Lin Ck

Factors linked to severe thrombocytopenia during antiviral therapy in patients with chronic hepatitis c and pretreatment low platelet counts

BackgroundBaseline low platelet count (< 150,000/μL) increases the risk of on-treatment severe thrombocytopenia (platelet count < 50,000/μL) in patients with chronic hepatitis C (CHC) undergoing antiviral therapy, which may interrupt treatment. The purpose of this study was to identify risk factors for severe thrombocytopenia during treatment for CHC in patients with baseline thrombocytopenia.MethodsMedical records were reviewed for 125 patients with CHC treated with antiviral therapy according to the standard of care, with regular follow-up examinations. Early platelet decline was defined as platelet decrease during the first 2 weeks of therapy.ResultsSevere thrombocytopenia developed in 12.8% of patients with baseline thrombocytopenia, and predicted a higher therapeutic dropout rate. Multivariate analysis revealed baseline platelet count < 100,000/μL and rapid early platelet decline (> 30% decline in the first 2 weeks) were significantly associated with severe thrombocytopenia (P < 0.001 and 0.003, odds ratios, 179.22 and 45.74, respectively). In these patients, baseline PLT ≥ 100,000/μL and lack of rapid early platelet decline predicted absence of severe thrombocytopenia (negative predictive values were 95.1% and 96.6%, respectively). In contrast, baseline platelet count < 100,000/μL combined with rapid early platelet decline predicted severe thrombocytopenia (positive predictive value was 100%).ConclusionsFor patients with CHC on antiviral therapy, baseline platelet counts < 100,000/μL and rapid early platelet decline can identify patients at high risk of developing on-treatment severe thrombocytopenia.

Baseline High Viral Load and Unfavorable Patterns of Alanine Aminotransferase Change Predict Virological Relapse in Patients With Chronic Hepatitis C Genotype 1 or 2 Obtaining Rapid Virological Response During Antiviral Therapy

Background Rapid virological response (RVR) strongly predicts sustained virological response (SVR) in patients with chronic hepatitis C (CHC), and abbreviates antiviral therapy in some patients. Objectives To identify factors predicting virological relapse (VR) in CHC patients who attained RVR. Patients and Methods Medical records of 133 CHC patients with an RVR after completing 24 weeks of antiviral therapy (a combination of pegylated interferon-α and ribavirin) were analyzed. Baseline characteristics and on-treatment responses were compared between the patients with an SVR and those with VR. Patients with normal alanine aminotransferase (ALT) levels at weeks 4 and 12 and at the end-of-treatment (EoT) and patients with elevated, but constantly decreasing, ALT levels were classified as having favorable patterns of ALT change. A trend of increasing ALT levels either between weeks 4 and 12 or between weeks 12 and EoT was classified as unfavorable. A high viral load (HVL) was defined as a baseline HCV RNA ≥ 600000 IU/mL. Results In total, 116 (87.2%) patients had a SVR and 14 (10.5%) had VR. The VR rates were comparable between patients with genotype-1 (13.1%) and genotype-2 infection (8.7%) (P = 0.572). Multivariate analysis revealed that HVL (P = 0.015; odds ratio [OR] = 14.754; 95% confidence interval (CI) = 1.671–130.240), and unfavorable ALT patterns (P = 0.039; OR = 4.397; 95% CI = 1.078–17.930) independently predicted VR. In subgroup analysis, low viral load (LVL) patients had a minimal VR rate (1.8%). Among the HVL patients, the VR rate of those using peg-IFN-α-2a was relatively low (9.1%). Patients using peg-IFN-α-2b had a slightly higher VR rate (23.8%; P = 0.128), and patients with favorable patterns of ALT changes had a lower VR rate (10.3%) compared to the 53.8% in patients with unfavorable ALT patterns (P = 0.005). Conclusions In southern Taiwan, 24 weeks of antiviral therapy achieved a high SVR rate in patients with CHC attaining RVR, except in the subgroup of patients treated with peg-IFN-α-2b with HVL and on-treatment unfavorable ALT patterns.

Endoscopic Tissue Glue Injection in a Pregnant Woman with Acute Cardiac Variceal Bleding: Report of a Case

Gastric variceal bleeding (GVB) in pregnancy is very rare and makes management more difficult than those without pregnancy. Endoscopic tissue glue obturation is the first choice of endoscopic therapy for GVB but it carries a risk of embolization, infection and huge ulceration. We report a first case of GVB in pregnancy in which endoscopic tissue glue obturation successfully controlled the bleeding. The available therapies for GVB and the efficacy and safety of endoscopic tissue glue obturation are also discussed.

Comparison of the Effectiveness of Three Bowel Preparations for Flexible Sigmoidoscopy

Background and Purpose: Various types of bowel preparations are used for flexible sigmoidoscopy, but the actual advantages of these bowel preparations are rarely discussed. The purpose of this study was to evaluate the efficacy and patient acceptability of three common methods of bowel preparation for flexible sigmoidoscopy. Methods: Consecutive outpatients undergoing flexible sigmoidoscopy were randomly assigned to three groups. In group 1, patients took 15 mg bisacodyl (Dulcolax(superscript ®)) both the evening before and 6 hours before the procedure. In group 2, patients received a glycerol enema (a total volume of 125 ml, Laitest(superscript ®)) one hour before the procedure. In group 3, patients received two hypertonic Sodium chloride enemas (a total volume of 40 ml, Atomic(superscript ®)) one hour before the procedure. Every patient was asked to fill out a questionnaire on preparation tolerability and adverse effects. Preparation quality was assessed as excellent, good, fair, and poor by endoscopists who were blinded to the form of the bowel preparations. Results: Three hundred and twenty-six patients were enrolled into this study (group 1-113 patients, groups 2-108 patients, group 3-105 patients). Acceptability of the bowel preparation was better in patients who received oral bisacodyl regimen as compared to either of the enema preparations (p＜0.01). Oral bisacodyl regimen also yielded better visualization of the colonic mucosa than two enema preparations (p＜0.05). Moreover, oral bisacodyl regimen was associated with deeper insertion of the sigmoidoscope (p＜0.05) and more complete procedures (p＜0.05). Fifty-nine of the participants had undergone previous sigmoidoscopy with hypertonic sodium chloride enema for bowel preparation, 20, 21 and 18 patients were randomly assigned to group 1, 2 and 3, respectively. More participants (16, 80%) in group 1 preferred oral bisacodyl regimen and fewer participants (7, 33%) in group 2 preferred the glycerol enema. With regard to adverse effects, abdominal pain was more common in patients receiving oral bisacodyl regimen (p＜0.01). More patients in the group 3 had anal irritation (p=0.01). Conclusions: A fractionated oral bisacodyl is more efficient, acceptable in preparing the left side of colon for sigmoidoscopy.