Trattamento antivirale in pazienti portatoricronici di epatite C e transaminasemianormale a lungo termine: risultati preliminaridi uno studio pilota

OBIETTIVI: valutare l\u2019efficacia del PEG-IFNa-2a + ribavirina in una coorte di pazienti HCV positivi con livelli di ALT persistentemente normali in accordo con le nuove linee guida internazionali.MATERIALI: sono stati inclusi nello studio un gruppo di soggetti con almeno 3 determinazioni di ALT normali in un periodo superiore a 12 mesi. Tali soggetti sono stati trattati con PEG-IFNa-2a 180mg/settimana + ribavirina 800 mg/die per 24 settimane se appartenenti ai genotipi 2 e 3, oppure per 48 settimane se appartenenti ai genotipi 1 e 4. RIASSUNTO: sono stati arruolati 206 pazienti (48 M, 158 F). I soggetti maschi, rispetto alle femmine, presentavano una differenza significativa con valori pi\uf9 alti di BMI, ALT, GGT, carica virale e grading/staging della fibrosi alla biopsia epatica. Il genotipo 2 \ue8 risultato il pi\uf9 rappresentato, rispettivamente, nel 65,5% delle femmine e nel 55,2% dei maschi, mentre i genotipi 1 e 4 erano presenti nel 34,5% dei soggetti. Il trattamento \ue8 stato completato dal 95,7% (188/206) dei pazienti, mentre 18 (8,7%) hanno interrotto il trial per le seguenti motivazioni: 3 hanno autosospeso il trattamento, 4 sono risultati non responder, i rimanenti 11, a causa della comparsa di effetti collaterali. I 188 pazienti che hanno concluso la terapia sono stati seguiti con un follow-up minimo di 6 mesi in cui veniva monitorata la carica virale con dosaggi mensili. Sono risultati non responders 11 (5,8%) pazienti, mentre 171 (90,9%) hanno risposto e mantenuto la risposta a distanza di 6 mesi dopo la fine della terapia con una percentuale di ricaduta, alla sospensione, del 2,9%. CONCLUSIONI: da una preliminare analisi dei dati, emerge l\u2019indicazione di offrire il trattamento antivirale anche a pazienti con epatite cronica da HCV e valori di ALT persistentemente normali

Female patients in fertile age with chronic hepatitis C, easy genotype, and persistently normal transaminases have a 100% chance to reach a sustained virological response.

Background: Patients with chronic hepatitis C and persistently normal alanine transaminase levels have recently been included in the guidelines for antiviral treatment. Aim: To evaluate the efficacy of PEG-interferon \u3b1-2a and weight-based ribavirin doses in patients with these characteristics in a single Italian centre. Materials and Methods: Patients with chronic hepatitis C and at least three normal alanine transaminase values over a 12-month period were offered a treatment with PEG-interferon \u3b1-2a 180 mg/week and ribavirin (800 mg/day for weight 60 and 75 kg) for 24 weeks (according to genotype 2 or 3) or for 48 weeks (according to genotype 1 or 4). Each patient at baseline underwent liver stiffness (LS) examination using Fibroscan. Data were analysed according to the intention-to-treat criteria. Results: A total of 227 patients (55 men, 172 women) were enrolled into the study: 65 (28.6%) had genotype 1, 144 (63.4%) genotype 2, nine (4.0%) genotype 3 and nine (4.0%) genotype 4. Patients with genotype 2 or 3 (N=153 with easy genotypes) were allocated in group 1 and those with genotype 1 or 4 (N=74 with difficult genotypes) in group 2. According to the LS measurement, patients were classified as follows: 159 (70.0%) presented absent or mild fibrosis (LS=2.5\u20137.0 kPa), 61 (26.9%) patients had significant fibrosis (LS=7.1\u20139.5) and seven (3.1%) patients had severe fibrosis (LS >9.6). Twelve patients (5.3%) dropped out within 4 months because of side-effects, whereas 215 patients completed the study. Overall, 13 patients were considered nonresponders (5.7%) and six patients (2.6%) were relapsers to the therapy. The sustained virological response (SVR) rate was 85.4% and it was higher in \u2018easy\u2019 genotypes (2 or 3) compared with \u2018difficult\u2019 genotypes (1 or 4) (92.2 vs. 74.3%, P<0.001). No statistical difference was found in the SVR rate between patients presenting absent or mild fibrosis as against those with significant fibrosis. Multivariate analysis, including factors correlated with SVR, showed that easy genotype and female sex are significantly associated with a SVR. Conclusion: Patients with chronic hepatitis C and persistently normal transaminases have an 85.4% chance to clear the virus with conventional antiviral treatment. Female patients in fertile age with easy genotypes have a 100% chance to reach a SVR

A Social Media-Based Acute Alcohol Consumption Behavior (NekNomination): Case Series in Italian Emergency Departments

Background: NekNomination, also known as NekNominate, Neck and Nominate, or Neck Nomination, is a social network–based drinking game which is thought to have originated in Australia and spread all over the world between 2013 and 2014. Individuals record videos of themselves while rapidly drinking excessive quantities of alcoholic drinks (necking) and then nominate friends to outdo them within 24 hours; the videos are then posted on social media such as Facebook or YouTube. The consequences of this drinking game have been very dangerous; at least 5 people under age 30 years have died after drinking deadly cocktails, and many others have suffered from alcohol intoxication. Objective: The goal of the research is to evaluate data about clinically important acute alcohol intoxication among teenagers and young adults and inform and educate the general public, especially parents, teachers, and health workers, about the spreading craze of dangerous Internet-related behavior among today’s teenagers and young people up to the age of 23 years. Methods: Patients aged 15 to 23 years with acute alcohol intoxication who came to the emergency department (ED) of 2 major hospitals in Italy from January 1, 2011, to June 30, 2014, were included in this study. Data were retrieved from prehospital and intrahospital medical records and included personal information, methods of intoxication, triage color code, date and time of access to the ED, any relevant signs and symptoms, blood alcohol concentration, and diagnosis at discharge. Results: A total of 450 young patients (male 277/450, 61.5%, female 173/450, 38.5%; age 15 to 16 years 15/450, 3.3%, age 17 to 18 years 184/450, 40.9%, age 19 to 23 years 251/450, 55.8%) were recruited. The causes of intoxication were happy hour, binge drinking, NekNominate, eyeballing, other alcoholic games, or a mix of them. Happy hour was found to be more common among the older patients, whereas NekNominate accounted for almost half of the youngest group of hospitalizations. Eyeballing occurred in 1.6% (7/450) of cases; binge drinking and other alcoholic games caused 23.3% (105/450) and 23.8% (107/450) of hospitalizations, respectively. On admission, 44.2% (199/450) of patients were assigned a red or yellow color code requiring immediate medical attention; about 14% of them required additional medical assistance (after being in the ED) or hospitalization, some in semi-intensive care units. Conclusions: Our study shows that the increased numbers of hospitalizations due to alcohol intoxication in the adolescent age group, as a consequence of NekNominate or other drinking games, is alarming and represents a serious public health issue. Thepotential markers of improper use of social networks must be clearly identified, including categories at risk of alcohol abuse, in order to develop intervention and prevention strategies in terms of education and awareness, which may help in averting potentially fatal episodes

Sopravvivenza nei soggetti con IMAin trattamento con statine nell\u2019AULSS 18della Regione Veneto

OBIETTIVI: Valutare la sopravvivenza di diverse coorti di soggetti infartuati in relazione all\u2019assunzione di statine.MATERIALI: Nell\u2019AULSS 18 di Rovigo \ue8 stato implementato un Sistema Epidemiologico Integrato (SEI) con analisi dei dati a partire dal 2002. Mediante l\u2019algoritmo SISMEC-AIE applicato agli archivi informatizzati contenenti le cause di morte (CM), le schede di dimissione ospedaliera (SDO) e le prescrizioni farmaceutiche (PF), \ue8 stato possibile identificare i casi di IMA incidenti nel periodo 2002-2008. I soggetti sono stati suddivisi in trattati, non trattati e con somministrazione non continuativa. I soggetti trattati sono stati identificati mediante la ricerca di una prescrizione di statine in un periodo inferiore ai 30 giorni dalla dimissione ospedaliera e con assunzione continuativa della terapia fino al termine del follow-up. Nell\u2019archivio di mortalit\ue0 \ue8 stato ricercato il decesso. RIASSUNTO: Complessivamente, sono stati identificati 2091 soggetti ricoverati per IMA, con una letalit\ue0 intraospedaliera del 13,4%. Dei 1810 soggetti inclusi nello studio, con un follow-up complessivo di 5031 anni, 482 hanno iniziato il trattamento con statine, di questi, il 33,4% ha sospeso la terapia. Nei primi 30 giorni dopo la dimissione, 1328 soggetti non hanno assunto alcuna terapia con statine, fra i quali il 17,4% ha successivamente iniziato il trattamento per poi sospenderlo nel 2,1% dei casi. La sopravvivenza a 6,8 anni risulta del 95,0% e del 51,2% rispettivamente nei soggetti trattati continuativamente e non trattati. Nei soggetti con trattamento \u201cnon continuativo\u201d la sopravvivenza a fine follow-up varia tra il 73,0% e l\u201980,0%. CONCLUSIONI: La sopravvivenza risulta essere significativamente superiore nei soggetti trattati con statine rispetto ai non trattati, sottolineando l\u2019importanza di una terapia appropriata e protratta nel tempo. Di rilievo risulta il numero di soggetti in trattamento \u201cnon continuativo\u201d. Tali conclusioni devono essere ulteriormente approfondite sia per eliminare gli eventuali effetti confondenti, sia per valutare la corretta applicazione della terapia in accordo con le linee guida regionali