Research & Treatment News
October 28, 2008
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Despite the prevalence of Hepatitis C infection in the U.S. prison population, some inmates are denied treatment due to the medications' high cost. However, a UCLA study insists that treating all infected U.S. prisoners with the standard therapy would actually be cost-effective.
Hepatitis C Treatment Is Cost-effective For The US Prison Population
ScienceDaily (Oct. 25, 2008) — Treating all U.S. prisoners who have hepatitis C with the standard therapy of pegylated-interferon and ribavirin would be cost-effective, according to a new study.
U.S. prisons incarcerate more than 2 million inmates each year, and between 12 and 31 percent of them are infected with chronic hepatitis C (HCV), mostly related to high rates of intravenous drug use. The current standard treatment for HCV has been shown to be cost-effective in the general population and the Federal Bureau of Prisons recommends HCV treatment for those who meet the AASLD's criteria for treatment, as long as therapy is likely to be completed. However, each state adopts its own set of treatment guidelines, and many prisoners do not ultimately get treated.
Proponents for treatment argue that we have an ethical duty to provide prisoners with the best medical practices available, and treating HCV could reduce new infections as well as future medical expenses from advanced liver disease. Opponents point out that treatment is expensive and must be paid for by taxpayers, while many non-imprisoned HCV patients who don't have health insurance are denied access to this care.
Researchers, led by Sammy Saab of the David Geffen School of Medicine at UCLA, sought to determine if HCV treatment would be cost-effective in the male prison population (men make up over 87 percent of U.S. prisoners). They examined published literature for relevant studies and constructed a decision analysis model employing Markov simulation, using the generally accepted cost-effectiveness threshold of $50,000 per quality-adjusted life years.
"Our model found that treatment was cost-saving for prisoners of all age ranges and genotypes when liver biopsy was not a prerequisite to starting antiviral therapy," they report. "In other words, treatment resulted in both decreased costs and improved quality of life." Treatment was also cost-saving in most situations that included a pre-treatment liver biopsy.
The authors had not expected treatment to be cost-effective, because of the high re-infection rates and non-liver mortality rates in the prison population. However, they write, "our results demonstrate that pegylated-interferon and ribavirin is cost-saving in the prison population, both in strategies with and without biopsy. Incorporating a pre-treatment liver biopsy may be the most cost-effective approach, however, as one could potentially exclude certain patients with no fibrosis from therapy."
"If the decision to treat is based on pharmacoeconomic measures," the authors conclude, "the results of our analysis suggest that treatment is cost-saving and should not be withheld in U.S. prisoners with hepatitis C."
Since the efficacy of treatment would be diminished by relapse to injection drug use and re-infection, treatment should be coupled with educational and substance abuse programs, they suggest. And because mental illness is widespread in the prison population, and can often be exacerbated by treatment, careful mental health screening and follow-up would be required.
This research is published in the November issue of Hepatology, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases (AASLD).
Adapted from materials provided by Wiley-Blackwell, via EurekAlert!, a service of AAAS.
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URL for Article Source:
http://www.sciencedaily.com/releases/2008/10/081020150617.htm
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October 27, 2008
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A specially designed breath test has been found to be a safe and accurate alternative to liver biopsy for determining the degree of inflammation and fibrosis in patients with chronic Hepatitis C infection and normal ALT, according to researchers from Jerusalem.
(13)C-methacetin Breath Test for Non-invasive Assessment of Liver Fibrosis in Chronic Hepatitis C Patients
By Liz Highleyman
Over years or decades, chronic hepatitis C virus (HCV) infection can progress to advanced liver disease including severe fibrosis, cirrhosis, and hepatocellular carcinoma.
Liver biopsy remains the "gold standard" for assessing liver disease progression, but since the procedure is expensive, uncomfortable, and carries a small risk of complications, researchers have explored various non-invasive methods.
Several of these methods employ various blood biomarkers. Liver function tests that measure alanine aminotransferase (ALT) and aspartate aminotransferase (AST) indicate liver inflammation and may be a sign of progressive liver damage, but as many as one-third of hepatitis C patients with significant liver disease have persistently normal ALT.
As background, the authors noted that the test reflects hepatic microsomal function and has been shown to correlate with liver fibrosis. Such tests work on the principle that a damaged liver is unable to efficiently metabolize various substances, which can be measured in the expelled breath.
The investigators tested 100 patients with untreated chronic HCV infection along with 100 healthy HCV negative age- and sex-matched volunteers. The (13)C-methacetin breath test was administered following ingestion of 75 mg methacetin. All participants had undergone a liver biopsy within 12 months of receiving the breath test.
Patients with a necroinflammatory grade <4 (based on Ishak score) were defined as having low-level inflammation, while those with a grade > 4 were defined as having high-level inflammation. Individuals with a histological activity fibrosis stage < 2 were defined as having non-significant fibrosis, while those > 2 were defined as having significant fibrosis.
Results
• A proprietary algorithm used to differentiate liver inflammation in chronic hepatitis C patients with normal ALT achieved an area under the curve (AUC) of 0.90.
• Setting a threshold on the point of best agreement, at 83%, resulted in 82% sensitivity and 84% specificity.
• Applying another proprietary algorithm to differentiate patients with non-significant or significant fibrosis, 67% of liver biopsies could have been avoided by using the breath test.
• This algorithm achieved an AUC of 0.92, with a sensitivity of 91% and a specificity of 88%.
" There was no correlation between body mass index and breath test scores for patients with the same histological score.
"The continuous BreathID (13)C-methacetin breath test is an accurate tool for measuring the degree of inflammation and fibrosis in patients with chronic HCV infection and normal ALT," the study authors concluded. "As such, it may prove to be a powerful, noninvasive alternative to liver biopsy in the management of this patient population."
10/24/08
Reference
G Lalazar, O Pappo, T Hershcovici, and others. A continuous (13)C methacetin breath test for noninvasive assessment of intrahepatic inflammation and fibrosis in patients with chronic HCV infection and normal ALT. Journal of Viral Hepatitis 15(10): 716-728. October 2008.
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URL for Article Source:
http://www.hivandhepatitis.com/hep_c/news/2008/102408_a.html
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Although new research demonstrates vitamin D deficiency in those with Hepatitis C, make sure you don’t overreact by taking a toxic amount of this supplement.
by Nicole Cutler, L.Ac.
In addition to dietary recommendations for liver disease, a significant portion of people with the Hepatitis C virus (HCV) take vitamins and herbs to support their liver. Despite this trend, American researchers have confirmed that living with chronic Hepatitis C is usually accompanied by a vitamin D deficiency. Worried about the consequences of a vitamin D deficiency, those with the virus may choose to supplement with this vitamin. However, vitamin D is toxic in large doses and taking too much of it could end up being more harmful than not having enough.
About Vitamin D
Vitamin D is a fat-soluble vitamin that helps the body absorb calcium and plays a crucial role in the growth and maintenance of strong, healthy bones. A lack of vitamin D causes calcium-depleted bone, which can weaken the bones and increase the risk of fractures resulting from osteoporosis. While vitamin D is probably best known for its role in bone development and maintenance, it’s also involved in the brain, immune and reproductive systems. A lack of vitamin D can cause osteomalacia in adults and rickets in children, both of which are unwelcome additions to the burden of chronic liver disease.
Vitamin D is found in food, but can also be produced in the body after exposure to ultraviolet rays from the sun. Some forms of vitamin D are relatively inactive, with a limited ability to function as a vitamin. The liver and kidney help convert vitamin D to its active hormone form. But for those with advanced liver disease from Hepatitis C, a deficiency can conceivably develop from the liver’s inability to convert vitamin D into its active form.
The Research
Presented in October 2008 at the 73rd Annual Scientific Meeting of the American College of Gastroenterology, researchers from the University of Tennessee in Memphis measured the vitamin D levels in people with chronic liver disease. Of those evaluated, 85 percent of the study participants had chronic Hepatitis C. After dividing every vitamin D deficiency into three categories (mild, moderate and severe), the investigators found the following:
· 92.4 percent of those with chronic liver disease had some degree of vitamin D deficiency
· At least 33 percent of participants were severely deficient in vitamin D
· Severe vitamin D deficiency was more common among those with cirrhosis
Lead researcher Dr. Satheesh P. Nair commented, “Since deficiency is common among these patients, Vitamin D replacement may hopefully prevent osteoporosis and other bone complications related to end stage liver disease.”
Vitamin D Supplementation
For those with a documented vitamin D deficiency, supplementation can help prevent bone density problems from emerging. Established by the U.S. Institute of Medicine of the National Academy of Sciences, the recommendations for supplementing with vitamin D are as follows:
· 200 International Units (IU) for those between the ages of 19 and 50
· 400 IU for those ages 50 to70
· 600 IU for people over age 70
Increased dosages may be recommended as a person ages due to the skin’s declining ability to absorb the sun’s radiation and an inability of the liver or kidneys to transform vitamin D to its active form.
Vitamin D’s Danger
Between the newly released research connecting vitamin D deficiency with chronic HCV and the ease of obtaining vitamin D supplements, it seems that those with HCV would jump at the opportunity to supplement with vitamin D. However, too much vitamin D is dangerous for those with liver disease because it is toxic. Vitamin D toxicity can cause:
· Nausea
· Vomiting
· Poor appetite
· Constipation
· Weakness
· Weight loss
Too much vitamin D can also raise blood levels of calcium, causing mental status changes such as confusion and heart rhythm abnormalities. Another consequence of excess supplementation is calcinosis, the deposition of calcium and phosphate in soft tissues like the kidney.
The Food and Nutrition Board of the Institute of Medicine considers an intake of 1,000 IU for infants up to 12 months of age and 2,000 IU for children, adults, pregnant and lactating women, to be the tolerable upper intake level. Toxicity reports are associated with dosages above these levels.
While the results of the trial conducted in Memphis clearly link vitamin D deficiency with chronic HCV infection, those affected must beware. Supplementing with vitamin D could help prevent some of the consequences of insufficient vitamin D – but taking too much poses even greater dangers. A person’s best bet to make sure their vitamin D levels are adequate is to discuss their concerns with their physician and, if necessary, agree on the best way to supplement with vitamin D.
References:
http://healthlink.mcw.edu/article/982088787.html, Vitamin D, Retrieved October 12, 2008, Medical College of Wisconsin, 2008.
http://hepatitis.about.com/b/2008/10/06/are-you-getting-enough-vitamin-d.htm, Are You Getting Enough Vitamin D?, Charles Daniel, Retrieved October 12, 2008, About.com, October 6, 2008.
http://hepatitisc.va.gov/vahep?page=diet-02-09&pf=doc-pf&pp=pf, Diet and Nutrition, Retrieved October 12, 2008, United States Department of Veteran Affairs, 2008.
http://www.eurekalert.org/pub_releases/2008-10/acog-vdd100308.php, Vitamin D deficiency common in patients with IBD, chronic liver disease, Retrieved October 12, 2008, American College of Gastroenterology, October 6, 2008.
http://www.merck.com/mmpe/sec01/ch004/ch004k.html, Vitamin D, Retrieved October 12, 2008, Merck & Co., 2008.
http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www
/story/09-25-2008/0004892578&EDATE=, Vitamin D Deficiency Reports May Be Causing Some to Overreact and Take Harmful Actions, Retrieved October 12, 2008, US Preventive Medicine, PR Newswire Association LLC, September 2008.
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Evidence indicates that incorporating meditation into your daily routine could prevent a Hepatitis C flare up. This article tells you how it works and what you can do.
by Nicole Cutler, L.Ac.
Most who have emerged from the invincible self-perception of the teen years know that their body is more vulnerable to illness when under stress. Whether evaluating the common cold or cancer, medical researchers have repeatedly confirmed this association. For those managing chronic Hepatitis C, the connection between health and stress takes on monumental significance. There are various ways one can reduce or relieve stress. However, meditation’s ability to prevent liver disease from flaring up makes it a top stress-relieving choice for many with chronic Hepatitis C.
Understanding Stress
Because it is a subjective sensation that differs with each person, stress is difficult to define. Caused by both positive and negative experiences, stress is the body’s way of responding to any kind of demand. When feeling stressed, the body reacts by releasing chemicals into the bloodstream to enhance energy and strength. Designed to prepare for “fight or flight,” the initial result of this chemical release is:
· Faster breathing
· Quickened heart rate
· Muscle tension
The physiological response described above is intended to boost people’s abilities when in physical danger. However, people often have no outlet for the extra energy and strength that was initiated by emotional stressors. Therefore, a person’s first line of defense against emotional stress is convincing the body to relax again. By quieting the mind and purposefully slowing down the breathing rate, meditation helps many people vent the tension in their body and subsequently achieve relaxation.
Meditation for Stress Relief
Eastern medical traditions and philosophies have recognized the health benefits of meditation for thousands of years. Due to its positive effects on relieving stress and consequently improving health, meditation is now widely practiced in the many parts of the Western world.
Meditation can be used for stress relief or as part of a spiritual practice. Either way, meditation is a tool to help quiet the mind while promoting awareness and a sense of well-being. Sometimes described as the practice of mindfulness or living in the present, there are many types of meditation a person can experiment with. Meditation can be self-taught or learned from a teacher, book or recording. While it may be simple to learn, regular meditation requires a commitment to its practice. Advocates claim that when part of a daily routine, meditation enforces health by relieving stress and tension.
Meditation for Hepatitis C
People with chronic viral hepatitis typically experience a flare-up of symptoms following a bout of stress. Various types of research have confirmed the connection between stress and its implication on liver inflammation. Some of the conclusions and physiological reasons supporting meditation for chronic Hepatitis C include:
· Research on hypnotically induced fear and anxiety resulted in a significantly decreased flow of blood through the liver.
· Those with Hepatitis C who were categorized as having a consistently stressed and uptight personality (type 1) were more likely to be associated with severe liver disease than those who had a more relaxed, easy-going personality.
· During stress, natural killer cells multiply in the liver. Natural killer cells can contribute to liver cell death and the worsening of liver disease.
· By monitoring the part of the brain that controls the liver, researchers observed that stress impairs blood flow and may lead to, or trigger, liver damage.
· During periods of stress, the body releases glucocorticoids, which maintain balance in the function of each organ. Mice pre-treated with glucocorticoids were found to have deterioration in their liver function.
· Therapies targeting stress reduction such as hypnosis, acupuncture and meditation can stimulate the vagus nerve, which counters the negative effects of stress on the liver.
All of the interactions between stress and the liver are not completely understood. However, there is an undeniable relationship between unrelieved stress and liver disease progression. While meditation does not offer a cure for Hepatitis C, its ability to relieve stress can reduce the virus’ opportunistic approach for causing liver damage.
References:
http://www.hbvadvocate.org/hepatitis/factsheets_pdf/stress_liver.pdf, The Liver: Stress and the Liver, Alan Franciscus, Retrieved September 22, 2008, Hepatitis C Support Project, 2008.
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Meditation.pdf, HCV Wellness: Meditation, Lucinda Porter, RN, Retrieved September 22, 2008, Hepatitis C Support Project, 2008.
http://www.hepatitis.va.gov/vahep?page=altmed-03-01, Alternative Therapies – Meditation, Retrieved September 22, 2008, United States Department of Veteran Affairs, 2008.
http://www.hepatitiswa.com.au/HC%20treatment.html, Treatment, Retrieved September 22, 2008, Hepatitis Council of Western Australia, 2008.
http://www.mtstcil.org/skills/stress-definition-1.html, What is Stress?, Retrieved September 25, 2008, Mountain State Centers for Independent Living, 2008.
http://www.stress.org/, Home and Stress Reduction, Stress Relievers, Paul J. Rosch, MD, FACP, Retrieved September 24, 2008, The American Institute of Stress, 2008.
http://www.webmd.com/depression/tc/meditation-topic-overview, Meditation – Topic Overview, Retrieved September 24, 2008, Healthwise, Incorporated, 2008.
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October 9, 2008
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People with chronic Hepatitis C are more vulnerable to worsening of liver disease when burdened by an additional form of viral hepatitis. HCV patients will learn more about the Hepatitis A/B combination vaccine and possible side effects in this article.
by Nicole Cutler, L.Ac.
The various types of viral hepatitis vary widely in how they affect people’s health. One strain may cause a temporary, mild illness while others can lead to a lifelong battle with chronic liver disease. Regardless of which hepatitis virus you are exposed to, the prognosis is always more grim if you are already infected with some other form of chronic hepatitis. Therefore, taking advantage of the vaccinations available for Hepatitis A and Hepatitis B can help someone with another kind of hepatitis prevent a worsening of their condition by becoming infected with multiple hepatitis viruses.
Hepatitis C
Of particular concern are the four to five million Americans estimated to be living with chronic Hepatitis C. When burdened with an additional type of viral hepatitis, research has shown that those with chronic Hepatitis C experience more rapid progression of liver disease than those not infected by another form of hepatitis.
Hepatitis A and Hepatitis B are two of the three most common viral hepatitis strains found in North America. Fortunately, vaccines to prevent these two infectious diseases are readily available. Unfortunately, there is currently no vaccine to prevent the other prevalent viral hepatitis, Hepatitis C. Adding insult to injury, Hepatitis C’s low cure rate, high infectivity and likelihood to cause chronic liver disease makes it the most perilous strain of the three common types of viral hepatitis. Due to the greater chance of liver damage with more than one kind of hepatitis, those with Hepatitis C are always advised to get vaccinated for both Hepatitis A and Hepatitis B. Thanks to the marvels of Western medicine, a vaccine targeting both Hepatitis A and Hepatitis B have been combined into one series of injections.
Combination Vaccine
Luckily for those already infected with Hepatitis C, there is a preventative vaccine combining ammunition against both Hepatitis A and Hepatitis B. By uniting two separate vaccination series into one, the Hepatitis A/B combination vaccine has made preventing these illnesses much simpler. Those considering this vaccination must know that they cannot get hepatitis from it because it does not contain a live virus. The combination vaccine is created from whole, killed Hepatitis A virus and a genetically engineered piece of Hepatitis B virus.
The combination Hepatitis A/B vaccine is routinely recommended for those at high risk for acquiring infections such as:
· Health care personnel
· Laboratory workers who handle blood and patient specimens
· Police, fire and emergency medical personnel who give first aid treatment
· Hemophiliacs
· Dialysis patients
· Household and intimate contacts of those with chronic Hepatitis B or active Hepatitis A
· Persons with multiple sex partners
· Men who have sex with men
· Sex workers
· Injection drug users
· Those traveling to high-risk areas
To prevent a worsening of their condition and save them the time of two vaccination series, those already living with chronic Hepatitis C are also prime candidates for the Hepatitis A/B combination vaccine.
Considerations
While many receiving the Hepatitis A/B combination vaccine do not experience serious side effects, the most common problems include:
· soreness at the injection site
· headache
· fatigue
In addition, the combination vaccine is contraindicated in those with:
· a known hypersensitivity to neomycin
· a known hypersensitivity to yeast
Another consideration for the combination Hepatitis A/B vaccine is someone’s immune system strength. Vaccines work by bringing a tiny amount of infection into the body to stimulate an antibody response against it. Unfortunately, those with a weakened immune system (such as those with HIV) may not be able to illicit an antibody response strong enough to create immunity. While this is a concern for the Hepatitis A/B combination vaccine, new research has shown that administering a double dose greatly increases its efficacy for immune-compromised individuals.
Although medications free of flaws are virtually non-existent, the combination Hepatitis A/B vaccine is a blessing for those with chronic Hepatitis C. Especially if never vaccinated for either Hepatitis A or Hepatitis B AND diagnosed with Hepatitis C, the Hepatitis A/B combination vaccine saves the time and inconvenience of two separate vaccination schedules for preventing multiple hepatitis infections.
References:
http://aids.about.com/od/howtostayhealthy/p/twinrix.htm?p=1, Twinrix Vaccine, Mark Cichocki, RN, Retrieved September 5, 2008, About.com, 2008.
http://aids.about.com/od/vaccinesscreenings/a/hepbdd.htm?p=1, Double Dose Hepatitis B Vaccine For People Living With HIV, Mark Cichocki, RN, Retrieved September 5, 2008, About.com, 2008.
http://www.hivandhepatitis.com/hep_b/news/2008/082908_a.html, Prior Non-responders Respond Well to a Double Dose of Combined Hepatitis A and B Vaccine, Retrieved September 5, 2008, hivandhepatitis.com, 2008.
http://www.journals.uchicago.edu/doi/abs/10.1086/589722, Excellent Response Rate to a Double Dose of the Combined Hepatitis A and B Vaccine in Previous Nonresponders to Hepatitis B Vaccine, Kristina Cardell, et al, Retrieved September 5, 2008, The Journal of Infectious Diseases, 2008;198:299–304.
http://www.webmd.com/drugs/drug-21049-Twinrix+IM.aspx?drugid=
21049&drugname=Twinrix+IM, Twinrix IM, Retrieved September 5, 2008, WebMD, LLC, 2008.
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Since medical spas are offering more treatments involving the use of needles, sometimes without the supervision of a medical physician or properly sterilized equipment, the potential for Hepatitis C transmission is rising. Learn about some of the spa treatment techniques that pose hepatitis transmission dangers, as well as five ways to increase your safety in a medical spa.
by Nicole Cutler, L.Ac.
Everyone wants to look good, and now there are more ways to do it. Medical spas are the fastest growing segment of the spa industry and the newest spin on the cosmetic surgery and anti-aging world – and may be contributing to the spread of Hepatitis C. Many medical spas offer services that blur the distinction between medical procedures and beauty treatments, creating a substantial void in regulation. When it comes to the transmission of the Hepatitis C virus, this lack of universal regulation poses an obscure danger.
The three primary destinations melding medical procedures with beauty treatments include:
1. Medical Spa Franchises – These businesses are becoming increasingly popular and are capitalizing on this growing market.
2. Existing Day Spas – More conventional spas are adding medical procedures to their list of offerings.
3. Cosmetic Surgery and Dermatology Offices – Many of these medical professionals are creating spa-like atmospheres to profit from this growing market.
With such varied types of businesses, government agencies are challenged to implement strict regulations or defined rules for the medical spa market. As Dr. Alexander Rivkin of Westside Medical Spa puts it, “the medical spa industry is the wild west at this point... It’s a buyer beware kind of field.”
Some say the problem with the medical spa industry is that their popularity has outpaced oversight. Some state laws say only doctors can botox injections, while California and New York only require doctor supervision. Still, others have no laws in place. And even where regulations exist, no one monitors medical spas until someone complains. CBS News went undercover in California and easily found a place willing to give botox injections by a technician only, which is against the law. “Oh, you don't need a doctor, or nurse,” says someone at the spa. “We've done this before.”
Hepatitis Transmission Dangers
As the number of people realizing they have the Hepatitis C virus continues to rise, so does the concern of how they were infected in the first place. Since Hepatitis C is only transmitted through the blood, a majority of infections occur through IV drug use or tainted blood transfusions. However, experts estimate that at least 10 percent of those infected cannot determine how they contracted Hepatitis C. The unregulated, burgeoning medical spa industry could be one of the culprits of mysterious Hepatitis C transmission cases.
Since medical spas are offering more treatments involving the use of needles, the potential for Hepatitis C transmission is rising. Anytime needles are involved, universal hygiene precautions must always be followed to prevent disease transmission. To maintain consumer safety, all licensed medical professionals who use needles are required to complete an approved course of study and pass an exam proving they fully understand and practice these precautions. Some of the techniques using needles in a spa environment include:
· Permanent Makeup – Called intradermal cosmetics or micropigmentation, this procedure is also known as cosmetic tattooing.
· Cosmetic Dermal Fillers – By injecting substances into wrinkles or folds, cosmetic dermal fillers such as Botox or Restylane are believed to restore volume and fullness to the skin.
· Mesotherapy – A type of body sculpting, small microinjections of medications, vitamins, minerals and amino acids into the skin’s middle layer is a new technique aimed at reducing cellulite.
· Derma Needle – Another type of body sculpting, a tattoo machine penetrates the skin with a small needle to create collagen formation, supposedly resulting in smoother, tighter skin.
While proper sterile practice eliminates the possibility of Hepatitis C transmission from any of these procedures, the lack of medical spa regulation removes this guarantee of consumer safety.
Making news in May of 2007, an incident in Ohio reminds us of the possibility of Hepatitis C transmission from a medical spa. Arrested for practicing medicine without a license, the owner of a medical spa in Westlake is accused of infecting a client with an improperly sterilized tool used in a spa procedure. It seems that a form of body sculpting was being conducted, using tiny needles on a roller. For this kind of procedure to be safe it is imperative that any needles used be in a sterile package for one-time use only – or – be properly sterilized in an autoclave.
What to Look For
When it comes to any kind of needle piercing the skin, a risk of Hepatitis C transmission exists if not properly sterilized, or is inappropriately used between clients. The Centers for Disease Control recommends that single-use instruments intended to penetrate the skin be used once, then disposed of properly. Reusable instruments or devices that penetrate the skin and/or contact a client’s blood should be thoroughly cleaned and sterilized between clients. Anything less creates the possibility of transmitting the highly contagious Hepatitis C virus.
Spa treatments utilizing needles can be safe (not transmit infectious disease) if the practitioner is following universal precautions. While the laws differ depending on the service and the spa location, here are five ways to increase your safety odds in a medical spa:
1. Research the spa first. Medical professionals say clients should do their homework: get references, check with local licensing agencies and ask questions before agreeing to any services.
2. Pay attention to the spa’s surroundings. Look for clues to their emphasis on safety and sanitation practices. Notice if customers are coming and going faster than instruments can be sterilized. Check to see if the staff changes the water in a footbath and sterilizes the tub between customers. If hygiene does not seem important – leave.
3. Never get an invasive spa treatment using needles from anyone other than a licensed medical practitioner. Confirm the status with your state’s medical board. Having a physician supervising your procedure is not the same as having one perform it.
4. When getting permanent makeup applied, make sure the technician uses a new, disposable needle for each person. Additionally, make certain they sterilize their hands and any other equipment before it touches your skin.
5. If not using sterile, single-use, disposable needles, ask the spa to see their sterilization equipment. The spa should be willing to show you their autoclave and accompanying spore test results. An effective autoclave is a device that properly sterilizes needles by using a combination of steam and pressure. A spore test confirms the autoclave is working properly.
Until regulation agencies catch up with the times and establish universal standards for medical spas, consumers need to be aware of the possible dangers. As technology races ahead finding new ways to make us appear more youthful and beautiful, we cannot lose sight of Hepatitis C transmission prevention. While a majority of medical spas in the U.S. pay scrupulous attention to hygiene practices, it only takes one non-sterile needle to pass on Hepatitis C. Be adamant about your own safety – and make certain that only a licensed professional is allowed to pierce your skin using only sterile needles.
References:
www.cbsnews.com, Medical Spa Makeovers Gone Wrong, CBS Broadcasting, Inc., 2007.
www.centredaily.com, Medical spas alluring, but lack of oversight worries some, Christy Arboscello, The Centre Daily Times, May 2007.
www.lindisima.com, Needling or Needle abrasion or Intradermabrasion, linidisima.com, 2007.
www.locateadoc.com, Inside the Medical Spa: What to Expect, Locateadoc.com, 2007.
www.medicalspaskincarehawaii.com, Restylane Filler, Medical Spa & Skin Care Hawaii, 2007.
www.milforddailynews.com, Nurses Say Many May Have Hepatitis C and Not Know It, Jennifer Lord, GateHouse Media, May 2007.
www.newhorizonsspa.com, Mesotherapy, New Horizons Medical Spa, 2007.
www.perfecttouchspa.com, Permanent Cosmetics, Perfect Touch LLP, 2007.
www.weathernet5.com, Bella Derm Patient Says She Got Ill From Spa Procedure, NewsNet5, May 2007.
www.webmd.com, Dying to be Beautiful, Coulette Bouchez, WebMD Inc., 2007.
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October 8, 2008
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While several theories are attempting to explain the connection, scientists are unsure why those with Hepatitis B appear to have 2 ½ times increased risk for developing pancreatic cancer. In this article you will learn more about the link and why treatment for viral Hepatitis B may reduce the occurrence of pancreatic cancer.
Possible Link between Hepatitis B Virus and Pancreatic Cancer
Researchers from the M. D. Anderson Cancer Center in Texas have reported that exposure to the hepatitis B virus may be associated with the development of pancreatic cancer. The study was recently published in the October 1, 2008 issue of the Journal of Clinical Oncology.
The causes of pancreatic cancer remain obscure. Some of the known factors that increase the risk of developing pancreatic cancer include cigarette smoking, increasing age, certain dietary characteristics, obesity, diabetes, and pancreatitis. Hepatitis B and C are associated with chronic liver disease; however, because hepatitis is a systemic infection, the virus may travel through the bloodstream and be deposited in non-liver tissue. The proximity of the liver and the pancreas, as well as the shared blood vessels and ducts between the two organs, make the pancreas a potential target for the hepatitis virus.
In this study researchers compared blood samples from 476 patients with pancreatic cancer against those of 879 age-, sex-, and race-matched healthy controls. The blood samples were tested for both the hepatitis B and C viruses. Antibodies to hepatitis C were found in 1.5% of cases with pancreatic cancer and 1% of controls. Antibodies to hepatitis B were found in 7.6% of cases with pancreatic cancer and 3.2% of controls. Patients who were hepatitis B positive had a 2.5-fold increase in risk for developing pancreatic cancer. This risk was not increased in persons who were positive for both hepatitis B and C. Persons who were hepatitis B positive and hepatitis C negative had a fourfold increased risk of developing pancreatic cancer. Persons who were diabetic and hepatitis B positive had a sevenfold increase in risk of developing pancreatic cancer.
These researchers concluded that past exposure and possibly chronic infection with hepatitis B may be linked to the development of pancreatic cancer. This, combined with evidence from several previous studies indicating that there may be reservoirs of the hepatitis B virus in the pancreas, suggests that more research into this association is warranted. Furthermore, these researchers found that the presence of the hepatitis B antibodies create the potential for reactivation of the hepatitis B among patients when they receive chemotherapy treatment. As such, oncologists may want to check the hepatitis B status of patients before beginning chemotherapy.
Comments: Research in this field is ongoing. As researchers continue to learn more about the link between hepatitis B and pancreatic cancer, they may gain insight into the etiology of this disease. If hepatitis B is indeed a risk factor, then treatment for the virus may even decrease the risk of pancreatic cancer.
Reference: Hassan, M., Li, D., El-Deeb, A., et al. Association between hepatitis B virus and pancreatic cancer. Journal of Clinical Oncology. 2008; 26: 4557-4562.
URL for Article Source:
http://professional.cancerconsultants.com/oncology_main_news.aspx?id=42690
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October 7, 2008
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On September 28, 2008, researchers announced study results showing a new way to reduce viral replication (the progression of viral infection). The liver disease Hepatitis C may be chosen as a candidate for further exploration in this new technique to inhibit viral replication. For their study, the scientists had experimented with the herpes virus and fatty acid metabolism, and believe they can use existing drugs to inhibit viral replication in a number of diseases, including Hepatitis C. To learn why scientists are considering Hepatitis C as one of the candidates for further exploration of this unique way of metabolically blocking viral replication, read this article.
Existing Anti-obesity Drugs May Be Effective Against Flu, Hepatitis And HIV
ScienceDaily (Sep. 29, 2008) — Viruses dramatically increase cellular metabolism, and existing anti-obesity drugs may represent a new way to block these metabolic changes and inhibit viral infection, according to a study just published in the journal Nature Biotechnology.
Metabolism refers to all the reactions by which living things break down nutrients to produce energy, along with those by which they rebuild broken-down nutrients into complex molecules (e.g. DNA). A significant example is the breakdown of blood sugar (e.g. glucose) and its conversation via chain reactions into adenosine triphosphate, the energy-storing currency of cellular life. As an important offshoot of that process, glucose can also be converted into fatty acids, the lipid building blocks of human hormones and cell membranes. Many viruses, including influenza, HIV and hepatitis, use those same fatty acids to build instead their viral envelopes, outer coatings that help them penetrate human cells. Going into the study, little was known about the mechanisms through which viruses hijack metabolic building blocks from their cellular hosts, with older techniques providing a limited picture.
In the current study, a team of researchers from the University of Rochester Medical Center and Princeton University created a new technique to clarify these mechanisms, and found that the technique could identify anti-viral therapeutic targets. Researchers combined drug discovery technologies to capture for the first time the exact concentrations and turnover, in other words, the fluxes, of interchangeable molecules within the metabolic chain reactions that convert sugars into fatty acids. The fields of metabolomics and fluxomics have emerged to measure these patterns, and to provide insight into diseases with a metabolic component, from diabetes to infectious diseases to cancer.
"Using new fluxomic techniques, our study reveals that viral infection takes control of cellular metabolism and drives, among other things, marked increases in fatty acid synthesis," said Joshua Munger, Ph.D., assistant professor of Biochemistry and Biophysics at the University of Rochester Medical Center, and a study author. "We also found that if you target these increases in fatty acid metabolism using existing anti-obesity and anti-metabolism drugs, you inhibit viral replication."
A Thousand-fold Reduction in Viral Replication
In their experiments, Munger and colleagues developed a technique to measure changes in metabolic flux in human cells as they become infected by human cytomegalovirus (HCMV), an enveloped virus of the b-herpes family that infects most human adults and that causes severe disease in those with weakened immune systems. Researchers chose cytomegalovirus for experiments because it serves as an excellent model for processes at play in many enveloped viral infections and in cancers. HCMV replicates in a variety of human cell types, including fibroblasts, the cell type used in the study.
To study metabolic flux, Munger and his team created a stable, isotope-labeled version of glucose, which when "fed" to cells, was metabolized in a similar fashion as unlabeled glucose. Liquid chromatography and mass spectrometry were then employed to track the isotope label as it spread, or permeated, through the metabolic network. The impact of viral infection on cellular metabolism could be measured by the speed at which the labeled version spread, and then compared to uninfected cells. Given the complexity of interconnections within the metabolic network, the team also developed a novel computer model of metabolic function to analyze the data and guide further experimentation.
Many metabolic processes are essential to the survival of human cells, and so are not candidates for research efforts that would shut them down in the attempt to stop viral replication. For that reason, Munger and colleagues chose to look at whether interfering with glucose-to-fatty acid metabolism could stop viral replication, because fatty acid biosynthesis is not essential in adult humans. It does appear, however, to be essential to the ability of viruses to build their envelopes, reproduce and spread.
Thus, the team next used drugs known to inhibit enzymes that build fatty acids, acetyl-CoA carboxylase (ACC) and fatty acid synthase (FAS), used in the treatment of obesity and high cholesterol, to determine whether HCMV-induced fatty acid production was necessary for enveloped viruses to make copies of themselves. Indeed, treatment (10 mg ml-1) with 5-tetradecyloxy-2-furoic acid (TOFA), an ACC inhibitor, resulted in a more than thousand-fold reduction in HCMV replication. C75 (trans-4-carboxy-5-octyl-3-methylene-butyrolactone), an inhibitor of FAS, resulted in a more than 100-fold effect at the same dose.
To investigate whether this requirement extended to other enveloped viruses, the team measured influenza A replication in the presence of the same TOFA and FAS inhibitors, and found similar reductions in replication. Influenza A has little in common with HCMV except for its lipid envelope.
Extensive clinical testing would be needed to draw conclusions about the safety of TOFA and C75, or similar compounds, as antiviral treatment. That said, the team took an early look at toxicity, exposing uninfected fibroblasts to C75 or TOFA for 96 hours. They found that the drugs blocked HCMV replication without causing cell toxicity or self-destruction (apoptosis).
Along with Munger, Jessica McArdle of the Department of Biochemistry and Biophysics contributed to the work. Bryson Bennett also worked on the project from the Lewis-Sigler Institute for Integrative Genomics in the Carl Icahn Laboratory at Princeton University. Leading the effort from the Princeton side was the corresponding author, Joshua Rabinowitz, who worked with Anuraag Parikh, Thomas Shenk in the Department of Molecular Biology, and Xiao-Jiang Feng and Herschel Rabitz at the Frick Laboratory. The work was supported by the National Institutes of Health (NIH) Metabolomics Roadmap initiative, the National Science Foundation, the Beckman Foundation, the American Heart Association, the National Science Foundation and the American Cancer Society.
"Recent studies have shown that fatty acid biosynthesis is important for the replication of diverse enveloped viruses," Munger said. "The replication of both hepatitis C and HIV, for example, has been linked recently with lipid synthesis, reinforcing our approach and its importance. Lastly, viral infection also clearly upregulates glycolysis, a marker for tumor growth, which is just the latest in the longstanding connection between viruses and cancer. Hopefully, our work will at some point provide insight into the metabolic manipulations seen in cancer as well."
Adapted from materials provided by University of Rochester Medical Center, via EurekAlert!, a service of AAAS.
URL for Article Source:
http://www.sciencedaily.com/releases/2008/09/080928145603.htm
Posted by Editors at 11:01 AM --- Printer-friendly version