Primary Care Providers Are Vital to Carrying out Hepatitis C Screening

Background: Chronic Hepatitis C Virus (HCV) infection affects approximately 3 million Americans. The 1945-1965 birth cohort has the highest prevalence, estimated at 2%. In 2013, the United States Preventive Services Task Force (USPSTF) endorsed screening for HCV in this cohort with the goal of identifying cases and initiating treatment. However, a variety of obstacles to screening are suspected to contribute to low screening rates. This study evaluated the role of the primary care physician in completing recommended screening in an historically underserved community with a high prevalence of HCV. Methods: Individuals attending an August 2015 health exposition sponsored by the Rodham Institute completed an anonymous survey. The exposition was hosted in an urban setting where the population has historically been predominantly African American; currently 92% of residents identify as such. The survey included questions on demographic information, access to a PCP, insurance status, as well as knowledge of various topics related to Hepatitis C. Responses were excluded if they did not provide information on their history of screening. The university institutional review board approved the study. Statistical analysis was performed using Fisher’s exact test, with significance set at p\u3c0.05. Results: Ninety five responses were analyzed. Among them were 29 born in the 1945-1965 timeframe. All of members of this cohort reported having a primary physician and 27 (96.4%) had health insurance. Sixteen discussed HCV with their doctor and 12 of them (75.0%) were screened. Thirteen respondents had not discussed HCV; among them, three (23.1%) were tested for the virus. Having a discussion with the primary physician resulted in a significantly higher rate of HCV screening (p=0.0092). Conclusions: The primary care provider is vital to implementing preventive health recommendations including those related to HCV screening. Our study showed that in a high-prevalence, insured cohort, patients who had discussed HCV with their primary physician were three times more likely to have been screened for the infection. The population studied all had health insurance and a primary care provider, so health care was broadly accessible. The study also suggests that some recent USPSTF guidelines may not have penetrated into community primary care practices as the screening rates were suboptimal

RNA sequencing of blood in coronary artery disease: involvement of regulatory T cell imbalance.

BACKGROUND: Cardiovascular disease had a global prevalence of 523 million cases and 18.6 million deaths in 2019. The current standard for diagnosing coronary artery disease (CAD) is coronary angiography. Surprisingly, despite well-established clinical indications, up to 40% of the one million invasive cardiac catheterizations return a result of \u27no blockage\u27. The present studies employed RNA sequencing of whole blood to identify an RNA signature in patients with angiographically confirmed CAD. METHODS: Whole blood RNA was depleted of ribosomal RNA (rRNA) and analyzed by single-molecule sequencing of RNA (RNAseq) to identify transcripts associated with CAD (TRACs) in a discovery group of 96 patients presenting for elective coronary catheterization. The resulting transcript counts were compared between groups to identify differentially expressed genes (DEGs). RESULTS: Surprisingly, 98% of DEGs/TRACs were down-regulated ~ 1.7-fold in patients with mild to severe CAD (\u3e 20% stenosis). The TRACs were independent of comorbid risk factors for CAD, such as sex, hypertension, and smoking. Bioinformatic analysis identified an enrichment in transcripts such as FoxP1, ICOSLG, IKZF4/Eos, SMYD3, TRIM28, and TCF3/E2A that are likely markers of regulatory T cells (Treg), consistent with known reductions in Tregs in CAD. A validation cohort of 80 patients confirmed the overall pattern (92% down-regulation) and supported many of the Treg-related changes. TRACs were enriched for transcripts associated with stress granules, which sequester RNAs, and ciliary and synaptic transcripts, possibly consistent with changes in the immune synapse of developing T cells. CONCLUSIONS: These studies identify a novel mRNA signature of a Treg-like defect in CAD patients and provides a blueprint for a diagnostic test for CAD. The pattern of changes is consistent with stress-related changes in the maturation of T and Treg cells, possibly due to changes in the immune synapse