April 18, 2013

New Phone App to Facilitate HIV Screening, Counseling, and Linkage to Care


NEW YORK, April 18, 2013 /PRNewswire-iReach/ -- The Johns Hopkins University School of Medicine, in collaboration with the Institute for Johns Hopkins Nursing, the American Academy of HIV Medicine (AAHIVM), and DKBmed, LLC, has announced the creation of an application (app) that brings essential features of the SCALE HIV™ program to iPhone, iPad, and iPod Touch devices. The app can be found at www.dkbmed.com/scale. The goal of the app is to enhance the ability of healthcare professionals to screen their patients with HIV infection and to link those with positive test results to appropriate counseling and treatment. A key component of the app is direct access to the AAHIVM ReferralLink database.

(Photo: http://photos.prnewswire.com/prnh/20130418/CG97551)

The new SCALE HIV app provides key information, including current CDC recommendations, guidance for counseling HIV-positive patients/partner notification, and how to access expert care. In addition to providing information on screening patients and counseling, the app also includes access to the AAHIVM ReferalLink Database, an essential tool for all clinicians.

Available for the first time on a mobile platform, the AAHIVM ReferalLink Database enables clinicians to find local HIV care providers simply by inputting a zip code and other customizable fields, such as provider expertise, services, and payment types. (This search tool can also be viewed at aahivm.org.)

"ReferralLinkconnects healthcare professionals with credentialed HIV care providers all over the country," said James M. Friedman, MD, Executive Director of the AAHIVM Corporate Scientific Advisory Board. "Making this feature available to more clinicians through an iPhone/Pod/Pad-enabled app will make it even easier for them to connect their patients with high-quality care quickly and efficiently. The app also enables clinicians to print or email referral information for their patients, helping to ensure patients will seek the treatment they need."

SCALE (Screening – Counseling – Linkage – Education) HIV was launched in 2011 to address key practice and knowledge gaps in HIV screening, counseling, linkage to care, and adherence to clinical guidelines among primary care clinicians. The program consists of a series of live symposia, webcasts and podcasts, and a Virtual Clinic where patients can be followed online (www.scalehiv.org).

"It is important to find effective and efficient ways to educate clinicians about HIV screening guidelines and to help them connect their patients to appropriate care," said Dean Beals, President and CEO of DKBmed, LLC. "Tools such as the SCALE HIV app go a long way to achieve those goals. The sooner we can start HIV treatment in the course of the infection, the better a patient's outcome is likely to be."

The U.S. Centers for Disease Control and Prevention recommend routine HIV testing for everyone between the ages of 13 and 64, but many healthcare professionals lack the tools to follow these guidelines. The CDC recently reports that youths ages 13 – 24 account for 25 percent of new HIV cases, but fewer than a third of this age group has been tested for the virus. Clinician inexperience or lack of training also means that many HIV-positive patients are not counseled effectively, if at all. Moreover, linkage to care for HIV-positive individuals is not optimal, especially among minorities and women.

SCALE HIV is supported by an educational grant from Bristol-Myers Squibb.

About DKBmed

DKBmed is an integrated, non-accredited, continuing medical education company operated by a team of experienced medical education. The goal of DKBmed is to provide health care professionals with effective medical education that closes identified knowledge/practice gaps to ensure optimal patient care.

Working with accredited providers, DKBmed develops a range of innovative educational programs and specializes in bringing new adult learning methodologies to the CME landscape. DKBmed was an early adopter of utilizing case scenarios with recorded and live actors, 3D animation, webcasts, podcasts, e-mail, and mobile phone applications for clinicians and patients. These forward-thinking approaches enable users to learn using the latest state-of-the-art techniques and to access educational programs in a manner that is most convenient and appropriate for them.

DKBmed's programs are accessible through the company's web site (www.dkbmed.com). They reach more than 30,000 clinicians specializing in a variety of areas, including neonatology, cystic fibrosis, infectious disease, dermatology, macular degeneration, rheumatoid arthritis, pulmonary disease, nephrology, hematology, transplantation, multiple sclerosis, gout, ulcerative colitis, depression, and pain management.

About the American Academy of HIV Medicine (AAHIVM)

The American Academy of HIV Medicine is a professional organization that supports the HIV practitioner and promotes accessible, quality care for all Americans living with HIV disease. Our membership of HIV practitioners and credentialed providers give direct care to more than three-fourths of HIV patients in the US.

Media Contact: Dean Beals DKBmed, 646-336-6495, dbeals@dkbmed.com

News distributed by PR Newswire iReach: https://ireach.prnewswire.com





IWPR Georgia Prompts Debate on Hepatitis C

The disease is close to epidemic scale, says participant in discussion on how to tackle hepatitis C with limited resources.

By IWPR team in Georgia - Caucasus

CRS Issue 683,

18 Apr 13

    An IWPR article on the high incidence of hepatitis C in Georgia prompted health officials, pharmaceutical industry representatives and pressure groups to meet and discuss strategies for combating the disease.

    In an article called Hepatitis Unchecked in Georgia, reporter Manana Vardiashvili found that just one in ten people with hepatitis C were receiving treatment as the drugs were so expensive.

    This important issue has often been passed over by local media, and is championed only the NGOs that work on it. In the course of interviews for the IWPR, it emerged that the different players – government officials, pharmaceutical companies, and pressure groups – felt left in the dark about what others were doing. IWPR’s Tbilisi office decided it would be a good idea to get them together in the same room to discuss some of the challenges and see whether they could be overcome.

    According to the most recent data available, around 200,000 people in Georgia are infected with this particularly virulent form of hepatitis. That is 6.7 per cent of the population. The National Centre for Disease Control and Public Health recorded 1,847 new cases last year.

    Georgia is shifting from the free healthcare system of the Soviet era to one based on private insurance. But despite the risk the hepatitis C poses to the nation’s health, neither the government nor the new health insurance companies are prepared to cover the high costs of testing and treatment. Only HIV-positive patients receive free medication for hepatitis C.

    A 24-week course of drug treatment costs 6,000 US dollars, a huge sum in a country where the average monthly wage is just over 400 dollars and the unemployment rate is 15 per cent.

    In the article, Health Minister David Sergeenko was quoted as saying that even if the government’s entire healthcare budget was given over to treating this one disease, “it still wouldn’t be enough”.

    Apart from the funding need, one of the problems with dealing with hepatitis C is the widespread perception that it spreads mainly among drug users sharing infected needles, so it is their own fault. But as Maia Zhamutashvili, a doctor from the Infectious Diseases, AIDS and Clinical Immunology Research Centre , said blood transfusions carried out in past years have been a common source of transmission. Tattoo parlours and acupuncture are also possible routes.

    At IWPR’s March 15 discussion event, Konstantin Rukhadze, executive director of the Hepa+ pressure group, said, “According to the only research that’s been done, which was nine years ago, only one in five [40,000 out of 200,000] infected people acquired the virus via the injection of narcotics.”

    Paata Sabelashvili of the Georgian Harm Reduction Network warns that the country is one step away from an epidemic, and he placed the blame squarely on the health ministry.

    “The Georgian health ministry says that the treatment of hepatitis C patients will cost the government 800 million laris [500 million dollars] and that they can’t afford to cover such high costs, because the ministry’s overall budget is only 650 million laris,” he said. “I think that reflects an irresponsible and uncaring attitude towards the thousands of people infected with hepatitis C.”

    During their discussion, participants looked at cases where the governments of developing countries have succeeded in significantly reducing the costs of treatment.

    “We have researched several international cases that could be applied to Georgia,” Rukhadze said. “All we need is the government to show the will. “We will continue advocating for increased public awareness and we’ll keep pushing until a national policy is developed.”

    As in other former Soviet states, Georgia’s prison system shows a particularly high incidence of hepatitis C, and other infectious diseases.

    In 2007, several prisoners filed a case at the European Court of Human Rights demanding that the state fully cover the costs of diagnosis and treatment. They won the case, and the government had to pay up.

    The prisons ministry does not have accurate statistics on infection rates, but it insists it has included treatment programmes in its plan for 2013.

    “Experts are working on a policy paper which will need to be backed up by comprehensive research in order to determine the right areas for intervention,” deputy minister Archil Talakvadze said at the meeting. “There’s a need to define what treatment systems are needed, and what funds will be required to implement the programme.”

    The IWPR event was covered by leading media outlets Radio Liberty (a report in Georgian is available here), and Radio Imedi, which ran a special programme on hepatitis C, with factual input and interviewees provided by IWPR’s Tbilisi office. In a later talk show (audio in Georgian here), Radio Imedi interviewed Sabelashvili from the Harm Reduction Network.

    After the meeting, Mariana Chokheli, harm reduction coordinator with the Open Society Georgia Foundation, said it had been valuable.

    “The pharmaceutical companies, government representatives, and journalists received some new information from one another, so such meetings must carry on,” she said. “In future, I'd like to see representatives from the Georgian drug agency and health ministry attending such meetings, although I know IWPR did invite them.”


    Dozens of Okla. dentist's patients positive for hepatitis


    W. Scott Harrington will appear at a revocation hearing before the Oklahoma Board of Dentistry on August 16.

    By CNN Staff

    April 18, 2013 -- Updated 1922 GMT (0322 HKT)

    (CNN) -- They went to the dentist to get a wisdom tooth pulled or perhaps have their jaw realigned. But they may have also contracted a blood-borne virus.

    Health officials in Oklahoma are notifying 57 patients who tested positive for hepatitis C and three patients who tested positive for hepatitis B after visiting oral surgeon W. Scott Harrington's office in Tulsa and a city suburb, according to a joint statement issued Wednesday by the Oklahoma State Department of Health and the Tulsa Health Department.

    At least one positive HIV result was also reported, but policy prohibits the Oklahoma State Department of Health from releasing the number if it's less than three.

    Health officials stress that it's not yet clear how many of the positive patients were exposed at Harrington's office, if any.

    "This is a complex investigation," state epidemiologist Kristy Bradley said in the statement. "The next phase will include more in-depth interviews of persons who test positive to determine the likelihood that their exposure is associated with their dental surgical procedure at the Harrington practice. We will certainly continue to keep the public informed as we learn more."

    More than 3,200 of Harrington's patients were screened for HIV, hepatitis B and hepatitis C after health investigators found sterilization violations and other infractions at the oral surgeon's office.

    Scores of Tulsa dental patients tested for hepatitis, HIV exposure

    "I will tell you that when ... we left, we were just physically kind of sick," Susan Rogers, executive director of the Oklahoma Board of Dentistry, told CNN earlier. "That's how bad it was, and I've seen a lot of bad stuff over the years."

    The dentistry board launched its probe after one of Harrington's patients came down with hepatitis C. That patient originally tested positive for HIV, too, but a subsequent test came back negative, the Tulsa Health Department said.

    Investigators raised a number of sterilization and "cross-contamination" alarms -- such as "unauthorized, unlicensed" employees using IVs to sedate patients and improper handling of needles.

    The outward cleanliness of the office belied the mess elsewhere, Rogers said, noting that "just basic universal precautions for blood-borne pathogens" weren't followed.

    Besides being "unlocked and unattended," the drug cabinet was rife with issues -- containing, for example, a drug that expired in 1993, according to the official complaint filed before the state dental board. Other records showed that morphine had been used in patients throughout 2012, even though the dentist had not received a morphine delivery since 2009.

    Harrington voluntarily surrendered his dental license on March 20. He will appear at a revocation hearing before the Oklahoma Board of Dentistry on August 16. His attorney could not be immediately reached for comment.

    Dentist's office a 'perfect storm' for HIV, hepatitis exposure, health official says

    Not all patients who may have contracted a virus have been identified, state health officials said, noting this is the first round of testing results. And the tests used to diagnosis hepatitis and HIV are based on the body's immune system response to infection, so some results could have come back negative prematurely.

    "Persons who are tested prior to six months after exposure and are found to be negative should be tested again at six months after exposure to assure they are negative," the statement advised.

    Hepatitis C is a contagious liver disease that can lead to liver failure and death, according to the Centers for Disease Control and Prevention. Approximately 70% to 80% of people living with the virus do not have any symptoms. Hepatitis B is a similar liver disease that can range from a mild illness to a serious, chronic condition.

    Anyone who was treated at Harrington's dental practice should contact Oklahoma's patient information hotline between 8 a.m. and 5 p.m. at (918) 595-4500 with questions.


    Also See: Dozens of Oklahoma dentist's patients test positive for hepatitis (Reuters)

    Dozens of Oklahoma dentist's patients test positive for hepatitis

    By Steve Olafson

    OKLAHOMA CITY | Fri Apr 19, 2013 1:49am IST

    OKLAHOMA CITY (Reuters) - Blood tests conducted on patients treated at an Oklahoma oral surgery practice that has been closed over health concerns show that 57 have hepatitis C, three have hepatitis B and as many as three have HIV, the virus than can lead to AIDS, officials said on Thursday.

    Health officials said it will take more investigation - including interviews with each patient and blood tests of the remaining patients - before they can determine whether the viruses were contracted at the dental offices, an extremely rare occurrence.

    "Now the real disease detective work goes into effect," state health department spokeswoman Leslea Bennet-Webb said.

    Officials cannot be more specific about the number of patients who tested positive for HIV because of the state's confidentiality policy that restricts public disclosure of HIV cases involving fewer than three people, Bennet-Webb said.

    Health officials so far have screened 3,122 people who underwent oral surgery procedures at clinics operated by Dr Scott Harrington, a Tulsa oral surgeon who is accused of using improper sterilization techniques that may have exposed his patients to blood-borne viruses.

    Harrington agreed to close his Tulsa practice and a nearby satellite clinic last month. Health officials want 7,000 of his patients to have their blood tested.

    Harrington's attorney has said his client has an impeccable record with the state dentistry board, which has filed a 17-count complaint against the oral surgeon that accuses him of being a "menace to the public health" because of his unsanitary procedures.

    There are only three known cases in the United States of viruses being transmitted during dental procedures, according to Centers for Disease Control.

    (Reporting by Steve Olafson; Editing by Mary Wisniewski and Jackie Frank)


    HCV-infected patients bury heads in sand

    By Kirsty Oswald, medwireNews Reporter

    08 April 2013

    J Viral Hepat 2013; Advance online publication

    medwireNews: Researchers have found poor levels of knowledge about hepatitis C virus (HCV) among individuals with HCV mono-infection and HCV/HIV co-infection.

    Patients who were indifferent to the need for treatment or reported feeling ashamed of their HCV-positive status scored particularly badly in knowledge tests.

    Mamta Jain (University of Texas Southwestern Medical Center, Dallas, USA) and colleagues found that both mono- and co-infected patients scored under 50% in a knowledge test, which assessed understanding of HCV disease, transmission, and treatment.

    Among 292 respondents recruited through outpatient clinics, many reported fear about their infection, with 56.8% acknowledging that they were scared about their HCV status, and 31.7% feeling stigmatized by it.

    Worryingly, 18.0% thought that HCV does not cause health problems, 15.2% thought that they do not require treatment due to lack of symptoms, and 20.7% said feeling ashamed prevented them from seeking treatment.

    Knowledge scores were significantly lower among the 26.6% of patients who thought medication was unnecessary for HCV, than for those who did not endorse this belief, at a mean of 15.1 vs 17.5 out of 34, with a similar gap in knowledge between those who did and did not say they felt ashamed about HCV (15.3 vs 17.2).

    While knowledge levels were comparable between mono- and co-infected patients, co-infected participants had more knowledge about HCV treatment and about HIV, and perceived less stigma from HCV. The authors suggest this may be due to their ongoing HIV care, and that these patients may perceive their HIV-positive status as more stigmatizing than HCV.

    Additionally, 87 patients took an abridged version of the survey before and after a 1-hour education session designed to improve knowledge and attitudes regarding HCV. The authors found that while this did not lead to changes in the respondents' attitudes, it did increase their mean knowledge score from a mean of 17.2 to 23.3 points out of 34.

    "However, re-education and ongoing support may be necessary to maintain patients' knowledge level about HCV," say Jain and colleagues, writing in the Journal of Viral Hepatitis.

    "There also remains a need to develop interventions that could specifically modify attitudes towards HCV treatment," they add.

    Despite effective treatments, which can lead to high rates of sustained virological response, many mono-and co-infected HCV patients fail to get treatment, the authors explain.

    "Future studies are needed to effectively change attitudes and determine whether those changes will affect health behaviour among mono-infected and co-infected populations," they conclude.

    medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

    Free abstract


    HCV infection alone not linked to diabetes risk

    By Ingrid Grasmo, medwireNews Reporter

    15 April 2013

    Am J Gastroenterol 2013; Advance online publication

    medwireNews: Individuals with hepatitis C virus (HCV) infection are at increased risk for developing Type 2 diabetes only if they have elevated alanine aminotransferase (ALT) levels, show study findings published in the American Journal of Gastroenterology.

    The authors dismissed the results of previous studies showing a direct association between anti-HCV antibodies at baseline and higher incidence of Type 2 diabetes at follow-up.

    In total, 2472 individuals from the electoral register of a town in Southern Italy were randomly selected and followed up over a 20-year period in 1985, 1992, and 2005. At each time point, individuals filled in a questionnaire and gave a blood sample to measure blood glucose and other serum variables including ALT. Anti-HCV antibodies were measured at the first and second timepoints.

    Authors Giovanni Misciagna (IRCCS Savierio de Bellis, Bari, Italy) and colleagues found a higher prevalence of diabetes in patients with anti-HCV antibodies in 1985 and 1992. Furthermore, patients with anti-HCV antibodies had a higher incidence of Type 2 diabetes during 1985-1992 compared with 1992-2005.

    Regression analysis controlling for gender, age, BMI, and ALT revealed no direct association between Type 2 diabetes and anti-HCV antibodies. However, Type 2 diabetes was associated with increased ALT at baseline. Indeed, HCV was shown to be associated with a 1.47-fold significantly increased risk for Type 2 diabetes only if ALT was elevated compared with negative HCV and ALT status.

    The same direct association between anti-HCV antibodies and Type 2 diabetes in the presence of elevated ALT was also observed when the authors used changes in blood glucose levels instead of incident cases of Type 2 diabetes.

    "Increased ALT values may be due to either HCV or conditions such as metabolic syndrome or steatohepatitis independently from HCV, conditions that could cause insulin resistance and then [Type 2 diabetes]," say the researchers.

    medwireNews (www.medwirenews.com ) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

    Free abstract


    Daclatasvir/asunaprevir effective in difficult-to-treat HCV populations

    Suzuki Y. J Hepatol. 2013;58:655-662.

    April 5, 2013

    Most patients with chronic hepatitis C who had been ineligible for or nonresponsive to interferon-based treatment benefited from dual therapy with daclatasvir and asunaprevir in a recent study.

    In an open-label, phase 2a study, researchers administered 24 weeks of dual oral therapy with 60 mg NS5A replication complex inhibitor daclatasvir (DCV) once daily and 200 mg NS3 protease inhibitor asunaprevir (ASV) twice a day to 43 Japanese patients aged 20 to 75 years with chronic HCV genotype 1b. The cohort included 21 null responders and 22 who had been ineligible or intolerant to previous therapy with pegylated interferon-alfa and ribavirin (PegIFN-a/RBV).

    Thirty-six participants completed therapy. At 4 weeks, more patients in the intolerant/ineligible group had achieved undetectable HCV RNA levels than null responders, with mean RNA reductions of 5.4 log10 IU/mL among intolerant/ineligible patients and 5.6 log10 IU/mL for null responders. All participants had undetectable HCV RNA levels after 8 weeks. Sustained virologic response (SVR) at 12 and 24 weeks after completion of treatment occurred in 76.7% of the cohort (90.5% of null responders and 63.6% of intolerant/ineligible participants).

    Virologic breakthrough occurred in three intolerant/ineligible participants, along with four relapses after treatment. No null responders experienced relapse or virologic breakthrough. Investigators observed no associations between breakthrough or relapse and factors including gender, IL28B genotype, age, HCV RNA level at baseline, fibrosis stage and reasons for previous treatment ineligibility.

    Common adverse events, all typically mild, included headache, nasopharyngitis, diarrhea and increases to ALT/AST. Five patients experienced serious events, and three discontinued treatment for hyperbilirubinemia or transaminase elevation.

    “Dual oral therapy with daclatasvir and asunaprevir elicited rapid clearance of detectable HCV RNA and achieved high rates of SVR in two difficult-to-treat patient populations,” the researchers concluded. “These results confirm initial findings that HCV genotype 1b infections can be cured with daclatasvir combined with asunaprevir, without PegIFN-a/RBV.

    “Further research will assess the benefits of this and other [direct-acting antiviral] combinations in larger and more diverse patient populations.”

    Disclosure: See the study for a full list of relevant disclosures.


    Consumers Urged to Avoid Ginkgo in Wake of New Cancer Concerns

    CSPI Downgrades Safety Rating of Common Supplement Ingredient

    April 18, 2013

    Consumers should avoid Ginkgo biloba, a common ingredient in dietary supplements, herbal teas, and some energy drinks, based on a new study from the government's National Toxicology Program that found "clear evidence" that the ingredient caused liver cancer in mice and "some evidence" that ginkgo caused thyroid cancer in rats. That is the advice of the Center for Science in the Public Interest, which today downgraded ginkgo from "safe" to "avoid" in its Chemical Cuisine guide to food additives.

    "Ginkgo has been used in recent years to let companies pretend that supplements or energy drinks with it confer some sort of benefit for memory or concentration," said CSPI executive director Michael F. Jacobson. "The evidence for those claims has been dubious, at best. The pretend benefits are now outweighed by the real risk of harm."

    Ginkgo is often sold as a supplement on its own by companies such as NatureMade, Nature's Bounty, GNC, and other companies, or as one of several ingredients in supplements marketed as memory aids. It is or has been used in energy drinks such as Rockstar, Crunk, Hansen's Energy Pro, Guru, and Steven Seagal's Lightning Bolt. The Food and Drug Administration has sent warning labels to several drink companies, including Rockstar, stating that ginkgo is not generally recognized as safe, or GRAS, for use in food, though it is legal as an herbal supplement.

    Researchers at the NTP gave male and female rats dosages of Ginkgo biloba extract five times a week for two years. The NTP is an interagency program connected to the Department of Health and Human Services and the National Institutes of Health. It is headquartered at the National Institute of Environmental Health Sciences in Research Triangle Park, NC.

    "We conclude that Ginkgo biloba extract caused cancers of the thyroid gland in male and female rats and male mice and cancers of the liver in male and female mice," the researchers stated.


    Liver disease: Understanding it will enable the provision of better treatment

    Posted By News On April 18, 2013 - 2:30pm

    In this prospective study, led by Dr Richard Moreau, INSERM Research Director (Mixed Research Unit 773 "Centre de Recherche biomédicale Bichat-Beaujon"; INSERM/Université Paris Diderot) who is also a practitioner attached to the Hepatology Department of the Beaujon Hospital (AP-HP), researchers studied a cohort of 1343 patients from 12 European countries.

    The results, published in the learned journal Gastroenterology, describe, for the first time, the specific profile of sufferers from this syndrome that is associated with cirrhosis. This also makes it possible to more clearly define the actual rules of attribution of the organs in those most severely affected, for whom there is a high risk of early death.

    Cirrhosis is an irreversible liver disease. It is characterised by chronic inflammation that destroys the liver cells and produces anarchic regeneration in the form of nodules. The disease causes the liver to lose function and is accompanied by multiple complications. When these complications manifest (bleeding in the digestive tract, bacterial infection, accumulation of liquid in the abdomen, etc.), this is known as decompensated cirrhosis and the patients are hospitalised.

    A certain number of these patients quickly develop a syndrome characterised by acute liver failure and/or failure of other vital organs1 (ACLF – acute-on-chronic liver failure). The syndrome is associated with a high risk of death at one month and no diagnostic criteria were clearly established hitherto that might make it possible to describe the condition.

    Through a consortium , the researchers in Mixed Research Unit 773 "Centre de Recherche biomédicale Bichat-Beaujon" (INSERM/Université Paris Diderot), analysed data from 1343 patients hospitalised due to acute cirrhosis complications between February and September 2011 in 29 Hepatology Departments in 12

    European countries . This enabled them to define robust diagnostic criteria for ACLF, indicating that one-third of the patients enrolled in the study had developed this syndrome.

    The researchers noted that, compared to patients not suffering from ACLF, those who developed acute failure of an organ or organs were younger, were most frequently prey to alcoholism, suffered from a larger number of bacterial infections and had higher levels of white blood cells, as well as other markers of organ inflammation.

    Quite unexpectedly, failure was most severe in patients without a previous history of cirrhosis complications. A high number of organ malfunctions (liver, kidneys, brain) were observed in these patients, including white blood cells in the blood and a mortality rate within one month of admission to hospital that was15 times greater than in patients who had a previous history.

    "The identification of the criteria to define acute failure of an organ or organs enabled us to show that this is a separate syndrome from cirrhosis complications. In addition to organ failure and the high associated mortality, the development of the disease depends on the patient's age and medical history", explains Richard Moreau, INSERM Director of Research, and the Principal Investigator for the study. "We hope to be able to better identify those at risk of early death in order to improve their treatment. Furthermore, these results could lead to improving the current rules for assigning organs for grafting in the severest cases", he concludes.

    Source: INSERM (Institut national de la santé et de la recherche médicale)


    Increased incidence of orthopedic fractures in cirrhotic patients: A nationwide population-based study

    Journal of Hepatology
    Volume 58, Issue 4 , Pages 706-714, April 2013

    Chia-Fen Tsai, Chia-Jen Liu, Tzeng-Ji Chen, Chi-Jen Chu, Han-Chieh Lin, Fa-Yauh Lee, Tung-Ping Su, Ching-Liang Lu

    Received 18 June 2012; received in revised form 28 November 2012; accepted 1 December 2012. published online 11 December 2012.


    Background & Aims

    Hepatic encephalopathy (HE) is a reversible neuropsychiatric disorder in cirrhotic patients. The cognitive dysfunction and increased accidental falls in HE and osteodystrophy in cirrhotic patients may contribute to orthopedic fractures. This study investigated the fracture incidence and risk factors in cirrhotic patients with HE.


    In total, 3764 cirrhotic patients with HE were identified from the Taiwan National Health Insurance database between 2000 and 2009. The fracture incidence of the HE patients was compared with that of 3764 age-, sex-, and comorbidity-matched cirrhotic patients without HE and non-cirrhotic controls. Cox proportional hazard models were used to estimate the risk of fracture in the HE patients.


    Cirrhotic patients with and without HE had comparable increased risks of fracture (p <0.05) and cumulative incidences of fracture than controls (log-rank p <0.001). The estimated fracture rates were 7.09% for the HE group, 7.72% for the cirrhosis without HE group, and 4.05% for the controls, during the 18-month follow-up. The HE group had a higher incidence rate of skull fractures (IRR=2.61, 95% CI 1.04–6.57), but a lower rate of upper limb fractures (IRR=0.45, 95% CI 0.29–0.70) than the cirrhosis without HE group. Alcoholism, heart failure, and cerebrovascular disease were associated with increased risk of fracture in HE patients.


    Cirrhotic patients, with or without HE, are at an increased risk of orthopedic fractures. Skull fractures, rather than fractures in weight-bearing bones, are more frequently observed in HE patients, particularly those with comorbidities.

    Abbreviations: HE, hepatic encephalopathy, IRR, incidence rate ratio, CI, confidence interval, NHI, National Health Insurance, ICD, International Classification of Diseases, DM, diabetes mellitus, HR, hazard ratio

    Keywords: Cirrhosis, Injury, Neuropsychiatric syndrome


    Vitamin B12 supplementation improves rates of sustained viral response in patients chronically infected with hepatitis C virus

    Gut2013;62:766-773 doi:10.1136/gutjnl-2012-302344


    Original article 

    Alba Rocco1, Debora Compare1, Pietro Coccoli1, Ciro Esposito2, Antimo Di Spirito2, Antonio Barbato3, Pasquale Strazzullo3, Gerardo Nardone1

    + Author Affiliations

    Correspondence to Professor Gerardo Nardone, Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples “Federico II”, via Pansini 5, 80131 Naples, Italy; nardone@unina.it

    Contributors AR, DC, GN: study concept and design and drafting of the manuscript. AR, DC, PC, CE, ADS: acquisition of data. AR, AB: analysis and interpretation of data; statistical analysis. PS, GN: critical revision of the manuscript for important intellectual content.

    Revised 5 June 2012

    Accepted 6 June 2012

    Published Online First 17 July 2012


    Background In vitro, vitamin B12 acts as a natural inhibitor of hepatitis C virus (HCV) replication.

    Objective To assess the effect of vitamin B12 on virological response in patients with chronic HCV hepatitis naïve to antiviral therapy.

    Methods Ninety-four patients with chronic HCV hepatitis were randomly assigned to receive pegylated interferon α plus ribavirin (standard-of-care; SOC) or SOC plus vitamin B12 (SOC+B12). Viral response—namely, undetectable serum HCV-RNA, was evaluated 4 weeks after starting treatment (rapid viral response), 12 weeks after starting treatment (complete early viral response) and 24 or 48 weeks after starting treatment (end-of-treatment viral response) and 24 weeks after completing treatment (sustained viral response (SVR)). Genotyping for the interleukin (IL)-28B polymorphism was performed a posteriori in a subset (42/64) of HCV genotype 1 carriers.

    Results Overall, rapid viral response did not differ between the two groups, whereas the rates of complete early viral response (p=0.03), end-of-treatment viral response (p=0.03) and SVR (p=0.001) were significantly higher in SOC+B12 patients than in SOC patients. In SOC+B12 patients, the SVR rate was also significantly higher in carriers of a difficult-to-treat genotype (p=0.002) and in patients with a high baseline viral load (p=0.002). Distribution of genotype IL-28B did not differ between the two groups. At multivariate analysis, only easy-to-treat HCV genotypes (OR=9.00; 95% CI 2.5 to 37.5; p=0.001) and vitamin B12 supplementation (OR=6.9; 95% CI 2.0 to 23.6; p=0.002) were independently associated with SVR.

    Conclusion Vitamin B12 supplementation significantly improves SVR rates in HCV-infected patients naïve to antiviral therapy.