Muhammad Salman Siddique

Al-1161B.S.(Hons.) Medical Lab Technology Final Prof.

Fatima Memorial Institute of Allied Health Sciences Shadman Lahore

Topic

Incidence of Diabetes Mellitus in patients with Hepatitis B and C virus infection.

Introduction

Hepatitis C Virus (HCV) infection is one of the most important cause of cirrhosis worldwide. (Simona, et al.,1999) Although HCV targets at the liver, it has become interestingly evident that HCV can induce diseases of many organs. It is reported that 38% of patients with HCV would manifest at least one extrahepatic manifestation during the illness. (Eman, et al., 2011) There are also some other evidences that both HBV and HCV have extra hepatic sites of viral colonization resulting in extrahepaticmanifestations especially of kidneys and pancreas resulting in proteinurea and diabetes. (Qureshi, et al., 2002)

Introduction (cont.)

Association of diabetes mellitus with chronic liver disease has been recognized for over 2 decades and the following hypothesis has been suggested:

“As liver is involved in glucose metabolism therefore it is presumed that abnormal glucose tolerance should be seen in chronic liver disease and this was confirmed in many studies, whereas about 70% cirrhoticswere found to have abnormal glucose tolerance. (Qureshi, et al., 2002)”

Introduction (cont.)

The highest Hepatitis C Virus (HCV) prevalence in the world occurs in Egypt at an estimated 12% among the general population and reaches 40% in persons 40 years of age and above in rural areas. (Eman, et al., 2011) In Paskistan the HBV carrier and HCV exposure rates are high; being 8-10% for HBV and 4% for HCV. (Qureshi, et al., 2002)

Objectives

• To observe the association of Diabetes Mellitus with patients suffering from Hepatitis B and C virus infection.

• To magnify the relationship between Diabetes Mellitus and Hepatitis B and C virus infection to spread the awareness of their association.

Rationale

The purpose of this study is to conclude the relationship of Diabetes Mellitus with Hepatitis B and C. It will also help magnify the problem and co-existence of Diabetes Mellitus and Hepatitis so that the treatment of Hepatitis B and C can be optimized.

Materials and Methods

Research work location: This present study will be conducted at the Department

of Pathology, FMH College of Medicine & Dentistry, Shadman Lahore.Sample Size:

Approximately 502 mixed samples of HCV and HBV positive patients will be collected. (Akbar, Siddique & Ahmad, 2002)

Materials and Methods (cont.)

Inclusion criteria:Patients positive of HBV or HCV infection will be

included.Exclusion criteria:

Patients negative of HBV or HCV infection will be excluded.Study Design:

Observational study.Duration:

Six months.

Materials and Methods (cont.)

Data Collection InstrumentQuestionnaire will be filled according to the collected

information of inclusive individuals.Data Analysis:

Data will be entered and analyzed using SPSS 17.0. (SPSS Inc. Chicago, USA). Appropriate statistical tools will be applied to analyze the data.Ethical Issues:

There will be no ethical issue observed during this study.

Methodology

Sampling: Routine blood sampling technique will be used to collect 3ml blood sample in clotted vial for PCR and 3ml in EDTA anticoagulant vial for HbA1c from patients that will be included in this study. The samples will be stored at 2-8˚C in a refrigerator.PCR: Then PCR will be done to confirm the viral infection. PCR depends on three steps denaturation, annealing and elongation. PCR is done by repeating several thermal cycles in a controlled manner. In denaturation step the DNA is heated usually to 95oC to render it single stranded.

Methodology (cont.)

Then in annealing step the two primers bind the appropriate complimentary strand. And in elongation step DNA polymerase extends the primer by its polymerase activity. This is done at a temperature optimal for the particular polymerase that is used. Currently the most popular enzyme for this step is Taq Polymerase, the DNA polymerase from the thermophilic (heat loving) bacteria Thermus aquaticus. The elongation takes place at 72oC. These steps are repeated from 28-35 times. In PCR the desired genetic material is enhanced and then its load is measured.

Methodology (cont.)

HbA1c: HbA1c test will be performed to confirm the Diabetes Mellitus according to the WHO’s Diagnostic criteria for Diabetes Mellitus, in those patients that are confirmed of having Hepatitis infection in PCR. Latex enhanced immunoassay method of HbA1c will be used. It is based on interaction between antigen molecules (HbA1c) and HbA1c specific antibodies coated on latex beads. This cross link reaction results in changes in the solution turbidity which is proportional to the amount of the antigen in the sample.

References

• Eman, L. E., Gamal, F. M., Mai, A. E.-D., Fatma, A. M., Gamal, G. E., & Mohamed, A.-h. (2011). Association of HCV with diabetes mellitus: an egyptian case control study. Virology, 367(8).

• Qureshi, H., Ahsan, T., Mujeeb, S., Jawad, F., Mehdi, I., Ahmad, W., & Alam, S. (2002). Diabetes mellitus is equally frequent in chronic HCV and HBV infection. J Pak Med Association, 52(7), 280-283.

References (cont.)

• Simona, C., Kevin, T., Luigi, P., Colin, C., Ugo, P., Juraj, P., Graeme, J. A. (1999). Further Evidence for an Association between Non–Insulin-Dependent Diabetes Mellitus and Chronic Hepatitis C virus infection. Hepatology, 30(4), 1059-1063.

• Akbar, D., Siddique, A., & Ahmad, M. (2002). Diabetes mellitus is equally frequent in chronic HCV and HBV infection. Med Princ Pract, 11(2), 82-85.

Incidence of Diabetes Mellitus in patients with Hepatitis B

and C virus infection.

Serial no. ________

Name: ______________________________

Age: _______

Gender: ____________

Occupation: ____________________

PCR test report:

Detected Not Detected

HBV

HCV

HbA1c test report:

Date: __/__/201_ __________

Signature

Control Reference

Value

Patient

Value

Ideal/Excellent 4.0 – 6.0 %

Desirable 6.1 – 7.0 %

Suboptimal 7.1 – 8.0 %

Very poor > 8.1 %