Association between hepatitis C antiviral treatment and diabetes mellitus: A case series.

The hepatitis C virus (HCV) infects 185 million people worldwide, and diabetes mellitus (DM) affects 415 million. There has long been a possible association between DM and liver outcomes for patients with HCV infection. We present two cases of worsening glucose resistance and one case of emergent type 1 DM after completion of HCV. The complex interactions between HCV infection and both type 1 and type 2 DM have not yet been elucidated. In addition, consequences and side effects of treatment options for HCV have not been fully studied in the diabetic population. Our case series illustrates a potential complication of HCV treatment, which may warrant additional consideration prior to initiation of therapy as well as monitoring and surveillance post-cure.

Le virus de l'hépatite C (VHC) infecte 185 millions de personnes dans le monde, et le diabète en atteint 415 millions. On sait depuis longtemps qu'il y a une association possible entre le diabète et les affections hépatiques chez les patients infectés par le VHC. Les auteurs présentent deux cas d'aggravation de la résistance au glucose et un cas d'apparition du diabète de type 1 après la fin du traitement du VHC. Les interactions complexes entre l'infection par le VCH et le diabète de type 1 et de type 2 ne sont pas encore établies. De plus, les conséquences et les effets secondaires des possibilités de traitement du VHC n'ont pas fait l'objet d'études approfondies dans la population diabétique. La présente série de cas fait état d'une complication potentielle du traitement du VHC, qui pourrait justifier un examen supplémentaire avant le début du traitement, de même qu'un contrôle et une surveillance par la suite.

Change in treatment paradigm in people who previously injected drugs with chronic hepatitis C in the era of direct-acting antiviral therapy.

BACKGROUND: Chronic hepatitis C virus (HCV) infection is highly prevalent among people who inject drugs but is often undiagnosed. The treatment paradigm for HCV patients has been changing since the availability of direct-acting antiviral (DAA) treatment. We aimed to evaluate the change in treatment paradigm of people who previously injected drugs (ex-PWID) in Hong Kong before and after the availability of DAA. METHOD: Consecutive ex-PWID referred from various nongovernmental organizations attended education talks at rehabilitation centers and received point-of-care rapid test for HCV antibody (anti-HCV) at the same session. Subjects tested positive for anti-HCV were invited to undergo further assessment. Afterwards, the patients were referred to the regional hospitals for follow-up and/or treatment. RESULTS: Three hundred sixty-five ex-PWID received HCV rapid test; 268 (73.4%) were found to be anti-HCV positive. Among these 268 HCV-positive ex-PWID, 234 (87.3%) attended the assessment session (mean age 52 years, 90.2% male, 45.5% genotype 1b, 41.1% genotype 6a, and median liver stiffness 5.9 kPa); 187 (69.8%) attended follow-up visits at regional hospitals. Seventy-one patients received antiviral treatment for HCV; 69 first received peginterferon and ribavirin (PegIFN/RBV), whereas 10 patients (eight PegIFN/RBV-treated patients) received DAA treatment. Fifty-two patients achieved sustained virologic response at 12 or 24 weeks. Treatment uptake rates of PegIFN/RBV and DAA treatment in the pre-DAA versus post-DAA era were 22.3% versus 48.5% and 0% versus 15.6%, respectively. CONCLUSIONS: Targeted screening in ex-PWID is effective in identifying patients with HCV infection in the community. To improve treatment uptake, further improvements in the referral system and treatment regimens are needed.

A population-based study of communication impairment in cerebral palsy.

To explore factors associated with communication impairments in children with cerebral palsy. Data were obtained on children born between 1999 and 2008 from the Quebec Cerebral Palsy Registry (REPACQ). Out of 535 children with cerebral palsy, 297 were identified to have communication impairments (55.5%). Of these, 96 were unable to communicate verbally (32.3%), 195 had some verbal communication (65.7%), and 6 were unspecified (2.0%). These children were significantly more likely to have a more severe motor deficit (Gross Motor Function Classification System levels IV and V and Manual Ability Classification System levels IV and V), to have spastic quadriplegia or dyskinetic subtypes of cerebral palsy, and gray matter injury on neuroimaging. Communication impairment is a common comorbidity in cerebral palsy and is associated with a more severe motor deficit, spastic quadriplegic or dyskinetic subtype of cerebral palsy, and gray matter injury on neuroimaging. This information allows clinicians to better predict and manage communication impairment in children with cerebral palsy.

StabilimaxNZ) versus simulated fusion: evaluation of adjacent-level effects.

Rationale behind motion preservation devices is to eliminate the accelerated adjacent-level effects (ALE) associated with spinal fusion. We evaluated multidirectional flexibilities and ALEs of StabilimaxNZ and simulated fusion applied to a decompressed spine. StabilimaxNZ was applied at L4-L5 after creating a decompression (laminectomy of L4 plus bilateral medial facetectomy at L4-L5). Multidirectional Flexibility and Hybrid tests were performed on six fresh cadaveric human specimens (T12-S1). Decompression increased average flexion-extension rotation to 124.0% of the intact. StabilimaxNZ and simulated fusion decreased the motion to 62.4 and 23.8% of intact, respectively. In lateral bending, corresponding increase was 121.6% and decreases were 57.5 and 11.9%. In torsion, corresponding increase was 132.7%, and decreases were 36.3% for fusion, and none for StabilimaxNZ ALE was defined as percentage increase over the intact. The ALE at L3-4 was 15.3% for StabilimaxNZ versus 33.4% for fusion, while at L5-S1 the ALE were 5.0% vs. 11.3%, respectively. In lateral bending, the corresponding ALE values were 3.0% vs. 19.1%, and 11.3% vs. 35.8%, respectively. In torsion, the corresponding values were 3.7% vs. 20.6%, and 4.0% vs. 33.5%, respectively. In conclusion, this in vitro study using Flexibility and Hybrid test methods showed that StabilimaxNZ stabilized the decompressed spinal level effectively in sagittal and frontal planes, while allowing a good portion of the normal rotation, and concurrently it did not produce significant ALEs as compared to the fusion. However, it did not stabilize the decompressed specimen in torsion.