Monday, July 18, 2011

Hepatitis News; Abnormal liver tests in people 75 and above assoc-with mortality

Abnormal liver tests in people aged 75 and above associated with mortality
A study in the latest issue of Alimentary Pharmacology & Therapeutics investigates the association between mortality and abnormal liver tests in people aged 75 and above.
Despite their common use the occurrence and consequences of abnormal liver tests remain unclear.
Dr Fleming and colleagues from the United Kingdom estimated the prevalence and mortality associated with abnormal liver tests in people aged 75 years and above.
A cohort study on 13 276 people aged 75 years and above, registered with general practices, with a valid measurement of one or more liver test, calculating the prevalence of abnormal aspartate transaminase (AST), alkaline phosphatase (ALP) or bilirubin.
Hazard ratios were calculated for all-cause and cause-specific mortality comparing elderly patients with abnormal liver tests to elderly patients with normal liver tests.
Abnormal AST had a hazard ratio of 1.3 for all-cause mortality
Alimentary Pharmacology & Therapeutics
At least one abnormal liver test was found in 2175 subjects.
The team found that the prevalence of a single abnormal liver test was 3% for AST, 9% for ALP, and 5% for bilirubin.
Abnormal AST, ALP and bilirubin were associated with increased risks of all-cause mortality; adjusted HRs, 1.3, 1.5, and 1.2, respectively.
The research team observed that abnormal AST and ALP were associated with 7-fold and 6-fold increased risk of death from liver disease, respectively.
The team found that 2 or more abnormal liver tests were associated with 2-fold and 17-fold increased risk of death from cancer and liver disease, respectively.
Of the causes examined, absolute mortality rates were highest for cardiovascular disease in subjects with and without abnormal liver tests.
Dr Fleming's team concluded, "Abnormal liver tests occur commonly in elderly people and are associated with a modest increase in all-cause mortality. There was a strong association with liver disease."
"However, the majority of deaths were not due to this cause."
Aliment Pharmacol Ther 2011: 34(3): 324–3418 July 2011

J Hepatol. 2011 Jul 11. [Epub ahead of print]
Gaps in the Achievement of Effectiveness of HCV Treatment in National VA Practice.
Kramer JR, Kanwal F, Richardson P, Mei M, El-Serag H, Kramerer JR.
Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX; Section of Health Services Research.

Antiviral treatment for hepatitis C virus (HCV) has high efficacy rates for achieving sustained viral response (SVR) in randomized controlled trials (RCTs) (40% to 80%); however, it can be lower in community-based practice settings. We wanted to determine the effectiveness of HCV treatment in Veterans Administration (VA) hospitals nationwide.

Using the nationwide VA HCV Clinical Case Registry (CCR), we examined cohort of veterans who had HCV viremia between 2000 and 2005 and identified patients who received pegylated-interferon (PEG-INF) and ribavirin. The duration of treatment and proportion of patients completing treatment was calculated. The effectiveness of treatment was measured as the proportion of patients who achieved SVR (negative viremia at least 12 weeks after the end of treatment) in the entire cohort, and among patients who initiated and completed treatment.

We identified 99,166 patients with HCV viremia. Of those, 11.6% received PEG-INF with ribavirin and 6.4% completed treatment. Contraindications were present in 57.2% of the patients that did not receive treatment. SVR was documented in 39.9% and 58.3% of patients who completed treatment; 23.6% and 50.6% of patients who initiated treatment; and 3.9% and 11.2% of the entire HCV cohort for genotype 1 or 4 and 2 or 3, respectively. Overall, only 3.5% of the entire HCV viremic cohort had documented SVR.

Treatment effectiveness for HCV is low. In addition to fixed factors, such as race and virus genotype, the drop in effectiveness is due to low rates of antiviral treatment initiation and treatment completion.
Copyright © 2011. Published by Elsevier B.V.
[PubMed - as supplied by publisher]

Glycyrrhizin as antiviral agent against Hepatitis C Virus
Hepatitis C virus is a major cause of chronic liver diseases which can lead to permanent liver damage, hepatocellular carcinoma and death. The presently available treatment with interferon plus ribavirin, has limited benefits due to adverse side effects such as anemia, depression, fatigue, and "flu-like"symptoms.Herbal plants have been used for centuries against different diseases including viral diseases and have become a major source of new compounds to treat bacterial and viral diseases.MaterialThe present study was design to study the antiviral effect of Glycyrrhizin (GL) against HCV. For this purpose, HCV infected liver cells were treated with GL at non toxic doses and HCV titer was measured by Quantitative real time RT-PCR.Results and DiscussionOur results demonstrated that GL inhibit HCV titer in a dose dependent manner and resulted in 50% reduction of HCV at a concentration of 14+/-2 ug.Comparative studies were made with interferon alpha to investigate synergistic effects, if any, between antiviral compound and interferon alpha 2a. Our data showed that GL exhibited synergistic effect when combined with interferon.Moreover, these results were verified by transiently transfecting the liver cells with HCV 3a core plasmid. The results proved that GL dose dependently inhibit the expression of HCV 3a core gene both at mRNA and protein levels while the GAPDH remained constant. Conclusion: Our results suggest that GL inhibit HCV full length viral particles and HCV core gene expression or function in a dose dependent manner and had synergistic effect with interferon.In future, GL along with interferon will be better option to treat HCV infection.Author: Usman AshfaqMuhammad MasoudZafar NawazSheikh RiazuddinCredits/Source: Journal of Translational Medicine 2011, 9:112

Health officials work to curb Mercer Co. hepatitis
July 18, 2011 · The numbers have apparently been climbing because of intravenous and nasal drug use.
According to health officials, Mercer County, West Virginia now has the most per capita hepatitis B cases in the nation and ranks third for the number of hepatitis C infections.

According to the Centers for Disease control both hepatitus B and C affect the liver, both can be deadly, but there is a vaccine for hepatitis B. This version becomes chronic 10 to 15 percent of the time. On the other hand, there is no vaccine for hepatitis C and it becomes a chronic problem about 85 to 90 percent of the time.
Per capita, Mercer County has the highest number of people living with hepatitis B in the country and the third most for hepatitis C. It’s been that way for at least 3 years and Mercer County Public Health Nurse Judy Bolton says the numbers continue to climb.

“People can be infected with B or C and be very very ill,” Bolton said, “or they can be infected with B or C and not have any symptoms at all and they don’t even find out till its years later and maybe it has turned into a chronic condition by that time.”

Bolton says she’s seeing more and more intravenous drug users in the area.

Corporal Alan P. Christian with the West Virginia State Police says most users that ‘shoot up’ in Mercer County are abusing dilaudid, a pain killer that comes in the form of a small pill.

“They’ll hand one needle forever ya know,” Christian said. “I’ve taken them off people and they’re crusty and stuff all over them and then they’re injecting theirselves and then passing it to their friends.”

“That’s where a lot of the problems that we have are coming from. I’ve seen a lot of cities passing out clean needles. I don’t know if we’ve come to that yet I hope not but I don’t know what the answer is.”

Mercer Street in Princeton has a reputation for being a prostitution hang out. Law enforcement agencies say most of the call girls are working to pay for drug habits. Hepatitis is also a sexually transmitted disease.

“I don’t know what kind of practices these girls are using by I would assume that they’re probably not being real safe,” he said.

“A lot of times it’s older gentleman that are going down to pick these girls up because they’re lonely their wives have passed on things of that nature and I’ve talked to few guys and that’s what they target are the older gentleman.”

Nurse Judy Bolton points out it’s not just intravenous drug users spreading this sometimes deadly illness.

“People think that snorting drugs if they don’t use drugs IV they are safe from blood born pathogens which hepatitis B and C is considered a blood born pathogens, however it only takes a microscopic amount of blood to transmit B or C they are very strong viruses.”

Bolton says many patients are shocked to find out they contracted the disease by snorting drugs.
Corporal Christian says abusing drugs nasally is common.

“Police officers have subjects tilt their head back and that’s a way of checking to see if their nose is packed you
know with powder and things of that nature. And unfortunately the IV drug use and snorting is probably running 50/50 I would say. And those that are snorting just haven’t bumped up to intravenous drug use. They are well on their way.”

Bolton says some people older than 18 are especially vulnerable since 20 years ago babies and children were not vaccinated for hepatitis C.
But, she says, it’s mostly a matter of personal responsibility.
“If they avoid risky behaviors whatsoever, we’re talking about snorting or IV drug use if they have a monogamas sexual partner and they don’t have multiple sexual partners then they are not at risk anymore and will greatly reduce the risk of contracting the virus.
The public health nurse says everyone should ask their health care provider about getting the hep B vaccine.

Heartbreak plea by wife in search for liver donor
Full story
A wife has made a tearful plea for those with blood types B or O - and under the age of 50 - to come forward on a life-saving liver transplant mission.


Novel In-Vitro Enhancement Enables Accelerated HIV Pre-Seroconversion Confirmed Diagnoses MARTube cuts false recent classifications, shows potential for use in incidence estimates. Unique new epidemiological tools aim to differentiate between recent and long-term HIV infections and measure incidence that can assist public health efforts
– SMART Biotech7/18/2011 9:00 AM EDT

IAS: 'Watershed' Moment for Fight Against HIV/AIDS 29 minutes ago ROME -- The battle against HIV and AIDS is at a "scientific watershed" and the world must now find ways to translate research into victory over the virus, the president of the International AIDS Society said at the association's 2011 conference.

Albert Einstein College of Medicine
Newly developed fluorescent protein makes internal organs visible July 17, 2011 – (BRONX, NY) – Researchers at Albert Einstein College of Medicine of Yeshiva University have developed the first fluorescent protein that enables scientists to clearly "see" the internal organs of living animals without the need for a scalpel or imaging techniques that can have side effects or increase radiation exposure.

The new probe could prove to be a breakthrough in whole-body imaging – allowing doctors, for example, to noninvasively monitor the growth of tumors in order to assess the effectiveness of anti-cancer therapies. In contrast to other body-scanning techniques, fluorescent-protein imaging does not involve radiation exposure or require the use of contrast agents. The findings are described in the July 17 online edition of Nature Biotechnology.
For the past 20 years, scientists have used a variety of colored fluorescent proteins, derived from jellyfish and corals, to visualize cells and their organelles and molecules. But using fluorescent probes to peer inside live mammals has posed a major challenge. The reason: hemoglobin in an animal's blood effectively absorbs the blue, green, red and other wavelengths used to stimulate standard fluorescent proteins along with any wavelengths emitted by the proteins when they do light up.

To overcome that roadblock, the laboratory of Vladislav Verkhusha, Ph.D., associate professor of anatomy and structural biology at Einstein and the study's senior author, engineered a fluorescent protein from a bacterial phytochrome (the pigment that a species of bacteria uses to detect light). This new phytochrome-based fluorescent protein, dubbed iRFP, both absorbs and emits light in the near-infrared portion of the electromagnetic spectrum– the spectral region in which mammalian tissues are nearly transparent.

The researchers targeted their fluorescent protein to the liver – an organ particularly difficult to visualize because of its high blood content. Adenovirus particles containing the gene for iRFP were injected into mice. Once the viruses and their gene cargoes infected liver cells, the infected cells expressed the gene and produced iRFP protein. The mice were then exposed to near-infrared light and it was possible to visualize the resulting emitted fluorescent light using a whole-body imaging device. Fluorescence of the liver in the infected mice was first detected the second day after infection and reached a peak at day five. (See accompanying images.) Additional experiments showed that the iRFP fluorescent protein was nontoxic.
"Our study found that iRFP was far superior to the other fluorescent proteins that reportedly help in visualizing the livers of live animals," said Grigory Filonov, Ph.D., a postdoctoral fellow in Dr. Verkhusha''''s laboratory at Einstein, and the first author of the Nature Biotechnology paper. "iRFP not only produced a far brighter image, with higher contrast than the other fluorescent proteins, but was also very stable over time. We believe it will significantly broaden the potential uses for noninvasive whole-body imaging."

Dr. Filonov noted that fluorescent-protein imaging involves no radiation risk, which can occur with standard x-rays and computed tomography (CT) scanning. And unlike magnetic resonance imaging (MRI), in which contrasting agents must sometimes be swallowed or injected to make internal body structures more visible, the contrast provided by iRFP is so vibrant that contrasting agents are not needed.
The study, "Bright and stable near-infrared fluorescent protein for in vivo imaging," was published in the July 17 online edition of Nature Biotechnology. Other Einstein researchers involved in the study were Kiryl Piatkevich, Ph.D., Li-Min Ting, Ph.D., Jinghang Zhang, M.D., and Kami Kim, M.D. This research was carried out at the Gruss Lipper Biophotonics Center and supported by grants from the National Institute of General Medicine Sciences of the National Institutes of Health.

Pharma Drops AIDS Discounts In Some Countries Several drugmakers have abandoned discount programs for AIDS drugs in middle-income countries, raising concerns that untold numbers of HIV patients will be denied access to life-saving meds, even as drugs are increasingly made available to the poorest nations, according to a report from Medecins Sans Frontieres, the non-government organization that is also known as Doctors Without Borders

Healthy You

Fend off liver cancer ― a nice coffee may help
2011-07-18 19:04
Coffee has been demonized and blamed for many ailments including heart disease, but evidence has emerged that the drink might actually help prevent liver cancer. A study done in Singapore has found that the more coffee you drink, the more you lower your risk of liver cancer. If you take three or more cups a day, for example, your risk could be up to 44 percent lower than for a total abstainer.
Hot water is poured into a glass of ground Ethiopian coffee. (Bloomberg)But the fine print here is that these findings apply only to Singaporean Chinese, as they come from the first large study on the link between coffee intake and liver cancer in the segment of the local population most susceptible to the disease.
The findings, from the Singapore Chinese Health Study of more than 63,000 ethnic Chinese aged 45 to 74 living here, were recently published in the American journal Cancer Causes and Control.When the participants were recruited for the study, they did not have liver cancer. By 2006, 360 had developed it.

Begun in 1993, the study was carried out by the department of epidemiology and public health in the Yong Loo Lin School of Medicine at the National University of Singapore, in collaboration with researchers from the United States.The research adds to the growing body of evidence debunking the long-held notion that coffee is bad for health. Earlier this year, other researchers had already reported, after studying 3,000 coffee drinkers here, that no detrimental effects had been brought about by the dark brew.Researchers postulate that the liver-protecting properties of coffee come from two of the oils found in the beans: cafestol and kahweol. They are present whether your drink is a designer concoction, a kopitiam brew or a mix out of a three-in-one foil pack.More relevant is how the coffee is made, as some brewing methods could remove the cafestol and kahweol.For example, brews from coffee machines that use paper filters to sieve out the coffee grounds tend to contain negligible amounts of the two oils, possibly because they are absorbed by the paper.Dark roasted coffee, like the kind sold in coffee shops here, is usually prepared by simply boiling coffee powder in a muslin bag. This method seems to preserve the oils, as is the case for other unfiltered brews such as Turkish coffee.

Associate professor Koh Woon Puay, who was involved in the study, said the findings do not mean that people should start gorging on coffee ― they just mean that coffee drinkers can now worry less as they down their brews.She said: “Coffee has often had to fight this bad image, compared with tea, which is often portrayed very positively.”

Indeed, coffee scores higher as far as liver cancer is concerned ― her team, which also studied the effects of drinking green tea, found that it delivered no protection against the disease.Studies similar to this installment of the Singapore Chinese Health Study’s look at the link between liver cancer and coffee have been done in Japan and Italy, and the same conclusions drawn, but the disease is not common in the two countries, so the results were less significant.In the Republic, liver cancer is the fourth most common among men, going by data from the Singapore Cancer Registry. Between 2004 and 2008, as many as 1,758 cases were diagnosed. The illness is also the third most deadly cancer here, contributing to 16.2 per cent of all cancer deaths.According to July 1 figures from the Singapore Liver Cancer Registry, which tracks about 2,300 patients, eight in 10 are men, mostly Chinese. A third of the patients are aged between 61 and 70.Dr. Desmond Wai of the Asian Centre for Liver Diseases and Transplantation said the study should reassure patients who might be thinking of kicking their coffee habit for fear of harming their livers. The liver specialist and gastroenterologist said: “Many can’t believe this convenient, inexpensive habit can protect them from liver cancer.”The findings are likely to alter the approach some doctors take. Dr. Wai explained that many tend to focus on controlling the viruses that lead to liver cancer, such as the hepatitis B virus. ‘They might not realize that other methods can help, such as drinking coffee.’Still, moderation is vital. Dr. Wai said over-consumption of caffeine could trigger heart palpitations, insomnia, headaches or even panic attacks. He recommends no more than three cups a day.Researchers involved in the Singapore Chinese Health Study also looked at whether drinking coffee could protect against colorectal cancer, the No.1 cancer here.The results, published separately last year, suggested that coffee could lower the risk of advanced colon cancer, but only among smokers. Koh said more studies were needed.In 2008, it was found that drinking four or more cups of coffee a day might lower the risk of diabetes by 30 percent.By Poon Chian Hui (The Straits Times)

'Love your body' to lose weight
Almost a quarter of men and women in England and over a third of adults in America are obese. Obesity increases the risk of diabetes and heart disease and can significantly shorten a person's life expectancy. New research published by BioMed Central's open access journal International Journal of Behavioral Nutrition and Physical Activity shows that improving body image can enhance the effectiveness of weight loss programs based on diet and exercise.
Researchers from the Technical University of Lisbon and Bangor University enrolled overweight and obese women on a year-long weight loss program. Half the women were given general health information about good nutrition, stress management, and the importance of looking after yourself. The other half attended 30 weekly group sessions (the intervention plan) where issues such as exercise, emotional eating, improving body image and the recognition of, and how to overcome, personal barriers to weight loss and lapses from the diet were discussed.
On the behavioral intervention plan women found that the way they thought about their body improved and that concerns about body shape and size were reduced. Compared to the control group they were better able to self-regulate their eating and they lost much more weight, losing on average 7% of their starting weight compared to less than 2% for the control group.
Dr Teixeira from Technical University of Lisbon, who led the research, said, "Body image problems are very common amongst overweight and obese people, often leading to comfort eating and more rigid eating patterns, and are obstacles to losing weight. Our results showed a strong correlation between improvements in body image, especially in reducing anxiety about other peoples' opinions, and positive changes in eating behavior. From this we believe that learning to relate to your body in healthier ways is an important aspect of maintaining weight loss and should be addressed in every weight control program."
Notes to Editors
1. Body image change and improved eating self-regulation in a weight management intervention in women Eliana V Carraca, Marlene N Silva, David Markland, Paulo N Vieira, Claudia S Minderico, Luis B Sardinha and Pedro J Teixeira International Journal of Behavioral Nutrition and Physical Activity (in press)
Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BioMed Central's open access policy.
Article citation and URL available on request at on the day of publication.
2. International Journal of Behavioral Nutrition and Physical Activity (IJBNPA) is an open access, peer-reviewed online journal devoted to furthering the understanding of the behavioral aspects of diet and physical activity.
3. BioMed Central ( is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector.

New Cancers in the Family May Merit Extra Screening
Frederik Joelving (Reuters, July 13, 2011)"Keeping your doctor up-to-date on cancers in your family could put you on the fast track to screening tests, according to a study that takes a new stab at personalizing preventive medicine…Having a close relative with cancer often puts people at increased risk of developing the disease themselves. That's why groups such as the American Cancer Society (ACS) have tailored their screening advice according to people's family histories…But those recommendations are not universally accepted, and some researchers say there is little conclusive knowledge about the relative harms and benefits from more-intensive screening. Widely acknowledged downsides of screening include false alarms that lead to painful, expensive diagnostic procedures, as well as detection of relatively harmless pre-cancerous cells."

Off The Cuff

Texas: Docs May Be Able to Get Their Degrees Much Faster Todd Ackerman(Houston Chronicle, July 12, 2011)"Aspiring doctors will be able to shave at least a year off their education under a new University of Texas initiative to reform the curriculum, increase the physician pipeline and cut costs…A medical education is the longest and most expensive of any profession. After four years in college, students spend four years in medical school, then anywhere from three to seven more in residency training in their chosen specialization. For medical school alone, students’ average debt is $160,000. The time and cost is considered a factor in a physician shortfall projected to leave the United States in need of 150,000 additional doctors in the next 15 years. Among the country’s most populous states, Texas already ranks last in the ratio of doctors to population."

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