Lege Artis Medicinae

[Treatment of hungarian chronic hepatitis C genotype 1 patients with severe fibrosis or compensated cirrhosis in the international telaprevir Early Access Program: Interim analysis of the week 16 results]

TORNAI István, BÁNYAI Tivadar, GERVAIN Judit, HORVÁTH Gábor, MAKARA Mihály, MARTYIN Tibor, NEMES Zsuzsanna, PÁR Alajos, PÁR Gabriella, PÉTERFI Zoltán, SZALAY Ferenc, SZINKU Zsolt, TÓTH Tamás, VINCZE Áron, ISABELLE Lonj

FEBRUARY 14, 2014

Lege Artis Medicinae - 2014;24(01-02)

[The approval of the first two direct acting antiviral agents, boceprevir and telaprevir, has been a major step forward in the treatment of chronic hepatitis C. Both protease inhibitors must be added to the dual peginterferon and ribavirin combination therapy. The triple combination therapy resulted in significantly higher rates of recovery both in naive patients and in those previously unresponsive to therapy. Following the approval of telaprevir, an Early Access Program has been initiated in 16 countries. In Hungary 132 patients were enrolled into this program. In the first interim analysis, data from the first 16 weeks of treatment of 92 patients are included. Liver cirrhosis (F4) was detected in 70% of the patients and severe fibrosis (F3) was found in the other 30%, on the basis of either liver biopsy or transient elastography. During their previous antiviral treatment, 64% of the patients were non-responders (partial and nullresponders), 26% were relapsers, and only 10% were treatment naives. The efficacy of the triple combination was excellent, as 82% of the patients had undetectable HCV RNA at week 12. Further - more, 48% had negative HCV RNA at week 4 as well as at week 12. Cessation of i.e. negative HCV RNA at week 4 through week 12. Only 5.4% of the patients had virologic failure and needed to stop therapy prematurely. The most frequent adverse event was anemia, hemoglobin level decreased below 100 g/l in 40% of the patients. In the majority of these patients ribavirin dose reduction was sufficient to treat anemia, only 16% needed blood transfusion. The rate of severe rash was 6%. Although this group of patients represents a difficult-to-treat population, both efficacy and safety data are similar to published data in international clinical trials. A very effective, triple combination therapy with telaprevir, peginterferon and ribavirin can be provided for patients with advanced liver disease, to reduce the risk of liver failure and hepatocellular carcinoma.]

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[The government attaches great importance to the health conservation and protection role of the forest. National forestry manages the vast majority of the forest parks in the country, without their effort these popular places have been destroyed a long time ago. Forest parks attract crowds of people, jut in suburban forests of the capital city ten million people visit in each year. Beside the introduction of their purpose and function in health prevention, authors aimed to summary the consequences of doing sport in the nature, especially in the forest. The fact confirmed by medicine that 20-30 minutes long exercising multiplies cardiac function and cause at least a bit difficulty in breathing, improve the physical fitness in healthy people. The same is true for walking and hiking as well. It is well known that fresh air, sunshine, exercise in diverse environment have favorable effects on physical and mental conditions physically active lifestyle is an important factor in health.]

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[Public health prevention in Hungary II.: established methods, adequate information, real screening results „Comprehensive Health Screening of Hungary 2010-2020” - four-year results]

KISS István, BARNA István, DANKOVICS Gergely, DAIKI Tenno

[In the past 10 years, a number of screening programs with various goals have been started in Hungary, with varying degrees of success. The „Comprehensive Health Screening of Hungary 2010-2020” program has been touring the country (with a screening truck), either joining organised events or as an independent screening, collaborating with local healthcare centers (primary care, occupational healthcare etc). The screening program has been conducted in a special truck, in which various examinations were performed in a set time. Those who participated in the screening received a prevention information pack (for studying and reading at home) and the official publication of the program (Health Book), in which the program and the screening results were described. In the past four years the screening truck has been to 725 places in Hungary and travelled 83,145 kilometers. 87,935 people have participated in comprehensive screening. 194,549 visitors received lifestyle counseling and 142,319 received Prevention Packs. In total 2,901,855 examinations have been performed, which required 6711 hours of work of 1132 healthcare professionals. 5,856,114 answers were given to queries of the survey related to the health status of the Hungarian population. The program has already overfulfiled its original goals to visit 1500 locations and perform 8 million examination during this period. It is of particular significance that the average age of participants was 40 years. As cardiovascular risk is still the leading health risk, screening for such risk factors has to be part of all general and complex screening programs. In this program, an increasing number of validated, rapid and effective risk-estimation tests were used. It is remarkable that 20% of the tests related to colorectal cancer risk has positive results. Also of importance are the test results for hearing loss (7% positive) and various degrees of visual impairment (over 50%). Both results have significant social and economical implications for both individuals and the society. Unfortunately, the general level of health consciousness is still low. This might be improved not only by the screening itself but the opportunity to inform the public and provide organised counselling and printed materials, for which the activity and expertise of professional healthcare worker is essential. ]

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[THE SAFETY OF TREATMENT WITH PEGYLATED INTERFERON-ALPHA-2A AND RIBAVIRIN IN PATIENTS WITH CHRONIC HEPATITIS C INFECTION, BASED ON HUNGARIAN EXPERIENCE]

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