Sunday, December 19, 2010

Hepatitis News: This and That On Sunday

Just In On The New Website: Dec 20th
Is IL28B Testing A Threat To Telaprevir Or To Patients ?


SUNDAY, Dec. 19 (HealthDay News) — Though holiday partying often includes alcohol consumption, cancer experts are urging partiers topartake moderately.
“Research shows that drinking even a small amount of alcohol increasesyour chances of developing cancer, including oral cancer, breast cancerand liver cancer,” Clare McKindley, clinical dietician in the CancerPrevention Center at the University of Texas M.D. Anderson Cancer Center,said in a news release from the center.
Vertex's Telaprevir Aims to Revolutionize HCV Treatment
The drug is widely regarded as a major advancement, and we think telaprevir could hit the market in the first half of next year.
We think telaprevir's slightly superior efficacy and convenience profile should give it an advantage with prescribers. However, Vertex has no commercialization experience, and Merck's established salesforce and ability to package the drug with the current standard of care should help even the commercialization playing field. Vertex ranked number 1 on our 2010 biotech takeout list, and we continue to believe the firm would benefit from the sales know-how of a larger pharma player like current partner Johnson & Johnson (JNJ).

Cancer Patients Are At An Almost Five-Fold Increased Risk Of Developing Listeria
Written by Janet EppingResearch by the Health Protection Agency (HPA) has shown that cancer patients have a five-fold increased risk of developing listeria than people with other underlying conditions - and that those with cancers of the blood have the greatest risk...
In case you missed it.............
SeraCare Aiming to Improve Early Diagnosis of Hepatitis C
Designed to accurately detect the virus early in the immune response process, SeraCare is introducing two new blood panels to improve Hepatitis C diagnostics.

Symptoms and Severity of Chronic Hepatitis C
Some medical tests are more accurate than others in ascertaining how severe Hepatitis C infection is - and that severity may or may not be associated with how much an infected person suffers with Hepatitis C's symptoms.
Differentiating Between Hepatitis C Genotypes and the IL-28B Genotype
December 13, 2010
Hepatitis C research represents how far the medical application of genetics has come in the past decade. Although they analyze different genetic material, tests that determine Hepatitis C genotype and IL-28B genotype will help guide the future of Hepatitis C treatment.
Continue reading
How is the IL28B gene related to Hepatitis C ?
Recent research has shown that DNA variations in and around the IL28B gene can reduce a person's chances of responding to the standard hepatitis C treatment.
What is the official name of the IL28B gene?
The official name of this gene is “interleukin 28B (interferon, lambda 3).
Lab Tests 101: Liver Function Tests
October 8, 2010 Dr. Pullen
Lab Results 101: Liver Function Tests
The first thing to know is that what is commonly called liver function testing (LFTs) has little if anything to do with the function of the liver. They are really tests that are clues to liver injury or disorders, but not really liver function. Still the name is likely here to stay, so liver function testing is what you will hear discussed. In the common test ordered at your doctor’s office, called the Comprehensive Metabolic Panel(CMP), several tests are included that give information about the liver.

The first two tests are the ALT (Alanine aminotransferase) and AST (Aspartate aminotransferase) were formally called SGPT and SGOT respectively. These are enzymes that normally function inside liver cells primarily, and are present in the blood stream in small quantities. When there is something causing injury to liver cells, these enzymes leak into the bloodstream in large quantities, and elevated serum levels of these enzymes what physicians call hepatocellular injury. At the top of the list of things that can lead to elevation of these enzymes is alcohol use. Excessive alcohol intake, especially chronic overuse, leads to hepatocellular damage, and eventually liver tissue scarring called cirrhosis. Elevation of the AST and ALT is often a clue to your physician that alcohol overuse may be a concern. Interestingly a high ratio of AST to ALT is especially suggestive of alcohol toxicity. Other toxic compounds, including acetaminophen (Tylenol) overuse, can cause similar liver cell injury and transaminase enzyme elevation.

Other causes of elevation of the AST and ALT include the various viral hepatitis infections. Currently hepatitis C is the cause we think of most commonly as a concern. It’s at epidemic proportions in the US now, and can be a silent cause of progressive liver damage, liver failure, and liver cancer. Often a physician will order testing for hepatitis C, B and sometimes A when evaluating for a cause of elevation of the liver transaminases. Less common causes of hepatitis include other medications, other ingested toxins, autoimmne hepatitis, and infiltrative diseases like cancer, hemochromatosis, amyloidosis, and fatty liver. Alcoholism, diabetes and obesity can be causes of fatty liver.

Another test result on the CMP is called alkaline phosphatase, or Alk Phos. This is an enzyme found mostly in the liver’s bile ducts. These are the tubes that bile flows through to exit the liver into the gallbladder and small intestine. Anything that causes obstruction to or inflammation of the bile ducts can lead to an elevated Alk Phos level. Examples of things your physician may look for include gall stones or other causes of bile duct obstruction, cancers or other masses that can block the bile ducts, and autoimmune disorders of the bile ducts, like primary sclerosing cholangitis.

Bilirubin is a breakdown product of the hemoglobin in our red blood cells. Red blood cells are constantly breaking down and being replenished. The end product of the metabolism of hemoglobin is bilirubin, and the liver excretes bilirubin in the bile as well as changes it in a process called conjugation into a form that can be excreted by the kidney in the urine. Elevation of bilirubin can be a clue to blockage of the bile ducts, to excessive red blood cell destruction or to failure of the liver to metabolize the bilirubin properly to be excreted. Significant elevation of bilirubin is a very concerning finding most of the time, and needs to be investigated.
Other tests in the CMP that reflect on liver function include the albumin level. The liver produces albumin, the primary intravascular protein, and low albumin levels can reflect malnutrition, chronic illness, or liver disease.
There are lots of additional tests available to investigate liver function, but these are the ones commonly seen on routine office testing. As you may have noted, most reflect problems with liver inflammation, blockage of the bile ducts, or liver cell damage rather than the true function of the liver, so they should be called liver disorder tests. The term is likely here to stay, so LFTs it is.

TSH – Understanding Thyroid Function Tests
November 6, 2010 Dr. Pullen

On The Blog : Thyroid and Hepatitis C .
TSH is the abbreviation for Thyroid Stimulating Hormone.
Measurement of TSH level is the standard test used by physicians to both screen for and monitor treatment of hypothyroidism. Understanding the TSH test results is quite simple once you know how the body regulates your thyroid function. The process begins in the hypothalamus, the portion of the brain just above the pituitary gland. The hypothalamus senses the level of thyroid hormone, and drives the process. If you need more thyroid hormone, the hypothalamus secretes a hormone called Thyroid Releasing Hormone (TRH) into the microcirculation from the hypothalamus, down the stalk of the pituitary and to the pituitary gland. The TRH signals the pituitary to secrete TSH into the bloodstream. The TSH goes through the bloodstream and stimulates the thyroid gland to put out thyroid hormone. So if your body needs more thyroid hormone as determined by the hypothalamus, the amount of TSH released by the pituitary increases dramatically. In most symptomatic hypothyroid patients the TSH level is markedly elevated. A normal TSH level is approximately 0.4 – 4.5.
In hypothyroidism typically the TSH level will be much higher, with levels of 15-300 quite common. We have more trouble deciding the significance of minor elevations of TSH, in the Less then 10 range. In patients on thyroid replacement therapy for hypothyroidism most physicians aim for a TSH level in the low normal range, from 0.4-2.0. If patients feel well with upper normal TSH levels these are fine too. (range varies from lab to lab, by gender, in pregnancy, etc.) Most experts recommend monitoring a TSH level about annually in patients on thyroid replacement therapy as the dose required can vary from time to time in any individual.
So it’s really simple: An elevated TSH indicates an underactive thyroid or under-treated hypothyroid condition. A low, or suppressed, TSH indicates an overactive thyroid, or an over-treated hypothyroid state. Sometimes, especially with a slightly suppressed TSH it is helpful to measure the levels of thyroid hormone in the bloodstream. In past years this was difficult, due to the large range of normal for total T4 and total T3 in different individuals. This huge range is in part because most of the circulating thyroid hormone is protein bound, and not available at any given moment to bind to the thyroid hormone receptors. Prior to the development and refinement of the TSH assay for routine use this was a big problem.

Fortunately in addition to the development of the highly sensitive TSH assays, we now have affordable measures of Free T4 and Free T3 levels. T4, or levothyroxine, is the thyroid hormone stored and released by the thyroid gland in largest quantities. T3, or triiodothyronine, is the more physiologically active thyroid hormone, and is a metabolite of T4. Both T3 and T4 circulate in the bloodstream both as protein bound and free or non-protein bound hormones. The free, or unbound form is the form that functions to control metabolic rate. In years past, before we had lab measurements of Free T4 and Free T3 we estimate the free amount by what was called the Free Thyroxine Index, a number calculated by multiplying the total T4 by the thyroid binding capacity. This was notoriously inaccurate and really plays no role in modern thyroid management. I still see non-endocrinologist, non-primary care physicians order a FTI (also called T7) level at times. Now in the circumstance when we need to know the level of circulating thyroid hormone levels we order a Free T4, and sometimes a Free T3 level and avoid the confusion of protein bound thyroid...
So now you know:
High TSH à Low thyroid hormone status.
Low TSH à High thyroid hormone status.
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Obesity May Interfere With Vitamin D Absorption
Finding may indicate need for supplements or more sunshine, study suggests

FRIDAY, Dec. 17 (HealthDay News) --
The more obese a person is, the poorer his or her vitamin D status, a new study by a team of Norwegian researchers suggests.
The study found an inverse relationship between excess pounds and an insufficient amount of vitamin D, which is critical to cell health, calcium absorption and proper immune function. Vitamin D deficiency can raise the risk for bone deterioration and certain types of cancer.
The researchers also suggest that overweight and obese people may have problems processing the vitamin properly.

The team noted that after the so-called "sunshine vitamin" is initially absorbed (through either sun exposure or the consumption of such foods as oily fish and fortified milk), the body must then convert it into a usable form, called 1,25-dihydroxyvitamin D. This conversion process, however, seems to be short-circuited among obese people, complicating efforts to gauge their true vitamin D health.

The findings are published in the January issue of the Journal of Nutrition.
To investigate the impact of obesity on vitamin D absorption, the team spent six years tracking 1,464 women and 315 men, with an average age of 49. Based on the participants' body mass index (BMI), an indicator of body fatness calculated from a persons weight and height, the average participant was deemed to be obese. About 11 percent were categorized as "morbidly obese."

From the outset, overall vitamin D levels were found to be below the healthy range, the authors noted. By the end of the study, overall levels of vitamin D were found to have dropped off "significantly" while BMI readings rose by 5 percent.
The research team concluded that having a higher-than-normal weight, body fat and BMI was linked to a poorer vitamin D profile.
For example, people with the lowest BMI readings had 14 percent higher vitamin D levels than those with the highest BMI readings.

Because vitamin D levels did not correlate properly with 1,25-dihydroxyvitamin D levels (and in fact appeared to have an abnormal inverse relationship), the authors suggested that future efforts to explore vitamin D status among obese people should test for both measures of vitamin D health.

They also suggested that people who are overweight and obese might benefit from vitamin D supplementation and more exposure to sunlight.
More information
The U.S. Office of Dietary Supplements has more on vitamin D.
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