IMPACT OF METHADONE MAINTENANCE THERAPY ON HIV INCIDENCE IN PERAK, 2008 - 2017: A COX REGRESSION ANALYSIS

In 2005, Ministry of Health introduced the Needle Syringe Exchange Program (NSEP) and Methadone Maintenance Therapy (MMT) program as a part of Harm Reduction program to combat HIV infection in Malaysia among people who inject drug (PWIDs). Expenditures were estimated approximately RM10 millions per year to establish and sustain the NSEP and MMT centres. This study examined the impact of MMT program on preventing HIV seroconversion among registered MMT clients that are people who inject drug (PWIDs), and to identify other predictors of HIV seroconversion among this group. This was a retrospective cohort study done in the state of Perak involving a total of 212 randomly selected MMT clients registered between 2008-2017 in 6 clinics. This study looks at data collected from the last ten-year cohort from baseline to follow-up. A questionnaire was used to obtain socio-demographic data, sexual and drugs abuse history. Test results for HIV were obtained from medical records. Cox regression analysis was performed to examine factors associated with seroconversion and Kaplan-Meier analysis to estimate HIV survival time. This study displayed that both Methadone take home supply (HR 10.4, 95% CI: 1.6 – 68.8) and unprotected sexual practice (HR 5.9, 95%CI: 1.1 – 31.5) shown higher risks of HIV seroconversion compared to DOTS and condom practice among MMT clients respectively. Mean survival for HIV seroconversion among MMT clients was 104.44 (95%CI: 101.85 – 107.04) months. This study provides reliable evidence that MMT program markedly reduces incidence of HIV infection among people who inject drug (PWIDs).

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The Impact of Enrolment in Methadone Maintenance Therapy on Initiation of Heavy Drinking among People Who Use Heroin

European Addiction Research ◽

10.1159/000444513 ◽

2016 ◽

Vol 22 (4) ◽

pp. 210-214 ◽

Cited By ~ 7

Author(s):

Jan Klimas ◽

Evan Wood ◽

Paul Nguyen ◽

Huiru Dong ◽

Michael John Milloy ◽

...

Keyword(s):

Maintenance Therapy ◽

Methadone Maintenance ◽

Heavy Drinking ◽

Methadone Maintenance Therapy ◽

Cannabis Use ◽

Incidence Density ◽

Opioid Agonist ◽

Cox Regression Analysis ◽

The Impact

Background: There is equivocal evidence regarding whether people who use heroin substitute heroin for alcohol upon entry to methadone maintenance therapy (MMT). We aimed to examine the impact of MMT enrolment on the onset of heavy drinking among people who use heroin. Methods: We derived data from prospective, community-based cohorts of people who inject drugs in Vancouver, Canada, between December 1, 2005, and May 31, 2014. Multivariable extended Cox regression analysis examined the effect of MMT enrolment on the onset of heavy drinking among people who used heroin at baseline. Results: In total, 357 people who use heroin were included in this study. Of these, 208 (58%) enrolled in MMT at some point during follow-up, and 115 (32%) reported initiating heavy drinking during follow-up for an incidence density of 7.8 events (95% CI 6.4-9.5) per 100 person-years. The incidence density of heavy drinking was significantly lower among those enrolled in MMT at some point during follow-up compared to those who did not (4.6 vs. 16.2; p < 0.001). MMT enrolment was not significantly associated with time to initiate heavy drinking (adjusted relative hazard (ARH) 1.27; 95% CI 0.78-2.07) after adjustment for relevant demographic and substance-use characteristics. Age and cannabis use were the only variables that were independently associated with the time to onset of heavy drinking (ARH 0.74; 95% CI 0.58-0.94 and ARH 2.06; 95% CI 1.32-3.19, respectively). Conclusion: In this study, MMT enrolment did not predict heavy drinking and may even appear to decrease the initiation of heavy drinking. Our findings suggest younger age and cannabis use may predict heavy drinking. These findings could help inform on-going discussions about the effects of opioid agonist therapy on alcohol consumption among people who use heroin.

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NLRP3 is a Novel Prognostic Biomarker and Correlates With Immune Infiltrates in Lung Adenocarcinoma and Skin Cutaneous Melanoma

10.21203/rs.3.rs-880002/v1 ◽

2021 ◽

Author(s):

Chenxi Yuan ◽

Qingwei Wang ◽

Xueting Dai ◽

Yipeng Song ◽

Jinming Yu

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Lung Adenocarcinoma ◽

Immune Cells ◽

Cutaneous Melanoma ◽

Cox Regression ◽

Cox Regression Analysis ◽

Potential Biomarker ◽

The Impact ◽

Nlrp3 Expression

Abstract Background: Lung adenocarcinoma (LUAD) and skin cutaneous melanoma (SKCM) are common tumors around the world. However, the prognosis in advanced patients is poor. Because NLRP3 was not extensively studied in cancers, so that we aimed to identify the impact of NLRP3 on LUAD and SKCM through bioinformatics analyses. Methods: TCGA and TIMER database were utilized in this study. We compared the expression of NLRP3 in different cancers and evaluated its influence on survival of LUAD and SKCM patients. The correlations between clinical information and NLRP3 expression were analyzed using logistic regression. Clinicopathologic characteristics associated with overall survival in were analyzed by Cox regression. In addition, we explored the correlation between NLRP3 and immune infiltrates. GSEA and co-expressed gene with NLRP3 were also done in this study. Results: NLRP3 expressed disparately in tumor tissues and normal tissues. Cox regression analysis indicated that up-regulated NLRP3 was an independent prognostic factor for good prognosis in LUAD and SKCM. Logistic regression analysis showed increased NLRP3 expression was significantly correlated with favorable clinicopathologic parameters such as no lymph node invasion and no distant metastasis. Specifically, a positive correlation between increased NLRP3 expression and immune infiltrating level of various immune cells was observed. Conclusion: Together with all these findings, increased NLRP3 expression correlates with favorable prognosis and increased proportion of immune cells in LUAD and SKCM. These conclusions indicate that NLRP3 can serve as a potential biomarker for evaluating prognosis and immune infiltration level.

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Liver Transplantation for HCC in HIV-Infected Patients: Long-Term Single-Center Experience

Cancers ◽

10.3390/cancers13184727 ◽

2021 ◽

Vol 13 (18) ◽

pp. 4727

Author(s):

Gian Piero Guerrini ◽

Massimiliano Berretta ◽

Giovanni Guaraldi ◽

Paolo Magistri ◽

Giuseppe Esposito ◽

...

Keyword(s):

Liver Transplantation ◽

Logistic Regression ◽

Regression Analysis ◽

Hiv Infection ◽

Highly Active Antiretroviral Therapy ◽

Cox Regression ◽

Independent Predictive Factor ◽

Cox Regression Analysis ◽

Single Center Experience ◽

Highly Active

Background: HIV-infected patients now have long life expectation since the introduction of the highly active antiretroviral therapy (HAART). Liver diseases, especially cirrhosis and hepatocellular carcinoma (HCC), currently represent a leading cause of death in this setting of patients. Aim: To address the results of liver transplantation (LT) for HCC in HIV-infected patients. Methods: All patients with and without HIV infection who underwent LT for HCC (n = 420) between 2001 and 2021 in our center were analyzed with the intent of comparing graft and patient survival. Cox regression analysis was used to determine prognostic survival factors and logistic regression to determine the predictor factors of post-LT recurrence. Results: Among 1010 LT, 32 were HIV-infected recipients. With an average follow-up of 62 ± 51 months, 5-year overall survival in LT recipients with and without HIV-infection was 71.6% and 69.9%, respectively (p = ns), whereas 5-year graft survival in HIV-infected and HIV-non infected was 68.3% and 68.2%, respectively (p = ns). The independent predictive factor of survival in the study group was: HCV infection (HR 1.83, p = 0.024). There were no significant differences in the pathological characteristics of HCC between the two groups. The logistic regression analysis of the study population demonstrated that microvascular invasion (HR 5.18, p< 0.001), HCC diameter (HR 1.16, p = 0.028), and number of HCC nodules (HR 1.26, p = 0.003) were predictors of recurrence post-LT. Conclusion: Our study shows that HIV patients undergoing LT for HCC have comparable results in terms of post-LT survival. Excellent results can be achieved for HIV-infected patients with HCC, as long as a strategy of close surveillance and precise treatment of the tumor is adopted while on the waiting list.

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Impact of Early C-Reactive Protein/Albumin Ratio on Intra-Hospital Mortality Among Patients with Spontaneous Intracerebral Hemorrhage

Journal of Clinical Medicine ◽

10.3390/jcm9041236 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1236 ◽

Cited By ~ 2

Author(s):

Michael Bender ◽

Kristin Haferkorn ◽

Michaela Friedrich ◽

Eberhard Uhl ◽

Marco Stein

Keyword(s):

Regression Analysis ◽

Intracerebral Hemorrhage ◽

Hospital Mortality ◽

Cox Regression ◽

Spontaneous Intracerebral Hemorrhage ◽

C Reactive Protein ◽

Albumin Ratio ◽

Cox Regression Analysis ◽

Reactive Protein ◽

The Impact

Objective: The impact of increased C-reactive protein (CRP)/albumin ratio on intra-hospital mortality has been investigated among patients admitted to general intensive care units (ICU). However, it was not investigated among patients with spontaneous intracerebral hemorrhage (ICH). This study aimed to investigate the impact of CRP/albumin ratio on intra-hospital mortality in patients with ICH. Patients and Methods: This retrospective study was conducted on 379 ICH patients admitted between 02/2008 and 12/2017. Blood samples were drawn upon admission and the patients’ demographic, medical, and radiological data were collected. The identification of the independent prognostic factors for intra-hospital mortality was calculated using binary logistic regression and COX regression analysis. Results: Multivariate regression analysis shows that higher CRP/albumin ratio (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.193–2.317, p = 0.003) upon admission is an independent predictor of intra-hospital mortality. Multivariate Cox regression analysis indicated that an increase of 1 in the CRP/albumin ratio was associated with a 15.3% increase in the risk of intra-hospital mortality (hazard ratio = 1.153, 95% CI = 1.005–1.322, p = 0.42). Furthermore, a CRP/albumin ratio cut-off value greater than 1.22 was associated with increased intra-hospital mortality (Youden’s Index = 0.19, sensitivity = 28.8, specificity = 89.9, p = 0.007). Conclusions: A CRP/albumin ratio greater than 1.22 upon admission was significantly associated with intra-hospital mortality in the ICH patients.

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Evaluating the Impact of Prescribed Versus Nonprescribed Benzodiazepine Use in Methadone Maintenance Therapy

Journal of Addiction Medicine ◽

10.1097/adm.0000000000000476 ◽

2019 ◽

Vol 13 (3) ◽

pp. 182-187

Author(s):

Joseph K. Eibl ◽

Andrew S. Wilton ◽

Alexandra M. Franklyn ◽

Paul Kurdyak ◽

David C. Marsh

Keyword(s):

Maintenance Therapy ◽

Methadone Maintenance ◽

Methadone Maintenance Therapy ◽

Benzodiazepine Use ◽

The Impact

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Increased Colonic Expression of ACE2 Associates with Poor Prognosis in Crohn’s Disease

10.21203/rs.3.rs-150844/v1 ◽

2021 ◽

Author(s):

Takahiko Toyonaga ◽

Kenza Araba ◽

Meaghan Kennedy ◽

Benjamin Keith ◽

Elisabeth Wolber ◽

...

Keyword(s):

Regression Analysis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Protein Expression ◽

Cox Regression ◽

Multivariate Regression Analysis ◽

Rna Seq ◽

Cox Regression Analysis ◽

Molecular Stratification ◽

The Impact

Abstract Background and Aims: The host receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2), is highly expressed in small intestine. Our aim was to study colonic ACE2 expression in Crohn's disease (CD) and non-inflammatory bowel disease (non-IBD) controls. We hypothesized that the colonic expression levels of ACE2 impacts CD course. Methods: We examined the expression of colon ACE2 using RNA-seq and quantitative (q) RT-PCR from 69 adult CD and 14 NIBD control patients. In a subset of this cohort we validated ACE2 protein expression and localization in formalin-fixed, paraffin-embedded matched colon and ileal tissues using immunohistochemistry. The impact of increased ACE2 expression in CD for the risk of surgery was evaluated by a multivariate regression analysis and a Kaplan-Meier estimator. To provide critical support for the generality of our findings, we analyzed previously published RNA-seq data from two large independent cohorts of CD patients. Results: Colonic ACE2 expression was significantly higher in a subset of adult CD patients (ACE2-high CD). IHC in a sampling of ACE2-high CD patients confirmed high ACE2 protein expression in the colon and ileum compared to ACE2-low CD and NIBD patients. Notably, we found that ACE2-high CD patients are significantly more likely to undergo surgery within 5 years of diagnosis, with a Cox regression analysis finding that high ACE2 levels is an independent risk factor (OR 2.18; 95%CI, 1.05-4.55; p=0.037). Conclusion: Increased intestinal expression of ACE2 is associated with deteriorated clinical outcomes in CD patients. These data point to the need for molecular stratification that may impact CD disease-related outcomes.

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Chromogranine A and neuron-specific enolase as the main predictors of survival for hormone-refractory prostate cancer (HRPC) patients

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15594 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15594-15594

Author(s):

A. Banu ◽

E. Banu ◽

D. Dionysopoulos ◽

J. Medioni ◽

F. Scotte ◽

...

Keyword(s):

Prostate Cancer ◽

Regression Analysis ◽

Gleason Score ◽

Cox Regression ◽

Neuron Specific Enolase ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Metastatic Sites ◽

Ecog Ps ◽

The Impact

15594 Background: Clinical studies suggested that the extent of neuro-endocrine differentiation in prostate cancer increases with tumor progression and the development of androgen refractory status. Chromogranine (CgA) and neuron-specific enolase (NSE) are currently explored as surrogate markers. Methods: Eligible chemonaive HRPC patients (pts) were required to have an ECOG performance status (PS) ≤ 2. Before chemotherapy initiation, we quantified NSE, CgA and PSA in the venous blood using commercial kits. We evaluated the impact of baseline NSE, CgA and PSA on overall survival (OS) using multivariate Cox regression analysis, stratified by chemotherapy regimen. Secondary, we studied the correlation between NSE, CgA, PSA and other important variables as age, Gleason score, hemoglobin, number of metastatic sites and ECOG PS. Results: Data of 39 consecutive HRPC pts treated between December 01–06 in a single French center were analyzed. Chemotherapy was docetaxel-based in 92% of pts. Median age was 71 years (range 51–86) and 79% of pts had bone metastases. Elevated NSE, CgA and PSA were observed in 6, 9 and 30% of pts and median levels were 10.8, 67 and 23.3 ng/mL, respectively. Gleason 8–10 was present in 49% of pts. Significant correlations were observed between NSE and the number of metastatic sites and between CgA and age, hemoglobin and ECOG PS. The baseline PSA was only correlated with Gleason score. Median OS for the entire cohort was 24.4 months (95% CI, 18.8–29.9). Two-year OS was 15% and only 19% of patients are dead. Univariate Cox regression analysis showed only a significant relationship between OS and baseline NSE: hazard ratio= 1.09 (95% CI, 1.03–1.16), P=0.006. No other known prognostic factors are related to outcome. A multivariate model including baseline NSE, CgA, ECOG PS and Gleason score showed a 15% rise of the risk of death related to NSE (borderline P value). Conclusions: NSE was the most powerful predictor of survival for HRPC pts. Our results emphasize the theory that cells secreting NSE are chemoresistant, with a negative impact on OS. No significant financial relationships to disclose.

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Adjuvant treatment for resected rectal cancer: Effect of postoperative oxaliplatin added to 5-FU in the neoadjuvant era.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.672 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 672-672

Author(s):

Benjamin Garlipp ◽

Patrick Stuebs ◽

Hans Lippert ◽

Karsten Ridwelski ◽

Henry Ptok ◽

...

Keyword(s):

Rectal Cancer ◽

Colon Cancer ◽

Regression Analysis ◽

Cancer Patients ◽

Adjuvant Treatment ◽

Cox Regression ◽

Disease Free Survival ◽

Data Set ◽

Cox Regression Analysis ◽

The Impact

672 Background: Oxaliplatin (Ox) added to postoperative 5-fluorouracil (5FU) based adjuvant treatment has shown a survival benefit in colon cancer. For rectal cancer, the impact of Ox on survival has almost exclusively been tested in studies using 5FU +/- Ox both as a component of preoperative chemoradiotherapy (CRT) and as adjuvant treatment. Only one study (NCT00807911) investigated adjuvant 5FU +/- Ox in patients undergoing preop 5FU based CRT without Ox. Thus, the evidence for the benefit of adding Ox to adjuvant 5FU in patients treated with preop 5FU based CRT is limited. Methods: Data from the prospective German multicenter Quality Assurance in Rectal Cancer observational trial involving more than 300 hospitals of all levels of care throughout Germany were retrospectively analyzed. Patients undergoing R0 total mesorectal excision (TME) for rectal cancer following neoadjuvant 5FU based treatment without oxaliplatin between 01/01/2008 and 12/31/2010 were included. Disease-free survival (DFS) in patients receiving adjuvant treatment with or without Ox was compared using the Kaplan Meier method. The impact of adjuvant treatment with 5FU with or without Ox on DFS was investigated in a Cox regression analysis including open vs. laparoscopic approach, pT stage, pN stage, tumor grading, TME quality grade, and presence of anastomotic leakage as potential confounding factors. Results: The entire data set included 1,861 patients. Data for all variables investigated were available for 599 patients of whom 512 (85%) and 89 (15%) received 5FU based adjuvant treatment without and with Ox, respectively. Mean DFS was not different in patients receiving 5FU only vs. 5FU with Ox (p=0.103). Cox regression analysis revealed no significant impact of adding Ox to adjuvant 5FU on DFS. Of all factors analyzed, only pN2 (vs. pN0) status had an independent adverse effect on DFS (Hazard ratio 4.22, p<0.001). Conclusions: These data indicate that adjuvant Ox added to 5FU does not provide a DFS benefit in rectal cancer patients treated with preoperative 5FU based CRT under routine care conditions. Rectal cancer patients may be different from patients with colon cancer with respect to benefit from adjuvant Ox.

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Use of Adjuvant Chemotherapy, Radiation Therapy, or Combined Modality Therapy and the Impact on Survival for Uterine Carcinosarcoma Limited to the Pelvis

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001014 ◽

2017 ◽

Vol 27 (6) ◽

pp. 1171-1177 ◽

Cited By ~ 3

Author(s):

Andrew T. Wong ◽

Yi-Chun Lee ◽

David Schwartz ◽

Anna Lee ◽

Meng Shao ◽

...

Keyword(s):

Radiation Therapy ◽

Regression Analysis ◽

Confidence Interval ◽

Cox Regression ◽

National Cancer Data Base ◽

Uterine Carcinosarcoma ◽

Cox Regression Analysis ◽

Cancer Data ◽

Impact On Survival ◽

The Impact

ObjectiveClinical outcomes for patients with uterine carcinosarcoma are poor after surgical management alone. Adjuvant therapies including chemotherapy (CT) and/or radiation therapy (RT) have been previously investigated, but the optimal management of this disease remains controversial. The purposes of this study were to analyze the patterns of use of adjuvant CT and RT and to assess the impact on survival of each of these treatment regimens using the National Cancer Data Base.Methods/MaterialsThe National Cancer Data Base was queried for patients given a diagnosis of uterine carcinosarcoma confined to the pelvis who underwent total hysterectomy/bilateral salpingo-oophorectomy between 2004 and 2011. Patients were excluded if they survived less than 4 months after diagnosis. Data regarding CT and RT use were collected. Overall survival (OS) was analyzed using the Kaplan-Meier method. Multivariable Cox regression analysis was performed to evaluate the effect of covariates on OS.ResultsA total of 4906 patients were included in this study. Median age was 67 years (interquartile range, 60–75 years). Median follow-up was 28.9 months (interquartile range, 15.4–52.9 months). There were 1777 patients (36.2%) who received no adjuvant treatment, 971 (19.8%) who received CT alone, 1060 (21.6%) who received RT alone, and 1098 (22.4%) who received both RT and CT. The 5-year OS for patients receiving no adjuvant therapy, adjuvant RT alone, adjuvant CT alone, and combined CT and RT were 44.9%, 47.1%, 47.5%, and 62.9%, respectively. On pairwise analysis, combined CT and RT was associated with improved survival compared with all other subgroups (P < 0.001). On multivariable Cox regression analysis, combined CT and RT (hazard ratio, 0.50; 95% confidence interval, 0.44–0.57; P < 0.001) and CT alone (hazard ratio, 0.78; 95% confidence interval, 0.69–0.88; P < 0.001) were significantly associated with improved OS, whereas RT alone was not.ConclusionsCombination therapy with CT and RT was associated with significantly improved 5-year OS compared with no further therapy, RT alone, or CT alone.

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