Pegylated interferon alfa 2a (Pegasys) plus ribavirin versus interferon alfa 2a (Roferon-A) plus ribavirin in the treatment of chronic hepatitis C

Cilj ovoga istraživanja bio je usporediti učinkovitost terapije na trajni virološki odgovor (SVR) u bolesnika s kroničnim hepatitisom C liječenih pegiliranim (PEG) - interferonom alfa 2a, u kombinaciji s ribavirinom, nasuprot bolesnika liječenih konvencionalnim interferonom alfa 2a, u kombinaciji s ribavirinom, tijekom 48 tjedana, u bolesnika s kroničnim hepatitisom C, koji su prethodno bili neuspješno liječeni konvencionalnim interferonom alfa 2a (monoterapija). Metode. Bolesnici su podijeljeni u dvije skupine po 25 ispitanika. U skupini A 25 bolesnika, u razdoblju od 2003. do 2005. godine dobivalo je, tijekom 48 tjedana, konvencionalni interferon alfa 2a (Roferon A) u dozi od 6 MIU 3× tjedno, plus ribavirin, ovisno o tjelesnoj težini, 1000 mg ili 1200 mg dnevno. U skupini B 25 bolesnika, u razdoblju od 2005. do 2008. godine dobivalo je, tijekom 48 tjedana, pegilirani interferon alfa 2a (Pegasys) u dozi od 180 μg jednom tjedno uz ribavirin 1000 ili 1200 mg dnevno. Rezultati. Trajni virološki odgovor (SVR) u bolesnika skupne A bio je 16% u odnosu na 24% u skupini B. SVR je statistički značajno viši u skupini bolesnika inficiranih HCV genotipovima 2 i 3 u usporedbi s genotipom 1 (u skupini A 50%, nasuprot 5%, a u skupini B 57%, nasuprot 11%). Nuspojave tijekom liječenja bile su blagog ili umjerenog intenziteta, te nisu zahtijevale smanjenje doze lijekova ili privremeni prekid liječenja. Nakon prestanka terapije sve su nuspojave nestale. Zaključak. Dvojna terapija pegiliranim interferonom alfa i ribavirinom pokazala je statistički značajniji učinak na SVR od dvojne terapije konvencionalnim interferonom i ribavirinom u liječenju bolesnika s kroničnim hepatitisom C koji nisu odgovorili na monoterapiju konvencionalnim interferonom.The aim of this study was to determine the efficiency and safety of PEG interferon alfa 2a therapy in combination with ribavirin versus interferon alfa 2a therapy plus ribavirin (double therapy) for 48 weeks among chronic hepatitis C patients who were unsuccessfully treated with interferon alfa 2a or alfa 2b (monotherapy). Methods. There were two groups of patients. In group A there were 25 patients in the period from 2003 to 2005 who were given alfa 2a (Roferon A) in doses of 6 MIU three times a week together with ribavirin 1000 mg or 1200 mg daily for a period of 48 weeks. In group B there were 25 patients in the period from 2005 to 2008 who were given pegylated interferon alfa 2a (Pegasys) in weekly doses of 180 mg together with ribavirin of 1000 or 1200 mg for a period of 48 weeks. Results. The sustained viral response (SVR) in group A was 16% versus 24% in group B. SVR was statistically significantly higher in the group of patients infected with HCV genotypes 2 and 3 in comparison to genotype 1 (in group A 50% vs 5% and in group B 57% vs 11%). Both groups of patients had side effects that varied from mild to moderate, so that it was not necessary to lower the medicine doses or to stop with the therapy temporarily. All side effects disappeared when the treatment ended. Conclusion. Double therapy with PEG interferon alfa and ribavirin is more efficient than the double therapy with conventional interferon and Ribavirin in the treatment of chronic hepatitis C patients who did not respond to the monotherapy with conventional interferon

Ramipril and Risk of Hyperkalemia in Chronic Hemodialysis Patients

Angiotensin converting enzyme (ACE) inhibitors provide well known cardiorenal-protective benefits added to antihypertensive effects in chronic renal disease. These agents are underused in management of patients receiving hemodialysis (HD) because of common concern of hyperkalemia. However, few studies have investigated effect of renin angiotensin aldosterone system (RAAS) blockade on serum potassium in hemodialysis patients. We assessed the safety of ramipril in patients on maintenance HD. We enrolled 28 adult end stage renal disease (ESRD) patients treated by maintenance HD and prescribed them ramipril in doses of 1.25 to 5 mg per day. They underwent serum potassium concentration measurements before ramipril introduction and in 1 to 3 months afterwards. No significant increase in kalemia was found. Results of our study encourage the use of ACE inhibitors in chronically hemodialyzed patients, but close potassium monitoring is mandatory

The influence of early nutrition on the nutrition status and course of disease in patients with acute pancreatitis

Cilj: Evaluirati utjecaj rane enteralne prehrane (EP) i totalne parenteralne prehrane (TPP) na nutricijski status i tijek bolesti u oboljelih od akutnog pankreatitisa. Ispitanici i metode: U randomizirani kontrolirani pokus uključeno je 35 bolesnika sa srednje teškim akutnim pankreatitisom, podijeljenih u dvije skupine, ovisno o tipu nutritivne potpore. Bolesnici u skupini na EP dobivali su Alitraq, Abbott, 25-30 kcal/kg putem nazojejunalne sonde, uz opće mjere liječenja. Druga skupina pacijenata na TPP primala je totalnu parenteralnu prehranu u kontinuiranoj infuziji putem venskog katetera, također uz opće mjere liječenja. Rezultati: Srednja vrijednost CRP-a u ispitanika na EP pokazivala je veći pad 7. dana liječenja u odnosu na TPP (101,5:142,6). Pad indeksa tjelesne mase (ITM) bio je veći u ispitanika na TPP u odnosu na početne vrijednosti (7,4%), dok se kod ispitanika na EP nakon početnoga pada ITM-a, vrijednost istoga na kraju liječenja približavaju početnima. Vrijednosti kalcija brže su se oporavljale i dosegle su krajnje više vrijednosti u skupini na EP (2,11 ± 0,11 mmol/L) u odnosu na ispitanike na TPP (2,06 ± 0,16 mmol/L). Porast vrijednosti serumskih albumina bio je u EP 6,5%, a u TPP 0,2% u odnosu na početne vrijednosti. Trajanje hospitalizacije bilo je u prosjeku dva dana kraće u skupini ispitanika na EP. Učestalost kompli-kacija bila je podjednaka u obje skupine. Zaključak: EP je jednako učinkovita i sigurna u liječenju akutnog pankreatitisa kao i uobičajeno korištena TPP.Aim. The aim of this study was to evaluate the effects of early enteral nutrition (EN) and total parenteral nutrition (TPN) to nutritional status and development of the disease in patients suffering from acute pancreatitis. Patients and methods. 35 patients suffering from average severe acute pancreatitis were included in this randomized controlled trial. The patients were divided into two groups, according to the type of nutritional support. Those receiving enteral nutrition were given Alitraq, Abbott, 25-30 kcak/kg via nasojejunal tube with general supportive treatment. Other patients receiving total parenteral nutrition were given this nutrition in continuous infusion through the central venous catheter with general supportive treatment. Results. Mean value of CRP in patients on EN demonstrated more pronounced decrease on day 7 of the treatment vs. TPN (101.5 : 142.6). A decrease in the body mass index (BMI) was higher in the TPN group when compared to initial values (7.4%), whereas in patients on EN group after initial decrease, the values approached baseline values. The values of serum calcium recovered faster and reached higher values in the EN group (2.11 ± 0.11mmol/L) vs. patients in TPN group (2.06 ± 0.16 mmol/L). An increase in the serum albumin levels in comparison to baseline values was 6.5% in EN group vs. 0.2% in TPN group of patients. The length of hospitalization was on average two days shorter in patients receiving EN. Complication incidence was similar in both groups. Conclusion. EN is equally efficient and safe in treatment of acute pancreatitis as standard nutritional support i.e. total parenteral nutrition

Fulminant Meningococcal Sepsis in a Young Child – A Case Report

We are presenting a case of isolated fulminant meningococcal sepsis with two and a half year old child. Initial symptoms were obscure and common to many medical conditions, but also previously described as symptoms of meningococcal sepsis. Unrecognizing the seriousness of the condition child died at home, within few hours after examination and discharge from the hospital. Autopsy and microbiological findings unquestionably proved that the child died from septic shock caused by fulminant meningococcal sepsis

Effects of Obesity Reduction on Cardiovascular Risk Factors: Comparison of Individual and Group Treatment – Substudy of the Croatian Healthy Weight Loss Programme

Prevention of obesity may help reduce the morbidity and mortality from cardiovascular diseases. In Croatia, over half of adult population is overweight. Aldo the basic medical principles of healthy weight-loss programmes are well known, it is believed that mainly because of the leak of successful therapeutic approach obesity remains the most challenging changeable cardiovascular risk factor in nowadays clinical practice. Objective of this Croatian Healthy Weight Loss Programme substudy was to determine effects and differences between the intensive group and intensive individual weight-loss program on weight loss and cardiovascular risk factor. A clinical trial included 476 adults whose body mass index (BMI) was >30 or >28 accompanied by increased blood pressure, glucose, and cholesterol. The study participants completed either a group (n=243) or individually-based (n=233) 6-month weight-loss program consisting of education, low-fat diet, pharmacological treatment with orlistat, psychological counselling, and exercise. Body weight, body mass index, blood pressure, blood sugar, and blood cholesterol were measured in all participants after 3 and 6 months. The average weight loss was 12.2 (13%) kg and 7.6 (9%) kg in the group and individual program, respectively. Beside the weight reduction, the levels of blood cholesterol, glucose, and blood pressure were also significantly reduced in comparison with baseline, decreasing to normal values in all participants (P<0.001 for all). Decrease in the monitored parameters was greater in participants in the group program. The weight loss program provided a healthy loss of extra weight in the period of 6 months. The group program produced greater decrease in body weight, body mass index, blood pressure, glucose, and cholesterol than the individual program

Fulminant Meningococcal Sepsis in a Young Child – A Case Report

We are presenting a case of isolated fulminant meningococcal sepsis with two and a half year old child. Initial symptoms were obscure and common to many medical conditions, but also previously described as symptoms of meningococcal sepsis. Unrecognizing the seriousness of the condition child died at home, within few hours after examination and discharge from the hospital. Autopsy and microbiological findings unquestionably proved that the child died from septic shock caused by fulminant meningococcal sepsis