Hepatitis C Virus Outbreaks in Hemodialysis Centers: A Continuing Problem

The Centers for Disease Control and Prevention (CDC) estimates that ~370,000 people in the United States rely on hemodialysis care.1 Despite the publication of multiple guidelines over the years, acquisition of hepatitis C virus (HCV) continues to occur in dialysis centers. In this commentary, we review recent outbreaks of hepatitis C in hemodialysis centers and describe the breach of infection control policies and procedures that were incriminated in these outbreaks

Effectiveness of Remdesivir Treatment Protocols among Patients Hospitalized with COVID-19: A Target Trial Emulation

Background: Remdesivir is recommended for certain hospitalized patients with COVID-19. However, these recommendations are based on evidence from small randomized trials, early observational studies, or expert opinion. Further investigation is needed to better inform treatment guidelines with regard to the effectiveness of remdesivir among these patients. Methods: We emulated a randomized target trial using chargemaster data from 333 US hospitals from 1 May 2020 to 31 December 2021. We compared three treatment protocols: remdesivir within 2 days of hospital admission, no remdesivir within the first 2 days of admission, and no remdesivir ever. We used baseline comorbidities recorded from encounters up to 12 months before admission and identified the use of in-hospital medications, procedures, and oxygen supplementation from charges. We estimated the cumulative incidence of mortality or mechanical ventilation/extracorporeal membrane oxygenation with an inverse probability of censoring weighted estimator. We conducted analyses in the total population as well as in subgroups stratified by level of oxygen supplementation. Results: A total of 274,319 adult patients met the eligibility criteria for the study. Thirty-day in-hospital mortality risk differences for patients adhering to the early remdesivir protocol were -3.1% (95% confidence interval = -3.5%, -2.7%) compared to no early remdesivir and -3.7% (95% confidence interval -4.2%, -3.2%) compared to never remdesivir, with the strongest effect in patients needing high-flow oxygen. For mechanical ventilation/extracorporeal membrane oxygenation, risk differences were minimal. Conclusions: We estimate that, among hospitalized patients with COVID-19, remdesivir treatment within 2 days of admission reduced 30-day in-hospital mortality, particularly for patients receiving supplemental oxygen on the day of admission

Generators and commutators in finite groups; abstract quotients of compact groups

Let N be a normal subgroup of a finite group G. We prove that under certain (unavoidable) conditions the subgroup [N,G] is a product of commutators [N,y] (with prescribed values of y from a given set Y) of length bounded by a function of d(G) and |Y| only. This has several applications: 1. A new proof that G^n is closed (and hence open) in any finitely generated profinite group G. 2. A finitely generated abstract quotient of a compact Hausdorff group must be finite. 3. Let G be a topologically finitely generated compact Hausdorff group. Then G has a countably infinite abstract quotient if and only if G has an infinite virtually abelian continuous quotient.Comment: This paper supersedes the preprint arXiv:0901.0244v2 by the first author and answers the questions raised there. Latest version corrects erroneous Lemma 4.30 and adds new Cor. 1.1

An Efficient, Large-Scale Survey of Hepatitis C Viremia in the Democratic Republic of the Congo Using Dried Blood Spots

Background Efficient viral load testing is needed for hepatitis C (HCV) surveillance and diagnosis. HCV viral load testing using dried blood spots (DBSs), made with a single drop of finger-prick whole blood on filter paper, is a promising alternative to traditional serum-or plasma-based approaches. Methods We adapted the Abbott Molecular m2000 instrument for high-Throughput HCV viremia testing using DBSs with simple specimen processing and applied these methods to estimate the national burden of infection in the Democratic Republic of the Congo (DRC). We tested DBSs collected during the 2013-2014 DRC Demographic and Health Survey, including 1309 adults ≥40 years of age. HCV-positive samples underwent targeted sequencing, genotyping, and phylogenetic analyses. Results This high-Throughput screening approach reliably identified HCV RNA extracted from DBSs prepared using whole blood, with a 95% limit of detection of 1196 (95% confidence interval [CI], 866-2280) IU/mL for individual 6-mm punches and 494 (95% CI, 372-1228) IU/mL for larger 12-mm punches. Fifteen infections were identified among samples from the DRC Demographic and Health Surveythe weighted country-wide prevalence of HCV viremia was 0.9% (95% CI, 0.3%-1.6%) among adults ≥40 years of age and 0.7% (95% CI,.6%-.8%) among human immunodeficiency virus-infected subjects. All successfully genotyped cases were due to genotype 4 infection. Conclusions DBS-based HCV testing represents a useful tool for the diagnosis and surveillance of HCV viremia and can easily be incorporated into specimen referral systems. Among adults ≥40 years of age in the DRC, 100000-200000 may have active infection and be eligible for treatment