[Consensus document on indications for liver transplantation. 2002]

Direct antiviral treatment in patients with hepatitis C virus: Implementation of a nurse telephone consultation

The treatment of chronic hepatitis C with direct action antivirals has led to a radical change in the management of patients. The elderly or people with morbidities, for whom it was previously contraindicated, are currently candidates for this treatment due to its being well tolerated and safe. The nursing visit at the beginning of treatment is essential to reinforce adherence, to educate on the management of adverse effects, to resolve doubts and to emphasise the importance of pharmacological interactions, in order to promote correct therapeutic compliance. However, due to the new communication tools, it is possible to convey healthcare services without requiring the physical presence of the patient in the medical centre. The telephone has become a routine and indispensable work tool for the nursing professional. This paper describes the pilot test that was performed with 38 patients, previously selected, whose nursing visit at the beginning of treatment was by telephone instead of face-to-face, in order to evaluate the implementation of the telephone nurse consultation, for patients who started treatment with direct antivirals for the hepatitis C virus.

Peripheral blood lymphocyte populations in end-stage liver diseases

GOALS/BACKGROUND

The aim of this study was to decipher whether end-stage liver failure modifies peripheral blood lymphocytes (PBL) in a homogeneous manner, independently of the base pathology, or, if on the contrary, PBL subsets show a different profile in each hepatic disease.

METHODS

We studied PBL subsets in 71 patients with end-stage liver disease, before liver transplant, and 74 healthy controls by flow cytometry. The results were statistically compared between patients and controls, and cohorts of patients classified according to their base pathology.

RESULTS

We observed lower absolute numbers in all lymphocyte populations in patients compared with controls. We found an increment of CD3+ activated cells (P<10) and CD45RO+CD4+ (P<10) in chronic hepatitis C virus versus controls; hepatitis B virus showed high TCRgammadelta+ and CD8+ T cells with respect to controls (P=0.008 and P=0.029, respectively); alcoholic cirrhotic patients showed low CD8+, mainly CD45RA+CD8+ (P=0.007) and high CD45RO+CD4+ (P<10) compared with the normal population; autoimmune diseases showed lower CD3+ and TCRalphabeta+ (P=0.002 and P=0.0001) than controls.

CONCLUSIONS

Regardless of the base pathology, patients with end-stage liver disease show a low absolute number of lymphocyte populations compared with controls. However, PBL profiles are different, characteristic, and specific of every disease causing chronic liver failure.

Enfermedad de Wilson con afectación neurológica grave: respuesta al tratamiento combinado con trientina y acetato de cinc

In patients with Wilson's disease and neurological manifestations, treatment with D-penicillamine can cause worsening of neurological symptoms, usually in the first few weeks of treatment. Because the neurological damage can be severe and irreversible, the use of D-penicillamine is controversial, and several authors believe that it should be avoided. Studies of the use of ammonium tetrathiomolybdate as an alternative chelating agent for the initial treatment of neurologic Wilson's disease are still in the experimental phase. Published experience on the simultaneous use of trientine, another chelating agent, and zinc, which blocks intestinal absorption of copper, is promising but limited. We present the case of a 17 year-old boy with severe neurologic Wilson's disease that had first presented six years previously. The patient showed a complete recovery after six months of treatment with a combination of trientine and zinc acetate.