Eligibility of persons who inject drugs for treatment of hepatitis C virus infection

In this decade, an increase is expected in end-stageliver disease and hepatocellular carcinoma, most commonly caused by hepatitis C virus(HCV) infection.Although people who inject drugs(PWID) are the ma-jor source for HCV infection, they were excluded fromantiviral treatments until recently. Nowadays there isincontrovertible evidence in favor of treating these patients, and substitution therapy and active substanceuse are no longer contraindications for antiviral treatment. The viral clearance in PWID after HCV antiviraltreatment with interferon or pegylated interferon combined with ribavirin is comparable to the viral clearancein non-substance users. Furthermore, multidisciplinary approaches to delivering treatment to PWID are advised, and their treatment should be considered on anindividualized basis. To prevent the spread of HCV inthe PWID community, recent active PWID are eligiblefor treatment in combination with needle exchange programs and substitution therapy. As the rate of HCV reinfection is low after HCV antiviral treatment, there is no need to withhold HCV treatment due to concerns about reinfection alone. Despite the advances in treatment efficacies and data supporting their success, HCV assessment of PWID and initiation of antiviral treatment remains low. However, the proportion of PWID assessed and treated for HCV is increasing, which can be further enhanced by understanding the barriers to and facilitators of HCV care. Removing stigmatization and implementing peer support and group treatment strategies, in conjunction with greater involvement by nurse educators/practitioners, will promote greater treatment seeking and adherence by PWID. Moreover, screening can be facilitated by noninvasive methods for detecting HCV antibodies and assessing liver fibrosis stages. Recently, HCV clearance has become a major endpoint in the war against drugs for the Global Commission on Drug Policy. This review highlights the most recent evidence concerning HCV infection and treatment strategies in PWID.

80例复杂性单绒毛膜多胎妊娠患者采取脐带凝固其妊娠结局及新生儿预后

Objective: This study was undertaken to document pregnancy and infant outcome after cord coagulation with laser and/or bipolar as a technique for selective feticide in complicated monochorionic multiple pregnancies. Study design: Prospective follow-up study in 2 tertiary fetal medicine centers. Results: Eighty cases were included in the study (73 twins, 7 triplets). The survival rate was 83% (72/87). There were 9 intrauterine fetal deaths (10% ), 5 within 24 hours and 4 between 4 and 10 weeks after the procedure. There was 1 termination of pregnancy because of chorioamnionitis. Median gestational age at delivery was 35.4 weeks, with 79% of patients delivering after 32 weeks. Preterm prelabor rupture of the membranes before 25 weeks accounted for all perinatal deaths (n = 5). Of the children older than 1 year of age (n = 67), 62 (92% ) have a normal development. Conclusion: Cord coagulation is an effective method for selective feticide in monochorionic multiple pregnancies.

A Cross-Sectional Study According to Risk Factors Associated with Erectile Dysfunction in Men

Background: Erectile dysfunction (ED) is a common condition in general population. It has a negative impact on the couple’s quality of life. In 1995, it was estimated that it affected 152 million people worldwide, and that it would affect more than 322 million people in 2025 with a large increase in developing countries. Several studies have suggested a causal link between ED and cardiovascular disease. In the Democratic Republic of Congo, no studies exist on this subject. Nonetheless, we are seeing increased promotion on the management of sexual disorders in our media, which could testify to the extent of this problem. Objective: To assess the extent of cardiovascular risk factors for ED in Kinshasa. Material and Methods: This is a cross-sectional study for analytical purposes. It collected several categories of individuals from May 1 to October 31, 2018. The severity of ED was assessed by the IIEF-5 score and the associated risk factors sought via logistic regression. Results: The mean age of the respondents was 59.9 ± 19.2 years, more than half of the respondents were over the age of 60 years old (60%). The ED proportion was 78.8%, and 75% of respondents had at least moderate ED. This anomaly was significantly elevated among respondents aged over 60 years (94.8%), diabetics (87.5%), hypertensive patients (92.3%) and stroke victims (86%). The independently associated risk factors were: age > 60 years [ORa: 9.87;95% CI: 6.42 - 10.48, p < 0.001], diabetes mellitus [ORa: 2.99;95% CI: 1.80 - 4.95, p = 0.013] and the stroke [ORa: 2.1;95% CI: 1.36 - 3.39;p = 0.012%]. The age threshold predicting ED was 67 years. Conclusion: ED is a frequent disorder in our environment and likely to affect the quality of life of men who suffer from it. There is an ED and cardiovascular risk factors correlation. A proactive attitude of the caregiver in current practice would allow early detection of ED with a view to early and optimal management.

Management of a Compressive Goiter at Term

Pregnant women sometimes have thyroid disease, and thus goiter;however, it does not become so large to the extent that the goiter obstructs the air way, causing respiratory symptoms. Here, we report such a case. A 27-year-old woman with large goiter presented with life threatening stridor at 37 weeks. After a multidisciplinary-team discussion, we performed caesarean section plus thyroidectomy, which resulted in good outcomes. Histological examination revealed hyperplasia and not malignancy. The postoperative course was uneventful. The mother and infant were healthy.

Proteomic Differences between Azole-Susceptible and -Resistant <i>Aspergillus fumigatus</i>Strains

Background: Azole-resistance is increasingly reported in Aspergillus fumigatus infections. It remains challenging to rapidly assess antifungal susceptibility to initiate the appropriate therapy. The aim of this study was to map the proteomic differences of azole-susceptible and -resistant strains. Methods: Proteomic studies were performed with ultra-performance liquid chromatography tandem mass-spectrometry (UPLC-MS/MS). Results: UPLC-MS/MS detected 7899 peptides, of which 1792 peptides had a significantly different abundance (p A. fumigatus resistance. Conclusions: UPLC-MS/MS provided proof-of-concept that the proteome of azole-resistant A. fumigatus is diverse enough to serve as a diagnostic tool.

一例左房内血栓仅未累及肺静脉口病例的三维CT成像

1例58岁女性患者因近三周来心力衰竭进行性加重就诊。因患者有外周水肿及舒张期杂音,行超声心动图检查,结果显示二尖瓣狭窄和左房内血栓。三维CT显示左房内大范围血栓仅未累及肺静脉口。

Disrupted Ca^(2+) h homeostasis and immunodeficiency in patients with functional IP_(3) receptor subtype 3 defects

Calcium signaling is essential for lymphocyte activation, with genetic disruptions of store-operated calcium (Ca^(2+)) entry resulting in severe immunodeficiency. The inositol 1,4,5-trisphosphate receptor (IP_(3)R), a homo- or heterotetramer of the IP_(3)R1-3 isoforms, amplifies lymphocyte signaling by releasing Ca^(2+) from endoplasmic reticulum stores following antigen stimulation. Although knockout of all IP_(3)R isoforms in mice causes immunodeficiency, the seeming redundancy of the isoforms is thought to explain the absence of variants in human immunodeficiency. In this study, we identified compound heterozygous variants of ITPR3 (a gene encoding IP_(3)R subtype 3) in two unrelated Caucasian patients presenting with immunodeficiency. To determine whether ITPR3 variants act in a nonredundant manner and disrupt human immune responses, we characterized the Ca^(2+) signaling capacity, the lymphocyte response, and the clinical phenotype of these patients. We observed disrupted Ca^(2+) signaling in patient-derived fibroblasts and immune cells, with abnormal proliferation and activation responses following T-cell receptor stimulation. Reconstitution of IP_(3)R3 in IP_(3)R knockout cell lines led to the identification of variants as functional hypomorphs that showed reduced ability to discriminate between homeostatic and induced states, validating a genotype–phenotype link. These results demonstrate a functional link between defective endoplasmic reticulum Ca^(2+) channels and immunodeficiency and identify IP_(3)Rs as diagnostic targets for patients with specific inborn errors of immunity. These results also extend the known cause of Ca^(2+)-associated immunodeficiency from store-operated entry to impaired Ca^(2+) mobilization from the endoplasmic reticulum, revealing a broad sensitivity of lymphocytes to genetic defects in Ca^(2+) signaling.