Monday, June 24, 2013

Low fat intake tied to poor recovery from HCC therapy

Low fat intake tied to poor recovery from HCC therapy

 June 24, 2013

Patients treated for hepatocellular carcinoma who had a lower dietary fat intake experienced slower recovery from invasive therapies in a recent study.

Researchers assessed the dietary intake of 35 patients with hepatocellular carcinoma (HCC) before and after hospitalization. Nitrogen balance and nonprotein respiratory quotient (npRQ) were measured upon admission and four days later.

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The epidemiology of hepatitis C virus in Egypt: a systematic review and data synthesis

The epidemiology of hepatitis C virus in Egypt: a systematic review and data synthesis

Yousra A Mohamoud, Ghina R Mumtaz, Suzanne Riome, DeWolfe Miller and Laith J Abu-Raddad 

BMC Infectious Diseases 2013, 13:288 doi:10.1186/1471-2334-13-288
Published: 24 June 2013

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Abstract (provisional)

Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, estimated nationally at 14.7%. Our study's objective was to delineate the evidence on the epidemiology of HCV infection among the different population groups in Egypt, and to draw analytical inferences about the nature of HCV transmission in this country.

We conducted a systematic review of all data on HCV prevalence and incidence in Egypt following PRISMA guidelines. The main sources of data included PubMed and Embase databases. We also used a multivariate regression model to infer the temporal trend of HCV prevalence among the general population and high risk population in Egypt.

We identified 150 relevant records, four of which were incidence studies. HCV incidence ranged from 0.8 to 6.8 per 1,000 person-years. Overall, HCV prevalence among pregnant women ranged between 5-15%, among blood donors between 5-25%, and among other general population groups between 0-40%. HCV prevalence among multi-transfused patients ranged between 10-55%, among dialysis patients between 50-90%, and among other high risk populations between 10% and 85%. HCV prevalence varied widely among other clinical populations and populations at intermediate risk. Risk factors appear to be parenteral anti-schistosomal therapy, injections, transfusions, and surgical procedures, among others. Results of our time trend analysis suggest that there is no evidence of a statistically significant decline in HCV prevalence over time in both the general population (p-value: 0.215) and high risk population (p-value: 0.426).

Egypt is confronted with an HCV disease burden of historical proportions that distinguishes this nation from others. A massive HCV epidemic at the national level must have occurred with substantial transmission still ongoing today. HCV prevention in Egypt must become a national priority. Policymakers, and public health and medical care stakeholders need to introduce and implement further prevention measures targeting the routes of HCV transmission.

Hepatitis B - Experts warn of a liver cancer time bomb

Experts warn of a liver cancer time bomb

Kate Hagan
Increased diagnosis and treatment of people with hepatitis B is vital to prevent a liver cancer time bomb, experts warn. 
A liver cancer prevention policy launched by the Cancer Council on Monday calls for increased testing of groups at risk of hepatitis B, and notes that less than half of Australians affected are aware they carry the disease. About 220,000 Australians are estimated to have chronic hepatitis B and among those most at risk are people of Aboriginal background or born overseas in countries where it is endemic, such as the Asia-Pacific region. 
Cancer Council Victoria prevention director Craig Sinclair said liver cancer was our fastest-growing cancer, with cases set to double in Australia over the next decade, to about 2500 a year, unless action was taken.
Mr Sinclair said recent focus groups from the Chinese community showed there was little knowledge of the link between hepatitis B and liver cancer, despite most liver cancers being caused by viral hepatitis.....

Read more here

Photo Credit
Illustration by Sarah L. Williamson, MA

Treatment of Primary Liver Cancer: Sarah Study Now Available for All Eligible Patients throughout France

PARIS, June 24, 2013 /PRNewswire/ --

Launched by the Assistance Publique - Hôpitaux de Paris (AP-HP) in December 2011, SARAH, a French national collaborative randomized controlled trial of radioembolization with yttrium-90 resin microspheres versus sorafenib in advanced hepatocellular carcinoma seeks to enroll 400 patients

To date, more than 150 patients have taken part in this study

PARIS (June 20, 2013) In patients with advanced HCC, sorafenib (Nexavar(R) , Bayer HealthCare Pharmaceuticals, Germany), with which radioembolization is being compared, is now the standard treatment. Its use is associated with an increased median overall survival (from 8 to 11 months in the SHARP trial) but 80% of patients also experience treatment-related adverse events. The SARAH trial is testing the hypothesis that radioembolization using yttrium-90 resin microspheres (SIR-Spheres(R) microspheres; Sirtex Medical Limited, Australia) can increase the median overall survival with fewer side effects and/or a better quality of life in comparison with sorafenib.

Coordinated at the national level by Professor Valérie Vilgrain MD, PhD (Department of Radiology, Beaujon Hospital, AP-HP) - Principal Investigator of this large study, 19 specialist cancer centres throughout France (Angers, Bondy, Bordeaux, Caen, Clichy, Créteil, Dijon, Grenoble, Marseille, Montpellier, Nancy, Nantes, Nice, Paris, Poitiers, Saint Etienne, Strasbourg, Villejuif; cf. are currently accruing patients. The aim is to recruit 400 patients in France with the following inclusion criteria:([) (1) (]) -- Patients with advanced HCC with or without portal vein thrombosis or whose disease has progressed after chemoembolization or recurrence of HCC; -- No extrahepatic spread; -- Ineligible for: -- surgical resection; -- liver transplantation; -- radiofrequency ablation.

There is a growing medical interest in radioembolization using yttrium-90 resin microspheres in this patient population, based on a substantial number of open-label single-group studies as well as a large multi-centre European analysis([) (2) (]) of the long-term outcomes related to survival and safety of radioembolization using SIR-Spheres microspheres in patients with inoperable HCC.

SIR-Spheres microspheres are approved for use in Australia, the European Union (CE Mark), New Zealand, Switzerland, Turkey and several other countries including in Asia (e.g. India, Korean, Singapore and Hong Kong) for the treatment of unresectable liver tumours. SIR-Spheres microspheres are indicated in the U.S. for the treatment of unresectable metastatic liver tumors from primary colorectal cancer together with adjuvant intra-hepatic artery chemotherapy (IHAC) of FUDR (Floxuridine).

About Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) occurs in people whose livers have become severely damaged or cirrhotic, due to conditions such as hepatitis and alcoholism. It is one of the ten most-common cancers in the world, with nearly 750,000 cases diagnosed annually, and the third-leading cause of cancer deaths.([) (3) (]) It occurs with greatest frequency in regions where viral hepatitis B or C are most often diagnosed, such as in Asia Pacific and Southern Europe.

Hepatocellular cancer can be cured by surgery, either by resecting the diseased parts of the liver, or by transplantation with a liver from a healthy donor. These interventions, however, are inappropriate for the great majority of patients, whose survival may range from a few months to two or more years depending largely on the state of their liver at the time of their diagnosis and the extent of tumour invasion.

About Selective Internal Radiation Therapy (SIRT)

SIRT, also known as radioembolization, is a novel treatment for inoperable liver cancer that delivers high doses of radiation directly to the site of tumours. It is a minimally-invasive treatment, in which millions of radioactive SIR-Spheres microspheres (diameter between 20-60 microns) are infused via a catheter into the liver, where they selectively target liver tumours with a dose of internal radiation up to 40 times higher than conventional radiotherapy, while sparing healthy tissue.

References: 1. SorAfenib versus Radioembolization in Advanced Hepatocellular carcinoma (SARAH): 2. Sangro B, Carpanese L, Cianni R et al on behalf of European Network on Radioembolization with yttrium-90 resin microspheres (ENRY). Survival after 90Y resin microsphere radioembolization of hepatocellular carcinoma across BCLC stages: A European evaluation. Hepatology 2011; 54: 868-878. 3. GLOBOCAN. Liver Cancer Incidence and Mortality Worldwide in 2008. accessed 28 June 2011.

SOURCE SARAH trialists

/CONTACT: Contact: MHC Communication, Marie-Hélène Coste, 38 avenue Jean Jaurès - 94110 Arcueil, Tél. : +33-(0)1-49-12-03-40 - Fax : +33-(0)1-49-12-92-19 - email :; Nathalie Amoury, Sirtex,

HIV, hepatitis C and injecting drug use

Published on Jun 24, 2013
For the first time in full on YouTube: a compelling documentary for everyone interested in blood borne virus epidemics and harm reduction.

This harm reduction works campaign film was made because there have been a number of major advances in the understanding of blood borne viruses in recent years, and it is vital that everyone in the field -- and injecting drug users -- has up-to-date information about the hepatitis C epidemic, HIV, and injecting drug use.

Aimed at drug workers, peer trainers, policy makers and commissioners, and anyone interested in injecting drug use, this full length documentary features leading experts in the field including Gerry Stimson, Noel Craine, Dr Roy Robertson and Robert Heimer giving their analysis of the current state of our knowledge.

The film covers issues such as hep C treatment, the role of needle exchange and substitute prescribing in prevention of blood borne virus epidemic, as well as describing the HIV epidemic that occured in Edinburgh in the late 1980s.

Dietary Fructose Causes Liver Damage in Animal Model, Study Finds

Dietary Fructose Causes Liver Damage in Animal Model, Study Finds 

WINSTON-SALEM, N.C. – June 19, 2013 – The role of dietary fructose in the development of obesity and fatty liver diseases remains controversial, with previous studies indicating that the problems resulted from fructose and a diet too high in calories.

However, a new study conducted in an animal model at Wake Forest Baptist Medical Center showed that fructose rapidly caused liver damage even without weight gain. The researchers found that over the six-week study period liver damage more than doubled in the animals fed a high-fructose diet as compared to those in the control group.

The study is published in the June 19 online edition of the American Journal of Clinical Nutrition.

"Is a calorie a calorie? Are they all created equal? Based on this study, we would say not," said Kylie Kavanagh, D.V.M., assistant professor of pathology-comparative medicine at Wake Forest Baptist and lead author of the study.

In a previous trial which is referenced in the current journal article, Kavanagh's team studied monkeys who were allowed to eat as much as they wanted of low-fat food with added fructose for seven years, as compared to a control group fed a low-fructose, low-fat diet for the same time period. Not surprisingly, the animals allowed to eat as much as they wanted of the high-fructose diet gained 50 percent more weight than the control group. They developed diabetes at three times the rate of the control group and also developed hepatic steatosis, or non-alcoholic fatty liver disease.

The big question for the researchers was what caused the liver damage. Was it because the animals got fat from eating too much, or was it something else?

To answer that question, this study was designed to prevent weight gain. Ten middle-aged, normal weight monkeys who had never eaten fructose were divided into two groups based on comparable body shapes and waist circumference. Over six weeks, one group was fed a calorie-controlled diet consisting of 24 percent fructose, while the control group was fed a calorie-controlled diet with only a negligible amount of fructose, approximately 0.5 percent.

Both diets had the same amount of fat, carbohydrate and protein, but the sources were different, Kavanagh said. The high-fructose group's diet was made from flour, butter, pork fat, eggs and fructose (the main ingredient in corn syrup), similar to what many people eat, while the control group's diet was made from healthy complex carbohydrates and soy protein.

Every week the research team weighed both groups and measured their waist circumference, then adjusted the amount of food provided to prevent weight gain. At the end of the study, the researchers measured biomarkers of liver damage through blood samples and examined what type of bacteria was in the intestine through fecal samples and intestinal biopsies.

"What surprised us the most was how quickly the liver was affected and how extensive the damage was, especially without weight gain as a factor," Kavanagh said. "Six weeks in monkeys is roughly equivalent to three months in humans."

In the high-fructose group, the researchers found that the type of intestinal bacteria hadn't changed, but that they were migrating to the liver more rapidly and causing damage there. It appears that something about the high fructose levels was causing the intestines to be less protective than normal, and consequently allowing the bacteria to leak out at a 30 percent higher rate, Kavanagh said.

One of the limitations of the study was that it only tested for fructose and not dextrose. Fructose and dextrose are simple sugars found naturally in plants.

"We studied fructose because it is the most commonly added sugar in the American diet, but based on our study findings, we can't say conclusively that fructose caused the liver damage," Kavanagh said. "What we can say is that high added sugars caused bacteria to exit the intestines, go into the blood stream and damage the liver.

"The liver damage began even in the absence of weight gain. This could have clinical implications because most doctors and scientists have thought that it was the fat in and around tissues in the body that caused the health problems."

The Wake Forest Baptist team plans to begin a new study using the same controls but testing for both fructose and dextrose over a longer time frame.

Photo Credit

Proposed Changes In Organ Donation Stir Debate

Sean Gallup/Getty Images

Proposed Changes In Organ Donation Stir Debate

by Rob Stein

June 24, 2013 3:04 AM

Donation after cardiac death involves removing organs minutes after life-support has been stopped for patients who still have at least some brain activity. Is that enough time to make sure a person won't recover?

NPR Morning Addition - Listen here..
Story - here

Sunday, June 23, 2013

Webcast - Managing Rashes Associated with Anti-HCV Triple Therapy

When a new educational resource is released online this blog provides readers with background information and links to the new activity.

Last month over at Projects In Knowledge three new learning activities were launched all discussing HCV triple therapy.

The first update includes two new chapters added to the sites "HCV Care and Guidance e-handbook," also called "The Living Medical eTextbook."

Chapter 10 and 11 updates:
Chapter 10 offers current data on efficacy, safety and response to first-generation protease inhibitors in HCV patients with compensated cirrhosis; Hepatitis C Treating Hepatitis C in Patients with Cirrhosis  and chapter 11 highlights important recent data and label updates for boceprevir and telaprevir; Anti-Hepatitis C Triple Therapy Update

*Additional chapters are provided below.

Webcast - Managing Rashes Associated with Anti-HCV Triple Therapy

A new webcast hosted by Anne Croghan, ARNP, will discuss dermatologic adverse events associated with HCV triple therapy.

Hepatitis C — Managing Rashes Associated with Anti-HCV Triple Therapy
By: Anne Croghan, ARNP

Dermatologic adverse events related to anti-HCV triple therapy are a challenge for both clinicians and patients. Boceprevir and telaprevir each have had recent label changes related to dermatologic events. Join Anne Croghan, ARNP, for this webcast in which she discusses rash assessment, symptom control, medication management, monitoring and referral, and patient education. “Managing Rashes Associated with Anti-HCV Triple Therapy,” is part of the HCV Care and Guidance: Practical Education and Resources for Nurse Practitioners and Physician Assistants program. 

Free Registration
As with any CME free registration is required. Once this is accomplished participants taking part in the webcast can skip the pre-test and go directly to the webcast by clicking on the "Activity Button."

May 29, 2013 two new e-handbook chapters offered
Practical Education and Resources

NEW Chapter 10 Hepatitis C - Treating Hepatitis C in Patients with Cirrhosis
By: P. Horne, BSN, MSN

Boceprevir and telaprevir triple therapies offer an improved opportunity for sustained virologic response (SVR) in patients with HCV-related compensated cirrhosis. SVR rates are significantly higher compared with traditional combination therapy in treatment-naive as well as treatment–experienced patients, particularly those who were prior relapsers. In this e-handbook chapter, Patrick M. Horne, BSN, MSN, reviews the importance of diagnosing cirrhosis prior to starting anti-HCV therapy and highlights efficacy and safety data, as well as on-treatment monitoring tips. “Treating Hepatitis C in Patients with Cirrhosis,” is part of the HCV Care and Guidance: Practical Education and Resources for Nurse Practitioners and Physician Assistants program.  

NEW Chapter 11  Anti-Hepatitis C Triple Therapy Update
By: Sherilyn C. Brinkley, MSN, CRNP

Since the approval of boceprevir and telaprevir triple therapy in 2011, studies in real-life clinical settings as well as retrospective reviews of phase III data have been undertaken to better understand how to optimize success with these first-generation protease inhibitors. Join Sherilyn C. Brinkley, MSN, CRNP, for this e-handbook chapter, in which she highlights important recent data and label updates for boceprevir and telaprevir triple therapy. “Anti-Hepatitis C Triple Therapy Update,” is part of the HCV Care and Guidance: Practical Education and Resources for Nurse Practitioners and Physician Assistants program.  

Other topics offered in the e-handbook
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 Populations
Chapter 9 Predictors of Response
Chapter 10 Treating Hepatitis C in Patients with Cirrhosis
Chapter 11 Anti-Hepatitis C Triple Therapy Update

Video- Hepatologist Urges caution among clinicians in the administration of telaprevir
High Incidence of Telaprevir-associated Severe Rash Leading to Discontinuation
HCV  Drug Incivek (telaprevir) - View Rash  Grade 1 and  2