Health Hot Spots: Mapping Hospital Costs and Social Determinants of Health

Accountable care organizations (ACOs) and hospitals are facing additional requirements and financial rewards for improving population health. Therefore, ACOs and hospitals will need tools to understand the relationship between their patients and social determinants and health. We demonstrate the use of hot spotting for identifying geographical sources of high hospital costs and examining links between social determinants of health and these high-cost areas, known as hot spots. In 2012, using hospital data, we generated maps of inpatient costs from 2011 throughout New Haven and within an example neighborhood, Dixwell. We defined hot spots as addresses where costs were in the top 25%. We also overlaid data on concerns and assets in the community. Finally, we calculated the number of concerns and assets that fall within the 250 and 500 ft radii of the defined hot spots. We found that 34 addresses in Dixwell accounted for 70% of total costs for Dixwell. Hot spotting is a straightforward, approachable, and easily understood method for ACOs and hospitals to begin to address population health.

Mental Health Issues of the Medical Workforce during COVID-19:A Review

The COVID-19 pandemic is a public health emergency.As we write,the world counts more than 10 million positive cases and more than 500 thousand deaths.The difficult conditions faced by healthcare workers helping with the COVID-19 pandemic are leading to severe adverse mental health consequences.The aim of this review is to summarize and analyze the mental health issues that healthcare workers are experiencing during the COVID-19 outbreak.We conduct a systematic literature review to investigate the healthcare workforce’s mental health disorders.About 145 articles were retrieved for the period between January 1,2020 and April 30,2020.After screening,27 articles were selected for full-text examination,13 were included in the review.Of the studies included,69%(9/13)and 61%(8/13)investigated depression and anxiety,respectively,although other mental health disorders such as insomnia,distress,stress,and fear were also assessed.Most of the healthcare workers in the studies reported high levels of stress,anxiety,and severe symptoms of depressions.Caregivers are working under high levels of pressure,in a high-risk environment,and are dealing with many physical and psychological challenges.Appropriate actions and well-timed psychological support to protect medical workers’mental health should be considered.

Effectiveness of an Indoor Air Pollution (IAP) Intervention on Reducing IAP and Improving Women’s Health Status in Rural Areas of Gansu Province, China

Given the deleterious health effects associated with indoor air pollution (IAP), this study was conducted to evaluate an IAP intervention in rural areas in Gansu, one of the poorest provinces of China. We selected 371 rural households to take part in intervention measures including stove improvement and health education. Eight of 371 households were selected to conduct IAP sampling. Four hundred and thirteen women in these households completed a questionnaire and 49 women took part in lung function tests. After the intervention, PM4 levels reduced from 455 μg/m3 to 200 μg/m3 and CO reduced from 3.40 ppm to 2.90 ppm in indoor air. The percentage of predicted value of FEV1 and FVC improved to some degree after the intervention, but all the parameters of lung function assessment did not show a significant change. Prevalence rates of several symptoms associated with IAP significantly declined in the study population, compared with baseline levels. Intervention measures combining stove improvement with health education were effective in reducing IAP levels. Women’s health status, including eye and respiratory symptoms, also showed improvement. However, the effect on lung function was not apparent and warranted additional follow-up. Similarly, evaluation of the long term effects of the IAP intervention will require future studies.

A Systematic Analysis of Early Life Exposure to the Chinese Famine(1959-1961)and the Health of Older Adults-China,2008-2023

What is already known about this topic?There is mounting evidence indicating that the aging process initiates during early life stages,with in utero the individual’s environment playing a significant role.Consequently,it is crucial to comprehend the enduring effects of early life circumstances on health in old age.What is added by this report?In this study,we conducted a meta-analysis to examine the effects of the Chinese Famine(1959–1961)on the health of older adults.We also explored potential mechanisms underlying these effects.What are the implications for public health practice?The complex interplay between early life circumstances,multiple health-related sectors,and healthy aging necessitates a comprehensive life-course approach and strategic interventions to enhance public health in an aging society.

Human Immunodeficiency Virus Infection-Associated Mortality during Pulmonary Tuberculosis Treatment in Six Provinces of China

Objective To investigate the risk factors attributable to tuberculosis-related deaths in areas with human immunodeficiency virus(HIV) infection epidemics. Methods A prospective cohort study of newly registered patients in tuberculosis(TB) dispensaries in six representative Chinese provinces was conducted from September 1, 2009 to August 31, 2011. Risk factors for TB-associated death were identified through logistic regression analysis. Results Of 19,103 newly registered pulmonary TB patients, 925(4.8%) were found to be HIV-positive. Miliary TB and acid-fast bacillus smear-negative TB were more common among these patients. Out of a total of 322(1.7%) deaths that occurred during TB treatment, 85(26%) of the patients were co-infected with HIV. Multivariate analysis revealed that HIV infection was the strongest predictor of death [adjusted odds ratio(aO R) 7.86]. Other significant mortality risk factors included presentation with miliary TB(aO R 4.10; 95% confidence interval: 2.14-7.88), ≥35 years of age(aO R 3.04), non-Han ethnicity(aO R 1.67), and farming as an occupation(aO R 1.59). For patients with TB/HIV co-infection, miliary TB was the strongest risk factor for death(aO R 5.48). A low CD4 count(≤ 200 cells/μL)(aO R 3.27) at the time of TB treatment initiation and a lack of antiretroviral therapy(ART) administration(aO R 3.78) were also correlated with an increased risk of death. Conclusion Infection with HIV was independently associated with increased mortality during TB treatment. Offering HIV testing at the time of diagnosis with TB, early TB diagnosis among HIV/acquired immunodeficiency syndrome patients, and the timely provision of ART were identified as the key approaches that could reduce the number of HIV-associated TB deaths.

Effects of Outdoor Temperature on Blood Pressure in a Prospective Cohort of Northwest China

Objective The relationship between outdoor temperature and blood pressure(BP) has been inconclusive. We analyzed data from a prospective cohort study in northwestern China to investigate the effect of outdoor temperature on BP and effect modification by season.Methods A total of 32,710 individuals who participated in both the baseline survey and the first follow-up in 2011–2015 were included in the study. A linear mixed-effect model and generalized additive mixed model(GAMM) were applied to estimate the association between outdoor temperature and BP after adjusting for confounding variables.Results The mean differences in systolic blood pressure(SBP) and diastolic blood pressure(DBP)between summer and winter were 3.5 mm Hg and 2.75 mm Hg, respectively. After adjusting for individual characteristics, meteorological factors and air pollutants, a significant increase in SBP and DBP was observed for lag 06 day and lag 04 day, a 0.28 mm Hg(95% CI: 0.27–0.30) per 1 °C decrease in average temperature for SBP and a 0.16 mm Hg(95% CI: 0.15–0.17) per 1 °C decrease in average temperature for DBP, respectively. The effects of the average temperature on both SBP and DBP were stronger in summer than in other seasons. The effects of the average temperature on BP were also greater if individuals were older, male, overweight or obese, a smoker or drinker, or had cardiovascular diseases(CVDs), hypertension, and diabetes.Conclusions This study demonstrated a significant negative association between outdoor temperature and BP in a high-altitude environment of northwest China. Moreover, BP showed a significant seasonal variation. The association between BP and temperature differed by season and individuals' demographic characteristics(age, gender, BMI), unhealthy behaviors(smoking and alcohol consumption), and chronic disease status(CVDs, hypertension, and diabetes).

Lifestyle factors and long-term survival of gastric cancer patients:A large bidirectional cohort study from China

BACKGROUND Lifestyle factors such as body mass index(BMI),alcohol drinking,and cigarette smoking,are likely to impact the prognosis of gastric cancer,but the evidence has been inconsistent.AIM To investigate the association of lifestyle factors and long-term prognosis of gastric cancer patients in the China National Cancer Center.METHODS Patients with gastric cancer were identified from the China National Cancer Center Gastric Cancer Database 1998-2018.Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models.RESULTS In this study,we reviewed 18441 cases of gastric cancer.Individuals who were overweight or obese were associated with a positive smoking and drinking history(P=0.002 and P<0.001,respectively).Current smokers were more likely to be current alcohol drinkers(61.3%vs 10.1%vs 43.2%for current,never,and former smokers,respectively,P<0.001).Multivariable results indicated that BMI at diagnosis had no significant effect on prognosis.In gastrectomy patients,factors independently associated with poor survival included older age(HR=1.20,95%CI:1.05-1.38,P=0.001),any weight loss(P<0.001),smoking history of more than 30 years(HR=1.14,95%CI:1.04-1.24,P=0.004),and increasing pTNM stage(P<0.001).CONCLUSION In conclusion,our results contribute to a better understanding of lifestyle factors on the overall burden of gastric cancer and long-term prognosis.In these patients,weight loss(both in the 0 to 10%and>10%groups)but not BMI at diagnosis was related to survival outcomes.With regard to other factors,smoking history of more than 30 years conferred a worse prognosis only in patients who underwent gastrectomy.Extensive efforts are needed to elucidate mechanisms targeting the complex effects of lifestyle factors.

Impact of body mass index on complications following pancreatectomy:Ten-year experience at National Cancer Center in China

AIM: To examine the impact of body mass index(BMI)on outcomes following pancreatic resection in the Chinese population.METHODS: A retrospective cohort study using prospectively collected data was conducted at the Cancer Hospital of the Chinese Academy of Medical Sciences, China National Cancer Center. Individuals who underwent pancreatic resection between January2004 and December 2013 were identified and included in the study. Persons were classified as having a normal weight if their BMI was < 24 kg/m2 and overweight/obese if their BMI was ≥ 24 kg/m2 as defined by the International Life Sciences Institute Focal Point in China. A χ 2 test(for categorical variables) or a t test(for continuous variables) was used to examine the differences in patients' characteristics between normal weight and overweight/obese groups. Multiple logistic regression models were used to assess the associationsof postoperative complications, operative difficulty,length of hospital stay, and cost with BMI, adjusting for age, sex, and type of surgery procedures.RESULTS: A total of 362 consecutive patients with data available for BMI calculation underwent pancreatic resection for benign or malignant disease from January1, 2004 to December 31, 2013. Of the 362 patients,156 were overweight or obese and 206 were of normal weight. One or more postoperative complications occurred in 35.4% of the patients following pancreatic resection. Among patients who were overweight or obese, 42.9% experienced one or more complications,significantly higher than normal weight(29.6%)individuals(P = 0.0086). Compared with individuals who had normal weight, those with a BMI ≥ 24.0kg/m2 had higher delayed gastric emptying(19.9% vs5.8%, P < 0.0001) and bile leak(7.7% vs 1.9%, P =0.0068). There were no significant differences seen in pancreatic fistula, gastrointestinal hemorrhage, reoperation,readmission, or other complications. BMI did not show a significant association with intraoperative blood loss, operative time, length of hospital stay, or cost.CONCLUSION: Higher BMI increases the risk for postoperative complications after pancreatectomy in the Chinese population. The findings require replication in future studies with larger sample sizes.

Epidemiology of HIV/AIDS in China: recent trends

We used nationally reported cases (NCAIDS/China CDC,2016) and published literature to summarize up-to the end of 2015 epidemiologic trends in the HIV/AIDS epidemic in China.HIV-positive cases are distributed unevenly with most infections found in southwest China and the most affected population being men who have sex with men.Transmission mode of HIV infection has shifted from drug injection to sexual contact,which accounts for 95% of total reported cases.Two thirds of cases are from heterosexual transmission.Transmission pattern varies greatly throughout China.Some provinces in China reported heterosexual transmission accounted for over 90% of cases while other provinces reported homosexual transmission accounted for over 80% of cases.Patterns of heterosexually acquired HIV also vary widely,with 80% of cases attributed to commercial sex in some provinces,while in other provinces non-commercial extramarital sex accounted for over 70% of cases.Significant increase in HIV infection was observed among young students aged 15-24.China has successfully controlled blood transfusion-and injecting drug-related transmissions of HIV.Homosexual and non-commercial extramarital heterosexual transmissions have become new challenges for China's HIV/AIDS program.Urgent adoption of the UNAIDS/WHO 90-90-90 target will help overcome these new challenges.

Re-evaluation of ABO gene polymorphisms detected in a genomewide association study and risk of pancreatic ductal adenocarcinoma in a Chinese population

Pancreatic cancer is a fatal malignancy with an increasing incidence in Shanghai, China. A genomewide association study(GWAS) and other work have shown that ABO alleles are associated with pancreatic cancer risk. We conducted a population-based case-control study involving 256 patients with pathologically confirmed pancreatic ductal adenocarcinoma(PDAC) and 548 healthy controls in Shanghai, China, to assess the relationships between GWAS-identified ABO alleles and risk of PDAC. Carriers of the C allele of rs505922 had an increased cancer risk [adjusted odds ratio(OR) = 1.42, 95% confidence interval(CI): 1.02-1.98] compared to TT carriers. The T alleles of rs495828 and rs657152 were also significantly associated with an elevated cancer risk(adjusted OR = 1.58, 95% CI: 1.17-2.14; adjusted OR = 1.51, 95% CI: 1.09-2.10). The rs630014 variant was not associated with risk. We did not find any significant gene-environment interaction with cancer risk using a multifactor dimensionality reduction(MDR) method. Haplotype analysis also showed that the haplotype CTTC was associated with an increased risk of PDAC(adjusted OR = 1.46, 95% CI: 1.12-1.91) compared with haplotype TGGT. GWAS-identified ABO variants are thus also associated with risk of PDAC in the Chinese population.

Prevalence of Tuberculosis among Close Contacts of Index Cases in 27 Universities in Beijing,China,2017-2018

The World Health Organization(WHO)launched the‘End TB Strategy’,which aims to reduce the mortality and incidence rate of tuberculosis(TB)by 95% and 90% by 2035,respectively,compared with the levels in 2015.To achieve these targets and milestones,the strategy set three pillars and 10 indicators,one of which is systematic screening of contacts and high-risk groups[1].

Digital chromoendoscopy utilization in clinical practice: A survey of gastroenterologists in Connecticut

AIM:To use a survey to characterize and identify potential barriers to the use of digital chromoendoscopy(DC)by practicing gastroenterologists.METHODS:An anonymous,internet-based survey was sent to gastroenterologists in Connecticut who were members of one of three national gastrointestinal organizations.The survey collected demographic information,frequency of DC use,types of procedures that the respondent performs,setting of practice(academic vs community),years out of training,amount of training in DC,desire to have DC training and perceived barriers to DC use.Responses were collected anonymously.The primary endpoint was the proportion of endoscopists utilizing DC.Associations between the various data collected were analyzed usingχ2 test.RESULTS:One hundred and twenty-four gastroenterologists(48%)of 261 who received the online survey responded.Seventy-eight percent of surveyed gastroenterologists have used DC during the performance of upper endoscopy and 81%with lower endoscopy.DC was used in more than half of procedures by only 14%of gastroenterologists during upper endoscopy and 12%during lower endoscopy.Twenty-three percent(upper)and 21%(lower)used DC more than one quarter of the time.DC was used for 10%or less of endoscopies by 60%(upper)and53%(lower)of respondents.Endoscopists reported lack of training as the leading deterrent to DC use with36%reporting it as their primary deterrent.Eighty-nine percent of endoscopists never received formal training in DC.Lack of time(30%of respondents),lack of evidence(24%)and lack of reimbursement(10%)were additional deterrents.There were no differences in DC use relative to academic vs community practice setting or years out of training.CONCLUSION:DC is used infrequently by most endoscopists,primarily due to a lack of training.Training opportunities should be expanded to meet the interest expressed by the majority of endoscopists.

Preferences for pre-exposure prophylaxis among U.S. military men who have sex with men:results of an adaptive choice based conjoint analysis study

Background: Pre-exposure prophylaxis(PrEP) prevents human immunodeficiency virus(HIV) infection, but its use remains low among U.S. military men who have sex with men(MSM), likely due to mis-matching with personal preferences. We conducted a study to characterize preferences to PrEP measures within this population.Methods: HIV-negative military MSM were recruited through a closed, Lesbian, Gay, Bisexual, and Transgendered(LGBT) military social media group. The survey was anonymous, and consisted of five experimentally varied attributes in service delivery: dosing method, provider type, visit location, lab work evaluation location, and dispensing venue.Relative importance and part-worth utility scores were generated using hierarchical bayes(HB) estimation, and the randomized first choice model was used to examine participation interest across eight possible PrEP program scenarios.Results: A total of 429 participants completed the survey. Among the eight scenarios with varying attributes, the most preferred scenario featured a daily tablet, PrEP injection or implant, along with a military provider, smartphone/telehealth visit, and on-base locations for lab evaluation and medication pick-up. The results also emphasized the importance for providers to be familiar with PrEP prescription knowledge, and to provide interactions sensitive to sexual identity and mental health.Conclusions: A PrEP program consisting of daily tablet is preferred in military healthcare settings is preferred. Longacting implants and injections are also desired.

Weather and Birth Weight:Different Roles of Maternal and Neonatal GPR61 Promoter Methylation

Objectives It is unclear whether G protein-coupled receptor 61(GPR61)affecting body weight,plays a role in the association between birth weight and weather.This study aimed to assess the effects of prenatal weather and GPR61 on birth weight.Methods A total of 567 mother-newborn pairs were recruited in Houzhai Center Hospital during2011–2012.We detected the maternal and neonatal GPR61 promoter methylation levels,and obtained meteorological and air pollution data.Results A positive association was observed between maternal and neonatal GPR61 methylation levels,and both of them were affected by precipitation,relative humidity(RH)and daily temperature range(DTR).Birth weight was associated negatively with RH and positively with DTR(P<0.05).A significant association was observed between birth weight and neonatal GPR61 methylation.We observed that maternal GPR61 methylation seemed to modify associations between weather and birth weight(P_(interaction)<0.10),while neonatal GPR61 methylation mediated the effects of RH and DTR on birth weight(P<0.05).Conclusions Our findings revealed the significant associations among prenatal weather,GPR61 methylation and birth weight.Maternal GPR61 methylation may modify the susceptibility of birth weight to prenatal weather conditions,while neonatal GPR61 methylation may be a bridge of the effects of prenatal RH and DTR on birth weight.

多囊卵巢综合征无排卵的胰岛素信号和雄激素合成的新遗传风险和代谢特征

促排卵是多囊卵巢综合征(PCOS)不孕症的一线治疗方案。卵巢对促排卵治疗的排卵应答差被认为与胰岛素抵抗和高雄激素血症相关。在一个包含1000名PCOS不孕妇女(PCOSAct)的前瞻性队列中,我们开展了一项全外显子联合靶向单核苷酸多态性(SNP)测序以及代谢组学研究。在全基因组水平找出与无排卵显著相关的常见变异和罕见突变,并通过机器学习算法构建排卵预测模型。研究发现,ZNF438基因中标记为rs2994652(p=2.47×10^(-8))的常见变异和REC114基因中的一个罕见功能突变(rs182542888,p=5.79×10^(-6))与促排卵治疗失败显著相关。携带rs2994652 A等位基因和REC114 p.Val101Leu(rs182542888)的PCOS不孕妇女进行促排卵治疗的总排卵率更低(分别为比值比(OR)=1.96,95%置信区间(CI)[1.55~2.49];OR=11.52,95%CI[3.08~43.05]),出现排卵的间隔时间更长(平均56.7天vs.49.0天,p<0.001;78.1天vs.68.6天,p=0.014)。对于rs2994652突变者,L-苯丙氨酸水平升高并与胰岛素抵抗稳态模型(HOMA-IR)指数(r=0.22,p=0.05)和空腹血糖(r=0.33,p=0.003)呈正相关;对于rs182542888突变者,花生四烯酸代谢产物水平下降并与升高的抗苗勒管激素(r=-0.51,p=0.01)和总睾酮(r=-0.71,p=0.02)呈负相关。整合基因变异位点、代谢产物及临床特征的联合预测模型可提高对排卵的预测能力[曲线下面积(AUC)=76.7%]。ZNF438基因的一个常见变异和REC114基因的一个罕见功能突变,以及与二者相关的苯丙氨酸和花生四烯酸代谢物改变,与PCOS女性不孕症的促排卵治疗失败相关。

Burkitt Lymphoma Presenting as Ileocolic Intussusception in an Adult

Adult intussusception is rare, highly associated with a malignant lead point, and often requires emergent surgical management. We report the case of a 44-year-old male who presented with generalized abdominal pain and was found to have early ileocolic intussusception secondary to a large ileocecal mass. Biopsies of the mass and an enlarged cardiophrenic lymph node, as well as pleural fluid cytology were all consistent with Burkitt lymphoma (BL). Curiously, the patient’s abdominal exam was reassuring, and the intussusception and malignant bowel obstruction resolved over 36 hours with conservative management alone. With a Burkitt lymphoma international prognostic index (BL-IPI) score of 2, the patient proceeded to treatment with combination chemoimmunotherapy and attained a complete response after four cycles. There was no bowel perforation or recurrent intussusception throughout treatment. Thus, this report marks the first reported case of adult BL-associated intussusception to resolve with non-invasive management and establishes a precedent for conservative management in select patients.

Applying Machine Learning Approach to Explore Childhood Circumstances and Self-Rated Health in Old Age-China and the US,2020-2021

Introduction:Childhood circumstances impact senior health,prompting the introduction of machine learning methods to assess their individual and collective contributions to senior health.Methods:Using health and retirement study(HRS)and China Health and Retirement Longitudinal Study(CHARLS),we analyzed 2,434 American and 5,612 Chinese participants aged 60 and above.Conditional inference trees and forests were employed to estimate the influence of childhood circumstances on self-rated health(SRH).Results:The conventional method estimated higher inequality of opportunity(IOP)values in both China(0.039,accounting for 22.67%of the total Gini coefficient 0.172)and the US(0.067,accounting for 35.08%of the total Gini coefficient 0.191).In contrast,the conditional inference tree yielded lower estimates(China:0.022,accounting for 12.79%of 0.172;US:0.044,accounting for 23.04%of 0.191),as did the forest(China:0.035,accounting for 20.35%of 0.172;US:0.054,accounting for 28.27%of 0.191).Childhood health,financial status,and regional differences were key determinants of senior health.The conditional inference forest consistently outperformed others in predictive accuracy,as demonstrated by lower out-of-sample mean squared error(MSE).Discussion:The findings emphasize the need for early-life interventions to promote health equity in aging populations.Machine learning showcases the potential in identifying contributing factors.

帕博利珠单抗治疗伴脑转移NSCLC患者的一项非随机、开放Ⅱ期试验的长期随访结果和生物标志物分析

背景与目的我们开展了一项帕博利珠单抗用于伴未治疗脑转移的非小细胞肺癌(non-small cell lung cancer,NSCLC)或黑色素瘤患者的疗效和安全性的II期试验,旨在评估程序性死亡受体1(programmed cell death 1,PD-1)抑制剂在中枢神经系统(central nervous system,CNS)中的疗效。中期结果已发表,现报道对NSCLC队列的更新分析结果。方法这是一项开放性、单中心、II期试验。纳入标准:年龄≥18岁,诊断为晚期NSCLC并伴有≥1个5 mm-20 mm脑转移病灶,既往从未治疗或之前放疗后进展,无神经系统症状,不需要激素治疗且美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)<2分。患者每2周接受一次帕博利珠单抗(10 mg/kg)治疗。队列1为程序性死亡配体1(programmed cell death ligand 1,PD-L1)≥1%的患者,队列2为PD-L1<1%或未评估的患者。主要终点是脑转移患者缓解比例。所有经治患者均纳入疗效与安全性终点的分析。该研究已结束入组,并于Clinicaltrials.gov登记注册,注册号为NCT02085070。结果2014年3月31日-2018年5月21日,共42例患者接受治疗。中位随访时间为8.3个月(IQR:4.5个月-26.2个月)。队列1的37例患者中11例有脑转移缓解[29.7%(95%CI:15.9%-47.0%)]。队列2未观察到缓解。治疗相关的3级-4级不良事件(adverse events,AEs)包括2例肺炎、1例全身症状、1例结肠炎、1例肾上腺皮质功能不全、1例高血糖症和1例低钾血症。6例(14%)患者发生了治疗相关的严重不良事件,包括肺炎、急性肾损伤、低钾血症和肾上腺皮质功能不全。没有观察到治疗相关死亡病例。结论帕博利珠单抗治疗PD-L1≥1%的NSCLC伴脑转移患者有效,且对所有纳入的未经治疗的脑转移患者安全。需要进一步探索免疫治疗用于NSCLC合并CNS转移。

Interleukin-28 and hepatitis C virus genotype-4:Treatment-induced clearance and liver fibrosis

AIM:To investigate the association between interleukin-28B(IL28B) genotype and response to treatment and hepatic fibrosis in patients with hepatitis C virus(HCV) genotype 4.METHODS:Two hundred and one HCV-genotype 4 patients were included.All patients were treated with Peginterferon alph2a/Ribavirin for 48 wk.End of treatment response(ETR) was defined as loss of detectable serum HCV RNA at the end of treatment.Sustained viral response(SVR) was defined as loss of detectable serum HCV RNA at the end of 24 wk follow up.Genotyping of IL28B rs12979860 was performed using the TaqMan assay.We used logistic regression to estimate the adjusted odds ratio(aOR) and 95%CI.RESULTS:The study included 201 HCV-genotype 4 patients.The majority of patients were men(89.6%),with a median age of 47 years,inter-quartile range(40-51).Approximately 62.5% of patients had ETR,and 49.6% had SVR.Individuals who achieved SVR were more likely to be younger(χ 2 = 4.91,P = 0.027),and less likely to have fibrosis(χ 2 = 15.54,P < 0.0001),or inflammation(χ 2 = 7.58,P = 0.006).The genotype distribution of rs12979860 was 36.2%,49.0% and 14.8% for genotypes CC,CT,and TT,respectively.In these participants,rs12979860 genotype distribution did not differ by gender(P = 0.466),pretreatment viral load(P = 0.600),inflammation(P = 0.435),or fibrosis(P = 0.291).The frequencies of IL28B rs12979860 genotypes were TT(14.8%),CT(49.0%),and CC(36.2%).Compared to rs12979860 genotype TT,aORs(95%CI) for ETR and SVR were:CC genotype,[17.55(5.34-57.69) and 5.92(2.09-16.76),respectively];CT genotype,[5.15(1.80-14.78) and 2.48(0.94-6.52),respectively].In the current study,the patients who did not achieve ETR or SVR had a lower prevalence of rs12979860 CC(17.4% and 23.3%,respectively) than individuals who had ETR or SVR(47.9% and 47.2%,respectively).Individuals with rs12979860 CC genotype had approximately 6 times the odds of SVR compared to individuals with TT genotype(aOR = 5.92;95%CI:2.09-16.76).Similarly,patients with CT genotype had SVR more often than patients with TT genotype(aOR = 2.48;95%CI:0.94-6.52).Carrying at least one copy of the C allele(genotypes CT and CC) had almost 8 times the probability of ETR compared to those with genotype rs12979860 TT(aOR = 7.87;95%CI:2.84-21.82),and approximately 3 times the odds of SVR compared to those with genotype rs12979860 TT(aOR = 3.46;95%CI:1.37-8.74).In addition,data were consistent with a significant gene-dose relationship(aOR = 4.05/allele;95%CI:2.27-7.22).The association between rs12979860 genotype and SVR was similar among those who achieved and those who did not achieve SVR.CONCLUSION:In HCV-genotype 4 patients,rs12979860 is a sensitive predictor of viral clearance,independent of viral load,age,gender or fibrosis,with no similar relation to severity of fibrosis.

Aspartate transaminase to platelet ratio index in hepatitis C virus and Schistosomiasis coinfection

AIM: To assess the diagnostic accuracy,of aminotransferase-to-platelet ratio index(APRI) alone and with antischistosomal antibody(Ab) in patients with hepatitis C virus(HCV) and schistosomiasis coinfection. METHODS: This retrospective study included medical records of three hundred and eighty three Egyptianmen patients who had undergone percutaneous liver biopsy between January 2006 to April 2014 in tertiary care hospital in Qatar for diagnosis or monitoring purpose were selected. Data of patients > 18 years of age were included in the study. The values of HCV RNA titer and antischistosomal antibody titer were also taken into consideration. Patients were excluded from the study if they had any other concomitant chronic liver disease,including; history of previous antiviral or interferon therapy,immunosuppressive,therapy,chronic hepatitis B infection,human immunodeficiency virus co-infection,autoimmune hepatitis,decompensated liver disease,hepatocellular carcinoma,prior liver transplantation,and if no data about the liver biopsy present. RESULTS: Median age of patients was 46 years. About 7.1% had no fibrosis,whereas 30.4%,37.5%,20.4%,and 4.6% had fibrosis of stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ respectively. In bivariate analysis,APRI score,levels of AST,platelet count and age of patient showed statistically significant association with liver fibrosis(P < 0.0001); whereas antischistosomal antibody titer(P = 0.52) and HCV RNA titer(P = 0.79) failed to show a significant association. The respective AUC values for no fibrosis,significant fibrosis,severe fibrosis and cirrhosis of APRI score were 63%,73.2%,81.1% and 88.9% respectively. This showed good sensitivity and specificity of APRI alone for grading of liver fibrosis. But the inclusion of anti-Schistosoma antibody did not improve the prediction of fibrosis stage. CONCLUSION: The study results suggest that noninvasive biochemical markers like APRI are sensitive and specific in diagnosing the degree of fibrosis and cirrhosis in patients with coinfection of HCV and schistosomiasis as compared to biopsy. The addition of antischistosomal Ab to APRI did not improve sensitivity for predicting the degree of cirrhosis.