Background Data on incidence of adverse liver outcomes is limited for cancer patients with chronic (HBsAg+/anti-HBc+) or past (HBsAg−/anti-HBc+) hepatitis B virus (HBV) after chemotherapy. We aimed to determine the impact of test timing and anti-HBV therapy on adverse liver outcomes in these patients. Methods We retrospectively studied patients with solid or hematologic malignancies who received chemotherapy during 2004–2011. We defined HBV testing and anti-HBV therapy to be early at initiation of cancer therapy and late after initiation. Outcomes included hepatitis flares, hepatic impairment, liver failure, and death. Time-to-event analysis was used to determine incidence, and multivariable hazard models to determine predictors of outcomes. Results There were 18,688 study patients (80.4% solid tumors). Prevalence of chronic HBV was 1.1% (52/4905) and past HBV was 7.1% (350/4905). Among solid tumor patients, late identification of chronic HBV was associated with higher risk of hepatitis flare, hepatic impairment, liver failure, and death compared with early identification [HR (95% CI), 4.02 (1.26–12.86), 8.48 (1.86–38.66), 9.38 (1.50–58.86), and 3.90 (1.19–12.83), respectively]. Among patients with hematologic malignancies and chronic HBV, risk of death was 7.8 (1.73–35.27) times higher in persons with late compared to early anti-HBV therapy initiation. Patients with late identification of chronic HBV had late/no anti-HBV therapy. Chronic HBV predicted liver failure in patients with solid or hematologic malignancies while male sex and late identification were predictors for solid tumor patients. Conclusion Early identification correlates with early anti-HBV therapy and reduces the risk of liver failure and death in chronic HBV patients receiving chemotherapy.
Background: Treatment data for latent tuberculosis infection (LTBI) among potential living kidney donors are scarce.Methods: This retrospective study was performed to evaluate the prevalence of positive QuantiFERON-TB Gold In-Tube (QFT-GIT) among potential living kidney donors that were screened from 2009 to 2017. We investigated if there was any difference in the time to donation between QFT-GIT-positive and QFT-GIT-negative donors.We assessed the regimens used to treat LTBI and whether the recipients of QFT-GIT-positive donors developed active tuberculosis (TB). Results: Forty out of 427 (9%) potential living kidney donors had a positive QFT-GIT. QFT-GIT-positive donors were as likely as negative donors to undergo donation (30 [75%] vs 315 [81%], P = .33). The time from QFT-GIT testing to donation was longer among QFT-GIT-positive donors (median 221 days [range: 4-1139] vs 86 days [range: 3-1887], P = .001). Twelve-week rifapentine (RPT)/Isoniazid (INH) was the most common treatment used and was not associated with significant adverse reactions. There was a trend toward longer time to donation among QFT-GIT-positive donors who were treated for LTBI compared with QFT-GIT-positive donors who were not (252 days [range: 88-1139] vs 95 days [range: 4-802], P = .05). Twenty-nine recipients of QFT-GIT-positive living kidney donors were evaluated. Eleven of these recipients received kidneys from donors that were not treated for LTBI. Two of these recipients were treated with INH post-transplantation. Conclusions: The time from QFT-GIT testing to donation was longer among QFT-GIT-positive donors. The short-course regimens appear to be excellent options for LTBI treatment among living kidney donors and avoid delaying organ donation further.
The sea cucumber (Holothuria glaberrima) is an excellent model to study regeneration processes in deuterostomes. H.glaberrima has the ability to regenerate most of its viscera after the process of evisceration, where most of the viscera are expelled from the body. We have showed that apoptosis takes place during intestinal regeneration. Apoptosis, is the result of DNA internucleosomal cleavage, the morphological characteristics are: cell contraction, nuclear pyknosis, chromatin condensation and cell fragmentation. By using the TUNEL assay, where the TdT enzyme catalyzes the addition of Br‐dUTP, labelling the 3′‐OH terminal groups exposed during the internucleosomal cleavage; we identified apoptotic cells by fluorescence microscopy. We showed a peak in the number of apoptotic cells throughout the first week of regeneration and the distribution of apoptotic cells in the different layers of the large intestine (serosa, sub‐mucosa, mucosa and mesentery). Moreover we have now identified the holothurian homologue of the Survivin gene that in vertebrates functions as an inhibitor of apoptosis. Preliminary results have shown a differential expression of this gene during regeneration. Molecular experiments, PCR and In‐situ hybridization are under way to asses the temporal and spatial expression of apoptosis and survivin expression. Our results prove that similar to embryonic development, apoptosis plays an important role during intestinal regeneration. These studies provide a deeper understanding of the process of intestinal regeneration in the sea cucumber and the applications to studies in other animals, including humans.
Cardiac implantable electronic device (CIED) infections are treated with antibiotics and device explantation. Lack of CIED removal is associated with infection recurrence.However, CIED removal can be associated with major complications including death. We reported two patients with advanced heart disease who developed CIED infection due Staphylococcus epidermidis while awaiting for orthotopic heart transplantation (OHT). Both patients were managed with a different approach. They were treated with antibiotic therapy and had their CIED removal postponed until OHT. Both patients were kept on suppressive antibiotic treatment until undergoing simultaneous OHT and removal of infected CIED. None of the patients had infection recurrence. Large studies are needed to assess whether the approach of delaying CIED removal until OHT is safe among carefully selected patients with CIED infection.
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