Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
ISSN: 2313-7479 Adv. Biomed. Pharma. 2:4 (2015) 175-180 Advances in Biomedicine and Pharmacy (An International Journal of Biomedicine, Natural Products and Pharmacy) Original Paper Prevalence of hepatic diseases among different patients at crescent gastroliver and general hospital limited, Dhaka, Bangladesh: a national survey Adity Bhowmik1, Mohammad Amjad Hossain2 1 Department of Pharmacy, Atish Dipankar University of Science and Technology 2 Atish Dipankar University of science and Technology. *Corresponding Author: Adity Bhowmik Department of Pharmacy, Atish Dipankar University of Science and Technology, House # 83, Road # 4 , Banani, Dhaka-1213 E-mail address: [email protected] Running Title: Prevalence of hepatic disease Received: 04 July, 2015; Revised: 01 August, 2015 Accepted: 14 August, 2015 Abstract As liver disorders are one of the most shared and frequent of all types of diseases in Bangladesh, So, we designed our survey on liver diseases with main objective to explore the epidemiology of liver disorders in one of the reputed hospital of Bangladesh, Crescent Gastro liver and General Hospital, Dhaka, Bangladesh which is receiving huge number of patients with different liver disorders The ultimate outcome of our survey is clear in case of patients data. Survey represents the prevalence of different forms of hepatic disorders among the patients visiting to this hospital such as obstructive jaundice 51%, Chronic HBV infection 16%, hepatocellular carcinoma 8%, decompensated liver cirrhosis 8%, liver cirrhosis 5%, liver abscess and biliary cirrhosis 3%, hepatic encephalopathy 2%, acute viral hepatitis 1%, hepato-renal syndrome 1%, acute hepatitis D on chronic hepatitis B 1%, hepatic precome and non-alcoholic steatohepatitis (NASH) to cirrhosis were less than 1% of all 452 hepatic patients respectively. Keywords: Prevalence, liver abscess, hepato-renal syndrome, non-alcoholic steatohepatitis Introduction virus, 800,000 people from hepatitis-C virus and nearly 20 million people are suffering from other liver- related diseases like liver cirrhosis, cancer and fatty liver disease," Professor Mobin Khan, President of Bangladesh Hepatology Society, was quoted as saying by leading English newspaper The Independent on Thursday [1,2]. The cause of the 43 percent cases admitted to hospitals with acute hepatitis and jaundice was hepatitis E virus, 22 percent cases by hepatitis B, 8 percent was hepatitis A and 3 percent was hepatitis C, he said. Mobin, a leading hepatologist in the South Asian country, said hepatitis-B virus causes about 41 percent of liver cirrhosis and 25 percent of liver cancer in the country [3-5]. Though the Although skin is considered to be the largest organ of the human body, liver is known to be the largest internal organ and the largest gland in the huma n body. Liver disease can be inherited (genetic) or caused by a variety of factors that damage the liver, such as viruses and alcohol use. Obesity is also associated with liver damage. Over time, damage to the liver results in scarring (cirrhosis), which can lead to liver failure, a lifethreatening condition. The number of people suffering from liver disease in Bangladesh is increasing at an alarming rate as about 35 million people are somehow suffering from the disease. "About 15 million people are now suffering from the chronic liver disease hepatitis-B 175 Bhowmik A et al. Advances in Biomedicine and Pharmacy Vol. 2 (4) 2015 vaccine of hepatitis-B is very effective to prevent the virus, very few people take the vaccine for lack of awareness, he said. He further said in 80 percent cases, hepatitis-B is not curable and prevention is the best way to combat the disease [6-8]. But hepatitis-C can be cured through early diagnosis and treatment. Though hepatitis-A and E viruses are not so malignant, hepatitis-B and C pose serious threats to human health, he said, stressing the need to be cautious during blood transfusion and using syringe and needles [9,10]. Questions for the patients are as follows Questionnaires on Epidemiology of Hepatic Disorder to patients: 1. What is your Age? 2. What is your sex? 3. What is your body Weight (kg)? 4. What is your height? 5. Are you suffering from Hepatic Disorder? 6. What Types of Hepatic Disorder you are affected with? 7. How long you are affected? 8. What about your food habit (majority)? 9. Are you smoker? 10. Do you drink Alcohol? 11. Do you have any Tattoos? 12. Does your job involve exposure to chemicals, blood or body fluids? 13. Have you ever had a blood transfusion? 14. Have you had liver problems before? 15. Has anyone in your family ever been diagnosed with liver disease? 16. What types of sign and symptom are observed? 17. Are you suffering from others disease? 18. What types of pathological test, have you done? 19. What types of medications and supplements do you take? 20. Will you need surgery? Materials and Methods Study design The survey conducted at the Crescent gastroliver & general hospital limited (CG&GHL) in Dhaka district. At the CG&GHL the survey sample was drawn from the target population and the information obtained from the sample once by questioning them and collected the information provided by them. Sample Selection In Crescent gastroliver & general hospital limited, questionnaire sheets were provided as a representative of the survey, a total of 20 questionnaires were processed for patient survey and total of 1000 questionnaire sheets for the patient survey were considered. In Crescent gastroliver & general hospital limited, registered physicians were interviewed. They are all specialized individual sectors and they are responsible for patient healthcare service. Results and Discussion It was a discern, descriptive and analytical research. . During the research period, we exhaustively screened all patients fulfilling our inclusion criteria. In case of age factor, majority was above 50 years (43%), 31-40 years (24%), 41-50 years (17%), below 30 years (16%) of all patients respectively. Female patients were 37% and male patients were 63%. The feature of hepatic patient described as 45% and other diseased patient were55% [Figure: 1].Hospital survey represents the prevalence of different forms of hepatic disorders in this hospital is high (45%) including, obstructive jaundice 51%, Chronic HBV infection 16%, hepatocellular carcinoma 8%, decompensated liver cirrhosis 8%, liver cirrhosis 5%, liver abscess and biliary cirrhosis 3%, hepatic encephalopathy 2%, acute viral hepatitis 1%, hepato-renal syndrome 1%, acute hepatitis D on chronic hepatitis B 1%, hepatic precome and non-alcoholic steatohepatitis (NASH) to cirrhosis were less than 1% of all 452 hepatic patients respectively [Figure: 2]. 56% were smoker and 12% were alcoholic [Figure: 3]. Field work The survey data were collected from the Crescent gastroliver & general hospital limited, from 1 st September 2014 to 30th December 2014, which were used for the development of study tools, collection of data and analysis. Data collection and Analysis This paper and pencil field survey consisted of open, close ended and multiple choice questions. An English language survey was developed based on information drawn from relevant literatures pertaining to use of Prescription drugs used during liver disorders in Bangladesh. Separate questionnaires were prepared for patient survey. Questionnaires for all the patients related to Hepatic disorder, age, height, patient history and list of drugs included. 176 Prevalence of hepatic disease Advances in Biomedicine and Pharmacy Vol. 2 (4) 2015 There were 8% of all patients who had tattoos [Figure: 3]. 15% were of all patient’s job involved exposure to chemicals, blood or, body fluids [Figure: 3]. 38% were of all patients had blood transfusion [Figure: 3]. Although not the majority but there were patients who faced chemicals, blood or, body fluids (15%) and blood transfusion (38%). These two might be their reason for disease.30% had family history and 70% was out of it. The most common symptom was Skin and eyes that appear yellowish (Jaundice) (70%). From 452 patients, 30% had family history (12% spouse, 17% parents, 1% grandparents) and 70% were out of it. The most common symptom was Skin and eyes that appear yellowish(Jaundice) (70%), then itchy skin (65%), followed by nausea or vomiting (62%), pale stool colour (41%), abdominal pain and swelling (38%),loss of appetite (28%), dark coloured urine (24%), swelling legs and ankles (7%), Chronic fatigue (1%) [Figure: 4]. During the survey, pathological tests were also be noted of all hepatic patients like HBsAg, Anti-HCV, Anti-HAVIgM, Anti-HEVIgM (100%) ; Serum creatinine, Alkaline phosphate (87%); Serum Bilirubin (72%); Complete blood count(CBC),alpha-fetoprotein (AFP),CA19.9 (Cancer antigen test) (69%); Prothrombin time (64%); Serum total protein, Serum albumin, Electrolytes (62%); Serum glutamate-pyruvate transaminase (61%);Ultrasound, CT and ERCP or MRCP (MRI of biliary tract and pancreas) (55%); Urine specific gravity(USG) (3%) respectively [Figure: 5]. Different hepatic diseased patients were treated by some medicines in which some of the medicines were similar and some were dissimilar. Used medicines were Lactulose (96%), Ceftriaxon and Cefixime (71%), Ondensatron (70%), Rifampin (68%), Trimonium methyl sulphate (65%), Antihistamines hydroxyzine, diphenhydramine (55%), Ursodeoxycholic Acid (39%), Phytomenadione (Vit-K) (30%), Ketorolac Tromethamine (29%), Meropenam (28%), Ribavirin (16%),Lamivudine (2%) respectively [Figure: 6]. Among those hepatic patients 64% needed surgery and 36% were treated by drugs only. Figure 1: The number of patient suffering from hepatic disease 177 Bhowmik A et al. Advances in Biomedicine and Pharmacy Vol. 2 (4) 2015 Figure 2: Types of hepatic disorders. Figure 3: Life style related information (smoking, alcoholic, having tattoos, chemical exposure, blood transfusion) of patients 178 Prevalence of hepatic disease Advances in Biomedicine and Pharmacy Vol. 2 (4) 2015 Figure 4: Patient’s signs and symptoms of liver problems Figure 5: Patient’s pathological test of liver problems Figure 6: Patient’s medication and supplements of liver problems 179 Bhowmik A et al. Advances in Biomedicine and Pharmacy Vol. 2 (4) 2015 as soon as possible and at the same time Government should take necessary steps regarding these issues. Conclusion Four months survey among the in-door patients in all departments of Crescent Gastro liver and General Hospital, we found patients visiting to this hospital were suffering with diverse hepatic disorders including mainly obstructive jaundice, chronic HBV infection, hepatocellular carcinoma, decompensated liver cirrhosis, liver cirrhosis, liver abscess and biliary cirrhosis. We found that diet habits and epidemiology plays an important role, however the exact mechanism of the prevalence of these disorders needs to be further investigated and cured Acknowledgements We want to thanks all the staff and members in the hospital for their countless contribution and the patients for their nice co-operation. Conflict of interest The authors declare that there is no conflict of interest to reveal. References [1] André F., “Hepatitis B epidemiology in Asia, the Middle East and Africa”, Vaccine, 2000; 18: S20-S22. [2] Arankalle VA and Chadha MS., “Who should receive hepatitis A vaccine?”, J. Viral Hepat., 2003; 10:157–158. [3] Arankalle VA and Chobe LP., “Hepatitis E virus: can it be transmitted parenterally?”, J. Viral Hepat., 1999; 6: 161-164. [4] Asim M, Ali R, Khan LA, Husain SA, Singla R and Kar P., “Significance of anti-HBc screening of blood donors & its association with occult hepatitis B virus infection: Implications for blood transfusion”, Indian J. Med. Res., 2010; 132: 312-317. [5] Batta A., “Viral hepatitis and enzyme study”, Int. J. Curr. Bio. Med. Sci., 2011; 1: 41-43. [6] Biswas S, Paul S, Syeed A, Mahbub MS, Khan MA and Gupta RD., “Spectrum of Alcoholic Liver Disease in Tribal Alcoholics of Chittagong Hill Tracts of Bangladesh”, J. Med., 2011; 12: 7-11. [7] Björnsson E, Talwalkar J, Treeprasertsuk S, Kamath PS, Takahashi N and Sanderson S., “Drug-Induced Autoimmune Hepatitis: Clinical Characteristics and Prognosis”, Hepatology, 2010; 51: 2040-2048. [8] CDC-Viral Hepatitis, Centers for Disease Control and Prevention, USA, 2011. Available at http://www.cdc.gov/hepatitis/ [Accessed on July 30, 2011]. [9] Chaudhry MA, Rizvi F, Afzal M, et al., “Frequency of Risk Factors for Hepatitis B (HBV) and Hepatitis C Virus (HCV)”, Ann. Pak. Inst. Med. Sci., 2010; 6: 161-163. [10] Mahtab MA, Rahman S, Khan M and Karim MF., “Hepatitis E virus is a leading cause of acute-on-chronic liver disease: experience from a tertiary centre in Bangladesh”, Hepatobiliary Pancreat. Dis. Int., 2009; 8:50-52. ABP © 2015 Reproduction is free for scientific studies 180