Thursday, December 30, 2010

Hepatitis News:Liver Disease A Few Safety Concerns

Liver Health

Contamination Prompts Recall of Liver Protectant

By John Gever, Senior Editor, MedPage TodayPublished: December 30, 2010
Six lots of injectable acetylcysteine (Acetadote) manufactured by Cumberland Pharmaceuticals have been recalled because of particulate matter found in some vials, the company said.The drug is used to prevent acute liver injury in patients taking potentially toxic amounts of acetaminophen.Cumberland said it was not aware of any adverse events but was recalling the products as "a precautionary measure."The company believes the particles originated in the product's glass containers, which were produced by a former supplier. Cumberland said it switched to a different source of vials in August 2009.

The exact product being recalled is Acetadote (acetylcysteine) Injection, 20% solution (200mg/mL) in 30 mL single dose glass vials, NDC 66220-107-30.

Affected lot numbers, with expiration dates, include 090304 and 090331 (February 2011), 090401 (March 2011), 090511 (April 2011), and 090602 and 090616 (May 2011).

The product was distributed to U.S. wholesalers and distributors nationwide.Cumberland's announcement did not include specific instructions to hospitals or other providers who may have the product in stock. The company, based in Nashville, can be contacted at (877) 484-2700.

Avelox Could Harm Liver, Health Canada Warns
Ottawa, Ontario: It was quietly floated back in March. However, the Canadian health authority earlier this year warned of a potential adverse reaction stemming from Avelox that could pose a threat to an individual's liver.
Avelox antibiotic, or moxifloxacin, is commonly used to treat a broad spectrum of bacterial infections."Health Canada has conducted a safety review and concluded that Avelox may be associated with the rare but potentially life-threatening risk of liver injury, including liver failure," the Canadian health authority—the equivalent to the US Food and Drug Administration—said in a statement released March 22.An earlier safety review by the European Medicines Agency prompted Health Canada to conduct its own safety review of moxifloxacin, which is an antibiotic within the quinolone family.

The review also found that while the potential for liver-related side effects was well documented on the Canadian product label, Health Canada determined that there needed to be a better job done with regard to communicating that information to patients in a real and effective way.Avelox, like many antibiotics in the quinolone family, can cause Avelox tendon rupture and other adverse reactions related to the tendon—including Avelox tendonitis. With other antibiotic products in the quinolone class getting a fair bit of ink in the media over tendon problems, more people are at least becoming aware of the potential for serious side effects involving tendons.

However, the potentially rare risk to proper liver function is not well known. It is also a sad truth that most patients do not read product labels or medication guides, leaving it to their doctor to sort all that out on the patient's behalf.Some doctors do not adequately inform their patients as to the possibility or potential severity of Avelox adverse reactions.Health Canada advised patients experiencing symptoms ranging from loss of appetite and abdominal pain, to dark urine and yellowing of the skin or eyes, "to stop taking Avelox and contact a health-care professional immediately."

Seafood safety concerns for those with liver disease

Created: 12/29/2010 05:22:28 PM PST

Today, if you walk into a seafood restaurant or store and do NOT see a sign that opens by stating, in English and Spanish: "Eating raw oysters may cause severe illness and even death in persons who have liver disease (for example, alcoholic cirrhosis), cancer or other chronic illnesses that weaken the immune system. ... " you should not hesitate to mention the lapse to a manager.

Of course, another hazard of shellfish and mollusks (in other words, oysters, clams and mussels) is hepatitis A, the most serious viral infection associated with seafood consumption. Contamination is most likely when human sewage pollutes an aquaculture site. The largest outbreak to date (affecting almost 300,000 people) occurred in China in 1988. The victims all ate clams from a sewage-sullied growing area.
Since hepatitis A virus targets the liver, it is a special threat to people with pre-existing liver disease. Fortunately, they can be well-protected by a safe and effective vaccine.
Dr. Claire Panosian Dunavan is an infectious disease specialist and a professor of medicine at the David Geffen School of Medicine at UCLA and a resident of Pasadena..
Continue reading......

Dec. 29, 2010
“Outbreak” of Hepatitis A Confirmed
by Cabell
Huntington Health Department
Release Huntington, WV (HNN) - Eleven cases of Hepatitis A have been confirmed in Cabell County, according to a Cabell-Huntington Health Department news release. Hepatitis A is a liver disease caused by a virus which found in the stool of an infected person. The disease is spread from person to person by hands that have not been washed after going to the bathroom or touching items such as diapers or linens soiled by a bowel movement.

It can also be spread by water or ice and by eating uncooked foods that may have become contaminated during handling. Hepatitis A can also be spread through common household items such as unclean eating utensils.
Symptoms include:
* tiredness* stomach pain* fever* dark urine* loss of appetite* yellowing of the skin and eyeballs* nausea
If you think you have any of the above symptoms, please contact your doctor. Hepatitis A is vaccine preventable disease. The hepatitis A vaccine is a two-dose shot and is available at the Health Department.

FDA News and Announcements
12/27/2010 FDA: Don’t Eat Tiny Greens Brand Alfalfa Sprouts or Spicy Sprouts
12/24/2010 FDA: Rolf’s Patisserie recalling all desserts made after November 1

Treatment of HCV Infection in 2011

A prediction Made In February Of 2010
By Mitchell L. Shiffman

Based on current data and ongoing clinical trials using DAA, I have attempted to speculate about the treatment of chronic HCV infection in 2011. The year 2011 will open with our current standard of care: peginterferon and ribavirin. Between now and 2011, a declining number of patients will likely be treated with peginterferon and ribavirin because of the desire to delay treatment until a DAA is available.

Futhermore, patients will likely be tested for the IL-28B haplotype; only those with the CC allele, and a high chance to achieve SVR, are likely to be treated with peginterferon and ribavirin. Patients with mild fibrosis may also opt to defer therapy because they have a low likelihood of developing significant fibrosis over the next several years.

Hey, I have a question about this IL28B gene and hepatitis c treatment.....

During this time, I anticipate more uniform application of the concepts of response-guided therapy. Patients who achieve RVR will be treated for 24 weeks, patients with cEVR will be treated for 48 weeks, and STR patients will be treated for 72 weeks. We will be more prepared to modify the doses of peginterferon and ribavirin to limit adverse events in patients who have already become HCV RNA undetectable. The use of epoetin-α will be limited to only those patients who become anemic very rapidly (within the first 1 to 2 months of treatment). This limitation will be especially true if IL-28B testing determines that the patient has a high chance for SVR.

It is anticipated that the first DAA will be approved by the US Food and Drug Administration by mid-late 2011. At that time, patients will be treated with triple therapy: peginterferon, ribavirin, and a DAA. About 80% of patients will achieve RVR and SVR of 70% is anticipated. The treatment duration will be reduced for all patients with RVR to 24 to 28 weeks, depending on whether a “lead-in” strategy using peginterferon and ribavirin is adopted. Relapse will be less than 5%; the remaining 10% of patients will simply be unable to tolerate the side effects of one or more of these three medications and will prematurely discontinue treatment. Patients who become HCV RNA undetectable after week 4 will be treated for 48 weeks. Patients who do not become HCV RNA undetectable by treatment week 8 to 12 will likely stop treatment. It remains to be determined if patients who do not achieve SVR with triple therapy could be more effectively treated after 2011 with a combination of DAAs.

See Full Text Here..........................


January 2011 HCV Advocate Newsletter
Download printable version
In This Issue:
Top 10 News of 2010 Alan Franciscus, Editor-in-Chief
HealthWise: Vitamin D and the Liver Lucinda K. Porter, RN
HCV Snapshots Lucinda K. Porter, RN
AASLD 2010: Part 2 Alan Franciscus, Editor-in-Chief

December 2010 HCV Advocate Newsletter
Download printable version
In This Issue:
AASLD 2010 Conference – Part 1 Alan Franciscus, Editor-in-Chief
IL28B Gene Highlighted at AASLD Liz Highleyman
HealthWise: 2010 Liver Meeting Update Lucinda Porter, RN
HCV Snapshots Lucinda Porter, RNHCV Advocate Eblast
Stay informed on the latest news here to register for email alerts

HBV Journal Review
HBV Journal ReviewJanuary 1, 2011,
Vol 8, no 1by Christine M. Kukka


EU -- Guidelines for Testing HIV, Viral Hepatitis and other Infections in Injecting Drug Users

December 30, 2010 20:23

Guidelines for Testing HIV, Viral Hepatitis and other Infections in Injecting Drug Users

Source: European Monitoring Centre for Drugs and Drug Addiction

Infectious diseases are among the most serious health consequences of injecting drug use and can lead to significant healthcare costs. Injecting drug users are vulnerable to a range of infectious and communicable diseases through a variety of risk behaviours, and because of underlying conditions such as poor hygiene, homelessness and poverty. This leads to higher morbidity and mortality in this group as compared with the same age groups in the general population. In addition, IDUs can act as a core group carrying infections that may pose a risk to the general population.Although HIV and hepatitis C infections remain the most important public health problem among IDUs, this document recognises that other blood-borne viral infections and various bacterial infections also play an important role in the health and well-being of IDUs. As the coverage of effective antiretroviral treatment and treatment for other infections in IDUs is being scaled up, access to and uptake of testing for HIV and other infectious diseases in IDUs also needs to be increased.Evidence-based interventions such as opioid substitution treatment, needle exchange programmes and other elements of the ‘comprehensive package’ for IDUs are important measures to prevent HIV infection, hepatitis and other infections in this group (WHO, UNODC and UNAIDS 2009), given that prevention of injecting drug use itself still proves to be very difficult.The recommendations in this document are primarily targeted at high-income countries with lowlevel or concentrated HIV epidemics where recorded infections are largely confined to individuals with risk behaviour, such as IDUs. This includes most European countries.

Monitoring by Nurses Aids Chronic Illness Care
Patients with chronic illnesses and coexisting depression had significantly better control of both conditions when medically supervised nurses provided guideline-based care, data from a randomized trial showed.
Continue reading............

Calif. liver recipient, 13, on mission of thanks
Published December 30, 2010

PASADENA, Calif. – Eleven-year-old Mikey Carraway's liver had failed — doctors had two weeks at most to find an organ donor to save his life. Two days later, they had one — 18-year-old Johnny Hernandez, who suffered a fatal brain injury in a motorcycle crash.
Mikey, now 13, and his mom Shaheda Wright thanked the Hernandez family in person Wednesday in a rare meeting between a donor family and an organ recipient.
"We just want to say to you that if it wasn't for your decision at tough time in your life, my son wouldn't be here today," Wright said.

"You don't have to thank me," said Johnny' s mother, Christine Hernandez, tears spilling down her cheeks. "It was a gift from God."

Mikey and his mom, who live in Oakland, arrived in Pasadena for Saturday's Rose Parade, in which Mikey will represent the California Transplant Donor Network on the "Donate Life" float. The float, titled "Seize the Day," will feature 30 organ recipients and the portraits of 60 donors made out of flowers

The Hernandez relatives, who live around inland Southern California, came to Mikey's hotel to meet him with photos of Johnny and a DVD of his funeral service. There were tears aplenty, but also some laughs.
"Do you feel Mexican at all now?" Denise Leyva, Johnny's aunt, asked Mikey. "Are you getting sudden cravings for tacos?"
J.R. Aranda, one of Johnny's close friends, related that Johnny was such a fan of the Oakland Raiders, he had the team's insignia tattooed on his upper arm — unbeknownst to his mother.
Mikey, also a diehard Raiders follower, said he wants to get one in the same place. "Kid, wait a minute," his mother cautioned. Instead, Aranda presented Mikey a blanket with the team symbol on it.
Donors and recipients don't often want contact, said Cathy Olmo, community development manager of the Oakland-based California Transplant Donor Network. Most donor families want to move on with their lives and prefer not knowing details. The network encourages recipients to write a letter to their donors, and for most on both sides, that suffices, she noted.
Mikey and his mom, though, are exceptional cases.

They are "paying forward" Mikey's gift of life by feeding the homeless once a month in a park in West Oakland in a venture called Mikey's Meals. Over the past two years, they estimate they've served 3,500 people. The events also serve to raise awareness about organ donation.
It was Mikey's idea, said Wright, 36. When she asked Mikey how he wanted to repay the generosity of his liver donor, well before they had contact with the Hernandezes, he said "feed the homeless."
"It was the first thing that popped into my head," he said. Now it's become his favorite thing to do.
At first Wright was paying for the food out of her own pocket, but recently various sponsors have stepped up, including the Oakland Fire Department and a local high school, and the event has expanded to include giveaways of school supplies and holiday toys.
"Mikey is an extraordinary young man," Olmo said. "He's really taking this cause to heart. It's a powerful message from him."

Judging by sheer odds, Mikey was lucky. More than 107,000 people across the nation are waiting for organs — 16,000 of them need livers, which tend to collapse fast so the window of time to find a donor is slim.

Mikey's liver failure came on suddenly — doctors believe from a virus. "He had been perfectly healthy," Wright said. "This was definitely a shock."

As Wright waited anxiously, the Hernandez family was facing death in another hospital. Johnny, who was an avid weightlifter and studied the Bible, had gone to night school on his motorcycle and collided with a truck on a freeway onramp. He was on life support.

Christine Hernandez said she had never thought about organ donation, but it turned out Johnny had. He was one of only 26 percent of Californians whose driver's license carries the pink dot denoting an organ donor — he had signed up after seeing the pink dot on Aranda's license.
"He thought that was pretty cool," Aranda said.

It was an agonizing decision, but the family decided to honor Johnny's wishes although his dad, Bob Hernandez, had a hard time when doctors came in with a list of organs and tissues for possible harvesting.

"He said 'you're tearing up my son' and had to leave," said Christine Hernandez, who has a tattoo with her son's name and dates of birth and death on her inner wrist.
Six months later, the family received word that Johnny's heart, lungs, kidneys, and liver saved five lives, including three children, and his corneas restored sight to others. The other recipients have not contacted the Hernandezes, but two months ago they heard from Wright and the families started connecting.

"I feel they're like extended family," Wright said.
For Christine Hernandez, the new relationship has helped her find solace and give meaning to the senseless end of a young man's life. "I don't know if closure will ever be complete," she said. "But it's a way of moving forward."

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