Sunday, August 21, 2011

Hepatitis Ticker; Monday Morning Updates

Aug-22/Health Canada Okays INCIVEK For People With Hepatitis C
Vertex Pharmaceuticals Inc.(VRTX: News ) Monday said Health Canada has approved INCIVEK, or telaprevir, tablets for people with genotype 1 chronic hepatitis C with compensated liver disease, including cirrhosis.....

Related;Health Canada Clears Victrelis-Boceprevir New Hepatitis C Drug

Turner to announce bill after Dayton VA scandel
By Ben Sutherly, Staff Writer 9:37 PM Sunday,
August 21, 2011
DAYTON — U.S. Rep. Mike Turner today will announce federal legislation that would let the government fine and imprison for up to one year Veterans Health Administration employees who intentionally fail to follow infection control practices.
Turner, R-Centerville, is introducing the bill in part as a result of revelations early this year that at least 535 veterans were put at risk by alleged poor infection control practices at the Dayton VA Medical Center’s dental clinic.

The dentist at the heart of the scandal, Dr. Dwight Pemberton, was reassigned after whistleblowers came forward in July 2010. Pemberton, 81, retired in February, before the VA took disciplinary action against him.

Pemberton has denied allegations he failed to change gloves and sterilize equipment between patients. He has voluntarily retired his Ohio dental license.
After the whistleblowers came forward, the Dayton VA closed the dental clinic for three weeks and offered testing for hepatitis B, hepatitis C and HIV to 535 veterans who had received invasive dental work from Pemberton since 1992.
The Dayton VA has said three positive cases — two for hepatitis B and one for hepatitis C — may be linked to the dental clinic.... Read More

Of Interest

Chronic fatigue syndrome: understanding a complex illness
Source: Nature Reviews Neuroscience
Stephen T. Holgate1, Anthony L. Komaroff2, Dennis Mangan3 & Simon Wessely4
About the authors

Chronic fatigue syndrome (CFS) is a debilitating illness that affects many people. It has been marred by controversy, from initial scepticism in the medical community about the existence of the condition itself to continuing disagreements — mainly between some patient advocacy groups on one side, and researchers and physicians on the other — about the name for the illness, its aetiology, its pathophysiology and the effectiveness of the few currently available treatments. The role of the CNS in the disease is central in many of these discussions. Nature Reviews Neuroscience asked four scientists involved in CFS research about their views on the condition, its causes and the future of research aimed at improving our understanding of this chronic illness.

Why do we not know what causes CFS and why is the field so polarized?

Stephen Holgate. For years the medical profession did not acknowledge chronic fatigue syndrome (CFS) as a 'real' condition. The situation became confused when the term myalgic encephalopathy (ME) was introduced and linked to CFS, with many preferring ME because it implied (rightly or wrongly) a concept of mechanisms. In 2002, a Lancet commentary noted, “The fact that both names for the illness were used symbolizes respect for different viewpoints while acknowledging the continuing lack of consensus on a universally acceptable name.” This confusion has been further compounded by major disagreements over the prevalence and pathophysiology of the illness, let alone the extraordinary range of available treatments, only a few of which have any evidence base. As a result, medical practitioners still view the diagnosis of CFS with great uncertainty and sometimes with outright denial. It is this view that creates a particularly polarized debate with — and sometimes an angry response from — patients. The division is especially great between patient groups and healthcare professionals who think that the syndrome has only psychological and psychosocial causes. This division is a main reason for patients receiving poor healthcare and for the erosion of patient–medical practitioner trust.

Anthony L. Komaroff. We do not know the cause of CFS for the same reason that we do not know the cause of many neurologic diseases: we have not yet been clever enough to figure it out. If the word 'polarized' means that opinions will remain unchanged regardless of the evidence, I would like to think that this is not the case. And I am not sure that the CFS field is more polarized than other fields. The reception that the prion hypothesis (which states that a prion is a protein that can replicate without the use of nucleic acid) received for more than a decade comes to mind. So, too, does the current debate over the possible aetiologic role of Epstein–Barr virus in multiple sclerosis.
CFS is controversial because the case definitions (that is, how the illness being .....
Read More @ Nature
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HCV Awareness

Step up to the plate against Hepatitis C
St. Louis (KSDK) - The Cardinals are stepping up to the plate against Hepatitis C.
Starting Monday, August 22, fans will be able to get free Hepatitis C screenings at Busch Stadium.
It's part of a nationwide effort by Major League Baseball to bring attention to the causes and treatment of Hepatitis C.

Facts about Hepatitis C
Approximately 3.2 million Americans have chronic hepatitis C virus.
While rates of new infection for chronic hepatitis C are dropping, the number of people with existing infection who are starting to develop serious complications, such as advanced liver disease and liver cancer, is expected to increase over the next 10 to 20 years.
As a result, there is a growing urgency for increased awareness and education to ensure people with HCV infection are diagnosed and seek the care of a physician.

Healthy You

Love Your Liver

By: Robert Scheinman August 21, 2011
Categories: Blood Sugar Control, Science

It’s been over 40 years now but I can still remember the plaintive cry of my father,” How can this be?!!? I ate nothing today. NOTHING!!!” He was talking about his blood sugar, of course. His diagnosis with type 2 diabetes was old news by that time and he did what his doctors told him: watch what you eat and measure your blood sugar regularly. An extensive clinical study (called the Diabetes Control and Complications Trial) which spanned 10 years and followed thousands of patients, demonstrated conclusively that high blood glucose is the major factor determining the likelihood of complications. Of course, it is the complications that destroy our health. Blood glucose acts like rust, eating away at body parts in characteristic ways. Clearly, then, it follows that if a patient keeps his or her blood glucose levels low, the chances of developing life destroying diabetes complications is vastly reduced. Indeed, one way to control blood glucose is to watch that you eat. Foods high in sugar are going to put lots of glucose in the blood. Even with insulin injections, the ability to get that glucose absorbed quickly is impaired in diabetic patients as compared to healthy individuals.

This is only the beginning of the story, however. To really understand the non-dietary sources of glucose we need to consider the ebb and flow of metabolism. Specifically we need to consider energy storage and release. The most famous molecule in metabolism is adenosine triphosphate (ATP). You’ll even find it advertised in sports energy drinks. The energy of ATP is found in the chemical bonds linking phosphorous and oxygen (phosphate = PO4). ATP is made in the mitochondria, of which, there are several thousand per cell. Glucose is easily converted to ATP, hence our ability to perk up when we cat a candy bar. Besides glucose, other molecules can serve as energy sources; particularly fatty acids and amino acids. These molecules also feed into the ATP generation machine – just not as quickly or directly. It is quite easy to envision our access to these fuels right after we eat. They are right there in the blood and each cell eagerly grabs what passes by. Several hours later things are a bit different.

There are still some glucose, fatty acid, and amino acid molecules in the blood but if you could map their source you would find that they did not come from your last meal. They came out of storage. Combine 3 fatty acids and you get a molecule of fat. We all know where our fat is stored (and work hard to hide it). Actually, fat is the king of energy storage as far as biological materials are concerned. It carries the most energy per mass of the various food stuffs. For us, with food within easy reach all the time, it is our bane. For the hunter who does not know where (or when) comes the next meal, fat keeps things going. Fat is stored in a specific kind of cell called an adipocyte. If you string sugar molecules together you get carbohydrates. These are found in most cells throughout the body as they provide glucose to burn as needed to make ATP. Carbohydrates can also be used for structural purposes. Cellulose (cellulite) is one example. When you string amino acids together you make proteins and, as we know, proteins are the machines that make everything work. They are the gene products – our genetic selves made manifest – if you want to get philosophical about it. They are also food storage. Biology can be so ironic sometimes. While all cells have proteins, the major cell type used as a source of protein for food is muscle tissue. So, to reiterate; fat is stored as fat, carbs are everywhere, and proteins are stored as muscle mass.

Enter insulin and glucagon.
Insulin orchestrates the storage of nutrients; fatty acids into fats, sugar into carbs, amino acids into proteins. It does so through a complicated set of signals initiated by the activation of the insulin receptor. I tell my students that insulin is the hormone of plenty. Glucagon serves the opposite function and so we think of it as the hormone of fasting. It orchestrates the release of nutrients. Enzymes which chew up carbohydrates to liberate sugars are activated as are similar enzymes in fat and muscle. The muscle story is a bit more complicated though and is integral to our story. Muscle is a bit too busy lifting heavy objects to be bothered with making glucose from amino acids. Instead, it contracts out the job to another body part. The organ that specializes in making glucose from amino acids is the liver. The process has to have a fancy name, of course, so we call it gluconeogenesis. This is the source of glucose in the blood during that time in between meals.

Let’s apply these concepts to the diabetic state. A critical feature of type 2 diabetes is insulin resistance. A good way to think about insulin resistance is to imagine that your satellite TV dish got turned a few degrees by a strong wind. You still get a signal but it is weak and your shows are full of static. If someone massively boosted the signal output from the satellite you might get better reception but the chances are that it will not be perfect. In the same fashion, something has happened to the insulin receptor signal detection process such that we need to put in a massive amount of signal (insulin) to get something that approaches a correct response. We are actually beginning to learn what happens to the receptor to create insulin resistance but that is a topic for another post. Instead, I want to focus here on the interplay between insulin and glucagon. The major stimulus of glucagon secretion is blood glucose BUT…..insulin is required for the alpha cells of the pancreas to detect that glucose. If the insulin signal is degraded, as is the case for the state of insulin resistance, then the alpha cells cannot tell that there is plenty of blood glucose present. They are perpetually sensing the fasting state and so they are perpetually secreting glucagon. Glucagon travels to the liver and initiates gluconeogenesis – pumping out sugar by the bucket loads.

The reason for my father’s frustration is now clear. The sugar he found in his urine (this was long before digital glucometers) came from muscle proteins via the liver. Besides the glucagon there is a second reason why the liver is the problem child for diabetic patients. When insulin is secreted from the pancreas it does not go into the blood stream proper. Instead, it goes into a special blood stream delivery system called a portal system.

Where is it delivered? Straight to the liver.

The concentration of insulin in the liver during is about twice that of the rest of the body under normal circumstances. Contrast this with the mode of insulin delivery for diabetes. It slowly enters the bloodstream via capillaries in the abdomen and immediately goes systemic. Here the concentration of insulin is more or less equal throughout the body. To fully control gluconeogenesis we have to overdose other parts of the body and risk hypoglycemia. The diabetic patient is between a rock and a hard place. We need to find new ways to target the liver if we are to truly recapitulate therapeutically what the healthy pancreas does.

Name that organ.....the liver loving truth!
17 August 2011 8:12 AM Pat Ferguson

Name that organ.....the liver loving truth!
What’s (almost) the size of a football, weights 2-3 lbs and considered the most vital organ in our body? Which organ in our body seems to get the least amount of respect until the day we realize why we need it so badly? Answer to both questions: The liver. Suspended behind the ribs in the upper right side of the abdomen, the liver almost spans the entire width of our body. Amongst other things, the liver filters, stores and links our body’s digestive and circulatory processes enabling us to live.

There are hundreds upon hundreds of functions performed by the liver that aid in the overall performance of other vital organs and tissues inside our body. Just to name a few of the liver’s functions and processes, the below are provided:

Digestion: As soon as we eat something, the gallbladder releases stored bile (produced by the liver with the excess stored in the gallbladder) into small bile ducts found in our liver, aiding digestion and transporting fat.

Detoxification: Through the performance of enzymatic reactions (oxidation, reduction, hydrolysis), the liver “filters” chemicals in our blood via the hepatic portal venous system making such chemicals less bio-active in order that they might pass through our intestines.

Regulation: The metabolism is regulated through the liver, resulting in the “anabolism” (storing for future use or supporting growth of new cells/tissues in the body) and “catabolism” (cells breaking down larger molecules to release energy to fuel the anabolism process) functions vital to our overall wellbeing. Without regulation, we would not receive the fuel our body needs to function, stay warm and support the continuous cycle of growth and renewal.

Assimilation and storage: Vitamins A, D, K and E are fat soluble vitamins converted through assimilation, stored for future use (A, D, K) or distributed (E) through the body’s fatty tissues. Production: Hormones and proteins are produced through the liver, aiding in our body’s ability to naturally heal itself and grow.

Amazingly, the liver is able to miraculously regenerate itself up to 75% after a loss from injury or surgery, restoring back to normal size within a few short months. The liver has a natural back-up plan through possessing two lobes which act independently of one another. In the event one lobe fails, another is in place to help assist the liver in its functioning. Even though the liver can do a lot by itself, we can’t abuse it.

Remember: Whatever we consume (food, beverage, drugs, medicine, etc.) affects the performance of our liver. Abusing alcohol, food and drugs only adds stress to the liver, eventually affecting its ability to perform.

Most common liver related diseases include: Hepatitis (A, B, C): Hepatitis is the inflammation of our liver, typically caused by virus, alcohol, drugs and/or blood exchange. Hepatitis A commonly occurs through poor food sanitation and hygiene. Hepatitis B typically occurs through the exchange of blood while Hepatitis C is often found in the exchange of blood or IV drug use and is thought to be able to go undetected for 15-20 years, causing cirrhosis or liver cancer.

Cirrhosis: Alcohol abuse overwhelms the liver’s ability to function properly. Alcohol is a form of concentrated sugar which can overwhelm the liver when consumed in excessive and continuous amounts. Without rest, the liver cannot recover from the concentrated sugar which causes fat to be deposited in the liver eventually leading to cirrhosis and/or hepatitis, usually damaging the liver beyond repair.

Common symptoms of liver disease/failure: Emotional: Depression, anxiety, anger and frustration Physical: Lumps in the neck/breast, ringing in the ears, eye problems, red/flushed face, warm palms and soles, vertigo, tremors, convulsions, etc.
There too many symptoms/signs of liver disease/illness to list in this blog.
For a more comprehensive list visit the following resources on the web and see your doctor immediately should you suspect a problem with your liver function properly -> <

You absolutely must tell your doctor everything, from how much alcohol you’re consuming, to what drugs, food, hygiene habits, and any contact with blood you’ve had in order for you to receive the proper diagnosis and treatment. Although early detection is possible, it’s not always conclusive at the onset of liver disease/illness.

The best method to practice is wellness in your diet and exercise program. A certified dietician and/or licensed nutritionist are also great resources for advice on receiving the proper nutrients in your daily diet/nutritional consumption.

Quick Tip for Wellness:
The overall affects of abuse through poor choices (diet, drugs and alcohol) have long term effects. Never exchange your wellness for temporary pleasure.

Quick Tips for Wellness, Pat Ferguson, Copyright © 2011, All Rights Reserved
The information provided in this blog is not given as medical advice or provided by a medical professional, but simply as basic information to help you better understand wellness and to encourage you to take your personal wellness seriously.

Red Meat Increases Risk of Liver Cancer
When we think of a healthy diet, it usually includes a very moderate consumption of red meat. There may be another reason to avoid red meat all together. According to a study by the National Cancer Institute, red meat may now be linked to hepatocellular carcinoma (HCC) or liver cancer.

Liver cancer is the third most cause of mortality worldwide and the sixth most common cancer. Damage to the liver leading to chronic liver disease increases the risk for liver cancer. There are several risk factors such as exposure to aflatoxins, excessive alcohol consumption, infection with hepatitis B virus, and now red meat intake which have been found to cause injury to the liver, chronic liver disease and liver cancer. In this study the researchers looked at red meat, white meat, and saturated fat consumption of men and women aged 50 to 71.

A positive association was found to link liver cancer, red meat and saturated fat intake whereas an inverse association was found in those who consumed more white meat. There are three potential theories to this association. First, red meat is a source of saturated fatty acids which are deposited in the liver and lead to chronic liver disease. Second, red meat is a good source of iron. Eating large amounts of red meat causes iron overload and the excess iron is deposited in the liver leading to chronic liver disease. Finally, red meat tends to be cooked at high temperatures and compounds with carcinogenic properties are formed.

The study did not discuss the recommendations of red meat intake to avoid increasing the risk of chronic liver disease and liver cancer. A good rule of thumb is to fill half of your plate with fruit and vegetables, a quarter with whole grain starch and a quarter with lean meats such as fish, poultry and vegetable-based proteins. As with many tasty indulgences, red meats should be consumed sparingly and in moderation.... Read The Supporting Research

Off The Cuff

Pruritus – When Should You See Your Doctor?
Pruritus is one of the most common problems seen in the office and is one of the most frustrating for patients because much of the time physicians simply treat the symptoms and expect that the pruritus will resolve. Pruritus is the medical term for itching. Few symptoms are more annoying than pruritus and when patients…Read More

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