Liver schistosomiasis: an unexpected finding in hepatitis B virus-related chronic hepatitis

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The role of teicoplanin in the treatment of SARS-CoV-2 infection: a retrospective study in critically ill COVID-19 patients (Tei-COVID Study)

Teicoplanin has a potential antiviral activity expressed against SARS-CoV-2 and was suggested as a complementary option to treat COVID-19 patients. In this multicentric, retrospective, observational research the aim was to evaluate the impact of teicoplanin on the course of COVID-19 in critically ill patients

Years of life that could be saved from prevention of hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) causes premature death and loss of life expectancy worldwide. Its primary and secondary prevention can result in a significant number of years of life saved. AIM: To assess how many years of life are lost after HCC diagnosis. METHODS: Data from 5346 patients with first HCC diagnosis were used to estimate lifespan and number of years of life lost after tumour onset, using a semi-parametric extrapolation having as reference an age-, sex- and year-of-onset-matched population derived from national life tables. RESULTS: Between 1986 and 2014, HCC lead to an average of 11.5 years-of-life lost for each patient. The youngest age-quartile group (18-61 years) had the highest number of years-of-life lost, representing approximately 41% of the overall benefit obtainable from prevention. Advancements in HCC management have progressively reduced the number of years-of-life lost from 12.6 years in 1986-1999, to 10.7 in 2000-2006 and 7.4 years in 2007-2014. Currently, an HCC diagnosis when a single tumour <2 cm results in 3.7 years-of-life lost while the diagnosis when a single tumour 65 2 cm or 2/3 nodules still within the Milan criteria, results in 5.0 years-of-life lost, representing the loss of only approximately 5.5% and 7.2%, respectively, of the entire lifespan from birth. CONCLUSIONS: Hepatocellular carcinoma occurrence results in the loss of a considerable number of years-of-life, especially for younger patients. In recent years, the increased possibility of effectively treating this tumour has improved life expectancy, thus reducing years-of-life lost

THU0643-HPR PHYSIOTHERAPISTS' ADHERENCE TO OSTEOARTHRITIS CLINICAL GUIDELINES: A NATIONAL ITALIAN SURVEY.

Background:Osteoarthritis (OA) is the most prevalent joint disease in the world, and one of the top causes of disability [1]. OARSI and EULAR guidelines recommend non-surgical interventions as first-line interventions for OA [2]. Despite this, only less than 40% of people suffering from OA receive the recommended intervention [3].Objectives:The aim of this study is to investigate to what extent a population of Italian physiotherapists adhere to the OA-guidelines in their clinical practice.Methods:A quantitative web-based cross-sectional survey was developed according to the Checklist for Reporting Results of Internet E-Survey. The questionnaire was realised in Italy by a panel of physiotherapists, based on the EULAR, OARSI and NICE OA-guidelines. The questionnaire was delivered using REDCap through the Italian Association of Physiotherapists and the University of Genoa newsletters. The questionnaire was divided into two sections. The first section included 24 statements adapted from the aforementioned guidelines. Participants were asked to express their statement agreement on a scale from 1 (completely disagree) to 5 (completely agree). Participants who partially or totally agreed (score 4-5) were considered to agree with the statements. We defined a ≥ 70% agreement with a statement as consensus. In the second section, a clinical vignette was presented, illustrating an OA clinical case. Participants had to select, from a list of clinical options, how they would manage this case. Participants were classified as 'Delivering', 'Partially delivering' and 'Non-delivering' the recommended intervention, depending on the recommended or not-recommended interventions chosen.Results:812 physiotherapists (age: 36±13,59; 48% women) completed the survey between 26 November 2019 and 9 January 2020. The consensus was achieved for 12 sentences (52%) out of 23 (Fig. 1). All the statements focussed on exercise, education, and surgical referral received > 70% of agreement, whereas no consensus was reached for the statements on the clinical diagnostic criteria, for the use of glucosamine or chondroitin products and for the use of topic NSAIDs. In the second section, 20% of the analysed physiotherapists would deliver an intervention in line with OA guidelines and a 20% would carry out an intervention that is partially in line with OA guidelines. Conversely, the 40% of the participants of this survey would include at least a not-recommended intervention, considered, therefore, as 'non-delivering' the recommended intervention (Fig. 2).Figure 1.Agreement to Clinical Guidelines (%)Figure 2.Adherence to Clinical Guidelines (%) reported in the Clinical VignetteConclusion:Our findings reveal an overall sub-optimal adherence to OA-guidelines in a sample of Italian physiotherapists. Italian physiotherapists appear to be aware of the importance of exercise and education for patients suffering from OA. Instead, a sub-optimal level of knowledge was found regarding the criteria for OA clinical diagnosis and on the role of other non-surgical interventions in the management of OA. These results identified some gaps between evidence and clinical practice, which may lead to an incorrect management of patients suffering from OA.References:[1]GBD 2017 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2018;392:1789–858.[2]Fernandes, L. et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis.Ann Rheum Dis. 2013;72:1125–35.[3]Basedow M et al. Assessing appropriateness of osteoarthritis care using quality indicators: a systematic review.J Eval Clin Pract. 2015;21:782–9.Disclosure of Interests:None declare

The role of teicoplanin in the treatment of SARS‐CoV‐2 infection: A retrospective study in critically ill COVID‐19 patients (Tei‐COVID study)

Teicoplanin has a potential antiviral activity expressed against SARS-CoV-2 and was suggested as a complementary option to treat COVID-19 patients. In this multicentric, retrospective, observational research the aim was to evaluate the impact of teicoplanin on the course of COVID-19 in critically ill patients

High Efficacy and Safety of Flat-Dose Ribavirin Plus Sofosbuvir/Daclatasvir in Genotype 3 Cirrhotic Patients

Background/Aims: Patients with genotype 3 hepatitis C virus (G3-HCV) cirrhosis are very difficult to treat compared to patients with other HCV genotypes. The optimal treatment duration and drug regimen associated with ribavirin (RBV) remain unclear. To evaluate the efficacy and safety of daclatasvir (DCV)/sofosbuvir (SOF) plus a flat dose of 800 mg RBV (flat dose) compared to DCV/SOF without RBV or DCV/SOF plus an RBV dose based on body weight (weight-based) in G3-HCV patients with compensated or decompensated cirrhosis. Methods: We analyzed data for 233 G3 cirrhotic patients. Of these, 70 (30%), 87(37%) and 76 (33%) received SOF/DCV, SOF/DCV/RBV flat dose, and SOF/DCV/RBV weight-based dose, respectively. Treatment duration was 24 weeks. Sustained virological response (SVR) was evaluated at week 12 posttreatment (SVR12). Results: Overall, SVR12 was achieved in 220 out of 233 patients (94.4%). The SVR12 rate was lower in the DCV/SOF group than in the DCV/SOF/RBV flat-dose group and the DCV/SOF/RBV weight-based group (87.1% vs 97.7% and 97.4%, respectively, p=0.007). A higher incidence of anemia occurred in the DCV/SOF/RBV weight-based group compared to those in the other two groups (p<0.007). Conclusions: We found that the DCV/SOF/RBV flat-dose regimen is an effective treatment in terms of efficacy and safety in patients with G3-HCV compensated or decompensated cirrhosis. Therefore, antiviral regimens without RBV should be restricted only to naïve patients with G3-HCV compensated cirrhosis who have a clear contraindication for RBV

Application of the Intermediate-Stage Subclassification to Patients with Untreated Hepatocellular Carcinoma

OBJECTIVES:The Barcelona Clinic Liver Cancer (BCLC) intermediate stage (BCLC B) includes a heterogeneous population of patients with hepatocellular carcinoma (HCC). Recently, in order to facilitate treatment decisions, a panel of experts proposed to subclassify BCLC B patients. In this study, we aimed to assess the prognostic capability of the BCLC B stage reclassification in a large cohort of patients with untreated HCC managed by the Italian Liver Cancer Group.METHODS:We assessed the prognosis of 269 untreated HCC patients observed in the period 1987-2012 who were reclassified according to the proposed subclassification of the BCLC B stage from stage B1 to stage B4. We evaluated and compared the survival of the various substages.RESULTS:Median survival progressively decreased from stage B1 (n=65, 24.2%: 25 months) through stages B2 (n=105, 39.0%: 16 months) and B3 (n=22, 8.2%: 9 months), to stage B4 (n=77, 28.6%: 5 months; P<0.0001). Moreover, we observed a significantly different survival between contiguous stages (B1 vs. B2, P=0.0002; B2 vs. B3, P<0.0001; B3 vs. B4, P=0.0219). In multivariate analysis, the BCLC B subclassification (P<0.0001), MELD score (P=0.0013), and platelet count (P=0.0252) were independent predictors of survival.CONCLUSIONS:The subclassification of the intermediate-stage HCC predicts the prognosis of patients with untreated HCC. The prognostic figures identified in this study may be used as a benchmark to assess the efficacy of therapeutic intervention in the various BCLC B substages, whereas it remains to be established whether incorporation of the MELD score might improve the prognosis of treated patients

Recalibrating survival prediction among patients receiving trans\u2010arterial chemoembolization for hepatocellular carcinoma

Background &amp; Aims The Pre-TACE-Predict model was devised to assess prognosis of patients treated with trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). However, before entering clinical practice, a model should demonstrate that it performs a useful role. Methods We performed an independent external validation of the Pre-TACE model in a cohort that differs in setting and time period from the one that generated the original model. Data from 826 patients treated with TACE for naïve HCC (2008-2018) were used to assess calibration and discrimination of the Pre-TACE-Predict model. Results The four risk-categories identified by the Pre-TACE-Predict model had gradient monotonicity, with median survivals of 52.0, 36.2, 29.9, and 14.1 months respectively. However, predicted survivals systematically underestimated observed survivals (R2: 0.667). A recalibration was adopted maintaining fixed the prognostic index and modifying the baseline survival function. This resulted in an almost perfect calibration (R2: 0.995) in all the four risk categories. Cox regressions showed that aetiology and macrovascular invasion, included in the Pre-TACE-Predict model, had no prognostic impact in the present study population, and that coefficients for tumour size and multiplicity were overestimated. The c-index was similar to that of the m-HAP-III, but higher than those of HAP, m-HAP-II and the six-and-twelve models. Conclusions The recalibration of Pre-TACE-Predict model improved the estimation of survival probabilities of HCC patients treated with TACE. The highest discriminatory ability of the Pre-TACE-model in comparison to other available models, together with risk stratification and recalibration, makes it the best prognostic tool currently available for these patients