and 245 (43.44%) were females. The mean duration of health-care work was 9.3 ± 6.7 years. The frequency of antibody against hepatitis C virus (anti-HCV) among included HCWs was 8.7% (n = 49). Old age and prolonged duration of health-care work were significantly associated with anti-HCV seropositivity. Forty (81.63%) of 49 with anti-HCV-positive HCWs had positive hepatitis C viremia. The frequency of HCV RNA positivity increased with age. The frequency of eradicated past infection among nurses (36.85%) was markedly higher than that (6.7%) detected in non-health-care providers. Conclusion: High rate of HCV infection is detected in Egyptian HCWs in rural Lower Egypt governorates. Health-care providers seem to eradicate HCV infection more frequently than non-health-care providers. National screening and treatment of infected HCWs are recommended.

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Background: Early promotion of hepatitis B (HB) vaccination among health care workers is an important component of the HBV infection control. No available data assess immune response of HB vaccination among Egyptian medical students. Objective: we conducted this study to evaluate the immune response among medical students after completion of their vaccination schedule. Methods: A total of 150 Egyptian medical students were included. Three doses of recombinant HB vaccine had been administered to all participating students at 0, 1 and 6 months. Antibody to hepatitis B surface antigen (Anti-HBs) titers, hepatitis B surface antigen (HBsAg), and total antibody to hepatitis B core antigen (anti-HBc) were measured by enzyme immunoassay, 1 to 2 months after completion of vaccination course. Results: Among 150 students included, the mean age was 22.4 ± 1.7 years (range 18-28 years). Fifty nine (39.4%) were males and 91 (60.6%) were females. All students have anti-HBs levels more than 100 IU/L. The mean anti-HBs of included students was 8994.2 ± 6373.1 IU/L. There was no significant difference of anti-HBs levels regarding age, sex, residence or body mass index distribution. Conclusion: Early HB vaccination of health care workers is associated with good immune response and should be encouraged.

Background:The efficacy and safety of Obinutuzumab (G), in combination with chlorambucil (Clb-G) in patients with treatment-naïve chronic lymphocytic leukemia (CLL) and comorbidities was demonstrated in the CLL11 study by improved progression-free survival and overall survival compared with Clb plus rituximab (R) or Clb alone, leading to the FDA approval for its use in combination with Clb in patients with previously untreated CLL in 2013. Nevertheless, the Clb dose used in CLL11 was lower than the other European experiences of its use in associations with Rituximab, and, moreover, has emerged that the infusion of G was burdened by a high incidence of infusion-related reactions (IRRs). IRRs are among the worst complications of the frontline G-Clb treatment to deal with in urgency, complicating collectively up to 87% of the infusions (67% grade 1-2, 20% grade 3-4); reducing the disease burden before the administration of G could be a solution to prevent the occurrence of these adverse events (AE). Aims: Given the previous experience of our group, we used, in the same setting of patients as the CLL11, an increased dose of Clb in association with G, looking at safety and response. Methods: We retrospectively analysed a pilot cohort of ten untreated CLL patients (median age 73 years) with comorbidities, treated with G-Clb regimen. Chlorambucil 1 mg/Kg every 28 days was administered at a standard daily dose of 10 mg for 8 cycles, with 2 cycles of purging before the start of the G administration. Obinutuzumab was infused intravenously from the third cycle onwards according to the manufacturer. An independent-samples t-test was conducted to compare complete blood counts (CBCs) before and after the first 2 cycles of Clb. Results: At 2 months after the end of the therapy (median observation time of 10 months) the overall response rate (ORR) was 80%, with the partial responses (PR) accounting for the 60% and the complete responses (CR) for the remaining 20%. In the safety analysis, grade 3 or 4 treatment-emergent AE occurred in 50% of patients; most common were neutropenia (30%), thrombocytopenia (20%), infections (20%) and anaemia (10%). Three patients experienced grade 1-2 IRR (30%), but no grade 3-4 IRRs or clinical TLS have been detected in our cohort. One patient was hospitalized for AE (spondylodiscitis). When comparing CBCs before and after the first 2 cycles of Clb, we observed a statistically significant reduction of peripheral white blood cells and lymphocytes from a mean of 58900/mmc to 20270/mmc and 50310/mmc to 15710/mmc respectively (p = 0.034), while no significant differences were detected in haemoglobin levels, neutrophil or platelets counts. Two patients had to permanently cease treatment for AEs (pulmonary toxicity and spondylodiscitis). Two patients needed a dose reduction of Clb, and 1 both G and Clb. Median dose of Clb was 520 mg for each patient (210-640 mg) with median Clb of 78 mg for each cycle. Summary/Conclusion: Our real-life pilot analysis confirmed that the use of a Clb purging regimen is a v...