Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
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An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 619 - 622

Viral Hepatitides among the Blood Donors in a Rural Based Hospital: A Five Year Study

Subhashish Das, Harendra Kumar M.L.

1. Associate Professor of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar. India. 2. Prof. & Head of Department of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, India.1. Associate Professor of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar. India. 2. Prof.

Correspondence Address :
Subhashish Das C/o Dr. Kalyani R. MD
P.C. Extension, Kolar, Karnataka, India - 563101.

Abstract

Background: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are important transfusion-transmissible infections. This study was performed for the assessment of the prevalence of HBV and HCV sero positivity among the blood donors at a tertiary care hospital- based blood bank which is located in rural southern India.

Study Design and Methods: The blood donation records over a period of 5 years which ranged from 2006-2010 were reviewed retrospectively, for the prevalence and the yearly trends of HBV and HCV sero positivity.

Results: A total of 25,341 donations were received .The overall number of the Hb- sero-positivedonations was 233 and that for HCV was 55. The prevalence rates of 0.92% and 0.22% were noted for the hepatitis B surface antigen (HBsAg) and for HCV respectively. The sero positivity rate was higher in the replacement donors as compared to that in the voluntary donors.

Conclusions: Stringent measures need to be taken, including the dissemination of information, strict screening of blood, inclusion of the antibody to the hepatitis B core antigen and other sensitive markers for the screening protocol, and better donor recruitment.

Keywords

HBsAg, HCV, blood donors

How to cite this article :

Subhashish Das, Harendra Kumar M.L.. VIRAL HEPATITIDES AMONG THE BLOOD DONORS IN A RURAL BASED HOSPITAL: A FIVE YEAR STUDY. Journal of Clinical and Diagnostic Research [serial online] 2012 May [cited: 2019 Nov 12 ]; 6:619-622. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=May&volume=6&issue=4&page=619-622&id=2108

Introduction
Approximately 30% of the world’s population or about 2 billion persons have serological evidence of either a current or past infection with HBV. Countries are classified on the basis of the endemicity of the hepatitis B virus (HBV) infection into high (8% or more) intermediate (2-1%) or low (less than 2%) incidence countries (1). The HBV and the HCV infections are transfusion transmissible infections; hence, it is mandatory to test all blood and blood components for the presence of HBV and HCV (2). Sero- surveys are one of the primary methods which can be used to determine the prevalence of HBV and HCV, as they give an idea about the prevalence of these diseases in the community and help in the creation of long-term strategies to improve the public health and to prevent spreading of the disease in the local population (2).

HBV is an enveloped DNA virus which belongs to the hepadnavirus family and HCV is an enveloped RNA virus which belongs to the flavivirus family (1). Both the viruses have the following common characteristics (i) presence of these agents in different constituents of blood (ii) a prolonged incubation period for the development of clinical symptoms (iii) ability to cause asymptomatic infections (iv) prolonged persistence in donor blood, giving rise to a carrier or a latent state and (v) stability in the stored blood and the plasma fraction at 4oC or lower (1). Although blood transfusion can be life-saving, there is an associated risk of an error in the entire process of the transfusion chain, right from the selection of the donors to the testing of patients and we are far from achieving a zero risk status (2). Only continuous improvement, careful donor selection, proper selection of the sensitive screening tests, adequate quality control measures and effective inactivation procedures can ensure the elimination, orat least reduction, of the risk of acquiring transfusion transmitted infections (2).

Material and Methods

The present study was undertaken at Kolar, which is located in southeastern Karnataka, India. The population of the Kolar district is 2,523,406 and its population density is 307 sq.km, with a gender ratio of 970 females per 1000 males. The literacy rate is 73.14% in males and it is 52.81% in females. The Kolar district of Karnataka shares borders with the states of Andhra Pradesh and Tamil Nadu. 90% of the local population is involved in agriculture and animal husbandry. Ours is a licenciated, 900 bedded, tertiary care, teaching hospital based blood bank, which is attached to a post graduate medical institute with the facilities for blood and blood component collection, preparation, storage and distribution. In addition to the routine hospital demand, our blood bank caters to the demand of the neighboring districts of Chikkaballapura, the Chittoor district of Andhra Pradesh and also the Hosur and the Krishnagiri districts of Tamil Nadu.

We reviewed 25,341 blood donor record over a period of five years, which ranged from January 2006 to December 2010. All the entries were double-checked by each author. The donors were carefully selected after a complete physical examination and after they satisfactorily answered the donor’s questionnaire. The family members, friends or relatives of the patients were categorized as the replacement donors. The people who selflessly donated blood or participated in voluntary blood donation camps were classified as voluntary blood donors. Paid donors and known high-risk donors were excluded. An informed written consent was obtained from all the donors.

5ml of blood was collected aseptically from each donor into sterile test tubes and it was tested for the HBsAg and the anti- HCV antibodies. HbsAg and HCV screening was done by using the commercially available ELISA Kit (J-Mitra Co. India) as per the manufacturer’s instructions. All the reactive samples were tested again by using the same ELISA kit, as well as a rapid test kit which was based on the principle of a one-step immunoassay (J-Mitra Co. India). Samples which showed a repeat test reactivity by both the methods were considered as positive and they were included for the calculation of the sero-prevalence. All those who turned out to be positive for HbsAg and HCV were subjected to a reconfirmation by testing them again twice on consecutive days. The Chi-square test was used for the statistical analysis of the results. The blood samples which were still sero-positive were discarded. All the sero-positive donors were notified and counseled via telephone calls, e-mail, or letters and they were requested to come to our hospital or to attend a local physician or hospital for further medical evaluation and possible treatment.

Results

(Table/Fig 1) shows the annual distribution of the donor category and the gender distribution. Male voluntary donors were the main group of blood donors. (Table/Fig 2) shows the year wise distribution of the HbsAg and the HCV sero-positivity. The HbsAg sero-positivity remained stable, while there was a gradual increase in the HCV sero-positivity. (Table/Fig 3) shows the comparison of the HBsAg prevalence rate in different parts of India. Kolar showed a prevalence of 0.92%. (Table/Fig 4) shows the comparison of the HCV prevalence rate in England and Kolkata. Kolar showed a prevalence of 0.22%.

Discussion

Every blood transfusion carriers a potential risk for transmissible diseases. This reflects the need and the importance of the mandatory screening for the above infectious markers in blood donations. The prevalence of infections among blood donors has been used as a surrogate marker for the prevalence of infections in the population at large. Although certain pitfalls like the exclusion of people below 18-years and over 60-years of age and the presence of a low number of female donors have been cited, it is still an important indicator of the disease burden (1). The screening and the assessment of these not only alleviates the risk of transmission through infected blood products, but it also gives an idea about the prevalence rates of the infections in the community (1). The blood transfusion services in India are primarily fragmented, disorganized and hospital based. The blood safety, as in other developing countries, remains an issue of major concern (1). This issue is aggravated by the lack of a comprehensive and systematic screening of the donated blood and the predominance of replacement donors. According to a study, 1.5 million units of blood are transfused in India every year. However, as in other countries in the region, the demand far outstrips the supply (1).

India, with a carrier rate of 3 %, contributes nearly 10 % of the total HBV carriers in the world (1). The number of HBsAg carriers in India is estimated to be over 40 million. Without any organized HBV prevention programme and with 25 million live births each year, nearly 1 million HBV infections are added to the HBV pool in India annually, thus contributing to its rapid expansion (1). Several epidemiological studies on hepatitis B and C have been conducted, mostly in blood banks, and some of them have analyzed specific subpopulations which are usually at a higher risk for blood-borne or sexually transmitted infections, such as patients who are infected with HIV, sex workers, dialysis patients, intravenous drug users, prisoners, haemophiliacs and populations in hyper endemic regions (2). In India, both these infections are common with a considerable variation, because of the variability in its ethnicity and geography. Despite the clinical and epidemiological importance and the impact of these diseases, no nationwide study on hepatitis B and C has been conducted (3).

In a vast country like India, a survey on blood transmissible diseases in the country as a whole, is very difficult. Individual epidemiological surveys of each state may help us to understand the seriousness of the problem and the changing trends (1). Among the blood transmissible diseases, hepatitis B and C, HIV, syphilis and malaria are the major public health problems in the developing countries. In India, hepatitis B accounts for 15-30 % of the cases of acute hepatitis and 70 % cases of chronic hepatitis, while HCV is an infrequent cause of acute icteric hepatitis, though it is responsible for most of the cases of post transfusion hepatitis. Moreover, these chronically infected patients serve as a reservoir for continuing the HBV transmission (2). Ideally, if 2% of the population donates blood, it will be sufficient to meet the needs. India, with a population of over a billion, hasa meager availability of 2.5 million blood units against an annual requirement of approximately 6 million units (2). Following the high incidence of hepatitis B among the paid donors, the Honorable Supreme Court of India, in 1998, banned the payment of money to the blood donors, leading to further shortage of blood units in India, because of the lack of a public initiative which was related to the general illiteracy, poor knowledge of the blood donation, little motivation and religious beliefs and misconceptions (1).

The HBV prevalence in the general population in India is 2% to 8% and it is 1% to 2% in the blood donors, according to various studies. HBV infection is the 10th leading cause of death and HBVrelated hepatocellular carcinoma is the fifth most frequent cancer which has been reported worldwide (2). Approximately 30% of the world’s population has a serologic evidence of a current or past infection with HBV. India lies in an intermediate HBV endemicity zone and the number of HBV carriers in India is estimated to be 50 million, thus giving it the status of being the second largest global pool of chronic HBV infections (1). In Delhi, Panda et al reported an HBsAg prevalence rate of 1.13% (3) amongst blood donors, while Pahuja et al the reported a prevalence of 2.23% (4). Garg et al reported a prevalence rate of 3.44% amongst the blood donors in western India (5). Chattoraj et al reported a 0.99% sero-prevalence of HbsAg amongst the blood donors at Dehradun (6). Bhattacharya et al reported a 1.66% sero-prevalence of HbsAg amongst the blood donors of Kolkatta (7), while Behal R et al, reported a 2.25% of seroprevalence of HbsAg amongst the blood donors at Kanpur (8). Srikrishna et al, observed a 1.86% sero-prevalence rate of HbsAg amongst blood donors at Bangalore (9), while Karandeep Singh et al, observed a 0.62% sero-prevalence rate of HbsAg amongst the blood donors in coastal Karnataka (10). In our study, we observed a sero-prevalence rate of 0.88% among the blood donors in the district of Kolar.

The global prevalence rate for the HCV sero positivity is 3.1% (11). The highest prevalence rate is in Africa (5.3%) and it is the lowest in Europe (0.03%). This virus infects approximately 3% of the world population, thus placing approximately 170 million people at a risk of developing HCV-related chronic liver disease (11). In India, the prevalence of the HCV infection, as a cause of acute viral hepatitis, has been reported to vary between 0-21 % and it has been found to be responsible for 14-26 % of the chronic liver diseases (12). The magnitude of the HCV infection amongst the patients of chronic liver disease is likely to increase in future, since the blood banks in India have only recently introduced the policy of anti-HCV screening. Hence, all those individuals who had been exposed before this are likely to develop the disease in the next 15-30 years. No vaccine has yet been developed against hepatitis C because of its large and frequent genetic variations (13). The screening of blood for HCV should be performed by using a highly sensitive and specific HCV antibody immunoassay or a combination HCV antigen-antibody immunoassay. The assay should be capable of detecting the genotypes which are specific to the country or region (14).

The sero-prevalence of HCV in England was 0.16% (15) and in Kolkata, it was 0.35% (15) respectively. The global sero-prevalence of HCV among the blood donors varies from 0.4% to 19.2% (15). In various studies which were performed at Delhi, the prevalence of HCV in the blood donors was reported to range from 0.66% to 2.5% (15). In our study, the sero-prevalence of the HCV antibody amongst the blood donors was 0.21%. Stringent measures need to be taken on an urgent basis, which include the dissemination of information, strict screening of blood and blood products, inclusion of the nucleic acid amplification test, the antibody to the hepatitis B core antigen and other sensitive markers to the mandatory voluntary donations, safer sexual practices, proper sterilization of the instruments, proper disposal of contaminated material and immunization of the people who are at risk, particularly the health care workers (16). The problem of a chronic infection with HCV may be greater than it has been generally recognized .While effective vaccines currently exist for HBV, a fully protective HCV vaccine is not yet available and the current treatment methods for the HCV infection are not highly effective or globally applicable (17).

Conclusion

The magnitude of the risk of the hepatitis infection via donated blood appears to vary with the demographic characteristic of the donor population. A higher incidence of the sero-prevalence was noted in the donor population of the reproductive age group, who had a low socio-economic status (16). ‘Blood saves lives’ was the World health Organization (WHO) theme for the 2000 AD (1). A universal access to safe and adequate blood is the essence of good blood transfusion services. An adequate quality blood can be ensured by promoting voluntary blood donation and it involves the identification, recruitment and the retention of voluntary blood donors (VBSs).

Voluntary blood donors provide the safest blood, followed by the replacement donors who are young, healthy and highly literate and those who have donated blood on more than 3 occasions (16). Such replacement donors could be sensitized, motivated and recruited as the regular voluntary donors. Our current findings provide an opportunity to the hospital based blood banks to improve blood safety and to reduce the wastage of contaminated blood by targeting safe replacement donors for recruitment as regular voluntary donors. These measures will also be in accordance with the W.H.O recommendations, to have voluntary, non remunerated blood donors as a source of a regular and safe blood supply (17). There is a need to collect data at the national, state, and the district levels for the evaluation and supervision of the public health programmes, as the existing systems are not credible enough for monitoring their effectiveness. The epidemiology of viral hepatitis is shifting and it presents new challenges which require support from governmental, academic, and community based organizations (17).

References

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