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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
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)
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
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
Hepatitis C Flaviviridae Single strand of RNA 3000 amino acids 10 encoded genes 6 genotypes (74% gt1 in USA) Many quasispecies Receptors? LDL, CD81
TESTS TO MAKE A DIAGNOSIS OF HEPATITIS C ,[object Object],[object Object],[object Object],[object Object],[object Object],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)
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
PROJECT DETAILS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Design: Experimental, randomized, clinical trial
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
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
Sign and Symptoms of Overall Patients  (Interferon alpha-2b and Ribavirin )  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],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
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
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
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
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
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
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
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
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
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
CONCLUSION ,[object Object],[object Object]
The Unresolved Hepatitis C ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
 
 
 
 
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Management of Hepatitis C with Natural and Synthetic Medicine

  • 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. 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. 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. 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. 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.
  • 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
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  • 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. 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.
  • 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. 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. 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. 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. 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. 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. 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. 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. 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
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  • 31. Thank You For Participating
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