Prevalence Study of Hepatitis B (Australian Antigen) Among Patients in National Orthopaedic Hospital Enugu

Prevalence Study of Hepatitis B (Australian Antigen) Among Patients in National Orthopaedic Hospital Enugu

Chapter One

PURPOSE OF STUDY

The need for study can never be over emphases having considered the above, this study serves the following purpose or objectives.

To obtain a general view of the group of individual affected whether children or adults.
To show circumstances which dispose to viral hepatitis and suggest means of reducing the incidence.
To review the management of these patients with regards to vestigation done and treatment.
To understand the complex or exorbitant nature of the structure of the hepatitis B virus as well as the debilitating effect it has on the patient
Also compare and contrast primary data from this study with secondary from the library
To how rate of progression to chronicity as well as make known the daily activities that will not result in contacting HBV.

CHAPTER TWO

LITERATURE REVIEW

STRUCTURE OF HEPATITIS B VIRUS

The hepatitis B virus is a 42nm particle comprising an electron dense nucleocapsid or core, 27nm in diameter surrounded by an outer envelope of the surface protein (HBsAg – Otherwise called the Australian Antigen) embedded in membranous lipoprotein derived from the host cell (figured) the Australian antigen, that is the surface antigen is produced in excess by the infected hepatocytes, and is secrete in the form of 22 nm particles and tubular structures with the same diameter. In other words, serum from individuals infected with hepatitis B contains three distinct antigenic particles: a spherical 22nm particle, a 42nm spherical particle (containing DNA and DNA polymerize) called the DANE Particle, and tubular or filamentous particles of the same diameter with the spherical particles (22nm). The small spherical and tubular particles are the unassembled components of the Dane particles the infective form of the virus. The unassembled particles contain hepatitis B surface antigen (HB_sAg) Australian antigen (Figure2). The 22nm particles are composed of the major surface protein in both non glycosylated and glycosylated form in approximately equimolar amount together with a minority component of the so called middle protein. The surface of the viron has a similar composition but also contains the large surface proteins. These large surface proteins are not found in the 22nm spherical particles (but maybe present in the tubular forms in highly viraemic individual) and their detection in serum correlates with viraemoa. The nuclecapsid of the Varian consists of the viral genome surrounded by the core antigen (HB_sAg). The carboxyl terminus of the core protein is anginine rise and this highly basic domais is believe to interact with the genome (van Regenmortel et al, 2000).

THE GENOME AND IT ORGANISATION

The genome, ( full set of genes present in a virus or cell) which is approximately 3.2kb in length, has an unusual structure and is composed of two line strands of DNA help in a circular configuration by base pairing at the 5 ends (cohesive end region). One of the strand is compact and the 3 end is associated with a DNA polymerize molecule that is able to complete that strand when supplied with deoxynucleocide triphosphatis, to date, the genomes of more than a done isolates of have been loaned and the complete nucleotide seaquake determined. Analysis of the some reveals four major polypeptide reading from genes) otherwise known as the opening Reading Frames (ORF) the S (surface) the C (core), the P (Polymerize) and the X (transcription transactivator) (Figure 3). The first opening reading frame, the S gene) encodes the various form of the surface protein and contains three in frame methonine cordons that are used for initiation of translation. The second opening reading frame the core also has two in phase initiation codons the precore region and they are the precore region is highly conserved, has the properties of a signal sequence, and is responsible for the section of HB_sAg. The third opening reading frame (the P gene) which is the largest and overlaps the other three encodes the viral polymerize. The protein seens he apparently synthesized following internal initiation of the ribosome. The fourth opening reading frame was designated X” recently identified as transcription transactivator and may be an ‘early gene product that Functions to up regulate the viral promoters (Zuckerman, ).

CHAPTER THREE

MATERIALS AND METHODROGY

This chapter given an sight into research methods, materials and collection of data.

MATERIALS USED:

-Measuring of pipette

-Tsetse/rack

-Timer/ high intensity lamp.

-Automated slide rotator (optional)

-Disposal test slides.

-Disposal dispensing pipettes, 50 ul drop size 0.9% sodium chloride solution.

-Refrigerator

-Centrifuge

-Syringe and needle

blood samples from patients
REAGENT
(a) HBsAg latex Reagent

(b) position & negative controls

fransaminase tests: Diazo beak

Benzoate-urea solution

Diazo reagents A&B

Distilled water

Methodology:

TEST FOR THE PRESENCE OF HEPATITIS B ANTIGEN

The blood samples were collected intravenously into sterile test tubes. After complete clot reaction, the sera were separated for testing with the and of a centrifuge.

All the reagents and samples were brought to room temperature. The latex was gently mixed to achieve complete resuspension of the particles. For each sample to be tested, a test tube was set up and labeled. 2.0me of 0.9 % sodium chloride solution was pipette into each labeled tube. The disposal dispensing pipette was used to draw up and express one free falling drop (50ul) of each sample into its dilution tube. This was tested as the 1:40 diluted sample and mixed well. The same pipette was used to draw up and express two free falling drop (100 ul) of the diluted sample onto a marked test area of the slide.

CHAPTER FOUR

RESULT

This chapter given the result of investigation done on the patients in national orthopedic Hospital Enugu. The blood sample of two hundred (200) patient were tested. The following variable were studies Age, Sex , Domicile, Occupation and Educating the Patients.

CHAPTER FIVE

DISCUSSION CONCLUSION

In this chapter a comprehensive analysis or discussion of the result is made. It gives a detailed analysis of the result of investigation done.

The blood sample of 200 (two hundred ) patient of the hospital that is national Orthopedic Hospital Enugu were tested. Of the tese, about 110 patients tested positive to Hepatitis B virus. The test done was a routine test in which HB_sAg was screened for in the blood sampling the patients. This is usually the test done in screening for HBV in patients in Orthopedic Hospital Enugu as the reag into were always readity available . for easy collection and analysis of dfata the patients were studied under five (5) variable age sex, Donicile occupation and education. The last variable education was not studies as it was not possible to obtain a comprehensive analysis of the educational status of the patent. For age, the patients were grouped into seven (7) different age groups between 1 to 70 years with 10 yeard interval between each age group that is 1-10, 11-20 and so on. Inection was highest amongest young adult within 21-30 age group. Tyhius accounted for 37.5% of the 200 population and 17.5% of the 110 infected population. It was lowest amongst two age group 1-10 and 60-7-0 as they both made up 2.5% apiece of the infected population. This is seenin.

Table 1 of chapter 4

Form the sex incidence, table 2 of chapter 4 both the male and female patient were both equally infected that to say 55 patients each were infected of male and female patient, in other word, 27.5% each of the positive. 40% of the patients that tested positive were urban dwellers as seen in section 4.3 of chapter 4 while the remaining 15% were from the rural areas. Further study revealed that the virus was more prevalent among the unskilled workers and lowest amongst housewives as none tested positive to the hepatitis B virus. Sections 4.4 and 4.5 showed that the unskilled workers have 40 patients that tested positive of all the 110 infected ones and the housewives had none as already mentioned. Further investigations done on the patients to ascertain the condition of their livers also revealed interesting test result. The hepatitis B virus infects the liver hepatic cell, as already mentioned in chapter 2, and causes degeneration of liver tissue with release of liver association enzymes –the transaminases into the bloodstream. This is followed by the accumulation of the breakdown product of hemoglobin – bilirubin under the skin giving the patients a yellowish appearance. A biochemical test done on the sera of the infected patients showed this sort of liver damage. It revealed the presence of these liver associated enzymes in most of the sera. 40% of the patients that tested positive had high level conjugated bilirubin total. It simply means the degree of damage done to the liver tissue resulting in the accumulation of a very high level of bilirubin. Alkaline phosphatese, another enzyme in the liver was found to be raised in 32% of the patient, the transaminase was raised in 39% of the patients.

The charts were used to throw more light on the result from the variables under which the patients were studied. They depicted the age group, sex, domicile, and occupational category that had the highest of positive patients with regards to the variables that was used for them. A good example is the graphs; they showed the particular age group that had the highest number of positive persons. The graph was done using the age variable.

The clinical presentation was jaundice, fever and abdominal discomfort which was present in almost hay of the 110 patients that were positive.

CONCLUSION

After the investigations, collection and analysis of data, in which 200 patients’ blood samples were tested, 110 patients tested positive to the virus, and only 90 patients were negative.

These 110 patients included five children, twenty students, forty unskilled workers, twenty semi skilled workers, and finally twenty-five professionals.

The above data went a long way to prove the hypothesis “Hepatitis B is prevalent among patients in Orthopedic Hospital Enugu” to be true. This is seen in the fact that more than half of the patients tested were positive.

Therefore, it is hereby concluded that the infection, Hepatitis B (Australian antigen) is prevalent among patients in the said hospital; undoubtedly as the data speaks for itself.

RECOMMENDATION

One cannot prevent a virulent organism such as the Hepatitis B virus without being extremely careful. It is, therefore, recommended that people who are at risk of contacting this virus should endeavor to take the vaccine against this virus in order to build up antibodies against the antigen. Also, when one is exposed to the virus, the vaccine should be given without 48hours of exposure and not 7days like most textbooks recommended.

Furthermore, contact with all body fluids infected with HBV, and equipment contaminated with infected body fluids should be avoided. Unprotected sex should be avoided, and also not encouraged, while the use of unstorile sharp instruments should be avoided inorder to prevent and control the transmission of Hepatitis B virus.

REFERENCES

Anderson, F.H, Natalie Rock, Susan Campbell (2002 The Hepatitis B Newsletter. Department Of Medicine, Vancouver General Hospital, Canada.
Evans, A.S (1997) Viral Infections of humans: Epidemiology and Control, 4^th ed., New York; Plenum. Pg. 102 – 9
Knight, D.M, Howley, P.M (2001) Fundamental Virology, 4^th ed., Philadelphia: Lippincott Williams and Wilkins Pg. 60 – 70
Prescott, M L, Harley, P. J, Klein, A D, (2005) Microbiology, 6^th ed., New York: McGraw Hill Companies. Pp 338, 765, 866 – 7
Schleringer, S. & Schleringer, M. J (2001). Viruses. In Encyclopedia Of Microbiology, 2^nd ed., Vol.4, San Diego: Academic Press. Pg 796 – 810
Seeger, C, & Masor, W. S (2000) Hepatitis B virus Biology, Micro. Mol Biology Rev 64 (1): 51 – 68
Shaw, Nite, Oliver Russel, Sean Green (1989) Comprehensive Study Of Hepatitis B in U.S.A, Ist ed., New York: Marion Press. Pg 68.
Sherker, A.H, Marion, P. L (1991) Hepadnaviruses and Hepatocellular Carcinoma. Annu. Rev. Microbiology. 45: 475 – 508

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