In-Limbo: the In-Practice Islamic Banking System, in Full Conformity With Sharī ‘ah Standards Or.

In-Limbo; the In-practice Islamic Banking System, in full Conformity with Sharī ‘ah Standards or.

Detection and Genetic Screening of Hbsag Mutants in Blood Donors & Multi-Transfused Patients of Pakistani Population

Hepatitis B virus (HBV) infection is one of the leading healthcare concern around the globe. HBV infection is affecting more than 6 million people in Pakistan. General population and the patients administrated for regular blood transfusions (Multi-transfused population) are always at greater risks to acquire HBV infection through unsecured process of transfusion. The existence of HBsAg mutants is well documented in studies from many countries. In Pakistan, most of blood banks perform HBV screening by rapid detection devices or ELISA tests. These tests are designed to detect HBsAg, but may not be equally effective to detect all mutations of HBsAg. Failure to detect these HBsAg mutants, may result in the transmission of HBV infection from donor to recipient. The determination of detection capacity of diagnostic assays and their respective capability to identify HBsAg mutants is very critical. Three routinely used diagnostic tests (rapid detection devices, ELISA and CLIA) for HBsAg along with LIAISON® XL Murex HBsAg Quant Assay were applied to determine the prevalence of HBV along HBsAg mutants in Pakistani healthy blood donor population and multitransfused patients (Thalassaemia and Hemophilia patients). The samples used in current study were collected from three different cities of Pakistan. The screening tests were performed by using SD Bioline rapid assay (n = 1500), ELISA (n = 1500), and Abbott ARCHITECT®CLIA system (n = 1500) at the same collection centres. All the samples (n = 4500) were re-tested for a comparative analysis on LIAISON® XL Murex HBsAg Quant assay (DiaSorin S.p.A.). PCR testing was performed as a gold standard on all discordant samples. . In current study total 4500 healhty blood donors were screened for presence of HBV infection, among them 119 (2.64%) were finally found positive for HBsAg by gold standard method. The other methods showed variable value of sensitivity and specificity in the screening results. Sensitivity of SD Bioline Rapid, GB HBsAg ELISA, Abbott ARCHITECT® and LIAISON® XL Murex HBsAg Quant assays were 17.24%, 43.75%, 90.91% and 100% respectively. Total 1440 thalassaemia patients were screened in this study among them 930 (64.6%) were males and 510 (35.4%). Screening revealed that total thalasssamia patients total 44 were positive for HBsAg. In HBV positive patients, 25 (56.8%) were males and 19 (43.2%) were females. Similarly total 950 hemophilia patients were screened; among them 755 (79.5%) were males and 195 (20.5%) were females. The screening of 950 revealed that total 23 (2.4 %) hemophilia patient samples were positive for HBsAg. Three genotypes were found in current study that included genotype A, genotype D and genotype C. Total seven HBsAg subtypes were determined those included subtypes ayw2, adw1, adw2, ayw1, ayw3, ayw4 and adr. The most common subgenotype/HBsAg subtype is D1/ayw2. The S-gene region representative phylogentic analyses were also performed. The sequence analysis of total 185 positive samples was performed. The sequencing analysis revealed mutations (non-synonymous nucleotide point mutations) in HBsAg nucleotides and total 28 (15.1%) samples showed sequence variations in “S region. In general the most common mutation was in amino acid region from 143-145 among S143L was largely counting exhibited in 13 (35.1%) samples. The study clearly demonstrated that there is a degree of variation in capacity of different screening assays currently used in Pakistan. Current study has also revealed the presence of HBsAg mutants in Pakistani healthy blood donors and multitransfused patients (Thalassaemia and Haemophilia patients).