HCV Rewind is a weekly post with a look back at this weeks headlines, including today's news with updates as the day progresses. Click here to view previous or future"HCV Weekly Rewind" articles.
Upper GI Bleeding New Guidelines from NICE
This week NICE Published " New Guideline on the Management of Acute Upper GI Bleeding." This clinical guideline offers evidence-based advice on the effective management of upper gastrointestinal bleeding in adults and young people aged 16 years and older, click here to view guidelines.
Stem Cells
Mentioned over at Scope is an article published in Cell Stem Cell by Irving Weissman, MD, a stem cell researcher from Stanford discussing barriers to stem cell research, download PDF here.
Ten-year-old girl gets vein grown from her stem cells
A 10-year-old girl has had a major blood vessel in her body replaced with one grown with her own stem cells, Swedish doctors report. She had poor blood flow between her intestines and liver...Continue reading here...
Interferon-alpha (IFNa) lozenges
Oral natural human interferon-alpha (IFNa) lozenges were studied in a Phase 2 clinical trial in Taiwan. In the trial 169 HCV patients with genotype 1b received oral lozenges containing 500 or 1500 international units (IU) of natural human interferon-alpha (IFNa) or matching placebo for 24 weeks, followed by 24 weeks of untreated observation. Read the press release: HCV: Oral Interferon Found to Reverse Thrombocytopenia; Reduced Relapse Rate Seen in Patients with Mild Fibrosis
Liver Fibrosis
An article on liver biopsy vs non-invasive tests published in Clinical Gastroenterology and Hepatology found that Biopsy has a low level of diagnostic performance for liver fibrosis stages F2 and F1. Read more @ AGA Journals Blog, or here on the blog.
At the Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK researchers studied the possibility of reversion of established liver fibrosis, read more here.
Doctors in Europe and the US have conflicting opinions about the pace of liver fibrosis in HIV-positive men with hepatitis C infection. In a study published in Clinical Infectious Diseases, European investigators showed that the pace of liver fibrosis slowed after the acute phase of infection. However, doctors from the US have published contrasting findings, showing that fibrosis continued to worsen with longer duration of co-infection, continue reading @ aidsmap.com
Transmission of hepatitis C via a clinical setting
The recent outbreak of hepatitis C at Exeter Hospital in NH may have been caused through narcotic tampering by an employee.
A New Hampshire hospital employee, infected with hepatitis c is being blamed for 20 others getting the disease. Hospital officials say they think the employee used their patients' drugs before injecting those patients with the dirty needle.
Public Health Director Dr. José Montero announced six new cases of hepatitis c linked to Exeter Hospital’s Cardiac Catheterization Lab, bringing the total number of cases to 20. The new discoveries are prompting another expansion of the investigation. Exeter Hospital will now have to test patients of the catheter lab dating back to October 2010.
Dr. Montero says the likely cause of the infections is an employee within the hospital using drugs. Dr. Montero is not saying whether that employee has been identified or if the police are involved in the investigation, but he believes his team will find more cases of hep c as the investigation continues.
The New Hampshire Department of Health and Human Services is holding a meeting for the public at 6 p.m. on Friday to answer questions anyone may have about the hepatitis c outbreak. That meeting is held in the Exeter High School auditorium
Continue Reading...
Unfortunately the same drug diversion tactics have played out before in other medical facilities across the US, in particular at three different medical centers where the reuse of contaminated syringes by medical providers caused an outbreak of hepatitis C. In all three outbreaks employees admitted to stealing syringes filled with the narcotic Fentanyl, injecting themselves, then replacing the syringes with saline to be used on future patients. Read a summary of the cases here.
Also See;
June 11 - Students in botched diabetes tests to get HIV results
June 8 - Attorney: Hepatitis C outbreak mishandled by state, Exeter Hospital
June 8 - San Diego lap band surgery centers accused of unsafe procedures that may have spread hepatitis C
May 6 - Pitt dental school accused of negligence, using dirty equipment
Awareness
In a study published in the July–August issue of Public Health Reports, researchers found that 26.7 percent of homeless adults tested and surveyed in downtown Los Angeles' skid row were infected with the hepatitis C virus (HCV) — more than 10 times the 2 percent rate among the general U.S. population. Of those surveyed, 46.1 percent were unaware that they were infected. Four percent of the sample were HIV-positive, read more here.
Liver Transplant
Pregnancy outcomes of liver transplant recipients
The most recent issue of Liver Transplantation reviews pregnancy outcomes of liver transplant recipients.
Approximately 14,000 women of reproductive age are currently living in the United States after liver transplantation, and another 500 undergo liver transplantation each year.
Although liver transplantation improves reproductive function in women with advanced liver disease, the associated pregnancy outcomes and maternal-fetal risks have not been quantified in a broad manner.
Dr Neha Deshpande and colleagues from Maryland, USA obtained more generalizable inferences, and performed a systematic review and meta-analysis of articles that were published between 2000 and 2011 and reported pregnancy-related outcomes for liver transplantation recipients.
The team identified 8 of 578 unique studies that met the inclusion criteria, and these studies represented 450 pregnancies in 306 liver transplantation recipients.
Rates of preterm delivery were higher than the rates for the US general population
Liver Transplantation
The post-liver transplantation live birth rate was higher than the live birth rate for the US general population, but was similar to the post–kidney transplantation live birth rate.
The team found that post-liver transplantation miscarriage rate was lower than the miscarriage rate for the general population but was similar to the post-kidney transplantation miscarriage rate.
The researchers found that rates of pre-eclampsia, cesarean section delivery, and preterm delivery were higher than the rates for the US general population but lower than the post-kidney transplantation rates.
The team observed that both the mean gestational age and the mean birth weight were significantly greater for liver transplantation recipients versus kidney transplant recipients.
Although pregnancy after liver transplantation is feasible, the complication rates are relatively high and should be considered during patient counseling and clinical decision making.
More case and center reports are necessary so that information on post-liver transplantation pregnancy outcomes, and complications can be gathered to improve the clinical management of pregnant liver transplantation recipients.
Dr Deshpande's team commented, "Continued reporting to active registries is highly encouraged at the center level."
Liver Transplant 2012: 18(6): 621–629
15 June 2012
HIV
Category: HIV Treatment
Published on Friday, 15 June 2012 00:00
Written by Liz Highleyman
The full program for the XIX International AIDS Conference (AIDS 2012) was announced this week and is now available online at www.aids2012.org. Abstracts, slides, posters, and webcasts of selected presentations will also added to the website throughout the meeting...Continue reading @ HIV and Hepatitis
The Berlin Patient: The HIV Cure Case Report with a Name
Controversy has been stirring among scientists, activists, and the media during the past week due to developments in the case of the Berlin Patient, Timothy Brown. So far there have been a dozen or more reports that have interpreted new information in a variety of ways. Even expert researchers are not exactly sure what to make of these developments.
The controversy began with a poster and oral presentation of Brown’s case by Steven Yukl from the University of California San Francisco at the International Workshop on HIV & Hepatitis Virus Drug Resistance and Curative Strategies last week in Sitges, Spain. Yukl presented new findings from extensive tests to determine whether HIV eradication has occurred and to define the potential role of various viral reservoir measurements...Continue Reading....
Hepatitis B Linked to More HIV+ Deaths than Hepatitis C, Risk High for People with AIDS
Details Category: HIV/HBV Coinfection
Published on Friday, 15 June 2012
Written by Liz Highleyman
HIV positive men who are coinfected with hepatitis B virus are more likely to die than those with hepatitis C virus coinfection, according to research published in the April 20, 2012, advance online edition of Clinical Infectious Diseases ...Continue reading....
Healthy You
How infection can lead to cancer
One of the biggest risk factors for liver, colon or stomach cancer is chronic inflammation of those organs, often caused by viral or bacterial infections. A new study from MIT offers the most comprehensive look yet at how such infections provoke tissues into becoming cancerous
Continue reading here....
Can Dietary Fish Intake Prevent Liver Cancer? Editorial
Hepatocellular carcinoma (HCC) is a common cancer worldwide, with poor 5-year survival. An estimated 748,300 new cases and 695,900 cancer deaths occur per year, ranking it fifth among cancers for incidence and third among cancers for mortality.1 There is considerable geographic variation in the incidence of HCC. The largest concentration of HCC cases in the world is in Asia, followed by Africa, Europe, and North and South America.2 Chronic hepatitis B (HBV) infection is the most important risk factor for HCC worldwide, especially in Asia. In Asian and African countries, >80% of patients with HCC have underlying chronic HBV infection.3 The 1 exception in Asia is Japan, where the prevalence of HCC has been related to chronic hepatitis C (HCV) infection.4 In Western countries, however, chronic HCV infection has been determined to be present in about 60% of patients with HCC, and is the main etiologic agent leading to HCC,5, 6 with obesity and insulin resistance also thought to be important risk factors. The incidence of HCC is expected to continue to rise in Western countries as the cohort of patients infected with HCV ages, concurrent with the increasing prevalence of obesity and diabetes... Continue Reading...
Blood Pressure: Getting It Right
Source - Berkeley
Getting your blood pressure measured may seem like a straightforward thing, like having your height or weight measured. So when you’re given those two numbers and told that they’re normal or elevated or possibly that you have hypertension, you may think that’s that. If only it were that simple. In fact, recent research suggests that blood pressure readings are often not as accurate as they should be and that as a result many people may be misdiagnosed. Usually the results err in being too high, meaning that some people may be put on medication unnecessarily or given doses that are too high.
The devil’s in the details
Everyone’s blood pressure fluctuates throughout the day—thus evaluating it is like shooting at a moving target. Complex bodily systems (including the heart, arteries, nerves, hormones, and kidneys) regulate and affect blood pressure. It can fluctuate from minute to minute, rising when you’re active, for instance, and typically dropping when you rest or sleep. Just standing up can cause pressure to rise—or fall. Your mental state can affect it, too, with anxiety or stress boosting it temporarily. In some people, blood pressure rises in the doctor’s office because of nervousness—this is called the “white-coat effect.” But many other factors can lead to inaccurate, inconsistent, or misleading blood pressure readings. For instance, did you know that you shouldn’t smoke, exercise, or consume caffeine during the 30 minutes before testing?
• For good measure. There is a standard way to measure blood pressure, described by American Heart Association guidelines. Studies have found that readings done in medical offices and hospital clinics usually differ by at least a few points from those done according to the guidelines. This doesn’t matter if your blood pressure is so high that there’s no doubt you have hypertension, or if your blood pressure is clearly normal. But it could affect your treatment if you’re in the gray area in between.
The guidelines discuss proper cuff size and placement on the arm, as well as arm and body position, all of which can affect results. Ideally, you should wait five minutes in a quiet room before being tested. Neither you nor the practitioner should talk during the test. You should sit on a chair (not on the examination table), with your back supported, feet flat on floor, sleeve rolled up, and forearm supported by the practitioner at your heart level. Crossing your legs, sitting with your back unsupported, or letting your arm hang too low (or holding it up by yourself) can raise blood pressure. Using a cuff that’s too small for a large upper arm will give an erroneously high reading.
• Multiple tests. Two measurements should be done at least one minute apart and the results averaged. Even if this shows that your blood pressure is elevated, that isn’t sufficient to diagnose hypertension, unless the numbers are quite high. In most cases, to confirm that blood pressure is persistently elevated, doctors should measure it at subsequent visits, as well as have patients measure it at home before making any decisions about treatment.
• Two arms? You may be surprised to learn that blood pressure should be measured in both arms, at least at the initial visit, with the second arm tested at least five minutes later. Most practitioners don’t do this. In many people the readings will differ significantly, in which case the numbers should be averaged. (If the difference is big, however, the arm with the higher pressure should always be used.) Moreover, according to a recent analysis in The Lancet that pooled data from 20 studies, a large inter-arm difference (more than 10 points) in systolic pressure is an indication of increased cardiovascular risk. This is especially true in people with hypertension.
• The gold standard. Even when the guidelines are followed, testing done in a doctor’s office or at home may not be accurate enough to diagnose mild hypertension, according a 2011 review article in the journal BMJ, though it can diagnose moderate or severe cases. Thus, if your doctor tells you that you have mild hypertension based on blood pressure measurements done at the office or at home, discuss the advisability of 24-hour “ambulatory” blood pressure testing, if it’s available, before going on medication. You wear a device that automatically measures blood pressure every half hour or so and stores the results. About one in four people with high readings in a clinic will not have a high ambulatory result. If you’re already taking medication for mild hypertension, ask your doctor if it would be a good idea to do a 24-hour test while you’re off your drug.
BOTTOM LINE: There is a right way to measure blood pressure. It’s debatable how much this matters for most people, but if you’re at the high end of prehypertension or low end of hypertension, readings that are off by 5 or 10 points could make the difference between taking a drug or not. Talk to your doctor about your results and ask any questions you may have about how the test is being done. You may want to request a chair to sit in, for instance. If the reading is elevated, make sure you’re retested several times before any treatment decision is made. Ambulatory testing will provide the clearest picture if blood pressure readings are close to the borderline between prehypertension and hypertension.
Blood pressure testing—the basics
Blood pressure is measured with a device called a sphygmomanometer, which typically consists of a bulb, inflatable compression cuff, and gauge or digital readout. The doctor, nurse, or other practitioner wraps the cuff around your upper arm and squeezes the bulb to inflate the cuff. Then the air in the cuff is slowly released, which gradually deflates the cuff and lowers the pressure constricting your arm. Meanwhile, the doctor or nurse listens with a stethoscope, just below the cuff, for sounds from the artery in your arm. Systolic pressure is indicated by the first sound heard through the stethoscope as the cuff deflates; diastolic pressure is the point at which the sound disappears. Many offices now use automated devices.
Normal blood pressure is less than 120/80. You have hypertension when your average systolic pressure (the first number) is 140 or higher and/or your average diastolic pressure (second number) is 90 or higher on at least two separate occasions. If your systolic number falls between 120 and 140 and/or your diastolic number is between 80 and 90, you have prehypertension, which puts you at elevated risk for eventually developing full-blown hypertension.
Issue: July 2012
EAST LANSING, Mich. — Each year, an estimated 4 million Americans experience adverse reactions to prescription medications. Many of these reactions, ranging from mild rashes and drowsiness to hospitalization and death, could be avoided if warning labels were more effective, according to a Michigan State University study.
When patients are handed a new prescription, few read the critical warning labels such as “do not consume alcohol while taking this medication” or “for external use only.” Using eye-tracking technology, MSU researchers found that one source of the labels’ ineffectiveness is an inability to capture patients’ attention.
The study, which appears in the current issue of PLoS ONE, reveals that only 50 percent of participants looked directly at the warning labels, and 22 percent did not look at any. Laura Bix, associate professor in MSU’s School of Packaging, suggests that relatively simple changes could improve the labels’ effectiveness.
“Given our results, we are recommending a complete overhaul of the design and labeling of the ubiquitous amber bottles, which have seen little change since their introduction some 50 years ago,” Bix said. “Our initial recommendations would be to move all of the warnings from the colored stickers to the main, white label, which 100 percent of the participants read, or to reposition the warnings so that they can be seen from this vantage point.”
The impact of this study could be especially beneficial to older patients. On average, more than 30 percent of those 65 and older take 10 different medications daily. Taking multiple medications increases the odds of adverse reactions. This combination is complicated further since older participants were less likely to notice or remember warning labels. Not surprisingly, more people who saw the stickers could recall them better, suggesting that enhancing the labels’ noticeability is a key factor for people remembering the warnings.
The results highlight the importance of how labels influence the attention process, said Mark Becker, assistant professor of cognition and cognitive neuroscience.
“By applying basic research on the control of attention to the design of labels, we may greatly improve their effectiveness,” he said. “This collaboration between the School of Packaging and the Department of Psychology makes such efforts possible.”
Bix and other MSU researchers have plans to continue testing the effectiveness of new and existing prescription packaging as well as reviewing prescription drug leaflets, currently under regulatory debate.
Part of Bix’s research is funded by MSU AgBioResearch.
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Michigan State University has been working to advance the common good in uncommon ways for more than 150 years. One of the top research universities in the world, MSU focuses its vast resources on creating solutions to some of the world’s most pressing challenges, while providing life-changing opportunities to a diverse and inclusive academic community through more than 200 programs of study in 17 degree-granting colleges.
Source
CDC Highlights Underuse of Clinical Preventive Services in U.S.
Just half of U.S. adults received clinical preventive services, such as screenings and prescriptions, from 2007 to 2010, according to a CDC study. Published as a supplement to MMWR, the report is intended to provide baseline data on the preventive services available before the Affordable Care Act was passed.
Among the notable findings:
- Less than half of people with ischemic cardiovascular disease were prescribed aspirin or other antiplatelet drugs.
- Less than half of those with hypertension had it under control.
- In the preceding 5 years, only 68% had their cholesterol assessed.
- Over a third of outpatient visits had no record of the patient's tobacco use. Of the patients who screened positive for tobacco use, only 21% received counseling and 8% received prescriptions for cessation medications.
- People without insurance were 10% to 30% less likely to use such preventive services, compared with population averages. The CDC suggests that improving insurance coverage could increase use of these services.
LINK(S):MMWR Supplement (Free)
MMWR Supplement foreword (Free)
MMWR Supplement conclusions (Free)
Published in Physician's First Watch June 15, 2012
Keep Washing Those Hands
The leading cause of gastroenteritis worldwide can survive on fomites for weeks.
Many infectious microbes have become media stars in recent years, but noroviruses remain relatively unknown, even though they cause more diarrheal disease in this country than any other pathogen (and are estimated to cause half of all gastroenteritis outbreaks worldwide.) A small outbreak among members of a girls' soccer team illustrates just how contagious these viruses are.
The index patient, a teenage girl, developed vomiting and diarrhea one night while at an out-of-town hotel for a tournament and, then, went home the next morning without any further contact with the rest of her group. Three days later, seven additional team members became ill. Investigators determined that illness was associated with eating grapes or packaged snacks that had been stored in a reusable grocery bag in the index patient's hotel bathroom. Swabs from the grocery bag (obtained 2 weeks after the outbreak) and all three stool specimens from ill individuals were positive for norovirus of the same genotype.
Comment: An editorialist calls noroviruses "the perfect human pathogens": A tiny dose causes infection, huge quantities of virions are shed in feces and vomit, and infection brings no lasting immunity. This case illustrates how important fomites are in transmission — they can contaminate both hands and food of secondary cases. Further, because norovirus infections can be acquired by ingestion of aerosolized particles, even assiduous handwashing might not have saved this team.
— Abigail Zuger, MD
Published in Journal Watch General Medicine June 14, 2012
Citation(s):
Repp KK and Keene WE. A point-source norovirus outbreak caused by exposure to fomites. J Infect Dis 2012 Jun 1; 205:1639. (http://dx.doi.org/10.1093/infdis/jis250)
- Original article (Subscription may be required)
- Medline abstract (Free)
Hall AJ. Noroviruses: The perfect human pathogens? J Infect Dis 2012 Jun 1; 205:1622. (http://dx.doi.org/10.1093/infdis/jis251)
- Original article (Subscription may be required)
- Medline abstract (Free)
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