SUMMARY. The disease burden of hepatitis C virus (HCV) is expected to increase as the infected population ages. A modelling approach was used to estimate the total number of viremic infections, diagnosed, treated and new infections in 2013. In addition, the model was used to estimate the change in the total number of HCV infections, the disease progression and mortality in 2013-2030. Finally, expert panel consensus was used to capture current treatment practices in each country. Using today's treatment paradigm, the total number of HCV infections is projected to decline or remain flat in all countries studied. However, in the same time period, the number of individuals with late-stage liver disease is projected to increase. This study concluded that the current treatment rate and efficacy are not sufficient to manage the disease burden of HCV. Thus, alternative strategies are required to keep the number of HCV individuals with advanced liver disease and liver-related deaths from increasing.

The use of NAC causes reduction in NAI-ALF mortality and its use was safe.

SUMMARY. Detailed, country-specific epidemiological data are needed to characterize the burden of chronic hepatitis C virus (HCV) infection around the world. With new treatment options available, policy makers and public health officials must reconsider national strategies for infection control. In this study of 15 countries, published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates were gathered from the literature and validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Iran and Lebanon to 4.2% in Pakistan. The largest viraemic populations were in Pakistan (7 001 000 cases) and Indonesia (3 187 000 cases). Injection drug use (IDU) and a historically unsafe blood supply were major risk factors in most countries. Diagnosis, treatment and liver transplant rates varied widely between countries. However, comparison across countries was difficult as the number of cases changes over time. Access to reliable data on measures such as these is critical for the development of future strategies to manage the disease burden.

SUMMARY. The total number, morbidity and mortality attributed to viraemic hepatitis C virus (HCV) infections change over time making it difficult to compare reported estimates from different years. Models were developed for 15 countries to quantify and characterize the viraemic population and forecast the changes in the infected population and the corresponding disease burden from 2014 to 2030. With the exception of Iceland, Iran, Latvia and Pakistan, the total number of viraemic HCV infections is expected to decline from 2014 to 2030, but the associated morbidity and mortality are expected to increase in all countries except for Japan and South Korea. In the latter two countries, mortality due to an ageing population will drive down prevalence, morbidity and mortality. On the other hand, both countries have already experienced a rapid increase in HCV-related mortality and morbidity. HCV-related morbidity and mortality are projected to increase between 2014 and 2030 in all other countries as result of an ageing HCVinfected population. Thus, although the total number of HCV countries is expected to decline in most countries studied, the associated disease burden is expected to

BACKGROUND: Cancer patients frequently visit the emergency department (ED) with various symptoms of cancer. The purpose of this study was to determine the clinical characteristics and 1-year survival rate of cancer patients in the ED of a university hospital. METHODS:We conducted a retrospective review of 408 cancer patients who visited the ED between January 2011 and December 2011. Patient information on demographics, chief complaints, fi ndings, and survival was gathered from the hospital registry and corresponding health administration. RESULTS:The study included 240 (58.8%) males and 168 (41.2%) females with a median age of 57.9 years (range 19-87). Regarding cancer staging, 266 patients (65.3%) had metastatic disease and 142 (34.7%) had local and loco-regional disease. The hospitalization rate was 59.6%. The most common symptoms were shortness of breath (23.2%), pain (17.8%), fever (14.2%), and nausea/vomiting (14.4%). The most common cancer sites were the lung (32.5%), gastrointestinal system (25.4%), and breast (9.3%). The initial evaluation determined progressive disease (42.4%), chemotherapy effects (20.7%), infections (17.2%), radiotherapy effects (4.7%), extravasation (1.8%), anemia (1.4%), and unknown (11.3%). During follow up, 191 (46.8%) patients died after admission to the ED. The 1-year overall survival of all patients was 7.3 months.CONCLUSIONS: Symptom management in cancer patients is a complex multifaceted concern for the emergency physician. Because of the increasing prevalence of cancer patients, emergency physicians should develop consensus algorithms in collaboration with the relevant disciplines to manage the commonly encountered problems.

SUMMARY. The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 15 countries in Europe, the Middle East and Asia, and the relative impact of two scenarios was considered: [1] increased treatment efficacy while holding the annual number of treated patients constant and [2] increased treatment efficacy and an increased annual number of treated patients. Increasing levels of diagnosis and treatment, in combination with improved treatment efficacy, were critical for achieving substantial reductions in disease burden. A 90% reduction in total HCV infections within 15 years is feasible in most countries studied, but it required a coordinated effort to introduce harm reduction programmes to reduce new infections, screening to identify those already infected and treatment with high cure rate therapies. This suggests that increased capacity for screening and treatment will be critical in many countries. Birth cohort screening is a helpful tool for maximizing resources. Among European countries, the majority of patients were born between 1940 and 1985. A wider range of birth cohorts was seen in the Middle East and Asia (between 1925 and 1995).

It is well established that adjuvant treatment reduces mortality after early breast cancer. However, the optimal timing of adjuvant treatment is not well described. To determine the optimal timing of adjuvant treatment, 402 breast cancer patients who received adjuvant treatment at Ankara Oncology Research and Training Hospital between January 1995 and August 2002 were evaluated retrospectively. Three hundred and fifty-seven (88.8%) patients received adjuvant chemotherapy, 204 (50.7%) of these patients received only adjuvant chemotherapy and 153 (38%) patients received tamoxifen following chemotherapy. Remaining 45 (11.2%) patients received only adjuvant tamoxifen. The median time to start adjuvant treatment after surgery was day 21 (range, days 4 to days 258), and the median follow-up was 50 months (range, 6-105 months). The patients were divided into 5 groups according to starting time of chemotherapy (shorter than 14 days, between days 15-29, between days 30-44, between days 45.-59 and more than 59 days). Overall survival (OS) and disease-free survival (DFS) were not shown significantly different between for 5 groups (P>0.05). Secondly, patients were divided into two groups as starting adjuvant treatment equal to or shorter than 44 days and longer than 44 days (n=344, 85.6% and vs. n=58, 14.4%, respectively). OS was significantly better in patients who started to receive adjuvant treatment within 44 days after surgery compared to patients who received adjuvant treatment after 44 days (92 vs. 83.3%, P=0.03) for 5 years, but DFS was not significantly different between two groups (83.4 vs. 82.2%, P>0.05). According to our study, adjuvant treatment of breast cancer should be initiated earlier after surgery.

Background: Metastasis-directed therapy (MDT) utilizing stereotactic body radiotherapy (SBRT) for oligoprogressive lesions could provide a delay in next-line systemic treatment (NEST) change while undergoing androgen receptor-targeted agents (ARTA) treatment. We evaluated prognostic factors for prostate cancerspecific survival (PCSS) and progression-free survival (PFS) to characterize patients receiving treatment with ARTA who may benefit from MDT for oligoprogressive lesions. The impact of MDT on delaying NEST and the predictive factors for NESTfree survival (NEST-FS) were also assessed. Materials and Methods:The clinical data of 54 metastatic castration-resistant prostate cancer patients with 126 oligoprogressive lesions receiving abiraterone (1 g/day) or enzalutamide (160 mg/day) before or after systemic chemotherapy were analyzed. A median of three lesions (range: 1-5) were treated with MDT. The primary endpoints were PCSS and PFS. The secondary endpoints were time to switch to NEST and NEST-FS.Results: The median follow-up time was 19.1 months. Univariate analysis showed that the number of oligoprogressive lesions treated with SBRT and the time between the start of ARTA treatment and oligoprogression were significant prognostic factors for PCSS, and the timing of ARTA treatment (before or after chemotherapy) and the prostate-specific antigen (PSA) response after MDT were significant prognostic factors for PFS. Multivariate analysis showed that early MDT for oligoprogressive lesions delivered less than 6 months after the beginning of ARTA and higher PSA levels after MDT were significant predictors of worse PCSS and PFS.The median total duration of ARTA treatment was 13.8 months. The median time between the start of ARTA treatment and the start of MDT for oligoprogressive lesions was 5.2 months, and MDT extended the ARTA treatment by 8.6 months on average. Thirty-two (59.3%) patients continued ARTA treatment after MDT. ARTA treatment after chemotherapy, early oligoprogression requiring MDT, and lower