Management and treatment of hepatitis C virus in patients with HIV and hepatitis C virus coinfection: A practical guide for health care professionals

Concomitant HIV and hepatitis C virus (HCV) is a common yet complex coinfection. The present document is a practical guide for treating HCV infection in people coinfected with HIV. Effective antiretroviral therapies have prolonged survival rates for HIV-infected people over the past decade, which have made latent complications of HCV major causes of morbidity and mortality in these patients. Advances in the treatment of HCV (eg, combined pegylated interferon and ribavirin) offer the possibility of eradicating HCV infection in coinfected persons. The treatment of HCV must be considered in all cases. Intensive management of the adverse effects of HCV treatment is one of the factors for the success of these therapies. HCV eradication is predicted to decrease the mortality associated with coinfection and reduce the toxicity of HIV treatment.     

Mutations in NSCLC and their link with lung cancer-associated thrombosis: A case-control study

Introduction

The association of venous thromboembolic events (VTE) and lung cancer is highly prevalent. Additionally, the occurrence of a VTE with cancer has been associated with a worse prognosis and a poor quality of life. Underlying cancer biological features such as tumour mutations may contribute to VTE risk and cancer prognosis. Since preclinical data suggest a link between thrombosis and KRAS mutations in tumours, we aimed to validate this association in a patient registry cohort. Methods: A retrospective case control study was performed using the CHUM NSCLC registry. Cases had VTE occurring 6 months previous to or after a diagnosis of NSCLC. Diagnosis of VTE (venous thrombosis, pulmonary embolism, and migratory superficial thrombophlebitis) was confirmed by a review of the imaging reports. Controls were patients with NSCLC without thrombosis matched for age and stage (I-IIIA/IIIB-IV). Exclusion criteria included insufficient tissue for KRAS/EGFR mutation analysis or insufficient clinical information.

Results

Between Jan 2000 and Dec 2009 a total of 57 cases with VTE and 102 controls without VTE were included. The OR for thrombosis in KRAS and EGFR mutated NSCLC patients are respectively 2.67 (1.12-6.42; p = 0.014) and 0.99 (0.27-3.48; p = 0.99).

Conclusions

KRAS mutation is associated with an increased risk of VTE in this NSCLC cohort. These findings are consistent with preclinical studies. Prospective data on VTE rates from clinical trials with molecularly defined NSCLC are needed to confirm these findings.     

Environmental barcoding of the ectomycorrhizal fungal genus Cortinarius

Understanding the role of ectomycorrhizal fungi in plant communities is hampered by a lack of knowledge about fungal diversity. DNA barcoding of the ectomycorrhizal fungal genus Cortinarius was used to compare fungal diversity in soil from four plant communities: (i) Nothofagus forest (where Cortinarius is common and diverse), (ii) Kunzea forest (where Cortinarius is present but with low diversity), (iii) a Pinus radiata plantation (Cortinarius is not thought to be present) and (iv) a sub-Antarctic island (where known ectomycorrhizal hosts are absent). PCR primers specific for the ITS region of Cortinarius species were developed. Specificity was tested in vitro and in silico against DNA from basidiocarps of Cortinarius and non-Cortinarius species. The primers were tested for their ability to amplify Cortinarius DNA in soil from forests of the three ectomycorrhizal forest communities and a range of soils from the ectomycorrhiza-free subantarctic Campbell Island. High diversity of Cortinarius was associated with soil of all three ectomycorrhizal communities, despite Cortinarius being previously unrecorded from Pinus. Soil from all three communities share some ectomycorrhizal fungi (including fungi shared between native and exotic hosts), having implications for community succession, introduction of exotic fungi and biodiversity assessment. No Cortinarius was detected from Campbell Island samples. The validated molecular protocol assessed species diversity in a rapid and cost effective way. Baseline biodiversity assessment based on DNA barcoding is more effective at detecting diversity than traditional methods, but requires careful consideration of the difference between ectomycorrhizal fungal diversity in soil versus root-tips.     

Promoting patient dignity in healthcare settings

Dignity is important to every individual, irrespective of the situation in which they find themselves, including healthcare settings. This article aims to heighten awareness of patient dignity, encourage readers to reflect on the concept and apply it to practice. Self-awareness of knowledge, skills and attitude is a prerequisite for supporting patient dignity. Using personal and professional knowledge, readers will reflect on practice to identify factors that influence the maintenance of patient dignity and develop strategies to promote and support it in clinical practice.