A randomized trial of a 4- vs 12-week daily interferon dose regimen combined with ribavirin in treatment of patients with chronic hepatitis C

BACKGROUND: Standard combination-therapy of ribavi- rin with alternate day interferon (IFN) in patients with chronic hepatitis C ( CHC) has been reported to achieve 30%-55% sustained viral response. Early reduction of viral load by daily dosage of IFN could enhance viral clearance. However, the duration of daily dosage protocol and the likely side-effects have not been well studied. We compared the efficacy and safety of a 4- vs 12-week daily IFN dosage in patients with CHC. METHODS: Fifty-nine, histologically proven CHC patients having ALT levels >1.5 ×ULN were divided randomly into 2 groups, group I was given IFN 3 MIU daily for 4 weeks, followed by tiw up to 12 months and group was given IFN 3 MIU daily for 12 weeks, followed by tiw up to 12 months. Ribavirin was given in a dose of 800-1200 mg/d for 12 months. RESULTS: Fifty-two of the 59 patients (group group completed the study. The pretreatment vari- ables and the prevalence of HCV genotype 1 were compara- ble between the groups. Nine patients (29%) in group and 6 (25%) in group had stage 3, 4 fibrosis. At the end of 4, 12, 24 and 52 weeks, HCV RNA negativity was ob- served in 27%, 54%, 65% and 71% in group I and 38%, 54%, 71% and 75% in group respectively (P =ns). Four of the eight (50%) patients with genotype 1 and 30 (69.8%) of 43 patients with genotype non-1 responded to therapy (P =ns). Sustained viral response was achieved in 61% and 71% in groups respectively. None of the variables predicted non-response precisely. No serious adverse effects were observed and they were comparable between the two groups. CONCLUSION: Daily IFN dosage with ribavirin is safe and can achieve response in up to 65% patients. Since the effica- cy of a 4-week daily dosage of IFN is comparable to a 12- week schedule, we recommend the former regimen.

Ominous lung cavity “Tambourine sign”

Mucinous adenocarcinoma represents a rare subtype of adenocarcinoma of the lung, which is frequently invasive and has a poorer prognosis. Of its wide range of imaging appearances, air-space consolidation is the most frequent pattern while cavitary form has only rarely been reported. Despite imaging advancements, the differentiation of benign and malignant cavitary lung lesions sometimes remains imperfect. We propose "Tambourine" sign on computed tomography to raise the suspicion of mucinous adenocarcinoma in a lung cavity, under appropriate clinical settings. The sign indicates an irregular cavity with undistorted prominent thick walled bronchioles within the wall and draping along thereby resembling the musical instrument "tambourine". Adjacent ground glass and internal septations may also be seen.

CCR5A32 mutation does not influence the susceptibility to HCV infection, severity of liver disease and response to therapy in patients with chronic hepatitis C

AIM: To study whether CCR5A32 mutation was associated with viral infection and severity of liver disease. METHODS: Two hundred and fifty two histologically proven, chronic HCV patients (mean age: 41±14 years; M/F: 164/88) were genotyped. PCR based genotyping of 32 bp deletion at the CCR5 locus was done. Four-hundred and eight matched healthy controls were studied to assess susceptibility to HCV infection. To assess correlation of immune gene polymorphism with severity of HCV related liver disease, patients with chronic HCV infection were divided into those with a fibrosis score of≤2 (mild) or > 2 (severe) and histological activity index (HAI) of≤5 or > 5. For correlation between CCR5A32 mutations and response to therapy, 129 patients who completed therapy were evaluated. RESULTS: The majority (89.4%) of the patients were infected with genotype 3. The frequency of homozygous CCR5A32 mutants was comparable to HCV patients as compared to the healthy controls (0.7% vs 0%, P = 0.1). Further more, the frequency of CCR5A32 mutation was comparable in patients with mild or severe liver disease. (P=NS). There was also no association observed with response to therapy and CCR5A32 mutation. CONCLUSION: CCR5A32 mutation does not have a role in disease susceptibility, severity or response to therapy in patients with chronic hepatitis C infection.