I nterferon alfa (IFN), lamivudine, and adefovir dipivoxil are the only approved treatments for chronic hepatitis B. IFN treatment has a moderate efficacy and frequent side effects, and is associated with an inconvenient 3-timesweekly dosing regimen. Lamivudine and adefovir have significant antiviral activity, although viral rebound after cessation of therapy and development of resistance after long-term lamivudine therapy are major clinical limitations.The new pegylated forms of IFN (pegylated interferon alfa-2a or 2b) are currently being evaluated among chronic hepatitis B patients. The benefit of conjugation of IFN with polyethylene glycol is the improvement of delivery of IFN by significantly prolonging its plasma halflife and thereby providing protracted activity, which allows once-per-week dosing. Results from trials among hepatitis B e antigen (HBeAg) (ϩ) or HBeAg (Ϫ) chronic hepatitis B patients indicate that treatment with pegylated interferon alfa-2a is superior to conventional interferon alfa-2a or lamivudine monotherapy. 1-3 The combination of pegylated interferon alfa-2a or alfa-2b and lamivudine was not found to improve sustained response rates over pegylated interferon monotherapy in HBeAg (Ϫ) or HBeAg (ϩ) chronic hepatitis B patients, respectively. 3,4 Mathematical modeling of the dynamics of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection during antiviral therapy has provided useful insight into viral replication, host cell death rate, and treatment efficacy. [5][6][7] In the last years, similar studies have been Abbreviations: IFN, interferon alpha; HCV, hepatitis C virus; HBV, hepatitis B virus; ALT, alanine aminotransferase; LMV, lamivudine; QD, daily; QW, once weekly. From the

IntroductionNon-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of metabolic syndrome (MetS), is common and accounts for 80% of cases of elevated liver function tests (LFTs). We assessed the long-term effects of multifactorial intervention on LFTs and their association with cardiovascular disease (CVD) events in patients with MetS without diabetes mellitus or CVD.Material and methodsThis prospective, randomized, open label study included 1,123 patients (aged 45-65 years). Patients received intensive lifestyle intervention and pharmacotherapy: atorvastatin in all patients (low density lipoprotein cholesterol [LDL-C] targets of<100 mg/dl [group A] or<130 mg/dl [group B]), inhibitors of the renin-angiotensin-aldosterone axis for hypertension, metformin for dysglycaemia and orlistat for obesity.ResultsAmong participants, 326 had modestly elevated LFTs and ultrasonographic (US) evidence of NAFLD (165 patients in group A2 and 161 patients in group B2). The NAFLD resolved during the 42-month treatment period in 86% of patients in group A2 and in 74% of patients in group B2 (p<0.001). In both groups nearly 90% of patients attained lipid goals. Mean LDL-C and TG levels were higher in group B2 than in group A2 (p<0.001). There were no CVD events in group A2 whereas 5 non-fatal events occurred in group B2 (log-rank-p = 0.024). There were no major side-effects.ConclusionsAttaining multiple treatment targets is safe and beneficial in primary prevention patients with MetS and NAFLD. Lipid levels and LFTs normalized, US findings associated with NAFLD resolved and no CVD events occurred in patients with LDL-C levels<100 mg/dl (group A2). Resolution of NAFLD might have contributed to the prevention of CVD events.

Presence of spur cells in patients with advanced cirrhosis is not always accompanied by spur cell anemia. The presence of 5% spur cells or more and/or hemolytic anemia is associated with poor prognosis and these patients might have to be given priority for liver transplantation.

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SUMMARY BackgroundHeparin could be beneficial to the treatment of active ulcerative colitis because of its anticoagulant, anti-inflammatory and immunomodulatory properties.