El síndrome de fatiga crónica en el curso de la hepatitis C. Presentación de un caso / Chronic fatigue syndrome in the course of Hepatitis C

RESUMEN Se supone que aproximadamente 80 millones de personas a nivel mundial están infectadas con el virus de la hepatitis C. Un aproximado del 60 % de dichos pacientes aqueja síndrome de fatiga crónica. Se presentó un paciente portador de hepatitis crónica de tipo C, con manifestaciones clínicas de síndrome de fatiga crónica por más de dos años. Se han reportado estudios internacionales que han demostrado la relación existente entre el desarrollo de la respuesta inmune y el daño que ocasiona en el tejido cerebral la infección por virus de hepatitis C. Este trabajo tiene como objetivo la presentación del primer caso que se tiene referencia (AU).

ABSTRACT It is believed that almost 80 million persons are infected with the Hepatitis C virus around the world, and 60 % of them suffer the chronic fatigue syndrome. For that reason we present the case of a patient who is a carrier of the chronic fatigue syndrome for more than two years. Reports of international research have showed the relation between the immune answer and the damage caused by the infection of the hepatitis C virus in the brain tissues. The aim of this work is presenting the first case reported in Cuba (AU).

Cardiac Disorder in Chronic Hepatitis C

Chronic hepatitis C (CHC) has a high prevalence in the world. In addition to hepatic complications with cirrhosis in about 20% of patients and high risk for hepatocarcinoma, extrahepatic manifestations may also occur. Cardiac involvement in patients with CHC is associated with several factors, such as increased risk for coronary artery disease, primary cardiomyopathies, or hemodynamic and electrophysiological changes observed in liver cirrhosis. Furthermore, antiviral treatment may, in rare cases, causes cardiovascular adverse effects. Cardiac arrhythmias are the main form of clinical presentation, and, often, markers of poor prognosis in individuals with advanced liver disease. Although some mechanisms that justify these changes have already been reported, many questions remain unanswered, especially about the true involvement of the hepatitis C virus in the genesis of primary cardiac abnormalities, and the risk factors for cardiac-related complications of antiviral treatment

Hand-foot syndrome due to hepatitis C therapy

SUMMARY INTRODUCTION Direct-acting antivirals are new drugs for chronic hepatitis C treatment. They are usually safe and well tolerated, but can sometimes cause serious adverse effects and there is no consensus on how to treat or prevent them. We described a case of hand-foot syndrome due to hepatitis C virus interferon-free therapy. METHODS We report the case of a 49-year-old man with compensated liver cirrhosis due to chronic hepatitis C genotype 1, treatment-naïve, who started viral treatment with sofosbuvir, simeprevir and ribavirin for 12 weeks. RESULTS At the sixth week of treatment he had anemia, requiring a lower dose of ribavirin. At the tenth week, he had erythematous, pruritic, scaly and flaky lesions on hands and feet, which showed a partial response to oral antihistamines and topical corticosteroids. It was not necessary to discontinue antiviral treatment, but in the first week after the end of treatment, there was worsening of injuries, including signs of secondary infection, that required hospitalization, antibiotics and oral corticosteroid, with progressive improvement. Biopsy of the lesions was consistent with pharmacodermia. The patient had sustained a virological response, despite the side effect. He had a history of pharmacodermia one year ago attributed to the use of topiramate, responsive to oral corticosteroid. CONCLUSION Interferon-free therapies can rarely lead to severe adverse reactions, such as skin lesions. Patients receiving ribavirin combinations and those who had a history of pharmacodermia or skin disease may be more susceptible. There is no consensus on how to prevent skin reactions in these patients.

RESUMO INTRODUÇÃO Antivirais de ação direta são as novas drogas utilizadas no tratamento da hepatite C crônica. São geralmente seguros, com boa tolerância, mas eventualmente podem causar efeitos adversos graves, e não há consenso sobre como tratá-los ou preveni-los. Descrevemos um caso de síndrome mão-pé secundária à terapia livre de interferon para hepatite C crônica. Materiais e métodos Relatamos o caso de um paciente de 49 anos com cirrose hepática compensada secundária à hepatite C crônica, genótipo 1, virgem de tratamento, que iniciou terapia com sofosbuvir, simeprevir e ribavirina por 12 semanas. Resultados Na sexta semana de tratamento, apresentou anemia, sendo necessária redução de dose da ribavirina. Na 20a semana, apresentou lesões eritematosas e descamativas, com prurido em mãos e pés, que teve resposta parcial ao uso de anti-histamínico oral e corticoide tópico. Não foi necessário descontinuar os antivirais, mas na primeira semana após o término do tratamento, houve piora das lesões, com sinais de infecção secundária, sendo necessárias hospitalização e terapia com antibiótico e corticoide oral, com melhora progressiva. Biópsias das lesões foram compatíveis com farmacodermia. O paciente teve resposta virológica sustentada, apesar dos efeitos adversos. Tinha história de farmacodermia há um ano, atribuída ao uso de topiramato, responsiva a corticoterapia oral. Conclusão Os tratamentos livres de interferon raramente causam eventos adversos graves, como lesões cutâneas. Pacientes em uso de ribavirina e com história de farmacodermia ou doença cutânea prévia podem ser mais susceptíveis. Não existe consenso sobre como prevenir reações cutâneas nesses pacientes.

Anthropometric changes caused by hepatitis C treatment with interferon and ribavirin: which patients and which measures are affected?

BACKGROUND: Chronic hepatitis C causes chronic hepatic inflammation, which can lead to cirrhosis, terminal liver failure, and hepatocellular carcinoma. The treatment aims to achieve viral clearance, but the usage of pegylated interferon and ribavirin is linked to side effects such as severe weight loss, which can lead to complications and treatment discontinuation. The aim of this study was to investigate which anthropometric measures were more affected in patients with chronic hepatitis C during 24 weeks of treatment with pegy lated interferon and ribavirin. Then, the influence of age, sex, hepatic fibrosis stage, and ribavirin doses on each measure was also evaluated. METHODS: Seventy-six patients were included and their weight, triceps skin fold thickness, arm circumference, middle-arm muscle circumference, and corrected arm muscle area were measured before and after 24 weeks of treatment. Epidemiological data and liver biopsy findings were obtained from patients' records. The sample was divided into two groups: one with advanced hepatic fibrosis and another group with mild to moderate fibrosis. Comparisons into each group were made using Wilcoxon or paired tests. After that, a linear regression model was applied to estimate the anthropometric changes during the treatment according to age, sex, hepatic fibrosis stage, and ribavirin doses. RESULTS: The subjects suffered reductions of important anthropometric measures, mainly related to fat mass (p<0.001).Some decrease of fat-free mass was also observed in subjects with advanced fibrosis. The statistic model showed that age and sex were more associated with the anthropometric changes observed. CONCLUSIONS: In conclusion, the antiviral treatment caused loss of relevant anthropometric measures, and the model proposed was able to estimate some of them

Hematologic adverse effects and efficacy monitoring in chronic Hepatitis C patients treated with interferon and ribavirin combination therapy

180 million people are affected by chronic Hepatitis C Virus infection globally and more than 50 million in South East Asia. Combination of Interferon and Ribavirin is the current anti-HCV therapy in practice and is associated with certain hematologic adverse effects. In this concurrent observational study the incidence rate of major hematologic adverse effects and efficacy outcomes of Interferon and Ribavirin combination therapy was evaluated in 288 chronic hepatitis C patients at Lahore General Hospital. Levels of Hb, TLC, and Platelets counts were monitored for hematologic adverse effects monitoring, whereas, ALT, AST and bilirubin levels were monitored for efficacy. PCR was done at week 4, 12 and 36 for therapeutic success evaluation. A significant reduction in Hb levels [p<0.05] was observed after week 4, 8 and 12 of therapy. Frequency of anemia increased in both genders with body weight <65kg and platelet count <150,000/mm3. End Treatment Response [ETR] was achieved in 64.5%. Anemia was the major side effect of the combination therapy particularly in the males. Higher ETR was observed in patients who achieved RVR and were <50 years of age

Fumarato de dimetila no tratamento da esclerose múltipla remitente-recorrente após a 1ª falha terapêutica / Dimethyl fumarate in the treatment of relapsing-remitting multiple sclerosis after the 1st treatment failure

Contexto: A Eslerose Múltipla é uma doença inflamatória desmielinizante, que, consequentemente, causa alterações visuais, fadiga muscular, parestesia, disfunções fonoaudiólogicas e problemas de equilíbrio e coordenação. Estima-se acometer aproximadamente 15/100.000 habitantes no Brasil. O tratamento segundo o protocolo clínico e diretrizes (PCDT) vigente inclui como alternativas, as betainterferonas, o acetato de glatirâmer, o natalizumabe e o fingolimode. Embora muitos pacientes apresentem melhora com o uso dos tratamentos atualmente disponíveis na primeira linha de tratamento (betainterferonas e glatirâmer), cuja via de administração é injetável, uma proporção considerável não responde, progredindo para estágios mais avançados da doença ou descontinuando o tratamento. Neste contexto, o fumarato de dimetila, via oral, poderia representar uma opção de tratamento para a EM após 1ª falha terapêutica. Pergunta: O uso do fumarato de dimetila (monoterapia) é eficaz, seguro e custo-efetivo em pacientes com esclerose múltipla após 1ª falha terapêutica quando comparado ao uso das betainterferonas e do acetado de glatirâmer? Evidências científicas: Foram encontrados dois ensaios clínicos randomizados, estudo CONFIRM e estudo DEFINE que foram sintetizados em uma metanálise realizada pela Cochrane Colaboration, que tinham como grupo controle o uso de placebo. Além dos 2 estudos originais, 6 estudos post-hoc com análise de subgrupos foram publicados. Há moderada evidência da eficácia que o fumarato de dimetila diminui a taxa de recidiva e o número de recidivas no período dos 2 anos de acompanhamento quando comparados com placebo. No entanto, não há comparações diretas consistentes entre o fumarato de dimetila e o uso de imunomoduladores. Há um estudo de comparação indireta, que demonstrou superioridade do fumarato de dimetila, no entanto, o estudo apresenta heterogeneidade entre os estudos envolvidos. Assim o grau de incerteza da superioridade do FDM ainda é alto em relação a sua superioridade em relação ao imunomoduladores. Decisão: Não incorporar o fumarato de dimetila para o tratamento da esclerose múltipla recorrente-remitente (EMRR), após 1ª falha de tratamento e/ou falta de aderência ou intolerância às formas parenterais (intramuscular ou subcutânea) de GLA e IFNß, no âmbito do Sistema Único de Saúde ­ SUS, dada pela Portaria SCTIE-MS nº 33 publicada no Diário Oficial da União (DOU) nº 183, de 22 de setembro de 2016.

Chronic hepatitis C virus; dermatological manifestations of interferon plus ribavirin therapy in patients

To determine the frequency and pattern of dermatological manifestations in patients receiving interferon and ribavarin for hepatitis C. The study was conducted in the Dermatology out patients department [OPD] of Dow University Hospital Karachi from April -November 2013.Patients diagnosed with hepatitis C who received interferon a[3 MIU subcutaneously thrice weekly] plus ribavirin [1200 mg daily for 24 weeks].Detailed history and dermatological examination including mucous membrane, hair and nails was performed initially and then monthly for six months and findings were recorded. A total of 109 patients were included in the study. Frequency of various skin diseases in these patients werepruritis 44[40.36%], transient alopecia 14[12.84%],generalized morbiliform rash in 22 [20.18%],photosensitivity in 8[7.33%], secondary hyperpigmentation in 17[15.59%] patients. Lichen Planus was observed in 6 [5.50%] patients while brittle nails were seen in 5 [4.58%], glossitis in 4[3.66%],chelitis in 8[7.33%]and generalized exfoliating dermatitis in 9[8.25%] patients. Apthous ulceration was observed in 7 [6.42%] patients. HCV and its treatment with interferon plus ribavirin is associated with significant dermatological complications. Physicians should be aware of these side effects and patients should be counseled before starting treatment

Borderline tuberculoid leprosy and type 1 leprosy reaction in a hepatitis C patient during treatment with interferon and ribavirin / Hanseniase boderline tuberculoide e reacao hansenica do tipo 1 em paciente com hepatite C durante tratamento com interferon e ribavirina

Hepatitis C is an inflammatory disease of the liver caused by a single-stranded RNA virus belonging to the Hepacivirus genus in the Flaviviridae family, called the hepatitis C virus. After initial infection, 70% to 85% of the patients develop chronic hepatitis C with hepatic fibrosis. In addition to specific liver changes, various extrahepatic manifestations have been associated with the hepatitis C virus infection or with medications used to treat the condition. We report the case of a patient with chronic hepatitis C who presented with the signs and symptoms of borderline tuberculoid leprosy and type 1 reaction four months after the start of treatment with a pegylated interferon/ribavirin combination.

A hepatite C é uma doença inflamatória fígado causada por um vírus RNA de fita simples, pertencente ao gênero Hepacivirus e à família Flaviviridae, denominado de vírus da hepatite C. Após infecção inicial 70 a 85% dos pacientes infectados evoluem para hepatite C crônica, com fibrose progressiva. Além das alterações hepáticas específicas, várias manifestações extra-hepáticas têm sido relacionadas à infecção pelo vírus da hepatite C ou às medicações utilizadas no seu tratamento. Nesse trabalho, apresenta-se caso de paciente portador de hepatite C crônica, que manifestou um quadro hanseníase boderline tuberculóide e reação hansênica do tipo I, quatro meses após início do tratamento com interferon peguilado associado à ribavirina.

Ocorrência de múltiplas neoplasias em paciente portador de leucemia mieloide crônica: relato de caso / Occurence of multiple neoplasms in patient with chronic myeloid leukemia: case report

Introdução: A leucemia mieloide crônica é um distúrbio mieloproliferativo clonal com uma anormalidade citogenética específica, resultante da translocação entre os cromossomos 9 e 22 com consequente produção de uma proteína com atividade tirosina quinase alterada. Tratamentos históricos com drogas como bussulfan, hidroxiureia e interferon passaram a ser pouco utilizados devido ao surgimento dos inibidores de tirosina quinase, cujo principal representante é o mesilato de imatinibe. Esse fármaco é a terapia de primeira linha, sendo bem tolerado pelos pacientes e com baixo risco de eventos adversos severos. Entretanto, com cerca de dez anos de uso, ainda há preocupação com efeitos colaterais em longo prazo, tais como o desenvolvimento de segunda neoplasia. Objetivo: Descrever a ocorrência de múltiplas neoplasias em um portador de leucemia mieloide crônica. Método: Relata-se o caso de um paciente com leucemia mieloide crônica há 13 anos, tendo utilizado hidroxiureia e interferon como terapias prévias e em uso de mesilato de imatinibe há nove anos. Resultados: Há dois anos, o paciente apresentou dois nódulos em coxa esquerda que foram totalmente ressecados. Diagnosticou-se lipossarcoma mixoide e o paciente foi submetido à radioterapia. A tomografia computadorizada do abdomên de controle aos seis meses detectou nódulo espiculado na gordura mesenquimal adjacente ao jejuno/íleo. Feita laparotomia exploradora e ressecção, o anatomopatológico demonstrou fibromatose desmoide. Conclusão: O portador de tumor maligno tem risco aumentado de desenvolver uma segunda neoplasia, que pode dessa forma ocorrer nos portadores de leucemia mieloide crônica. Essa associação pode estar relacionada aos fármacos usados no tratamento da mesma.

Hypercalcemia induced by interferon therapy in chronic hepatitis C

Interferon is being increasingly used in the treatment of chronic hepatitis C. Several case reports have suggested an association between interferon therapy and sarcoidosis with hypercalcemia. We report a case of severe hypercalcemic crisis with bilateral hilar lymphadenopathy in a male patient who was receiving interferon therapy for hepatitis C. Gastroenterologists should be aware of this unusual but clinically important complication of interferon therapy

Impact of mono or combined interferon therapy on thyroid function in chronic hepatitis C virus adult patients

Egypt has the highest prevalence of antibodies to hepatitis C virus [HCV] in the world, estimated nationally at 14.7%. Numerous HCV prevalence studies in Egypt have published various estimates from different Egyptian communities, suggesting that Egypt, relative to the other nations of the world, might be experiencing intense ongoing HCV transmission. Interferon-alpha [IFN-alpha] monotherapy or combined therapy with ribavirin is the cornerstone therapeutic agent for chronic HCV infection. Treatment with IFN may cause thyroid dysfunction. Unfortunately, the clinical approach to this toxic effect is often carried out by personal judgment rather than by defined guidelines. Indeed, clinicians often reduce the dose or sometimes discontinue IFN-alpha treatment in those patients who develop thyroid dysfunction. This may reduce the therapeutic response to this drug. Hence, this study was undertaken to evaluate the impact of INF-alpha monotherapy or combined therapy with ribavirin on thyroid function in chronic HCV adult patients of both sexes in the period from January 2009 to August 2009. Sixty adult chronic HCV patients with normal thyroid function before the start of treatment with IFN-alpha - or IFN-alpha + ribavirin were selected for the study. Of them, 7 patients discontinued treatment, 1 patient died and 5 patients could not be followed during the study period. So the number of patients enrolled in the study after 6 months was 47. Clinical examination for thyroid dysfunction as well as thyroid function tests was then carried out. The study revealed that 17 patients [36.1%] developed abnormal thyroid dysfunction. This risk increased with female gender and in combined therapy with ribavirin. The incidence of hypothyroidism was more than hyperthyroidism particularly, in patients treated with combined therapy. Given the high prevalence of HCV disease in Egypt, it is essential that physicians treating patients with IFN-alpha be aware of the clinical spectrum of thyroid dysfunction, and test for thyroid function prior to starting IFN therapy. Careful thyroid surveillance throughout the treatment period is mandatory, especially in female patients and in those receiving combined therapy with ribavirin. Moreover, patients should be informed of this risk and should be advised to tell their physicians of any related symptoms

Nuevos avances en el manejo de la hepatitis C / Current advances in hepatitis C treatment

La hepatitis por virus C constituye un problema de salud importante en México. El diagnóstico de poblaciones de alto riesgo es esencial dada la probabilidad de desarrollar enfermedad crónica, cirrosis, descompensación de la cirrosis y la consecuente necesidad de un trasplante hepático o de desarrollar carcinoma hepatocelular. Actualmente, el tratamiento de elección establecido (TEE) incluye interferón pegilado y ribavirina, los cuales han mostrado una tasa de respuesta de alrededor de 57 por ciento en el caso del genotipo 1, el más prevalente en México. Sabemos que entre 30 y 60 por ciento de la población no muestra una respuesta viral sostenida (RVS) o curación. Por lo tanto, en este artículo se revisan las estrategias terapéuticas existentes para optimizar el tratamiento, y se describen también las estrategias de tratamiento para el futuro. Eventualmente, será posible adicionar una o dos moléculas de los nuevos antivirales que actúan directamente (AAD) sobre áreas específicas del virus al TEE. Cada una de ellas cuenta con mecanismo de acción diferente y se está contemplando la posibilidad de una terapéutica libre de interferón después del año 2015.

Infection by hepatitis C virus constitutes an important health problem in Mexico. Diagnosis of high-risk population is essential given the probability of developing chronic disease, cirrhosis and cirrhosis decompensation, likely leading to the need of a liver transplant and/or the development of hepatocellular carcinoma. Currently, the standard of care (SOC) treatment includes pegylated interferon and ribavirin, which have shown an approximately 57 percent rate response in genotype 1, the most prevalent in Mexico. It is known that between 30 and 60 percent of the infected population does not show a sustained virological response or cure. Therefore, in this article, we review existing therapeutic strategies in order to optimize the treatment. Future treatment strategies are also described. Eventually, it will be possible to add one or two molecules of the new directly acting antiviral drugs, to the SOC treatment. Each of them has a different action mechanism, and we are envisioning the possibility of an interferon-free therapy after 2015.

Trastornos psiquiátricos y cognitivos de la hepatitis C y su tratamiento con interferón / Psychiatric and cognitive problems associated to hepatitis C and its treatment with interferon

This article is a literature search about the psychopathology related to hepatitis C and its treatment with interferon. An overview of the methodology of the available studies is presented. New theories for a better understanding and diagnosis of the psychiatric alteration associated to hepatitis C or interferon treatment are proposed, to improve future research. We discuss neurobiological aspects, clinical manifestations, psychosocial features and pharmacotherapy of the psychiatric manifestations of hepatitis C and its treatment with interferon.

Interferon associated retinopathy

Interferon is an immunomodulating cytokine which is used to treat different diseases. Nowadays it is being commonly used for the treatment of chronic hepatitis C. Few patients develop ocular complications secondary to the use of Interferon. We report here a case in which a young soldier with no other risk factors developed retinopathy changes after five months of interferon alpha 2b therapy which included cotton wool spots at the posterior pole and dot-blot haemorrhages in both fundi. These changes gradually started resolving after cessation of treatment and completely disappeared after six months

Hepatitis C; frequency of thrombocytopenia patients treated with interferon

To determine the frequency of thrombocytopenia and its manifestations in patients with Chronic Hepatitis C Virus infection treated with interferon and ribavirin. In door and out door patients. Case series. Department of Medicine PNS Shifa Hospital Karachi, from 1[st] August 2006 to 1[st] July 2007. A Proforma was designed to enter the data of 100 patients fulfilling the inclusion criteria included in the study. Adult patients between the ages of 18 and 50 years of both gender were selected. Presence of anti HCV antibodies, elevated serum alanine transaminase, a positive polymerase chain reaction for hepatitis C ribonucleic acid and compensated liver disease were prerequisites. All patients were treated with combination of interferon and ribavirin. Blood counts, alanine transaminase and prothrombin time were done at baseline and at 2, 4 and 8 weeks intervals after starting interferon. A drop in platelets count below 100,000/cmm was taken as interferon induced thrombocytopenia. In our study thrombocytopenia occurred in 1 1% patients. Grade 3 thrombocytopenia [platelet counts < 50,000] occurred in 01 patient out of hundred in which there was severe gum bleeding and purpura so antiviral treatment was discontinued. Grade 2 thrombocytopenia [platelet counts between 50,000-75,000] was observed in 03% patients but there were no bleeding episodes, 50% reduction dose was done in these patients. Grade 1 thrombocytopenia [platelet counts between 75,000- 100,000] was noticed in 07% patients but there were no bleeding manifestations and dose reduction was not done. Combination therapy is well tolerated, however, it can cause life threatening complications like bleeding episodes in a few patients. Bleeding complications and manifestations as a result of thrombocytopenia are uncommon

Molde brônquico devido ao uso de interferon peguilado e ribavirina / Bronchial casts attributed to the use of pegylated interferon and ribavirin

Relatamos o caso de um homem de 50 anos com uma rara associação entre moldes brônquicos e o uso de interferon peguilado e ribavirina. O paciente procurou o serviço de pneumologia por apresentar, há quatro meses, dispneia progressiva que evoluiu com tosse progressiva seguida da expulsão de moldes brônquicos frequentes e abundantes. O paciente foi tratado inicialmente com medicações broncodilatadoras e uso de corticoide oral e inalatório. Foram realizados fibrobroncoscopia, lavado broncoalveolar e análise do escarro, os quais não acrescentaram informações para elucidação diagnóstica. Durante o período sintomático, o paciente fez uso de interferon peguilado e ribavirina para o tratamento de hepatite C. Após 30 dias da interrupção das medicações, o paciente ficou assintomático. Este é o primeiro relato sobre a associação entre molde brônquico e o uso de interferon peguilado e ribavirina.

We report the case of a 50-year-old male patient with a rare profile: bronchial casts associated with the use of pegylated interferon and ribavirin. The patient sought treatment in a pulmonology clinic with a history of progressive dyspnea for four months that had evolved to progressive cough followed by frequent and abundant elimination of bronchial casts. The patient was initially treated with bronchodilators, as well as with oral and inhaled corticosteroids. Fiberoptic bronchoscopy, bronchoalveolar lavage and sputum analysis were carried out but did not contribute to the elucidation of the diagnosis. The symptoms developed while the patient was receiving pegylated interferon and ribavirin for the treatment of hepatitis C. The symptoms resolved 30 days after the discontinuation of the treatment. To our knowledge, this is the first report of bronchial casts caused by the use of pegylated interferon and ribavirin.

Quantificação do interferon-tau durante o reconhecimento materno da gestação em fêmeas bovinas Bos taurus indicus / Quantification of interferon-tau during the maternal recognition of pregnancy in Bos taurus indicus cows

Durante o período crítico do reconhecimento materno, compreendido entre o 15º e 19º dias da gestação, o concepto deve sintetizar competentemente moléculas capazes de bloquear a síntese de prostaglandina F2α (PGF2α) e a luteólise. Em bovinos, a principal macromolécula protéica envolvida em tal bloqueio é o interferon-tau(IFN-τ). Durante o período crítico, falhas neste reconhecimento determinam à mortalidade embrionária em até 40% das fêmeas inseminadas. Informações sobre o IFN-τ em animais Bos taurus indicus,ainda são restritas. Este estudo objetivou uma avaliação quantitativado IFN-τ durante o período crítico do reconhecimento materno, em lavados uterinos obtidos por sonda de Foley (dias 14, 16 e 18 pós estro)ou post-mortem (dia 18 pós-estro). Para tanto, foram utilizadas fêmeas multíparas azebuadas (Bos taurus indicus), cíclicas ou prenhes, nos dias 14, 16 e 18 pós-estro. Para a obtenção dos lavados, os úteros foram infundidos com solução de Ringer Simples. Os lavados foram concentrados por ultra-filtração e liofilizados. As macromoléculas protéicas foram separadas por Eletroforese Unidimensional SDSPAGE, em gel com 15% de poliacrilamida. A quantificação doIFN-τ nos...

During the critical period of the maternal recognition, which occurs between days 15 and 19 of pregnancy, the conceptus must competently synthesize molecules capable of blocking the synthesis of prostaglandin F2α (PGF2α) and luteolysis. In cattle, the major macromolecule involved in suck blockage is the protein interferontau(IFN-τ). During the critical period, failures in the recognition of pregnancy determine embryonic mortality on up to 40% of inseminated cows. Data about IFN-τ in Bos taurus indicus are stills carce. Objective of this study was to quantitatively evaluate the presenceof IFN-τ during the critical period for maternal recognition of pregnancy in uterine flushings obtained in vivo by Foley catheter (Days14, 16 and 18 post estrus) or post-mortem (Day 18 post estrus). Multiparous, cyclic or pregnant zebu cows (Bos taurus indicus) on days 14, 16 and 18 post estrus were used for in vivo or post mortem uterine flushing collection. In both cases, a Ringer solution was used to wash the uterus of cows...

Side effects of combination of Interferon plus ribavirin therapy in patients with chronic hepatitis C; an experience with 400 patients

To assess the side effects of combination therapy of interferon plus ribavirin in chronic hepatitis C patients. Material and This prospective observational study was conducted in Medical unit DHQ hospital Daggar and a private clinic of consultant physician in Peshawar from January 2001 to June 2004. A total of 400 patients of chronic hepatitis C with positive Anti HCV [hepatitis C virus] antibodies and HCV RNA by polymerase chain reaction [PCR] were enrolled in the study. These patients received combination therapy of interferon plus ribavirin for six months. During each visit these patients were assessed for various unwanted effects related to the treatment. These side effects were graded as mild, moderate and severe. The most common side effects observed in our patients were haematological in 92.5% [n=370], flu like symptoms in 91% [n=364], gastro intestinal in 88.5% [n=354], dermatological in 81.5% [n=326], neuropsychiatric in 71.25%[n=285], respiratory symptoms in 14% [n=57], thyroid function abnormalities in 4% [n=16], major depression in 1% [n=4] and suicide attempt in 0.5% [n=2]. Most of the side effects were mild to moderate. The severe adverse effects that led to reduction in dose or withdrawal of treatment were noted in 50 [12.5%] patients. Treatment of hepatitis C with combination therapy is not without harmful effects. Most of the side effects are attributed to interferon and some to ribavirin