ABSTRACT
The availability of effective, simple, well-tolerated oral direct-acting antiviral (DAA) hepatitis C regimens has raised optimism for hepatitis C virus (HCV) elimination at the population level. HCV reinfection in key populations such as people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM) however threatens the achievement of this goal from a patient, provider and population perspective. The goal of this review was to synthesize our current understanding of estimated rates and factors associated with HCV reinfection. This review also proposes interventions to aid understanding of and reduce hepatitis C reinfection among PWID and HIV-infected MSM in the oral direct-acting antiviral era.
Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/epidemiology , Administration, Oral , Homosexuality, Male , Humans , Incidence , Male , Recurrence , Risk Factors , Substance Abuse, IntravenousABSTRACT
A case is reported of a 59 y/o woman with a large cell CNS lymphoma and a small cell lymphocytic lymphoma in the bone marrow. The brain tumor underwent spontaneous regression and subsequent regrowth while there was slow progression of the systemic small cell lymphoma. The CNS lymphoma regressed rapidly following treatment with prednisone and cyclophosphamide. We hypothesize that the small cell lymphoma in this patient may represent an underlying immunodeficiency disorder.
Subject(s)
Brain Neoplasms/pathology , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Lymphoma, Large B-Cell, Diffuse/pathology , Neoplasms, Multiple Primary/pathology , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/drug therapy , Female , Follow-Up Studies , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/diagnostic imaging , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Lymphoma, Large B-Cell, Diffuse/diagnostic imaging , Middle Aged , Neoplasms, Multiple Primary/diagnostic imaging , Neoplasms, Multiple Primary/drug therapy , Tomography, X-Ray ComputedABSTRACT
The neonatal neurobehavioral effects of bupivacaine, mepivacaine, and 2-chloroprocaine used in random sequence for pudendal block anesthesia were studied. The neurobehavioral status of 54 infants was studied 4 and 24 hours after delivery. Except for a significant difference in the responses to pinprick, there was no significant effect of any of these agents on infant neurobehavior, and no differences were found among the agents themselves. Mean mepivacaine levels in neonatal capillary blood at 4 hours of age were low (0.10 +/- .02 microgram/ml) compared with those in previous studies because of the short interval between maternal injection and delivery (13 +/- 3 min). Bupivacaine gave higher neonatal capillary blood levels (0.15 microgram/ml at 4 hours of age) than previously reported, but the drug still produced no detectable neonatal neurobehavioral effects.
Subject(s)
Anesthesia, Obstetrical/adverse effects , Arousal/drug effects , Bupivacaine/pharmacology , Infant, Newborn , Maternal-Fetal Exchange , Mepivacaine/pharmacology , Nerve Block/adverse effects , Procaine/analogs & derivatives , Procaine/pharmacology , Adolescent , Adult , Anesthesia, Epidural , Bupivacaine/blood , Female , Humans , Mepivacaine/blood , Pregnancy , Procaine/bloodABSTRACT
Increases in the maternal-fetal pH gradient that may occur during labor and delivery may increase the fetal concentration of local anesthetics. The authors evaluated effects of pH changes on the transplacental concentration equilibrium of bupivacaine. They increased the maternal-fetal pH gradient in each of six pregnant ewes from a control value of 0.15 to 0.54 by hyperventilating the lungs of the ewe and infusing lactic acid into her fetus. After infusion of bupivacaine, 0.15 mg/kg, intravenously into the mother, the drug rapidly appeared in fetal blood, with values significantly increased over control values at 1 and 5 min. The fetal/maternal (f/m) ratios were increased significantly at 5, 15, and 30 min. The f/m ratios had stabilized by 15 min in both control and experimental states, suggesting that equilibrium had been achieved. The consistently low f/m ratios are explained by the presumed similarity of the ovine maternal and fetal protein binding rates to those of man. It is concluded that the maternal and fetal pH values are major factors in the determination of the f/m ratios.
Subject(s)
Bupivacaine/pharmacology , Maternal-Fetal Exchange , Placenta/drug effects , Alkalosis, Respiratory/etiology , Animals , Blood Pressure/drug effects , Female , Fetus/drug effects , Heart Rate/drug effects , Hydrogen-Ion Concentration , Pregnancy , SheepABSTRACT
A recent study found no neurobehavioral change in infants whose mothers received bupivacaine epidural anesthesia (112 +/- 7 mg) for labor and vaginal delivery. The present study was undertaken to examine the possibility that the larger doses of bupivicaine necessary for cesarean section might cause neurobehavioral changes in the neonate. Ten infants delivered by cesarean section with bupivacaine epidural anesthesia (168 +/- 7 mg) was assessed by Scanlon's neonatal neurobehavioral examination. They were compared in a prospective randomized study with a control group of ten infants delivered with tetracaine spinal anesthesia. In the experimental group bupivacaine was detectable in umbilical arterial blood (.17 +/- .07 microgram/ml), umbilical venous blood (.21 +/- .09 microgram/ml), and neonatal blood samples at 4 hours of age (.04 +/- .04 microgram/ml). By 24 hours of age bupivacaine was no longer detectable in newborn blood samples. Infants in the experimental group were indistinguishable from control infants in terms of their motor organization, responsiveness to external stimuli, and habituation to repetitive stimuli. Detectable neurobehavioral effects were absent despite the fact that 1.5 times the dose of bupivacaine used for labor and vaginal delivery was employed in this study.
