Objectives There are few systematic assessments of street-obtained buprenorphine use from community-based samples in the United States. The objective of this study was to characterize the prevalence, correlates, and reasons for street-obtained buprenorphine use among current and former injection drug users (IDUs) in Baltimore, Maryland. Methods In 2008, participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based cohort of IDUs, were administered a survey on buprenorphine. Street-obtained buprenorphine represented self-reported use of buprenorphine obtained from the street or a friend in the prior three months. Results 602 respondents were predominantly male (65%), African-American (91%), and 30% were HIV-positive. Overall, nine percent reported recent street-obtained buprenorphine use, and only 2% reported using to get high. Among active opiate users, 23% reported recent use of street-obtained buprenorphine. Use of buprenorphine prescribed by a physician, injection and non-injection drug use, use of street-obtained methadone and prescription opiates, homelessness, and opioid withdrawal symptoms were positively associated, while methadone treatment, health insurance, outpatient care, and HIV-infection were negatively associated with recent street-obtained buprenorphine use in univariate analysis. After adjustment, active injection and heroin use were positively associated with street-obtained buprenorphine use. Ninety-one percent reported using street-obtained buprenorphine to manage withdrawal symptoms. Conclusions While 9% reported recent street-obtained buprenorphine use, only a small minority reported using buprenorphine to get high, with the majority reporting use to manage withdrawal symptoms. There is limited evidence of diversion of buprenorphine in this sample and efforts to expand buprenorphine treatment should continue with further monitoring.
The present findings on published studies and registered trials in pediatric VTE mark an ongoing period of remarkable activity and advancement in the field of pediatric VTE.
RATIONALE: DiGeorge syndrome (DGS) is the result of microdeletions of chromosome 22q11.2, resulting in a highly variable phenotype. Since limited clinical information is available, the purpose of this study was to characterize the immunologic status of a cohort of Hispanic DGS patients. METHODS: We studied 50 Hispanic patients diagnosed with DGS (64% confirmed using FISH), ages 0-21 years old (27 females and 23 males, mean age of diagnosis 4.1 6 2.1 years) by retrospective medical record review. Immune studies including lymphocyte subsets, mitogen proliferation, serum immunoglobulins and specific antibody response, and other clinical data were recorded. RESULTS: Nine patients (18%) had normal Tand B lymphocyte numbers, and normal total serum immunoglobulins. Twenty six patients (52%) had decreased T cells (both CD4+ and CD8+). Both T and B lymphocytes were affected in five (10%) patients. Five patients (10%) had decreased vaccine titers, two patients (4%) had hypogammaglobulinemia, and two patients (4%) had reduced, but not absent, proliferative response to mitogens. No patients had complete DGS. A variety of pre-diagnosis infections were found in 20% of patients. Post-diagnosis infections were present in 52%, the majority Otitis Media (28%). Prophylactic antibiotics were given to 20% of the patients. Cardiac malformations were common (82%). Other affected systems included: endocrine (48%), gastrointestinal (54%), and neurologic (56%). Developmental disorders included speech delay (78%) and learning disabilities (54%). CONCLUSIONS: Hispanic patients with partial DGS had diminished T lymphocyte numbers and hypogammaglobulinemia, similar to those previously described in the literature.
Background: Leukemia is the most prevalent pediatric malignancy, representing 25% of all cancer diagnoses among children. Despite recent substantial improvements in therapy that have dramatically increased survival, 10-20% of cases develop relapse and become refractory to treatment. Although racial/ethnic disparity in survival is well documented, limited knowledge currently exists on the disparity in relapse. The objective of this study was to compare the risk of pediatric leukemia relapse between Hispanic Whites and non-Hispanic Whites. Methods: The study included children (<21 years) diagnosed with leukemia between January 2006 and December 2014 at the All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL. Patients’ demographic and clinical information were obtained from an electronic health record-derived data warehouse. Ethnicity was self-reported. Leukemia diagnosis and relapse were identified using appropriate ICD-9 codes. Relapse-free survival was defined as the time from diagnosis to the first documentation of relapse. Hazard ratios (HR) and 95% confidence intervals (95% CI) for relapse-free survival were calculated using Cox proportional hazard models adjusting for age at diagnosis, gender and type of insurance (commercial vs government). Results: The study included 66 Hispanic Whites and 202 non-Hispanic Whites. The median age for both groups was 7 years. However compared to non-Hispanic Whites, Hispanic Whites were more likely to be males (59% vs 53%), to have government insurance (71% vs 35%) and had a shorter median follow up time (52 vs 66 months). Approximately 15% of Hispanic Whites developed relapse compared to only 5% non-Hispanic Whites. Kaplan-Meier survival analysis showed a difference in relapse between the two groups (log-rank p = 0.006). After adjusting for age at diagnosis, gender and type of insurance, Hispanic Whites were three times more likely to develop relapse compared to non-Hispanic Whites (HR = 3.1, 95%CI = 1.2-8.0, p = 0.02). Conclusion: Although the findings of this study suggest that ethnic disparity in pediatric leukemia may exist, our findings are limited by the inability to control for potential confounders such as medication adherence, timing of diagnosis, white blood cells at diagnosis and minimal residual disease. Future studies should further investigate this racial/ethnic disparity. Citation Format: Mirinda Gillespie, Greg Hale, Ernest K. Amankwah. Ethnic disparity in pediatric leukemia relapse. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1781.
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