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.

Instalaciones oleícolas y vinícolas estudiadas en el marco del Proyecto Ager Tarraconensis (PAT)

Dentro del Proyecto Ager Tarraconensis, se han estudiado en el Camp de Tarragona 19 yacimientos con indicios de instalaciones de producción de aceite o vino, que se centran especialmente entre los siglos I a.C. y II d.C. También se han estudiado 22 yacimientos con indicios de alfarería, en siete de los cuales se conoce la producción de ánforas vinarias. El hallazgo de diversas marcas de alfarero dónde identificamos el nombre de M. Clodius Martialis apunta hacia una rica familia de la elite de Tarraco, con la que se han relacionado cuatro yacimientos y quizás un quinto. Entre la época de Augusto y el siglo III, el vino se confirma como el producto principal de una agricultura desarrollada dentro del sistema de la villa, enfocada al mercado de ultramar. El aceite se debió producir para el consumo local. Esta región no volvió a potenciar la producción de vino a nivel de gran negocio de ámbito internacional hasta el siglo XVIII, con el cual se establece una comparación.

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.

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

Indicadors sorprenents

L'anàlisi de l'informe ens diu que, efectivament, els resultats són per amoïnar-se perquè si bé la gent més jove està més ben formada, les diferents lleis educatives no han servit per millorar gaire les capacitats dels ciutadans, sobretot si tenim en compte que els països que ens envolten milloren més que nosaltres. Alguns polítics ens diuen, molt contents, que ara l'educació arriba a tothom, que bé. A més d'anar a l'escola, entenen el que llegeixen? Aquest sembla que és el problema

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

Estalviar en R+D+I surt car

A Catalunya parlar d'innovació s'ha convertit gairebé en un tòpic. Sentim en declaracions i discursos que la R+D+I hauria de salvar l'economia del país, però, realment, quants dels que ho diuen s'ho creuen? No ho sé, però és evident que per sortir enfortits de la crisi necessitem innovar. Tanmateix, perquè la innovació es converteixi en un motor de l'economia fan falta polítiques que ho facin possible. La innovació no la fa l'administració, també ha d'innovar, com qualsevol organització, però no és l'administració la que té aquesta funció. Amb tot, sense l'administració la innovació no reïx. Els països que han fet de la innovació una prioritat política han crescut més

Caedes C. J. Caesari injuste illata

Invocatio: B.C.D.

Tolerância do milheto (Pennisetum americanum) ao 2, 4-D

Objetivou-se com este trabalho avaliar os efeitos do 2,4-D sobre o crescimento das plantas, a produção de massa seca e verde e a produtividade de grãos do milheto. O experimento foi realizado no período de março a junho de 2006, em Rio Verde-GO, em um Latossolo Vermelho eutroférrico. O milheto (cultivar ADR 500) foi semeado manualmente em área cultivada sob sistema de plantio direto, em espaçamento de 0,45 m, distribuindo-se 12 sementes por metro. Utilizou-se o delineamento de blocos casualizados, em esquema fatorial 4 x 4, sendo avaliadas quatro doses de 2,4-D (0, 335, 670 e 1.005 g ha-1) aplicadas em quatro épocas [10 dias após a emergência das plantas de milheto (DAE) (3 folhas); 20 DAE (5 a 6 folhas expandidas); 30 DAE (início de emissão da inflorescência); e 40 DAE (florescimento pleno)]. Para evitar a interferência das plantas daninhas na cultura, esta foi capinada manualmente, sempre que necessário. Não se observou nenhum sinal de intoxicação das plantas de milheto pelo 2,4-D aos 15 dias após a aplicação, independentemente da dose ou época de aplicação do herbicida. Todavia, as maiores doses de 2,4-D, em qualquer época de aplicação, provocaram menor acúmulo de massa verde e seca das plantas de milheto, quando se avaliaram os resultados no ponto de rolagem da cultura. O 2,4-D, independentemente da dose utilizada ou época de aplicação, não influenciou a produtividade de grãos do milheto.

Hepatitis B virus genotype E detected in Brazil in an African patient who is a frequent traveler

Genotype E of hepatitis B virus (HBV) has not been described in Brazil and is found mainly in Africa. Genotype A is the most prevalent in Brazil, and genotypes B, C, D, and F have already been reported. We report here an HBV genotype E-infected patient and some characterization of surface (S) protein, DNA polymerase (P) and precore/core (preC/C) coding regions based on the viral genome. The patient is a 31-year-old black man with chronic hepatitis B who was born and raised in Angola. He has been followed by a hepatologist in São Paulo, Brazil, since November 2003, and he is a frequent traveler to Latin America, Africa, and Europe. In 2003, he was diagnosed with HBV infection and started treatment with lamivudine with the later addition of adefovir dipivoxil. No known risk factor was identified. Serologically, he is HBsAg and anti-HBe positive, but HBeAg and anti-HBs negative. DNA sequence analysis of the S/P region confirmed that this patient is infected with genotype E, subtype ayw4. The preC/C region showed G1896A and G1899A mutations but no mutations in the basal core promoter. Nucleotide substitutions common in genotype E were also observed (C1772, T1858 and A1757). Although this is not an autochthonous case and there is no evidence of further spread, the description of this case in Brazil highlights the current risk of viral genotypes spreading with unprecedented speed due to constant travel around the world.

C-reactive protein in acute coronary syndrome: association with 3-year outcomes

Inflammatory markers have been associated with clinical outcome in patients with acute coronary syndrome (ACS). The present study evaluated the role of high-sensitivity C-reactive protein (CRP) measurements as a predictor of late cardiovascular outcomes after ACS. One hundred and ninety-nine ACS patients in a Coronary Care Unit from March to November 2002 were included and were reassessed clinically after ~3 years. Clinical variables and CRP levels were evaluated as predictors of major cardiovascular events (MACE, defined as the occurrence of cardiac death, ischemic stroke or myocardial infarction) and mortality. Statistical analyses included Cox multivariable analysis and survival curves (Kaplan-Meier). Of the 199 patients, 11 died within 1 month (5.5%). Of the 188 remaining patients, 22 died after a mean follow-up of 2.9 ± 0.5 years. Baseline CRP levels for patients with MACE (N = 57) were significantly higher than those of patients with no events (median = 0.67 mg/L; 25th-75th percentiles = 0.32 and 1.99 mg/L vs median = 0.45 mg/L; 25th-75th percentiles = 0.24 and 0.83 mg/L; P < 0.001). Patients with CRP levels >3 mg/L had a significantly lower survival than the other two groups (1-3 and <1 mg/L; P = 0.001, log-rank test). The odds ratio for MACE was 7.41 (2.03-27.09) for patients with CRP >3 mg/L compared with those with CRP <1 mg/L. For death by any cause, the hazard ratio was 4.58 (1.93-10.86). High CRP levels predicted worse long-term outcomes (MACE and death by any cause) in patients with ACS.