Martina Smolic

By Hrvoje Roguljic, Sonja Sarcevic, Robert Smolic, Nikola Raguz Lucic, Aleksandar Vcev and Martina Smolic

Part of the book: Drug Discovery and Development

By Ines Bilić-Ćurčić, Hrvoje Roguljić, Marul Ivandić, Aleksandar Včev, Robert Smolić and Martina Smolić

Diabetes type 2 mellitus (T2DM) is the most common extrahepatic association of hepatitis C virus (HCV) infection. Substantial research has suggested that insulin resistance (IR) has crucial importance in development of type 2 diabetes in HCV-infected patients. Several pathophysiological mechanisms are proposed, such as direct effect of HCV proteins on inhibition of the insulin-signaling pathway inducing central insulin resistance (IR), while overproduction of inflammatory cytokines and increased lipolysis promote peripheral IR. IR in HCV-infected patients is associated with impaired sustained virologic response (SVR) and higher incidence of hepatocellular carcinoma (HCC). Some, but not all, studies have shown improvements in achieving SVR in patients with interferon/ribavirin (RBV) therapy co-treated with metformin or pioglitazone as well as beneficiary effect on the incidence of hepatocellular carcinoma. Recent studies indicate that response to the new direct-acting antiviral (DAA) treatments is unaffected by insulin resistance thus diminishing importance of IR in the new era of DAA. Additionally, viral eradication by DAAs has been shown to ameliorate insulin resistance, attenuating the risk of new-onset diabetes type 2. However, those metabolic improvements are sustainable long after the treatment remains unclear.

Part of the book: Update on Hepatitis C

By Milan Milošević, Jelena Jakab, Lucija Kuna and Martina Smolić

Modifications to work and work ability assessment are required to prevent occupational transmission of hepatitis C virus (HCV). This is usually required in the health care setting, where exposure-prone procedures (EPPs) should not be carried out by infectious carriers of HCV. The risk of an individual surgeon acquiring HCV has been estimated at 0.001–0.032% per annum. Even in an area with a high prevalence of HCV among its population, the risk of acquiring HCV through occupational exposure is low. Rates of viral clearance with treatment of acute HCV infection are considerably higher than treatment of chronic HCV infection. Consequently, it is imperative that health care workers follow universal precautions and promptly report all exposures to blood or body fluid exposures according to their local policy. Health care workers who embark on, or transfer to, a career that requires EPP (exposure-prone procedures and dialysis work) should be assessed to ensure that they are free from infection with HCV. If the HCV antibodies are positive, the health care worker should be tested for HCV RNA PCR. If the HCV RNA PCR is negative on two separate occasions, the health care worker may be permitted to perform EPPs. If the HCV RNA PCR is positive, the health care worker should not be allowed to perform EPPs. Health care workers who already perform EPPs and who believe they may have been exposed to HCV infection should be advised to seek advice from their occupational health department for confidential advice on whether they should be tested.

Part of the book: Update on Hepatitis C

By Martina Smolić, Tea Omanović, Ivana Božić, Ines Bilić-Ćurčić, Robert Smolić and Aleksandar Včev

Hepatitis C affects approximately 180 million people worldwide, with 3–4 million newly infected each year. Hepatitis C virus (HCV) has been classified into seven different genotype categories, wherein HCV genotype 1 (HCV-1) is the most prevalent. To date, there is still no vaccine available against HCV infection. Until recently, combination therapy of pegylated interferon-a (PegIFN) and ribavirin (RBV) has been the standard of care. Nevertheless, for many patients, particularly those infected with HCV genotype 1 (HCV-1), this treatment has resulted with unsatisfactory treatment response rates and high adverse drug reaction (ADR) rates. Many clinical factors, including pharmacogenetics, influence the treatment response rate. This review focuses on the association between pharmacogenetics and HCV antiviral therapy in patients infected with HCV genotype 1 and other genotypes (GT); patients reinfected with HCV after liver transplantation; and patients coinfected with HCV and human immunodeficiency virus. Data considering triple therapy in HCV-infected patients are also reviewed. Additionally, various genetic polymorphisms, with an emphasis to IL-28B, and their association with pharmacogenetic testing in HCV are discussed.

Part of the book: Update on Hepatitis C

By Robert Smolić, Jelena Jakab, Lucija Kuna, Martina Smolić, Martina Kajić, Marinko Žulj and Aleksandar Včev

The complexity of the hepatitis C virus (HCV) infection is reflected in its therapy, and great efforts are needed from the patient and the physician to be successful in eliminating the infection. How HCV will progress depends a lot on patient characteristics and social factors, in addition to the timing of initiation, duration, and final results of the therapy. The first treatment approved for patients with chronic hepatitis C was interferon (IFN) which had a sustained viral response (SVR) rate in 20%. Due to side effects, the adherence to this treatment was limited and required a patient-tailored approach with various medical disciplines working together and intervening at the right time to minimize potential obstacles. The introduction of direct-acting antivirals (DAAs) has contributed to the advancement of HCV treatment. However, a major obstacle to wide use of DAAs is their high price which has largely limited access to treatment. Guidelines and recommendations on treatment of hepatitis C have been developed to assist physicians and other health care providers to determine priority. Despite that, the arrival of new oral therapies has been met with enthusiasm as shorter, simpler, safer treatment allows for the possibility of delivering antiviral therapy on a large scale.

Part of the book: Update on Hepatitis C

By Aleksandar Včev, Jelena Jakab, Lucija Kuna and Martina Smolić

Chronic hepatitis C has a profound negative impact on both physical and mental well-being, thus decreasing health-related quality of life (HRQL). The most common complaints include symptoms such as fatigue, depression, and neurocognitive deficits. The burden of chronic HCV infections is multiplied by emotional and psychological issues that affect patients’ functional health and work ability. Treatment of chronic HCV infection may at the beginning cause worse HRQL rates, as a result of common adverse effects like fatigue, muscle aches, and depression. However, the relationship between sustained virologic response (SVR) and improvement in HRQL is well known. Treatment-related adverse effects may discourage patients from starting therapy and reduce their adherence to treatment. Novel agents, with improved adverse effect profiles and SVR rates, allow more patients the opportunity to achieve improvements in HRQL during and after treatment.

Part of the book: Update on Hepatitis C

By Jelena Jakab, Robert Smolić, Aleksandar Včev and Martina Smolić

Obesity is a complex metabolic and behavioural disorder associated with increased health risk, including coronary artery disease, congestive heart failure and sudden cardiac death. Effective prevention and treatment strategies for obesity are needed. This unmet need for efficient and safe antiobesity medication resulted in many new therapies at various stages of development. Obesity has become one of the most intensively studied diseases because of the availability of suitable animal and cell culture models of adipocyte differentiation and appetite regulation.

Part of the book: Drug Discovery

By Martina Smolic, Reham Dawood, Ghada Salum, Mai Abd El Meguid, Moataza Omran and Robert Smolic

SARS-CoV-2, a novel coronavirus, is currently represented a major public health concern. The high transmission rate of this virus increases the mortality rate worldwide. To date, significant efforts and restricted regulations were performed around the world to control this crisis effectively, but unfortunately, there is no specific and successful therapy for COVID-19. Many approaches have been repurposed for SARS-CoV-2 treatment such as antivirals and anti-inflammatories. Furthermore, antibody therapies are one of the main and important approaches of SARS-CoV-2 infection treatment. In recent trials, various immunotherapeutic interventions such as convalescent plasma therapy and monoclonal antibodies, as well as immunomodulatory agents are being proposed. However, the development of a vaccine that provides durable protective immunity will be the most effective therapy for controlling possible epidemics of this virus. The current review summarized all the proposed therapeutic approaches together with information on their safety and efficacy in treating COVID-19, as well as the vaccine candidates. The provided comprehensive information regarding the applied therapeutic strategies against COVID-19 might help the scientific community in any progress toward the treatment of COVID-19 infection.

Part of the book: Post COVID-19