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Week Ending: November 25th , 2006
Alan Franciscus
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November 18th, 2006
Cocktail Therapy Effective for Hepatitis B/C Dual Infection: Study
http://www.cna.com.tw/
By Y.F. Low
Taipei, Nov. 18 (CNA) The nine major medical centers in Taiwan have cooperated to develop a cocktail therapy that is effective in the treatment of patients with dual infection of hepatitis B and hepatitis C, researchers said Saturday.
The therapy involves the combined use of the long-acting interferon Pegasys and the anti-viral drug Ribavirin, and has a cure rate reaching 75 percent on average, according to the researchers.
According to Liu Chun-jen, a general internist at National Taiwan University Hospital, more than 300 patients have participated in the study.
The study found that 56 percent of the patients with dual infection of hepatitis B and type 1 hepatitis C were cured after using the therapy, while the cure rate was 81 percent among patients with dual infection of hepatitis B and non-type 1 hepatitis C, Liu said.
Liu noted that type 1 hepatitis C infection is more difficult to cure than other types of infection and that half of Taiwan's patients suffering from hepatitis C are infected with the type 1 hepatitis C virus.
For the purpose of the study, patients with dual infection of hepatitis B and type 1 hepatitis C were given the therapy for 48 weeks, while patients with dual infection of hepatitis B and non-type 1 hepatitis C were given the therapy for 24 weeks, Liu said.
The study indicates that the best results are produced if patients with dual infection of hepatitis B and type 1 hepatitis C receive the therapy for 48 weeks, he said.
Chuang Wan-lung, a hepatologist at Kaohsiung Medical University's Chung-Ho Memorial Hospital, pointed out that one in every 10 hepatitis B patients in southern Taiwan is simultaneously infected with hepatitis C.
While most hepatitis B patients contracted the virus from their mothers at birth, they were later infected with hepatitis C virus while getting an injection, tattoo or blood transfusion, Chuang said.
The hepatitis C virus can inhibit the hepatitis B virus, and one-fifth of the patients with dual infection see their hepatitis B antigen disappear when their hepatitis C is cured, Chuang added.
According to Liu, approximately 10 million people around the world, mostly ethnic Chinese, are infected with both hepatitis B and hepatitis C.
There are more than 100,000 such patients in Taiwan, most of whom are in central and southern Taiwan, he said.
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November 20th, 2006
30 Students to Be Tested after Sharing Lancets
http://sfgate.com/
Diana Walsh, Chronicle Staff Writer
(11-20) 15:16 PST REDWOOD CITY -- As many as 30 seventh-graders at a Redwood City middle school will be tested for hepatitis and HIV after their substitute science teacher allowed the students to share needle-like devices to prick themselves for blood.
The substitute teacher, who has been fired as a result of the incident, was giving a life-science lesson to five classes Thursday at Kennedy Middle School when he asked for volunteers to have their blood drawn using lancets -- which are similar to the small tools that diabetics use to test their blood.
Rather than giving each volunteer a new lancet to draw individual blood samples, the teacher, whose name was not released, permitted students to share them, according to Jan Christensen, superintendent of the Redwood City School District.
"Each student should have had their own one,'' Christensen said today. "I'm shocked and stunned that anyone would have thought this was appropriate protocol.''
A mother whose daughter participated in the class notified the school about the science experiment late Thursday. The school's vice principal and the substitute teacher spent Friday meeting with the classes and identifying the students who had blood drawn.
The school then notified county health officials and the principal began contacting parents whose children were involved in the experiment. School officials plan to meet this afternoon with parents from the five classes.
Chances that any of the children involved are infected with Hepatitis B, Hepatitis C or HIV are very slim, according to Doris Estremera, public information officer for the San Mateo County health department. In the past 15 years, the county has recorded seven cases of Hepaptitis B in children ages 12 to 14 and one Hepatitis C case each year in all age groups combined. In the last 26 years, only 12 children under age 14 have tested positive for HIV.
Christensen said the teacher, who has expressed deep remorse about what had happened, had worked in the school for the past six weeks as a long-term substitute for the regular teacher who is on maternity leave.
"He was very honest about it. He screwed up,'' said Warren Sedar, principal at Kennedy. "He's got kids himself and he felt bad about putting anybody at risk and worrying the parents. He made a really big mistake.''
The school has asked parents to either take their children to their pediatricians or to have their blood drawn at the county's mobile lab, which will be on campus all day Tuesday.
Sedar and Christensen said they were shocked not only that the kids had shared lancets, but that they were drawing blood at all. The science lesson is designed to allow children to look at their cells under a microscope. Normally, students gather the cells by swabbing the inside of their cheeks and are not asked to draw blood.
"I am extremely upset because the safety of our students is our number-one concern,'' Christensen said.
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On the Move: Jenken Biosciences Files New Drug Application, Lands Cato as Partner
http://www.localtechwire.com
By Rick Smith, LocalTechWire
RESEARCH TRIANGLE PARK, N.C. – Jenken Biosciences, a startup pharmaceutical firm, has filed its first investigational new drug (IND) application with the Food and Drug Administration and also landed an investor through a services agreement with Cato Research and Cato BioVentures.
The two milestones are part of Jenken’s moves to land $6.5 million in first-round venture capital funding, which Chief Executive Officer Barry Buzogany has been on the road in recent months trying to raise.
The company’s emphasis at the moment is on a compound known as JKB-122, which Jenken believes will prove to be an effective treatment or prevention of liver damage associated with Hepatitis C and other diseases also associated with inflammation of the liver, kidney and lungs.
“It’s a potential blockbuster,” said Buzogany, a former chief operating officer with RTP-based Icoria who joined Jenken earlier this year. Jenken sees the potential market for JKB-122 and other compounds it is pursuing as being worth more than $10 billion a year.
“We filed an IND two weeks ago for JKB-122,” he added.
JKB-122 is a repurposed drug, or one that the firm with FDA approval will test for a new use. Jenken plans to repurpose other drugs as well.
“Because it is a repurposed drug with a proven safety profile for another use means we really can accelerate through the approval process for a new use,” Buzogany said.
The company is staying tight-lipped about JKB’s current use due to intellectual property concerns,. “When the IND is approved by the FDA, we might be able to talk more about what the active ingredient is,” Buzogany added.
Jenken, which is the translation for “prosperity” in Chinese according to Buzogany, currently has two full-time employees – Buzogany and founder Edwin Wu. The firm also has a group of consultants and advisors, including other former Icoria officers.
Wu is one of the inventors of the JKB-122 compound. He formed Jenken in 2003, and operations began in 2004.
To this point, the company has been funded by its founder, friends of family and from an upfront licensing fee paid to Jenken by a Taiwanese drug company last year for rights to JKB-122 in some Asian markets.
Cato and Cato BioVentures will provide drug development services to Jenken with a value of up to $2 million.
"Cato BioVentures and Cato Research are committed to working with early-stage companies like Jenken,” said Shawn Singh, managing principal for Cato BioVentures, in a statement. “When we partner early, as we have here, we can make a positive difference in the overall development of promising drug candidates like Jenken's JKB-122, a compound with exciting potential to impact the treatment of hepatitis C-related inflammatory liver disease.”
In exchange, Cato and Cato BioVentures will receive warrants for stock in Jenken as well as some cash.
“The early level of services is for strategic consulting, and we certainly can use someone with the reputation of Cato,” Buzogany said. “It’s advantageous for us whereby we gain needed services in exchange for warrants.”
Jenken also hopes to leverage the Cato investment to secure a loan from the North Carolina Biotechnology Center.
Buzogany, who has more than 25 years of experience in the life science business, is optimistic that he will secure the Series A venture money soon. “Job No. 1 for me is to secure the Series A funding so we can go to clinical trials,” he said.
Not only has Jenken filed the NDA, but it also has two other compounds waiting further development, and he has the help of other former Icoria executives.
“I’m so pleased with our Icoria connections, and I hope potential investors find that attractive,” he said. “We have a track record of having worked successfully together.”
Buzogany left Icoria after the company, which was once known as Paradigm genetics, was sold to Clinical Data, Inc. He worked at Icoria for more than three years.
Other former Icoria executives advising Jenken are Peter Johnson as operations advisor and Phil Alfano as financial advisor. Preclinical research advisor is Philip Morgan, a former head of molecular pharmacology at GlaxoSmithKline.
Wu has worked more than 20 years in drug research and development, including management positions at two pharmaceutical firms. He is the inventor of an anti-hypertensive drug that is undergoing clinical trials. Wu also is a co-inventor of potential treatments for Alzheimer’s disease, asthma and cognition enhancement.
Jenken Biosciences: www.jenkenbio.com
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November 21st, 2006
Bayer Diagnostics and Innogenetics Launch Versant HCV Genotype 2.0 Assay (LiPA) for HCV Genotyping
http://www.medadnews.com
TARRYTOWN, NY, and GHENT, Belgium – November 21, 2006 – 18h - Bayer HealthCare, Diagnostics Division, a member of the Bayer Group (NYSE:BAY) and Innogenetics N.V. announced today that the VERSANT® HCV (Hepatitis C Virus) Genotype 2.0 Assay (LiPA) has been released for sale in Europe. This next generation hepatitis C assay is an upgrade of Bayer’s VERSANT® HCV Genotype 1.0 Assay (LiPA), which is considered to be the most widely used assay for HCV Genotyping. In addition to its ability to accurately classify all major HCV genotypes (genotypes 1 to 6), the assay now also provides accurate identification of genotypes 6c-l (formerly known as genotypes 7, 8, and 9) and improves the identification of genotype 1a and 1b. These additions will permit improved therapy management of hepatitis C-infected patients.
It is now widely accepted by clinicians that HCV genotyping is a key element in HCV treatment management1. Knowing which genotype and subtype a patient has is extremely important to physicians since each genotype responds differently to treatment1. The launch of the VERSANT HCV Genotype 2.0 Assay (LiPA) now provides correct and broader identification of HCV genotypes with improved subtype accuracy that was not possible by commercial HCV genotyping products until now.
The combined CE-marked reagents: the VERSANT HCV Amplification 2.0 Kit (LiPA), VERSANT HCV Genotype 2.0 Assay (LiPA), and LiPA-Scan HCV Software provide easy to use products that minimize hands-on time and maximize results. The system is completed by the release of plasma based run controls in the VERSANT HCV Control 2.0 Kit (LiPA).
Based on Innogenetics’ important intellectual property assets with respect to HCV genotyping, the new test was developed through a joint development agreement. Bayer has the exclusive worldwide rights for the sales and marketing of Innogenetics’ LiPA HCV products, while Innogenetics is responsible for the manufacturing of this product.
“Bayer has proven to be a solid and reliable partner for the sale and marketing of Innogenetics LiPA HCV products. They successfully kept this LiPA-based product as the most widely used assay for HCV genotyping,” said Frank Morich, CEO, Innogenetics. “Bayer’s decision to develop an updated version, based on our established LiPA platform, is a further validation of our technology and know-how. We are confident that this next generation product resulting from our corporate partnership will achieve the same success.”
“Bayer recognizes there is a tremendous unmet need for a more accurate detection and diagnosis of the hepatitis C virus. The addition of the next generation VERSANT® HCV Genotype 2.0 Assay (LiPA) to our portfolio will help provide better treatment regimes for those infected with the virus,” said Tony Bihl, President, Bayer Diagnostics.
To date hepatitis C infection remains an important challenge for the medical community. Approximately 200 million people are infected world-wide, of whom more than 10 million are located in the US and Europe. Once infected, 85% of the individuals become chronic carriers, which ultimately results in liver failure.
1 Hepatitis C Support Project, Version 1.0; April 2004:
http://www.hcvadvocate.org/hepatitis
/easyfacts/Genotype_final.pdf
About Bayer HealthCare, Diagnostics Division
Bayer HealthCare Diagnostics Division is one of the world’s market leaders in diagnostics for critical and intensive care, hematology, DCA (hemoglobin A1C), urinalysis, immunology, clinical chemistry and molecular testing.
With operations in more than 100 countries, Bayer Diagnostics offers an extensive portfolio of diagnostic systems, point of care testing, molecular diagnostics, laboratory automation and productivity solutions and services to hospitals and health care organizations, laboratories and physicians’ offices across the world.
Bayer Diagnostics’ extensive portfolio covers a myriad of congenital and acquired disease states, including: allergy, anemia, autoimmune disorders, cardiopulmonary care, cardiovascular/heart, diabetes, fertility, infectious diseases, HIV/AIDS, urinary tract infections, kidney and metabolic function, thyroid functions, oncology and virology, as well as immunosuppressant therapy and therapeutic drug monitoring.
Bayer HealthCare Diagnostics Division global headquarters are based in Tarrytown, New York, U.S.A, and operate as part of Bayer HealthCare LLC.
For further information, please contact:
Media Contacts
Susan Oelerking
Bayer HealthCare
Tel.: 01-914-366-1807
Email: susan.oelerking.b@bayer.com
Forward looking statement
This news release contains forward-looking statements based on current assumptions and forecasts made by Bayer Group management. Various known and unknown risks, uncertainties and other factors could lead to material differences between the actual future results, financial situation, development or performance of the company and the estimates given here. These factors include those discussed in our public reports filed with the Frankfurt Stock Exchange and with the U.S. Securities and Exchange Commission (including our Form 20-F). The company assumes no liability whatsoever to update these forward-looking statements or to conform them to future events or developments.
About Innogenetics
Innogenetics is an international biopharmaceutical company building parallel businesses in the areas of specialty diagnostics and therapeutic vaccines.
In 2005, total revenues (product sales, royalties, and license fees) reached €48.6 million, with a profitable Specialty Diagnostics Division. Its Diagnostics Division develops a large number of specialty products covering three areas: infectious diseases (hepatitis C, hepatitis B, and HIV), genetic testing (HLA tissue typing and cystic fibrosis), and neurodegeneration (Alzheimer’s disease). In its Therapeutics Division, Innogenetics focuses on the development of therapeutic vaccines to address unmet medical needs in the field of infectious diseases, with two compounds now in clinical trials (hepatitis C in phase IIb and hepatitis B in phase I).
Founded in 1985, Innogenetics is listed on Euronext Brussels [Ticker: INNX]. Innogenetics’ headquarters are in Gent, Belgium, with sales subsidiaries in France, Germany, Italy, Spain, Brazil, and the United States. Innogenetics employs 525 people worldwide and has a market capitalization of approximately €295 million
For further information, please contact:
Innogenetics
Filip Goossens
Investor Relations Manager
Phone + 32 9 329 1639
Fax + 32 9 245 7625
investor_relations@innogenetics.com
www.innogenetics.com
TVA BE 0427.550.660 RPR Gent
Forward looking statement
This press release contains forward-looking statements that involve risks and uncertainties, including but not limited to projections of future revenues, operating income, and other risks. Prospective investors should be aware that these statements are estimates, reflecting only the judgments and projections of Innogenetics’ management, and no undue reliance should be placed on such forward-looking statements.
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November 22nd, 2006
Hepatitis C Patient Needs New Kidney and Liver
http://www.cjnews.com
By LEILA SPEISMAN,
Staff Reporter
About 20 years ago, Suzi Kind had a gallbladder operation – not, one would think, a terribly serious procedure.
Kind, however, was among those who contracted hepatitis C from a tainted blood transfusion. The effect on her was devastating.
In December 1999, her liver failed, and she received a liver transplant. Unfortunately, the drugs that treat hepatitis C proved too harsh for her system, and the treatment had to be stopped. She was placed on hemodialysis, but that treatment severely damaged her kidneys.
Now, Kind, 52, needs both a new liver and a new kidney.
Her daughter, Sherry, explained that her mother’s kidneys aren’t working at all, and her liver is only functioning a little bit.
“When the liver fails, other organs begin to fail, too. She is becoming confused, and might go into a liver coma.”
In addition, fluid is collecting in her stomach, which causes considerable pain in her abdomen and back, her daughter said.
It’s too late for a live donor transplant, Sherry said, and even with a cadaver, the donor must be the right blood type and the liver must be the right size.
What’s more, the waiting period for a liver transplant is more than two years, and nearly 2,000 people are on the transplant list.
People are simply not signing organ donor cards, and so the demand for organs far outpaces the supply, Sherry said.
She and her sister, Sarit, are desperately trying to encourage organ donations. In Austria and Spain, Sherry notes, there are laws insisting on them, but “Canada and the U.S. have the lowest rate of organ donation in the world. We just don’t know what to do anymore.”
A hospital in the United States could help Suzi Kind, but it would cost $500,000.
Her family is trying to raise the money in the community. They are also waging a campaign to educate the public about the shortage of organ donors, and to push the government to introduce a “presumed consent” system for organ and tissue donations.
Last week, the family held a fundraising event to benefit the Canadian Liver Foundation. Sarit and Sherry have also spoken on television and to the press about their cause.
Suzi Kind’s husband, Yosef, is not well either, having suffered several strokes. Nevertheless, he went to New York to pray for his wife at the grave of the late Lubavitcher Rebbe, Rabbi Menachem Mendel Schneerson.
Sherry described her mom as an “amazing mother, hostess and cook who kept the family together.”
She also described her as compassionate, recounting how she used to make sandwiches for a homeless person who had stationed himself outside the Food Basics store at Bathurst Street and Steeles Avenue, where she worked as a pharmacist’s assistant.
She is a movie buff, and loves sewing, reading, talking to friends and travelling.
The family tries to cheer her up by bringing food, books and movies to her.
Still, Sherry said, “there is nothing worse than being in the hospital, totally dependent on others for everything.”
For more information, call Sarit Kind at 416-573-5132 or Sherry Kind at 416-427-4636.
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Guangdong Develops Biological Immunotherapy to Fight Hep B
http://www.interfax.com
Shanghai. November 22. INTERFAX-CHINA - The Guangdong Liver Disease Association (GLDA) announced today the development of a new biological immunotherapy to rid the hepatitis B virus in carriers.
Clinical trials showed the therapy is effective in 98 percent of hepatitis B virus carriers, Wu Bangfu, the lead of GLDA's research team said.
Current hepatitis B therapies and drugs mainly target chronic hepatitis B patients, which help to curb virus replication. They do not have any effect on carriers and preventing the progression of active disease.
The immunotherapy allows activated antigen-presenting cells to carry hepatitis B antigen information. Once these cells are injected into the body, the antigen-presenting cells will be able to break the immunological tolerance created by the hepatitis B virus. When normal immune functions are restored, protective antibodies that are produced will kill the virus.
"The therapy has already been filed with the Ministry of Health and we have applied to obtain patents from the State Intellectual Property Office," another official with the GLDA said. "We also plan to extend the biological immunotherapy research to investigate other disease such as cancer and AIDS."
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Organizing to Live Longer
http://www.wwmt.com
By Carolyn Wyllie
(NEWS 3) - Several years after contracted Hepatitis from an emergency room patient, Dr. Michael Hagan's liver deteriorated.
He needed a transplant.
Hagan spent two years on a waiting list, as his health continued to go downhill. "I had total liver failure," says Hagan. Then one night the phone rang. An organ match was found.
Hagan's doctor's told him, he likely wouldn't have survived much longer without the liver transplant.
"When the transplant lists are done, the sickest patients are at the top," says Hagan.
That's not true for a list compiled by an organization called LifeSharers. Members of the group agree, upon death, to donate their organs to other group members first.
"We have to do something creative," says LifeSharers advisor Larry Reed.
"All LifeSharers does is indicate as a member you are entitled to another member's organ if you need it, and if there is one available."
Already there are more than 6200 people looking to better their odds, including nearly a dozen from West Michigan.
LifeSharers claims it could help "reduce the chance you'll die waiting" should you need a transplant.
Still, transplant reciepient Dr. Hagan, doesn't think the LifeSharers concept is fair.
Watch News 3 Reporter Carolyn Wyllie's Special Report "Organizing to Live Longer"
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FDA Public Health Advisory : Epoetin alfa (marketed as Procrit, Epogen)Darbepoetin alfa (marketed as Aranesp)
http://www.fda.gov/cder/drug/advisory/RHE.htm
Today, The New England Journal of Medicine published the results of a research study about Procrit, an erythropoiesis-stimulating agent (ESA) also known as recombinant human erythropoietin. The study found a higher chance of the combination of death, heart attack, hospitalizations for heart failure and stroke in patients with chronic kidney disease who are not on dialysis and were treated with Procrit to raise their hemoglobin levels higher than what the labeling for the product recommends. Procrit, like the other ESAs Epogen, and Aranesp, increases blood hemoglobin levels, the oxygen carrying component of blood, by increasing the number of red blood cells in the body. These products are used to treat anemia in certain patients.
The maximum treatment level recommended in product labeling for all approved ESAs is to raise blood hemoglobin levels to no higher than 12 g/dL. The results of this latest study emphasize the importance of following this recommendation.
In light of this research study, FDA is advising the following:
- To reduce serious complications from the use of ESAs, healthcare professionals should be familiar with the recommendations in the product labeling to maintain hemoglobin levels between 10 to 12 g/dL.
- Frequent tests to monitor blood hemoglobin levels are an important component of an ongoing ESA treatment plan. Healthcare professionals should talk with their patients about the importance of keeping appointments for simple blood tests to monitor hemoglobin levels.
- Patients should contact their doctor if they feel any worsening in shortness of breath, pain or the swelling in the legs or increases in blood pressure.
The New England Journal of Medicine article, published on November 16, 2006, presented the results of the Correction of Hemoglobin and Outcomes in Renal Insufficiency (CHOIR) study. The CHOIR study evaluated the potential benefit and harm from treatment with Procrit in patients with chronic kidney disease who are not on dialysis. In the study, harm was defined as a group of effects that included death, heart attack, hospitalizations for heart failure and stroke. The research found that patients in the study who were treated with Procrit to raise their blood hemoglobin concentration to the higher 13.5 g/dL level experienced more death and life-threatening harm than those who were treated to raise their blood hemoglobin concentration to the lower 11.3 g/dL level.
The FDA is working to fully evaluate the CHOIR study data and to determine if any additional actions are necessary in order to optimize the use of erythropoiesis-stimulating agents. FDA plans to notify healthcare providers and patients as additional information becomes available.
The FDA urges both healthcare providers and patients to report adverse events to MedWatch. MedWatch reports may be made by phone: 1-800-FDA-1088; fax: 1-800-FDA-0178; or via the Internet at http://www.fda.gov/medwatch/index.html
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C Sick: Hepatitis C and the Damage Done, Part II
http://www.austinchronicle.com
BY MARGARET MOSER
Randy "Biscuit" Turner mopped the sweat from his forehead and leaned into the toilet to vomit. Red sprayed on white porcelain. He flushed the toilet and grabbed a towel nearby, trying to wipe up the spatters. Blood, again.
Nothing worked. The wastebasket filled with antacids, Pepto-Bismol, and Alka-Seltzer packages and bottles, his attempt to self-medicate against the pain and discomfort.
Biscuit knew he had hepatitis C. Known since about 2003, when he was diagnosed. Had a liver biopsy and was told he needed a liver transplant. Neither his work in seminal Austin bands like the Big Boys nor his beloved artwork bought him health insurance, and the cost of treatment was prohibitive. Too proud to take the help available or go through the attendant trials of paperwork, appointments, tests, qualifying processes required, he simply let the disease take its course. Sometime around Aug. 15 or 16, 2005, the disease took him.
He may have suffered terribly in those final hours. His liver was cirrhotic, failed, shut down. When he had vomited up everything possible, he pulled himself to his feet and staggered toward his bedroom. He collapsed near the bedroom door, perhaps ready to phone for help. But life slipped away faster than he could take labored breaths. He lay on the bare floor in the mid-August heat.
Biscuit closed his eyes for the last time.
Enter the Dragon
"This was the year I was supposed to die," says Danny Crooks, who was first diagnosed with hep C and treated in 1998. "Oh-Six. They told me I had eight years left."
The longtime Austin club owner went into treatment for six months, but it wasn't working, so he was taken off and told to enjoy his life. He felt fine for a while, but in 2004, it came back. This time he sold his beloved Sixth Street rock palace Steamboat.
"I couldn't be there, and I didn't want to be there," he admits. "I was sick, and it was getting worse. I thought I had a couple months to live. I was getting myself ready to check out for good."
His doctor asked if he wanted to try treatment again. Crooks said no, but his wife said yes. After a slow start, he got results in the eighth month. In January of this year, he was pronounced hep C-free. "My liver wasn't in as bad a shape as many people's, but it's still scarred."
In 1998, Crooks talked about his battle with hep C to Chronicle writer Greg Beets (see "The Growing Chorus," August 21, 1998). He, local musicologist and historian Tary Owens, and musician Alejandro Escovedo were the prominent Austin music-industry veterans to step forward about the then little-known disease.
A life-threatening disease, hepatitis C cuts across gender, racial, and economic borders as the most common blood-borne viral infection in the United States. Upward of 5 million Americans – about one in 50 – are infected with chronic hep C. Among Americans 25 and older, chronic liver disease ranks in the Top 10 killers. In Texas, 360,000 people have hep C, according to the Texas Liver Coalition. Eight thousand to 10,000 people will die from hep C this year.
The most compelling reason for hep C testing is that if left untreated, the disease can lead to cirrhosis, liver failure, and/or liver cancer. The reason for seeking treatment, according to Dr. Robert Frachtman of Austin Gastroenterology, is that "you can be cured permanently. If you're negative six months after your last injection, the odds of relapsing are 1 percent or 2 percent. And if it's going to come back, it will come back within six months."
The Texas Liver Coalition reports that hepatitis C is known in Internet jargon as "the dragon." That's an apt symbol for a disease with a ferocious appetite. The dragon slew not only Biscuit but one of Beets' three 1998 subjects, Tary Owens. Guitarist Jesse Taylor, plus local music infrastructure mainstays T.J. McFarland and Al Ragle all died from hep C-related illnesses since then.
Crooks and Escovedo are among the many dragon slayers living with hep C. Asleep at the Wheel master Ray Benson, songwriter and drummer Doyle Bramhall, Double Trouble bassist Tommy Shannon, Fastball's Tony Scalzo, and songstress Sarah Elizabeth Campbell have all done battle with the dragon. There are numerous other names, some you'd recognize in a heartbeat. Behind every name is a story, and for a few of them, the fight isn't over.
Needles and the Damage Done
"Speed. Heroin. Cocaine." Fastball's Tony Scalzo reels off the drugs that led him to hep C.
"I was obsessed with needles and indiscriminate when I first discovered them as a teenager," says the million-seller candidly. "Seriously. I read that William Burroughs book Junky. That stupid book made me and probably 10 other people I knew – two are dead – turn into junkies and criminals. It's written in an unglamorous way. I don't know how I gleaned glamour from it."
Hep C is always contracted through blood-to-blood contact. That means transfusions, if they happened before 1992, and tattoos, if the artist was sloppy with ink or sterilizing equipment. It's an occupational hazard for health care workers stuck by contaminated needles. Less common but possible is contraction through sharing straws while snorting drugs and transmission through sex. Most people who contract hep C get it by sharing needles through intravenous drug use.
"Bingo," agrees Tommy Shannon. "That's exactly how I got mine. I did a lot of speed long before they knew what hep C was."
The New York City drug scene was so pervasive that Alejandro Escovedo "moved here to get away from it." His battle with hep C is the most publicized in the national music community as a result of the Por Vida tribute album and concert. There's no doubt in his mind that he contracted it through intravenous drug use.
"I came from San Francisco where drugs were a fixture on the scene," he says. "They were easy to get, and a lot of people did them. I knew enough about them to know that I was taking a risk when I did them. Because of my brothers, I knew what the world of drugs was like. I knew people who had OD'd. Then we moved to New York, and drugs were even more accessible and easier to get. Bobbie and I lived in the Chelsea when the Sid and Nancy incident happened.
"Moving to Austin was a step in trying to get away from that world. Austin wasn't as out in the open as New York. We'd lived on the Lower East Side, where you walked down the street and everybody you passed wanted to sell you something. Austin was more private. It seemed clean. You had to seek drugs out if you wanted them. And we didn't.
"I remember when my mother first heard 'Heroin' by the Velvets, she broke my Velvet Underground record. I kind of fell into that whole rock & roll romanticism of the artist – hashish poets, people smoking opium, that stuff. I read the right books but maybe the wrong books, too. I knew it was risky and dangerous, but I went head on into it."
Por Vida
Escovedo couldn't get away from the drugs even when he wasn't doing them. Twice he dealt with drug problems of prominent bandmates. In 1996, he was first diagnosed with hep C for his own stint with intravenous drug use 20 years before. He went into treatment but suffered an adverse reaction to interferon and stopped. He didn't stop drinking, even though alcohol advances liver-disease progression. In 2003, Escovedo's hep C caused his collapse onstage in Arizona. He has since chosen an alternative holistic treatment. And abstinence from alcohol.
"I had a very hard time with [injecting] interferon," he says. "I had to inject this drug that was going to save my life. It was really hard. I would put it off. Wait a day, talking myself into it. The depression I went through as a result of the disease and the treatment was awful."
Doyle Bramhall, one of Austin's first-generation white bluesmen and Stevie Ray Vaughan's writing partner, also found a terrible irony in the traditional method of treatment for the virus that's beaten him three times. "It was so strange," he agrees, "looking at a syringe again. Injecting myself for treatment was like what got me in trouble in the first place."
"I knew I'd have to do it," reasons Tony Scalzo. "I'd sit there and look at [the needle] for about five minutes, then get the swab and say, 'Okay. Do it.' Then I'd try not to think about it until two days later when it hit me. I'd do my shot Monday and know that Wednesday morning, it would be all about 'dark house.' Closed, sleep all day, drink lots of liquids, try to eat, get outside for 10 to 15 minutes. Keep it simple; don't do anything."
"I only did [intravenous drugs] for a few months in '74, but that part of treatment was the worst: injecting myself," shudders Danny Crooks. "Every 'shot day' I'd flash back. It would take me a half hour to work myself up. I'd go in the bathroom and sit on the toilet and start five or six times before I'd stick it in. But I didn't want anyone else involved. I brought it on myself and wanted to get rid of it myself."
"One Pill-Popping Bitch'
"My tongue. Dry mouth. My hands and my feet cracked. Rashes."
Sarah Elizabeth Campbell ticks off her roster of side effects like a grocery list. Interferon treatment for hep C comes with myriad side effects, some mild and some so debilitating as to require additional medication. The side effects are so numerous that each case seems unique in its combination, yet all have a disturbing similarity.
"I lost a ton of hair," laments the seasoned singer-songwriter. "I used to have big, curly hair, and now it's straight. I could make peace with that because when I was a kid I always wanted straight hair. I was losing enough hair so that I found it in the bed and the shower. Sleeping was a horrible part. Ambien was my friend. I was one pill-popping bitch there for a while."
Campbell's bout with hepatitis C stands out among the others because she represents the percentage of those who most likely contracted it through a blood transfusion. Her mother's blood type was Rh negative, which meant that Campbell required multiple transfusions not long after birth. The virus developed with a particularly resistant edge, one that's forced Campbell to enter treatment "four or five times. They just can't kill mine.
"I was never a druggie; I was a chicken shit. In the period of time when people were shooting drugs, I wasn't into that at all," she explains, adding that injecting interferon didn't bother her, but the side effects were miserable.
"My memory. Forget marijuana, drugs, and alcohol. I thought I was losing my mind. I know we're older, menopause and all that, but this was something else."
The Politics of Hep C
Musician-physician Ron Byrd is quick to point out two things. First, most of the people he sees for hepatitis C are not musicians, and second, he does not specialize in treatment of hep C. That said, he does examine and diagnose hep C patients, sending them to gastroenterologists, such as Dr. Frachtman or Dr. Scott Becker, for biopsy and management of the virus. Dr. Byrd was one of the physicians interviewed for the Chronicle's 1998 story. His view of the virus includes blunt cautionary advice.
"When you're in the throes of a drug abuse problem, you don't always think about good choices," he states flatly. "Hopefully, musicians will steer away from substance abuse because it doesn't help their career and they find to their shock that using drugs doesn't help you write better songs. It's dangerous, and if people insist on making it part of their lives, they damn sure better not share needles.
"Another important point to make is that alcohol will accelerate hep C progression or damage," says the Prescott Curlywolf guitarist. "Your liver can tolerate significant insult through trauma, but what it can't tolerate is constant insult to the liver cells. That's when scarring and cirrhosis develops. That's the wrong time to find out you have hep C."
Byrd also notes an aberration in the statistics.
"About 20 percent of the people exposed to hep C will develop immunity to the virus and not go on to a chronic hepatitis C infection. For some people, their immune system takes care of it."
"I am among that lucky 20 percent," marvels Asleep at the Wheel frontman Ray Benson. "I got it through a tattoo needle. I went in after [Fabulous Thunderbirds bassist] Keith Ferguson and T.J. McFarland. I know T.J. got it. I think Keith had it. Now, I did intravenous drugs in the Sixties with a friend. We did heroin once. And he called me up when I went public, all apologetic for giving me hep C. I asked him his genotype, and he said he was a 2. I was a 1, so I didn't get it from him. That's why I'm pretty sure it was tattoos."
Like Escovedo, Benson stands at the forefront of the fight as a hep C poster child. He's vocal and proactive on the topic. He knows that how you contracted hep C isn't as important as being tested and treated for the disease and points out that a disproportionate number of Vietnam vets have hep C, as do elderly people.
"The perception is that it's a dirty disease," he says. "When I went public, I had an instance where the friend of a girl I was dating said, 'How can you go out with him? He's got AIDS.' I explained the facts, but to him, I was a leper. That doesn't bother me, but it does some people because of the connotation that you did IV drugs at some point.
"I had a terrible meeting with a banker when I was trying to raise money," Benson recounts. "He said, 'You want me to give money to people who abuse drugs?' And I said, 'Never mind.'
"The other sobering thought is that there are more hep C cases than AIDS cases. To be fair, hep C is a slower disease, but it's just as destructive. Then you have idiots like Pamela Anderson and Steven Tyler who come out with ridiculous statements about their hep C. Tyler said, 'I underwent chemotherapy for seven months, and I'm fine.' What kind of crap is that? Pamela Anderson told Larry King the consequences of hep C were that you can get 'psoriasis of the liver.'"
Good News, Bad News
"It's important to stress it's not just the musicians out there. They're a small slice of the people with hep C," assures Dr. Scott Becker, who jokes that he's "the research guy" at Austin Gastoenterology and another source interviewed in 1998. "People get it from all walks of life, and we cure a fair number of them. The conventional wisdom when I was in med school was that a scar on the liver never goes away. There's good evidence now that liver scars are reversible."
That is good news to those for whom the shot-and-pills approach works. Others, like Escovedo, chose less traditional means. "I feel herbs are the way to go. I feel so much lighter without the interferon in me. The herbs really make me feel like I'm cleansing myself. I know I haven't gotten rid of it, but I can maintain a positive life."
Tommy Shannon chose the alternative herbal route because, "I'm not a candidate for interferon. I take anti-depressants for clinical depression. A Chinese doctor has me on an herb regimen, and it seems to help a lot."
Shannon considers himself lucky because the disease "hasn't made me feel bad yet, knock on wood. But it could jump up and bite me on the ass any time."
Carol Mitchell, a clinical nurse specialist with Austin Gastroenterology cautions about relying solely on herbal treatments, noting that medical personnel "practice on evidence-based medicine and nursing. Alternative medicines generally are not as well researched. When it comes to liver disease, be careful what you put into your liver."
Mitchell does ascribe to the recommendation of milk thistle, however.
"Milk thistle, [is] an herb that's been around for hundreds of years and widely used in Europe," she acknowledges. "The problem is that it's not regulated by the FDA. You don't know how strong it is or how pure it is. That's one of the risks when you take an herbal supplement. However, lots of drugs are herb-based or come from the same chemical compound as plants, and there's lots of good evidence based on research that milk thistle will not hurt your liver."
After doing the hard treatments three times, Doyle Bramhall's hep C came back again. Like Shannon and Escovedo, he's chosen herbal treatment. "I had tests done three months after starting them. My levels were down, much better than they had been," he reports.
"What I've learned is that I'm not going to let this disease control me. I know there are things I can do that are common sense: don't drink, watch what I eat, don't eat beef because your liver has a hard time processing it, drink plenty of water. I feel better than I have in years, and I think it's because of the herbs. My heart goes out to anyone who goes in treatment. It's chemo. It's tough."
Sarah Elizabeth Campbell echoes Doyle Bramhall's empathy.
"It takes a while to get your strength back up after interferon," she says. "However long they tell you it will be to get that stuff out of you, multiply it by three. Honestly. It doesn't just go flying out of you. I can't believe how much I know about the liver now. I could write a book."
Taking Care of Business
"I would advise anyone who messed around back then, even if they think they're healthy, to check it," Tony Scalzo urges. "Take care of it while you're not symptomatic. Your liver doesn't tell you it's sick until it's damaged. And I believe it's going to get easier and easier to treat hep C."
"One, we need testing and screening. Two, we need research and development. That's my mantra," chants Ray Benson. "Ted Kennedy and Kay Bailey Hutchison co-sponsored a bill in Congress to allocate money for testing and screening. The one good thing George W. did is that Texas has one of the best networks for hep C screening and testing processes. It's a model, and nobody knows about it."
Locally, the Liver Foundation of Central Texas (www.lfct.org) offers free testing and assistance with treatment costs. San Antonio's Alamo Medical Research (www.alamomedicalresearch.com) is looking for hep C patients for trial medicines. Escovedo's Por Vida Foundation, intended for ongoing assistance for musicians living with hep C, is dormant.
"It's in a holding pattern," he explains. "My hope is to be able to concentrate on it soon. Maybe do another panel on it at SXSW. Alternative treatments are working for some people. They're discovering new things all the time. We need to keep people aware of the choices."
Dr. Ron Byrd is a little more circumspect while urging awareness and education. "We've discovered HIV and hepatitis C, but don't think there isn't something else on the horizon."
Danny Crooks gives a more personal view.
"Before I got sick with hepatitis C, I'd taken everything for granted. I let money influence how I acted. Now, I couldn't give a damn about anything other than the people who love me and helping other people. I never let my family leave the house without telling them I love them."
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Ichilov Gynecologist Suspected of Infecting Patient with Hepatitis C
http://www.haaretz.com
By Ran Reznick, Haaretz Correspondent
The Health Ministry is investigating suspicions that a gynecologist from Ichilov Hospital in Tel Aviv infected one of his patients with hepatitis C while performing a cesarean section on her in 2005.
Ichilov, a government-municipal hospital, said on Tuesday that in the wake of the suspicions, the doctor in question has stopped operating in the hospital.
According to information given to the patient's family, the doctor is a hepatitis C carrier, but the lab test that can ascertain whether the viruses carried by the doctor and the patient have the same genetic makeup has yet to be done.
The test is slated to be carried out within the next few days, and only afterward will it be clear whether the surgeon was the one who infected the woman.
Tests carried out at Ichilov show that she did not have hepatitis C while she was pregnant or during the C-section.
She was found to be carrying the disease a few weeks after giving birth; most of the time, the virus can only be detected in the blood a few weeks after infection.
The baby born after the C-section is healthy, but his mother now requires weekly shots, which can have side effects such as depression, hair loss and thyroid problems.
In addition, some 20 percent of hepatitis C patients suffer serious liver damage, a top doctor said. He said it was important to detect the disease early in order to treat it most efficiently and prevent others from being infected.
The suspicion that the gynecologist had infected his patient was first raised on September 17 before Ichilov director Prof. Gabi Barabash and Prof. Yosef Lessing, who heads its gynecology and maternity ward.
On that date, the attorney representing the patient - Doron Caspi, from the medical negligence firm Caspi Sror - asked the two Ichilov officials to act immediately, "in light of the supreme public importance of an urgent clarification to prevent additional instances of infection."
But it was only on Tuesday, after Haaretz requested information on the case, that Ichilov Hospital informed the estimated 50 women who had been treated by the doctor since December 2005 about the possibility of infection.
The hospital said the women had been offered the choice of getting examined immediately, or of waiting until Ichilov tells them the results of the pending lab tests.
The doctor in question began working at Ichilov last December, after spending about seven years as a gynecology intern at Sheba Medical Center, Tel Hashomer.
He also works for the Maccabi health maintenance organization.
The Health Ministry said on Tuesday that the chance of a woman being infected by the physician operating on her, if the doctor carries the virus, "is very small to negligible."
Ichilov said: "The type of virus the doctor carries is not transmitted through regular contact, but only through the transmission of blood or bodily fluids, and so the chance of infection during surgery, when the team is protected by gloves, is small."
Nonetheless, several articles published in medical journals over the last few years describe dozens of such incidents around the world.
The transmission of the hepatitis C virus takes place when the carrier's blood - for instance, through an open cut on his hand after the surgical glove tears - comes into contact with the patient's body.
According to these articles, hepatitis C is the most prevalent of the viral infections that medical teams transmit to their patients.
Caspi asked the Health Ministry and the deputy director of Ichilov Hospital on Monday to "act immediately" to locate the women who have been treated by the doctor.
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Life in Limbo
http://www.jacksonholenews.com
By Kelsey Dayton
Hepatitis-suffering father of two takes life day by day, waiting for liver transplant.
About half a dozen llamas took hay from the outstretched hands of two little girls on a chilly fall evening. The fading light made the blond hair on one bobbing head glow and reflected a burning red off the other.
Off to the side, a tired middle-aged man watched the girls dart among the animals, their breath coming out in faded puffs of steam.
“I’ve shot a moose, I’ve been a rock star, I’ve done it all,” Lou Centrella said, watching his daughters and animals. “But what matters most is the family.”
“Llama Louie,” a man known for his jovial spirit, constant energy and a herd of llamas that he used to lead tourists on camping trips, is only a shadow in this man. His cheeks are slightly sunken and his skin has a sallow look to it, not quite jaundiced. Llama Louie, who came to Jackson Hole in 1973 and earned the nickname he never could shake even after selling his business, has been replaced by Lou Centrella, or No. 14, on the ever-fluctuating regional liver waiting list.
It has been a hard seven and a half years of life in limbo for the Centrella family. They have become dependent on strangers who check the “organ donor” box on their driver’s license.
Mom, it’s kind of hard to pray for someone to die, Lou’s daughters told their mom, Susan, when she tried to explain why their dad was always sick.
“I said, ‘Girls, don’t pray for someone to die, pray that if someone does, their family will want to donate their organs,’” Susan said.
Good at denial
Seven years ago, Centrella exuberantly started a cabbage diet to melt away weight to get the best deal on life insurance – his wife was pregnant.
The couple had been married three years. Susan had been taken by his “ruggedly handsome” looks. He wooed her in the mountains, taking her hiking and camping, sometimes with llamas. Every morning, he serenaded her on his guitar.
Laughter filled their days. Lou was always telling jokes.
“He was a full Italian, so full of life and drama,” Susan said.
Sheepishly, Centrella called the insurance agent back after learning he had been rejected.
“OK, you caught me,” he said, explaining his radical diet.
That wasn’t the problem. Hepatitis C, a disease Centrella had never heard of, was the problem. Doctors speculated he had become infected during a knee surgery in the 1970s, before blood was screened for hepatitis. Centrella didn’t really believe them.
“I’m one of those guys that is real good at denial,” he said.
Centrella was put on drugs that made him feel sicker than the disease ever had. But soon they were ineffective.
Doctors told him he’d need a new liver – or a box.
They told Susan, who was tested and did not have the virus, not to talk about Centrella’s sickness. Hepatitis C, which is transferred through blood contact, had a similar stigma as AIDS.
Private people by nature, the Centrellas broke their silence about Lou’s disease in hopes of getting more people to be organ donors.
According to the United Network for Organ Sharing, Centrella is one of more than 17,000 people waiting for a liver in the United States. He is one of 92,000 people waiting for some sort of organ.
Lou, who wasn’t a donor himself, doesn’t blame people who aren’t. Most people don’t think about it, he said.
“I’m frustrated that the education is not going to happen in the time frame I need it to,” he said. “A lot of people are dying and going to die that don’t have to. A lot of livers and kidneys and hearts are going into boxes into the ground.”
A precious resource
Organs are an “extremely precious resource,” said Liz Roach, a nurse and director of professional education at Intermountain Donor Services in Salt Lake City.
“If everyone donated that could, we wouldn’t be in the pickle we are,” she said.
Because there are not enough organs to go to everyone in need, they are allocated based on how long a person has been on the waiting list, blood and tissue type, and also how sick a person is, she said.
“There is a window you have,” Centrella said. “You have got to be sick, but not too sick. That’s the bitch of it.”
While it won’t help their father, Lane and Mila have already told their parents they want to be organ donors.
“It’s kind of like recycling your body instead of recycling cans,” Lane said.
Centrella was starting to show symptoms when Susan gave birth to twin girls, Lane and Mila, seven years ago. He was tired all the time, leaving Susan to take care of the newborns on her own.
“A lot of our relationship has been directed by this disease,” Susan said.
Centrella started to itch so badly he would scratch himself until he bled. His abdomen swelled with a buildup of fluids, pushing on his other organs.
“It feels like your ribs are cracked,” he said.
Diuretics help drain it, but there is still constant pain.
“It feels like pulling a rake over the stomach,” he said.
Now there are the cramps – usually in his fingers and forearms, but sometimes his legs. They leave him writhing and sometimes screaming on the floor. Only weekly acupuncture offers relief. Every day he feels worse.
Sometimes the world seems fuzzy. Centrella will pick up his cell phone and point it at the TV, trying to change the channels.
He takes about 15 pills every morning to help keep the symptoms at bay.
Since they were born, Lane and Mila have known only the lethargic Louie who shuffles slowly across the room. The energetic man Susan married is rarely around.
“I miss him,” Susan said.
The girls have never heard Lou play guitar. They have never been camping. When they pitch a tent in the backyard, Lou has too much back pain to sleep in it with them.
Surgery can give hope
Jackson resident John Hess, who had a liver transplant about three years ago, knows what Centrella and his family are going through, as well as what they might face in the future.
Hess’ illness, like Centrella’s, lay dormant for years after he contracted it in a Navy hospital lab in 1971. By the time he was diagnosed, his liver was shutting down.
Hess and Centrella have talked briefly about what it is like to live life in a holding pattern.
If they were to talk more, Hess would tell him about falling into a coma twice. He would tell him about struggling to take just a step or two on his own to prove he would be strong enough to survive the surgery.
Hess has told him about what it is like to wake up in the No. 1 spot on the transplant list.
Hess still cries when he remembers Nov. 13, 2003. He went into surgery at 1 a.m.
He awoke with a new life before him. It’s strange, he says. All he wanted to do was swim. He wanted to swim in the lakes he had known when he was growing up in Minnesota. He wanted to swim in the Caribbean.
First he had to heal. Some people bounce back from transplant surgery within a week. Hess was rehospitalized with infection. He had lost so much muscle that it took him months to do things like walk up stairs.
He hasn’t gotten to swim, yet. But with no symptoms of hepatitis C, Hess plans to hit the places he awoke longing for.
“What was impressed upon me was the power of the hope that the idea of getting a transplant was able to give me,” he said.
The few llamas left in the Centrellas’ pasture are for when Lou is well. He doesn’t dream of swimming. He dreams of taking Lane and Mila camping with the llamas.
The llamas are the last pieces of hope the family clings to.
Loving Louie
Even Lou, ever the optimist, realized about three weeks ago at a checkup that he might not ever get a liver. But, if he doesn’t, maybe somebody else will because of him.
The Centrellas hope Lou’s story will encourage more people to become organ donors, so fewer people will die on waiting lists.
Susan’s breath doesn’t catch in her chest when the phone rings. She never thinks, even for a second, the ring could be the call that saves her husband.
Instead, she cherishes hearing Mila read her homework to Lou as he dozes in his recliner. She relishes the sound of Lane’s giggles when she makes him put on a plastic Halloween mask.
There was a time Susan thought her husband might not see his daughters off to their first day of school.
“This, the rest of the time, this is gravy,” she said.
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Survival from First Episode of Cirrhotic Ascites Is High
www.gastrohep.com
Survival from first episode of cirrhotic ascites is high, and is influenced by age, shows this month's Clinical Gastroenterology & Hepatology.
The International Ascites Club published the diagnostic criteria of refractory ascites, and hepatorenal syndrome.
Since this publication, there have been few studies assessing the natural history of ascites.
Dr Ricard Solà and colleagues from Spain defined the natural history of cirrhotic ascites.
The research team also identified prognostic factors for dilutional hyponatremia, refractory ascites, hepatorenal syndrome, and survival.
1-year survival after developing refractory ascites was 32% -- Clinical Gastroenterology & Hepatology
The researchers followed 263 consecutive cirrhotic patients for 41 months after their first significant ascites.
During follow-up 28% of patients developed dilutional hyponatremia, 11% refractory ascites, and 7% hepatorenal syndrome.
The researchers found that the 5-year probability of developing dilutional hyponatremia and refractory ascites was 37% and 11%, respectively.
The 5-year probability of developing hepatorenal syndrome development was 11%.
The team observed that the probability of survival at 1 and 5 years was 85% and 57%, respectively.
The team noted that independent predictors for survival were baseline age, baseline Child-Pugh score, and dilutional hyponatremia development.
The 1-year probability of survival after developing dilutional hyponatremia and refractory ascites was 26% and 32%, respectively.
The researchers found that the 1-year probability of survival after developing type 2 hepatorenal syndrome was 39%.
In contrast, the mean survival was only 7 days in those patients developing type 1 hepatorenal syndrome.
Dr Solà's team concludes, “The survival of cirrhotic patients with first episode of ascites is relatively high.”
“It is mainly influenced by age and Child-Pugh score at the time of ascites decompensation, as well as by dilutional hyponatremia development.”
“The probability of refractory ascites, and hepatorenal syndrome development is relatively low, but they are associated with a poor prognosis.”
Clin Gastroenterol Hepatol 2006: 4(11): 1385-94
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November 23rd, 2006
Esophageal Varices Are Prognostic in Hepatocellular Carcinoma
www.gastrohep.com
Esophageal varices are associated with a higher risk of death from bleeding in hepatocellular carcinoma patients, finds November's issue of Clinical Gastroenterology & Hepatology.
It has been suggested that clinically relevant portal hypertension may affect the management and prognosis of cirrhotic patients with hepatocellular carcinoma.
Nevertheless, the importance of the presence of esophageal varices in these patients has not yet been addressed formally.
Dr Eugenio Caturelli and colleagues from Italy evaluated the prevalence and prognostic relevance of esophageal varices in a large series of patients with hepatocellular carcinoma.
The prevalence of esophageal varices was evaluated in 1153 hepatocellular carcinoma patients who were consecutively referred to 10 Italian centers.
Survival was calculated from the time of hepatocellular carcinoma diagnosis until death or until the most recent follow-up visit.
Esophageal varices were found in 63% of patients -- Clinical Gastroenterology & Hepatology
The investigative team evaluated survival according to the presence or absence of esophageal varices.
The independent prognostic meaning of the presence of esophageal varices was evaluated further in a multivariate regression analysis.
The investigators found esophageal varices in 63% of patients.
The team observed that patients with varices showed significantly shorter survival times as compared with patients without varices.
The investigators noted that death as a result of bleeding was more common in patients with varices.
In multivariate analysis, the presence of esophageal varices was associated independently with poorer survival.
Dr Caturelli's team commented, “More than half of the patients with hepatocellular carcinoma have esophageal varices.”
“The presence of esophageal varices is associated with a higher risk of death from bleeding, and is an independent determinant of the patient's prognosis.”
“This variable should be taken into account in the diagnostic and therapeutic work-up of hepatocellular carcinoma patients.”
Clin Gastroenterol Hepatol 2006: 4(11): 1378-84
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Too Many Healthcare Workers Exposed to Bloodborne Viruses, UK
http://www.medicalnewstoday.com/
A new report from the Health Protection Agency shows that healthcare workers are still being exposed to bloodborne virus infections, even though such exposures are largely preventable. According to data collected by the Agency, eleven healthcare workers were infected with hepatitis C via needle stick injuries in the last eight years; two of these incidents were reported in the last 12 months.
The report entitled Eye of the Needle shows that even though a lot has been done to protect healthcare workers through the course of their work, the number of reported occupational exposures increased by 49% in three years; from 206 in 2002 to 306 in 2005. This rise could be due to increased awareness of the risks of needlestick injuries or a genuine increase in the number of injuries: either way th e report draws attention to the need for NHS Trusts to provide local protocols and information on the risk of bloodborne viruses in the work place and to ensure that healthcare workers are adequately trained on how to prevent injuries.
Just under half of those exposed were nursing professionals. However although doctors and dentists comprise a much smaller group of healthcare workers, they reported a similar number of injuries, which suggests they have a higher injury rate.
Dr Fortune Ncube who compiled the report for the Agency said, "These figures show us that there are still too many healthcare workers being exposed to hepatitis C, hepatitis B and HIV through the course of their work. Most needle stick injuries are preventable. It is crucial that interventions to prevent occupational exposure injuries, such as the use of retractable needles are examined."
On the whole, the report shows encouraging results on the implementation of national policies in the management of these infections, with the exception of Hepatitis C Guidelines on testing and follow-up. The report recommends improvements in the level of information that is collected on each incident. The current methods of gathering this information have worked well in identifying and dealing with incidents, but the report recommends that a more detailed surveillance system is established to provide better information.
Professor Pat Troop , Chief Executive of the HPA said "The HPA will continue to monitor these exposure incidents; however we also encourage NHS managers to ensure the guidance is followed so that staff are effectively protected."
-- This report includes all occupational exposures to bloodborne viruses in healthcare workers that were reported to the Health Protection Agency between 1 January 1997 and 31 December 2005 from 180 reporting centres, geographically scattered throughout England with four actively reporting centres in Wales and two in Northern Ireland . Reporting to the surveillance is voluntary. Therefore the data used in this release refers to a small number of hospitals (40 in total) that consistently reported exposures to the programme between 2002 and 2005.
-- 47% or 478 out of 1007 of exposures involved nurses and 41% or 409 out of 1007 involved doctors and dentists.
-- Hepatitis means swelling or inflammation of the liver. The most common causes of hepatitis are viral infections. Hepatitis C infection (also known as Hep C or HCV) is one such virus that can cause long-lasting infection and can lead to liver disease including liver cancer. In the absence of treatment it is estimated that around 15-20% of infected people clear their infections naturally within the first 6 months of infection. For the remainder, hepatitis C is a chronic infection that can span several decades and can be life-long.
-- The first documented case in the UK of a health care worker acquiring HIV following an occupational exposure was in 1984. Following this, a passive surveillance system was established, involving health care workers in England , Wales and Northern Ireland for exposures to HIV. This was changed to a more active surveillance system in July 1997, and was expanded to include hepatitis B and hepatitis C. There were no new cases of HIV in healthcare workers from HIV positive patients in 2005.
-- The full report can be accessed here
http://www.hpa.org.uk
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