Chronic hepatitis C virus infections in Switzerland in 2020: Lower than expected and suggesting achievement of WHO elimination targets

In this multi-method study, we investigated the prevalence of chronic infections with the hepatitis C virus (HCV) in Switzerland in 2020, and assessed Switzerland's progress in eliminating HCV as a public health problem by 2030 with regard to the World Health Organization (WHO) criteria targeting infections acquired during the preceding year ('new transmissions') and HCV-associated mortality. Based on a systematic literature review, the reappraisal of a 2015 prevalence analysis assuming 0.5% prevalence among the Swiss population and data from many additional sources, we estimated the prevalence among subpopulations at increased risk and the general population. For new transmissions, we evaluated mandatory HCV notification data and estimated unreported new transmissions based on subpopulation characteristics. For the mortality estimate, we re-evaluated a previous mortality estimate 1995-2014 based on new data on comorbidities and age. We found a prevalence of ≤0.1% among the Swiss population. Discrepancies to the 2015 estimate were explained by previous (i) underestimation of sustained virologic response numbers, (ii) overestimation of HCV prevalence among PWID following bias towards subgroups at highest risk, (iii) overestimation of HCV prevalence among the general population from inclusion of high-risk persons and (iv) underestimation of spontaneous clearance and mortality. Our results suggest that the WHO elimination targets have been met 10 years earlier than previously foreseen. These advancements were made possible by Switzerland's outstanding role in harm-reduction programmes, the longstanding micro-elimination efforts concerning HIV-infected MSM and nosocomial transmissions, little immigration from high-prevalence countries except Italian-born persons born before 1953, and wealth of data and funding.

[Treating cocaine addiction]

Estimates assume approximately 100'000 occasional and 11'000 addicted cocaine consumers in Switzerland. Although there is no established «standard treatment», helpful pharmacological and psychotherapeutic treatment strategies for cocaine addiction and its consequences exist. A selection of the most relevant treatment options is presented in this review. Their application should be embedded within an individualized treatment plan, which usually includes several of the therapeutic elements presented hereafter, depending on the patient's current situation. The treatment of patients with cocaine dependence might encompass longer periods and multiple sequences of treatment in out- or inpatient setting, yet it is promising.

Swiss multicenter study evaluating the efficacy, feasibility and safety of peginterferon-alfa-2a and ribavirin in patients with chronic hepatitis C in official opiate substitution programs

BACKGROUND

Though patients in opiate substitution programs are commonly infected with HCV, due to safety and efficacy concerns, they are rarely treated with interferon and ribavirin.

METHODS

In a multicenter study, HCV-infected patients in opiate maintenance treatment programs received 180 microg pegylated interferon-alfa-2a once weekly, plus daily ribavirin for 24 weeks (genotypes 2, 3), or 48 weeks (genotypes 1, 4).

RESULTS

Of the 67 patients enrolled, 31 (46%) had HCV genotypes 1 or 4, and 36 (54%) had genotypes 2 or 3. Intent-to-treat analysis showed end-of-treatment virologic response in 75% of patients (81% of genotypes 2 or 3; 65% of genotypes 1 or 4), and a sustained virologic response in 61% of patients (72% of genotypes 2 or 3; 48% of genotypes 1 or 4). Fifteen patients (22%) did not complete the study, in 5 (8%) cases because of severe adverse events.

CONCLUSIONS

Drug users with chronic HCV infection, regularly attending an opiate maintenance program in which close collaboration between hepatologists/internists and addiction specialists is assured, can be treated effectively and safely with pegylated interferon-alfa-2a and ribavirin. Treatment results are very similar to those in other patient groups, and thus therapy should also be considered for this population.

Descriptive epidemiology of collegiate men's wrestling injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE

To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's wrestling and identify potential areas for injury prevention initiatives.

BACKGROUND

From 1988-1989 through 2003-2004, 17% of NCAA schools sponsoring varsity men's wrestling programs participated in annual Injury Surveillance System (ISS) data collection.

MAIN RESULTS

Patterns of injury were consistent with the person-to-person, combative contact between wrestlers. The musculoskeletal system and head were the most vulnerable areas during competitions; skin infections are a continuing concern in the practice environment. The incidence of injuries in practices exhibited no significant increase over time, a positive trend that may be consistent with the influence of the recent NCAA weight management rules.

RECOMMENDATIONS

Expansion of the present ISS to include indirect causes of injury, such as weight loss practices, would strengthen the analysis of data. Efforts by referees to be vigilant for potentially dangerous holds and by athletic trainers to improve wrestler and mat hygiene should be continued.

Interferon alpha-2a plus ribavirin 1,000/1,200 mg versus interferon alpha-2a plus ribavirin 600 mg for chronic hepatitis C infection in patients on opiate maintenance treatment: an open-label randomized multicenter trial

BACKGROUND

Many intravenous opiate users are infected with hepatitis C virus (HCV) but few are treated. Although this complies with various guidelines, virtually no published evidence supports such a recommendation.

PATIENTS AND METHODS

In a multicenter study, HCV-infected patients in opiate maintenance treatment programs received interferon plus high- or low-dose ribavirin (1,000/1,200 mg or 600 mg). HIV-coinfected patients were not included. Endpoints were feasibility, efficacy, side effects, and reasons for dropout.

RESULTS

Of the 420 patients who tested positive for HCV, 27 (6%) were enrolled; 393 (94%) either failed to meet the inclusion criteria or refused treatment. Virologic end-of-treatment response was achieved in 12/27 patients, and sustained response in 13/27 (48%). Response depended on viral genotype, not ribavirin dose. The two doses of ribavirin did not differ in their side effects.

CONCLUSION

In a small fraction of HCV-infected intravenous drug users in an opiate maintenance treatment program, antiviral therapy was feasible, safe, and effective. The success rate was comparable to that achieved in controlled studies that excluded drug users.

Methadone maintenance treatment and St. John's Wort - a case report

St. John's wort, a popular over-the-counter drug for treatment of depression, might reduce concentrations of drugs such as cyclosporin and indinavir and lead to drug resistance and treatment failure. No studies as yet have examined its influence on methadone plasma levels. The trough methadone plasma levels were measured in four patients (2 males, median age: 31 years; range 19 - 40 years) in methadone maintenance treatment just before the introduction of St. John's wort (900 mg/d) and after a median period of 31-day treatment (range 14 - 47). The study was proposed to addict patients about to start an antidepressant therapy. Introduction of St. John's wort resulted in a strong reduction of (R,S)-methadone concentration-to-dose ratios in the four median patients included, with a median decrease to 47 % of the original concentration (range: 19 % - 60 % of the original concentration). Two patients reported symptoms that suggested a withdrawal syndrome. Thus, prescription of St. John's wort might decrease methadone blood levels and induce withdrawal symptoms which, if not correctly identified and handled (by changing the antidepressant or by increasing the methadone dose), might cause unnecessary discomfort to the patient, lead to resumption of illicit drug uses, or be a risk factor for discontinuation of the methadone or antidepressant treatment.

The Heterogeneous Kinetics of the Reactions ClONO2 + HX/ice (X = Br, I), BrONO2 + HI/ice and the Reactivity of the Interhalogens BrCl, ICl and IBr with HX/ice (X = Cl, Br, I) in the Temperature Range 180 to 205 K

The kinetics and mechanism of the title heterogeneous halogen exchange reactions of potential atmospheric importance have been studied under molecular flow conditions in a FEP Teflon-coated Knudsen flow reactor on HX (X = Cl, Br, I) - doped ice condensed from the vapor phase under conditions of several formal monolayers of HX coverage at approximately 200 K. In addition, the halogen exchange reactions involving the expected primary reaction products BrCl, ICl and IBr of the above mixed anhydrides with HX-doped ice have been studied at 200 K as well. The uptake coefficient γ for the heterogeneous reaction ClONO

Running and its effect on family life

OBJECTIVES

To determine the frequency with which commitment to running conflicts with family life, to distinguish between runners who experience conflict and those who do not based on their levels of commitment to the roles of runner and family member, and to determine whether runners who reported conflict receive less support for running from their significant other.

DESIGN

A questionnaire was mailed to 1426 members of a running club. Personal demographics, running quantity, conflict, commitment to running, family commitment, and spouse support were measured. The Family APGAR scale was used to measure global family functioning, assessing adaptation, partnership, growth, affection, and resolve.

RESULTS

There were 724 respondents for a response rate of 50.8%. Five hundred fifty-eight runners (356 men, and 202 women) lived with a partner. The mean score for conflict was 1.9. Only 32 (5.5%) had a score above 3 (high conflict). When evaluated together and separately, the women and men in the high-conflict groups had equal commitment to running, lower family commitment, lower spouse support, and a lower Family APGAR score compared with the low-conflict group.

CONCLUSIONS

In this study running is not a major contributor to family conflict. Those runners who are experiencing conflict seem to have a more global conflict with their families that is independent of running, manifested by decreasing spouse support for the runner's activities. If a runner is an active, committed member of his or her own family and sets this commitment as a priority, it does not appear that the time and energy of running is by itself a source of conflict.

[Efficacy of 2 different leukocyte filters for erythrocyte concentrates]

By leukocyte reduction in red blood cell concentrates to < 5 x 10(6) leukocytes per transfused unit, febrile non-hemolytic transfusion reaction as well as alloimmunization and transmission of certain viral diseases (CMV, HTLV-1) can be prevented. Using a Nageotte hemocytometer with a large-volume chamber, the residual leukocyte number after filtration of 40 buffy-coat free red blood cell units with the filters Pall RC100 and Sepacell R500 B1 was determined in a clinical routine setting. Both tested filters underscored the limit (< 5 x 10(6) leukocytes per unit) set by the American Association of Blood Banks. Hemoglobin loss accounted for 8.9 g (Pall RC100) versus 7.7 g (Sepacell R500 B1), which is about 15-18% of the hemoglobin content of a red blood cell concentrate.

Reduction of plasma cold agglutinin titers by means of plasmapheresis to prepare a patient for coronary bypass surgery

A 53-year-old man with abnormally elevated cold agglutinins was treated successfully by plasma exchange so that he was able to sustain coronary artery surgery and extracorporeal circulation. Two plasma exchanges, consisting in the exchange of one plasma volume with a 5% albumin solution each, were performed in our intensive care unit with careful monitoring of vital parameters. The plasma exchanges resulted in a reduction of the titer of the cold agglutinins and of the thermal amplitude as well. With the exception of postoperative bleeding requiring re-intervention, the patient was successfully operated and could be dismissed on the 16th postoperative day in good condition.

Prevalence of the Rhesus-negative phenotype in Caucasian patients with small-cell lung cancer (SCLC)

We report that the Rhesus (Rh)-negative phenotype is more prevalent in patients with small-cell lung cancer (SCLC) than in the normal Caucasian population (SCLC: 25% Rh-negative vs. 15% expected, p less than 0.0001). This finding has been validated for a Central and a Northern European population (Switzerland and UK). In contrast, the Rh-negative phenotype is no more frequent in non-small-cell lung cancer patients or in heavy smokers with coronary heart disease than in the general population. There was a normal distribution of the ABO blood group phenotype in all patients studied. Whilst the significance of this observation is unclear, we hypothesize that a genetic predisposition to the development of SCLC may be linked to a hitherto unidentified gene on chromosome 1p near the Rh locus. Our observation may perhaps allow further progress to be made in understanding genetic mechanisms of SCLC carcinogenesis.

Splanchnic sympathetic nerve activity and circulating catecholamines in the hyperthermic rat

The mechanisms responsible for the initial rise in splanchnic vascular resistance with environmental heating are controversial, and those responsible for the subsequent fall in splanchnic resistance in the severely hyperthermic animal are unknown. Thus we examined the effect of environmental heating on plasma catecholamine concentration, splanchnic sympathetic nerve activity (SNA), and select blood chemistries. In one study, 25 male Sprague-Dawley rats (270-300 g) were assigned to one of five groups on the basis of their core temperature (Tc, 37, 39, 41, 43, or 44 degrees C) at death. Heart rate (HR), mean arterial pressure (MAP), and Tc were monitored during heat stress under alpha-chloralose anesthesia (12.5 mg.ml-1.h-1). At each predetermined Tc, an aortic blood sample was drawn and analyzed for mean plasma concentration of norepinephrine (NE), epinephrine (E), Na+, K+, and lactate. From 41 to 43 degrees C, NE and E rose significantly, and the animals became hyperkalemic and lactacidemic. In a separate study, we quantitated SNA from the greater splanchnic nerve during heat exposure of artificially respired animals anesthetized with pentobarbital sodium (50 mg/kg). MAP, splanchnic SNA, and Tc were recorded. Tc was elevated from 37.0 +/- 0.12 to 41.3 +/- 0.18 degrees C in 70 min by increase of ambient temperature to 38 degrees C in an environmental chamber. Splanchnic SNA was 54 +/- 8 spikes/s at a Tc of 37 degrees C and increased significantly as Tc exceeded 39 degrees C (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

The Effects of Overhead Transparency Design on Retention, Recall, and Application of Data Analysis Content

This experimental study tested the effects of overhead transparency design in conjunction with live lecture on retention, recall, and application of data analysis content over three occasions using a Solomon Four-Group, pretest-posttest design. Pretested subjects showed significant (p less than .001) gains in test scores from pre to posttest. No significant differences were found in pretest scores between control and experimental treatment groups or among the posttest scores of either the experimental or control groups.

[Positive direct Coombs' test in acute leukemias and other hemoblastoses: relation to clavulanic acid-containing antibiotics?]

Alerted by a high incidence of positive autologous controls in pretransfusion compatibility testing for patients with acute leukemia, we retrospectively analysed 59 cases of severe hemoblastoses undergoing myelosuppressive treatment. Seventeen (29%) of these patients had a positive direct antiglobulin test (DAT) with the following characteristics: the test was of the IgG and/or C3d type in all but two cases, which reacted with polyvalent antiglobulin sera only; the reaction was very weak throughout; very high concentrations of monospecific sera were needed to elicit positive reactions; free antibodies were never detected in the patients' serum; the eluates of the patients' red cells were non-reactive against a very large panel of test erythrocytes. All these criteria suggested a non-immunologic absorption of proteins under the influence of drugs such as cephalosporins and clavulanic acid. Timenten (ticarcillin and clavulanic acid) was found to be the only common drug which had been administered to the majority of the patients with a positive DAT: 15 of the 17 patients with a positive DAT (88%) had received Timenten against 19 of 42 patients (45%) with negative DAT. 44% of all the patients receiving Timenten thus had a positive DAT, whereas only 8% of the patients without this drug reacted in this way. These data document the role of clavulanic acid in the development of a positive DAT. The literature and our experience show that this kind of unspecific binding of proteins to the red cell membrane is not associated with increased hemolysis. Knowledge of the phenomenon, however, is important for differential diagnosis of anemias and interpretation of difficulties arising during pretransfusional compatibility testing.