Centro Medico Lachesi

Mese: Novembre 2019

  • Drug-induced liver injury

    Drug-induced liver injury

    Lack of substantial advances in pre-clinical testing for hepatotoxicity has meant that drug-induced liver injury (DILI) remains an important issue during both the drug development and post-marketing phases. A number of drug-related, genetic and non-genetic host factors influence the risk of DILI in any individual.

    Demonstration of human leukocyte antigen genotype as a strong risk factor for the development of DILI from a range of drugs has highlighted the role of the adaptive immune system in its pathogenesis; there is accumulating evidence that drug metabolism genes also contribute to some forms of DILI. Early recognition and prompt withdrawal of the drug is essential in preventing serious hepatic failure and is the critical step in the management of adverse reactions.

    Diagnosis of DILI relies upon index of suspicion, careful evaluation of a temporal relationship between the exposure to a particular drug and the specific clinical event, and exclusion of potential alternative diagnoses. A high negative predictive value of genetic tests can be used to rule out DILI caused by particular drugs and to correctly identify the agent underlying DILI in a patient exposed to two concomitant medications.

    Keywords

    Adverse drug reactiondrug-induced liver injuryhepatotoxicityhuman leukocyte antigenMRCPpharmacogenetics

  • Histological assessment

    Histological assessment

    Histopathological assessments play an important role in the diagnosis and management of patients with liver disease. For some conditions, liver biopsy is still routinely used to establish the cause of liver disease. In other circumstances, evaluation of morphological changes provides additional information that is useful for clinical management, for example when assessing disease severity in chronic viral hepatitis and non-alcoholic fatty liver disease.

    However, with the increased use of non-invasive methods for assessing the severity of liver injury, particularly fibrosis, the role of liver biopsy in this respect is changing. In cases where a dual pathology is suspected, histological assessment can help to identify the main cause of liver injury. In addition, liver biopsy sometimes reveals abnormalities that have not been detected by previous investigations.

    Histopathological assessment of liver biopsies involves a systematic evaluation of changes involving individual components of the normal liver. The final interpretation of the abnormalities detected depends on clinico-pathological correlation. Sampling variation is a problem, particularly with small needle biopsies, and should be considered as a possible explanation when there is a disparity between clinical and pathological findings.

    Keywords

    Liver biopsyliver histologyliver pathologyMRCP

  • Maribavir for Preemptive Treatment

    Maribavir for Preemptive Treatment

    Maribavir is a benzimidazole riboside with activity against cytomegalovirus (CMV). The safety and efficacy of maribavir for preemptive treatment of CMV infection in transplant recipients is not known. Design adds clarity. Using colour, typo graphy, hierarchy, contrast, and all the other tools at their disposal, designers can take an unordered jumble of…

    In a phase 2, open-label, maribavir dose–blinded trial, recipients of hematopoietic-cell or solid-organ transplants (≥18 years of age, with CMV reactivation [1000 to 100,000 DNA copies per milliliter]) were randomly assigned to receive maribavir at a dose of 400, 800, or 1200 mg twice daily or the standard dose of valganciclovir for no more than 12 weeks. The primary efficacy end point was the percentage of patients with a response to treatment, defined as confirmed undetectable CMV DNA in plasma, within 3 weeks and 6 weeks after the start of treatment. The primary safety end point was the incidence of adverse events that occurred or worsened during treatment.

    RESULTS

    Of the 161 patients who underwent randomization, 159 received treatment, and 156 had postbaseline data available — 117 in the maribavir group and 39 in the valganciclovir group. The percentage of patients with postbaseline data available who had a response to treatment within 3 weeks was 62% among those who received maribavir and 56% among those who received valganciclovir. Within 6 weeks, 79% and 67% of patients, respectively, had a response (risk ratio, 1.20; 95% confidence interval, 0.95 to 1.51). The percentages of patients with a response to treatment were similar among the maribavir dose groups.

    Two patients who had a response to treatment had a recurrence of CMV infection within 6 weeks after starting maribavir at a dose of 800 mg twice daily; T409M resistance mutations in CMV UL97 protein kinase developed in both patients. The incidence of serious adverse events that occurred or worsened during treatment was higher in the maribavir group than in the valganciclovir group (52 of 119 patients [44%] vs. 13 of 40 [32%]). A greater percentage of patients in the maribavir group discontinued the trial medication because of an adverse event (27 of 119 [23%] vs. 5 of 40 [12%]). A higher incidence of gastrointestinal adverse events was reported with maribavir, and a higher incidence of neutropenia was reported with valganciclovir.

  • Diabetes Tougher on Women’s Hearts

    Diabetes Tougher on Women’s Hearts

    Diabetes might be more deadly for women than men, at least when it comes to heart troubles, new research shows. Heart disease occurs an average of 15 years earlier in people with diabetes, and is their main cause of illness and death. In women, the connection between diabetes and heart disease is particularly strong.

    Worldwide, more women die due to diabetes than men, 2.1 million versus 1.8 million a year, the researchers said.

    Coronary heart disease is the most common and deadly type of heart disease in people with diabetes. Women with diabetes have a 1.8 times higher risk of death from coronary heart disease than women without diabetes. Men with diabetes have a 1.5 times higher risk of death from coronary heart disease than men without diabetes.

    Peripheral artery disease — which can eventually lead to foot amputation — is the most common initial sign of heart disease in type 2 diabetes patients, and it is 1.8 times more common in women than men.

  • Global cancer statistics for the most common cancers

    Global cancer statistics for the most common cancers

    Find information about world cancer statistics for the most common cancers (excluding non-melanoma skin cancer) in 2018, the latest year available.

    There were an estimated 18 million cancer cases around the world in 2018, of these 9.5 million cases were in men and 8.5 million in women. The most common cancers globally are listed in the table below.

    With this growing global burden, prevention of cancer is one of the most significant public health challenges of the 21st century. Our Cancer Prevention Recommendations work together as an overall way of living healthily to prevent cancer through changing dietary patterns, reducing alcohol consumption, increasing physical activity and achieving and maintaining a healthy body weight – read our blog here.

    As well as action by individuals, achieving healthy patterns of diet and sustained physical activity over the life course requires concerted and integrated action from all sectors of society, including civil society, private sector, and health and other professions. Read more about policy action for cancer prevention here.

  • Studies Confirm HPV Shot Is Safe

    Studies Confirm HPV Shot Is Safe

    The HPV vaccine gives parents a chance to prevent their children from developing some types of cancer, and two new studies reaffirm what past research has found — the vaccine is safe.

    The two studies included millions of doses of Gardasil 9 vaccine, the only vaccine currently used in the United States for the prevention of HPV-related cancers.

    “The data from our study was very reassuring. We saw nothing unexpected or surprising. With Gardasil 9, we can now prevent a large portion of cervical, oropharyngeal [mouth, tongue and throat] and other cancers,” said one of the studies’ lead author, Dr. James Donahue. He’s an epidemiologist with the Marshfield Clinic Research Institute in Wisconsin.

    The studies and an accompanying editorial were published Nov. 18 in the journal Pediatrics.

    Human papillomavirus (HPV) is a sexually transmitted virus. It’s estimated that 79 million people in the United States are already infected with HPV. Around 14 million new infections with HPV occur every year. About half of those are teens and young adults, according to the editorial. Sometimes these infections get better on their own, but many do not.

    HPV is responsible for more than 33,000 cancers each year — 20,000 in women and 13,000 in men. Routine use of the Gardasil 9 vaccine could prevent about 90% of these cancers, the editorial said.

  • Are Vaping Bans the Way to Go?

    Are Vaping Bans the Way to Go?

    As cases of vaping-related lung injury climb, public health officials are scrambling for solutions to stem the epidemic. At the center of the debate: to ban vaping or not.

    Massachusetts became the first state to enact a law banning flavored tobacco and vaping products, including menthol cigarettes. The ban on flavored vaping products is effective immediately, while the ban on menthol cigarettes goes into effect June 1, 2020.

    The American Medical Association called for a ban on all e-cigarette and vaping products from the market. “We have very little evidence about the short- and long-term health consequences of e-cigarettes and vaping products,” said AMA President Patrice A. Harris, MD, in a statement.

    More and more states are trying to enact some type of ban on e-cigarettes — but are meeting resistance. Courts have blocked many of the bans already, while others are being challenged in court.

    Public health officials, including tobacco control experts, say the bans may backfire, driving people who vape as an alternative to traditional cigarettes back to smoking.

    Michael Siegel, MD, a professor of community health sciences at Boston University School of Public Health, says an estimated 2.5 million former cigarette smokers use e-cigarettes.

    “We take these 2 million people and basically say, ‘Congratulations on this great accomplishment [of smoking cessation.]’ Now we are going to take away the product that is helping you quit,” he says.

  • Experimental Block Peanut Allergy

    Experimental Block Peanut Allergy

    People with peanut allergy must be constantly vigilant to avoid a life-threatening allergic reaction. But researchers report that a new drug injection might offer at least temporary protection against the most severe reactions.

    Just one shot of an experimental antibody treatment allowed people with severe peanut allergy to eat about one peanut’s worth of peanut protein two weeks later, the study found.

    The drug is like “a protective blanket” shielding people from accidental peanut exposure, said study senior author Dr. Kari Nadeau, director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University in California.

    Peanut allergy affects an estimated 2.5% of American children, and that number has risen sharply over the past decade, according to the American College of Allergy, Asthma and Immunology (ACAAI).

    Children and adults with a peanut allergy are at risk of having a sudden and severe allergic reaction (anaphylaxis) that can be life-threatening if they consume even small amounts of peanuts.

    The problem is that peanuts are in many foods, such as candy, cereal, baked goods, sauces, marinades and even in ice cream, according to the ACAAI.

  • New Shingles Vaccine: What You Need To Know

    New Shingles Vaccine: What You Need To Know

    Unlike some vaccines, there’s been so much demand for the new shingles vaccine Shingrix that it’s not always easy to find. It was approved in 2017, and the CDC recommends the vaccine for adults 50 and older to prevent this painful, blistering illness. It is being used in place of the previous vaccine, Zostavax.

    More than a year later, doctors say they are learning more about how it works, its safety risks, and how it compares to Zostavax.

    How effective is Shingrix?

    “It’s just remarkable,” says Wilbur Chen, MD, an associate professor of medicine at the Center for Vaccine Development and Global Health, University of Maryland School of Medicine. “It has performed better than I expected.”

    The CDC’s Advisory Committee on Immunization Practices (ACIP) hasn’t confirmed whether the vaccine is safe for people who have a weakened immune system because of a disease or medicine.

    “The big concern among certain groups of doctors is that they don’t want to evoke a reaction that might, for example, in a transplant patient result in a rejection of the transplant,” Schaffner says. “They want to make absolutely sure the vaccine is safe.” Another worry is that taking drugs that weaken the immune system might make the shingles vaccine less effective.

    ACIP is discussing how to give the vaccine to people with a weakened immune system. It’s important for this group to be protected because they’re at higher risk for shingles and its complications.

  • Cancer Risk May Rise After Heart Attack

    Cancer Risk May Rise After Heart Attack

    Here’s some worrisome news for folks who manage to survive a heart attack: New research suggests they might be far more vulnerable to developing cancer down the road.

    People who suffered a heart health scare — a heart attack, heart failure or a dangerously erratic heart rhythm — had a more than sevenfold increased risk for subsequently developing cancer, compared to those with healthy tickers, researchers said.

    “We found that folks with certain risk factors for heart disease had an increased risk of cancer and, more intriguingly, we found up that individuals who ended up developing heart disease had a significantly increased risk of future cancer,”

    lead researcher Dr. Emily Lau, a cardiology fellow at Massachusetts General Hospital in Boston.

    These findings are based on data from the Framingham Heart Study, a famous decades-long research project following the heart health of people living in the small town of Framingham, Mass.

    Lau and her colleagues had noticed that many regular patients with heart disease were also fighting cancer.

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