Category Archives: Grand Rounds

Eureka!

Today at Parkland Morning Report, Dr. David Hellmann (Chairman of Internal Medicine at Johns Hopkins Bayview Medical Center) talked about the origins of the word, eureka, and how it applies to the practice of medicine. Eureka is derived from Ancient Greek and means “I have found it!” and is thought to have been exclaimed by the great Greek scholar Archimedes when he discovered how to determine the volume of an irregular shape. As physicians, we can be recognizing our “eureka” moments when we are talking to patients, obtaining a history, examining them, interpreting their tests, and so forth. What eureka moments have we had as physicians taking care of our patients and doing research? Maybe these discoveries can lay the foundation of a caring, thoughtful physician.

Grand Rounds: An update on Hep C management and treatment

Today Dr. Brown gave her Grand Rounds talk on Hep C management and treatment. Here are some highlights from her talk:

  • Hep C affects 180 million people worldwide
  • 80% of acutely infected HCV patients progression to chronic infection, 20% of whom develop cirrhosis within 25 years
  • In 2014, a national task force with members from the American Association for the study o f Liver Disease and the Infectious Disease Society of America provided comprehensive guidelines
  • Screening:
    • Annual screenign for IVDA, HIV + men
    • One time screening for asymptomatic adults born between 1945 and 1965, patients on HD, abnormal LFTs, transfusion or transplant recipients before 1992 or clotting factor concentrates before 1987, children bron to HCV infected mothers, + tattoos or +incarceration
  • For those with HCV antibodies:
    •  Check HCV quant RNA, HCV genotype prior to antiviral initiation
    • Evaluate for advanced fibrosis with liver biopsy or imaging
    • Vaccinate against Hep A, B
    • Educate on risk of transmission and conditions that can accelerate fibrosis (ETOH use, concurrent HBV, HIV)
  • Current 2014 clinical guidelines include two direct acting antiviral agents: Sofosbuvir – NS5B nucleotide polymerase inhibitor and Simepravir Ns3/4a protease inhibitor
    • Future clinical studies are looking at interferon free regimens consisting of combinations of NS5A and NS5B inhibitors as well as protease, NS5A and NS5B combinations
Current Guidelines:

Naive/Relapsers to PEG/Ribavirin (RBV) Genotype

Recommended Alternative
1 IFN eligible-Sofosbuvir + PEG/RBV-12 wk

IFN ineligible –Sofosbuvir + Simeprevir ± RBV-12 wk

IFN eligible –Simeprevir-12 wk + PEG/RBV -24 wk

IFN ineligible –Sofosbuvir + RBV-24 wk

2 Sofosbuvir + RBV – 12 wk
3 Sofosbuvir + RBV – 24 wk Sofosbuvir + PEG/RBV -12 wk
4 IFNeligible – Sofosbuvir +PEG/RBV-12 wk

IFN ineligible – Sofosbuvir +RBV-24 wk

Simeprevir X 12 wks + PEG/RBV -24-48 wk
5 or 6 IFN eligible – Sofosbuvir + PEG/RBV-12 wk IFN eligible – PEG/RBV – 48 wk