Recurrence of hepatitis C virus after treatment with pegylated interferon and direct acting antivirals in Punjab Pakistan / Recorrência do vírus da hepatite C após tratamento com interferon peguilado e antivirais de ação direta em Punjab, Paquistão

Although increased response rates concomitant in hepatitis C virus but relapse after treatment is threatened. Therefore, it is terrible requirement to evaluate the response of Pegylated interferon and direct acting antivirals in Punjab Pakistan. The study was conducted to find the rate of recurrence of HCV infection after treatment with Pegylated Interferon and Direct Acting Antivirals in Punjab Pakistan. This study was conducted at Department of Pathology, Nawaz Sharif Medical College Gujrat, while treatment effects monitored in different Government and Private Hospitals of Punjab, Pakistan. Total 973 patients who administered the recommended dose and divided in two groups (i) Interferon based therapy (ii) direct acting antivirals (DAAs).Other parameters like ALT and viral load studied. The rate of recurrence was higher in female infected with genotype 2b and in male with mixed genotype 3a/2b after six month of antiviral therapy. Genotype 3a showed significant response to therapy after three month. 32 among 374 (8.5%) were positive after 24 weeks of treatment with interferon, 29 (7.7%) patients have same genotype while 3 patients were re-infected with different HCV strains. With DAAs, only 27 (4.8%) patients were positive among 558 after 2 weeks and one patient re-infected with different genotype. Early and sustained virological response noted in DAAs. ALT and viral load decreased faster with DAAs that not achieved after 4 weeks with pegylated interferon. Sustained virological response appears in DAAs and recurrence rate is high in interferon therapy compared to DAAs. Therefore, reinfection has implications for correct treatment efficiency and to select strategies for retreatment cases.

Embora aumentem as taxas de resposta concomitantes no vírus da hepatite C (HCV), há risco de recidiva após o tratamento. Portanto, é um requisito terrível avaliar a resposta do interferon peguilado e antivirais de ação direta em Punjab, Paquistão. O estudo foi conduzido para encontrar a taxa de recorrência da infecção por HCV após o tratamento com interferon peguilado e antivirais de ação direta em Punjab, Paquistão. Este estudo foi conduzido no Departamento de Patologia Nawaz Sharif Medical College Gujrat, enquanto os efeitos do tratamento foram monitorados em diferentes hospitais públicos e privados de Punjab, Paquistão. Total de 973 pacientes que administraram a dose recomendada foram divididos em dois grupos: (i) Terapia baseada em interferon, (ii) antivirais de ação direta (DAAs). Outros parâmetros como ALT e carga viral foram estudados. A taxa de recorrência foi maior em mulheres infectadas com o genótipo 2b e em homens com genótipo misto 3a / 2b após seis meses de terapia antiviral. O genótipo 3a mostrou resposta significativa à terapia após três meses. 32 entre 374 (8,5%) foram positivos após 24 semanas de tratamento com interferon, 29 (7,7%) pacientes têm o mesmo genótipo, enquanto 3 pacientes foram reinfectados com diferentes cepas de HCV. Com DAAs, apenas 27 (4,8%) pacientes foram positivos entre 558 após duas semanas e um paciente reinfectado com genótipo diferente. Resposta virológica precoce e sustentada observada em DAAs. ALT e carga viral diminuíram mais rapidamente com DAAs, que não alcançou após 4 semanas com interferon peguilado. A resposta virológica sustentada aparece em DAAs, e a taxa de recorrência é alta na terapia com interferon em comparação com DAAs. Portanto, a reinfecção tem implicações para a eficiência do tratamento correto e para selecionar estratégias para casos de retratamento.

The stimulator of interferon genes (STING) agonists for treating acute myeloid leukemia (AML): current knowledge and future outlook

Acute myeloid leukemia (AML) is an aggressive hematologic cancer in adults. Some patients exhibit restricted T cell infiltration and do not respond to routine treatments. This may be prevented by enhancing adaptive immunity by stimulating innate immune cells inside the tumor microenvironment (TME). To activate the adaptive immunological reaction against tumors, type I interferons (IFNs) can promote the presentation of tumor-specific cytotoxic T lymphocyte (CTL) cell recruitment. During the activation of innate immunity, cyclic di-nucleotides (CDNs) bind to and stimulate the stimulator of interferon genes (STING), a protein localized inside the endoplasmic reticulum (ER) membrane, resulting in the expression of type I IFNs. The efficacy of STING agonists as effective stimulators of the anti-tumor response in AML is being investigated in numerous clinical studies. Therefore, the purpose of this investigation was to thoroughly review existing knowledge in this field and provide perspective into the clinical potential of STING agonists in AML (AU)

Effectiveness of first-wave protease inhibitors in hepatitis C virus genotype 1 infection: a multicenter study in Brazil

Abstract INTRODUCTION: In 2013, combination therapy using peginterferon, ribavirin, and boceprevir or telaprevir was introduced to treat hepatitis C virus genotype 1 infection in Brazil. The effectiveness of this therapy in four Brazilian regions was evaluated. METHODS: Clinical and virological data were obtained from patients of public health institutions in five cities, including sustained virological response (SVR) and side effects. Patients with advanced fibrosis (F3/4), moderate fibrosis (F2) for > 3 years, or extra-hepatic manifestations were treated according to Ministry of Health protocol. Treatment effectiveness was verified by using bivariate and multivariate analysis; p-values of < 0.05 were considered significant. RESULTS: Of 275 patients (64.7% men; average age, 57 years old), most (61.8%) were treatment-experienced; 53.9% had subgenotype 1a infection, 85.1% had advanced fibrosis, and 85.5% were treated with telaprevir. SVR was observed in 54.2%. Rapid virological response (RVR) was observed in 54.6% of patients (data available for 251 patients). Overall, 87.5% reported side effects and 42.5% did not complete treatment. Skin rash, severe infection, and death occurred in 17.8%, 2.5%, and death in 1.4% of cases, respectively. SVR was associated with treatment completion, RVR, and anemia. CONCLUSIONS: The effectiveness of hepatitis C virus triple therapy was lower than that reported in phase III clinical trials, possibly owing to the prioritized treatment of patients with advanced liver fibrosis. The high frequency of side effects and treatment interruptions observed supported the decision of the Brazilian authorities to suspend its use when safer and more effective drugs became available in 2015.

Epiteliopatía progresiva en ondas tras neoplasia intraepitelial conjutival. Caso clínico atípico / Advancing wavelike epitheliopathy after conjunctival intraepithelial neoplasia. Atypical case report

Se presenta un caso atípico de epiteliopatía progresiva en ondas consecutiva a tratamiento tópico de una neoplasia intraepitelial conjuntival en 360°. Se usaron colirios de mitomicina (0,2mg/ml) e interferón (1MUI/ml). Presentación atípica con foco limbar principal migratorio, y no claramente delimitado en su sitio horario a través de su evolución. Tratado con flurometolona y lágrimas artificiales, con resultado de resolución completa (AU)

An atypical Advancing Wavelike Epitheliopathy case, consecutive to topical treatment for a 360° Conjunctival Intraepithelial Neoplasia, is presented. Mitomycin (0.2mg/ml) and interferon (1MUI/ml) drops were used. An atypical presentation, with migrating limbal focus, non clearly delimited in its hourly site through its evolution. Treated with flurometholone drops plus artificial tears, working to complete resolution (AU)

Therapeutic effectiveness of biosimilar standard interferon versus pegylated interferon for chronic hepatitis C genotypes 2 or 3

BACKGROUND: Pegylated interferon (Peg-IFN) and standard interferon (IFN) play a significant role in the treatment of hepatitis C virus (HCV) infection. Biosimilar standard IFN is widely available in Brazil for the treatment of HCV infection genotypes 2 or 3, but its efficacy compared to Peg-IFN is unknown. OBJECTIVE: To compare the sustained virological response (SVR) rates following treatment with biosimilar standard IFN plus ribavirin (RBV) versus Peg-IFN plus RBV in patients with HCV genotypes 2 or 3 infection. METHODS: A retrospective cohort study was conducted in patients with HCV genotypes 2 or 3 infection treated with biosimilar standard IFN plus RBV or with Peg-IFN plus RBV. SVR rates of the two treatments were compared. RESULTS: From January 2005 to December 2010, 172 patients with a mean age of 44 +/- 9.3 years were included. There were eight (4.7%) patients with HCV genotype 2 infections. One hundred fourteen (66.3%) were treated with biosimilar standard IFN plus RBV, whist 58 (33.7%) patients were treated with Peg-IFN plus RBV. Between the two groups, there were no significant differences regarding age, gender, glucose level, platelet count, hepatic necroinflammatory grade, and hepatic fibrosis stage. Overall, 59.3% (102/172) patients had SVR. In patients treated with Peg-IFN plus RBV, 79.3% (46/58) had SVR compared to 49.1% (56/114) among those treated with biosimilar standard IFN plus RBV (p = 0.0001). CONCLUSION: In patients with HCV genotypes 2 or 3 infection, a higher SVR was observed in patients receiving Peg-IFN plus RBV related to patients treated with biosimilar standard IFN plus RBV.

Interferones lambdas (IFNs-lambda) en infección con virus hepatitis C / Lamba interferons in infection with hepatitis C virus

The current standard therapy for patients chronically infected with hepatitis C virus (HCV) is the administration of pegylated interferon-alpha (PEG-IFN) plus ribavirin (RBV), eliminating the virus in only about half of patients infected with the genotype most common in Chile and the world (genotype 1), being higher for genotypes 2 and 3. Genotyping of the HCV is a strong predictor of treatment response, and it defines the treatment duration (48 weeks for genotype 1 and 24weeks for genotypes 2 and 3). Genome studies revealed the association of polymorphisms (SNPs) close to IL28B gene with increased spontaneous and treatment-inducing clearance for HCV, which are now evaluated as a strong predictor of treatment response. These SNPs are close to genes coding for type III IFNs family, known as IFNs lambda (IFNs lambda), composed by IFN lambda1 (IL29), IFN lambda2 (IL28A) and IFN lambda3 (IL28B). It has been shown that these cytokines are highly involved in antiviral immune responses, including HCV, playing IFN lambda1 a central role. Today, there is an ongoing study where pegylated IFN alpha1 was administrated in chronic HCV patients as alternative to IFN lambda therapy, seeking for a more specific response to infected hepatocytes and with fewer adverse effects.

Extended treatment with interferon and ribavirin in a hemodialysis patient with chronic hepatitis C

Hemodialysis patient with chronic HCV infection,who was started on monotherapy with interferon.Qualitative HCV RNA remained positive at 12 weeks of treatment; ribavirin was associated. HCV RNA was negative at week 24 and treatment was extended to 72 weeks. HCV RNA negative six months after treatment.

Long-term follow-up of patients with chronic hepatitis C with sustained virologic response to interferon

BACKGROUND AND AIM: The durability of the sustained virologic response (SVR) in patients with chronic hepatitis C after treatment and the ideal follow-up time for these patients remains undefined. The objective of the study was to evaluate the durability of the virologic response in patients with chronic hepatitis C followed up for at least 12 months after SVR at HCFMRP-USP. METHODS: The study was conducted on 174 patients with chronic hepatitis C treated with different antiviral regimens who had achieved SVR. Qualitative serum HCV-RNA was determined by the commercial kit (COBAS AMPLICOR HCV, v2.0). RESULTS: There was predominance of male (73 percent) with a mean age of 45.6 ± 10 years. Liver cirrhosis was present in 16.1 percent of the study subjects. Mean follow-up time after SVR was 47 months (12-156 months). Twenty-two patients received monotherapy with interferon; 94 received interferon plus ribavirin, and 58 received pegylated interferon plus ribavirin. A total of 134 patients (77.0 percent) received one treatment course, 29 (16.7 percent) received two courses, and 11 (6.3 percent) received three courses. The distribution of HCV genotypes was: genotype 1 (40.2 percent), genotype 3 (40.8 percent) and genotype 2 (10.3 percent). Genotype was undetermined in 8.7 percent of cases. None of the 174 patients had recurrence of HCV infection. Two cirrhotic patients developed hepatocellular carcinoma (HCC) during follow-up. CONCLUSIONS: Among patients with SVR there was no recurrence of HCV infection or evidence of liver disease progression in any patient followed up for a mean of 47 months after SVR, except for patients with advanced hepatic disease before treatment, who may develop HCC despite SVR. Therefore, one can assume that SVR is associated with long term good prognosis.

Chronic hepatitis C: hepatic iron content does not correlate with response to antiviral therapy / Hepatite C crônica: concentração hepática de ferro não é correlacionada com a resposta ao tratamento antiviral

The complex interaction between hepatitis C virus infection, iron homeostasis and the response to antiviral treatment remains controversial. The aim of this study was to evaluate the influence of hepatic iron concentration (HIC) on the sustained virological response (SVR) to antiviral therapy in patients with chronic hepatitis C. A total of 50 patients who underwent pretreatment liver biopsy with assessment of HIC by graphite furnace atomic absorption spectroscopy and were subsequently submitted to antiviral treatment with interferon/peginterferon and ribavirin were included in the study. Patients with alcoholism, history of multiple blood transfusion, chronic kidney disease, hemolytic anemia and parenteral iron therapy were excluded. The iron related markers and HIC were compared between those who achieved an SVR and non-responders (NR) patients. The mean age was 45.7 years and the proportion of patients' gender was not different between SVR and NR patients. The median serum iron was 138 and 134 µg/dL (p = 0.9), the median serum ferritin was 152.5 and 179.5 ng/mL (p = 0.87) and the median HIC was 9.9 and 8.2 µmol/g dry tissue (p = 0.51), for SVR and NR patients, respectively. Thus, hepatic iron concentration, determined by a reliable quantitative method, was not a negative predictive factor of SVR in patients with chronic hepatitis C presenting mild to moderate hepatic iron accumulation.

A complexa interação entre infecção pelo vírus da hepatite C, homeostase do ferro e resposta ao tratamento antiviral permanece controversa. O objetivo deste estudo foi avaliar a influência da concentração hepática de ferro (CHF) na resposta virológica sustentada (RVS) à terapia antiviral na hepatite C crônica. Foram incluídos 50 pacientes que foram submetidos à biopsia hepática pré-tratamento com determinação da CHF por espectrofotometria de absorção atômica com forno de grafite e tratados posteriormente com interferon/peginterferon e ribavirina. Pacientes com alcoolismo, história de múltiplas transfusões sanguíneas, doença renal crônica, anemia hemolítica e terapia com ferro parenteral foram excluídos. O perfil de ferro sérico e a CHF foram comparados entre aqueles que atingiram RVS e os não-respondedores (NR). A média de idade dos pacientes foi 45,7 anos e não houve diferença na proporção de homens e mulheres entre os grupos RVS e NR. A mediana do ferro sérico foi 138 and 134 µg/dL (p = 0.9), a mediana da ferritina sérica foi 152,5 e 179,5 ng/mL (p = 0,87) e a CHF mediana foi 9,9 e 8,2 µmol/g de tecido seco (p = 0,51), para pacientes com RVS e NR, respectivamente. Concluindo, a concentração hepática de ferro, determinada por um método quantitativo confiável, não foi um fator preditivo negativo de RVS em pacientes com hepatite C crônica e acúmulo de ferro hepático leve a moderado.

Histological response study of chronic viral hepatitis C patients treated with interferon alone or combined with ribavirin

Chronic hepatitis C is often a progressive, fibrotic disease that can lead to cirrhosis and other complications. The recommended therapy is a combination of interferon and ribavirin. Besides its antiviral action, interferon is considered to have antifibrotic activity. We examined the outcome of hepatic fibrosis and inflammation in chronic hepatitis C patients who were non-responders to interferon. We made a case series, retrospective study, based on revision of medical records and reassessment of liver biopsies. For inclusion, patients should have been treated with interferon alone or combined with ribavirin, with no virological response (non responders and relapsers) and had a liver biopsy before and after treatment. Histological evaluation included: i-outcome of fibrosis and necroinflammation; ii-annual fibrosis progression rate evaluation, before and after treatment. Seventy-five patients were included. Fifty-seven patients (76 percent) did not show progression of fibrosis after treatment, compared to six (8 percent) before treatment (p < 0.001). The mean annual fibrosis progression rate was significantly reduced after treatment (p = 0.036). Inflammatory activity improved in 19 patients (25.3 percent). The results support the hypothesis of an antifibrotic effect of interferon-based therapy, in non-responder patients. There was evidence of anti-inflammatory effects of treatment in some patients.

Tratamiento de la infección crónica por VHC en pacientes coinfectados por el VIH / Treatment of chronic hepatitis C virus infection in human immunodeficiency virus (HIV) infected patients

El tratamiento de la infección por el virus de la hepatitis C (VHC) en los pacientes coinfectados por el virus de la inmunodeficiencia humana (VIH) se ha convertido en un tema de gran importancia, ya que las complicacionesde la hepatopatía son actualmente la primera causa de mortalidad entre el colectivo con infección por el VIH. El objetivo de este trabajo es revisar los datos biológicos y epidemiológicos de la coinfección, y sobre todo las pautas de tratamiento a seguir, valorando las complicaciones producidas por los fármacos utilizados y sus interacciones, e informar de los resultados de los principales estudios realizados. La pauta de tratamiento actualmente aceptada incluye interferón pegilado y ribavirina. Con estos fármacos han mejorado los resultados respecto a pautas previas, aunque la respuesta es variable según el genotipo- VHC que presente el paciente

Treatment of chronic hepatitis C Virus (HCV) infection in human immunodeficiency virus (HIV) infected patients has become a topic of great importance, since the complications of chronic hepatitis are the first one cause of mortality among HIV patients. The aim of this study is to review the biological and epidemiological data in HIV-HCV coinfection, to establish treatment guidelines taking in consideration drugs adverse effects and interations, and to report the results of the main studies carried out. The treatment currently accepted includes pegylate interferon and ribavirin, wich have improved prior treatments, but the respouse rate depends on HCV genotype

Efectividad y seguridad de sorafenib en pacientes con cáncer renal de células claras, metastásico, sin respuesta a inhibidores de tirosin-quinasa o citoquinas (interleuquina o interferón), riesgo bajo-intermedio / Effectiveness and safety of sorafenib in patients with clear-cell, metastatic renal cancer without response to tyrosine kinase inhibitors or cytokines (interleukin or interferon), low-intermediate risk

Introducción: en el mundo, en relación con la frecuencia de todos de cánceres de cualquier localización, el cáncer renal se encuentra dentro de los diez más frecuentes en hombres y el catorceavo en mujeres (1). Existen varias opciones terapéuticas de segunda línea en aquellos pacientes con cáncer renal avanzado o metastásico, sin respuesta a inhibidores de tirosina-quinasa o citoquinas, que pueden incluir medicamentos como: Inhibidores de mTOR (Temsirolimus, everolimus), inhibidores de tirosinquinasa (Sunitinib, sorafenib, pazopanib, axitinib), y otros inhibidores de la angiogénesis como bevacizumab. Dadas las opciones planteadas se hace necesario conocer la efectividad y la seguridad de estas intervenciones. Objetivo: examinar los beneficios y riesgos del uso de sorafenib como uno de los criterios para informar la toma de decisiones relacionada con la posible inclusión de tecnologías en el Plan Obligatorio de Salud, en el marco de su actualización ordinaria para el año 2015. Metodología: la evaluación fue realizada de acuerdo con un protocolo definido a priori por el grupo desarrollador. Se realizó una búsqueda sistemática en MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, LILACS y Google, sin restricciones de idioma, fecha de publicación y tipo de estudio. Las búsquedas electrónicas fueron hechas en noviembre de 2014 y se complementaron mediante búsqueda manual en bola de nieve y consulta con expertos temáticos. La tamización de referencias se realizó por dos revisores de forma independiente y los desacuerdos fueron resueltos por consenso. La selección de estudios fue realizada mediante la revisión en texto completo de las referencias preseleccionadas, verificando los criterios de elegibilidad predefinidos. Las características y hallazgos de los estudios fueron extraídos a partir de las publicaciones originales. Resultados: Efectividad existe mejoría significativa para el desenlace de supervivencia libre de progresión a favor de sorafenib comparado con placebo, con un HR 0,44 (IC 95 % 0,35-0,55; I2 11%) mediante comparación indirecta; se reportó mejoría significativa para el desenlace de supervivencia libre de progresión a favor de sunitinib comparado con sorafenib, con un HR 1,63 (IC 95% 1,09- 2,45); mejoría significativa para el desenlace de supervivencia libre de progresión a favor de axitinib comparado con sorafenib, con un HR 0,67 (IC 95% 0,54- 0,81). Seguridad: mediante comparación indirecta, reportó que el axitinib disminuye del 45% del abandono de terapia secundaria a eventos adversos cuando se compara con sorafenib (IC 95% 0,24-0,84). No se encontraron diferencias estadísticamente significativas para los desenlaces de: abandono de terapia y diarrea. Para el desenlace de fatiga se presenta un incremento del riesgo con axitinib comparado con sorafenib, RR 2,30 (IC 95% 1,34-4,10). Sorafenib incrementa el riesgo de reacción cutánea mano-pie comparado con axitinib, RR 0,31 (IC 95% 0,17-0,52), así como, incremento del riesgo de rash, RR 0,10 (IC 95% 0,02-0,41) en la misma comparación. El axitinib incrementa el riesgo de estomatitis RR 8,1 (IC 95% 1,1->100). Conclusiones: efectividad: Sorafenib presenta mejoría significativa en la supervivencia libre de progresión cuando se compara con placebo. Al comparar de manera indirecta sorafenib con otros agentes como axitinib y sunitinib, se reportó mejoría de la supervivencia libre de progresión significativa clínicamente a favor de axitinib y sunitinib. No se reportaron desenlaces de efectividad clínicamente significativos con otros agentes como: pazopanib, everolimus, temsirolimus. En esta revisión no se identificó evidencia que cumpliera con los criterios de inclusión y que comparara sorafenib con bevacizumab, ni evidencia que reporte los desenlaces de supervivencia global y calidad de vida. Seguridad: En relación con la seguridad del tratamiento de segunda línea con sorafenib se evidencia de manera general un aumento del riesgo de presentar eventos adversos grado III/IV. Al evaluar el desenlace de abandono de terapia secundaria a eventos adversos se evidencia que sorafenib aumentó el riesgo, comparado con axitinib. Para el desenlace de reacción cutánea mano-pie el uso de sorafenib presenta aumento del riesgo comparado con placebo, pazopanib, axitinib y everolimus. Sorafenib reporta aumento de riesgo de presentar rash comparado con axitinib, así como, de diarrea cuando se compara con placebo. En esta revisión no se identificó evidencia que cumpliera con los criterios de elegibilidad y que comparara sorafenib con bevacizumab.(AU)

Infección aguda por el VHC / Acute hepatitis C virus infection

La infección aguda por el virus C de la hepatitis produce un cuadro clínico y bioquímico no específico e indistinguible de los causados por otros virus hepatotropos. El diagnóstico específico de la hepatitis aguda por virus C se basa en la detección en sangre del RNA-VHC mediante una técnica de reacción en cadena de la polimerasa cuyo resultado será positivo a partir de 1-2 semanas tras el contacto inicial con el virus. Los anticuerpos frente al VHC se detectan más tardíamente (a las 7-8 semanas por término medio) no siendo útiles, como determinación aislada, para distinguir infección aguda de infección crónica o aclaramiento del virus (espontáneo o tras tratamiento). El 55-85 por ciento de los pacientes con infección aguda por el VHC no aclaran el virus y desarrollan una infección crónica con riesgo de evolución a cirrosis y de desarrollo de hepatocarcinoma. Por ello, la tendencia actual es tratar con interferón a todos aquellos pacientes en los que el RNA-VHC se mantenga positivo más allá de 3-4 meses tras el diagnóstico de la infección aguda (AU)

Un caso de melanoma maligno meníngeo en un varón adulto que debuta con paraplejia / A case of meningeal malignant melanoma in an adult man presenting with paraplegia

Este es el caso de un varón afecto de un probable melanoma meníngeo que debuta con una paraplejia por compresión medular. El melanoma maligno de localización en el sistema nervioso central varía en las características citológicas mucho más que en otros lugares. En ocasiones puede resultar muy dificultosa e incluso imposible su precisa clasificación histológica. Paralelamente se revisará el tratamiento bioquimioterápico en este tipo de tumores (AU)

Tratamiento de la infección por el virus de la hepatitis C. Estado actual y perspectivas / Treatment of hepatitis C virus infection: current status and perspectives

El tratamiento actual de los pacientes con hepatitis C crónicaes el interferón pegilado y la ribavirina. La aplicación dela cinética viral está permitiendo optimizar el tratamientovariando Ia pauta de 24 semanas para genotipos 2 y 3, y 48para los demás genotipos. Así, los pacientes con genotipo 1con una carga viral baja y una rápida respuesta virológicaobtienen una alta respuesta viral sostenida con 24 semanasde tratamiento. Por el contrario, los pacientes respondedoreslentos pueden beneficiarse de 72 semanas de tratamiento.Los pacientes con genotipo 2 y 3 también pueden beneficiarsede las pautas según la cinética viral. En los pacientesno respondedores al tratamiento actual se ha ensayado dosismás altas y tiempos más prolongados, aunque para gran númerode ellos no tenemos otra opción que esperar una nuevageneración de fármacos. El tratamiento de mantenimientocon dosis bajas de interferón para prevenir la cirrosis y/o elhepatocarcinoma está siendo evaluado

Current treatment of patients with chronic hepatitis C consistsof pegylated interferon and ribavirin. The application ofviral kinetics is currently allowing treatment to be optimizedby varying the length of treatment to 24 weeks for genotypes2 and 3 and 48 weeks for the remaining genotypes. Thus, patientswith genotype 1, with a low viral load, and rapid virologicalresponse (RVR) obtain a high RVS with 24 weeks’treatment. In contrast, slow responders may benefit from 72weeks’ treatment. Patients with genotypes 2 and 3 can alsobenefit from regimens designed according to viral kinetics.Higher doses and more prolonged periods have been testedin non-responders to current treatment, although for many,the only option is to wait for a new generation of drugs.Maintenance therapy with low-dose interferon to preventcirrhosis and hepatocarcinoma is currently being evaluated

Unidad de atención continuada y hospital de día como alternativa a la hospitalización convencional: experiencia de 10 años en un hospital comarcal / Continuing care unit and day hospital as an alternative to conventional hospitalization: 10 years’ experience in a district hospital

La unidad de atención continuada y hospital de día permite el manejo ambulatorio de los pacientes con una enfermedad digestiva. Objetivo: Disminuir los ingresos hospitalarios y el número de pacientes con una enfermedad digestiva que acude a urgencias. Material y métodos: Los pacientes se atienden según dos niveles asistenciales: a) atención continuada, en que se visitan de forma urgente los pacientes con una descompensación aguda de su enfermedad digestiva, y b) atención programada, en que se realizan procedimientos que por su complejidad requieren personal de enfermería, sin ser necesario el ingreso hospitalario. Resultados: En el período comprendido entre 1995 y 2005 se ha pasado de realizar 118 visitas en atención continuada en 1995 a 784 en 2005. En atención programada las paracentesis han aumentado de 237 en 1995 a 687 en 2006 y las infusiones de hierro intravenoso de 111 en 2004 a 519 en 2006. El número de ingresos hospitalarios pasó inicialmente de 605 en 1995 a 430 en 2000, para posteriormente aumentar. El número de pacientes con una enfermedad digestiva que acudió a urgencias disminuyó un 75% estos años. Conclusiones: La unidad de atención continuada y hospital de día permite una disminución inicial del número de ingresos en el área de hospitalización convencional y en el porcentaje de pacientes con patología digestiva que acuden a urgencias

The continuing care unit and day hospital allows ambulatory care of patients with digestive diseases. Aim: Reducing hospital admissions and the number of patients with digestive diseases that attend the emergency department. Material and methods: Two types of care are provided: a) continuing care; patients are urgently visited when they show acute decompensation of their digestive disease, and b) scheduled care: procedures that, due to their complexity, require nursing care but not necessarily hospital admission. Results: In the period 1995-2005, visits to the continuing care unit increased from 118 in 1995 to 784 in 2005. In scheduled care, the number of paracentesis increased from 237 in 1995 to 687 in 2006. Intravenous iron infusions increased from 111 in 2004 to 519 in 2006. The number of hospital admissions initially decreased from 605 in 1995 to 430 in 2000, and then increased. The number of patients with digestive diseases attending the emergency department decreased by 75% throughout the period studied. Conclusions: The continuing care unit and day hospital allowed an initial reduction in the number of conventional hospitalizations and in the percentage of patients with digestive diseases attending the emergency department

Lamivudina / Lamivudine

No disponible

No disponible