RESUMO
OBJECTIVE: To see the frequency of newly diagnosed Hepatitis-B and Hepatitis-C cases during pre-operative surgical assessment of patients from lower socioeconomic class and to study the possible risk factors
STUDY DESIGN: Descriptive Cross Sectional study
SETTING: Department of Surgery, Sir Syed College of Medical Sciences and Hospital, Karachi
STUDY DURATION: From July 2012 to July2013
MATERIAL AND METHODS: Total 107 patients [>18 years] of both genders from lower socioeconomic class planned for elective surgical procedure were included after ethical approval. Previously diagnosed cases of Hepatitis-B and C were excluded. After history and clinical examination, Hepatitis-B and Hepatitis-C serology was performed [ELIZA technique]. History of blood transfusion, previous dental or surgical procedures, intravenous injections, intravenous drug abuse, tattooing, piercing, circumcision, shaving by barbers, unprotected sex and Hepatitis-B vaccination status obtained. Data was analyzed by SPSS version 17
RESULTS: Among 107 cases [42% males and 58% females] with mean age 39+14 years, Hepatitis-B infection was present in 6[6%] cases, Hepatitis-C in 11[10%] and Hepatitis-B and C serology was negative in 90 [84%] cases. Frequency of Hepatitis-B was 3% [in males] versus 9% [in females]; Hepatitis-C 6.4% [in males] versus 15.5% [in females]. Among those with Hepatitis-B or C, history of previous surgical procedure present in 47% cases [vs. 21% in Hepatitis-B and C negative cases], dental procedure in 29.4% [vs. 7.7 %], intravenous injections in 94% [vs. 43%], intravenous drug abuse in 5.8% [vs. 0 %], blood transfusion in 35% [vs. 12%], tattooing in 0% [vs. 2%], unprotected sex in 5.8% [vs. 1%], piercing in 64.7% [vs. 39%], circumcision by barbers in 83.3%of males [vs. 80%], shaving by barbers in 66.6% of males [vs. 27%]. Hepatitis-B and C was found to be associated with history of blood transfusion, intravenous injections, dental procedures, shaving by barbers, piercing and intravenous drug abuse [p< 0.05]. Clinical stigmata of liver disease were present in 3% cases. Among all cases 9% were previously vaccinated for Hepatitis-B
CONCLUSION: Preoperative determination of Hepatitis viral markers is a good clinical practice to limit transmission from asymptomatic carriers and to diagnose new cases. Pakistan has high prevalence of Hepatitis-B and C and poverty and low literacy rate are the main determinants of its spread. Those who are negative for Hepatitis-B should be encouraged to get vaccinated
There is need for measures to create awareness about preventive measures and affective control of transmission of Hepatitis-B and C in community as well as at health care facilities