Optimizing Hepatitis C Virus (HCV) Treatment in a US Colocated HCV/Opioid Agonist Therapy Program

Background

A minority of patients with opioid use disorder are treated for hepatitis C virus infection (HCV). While colocated HCV and opioid agonist therapy (OAT) along with harm reduction can facilitate prevention and cascade to cure, there are few real-world examples of such embedded care models in the United States in the direct-acting antiviral (DAA) era.

Methods

We conducted a retrospective chart review to determine sustained virologic response (SVR) and reinfection rates during the first 5-year period of DAA availability among individuals tested and treated on-site at Rhode Island’s only nonprofit methadone maintenance program.

Results

Of 275 who initiated DAAs, the mean age (range) was 43 (22–71) years, 34.5% were female, 57.5% had genotype 1a, 23.3% had cirrhosis, and 92% were Medicaid recipients. SVR was 85.0% (232/273), while modified intent-to-treat SVR was 93.2% (232/249); 17 patients did not achieve SVR, 2 awaited SVR 12 weeks post-end-of-treatment, and 24 were lost to follow-up. Thirty reinfections were identified over 375.5 person-years of follow-up (rate, 7.99/100 person-years). The median time to first reinfection (interquartile range) was 128 (85.25–202.5) days. Before July 1, 2018, 72 patients accessed DAAs over 3.7 years; after Medicaid DAA restrictions were lifted, 109 patients accessed DAAs over 1.3 years. The Prior Authorization (PA) process requires many steps, differing across 11 RI insurers, taking 45–120 minutes per patient.

Conclusions

DAA treatment was effective among a marginalized population in an urban colocated OAT/HCV program. Removing DAA restrictions facilitates treatment initiation. The PA process remains a modifiable barrier to expanding capacity in the United States.

Monitoring spatiotemporal changes in chaperone-mediated autophagy in vivo

Autophagy malfunctioning occurs in multiple human disorders, making attractive the idea of chemically modulating it with therapeutic purposes. However, for many types of autophagy, a clear understanding of tissue-specific differences in their activity and regulation is missing because of lack of methods to monitor these processes in vivo. Chaperone-mediated autophagy (CMA) is a selective type of autophagy that until now has only been studied in vitro and not in the tissue context at single cell resolution. Here, we develop a transgenic reporter mouse that allows dynamic measurement of CMA activity in vivo using image-based procedures. We identify previously unknown spatial and temporal differences in CMA activity in multiple organs and in response to stress. We illustrate the versatility of this model for monitoring CMA in live animals, organotypic cultures and cell cultures from these mice, and provide practical examples of multiorgan response to drugs that modulate CMA.

Preliminary Study on the Carcinogenic Activity of the Fungicide Manganese Ethylenebisdithiocarbamate in the Adult Newt, Triturus Cristatus Carnifex

Percutaneous exposure of adult newts to the fungicide manganese ethylenebisdithiocarbamate (maneb) at 3 concentration levels (0.5, 2.5 and 5.0 ppm) for a total of 19-23 weeks did not result in the induction of any neoplasms.

Synthesis and photophysical and supramolecular study of π-conjugated (diethylene glycol methyl ether) benzoateethynylene oligomers and polymers

The strong π–π interaction that governs (diethylene glycol methyl ether) benzoateethynylene macromolecules was evidenced by X-ray scattering and HRTEM.

Tuberculosis Diagnostic Committees' contribution to the National TB Program in Manila and Quezon Cities

SETTING

The Philippines Tuberculosis Diagnostic Committees (TBDCs) were created to improve the quality of diagnosis of sputum smear-negative chest radiography suggestive of pulmonary tuberculosis (sn-PTB).

OBJECTIVE

To determine current TBDC activities, obstacles and possible solutions for improvements in the quality of diagnosis of sn-PTB in Manila City and Quezon City.

DESIGN

A descriptive review of TBDC Masterlist records and interviews with TBDC members using a semi-structured questionnaire.

RESULTS

A record review of nine of 10 TBDCs was conducted, with interviews of 33 of the 49 current members. During the second and third quarters of 2009, respectively 1142 and 1563 sn-PTB cases were evaluated by the TBDCs in both cities. Of these, 53% in Manila City and 65% in Quezon City were classified as active TB patients. There were significant variations in the percentage of patients recommended for anti-tuberculosis treatment by the TBDC. The participation of its members is based on their expressed commitment to program sustainability.

CONCLUSION

TBDC activities contribute to TB control in the Philippines by ensuring the judicious use of resources. Further research to assess the contributions of TBDCs in reducing diagnostic and treatment delays, and factors affecting the sustainability of the TBDCs, is recommended.

Modeling of Changes in Atmosphere Composition in Fresh-cut Peach Packages due to Temperature Fluctuations

Storage temperature is not always constant in the distribution chain of modified atmosphere fresh food packages. A change in temperature means an alteration in the respiration rate of the product and in the gas transmission rates through the film. Because of their high metabolic activity, minimally processed products are particularly sensitive to temperature variation, and hence this study has been carried out with five cultivars of fresh-cut peaches (Prunus persica). Their respiratory activity has been determined by a closed system at 4, 15, and 25 °C. The peach segments are wrapped in microperforated films whose transmission rate is determined according to the size of the microperforations (between 100 × 130 μm and 215 × 190 μm). To quantify the effect of temperature fluctuations (5 h at 25 °C) on the O2 and CO2 concentrations of the packaging atmosphere of the product, a mathematical model has been applied. Using experimental data, it has been established that the rate of O2 consumption is a potential function of the O2 concentration, while the production of CO2 is linear. Although, all cultivars are of nonmelting fresh with no big differences in respiratory activity; these differences are accentuated with O2 concentrations greater than 10% and raising the temperature. The solution of the model provides knowledge of the behavior of the product during its nonstationary period and equilibrium once reached. The results show in all cases that the CO 2 concentration is more sensitive (increase of 5 units) to a break in the cold chain than that of O2 (reduction of 2 units).

Synthesis of fluorescent dendrimers with an oligo(phenylenevinylene) core

Novel fluorescent dendrimers of first, second, and third generation bearing a conjugated oligo(phenylenevinylene) (OPV) core and peripherial allyl chains as dendrons have been synthesized by a convergent method. The compounds have been fully characterized by 1H, 13C NMR, FTIR, UV-vis, and fluorescence spectroscopy, MALDI-TOF or FAB+ mass spectroscopy and elemental analysis. All dendrimers showed in solution a blue fluorescence with a maximum wavelength at 444-446 nm and can be deposited as thin films emitting in the blue-green region. The most homogeneous films were obtained for the second generation dendrimer which also exhibits the higher quantum yield in solution. These properties make it a possible candidate for application in organic light emitting diodes (OLEDs).

Competitive and uncompetitive inhibitors simultaneously acting on an autocatalytic zymogen activation reaction

The time course of the residual enzyme activity of a general model consisting of an autocatalytic zymogen activation process inhibited by an irreversible competitive inhibitor and an irreversible uncompetitive inhibitor has been studied. Approached analytical expressions which furnish the time course of the residual enzyme activity from the onset of the reaction depending on the rate constants and initial concentration have been obtained. The goodness and limitations of the analytical equations were checked by comparing with the results obtained from the numerical integration, i.e. with the simulated progress curves. A dimensionless parameter giving the relative contributions of both the activation and the inhibitions routes is suggested, so that the value of this parameter determines whether the activation or the inhibitions routes prevail or if both processes are balanced during the time for which the analytical expressions are valid. The effects of the initial zymogen, free enzyme and inhibitors concentrations are analysed. Finally an experimental design and kinetic data analysis is proposed to evaluate simultaneously the kinetic parameters involved and to discriminate between different zymogen activation processes which can be considered particular cases of the general model.

Deaths: final data for 1999

OBJECTIVES

This report presents final 1999 data on U.S. deaths and death rates according to demographic and medical characteristics. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described. A previous report presented preliminary mortality data for 1999.

METHODS

In 1999 a total of 2,391,399 deaths were reported in the United States. This report presents tabulations of information reported on the death certificates completed by funeral directors, attending physicians, medical examiners, and coroners. Original records are filed in the State registration offices. Statistical information is compiled into a national data base through the Vital Statistics Cooperative Program of the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention. For the first time in a final mortality data report, age-adjusted death rates are based upon the year 2000 population and causes of death are processed in accordance with the Tenth Revision of the International Classification of Diseases (ICD-10).

RESULTS

The 1999 age-adjusted death rate for the United States was 881.9 deaths per 100,000 standard population, a 0.7 percent increase from the 1998 rate, and life expectancy at birth remained the same at 76.7 years. For all causes of death, age-specific death rates rose for those 45-54 years, 75-84 years, and 85 years and over and declined for a number of age groups including those 5-14 years, 55-64 years, and 65-74 years. Aortic aneurysm and dissection made its debut in the list of leading causes of death and atherosclerosis exited from the list. Heart disease and cancer continued to be the leading and second leading causes of death. The age-adjusted death rate for firearm injuries decreased for the sixth consecutive year, declining 6.2 percent between 1998 and 1999. The infant mortality rate, 7.1 infant deaths per 1,000 live births, was not statistically different from the rate in 1998.

CONCLUSIONS

Generally, mortality continued long-term trends. Life expectancy in 1999 was unchanged from 1998 despite a slight increase in the age-adjusted death rate from the record low achieved in 1998. Although statistically unchanged from 1998, the trend in infant mortality has been of a steady but slowing decline. Some mortality measures for women and persons 85 years and over worsened between 1998 and 1999.

Analysis of pesticide residues in wine by solid-phase extraction and gas chromatography with electron capture and nitrogen-phosphorus detection

A feasible and reproducible method for multiresidue analysis of several common pesticides, of different polarities, in wine samples is proposed. The method combines a solid-phase extraction on polymeric cartridges eluted with ethyl acetate and a gas chromatographic determination using electron capture and nitrogen-phosphorus detection. To avoid the matrix effect, previous washing of the cartridges with a mixture of water-2-propanol (90:10) and further clean-up of the extract on Florisil cartridges, together with a calibration using spiked extracts, are recommended.

Evolutive behavior towards cardiomyopathy of treated (nifurtimox or benznidazole) and untreated chronic chagasic patients

The aim of this work was to compare the evolution of chronic chagasic untreated patients (UTPs) with that of benznidazole or nifurtimox-treated patients (TPs). A longitudinal study from a low endemic area (Santa Fe city, Argentina) was performed during an average period of 14 years. Serological and parasitological analyses with clinical exams, ECG and X-chest ray were carried out. At the onset, 19/198 infected patients showed chagasic cardiomyopathy (CrChM) while 179 were asymptomatic. In this latter group the frequency of CrChM during the follow-up was lower in TPs compared with UTPs (3.2% vs 7%). Within the CrChM group, 2/5 TPs showed aggravated myopathy whereas this happened in 9/14 UTPs. Comparing the clinical evolution of all patients, 5.9% of TPs and 13% of UTPs had unfavourable evolution, but the difference is not statistically relevant. Serological titers were assessed by IIF. Titers equal to or lower than 1/64 were obtained in 86% of the TPs, but only in 38% of UTPs. The differences were statistically significant (geometric mean: 49.36 vs. 98.2). Antiparasitic assessment of the drugs (xenodiagnosis) proved to be effective. The low sensitivity in chronic chagasic patients must be born in mind. Despite treated patients showed a better clinical evolution and lower antibody levels than untreated ones, it is necessary to carry on doing research in order to improve therapeutic guidelines, according to the risk/benefit equation and based on scientific and ethical principles.

Airway hyperresponsiveness to ultrasonically nebulized distilled water in subjects with tetraplegia

The majority of otherwise healthy subjects with chronic cervical spinal cord injury (SCI) demonstrate airway hyperresponsiveness to aerosolized methacholine or histamine. The present study was performed to determine whether ultrasonically nebulized distilled water (UNDW) induces airway hyperresponsiveness and to further elucidate potential mechanisms in this population. Fifteen subjects with SCI, nine with tetraplegia (C4-7) and six with paraplegia (T9-L1), were initially exposed to UNDW for 30 s; spirometry was performed immediately and again 2 min after exposure. The challenge continued by progressively increasing exposure time until the forced expiratory volume in 1 s decreased 20% or more from baseline (PD20) or the maximal exposure time was reached. Five subjects responding to UNDW returned for a second challenge 30 min after inhalation of aerosolized ipratropium bromide (2.5 ml of a 0.6% solution). Eight of nine subjects with tetraplegia had significant bronchoconstrictor responses to UNDW (geometric mean PD20 = 7.76 +/- 7.67 ml), whereas none with paraplegia demonstrated a response (geometric mean PD20 = 24 ml). Five of the subjects with tetraplegia who initially responded to distilled water (geometric mean PD20 = 5.99 +/- 4.47 ml) were not responsive after pretreatment with ipratropium bromide (geometric mean PD20 = 24 ml). Findings that subjects with tetraplegia are hyperreactive to UNDW, a physicochemical agent, combined with previous observations of hyperreactivity to methacholine and histamine, suggest that overall airway hyperresponsiveness in these individuals is a nonspecific phenomenon similar to that observed in patients with asthma. The ability of ipratropium bromide to completely block UNDW-induced bronchoconstriction suggests that, in part, airway hyperresponsiveness in subjects with tetraplegia represents unopposed parasympathetic activity.

Inhibitory effect of propranolol on lipid synthesis in gonadectomized male hamster flank organs

BACKGROUND

This paper describes the inhibitory effect produced by propranolol pre-treatment on lipid synthesis in flank organs from intact, gonadectomized, and isoproterenol-treated male hamsters. Furthermore, the effect induced by the same treatments on gland sebum composition is reported.

METHODS

Different groups of male hamsters were injected daily with propranolol, isoproterenol or propranolol plus isoproterenol. Treatment-effect was evaluated determining the in vitro incorporation of radioactive acetate into lipids in hamster flank organs from intact and castrated animals. Additionally, radiolabeled lipids were isolated and identified using TLC and autoradiography as methods.

RESULTS

Results demonstrate that castration significantly decreases lipid synthesis in male hamster flank organs. In addition, propranolol treatment inhibits such synthesis in glands from intact, gonadectomized, and isoproterenol-treated animals. However, isoproterenol treatment was ineffective when compared to intact or gonadectomized control vehicle-treated animals. Lipid classes isolated and identified lipids either in castrated or in drug-treated animals were phospholipids, cholesterol, monoglycerides, fatty acids, waxes and cholesterol esters.

CONCLUSIONS

Results indicate an inhibitory effect induced on lipid synthesis by beta-adrenergic receptor antagonists; however, beta-adrenergic agonists drugs do not stimulate it. Data suggest a permissive role of adrenergic hormones on lipid synthesis in intact and in gonadectomized animals. Furthermore, castration decreased the synthesis, suggesting that a tight coupling between beta-adrenergic receptors and androgen receptors may be a prerequisite for lipogenesis in this tissue. Pre-treatment does not modify sebum composition in gonadectomized animal glands. These data support the evidence that activation of beta-adrenergic receptors could be an independent factor in the lipid composition regulation process.

Evaluation of the tumor-promoting activity of two beta-adrenoreceptor blocking agents, propranolol and atenolol, in liver of Fischer 344 rats

The tumor-promoting activity of two beta-adrenoreceptor blocking agents, propranolol and atenolol, was tested in a two-stage protocol of hepatocarcinogenesis in male and female Fischer 344 rats. Propranolol is a lipophilic non-selective beta-blocker mainly eliminated via the liver; atenolol is a hydrophilic beta 1-selective blocking agent, mainly eliminated via the kidney. Animals were initiated with a single dose of diethylnitrosamine (DEN, 200 mg/kg, i.p.) and, after 17 days of recovery, were continuously treated with propranolol (75-100 mg/kg) or atenolol (300 mg/kg) by gavage for up to 21 months. Rats given phenobarbital (0.05% in the diet) were used as positive controls. After 2, 4 and 8 months of promotion, preneoplastic lesions were quantified by staining sections of liver for gamma-glutamyltranspeptidase (GGT). In non-initiated rats, neither propranolol nor atenolol influenced the development of spontaneous preneoplastic or neoplastic liver lesions. The results obtained in DEN-initiated rats given propranolol cannot be unequivocally interpreted. In the male, propranolol seemed to be ineffective. In the female, there was weak enhancement of DEN-induced GGT foci at 4 and 8 months and of neoplastic lesions thereafter. However, there was great interindividual variability in focus and tumor yields. Unfortunately, due to the high incidence of liver tumors in rats given DEN alone and the small number of propranolol-treated rats that survived until the end of the experiment, no definite conclusion can be drawn about the modifying potential of this beta-blocker on liver carcinogenesis. There was no evidence of liver tumor promotion in DEN-initiated rats of either sex given atenolol.

[Effect of a synthetic somatostatin analogue with delayed action (SMS 201-995) on the biliary expenditure in a patient with an external biliary tract fistula]

The effect of treatment with a long acting analogue of somatostatin (SMS 201-995) administered by subcutaneous route 165 micrograms every eight hours in a patient with a external biliary fistula is reported. There was a significant reduction of the daily fistula output during treatment when compared with the basal periods (p = 0.04), with an average decrease of 270 ml/day during the first period of treatment and 357 ml/day when the drug was administered the second time (p = 0.04). There where not changes in the chemical composition of the bile neither adverse side effects were observed during treatment. These results suggest that SMS 201-995 might be useful in the treatment of external biliary fistulas.

Changes in catalase, glutathione peroxidase and glutathione-S-transferase activities in the liver of newts exposed to 2-methyl-4-chlorophenoxyacetic acid (MCPA)

Activities of catalase, glutathione peroxidase (GSH-Px) and glutathione-S-transferase (GST) were measured in livers of the crested newt (Urodele Amphibian) after 16 days of percutaneous exposure to the herbicide Agroxone 3, a commercial formulation of 2-methyl-4-chlorophenoxyacetic acid (MCPA) containing 25% MCPA as sodium salt and 75% wetting and dispersing ingredients. Animals of both sexes were exposed to 800 p.p.m. of the active ingredient. There was a three-fold increase in catalase and a clear enhancement of GSH-Px in the MCPA-exposed animals of both sexes. A sex-dependent effect of MCPA was observed on GST activity, which increased significantly in female newts only. Similar liver enzyme changes were observed in female newts, and not in males, given the hypolipidaemic drug clofibrate (13 mg/animal/day, by gavage, for 8 days), which is structurally related to phenoxyherbicides. These findings indicate that the crested newt is sensitive to the hepatic effects of the peroxisome proliferators.

Sister-chromatid exchanges and chromosomal aberrations in chick embryos after treatment with the fungicide maneb

The genotoxic potential of a commercial formulation of the fungicide maneb (Maneb 80, containing 80% manganese ethylenebisdithiocarbamate as active ingredient) in chick embryos was evaluated, using as genetic end-points the frequency of sister-chromatid exchanges (SCE) and of chromosomal aberrations. Unincubated eggs were dipped in 0, 0.5, 1.5, 4.5, 13.5 or 27 g/l maneb aqueous solutions for 30 sec. Eggs were then incubated for 4 days. Maneb significantly increased SCE values at 13.5 g/l and at 27 g/l (means 1.33 and 1.74) over the control value (mean 0.87). The concentration of 27 g/l, which corresponds to 10.8 times the recommended maximum application level for use in the field, also resulted in a high mortality rate. No clastogenic effects following exposure to maneb were observed.

Toxicity and distribution of 2-methyl-4-chlorophenoxyacetic acid (MCPA) in developing chick embryos

The toxicity of the herbicide Erbitox E30, a commercial formulation of 2-methyl-4-chlorophenoxyacetic acid (MCPA) containing 28% MCPA as sodium-potassium salt and 72% of unknown ingredients, was tested on chick embryos. Sterile aqueous solutions of MCPA were injected into the air chamber at doses of 0, 1.5, 3.0, 6.0, 9.0, or 10.5 mg/egg on day 0 or on day 4 of incubation. The mortality rate for the embryos treated on day 0 of incubation was high in the first 5 days, low from 5-12 days and again increased by 15 days. The 15-day LD50 was 4.4 mg/egg (95% C.I. 3.7-5.3 mg/egg). HPLC analysis of albumen and yolk showed that concentrations of MCPA in the albumen were detectable at 5 min, highest at 7 days and markedly diminished by 14 days of incubation; a significantly lower concentration of MCPA was found in the yolk throughout the incubation period, except at 14 days when the yolk concentration was 4 times higher than the albumen concentration. At 15 days of incubation, MCPA was evenly distributed in the tissues of the embryo. MCPA was more toxic to 4-day embryos; concentrations above 6.0 mg/egg were lethal to all embryos within the first week of incubation. The 15-day LD50 for treatment on day 4 of incubation was 2.8 mg/egg (95% C.I. 2.5-3.2 mg/egg). The liver was affected by treatment with MCPA, being green in treated embryos. However, histological examination revealed few changes in the liver parenchyma.