صفحه 1:
صفحه 2:
A Case, Study, Of
Chronic Hepatitis, B & ©
Presented by;
Hk.M:Ahmad Saleemi;
صفحه 3:
Hepatitis:
Hepatitis is an inflammation of the liver
characterized by the presence of inflammatory
cells in the tissue of the organ.
Viral Hepatitis:
Viral hepatitis is liver inflammation due to a viral
infection. It may present in acute (recent
infection, relatively rapid onset) or chronic
forms. The most common causes of viral
hepatitis are the five unrelated hepatotropic
viruses Hepatitis A, Hepatitis B, Hepatitis C,
Hepatitis D, and Hepatitis E. In addition to the
hepatitis viruses, other viruses that can also
cause hepatitis include Herpes simplex,
Cytomegalovirus Epstein-Barr virus, or
صفحه 4:
Hepatitis-B
Chronic hepatitis B is a major global healthcare
problem. Affecting an estimated 350 to 400
million people worldwide,
1,Chronic hepatitis B results in approximately
one million deaths each year,
2 Making it the world's tenth leading cause of
death.
In the US,1 to 1.25 million people have chronic
hepatitis B,and approximately 4000 to 5000 die
each year of its complications.
3 The progression of chronic hepatitis B is
variable, ranging from mild asymptomatic
infection to severe chronic liver disease. In
about 15% to 25% of patients, ongoing viral
replication leads to serious complications
including hepatic decomposition, cirrhosis, and
Hepatocellular carcinoma (HCC).
صفحه 5:
Hepatitis-C
- 170 million people are chronic carrier of
Hep-C i.e.3 % of world population.
- 2-4Million Persons in USA may be
Chronically affected.
- 5-10 Million in Europe.
- 12 Million in India
- 4-6 Million in Pakistan
* Source:
http://www.who.int/csr/disease/hepatitis/whocdsc
srlyo2003/en/index4.html
صفحه 6:
Modes Of Transmission
Hepatitis C affects up to 500,000
people in the UK, approximately
10 times more than HIV.
Mystery surrounds
this silent killer, with
90% of those infected
صفحه 7:
HEV
30
nm
RNA
Unkno
wn
Fecal
‘erence between Hepat
2-۳۹ سس
Size of Virus 40 42 30 40
nm nm nm nm
Nucleus |RNA |DNA |RNA ۸
Type of
Vaccine Available |Yes وهلا 0 No
Mean Incubation |25 75 50 35
Days |Days |Days | Days
Time
Chronic Infection |No ۲۶۶ ۲6۶ /No
Mode of Fecal |Sexua | Blood | Blood
Transmission or it Tras | Trans
oral |Trans
صفحه 8:
Signs & Symptoms
( ب جينى ب 4 Malaisels
(بهوککیک می) (61[16 ۵00 Anorexia (Poor
( متلی لبکائیار) 56لا ۱۱۵
( شکم درد)031 ۸۵۵00۳0۱۴۵۱
(نر می) 16006۲۳۳0655"
(پثهاوجوژ درد )۴۵10 01۳6[ 6 Muscle
صفحه 9:
۵0 26-۴
ety el Lethe بولک رو
4, Pepi
Grate Pe sorte tn sh Le BL Bee
re bigs
ویر مت تمرم ورمگ‌سورت بل او
tle lei سكاجا ثيل كسبل
ادویا تک Seber
صفحه 10:
el O0*¥
Been
B Sey tetdocte tn te ck Bem
wt
Siete
BASLE
لات :سح دسب حص ريل ود صورت بل شا بآ دراه بات اقلا ای لت مل دستآ ده
spice
HE?
Bee ۳0 3 ۳ سا as
espe Nei Rese Hrus حص لعو اوراد ست 3 نا لرددم كان
جاه (طب كر
صفحه 11:
0 [۷
ne tree Kes)
موی 2 صفراوی
وی
©
سای
ردیر ومو یک علا مایت :و رمرم یک‌صوررت ص
Suk
رن بو اون
PAOLA
els
اشل‌ترالی +
چرهس بان هلان
LS
چشاب‌سرخاورگ رها اد
Tu tew bh vores
صفحه 12:
ا 1 ©
ورمجكرصغراو ىك علايات:
ediige Lorre sASet Anew ily
ذياك اس جترمكاردمرة
bathe te
زین ون موف سیک شرت نا بر
bounty bl &
صفحه 13:
ا 1 ©
ورم فيك علاءات:
يكلف ورم صورت عل ددزاذ ات ای
dni eg پاخادکا یره چردادچره کل تکمیا مدز
cbt BI که کارت
نع BD ease یار سب هر بی)
ورم داد ی علاانت:
Hehe tapered alg thy إن ددمكا نت مدت جوتو طور بعلا كسب
ro tlnino de Let
صفحه 14:
B. ELISA (En
C. RIBA, (Ré
كن ام
Liver Biopsy.
F. Other Biochem
0 Bilirubin
0 ESR etc.
صفحه 15:
TREATMENT
A. Mono therapy with alpha interferon.
Work in 10 - 20 person out of 100.
+ Side effect profile is high
Dosage reduced in 40 out of 100.
Treatment withdrawn in 15.
. Pregnant can not use.
B. Combination therapy Interferon + Ribavirin
Works in 30 - 40 out of 100
Ribavirin alone does not work.
Serious side effects like severe anemia myocardial
infarction
صفحه 16:
The challenge of science
* Paracelsus, the Father of
Pharmacology said..
“All that mankind needs for good
health and
healing is provided in nature..
the challenge of science is to find it!”
صفحه 17:
Herbal Treatment
Main Ingredients
1. Glycyrrhiza (Mulathi)
2. Silybum marianum(Oont Catara)
3. Withania coagulans (Paneer Doodi)
4. Solanum nigrum Linn (Mako)
5. Piprum nigrum (Mirch sia)
6. Artemisia absinthium(afsanteen)
7.Chichorium intybus(kasni)
8.Aloe Vera (Kanwar Gundal)
صفحه 18:
Silibum marianum(Oont Catara)
- Milk thistle has been used for liver problems for over 2000
years
- It offers Hepato-protective action through a number of
mechanisms
- Anti-oxidant activity
- Toxin blockade at the membri
- Enhances protein synthesis
- Anti fibroitic activity
- Anti-inflammatory and
- Immune-modulating effects.
صفحه 19:
Silybum marianum (Oont Cata
Silybum marianum has been shown to have clinical
applications in the treatment of toxic hepatitis, fatty liver,
cirrhosis, ischemic injury, radiation toxicity and viral hepatitis.
- Significantly reduces insulin requirements
It also significantly reduces insulin requirement in cirrhosis
related diabetes mellitus patients.
صفحه 20:
Glycyrrhiza glabra
(Mulathi)
OUTSTANDING EFFICACY IN L'
* Glycyrrhiza Glabra offers out standing surveillance rate in
liver patients.
*Reduces The Risk Of Liver Carcinoma
*Glycyrrhiza Glabra has reduced half the rate of hepatocellular
carcinoma as compared to other supportive therapy.
*Restores Liver Functions
*Hepatitis treatment with Glycyrrhiza Glabra restores AST &
ALT plasma concentrations.
صفحه 21:
Withania coagulans (Paneer Do
IMPROVES LIVER FUNCTIONS
* Increases thyroxine (T4), hepatic glucose and decreases
liver lipid peroxidation.
Anti Inflammatory Action
-Anti-inflammatory action is comparable to hydrocortisone.
+ Reduces Hepatotoxicity
+ Hepatotoxicity is reduced by withania comparable to
hydrocortisone.
صفحه 22:
er nigrum (Kali mirch
HACK REPRE Ant, carmina
antipyretic, anthelmintic, antiperiodic action whe
internally and externally it acts as rubefacient, stimulant,
resolvent. Pepper has long been known for stimulating the
appetite and relieving nausea. In India it had been used as a
medicine for variety of ailments from paralysis to toothache.
According to Ayurveda it is useful in treatment of asthma,
chronic indigestion, colon toxins, obesity, sinus congestion,
fever, intermittent fever, cold extremities, colic pain, cholera,
gastric ailments, diarrhea, piles, worms and sore throat.
Externally it can be applied to boils and other skin diseases in
form of paste.
DETOXIFYING AGENT
- Hepatotoxicity is decreased reducing lipid peroxidation,
enzymatic leakage of GPT, AP and preventing depletion of
GSH.
صفحه 23:
Chichorium intybus
(Chicory) (Kasni) ۲
Chicory (especially the flower) was used as a
treatment in Germany, and is recorded in many
books as an ancient German treatment for
everyday ailments. It is variously used as a tonic
and as a treatment for gallstones, gastro-enteritis
sinus problems and cuts and bruises. (Howard M.
1987). Inulin, the dietary fiber found in Chicory
finds application in diabetes and constipation.
Chicory has demonstrated antihepatotoxic
potential in animal studies.,[
صفحه 24:
Artemisia
absinthium
(Afsanteen)
٠ Its active substances include silica,
two bitter substances (absinthin and
anabsinthine), thujone, tannic and
resinous substances, malic acid,
and succinic acid. It is used
medicinally as a tonic, stomachic,
antiseptic, antispasmodic,
carminative, cholagogue, febrifuge
and anthelmintic. It has also been
used to remedy indigestion.
صفحه 25:
Compound medicine
* Majoon Dabeed ul ward
* Jawarish Amla
* Dawa ul Qurkum kabir
* Dawa ul Misk
* Sharbat Deenar
* Sharbat Kasni
* Sharbat Bazoori
+ Hepta Care
٠ Akseer e Jiger Syrup & Tab
+ Aloe Care Cap & Syrup
۰
+ Actirn Tab
+ Berisal Syrupetc
صفحه 26:
[Condition]
Chronic Hepatitis B & C
A combination of her! dients mainly Glycrrhiza, اسل
Investigational
Tests & frequency
۳۳۲۲۳ حنطننا
| Anti HCV
PCR Quantitative
Data collection pi
L2eation سس
= ۳
صفحه 27:
Clinical Trials of
Herbal medicine on Hepatitis C Patients
صفحه 28:
Hepatitis C Study
PATIENTS & METHODS
All patients who were Hepatitis B surface antigen negative,
and had impaired liver functions were tested for Hepatitis C
virus antibodies. PCR was done in those who tested positive
for HCV antibodies. Patients who had detected virus on PCR
and abdominal ultra sound showed no stigmata of portal
hypertension were included in the study.
Hemoglobin SGPT (ALT), AST, White cell count. Platelets
were done at the interval of every three weeks. Liver
function test, Renal function test, PCR was done Pre and
Post treatment.
The study comprised of 18 patients (12 males, 6 females)
The mean age was (40 + 15)
Mean AST 105 + 30 (N > 40 uL/ml)
Mean ALT 115 + 42 (N < 41 uL/ml)
صفحه 29:
Hepatitis C Study
These patients were treated with a combination of herbal ingredients
mainly glycyrrhizinate, silybum marianum, zinc compound, withinia
coagulant, ginseng, Rheum emodi given in divided doses daily for one
year. With serial monitoring of AST, ALT, hemoglobin and platelets.
Of initial 18 patients 5 patients lost follow up. Of the 13 patients who
completed this study for 6 months, a subjective improvement was seen
in 12 patients (93 %).
Out of 13 only 8 patients completed the study for 11 months
( Recommended duration of treatment is one year).
The response to therapy with Herbal medicine depending on
biochemical and molecular biological test (PCR) were as follows.
Improvement in ALT & AST levels 12 (93%)
Results PCR - Non Detected 5 out of 8 (62.5 %)
(in patients taken the medicine for recommended duration i.e. 11
months)
The Mean level of ALT, for the 13 patients who completed the study
successfully, fell from (115 + 42) to 40 + 24 UL/ml and that of AST fell
from (105 + 30) to 43 + 21 UL/ml.
صفحه 30:
Clinical Trials of
Herbal medicine on Hepatitis B
Patients
صفحه 31:
Hepatitis B Study
All patients were confirmed Hepatitis ‘B’ surface antigen
positive, and had increased SGPT & SGOT levels.
PCR was done and willing patients (child bearing female
exempted) were included in the study. Pregnant ladies and
patients with diabetes and leumpensated cirrhosis were
included.
Hemoglobin, SGPT (ALT), AST, Blood chemistry were done at
the interval of every three weeks , pcr was done pre & post
treatment.
The study comprised of 10 patients (6 male, 4 female)
The Mean age was 40
MEAN AST 1300 (N < 40pl/ml)
MEAN ALT 1950 (N < 42 pl/ml)
صفحه 32:
These patients were treated with a combination of herbal
ingredients mainly glycyrrhizinate, silybum marianum, zinc
compound, withinia coagulant, ginseng, Rheum emodi given
in divided doses daily maximum 180 days with periodic
monitoring of AST, ALT & CBC. At the initial stage 10
patients completed the study and showed 100% results
within 180 days response was as follows.
Improvement in ALT & AST 10 (100%)
PCR Non Detected 10 (100%)
(Mean period in which PCR became -ve in 155 days)
Mean improvement in ALT & AST
Before 1950 1300
After 22 20
(Mean period 60 days)
No major side effect was reported.
صفحه 33:
Herbal Treatment
Feedback of Hepatitis B Patients
No. of patients registered for Treatment:
- 100 patients
Regular Patients:
- 92 patients
Defaulters:
- 8 patients
صفحه 34:
PCR Test Reports
From Aga Khan University Hospital —
Abdul Hafeez Ali Nawaz DK #16719 _Not detected
Muhammad aa
10 Sajid Hussain Noor Hassan 18 DK #16728 Not detected
صفحه 35:
PCR Test Reports
From Aga Khan University Hospital Karachi Through
Collection Unit Dhairki
Not detected
Not detected
Not detected
Not detected
Not detected
Not detected
Not detected
Not detected
Dk # 16755
Dk # 16756
DK # 16757
Dk # 16758
Dk # 16759
Dk # 16760
Dk # 16761
Dk # 16762
Dk # 16763
Dk # 16764
26
30
22
20
22
10
25
20
18
1
Ellahi Bux
Dhani Bux
Yaar Muhammad
Abdul Rahim
Haji Ghulam
Yaseen
Shehzado
Shaukat All
Khuda Bux
Abdul Rasheed
‘Abdul Wahid
Muhammad islam
Allah Yar
Abdul Wahab
Muhammad Ishage
Nisar Ahmed
Zubair Anmed
Mai Zohra
Shahzad Ali
Ali Gohar
‘Muhammad Hanif
11
12
13
14
15
16
17
18
19
20
صفحه 36:
PCR Test Reports
From Aga Khan University Hospital Karachi Through
Not detected
Not detected
Not detected
Not detected
Not detected
Not detected
Not detected
Collection Unit Dhairki
Ali Raza Muhammad Sadiq 16 DK # 16781
Walid الم Maula Bux 17 Dk # 16782
Sajid Hussain karim Bux 2 DK # 16783
Mai Rukhsana Qurban All 22 DK # 16784
Muhammad Zeesahn Ghulam Akbar 22 DK # 16785
Muhammad
Amjad Ali Aslam 31 Dk # 16786
Muhammad Ameen Rehmat Al 42 DK # 16787
Abdul Latif Sher Muhammad 20 Dk # 16788
Daulat Ali Dahar All 23 Dk # 16789
Asad All ‘Anwar All 10 DK # 16790
21
22
23
24
25
26
27
28
29
30
صفحه 37:
PCR Test Reports
From Aga Khan University Hospital Karachi Through
Collection Unit Dhairki
Not detected
Not detected
Not detected
Not detected
Not detected
Not detected
Not detected
Not detected
Dk # 16831
Dk # 16832
Dk # 16833
Dk # 16834
Dk # 16835
Dk # 16836
Dk # 16837
Dk # 16838
Dk # 16839
Dk # 16840
38
22
15
30
17
18
30
20
18
20
Muhmmad Younis
Bilal Shar
Ameer Bux
Muhammad
Yaqoob
‘Abdul Wahid
‘Sher Muhammad
Muhammad
Yaqoob
موس
Jamal Din
‘Muhammad
Usman
Abdul Hameed
Akhtiar Ahmed
Atta Ellahi
Kalsoom
Meer Hassan
Rizawan
Saeed Ahmed
Zahid Ali
Bashir Ahmed
Shehzado
31
32
33
34
35
36
37
38
39
40
صفحه 38:
PCR Test Reports
From Aga Khan University Hospital Karachi Through
Not detected
Not detected
Not detected
Not detected
Not detected
Not detected
Not detected
Not detected
Collection Unit Dhairki
Jahanzaib Shehbaz Ali 14 Dk # 16873
Mai Meerut Shehbaz Ali 30 Dk # 16874
Sadia Shehbaz Ali 10 Dk # 16875
Aneeta Shehbaz Ali 12 Dk # 16876
‘Moomal Sain Dad 30 Dk # 16877
Sanawli ‘Momin Ali 16 Dk # 16878
Gul Hassan Somer Khan 25 Dk # 16879
Hussana Soomer Khan 20 Dk # 16880
Lal Bux Gul Muhammad 25 Dk # 16881
Noor Muhammad Gul Muhammad 23 Dk # 16882
41
42
43
44
45
46
47
48
49
50
صفحه 39:
PCR Test Reports
From Aga Khan University Hospital Karachi Through Collection
Unit Dhairki
52 Amina Abbass: 40 DK # 16911
60 Naeem Ahmed Sultan Ahmed 16 DK #16919 Not detected
صفحه 40:
PCR Test Reports
From Aga Khan University Hospital Karachi Through
Collection Unit Dhairki
Not detected
Not detected
Not detected
Not detected
Not detected
DK # 16941
Dk # 16942
Dk # 16943
Dk # 16944
Dk # 16945
Dk # 16946
Dk # 16947
Dk # 16948
Dk # 16949
Dk # 16950
43
10
19
20
20
15
15
20
10
10
Allah Wadhayo
‘Anwar Din
Lugman
Sabzal
Mitho Khan
‘Mohib Khan
Qamar Din,
Jeeand Khan
Jeeand Khan
‘Abdul Malik:
Qaim Din
Shafige Ahmed
Khalil Anmed
Arshad All
Khalid Hussain
Mai willaitan
Allah Wasal
Farman Ali
Insaf Ali
Bilal Ahmed.
61
62
63
64
65
66
67
68
69
70
صفحه 41:
PCR Test Reports
From Aga Khan University Hospital Karachi Through
Collection Unit Dhairki
Not detected
Not detected
Not detected
Not detected
Not detected
Not detected
Dk # 16980
Dk # 16981
Dk # 16982
Dk # 16983
Dk # 16984
Dk # 16985
Dk # 16986
Dk # 16987
Dk # 16988
Dk # 16989
16
22
20
12
12
50
22
35
35
12
Muhammad
Bachal
‘Muhammad
Chhuttal
Allah Bux
‘Manzoor Ahmed
Muhammad
Ramzan
‘Abdul Ghafoor
Mir Muhammad
Gul Hassan
Ghulam Mustafa
Roshan Lal
Abdul Jabbar
Faiz Muhammad
Alb All
Muhammad irfan
Imam Khatoon
Mai Hanifan
Niaz Al
Mai Sharifan
‘Akshay Kumar
81
82
83
84
85
86
87
88
89
90
صفحه 42:
Herbal Treatment
Feedback of Hepatitis B Patients
Observations:
Medication
1. 8 patients out of 100 didn't complete the course of
medicine (7 patients left the course and 1 was Cirrhotic
patient).
2. 82 patients out of 92 were healthy and feeling better than
before taking the medicine.
3. 10 patients out of 92 patients had one of these problems
like constipation, flatulence, weakness & insomnia.
صفحه 43:
Herbal Treatment
Feedback of Hepatitis B Patients
Observations:
PCR Test Results:
1. PCR test of 90 patients was conducted to find out the
Hepatitis - B virus in patients after treatment.
2. As per PCR Tests Report from Aga Khan University
Hospital Karachi, in 66% patients (59 patients) Hepatitis -
B virus was not detected.
3. Whereas in 34% patients (31 patients), Hepatitis B +
virus was detected.
صفحه 44:
Herbal Treatment
Feedback of Hepatitis C Patients
No. of Patients Registered for Treatment:
- 40 patients
Results:
- Treatment of Hepatitis C Patients under
process
- Treatment process will be completed till
April 2011
صفحه 45:
Thanks