Soumitra S. Bhuyan

Effectiveness of AMD3100 in treatment of leukemia and solid tumors: from original discovery to use in current clinical practice

AMD3100, also known as plerixafor, was originally developed as an anti-human immunodeficiency virus (HIV) drug, and later characterized as a C-X-C chemokine receptor type 4 (CXCR4) antagonist. Previous reviews have focused on the application of AMD3100 in the treatment of HIV, but a comprehensive evaluation of AMD3100 in the treatment of leukemia, solid tumor, and diagnosis is lacking. In this review, we broadly describe AMD3100, including the background, functional mechanism and clinical applications. Until the late 1990s, CXCR4 was known as a crucial factor for hematopoietic stem and progenitor cell (HSPC) retention in bone marrow. Subsequently, the action and synergy of plerixafor with Granulocyte-colony stimulating factor (G-CSF) led to the clinical approval of plerixafor as the first compound for mobilization of HSPCs. The amount of HSPC mobilization and the rapid kinetics promoted additional clinical uses. Recently, CXCR4/CXCL12 (C-X-C motif chemokine 12) axis was found to be involved in a variety of roles in tumors, including leukemic stem cell (LSC) homing and signaling transduction. Thus, CXCR4 targeting has been a treatment strategy against leukemia and solid tumors. Understanding this mechanism will help shed light on therapeutic potential for HIV infection, inflammatory diseases, stem-cell mobilization, leukemia, and solid tumors. Clarifying the CXCR4/CXCL12 axis and role of AMD3100 will help remove malignant cells from the bone marrow niche, rendering them more accessible to targeted therapeutic agents.

Patient–Provider Communication About Prostate Cancer Screening and Treatment New Evidence From the Health Information National Trends Survey

The American Urological Association, American Cancer Society, and American College of Physicians recommend that patients and providers make a shared decision with respect to prostate-specific antigen (PSA) testing for prostate cancer (PCa). The goal of this study is to determine the extent of patient–provider communication for PSA testing and treatment of PCa and to examine the patient specific factors associated with this communication. Using recent data from the Health Information National Trends Survey, this study examined the association of patient characteristics with four domains of patient–provider communication regarding PSA test and PCa treatment: (1) expert opinion of PSA test, (2) accuracy of PSA test, (3) side effects of PCa treatment, and (4) treatment need of PCa. The current results suggested low level of communication for PSA testing and treatment of PCa across four domains. Less than 10% of the respondents report having communication about all four domains. Patient characteristics like recent medical check-up, regular healthcare provider, global health status, age group, marital status, race, annual household income, and already having undergone a PSA test are associated with patient–provider communication. There are few discussions about PSA testing and PCa treatment options between healthcare providers and their patients, which limits the shared decision-making process for PCa screening and treatment as recommended by the current best practice guidelines. This study helps identify implications for changes in physician practice to adhere with the PSA screening guidelines.

India's plan to eliminate tuberculosis by 2025: converting rhetoric into reality

The Government of India announced its plan to eliminate tuberculosis (TB) by 2025 during the Union Budget address last month.1 The declaration is extraordinarily ambitious, considering that India accounts for 27% of the worlds 10.4 million new TB cases, and 29% of the 1.8 million TB deaths globally.2 India also accounts for 16% of the estimated 480 000 new cases of multidrug-resistant TB. The End TB Strategy by WHO aims to end the global TB epidemic, with targets to reduce TB deaths by 95% and to cut new cases by 90% by 2035.3 While high-level political commitment is welcome and necessary, the real question now is how India can go from rhetoric to real progress? We offer some suggestions that might help bridge the gap between ambition and reality. First and foremost, India needs to give priority to and begin investing in health. For decades, governmental expenditure on health has been one of the lowest in the world at 1.4% of the GDP (but even lower in the previous years).4 While the 2017 Union Budget has allocated additional funding for health, the allocation will substantially fall short of the 2.5% of the GDP that has been considered a realistic goal in the draft National Health Policy 2015.5 The budget for Indias Revised National TB …

Paid sick leave is associated with fewer ED visits among US private sector working adults.

CONTEXT The United States (US) is the only developed country that does not guarantee short-term or longer-term paid sick leave. OBJECTIVE This study used a multiyear nationally representative database to examine the association between availability of paid sick leave and frequency of emergency department (ED) use among US private sector employees. STUDY SAMPLE We used the National Health Interview Survey data (2012-2014). The final study sample consists of 42,460 US adults between 18 and 64years of age and working in nongovernmental private sector. RESULTS Our results suggest that availability of paid sick leave is significantly associated with lower likelihood of ED use, for both moderate (1-3 times/year) and repeated users (4 or more times/year). After controlling for confounding factors, respondents with paid sick leave are 14% less likely to be moderate ED users (adjusted odds ratio, 0.86; 95% CI, 0.79-0.93) and 32% less likely to be repeated ED users (adjusted odds ratio, 0.68; 95% CI, 0.50-0.91). DISCUSSION Although expansion of health insurance coverage under the Affordable Care Act has not been shown to reduce utilization of high cost health care services such as the ED, our study suggests other factors such as the availability of paid sick leave may do so, by allowing patients to seek care through other more cost-effective mechanisms (eg, primary care providers). To reduce ED utilization, health policymakers should consider alternative reforms including paid sick leave.

Disparities in Emergency Department Wait Time Among Patients with Mental Health and Substance-Related Disorders

This study examined disparities in emergency department (ED) wait time for patients with mental health and substance-related disorders (PwMHSDs), using data from the 2009–2011 National Hospital Ambulatory Medical Care Survey (NHAMCS). Wait time was defined as the time between arrival at ED and being seen by an ED provider. Results from multivariable regression models show racial disparities, with non-Hispanic Black PwMHSDs experiencing longer ED wait time, compared to non-Hispanic White PwMHSDs. A temporal decline in ED wait time was also observed over the study period. The findings of this study have implications for informing the development of policies tailored at facilitating the delivery of equitable emergency care services to all PwMHSDs.

Access to Employee Wellness Programs and Use of Preventive Care Services Among U.S. Adults

INTRODUCTION There is little research at the national level on access to employee wellness programs and the use of preventive care services. This study examined the use of seven preventive care services among U.S working adults with access to employee wellness programs. METHODS The study population comprised 17,699 working adults aged ≥18 years, obtained from the 2015 National Health Interview Survey. Multivariate logistic regression models examined the relationship between access to employee wellness programs and use of seven preventive care services: influenza vaccination, blood pressure check, diabetes check, cholesterol check, Pap smear test, mammogram, and colon cancer screening. Data analysis began in Fall 2016. RESULTS Overall, 46.6% of working adults reported having access to employee wellness programs in 2015. Working adults with access to employee wellness programs had higher odds of receiving influenza vaccination (OR=1.57, 95% CI=1.43, 1.72, p<0.001), blood pressure check (OR=2.46, 95% CI=2.17, 2.78, p<0.001), diabetes check (OR=1.30, 95% CI=1.12, 1.50, p<0.001), cholesterol check (OR=1.48, 95% CI=1.33, 1.67, p<0.001), and mammogram (OR=1.57, 95% CI=1.24, 1.98, p<0.001). However, there was no significant difference between access to employee wellness programs and the use of Pap smear test and colon cancer screening services. CONCLUSIONS Using a nationally representative sample of individuals, this study found a positive association between access to employee wellness programs and the use of preventive care services. The results support favorable policies to encourage implementing wellness programs in all worksites, especially those with <50 employees.

Zika Virus infection and microcephaly: anxiety burden for women

The re-emergence of Zika virus in Brazil and other contiguous countries is a source of anxiety for pregnant women on account of its association with microcephaly. Adverse pregnancy outcome has huge mental health implications. It is essential for health providers to incorporate psychosocial care as part of pre and postnatal care for women in all countries affected by the Zika virus infection.

Mobile Health Application and e-Health Literacy: Opportunities and Concerns for Cancer Patients and Caregivers

Health literacy is critical for cancer patients as they must understand complex procedures or treatment options. Caregivers’ health literacy also plays a crucial role in caring for cancer patients. Low health literacy is associated with low adherence to medications, poor health status, and increased health care costs. There is a growing interest in the use of mobile health applications (apps) to improve health literacy. Mobile health apps can empower underserved cancer patients and their caregivers by providing features or functionalities to enhance interactive patient-provider communication and to understand medical information more readily. Despite the potentiality of improving health literacy through mobile health apps, there exist several related concerns: no equal access to mobile technology, no familiarity or knowledge of using mobile health apps, and privacy and security concerns. These elements should be taken into account for health policy making and mobile apps design and development. Importantly, mobile apps should be developed with the goal of achieving a high range of user access by considering all health literacy level and various cultural and linguistic needs.

Persisting trend in the breach of medical neutrality: a wake-up call to the international community

History is dotted with stories of war crimes in which civilians, patients and health personnel have been killed and health facilities destroyed by warring factions. In 1949, the International Humanitarian Law (IHL) as contained in the four 1949 Geneva Conventions was officially ratified by 196 countries.1 The law promoted medical neutrality and non-interference with medical services for people in war zones. The breach of medical neutrality became regarded as war crime, due to its impact on civilians and the health personnel who have a duty to save lives and treat the wounded in and around war zones. In time, the IHL, which has its roots on principles of humanity, impartiality and neutrality, have undergone modifications with the Additional Protocols in 1977 (to protect the victims of international and non-international armed conflicts) and 2005 (to adopt the Red Crystal, in countries where the Red Cross and Red Crescent emblems may be objectionable).1 But over the years, war crimes have persisted with little or no definitive action by the international community to stem the tide.2 From the 1970s, when facilities and human lives were destroyed in Mozambique to the 1990s in Chechnya, Thailand and El Salvador where similar acts were perpetrated. The destruction of health facilities in Syria, Iraq, Afghanistan …