Outcomes of hepatitis C virus seropositive donors to hepatitis C virus seronegative liver recipients: A large single center analysis.

INTRODUCTION AND OBJECTIVES: The success of direct-acting antivirals (DAA) has transformed the management of hepatitis C virus (HCV) infection and has led to the expansion of the deceased donor organ pool for liver transplantation. MATERIAL AND METHODS: We present a single center retrospective review of liver transplantations performed on HCV-seronegative recipients from HCV-seropositive organs from 11/2017 to 05/2020. HCV nucleic acid testing (NAT) was performed on HCV-seropositive donors to assess active HCV infection. RESULTS: 42 HCV-seronegative recipients underwent a liver transplant from a HCV-seropositive donor, including 21 NAT negative (20 liver, 1 simultaneous liver kidney transplant) and 21 NAT positive liver transplants. Two (9.5%) HCV antibody positive/NAT negative recipients developed HCV viremia and achieved sustained virologic response with DAA therapy. The remaining patients with available data (19 patients) remained polymerase chain reaction (PCR) negative at 6 months. 20 (95%) of HCV antibody positive/NAT positive recipients had a confirmed HCV viremia. 100% of patients with available data (15 patients) achieved SVR. Observed events include 1 mortality and graft loss and equivalent rates of post-transplant complications between NAT positive and NAT negative recipients. CONCLUSIONS: HCV-seropositive organs can be safely transplanted into HCV-seronegative patients with minimal complications post-transplant.

Cannabis use may reduce healthcare utilization and improve hospital outcomes in patients with cirrhosis.

INTRODUCTION AND OBJECTIVES: Previous studies reveal conflicting data on the effect of cannabis use in patients with cirrhosis. This research evaluates the impact of cannabis on hepatic decompensation, health care utilization, and mortality in patients with cirrhosis. MATERIAL AND METHODS: A retrospective analysis of the State Inpatient Database (SID) was performed evaluating patients from Colorado and Washington in 2011 to represent pre-cannabis legalization and 2015 to represent post-cannabis legalization. Multivariable analysis was performed to study the impact of cannabis on the rate of admissions with hepatic decompensations, healthcare utilization, and mortality in patients with cirrhosis. RESULTS: Cannabis use was detected in 370 (2.1%) of 17,520 cirrhotics admitted in 2011 and in 1162 (5.3%) of 21,917 cirrhotics in 2015 (p-value <0.001). On multivariable analysis, cirrhotics utilizing cannabis after its legalization experienced a decreased rate of admissions related to hepatorenal syndrome (Odds Ratio (OR): 0.51; 95% Confidence Interval (CI): 0.34-0.78) and ascites (OR: 0.73; 95% CI: 0.63-0.84). Cirrhotics with an etiology of disease other than alcohol and hepatitis C had a higher risk of admission for hepatic encephalopathy if they utilized cannabis [OR: 1.57; 95% CI: 1.16-2.13]. Decreased length of stay (-1.15 days; 95% CI: -1.62, -0.68), total charges (-$15,852; 95% CI: -$21,009, -$10,694), and inpatient mortality (OR: 0.68; 95% CI: 0.51-0.91) were also observed in cirrhotics utilizing cannabis after legalization compared to cirrhotics not utilizing cannabis or utilizing cannabis prior to legalization. CONCLUSION: Cannabis use in patients with cirrhosis resulted in mixed outcomes regarding hospital admissions with hepatic decompensation. A trend towards decreased hospital utilization and mortality was noted in cannabis users after legalization. These observations need to be confirmed with a longitudinal randomized study.

First study of food webs in a large glacial river: the trophic role of invasive trout

The aim of this study was to determine the food webs structure of a large Patagonian river in two river sections (Upstream and Midstream) and to evaluate isotopic overlap between native and introduced species. We used stable isotope analyses of δ15N and δ13C and stomach content. The Upstream section had a more complex food webs structure with a greater richness of macroinvertebrates and fish species than Midstream. Upstream basal resources were dominated by filamentous algae. Lake Trout were found to have a higher trophic position than all other fish species in that area although, the most abundant fish species, were Rainbow Trout. Depending on the life stage, Rainbow Trout shifted from prey to competitor/predator. In the Midstream section, the base of the food webs was dominated by coarse particulate organic matter, and adult Rainbow Trout had the highest trophic level. Isotopic values changed among macroinvertebrates and fish for both areas. The two most abundant native and invasive species — Puyen and Rainbow Trout — showed an isotopic separation in Midstream but did not in Upstream areas. The presence of invasive fish that occupy top trophic levels can have a significant impact on native fish populations that have great ecological importance in the region.(AU)

El objetivo de este estudio fue determinar la estructura trófica de un gran río de la Patagonia en dos secciones (río arriba y medio) y evaluar la superposición isotópica entre especies nativas e introducidas. Utilizamos análisis de isótopos estables δ15N y δ13C y contenido estomacal. La sección río arriba tuvo una estructura de trama trófica más compleja, con mayor riqueza de macroinvertebrados y peces respecto de la sección media. Los recursos basales dominantes río arriba fueron las algas filamentosas. En esta área, la trucha de lago tuvo la posición trófica más alta entre los peces, aunque, las especies de peces más abundantes fueron las truchas arcoiris. Dependiendo del estadio, la trucha arcoiris cambió su rol de presa a competidor/depredador. En la sección media del río, la base de la trama trófica estuvo dominada por materia orgánica particulada gruesa y la trucha arcoíris adulta fue el depredador tope. Los valores isotópicos variaron entre zonas para invetebrados y peces. Las dos especies nativas e invasoras más abundantes, Puyen y trucha arcoiris, mostraron una separación isotópica en la sección media, pero no en secciones de río arriba. La presencia de peces invasores que ocupan una posición tope en los niveles tróficos puede tener un impacto significativo sobre las poblaciones de peces nativos de gran importancia ecológica en la región.(AU)

First study of food webs in a large glacial river: the trophic role of invasive trout

The aim of this study was to determine the food webs structure of a large Patagonian river in two river sections (Upstream and Midstream) and to evaluate isotopic overlap between native and introduced species. We used stable isotope analyses of δ15N and δ13C and stomach content. The Upstream section had a more complex food webs structure with a greater richness of macroinvertebrates and fish species than Midstream. Upstream basal resources were dominated by filamentous algae. Lake Trout were found to have a higher trophic position than all other fish species in that area although, the most abundant fish species, were Rainbow Trout. Depending on the life stage, Rainbow Trout shifted from prey to competitor/predator. In the Midstream section, the base of the food webs was dominated by coarse particulate organic matter, and adult Rainbow Trout had the highest trophic level. Isotopic values changed among macroinvertebrates and fish for both areas. The two most abundant native and invasive species — Puyen and Rainbow Trout — showed an isotopic separation in Midstream but did not in Upstream areas. The presence of invasive fish that occupy top trophic levels can have a significant impact on native fish populations that have great ecological importance in the region.(AU)

El objetivo de este estudio fue determinar la estructura trófica de un gran río de la Patagonia en dos secciones (río arriba y medio) y evaluar la superposición isotópica entre especies nativas e introducidas. Utilizamos análisis de isótopos estables δ15N y δ13C y contenido estomacal. La sección río arriba tuvo una estructura de trama trófica más compleja, con mayor riqueza de macroinvertebrados y peces respecto de la sección media. Los recursos basales dominantes río arriba fueron las algas filamentosas. En esta área, la trucha de lago tuvo la posición trófica más alta entre los peces, aunque, las especies de peces más abundantes fueron las truchas arcoiris. Dependiendo del estadio, la trucha arcoiris cambió su rol de presa a competidor/depredador. En la sección media del río, la base de la trama trófica estuvo dominada por materia orgánica particulada gruesa y la trucha arcoíris adulta fue el depredador tope. Los valores isotópicos variaron entre zonas para invetebrados y peces. Las dos especies nativas e invasoras más abundantes, Puyen y trucha arcoiris, mostraron una separación isotópica en la sección media, pero no en secciones de río arriba. La presencia de peces invasores que ocupan una posición tope en los niveles tróficos puede tener un impacto significativo sobre las poblaciones de peces nativos de gran importancia ecológica en la región.(AU)

The Utilization of Palliative Care Services in Patients with Cirrhosis who have been Denied Liver Transplantation: A Single Center Retrospective Review

ABSTRACT Introduction and aim. Utilization of palliative care services in patients dying of end-stage liver disease (ESLD) is understudied. We performed a retrospective review of palliative care services among patients with ESLD unsuitable for liver transplantation (LT) at a tertiary care center. Material and methods. Deceased ESLD patients considered unsuitable for LT from 2007-2012 were identified. Patients were excluded if they received a transplant, had an incomplete workup, were lost to follow up or whose condition improved so LT was not needed. Of the 1,175 patients reviewed, 116 met inclusion criteria. Results. Forty patients (34.4%) received an inpatient palliative care (PC) consultation and forty-one patients (35.3%) were referred directly to hospice. Thirty-three patients (28.4%) transitioned to comfort measures without PC consultation (median survival < 1 day). The median interval between LT denial and PC consultation or hospice was 28 days. Median survival after PC consult or hospice referral was 15 days. In conclusion, in a single center retrospective review of ESLD patients, palliative care services, when utilized, were for care at the very end of life. Without consultation, aggressive interventions continued until hours before death. We propose that ESLD patients could benefit from PC consultation at time of LT evaluation or based on MELD scores.

The Utilization of Palliative Care Services in Patients with Cirrhosis who have been Denied Liver Transplantation: A Single Center Retrospective Review.

INTRODUCTION AND AIM: Utilization of palliative care services in patients dying of end-stage liver disease (ESLD) is understudied. We performed a retrospective review of palliative care services among patients with ESLD unsuitable for liver transplantation (LT) at a tertiary care center. MATERIAL AND METHODS: Deceased ESLD patients considered unsuitable for LT from 2007-2012 were identified. Patients were excluded if they received a transplant, had an incomplete workup, were lost to follow up or whose condition improved so LT was not needed. Of the 1,175 patients reviewed, 116 met inclusion criteria. RESULTS: Forty patients (34.4%) received an inpatient palliative care (PC) consultation and forty-one patients (35.3%) were referred directly to hospice. Thirty-three patients (28.4%) transitioned to comfort measures without PC consultation (median survival < 1 day). The median interval between LT denial and PC consultation or hospice was 28 days. Median survival after PC consult or hospice referral was 15 days. In conclusion, in a single center retrospective review of ESLD patients, palliative care services, when utilized, were for care at the very end of life. Without consultation, aggressive interventions continued until hours before death. We propose that ESLD patients could benefit from PC consultation at time of LT evaluation or based on MELD scores.

Stable isotope analyses of web-spinning spider assemblages along a headwater stream in Puerto Rico.

Web-spinning spiders that inhabit stream channels are considered specialists of aquatic ecosystems and are major consumers of emerging aquatic insects, while other spider taxa are more commonly found in riparian forests and as a result may consume more terrestrial insects. To determine if there was a difference in spider taxa abundance between riverine web-spinning spider assemblages within the stream channel and the assemblages 10 m into the riparian forest, we compared abundances for all web-spinning spiders along a headwater stream in El Yunque National Forest in northeast Puerto Rico. By using a nonmetric dimensional scaling (NMDS) abundance analysis we were able to see a clear separation of the two spider assemblages. The second objective of the study was to determine if aquatic insects contributed more to the diet of the spider assemblages closest to the stream channel and therefore stable isotope analyses of δ (15)N and δ (13)C for web-spinning spiders along with their possible prey were utilized. The results of the Bayesian mixing model (SIAR) however showed little difference in the diets of riverine (0 m), riparian (10 m) and upland (25 m) spiders. We found that aquatic insects made up ∼50% of the diet for web-spinning spiders collected at 0 m, 10 m, and 25 m from the stream. This study highlights the importance of aquatic insects as a food source for web-spinning spiders despite the taxonomic differences in assemblages at different distances from the stream.

A multidisciplinary approach to improving women's health in semi-urban Ecuador.

OBJECTIVE: To examine women's reasons for seeking care at The Quito Project (TQP), a student-led organization that aims to improve the health, education, and well-being of a semi-urban community in Quito, Ecuador, and to explore the need for additional preventative interventions. METHODS: An oral survey was administered to 86 adult patients in 2008. We also completed a chart review to evaluate patient demographics and medical conditions. RESULTS: Sixty-three (73.3%) survey respondents were female. Nearly three-quarters of the women reported an income below the minimum wage; 60% reported that the cost of medical care posed a burden. Fifty-two percent sought care at TQP because the services were free. Additionally, 77% of women reported going to the doctor only when ill and did not access preventative services. CONCLUSIONS: By offering medical, dental, and tutoring services, along with preventative health workshops, TQP addresses established barriers to achieving adequate women's health. Survey results have reinforced TQP's focus on prevention.