Публикации

151

Предстои ми лечение / Re: Започвам лечение скоро

« -: Април 03, 2007, 04:12:55 »

Zdrasti,

shte pisha v foruma, niama problem, samo da ima koi da slusha
znachi iskam dove4era da zapochna, malko me e strah i sum obarkan. sashto taka imam i pove4e stres otkolkoto po princip, zaradi semeini problemi . oshte neshto e 4e niama koi da e do men prez parvite sedmici. kakto i da e, vapreki tova mislia da zapochna, zashtoto mi pisna da chakam i da se podgotviam i t.n.

Nadiavam se tozi forum i drugite podobni da mi pomognat psihicheski da premina prez trudnostite a kolkoto za fizicheskite she se borim i tova e

Pozdravi

152

Предстои ми лечение / Re: Започвам лечение скоро

« -: Март 31, 2007, 06:33:17 »

Днес получих лекарствата - PEGASYS (peginterferon alfa 2a) + Copegus (rivabirin),  четири заредени спринцовки и хапчета за 1 месец. Като сваршат им се обаждам и пращат още.

Сега се опитвам да реша кога да започна, най вероятно ще почна на 9ти че тогава ми започва и отпуската. 

153

Моята история / Re: Здравейте

« -: Март 27, 2007, 17:20:16 »

Vera,

niama li i kade da ti napraviat izsledvane za genotipa? to po princip se pravi zaedno s tova za kolichestvoto na virusa,
Genotipa sashto e mnogo vajen, zashtoto toi opredelia prodaljitelnostta na lechenieto.

154

Терминология, статии и обща информация за болестта / Re: Steps in the Management of Chronic Hepatitis C

« -: Март 23, 2007, 07:22:17 »

точно затова постнах тази тема, към нея може да се прибавят още неща но като цяло основните стъпки са няколко и общо взето са задалжителни. голиямата част от докторите в бг изглежда все още пускат само изследвания за чернодробни ензими.

Сащо доколкото знам практиката е да пускат направления за биопсия, генотип и ПСР само ако ще се започва лечение. А всъщност тези изследвания са ти необходими да прецениш докаде се е развила болеста и колко време можеш да чакаш, както и да се предвиди донякаде изхода от лечение. Скоро ще я преведа.

 

155

Предстои ми лечение / Започвам лечение скоро

« -: Март 21, 2007, 20:35:13 »

Zdraveite,

Dnes polu4ih dobrata novina, obadiha mi se po telefona i mi kazaha 4e sum odobren da polu4a bezplatni lekarstva to La Roche. Te Praviat Pegasys (Pegylated interferon) + Copegus (Rivabirin).
Drugata sedmica lekarstvata shte sa pri men i zapo4vam.

Mnogo se radvam che nai nakraia vsi4ko se podrejda, dosega minah prez dosta lekari i sestri i bezbroi pati izledvania na kravta. nai nakraia lechenieto e pred praga

V moia sluchai to shte e 6 meseca zashtoto sum genotip 3 i shansa na uspevaemost e znachitelen - 80% taka che se nadiavam vsi4ko da mine uspeshno. Sled 1 sedmica kato pochna shte moga da pisha i pove4e v tazi tema za tova kak protichat neshtata. Nadiavam se skoro da stavame vse pove4e horata koito mojem da postvame tuk!

Pozdravi !

Stefan

156

Терминология, статии и обща информация за болестта / Steps in the Management of Chronic Hepatitis C

« -: Март 21, 2007, 20:17:19 »

Това е откъс от статия, описваща най-важните стъпки които трябва да се предприемат при лечение на хепатит C.
Съжалявам, че е на английски, но обещавам да я преведа статията скоро. В нея кратко и ясно е обяснено какво трябва да се направи и е много добра в случай, че се чудите откъде да захванете нещата, или личния лекар ви казва - "няма страшно, ти сам ще се излекуваш!?"

A Summary Review of Steps in the Management of Chronic Hepatitis C


Treatment options for chronic HCV infection have evolved significantly over the last few years, and current therapy with pegylated interferon and ribavirin is effective in 50% to 60% of patients with previously untreated infection.

Although there is some encouraging progress in new antiviral drug development for hepatitis C, it will be several years before any of these novel compounds are available in clinical practice.

In the interim, pegylated interferon and ribavirin remain the cornerstone of therapy. Healthcare providers have an important role in educating and selecting appropriate patients for therapy, recognizing common side effects, establishing a team approach to the management of chronic HCV infection, and keeping abreast of changes in treatment guidelines.

Following are brief excerpts on approaches to the treatment and management of chronic HCV from an article by Drs. Keyur Patel and John G. McHutchison.

Before initiating therapy, ensure there are no contraindications to interferon alfa (or peginterferon) and ribavirin. These include

For Interferon Alfa or Peginterferon Alfa

· Decompensated liver disease


· Autoimmune hepatitis

· Severe neuropsychiatric illness

· Unstable coronary artery disease

· Unstable epilepsy

· Poorly controlled diabetes

For Ribavirin

· * Anemia (hemoglobin, <11 g/dL)

· Hemoglobinopathies (thalassemia major, sickle cell disease)

· Ischemic heart disease

· Cerebrovascular disease

· Pregnancy

· Refusal to practice barrier contraception

· Chronic renal impairment (creatinine clearance, <50 mL/min)

There are 10 steps with which patient and physician should move forward:

1. Ensure there are no contraindications to therapy.

2. Assess carefully for comorbid conditions (including depression, hypothyroidism, cardiac disease, and diabetes) that should be evaluated and controlled before starting antiviral therapy.

3. Determine HCV genotype and HCV RNA level.

4. Obtain liver biopsy to assess disease severity.

5. Discuss with the patient the side effects and possible treatment outcomes.

6. If appropriate, start therapy with pegylated interferon and ribavirin.
a) Determine dose of ribavirin according to genotype and weight.
 Continue treatment for 24 or 48 weeks, according to genotype.

7. Perform laboratory monitoring.* (see Table 1).

8. Carefully perform a clinical evaluation monthly (or more often) for depression and other side effects; assess treatment adherence.

9. For genotype 1 infection, measure HCV RNA level at week 12.
a) Continue treatment for another 36 weeks if the patient has an early
virologic response.
 Consider terminating therapy if there is no early virologic response.
10. Measure HCV RNA level at end of treatment. If HCV RNA is still not present at 6 months post-therapy (a sustained response), long-term eradication is likely to have occurred.

157

Моята история / Re: Здравейте

« -: Март 21, 2007, 19:55:41 »

Zdrasti Vera,

Parvo sas sigurnost triabva da namerish drug lekar ot tozi koito imash v momenta. Gledaneto na ehograf i chernodrobnite izseldvania ne sa kriterii. Otidi v niakoi laboratoria ili prosto porazpitai za niakoi opiten gasteroneterolog i im kaji da ti pusnat izsledvania za hep C dali e polojitelen, PCR test i da vidiat kakuv ti e Genotipa. Ima niakolko choveka v tozi forum koito veche sa si gi napravili taka che te mogat da te nasochat kum bolnica/lekar. PCR izsledvaneto e skapo. neznam koi ti go pokriva i kak stoiat neshatat s plashtaneto mu, no e normalno da struva niakvi kinti.

Oshte vednaj shte kaja, 4e ako si polojitelna hep c niama kak da se 'razminesh' s bolestta. Tia si e tam, veche drug vapros e 4e da rechem oshte 20 godni moje da niama vidimi belezi. Kakto i da e, nameri si nikaoi doktor koito gi razbira neshtata. Izglejda v Balgaria pove4eto lekari - vklu4itelno i niakoi gasteroenterolozi sa super neveji po tazi bolest. Veche ima ustanoveni proceduri i metodi koito se sledvat ako si hep c polojitelen. Edinstvenoto koeto e vapros na lichna precenka e dali da pochnesh lechenie ili da go otlojish i da pochnesh sled vreme.

Stefan

PS. Vav vseki po goliam grad ima po niakolko specialista po tazi bolest. Predpolagam che v Sofia sa nai-mnogo i e po lesno da se otkriat.

158

Предстои ми лечение / За очите по време на лечение

« -: Март 15, 2007, 15:57:05 »

Това изглежда е нещо ново, но ми препорачаха преди лечение да си прегледам очите. Потарсих малко инфо в нета и ето какво намерих, сигурно има и други неща. като цяло това е рядкост, но е вазможно. доколкото го разбирам се казва че ако имаш автоимунно заболяване на очите то от лечението с интерферон може да се влоши много барзо. ето го и цитата:

Main Category: Eye Health / Optometry News
Article Date: 06 Jan 2007 - 9:00 PDT

Persons with chronic hepatitis C being treated with Interferon (IFN) are at risk of developing retinopathy as early as two weeks into treatment according to the results of a new study published in the January 2007 issue of Investigative Ophthalmology & Visual Science (IOVS).

Researchers from the Departments of Ophthalmology and Hepatology at Asahikawa Medical College in Japan measured the changes in vessel diameter and blood velocity and calculated retinal blood flow (RBF) and wall shear rate (WSR) using a laser Doppler velocimetry in 36 patients with chronic hepatitis C who were treated with high-dose IFN. Sixty-one percent of these patients developed asymptomatic retinopathy, including retinal hemorrhage and cotton-wool spots, during treatment. Retinopathy was first diagnosed two to 16 weeks after the start of treatment and resolved at the end of treatment in all but nine patients.

Of these patients, all experienced an increase in blood velocity, RBF, and WSR. The increased RBF was associated with anemia induced by IFN treatment. The increase in WSR in patients with retinopathy especially indicates that endothelial dysfunction may play an important role in IFN-induced retinopathy as shear stress should be constant under physiologic conditions.

###

Read this article online at http://www.iovs.org/cgi/content/full/48/1/368.

Ето и инфо за това какво е Retinopathy:

Retinopathy is a general term that refers to some form of non-inflammatory damage to the retina of the eye. Most commonly it is a problem with the blood supply that is the cause for this condition. Frequently, retinopathy is an ocular manifestation of systemic disease.

Main causes of retinopathy are :

    * diabetes - diabetic retinopathy
    * arterial hypertension - hypertensive retinopathy
    * prematurity of the newborn - retinopathy of prematurity (ROP)
    * sickle cell anemia
    * direct sunlight exposure - solar retinopathy
    * medicinal products - drug-related retinopathy
    * retinal vein or artery occlusion

Many types of retinopathy are progressive and may result in blindness or severe vision loss or impairment, particularly if the macula becomes affected.

Retinopathy is diagnosed by an optometrist or an ophthalmologist during ophthalmoscopy. Treatment depends on the cause of the disease.

T.e. с две думи при лечение на интерферон зрението може да се влоши много бързо в една част от хората които имат преди това заболявания на очната ябълка.
поне това е моята интерпретация на тези два текста. на мен лекаря ми каза просто да се прегледам очите преди да се почва лечение с интерферон и ако има нещо да внимавам докато се лекувам за да не се влоши. 

159

Моята история / Re: Привет

« -: Март 14, 2007, 02:31:51 »

Zdrasti,

tezi pokazateli koito si postnal ne mi govoriat osobeno mnogo i izglejdat normalni. po princip tezi pokazateli ne sa tolkova vajni pri hepatit c. Triabva da se opredeli genotipa, viral load (kolichestvoto na virusa) i ako ima vazmojnost da si napravi edna biopsia. nai vajnoto za lechenieto e genotipa, zashtoto toi ti pokazva kakvi sa i shansovete da se izlekuva i kolko dalgo shte e lechenieto. a biopsiata moje da ti pokaje v kakvo sastoianie e chernia drob i dali moje da chaka dalgo vreme predi da zapochne lechenie ili triabva da pobarza. Kato cialo doktorite preporachvat da se zapochne lechenie kolkoto se moje po skoro pri normalni drugi obstoiatelstva. No razbira se ako chernia ti drob e zdrav niama zakade da se barza i moje da se pochaka niakolko godinki dokato e podhodiasht momenta ili imash vazmojnost. az ve4e chakam kum 8 godini i 4ernia mi drob e zasegnat minimalno, no tova e razlichno pri vseki. t.e. v moia sluchai moga da chakam sigurno pone o6te 10g bez problem dokato zapochna lechenie, no az sum reshil da pochna kolkoto se moje po skoro.

V Balgaria niakolko lekari sa mi kazvali 4e niama nujda ot lechenie i da ne se pritesniavam za bolestta. Tova veche sa mitove. bolesta se lekuva, makar i trudno i vsi4ki specialisti preporachvat lechenie, razbira se vzimat se pod vniamnie i stranichnite efekti i drugi bolesti ako imash i drugi neshta, sashto taka v povecheto sluchai lechenieto ne e speshno i moje da minat godini predi da go zapochnesh, no 4ak puk da niama nujda...

neka da si napravi izledvaniata za genotip i viral load i s tiah da otide pri niakoi sdrug pecialist, koito e lekuval hora s hep c, toi shte i kaje za kakvo stava vapros i dali ima nujda ot biopsia.

160

Диагностика / Re: Резултати от ПСР - изследването

« -: Март 13, 2007, 02:17:08 »

s moita priatelka nemojem da razberem koi kogo e zarazil i koga tochno. sashto ne se znae dali pootdelno sme se zarazili ili edin drug. Vsi4ki varianti sa vazmojni. Po skoro si mislim 4e az sum zarazil neia... no pak ne se znae.

Moiat lekar kaza da si napravia i ochen pregled, na ochnata kuhina dali imam niakavi predrazpolojenia za bolesti na ochite. kaza mi 4e ako imam niakakva bolest po o4ite to ot lekarstata tia moje da se razvie mnogo barzo i da se vloshi... pak se po4va lechenie, no se pravi pregled za da znam ako imam neshto da sledia za da reagiram navreme.


Dadoha mi edni mnogo interesni knijki s kartinki i vsiakakvo info za hepatit c. te sa ot kompaniite koito praviat lekarstvata, kakto i shte dosta broshurki i daje edin disk s video. Obache nezna kak moga da go sherna tuk v foruma ?

161

Диагностика / Re: Резултати от ПСР - изследването

« -: Март 12, 2007, 05:30:56 »

Zdrasti Irka,


sajaliavam da chuia che nemoje da se lekuvash na toia etap. Ako popadna na info po tazi tema za shtitovidnata jleza shte ti pisha.

Ne sum siguren za rezultatite ot biopsiite vi zashtoto ne sum zapoznat s terminite na balgarski. Tuka se izpolzva Stage i Grade. Naprimer az sum Stage 1 Grade 1.  Taka kato gledam sas sapruga ti sme na ednakvi pokazateli - Genotip 3, kolichestvo na virusa - 36 000. Az podadoh moite dokumenti za bezplatni lekarstva sega v petak i chakam otgovor sled okolo dve-tri sedmici. Ako mi gi dadat pochvam lechenie vednaga, ako li ne moje i da poizchakam niakoi druga godinka. Dano i na tvoia saprug da mu otpusnat lekarstvata skoro. Nie sme 'kasmetlii''4e sme genotip 3.

Kolkoto do zaraziavaneto, naistina e mnogo stranno  4e ste se zarazili ot razlichni mesta. S moita priatelka i dvamata sme genotip 3. samo neinoto kolichestvo na virusa e  malko po goliamo ot moito. Naistina mnogo veroiatno e sapruga ti da se e zarazil ot zamarseni igli za tatuirovki. Ama ti ak osi niamala kravoprelivane predi napravo neznam kak bi mogla da se zarazish i to s genotip 1.

Tova che ne gledat Asat i Alat za zapochvane na lechenie e mnogo hubavo, zashtoto men doktorite v bg vseki pat me vrashtaha i mi kazvaha 4e shtom asat i alat sa ok niama pari ot zdravnata kasa da ima.

Pozdravi

Stefan

162

Превенция и заразяване / Re: Как се заразихте

« -: Март 05, 2007, 04:00:48 »

http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm

sintezirani facti za hepatit c, vklu4itelno nachini na zaraziavane.

163

Диагностика / Re: Резултати от ПСР - изследването

« -: Март 01, 2007, 04:26:20 »

HCV Viral Load Tests
Alan Franciscus, Editor-in-Chief
Liz Highleyman
 

Viral load tests are blood tests that measure HCV ribonucleic acid (RNA, or genetic material) in the blood. The presence of viral RNA indicates that the virus is actively replicating (reproducing and infecting new cells). A viral load test is usually first done after a person has tested positive for exposure to HCV based on an antibody test. A blood sample is taken and the amount of HCV RNA in a milliliter of blood is measured. Viral load tests confirm whether an individual is actively infected with HCV. Viral load test results were previously measured in number of copies, but are now typically reported in terms of International Units per milliliter (IU/mL).

Types of HCV Viral Load Tests
There are two categories of HCV viral load tests:

Qualitative viral load tests — These tests determine the presence of HCV RNA in the blood. This type of test is usually used to confirm chronic infection with HCV. If viral RNA is detected, a positive result is reported; if viral RNA is not detected, the test result is negative.

Quantitative viral load tests — These tests measure the amount of virus in one milliliter of blood. They are often used to assess whether or not treatment with interferon or interferon plus ribavirin is likely to be successful and, later, if treatment is working.

There are currently three tests commonly used for HCV viral load testing:

Polymerase chain reaction (PCR) — PCR tests detect HCV RNA in the blood, which indicates current active infection. This type of quantitative PCR test is very sensitive, and can measure as few as 50 IU/mL.

Branched-chain DNA (bDNA) — The bDNA method quantitative viral load testing is easier (and cheaper) to use for a large number of samples, but only measures viral loads greater than 500 IU/mL. This means that if a person has a viral load below 500 IU/mL, HCV could be present in the blood but not detected by the test.

Transcription-mediated amplification (TMA) — TMA technology allows for the amplification and detection of nucleic acids (components of genetic material) in the blood. This test can measure as few as 5-10 IU/mL. This newer test appears easier and cheaper to use, streamlining test processing and producing consistent, reliable, and more rapid results.

Interpreting Viral Load Test Results
HCV viral load is often reported as low or high.
Expressed as copies/mL:
 ·Low: less than 2 million copies
 ·High: more than 2 million copies

Expressed as International Units (IU/mL):
 ·Low:less than 800,000 IU/mL
 ·High:more than 800,000 IU/mL

If no HCV RNA is found by a test, a person’s viral load is said to be undetectable. Note that whether viral load is undetectable depends on which test is used. PCR and TMA tests can measure viral loads much lower than those a bDNA test can detect. Importantly, the blood of an individual with a very low viral load may still contain HCV even though the current tests cannot measure it; that is, the virus may not have been truly eradicated from the body.

Viral load test results can vary depending on how a blood sample is handled and stored. Furthermore, results may vary from lab to lab. For this reason, most experts recommend that people should get their viral load testing done by the same laboratory each time, so that results are more comparable.

Changes in viral load are sometimes expressed in terms of logs. A log change is a 10-fold increase or decrease. For example, a change from 1,000,000 IU/mL to 10,000 IU/mL is a 2-log decrease.

tozi otkas opisva PCR testovete, chesno da ti kaja i az malko se obarkah, poneje na tvoia ima 2 cifri - 3 miliona i 700 000 iu. ta nemoga da razbera koia za koe se otnasia. no pak sega kato se rovih 4etoh 4e koli4estvoto na virusa ne e opredeliashto za kolko vreda e nanesena na chernia ti drob.

ako iskash da vidish cialata statia koiato e super podrobna eto go linka
http://janis7hepc.com/Viral_Loads.htm#hcv%20viral

164

Диагностика / Re: Резултати от ПСР - изследването

« -: Март 01, 2007, 03:53:14 »

Imashe edna tablica niakade iz neta za PCR testa, sega shte ia nameria i postna. kakto ve4e razbra biopsiata e nai vajna, zatova kato polu4ish rezultatite pishi ni kakvi sa. 

165

Диагностика / Re: Резултати от ПСР - изследването

« -: Февруари 28, 2007, 21:44:16 »

Zdrasti Irka,

Naistina losho 4e si genotip 1, izglejda tova e po razprostranenia genotip kato cialo. za a i b neznam to4no, no razlikata e minimalna, sigurno Rado znae po dobre poneje i toi e bil 1. kolkoto do kolichestvenoto izsledvane okolo 3 miliona 4eta 4e e chesto sreshtan rezultat, t.e. ne s es4ita 4e e mnogo visok, a po skoro za sredno nivo. moito e nisko. tozi koli4estven pokazatel ima tendencia da se promenia barzo - namaliava ili uvelichava i ne e osoben factor pri predvijdane na izhoda ot lechenieto.

ne si spomniam praviha li ti biopsia ili oshte ne?