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The Editors at Hepatitis Central
July 11, 2022 WHO publishes updated guidance on hepatitis C infection – with new recommendations on treatment of adolescents and children, simplified service delivery and diagnostics Updated WHO Guidance on hepatitis C (HCV) infection was released today during a joint WHO-EASL-CDC symposium at the EASL International Liver Congress 2022 in London. These guidelines recommend a radical simplification of the care pathway to overcome barriers in access to HCV testing and treatment. Continue reading this entire article: https://www.who.int/news/item/24-06-2022-WHO-publishes-updated-guidance-on-hepatitis-C-infection
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By Kristen Fuller, MD | Fact-checked by MDLinx Staff
| Updated July 5, 2022 There’s a lot we don’t know about doctors who identify as LGBTQ. LGBTQ is an acronym for lesbian, gay, bisexual, transgender and queer. We don't know how many LGBTQ doctors there are, what specialties they're in, or where they practice. As physicians, we’re often so focused on the inclusion of our LGBTQ patient population, but we’re behind in discussing LGBTQ medical students and physicians. It’s time to have that discussion, and consider how we can better support our LGBTQ colleagues in the medical workplace. The numbers The Association of American Medical Colleges (AAMC) has only recently started to collect information pertaining to sexual orientation and gender identity from medical students.[1] Since 2016, the organization has included two sexual orientation and gender identity (SOGI) questions in its annual Matriculating Student Questionnaire and Medical School Graduation Questionnaire. From 2017 to 2019, the percentage of graduating medical students identifying as bisexual increased from 4.2% to 5%, and those who identified as gay or lesbian increased from 3.6% to 3.8%. TO CONTINUE READING: https://www.mdlinx.com/article/real-talk-the-challenges-of-being-an-lgbtq-doctor/3Qce6426b4MmPThCfmDhp?utm_campaign=Realtalk__070522 CORRESPONDENCE| VOLUME 7, ISSUE 7, P598-599, JULY 01, 2022PDF [71
Neil Gupta,Lindsey Hiebert,Paige A Armstrong,Carolyn Wester,John W Ward Published:July, 2022DOI:https://doi.org/10.1016/S2468-1253(22)00168-6 Over a fifth of hepatitis C virus (HCV) infections occur in women of childbearing age. At least 19 countries, including the USA, have policies or guidelines recommending universal HCV screening during pregnancy. 2However, options for management and treatment of HCV infection during pregnancy are not well defined. Typical clinical practice is to refer and link pregnant individuals for treatment after pregnancy and the breastfeeding period; however, in practice, very few are successfully treated. 3Despite an excellent safety profile, direct-acting antivirals (DAAs) are not recommended for use in pregnancy. To date, only one prospective clinical trial has been published assessing HCV treatment in pregnancy.4 To Continue:https://www.thelancet.com/journals/langas/article/PIIS2468-1253(22)00168-6/fulltext Published June 21, 2022 | Originally published on Reuters Health Medical News
Alcohol-associated liver disease is now the most common indication for liver transplant wait-listing among young American adults, researchers say. From 2003 to 2018, the diagnosis of alcoholic liver disease (ALD) as an indication for wait-listing for liver transplant in the U.S. increased 4-fold (from 0.03/100,000 to 0.13/100,000) in people ages 20-39, they found. In a report published in Transplantation, the researchers note that during the COVID-19 pandemic, alcohol sales increased most in young adults and in households with dependent children. The increase in wait-listing for ALD in young adults, however, and particularly in young women, may be due to a number of factors, they say. They note that the gender gap for alcohol consumption has narrowed, that women are more likely to have harmful effects of alcohol at lower levels of exposure compared to men, and that there may be more barriers to treatment of alcohol abuse in women. In order to describe rates of liver transplant wait-listing stratified by age, sex, and indication, George Philip and colleagues from the Queen's University, Kingston, Ontario, Canada reviewed data from the Scientific Registry of Transplant Recipients on 209,399 individuals who were listed for primary liver transplant between 2003 and 2018. The majority were male (68%) and white (85%). The most common indications for listing were hepatitis C virus (HCV; 47%), followed by ALD (19%) and non-alcoholic fatty liver disease (NAFLD; 18%). Overall, 10,326 (5%) were between 20 and 39 years of age at the time of listing. Compared to patients who were at least 40 years old when placed on the waiting list, these younger adults were more likely to be listed for autoimmune liver disease (AILD; 40% vs 8%) and ALD (25% vs 19%) and less likely to be listed with HCV (14% vs 47%) or NAFLD (14% versus 18%). The average annual increase in the number of patients wait-listed was 2% per year in those aged 20 to 39 (IRR, 1.02; P<0.001) and 4% per year in those aged 40 or older (IRR, 1.04; P<0.001). TO CONTINUE READING: https://www.mdlinx.com/news/alcoholic-cirrhosis-is-most-common-liver-transplant-indication-in-young-u-s-adults/66rLsPbpvtKqzEO4xZxEab? By Jules Murtha | Fact-checked by Barbara Bekiesz
| Updated April 25, 2022 MD Linx Key Takeaways
As a resident, you may be privy to the very real effects that social determinants of health have on certain patients. A patient’s language and culture, after all, are known indicators of the quality of care they will likely receive from healthcare providers—and racial and ethnic minorities often suffer as a result. One way to improve patient care for minorities is by practicing cultural competence and cultural safety. TO CONTINUE:https://www.mdlinx.com/article/cultural-competency-how-to-work-with-a-patient-who-is-not-like-you/ET1eEoXKcgzmo8gyqjSu6?show_order=4&article Healio Gastroenterology May 31st 2022
Alcohol-related deaths have climbed steadily over the past two decades, and with the onset of the COVID-19 pandemic, alcohol-associated disease and mortality rates have continued to soar. “It is clear that there has been an increase in hospitalizations for alcohol-associated hepatitis, at least at large tertiary centers,” Douglas Simonetto, MD, associate professor of medicine and director of gastroenterology and hepatology fellowship program at the Mayo Clinic in Minnesota, said, noting an increase in alcohol-associated hepatitis particularly among young adults and women in his practice. “There are a few studies already published showing this trend, and we are seeing the same here in Rochester.” To Continue Reading: ps://www.healio.com/news/gastroenterology/20220524/surge-in-alcoholrelated-disease-during-pandemic-reveals-unmet-need-for-treatment?utm Distributed via the CDC Health Alert Network
May 11, 2022, 12:15 PM ET CDCHAN-00465 Summary The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Update to provide clinicians and public health authorities with updated information about an epidemiologic investigation of pediatric cases of hepatitis of unknown etiology in the United States. This investigation focuses on collecting information to describe the epidemiology, etiology, clinical presentation, severity, and risk factors related to illness and to identify any relationship between adenovirus infection or other factors and hepatitis. As of May 5, 2022, CDC and state partners are investigating 109 children with hepatitis of unknown origin across 25 states and territories, more than half of whom have tested positive for adenovirus with more than 90% hospitalized, 14% with liver transplants, and five deaths under investigation. Because this investigation is ongoing and includes reviewing cases of hepatitis of unknown cause with onset since October 2021, patients under investigation are not limited to current or newly diagnosed pediatric hepatitis illnesses. This HAN Health Update also provides updated recommendations for testing specimens from patients under investigation. It is an update to a HAN Health Advisory that CDC issued on April 21, 2022, that initially notified clinicians and public health authorities of children identified with hepatitis of unknown origin and adenovirus infection. Background A cluster of pediatric cases of hepatitis without an apparent etiology was identified and reported to CDC in November 2021. A possible association between pediatric hepatitis and adenovirus infection is under investigation after laboratory testing identified adenovirus infection in all nine patients in the initial cluster; the five specimens that could be typed were all adenovirus type 41. Investigators continue to examine the role of other possible causes and identify contributing factors. Recommendations for Clinicians
April 30, 2022 NY TIMES OPINION
By Maia Szalavitz-Ms. Szalavitz is a contributing Opinion writer. She covers addiction and public policy. Jason Norelli, a San Francisco native, spent several years homeless in and around the city’s Tenderloin district, addicted to methamphetamine. In 2001, he was legally mandated to attend rehab and has been in recovery ever since. Today he helps others like him get care. Mr. Norelli’s experience makes him seem like a poster child for legally mandated addiction treatment. At least 37 states now have laws on the books that allow parents, police or concerned others to petition courts to compel rehab through civil commitment if a judge deems someone a threat to themselves or others. Twenty-five such laws were passed or expanded between 2015 and 2018 alone, according to a recent investigation by The Intercept, and this growth continues. This month, Massachusetts proposed an increase in funding to its civil commitment program for addiction, bringing it to about $23 million. In March, Gov. Gavin Newsom of California proposed a new system of “CARE Courts,” to expand civil commitment for homeless people with schizophrenia and often addiction. But voluntary rehab has a better track record and is less likely to harm the people it is intended to help. Criminalization and coercion have helped create a patchwork of addiction programs that is harsh, low quality, underfunded, understaffed and too often fraudulent. Since legally mandated care is often the only way to get immediate and free treatment, a damaging cycle continues.
Continue reading the main story OPINIONGUEST ESSAY Why Forced Addiction Treatment Fails April 30, 2022 Credit...Julianna Brion
By Maia Szalavitz Ms. Szalavitz is a contributing Opinion writer. She covers addiction and public policy. Jason Norelli, a San Francisco native, spent several years homeless in and around the city’s Tenderloin district, addicted to methamphetamine. In 2001, he was legally mandated to attend rehab and has been in recovery ever since. Today he helps others like him get care. Mr. Norelli’s experience makes him seem like a poster child for legally mandated addiction treatment. At least 37 states now have laws on the books that allow parents, police or concerned others to petition courts to compel rehab through civil commitment if a judge deems someone a threat to themselves or others. Twenty-five such laws were passed or expanded between 2015 and 2018 alone, according to a recent investigation by The Intercept, and this growth continues. This month, Massachusetts proposed an increase in funding to its civil commitment program for addiction, bringing it to about $23 million. In March, Gov. Gavin Newsom of California proposed a new system of “CARE Courts,” to expand civil commitment for homeless people with schizophrenia and often addiction. But voluntary rehab has a better track record and is less likely to harm the people it is intended to help. Criminalization and coercion have helped create a patchwork of addiction programs that is harsh, low quality, underfunded, understaffed and too often fraudulent. Since legally mandated care is often the only way to get immediate and free treatment, a damaging cycle continues. To do better, the United States needs more evidence-based treatment. And since the data shows that the best treatment is compassionate and inviting, coercion should be the last resort, not the first. Mr. Norelli opposes compulsory drug treatment. He feels that being forced into treatment can push people in the other direction if they are not ready to quit. “Of the hundred people that came in at the same time I did, only a few completed it,” he said, adding that he is still disturbed by the “humiliating” way they were treated. TO CONTINUE READING: https://www.nytimes.com/2022/04/30/opinion/forced-addiction-treatment.html? AUTHORDavid Brand DATEMarch 30, 2022 CITY LIMITS
The Adams administration has touted Safe Havens as an alternative for those who would rather sleep outside than in a traditional homeless shelter. But there are too few of the facilities to accommodate the majority of unsheltered New Yorkers. After more than a year sleeping in parked cars and city parks, Michael Torres got a chance to try something new earlier this month. When a bed opened up in a Safe Haven shelter near Crotona Park, Torres, 45, received a referral from an outreach team and moved into a room he shares with one other person. Safe Havens have fewer restrictions than most facilities in the city’s sprawling shelter system and allow people to come and go as they please. Along with similar so-called stabilization shelters, they are designed to appeal to homeless New Yorkers, like Torres, who have left or avoided other congregate facilities—typically due to autonomy, privacy or safety considerations—and have instead opted to bed down in public spaces. The arrangement is not perfect—Torres says he really wants a permanent apartment—but the flexibility is working for him. “I don’t need a curfew,” Torres said outside a Manhattan drop-in center Tuesday. “I just need to eat a bowl of oatmeal and go out looking for work.” The specialized shelters also feature on-site services and, ideally, a pathway to housing via case managers and social workers who assist residents with rental subsidy or supportive housing applications. But there are too few of the facilities to accommodate the majority of unsheltered New Yorkers. That means outreach workers can rarely offer placement to people in need, even as police, under the direction of Mayor Eric Adams, drive them off the trains and sanitation workers throw their belongings into garbage trucks. Adams, who came into office pledging to evict homeless New Yorkers from the subway system, said last Friday that he also plans to order the removal of every homeless encampment in the city, stepping up a practice that his predecessor Bill de Blasio accelerated at the tail end of his tenure. TO CONTINUE READING: https://citylimits.org/2022/03/30/the-city-is-pushing-homeless-new-yorkers-off-the-streets-and-subways-where-will-they-go/ Published April 19, 2022 | Originally published on The Scientist MD Linx
Scientists and public health officials in the UK, US, and Spain are investigating the cause of a number of cases of severe hepatitis in children younger than 10. On April 5, public health officials in Scotland notified the World Health Organization of 10 cases of severe hepatitis—liver inflammation—in children under the age of 10 years old, according to a WHO press release. Within three days, 74 cases had been identified throughout the United Kingdom. All of the children were admitted to and diagnosed in the hospital. As of April 12, none of the children had died, but some were severely ill. Seven have had to receive liver transplants. “This is a severe phenomenon,” Deirdre Kelly, a pediatric hepatologist at Birmingham Children’s Hospital in England, tells Science. “These [were] perfectly healthy children . . . up to a week ago. Most of [the children] recover on their own,” Kelly notes. According to New Scientist, doctors in the UK have been advised to watch out for children age under age 16 who have symptoms of hepatitis, which include jaundice (a yellowish tinge to the skin), discoloration of the urine or feces, itchy skin, fever, nausea, and abdominal pain. On April 14, the Centers for Disease Control (CDC) reported that nine cases of hepatitis have been identified in children ages one to six in Alabama since last fall. Two of the nine needed liver transplants, Science reports. In a statement issued to STAT, the CDC says it’s working with the Alabama Department of Public Health and other state departments to investigate the cause of the outbreak. STATreports that the Alabama public health department issued an alert to doctors in early February that mentioned a case in another state, but the alert did not give details. Meanwhile, in Spain, the government of the Madrid region announced on April 13 that three regions—Madrid, Aragón, and Castilla-La Mancha—have each reported one case of severe hepatitis of indeterminate origin in young children, according to Science, and one of those children has received a liver transplant. Hepatitis is typically caused by pathogens, most commonly the hepatitis C virus. That virus, along with the hepatitis A, B, and E viruses, was not present in any of the UK or Spanish cases, according to Science. According to STAT, hepatitis viruses have also been ruled out as a potential cause of the outbreak in Alabama. Severe cases of hepatitis are rarely found in children who are not immunocompromised, and the cause of the current outbreak is still unknown. “Seeing children with severe [hepatitis] in the absence of severe underlying health problems is very rare,” pediatrician Karen Landers, a district medical officer for the Alabama Department of Public Health, tells STAT in an interview. “That’s what really stood out to us in the state of Alabama.” Experts tell Science that an adenovirus, a virus that typically causes colds, may be the culprit. Adenoviruses typically attack the respiratory tract but have occasionally been linked to hepatitis. Researchers in Scotland published a study on April 14 detailing cases of children with hepatitis in five children ages three to five this year, writing that an adenovirus infection is “the leading hypothesis.” According to Science,as many as half of the affected children in Spain and the UK tested positive for an adenovirus upon entering the hospital. Five of the nine children in Alabama also tested positive for an adenovirus. TO CONTINUE READING: https://www.mdlinx.com/news/mysterious-hepatitis-cases-reported-in-young-children/5Wu8skb3qpDTFgmCmSMHZF?show_order=5&article_type=sele LEGAL MATTERS What can be done to fix EHRs? PhysicianSense OBESITY New study on mice sheds light on the anti-obesity effects of vitamin E Newswise Gastrointestinal System Disorders > Hepatitis (Viral) Mysterious hepatitis cases reported in young childrenPublished April 19, 2022 | Originally published on The Scientist Scientists and public health officials in the UK, US, and Spain are investigating the cause of a number of cases of severe hepatitis in children younger than 10. On April 5, public health officials in Scotland notified the World Health Organization of 10 cases of severe hepatitis—liver inflammation—in children under the age of 10 years old, according to a WHO press release. Within three days, 74 cases had been identified throughout the United Kingdom. All of the children were admitted to and diagnosed in the hospital. As of April 12, none of the children had died, but some were severely ill. Seven have had to receive liver transplants. “This is a severe phenomenon,” Deirdre Kelly, a pediatric hepatologist at Birmingham Children’s Hospital in England, tells Science. “These [were] perfectly healthy children . . . up to a week ago. Most of [the children] recover on their own,” Kelly notes. According to New Scientist, doctors in the UK have been advised to watch out for children age under age 16 who have symptoms of hepatitis, which include jaundice (a yellowish tinge to the skin), discoloration of the urine or feces, itchy skin, fever, nausea, and abdominal pain. ADVERTISEMENT -SCROLL TO KEEP READING On April 14, the Centers for Disease Control (CDC) reported that nine cases of hepatitis have been identified in children ages one to six in Alabama since last fall. Two of the nine needed liver transplants, Science reports. In a statement issued to STAT, the CDC says it’s working with the Alabama Department of Public Health and other state departments to investigate the cause of the outbreak. STATreports that the Alabama public health department issued an alert to doctors in early February that mentioned a case in another state, but the alert did not give details. Meanwhile, in Spain, the government of the Madrid region announced on April 13 that three regions—Madrid, Aragón, and Castilla-La Mancha—have each reported one case of severe hepatitis of indeterminate origin in young children, according to Science, and one of those children has received a liver transplant. Hepatitis is typically caused by pathogens, most commonly the hepatitis C virus. That virus, along with the hepatitis A, B, and E viruses, was not present in any of the UK or Spanish cases, according to Science. According to STAT, hepatitis viruses have also been ruled out as a potential cause of the outbreak in Alabama. Severe cases of hepatitis are rarely found in children who are not immunocompromised, and the cause of the current outbreak is still unknown. “Seeing children with severe [hepatitis] in the absence of severe underlying health problems is very rare,” pediatrician Karen Landers, a district medical officer for the Alabama Department of Public Health, tells STAT in an interview. “That’s what really stood out to us in the state of Alabama.” Experts tell Science that an adenovirus, a virus that typically causes colds, may be the culprit. Adenoviruses typically attack the respiratory tract but have occasionally been linked to hepatitis. Researchers in Scotland published a study on April 14 detailing cases of children with hepatitis in five children ages three to five this year, writing that an adenovirus infection is “the leading hypothesis.” According to Science,as many as half of the affected children in Spain and the UK tested positive for an adenovirus upon entering the hospital. Five of the nine children in Alabama also tested positive for an adenovirus. |
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