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Laish I, Schechter M, Dancour A, Lieberman S, Levi Z, Goldberg Y, Kedar I, Hasnis E, Half E, Levi GR, Katz L, Vainer ED, Genzel D, Aharoni M, Chen-Shtoyerman R, Abu-Freha N, Raitses-Gurevich M, Golan T, Bernstein-Molho R, Ben Yehoyada M, Gluck N, Rosner G. The benefit of pancreatic cancer surveillance in carriers of germline BRCA1/2 pathogenic variants. Cancer 2024; 130:256-266. [PMID: 37861363 DOI: 10.1002/cncr.35052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/22/2023] [Accepted: 08/03/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Surveillance of high-risk individuals for pancreatic ductal adenocarcinoma (PDAC) is recommended. This study aimed to determine the prevalence and outcomes of PDAC and its precursor lesions in BRCA1/2 pathogenic variants (PVs) carriers undergoing pancreatic surveillance. METHODS A retrospective multicenter cohort study of pancreatic surveillance outcomes in Israeli BRCA1/2 carriers preferably with a family history of PDAC. RESULTS A total of 180 asymptomatic carriers participated in the screening programs, including 57 (31.7%) with BRCA1 PVs, 121 (67.2%) with BRCA2 PVs, and 12 (6.6%) with PVs in BRCA1/2 and other genes, for a median follow-up period of 4 years. Ninety-one individuals (50.5%) fulfilled the International Cancer of the Pancreas Screening (CAPS) criteria for surveillance whereas 116 (64.4%) fulfilled the American College of Gastroenterology (ACG) criteria. There were four cases of adenocarcinoma and four cases of grade 1-neuroendocrine tumor (G1-NET). All were BRCA2 carriers, and two had no family history of PDAC. Three cancer patients were at resectable stages (IA, IIA, IIB) whereas one had a stage IIIB tumor. Of the G1-NET cases, one had surgery and the others were only followed. Success rate for detection of confined pancreatic carcinoma was thus 1.6% (three of 180) in the whole cohort, 1.6% (two of 116) among individuals who fulfilled ACG criteria and 2.2% (two of 91) in those fulfilling CAPS criteria for surveillance. CONCLUSIONS Despite the low detection rate of PDAC and its' high-risk neoplastic precursor lesions among BRCA1/2 carriers undergoing pancreatic surveillance, 75% of cancer cases were detected at a resectable stage.
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Affiliation(s)
- Ido Laish
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Menachem Schechter
- Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Alain Dancour
- Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sari Lieberman
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Zohar Levi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Gastroenterology Institute, Beilinson Hospital, Petah Tikva, Israel
| | - Yael Goldberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Raphael Recanati Genetics Institute, Beilinson Hospital, Petah Tikva, Israel
| | - Inbal Kedar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Raphael Recanati Genetics Institute, Beilinson Hospital, Petah Tikva, Israel
| | - Erez Hasnis
- Gastroenterology Institute, Rambam Health Care Campus, Haifa, Israel
| | - Elizabeth Half
- Gastroenterology Institute, Rambam Health Care Campus, Haifa, Israel
| | | | - Lior Katz
- Section of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Elez D Vainer
- Section of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Dor Genzel
- Section of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Maya Aharoni
- Gastroenterology Institute, Kaplan Medical Center, Rehovot, Israel
| | - Rakefet Chen-Shtoyerman
- The Genetic Institute, Kaplan Medical Center, Rehovot, Israel
- The Adelson School of Medicine and the Molecular Biology Department, Ariel University, Ariel, Israel
| | - Naim Abu-Freha
- The Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Maria Raitses-Gurevich
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Talia Golan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Rinat Bernstein-Molho
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Merav Ben Yehoyada
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nathan Gluck
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Guy Rosner
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Boaz E, Bar-Gil Shitrit A, Schechter M, Goldin E, Reissman P, Yellinek S, Koslowsky B. Inflammatory bowel disease in families with four or more affected first-degree relatives. Scand J Gastroenterol 2023; 58:20-24. [PMID: 35929993 DOI: 10.1080/00365521.2022.2106153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Family history increases the risk for inflammatory bowel diseases (IBDs). However, data on differences in phenotypic characteristics among patients with a strong family history of IBD are scarce and controversial. The aim of the study was to compare the phenotypic features of IBD patients with four or more affected first-degree relatives with sporadic cases of IBD. METHODS Patients with familial and sporadic IBD were identified from the institutional IBD database. IBD patients from families with at least four first-degree affected relatives were selected for analysis and were compared to non-matched sporadic cases with IBD chosen randomly. Comparison for type of IBD (Crohn's disease (CD) vs. ulcerative colitis (UC)), age at onset as well as for disease extent, behavior, extraintestinal manifestations and indicators of severe disease were analyzed. RESULTS Thirty-five patients with familial IBD (28 CD, seven UC) were compared to 88 sporadic IBD patients (61 CD, 24 UC and three IBDU). Disease duration was 10.3 ± 8.2 in the familial and 8.0 ± 7.2 years in the sporadic cases, p=.13. The familial cases were younger at diagnosis (19.3 ± 8.6 vs. 25.7 ± 11.8, p=.004). Patients with familial compared to sporadic IBD were significantly more likely to require steroid treatment (80% vs. 54.5%, p=.009), biological treatment (94.3%, vs. 63.6%, p<.001) or surgery (25.7%, vs. 11.4%, p=.048). CONCLUSIONS IBD with a very strong positive family history is associated with younger age at onset and a more adverse IBD phenotype compared to sporadic IBD.
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Affiliation(s)
- Elad Boaz
- Department of General Surgery, Faculty of Medicine, Hebrew University of Jerusalem, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Ariella Bar-Gil Shitrit
- Faculty of Medicine, Hebrew University of Jerusalem, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Menachem Schechter
- Faculty of Medicine, Hebrew University of Jerusalem, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eran Goldin
- Faculty of Medicine, Hebrew University of Jerusalem, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Petachia Reissman
- Department of General Surgery, Faculty of Medicine, Hebrew University of Jerusalem, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Shlomo Yellinek
- Department of General Surgery, Faculty of Medicine, Hebrew University of Jerusalem, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Benjamin Koslowsky
- Faculty of Medicine, Hebrew University of Jerusalem, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
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Ostrenga J, Morgan W, Cromwell E, Ren C, Sanders D, Schechter M. 25 Impact of repeated non-treatment on long-term lung function. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Schechter M, Molzhon A, Everheart R, Kang L, Weiskittle R, Castleberry B, Thompson N. 331 Using Practice and Learning to Increase Favorable Thoughts: Preliminary results of a web-based group mental health intervention study in cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Holder R, Everhart R, Corona R, Schechter M. 305 Empowerment in adolescents and young adults with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00995-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Quittner A, Georgiopoulos A, Barker D, Muther E, Tillman L, Schechter M, Graziano S, Verkleij M, Mueller A, Lomas P, Hempstead S, Smith B. 324 National implementation of depression and anxiety screening and treatment at U.S. CF centers: What predicts success? J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bailey J, Brown G, Corbera-Hincapie M, Clemm C, Dasenbrook E, Durham D, Oates G, Reno K, Sapp S, Schechter M, Robinson K. 337: Food insecurity in the cystic fibrosis care center network during COVID-19: Prevalence, screening, and interventions. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01761-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Graziano S, Landau E, Verkleij M, Georgiopoulos A, Schechter M, Abbott J, Quittner A, Smith B. 298: Mental health screening in CF: Thematic analysis of determinants of implementation in Europe and the United States. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01723-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Landau E, Verkleij M, Graziano S, Quittner A, Georgiopoulos A, Smith B, Schechter M, Abbott J. WS11.5 Mental health screening as an intervention: how patients and caregivers contribute to improving our processes. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)00979-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Siba Y, Culpepper-Morgan J, Schechter M, Alatevi E, Jallow S, Onaghise J, Sey A, Ozick L, Sabbagh R. A decade of improved access to screening is associated with fewer colorectal cancer deaths in African Americans: a single-center retrospective study. Ann Gastroenterol 2017; 30:518-525. [PMID: 28845107 PMCID: PMC5566772 DOI: 10.20524/aog.2017.0155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 03/27/2017] [Indexed: 12/22/2022] Open
Abstract
Background Controversy exists as to whether disparities in colorectal cancer (CRC) outcomes in African Americans (AAs) are best resolved by screening at age 45 or by proper use of existing guidelines. In 2004, an aggressive colonoscopy-based CRC screening program was implemented throughout New York City. Our goal was to determine the effect of that program on CRC outcomes in our mostly AA population. Methods CRC cases entered into Harlem Hospital’s tumor registry from January 1992 to December 2011 were divided into two cohorts: 1992-2003, the pre-intensive screening era (PSE), and 2004-2011, the intensive screening era (ISE). Each cohort was reviewed for demographics, indication for colonoscopy, tumor location, tumor stage, and mortality. Multivariate analysis was applied to the pooled cohorts to determine factors associated with survival. Results Inclusion criteria were met by 379 patients: 207 PSE and 172 ISE. Racial distribution, gender, age at presentation, and tumor location were not different during the two eras. Over 75% of patients were AA. During the ISE, 84% were insured compared to 34% in the PSE (P<0.0001). Fewer patients died during the ISE (21%) than during the PSE (67%) (P<0.0001). The ISE patients were diagnosed with earlier stages of CRC compared to the PSE. Increased survival was associated with being insured (hazard ratio [HR] 1.91, 95% confidence interval [CI] 1.30-2.81), distal tumors (HR 1.43, 95%CI 1.05-1.95), and being female (HR 1.36, 95%CI 1.01-1.850). Conclusions A multifaceted program reduced CRC outcome disparities in a poor AA community. Aggressive implementation of current colonoscopy screening guidelines still has unrealized potential to reduce CRC mortality disparities in AAs.
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Affiliation(s)
- Yahuza Siba
- Department of Medicine, Division of Gastroenterology, Harlem Hospital Center, Columbia University Medical Center, New York (Yahuza Siba, Joan Culpepper-Morgan, Menachem Schechter, Lisa Ozick), USA
| | - Joan Culpepper-Morgan
- Department of Medicine, Division of Gastroenterology, Harlem Hospital Center, Columbia University Medical Center, New York (Yahuza Siba, Joan Culpepper-Morgan, Menachem Schechter, Lisa Ozick), USA
| | - Menachem Schechter
- Department of Medicine, Division of Gastroenterology, Harlem Hospital Center, Columbia University Medical Center, New York (Yahuza Siba, Joan Culpepper-Morgan, Menachem Schechter, Lisa Ozick), USA
| | - Eric Alatevi
- Department of Medicine, Harlem Hospital Center, Columbia University Medical Center, New York (Eric Alatevi, Sainabou Jallow, Jude Onaghise), USA
| | - Sainabou Jallow
- Department of Medicine, Harlem Hospital Center, Columbia University Medical Center, New York (Eric Alatevi, Sainabou Jallow, Jude Onaghise), USA
| | - Jude Onaghise
- Department of Medicine, Harlem Hospital Center, Columbia University Medical Center, New York (Eric Alatevi, Sainabou Jallow, Jude Onaghise), USA
| | - Albert Sey
- Department of Hospitalist Medicine, Ashtabula County Medical Center, Ohio (Albert Sey), USA
| | - Lisa Ozick
- Department of Medicine, Division of Gastroenterology, Harlem Hospital Center, Columbia University Medical Center, New York (Yahuza Siba, Joan Culpepper-Morgan, Menachem Schechter, Lisa Ozick), USA
| | - Raja Sabbagh
- Department of Surgery, Harlem Hospital Center, Columbia University Medical Center, New York (Raja Sabbagh), USA
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Lieberman S, Walsh T, Schechter M, Adar T, Goldin E, Beeri R, Sharon N, Baris H, Ben Avi L, Half E, Lerer I, Shirts BH, Pritchard CC, Tomlinson I, King MC, Levy-Lahad E, Peretz T, Goldberg Y. Features of Patients With Hereditary Mixed Polyposis Syndrome Caused by Duplication of GREM1 and Implications for Screening and Surveillance. Gastroenterology 2017; 152:1876-1880.e1. [PMID: 28242209 DOI: 10.1053/j.gastro.2017.02.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/04/2017] [Accepted: 02/16/2017] [Indexed: 12/02/2022]
Abstract
Hereditary mixed polyposis syndrome is a rare colon cancer predisposition syndrome caused by a duplication of a noncoding sequence near the gremlin 1, DAN family BMP antagonist gene (GREM1) originally described in Ashkenazi Jews. Few families with GREM1 duplications have been described, so there are many questions about detection and management. We report 4 extended families with the duplication near GREM1 previously found in Ashkenazi Jews; 3 families were identified at cancer genetic clinics in Israel and 1 family was identified in a cohort of patients with familial colorectal cancer. Their clinical features include extracolonic tumors, onset of polyps in adolescence, and rapid progression of some polyps to advanced adenomas. One family met diagnostic criteria for Lynch syndrome. Expansion of the hereditary mixed polyposis syndrome phenotype can inform surveillance strategies for carriers of GREM1 duplications.
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Affiliation(s)
- Sari Lieberman
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Tom Walsh
- Department of Medicine, Department of Genome Sciences, University of Washington, Seattle, Washington
| | - Menachem Schechter
- Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Tomer Adar
- Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eran Goldin
- Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Rachel Beeri
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nitzan Sharon
- Genetics Institute, Rambam Medical Center, Jerusalem, Israel
| | - Hagit Baris
- Genetics Institute, Rambam Medical Center, Jerusalem, Israel
| | - Liat Ben Avi
- Department of Human Genetics and Metabolic Diseases, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Elizabeth Half
- Gastroenterology Institute, Rambam Medical Center, Jerusalem, Israel
| | - Israela Lerer
- Department of Human Genetics and Metabolic Diseases, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Brian H Shirts
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Ian Tomlinson
- Oxford Centre for Cancer Gene Research and Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Mary-Claire King
- Department of Medicine, Department of Genome Sciences, University of Washington, Seattle, Washington
| | - Ephrat Levy-Lahad
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yael Goldberg
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
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12
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Schechter M, Choi JJ, Culpepper-Morgan JA. Progressive Dysphagia in a Pregnant Woman. Gastroenterology 2017; 152:e12-e14. [PMID: 27893973 DOI: 10.1053/j.gastro.2016.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 07/20/2016] [Accepted: 08/01/2016] [Indexed: 12/02/2022]
Affiliation(s)
| | - Jenny J Choi
- Department of Surgery, Montefiore Medical Center, Bronx, New York
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13
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Ali A, Schechter M, Southerland K, Harling L, Schroder J, Milano C. Cost Implications of Mechanical Circulatory Support for Primary Graft Dysfunction Following Heart Transplantation. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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14
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Ali A, Schechter M, Harling L, Southerland K, Ashrafian H, Athanasiou T, Schroder J, Milano C. Right Ventricular Assist Device Support for Right Ventricular Dysfunction following Heart Transplantation: Risk Factors and Clinical Outcome. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Sharma S, Babiker AG, Emery S, Gordin FM, Lundgren JD, Neaton JN, Bakowska E, Schechter M, Wiselka MJ, Wolff MJ. Demographic and HIV-specific characteristics of participants enrolled in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:30-6. [PMID: 25711321 PMCID: PMC4341937 DOI: 10.1111/hiv.12231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The risks and benefits of initiating antiretroviral treatment (ART) at high CD4 cell counts have not been reliably quantified. The Strategic Timing of AntiRetroviral Treatment (START) study is a randomized international clinical trial that compares immediate with deferred initiation of ART for HIV-positive individuals with CD4 cell counts above 500 cells/μL. We describe the demographics, HIV-specific characteristics and medical history of this cohort. METHODS Data collected at baseline include demographics, HIV-specific laboratory values, prior medical diagnoses and concomitant medications. Baseline characteristics were compared by geographical region, gender and age. RESULTS START enrolled 4685 HIV-positive participants from 215 sites in 35 countries. The median age is 36 years [interquartile range (IQR) 29-44 years], 27% are female, and 45% self-identify as white, 30% as black, 14% as Latino/Hispanic, 8% as Asian and 3% as other. The route of HIV acquisition is reported as men who have sex with men in 55% of participants, heterosexual sex in 38%, injecting drug use in 1% and other/unknown in 5%. Median time since HIV diagnosis is 1.0 year (IQR 0.4-3.0 years) and the median CD4 cell count and HIV RNA values at study entry are 651 cells/μL (IQR 584-765 cells/μL) and 12,754 HIV RNA copies/mL (IQR 3014-43,607 copies/mL), respectively. CONCLUSIONS START has enrolled a diverse group of ART-naïve individuals with high CD4 cell counts who are comparable to the HIV-positive population from the regions in which they were enrolled. The information collected with this robust study design will provide a database with which to evaluate the risks and benefits of early ART use for many important outcomes.
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Affiliation(s)
- S Sharma
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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16
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Churkin A, Barash D, Schechter M. Acoustic interactions between inversion symmetric and asymmetric two-level systems. J Phys Condens Matter 2014; 26:325401. [PMID: 25031225 DOI: 10.1088/0953-8984/26/32/325401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Amorphous solids, as well as many disordered lattices, display remarkable universality in their low temperature acoustic properties. This universality is attributed to the attenuation of phonons by tunneling two-level systems (TLSs), facilitated by the interaction of the TLSs with the phonon field. TLS-phonon interaction also mediates effective TLS-TLS interactions, which dictates the existence of a glassy phase and its low energy properties. Here we consider KBr:CN, the archetypal disordered lattice showing universality. We calculate numerically, using conjugate gradients method, the effective TLS-TLS interactions for inversion symmetric (CN flips) and asymmetric (CN rotations) TLSs, in the absence and presence of disorder, in two and three dimensions. The observed dependence of the magnitude and spatial power law of the interaction on TLS symmetry, and its change with disorder, characterizes TLS-TLS interactions in disordered lattices in both extreme and moderate dilutions. Our results are in good agreement with the two-TLS model, recently introduced to explain long-standing questions regarding the quantitative universality of phonon attenuation and the energy scale of ≈ 1-3 K below which universality is observed.
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Affiliation(s)
- A Churkin
- Department of Physics, Ben Gurion University of the Negev, Beer Sheva 84105, Israel. Department of Computer Science, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
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Ali A, Southerland K, Schechter M, Saeed A, Schroder J, Milano C. Delayed Sternal Closure Following Heart Transplantation: Outcomes and Implications. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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18
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Jeffers L, Van Rensburg CJ, Banks A, Schechter M, Schmidt SJ, Hu W, Llamoso C, Parana R. Antiviral efficacy of entecavir in nucleos(t)ide-naïve patients of Black/African descent with chronic hepatitis B. J Viral Hepat 2014; 21:74-6. [PMID: 24112755 DOI: 10.1111/jvh.12144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 05/30/2013] [Indexed: 01/04/2023]
Abstract
This single-arm, open-label, descriptive study assessed the efficacy and safety of entecavir (ETV) in nucleos(t)ide-naïve Black/African American patients with chronic hepatitis B (CHB), a patient population underrepresented in ETV registration trials. Forty patients with HBeAg(+) or HBeAg(-) compensated CHB of self-described Black/African American race received ETV 0.5 mg daily for 52 weeks; 37 patients completed 52 weeks of treatment. At Week 48, 29/40 (72.5%, noncompleter = failure) patients achieved the primary endpoint of HBV DNA <50 IU/mL. Rates for HBeAg loss (11/22; 50%) and HBeAg seroconversion (9/22; 41%) were high, possibly due to the high HBV genotype A prevalence (70%). No patient experienced virological breakthrough. Samples for resistance testing were available in 6/8 patients with HBV DNA >50 IU/mL at Week 48 or last on-treatment visit. No ETV resistance was detected. The safety profile of ETV was consistent with that observed in ETV registration trials. This study shows that in Black/African American patients with CHB, ETV was well tolerated and demonstrated comparable antiviral efficacy to that observed in White and Asian patients in ETV Phase III studies.
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Affiliation(s)
- L Jeffers
- Center for Liver Diseases, University of Miami, Miami, FL, USA
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Schechter M, Weller A, Pittel Z, Gross M, Zimmer A, Pinhasov A. Endocannabinoid receptor deficiency affects maternal care and alters the dam's hippocampal oxytocin receptor and brain-derived neurotrophic factor expression. J Neuroendocrinol 2013; 25:898-909. [PMID: 23895426 DOI: 10.1111/jne.12082] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 07/10/2013] [Accepted: 07/24/2013] [Indexed: 01/12/2023]
Abstract
Maternal care is the newborn's first experience of social interaction, and this influences infant survival, development and social competences throughout life. We recently found that postpartum blocking of the endocannabinoid receptor-1 (CB1R) altered maternal behaviour. In the present study, maternal care was assessed by the time taken to retrieve pups, pups' ultrasonic vocalisations (USVs) and pup body weight, comparing CB1R deleted (CB1R KO) versus wild-type (WT) mice. After culling on postpartum day 8, hippocampal expression of oxytocin receptor (OXTR), brain-derived neurotrophic factor (BDNF) and stress-mediating factors were evaluated in CB1R KO and WT dams. Comparisons were also performed with nulliparous (NP) CB1R KO and WT mice. Compared to WT, CB1R KO dams were slower to retrieve their pups. Although the body weight of the KO pups did not differ from the weight of WT pups, they emitted fewer USVs. This impairment of the dam-pup relationship correlated with a significant reduction of OXTR mRNA and protein levels among CB1R KO dams compared to WT dams. Furthermore, WT dams exhibited elevated OXTR mRNA expression, as well as increased levels of mineralocorticoid and glucocorticoid receptors, compared to WT NP mice. By contrast, CB1R KO dams showed no such elevation of OXTR expression, alongside lower BDNF and mineralocorticoid receptors, as well as elevated corticotrophin-releasing hormone mRNA levels, when compared to CB1R KO NP. Thus, it appears that the disruption of endocannabinoid signalling by CB1R deletion alters expression of the OXTR, apparently leading to deleterious effects upon maternal behaviour.
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Affiliation(s)
- M Schechter
- Department of Molecular Biology, Ariel University, Ariel, Israel; Faculty of Life Sciences, Bar Ilan University, Ramat-Gan, Israel; Gonda Brain Research Center, Bar Ilan University, Ramat-Gan, Israel
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Ali A, Southerland K, Schechter M, Schroder J, Milano C. The Downtime Donor Heart: Analysis of Pre-Transplant Function and Current Utilization for Transplantation. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fenner L, Forster M, Boulle A, Phiri S, Braitstein P, Lewden C, Schechter M, Kumarasamy N, Pascoe M, Sprinz E, Bangsberg DR, Sow PS, Dickinson D, Fox MP, McIntyre J, Khongphatthanayothin M, Dabis F, Brinkhof MWG, Wood R, Egger M. Tuberculosis in HIV programmes in lower-income countries: practices and risk factors. Int J Tuberc Lung Dis 2011; 15:620-7. [PMID: 21756512 DOI: 10.5588/ijtld.10.0249] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a common diagnosis in human immunodeficiency virus (HIV) infected patients on antiretroviral treatment (ART). OBJECTIVE To describe TB-related practices in ART programmes in lower-income countries and identify risk factors for TB in the first year of ART. METHODS Programme characteristics were assessed using standardised electronic questionnaire. Patient data from 2003 to 2008 were analysed and incidence rate ratios (IRRs) calculated using Poisson regression models. RESULTS Fifteen ART programmes in 12 countries in Africa, South America and Asia were included. Chest X-ray, sputum microscopy and culture were available free of charge in respectively 13 (86.7%), 14 (93.3%) and eight (53.3%) programmes. Eight sites (53.3%) used directly observed treatment and five (33.3%) routinely administered isoniazid preventive treatment (IPT). A total of 19 413 patients aged ≥ 16 years contributed 13,227 person-years of follow-up; 1081 new TB events were diagnosed. Risk factors included CD4 cell count (>350 cells/μl vs. <25 cells/μl, adjusted IRR 0.46, 95%CI 0.33-0.64, P < 0.0001), sex (women vs. men, adjusted IRR 0.77, 95%CI 0.68-0.88, P = 0.0001) and use of IPT (IRR 0.24, 95%CI 0.19-0.31, P < 0.0001). CONCLUSIONS Diagnostic capacity and practices vary widely across ART programmes. IPT prevented TB, but was used in few programmes. More efforts are needed to reduce the burden of TB in HIV co-infected patients in lower income countries.
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Affiliation(s)
- L Fenner
- Institute of Social and Preventive Medicine, Berne, Switzerland.
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Goenka A, Magsanoc J, Pei X, Schechter M, Eastham J, Zelefsky M. Late Toxicity following High Dose Post-prostatectomy Salvage Radiation Therapy. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Spaar A, Graber C, Dabis F, Coutsoudis A, Bachmann L, McIntyre J, Schechter M, Prozesky HW, Tuboi S, Dickinson D, Kumarasamy N, Pujdades-Rodriquez M, Sprinz E, Schilthuis HJ, Cahn P, Low N, Egger M. Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings. AIDS Care 2010; 22:775-83. [PMID: 20473792 DOI: 10.1080/09540120903349102] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Expanded access to antiretroviral therapy (ART) offers opportunities to strengthen HIV prevention in resource-limited settings. We invited 27 ART programmes from urban settings in Africa, Asia and South America to participate in a survey, with the aim to examine what preventive services had been integrated in ART programmes. Twenty-two programmes participated; eight (36%) from South Africa, two from Brazil, two from Zambia and one each from Argentina, India, Thailand, Botswana, Ivory Coast, Malawi, Morocco, Uganda and Zimbabwe and one occupational programme of a brewery company included five countries (Nigeria, Republic of Congo, Democratic Republic of Congo, Rwanda and Burundi). Twenty-one sites (96%) provided health education and social support, and 18 (82%) provided HIV testing and counselling. All sites encouraged disclosure of HIV infection to spouses and partners, but only 11 (50%) had a protocol for partner notification. Twenty-one sites (96%) supplied male condoms, seven (32%) female condoms and 20 (91%) provided prophylactic ART for the prevention of mother-to child transmission. Seven sites (33%) regularly screened for sexually transmitted infections (STI). Twelve sites (55%) were involved in activities aimed at women or adolescents, and 10 sites (46%) in activities aimed at serodiscordant couples. Stigma and discrimination, gender roles and funding constraints were perceived as the main obstacles to effective prevention in ART programmes. We conclude that preventive services in ART programmes in lower income countries focus on health education and the provision of social support and male condoms. Strategies that might be equally or more important in this setting, including partner notification, prompt diagnosis and treatment of STI and reduction of stigma in the community, have not been implemented widely.
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Affiliation(s)
- A Spaar
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
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Goenka A, Magsanoc J, Pei X, Schechter M, Zelefsky M. Long-term Predictors of Biochemical and Distant Metastatic Failure following Post Prostatectomy Salvage Radiotherapy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kollmeier M, Algur E, Schechter M, Pei X, Cohen G, Yamada Y, Cox B, Zelefsky M. A Comparison of the Impact of Isotope on Acute Urinary Toxicity following Interstitial Brachytherapy and External Beam Radiation Therapy for Clinically Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Arnoldi W, Schechter M. Zur Pathogenese der Sekretionsstörungen des Magens1). II. Beziehungen zwischen Magen und Duodenalsaft. Abhängigkeit der sekretorischsen Magenfunktion von Leber- und Pankreastätigkeit. Dtsch Med Wochenschr 2009. [DOI: 10.1055/s-0029-1200641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Masys DR, Fang F, Ye I, Fink V, Gotuzzo E, Padgett D, Pape JW, Cortes C, Bacon M, Schechter M. Preliminary findings on cancer incidence in HIV-infected persons from six countries in Central and South America and the Caribbean. Infect Agent Cancer 2009. [PMCID: PMC4261722 DOI: 10.1186/1750-9378-4-s2-o18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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May SB, Barroso PF, Nunes EP, Barcaui HS, Almeida MMT, Costa MD, Faulhaber JC, Santoro-Lopes G, Schechter M. Effectiveness of highly active antiretroviral therapy using non-brand name drugs in Brazil. Braz J Med Biol Res 2007; 40:551-5. [PMID: 17401499 DOI: 10.1590/s0100-879x2007000400014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 02/02/2007] [Indexed: 11/22/2022] Open
Abstract
In Brazil, HIV-infected individuals receive drugs (including non-brand name drugs which comprise locally produced generics and drugs that have not been tested in bioequivalence trials) free of charge from the government. The objective of the present study was to evaluate the effectiveness of highly active antiretroviral therapy (HAART) in Rio de Janeiro, Brazil, where non-brand drugs are widely used. For this purpose, we estimated the proportion of subjects with virologic failure (plasma HIV viral load greater than 400 copies/mL at 6 months after initiation of treatment). This was a retrospective cohort study of drug-naive HIV-infected subjects who initiated HAART. Subjects were included in the analysis if they were 18 years of age or older, were treatment naive, started HAART with a minimum of 3 drugs, and had available information on blood plasma HIV-1 viral load after 6 months on therapy. All subjects used antiretrovirals in dosing regimens recommended by the Brazilian National Advisory Committee for Antiretroviral Therapy. Chart reviews were conducted in three settings: at two public health outpatient units, at one clinical trial unit and at one private office. No comparisons of the effectiveness of non-brand name with the effectiveness of brand name drugs were made. We present results for 485 patients; of these, 354 (73%), 55 (11%), and 76 (16%) were seen at the public health outpatient units, private office, and clinical trial unit, respectively. Virologic failure was observed in 119 (25%) of the subjects. This study demonstrates the effectiveness of HAART in a setting where non-brand name drugs are widely used.
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Affiliation(s)
- S B May
- Serviço de Doenças Infecciosas e Parasitárias, Departamento de Medicina Preventiva, Hospital Universitário Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Lampinen T, Chan K, Anema A, Miller M, Schilder A, Schechter M, Hogg R, Strathdee S. Incidence and Risk Factors for Sexual Orientation-Related Physical Assault of Young Men Who have Sex with Men. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s232-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Quittnert A, Schechter M, Rasoulivan L, Pasta D, Wagener J. 465 Effects of socioeconomic status, race and ethnicity on quality of life in a national database. J Cyst Fibros 2006. [DOI: 10.1016/s1569-1993(06)80391-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schechter M, Stamp PCE. Significance of the hyperfine interactions in the phase diagram of LiHoxY1-xF4. Phys Rev Lett 2005; 95:267208. [PMID: 16486398 DOI: 10.1103/physrevlett.95.267208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Indexed: 05/06/2023]
Abstract
We consider the quantum magnet at LiHo(x)Y(1-x)F(4) at x = 0.167. Experimentally the spin glass to paramagnet transition in this system was studied as a function of the transverse magnetic field and temperature, showing peculiar features: for example, (i) the spin glass order is destroyed much faster by thermal fluctuations than by the transverse field; and (ii) the cusp in the nonlinear susceptibility signaling the glass state decreases in size at lower temperature. Here we show that the hyperfine interactions of the Ho atom must dominate in this system, and that along with the transverse inter-Ho dipolar interactions they dictate the structure of the phase diagram. The experimental observations are shown to be natural consequences of this.
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Affiliation(s)
- M Schechter
- Department of Physics & Astronomy and Pacific Institute for Theoretical Physics, University of British Columbia, Vancouver, Canada
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van Leth F, Conway B, Laplumé H, Martin D, Fisher M, Jelaska A, Wit FW, Lange JMA, Laplumé H, Lasala MB, Losso MH, Bogdanowicz E, Lattes R, Krolewiecki A, Zala C, Orcese C, Terlizzi S, Duran A, Ebensrteijn J, Bloch M, Russell O, Russell DB, Roth NR, Eu B, Austin D, Gowers A, Quan D, Demonty J, Peleman R, Vandercam B, Vogelaers D, van der Gucht B, van Wanzeele F, Moutschen MM, Badaro R, Grinsztejn B, Schechter M, Uip D, Netto EN, Coelho SS, Badaró F, Pilotto JH, Schubach A, Barros ML, Leite OHM, Kiffer CRV, Wunsch CT, Nunes D, Catalani A, de Cassia Alves LR, Dossin TJ, D'Alló de Oliveira MT, Martini S, Conway B, de Wet JJ, Montaner JSG, Murphy C, Woodfall B, Sestak P, Phillips P, Montessori V, Harris M, Tesiorowski A, Willoughby B, Voigt R, Farley J, Reynolds R, Devlaming S, Livrozet JM, Rozenbaum W, Sereni D, Valantin MA, Lascoux C, Milpied B, Brunet C, Billaud E, Huart A, Reliquet V, Charonnat MF, Sicot M, Esnault JL, Slama L, Staszewski S, Bickel M, Lazanas MK, Stavrianeas N, Mangafas N, Zagoreos I, Kourkounti S, Paparizos V, Botsi C, Clarke S, Brannigan E, Boyle N, Chiriani A, Leoncini F, Montella F, Francesco L, Ambu S, Farese A, Gargiulo M, Di Sora F, Lavria F, Folgori F, Beniowski M, Boron Kaczmarska A, Halota W, Prokopowicz D, Bander DB, Leszuzyszyn-Pynka MLP, Wnuk AW, Bakowska E, Pulik P, Flisiak R, Wiercinska-Drapalo A, Mularska E, Witor A, Antunes F, Sarmento RSE, Doroana M, Horta AA, Vasconcelos O, Andrews SM, Huisamen CB, Johnson D, Martin O, Bekker LG, Maartens G, Wilson D, Visagie CJ, David NJ, Rattley M, Nettleship E, Martin DJ, Keyser V, Moraites TM, Moorhouse MA, Pitt JA, Orrell CJ, Bester C, Parboosing R, Moodley P, Gathiram V, Woolf D, Bernasconi E, Magenta L, Cardiello P, Kroon E, Ungsedhapand C, Fisher M, Wilkins EGL, Stockwell E, Day J, Daintith RS, Perry N, Timaeus C, Intosh-Roffet JM, Powell A, Youle M, Tyrer M, Madge S, Drinkwater A, Cuthbertson Z, Carroll A, Becker S, Katner H, Rimland D, Saag MS, Thompson M, Witt M, Aguilar MM, LaVoy A, Illeman M, Guerrero M, Gatell J, Belsey E, Hirschel B, Potarca A, Cronenberg M, Kreekel L, Meester R, Khodabaks J, Botma HJ, Esrhir N, Farida I, Feenstra M, Jansen K, Klotz A, Mulder M, Ruiter G, Bass CB, Pluymers E, de Vlegelaer E, Leeneman (VCL) R, Carlier H, van Steenberge E, Hall D. Quality of Life in Patients Treated with First-Line Antiretroviral Therapy Containing Nevirapine And/Or Efavirenz. Antivir Ther 2004. [DOI: 10.1177/135965350400900512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To assess whether differences in safety profiles between nevirapine (NVP) and efavirenz (EFV), as observed in the 2NN study, translated into differences in ‘health related quality of life’ (HRQoL). Design A sub-study of the 2NN study, with antiretro-viral-naive patients randomly allocated to NVP (once or twice daily), EFV or NVP+EFV, in addition to stavudine and lamivudine. Methods Comparing differences in changes of HRQoL over 48 weeks as measured with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire, using analysis of variance. Results The 2NN study enrolled 1216 patients. No validated questionnaires were available for 244 patients, and 55 patients had no HRQoL data at all, leaving 917 patients eligible for this sub-study. A total of 471 (51%) had HRQoL measurements both at baseline and week 48. The majority (69%) of patients without HRQoL measurements did, however, complete the study. The change in the physical health score (PHS) was 3.9 for NVP, 3.4 for EFV and 2.4 for NVP+EFV ( P=0.712). For the mental health score (MHS) these values were 6.1, 7.0 and 3.9, respectively ( P=0.098). A baseline plasma HIV-1 RNA concentration (pVL) ≥100 000 copies/ml and a decline in pVL (per log10) were independently associated with an increase of PHS. An increase of MHS was only associated with pVL decline. Patients experiencing an adverse event during follow-up had a comparable change in PHS but a significantly smaller change in MHS, compared with those without an adverse event. Conclusions First-line ART containing NVP and/or EFV leads to an improvement in HRQoL. The gain in HRQoL was similar for NVP and EFV, but slightly lower for the combination of these drugs.
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Affiliation(s)
| | - Frank van Leth
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Brian Conway
- University of British Columbia, Vancouver, BC, Canada
| | - Hector Laplumé
- Hospital Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Des Martin
- Toga Laboratories, Edenvale, South Africa
| | - Martin Fisher
- Brighton and Sussex University Hospitals, Brighton, UK
| | - Ante Jelaska
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Conn., USA
| | - Ferdinand W Wit
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joep MA Lange
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
The magnetization of an ensemble of isolated lead grains of sizes ranging from 4 to 1000 nm is measured. A sharp disappearance of the Meissner effect with a lowering of the grain size is observed for the smaller grains. This is a direct observation by magnetization measurement of the occurrence of a critical particle size for superconductivity, which is consistent with Anderson's criterion.
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Affiliation(s)
- S Reich
- Department of Materials and Interfaces, The Weizmann Institute of Science, Rehovot 76100, Israel
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Just R, Hoh C, Vogl T, Neese P, Doemeny J, Schechter M, Varney R, Stanton W, Schiemann M, Goldfarb P. 975 A phase I/II single arm trial to determine the safety, tolerability, and biological activity of intrahepatic delivery of doxorubicin hydrochloride adsorbed to magnetic targeted carriers (MTC-DOX) in patients with metastatic tumors in the liver. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)91002-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Schechter M, Oreg Y, Imry Y, Levinson Y. Magnetic response of disordered metallic rings: large contribution of far levels. Phys Rev Lett 2003; 90:026805. [PMID: 12570570 DOI: 10.1103/physrevlett.90.026805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2002] [Indexed: 05/24/2023]
Abstract
We calculate the orbital linear magnetic response of disordered metallic rings to an Aharonov-Bohm flux using the BCS model for attractive electron-electron interaction. The contribution of all levels including those up to a high energy cutoff results in a much larger value than previously obtained using the local interaction model. The possible relevance of our results to the resolution of the discrepancy between the experimental and theoretical values for the ensemble-averaged persistent currents in these systems is discussed.
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Affiliation(s)
- M Schechter
- The Racah Institute of Physics, Hebrew University, Jerusalem 91904, Israel
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Abstract
OBJECTIVE To study the impact of chemoprophylaxis for tuberculosis on the survival of HIV-infected patients with a positive tuberculin skin test. DESIGN Prospective observational cohort study. SETTING Outpatient clinic of a university hospital, in Rio de Janeiro, Brazil. PATIENTS Two-hundred and ninety-seven patients with a positive tuberculin skin test (reaction > or = 5mm) who were admitted to the cohort between January 1991 and December 1994. Follow-up ended on September 30, 1998. INTERVENTION The use of chemoprophylaxis for tuberculosis. MAIN OUTCOME MEASURES Death was the primary outcome variable. The occurrence of tuberculosis was studied as a secondary outcome. Cox regression models were used in these analyses. RESULTS The median follow-up time was 43.6 months. Chemoprophylaxis was used by 128 (43%) of the patients. The use of chemoprophylaxis was associated with a reduction in risk for tuberculosis (hazard ratio, 0.38; 95% confidence interval, 0.14-1.04; P = 0.05). In a regression model adjusted for baseline CD4 cell count, chemoprophylaxis was associated with longer survival (hazard ratio, 0.24; 95% confidence interval, 0.09-0.65; P = 0.002). CONCLUSIONS Anti-tuberculosis chemoprophylaxis was associated with a substantially prolonged survival among purified protein derivative-positive HIV-infected patients in Brazil. These data have important implications for the clinical care of patients with HIV infection in areas of the world with a high prevalence of Mycobacterium tuberculosis infection.
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Affiliation(s)
- A M de Pinho
- Infectious Diseases Service, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Périssé AR, Schechter M, Moreira RI, do Lago RF, Santoro-Lopes G, Harrison LH. Willingness to participate in HIV vaccine trials among men who have sex with men in Rio de Janeiro, Brazil. Projeto Praça Onze Study Group. J Acquir Immune Defic Syndr 2000; 25:459-63. [PMID: 11141246 DOI: 10.1097/00126334-200012150-00012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Evaluation of HIV vaccines requires high-risk individuals willing to participate in a vaccine trial. We investigated the willingness to participate in HIV vaccine trials of initially HIV-seronegative homosexual men enrolled in an HIV seroincidence cohort study. Of 815 initially HIV-seronegative participants, 569 (69.8%) reported willingness to participate in an HIV vaccine trial. Altruism was the primary reason given for wanting to participate. Fear of HIV infection from the study's immunizations and a vaccine-induced positive HIV test result were the main reasons for not wanting to participate. Of the 34 study subjects who eventually had HIV seroconversion, 29 (85%) had indicated a willingness to participate. In a univariate analysis, factors associated with willingness to participate included HIV seroconversion during follow-up (odds ratio [OR]. 2.6; p =.04), low educational level (OR, 1.6; p =.005), low family income (p =.02), and exchanging sex for housing, food, or clothing (OR 6.1; p =.005). Students were less likely to be willing to participate in a trial (OR, 0.7; p = .03), as well as those who reported sex at the first encounter (OR, 0.7; p = .05). In a multivariate analysis, low education level, infection with Condyloma, and exchanging sex for housing, food, or clothing were positively associated with willingness to participate, whereas being a student and reporting sex at first encounter were negatively associated. In general, factors indicative of high-risk of HIV infection were associated with a higher willingness. These data demonstrate that this high-risk homosexual male cohort has a high willingness to participate in HIV vaccine trials.
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Affiliation(s)
- A R Périssé
- Infectious Diseases Service, Hospital Universitário Clementino Fraga Filho, Brazil
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Hofer CB, Harrison LH, Struchiner CJ, Moreira RI, do Lago RF, de Melo MF, Schechter M. Acute retrovirus syndrome among prospectively identified homosexual men with incident HIV infection in Brazil. Projecto Praça Onze Study Group. J Acquir Immune Defic Syndr 2000; 25:188-91. [PMID: 11103050 DOI: 10.1097/00042560-200010010-00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Symptoms associated with HIV infection are common among HIV seroconverters, but the acute retroviral syndrome (ARS) is a diagnostic challenge because of the absence of a sensitive and specific case definition. We conducted an analysis of HIV seroconverters in Projeto Praça Onze, a HIVNET HIV seroincidence study among homosexual men in Rio de Janeiro. METHODS Information from study subjects enrolled in Projeto Praça Onze who were documented HIV seroconverters were compared with nonseroconverters. At each semiannual study visit, participants were asked about HIV seroconversion symptoms and sexually transmitted diseases (STDs) during the preceding 6 months. All information was collected before the laboratory evaluation. A classification tree analysis was used to identify an ARS case definition, first using clinical information and then after including risk factor data for seroconversion in our cohort. RESULTS As of July 1998, 674 volunteers were enrolled and 34 of these seroconverted; information was available for 33 of these. Among the seroconverters, 11 (34%) denied any symptoms, and 22 (66%) reported one or more symptoms, the most common of which were fever (25% of seroconverters versus 7% of nonseroconverters; p <.01), night sweats (9% versus 2%, respectively; p =.05), incapacitating disease (ID) for >/=3 days (27% versus 7%, respectively; p <.001), and weight loss of >/=2 kg (21% versus 9%, respectively; p =.05). STDs were more common in seroconverters (gonorrhea: 9% versus 1%, respectively; p <.01 and condyloma: 9% versus 3%, respectively; p =. 08). The first case definition was ID for >3 days, fever, pharyngitis, and myalgia (seroconverters, 3 of 32, versus nonseroconverters, 2 of 640). The second case definition was was ID for >3 days, anti-core hepatitis b-positive, and age <21 years (seroconverters: 6 of 32 versus nonseroconverters 4 of 640). The sensitivity and specificity for the first and second case definitions were: 9.4%, 99.4%, and 18.8%, 99.8%, respectively. CONCLUSIONS Among HIV seroconverters, symptoms consistent with ARS were common. We were unable to identify a sensitive case definition that could be used as a screening tool. Although the clinical case definition was not validated, the specificity of our case definitions was high, suggesting that subjects within this HIV risk group who fulfill the case definition should be tested for HIV.
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Affiliation(s)
- C B Hofer
- Infectious Diseases Service, Hospital Universitário Clementino Fraga Filho, Department of Preventive Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
BACKGROUND The effect of antiretroviral therapy on seminal HIV shedding in the community remains unknown. OBJECTIVE To evaluate the effect of antiretroviral therapy on HIV shedding in semen. DESIGN Prospective cohort study. SETTING University hospital in Rio de Janeiro, Brazil. PATIENTS 93 HIV-infected men. INTERVENTION Antiretroviral therapy as prescribed by each patient's physician. MEASUREMENT HIV RNA in semen and blood plasma before and after introduction of therapy. RESULTS At baseline, HIV RNA was detected in 69 semen samples (74%) and 89 blood samples (96%). Six months after introduction of therapy, HIV RNA was detected in 29 semen samples (33%) and 33 blood samples (38%). The mean reduction in levels of HIV RNA in semen at 6 months was 1.65 log10 units. CONCLUSIONS Antiretroviral therapy reduces shedding of HIV in semen, which probably in tum reduces HIV transmissibility. However, a substantial proportion of patients may still be infectious and may have drug-resistant strains of the virus.
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Affiliation(s)
- P F Barroso
- Laboratório de Pesquisas, Hospital Universitário Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Brazil
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Santoro-Lopes G, Harrison LH, Tavares MD, Xexéo A, Dos Santos AC, Schechter M. HIV disease progression and V3 serotypes in Brazil: is B different from B-Br? AIDS Res Hum Retroviruses 2000; 16:953-8. [PMID: 10890356 DOI: 10.1089/08892220050058362] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV-1 serotype B-Br (GWGR) is rare in the United States but predominates in Brazil. Differences in prognosis for patients infected with serotype B-Br or serotype B (GPGR) have not been addressed previously. In this prospective cohort study, we compared the rate of disease progression between patients infected with the HIV-1 V3 serotype B or B-Br in Brazil. Progression to AIDS or death was studied by the Kaplan-Meier and Cox proportional hazard methods. Among 445 HIV-infected patients who were tested with a specific enzyme immune assay, 204 (46%) had serotype B-Br infection and 127 (28%) had serotype B infection. Both groups were similar with regard to baseline CD4+ cell count, serum HIV RNA viral load, initial clinical stage, and the proportions who were treated with antiretroviral drugs. Patients with serotype B infection were significantly younger (p = 0.005) and tended to report homosexual behavior more frequently (p = 0.08). Mean follow-up was 30 +/- 13.5 months. During the study period, 41 (32%) patients infected with serotype B and 44 (22%) infected with serotype B-Br developed AIDS (p = 0.03). In a regression model adjusted for age and risk factor for HIV infection, progression to AIDS was faster in patients infected with serotype B (hazard ratio [HR] 1.59; 95% CI, 1.03-2.43; p = 0.03). A similar trend was observed in a model that considered AIDS or death as the outcome (HR, 1.43; 95% CI, 0.95-2.0; p = 0.09). These results suggest that patients infected with closely related HIV-1 serotypes may differ in the rate of progression to AIDS and indicate that serotype should be taken into account in HIV vaccine studies in Brazil.
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Affiliation(s)
- G Santoro-Lopes
- Infectious Diseases Clinic, Department of Preventive Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil
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Affiliation(s)
- M Schechter
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Schechter M, do Lago RF, de Melo MF, Sheppard HW, Guimarães NC, Moreira RI, Faulhaber JC, Batista S, Harrison LH. Identification of a high-risk heterosexual population for HIV prevention trials in Rio de Janeiro, Brazil. Projeto Praço Onze Study Group. J Acquir Immune Defic Syndr 2000; 24:175-7. [PMID: 10935694 DOI: 10.1097/00126334-200006010-00013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The study of interventions to prevent HIV transmission requires access to populations with a high rate of HIV transmission. We estimated HIV incidence among heterosexual males and females who were seen at an HIV testing site in Rio de Janeiro, Brazil. Stored sera from individuals who visited the site between March and December 1998 were analyzed using the sensitive/less sensitive (S/LS) assay and a chart abstraction was performed. During the study period, 6353 serum samples were tested. Of those tested, 1203 were found to be HIV-seropositive or indeterminate, of which 1050 (87%) remained available for further testing. In addition, 84 serum samples, representing 63 adults, were found to produce results suggesting early HIV infection. Of these, 14 were heterosexual and female (median age, 38 years), and 19 were heterosexual and male (median age, 25 years). The estimated HIV seroincidence was 1.9 (95% confidence limits (CL), 0.9%-3.9%) and 2.8 (95% CL, 1.4%-5.3%) per 100 person-years among heterosexual women and men, respectively. A survey on willingness to participate in future placebo-controlled HIV vaccine trials in this population indicated that 54.5% and 53.9% of heterosexual women and men, respectively, indicated that they would definitely be willing to participate. We have identified a heterosexual population in Rio de Janeiro with a high rate of HIV transmission willing to participate in placebo-controlled vaccine trials. This study demonstrates the usefulness of the newly described S/LS assay, which allows one to estimate HIV incidence from single serum specimens.
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Affiliation(s)
- M Schechter
- Infectious Diseases Service, Hospital Universitário Clementino Fraga Filho, Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Brazil.
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Gordin F, Chaisson RE, Matts JP, Miller C, de Lourdes Garcia M, Hafner R, Valdespino JL, Coberly J, Schechter M, Klukowicz AJ, Barry MA, O'Brien RJ. Rifampin and pyrazinamide vs isoniazid for prevention of tuberculosis in HIV-infected persons: an international randomized trial. Terry Beirn Community Programs for Clinical Research on AIDS, the Adult AIDS Clinical Trials Group, the Pan American Health Organization, and the Centers for Disease Control and Prevention Study Group. JAMA 2000; 283:1445-50. [PMID: 10732934 DOI: 10.1001/jama.283.11.1445] [Citation(s) in RCA: 201] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Because of problems with adherence, toxicity, and increasing resistance associated with 6- to 12-month isoniazid regimens, an alternative short-course tuberculosis preventive regimen is needed. OBJECTIVE To compare a 2-month regimen of daily rifampin and pyrazinamide with a 12-month regimen of daily isoniazid in preventing tuberculosis in persons with human immunodeficiency virus (HIV) infection. DESIGN Randomized, open-label controlled trial conducted from September 1991 to May 1996, with follow-up through October 1997. SETTING Outpatient clinics in the United States, Mexico, Haiti, and Brazil. PARTICIPANTS A total of 1583 HIV-positive persons aged 13 years or older with a positive tuberculin skin test result. INTERVENTIONS Patients were randomized to isoniazid, 300 mg/d, with pyridoxine hydrochloride for 12 months (n = 792) or rifampin, 600 mg/d, and pyrazinamide, 20 mg/kg per day, for 2 months (n = 791). MAIN OUTCOME MEASURES The primary end point was culture-confirmed tuberculosis; secondary end points were proven or probable tuberculosis, adverse events, and death, compared by treatment group. RESULTS Of patients assigned to rifampin and pyrazinamide, 80% completed the regimen compared with 69% assigned to isoniazid (P<.001). After a mean follow-up of 37 months, 19 patients (2.4%) assigned to rifampin and pyrazinamide and 26 (3.3%) assigned to isoniazid developed confirmed tuberculosis at rates of 0.8 and 1.1 per 100 person-years, respectively (risk ratio, 0.72 [95% confidence interval, 0.40-1.31]; P = .28). In multivariate analysis, there were no significant differences in rates for confirmed or probable tuberculosis (P = .83), HIV progression and/or death (P = .09), or overall adverse events (P = .27), although drug discontinuation was slightly higher in the rifampin and pyrazinamide group (P = .01). Neither regimen appeared to lead to the development of drug-resistant tuberculosis. CONCLUSIONS Our data suggest that for preventing tuberculosis in HIV-infected patients, a daily 2-month regimen of rifampin and pyrazinamide is similar in safety and efficacy to a daily 12-month regimen of isoniazid. This shorter regimen offers practical advantages to both patients and tuberculosis control programs.
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Affiliation(s)
- F Gordin
- Veterans Affairs Medical Center and Georgetown University, Washington, DC 20422, USA.
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Carpenter CC, Cooper DA, Fischl MA, Gatell JM, Gazzard BG, Hammer SM, Hirsch MS, Jacobsen DM, Katzenstein DA, Montaner JS, Richman DD, Saag MS, Schechter M, Schooley RT, Thompson MA, Vella S, Yeni PG, Volberding PA. Antiretroviral therapy in adults: updated recommendations of the International AIDS Society-USA Panel. JAMA 2000; 283:381-90. [PMID: 10647802 DOI: 10.1001/jama.283.3.381] [Citation(s) in RCA: 800] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To update recommendations for antiretroviral therapy for adult human immunodeficiency virus type 1 (HIV-1) infection, based on new information and drugs that are available. PARTICIPANTS A 17-member international physician panel with antiretroviral research and HIV patient care experience initially convened by the International AIDS Society-USA in December 1995. EVIDENCE Available clinical and basic science data including phase 3 controlled trials; data on clinical, virologic, and immunologic end points; research conference reports; HIV pathogenesis data; and panel expert opinion. Recommendations were limited to therapies available (US Food and Drug Administration approved) in 1999. CONSENSUS PROCESS The panel assesses new research reports and interim results and regularly meets to consider how the new data affect therapy recommendations. Recommendations are updated via full-panel consensus. Guidelines are presented as recommendations if the supporting evidence warrants routine use in the particular situation and as considerations if data are preliminary or incomplete but suggestive. CONCLUSIONS The availability of new antiretroviral drugs has expanded treatment choices. The importance of adherence, emerging long-term complications of therapy, recognition and management of antiretroviral failure, and new monitoring tools are addressed. Optimal care requires individualized management and ongoing attention to relevant scientific and clinical information in the field.
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Affiliation(s)
- C C Carpenter
- Brown University School of Medicine, Providence, RI 02906, USA.
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Schechter M, Harrison LH. Therapy of early HIV infection: time for the pendulum to swing back? AIDS Clin Care 1999; 11:79-81, 86. [PMID: 11366705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- M Schechter
- Universidade Federal do Rio de Janeiro, AIDS Research Laboratory
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Harrison LH, do Lago RF, Friedman RK, Rodrigues J, Santos EM, de Melo MF, Moulton LH, Schechter M. Incident HIV infection in a high-risk, homosexual, male cohort in Rio de Janeiro, Brazil. J Acquir Immune Defic Syndr 1999; 21:408-12. [PMID: 10458622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
An HIV seroincidence study was conducted to identify a high-risk population for HIV prevention trials. Inclusion criteria were male gender, homosexual behavior, age between 18 and 50 years, and negative HIV serostatus; 862 study subjects were screened and 753 were enrolled and observed during follow-up for a mean of 1.5 years. In this population, 34 people had HIV seroconversions for an overall annual seroincidence of 3.1% (95% confidence interval [CI], 2.1%-4.1%). Among study subjects <20 years old, annual incidence was 8.4% (95% CI, 1.7%-15%). Independent risk factors for seroconversion were age <25 years (p = .01), hepatitis B core antibody seropositivity (p > .01), sex at first encounter in the preceding 6 months (p = .11), and a history of gonorrhea or condyloma in the 6 months before seroconversion (p = .04 and p = .08, respectively). At enrollment, 85% of the eventual seroconverters said they would participate in a vaccine trial; all agreed to participate when told there would be a placebo arm. Follow-up rates were 97%, 91%, and 88% at 6, 12, and 18 months, respectively. The HIV-1 subtype was B for each of the first 17 seroconverters. These data demonstrate the suitability of this cohort for HIV prevention trials, based on high HIV incidence and retention rates, and a willingness to participate in such trials.
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Affiliation(s)
- L H Harrison
- Departments of Epidemiology and Medicine, University Pittsburgh Graduate School of Public Health, Pennsylvania 15261, USA.
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Tanuri A, Vicente AC, Otsuki K, Ramos CA, Ferreira OC, Schechter M, Janini LM, Pieniazek D, Rayfield MA. Genetic variation and susceptibilities to protease inhibitors among subtype B and F isolates in Brazil. Antimicrob Agents Chemother 1999; 43:253-8. [PMID: 9925514 PMCID: PMC89059 DOI: 10.1128/aac.43.2.253] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The genetic variation of the human immunodeficiency virus type 1 (HIV-1) protease gene (prt) permits the classification of HIV-1 strains into five distinct protease subtypes, which follow the gag subtyping patterns. The susceptibilities of non-B-subtype strains to protease inhibitors (PIs) and other antiretroviral drugs remain largely unknown. Subtype F is the main non-B strain contributing to the Brazilian epidemic, accounting for 15 to 20% of these infections. In this work, we report the findings on 81 isolates from PI-naive Brazilian patients collected between 1993 and 1997. In addition, the relevant PI resistance mutations and their phenotypes were determined in vitro for 15 of these patients (B = 9 and F = 6). Among these, the subtype F samples evidenced high sensitivities in vitro to ritonavir and indinavir, with MICs at which 50 and 90% of the isolates are inhibited similar to those of both the Brazilian and the U.S. subtype B isolates. Analysis of the 81 Brazilian prt sequences demonstrated that the subtype F consensus sequence differs from the U.S. and Brazilian subtype B consensus in eight positions (I15V, E35D, M36I, R41K, R57K, Q61N, L63P, and L89M). The frequency of critical PI resistance substitutions (amino acid changes D30N, V82A/F/T, I84V, N88D, and L90M) among Brazilian isolates is very low (mean, 2.5%), and the associated secondary substitutions (amino acid positions 10L, 20K, 36M, 46M, 48G, 54I, 63P, 71A, and 77A) are infrequent. These observations document the relative rarity of resistance to PIs in the treatment of patients infected with HIV-1 subtype F in South America.
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Affiliation(s)
- A Tanuri
- Laboratorio de Virologia Molecular, Department of Genetics, UFRJ, Rio de Janeiro, Brazil.
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