Pangenotypic and Genotype-Specific Antivirals in the Treatment of HCV Genotype 4 Infected Patients with HCV Monoinfection and HIV/HCV Coinfection

The introduction of the direct-acting antivirals (DAA) has substantially improved the effectiveness of the therapy in patients with chronic hepatitis C. We aimed to compare the efficacy of pangenotypic and genotype-specific DAA in the cohort of genotype (GT) four patients with HCV monoinfection and HIV coinfection. A total of 662 GT4-infected patients treated in 2015–2020—of whom 168 (25.3%) were coinfected with HIV, selected from the retrospective EpiTer-2 database—were enrolled in the analysis. Among HIV-coinfected patients, 54% (90) were treated with genotype-specific regimens and 46% (78) with pangenotypic options, while among HCV-monoinfected patients, the rates were 72% and 28%, respectively. Significantly higher rate of males (67.9% vs. 57.7%, p = 0.01), a lower rate of liver cirrhosis (10.2% vs. 18.1%, p = 0.02), and higher of treatment-naïve patients (87.5% vs. 76.7%, p = 0.003) were documented in the HIV coinfected population. The overall sustained virologic response after exclusion of non-virologic failures was achieved in 98% with no significant difference between HIV-positive and HIV-negative patients, 96.2% vs. 98.5%, respectively. While the genotype-specific regimens resulted in a similar cure rate regardless of the HIV status, the pangenotypic options were more efficacious in patients with HCV monoinfection (99.3% vs. 94.4%, p = 0.05). Hereby, we demonstrated the high effectiveness and good safety profile of the DAA therapy in the population of HCV GT4 infected patients with HIV coinfection supporting the current recommendations to treat HCV/HIV coinfected patients with the same options as those with HCV monoinfection.

Efficacy of the Treatment of Plantar Warts Using 1064 nm Laser and Cooling

Cutaneous plantar warts may be treated using several optional methods, with the use of laser surgery having increased in the last few years. This work examined the efficacy of laser treatment combined with simple cooling to reduce pain. The cure rate was approximately 84%. There were no significant differences in the efficacy of treatment for different viral genotypes. The laser parameters were 500 msec pulses, 30 W of power, and a fluence of 212 J/cm2 delivered in up to four sessions. Successful treatment was achieved after an average of 3.6 sessions.

Meta-analysis of the Efficacy of Hemoperfusion Combined With Hemodialysis in Treating Acute Severe Organophosphorus Pesticide Poisoning

BackgroundAcute severe organophosphorus pesticide poisoning (ASOPP) is a common severe emergency in developing countries. At present, the incidence of complications and mortality are still very high, and there are some difficulties in treatment. More and more studies have found that hemoperfusion combined with hemodialysis can improve the prognosis of patients based on conventional emergency treatment, but there is a lack of evidence-based medical evidence. Our meta-analysis is mainly to clarify the efficacy of hemoperfusion combined with hemodialysis on ASOPP.MethodsWe searched several databases. After formulating relevant inclusion and exclusion criteria, qualified studies were included and data were extracted. The outcome indicators were cure rate, efficacy, incidence of complications, time for cholinesterase level to return to normal, coma time, time of hospitalization and atropine dosage. Results were analyzed using risk ratios (RR), odds ratios (OR), weighted mean difference (WMD), standard mean difference (SMD), and 95% confidential interval (95% CI). The cochrane collaboration tool was used for the assessment of the risk of bias of every included studies. In terms of statistical methods, we used RevMan software (version 5.3) and Stata (version 14 and 16) for data analysis.ResultsWe included 35 RCTs, including 2650 participants. Compared with the emergency conventional treatment group, the use of hemoperfusion combined with hemodialysis to treat ASOPP patients based on conventional emergency treatment significantly increased the cure rate [RR=1.20, 95% CI (1.16, 1.25), p<0.00001], improved the efficacy [OR=2.76, 95% CI (2.07, 3.67), p=0.000], and reduced the incidence of complications [RR=0.26, 95% CI (0.20, 0.34), p<0.00001] and also reduced the patient's time for cholinesterase level to return to normal [WMD=-4.05, 95% CI (-4.40, -3.70), p<0.00001], coma time [SMD=-2.62, 95% CI (-3.08, -2.15), p<0.00001], time of hospitalization [WMD=-5.80, 95% CI (-6.57, -5.02), p<0.00001], and atropine dosage [WMD=-194.81, 95% CI (-223.55, -166.08), p<0.00001].ConclusionHemoperfusion combined with hemodialysis can apparently improve the prognosis of patients and has a good effect in the treatment of acute severe organophosphorus pesticide poisoning. In the future, more scientifically designed large-scale, high-quality, multi-center randomized controlled trials are needed to further illustrate the significance of this study.

Development and Evaluation of Clove and Cinnamon Supercritical Fluid Extracts-Loaded Emulgel for Antifungal Activity in Denture Stomatitis

Denture stomatitis (DS), usually caused by Candida infection, is one of the common denture-related complications in patients wearing dentures. Clove and cinnamon oils have been acknowledged for their anti-inflammatory, antimicrobial activity, and antifungal effects in the oral cavity. The aim of this study, therefore, was to prepare clove/cinnamon oils-loaded emulgel and to assess its efficacy in treating Candida albicans-associated denture stomatitis. Central composite design was adopted to formulate and optimize clove/cinnamon extracts-loaded emulgel. The formulated preparations were assessed for their physical appearance, particle size, viscosity, spreadability, and in-vitro drug release. In addition, in-vivo therapeutic experiments were conducted on 42 patients with denture stomatitis. The prepared emulgel formulations showed good physical characteristics with efficient drug release within 3 h. In addition, in-vivo antifungal studies revealed that the optimized formula significantly (p < 0.001) reduced Candida colony counts from the denture surface, compared to commercially available gel (240.38 ± 27.20 vs. 398.19 ± 66.73 CFU/mL, respectively). Furthermore, the optimized formula and succeeded in alleviating denture stomatitis-related inflammation with a better clinical cure rate compared to commercially available gel Collectively, herbal extracts-loaded emulgel might be considered an evolution of polyherbal formulations and might represent a promising alternative to the existing allopathic drugs for the treatment of denture stomatitis, with better taste acceptability and no side effects.

Hyperfractionated Treatment with 177Lu-Octreotate Increases Tumor Response in Human Small-Intestine Neuroendocrine GOT1 Tumor Model

Radionuclide treatment of patients with neuroendocrine tumors has advanced in the last decades with favorable results using 177Lu-octreotate. However, the gap between the high cure rate in animal studies vs. patient studies indicates a potential to increase the curation of patients. The aim of this study was to investigate the tumor response for different fractionation schemes with 177Lu-octreotate. BALB/c mice bearing a human small-intestine neuroendocrine GOT1 tumor were either mock treated with saline or injected intravenously with a total of 30–120 MBq of 177Lu-octreotate: 1 × 30, 2 × 15, 1 × 60, 2 × 30, 1 × 120, 2 × 60, or 3 × 40 MBq. The tumor volume was measured twice per week until the end of the experiment. The mean tumor volume for mice that received 2 × 15 = 30 and 1 × 30 MBq 177Lu-octreotate was reduced by 61% and 52%, respectively. The mean tumor volume was reduced by 91% and 44% for mice that received 2 × 30 = 60 and 1 × 60 MBq 177Lu-octreotate, respectively. After 120 MBq 177Lu-octreotate, given as 1–3 fractions, the mean tumor volume was reduced by 91–97%. Multiple fractions resulted in delayed regrowth and prolonged overall survival by 20–25% for the 120 MBq groups and by 45% for lower total activities, relative to one fraction. The results indicate that fractionation and hyperfractionation of 177Lu-octreotate are beneficial for tumor reduction and prolongs the time to regrowth.

Prognostic and predictive factors in early stages of classic Hodgkin’s lymphoma

Rationale. In the early stages of classical Hodgkin’s lymphoma (cHL), the cure rate reaches 85–95 %, but the long-term effects of therapy can worsen overall survival. Current trials for early stages of Hodgkin’s lymphoma with favorable prognosis address the task of maintaining cure rates while reducing sequelae. For early unfavorable stages, the challenge is to improve cure rate without increasing toxicity.Purpose. To assess the potential significance of individual risk factors for optimal choice of the first line chemotherapy in early-stage Hodgkin lymphoma.Materials and methods. This single-center retrospective study included 290 patients with early stage cHL who had received ABVD – based (n = 249; 86 %) or BEACOPP‑21 – based (n = 41; 14 %) combined modality therapy from 2000 to 2017. Progression-free survival (PFS) and overall survival (OS) were assessed in Cox regression analysis including 12 clinical parameters.Main results. At a median follow up of 60 months for the entire group, OS was 95 % and PFS was 89 %. In a multivariate analysis PFS, at 5 years, was significantly inferior in patients with mediastinal bulk, baseline lymphocytopenia (≤ 0.6 × 109/L, р = 0.002; < 1.0 × 109/L, р = 0.000) and male gender; OS was inferior only in patients with an absolute lymphocytopenia (AL). In patients with AL, PFS after ABVD-based regimen was, respectively, 12 % in the high-risk group with mediastinal bulk and 56 % without it. PFS of patients without AL when treated with ABVD did not differ compared to BEACOPP‑21 within the same prognostic group: 95.2 % vs. 92.3 % for non-bulky and 86.4 % vs. 84.2 % for bulky disease. In the absence of AL, mediastinal bulk remained the main and only risk factor in multivariate analysis.Conclusions. The ABVD regimen is highly effective in the first line of chemotherapy for cHL, except for cases with baseline lymphocytopenia, in which the early usage of the BEACOPP regimen in the escalated or 14-day variants might be justified. In patients with mediastinal bulk, standard chemotherapy is not effective enough even in the absence of AL; therefore, if an intermediate PET/CT scan is available, it seems more appropriate to use a milder ABVD regimen on the first line and leave intensive therapy for patients with proven refractory disease. Prospects for improving the efficiency are opened with the new N-AVD and A-AVD schemes, the benefits of which should be evaluated, first of all, in patients with AL and mediastinal bulk.

Digestive manifestations of SARS-COV2 infection in Togo

Objective: to identify the main digestive manifestations related to SARS-CoV-2 in Togo and to determine their impact on the prognosis of the disease. Patients and method: This was a cross-sectional study with retrospective and prospective collection, with descriptive and analytical aims, conducted from May 1, 2020 to April 30, 2021 at the national center for the management of infectious diseases of Lome. Patients of both sexes and of any age, tested positive for SARS-CoV-2 by PCR on nasopharyngeal and oropharyngeal samples and hospitalized at the national center for infectious disease management of Lome were included in this study. Digestive manifestations were divided into gastrointestinal manifestations and hepatobiliary manifestations. The threshold of significance of the tests was retained for a p value less than or equal to 0.05. Results: out of 876 patients hospitalized during the study period, 215 presented with digestive manifestations, corresponding to a prevalence of 24.54%. the predominance was male, with a male/female sex ratio of 1.74. the mean age was 46.07+/-16.14 [02 months – 82 years]. gastrointestinal manifestations were found in 11.98% of cases. abdominal pain was the most frequent digestive symptom (15.35%). hepatobiliary manifestations were represented by cytolysis syndrome (44.19%) and cholestasis syndrome (36.28%). digestive manifestations were associated with renal failure (p=0.03) and thrombocytosis (p<0.01). The occurrence of death was associated with a decrease in HDL-cholesterol (p<0.001) and the presence of renal failure (p=0.027). The cure rate in our study was 83.72% with a lethality of 16.27%. Conclusion: the digestive manifestations constitute a not negligible form of revelation of the disease with coronavirus 2019. The best prevention is the vaccination and the respect of the measures of social distanciation.

Pengaruh Peran Pengawas Menelan Obat dan Efek Samping Obat Anti Tuberkulosis Terhadap Angka Kesembuhan (Cure Rate) Pasien Tuberkulosis

Kunci sukses penanggulangan TBC adalah penemuan pasien dan pengobatan pasien sampai sembuh. keberhasilan pengobatan dipengaruhi oleh beberapa faktor yaitu faktor kepatuhan pasien, faktor pengawas menelan obat dan efek samping yang dirasakan pasien. Kecamatan Palu Selatan merupakan penyumbang angka kejadian TBC yang cukup tinggi dengan angka kesembuhan pasien TBC yang belum mencapai target nasional (85%). Wilayah Kecamatan Palu Selatan terdiri dari 3 Puskesmas yaitu Puskesmas Mabelopura terdapat 62 kasus, Puskesmas Birobuli 46 kasus dan Puskesmas Bulili 28 kasus, dengan angka kesembuhan yaitu Puskesmas Mabelopura 44 (70,96%) kasus, Puskesmas Birobuli 30 (65,21%) kasus dan Puskesmas Bulili 19 (67,85%) kasus. Penelitian ini bertujuan untuk mengetahui faktor yang mempengaruhi angka kesembuhan TBC di Kecamatan Palu Selatan. Jenis penelitian ini adalah kuantitatif dengan pendekatan cross sectional. Populasi berjumlah 136 orang dan sampel sebanyak 97 orang. Pengambilan sampel menggunakan teknik Proportionate Stratified Random Sampling. Analisis yang digunakan yaitu regresi linear sederhana dengan nilai α =5%. Hasil penelitian ini menunjukkan bahwa ada pengaruh signifikan antara pengawas menelan obat (Sig. 0,010) dan efek samping (Sig. 0,010) terhadap angka kesembuhan pasien TBC. Disarankan kepada pasien TBC untuk patuh dalam mengonsumsi obat walaupun responden merasakan efek samping yang ditimbulkan oleh OAT, kepada keluarga diharapkan berperan aktif dalam mengawasi saat minum obat dan memberikan dukungan kepada pasien agar menyelesaikan pengobatan.