1.
Epidemiological And Molecular Profile Of Hepatitis-C Viral Infection Among Different Groups Of Population In And Around Lahore, Pakistan
by Dr. Abdul Majeed Akhter | Prof. Dr. Muhammad Athar Khan | Prof. Dr. Azhar Maqbool.
Material type: ; Format:
print
; Literary form:
drama
Publisher: 2012Dissertation note: Hepatitis C is an infectious disease affecting primarily the liver, caused by the hepatitis C virus (HCV). The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years. In some cases, those with cirrhosis will go on to develop liver failure, liver cancer or life-threatening esophageal and gastric varices.
The present project was carried out to study the prevalence of laboratory based confirmed patients of Hepatitis-C in various public, private hospitals and in high risk groups among the population of Lahore metropolitan and its distribution and pattern with respect to person, time and place. Second part of the project was designed to study the risk factors of Hepatitis-C patients from out patient departments of various public and private hospitals of Lahore. Individuals at high risk from different organizations and occupations across the city population of Lahore metropolitan were also included in the study. The third part of the project was designed to investigate the distribution of genotypes of Hepatitis-C virus among patients through RT-PCR and theireffect on viral load, various haematological and biochemical parameters.
Project-I
Study-1: To estimate the prevalence of hepatitis C in various public and private hospitals of Lahore Metropolitan among different groups a total of 1399 individuals were tested to estimate the hospital based prevalence of HCV. Out of these 233 individuals produced positive result for Hepatitis-C virus infection. The overall hospital based prevalence was estimated to be 16.66% during the year 2009. The current study revealed that the highest prevalence was estimated in Dialysis patients and Organ recipients (41.17%) followed by General Patients of age > 12 years (14.60%) and pregnant women (10.84%). It was further observed that the least affected group was the Children of age ? 12 years (3.85%).
Study-2: The results of estimated prevalence of Hepatitis C virus infection in high risk groups from the population in and around Lahore revealed that the highest prevalence was estimated in patients with HIV/AIDS (36.36%) followed by injecting drug users (36.09%), blood donors (17.78%), long rout truck drivers (14.70%), house hold and direct contact personal (14.6%) and prisoners (14.28%). It was also find out that the less affected groups were police department (10.66%), staff nurses and other health care workers (9.87%) and barbers and beauticians (6.97%) while doctors and dental surgeons were least affected (1.32%) among the high risk groups.
Study-3: To find out the pattern and distribution of HCV patients with respect to person place and time a total of 924 patients were selected from the registry of Provincial Hepatitis Control Cell Lahore through systematic random sampling. Out of these, 154 fulfilled the inclusion criteria. Among these, 90 were male and 64 were females. Average age of male and female patients was 35.88±10.49 and 37.78±9.12 years, respectively. The age difference between male and female patients was statistically non-significant (P-value>0.05). It was further observed that 147 patients were Punjabi and 7 were from other provinces. Moreover, It was found that the highest number of patients was observed during the month of December (n=18) followed by November, 2008 (n=15), March (n=15) and July, 2009 (n=14) while the least number of patients were observed during the months of September, 2008 and May, 2009 (n=10).
Project-II
To study the risk factors associated with HCV infection an analytical cross sectional study was conducted.
Study-1: Lower socio economic class, place of birth (hospital), delivery assisted by whom and breast feeding were significantly associated with HCV infection in children of age ? 12 years. The mean age of reactive and non-reactive general patients was significantly associated (P=0.012) with anti-HCV status. Marital status (OR=2.042), socioeconomic status, blood donation (OR=2.15), prescription by doctor or non-doctor (OR=2.664), route of drug administration, relative having hepatitis and towel sharing (OR=1.987) were also significantly associated (P<0.05) risk factors for HCV infection. The mean age of reactive and non-reactive pregnant women was 27.55±3.43 and 25.37±4.24 years, respectively. Educational level (OR=3.093) and occupational status (OR=2.228) were the important risk factors associated with HCV infection. Tattoo on the body (OR=11.833), comb sharing (OR=20.86) and razor sharing (OR=4.786) were significantly associated (P<0.05) with HCV infection. Pregnant women who gave the history of dental procedures and tooth brush sharing were 3.15 and 4.12 times more prone to get HCV infection, respectively. In 205 patients having dialysis and organ recipients 41.17% patients were reactive for Anti-HCV. Blood transfusion, glass sharing and qualification of the patients were significant factors in this group.
Study-2: In case of doctors/dental surgeons a significant association was observed with history of blood transfusion and duties in medical and surgical wards. The nurses who worked in surgical wards, visited beauty salons were significantly associated (P<0.05) with HCV infection. Among health care workers age, gender and other factors did not have any significant influence on the reaction of HCV. Among blood donors female to male ratio was 1:16.5. It was found that the occupational status (p=0.002), place of surgical treatment (p=0.035), history of blood transfusion (p=0.000), ever pricked by sharps (p=0.045), habit of injecting drugs (p=0.04) and glass sharing (p=0.017) were significantly associated with occurrence of hepatitis C in blood donors. In long route truck drivers geographical status, surgical procedure, dental treatment and family history were significantly associated (P<0.05). Among the injecting drug users, demographic factors like marital (P=0.007) and educational status (P=0.000) were found to be significantly associated with HCV infection. Furthermore, the behavioral factors; use of injectable drugs with reused syringes (P=0.003), sharing of syringes in groups (P=0.004), place of shaving (P=0.000), use of disinfected ustra (razor) (P=0.003) and razor sharing (P=0.000) were significantly associated with anti-HCV status for IDUs. Among HIV/Aids patients a statistically significant (P<0.05) difference was present among the ages of reactive and non reactive patients. Comb sharing has also a positive effect of HCV but all other factors were not contributing in this group. In Police personals odds ratio for married persons was higher (9.57) but statistically insignificant. The mean age for reactive persons was 39.75±8.24 years. A non-sexual contact with HCV patient and spoon sharing were significantly associated. In prison inmates skin infection and sexual involvement were significantly associated (P<0.000) with HCV infection. In the group of 43 barbers/beauticians age, working shift, tattoo on body (OR=19.5), injecting drugs (OR=19.5) and pre-testing for HCV (OR=19.5) were significantly associated with HCV infection. In house hold and direct contact group previous history of accidents and family history of HCV (OR=18.36) were significantly associated with HCV infection.
Project-III
A molecular epidemiological study was conducted in which the HCV reactive patients as tested by ELISA test were subjected to viral load and genotyping through RT-PCR. The positive cases of Project-I were included in this project. In the present study 558 patients were reactive for Anti-HCV. Out of these, 34 (6.09%) patients had Type-1 genotype, 67 (12%) patients were accounted for Type-2 and 410 (73.47%) patients were positive for Type-3. Multiple genotypes were seen in 19 (3.4%) patients, 9 (1.61%) patients had un-type able genotype whereas in 19 (3.4%) patients genotype could not be detected. According to the distribution of genotype-1, 1a was present in 30 (88.23%) while 1b was seen in 4 (11.76%) patients. In patients of Type-2 genotype, 2a and 2b were present in 54 (80.59%) and 13 (19.40%) patients, respectively. In patients having Type-3, 3a and 3b were identified in 353 (86.09%) and 57 (13.90%) patients, respectively. Furthermore, Bilirubin, ALT, AST, ALPT, viral load, Hb, TLC, DLC, Platelet and ESR were statistically same in all genotype.
Availability: Items available for loan: UVAS Library [Call number: 1529,T] (1).
2.
A Study On The Incidence Of Zoonotic Tuberculosis To Assess The Associated Risk Factors And Zoonotic Potential Of Bovine Tuberculosis In Lahore
by Syeda Anum Hadi (2013-VA-04) | Dr. Hassan Mushtaq | Dr. Abdul Majeed Akhtar | Professor Dr.Mansur-ud-din Ahmad | Dr. Aamir Gafoor Bajwa.
Material type: ; Format:
print
; Literary form:
not fiction
Publisher: 2015Dissertation note: In the review by O’Reiley and his colleagues, Tuberculosis has been defined as a disease that affects the respiratory system foremost and its route of transmission from one animal species to another is by the airborne route along with consumption of un-pasteurized milk (O'Reilly, 1995) (De la Rua-Domenech, 2006) (Thoen et al. 2006). The review states that Mycobacteriumbovis causes tuberculosis in bovines as well as a number of wild animals such as goats, cats, dogs, pigs, buffalo, badgers, possums, deer, bison and non-human primates but most importantly it causes tuberculosis in humans. This makes the disease of significant public health importance due to its zoonotic nature.
The study was conducted in two of the largest dairy colonies in Lahore- Rakhchandra and Harbanspura dairy colony. 400 dairy animals (lactating) were selected from the target areas. 200 animals per field were chosen through convenience sampling. The research was divided into two parts. Phase 1 was concerned with screening of animals for bovine tuberculosis through performance of comparative intradermal tuberculin test (CIDTT) and followed by culturing of milk samples from animals that came positive. Phase 2 was concerned with testing of all human subjects who were in contact with the positively screened livestock. Since none of the human subjects showed any of the signs for tuberculosis, no testing of the humans could be performed.
The first step to animal testing was concerned with the screening of selected animals with comparative cervical intradermal tuberculin test (CIDTT). This involved the intradermal injection of bovine tuberculin purified protein derivative (PPD) and the subsequent detection of swelling (delayed hypersensitivity) at the site of injection 72 hours later (Anonyms, 2008a). The test was considered positive if the difference between the swellings on the two sites was more than 4mm and it was the mammalian site that showed more swelling. Once the results were read, the dairy farmers were asked a set of questions designed to identify risk-factors for zoonotic tuberculosis. The farmers responded to nearly all the questions that were posed to them.
Milk sample was collected from the animals that tested positive. 50 ml of milk was collected from the positive animals. Once collected, the milk bottles were quickly capped and labeled and put in the ice-box before being transported to Provincial Tuberculosis Reference Laboratory in Lahore. Staining followed by culturing of milk samples for the isolation of Mycobacterium bovis was then proceeded with. For the purpose of culturing two types of media were prepared before-hand-Lowenstein Jensen (LJ) media and LJ-pyruvate media. LJ medium allows the growth of Mycobacterium tuberculosis, whereas LJ with pyruvate medium allows the growth of Mycobacterium bovis.
Petroff’s method was employed for the processing of milk samples which originally is used for sputum processing (Anonyms, 2009). The process was altered to suit our requirements. Once processed 300ul of pipette tips were used to place 100ul of processed sample on pre-marked slides for ziehl-neelson staining and 120ul on pre-made media slants a total of 4 bottles, 2 each of LJ media and LJ pyruvate media for duplication of results and to act as control. The bottles were checked for growth every week on Monday till 8 weeks of time.
At Rakhchandra dairy colony the tuberculin test done on 200 animals revealed only three (3) positive animals. Thus the prevalence of TB in Rakhchandra came out to be 1.5%. Out of 200 animals in Harbanspura dairy colony, six (6) animals showed hypersensitivity reaction and were positive. Prevalence of TB in Harbanspura came out to be 3%. Out of 400 animals tested, 90 were cattle and 310 were buffaloes. Only buffaloes showed hypersensitivity reaction to tuberculin. None of the cows tested came out to be tuberculin positive. In this particular study, the prevalence of TB on the basis of tuberculin test in buffalo was 2.9% where as in cattle it was 0%. When milk was collected and processed from the above mentioned nine (9) animals, the results showed a different picture. None of the cultures showed any signs of growth by 8 weeks of incubation. All nine milk samples after cleaning were stained by ZN staining and observed under microscope for the presence of mycobacterium, none came out positive.
The Basic Health Units (BHU) in each of the colony were contacted and it was found that in the last 10 years less than 10 patients who were suspected to have tuberculosis were referred to District Health Quarter (DHQ).
Even though a higher percentage (44.44%) of farmers in Harbanspura was recorded to have some knowledge about the zoonotic aspect of tuberculosis as compare to those in Rakhchandra (22.22%), yet a higher number of tuberculin positive animals was found in Harbanspura (6 versus 3). The economic status of farmers in Harbanspura was comparatively higher with 33.33% of farmers earning more than 1 lakh rupees per month, whereas in Rakhchandra this figure stood at 27.78%. This might be a mere chance of co-incidence but it also implies the unwillingness of farmers to apply biosecurity measures at their farms. Lack of willingness to take such precautionary steps places the farmers and their animals in great peril, since in the last six months alone 66.67% of the farmers in Harbanspura had purchased at least one animal, which is enough to bring disease in an un-infected herd. Only 27.78% of farmers in Rakhchandra had purchased animals on the other hand. Also only 77.78% of farmers in Harbanspura would clean the dung from the farms twice a day whereas 100% Rakhchandra farmers would cleanup twice a day. The tuberculin positive animals were found to be spending most time of their day in filthy places. Their sheds were not cleaned regularly. Heaps of dung and ground wet with urine was observed on every visit. It exposed animals to numerous infections and 11.11% of animals in Harbanspura and 44.44% of animals in Rakhchandra were suffering from unidentified chronic illnesses. Farmers said that they preferred to sell such animals to butchers (85.8% combined percentage), rather than burying after culling (3.7% combined percentage). Deworming was not considered a mode of disease prevention amongst the farmers since only 22.22% of all farmers bothered to deworm their animals. The animals were seen to not having a score of above 2.5 when their body scoring was done (Scale 1-5). The one blissful factor discovered was the habit of nearly all farmers (92.59%) preferred to boil milk before consumption. Even dairy products were made from boiled milk (81.48%). This single factor could be the reason why the farmers consuming otherwise contaminated milk was still in such a glowing healthy condition.
The study allowed us to get a measure of the status of disease in lactating animals and to investigate the conditions that prevail in the two dairy colonies. It showed a difference in the prevalence of disease in Harbanspura and Rakhchandra famous for providing milk to Lahore city. This was scrutinized through a detailed analysis of farmer habits and environment of animals in both the fields. This study would permit upcoming researchers to have an up-to-date status of tuberculosis in the dairy colonies.
Availability: Items available for loan: UVAS Library [Call number: 2321-T] (1).
