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Title: Comparative Analysis of Biochemically and Behaviorally Symptomatic and Asymptomatic Hepatitis C Positive Patients, Karachi and Effect of Aflatoxin B1 on Hepatitis C.
Authors: Zia, Zubia
Keywords: Pharmacology
Issue Date: 2019
Publisher: Baqai Medical University, Karachi.
Abstract: Pakistan is the country, which has contributed to the excessive burdens of hepatitis C of chronic nature as a result of which high rate of mortality has been reported that are triggered by the conditions of liver failure and hepatocellular carcinoma. Simultaneously, there is very less recent data available for depicting the prevalence and risk factors associated with the clinical condition on the national level, whereas different studies have been put forth with varying rate of prevalence in the country. High prevalence rate of hepatitis C has been observed in Pakistan, which elaborates that about 10 million of the population has been diagnosed with the infection of hepatitis C alone. The study was designed to obtain adequate information about underlying factors that are contributing to the increase prevalence of this disease. Knowledge regarding high risk factors among carriers of HCV, role of biochemical parameters, therapeutic effect of drugs prescribed against the disease on clinical outcome along with this, the exposure of aflatoxin B1 among HCV infected patients and quality of lifestyle of these patients were studied in depth that provides significant insight into the study. This is a cross sectional designed study conducted to collect data from HCV patients. Patients visiting hospital setting (JMPC) were approached to participate in the study and explained the purpose of this research. Those who accepted to contribute, their approval in written has been taken on informed consent form signed by patients. Afterwards, their blood samples were withdrawn for confirmation of HCV RNA that was detected by the polymerase chain reaction (PCR). Patient, who were found positive after evaluation through PCR, i.e. 88 patients were enrolled in the study. Their blood samples were also evaluated for liver enzymes and aflatoxin B1 levels. Patients were then provided with a structured proforma containing various questions for evaluation of their demographic data, to assess their knowledge status, history of exposure to high risk factors (to identify possible cause of Hepatitis C Virus acquaintance) and to observe their routine lifestyle practices. Afterwards, their blood samples were also evaluated to assess hepatic biomarkers, and other biochemical test. Elisa was used to assess the levels of aflatoxin B1. Appropriate treatment regimen was then provided to enroll patients including interferon and ribavirin for the period of 6 months. During the period patients were properly followed and after that, their blood samples were again withdrawn for post-treatment analysis of HCV status, hepatic biomarkers and other biochemical tests. Conferring to the findings of this study, based on post treatment analysis, patients were divided into two groups. Those found negative with HCV RNA were placed in one group named `treatment responder group`, others with positive HVC RNA were placed in second group named `treatment non-responder group`. Statistical analysis was performed on IBM SPSS 20. Chi-square test was used to find possible association among various parameters qualitatively. Socio-demographic assessment of the study population revealed that the high incidence of HCV patients reported at above 40 years of age make up to 60% of total population. While females were found to be the most susceptible ones. This study also reported that the rate of incidence of this disease is higher in patients who are illiterate or have received no formal education i.e. 60%. Along with this high incidence of HCV have also been observed in patients with less earning outcome. However, most of the patients affected lived in proper houses which indicate the lack of serious apprehension towards avoidance of associated risk for this disease. On assessing the knowledge of patients toward the risk factors associated with transmission of hepatitis C, most of the patients found aware of the fact that blood transfusion, unsafe sex, blade, razor, miswak, used needles, tattoo along with ear and nose piercing have potential to spread disease whereas they were found quiet unaware about body secretion as well as use of utensils of persons already infected with HCV which also have the ability to transmit the disease. On evaluating the historical events of studied patients, foremost reason responsible for transmission of hepatitis C infection was possibly the use of unsterile instruments during any surgery or dental procedure. However, the other reasons accounts for transmission of this disease in patients could be a family member affected with HCV, may be blood transfusion, piercing of any body part usually ear or nose, exposed to needle stick injury etc. Insecure sex along with injecting drug are also contributing for the disease but to a lesser extent. The effects of therapy provided against HCV infection comprising of interferon and ribavirin on hepatic biomarkers and various blood parameters have been investigated in this study. In post treatment analysis significant adaptations have been observed in serum ALT levels, bilirubin, HBA1c, prothrombin time and levels of uric acid i.e. P-value < 0.05. While there is no such association recorded between anti HCV drugs and serum levels of AST, GGT, alkaline phosphatase, total proteins and serum creatinine. The established side effects of therapy on hematopoietic lineages have also been observed representing reduction in Hb levels and platelet count. Exposure of aflatoxin B1 among HCV patients have also being ruled out. Aflatoxins are mutagenic, carcinogenic, teratogenic, and immunosuppressive in nature. It is present in nuts, grains, and cottonseed as well as other commodities that are related to food for human consumption or animal feeds. On the other hand, some of crops may be observed contaminated by the manifestation of one or more sub-types of the aflatoxins including B1, B2, G1, and G2. Aflatoxin B1 is known for its toxic nature among other types of aflatoxins, which is mainly due to its hepatotoxic and hepatocarcinogenic properties that not only leads to the development of hepatitis, but also contribute to the manifestation of lung cancer, HCC, and immune suppression. This study did not found any association on treatment outcome of therapy directed against HCV in connection with AFB1 exposure. On the other hand, the evaluation of patients exposed to AFB1 showed that most cases of AFB1 exposure has been reported at age group of 50-59 years. However, with the increase in age, increase in exposure has also been observed upto 60 years. Females were found to have more exposed gender with AFB1 whereas males are also exposed to this toxin. Educational standing of the patients exposed to AFB1 suggest that there is no difference recorded based on literacy. As noted in study most educated people have more AFB1 exposure. Similarly, income level as well as the type of house in which patients are living does not affect the level of AFB1exposure. In a nut shell, this study through light primary factors accountable for increase prevalence of HCV in which socio-demographic characteristic play a vital role. Patients were quiet aware of most of the transmission factors that are increasing burden of the disease. Most of the patients could have received this virus (HCV) after some surgical procedures. Moreover, after receiving therapy against this disease, mostly patients have responded and the consequence of therapy on hepatic biomarkers and other biochemical parameters were also noted. Significant correlation was documented against serum ALT levels, bilirubin, HBA1c, prothrombin time and levels of uric acid along with decreasing effect on hematopoietic lineages. The level of aflatoxin exposure among patients were independents of socio-demographic factors.
Gov't Doc #: 19388
Appears in Collections:PhD Thesis of All Public / Private Sector Universities / DAIs.

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