Matt's Blog

Syringe probe fuels kins' pain
BY PATRICK WHITTLE | patrick.whittle@...
9:59 PM EST, December 8, 2007
When the state urged patients of Dr. Harvey Finkelstein to get tested for
exposure to blood-borne diseases due to the doctor's reuse of syringes, it only
deepened the painful questions nagging the family of Peter Cicero.
The Bayville man had lived with HIV for 22 years before he died at 49 in 2005 of
complications from hepatitis C. The family has never known how Cicero contracted
hepatitis.
Now, they are following closely the investigation of Finkelstein that has left
them with unanswered questions, and they are troubled by the three years it took
the state Department of Health to notify the public of the potential exposure to
blood-borne diseases including hepatitis.
Family members said they hope the investigation and hearings will shed some
light on why the state took so long.
"My feeling is he should not be allowed to hurt anyone else," said Cicero's
father, Vincent Cicero of Bayville.
Peter Cicero went to Finkelstein in 2000 to relieve chronic back pain.
there, his problems got worse, according to court papers in Cicero's malpractice
lawsuit settled in 2004.
Cicero got a $975,000 settlement after a spinal procedure by Finkelstein left
him partially paralyzed. Finkelstein did not admit responsibility for the
paralysis, according to court papers.
Cicero, an artist and landscaper who lived in East Hampton, spent his final
years in constant pain, his family said. His right hand, the same hand he used
to create a painting that hangs in his father's living room today, became
useless, and his right eye began to droop, according to the lawsuit.
Symptoms worsened and Cicero moved back in with his parents in Bayville in 2002.
Another of his doctors at the time, Dr. Mark Kaplan, diagnosed him with
hepatitis C in 2003. Two years later, he died of "hepatitis C cirrhosis,"
according to the death certificate.
Although Cicero was a patient of Finkelstein's during the years the state has
indicated it is investigating whether the reused syringes transmitted disease,
he had died by the time the investigation began. So his family will never know,
they say, how he contracted the virus. Health officials have said the chance of
contracting it through a reused syringe is very small, though they say at least
one confirmed case of hepatitis C was transmitted that way through Finkelstein's
practice.
Referring to Cicero's paralysis after the injection for back pain, Kaplan, who
treated Cicero until his death, said in an e-mail to Newsday: "Hopefully
measures will be taken to safeguard other patients who have suffered similar
tragedy." Now doing HIV research at the University of Michigan, Kaplan declined
to discuss the case in detail.
But his own records indicate that in 2003, three years after he was a patient of
Finkelstein's, Cicero was diagnosed with hepatitis C. Records include a signed
statement Kaplan filed with North Shore University Hospital, where he worked,
after treating Cicero. The hospital authenticated the statement for Newsday.
In it, Kaplan considered the possibility that Cicero might have contracted
hepatitis through the spinal procedure. "He never had hepatitis C in the past
and it was presumed that the same needles that injured his spinal cord may have
given him hep C," the statement said.
Kaplan also wrote an e-mail to Cicero's family noting that according to Cicero's
medical charts "before he had his catastrophic spinal cord injury, his hepatitis
C tests were negative. This makes me suspect that this virus came with the
injury as well, although there is no way for me to prove this."
State officials said they have discussed the Cicero case, but would not comment
further.
Finkelstein, through a spokesman, declined to comment.
Without answers, the family hopes that at least the state investigation results
in stricter infection control standards for doctors and stiff penalties for
Finkelstein.
"You pack it away and there's this emotional rush that takes you back to a time
and place and you don't want to go there," Vincent Cicero said.
The state has asked all of Finkelstein's patients from 1994 to January 2005 to
get tested for hepatitis and HIV because the doctor reused syringes. Cicero's
family requested, and received, a copy of a letter the state sent to
Finkelstein's patients in November advising them to get tested. The family has
not had any other contact with state health officials, Vincent Cicero said.
Peter Cicero's sister, Roxann Kellermann of Syosset, said the news about the
Finkelstein investigation reminded her of her brother's suffering. Vincent
Cicero said he hopes his son's example will prompt the remaining Finkelstein
patients to get tested and treated if they need it.
"There are treatments if caught early enough," he said. "It's very important for
the public to be aware that they might have been exposed and they need to get
tested."
http://www.newsday.com/news/local/ny-licice1209,0,1500219.story

Note: forwarded message attached.
walk in peace.
brenda

Novel HCV Polymerase Inhibitor VCH-759 Monotherapy Demonstrates Promising
Antiviral Activity
In an attempt to improve sustained treatment response rates in people with
chronic hepatitis C, researchers continue to explore new directly targeted
antiviral agents.
Data on one such agent, VCH-759, were reported in a late-breaker presentation at
the 58th Annual Meeting of the American Association for the Study of Liver
Diseases in Boston (November 2-6, 2007).
VCH-759 is a novel orally bioavailable non-nucleoside inhibitor of HCV
RNA-dependent RNA polymerase. In laboratory studies to date, it has demonstrated
activity against genotype 1a and 1b HCV replicons at sub-micromolar
concentrations
Investigators undertook a multiple ascending-dose study to assess the effect on
HCV viral kinetics, viral resistance, pharmacokinetics, safety, and tolerability
of VCH-759 given as monotherapy for 10 days, with a 14-day follow-up period.
In this trial, 3 cohorts of treatment-naive chronic hepatitis C patients with
HCV genotype 1 received either placebo or VCH-759 at doses of 400 mg
three-times-daily, 800 mg three-times-daily, or 800 twice-daily. In total, 32
subjects were enrolled and completed the study (9 each in the placebo and the 2
three-times-daily VCH-759 dose groups; 5 in the twice-daily dose group).
HCV viral load was determined using the Roche Amplicor assay with a lower limit
of quantification of 600 IU/mL. VCH-759 plasma levels were assessed over 6 hours
for the three-times-daily regimen and over 12 hours for the twice-daily regimen
on days 1 and 10, and daily, prior to the morning dose, on days 1 to 11.
Results
. VCH-759 was rapidly absorbed, with peak plasma levels at day 1 of 1857 ng/mL
for the 400 mg three-times-daily dose, 3675 ng/mL for the 800 mg
three-times-daily dose, and 4627 ng/mL for the 800 mg twice-daily dose.
. All participants experienced a greater than 1 log reduction in HCV RNA, with
values ranging from 1.4 to 2.6 log10 for the 400 mg three-times-daily dose, 1.5
to 2.9 log10 for the 800 mg twice-daily dose, and 1.2 to 3.3 log10 for the 800
mg three-times-daily dose.
. The mean maximal decreases in HCV RNA were 1.9 log10 for the 400 mg
three-times-daily dose, 2.3 log10 for the 800 mg twice-daily dose, and 2.5 log10
for the 800 mg three-times-daily dose.
. VCH-759 trough plasma levels before the morning dose were higher than the
90% inhibitory concentration (420 ng/mL) between days 2 and 11 for the 800 mg
three-times-daily dose and between days 2 and 7 for the 800 mg twice-daily dose.
. VCH-759 was well tolerated, with the most frequent adverse events being
gastrointestinal disorders reported in both the active drug and placebo groups.
Conclusion
VCH-759 achieved a 2 log10 or larger decline in HCV RNA at doses of 800 mg
[three-times-daily] and [twice-daily]," the investigators concluded. "VCH-759
was well tolerated with no serious adverse events and no discontinuation."
They added that genetic sequencing of NS5B is ongoing, and recommended that,
"Further studies combining VCH-759 with current therapies are warranted."
Ottawa Hospital, Ottawa, Ontario, Canada; Alamo Medical Research, San Antonio,
TX; McGill University Health Center, Royal Victoria Hospital, Montreal, Quebec,
Canada; Fundacion de Investigacion de Diego, San Juan, PR; Liver and Intestinal
Research Center, Vancouver, BC, Canada; University of Calgary, Calgary, Alberta,
Canada; ViroChem Pharma Inc, Laval, Quebec, Canada.
12/07/07
Reference
C Cooper, EJ Lawitz, P Ghali, and others. Antiviral activity of the
non-nucleoside polymerase inhibitor, VCH-759, in chronic Hepatitis C
patients:Results from a randomized, double-blind, placebo -controlled, ascending
multiple dose study. 58th Annual Meeting of the American Association for the
Study of Liver Diseases. Boston, MA, November 2-6, 2007. Abstract LB11.
http://www.hivandhepatitis.com/2007icr/aasld/docs/120707_b.html

Polymerase Inhibitor NM107 and Protease Inhibitor Boceprevir Show Enhanced
Anti-HCV Activity When Used in Combination
By Liz Highleymanz
As is the case with therapy for HIV, experts expect that combining directly
targeted small-molecule antiviral agents for the treatment of hepatitis C will
lead to better outcomes and reduced emergence of drug resistance.
In a study presented at the 58th Annual Meeting of the American Association for
the Study of Liver Diseases in Boston (November 2-6, 2007), researchers assessed
the combined effect of 2 experimental agents directed at different HCV molecular
targets:
. NS5B polymerase inhibitor NM107 (the active form of valopicitabine, or
NM238)
. NS3 protease inhibitor boceprevir (formerly SCH 503034).
Both valopicitabine and boceprevir have demonstrated anti-HCV activity when used
as monotherapy in clinical trials.
The investigators used a genotype 1b HCV replicon in laboratory cell cultures to
assess the combined antiviral activity of the 2 drugs. Potential
cross-resistance was evaluated using replicon variants carrying single protease
inhibitor resistance mutations (T54A, A156S, V170A, A156T) or a known polymerase
inhibitor resistance mutation (S282T). The selection of resistant cell colonies
was carried out for 3-4 weeks in the presence of various concentrations of one
or both drugs.
Results
. The combination of NM107 and boceprevir led to dose-dependent enhancement of
HCV replicon inhibition, compared with the effect of either drug alone.
. The combination demonstrated no cross-resistance and the suppression of
treatment-emergent resistance, as compared to monotherapy with either drug.
. In cross-resistance studies, NM107 showed similar antiviral activity (EC50
1.5-2 mcM) against wild-type and boceprevir-resistant replicons.
. Boceprevir showed similar activity (EC50 0.3-0.4 mcM) against wild-type and
NM107-resistant replicons.
. When tested against HCV with known resistance mutations, each compound
showed a 5-fold to 125-fold decrease in susceptibility.
. In selection experiments, the combination of NM107 and boceprevir
significantly reduced the frequency of drug-resistant colonies in a
dose-dependent manner, compared with either agent used alone.
Conclusion
"In these in vitro studies, the combination of the polymerase and protease
inhibitors showed enhanced anti-replicon activity with no cross-resistance and a
greater genetic barrier to resistance," the investigators concluded.
They added that, "These results support clinical evaluation of this combination
in patients with chronic hepatitis C."
Idenix Pharmaceuticals, Cambridge, MA; Schering-Plough Research Institute,
Kenilworth, NJ.
12/07/07
Reference
DN Standring, V Bichko, R Chase, and others. HCV Polymerase (NM107) and Protease
(boceprevir) Inhibitors in Combination Show Enhanced Activity and Suppression of
Resistance in the Replicon System. 58th Annual Meeting of the American
Association for the Study of Liver Diseases. Boston, MA, November 2-6, 2007.
Abstract 1391.
http://www.hivandhepatitis.com/2007icr/aasld/docs/120707_c.html

Experimental Polymerase Inhibitor HCV-796 is Safe and Effective in Combination
with PegIntron or Pegasys
HCV-796 is an experimental inhibitor of hepatitis C virus (HCV) RNA-dependent
RNA polymerase that has demonstrated antiviral activity across multiple HCV
genotypes when administered as monotherapy or in combination with pegylated
interferon alfa-2b (PegIntron).
In a study presented at the 58th Annual Meeting of the American Association for
the Study of Liver Diseases in Boston (November 2-6, 2007), researchers
evaluated the safety and antiviral efficacy of HCV-796 when administered with
either PegIntron or pegylated interferon alfa-2a (Pegasys), the other marketed
formulation.
This Phase I randomized, double-blind trial included adult chronic hepatitis C
patients who had not previously received treatment. The mean baseline HCV RNA
level was 6.4-6.5 log10 in each group; 71% of patients had HCV genotype 1.
In one group, patients were randomly assigned to receive 500 mg oral HCV-796 or
placebo every 12 hours for 14 days; in addition, all were assigned to receive
1.5 mcg/kg PegIntron 1 day before starting HCV-796 or placebo (day -1) and on
day 7. In the second group, the design was the same except the patients received
180 mcg Pegasys on day -1 and day 7. In each group, 12-16 patients were assigned
to receive HCV-796 with 1 type of pegylated interferon.
Results
. For both types of pegylated interferon, combination with HCV-796 reduced
plasma HCV RNA levels more than either PegIntron or Pegasys alone.
. At day 14, the mean reduction in HCV RNA for HCV-796 + PegIntron was 3.4
log10 vs 1.6 log10 for PegIntron alone.
. The mean reduction for HCV-796 + Pegasys was 3.7 log10 vs 1.1 log10 for
Pegasys alone.
. For both groups, antiviral activity indicated by mean HCV RNA reductions at
day 14 differed by genotype:
. Genotype 1: 2.9 log10 for HCV-796 + PegIntron and 3.2 log10 for HCV-796 +
Pegasys.
. Non-1 genotypes: 4.4 log10 and 4.7 log10, respectively.
. The combination of HCV-796 with either type of pegylated interferon was
generally well tolerated.
. Common adverse events in all groups were those typically associated with
interferon, including headache, chills, and myalgia.
Conclusion
"The combination of HCV-796 with either [PegIntron] or [Pegasys] provides
similar antiviral activity across multiple HCV genotypes over 14 days of
therapy," the researchers concluded. "Results support clinical studies of more
long-term administration of HCV-796 with either [pegylated interferon] therapy.
ViroPharma Incorporated, Exton, PA; Wyeth Research, Collegeville, PA; Northwest
Kinetics, Tacoma, WA; Center for Clinical Trials Research, University of
Florida, Gainesville, FL.
12/07/07
Reference
S Villano, D Raible, D Harper, and others. Phase 1 evaluation of antiviral
activity of the non-nucleoside polymerase inhibitor, HCV-796, in combination
with different pegylated interferons in treatment-naive patients with chronic
HCV. 58th Annual Meeting of the American Association for the Study of Liver
Diseases. Boston, MA, November 2-6, 2007. Abstract 1302.
http://www.hivandhepatitis.com/2007icr/aasld/docs/120707_a.html

You'll Enjoy This !
Click on the link below and follow the instructions.
It's a good trick !
It is amazing!
http://www.quizyourprofile.com/guessyournumber.swf

Viral pathogenesis: Death by viroporin
Susan Jones
A paper recently published in Cellular Microbiology reports that viroporins of
hepatitis C virus (HCV), poliovirus and other animal RNA viruses induce
apoptosis in host cells.
Viroporins are present in tiny amounts in the virions of most enveloped animal
RNA viruses. Examples include Sindbis virus 6K protein, influenza A virus M2
protein, poliovirus 2B and 3A proteins, mouse hepatitis virus E protein, HIV Vpu
and severe acute respiratory syndrome coronavirus E protein. These small (around
100 amino acids), extremely hydrophobic proteins oligomerize to form pores in
host-cell membranes through which viruses can bud. Viroporins contribute to the
pathology of disease by altering membrane permeability and disrupting ion
homeostasis in cells.
Inspection of the structural features and hydrophobicity profiles of small
proteins encoded by HCV revealed two candidate viroporins, NS4A and p7. Using an
expression system that was based on Sindbis virus to mimic the expression of
viroporins during infection, the comparative effects of selected viroporins -
Sindbis virus 6K protein, influenza A virus M2 protein, poliovirus 2B and 3A
proteins, mouse hepatitis virus E protein and HCV p7 and NS4A proteins - on baby
hamster kidney (BHK) cells was evaluated. On expression, each protein that was
tested altered membrane permeability, which confirmed that these proteins are
bona fide viroporins.
Mouse hepatitis virus E protein and HIV Vpu had both previously been shown to
induce apoptosis, so Madan and colleagues looked for characteristic signatures
of apoptosis in BHK cells that expressed viroporins. All the viroporins induced
chromatin condensation, nuclear DNA fragmentation and activation of the key
apoptosis enzyme caspase 3, but the strongest pro-apoptotic response was induced
by HCV NS4A and poliovirus protein 2B.
Another intriguing link between viroporins and apoptosis is the reported
association of a fraction of HCV p7 and NS4A proteins with mitochondria. The
authors showed that HCV NS4A and poliovirus 2B colocalized with mitochondria and
that expression of other viroporins altered mitochondrial morphology and
distribution. Notably, the expression of all viroporins led to the release of
cytochrome c from mitochondria. Taken together, this evidence led the authors to
propose that viroporins activate apoptosis by the mitochondrial pathway. These
findings are all the more surprising given that poliovirus proteins 2B and 3A
suppress apoptosis in HeLa cells at low levels. It is possible that viroporins
have different effects depending on the level of expression and/or the host-cell
type.
The induction of apoptosis in host cells by viruses is common and could aid
virus spread. The next step in understanding the intriguing links between
viroporins and apoptosis will be to unravel the mechanisms by which viroporins
trigger apoptotic pathways and demonstrate that these findings are relevant
during infection.
References and links
ORIGINAL RESEARCH PAPER
1.. Madan, V., Castello, A. & Carrasco, L. Viroporins from RNA viruses induce
caspase-dependent apoptosis. Cell. Microbiol. 25 Oct 2007 (doi
10.1111/j.1462-5822.2007.01057.x)
http://www.nature.com/nrmicro/journal/v5/n12/full/nrmicro1801.html

Health commish grilled over syringe case
Access video at:
http://www.newsday.com/news/local/suffolk/ny-lifink1207,0,7950623.story

Hepatitis C: Progress Towards Vaccine?
Antibodies That Target The Hepatitis C Virus May Spur Creation Of A Hepatitis C
Vaccine
(WebMD) Scientists have discovered antibodies that target the hepatitis C virus
(HCV). The findings may lead to a preventive hepatitis C vaccine.
The hepatitis C virus can cause liver damage and can be deadly.
There is no hepatitis C vaccine. That's partly because "extreme variability" in
HCV makes the virus a difficult target, write Mansun Law, PhD, and colleagues.
Law works in the immunology department at the Scripps Research Institute in La
Jolla, Calif.
Law's team found antibodies that neutralize various forms of the hepatitis C
virus. They tested those antibodies against the HCV virus in mice.
The researchers injected the antibodies into some mice. For comparison, other
mice didn't get the antibodies.
After that, all of the mice were exposed to HCV. Six days later, the HCV virus
was gone from the mice that had received the antibodies, but the hepatitis C
virus lingered in the other mice.
The antibodies' effects against HCV faded with time, and high doses of the
antibodies were needed to curb HCV.
More work is needed, but the results are "favorable" for the prospects of
developing a hepatitis C vaccine, write Law and colleagues.
Their findings appear in today's advance online edition of Nature Medicine.
http://www.cbsnews.com/stories/2007/12/06/health/webmd/main3586966.shtml

More hepatitis cases follow LI needle scare, but relation unclear
MELVILLE, N.Y. - Authorities say they have found more hepatitis infections among
patients of a doctor accused of spreading the disease through slipshod injection
techniques. But it may never be clear whether the newly diagnosed cases are
linked to the doctor's practices.
The Nassau County Health Department says recent tests have found six hepatitis B
cases and six hepatitis C cases among Dr. Harvey Finkelstein's patients. State
Health Department spokeswoman Claudia Hutton says that because the virus can
mutate in people's bodies, it's too late for genetic tests to establish whether
the infections stemmed from Finkelstein's needle technique.
Health officials have said an earlier investigation showed the Long Island
anesthesiologist infected at least one person with hepatitis by plunging
syringes more than once into vials of medicine, contaminating the drugs.
Finkelstein has said he has stopped doing so.
http://www.newsday.com/news/local/wire/newyork/ny-bc-ny--at-riskpatients1206dec0\
6,0,6160551.story

Florida Hospital performs first paired organ transplant
Florida Hospital Transplant Center performed its first paired organ transplant
Friday.
Paired donation occurs when someone needing an organ transplant has an
individual willing to donate it, but the two are not a match. Information on
both individuals is entered into a database of other non-matching individuals
where doctors can match one pair with another pair in a similar situation. Then,
the individuals swap donors.
This relatively new concept is expected to make an additional 3,000 living donor
kidney transplants a year possible in the U.S.
This was the first time Florida Hospital Transplant Center had performed a
paired donor transplant. Matching a pair in Ohio with a pair in Titusville marks
the first time an institution in Florida performed a paired donation with
another state.
http://news.moneycentral.msn.com/provider/providerarticle.aspx?feed=ACBJ&date=20\
071207&id=7918607

Transplant offers boy hope of life without harsh drugs
MIAMI, Florida (AP) -- Kimberly Lindsey marvels that her 3-year-old son Merrick
doesn't need to take 10 different medicines anymore. He can safely frolic on the
playground among the germs that lurk there.
Two years ago, Merrick's liver suddenly shut down. Standard treatment would have
meant a full liver transplant and a lifetime on drugs to keep his body from
rejecting the new organ. The medication suppressing his immune system would have
raised his risk for infection and possibly damaged his kidneys.
Instead, Merrick underwent a rare and once virtually abandoned operation in
which a partial donor liver was attached temporarily to his failing liver.
His own liver regenerated, and the transplanted liver is shrinking and may
eventually waste away. He has been taken off the anti-rejection medication.
Seven children have had the operation at the University of Miami/Jackson
Memorial Hospital -- the only U.S. facility believed to be regularly performing
the surgery. Four of them are now off anti-rejection drugs and a fifth is close.
The procedure was first tried in the mid-1990s, but U.S. doctors thought the
chance of death or complications was too high. One patient who had the surgery
at the Miami hospital in 1998 remained hospitalized for three months because of
complications. Ultimately, his liver recovered and he too was taken off the
anti-rejection drugs.
Surgeons in England, France and Japan continued to do the procedure, and in
several cases had favorable results. Jackson's Dr. Tomoaki Kato was encouraged
by reports out of Europe. Since 2005, he has performed six partial transplants;
all have survived.
Health Library
a.. MayoClinic.com: Health Library
It's "time to revisit the procedure," said Kato, the hospital's director of
pediatric liver and gastrointestinal transplant program. "There's a great
benefit for the children and the technology has developed so much."
Still, some surgeons say they will stick with the traditional transplant until
they see more proof that the partial transplant is safe. The operation can take
more than 10 hours, twice as long as the standard transplant surgery, and is
more complicated, increasing risks to the patient. After surgery, a patient must
have multiple biopsies to see if his own liver is regenerating.
Dr. Charles Miller, director of liver transplantation at the Cleveland Clinic,
said that what concerns surgeons "is that you're taking a very sick patient and,
in most cases, you would rather do the simplest operation."
The liver, which cleans toxins from the blood, is unique among the body's organs
in its ability to regenerate, making the procedure possible. In some cases, the
liver can recover from acute, or sudden, failure on its own. But if the organ
doesn't recover fast enough, patients can suffer brain damage from the toxins if
they don't get a transplant.
For Lindsey, choosing the potentially riskier partial transplant for Merrick was
easy. Either road was going to be difficult, she said, and at least with the
partial transplant, the little boy had a chance to regain the use of his own
liver.
Little more than a year after the operation, Merrick's liver had regenerated
enough that Kato took him off his anti-rejection drugs. His transplanted liver
is shrinking and may eventually disappear. (In some patients, it is surgically
removed.)
"I can sit here and say my son is off. He's off everything," Lindsey said. "What
they did was a true miracle."
Because the operation is so rare, organizations like the United Network for
Organ Sharing and the American Liver Foundation do not track the number of
partial transplants performed or have specific guidelines for it.
Kato has created his own rough guidelines. He says children fare better with the
operation because their livers have better rejuvenating abilities than adults,
and he's only used it for cases of acute liver failure. Chronic liver problems,
like hepatitis or cancer, would not be cured with this procedure.
Using this criteria, the number of people who could benefit from this procedure
is limited. Fewer than 400 people got transplants for acute liver failure in
2006, about a fifth of them children, according to data from the Organ
Procurement and Transplantation Network.
The procedure is covered by insurance companies. Kato said the cost is roughly
the same as traditional transplants. He also noted the long-term health care
savings: After patients get off anti-rejection drugs, they save thousands of
dollars a year.
And while the Miami patients received livers from deceased donors, the surgery
could be performed using a live donor, such as a parent if tests showed
compatibility.
The University of Chicago's Dr. Donald Jensen said that although the procedure
is promising, if his own child were involved, he would still choose a standard
liver transplant.
Jensen, director of the university's Center for Liver Disease, said some of the
partial transplant's safety and other issues, still need to be worked out.
Some of Kato's patients have needed a second surgery to remove the transplanted
partial liver because it became inflamed after anti-rejection drugs were halted.
And a few have yet to get off those drugs.
Yailin Nunez's 2-year-old son Jonathan was the sixth patient to have the partial
liver transplant at Miami. Of all the patients, his liver has shown the least
recovery more than 20 months later, even compared to a boy who had the operation
this summer.
"I still have faith my son's liver's going to regenerate.... It's just taking a
little longer," Nunez said through tears. "And if it doesn't, it's OK.... We're
given the chance and I've met other moms who weren't given the chance."
Brenner Logan's parents are praying the toss-up goes in their favor. In August,
the 2-year-old became the most recent to have the surgery.
His liver is already showing signs of recovery.
Brenner's mother, Kristen Logan, is cautiously optimistic. After her son's
surgery, she met one of the patients whose transplant was a success.
"You think, 'Wow. This could be my son,"' Logan said. "You begin to have so much
more hope for the future."
http://www.cnn.com/2007/HEALTH/conditions/12/07/half.liver.transplant.ap/

2 men file first lawsuit over hepatitis from fibrinogen adhesive
Saturday, December 8, 2007 at 07:28 EST
TOKYO - Two men who launched a lawsuit in late November against the state and
pharmaceutical companies over the contraction of hepatitis C represent the first
plaintiffs seeking compensation for contracting the disease from the use of a
fibrinogen-based adhesive agent, the plaintiffs' lawyer said Friday.
Other plaintiffs are expected to come forward given the high number of people
estimated to have contracted the disease in the same way.
http://www.japantoday.com/jp/news/422635

Subject: Something to be thankful for
I AM THANKFUL:
FOR THE WIFE
WHO SAYS IT'S HOT DOGS TONIGHT,
BECAUSE SHE IS HOME WITH ME,
AND NOT OUT WITH SOMEONE ELSE.
FOR THE HUSBAND
WHO IS ON THE SOFA
BEING A COUCH POTATO,
BECAUSE HE IS HOME WITH ME
AND NOT OUT AT THE BARS.
FOR THE TEENAGER
WHO IS COMPLAINING ABOUT DOING DISHES
BECAUSE IT MEANS SHE IS AT HOME,
NOT ON THE STREETS.
FOR THE TAXES I PAY
BECAUSE IT
I AM EMPLOYED .
FOR THE MESS TO CLEAN AFTER A PARTY
BECAUSE IT MEANS I HAVE
BEEN SURROUNDED BY FRIENDS.
FOR THE CLOTHES THAT FIT A LITTLE TOO SNUG
BECAUSE IT MEANS
I HAVE ENOUGH TO EAT.
FOR MY SHADOW THAT WATCHES ME WORK
BECAUSE IT MEANS
I AM OUT IN THE SUNSHINE
FOR A LAWN THAT NEEDS MOWING,
WINDOWS THAT NEED CLEANING,
AND GUTTERS THAT NEED FIXING
BECAUSE IT MEANS I HAVE A HOME .
FOR ALL THE COMPLAINING
I HEAR ABOUT THE GOVERNMENT
BECAUSE IT MEANS
WE HAVE FREEDOM OF SPEECH..
FOR THE PARKING SPOT
I FIND AT THE FAR END OF THE PARKING LOT
BECAUSE IT MEANS I AM CAPABLE OF WALKING
AND I HAVE BEEN BLESSED WITH TRANSPORTATION .
FOR MY HUGE HEATING B ILL
BECAUSE IT MEANS
I AM WARM.
FOR THE LADY BEHIND ME IN CHURCH
WHO SINGS OFF KEY BECAUSE IT MEANS
I CAN HEAR.
FOR THE PILE OF LAUNDRY AND IRONING
BECAUSE IT MEANS
I HAVE CLOTHES TO WEAR.
FOR WEARINESS AND ACHING MUSCLES
AT THE END OF THE DAY
BECAUSE IT MEANS I HAVE BEEN
CAPABLE OF WORKING HARD.
FOR THE ALARM THAT GOES OFF
IN THE EARLY MORNING HOURS
BECAUSE IT MEANS I AM ALIVE.
AND FINALLY, FOR TOO MUCH E-MAIL
BECAUSE IT MEANS I HAVE
FRIENDS WHO ARE THINKING OF ME.
SEND THIS TO SOMEONE YOU CARE ABOUT. I JUST DID.
Live well, Laugh often, & Love with all of your heart!
walk in peace.
brenda

Here's a cool site! Top 100 tunes from the years 1950 to 1982 - plus other
collections. Listen while you surf!
http://www.tropicalglen.com/

Hong Kong hospitals transplanted organs from a cancer patient
HONG KONG -- Hong Kong hospitals transplanted liver grafts and kidneys to four
patients from a man who was later found to have lung cancer, a hospital said
Wednesday.
The hospital learned of the situation a month after the organ transplants were
performed when an autopsy revealed the donor was in the early stages of a rare
type of lympho-epithelioma-like-carcinoma, the Queen Elizabeth Hospital said.
Doctors were aware of a lung nodule 1.4 centimeters (0.6 inch) in diameter in
the 46-year-old male patient, who died as a result of a serious fall last month,
but they considered it benign, the hospital said in a statement.
His liver and kidneys were then transplanted to four patients - aged from seven
months to 59 years - at two other hospitals a day later.
In Hong Kong, cancer patients cannot be accepted as organ donors, and no other
known transplants from cancer patients have occurred in the city.
William Foo, a clinical oncologist and spokesman for the Anticancer Association,
said it was rare but not unheard of that cancer is transmitted to recipients of
organ transplants.
However, the chances of the patients contracting cancer in this situation were
very small because there was no confirmation that the disease had spread to the
donated organs, he said.
"If this was lung cancer, then the chance that the kidney harbors a couple of
cancer cells is not that high," Foo said.
A hospital spokeswoman, who requested not to be named citing internal policy,
said it was the doctors' clinical judgment that caused the incident.
"Doctors made the clinical judgment based on their knowledge and experiences.
The post-mortem results turned out to be different from the clinical judgment
... which can't be classified as a medical blunder," she said in a phone
interview.
Foo also said it was virtually impossible to ensure that donors are cancer-free
because there is no single method to screen all parts of the body.
"But as long as doctors have carried out a reasonable scrutiny for cancer, and
ruled out infectious diseases, such as hepatitis and AIDS, I think one should
proceed with the donation because otherwise due to time lost, the organ will not
be useful," he said.
Tim Pang, spokesman for the Patients Rights Association, also said the
information available didn't show the doctors had done anything wrong.
"It doesn't look like a case of negligence," he said. "It's just unfortunate
that this had happened."
http://www.chinapost.com.tw/asia/2007/11/30/133045/Hong%2DKong.htm

Ministry not obliged to inform patients
12/03/2007
THE ASAHI SHIMBUN
A government panel concluded the health ministry was not responsible for
informing hundreds of people five years ago that they were at risk of hepatitis
C infection through a tainted blood product.
The health ministry team, which released its final report Friday, investigated
after earlier revelations that no one at the ministry who examined a list of 418
people ever told them that they were at risk.
"It cannot be determined that the state should be held responsible in a specific
area," the report said.
The list was submitted to the health ministry in 2002 by Mitsubishi Pharma
Corp., predecessor of Mitsubishi Tanabe Pharma Corp.
It described the cases of 418 patients who had received transfusions of
Mitsubishi Pharma's blood product fibrinogen that was found to be contaminated
with the hepatitis C virus.
Friday's report met with anger from plaintiffs in lawsuits against the state and
the drug maker over their infections via the blood product.
Many were given tainted blood coagulants in the 1980s to stop bleeding during
childbirth, but they were not told of the risk of infection.
The ministry team questioned current and former ministry officials and hepatitis
specialists, obstetricians who used the blood products and Mitsubishi Tanabe
Pharma officials.
The team found the ministry had identified and warned patients who received
other tainted blood products, such as christmassin, in a 2001 probe. But the
ministry did not do that in the 2002 fibrinogen case. All current and former
officials involved in the 2002 case said they never discussed telling the
patients who received fibrinogen.
Some officials even told the team that ministry bureaucrats should not be
involved in informing patients.
The report said, "The state should have been considerate about informing
patients for their benefit." The report also said, "The ministry as a whole
gravely accepts criticism that it should consider the problems of patients
suffering from hepatitis (developed as result of tainted blood products)."
However, the report said the government is not obligated to inform patients.
Although three ministry officials visited Mitsubishi Tanabe Pharma in 2002 to
investigate the issue, they did not realize that patient information, such as
the names of 197 people, was included in the material they examined, the report
said. The officials were looking into Tanabe's production methods and fibrogen
side-effects.
As of Nov. 22, the company had identified 250 of the 418 recipients of
fibrinogen. Of identified patients, 47 had died
http://www.asahi.com/english/Herald-asahi/TKY200712030094.html

Crystal Meth and HIV/AIDS: The Perfect Storm?
Methamphetamine use is already influencing the HIV/AIDS epidemic in the U.S. and
could have an even greater impact in coming years.
Crystal methamphetamine (CM) is an extremely addictive stimulant that increases
sexual arousal while reducing inhibition and judgment. Its use is associated
with a range of high-risk sexual behaviors that increase the likelihood of
acquiring or transmitting HIV. Given the relatively high prevalence of CM use
among people living with HIV and among men who have sex with men (MSM), there is
great concern that this drug is fueling the HIV epidemic. Equally worrisome are
the effects that CM use can have on the prognosis and overall health of
HIV-infected patients.
Background
Known by various street names (most commonly, "ice" and "glass"), CM can be
smoked, snorted, injected, swallowed, or inserted into the rectum. Compared with
other illegal drugs, CM is inexpensive, readily available, and provides a
stronger, longer-lasting "high" (8-24 hours).1 Prevalence of use in the U.S. is
difficult to pinpoint, but estimates of past-year use from national
cross-sectional surveys range from 1.5% to 2.8% among young adults.2 Estimates
of past-year use are even higher among MSM - 9.7%, according to one San
Francisco study (ACC Sep 28 2005)3 - in part because the drug is now deeply
embedded in the MSM "circuit party"culture.4
Commonly cited reasons for using CM, aside from peer pressure, are increased
sexual sensitization, mood enhancement, and disinhibition. However, the drug is
also used to provide an escape from stress, depression, alienation, and
loneliness, all of which are common among people living with HIV. Furthermore,
many HIV-infected MSM report using CM as a way to deal with their illness or
with homophobia or prejudice.4,5 Consequently, CM use is highly prevalent among
people living with HIV. In a San Francisco study, 19% to 39% of HIV-infected
people reported using CM during the previous year.6 This high prevalence is
alarming because CM use can increase the risk for HIV transmission and also
contribute to poorer health outcomes in HIV-infected users.
Methamphetamine Use and HIV Transmission
CM use increases the risk for HIV transmission and acquisition in a number of
ways.
First, the drug lowers sexual inhibitions, impairs judgment, and provides the
necessary energy and confidence to engage in sexual activity for long periods of
time. As a result, methamphetamine users are more likely than nonusers to engage
in unprotected anal sex and to have sex with injection drug users, HIV-positive
partners, and those of unknown HIV status; they also tend to report a greater
number of sex partners and to have a history of other sexually transmitted
diseases (STDs).3,7,8
Second, CM use is a well-documented cause of erectile dysfunction, which can
lead users to engage in even higher-risk sexual activities. For example, users
who cannot sustain an erection may switch to receptive anal sex ("bottoming"),
which carries a higher risk of HIV acquisition than does insertive anal sex.
Alternatively, users may take erectile-dysfunction drugs, and the combination of
these with CM can lead to longer, more-aggressive periods of sex, potentially
resulting in condom breaks or mucosal tears, which can cause bleeding and
increased risk of HIV transmission.
Third, CM causes mucosal dryness, which increases the risk for tissue tears.
Additional damage to rectal tissues can occur when CM is inserted into the
rectum ("keistering," "booty bumping").
Finally, when CM is injected, needle sharing can greatly enhance transmission of
HIV and hepatitis viruses.
Numerous cross-sectional studies have demonstrated an association between CM use
and increased risk for HIV infection, but only a few studies have prospectively
assessed seroincidence. In the largest of these, the Multicenter AIDS Cohort
Study, the relative risk for HIV seroconversion was 1.5 among CM users compared
with nonusers and was even higher (3.1) among men who used both methamphetamine
and poppers (ACC Apr 13 2007).9
Methamphetamine Use and Progression of HIV Disease
In addition to facilitating HIV transmission, CM use is associated with
detrimental behavior changes that can affect the prognosis and overall health of
people living with HIV. For instance, current methamphetamine use decreases
adherence to HIV treatment and medical follow-up.10 Frequent CM use has also
been associated with increased risk for antiretroviral resistance, particularly
to NNRTIs, with the obvious implications for treatment and transmission risk.11
For example, CM use is thought to have contributed to the acquisition of
triple-class-resistant virus by the New York City patient described in 2005 (ACC
Sep 1 2006).12 In addition, some patients use CM to treat HIV-associated
symptoms, such as fatigue, instead of seeing a physician. Such self-medication
may lead to underdiagnosis and undertreatment of HIV and to important
complications such as anemia and hypogonadism.5,10
CM use may also influence progression and complications of HIV disease more
directly. For example, animal studies have shown that CM can impair the immune
system13 and increase HIV replication,14 and human studies suggests that it can
accelerate the progress of HIV-related dementia.15
Other Consequences of Methamphetamine Use
Other consequences of CM use that are particularly harmful to HIV-infected
patients include deterioration of the teeth and gums (a result of dry mouth and
grinding of the teeth), reduced appetite, poor eating habits, and weight loss.
Furthermore, many users "crash" after using CM for several days straight and are
left with little energy and the very feelings they were trying to avoid -
depression and isolation.
Other adverse effects of CM use include intense cravings for CM when not taking
it; tachyphylaxis; increased risk for heart attack and stroke (because of
increases in blood pressure, heart rate, and body temperature); impaired memory,
reasoning, and ability to process information; and psychological problems, such
as depression, psychosis, aggressive behavior, hallucinations, and paranoia.
Chronic use can also cause skin lesions and damage the cardiovascular system,
lungs, liver, muscles, and nerve cells in the brain.
Although methamphetamine is not known to affect HIV medications, some PIs
increase absorption and decrease metabolism of CM, leading to severe reactions
or overdosing.16,17
Preventing and Treating Methamphetamine Addiction
Prevention of methamphetamine use is hampered by a relative paucity of
epidemiologic data that would enable us to assess the magnitude of the current
problem adequately and to evaluate the efficacy of various interventions.
Despite federal efforts to restrict pseudoepinephrine imports and a nationwide
decline in small methamphetamine laboratories, the drug continues to be widely
available. A report from the National Drug Intelligence Center suggests that
Mexican drug traders have relocated their labs from the U.S. to Mexico and have
expanded distribution to the midwestern and eastern U.S., underscoring the
difficulties of drug enforcement in the era of global trade.18 Developing
methamphetamine prevention "task forces" (involving community members and
representatives from at-risk groups, STD treatment centers, health departments,
and law enforcement) is a reasonable approach, despite a lack of efficacy
data.19 Educational campaigns should be tailored to specific target populations,
and care should be taken to help ensure that such campaigns do not increase
cravings in CM-addicted patients.20
Given the high prevalence and dire consequences of CM use among HIV-infected
patients, clinicians should be sure to ask patients about past or current use.
Drug testing is recommended for all patients who have a history of, or are
suspected of, using CM.
Few data are available to recommend any one method of methamphetamine treatment
over another.21 Cognitive behavior-based interventions (Matrix Model), 12-step
programs, drug testing, and contingency management interventions have been used
by different treatment centers, with varying degrees of success. Nevertheless,
treatment of CM addiction can be successful in decreasing risky sexual behaviors
and should be an integral part of any HIV prevention effort.21,22
Conclusion
All current data underscore the potential of methamphetamine to substantially
worsen the current HIV epidemic, with some studies indicating that this
potential is already being realized. Methamphetamine use is an important public
health problem and is associated with risky sexual behavior; increased rates of
transmission of HIV, other STDs, and hepatitis; serious adverse events; and poor
adherence to antiretroviral treatment. Prevention efforts not only must
encompass traditional education and awareness campaigns but also will require
local, national, and international policy changes, including allocation of
appropriate resources and funding. Comparative trials of different treatment
approaches are needed, as are better evidence-based protocols for treatment.
- Philip A. Yeon, MD, MPH&TM, and Helmut Albrecht, MD
Dr. Yeon is Assistant Professor of Medicine in the Division of Infectious
Diseases at University of South Carolina School of Medicine. Dr. Albrecht is
Professor of Medicine and Chief of the Division of Infectious Diseases at
University of South Carolina School of Medicine.
Published in AIDS Clinical Care December 3, 2007
Citation(s):
1. Centers for Disease Control and Prevention (CDC). Methamphetamine use and
risk for HIV/AIDS [fact sheet]. Jan 2007.
(http://www.cdc.gov/hiv/resources/factsheets/meth.htm)
2. Iritani BJ et al. Crystal methamphetamine use among young adults in the USA.
Addiction 2007 Jul; 102:1102.
Medline abstract (Free)
3. Buchacz K et al. Amphetamine use is associated with increased HIV incidence
among men who have sex with men in San Francisco. AIDS 2005 Sep 2; 19:1423.
Medline abstract (Free)
4. Kurtz SP. Post-circuit blues: Motivations and consequences of crystal meth
use among gay men in Miami. AIDS Behav 2005 Mar; 9:63.
Medline abstract (Free)
5. Semple SJ et al. Motivations associated with methamphetamine use among HIV+
men who have sex with men. J Subst Abuse Treat 2002 Apr; 22:149.
Medline abstract (Free)
6. Mitchell SJ et al. Methamphetamine use and sexual activity among HIV-infected
patients in care - San Francisco, 2004. AIDS Patient Care STDS 2006 Jul; 20:502.
Medline abstract (Free)
7. Frosch D et al. Sexual HIV risk among gay and bisexual male methamphetamine
abusers. J Subst Abuse Treat 1996 Nov/Dec; 13:483.
Medline abstract (Free)
8. Celentano DD et al. Associations between substance use and sexual risk among
very young men who have sex with men. Sex Transm Dis 2006 Apr; 33:265.
Medline abstract (Free)
9. Plankey MW et al. The relationship between methamphetamine and popper use and
risk of HIV seroconversion in the Multicenter AIDS Cohort Study. J Acquir Immune
Defic Syndr 2007 May 1; 45:85.
Medline abstract (Free)
10. Reback CJ et al. Methamphetamine abuse as a barrier to HIV medication
adherence among gay and bisexual men. AIDS Care 2003 Dec; 15:775.
Medline abstract (Free)
11. Colfax GN et al. Frequent methamphetamine use is associated with primary
non-nucleoside reverse transcriptase inhibitor resistance. AIDS 2007 Jan 11;
21:239.
Medline abstract (Free)
12. Centers for Disease Control and Prevention (CDC). Investigation of a new
diagnosis of multidrug-resistant, dual-tropic HIV-1 infection - New York City,
2005. MMWR Morb Mortal Wkly Rep 2006 Jul 28; 55:793.
Medline abstract (Free)
13. In SW et al. Methamphetamine administration produces immunomodulation in
mice. J Toxicol Environ Health A 2005 Dec 10; 68:2133.
Medline abstract (Free)
14. Phillips TR et al. Methamphetamine and HIV-1: Potential interactions and the
use of the FIV/cat model. J Psychopharmacol 2000; 14:244.
Medline abstract (Free)
15. Flora G et al. Methamphetamine potentiates HIV-1 Tat protein-mediated
activation of redox-sensitive pathways in discrete regions of the brain. Exp
Neurol 2003 Jan; 179:60.
Medline abstract (Free)
16. Antoniou T and Tseng AL. Interactions between recreational drugs and
antiretroviral agents. Ann Pharmacother 2002 Oct; 36:1598.
Medline abstract (Free)
17. Hales G et al. Possible fatal interaction between protease inhibitors and
methamphetamine. Antivir Ther 2000 Mar; 5:19.
Medline abstract (Free)
18. National Drug Intelligence Center. National methamphetamine threat
assessment 2007. Nov 2006. (http://www.usdoj.gov/ndic/pubs21/21821)
19. Mansergh G et al. CDC consultation on methamphetamine use and sexual risk
behavior for HIV/STD infection: Summary and suggestions. Public Health Rep 2006
Mar/Apr; 121:127.
Medline abstract (Free)
20. Nanín JE et al. Community reactions to campaigns addressing crystal
methamphetamine use among gay and bisexual men in New York City. J Drug Educ
2006; 36:297.
Medline abstract (Free)
21. Cretzmeyer M et al. Treatment of methamphetamine abuse: Research findings
and clinical directions. J Subst Abuse Treat 2003 Apr; 24:267.
Medline abstract (Free)
22. Lyons T et al. Stimulant use and HIV risk behavior: The influence of peer
support group participation. AIDS Educ Prev 2006 Oct; 18:461.
Medline abstract (Free)

Flu Pandemic Would Cost Hospitals Billions
By Michael Smith , North American Correspondent, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
BALTIMORE, Dec. 4 -- A flu pandemic like the one in 1918 could cost U.S.
hospitals $3.9 billion, but a human-to-human outbreak of the H5N1 avian
influenza strain could dwarf that estimate.
The lost revenue to hospitals from a 1918-style pandemic would come from
deferred elective cases and uncompensated care for flu victims, found Eric
Toner, M.D., and colleagues at the Center for Biosecurity of the University of
Pittsburgh, in Baltimore.
The average community hospital would lose $353,985 by deferring cases over an
eight-week pandemic period, Dr. Toner and colleagues reported in the quarterly
Journal of Health Care Finance.
At the same time, the effects of the pandemic would mean uncompensated costs of
$430,607 per hospital to treat the influx of flu patients, the researchers said.
Across all U.S. hospitals, that adds up to $3.9 billion -- a sum that could
create severe financial strains in the health care system, the researchers said.
"Some hospitals may not have sufficient cash on hand to cover these losses,"
they said.
Government planning assumptions also suggest that if a pandemic were on the 1918
scale, hospitals would find it difficult to treat all the patients who required
care.
For example, Dr. Toner and colleagues said, the average community hospital has
20 ventilators available and -- by deferring cases -- could have 81 free beds.
But at the height of a 1918-style pandemic, 42 patients would need ventilators
and 290 would need beds, they said.
All this is based on extrapolations of planning assumptions from the Department
of Health and Human Services, which were predicated on the 24% mortality rate
from infections in the 1918 flu.
If the pathogen involved is a humanized version of the H5N1 avian flu strain,
"the severity and duration of a pandemic could be greater than [the government]
assumes," the researchers said.
The health and human services department is assuming inpatient mortality would
be about 24% in a 1918-type pandemic, they said, but when the H5N1 virus has
infected humans it has killed more than half of its victims.
As of Dec. 4, the World Health Organization says there have been 336 confirmed
cases of H5N1 influenza in humans, of which 207 have been fatal.
"A 1918-like pandemic is far from the worst case possible," Dr. Toner said in an
accompanying audio interview on the journal's website. (Click here to go to the
website to hear the entire audio)
"A pandemic with [the H5N1] virus could certainly be worse than that, worse than
1918," he said.
Among other things, the numbers of sick would swamp available capacity. At the
height of such a pandemic, an estimated 60 million people could be sick, 30
million could need intensive care, and six million could need ventilators.
Currently, Dr. Toner said, there are 105,000 ventilators in the entire U.S. and
about 87,000 intensive care beds. "The numbers are truly frightening and far
exceed our ability to care for those numbers of patients," he said.
In their article, Dr. Toner and colleagues said, hospitals need to have a
financial plan in place because "the expected negative financial impact on
hospitals of a severe pandemic is significant."
They said hospitals should include financial departments in pandemic planning
and suggested federal policymakers should look for ways to make sure hospitals
don't go broke during a pandemic.
The researchers did not report any external study support or any potential
conflicts.
http://www.medpagetoday.com/InfectiousDisease/URItheFlu/dh/7576

Woman Infected with HIV from Organ Transplant Did Not Know Donor Was High-Risk
A woman infected with HIV and hepatitis from the kidney she received from a
donor says she was not notified that her donor was high-risk. She also says that
she previously turned down another donor due to his "lifestyle."
Her attorney in Illinois asked the Cook County Circuit Court to prevent the
organ procurement center and the hospital where she received her transplant from
modifying or destroying any records related to her case. He claims that both the
University of Chicago and the Gift of Hope Organ & Tissue Donor Network were
aware that the kidney belonged to a patient who was at high-risk of getting HIV.
The CDC's guidelines mandates that gay men who are sexually active should not be
allowed to donate their organs unless the patient is in danger of dying
immediately.
Officials at the University of Chicago claim that they followed the proper
guidelines when arranging for the transplant. The woman's attorney, however,
claims that guidelines were not followed when the woman was not notified of the
patient's status and she wasn't tested for HIV immediately after the transplant.
She was also told that her donor was a healthy male.
The woman received a new kidney in January. She was diagnosed with HIV and
hepatitis on November 1. Her HIV medical treatment is negatively affecting her
kidneys.
Gift of Hope was also involved in the donor process of the four other patients
who were diagnosed with HIV following their transplants. All four of them
received their transplants from a donor who died following a traumatic brain
injury. An initial HIV test on the donor had come back with a negative result.
Over 300,000 people receive transplants in the United States every year.
If you or someone you love has became injured or ill because of a medical error,
you may be able to file a medical malpractice claim or lawsuit against the
hospital, doctor, surgeon, medical center, or anyone else who can be held liable
for causing your injuries or sickness.
Failure to follow proper procedures, failure to obtain informed consent,
performing the wrong surgery, mistakes during surgery, failure to diagnose, or
providing a patient with the wrong treatment are some of the many errors that
can result in a medical malpractice claim or lawsuit.
Chances of infection low, organ donation official says, The Jeffersonian.com,
November 27, 2007
Lawyer: Woman who got HIV wasn't told organ donor was risk, USA Today, November
16, 2007
Four Transplant Recipients Contract HIV, Hepatitis C From High-Risk Organ Donor,
The Body Pro, November 14, 2007
Related Web Resources:
Gift of Hope Organ & Tissue Donor Network
The Living Legacy Foundation, MDTransplant.org
In Maryland and Washington D.C., the medical malpractice law firm of Lebowitz &
Mzhen has helped many injured patients recover compensation for their injuries,
medical costs, pain and suffering, and other related expenses.
Contact Lebowitz & Mzhen and ask for your free consultation today.
http://www.marylandaccidentlawblog.com/2007/12/woman_infected_with_hiv_after.htm\
l

Hepatitis C redress tallied at ¥3 billion
Kyodo News
The government would have to pay about ¥3 billion to compensate hepatitis C
sufferers who caught the disease through tainted blood products, sources
familiar with the health ministry's estimate said Wednesday.
The sum, which the government has been considering presenting to the victims,
appears to have been calculated based on the Tokyo District Court ruling in
March that ordered the government and three drugmakers to pay damages to the
victims.
The government believes paying the ¥3 billion in a lump sum enables all of the
victims to receive some level of compensation. But such a proposal is likely to
draw criticism. A plaintiff has said, "It won't be a relief for everyone
involved."
Presiding Judge Atsuo Nagano, acting on a ¥1.353 billion damages suit, ordered
the government and drugmakers to pay a combined ¥259 million to 13 of the 21
plaintiffs.
The three-judge panel found that the plaintiffs were given hepatitis C
virus-tainted blood products - fibrinogen, christmassin or PPSB-Nichiyaku - from
1980 to 1988 to stop bleeding when they underwent surgery or gave birth.
The panel held the government responsible for administering fibrinogen between
April 1987 and June 1988, and the pharmaceutical companies between August 1985
and June 1988. It also held the pharmaceutical companies responsible for
administering either christmassin or PPSB-Nichiyaku for all infections since
January 1984.
The defendants in the suit were the government, Mitsubishi Pharma Corp., its
subsidiary, Benesis Corp., and Nihon Pharmaceutical Co. Mitsubishi Pharma is the
successor to the now defunct major blood product maker Green Cross Corp.
On Tuesday, Health, Labor and Welfare Minister Yoichi Masuzoe apologized to a
group of victims infected with hepatitis C through tainted blood products.
http://search.japantimes.co.jp/cgi-bin/nn20071206a6.html

High Normal ALT Limit Lowered for Male Adolescents
By John Gever , Contributing Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
SYDNEY, Australia, Dec. 5 -- The upper limit of normal for alanine
aminotransferase (ALT) in adolescent males has been too high, said researchers
here.
The upper limit was calculated at 28 IU/L in 439 males 12 to 19 years old,
considerably lower than standard definitions, which are in the 45 to 55 IU/L
range, Jacob George, Ph.D., of the University of Sydney, and colleagues,
reported in the December issue of Hepatology.
The new upper limit is the 95th percentile for ALT levels in adolescents at the
lowest risk for liver disease.
The group found that 17% of those in the overall group, all juvenile offenders,
had above-normal ALT.
Strong associations with elevated ALT included HCV antibody positivity,
overweight and obesity, and elevated total cholesterol, they found. More than
90% of adolescents with elevated ALT levels had one or more features of the
metabolic syndrome.
"There was a strong association for overweight or obesity (72% versus 25.1%;
P<0.001) to predict elevated ALT," they wrote. Multivariate analysis for these
factors indicated an odds ratio of 6.9 for elevated ALT with overweight or
obesity (95% CI: 3.7 to 13.1, P<0.001).
"This definition will permit greater sensitivity in diagnosing early liver
injury in adolescent male populations," they wrote. "By identifying those with
[hepatitis B and C infection] and obesity-related liver disease, targeted
interventions can and should be implemented to minimize future health-related
morbidity."
The researchers also identified new upper limits of normal in male adolescents
for two other liver enzymes: 32 IU/L for aspartate aminotransferase (AST), and
29 IU/L for gamma-glutamyltranspeptidase (GGT). Published values for the upper
normal limits in adults range up to 42 IU/L for AST and 48 IU/L for GGT.
The 439 adolescents in the New South Wales criminal justice system agreed to
participate and did not have serious mental problems or substance withdrawal or
disruptive behavior when blood samples were drawn. In addition to liver enzymes,
the samples were tested for blood lipids, glucose, and hepatitis B and C
antibodies and viral loads.
As expected, participants with HCV infection were at significant risk for
elevated ALT relative to HCV-negative participants (57.1% versus 16.3%,
P<0.001). This translated into an odds ratio of 14.6 (95% CI: 3.7 to 57.6) for
elevated ALT in HCV-positive participants.
When 81 of the participants gave additional blood samples one year later, about
3.7% of those who were initially HCV-negative tested positive.
"Greater education regarding blood-borne viruses, risk factors for transmission,
and implementing harm minimization strategies in this population is crucial,"
the researchers said.
They also recommended routine hepatitis B vaccination for adolescent offenders,
noting that only 30% of the participants showed immunity to HBV. Risk-taking
sexual activity and drug-taking behaviors put this population at high risk for
HBV infection, they said, though only 4% of participants were HBV positive.
High levels of cholesterol were also significantly associated with above-normal
ALT (odds ratio: 3.6, 95% CI: 1.7 to 7.7).
The study was funded by the Australian Research Council, the University of
Sydney and industry partners, and the New South Wales Department of Juvenile
Justice and Justice Health.
No financial disclosures were reported.
http://www.medpagetoday.com/PrimaryCare/PreventiveCare/tb/7592

Four other epidemics kill 60 people
By Anne Mugisa
FOUR more epidemics are raging in western and northern Uganda, killing 60 people
and infecting over 1,000 others in the past few months. The diseases, cholera,
plague, meningitis, and suspected hepatitis, are all contagious.
The plague has killed 10 out of 121 infected people in Arua, and nine out of 39
in Nebbi, according to the Ministry of Health.
The disease broke out in Logiri and Vurra sub-counties of Arua. In Nebbi, the
affected area was Nyapea. No new cases have been reported in either area in the
past one week, partly because of massive indoor residual spraying against fleas.
The Minister of Primary Health, Dr. Emmanuel Otaala, said women were most
affected due to the local custom that women sleep on the ground. They are only
allowed in bed when the husband invites them for sex, he explained.
Meningitis broke out in Arua in July, but the infections were confined to Vurra
county in the sub-counties of Arivu, Logiri, Ajia, Vurra and Adumi. According to
Otaala, climatic change is one of the causes for the outbreak of the diseases.
The ministry is investigating another viral disease which has broken out in
Kitgum, killing two people and infecting 30 others. The disease broke out in
Madi Opei sub-county. Laboratory tests have ruled out yellow fever and Hepatitis
B and Hepatitis C. The ministry said tests were being done in Kenya and the
Centres for Disease Control and Prevention in Atlanta, USA, to see if it was
Hepatitis A or Hepatitis C.
Cholera broke out in Nebbi on October 15 and has infected 320 people, killing
four of them. The cases were mainly in Jonamu and Padyere counties. It also
broke out in Buliisa district on November 4, killing five of the 140 people
infected. The cases, according to the ministry, are in Butiaba parish in Biiso
sub-county.
Another three people died in Hoima district where the disease has infected 84
people since it was first reported in Kigorobya sub-county last month.
In Kasese, 15 cases were reported, but the ministry said all of them were
imported from Buliisa. "There was no local transmission in Kasese and the
outbreak is now under control," the ministry said in a statement.
http://www.newvision.co.ug/D/8/12/600650

Ladies warned to protect themselves on girlfriend getaways
By SHARON LEM, SUN MEDIA
The girls' night out has expanded into girlfriend getaway vacations, but women
need to take precautions to ensure a healthier holiday, a Toronto expert warns.
A new survey shows that working women with disposable income taking vacations
with female friends is becoming a growing trend.
The survey of 1,000 women between the ages of 18 and 50, shows that almost 50%
of women will not attend a travel clinic or advice before taking off.
"This is an increasing trend we call girlfriend getaways where more women are
travelling with girlfriends on their own, but with respect to health, safety and
security, they are not taking the precautionary steps," Dr. Jay Keystone,
Medical Director of Medisys Travel Clinic and professor of medicine at The
University of Toronto.
The survey also showed that 40 to 60% of women do not worry about the food and
water they ingest when travelling.
Keystone said women need to be aware that Hepatitis A and Hepatitis B is a
danger they can avoid by simply getting inoculated with a three-dose vaccine.
One can be infected with Hepatitis A from food and water, and you can get
infected with Hepatitis B through IV injections, tattoos, piercing, sexual
intercourse, or even manicures and pedicures.
In Canada, 1,000 to 3,000 people are infected with Hepatitis A and about 3,000
are infected with Hepatitis B.
Keystone advises that anyone travelling to the Dominican Republic, Punta Canta,
or Kingstone, Jamaica, should get malaria pills before going.
There is also a vaccine available to combat diarrhea.
Keystone says security for women travelling should be a priority as well. The
survey found that 40 to 50% of women had no problem being intimate with a new
partner when travelling.
"Don't let your guard down, you may think that by drinking your inhibitions drop
and this increases the likelihood of making contact with a new partner. Women
shouldn't travel alone at night or leave their drink unattended and should dress
appropriately," Keystone said.
Keystone says the number one killer of travellers is a motor vehicle accident.
He said about 40% of travellers die in motor vehicle accidents.
"The number one rule for people travelling is not to travel in developing worlds
by car at night. The roads are bad, the drivers are worse and the vehicles are
not properly maintained," Keystone said.
http://torontosun.com/News/TorontoAndGTA/2007/12/05/4709096.html

Surveillance for Early Diagnosis of Hepatocellular Carcinoma: Is It Effective in
Intermediate/Advanced Cirrhosis?
Posted 11/28/2007
Franco Trevisani, M.D.; Valentina Santi, M.D.; Annagiulia Gramenzi, M.D.; Maria
Anna Di Nolfo, M.D.; Paolo Del Poggio, M.D.; Luisa Benvegnù, M.D.; Gianludovico
Rapaccini, M.D.; Fabio Farinati, M.D.; Marco Zoli, M.D.; Franco Borzio; Edoardo
Giovanni Giannini, M.D.; Eugenio Caturelli, M.D.; Mauro Bernardi, M.D.
Abstract and Introduction
Abstract
Objectives: Surveillance of cirrhotic patients for early diagnosis of
hepatocellular carcinoma (HCC), based on ultrasonography and alpha-fetoprotein
(AFP) measurement, is widely used. Its effectiveness depends on liver function,
which affects the feasibility of treatments and cirrhosis-related mortality. We
assessed whether patients with intermediate/advanced cirrhosis benefit from
surveillance.
Methods: We selected 468 Child-Pugh class B and 140 class C patients from the
ITA.LI.CA database, including 1,834 HCC patients diagnosed from January 1987 to
December 2004. HCC was detected in 252 patients during surveillance (semiannual
172, annual 80 patients; group 1) and in 356 patients outside surveillance
(group 2). Survival of surveyed patients was corrected for the estimated lead
time.
Results: Child-Pugh class B: cancer stage (P < 0.001) and treatment distribution
(P < 0.001) were better in group 1 than in group 2. The median (95% CI)
survivals were 17.1 (13.5-20.6) versus 12.0 (9.4-14.6) months and the survival
rates at 1, 3, and 5 yr were 60.4% versus 49.2%, 26.1% versus 16.1%, and 10.7%
versus 4.3%, respectively (P = 0.022). AFP, gross pathology, and treatment of
HCC were independent prognostic factors. Child-Pugh class C: cancer stage (P =
0.001) and treatment distribution (P = 0.021) were better in group 1 than in
group 2. Nonetheless, median survival did not differ: 7.1 (2.1-12.1) versus 6.0
(4.1-7.9) months (P= 0.740).
Conclusions: These results suggest surveillance be offered to class B patients
and maintained for class A patients who migrate to the subsequent class.
Surveillance becomes pointless in class C patients probably because the poor
liver function adversely affects the overall mortality and HCC treatments.
Introduction
Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide, with
an increasing incidence in the western world.[1] The prognosis of patients with
HCC has marginally improved over the last two decades, the 5-yr survival rate
currently being 5%.[2] This dismal result is in part due to the fact that
diagnosis is frequently made at an advanced tumor stage precluding effective
treatment. Therefore, most gastroenterologists routinely offer patients at risk
HCC surveillance programs, based on ultrasonography (US) with or without
alpha-fetoprotein (AFP) measurement,[3] which can detect most tumors at a stage
still eligible for treatment for review, see.[4]
Although it has been definitely proven that surveillance increases the survival
rate only in hepatitis B virus (HBV) carriers,[5] several cohort studies
indicate that even patients with cirrhosis, which underlies
benefit from this practice.[6-10] Consequently, both European and American
guidelines for HCC management[11,12] recommend offering surveillance to
cirrhotic patients, provided that the following condition is met: "the patients
who should undergo surveillance should be those cirrhotics who would be treated
if diagnosed with HCC".[11] In this respect, it is worth noting that liver
function and portal hypertension are the main limiting factors for the
applicability of HCC treatments other than liver transplantation (OLT), which,
however, only accounts for 10% of therapeutic options.[7,8,10,13] Moreover, the
benefit of surveillance critically depends on the underlying cirrhosis-related
survival.[14]
The Child-Pugh (C-P) classification scores three liver tests and two
complications of portal hypertension, and is the most widely used means of
gauging the severity of cirrhosis and its prognosis in clinical practice.[15]
Therefore, the pertinent question that can be pragmatically posed is: which C-P
class/es must a patient belong to at the time of HCC detection in order to
benefit from surveillance? From the answer we can infer which patients can
gainfully enter into a surveillance program and when they must be removed from
it because they have migrated to a C-P class where the procedure is futile. This
strategy may ultimately improve the unsatisfactory cost/effectiveness ratio of
surveillance for HCC in unselected cirrhotic patients[7,14,16]
Only two studies have addressed this topic and both found that surveillance
prolonged the survival of patients belonging to class A at the time of HCC
diagnosis, but not that of class C subjects.[6,8] For class B, the results are
less univocal: surveyed subjects had a prognostic benefit in the oriental
series, while the advantage achieved in the Italian Liver Cancer (ITA.LI.CA)
group series was at the borderline of statistical significance. Thus, although
it is known that the occurrence of HCC halves the expected 3-yr survival rate of
class B patients,[7] whether they should undergo surveillance still remains
undefined.[11,12] Some experts suggest offering surveillance programs to these
subjects only if OLT is available.[17]
Major advances in HCC management have occurred in recent years: (a) modern
diagnostic imaging techniques can disclose "very small" HCCs (â¤2 cm) curable
with percutaneous procedures applicable even to patients with relatively
advanced cirrhosis; (b) percutaneous thermoablation, which is thought to be
superior to percutaneous ethanol injection (PEI),[18,19] has spread rapidly in
specialized centers; (c) the improper "lobar" transarterial chemoembolization
(TACE) has been abandoned in favor of the safer and more effective "segmental or
subsegmental" procedures;[11,20] (d) the available algorithms tailoring
treatment according to tumor burden, liver function, and clinical status have
optimized the therapeutic strategy.[21,22] These advances, together with the
reduction of cirrhosis-related mortality due to an improved management of its
complications, may have enhanced the surveillance benefit, extending it beyond
class A patients.
Thus, the time has come to re-evaluate surveillance for HCC in
intermediate/advanced cirrhosis. The current study aims to assess whether
surveillance improves the prognosis of patients belonging to C-P classes B and C
at the time of HCC diagnosis as compared with their counterparts whose cancer
diagnosis was made outside a periodic screening.
Patients and Methods
Patients
The ITA.LI.CA database currently includes the data of 1,834 HCC patients seen
consecutively from January 1987 to December 2004 at 10 medical institutions. The
data were collected prospectively and updated every 2 yr. After data collection
from any single center, the consistency of the dataset was checked by the group
coordinator (F. T.). When clarification or additional information was needed,
the data were resubmitted to each center before statistical evaluation. For the
purpose of the study, the eligibility criteria were the description of: (a) the
interval of surveillance, (b) the C-P class at the time of HCC diagnosis.
According to these criteria, we retrospectively selected 608 patients: 468 class
B and 140 class C cases. The causes of exclusion were: class A (1,084 patients),
class unreported (59 patients), and surveillance interval unspecified (83
patients).
Click link for the rest of this lengthy article..............
http://www.medscape.com/viewarticle/565828?src=mp

Intensive Care of Patients With Acute Liver Failure: Recommendations of the U.S.
Acute Liver Failure Study Group
Posted 11/26/2007
R. Todd Stravitz, MD; Andreas H. Kramer, MD, MSc; Timothy Davern, MD; A. Obaid
S. Shaikh, MD; Stephen H. Caldwell, MD; Ravindra L. Mehta, MD; Andres T. Blei,
MD; Robert J. Fontana, MD; Brendan M. McGuire, MD; Lorenzo Rossaro, MD; Alastair
D. Smith, MD; William M. Lee, MD; the Acute Liver Failure Study Group
Abstract and Introduction
Abstract
Objective: To provide a uniform platform from which to study acute liver
failure, the U.S. Acute Liver Failure Study Group has sought to standardize the
management of patients with acute liver failure within participating centers.
Methods: In areas where consensus could not be reached because of divergent
practices and a paucity of studies in acute liver failure patients, additional
information was gleaned from the intensive care literature and literature on the
management of intracranial hypertension in non-acute liver failure patients.
Experts in diverse fields were included in the development of a standard
study-wide management protocol.
Measurements and Main Results: Intracranial pressure monitoring is recommended
in patients with advanced hepatic encephalopathy who are awaiting orthotopic
liver transplantation. At an intracranial pressure of ⥠25 mm Hg, osmotic
therapy should be instituted with intravenous mannitol boluses. Patients with
acute liver failure should be maintained in a mildly hyperosmotic state to
minimize cerebral edema. Accordingly, serum sodium should be maintained at least
within high normal limits, but hypertonic saline administered to 145-155 mmol/L
may be considered in patients with intracranial hypertension refractory to
mannitol. Data are insufficient to recommend further therapy in patients who
fail osmotherapy, although the induction of moderate hypothermia appears to be
promising as a bridge to orthotopic liver transplantation. Empirical
broad-spectrum antibiotics should be administered to any patient with acute
liver failure who develops signs of the systemic inflammatory response syndrome,
or unexplained progression to higher grades of encephalopathy. Other
recommendations encompassing specific hematologic, renal, pulmonary, and
endocrine complications of acute liver failure patients are provided, including
their management during and after orthotopic liver transplantation.
Conclusions: The present consensus details the intensive care management of
patients with acute liver failure. Such guidelines may be useful not only for
the management of individual patients with acute liver failure, but also to
improve the uniformity of practices across academic centers for the purpose of
collaborative studies.
Introduction
Acute liver failure (ALF), defined as the onset of hepatic encephalopathy and
coagulopathy within 26 wks of jaundice in a patient without preexisting liver
disease, remains one of the most dramatic and highly mortal of all human
afflictions. Nevertheless, the optimal management of patients with ALF remains
very poorly defined and center-specific. Several reasons underlie the
heterogeneous management of ALF, including the fact that ALF is a syndrome
rather than a disease, representing the final manifestation of numerous
etiologies. In addition, the syndrome is extremely difficult to study because of
its high mortality and rarity (2,000 U.S. cases per yr).[1]
The Adult U.S. Acute Liver Failure Study Group (ALFSG) was founded in 1997 to
define the epidemiology and management of patients with ALF. Since its
inception, the group has collected data on
prominent liver transplant centers. To more uniformly manage patients with ALF
at participating centers, the ALFSG convened in December 2005 to review the
available literature on the management of ALF, to compare the intensive care of
patients with intracranial hypertension of various etiologies, and to compare
practices within participating centers. Investigators in specialties outside of
hepatology-including neuro-intensive care, nephrology, and coagulation-were
invited to participate in formulating a standard study-wide management protocol.
Where possible, the protocol was based upon literature pertaining to patients
with ALF; where studies specifically examining ALF did not exist, management
recommendations were derived from other literature. Recommended measures were
defined as those in which evidence-based studies suggest possible benefit in the
clinical course or outcome of patients with ALF. Measures without supporting
clinical data, but which potentially may be of benefit based upon a reasonable
rationale, or supported by literature not specifically pertaining to patients
with ALF, were deemed insufficient data to recommend. Finally, measures which
clinical studies suggest may be detrimental were not recommended. The protocol
was approved by the 23 member sites on September 23, 2006, and revisions were
approved on May 10, 2007.
The present protocol expounds on a previous position paper[2] sanctioned by the
American Association for the Study of Liver Diseases. The position paper offers
general guidelines targeted at nonintensivists, and is cited within the present
protocol for completeness and to avoid duplication of publication.
Click link for rest of 6 part article.........
http://www.medscape.com/viewarticle/565697?src=mp

I have listened to the entire CD now and found it VERY helpful and relaxing! I
strongly encourage everyone to listen to the free 7 minutes! I have also put
an info post about the benefits of meditation and healing below the free 7
minute link. Please MEDITATE, RELAX and HEAL :-)

Save the Date! First Annual State of Nevada Hepatitis C Conference
Dear Friends,
The California Hepatitis C Task Force together with the Nevada Hepatitis C Task
force and National Association of Hepatitis Task Forces has been working
together to put on this special event. Please save the date, spread the word and
go to these links and register. We look forward to seeing you there.
First Annual Nevada Hepatitis C Conference
http://www.medicine.nevada.edu/cme/
http://www.medicine.nevada.edu/cme/documents/hepc_web.pdf
Happy Holidays!
Bill
Bill Remak, B.Sc.M.T.; B.Public Health
Chairman, California Hepatitis C Task Force
Secretary, National Association of Hepatitis Task Forces
149 Wyndham Way , Suite #223
Petaluma, Ca 94954
(707) 773-4922
cell (707) 364-1802
fax (415) 276-5893
wmremak@...

State: Key factors delayed patient notification
BY MICHAEL AMON AND RIDGELY OCHS | michael.amon@...,
ridgely.ochs@...
country's top disease detectives dialed in to a conference call in May 2006. The
topic: Dix Hills physician Dr. Harvey Finkelstein and lab results showing he had
infected at least one patient with hepatitis C through his practice of re-using
syringes.
So began discussions among officials with the state Department of Health, the
Nassau County Department of Health and the federal Centers for Disease Control
and Prevention about whether to inform hundreds of Finkelstein's patients that
they were at risk for blood-borne diseases.
By the end of the call, CDC officials believed "there was a consensus on the
ground" to go ahead with a broad notification, spokeswoman Nicole Coffin said.
But no action was taken.
Nor was any decision made after a July 2006 call, nor after several other
discussions over the next few months, according to records and interviews with
state and local officials.
A history of scrutiny
Those discussions, state officials now say, represented one of several junctures
in the Finkelstein investigation when they could have moved more quickly to tell
the public about an emerging public health risk, but decided not to. The state's
deliberate handling of the case has elicited a mea culpa from Gov. Eliot Spitzer
and a vow by State Health Commissioner Richard Daines to speed up investigations
and improve communication with the public.
The Finkelstein case is under investigation by the Nassau district attorney's
office. "We kept asking them [the state Health Department] -- 'What is
happening?'" said acting Nassau Health Commissioner Dr. Abby Greenberg, who sat
in on the May 30, 2006, conference call in her former capacity as county
infectious disease control director. "We were told there were a lot of
considerations."
Daines said three things held up informing the public: Not giving the
notification "the right priority"; a staff with its hands full with other urgent
public health crises; and a "back and forth" with Finkelstein over patient
records that "in retrospect I would have to ask: Could we have been more
authoritative to force that issue?"
Delay blasted
Daines and his department took heavy criticism for waiting until Nov. 10 to send
letters to more than 600 patients, urging them to get tested for hepatitis B and
C and HIV. The department first learned of Finkelstein's practices in January
2005.
"Commissioner Daines and the Health Department need to be held accountable for a
fundamental failure to protect and notify the public," said Assemb. Kenneth
Zebrowski (D-New City), who has introduced legislation requiring the Health
Department to notify patients of communicable disease risks.
Health authorities have wide discretion in such cases -- there are no state
statutes forcing them to notify the public of a risk or exactly what to tell
patients. "This is an art form," said Georges Benjamin, executive director of
American Public Health Association in Washington, D.C. "Every case is separate
and the primary goal is taking care of public health; that's most important."
Still, Benjamin added: "I have always argued it's better to overcommunicate
cautiously than to undercommunicate. Tell people what you know when you know
it."
How holdups began
The case first unfolded in December 2004. After zeroing in on Finkelstein's
practice when three hepatitis C cases arose who all had injections from the
doctor, the Health Department tested 84 patients who were injected in July and
October 2004. One more patient tested positive for hepatitis C. Of those four
cases, at least one was linked to Finkelstein's practices through genetic
testing.
The identity of the original, or "sentinel" hepatitis C case, who had the
disease before visiting Finkelstein's office, remains elusive. One possibility
-- a patient seen on July 15, 2004, the same day as two other patients who were
then diagnosed with hepatitis C -- is missing and has not been tested. Guthrie
Birkhead, state deputy health commissioner for public health, said investigators
searched for the person for "a couple months" after lab results in February
2006. "That was part of the delay in this," Birkhead said.
Holdups can also be traced to officials' reticence for broad notification based
on one transmission -- one discovered through genetic "fingerprinting" of the
hepatitis strains, a method state investigators were using for the first time.
The CDC questioned state investigators for months about their lab work, a "back
and forth" that increased confidence in the results but slowed the process,
state officials said. But the CDC spokeswoman Coffin said federal
epidemiologists do not recall seriously questioning the lab results. A state
summary of the May 2006 conference call shows they had questions, though it's
unclear what they were.
98 cases deemed sufficient
And some also argued that a smaller notification -- to 98 patients injected the
week before, during and after the original hepatitis C case -- was sufficient.
They included some officials from the Nassau County Health Department, said
state Health Department spokeswoman Claudia Hutton.
"I'm not sure they were there right from the get-go," Hutton said. "They said
they had people who disagreed."
Nassau health spokeswoman Cynthia Brown said the office could not comment
further because of the district attorney's investigation. Then more delays
ensued as two key state investigators took different jobs, and the
epidemiological team got busy with other big cases, Birkhead said. The next
opportunity to go public came following an Oct. 6, 2006 Department of Health
letter sent to Finkelstein. The state had decided to do a broad notification,
and they asked him for names and addresses going back to 1999. Finkelstein did
not respond and by the end of the month, he had hired attorneys.
A series of obstacles
In November 2006, the law firm representing him turned over a list of 272
patients, said Andrew Kraus, a spokesman for Finkelstein, but by Dec. 8, the
Health Department had requested all the records. And so ensued a series of
letters, phone calls and meetings between health officials and Finkelstein's
attorneys that Daines now says the department should have tried harder to avoid.
The Health Department had the power to subpoena the records but using it was no
guarantee that the department would get the records quickly. Historically,
Daines said, the department has asked doctors to comply with requests
voluntarily. Now, Daines said, the department is asking "are there points where
we can be more authoritative and step in and say -- 'Doctor we've got to have
these records,' and use the department's authority more openly."
Finkelstein's records in hand, health officials began preparing a master list to
notify that eventually reached 628. Public notification again was an option at
this point, but staffers thought the records Finkelstein provided them seemed
too few for the 5-year period they covered from Jan. 1, 2000 to Jan. 15, 2005.
"We went back to the physician and had to set up another call and talk to them
about whether they really thought this was the complete list," Birkhead said.
Finkelstein's attorneys said it was. But, in a fitting coda to a troubled
notification effort, they were wrong, state officials now say. After news of the
Nov. 10 letters broke, hundreds of Finkelstein's patients besieged the Health
Department, complaining they had been injected but not notified. That forced the
department to urge anyone injected by him since 1993 to get tested for
infectious diseases. Now, state officials say, how many patients are at risk is
unknown, but they surely number in the thousands.
http://www.newsday.com/news/local/ny-lidoc1203,0,1811752.story

Contact: Amy Molnar
amolnar@...
Wiley-Blackwell
Treating patients with psychiatric disorders for hepatitis C
Sustained viral response achieved with no increased risk of side effects
People with severe mental illnesses are far more likely to be infected with
Hepatitis C virus compared to the general population, however, they often do not
get treatment for their liver disease because current antiviral therapies have
known psychiatric side effects.
"Against this epidemiological background, the article by Schaefer and
colleagues, Hepatitis C treatment in psychiatric risk patients, represents an
important study in the field," write Sanjeev Arora and Cynthia Geppert, in the
December issue of Hepatology, a journal published by John Wiley & Sons on behalf
of the American Association for the Study of Liver Diseases (AASLD). Their
editorial is also available online at Wiley Interscience
(http://www.interscience.wiley.com/journal/hepatology).
"It provides an even stronger empirical foundation for the findings of other
less methodologically rigorous studies showing that patients with HCV and
comorbid psychiatric and substance use disorders have comparable sustained viral
responses (SVR) and rates of depression when treated with antiviral therapies,"
Arora and Geppert report.
While the National Institutes of Health once advised doctors against treating
HCV-infected patients who continued to use illicit drugs, drink alcohol, or who
had a psychiatric history, in 2002, the agency released a statement that said
"efforts should be made to increase the availability of the best current
treatments" to those patients.
Research has shown this approach to be feasible and effective, and it also has
important implications for public health. Still, doctors have been slow to act
on the recommendation.
Arora and Geppert applaud Shaefer et. al's work with very difficult to treat
patients and point out that the key to their success was the use of a
multidisciplinary team. "The patients in this study were carefully screened and
monitored and received extensive education and counseling," they point out. They
also praise the work because it assessed both depressive and psychotic symptoms
and demonstrates that neither diagnosis adversely affected SVR or outcome.
Instead, the study adds to the growing body of evidence that shows using
anti-depressant agents prior to and during HCV treatment can lessen, or even
prevent, depressive reactions.
While Arora and Geppert point out that the small sample size in Schaefer et.
al's study means that the conclusion that there is no difference in SVR between
controls and patients with mental health diagnosis is stronger than the data can
support, they praise the forward-thinking nature of the work.
"The value of Schaefer et al.'s work is precisely in contributing to the growing
body of data that challenge hepatologists and mental health professionals to
develop new medications and innovative programs that can further widen the door
to admit these patients to HCV treatment," the authors conclude.
###
Article: "Widening the Door: The Evolution of Hepatitis C Treatment in Patients
with Psychiatric Disorders." Arora, Sanjeev; Geppert, Cynthia. Hepatology;
December 2007; (DOI: 10.1002/hep.21891).

Free Testing Marks AIDS Day
Published: December 3, 2007
TAMPA - The Hillsborough County Health Department is marking World AIDS Day
today by offering free testing for HIV, syphilis and hepatitis C.
The organization also is offering confidential counseling, spokesman Steve Huard
said.
Approximately 100,000 people in Florida have the virus that causes AIDS,
statistics show. More than half of new infections occur in people younger than
25.
Anyone wishing to get tested or receive free counseling can go to the
Hillsborough County Health Department, 1105 E. Kennedy Boulevard in Tampa, from
now until 6:30 p.m.
The blood test takes about 15 minutes, health department worker Maritza Acosta
said. It takes about two weeks to receive the results. The department only calls
people who test positive for HIV.
Anyone who does not receive a phone call but wants to confirm the results can
take a photo ID to the health department do so.
Saturday was World AIDS Day.
http://www2.tbo.com/content/2007/dec/03/free-testing-marks-aids-day/?news-breaki\
ng

Montel Williams, the bully
Opinion | Editorial
Monday, December 3, 2007 at 12:30 am
Montel Williams was a decorated Navy officer, but he was no gentlemen when he
threatened a 17-year-old high school student and Savannah Morning News intern.
TELEVISION PERSONALITY Montel Williams apologized Saturday, and rightly so, for
threatening a 17-year-old high school student who had asked him a fair question
Friday while she was covering an assignment as a Savannah Morning News intern.
Of course, if Mr. Williams was genuinely contrite about his shameful behavior,
he wouldn't have issued an apology Saturday through a spokeswoman for his TV
talk show. Instead, he would have apologized personally.
Or sent flowers and a card. That's what a real gentleman would have done.
Intern Courtney Scott, a senior at Jenkins High School, was assigned to cover
Mr. Williams, who was in town promoting free prescriptions for poor people. It
should have been a tame story. Instead, Mr. Williams got angry when Ms. Scott
asked him a question he didn't like. He stormed away.
Then later, when Ms. Scott was at the Westin hotel doing a feature about
gingerbread houses, Mr. Williams and his bodyguard walked up to the young
student and angrily confronted her.
According to Ms. Scott and two witnesses, Mr. Williams threatened to find and
"blow up" the residences of the intern and two reporters with her.
Ms. Scott filed a police report late Saturday, but not because a celebrity acted
like a jerk. No one, whether a "big star," as Mr. Williams claimed to be, or a
no-name street person, has a right to threaten bodily harm on another.
What's sad is that Ms. Scott was looking forward to interviewing Mr. Williams.
Her mother and grandmother are fans and watch his show. Her Navy Junior ROTC
commander at Jenkins (Ms. Scott is in J-ROTC) told her he was at the U.S. Naval
Academy during the same time as Mr. Williams.
Montel Williams left the Navy as a decorated officer. But he apparently left the
gentleman part behind, too. Still, student-intern Scott learned a valuable
lesson - how to deal with a bully.
She passed that test, with flying colors.
http://savannahnow.com/node/407736

GSK Drug Boosts Fight against Hepatitis C, Duke Study Shows
By Duke University News Service
Editor's note: This article is part of WRAL Local Tech Wire's efforts to
highlight research at universities across the Carolinas and Georgia.
DURHAM - It's not a cure, but it may be some of the best news patients infected
with the hepatitis C virus (HCV) have heard in a long time: A new drug,
eltrombopag, appears to be effective in boosting low platelet counts, one of the
major reasons why patients can't endure antiviral treatments.
Other drugs that can restore normal platelet functions are infusions or
injections; eltrombopag is a pill taken just once a day.
Researchers at Duke University Medical Center and other centers world-wide
studied eltrombopag (marketed by GlaxoSmithKline as Promacta in the U.S. and
Revolade in Europe) in 74 patients with low platelet counts and cirrhosis of the
liver due to HCV infection. They found that it boosted platelet counts in a
majority of patients at each of three dosage levels, enabling most of them to
continue or start conventional antiviral treatment.
The findings appear in the current issue of the New England Journal of Medicine.
"We feel this is an important development for many people infected with the
hepatitis C virus world-wide," said Dr. John McHutchison, professor of medicine
and associate director of the Duke Clinical Research Institute. "A significant
number of patients with HCV infection will at some point develop platelet
problems that will compromise their getting the best treatments we have.
Anything we can do to prevent that from happening would improve their care."
The study was sponsored by GlaxoSmithKline, which manufactures eltrombopag.
McHutchison and many of the coauthors also report having received grants,
consulting, advisory or speaking fees from the company.
It's estimated that 4 million people in the U.S. and 170 million worldwide carry
the hepatitis C virus. The virus causes inflammation and scarring in the liver,
and while it is curable in about half of those who have it, it can lead to
significant liver damage, liver cancer and death in others.
HCV infection is a common cause of cirrhosis and the most common reason for a
liver transplant.
Platelets are cells made in the bone marrow and are important in clot formation,
and serious bleeding can occur if platelet levels fall too low. Some diseases,
like HCV infection, can cripple the body's ability to manufacture platelets, but
so can some medical treatments. Cancer patients, for example, can experience
plummeting platelet levels when undergoing chemotherapy.
In the phase II, multi-center trial, participants were randomized to a control
group or to receive 30, 50, or 75 milligrams of eltrombopag daily. The patients
had platelet levels ranging from 20,000 to 70,000 (145,000 to 450,000 is
normal).
A phase II trial is designed to test the safety and efficacy of a drug at
different doses, and the Duke study found that eltrombopag worked in a
dose-dependent manner, meaning that patients got a better response with
increasing amounts of the drug. Seventy-four percent of those in the trial who
took the lowest dose saw their platelet counts go up significantly, while 79
percent and 95 percent of the participants saw increases with the higher doses.
Eltrombopag does cause side effects. Some of the patients complained of
headaches, dry mouth, abdominal pain and nausea.
"We are encouraged by these results and are already working on another
multi-center, international, phase III trial where we hope these results will be
confirmed," said McHutchison.
Colleagues who contributed to the study include Geoffrey Dusheiko, M.D., Royal
Free Hospital, London; Mitchell Schiffman, M.D., Virginia Commonwealth
University Medical Center; Maribel Rodriguez-Torres, M.D., Fundacion de
Investigacion de Diego, San Juan; Samuel Sigal, M.D., Weill Medical College;
Marc Bourliere, M.D., Hopital St. Joseph, Marseille; Thomas Berg, M.D., Charite,
Berlin; Stuart Gordon, M.D., Henry Ford Hospital and Health System, Detroit;
Fiona M. Campbell, B.Sc., GlaxoSmithKline, Greenford, UK; Dickens Theodore,
M.D., M.P.H., GlaxoSmithKline, Research Triangle Park; Nicole Blackman, Ph.D.
and Julian Jenkins, M.Sc.,GlaxoSmithKline, Philadelphia; and Nezam Afdhal, M.D.,
Beth Israel Deaconess Medical Center, Boston.
http://www.localtechwire.com/business/local_tech_wire/biotech/story/2116331/
Peace and Love
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Mahatma Gandhi put it well: "Be the change you want to see in the
world." It always begins with one person.

Chocolate lovers feast at Hep C fundraiser
By Joanne Davidson
Denver Post Society Editor
Article Last Updated: 12/01/2007 03:56:10 PM MST
Ann Jesse started the Hep C Connection as a "patients helping patients" support
network. She stepped down as executive director 10 years later but remains
involved as a volunteer and adviser. Her service was recognized last year at the
first Desserts & Delights.
The 2007 edition, chaired by Katie Barton and Karen Robinson Rosenthal and held
at the Walnut Foundry in Denver's River North Art District, honored businessman
Taylor Owen, a former president of the Hep C Connection board.
While sampling hors d'oeuvres and a lavish array of chocolate desserts, the
250-plus guests placed their silent auction bids while jazz musicians provided
some lively tunes. Cynthia Hessin, an executive producer for KRMA, was mistress
of ceremonies, encouraging everyone to bid high and bid often on the array of
weekend getaways, pieces of art and tickets to various sports match-ups.
Among the guests: Sherry Jackson, executive director of the Colorado Democratic
Party, and Adrian Miller; Jim Bernuth; Christy Calvin; Cheryl Anderson; Betsy
Hoover; Jared and Sarah Hamilton; Ann McDougal; Don Rowe; Ron and Charlene
Bushe; Carma Lytle; and executive director Nancy Steinfurth.
Hepatitis C is a blood-bo