Reversing An Overdose Isn't Complicated, But Getting The Antidote Can Be

Of Interest
Should you carry the opioid overdose rescue drug naloxone?
Posted May 04, 2018, 6:30 am , Updated May 07, 2018, 11:57 am

Scott Weiner, MD
I would answer “yes” but with some qualifiers. As the Surgeon General wrote, naloxone is most effective for people taking high doses of opioids, who are misusing prescription opioids, or who are using illicit opioids. It makes sense to have naloxone on hand if you fall into one of these categories, or if you are a friend, family member, or community member who comes into contact with people at risk for overdose. You should also know that in most states, you can request naloxone at most pharmacies without a prescription.

Full article: https://www.health.harvard.edu/blog/should-you-carry-the-opioid-overdose-rescue-drug-naloxone-2018050413773

Reversing An Overdose Isn't Complicated, But Getting The Antidote Can Be

May 7, 20185:01 AM ET
Jake Harper

Heard on Morning Edition

A few months ago, Kourtnaye Sturgeon helped save someone's life. She was driving in downtown Indianapolis when she saw people gathered around a car on the side of the road. Sturgeon pulled over and a man told her there was nothing she could do: Two men had overdosed on opioids and appeared to be dead.

"I kind of recall saying, 'No man, I've got Narcan,' " she says, referring to the brand- name version of the opioid overdose antidote, naloxone. "Which sounds so silly, but I'm pretty sure that's what came out."

Sturgeon sprayed a dose of the drug up the driver's nose, and waited for it to take effect. About a minute later, she says, the paramedics showed up.

View Article: https://www.npr.org/sections/health-shots/2018/05/07/607760827/reversing-an-overdose-isnt-complicated-but-getting-the-antidote-can-be

Fewer non-liver cancers in people treated with DAAs compared to the interferon era

infohep
Fewer non-liver cancers in people treated with DAAs compared to the interferon era
03/05/2018

By Keith Alcorn

The risk of non-liver cancer is lower in people treated with direct-acting antivirals (DAAs) than in those treated with interferon and is probably an effect of the improved cure rate of hepatitis C on these drugs, according to an analysis of US patients treated for HCV presented last month at the 2018 International Liver Congress in Paris.

Several non-hepatic cancers occur more frequently in people with chronic hepatitis C infection, especially non-Hodgkin lymphoma. Successful interferon-based treatment for hepatitis C has been shown to reduce the risk of non-hepatic cancers but part of this effect may be a consequence of a direct anti-tumour effect of interferon. Any reduction in cancer incidence in people treated with DAAs might represent an effect of hepatitis C cure on cancer risk as DAAs have no known anti-tumour effects.

To investigate whether curing hepatitis C with DAAs reduces the risk of non-liver cancers compared to interferon-based treatment, researchers from pharmaceutical company Gilead Sciences looked at 367,156 adults with hepatitis C identified from US health insurance claims databases. Insurance claims data were used to identify treatment for both hepatitis C and for any form of cancer.

The researchers compared people treated for hepatitis C in two periods: between January 2006 and May 2011, when people would have been exposed to interferon or pegylated interferon only, and from December 2013 to March 2017, when people would have been exposed to DAA treatment (and excluding the first generation of DAAs that were used in combination with interferon).

The study identified 10,989 people treated with interferon and 22,894 people treated with DAAs. People treated with interferon were younger than those treated with DAAs (a median of 51 years compared to 57 years of age) and tended to have a lower prevalence of co-morbidities, risk factors for cancer such as smoking and obesity, and less advanced liver disease.

Interferon-treated individuals were treated for a median of 2.6 years and DAA-treated individuals for a median of one year.

Analysis of the relative risk of cancer showed that whereas the risk of cancers strongly associated with hepatitis C – non-Hodgkin lymphoma and bile duct cancer – was no lower in people treated with DAAs, the risk of several major cancers was reduced in people treated with DAAs. Prostate cancer, lung cancer, leukaemia and bladder cancer occurred less frequently in people treated with DAAs.

The reduction in the risk of a major cancer ranged from a 29% reduction in the risk of prostate cancer (adjusted hazard ratio 0.71, 95% CI 0.52-0.97), the most common major cancer in the study population (three cases per thousand people during each year of follow-up), to a 62% reduction in the risk of leukaemia (aHR 0.38, 95% CI 0.24-0.60), which occurred in less than one in a thousand people during each year of follow-up.

The study found no significant reduction in the risk of colorectal, breast, oesophageal or pancreatic cancers in people treated with DAAs.

The overall risk of any major cancer was reduced by 14% in those treated with DAAs when compared to those treated with interferon (aHR 0.86, 95% CI 0.80-0.93).

The investigators concluded that although the mechanisms for the differences in risk by tumour site are unclear, the overall reduction in the risk of major cancers may reflect the difference in cure rates between people treated with interferon-based regimens and people treated with much more effective DAA regimens.

Reference
Chokkalingam A et al. Risk of total non-hepatic cancer following treatment for HCV infection with direct-acting antiviral agents. The International Liver Congress, Paris, abstract PS-155, 2018. Journal of Hepatology 68: S86, 2018.

Source - infohep

Coverage @ infohep: The International Liver Congress

Even one drink a day linked to lower life expectancy

Behind The Headlines
People who drink above UK alcohol guidelines 'lose one to two years of life'
April 13 2018
"Just one alcoholic drink a day could shorten your life," reports BBC News. A huge study of almost 600,000 drinkers showed that people who drank more than 12.5 units (100g) of alcohol a week were likely to die sooner than those who drank no more than this amount. The results applied equally to women and men.

Continue reading.....

Reuters Health
Even one drink a day linked to lower life expectancy
May 3, 2018
Lisa Rapaport

(Reuters Health) - Even light drinkers who enjoy a single beer or glass of wine every night may still be more likely to die prematurely than people who drink less, a recent study suggests.

Compared to people who drink less than 100 grams of pure alcohol a week - roughly the equivalent of five to six glasses of wine or beer - those who consume 100 grams to 200 grams of alcohol weekly have an estimated life expectancy at age 40 that’s about six months shorter, the study found.

Continue reading.....

Study
Published in April online in The Lancet

High efficacy of direct-acting anti-viral agents in hepatitis C infected cirrhotic patients with successfully treated hepatocellular carcinoma

In Case You Missed It

Aliment Pharmacol Ther. 2018 May 3. doi: 10.1111/apt.14685. [Epub ahead of print]

High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma.
Persico M1, Aglitti A1, Aghemo A2, Rendina M3, Lleo A2, Ciancio A4, Di Marco V5, Lampertico P6, Brunetto MR7, Zuin M6, Andreone P8, Villa E9, Troshina G4, Calvaruso V5, Degasperi E6, Coco B7, Giorgini A6, Conti F8, Di Leo A3, Marzi L9, Boccaccio V2, Bollani S2, Maisonneuve P6, Bruno S2.

Full-Text

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Abstract

BACKGROUND:
The efficacy of direct-acting anti-viral (DAA) therapy in patients with a history of hepatocellular carcinoma (HCC) is unknown.

AIM:
We prospectively evaluated whether previously treated HCC affects DAA efficacy in a large real-life cohort of cirrhotic patients.

METHODS:
From January to December 2015 all consecutive HCV mono-infected patients with cirrhosis and/or history of HCC attending 10 Italian tertiary liver centres were enrolled. Baseline characteristics and response to therapy were recorded. 1927 patients were enrolled (mean age: 62.1 ± 10.9 years; 1.205 males). Genotype 1 was the most frequent (67.9%) followed by genotypes 3 (12.4%), 2 (11.2%) and 4 (8.6%). 88.4% and 10.9% of cases were classified Child A and B, respectively, and 14 (<1%) cases were classified Child C. Ascites and hepatic encephalopathy occurred in 10.7% and 3.2% of patients, respectively. Varices were detected in 39.3% of patients. Suboptimal and optimal treatment was prescribed: 15.9% of patients received sofosbuvir/simeprevir, 33.4% sofosbuvir/ledipasvir, 20.2% a Viekirax + Exviera regimen, 15.7% sofosbuvir/ribavirin, 9.9% sofosbuvir/daclatasvir and 3.4% Viekirax; 1.3% of patients received an interferon-based regimen.

RESULTS:
The sustained virologic response (SVR) rate at intention-to-treat analysis was 95.1%. It differed significantly across Child classes, that is, 96.3%, 86.1% and 71.4% Child A, B and C, respectively (P < 0.0001) and across genotypes (P = 0.002). The SVR rate did not differ between patients with (95.0%) and those without previous HCC (95.1%). At multivariable analysis, SVR was significantly associated with HCV genotype, Child class.

CONCLUSION:
This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.
Continue to full article: https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.14685

On This Blog

Liver Cancer After Treatment For Hepatitis C

This page offers an index of links to current data investigating the possible risk of developing liver cancer (hepatocellular carcinoma, or HCC) during and after direct-acting antiviral therapy in patients with hepatitis C.

Hepatitis B and C coinfection in a real-life setting: viral interactions and treatment issues

Ann Gastroenterol. 2018 May-Jun;31(3):365-370. doi: 10.20524/aog.2018.0255. Epub 2018 Mar 28.

Hepatitis B and C coinfection in a real-life setting: viral interactions and treatment issues.
Papadopoulos N1, Papavdi M2, Pavlidou A1, Konstantinou D2, Kranidioti H2, Kontos G2, Koskinas J2, Papatheodoridis GV3, Manolakopoulos S2, Deutsch M2.

Full-Text

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Abstract

Background:
Only limited data concerning hepatitis B (HBV) and C viruses (HCV) coinfection are available. Direct-acting antivirals (DAAs) may be more effective for HCV clearance than interferon (IFN)-based regimens with a risk of HBV reactivation.

Methods:
We retrospectively enrolled 40 HBV/HCV-coinfected patients to evaluate their clinical profile and treatment outcomes.

Results:
Chronic dual infection was present in 25/40 (62.5%) patients, acute HCV superinfection in 5/40 (12.5%) patients and acute HBV superinfection in 10/40 (25%). Twenty-five patients (62.5%) were treated: 16/25 (64%) with IFN, 4/25 (16%) with nucleot(s)ide analogs (NUCs) and 5/25 (20%) with DAAs. Of the 16 patients treated with IFN-based therapy, 6 (37.5%) achieved both sustained virological response (SVR) and HBsAg clearance. Of the 4 patients treated with NUCs, one (25%) achieved both SVR and HBsAg clearance. All five patients treated with DAAs (100%) achieved SVR, while one case of HBV reactivation was recorded. Fifteen of the 40 patients (37.5%) did not receive any treatment. Eight of them (53.5%) presented with acute HBV superinfection: spontaneous HCV clearance was recorded in 5/8 (62.5%), while HBsAg clearance occurred in 6/8 (75%). Three of them (20%) presented with acute HCV superinfection; spontaneous HCV clearance was recorded in one of the three (33.5%). The other four patients (26.5%) presented with dual HBV/HCV infection.

Conclusions:
A significant proportion of patients presented with active HBV replication. Treatment with DAAs seems to be efficacious for HCV eradication. However, clinicians should be aware of HBV reactivation. HBV superinfection may lead to both HBsAg and HCV clearance.

Continue to complete article: View Online

HCV Infection in Teens on the Rise - Second-wave epidemic

AGA Reading Room
05.03.2018

HCV Infection in Teens on the Rise

Second-wave epidemic

by Pippa Wysong
Contributing Writer, MedPage Today
The prevalence of HCV infection in children and adolescents has been reported to vary from 0.05% to 0.36% in the United States and Europe, to 1.8% to 5.8% in some developing countries -- and even that might be low.

According to a review published in Hepatology Communications, the six genotypes seen in adults have been identified in children, with similar global geographic distribution as adults -- but that like adults, the younger cohort in the U.S. tend to have genotypes 1 through 3.

The paper notes that while HCV infection in younger children tends to be from vertical transmission from HCV-infected mothers, in adolescents it is increasingly linked to intravenous drug abuse. In fact, one study from the Centers for Disease Control and Prevention shows a 364% increase in HCV infection among people ages 12 to 29 living in the Appalachian region of the U.S. between the years 2006 to 2012.

Full article @ MedPage Today

May Hepatitis Newsletters: 2018 International Liver Congress Recap & The Fallout Guide for Hep C

May Hepatitis Newsletters

Welcome to this month's index of viral hepatitis newsletters, with updates from your favorite bloggers and today's news.

Where To Begin?

HCV Advocate's May issue is all about key data presented at the 2018 International Liver Congress, with easy to understand commentary by Alan Franciscus and lovely Lucinda K. Porter. The ever so talented Rick Nash is working on a six-part series called: The Fallout Guide for Hep C, part one is ready over at HEPATITISC.NET. Additional blog and newsletter updates are provided below, enjoy!

May Is Hepatitis Awareness Month

The month of May is designated as Hepatitis Awareness Month in the United States, and May 19th is Hepatitis Testing Day. Learn more: Resources for Hepatitis Awareness Month and Hepatitis Testing Day

National Viral Hepatitis Roundtable 

NVHR Calls for Increased Recognition of Hepatitis C as a Systemic Health Condition
Washington, D.C. (May 1, 2018) – The National Viral Hepatitis Roundtable (NVHR) today urged healthcare providers, policymakers, and the public health community to use Hepatitis Awareness Month as an opportunity to expand treatment opportunities for patients living with the hepatitis C virus (HCV) by reconsidering the way we think about HCV. Despite the availability of new, highly effective oral medications to cure the disease, the burden of hepatitis C continues to grow in the United States.
View NVHR May Newsletter

In The News

Infants Exposed to Hepatitis C Virus During Pregnancy Often Are Not Screened for Infection After Delivery

Due to the opioid epidemic, the rate of hepatitis C virus infection among pregnant women increased 60 percent between 2006 and 2014, according to a study, yet only 30 percent of infants exposed to the virus were screened for infection. The study, “Hepatitis C Virus Screening Among Children ExposedDuring Pregnancy,” will be published in the June 2018 issue of Pediatrics (published online May 2).

Seatbelts may protect against severe liver injury in car crashes

(Reuters Health) - Wearing a seatbelt may not prevent liver injuries in a car crash, but it could lessen their severity and make a major difference in the accident’s consequences and costs, researchers say. Among more than 50,000 people with liver injuries as a result of a car crash, those with severe liver injuries were twice as likely to die as those with mild or moderate liver injuries, researchers found.

Tick, mosquito-borne infections surge in United States: CDC

NEW YORK (Reuters) - The number of Americans sickened each year by bites from infected mosquitoes, ticks or fleas tripled from 2004 through 2016, with infection rates spiking sharply in 2016 as a result of a Zika outbreak, U.S. health officials said on Tuesday.

Hospital: Injected patients at risk of Hep C exposure from nurse who stole drugs
May 1, 2018

A hospital is warning 2,600 emergency room patients they may be at risk of Hepatitis C exposure from a nurse who admitted to stealing drugs.

Take-home Narcan kits lifesaving in opioid overdoses
(Reuters Health) - Distributing take-home overdose prevention kits substantially reduced the number of deaths from opioid overdoses in a Canadian province, researchers say.

Flu Vaccines Have High Impact, Even With Relatively Low Efficacy

Last Updated: April 30, 2018.
Even relatively low-efficacy influenza vaccines can have a high impact, especially with optimal distribution across age groups, according to a study published online April 30 in the Proceedings of the National Academy of Sciences.

In Case You Missed It
Cochrane Review Flawed For Discounting SVR As A Marker Of Viral Cure & Endpoint For Measuring Treatment Impact.
Patients, advocates, and experts agree stigma and discrimination remains a barrier to testing and treatment, however, the benefit of curing hepatitis C with astounding cure rates is not all that controversial. Reason enough for experts to get caught up in a 2017 systematic review published by the Cochrane Collaboration on the benefit of achieving a cure using hepatitis C direct-acting antivirals (DAAs). The review concluded patients who were cured with DAA-based regimens did not reduce their risk for HCV-related morbidity or all-cause mortality. Within days, an outcry emerged from experts urging patients not to be influenced by the misleading and harmful conclusion, or be confused by any media coverage that followed....

Dietary improvements may prevent NAFLD
(Reuters Health) - People who make an effort to improve their diet may have a lower risk of non-alcoholic fatty liver disease (NAFDL) than individuals who stick to unhealthy eating habits, a U.S. study suggests. While dietary changes are recommended to treat NAFLD, research hasn't clearly demonstrated whether these changes can work for prevention.

Radiation segmentectomy a potential curative therapy for liver cancer
NEW YORK (Reuters Health) - Long-term outcomes with radiation segmentectomy are on par with curative-intent treatments for patients with early-stage hepatocellular carcinoma (HCC), according to a new paper.

2018 International Liver Congress
Patients looking for an overview of EASL's 2018 International Liver Congress can find it in this month's "infohep bulletin".

Clinical Care Options
Key Viral Hepatitis Studies Influencing My Practice Following EASL 2018

Expert faculty members summarize key viral hepatitis studies from this important annual conference.

Key NAFLD/NASH Studies Influencing My Practice Following EASL 2018

Listen to downloadable audio from a live Webinar by Zobair M. Younossi, MD, MPH, FACP, FACG, AGAF, in which the clinical impact of new NAFLD/NASH data reported at the Paris meeting is discussed.
*Free registration required

EASL LiverTree - Open To All
This year webcasts and congress materials are open access! Watch freely the conferences and ePosters: https://livertree.easl.eu/easl/#!*menu=6*browseby=3*sortby=2*ce_id=1307

*Free registration required

HepCBC

Read today's news or a nice summary of notable headlines published in the latest issue of The Weekly Bull.

Caring Ambassadors
Literature Review
Monthly Pubmed Review of the Most Relevant Research on Hepatitis C
March & April 2018

Healio
SVR after HCV therapy reduces extrahepatic mortality, manifestations
Results of a recent systematic review and meta-analysis showed that sustained virologic response after hepatitis C therapy can reduce extrahepatic manifestations including insulin resistance and cardiovascular risks...

Conatus completes enrollment in phase 2 trial for NASH cirrhosis inhibitor
Conatus Pharmaceuticals completed enrollment in its ENCORE-PH phase 2 clinical trial for emricasan, an orally-active pan-caspase inhibitor designed to treat nonalcoholic…

Healio Updates
Read the latest news
Current Publications
HCV Next
Healio Gastroenterology
Infectious Disease News

Newsletters

HCV Advocate 

In this edition of the HCV Advocate we have devoted nearly the entire issue to the 2018 International Liver Congress. Lucinda Porter, RN and I cover some of our favorite posters and presentations in the current issue and in the upcoming June 2018 issue.

May Newsletter

Lucinda’s Highlights from the 2018 International Liver Congress:
Risk of Liver Fibrosis Progression in Patients with Undiagnosed Hepatitis C Virus Infection
Protective Effect of Cannabis and Coffee Consumption on HCV-related Mortality in French HIV-HCV Co-Infected Patients
Poor Awareness of Liver Disease Shortly Before Cirrhosis Death: Findings from a Large Community Cohort in the UK
The Covert “C”; Prevalence: Risk Factors and Management of Hepatitis C in Psychiatric In-Patients
Effectiveness of Hepatitis C Virus Screening Laws in the United States: Evidence from Paid Claims Data from 2010 to 2016
Lower Risk of Multiple Sclerosis in Patients with Chronic Hepatitis
Screening for Neurocognitive Dysfunction in Non-Cirrhotic Chronic Hepatitis C Infection in an Irish Academic Unit

Alan’s Highlights from the 2018 International Liver Congress:
Testing and linkage to care outcomes in baby boomers versus young adults tested in the community and linked to care at a Federally Qualified Health Center in the US
Linkage to HCV care and reincarceration following release from New York City jails
Direct Antiviral Agents are safe and efficacious in pediatric patients with chronic hepatitis C; Real-world data from the public health perspective
Salvage treatment of HCV patients by Sofosbuvir, Daclatasvir, Simeprevir, and Ribavirin after repeated treatment failures is associated with SVR and reduced risk of hepatocellular carcinoma

Hepatitis Headlines – read about a new hepatitis C therapy in clinical trials, hepatitis C screening rates among baby boomers, the opioid epidemic and about Hepatitis Awareness Month in May.

What’s Up!
We have updated the following HCSP’s Guide and Fact Sheets:

A Guide to Understanding HCV is our most popular downloaded publication. We have completely rewritten and designed the Guide.

HCSP Fact Sheets:
Overview of Disease Progression
HCV Disease Progression: What is Fibrosis?

Don’t forget to check out PackHealth.com for a free resource to help patients navigate their HCV treatment journey. Click on PackHealth.com/hcv and use promo code HCV2017.

Check out our Hep C Video of a patient journey through treatment and cure . . .

The New York City Hepatitis C Task Force

CME | Hep C Clinical Provider Web Training - Special Topics (HIV, PWUD, Med Coverage)
View all: Hep Free NYC Newsletters

British Liver Trust

We’d love to keep in touch to let you know how your support is helping so to keep receiving our newsletter and updates, please click here to register your preferences today.

All Newsletters

Latest News

HCVAction
May - Good practice case study: Nottingham University Hospitals NHS Trust Homecare treatment delivery
This HCV Action good practice case study focuses on Nottingham University Hospitals Trust's Homecare treatment delivery project. The project offered patients the option to receive treatment for hepatitis C in their own homes. The project proved popular with patients and resulted in a number of benefits to the service compared with delivering treatment in secondary care.

View All Updates: http://www.hcvaction.org.uk/

POZ

April/May 2018 Issue
In every issue, you’ll find the hottest topics of interest to our readers along with cutting-edge health information.
View all updates: https://www.poz.com/

National Institutes of Health
A monthly newsletter from the National Institutes of Health, part of the U.S. Department of Health and Human Services
May Newsletter
Newsletters: https://newsinhealth.nih.gov/

World Hepatitis Alliance

Sustained virological response reduces risk of serious cardiovascular disease in people with HCV-related compensated cirrhosis

Successful hepatitis C virus (HCV) therapy reduces the risk of a serious cardiovascular event in people with compensated liver cirrhosis, French.

Read all updates: http://www.worldhepatitisalliance.org/latest-news

Newsletter: HEPVOICE - World Hepatitis Alliance

All Issues

Pacific Hepatitis C Network
Help-4-Hep BC Celebrates 1 Year!
4 May 2018
by Daryl Luster, PHCN Board President
As we near the completion of our first year operating the Help-4-Hep helpline herein BC, I thought it would be a good time to reflect back. A private and confidential service like our helpline fills a gap not met by other resources. With the stigma still unfortunately alive and well across all populations affected by hep c, Help-4-Hep BC provides a means to access peer support and knowledge, as well as resources to help people navigate a process that can be overwhelming.

Website: http://www.pacifichepc.org/

GI & Hepatology

View all updates: https://www.mdedge.com/gihepnews/liver-disease

Blog Updates

New Blog: Canadian Liver Foundation

Why Bringing Liver Research to Life Matters
If liver disease is a jigsaw puzzle, then research are the puzzle pieces. When put in the right sequence these pieces have the ability to create a full and detailed picture…

Read it here: https://www.liver.ca/blog/

HEP Blogs

Hepatitis Awareness Month is Officially Here
It is Hepatitis Awareness Month and for the next 31 days we pay extra attention to issues surrounding viral hepatitis. I am committing to do at least one daily action to raise awareness about virus hepatitis. I hope you will join me today and throughout this month, as we work to educate, challenge, and eventually eliminate viral hepatitis.

5 Ways You Can Take Care of Your Liver

An unhealthy diet can lead to liver disease and compromise the function of your liver. The American Liver Foundation states,“eating high fatty foods will put you at risk of being overweight and having non-alcoholic fatty liver disease and at risk for other disease.”

Hepatitis C Treatment w/o Borders

Still in India, Greg writes the next installment of his blog sitting in the back seat of a taxi driving from Udaipur to Jaipur.

Common Co-Infections with Hepatitis C

A look at some of the common co-infections that may accompany hepatitis C

Arrested for Hepatitis? It Could Happen

Is hepatitis C criminalized in your state?

Read all updates: https://www.hepmag.com/blogs

Hep News
View all updates: https://www.hepmag.com/category/treatment-news

HEPATITISC.NET

The Fallout Guide for Hep C: Survival Mode

This is part one of a six-part series called The Fallout Guide for Hep C. Six emotional components of living with hep C which are important to address to maintain our sense of self as we traverse the difficult hardships ahead.

Read all updates: https://hepatitisc.net/community/

I Help C

Falling Apart with Hepatitis C

Have you ever had a perfectly fine day turn into a hot mess? It happened to me recently. I made it through, and even learned a few lessons. Mostly, I survived. It started when I met with the mechanic for an engine check. We had been feeling it downshift occasionally. I was fine right up until the checker inner guy asked me what was wrong. All of a sudden, I slumped down and tears sprang to my eyes. The room went blurry. My purse felt like it weighed 90 pounds. After leaning on the counter, I tried to tell him my story. Looking back, I was falling apart with the long term side effects from Hepatitis C.

Ethanol Alcohol Ablation for HCC

Then I went in for my 3 months screening and sure enough, the tumor was back. It’s the same one that I had the Transcatheter Arterial Chemoembolization (TACE) for. It worked and knocked that sucker out for a while. But I understood that it could grow again. They call it a recurrent or residual tumor.
Read all updates: http://www.ihelpc.com/

Creating a World Free of Hepatitis C

Medicine: Pharmacology Made Simpler

Last week, I talked about how to read drug product information (PI). This week I’ll discuss the parts of the PI that I didn’t cover last week in Medication: Reading the Fine Print. This includes the more complicated concepts, which I will try to put in to simpler terms.
Read all updates: http://www.lucindaporterrn.com/blog/

Hep B Blog

Journey to the Cure: What Programs are Available for People Living with Hepatitis B?

Welcome to “Journey to the Cure.” This is a web series that chronicles the progress at the Hepatitis B Foundation and Baruch S. Blumberg Institute towards finding the cure for hepatitis B.
Read all updates: http://www.hepb.org/blog/2018/04/

Confused and trying to understand your hepatitis B blood test results? Check out our easy to use chart. http://www.hepb.org/prevention-and-diagnosis/diagnosis/understanding-your-test-results/

HIV and ID Observations

ID Learning Unit: Clinically Important Streptococcal Infections You Need to Know

As mentioned last week, I’m currently attending on the general medical service, a chance to brush up on non-ID clinical skills, and more importantly, to work with smart, energetic house staff and medical students.

Not surprisingly, there’s a wide range of clinical ID on this service, and this year we’ve had a rash of streptococcal infections.
Read all updates: https://blogs.jwatch.org/hiv-id-observations/

Al D. Rodriguez Liver Foundation

Alcohol’s Heart Benefits May Not Apply to People With Liver Disease
Numerous articles and videos circulated on social media and reputable websites, stating that light to moderate alcohol intake offers cardio-vascular health benefits. But does this apply to everyone? Studies show that it might not be the case for people with liver disease.
Read all updates: http://www.aldrodriguezliverfoundation.com/homepage-2/

Harvard Health Blog

Why we all really need Screen-Free Week this year
Aerobic exercise or tai chi for fibromyalgia — which is better?
4 ways to protect against skin cancer (other than sunscreen)
Heart attack versus cardiac arrest 

Read all updates: https://www.health.harvard.edu/

Links
2018 List Of Popular Blogs

Healthy You

Journal Of Hepatology

May 2018 Volume 68, Issue 5, Pages 1063–1075

Fructose and sugar: A major mediator of non-alcoholic fatty liver disease
Thomas Jensen , Manal F. Abdelmalek, Shelby Sullivan, Kristen J. Nadeau, Melanie Green, Carlos Roncal, Takahiko Nakagawa, Masanari Kuwabara, Yuka Sato, Duk-Hee Kang, Dean R. Tolan, Laura G. Sanchez-Lozada, Hugo R. Rosen, Miguel A. Lanaspa, Anna Mae Diehl, Richard J. JohnsonFull-Text

View Online
PDF (952 KB)

TAKE-HOME MESSAGE

While we have known for many years that fructose and beverages sweetened with high fructose corn syrup can contribute to nonalcoholic fatty liver disease, this is an excellent review of the literature to date on this topic. In addition, it postulates the potential mechanisms that could be contributing to fructose's contribution to the development of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. It also highlights the factors that can potentiate the effect that fructose has on the liver, including genetic mechanisms, the role of fructokinase, high-fat diets, and alcohol.

Even one drink a day linked to lower life expectancy
Even light drinkers who enjoy a single beer or glass of wine every night may still be more likely to die prematurely than people who drink less, a recent study suggests.

Benzodiazepines: America's 'Other Prescription Drug Problem'

Public Radio Tulsa

Drugs like Valium, Xanax and Ativan are more popular than ever. Frequently used to treat anxiety, the medicines can be risky, especially when mixed with alcohol or opioids.

The BMJ 28 Apr 2018
From Richard Lehman’s journal review—30 April 2018
Old surgeons and good outcomes
Watching snooker on the television is a harmless pastime, though you must be sure to press the mute button. Then you can listen to music, or trawl through lists of references, or have a snooze. Such are the diminishing pleasures of elderly life. Should you happen to watch the game, you will find that younger players tend to become overconfident and take on shots which, when missed, lead to their eventual downfall. Older players simply go for safety, and end up winning. Here is a study which shows that surgeons are the same. “Using national data on Medicare beneficiaries in the US, this study found that patients treated by older surgeons had lower mortality than patients treated by younger surgeons. There was no evidence that operative mortality differed between male and female surgeons.” Strange there are so few female snooker players.

Diabetes
Diabetes remission through diet may be doable, with support

Dietary interventions may be able to send type 2 diabetes into remission, and intensive lifestyle interventions with some help from modern technology means more patients may now have the support they need to accomplish this.

On This Blog
HCV, type 2 diabetes & fatty liver disease - Importance of diet and exercise

The link between hepatitis C virus and diabetes mellitus: Improvement in insulin resistance after HCV eradication

Just So You Know

Reports that dark chocolate 'improves eyesight' are unconfirmed

"Dark chocolate improves your eyesight," is the unusual headline from the Mail Online following a small trial comparing the effects of dark and milk chocolate on vision. The theory is that dark chocolate is high in antioxidant flavanols, which are touted as having many potential health benefits, including effects on the nervous system.

Dark chocolate and health: Fudging the evidence with USA Today

How does dark chocolate “support” your health? According to USA Today, it can do so because an unpublished pilot study involving just five people–yes, five–showed eating lots of it over a few days “influenced gene activity, increased anti-inflammatory agents and increased infection-fighting cells.” A second pilot study also showed it can “positively impact brain function” on five people, the paper reported.

Wishing you all a good week ahead, thanks for stopping by.

Tina

FDA Advises Consumers & Retailers to Avoid Potentially Contaminated Raw Oysters from Canada

U.S. joins Canada in investigation of outbreak linked to oysters

By News Desk | May 1, 2018 

A Canadian outbreak of norovirus traced to raw oysters is now on the U.S. radar as federal and state officials report they are investigating a multistate outbreak in this country.

More than 170 people across three Canadian provinces, Alberta, British Columbia and Ontario, had been infected by the highly contagious virus as of the most recent report from the Public Health Agency of Canada. The health agency and the Canadian Food Inspection Agency have been working on the outbreak investigation since early April. Monday evening the U.S. Food and Drug Administration issued its own outbreak investigation notice.... 

Raw oysters can cause illness in anyone, but they are particularly dangerous for young children, older adults, pregnant women and people with compromised immune systems. Oysters and other food contaminated with noroviruses usually looks, smells and tastes normal.

Read the article... http://www.foodsafetynews.com/2018/05/u-s-joins-canada-in-investigation-of-outbreak-linked-to-oysters/

FDA Press Release: FDA Advises Consumers & Retailers to Avoid Potentially Contaminated Raw Oysters from Canada
May 2, 2018
What is the Problem and What is being Done About It?

The U.S. Food and Drug Administration is working with federal, state, and local officials regarding a norovirus outbreak linked to raw oysters from British Columbia, Canada. The FDA has confirmed that potentially contaminated raw oysters harvested in the south and central parts of Baynes Sound, British Columbia, Canada, were distributed to AK, CA, IL, MA, NY, and WA. It is possible that additional states received these oysters either directly from Canada or through further distribution within the U.S.

FDA and the states are conducting a traceforward investigation to determine where the raw oysters were distributed and ensure they’re removed from the food supply. Retailers should not serve raw oysters harvested from the following harvest locations (or landfiles) within Baynes Sound: #1402060, #1411206, #1400483, and #278757.

Oysters can cause food-related illness if eaten raw, particularly in people with compromised immune systems. Food contaminated with noroviruses may look, smell, and taste normal.

What are the Symptoms of Norovirus Infection
Most people infected with Norovirus develop diarrhea, vomiting, nausea, and stomach pain. Diarrhea tends to be watery and non-bloody. Diarrhea is more common in adults and vomiting is more common in children.

How Soon After Exposure do Symptoms Appear?
Most people infected with Norovirus develop diarrhea, fever, and abdominal cramps 12 to 48 hours after infection.

Who is at Risk?
Anyone who consumes raw shellfish is at risk of contracting Norovirus. Children younger than five, the elderly, and those people with weakened immune systems are more likely to have severe infections.

What Do Restaurants and Retailers Need To Do?
Restaurants and retailers should not sell the potentially affected raw oysters. Restaurants and retailers should dispose of any products by throwing them in the garbage or returning to their distributor for destruction.

Restaurants and retailers should also be aware that the oysters may be a source of pathogens and should control the potential for cross–contamination of food processing equipment and the food processing environment. They should follow the steps below:

-Wash hands with warm water and soap following the cleaning and sanitation process.
-Retailers, restaurants, and other food service operators who have processed and packaged any potentially contaminated products need to be concerned about cross contamination of cutting surfaces and utensils through contact with the potentially contaminated products.
-Retailers that have sold bulk product should clean and sanitize the containers used to hold the product.

-Regular frequent cleaning and sanitizing of food contact surfaces and utensils used in food preparation may help to minimize the likelihood of cross–contamination.

What Do Consumers Need To Do?
People should not eat any raw oysters from the locations listed above. If they have any of the listed products, they should throw them in the garbage.

People who think they might have become ill from eating possibly contaminated raw oysters should talk to their health care providers.

Consumers should always practice safe food handling and preparation measures. Wash hands, utensils, and surfaces with hot, soapy water before and after handling food.

For food preparation surfaces and food cutting utensils that may have come in contact with the potentially contaminated oysters, it is very important that the consumers thoroughly clean these areas and items.

Who Should be Contacted?
People who think they might have become ill from eating possibly contaminated oysters should talk to their health care providers. Contact your healthcare provider if you have diarrhea that lasts for more than 3 days, or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine.

The FDA encourages consumers with questions about food safety to call 1-888-SAFEFOOD or consult the fda.gov website: http://www.fda.gov.

Additional Information
CDC Norovirus
Raw Oyster Myths
Canadian Public Health Notice - Norovirus

https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm606139.htm