Pancreatic toxic effects associated with co-administration of didanosine and tenofovir in HIV-infected adults

The rise in didanosine concentrations in plasma when given with tenofovir raises concern for a high risk of toxic effects. Recommendations to reduce didanosine dose have been issued, but only for adults weighing more than 60 kg. We reviewed cases of pancreatitis in patients receiving didanosine plus tenofovir, didanosine alone, and tenofovir alone to assess the incidence of and risk factors for pancreatitis. Between Aug 1, 2001, and Nov 30, 2003, five of 185 (2.7%) patients receiving didanosine plus tenofovir, one of 182 (0.5%) on didanosine without tenofovir, and none of 208 on tenofovir without didanosine developed pancreatitis (p=0.016). Co-administration of both drugs versus each of them individually was an independent risk factor for pancreatitis (crude hazard ratio 10.666, 95% CI 1.246-91.294, p=0.031). These results suggest that the risk of pancreatitis is heightened when didanosine and tenofovir are given together.     

Evidence‐Based Practice in a Global Context

This commentary examines how the adoption of benchmarking can promote the internationalization of evidence‐based practice. Given the increasing evidence documenting the role of culture and context in the shaping of experiences and expressions of distress, as well as influencing attitudes and conceptions of mental health services, benchmarking may not represent the best approach to addressing global public health agendas. A brief overview of the sequential approach to developing, evaluating, and disseminating treatments in novel cultural contexts is presented, in which benchmarking can play an important, albeit secondary role. It is argued that in a global context, benchmarking's role may better function to promote dissemination within particular contexts, rather than between them.     

Examining Potential Substance Use Disorders Among Former Interscholastic Athletes

Background: Despite numerous studies examining the association between competitive sports participation and substance use behaviors among adolescents and young adults, the use of standardized measures to assess potential substance use disorders has been largely neglected. The objective of this study was to examine if past involvement in interscholastic sports (competitive school-sponsored sports) was associated with potential substance use disorders in young adulthood. Methods: Data for this study were taken from the Student Life Survey (SLS). A total of 3442 young adults participated in the SLS during the spring semester in 2013, with 74% of males and 71% of females indicating participation in interscholastic sport during high school. Results: Respondents who participated in interscholastic sports during high school had higher odds of positive screens for potential alcohol use disorders when compared with their peers who did not participate in interscholastic sports. No association was detected between interscholastic sports participation and potential drug abuse disorders. Moreover, previous involvement in certain types of sports was found to be associated with positive screens for potential alcohol use disorders (i.e., crew and football) and positive screens for potential drug abuse disorders (i.e., lacrosse) among the sample of young adults. Conclusions: School and community sport organizations should be aware of the potential link between sports participation and potential substance use disorders, and may consider brief substance use screeners during yearly physicals to monitor potential substance use problems among athletes.     

Interferon-alpha in acute posttransfusion hepatitis C: a randomized, controlled trial.

To assess the efficacy of interferon-alpha in acute hepatitis C, 28 patients with acute posttransfusion hepatitis were randomized to receive 3 million units of recombinant interferon-alpha three times weekly for 12 wk or no treatment. Biochemical, histological and serological parameters were monitored during 1 yr of follow-up. Serum ALT levels were normal at the end of therapy in 73% of treated patients and only in 38% of control patients (p = 0.06); these differences disappeared at 6 and 12 mo of follow-up. Anti-hepatitis C virus seroconversion occurred later and at a lower rate in the group of patients who received interferon-alpha. Treated patients had a trend toward less severe hepatic lesions with lower histological activity as compared with the control group, but no statistical differences were observed. No severe side effects of interferon-alpha were detected during the study. In summary, a 3-mo course of interferon-alpha in acute hepatitis C is safe and might have some effect in diminishing disease activity only during the treatment period; however, and probably because of a small sample size, no benefit of interferon-alpha in the long-term outcome of this disease was demonstrated.