Background:The management of patients with chronic hepatitis C who have relapsed or failed to respond to interferon based therapies is an important issue facing hepatologists. Aims: We evaluated the efficacy and safety of peginterferon alfa-2a (40KD) plus ribavirin in this population by conducting a multicentre open label study. Patients: Data from adults with detectable serum hepatitis C virus (HCV) RNA who had not responded or had relapsed after previous conventional interferon or conventional interferon/ribavirin combination therapy were analysed. Methods: Patients were retreated with peginterferon alfa-2a (40KD) 180 mg/week plus ribavirin 800 mg/day for 24 or 48 weeks at the investigators' discretion. The study was conceived before the optimal dose of ribavirin (1000/1200 mg/day) for patients with genotype 1 was known. The primary endpoint was sustained virological response (SVR), defined as undetectable HCV RNA (,50 IU/ml) after 24 weeks of follow up. The analysis was conducted by intention to treat. Results: A total of 312 patients (212 non-responders, 100 relapsers) were included. Of these, 28 patients were treated for 24 weeks and 284 for 48 weeks. Baseline characteristics between non-responders and relapsers were similar although more non-responders had genotype 1 infection (87% v 69%). Overall SVR rates were 23% (48/212) for non-responders and 41% (41/100) for relapsers. When data were analysed by genotype, SVR rates were 24% (61/253) in genotype 1 and 47% (28/59) in genotype 2/3. Conclusions: These results in a large patient cohort demonstrate that it is possible to cure a proportion of previous non-responders and relapsers by retreating with peginterferon alfa-2a (40KD) plus ribavirin.

SUMMARY BackgroundPegylated interferon alfa-2a (40 KD) plus ribavirin therapy induces sustained virological response rates up to 63% in randomized-controlled trials.

Punctal plug occlusion provided symptomatic relief and reduced fluorescein staining in all except the inferior zone. However, insertion of punctal plugs had minimal effect on tear cytokines and MMP-9 levels, suggesting a need for earlier treatment with anti-inflammatory agents for management of dry eye disease.

Fixed-combination brimonidine-timolol provided the same or greater IOP lowering compared with fixed-combination dorzolamide-timolol. Both fixed-combination medications were safe and well-tolerated. Brimonidine-timolol received higher ratings of ocular comfort than dorzolamide-timolol. The duration of the studies was 3 months, and additional studies will be needed to compare the efficacy and tolerability of brimonidine-timolol and dorzolamide-timolol during long-term treatment.

Background: Dystonia must be accurately diagnosed so that treatment can be administered promptly. However, dystonia is a complex disorder, with variable presentation, which can delay diagnosis. Methods: Data were gathered by questionnaire from 866 patients with dystonia or hemifacial spasm (HFS) treated in 14 movement disorders centres in Canada injecting botulinum toxin, to better understand the path to diagnosis, wait times and obstacles to treatment. Results: Most participants were female (64.1%), mean age was 58 years, and patients consulted an average of 3.2 physicians before receiving a dystonia or HFS diagnosis. Many patients (34%) received other diagnoses before referral to a movement disorders clinic, most commonly "stress" (42.7%). A variety of treatments were often received without a diagnosis. The mean lag time between symptom onset and diagnosis was 5.4 years. After the decision to use botulinum toxin, patients waited a mean of 3.1 months before treatment. The most common diagnoses were cervical dystonia (51.6% of patients), HFS (20.0%) and blepharospasm (9.8%). Conclusions: Survey results show that diagnosis of dystonias or of HFS, and therefore, access to treatment, is delayed. An educational program for primary care physicians may be helpful to decrease the time to diagnosis and referral to a specialist centre for treatment.RÉSUMÉ: Enquête canadienne sur les causes de retard dans le traitement de la dystonie et du spasme hémifacial. Contexte : Un diagnostic précis doit être posé pour que la dystonie soit traitée promptement. Cependant, la dystonie est une maladie complexe dont le mode de présentation est variable, ce qui peut retarder le diagnostic. Méthode : Nous avons recueilli les données au moyen d'un questionnaire administré à 866 patients atteints de dystonie ou de spasme hémifacial (SHF) qui ont été traités par injection de toxine botulique dans 14 centres de traitement des désordres du mouvement au Canada, afin de mieux comprendre le parcours diagnostic, les délais et les obstacles au traitement. Résultats : La majorité des patients étaient des femmes (64%) et l'âge moyen était de 58 ans. Les patients avaient consulté en moyenne 3,2 médecins avant de recevoir un diagnostic de dystonie ou de SHF. Plusieurs patients (34%) avaient reçu d'autres diagnostics avant d'être référés à une clinique des désordres du mouvement, le diagnostic le plus fréquent étant celui de "stress" (42,7%). Différents traitements avaient souvent été administrés, sans qu'un diagnostic n'ait été posé. Le temps moyen écoulé entre le début des symptômes et le diagnostic était de 5,4 ans. Après que la décision d'employer de la toxine botulique ait été prise, les patients avaient attendu en moyenne 3,1 mois avant d'être traités. Les diagnostics les plus fréquents étaient les suivants : dystonie cervicale (51,6% des patients), SHF (20,0%) et blépharospasme (9,8%). Conclusions : Les résultats de l'enquête démontrent qu'il existe un retard dans le diagnostic des dystonies ou du SHF et donc que l'accès au traitement ...