The impact of an educational program in the management of patients with chronic hepatitis C

Introduction: This study was designed to measure the impact of lifestyle changes, involving a diet therapy and physical exercises in patients with chronic hepatitis C (CHC). Methods: The study was conducted during January 2008 - December 2009 at ”Prof. N. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases - Bucharest, Romania. We selected 67 patients (34 men/33 women). We performed anthropometric measurements (weight, height, BMI (body mass index), bioimpedance analysis (BIA) as well as fasting serum lipids (cholesterol, triglycerides, HDL-cholesterol), glucose profile (glucose, HbA1c), liver profile (ALT, AST, GGT, alkaline phosphatase, bilirubin, albumin, total protein), blood count for all patients at baseline. Results: The average age was 53.91±10.19 years. Obesity was present in 32.8% (n=22) of patients at baseline. Total fat mass decreased with weight loss 2.21 kg (p = 0.0001) respectively 3.17 kg (p = 0.0001). Weight loss was accompanied by decreased resting energy expenditure. Triglycerides decreased from 158.11±7.63 mg/dl to 134.88±6.1 mg/dl, cholesterol decreased from 187.3±6.8 mg/dl to 168.65±4.42 mg/dl and HDL-cholesterol increased from 45.13±1.9 mg/dl to 47.2±1.39 mg/dl after 12 months. Aspartaminotransferase, alaninaminotransferese, gamma-glutamil transpeptidase decreased with significant differences. Conclusions: Patients with hepatitis C undergoing an 1-year lifestyle intervention had significant improvements in fasting glucose, fasting insulin, HOMA-IR, lipidic profile, hepatic profile and adipose tissue distribution. The present study establishes the positive impact of an educational program in the management of patients with hepatitis C

Statin therapy in patients with diabetes and hepatitis C

The objective of this study was to determine the effects of statin therapy (atorvastatin) on serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in patients with type 2 diabetes mellitus (T2DM) and chronic hepatitis C (CHC). A number of 77 patients with T2DM and CHC were selected, treated with atorvastatin, 20 mg, for 6 months, who underwent anthropometric measurements and biochemical tests (including fasting serum glucose, lipid profile, liver profile, cytokines profile) at baseline, after 1 month (clinical and biochemical profile for safety) and after 6 months of treatment. The patients’ average age was 52.53±9.7 years. Plasma low-density lipoprotein cholesterol (LDL-C) (-32.4 mg/dL), triglycerides (-29.7 mg/dL), total cholesterol (-32.8 mg/dL) decreased (p<0.05), and high-density lipoprotein cholesterol (HDL-C) (+3.04 mg/dL) increased (p<0.05), after 6 months. Atorvastatin treatment was associated with decreases of AST, ALT, and also leptin and interleukin-6 (IL-6) levels (all p<0.05) but we did not find any effect on plasma tumor necrosis factor-alpha (TNF-α) (p=0.119). Atorvastatin was an effective and well tolerated treatment for lowering total cholesterol, LDL-C, triglycerides in patients with CHC. Among patients with CHC there was no significant elevation of liver enzymes during statin treatment, and we even noticed an improvement of hepatic profile

The insulin polymorphism -23Hph increases the risk for type 1 diabetes mellitus in the Romanian population

The insulin -23Hph and IGF2 Apa polymorphisms were genotyped in Romanian patients with T1DM (n = 204), T2DM (n = 215) or obesity (n = 200) and normoponderal healthy subjects (n = 750). The genotypes of both polymorphisms were distributed in concordance with Hardy-Weinberg equilibrium in all groups. The -23Hph AA genotype increased the risk for T1DM (OR: 3.22, 95%CI: 2.09-4.98, p < 0,0001), especially in patients without macroalbuminuria (OR: 4.32, 95%CI: 2.54-7.45, p < 0,0001). No other significant association between the alleles or genotypes of insulin -23Hph and IGF2 Apa and diabetes or obesity was identified

Efficacy and Safety of Lacosamide in Painful Diabetic Neuropathy

OBJECTIVE: To evaluate efficacy and safety of lacosamide compared with placebo in painful diabetic polyneuropathy. RESEARCH DESIGN AND METHODS: Diabetic patients with at least moderate neuropathic pain were randomized to placebo or lacosamide 400 (in a slow or standard titration) or 600 mg/day over 6-week titration and 12-week maintenance periods. Primary efficacy criterion was intra-individual change in average daily Numeric Pain Rating Scale score from baseline to the last 4 weeks. RESULTS: For the primary end point, pain reduction was numerically but not statistically greater with lacosamide compared with placebo (400 mg/day, P = 0.12; 600 mg/day, P = 0.18). Both doses were significantly more effective compared with placebo over the titration (P = 0.03, P = 0.006), maintenance (P = 0.01, P = 0.005), and entire treatment periods (P = 0.03, P = 0.02). Safety profiles between titration schemes were similar. CONCLUSIONS: Lacosamide reduced neuropathic pain and was well tolerated in diabetic patients, but the primary efficacy criterion was not met, possibly due to an increased placebo response over the last 4 weeks.status: publishe

Prepackaged therapy for urethritis: the "MSTOP" experience in Cameroon

RATIONALE: The social marketing of STD treatment may be a strategy to increase the availability of effective therapy for urethritis in male patients. OBJECTIVE: To evaluate a pilot project of social marketing of urethritis treatment packages. The project, initially designed for over the counter sale in private pharmacies, was finally restricted by national health authorities to primary healthcare settings in Yaounde and Douala, Cameroon. METHODS: Monthly sales of packages containing antibiotics, condoms, partner referral cards, and written information on STDs were monitored by the social marketing agency. Structured interviews were conducted with a sample of traceable patients who had consulted for urethritis. Structured interviews completed by focus group discussions were conducted among healthcare providers. Interview findings were further validated by a "mystery patient" survey, using surrogate patients. Lastly, 15 key informants among the decision markers involved in the project were interviewed in depth. Local independent consultants carried out the whole evaluation. RESULTS: A total of 1392 treatment packages were sold in 10 months. Patients who had purchased the package reported high compliance with the treatment, with 99% taking the single dose of cefuroxime-axetil and 83% completing the course of doxycycline. 76% notified all or some partners, and 84% of those who had sex during treatment used condoms. In contrast, only 27% of trained healthcare providers prescribed "MSTOP". They questioned the omission of laboratory diagnosis, the selection of antibiotics, and the duration of therapy. Public health authorities were also sceptical about the choice of antibiotics and viewed the initial project as an overt encouragement of self medication. CONCLUSIONS: Although the MSTOP project was not implemented in the way it had initially been designed, it highlighted the patients' interest in the product. Public health authorities in Cameroon should have been made aware of the limitations of the formal sector's response to STD care among men before over the counter sale of prepackaged therapy could have been considered as an alternative approach to inadequate self medication.