Early liver function improvement following successful treatment of chronic hepatitis C in patients with decompensated cirrhosis: a real-life study

OBJECTIVES: Despite higher rates of sustained virologic response (SVR), important concerns remain when patients with decompensated cirrhosis due to hepatitis C virus (HCV) are treated with direct-acting antiviral agents (DAA). Questions include efficacy, safety, and the magnitude of liver function improvement. Here, we aimed to evaluate HCV treatment data in this specific population in Brazil. METHODS: We included 85 patients with decompensated cirrhosis submitted to HCV therapy with DAA followed at two academic tertiary centers in the southeastern region of Brazil. RESULTS: Seventy-nine patients (92.9%) were Child-Pugh (CP) score B, and six (7.1%) were CP score C. The mean MELD score was 12.86. The most common treatment was sofosbuvir plus daclatasvir±ribavirin for 24 weeks. The overall intention-to-treat (ITT) SVR rate was 87.4% (74/85) and modified-ITT 96.1% (74/77). ITT SVR was associated with lower baseline INR values (p=0.029). Adverse events (AE) occurred in 57.9% (44/76) of patients. Serious AE were reported in 12.8% (10/78), and were related to the presence of hepatic encephalopathy (p=0.027). SVR was associated with improvement in CP (p<0.0001) and MELD scores (p=0.021). Among baseline CP score B patients with SVR, 46% (29/63) regressed to CP score A. Ascites was independently associated with no improvement in liver function in patients who achieved SVR (p=0.001; OR:39.285; 95% CI:4.301-258.832). CONCLUSIONS: Patients with decompensated HCV cirrhosis showed a high SVR rate with interferon-free therapy. Early liver function improvement occurred after successful HCV eradication. However, long-term follow-up of these patients after SVR remains strongly advised.

Exercício Profissional da Medicina por Estudantes / Professional Practice of Medicine by Students

Resumo: As atividades práticas desempenhadas pelo aluno de medicina são indispensáveis e devem ser realizadas em ambiente universitário. Quando este procura outros serviços para exercer a profissão médica, infringe os códigos de ética médica e penal brasileiros. Objetivamos identificar e analisar as atividades profissionais na área médica exercidas pelos estudantes de medicina da Universidade Federal de Uberlândia (UFU) fora desta instituição. Foi aplicado um questionário com 19 perguntas a 173 alunos do 6o a 12o períodos do curso médico da UFU. Verificou-se que 23,70% dos alunos exerceram a profissão médica fora da instituição de ensino. Durante o último ano do curso, 63,16% já o fizeram. A totalidade destes alunos prestou serviços remunerados, a maioria em hospitais públicos (48,78%) e 21,96% os realizam frequentemente. Ademais, 46,34% das atividades foram indicadas por médicos formados, coniventes com tal situação; 31,71% nunca dizem ao paciente que não são médicos formados; 39,03% consideram tais atividades totalmente antiéticas e 68,29% totalmente ilegais, mas mesmos assim continuam a praticá-las. Este dados preocupantes mostram ser imprescindível uma atuação conjunta de professores, CFM e dos próprios alunos com o objetivo de corrigir este grave erro de conduta.

Abstract: The practical activities carried out by medical students are indispensable and should be applied in academical institutions. When these students seek other services to exercise the medical profession, they infringe the penal and the medical ethics codes. We aim to identify and analyze the professional activities in the medical area exercised by the students to medicine of the Federal University of Uberlândia (UFU) out of this institution. A questionnaire was applied to 173 students of the 6th to the 12th periods, of the Medical School of UFU. It was verified that 23,70% of the students exercised the medical profession out of the institution. During the last year of the course, 63,16% have already done it. All the students rendered paid services, inmost in public hospitals (48,78%), and 21,96% frequently accomplish them. Also, 46,34% of the activities were indicated by formed doctors, connivent with such situation; 31,71% never tell the patient that he/she isn't a formed physician; 39,03% consider it totally anti-ethics and 68,29% illegal, but even so they continue to practice them. These preoccupying data show it is indispensable that professors, CFM and students should act with the objective of correcting this misconduct.Introdução