Diagnosis of Hepatitis by Use of APRI Paper Example

Introduction

This is the viral infection that causes inflammation and destruction of the liver, it's caused by hepatitis c virus, it's a time asymptomatic but may present with symptoms such as jaundice (yellowing of the skin, eye, and urine), appetite loss, fatigue and nausea with stomach pains. Type I is the most common form of hepatitis in the U.S with infection averaging to 3.9 million. Persistence in the liver eventually results in liver cirrhosis and may progress to further damage like liver failure, cancer, and dilation of blood vessels in the gastrointestinal system (Australia 2018)

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Transmission of hepatitis involves direct contact by blood to blood transfusion or fluids, sharing sharp objects such as needles and vertical transmission from mother to child during delivery of the baby. The virus may also be spread via organ transplant and in that patient who has long-term kidney dialysis, in addition, sexual intercourse with infected people can result to transmission of hepatitis virus (Bostan, Mahmood 2010).

A number of people are at a great risk in acquiring the infection and includes the drug abusers who share needle with no knowledge of their status, patients with long period of kidney dialysis, unprotected sexual interaction with infected people, health workers who stay in contact with blood for long hours and those patients receiving organ transplant and blood transfusion from infected people with hepatitis c virus.

Epidemiology

Globally an estimation of hepatitis c infection range from 130- 145 million with 2% of people suffering from chronic infections. Infected individuals act as the source of transmission of the disease and are the risk of progressing to liver cirrhosis and primary hepatocellular carcinoma. Infection caused by hepatitis c virus accounts for 27% and 25% of liver cirrhosis and hepatocellular carcinoma respectively (Hanafiah et al., 2013).

The prevalence is at 2.2% which correlates to 1.3 million of reported cases. Due to lack of data estimation based on weight revealed <1.0% in north Europe to >2.9% in northern Africa. Low prevalence has been recorded in the United Kingdom and high prevalence in Egypt (15-20%) the geographical distribution is also related to age preferences as those within 30-49 years account to higher rates of infection as compared to below 20 years and older than 50 years. The rate of infection in Egypt increases with age preference and all age groups present an increased risk of transmission following a mass campaign against schistosomiasis by using poorly sterilized needles for the practice. Despite all factors to determine the risk of infection, those newly acquired infections pose a challenge as i8nfections are asymptomatic and available techniques are not able to distinguish between chronic and acute infections. Other countries have used seroconversions among negative individuals in determining the rate hepatitis infection.

The health personnel must ensure adequate sterilization of needles or other sharp objects if they are to be used on different patients. A major cause of transmission is direct contact with body fluids which health personnel must observe proper attire while handling blood and other fluids using gloves, proper screening of blood samples before transmission reduces the incidence of transmitting hepatitis from infected to non-infected. Mothers and those receiving organ transplant are subjected to tests to establish whether they are sick to protect the infant during birth.

Early diagnosis of infection is the key to initiating necessary therapies and limit the spread. Prevention is always better than cure diagnosis of hepatitis is done by either aspartate platelet ratio index or by biopsy from the tissue obtained in the liver. Progression of the disease always results in multiple problems affecting other organs aside from the liver such as spleen and kidneys

Failure to implement the above practices the risk of infection tend to increase with the development of liver cirrhosis and hepatosplenomegaly. Children born from infected mothers tend to suffer from chronic infections and the rate of disease burden is likely to increase in the population.

Clinical problems

Etiology

Hepatitis c virus is a member of the Flavivirus family, it is spherical, positive single-stranded enveloped RNA virus. They are grouped into seven genotypes (1-7) with several subtypes. The genotype 1 is most prevalent in the United States with a rate of 70% of reported cases in addition to South African and Europe and 20 % associated with genotype 2 and the rest account to 1% of reported infections (Galli, Bukh 2014).

Transmission of the virus entails blood transfusion which has been reduced by screening, use of sharp objects such as needles, sexual intercourse with infected individuals, healthcare workers via direct contact with blood products or pricks in addition to tattooing and maternal to fatal transmission.

Pathophysiology

The virus targets the hepatocytes and B lymphocytes. The occurrence of acute infection healthy individuals develops antibody and cell-mediated immune response by using cytotoxic T lymphocytes and T helper cell to eradicate the viral infections. Clearance of all viral load may be impossible and such attempts leads to persistent of the virus progressing to chronic infection and severe liver damage (Rehemann, Nascimbeni 2005).

Persistence of the virus in the blood often results into hepatic inflammation and fibrosis and more hepatocytes being affected by hepatitis c virus increase to 50% according to research.

The virus has a mechanism for proteolytic cleavage to form two glycoproteins (E1 and E2) and core protein they have receptors for CD-81 receptors expressed by hepatocytes that act as binding receptors for hepatitis c virus. Other non-structural proteins such as NS2 serve as an agent of transmission of the virus.

Signs and symptoms

Long-term infection with hepatitis causes chronic symptoms ranging from extrahepatic to hepatic, they include; weight loss, cryoglobulinemia, joint pain, jaundice, sensory neuropathy, idiopathic thrombocytopenic purpura, and paraesthesia's. Other infections may affect the brain causing hepatic encephalopathy, some causing ankle oedema and abdominal distention (Minemura, Tajir, & Shimizu 2009).

Treatment

A standard therapy with interferons which patients respond for 6 months, the use of antivirals agents especially on patients with advanced fibrosis, cirrhosis and liver transplant recipients in addition to those with extrahepatic hepatitis.

The establishment of preventive and treatment care has impacted positively to the lives of the people as the disease burden is cut down, the rate of transmission is reduced among their people and health workers reducing the incidence of stigmatization. The discovery of antivirals is able to protect and prevent disease spread within the body to limit the damage of other organs such as brain and spleen. Chronic infection is limited to the liver and the rate of attack on liver cells are reduced. This diseases often destroy the liver impairing other liver functions. The digestive system is also affected leading to low production of stomach acids, bile and breakdown of fats are impeded due to the destruction of various sites within the body. The central nervous system and cardiovascular system are also affected as a result of infection with the virus. Nervous breakdown often results from toxins not able to remove by the liver that causes confusions, poor concentrations, and disorientation. Immunity and the skin pigmentation are equally affected with the body's immune system decreasing (World health organization 2015)

The virus is also known to affect health care workers making the susceptible when they interact with contaminated fluids and blood, such a risk reduces the number of health personnel capable to work under those environments.

Early diagnosis of the infection through blood samples and tissue biopsy has aid to reduce the amount of viral load and spread to other organs within the body. Mass education of the people on symptoms and methods of transmission has aid to reduce disease burden and number of people visiting health facilities for diagnosis and treatment.

The need of organ transplant and transfusion of blood has led to the introduction of the screening techniques to identify the virus and prevent transmission of the virus from the infected to non-infected, this has improved healthcare systems and service delivery.

Safe sexual practices and maternal care during delivery has limited transmission from the mother to the child. Life of the new born is saved with no chronic development of the disease.

The cost of implementation and obtaining treatment is high, antiviral manufacturing and diagnostic techniques are expensive, it involves professionals who can obtain the liver tissues and examine blood samples. Adequate training for the workers also is costly in addition to equipment's required for diagnosis.

The government is investing in research on newer drugs and trials on other antivirals and interferons for eradication and prevention of hepatitis, the mass education and providing of facilities has led to a reduction in the rate of transmission, adequate training and provision of automated machines and equipment's facilitates the prevention of further destruction of the body organs by the virus.

Nurses are faced with a challenge of inadequate training and use of outdated faulty machines which a time fail or produce wrong diagnostic information. They are the health workers who are most likely to come in contact with contaminated blood and fluids leading to their self-infection, in addition, the number of trained nurses is less as compared to the general population they need to attend.

Review of the evidence

This section illustrates the methods and results of the literature review undertaken to determine the accuracy of AST platelet ratio index over biopsy in diagnosing hepatitis c.

Pico question

In persons diagnosed with hepatitis C (P), how does the use of AST platelet ratio index (APRI) score (I) compared to liver biopsy (C) influence early detection of liver fibrosis (O) (P) in patients? Our PICO question is a diagnostic question and is best answered by a systematic review of level 11 studies. The study among correlative patients is based used to answer this type of questions in addition to correlative study among non-consecutive patients and diagnostic case-control study.

Search method

Data obtained for the study was generated from the research of Hamad Medical Corporation from the department of Hepatology. The study included 383 men who had been infected with hepatitis c and had had the liver biopsy from the January 2006 to April 2014. The patients were to receive hepatitis c treatment. Chronic infection was termed as positive anti-HCV serology, the manifestation of the active virus was detected by HCV-RNA and a recurrent increase in alanine aminotransferase and chronic hepatitis patterns. Patients included in the study were 18 years and above who were diagnosed with HCV and those excluded had a concomitant chronic liver disease such as HIV, autoimmune hepatitis, hepatocellular carcinoma and a history of previous therapy such as antiviral and interferon therapy. APRI score was determined same to biopsy to compare the two (Simon et al., 2016).

Search results

The retrospective search published in the worl...