A significant number of patients with anti-HBc had detectable levels of HBV-DNA in the serum. Egyptian chronic HCV patients have a high prevalence of occult HBV infection.

Regardless of all efforts to guarantee safety of blood, hepatitis B residual risk is the highest among transfusiontransmitted diseases [1]. HBV DNA was detected in 3.3% of blood donors negative for hepatitis B surface antigen (HbsAg) and hepatitis B surface antibody (HBsAb) but positive for anti-HBc [2].The frequency of HBsAg in Egyptian blood donors is 4.3% [3]. There are no available data about the frequency of either hepatitis B core antibody (HBcAb) or HBsAb in Egyptian blood donors. In order to evaluate the role of HBcAb in blood screening for HBV infection, 150 blood donors (negative for HBsAg, HBsAb, hepatitis C virus antibody, and human immunodeficiency virus) were tested for HBcAb (total). In the anti-HBc-positive samples (n = 20), HBV-DNA polymerase chain reaction (PCR) assay tests were performed. HBV-DNA was detected in only 2 (10%) out of the 20 HBcAb-positive samples. Isolated anti-HBc that tested negative for HBV DNA was detected in 18 (12%) of the 150 samples that tested negative for HBsAg.Isolated anti-HBc was reported in 2% of the 6,035 consecutive Saudi blood donors [4]. In a single Brazilian study, it was 10% [5]. In our institution, however, the prevalence of isolated HBcAb in tested samples was 13.3%. Isolated anti-HBc serologic profile may be associated with occult chronic HBV infection with undetectable HBsAg, remote HBV infection with loss of measurable HBsAb, passive transfer of anti-HBc, nonspecific crossreacting antibody, or the period when HBsAg has disappeared and anti-HBs has not been detected. The higher prevalence of isolated anti-HBc in our study may be related to the absence of donor selection.Molecular methods have demonstrated the presence of the virus in patients with HBcAb alone with frequencies of 0.8% and 12.2% in a Brazilian [6] and an Iranian [7] study, respectively. In our study, the overall prevalence of HBV-DNA in healthy blood donors was 10% among isolated anti-HBc-positive individuals. Such wide discrepancy, not completely understood, could result from virological, immunological, methodological, or epidemiological factors. The detection of HBV DNA by PCR in these individuals rules out the possibility of false positive results and remote HBV infection. At the same time, it confirms the presence of occult HBV infection.Individuals with isolated anti-HBc who tested negative for HBV DNA constituted 12% of our tested populations. These subjects may have remote infection, false positive result, or represent an immunological window period. We have tested subjects for total HBcAb rather than IgM and IgG isotypes. Therefore, the differentiation between acute and chronic HBV infection was difficult.The exclusion of all anti-HBc positive blood donors leads to unnecessary blood shortage in blood banks (12%

Routine serological testing for hepatitis C virus (HCV) infection among hemodialysis (HD) patients is currently recommended. A dilemma existed on the value of serology because some investigators reported a high rate of false-negative serologic testing. In this study, we aimed to detect the false-negative rate of anti-HCV among Egyptian HD patients. Seventy-eight HD patients, negative for anti-HCV, anti-HIV, and hepatitis B surface antigen, were tested for HCV RNA by reverse transcriptase polymerase chain reaction (RT-PCR). In the next step, the viral load was quantified by real-time PCR in RT-PCR-positive patients. Risk factors for HCV infection, as well as clinical and biochemical indicators of liver disease, were compared between false-negative and true-negative anti-HCV HD patients. The frequency of false-negative anti-HCV was 17.9%. Frequency of blood transfusion, duration of HD, dialysis at multiple centers, and diabetes mellitus were not identified as risk factors for HCV infection. The frequency of false-negative results had a linear relation to the prevalence of HCV infection in the HD units. Timely identification of HCV within dialysis units is needed in order to lower the risk of HCV spread within the HD units. The high false-negative rate of anti-HCV among HD patients in our study justifies testing of a large scale of patients for precious assessment of effectiveness of nucleic acid amplification technology testing in screening HD patient.

Introduction Patients with chronic liver disease ultimately progress to develop cirrhosis and portal hypertension. Recently it seems well established that nitric oxide disturbances play a key role in the pathogenesis of chronic liver disease and portal hypertension. The aim of this work was to clarify the correlation between chronic liver disease stages, liver function status, esophageal varices presence and nitric oxide disturbances. Subjects and methods All subjects (n = 120) in the present study were classified into; group I which included 15 age and sex matched healthy volunteers (taken as control), group II which included 20 patients with chronic active hepatitis, and group III which included 85 patients with hepatic cirrhosis. All subjects included were subjected to full clinical assessment, routine laboratory investigations, serum nitrate level determination using colorimetric method, abdominal ultrasonography and upper endoscopy. Results Increased serum nitrate level could not be detected in patients with chronic active hepatitis as well as those with early cirrhosis (Child's class A). Progressive and significant increase of serum nitrate levels were detected in more advanced stages of cirrhosis (Child's class B & C). The best non-invasive predictor for the presence of oesophageal varices was a combination of platelet count \150.000/mm 3 , splenomegaly [18 cm, Child's class B or C and serum nitrate C38 lmol/l, with 93.3% sensitivity and 100% specificity. Conclusion Serum nitrate level can be used as a non-invasive predictor for progression of chronic liver disease as well as for the presence of oesophageal varices.

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