Hepatitis C virus (HCV) was identified in the 1970s and can lead to chronic liver disease. Globally, an estimated 71 million people have chronic HCV infection. In India, the prevalence is estimated between 0.5-1.5% with genotype 3 being most common. HCV is transmitted through blood and blood products, unsafe medical injections, and from mother to child. Most infections become chronic, potentially leading to cirrhosis or liver cancer over time. Screening and treatment have advanced significantly in recent decades to help eliminate HCV transmission through blood and cure chronic infections.
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.
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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
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)
This lecture is about Virology of HCV presented by Dr. Mahmoud Elzalabany, Internal Medicine Resident, 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.
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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
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)
This lecture is about Virology of HCV presented by Dr. Mahmoud Elzalabany, Internal Medicine Resident, 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
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
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/
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
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3. HISTORY OF HCV
• 1975 Researchers identified a type of hepatitis didn’t test positive for HAV & HBV
• 1989 HCV isolated from the serum by Choo et al
• 1991 (FDA) approves interferon alfa-2B (Intron A), the first interferon drug for the
treatment of HCV
• 1992 Testing of the Blood for HCV begins
• 1998 FDA Approves combination of Interferon and Ribavirin
4. HISTORY OF HCV
• 2001 Pegylated Interferon boosts effectiveness of Interferon therapy
• 2002 Mandatory screening for HCV was introduced in India
• 2010 Rapid Antibody Test improves HCV detection
• 2013 New Direct-Acting Anti-Virals are approved
6. EPIDEMIOLOGY
• Globally estimated 71 million people living with chronic hepatitis C
• 399,000 were estimated to have died from HCV-related liver
disease in 2017.
• Most affected regions are Eastern Mediterranean and European
Regions, with prevalence of 2.3% and 1.5% respectively.
• Prevalence of HCV infection in other regions varies from 0.5% to
1.0%.
Source:(WHO), 2018
7.
8. GLOBAL DISTRIBUTION - HCV GENOTYPES
• HCV virus classified into 6 recognized genotypes
• On the basis of the sequence of amino acids in the HCV
• HCV genotype 1 is the most prevalent worldwide (46.2%)
• Genotype 3 is the next most prevalent globally (30.1%)
• Genotyping is used for assessment course of infection , treatment duration
and response.
9. PREVALENCE OF HCV GENOTYPE
Hepatology. 2014 Jul 28. doi: 10.1002/hep.27259.
India, majority HCV genotype 3 ( green)
10. INDIAN SCENARIO
HCV prevalence estimated between 0.5% and 1.5% (15-18 million)
Higher in the north-eastern part, tribal populations and Punjab.
Lower in the western and eastern parts of the country
Genotype 3 is the most common HCV genotype in India ( 54–80% of cases),
followed by genotype 1
Genotype 1 has been reported more commonly from southern India
11. BURDEN OF DISEASE
• Hepatitis C is the most common cause of chronic liver disease and cirrhosis
• Worldwide 27% of cirrhosis and 25% of liver cancer is due to hepatitis C
• Leading cause of liver transplantation
• HCV prevalence exceeds 5 times HIV prevalence
• No prophylactic vaccine or Specific immunoglobulin
• Effective antiviral treatment exist, which is disease prophylaxis as well
13. STRUCTURE OF THE HEPATITIS C VIRUS
• HCV virus is enveloped , spherical, 55-65 nm in diameter
• Family-Flaviviridae , Genus - Hepacivirus
• Single-stranded RNA as genetic material
• A lipid envelope (E) containing glycoproteins (E1 and E2) , core of capsid proteins
14. GENOME
• 9600 nucleotides , composed of a long open reading frame (ORF) flanked by
untranslated regions (UTR's) at both the ends
• Viral RNA forms 3 structural and 7 non-structural proteins
• Structural proteins (core, E1, E2) help in forming structure of the virus
• non-structural proteins (NS1,NS2, NS3, NS4A, NS4B, NS5A, NS5B)
• The non structural proteins are important for performing viral functions
16. PATHOGENESIS
• HCV has high propensity for establishing chronic infection.
• Chronically infected people generated approximately 1012 viral particles every day.
• Remarkable replicative rate with highly error prone polymerase activity results in
genetic diversity
• Existence of various quasispecies within infected individual.
• CD8+ and CD4+ T cell responses are higher in individuals who control the infection.
• Chronic infections occur when unable to mount HCV-specific T cell responses
• Impairment of Natural Killer (NK) in chronic infections
17. TRANSMISSION OF HCV
• Injection/I.V drug abuse (60%)
• Sexual transmission(15%)
• Transfusion of blood and blood products (1-10%)
• Occupational exposure to blood (2-4%)
• Mother to baby (1%)
• Unknown (10%)
HCV spread in India mainly through unsafe blood transfusion and injection
reuse
18. TRANSMISSION BY TRANSFUSION
• 1988, 90% of posttransfusion hepatitis were due to HCV
• Volunteer blood donors significantly reduced the risk of posttransfusion hepatitis to 10%.
• Screening reduced transmission to a rate of 1 per million transfusions.
• New cases due to infected people donating blood in the window period
• Recent studies report prevalence of <1.0% by blood transfusion.
20. SIGNS AND SYMPTOMS OF HCV
• Most patients are asymptomatic or very mild non-specific symptoms
• Fatigue or tiredness may be prominent
• symptoms appear 6 to 7 weeks after infection
• Other symptoms include:
mild fever
muscle and joint pain
nausea & vomiting
loss of appetite
abdominal pain
diarrhea
23. CHRONIC HEPATITIS C
• Persistence of HCV RNA at least 6 months after the onset of acute infection.
• The risk of progression to chronic infection is influenced by various factors including:
1. Age (more if infection occurs at age >25 years)
2. Gender (males > females)
3. Ethnicity ( Africans > Caucasians and Hispanic whites)
4. Coinfection with HIV, HBV
5. Concomitant alcohol consumption
6. Comorbid conditions like cancer, immunosuppression, insulin resistance,
nonalcoholic steatohepatitis, obesity, etc.
24. SCREENING FOR HEPATITIS C
IV drug users
Recipients of blood & blood products
Invasive procedures
Children born to mothers infected with HCV
People with sexual partners ( HCV-infected)
People with HIV infection
Prisoners
People with tattoos or piercings
Healthcare workers after needle sticks, sharps, or mucosal exposures
Patients of Thalassemia
Patients receiving long-term hemodialysis
Unexplained long term liver disease and hepatitis including high liver enzymes
25. DIAGNOSIS OF HCV
• Virological diagnosis of HCV infection is based on two categories of tests :
1. Indirect tests : serologic assays detecting specific antibody to HCV (anti-HCV)
2. Direct tests : assays that detect, quantify or characterize components of HCV viral
particles( HCV RNA and core antigen)
• Tests play a key role in the diagnosis , therapeutic decision-making, and assessment
of response to therapy
26. WHO RECOMMENDATIONS
To minimize the risk of HCV through transfusion:
1. Screening should be performed using a highly sensitive and specific HCV
antibody immunoassay or a combination HCV antigen-antibody immunoassay
(EIA/CLIA).
2. The assay should be capable of detecting genotypes specific to the country or
region.
3. Screening using a highly sensitive and specific HCV antibody rapid assay may
be performed in laboratories with small throughput, in remote areas or
emergency situations
27. INDIRECT TESTS
• Seroconversion occurs on an average at 6-8 weeks after the onset of infection.
• In patients with spontaneously resolving infection, antibodies may persist throughout
life, decrease slightly , gradually disappear after several years.
• Antibodies persists indefinitely in patients who develop chronic infection
• Antibodies may become undetectable in hemodialysis patients or in cases of profound
immunosuppression.
29. ANTI HCV ELISA
• Four generations of ELISAs have been developed :
• 1989, First generation assays, which incorporated the recombinant c100-3 epitope
from the NS4 region
• 1992, Second generation assays, which additionally incorporated epitopes c22-3 and
c33c from the HCV core and NS3 regions.
• 1995,Third generation assays contain reconfigured core and NS3 antigens and in
addition a newly incorporated antigen from the NS5 region.
• 2012,Fourth generation of tests is simultaneously detect HCV capsid antigen as well
as antibodies to the core, NS3, NS4, and NS5 regions of the virus
31. REDUCTION IN
WINDOW PERIOD
Reduction in window period :
1ST GEN : 16 weeks
2ND GEN : 10 weeks
3RD GEN : 8 weeks
4TH GEN : 17 days less than 3rd
NAT : 7 days
32. NAT: DETECTION OF HCV RNA
NAT is considered the ‘gold standard’ for detecting active HCV replication.
HCV NAT useful :
1. Establishing diagnosis of acute HCV infection (RNA detectable as early as 1
week after exposure )
2. Confirmation as well as for follow-up of patients
3. Viral load assessment for determining response during therapy.
33. NAT
• Qualitative NAT traditionally used as confirmatory tools for HCV diagnosis.
• These assays commonly utilize conventional RT-PCR or transcription-
mediated amplification (TMA).
• Quantitative NAT include quantitative RT-PCR (qRT-PCR) and branched
deoxyribonucleic acid (bDNA) technology
• Due to greater sensitivity (99%) and specificity (98-99%) quantitative PCR
has replaced qualitative PCR.
34.
35. TREATMENT
Goal of treatment :
1.No HCV detected at least 12 weeks after complete treatment:
sustained virologic response (SVR)
2.Prevent progression to cirrhosis, HCC, and decompensated liver disease
Earlier weekly injections of Interferons were administered with daily oral
Ribavirin (antiviral drug) for as long as 6-12 months (40-70% cure rates)
36. DIRECTLY ACTING ANTIVIRALS
Directly acting antivirals or DAAs :
1. Sofosbuvir
2. Daclatasvir
3. Sofosbuvir-Ledipasvir
4. Sofosbuvir-Velpatasvir (fixed dose combination)
Achieve cure rates above 95%
Effective, safer and better-tolerated than the older therapies
Treatment is shorter (usually 12 weeks)
37. IATROGENIC EXPOSURE AND POSTEXPOSURE
PROPHYLAXIS
Transmission HCV to healthcare worker (HCW) due to :
(estimated incidence of 1.9%)
• Poor disinfection practices
• Contaminated equipment ,improper cleaning , unsterilized equipment
• Medication administration ( through syringe reuse, etc.)
• Unsafe Blood sampling/ handling procedures
38. POST EXPOSURE PROPHYLAXIS
Follow-up of personnel who sustain percutaneous or per mucosal exposure :
Baseline testing for anti-HCV at source.
Follow-up testing for anti-HCV and alanine aminotransferase (ALT) levels at 6
months and 1 year postexposure.
Confirmation by NAT
Education of workers about the risk and prevention of spread
PEP is not recommended for HCV exposures
Egypt has a reported seroprevalence of about 22% and is the highest in the world.
(HCV) is a hepatotropic virus which is one of the major cause of chronic liver disease and a potential cause of substantial morbidity and mortality worldwide.
family Flaviviridae (also containing yellow fever, dengue , and West Nile virus)
An important feature of the HCV genome is its high degree of genetic variability. The E1 and E2 regions are the most variable, while the untranslated regions are highly conserved
The key to developing chronic infections is to ecsape the immune system.
Very few may progress to acute hepatitis with sign and symptoms of jaundice
HCV infects only 1-10% of hepatocytes . IFN-γ and TNF-α from CD8+ destroy both infected and nearby non-infected hepatocytes (“bystander killing”)
HCC occurs mainly due to high turnover rate in hepatocytes high death and regeneration rates
Basis of indirect tests is to detect anti hcv antibodies
Recent study conducted in the duke clinical research institute and school of medicine in north Carolina suggested that pep is not recommended in hcv and there is a very limited role of prescribing directly acting antivirals in pep cases , instead appropriate follow up , testing and early treatment if positive is more effecient