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

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On Sep 2018

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"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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On Aug 2018

Dr. Arundhathi. S
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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
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
(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)
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.
On April 2011

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
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : DC05 - DC08 Full Version

Burden of Hepatitis B Virus at a Tertiary Care Hospital, Doda, Jammu and Kashmir, India: A Cross-sectional Study

Published: December 1, 2022 | DOI:
Sameera Akhtar, Sufhia Akhtar, Shoket Ali, Nazia Tabassum

1. Demonstrator, Department of Microbiology, Government Medical College, Doda, Jammu and Kashmir, India. 2. Assistant Professor, Department of Microbiology, Government Medical College, Doda, Jammu and Kashmir, India. 3. Postgraduate Student, Department of Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India. 4. Assistant Professor, Department of Pathology, Government Medical College, Doda, Jammu and Kashmir, India.

Correspondence Address :
Dr. Sameera Akhtar,
Demonstrator, Department of Microbiology, Government Medical College, Doda, Jammu and Kashmir, India.


Introduction: Hepatitis B Virus (HBV) causes most frequent chronic liver disease of infectious origin in human beings worldwide, with more than 600,000 deaths caused by end-stage liver disease complications per year. The most used test for identifying acute HBV infections and carriers is the detection of HBsAg. Immunochromatography assays have been suggested for routine use in clinical microbiology laboratories for the detection of HBsAg since they are easy to use, affordable, don’t need specialised equipment, and are straightforward to run. Compared to commercially available HEPA card kit for the detection of the same markers, Enzyme Linked Immunosorbent Assay (ELISA) was shown to be more sensitive for the detection of HBsAg. This study is first of its kind in District Doda, Jammu and Kashmir, India.

Aim: To know the burden of HBV in a Tertiary Care Hospital, Government Medical College, Doda using HEPA card kit and ELISA method.

Materials and Methods: The present hospital-based cross-sectional study was carried out in the Department of Microbiology, Government Medical College and Hospital, Doda Jammu and Kashmir, India during the period from January 2020 to December 2020. The study comprised blood samples from all age groups referred by clinical departments for testing HBsAg. Tests were performed using an immunochromatographic technique (HEPA card Diagnostic enterprises) for the qualitative detection of HBsAg, and results were interpreted in accordance with the manufacturer’s guidelines. The collected data was analysed in Microsoft excel sheet using Chi-square test to know the burden of HBV infection.

Results: Among total number of 5,448 samples tested, 50 (0.92%) were positive for HBsAg which comes under low epidemicity (<2%) as per World Health Organisation (WHO) guidelines. The number of positive females and males were 30 (0.84%) and 20 (1.07%), respectively. Females were predominate over males and majority of the positive patients (N=29) were younger than 40 years though prevalance (2.1%) was higher in age group above 40 years. All samples which shows positive by rapid test were also shown positive by ELISA test.

Conclusion: Overall prevalence of HBV was 0.92% which comes under low epidemicity (<2%) as per WHO guidelines. It can be an alternate option for community based studies and also helps to improve the public health and to prevent the spreading of disease in the local population.


Enzyme linked immunosorbent assay test, Low epidemicity, Rapid test

The HBV is one of the major global health problem. Annually more than two billion people are infected worldwide (1) among which more than 240 million (2) are HBV carrier cases and more than 7,86,000 deaths with liver cirrhosis and hepatocellular carcinoma (3). According to WHO, from the estimated 257 million people infected with HBV, about 89% are oblivion of their carrier status because of the absence of symptoms (4) thereby creating a “silent epidemic” (5). Hepatitis B may cause Acute Hepatitis (AHB) or Chronic Hepatitis (CHB) (6) having an incubation period of about 75 days on average, but can be upto 180 days (7).

The countries are categorised into zones of High prevalence (8%), Moderate prevalence (2-8%), and Low prevalence (2%) based on the prevalence of chronic HBV infection worldwide (5). High HBV endemicity is defined as the presence of HBsAg in populations in Sub-Saharan Africa, East Asia, and Alaska, while intermediate endemicity is defined as the presence of HBsAg in populations in the Amazon basin, Middle East, and Indian Subcontinent, and low endemicity is defined as the presence of HBsAg in populations in western and northern Europe, North America, and Australia (8).

India harbours 10%-15% of the global pool of HBV, with the prevalence rate of 2%-4%, falls in the intermediate HBV endemicity group. Transmission is believed to be mostly occur during early childhood by close physical contact (horizontally transmission), although upto 30% of cases are due to vertical transmission (9). At community level, researchers reported the pravalance of HBV in Tamil Nadu, Tripura, West Bengal and North India as 5.7%, 3.6% (10), 2.97% (11) and 2.1% (12), respectivey.

In Kashmiri population prevalence of HBV has been reported as 0.56%-1.1% (13) and 1.2% (14). In Ladakhi population high pravalance of 7.86% (15) and 4.2% (16) has been reported. In Jammu prevalence of 2.44% has been reported (5). Kadla SA et al., reported overall prevalence of HBV in south Kashmir as 2.4% with Anantnag, Kulgam, Shopian and Pulwama having prevalance of 2.25%, 2.5%, 2.61% and 2.19%, respectively (17). The probability of HBV in Jammu and Kashmir is now more likely, necessitating a thorough regional epidemiological assessment, which is currently lacking as a result of subpar study results from various districts. In order to identify hotspots of HBV endemic areas, it is crucial to research and quantify the prevalence of HBV in various regions of the state. HBV seroprevalence research has never been conducted in the Doda district of Jammu, Jammu and Kashmir, India. Hence, it is important to estimate the prevalence of HBV in Doda district of Jammu province. This was the first study conducted in Doda District of Jammu and Kashmir, India. Doda is the largest district (Geographical Area-2758.95 Sq Km) in the Jammu province having population of 409,936 (Male: 213,641, Female: 196,295), located at 33.13°N 75.57°E, at an altitude of 5000 feet above the sea level. The district shares border with Anantnag, Ramban, Kishtwar, Udhampur and Chamba district of Himachal Pradesh, India. The entire district is hilly, being divided into 02 assembly constituencies viz. Doda and Bhaderwah. The distict is predominantly rural and has agricultural and pastoral economy (18).

Unawareness of an ongoing infection of HBV delays the diagnosis of HBV-related liver disease and favours the spread of the virus. Therefore an attempt was made to know the seropositivity of HBV at tertiary care centre which helps to improve the public health and to prevent the spreading of disease in the local population. HBV can be detected by serological methods like rapid test (card method) and ELISA test as the most common, fast and economic methods to detect different virus markers such as HBsAg, anti-HBsAg, anti-HBcAg, HBeAg and anti-HBeAg (19).

ELISA is a biochemical assay that uses antibodies and an enzyme-mediated colour change to detect the presence of antigen with high sensitivity (20). Rapid diagnostic test strip is a lateral flow one step immunoassay based on the antigen capture, or “sandwich” principal (19). HEPA card is a one step immunoassay based on the antigen capture, or “sandwich” principle. The method uses anti-HBsAg antibodies conjugated to colloidal gold and anti-HBsAg antibodies immobilised on a nitrocellulose strip in a thin line (16),(13). This study was conducted since the presence of HBsAg in serum or plasma is the most important indicator for the diagnosis of HBV infection (20). Hence, present study was conducted to know the burden of HBV in Tertiary care Hospital, GMC Doda using HEPA card kit and ELISA method.

Material and Methods

The present hospital-based prospective study was carried out in the District Doda, which falls under the jurisdiction of Government Medical College and Hospital, Doda, Jammu and Kashmir, India. The duration of study was one year from January 2020 to December 2020. Samples were collected by various clinical departments (OPD and IPD) from preoperational, antenatal and haemodialysis patients and dispatched to Microbiology laboratory for testing. Demographic details of the patients were recorded. Results were shared with the patients and the concerned clinicians.

Sample size calculation: Sample size for the study was determined using formula, n=4 pq/l2 where, ‘n’ is the sample size, ‘p’ was the estimated prevalence of HBsAg based on neighbouring region of Ladakh with reported prevalance of 4.2% (16). ‘q’=(1-p) and ‘l’ is the allowable error, and l=1% (absolute error). Based on the findings of pilot study, a non response rate of 15% was taken into consideration (14).

Specimen Collection

Blood samples of all age groups and both sex were sent by various clinical departments (OPD and IPD) for testing HbsAg was included in the study. Blood samples (5 mL) were collected from the total of 5,448 patients. The blood sample was poured into a red top tube without anticoagulant and centrifuged at 3000 rpm for five minutes. The serum was separated and it was used for the present study. Samples were immediately tested for the presence of HBsAg. If positive, the serum was stored for ELISA (-20ºC) and if negative the sample were discarded as per Helsinki Guidelines.

1. HBV rapid test by HEPA card: These tests were done as part of preoperative screening, antenatal screening, screening on haemodialysis patients. The sera was screened for the presence of HBsAg by a rapid test kit based on the principle of one step immunoassay (HEPA card-Diagnostic enterprises). Those found positive on screening were confirmed by third generation ELISA kits (Bioelisa HBsAg Kit, Spain) according to the manufacturers protocol.

For rapid card test, about 50 μL of serum was transferred to the specimen well and timer was started for 15 minutes. The results were read according to the manufacturer’s instructions. The positive result is, when two coloured lines appeared, one in the control region (C) and the other in the test region (T). The negative result, shows one coloured line should appear in the region (C) only (Table/Fig 1).

2. ELISA screening test: Samples positive for HBV were confirmed by ELISA (Bioelisa HBsAg Kit, Spain) at Department of Microbiology, Government Medical College and Hospital, Doda Jammu and Kashmir, India. This test was based on a one-step “Sandwich” principle. In brief, HBsAg coupled with Horseradish Peroxides (HRP) serves as the conjugate, Tetramethyl Benzedrine (TMB) and peroxide as a substrate. Upon completion of the test, a colour develops which is directly proportional to the amount of HBsAg in the sample. The method was followed according to the manufacturer instructions. The absorbance was read for each blank well at 450 nm within 30 minutes. It is recommended to read positive samples using a 620-630 nm reference filter.

Statistical Analysis

Data was analysed in Microsoft excel Sheet. Continuous variables were analysed in the form of mean and standard deviation while categorical variables were summed up as frequency and percentages. Chi-square test was used to obtain results. A p-value <0.05 was considered statistically significant.


Total 5,448 patients were screened for HbsAg with 3,578 (65.68%) female and 1,870 (34.32%) male. Fifty samples were positive on screening by HEPA card method, all 50 positive samples were confirmed by ELISA method. Seropositivity of HBsAg was 0.92% (Table/Fig 2). Out of 3578 female patients 30 (0.84%) were positive and out of 1870 male patients 20 (1.07%) were positive for HbsAg (Table/Fig 2). Among 50 positive patients, females (30) were more affected than males (20), though proportion wise males (1.07%) were more affected than females (0.84%). No seropositive patient was affected in age group of 0-20 years. The majority of the studied population (75.5%) and majority of the seropositive patients (N=29) were younger belonged to the age group of 21-40 years though the infection rate was more prevalent (2.1%) in the age group of above 40 years. Highest positivity was seen in the month of April (1.55%) (Table/Fig 3).


This was the first study of its kind in District Doda to estimate the prevalence of HbsAg amongst general population. In this study, the overall seroprevalence of HbsAg of 0.92% was observed. The prevalence was lower than the national average of 2-4% [21,22], and lower than many adjoining regions with Anantnag, Kulgam, Shopian and Pulwama having prevalance of 2.25%, 2.5%, 2.61% and 2.19%, respectively (17), 0.56%-1.1% (13) and 1.2% (14) in Kashmiri population and 2.44% (5) in Jammu. A total 5448 blood samples were tested. Out of these, 50 (0.92%) were positive for HBsAg, which comes under low epidemicity (<2%) as per WHO guidelines. The present study has reported higher positive rate among male (1.07%) as compared to females (0.84%). These findings were in consonance with Shashi SS et al., (5), who observed seropositivity of 2.44% with 1.58% in males and 0.86% in females, respectively. In the present study, higher prevalence rate was seen in the age group above 40 years. These findings were in consonence with the studies by Ingale H et al., (23), Sood S and Malvankar S, (24), Dutta S et al., (25) and Shashi SS et al., (5) who observed highest prevalance in the age group of 40-60 years in Jammu. Another community based cross-sectional study conducted in Ladakh region found prevalence of HbSAg of 4.2% (Kargil district-7.40%; Leh district 1.96%) with higher prevalence in males (4.86%) than females (3.78%) and more positivity within 21-40 years age group (16). Naqshbandi I et al., reported that the prevalence of HBsAg in Srinagar region was 1.2%, with significantly higher positivity among males (14-4.2%) and only 1 (0.1%) was female (14). The reported prevalence of HbsAg in neighbouring countries of Pakistan, China, Sri-Lanka, Bangladesh and Iran is 3-5% (10), 6.89% (11), less than 2% (12), 5.4% (26) and 1.7% (27), respectively (Table/Fig 4).

Month-wise highest cases were recorded during first four months (January, Febuary, March and April) as 21 positive cases followed by 17 positive cases during next four months (May, June, July and August) and 12 positive cases during last four months (September, October, November and December) of the year. Highest and lowest number of positive cases were recorded during the month of March and July/September/October as nine and two positive cases, respectively. However, proportion-wise highest and lowest cases were recorded during the month of April and September as 1.55% and 0.33% respectively.

Although India lies in intermediate endemicity zone, the prevalence of HBV infection is low in Nanded region. Effective childhood immunisation programe is likely to further reduce the burden of infection in our country. The similar study in Maharashtra and costal Karnataka reported the prevalence of <2% (1.57%) and 0.62%, respectively (28).

Serological testing can identify patients with persistent HBV infection based on their HbsAg levels. Infants born to HBsAg-positive mothers, pregnant women, sex partners of HBV infected people, homosexuals, household contacts, people born in areas with an HBsAg prevalence of less than 2%, injection drug users, and people who have been exposed to blood and body fluids due to sexual assault and needle stick injuries among healthcare workers are all groups for which the Centres for Disease Control and prevention (CDC) has advised HBsAg testing (CDC, 2008) (29). According to Sandhu R and Sharma G practices like having several sexual partners, engaging in unprotected sexual activity, sharing needles with IV drug users, and getting tattoos may be the cause of the increased frequency among men (9). However, in females, a strong immune response aids in the faster and more effective removal of HBV. Furthermore, Ingale H et al., reports high prevalence of infection in adults may be due to higher chances of exposure to HBV due to sexual activity (23).


The topography of the district Doda is hilly mountainous region with the general population having limited access to healthcare facility, for that reason resampling of any suspected patients was a very difficult task.


In present study, the prevalence of HBV infection in this region is 0.92%, with higher positive rate among male (1.07%) as compared to females (0.84%). Therefore, as per WHO classification present study area is a low prevalence area. Effective childhood immunisation programme might reduce the burden of infection in our area. Hospital-based studies like this can be an alternative option for improve the public health and to prevent the spread of the disease in the local population.


All authors have declared that no financial support was received from any organisation for the submitted work.


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DOI and Others

DOI: 10.7860/JCDR/2022/59144.17244

Date of Submission: Jul 17, 2022
Date of Peer Review: Aug 10, 2022
Date of Acceptance: Oct 20, 2022
Date of Publishing: Dec 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

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