Treatment of recurrent hepatitis C (genotype 1) with pegylated interferon alfa-2b and ribavirin combination and maintenance therapy.

BACKGROUND/AIMS: This study aims at evaluating the efficacy of treatment with pegylated interferon (PEG-IFN) alfa-2b and ribavirin in patients with recurrent hepatitis C (genotype 1) after orthotopic liver transplantation (OLT) and the impact of this therapy on hepatic fibrosis at the end of conventional therapy and at the end of a period of maintenance treatment in non-responder patients. METHODOLOGY: Thirty-two consecutive patients diagnosed with recurrent HCV were considered candidates for antiviral therapy. RESULTS: Ten patients (31.2%) interrupted therapy due to side effects; sustained virological response (SVR) was observed in 27.2%, sustained biochemical response (SBR) in 31.8% and NR in 40.9% of cases. Eighteen patients underwent a biopsy at the end of conventional treatment: improved fibrosis score in all patients with SVR, improved score in 1 patient with SBR and stable score in 6 patients with SBR, worse score in 1 NR patient and stable in 6 NR patients. Six NR patients with stable score submitted to a maintenance therapy: improved score in 1 patient and stable score in 5 patients. CONCLUSIONS: In recurrent hepatitis C, in spite of the type of response, treatment slows down hepatic fibrotic evolution.

Influence of body mass index, cholesterol, triglycerides and steatosis on pegylated interferon alfa-2a and ribavirin treatment for recurrent hepatitis C in patients transplanted for HCV and alcoholic cirrhosis.

Up to today no work has evaluated yet the importance of parameters such Body Mass Index (BMI), cholesterol, triglycerides (TGC) and hepatic percentage of steatosis in the response to therapy with Pegylated Interferon Alfa-2a and Ribavirin in patients with recurrent hepatitis C (genotype 1). 30 consecutive prospectively followed patients diagnosed with recurrent HCV were considered candidates for antiviral therapy. Qualitative and quantitative detection of HCV-RNA was performed with the Cobas Amplicor Hepatitis C Virus Test, version 2.0 and the Cobas Amplicor HCV Monitor, version 2.0 (Roche Diagnostics, Branchburgh, NJ, U.S.A.). HCV genotyping was performed by sequencing of the 5 untraslated region (5' UTR) (Visible Genetics TruGene Hepatitis Assay, Toronto, Canada). The observed distribution of BMI, cholesterol, TGC and steatosis were confirmed to be normally distributed by the one-sample Kolmogorov-Smirnov Goodness of fit test procedure. Comparison of BMI, cholesterol, TGC and steatosis between non responders (NR), sustained virological responders (SVR) and sustained biochemical responders (SBR) groups were analyzed by ANOVA with a post hoc Bonferroni test and correlation between variables was tested by Pearson test. The multivariate analysis was performed to estimate the chance of response on basis of the above mentioned variables. In patients with abnormal results in at least two out of four considered variables the chance of no-response was 40 times higher than that of SBR and 96 times than that of SVR. We can conclude how the management of dismetabolism, diet and exercise therapy can improve BMI, liver histology and, therefore, the response to PEG-IFN Alfa-2a and Ribavirin.

Relationship between laboratory parameters and intensive care unit stay post-liver transplantation: proposal of a model.

UNLABELLED: The aim of this study was to create a model that forecasted the stay in the intensive care unit in post-liver transplantation. METHODS: Twenty-three consecutive patients who underwent liver transplantation provided samples for serum sodium, serum creatinine, total bilirubin, cholesterol, aspartate and alanine aminotransferase, alkaline phosphatase (ALP), albumin, and platelet count for correlation together with age at transplantation in a Pearson correlation model with intensive care unit stay. Multivariate analysis used a regression model to evaluate the relationship between the dependent variable "intensive care unit stay" and the predictor variables that were correlated by a Pearson correlation test. To test the acceptability and strength of the model, analyses of variance was performed and a multiple correlation coefficient R was calculated for the model. RESULTS: Pearson correlation test showed a strong correlation between intensive care unit stay and creatinine (correlation coefficient = 0.34, P = .03), serum sodium (correlation coefficient = -0.42, P < .01), and total bilirubin (correlation coefficient = -0.29, P = .06). Other variables showed no significant correlation, namely correlation coefficients < 0.24 (P > .1). The final model to evaluate the relationship between the dependent variable "intensive care unit stay" and laboratory parameters included ALP, serum creatinine, serum sodium, and total bilirubin as well as a correction for age. CONCLUSIONS: The most significant parameters were total bilirubin, serum creatinine, and serum sodium. The proposal model significantly correlated with the variable "intensive care unit stay." Such data are particularly important since increased intensive care unit stay correlates with a significant reduction in 1-year survival rate.

[Helicobacter pylori and gastric carcinogenesis]. / Helycobacter pylori e carcinogenesi gastrica.

Gastric carcinogenesis is a multistep and multifactorial process beginning with chronic gastritis Helicobacter pylori (Hp) induced in most cases. There are some obstacles to an exclusive acceptance of the idea that the relation of Hp with the preneoplastic/neoplastic changes solely develops by means of the chronic gastritis with its atrophic evolution and achlorydria. Hp may be considered a trigger by means of alteration of cellular synetics without any direct influence on genetic alterations. Under the push of an intense proliferation, the expression of typical antigens of the organ is progressively lost, with acquisition of antigens from other organs. Cellular dedifferentiation displayed, with the progressive increase of immature elements that progress to the more or less total disappearance of differentiated gastric cells or differentiating ones, with the formation of metaplastic/dysplastic clones or even neoplastic ones. The bacteria, together with other environmental factors and individual genetic susceptibility, determine the final risk for the development of gastric cancer. Considering that 1-2% of the Hp positive subjects are estimated to develop gastric cancer and that Hp is considered the cause of 75% of gastric cancer, the eradication of the infection, not only in the initial phases but even in those with preneoplastic changes, involves an advantage for the prevention of gastric cancer. For the prevention among the general population testing Hp-positive subjects for serum antibodies against CagA protein might represent an effective way of identifying patients in whom Hp eradication is advisable also in term of gastric cancer prevention.

[Epidemiologic model for the assessment of health needs]. / Un modello epidemiologico per la valutazione dei bisogni di salute.

Health is a high priority in public health planning, a process by which health, services and resources are connected to each other. Assessing peoples health needs is one of the most difficult tasks, because of the lack of information on the spread of diseases, the seriousness of them and their capacity to disable, as well as the lack of timely and appropriate information on them. The epidemiological model put forward describes the volume of resources necessary to maintain the health needs of a population as depending upon the prevalence of diseases, the health services used to combat these diseases and the consequent human and financial resources employed. According to this model the management of the supply of health services depends on monitoring the relationship between population, disease, health services and resources.