Enigma

The history of scurvy is heavily marked by the conflict of interests between those who dwell inside the drama and those who don't. The biochemical breakthrough that isolated ascorbic acid and explained its physiological and neurological importance to the human organism was never aligned with the history of empirical knowledge of the disease. That is to say, biochemistry and naval medicine never shared an inevitable and common destination, although there were many occasions when a coalition of the two was accidentally and briefly achieved. This chapter shows that it is difficult for anyone outside the disorganized and passionate situation of scurvy itself not to consider its history as anything but periodic fits of willful ignorance that blinded the world to a necessary truth and an obvious cure: a dismal record then of lost opportunities and culpable amnesias.

Tenofovir as Rescue Therapy Following Clinical Failure to Lamivudine in Severe Acute Hepatitis B

Acute hepatitis B (AHB) is a self-limiting condition in more than 95% of cases. Treatment is however recommended in patients with severe AHB (<1% of cases), aiming to prevent liver failure and death. Various nucleos(t)ide analogues (NA) have been found to be effective in severe AHB, although NA-resistant strains causing AHB have been also recently reported. The use of tenofovir in this setting has only been reported once with a favorable outcome. We hereby report a 47-year-old treatment-naïve male, who developed severe AHB and was treated with lamivudine (LMV). Initial rapid biochemical response was followed by biochemical breakthrough after 9 days, suggesting LMV resistance. Rescue therapy with ‘add-on’ tenofovir brought about a sustained improvement in biochemical, serological and virological markers until HBsAg was lost after 4 months. Thus, this is the second case reporting the successful use of tenofovir in severe AHB.