Hepatic Encephalopathy and Rifaximin

 What is hepatic encephalopathy?

Hepatic Encephalopathy is a condition that develops in individuals with cirrhosis who have a damaged liver, which usually cannot eliminate toxins as a healthy liver would. These toxins move through the body until they reach the brain and then they damage the brain and cause Hepatic Encephalopathy.

What are the hepatic encephalopathy symptoms? 

Signs and symptoms of moderate HE (Hepatic Encephalopathy) are:

• Difficulty thinking
• Personality changes
• Lack of concentration
• Confusion
• Forgetfulness
• Lack of judgment
• Sweet breath odor

The severe hepatic encephalopathy symptoms may include:

• Confusion
• Drowsiness
• Lethargy
• Anxiety
• Seizures
• Fatigue
• Confused speech
• Shaky hands
• Slow movements
• Severe changes in personality

Seek emergency medical assistance right away in case you develop signs of severe hepatic encephalopathy. These signs may lead to a coma in case left untreated for a longer period of time.

What is the most serious sign of hepatic encephalopathy?

In most individuals with severe hepatic encephalopathy, confusion or disorientation, amnesia, stupor or coma may develop. 

What are the stages of hepatic encephalopathy?

The four hepatic encephalopathy stages are listed as follows:

• Stage 1: (Mild HE): Patients may experience sleep problems, trouble concentrating and may have mood swings. 
• Stage 2: (Moderate HE): Patients may feel exhausted, have problems with basic math, and may react strangely. Hands might be shaking, and have difficulty writing.
• Stage 3: (Severe HE): Patients may be very sleepy and sometimes pass out. They are unable to do basic math at all. They may act strange and may be very fearful as well as jumpy.
• Stage 4: (Coma): The last stage of hepatic encephalopathy is coma, means the patient is unconscious.

How is hepatic encephalopathy diagnosed?

By performing blood tests can help in order to identify complications such as infections as well as bleeding associated with liver disease. Your healthcare practitioner may prescribe a few other tests in order to rule out conditions responsible for causing identical symptoms, such as strokes and brain tumors.

These tests include MRI, CT scans and EEG.

Generally, your healthcare practitioner makes a diagnosis on behalf of your Medical history, Symptoms and Office exam.

How is hepatic encephalopathy treated?

The hepatic encephalopathy treatment varies depending on your symptoms, overall health and how severe the disease is. Treatment is able to slow, and sometimes stop, the disease from getting worse. In order to treat HE, your healthcare practitioner may prescribe rifaximin (Xifaxan), or Laxatives. 

Rifaximin (Xifaxan): Inside the body, bacteria makes natural toxins from the digested foods. As an antibiotic, Rifaximin for hepatic encephalopathy helps stop the bacterial growth. As an outcome, the body starts producing fewer toxins.

Although the evidence is still lacking, rifaximin (Xifaxan) appears to be comparatively more effective than other existing treatments for HE. 

Eligibility criteria: To be suitable/eligible for treatment with Rifaximin the patient must:

• be established, with an appropriate therapeutic trial (at least 30 days), on a dose of lactulose (up to a maximum dose of 30 mL QID) that achieves 2 to 3 semi-formed stools daily, unless not tolerated. 

• be aged 18 years or older. 

• have experienced, in the last 6 months, at least 2 episodes of overt hepatic encephalopathy (Conn score ≥ 2) related to hepatic cirrhosis. 

• be in remission of Hepatic Encephalopathy (Conn score ≤1) with a MELD or Model for End-Stage Liver Disease score ≤ 25.

Exclusion criteria: Patients should be excluded from the treatment with rifaximin if:

• liver transplant is awaited within 30 days. 

• lactulose has not been appropriately trialled because of non-compliance. 

• an ongoing infection or active spontaneous bacterial peritonitis or

• Hepatic Encephalopathy is caused by a reversible precipitating cause.

Treatment: 

Should all the patients fulfil the requirements mentioned above, rifaximin treatment may be commenced at 550 mg twice in day, with or without meals, either as an inpatient or outpatient. 

Treatment with lactulose should continue as tolerated, maintaining a response of 2 to 3 semi-formed stools daily. 

Treatment may only be begun by an experienced Consultant Hepatologist. Rifaximin therapy needs to be reviewed on a regular basis at least every 3 months (90 days); where there is establishment of disease progression or no evidence of clinical benefit has been seen within a six month time-span treatment needs to be ceased.

Side Effects of Rifaximin: The rifaximin side effects are generally mild, fewer as well as uncommon. These are:

• Dizziness
• Hands
• Gas
• Headache
• Low Energy
• Nausea
• Stomach Cramps

What dosage form and strength Rifaximin is available? 

This medication comes in the form of tablets as following strength:

• rifaximin 200 mg
• rifaximin 550 mg
• rifaximin Rifagut 400 mg

How to take it: The recommended dose for HE is rifaximin 550 mg, which is consumed orally two times daily. know about indication of rifaximin tablets

NOTE: The piece of information provided about hepatic encephalopathy and rifaximin in this article is only for the informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis of an experienced healthcare practitioner.

Ovarian Cancer and Thiotepa Injection

What is Ovarian Cancer?

The cancer of the ovarian basically occurs when the cells in one or both ovaries become abnormal, grow in an uncontrolled way and develop a lump named a tumour.

Symptoms of Ovarian Cancer: When the cancer of the ovarian starts to grow, it isn't always responsible for causing symptoms. But the cancer can cause the following symptoms:

• Bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Needing to urinate frequently

Less common ovarian cancer symptoms may include: 

• Fatigue
• Indigestion
• Back pain
• Pain with intercourse
• Constipation
• Changes in the menstrual cycle 

Of course, above mentioned are very general symptoms. Many females have some of these symptoms from time to time, but that does not mean they have ovarian cancer. Only in case the symptoms are new, appear almost daily, and last for over 2 to 3 weeks might they suggest something serious, such as ovarian cancer.

Ovarian Cancer and Thiotepa Injection

Things that may emerge throughout or within hours of treatment:

1.Mild-moderate nausea, vomiting, and loss of appetite may emerge. You may be given medicines to tackle this.

Things that may emerge a few days to weeks later:

1. Blood cell counts may drop. This is called bone marrow suppression. This includes a drop in:

• Red blood cells (RBCs), which carry oxygen in the body to provide you energy

• White blood cells (WBCs), which fight infection in the body

• Platelets, which help clot the blood in order to stop bleeding

This may happen 7-14 days after the medicine is given and then blood counts get normal. In case you have a fever of 100.5°F (38°C) or higher, a cough, chills, or any bleeding complications, call your cancer care team immediately.

2. Some or all of your hair may fall out around 3-4 weeks after treatment begins. You may lose head hair, facial and body hair. Hairs may start growing back during treatment.

3. Skin changes (dryness or a rash on the body) may appear. Discuss with your cancer care team what lotions or creams you may consider.

4. Diarrhea or loose stools may occur within a few days after the medicine is started. You may look for loperamide to manage diarrhea. Be sure to also consume more fluids (water/juice/sports drinks). In case these do not help within 24 hours, call your cancer specialist.  

5. A few patients may feel tiredness, also named fatigue. It is advisable to take rest or naps more often. Mild to moderate workout/exercise may help boost your energy.

6. You may experience a headache. Please discuss with your cancer specialist about what you can consider for this.

How do you get Ovarian Cancer: The following may be responsible for raising the risk of getting the most common types of ovarian cancer: 

• Older age (age 63 and older)
• Obesity
• Use of estrogen replacement therapy after menopause. 
• Having a blood relative who had ovarian, breast, or colorectal cancer. 
• Inherited genetic factors (but data suggests that the most ovarian cancer occurs in people who have no family history of the disease as well as no genetic risk).
• Having a personal history of breast cancer. 

Stages of Ovarian Cancer: Staging determines how advanced the cancer is and whether it has spread to other parts of the body. The ovarian cancer stages are defined by the FIGO system. 

• Stage I: Tumour confined to ovaries.
• Stage II: Tumour involving one or both ovaries and extending into the tissues in the pelvic region. 
• Stage III: In this stage, the tumour involves one or both ovaries and evidence of spread to the abdominal lining outside of the pelvic region. 
• Stage IV: Highly advanced stage when the cancer has reached to more distant organs e.g. liver, lungs. 

What are the symptoms of stage 1 ovarian cancer: At stage 1, the cancer exists only in the ovaries i.e. it has not reached any other organs. Signs and symptoms at stage 1 may include

• Mass felt in the abdomen
• Distension or swelling of abdomen
• Pain in the lower abdomen
• Back pain
• Bloating.
• Feeling full even with small portions of food
• Loss of appetite
• Comparatively more frequent or urgent need in order to urinate or constipation.
• Abnormal vaginal bleeding (between menstrual periods or following menopause). 

Method of Diagnosis: Methods of diagnosis may vary from nation to nation but typically when a woman goes to her healthcare practitioner with symptoms, she will be recommended for a physical examination. In case this raises any kind of concerns, a few additional tests can be performed:

• A blood test in order to check for raised levels of a protein in the blood named CA-125. 
• CT scan or MRI (Magnetic Resonance Imaging). 
• Ultrasound

How deadly is ovarian cancer?

Epithelial form of ovarian cancer is one of the deadliest of the gynecologic cancers. About 80% of patients will eventually die of the disease.

Although, the survival in the short term is absolutely quite healthy, meaning multiple years. Existence of IP chemotherapy, ovarian cancer survival has been extended.

Treatment: The options of ovarian cancer treatment may vary on behalf of stage of the cancer, and are assessed considering into the account the below listed variables:

• Tumour size
• Tumour position
• Degree of spread
• Patient’s physical condition

Although, in this article, we're covering thiotepa, which is a widely used agent for the treatment of ovarian cancer. 

Thiotepa (Tepadina): It is an alkylating agent and widely used for the treatment of ovarian cancer as well as certain other cancers. It is a clear liquid, which should be administered by vein (IV).

In patients taking this medication may have some side effects, which may include:

• Rash
• Abnormal bleeding
• Soreness of the mouth 
• Feeling tired, or weak
• Headache
• Stomach pain
• Diarrhea
• Throwing up
• Upset stomach
• Feeling less hungry
• Injection site irritation

Certain Other Things Need to Know About Thiotepa Injection:  

• Women with child bearing potential should inform their healthcare team before receiving this drug.
• Patients are advised to avoid breastfeeding while receiving thiotepa 15 mg injection. 
• Patients must be counsel on the signs and symptoms of hypersensitivity. 
• Vials need to be stored and transported refrigerated at 2°-8°C (36°-46°F). Freeze is not recommended.
• The thiotepa injection brands in india are available at WHO-GDP & ISO certified pharmaceutical wholesaler company. 

Can you be fully cured of ovarian cancer?

According to data, approximately 2 out of 10 women with advanced stage ovarian cancer are effectively cured and survive at least 12 years following the treatment. Your response to the cancer therapy and probability for a cure basically depend on the type and stage of ovarian cancer during diagnosis.

NOTE: The piece of information provided about Ovarian Cancer and Thiotepa Injection in this article is just for informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis of a qualified healthcare practitioner. More things need to know about thiotepa injection