Jan Dyer

Dexamethasone (Dex), a synthetic glucocorticoid, for years has been widely used both to treat adverse effects of antitumor agents and in direct chemotherapy regimens for hematologic malignancies, such as leukemia and lymphoma. But might it be modified to work against solid cancers as well? Researchers from Advanced Radiation Technology Institute, Medical Device Development Center, and University of Science and Technology in South Korea, suggest that ionizing radiation could produce new anticancer options from an old drug.

The researchers irradiated Dex with γ- rays to produce ionizing-radiation-irradiated.

 Dex (Dex-IR), then investigated its effects on human lung cancer cells (cell lines H1650, A549, and H1299). The researchers used ionizing radiation because introducing energy into materials can produce favorable changes; irradiated materials with sufficiently high energy can decompose to yield very reactive intermediate molecules and form new ones. In this study, γ -irradiation produced “remarkable changes” in the chemical properties of dexamethasone; changes included degradation products, such as methanol vapor and carbon monoxide.

Original Dex inhibits the proliferation of non-small cell lung cancer (NSCLC) cells but has minimal cytotoxic effects, the researchers say. However, Dex-IR not only significantly inhibited the proliferation of NSCLC cells, but also induced apoptosis, arrested cell cycles of H1650 lung cancer cells, and significantly reduced cells’ invasiveness.

The researchers say their results “strongly suggest” a direct link between the chemical derivatives of Dex and inhibition of NSCLC cell growth. Their findings are the first evidence that γ -irradiated Dex represents a novel class of anticancer agents for lung cancer.

Lee EH, Park CH, Choi HJ, Kawala RA, Bai HW, Chung BY. PLoS One. 2018;13(4):e0194341.
doi: 10.1371/journal.pone.0194341.

Dexamethasone (Dex), a synthetic glucocorticoid, for years has been widely used both to treat adverse effects of antitumor agents and in direct chemotherapy regimens for hematologic malignancies, such as leukemia and lymphoma. But might it be modified to work against solid cancers as well? Researchers from Advanced Radiation Technology Institute, Medical Device Development Center, and University of Science and Technology in South Korea, suggest that ionizing radiation could produce new anticancer options from an old drug.

The researchers irradiated Dex with γ- rays to produce ionizing-radiation-irradiated.

 Dex (Dex-IR), then investigated its effects on human lung cancer cells (cell lines H1650, A549, and H1299). The researchers used ionizing radiation because introducing energy into materials can produce favorable changes; irradiated materials with sufficiently high energy can decompose to yield very reactive intermediate molecules and form new ones. In this study, γ -irradiation produced “remarkable changes” in the chemical properties of dexamethasone; changes included degradation products, such as methanol vapor and carbon monoxide.

Original Dex inhibits the proliferation of non-small cell lung cancer (NSCLC) cells but has minimal cytotoxic effects, the researchers say. However, Dex-IR not only significantly inhibited the proliferation of NSCLC cells, but also induced apoptosis, arrested cell cycles of H1650 lung cancer cells, and significantly reduced cells’ invasiveness.

The researchers say their results “strongly suggest” a direct link between the chemical derivatives of Dex and inhibition of NSCLC cell growth. Their findings are the first evidence that γ -irradiated Dex represents a novel class of anticancer agents for lung cancer.

Lee EH, Park CH, Choi HJ, Kawala RA, Bai HW, Chung BY. PLoS One. 2018;13(4):e0194341.
doi: 10.1371/journal.pone.0194341.

Dexamethasone (Dex), a synthetic glucocorticoid, for years has been widely used both to treat adverse effects of antitumor agents and in direct chemotherapy regimens for hematologic malignancies, such as leukemia and lymphoma. But might it be modified to work against solid cancers as well? Researchers from Advanced Radiation Technology Institute, Medical Device Development Center, and University of Science and Technology in South Korea, suggest that ionizing radiation could produce new anticancer options from an old drug.

The researchers irradiated Dex with γ- rays to produce ionizing-radiation-irradiated.

 Dex (Dex-IR), then investigated its effects on human lung cancer cells (cell lines H1650, A549, and H1299). The researchers used ionizing radiation because introducing energy into materials can produce favorable changes; irradiated materials with sufficiently high energy can decompose to yield very reactive intermediate molecules and form new ones. In this study, γ -irradiation produced “remarkable changes” in the chemical properties of dexamethasone; changes included degradation products, such as methanol vapor and carbon monoxide.

Original Dex inhibits the proliferation of non-small cell lung cancer (NSCLC) cells but has minimal cytotoxic effects, the researchers say. However, Dex-IR not only significantly inhibited the proliferation of NSCLC cells, but also induced apoptosis, arrested cell cycles of H1650 lung cancer cells, and significantly reduced cells’ invasiveness.

The researchers say their results “strongly suggest” a direct link between the chemical derivatives of Dex and inhibition of NSCLC cell growth. Their findings are the first evidence that γ -irradiated Dex represents a novel class of anticancer agents for lung cancer.

Lee EH, Park CH, Choi HJ, Kawala RA, Bai HW, Chung BY. PLoS One. 2018;13(4):e0194341.
doi: 10.1371/journal.pone.0194341.

It might only take 1 month of antibiotics, not 9, to prevent tuberculosis in people with HIV, according to National Institute of Allergy and Infectious Diseases (NIAID) researchers.

A phase 3 trial, ACTG 5279, enrolled 3,000 people aged ≥ 13 years living with HIV. All participants lived in an area with a high tuberculosis (TB) burden or had a skin or blood test indicating latent infection. Among people with latent TB infection, HIV infection is the greatest risk factor for progression to active TB disease. About half were taking antiretroviral therapy (ART). The participants were randomly assigned to a 1-month course of rifapentine and isoniazid or 9 months of isoniazid. They were monitored for an average of 3 years.

Tuberculosis incidence was lower than expected and similar in both treatment groups: 32 participants in the 1-month group and 33 in the 9-month group developed active TB. Regardless of treatment, TB rates were higher among participants who were not taking ART when the study began, and among those with positive TB tests.

Adherence was high in both groups, but it was significantly better in the group with the shorter regimen. Nearly all (97%) of those in the 1-month group finished the full antibiotic course, compared with 90% in the 9-month group.

Few adverse events were reported in the 1-month group.

Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, and Robert Eisinger, PhD, special assistant for scientific projects at NIAID, have called for systems biology approaches using large datasets and modeling to understand how Mycobacterium tuberculosis infection causes disease. Noting that lengthy and complex treatment regimens make the disease increasingly difficult to cure, they say the ultimate treatment goal should be drug combinations administered for shorter time periods, as well as, a safe and more broadly effective vaccine and rapid, inexpensive diagnostic tests for drug-resistant TB.

It might only take 1 month of antibiotics, not 9, to prevent tuberculosis in people with HIV, according to National Institute of Allergy and Infectious Diseases (NIAID) researchers.

A phase 3 trial, ACTG 5279, enrolled 3,000 people aged ≥ 13 years living with HIV. All participants lived in an area with a high tuberculosis (TB) burden or had a skin or blood test indicating latent infection. Among people with latent TB infection, HIV infection is the greatest risk factor for progression to active TB disease. About half were taking antiretroviral therapy (ART). The participants were randomly assigned to a 1-month course of rifapentine and isoniazid or 9 months of isoniazid. They were monitored for an average of 3 years.

Tuberculosis incidence was lower than expected and similar in both treatment groups: 32 participants in the 1-month group and 33 in the 9-month group developed active TB. Regardless of treatment, TB rates were higher among participants who were not taking ART when the study began, and among those with positive TB tests.

Adherence was high in both groups, but it was significantly better in the group with the shorter regimen. Nearly all (97%) of those in the 1-month group finished the full antibiotic course, compared with 90% in the 9-month group.

Few adverse events were reported in the 1-month group.

Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, and Robert Eisinger, PhD, special assistant for scientific projects at NIAID, have called for systems biology approaches using large datasets and modeling to understand how Mycobacterium tuberculosis infection causes disease. Noting that lengthy and complex treatment regimens make the disease increasingly difficult to cure, they say the ultimate treatment goal should be drug combinations administered for shorter time periods, as well as, a safe and more broadly effective vaccine and rapid, inexpensive diagnostic tests for drug-resistant TB.

It might only take 1 month of antibiotics, not 9, to prevent tuberculosis in people with HIV, according to National Institute of Allergy and Infectious Diseases (NIAID) researchers.

A phase 3 trial, ACTG 5279, enrolled 3,000 people aged ≥ 13 years living with HIV. All participants lived in an area with a high tuberculosis (TB) burden or had a skin or blood test indicating latent infection. Among people with latent TB infection, HIV infection is the greatest risk factor for progression to active TB disease. About half were taking antiretroviral therapy (ART). The participants were randomly assigned to a 1-month course of rifapentine and isoniazid or 9 months of isoniazid. They were monitored for an average of 3 years.

Tuberculosis incidence was lower than expected and similar in both treatment groups: 32 participants in the 1-month group and 33 in the 9-month group developed active TB. Regardless of treatment, TB rates were higher among participants who were not taking ART when the study began, and among those with positive TB tests.

Adherence was high in both groups, but it was significantly better in the group with the shorter regimen. Nearly all (97%) of those in the 1-month group finished the full antibiotic course, compared with 90% in the 9-month group.

Few adverse events were reported in the 1-month group.

Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, and Robert Eisinger, PhD, special assistant for scientific projects at NIAID, have called for systems biology approaches using large datasets and modeling to understand how Mycobacterium tuberculosis infection causes disease. Noting that lengthy and complex treatment regimens make the disease increasingly difficult to cure, they say the ultimate treatment goal should be drug combinations administered for shorter time periods, as well as, a safe and more broadly effective vaccine and rapid, inexpensive diagnostic tests for drug-resistant TB.

Starting antiretroviral therapy (ART) right after diagnosis does not prevent the depletion of CD4+ T cells from the gut or help restore them—and researchers at the National Institutes of Health (NIH) may have found the reason. For the first time, the NIH says, scientists have shown a relationship between high levels of a “gut-homing” protein called α4β7 and HIV health outcomes.

The researchers found that women who had more CD4+ T cells with high levels of α4β7 were more likely to become infected with HIV, and the virus damaged their immune systems more rapidly than it did in women with fewer such cells.

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) and coauthor of the study paper found that HIV “preferentially infects” those cells. That leads to more HIV-infected CD4+ T cells moving to the gut, which in turn leads to extensive damage to gut-based immune cells.

In the study, which compared blood samples from 59 women shortly before they acquired HIV to those of 106 women who remained HIV negative, the risk of HIV acquisition rose by 18% for each 1% increase in α4β7 protein.

The α4β7 cells also “strongly affected” how quickly HIV damaged the immune system. CD4+ T-cell levels dropped twice as fast among women with higher pre-infection levels of α4β7. Within a few months, those women also had more HIV in the blood. The researchers say the mechanism for immune system damage was likely HIV-related damage to the gut, because higher pre-infection levels of α4β7 were associated with higher levels of a biologic marker of gut damage.

The study findings suggest that ART alone may not be enough; people with HIV may also benefit from interventions to restore CD4+ T cells in their gastrointestinal tracts. One possible solution could be vedolizumab, an anti- α4β7 antibody approved for treatment of ulcerative colitis and Crohn disease. In animal studies, vedolizumab contributed to “near replenishment” of CD4+ T cells.

To determine whether short-term treatment with vedolizumab in combination with ART could generate sustained HIV remission, NIAID has initiated an early-phase clinical trial.

Source:
US Department of Health and Human Services. National Institutes of Health. https://www.nih.gov/news-events/news-releases/study-links-gut-homing-protein-levels-hiv-infection-risk-disease-progression. Published January 24, 2018. Accessed April 19, 2018.

Starting antiretroviral therapy (ART) right after diagnosis does not prevent the depletion of CD4+ T cells from the gut or help restore them—and researchers at the National Institutes of Health (NIH) may have found the reason. For the first time, the NIH says, scientists have shown a relationship between high levels of a “gut-homing” protein called α4β7 and HIV health outcomes.

The researchers found that women who had more CD4+ T cells with high levels of α4β7 were more likely to become infected with HIV, and the virus damaged their immune systems more rapidly than it did in women with fewer such cells.

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) and coauthor of the study paper found that HIV “preferentially infects” those cells. That leads to more HIV-infected CD4+ T cells moving to the gut, which in turn leads to extensive damage to gut-based immune cells.

In the study, which compared blood samples from 59 women shortly before they acquired HIV to those of 106 women who remained HIV negative, the risk of HIV acquisition rose by 18% for each 1% increase in α4β7 protein.

The α4β7 cells also “strongly affected” how quickly HIV damaged the immune system. CD4+ T-cell levels dropped twice as fast among women with higher pre-infection levels of α4β7. Within a few months, those women also had more HIV in the blood. The researchers say the mechanism for immune system damage was likely HIV-related damage to the gut, because higher pre-infection levels of α4β7 were associated with higher levels of a biologic marker of gut damage.

The study findings suggest that ART alone may not be enough; people with HIV may also benefit from interventions to restore CD4+ T cells in their gastrointestinal tracts. One possible solution could be vedolizumab, an anti- α4β7 antibody approved for treatment of ulcerative colitis and Crohn disease. In animal studies, vedolizumab contributed to “near replenishment” of CD4+ T cells.

To determine whether short-term treatment with vedolizumab in combination with ART could generate sustained HIV remission, NIAID has initiated an early-phase clinical trial.

Source:
US Department of Health and Human Services. National Institutes of Health. https://www.nih.gov/news-events/news-releases/study-links-gut-homing-protein-levels-hiv-infection-risk-disease-progression. Published January 24, 2018. Accessed April 19, 2018.

Starting antiretroviral therapy (ART) right after diagnosis does not prevent the depletion of CD4+ T cells from the gut or help restore them—and researchers at the National Institutes of Health (NIH) may have found the reason. For the first time, the NIH says, scientists have shown a relationship between high levels of a “gut-homing” protein called α4β7 and HIV health outcomes.

The researchers found that women who had more CD4+ T cells with high levels of α4β7 were more likely to become infected with HIV, and the virus damaged their immune systems more rapidly than it did in women with fewer such cells.

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) and coauthor of the study paper found that HIV “preferentially infects” those cells. That leads to more HIV-infected CD4+ T cells moving to the gut, which in turn leads to extensive damage to gut-based immune cells.

In the study, which compared blood samples from 59 women shortly before they acquired HIV to those of 106 women who remained HIV negative, the risk of HIV acquisition rose by 18% for each 1% increase in α4β7 protein.

The α4β7 cells also “strongly affected” how quickly HIV damaged the immune system. CD4+ T-cell levels dropped twice as fast among women with higher pre-infection levels of α4β7. Within a few months, those women also had more HIV in the blood. The researchers say the mechanism for immune system damage was likely HIV-related damage to the gut, because higher pre-infection levels of α4β7 were associated with higher levels of a biologic marker of gut damage.

The study findings suggest that ART alone may not be enough; people with HIV may also benefit from interventions to restore CD4+ T cells in their gastrointestinal tracts. One possible solution could be vedolizumab, an anti- α4β7 antibody approved for treatment of ulcerative colitis and Crohn disease. In animal studies, vedolizumab contributed to “near replenishment” of CD4+ T cells.

To determine whether short-term treatment with vedolizumab in combination with ART could generate sustained HIV remission, NIAID has initiated an early-phase clinical trial.

Source:
US Department of Health and Human Services. National Institutes of Health. https://www.nih.gov/news-events/news-releases/study-links-gut-homing-protein-levels-hiv-infection-risk-disease-progression. Published January 24, 2018. Accessed April 19, 2018.

Exercise and physical therapy in the first weeks after surgery can have a positive impact on health, physical function, and quality of life (QOL) in patients with oral cancer. The changes persist for months afterward, say researchers from Chang Gung Memorial Hospital in Taiwan.

The study involved 65 patients who had undergone reconstructive microsurgery for oral cavity squamous cell carcinoma. The time of intervention had 3 phases: early (8 days to within a month after surgery), middle (1- 3 months after surgery), and late (> 3 months after surgery). The program included pain management, temporomandibular joint exercise, and shoulder and neck exercises.

In the early phase, the main goal was to help participants deal with pain, edema, shoulder dysfunction, and other consequences of surgery. Transcutaneous electrical stimulation for 15 minutes in each treatment session was followed by gentle massage and exercise. During the middle phase, the intervention focused on impairment from surgery or radiation therapy and intensified exercise. The late phase goal was to recover residual function as much as possible.

At 1 month, 40% of patients were on a soft diet. By 6 months, all nasogastric tubes had been removed, and 53% of patients had returned to a normal diet. The researchers note that early intervention to exercise the temporomandibular joint exercise may improve mouth opening. In the advanced stage group, the maximum mouth opening reached its highest at 3 months.

Scapular muscle strength and shoulder range of motion improved progressively during the 6-month follow-up. At 1 month, the mean DASH (Disability of the Arms, Shoulder, and Hand) score showed significant improvement (dropping from 34 to 17). Health-related QOL also showed significant improvement. The predicted return-to-work rate was 80% at 1 year: Patients in skilled or semiskilled work and the self-employed had the highest rates (88% and 87%, respectively).

Source:
Chen YH, Liang WA, Hsu CY, et al. PeerJ. 2018;6e4419.
doi: 10.7717/peerj.4419.

Exercise and physical therapy in the first weeks after surgery can have a positive impact on health, physical function, and quality of life (QOL) in patients with oral cancer. The changes persist for months afterward, say researchers from Chang Gung Memorial Hospital in Taiwan.

The study involved 65 patients who had undergone reconstructive microsurgery for oral cavity squamous cell carcinoma. The time of intervention had 3 phases: early (8 days to within a month after surgery), middle (1- 3 months after surgery), and late (> 3 months after surgery). The program included pain management, temporomandibular joint exercise, and shoulder and neck exercises.

In the early phase, the main goal was to help participants deal with pain, edema, shoulder dysfunction, and other consequences of surgery. Transcutaneous electrical stimulation for 15 minutes in each treatment session was followed by gentle massage and exercise. During the middle phase, the intervention focused on impairment from surgery or radiation therapy and intensified exercise. The late phase goal was to recover residual function as much as possible.

At 1 month, 40% of patients were on a soft diet. By 6 months, all nasogastric tubes had been removed, and 53% of patients had returned to a normal diet. The researchers note that early intervention to exercise the temporomandibular joint exercise may improve mouth opening. In the advanced stage group, the maximum mouth opening reached its highest at 3 months.

Scapular muscle strength and shoulder range of motion improved progressively during the 6-month follow-up. At 1 month, the mean DASH (Disability of the Arms, Shoulder, and Hand) score showed significant improvement (dropping from 34 to 17). Health-related QOL also showed significant improvement. The predicted return-to-work rate was 80% at 1 year: Patients in skilled or semiskilled work and the self-employed had the highest rates (88% and 87%, respectively).

Source:
Chen YH, Liang WA, Hsu CY, et al. PeerJ. 2018;6e4419.
doi: 10.7717/peerj.4419.

Exercise and physical therapy in the first weeks after surgery can have a positive impact on health, physical function, and quality of life (QOL) in patients with oral cancer. The changes persist for months afterward, say researchers from Chang Gung Memorial Hospital in Taiwan.

The study involved 65 patients who had undergone reconstructive microsurgery for oral cavity squamous cell carcinoma. The time of intervention had 3 phases: early (8 days to within a month after surgery), middle (1- 3 months after surgery), and late (> 3 months after surgery). The program included pain management, temporomandibular joint exercise, and shoulder and neck exercises.

In the early phase, the main goal was to help participants deal with pain, edema, shoulder dysfunction, and other consequences of surgery. Transcutaneous electrical stimulation for 15 minutes in each treatment session was followed by gentle massage and exercise. During the middle phase, the intervention focused on impairment from surgery or radiation therapy and intensified exercise. The late phase goal was to recover residual function as much as possible.

At 1 month, 40% of patients were on a soft diet. By 6 months, all nasogastric tubes had been removed, and 53% of patients had returned to a normal diet. The researchers note that early intervention to exercise the temporomandibular joint exercise may improve mouth opening. In the advanced stage group, the maximum mouth opening reached its highest at 3 months.

Scapular muscle strength and shoulder range of motion improved progressively during the 6-month follow-up. At 1 month, the mean DASH (Disability of the Arms, Shoulder, and Hand) score showed significant improvement (dropping from 34 to 17). Health-related QOL also showed significant improvement. The predicted return-to-work rate was 80% at 1 year: Patients in skilled or semiskilled work and the self-employed had the highest rates (88% and 87%, respectively).

Source:
Chen YH, Liang WA, Hsu CY, et al. PeerJ. 2018;6e4419.
doi: 10.7717/peerj.4419.

The Indian Health Service (IHS) has announced a new tool to monitor and report information system-wide. The National Accountability Dashboard for Quality (NAD-Q) will allow IHS to report on key performance data in a “succinct and easily viewed display.”

The NAD-Q shows how IHS is functioning in the following key domains for health care systems:

• Quality (efficient, effective, and equitable);
• Accreditation;
• Workforce;
• Patient-centered care;
• Safety; and
• Timely care.

The dashboard will monitor and report on compliance with policy requirements, accreditation standards, and regulations at hospitals and ambulatory health centers. The tool also supports oversight and management, and will allow IHS to make fact-based decisions to ensure quality and safety of care.

The NAD-Q also allows IHS to share with tribes, tribal and urban Indian organizations, and Congress how well it is meeting standards and requirements

The Indian Health Service (IHS) has announced a new tool to monitor and report information system-wide. The National Accountability Dashboard for Quality (NAD-Q) will allow IHS to report on key performance data in a “succinct and easily viewed display.”

The NAD-Q shows how IHS is functioning in the following key domains for health care systems:

• Quality (efficient, effective, and equitable);
• Accreditation;
• Workforce;
• Patient-centered care;
• Safety; and
• Timely care.

The dashboard will monitor and report on compliance with policy requirements, accreditation standards, and regulations at hospitals and ambulatory health centers. The tool also supports oversight and management, and will allow IHS to make fact-based decisions to ensure quality and safety of care.

The NAD-Q also allows IHS to share with tribes, tribal and urban Indian organizations, and Congress how well it is meeting standards and requirements

The Indian Health Service (IHS) has announced a new tool to monitor and report information system-wide. The National Accountability Dashboard for Quality (NAD-Q) will allow IHS to report on key performance data in a “succinct and easily viewed display.”

The NAD-Q shows how IHS is functioning in the following key domains for health care systems:

• Quality (efficient, effective, and equitable);
• Accreditation;
• Workforce;
• Patient-centered care;
• Safety; and
• Timely care.

The dashboard will monitor and report on compliance with policy requirements, accreditation standards, and regulations at hospitals and ambulatory health centers. The tool also supports oversight and management, and will allow IHS to make fact-based decisions to ensure quality and safety of care.

The NAD-Q also allows IHS to share with tribes, tribal and urban Indian organizations, and Congress how well it is meeting standards and requirements

In 2016, a Virginia dentist who had been recently diagnosed with idiopathic pulmonary fibrosis (IPF) was being treated at a specialty clinic. The CDC was contacted to report concerns that IPF had been diagnosed in multiple dentists, also from Virginia, who had also sought treatment at the same specialty clinic.

CDC researchers reviewed medical records of 894 patients treated for IPF at the tertiary care center between 1996-2017. They found 8 patients were dentists and 1 was a dental technician. Seven of the patients had died.

Idiopathic pulmonary fibrosis is a chronic, progressive, fibrosing interstitial pneumonia. This is the first known described cluster of IPF among dental personnel, the CDC says. Although no clear etiology could be found, it is possible that occupational exposure contributed to the development of IPF. Viral infections, cigarette smoking, and exposure to dust, wood dust, and metal dust have been implicated. One of the surviving patients reported polishing dental appliances and preparing amalgams and impressions without respiratory protection, which could have exposed him to silica, alginate, and other compounds with known or potential respiratory toxicity.

The CDC researchers note that dental personnel are exposed to infectious agents, chemicals, airborne particulates, ionizing radiation, and other potentially hazardous materials. They cite the case of a dentist who died of respiratory failure. Postmortem analysis identified pneumoconiosis; examination of lung tissue revealed particles consistent with alginate impression powders.

Idiopathic pulmonary fibrosis has not previously been described among dental personnel, the researchers say. But when they queried the National Occupational Respiratory Mortality System for “other interstitial pulmonary diseases with fibrosis” listed as the underlying or contributing cause of death, they found 35 decedents categorized as having worked in dentists’ offices or as dentists. During 2016, dentists accounted for an estimated 0.038% of US residents, yet represented 0.893% of patients being treated for IPF at a tertiary care center—nearly a 23-fold difference. Those findings suggest, the researchers say, that a higher rate of IPF might occur among dental personnel than among the general population.

In 2016, a Virginia dentist who had been recently diagnosed with idiopathic pulmonary fibrosis (IPF) was being treated at a specialty clinic. The CDC was contacted to report concerns that IPF had been diagnosed in multiple dentists, also from Virginia, who had also sought treatment at the same specialty clinic.

CDC researchers reviewed medical records of 894 patients treated for IPF at the tertiary care center between 1996-2017. They found 8 patients were dentists and 1 was a dental technician. Seven of the patients had died.

Idiopathic pulmonary fibrosis is a chronic, progressive, fibrosing interstitial pneumonia. This is the first known described cluster of IPF among dental personnel, the CDC says. Although no clear etiology could be found, it is possible that occupational exposure contributed to the development of IPF. Viral infections, cigarette smoking, and exposure to dust, wood dust, and metal dust have been implicated. One of the surviving patients reported polishing dental appliances and preparing amalgams and impressions without respiratory protection, which could have exposed him to silica, alginate, and other compounds with known or potential respiratory toxicity.

The CDC researchers note that dental personnel are exposed to infectious agents, chemicals, airborne particulates, ionizing radiation, and other potentially hazardous materials. They cite the case of a dentist who died of respiratory failure. Postmortem analysis identified pneumoconiosis; examination of lung tissue revealed particles consistent with alginate impression powders.

Idiopathic pulmonary fibrosis has not previously been described among dental personnel, the researchers say. But when they queried the National Occupational Respiratory Mortality System for “other interstitial pulmonary diseases with fibrosis” listed as the underlying or contributing cause of death, they found 35 decedents categorized as having worked in dentists’ offices or as dentists. During 2016, dentists accounted for an estimated 0.038% of US residents, yet represented 0.893% of patients being treated for IPF at a tertiary care center—nearly a 23-fold difference. Those findings suggest, the researchers say, that a higher rate of IPF might occur among dental personnel than among the general population.

In 2016, a Virginia dentist who had been recently diagnosed with idiopathic pulmonary fibrosis (IPF) was being treated at a specialty clinic. The CDC was contacted to report concerns that IPF had been diagnosed in multiple dentists, also from Virginia, who had also sought treatment at the same specialty clinic.

CDC researchers reviewed medical records of 894 patients treated for IPF at the tertiary care center between 1996-2017. They found 8 patients were dentists and 1 was a dental technician. Seven of the patients had died.

Idiopathic pulmonary fibrosis is a chronic, progressive, fibrosing interstitial pneumonia. This is the first known described cluster of IPF among dental personnel, the CDC says. Although no clear etiology could be found, it is possible that occupational exposure contributed to the development of IPF. Viral infections, cigarette smoking, and exposure to dust, wood dust, and metal dust have been implicated. One of the surviving patients reported polishing dental appliances and preparing amalgams and impressions without respiratory protection, which could have exposed him to silica, alginate, and other compounds with known or potential respiratory toxicity.

The CDC researchers note that dental personnel are exposed to infectious agents, chemicals, airborne particulates, ionizing radiation, and other potentially hazardous materials. They cite the case of a dentist who died of respiratory failure. Postmortem analysis identified pneumoconiosis; examination of lung tissue revealed particles consistent with alginate impression powders.

Idiopathic pulmonary fibrosis has not previously been described among dental personnel, the researchers say. But when they queried the National Occupational Respiratory Mortality System for “other interstitial pulmonary diseases with fibrosis” listed as the underlying or contributing cause of death, they found 35 decedents categorized as having worked in dentists’ offices or as dentists. During 2016, dentists accounted for an estimated 0.038% of US residents, yet represented 0.893% of patients being treated for IPF at a tertiary care center—nearly a 23-fold difference. Those findings suggest, the researchers say, that a higher rate of IPF might occur among dental personnel than among the general population.

The CDC estimates that > 1.2 million people in the US could benefit from pre-exposure prophylaxis (PrEP). The National HIV/AIDS Strategy (NHAS) aims to increase the number of adults prescribed PrEP by at least 500% by 2020, or about 47,832 people.

So far, prescriptions for PrEP increased by > 300% between 2014 and 2015. In 2015, 33,273 people had been prescribed PrEP, triple the NHAS target for that year, says Richard Wolitski, PhD, director, Office of HIV/AIDS and Infectious Disease Policy.

But according to 1 study, only 10% of the new prescriptions were for African Americans and 12% for Latinos, even though in 2016 African Americans accounted for 44% of new HIV diagnoses and Latinos for 25%. By contrast, 74% of new prescriptions were written for whites who made up only 26% of new diagnoses in 2016.

Such disparities highlight the need to continue to monitor uptake and expand efforts to increase use of PrEP, Wolitski says in his blog for HIV.gov. Studies show that daily PrEP can reduce the risk of acquiring HIV via sex by > 90% and > 70% among injection drug users.

The NHAS has added a PrEP indicator as 1 of 3 developmental indicators, introduced in 2016. Wolitski advocates multiple strategies for HIV prevention, including policies, programs, education, and monitoring. But he emphasizes that preventing HIV is only one component of an individual’s overall health and well-being—it’s also necessary to address other “competing needs,” such as access to jobs and housing, coordinated systems of care, and collaborations with social services.

The CDC estimates that > 1.2 million people in the US could benefit from pre-exposure prophylaxis (PrEP). The National HIV/AIDS Strategy (NHAS) aims to increase the number of adults prescribed PrEP by at least 500% by 2020, or about 47,832 people.

So far, prescriptions for PrEP increased by > 300% between 2014 and 2015. In 2015, 33,273 people had been prescribed PrEP, triple the NHAS target for that year, says Richard Wolitski, PhD, director, Office of HIV/AIDS and Infectious Disease Policy.

But according to 1 study, only 10% of the new prescriptions were for African Americans and 12% for Latinos, even though in 2016 African Americans accounted for 44% of new HIV diagnoses and Latinos for 25%. By contrast, 74% of new prescriptions were written for whites who made up only 26% of new diagnoses in 2016.

Such disparities highlight the need to continue to monitor uptake and expand efforts to increase use of PrEP, Wolitski says in his blog for HIV.gov. Studies show that daily PrEP can reduce the risk of acquiring HIV via sex by > 90% and > 70% among injection drug users.

The NHAS has added a PrEP indicator as 1 of 3 developmental indicators, introduced in 2016. Wolitski advocates multiple strategies for HIV prevention, including policies, programs, education, and monitoring. But he emphasizes that preventing HIV is only one component of an individual’s overall health and well-being—it’s also necessary to address other “competing needs,” such as access to jobs and housing, coordinated systems of care, and collaborations with social services.

The CDC estimates that > 1.2 million people in the US could benefit from pre-exposure prophylaxis (PrEP). The National HIV/AIDS Strategy (NHAS) aims to increase the number of adults prescribed PrEP by at least 500% by 2020, or about 47,832 people.

So far, prescriptions for PrEP increased by > 300% between 2014 and 2015. In 2015, 33,273 people had been prescribed PrEP, triple the NHAS target for that year, says Richard Wolitski, PhD, director, Office of HIV/AIDS and Infectious Disease Policy.

But according to 1 study, only 10% of the new prescriptions were for African Americans and 12% for Latinos, even though in 2016 African Americans accounted for 44% of new HIV diagnoses and Latinos for 25%. By contrast, 74% of new prescriptions were written for whites who made up only 26% of new diagnoses in 2016.

Such disparities highlight the need to continue to monitor uptake and expand efforts to increase use of PrEP, Wolitski says in his blog for HIV.gov. Studies show that daily PrEP can reduce the risk of acquiring HIV via sex by > 90% and > 70% among injection drug users.

The NHAS has added a PrEP indicator as 1 of 3 developmental indicators, introduced in 2016. Wolitski advocates multiple strategies for HIV prevention, including policies, programs, education, and monitoring. But he emphasizes that preventing HIV is only one component of an individual’s overall health and well-being—it’s also necessary to address other “competing needs,” such as access to jobs and housing, coordinated systems of care, and collaborations with social services.

Patients with HIV often also have herpes simplex virus type 2 (HSV-2) infection in part because lesions act as entry portals to susceptible HIV target cells. Some research also has suggested that HSV-2 accelerates HIV progression by upregulating HIV replication and increasing HIV viral load, but data are inconclusive, say researchers from the Iranian Research Center for HIV/AIDS, Pasteur Institute of Iran, Iranian Society for Support of Patients With Infectious Disease, Kermanshah University of Medical Sciences, Tehran University of Medical Sciences, and Zanjan University of Medical Sciences in Iran. They conducted a study to investigate HSV-2 seroprevalence in patients with and without HIV and to find out whether HSV-2 serostatus changed as CD4 counts and HIV viral load changed after 1 year.

The researchers compared 116 HIV patients who were not on HAART with 85 healthy controls. The prevalence and incidence of HSV-2 infection were low in the HIV cases and “negligible” in the control group: 18% of naïve HIV patients had HSV-2 IgG, and none of the control patients did.

Few data exist about HSV-2 seroconversion in HIV patients, the researchers say. In this study, HSV-2 seroconversion was found in 2.43% of HIV patients after 1 year.

Co-infection with HSV-2 had no association with CD4 count and HIV RNA viral load changes in the study participants at baseline or over time, the researchers say. CD4 counts after 1 year were 550 cells/mm³ in the HSV-2 seropositive patients and 563 cells/mm³ in the control group. The viral load in the seropositive group was 3.97 log copies/mL, and 3.49 log copies/mL in the seronegative group.

The researchers conclude that HIV-HSV-2 co-infection does not seem to play a role in HIV infection progression.

Patients with HIV often also have herpes simplex virus type 2 (HSV-2) infection in part because lesions act as entry portals to susceptible HIV target cells. Some research also has suggested that HSV-2 accelerates HIV progression by upregulating HIV replication and increasing HIV viral load, but data are inconclusive, say researchers from the Iranian Research Center for HIV/AIDS, Pasteur Institute of Iran, Iranian Society for Support of Patients With Infectious Disease, Kermanshah University of Medical Sciences, Tehran University of Medical Sciences, and Zanjan University of Medical Sciences in Iran. They conducted a study to investigate HSV-2 seroprevalence in patients with and without HIV and to find out whether HSV-2 serostatus changed as CD4 counts and HIV viral load changed after 1 year.

The researchers compared 116 HIV patients who were not on HAART with 85 healthy controls. The prevalence and incidence of HSV-2 infection were low in the HIV cases and “negligible” in the control group: 18% of naïve HIV patients had HSV-2 IgG, and none of the control patients did.

Few data exist about HSV-2 seroconversion in HIV patients, the researchers say. In this study, HSV-2 seroconversion was found in 2.43% of HIV patients after 1 year.

Co-infection with HSV-2 had no association with CD4 count and HIV RNA viral load changes in the study participants at baseline or over time, the researchers say. CD4 counts after 1 year were 550 cells/mm³ in the HSV-2 seropositive patients and 563 cells/mm³ in the control group. The viral load in the seropositive group was 3.97 log copies/mL, and 3.49 log copies/mL in the seronegative group.

The researchers conclude that HIV-HSV-2 co-infection does not seem to play a role in HIV infection progression.

Patients with HIV often also have herpes simplex virus type 2 (HSV-2) infection in part because lesions act as entry portals to susceptible HIV target cells. Some research also has suggested that HSV-2 accelerates HIV progression by upregulating HIV replication and increasing HIV viral load, but data are inconclusive, say researchers from the Iranian Research Center for HIV/AIDS, Pasteur Institute of Iran, Iranian Society for Support of Patients With Infectious Disease, Kermanshah University of Medical Sciences, Tehran University of Medical Sciences, and Zanjan University of Medical Sciences in Iran. They conducted a study to investigate HSV-2 seroprevalence in patients with and without HIV and to find out whether HSV-2 serostatus changed as CD4 counts and HIV viral load changed after 1 year.

The researchers compared 116 HIV patients who were not on HAART with 85 healthy controls. The prevalence and incidence of HSV-2 infection were low in the HIV cases and “negligible” in the control group: 18% of naïve HIV patients had HSV-2 IgG, and none of the control patients did.

Few data exist about HSV-2 seroconversion in HIV patients, the researchers say. In this study, HSV-2 seroconversion was found in 2.43% of HIV patients after 1 year.

Co-infection with HSV-2 had no association with CD4 count and HIV RNA viral load changes in the study participants at baseline or over time, the researchers say. CD4 counts after 1 year were 550 cells/mm³ in the HSV-2 seropositive patients and 563 cells/mm³ in the control group. The viral load in the seropositive group was 3.97 log copies/mL, and 3.49 log copies/mL in the seronegative group.

The researchers conclude that HIV-HSV-2 co-infection does not seem to play a role in HIV infection progression.

American Indians/Alaska Natives (AI/AN) have a disproportionately high rate of suicide—more than 3.5 times those of racial/ethnic groups with the lowest rates, according to a CDC study. And the rate has been steadily rising since 2003.

Those at highest risk are young people aged 10 to 24 years: More than one-third of suicides have occurred in that group compared with 11% of whites in the same age group.

In the CDC study, about 70% of AI/AN decedents lived in nonmetropolitan areas, including rural areas, which underscores the importance of implementing suicide prevention strategies in rural AI/AN communities, the researchers say. Rural areas often have fewer mental health services due to provider shortages and social barriers, among other factors. The researchers point out that in their study AI/AN had lower odds than did white decedents of having received a mental health diagnosis or mental health treatment.

The researchers also found suggestions of “suicide contagion”; AI/AN decedents were more than twice as likely to have a friend’s or family member’s suicide contribute to their death. Community-level programs that focus on “postvention,” such as survivor support groups, should be considered, the researchers say. They also advise that media should focus on “safe reporting of suicides,” for example, by not using sensationalized headlines.

Nearly 28% of the people who died had reported alcohol abuse problems, and 49% had used alcohol in the hours before their death. The researchers caution that differences in the prevalence of alcohol use among AI/AN might be a symptom of “disproportionate exposure to poverty, historical trauma, and other contexts of inequity and should not be viewed as inherent to AI/AN culture.”

American Indians/Alaska Natives (AI/AN) have a disproportionately high rate of suicide—more than 3.5 times those of racial/ethnic groups with the lowest rates, according to a CDC study. And the rate has been steadily rising since 2003.

Those at highest risk are young people aged 10 to 24 years: More than one-third of suicides have occurred in that group compared with 11% of whites in the same age group.

In the CDC study, about 70% of AI/AN decedents lived in nonmetropolitan areas, including rural areas, which underscores the importance of implementing suicide prevention strategies in rural AI/AN communities, the researchers say. Rural areas often have fewer mental health services due to provider shortages and social barriers, among other factors. The researchers point out that in their study AI/AN had lower odds than did white decedents of having received a mental health diagnosis or mental health treatment.

The researchers also found suggestions of “suicide contagion”; AI/AN decedents were more than twice as likely to have a friend’s or family member’s suicide contribute to their death. Community-level programs that focus on “postvention,” such as survivor support groups, should be considered, the researchers say. They also advise that media should focus on “safe reporting of suicides,” for example, by not using sensationalized headlines.

Nearly 28% of the people who died had reported alcohol abuse problems, and 49% had used alcohol in the hours before their death. The researchers caution that differences in the prevalence of alcohol use among AI/AN might be a symptom of “disproportionate exposure to poverty, historical trauma, and other contexts of inequity and should not be viewed as inherent to AI/AN culture.”

American Indians/Alaska Natives (AI/AN) have a disproportionately high rate of suicide—more than 3.5 times those of racial/ethnic groups with the lowest rates, according to a CDC study. And the rate has been steadily rising since 2003.

Those at highest risk are young people aged 10 to 24 years: More than one-third of suicides have occurred in that group compared with 11% of whites in the same age group.

In the CDC study, about 70% of AI/AN decedents lived in nonmetropolitan areas, including rural areas, which underscores the importance of implementing suicide prevention strategies in rural AI/AN communities, the researchers say. Rural areas often have fewer mental health services due to provider shortages and social barriers, among other factors. The researchers point out that in their study AI/AN had lower odds than did white decedents of having received a mental health diagnosis or mental health treatment.

The researchers also found suggestions of “suicide contagion”; AI/AN decedents were more than twice as likely to have a friend’s or family member’s suicide contribute to their death. Community-level programs that focus on “postvention,” such as survivor support groups, should be considered, the researchers say. They also advise that media should focus on “safe reporting of suicides,” for example, by not using sensationalized headlines.

Nearly 28% of the people who died had reported alcohol abuse problems, and 49% had used alcohol in the hours before their death. The researchers caution that differences in the prevalence of alcohol use among AI/AN might be a symptom of “disproportionate exposure to poverty, historical trauma, and other contexts of inequity and should not be viewed as inherent to AI/AN culture.”

Tenofovir disoproxil fumarate (TDF), an antiviral used to treat hepatitis B virus (HBV) infection, does not significantly reduce mother-to-child transmission of the virus when taken during pregnancy and after delivery, according to an NIH-funded phase 3 study.

The limited evidence of benefit from antiviral drugs to prevent mother-to-child transmission of HBV has led to conflicting practice recommendations, says Nahida Chakhtoura, MD, a member of the study team and medical officer at the National Institute of Child Health and Human Development. The World Health Organization recommends that all newborns receive their first dose of HBV vaccine within 24 hours of delivery. Those born to HBV-infected mothers also are given hepatitis B immune globulin (HBIG) for added protection. However, infants are still at risk for the virus if the mother has high levels of virus or mutated versions.

The study, conducted at 17 hospitals in Thailand, enrolled 331 pregnant women with HBV. The women received placebo or TDF at intervals from 28 weeks of pregnancy to 2 months after delivery. All 294 infants received HBIG and 5 doses of the HBV vaccine and were followed through age 6 months.

Three infants in the placebo group and none of the TDF group had HBV infection at 6 months. “Our study suggests that adding TDF to the current regimen seems to have little effect on infant infection rates when transmission rates are already low,” Chakhtoura says

Tenofovir disoproxil fumarate (TDF), an antiviral used to treat hepatitis B virus (HBV) infection, does not significantly reduce mother-to-child transmission of the virus when taken during pregnancy and after delivery, according to an NIH-funded phase 3 study.

The limited evidence of benefit from antiviral drugs to prevent mother-to-child transmission of HBV has led to conflicting practice recommendations, says Nahida Chakhtoura, MD, a member of the study team and medical officer at the National Institute of Child Health and Human Development. The World Health Organization recommends that all newborns receive their first dose of HBV vaccine within 24 hours of delivery. Those born to HBV-infected mothers also are given hepatitis B immune globulin (HBIG) for added protection. However, infants are still at risk for the virus if the mother has high levels of virus or mutated versions.

The study, conducted at 17 hospitals in Thailand, enrolled 331 pregnant women with HBV. The women received placebo or TDF at intervals from 28 weeks of pregnancy to 2 months after delivery. All 294 infants received HBIG and 5 doses of the HBV vaccine and were followed through age 6 months.

Three infants in the placebo group and none of the TDF group had HBV infection at 6 months. “Our study suggests that adding TDF to the current regimen seems to have little effect on infant infection rates when transmission rates are already low,” Chakhtoura says

Tenofovir disoproxil fumarate (TDF), an antiviral used to treat hepatitis B virus (HBV) infection, does not significantly reduce mother-to-child transmission of the virus when taken during pregnancy and after delivery, according to an NIH-funded phase 3 study.

The limited evidence of benefit from antiviral drugs to prevent mother-to-child transmission of HBV has led to conflicting practice recommendations, says Nahida Chakhtoura, MD, a member of the study team and medical officer at the National Institute of Child Health and Human Development. The World Health Organization recommends that all newborns receive their first dose of HBV vaccine within 24 hours of delivery. Those born to HBV-infected mothers also are given hepatitis B immune globulin (HBIG) for added protection. However, infants are still at risk for the virus if the mother has high levels of virus or mutated versions.

The study, conducted at 17 hospitals in Thailand, enrolled 331 pregnant women with HBV. The women received placebo or TDF at intervals from 28 weeks of pregnancy to 2 months after delivery. All 294 infants received HBIG and 5 doses of the HBV vaccine and were followed through age 6 months.

Three infants in the placebo group and none of the TDF group had HBV infection at 6 months. “Our study suggests that adding TDF to the current regimen seems to have little effect on infant infection rates when transmission rates are already low,” Chakhtoura says