There is a strong association between porphyria cutanea tarda (PCT) and chronic viral hepatitis C. Therapy for chronic viral hepatitis C may improve PCT. However, there are only a few reports of the de novo development of PCT during therapy for chronic viral hepatitis C. We describe the development of PCT in a 56-year-old patient with chronic viral hepatitis C after 12 wk of peginterferon/ribavirin therapy. In addition, the patient was homozygous for the H63D hereditary hemochromatosis gene (HFE) mutation. The association of PCT with chronic viral hepatitis C and the possible role of hepatic iron overload and ribavirin-induced hemolytic anemia in the development of PCT during therapy for chronic viral hepatitis C are discussed.
literature. Nurses are often portrayed as victims, passive actors, with physicians seen as the perpetrators instigating ''aggressive'' or ''disproportionate'' care against a child's interests. The decision-making is criticized, generally without mention of the parents who are also decision-makers: the patient and the moral dilemma are often lost in the dialogue. Within the medical literature, moral distress is described in terms of dilemmas or ethical confrontations, despite evidence of constrained practice. None of the articles mention the potential moral distress parents have when making life-and-death decisions for their children. Conclusions: Moral distress is generally experienced when individuals disagree about life-and-death decisions. Our role-defined accounts of moral distress vary. In the shared decision-making context, parents should also be asked about the moral distress associated with these difficult decisions. Our egocentric investigations relative to moral distress make us wonder who the victim really is.
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