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

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On Sep 2018




Prof. Somashekhar Nimbalkar

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




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



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.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
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.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
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
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2010 | Month : October | Volume : 4 | Issue : 5 | Page : 3100 - 3105 Full Version

Seroepidemiology Of Hepatitis B Virus Infection Diagnosed At A Teaching Hospital In Western Nepal: A Prospective Study


Published: October 1, 2010 | DOI: https://doi.org/10.7860/JCDR/2010/.957
EASOW J M*, SHANKAR P R**, TULADHAR R***, SINGH Y I****

*Associate Professor, Dept. of Microbiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India; **Professor, Dept. of Clinical Pharmacology, KIST Medical College, Lalitpur, Nepal; ***Dept. of Microbiology, Ohio State University, Columbus, Ohio. USA; ****Professor, Dept. of Microbiology, College of Medical Sciences, Bharatpur, Nepal.

Correspondence Address :
Dr. P. Ravi Shankar
KIST Medical College
P.O. Box 14142
Kathmandu
Nepal.
Email address: ravi.dr.shankar@gmail.com

Abstract

Background
Hepatitis B virus (HBV) infection is a major problem in developing countries and a major cause of jaundice in Nepal. Hepatitis B surface antigen (HBsAg) is the first serological hallmark of HBV infection. In a study of the Nepalese male population, inhabiting various districts, HBsAg was found to be positive in 4% of the population. The prevalence of HBV infection among patients attending the Manipal Teaching Hospital, a major healthcare provider in the western region of Nepal, has not been studied. Hence, the present study was carried out to determine the prevalence of HBV infection in patients attending the hospital and to assess the associated risk factors.
Method
The study was carried out during the period from 15th March 2004 to 15th September 2005. Serum samples requisitioned for the investigation of HBsAg from the wards and the Out Patient Departments to the Department of Microbiology were included. The demographic and clinical details of the patients who tested positive for HBsAg, was obtained through a semi structured questionnaire, as well as from their medical records. The results were analyzed according to their demographic characteristics.
Results
288 serum samples were included; 215 samples (74.6%) were from males. Inpatients accounted for 195 specimens (67.7%). Thirty-six (12.5%) samples were positive. The seroprevalence of HBsAg was higher among males, individuals from Kaski district where the hospital is located and ex-army and businessmen respondents. A majority of the positive individuals were males from Kaski district, students, ex-army men, agriculturists or housewives belonging to the 21 to 30, 41-50 or the 31-40 year age groups. High risk sexual behaviour was elicited in two individuals, intravenous drug abuse in two and a history of blood transfusion and dental manipulation in one each, while one person had shared razors with an infected person.
Conclusion
The frequency of seropositivity among individuals who were referred for HBsAg testing was high. Various factors could have influenced the results. Further studies are required to assess the seroprevalence among all the patients attending the hospital OPD and admitted in the wards.

Keywords

Hepatitis B, Hepatitis B Surface Antigen, Nepal, Seroprevalence

Background
The burden of Hepatitis B virus (HBV) infection varies widely among different countries. In western countries, the disease is relatively rare and is acquired primarily in adulthood. In the South East Asian Region (SEAR), annually, approximately 14-16 million people are infected with HBV. It is estimated that there are 98 million HBV carriers which is almost 6% of the total population of this region (1),(2). In Nepal, the total morbidity due to acute hepatitis HBV for the year 2004-2005 was 30,071 out of 9,699,858 hospital visits (3). Hepatitis B consumes a substantial portion of health resources in developing countries (4).

HBV presently infects 2 billion people and is the ninth leading cause of death worldwide (5). Approximately 350 million people are chronically infected with this virus (1),(2). Hepatocellular carcinoma (HCC), which is caused by HBV infection, is one of the three leading causes of death due to cancer in most parts of Africa, Asia and the Pacific Basin, resulting in a million deaths annually (2). 80 % of liver cancers are attributed to HBV, which is the most common cause of cancer mortality worldwide after smoking (6). Among 35 million health care workers worldwide, 3 million are exposed to blood borne pathogens each year and 2 million of these are due to HBV. These injuries may result in 70,000 HBV infections (7).

Of the more than 350 million new cases of HBV infection, more than 100,000 occur in the United States (US) alone (5). However, the prevalence is decreasing in developed nations. The prevalence of HBsAg chronic carriers is less than 2 % in Western Europe, North America and parts of South America and intermediate (2-7%) in Southern and Eastern Europe (8). The Hepatitis B surface antigen (HBsAg) in serum is the first sero-marker to indicate active HBV infection, either in acute or chronic forms. HBsAg is the serological hallmark of HBV infection. In acute hepatitis B, HBsAg may be undetectable very rarely at the time of presentation, either because the levels of HBsAg never reach or have already declined below the detectable threshold of the assay. The persistence of HBsAg for more than 6 months implies chronic infection (9).

The prevalence of chronic HBsAg carriers in developing nations of Asia and Africa is high (more than 8%) (8),(10). In China, the prevalence of HBV is 20% (12). In Thailand, it was 10%; in Korea and Bangladesh, it was 9%; in Maldives, Indonesia and Bhutan, it was 6%; in India, it was 5% and in Sri Lanka, it was 1% for the year 2000 (1),(12).

HBV is a major cause of jaundice in Nepal (13). A study among the Sherpa community revealed prevalence of HBsAg, anti HBs (antibody to HBsAg) and anti HBc (antibody to HBcAg), to be 1.9% 22.3%, and 24.3%, respectively (14). HBsAg positivity was found to be 0.45% in a study among voluntary blood donors conducted in the Department of Microbiology, Universal College of Medical Sciences, Bhairahawa, Nepal (15). In a study of the Nepalese male population inhabiting various districts, HBsAg was found to be positive in 4% of the individuals. The percent positivity of HBsAg was found to increase steadily from the Eastern (2%) to the Far Western (6.2%) development regions. The Kailali district showed a characteristically high prevalence, followed by Rukum and Kaski. Other districts having a high prevalence of HBsAg were Sankhuwasabha, Jhapa, Ramechhap, Sarlahi, Dhanusa, Baglung, Gulmi, Palpa and Dang (16).

Manipal Teaching Hospital is the teaching hospital of the Manipal College of Medical Sciences (MCOMS), a medical school in Pokhara city, western development region, Nepal. The hospital is a major healthcare provider for the region. The institution caters to the population of ten of the fifteen districts of the western development region of Nepal. The population of these ten districts was about 2 million according to the 2001 census (17). We are not sure about the percentage of the population who use the services of the institution. The teaching hospital has a daily patient load of 500 outpatients and 150 inpatients, though it shows seasonal variations. The prevalence of HBV infection among the patients attending the hospital has not been studied. Hence, the present study was carried out. The aims of the present study were to determine the prevalence of HBV infection among samples sent for investigation of HBsAg to the Department of Microbiology and to assess the associated risk factors.

Material and Methods

The cross-sectional study was conducted during the period from 15th March 2004 to 15th September 2005. The study was approved by the Academic Committee of the institution. At the time when the study was carried out, the institution did not have an ethics committee.

All patients attending the hospital during the study period (both outpatients and inpatients), with a clinical request for HBsAg testing, were included in the study; however, previously known positives were excluded. Due to the ethical issues involved, no samples were collected from sources other than patients attending the hospital. Oral informed consent was obtained from all individuals undergoing HBsAg testing for inclusion in the study. Randomization was not done. Demographic and clinical details of the patients included in the study were obtained from their medical records. The parameters considered were gender, whether the patient was an inpatient/outpatient, the district from where the patient came, their occupation and age. There were no drop outs and all patients approached for inclusion in the study, consented to it. For testing for HBV, three ml blood was collected aseptically by venepuncture. The blood was allowed to clot, after which it was centrifuged and the serum extracted. The sera were analyzed for HBsAg by an immunoassay based on an immunochromatographic sandwich principle by using HBsAg Rapid Card Test, Hepacard (J Mitra and Co. Ltd.) as per the manufacturer’s instructions.

The serum was stored at -20°C till adequate number of samples was collected to perform ELISA with a 3rd generation ELISA Kit, manufactured by Biokit, Spain. Repeatedly reactive results were considered as seropositive for HBV infection. Patients found to be HBsAg positive were interviewed by one of the authors using a semi structured questionnaire, regarding risk factors and high risk behaviour for Hepatitis B. Relevant clinical details were retrieved from case records. Manipal hospital, being a teaching hospital, utmost importance was given to the maintenance of case sheets and regular audits conducted to assure compliance.
This study was done as a part of the requirement by Kathmandu University for the completion of M.Sc Medical Microbiology. Funds are allotted by the Medical School for such projects/thesis work by the students. Hence, the institution bore the involved expenses.

Results

A total of 288 serum samples were included in the study. Two hundred and fifteen samples (74.6%) were from male patients. Inpatients accounted for 195 specimens (67.7%), while outpatients accounted for 89 specimens (30.9%). (Table/Fig 1) shows the distribution of tested patients according to gender, district, occupation and age group and the seroprevalence of HBsAg according to these characteristics. A large majority of patients [165 (57%)] were from Kaski district where the hospital is situated. One hundred and ninety-five samples (68%) were from patients admitted in various wards of the hospital. Thirty-six (12.5%) of the 288 patient samples were positive.

A majority of the HBsAg positive individuals were males from Kaski district, students, ex-army men and agriculturists or housewives belonging to the age groups of 21-30, 41-50 or 31-40 years. Coinfection with HIV was seen in two individuals (5.5%), while coinfection with HCV was not observed. High risk sexual behaviour was elicited in two individuals, intravenous drug abuse in two and a history of blood transfusion and dental manipulation in one each, while one person had shared razors with an infected person. The mode of transmission was not clear in a majority of the patients.

Discussion

Of the 288 samples, 36 (12.5%) were found to be positive for HBsAg. Of the 36 positive samples, 30 (83.33%) were from males and 6 (16.66%) from females. The gender distribution was similar to that observed in a study done by Chander and co-workers (15). A study done by Shrestha SM (18) showed the prevalence of HBsAg to be higher in males than in females, which was in agreement with this study. Zali and coworkers in Iran found the prevalence in males and females to be 1.9% and 1.5%, respectively (4).

Various studies done by different researchers have revealed different percentage prevalence of HBsAg in Nepal. A study done by Chander et al (15) in 2003, among blood donors at the Universal College of Medical Sciences, Bhairahawa, showed the prevalence of HBsAg to be 0.45%. Another study done in 2002 by Shrestha B (19) in a Nepali population which required medical check up for going abroad, detected the seroprevalence of HBsAg to be 0.93%. A study by Manandhar et al (16) on the seroprevalence of HBsAg in various districts of Nepal showed a prevalence of 4%. In 1996, Sawayama et al (20) studied the seroprevalence of HBsAg in two rural Nepali villages, where the prevalence was found to be 1.1%. The high prevalence found in this study may be because this was a hospital-based study. A majority of the samples were from people who presented with complaints of HBV infection and were clinically suspected of being infected and thus, it may not have revealed the disease status in the community.

In this study, 165 samples were from Kaski district in Pokhara city, where the hospital is located. The sample size from other districts was small. Among the samples from Kaski, 18 (10.9%) were HBsAg positive. The high seroprevalence of HBsAg in Kaski is supported by a study done by Manandhar et al (16) in 2000, according to which the percent positivity of HBsAg was found to increase steadily from the Eastern (2%) to the Far-Western (6.2%) development regions of Nepal. That study also noted a high prevalence of HBsAg in Kaski district. Ex-army men were seen to have the highest positivity rate (15.62%) among people from different occupations studied.

The age group of 21-30 years showed the highest rate of positivity. This observation was also supported by the study done by Chander et al (15), where they found most seropositive cases of HBsAg belonged to the age group of 15-45 years. A study done by Gyawali et al (13) also detected a higher prevalence of HBsAg in the age group of 21-30 years, which is similar to the results of our study. Also, this age group had the highest frequency (57 individuals) of testing for HBsAg. It may be because this age group has a higher frequency of going abroad for studies and employment and thus, more tests may have been done in this age group (21). Of the 36 positive cases of HBsAg, the modes of acquisition of HBsAg by 29 individuals were not known. This might have been due to hesitation on the part of patients to reveal their behaviours such as extra marital sex, sharing of needles for intravenous (IV) drug use, etc. Two cases (5.55%) had a history of unprotected sex outside marriage. Since HBV is transmitted commonly via the sexual route, the mode of acquisition in these cases may have been sexual. In a study by Gyawali et al (13), at Tribhuvan University Teaching Hospital, Kathmandu, HBV infection was commonly found to be associated with heterosexual activity. Two (5.55%) of the positive cases had a history of IV drug abuse. One of these had a history of using injection buprenorphine. Since sharing of needles is common among IV drug users (IVDU), the contamination from needles used by an HBV infected person may have transmitted the infection to others. A study done by Shrestha et al (22) found the prevalence of HBsAg in IVDU in Nepal to be 5.5%. A study done by Gyawali et al (14) showed that 5% of the HBV infected patients acquired the HBV infection from IV drug abuse.

Of the 36 samples showing the presence of HBsAg, 2 (5.55%) were also found to be infected with HIV, while none were positive for HCV. The co-infection between HBsAg and HIV could be due to the shared modes of transmission of the two diseases (23). A study done by Devi et al found that 6.2% of hepatitis patients showed HIV seropositivity (23). Of the 36 positive samples, 7 were detected during routine blood tests done as a requirement for going abroad. A recent study looked at the pattern of liver diseases among patients admitted to the liver unit of Bir hospital, the oldest hospital in Nepal over a six month period (24). Alcohol consumption, followed by the presence of hepatitis B and C viruses were the major causes of chronic liver disease. A recent study looked at the seroprevalence of four transfusion transmissible infections among blood donors in Kathmandu, Nepal. The seroprevalence of HBV (HBsAg) was 0.47% (25). A retrospective study among Nepalese blood donors over a six year period from 2001 to 2007 was conducted. The overall seroprevalence of HBV nationwide and at the Central Blood Transfusion Service in Kathmandu were found to be 0.82 and 0.92% (26).
Recently, there is an increasing trend among young people of going abroad for further studies and for employment. This may have resulted in the detection of HBsAg seropositivity in many patients who otherwise may have gone undetected until serious infection had set in. Thus, the routine testing of the HBsAg status may serve to improve the management of HBV infection and could be an option.

Preventing the transmission of blood borne pathogens requires a robust approach which includes having effective childhood immunization as a national policy which will reduce the burden of infection, vaccinating vulnerable groups, educating the public about high risk behaviours and committing healthcare workers to safe work practices.

The limitation of this study was that it was done in a tertiary care hospital which caters to patients who are referred for complications of liver disease, which could cause a likely bias in sampling. Only patients who tested positive for HBsAg were interviewed and information about other respondents was obtained from case sheets. The data is also from an older time period. Patients visiting other hospitals or who did not have access to hospitals were not included.

Conclusion

The frequency of seropositivity among individuals referred for HBsAg testing at the tertiary care hospital was high. Various factors could have influenced the results. Further studies are required to assess the seroprevalence among all patients attending the hospital OPD and wards.

Acknowledgement

The authors would like to acknowledge the support of the Department of Microbiology and of the Medical Records Department of the hospital during the study.

Conflicts of interest
The authors declare that they have no competing interests.

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