Outcomes in Hepatitis C Positive Liver Transplantation: Timing of Direct-Acting Antiviral Treatment and Impact on Graft Fibrosis

Liver transplantation for hepatitis C virus (HCV)-related disease has the lowest five-year graft survival among all liver transplant recipients. Graft failure due to accelerated fibrosis from unrestrained HCV replication is common. Optimal timing of HCV treatment with direct-acting antiviral agents remains unknown. We compared HCV liver transplant recipients successfully treated for HCV before transplant to those treated within 1 year of transplant to determine if graft fibrosis, measured by Fib-4 scores, differs with timing of treatment. Fib-4 scores less than or equal to 1.45 defined minimal fibrosis and greater than 1.45 defined greater than minimal fibrosis. We identified 117 liver transplant recipients: 52 treated before transplantation and 65 treated within 1 year of transplantation. Overall, 34% of recipients had minimal fibrosis, and the likelihood of having minimal fibrosis following treatment and liver transplantation did not differ by timing of treatment. The odds ratio of having greater than minimal fibrosis was 0.65 (95% CI 0.30, 1.42) among those treated within 1 year after transplantation compared to those treated before transplantation (p-value 0.28). Importantly, nearly 2/3 of these patients had evidence of fibrosis progression one year after sustained virologic response, supporting recommendations for early antiviral-based treatment to prevent accumulation of HCV-related disease.

Stafne's Defect: a case report

The article reports on the clinical case of a patient with a diagnosis of "Stafne cyst", who was treated in the oncology department No. 8 of the Pavlov PSPbSMU. The features of differential diagnosis and diagnostic measures necessary to clarify the diagnosis are given. The situations when it is possible to avoid additional traumatic tests, as well as indications for the choice of surgical intervention or the possibility of refusing it, are analyzed. The presented data can be useful when creating algorithms for the diagnosis and treatment of a Staph cyst and making recommendations on the timing of treatment.

Stafne's Defect: a case report

The article reports on the clinical case of a patient with a diagnosis of "Stafne cyst", who was treated in the oncology department No. 8 of the Pavlov PSPbSMU. The features of differential diagnosis and diagnostic measures necessary to clarify the diagnosis are given. The situations when it is possible to avoid additional traumatic tests, as well as indications for the choice of surgical intervention or the possibility of refusing it, are analyzed. The presented data can be useful when creating algorithms for the diagnosis and treatment of a Staph cyst and making recommendations on the timing of treatment.

Tuberculous meningitis: Impact of timing of treatment initiation on mortality

We conducted a retrospective cross-sectional study of adult hospitalized patients with confirmed tuberculous meningitis to determine the impact of the timing of treatment initiation upon mortality. Mortality of tuberculous meningitis was high and associated with delay in initiation of treatment, older age, HIV infection, and higher disease severity at admission.