Hepatitis B Reactivation Following Eradication of HCV with Direct-Acting Antiviral Drugs (DAAs) in a Cohort of Patients from Different Institutions in Egypt.

Background: Concerns about HBV reactivation (HBVr) have been raised with the introduction of DAA for HCV treatment. The aim of the study was to assess the risk of HBVr in chronic HCV patients during or after DAA. Methods: A cohort of 166 chronic HCV patients who were treated with SOF-based DAA regimens and initially positive for HBcAb total were evaluated; 10 HBsAg-positive, 156 had past HBV exposure (HBsAg-negative/HBcAb-positive). Laboratory investigations, including liver functions tests, HBV-DNA, LSM by Transient elastography, and ARFI together with serum markers of fibrosis; APRI and FIB-4 were done at baseline and after 12 weeks of DAAs therapy. HBV-DNA levels and liver functions were monitored for assessment of HBVr. Results: Virological HBVr was diagnosed by ≥ 1 log10 IU/ml HBV-DNA levels in 2/166 patients (1.2%) among the whole HCV cohort, who were initially positive for HBsAg; 20%. Clinical HBVr (>3 folds liver enzyme elevation) was detected in one patient with virological HBVr. Conversely, none of past HBV-infected patients experienced HBVr. All patients achieved SVR12 and had a significant decline in serum transaminases, bilirubin, APRI, and LSM measurements after HCV eradication. Conclusion: HBVr might be considered after successful eradication of HCV following DAAs therapy, especially among patients who are positive for HBsAg, while past HBV infection does not seem to be a predisposing condition to HBVr.

Food Insecurity and Diabetes: The Role of Federally Qualified Health Centers as Pillars of Community Health.

Food insecurity is a complex public health problem affecting millions of people globally. It leads to negative health outcomes in the afflicted population and the society at large. There is a self-perpetuating vicious cycle between food insecurity and chronic health conditions like diabetes. It is important for healthcare professionals to be aware of its existence, to be able to recognize it, and to work with their patients to find solutions for it. Simultaneously, the providers should advocate for their patients and make program administrators, policymakers, and legislatures aware of this crisis. During the current coronavirus disease 2019 (COVID-19) pandemic, when economies have been badly affected and many people have lost their jobs, this subject has arguably assumed much greater importance. In this article, we discuss the magnitude of the problem, its relation to diabetes mellitus, and the role that a Federally Qualified Health Center (FQHC) can play in mitigating this problem.

La universidad y su articulación con la sociedad en la búsqueda de entornos saludables en Yaguajay / The university and its coordination with the society in the search of healthy environments

RESUMEN Analizar el papel del centro universitario en la articulación con la universidad médica en la búsqueda de entornos saludables y su contribución al desarrollo local en el municipio Yaguajay, constituye el propósito fundamental del presente trabajo, para el que se realizó una revisión documental de numerosos documentos y entrevistas a los principales líderes y a la población. El fomento de prácticas y estilos de vida sanos, la integración y capacitación de actores sociales, el desarrollo de la ciencia, la innovación tecnológica y del potencial científico productivo, junto a la sostenibilidad ambiental, fueron algunos de los resultados evidenciados. Se constató que la universidad en el territorio trabajó por incentivar una cultura saludable, por unificar esfuerzos, coordinar acciones, involucrar sectores, consolidar alianzas interinstitucionales dentro y fuera de la esfera sanitaria, con lo que se demostró la fortaleza de la promoción de salud dentro de los procesos de desarrollo local.

ABSTRACT To analyze the role of the university center in the coordination with the medical university in the search of healthy environments and its contribution to the local development in the municipality Yaguajay, constitutes the fundamental intention of the present work, for which a documentary review of numerous documents was carried out and interviews to the principal leaders and the population. The promotion of practices and healthy life styles, the integration and training of social actors, the development of the science, the technological innovation and of the productive scientific potential, along with the environmental sustainability, were some of the demonstrated results. It was stated that the university at the territory was employed for encouraging a healthy culture, for unifying efforts, coordinating actions, involving sectors, consolidating inter-institutional alliances inside and out of the sanitary sphere, with what there was demonstrated the fortitude of the promotion of health inside the processes of local development.

In-hospital organization of primary care of patients presenting a life-threatening emergency: A French national survey in 32 university hospitals.

INTRODUCTION: The development of specialized units dedicated to life-threatening management has demonstrated to improve the prognosis of patients requiring such treatments. However, apart those focused on trauma and stroke, networks are still lacking in France. Despite, the implementation of standardisation of practices and guidelines, particularly in prehospital care, in-hospital clinical practices at admission remain heterogenous. This survey aimed to assess the structural and human organization of teaching hospitals in France concerning the primary in-hospital care for critically ill patients. MATERIAL AND METHOD: A questionnaire of 45 items was sent by e-mail to 32 teaching hospitals between January and March 2013. It included information related to the description of the emergency department, of ICUs, and both structural and human organizations for primary in-hospital care of life-threatening patients. RESULTS: Seventy-five percent of teaching hospitals answered to the survey. Seven hundred to 1400 patients were admitted to emergency units per week and among them 10 to 20 were admitted for critically ill conditions. These latter were addressed in a specialized room of the emergency unit (Service d'admission des urgences vitales [SAUV]) in 40% of hospitals and in specialized room in ICU in 18% of cases. Intensivists were involved in 50% of hospitals, emergency physicians in 26% and it was mixed in 24% of hospitals. CONCLUSION: This survey is the first to assess the in-hospital organization of primary care for instable and life-threatening patients in France. Our results confirmed the extreme heterogeneity of structural and human organizations for primary in-hospital care of patients presenting at least one organ failure. Thus, a consensus is probably needed to homogenize and improve our practices.

The Northern California Conference for Guidelines on Aid-in-Dying.

End-of-life care in the United States is inadequate. Long-standing and unresolved issues in the care of the terminally ill have led to debates that have become major bioethical issues. Recognizing that practical solutions to deal with these issues are desperately needed, the Stanford University Center for Biomedical Ethics organized and convened a consensus development conference for health care professionals and health care institutions on Sept. 27 and 28, 1996.

Report of the Northern California Conference for Guidelines on Aid-in-Dying: definitions, differences, convergences, conclusions.

In September 1996, the Stanford University Center for Biomedical Ethics convened a conference entitled "Comprehensive Care of the Terminally Ill: The Northern California Consensus Development Conference for Guidelines on Aid-in-Dying." The regionally based, multidisciplinary conference gathered people from a variety of disciplines and diverse perspectives on physician aid-in-dying. This report documents important points of convergence, disagreement, and uncertainty that emerged from the conference and provides commentary on crucial issues: the definition of terminal illness, ensuring adequate palliative care, psychiatric challenges, coping with family pressures, the doctor-patient relationship, the managed care context, the role of ethics committees, and institutional challenges. Should physician aid-in-dying become a legal practice in California, the report will provide guidance to health care organizations, health professionals, and public policy officials engaged in local or state guideline or policy development.