We observed a sustained viral response (SVR) of ombitasvir/paritaprevir/ritonavir, dasabuvir and ribavirin therapy, for 12 wk, in two cases with compensated liver cirrhosis and fully destroyed early hepatocellular carcinoma (HCC). Patients were infected with hepatitis C virus (HCV) genotype 1b and were previous null responders/relapsers to interferon-alpha/ribavirin (IFN/RBV). There was a rapid suppression of HCV RNA to undetectable levels within the first two treatment weeks. SVR was achieved even after marked reduction of the RBV dose. The treatment was well tolerated. Both subjects experienced worsening of liver disease during therapy, in different patterns: severe, transient, predominantly direct hyperbilirubinemia without cytolysis (case 1) or progressive increase of aminotransferases (grade 4) without severe hyperbilirubinemia (case 2). Adverse events spontaneously resolved. The patients remained in a good clinical condition without hepatic decompensation. There was no re-occurrence of HCC. This is the first report for treatment of HCV cirrhosis after complete HCC destruction.
Anemia of diverse etiology occurs in about 75% of patients with liver cirrhosis. Mucosal injury due to portal hypertension is an underestimated cause of occult bleeding and iron-deficiency anemia. Iron isomaltoside is a parenteral agent with low free-iron toxicity that is used as a short-term infusion without need of test-dose. There are no data on its safety and efficacy in patients with liver cirrhosis.Two males (30 and 66 years old) with Child-A liver cirrhosis and iron-deficiency anemia were evaluated. Both of them had pre-treatment hemoglobin level <90g/l. The older patient once was anti-RBC antibody positive once. No obvious signs and no recent history of blood-loss were established. The first patient had severe portal hypertension: large oesophageal varices with red signs and portal hypertensive gastropathy, while the other one was with significant portal colonopathy, hypertensive gastropathy and medium oesophageal varices. Endoscopic evaluation in both patients showed no active bleeding but marked mucosal friability. Other sources of blood-loss were excluded. Anemia had been previously orallytreated with ferric-hydroxide polymaltose complex, however no improvement was achieved. Both patients were treated with iron isomaltoside infusions. The younger one received a single dose of 1000 mg and after one month Hb levels increased from 80 to 122 g/l. The older subject was treated initially with 600 mg. As a result, Hb levels remained relatively unchanged. A second infusion in a dose of 1200 mg was given amonth later and elevation of Hb from 75 to 95 g/l was achieved. The ferritin rose from 14 to 23 ng/mL. Treatment was well tolerated and no side effects were observed. This is the first report for treatment of iron-deficiency anemia by iron isomaltoside infusion in cirrhotic patients. Further studies are needed to establish its safety and efficacy in subjects with liver cirrhosis.
Abstract:The transition from empirical and applied approach toward a scientific approach in modern medical disinsection is a result of the discoveries of the organic chemistry. The most intensive used substance in this field-DDT (dichlorodiphenyltrichloroethane) is introduced during World War II and contributes to world practical epidemiology just as antibiotics in clinical medicine. However, after the 70s, this substance was placed under a ban, because of the accumulated evidence of many adverse health and environmental impacts globally. Improvement of the insecticides after "DDT-era" is represented by the introduction of organophosphate and carbamate insecticides in the 1960s. Their broad application is determined by better ecotoxicological characteristics. The advance in biotechnology after the 1980s establishes the new class of insecticides-synthetic pyrethroids. Nowadays they are basic for the insect control. Pyrethroids are characterized by selective impact on insects with much less impact on warm-blooded animals and the environment. Insecticides from the newest class insect growth regulators realize their mode of activity by interfering with chitin metabolism and thus prevent an insect from reaching maturity. These substances have extremely low toxicity, which makes them very promising for the treatment of civilian and military facilities.
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