The oral hepatitis C drug telaprevir (Incivek) will now carry a boxed warning about potentially fatal skin reactions in the wake of multiple deaths, its manufacturer said Wednesday.
via Hep C Drug Linked to Fatal Skin Reactions.
Oops.
Hepatology
CDC Recommends Hepatitis C Testing For All Boomers
One reason so many boomers are infected is that more than a few used injected drugs much earlier in their lives, says Dr. John Ward, who runs the CDC’s viral hepatitis division.
CDC Recommends Hepatitis C Testing For All Boomers : Shots – Health Blog : NPR.
Link to the CDC report below:
The Answer is 9.9%
From 1988 to 2008, the prevalence of NAFLD rose from 3.6% to 9.9% among children ages 12 to 18…
via Medical News: Fatty Liver Disease on Rise in Teens – in Meeting Coverage, DDW from MedPage Today.
Question: What is the prevalence of NAFLD in children ages 12-18?
Liver Risk Found with Arthritis Supplement
Causality was called very likely due to flavocoxid in three patients and possibly due to the agent in one patient, as that case was complicated by exposure to several other agents that may have caused the injury, including pregabalin (Lyrica), duloxetine (Cymbalta), and tizanidine (Zanaflex).
Hepatitis B on Rise in U.S. Immigrants
More than 1.3 million foreign-born residents of the U.S. are living with hepatitis B (HBV), according to a new estimate.
Spider Angioma — NEJM Images in Clinical Medicine
Compression of the central arteriole caused the entire lesion to blanch, and it quickly refilled once the compression was released This pattern of blanching and refilling characterizes spider angiomas, which are suggestive of liver disease.
For the underwriter who always wondered what one of these things looks like. For the geekiest underwriters, click on and take a look at the video. And for the underwriter who thinks she should have a Medical Doctor, the following is from the NEJM Resident E-Bulletin of 02.23.12.
Clinical Pearls
- What is the differential diagnosis of a subacute confusional state in a patient with liver disease?
The differential diagnosis includes five major syndromes: hepatic encephalopathy, Wernicke’s encephalopathy, alcohol withdrawal, occult seizures, and infection. Hepatic encephalopathy refers to an alternation in cognitive function that is secondary to a metabolic process caused by liver failure. Wernicke’s encephalopathy refers to the triad of gait ataxia, ophthalmoplegia and confusion caused by thiamine deficiency, commonly seen in chronic alcoholics. Alcohol withdrawal, occult seizures, and underlying infection may also cause a subacute confusional state in a patient with chronic liver disease.
Non-Alcoholic Fatty Liver Disease and Mortality
Conclusion: Non-alcoholic fatty liver disease was not associated with an increased risk of death from all causes, cardiovascular disease, cancer, or liver disease.
via Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study | BMJ.
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Acetaminophen OD More Deadly if Taken in Stages
Those who ingested more than 4,000 mg of acetaminophen in a single day spread out over more than one time point had a significantly higher mortality rate compared with those who overdosed at a single time point (37.3% versus 27.8%, P=0.025), according to Kenneth Simpson, MD, of the University of Edinburgh in Scotland, and colleagues.
The cohort analysis included 663 patients admitted with acetaminophen-induced severe liver injury from November 1992 through October 2008. About one-quarter (24.3%) overdosed in a staggered fashion, defined as taking at least two excessive doses separated by more than eight hours and adding up to more than 4,000 milligrams in one day. The rest of the patients ingested that much at a single time point.
Most of the patients who had a staggered overdose (58.2%) said that pain relief was the reason they repeatedly took an excessive dose. Another 34.3% said it was a suicide attempt.
Learn more at Acetaminophen Toxicity.
Personally I rarely take the stuff. It’s pure poison for the liver.
NEJM Resident e-Bulletin Teaching Topics 11.10.11
Alcoholic Hepatitis
Original Article
Glucocorticoids plus N-Acetylcysteine in Severe Alcoholic Hepatitis
E. Nguyen-Khac and Others
Severe acute alcoholic hepatitis is a life-threatening liver disease. Although glucocorticoid treatment is recommended and improves survival, the mortality remains high, with 35% of patients dying within 6 months.
Clinical Pearls
How does chronic alcohol consumption lead to hepatitis?
Chronic alcohol consumption increases intestinal permeability, worsens endotoxemia, stimulates Kupffer cells, and thus increases production of proinflammatory cytokines. High levels of tumor necrosis factor α (TNF-α) activate cell-death pathways and induce the production of reactive oxygen species, notably superoxide anions, by the hepatocyte mitochondria, leading to cell death.
Hepatitis C Now Bigger Killer than HIV
Nearly two days, no aftershocks, no earthquakes. Time to get back to underwriting!
A CDC review of death certificate data from 1999 through 2007 found that mortality due to hepatitis C virus HCV has risen dramatically, overtaking deaths due to HIV in 2006.
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