Aim: to measure Seroprevalence of HBsAg and Anti HCV in surgical patients admitted at Ghulam Mohammad Maher Medical College infirmary Sukkur.
Methodology: This prospective observational survey was conducted in Surgical Unit-1 Ghulam Mohammad Maher Medical College Hospital Sukkur. All the patients above 15 old ages age, admitted for surgery from 1st July 2008 to 31st December 2008 were included in survey. Patients were screened for HBsAg and Anti-HCV by Immunochromatography kit. Those who were holding past history of seropositivety for Hepatitis B and C or chronic liver disease were excluded from survey.
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Consequences: During survey period of six months 449 patients were admitted and screened for HBsAg and Anti-HCV. It included 290 ( 64.5 % ) males and 159 ( 35.5 % ) females. Out of these 19 ( 4.3 % ) patients were HBsAg positive and 38 ( 8.4 % ) patients were Anti-HCV positive while 3 ( 0.6 % ) were positive for both HBV and HCV. Parenteral injections, old surgery/ blood transfusion and shave by Barbers found to be the hazard factors.
Decisions: We conclude that there is considerable symptomless prevalence of Hepatitis B and C in surgical patients. There is a great blank in our infirmaries that we are non making pre-operative showing of patients as everyday which poses a menace of transmittal of disease. Since there is no remedy or remedies are really expensive for hepatitis B and C, in order to forestall the spread of disease it is necessary to test every patient before surgery. Every individual should be vaccinated against HBV. Multitudes are to be informed through electronic and print media for hazard factors.
Cardinal words: Hepatitis B, Hepatitis C, HBsAg, Anti-HCV, Surgical patients.
Viral hepatitis is a planetary public wellness job. There is a scope of Hepatitis viruses named A, B, C, D, and E Virus that affect the liver. Hepatitis A and E has a ego restricting class and they do non come on to chronic liver disease ( CLD ) .1 Hepatitis B ( HBV ) and C ( HCV ) are a serious challenge to wellness attention professionals universe broad since they progress to CLD and Hepatocellular carcinoma. The Hepatitis D or delta virus is unable to retroflex on its ain but is activated by the presence of HBV. It is peculiarly seen in endovenous drug maltreaters. HBV was discovered in 1963 and its serological marker, Hepatitis B Surface Antigen ( HBsAg ) , was isolated by Blumberg in same year.2-3 It is estimated that there are more so 350 million HBV bearers in the universe and approximately more than one million people die each twelvemonth due to HBV related liver disease.4 HCV was isolated in 1989. It has infected about 500 million people in the world.5 Assorted prevalence rates of HCV have been reported locally and abroad, runing from 0.4 % to 24 % .6-8 HBV and HCV both are transmitted by contaminated blood transfusion, unsterlized panpipes and surgical instruments, dental surgery, sexual contact, drug maltreatment, sharing of razors, tooth coppices and shaving by barbars.9-11 Transmission of blood borne HBV and HCV from wellness attention professionals to patient has besides been documented.12-14
Our state has immense load of these viral diseases and symptomless patients pose a great danger of distributing the infection to wellness attention professionals and other patients. To understand and measure the magnitude and kineticss of disease transmittal in a community and for its control and bar, the appraisal and survey of its prevalence is indispensable. Therefore we decided to measure the magnitude of these viral diseases in the hospitalized surgical patients so that particular safeguards could be taken to look into their transmittal.
Patients AND METHODS
This survey was conducted in Department of Surgery, Unit-1, Ghulam Mohammad Maher Medical College Hospital ( GMCH ) that is a teaching infirmary providing services to Upper Sindh, next countries of Balouchistan and lower Punjab. All the patients admitted for surgery from 1st July 2008 to 31st December 2008 were included in survey. The patients were screened for HBsAg and Anti HCV utilizing immunochromatography ( ICT ) method in GMCH research lab located in close locality of indoor block. Those who were weak positive by ICT were farther tested by Enzyme Linked Immunosorbent Assay ( ELISA ) . Those patients who had past history of Hepatitis B and C and chronic liver disease were excluded from survey. The information sing demographics, old known hepatitis profile, hazard factors and inoculation was recorded on proforma. Particular safeguards were taken during surgery of positive patients like utilizing custodies free transportation of crisp film editing instruments, have oning dual baseball mitts and being watchful during skin closing with cutting acerate leafs. The nursing staff in the ward was besides warned to avoid needle stick hurts while managing these patients. After surgery all patients were referred to doctors for farther direction in Liver clinic established by Prime Ministers plan in our infirmary.
During six months study period, 449 patients were admitted for surgery which included 290 ( 64.5 % ) males and 159 ( 35.5 % ) females. Their ages range from 15 to 80 old ages. The average age was 40.3 old ages with SD= 16.79. Out of 449 screened patients, 19 ( 4.3 % ) were positive for HBsAg and 38 ( 8.4 % ) were positive for Anti HCV and three ( 0.6 % ) patients were positive for both HCV and HBV. Among 19 HBsAg positive patients, 13 ( 68.5 % ) were male and 6 ( 31.5 % ) were female and out of 38 Anti HCV positive patients 23 ( 60.5 % ) were male and 15 ( 39.5 % ) were female. Their distribution is shown in Table No.1. Hazard factors identified in seropositive patients are shown in tabular array: 2. No patient had history of inoculation against HBV.
Table No:1 Age wise distribution of HBV and HCV positive instances.
No. Age HBV positive HCV positive
15 – 20 old ages 3 ( 15.7 % ) 5 ( 13.2 % )
21 – 30 old ages 5 ( 26. 3 % ) 9 ( 23.7 % )
31 – 40 old ages 3 ( 15.7 % ) 8 ( 21.1 % )
41 – 50 old ages 5 ( 26. 3 % ) 5 ( 13.2 % )
51 – 60 old ages 1 ( 5. 3 % ) 2 ( 5. 2 % )
61 – 70 old ages 0 6 ( 15.7 % )
71 – 80 old ages 2 ( 10.7 % ) 3 ( 7. 9 % )
Entire 19 ( 100 % ) 38 ( 100 % )
Table No.2 Risk factors
No. Risk factor No. of instances HBV +ve No. of instances HCV +ve
Parenteral injections 13 ( 68.5 % ) 20 ( 52.7 % )
Previous surgery / blood 2 ( 10. 6 % ) 6 ( 15. 7 % )
3. Shaving from Samuel barbers 1 ( 5. 2 % ) 5 ( 13.1 % )
4. No cause found 3 ( 15.7 % ) 7 ( 18. 5 % )
Entire 19 ( 100 % ) 38 ( 100 % )
Hepatitis B and C are the major causes of morbidity and mortality around the universe, particularly in developing states. Prevalence of HBV and HCV in the Asia-pacific is 10 % and 4-12 % severally. [ 15-16 ] Incidence of these viruses in general Pakistani population ranges between 4 to 25 % . [ 17-18 ] In our survey the prevalence of HBsAg and Anti HCV in surgical patients was 4.3 % and 8.4 % while 0.6 % was positive for both. The consequences of our survey are comparable to surveies done in different metropoliss of Pakistan, Karachi HBV ( 6.5 % ) and HCV ( 11.3 % ) [ 19 ] , Rawalpindi HBV ( 2.8 % ) and HCV ( 7.5 % ) [ 20 ] , Nawabshah HBV ( 8.6 % ) and HCV ( 11.6 % ) [ 21 ] , Jacobabad HBV ( 9.33 % ) and HCV ( 14 % ) [ 22 ] , survey from Rawalpindi by Bhopal FG et Al HBV ( 18.66 % ) and HCV ( 6.33 % ) [ 23 ] . Two surveies done in Japan 1 shows seropositivety of HBV ( 1.8 % ) and HCV ( 7.1 % ) and other shows seropositivety of HCV ( 16.9 % ) [ 24-25 ] .
We have recognized three hazard factors in our survey. ( Table-2 ) The most common was usage of contaminated panpipes. History of I/V and I/M drug injection was present in 68.5 % patients positive for HBV and 52.7 % patients were positive for HCV. Same hazard factor is most often seen in their survey by Zubia et Al. They have noted history of parenteral therapy in 96 % patients positive for HBV and 95.4 % patients ‘ positive for HCV. Faridullah S et Al [ 26 ] and Aslam M et Al [ 27 ] have reported parenteral drug therapy as a hazard factor for transmittal of hepatitis B and C 40.8 % and 4.76 % severally. There are 1000s of quacks practising in rural countries that have no construct of sterilisation. They are utilizing same syringe for more than one patient and charge money harmonizing to figure of injections injected in any one patient.
Past history of surgery and blood transfusion was present in 10.6 % of HBsAg positive patients and 15.7 % of Anti-HCV positive patients in our survey. This hazard factor was seen in those patients who were operated in exigency. Mistake may be lying in wrong showing of blood arranged in exigency or utilizing same blade for many patients to shave abdominal hair. Shave of venters of patient is routinely done by sweepers who are utilizing a same razor for many patients.
We conclude that there is considerable symptomless prevalence of Hepatitis B and C in surgical patients. There is a great blank in our infirmaries that we are non making pre-operative showing of patients as everyday which poses a menace of transmittal of disease.
Keeping in position high prevalence of hepatitis B and C in surgical patients, we recommend:
Everyday showing of all patients for HCV and HBV before surgery.
Shaving of surgical site should be done by disposable razors.
Ban should be imposed on pattern of Quacks.
The disposable panpipes should be used for every patient and after usage they should be disposed decently to avoid their reuse.
To avoid transmittal of disease from patient to wellness attention workers and vise versa, exceptional precautional steps like, custodies free transportation of crisp instruments, have oning dual baseball mitts, should be taken.
Public should be made cognizant of hazard factors through electronic and print media.