treatment Hepatitis

treatment Hepatitis

What is the treatment for viral hepatitis?

Treatment of acute viral hepatitis and chronic viral hepatitis are different. Treatment of acute viral hepatitis involves relieving symptoms and maintaining adequate intake of fluids. Treatment of chronic viral hepatitis involves medications to eradicate the virus and taking measures to prevent further liver damage.

Acute hepatitis

In patients with acute viral hepatitis, the initial treatment consists of relieving the symptoms of nausea, vomiting, and abdominal pain (supportive care). Careful attention should be given to medications or compounds, which can have adverse effects in patients with abnormal liver function (for example, acetaminophen [Tylenol and others], alcohol, etc.). Only those medications that are considered necessary should be administered since the impaired liver is not able to eliminate drugs normally, and drugs may accumulate in the blood and reach toxic levels. Moreover, sedatives and "tranquilizers" are avoided because they may accentuate the effects of liver failure on the brain and cause lethargy and coma. The patient must abstain from drinking alcohol, since alcohol is toxic to the liver. It occasionally is necessary to provide intravenous fluids to prevent dehydration caused by vomiting. Patients with severe nausea and/or vomiting may need to be hospitalized for treatment and intravenous fluids.
Acute HBV is not treated with antiviral drugs. Acute HCV - though rarely diagnosed - can be treated with several of the drugs used for treating chronic HCV. Treatment of HCV is recommended primarily for the 80% of patients who do not eradicate the virus early. Treatment results in clearing of the virus in the majority of patients.

Chronic hepatitis

Treatment of chronic infection with hepatitis B and hepatitis C usually involves medication or combinations of medications to eradicate the virus. Doctors believe that in properly selected patients, successful eradication of the viruses can stop progressive damage to the liver and prevent the development of cirrhosis, liver failure, and liver cancer. Alcohol aggravates liver damage in chronic hepatitis, and can cause more rapid progression to cirrhosis. Therefore, patients with chronic hepatitis should stop drinking alcohol. Smoking cigarettes also can aggravate liver disease and should be stopped.
Medications for chronic hepatitis C infection include:

• injectable interferons
• oral ribavirin (Rebetol, Copegus)
• oral boceprevir (Victrelis)
• simeprevir (Olysio)
• oral telaprevir (Incivek - Note that on 12/19/12, warned that a few patients can develop a fatal rash, especially when telaprevir is used in combination with other antivirals. The drug was discontinued for production in August 2014.) 

Medications for chronic hepatitis B infection include:

• injectable alpha interferons
• oral lamivudine (Epivir)
• oral adefovir (Hepsera)
• oral entecavir (Baraclude)
• oral tenofovir (Viread)

Decisions regarding treatment of chronic hepatitis can be complex, and should be directed by gastroenterologists or hepatologists (doctors specially trained in treating diseases of the liver) for several reasons including:

1. The diagnosis of chronic viral hepatitis may not be straightforward. Sometimes a liver biopsy may have to be performed for confirmation of liver damage. Doctors experienced in managing chronic liver diseases must weigh the risk of liver biopsy against the potential benefits of the biopsy.
2. Not all patients with chronic viral hepatitis are candidates for treatment. Some patients need no treatment (since some patients with chronic hepatitis B and C do not develop progressive liver damage or liver cancer).
3. Medications for chronic infection with hepatitis B and hepatitis C are not always effective. Prolonged treatment (6 months to years) often is necessary. Even with prolonged treatment, rates of successful treatment (defined as complete and lasting eradication of the virus) often are low (usually less than 80% and often around 50%).
4. Most of the medications such as interferon and ribavirin can have serious side effects, and doses may have to be reduced.
5. There are several different strains of hepatitis C viruses with differing susceptibilities to medications. For example, hepatitis C type 3 is more likely to respond to interferon injections and ribavirin than type 1. Certain hepatitis B strains are resistant to lamivudine but respond to adefovir or entecavir.

In addition, recent research has shown that combination of certain antiviral medications result in a cure (viral clearance) in many patients with chronic hepatitis C. Further studies and FDA approval is pending.

Fulminant hepatitis

Treatment of acute fulminant hepatitis should be done in centers that can perform liver transplantation since acute fulminant hepatitis has a high mortality (about 80%) without liver transplantation. Continue Reading

Bacterial vaginosis facts

Bacterial vaginosis facts

• Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.
• Bacterial vaginosis is not dangerous, but it can cause disturbing symptoms.
• Most women do not experience symptoms of bacterial vaginosis, but when they do they are:
  • vaginal discharge, and
  • vaginal odor.
• In diagnosing bacterial vaginosis, it is important to exclude other serious infections, such as the STDs gonorrhea and Chlamydia.
• Treatment options for bacterial vaginosis include prescription oral antibiotics and vaginal gels.
• Serious complications of bacterial vaginosis can occur during pregnancy, and recurrence is possible even after successful treatment.

What is bacterial vaginosis?

Bacterial vaginosis is a vaginal condition that can produce vaginal discharge and results from an overgrowth of certain kinds of bacteria in the vagina. In the past, the condition was called Gardnerella vaginitis, after the bacteria that were thought to cause the condition. However, the newer name, bacterial vaginosis, reflects the fact that there are a number of species of bacteria that naturally live in the vaginal area and may grow to excess. The Gardnerella organism is not the sole culprit causing the symptoms. When these multiple species of bacteria that normally reside in the vagina become unbalanced, a woman can have a vaginal discharge with a foul odor.
Bacterial vaginosis is not dangerous, but it can cause disturbing symptoms. Any woman with an unusual discharge should be evaluated so that more serious infections such as Chlamydia and gonorrhea, can be excluded. Symptoms may also mimic those found in yeast infections of the vagina and trichomoniasis (a sexually-transmitted disease or STD), and these conditions must also be excluded in women with vaginal symptoms.
Bacterial vaginosis is a common condition. It is the most common vaginal complaint in women of child bearing age. Studies have shown that approximately 29% of women in the U.S. are affected. Bacterial vaginosis is found in about 25% of pregnant women in the U.S. and approximately 60% of women who have a sexually-transmitted disease (STD).

What is causes bacterial vaginosis?

Researchers have had difficulty determining exactly what causes bacterial vaginosis. At present, it seems to be that a combination of multiple bacteria must be present together for the problem to develop. Bacterial vaginosis typically features a reduction in the number of the normal hydrogen peroxide-producing lactobacilli in the vagina. Simultaneously, there is an increase in concentration of other types of bacteria, especially anaerobic bacteria (bacteria that grow in the absence of oxygen). As a result, the diagnosis and treatment are not as simple as identifying and eradicating a single type of bacteria. Why the bacteria combine to cause the infection is unknown.
Certain factors have been identified that increase the chances of developing bacterial vaginosis. These include:

• multiple or new sexual partners,
• IUDs (intrauterine devices) for birth control,
• recent antibiotic use,
• vaginal douching, and
• cigarette smoking.

However, the role of sexual activity in the development of the condition is not fully understood, and although most experts believe that bacterial vaginosis does not occur in women who have not had sexual intercourse, others feel that the condition can still develop in women who have not had sexual intercourse. Continue Reading

Pneumonia - Treatment

Pneumonia - Treatment

Bacterial pneumonia

Doctors use antibiotics to treat pneumonia caused by bacteria, the most common cause of the condition. Antibiotics have a high cure rate for pneumonia.⁵

Your doctor will choose your antibiotic based on a number of things, including your age, your symptoms and how severe they are, and whether you need to go to the hospital. The number of days you take antibiotics depends on your general health, how serious your pneumonia is, and the type of antibiotic you are taking.

Most people see some improvement in symptoms in 2 to 3 days. Unless you get worse during this time, your doctor usually will not change your treatment for at least 3 days.

Getting started on antibiotics soon after getting pneumonia may help recovery.⁵

If there is no improvement or if your symptoms get worse, you may need a culture and a sensitivity test. These tests help identify the organism that is causing your symptoms. These tests also help your doctor find out whether the bacteria is resistant to the antibiotic.

If you do not need to go to the hospital for pneumonia, it is not usually necessary to identify the organism causing the pneumonia before starting treatment. If you do go to the hospital, you will probably have some testing to identify the bacteria.

You likely will not have to go to the hospital unless you:

• Are older than 65.
• Have other health problems, such as COPD, heart failure, asthma,شer disease.
• Cannot care for yourself or would not be able to tell anyone if your symptoms got worse.
• Have severe illness that reduces the amount of oxygen getting to your tissues.
• Have chest pain caused by inflammation of the lining of the lung (pleurisy) so you are not able to cough up mucus effectively and clear your lungs.
• Are being treated outside a hospital and are not getting better (such as your shortness of breath not improving).
• Are not able to eat or keep food down, so you need to take fluids through a vein (intravenous).ش

Older diabetics face high over-treatment risk

Older diabetics face high over-treatment risk

he “one size fits all” approach to diabetics treatment may cause significant problems for older patients also suffering from other conditions. Attempting to aggressively control blood sugar with insulin and sulfonylurea drugs could lead to over-treatment and hypoglycemia (low blood sugar), Yale researchers report.

Diabetes overtreatment may threaten the health and lives of older patients. Image via Health Works.

The study, which was published in JAMA Internal Medicine, found that many older patients received the same treatment as their younger counterparts, despite having other health conditions to struggle with. In patients with diabetes aged 65 and older this raises major problems – potentially even life threatening ones.

“We treat diabetes to prevent complications of the disease by lowering blood sugar levels, but the problem with aggressively lowering blood sugars in older people — to a hemoglobin A1c below 7% — is that it is uncertain whether this approach provides a benefit, and it could, in fact, cause greater harm,” said lead author Dr. Kasia Lipska, assistant professor of internal medicine at Yale School of Medicine. “Our study suggests that we have a one-size-fits-all approach despite questionable benefits and known risks. We have been potentially over-treating a substantial proportion of the population.”

This study asks some very valid questions and shows that even though managing diabetes is very important, we need to find a way to tailor treatments for individual patients and needs.

For this study, patients were divided into three groups depending on their relative health – poor, intermediate and good. Blood sugar was considered controlled if it fell below 7%. About 62% of the patients had blood sugar levels less than 7%. Out of them, 55% were treated with either insulin or sulfonylureas medications.

“We should use an individualized therapy approach when treating older diabetes patients,” said Lipska. “Older patients who are relatively healthy may benefit if they are treated in a similar way to younger diabetes patients, but this approach might not work in older patients who often have other health issues.”

Diabetes is a term denoting a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. As at 2013, 382 million people have diabetes worldwide, with type 2 diabetes making for 90% of all cases.
Journal Reference: Kasia J. Lipska, Joseph S. Ross, Yinghui Miao, Nilay D. Shah, Sei J. Lee, Michael A. Steinman. Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control