Hepatitis C is a global health problem that causes 700,000 deaths per year. In Bangladesh, 1% of the population has HCV. New guidelines recommend screening high-risk groups and treating with direct-acting antiviral drugs, which have cure rates over 90% and shorter treatment durations compared to previous interferon-based regimens. Proper treatment can prevent cirrhosis, liver cancer and death from HCV. While challenges remain, scientists hope to eliminate HCV globally by 2030 with new pan-genotypic drugs. Prevention through injection safety, screening blood products, and educating healthcare workers is also important to control the disease.
BCC4: Pierre Janin on 4 Newer Agents for Hepatitis CSMACC Conference
Janin speaks on the dawn of a revolution for treating Hepatitis C. This was recorded at Bedside Critical Care Conference 4. Full postings can be found at www.intensivecarenetwork.com
Christian B. Ramers, M.D., M.P.H., of Family Health Centers of San Diego, presents "The HCV Treatment Revolution: A View from the Community Health Center" for AIDS Clinical Rounds at UC San Diego
BCC4: Pierre Janin on 4 Newer Agents for Hepatitis CSMACC Conference
Janin speaks on the dawn of a revolution for treating Hepatitis C. This was recorded at Bedside Critical Care Conference 4. Full postings can be found at www.intensivecarenetwork.com
Christian B. Ramers, M.D., M.P.H., of Family Health Centers of San Diego, presents "The HCV Treatment Revolution: A View from the Community Health Center" for AIDS Clinical Rounds at UC San Diego
A power point presentation on Hepatitis C virus on epidemiology, presentation, diagnosis and current treatment strategies we are practicing in BSMMU at a international standerd.
This lecture is about Spectrum of HCV infection presented by Dr. Muhammad Mostafa Abdel Ghaffar, Head of Tropical Medicine Department, Ahmed Maher Teaching Hospital.
The lecture was presented in the scientific meeting of Internal and Tropical Medicine departments, Ahmed Maher Teaching Hospital titled (Towards Eradication of HCV in Egypt) in celebration of World Hepatitis Day on July 28, 2016.
https://www.facebook.com/AMTH.IM
https://www.facebook.com/events/1072758396145209/
http://www.no4c.com
Evolution and Revolution: Current Issues in HIV and HCV Co-infection
Chapter 1 – HIV-Hepatitis C Virus Co-infection: An evolving epidemic
Chapter 2 - Management of HIV infection in HIV/HCV co-infected patients
Chapter 3 - Management of HCV in co-infected patients
Chapter 4 - HCV Therapy: Direct acting antiviral agents in co-infected individuals
Chapter 5 - Drug interactions with directly acting antivirals for HCV: Overview & challenges in HIV/HCV Co-infection
Chapter 6 - Complicated cases
Chapter 7 - Future trials of Hepatitis C therapy in the HIV co-infected
Chapter 8 - HCV infection in marginalized populations
Chapter 9 - HIV/HCV Co-infection: Through the eyes of a co-infected hemophiliac
To create awareness about Generics treatment and make it available worldwide. My Aim is to raise awareness about hepatitis c treatment and generic. Visit here: http://anandmedicos.com/
Patients with acute hepatitis C virus (HCV) infection appear to have an excellent chance of responding to 6 months of standard therapy with interferon (IFN). Because spontaneous resolution is common, no definitive timing of therapy initiation can be recommended; however, waiting 2-4 months after the onset of illness seems reasonable.
Treatment for chronic HCV is based on guidelines from the Infectious Diseases Society of America (IDSA) and the American Associations for the Study of Liver Diseases (AASLD), in collaboration with the International Antiviral Society-USA (IAS-USA). These guidelines are constantly being updated. For more information, see HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C.
The guidelines propose that because all patients cannot receive treatment immediately upon the approval of new agents, priority should be given to those with the most urgent need.
The recommendations include the following :
Patients with advanced fibrosis, those with compensated cirrhosis, liver transplant recipients, and those with severe extraheptic hepatitis are to be given the highest priority for treatment
Based on available resources, patients at high risk for liver-related complications and severe extrahepatic hepatitis C complications should be given high priority for treatment
Treatment decisions should balance the anticipated reduction in transmission versus the likelihood of reinfection in patients whose risk of HCV transmission is high and in whom HCV treatment may result in a reduction in transmission (eg, men who have high-risk sex with men, active injection drug users, incarcerated persons, and those on hemodialysis)
A power point presentation on Hepatitis C virus on epidemiology, presentation, diagnosis and current treatment strategies we are practicing in BSMMU at a international standerd.
This lecture is about Spectrum of HCV infection presented by Dr. Muhammad Mostafa Abdel Ghaffar, Head of Tropical Medicine Department, Ahmed Maher Teaching Hospital.
The lecture was presented in the scientific meeting of Internal and Tropical Medicine departments, Ahmed Maher Teaching Hospital titled (Towards Eradication of HCV in Egypt) in celebration of World Hepatitis Day on July 28, 2016.
https://www.facebook.com/AMTH.IM
https://www.facebook.com/events/1072758396145209/
http://www.no4c.com
Evolution and Revolution: Current Issues in HIV and HCV Co-infection
Chapter 1 – HIV-Hepatitis C Virus Co-infection: An evolving epidemic
Chapter 2 - Management of HIV infection in HIV/HCV co-infected patients
Chapter 3 - Management of HCV in co-infected patients
Chapter 4 - HCV Therapy: Direct acting antiviral agents in co-infected individuals
Chapter 5 - Drug interactions with directly acting antivirals for HCV: Overview & challenges in HIV/HCV Co-infection
Chapter 6 - Complicated cases
Chapter 7 - Future trials of Hepatitis C therapy in the HIV co-infected
Chapter 8 - HCV infection in marginalized populations
Chapter 9 - HIV/HCV Co-infection: Through the eyes of a co-infected hemophiliac
To create awareness about Generics treatment and make it available worldwide. My Aim is to raise awareness about hepatitis c treatment and generic. Visit here: http://anandmedicos.com/
Patients with acute hepatitis C virus (HCV) infection appear to have an excellent chance of responding to 6 months of standard therapy with interferon (IFN). Because spontaneous resolution is common, no definitive timing of therapy initiation can be recommended; however, waiting 2-4 months after the onset of illness seems reasonable.
Treatment for chronic HCV is based on guidelines from the Infectious Diseases Society of America (IDSA) and the American Associations for the Study of Liver Diseases (AASLD), in collaboration with the International Antiviral Society-USA (IAS-USA). These guidelines are constantly being updated. For more information, see HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C.
The guidelines propose that because all patients cannot receive treatment immediately upon the approval of new agents, priority should be given to those with the most urgent need.
The recommendations include the following :
Patients with advanced fibrosis, those with compensated cirrhosis, liver transplant recipients, and those with severe extraheptic hepatitis are to be given the highest priority for treatment
Based on available resources, patients at high risk for liver-related complications and severe extrahepatic hepatitis C complications should be given high priority for treatment
Treatment decisions should balance the anticipated reduction in transmission versus the likelihood of reinfection in patients whose risk of HCV transmission is high and in whom HCV treatment may result in a reduction in transmission (eg, men who have high-risk sex with men, active injection drug users, incarcerated persons, and those on hemodialysis)
Common causes and approach to new fever in ICU, both infectious and non-infectious, including VAP (ventilator associated pneumonia), CLABSI (central line associated blood stream infections), CAUTI (catheter associated UTI), drug fever, fungal infections, postoperative fever.
Brief mention of SOFA scores, new Sepsis definitions (2016), Sepsis biomarkers (ex procalcitonin).
CASE PRESENTATION ONCIRRHOSIS OF LIVER WITH PORTAL HYPERTENSION, HEPATIC EN...Akhil Joseph
A DETAIL CASE PRESENTATION ON CIRRHOSIS OF LIVER WITH PORTAL HYPERTENSION, HEPATIC ENCEPHALOPATHY AND GRADE II OESOPHAGEAL VARICES WITH CONGESTIVE GASTROPATHY. LIVER CIRRHOSIS AND ALL ITS COMPLICATION IN A PATIENT.
Every year universal expiries after viral hepatitis are 1.4 million. The organization has known a method to treat 80% of HCV patients by 2030. In Pakistan, HCV occurrence is 1%. There is no correct indication about the real occurrence of HCV chronic infection, though current meta-analyses approximation that currently, about 130-150 million people live with chronic hepatitis C and that HCV reasons about 500,000 deaths each year The purpose of this review article to describes the introduction of HCV, risk factors of HCV, Early treatment option sand result of sofosbuvir plus Ribavirin on the treatment of HCV.
High SVR rates in HCV/HIV-1 co-infected patients regardless of baseline chara...Илья Антипин
Wyles D и др. «High SVR rates in HCV/HIV-1 co-infected patients regardless of baseline characteristics» 8th IAS Conference on HIV Pathogenesis, Treatment, and Prevention, Vancouver, 2015. TUAB0203.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Surgical Site Infections, pathophysiology, and prevention.pptx
Hepatitis c
1. Hepatitis C
A NEW FUTURE EVERYDAY
Dr.S.M.Nazmul Alam
Medicine,Orange Unit
Resident,Oncology
BSMMU.
2. Source
AASLD(American Association for the Study of
Liver Disease) Guidelines updated on
February,2016
WHO Guidelines updated on April,2016
EASL(European Association for the Study of
Liver Disease) Guidelines updated on
September,2016
3. Introduction
Globally,the morbidity and mortality
attributable to hepatitis C virus(HCV) infection
continues to increase.About 700000 persons
die in each year.
In Bangladesh 1 percentage of total
population are suffering from HCV.
Consequently,the field of HCV therapeutics
continues to evolve rapidly as well Since 1989
to 2016.
4. The virus and distribution of
genotypes
The HCV is a spherical,single
stranded RNA enveloped
Flavivirus.
It has a highly variable
genome,classified into six
genotypic group.
Genotype 1 is the most
common,accounting for
46.2% of all HCV
infections,followed by
genotype 3(30.1%)
7. Highlights of 2016 Recommendations
1. Screening
2. Assessment for HCV treatment
3. Clinical assessment or care of patients
4. Treatment of Chronic HCV infection
5. Treatment in special situations
6. Prevention
8. Recommendations on Screening
HCV serology testing be offered to individuals
who are part of a population with high HCV
seroprevalence or who have a history of HCV
risk exposure/behaviour(A1).
Such as
IV drug misuser.
Medical or Dental interventions.
Unscreened Blood Product.
Vertical transmission
Person with HIV infection
9. How to confirm?
Detection of anti-HCV antibodies(A1).
If anti-HCV antibodies are detected,HCV RNA or
alternatively core antigen should be determined
to identify patients with on-going infection(A1).
Anti-HCV positive,HCV RNA-negative individuals
should be informed that they do not have
evidence of current(active) infection,but should
retested 3 months later to confirm definitive
clearance(A1)
10. Goals and Endpoints of Treatment
The goal of therapy is to cure HCV infection to
prevent hepatic cirrhosis,decompensation of
cirrhosis,HCC,severe extra hepatic manifestation
and death(A1).
Success of treatment measured by Sustained
Virological Response(SVR) has steadily increased.
The endpoint of therapy is undetectable HCV
RNA in blood(<15IU/ml) by 12 weeks(SVR12) and
/or 24 weeks(SVR24) after the end of
treatment(A1).
11. The benefits of treatment clearly
outweighed the potential harms
Virological cure (SVR) offers:
-A decrease in liver inflammation.
-Regression fibrosis,resolution of cirrhosis.
-Portal hypertention,splenomegaly,and other
clinical manifestation also improve.
-More than 70% reduction in the risk of liver
cancer(HCC) & a 90% reduction in the risk of
liver related mortality and liver transplantaion.
14. Standard laboratory tests prior to
treatment initiation include
A full blood count(CBC),
International normalized ratio(INR),
Renal function,
Liver function tests:ALT,AST,bilirubin,albumin
& alkaline phosphatase,
Thyroid function test.
15. Staging:the degree of liver fibrosis
and cirrhosis
Liver biopsy is considered the gold standard
method for fibrosis assessment.
Several liver biopsy scoring system have been
developed of which the METAVIR system is
most widely used.
METAVIR
stage
F0 F1 F2 F3 F4
Defination No fibrosis Portal
fibrosis
without
septa
Portal
fibrosis
with septa
Numerous
septa
without
cirrhosis
Cirrhosis
16. Staging:the degree of liver fibrosis
and cirrhosis
But,liver biopsy is not widely used in low-
income countries for
-high cost,
-invasiveness,
-patient discomfort
-risk of complications.
-need for expert histological interpretion.
So,Non-invasive methods are recommended
for low income countries.
17. Components of Non Invasive Tests
Test Component
Fibroscan Transient elastography
APRI AST,Platelets
FIB-4 Age,AST,ALT,Platelets
18. Genotype Testing
The 2016 Guidelines provide
recommendations on the preferred &
alternative Direct Acting Antiviral(DAA)
regimens by HCV genotype.
Therefore knowing a patients genotype is still
important for determining the most
appropriate treatment regimen.
So genotype have no effect on progression of
disease but does effect response of treatment.
21. The Direct Acting Anti-Viral Agents…
Oral medicines that directly inhibited the
replication cycle of HCV.
These medicines
-have higher SVR than interferon-based
regimens,
-shorter in treatment duration(as short as 12
weeks),
-orally administered,
-have fewer side-effects.
22. Classes of DAAs licensed for the treatment
of HCV(as of october 2015)
Asunaprevir Paritaprevir Simeprevir
Daclatasvir Ledipasvir Ombitasvir
Sofosbuvir Dasabuvir Velpatasvir(2016)
23. Removal of recommendation for
treatment with teleprevir or
boceprevir
The use of this two 1st generation DAA is no
longer recommended for the treatment of
persons with hepatitis C infection(B1)
Because of
-Require co-adminstration of IFN(weekly inj.),
-Intensive laboratory monitoring,
-Longer duration of therapy with lots of side
effect.
31. Treatment Picture in Bangladesh &
South Asia
In Bangladesh,since February,2015 patients
received Sofosbuvir containg regimens along with
RBV &/or Peg-INF,have mostly clear HCV &achieved
SVR at 24 weeks.
Introduction of Daclatasvir since September,2015 &
Ledipasvir further improved the management,with
excellent initial results.
Managing Genotype 3,which is more prevalent in
this area & is difficult to treat,newer DAAs have
overcome this problem.
• Source-Bangladesh J Medicine 2016,27:74-77
33. Persons with HIV/HCV co infection:
• DAA therapy can be given,SVR>95%,but drug
drug interaction should be checked.
Children and Adolescents:
• None of the DAA have been approved,
• Only approved treatment peg-IFN/RBV older
than 2 years.
Persons with CKD(eGFR<30 ml/min/1.73m2):
• RBV and peg-IFN require dose adjustment.
Persons with TB/HCV co infection:
• Active TB should be treated first.
35. WHO guidance on prevention of HCV
infection
Hand hygiene:including surgical hand
preparation,use of gloves(for health care giver)
Use of sterile disposable syringes and needle.
Adequate sterilization,Safe handling & disposal
of sharps & waste.
Screening of donated blood and blood products.
Improve access to safe blood.
Identification & treatment of carriers.
Training of health personel
36. Conclusion
Due to availability of very effective oral
medications with a high sustained virological
response,scientists working in this field are
hopeful to eradicate HCV infection from the
planet in future.
DAAs which are pan-genotypic are great hope
to achieve “NOhep” within 2030.
Properly addressing the global burden with
appropriate management to combat HCV
infection surely mark great advancement
towards a newer and better future.