Viral hepatitis and the surgeon

Universal Precautions Provide Appropriate Protection during Autopsies of Patients with Infectious Diseases

The current coronavirus disease 2019 (COVID-19) pandemic has raised concerns about the safety of laboratory personnel who handle tissue samples that harbor pathogens, including those performing autopsies. While pathologists have performed autopsies on infected decedents for centuries, universal precaution protocols for limiting exposure to pathogens were not developed until the 20th century. This article reviews the history and effectiveness of universal precautions, with an emphasis on performing autopsies on COVID-19 decedents.

Molecular epidemiology of hepatitis B virus genotypes in blood donors in Islamabad, Pakistan

BACKGROUND:

Hepatitis B virus (HBV) is a major causative agent of early, severe and prolonged liver infection that subsequently leads to cirrhosis of liver and hepatocellular carcinoma. The aim of this study was to evaluate the molecular epidemiology of hepatitis B virus (HBV) genotypes and comparison of serological assay performance versus polymerase chain reaction (PCR) in HBV screening.

METHODS:

Blood samples of 8517 healthy blood donors were collected during the period of January to June 2017 from Blood Bank of Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad. Samples were screened for HBsAg assay using technique of chemiluminescence immunoassay. PCR of positive samples was carried out using already reported genotype-specific primers by Naito et al. (2001). The results were confirmed by visualizing genotype bands.

RESULTS:

The study confirmed the presence of HBV in 2.5% of blood donors, and PCR confirmed the presence of HBV-DNA in 92 samples. The genotyping was done by PCR using type-specific primer sequences. PCR was dogged to check six genotypes, i.e., A, B, C, D, E, and F. The results of this study show high levels of Genotype D is this region, i.e., 52.17% with less dominating Genotype C, which is 16.30% with decreasing ratio of Genotype E (14.13%), Genotype A and B (9.78%), and mixed D + E (2.17%). The presence of coinfection is found at lowest rate. Due to the high percentage of HBV/D, it is concluded that D genotype is common in our population.

CONCLUSION:

The most prevalent HBV genotype in ICT region was genotype D, which is responsible for liver cirrhosis and hepatocellular carcinoma. Efficacy of drugs varies with variation in genotypes of hepatitis B virus and also with geographical distribution.

Seroprevalence of Hepatitis B Virus and Compliance to Standard Safety Precautions among Scavengers in Ilorin Metropolis, Kwara State, Nigeria

BACKGROUND

Scavengers, due to the nature of their work, are at risk of various occupational hazards while sorting for materials for recycling and sale. They are exposed to blood borne infections such as hepatitis B virus (HBV) infection from injuries from sharps and contact with discarded materials due to non-compliance with standard precautions.

OBJECTIVE

The present study assessed the prevalence of HBV and compliance with safety precautions among scavengers in Ilorin Metropolis, Kwara State, Nigeria.

METHODS

A cross-sectional study was conducted among 236 scavengers (comprised of scavengers dealing with biomedical wastes and those that were not) using structured questionnaires during the first stage of the study and a second testing stage. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 20.0 for descriptive and inferential statistics at a 5% level of significance.

RESULTS

The prevalence of HBV infection among the scavengers was found to be 17.4%, indicating that scavengers are at high risk of HBV infection. There was a significant difference in the prevalence of HBV among scavengers that handled biomedical wastes and those that did not. The majority of the scavengers (74.2%) did not have knowledge of or use standard precautions such as personal protective equipment (PPE). The level of injuries was considerably high and the treatment of injuries among scavengers illustrated their lack of awareness of the hazards involved in their occupations, as the majority of respondents (51.3%) engaged in self-treatment of occupational injuries.

CONCLUSIONS

The probable pathway for virus transmission was waste handling, especially biomedical waste, which is mostly handled with bare hands without standard safety precautions. Vaccination against HBV, proper personal hygiene practices, regular training in occupational safety, monitoring by regulatory agencies and inclusion of scavengers in a mandatory health insurance scheme are recommended to control the risk of HBV infection among scavengers.

INFORMED CONSENT

Obtained.

ETHICAL APPROVAL

This study was approved by the Kwara State Ministry of Health Ethical Review Committee. Permission was also granted by the scrap dealers association through the Kwara State Environmental Protection Agency that oversees issues relating to the environment and public health in the state.

COMPETING INTERESTS

The authors declare no competing financial interests.

Sustaining a career in surgery

Surgery is a demanding career with great rewards and equally great challenges. In order to sustain our careers as well as the careers of our colleagues, it is important to understand and address the physical, psychological and spiritual challenges of surgery. With rare exception, the majority of surgery residents and practicing surgeons who prematurely leave surgery do so because they find the work to be physically, emotionally or spiritually incompatible with the vision they have for their life. Understanding these issues and providing solutions to improve surgeon wellness can help prevent societal loss of these highly trained professionals and suffering for surgeons and their families.

Seroprevalence of Hepatitis B Infection in Nigeria: A National Survey

Hepatitis B virus (HBV) infection accounts for about 1 million deaths worldwide annually. This study was to determine the prevalence, distribution of HBV, and factors associated with infection in an apparently healthy population in Nigeria. A cross-sectional study among the general population was conducted employing a multistage sampling technique. Data on demographic, social, and behavioral indicators were collected using questionnaires and blood samples tested for HBV seromarkers. Descriptive, bivariate, and multivariate analyses were done. Prevalence of hepatitis B infection was 12.2% (confidence interval [CI] = 10.3-14.5). Of the participants, more than half, 527 (54.6%), had evidence of previous exposure to HBV, while 306 (31.7%) showed no serologic evidence of infection or vaccination. Only 76 (7.9%) participants showed serologic evidence of immunity to HBV through vaccination. Factors associated with testing positive for HBV infection were dental procedure outside the health facility (odds ratios [OR] = 3.4, 95% CI = 1.52-7.70), local circumcision (OR = 1.73, 95% CI = 1.17-2.57), and uvulectomy (OR = 1.65, 95% CI = 1.06-2.57). With logistic regression, only dental procedure outside the health facility (adjusted OR = 3.32, 95% CI = 1.38-7.97) remained significant. This first national survey on seroprevalence of hepatitis B describes the epidemiology and high prevalence of HBV infection in Nigeria and highlights the need for improved vaccination against HBV.