Blood-borne viral diseases and the surgeon

High Anti-HCV Seroprevalence and Low Performance of ICT Strip in Diagnosing Hepatitis C Virus Infection in Children in Enugu Metropolis

Background:

The lack of a vaccine for Hepatitis C virus (HCV) places children at a high risk of contracting the infection. It becomes necessary to accurately diagnose this infection for proper treatment as well as identifying potential risk factors for effective management.

Aim:

This study was conceived to assess the test performance of the commonly used Immunochromatographic test (ICT) strip and identify the associated clinical manifestations and risk factors of HCV in children in Enugu Metropolis.

Method:

A cross-sectional study involving randomly selected 270 children below six years of age was conducted in Enugu Nigeria. The subjects were screened for anti-HCV by ICT and Enzyme-Linked Immunosorbent Assay (ELISA) and the demographic, signs and symptoms and risk factors were collected.

Results:

A total of 50 out of 270 children were positive for anti-HCV with a seropositivity of 18.5%. ICT strip had a very low sensitivity of 38.00% with an accuracy of 88.52% in detecting anti-HCV. The presence of dark urine was associated (p= 0.01) with HCV infection.

Conclusion:

A seroprevalence of 18.5% of Anti-HCV was found in children below six years old in Enugu metropolis and the performance of ICT in diagnosing HCV infection was poor compared to ELISA.

Seroprevalence and Associated Risk Factors of Hepatitis B Virus Infection Among Children in Enugu Metropolis

Background:

Though measures are being put in place for the management of Hepatitis B virus (HBV) infection in Nigeria, children remain the most vulnerable to develop chronic hepatitis. Routine screening in children is therefore necessary for effective control. However, the performance of the commonly used immunochromatographic test (ICT) strips has been challenging. Also, identifying the risk factors of transmission in this age group is of importance for the implementation of preventive measures. Hence, the goal of this study was to assess the test performance of the routinely used ICT strip and identify the associated clinical manifestations and risk factors of HBV.

Methods:

A cross sectional study involving 270 children below six years of age was conducted at ESUTH and Favor Child Pediatrics Hospital in Enugu, Nigeria. The subjects were screened for HBV by ICT and ELISA assays and a structured questionnaire was used to obtain participants data including demographic, socioeconomic, signs and symptoms, risk factors and vaccination.

Results:

BBased on ELISA, 31 out of 270 children were positive for HBV with an infection rate of 11.5%. ICT kit showed a low sensitivity of 51.6% in diagnosing HBV but was highly specific (100%) and accurate (94.4%). HBV infection was not associated with sex (χ2: 0.209; p = 0.401). The prevalence of HBV infection was similar in all the age group and HBV infection was not associated (χ2: 2.099; p = 0.914) with age group. All the clinical manifestations were not associated (p > 0.05) with HBV infection. Blood transfusion, shared items, tattoo marks and history of surgery associated significantly (p < 0.05) with HBV infections having odd ratios of 4.247, 4.224, 3.134 and 3.195 respectively. The vaccination rate was 55.2% (159/270) and only 3 (1.1%) out of 159 vaccinated subjected contracted the infection (OR: 0.068, p < 0.0001).

Conclusions:

HBV was prevalent (11.5%) in children below six years old in Enugu metropolis. Moreover, the routinely used ICT test was less reliable than ELISA in diagnosis HBV infection. More so, shared items, blood transfusion, tattooing and history of surgery were potential risk factors while vaccination served as a protective factor against the infection.

Needlestick injuries during surgical procedures: a multidisciplinary online study

BACKGROUND

Needlestick injuries are common during surgical procedures. Following such an injury, local protocols should be followed to minimize the risk of infection.

AIMS

To identify who sustains such injuries, under what circumstances and what actions are taken to minimize the risk and in response to intraoperative needlestick injuries.

METHODS

A questionnaire was submitted via e-mail to all staff in a National Health Service trust who took part in operations. The results were checked against occupational health department (OHD) records.

RESULTS

One hundred and thirty-six of 255 appropriate responders completed the questionnaire (53%). Fifteen of 31 consultants (48%), 12/36 junior doctors (33%), 0/39 midwives (0%) and 8/30 theatre staff (27%) reported having had at least one intraoperative needlestick injury over the past year. Awareness of local protocols was significantly worse in the junior doctor group. Ninety-three percent of consultants, 67% of junior doctors and 13% of theatre staff did not comply with local protocols. The length of time it takes to do so (48%) and a perceived low infection risk of the patient (78%) were the commonest reasons for this. Hand dominance, role during surgery and double gloving were not significant risk factors; however, rare use of a no-touch technique was. Comparison with OHD records suggested that a maximum of 16% of intraoperative needlestick injuries were dealt with in accordance to local policy.

CONCLUSIONS

Non-compliance with needlestick injury protocols is commonest among senior surgical staff. A revision of the protocol to reduce the time it takes to complete it may improve compliance.

HIV-infected patients: the risks of surgery

There are increasing demands for surgical interventions in Human Immunodeficiency Virus (HIV)-infected patients as a consequence of antiretroviral therapy. This article will discuss various risk factors involved in the surgical management of patients with HIV infection including: anaesthetic and surgical risk to patients with HIV infection undergoing surgical procedures; risk to healthcare professionals involved in the treatment of HIV-infected patients; and measures taken to ensure a safe and optimal outcome from surgery.

The risks of surgery in HIV-infected patients

There are increasing demands for surgical interventions in Human Immunodeficiency Virus (HIV)-infected patients as a consequence of antiretroviral therapy. This article will discuss various risk factors involved in the surgical management of patients with HIV infection including: anaesthetic and surgical risk to patients with HIV infection undergoing surgical procedures; risk to healthcare professionals involved in the treatment of HIV-infected patients; and measures taken to ensure a safe and optimal outcome from surgery.