Marijuana use in hepatitis C infection does not affect liver biopsy histology or treatment outcomes

BACKGROUND:

Marijuana smoking is prevalent among hepatitis C virus-infected patients. The literature assessing the influence of marijuana on liver disease progression and hepatitis C virus antiviral treatment outcomes is conflicting.

METHODS:

The authors evaluated hepatitis C virus RNA-positive patients followed at The Ottawa Hospital Viral Hepatitis Clinic (Ottawa, Ontario) from 2000 to 2009. Using The Ottawa Hospital Viral Hepatitis Clinic database and charts, information regarding demographics, HIV coinfection, alcohol use, liver biopsy results, treatment outcomes and self-reported marijuana use was extracted. Biopsy characteristics and hepatitis C virus antiviral treatment outcomes were assessed for association with categorized marijuana use by adjusted logistic regression; covariates were specified according to clinical relevance a priori.

RESULTS:

Information regarding marijuana use was available for 550 patients, 159 (28.9%) of whom were using marijuana at the time of first assessment. Biopsy fibrosis stage and marijuana use data were available for 377 of these 550 (F0-2=72.3%). Overall, marijuana use did not predict fibrosis stage, inflammation grade or steatosis. Sustained virological response and marijuana use data were available for 359 of the 550 cohort participants; a total of 211 (58.8%) achieved a sustained virological response. Marijuana use was not associated with premature interruption of therapy for side effects, the likelihood of completing a full course of therapy or sustained virological response.

CONCLUSION:

Marijuana use did not influence biopsy histology or alter key hard outcomes of hepatitis C virus antiviral therapy.     

The effect of a decontamination protocol on contaminated titanium dental implant surfaces with different surface topography in edentulous patients

Objectives: To investigate if it is possible to achieve complete decontamination of dental implant surfaces with different surface characteristics.

Materials and methods: Twelve implant pieces with an Osseotite^® surface and 12 implant pieces with a Ti-Unite^® surface were attached on to the complete lower dentures of six patients and were allowed to accumulate plaque for 30 days. When retrieved, the implant decontamination protocol used, involved both mechanical (PeriBrush?) and chemical (3% H₂O₂) decontamination. The number of colony forming units per millilitre was determined and the dominant micro-organisms in selected samples was identified by 16s rRNA gene amplicon sequencing. The effect of the titanium brush on the implant surface was examined by SEM.

Results: Complete decontamination was achieved in five out of 24 implants (four Osseotite^® and one Ti-Unite^®). The mean CFU/ml detected after decontamination were 464.48 for Osseotite^® and 729.09 for Ti-Unite^® implants. On the surface of the implants in which complete decontamination was not achieved, all of the predominant bacteria identified were streptococci except for one which was identified as micrococcus. SEM images revealed that the surface features of the decontaminated implants were not significantly altered.

Conclusions: Mechanical decontamination using a titanium brush supplemented with chemical treatment for one minute (3% H₂O₂) can achieve complete decontamination of implant surfaces in edentulous patients.     

Unique etiologic,demographic, and pathologic characteristics of localized aggressive periodontitis support classification as a distinct subcategory of periodontitis

BackgroundLocalized aggressive periodontitis (LAgP) occurs in 2% of African-American adolescents but only 0.15% of white adolescents. First molars and incisors are affected by rapid onset and progression.MethodsThis nonsystematic critical review evaluated published data for LAgP and chronic periodontitis (CP), focusing on potential differences in epidemiology, microbiology, immunology, genetics, and response to therapy.ResultsLAgP differs from CP by localization to incisors and first molars, early onset and rapid progression in adolescents and young adults, and a 10-fold higher prevalence in populations of African or Middle Eastern origin, often with strong familial aggregation. The bacterium Aggregatibacter actinomycetemcomitans and hyperresponsive neutrophils are frequently observed. Antibiotic and nonsurgical therapies are highly effective.ConclusionsLAgP differs in many ways from the far more common CP that affects older adults. The substantial evidence of dissimilarities summarized in this review strongly supports the classification of LAgP as a distinct form of periodontitis.Practical ImplicationsClassifying LAgP as a distinct subcategory of periodontitis will encourage future research and does not conflict with the newly proposed “staging and grading” system. The silent onset and rapid progression of LAgP make early diagnosis and frequent follow-up with patients essential for effective treatment.     

Emergency department revisits for nontraumatic dental conditions in Massachusetts

BackgroundInadequate access to oral health care and palliative care provided in the emergency department (ED) creates a pattern of repeat nontraumatic dental condition (NTDC) ED visits. The authors examined NTDC ED revisits and assessed the determinants associated with these visits in Massachusetts.MethodsThe authors examined NTDC ED revisits in Massachusetts during 2013 using the Massachusetts All-Payer Claims Database. The authors report patient characteristics of those who made a single NTDC ED visit and of those who made NTDC ED revisits within 30 days of the index NTDC ED visit. The authors used a multilevel logistic regression model to examine the determinants associated with NTDC ED repeat visits.ResultsIn 2013, 21.5% of NTDC ED visits were revisits. Men from 26 through 35 years of age who were enrolled in Medicaid and who did not make an outpatient dental office visit within 30 days of the index NTDC ED visit had increased odds of repeat visits.ConclusionsThe sizable proportion of NTDC ED repeat visits indicates that certain patients in Massachusetts experience consistent and systematic barriers in accessing appropriate and timely oral health care.Practical ImplicationsPrioritizing young adults and Medicaid enrollees for ED diversion programs and setting up a formal referral process via connecting patients to dental offices and community health centers after an NTDC ED visit may reduce NTDC ED revisits and provide appropriate oral health care to these patients.     

Associations between model-predicted rivaroxaban exposure and patient characteristics and efficacy and safety outcomes in the treatment of venous thromboembolism

Journal of Thrombosis and Thrombolysis - Traditional statistical models allow population based inferences and comparisons. Machine learning (ML) explores datasets to develop algorithms that do not...     

Retapamulin 1% Ointment and Clobetasol Propionate 0.05% Foam is More Efficacious than Vehicle Ointment and Clobetasol 0.05% Propionate Foam in the Treatment of Hand/Foot Dermatitis: A Single Center,Randomized, Double-blind Study

Background: Staphylococcus aureus has been implicated in the pathogenesis of adult hand/foot dermatitis. Objective: The authors hypothesized that retapamulin 1% ointment and clobetasol propionate 0.05% foam would decrease disease severity in subjects with hand/foot dermatitis and provide a higher clearance of Staphylococcus aureus colonization, when compared to vehicle (placebo) ointment and clobetasol propionate 0.05% foam. Methods: Adult subjects with moderate to very severe hand/foot dermatitis had twice-daily topical application of clobetasol propionate 0.05% foam to hands/feet for 14 days and were randomized to apply either retapamulin 1% ointment or vehicle ointment twice daily to hands/feet and nares for five days. Results: Seventy-three percent of subjects in the retapamulin/clobetasol group were clear/almost clear at Day 15 compared to 47 percent of subjects in the vehicle/clobetasol group (p-value of 0.04). The percentage of subjects who had both negative skin and nares cultures and were clear/almost clear was also statistically significant in favor of the retapamulin/clobetasol group at Day 15 (p-value of 0.05). Limitations: Sample size, study population. Conclusion: At Day 15, retapamulin 1% ointment with clobetasol propionate 0.05% foam was more efficacious than vehicle ointment and clobetasol propionate 0.05% foam for disease improvement and Staphylococcus aureus clearance in adult subjects with hand/foot dermatitis.Hand/foot dermatitis (HFD) is a chronic disease with both genetic and environmental contributing risk factors.1 Several studies have implicated bacterial colonization, especially Staphylococcus aureus, as a pathogenic factor for eczematous lesions.2-4 Different mechanisms have been suggested to account for the increased S. aureus colonization. For example, the defective epidermal barrier in subjects with eczema allows S. aureus to invade these lesions and stimulate keratinocytes to release proinflammatory cytokines.5-9 In a recent study, which investigated the relationship between S. aureus and hand dermatitis, infection rates with S. aureus were found to be significantly higher in the disease cohort (48%) as compared to controls (8%). Furthermore, the presence of S. aureus correlated closely to disease severity.10 Another published clinical trial investigated the effect of treating S. aureus infection in children with generalized atopic dermatitis. The concomitant use of intranasal mupirocin and dilute bleach baths significantly decreased the severity of eczema in the treatment arm as compared to placebo. However, S. aureus carriage persisted in both skin and nares cultures.11 In a randomized, double-blind, placebo-controlled study of nasal carriers of S. aureus who applied retapamulin 1% ointment (Altabax®, Stiefel Laboratories) to both nostrils for five days, cultures carriage four weeks after treatment was negative for 86 percent of subjects.12 Thus, retapamulin 1% ointment offers the opportunity to effectively treat the presence of S. aureus in HFD. The primary purpose of this study was to investigate the use of retapamulin 1% ointment in combination with clobetasol propionate 0.05% foam for the treatment of HFD in adult subjects.     

Cigarette Smoking and Mental Illness: A Study of Nicotine Withdrawal

Objectives. We compared prevalence, severity, and specific symptom profiles for nicotine withdrawal across categories of mental illness. We also examined the influence of nicotine withdrawal on efforts to quit smoking among those with mental illness.Methods. We analyzed data from 2 sources: wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions, limiting the sample to current smokers (2001–2002; n = 9913); and a 2-wave cohort telephone survey of a national sample of adult smokers (2004–2006; n = 751).Results. Mental illness was associated with a substantially greater likelihood of nicotine withdrawal syndrome; approximately 44% of nicotine withdrawal syndrome diagnoses were attributable to mental illness. Symptom profiles were highly comparable between mental illness categories, although anxiety-related symptoms were better markers of withdrawal for those with an internalizing disorder. Smokers with mental illness were motivated to quit but were less likely to be successful in their quit attempts, and both dependence and withdrawal independently accounted for this lower likelihood of success.Conclusions. Nicotine withdrawal may be a particularly important target for intervention among those with mental illness who smoke cigarettes.Individuals with mental illness are more likely to smoke cigarettes, are more dependent on nicotine, and have greater difficulty quitting smoking1,2 than are those without mental illness. The prevalence of mental illness in the United States is approximately 28%; yet, smokers with mental illness consume 40%–50% of cigarettes.1,2 A self-medication hypothesis has largely driven the conceptualization of this issue3–8: smoking is initiated and maintained to reduce psychiatric symptoms, and these symptoms are exacerbated during abstinence. This notion, that smoking can be important for symptom self-management, has likely contributed to smoking disparities between those with and those without mental illness.3 There are effective means of treating smoking for those with mental illness9; however, nontreatment remains the norm.10 A growing body of researchers, clinicians, and policymakers has called for a paradigm shift in how we approach this issue.3,11–13 Smoking is becoming increasingly viewed as a preventable and treatable cause of diminished life quality among those with mental illness,3,12 rather than a necessary form of self-medication.A 2008 National Institute of Mental Health report noted that the focus on a self-medication hypothesis has come at the expense of research on other important facets of smoking, particularly nicotine withdrawal.3 Studies have found that cigarette smokers with mental illness may experience more severe nicotine withdrawal symptoms14,15; however, these studies were conducted among small samples with a limited range of diagnoses. Weinberger et al. conducted an investigation using data from a US nationally representative sample of cigarette smokers and found that those with mental illness were more likely to report nicotine withdrawal symptoms and life problems associated with their withdrawal.16 Weinberger et al. focused on a few particular diagnoses; thus, they did not investigate the overall extent to which nicotine withdrawal is an issue among those with mental illness or comparisons of nicotine withdrawal between mental illness diagnoses. Previous research on this topic has also been limited in that specific nicotine withdrawal symptom profiles have not been compared across mental illness diagnoses. This type of analysis will potentially highlight specific nicotine withdrawal symptom targets for intervention. Finally, it remains unclear whether nicotine withdrawal in itself is associated with lower likelihood of quit success among those with mental illness or whether nicotine withdrawal is simply an extension of greater nicotine dependence among those with mental illness.We conducted 2 studies of nicotine withdrawal, mental illness, and tobacco cessation. In the first, we compared the likelihood of being diagnosed with a nicotine withdrawal syndrome and the severity of nicotine withdrawal symptoms between smokers with and those without mental illness and across mental illness diagnoses. We then estimated the proportions of nicotine withdrawal syndrome in the population of smokers attributable to each mental illness category. We compared nicotine withdrawal symptom profiles between mental illness categories to better understand consistencies and differences in specific nicotine withdrawal symptoms.In the second study, we examined whether smokers with mental illness were more or less motivated to quit smoking and more or less likely to make quit attempts. Among smokers who made a quit attempt, we examined whether those with mental illness were more or less likely to successfully stop using tobacco and how nicotine withdrawal and dependence influenced cessation efforts.