geoffrey modest medical blogs

  A recent VA study assessed mRNA vaccine effectiveness in veterans with cirrhosis (see  covid mRNA vaccine in cirrhosis jamaintmed2021  in dropbox, or doi:10.1001/jamainternmed.2021.4325 ).    Details:  -- mRNA vaccines were administered to 20,037 veterans (51% Moderna, 49% Pfizer), from Dec 18,2020 to March 17, 2021      -- 99.7% of those receiving a first dose who had a follow-up of least 42 days received a second dose  -- median age 69, 97% male, 45% age 60-70yo/43% 70-85yo, 61% white/23% Black/8% Latinx, 42% alcohol-associated cirrhosis, 77% overweight or obese, 52% diabetes, 39% current smoker/32% former  -- propensity matching for the control group (also 20,037 veterans as controls) to achieve similarity regarding age, sex, race or ethnicity, duration of follow-up, comorbidities, alcohol-associated liver disease, and severity of liver disease estimated by the Child-Turcotte-Pugh score  -- primary outcome: Covid-19 i...

A recent review looked at the varying efficacies of different nonselective  b -blockers in patients with portal hypertension in cirrhosis (see  cirrhosis portal htn bmjopen2016 ​ in dropbox, or Li T. BMJ Open 2016; 6: e010902), finding that carvedilol may be more effective than propranolol or nebivolol and as effective as the combo of nadalol plus isosorbide mononitrate. details: --12 RCTs were evaluated, though mostly not-so-great quality --results:     ​--7 trials (379 patients, about 2/3 male, mean age around 50, most with alcoholic cirrhosis but some hepatitis B or C) compared carvedilol vs propranolol for hemodynamic outcomes: hepatic venous pressure  (HVPG)  reduction, hemodynamic response rate, post-treatment arterial pressure (mean arterial pressure, MAP). most follow-up of only up to 6 weeks. finding:             --carvedilol was associated with a...

A recent study provides up to 12-13 year follow-up showing longterm improvement in important clinical outcomes (liver cancer, decompensation and death) in patients treated successfully for hepatitis C (see  hep c rx regression of fibrosis gastro2016 ​ in dropbox , or doi.org/10.1053/j.gastro.2016.03.036). the value of this study, using PEG interferon/ribavirin, is that it has long-term results which I think are applicable to our newer and much better therapies. Details: --444 patients with hepatitis C (HCV) infection and compensated cirrhosis were treated with PEG interferon/ribavirin (PEG- IFN/RBV) in Italy, from 2001-2009, with mean of 7.6 years of follow-up --mean age 58, 62% male, BMI 27, ALT 150, bili 1, albumin 4, 27% with diabetes, 83% genotype 1, 26% IL28B SNP CC/74% either CT or TT (those with the CC genotype have a stronger immune response to HCV than the non-CC genotypes and historically have been more likely to be cured of HCV infection) --they looked at 2 grou...