The included samples are convenience samples and do not represent the prevalence in the community. In our study, the seroprevalence of HCV was higher in older age groups than in HBV, and in males from rural areas which is comparable to other studies in Egypt [22-27]. The relatively higher prevalence of HCV than HBV could be explained by the compulsory HBV vaccination in the first year of life. The higher prevalence in males could possibly be due to higher exposure to risk factors. Our results are also comparable to those obtained in a previous study performed in Minia (Upper Egypt) by Khattab and coworkers  and to a similar study carried out in Alexandria (Lower Egypt) by Wasfi and colleagues .
Transfusion of blood and blood product is a life- saving measure and benefits numerous patients worldwide. However, transfusion is an important mode of transmission of infection to the recipients. In 2005, all member states of WHO signed a document that commits them to the provision of safe and adequate blood and blood products to patients . Transfusion-transmitted infectious diseases remain a major topic of interest for those involved in blood safety . To avoid infection by blood transfusion, safety is very important because of blood transfusion is an integral part of medical and surgical therapy. Therefore, the tests for HIV, HBV, HCV syphilis and malaria are mandatory in the blood bank . HepatitisBvirus (HBV), hepatitisCvirus (HCV) are a major global public health problem warranting high priority efforts for prevention, control and treatment . Testing for hepatitisB surface antigen (HBsAg) is the commonly used screening test in developing countries . The hepatitisCvirus was discovered in 1989. It is transmitted via blood and blood products, both parenterally and through sexual contact . Libya, a developing country of approximately 6 million people, belongs to the intermediate endemicity countries with a wide variance of sero-positivity among different regions and populations . A national serological survey for HBV and HCVinfectionsamong the general population was performed in Libya during 2003 and revealed prevalence of 2.2% and 1.2% for HBV and HCV, respectively . A local surveys reported that the rate of HBsAg positivity amongblooddonors ranged from 1.3% to 4.6% , while the rate of HCV antibodies was 1.2% [9,10]. Very recently, the frequency of HBsAg positive blooddonors and anti-HCVamong this sample was 0.8% and 0.7% respectively in blooddonors in western Libya (Tripoli) . There has
Aims: Millions of lives are saved each year through blood transfusion but a safe blood supply is a critical component of health care to prevent the spread of blood-borne infectious diseases. Therefore, it is essential to assess the prevalence and identify the most common culprit and risk in transfusion services. Methods A cross-sectional study was conducted from April 2015 to May 2015 at the Hawassa blood bank center. Blooddonors who donated blood for transfusion purposes were considered for the study. Whole blood was collected and serum was separated from each donor. The sera were used for examination of human immunodeficiency virus (HIV), hepatitisBvirus (HBV), hepatitisCvirus (HCV), and syphilis. Thick film was prepared and stained using Giemsa for malaria detection. Results: A total of 384 blooddonors were screened during the study period. Among these donors, 67.2% (258) were males and 32.8% (126) were females. The overall prevalence of transfusion transmitted infections (TTI) was 28 out of 384 (7.29%) apparently healthy donors. The seroprevalence of HIV, HBV, HCV, syphilis
The evaluation of the prevalence and distribution of HBV, HCV and HIV is important for the planning of preventive measures and particularly, in the case of HBV, for the development of vaccination programs. The preva- lence rates across the world are difficult to calculate given the asymptomatic and often latent nature of these dis- eases prior to clinical presentation [6,7]. The ideal condi- tion to carry out a seroprevalence study is to sample the general population; however, this is not always feasible. Because of the low prevalence of these infections in the general population, their determination is cumbersome because it would imply large sample sizes. For this reason, although blooddonors may not reflect the general population, most of the studies are performed in this group because results could be invaluable data to bet- ter understand the epidemiology of these diseases in the community [8-11].
a cause of concern in the hospitals, though a significant improvement has been achieved regarding the testing methodologies over time. Our study also revealed a low HIV-HBVco- infection (0.06%) and there was neither co-infection with HCV nor a triple infection including HIV/HBV/HCV in the subjects included in the study. The increase in non- HIV virusinfection rates can be attributed to policies, which have been more concentrated in dealing with HIV infection and ignoring the other viral infections including HBV and HCV that are even more infectious and can result in chronic infections and severe morbidity in infected populations. Previous studies have been in voluntary blooddonors, patients attending Sexually transmitted Disease (STD) clinics, hospital for drug addicts and infertility clinics. Studies have also reported HIV, HBV and HCVinfection rates in various patient groups including patients posted for surgeries, orthopedic clinics and pregnant women. Very few studies have reported the prevalence of blood-borne viral infections in tertiary care centers. Our study results showed that overall Seroprevalence (3.3%) was higher when compared to a recent north Indian study which reported a prevalence rate of 2.5%, for HIV(1.24%), HBV(1.56%) and HCV(0.2%). Only 0.8% had co-infection of HIV and HBV and there was no co-infection with HIV and HCV . The rates of HIV-HBVco-infection in our study was low (0.06%) as compared to hospital based study from north India by Swathi et al. (5.32%) who included only HIV seropositive subjects and compared them with blooddonors (1.4%) . Ankur et al. in their study which included inpatients in a tertiary care hospital in north India revealed a prevalence rate of 4.04 % for HIV and 1.7% and 1.1% rates of co-infection of HIV with HBV and HCV respectively . A study from south India by Gowri et al. in a tertiary care centre revealed lower rates of HCV Seroprevalence
The limitations of the majority of serological and DNA tests were also considerable to the test kit used by this study. Determination of HBsAg alone may not exactly measure the overall prevalence of HBVinfection in a given population as other viral co-infections such as HIV or HCV are indicators of the total infection rate. The carrier state of HBsAg is defined as persistence of this antigen in the blood for over 6 months. Thus, a sin- gle determination of HBsAg may not be the ideal way of defining the carrier state among study subjects.
HCV is rarely transmitted by blood transfusion or organ transplantation because of careful testing of blood and blood products for the presence of the virus and the disabling pro- cedures that destroy blood-borne viruses. The prevalence of HCVamong household contacts for people with HCVinfection is low. Care providers only need to advise patients to take “common sense” precautions such as not sharing items that may contain blood (eg, razors and toothbrushes) and covering wounds or open wounds properly. Health care workers exposed to blood are at risk of developing HCV and other blood-borne pathogens. However, the incidence of HCVinfection is not greater in health care workers, including surgeons, than in the general population. 22
There are few studies that reported GBV-C frequency in blooddonors populations. In Salvador and in Rio de Janeiro, Brazil it was reported 10% of frequency of GBV- Camongblooddonors [42,43]. Also, in São Paulo, Brazil it was reported a high prevalenceamongblooddonors with normal and elevated ALT levels: 5.2% (5/95) and 6.5% (5/76), respectively . Furthermore, the preva- lence of GBV-C was 9.7% among 545 blooddonors in São Paulo  and 8.3% in 1.039 healthy individuals . In Iranian volunteer blooddonors the prevalence of GBV-C was around 1% . A study of prevalence of GBV-Camong northeastern Thai blooddonors carrying HBsAg and anti-HCV revealed a higher frequency of GBV-C RNA (10% and 11%, respectively) in the co- infected when compared with the controls . In United States, GBV-Cprevalence in blooddonors was reported ranging from 0.8% to 12.9% [48,49]. In Turkey the preva- lence of GBV-C was 14% in hemodialysis patients and 5% in blooddonors . Also, in Thailand the GBV-C RNA positivity amongblooddonors was 4.8% . In France, among 306 HCV RNA-positive donors, 19.3% were GBV- C RNA positive . In Egypt, El-Zayadi et al.,  found 12.2% of GBV-Cprevalenceamongblooddonors and GBV-C coinfection in HBV and HCV infected patients were 7.6 and 64.9%, respectively. GBV-Cinfection is gen- erally more common in groups with risk factors for per- cutaneous and sexual transmission of infectious agents .
HepatitisCvirus (HCV) is a serious global public health problem is one of the most frequent infections associated with blood transfusion . It has been reported that, HCV responsible for 90- 95% of post transfusion, previously known as Non A Non B (NANB) transfusion-related hepatitis [2,3]. The estimated prevalence of HCVinfection worldwide is 2.8% , whereas 3 to 4 million people are newly infected each year [2,3,5] and 2% of the world’s population have chronic HCVinfection .
Our study identified another very important public health challenge—the safety of blood and blood prod- ucts when donors have only been screened serologic- ally. The national program on blood safety in Georgia was implemented in 1997 and currently ensures screening of all donated blood for HIV, HBV, HCV and syphilis. Implementation of this program resulted in a significant reduction of transfusion transmitted infections (TTI). However, as seen in our study the program failed to detect 7 blooddonors with recent HCV due to the fact that the national program relies only on antibody detection against this infection. Since the late 1990s nucleic acid testing (NAT) of do- nated blood become a gold standard in high income countries, which minimized the residual risks of transmission of viral agents . Our study provides evidence that justifies the introduction of NAT testing of blooddonors in Georgia. This is particularly im- portant for HCV taking into consideration its high prevalence in the country and longer seronegatve window period than HIV .
The magnitude TTIs was lower than the previous studies conducted in Ethiopia. However, the study area has high intermediate endemic transmission. Majority of TTIS occurred among first time blooddonors. Those students, private employed and government employed were less likely to be infected with syphilis and hepatitisBvirus. Male were more likely to infected with HBV. There was significantly decline in the prevalence of HCV and Syph- ilis infection, but not for HIV and HBV. The prevalence of syphilis and HCV also increases with age. Therefore, strict adherence with the criteria of preliminary blood donor selection should be implemented to reduce the amount of blood being withdrawn from transfusion after collection and screening. It is also important to increase the number of repeated voluntary donors through promo- tion of blood bank activity. In addition, further study should be conducted to identify the gaps in the failure of preliminary screening in removing the donor before blood donation and feasible way increasing voluntary donors. There is also an assessment and taking measures on the potential risk factors of major TTI in the community.
In country with intermittent and low prevalence of HBsAg, anti-HBc prevalence vary from, 0.56% in the Uni- ted Kingdom, 0.84% in United States, 1.4% in Germany, 15.03% in Greece [10,34-38]. In our study the HBsAg negative/anti-HBc positive donor population is carry out in two blooddonors groups, regular blooddonors and first time blooddonors. The prevalence rate of anti-HBc was higher in first time blooddonors than regularly donors. So, the establishment of a panel of regular blooddonors is very important in providing safe blood and blood products. Anti-HBc screening of blood donations is controversial and variably performed in different coun- tries. Currently it is limited to areas where the seropreva- lence of HBV is low (generally <2%), while it is not performed in areas with a high HBV seroprevalence because the impact of the deferral of anti-HBc-positive donors is considered not sustainable. However, the preva- lence of occult HBVinfection is higher in areas in which HBVinfection itself is more frequent. The safety of this measure is currently being debated [40-42]. Our study underscores the increasing the HBsAg prevalence in our donor population. This trend, suggest that routine anti- HBc screening of blooddonors could possibly prevent some transfusion-transmitted HBVinfections from blooddonors. However, usefulness of screening for anti-HBc in addition to HBsAg detection and introduction of PCR based screenings like NAT to improve the safety of the blood supply in Albania deserves further analysis.
virusprevalence rate in the general population. Therefore, screening antenatal women for HBsAg can give a reliable prevalence of the disease in a population and provide an avenue for preventing mother to child transmission of the virus . Routine screening of HBVamong pregnant women is not really practiced in the country. Hence, recent data is lacking and this could be influenced by the HIV endemicity which has a shared mode of transmission with HBV. There is thus a need for a study in order to get a clearer picture of hepatitisBvirusinfection in this era, most especially among pregnant women since vertical transmission is one of the frequent modes of transmission of the disease. Prevention of vertical transmission is extremely important because HBVinfection in early life can result in a chronic carrier state  36T .
Recruitment of study participants and serologic testing were effectuated only after ethical approval of the study protocol by Ethical review board of the Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. Administrative authorisations were obtained from the Regional Delegation for Health for the South Region and Director General of the Yaoundé University Teaching Hospital and The Centre Pasteur du Cam‑ eroun. All of our study participants were either English‑ or French‑speaking. According to the language of choice (English or French), all participants were duly informed of the details of the study and were required to each sign a consent form after full understanding of the project. Children from 18 years and below needed approval from a parent or guardian to be enrolled into the study. A pre‑structured questionnaire was completed for each participant and each was attributed a code for confidentiality and identification. Only those who gave an informed consent were enrolled in this study. All questionings, counselling and delivery of results were conducted in set‑ups that guaran‑ teed maximum privacy and all results were coded for confidentiality. The participants, as desired, were all informed of their HIV screening results after a post‑test counselling. All HCV and/or HIV infected participants were referred to the nearest certified treatment centre for better management.
7. Cirrhosis of Liver: Cirrhosis occurs in 80-90% of HCC patients 125 . Cirrhosis is characterized by fibrous septae and nodule formation as well as alterations in blood flow. Hepatocellular carcinoma (HCC) can develop at any stage of cirrhosis 126 . The presence of cirrhosis of any cause increases the risk of HCC 127 . Main causes of liver cirrhosis are alcohol use, chronic hepatitisB, C and non- alcoholic steatohepatitis 128 . A high rate of HCC has also been reported in patients with cirrhosis due to genetic hemochromatosis 129 and primary biliary cirrhosis 130 . Different risk of HCC causes different rates of incidence: HCV>HBV>hemochromatosis. The stage of cirrhosis is also significant in determining the risk of HCC development 131, 132 . CONCLUSION: HCC is a common malignancy worldwide. The principal causal factors for carcinogenesis are viral infections, hereditary diseases, chronic medical conditions like diabetes and personal habits like alcohol drinking, smoking, etc. A detailed understanding of these risk factors and distribution is necessary to improve the screening, prevention, early identification, and management of HCC.
There are several risk factors for liver cirrhosis, including chronic hepatitisBvirus (HBV) and hepatitisCvirus (HCV) infections, alcohol-related liver disease (ARLD), and obesity- related non-alcoholic fatty liver disease (NAFLD). Other causes include cholestatic and autoimmune liver diseases, metabolic liver diseases, and cryptogenic cirrhosis. In Asian and African nations, viral etiologies are more common. Their prevalence varies in European countries and in Italy and Spain, where there is a relatively higher HCC incidence and mortality, the differences have been attributed to the prevalence of HCV. 5 In the UK, where the prevalence of viral
Presence of HBsAg in cord blood does not necessarily indicate another infection as it may represent transient maternally derived antigenemia. Perinatal infection is much more frequent when the mother carries both the surface antigen (HBsAg) and ‘e’ antigen (HBeAg) of the virus. In many instances babies with positive cord blood specimen become negative shortly after birth. Persistent antigenemia is affected by maternal antibody titre and antigenemia in siblings. Antigenemia that developed in the first six months of life suggests transmission at birth. Infants who develop chronic HBsAg carriage due to perinatal infection are sources of continuous exposure to siblings and the rest of population.
Elimination of unwanted, injured or diseased cells by apoptosis is the requirement for the maintenance of homeostasis and regulation of physiological functions in multicellular organisms. Because of its exceptional role and anatomical position, liver is susceptible to exogenous xenobiotics and toxins, and highly vulnerable to tissue apoptosis. Apoptosis, which is accompanied by biochemical features such as DNA fragmentation, membrane alterations, and degradation of liver cells can be initiated by extrinsic or intrinsic pathways by means of death signals from the cell exterior. The extrinsic pathway is activated by the binding of a group of transmembrane receptors (death receptors) to their related ligands. Some of the d eath receptors in liver comprise Fas or CD95, Tumor TNF-R1, TRAIL-R2 also called death receptor 4 and 5 (DR4 and DR5). The intrinsic pathway usually activates apoptosis through members Bcl-2 family, which control mitochondrial outer membrane permeabilization, cytochrome C release, and consequently caspase initiation. Caspases are a family of aspartate-specific cysteinyl proteases that are triggered during and assist the execution of apoptosis in liver cells. A group of caspases that are triggered first in the process (upstream) are called initiation caspases, while others that bring the important structural hits of apoptosis are called executioner caspases. Caspases, that is, caspase -2, -8, -9, and -10, belong to the group of initiator caspases, while caspases, that is, caspase- 3, -6, and -7, belong to the group of executioner enzymes. Any malfunctioning in the course of liver apoptosis might result in various kinds of liver disorders from auto-immune diseases to the high risk hepatocellular carcinoma (liver cancer). In this review, we addressed some common molecular concepts and mechanisms of hepatic apoptosis and circumstances that are linked to hepatic apoptosis.
by suture needles some people have suggested using blunt needles wherever possible, and many surgeons are adopting this instrument. There is convincing evidence for the protective effect of double gloving, but this technique is not acceptable to some surgeons because of concerns about loss of manual dexterity. This study identified other variables where there might be the potential for change. The association between spectacle wearers and blood exposures is interesting. If spectacle wearing is a marker for age, then the finding could indicate a reduction in manual dexterity in older surgeons. This may be relevant to the whole issue of reaccreditation of surgeons, especially if such a programme were to include evaluation of manual skills and outcome of operations. The sensitive issue of spectacles, age and manual skills needs to be raised with surgeons. There could be an indication for a further study in which individual surgeons were identified, but this would need careful planning and
partners prepared screening campaigns to identify in- fected patients to be linked to a free of charge treatment. In 2018, campaigns were specifically conducted in dis- tricts previously found to have higher prevalence of HCVamong the general population and targeted indi- viduals aged 25 years old and above from districts in Southern, Eastern and Northern Provinces previously found to have higher prevalence. The study population consists of voluntary participants of the 2018 campaigns. People who were not Rwandan by nationality or under 25 years old were excluded. Screening campaigns were conducted between March to October 2018 for 2 weeks in each district. Community awareness for viral hepatitis screening was done by radio advertisements and with the help of community health workers before and during the screening period. Individuals who belonged to tar- geted demographic groups and attended screening sites (health centers) were screened for HCV and included in the study population of this analysis.