Domanda in cui, avendo una tabella in testa, viene fuori da sola, scartando le opzioni: Opzione 1: L'infezione acuta sarebbe HBeAg + e ANTI-HBe - . Inoltre, l'ANTI-HBec sarebbe di tipo IgM (solo per quest'ultima informazione, dovremmo escluderla direttamente). Opzione 2: è quella corretta. Soddisfa tutte le caratteristiche. Opzione 3: il paziente vaccinato non può avere il DNA del virus (l'unica cosa positiva in un paziente vaccinato è il tipo AntiBs. IgG). Opzione 4: l'opzione che potrebbe offrire maggiori dubbi. Nel portatore asintomatico (portatore cronico/seroconvertito) la differenza è che non c'è DNA virale.

Domanda in cui, avendo una tabella in testa, viene fuori da sola, scartando le opzioni: Opzione 1: L'infezione acuta sarebbe HBeAg + e ANTI-HBe - . Inoltre, l'ANTI-HBec sarebbe di tipo IgM (solo per quest'ultima informazione, dovremmo escluderla direttamente). Opzione 2: [HIDDEN]. Soddisfa tutte le caratteristiche. Opzione 3: il paziente vaccinato non può avere il DNA del virus (l'unica cosa positiva in un paziente vaccinato è il tipo AntiBs. IgG). Opzione 4: l'opzione che potrebbe offrire maggiori dubbi. Nel portatore asintomatico (portatore cronico/seroconvertito) la differenza è che non c'è DNA virale.

Indicare la situazione clinica in relazione all'infezione da virus dell'epatite B in un paziente di 5 anni proveniente dalla Nigeria con un esame fisico normale e la seguente sierologia per l'epatite B: HBsAg + / ANTI- HBs - / HBeAg - / ANTI- Hbe + / ANTI- Hbc IgM - / ANTI- Hbc IgG +/ DNA HBV +:

Hepatitis B

Shortly after the appearance of the HBsAg, another antigen called e antigen (HBeAg) will appear. Traditionally, the presence of HBeAg in a host's serum is associated with much higher rates of viral replication and enhanced infectivity; however, variants of the virus do not produce the 'e' antigen, so this rule does not always hold true. During the natural course of an infection, the HBeAg may be cleared, and antibodies to the 'e' antigen (anti-HBe) will arise immediately afterwards. This conversion is usually associated with a dramatic decline in viral replication. If the host is able to clear the infection, eventually the HBsAg will become undetectable and will be followed by IgG antibodies to the surface antigen and core antigen (anti-HBs and anti HBc IgG). The time between the removal of the HBsAg and the appearance of anti-HBs is called the window period. A person negative for HBsAg but positive for anti-HBs either has cleared an infection or has been vaccinated previously.

Hepatitis B -- Evaluation -- Interpretation of Serologic Markers

Following serologic markers are often tested: Hepatitis B surface antigen (HBsAg), antibody to Hepatitis B surface antigen (anti-HBs), Hepatitis B core Ab (Anti-HBc) IgM, Hepatitis B core Ab (Anti-HBc) IgG, Hepatitis B e antigen (HBeAg), and Hepatitis B e antibody (anti-HBe). [10] HBsAg: Acute infection (less than 6 months) or chronic infection (more than 6 months). Anti-HBs: Recovery from acute infection or immunity from vaccination. HBeAg: Mostly associated with high viral load. Anti-HBe: Low replicative phase. Anti-HBc IgM: Acute infection, an only marker present in the window period, can be present during exacerbation of chronic infection. Anti-HBc IgG: Exposure to infection, chronic infection (if present along with HBsAg), recovery from acute infection (if present with anti-HBs), if isolated presence, may represent occult infection.

[The assessment of work ability in persons with hepatitis B and C].

A risk group for infection of virus hepatitis B (HBV) and C (HCV) makes health care professionals who contact with blood, and body fluid. The aim of this study was, on the base of markers of infection with hepatitis B and hepatitis C virus define criteria for evaluation work ability of the infected personnel. On the base of markers of HBV infection enabled identification of four groups infection persons with different work ability: 1) HBsAg-positive, anti-HBc-positive, HBcAg-positive, anti-HBc IgM-positive and HBV DNA-positive; 2) HBsAg-positive, anti-HBc-positive, HBcAg-negative, anti-HBc-positive, anti-HBc IgM-positive and HBV DNA-positive; 3) HBsAg-positive, anti-HBc-positive, HBcAg-negative, anti-HBe-positive, anti-HBc IgM-negative and HBV DNA-negative; 4) Anti-HBs-positive, anti-HBc-positive, anti-HBc IgM-negative and anti-HBc-positive. For HCV infection, two groups with different work ability were identified: 1) Anti-HCV-positive and HCV RNA-negative; 2) Anti-HCV-positive and HCV RNA positive.

Seroconversion

individual with an acute HBV infection would test positive for HBsAg and anti-HBc (total and IgM) while negative for anti-HBs. An individual with a chronic infection would test positive for HBsAg and total anti-HBc (IgM and IgG), but negative for IgM anti-HBc and anti-HBs. An individual who has successfully resolved their HBV infection will test negative for HBsAg, positive for anti-HBc, and may test negative or positive for anti-HBs, although most will test positive.

Window period

Hepatitis B Two periods may be referred to as window period in hepatitis B infection: (1) the period that elapses during HBsAg to HBsAb seroconversion, i.e. between the disappearance of surface antigen (HBsAg) from serum and the appearance of HBsAb (anti-HBs), and (2) the period between infection and appearance of HBsAg. During the window of HBsAg to HBsAb seroconversion, IgM anti-core (HBc-IgM) is the only detectable antibody. HBV DNA may be positive as well. This window period does not occur in persons who develop chronic hepatitis B, i.e. who continue to have detectable HBV DNA for greater than 6 months (HbsAg remains positive), or in people who develop isolated HBcAb positivity, i.e. who lose HBsAg, but do not develop HBsAb (HBV DNA may or may not remain positive). See also Incubation period, the time between infection and the appearance of symptoms References HIV/AIDS Serology

[Evaluation of the immunization status against hepatitis B and of the prevalence of Ag HBs among Beninese soldiers participating in military missions in Ivory Coast].

This study aims to determine the rate of anti-hepatitis B virus coverage (anti-HBV) and the prevalence of Ag HBs among Beninese soldiers participating in military missions in Ivory Coast. We conducted a cross-sectional study within the Beninese battalion based in Anankouakouté in the Ivory Coast. The company's soldiers were administered interview-based questionnaire during a health education session. It focused on socio-demographic data, risk factors for infection and a history of vaccination against hepatitis B. Samples were analyzed for Ag HBs and HBS antibodies. Sodiers positive for AgHBs underwent complementary tests (ALT, HBeAg, anti-HBe antibody, IgM anti-HBc antibody and HBV DNA using PCR). One hundred seventy-five soldiers were enrolled in this study (with an average age of 31 years, ranging between 23 and 52 years; sex-ratio 5.73). Protective anti-HB antibody levels were found in 41 soldiers (23.4%). Some soldiers had had B hepatitis and had developed immunity to the virus (25 cases/41) while others had developed immunity after vaccination (16 cases/41). Eighteen soldiers (10.3%) had HBV (HBsAg+) infection. This infection was chronic (IgM anti-HBc - and anti-HBc antibody total + in 18 cases/18). Among the infected soldiers, 4 had elevated aminotransferase levels, 4 were found HBeAg-positive and 4 had elevated viremia levels (HBV DNA >2000IU/ml). The prevalence of Ag HBs among Beninese soldiers participating in military missions is high. However, immunization coverage is low. Intervention strategies should be implemented in order to treat subjects who meet the criteria and to vaccinate the unimmunized patients.

Seroconversion

On a serological assay, the presence of hepatitis B surface antigen (HBsAg) indicates an individual with a currently active hepatitis B infection, whether acute or chronic. The presence of core antibody (anti-HBc) indicates an individual with an infection in general, whether current or previously resolved. The presence of surface antibody (anti-HBs) indicates an individual with immunity to hepatitis B, whether due to previously resolved infection or due to hepatitis B vaccination. For example, an individual who has never had any exposure to HBV, either by vaccine or by infection, would test negative for the entire serology panel. An individual who has been vaccinated and never had an infection will test seropositive for anti-HBs due to vaccination and negative for markers of infection. An individual with an acute HBV infection would test positive for HBsAg and anti-HBc (total and IgM) while negative for anti-HBs. An individual with a chronic infection would test positive for HBsAg and

[Significance of the "isolated anti-HBc" serological pattern determinated by the serological response to the vaccination against Hepatitis B].

Frequently Blood Bank donors are found to have a presence of Total Anti-Bc in the serum in the absence of the Hepatitis B surface antigen (HBsAg) and the Hepatitis B Surface Antigen (Anti-Bs) antibody. This study was designed to determine the serological response to the vaccination against the Hepatitis B virus, and evaluate the effectiveness of the vaccine in such cases, taking into consideration that the protective antibody titers for Hepatitis B are measured in levels above 10 mUl/ml.Thirty-one patients with the HBsAg negative/Anti-Bs negative/Antil-Bc positive serological patterns received three doses of the recombinant DNA vaccine (Hepavax Gene 20 microg), in a 0, 1, 2 months vaccination schedule. Anti-HBs levels were taken 30 days after the application of the last dose. After the 3 doses of the vaccine, the Anti-HBs levels were > 100 mUl/ml in 89% of the cases, > 500 in 50% and > 1000 in 14.3% of the vaccinated patients. Only 3 patients (9.7%) did not show serological response 30 days after the application of the last dose of the vaccine. In conclusion, 90% of the patients administered the HBsAg negative/Anti-HBs negative/Anti-HBc positive serological patterns, obtained Anti-HBs levels considered protectors ( > 10 mUl/m).

[Determination of specific anti-HBO immunoglobulin of IgM or IgG type. Relation to other virus HB markers].

A procedure for determining anti-HBc of IgM class is described herein. After IgG anti-HBc antibodies have been preferentially absorbed with Staphylococcus aureus cells positive for protein A, we have tested for residual IgM anti-HBc in the supernatant (absorbed serum) by radioimmunoassay. The occurrence and time course of anti-HBc, studied in 3 patients with ongoing infection, show that IgM anti-HBc persist for about 2 months in cases of acute hepatitis. IgM anti-HBc --marker for a recent HBV infection-- was found to be a useful tool in diagnosis of an unapparent hepatitis with transient or undetectable HBs antigenemia (case no 5). The presence of IgM or IgG anti-HBc, HBeAg and anti-HBe was determined by radioimmunoassay in 68 patients HBsAg positive. The immunoglobulin classes (IgM or IgG) of anti-HBc are dependent on the phase of hepatitis B. Of the 29 IgM anti-HBc positive specimens, 28 were found to be HBeAg positive, 18 of these patients were hemodialysed. 62 among 63 HBsAg positive blood donors had IgG anti-HBc, 6 associated with HBeAg and 56 with anti-HBe. All anti-HBc of anti-HBs positive sera were of IgG class (patients or blood donors). In order to estimate the anti-HBc titer, we have determined the per cent inhibition of 134 HBsAg and 46 anti-HBs positive sera diluted to 1 : 100. We correlate the presence of HBsAg --regardless of the level of titer of it --with high titers of anti-HBc and the presence of anti-HBs with low titers (P less than less than 0,0001). These results are very instructive with regard to the problem of anti-HBc titer and possibility of persisting HBV and we support the hypothesis that HBsAg negative but strongly anti-HBc positive blood might be infectious. IgM anti-HBc are on the average of lower titer than IgG anti-HBc, but we did not observe difference in IgG anti-HBc titer between HBeAg positive sera and anti-HBe, HBsAg positive sera.

[Prospective study of HBV circulation and long-term evaluation of anti-hepatitis-B vaccination in patients undergoing hemodialysis].

Hemodialysis patients were screened and monitored for HBV markers and at renal unit (identification EDTA 13ND) Palermo. Eighty-five patients received the hepatitis B vaccine (Haevac B Pasteur); fifty-three were followed up for more than three years; they received one of the three following schedules: 5 micrograms at 0, 1, 2 and 14 months; 5 micrograms at 0, 1, 2, 3, and 14 or 10 micrograms at 0, 1, 2, and 14 months. The best result was obtained by third schedule with a sero-conversion to anti-HBs of 83% at one month after the booster doses; and with the same percentage of anti-HBs positivity two years after the booster dose. During the study time (January 1984, March 1989) no new HBV events in patients and in the hemodialysis staff, who was also on monitoring, were observed.

[Effectiveness of vaccination against hepatitis B in HIV infected children].

The aim of the study was to evaluate hepatitis B vaccination effectiveness in HIV infected children. 45 children vertically infected with HIV who received hepatitis B vaccination were evaluated. Anti-HBs antibodies were assayed to established vaccination efficiency and were repeated every 6-12 months. No-responders received the next vaccination schedule with doubled dose. Children with antibody levels < 100 IU/ml were boostered. All the children have been receiving HAART. 35/45 (77,8%) children had anti-HBs antibodies > 100 IU/ml, including 20 with anti-HBs antibodies > or = 1000 IU/ml (32 children without immunodeficiency, 2 with moderate and 1 with severe immunodeficiency). Anti-HBs level 8-100 IU/ml was observed in 6/46 (13,3%) children (5 children without immunodeficiency and 1 with severe immunodeficiency). 4/46 (8.9%) children had no anti-HBs antibodies (2 children without immunodeficiency, 1 with moderate and 1 with severe immunodeficiency). In HIV infected children anti-HBs antibodies should be assayed to establish hepatitis B vaccination efficiency and repeated every 6-12 months.

[Hepatitis B vaccination effectiveness based on anti-HBs antibodies presence in children vertically infected with HIV].

To evaluate hepatitis B vaccination effectiveness. 49 vertically HIV-infected children were enrolled. Anti-HBs antibodies were evaluated at HIV diagnosis, at evaluation (year 2004) and after primary vaccination. The following factors were analyzed: age, time since the last vaccine dose, clinical and immunological CDC category, HIV viral load, age at the beginning of ART. At HIV diagnosis 14% of children had anti-HBs antibody level > or = 100 mLU/ml. At evaluation 76% of patients had anti-HBs antibody level > or = 100 mIU/ml. Children, who were diagnosed before their first birthday, were more likely to have protective antibody level (p < 0.01). Percentage of lymphocyte T CD4+ count (p < 0.01) and time since last vaccination (p < 0.01) were found to be important factors of vaccination response. Primary vaccination was effective in 86% of children. Factors which influenced vaccination effectiveness included early HIV diagnosis, percentage of lymphocyte T CD4+ at evaluation and time since last vaccination. The effectiveness of primary vaccination was high.

Hepatitis -- Evaluation -- Chronic Infection

Patients who have chronic hepatitis B infection can have positive HBsAg for life.  These patients can be inactive carriers of the hepatitis B virus or may have active chronic hepatitis. All patients with chronic hepatitis B virus infection have the presence of anti-HBc. If HBeAg may or may not be present, but if it present in patients with active chronic hepatitis, it can indicate viral replication. Similarly, hepatitis B virus DNA may or may not be present, but high levels indicate active chronic hepatitis. Patients with chronic infection of hepatitis B usually have an absence of anti-HBs, but the presence of anti-HBs with positive HBsAg in patients with chronic infection with the hepatitis B virus means that the antibody was unsuccessful in inducing the viral clearance.

[Polyclonal activation due to Epstein-Barr virus superinfection in a case with chronic hepatitis B].

Primary infection with Epstein-Barr virus (EBV) often occurs subclinically during childhood, resulting in a latent infection of B lymphocytes. In this report, a chronic hepatitis B case who presented with a serologic profile mimicking acute hepatitis B virus (HBV) infection and exhibiting transient autoantibody positivities because of the polyclonal activation of B cells due to EBV reactivation has been presented. The test results of 56 years old male patient who suffered from fatigue and pain on the right upper quadrant, revealed high levels of liver enzymes (AST: 187 U/L, ALT: 569 U/L), positivity of HBsAg, anti-HBc IgG and anti-HBe, and negativity of anti-HBc IgM, HBeAg and anti-HBs. Since HBV-DNA level was found 405,974 copies/mL by quantitative real time polymerase chain reaction (PCR), the patient was taken into follow-up. At the 6th month AST and ALT levels further elevated (352 U/L and 609 U/L, respectively), and anti-HBc IgM and anti-HBs became positive in addition to the previous positive markers of HBV. With the suspicion of superinfection, further laboratory investigations yielded negative results in CMV-IgM and Paul Bunnel test, while positive results in EBV anti-VCA IgM and IgG, anti-EBNA IgM and IgG, anti-p22 IgM and IgG and anti-EA IgM. In the follow-up period high levels of autoantibody positivities [rheumatoid factor (42.200 U/ml), anti-nuclear antibody (1/100) and anti-Ro-52] together with increased levels of total IgG, IgM and IgA were detected. In the following months, the levels of transaminases, total immunoglobulins and HBV-DNA have distinctively decreased, and in the 20th month the previous HBV profile regained (HBsAg, anti-HBc IgG and anti-HBe positive, anti-HBc IgM and anti-HBs negative, HBV-DNA: 6984 copies/ml) and the other pathological test results returned to normal. As a result, ALT increases seen during the course of chronic hepatitis B should not always be considered as HBV manifestations and the unusual serologic patterns should be evaluated as a consequence of superinfection with various viral agents.

[Does vaccination protect a child of an HBs Ag carrier mother against HBV infection?].

The aim of the study was to determine the degree of protection provided to the children born from HBs antigen carrying mothers, by vaccination administered according to the 0-1-2-12 scheme (Engerix B, SmithKline Beecham) as well as the level of HBs antibodies after a booster dose given 5 years later. The examination was conducted in 52 children. The level of HBs antibodies as well as the remaining serological markers of HBV infection were assessed at the age of 6. Four to six months after booster dose administration the level of HBs antibodies was assesed again. The markers of HBV infection were determined with the IMx-AUSAB test (Abbott Laboratories). After 5 years from the vaccination, 3 (5.8%) children were found infected with HBV; the performed assessment of their immune system did not reveal any significant compromise. Values of anti-HBs < 10 mlU/ml were found in 4 (8.2%) of 49 infection-free children and low levels (11-100 mlU/ml) in other 4 (8.2%) children, moderate (101-1000 mlU/ml) in 29 (55.8%), and very high (> 1000 mlU/ml) in 9 (17.3%). Four to six weeks after a booster dose, only one child did not respond to the vaccination. High levels of anti-HBs antibodies were obtained in the rest of the children. In our opinion there is a justified need to administer a booster dose 5 years after completing the vaccination in the risk group children.

InternalMed_Harrison

well as those with chronic HBV infection, anti-HBc is predominantly of the IgG class. Infrequently, in ≤1–5% of patients with acute HBV infection, levels of HBsAg are too low to be detected; in such cases, the presence of IgM anti-HBc establishes the diagnosis of acute hepatitis B. When isolated anti-HBc occurs in the rare patient with chronic hepatitis B whose HBsAg level is below the sensitivity threshold of contemporary immunoassays (a low-level carrier), anti-HBc is of the IgG class. Generally, in persons who have recovered from hepatitis B, anti-HBs and anti-HBc persist indefinitely.

Evaluation of hepatitis B virus infection can be complicated, and some uncommon but possible scenarios should be kept in mind while investigating. Patients can test negative for HBsAg and anti-HBs but can have the presence of anti-HBc. This situation is possible when the result is false positive but can also happen in patients who are in the time window where they have cleared HBsAg from the blood, but anti-HBs has not yet appeared. Some patients who have cleared hepatitis B virus infection but have lost the anti-HBs over the years can test negative both for HBsAg and anti-HBs but positive for anti-HBc.  Also, patients infected with the hepatitis B virus many years ago can sometimes develop a core mutant variant of the hepatitis B virus where they can test negative for HBeAg and positive for anti-HBe even though the virus may still be active and is replicating. When lab findings like these are detected, the hepatitis B virus DNA PCR assay to check for viral replication is recommended.

Until 20 or 30 years ago, the diagnosis and treatment of breast disease was managed exclusively by the surgeon. This situation has changed to some extent as a result of recent technological advances, and clinicians' contributions to the diagnostic work-up and/or treatment of these cases can begin at any time. If they are the first physician to see the patient after the examination and formulation of a diagnostic hypothesis, they will almost always have to order a panel of imaging/instrumental examinations that is appropriate for the type of lesion suspected, the patient's age, and other factors; if they intervene at the end of the diagnostic work-up, it will be their job to arrive at a conclusion based on all of the data collected. The clinical examination includes various steps - history taking and inspection and palpation of the breasts - each of which is essential and requires the use of appropriate methods and techniques. The diagnostic capacity of the examination will depend largely on the consistency of the breasts, but it is influenced even more strongly by the doctor-patient relationship. Physicians must know their patient well, listen to and understand what she is saying, explain their own findings and verify that the explanations have been understood, and they must be convincing. Clinicians must also be able to assess the results of imaging studies (rather than relying solely on the radiologist's report), and this requires interaction with other specialists. The days are over when a clinician or radiologist or sonographer worked alone, certain that his/her examination method was sufficient in itself: today, teamwork is essential. But this also means that each member of the team must be extremely competent in his/her own sector and be aware of the other team members' limitations and expectations. The clinical examination remains central to the process since it is the basis for selecting appropriate treatment.  SOMMARIO: Da quando si conosce la patologia mammaria la diagnosi e la terapia di tale patologia sono state a totale appannaggio del chirurgo, situazione che è proseguita fino a qualche decennio fa. Il recente progresso tecnologico ha modificato, in parte, questa situazione e il clinico può entrare nel percorso diagnostico o terapeutico in qualsiasi momento. Se è il primo coinvolto, dopo l'esame e dopo un'ipotesi diagnostica, dovrà, quasi sempre, orientarsi verso indagini strumentali in relazione al sospetto, all'età della paziente ecc., se è l'ultimo anello deve arrivare a una conclusione mettendo insieme tutte le informazioni. L'esame clinico è composto di varie fasi: anamnesi, ispezione, palpazione, ognuna essenziale. Ogni singola fase va affrontata con metodo e tecnica appropriata. La capacità diagnostica dell'esame clinico è influenzata dalla costituzione della mammella, ma ancor di più è condizionata da uno stretto rapporto tra paziente e medico che deve conoscere molto la paziente che gli sta davanti e che non solo deve "visitare", ma capire, spiegare, accertarsi che si abbia capito, convincere. È inoltre indispensabile che il clinico sia in grado di esaminare le indagini strumentali e non limitarsi a leggere i referti, quindi interagire con gli altri specialisti. L'epoca del clinico o del radiologo o dell'ecografista che lavora da solo credendo che il proprio esame sia sufficiente o sganciato da altri contesti è finita da tempo, tutti hanno bisogno di tutti. È però vero che ciascuno deve essere estremamente competente nel suo settore e deve conoscere i limiti e le aspettative di chi collabora in altre specialità, come rimane valida la regola che la clinica resta comunque il momento centrale, non fosse altro perché poi deve affrontare la terapia.

[The prevalence of HBsAg in hospitalized children as a marker of hepatitis B virus infection].

The aim of this study was to determine the prevalence of hepatitis B surface antigen (HBsAg) in hospitalised children, as specific marker for hepatitis B virus (HBV) infection. Our study group consists of 517 children, 68 of them diagnosed with chronic hepatitis. For HBsAg determination we used an ELISA test (Labsystems); for some children we also tested by ELISA the following markers: the antibodies and anti-hepatitis C virus (HCV) antibodies. From 517 children 24.28% were HBSAg positive and 75% of children with chronic hepatitis were positive for the same marker. Almost 100% of chronic active hepatitis (CAH) patients was positive for HBSAg. 1. The prevalence of HBsAg was much higher as compared with the healthy population prevalence; it is a clear prove that HBV infection has an important role in chronic hepatitis appearance. 2. For all HBsAg positive patients, it is necessary to determine other markers like HBeAg-anti-HBe antibodies system as well as markers for other viral hepatitis (HDV, HCV). 3. The anti-HBV infection vaccine will reduce significantly the prevalence of HBV and HDV infections; 4. Biological molecular technique, like PCR will be necessary in our country, in the future, even the price is so high, to monitoring the IFN treatment for chronic infection as unique solution for these patients.

Hepatitis D -- Evaluation

In response to the HDAg, antibodies of the IgM and IgG class (anti-HDV) are produced. The three infective patterns (acute HDV/HBV coinfection, acute HDV superinfection, and chronic HDV infection) vary with respect to appearance and levels of HDV RNA, HDAg, and anti-HDV as well as HBV markers (Table 1). As HDV is dependent on HBV, the presence of HBsAg is essential for diagnosis. Additionally, the presence of IgM antibody to hepatitis B core antigen (IgM anti-HBc) is essential to diagnose acute HBV/HDV coinfection. [18]

Patients who receive a vaccine for the hepatitis B virus develop protective anti-HBs as a response to recombinant HBsAg in the vaccine.  There are no hepatitis B virus DNA or other hepatitis B virus-associated proteins in the vaccine.  Patients who receive the vaccine are not positive for anti-HBc unless they had a previous infection with the hepatitis B virus. [39]

Seroprevalence of hepatitis B e antigen (HBe antigen) and B core antibodies (IgG anti-HBcore and IgM anti-HBcore) among hepatitis B surface antigen positive blood donors at a Tertiary Centre in Nigeria.

Hepatitis B virus (HBV) is a common cause of liver disease throughout the world. HBV is transmitted through blood and other body fluids, including semen and saliva. Chronic replication of HBV virons is characterized by persistence circulation of HBsAg, HBeAg and HBV DNA; usually with anti-HBc and occasionally with anti-HBs. To determine the prevalence of HBeAg, IgG anti-HBcore and IgM anti-HBcore amongst HBsAg positive blood donors. These parameters are reflective of transmissibility and active hepatitis B infection. A cross sectional study was carried out at the blood donor clinics of Lagos State University Teaching Hospital Ikeja and Lagos University Teaching Hospital Idiaraba. A total of 267 donors were recruited to determine HBe antigen, IgG and IgM anti-HBcore antibodies amongst hepatitis BsAg positive donors. Five milliliters of blood was collected from those who tested positive to HBsAg screen during donation. The sera were subjected to enzyme linked immunosorbent assay (ELISA). Pearson chi-squared test was used for the analytical assessment. A total number of 267 HBsAg positive blood donors were studied. A seroprevalence of 8.2% (22 of 267) HBeAg was obtained, 4 of 267 (1.5%) were indeterminate while 241 (90.3%) tested negative. Only 27 out of 267 donors (10.1%) tested positive to IgM anti-HBcore, 234(87.6%) tested negative, while 6(2.2%) were indeterminate. A higher percentage of 60.7% (162 of 267) tested positive to IgG anti-HBcore, while 39.3% (105 of 267) tested negative. There is a low seroprevalence rate of HBeAg-positive chronic hepatitis and relatively high IgG anti-HBcore and IgM anti-HBcore rates in South West Nigeria.

[Hepatitis B virus infection in Tunisian pregnant women: risk factors and viral DNA levels in HBe antigen negative women].

To evaluate the seroprevalence and the risk factors of hepatitis B virus (HBV) infection in 2303 Tunisian pregnant women and to estimate the risk of perinatal transmission in women positive for hepatitis B surface antigen (HBsAg) but negative for hepatitis B e-antigen (HBeAg). Positive samples were tested for HBeAg and anti-HBe antibody using enzyme immunoassays. Serum HBV-DNA was determined by real time PCR assay. Overall, 4% of women were HBsAg positive and for the majority of them (96.8%) this status was unknown. Only 1.4% of studied population were vaccinated previously against hepatitis B. Study of risk factors revealed association between the HBsAg status and presence of intrafamilial hepatitis cases (p<0.05). Only four women were positive for HBeAg. Among patients with HBeAg negative status, only 11% were negative for HBV DNA. For the others, DNA level ranged from 34 to 10(8)copies/ml; it was greater than 10(4)copies/ml in 26.5% of them. Hepatitis B virus (HBV) prevalence in pregnant women is of intermediate endemicity in Tunisia. Universal vaccination before pregnancy and antenatal screening is recommended. Pregnant women who are found to be HBsAg positive and HBeAg negative should be tested systematically for DNA level to evaluate the risk of perinatal infection and to prevent it by sero-prophylactic for babies or by treatment during the third trimester of pregnancy.

[The OIBOH Registry (Optimal Intensification therapy in a Broad Observed High risk patient population with coronary disease): an Italian observational study of secondary prevention after a coronary event during the pandemic COVID-19 outbreak].

Razionale. In Italia la pandemia COVID-19 ha determinato importanti riorganizzazioni logistiche nell'erogazione delle cure ospedaliere e di specialistica ambulatoriale. Ciò ha spinto clinici e decisori pubblico-amministrativi della Sanità ad adottare nuovi modelli organizzativi in molteplici scenari clinici. Materiali e metodi. Il registro OIBOH (Optimal Intensification therapy in a Broad Observed High risk patient population with coronary disease) è uno studio osservazionale "cross-sectional" condotto in vari centri italiani di cardiologia ambulatoriale per valutare durante la pandemia COVID-19 la capacità di identificare in breve tempo i pazienti ad altissimo rischio cardiovascolare residuo dopo un evento coronarico recente (<12 mesi). Successivamente alla valutazione clinica iniziale, venivano arruolati i pazienti ritenuti ad altissimo rischio, registrando le caratteristiche cliniche e di trattamento in una scheda di raccolta dati elettronica.Risultati. Al registro hanno partecipato 134 centri di cardiologia ambulatoriale che hanno arruolato 1428 pazienti su 3227 esaminati fra quelli che avevano avuto accesso ad una visita cardiologica durante la pandemia nel periodo ottobre 2020-marzo 2021. Il criterio di arruolamento era costituito dall'aver avuto una diagnosi di coronaropatia confermata angiograficamente negli ultimi 12 mesi, per sindrome coronarica acuta (SCA) o cronica (SCC). La SCA come evento indice era presente nel 93% dei pazienti arruolati mentre la SCC nel 7%. L'età media era 67 ± 10 anni, il 25% era di sesso femminile. Il 96.1% dei pazienti con SCA e il 67.6% dei pazienti con SCC sono stati sottoposti a rivascolarizzazione coronarica. Il 46% e 47% dei pazienti con SCA e SCC, rispettivamente, era diabetico. Oltre il 65% dei pazienti presentava una malattia coronarica multivasale. È stata osservata una importante prevalenza di arteriopatia periferica (17.5% nei pazienti con SCA e 19.6% nei pazienti con SCC). I valori di pressione arteriosa e frequenza cardiaca risultavano ben controllati (128 ± 25.2 mmHg e 65 ± 12.3 b/min nei pazienti con SCA; 127 ± 23.4 mmHg e 67 ± 13.2 b/min nei pazienti con SCC). Viceversa, è stato riportato uno scarso controllo dei livelli di colesterolemia LDL, con un valore medio di 88.8 ± 38.6 mg/dl nei pazienti con SCA e 86 ± 36.6 mg/dl nei pazienti con SCC. Solo il 16.4% dei pazienti con SCA raggiungeva i livelli raccomandati dalle attuali linee guida europee. Nonostante l'estensivo uso di statine (>90%), si è rilevato un utilizzo limitato dell'associazione statina ad alta intensità + ezetimibe (solo il 22.4% dei pazienti). Estremamente basso è stato l'utilizzo di inibitori di PCSK9 (2.5%). La duplice terapia antiaggregante piastrinica (DAPT) è risultata complessivamente ben condotta fin dalla dimissione ospedaliera. Nei pazienti in DAPT, l'inibitore P2Y12 più utilizzato è risultato il ticagrelor alla dose di 90 mg, soprattutto dopo un evento coronarico acuto (in circa l'80% dei pazienti con SCA). Nella stragrande maggioranza dei casi (>90%) i cardiologi ambulatoriali hanno posto indicazione a prosecuzione della DAPT oltre i 12 mesi con aspirina e ticagrelor 60 mg bid. Conclusioni. La gestione del paziente con coronaropatia in fase cronica stabilizzata è molto complessa. Tale complessità logistico-gestionale si è accentuata durante la pandemia COVID-19. Il registro OIBOH ha evidenziato un'ottima capacità di identificare le problematiche clinico-prognostiche delle cardiologie ambulatoriali italiane, specie nei pazienti ad altissimo rischio residuo. Rimangono importanti aree di miglioramento come uno stretto controllo della colesterolemia LDL, mentre altre raccomandazioni delle linee guida, come la prosecuzione della DAPT con ticagrelor 60 mg oltre i 12 mesi, risultano ben applicate. L'implementazione dell'assistenza con la medicina digitale e l'intelligenza artificiale potrebbe migliorare di molto la performance dei clinici.

[Hepatitis B virus serologic status among hospital health care staff in Lome].

To assess the hepatitis B virus (HBV) serologic status of hospital health care personnel in Lome. From June 1 to August 31, 2007, 100 workers vaccinated against HBV and 50 unvaccinated workers participated in this comparative cross-sectional study. The data studied were: age, sex, vaccination status, history of accidental exposure to blood, and enzyme-linked immunoassay results for HBs antigen (Ag), total anti-HBc antibodies (Ab), and anti-HBs Ab. Vaccinated subjects had a mean age of 33.2 ± 8.2 years and unvaccinated subjects of 35.2 ± 9.6 years; their respective sex ratios (M:W) were 2:1 and 3:1. Protective levels (>10 IU/L) of anti-HBs Ab were found in 78% (n = 78) of vaccinated subjects compared with 44% (n = 22) of those unvaccinated. HBs Ag was found in 36% (n = 36) of vaccinated and 56% (n = 28) of unvaccinated subjects. Of subjects previously accidentally exposed to blood, 67% (n = 35) had HBs Ag compared with 30% (n = 29) of those subjects without such exposure. This study has proved the high prevalence of HBs Ag carrier status among health care workers in Lome and confirms the importance of vaccination against HBV.

Pathology_Robbins

Anti-HBs antibody appears after the acute disease is over and usually is not detected until a few weeks to several months after HBsAg disappears. Anti-HBs may persist for life and confers protection, which is the rationale for current vaccines containing HBsAg. HBeAg and HBV DNA appear in serum soon after HBsAg and signify ongoing viral replication. Persistence of HBeAg is an indicator of progression to chronic hepatitis. The appearance of anti-HBe antibodies implies that an acute infection has peaked and is on the wane. IgM anti-HBc becomes detectable in serum shortly before the onset of symptoms, concurrent with the onset of elevated serum aminotransferase levels (indicative of hepatocyte destruction). Over a period of months, the IgM anti-HBc antibody is replaced by IgG anti-HBc. As in the case of anti-HAV, there is no direct assay for IgG anti-HBc; its presence is inferred from decline of IgM anti-HBc in the face of rising total anti-HBc.

Hepatitis B virus among Saudi children in Gizan, Saudi Arabia.

Using the enzyme-linked immunosorbent assay (ELISA), the prevalence rates for hepatitis B virus surface antigen (HBsAg), antibody to core antigen (anti-HBc), and antibody to surface antigen (anti-HBs) were studied among 325 school children and those seeking treatment for minor ailments in Gizan City, Saudi Arabia. Tests for hepatitis B virus e antigen (HBeAg), antibody to HBeAg (anti-HBe), IgM antibody to HBV core antigen (IgM anti-HBc) and antibody to delta-virus were made in HBsAg carriers. There was a serological evidence of HBV infection in 91 (28%) Saudis of which 11.1% were HBsAg carriers, 9.5% positive for anti-HBs and 7.4% positive only for anti-HBc. There was no intersex difference for positivity for HBsAg, anti-HBs and anti-HBc. The evidence of existing or earlier infection was higher in females. Among HBsAg carriers, none of the 24 was positive for IgM anti-HBc, 12% were positive for HBeAg or anti-HBe. Anti-delta antibody was present in one of the nine carriers tested. HBV infection in Gizan City is acquired fairly early during childhood with little clinical evidence suggestive of an acute hepatitis. Immunization against HBV should be considered in the neonatal period to prevent the long term sequelae of HBV, like cirrhosis and primary hepatocellular carcinoma.

[Anti-HBs titers after a vaccination program in children and adolescents. Should a booster dose be given?].

To determine the efficacy and immunogenicity achieved 6 years after the start of a massive vaccination campaign against hepatitis B in newborn infants and adolescents (12 years). The persistence of anti-hepatitis B virus surface antigen (HBS) levels and the need for a booster dose were also assessed. From 1993 to 1997 the Engerix vaccine (10 micrograms) and since then the Recombivax vaccine (5 micrograms). The vaccination schedule was the standard of three doses (0, 1, 6). Blood analyses were used for determination of anti-HBs between October of 1998 and May of 2000. We studied 382 cases. Five years after the first dose, 96.1% (73/76) has anti-HBs and in 75% (57/76) levels were above 10UI/L. Six to seven years after vaccination anti-HBs were detected in 94,1 (32/34) of the children and in 70.6% (24/34) of these, levels were above 10UI/L. A high percentage of children were found to have good levels of anti-HBs 67 years after vaccination. Recent studies show that booster doses are not required because of the immunologic memory that produces the vaccine. The anti-HB protective level (> or = 10UI/l) should not be taken into consideration because this level is only valid when passive immunity with immunoglobulins is applied.

Seroconversion

In the typical disease course for hepatitis B, the individual will first seroconvert for hepatitis B surface antigen (HBsAg). While some can convert within one week, most individuals take about four weeks after initial infection to convert. Anti-core antibodies (anti-HBc) are the first antibodies produced by the body, first in short-term IgM (anti-HBc IgM), and subsequently in long-term IgG; while levels of IgM anti-HBc will peak around sixteen weeks after exposure and fall within about seven to eight months, IgG anti-HBc will remain detectable in the serum as a sign of chronic infection for years. IgM anti-HBc concentration will fall regardless of whether or not the individual clears the infection. The window period for HBsAg/anti-HBs testing occurs as concentration of HBsAg falls and before the body develops anti-HBs antibodies, lasting approximately six to eight weeks in most individuals. During this time, serology assays can test for total anti-HBc. Levels of anti-surface antibody

[Study of hepatitis B virus replication and infection by other hepatitis viruses in patients with chronic hepatitis B virus infection].

To study hepatitis B virus (HBV) replication in a series of patients with HBV infection and to analyze the frequency of associated hepatitis C virus (HCV) and hepatitis D (HDV) infection. Serological markers of HBV, HCV and HDV, transaminase values and HBV DNA were studied in serum samples from 463 patients with chronic HBV infection. Three hundred ninety-six (85.5%) were classified as hepatitis B, 33 (7.1%) as hepatitis B and C, 17 (3.6%) as hepatitis B and D and 17 (3.6%) as hepatitis B, C and D. Sixty-seven percent of patients with hepatitis B and 33% of those with chronic hepatitis B were asymptomatic HBsAg carriers. HVB DNA was identified in 27.7% of patients with hepatitis B, in 24% of those with hepatitis B and C, in 11.7% of those with hepatitis B and D and in 29.4% of those with hepatitis B, C and D. HBV DNA and elevated transaminase levels were found in 63% of HBeAg-positive patients and in only 16% of those who were anti-HBe-positive. These latter were considered candidates for antiviral treatment. In our environment, most patients with HBV infection are asymptomatic HBsAg carriers. Viral replication and elevated alanine aminotransferase levels were found in 22% of the patients. Consequently, these patients are candidates for antiviral treatment. Between 3.6% and 7.1% of patients with hepatitis B presented coinfection with HCV or HDV, or both. No significant differences were found in HBV replication among the different groups.

Low rate of occult hepatitis B virus infection among anti-HBc positive blood donors living in a low prevalence region in Brazil.

The aim of this study was to determine the rate of occult hepatitis B virus (HBV) infection among blood donors living in a geographic region of low (5.6%) anti-HBc prevalence. Sera from 150 candidate blood donors whose blood was rejected due to total anti-HBc reactivity (despite absence of HBsAg) were tested for anti-HBs and IgM anti-HBc antibodies, as well as for HBeAg/anti-HBe. Serum HBV DNA was sought by using a PCR assay able to amplify part of the surface gene. Viral load was measured in the PCR positive samples. The pattern 'anti-HBc alone' (without HBsAg and anti-HBs antibodies) was found in 64 (42.7%) subjects. IgM anti-HBc and anti-HBe antibodies were detected in 2 (1.3%) and 80 (53.3%) samples, respectively. No sample was HBeAg-reactive. HBV DNA was repeatedly found in five (3.3%) samples, three of which were anti-HBs positive and two anti-HBs negative. All five HBV DNA positive samples showed a low viral load (<1000copies/ml). The data indicated a low rate of occult infection among anti-HBc positive, HBsAg negative blood donors living in a region of low prevalence of infection. Viral load was very low in all HBV infected subjects.

[Persistence of hepatitis B virus in children after interferon-alpha therapy despite the seroconversion in HBsAg/anti-HBs system].

The aim of our study was to assess: (1) whether seroconversion to IgG anti-HBs, induced by IFN-alpha therapy in children with chronic active hepatitis B, is maintained 4-10 years after treatment; and (2) whether HBV-DNA is present in circulation despite the synthesis of anti-HBs. Serum samples were collected from 38 patients and serological markers of HBV were determined in each of them. HBV-DNA was determined by PCR in anti-HBs positive sera. Serum samples obtained from 19 subjects with a complete spontaneous seroconversion after acute HBV served as controls. Four to 10 years after therapy, anti-HBs were present in ca. 97.4% patients with GMT value of 775 IU/L vs 127 IU/L found in controls. HBsAg was found in 2/38 subjects. In 13 out of 37 patients (35.1%) free and/or bound HBV-DNA was present. This study showed that seroconversion induced by IFN-alpha may not be a sustained phenomenon. HBV-DNA may persist for a long time after therapy despite the anti-HBs synthesis.