Original Article
Frequency
of Hepatitis C in Patients Undergoing Ophthalmic Surgeries; A Multicenter Study
M. Ali A. Sadiq, Faiqa Jabeen Naeem, Mehrin
Usman Ali Arifa, Haroon Tayyab, Saima Jamshed, Irfan Qayyum Malik, Hafiz
Muhammad Qamar, Ayesha Hanif
DOI 10.36351/pjo.v35i4.989 Pak J Ophthalmol 2019, Vol. 35, No. 4
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See end of article for authors affiliations …..……………………….. Correspondence to: Dr. M. Ali
A. Sadiq Associate
Professor, King
Edward Medical University, Lahore Email: Sadiq.maa@gmail.com |
Purpose: To
find the frequency of Hepatitis C in tertiary care hospitals in Gujranwala
and Lahore. Study Design: Cross sectional observational study. Place and Duration of Study: Ophthalmology Departments of District Head Quarters
Teaching Hospital Gujranwala and at Sardar Trust Eye Hospital, Garhi Shahu,
Lahore for a duration of 12 months from March 2017 to March 2018. Material and Methods: A chart review of all patients admitted in the above
mentioned hospitals was conducted. Patients with insufficient clinical
information documented in hospital record were excluded from the study.
Status of each of the patient whether Hepatitis C positive or not, was
determined by the method of rapid chromatography immunoassay for qualitative
detection. The results of all patients were recorded according to their age,
sex and their demography. Results: The
study was conducted on 4968 patients admitted for ophthalmic surgeries above
the age of 13 years. There were 1003 patients at DHQ Hospital Gujranwala and
3965 at Sardar Trust Eye Hospital. Out of 1003, 548 patients (54.6%) were
male and 455 (45.3%) were female. 189 patients turned out to have Hepatitis C
having a prevalence of 18.8%. However, at Sardar Trust Eye Hospital, out of
3965 patients admitted, 2914 (73%) were male, and remaining (27%) were
female. 418 patients were found to be Hepatitis C positive, which constituted
about 10.5% of all patients in Lahore. Conclusion: Frequency
of Hepatitis C was 18% in Gujranwala with female dominance and 10.5% in
Lahore with male predominance. Key Words: Eye Surgery, Hepatitis C, Frequency. |
Hepatitis C is a single stranded enveloped
RNA virus1,2 belonging to family Flaviviridae3,4 transmitted
primarily via blood, body surface secretions and by piercing through
percutaneous veins and mucosal surfaces5,6. Hepatitis C virus has an
incubation period of 14 to 180 days with an average of 45 days3,4.
It can occur in both acute and chronic form leading to cirrhosis7,8,
hepatic encephalopathy, coma and death. Worldwide, an estimated 130-150 million
people (2-3%) are living with Hepatitis C infection with highest prevalence in
middle income countries including Pakistan. More than 350,000 deaths have been
reported to occur with Hepatitis C9.
In Pakistan, 6%
of its population is actively infected with 1 in every 20 person suffering from
it10. The prevalence in Punjab is 5.46% with maximum population of
25.77% affected in Balochistan11. The purpose of this study is to
determine the frequency of hepatitis C presenting in tertiary care hospital in
Lahore and Gujranwala. It is also a reflection of the
Table 1: Demographics of
patients in Gujranwala.
|
Age Group |
Total Patients
Screened |
Patients
Diagnosed with Hepatitis C Virus |
||
|
Male |
Female |
Total |
||
|
Less than 21 |
40 |
2 |
0 |
2 (5%) |
|
Between 21 and 40 |
150 |
8 |
16 |
24 (16%) |
|
Between 41 and 60 |
476 |
44 |
57 |
101 (21%) |
|
Between 61 and 80 |
308 |
33 |
19 |
52 (17%) |
|
More then 80 |
29 |
6 |
4 |
20 (34%) |
|
Total |
1003 |
93 (17%) |
96 (21%) |
189 (18%) |
Table 2: Demographics of
patients in Sardar Trust Eye Hospital, Lahore,
|
Age Group |
Total Patients
Screened |
Patients Diagnosed
with Hepatitis C Virus |
||
|
Male |
Female |
Total |
||
|
Less than 21 |
268 |
4 |
1 |
5 (1.8%) |
|
Between 21 and 40 |
644 |
28 |
27 |
55 (9%) |
|
Between 41 and 60 |
1787 |
136 |
104 |
240 (13%) |
|
Between 61 and 80 |
1221 |
80 |
32 |
112 (9%) |
|
More then 80 |
45 |
4 |
3 |
7 (15%) |
|
Total |
3965 |
250 (6.3%) |
168 (4.2%) |
418 (10.5%) |
risk faced by
health care workers due to cross infection.
MATERIAL AND METHODS
A cross sectional observational study
was conducted at District Head Quarter Teaching Hospital Gujranwala and Sardar
Trust Eye Hospital from 1st March 2017 to 31st March 2018
after approval by Institutional review boards of the two hospitals. Patients
were excluded if there was insufficient clinical information documented in
hospital record. The age and sex of patients, demographical distribution and
method of screening used were recorded from medical record. Cases were
identified as Hepatitis C positive through screening kits. The primary outcome
was the occurrence of Hepatitis C among patients being admitted for surgical
procedures. Secondary outcome was the distribution of the disease among masses
respective to their age, gender and demography.
The data collected in both the hospitals
was stored electronically and analyzed by SPSS version 20. Percentages were
calculated for gender, age and demographical distribution.
RESULTS
Majority of the patients presenting
for ocular surgery were from the age group of 50 to 70 years, with 101 patients
(21%) between 51 to 60 years of age and 52 (17%) patients in their 60’s in
Gujranwala while 1161 patients (29.25%) between 51 to 60 years of age and 979
(24.6%) patients in their 60s in Lahore. Out of the 1003 patients admitted in
DHQ Hospital Gujranwala, 548 (54.6%) patients were male and 455 (45.3%) were
female. However out of 3965 patients admitted in Sardar Trust Eye Hospital,
2895 (73%) were male and 1030 (26%) were females.
In DHQ Hospital
Gujranwala, 189 (18.8%) out of 1003 patients turned out to be positive for
Hepatitis C. The frequency of Hepatitis C in Sardar Trust Eye Hospital, Lahore
was 10.5% (418 patients out of 3965). Out of the Hepatitis C positive patients
in Sardar Trust Eye Hospital Lahore 194 (46%) cases were reported from Lahore
followed by Gujranwala 60 cases (14. 28%).
DISCUSSION
Aslam et al
showed the prevalence of Hepatitis C in Lahore to be 6.7%12. Tanveer
et al found the prevalence to be 1.48%13. However, it varied from
2.1 to 13.5 % in the study conducted by Bostan et al14. Our current
estimate of frequency (10.6%) was higher when compared to nationwide data
surveillance study conducted through ELISA blood screen15 which
showed the prevalence to be 6.8% in Lahore. Furthermore, the frequency was more
among males in Lahore which was different from that found in previous studies
conducted in Jinnah and Sheikh Zayed Hospital Lahore16. However, the
prevalence of Hepatitis C in Pakistan is much more when compared to Bangladesh
(1.3%), India (0.8%) and other South Asian countries17. In a study
conducted in New Delhi in 2007, prevalence of 0.66% was noted in blood donors18.
Chowdery et al. from West Bengal depicted a seroprevalence of 0.87%. It showed
a rise from 0.31% in children aged below 10 years to 1.85% in adults aged 60
years with no difference in prevalence between males and females19.
In Punjab, 5% anti HCV positive persons were found in 201220. One
exception was that of Uzbekistan (Central Asian country) which had got slightly
higher prevalence (11.3%). The percentages were on the lower side for Central,
Southern, Northern and Tropical areas of America which demonstrates percentages
varying from 1.2% to 1.6%, depicting rapidly inclining trend of Hepatitis C
(10.6%) in Pakistan. The total global prevalence was estimated to be less than
2%, with major chunk comprising of population older than 15 years, congruent to
our estimate. According to our result, there was 1.6 times surge in incidence
as compared to standard nationwide rate (6%)17. The actual burden of
disease may be much higher than current and previous estimates. A limitation to
our study was its retrospective nature because in some cases only limited data
were available to be reviewed. Another limitation was the screening technique
which was less sensitive as compared to ELISA technique. More studies are
needed to fill the gap in our knowledge regarding the burden of HCV disease in
Pakistan.
CONCLUSION
Frequency of
Hepatitis C in admitted patients is mostly concentrated between 50-60 years
indicating the enhanced expression of disease in middle to older age groups
with decreased immunity.
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Author’s Affiliation
Dr. M. Ali A. Sadiq
Associate
Professor, King Edward Medical University,
Lahore.
Dr. Faiqa Jabeen Naeem
House Officer
King Edward
Medical University,
Lahore
Dr. Mehrin Usman Ali Arifa
House Officer, Mayo Hospital
Lahore
Dr. Haroon Tayyab
Assistant
Professor, King Edward Medical University,
Lahore
Dr. Saima Jamshed
Women Medical Officer, Gujranwala Medical College
Gujranwala
Dr. Irfan Qayyum Maliks
Associate Professor, Gujranwala Medical College
Gujranwala
Dr. Hafiz Muhammad Qamar
Post Graduate Resident, Gujranwala Medical College
Gujranwala
Dr. Ayesha Hanif
Senior Registrar, Gujranwala Medical College
Gujranwala
Author’s Contribution
Dr. M. Ali A. Sadiq
Project Design, Manuscript Writing, Critical analysis.
Dr. Faiqa Jabeen Naeem
Data Analysis, Manuscript Writing.
Dr. Mehrin Usman Ali Arifa
Data Analysis, Final review.
Dr. Haroon Tayyab
Data Analysis, Final review.
Dr. Saima Jamshed
Data Analysis, Manuscript Writing.
Dr. Irfan Qayyum Malik
Project design, Final review.
Dr. Hafiz Muhammad Qamar
Data Analysis, Manuscript Writing.
Dr. Ayesha Hanif
Data Analysis, Final review.