Occult hepatitis B infection is characterized by the presence of hepatitis B virus (HBV) DNA in the serum in the absence of hepatitis B surface antigen (HBsAg). Prevalence of hepatitis C virus (HCV) infections in Egypt is among the highest in the world. In this study, we aim at analysing the rates of occult HBV infections among HCV paediatric cancer patients in Egypt. The prevalence of occult HBV was assessed in two groups of paediatric cancer patients (HCV positive and HCV negative), in addition to a third group of paediatric noncancer patients, which was used as a general control. All groups were negative for HBsAg and positive for HCV antibody. HBV DNA was detected by nested PCR and real-time PCR. HCV was detected by real-time PCR. Sequencing was carried out in order to determine HBV genotypes to all HBV patients as well as to detect any mutation that might be responsible for the occult phenotype. Occult hepatitis B infection was observed in neither the non-HCV paediatric cancer patients nor the paediatric noncancer patients but was found in 31% of the HCV-positive paediatric cancer patients. All the detected HBV patients belonged to HBV genotype D, and mutations were found in the surface genome of HBV leading to occult HBV. Occult HBV infection seems to be relatively frequent in HCV-positive paediatric cancer patients, indicating that HBsAg negativity is not sufficient to completely exclude HBV infection. These findings emphasize the importance of considering occult HBV infection in HCV-positive paediatric cancer patients especially in endemic areas as Egypt.

Introduction Risk stratification in acute pulmonary embolism (PE) is useful in identifying low risk patients suitable for ambulatory care and those at high risk in need of intensive monitoring.In this study we compared two of the most well used scoring systems, the European Society of Cardiology (ESC) criteria and the simplified pulmonary embolism severity index (sPESI). Methods We retrospectively identified patients admitted to NHS Tayside over a 4 year period with radiologically confirmed PE and calculated their ESC and sPESI scores.RV dysfunction was defined by RV/LV ratio >1 on CTPA or by echocardiography. As per the ECS criteria, patients with shock (defined as SBP<90mmHg) and RV dysfunction or myocardial injury (defined as troponin I >0.045) were classified as high risk, RV dysfunction or myocardial injury without shock as intermediate risk and patients with none of the above criteria classified as low risk.Patients with any one of the six sPESI risk factors (age>80, cancer, chronic lung disease, SpO 2 <90%, SBP<90mmHg, HR>110) were classified as high risk.The primary outcome was 30-day mortality or requirement for thrombolysis. Results 291 patients (45.8% male) were identified with a median age of 67 years (interquartile range 54-78 years).Low risk sPESI patients had a 2.2% risk of mortality or requirement for thrombolysis, in high risk patients (1 or more risk factors) the rate was 15.2%. Using ESC criteria, low risk patients had a 7.0% risk or mortality or thrombolysis with high risk patients having a risk of 21.2%.The positive likelihood ratio for ESC was 2.2 vs 1.6 for sPESI. The negative likelihood ratio was 0.18 for sPESI compared to 0.7 for ESC.The area under the receiver operator characteristic curves for both scores is shown in Figure 1. Both had moderate overall predictive value (AUC 0.68, 95% CI 0.63-0.73) for both scores, p<0.0001.Conclusion The sPESI score is superior to the ESC score in identifying patients with acute PE who are at low risk of poor outcome, while ESC is superior to sPESI at identifying high risk patients.Abstract P142 Figure 1 P142