Saturday, September 1, 2012

Weekend Reading-Hepatitis C "Living Medical eTextbook"

I hope everyone in the U.S. is having a lovely Labor Day weekend.

Most weekends this blog offers up a few substantial links to relevant HCV information, research or education, click here for previous "Weekend Reading" articles.

A must read this weekend is the article "The Waiting Game" written by Alan Franciscus.


Back in July 2010, I wrote an editorial about whether it was safe to wait for the new HCV protease inhibitor combination therapy. At that time, I was of the opinion that the sooner that people were treated the better. Examining the same issue 2 years later I realize that this time it is not such a black and white issue. The medications (PEG/RBV and HCV protease inhibitor) we were waiting for in 2010 have been approved. However, studies of newer therapies to treat hepatitis C have escalated at a phenomenal rate and there is a very real possibility that the newer therapies could be available within 2 to 3 years. But is it safe to wait? In this article I will explore some of the issues that patients and medical providers should consider before making “the” decision.

The article is available in the September newsletter at HCV Advocate.

More At  HCV Advocate

Medicare Overview
In addition to providing health coverage for persons age 65 and over, the federal Medicare program also covers persons who are collecting disability benefits from Social Security Disability Insurance (SSDI). However, a person collecting SSDI benefits does not become eligible for Medicare until he/she has collected SSDI benefits for 24 months. With the five month waiting period for SSDI benefits to begin, Medicare doesn’t start until 29 months after the Onset Date of the disability as determined by Social Security...continue reading...

Projects In Knowledge

Over at "Projects In Knowledge" readers will find eight chapters of hepatitis C information in the newly updated "Living Medical eTextbook".  Added in August was "Chapter 8-Treating HCV In Special Populations" with "Chapter 9-Predictors Of Response" coming in October, all chapters with links are provided below.

Although, like any site offering continuing medical education (CME), it requires a free quick registration.

Navigating The CME

1- Either log in or register at "Projects In Knowledge".
2-Click on chapter links below, or at the website.  Each link will take readers to the first page of the CME index,  scroll down and click on "launch activity."
3- Pretest-Participant's have the option to skip the pretest and go directly to the CME by clicking - "No thanks, Proceed to the activity" 

Chapters 1 - 8

New-Treating HCV in Special Populations Living Medical eTextbook Chapter 8

Chapter 1
Getting Ready for Direct-Acting Antiviral (DAA) Therapy

Chapter 2
What You Need to Know About the New Direct-Acting Antiviral (DAA) Regimens

Chapter 3
Hematologic Adverse Effects

Chapter 4
Dermatologic Adverse Effects

Chapter 5
Gastrointestinal Adverse Effects

Chapter 6
Neuropsychiatric Adverse Effects

Chapter 7
Understanding Drug-Drug Interactions in This New Triple-Therapy Era

Chapter 8
Treating HCV in Special Population

Coming Soon

Chapter 9 - Predictors Of Response - Release Date Oct 2012

In The News

Telaprevir-based triple therapy in liver transplanted HCV patients: A 12 week pilot study providing safety and efficacy

Following liver transplantation, management of recurrent Hepatitis C virus (HCV) infection still remains a major challenge. In non-transplanted HCV genotype 1 patients the introduction of protease inhibitor based regimens has increased the rate of sustained virological response, significantly.

This pilot study investigated both safety and efficacy data of a telaprevir-based triple therapy in liver transplant HCV patients with special emphasis on drug-drug interactions between immunosuppressants and protease inhibitors.

Gathering week 12 safety and efficacy data in 9 liver transplant HCV patients who have been treated with a combination of telaprevir, pegylated interferon, and ribavirin, in parallel with immunosuppressive drugs such as tacrolimus (n=4), cyclosporine (n=4), or sirolimus (n=1). 7 of the transplanted patients accomplished the 12 week triple therapy.

At week 4, 4 of the patients were found to be HCV RNA negative and importantly 8 at week 12. During the course of the 12 week triple therapy, short-termed measurements of immunosuppressant trough levels required individual dose reductions in all patients (cyclosporine 2.5 fold, sirolimus 7 fold, tacrolimus 22 fold, respectively).

Furthermore, two thirds of patients exhibited hematological side effects requiring ribavirin dose reductions, administration of erythropoietin, or even blood transfusions.

This pilot study provides evidence that telaprevir-based triple therapy is effective within the first 4 to 12 weeks in liver transplant patients suffering from HCV genotype 1 recurrence and also provides evidence that drug-drug interactions between telaprevir and the immunosuppressants can be handled appropriately by close monitoring of trough levels and adequate dosage adjustment.
Liver Transpl, 2012.

Healthy You

Flu may be more contagious than previously thought Flu can spread before symptoms show
“Flu can be spread long before symptoms appear,” according to the Daily Mail. The news reports followed a study aiming to investigate whether someone could pass the flu virus onto others before they themselves have developed... 

It’s Late, Turn Off That Computer!

Twenty years ago there were concerns about electromagnetic radiation from old-fashioned computer monitors, so much so that many experts suggested sitting at least an arm’s length away. That’s no longer an issue with today’s computers. But the LED backlit screens now on most computers, including tablets (such as the iPad and Kindle Fire) and smartphones, as well as many flatscreen TVs, emit something else, albeit of lesser concern: blue light. As people spend more and more hours using these devices, especially at night, the blue light may interfere with their sleep.

Big blue
Exposure to light through the eyes helps regulate the body’s sleep/wake cycle by affecting the pineal gland’s secretion of melatonin. This hormone is produced at night and promotes drowsiness; exposure to light, notably blue light, suppresses it. This is one way sunlight contributes to alertness, and why lack of light at night helps increase sleepiness.

The potential problem is that LED screens produce enough blue light that, when the devices are used close to bedtime, they can greatly reduce melatonin, increase alertness, and thus delay the onset of sleep and reduce deep sleep. And the less sunlight you get during the day, the more sensitive you become to the melatonin-suppressing effects of light at night.

Computer work or games can interfere with sleep simply because they are stimulating. So researchers have compared the effects of doing exciting or boring tasks on LED screens or on old-style screens (as well as on bright LED screens versus darker ones) before bedtime. At least a few small, short studies have found that bright LED screens have the biggest effect on melatonin production, alertness, and/or sleep onset and quality, particularly when stimulating tasks are done on them.

Research on blue light and its effect on sleep (and health in general) is in its infancy. More needs to be done to determine which LED screen variables affect sleep most—for instance, the brightness and size of the screen, your distance from it, when and how long you use it, your sensitivity to blue light, and so on. And, of course, the effects depend greatly on what you’re doing on the computer.

Bottom line:
If you’re having sleep problems and use a device with an LED screen a lot before bedtime, try using it earlier, or at least dim it as much as possible (in a dark room even a dimmed screen appears quite bright). One basic “sleep hygiene” step is to use your bed only for sleep. That means not using your device in bed, especially if you’re very sensitive to blue light. Try to reserve the hours before bedtime for calming, low-key activities, perhaps reading a paper book. There are special amber-tinted eyeglasses that block blue light, but there’s no clinical evidence showing that they improve sleep. You could also try low-dose melatonin at bedtime, but only for occasional use.
Issue: September 2012

In Case You Missed It-

Dr. Paul Sax seeks answers to three questions about the future of hepatitis C virus treatment
Early treatment could clear Hepatitis C
PodMed: Hepatitis C screening

Also See-

HCV Weekend Reading: 168 Pages Of Hepatitis C FAQs

No comments:

Post a Comment