HBsAg Test Research Articles

Evaluation of a Hepatitis B Virus Reactivation Prevention Program in Lymphoma Patients Receiving Immunochemotherapy

INTRODUCTIONChemotherapy-induced hepatitis B virus (HBV) reactivation is a well-recognized complication and is a potentially life-threatening condition in cancer patients with chronic HBV (hepatitis B surface antigen [HBsAg]-positive).Rituximab has been associated with an increase in HBV reactivation in chronic HBV patients (45%) and even in patients with resolved infection (HBsAg negative and hepatitis B core antibody [anti-HBc]-positive (22%); however, the reported frequency varies among different studies.Current guidelines for management of chronic HBV recommend routine antiviral HBV prophylaxis with lymphoma before starting chemotherapy. In contrast, there is little evidence-based consensus regarding patients with resolved HBV infection.Aim: To analyze the incidence of HBV reactivation and the role of antiviral HBV prophylaxis in lymphoma patients with chronic HBV or resolved HBV treated with chemotherapy, immunotherapy or immunochemotherapy managed according to our institutional HBV guidelines. Secondary endpoints were to analyze the incidence of HBV in this population and HBV guidelines adherence.PATIENTS AND METHODSLymphoma patients with chronic HBV or resolved HBV in a single center.HBV viral status definitions: Active Chronic HBV infection: HBsAg positive, anti-HBc positive and HBV DNA >2000 IU/mL; Inactive Carriers: HBsAg positive, Anti-HBc positive, HBV DNA undetectable or <2000 IU/mL with normal transaminases; Resolved HBV: HBsAg negative, anti-HBc positive, HBV DNA undetectable.HBV reactivation was defined as increased serum HBV DNA (≥1 log10), regardless of liver biochemistry or HBsAg status.Institutional HBV guidelines: serum samples were collected at baseline for HBsAg and anti-HBc testing in all lymphoma patients. Patients were evaluated by a hepatologist if any of them fulfilled HBV viral status definition. Baseline at screening and monitoring every 3 months during therapy and up to 24 months after completing therapy (assessment of liver biochemistry, serum HBV DNA, HBsAg and anti-HBs levels). Specific prophylaxis strategies according to HBV status: Group A (Active chronic HBV): treatment for HBV; Group B (Inactive carriers): antiviral HBV prophylaxis; Group C (Resolved HBV): antiviral HBV prophylaxis if rituximab containing-therapy or follow-up only if rituximab-free therapy. HBV antiviral prophylaxis was started before therapy and finished 12 months after completing therapy.RESULTSFrom January 2012 to January 2015, 227 lymphoma patients received chemotherapy or immunochemotherapy. 142 (63%) patients received rituximab-containing therapy. 43 (19%) patients were anti-HBc positive. Group A: 2 (1%) patients; Group B: 2 (1%) patients; Group C: 39 (17%) patients. 14 (6%) patients have coinfection with hepatitis C virus and 12 (5%) patients co-infection with human immunodeficiency virus (HIV). Adherence to HBV guidelines was 90%. Patients in Group A (n=2) and B (n=2) received antiviral treatment/prophylaxis before starting therapy. In the Group C, 16 (41%) patients underwent only follow-up and 23 (59%) patients received HBV antiviral prophylaxis (lamivudine in 4, entecavir in 8 and tenofovir in 11). Median duration of HBV prophylaxis was 18 months (95% CI: 16-19 months). After a median follow-up of 21 months, 2 patients developed HBV reactivation during lymphoma treatment: 1 from group B (reactivation rate of 50%) and 1 from group C (reactivation rate of 3%). Both patients had received rituximab-containing treatment and both developed HBV reactivation (without hepatitis flare) within the first 6 months after finishing antiviral HBV prophylaxis (delayed HBV reactivation). Outcome was favorable in both patients. Characteristics of HBV reactivation patients are shown in table I. Cumulative incidence of HBV reactivation at 12 and 24 months were 0% and 8%, respectively.CONCLUSIONOur strategy of close monitoring patients with chronic HBV or resolved HBV that receive chemotherapy and adding antiviral HBV prophylaxis only in selected patients clearly decrease HBV reactivation. Nevertheless, this strategy may not fully protect patients from late HBV reactivations. Larger validation studies are needed to confirm our data and to establish the best cost-effective strategy in this lymphoma population, especially in the new era of inmunomodulatory drugs of their real involvement in HBV reactivation is unknown. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Sero-prevalence and Correlates of Hepatitis B and C Co-infection Among HIV-infected Individuals in Two Regional Hospitals in Cameroon.

Background:Liver disease related to Hepatitis B (HBV) and C (HCV) infection has become a major cause of morbidity and mortality in HIV/AIDS patients. Data on the prevalence of HBV and HCV in Cameroon remains inconclusive.Objective:We aimed to determine the sero-prevalence and correlates of Hepatitis markers in HIV/AIDS patients in two Regional Hospitals.Methods:A cross-sectional study carried out from December 2014 to March 2015. HIV/AIDS patients aged 21 were included and above, receiving care at HIV treatment centres. Data was collected using a structured questionnaire. Blood samples were collected to screen for Hepatitis with HBsAg and anti HCV antibody rapid immunochromatographic test kits. Correlates of hepatitis were investigated by logistic regression. STATA was used for data analysis.Results:We included 833 HIV/AIDS patients,78.8% (657) were female. Mean age was 44(SD 11) years. Prevalence of Hepatitis in general (total of two viral markers tested) was 8.9% (74/833), with 6.1% for HBsAg and 2.8% for Anti-HCV antibodies. From multivariate analysis, the likelihood of having hepatitis was independently increased by a history of surgical interventions [OR: 1.82(1.06-3.14)], and of sexually transmitted infections [OR: 2.20(1.04-4.67)].Conclusion:Almost one in ten participants with HIV/AIDS attending the BRH and LRH tested positive for either HBsAg or anti HCV antibodies. Screening for HBV and HCV should therefore be integrated to the existing guidelines in Cameroon as it can influence management. More studies are needed to evaluate the extent of liver disease and magnitude of HIV suppression in hepatitis and HIV coinfection in this setting.

P187 Estimating cost savings by introducing a reflex Hepatitis B virus screening algorithm in a sexual health service

Background/introduction BASHH recommends that screening for HBV infection may be with HBcAb, with reflex HBsAg testing in HBcAb-positive patients. False negative HBcAb (eg in acute HBV infection or with low assay sensitivity) is rare. At the time our laboratory did not routinely perform reflex HBsAg testing, placing the onus on clinicians, many of whom therefore requested both tests simultaneously (with redundant sAg tests being performed in the presence of a negative cAb). We wished to audit the extent of this practice and estimate cost savings by introducing reflex testing. Aim(s)/objectives This was a retrospective case notes review of patients for whom HBcAb had been requested between 01/01/15 and 01/05/15. The cost of performing HBsAg testing was estimated at £3.60 per test. Methods There were two hundred patients with HBcAb results: 110 (55%) male; median age 32 (IQR 26–39) years; 9 (4.5%) HIV-infected. Twenty-two (11%) tested HBcAb-positive of whom 5 (2.5%) were HBsAg-positive, 16 (8.0%) HBsAg-negative and 1 (0.5%) not tested for HBsAg. Of the HBcAb-positive individuals, requesting details were available for 10 cases: for 8/10 both HBsAg and HBcAb were requested initially. Of 178 (89.0%) HBcAb-negative individuals, HBsAg was performed for 49 (24.5%); all were HBsAg-negative. Across the Trust, 11,500 HBcAb tests were requested in 12 months. Assuming 89.0% HBcAb-negativity, the cost of testing 24.5% of these patients for HBsAg would almost reach £10,000. Results Reducing HBsAg testing in HBcAb-negative individuals would provide savings. Reflex laboratory HBsAg should be implemented for HBcAb-positive patients.

Seroepidemiology of HIV, syphilis and hepatitis B and C viruses among blood donors in Bangui, Central African Republic.

The aim of this study was to determine the seroprevalence of HIV, the hepatitis B and C viruses, and syphilis as well the risk factors for these diseases among blood donors in Bangui, Central Africa Republic. This cross-sectional study examined samples from donors giving blood in August and September, 2013. HIV1/2 antibodies was screened with the Determine and Unigold HIV tests. Hepatitis B surface antigens were detected by sandwich immunochromatographic methods (DIAspot HBsAg test), and antibodies to HCV by the DIAspot test strip. Syphilis was diagnosed with the VDRL and TPHA methods (Omega Diagnostic, UK). The Chi(2) test was used for statistical analysis. The study included samples from 551 individuals, 350 (63.52%) of whom were frequent volunteer donors. In all, 132 (23.95%) were infected with at least one pathogen. The overall seroprevalence rate was 8.89% for HBV, 4.72% for HCV, 4.36% for syphilis, and 5.98% for HIV. Eight patients had two concomitant infections, with HIV-HBV the most common combination. Compared to long-term volunteers, first-time donors were more often infected by at least one of the pathogens we screened for, most especially HVB (OR=5.06; 95% CI=4.22-7.11) and syphilis (OR=2.05; 95% CI=2.02-7.44). Our findings indicate the high seroprevalence of transfusion-transmitted infections in blood donated in Bangui. The most common combined infections were HIV-HBV. The most common risk factor was a family history of HBV infection, and especially, mother-child transmission.

Correlation between hepatitis B virus DNA levels and diagnostic tests for HBsAg, HBeAg, and PreS1-Ag in chronic hepatitis B.

The aim of this study was to investigate the diagnostic value of the serum markers HBsAg and HBeAg and PreS1 protein (PreS1-Ag) in quantifying the levels of hepatitis B virus (HBV) DNA in patients with chronic hepatitis B (CHB). One thousand CHB patients were recruited from Beijing You'an Hospital between June and December 2012. Serum HBsAg and HBeAg levels were detected by electrochemiluminescence immunoassay. Enzyme-linked immunosorbent assay and fluorescence quantitative PCR were used to determine the level of PreS1-Ag and HBV DNA, respectively. We observed a low correlation between HBsAg and HBV DNA (r = 0.172, P < 0.001) expression; however, the correlation coefficient increased gradually with the increase in HBV DNA levels, and was more significant when HBV DNA log10 > 7 (r = 0.597, P < 0.001). Additionally, HBsAg and HBV DNA showed a significant positive correlation in the HBeAg+ group (r = 0.321, P < 0.001), whereas no correlation was observed in the HBeAg- group (r = -0.016, P = 0.825). HBV DNA expression was correlated with HBeAg (χ2 = 83.07, P < 0.001) and PreS1-Ag (χ2 = 36.01, P < 0.001). HBV DNA-positive rate was higher in HBeAg/PreS1-Ag++ patients (72.26%) than that in the single-positive groups (P < 0.001). Therefore, serum HBsAg is not a good marker for the prediction of HBV replication, and co-detection of HBeAg and PreS1-Ag, which can better predict HBV DNA replication, can be used as a reliable method for the clinical diagnosis and treatment of CHB.

Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration.

To evaluate pretreatment hepatitis B virus (HBV) testing, vaccination, and antiviral treatment rates in Veterans Affairs patients receiving anti-CD20 Ab for quality improvement. We performed a retrospective cohort study using a national repository of Veterans Health Administration (VHA) electronic health record data. We identified all patients receiving anti-CD20 Ab treatment (2002-2014). We ascertained patient demographics, laboratory results, HBV vaccination status (from vaccination records), pharmacy data, and vital status. The high risk period for HBV reactivation is during anti-CD20 Ab treatment and 12 mo follow up. Therefore, we analyzed those who were followed to death or for at least 12 mo after completing anti-CD20 Ab. Pretreatment serologic tests were used to categorize chronic HBV (hepatitis B surface antigen positive or HBsAg+), past HBV (HBsAg-, hepatitis B core antibody positive or HBcAb+), resolved HBV (HBsAg-, HBcAb+, hepatitis B surface antibody positive or HBsAb+), likely prior vaccination (isolated HBsAb+), HBV negative (HBsAg-, HBcAb-), or unknown. Acute hepatitis B was defined by the appearance of HBsAg+ in the high risk period in patients who were pretreatment HBV negative. We assessed HBV antiviral treatment and the incidence of hepatitis, liver failure, and death during the high risk period. Cumulative hepatitis, liver failure, and death after anti-CD20 Ab initiation were compared by HBV disease categories and differences compared using the χ(2) test. Mean time to hepatitis peak alanine aminotransferase, liver failure, and death relative to anti-CD20 Ab administration and follow-up were also compared by HBV disease group. Among 19304 VHA patients who received anti-CD20 Ab, 10224 (53%) had pretreatment HBsAg testing during the study period, with 49% and 43% tested for HBsAg and HBcAb, respectively within 6 mo pretreatment in 2014. Of those tested, 2% (167/10224) had chronic HBV, 4% (326/7903) past HBV, 5% (427/8110) resolved HBV, 8% (628/8110) likely prior HBV vaccination, and 76% (6022/7903) were HBV negative. In those with chronic HBV infection, ≤ 37% received HBV antiviral treatment during the high risk period while 21% to 23% of those with past or resolved HBV, respectively, received HBV antiviral treatment. During and 12 mo after anti-CD20 Ab, the rate of hepatitis was significantly greater in those HBV positive vs negative (P = 0.001). The mortality rate was 35%-40% in chronic or past hepatitis B and 26%-31% in hepatitis B negative. In those pretreatment HBV negative, 16 (0.3%) developed acute hepatitis B of 4947 tested during anti-CD20Ab treatment and follow-up. While HBV testing of Veterans has increased prior to anti-CD20 Ab, few HBV+ patients received HBV antivirals, suggesting electronic health record algorithms may enhance health outcomes.

GENOTYPE POLYMORPHISMS OF NAT2 AND CYP2E1 GENES ASSOCIATED WITH DRUG INDUCED LIVER INJURY (DILI) IN INDONESIAN TUBERCULOSIS PATIENTS

Currently, Indonesia is in the fifth rank of highest TB prevalence over the world. One of the TB problem is low patients’ adherence due to the oral antituberculosis induced hepatotoxicity. Polymorphisms of NAT2 and CYP2E1 genes had important role in the isoniazid (INH)-induced hepatotoxicity. The aim of this study was to evaluate the polymorphisms profile of NAT2 and CYP2E1 genes associated with hepatotoxicity induced by INH. We used cohort design in Public Health Centers and Lung Clinics of Yogyakarta and Lampung. The inclusion criteria were adult subjects (> 18 yo), newly diagnosed TB and treated by oral antituberculosis, normal function of renal and live and willingness to participate in this study. Subjects were excluded when having positive reaction of HbsAg test, history of HIV and abnormality of renal and liver function. The SNPs of NAT2 and CYP2E1 were designed using IPlex method of DNA sequenom. Among 57 TB patients, we found 14 patients with higher INH serum concentration and experienced increase of ALT-AST. Subjects with SNPs of rs 2070676, rs 1329149, rs 3813867, rs 6413432, rs 8192772, rs 2031920, rs 2515641, rs 8192775, rs 915908 of CYP2E1 experienced increase of ALT and AST . Subjects with SNPs of rs 1799930, rs1799931, rs1801279, rs1801280, rs1799929 , rs1208, rs1041983 of NAT2 are associated with the increase of ALT and AST . The polymorphisms of CYP2E1 and NAT2 may have a role in the mechanisms of INH induced DILI. Keywords: CYP2E1, NAT2, tuberculosis, isoniazid, Indonesia

Cost of Unnecessary Repeat Requesting of Tests for HBsAg, Anti-HCV and Anti-HIV Screening in a University Hospital

Cost of Unnecessary Repeat Requesting of Tests for HBsAg, Anti-HCV and Anti-HIV Screening in a University Hospital

Prevalence of hepatitis B and C viruses infection among military personnel at Bahir Dar Armed Forces General Hospital, Ethiopia.

BackgroundMilitary personnel are high-risk people for parenteral and sexually transmitted diseases such as hepatitis B virus (HBV) and hepatitis C virus (HCV). Data regarding HBV and HCV prevalence among military personnel in Ethiopia is limited. Hence, the study aimed to determine sero-prevalence and associated risk factors of HBV and HCV among military personnel at Bahir Dar Armed Forces General Hospital, Ethiopia.MethodsA cross-sectional study was conducted in a total of 403 military personnel from February to May 2015. Socio-demographic characteristics and risk factors were collected through face to face interview using structured questionnaire. HBV and HCV infection was determined using HBsAg and anti-HCV antibody rapid tests. Logistic regression analysis was employed to assess possible risk factors for HBV and HCV infections.ResultsThe sero-prevalence of HBV and HCV infection were 4.2 and 0.2 %, respectively. None of the study subjects were co-infected with HBV and HCV. Higher prevalence of HBV infection (11.3 %) was observed in the age group of 40 and above. Being at the age of 40 years and above (COR 7.6; 95 % CI 2.0–29.0, p = 0.003), history of nose piercing (COA 5.9; 95 % CI 1.2–29.9, p = 0.033) and sexually transmitted infection (COR 4.3; 95 % CI 1.1–16.4, p = 0.03) were significantly associated with these viral hepatitis infections.ConclusionIntermediate prevalence of HBV and low prevalence of HCV were observed among military personnel. Strengthening HBV screening strategies among military personal may further reduce these viral diseases.

PREVALENCE OF HEPATITIS B VIRUS IN BLOOD DONORS AT DA NANG HOSPITAL C IN 2014

Objectives: Study on prevalence of hepatitis B virus in blood donors at Hospital C Danang to determine the percentage of HBsAg-positive in blood donors and identify some risk factors related to hepatitis B virus infection in blood donors. Material and methods: Samples of blood of donors were HBsAg testing by ELISA, the research conducted by descriptive cross-sectional design. The results and conclusions are as follows: Results: HBsAg positive rate was 10.6% (35/330), which accounted for 14.7% males and 7.5% females. HBsAg positive rate high percentage of first-time blood donor group (15.2%), very low proportion of repeat blood donor group (0.9%). Conclusion: HBsAg positive is according to the risk factors for hepatitis B virus transmission associated with surgery, acupuncture, tattooing, infusion, injection, dental treatment, skin sewing and manicure, not associated with history of blood transfusion and endoscopy. Key words: HBsAg, blood donors, HBV.

Clinical and epidemiological profile of female blood donors with positive serology for viral hepatitis B.

Since women are frequently the minority among blood donors worldwide, studies evaluating this population usually reflect male features. We assessed the features of female blood donors with positive serology for HBV and compared them with those of men.METHODS The study comprised consecutive blood donors referred to a specialized liver disease center to be evaluated due to HBsAg- and/or anti-HBc-positive tests. The study encompassed 1,273 individuals, 219 (17.2%) of whom were referred due to positive HBsAg test and 1,054 (82.8%) due to reactive anti-HBc test. Subjects' mean age was 36.8±10.9 years, and 28.7% were women. Female blood donors referred for positive HBsAg screening tests demonstrated higher prevalence of healthcare workers (9.3% vs 2.5%) and lower prevalence of sexual risk behaviors (15.1% vs 41.1%) and alcohol abuse (1.9% vs 19.8%) compared to men. Women had lower ALT (0.6 vs 0.8×ULN), AST (0.6 vs 0.8×ULN), direct bilirubin (0.2 vs 0.3mg/dL), and alkaline phosphatase (0.5 vs 0.6×ULN) levels and higher platelet count (223,380±50,293 vs 195,020±53,060/mm3). Women also had a higher prevalence of false-positive results (29.6% vs 17.0%). No differences were observed with respect to liver biopsies. Female blood donors referenced for reactive anti-HBc screening tests presented similar clinical, epidemiological, and biochemical characteristics to those reported for positive HBsAg screening tests and similarly had a higher prevalence of false-reactive results. Compared to men, female blood donors with positive HBsAg and/or anti-HBc screening tests demonstrated higher prevalence of professional risk and false-positive results and reduced alteration of liver chemistry.

Kidney Paired Donation Protocol for Participating Donors 2014.

Kidney Paired Donation Protocol for Participating Donors 2014.

Prevalence of hepatitis B markers in Senegalese HIV-1-infected patients.

The study aimed to estimate the prevalence of Hepatitis B virus (HBV) infection and to describe the HBV virological profiles among Senegalese HIV-1-infected patients. We conducted a retrospective study between 2006 and 2010 among Senegalese HIV-1-infected patients from the antiretroviral therapy cohort. Samples were screened using Determine(®) HBsAg or MONOLISA(®) POC test. The HBsAg positivity status was confirmed by Architect(®) HBsAg. Detection of HBeAg, anti-HBe Ab, and HBV DNA load were done for the HBsAg-positive samples. Then, Anti-HBcAb was tested for the HBsAg-negative samples. Microsoft Excel was used for data collection and statistical analyses were performed using Epi info 3.5.1. Overall, 466 HIV-infected patients were enrolled including 271 women (58.4%), and 193 men (41.6%) with a median age of 39 years (19-74 years). The global prevalence of HIV/HBV coinfection (HBsAg positive) was 8.8% (41/466). For HBsAg positives samples, the prevalence of HBeAg and the anti-HBeAb were, respectively, 24.4 and 69.2% and the median of HBV DNA viral load, for 27 HBsAg-positive samples, was 3.75 log10 copies/ml. The virological profiles were the following: 7, 15, and 5 patients infected, respectively, by a replicative virus, an inactive virus and a probably mutant virus. For HBsAg-negative samples, 83 out of 109 were positive for anti-HBcAb. This study showed a significant decrease of the prevalence of HBV/HIV coinfection between 2004 and 2014 (P = 0.003), which highlighted the performance of the Senegalese HBV vaccine program. However, implementing a systematic quantification of HBV DNA viral load could improve the monitoring of HBV-infected patient.

Hemodiyaliz hastalarında gizli Hepatit B enfeksiyonunun polimeraz zincir reaksiyonu ile araştırılması

Aim: It is known as the occult Hepatitis B that Hepatitis B virus DNA (HBV DNA) exists in serum very little if Hepatitis B virus surface antigen in serum is negative. The studies about occult Hepatitis B infection prevalence are limited in patients who undergo hemodialysis implements for along time. HBV existence is able to continue in plasma and liver tissue of some patients whose HBsAg test is negative. This condition causes many diagnostic problems. It is very crucial the description of people who have this clinical risk of HBV transmission in the community, especially in dialysis units. This study is aimed to determine the prevalence of occult Hepatitis B in dialysis patients. Material and Methods: 160 HBsAg-negative patients and 28 predialysis total of 188 patients were included in this study. 5 ml venous blood samples taken from the patients into sterile vacutainer tubes contain anticoagulant. Blood tubes to separate serum 800-1600 x g for 20 min. centrifuged. The separated serum was collected into polypropylene tubes and was stored at -20 oC until the applied test procedure. For the detection of HBV DNA; HBV Isolation Device (Magnesia 16 Geneworks Anatolia, Turkey) and HBV DNA isolation kit (16/201 viral nucleic acid isolation kit) was used and isolated, then serum were tagged on the elution tube. Real-Time PCR Device (Montanide 483 Geneworks Anatolia, Turkey) and Real-time PCR kit (Bosphore Quantification Kit V2) was used in PCR process. Real Time PCR kit, which is used in the study, was detected whole HBV genotypes between A and H of the Hepatit B virus DNA in human serum or plasma sample. Analytical sensitivity of the kit was 10 IU / mL linear range 1x101-1x109 IU/ml. Hepatitis B virus markers (HBsAg, anti-HBcAg, anti-HBs) ) were studied using commercial ELISA kits (Abbott ARCHITECT Qualitative Reagan Kit) and ELISA device (Abbott ARCHITECT i2000 SR), CRP (SIEMENS cardiophase to hsCRP the kit and SIEMENS BN II device. Likewise, aspartate aminotransferase (AST), alanine aminotransferase (ALT), (aspartate aminotransferase A / Alanine aminotransferase Roche Cobas INTEGRA / cobas c system) were studied using with test kits Roche Cobas 501 devices. Results: In 11.3% of hemodialysis patients (18/160) HBV DNA positivity (occult Hepatitis B infection) were detected. Predialysis patients who are in the control group was not observed HBV DNA positivity (0/28). Anti-HBs positivity in 142 hemodialysis patients (88.7%), while 14 predialysis patients (50%) were found (p <0.05). There was no statistically significant difference between the other parameters. Conclusions : Dialysis centers are areas of risk for transmission of HBV. HBV DNA screening of all patients undergoing dialysis must be performed. In addition; suggested to vaccination of susceptible patients, GHB has been diagnosed patients isolating dialyzer, the diagnosis of HBV patients receiving a specific service area. Key Words: HBV, occult Hepatitis B, hemodialysis

Presence of Essential Hypertension or Diabetes Mellitus Is a Predictor of Intracranial Bleeding in Elderly Patients: A Study of 108 Patients with Isolated Thrombocytopenia from a Single Reference Center.

Objective:Thrombocytopenia poses a significant problem in the elderly. Not only are there varied causes, but it is also associated with significant morbidity and mortality. We carried out a study to learn the causes of isolated thrombocytopenia in elderly patients and to correlate the severity of thrombocytopenia and bleeding manifestations with various etiologic factors and comorbidities. Materials and Methods:A total of 108 patients above 50 years of age presenting with isolated thrombocytopenia (platelet counts of <100x109/L with normal hemoglobin and total leukocyte counts) were enrolled in the study. Detailed history and clinical examinations were carried out for each patient. Complete blood counts were analyzed by automated cell counter. Peripheral smears were examined in all cases. HbsAg, anti-HCV, and anti-HIV testing by enzyme-linked immunosorbent assay was done in all patients. Wherever clinically indicated, bone marrow aspiration biopsy and cytogenetic studies were done. Results:Out of 108 patients, 102 (94.4%) presented with bleeding tendencies. Twenty-nine (26.8%) presented with serious (World Health Organization grade 3/4) bleedings. Major findings were immune thrombocytopenic purpura in 79 (73.1%), myelodysplastic syndrome in 7 (6.5%), drug-induced thrombocytopenia in 7 (6.5%), and connective tissue disorder in 4 (3.7%) cases. Ten patients presented with intracranial bleedings. Upon logistic regression analysis, comorbidities in the form of essential hypertension and diabetes mellitus were significantly associated with occurrence of intracranial bleeding. There was no correlation of serious bleedings with platelet counts.Conclusion:Isolated thrombocytopenia in the elderly is associated with significant morbidity. Diligent clinical and laboratory evaluation is required to elucidate the cause of thrombocytopenia in the elderly. Comorbidities in this population are associated with serious bleedings and not low platelet counts as is commonly thought.

Molecular and serological analysis of surface antigen negative hepatitis B-Virus infection among jordanian blood donors

Occult hepatitis B virus (HBV) infection is characterized by the presence of viral DNA circulating blood and/or in liver tissue without detectable HBV surface antigen (HBs Ag). This study aims to investigate the molecular basis of occult hepatitis B virus (HBV) infection (OBI) among Jordanian blood donors. OBI blood donors were tested for HBV serological marker and they had normal alanine aminotransferase (ALT). In this study, we examined a total 578 HBsAg donated healthy individual from the blood bank unit/Islamic Hospital Amman-Jordan, enrolled during 2013. The people age between 20 – 48 years. The test was performed on serum for anti HBC by ELISA and plasma for PCR/NAT. Out of 578 HBsAg negative anti HBc antibody was found positive in 30 donors (5.2%). The positive samples for anti HBC antibody were then investigated to determine the presence of hepatitis B virus DNA using PCR- technique. In conclusion, to be potentially safe of blood donations HBsAg and nucleic acid amplification testing should be implemented even if anti HBsAg negative before blood and organ donation, transplantation, and chemotherapy and in hemodialysis to reduce the risk of HBV transmission among people who donate blood.

HEPATITIS B &amp; C

Hepatitis B and C are serious global public health problems. Objectives:The objective of this study is to assess the knowledge regarding HBV and HCV transmission,risk factors and prevention among women attending the OBS/GYN clinic. Study Design:Descriptive observational study. Period: 1st January 2012 up to 31st of December 2013.Setting: Gynae Department Lady Dufferin Hospital Karachi and Al Tibiri Medical College IsraUniversity Karachi campus. Methods: Total 123 patients were included in study. All the patientswho were admitted during the study period from gynecological surgery were included in thestudy while gynae patients who were managed conservatively were excluded from the study.Blood testing for HbsAg and Anti HCV were done through ELISA. Data was analyzed throughSPSS version 11. Results: Total 123 women were included in the study. Only 56(45.5%)of women and 61(49.5%) of women knew that hepatitis B and C affects which part of bodyrespectively.59 (47.9%) and 22(17.8%) women knew that hepatitis B and C are major healthproblem respectively. 89(72.3%) and 69(56%) of women knew that Hepatitis B and HCV canbe transmitted by blood and blood products respectively.45 (36.5%) and 54(43.9%) womenanswered correctly regarding transmission of HBV and HCV from mother to child respectively69(56%). 41 (33.3%) women and 35(28.4%) women answered correctly regarding treatment ofHBV and HCV through medicines. Only 51(41.4%) and 56(45.5%) women knew that vaccineis available for HBV and no vaccine is present for HCV28 (22.7%). Source of information wasmedia in 62(50.4%) women, relatives and friends in 40(32.5%) women and literature in 21(17%).Conclusion: Our study found that the knowledge about hepatitis B and C among womenattending OBGYN clinic is inadequate.

Evaluation of midwives' practices for the prevention of mother-to-child transmission of hepatitis B in Abidjan (Ivory Coast)

Prevention of mother-to-child transmission of hepatitis B virus (HBV) assumes and requires good practices by midwives. The objective of this study was to evaluate their practices for this prevention. This prospective, descriptive study in Abidjan took place from January 2 to May 31, 2014 and included the midwives in Abidjan (recruited from university hospitals, general hospitals, and peripheral health care facilities) at the time of the survey who agreed to complete this written survey. Univariate analyses were done with Pearson Chi 2 tests or Fisher's test, as appropriate, P<0.05 was defined as significant. The study included 197 of the 220 midwives approached (89.5%), 88 (44.6%) of whom worked in the university hospital delivery rooms. Overall, 59% performed HBsAg tests during the second trimester, and 47.72% vaccinated newborns of HBsAg-positive mothers at birth. Hospital-based midwives had the best prevention practices, including HBsAg testing (P = 0.023) and immunization of the newborn at birth (P = 0.005). Midwives' practices for the prevention of mother-to-child transmission of HBV in Abidjan are improving.

Hepatitis B, Hepatitis C and human immunodeficiency virus prevalences among first time blood donors in Istanbul, Turkey, 2004–2011

ObjectiveThis study aims to determine the yearly change rates of the HBsAg, anti-HCV and anti-HIV test results and their positivity rates obtained from the 68,393 donors who applied and donated blood for the first time at the Blood Center of the hospital. Materials and MethodsUsing the ELISA method, screening tests were applied to the blood samples obtained from blood donors, and the HBsAg, anti-HCV and anti-HIV positivity rates were calculated at the end of year eight. However, HBsAg and anti-HCV positivities showed a decreased tendency of positivity in years. ResultsA total of 68,393 donations were received within eight years. Seroprevalences for anti-HIV, HBsAg and anti-HCV tests were, respectively 0.01%, 1.54% and 0.38%. HBsAg and anti-HCV positivities showed a decreased tendency of positivity in years.

English

BACKGROUND: In central India (M.P.) there is high prevalence of hepatitis; of which hepatitis B contributes as a major cause of hepatitis. In our area there were no major efforts to contain the disease. According to one estimate most of the hepatitis B occurs due to negligence transfusion of infected blood (Hepatitis B). Therefore we have tried to found percentage of population infected with this disease. MATERIAL AND METHODS: Study design – Prospective study. For screening donors we have used one step rapid test for the detection of HBsAg and confirmatory test was done by ELISA method. STATISTICAL ANALYSIS: Statistical analysis was done by using Minitab 17 Pennsylvania, USA. RESULTS: In our study we found 2.8% HBsAg infected blood among healthy donors; which was significantly (P < 0.05) more in voluntary donors in comparison to replacement donors. Male between age groups 39-48 were found highly infected in comparison with other age groups. We also found prevalence was highest in Hindu community (2.9%) and more in working group (3.9%) in comparison to students and farmers. CONCLUSION: For effective control of transfusion of infected blood and to prevent its spread, we have to improve community knowledge towards vaccination; educational programs for blood bank personals; and government should open blood banks at Community Health Center level.