الفهرس 
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Abstract
Hepatitis B virus (HBV) is a widely distributed pathogen that produces both acute and chronic infection in man. Chronically infected persons represent the major source of infection and’ also experience the increased risk of mortality and severe morbidity associated with chronic liver disease and primary hepatocellular carcinoma (PHC). Worldwide, it has ’been estimated that over 300 million persons are chronically infected with HBV, and over 250,000 persons die annually from hepatitis B associated acute and chronic liver disease.Egypt is one of the countries in which intermediate rates of HBV infection occur and chronic HBV infection ranges from 2 to 7. Transmission of HBV infection occurs bv percutaneous (intravenous, intramuscular, subcutaneous or intradermal) and permucosal exposure to infective body fluids as may occur in needle stick accidents, perinatal exposure, or sexual exposure. Frequent and routine exposure to blood or serous fluids is common among health care workers who are thus at highest risk of infection with HBV:as a group their risk has been estimated to be ten times thatof the general population. Among health care workers surgeons are particularly at risk where the highest frequency of hepatitis was recorded among them. This represents a major threat to their wellbeing in addition to the devasting consequences if they became carriers. Now that hepatitis B vaccine is available; effective and long lasting protection WIll became feasible. This study defines the distribution and intensity of hepatitis B exposure among surgeons and thus will help determine priorities for allocation of the vaccine as well as the necessity and organization of a prevaccination screening program. One hundred and eighty surgeons were included in this study. They worked in the following hospitals in Alexandria: University hospital,El Shatby hospital, ~as El Teen hospital, El Hadara hospital, Dar Ismail hospital, Medical Research Institute hospital, Shark El Madina hospital and El Mabara hospital. Both sexes were included with age range betWeen 25 to 70 years old .Relevant data were collected from each person, these included personal data (e.g age, sex, speciality, years in employment, etc...) and health data (e.g history of jaundice, history of blood transfusion, history of needlestick injury, history of HBV prophylaxis. Three C.c of intravenous blood was collected aseptically from each doctor and tested for evidence of HBV exposure by detection of the following HBV markers: anti-HBc, anti-HBs and HBsAg using ELISA technique. -Detection of anti-HBc: .’ The test principle is an EIA in which during the first reaction step the antibodies to HBcAg to be determined in the sample are bound to HBcAg with which the surface of the microtitration plate is coated. After washing, peroxidase-conjugated anti-HBc is bound in a second reaction step to the still free anti genic determinants of the solid phase. The excess conjugate is washed out, and the bound enzyme activity subsequently determined. The enzyme reaction of hydrogen peroxide with chromogen is stopped by addition of dilute sulphuric acid. The colour intensity is inversely proportional to the concentration of anti-HBc present in the sample. The HBcAg coated test plates and all the necessary reagents used to carry out the test were purchased from Behring Institute, Germany. -Detection and quantitation of anti-HBs: The test is an EIA using the sandwich principle.The anti-HBs present in the sample is bound to HBsAg fixed on the surface of microtitration plates. After washing, peroxidase-conjugated HBsAg is bound to the remaining antigen-binding sites in a second reaction. The excess conjugate is removed by washing and the enzyme activity on the solid phase is determined. The enzymatically catalysed reaction of hydrogen ~roxide. and chromogen is stopped by adding dilute sulphuric acid. The colour intensity is proportional to the anti-HBs concentration in the sample. Anti-HBs titre was determined by the anti-HBs standard(10 IDIL and 30IDIL). The HBsAg coated test plates and the necessary reagents used to carry out the test were purchased from Behring Institute, Germany. ” -Detection ofHBsAg: The test principle is an EIA based on the one step sandwich technique. The HBsAg contained in the sample simultaneously reacts with the polyclonal anti-HBs antibodies attached to the wells of the microtitration plate and with the monoclonal anti-HBs antibodies conjugated with peroxidase. Unbound reactants then are washed out,chromogen is added and the peroxidase conjugate bound to the solid phase reacts with the chromogen producing a blue colour. This enzymatic reaction is stopped by the addition of stopping solution and the resulting yellow colour is then measured. The colour intensity is proponional to the concentration of antigen in the sample. The anti HBs coated test plate,and all the necessary reagents were purchased from Behring Instit ute, Germany. Among the 180 surgeons screened in this study anti-HBc was detected in 47(26) while anti-HBs was present in 55(30.5).Both antibodies were found together in 41(22.8) out of the 180 samples.