Introduction of effective drugs in the treatment of hepatitis C virus(HCV)infection has prompted the World Health Organization to declare a global eradication target by 2030.Propositions have been made to screen the g...Introduction of effective drugs in the treatment of hepatitis C virus(HCV)infection has prompted the World Health Organization to declare a global eradication target by 2030.Propositions have been made to screen the general population and treat all HCV carriers irrespective of the disease status.A year ago the new severe acute respiratory syndrome coronavirus 2 virus appeared causing a worldwide pandemic of coronavirus disease 2019 disease.Huge financial resources were redirected,and the pandemic became the first priority in every country.In this review,we examined the feasibility of the World Health Organization elimination program and the actual natural course of HCV infection.We also identified and analyzed certain comorbidity factors that may aggravate the progress of HCV and some marginalized subpopulations with characteristics favoring HCV dissemination.Alcohol consumption,HIV coinfection and the presence of components of metabolic syndrome including obesity,hyperuricemia and overt diabetes were comorbidities mostly responsible for increased liverrelated morbidity and mortality of HCV.We also examined the significance of special subpopulations like people who inject drugs and males having sex with males.Finally,we proposed a different micro-elimination screening and treatment program that can be implemented in all countries irrespective of income.We suggest that screening and treatment of HCV carriers should be limited only in these particular groups.展开更多
Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older p...Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older patients are frequently suboptimal or potentially inappropriate and often result in negative outcomes such as adverse drug events, hospitalisation and increased healthcare resource utilisation. Several factors influence the appropriateness of medication selectionin older patients including age-related changes in pharmacokinetics and pharmacodynamics, high numbers of concurrent medications, functional status and burden of co-morbid illness. With ever-increasing therapeutic options, escalating proportions of older patients worldwide, and varying degrees of prescriber education in geriatric pharmacotherapy, strategies to assist physicians in choosing appropriate pharmacotherapy for older patients may be helpful. In this paper, we describe important age-related pharmacological changes as well as the principal domains of prescribing appropriateness in older people. We highlight common examples of drugdrug and drug-disease interactions in older people. We present a clinical case in which the appropriateness of prescription medications is reviewed and corrective strategies suggested. We also discuss various approaches to optimising prescribing appropriateness in this population including the use of explicit and implicit prescribing appropriateness criteria, comprehensive geriatric assessment, clinical pharmacist review, prescriber education and computerized decision support tools.展开更多
基金Corresponding author:Elias Kouroumalis,MD,PhD,Emeritus Professor,Department of Gastroenterology,University of Crete Medical School,Voutes,Heraklion 71500,Crete,Greece.kouroumi@uoc.gr。
文摘Introduction of effective drugs in the treatment of hepatitis C virus(HCV)infection has prompted the World Health Organization to declare a global eradication target by 2030.Propositions have been made to screen the general population and treat all HCV carriers irrespective of the disease status.A year ago the new severe acute respiratory syndrome coronavirus 2 virus appeared causing a worldwide pandemic of coronavirus disease 2019 disease.Huge financial resources were redirected,and the pandemic became the first priority in every country.In this review,we examined the feasibility of the World Health Organization elimination program and the actual natural course of HCV infection.We also identified and analyzed certain comorbidity factors that may aggravate the progress of HCV and some marginalized subpopulations with characteristics favoring HCV dissemination.Alcohol consumption,HIV coinfection and the presence of components of metabolic syndrome including obesity,hyperuricemia and overt diabetes were comorbidities mostly responsible for increased liverrelated morbidity and mortality of HCV.We also examined the significance of special subpopulations like people who inject drugs and males having sex with males.Finally,we proposed a different micro-elimination screening and treatment program that can be implemented in all countries irrespective of income.We suggest that screening and treatment of HCV carriers should be limited only in these particular groups.
文摘Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older patients are frequently suboptimal or potentially inappropriate and often result in negative outcomes such as adverse drug events, hospitalisation and increased healthcare resource utilisation. Several factors influence the appropriateness of medication selectionin older patients including age-related changes in pharmacokinetics and pharmacodynamics, high numbers of concurrent medications, functional status and burden of co-morbid illness. With ever-increasing therapeutic options, escalating proportions of older patients worldwide, and varying degrees of prescriber education in geriatric pharmacotherapy, strategies to assist physicians in choosing appropriate pharmacotherapy for older patients may be helpful. In this paper, we describe important age-related pharmacological changes as well as the principal domains of prescribing appropriateness in older people. We highlight common examples of drugdrug and drug-disease interactions in older people. We present a clinical case in which the appropriateness of prescription medications is reviewed and corrective strategies suggested. We also discuss various approaches to optimising prescribing appropriateness in this population including the use of explicit and implicit prescribing appropriateness criteria, comprehensive geriatric assessment, clinical pharmacist review, prescriber education and computerized decision support tools.
