Почему от воды чернеют руки?
Бывает так, что от воды чернеют руки, ногти и даже посуда. Это происходит из-за повышенного содержания марганца в воде! Да, и такое бывает.
Обычно руки чернеют после воды из скважины или колодца, если нет фильтров для воды или они не справляются. Т.е. от природной воды, где нет водоочистки. Гораздо реже этот феномен всречается в водопроводной воде в квартире, т.к. она уже проходит водоочистку.
Обычно руки чернеют после воды из скважины или колодца, если нет фильтров для воды или они не справляются. Т.е. от природной воды, где нет водоочистки. Гораздо реже этот феномен всречается в водопроводной воде в квартире, т.к. она уже проходит водоочистку.
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Ученые из департамента по делам ветеранов, Службы здравоохранения населения, Системы здравоохранения Пало-Альто, Калифорния, США, решили все таки выяснить, что же эффективнее для лечения 2 и 3 генотипа вируса гепатита С софосбувир и даклатасвир или софосбувир и велпатасвир?
Цель
Понимание реальной эффективности схем пероральной терапии гепатита С (HCV) позволяет принимать решения о лечении. Мы оценили эффективность даклатасвира + софосбувира ± рибавирина (DCV + SOF ± RBV) и велпатасвира / софосбувира (VEL / SOF) ± RBV у пациентов с генотипом 2 и генотипом 3 инфекции, получавших лечение в обычной практике.
Cравнивали частоту Устойчивых Вирусологических Ответов (далее по тексту УВО) Этот обсервационный анализ был проведен в когорте пациентов с намерением лечить гепатит С генота 2 и генотипа 3. Анализ устойчивого вирусологического ответа (УВО) был получен у 5400 пациентов, начавших лечение DCV + SOF ± RBV или VEL / SOF ± RBV, что действительно может говорить, об серьезности доказательной базы.
Результаты
Для генотипа 2 показатели УВО не различались между DCV + SOF (94,5%) и VEL / SOF (94,4%) или между DCV + SOF + RBV (88,1%) и VEL / SOF + RBV (89,5%). Для генотипа 3 показатели SVR не различались между DCV + SOF (90,8%) и VEL / SOF (92,0%) или между DCV + SOF + RBV (88,1%) и VEL / SOF + RBV (86,4%). В многомерных моделях пациентов с генотипом 2 и 3, режим лечения не был значимым предиктором шансов УВО. Для генотипа 3 значимыми предикторами снижения шансов УВО были предшествующий опыт лечения ВГС (отношение шансов [OR] 0,51, 95% CI 0,36–0,72; p <0,001), FIB-4> 3,25 (OR 0,60; 95% CI 0,43 –0,84; р ?= 0,002) и декомпенсированный цирроз печени (ОШ 0,68; 95% ДИ 0,47–0,98; р?= 0,04). Для пациентов с генотипом 2 и 3, получавших VEL / SOF ± RBV, 89% и 85% получали 12-недельное лечение соответственно. Для DCV + SOF ± RBV 56% и 20% пациентов с генотипом 2 HCV получали 12-недельное и 24-недельное лечение соответственно; в то время как 53% и 23% пациентов с генотипом 3 ВГС получали 12 недель и 24 недели, а большинство пациентов получали 24 недели.
Выводы
У пациентов, инфицированных генотипом 2 и 3 ВГС, DCV + SOF ± RBV и VEL / SOF ± RBV вызывали одинаковую частоту УВО в каждом генотипе, и режим не оказывал значительного влияния на шансы УВО. Для пациентов с генотипом 3 предшествующий опыт лечения и прогрессирующее заболевание печени были значимыми предикторами снижения шансов УВО независимо от режима.
Резюме
В клинической практике показатели излечения для генотипа 2 вируса гепатита С (ВГС) составляли 94%, а показатели излечения для генотипа 3 ВГС — 90%. Вероятность достижения излечения была одинаково независимой от того, получал ли человек даклатасвир плюс софосбувир или велпатасвир / софосбувир. Рибавирин не влиял на показатели излечения. Вероятность излечения была самой низкой у людей, которые получали терапию от ВГС в прошлом.
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