ABSTRACT
The role of liver stiffness measurement (LSM) after sustained virological response (SVR) in HCV patients treated by direct-acting antivirals (DAAs) remains unclear. We aimed to evaluate LSM regression value after SVR and to identify risk factors associated with liver related complications (LRC) or death. This retrospective study analyzed patients with LSM ≥ 10 kPa with LSM by transient elastography pre-DAAs and post-SVR. Patients with previous hepatic decompensation were excluded. Medical records were reviewed to identify primary outcomes. Kaplan-Meier curves and time-to-event Cox proportional-hazard models were performed. 456 patients [65% female, 62 years (IQR 57-68)] were included. During a follow-up of 2.3 years (IQR 1.6-2.7), 28 patients developed 37 outcomes [rate = 29.0 (95% CI 20.0-42.0) per 1000 person-years]. The cumulative incidence of outcomes was significantly lower in patients who regressed LSM ≥ 20% [3.4% (95% CI 1.8-7.0) vs. 9.0% (5.5-14.5), p = 0.028]. In a multivariate Cox-model [HR(95% CI)], male gender [HR = 3.00 (1.30-6.95), p = 0.010], baseline albumin < 3.5 mg/dL [HR = 4.49 (1.95-10.34), p < 0.001] and baseline unfavorable Baveno-VI [HR = 4.72 (1.32-16.83), p = 0.017] were independently associated and LSM regression ≥ 20% after SVR had a trend to reduce the risk of LRC or death [HR = 0.45 (0.21-1.02), p = 0.058]. The use of simple parameters before DAAs and repetition of LSM post-SVR can identify patients with different risks for severe outcome after HCV eradication.
Subject(s)
Hepatitis C, Chronic/complications , Liver Cirrhosis/diagnostic imaging , Liver Cirrhosis/pathology , Antiviral Agents/therapeutic use , Coinfection , Elasticity Imaging Techniques , Female , Genotype , Hepacivirus/genetics , Hepatitis B/complications , Hepatitis B/virology , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/epidemiology , Humans , Incidence , Liver Cirrhosis/epidemiology , Liver Cirrhosis/etiology , Male , Patient Outcome Assessment , Retrospective Studies , Risk Factors , Sustained Virologic Response , Treatment OutcomeABSTRACT
RESUMO Objetivo analisar as facilidades e dificuldades percebidas por egressos de uma pós-graduação em Estomaterapia para atuação no mundo do trabalho. Métodos pesquisa qualitativa, desenvolvida com 22 egressos de um Curso de Pós-graduação em Enfermagem em Estomaterapia, de uma universidade pública da Região Sudeste do Brasil. A coleta de dados ocorreu por meio de entrevista semiestruturada, entre janeiro e abril de 2018. As entrevistas foram tratadas com base na análise temática de conteúdo. Resultados apreenderam-se como facilidades: reconhecimento do especialista, autonomia profissional, conhecimentos adquiridos por meio da especialização, disponibilidade de tecnologias de cuidados. Como fatores dificultadores, citaram-se: carência de recursos humanos e materiais, baixa remuneração do especialista, política institucional desfavorável, não valorização do estomaterapeuta. Conclusões e implicações para a prática as facilidades identificadas se relacionaram com o reconhecimento do especialista; a autonomia; a ascensão e o crescimento profissional; os conhecimentos adquiridos por meio da especialização; e a disponibilidade de tecnologias do cuidado para realização da prática profissional. As dificuldades analisadas no estudo estiveram vinculadas predominantemente à configuração do mundo do trabalho, cujos fundamentos se pautam no ideário neoliberal do Estado mínimo e no enxugamento da máquina pública.
RESUMEN Objetivo analizar las instalaciones y dificultades percibidas por los egresados de una Postgrado en Estomatoterapia para trabajar en el mundo laboral. Métodos investigación cualitativa, desarrollada con 22 graduados de un curso de Postgrado en Enfermería en Estomatoterapia, de una universidad pública en la Región Sudeste de Brasil. La recopilación de datos se realizó a través de entrevistas semiestructuradas, entre enero y abril de 2018. Las entrevistas se trataron en función del análisis de contenido temático. Resultados fue aprehendido como instalaciones: reconocimiento del especialista, autonomía profesional, conocimiento adquirido a través de la especialización, disponibilidad de tecnologías de atención. Como factores que obstaculizan, se citaron los siguientes: falta de recursos humanos y materiales, baja remuneración del especialista, política institucional desfavorable, falta de valoración del terapeuta del estoma. Conclusión e implicación para la práctica las dificultades analizadas en el estudio estuvieron principalmente relacionadas con la configuración del mundo del trabajo, cuyos fundamentos se basan en las ideas neoliberales del estado mínimo y la eliminación de la maquinaria pública.
ABSTRACT Objective to analyze the practicalities and difficulties perceived by graduates of a post-graduate program in Stomatherapy to perform in the world of work. Methods a qualitative research study, developed with 22 graduates from a Postgraduate course in Nursing in Stomatherapy, from a public university in the Southeast of Brazil. Data collection took place through semi-structured interviews, between January and April 2018. The interviews were treated based on the Thematic Content Analysis. Results the following were learned as practicalities: recognition of the specialist, professional autonomy, knowledge acquired through specialization, availability of care technologies. As hindering factors, the following were cited: lack of human and material resources, low remuneration of the specialist, unfavorable institutional policy, lack of appreciation for the stomatherapist. Conclusion and implication for the practice the difficulties analyzed in the study were predominantly linked to the configuration of the world of work, whose foundations are based on the neoliberal ideas of the minimum state and the wiping out of the public machinery.
Subject(s)
Humans , Professional Practice , Specialties, Nursing , Ostomy/education , Job Market , Ostomy/nursing , Qualitative Research , Education, Nursing, GraduateABSTRACT
BACKGROUND AND AIM: Few studies have evaluated sustained virological response (SVR) rates by direct-acting agents (DAAs) and liver stiffness measurement (LSM) changing post-SVR in limited-resource settings. We aimed to describe the effectiveness of DAAs for hepatitis C virus treatment and to assess the changing of LSM post-SVR. METHODS: This retrospective study analyzed data of consecutive hepatitis C virus-infected patients treated by DAAs from 2015 to 2017 in two tertiary centers in Brazil. SVR rates were reported by intention-to-treat and per-protocol analyses. LSM by transient elastography performed before treatment and post-SVR was compared, and logistic regression models were performed. RESULTS: Six hundred seventy-one patients (63% female, 62 years [55-68], 89% genotype 1, 8% HIV co-infected, and 64% with cirrhosis) were included. Most patients were treated by sofosbuvir/daclatasvir ± ribavirin (74%) and sofosbuvir/simeprevir ± ribavirin (21%). SVR rates (95% confidence interval [CI]) were 94.6% (92.7-96.1) and 97.8% (96.4-98.7) for intention-to-treat and per-protocol analyses, respectively. The leading adverse event was anemia (9.6% [95% CI 7.6-12.1]). Pretreatment and post-SVR12 LSM were available in 400 patients. LSM had significantly decreased after SVR (13.6 kPa [interquartile range, 10.0-21.6] vs 10.2 kPa [7.0-17.6], P < 0.001). A total of 167 patients (42%) decreased at least 30% of LSM post-SVR. The absence of type 2 diabetes (odds ratio = 1.52 [95% CI 1.05-2.21], P = 0.028) and presence of platelet count ≥ 150 × 109 /mm3 (odds ratio = 1.75 [1.23-2.50], P = 0.002) were independently associated with a significant LSM regression (≥ 30%) post-SVR. CONCLUSION: DAAs were highly effective and safe, and LSM significantly decreased after SVR in a real-life cohort in Brazil. The absence of type 2 diabetes and presence of high platelet count were independently associated with LSM decrease post-SVR.
