The HCV Sicily Network: A web-based model for the management of HCV chronic liver diseases

Epidemiological studies report that in Sicily reside about 30,000 citizens with a diagnosis of chronic hepatitis due to HCV. The availability of direct antiviral action (DAA) is a real therapeutic breakthrough, but the high cost of the therapeutic regimes limits their use and forced the National Health System to establish clinical priority for the treatment.The HCV Sicily Network is a web-based model of best medical practice, which was designed to improve the management and the treatment of HCV chronic hepatitis and cirrhosis. The network includes 41 centers and 84 gastroenterologists or infectivologists connected by a web platform that recorder the diagnosis and the clinic priority for the…

GRP78 POLYMORPHISM rs430397 IS ASSOCIATED WITH HEPATOCELLULAR CARCINOMA IN A SOUTHERN ITALIAN POPULATION

630 SERUM BLYS/BAFF LEVELS IN ACUTE HEPATITIS C PREDICT CLINICAL OUTCOME

Direct acting antivirals after successful treatment of early hepatocellular carcinoma improve survival in HCV-cirrhotic patients

Background & aims: The effectiveness of direct-acting antivirals (DAAs) against hepatitis C virus (HCV) after successful treatment of early hepatocellular carcinoma (HCC) has been studied extensively. However, the benefit in terms of overall survival (OS) remains to be conclusively demonstrated. The aim of this study was to assess the impact of DAAs on OS, HCC recurrence, and hepatic decompensation. Methods: We enrolled prospectively 163 consecutive patients with HCV-related cirrhosis and at first diagnosis of early Barcelona Clinic Liver Cancer (BCLC) 0/A HCC who had achieved a complete radiologic response after curative resection or ablation, subsequently treated with DAAs. DAA-untrea…

A patient with acute hepatitis C and possible IFN toxicity [2]

[No abstract available]

Non recurrent laryngeal nerve. Personal experience

P1013 : Chronic intermittent hypoxia is associated with liver damage and atherosclerosis in patients with non-alcoholic fatty liver disease

all the steatosis grades, except S2 vs S3. The diagnostic performances of CAP in quantifying each steatosis grade was: for S ≥1 AUC=0.813 (cutoff 260dB/m, Se = 64.84%, Sp =87.27%, PPV=80.8%, NPV=75%, +LR =5.09, −LR =0.40, DA=76.11%); for S ≥2 AUC=0.822 (cutoff 285dB/m, Se = 69.70%, Sp =85.12%, PPV=47.9%, NPV=93.5%, +LR =4.68, −LR =0.36, DA=82.08%); for S ≥3 AUC=0.838 (cutoff 294dB/m, Se =83.33%, Sp =82.54%, PPV=23.3%, NPV=98.7%, +LR =4.77, −LR =0.20, DA=81.59%). AUCs calculated between two steatosis grades only were: 0.772 (for S0 vs S1), 0.874 (S0 vs S2), 0.904 (S0 vs S3), 0.659 (S1 vs S2), 0.777 (S1 vs S3), and 0.665 (S2 vs S3) respectively. Conclusions: Maximal diagnostic accuracy could …

Undetectable HCV-RNA at treatment-week 8 results in high-sustained virological response in HCV G1 treatment-experienced patients with advanced liver disease: The International Italian/Spanish Boceprevir/Peginterferon/Ribavirin Name Patients Program

In many countries, first-generation protease inhibitors (PIs)/peginterferon/ribavirin (P/R) still represent the only treatment option for HCV-infected patients. Subjects with advanced disease and previous failure to P/R urgently need therapy, but they are under-represented in clinical trials. All treatment-experienced F3/4 Metavir patients who received boceprevir (BOC)+P/R in the Italian-Spanish Name Patient Program have been included in this study. Multivariate logistic regression analysis (MLR) was used to identify baseline and on-treatment predictors of SVR and adverse events (AEs). Four hundred and sixteen patients, mean age 57.7 (range 25-78 years), 70% males, 69.5% (289/416) F4, 14% (…

An uncommon complication of liver biopsy: obstructive jaundice from blood clots

Introduction: The AA. report on a case of one young woman who developed obstructive jaundice induced by hemo- bilia after percutaneous liver biopsy, successfully treated with endoscopic retrograde cholangiopancreatography (ERCP) Methods: An endoscopic sphincterotomy was performed with extraction of the clots Observations: Four weeks after ERCP the patient was healthy and asymptomatic, valuated as outpatient Conclusions: The role of ERCP in managing biliary sequelae of hemobilia is well established: biliary decompression is required if and intrabiliary lot causes obstructive jaundice and/or biliary colic. ERCP is feasible and leads to relief of symptoms in most cases, without the need of sur…

OC.03.2 THE PRESENCE OF WHITE MATTER LESIONS IS ASSOCIATED WITH THE HISTOLOGICAL SEVERITY OF NON-ALCOHOLIC FATTY LIVER DISEASE

Mortality rate and risk factors for gastrointestinal bleeding in elderly patients

Abstract Background Gastrointestinal bleeding (GIB) is burdened by high mortality rate that increases with aging. Elderly patients may be exposed to multiple risk factors for GIB. We aimed at defining the impact of GIB in elderly patients. Methods Since 2008, samples of elderly patients (age ≥ 65 years) with multimorbidity admitted to 101 internal medicine wards across Italy have been prospectively enrolled and followed-up (REPOSI registry). Diagnoses of GIB, length of stay (LOS), mortality rate, and possible risk factors, including drugs, index of comorbidity (Cumulative Illness Rating Scale [CIRS]), polypharmacy, and chronic diseases were assessed. Adjusted multivariate logistic regressio…

Chronic Intermittent Hypoxia is associated with Liver Damage and Atherosclerosis in Patients with Non-alcoholic Fatty Liver Disease

Il nervo ricorrente che non ricorre

Incidence of Hepatocellular Carcinoma in Patients With HCV-Associated Cirrhosis Treated With Direct-Acting Antiviral Agents.

Background & Aims: Studies have produced conflicting results of the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis C virus–associated cirrhosis treated with direct-acting antivirals (DAAs). Data from clinics are needed to accurately assess the occurrence rate of HCC in patients with cirrhosis in the real world. Methods: We collected data from a large prospective study of 2,249 consecutive patients (mean age = 65.4 years, 56.9% male) with hepatitis C virus–associated cirrhosis (90.5% with Child-Pugh class A and 9.5% with Child-Pugh class B) treated with DAAs from March 2015 through July 2016 at 22 academic and community liver centers in Sicily, Italy. HCC occurren…

Retinol-binding protein 4 (RBP4): A new marker of G1 HCV-induced steatosis

Need for Deprescribing in Hospital Elderly Patients Discharged with a Limited Life Expectancy: The REPOSI Study

<b><i>Objective:</i></b> Older people approaching the end of life are at a high risk for adverse drug reactions. Approaching the end of life should change the therapeutic aims, triggering a reduction in the number of drugs.<b><i></i></b>The main aim of this study is to describe the preventive and symptomatic drug treatments prescribed to patients discharged with a limited life expectancy from internal medicine and geriatric wards. The secondary aim was to describe the potentially severe drug-drug interactions (DDI). <b><i>Materials and Methods:</i></b> We analyzed Registry of Polytherapies Societa Italiana di Medicina I…

EFFETTI DELLA TERAPIA CON DIRECT ACTING ANTIVIRALS (DAAS) SUI PARAMETRI ECOGRAFICI DI IPERTENSIONE PORTALE

Obiettivi dello studio: Tra gli end point della terapia antivirale con DAAs nella cirrosi HCV (LCHCV) oltre all' eradicazione del virus vi sono: la regressione della fibrosi e dell’ipertensione portale. Abbiamo valutato in pazienti LCHCV e risposta sostenuta (SVR) alla terapia con DAAs il comportamento dell’AST to Platelet Ratio Index (APRI) (marker indiretto di fibrosi) e di due segni ecografici di ipertensione portale: calibro della vena porta (cVP) e diametro longitudinale della milza (DLM). Materiali: 98 pazienti con LCHCV,al Baseline (BL) a fine terapia (FT) e tre mesi (PostT3) e 9 mesi dopo la fine della terapia (PostT9) eseguivano i test di funzionalità epatica e la conta piastrinica…

Insulin resistance and diabetes increase fibrosis in the liver of patients with genotype 1 HCV infection.

OBJECTIVES: Metabolic factors may affect the course of chronic hepatitis C (CHC). Insulin resistance (IR) determines steatosis, but its direct role in affecting progression of hepatic fibrosis is less clear. We aimed to assess whether increasing degrees of IR, up to overt diabetes, are linked to steatosis and higher stages of fibrosis in patients with CHC resulting from genotype 1 HCV (G1-HCV). METHODS: Two hundred one consecutive patients with G1-HCV infection were evaluated by liver biopsy and anthropometric and metabolic measurements, including IR, by the homeostasis model assessment (HOMA). Nondiabetic patients were defined as insulin resistant if HOMA-IR was >2.7. All biopsies were …

Treatment of elderly HCV patients with severe fibrosis: safety and efficacy data from RESIST-HCV, a large regional database

Complicanze in chirurgia tiroidea: ipoparatiroidismo sintomatico post-operatorio.Incidenza, note di tecnica chirurgica, prevenzione e trattamento.

Introduction: Total thyroidectomy has a definite role in the management of malignant and benign thyroid disorders, with minimal complications and rare postoperative mortality. Even though thyroid surgery is quite safe, mechanical damage, devascularization or inadvertent removal of the parathyroid glands are possible. The aim of this study is to report report the personal surgical experience and to define some of the pathologic and clinical characteristics of unintentional parathyroidectomy and post-thyroidectomy hypocalcemia Materials and methods: A retrospective-observational study was carried on 313 thyroidectomies from January 2000 to January 2004 (60 males and 253 females), mean age 41 …

Efficacy and safety of Boceprevir-based therapy in HCVG1 treatment-experienced patients with advanced fibrosis/cirrhosis: Italian NPP survey

S. Bruno1, S. Bollani1, A.L. Zignego2, V. Calvaruso3, C. Magni4, S. Landonio4, M. Rizzetto5, A. Ciancio5, A. Mangia6, V. Piazzolla6, M. Caremani7, S. Piovesan8, L. Cavalletto9, S. Babudieri9, A. Moretti 10, C. Colletta11, M. Massari12, S. Fangazio13, F. Mazzotta14, L. Muratori15, A.E. Colombo16, M. Zuin17, A. Traverso18, T. Santantonio19, F. Farina20, E. Marchionne21, G. Serviddio22, M. Russello23, A. Licata24, A. Craxi3, V. Di Marco3 1 Internal Medicine, AO Fatebenefratelli e Oftalmico, Milano, Italy 2 Internal Medicine, Universita di Firenze, Italy 3 Gastroenterology, Universita di Palermo, Italy 4 Infectiuos Diseases, Ospedale Sacco, Milano, Italy 5 Gastroenterology, Universita di Torino…

EFFICACY AND SAFETY OF BOCEPREVIR-BASED THERAPY IN HCVG1 TREATMENT-EXPERIENCED PATIENTS WITH ADVANCED FIBROSIS/CIRRHOSIS: THE ITALIAN AND SPANISH NPP EARLY ACCESS PROGRAM

Background and Aims: To maximize cost/efficay of boceprevirbased triple therapy (BOC) in patients with HCV-related advanced fibrosis/cirrhosis. Methods: ITT SVR12, safety and futility rules value were evaluated in the multicenter national Italian and Spanish early access Name- Patient-Program which includes treatment-experienced patients with HCVG1-related advanced fibrosis/cirrhosis (Metavir F3/4) treated with BOC in both countries. Results: 402 patients (mean age 55 years; range 22–75), 316 (78.6%) G1b, 255 (63.4%) F4, 60 (30.9%) with oesophageal varices, 137 (34.1%) relapsers, 95 (23.6%) partial and 168 (41.8%) null responders were enrolled. Platelets count <100,000 and albumin levels <3…

A phenobarbital overdose: a case report

Background: Phenobarbital is a long-acting barbiturate, responsible for many cases of poisoning, from unintentional overdose or attempted suicide. We report a case of phenobarbital overdose in a patient with history of depression. Patients and Methods: A 60 year old woman was admitted to our Internal Medicine Unit for drowsiness, irritability, difficulties in the maintenance of an upright position, dysphasia and weakness. She was suffering from depression and epilepsy and treated with phenobarbital 150 mg/die. Results: At the admittance, she had high fever and neck stiffness; phenobarbital serum levels were 71.2 mcg/ml (3 times u.n.l.); aminotransferases were 12-17u.n.l. Arterial blood pres…

Economic Consequences of Investing in Anti-HCV Antiviral Treatment from the Italian NHS Perspective: A Real-World-Based Analysis of PITER Data

OBJECTIVE:\ud We estimated the cost consequence of Italian National Health System (NHS) investment in direct-acting antiviral (DAA) therapy according to hepatitis C virus (HCV) treatment access policies in Italy.\ud \ud METHODS:\ud A multistate, 20-year time horizon Markov model of HCV liver disease progression was developed. Fibrosis stage, age and genotype distributions were derived from the Italian Platform for the Study of Viral Hepatitis Therapies (PITER) cohort. The treatment efficacy, disease progression probabilities and direct costs in each health state were obtained from the literature. The break-even point in time (BPT) was defined as the period of time required for the cumulativ…

P1030 : The presence of white matter lesions is not associated with non-alcoholic fatty liver disease but with its histological severity