Background Patients in rural communities are less likely to receive treatment for their hepatitis C (HCV) infection. Telemedicine (TM) consultation can close the gap of access to specialists in remote and under-served areas. Aim To determine treatment response and side-effect profiles among HCV patients treated with pegylated interferon and ribavirin via TM consultation in different rural locations in Northern California compared with patients treated in traditional hepatology office visits. Methods We performed a retrospective analysis of 80 HCV patients treated at different TM sites (TM, n = 40) and at the University of California Davis Hepatology Clinic (HC, n = 40) between 2006 and 2010, comparing baseline characteristics and clinical outcomes. Results At baseline, response to therapy was similar for patients in both groups. Sustained virological response (SVR) was similar in both groups (TM: 55 vs. HC: 43 %; p = 0.36), and a higher proportion of patients treated via telemedicine completed treatment (TM: 78 vs. HC: 53 %; p = 0.03). TM patients had many more visits per week of therapy (TM: 0.61 vs. HC: 0.07; p < 0.001). Neutropenia, GI side effects, fatigue, depression, weight loss, insomnia, and skin rash were similar in both groups. For HC patients incidence of anemia was significantly higher (53 %) than for the TM group (25 %; p = 0.02). Conclusions The two groups had equivalent SVR. For the TM group therapy completion was superior and incidence of anemia was lower. This initial study suggests that, as a group, patients with HCV, can be safely and effectively treated via telemedicine.

Background Clinical trials have demonstrated an increased risk of cardiotoxicity in patients with breast cancer (bca) receiving trastuzumab-based therapy. Diabetes, dyslipidemia, and obesity are known risk factors for cardiovascular disease. Studies have yielded conflicting results about whether those factors increase the risk of cardiotoxicity in patients with bca receiving trastuzumab.Methods In this retrospective cohort study, data were collected for 243 patients with bca positive for her2 (the human epidermal growth factor receptor 2) who were receiving trastuzumab and who were referred to The Ottawa Hospital Cardio-oncology Referral Clinic between 2008 and 2013. The data collected included patient demographics, reason for referral, cardiac function, chemotherapy regimen (including anthracycline use), and 3 comorbidities (diabetes, dyslipidemia, obesity). Rates of symptomatic cancer treatment–related cardiac dysfunction (sctcd) and asymptomatic decline in left ventricular ejection fraction (adlvef) were calculated for patients with and without the comorbidities of interest.Results Of the 243 identified patients, 104 had either diabetes, dyslipidemia, or obesity. In that population, the most likely reason for referral to the cardio-oncology clinic was adlvef. The combination of 2 or 3 comorbidities significantly increased the incidence of sctcd in our population, reaching a rate of 67% for patients with obesity and dyslipidemia [relative risk (rr): 2.2; p = 0.04], 69% for patients with obesity and diabetes (rr: 2.3; p = 0.02), and 72% for patients with all 3 risk factors (rr: 2.4; p = 0.08).Conclusions The combination of 2 or 3 comorbidities significantly increases the incidence of symptomatic cancer treatment–related cardiotoxicity. Patients with bca experiencing cancer treatment–related cardiotoxicity who have a history of diabetes, dyslipidemia, and obesity might require more proactive strategies for prevention, detection, and treatment of cardiotoxicity while receiving trastuzumab-based treatment.

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BackgroundAn urgent need exists for differentiated RA therapies that are safer and cost-effective to expand treatment approaches for non-responders to disease-modifying anti-rheumatic drugs (DMARDs). Electrical stimulation of the vagus nerve activates the inflammatory reflex and has been shown to inhibit the production and release of inflammatory cytokines and decrease clinical signs and symptoms in chronic inflammatory diseases, including rheumatoid arthritis[1].ObjectivesThe RESET-RA Study (NCT04539964) was designed to determine the safety and efficacy of a novel neuroimmune modulation device for treating rheumatoid arthritis. Presented here are data on the safety of the surgical implantation and use of this device in the first 60 human subjects enrolled in the study.MethodsThe RESET-RA study is a randomized, double-blind, sham-controlled, multi-center, two-stage pivotal study to evaluate the safety and efficacy of a novel neuroimmune modulation device in patients with moderate-to-severe RA who are incomplete responders or are intolerant to one or more biologic or targeted synthetic DMARDs. The device system (SetPoint Medical, Valencia, CA) consists of 2 implanted components: a miniature, rechargeable, leadless pulse generator that is surgically implanted in the neck on the left vagus nerve and a silicon sleeve referred to as a positioning and orientation device (POD) that holds the generator in close approximation to the nerve; and two external components: a wireless charger and an iPad application for programming the pulse generation. All subjects were implanted with the study device. One to three weeks after the implant procedure, subjects were randomly assigned (1:1) to receive either active or sham stimulation (control). The safety of the surgical procedure, device, and device stimulation was blindly assessed after 12 weeks of stimulation therapy.ResultsAll device implant procedures were completed with no intraoperative complications, infections, or surgical revisions. No unanticipated adverse events (AEs) were reported during the perioperative period and at the end of 12 weeks of follow-up. No study discontinuations were due to AEs, and no subjects died during the study. There were no serious AEs related to the device, stimulation, or explant procedures. There were two serious AEs related to the implant procedure: vocal cord paresis and prolonged hoarseness were reported in two subjects and are known risks of implanting a device on the vagus nerve. The vocal cord paresis resolved following vocal cord augmentation with injectable filler and speech therapy; the other SAE is ongoing and improving with speech therapy.ConclusionInitial results demonstrated that implantation and programming of the novel neuroimmune modulation device was safe, and the surgical procedure and device were well tolerated. Full results from this study, including the clinical efficacy, will be presented after the study is fully enrolled and data is analyzed to determine potential of neuroimmune modulation for treating rheumatoid arthritis.Reference[1]Genovese MC, et al. The Lancet Rheumatology. 2020 Sep 1;2(9):e527-38.Acknowledgements:NIL.Disclosure of InterestsDaniel Peterson: None declared, Mark Van Poppel: None declared, Warren Boling: None declared, Perry Santos: None declared, Jason Schwalb: None declared, Howard Eisenberg: None declared, Ashesh Mehta: None declared, Heather Spader: None declared, James Botros: None declared, Frank Vrionis: None declared, Andrew Ko: None declared, David Adelson: None declared, Bradley Lega: None declared, Peter Konrad: None declared, Yaakov Levine Shareholder of: SetPoint Medical, Employee of: SetPoint Medical, David Chernoff Shareholder of: SetPoint Medical, Employee of: SetPoint Medical, Mark Richardson: None declared.