ABSTRACT
Background: The main goal of anti-HCV therapy in patients with decompensated [Child-Pugh B] cirrhosis, not on a transplant waiting list is to achieve improvement in liver function and survival. Several studies have demonstrated acceptably high sustained virological response [SVR] rates, equivalent in Child-Pugh B patients, in individuals with decompensated cirrhosis, together with an effect of therapeutic viral clearance on liver function, with significant improvements in bilirubin, albumin and international normalized ratio values and, as a result, in model for end stage liver disease [MELD] and Child-Pugh scores in one-third to half of patients. Similar results were reported in real-world studies
Aim of the work: Assessment of the safety and efficacy of sofosbuvir/ ledipasvir in infected naïve and experienced HCV Egyptian patients with decompensated liver disease
Patients and Method: This study was conducted on 100 patients with HCV related decompensated liver disease who presented to the hepatology outpatient clinic in El Agouza Police hospital and were evaluated according to the inclusion and exclusion criteria
Results: Among the 100 enrolled patients; there was male predominance being 72 males [72%] and 28 females [28%]. Their age ranged between 34 and 65 years [mean 52.7 ±8.2 years]. Age was significantly higher in patients who did not achieve SVR. Among the 100 studied cases 6 patients stopped treatment; 3 of them developed HCC, 1 developed precoma, 1 died and 1 lost follow up. SGOT, SGPT, ALP, total and direct bilirubin, serum urea and creatinine and AFP showed significant improvement at the end of treatment and 3 months after end of treatment. As regards Child and MELD scores among the studied cases, Child and MELD significantly decreased in the whole sample
Conclusion: Ledipasvir/sofosbuvir is effective and safe in the treatment of HCV decompensated patients Child Pugh B. MELD and Child scores significantly improved with HCV treatment in decompensated patients
Recommendations: Longer follow up with assessment of the need for liver transplantation or HCC development is important. Larger number of patients is required
ABSTRACT
Background: the administration of anti-vascular endothelial growth factor [anti-VEGF] agents has become an application of IVIs to treat a variety of retinal and choroidal neovascular diseases including neovascular age-related macular degeneration, vein occlusion with macular edema, and diabetic maculopathy. ranibizumab is the most commonly used anti-VEGF treatments for retinal disease. While Intravitreal ranibizumab appears to be safe and effective but it can cause adverse effects as intraocular inflammation, cataract, vitreous haemorrhage, and increased intraocular pressure
Aim of the work: this study aimed to Evaluation of Iop changes after intravitreal injection of Ranibizumab retinal and choroidal neovascular diseases as neovascular age-related macular degeneration [AMD], central vein or branch vein occlusion with macular edema, and diabetic maculopathy
Patients and Methods: this prospective study was carried out from March 2018 to September 2018 on 35 eyes of patients attending outpatient clinic of Al-Azhar University Hospitals and Ophthalmology Department of Research Institute of Ophthalmology in Giza. All participant names were hidden and were replaced by code numbers to maintain privacy of the patients. IOP was measured Using Applanation tonometer and Perkins tonometer before IVI of ranibizumab immediately after injection, 30 minutes, 1ST day, 1st week, and 1st month after injection
Results: IOP was highly increased immediately after injection of ranibizumab, preoperative mean IOP 15.31+/-3.70, immediate after injection mean IOP 24.62+/-11.38, then it started to decrease till reaching normal values in the first 24h after injection, 1st 24hours mean IOP 16.31+/-3.60.The mean IOP for patients who were previously injected was 16.47+/-3.74 pre injection, and it was 30.88+/-12.55 immediately after injection, it still decreasing till reaching 20.24+/-2.77 after 30 minutes, we follow the patients after 1 day it was 18.41+/-3.12, then it became 18.29+/-3.62 after 1 week, and 17.88+/-3.33 after 1 month. The mean IOP for patients who were the first time to be injected was 14.22+/-3.41 pre injection, Immediate after injection the mean IOP was 18.72+/-5.92, after 30 minutes of injection the mean IOP was 15.44+/-3.99 mm Hg, after 1 day of injection the mean IOP was 14.33+/-2.87 mm Hg, We followed up the patients to one week after injection and we checked the IOP. The mean IOP after one week was 13.72+/-2.93mm Hg, We continue following the patients for one month and checked IOP, The mean IOP was 14.06+/-3.21 mm Hg
Conclusion: IOP tends to increase after intravitreal injection of Ranibizumab 0.05ml [0.5 mg]. It causes mainly a transient immediate increase in intraocular pressure especially in patients who exposed to repeated intravitreal injection. This elevation of IOP tends to normalize after one day
Recommendations: this study recommend monitoring of IOP after intravitreal injection of ranibizumab and Care should be taken for cases with multiple injections and predisposing risk factors like glaucoma and glaucomatous patients