Incident Hepatitis C Virus Infections in the Swiss HIV Cohort Study : changes in treatment uptake and outcomes between 1991 and 2013

Background: The hepatitis C virus (HCV) epidemic is evolving rapidly in patients infected with human immunodeficiency virus (HIV). We aimed to describe changes in treatment uptake and outcomes of incident HCV infections before and after 2006, the time-point at which major changes in HCV epidemic became apparent. Methods.  We included all adults with an incident HCV infection before June 2012 in the Swiss HIV Cohort Study, a prospective nationwide representative cohort of individuals infected with HIV. We assessed the following outcomes by time period: the proportion of patients starting an HCV therapy, the proportion of treated patients achieving a sustained virological response (SVR), and the proportion of patients with persistent HCV infection during follow-up. Results.  Of 193 patients with an HCV seroconversion, 106 were diagnosed before and 87 after January 2006. The proportion of men who have sex with men increased from 24% before to 85% after 2006 (P < .001). Hepatitis C virus treatment uptake increased from 33% before 2006 to 77% after 2006 (P < .001). Treatment was started during early infection in 22% of patients before and 91% after 2006 (P < .001). An SVR was achieved in 78% and 29% (P = .01) of patients treated during early and chronic HCV infection. The probability of having a detectable viral load 5 years after diagnosis was 0.67 (95% confidence interval [CI], 0.58-0.77) in the group diagnosed before 2006 and 0.24 (95% CI, 0.16-0.35) in the other group (P < .001). Conclusions. In recent years, increased uptake and earlier initiation of HCV therapy among patients with incident infections significantly reduced the proportion of patients with replicating HCV.

El cos molest en l'obra d'Epictet

The work by Epictetus shows a remarkable amount of allusions to unpleasant aspects of the human body. It deals with expressions which sometimes could be almost considered aischrologia and, on other occasions, they really are. Our contribution approaches this subject and asks which might be the origin of this practice. We suggest the use of those expressions describes the body in terms fitting with Epictetus" stoic philosophy aimed to establish an inner separation between body and the right use of reason leading us into virtue. Furthermore his humble origin as a slave could help him in using unpleasant words without prejudices. Also Arrian could insist on that characteristic when transmitting Epictetus" teachings.

Ability of physicians to diagnose influenza and usefulness of a rapid influenza antigen test in febrile returning travelers: A randomized controlled trial.

BACKGROUND: Fever is a frequent cause of medical consultation among returning travelers. The objectives of this study were to assess whether physicians were able to identify patients with influenza and whether the use of an influenza rapid diagnostic test (iRDT) modified the clinical management of such patients. METHODS: Randomized controlled trial conducted at 2 different Swiss hospitals between December 2008 and November 2012. Inclusion criteria were 1) age ≥18 years, 2) documented fever of ≥38 °C or anamnestic fever + cough or sore throat within the last 4 days, 3) illness occurring within 14 days after returning from a trip abroad, 4) no definitive alternative diagnosis. Physicians were asked to estimate the likelihood of influenza on clinical grounds, and a single nasopharyngeal swab was taken. Thereafter patients were randomized into 2 groups: i) patients with iRDT (BD Directigen A + B) performed on the nasopharyngeal swab, ii) patients receiving usual care. A quantitative PCR to detect influenza was done on all nasopharyngeal swabs after the recruitment period. Clinical management was evaluated on the basis of cost of medical care, number of X-rays requested and prescription of anti-infective drugs. RESULTS: 100 eligible patients were referred to the investigators. 93 patients had a naso-pharyngeal swab for a PCR and 28 (30%) swabs were positive for influenza. The median probability of influenza estimated by the physician was 70% for the PCR positive cases and 30% for the PCR negative cases (p < 0.001). The sensitivity of the iRDT was only 20%, and specificity 100%. Mean medical cost for the patients managed with iRDT and without iRDT were USD 581 (95%CI 454-707) and USD 661 (95%CI 522-800) respectively. 14/60 (23%) of the patients managed with iRDT were prescribed antibiotics versus 13/33 (39%) in the control group (p = 0.15). No patient received antiviral treatment. CONCLUSION: Influenza was a frequent cause of fever among these febrile returning travelers. Based on their clinical assessment, physicians had a higher level of suspicion for influenza in PCR positive cases. The iRDT used in this study showed a disappointingly low sensitivity and can therefore not be recommended for the management of these patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT00821626.

Prevalence and management of familial hypercholesterolaemia in patients with acute coronary syndromes.

AIMS: We aimed to assess the prevalence and management of clinical familial hypercholesterolaemia (FH) among patients with acute coronary syndrome (ACS). METHODS AND RESULTS: We studied 4778 patients with ACS from a multi-centre cohort study in Switzerland. Based on personal and familial history of premature cardiovascular disease and LDL-cholesterol levels, two validated algorithms for diagnosis of clinical FH were used: the Dutch Lipid Clinic Network algorithm to assess possible (score 3-5 points) or probable/definite FH (>5 points), and the Simon Broome Register algorithm to assess possible FH. At the time of hospitalization for ACS, 1.6% had probable/definite FH [95% confidence interval (CI) 1.3-2.0%, n = 78] and 17.8% possible FH (95% CI 16.8-18.9%, n = 852), respectively, according to the Dutch Lipid Clinic algorithm. The Simon Broome algorithm identified 5.4% (95% CI 4.8-6.1%, n = 259) patients with possible FH. Among 1451 young patients with premature ACS, the Dutch Lipid Clinic algorithm identified 70 (4.8%, 95% CI 3.8-6.1%) patients with probable/definite FH, and 684 (47.1%, 95% CI 44.6-49.7%) patients had possible FH. Excluding patients with secondary causes of dyslipidaemia such as alcohol consumption, acute renal failure, or hyperglycaemia did not change prevalence. One year after ACS, among 69 survivors with probable/definite FH and available follow-up information, 64.7% were using high-dose statins, 69.0% had decreased LDL-cholesterol from at least 50, and 4.6% had LDL-cholesterol ≤1.8 mmol/L. CONCLUSION: A phenotypic diagnosis of possible FH is common in patients hospitalized with ACS, particularly among those with premature ACS. Optimizing long-term lipid treatment of patients with FH after ACS is required.

Hépatite C: épidémiologie, histoire naturelle et diagnostic [Hepatitis C: epidemiology natural course and diagnosis].

L'infection par le virus de l'hépatite C (HCV) représente une des causes les plus fréquentes d'hépatite chronique, de cirrhose et de carcinome hépatocellulaire au niveau mondial. D'énormes progrès ont été réalisés durant ces 25 dernières années depuis la découverte du HCV, notamment dans la compréhension de la virologie moléculaire, de la pathogenèse et de l'histoire naturelle ainsi que dans la prévention, le diagnostic et le traitement de l'hépatite C. Ces avancées seront résumées dans cet article et discutées à la lumière de nouveaux défis. Hepatitis C virus (HCV) infection represents a major cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma worldwide. Great progress in the understanding of the molecular virology, pathogenesis and natural course as well as the prevention, diagnosis and treatment of hepatitis C have been made in over the last 25 years since the discovery of HCV. Here, we review recent advances and discuss them in the light of new challenges.

Large-scale genomic analyses link reproductive aging to hypothalamic signaling, breast cancer susceptibility and BRCA1-mediated DNA repair.

Menopause timing has a substantial impact on infertility and risk of disease, including breast cancer, but the underlying mechanisms are poorly understood. We report a dual strategy in ∼70,000 women to identify common and low-frequency protein-coding variation associated with age at natural menopause (ANM). We identified 44 regions with common variants, including two regions harboring additional rare missense alleles of large effect. We found enrichment of signals in or near genes involved in delayed puberty, highlighting the first molecular links between the onset and end of reproductive lifespan. Pathway analyses identified major association with DNA damage response (DDR) genes, including the first common coding variant in BRCA1 associated with any complex trait. Mendelian randomization analyses supported a causal effect of later ANM on breast cancer risk (∼6% increase in risk per year; P = 3 × 10(-14)), likely mediated by prolonged sex hormone exposure rather than DDR mechanisms.

Hépatite C: traitement actuel [Hepatitis C: current therapy].

Le traitement de l'hépatite C chronique a été révolutionné par l'introduction de nouveaux antiviraux (directly acting antivirals [DAA]). Ces inhibiteurs de protéase, de la protéine NS5A et de la polymérase peuvent être associés dans des traitements oraux hautement efficaces et bien tolérés sans interféron. Dans cet article, nous fournissons un aperçu du traitement actuel de l'hépatite C chronique avec considération particulière des DAA actuellement autorisés en Suisse. Treatment of chronic hepatitis C is currently being revolutionised, with the introduction of directly acting antivirals (DAA), including protease, NS5A and polymerase inhibitors. These can be combined in interferon-free oral therapies with unprecedented efficacy and good tolerance. Here, we review the current therapy of chronic hepatitis C, with a particular focus on DAA that are approved in Switzerland today.

N-WASP is required for B-cell-mediated autoimmunity in Wiskott-Aldrich syndrome.

Mutations of the Wiskott-Aldrich syndrome gene (WAS) are responsible for Wiskott-Aldrich syndrome (WAS), a disease characterized by thrombocytopenia, eczema, immunodeficiency, and autoimmunity. Mice with conditional deficiency of Was in B lymphocytes (B/WcKO) have revealed a critical role for WAS protein (WASP) expression in B lymphocytes in the maintenance of immune homeostasis. Neural WASP (N-WASP) is a broadly expressed homolog of WASP, and regulates B-cell signaling by modulating B-cell receptor (BCR) clustering and internalization. We have generated a double conditional mouse lacking both WASP and N-WASP selectively in B lymphocytes (B/DcKO). Compared with B/WcKO mice, B/DcKO mice showed defective B-lymphocyte proliferation and impaired antibody responses to T-cell-dependent antigens, associated with decreased autoantibody production and lack of autoimmune kidney disease. These results demonstrate that N-WASP expression in B lymphocytes is required for the development of autoimmunity of WAS and may represent a novel therapeutic target in WAS.

La France arabo-orientale : treize siècles de présences du Maghreb, de la Turquie, d'Egypte, du Moyen-Orient et du Proche-Orient

La France arabo-orientale est une longue histoire, qui commence au VIIIe siècle au moment des conquêtes arabes et traverse treize siècles d'histoire de France, avec les présences de populations maghrébines, proche-orientales et ottomanes dans l'Hexagone. Celles-ci ont contribué à bâtir l'histoire politique, culturelle, militaire, religieuse, artistique et économique de ce pays, de l'empire carolingien de Charlemagne à la République actuelle. Cette anthologie en raconte pas à pas le récit (oublié), en montre les images (inédites) et en souligne tous les paradoxes des "Sarrasins" à la citoyenneté. Etre "Arabo-Oriental" en France, quel que soit le pays, l'empire, la culture, la colonie ou le département d'où l'on vient ou la religion qui est la sienne (chrétien, musulman ou juif), c'est inscrire dans un récit peuplé de héros, de lieux de mémoire, de mythes, de combats, de violences, de rêves et d'échecs, mais c'est aussi s'inscrire aujourd'hui dans ces identités multiples qui sont partie intégrante de la France du XXIe siècle. La France arabo-orientale est un livre unique au regard de l'incroyable iconographie qu'il propose, des enjeux qu'il porte et de l'histoire qu'il rend désormais accessible.

Catalunya, pol de recerca del sud d'Europa

A principis del decenni, Andreu Mas-Colell va iniciar una política que anava adreçada a la captació de talent. Andreu Mas-Colell és ara al govern, com aleshores, i aquesta política continua malgrat la crisi. Tanmateix, quan el govern era un altre, aquell govern va seguir la mateixa política. No va fer allò tan comú en els nostres polítics que és eliminar aquelles accions perquè les havia fet un altre partit. La política continuada durant deu anys ens ha situat relativament bé en el context internacional

Les comunitats d'innovació

La missió d'InnoLife és promoure l'esperit empresarial i el desenvolupament d'innovacions en la vida sana i l'envelliment actiu, dotar Europa de noves oportunitats i recursos. Entre altres ambiciosos objectius, el consorci preveu que el 2018 s'hagin creat 70 empreses 'start-up' i que 1.000.000 estudiants hagin participat en programes educatius en línia per any. InnoLife tindrà la seva seu central a Munic i sis centres de colocalització a tot Europa que seran Londres (per al Regne Unit i Irlanda), Estocolm (per Escandinàvia), Barcelona (per Espanya), París (per França), Heidelberg (per Alemanya) i Rotterdam (per Bèlgica i els Països Baixos)

La universitat funciona més bé que la política i l'empresa

La universitat catalana actual, deixant de banda els econòmics, té dos problemes. Un és la lentitud a adaptar-se i respondre a les demandes ciutadanes. El segon és la manca d'un sistema ben definit i sistemàtic de retiment de comptes a la societat. Resolts ambdós problemes, la universitat faria en poc temps un gran canvi per bé. La resposta a aquests problemes pot donar-se amb petites modificacions de la norma externa i algunes de més profundes en la interna que aportin més flexibilitat i autonomia

Caedes C. J. Caesari injuste illata

Invocatio: B.C.D.

Spectrophotometric determination of arsenic in soil samples using 2-(5-bromo-2-pyridylazo)-5-di-ethylaminophenol (Br-PADAP)

In this paper, a new, simple and sensitive method for arsenic determination in soil is proposed. This is based on the reduction of silver (I) and iron (III) ions by arsine followed by a complexation reaction of iron (II) with the spectrophotometric reagent Br-PADAP 2-(5-bromo-2-pyridylazo)-5-di-ethylaminophenol. Arsenic determination with a Sandell's sensitivity of 3.1 10-4 cm-2, linear range from 0.1 µg ml-1 to 2.0 µg ml-1 (r560 = 0.9995), molar absorptivity of 2.45 10(5) l mol-1 cm-1 and a concentration detection limit of 1.4 ng ml-1 (3s) were obtained using a 10 ml sample volume. Selectivity was increased with the use of EDTA as a masking agent. The proposed method was applied for arsenic determination in the presence of several ions amounts in digested soil samples. The results revealed that antimony (III), mercury (II), germanium (IV), platinum (IV) interferes at all analyzed proportions. The interferences can be easily removed by the use of EDTA. Precision and accuracy obtained were satisfactory with a R.S.D. < 5 %. Recovery of arsenic in soil samples varied from 95.55 to 102.70 % with a mean of 99.63 %. These results demonstrated that the proposed method is applicable for arsenic analysis in different soil samples.

Thinning effect on plant growth of pruned eucalypt clone

A pruned stand of eucalypt clone underwent five thinning treatments with the removal of different proportion of the planted trees, at different ages: a) 0% - unthinned, b) 35% at 55 months, c) 35% at 81 months, d) 70% at 81 months, removing sprouts in the thinned plant stumps and, e) 70% at 81 months, without coppice sprouts removal. By the age of 141 months, the Weibull distribution showed higher number of trees in the smallest diameter classes for the unthinned treatment. The 70% thinning, with thinned coppice sprouts removal, presented higher number of individuals in the largest diameter classes. Height and yield were the smallest with the removal of 70% of the trees at 81 months, maintaining coppice sprouts. The afterthinning periodic annual increment was greater by thinning 35% of the trees at 55 months resulting in greater number of trees in the largest diameter classes as compared to the other treatments. Yield was higher for the unthinned treatment. The results of this study indicated that thinning 70% of the trees at the age of 81 months, with coppice sprout removal, could be recommended to obtain trees of larger diameter for multiproduct.