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P Husa

Publications and source records attributed to P Husa.

At least 19 recordsLinked to original sources
PubMed2006

[The meaning of viral kinetics in the beginning of the pegylated interferon-alpha and ribavirin therapy for chronic hepatitis C].

UNLABELLED: Pegylated interferon alpha (PEG-IFN) and ribavirin combination therapy is the contemporary standard therapy of the patients chronically infected with hepatitis C virus (HCV). OBJECTIVE OF THE STUDY: The study is monitoring the changes in viremy through the changes of HCV RNA in serum before and during antiviral therapy and it attempts to find a relationship between the viral kinetics in the beginning of the therapy and the sustained virologic response. SET OF THE PATIENTS AND THE METHODICS: The study involved 133 patients with chronic infection with HCV, of the average age of 38 years (ranged 18-68 years). 86 of them were men. There were 88 patients who had not been treated before (naive patients), 19 of them were relabing and 26 were non-responders to the previous therapy with conventional IFNalpha and ribavirin. 106 patients (80%) were infected with genotype (G) 1, 3 (2%) with G2, 18 (14%) with G3, 1 patient with G4 and 1 with G6 (under 1%), in 4 (3%) the genotype could not be determined. All of them were treated with the combination of PEG-IFNalpha-2a (180 microg once a week) and ribavirin (800 mg per day in the infection with G2 or G3, 1000 mg at the infection with G1 and the weight up to 74 kg, 1200 mg per day at the infection with G1 and the weight 75 kg and higher). RESULTS: Up to now, 122 patients completed the therapy and 93 of them (76%) had negative HCV RNA in serum at the time of completion of the therapy. Negative HCV RNA after 24 weeks (sustained virologic response SVR) after the completion of the therapy had 64/107 (60%) of the treated patients. In the course of 12 weeks of the therapy the viremy decreased by at least 2 decadic logarithms (early virologic response - EVR) in 87 patients (82%) and in 63 of them (72%) also SVR was noted. Only 19 patients had not EVR and just 1 one of them, nevertheless, achieved SVR (5%). CONCLUSION: The achievement of EVR is a prerequisite to the successful therapy for chronic infection with HCV with the combination of PEG-IFNalpha and ribavirin. Quantitative determination of HCV RNA in serum before and during antiviral therapy is a prerequisite to the modern antiviral therapy for chronic infection with HCV.

Adolescent↗
PubMed2006

[The effect of patient's body weight, gender and baseline viral load on the efficacy of hepatitis C therapy].

UNLABELLED: Today, the standard therapy of patients with chronic HCV (hepatitis C virus) infection is based on combination of pegylated interferon alpha (PEG-IFN) and ribavirin. THE STUDY OBJECTIVE: The aim of the study is to find correlations between patient's body weight, gender and baseline viral load and the efficacy of antiviral therapy in terms of achieving end-of-treatment viral response (ETVR) and sustained viral response (SVR). METHODS AND PATIENT SAMPLE: We enrolled 133 patients with chronic HCV infection. All of them were treated by combination of PEG-IFN alpha-2a (180 microg once a week) and ribavirin. Ribavirin doses were the following: For body weight < or = 74 kg - 800 mg daily in patients infected by genotype 2 (G2 - 3 patients) or G3 (18 patients), 1000 mg in patients infected by G1 (106 patients), G4 (1 patient) or G6 (1 patient); for body weight > or = 75 kg - 1200 mg daily in case of infection by G1. RESULTS: To date, 122 patients completed the therapy; 107 of them completed their therapy at least 24 weeks ago, so they can be assessed for SVR. ETVR was achieved in 76% and SVR in 60% patients. Statistically higher proportion of SVR was observed in women (p = 0.039), patients with relatively lower body weight (p = 0.034), patients in lower baseline viral load (p = 0.010) and patients with genotypes 2 and 3 (p = 0,008). Correlation analysis of individual predictive factors showed the statistically significant correlation between body weight and gender (p < 0.001), gender and baseline viral load (p = 0.027) and body weight and virus genotype (p = 0.003). Therefore, the only independent predictive factor of ETVR (p = 0.020) and SVR (p = 0.010) was the level of baseline viral load. CONCLUSION: Efficacy of PEG-IFN therapy is significantly influenced by the level of baseline viral load. According to the results of this study, patient's body weight and gender are not independent predictive factors that affect the therapy efficacy.

Adolescent↗
PubMed2005

Hepatitis D.

Hepatitis D virus (HDV) is a small, RNA-containing virus that requires the concomitant presence of Hepatitis B virus (HBV) in an obligate manner for its survival and pathogenicity. HDV infection is very uncommon in Czech Republic. The results of antiviral therapy of hepatitis D patients are not satisfactory. Alpha-interferon (alpha-IFN) in high doses (9-10 MU three times a week for 12 months) is usually recommended.

Antiviral Agents↗
PubMed2005

[Atypital localisation of pyoderma gangraenosum in patient with ulcerative colitis].

The authors present a case of 61-year-old man with ulcerative colitis and with extraintestinal manifestation of the disease in the form of pyoderma gangraenosum. Multiple skin defects, which developed in atypical localisation (extensive affection of facial and hairy parts of the head) in patient with chronically active form of ulcerative colitis were complicated with bacterial contamination of methicilin-resistant strains of Staphylococcus aureus. After application of the parenteral feeding, corticotherapy and targeted antibiotic therapy the subjective and objective status of the patient markedly improved, stool frequency was reduced, admixture of blood in the stool disappeared, temperatures fell back and there was a decrease in activity of non-specific bowel inflammation in laboratory findings. However endoscopic examination of the intestine confirmed the finding of chronically active ulcerative colitis with ulcerations and bridging polyps. Patient was indicated to total colectomy, but he refused it.

Colitis, Ulcerative↗
PubMed2004

[Successful treatment of chronic hepatitis C in hemophiliacs based on historical development of therapeutic protocols].

Chronic infection with hepatitis C virus is very frequent among hemophilic patients in all developed counties, including the Czech Republic. Because of a possibility of developing serious terminal stages of infection, liver cirrhosis and hepatocellular carcinoma, the tendency in treatment of patients with chronic hepatitis C is to start it as soon as possible and thus reduce the probability of developing these advanced stages of disease which are difficult to treat. Treatment of hemophilic patients with chronic hepatitis C started in the Department of Infectious Diseases, University Hospital Brno Bohunice, in 1996. Used treatment schemes have reflected historical evolution of treatments used to treat chronic hepatitis C. Initially, alpha-interferon (IFN) was administered in monotheraphy (6 patients), later, since 1999, a combination of alpha-IFN and ribavirin was administered (13 patients), and since 2001 a combination of pegylated interferon (PEG-IFN) and ribavirin (3 patients) was administered. In all the patients the individual treatments took 12 month. Sustained negativization of HCV RNA in serum has not been achieved in any patient treated only with alpha-IFN. In patients who were administered the combination of alpha-IFN and ribavirin this effect appeared in 4 from 7 cases without history of treatment with alpha-IFN (57%), one from 2 relapses and one from 3 non-responders. The combination PEG-IFN and ribavirin was effective in the only one patient who relapsed after alpha-IFN and ribavirin and in one from the two non-responders to this combination. The tolerance and safety of treatment was good in haemophilia patients and could be fully compared to those in other patients with chronic hepatitis C.

Antiviral Agents↗
PubMed2004

[Procalcitonin as an indicator of infection in patients with liver cirrhosis].

Incidence of bacterial infections in hospitalised patients with liver disease is high. Due to a liver dysfunction immune reactivity is significantly impaired and bacterial infections are more frequent. Also incidence of nosocomial infections is higher in patients with liver disease compared to patients hospitalised for other conditions. To make a differential diagnosis of infectious and non-infectious aetiology of an inflammation is very difficult. Characteristic laboratory tests for bacterial infection include test of a number of leucocytes in peripheral blood, differential count of leucocytes, erythrocyte sedimentation, procalcitonin, C-reactive protein, tumor necrosis factor alpha, interleukin-1, interleukin-6, interleukin-8, and complement fragment C3a. Clinically the most significant are C-reactive protein test and procalcitonin test. Procalcitonin is a protein, a calcitonin precursor, which is in healthy individuals produced by cells of thyroid gland. A half-life of procalcitonin in serum is 20-24 hours which makes it suitable for daily monitoring and enables to control a course of treatment and to distinguish bacterial infection from other types of inflammations. Procalcitonin levels rise in bacterial, parasite, and yeast infections. Elevated procalcitonin levels appear only in inflammations of an infectious etiology with systemic signs. In patients with liver cirrhosis bacterial infections are more frequent. They usually include spontaneous bacterial peritonitis, infection of the respiratory system, urinary infections, and bacteremia. A timely proof of a bacterial infection and an appropriate and effective antibiotic therapy lead to an improvement of the general state of a patient and to his/her better prognosis. Procalcitonin determination is appropriate for diagnosing infections and control of treatment.

Bacterial Infections↗
PubMed2004

[Large-droplet liver steatosis in celiac disease].

Authors monitored a case of a 25 years old woman who was admitted for swelling of lower limbs. Laboratory results showed hypoproteinemia, elevation of liver enzymes, and prolonged prothrombin time. Ultrasound examination proved hepatomegalia with diffusely hyperechogenic liver without central lesion. Computer tomography confirmed hepatomegalia with diffusely hyperechogenic liver and a suspicion of liver steatosis was expressed. Liver biopsy confirmed serious diffuse large droplet steatosis of unclear genesis. Carried out examinations excluded infectious and autoimmune liver diseases, metabolic diseases, and congenital liver diseases (Wilson's disease, porphyria, haemochromatosis etc.). Laboratory results showed gliadin, endomysin, and reticulin antibodies. An enteroscopy picture showed villi decrease. Histology examination of a biopsy specimen confirmed total villi atrophy with non-differentiated enterocytes and round-cell cellulisation of epithelium and proprium. Histology and histochemical findings were distinct proves of coeliac disease. A patient was prescribed a gluten free diet. Her metabolic parameters (normalisation of albumine levels, prothrombine time, and trace elements) and anino transferase levels gradually improved. This case documents development of a serious liver disorder as a result of malnutrition which developed in a young woman as a result of unrecognised coeliac disease.

Adult↗
PubMed2004

Treatment of chronic hepatitis C in hemophilic patients.

Chronic hepatitis C infection is common among hemophiliacs in all the developed countries. Since 1996, only alpha-interferon (alpha-IFN) in monotherapy has been used for the treatment of chronic hepatitis C in hemophiliacs (6 patients). In Czech Republic a combination therapy with alpha-IFN and ribavirin has been used since 1999 (13 patients). Finally, a combination therapy with pegylated alpha-IFN (PEG-alpha-IFN) and ribavirin is being used since 2001 (still 3 patients). In all cases, the treatment lasted 48 weeks. A sustained virological response (SVR, defined as an undetectable serum HCV RNA level 24 weeks after the treatment was completed) was not achieved in any of 6 patients treated with alpha-IFN alone. A combination therapy with alpha-IFN and ribavirin yielded better results: four of eight patients still untreated with alpha-IFN (naive patients), one of two relapsers, and one of three non-responders to previous alpha-IFN monotherapy achieved SVR. So far the combination therapy with PEG-alpha-IFN and ribavirin has been used only in 3 patients. SVR was achieved in one patient who had relapsed after the combination therapy with IFN-alpha and ribavirin, and in 1 of 2 non-responders to this therapy. We conclude that the efficacy and tolerability of the treatment of chronic hepatitis C in hemophiliacs did not differ from that of chronic hepatitis C in other patients.

Antiviral Agents↗
PubMed2004

[What risk is a health care worker infected with hepatitis B or C virus for his patients?].

Presently, there are no legislative standards in the Czech Republic banning health care workers with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection to do activities with a risk of the transmission of these viral infections to patients (surgeries and other invasive interventions). In a range of developed countries in the world individuals with chronic HBV infection, HBeAg positive individuals, have a restricted access to the risk interventions. A quantitative assessment of viremia is important in the health care workers infected with HBeAg-minus mutant of the virus. There are particular critical viremia values set up (serum HBV DNA levels) which exceeding in the health care workers leads to banning them to do the risk interventions. In cases of proved transmission of hepatitis B infection from a health care worker to a patient, the ban of doing risk interventions is a rule. Transmission of HCV infection from a health care worker to a patient is much less probable so the individuals with chronic hepatitis C are usually not forbidden to make invasive procedures. An exception are cases when there was a patient infected by a particular health care worker in the past. There are various attitudes to the health care workers with chronic HBV or HCV infection in various countries of the world. A necessity to reach a definite consensus is necessary. The first step to it are common recommendations of 12 European countries and the USA which are repeatedly cited in the text. We can expect that these problems will have to be solved very soon in the Czech Republic too.

Czech Republic↗
PubMed2003

[Bacterial infections in patients with acute hemorrhage due to portal hypertension--personal experience].

Acute haemorrhage from the upper gastrointestinal tract is a frequent and serious complication which affects 20-60% patients with cirrhosis of the liver and portal hypertension. It is assumed that bacterial infections can be the direct cause of haemorrhage but accurate data on the influence of infection on the development and course of haemorrhage are lacking. Acute haemorrhage as a result of portal hypertension has a very high mortality, 30-50%, and an early relapse of haemorrhage occurs in as many as 40% of these patients. Most recent meta-analyses indicate that bacterial infection is an independent prognostic factor in failure of haemostasis and has a significant impact on the mortality of these patients. The authors examined for the presence of bacterial infection (blood, urine, throat, ascites) 25 patients with cirrhosis of the liver and acute haemorrhage as a result of portal hypertension and compared the results with a group of 25 patients with cirrhosis of the liver and portal hypertension without acute haemorrhage. According to the results in patients with acute haemorrhage due to portal hypertension there is a significantly higher incidence of bacterial infections than in patients with cirrhosis of the liver and portal hypertension without acute haemorrhage. The results confirm the necessity to administer antibiotic prophylaxis to cirrhotic patients with varicose bleeding, not only to patients with symptoms and evidence of infection but also in their absence. Antibiotic prophylaxis extends the survival period of these patients.

Acute Disease↗
PubMed2003

Treatment of chronic hepatitis B in 2002.

Viral hepatitis B is a serious health problem, above all in the world's developing countries. It is estimated that two billion people will be infected with the hepatitis B virus in the course of their lives and between 350 and 400 million people are chronically infected at present. The aims of the treatment of chronic hepatitis B are sustained suppression of viral replication and remission of liver disease. For the treatment of chronic hepatitis B two drugs have been licensed worldwide: alpha-interferon and lamivudine. In chronic hepatitis B therapy there are new developments in antiviral, such as nucleoside analogues--entecavir, emtricitabine, clevudine, beta-L-nucleosides. Studies comparing pegylated interferon with lamivudine and with the combination of lamivudine and pegylated interferon are in progress. Several innovative antiviral approaches have been evaluated in vitro, and in animal models of hepadnavirus infections. These approaches are including antisense oligonucleotides, ribozymes, inhibitors blocking virus entry into hepatocytes, and decoy virus or dominant negative mutants.

Antiviral Agents↗
PubMed2003

[Initial experience with treatment of chronic hepatitis C in HIV-positive patients].

A 30 years old man originating from Ukraine was infected by the human immunodeficiency virus (HIV) and virus of hepatitis C (HCV) due to injection administration of drugs of abuse in his own country before coming to Czech Republic. He was infected by genotype 3 of HCV and the infection became chronic. Under the influence of a three-combination anti-retrovirus therapy his conditions related to HIV infection became stable and it proved to be possible to apply a combined treatment by alpha-interferon and ribavirin at commonly used doses for the period of 12 months. In the course of therapy the HCV nucleic acid (HCV RNA) disappeared from serum and serum activity of alanine aminotransferase (ALT) became normal. However, two months after the therapy ended a relapse of the disease occurred--HCV RNA reappeared in serum and ALT activity increased. The therapy was well tolerated. A rapid decrease of hemoglobin level during the first four weeks of therapy was stopped by reduction of ribavirin dose.

AIDS-Related Opportunistic Infections↗
PubMed2003

[Antibiotic prophylaxis in patients with acute hemorrhage due to portal hypertension--personal experience].

Acute bleeding from upper part of gastrointestinal tract is a frequent and serious complication affecting 20 to 60% of patients with liver cirrhosis and portal hypertension. It is associated with a high death rate of 30 to 50% and a frequent relapse of bleeding occurs in up to 40% of these patients. The most recent meta-analyses have shown that bacterial infection is an independent factor in the failure of blood hemostasis and significantly influenced mortality in these patients. The authors investigated 25 patients with acute bleeding from the upper part of gastrointestinal tract due to portal hypertension in patients with liver cirrhosis. Irrespective of the proved bacterial infection the patients were given antibiotic prophylaxis. In 13 patients the authors administered norfloxacin orally and 12 patients were treated intravenously with ampicilin/sulbactam. The prophylaxis of the bleeding cirrhotic patients by norfloxacin (orally) resulted in a statistically significant prevention of early relapse as compared with the therapy by ampicilin/sulbactam (intravenously). The death rate reached 40% in spite of the antibiotic prophylaxis. There was no significant difference in the death rate between the two groups with different treatments.

Acute Disease↗
PubMed2002

[The SEN virus--will there be another letter in the alphabet of viral hepatitis?] ].

The SEN virus (SENV) is a small nonenveloped single-stranded DNA virus which is probably a circovirus. By phylogenetic analysis it is possible to differentiate genotypes SENV A-H. The pathway of transmission of infection is not known so far but the infection by this virus is frequent in recipients of blood transfusions and liver grafts and in intravenous drug addicts. This suggests possible parenteral transmission of infection. Other routes of transmission of the infection are also possible as the virus can be detected also in a significant proportion of young subjects without the risk of parenteral infection in the case-history. Whether SENV causes hepatitis has not been proved unequivocally so far. The prevalence of this infection does not differ significantly in patients with different liver diseases, acute or chronic viral or non-viral. SENV infection very probably does not influence the course of chronic hepatitis C.

DNA Virus Infections↗