Image Credit: Julien Tromeur, Unsplash

It is time to celebrate researchers’ amazing identification of our the body’s big secret—liver cells! These silent miraculous unrecognized liver cells have been hiding inside our noncomplaining, liver.

The liver cells that protect us and keep our bodies functioning 24/7, 365 days a year.

This amazing, unrecognized organ has provided us with the sorely needed rationale for eating less sugar, fats and carbohydrates that tragically underlie the development of 13 types of preventable obesity related cancers.

Preventive liver information is sorely needed to motivate individuals to protect their precious liver cells from being damaged by hepatitis viruses, alcohol and drug abuse and overeating unhealthy foods that underlie the development of cirrhosis and any one of the 13 obesity-related cancers. Hepatitis viruses damage liver cells that create energy stored as sugar (called glycogen) in fat cells in the liver.

Overcrowding of the liver with excess fat cells that contain the unused energy, unrecognized, smothers healthy liver cells plus “cancer fighting liver cells, unknowingly created by overeating sugar laden and fatty foods, not using the energy stored in fat cells and by avoiding regular exercise. This eventually underlies the development of fatty liver diseases, obesity, cirrhosis and many types of cancer.

Promoting understandable liver information, glaringly absent from our national health agenda for decades, is essential to saving lives by empowering millions of uninformed individuals with unreported or unrecognized liver diseases that are preventable. These preventable liver related diseases include; obesity and 13 obesity-related types of cancer, hepatitis, type 2 diabetes, NASH, cardiovascular diseases and especially alcohol and drug abuse.

Obesity is a chronic disease that can increase the risk of other chronic diseases, including cancer.¹ The CDC’s latest data² shows 40.3% of US adults are obese, with severe obesity affecting 9.7% of adults. A JAMA study³ found that children and adults in low-income and low-food access neighborhoods face an increased risk of obesity, highlighting the need for targeted interventions.

Hepatitis viruses are a leading cause of liver disease and disfunction. Often called the silent killer, hepatitis C, is one of the hepatitis viruses that can be asymptomatic.

It is time for Congress to require life-saving liver education as part of the national health agenda. You and your precious children need to be informed about the importance of their life supporting liver to motivate them to protect it and avoid the temptation to experiment with drugs, alcohol and unhealthy food and lifestyle behaviors.

References

1.Bodelon C, Sung H, Mitchell EL, et al. Excess Body Weight and the Risk of Second Primary Cancers Among Cancer Survivors. JAMA Netw Open. 2024;7(9):e2433132. doi:10.1001/jamanetworkopen.2024.33132

2.Emmerich SD, Fryar CD, Stierman B, Ogden CL. Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023. NCHS Data Brief, no 508. Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc/159281

3.Aris IM, Wu AJ, Lin PD, et al. Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity. JAMA Pediatr. Published online September 16, 2024. doi:10.1001/jamapediatrics.2024.3459

In this article a pharmacist with experience in writing and publishing provides 5 quick tips for pharmacy residents preparing manuscripts

Authored By: Timothy P. Gauthier, Pharm.D., BCPS, BCIDP

Article Posted October 2024, First Released in the June 2024 IDstewardship Newsletter

Tip 1: Start by picking an article type and journal

The article type (e.g., brief report, concise communication) will provide structure guidance (number of words, figures/tables, references allowed). The journal will have published examples of the article type that can be used for reference when constructing the manuscript. These are very important for drafting your outline. If you need to pick a journal, try using the references list you have developed, those journals are likely to be a good fit for your project. When picking an article type be honest with yourself about the novelty and strength of your data. Single center retrospective studies often do not merit 3,000+ word publications.

Tip 2. Determine your major take home points before you draft your title

So often residents use titles that were drafted before an IRB approval and they do not fit the down-stream project manuscript well at all. Determine the topic you want to address in the manuscript and then use the main findings of your project to draft the title. Revisit your title periodically to make sure it matches the manuscript text. Keep in mind a major goal is having your article make sense to any reader that might pick it up. It is all about the reader understanding your paper, it is not about you getting your way. You will not have a lot of words to get the job done, so use them wisely.

Tip 3. Do not get ahead of yourself in writing your manuscript

If you do not know the point of your paper, it is hard to develop a good title. If you do not have the methods developed, it is difficult to write the results to match them with a good flow. If you do not have the results done, it’s hard to write a focused discussion. First focus primarily on your methods and results. Once those are developed along with a plan for your tables/figures, you will know how much text you have for introduction and discussion. My suggestion is to write your discussion last, and write your abstract even after that so you don’t have to keep editing it as your manuscript develops.

Tip 4. Use outlines to guide yourself

Do a simple outline for your discussion and then slowly develop it more and more as you work on other parts of your paper. Use simple bullets with key points or references. Rearrange things to make sense and flow with the rest of the paper. While it is a lot easier to chop content than add content, try not to get too far ahead of yourself, recognizing that you need your methods and results worked out before you can truly write your discussion. This is a process that takes a lot of time to do it well (i.e., give you the best shot for not getting rejected by the journal editors). Do not be surprised if you have to re-write sections of your paper a few times to make the entire manuscript fit together and on-point.

Tip 5. Set deadlines and stick to them

Time seems to go by faster when there is so much going on. The manuscript may be one of the last checkpoints to pass in the residency year, so beware “senioritis” and hold yourself accountable by setting and then sticking to deadlines. You have done so much great work to get to this point and you have a great chance to share what you have learned with the world through a published manuscript. Make deadlines, stick with your project, and see it through to publication!

BONUS TIP: Use artificial intelligence to help you. For example if you get stumped with how to write something, tell AI to write about it and use that to help organize your thoughts. Do not have it write your content for you or put any protected health information in, but certainly you can use it as a tool within your process. Some AI websites to check out include Dall-E for images, ChatGPT or Google Gemini for text, Suno for music generation, Microsoft Copilot for document analysis, and Plus for presentations.

Disclaimer: The views and opinions presented in this article represent those of the author and do not necessarily reflect the policy or position of any previous, current, or potential future employer.

RECOMMENDED TO YOU

COVID-19 antiviral

Image credit: Unsplash

A recent report from MMWR Morb Mortal Wkly Rep highlights how older adults, 65 and older, are at high risk for severe COVID-19 outcomes with risk escalating with age. Outpatient antiviral treatments have been shown to reduce these risks, yet there is limited information on how their usage varies among older adults by age group. Antiviral therapy for COVID-19 is underutilized among this age demographic, especially in the oldest age group, underscoring the need for increased use of these medications to mitigate COVID-19–related morbidity and mortality.

Among 393,390 adults aged 65 and older, 45.9% received outpatient COVID-19 antivirals, with usage rates of 48.4% for ages 65–75, 43.5% for ages 76–89, and 35.2% for those 90 and older. The adjusted odds of being untreated were significantly higher for patients aged 75–89 (1.17 times) and those 90 and older (1.54 times) compared to those aged 65–74. Among patients with severe outcomes, only 21.1% had received antiviral treatment, compared to 46.7% of those without severe outcomes.¹

Another recent MMWR Morb Mortal Wkly Rep examined nonhospitalized patients aged 65 and older with COVID-19 from the National Patient-Centered Clinical Research Network between April 2022 and September 2023. Researchers assessed antiviral treatment usage among the same three age groups (65–74, 75–89, and 90+), using multivariable logistic regression to analyze the association between age and the likelihood of not receiving antiviral treatment.²

In these findings, hospitalization rates for adults aged 75 and older approached one COVID-19 hospitalization for every 100 individuals. Among hospitalized adults, 88.1% had not received the 2023–2024 COVID-19 vaccine prior to admission, while 80% had multiple underlying medical conditions. Additionally, 16.6% of these patients were residents of long-term care facilities (LTCFs).²

COVID-19 hospitalization rates among adults are notably increasing with age, particularly for those 65 and older, who represented 70% of all adult COVID-19 hospitalizations during the October 2023–April 2024 surveillance period. This data, sourced from the COVID-19–Associated Hospitalization Surveillance Network, highlights a concerning trend, even as overall cumulative hospitalization rates were the lowest for all adult age groups since the 2020-2021 season.²

Further research by JAMA utilized modeling from 2021-2022 data, indicating that achieving an 80% treatment uptake could reduce hospitalizations by 42% and deaths by 51%. Although, a 2024 survey of 2,858 high-risk older adults revealed that only 16.5% had received COVID-19 treatment, and just 23.3% would accept an antiviral if prescribed.³

Despite evidence supporting outpatient treatment efficacy in preventing severe outcomes, many older adults remain untreated. Concerns about drug interactions and side effects contribute to clinicians’ reluctance to prescribe these treatments. Additionally, inequities in vaccine access and healthcare may hinder antiviral use.³

Experts emphasize the need for continued guidance focused on high-risk populations. For older adults and LTCF residents, strategies should prioritize measures to minimize COVID-19 exposure, advocate for up-to-date vaccinations, and encourage prompt access to outpatient antiviral treatments following a positive SARS-CoV-2 test. These steps mitigate severe outcomes and enhance patient care in this vulnerable demographic.

References

1. Quinlan CM, Shah MM, DeSantis CE, et al. Differences in COVID-19 Outpatient Antiviral Treatment Among Adults Aged ≥65 Years by Age Group — National Patient-Centered Clinical Research Network, United States, April 2022–September 2023. MMWR Morb Mortal Wkly Rep 2024;73:876–882. DOI: http://dx.doi.org/10.15585/mmwr.mm7339a3

2. Taylor CA, Patel K, Pham H, et al. COVID-19–Associated Hospitalizations Among U.S. Adults Aged ≥18 Years — COVID-NET, 12 States, October 2023–April 2024. MMWR Morb Mortal Wkly Rep 2024;73:869–875. DOI: http://dx.doi.org/10.15585/mmwr.mm7339a2

3. Patel P, Wentworth DE, Daskalakis D. COVID-19 Therapeutics for Nonhospitalized Older Adults. JAMA. Published online October 07, 2024. doi: 10.1001/jama.2024.16460

Leah Harvey, MD, MPH Credit: Brown University

This article originally appeared on our sister site, HCPLive.

Testing is key to getting people with hepatitis C into the continuum of care. And, getting people tested can be challenging, especially as the virus can be asymptomatic. However, new research is calling attention to the potential utility of a point-of-care hepatitis C virus (HCV) RNA assay (Xpert HCV) in a nontraditional, nonclinical setting for facilitating more rapid diagnosis and linkage to care among individuals under active community supervision.¹

Study results showed that the availability of a point-of-care HCV RNA assay for clinical use among individuals under active probation or parole would have enabled 30 people, including 2 with acute HCV infection, to receive an immediate HCV diagnosis, highlighting the feasibility and clinical performance of Xpert HCV in this setting.¹

“Progress toward HCV elimination in the US has been stalled by reliance on a multistep diagnostic algorithm to confirm viremia, reducing access to curative treatment,” Leah Harvey, MD, MPH, an infectious disease and addiction medicine physician and an assistant professor in the division of infectious diseases at the Warren Alpert School of Medicine at Brown University, and colleagues wrote.¹ “In populations at highest risk of infection—including people who use drugs and those involved in the carceral system—treatment is often inaccessible owing to substantial barriers along the HCV care cascade.”

According to the World Health Organization, an estimated 50 million people have chronic HCV infection, with about 1 million new infections occurring per year. Since new HCV infections are often asymptomatic, diagnosis typically does not occur when the infection is recent.² Risk of infection and delayed diagnosis/treatment are especially prevalent among people who use drugs and those involved in the carceral system.¹

On June 27, 2024, the FDA granted marketing authorization to Cepheid for the Xpert HCV test and GeneXpert Xpress System, the first point-of-care HCV test allowing for a more rapid test-and-treat approach than the standard multi-step HCV testing process. Rather than requiring a sample to be sent to a central lab for testing, the Xpert HCV detects HCV RNA and provides results in about an hour using a blood sample from the fingertip.³

The test, which is intended for adults at risk of or with signs or symptoms of HCV, can be performed in settings operating under a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver, such as certain substance use disorder treatment facilities; correctional facilities; syringe service programs; doctor’s offices; emergency departments; and urgent care clinics.³ However, its clinical use in a community supervision setting has not yet been explored.¹

To examine the feasibility and clinical performance of a point-of-care HCV RNA assay (Xpert HCV) in a nonclinical justice setting, investigators conducted a cross-sectional study of English-speaking adults ≥ 18 years of age under active community supervision status (probation or parole) with unknown HCV status or no self-reported prior HCV treatment.¹

Among 482 participants enrolled in a larger HCV antibody study assessing HCV testing and linkage to care for this population, a convenience sample of 203 participants underwent point-of-care HCV RNA testing and were included in the present analysis. Among this group, the median age was 38 (Interquartile range, 31-48.5) years, 78.3% of participants were male, and 47.7% were White. Investigators pointed out approximately ⅓ of participants had not completed high school or reported homelessness.¹

In total, 190 (94%) participants had valid laboratory HCV RNA results. Missing data were due to inconclusive results (n = 1), unavailable results (n = 5), or testing was not performed (n = 7).¹

Using laboratory HCV RNA testing for confirmation, investigators noted the sensitivity of the point-of-care assay for HCV RNA detection was 96.8% (95% CI, 83.3%-99.9%), and the specificity was 99.4% (95% CI, 96.6%-100%). They also pointed out discrepant RNA results in 2 participants: the first was interpreted as a false positive point-of-care HCV RNA (had reactive HCV antibody, POC HCV RNA detected, laboratory HCV RNA not detected) and the second was interpreted as a false negative point-of-care HCV RNA (nonreactive HCV antibody, POC HCV RNA not detected, laboratory HCV RNA detected).¹

Further analysis revealed approximately 9 of 39 participants (23.1%) with reactive HCV antibody did not have detectable HCV RNA (point-of-care and laboratory), indicative of spontaneous HCV clearance. Additionally, a single participant had negative HCV antibody and detectable HCV RNA (point-of-care and laboratory) consistent with acute HCV infection.¹

Investigators outlined multiple limitations to these findings, including the potential lack of generalizability to other settings due to the single-site study design; the fact that Xpert HCV was not approved for clinical use when the study was conducted; and the use of referral to complete laboratory-based confirmatory testing, which may have led to delays.¹

“Multistep diagnostic algorithms cause unnecessary delay in HCV diagnosis, particularly for marginalized populations. The recent approval of the first POC HCV RNA assay in the US will facilitate same-day initiation of curative HCV treatment in low-barrier, nontraditional settings,” investigators concluded.¹

References

1. Harvey L, Jacka B, Bazerman L, et al. Feasibility and Performance of a Point-of-Care Hepatitis C RNA Assay in a Community Supervision Cohort. JAMA Netw Open. doi:10.1001/jamanetworkopen.2024.38222

2. World Health Organization. Hepatitis C. Newsroom. April 9, 2024. Accessed October 10, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c

3. Brooks, A. FDA Grants Marketing Authorization to Xpert HCV, First Point-of-Care Hepatitis C RNA Test. HCPLive. June 27, 2024. Accessed October 10, 2024. https://www.hcplive.com/view/fda-grants-marketing-authorization-xpert-hcv-first-point-care-hepatitis-c-rna-test

Image credit: Kenny Eliason, Unsplash

A new study sheds light on the increased risk of acute cardiovascular events and death in patients infected with the original strain of COVID-19 demonstrating risks in both patients with severe infections or moderate cases.¹

Specifically, patients infected with COVID-19 appeared to have a significant increase for heart attack, stroke, and death for up to 3 years among unvaccinated people early in the pandemic when the original virus emerged.¹

Compared to people with no COVID-19 history, the study found those who developed COVID-19 early in the pandemic had double the risk for cardiovascular events and death, and those patients deemed to have severe cases of infection and were hospitalized had nearly 4 times the risk.¹

“This study sheds new light on the potential long-term cardiovascular effects of COVID-19, a still-looming public health threat,” David Goff, MD, PhD, director for the Division of Cardiovascular Sciences at NIH’s National Heart, Lung, and Blood Institute (NHLBI), said in a statement.¹

NHLBI largely funded the study and the results were published in the American Heart Association’s journal, Arteriosclerosis, Thrombosis, and Vascular Biology.

Study Parameters, Other Findings

Investigators analyzed data from 10,000 people enrolled in the UK Biobank, a large biomedical database of European patients. Patients were ages 40 to 69 at the time of enrollment and included 8,000 who had tested positive for the COVID-19 virus and 2,000 who were hospitalized with severe COVID-19 between Feb. 1, 2020, and Dec. 31, 2020. As this was in the period prior to the authorization of vaccines, the study population was unvaccinated.¹

The investigators compared the 2 COVID-19 subgroups to a group of nearly 218,000 people who did not have the condition. They then tracked the participants from the time of their COVID-19 diagnosis until the development of either heart attack, stroke, or death, up to nearly 3 years.¹

Accounting for patients who had pre-existing heart disease—approximately 11% in both groups—the investigators found that the risk of heart attack, stroke, and death was twice as high among all the COVID-19 patients and four times as high among those who had severe cases that required hospitalization, compared to those who had never been infected. The data further show that, within each of the 3 follow-up years, the risk of having a major cardiovascular event was still significantly elevated compared to the controls; and in some cases, almost as high or even higher than having a known cardiovascular risk factor, such as type 2 diabetes.¹

Do Certain Blood Types Increase Risk for Severe COVID-19, Cardiovascular Risks?

Another interesting component of the study was the potential correlation between certain blood types and severe infection. Specifically, the study is the first to show the increased risk of heart attack and stroke in patients with severe COVID-19 may have a genetic component involving blood type. The investigators write that hospitalization for COVID-19 more than doubled the risk of heart attack or stroke among patients with A, B, or AB blood types, but not in patients with O types, which seemed to be associated with a lower risk of severe COVID-19.

“Hospitalization for COVID-19 represents a coronary artery disease risk equivalent, with post–acute myocardial infarction and stroke risk particularly heightened in non-O blood types,” the investigators wrote. “These results may have important clinical implications and represent, to our knowledge, one of the first examples of a gene-pathogen exposure interaction for thrombotic events.”²

Additionally, the investigators pointed out this was during the earliest strain of the virus without any previous immunity, and the population studied was primarily White. They note it remains unclear if a study population with more racial and ethnic diversity would have affected the results.¹

Another aspect to consider is if the long-term cardiovascular effects will remain for patients with severe COVID-19. The investigators point out the need for additional longitudinal studies to confirm the findings to assess if severe COVID-19 is a significant acute cardiovascular episode risk factor.

“These results, especially if confirmed by longer term follow-up, support efforts to identify effective heart disease prevention strategies for patients who’ve had severe COVID-19. But more studies are needed to demonstrate effectiveness,” Goff said.¹

References

1. https://www.nih.gov/news-events/news-releases/first-wave-covid-19-increased-risk-heart-attack-stroke-three-years-later
2.Allayee, H, et al. COVID-19 Is a Coronary Artery Disease Risk
Equivalent and Exhibits a Genetic Interaction With ABO Blood Type <https://www.ahajournals.org/doi/10.1161/ATVBAHA.124.321001>. [2024] Arteriosclerosis, Thrombosis, and Vascular Biology. DOI: 10.1161/ATVBAHA.124.321001