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Although hepatitis C damages the liver, 80% of people with the disease do not have symptoms. In those who do, symptoms may not appear for 10-20 years, or even longer. Even then, the symptoms usually come and go and are mild and vague. Unfortunately, by the time symptoms appear, the damage may be very serious.A minority of people have symptoms during the early acute phase of the infection. These symptoms typically develop 5-12 weeks after exposure to HCV. Some people describe the symptoms as being flulike. The symptoms may last a few weeks or months.

Hepatitis C Signs and Symptoms:

1.Stools become pale in color (grayish or clay colored)
2.Dark-colored urine (may look like cola or tea)
3.Jaundice – A condition in which the skin and the whites of the eyes turn yellow
4.Pain over the liver (on the right side of the abdomen, just under the rib cage)
5.oFatigue
6.Loss of appetite
7.Diarrhea
8.Vomiting
9.Nausea

Acute:Acute hepatitis C refers to the first 6 months after infection with HCV. Between 60% to 70% of people infected develop no symptoms during the acute phase. In the minority of patients who experience acute phase symptoms, they are generally mild and nonspecific, and rarely lead to a specific diagnosis of hepatitis C. Symptoms of acute hepatitis C infection include decreased appetite, fatigue, abdominal pain, jaundice, itching, and flu-like symptoms. Hep C genotypes 2A & 3A have the highest cure rates at 81% and 74% respectively.

The hepatitis C virus is usually detectable in the blood within one to three weeks after infection by PCR, and antibodies to the virus are generally detectable within 3 to 15 weeks. Spontaneous viral clearance rates are highly variable and between 10 to 60% of persons infected with HCV clear the virus from their bodies during the acute phase as shown by normalization in liver enzymes (alanine transaminase (ALT) & aspartate transaminase (AST)), and plasma HCV-RNA clearance (this is known as spontaneous viral clearance). However, persistent infections are common and most patients develop chronic hepatitis C, i.e., infection lasting more than 6 months.

Previous practice was to not treat acute infections to see if the person would spontaneously clear; recent studies have shown that treatment during the acute phase of genotype 1 infections has a greater than 90% success rate with half the treatment time required for chronic infections.

Chronic:Chronic hepatitis C is defined as infection with the hepatitis C virus persisting for more than six months. Clinically, it is often asymptomatic (without symptoms) and it is mostly discovered accidentally (e.g. usual checkup).

The natural course of chronic hepatitis C varies considerably from one person to another. Although almost all people infected with HCV have evidence of inflammation on liver biopsy, the rate of progression of liver scarring (fibrosis) shows significant variability among individuals. Accurate estimates of the risk over time are difficult to establish because of the limited time that tests for this virus have been available.

Recent data suggest that among untreated patients, roughly one-third progress to liver cirrhosis in less than 20 years. Another third progress to cirrhosis within 30 years. The remainder of patients appear to progress so slowly that they are unlikely to develop cirrhosis within their lifetimes. In contrast the NIH consensus guidelines state that the risk of progression to cirrhosis over a 20-year period is 3-20 percent.

Factors that have been reported to influence the rate of HCV disease progression include age (increasing age associated with more rapid progression), gender (males have more rapid disease progression than females), alcohol consumption (associated with an increased rate of disease progression), HIV coinfection (associated with a markedly increased rate of disease progression), and fatty liver (the presence of fat in liver cells has been associated with an increased rate of disease progression).

Symptoms specifically suggestive of liver disease are typically absent until substantial scarring of the liver has occurred. However, hepatitis C is a systemic disease and patients may experience a wide spectrum of clinical manifestations ranging from an absence of symptoms to a more symptomatic illness prior to the development of advanced liver disease. Generalized signs and symptoms associated with chronic hepatitis C include fatigue, flu-like symptoms, joint pains, itching, sleep disturbances, appetite changes, nausea, and depression.

Once chronic hepatitis C has progressed to cirrhosis, signs and symptoms may appear that are generally caused by either decreased liver function or increased pressure in the liver circulation, a condition known as portal hypertension. Possible signs and symptoms of liver cirrhosis include ascites (accumulation of fluid in the abdomen), bruising and bleeding tendency, varices (enlarged veins, especially in the stomach and esophagus), jaundice, and a syndrome of cognitive impairment known as hepatic encephalopathy. Hepatic encephalopathy is due to the accumulation of ammonia and other substances normally cleared by a healthy liver.

Liver enzyme tests show variable elevation of ALT and AST. Periodically they might show normal results. Usually prothrombin and albumin results are normal, but may become abnormal, once cirrhosis has developed. The level of elevation of liver tests do not correlate well with the amount of liver injury on biopsy. Viral genotype and viral load also do not correlate with the amount of liver injury. Liver biopsy is the best test to determine the amount of scarring and inflammation. Radiographic studies such as ultrasound or CT scan do not always show liver injury until it is fairly advanced. However, non-invasive tests (blood sample) are coming, with FibroTest and ActiTest, respectively estimating liver fibrosis and necrotico-inflammatory. These tests are validatedand recommended in Europe (FDA procedures initiated in USA)

Chronic hepatitis C, more than other forms of hepatitis, can be associated with extrahepatic manifestations associated with the presence of HCV such as porphyria cutanea tarda, cryoglobulinemia (a form of small-vessel vasculitis)and glomerulonephritis (inflammation of the kidney), specifically membranoproliferative glomerulonephritis (MPGN). Hepatitis C is also rarely associated with sicca syndrome (an autoimmune disorder), thrombocytopenia, lichen planus, diabetes mellitus and with B-cell lymphoproliferative disorders.

Eighty percent of those infected do not have symptoms. Some people feel like they have the flu. Symptoms of hepatitis C can include fatigue, decreased appetite, nausea, jaundice, fever, and an enlarged liver.

Following acute infection with HCV, approximately 80 percent of patients will develop chronic infection. Chronic liver disease develops in 50-60 percent of those with chronic infection. The patients with cirrhosis, the most severe type of chronic liver disease, are also at risk (about 3 percent per year) of all liver cancer (hepatocellular carcinoma).

Several vaccines have been developed by Maurice Hilleman for the prevention of hepatitis B virus infection. These rely on the use of one of the viral envelope proteins (hepatitis B surface antigen or HBsAg). The vaccine was originally prepared from plasma obtained from patients who had long-standing hepatitis B virus infection. However, currently, it is made using a synthetic recombinant DNA technology that does not contain blood products. You cannot catch hepatitis B from this vaccine.

Following vaccination, hepatitis B surface antigen may be detected in serum for several days; this is known as vaccine antigenaemia.The vaccine is administered in either two-, three-, or four-dose schedules into infants and adults, which provides protection for 85–90% of individuals. Protection has been observed to last 12 years in individuals who show adequate initial response to the primary course of vaccinations, and that immunity is predicted to last at least 25 years.

Unlike hepatitis A, hepatitis B does not generally spread through water and food. Instead, it is transmitted through body fluids; prevention is thus the avoidance of such transmission: unprotected sexual contact, blood transfusions, re-use of contaminated needles and syringes, and vertical transmission during child birth. Infants may be vaccinated at birth.

Shi, et al showed that besides the WHO recommended joint immunoprophylaxis starting from the newborn, multiple injections of small doses of hepatitis B immune globulin (HBIg, 200–400 IU per month), or oral lamivudine (100 mg per day) in HBV carrier mothers with a high degree of infectiousness (>106 copies/ml) in late pregnancy (the last three months of pregnancy), effectively and safely prevent HBV intrauterine transmission, which provide new insight into prevention of HBV at the earliest stage.

Take prevention of hepatitis B. If you know you have hepatitis B, realize that it’s contagious. You can spread it to others. Avoid contact with others. You can prevent hepatitis from sharing needles. Although, those who use needles (outside from doctor appointments) are probably drug addicts. Don’t engage in unprotected sex, without proof your partner isn’t carrying any diseases. Avoid sharing eating utensils, or drinks with others.

Drink green tea. Drinking green tea can help get rid of a virus. That antioxidant called catechin can help in reduce symptoms. Green tea is rich in antioxidants. You want to get more antioxidants into your diet. Green tea does contain caffeine, but not the amount found in coffee and soda drinks.

Stay hydrated. Get a lot of fluids into your body. Drink water, not alcohol and caffeine drinks. Alcohol and caffeine can cause dehydration. Drink 8-10 glasses of cold water daily. Avoid a lot of fatty foods, and eat liquid foods like chicken noodle soup. Tomato soup isn’t bad as well.

Get vitamins into your diet. You should eat foods that contain a good amount of vitamins. A good source of vitamins are found in fruits. Avoid fruits that are real sour, though. Sour fruits could cause nausea and vomiting. Vitamin E supplements can help with hepatitis. Vitamin E helps protect the liver from damage, and studies suggest its helpful. Vitamin E helps fight off the virus in your liver.

Using herbal remedies. There are some helpful remedies out there, that can help treat hepatitis B. There’s a herbal supplement called hepatitone. It contains five herbs, and helps maintain a health liver function. Milk thistle, also known as silybum marianum has been used over 2,000 years for liver problems. Discuss any herbal supplements with your doctor first.

All infants should receive the hepatitis B vaccine: this is the mainstay of hepatitis B prevention.

The vaccine can be given as either three or four separate doses, as part of existing routine immunization schedules. In areas where mother-to-infant spread of HBV is common, the first dose of vaccine should be given as soon as possible after birth (i.e. within 24 hours).

The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. After age 40, protection following the primary vaccination series drops below 90%. At 60 years old, protective antibody levels are achieved in only 65 to 75% of those vaccinated. Protection lasts at least 20 years and should be lifelong.

All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine. People in high risk groups should also be vaccinated, including:

Prevention Tips:

1.International travellers to countries with high rates of HBV.
2.Those at occupational risk of HBV infection, including health care workers.
3.Recipients of solid organ transplantation.
4.Persons who frequently require blood or blood products.
5.Injecting drug users.
6.Partners and household contacts of HBV infected persons.
7.Persons with high-risk sexual behaviour.
The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.

As of December 2006, 164 countries vaccinate infants against hepatitis B during national immunization programmes – a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B.

Hepatitis A can be prevented by vaccination, good hygiene and sanitation. Hepatitis A is also one of the main reasons not to surf or go in the ocean after rains in coastal areas that are known to have bad runoff.

The vaccine protects against HAV in more than 95% of cases for 10 years. It contains inactivated Hepatitis A virus providing active immunity against a future infection. The vaccine was first phased in 1996 for children in high-risk areas, and in 1999 it was spread to areas with elevating levels of infection.

The vaccine is given by injection into the muscle of the upper arm. An initial dose provides protection starting two to four weeks after vaccination; the second booster dose, given six to twelve months later, provides protection for up to twenty years.

1.Crus not eat shellfish or cooked. If molluscs that live in water have been contaminated with feces containing the virus of hepatitis A infected molluscs May.

Child care workers should be educated about how often prevent the spread of hepatitis A prevention. Although children infected with hepatitis A may have little or no symptoms, can infect other people, including child care workers and other adults who may develop more severe symptoms. To prevent the spread of hepatitis A virus HAV, the child care workers must :

1.Talk to your doctor about getting vaccinated against HAV
2.Clean the diaper changing surface after each mutation.
3.Wash children’s hands, and then use a new pair of gloves when changing diapers for another child.

Use plastic (not latex, because of the risk of allergic reaction), disposable gloves when changing diapers

2.Protect yourself before flying and when on his journey. If you are traveling to some of the world where sanitation is poor or if hepatitis A is a known problem, consult your doctor about vaccination against hepatitis A, immune globulin (Ig) or a combination vaccine against hepatitis A and B. Always drink bottled water or boil water before drinking. Avoid tap water or untreated well water or drinks with ice. And do not eat raw foods (such as unpeeled fruits or vegetables).

3.Develop habits of hygiene.

Do not eat or drink anything that you think may have been prepared in filthy conditions.
Discourage children from putting objects in their mouths, especially when they share toys with other children.
Wash dishes in hot soapy water or a dishwasher.
Make sure you and all family members wash their hands with soap and warm water after using the toilet and before preparing or eating food.

4.Get vaccinated against hepatitis A, if your travel plans, work, health, or lifestyle puts you at risk for exposure to hepatitis A (HAV). For more information, see what increases the risk of this category.

The following tips can help reduce your risk of spreading or catching the virus:

1.Avoid unclean food and water

2.Always wash your hands thoroughly after using the restroom and when you come in contact with an infected person’s blood, stools, or other bodily fluid

The virus may spread more rapidly through day care centers and other places where people are in close contact. Thorough hand washing before and after each diaper change, before serving food, and after using the restroom may help prevent such outbreaks.

If you have recently been exposed to hepatitis A and have not had hepatitis A before or have not received the hepatitis A vaccine series, ask your doctor or nurse about receiving either immune globulin or the hepatitis A vaccine. Common reasons why you may need to receive one or both of these include:

1.You have eaten in a restaurant where food or food handlers were found to be infected or contaminated with hepatitis A
2.You have had close personal contact over a period of time with someone who has hepatitis A
3.You recently shared illegal drugs, either injected or non-injected, with someone who has hepatitis A
4.You recently had sexual contact with someone who has hepatitis A
5.You live with someone who has hepatitis A

Vaccines that protect against hepatitis A infection are available. The vaccine begins to protect 4 weeks after receiving the first dose. The 6 to 12 month booster is required for long-term protection. See: Hepatitis A vaccine

Travelers should take the following precautions:

1.Heated food should be hot to the touch and eaten right away.
2.If no water is available, boiling water is the best method for eliminating hepatitis A. Bringing the water to a full boil for at least 1 minute generally makes it safe to drink.
3.Use only carbonated bottled water for brushing teeth and drinking. (Remember that ice cubes can carry infection.)
4.Get vaccinated against hepatitis A (and possibly hepatitis B) if traveling to countries where outbreaks of the disease occur.
5.Do not buy food from street vendors.
6.Beware of sliced fruit that may have been washed in contaminated water. Travelers should peel all fresh fruits and vegetables themselves.
7.Avoid raw or undercooked meat and fish.
8.Avoid dairy products.

Consider a hepatitis A vaccination (Havrix) or an immunoglobulin (IG) injection if you fall into a high-risk group (see the Tips, below). IG injections provide short-term protection against hepatitis A (several months), while a vaccination is effective for a longer period (years).Consider getting tested for antibodies to hepatitis A if you have been infected before or if you are over 50. You may not need vaccination, as you may already be immune.

Employees’ State Insurance Corporation (ESIC) GUJARAT REGION

Applications, On line are invited to fill up 46 vacancies in the Lower Division Clerk in the offices of ESIC in Gujarat State :

Lower Division Clerks :

No of Posts : 46

Pay Scale : 5200-20200 +1900/-

Qualification :
(i) Higher Secondary Pass (pass in 12th Standard) or equivalent from a recognised Board.
(ii) Working knowledge of computer including the use of office suites and data base with typing speed of 40 words per minute in English or 35 words per minute in Hindi.

Age : Minimum 18 years and Maximum 27 years as on 18-11-2010

Scheme of Examination : The examination will consist of two parts viz :
Part I : Written Test
Part II : Skill test in typing on computer and knowledge of computer, including use of Office Suites and database.

Application Fee : Fee for SC/ST/persons with disability/Employees of ESIC/Ex Servicemen and Women candidates Rs. 55/- and for others i.e. General & OBC candidates Rs. 230/- should be paid in any branch of State Bank of India in the designated Account No.31463702683 OR 31463687697 by filling up challan in triplicate, to be down loaded from the website.

How to Apply : Apply online at ESIC Gujarat webcsite only from 18/10/2010 to 12/11/2010. Take a printout of the computer generated application and send it to the following address on by Regd. Post/ Speed Post in an envelope superscribed “Application for the post of LDC-2010-11” at the following address on or before 18/11/2010.

*Regional Director Regional Office, ESI Corporation, Panchdeep Bhavan, Ashram Road, Ahmadabad – 380014 , Gujarat

Last Date : 18/11/2010

Employees’ State Insurance Corporation (ESIC) GUJARAT REGION

Applications, On line are invited to fill up 46 vacancies in the Lower Division Clerk in the offices of ESIC in Gujarat State :

Lower Division Clerks :

No of Posts : 46

Pay Scale : 5200-20200 +1900/-

Qualification :
(i) Higher Secondary Pass (pass in 12th Standard) or equivalent from a recognised Board.
(ii) Working knowledge of computer including the use of office suites and data base with typing speed of 40 words per minute in English or 35 words per minute in Hindi.

Age : Minimum 18 years and Maximum 27 years as on 18-11-2010

Scheme of Examination : The examination will consist of two parts viz :
Part I : Written Test
Part II : Skill test in typing on computer and knowledge of computer, including use of Office Suites and database.

Application Fee : Fee for SC/ST/persons with disability/Employees of ESIC/Ex Servicemen and Women candidates Rs. 55/- and for others i.e. General & OBC candidates Rs. 230/- should be paid in any branch of State Bank of India in the designated Account No.31463702683 OR 31463687697 by filling up challan in triplicate, to be down loaded from the website.

How to Apply : Apply online at ESIC Gujarat webcsite only from 18/10/2010 to 12/11/2010. Take a printout of the computer generated application and send it to the following address on by Regd. Post/ Speed Post in an envelope superscribed “Application for the post of LDC-2010-11” at the following address on or before 18/11/2010.

*Regional Director Regional Office, ESI Corporation, Panchdeep Bhavan, Ashram Road, Ahmadabad – 380014 , Gujarat

Last Date : 18/11/2010

Sikkim is the second smallest state of India. This landlocked state is least populated and has Gangtok as its capital. The world's third highest peak, Kanchenjunga, is located here. The state has twenty-eight mountain peaks, twenty-one glaciers, 227 high altitude lakes, five hot springs, and over 100 rivers and streams, including the famous Teesta, which is also called "lifeline of Sikkim". Sikkim's economy is mainly agrarian.

It produce crops of rice, cardamom, oranges, apples and tea. It is also a mineral rich state and have mines of copper, dolomite, limestone, graphite, mica, iron, and coal. The state also has a vast tourism potential. There are many hotels and guest houses to cater to the flourishing tourism industry. Apart from the major contribution from tourism, the service sector also boasts of its real estate.

Coal India IPO subscribed 0.34 times on Day 1

The Initial Public Offering (IPO) of Coal India Limited which opened for subscription on October 18, 2010 has received subscription of 0.34 times at the end of first day.

The company has come out with Public offer of 631,636,440 equity shares of face value of Rs. 10 each for cash at a price band of Rs.225 to Rs.245 through 100% book building process.

The IPO has received total bids for 213486275 equity shares against the offer of 631636440 equity shares. The issue has received bids for 11324150 equity shares at cut-off price.

The Qualified Institutional Buyers (QIBs) portion of the issue has received bids for 178061900 equity shares against the offer of 284236398 equity shares resulting in a subscription of 0.63 times.

The Non Institutional Investors portion of the issue has received subscription of 0.18 times with bids for 15166550 equity shares against the offer of 85270919 equity shares.

The Retail Individual Investors (RIIs) portion of the issue has received bids for 20170400 equity shares against the offer of 198965479 equity shares resulting in a subscription of 0.10 times.

The Employee Reservation portion of the issue has received subscription of 0.00 times with bids for 87425 shares against the offer of 63163644 shares.

The IPO closes for subscription on October 21, 2010.

The Institute of Chartered Accountants of India (ICAI) Published the November 2010 Examination Admit Card


The Institute of Chartered Accountants of India (ICAI) is a statutory body established under the Chartered Accountants Act, 1949 (Act No. XXXVIII of 1949) for the regulation of the profession of Chartered Accountants in India. During its 61 years of existence, ICAI has achieved recognition as a premier accounting body not only in the country but also globally, for its contribution in the fields of education, professional development, maintenance of high accounting, auditing and ethical standards.ICAI now is the second largest accounting body in the whole world.

From Civil Service Examination 2011, Preliminary Examination would consist of two papers- Paper I and Paper II.

The syllabus and pattern of the Preliminary Examination would be as under :
(Paper 1) (200 marks) – Duration : Two hrs.

Current events of national and international importance
History of India and Indian national movement
Indian and World Geography- physical, social, economic geography of India and the world
Indian Polity and governance – constitution, political system, panchayati raj, public policy, Rights issues, etc.
Economic and social development – sustainable development, poverty, inclusion, demographics, social sector initiatives etc.
General issues on environmental ecology, bio-diversity and climate change-that donot require subject specialization
General science.

(Paper II) (200 marks) – Duration : Two hrs

Comprehension
Interpersonal skills including communication skills
Logical reasoning and analytical ability
Decision making and problem solving
General mental ability
Basic numeracy (numbers and their relations, orders of magnitude etc. (Class X level), Data interpretation (charts, graphs, tables, data sufficiency etc. –Class X level)
English language comprehension skills (Class X level)

From Civil Service Examination 2011, Preliminary Examination would consist of two papers- Paper I and Paper II.

The syllabus and pattern of the Preliminary Examination would be as under :
(Paper 1) (200 marks) – Duration : Two hrs.

Current events of national and international importance
History of India and Indian national movement
Indian and World Geography- physical, social, economic geography of India and the world
Indian Polity and governance – constitution, political system, panchayati raj, public policy, Rights issues, etc.
Economic and social development – sustainable development, poverty, inclusion, demographics, social sector initiatives etc.
General issues on environmental ecology, bio-diversity and climate change-that donot require subject specialization
General science.

(Paper II) (200 marks) – Duration : Two hrs

Comprehension
Interpersonal skills including communication skills
Logical reasoning and analytical ability
Decision making and problem solving
General mental ability
Basic numeracy (numbers and their relations, orders of magnitude etc. (Class X level), Data interpretation (charts, graphs, tables, data sufficiency etc. –Class X level)
English language comprehension skills (Class X level)