Evaluation of a hepatitis C clinical care coordination programme's effect on treatment initiation and cure: A surveillance-based propensity score matching approach.

Hepatitis C (HCV) is a viral infection that if left untreated can severely damage the liver. Project INSPIRE was a 3 year HCV care coordination programme in New York City (NYC) that aimed to address barriers to treatment initiation and cure by providing patients with supportive services and health promotion. We examined whether enrolment in Project INSPIRE was associated with differences in HCV treatment and cure compared with a demographically similar group not enrolled in the programme. INSPIRE participants in 2015 were matched with a cohort of HCV-infected persons identified in the NYC surveillance registry, using full optimal matching on propensity scores and stratified by INSPIRE enrolment status. Conditional logistic regression was used to assess group differences in the two treatment outcomes. Two follow-up sensitivity analyses using individual pair-matched sets and the full unadjusted cohort were also conducted. Treatment was initiated by 72% (790/1130) of INSPIRE participants and 36% (11 960/32 819) of study-eligible controls. Among initiators, 65% (514/790) of INSPIRE participants compared with 47% (5641/11 960) of controls achieved cure. In the matched analysis, enrolment in INSPIRE increased the odds of treatment initiation (OR: 5.25, 95% CI: 4.47-6.17) and cure (OR: 2.52, 95% CI: 2.00-3.16). Results from the sensitivity analyses showed agreement with the results from the full optimal match. Participation in the HCV care coordination programme significantly increased the probability of treatment initiation and cure, demonstrating that care coordination for HCV-infected individuals improves treatment outcomes.

Perceived benefits of the hepatitis C peer educators: a qualitative investigation.

BACKGROUND: Although opioid-dependent patients are disproportionately impacted by hepatitis C (HCV), many do not receive treatment. In addition to HCV treatment-access barriers, substance-using patients may be reluctant to pursue treatment because of wariness of the medical system, lack of knowledge, or stigma related to HCV treatment. Implementation of a formal peer education program is one model of reducing provider- and patient-level barriers to HCV treatment, by enhancing mutual trust and reducing stigma. METHODS: We used thematic qualitative analysis to explore how 30 HCV patients and peer educators perceived a HCV peer program within an established methadone maintenance program in the USA. RESULTS: Participants unanimously described the program as beneficial. Participants described the peer educators' normalization and dispelling of myths and fears around HCV treatment, and their exemplification of HCV treatment success, and reductions in perceived stigma. Peer educators described personal benefits. CONCLUSIONS: These findings indicate that HCV peer educators can enhance HCV treatment initiation and engagement within opioid substitution programs.

Paper-based microfluidic devices by asymmetric calendaring.

We report a simple, efficient, one-step, affordable method to produce open-channel paper-based microfluidic channels. One surface of a sheet of paper is selectively calendared, with concomitant hydrophobization, to create the microfluidic channel. Our method involves asymmetric mechanical modification of a paper surface using a rolling ball (ball-point pen) under a controlled amount of applied stress (σz) to ascertain that only one side is modified. A lubricating solvent (hexane) aids in the selective deformation. The lubricant also serves as a carrier for a perfluoroalkyl trichlorosilane allowing the channel to be made hydrophobic as it is formed. For brevity and clarity, we abbreviated this method as TACH (Targeted Asymmetric Calendaring and Hydrophobization). We demonstrate that TACH can be used to reliably produce channels of variable widths (size of the ball) and depths (number of passes), without affecting the nonworking surface of the paper. Using tomography, we demonstrate that these channels can vary from 10s to 100s of microns in diameter. The created hydrophobic barrier extends around the channel through wicking to ensure no leakages. We demonstrate, through modeling and fabrication, that flow properties of the resulting channels are analogous to conventional devices and are tunable based on associated dimensionless numbers.

Protective effects of melatonin against caustic esophageal burn injury in rats.

Caustic ingestion is one of the most life-threatening events in the pediatric age group, which requires the immediate management and subsequent treatment of its most significant complication, i.e. alterations in esophageal structure. We investigated whether melatonin could reduce the esophageal burn damage induced by sodium hydroxide. It was assumed that melatonin could be effective because of its function as a direct free radical scavenger, its antioxidative actions and its ability to diminish tissue hydroxyproline (HP) levels. Esophageal burns were induced in male rats by the administration of 10% sodium hydroxide. Lipid peroxidation (LPO) products were then measured at the following times: 0, 1, 6, 24, 48 and 72 hr after treatment. Tissue HP concentrations in the injured area were assessed at 14 days after the administration of sodium hydroxide. The groups received either systemic melatonin or normal saline. There were two, non-ischemic, sham control groups treated with or without melatonin. LPO products, malondialdehyde (MDA) and 4-hydroxyalkenal (4-HDA), increased immediately after the administration of sodium hydroxide; this indicates the participation of free radicals in the development of damage. Melatonin diminished the oxidative response and the amount of HP in the late phase of the lesion. Melatonin reduced oxidative damage in the early phase of the esophageal burns induced by sodium hydroxide.

Monosodium glutamate-induced damage in liver and kidney: a morphological and biochemical approach.

It has been demonstrated that high concentrations of monosodium glutamate in the central nervous system induce neuronal necrosis and damage in retina and circumventricular organs. In this model, the monosodium glutamate is used to induce an epileptic state; one that requires highly concentrated doses. The purpose of this study was to evaluate the toxic effects of the monosodium glutamate in liver and kidney after an intra-peritoneal injection. For the experiment, we used 192 Wistar rats to carry out the following assessments: a) the quantification of the enzymes alanine aminotransferase and aspartate aminotransferase, b) the quantification of the lipid peroxidation products and c) the morphological evaluation of the liver and kidney. During the experiment, all of these assessments were carried out at 0, 15, 30 and 45 min after the intra-peritoneal injection. In the rats that received monosodium glutamate, we observed increments in the concentration of alanine aminotransferase and aspartate aminotransferase at 30 and 45 min. Also, an increment of the lipid peroxidation products, in kidney, was exhibited at 15, 30 and 45 min while in liver it was observed at 30 and 45 min. Degenerative changes were observed (edema-degeneration-necrosis) at 15, 30 and 45 min.

HLA-A and HLA-B allele frequencies in a mestizo population from Guadalajara, Mexico, determined by sequence-based typing.

HLA-A and HLA-B genes were typed by DNA sequencing in a mestizo population from Guadalajara, Jalisco, Mexico. Thirty-seven HLA-A and 51 HLA-B alleles were observed in 103 samples. The common typical Amerindian alleles (>5%) and haplotypes (>or=2.0%) found were A*02010101, *24020101, *310102, B*350101, and *4002, and A*310102-B*4002, A*240201-B*350101, and the typical European alleles were A*010101, *29010101, B*1402, B*180101, and A*020101-B*1402, A*020101-B*510101, and A*3002-B*180101. This reflects the blending of the two main parental populations of mestizos: Amerindian and Iberian. Mexicans were found to be relatively closer to the Portuguese than to Spaniards. This proximity may indicate a larger Portuguese influence in Mexicans than previously considered. Present data contribute to the understanding of the genetic structure in Mexico.

Effect of exogenous melatonin on hepatic energetic status during ischemia/reperfusion: possible role of tumor necrosis factor-alpha and nitric oxide.

BACKGROUND: This study was designed to determine if the very potent antioxidant melatonin is able to reduce organ damage and improve energetic status in an in situ liver ischemia/reperfusion model. MATERIALS AND METHODS: Total hepatic ischemia was induced in rats by occlusion of the hepatic artery, portal vein, and bile duct. A portojugular shunt was inserted. After 60 min of ischemia, reperfusion was established for a period of 120 min. Rats were assigned to one group receiving systemic melatonin administration or to another receiving only normal saline. Variables were observed at preischemia, after 60 min of ischemia, and at 30, 60, and 120 min of reperfusion. RESULTS: Energy charge, measured as the arterial ketone body ratio, showed higher values in the melatonin group during the first 60 min of reperfusion. Rises in plasma nitrite, tumor necrosis factor (TNF)-alpha, aspartate aminotransferase, alanine aminotransferase, lipid peroxidation products, and inducible nitric oxide synthase (iNOS) expression were less severe with melatonin. Linear regression analysis demonstrated a significant correlation between nitrites and arterial ketone body ratio (R(2) = 0.2454). Bile production was higher with melatonin. Seven-day survival rates were 52% for control, 80% for melatonin, and 100% for sham groups. CONCLUSIONS: Exogenous melatonin is capable of preserving the functional and energetic status during ischemia/reperfusion which is associated with reduced concentrations of TNF-alpha and inhibited expression of iNOS and NO production. This improvement may be due to an adequate preservation of the hepatic mitochondrial redox status.

Blood flow rate and energy charge in the isolated perfused canine liver.

Background. Liver viability depends on blood flow rate, which varies among isolated perfused livers used in different studies. We aimed to identify the minimal blood flow capable of keeping the energy charge compatible with liver viability. Materials and methods. Isolated canine livers were assigned to different groups (n = 4) with blood flow rates of 0.5 (Group I), 1.0 (Group II), and 1.5 ml/g/min (Group III). Blood gases, hematocrit, and glucose were measured over 180 min. Nucleotides, serum osmolarity, and electrolytes were also measured. Morphological changes were recorded at the end of each experiment. Results. Acid-base balance was better in livers from Group III. Electrolytes, osmolarity, hematocrit, and glucose showed no differences. Higher energy charges correlated with higher blood flow rates. On histopathology, there was evidence of more hydrostatic pressure-related changes in Group III, with no difference in necrosis or inflammatory-related alterations. Conclusions. (1) Energy charge correlates strongly with blood flow rate. (2) A rate of 1.5 ml/g/min allows for a better electrolyte, osmolarity, and acid-base balance. (3) Morphological analysis is not a sensitive predictor of organ viability as assessed by energetic potential. (4) The minimal blood flow rate required to attain an energy charge above 0.75 is 1.33 ml/g/min.

A model of suture-induced urolithiasis with urographic control in the bladder of the rat.

The characteristics of a model of urolithiasis in the bladder of male Wistar rats were evaluated. Two techniques were compared: one knot of suture material through the bladder wall, or 15-throw knots inside the bladder. Rats were randomly assigned to one of six groups, according to the technique and suture material used (polyester, silk, or chromic catgut). An excretory urogram was performed at days 30, 60, and 90. At the moment of positive radiographic diagnosis, animals were sacrificed and stones were obtained. All rats were sacrificed at day 90 regardless of the x-ray results. Variables evaluated were average days to a positive urogram, average weight of all uroliths, and percentage of animals developing urolithiasis throughout the study. There were no statistical differences between groups for the average weight of stones, which ranged from 0.008 to 1.502 g for individual cases. All three materials were more lithogenic with the 15-throw knot inside technique. No significant differences were detected for lithogenesis criteria between suture materials. X-ray dispersion spectroscopy evidenced calcium phosphate composition of two stones from chromic catgut, and magnesium phosphate composition of two stones from chromic catgut, two from silk, and two from polyester. Neo-epithelization over the suture was confirmed microscopically in bladders with the one-throw technique. We conclude that (1) this is an effective model of urolithiasis, with predictability in time, composition, and amount of stone formation; (2) the presence of more suture material inside the bladder is more lithogenic; and (3) excretory urograms are highly sensitive and specific for the noninvasive diagnosis of bladder urolithiasis.

Obstructive jaundice as the first clinical manifestation of a metastatic malignant melanoma in the ampulla of vater.

The authors report a patient with obstructive jaundice as the first clinical manifestation of a primary malignant melanoma metastatic in the ampulla of Vater. After the histologic diagnosis of the metastases was made, the primary tumor was located in the skin of the back. Obstruction jaundice secondary to ampullary obstruction due to metastatic melanoma has only been reported twice, and in neither case was jaundice the first symptom of the disease.

Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers' wellbeing in a Mexican public hospital: a randomised clinical trial.

OBJECT: To evaluate the effects of psychosocial support during labour, delivery and the immediate postpartum period provided by a female companion (doula). DESIGN: The effects of the intervention were assessed by means of a randomised clinical trial. Social support by a doula was provided to women in the intervention group, while women in the control arm received routine care. SETTING: A large social security hospital in Mexico City. PARTICIPANTS: Seven hundred and twenty-four women with a single fetus, no previous vaginal delivery, < 6 cm of cervical dilatation, and no indications for an elective caesarean section were randomly assigned to be accompanied by a doula, or to receive routine care. OUTCOME MEASURES: Breastfeeding practices, duration of labour, medical interventions, mother's emotional conditions, and newborn's health. METHODS: Blinded interviewers obtained data from the clinical records, during encounters with women in the immediate postpartum period, and at their homes 40 days after birth. Relative risks and confidence intervals were estimated for all relevant outcomes. RESULTS: The frequency of exclusive breastfeeding one month after birth was significantly higher in the intervention group (RR 1.64; I-C: 1.01-2.64), as were the behaviours that promote breastfeeding. However, the programme did not achieve a significant effect on full breastfeeding. More women in the intervention group perceived a high degree of control over the delivery experience, and the duration of labour was shorter than in the control group (4.56 hours vs 5.58 hours; RR 1.07 CI (95%) = 1.52 to -0.51). There were no effects either on medical interventions, mothers' anxiety, self-esteem, perception of pain and satisfaction, or in newborns' conditions. CONCLUSIONS: Psychosocial support by doulas had a positive effect on breastfeeding and duration of labour. It had a more limited impact on medical interventions, perhaps because of the strict routine in hospital procedures, the cultural background of the women, the short duration of the intervention, and the profile of the doulas. It is important to include psychosocial support as a component of breastfeeding promotion strategies.

PIP: Studies in numerous countries have documented the positive contributions of doulas--women experienced in childbirth who provide continuous physical, emotional, and informational support to women before, during, and just after childbirth. The present study, conducted in a Mexican Institute of Social Security public hospital, explored the hypothesis that psychosocial support from a doula increases exclusive and full breast feeding by improving the mother's emotional status, shortening the duration of labor, and decreasing medical intervention. 724 women with no previous vaginal delivery and no indications for cesarean section delivery were randomly assigned to be accompanied by a doula (n = 361) or to receive routine care (n = 363). Blinded interviewers obtained outcome data from the clinical records, encounters with mothers in the immediate postpartum period, and home visits 40 days after delivery. The frequency of exclusive breast feeding 1 month after birth was significantly higher in the intervention group than the control group (12% vs. 7%; relative risk (RR), 1.64; 95% confidence interval (CI), 1.01-2.64). However, the program did not achieve a significant effect on full breast feeding (37% and 36%, respectively). The duration of labor was shorter in the intervention group than the control group (4.56 vs. 5.58 hours; RR, 1.07; 95% CI, -1.52-0.51). A significantly larger proportion of women in the intervention group than the control group perceived a high level of control over labor (79.8% vs. 77.1%; RR, 1.14; 95% CI, 1.03-1.27). There were no effects on medical interventions, maternal anxiety, self-esteem, perception of pain, maternal satisfaction, or newborn Apgar scores. Although the prevalence of exclusive breast feeding was low in both groups, these findings suggest that psychosocial support during labor and the immediate postpartum period should be part of a comprehensive strategy to promote breast feeding.

"Alone, I wouldn't have known what to do": a qualitative study on social support during labor and delivery in Mexico.

This article presents some of the most relevant qualitative results of a trial to evaluate the effects of the provision of psychosocial support to first-time mothers during labor, childbirth and in the immediate postpartum period in a social security hospital in Mexico City. The article focuses on the experiences of mothers who have received psychosocial support from a doula (the term doula is used to identify a woman who provides continuous support to a woman during labor. delivery and the immediate postpartum period) and compares them with the experiences of those women who gave birth following normal hospital routine. Sixteen in-depth interviews were held with women in the immediate post partum period (eight of whom had been accompanied by a doula and eight who had not) before they were discharged from hospital, and the results were analyzed using qualitative techniques. The interviews showed that the women accompanied by a doula had a more positive childbirth experience. The differences between both groups related to their perceptions of the childbirth experience; the treatment they received from hospital staff; the information they were given and how well they understood it; their perception of hospital routines; their feelings about cesarean sections and, spatial and temporal perceptions. The most important difference between the two groups was the way they expressed their feelings about their own labor, their sense of control and their self-perception.

[Polypectomy of the digestive tract]. / Polipectomía del tubo digestivo.

Endoscopic polypectomy was one of the first therapeutic procedures, as it was done even before the appearance of colonoscopy through rigid endoscopies. Immediately after the use of monopolar current in endoscopy, polyp resection in the digestive tract has been a elective treatment, and is reserved only for surgeries which are very extensive, or those which cannot be surrounded with a wire loop. The impact of the polypectomy in colonic adenomas has been notable because of the possibility of the diagnosis of the entire surgical piece, and for the treatment of lesions with premalignant potential. The success of the complete resection of a colonic polyp is directly proportional to its size and shape, given that pendicular polyps guarantee the complete extirpation of the tumor, in that sessile polyps require additional techniques to elevate the lesion. Among the precautions in prepolypectomy are found the following: Anti-inflammatory non-steroidal (AINS) suspension; anticoagulant suspension, and adequate intestinal preparation. Hemorrhage and perforation occur in 0.1% of each. Postcoagulation syndrome is a secondary effect which only requires vigilance. The inherent complications in the use of secondary current are minimal when its technical principles are known. The success of endoscopic polypectomy depends on the refinement of the procedure, which is achieved through experience.

[Optimization of the tagged urea test for the detection of H. pylori in patients with dyspepsia]. / Optimización de la prueba de la urea marcada para la detección de H. pylori en pacientes con dispepsia.

Helicobacter pylori (Hp) has been associated to gastritis, peptic ulcer, gastric cancer, and other gastrointestinal disorders. The 14C-urea breath test (UBT) has been proposed as a simple and noninvasive method for its detection, and has recently been implemented in our institution. To optimize our resources, we performed a sensitivity analysis to determine the minimal sampling and duration of testing required, and to establish objective criteria for its interpretation. With this purpose, endoscopy, antral biopsy and UBT were performed in 104 dyspeptic patients. For the UBT, a basal breath sample was taken before the administration of 10 microCi of 14C-urea and followed by sequential breath sampling at 5, 15, 30 and 60 minutes. Considering histologic findings as the gold standard, receiver operating characteristic (ROC) curves were constructed for the following three 14CO2 excretion strategies: excretion by sample, maximum excretion, and cumulative excretion. Hp was detected in 74 (71%) of the patients, and its presence coincided with significantly higher 14CO2 excretion than in the Hp negative (p < 0.001). The three excretion strategies were comparable in terms of diagnostic accuracy, but the most efficient results were given by the 15 minute sample. With a cut-off point of > or = 1.7%, the sensitivity and specificity of this sample was > or = 83%, the positive and negative predictive values were 93% and 68%, and the accuracy was 84%. We conclude that UBT can be completed with a single breath sampling at 15 min, and its results objectively interpreted as positive if the 14CO2 excretion is > or = 1.7%.

[Psychosocial support in pregnancy as a strategy to promote the newborn's health]. / El apoyo psicosocial durante el embarazo como estrategia para promover la salud del recién nacido.

In this project we developed a social support and health education intervention meant to answer whether or not a program of this kind, within the present medical system, can improve perinatal outcomes. A multicenter randomized controlled trial was conducted in four Latin American countries. In Mexico, the project was carried out in a third level obstetric hospital. Patients were screened between the 15th and 22nd week of gestation. Inclusion criteria were factors associated with high risk of low birthweight. A total of 620 women were recruited, randomized and followed up during pregnancy and up to the 40th day post partum. Women in the intervention group were visited four to six times during pregnancy, could use a telephone hot line and a consultation service. A poster and a pamphlet meant to reinforce health education were handed out in the first visit. A "guided tour" for women at the end of pregnancy was organized periodically. Outcomes were measured in both groups at the 36th week of gestation, post partum and 40 days after delivery. Neonatal outcomes were obtained by blind interviewers from the clinical records. Neither in the multicenter nor in the Mexican sample were we able to modify the incidence of low birthweight and prematurity. However, in Mexico we obtained positive effects on birthweight and gestational age in the whole sample and in some specific strata. These results strongly suggest the convenience of replicating the study in Mexico.

[Non-neoplastic polyps of the colon]. / Pólipos no neoplásicos del colon.

Non-neoplastic colon polyps are benign lesions with normal histology components, we present our experience with colonoscopy polypectomy in 10 years. We resected 187 polyps in 96 patients (50 males) with medium age of 49.3 years and range 2-82. Most common indication was hemorrhage (37%) taking out the hyperplastic polyps who were found in asymptomatic patients with the highest frequency (41%). Juvenile polyps follows with 25%. 71% polyps were unique but hamaetomatous polyps of Peutz-Jeghers syndrome were multiple (39%). Juvenile (retention) polyps were found among the youngest patients (average 13.2 years) and frequently had hemorrhage (21-25). Lipomas were found in elder patients (range 52.5 years). We had no major complications with hemorrhage or mortality, minor complications were found in 3.09%.