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SYED ASIF RAZA ZAIDI B.pharm,MBA Student of M.Pharm (Pharmacognosy) University of Karachi, Pakistan 2009 ©
What is it ?
Any Guess !
Disease that impairs liver function either temporarily or permanently even leading to death.
Acute Hepatitis < 6 month caused by hepatitis any virus. Chronic Hepatitis >6month caused by Hepatitis B,C,D Viruses. Alcoholic Hepatitis, hepatocytes swelling due to heavy drinking, Autoimmune Hepatitis , Chronic hepatitis with high serum globulin usually in young women's, positive antinuclear antibody ( ANA) & smooth muscle antibody is most common type Drug Induced , The liver helps the body break down certain drugs. However, the process is slower in some people, which can make them more likely to get liver damage. Even small doses of certain drugs can cause hepatitis
Lets have a look ;
VIRUS A group of infectious agents characterized by their inability to reproduce outside of a living host cell. Viruses may subvert the host cells' normal functions, causing the cell to behave in a manner determined by the virus. VIROLOGY The study of viruses and viral disease. VIREMIA. The presence of virus in the blood VIROID A very exotic type of virus-like particle that only infects plant cells and consists of a group of membraneless circular RNAs that neither code for nor contain any structural protein. They replicate without other viruses being present. VIRION A virus particle existing freely outside a host cell. VIRULENCE Refers to the ability of a microorganism to produce serious disease. Tuberculosis is a virulent organism. Some nontuberculous mycobacteria are virulent (e.g., M. kansasii), while others (e.g., M. gordonae) are not. (PATHOGENICITY is a related--though not identical--concept.)
VIRUS & ITS GLOSSARY
Hepatitis B virus
Hepatitis E virus
Hepatitis A virus
Hepatitis Delta agent
Single stranded RNA & Non Envelope.
Double Stranded Circular DNA genome, envelope contains a surface antigen HBsAg.
Single stranded RNA virus
Small Single stranded RNA ,Composed HBsAg
Single Stranded RNA virus.
Single stranded RNA Virus.
HAV HBV HCV Picornavirus Hepadnaviri Flaviviridae dae 28nm 30 - 60nm 40nm Incubation Incubation Incubation period is 30 period is 120period is 60 days. days. days. Fecal/Oral Parenteral,s route, exual, contaminate Infected d food & mother to water, new born. person contact Mortality rate <0.5%
HDV HEV Delta Agent Hepeviridae 40nm 30 - 35 nm Incubation period is 90 days. Incubation period is 40 days. Fecal/Oral route, contaminate d food & water, person contact
Parenteral,se Parenteral, xual, Sexual Infected contact HDV mother to person., new born.
Mortality Mortality High to very 1-2% High in rate 1%-2% rate 0.5%-1% high Pregnancy. Severe, Severe, Acute & high Acute and Chronic Chronic Acute Hepatitis.se vere in
Mild Severe, Severity and Acute and Acute Chronic
HGV Now GBV-C
• GB virus C (GBV-C), formerly known as Hepatitis G virus (HGV), • Flaviviridae family which has not yet been assigned to a genus, is known to infect humans, but is not known to cause human disease.
• Parenteral, sexual and vertical transmission of GBV-C have all been documented, and because of shared modes of transmission, individuals infected with HIV are commonly co-infected with GBV-C. Among people with HIV infection, the prevalence of GBV-C viraemia ranges from 14 to 43%.
• Some studies have suggested that co-infection with GBV-C will actually slow the progression of HIV disease
How we can find virus & what is there Geographical location !!!
• The electron microscope negativecontrast method makes it possible to detect virus particles directly. • Considering the course of the disease and other investigations, results often lead to a definite diagnosis very quickly. In contrast with many other diagnostically methods, electron microscopy is not limited to the detection of one specific, previously known pathogen. This is why it plays such a key role in the detection of new viral pathogens as well. • Searching for virus particles in samples of organs, excretions or cultured media usually takes place at a magnification of 40 000x. • In order to identify the characteristic structural features of the virus reliably, the scientists use higher magnifications - i.e., ranging from 150 000 to 300 000x. This would not be feasible using a light microscope as it can only magnify up to 1000x.
Hepatitis G virus (HGV)
has been recently documented in the Americas, Europe, and Australia. Distinct risk populations from North Africa, South America, and Southeast Asia were screened for HGV, in addition to hepatitis B and C viruses. First time recognition of HGV is described from Egypt and Indonesia. Notable is the high proportion of HGV positive individuals among multiply transfused children, ranging from 24% of those sampled from Egypt to 32% in Indonesia. Also, data from Peru suggest the likely association of HGV infection with progressive liver disease. Hepatitis G virus should be considered a world-wide health concern.
We need a cure!
But first we shall looks towards sign & symptom's
Sign & Symptoms
•Jaundice - yellowing of skin, eyes, nail beds
•Dark urine •Abdominal pain & Malase
Tests include: • • • • • • • • • • • Liver Function Tests History and Physical Exam Serum Alanine Aminotransferase (ALT) Level Test SerumAspartate Aminotransferase (AST) Level Test Serum Bilirubin Test Serum Gamma-glutamyl Transferase (GGT) Test Serum Albumin Test Serum Alkaline Phosphatase (ALP) Level Test Acute Hepatitis Panel Total Hepatitis A Antibody Level Test Hepatitis A Antibody Test
ission ransm se t l-oral drug u . Feca nous 1 Blood ra v e ected ake 2. Int to Inf sure od Int ke o 3. Exp minated Fo er Inta s ta at untrie ns 4. Con minated W ffected co cretio e onta iting a .C dily S s 5 ers vi nfected Bo l . trave re to I 6 xposu 7. E
Drug Induced Hepatitis :
• • • • • • • • • • • Drugs that can lead to liver inflammation include: Amiodarone Anabolic steroids Birth control pills Chlorpromazine Erythromycin Halothane Methyldopa Isoniazid (used to treat tuberculosis) Methotrexate Statins
Drug Induced Hepatitis :
Exams and Tests Blood tests will be done to check liver function. Liver Enzymes may be increased. A physical exam may reveal an enlarged liver and abdominal tenderness in the right upper part of the belly area. Treatment There is no specific treatment for most cases of drug-induced hepatitis other than stopping the drug that is causing the problem. The exception is acetaminophen. Treatment should be started as soon as possible after you take excessive doses of acetaminophen and have developed hepatitis. Outlook (Prognosis)
Usually, drug-related hepatitis goes away within days or weeks after you stop taking the drug that caused it. Possible Complications Liver failure is a possible but rare complication of drug-induced hepatitis.
L-ornithine-L-aspartate for Hepatic Encephalopathy
Hepatic encephalopathy. Abnormal ammonia metabolism is one of several possible mechanisms for hepatic encephalopathy. In cirrhosis,impaired hepatic metabolism and blood flow lead to raised serum and CNS ammonia concentrations. Ornithine and aspartate are important substrates in the metabolic conversion of ammonia to urea and glutamine, respectively. Ornithine aspartate thus provides for both of these ammonia detoxification pathways. Controlled clinical trials suggest that ornithine aspartate, significantly reduce ammonia levels and have useful therapeutic effects in patients with cirrhosis and mild hepatic encephalopathy. (3g active ingredient) which is dissolved in water for oral administration. The dose is one or two sachets three times a day.
All medication duration depends on the severity of disease.
• MEDICINES • Entecavir 0.5mg in chronic Hep B. • Acyclovir 200-800mg. • Adefovir Depivoxil 10 mg. • Ribavarin.200600mg.in combination with interferon , Hep C.
• DOSSAGE • Once Daily. • 5 times daily . • 1 tab daily. • Twice daily
Treatment & Prevention:
There is no specific treatment for Hepatitis A . However, the most common treatment. are bed rest , drink a lot of fluids .Prevention is by Immune globulin and Hepatitis A vaccine. Immuno globulin 0.02ml/kgIM is protective and recommended dose. Vaccine dse is 1ml 0r 0.5ml IM followed by a booster dose at 6-12 months . For treating hepatitis B there are 2 drugs approved: interferon and lamivudine. The therapy with interferon lasts from 6 to 12 months and it has many side effects. The therapy with lamivudine lasts for at least one year and it could have lower effects than the therapy with interferon. For treating hepatitis C there are 3 drugs approved: interferon alfa, pegylated interferon (recently introduced) and ribavirin. The treatment varies with the form of the infection with hepatitis D virus. In the acute stage, the treatment is identical with the one from the other types of hepatitis: rest in bed as needed, balanced diet and avoiding alcohol. The situation regarding the chronic infection with hepatitis D virus is more complicated. Liver transplantation is an option in cases of largely destroyed or stopped functioning liver. Liver transplantation has been helpful for treating fulminant acute and end-stage chronic hepatitis. Hepatitis E can be prevented by Bed rest and taken lot of fluids. There is no treatment available for hepatitis G . Prevention is same as other Hepatitis viruses.
• Chemoembolization is most beneficial to patients whose disease is limited to the liver. Some success has been demonstrated with patients whose cancer has spread to other areas. Patients with kidney disease, blood coagulation problems, or known allergies to contrast agents are not good candidates for this procedure. • The chemoembolization procedure takes place in a hospital setting. The actual procedure depends on the embolizing agent being used. Such issues as drug administration, anesthetic requirements, length of time of procedure, and potential side effects differ with each agent. • Chemoembolization is considered to be a relatively safe and effective method of treating unresectable liver tumors. The overall risk of the procedure is related to your general underlying health. People with Juandice , severe cirrhosis or kidney failure have an increased chance of complications. • Under x-ray guidance a small catheter is inserted into the femoral artery (located in the groin) and advanced into the liver artery. The embolic material and drugs are then injected through the catheter into the liver tumor. The procedure usually lasts 2 - 3 hours.
CURE WITH !
Science of Natural Medicines
Natural cure for HEPATITIS :
Principal Proposed Treatments = none • Other Proposed Natural Treatments Ayurvedic Medicines. TCM Traditional Chinese Medicines.
Ayurvedic medicine, the ancient medical system of India, has many traditional treatments for hepatitis. Some of these have undergone scientific evaluation. One such is a combination treatment called Kamalahar, which contains Tecoma undulata, phyllanthus urinaria, Embelia ribes, Taraxacum Officinale, Nyctanthes arbortristis, and Terminalia ariuna. In a double-blind, placebo-controlled study, 52 people with acute hepatitis were randomly assigned to receive placebo or this combination herbal therapy at a dose of 500 mg, 3 times daily for 15 days. The results indicate that the herbal combination improved liver function to a significantly greater extent than placebo
Traditional Chinese Medicine Licorice and Its Component Glycyrrhizin One of the substances frequently mentioned in the Chinese literature regarding hepatitis B is glycyrrhizin, a component of licorice root (Glycyrrhiza uralensis is the species used in China). Licorice was an ingredient in many of the prescriptions used in ancient times to treat hepatitis Hu-Chang and Its Anthraquinone ComponentsHu-chang (Polygonum cuspidatum) refers to one of the many species of Polygonum used by Chinese doctors. It contains anthraquinones as main active components, as well as resveratrol, a stilbene. The herb, used alone, or in combination with other herbs, has been reported to cure both acute and chronic hepatitis
Curcuma and Its Essential Oil Components Curcuma (yujin) refers to one of three major species of curcuma used in Chinese medicine, the other two are turmeric (huangjiang) and zedoaria (ezhu). It contains a complex essential oil that regulates blood lipids and treats infectious hepatitis Ligustrum and Its Component Oleanolic AcidLigustrum refers to the seed of Ligustrum lucidum. It is rich in oleanolic acid, a compound that appears to be effective in treatment of liver diseases, acting mainly as a liver-protective agent. It is reported to be efficacious in treating both acute and chronic hepatitis, with a cure rate of 70% for acute hepatitis and it was markedly effective in treating 44% of cases of chronic hepatitis. Silybum and Its Component Silymarin Silymarin is a complex flavonoid from Silybum marianum, an herb that was initially introduced as a therapeutic agent by European researchers, but soon taken up by their counterparts in China as a treatment for liver diseases
HERBAL REMEDIES FOR HEPATITIS
• Silybum marianum, milk thistle Also
known as variegated thistle regarded as the standard amongst hepatoprotective herbs and remains the most well studied (up to 50 studies and clinical trials). Constituents: Flavonolignans. These are unusual polyphenolic compounds referred to collectively as silymarin. Thistle seed preparations are ideal for chronic and post-acute stages of hepatitis, rapidly bringing an improvement in appetite and well-being. It is also used in fatty degeneration and even cirrhosis of the liver. The seeds can be gathered (use gloves!) and made into decoctions, or ground up and used quite safely as foods.
Dandelion. (Taraxacum officinalis).
• This is one of the most well known herbs and universal weed. Dandelion has a long history of use for liver ailments, and its nutrient content is outstanding. While the leaves tend to act as potent diuretics it is the roots that are used specifically to promote bile and restore liver function. • Constituents: Vitamins- esp. beta carotine (vit.A) and ascorbic acid.; minerals including potassium and calcium; inulin and pectin; sterols. • Actions and use: Dandelion is classes as a choleretic, cholagogue, diuretic and mild laxative. It increases appetite and improves digestion. Its alkalising effect is beneficial in all detoxification treatments. The dried roots can be roasted and taken instead of coffee. However unroasted roots are more therapeutic. They can be taken in decoction form. Fresh juice of leaves and roots can be taken in 5 ml doses. This is the most bitter preparation.
Artichoke. (Cynara scolymus).
• Globe artichoke is a popular food originating in Europe which can be easily cultivated in Australia. It has a long history of use as a bitter digestive herb and is a major remedy for liver and gall bladder disorders. It is the leaf that contains these properties. • Constituents: Cynarin and other phenolic acids; sesquiterpene lactones; flavonoids; inulin. Minerals, vitamins and enzymes. • Actions and use: Choleretic; digestive tonic; diuretic; hypocholesterolemic; hepatoprotective. • A safe and reliable herb for all liver disturbances including hepatitis. Helps lower cholesterol (made in the liver) and assists weight reduction. It can be made into a leaf decoction and take alone or in combination with the above two remedies. Artichoke, St.Mary's thistle and dandelion all belong to the Asteraceae family and work well in combination.
Schizandra. (Schizandra sinensis).
• The dried fruits are derived from an aromatic, woody vine that grows in China and north-east Asia. It is a member of the Magnolia family. The fruits are sour tasting, subsequently stimulating bile production. Constituents: Lignans known as schizandrins. Also contains essential oil, fatty oil and mucilage. Actions and use: Tonic; astringent; sedative; hepatoprotective. Studies show it decreases liver enzymes rapidly in various forms of hepatitis. In mice it protects liver cells from toxins and viruses, and promotes liver protein synthesis. Schizandra is beneficial for insomnia, memory loss and vision impairment. Chinese herbalists make a decoction of the dried berries, though they are sometimes eaten. The herb is generally taken as part of a specific formula.
• • •
Reishi Mushroom. (Ganoderma lucidum).
This is a polyphore mushroom known in China as Ling-Zhi. It is rated as one of the greatest of all medicines, even rivalling the legendary ginseng. The wild fungus is now hard to find, but extensive cultivation occurs in many Asian countries so it is readily available though quite expensive. • Constituents: Triterpenes including ganoderic acid; polysaccharides; organic germanium; adenosine. • Actions and use: Antiviral; antioxidant; antitumor; immuno-stimulant; hypoglycaemic; cardiotonic; anti-inflammatory. Hepatoprotective action in mice. Hepatitis patients show improved symptoms and less tiredness in clinical trials. In China it is frequently used for chronic hepatitis. It can be obtained in the dried form or in tablets. Daily doses range between 2 and 10g. This herb should to be taken under the supervision of a suitably qualified practitioner. •
Phyllanthus. (Phyllanthus amarus, P.gasstroemii).
• Phyllanthus are low shrubs common across southern Asia and Australia. In parts of India the herb is renowned for its success in treating hepatitis and jaundice. It has acheived international status since the publication of a clinical trial with hepatitis B(HVB) patients. • Constituents: Ellagitannins including geraniin; lignans- phyllanthin; flavanoids; alkaloids. • Actions and use: Astringent; diuretic; cholagogue; antiviral; hepatoprotective. • Direct antiviral effects have been demonstrated in human and animal HVB studies, which could be measured by a reduction in the virus surface antigen. Several Australian species have also shown antiviral properties in animal studies on HVB but no clinical data is available. In India fresh roots are considered the most effective for jaundice. Australian use is restricted to prescription by medical herbalists.
Liquorice. (Glycyrrhiza glabra).
• One of the most widely used herbs throughout the world, liquorice is regarded by herbalists as a harmoniser or balancing agent. It certainly improves the flavour of herbal compounds but its properties extend much further than flavouring. • Constituents: Glycyrrhizin, a triterpenoid saponin; isoflavones • Actions and use: Demulcent; expectorant; antiulcer; tonic; antiviral; antiinflammatory; hepatoprotective. Chinese teaching hospitals found its effective rate in treatments of chronic HVB over 70%. The herb has a mineralcorticoid effect and can cause oedema and hypertension in some people. The popular liquorice stick candies are of little use therapeutically, since the percentage of liquorice is small while the sugar content is high. Pure liquorice root can be obtained in bulk , it has a distinct yellow colour due to its flavonoid content. Manufacturers use thick liquorice concentrates which are included into a wide range of products. Liquorice should not be used over long times unless under supervision of a practitioner.
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.اپ کا شکری ہ پیش کیا
سید اصف رضا زیدی
© 2009 Department of Pharmacognosy, Uok, Pakistan.
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