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HCV treatment in CKD
13/08/2025

HCV treatment in CKD

13/08/2025

Miracle Drugs so far in Medical History

The term miracle drugs” usually refers to medications that dramatically changed the prognosis of a disease, often saving millions of lives or transforming previously untreatable conditions.

1. Penicillin (1928, Alexander Fleming)
• Category: Antibiotic (β-lactam)
• Impact: First true antibiotic; revolutionized treatment of bacterial infections such as syphilis, strep infections, pneumonia.
• “Miracle” aspect: Turned once fatal bacterial infections into treatable conditions.

2. Insulin (1921, Banting & Best)
• Category: Hormone / antidiabetic
• Impact: Life-saving for type 1 diabetes.
• “Miracle” aspect: Patients previously dying of diabetic ketoacidosis could now survive long-term.

3. Sulfonamides (1930s)
• Category: Antibiotics
• Impact: First widely used systemic antibacterial drugs.
• “Miracle” aspect: Reduced mortality from pneumococcal and streptococcal infections dramatically.

4. Statins (1980s)
• Category: Lipid-lowering drugs
• Impact: Reduced cardiovascular events, stroke, and mortality in high-risk patients.
• “Miracle” aspect: Changed the natural history of atherosclerotic cardiovascular disease.

5. Imatinib (Gleevec, 2001)
• Category: Tyrosine kinase inhibitor
• Impact: Targeted therapy for chronic myeloid leukemia (CML).
• “Miracle” aspect: Transformed CML from fatal to a chronic, manageable disease.

6. Antiretroviral Therapy (ART) for HIV (1996 onward)
• Category: Combination antiviral therapy
• Impact: Suppresses HIV replication, prevents progression to AIDS.
• “Miracle” aspect: Turned a once universally fatal disease into a manageable chronic illness.

7. Corticosteroids (1940s onward)
• Category: Anti-inflammatory / immunosuppressive
• Impact: Dramatically improved survival in Addison’s disease, autoimmune conditions, severe allergies.
• “Miracle” aspect: Rapidly life-saving in adrenal insufficiency and severe inflammatory states.

8. Vaccines (Various, 20th century)
• Category: Preventive medicines
• Impact: Eradication or control of polio, smallpox, measles, hepatitis B.
• “Miracle” aspect: Prevented millions of deaths globally.

• Key examples: not only Steroids but Also Penicillin, Insulin, Sulfonamides, Imatinib, ART.

Chronic Hepatitis C Virus (HCV) infection, based on current guideline recommendations:First-Line Treatments (for treatme...
13/08/2025

Chronic Hepatitis C Virus (HCV) infection, based on current guideline recommendations:

First-Line Treatments (for treatment-naïve patients)

Recommended pangenotypic DAAs (Direct-Acting Antivirals) that offer high cure rates and favorable safety profiles:

1. Sofosbuvir/Velpatasvir (Epclusa)
• Effective across HCV genotypes 1–6, including patients with or without cirrhosis, also those co-infected with HIV.
• Taken as a once-daily oral pill; standard duration: 12 weeks.
• SVR (cure) rates are > 90%, often near 100%. 

2. Glecaprevir/Pibrentasvir (Mavyret)
• Pangenotypic, highly effective for all genotypes.
• 8-week regimen for treatment-naïve patients without cirrhosis; 12 weeks if compensated cirrhosis or other factors present.
• Not suitable for patients with decompensated (CTP B or C) cirrhosis.   

These regimens are the preferred first-line options due to their broad applicability, high efficacy, and simplified dosing.

Second-Line / Salvage Treatments
(for failures or specific scenarios)

When primary therapy fails or in special circumstances (e.g., NS5A resistance):

Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi)

• Triple-combination DAA—a potent option for patients with prior treatment failure (especially to NS5A-containing regimens).
• Indicated for both non-cirrhotic and compensated cirrhotic patients.
• Offers SVR rates of ~96–97% upon retreatment.
• Note: Carries a boxed warning for HBV reactivation, so monitor if co-infected.  

Alternative Treatment According to Genotype

Other regimens like Ledipasvir/Sofosbuvir (Harvoni) or Elbasvir/Grazoprevir (Zepatier) may be considered depending on genotype, prior treatment history, and presence of resistance or cirrhosis—but are generally less favored compared with pangenotypic combinations.  

Predictors of Coronary Stent Blockage (In-Stent Restenosis or Thrombosis)1. Stent-Related Factors • Type of stent • Bare...
13/08/2025

Predictors of Coronary Stent Blockage
(In-Stent Restenosis or Thrombosis)

1. Stent-Related Factors
• Type of stent
• Bare-metal stents (BMS): higher restenosis rates than drug-eluting stents (DES)
• First-generation DES: more late thrombosis than newer-generation DES
• Stent under-expansion or malapposition (poor deployment)
• Stent length and diameter
• Long stents (>30 mm) and small diameter (1 year (risk persists, especially with first-gen DES)
• In-stent restenosis (tissue growth inside stent) — usually within 6–12 months for BMS, 1–3 years for DES; risk decreases after that

13/08/2025

First-line HCV Treatment

Sofosbuvir/velpatasvir
Glecaprevir/pibrentasvir

13/08/2025

Hereditary hemochromatosis, liver enzyme elevation is usually mild to moderate and often not proportional to the degree of iron overload.

Typical pattern:
• ALT and AST: Often mildly elevated (about 1–3× the upper limit of normal in early disease).
• Advanced fibrosis or cirrhosis: Enzymes may normalize or remain only slightly elevated, despite significant histologic damage.
• ALP: Usually normal or slightly elevated, unless there is advanced cholestasis.
• GGT: Can be mildly elevated.

Key point: Many patients with hemochromatosis have normal or only slightly elevated liver enzymes despite severe iron overload — this is why screening relies more on ferritin and transferrin saturation than on liver enzymes.

13/08/2025

The normal common bile duct (CBD) diameter is usually:
• ≤ 6 mm in most healthy adults.
• In patients > 60 years old, add about +1 mm per decade as an upper limit.
• Post-cholecystectomy: can be up to 10 mm without pathology.

📏 Rule of thumb:
• < 6 mm = normal (young adults)
• 6–8 mm = possible age-related or post-surgical dilation
• 8–10 mm = investigate for obstruction (stones, stricture, tumor)

The normal diameter of the common hepatic duct (CHD) is generally:
• ≤ 6 mm in most healthy adults.
• Can be up to 7–8 mm in older adults (due to age-related dilation).
• After cholecystectomy, mild dilation is common — up to 10 mm can still be considered normal if there are no symptoms or lab abnormalities.

Tip: Ultrasound measurement is usually taken inner wall to inner wall.

Key abnormal CSF patterns
12/08/2025

Key abnormal CSF patterns

For MDR typhoid, azithromycin or a third-generation cephalosporin remains effective. • For XDR typhoid, azithromycin is ...
12/08/2025

For MDR typhoid, azithromycin or a third-generation cephalosporin remains effective.

• For XDR typhoid, azithromycin is the oral option when susceptible, while IV meropenem, with or without azithromycin, is the mainstay for complicated or severe cases.

Dunkin Donut MassSigmoid Colon Mass
12/08/2025

Dunkin Donut Mass
Sigmoid Colon Mass

12/08/2025

A duplication cyst is a rare congenital malformation of the gastrointestinal (GI) tract where a portion of the bowel is duplicated, forming a cystic or tubular structure that shares a wall and blood supply with the native GI tract.

Key Features
• Origin: Present from birth (developmental anomaly during embryogenesis)
• Location: Can occur anywhere along the GI tract, most commonly in:
• Ileum (most frequent)
• Esophagus
• Colon
• Stomach and duodenum (less common)
• Structure:
• Has a smooth muscle layer
• Lined with GI mucosa (sometimes ectopic gastric or pancreatic tissue → risk of ulceration/bleeding)
• Usually attached to native bowel and shares its blood supply
• Types:
1. Cystic (most common) — closed sac adjacent to bowel
2. Tubular — communicates with the bowel lumen

Clinical Presentation
• Infants/Children:
• Abdominal mass
• Vomiting, abdominal distension, feeding difficulty
• GI bleeding (if ulceration from ectopic mucosa)
• Intestinal obstruction or intussusception
• Adults: Often incidental finding, or present with complications

Diagnosis
• Ultrasound: “Double wall” or “double-layer” sign (mucosa + muscle)
• CT / MRI: Defines anatomy, complications
• Endoscopy: Sometimes useful if lesion communicates with lumen

Treatment
• Surgical excision is definitive (usually required due to risk of bleeding, infection, perforation, obstruction, or rarely malignant change)
• Resection often involves removing the adjacent segment of bowel due to shared blood supply

Fast and Long-Lasting Effect Eye Drops for presbyopia • Onset: Improvement in near vision within 30 minutes. • Duration:...
12/08/2025

Fast and Long-Lasting Effect Eye Drops for presbyopia
• Onset: Improvement in near vision within 30 minutes.
• Duration: Benefits last up to 10 hours after a single daily dose.

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