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0:18 Bismillahirrahmanirrahim. Peace be upon 0:21 you, brothers and sisters, may Allah 0:24 have mercy on you. Alhamdulillah, thank 0:27 God, we can be together again at the 0:31 health room event, a series of events 0:34 that will make us even more prepared to 0:41 face our days ahead, in a condition 0:45 where health is a very important part 0:50 for us to maintain. Hopefully everyone 0:54 is healthy. Amen. And of course, 0:59 hopefully what we are discussing this 1:03 time will make us understand more about 1:08 what we will and must do. Meanwhile, 1:13 the doctor present today is a doctor 1:16 who, if I'm not mistaken, was also with 1:19 us some time ago at our event, namely 1:22 Dr. Dasril Nizam, an internal medicine 1:25 specialist. And today's discussion is 1:30 related to what viruses are these? 1:34 Hepatitis and how to treat it, prevent 1:37 it and all kinds of things. Of course, 1:40 we also send salawat to the leader of 1:42 our beloved nation, Muhammad Rasulullah 1:45 sallallahu alaihi wasallam. May we 1:47 receive his intercession and be 1:49 reunited with him at the time we long 1:52 for in the final day. Sisters, our 1:55 resource person is here. Peace be upon 1:59 you. Peace be upon 2:02 you. May Allah bless you. Are you 2:03 healthy, Doc? Yes, 2:05 healthy, Ms. Nuning. Alhamdulillah. 2:06 Alhamdulillah. So, it turns out that 2:09 the heart isn't only grieved by love. 2:11 Yes, that's 2:12 right. That's right. It can be because 2:13 of other things, 2:14 it can be because of other things. 2:15 Hepatitis also affects the heart, right 2:17 , Doc. 2:17 Yes. 2:17 Okay, 2:18 Broken, 2:20 Sisters, let's listen with our ears and 2:25 with our hearts. Please, Doc. 2:29 Yes. Okay, Sisters, on this occasion we 2:36 want to discuss viral liver disease. 2:42 Hepatitis is a disease that we often 2:50 encounter in our society, and there may 2:54 be many causes. Hepatitis can be caused 2:58 by viruses, drugs, or autoimmune 3:03 diseases. 3:05 It can also be caused by bacterial 3:08 infections or by consuming too much of 3:11 certain foods, such as alcohol, 3:14 chemicals, and so on. This time, we're 3:19 discussing viral hepatitis. Why is this 3:25 happening? Because it's quite common in 3:30 our society. For example, hepatitis B 3:35 and C cause chronic, potentially 3:39 serious illnesses with complications, 3:43 as does hepatitis A. Now, we also know 3:47 about hepatitis D. So, there are at 3:51 least five known causes of viral 3:54 hepatitis: 3:56 hepatitis A, hepatitis B, hepatitis C, 4:01 hepatitis D, and hepatitis E. Okay, 4:07 let's explain these five viral 4:11 hepatitis diseases one by one. 4:16 In general, this condition, hepatitis, 4:21 is an inflammation of the liver, which 4:26 has probably been affecting our society 4:31 for a long time. The main cause of 4:36 viral hepatitis is the hepatotropic 4:41 group, which is a virus that attacks 4:45 only the liver or favors the liver. 4:51 There's also the nonpathotropic group, 4:55 which is a virus that attacks the 4:57 system and also attacks the liver. 5:00 There are two groups of names. Other 5:04 causes of EE, as previously explained, 5:07 include chemicals, drug abuse, certain 5:11 medications, autoimmune diseases, 5:14 bacteria, toxins, and alcohol. Okay, 5:19 let's discuss what we know as hepatitis 5:25 A one by one. Hepatitis A most commonly 5:30 affects children, adolescents, and 5:36 young adults. That's its prevalence. 5:40 Compared to hepatitis B and C, it 5:44 usually occurs more frequently in 5:48 adults. Hepatitis C tends to affect 5:54 older adults, meaning those 40 and 5:59 older. So, based on the age 6:01 distribution, hepatitis A is probably 6:05 from 20 years old and under, up to 20 6:08 to 29 years old. The group up to 30 6:11 years old is hepatitis B. Those 40 and 6:14 older are more or less the same as 6:16 hepatitis C. That's the general 6:18 prevalence. Meanwhile, hepatitis D is a 6:24 type of hepatitis that is often found 6:27 together with hepatitis B. Its 6:30 incidence is 6:32 very low, around 10 to 20%in chronic 6:36 hepatitis B sufferers. Then, hepatitis 6:40 E is found to be transmitted through 6:44 water, which is also similar to 6:47 hepatitis A. So, between A and E, 6:51 transmission is the same through the 6:55 mouth, contaminated food, fluids. As 6:59 for hepatitis B, C, and D, it is 7:04 through serum or fluids, needles, and 7:09 so on. Let's go back to hepatitis A. So 7:15 , hepatitis A usually occurs in 7:19 children. We often know that in 7:22 childhood, children get yellow 7:25 hepatitis A. 7:27 Well, that's usually 7:28 hepatitis A disease in children, 7:32 although there is no possibility of 7:37 hepatitis B. Yes, it is symptomatic 7:37 because usually hepatitis A is 7:38 symptomatic. Well, hepatitis B is also 7:45 symptomatic, but some are asymptomatic, 7:48 silent. However, hepatitis A is mostly 7:51 symptomatic. What are the symptoms? 7:54 Symptoms are fever, fatigue, decreased 7:58 appetite, nausea, and vomiting. 8:01 Sometimes there's discomfort in the 8:05 upper right abdomen or in the abdominal 8:09 area. It's also characterized by dark 8:15 urine, dark like dark tea, and the eyes 8:20 can also be yellow. That's a sign of 8:24 hepatitis A. So, the person won't want 8:27 to eat, feels nauseous, and vomits. 8:34 Serology tests will indicate hepatitis 8:39 A, where a blood test will reveal a 8:43 positive HAV anti-virus. There's also 8:49 an increase in liver enzymes, which are 8:53 signs of general liver inflammation. 8:57 For example, SG1 and SGPT enzymes are 9:01 sometimes accompanied by bile duct 9:06 levels. This duct level is a sign of 9:12 impaired bile flow and bile metabolism. 9:19 This inflammation causes edema, which 9:23 also inflames the bile ducts in the 9:30 liver. Nausea and vomiting are signs of 9:35 digestive disorders. Ladies and 9:40 gentlemen, inflammation results in 9:46 impaired digestion, resulting in 9:52 decreased motility. Because if he moves 9:59 a lot, he ee me me affects the 10:02 inflammatory process. Well, food too. 10:07 If we eat too much that stimulates 10:12 digestion, for example, too much fat or 10:16 stimulants, that will also disrupt 10:20 digestion because most digestion is 10:25 synthesized in the liver and stomach. 10:31 This Hepat A can actually be cured 10:36 because the cure is with rest, yes, 10:40 that is accompanied by a proper, 10:44 proportional, adequate diet, namely 10:49 avoiding foods that burden liver 10:53 function, such as foods that are high 10:58 in fat. Well, we avoid that. We 11:01 recommend foods that are high in 11:04 carbohydrates or those that do not 11:08 burden digestion, for example, those 11:11 that are easily digested. Then also 11:16 avoid high proteins. So just enough 11:21 protein. Plus, there will be 11:26 hepatoprotectors to protect liver 11:30 function and these vitamins. Meanwhile, 11:35 prevention is because it is related to 11:38 food, yes, it is transmitted fecal-oral 11:42 from the feces of a hepatitis A 11:45 sufferer who passes out, he will later 11:48 ee because of poor hygiene sanitation, 11:52 yes, maybe in the process of ee making 11:55 food, yes, maybe where, yes, in a stall 11:59 or where drinking ice, yes, where the 12:02 ice is made from unclean water 12:05 contaminated with the hepatitis C virus 12:08 from feces, then the transmission 12:12 occurs. So it is very important to 12:14 explain food safety, healthy 12:16 environmental sanitation and also 12:18 vaccination. Well, thank God, 12:21 vaccination is now available, brothers 12:25 and sisters, ee through injections, yes 12:28 . It will be given twice, injected 12:33 intramuscularly, either in the deltoid 12:37 or in the upper arm or in the thigh, or 12:44 intramuscularly, repeated every 6 12:49 months. Yes, that will later stimulate 12:54 the emergence of antibodies against 12:56 hepatitis A called immunoglobulin A. 13:01 Yes. Then once immunoglobulin A has 13:05 appeared, it is sufficient to protect 13:09 ee ourselves from the virus that causes 13:14 infection in our hepatitis, namely 13:18 hepatitis A. So who are these ee who 13:22 are candidates for vaccination are, yes 13:27 , children, yes, it can also be nurses 13:31 or those in endemic areas where 13:33 hepatitis A is common. 13:36 Well, that's why we recommend 13:39 vaccination. So, in most cases, 13:42 hepatitis A is actually very easy to 13:46 treat. However, in certain severe cases 13:50 , what's called cholestasis can occur, 13:56 a type of cholestasis in hepatitis A 14:01 where, uh, it can't be cured with 14:05 medication. The jaundice persists, even 14:09 though the SG SPT has dropped, but the 14:11 bilirubin remains high. Well, this type 14:18 of cholestasis is rare, but when it 14:20 does occur, it's very severe. But 14:23 patients usually don't have a fatal 14:26 outcome like hepatitis B or C. 14:29 Hepatitis B, which has jaundice, is 14:32 severe. It's usually called fulminant 14:34 hepatitis, which can cause death. In 14:37 hepatitis A, this doesn't happen. After 14:39 an EE identification, if there are no 14:41 other causes besides hepatitis A, 14:43 steroids can be administered. If no 14:45 hepatitis B or C virus is found, only 14:47 hepatitis A is found. In this type of 14:55 cholestasis, tests are carried out, 14:58 even if the bilirubin level is high, 15:00 what is the EE marker for high jaundice 15:02 , which is called cholestasis? It can 15:05 be more than 10, for example, which is 15:08 called severe cholestasis. Moderate 15:11 cholestasis is between 3 and 10. Mild 15:15 cholestasis is below 3. E is because 15:19 the normal bilirubin value is between 1 15:22 and 3, which is when it tends to rise. 15:27 If that happens, the bilirubin level 15:30 will decrease, and the patient can 15:34 recover and return to work as usual. If 15:38 that doesn't work, plasmapheresis is 15:40 performed with steroids. This treatment 15:44 is for severe cases of hepatitis A. But 15:48 in general, hepatitis A can be treated 15:52 well, through rest, BRES, a liver diet, 15:56 hepatoprotective therapy, or vitamins. 16:00 Then with certain medications. So, when 16:04 the patient recovers, they can return 16:06 to work. It might take 5 days of rest 16:09 at home until the SG and SGPT levels 16:13 are normal, then they can resume their 16:16 activities, work, or school. 16:19 That's all about hepatitis A. Now let's 16:22 move on to hepatitis B. 16:24 Hey, 16:25 fellow brothers and sisters. Ahah. This 16:29 is hepatitis B. We did know about 16:32 hepatitis B before hepatitis C, right? 16:37 Hepatitis B is a rather serious problem 16:40 because it causes chronic liver disease 16:43 . Hepatitis B 16:44 can also cause complications, leading 16:49 to nearly 1 million deaths per year in 16:55 Indonesia. Globally, 310 million deaths 17:00 are due to hepatitis B, which can lead 17:04 to complications such as cirrhosis. 17:08 Hepatitis B, on the other hand, causes 17:11 340 million deaths due to liver cancer. 17:15 So, there are approximately 240 million 17:19 people worldwide with hepatitis B. 17:23 Therefore, going forward, we are aiming 17:27 to be free of hepatitis B by 2030. 17:32 Government programs, including 17:34 vaccination, must also be supported. 17:36 Hepatitis B can also be effectively 17:38 eradicated through healthy 17:43 environmental sanitation and avoiding 17:46 unprotected sex. Hepatitis B is 17:49 transmitted through serum, through 17:54 shared needles, or through bodily 17:57 fluids. Body fluids, for example, 18:02 through serum, can include blood, 18:06 saliva, vaginal fluids, or semen. So, 18:11 how is transmission? The virus can be 18:18 transmitted, for example, through 18:22 scrapings from someone who has the same 18:27 coin. That can be dangerous. Also, for 18:32 example, in acupuncture, cupping, and 18:38 tooth extraction, be careful when using 18:42 sterile needles, as transmission can 18:45 occur. Yes, like hepatitis C, hepatitis 18:49 B can also occur through needles. 18:52 Hepatitis C was previously known to be 18:54 transmitted through blood. Meanwhile, 18:57 hepatitis B can also be transmitted 19:01 through serum fluids, such as body 19:04 fluids. For example, from some of the 19:09 breast milk that is passed to the baby. 19:14 Likewise, transmission can also occur 19:18 through childbirth because during 19:21 childbirth, blood is transferred from 19:25 the mother to the baby, or through the 19:28 uterus, so the umbilical cord, from the 19:32 mother to the child. So, it must be 19:36 prevented, yes, later with vaccination. 19:39 There are also now, for hepatitis B, we 19:43 used to go through, eh, what vaccines 19:46 were imported, some were imported, some 19:50 were from abroad, or some were produced 19:53 domestically. Back in 19:56 the days of Pak Harto, Ibu 19:58 Nuning established a factory in Nusa 20:02 Tenggara. He. 20:03 Well, that became a government program. 20:05 So, after mass production, the 20:09 hepatitis B vaccination can be used for 20:13 babies and toddlers. That was a 20:16 government program. So, thank God, if 20:19 it's still around, I think, since the ' 20:24 50s and' 60s, there was free hepatitis 20:28 vaccination. Including us 20:32 at RSCM, when we were in the PBDS for 20:35 internal medicine, we were also given 20:38 free BPDS vaccinations by RSCM. It's a 20:42 bit expensive, at Rp 150,000, but one 20:46 file is three basic vaccinations. 20:50 Hepatitis A was twice, and hepatitis B 20:52 was three times. So now, at 0, 1 month, 20:56 and 6 months, the three basic hepatitis 20:59 B immunizations are needed to produce 21:03 antibodies called anti-HBS. 21:06 Hmm. Anti-HBS. If anti-HBS is present, 21:11 it's enough to protect, protect, 21:15 prevent more severe damage to liver 21:19 cells. Now, this is about liver B. So, 21:24 let's briefly explain how hepatitis B 21:28 can cause cirrhosis. Cirrhosis is a 21:31 disease caused by liver B, which causes 21:35 chronic hepatitis B. Well, there is a 21:38 chronic active disease called that. 21:42 Well, that's where it's left untreated, 21:45 undetected, or it takes a long time to 21:48 be discovered, then it will turn into a 21:51 shriveled state. Because fibrosis 21:55 occurs, fibrosis of liver cells causes 21:58 scar tissue, causing fibrosis. Fibrosis 22:03 is shrinkage, so the shriveled liver 22:09 compresses the blood vessels in the 22:14 liver. 22:15 Huh. Blood vessels, arteries, veins, 22:19 are pinched, or vessels, uh, what are 22:22 they called? Lymphatic. So, as a result 22:27 , blood flow from the digestive tract 22:36 cannot enter. So the elevation of the 22:40 venous pressure of the portal vein, yes 22:43 , the portal vein increases, three 22:47 portal veins, ee, which are from the 22:50 vein, meaning the blood vessels 22:53 returning to the spleen towards the 22:58 liver, it should be able to because of 23:01 the increase in 23:03 portal pressure, it is diverted to the 23:07 azygos vein in the stomach here in the 23:10 esophagus, so it thickens, pharisees 23:14 occur, like if we look at ee mothers 23:18 after giving birth, ee, they are wide, 23:21 Ms. Nuning, what are the blood vessels, 23:25 blue, 23:26 protruding like small snakes. Well, 23:29 that also happens with pharisees in the 23:31 esophagus like that. So, it protrudes 23:34 so it's very easy if we eat hard things 23:37 , ee, it can be touched, bleeding, so 23:40 it leaks like that. So the symptoms of 23:45 hepatitis with cirrhosis can be 23:48 recognized by vomiting blood, Ms. 23:51 Nuning. He can 23:53 also have black stools because 23:57 ee, blood mixes with stomach acid, it 24:01 becomes black because there are hematin 24:05 spots. So, HCl stomach acid with 24:11 hemoglobin turns into hematin. Hematin 24:16 is a black dye. So that's why the color 24:19 of the stool is like tar, like coffee. 24:24 So the color is a sign of vomiting 24:26 blood and black stools are signs of 24:29 hepatitis B. Then there can also be 24:32 abdominal enlargement 24:34 due to 24:35 fluid accumulation called ascites, 24:38 right? This is ASIES. So, that's why 24:40 this hepatitis B program is a 24:42 government program that we really have 24:45 to work together to reduce the number 24:47 of complications to prevent. Besides 24:51 that, Sir, it can also require liver 24:55 cancer, which is said to reach 340,000 24:59 deaths per year due to liver cancer 25:02 caused by hepatitis B worldwide. Huh, 25:06 yes, that's a huge number. We also see 25:09 a lot of experience here, I also have 25:13 hepatitis B causing more liver cancer 25:16 than hepatitis C, that's what I 25:19 experienced, right? 25:21 Yes, that's 25:22 it. So the incubation period of the 25:25 virus is 2 to 4 to 24 weeks. Huh. So 25:29 usually transmission occurs through 25:32 sexual contact, sharing needles, 25:36 other drug injection equipment, and 25:40 from mother to baby during childbirth. 25:44 So the signs are the same as general 25:48 fatigue, decreased appetite or even 25:53 worsening, stomach ache, nausea, yellow 25:58 skin and eyes, and tea-like urine. Well 26:02 , that's it. So that's hepatitis Bicah 26:07 through ee not careless use of 26:11 synthetic needles. Also, normal sexual 26:16 relations are good, as well as 26:22 vaccination. We continue with hepatitis 26:26 C. A has been, B has been. Now C. 26:28 Hepatitis 26:29 C was discovered around 1991, right? 26:37 Well, that's even earlier, younger. The 26:41 first time hepatitis A was identified 26:43 was in the 26:44 1940s, hepatitis B in the 1950s. Well, 26:50 this hepatitis B was identified around 26:53 1990, and 26:54 hepatitis C was discovered. Heeh. 1991. 26:58 So, hepatitis C is ee is a viral 27:02 disease that is RNA, different from 27:06 hepatitis B. If hepatitis B is a DNA 27:10 virus, DNA deoxyribonucleid comes from 27:15 the type of hepatnavirus. While 27:19 hepatitis C is plavivirus. Heeh. RNA. 27:25 RNA. So, in the chromosome, the 27:32 ribonucleic acid is only 27:35 single-stranded, not double-stranded, 27:39 just one. Likewise, hepatitis A is also 27:43 included in RNA, as is the picornavirus 27:47 . So, hepatitis C was discovered in the 27:57 early 90s. Our friend, our senior 27:59 professor, Dr. 28:03 Sometimes, who was the head of the 28:06 internal medicine department, studied 28:10 hepatitis C in CABG patients undergoing 28:14 heart surgery at Harapan Kita. Well, 28:18 around 4%of the 28:20 patients who received blood 28:23 were found to have hepatitis C, which 28:27 is quite high. So, after Dr. Dadang's 28:31 research, we were careful about 28:33 receiving blood transfusions. There 28:37 might be a hepatitis C virus that 28:40 contaminates the prospective recipient 28:44 of the blood. Yes, that's why since 28:47 then, donors have been screened. If 28:50 there is, they definitely cannot be 28:52 donated. They also cannot be given to 28:55 healthy people, you know. That's why 28:59 screening before donating is important, 29:02 it's quite high and it can cause, uh, 29:05 liver cancer. At that time, the rate of 29:07 liver cancer was very high. If you have 29:10 hepatitis C, it can develop into liver 29:12 cancer, almost, more than 60%; In the 29:15 past, there was no cure, up to 80%. 29:18 Be careful because it is chronic, while 29:22 hepatitis B is 50%or 60%, it's not 29:26 silent, Ms. Nuning, 29:28 silent, the symptoms are mild, 29:30 asymptomatic, and then suddenly it just 29:32 gets better. 29:33 Heeh. 29:34 Yes. Ee there are also a few other 29:38 symptoms because it is not detected so 29:40 it is not known that it has hepatitis 29:43 B. 29:43 He. 29:44 Well, while those who are symptomatic, 29:47 yes, a certain percentage, the 29:49 remaining 30%are symptomatic, it can 29:52 become chronic and severe. Yes. Heeh. 29:55 Now hepatitis C is actually a bit more 29:58 worrying because the vaccine has not 30:01 been found. 30:03 Heeh. 30:03 Unlike hepatitis B. Heeh. 30:06 So if there is no cure for hepatitis C, 30:10 we only do prevention. So prevention is 30:13 healthy environmental sanitation, 30:16 avoiding free sex, 30:17 avoiding the use of unsterile needles, 30:21 there is no vaccination yet. So that's 30:25 all we do, eh, prevention. Meanwhile, 30:29 treatment may later be done with 30:33 antivirals, analogous. Ee for hepatitis 30:39 C, you can be given antiviral drugs 30:43 where in 3 months it can be completely 30:47 cured. So the virus is gone, but 30:51 therapy must be done quickly. If it's 30:57 too late, even though it's gone, it's 31:00 already had time to change, sometimes 31:04 becoming malignant, cancer can still 31:07 occur. So, from liver C, it can also 31:10 become cancer, Ms. Duning. 31:12 So, it can become cancer in both liver 31:13 B and liver C 31:15 because it can cause cirrhosis. 31:19 Cirrhosis is shrinkage. In liver B, it 31:23 causes cirrhosis and cancer. Hepatitis 31:27 C can also cause cirrhosis and cancer. 31:30 So, in addition to this, interferon can 31:35 also be given. Interferon injections 31:40 and, uh, DAA drugs. So, with hepatitis 31:46 C, if you get hepatitis C compared to 31:50 hepatitis B, from the 2000s until now, 31:55 more than 2000, it was already in 2015, 32:00 it can be controlled, it can be cured. 32:05 Most of our patients at PORI Hospital 32:09 are cured for hepatitis C. Hepatitis B 32:13 is very rare. Since 2012, I've had 32:16 hepatitis B that has improved after 32:19 being given tenofovir, the antiviral 32:22 for hepatitis B. There were four people 32:26 . 32:27 Two of them, uh, their hepatitis B 32:30 became negative, and they stopped HBS. 32:34 The other two were only HBV DNA 32:38 negative, and HBVDN negative, of those 32:42 four people. So, it's not clear yet for 32:45 the other two. But those two have 32:48 really developed anti-HBS, and their 32:53 HBSAG has disappeared. Meanwhile, for 32:57 hepatitis C, we've had experience since 33:00 2015 because the drugs were given free 33:02 of charge, Ms. Nuni. 33:04 Huh. 33:04 Given by the government. 33:06 Yes. 33:06 Yes. What is the anti-, uh, uh, 33:10 antiviral drug? This antiviral can be 33:14 obtained. So, they can be negative 33:18 within 3 months. Huh. But the treatment 33:23 must be fast and, uh, according to the 33:26 treatment instructions. So, that's 33:30 hepatitis C. Now we move on to 33:33 hepatitis D. So, what is hepatitis D? 33:39 Hepacitic is a rare hepatitis disease 33:42 that occurs simultaneously with 33:45 hepatitis B infection. 33:47 Huh. 33:48 This case is very rare. It usually 33:51 accompanies a hepatitis B infection. 33:54 This disease is caused by the hepatitis 33:58 D virus, hepatitis D, or HDV, which 34:02 causes liver inflammation like other 34:06 viruses. Interestingly, a person cannot 34:09 be infected with the hepatitis D virus 34:12 if they are not infected with hepatitis 34:14 B. So, there must be a hepatitis B 34:16 virus first. Hehe. So, it can't infect 34:20 itself. 34:21 Yes. 34:22 Eh, sufferers without hepatitis B. If 34:25 there is chronic hepatitis B, it will 34:29 be found in almost 5%of chronic 34:32 hepatitis sufferers with an incubation 34:35 period of hepatitis D between 4 and 12 34:39 weeks. So, until now, there is no 34:43 specific vaccine for this hepatitis D. 34:46 Hehe. 34:47 But it will automatically be protected 34:50 after receiving the hepatitis B vaccine 34:53 in patients who want to be vaccinated. 34:56 Yes. Therefore, in cases of acute 34:59 hepatitis, the examination team usually 35:01 only looks at the results of the 35:03 presence or absence of hepatitis B 35:05 infection. If declared negative for 35:08 hepatitis B, it means the patient is 35:11 also negative for hepatitis D. So, 35:15 prevention and treatment are almost the 35:19 same as for hepatitis B. Healthy 35:21 environmental sanitation is important, 35:25 avoiding unprotected sex, and avoiding 35:28 the use of unsterile needles. Hepatitis 35:32 B vaccination is also possible. 35:35 Treatment is the same as a liver diet 35:37 and hepatoprotective agents. This is 35:41 the last time regarding hepatitis E. 35:45 Hepatitis E 35:46 was discovered, yes, when our colleague 35:52 , Dr. Jarot, reported it. Dr. Jarot was 35:57 with us at the Faculty of Medicine, 36:01 University of Indonesia, and he was 36:03 assigned to West Kalimantan. He 36:05 apparently heard about the incident in 36:09 Vietnam and Thailand involving women 36:13 bathing in the river. There, in the 36:17 Kalimantan river, there were also 36:20 reports of jaundice, a hepatitis 36:23 disease. It turned out that the virus 36:26 was O, not hepatitis B, not hepatitis A 36:28 , not hepatitis C, not D. It turned out 36:31 to be hepatitis E. Well, that's why we 36:34 thank Dr. Jarot, our colleague, because 36:37 this was the first incident in 36:40 Indonesia in West Kalimantan where 36:42 women washing clothes in the river were 36:45 reported to have hepatitis E. Now, what 36:48 is the typical percentage of hepatitis 36:51 E during pregnancy? 10%can be dangerous 36:55 . 36:56 So the disease becomes severe. So, 36:59 that's why special treatment is needed 37:03 for pregnant women who are affected by 37:06 hepatitis E. So, the symptoms are the 37:10 same, but they still have a weak body, 37:13 right, like the symptoms of hepatitis A 37:17 , there are yellow eyes, nausea, 37:20 vomiting, not feeling well, sometimes 37:23 there is pain in the upper right 37:26 abdomen and so on. Well, the treatment 37:30 is rest, liver diet, they are given 37:33 hepatoprotectors and vitamins, right. 37:36 So food security and healthy 37:38 environmental sanitation are also 37:40 important. So, we, uh, so the water 37:43 source is very important, the water 37:46 source must be properly controlled, 37:50 like that, Ms. Nuning. 37:52 Yes. That's more or less our 37:55 explanation. Maybe if there are 37:57 questions later, B, please B. 37:59 Yes. Masyaallah. So, brothers and 38:03 sisters, we often hear about hepatitis 38:07 A, B, C, D, E, but the differences 38:10 between one and the other, the causes 38:13 and how to treat them, I think we never 38:17 fully understand, right? And today we 38:21 have discussed what we all heard 38:24 earlier. Meanwhile, for questions, 38:28 Doctor. Someone has already come in 38:32 from Mr. Rahmat in South Jakarta. 38:36 Doctor, many diseases can be directly 38:39 felt by the symptoms. But hepatitis is 38:42 called a silent disease because it 38:46 comes silently. According to the doctor 38:51 , with conditions like this, why is our 38:55 public awareness of our liver health 38:58 relatively low compared to other 39:01 diseases like heart disease or diabetes 39:05 ? So, because it's a silent disease, 39:09 what should we do so that we and other 39:13 people care and can detect health 39:17 problems related to the liver before 39:21 they occur. Thank you very much, Mr. 39:25 Rahmat. 39:26 Okay, okay. Thank you for your question 39:30 , Mr. Rahmat. This is a very good 39:33 question. Regarding our awareness of 39:38 hepatitis, this disease is also a 39:42 government program to protect the 39:46 public from infectious diseases. So in 39:52 developed countries like Japan, where 39:55 screening occurs, screening occurs 39:58 during check-ups and so on, 40:01 surveillance is carried out, for 40:04 example, to determine the number of 40:07 people in certain areas affected by 40:11 hepatitis B, C, or A, and to check for 40:14 antibodies. Check for anti-HAV, for 40:18 example, HBsAg. Anti-HCV, like the 40:24 signs of hepatitis A, hepatitis B, or 40:28 hepatitis C, does require costs. 40:32 Frankly, our level of awareness and 40:35 concern, Mr. Rahmat, is not like that 40:37 of developed countries. Well, that's 40:42 because we're considered not yet 40:48 progressive, our decision-makers here. 40:51 Therefore, for those of us like Mr. 40:54 Rahmat, who are now progressive, it's 40:57 very important to identify. So, consult 41:01 a doctor, a 41:03 pediatrician for example. How can you 41:08 detect hepatitis B early? Because the 41:13 earlier it's detected, the more 41:16 preventable it can be. For example, in 41:20 children, uh, it's very dangerous if 41:23 it's not monitored, not detected, and 41:26 not followed up on, because the 41:28 complication rate is very high. In 41:32 infants, toddlers, and teenagers, the 41:35 prognosis varies. The most serious is 41:38 if it's not controlled in infants. Well 41:42 , that will increase the risk of 41:45 chronic hepatitis B, complications such 41:48 as cirrhosis or cancer. Well, likewise, 41:52 in general, hepatitis C prevention is 41:56 that we shouldn't use needles 41:59 carelessly, and 42:01 especially now, there's the model, 42:05 drug use. Yes. 42:07 Now, be careful about smoking and so on 42:10 , that doesn't mean smoking among 42:13 people who are having promiscuous 42:16 relationships, right? There are drugs, 42:20 right? Sometimes they have promiscuous 42:22 relationships. They use unsterile tools 42:30 . Well, that can touch the skin, right? 42:33 You can get hepatitis B, hepatitis C, 42:36 or even other viruses like HIV. Well, 42:40 that's what we need to be aware of, eh, 42:44 ask professionals, pediatricians, 42:48 internists, and other 42:51 doctors. For example, at the Community 42:53 Health Center, there's definitely an 42:54 immunization program, right? Well, we 42:56 get immunized. At least now there are 42:59 two forms of immunization, hepatitis A 43:01 and hepatitis B. Well, if we just 43:04 follow the existing program from the 43:06 Indonesian Institute of Sciences, right 43:09 ? 43:09 Heeh. That's what 43:11 saves us. But sometimes we forget, eh, 43:15 the Community Health Center forgets to 43:18 remind us. If the hepatitis can't be 43:21 treated, maybe the prevention is 43:23 already prevention, right? My answer is 43:26 yes, indeed, 43:28 ee, in developed countries it's free, 43:32 for example, complications from liver B 43:35 have been screened for, ultrasound, 43:39 city scan, MRI, so it can be found out 43:45 early or not, if the tumor is still 43:49 small, 3 cents, it can still be removed 43:52 by surgery, it's cured. In our country, 43:56 the tumor is already large, 43:58 then we realize it's 43:59 sick. 44:00 But by the way, is BPJS covering the 44:03 processes of 44:04 finding out about this hepatitis? 44:06 Yes. Well, for BPJS, if it's a 44:08 government program, yes, the one in the 44:11 community, ee, at the Community Health 44:15 Center, 44:16 if the hepatitis B vaccination is still 44:18 covered. If I heard the news, yes, 44:22 during the Pak Harto era and then in 44:26 the 90s, it was already available, 44:32 right? Now it's not still available. 44:34 I don't know because I'm an internist. 44:38 Some children, if you look at it, it's 44:40 in the 44:40 form of vaccination books, that's why 44:43 pediatricians have it. So there should 44:47 be, especially if I used to know that 44:51 hepatitis A was treated with oral drops 44:54 , like polio now, but there are 44:57 injections 44:59 that are good. So, you have to ask your 45:03 pediatrician. Heeh. If it's free, thank 45:08 God, if there is a program that must be 45:11 achieved by the community health center 45:15 , it's a 45:16 shame this vaccination is good, besides 45:19 there are for polio, smallpox, or tibi, 45:22 and some vaccinations, there are 45:25 measles. 45:26 Yes. 45:27 There is hepatitis B. Hopefully, there 45:29 will be an announcement soon. Please 45:31 have a free mass vaccination. Doctor 45:34 Rahmat, 45:35 or we can advocate, we can demand it, 45:38 right? 45:39 As a society, how can this be done so 45:43 that we don't get complications from 45:46 hepatitis later if it's not controlled. 45:52 Yes. Yes. So, sisters, if we urinate or 45:57 what is it called? Our feces are 46:00 different colors, please. This is 46:02 probably part of what we should pay 46:04 attention to. Okay, Doc. We happen to 46:07 be at the end. Maybe, from what we 46:10 discussed, we can close the idea. Go 46:14 ahead. 46:15 Yes. Okay, Ms. Nuning, colleagues. Dear 46:21 sisters, dear viewers, perhaps for this 46:27 coronavirus hepatitis, we need to 46:34 understand that this is actually a 46:38 preventable infectious disease. So 46:42 there are two forms of prevention: oral 46:49 prevention. 46:50 Hmm. Yes. Prevention through the skin. 46:55 Yes, just the skin. If it's through 47:01 that, there are two diseases, namely 47:03 hepatitis A and hepatitis E. A and E, 47:05 yes. A, B, C, D, E. Well, it's 47:09 through the mouth. In the fecal-oral 47:13 route, it's passed on, transmitted 47:16 through feces to the mouth, oral, and 47:20 swallowed. Well, that's usually the 47:23 defense system, eh, immunoglobulin A, 47:27 which is in the digestive tract here. 47:31 Well, for hepatitis B, C, and D, it's 47:34 through the skin. 47:37 Hmm. For example, there are tattoos on 47:41 the skin, right? Well, using 47:43 non-sterile needles. Well, that can be 47:46 transmitted from other people to our 47:49 skin. Tattoos, for example, eh, 47:52 syringes, can also be non-sterile 47:56 syringes. Not medical personnel, maybe 48:00 they're used for drugs. Ah, we can 48:04 prevent that, like cupping. Be careful 48:08 not to use the same coin from other 48:11 people, cupping and so on, that must be 48:15 considered. Well, for some cases, when 48:20 I was at the Pori Hospital, I also 48:24 found that I was assigned to this, uh, 48:28 HIV disease at the PORI Hospital. How 48:33 come my patient was found to be HIV 48:36 positive, he is a massage therapist. 48:41 Massage therapist. Massages athletes at 48:46 the central center in Senayan. So how 48:52 come I never had any kind of contact? 48:56 So maybe there were blood wounds from 49:00 some athletes or artists that he 49:03 massaged who had HIV. So, 49:06 according to my logic, that's how he 49:08 contracted it. So it could be from the 49:11 skin, so from the mouth, it could be 49:14 diseases A and E, and from the skin, uh 49:21 , diseases B, C, and D. That's roughly 49:27 our summary. Hopefully, it's useful. 49:31 Thank you, Doctor. And ikhwan akhwat. 49:34 Before we end this gathering, there is 49:38 information that God willing, there 49:41 will be a Tasin Tilawah Al-Qur'an 49:45 congregational gathering held on Sunday 49:48 , tomorrow, June 14th from 0.30 to 49:52 11.00 at the Silaturahim ee Mosque near 49:55 Studio Rasil. The event will be 49:59 presented by Ustazah Dara M. Anisa and 50:03 this activity is open to the public so 50:06 please, if you have time, listeners, 50:10 congregations and their families to 50:13 attend together in this event full of 50:17 knowledge and blessings. Doctor, once 50:20 again thank you very much and to the 50:23 brothers and sisters, God willing, we 50:26 are given the ability to be able to 50:28 live our days with much healthier body 50:31 and soul. If today's discussion is 50:34 related to hepatitis, hopefully we 50:36 understand more. Once again, may Allah 50:39 grant us guidance and guidance. 50:40 Wasalamualaikum warahmatullahi 50:42 wabarakatuhikumsalam. 
