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Yasir Waheed, Talha Bin-Rahat, Sher Zaman Safi and Ishtiaq Qadri

Abstract

Hepatitis B virus prevalence is increasing in Pakistani population. National level estimates regarding the prevalence are missing. People are unaware of the risk factors involved in HBV transmission. The objective of the study was to review the prevalence, genotypes, and risk factors associated with HBV transmission in Pakistani Population. Literature search was done by using keyword HBV prevalence, genotypes and risk factors from Pakistani population at Pubmed, PakMediNet and Google scholar. Six different studies showed that the percentage prevalence of HBV in general population was 4.61±0.73%, and 21 different studies showed the percentage prevalence of 2.33±0.46% in blood donors. High prevalence of 7.94±1.49% and 12.86±4.52% were observed in multi transfused and IDU populations. Six different studies showed that the major prevalent genotype was D. Awareness regarding various risk factors involved in-viral transmission was very low. Prevalence of HBV was very high in multitransfused populations due to non-implementations of international standards regarding blood transfusions. Barbers were unaware of the risk factors associated with their shops in viral transmission. Practices of unsterilized dental and surgical instruments and recycling of syringes were major factors in viral transmission. Massive awareness and vaccination programs are required to decrease the future burden of HBV from Pakistani population.

Open access

Yasir Waheed, Umar Saeed, Sher Zaman Safi, Waqas Nasir Chaudhry and Ishtiaq Qadri

Abstract

Background: In Pakistan, most patients with Hepatitis B and C have history of facial and armpit shaving from barbers. Objective: Evaluate the awareness and risk factors associated with barbers in transmission of Hepatitis B and C. Subjects and methods: A cross sectional survey was conducted in Rawalpindi and Islamabad, the twin capital cities of Pakistan between January and July 2009. Five hundred and eight barbershops were surveyed. Results: Out of 508 barber shops, 99.8% and 98.2% were washing their razor with water and water plus antiseptic solution, respectively, while 99.8% were using new blades. Only 39.6% knew that hepatitis B virus (HBV) and hepatitis C virus (HCV) were viral diseases, 26.6% knew that it can lead to cancer, 90.7% thought that hepatitis could be transferred by blade sharing, 47.8% knew that a vaccine for HBV was available, and 43.0% had education beyond the primary level. None of the barbers used a new or washed apron/towel on every customer. Conclusion: In Pakistan, a small number of barbers are shaving clients with an old style razor with a permanent blade. There is moderate awareness about the various modes of transmission of hepatitis among the barbers, and most of them don’t know about vaccination. A predominant number of them are considering interferon treatment as a vaccine for hepatitis B and C.

Open access

Sher Zaman Safi, Yasmin Badshah, Yasir Waheed, Kaneez Fatima, Sadia Tahir, Alamgir Shinwari and Ishtiaq Qadri

Abstract

Background: Due to the inherently unstable nature of HCV, various genotypes have been identified. Steatosis is a histological feature in the progression of HCV-associated liver disease and has been shown to alter the host lipid metabolism. Objective: Assess the distribution of HCV genotypes in the two provinces of Pakistan, and determine the association of hepatic steatosis with altered clinical and virological factors in chronic HCV patients. Methods: One hundred twenty six chronic HCV patients (steatosis in 49 patients) were enrolled for qualitative analysis by PCR. Out of 126 ELISA and PCR positive samples, 119 (48 with hepatic steatosis) chronic HCV patients (mean age 42.0±13.3 years, mean body mass index (BMI) 24.2±4.1) were proved positive after PCR-based detection. Biochemical and virological factors such as HCV genotype, or glucose, in 119 CHC patients were determined and compared between patients with and without hepatic steatosis. Results: Out of 126 samples, 119 were HCV positive, where 58 (48.7%) were genotype 3a, 24 (20.2%) were 3b, 12 (10.1%) were 1a, eight (6.7%) were 2a, six (5.0%) were 1b, and one (0.8%) was 4. Furthermore, seven (5.9%) had a co-infection and three (2.5%) were untypable. BMI (p=0.004), genotype 3a (p<0.001), and triglycerides (p=0.002) were significantly associated with steatosis. It is noteworthy that cholesterol (p=0.281), glucose (p=0.305), lowdensity lipoprotein (p=0.101), high-density lipoprotein (p=0.129), alanine amino transferase (p=0.099), aspartate transaminase (p=0.177), bilirubin (p= 0.882), and age (p=0.846) showed non-significant association. Conclusion: Genotype 3a is the predominant genotype in Pakistan. Hepatic steatosis is quite frequent feature in HCV patients and strongly correlates with BMI, genotype 3a, and triglyceride contents in patients infected with HCV.

Open access

Sher Zaman Safi, Muhammad Sohail Afzal, Yasir Waheed, Umer Javed Butt, Kaneez Fatima, Yousaf Parvez and Ishtiaq Qadri

Abstract

Background: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections are major health problems associated with blood transfusion practices in Pakistan. This study was conducted on a large population to asses the epidemiology of HCV and HIV in the North West Frontier Province (N.W.F.P) of Pakistan.

Methods: Between January 2008 and July 2009, 62,251 healthy blood donors (BDs), aged 17-50, were included. In that group, 61,059 (98.1%) were male and 1192 (1.9%) were female. All donors from the 11 areas of N.W.F.P were screened for HCV and HIV antibodies by ELISA (Biokit). Blood groups were also determined.

Results: HCV prevalence was 2.6% while HIV infection was 0.045% in this Pakistani population. Prevalence of HCV and HIV in 2008 was 2.4% and 0.049% respectively. In 2009, it was 3.0% for HCV and 0.038 for HIV. Among the age groups, the prevalence of HCV and HIV was not significantly different (p=0.128). Only 1484 (2.4%) of the donors were voluntary, the remaining were paid and family blood donors. The difference in the number of male and female donors was highly significant (p=0.00001). The B+ blood group was found in 30.5% followed by O+ in 25.9%, A+ in 24.9%, AB+ in 10.4%, A- in 2.6%, B- in 2.5%, O- in 2.3%, and AB- in 0.9%. Our study revealed a higher prevalence of HIV than in most of previous reports.

Conclusion: The frequency of HCV infection in blood donors is higher in N.W.F.P than in most of the rest of the world and lower than in other regions of Pakistan. Transfusion of infected blood is a common cause of transmission. HIV prevalence is increasing in Pakistan.

Open access

Muhammad Sohail Afzal, Shakir Ullah, Zia Ur Rehmann Farooqi, Sadia Anjum, Talha Shafi, Tahir Ahmed, Muhammad Ashraf and Ishtiaq Qadri

Abstract

Background: Malaria is a leading cause of morbidity and mortality worldwide resulting in approximately 350 to 500 million clinical cases and up to two million deaths. In Pakistan, 1.5 million cases of malaria are reported annually. The genetic factors of both host and pathogen are related to the severity of the disease. Interleukin-10 (IL-10) is an anti-inflammatory cytokine that can play a key role in plasmodium falciparum infection. Variations in IL-10 production are genetically related to polymorphisms within the IL-10 promoter region.

Objective:We investigated the association of IL-10 gene promoter -1082 G/A, -819 C/T, and -592 C/A polymorphism with malarial susceptibility in Pakistani individuals.

Methods: Ninety malarial patients and 99 healthy control subjects were enrolled. IL-10 genotyping was performed by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Results: There was no significant difference observed in inheritance pattern of studied single nucleotide polymorphisms. All the alleles, genotypes, and haplotypes had almost similar frequencies among diseased and healthy control groups. IL-10 -1,082 homozygous G was comparatively higher in healthy subjects but difference was not statistically significant.

Conclusion: We have found no significant association between IL-10 promoter polymorphism and plasmodium falciparum infection in Pakistan. Our result from Pakistani population confirm previous association in studies from Thailand, Gambia, Republic of Mali, Tanzania, and contradict one from Kenyan population.

Open access

Muhammad Sohail Afzal, Sadia Anjum, Zia-ur-Rehman Farooqi, Mamoona Noreen, Sher Zaman Safi, Muhammad Ashraf and Ishtiaq Qadri

Abstract

Background: Coronary Artery Disease (CAD) is the most frequent form of heart diseases. IL-10 is an antiinflammatory cytokine and down regulates the Th1 response by suppression of pro-inflammatory cytokine. There are interindividual variations in IL-10 production, which are genetically contributed by polymorphisms within IL- 10 promoter region.

Objectives: We investigated the association of IL-10 gene promoter -1082 G/A, -819 C/T, and -592 C/A polymorphism with CAD susceptibility in Pakistani individuals.

Methods: Ninety-three CAD patients and ninety-nine controls were enrolled in the study. IL-10 (-1,082 G/A, -819 C/T, -592 C/A) genotyping was performed by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR).

Results: There is an indication that IL-10 -1082 GG (p = 0.033, OR = 0.26, 95%, CI = 0.07-0.97) has positive association while -1082 GA (p = 0.031, OR = 2.7, 95%, CI = 1.07-6.90) has negative association with CAD. IL-10 -819 TT (-592 AA) were significantly higher in control than in patients (p = 0.008, OR= 3.1, 95%, CI = 1.09-9.02). We have not found any significant association between IL-10 alleles and haplotypes and CAD. GTA/ATA was the diplotype, which showed the protective effect (p = 0.006, OR = 3.6, 95%, CI = 1.16-10.57) in CAD susceptibility.

Conclusion:We found a significant distributional variation in IL-10 promoter SNPs in healthy individuals and the disease group. This difference may be manifested in IL-10 production and disturb the pro- and anti- inflammatory cytokine balance hence influencing the susceptibility of CAD.