Comparing sexual risks and patterns of alcohol and drug use between injection drug users (IDUs) and non-IDUs who report sexual partnerships with IDUs in St. Petersburg, Russia

<p>Abstract</p> <p>Background</p> <p>To date, the great majority of Russian HIV infections have been diagnosed among IDUs and concerns about the potential for a sexual transmission of HIV beyond the IDU population have increased. This study investigated differences in the prevalence of sexual risk behaviors between IDUs and non-IDUs in St. Petersburg, Russia and assessed associations between substance use patterns and sexual risks within and between those two groups.</p> <p>Methods</p> <p>Cross-sectional survey data and biological test results from 331 IDUs and 65 non-IDUs who have IDU sex partners were analyzed. Multivariate regression was employed to calculate measures of associations.</p> <p>Results</p> <p>IDUs were less likely than non-IDUs to report multiple sexual partners and unprotected sex with casual partners. The quantity, frequency and intensity of alcohol use did not differ between IDUs and non-IDUs, but non-IDUs were more likely to engage in alcohol use categorized as risky per the alcohol use disorders identification test (AUDIT-C). Risky sexual practices were independently associated with monthly methamphetamine injection among IDUs and with risky alcohol use among non-IDUs. Having sex when high on alcohol or drugs was associated with unprotected sex only among IDUs.</p> <p>Conclusions</p> <p>Greater prevalence of sexual risk among non-IDUs who have IDU sex partners compared to IDUs suggests the potential for sexual transmission of HIV from the high-prevalence IDU population into the general population. HIV prevention programs among IDUs in St. Petersburg owe special attention to risky alcohol use among non-IDUs who have IDU sex partners and the propensity of IDUs to have sex when high on alcohol or drugs and forgo condoms.</p

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

REDUCTION IN NEUTROPHIL-LYMPHOCYTE RATIO DURING INITIAL CONCURRENT CHEMORADIOTHERAPY IS PROGNOSTIC FOR SURVIVAL OF GLIOBLASTOMA PATIENTS

INTRODUCTION: Elevated baseline neutrophil-lymphocyte ratio (NLR) has been associated with poorer outcome in multiple tumour sites. In the context of glioblastoma (GBM), elevated NLR prior to any initial therapy, including surgery or corticosteroids, or prior to second surgery for recurrent disease predicted worse outcome. The aim of this retrospective cohort study was to assess if change in NLR during initial focal radiotherapy (RT) and concurrent temozolomide (TMZ) predicted outcome in newly diagnosed GBM patients. METHODS: A retrospective chart review was performed for patients treated concurrently with TMZ and RT, at our tertiary referral centre between Jan 2004 and Sept 2010, for histologically confirmed GBM. Age, baseline ECOG performance status (ECOG-PS) and extent of surgery were recorded. Baseline NLR, change in NLR, and time-weighted mean dexamethasone dose (TWMdex) were collected between 2 weeks prior to commencing RT and 10 weeks following the start of RT. Overall survival (OS) was calculated using Kaplan Meier method. Univariate (UVA) and multivariable (MVA) analyses using cox proportional hazard models evaluated variables associated with OS, accounting for colinearity of variables. RESULTS: There were 394 patients who met eligibility and were included in the final analysis. Median age was 54 (range 18-73). With median follow up of 15.2 months (range 1.6-134.6), OS was 66.4% (CI 61.4-70.7) and 31.1% (CI 26.5-35.8) at 1 and 2 years respectively. Median baseline dexamethasone dose was 8 mg (0-30 mg) and median TWMdex dose was 4.94 mg (0.0 -27.4 mg). On UVA, older age (HR 1.034, p <0.0001) and ECOG-PS>2 (HR 1.076, p < 0.001) were associated with shorter survival whereas baseline NLR below the median of 7.5 (HR 0.628, p < 0.0001) and decrease in NLR during treatment (HR 0.644, p < 0.0001) were associated with better survival. On MVA, decrease in NLR remained significantly prognostic for OS (HR 0.763, p = 0.02; CI 0.603 - 0.964) in addition to age (HR 1.032, p < 0.001; CI 1.018-1.045), TWMdex (HR 1.039, p = 0.002; CI 1.014-1.065) and ECOG-PS (HR 0.593, p = 0.008; CI 0.430-0.873). Although, baseline NLR was no longer statistically significant (HR 0.814, p = 0.09; CI 0.641 - 1.032), patients with low baseline NLR and further reduction in NLR during treatment had significantly longer survival (p < 0.0001). The association between change in NLR and change in dexamethasone dose over time was weak (r = 0.22). CONCLUSION: In patients with newly diagnosed glioblastoma, any reduction in neutrophil-lymphocyte ratio during initial concurrent chemoradiotherapy was an independent prognostic factor for longer survival, accounting for other prognostic factors including dexamethasone dose. Patients with low baseline NLR and further reduction in NLR during treatment had the best prognosis

Prognostic value of early changes in neutrophil and lymphocyte measures during chemoradiotherapy for glioblastoma

OBJECTIVES: Elevated baseline neutrophil-lymphocyte ratio (NLR) has been associated with worse outcome in various cancers, including glioblastoma (GBM). This retrospective study assesses if change in NLR during focal radiotherapy (RT) with Temozolomide (TMZ) for newly diagnosed GBM predicts outcome. METHODS: Patients treated with concurrent RT and TMZ for newly diagnosed GBM, between January 2004 and September 2010 were included. Age, ECOG performance status (ECOG-PS), dexamethasone dose, extent of surgery, tumor volume, neutrophil and lymphocyte counts (from baseline to 10 weeks) were collected. Statistical analysis included Kaplan Meier analysis and cox proportional hazard models with univariate (UVA) and multivariable (MVA) analyses. RESULTS: A total of 394 patients with median age of 54 (range 18-73) and median follow up 15.2 months (range 1.6-134.6) were analyzed. Median survival was 15.3 months (95% CI 14.3-16.9 months). Median baseline dexamethasone dose was 8mg (0-30mg) and median time-weighted mean dexamethasone dose (TWMdex) was 4.94mg (0.0 -27.4mg). On UVA, older age (HR 1.034, p<0.0001) and ECOG-PS>2 (HR 1.076, p < 0.001) were associated with shorter overall survival (OS). Baseline NLR below the median of 7.5 (HR 0.628, p < 0.0001) and decline in NLR (decNLR) (HR 0.644, p < 0.0001) were associated with better OS. On MVA, decNLR (HR 0.763, p = 0.02; CI 0.603 - 0.964), age (HR 1.032, p < 0.0001; CI 1.018-1.045), TWMdex (HR 1.039, p = 0.002; CI 1.014-1.065) and ECOG-PS (HR 0.593, p = 0.008; CI 0.403-0.873) remained prognostic for OS but not baseline NLR (HR 0.814, p = 0.09; CI 0.641 - 1.032). A low baseline NLR and further decrease in NLR predicted the longest survival (p < 0.0001). No significant linear correlation existed between tumor volume and baseline neutrophils (Rho =0.046, p = 0.42), lymphocytes (Rho = -0.015, p = 0.80) or NLR (Rho = 0.05, p = 0.40). CONCLUSIONS: Reduction in NLR during RT and TMZ for newly diagnosed GBM predicted for longer survival, even after accounting for steroid use