Factors to Improve the Management of Hepatitis C in Drug Users: An Observational Study in an Addiction Centre

Barriers to management of HCV in injection drug users are related to patients, health providers, and facilities. In a primary care drug user's addiction centre we studied access to HCV standard of care before and after using an onsite total care concept provided by a multidisciplinary team and noninvasive liver fibrosis evaluation. A total of 586 patients were seen between 2002 and 2004. The majority, 417 patients, were HCV positive and of these patients 337 were tested positive for HCV RNA. In 2002, patients were sent to the hospital. with the Starting of 2003, patients were offered standard of care HCV management in the center by a team of general practitioners, a consultant hepatologist, psychiatrists, nurses, and a health counsellor. Liver fibrosis was assessed by a non invasive method. In 2002, 6 patients had liver fibrosis assessment at hospital facilities, 4 patients were assessed with liver biopsy and 2 patients with Fibrotest-Actitest. 2 patients were treated for HCV at hospital. In 2003 and 2004, 224 patients were assessed with Fibrotest-Actitest on site. Of these, 85 were treated for HCV. SVR was achieved in 43%. We conclude that the combination of an onsite multidisciplinary team with the use of a noninvasive assessment method led to improved management of HCV infection in drug users' primary care facility

Recommendations for the Management of Hepatitis C Virus Infection Among People Who Inject Drugs

In the developed world, the majority of new and existing hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). The burden of HCV-related liver disease in this group is increasing, but treatment uptake among PWID remains low. Among PWID, there are a number of barriers to care that should be considered and systematically addressed, but these barriers should not exclude PWID from HCV treatment. Furthermore, it has been clearly demonstrated that HCV treatment is safe and effective across a broad range of multidisciplinary healthcare settings. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment and treatment in this group are urgently needed. These recommendations demonstrate that treatment among PWID is feasible and provides a framework for HCV assessment, management, and treatment. Further research is needed to evaluate strategies to enhance assessment, adherence, and SVR among PWID, particularly as new treatments for HCV infection become availabl

Comunità cristiane nell’islam arabo. La sfida del futuro

Preesistenti all'islamizzazione del Medio Oriente, le comunità cristiane costituiscono tuttora un importante elemento di pluralismo, sebbene oggi a rischio di sopravvivenza, nelle società arabe a maggioranza musulmana. Il volume presenta il ruolo storico delle comunità cristiane orientali nelle rispettive società arabe, la loro funzione di intermediazione culturale tra Oriente e Occidente e la discriminazione giuridica e sociale subìta con l'avvento dell'islam.- Indice #4- Introduzione, Andrea Pacini #10- Gli arabi cristiani: dalla questione d’Oriente alla recente geopolitica delle minoranze, Joseph Maïla #38- I cristiani arabi dell’Oriente: una prospettiva demografica, Philippe Fargues #64- Le comunità cristiane, soggetti attivi della società araba nel corso della storia, Samir Khalil Samir #84- Le chiese del Medio Oriente: origini e identità, tra radicamento nel passato e apertura al presente, Jean Corbon #110- Il diritto dello stato/nazione e lo status dei non musulmani in Egitto e in Siria, Bernard Botiveau #130- L’emigrazione degli arabi cristiani: dimensioni e cause dell’esodo, Bernard Sabella #148- La produzione culturale dei cristiani arabi oggi: espressione di identità nella società a maggioranza musulmana, Camille Hechaïmé #178- Le dinamiche politiche dei copti: rendere la comunità un protagonista atti, Dina El Khawaga #196- La posizione e il ruolo attuale dei copti nell’economia egiziana: tradizioni e specializzazioni, Adel A. Beshai #216- Le dinamiche dei cristiani libanesi: tra il paradigma delle ‘āmmiyyāt e il paradigma Hwayyek, Elizabeth Picard #226- Le comunità cristiane e la situazione economica e sociale in Libano, Boutros Labaki #250- Dinamiche comunitarie e sociopolitiche dei cristiani arabi in Giordania, in Israele e nei territori palestinesi autonomi, Andrea Pacini #290- I cristiani di Siria, Habib Moussalli #320- I cristiani in Iraq, Yūsuf Habbi #330- Il contributo delle comunità arabo-cristiane al futuro delle società arabe del Medio Oriente: alcune prospettive, Maurice Borrmans #342- I riti delle chiese orientali #356- Glossario #376- Riferimenti bibliografici #40

An Accurate Definition of the Status of Inactive Hepatitis B Virus Carrier by a Combination of Biomarkers (FibroTest-ActiTest) and Viral Load

BACKGROUND: The combination of transaminases (ALT), biopsy, HBeAg and viral load have classically defined the inactive status of carriers of chronic hepatitis B. The use of FibroTest (FT) and ActiTest (AT), biomarkers of fibrosis and necroinflammatory activity, has been previously validated as alternatives to biopsy. We compared the 4-year prognostic value of combining FT-AT and viral load for a better definition of the inactive carrier status. METHODS AND FINDINGS: 1,300 consecutive CHB patients who had been prospectively followed since 2001 were pre-included. The main endpoint was the absence of liver-related complications, transplantation or death. We used the manufacturers' definitions of normal FT (< = 0.27), normal AT (< = 0.29) and 3 standard classes for viral load. The adjustment factors were age, sex, HBeAg, ethnic origin, alcohol consumption, HIV-Delta-HCV co-infections and treatment. RESULTS: 1,074 patients with baseline FT-AT and viral load were included: 41 years old, 47% African, 27% Asian, 26% Caucasian. At 4 years follow-up, 50 complications occurred (survival without complications 93.4%), 36 deaths occurred (survival 95.0%), including 27 related to HBV (survival 96.1%). The prognostic value of FT was higher than those of viral load or ALT when compared using area under the ROC curves [0.89 (95%CI 0.84-0.93) vs 0.64 (0.55-0.71) vs 0.53 (0.46-0.60) all P<0.001], survival curves and multivariate Cox model [regression coefficient 5.2 (3.5-6.9; P<0.001) vs 0.53 (0.15-0.92; P = 0.007) vs -0.001 (-0.003-0.000;P = 0.052)] respectively. A new definition of inactive carriers was proposed with an algorithm combining "zero" scores for FT-AT (F0 and A0) and viral load classes. This new algorithm provides a 100% negative predictive value for the prediction of liver related complications or death. Among the 275 patients with the classic definition of inactive carrier, 62 (23%) had fibrosis presumed with FT, and 3 died or had complications at 4 year. CONCLUSION: In patients with chronic hepatitis B, a combination of FibroTest-ActiTest and viral load testing accurately defined the prognosis and the inactive carrier status

Diagnostic performance of FibroTest, SteatoTest and ActiTest in patients with NAFLD using the SAF score as histological reference

BACKGROUND: Blood tests of liver injury are less well validated in non‐alcoholic fatty liver disease (NAFLD) than in patients with chronic viral hepatitis. AIMS: To improve the validation of three blood tests used in NAFLD patients, FibroTest for fibrosis staging, SteatoTest for steatosis grading and ActiTest for inflammation activity grading. METHODS: We pre‐included new NAFLD patients with biopsy and blood tests from a single‐centre cohort (FibroFrance) and from the multicentre FLIP consortium. Contemporaneous biopsies were blindly assessed using the new steatosis, activity and fibrosis (SAF) score, which provides a reliable and reproducible diagnosis and grading/staging of the three elementary features of NAFLD (steatosis, inflammatory activity) and fibrosis with reduced interobserver variability. We used nonbinary‐ROC (NonBinAUROC) as the main endpoint to prevent spectrum effect and multiple testing. RESULTS: A total of 600 patients with reliable tests and biopsies were included. The mean NonBinAUROCs (95% CI) of tests were all significant (P < 0.0001): 0.878 (0.864–0.892) for FibroTest and fibrosis stages, 0.846 (0.830–0.862) for ActiTest and activity grades, and 0.822 (0.804–0.840) for SteatoTest and steatosis grades. FibroTest had a higher NonBinAUROC than BARD (0.836; 0.820–0.852; P = 0.0001), FIB4 (0.845; 0.829–0.861; P = 0.007) but not significantly different than the NAFLD score (0.866; 0.850–0.882; P = 0.26). FibroTest had a significant difference in median values between adjacent stage F2 and stage F1 contrarily to BARD, FIB4 and NAFLD scores (Bonferroni test P < 0.05). CONCLUSIONS: In patients with NAFLD, SteatoTest, ActiTest and FibroTest are non‐invasive tests that offer an alternative to biopsy, and they correlate with the simple grading/staging of the SAF scoring system across the three elementary features of NAFLD: steatosis, inflammatory activity and fibrosis

Allmerica project reporting improvements

Our work focused on the enhancement of the project reporting process at Allmerica Financial. We worked closely with Allmerica employees through the system development lifecycle to provide newly-automated reports, as well as a project management web portal which facilitates the entry of report information into a structured database. We have created a system which has the potential to improve upon additional business processes and have therefore made recommendations for further technical and operational improvements at the company

Hepatitis C virus infection impacts work productivity and fatigue: An epidemiologic real-life study

Introduction and Objective: Hepatitis C virus (HCV) infection and treatment impact the patient's daily life and work productivity. Until recently, treatments were associated with side effects and insufficient virologic and hepatic results.This study evaluated fatigue, work productivity, and treatment modalities in patients with HCV infection. Materials and methods: This cross-sectional, non-interventional, multicenter study was conducted in real-life settings between March and December 2015 at 109 sites in France. Results: Data from 1269 patients were evaluable. The mean patient age was 55.8 ± 12.5 years; 53.3% (676) patients were male. A total of 80.1% (1015) of patients were Caucasian and 62.3% (791) had a genotype 1 infection, 34.2% (433) had at least one comorbidity and 15.6% (198) had ≥1 clinical sign/symptom. Illicit drug use was the main route of HCV transmission and accounted for 36.8% (466) of all infections. Fibrosis stage F0/F1 was reported in 41.4% (525) of patients. A majority of patients (60.4%, 764) had never been treated. In patients previously treated, 85.8% (430) received ribavirin and pegylated interferon and only 13.4% (67) direct-acting antivirals.The mean percent of global impairment due to health was highest (34.8 ± 30.9%) in patients 18–45 years of age. The prevalence of active employed patients with a total fatigue score ≥ its median value (45/160) was 38.6%. The mean percent work time missed due to health was 9.6 ± 23.6% for working patients of 18–45 years of age and 7.3 ± 21.8% for working patients of 45–65 years of age. The mean overall prevalence of employed patients with impairment due to health issues was 21.8 ± 26.8%. The prevalence of patients with a reduced work activity of ≥50% due to their health status was 32.1%. Conclusion: These data reinforce the request for improved disease management in France, allowing patients with HCV infection to increase work productivity, reduce fatigue, and, hopefully, cure their disease

Biopsie du foie contre prise de sang pour le suivi de l’hépatite C ?

La biopsie hépatique est actuellement un examen indispensable à la prise en charge des patients atteints d’hépatite chronique C. Elle permet d’évaluer l’intensité des lésions hépatiques, en particulier de la fibrose, de guider le choix thérapeutique et d’évaluer l’efficacité du traitement. Il s’agit cependant d’un examen agressif qui peut être un obstacle à la prise en charge des patients. Le développement de marqueurs sériques biochimiques fiables, reproductibles et de valeur prédictive élevée, pourrait représenter une alternative très utile en permettant de diminuer le nombre de biopsies hépatiques

Phylogeny and distribution of the mayfly genus Austrophlebioides Campbell & Suter (Ephemeroptera: Leptophlebiidae)

The mayfly genus Austrophlebioides Campbell & Suter, 1988 is endemic to Australia and is widely distributed in eastern Australia and Tasmania. Here, the phylogenetic relationships among species of Austrophlebioides are investigated using cladistic analyses based on morphological characters of the nymph and adult, and the first phylogenetic hypothesis for the genus is presented. The results from the phylogenetic analyses support the recognition of three monophyletic species-groups: the 'rieki', 'pusillus' and 'marchanti' clades. The 'pusillus' clade is the sister-group to the 'rieki' clade, and the clade comprising these two groups is sister to the 'marchanti' clade. Minimal overlap was observed in the geographic distribution of the three Austrophlebioides clades. The 'rieki' clade is confined to the Wet Tropics bioregion of north-eastern Queensland. The 'pusillus' clade is distributed from central-eastern Queensland to Victoria. The 'marchanti' clade occurs in southern New South Wales, Victoria and Tasmania. Distributional limits of the three clades correspond with the presence of recognised biogeographic barriers (Burdekin Gap, Hunter Valley and Bass Strait) suggesting that vicariance has been important in the differentiation of the group and in determining present-day distributions of species