Evolutive Aspects Of Patients With Cirrhosis After Harvoni Therapy

2021 ◽  
Author(s):  
Mircea-Catalin Fortofoiu
Keyword(s):  
Antiviral Treatment ◽  
Antiviral Agents ◽  
Treatment Completion ◽  
Fixed Dose ◽  
Decompensated Cirrhosis ◽  
Hcv Rna ◽  
Study Group ◽  
Significant Difference ◽  
Before And After ◽  
Direct Antiviral Agents

Introduction: Cirrhosis, is a final pathway of chronic liver diseases. In recent years, Direct-Acting Antiviral Agents (DAAs) gained a leading role in the treatment of chronic hepatitis of viral etiology. Aim of the study: The proposed aims of this research are to estimate the virological response after 12 weeks after treatment completion and to evaluate the beneficial effects of the treatment on patients with decompensated cirrhosis. Patients and methods: The study was of a descriptive type, longitudinal and retrospective, conducted over a 15 months period, including patients with HCV-related cirrhosis patients. It was established the correlation between liver function, metabolic function, comorbidities and severity of cirrhosis and the level of HCV RNA before and after treatment. It was assessed also the neuroinflammatory activity from the results of Fibromas and the complication after therapy. Results: From January 2018 to April 2019, patients with liver cirrhosis were hospitalized. 48 HCV- related cirrhosis patients have fulfilled the eligibility criteria for antiviral treatment and they have constituted the study group. From all the HCV-infected patients with cirrhosis, 41.66% were women and 58.33% were men, most of them in the interval 60-70 years (37.5%) and 70-80 years (33,33%). 87.5% from the patients had compensated cirrhosis (Child-Pugh A class) and 12.5% had decompensated cirrhosis (Child-Pugh B and C class). 77.08% of the patients had severe neuroinflammatory activity – A3, 10.41% had moderate -A2 activity and 12.5% had lower neuroinflammatory activity-A1. The treatment with direct antiviral agents for the study group consisted in three treatment regimens.60% received a two-drug fixed-dose combination- sofosbuvir (SOF)/ledipasvir (LDV). 10% received SOF/LDV combination with Ribavirin. Only 1 patient with Child-Pugh C decompensated cirrhosis received SOF/LDV combination without Ribavirin. Also, a double combination received 10.48% of the patients- grazoprevir (GZR)/ elbasvir (EBR) 20.83% received quadruple combination ombitasvir (OBV)/ paritaprevir (PTV)/ritonavir(r) and dasabuvir (DSV). After 12 weeks from treatment completion, all the HCV-RNA’s level were undetectable. There were no side effects of the treatment. None of the patients didn’t stop the treatment during the period of treatment. There was a statistically significant difference between the ASAT and ALAT level before and after treatment (p<0.0001). 1 patient with Child-Pugh score C, died and another patient with Child-Pugh score B had an episode of variceal bleeding. Conclusion: Treatment with direct antiviral agents as Harvoni regimen, is a safe therapy and effective for HCV-infection and advanced liver disease. Despite the efficiency of the treatment on HCV-RNA, there were patients with complications due to the cirrhotic status of the subjects. The patients with existing decompensated cirrhosis remain at an elevated risk of numerous other complications.

The effects of breathing exercises on respiratory functions, functional capacity and quality of life in vehicle spray painters

2021 ◽  
Vol 28 (12) ◽  
pp. 1-8
Author(s):  
Burak Yilmaz ◽  
Cagtay Maden ◽  
Begümhan Turhan
Keyword(s):  
Quality Of Life ◽  
Functional Capacity ◽  
Control Group ◽  
Study Group ◽  
Breathing Exercises ◽  
Sf 36 ◽  
Significant Difference ◽  
Before And After ◽  
Respiratory Exercises

Background/aims Workers engaged in vehicle spray painting are at a risk of developing respiratory problems because of the solvents in the spray paints. Changes in respiratory functions and functional capacities caused by spray painting can be improved with respiratory exercises. The aim of this study was to examine the effects of respiratory exercises on the respiratory functions, functional capacity and quality of life in vehicle spray painters. Methods A total of 70 volunteers with similar characteristics participated in the study. The groups were divided into two groups randomly (35 study group, 35 control group). Respiratory functions (value of forced expiratory volume percentage in 1 second [FEV1]), forced vital capacity percentage [FVC], FEV1/FVC percentage, peak expiratory flow percentage [PEF (%)] and maximum voluntary ventilation percentage [MVV (%)]), functional capacity (6-Minute Walk Test) and quality of life (Short Form Health Survey [SF-36]) were evaluated. The study group undertook supervised breathing exercises 3 days a week for 6 weeks. The same exercises were given to the control group as a home programme. Home programmes were followed up by telephone calls. Evaluations were performed again after 6 weeks. Results In the study group, FEV1 (%) increased more than in the control group (P<0.05). The increase in PEF (%) was similar in both groups (P>0.05). In the study group, FEV1/FVC (%) and MVV (%) were significantly different before and after the intervention (P<0.05), but there was no difference in the control group (P>0.05). There was a greater increase in the study group than in the control group (P<0.05). 6-Minute Walk Test distance (m) before and after the intervention in both groups were similar (P>0.05). Before and after the intervention, a significant difference was found in the vitality and the social function domains of the SF-36 in the study group. In the comparisons of groups, a significant difference was found in the study group in the role-emotional, social function and bodily pain domains of the SF-36 after the intervention (P<0.05). Conclusions Breathing exercises can be recommended for vehicle spray painters to avoid an increase in respiratory resistance and to improve their quality of life.

Assessment of Doppler haemodynamic changes suggestive of portal hypertension in cirrhotic HCV patients after sustained virological response to direct antiviral agents

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mennatullah M Ezzat ◽  
Sara M Abdelhakam ◽  
Amira M Al-Balakosy ◽  
Ahmed A Ghalwash
Keyword(s):  
Portal Hypertension ◽  
Sustained Virological Response ◽  
Virological Response ◽  
Antiviral Agents ◽  
Liver Stiffness ◽  
University Hospital ◽  
Core Antigen ◽  
Hcv Rna ◽  
Haemodynamic Changes ◽  
Direct Antiviral Agents

Abstract Background Egypt has the highest prevalence rate of HCV in the world. About 14.7% of the Egyptian people have HCV antibodies and 9.8% have an active infection. The death rate due to liver disease about 40,000 each year (near10% of all deaths). It is the second after the cardiac diseases. Aim of Work to assess Doppler haemodynamic changes suggestive of portal hypertension in cirrhotic HCV Egyptian patients after sustained virological response to direct antiviral agents, and their correlation with liver stiffness measurements by Fibroscan. Patients and Methods This prospective cohort study was conducted at Viral Hepatitis Unit at Ain Shams University Hospital and Al-Agouza Police Hospital during the period from May 2018 to July 2019. The study included 50 Egyptian treatment-naïve chronic hepatitis C patients with cirrhosis on Sofosbuvir, Daclatasvir for 12 weeks. Patients were subjected to history and full physical examination, radiology assessment (Abdominal Ultrasound and color Doppler), Upper GI endoscopy and Fibroscan before treatment and 6 months after treatment. Followed up with CBC, AST, ALT, Total bilirubin, Albumin, creatinine and Coagulation profile before and after 12 weeks of treatment And HCV RNA by PCR and HCV CORE Antigen before and then after 12 weeks of treatment. Results Treatment with sofosbuvir plus Daclatasvir for 12weeks resulted in undetectable HCV RNA by PCR in 100% of the patients at the end of treatment. There was a significant improvement in portal hemodynamics 6 months after treatment as well as a significant correlation between Doppler indices and fibroscan. Conclusion: Doppler portal hypertensive parameters, as a marker of portal hypertension, were improved in parallel with the improvement in fibroscan values after viral clearance and its improvement in the current study mandate urgent treatment to avoid possible complications.

scholarly journals Direct-acting antiviral therapy improves kidney survival in hepatitis C virus–associated cryoglobulinaemia: the RENALCRYOGLOBULINEMIC study

2020 ◽  
Author(s):  
Ana Pérez de José ◽  
Javier Carbayo ◽  
Anna Pocurull ◽  
Teresa Bada-Bosch ◽  
Clara Maria Cases Corona ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Treatment ◽  
Antiviral Agents ◽  
Direct Acting Antiviral ◽  
Primary Endpoints ◽  
Kidney Involvement ◽  
Before And After ◽  
Mixed Cryoglobulinaemia ◽  
Direct Acting

Abstract Background Direct-acting antiviral agents (DAAs) have shown high rates of sustained virological response in chronic hepatitis C virus (HCV) infection. However, the influence of DAAs on the course of kidney involvement in HCV-associated mixed cryoglobulinaemia (HCV-MC) has been little studied. The aim of this study was to analyse the effects of antiviral treatment on kidney prognosis and evolution in patients diagnosed with HCV-MC. Methods The RENALCRYOGLOBULINEMIC study is an observational multicentre cohort study of 139 patients with HCV-MC from 14 Spanish centres. Clinical and laboratory parameters were measured before and after antiviral treatment. Primary endpoints were kidney survival and mortality after HCV-MC diagnosis. Secondary endpoints were clinical, immunological and virological responses after antiviral treatment. Results Patients were divided into three groups based on the treatment received: treatment with DAAs (n = 100) treatment with interferon (IFN) and ribavirin (RBV) (n = 24) and no treatment (n = 15). Patients were followed up for a median duration of 138 months (interquartile range 70–251. DAA treatment reduced overall mortality {hazard ratio [HR] 0.12 [95% confidence interval (CI) 0.04–0.40]; P &lt; 0.001} and improved kidney survival [HR 0.10 ( 95% CI 0.04–0.33); P &lt; 0.001]. Conclusions Results from the RENALCRYOGLOBULINEMIC study indicated that DAA treatment in patients with HCV-MC improves kidney survival and reduces mortality.

scholarly journals Clinical Outcomes After Treatment With Direct Antiviral Agents: Beyond The Virological Response in Patients With Previous HCV-Related Decompensated Cirrhosis

2021 ◽  
Author(s):  
Georges-Philippe PAGEAUX ◽  
Clovis LUSIVIKA NZINGA ◽  
Nathalie GANNE ◽  
Didier SAMUEL ◽  
Céline DORIVAL ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Virological Response ◽  
Antiviral Agents ◽  
Multivariable Analysis ◽  
Decompensated Cirrhosis ◽  
All Cause Mortality ◽  
Clinical Benefits ◽  
Direct Antiviral Agents ◽  
Related Mortality

Abstract Background In HCV-infected patients with advanced liver disease, the direct antiviral agents (DAAS)-associated clinical benefits remain debated. We compared the clinical outcome of patients with a previous history of decompensated cirrhosis following treatment or not with DAAs from the French ANRS CO22 HEPATHER cohort. Methods We identified HCV patients who had experienced an episode of decompensated cirrhosis. Study outcomes were all-cause mortality, liver-related or non-liver-related deaths, hepatocellular carcinoma, liver transplantation. Secondary study outcomes were sustained virological response (SVR) and its clinical benefits Results 559 patients met the identification criteria, of which 483 received DAA and 76 remained untreated after inclusion in the cohort. The median follow-up time was 39·7 (IQR: 22·7–51) months. After adjustment for multivariate analysis, exposure to DAAs was associated with a decrease in all-cause mortality (HR 0·45, 95% CI 0·24–0·84, p = 0·01) and non-liver-related death (HR 0·26, 95% CI 0·08–0·82, p = 0·02), and was not associated with liver-related death, decrease in hepatocellular carcinoma and need for liver transplantation. The SVR was 88%. According to adjusted multivariable analysis, SVR achievement was associated with a decrease in all-cause mortality (HR 0·29, 95% CI 0·15–0·54, p < 0·0001), liver-related mortality (HR 0·40, 95% CI 0·17–0·96, p = 0·04), non-liver-related mortality (HR 0·17, 95% CI 0·06–0·49, p = 0.001), liver transplantation (HR 0·17, 95% CI 0·05–0·54, p = 0.003), and hepatocellular carcinoma (HR 0·52, 95% CI 0·29–0·93, p = 0·03). Conclusion Treatment with DAAS is associated with reduced risk for mortality. Thus, DAA treatment should be considered for any patient with HCV-related decompensated cirrhosis.

scholarly journals Characteristics of HCV infection in oncohematological patients

2020 ◽  
Vol 12 (1) ◽  
pp. 91-95
Author(s):  
D. A. Lioznov ◽  
M. S. Nozhkin ◽  
O. V. Gorchakova ◽  
T. V. Antonova
Keyword(s):  
Liver Fibrosis ◽  
Antiviral Treatment ◽  
Antiviral Agents ◽  
Significant Proportion ◽  
Hcv Infection ◽  
Activity Level ◽  
Hcv Rna ◽  
Spontaneous Clearance ◽  
Genotype 3 ◽  
Direct Acting Antiviral

Objective: clinical and laboratory characteristics of HCV infection in patients with oncohematological malignancies. Materials and Methods: The study included 106 patients with a positive serum HCV antibody (anti-HCV) test result, who were examined or treated in 5 specialized oncohematological units of different hospitals in Saint Petersburg in 2018–2019.Laboratory tests included: ALT and AST activity, qualitative (with sensitivity of 60 IU/ml) and quantitative determination of HCV RNA, as well as HCV genotyping by real-time PCR. The presence and the grade of liver fibrosis according to the METAVIR scale were evaluated by indirect elastography on Fibroscan. Results: Men were predominant (62,2%), and most of patients (67%) were of young and middle age (18-59 years old). HCV infection was confirmed in 68% patients, and in 41.7% of them HCV genotype 3 was detected. HCV RNA was not detected in 32% cases, suggesting the spontaneous clearance of the virus. Severe liver fibrosis (F3) or cirrhosis (F4) were found in 40% patients with confirmed viremia. In most patients, the normal ALT activity level was registered. 86% patients diagnosed with HCV infection were followed up by an infectious disease specialist until the present study. 19% patients received antiviral therapy for HCV infection. Conclusion: A significant proportion of patients with advanced liver fibrosis and HCV 3 genotype, causing the greatest difficulties in antiviral treatment for HCV infection, was revealed. Prescription of direct-acting antiviral agents in the early terms after establishment of the diagnosis is reasonable.

Impact of Interleukin 28B and ICAM-1 Genetic Polymorphisms on Response to Direct Antiviral Treatment Among HCV Infected Patients

2020 ◽  
Vol 20 (8) ◽  
pp. 1328-1335 ◽  
Author(s):  
Amel G. Elsheredy ◽  
Abdulrahman H. Almaeen ◽  
Amany A. Ghazy ◽  
Ghada F. Helaly ◽  
Ibrahim Amer ◽  
...  
Keyword(s):  
Antiviral Treatment ◽  
Antiviral Agents ◽  
Response To Treatment ◽  
Hcv Rna ◽  
Nucleotide Polymorphisms ◽  
Allelic Discrimination ◽  
Liver Function Testing ◽  
Egyptian Patients ◽  
Hcv Genotyping ◽  
The Impact

Background: Single nucleotide polymorphisms (SNPs) of IL-28B and/or ICAM-1 could have a role in expecting a response from HCV infected patients to direct antiviral agents (DAAs). Objective: The aim of the current study was to investigate the impact of IL-28B rs12979860 and rs8099917, and, ICAM-1 rs281437 SNPs on response to treatment with sofosbuvir + Daclatsvir ± Ribavirin, among HCV-infected Egyptian patients. Methods: Whole blood genomic DNA was extracted from 120 participants (80 HCV-infected patients and 40 healthy volunteers). HCV-infected patients were subdivided into responders and nonresponders to DAAs. Liver function testing, anti-HCV antibodies, HCV-RNA viral load and HCV genotyping were performed. IL-28B and ICAM-1 SNPs were evaluated by real-time PCR. Results: ALT and AST levels were significantly higher among non-responder HCV infected patients (P = 0.001*). 90% of the patients had HCV genotype 4a and the remaining 10% had 4l genotype. Allelic discrimination revealed that IL-28B rs12979860 T, IL-28B rs809917 T and ICAM-1 rs281437 C alleles were more frequent among HCV-infected patients (responders or non-responders) than controls. However, IL-28B rs8099917 G allele was more frequent among healthy controls. Regarding the response to DAAs treatment, HCV-infected patients with IL-28B rs8099917 GG genotype showed a significantly earlier viral response compared to those carrying TT alleles. ICAM-1 rs281437 CT alleles were non significantly more frequent among responders. However, IL-28B rs12979860 alleles did not show any difference. Conclusion: Genotyping of IL-28B rs8099917 is a useful independent tool for expecting a response of Egyptian HCV-infected patients to DAAs.

Effects of an educational program in increasing knowledge and reducing premenstrual syndrome signs, symptoms and severity among nursing college students

2016 ◽  
Vol 5 (4) ◽  
pp. 200
Author(s):  
Nafisa Abdalla ◽  
Mohammed Gibreel
Keyword(s):  
Education Program ◽  
Premenstrual Syndrome ◽  
Educational Program ◽  
Signs And Symptoms ◽  
Study Group ◽  
Significant Difference ◽  
Before And After ◽  
Increasing Knowledge ◽  
Nursing College

Objective: The objective of the following study is to determine the effects of an Educational Program in increasing knowledge and reducing premenstrual syndrome symptoms and severity among nursing college students.Material and Methods: A total of 60 students with Premenstrual Syndrome (PMS) symptoms were included in the study group (n=60), the age of the majority of them (75.8%) was between 20-24 years, pre and post education program questionnaire was developed as a tool of data collection before and after the educational program. Also premenstrual symptoms and severity follow-up sheet was designed and conducted three month after the post education program to follow the effectiveness of the educational program in reducing the severity of the symptoms.Results: The study results indicate that there was significant difference between students’ knowledge before and after the program, the total score mean rank before program was (34.72), while after program was (86.28) p < 0.01 with significant difference between score before and after the program at 1% level of significant. It also shows a significant difference between PMS signs, symptoms and severity before and after program at 1% level of significant (total score mean and SD before program were (132.42, 13.72) respectively, and after program are (107.52, 14.47) respectively p < 0.01 with larger effect size of 0.613. The follow-up result shows a reduction in PMS symptom’s severity, the total severity averages of PMS sign and symptoms were 3.4 first month, 2.6 the second month and 2.2 for the third month out of 4 respectively.Conclusion: The educational program had a positive effect on increasing knowledge and decreasing PMS signs and symptoms severity. Also the program has decrease the effect of PMS signs and symptoms on study group life.

scholarly journals Safety and efficacy of direct-acting antiviral drugs in the treatment of chronic hepatitis C virus infection in patients with thalassemia: a prospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Elsayed Ghoneem ◽  
Ahmed Saleh ◽  
Shahira Aly El-Etreby ◽  
Metwaly Ibrahim Mortada ◽  
Mayada A. Ghannam ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Agents ◽  
Virologic Response ◽  
Direct Acting Antiviral ◽  
Significant Difference ◽  
Before And After ◽  
Chronic Hcv ◽  
Direct Acting ◽  
A Prospective Study

Abstract Background Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality among thalassemic patients. Direct-acting antiviral agents (DAAs) are highly effective and well-tolerated by chronic HCV patients. Results The mean age of our patients was 29 years. Sustained virologic response (SVR) at 12 and 24 weeks was achieved in all patients (100%). The most common side effects were fatigue (18%), anemia (13.63%), and headache (4.5%). There was no statistically significant difference in the hemoglobin level before and after treatment (p = 0.48). There was a significant improvement in serum bilirubin and mean ALT levels after treatment compared to baseline data (p < 0.0005 each). Conclusions DAAs, namely, sofosbuvir plus daclatasvir or sofosbuvir plus ledipasvir, are effective and well-tolerated regimens in thalassemic patients with chronic HCV.

scholarly journals Global longitudinal strain as a predictor of short-term effect of oral antiviral regimens on myocardium in Egyptian patients with chronic viral hepatitis C

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Hazem Mohammad-Ali Farrag ◽  
Mina Samir Monir ◽  
Wael Soliman Abdel-Dayem ◽  
Hisham Abdel-Haleem Ali ◽  
Alaa Mohammad Ibrahim
Keyword(s):  
Hepatitis C ◽  
Longitudinal Strain ◽  
Antiviral Treatment ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Hcv Rna ◽  
Ventricular Ejection Fraction ◽  
Viral Hepatitis C ◽  
Significant Difference

Abstract Background Hepatitis C virus (HCV) infection has been noted with various cardiovascular (CV) diseases, and patients with detected HCV-RNA had higher CV mortality than uninfected individuals. The new direct-acting antiviral drugs (DAA) proved to be more effective with fewer side effects compared to interferon in eradicating HCV, but their effect on myocardium is still questionable. In order to get some answers for such question, two-dimensional speckle tracking echocardiography (2D-STE) was studied before and after treatment with different DAA regimens in HCV patients with either mildly impaired or normal basic left ventricular ejection fraction (LVEF). Results Global longitudinal strain (GLS) significantly worsened after finishing antiviral treatment in patients with basic impairment of LVEF (n = 100) and those with normal basic LVEF (n = 20) [p = 0.006 and 0.039, respectively]; also, segmental strain showed significant worsening of many segments. Such worsening was significantly more in those with basic impairment of LVEF compared to those with normal basic LVEF (p = 0.036). No significant difference was observed in GLS and segmental strain when classifying and comparing patients according to gender, presence of diabetes mellitus, hypertension, ischemic heart disease and established cardiac medications, or according to DAA regimen received. Conclusion DAA may have a cardiotoxic effect that could be early detected by 2D-STE, which was more significant in patients with pre-treatment impairment of LVEF.

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