Risk Factors and Therapy of Chronic Leg Ulcers Lasting More Than 6 Months
The therapy of chronic leg ulcers in diabetics continues to be a significant challenge for attending physicians and surgeons. Authors of a recently published study have addressed the risk factors, clinical symptoms, and, last but not least, the therapy outcomes of chronic leg ulcers lasting more than 6 months.
Substitution treatment could be a suitable framework for the treatment of chronic hepatitis C (CHC) in patients dependent on injection opioids. A retrospective Swiss study showed a high compliance rate with antiviral treatment and achievement of a virological response in patients who used this substitution treatment in primary care.
A high incidence of CHC in individuals dependent on injection drug use and poor compliance with the antiviral treatment regimen among these patients led the authors of the study to think that administering substitution treatment during opioid addiction withdrawal might be a good motivation for adherence to antiviral therapy. They conducted a retrospective analysis of records of CHC patients who used substitution treatment for opioid addiction withdrawal for more than 3 months. These were patients of a single general practitioner in Zurich treated between 2002 and 2008.
The study included 85 patients aged 35–44 years, 61% of whom were men. Pegylated interferon and ribavirin were administered in CHC treatment. The use of antiviral treatment and the achievement of complete virological response, defined as undetectable hepatitis C virus RNA 6 months after the end of antiviral treatment, were evaluated.
Antiviral treatment was initiated in 35 patients (41.2%). These patients used substitution treatment for an average of 55 months (35–110 months), while the remaining patients without antiviral treatment used it for only 24 months (9–46 months; p < 0.001). Longer use of substitution treatment significantly impacted compliance with antiviral treatment even after adjusting for potentially confounding factors. A sustained virological response was achieved in 25 patients (71%).
Motivating individuals undergoing substitution treatment for opioid addiction withdrawal can be utilized for CHC treatment, the incidence of which is high in these individuals.
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Source: Seidenberg A., Rosemann T., Senn O. Patients receiving opioid maintenance treatment in primary care: successful chronic hepatitis C care in a real-world setting. BMC Infect Dis. 2013 Jan 8; 13 (1): 9. [Epub ahead of print]
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