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Journal Article

Frequency of acute hepatitis C after needle stick injury and its treatment outcome.

01 Jan 2009-Pakistan Journal of Medical Sciences (Professional Medical Publications)-Vol. 25, Iss: 5, pp 766-769
TL;DR: Acute HCV is an uncommon disease to diagnose; it has favorable response to therapy if initiated early after a strict surveillance of patients for 8-16 weeks.
Abstract: Objective: To determine the frequency of acute HCV infection after needle stick injury and its treatment outcome. Methodology: Patients with HCV positive needle stick injury and reporting within 72 hours of incident were selected. Co-infections with HBV, HDV, HIV, hematological disorders and depression were excluded. Anti-HCV was done at presentation and those testing positive were excluded. HCV RNA was done after two weeks or anti-HCV after six weeks of incident. Those testing positive were kept under observation for 16 weeks for spontaneous resolution. After this period HCV RNA and Genotype were done and therapy with Peg-interferon was started. Rapid, early and sustained virological responses were checked. Results: Two hundred eight patients with HCV positive needle stick injury were selected, 10 (4.8%) developed acute HCV infection out of them one (10%) had spontaneous recovery during the observation period of 16 weeks. seven (77.8%) achieved rapid virological response and eight (88.9%) achieved sustained virological response. Conclusions: Acute HCV is an uncommon disease to diagnose; it has favorable response to therapy if initiated early after a strict surveillance of patients for 8-16 weeks.

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Citations
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Journal ArticleDOI
TL;DR: To characterize hepatitis C virus (HCV) epidemiology in Pakistan and estimate the pooled mean HCV antibody prevalence in different risk populations, all available records of HCV incidence and/or prevalence from 1989 to 2016 were systematically reviewed.
Abstract: To characterize hepatitis C virus (HCV) epidemiology in Pakistan and estimate the pooled mean HCV antibody prevalence in different risk populations, we systematically reviewed all available records of HCV incidence and/or prevalence from 1989 to 2016, as informed by the Cochrane Collaboration Handbook. This systematic review was reported following the PRISMA guidelines. Populations were classified into six categories based on the risk of exposure to HCV infection. Meta-analyses were performed using DerSimonian and Laird random-effects models with inverse variance weighting. The search identified one HCV incidence study and 341 prevalence measures/strata. Meta-analyses estimated the pooled mean HCV prevalence at 6.2% among the general population, 34.5% among high-risk clinical populations, 12.8% among populations at intermediate risk, 16.9% among special clinical populations, 55.9% among populations with liver-related conditions and 53.6% among people who inject drugs. Most reported risk factors in analytical epidemiologic studies related to healthcare procedures. Pakistan is enduring an HCV epidemic of historical proportions—one in every 20 Pakistanis is infected. HCV plays a major role in liver disease burden in this country, and HCV prevalence is high in all-risk populations. Most transmission appears to be driven by healthcare procedures. HCV treatment and prevention must become a national priority.

92 citations


Cites background from "Frequency of acute hepatitis C afte..."

  • ...Only one study was identified for HCV incidence [144] (not shown in the electronic supplementary material, table S5), in which there were greater than or equal to 100 participants, and was therefore classified as having high precision....

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Journal ArticleDOI
TL;DR: Although a single case definition for recent HCV is not warranted, a degree of standardization within specific study categories would enable improved cross-study comparison and more uniform evaluation of HCV prevention and management strategies.

46 citations

Journal Article
TL;DR: Needle stick injury is the most important occupational health hazard in nurses with alarmingly high rates and screening of nurses after needle stick injury and promotion of safety measures against it should be greatly encouraged.
Abstract: Background: Needle-stick injury (NSI) is a major occupational health and safety issue faced by healthcare professionals globally. This study was aimed to assess the frequency and factors associated with NSIs in nurses of a tertiary health care facility in Lahore, Pakistan. It also focuses on safety measures adopted by these nurses after a needle stick injury. Methods : This cross-sectional descriptive study was conducted in Ghurki Trust Teaching Hospital, Lahore from October 2009 to January 2010. All nurses have participated in the study with a response rate of 99%. These responses were obtained via a pretested self-administered questionnaire. The data was analysed using SPSS-16. Percentages of the categorical variables were computed and represented in various statistical data presentation forms, for analysis and comparison. Chi-square test was applied as a test of significance with fixing the p value of 0.05 as significant. Results: Out of 77 nurses who participated in our study, only 33 (42%) nurses were aware of the occupational hazards of their profession when they joined nursing. Needle stick injury was reported by 40 (71.9%) of the nurses in last one year. About 17 (31.5%) were injured at the time of recapping the syringe. The availability of needle cutters in the hospital was reported by 75 (97.4%) nurses while only 46 (60%) of them had undertaken a sharp management training course. Approximately 50 (64.9%) nurses failed to use gloves while administering injections. After getting stuck by a contaminated needle 71 (92%) of the nurses cleaned the wound with a spirit swab, 67 (87%) washed the area with soap and water and 58 (75%) applied a readily available bandage. Only 38 (49%) went on to inform the higher officials about a needle stick injury. Fifty-seven (74%) of the nurses were vaccinated against HBV, and 56 (72.2%) of needle stick injured nurses proceeded for HBV screening, while 53 (68.6%) for HCV and 37(48.5%) for HIV. Conclusion: Needle stick injury is the most important occupational health hazard in nurses with alarmingly high rates. Reporting to the concerned authorities, screening of nurses after needle stick injury and promotion of safety measures against it should be greatly encouraged. Keywords: Needle stick injuries, Nurses, Pakistan

32 citations


Cites background from "Frequency of acute hepatitis C afte..."

  • ...3% in nurses.(11) The gravity of situation in Pakistan can be estimated by another study conducted in operation room personnel, 58....

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Journal ArticleDOI
31 Oct 2017-PLOS ONE
TL;DR: Though there is extensive variation in study-specific measures of HCV viremic rate, pooled mean estimates are similar regardless of risk population or subpopulation, country/subregion, HCV antibody prevalence in the background population, or sex.
Abstract: Objectives To estimate hepatitis C virus (HCV) viremic rate, defined as the proportion of HCV chronically infected individuals out of all ever infected individuals, in the Middle East and North Africa (MENA). Methods Sources of data were systematically-gathered and standardized databases of the MENA HCV Epidemiology Synthesis Project. Meta-analyses were conducted using DerSimonian-Laird random-effects models to determine pooled HCV viremic rate by risk population or subpopulation, country/subregion, sex, and study sampling method. Random-effects meta-regressions were conducted to identify predictors of higher viremic rate. Results Analyses were conducted on 178 measures for HCV viremic rate among 19,593 HCV antibody positive individuals. In the MENA region, the overall pooled mean viremic rate was 67.6% (95% CI: 64.9-70.3%). Across risk populations, the pooled mean rate ranged between 57.4% (95% CI: 49.4-65.2%) in people who inject drugs, and 75.5% (95% CI: 61.0-87.6%) in populations with liver-related conditions. Across countries/subregions, the pooled mean rate ranged between 62.1% (95% CI: 50.0-72.7%) and 70.4% (95% CI: 65.5-75.1%). Similar pooled estimates were further observed by risk subpopulation, sex, and sampling method. None of the hypothesized population-level predictors of higher viremic rate were statistically significant. Conclusions Two-thirds of HCV antibody positive individuals in MENA are chronically infected. Though there is extensive variation in study-specific measures of HCV viremic rate, pooled mean estimates are similar regardless of risk population or subpopulation, country/subregion, HCV antibody prevalence in the background population, or sex. HCV viremic rate is a useful indicator to track the progress in (and coverage of) HCV treatment programs towards the set target of HCV elimination by 2030.

30 citations

Journal Article
TL;DR: Dental practitioners were at high risk of getting Needle Stick Injuries in dental offices because there was lack of practice of universal precautions.
Abstract: Background: Needle stick injury has been identified as the foremost health allied concern and the specialty of dentistry is not an exception. Its incidence can be reduced when a dental practitioner is completely proverbial to the standard cross-infection control measures. This study was intended to assess the knowledge, attitude and practices among the dental practitioners regarding Needle Stick Injuries and associated risk factors. Methods: This survey was carried out in the Oral Surgery Department, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Karachi. Dental practitioners of different job categories were conveniently approached by the BDS students. They all were provided with a structured and validated, self-administered questionnaire. Descriptive statistics and Chi-square test was applied with 5% level of significance. Results: All 100 (55 females and 45 males) practitioners agreed to participate in the study. Prevalence of Needle Stick Injury observed was 30% with no significant relationship with the demographic characteristics. Seventy-four percent of the participants were aware of the universal guidelines. Majority (88%) of the dental personnel believed that recapping of needles should be performed soon after use and 53% knew about needle-less safety devices. These injuries were experienced by 30% of the respondents, of which just 28% were reported. Conclusion: Dental practitioners were at high risk of getting Needle Stick Injuries in dental offices. Most of them had knowledge about it but there was lack of practice of universal precautions. Keywords: Needle Stick Injury, Blood Borne Diseases, Dental Practitioners, precaution, infection

17 citations


Cites background from "Frequency of acute hepatitis C afte..."

  • ...3% in nurses.(8) In United Kingdom, nearly 48% of the nurses have reported that they have been stuck by a needle or sharp instrument used on a patient at some point in their career....

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References
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Journal ArticleDOI
TL;DR: SVR rates were higher in patients who had RVR with SdIF and high pre treatment ALT values correlated to probability of having RVR, and ROC plots of pretreatment age, ALT and albumin for SVR showed only ALT to have a significantly large area under the curve.
Abstract: Sustained virological response based on rapid virological response in genotype-3 chronic hepatitis C treated with standard interferon in the Pakistani population

27 citations

Journal ArticleDOI
TL;DR: A large number of discarded needles could act as a vector for transmission of Hepatitis C virus, typically by sharing of needles by injecting drug users.
Abstract: Background: Hepatitis C virus (HCV) is predominantly transmitted by blood-to-blood contact, typically by sharing of needles by injecting drug users. Discarded needles could act as a vector for transmission of this infection. Methods: Two cases of HCV seroconversion following a needle-stick injury in a community setting were identified. The effects of specimen processing and storage conditions on detection of HCV RNA were assessed to provide information about the likelihood of discarded needles containing infectious HCV. Results: Consistent with a role for discarded needles in viral transmission, in vitro studies demonstrated that viral load declined by less than one log following storage for 24 h. Conclusion: All needle-stick injuries should be promptly investigated by serology and HCV-PCR.

20 citations

Journal Article
TL;DR: In patients coming with one hepatic infection, other infections should be sought as they share a common mode of spread and may affect the overall response to treatment.
Abstract: Objective: To determine the frequency of hepatitis C and D in patients of chronic hepatitis B and the treatment response of hepatitis B in such patients. Study Design: Case series. Place and Duration of Study: Civil Hospital and Lyari General Hospital, Dow University of Health Sciences, from July 2003 to June 2005. Patients and Methods: All patients of hepatitis B presenting during the study period were screened for triple infection by carrying out anti-HBc (IgG), anti-HCV and anti-HDV. Patients who were positive to all three were included in the study. Complete Blood Count (CBC); HBsAg; HBeAg; anti-HBc IgM; anti-HDV; anti-HCV; HBV DNA PCR; HCV RNA PCR; serum albumin; SGPT; serum bilirubin and ultrasound abdomen were acquired in all patients. All patients received pegylated interferon-α 2a 180 mcg sc weekly x 48 weeks. Patients who were also positive for HCV RNA also received ribavirin 10001200 mg/d po x 24 weeks for genotype 3 and 48 weeks for genotype 1. Descriptive statistics were used for describing the data. Results: Out of the 246 patients of HBV, 29 (11.8%) patients were also positive for anti-HBc IgG, anti-HDV and anti-HCV. After 48 weeks of therapy, the respective viral undetection by PCR was 4 (13.8%) in patients having only HBV DNA, 3 (10.3%) in patients with only HCV RNA and in patients who had both HBV DNA and HCV RNA positive, simultaneously HCV was cleared in 2 (6.9%) while HBV was not cleared in any case. Conclusion: In patients coming with one hepatic infection, other infections should be sought as they share a common mode of spread and may affect the overall response to treatment.

20 citations

Journal ArticleDOI
TL;DR: Early and strong CD4(+)/Th1 immune response against HCV might play an important role in the disease resolution and Viral clearance within the first month after clinical presentation accompanied by monophasic alanine aminotransferase profile could predict recovery.
Abstract: Objective Hepatitis C virus infection (HCV) has a high rate of chronic evolution; however, the underlying mechanisms remain to be elucidated We investigated natural clinical, virological, and immunological course of acute HCV infection in order to identify possible prognostic factors of spontaneous resolution and to gain more understanding of early characteristics responsible for viral clearance or persistence Materials and methods Eight patients with acute symptomatic hepatitis C were prospectively followed up for more than 6 months (range, 8–14 months) None of the individuals received antiviral therapy during the study period We analyzed biochemical, virological, and immunological parameters of these patients detected at different time-points of the follow-up Plasma HCV RNA was quantitated using TaqManâ real-time polymerase chain reaction Virusspecific CD4+ T cells were enumerated by interferon-gamma (IFN-g) ELISpot assay Results Two of eight individuals resolved HCV spontaneously, while the remaining patients developed chronic HCV infection HCV RNA became undetectable within 14 days of the study, followed by a rapid alanine aminotransferase normalization in patients with resolved infection On the contrary, chronically infected subjects demonstrated persistent viremia or intermittently undetectable HCV-RNA, accompanied by polyphasic alanine aminotransferase profile throughout the study Patients with self-limited hepatitis C displayed the strongest virus-specific CD4+ T (IFN-g) cell reactivity within the first weeks of the follow-up, while persistently infected subjects initially showed a weak antiviral CD4+ T (IFN-g) cell response Conclusions In most cases, acute hepatitis C progresses to chronic disease Viral clearance within the first month after clinical presentation accompanied by monophasic alanine aminotransferase profile could predict recovery Early and strong CD4+/Th1 immune response against HCV might play an important role in the disease resolution

18 citations

Journal ArticleDOI
TL;DR: The clinical presentation of acuteHCV infection and the patterns of viremia and liver alanine transaminase levels observed are described and the serological and virological assessment and potential pitfalls in accurately diagnosing acute HCV are discussed.
Abstract: Acute hepatitis C virus (HCV) infection is often a clinically silent infection, and is therefore rarely detected. A high index of clinical suspicion in addition to careful serological and virological assessment is required to identify the disease, and to determine the eventual clinical outcome after primary infection; the minority of acutely infected individuals spontaneously control viremia in long term whilst the majority become persistently infected. Here, we describe the clinical presentation of acute HCV infection and the patterns of viremia and liver alanine transaminase levels (ALT) observed. We discuss the serological and virological assessment and potential pitfalls in accurately diagnosing acute HCV. Good prospective studies that identify host and virological factors that determine clinical symptoms and disease outcome are difficult to perform due to the asymptomatic nature of infection, but some progress has been made in this field. Host factors including gender, age at time of infection, prior resolution of infection, symptomatic infection and host immune responses, and viral factors such as the nature of the infecting quasispecies and more speculatively viral genotype, are some features that have been correlated with disease outcome. In spite of this, on an individual patient level, it is currently not possible to predict those that will resolve infection. Identifying, in detail therefore, those factors that are responsible for viral control remains an important research goal not only to aid clinical management but also to develop effective treatment and vaccination strategies.

18 citations

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