Effectiveness and safety of ombitasvir, paritaprevir, ritonavir ± dasabuvir ± ribavirin: An early access programme for Spanish patients with genotype 1/4 chronic hepatitis C virus infection.

Over the last 5 years, therapies for hepatitis C virus (HCV) infection have improved significantly, achieving sustained virologic response (SVR) rates of up to 100% in clinical trials in patients with HCV genotype 1. We investigated the effectiveness and safety of ombitasvir/paritaprevir/ritonavir±dasabuvir in an early access programme. This was a retrospective, multicentre, national study that included 291 treatment-naïve and treatment-experienced patients with genotype 1 or 4 HCV infection. Most patients (65.3%) were male, and the mean age was 57.5 years. The mean baseline viral load was 6.1 log, 69.8% had HCV 1b genotype, 72.9% had cirrhosis and 34.7% were treatment-naïve. SVR at 12 weeks posttreatment was 96.2%. Four patients had virological failure (1.4%), one leading to discontinuation. There were no statistical differences in virological response according to genotype or liver fibrosis. Thirty patients experienced serious adverse events (SAEs) (10.3%), leading to discontinuation in six cases. Hepatic decompensation was observed in five patients. Four patients died during treatment or follow-up, three of them directly related to liver failure. Multivariate analyses showed a decreased probability of achieving SVR associated with baseline albumin, bilirubin and Child-Pugh score B, and a greater probability of developing SAEs related to age and albumin. This combined therapy was highly effective in clinical practice with an acceptable safety profile and low rates of treatment discontinuation.

[Furuncular myiasis]. / Miasis furunculosa.

Prior knowledge of foruncular myiasis in Africa and American specially México, is reviewed, leading to current criteria for definitive on of this disease. The Dermatobia genus, species hominis, are parasitic for man. Our cases belong to the latter. Epidemiological studies show the States of Tabasco, Chiapas and Campeche as most heavily affected, specially during the rainy season in which insects proliferate including vectors. Clinical studies confirmed five evolutionary stages of larvae. In the first stage larvae show a wide anterior and a narrow distal ends. The latter curls in. They show noticeable rings and reach up to 1 cm. in length. In the second stage, at 15 days, larvae resemble a segmented dagger. In the third stage, at 30 days, become ovate, showing rings and cyliae, the worms being white and soft. In the fourth stage, at 45 days, the worms are two cms. long and one cm. thick, the cyliae becoming more abundant and black. At 50 days structures suggesting wings appear. Adult Dermatobia are large flies, two cms. in length, with long extremities, a brown thorax, and a purplish blue abdomen, with a metallic sheen. Man becomes infested through arthropod bites or bathing in a pool larvae reach inside follicles, giving rise to erythema, papules and severe pruritus, Papules increase in size, infiltrate subcutaneous tissue, forming bluish red hard nodules, 1-2 cms. in length, which contain one or several larvae. From 10 to 60 days, their tops show an ecchymotic plaque which breaks down. The parasites come out usually dead. Besides pruritus symptoms include pain, a burning sensation, perception of larval motion.(ABSTRACT TRUNCATED AT 250 WORDS)