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Background: People in prison are at high risk of hepatitis C virus (HCV) infection and often have a history of injection drug use and mental health disorders. Simple test-and-treat regimens which require minimal monitoring are critical. Methods: This integrated real-world analysis evaluated the effectiveness of once daily sofosbuvir/velpatasvir (SOF/VEL) in 20 prison cohorts across Europe and Canada. The primary outcome was sustained virological response (SVR) in the effectiveness population (EP), defined as patients with a valid SVR status. Secondary outcomes were reasons for not achieving SVR, adherence and time between HCV RNA diagnosis and SOF/VEL treatment. Results: Overall, 526 people in prison were included with 98.9% SVR achieved in the EP (n = 442). Cure rates were not compromised by drug use or existence of mental health disorders. Conclusion: SOF/VEL for 12 weeks is highly successful in prison settings and enables the implementation of a simple treatment algorithm in line with guideline recommendations and test-and-treat strategies.

Distance education has recently become a very useful educational practice due to the dynamics of today's world, the advances in the Information and Communication Technologies, as well as the need to achieve quality education overcoming distances and promoting personal growth and intellectual maturity of a growing number of people of all genres and latitudes. This paper aims to conduct a historical review of this type of education in Cuba and the world, from its origins to present times, for which a literature review was conducted covering different countries in Europe, Asia, Africa, America and Cuba, so that it can help all those who study this subject.

3,4-Methylenedioxymethamphetamine (MDMA) is frequently consumed in association with alcohol. The effect of this combination in humans has not been previously investigated. Nine male healthy volunteers received single oral doses of 100 mg of MDMA plus 0.8 g/kg ethanol, 100 mg of MDMA, 0.8 g/kg of ethanol, and placebo in a double blind, double dummy, randomized crossover trial. Measurements included psychomotor performance, subjective effects, and pharmacokinetics. Plasma concentrations of MDMA showed a 13% increase after the use of alcohol, whereas plasma concentrations of alcohol showed a 9 to 15% decrease after MDMA administration. The MDMA-alcohol combination induced longer lasting euphoria and well being than MDMA or alcohol alone. MDMA reversed the subjective sedation induced by alcohol but did not reduce drunkenness feelings. MDMA did not reverse the actions of alcohol on psychomotor abilities. Combined use of MDMA and alcohol causes dissociation between subjective and objective sedation. Subjects may feel euphoric and less sedated and might have the feeling of doing better, but actual performance ability continues to be impaired by the effect of alcohol. Confirmation of these findings in further studies will be highly relevant in terms of road safety.

Computerized physician order entry (CPOE) applications are widely used to prevent medical errors. In our center, a CPOE system has been in use since 2009 on both the inpatient and outpatient levels. A new and simple alert was introduced in the CPOE system to notify healthcare providers of the potential risk of viral reactivation when prescribing biological therapies, thereby facilitating the request for a serological profile (hepatitis B surface antigen [HBsAg], anti-HBc, and anti-HBs) in patients who have not had these tests. Between May 2012 and May 2013, a total of 1,076 patients undergoing biological treatment were included in the implementation of the CPOE in our hospital, resulting in the identification of 4 HBsAg-positive and 69 anti-HBc-positive/HBsAg-negative patients, two of them with positive viral loads. Since the implementation of this alert system, over 90% of patients who were prescribed a biological drug (BD) have undergone serological screening to detect hepatitis B virus (HBV) infection. The use of the alert system has increased the screening rate from less than 50% to 94% for HBsAg and from less than 30% to 85% for anti-HBc in patients for whom a BD is prescribed. Six patients received prophylactic antiviral therapy. No patient had HBV reactivation. Conclusion: This study demonstrates the feasibility of implementing a CPOE system that has allowed our hospital to increase the rate of HBV screening. Its use has facilitated the identification of patients at high risk for HBV reactivation and permitted physicians to prescribe prophylactic measures according to current guidelines. (Hepatology 2014;106–113)

The author has included five annotated Huastec texts. Four are by Cándido Hernandez: "The story of the Tepa", "The homed serpent", "Respect for the stars", and "The influence of the moon and the stars", and a fifth, the "Tsakam kwitool" or "Little Boy", is by Francisca Vidales. The "Tepa" is described as a man who was born in the mountains and baptized in water, and who grew up with the ability to fly at great speed, even as far as Spain. In this particular story he helps a poor man by giving him food. Edmonson notes that the text "The little boy", in which the title character brings water and fire to the village, is told with great drama and much use of dialogue. The texts referring to the stars report various Huastec beliefs about these, while "The horned serpent" describes a serpent with golden horns that leave gold in its path.

TO THE EDITOR: In the clinical opinion update by Hwang et al, the authors reviewed the most important issues related to hepatitis B virus (HBV) screening in patients who are about to receive cytotoxic chemotherapy for the treatment of malignant diseases. This update notes the importance of screening all patients who are going to be treated with anti-CD20 therapy. The authors also point out that this screening should be extended to patients with high risk factors for HBV infection. Then, when a patient who is hepatitis B surface antigen (HBsAg) positive/hepatitis B core antibody (anti-HBc) positive is identified, antiviral treatment should be started just before or at the same time as chemotherapy. In contrast, patients who are HBsAg negative/anti-HBc positive could be carefully observed with ALT and HBV-DNA levels. In the article by Hwang et al, Spain is included as a country with HBV prevalence greater than 2%. We believe this statement is currently obsolete and should be corrected. Because of the universal vaccination program started circa 1992, the HBV prevalence in Spain is now approximately 0.7% (HBsAg positive). However, this 0.7% prevalence in HBsAg does not disqualify, in our opinion, a universal HBsAg screening for all patients scheduled to receive systemic cancer therapy. As Hwang et al succinctly mentioned, previous studies have shown that universal screening for HBsAg is not only cost effective but actually cost saving when compared with no screening or screening only high-risk individuals before starting chemotherapy, particularly when the prevalence of HBsAg in the low-risk population is greater than 0.20%. Finally, one aspect that we miss in this special article is the mention of currently available innovative strategies to facilitate this HBV screening in the hospital setting, where the majority of immunosuppressive therapies are prescribed. We are referring specifically to the use of the computerized physician order entry–based (CPOE) systems that apply to this subject. As we previously have demonstrated, the use of this CPOE system in our hospital increased theHBV screening rate from less than 50% to 94% forHBsAg and from less than 30% to 85% for anti-HBc in patients for whom a biologic drug was prescribed. In conclusion, we consider it reasonable to recommend universal HBsAg (and anti-HBc) screening for all patients scheduled to receive systemic cancer therapies or other immunosuppressive therapies, adding when available or feasible the potential benefits of new tools such as CPOE systems together with educational efforts to improve the HBV screening rates.

Introduccion La metilenodioximentanfetamina (MDMA, extasis, pastillas) es una de las drogas de abuso mas utilizadas entre la juventud espanola. Ademas de provocar casos de intoxicaciones agudas e incluso la muerte, la gran preocupacion de su uso es la posibilidad de que produzca efectos toxicos y degeneracion en las neuronas serotonergicas. Esta neurotoxicidad se ha demostrado en modelos experimentales en animales. Los efectos neurotoxicos en humanos son aun motivo de investigacion, aunque se ha descrito que los grandes consumidores pueden presentar alteraciones leves de la memoria y mayor incidencia de psicopatologia. El consumo de MDMA se realiza en grupos, predominando su uso en fiestas y actos multitudinarios (raves). Es frecuente que se utilice la MDMA junto a otras drogas de abuso en la misma sesion festiva. Mas de la mitad de los consumidores toman mas de una dosis, con un promedio de unas 2,5 pastillas (intervalo entre menos de una y hasta varias docenas). El intervalo de tiempo entre dosis es variable. No existen estudios experimentales en humanos de la administracion a dosis repetida de la MDMA. En el caso de otros estimulantes como la cocaina y anfetamina se ha descrito la aparicion de tolerancia aguda (taquifilaxia) a sus efectos. Este estudio fue disenado para investigar los efectos farmacologicos y la farmacocinetica de la MDMA tras la administracion de dos dosis separadas por 4 horas. Sujetos, material y metodos Se seleccionaron 8 varones consumidores recreacionales de MDMA. Participaron voluntariamente tras ser informados en cuatro sesiones experimentales separadas por una semana. En cada sesion se administro uno de los siguientes tratamientos (intervalo de cuatro horas): placebo ± placebo (placebo); placebo ± MDMA 100 mg (segunda administracion); MDMA 100 mg + placebo (primera administracion); MDMA 100 mg + MDMA 100 mg (dosis repetida). Los tratamientos se administraron enmascarados a doble ciego, fueron asignados de forma aleatoria y el diseno fue cruzado. Se evaluaron variables de efectos fisiologicos (presion arterial, frecuencia cardiaca, temperatura, diametro pupilar), rendimiento psicomotor (ala de Maddox, tiempo de reaccion, DSST, Test de Pauli), efectos subjetivos (escalas analogicas visuales, cuestionario ARCI-reducido), se extrajeron muestras de sangre para determinar las concentraciones de MDMA y sus metabolitos (HMMA, HMA, MDA) y de hormonas (cortisol y prolactina). Resultados Las concentraciones de MDMA tras la dosis repetida fueron superiores en un 20% a las esperadas por el principio farmacocinetico de superposicion. Pero las concentraciones de la HMMA fueron inferiores en un 45% a las esperadas. Parece que existe una inhibicion de la formacion de este metabolito. En cuanto a los efectos farmacologicos, a pesar de que las concentraciones en sangre eran mas del doble, en algunos de ellos los efectos de la segunda dosis fueron similares a los observados tras una dosis unica (frecuencia cardiaca, diametro pupilar, ARCI). En otras variables los efectos de la segunda dosis fueron mayores que los de la primera (presion arterial, efectos subjetivos de las EAV). En ambos casos teniendo en cuenta las concentraciones plasmaticas se observo una tolerancia aguda clara. En los efectos psicomotores y la temperatura la dosis repetida produjo efectos mucho mayores de los esperados, que demostraron que no existio tolerancia. Incluso podria existir hipersensibilidad. Conclusiones La administacion de dos dosis repetidas de MDMA no produce incrementos proporcionales de los efectos placenteros pero incrementa los efectos musculares y la temperatura. Puede por ello incrementarse el riesgo de toxicidad. Agradecimientos Este estudio se ha realizado gracias a las ayudas FIS 98/0181, CIRIT 1999SGR00246 y Plan Nacional sobre Drogas.

A gas chromatography-mass spectrometry (GC-MS) method was used for the simultaneous quantitation of 3,4-methylenedioxymethamphetamine (MDMA) and the 3,4-methylenedioxyamphetamine (MDA), 4-hydroxy-3-methoxymethamphetamine (HMMA), and 4-hydroxy-3-methoxyamphetamine (HMA) metabolites in plasma and urine samples after the administration of 100 mg MDMA to healthy volunteers. Samples were hydrolyzed prior to a solid-phase extraction with Bond Elut Certify columns. Analytes were eluted with ethyl acetate (2% ammonium hydroxide) and analyzed as their trifluoroacyl derivatives. Linear calibration curves were obtained at plasma and urine concentration ranges of 25-400 ng/mL and 250-2000 ng/mL for MDMA and HMMA, and of 2.5-40 ng/mL and 100-1000 ng/mL for MDA and HMA. Following the same urine preparation procedure but without the derivatization step, a capillary electrophoresis (CE) method for enantiomerical resolution of compounds was developed using (2-hydroxy)propyl-beta-cyclodextrin at two different concentrations (10 and 50mM in 50mM H3PO4, pH 2.5) as chiral selector. Calibration curves for the CE method were prepared with the corresponding racemic mixture and were linear between 125 and 2000 ng/mL, 50 and 1000 ng/mL, and 125 and 1500 ng/mL for each enantiomer of MDMA, MDA, and HMMA, respectively. Stereoselective disposition of MDMA and MDA was confirmed. HMMA disposition seems to be in apparent contradiction with MDMA findings as the enantiomer ratio is close to 1 and constant over the time.