Management of Hepatitis C with Natural and Synthetic Medicine

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  • Management of Hepatitis C with Natural and Synthetic Medicine

    1. 1. Management of Hepatitis C with Natural and Synthetic Medicine Khan Usmanghani, Asif Iqbal Department of Basic Clinical Sciences, Faculty of Eastern Medicine HAMDARD UNIVERSITY, Karachi, Pakistan 6 th International Conference of Infection Control December 19, 2006 Liaquat National Hospital, Karachi
    2. 2. COMPARATIVE RESEARCH STUDY ON HEPATITIS C A     Picrorhiza kurroa W   Tamarix galica Glycyrrhiza glabra Phylanthus emblica A Rosae damascena 2.6.2 Ribavirin (Rebazole) A 2.6.1 Interferon alfa 2b (Uniferon)
    3. 3. Introduction Viral hepatitis is defined as viral infection of hepatocytes that produces necrosis and inflammation of the liver. Viral Hepatitis is a parenchymal disease of liver. This disease is caused by (a) Hepatotropic viruses A, B, C (Non-A-Non B), D,E,F,G,H (b) Other viruses like Epstein-Barr, Cytomegalovirus, and Coxsackie virus etc. Hepatitis C virus (HCV), the major causative agent of non-A and non-B hepatitis, poses a serious worldwide health problem. about 170 million people, 3% of the world's population, are infected with HCV High prevalence rates Southeast Asian countries WHO
    4. 4. Hepatitis C Prevalence and number infected by WHO Region In Pakistan: anti HCV prevalence 13.5% in chronic liver disease. Karachi: 43.06% shows seropositivity in chronic liver diseases and cirrhosis combined, with 45.7% cases of chronic liver disease and 37.7% cases in cirrhosis. 169.7 18.68 5811 Total 62.2 3.9 1600 Western Pacific 32.3 2.15 1500 South-East Asia 8.9 1.03 858 Europe 21.3 4.6 466 Eastern Mediterranean 13.1 1.7 785 America 31.9 5.3 602 Africa Rate % Millions Infected Population Hepatitis C prevalence Total Population Region of WHO
    5. 5. Hepatitis C Flaviviridae Single strand of RNA 3000 amino acids 10 encoded genes 6 genotypes (74% gt1 in USA) Many quasispecies Receptors? LDL, CD81
    6. 6. TESTS TO MAKE A DIAGNOSIS OF HEPATITIS C <ul><li>STANDARD TESTS FOR HCV </li></ul><ul><li>ELISA (ENZYME IMMUNOASSAY) </li></ul><ul><li>PCR (POLYMERASE CHAIN REACTION) </li></ul><ul><li>Other tests are used to monitor </li></ul><ul><li>liver function and damage </li></ul>Looks for virus RNA Liver cancer screen Liver Ultrasound Microscopic look at how badly the liver is scarred Liver Biopsy Checks to see if liver is clearing toxins and producing proteins Liver Function (Bilirubin, Albumin, INR) Checks for amount of liver cell inflammation Liver Enzymes (ALT, AST, GGT, LDH)
    7. 7. TEST AND CONTROLLED DRUG QUANTITATIVE AND COMPARATIVE STUDY:HEPATITIS C Ribavirin (Rebazole) For patients of Hepatitis C according to patient body weight: • Less than 55kg (Patient body weight) Ribavirin 400mg bid • Between 55 and 75kg Ribavirin 500mg bid • Greater than 75kg Ribavirin 600mg bid R Rosae damascena, 250 mg Glycyrrhiza glabra, 250mg Phylanthus emblica 250mg Sugar10 Water distilled 10 litre Composition of Vironil syrup Interferon alfa 2b (Uniferon) Chronic Hepatitis C: Interferon alfa 2b 3MIU injections three times a week for 6-12 months. Tamarix galica, 500mg Picrorhiza kurroa, 500mg Composition of HepotinTab Hepatitis C Control Drugs Test Drugs Formulation Test Drugs Diseases
    8. 8. PROJECT DETAILS <ul><li>Objective: </li></ul><ul><li>To identify the effectiveness of Herbal drug coded as Hepotin Tablets, Vironil syrup and Allopathic drug Interferon alpha-2b , Ribavirin. </li></ul><ul><li>The basic theme to compare the variable efficacy between two frequent groups, and evaluate the Reverse effect of both drugs . </li></ul><ul><li>To determine the side effects. </li></ul><ul><li>Work Plan : </li></ul><ul><li>ACTIVITY OUT LINE DESCRIPTION </li></ul><ul><li>1) No. of drug for compared 2Testdrug(Hepotintab,Vironilsyrup.) Interferonalpha-2band Ribavirin </li></ul><ul><li>2) No. of patients 60 Both sex </li></ul><ul><li>3) No. of test BloodUrea,Creatinine,CBC,ESR, ALT,Anti HCV,HCV(RNA)By PCR </li></ul><ul><li>4) Time period 6-month </li></ul><ul><li>5) Total duration 4years June 2001-June 2005 </li></ul><ul><li>6)Present action of report After every 6 month </li></ul>Design: Experimental, randomized, clinical trial
    9. 9. INCLUSION CRITERIA Chronic Hepatitis B and C Hyper Pyrexia EXCLUSION CRITERIA All socio- economical classes No other Disease Karachi, Pakistan AGE: 20-55 Hepatic or Cardiac Impairment Liver Abcess
    10. 10. Description Characteristic of Study Sample 3MIU injections three times a week for 6-12 months Control Drug 2 tablet twice a day, 15 ml twice a day ( for 6 months) Test Drug Dosage 8 > 40 11 26 – 43 1 < 25 Age Control Drug 14 > 40 24 26 – 43 2 < 25 Age Test Drug 27 Female 33 Male Gender 20 Control Drug 40 Test Drug Total 60 Total Hepatitis C Variables
    11. 11. Sign and Symptoms of Overall Patients (Interferon alpha-2b and Ribavirin ) <ul><li>Non-specific, mild, intermittent (<25% of patients) </li></ul><ul><li>Most common symptom is fatigue </li></ul><ul><li>Nausea, poor appetite, muscle aches, fever, weight loss </li></ul><ul><li>You may not feel ill or have any symptoms until so much damage has taken place that the liver can no longer function properly </li></ul><ul><li>Advanced symptoms </li></ul><ul><li>Jaundice </li></ul><ul><li>Dark urine </li></ul><ul><li>Abdominal pain </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Nausea and vomiting </li></ul>Symptoms of HCV 33 10 14 27 39 28 31 5 31 Test Drug 14 Burning Palm and Sole 3 Fever 10 Burning Micturation 16 Indigestion 4 Body-AcheIn 9 Constipation 14 Epi Gestric Pain 14 Heart Burn 16 Anorexia Control Drug Sign and Symptoms
    12. 12. CLINICAL CPMPARATIVE STUDY Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Anorexia) 4% 50% 50% Interferon alpha-2b and Ribavirin 0.01 0% 19% 81% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement
    13. 13. Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Heart Burn) 30% 64% 36% Interferon alpha-2b and Ribavirin 0.00 0% 0% 100% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement
    14. 14. Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Epigastric pain ) 30% 71% 29% Interferon alpha-2b and Ribavirin 0.00 0% 16% 84% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement
    15. 15. Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Body-ache ) 75% 75% 25% Interferon alpha-2b and Ribavirin 0.00 0% 11% 89% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement
    16. 16. Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Burning Micturation ) 50% 70% 30% Interferon alpha-2b and Ribavirin 0.00 0% 21% 79% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement
    17. 17. Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Fever ) 85% 67% 33% Interferon alpha-2b and Ribavirin 0.00 0% 10% 90% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement
    18. 18. Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Burning Palm and Sole ) 15% 33% 57% Interferon alpha-2b and Ribavirin 0.01 0% 12% 88% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement
    19. 19. BIOCHEMISTRY COMPARATIVE STUDY Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (ALT ) 45% 55% Interferon alpha-2b and Ribavirin 0.02 10% 90% Hepotin tablet and Vironil syrup p value No Improved Complete Improved Level of Improvement
    20. 20. SEROLOGICAL COMPARATIVE STUDY Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (RNA ) Frequent Adverse Reactions Peginterferon alfa-2b (12KD) 1.5  g/kg sc qw plus ribavirin 800 mg po qd 45% 55% Interferon alpha-2b and Ribavirin 0.4 35% 65% Hepotin tablet and Vironil syrup p value No Improved Complete Improved Level of Improvement
    21. 21. CONCLUSION <ul><li>A randomozted clinical trial has been carried out to comparatively examine the efficacy of coded Unani formulation Hepotin tablet and Vironil syrup with allopathic medicines Interferon alpha-2b and Ribavirin. </li></ul><ul><li>Statistical results demonstrate univariate association of the positive efficacy of all the test drugs. The findings are important for ensuring Unani medicine efficacy in primary care practices to treat hepatitis C.. </li></ul>
    22. 22. The Unresolved Hepatitis C <ul><li>RNA virus isolated in 1988 but still not cultured in the laboratory </li></ul><ul><li>There are still many questions about: </li></ul><ul><ul><li>Transmission </li></ul></ul><ul><ul><li>Who will progress to severe liver disease </li></ul></ul><ul><ul><li>Who to treat </li></ul></ul><ul><ul><li>And we need better treatment options and Herbal Medicine could be one of the option- </li></ul></ul>
    23. 31. Thank You For Participating

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