January 2, 2011

A New Meaning for “Antiviral”

Paul Sax • January 2nd, 2011

Paul E. Sax, MD is the Editor-in-Chief, Journal Watch HIV/AIDS Clinical Care and Clinical Director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital

January 1, 2011

Dear Lake Superior State University,

Clinicians are particularly concerned about this year’s “List of Words Banished from the Queen’s English for Mis-use, Over-use and General Uselessness“, as topping the list was the word, viral.

One nominator said:

Events, photographs, written pieces and even occasional videos that attracted a great deal of attention once were simply highly publicized, repeated in news broadcasts, and talked about for a few days. Now, however, it is no longer enough to give such offerings their 15 minutes of fame, but they must be declared to ‘go viral.’ As a result, any mindless stunt or vapid bit of writing is sent by its creators whirling around the Internet and, once whirled, its creators declare it (trumpets here) ‘viral!’ Enough already!

Unfortunately, those of us who make a living seeing patients could never survive without this precious word.

When we say to a patient, “It could be a virus”, or “You probably have something viral”, what we really mean is, “I realize you’re sick, but I don’t know what you have.”

And it’s not really a lie, because literally hundreds of viruses cause human illness — and our diagnostic tests for them for the most part stink.

So I am hoping that MDs, NPs, and PAs may be granted a lifetime exemption for viral’s banishment, and continue to use it in the rigorously scientific manner described above.

Thank you for considering, and Happy New Year.

Paul Sax
(on behalf of clinicians everywhere)


Hepatitis C infection, Cognition, and inflammation in an Egyptian sample

J Med Virol. 2011 Feb;83(2):261-6.

Farag NH, Rashed HA, Hassan M, Darweesh A, Shehata M, Hassanein T, Mills PJ.

Department of Epidemiology and Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.


Chronic hepatitis C (HCV) infection is associated with cognitive impairments which might be mediated through a secondary inflammatory cascade. Egypt has an unusually high prevalence of HCV monoinfections and is an ideal site for the study of the isolated effects of HCV infection. Therefore, in a hospital-based cross-sectional study based in Egypt, this study compared cognitive functioning and serum markers of inflammation in 11 HCV positive cases and 14 HCV negative controls. The Wisconsin Card Sorting Test was used to assess cognitive flexibility and the Brief Visuospatial Memory Test-Revised was used to assess learning and memory. Circulating levels of soluble tumor necrosis factor receptor II (sTNFR-II), monocyte chemotactic protein-1 (MCP-1/CCL2), and soluble CD14 (sCD14) were determined as indices of inflammation. HCV positive cases had higher levels of sTNFR-II (t = -3.5, P = 0.002). HCV positive cases also had significantly worse cognitive flexibility with higher number of total errors (t = -2.18, P = 0.04), and preservative responses (t = -2.12, P = 0.05), and lower number of conceptual level responses (t = 1.32, P = 0.04) on the Wisconsin Card Sorting test. In conclusion, results from this pilot study indicate that HCV+ patients have worse cognitive performance and somewhat greater inflammatory activity as compared to controls. The increased inflammation may be associated with the cognitive impairments observed in these HCV+ patients. J. Med. Virol. 83:261-266, 2011. © 2010 Wiley-Liss, Inc.

PMID: 21181920 [PubMed - in process]


Dietary History and Physical Activity and Risk of Advanced Liver Disease in Veterans with Chronic Hepatitis C Infection

Dig Dis Sci. 2010 Dec 28. [Epub ahead of print]

White DL, Richardson PA, Al-Saadi M, Fitzgerald SJ, Green L, Amaratunge C, Anand M, El-Serag HB.

Section of Health Services Research, Department of Medicine, Baylor College of Medicine, 2450 Holcombe Blvd (01Y), Houston, TX, 77021, USA, dwhite1@bcm.edu.


BACKGROUND: The role of customary diet and physical activity in development of advanced HCV-related liver disease is not well-established.

METHODS: We conducted a retrospective association study in 91 male veterans with PCR-confirmed chronic HCV and biopsy-determined hepatic pathology. Respondents completed the Block Food Frequency and the International Physical Activity questionnaires. We conducted three independent assessments based on hepatic pathology: fibrosis (advanced = F3-F4 vs. mild = F1-F2), inflammation (advanced = A2-A3 vs. mild = A1) and steatosis (advanced = S2-S3 vs. mild = S1). Each assessment compared estimated dietary intake and physical activity in veterans with advanced disease to that in analogous veterans with mild disease. Multivariate models adjusted for total calories, age, race/ethnicity, biopsy-to-survey lag-time, BMI, pack-years smoking, and current alcohol use.

RESULTS: Average veteran age was 52, with 48% African-American. Advanced fibrosis was more prevalent than advanced inflammation or steatosis (52.7% vs. 29.7% vs. 26.4%, respectively). The strongest multivariate association was the suggestive 14-fold significantly decreased advanced fibrosis risk with lowest dietary copper intake (OR = 0.07, 95% CI 0.01-0.60). Other suggestive associations included the 6.5-fold significantly increased advanced inflammation risk with lower vitamin E intake and 6.2-fold significantly increased advanced steatosis risk with lower riboflavin intake. The only physical activity associated with degree of hepatic pathology was a two-fold greater weekly MET-minutes walking in veterans with mild compared to advanced steatosis (P = 0.02).

CONCLUSIONS: Several dietary factors and walking may be associated with risk of advanced HCV-related liver disease in male veterans. However, given our modest sample size, our findings must be considered as provisional pending verification in larger prospective studies.

PMID: 21188525 [PubMed - as supplied by publisher]