Therapeutic outcome of 6198 interferon-naïve Egyptian patients with chronic hepatitis C: a real-life experience and lessons to be learned in DAAs' era

Antiviral therapy for HCV infection has been validated in randomized controlled clinical trials, but its value in the real world is less well studied. There is relatively little data on real-world responses to interferon-based therapies for patients with genotype 4 infection. We aimed to examine experience with large-scale access to antiviral therapy in chronic HCV in a real-life clinical setting in Egypt. Detailed pretreatment data of 6198 IFN-naïve chronic HCV patients who had received PEG-IFN/RBV therapy at Cairo-Fatemic Hospital, Egypt, between 2009 and 2012 were obtained from the HCV database. At week 12, 95.7% of patients had undetectable HCV RNA, and by week 24 and 48, breakthrough was 6% and 4%, respectively. However, 43.7% of patients discontinued treatment prematurely, and intent to treat end of treatment response was 44.6% (79.3% per protocol). Sustai-ned response data were available from only 1281 patients and was 84.9%. Haematological abnormalities were comparable in patients who did or did not comply with therapy. This is the first real-world, large-scale experience of antiviral therapy in chronic HCV in Egypt. Suboptimal response in HCV predominantly genotype 4 was mainly driven by noncompliance as well as gaps in the healthcare system leading to treatment discontinuation. These results need to be considered in the era of all oral antiviral regimes.

Handling the sequelae of breast cancer treatment: use of NPWT to enhance patient independence

A cancer diagnosis can be an overwhelming experience and has devastating implications for an individual, their family and friends. Radical treatment, although often essential, can have its own health consequences. This case study describes the management of a 38-year-old woman with a portable, non-electrical negative pressure wound therapy device, suggesting benefits in terms of healing, patient independence and improved quality of life. The case study also highlights the importance of effective communication, patient involvement and empowerment in clinical decision-making, showing that an effective client-clinician relationship can help overcome the physical and emotional sequelae of this diagnosis.

Spectrophotometric, spectrofluorimetric and LC determination of trazodone hydrochloride

Three methods are described for the determination of trazodone hydrochloride in pharmaceutical tablets. The spectrophotometric method was based on the formation of yellow ion pair complex between the basic nitrogen of the drug and bromophenol blue at pH 3.4. The formed complex was extracted with chloroform and measured at 414 nm. The spectrofluorimetric method was based on measurement of the native fluorescence of the drug in 50% acetic acid upon excitation at a maximum of 320 nm and the emission wavelength is 435 nm. The third method was based on the high performance liquid chromatographic determination of trazodone hydrochloride using a reversed phase, ODS column, with a mobile phase of acetonitrile--phosphate buffer at pH 4.5 (60:40, v/v). Quantization was achieved with UV detection at 250 nm based on peak area. The three methods were simple, accurate and suitable for quality control application.

Spectrophotometric determination of trifluoperazine HCl and isopropamide iodide in binary mixture using second derivative and second derivative of the ratio spectra methods

Two methods are presented for the simultaneous determination of trifluoperazine hydrochloride and isopropamide iodide in binary mixture. The first method depends on second derivative ((2)D) ultraviolet spectrophotometry, with zero crossing and peak to base measurement. The second derivative amplitudes at 270.4 and 230.2 nm were selected for the assay of trifluoperazine hydrochloride and isopropamide iodide, respectively. The second method depends on second derivative of the ratio spectra by division of the absorption spectrum of the binary mixture by a normalized spectrum of one of the components and then calculating the second derivative of the ratio spectrum. The second derivative of the ratio amplitudes at 257 and 228 nm were selected for the determination of trifluoperazine hydrochloride and isopropamide iodide, respectively. The two proposed methods were successfully applied to the determination of the two drugs in laboratory prepared mixtures and in commercial tablets.