Neurosyphilis in AIDS patient presenting as isolated cranial nerve 6 palsy.

Early neurosyphilis can occur in an immunocompromised host. It has a widely varied presentation. Isolated CN6 as presenting symptom has not been described.

CACNA1S Arg528Cys mutation in a young Chinese man with thyrotoxic hypokalemic periodic paralysis.

It has long been believed that the patients with thyrotoxic hypokalemic periodic paralysis (THPP) may harbor genetic mutations commonly found in familial hypokalemic periodic paralysis. Despite extensive testing, such a mutation has escaped detection until now.

Clinical Impact and Cosmetic Acceptability of Chlorhexidine-enriched Toothpaste and Mouthwash Application on Periodontal Disease: A Randomized Clinical Study.

AIMS: Oral hygiene is key to prevent periodontal disease (PD). The efficacy of chlorhexidine-containing products has been largely proven, often being tooth discoloration an unwanted associated side-effect. Importantly, some differences related to the pharmaceutical presentation of these products have also been reported. This study aimed to evaluate the efficacy of two different pharmaceutical forms [toothpaste (TP) and mouthwash (MW)] of a new product containing chlorhexidine, dexpanthenol, allantoin and bioadhesive excipient (CDAB) (Bexident® Gums Coadjuvant Treatment) on volunteers with PD. Their preferences, acceptability and cosmetic properties, as well as tooth discoloration, were also assessed. MATERIALS AND METHODS: Total 60 subjects showing mild-moderate symptoms of gingivitis were randomly assigned to two different groups: one receiving TP (n = 30) and the other one receiving MW (n = 30). Periodontal disease index (PDI) was used to evaluate clinical signs at baseline (T0) and after 21 days (T21) of daily use of the products. Satisfaction was assessed through the affirmative/negative answers obtained with the visual analog scale (VAS). RESULTS: All participants completed the study. A significant improvement of PDI score after treatment was reported in both groups (T21/T0) (p < 0.001). Thus, gingivitis improved from moderate to negative [increase = 20.0% (TP)/36.7% (MW)] and from mild to negative [increase = 56.7% (TP)/50.0% (MW)]. After treatment, all subjects reported to have healthier and/or less bleeding teeth (TP 9.0/9.4; MW 8.0/8.2) and would recommend the product (TP:100%/MW:96.6%) with no specific preference regarding its presentation. No change of teeth color was observed. CONCLUSION: Subjects with PD who received oral care with a new formulation of either chlorhexidine-containing TP or MW for 21 days, reported a significant improvement of their symptoms and resolution of the gingivitis with no associated tooth discoloration. Patients did not show a specific preference for any of the pharmaceutical presentations. CLINICAL SIGNIFICANCE: This new formulation of a chlorhexidine-containing product in both TP and MW forms resulted effective for PD treatment and well accepted by the patients.

Virological response after 6 week triple-drug regimens for hepatitis C: a proof-of-concept phase 2A cohort study.

BACKGROUND: Direct-acting antiviral drugs have a high cure rate and favourable tolerability for patients with hepatitis C virus (HCV). Shorter courses could improve affordability and adherence. Sofosbuvir and ledipasvir with ribavirin have high efficacy when taken for 8 weeks but not for 6 weeks. We assessed whether the addition of a third direct-acting antiviral drug to sofosbuvir and ledipasvir would allow a shorter treatment duration. METHODS: In this single-centre, open-label, phase 2A trial, we sequentially enrolled treatment-naive patients with HCV genotype 1 infection into three treatment groups: 12 weeks of sofosbuvir and ledipasvir; 6 weeks of sofosbuvir, ledipasvir, and GS-9669; or 6 weeks of sofosbuvir, ledipasvir, and GS-9451. Patients and investigators were not masked to treatment assignment. The primary endpoint was the propotion of patients with sustained viral response at 12 weeks after treatment completion (SVR12), assessed by serum HCV RNA concentrations lower than 43 IU/mL (the lower limit of quantification). We did an intention-to-treat analysis for the primary endpoint and adverse events. This study is registered with ClinicalTrials.gov, number NCT01805882. FINDINGS: Between Jan 11, 2013, and Dec 17, 2013, we enrolled 60 patients, and sequentially assigned them into three groups of 20. We noted an SVR12 in all 20 patients (100%, 95% CI 83-100) allocated to sofosbuvir and ledipasvir for 12 weeks; in 19 (95%, 75-100) of the 20 patients allocated to sofosbuvir, ledipasvir, and GS-9669 for 6 weeks (one patient relapsed 2 weeks after completion of treatment); and in 19 (95%, 75-100%) of the 20 patients allocated to sofosbuvir, ledipasvir, and GS-9451 for 6 weeks (one patient was lost to follow-up after reaching sustained viral response at 4 weeks). Most adverse events were mild and no patients discontinued treatment. Two serious adverse events occurred (pain after a post-treatment liver biopsy and vertigo), both unrelated to study drugs. INTERPRETATION: In this small proof-of-concept study, two different three-drug regimens that were given for 6 weeks resulted in high cure rates for HCV infection with excellent tolerability. Addition of a third potent direct-acting antiviral drug can reduce the duration of treatment required to achieve sustained viral response in patients with chronic HCV genotype 1 infection without cirrhosis. FUNDING: National Institute of Allergy and Infectious Diseases (NIAID), National Cancer Institute and Clinical Center Intramural Program, German Research Foundation, National Institutes of Health, Gilead Sciences.

Re-treatment of chronic hepatitis C virus genotype 1 infection after relapse: an open-label pilot study.

BACKGROUND: The interferon (IFN)-free regimen of sofosbuvir and ribavirin for 24 weeks was recently approved to treat chronic hepatitis C virus (HCV) genotype 1 (GT-1) infection for patients ineligible for IFN. However, sofosbuvir plus ribavirin therapy is associated with relapse in 15% to 30% of patients with HCV GT-1. Neither the mechanism of relapse nor the optimal re-treatment strategy for these patients is defined. OBJECTIVE: To assess the safety and efficacy of sofosbuvir plus ledipasvir in patients with chronic HCV GT-1 that relapsed after sofosbuvir plus ribavirin therapy. DESIGN: Phase 2a, open-label study. (ClinicalTrials.gov: NCT01805882). SETTING: Single U.S site. PATIENTS: 14 patients with HCV GT-1 that relapsed after treatment with sofosbuvir plus ribavirin for 24 weeks were re-treated with sofosbuvir plus ledipasvir for 12 weeks. MEASUREMENTS: HCV RNA concentration and population sequencing to detect NS5B S282T mutations. RESULTS: All 14 patients treated with sofosbuvir plus ledipasvir for 12 weeks achieved a sustained virologic response, including 7 with advanced liver disease (Knodell Histology Activity Index score of 3 or 4) and 1 with a detectable NS5B S282T mutation after sofosbuvir plus ribavirin therapy. Sofosbuvir plus ledipasvir was well-tolerated with few adverse events. Four grade 3 events (elevated serum creatinine in a patient with baseline renal insufficiency, hypercholesterolemia, and hypophosphatemia) occurred. There were no grade 4 events or treatment discontinuations. LIMITATION: Small sample size. CONCLUSION: The fixed-dose combination of sofosbuvir plus ledipasvir was efficacious in a small cohort of patients with HCV GT-1 that relapsed after sofosbuvir plus ribavirin therapy, even in the setting of advanced liver disease. Larger studies are needed to confirm these preliminary efficacy results. PRIMARY FUNDING SOURCE: National Institute of Allergy and Infectious Diseases, National Institutes of Health, National Cancer Institute, and Gilead Sciences.

Sustained Virologic Response for Chronic Hepatitis C Infection after 27 Days of Treatment with Sofosbuvir and Ribavirin.

Successful treatment of chronic hepatitis C virus infection can now be achieved using directly acting antiviral agents without interferon. We report a patient who achieved a sustained virologic response after 27 days of treatment with sofosbuvir and ribavirin. Identifying factors that allow for shorter treatment in some individuals is imperative.

Utilidad de la encuesta dietética cualitativa en los pacientes en hemodiálisis periódica / Usefulness of the qualitative dietetic questionnaire in patients undergoing periodic haemodialysis

Introducción y objetivos: La desnutrición es frecuente en pacientes con insuficiencia renal crónica en hemodiálisis periódica (HDP), dentro de su origen multifactorial la ingesta insuficiente es una causa importante. Esta desnutrición produce una mala calidad de vida y un aumento de mortalidad en nuestros pacientes. El objetivo de nuestro trabajo es valorar la información que nos aporta una encuesta cualitativa frente a la cuantitativa realizadas ambas simultáneamente. Material y métodos: Se realiza el estudio con 20 pacientes de nuestra unidad de diálisis, en los que se determina la edad, parámetros de calidad de diálisis y parámetros nutricionales bioquímicos y antropométricos. Se realizan dos tipos de encuesta dietética: cualitativa y cuantitativa. En la encuesta cuantitativa se recoge un registro alimentario de dos días en el que se valora la ingesta calórica y proteica mediante tablas de composición de alimentos. En la encuesta dietética cualitativa se puntúan de 1 a 3 siete variables subjetivas de la dieta: el apetito, los cambios de apetito, descripción de la cantidad de ingesta, dificultad para seguir una dieta, las tomas principales, otras tomas, y los indicadores seleccionados de ingesta proteica. Resultados: Al contrastar los datos obtenidos en ambas encuestas, se detecta que los pacientes con una puntuación superior a 17 en la encuesta cualitativa tienen una mejor ingesta calórica y proteica que los pacientes con una puntuación inferior a 17 (1,44 versus 1,08 gr/Kg/día de proteínas y 32,01 versus 27,8 Kcal/Kg/día de calorías; p< 0,05). Conclusión: La encuesta cualitativa es más sencilla de realizar que la cuantitativa y se puede incluir en el trabajo cotidiano de enfermería nefrológica pudiendo detectar así de forma precoz los déficit de ingesta, evitando el desarrollo de malnutrición (AU)

Malnutrition is often observed in patients with chronic renal insufficiency (CRI) under periodic haemodialysis (PH). This malnutrition leads to poor quality of life and an increase in the mortality rate. The aim of our study was to compare the information provided by a qualitative dietetic questionnaire with a quantitative one. The study was performed with 20 patients from our dialysis Unit. We recorded the following data: age, dialysis quality parameters and biochemical and nutritional parameters. We performed two dietetic questionnaires: qualitative and quantitative. In the quantitative questionnaire we recorded the dietary intake for two days based on dietetic tables. In the qualitative questionnaire we scored from 1 to 3 seven subjective items: appetite, appetite changes, intake quantity, difficulties in following the diet, main intakes, and other items of protein intake. When data from the two questionnaires are compared we observe that in patients with a score over 17 from the quantitative questionnaire, a better protein and caloric intake than patients under 17. (1.44 vs. 1.08 gr protein/Kg/day, and 32.01 vs 27.8 Kcal/Kg/day, p<0.05). In conclusion, the qualitative questionnaire is easier to perform than the quantitative one, and can be used by nursing staff to detect malnutrition promptly (AU)