Immunity after Primary Hepatitis B Vaccination in Children 7 Years or More Attending A Tertiary Care Hospital.

Hepatitis B virus is a serious public health problem. Effective hepatitis B vaccination gives protection in about 85-90% cases. Most follow-up studies in different countries showed a similar pattern of antibody decline with increasing age. Many authors observed a declined level of HBs-antibody over a period of 3-6 years. This study was aimed at to observe immune status in children 7 years or more after primary hepatitis B vaccination. This cross sectional descriptive study was conducted at the department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh from April 2015 to March 2016. For this study children of both sexes aged between 7 to 18 years, who had history of 2 or more doses of hepatitis B vaccine 7 or more years back were included in the study. All the serum samples were tested for anti HBs by chemiluminescence's technique. Total 120 children were studied among them male was 59.2% and male female ratio was 1.4:1 with a mean age of 8.6±1.7 years. Good immune response (66.7%) was observed against hepatitis B. Significantly higher geometric mean titer of anti HBs was found in the age group of 7-8 years (p=0.02). Waning of immunity including non seroprotectivity was significantly associated with increasing age (p=0.015). Majority (96.7%) of children received EPI vaccination than commercially available vaccine. Children with weight for age percentile (WAP), height for age percentile (HAP) and BMI for age lies below 5th percentile had comparatively lower non seroprotection rate than normal children, but this was not statistically significant. History of dental or surgical procedure, blood transfusion and family history of contact with known case of hepatitis B infection did not have any significant inference on anti- HBs response. The study detected a good immune response against hepatitis B. About 66.7% of children were seroprotective 7 years or more after primary hepatitis B vaccination. Waning of immunity including non seroprotectivity was significantly associated with increasing age. Further studies with larger sample size are needed about booster dose to come to a final conclusion.

Tuberculosis in Systemic Lupus Erythematosus Patients.

The tubercular infections (TB) are most important cause of morbidity and mortality in SLE patients worldwide and an ongoing alarming issue in developing countries. This observational study was carried out in SLE clinic of BSMMU, Bangladesh from April 2015 to March 2016 after taking ethical clearance from IRB to observe frequency and risk factors of tuberculosis in SLE patients. A total 230 consecutive SLE patients were enrolled. Patient's clinical characteristics, history of TB, SLEDAI score, cumulative doses of immunosuppressants were recorded. In clinically suspected cases tuberculin test, chest X-ray, spot and first morning sputum for AFB, Gene Xpert MTB/RIF, ADA, FNAC and tissue biopsy were requested along with routine tests. The multivariate logistic regressions were done for risk factors. Out of 230 patients TB was documented in 23 (10%) subjects. Among TB cases 16 women and 7 men. Mean age of patients was 27.56±9.3 years and mean duration of occurrence of tuberculosis after SLE diagnosis was 4.26±5.38 years. Present and past TB was observed in 10 and 13 cases respectively. Cough, night sweat, fever, anorexia were significant presenting features. Fifteen and 8 patients had pulmonary and extra pulmonary TB respectively. Organ involvement pattern was multi-lobed lungs, joint, meninges, lymph nodes, peritoneum and pleura. High disease activity disease (SLEDAI score >12), total intake of prednisolone >1000mg were risk factors of TB. Frequency of tuberculosis was high (10%) in SLE patients. Awareness including prevention of flares and judicious use of steroids might reduce the rate of TB.

Polyarthritis is a Rare Manifestation of Pachydermoperiostosis: A Case Report.

Pachydermoperiostosis or primary hypertrophic osteoarthropathy, also known as Touraine-Solente-Gole syndrome, is a rare process, frequently inherited. In its complete form it is characterized by pachydermia (thickening of the skin), skeletal changes (periostosis) and acropachia (digital clubbing). Diagnosis can be made considering the typical clinical features and the histological feature. We report a patient of 25-year old man presented with joint pain involving in multiple joints for last 7 years and progressive enlargement of his hands and feet with profuse sweating of palms and soles for last 4 years. Physical examination revealed thickened skin with excessive furrowing of his forehead, dropping of both eyelids, clubbing of all fingers, toes and enlargement of his hands and feet with pamoplantar hyperhidrosis. Laboratory investigation shows raised CRP, X-ray feet lateral view showed normal heel pad thickness, new bone formation and periosteal elevation in lower end of tibia and fibula and skin biopsy showed dense fibrocollagenous tissue in dermis and subcutis and mild acanthosis. With this scenario he was diagnosed as primary hypertrophic osteoarthropathy (Pachydermoperiostosis). After diagnosis he was treated with cholchicine (0.6mg) twice daily, naproxen (500mg) twice daily, and risedronate (150mg) monthly. After one year his skin texture became less thickened, joint pain improved, there was no further enlargement of acral part of fore arm. In this report we review the characteristic features of this syndrome. We highlight the importance of ruling out secondary forms of hypertrophic osteoarthropathy and of a close follow-up of these patients because of complications that might develop on long-term. Although no treatment was satisfactory, we wanted to emphasize that NSAIDs, Cholchicine and risedronate could be an effective treatment option.