Séance d’apprentissage interprofessionnel animée par un pharmacien pour les résidents en médecine familiale spécialisés dans les soins liés au VIH

Implication Statement We developed a pharmacist-led one-month teaching rotation for medical residents to learn HIV pharmacotherapy.  This interprofessional education (IPE) was deemed extremely valuable by postgraduate-year-3 residents who intended to have a future practice in HIV care.  The overarching concept of this rotation was for the medical trainee to “become-the-pharmacist”, learning to recognize, prevent, and manage drug-related issues in HIV patients.  Pharmacist-led IPE should be considered to support medical training in other highly specialized pharmacotherapeutic areas.Énoncé des implications de la recherche Nous avons mis au point une formation sur la pharmacothérapie du VIH, présentée par un pharmacien, pour les résidents en médecine de troisième année. Ces derniers ont trouvé cette expérience d’apprentissage interprofessionnel extrêmement précieuse pour leurs interventions futures dans le traitement du VIH. Le concept au cœur de cette rotation d’une durée d’un mois était de mettre les stagiaires en médecine dans la peau du pharmacien pour leur apprendre à reconnaître, à prévenir et à gérer les problèmes liés à la prise de médicaments chez les patients séropositifs. Nous recommandons la formule d’apprentissage interprofessionnel mené par un pharmacien pour appuyer la formation médicale dans les domaines hautement spécialisés de la pharmacothérapie

Satellitosis, a crosstalk between neurons, vascular structures and neoplastic cells in brain tumours; early manifestation of invasive behaviour

The secondary structures of Scherer commonly known as perineuronal and perivascular satellitosis have been identified as a histopathological hallmark of diffuse, invasive, high-grade gliomas. They are recognised as perineuronal satellitosis when clusters of neoplastic glial cells surround neurons cell bodies and perivascular satellitosis when such tumour cells surround blood vessels infiltrating Virchow–Robin spaces. In this review, we provide an overview of emerging knowledge regarding how interactions between neurons and glioma cells can modulate tumour evolution and how neurons play a key role in glioma growth and progression, as well as the role of perivascular satellitosis into mechanisms of glioma cells spread. At the same time, we review the current knowledge about the role of perineuronal satellitosis and perivascular satellitosis within the tumour microenvironment (TME), in order to highlight critical knowledge gaps in research space

Age-Specific Effects of Mirror-Muscle Activity on Cross-Limb Adaptations Under Mirror and Non-Mirror Visual Feedback Conditions

Cross-limb transfer (CLT) describes the observation of bilateral performance gains due to unilateral motor practice. Previous research has suggested that CLT may be reduced, or absent, in older adults, possibly due to age-related structural and functional brain changes. Based on research showing increases in CLT due to the provision of mirror visual feedback (MVF) during task execution in young adults, our study aimed to investigate whether MVF can facilitate CLT in older adults, who are known to be more reliant on visual feedback for accurate motor performance. Participants (N = 53) engaged in a short-term training regime (300 movements) involving a ballistic finger task using their dominant hand, while being provided with either visual feedback of their active limb, or a mirror reflection of their active limb (superimposed over the quiescent limb). Performance in both limbs was examined before, during and following the unilateral training. Furthermore, we measured corticospinal excitability (using TMS) at these time points, and assessed muscle activity bilaterally during the task via EMG; these parameters were used to investigate the mechanisms mediating and predicting CLT. Training resulted in significant bilateral performance gains that did not differ as a result of age or visual feedback (both p > 0.1). Training also elicited bilateral increases in corticospinal excitability (p < 0.05). For younger adults, CLT was significantly predicted by performance gains in the trained hand (β = 0.47), whereas for older adults it was significantly predicted by mirror activity in the untrained hand during training (β = 0.60). The present study suggests that older adults are capable of exhibiting CLT to a similar degree to younger adults. The prominent role of mirror activity in the untrained hand for CLT in older adults indicates that bilateral cortical activity during unilateral motor tasks is a compensatory mechanism. In this particular task, MVF did not facilitate the extent of CLT

Erythema annulare centrifugum-like eruption associated with pegylated interferon treatment for hepatitis C

Current standard of treatment for chronic hepatitis C virus infection requires the use of pegylated interferon plus ribavirin. Treatment with these two agents has been associated with numerous side effects, which frequently include dermatologic eruptions. We report a cutaneous eruption associated with interferon having clinical presentation of erythema annulare centrifugum. The eruption occurred within days of the first interferon injection and repeatedly flared following subsequent injections. Our patient was able to continue therapy without interruption, while managing the reaction with topical corticosteroid and oral antihistamine. We conclude that this is a benign cutaneous eruption associated with interferon which can be managed without dis- continuing treatment for hepatitis C

Employment outcomes of foster youth: The results from the Midwest Evaluation of the Adult Functioning of Foster Youth

Youth emancipated from the foster care system face challenges in securing steady employment and earning a living wage. Using data from the Midwest Evaluation of the Adult Functioning of Former Foster Youth, this article uses Tobit analyses to test the statistical relationship between multiple factors (demographics, human capital, and independent living services) and yearly income for former foster youth at age 21 years. The findings revealed that race, level of education, histories of drug and alcohol use, and histories of mental illness significantly impact yearly earnings within the sampled population. Equally significant, self-reported receipt of help related to employment did not impact yearly earnings. However, the limitations associated with using a non-experimental design and the challenges associated with the endogeneity of the measures of employment-related help suggest areas for future research on this topic.Foster youth Emancipation Transition to adulthood Independent living Employment services Tobit analysis

A pharmacist-led interprofessional education program for family practice medical residents specializing in HIV care

Implication Statement We developed a pharmacist-led one-month teaching rotation for medical residents to learn HIV pharmacotherapy.  This interprofessional education (IPE) was deemed extremely valuable by postgraduate-year-3 residents who intended to have a future practice in HIV care.  The overarching concept of this rotation was for the medical trainee to “become-the-pharmacist”, learning to recognize, prevent, and manage drug-related issues in HIV patients.  Pharmacist-led IPE should be considered to support medical training in other highly specialized pharmacotherapeutic areas

Treatment-emergent reverse transcriptase resistance during antiretroviral therapy with bictegravir, tenofovir alafenamide, and emtricitabine: A case series

OBJECTIVES: Bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) is a complete regimen for the treatment of HIV with a high barrier to resistance and few reported cases of treatment failure. We present three cases of treatment-emergent resistance to nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) in patients with suboptimal treatment adherence and assess whether the resistance-associated mutations were present before BIC/TAF/FTC initiation or emerged during therapy. METHODS: We used genotypic drug resistance testing by Sanger sequencing to identify emergent resistance mutations in plasma viral load specimens collected after combination antiretroviral therapy initiation in all participants. Additionally, we performed ultra-deep sequencing by Illumina MiSeq on the earliest available plasma HIV-1 viral load specimen and on any available specimens closest in time to the initiation of BIC/TAF/FTC therapy to identify low-abundance resistance mutations present in the viral quasispecies. RESULTS: All three participants developed NRTI resistance after prolonged exposure and incomplete adherence to BIC/TAF/FTC. The T69N, K70E, M184I, and/or T215I mutations identified in clinical samples at the time of virological failure were not present on deep sequencing of either baseline samples or samples collected before BIC/TAF/FTC initiation. CONCLUSIONS: Despite a generally high genetic barrier to resistance, NRTI resistance-associated mutations may emerge during therapy with BIC/TAF/FTC in the setting of suboptimal adherence

High prevalence of syndemic health problems in patients seeking post-exposure prophylaxis for sexual exposures to HIV.

INTRODUCTION: The standard clinical approach to non-occupational HIV post-exposure prophylaxis (nPEP) focuses on biomedical aspects of the intervention, but may overlook co-occurring or 'syndemic' psychosocial problems that reinforce future vulnerability to HIV. We therefore sought to determine the prevalence of syndemic health problems in a cohort of Ontario nPEP patients, and explored the relationship between syndemic burden and HIV risk. METHODS: Between 07/2013-08/2016, we distributed a self-administered questionnaire to patients presenting to three clinics in Toronto and Ottawa seeking nPEP for sexual HIV exposures. We used validated screening tools to estimate the prevalence of depression (CES-D score ≥16), harmful alcohol use (AUDIT ≥8), problematic drug use (DUDIT ≥6 men/≥2 women), and sexual compulsivity (SCS ≥24) among men who have sex with men (MSM) respondents. In exploratory analyses, we examined the relationships between syndemic conditions using univariable logistic regression models, and the relationship between syndemic count (total number of syndemic conditions per participant) and HIV risk, as estimated by the HIRI-MSM score, using linear regression models. RESULTS: The 186 MSM included in the analysis had median age 31 (IQR = 26-36), including 87.6% having a college/undergraduate degree or higher. Overall, 53.8% screened positive for depression, 34.4% for harmful alcohol use, 30.1% for problematic drug use, and 16.1% for sexual compulsivity. Most participants (74.2%) had at least one syndemic condition and 46.8% had more than one. Exploratory analyses suggested positive associations between depression and harmful alcohol use (OR = 2.11, 95%CI = 1.13, 3.94) and between harmful alcohol use and problematic drug use (OR = 1.22, 95%CI = 0.65, 2.29). Syndemic count was associated with increased HIRI-MSM risk scores in univariable (2.2, 95%CI = 1.0, 3.3 per syndemic condition) and multivariable (2.1, 95%CI = 0.6, 3.6) linear regression models. CONCLUSIONS: The prevalence of syndemic conditions in MSM seeking nPEP for sexual exposure is alarmingly high, and is associated with underlying HIV risk. Routine screening for these conditions may identify opportunities for intervention and could alleviate future vulnerability to HIV