The management of common mental health concerns in primary care
Julie M Schirmer MSW, Alain J Montegut MD, Stephen J Spann MD, Gabriel Ivbijaro MD, Alfred Loh MD in Behavioral Medicine in Primary Care, 2017
In Ngozi’s case, in the second of the above scenarios, when his practitioner asked the four CAGE questions, Ngozi admitted that he had thoughts about cutting down his alcohol intake, that he was annoyed by his family members’ criticism of his drinking, and that he occasionally needed an eye-opener to feel normal. His CAGE score of three suggested that alcohol abuse was likely. Physical examination revealed no signs of end-stage liver disease, although liver function testing revealed a slight elevation of transaminases. When he was presented with this information in a non-judgmental fashion, Ngozi continued to deny that alcohol was a problem in his life. His practitioner reaffirmed that she was concerned about his health, and that whenever he might be interested in developing a treatment plan, she would be available for consultation.
Interferon Alpha
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Despite the fact that there may be very few clinical symptoms and signs of liver progression before the development of end-stage liver disease, histopathologic evidence of progression can be identified earlier. The gold standard for the assessment of the extent of liver disease is the liver biopsy (Seeff and Hoofnagle, 2003; Strader et al., 2004), which provides important information on inflammation and fibrosis occurring in the liver. During persistent HCV infection, there is a chronic inflammatory response that is associated with the development of fibrosis (Kiyosawa et al., 1990; Perrillo, 1997). Fibrosis will often progress to cirrhosis, eventually leading to end-stage liver disease or HCC (Goodman and Ishak, 1995). However, disease progression is affected by a number of factors and not all chronically infected patients follow this sequence of events, and those who do progress do so over 20–40 years or even longer.
Development of palliative medicine in the United Kingdom and Ireland
Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita in Textbook of Palliative Medicine and Supportive Care, 2015
Recognizing the potential for dramatic improvement in health with HAART for patients with previously untreated, advanced HIV disease, how does one recognize the patient who is no longer appropriate for life-sustaining therapy? Virological, clinical characteristics and comorbidities provide useful information. Patients with a history of nonadherence to ART regimens, inability to obtain HAART, and/or highly resistant HIV infection fare poorly. Underlying liver disease, particularly cirrhosis and/or active hepatitis interfering with the ability to deliver effective ART safely, also poses a significant risk for patients overall longevity. Refractory malignancy, with or without adequate control of HIV infection, predicts a poor prognosis, as it does in the general population. Similarly, end-stage liver disease, generally secondary to HCV, carries a poor prognosis. For patients whose prognosis is defined by a secondary illness or uncontrolled, refractory HIV infection, withdrawal of HIV medications should at least be considered and discussed at length with the patient. The balance between the potential benefit from HAART versus the burden of continuing to take the medications should be weighed in the context of the patient's goals and comorbidities. As is the case for all patients with chronic and/ or progressive illness, constant reassessment of goals, toxicities of therapy, and definitions of quality of life need repeated evaluation and discussion.
Histological and biochemical studies on effect of Sofosbuvir (Sovaldi) on adult male albino rat kidney
Published in Ultrastructural Pathology, 2021
Amany F. Mohamed, Amany M. Abo-Ouf, Mona A.A. Arafa
Hepatitis C is a global health problem that affects almost every region across the world. It is the leading cause of end-stage liver disease and primary liver cancer. There is an intense interest in developing therapeutic regimens that are capable of inhibiting HCV replication and eradicating infection.1 Sofosbuvir (Sovaldi) is an antiviral candidate against multiple hepatitis C virus genotypes.2 It is the backbone of many anti‐HCV drug regimens.3 It is a nucleotide analogue that is a potent inhibitor of NS5B polymerase in HCV. NS5B is a non-structural protein that is essential for viral RNA replication and has been a valuable target for many directly acting antiviral agents.4 The Food and Drug Administration approve it for the treatment of chronic HCV infection.2 Effective and powerful antiviral drugs are well-known causes of the additional increase in the incidence of antiviral drug nephrotoxicity.5 Sofosbuvir is principally renal excreted. It is converted into inactive metabolites that undergo renal excretion.3 Many clinicians had concerns to use sofosbuvir-based regimens in chronic kidney disease patients because clinical data are limited and heterogeneous.6
Reduced platelet activation and platelet aggregation in patients with alcoholic liver cirrhosis
Published in Platelets, 2018
Pernille Just Vinholt, Anne-Mette Hvas, Christian Nielsen, Anna Cecilia Söderström, Ulrik Sprogøe, Annette Dam Fialla, Mads Nybo
A cross-sectional observational study was conducted at Odense University Hospital, Denmark. From April 2015 to August 2016, patients were included from the Department of Gastroenterology, while healthy individuals were recruited from the blood bank waiting room at the Department of Clinical Immunology. Patients were eligible for inclusion if they had been diagnosed with alcoholic liver cirrhosis. Liver cirrhosis was identified by clinical, biochemical, endoscopic, ultrasonographic characteristics, and/or histological findings. Viral hepatitis was excluded by relevant serological testing. Exclusion criteria were hospital admission, active bleeding, platelet transfusion, or treatment with platelet inhibitors, nonsteroid anti-inflammatory drugs, low-molecular weight heparin, or warfarin within the past 14 days. Eligible healthy individuals were blood donors without systemic diseases, and who were not receiving any medication. They had not taken any platelet inhibitors, nonsteroid anti-inflammatory drugs, low-molecular weight heparin, or warfarin within the past 14 days.
RNAi therapeutics for diseases involving protein aggregation: fazirsiran for alpha-1 antitrypsin deficiency-associated liver disease
Published in Expert Opinion on Investigational Drugs, 2023
Pavel Strnad, Javier San Martin
Although AATD-related liver disease sometimes manifests in early childhood (birth to 5 years) and has been linked to pediatric liver conditions, such as neonatal cholestasis [19,20], most children will survive to adulthood. In adults, liver disease often manifests in the fourth or the fifth decade of life. Both the Pi*Z and Pi*S mutations are found primarily in Caucasians, with Pi*Z and Pi*S being more common in northern and southern European countries, respectively [17]. Approximately, a third of adults with the Pi*ZZ genotype (population frequency in Caucasians is about 1:3000) develop significant liver fibrosis [21,22]. The lifetime risk of cirrhosis may be 20% to 40% among individuals with AATD liver disease [23–26]. Patients with the PiZZ genotype are 20 times more likely to undergo liver transplantation than noncarriers [27]. Once liver disease progresses to cirrhosis, prognosis is usually poor, with a median survival of 1.8 years and a 1 year survival probability of 55% [25].
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