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BACKGROUND Hepatitis C (HCV) incidence among 18–30 year-olds is increasing and guidelines recommend treatment of active injection drug users to limit transmission. OBJECTIVE (1) To measure linkage to HCV care among 18–30 year-olds and identify factors associated with linkage; (2) To compare linkage among 18–30 year-olds to that of patients >30 years. METHODS We used the electronic medical record at an urban safety net hospital to create a retrospective cohort with reactive HCV antibody between 2005 and 2010. We report seroprevalence and demographics of seropositive patients, and used multivariate logistic regression to identify factors associated with linkage to HCV care. We defined linkage as having evidence of HCV RNA testing after reactive antibody. RESULTS 32,418 individuals were tested including 8,873 between 18–30 years. The seropositivity rate among those ages 18–30 was 10%. In multivariate analysis, among those 18–30, diagnosis location (Outpatient vs. Inpatient/ED) (OR 1.78, 95% CI 1.28–2.49) and number of visits after diagnosis (OR 5.30, 95% CI 3.91–7.19) were associated with higher odds of linking to care. When we compared linkage in patients ages 18–30 to that among those older than 30, patients in the 18–30 years age group were more likely to link to HCV care than those in the older cohort even when controlling for gender, ethnicity, socioeconomic status, birthplace, diagnosis location and duration of follow-up. CONCLUSION 18–30 year-olds are more likely to link to HCV care than their older counterparts. During the interferon-free treatment era, there is an opportunity to prevent further HCV transmission in this population.

Background Little is known about real-world outcomes for new interferon-free treatment for hepatitis C virus (HCV) among underserved and diverse communities. Objective To identify predictors of treatment prescription and evaluate outcomes as measured by sustained virologic response (SVR) with HCV RNA testing three months after therapy completion. Design Retrospective cohort at a safety-net health care system. Participants Patients with (1) at least one clinical visit between December 6, 2013, and December 31st 2014; and (2) at least three months follow-up. Key results Predominantly non-White cohort (61%). Of 1,284 HCV-infected patients 121 prescribed sofosbuvir-based therapy. Severe liver fibrosis (OR 1.66, 95% CI 1.05, 2.64) independently associated with treatment prescription. In those with evaluable HCV RNA, SVR was 99%. Conclusion Cure rates similar to clinical trial data can be achieved in diverse underserved communities.

Background: The incidence of gastrointestinal stromal tumors (GIST) is increasing though its epidemiology remains poorly understood. The epidemiological factors involved in GIST were examined in the multi-ethnic population of Hawaii, which has the highest incidence of GIST of all Surveillance, Epidemiology and End Results (SEER) sites in the USA, in order to gain insight into the potential risk factors for GIST.Methods: Archival tumor tissue from 71 morphologically and immunohistochemically confirmed GIST cases and 65 gastritis-only controls diagnosed between 1998-2017 were evaluated for five Helicobacter pylori (H. pylori) genes (HP1177, 16S rRNA, iceA, ureB, vacA) by polymerase chain reaction (PCR) and gastritis controls.Results: Across the ethnically diverse Hawaii population, GIST were significantly more common in Asians compared with whites. The gastric predominance of GIST and higher prevalence of H. pylori in Asians than whites in Hawaii led us to examine this infection as a potential causative factor of GIST. Forty-nine (69.0%) GIST cases were gastric in origin. Of 71 GIST cases, 48 (67.6%) were positive for at least one H. pylori gene, compared with only 13 (20.0%) of the controls {unadjusted odds ratio (OR): 8.3 [95% confidence interval (CI): 3.8-18.3]; P<0.0001}; 23 (32.4%) of GIST cases were positive for at least two different H. pylori genes, compared with only 6 (9.2%) controls [unadjusted OR: 4.7 (95% CI: 1.8-12.5); P=0.002].Conclusions: H. pylori infection is strongly associated with GIST and may play an important role in its tumorigenesis.

A 67-year-old male with metastatic cholangiocarcinoma presented with dehydration and delirium approximately 6 weeks after participating into a Rare Cancer Trial utilising combination of immune checkpoint inhibitors (ICIs), i.e., ipilimumab and nivolumab. His electrolytes were normal but cortisol was 36 nmol/L (185-625) and ACTH was 2 pmol/L (<10). Sixty-minute post-Synacthen cortisol was 153 nmol/L (>530). Secondary hypoadrenalism was diagnosed on the basis of low ACTH and baseline cortisol with poor response to Synacthen. Thyroid function tests revealed thyrotoxicosis, while TPO, thyroglobulin and TSH receptor antibodies were all negative. ICIs have been increasingly implicated in autoimmune endocrinopathies. Combination of ipilimumab and nivolumab can give rise to hypopituitarism or hypophysitis, and thyroid dysfunction. In healthy individuals, immune checkpoints maintain immunological tolerance to self-antigens. By inhibiting these immune checkpoints, ICIs cause auto-immune like manifestations against multiple organs. Typically, complications develop in susceptible patients 6-15 weeks after introduction of ICIs. The preferred screening test for hypophysitis is morning cortisol and ACTH, followed by Synacthen test. 1 In oncology, ICIs are the most rapidly expanding class of drugs alternatives to traditional chemotherapy. Therefore, oncologists, endocrinologists and pathologists need to understand their mechanism of action, side effects, importance of monitoring ICI usage to detect and investigate the associated endocrine disorders. Reference