PREVALENCE OF HEPATITIS B AND HEPATITIS C AMONG PREOPERATIVE SURGICAL PATIENTS AT BASRAH GENERAL HOSPITAL

Viral hepatitis is a worldwide health problem which requires a thorough knowledge and orientation. Clinical awareness of medical and paramedical staff regarding hepatitis portfolios so important to avoid serious short and long term sequel of hepatitis distribution to other individuals therefore a fundamental strategy has been planned and made in our local surgical field to highlight that issue in different types of surgery. Patients and methods: Retrospective descriptive study was carried out at Basrah General Hospital; Department of Surgery between Sept 2012 and Sept 2013 for patients underwent elective surgery in surgical department. Data was collected on the patients’ clinical history and laboratory findings of hepatitis screen for preoperative patients. The findings were recorded in a structured compilation. Results: A total of one thousand and seven hundred and thirty patients entered the study and those were analyzed in terms of general patient data in respect to age and sex as well as analysis of hepatitis screening findings. There were 1034 (59.7 %) males and 696 (40.3 %) females, with ages ranging from 8 months -70 year. The highest prevalence of Hepatitis B and C occurred in the same age group of 40 to 49 years. The sex related distribution of Hepatitis in general patients revealed more female patients than male ones (45/43).This figure is similar among patients in Hepatitis C (22/19) and both Hepatitis B and C (2/1). Hepatitis B showed a reverse pattern of being male predominance with a male to female distribution (23/21). In conclusion: Clinical awareness is the master of prevention of Hepatitis spread as proper knowledge about transmission and precautions could be of value in reducing disease transmission. Introduction iral hepatitis is a worldwide health problem which requires a thorough knowledge and orientation. About two billion people has infected by hepatitis B virus (HBV) and 350 million people are estimated to be carrier of the virus as well as around one million people die from hepatitis B, makes it one of the major causes of morbidity and mortality 1 . According to WHO estimates, Hepatitis C virus (HCV) prevalence is 3% of world population with 170 million cases. Almost 50% of all cases become chronic carriers at risk of liver cirrhosis and liver cancer 2 . Both Hepatitis B and C are transmitted through blood either by percutaneous or body fluids (semen, saliva or vaginal secretion) 3,4 . Doctors, especially surgeons, and the paramedical staff have a high occupational risk of acquiring HBV and HCV infection from patients 5 . There are few population based surveys of HCV and HBV from Europe and USA which reports a prevalence ranging between 1-12% for anti-HCV and 0.8-2.1% for HBs Ag 6-8 . Prevalence of HCV and HBV is high among injection and drug users, prisoners, V Hepatitis b & c among preoperative surgical patients MH Al-Hawaz, MH Al-Hijaj & SA Al-Mansori 63 Bas J Surg, June, 20, 2014 haemodialysis patients, health care workers, patients with history of blood transfusions, voluntary and paid blood donors, and pregnant women 6 . Approximately 500,000 percutaneous blood exposures occur among hospitalbased health care workers in the United States each year 6 . Surgeons and operating room personnel have the highest risk of occupational exposure 7,8 and sharp injuries in the operating room are the least likely to be reported. While the exposure rate associated with the operating room setting is recognized to be significant, little is known about the current prevalence rate of Hepatitis B and Hepatitis C among patients presenting for surgery in some health institutions 9 . Unfortunately, once inflicted, these infections show poor response to the available treatment modalities. Therefore precautionary methods are considered the best way to avoid spreading of this disease. Unlike HCV, several vaccines have been developed for HBV that provide long lasting immunity to individuals 10 . It is the most important precautionary measure of HBV as a vaccinated individual may never contract the infection 11 . Clinical awareness of medical and paramedical staff regarding hepatitis portfolios so important to avoid serious short and long term sequel of hepatitis distribution to other individuals therefore a fundamental strategy has been planned and made in our local surgical field to highlight that issue in different types of surgery. Aim of study This study was carried out in the general surgical ward of Basrah General Hospital to find out the prevalence of Hepatitis B and C among admitted preoperative patients. Patients and Methods This retrospective descriptive study was carried out at Basrah General Hospital, Department of Surgery between Sept 2012 and Sept 2013 for patients underwent elective surgery in surgical department. Patient demographics was evaluated. The study protocol was approved by the ethics committee of Basrah General Hospital and College of medicine, University of Basrah. The inclusion criteria were patients of both age and sex who needed surgery. The exclusion criteria were patients who did not need surgery and serious patients who presented in accident and emergency and needed immediate surgery. Data was collected on the patients’ clinical history and laboratory findings of hepatitis screen for preoperative patients. The findings were recorded in a structured compilation. An enzyme-linked immunosorbent assay (ELISA) was used to screen for hepatitis C virus (HCV) antibodies which was confirmed by hepatitis C recombinant immunoblot assay (RIBA). Hepatitis B virus was tested by using hepatitis B surface antigen (HBSAg). Data were analyzed using SPSS 18.0 software. Results A total of one thousand, seven hundred and thirty patients entered the study and those were analyzed in terms of general patient data in respect to age and sex as well as analysis of hepatitis screening findings. Concerning general criteria of patients, a total of 1730 patients were included in the study. There were 1034 (59.7 %) males and 696 (40.3 %) females, with ages ranging from 8 months -70 year. The age-specific prevalence’s for Hepatitis B and C markers are presented in Table I. The highest prevalence of Hepatitis B and C occurred in the same age group of 40 to 49 years, The sex related distribution of Hepatitis in general patients revealed more female patients than male ones (45/43) This figure is similar among patients in Hepatitis C Hepatitis b & c among preoperative surgical patients MH Al-Hawaz, MH Al-Hijaj & SA Al-Mansori 64 Bas J Surg, June, 20, 2014 (22/19) and both Hepatitis B and C (2/1). Hepatitis B showed a reverse pattern of being male predominance with a male to female distribution (23/21)(Table II). Table I: Distribution of hepatitis cases according to age Age group Number of patients HBsAg Anti HCV HBsAg + Anti HCV


Introduction
iral hepatitis is a worldwide health problem which requires a thorough knowledge and orientation.About two billion people has infected by hepatitis B virus (HBV) and 350 million people are estimated to be carrier of the virus as well as around one million people die from hepatitis B, makes it one of the major causes of morbidity and mortality 1 .According to WHO estimates, Hepatitis C virus (HCV) prevalence is 3% of world population with 170 million cases.Almost 50% of all cases become chronic carriers at risk of liver cirrhosis and liver cancer 2 .
Both Hepatitis B and C are transmitted through blood either by percutaneous or body fluids (semen, saliva or vaginal secretion) 3,4 .Doctors, especially surgeons, and the paramedical staff have a high occupational risk of acquiring HBV and HCV infection from patients 5 .There are few population based surveys of HCV and HBV from Europe and USA which reports a prevalence ranging between 1-12% for anti-HCV and 0.8-2.1% for HBs Ag [6][7][8] .Prevalence of HCV and HBV is high among injection and drug users, prisoners, V haemodialysis patients, health care workers, patients with history of blood transfusions, voluntary and paid blood donors, and pregnant women 6 .Approximately 500,000 percutaneous blood exposures occur among hospitalbased health care workers in the United States each year 6 .Surgeons and operating room personnel have the highest risk of occupational exposure 7,8 and sharp injuries in the operating room are the least likely to be reported.While the exposure rate associated with the operating room setting is recognized to be significant, little is known about the current prevalence rate of Hepatitis B and Hepatitis C among patients presenting for surgery in some health institutions 9 .Unfortunately, once inflicted, these infections show poor response to the available treatment modalities.Therefore precautionary methods are considered the best way to avoid spreading of this disease.Unlike HCV, several vaccines have been developed for HBV that provide long lasting immunity to individuals 10 .It is the most important precautionary measure of HBV as a vaccinated individual may never contract the infection 11 .Clinical awareness of medical and paramedical staff regarding hepatitis portfolios so important to avoid serious short and long term sequel of hepatitis distribution to other individuals therefore a fundamental strategy has been planned and made in our local surgical field to highlight that issue in different types of surgery.

Aim of study
This study was carried out in the general surgical ward of Basrah General Hospital to find out the prevalence of Hepatitis B and C among admitted preoperative patients.

Patients and Methods
This retrospective descriptive study was carried out at Basrah General Hospital, Department of Surgery between Sept 2012 and Sept 2013 for patients underwent elective surgery in surgical department.Patient demographics was evaluated.The study protocol was approved by the ethics committee of Basrah General Hospital and College of medicine, University of Basrah.The inclusion criteria were patients of both age and sex who needed surgery.The exclusion criteria were patients who did not need surgery and serious patients who presented in accident and emergency and needed immediate surgery.Data was collected on the patients' clinical history and laboratory findings of hepatitis screen for preoperative patients.The findings were recorded in a structured compilation.An enzyme-linked immunosorbent assay (ELISA) was used to screen for hepatitis C virus (HCV) antibodies which was confirmed by hepatitis C recombinant immunoblot assay (RIBA).Hepatitis B virus was tested by using hepatitis B surface antigen (HBSAg).Data were analyzed using SPSS 18.0 software.

Results
A total of one thousand, seven hundred and thirty patients entered the study and those were analyzed in terms of general patient data in respect to age and sex as well as analysis of hepatitis screening findings.Concerning general criteria of patients, a total of 1730 patients were included in the study.There were 1034 (59.Sayed et al also showed that the total prevalence of Hepatitis B and Hepatitis C in males was very high compared to females among preoperative surgical patients 19 .
Male predominance was seen in other studies as in Khan and Mashud et al 20,21 .
We think that our study does not reflect the true prevalence of HBV and HCV in the general population because the sample taken was only of surgical data which might under estimate the true prevalence of Hepatitis B and C infection in the general population.Clinical awareness is the master of prevention of Hepatitis spread as proper knowledge about transmission and precautions could be of value in reducing disease transmission.