Wednesday, September 7, 2011

HCV News Ticker;Hepatitis C treatment gets personal: predicting drug response

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Dramatic Changes in Hepatitis C Treatment Expected to Continue
Benefits of Almonds for Individuals with Type 2 Diabetes

Today's Updates

Hepatitis C treatment gets personal: predicting drug response
Wednesday Sep 07, 2011
Around 3% of the world’s population is infected with hepatitis C virus (HCV), which affects the liver. The current standard-of-care therapy is not effective in the majority of genotype 1 viral cases and more serious, chronic diseases of the liver can result. Recently published in Genome Medicine, David Booth and colleagues from the Universities of Sydney and Melbourne use a powerful sequencing approach to identify DNA variants that can predict failure to respond to hepatitis C therapy. Their findings could help to optimize treatment options for many hepatitis C patients.

The recommended treatment for HCV infection is a 48-week course of pegylated interferon alpha and ribavirin, which clears the infection in less than 50% of genotype 1 cases. Over the past few years, researchers have performed genome-wide association studies (GWAS) to identify genetic factors underlying the lack of viral clearance in most patients. These analyses revealed that single nucleotide changes, or polymorphisms, in the IL28B gene region can predict non-response to treatment. In their latest study, David Booth and colleagues used a high-throughput “massively parallel sequencing” approach to identify new, highly sensitive genetic predictors of drug response. DNA samples from responders or non-responders were pooled, so that many patients could be screened simultaneously and cost-effectively for common mutations. Compared with previous results, the genetic variants identified through this analysis were shown to predict failure to respond with high sensitivity and specificity.

By predicting which patients are unlikely to respond to the standard treatment, clinicians would be able to make an informed choice about which patients should be offered newly emerging therapies. These results therefore hold great promise for the clinical management of hepatitis C.

Long-Term Viral Negativity After Interferon for Chronic Hepatitis C Virus Infection in Hemodialysis
Author: Gordon, C. E., Uhlig, K., Schmid, C. H., Levey, A. S., Wong, J. B.Publication: Clinical Journal of the American Society of NephrologyVolume: 6, Issue: 9, Pages: 2226 to 2234 Date: Wednesday, September 07, 2011

Background and objectives
Interferon (IFN) and pegylated-IFN treatment of hepatitis C virus (HCV) infection in hemodialysis patients result in sustained virological response (SVR) rates of 45% and 37%, respectively. Although most nonhemodialysis patients who achieve SVR remain persistently viral negative, the durability of SVR in hemodialysis patients is unknown. We analyzed the rate of long-term virological negativity in hemodialysis patients who achieved SVR after IFN or pegylated-IFN through analysis of patient-level data.

Design, setting, participants, & measurements
After performing a systematic literature review for IFN-based treatment of hemodialysis patients with chronic HCV infection, we extracted patient-level data on patients who achieved SVR. We performed life table analysis to estimate long-term virological negativity rates after SVR in patients who continued on hemodialysis or subsequently underwent kidney transplantation.

Long-term HCV RNA outcomes following SVR were available for 121 hemodialysis patients (20 studies) and 45 patients who subsequently underwent transplantation (11 studies). The probability of remaining HCV RNA negative was 86% (95% confidence interval, 77% to 96%) for patients followed on hemodialysis 48 months after SVR and 95% (95% confidence interval, 89% to 100%) for kidney recipients followed 48 months after transplant.

Viral negativity from IFN-based HCV treatment in hemodialysis patient appears durable during extended follow-up, including after kidney transplantation. The certainty of the viral negativity estimate is limited by the small number with follow-up beyond 48 months or longer. Transplantation does not confer an increased risk of relapse. Future research should investigate whether IFN-based treatment improves clinical outcomes for hemodialysis patients.

Education by a nurse increases response to hepatitis C to therapy
September's issue of Clinical Gastroenterology & Hepatology investigates the influence of education by a nurse on response to hepatitis C to therapy.

Education of patients with chronic hepatitis C has been proposed to increase response to therapy with peginterferon and ribavirin.

Dr Dominique Larrey and colleagues performed a prospective study to determine the effects of systematic consultation by a nurse on patient adherence and the efficacy of therapy.
The researchers analyzed data from 244 patients who received either systematic consultation after each medical visit from a nurse who used a standard evaluation grid and provided information about the disease and treatment or the conventional clinical follow-up procedure.
Treatment lasted 24 to 48 weeks.

A prognostic factor for a sustained virologic response was virologic response at week 12
Clinical Gastroenterology & Hepatology

Characteristics of each group were similar at baseline, including prior treatment.
Overall, the team found that GrA had significantly better adherence to treatment than GrB, especially among patients who received 48 weeks of treatment.
The research team found that significantly more patients in GrA had a sustained virologic response, compared with GrB overall, as well as treatment-naive patients, and those with genotypes 1, 4, or 5 infections.

There were no differences between GrA and GrB in response of patients with genotypes 2 or 3 infections or advanced fibrosis.
The research team observed that prognostic factors for a sustained virologic response were virologic response at week 12, genotypes 2 or 3, therapeutic education, and lack of previous treatment.

Dr Larrey's team commented, "Therapeutic education by a specialized nurse increases the response of patients with hepatitis C to therapy, particularly in difficult-to-treat patients."
Clin Gastroenterol Hepatol 2011: 9(9): 781-785
07 September 2011

Occult Hepatitis B Infection May Be the Cause of Unexplained Liver Cancer
Published on Tuesday, 06 September 2011 00:00
Written by Liz Highleyman
Hepatitis B virus (HBV) infection may cause more cases of hepatocellular carcinoma (HCC) than estimated if occult or "hidden" HBV is taken into account, according to a study described in the September 2, 2011, issue of Hepatology....
Continue reading...

How to Prepare for Medical Bills
My husband needs a liver transplant within the next two years, because he has Hepatitis C. We make about $70,000 a year, but we have $25,000 in debt.


Seventeen year old forcibly pierces navel of 13 year old during school lunch
Patricia Walston Atlanta News
You Can Use Examiner September 5, 2011 -
Apparently, seventeen year old Christian Tucker, who is a student at Fayette County High School in Fayetteville, has been doing body piercing on other students during breaks at school. Fayette County High School is one of five high schools in Fayette County which is just south of Atlanta. Parents are urged to talk with their children about the dangers of body piercing in general; and especially by an untrained practitioner in unsanitary conditions.
This could present a high risk of infection and/or serious injury.

The CDC in Atlanta reports: “Tattoo artists and body piercers should follow health and safety practices to protect themselves as well as their clients from bloodborne pathogens such as hepatitis B, hepatitis C, and/or human immunodeficiency virus (HIV).”

A thirteen year old female student (name withheld) was game for having her naval pierced; but then changed her mind. With the assistance of two other students (who were holding her down), Tucker then proceeded with the piercing. Tucker was arrested on the scene; and the two other students were charged later. Tucker is being charged with battery, disruption of public school, and piercing the body of a person under the age of 18. The school’s administrator responded when notified; and saw the attack first hand. Detective Mike Whitlow was the reporting officer. It was later discovered that the 13 year old had witnessed the piercing of another student (who was 18) earlier in the day in the school’s bathroom; and apparently had changed her mind. It is not known at this time if Tucker charged students for piercings.

Source: Fayette Citizen reporter Ben Nelms:

Parents are urged to talk with their children about the dangers of body piercing in general; and especially by an untrained practitioner and in unsanitary conditions. Even when piercings are performed by professionals, there is still a high risk of infections; and certainly should never be done in a bacteria laden high school bathroom.

Viruses, germs, and bacteria that can cause infections
• Tuberculosis
• Hepatitis B
• Hepatitis C
• HIV and AIDS

While this mother and grandmother does not endorse or advocate body piercing, students are apt to act impulsively in “following the crowd.” Students should discuss this with their parents to obtain their permission; and also to insure that there is little risk as possible. Many times kids just want to do what other students are doing without forethought of such actions.

FDA: “Think before you Ink!” Are Tattoos Safe?
Parents need to be informed and educated about such matters and speak frankly and openly with their children about making decisions like body piercing or tattoos – helping their child to understand that these are permanent and can present serious health hazards. This old adage certainly applies here? “Act in haste, and repent in leisure!”
Parents and students should at least make sure that the CDC guidelines are adhered to:

Stem Cells

For the first time researchers of the Colorectal Cancer Lab at the Institute for Research and Biomedicine (IRB Barcelona) identified and managed to grow human colon stem cells in a lab-plate. The research, published in Nature Medicine is a major important advancement for regenerative medicine.

Scientists identify new drug target to stimulate growth of insulin-producing cells
JDRF-funded researchers in collaboration with the pharmaceutical company Hoffmann-La Roche…

Healthy You

The liver is the primary organ responsible for filtering the blood for the processing and removal of toxins. When the liver is healthy, toxins are more readily released from your body in the form of sweat, urine, and excrement, via the liver’s metabolic functions.There are yoga poses that massage and stimulate the liver by flushing it with fresh blood and oxygen, in an effort to support its task as the body’s housekeeper. The following is an explanation of how and why certain poses help liver function.

Yoga Is Put To The Test As A Modern Treatment For Psychiatric Disorders
Yoga is commonly seen as a practice beneficial to body and mind. Increasingly, yoga is being taken a step further and applied as a form of complementary and alternative medicine in treating psychiatric disorders...

Brain Exercise: What to Keep in Mind
As we grow older, we all worry about having “senior moments” that last more than a moment. That’s why brain-training programs have become a big business. Can mental workouts really “improve memory by 10 years” and prevent age-related cognitive decline and even dementia, as the programs claim?
Full Story

UC Berkeley Wellness Letter, October 2011
Ask the Experts October 2011
Q: I know that partially hydrogenated oils are unhealthy. What about “fully hydrogenated” oils?

A:They are not as bad, though more research is needed to better understand their health effects. The two kinds of oil are very different. Food manufacturers hydrogenate liquid vegetable oils to make them more solid and shelf stable. In partial hydrogenation, the resulting fats are semi-solid at room temperature. In full hydrogenation, the oils become completely solid.
The problem with partially hydrogenated oils is that they contain trans fat, which raises LDL (“bad”) cholesterol, lowers HDL (“good”) cholesterol and has other harmful effects.
In contrast, fully hydrogenated oils, in essence, become saturated fats—but they contain no trans fat. And the type of saturated fat typically produced is thought to have no significant effect on cardiovascular risk.

The story doesn’t end there, however. Fully hydrogenated oils are being used as a supposedly healthier replacement for partially hydrogenated oils. But food companies often blend fully hydrogenated oils with liquid vegetable oils and put them through a process called interesterification. This changes the structure of the oil so that it performs like a partially hydrogenated oil without the trans fat. Sounds great, but we don’t yet know whether interesterified fats might have their own adverse health consequences.

Read the ingredients list. If you see “partially hydrogenated oil,” that means some trans fat is present, even if the label says “0” trans fat, which is allowed if a serving contains less than 0.5 grams. Some products, such as Crisco All-Vegetable Shortening, contain both partially and fully hydrogenated oils. If the label just says “hydrogenated” oil, you don’t know if it’s fully or partially hydrogenated. Moreover, you can’t always tell from the label if a fully hydrogenated oil has been interesterified.

All this is more reason to limit or avoid foods that contain any type of hydrogenated oil. These foods—often baked sweets and snack foods—tend not to be healthy choices anyway.

For Your Reading Pleasure

Grand Rounds is the weekly collection of the best in online medical writing. Each week, a doctor, nurse, patient or healthcare professional with a blog will "host" Grand Rounds and compiles links to noteworthy posts about medicine.

This weeks host is Dr. Rich

While Grand Rounds is normally the highlight of everybody’s week here in the medical blogosphere, this time it’s different. This week, we are all – each and every one of us – completely distracted by the most wonderful sense of expectation and joy, to the exclusion of virtually every other human emotion. For DrRich, at least, the feeling puts him in mind of the giddy anticipation he experienced on, say, his 5th Christmas eve, when he was still young enough to consider Santa Claus a magical-but-real agent of earthly delights. (This was before DrRich realized that Santa, being obese, is actually a great menace to society.)
For this, dear reader, is the week when President Obama will turn his considerable powers of intellect, at long last, to the issue of jobs. The President indicated to us more than a month ago that he would, in his own good time, present to us his program for fixing the horrific and prolonged unemployment problem which now affects most American families in some way. And thus realizing that a solution is finally at hand, we in the great unwashed masses have waited, as patiently as we could, through earthquakes, hurricanes, Martha’s Vinyard vacations, and numerous pre-season football games, for the President to tell us the Answer. And, summoning together a Joint Session of Congress – a venue most often reserved for declarations of war and similar life-altering policy initiatives, thus confirming the momentous nature of his coming words – he will finally proclaim to us the Good News, a mere two days from now. One can cut the anticipation with a knife.
So, while it is indeed an honor to be hosting Grand Rounds during this historic week. DrRich must admit to finding it a little difficult to concentrate his efforts. No doubt readers will likewise find it a challenge to turn their attention away from the Big Event long enough to peruse the following posts – the best of the medical blogosphere this week.
But be assured that there is good stuff to follow. So, if you find yourself incapable of focusing your attention on Grand Rounds at the moment, simply bookmark this page, and return to it once your sense of soaring happiness returns (as it inevitably must) to a more normal state. Be assured that this week’s entries are timeless enough to outlive your ecstasy (an emotion which – alas! – to be effective, must always be transient).
So let us begin.

A few submissions, to read all the entries click here

The ACP Hospitalist notes that, according to the Institute for Safe Medication Practices, a “grey market” is developing for life-saving medications that have been in severe short supply for the past few years. A grey market, DrRich thinks, is like a black market, but less illegal – though it is possible they are referring to Old Farts who are merchants. In any case, the ISMP says the grey market is price-gouging hospitals that need those important drugs, and have nowhere else to buy them. The solution, according to the ISMP, is (among other things) to empower the FDA to manage drug shortages and tighten regulations for drug distribution.

The ACP Internist reports a study showing that 80% of today’s doctors look up on-line information in front of their patients. DrRich, who admits to being an Old Fart, does not find this surprising, since young physicians these days are, well, young. And young people are on-line all of the time, reporting their every trivial thought and mundane action instantaneously to the Cloud. (If Andy Warhol were alive today he’d be talking about our 15 minutes of anonymity.) But you don’t have to be a young doctor to take up these new habits.

James Gault, MD, of the blog Retired Doc’s Thoughts, is a long-time champion of classical medical ethics (as opposed to the New Age medical ethics now formally espoused by all the major professional organizations). As such, Dr. Gault often deconstructs arguments being published by modern medical ethicists supporting these New Age ethics, which require doctors to act for the benefit of the collective rather than for the benefit of their individual patients. In this post, Dr. Gault gives a very effective what-for to Professor Fuchs of Stanford, who, once again, has published a paper advancing the bankrupt argument that what’s good for the collective is necessarily good for the individual. These kinds of vapid arguments may fool the Whippersnappers, but they’re not fooling us Old Farts.
Read More....


Unravelling Of NDM-1 Structure Signals Breakthrough In Fight Against Vicious Superbug
Written by Catharine Paddock PhDNews of a significant breakthrough in the fight against drug-resistant infections arrived this week in the form of a paper in the online journal Acta Crystallographica Section F: Structural Biology and Crystallization...

New Drugs Should Be Compared To Current Treatments Before Approval
Written by Grace RattueToday on researchers argue that, before approval, manufactures should have to reveal how their medicine compares to treatments that already exist, in order to make sure that the most effective and safest treatments...

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