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Lack of evidence
for the heterosexual transmission of hepatitis C |
The
importance of sexual transmission in the epidemiology of
hepatitis C virus (HCV) infection is still
controversial. To assess the risk of heterosexual HCV
transmission, we examined
eighty patients with chronic HCV-associated liver disease
and their spouses in a cross-sectional clinical and
serological cohort study. |
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Lamivudine drug treatment for nonresponders |
Lamivudine
treatment for 52 weeks is as effective in interferon
nonresponders as in treatment-naive patients, finds a research
team from the United States. |
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L-arginine
& Cirrhosis |
Nitric oxide
(NO) is known to play an important role in modulating both the
hepatic and mesenteric circulation under physiological and
pathological conditions. |
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LEF-liver cirrhosis |
Cirrhosis of
the liver is a chronic, diffuse (widely spread throughout the
organ), degenerative liver disease in which the parenchyma (the
functional organ tissue) degenerates, the lobules are
infiltrated with fat and structurally altered, dense perilobular
connective tissue forms, and areas of regeneration often
develop. |
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Liver disease-animal
hospital
(LARGE REPORT-INCREASED DOWN-LOAD TIME) |
With:
Introduction, Liver Terminology, Anatomy, Physiology, Cause,
Symptoms, Diagnosis,
Specific Diseases, Gall Bladder Surgery |
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LIVER
RETRANSPLANTATION: ETHICS AND OUTCOMES |
Everybody is
very familiar with this slide and we have seen it over and over
again. The reason that we keep talking about re-transplantation
is that we are wasting organs for patients who got one chance
already. We have one pie and we have to slice the pie in many
different ways, so if somebody got one slice, why does he have
to have two |
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Liver Roulette: |
Liver Roulette
is a unit in which students examine the procedures involved in
organ transplants and the ethical issues surrounding organ
donations. |
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Liver Cirrhosis |
Cirrhosis of
the liver is a chronic, diffuse (widely spread throughout the
organ), degenerative disease in which the parenchyma (the
functional organ tissue) deteriorates; the lobules are
infiltrated with fat and structurally altered; dense perilobular
connective tissue forms; and often areas of regeneration
develop. The surviving cells multiply in an attempt to
regenerate and form "islands" of living cells that are separated
by scar tissue. These islands of living cells have a reduced
blood supply, resulting in impaired liver function. As the
cirrhotic process continues, blood flow through the liver
becomes blocked; portal hypertension may occur (high blood
pressure in the veins connecting the liver with the intestines
and spleen); glucose and vitamin absorption decrease; the
manufacturing of hormones and stomach and bowel function are
affected; and noticeable facial veins may appear |
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LIVER
TRANSPLANTATION |
Liver transplantation should ideally be offered to the patient who has a high
risk of dying without liver transplantation, but who is likely to have prolonged
survival and improved quality of life posttransplantation. Allocation systems
for liver transplantation currently do not identify patients who benefit the most
from liver transplantation. Rather, the systems are geared toward determining
which patients should receive a donor organ on a priority. Under the previous
allocation system, for the vast majority of patients, waiting time was the major
determinant of liver allocation
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Liver
Transplants: How Do We Choose Who Should Live When Not All Can? |
With a scarce,
non-renewable resource such as livers for transplantation,
shouldn’t the individuals who receive organs be the persons who
need them most? If recipients could be selected based on need,
allocation finally could be divorced from onerous criteria such
as social value. Since need in this context can be equated with
death (if life-saving treatment is withheld), the manner in
which recipients are chosen becomes paramount. On an existential
level, the question may be reduced simply to choosing who should
live when not all can. |
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Martin studies tainted blood lawsuit |
THE government
is considering hiring an American law firm to take a
multi-million-dollar case against US-based drug companies
implicated in infecting Irish haemophiliacs with HIV and
hepatitis C. |
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MELD Scores of Liver Transplant
Recipients According to Size of Waiting List
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The Model for
Endstage Liver Disease (MELD) score serves as the basis for the
distribution of deceased-donor (DD) livers and was developed in
response to ‘the final rule’ mandate, whose stated principle is
to allocate livers according to a patient’s medical need, with
less emphasis on keeping organs in the local procurement area. |
85 kb pdf |
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More people getting liver cancer |
The study focused on hepatocellular carcinoma (HCC), the most
common primary malignant tumor of the liver. People infected
with chronic hepatitis B or C, or cirrhosis, face a
substantially increased risk of developing this cancer |
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National Hepatitis C Needs Assessment |
PowerPoint
Presentation |
133 kb |
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Neurovisual Visual Impairment |
In conclusion,
subclinical neurovisual impairment is a frequent, largely
unrecognized complication of low-dose IFN therapy, and patients
with chronic hepatitis B and older age appear to be most
susceptible. This apparently innocuous complication is long
lasting, possibly irreversible in some patients, with yet
undetermined consequences on visual function. |
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Opportunistic Infections still exist |
At the 10th
Conference on Retroviruses and Opportunistic Infections (CROI),
there was broad and outspoken recognition that opportunistic
infections (OIs) continue to cause morbidity and mortality in
patients who are unaware of their HIV infection, individuals who
have inadequate access to healthcare |
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PANCREATIC TAIL ADENOCARCINOMA PRESENTING AS EARLY SINISTRAL
PORTAL HYPERTENSION |
The patient
had sinistral portal hypertension, a clinical syndrome
consisting of splenic vein thrombosis caused by pancreatic
adenocarcinoma of tail manifested as isolated gastric varices
with patent portal vein and normal hepatic function. By
presenting this case, I want to draw attention to a rare
syndrome, sinistral (left-sided) portal hypertension secondary
to pancreatic adenocarcinoma of the tail. |
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Pharmacological Treatment of Portal Hypertension |
Continuing advances in the knowledge of the pathophysiology of
portal hypertension result in the progressive expansion of the
spectrum of drugs with a potential role for clinical practice,
with objectives that now tend to include the prevention of the
enlargement or even the development of esophageal varices. This
systematic review summarizes the evidence of efficacy of drug
therapy for portal hypertension and draws recommendations for
clinical practice. Although there is not yet enough evidence to
support the treatment for the prevention of the development or
enlargement of varices, nonselective beta-blockers are the
first-choice therapy to prevent the first bleeding in patients
with medium or large-sized varices and rebleeding in patients
surviving a bleeding episode. |
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Portal Hypertension |
Increases in
portal pressure cause development of a portosystemic collateral
circulation with resultant compensatory portosystemic
shunting and disturbed intrahepatic circulation. These factors
are partly responsible for the important complications of
chronic liver disease, including variceal bleeding,
hepatic encephalopathy, ascites, hepatorenal
syndrome, recurrent infection, and abnormalities in
coagulation. Variceal bleeding is the most serious complication
and is an important cause of death in patients with
cirrhotic liver disease |
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Portal hypertension |
Clinical
strategies for managing portal hypertension have undergone
significant refinements over the past half-century. This
evolution has been driven by advances in our understanding of
the physiology of both the disease and the therapies employed
against it. Today, clinical management of the portal
hypertensive patient is a truly multidisciplinary endeavor,
requiring the coordinated efforts of skilled intensivists,
gastroenterologists, hepatologists, interventional radiologists,
and surgeons. Nevertheless, portal hypertension and its manifold
complications remain some of the most vexing problems
encountered in modern medicine and surgery. |
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Portal Hypertensive Bleeding |
Bleeding from
esophageal varices occurs in approximately 30% of patients with
chronic liver disease and portal hypertension. |
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Prevalence and risk factors of hepatitis C virus infection in
haemodialysis patients: a multicentre study in 2796 patients |
Patients on
chronic haemodialysis treatment have been identified
by serological testing with second and third generation
immunosorbent assays (ELISA) as a high risk group for
hepatitis C virus (HCV) infection Hepatitis C is the
most common cause of chronic viral liver disease in
haemodialysis patients. Due to parenteral
transmission of the virus, HCV contaminated blood
transfusion was identified as the main risk factor for viral
transmission before the availability of reliable HCV
screening of blood products in 1990. The extensive
use of recombinant erythropoietin to correct renal
anaemia in haemodialysis patients resulted in a
significant reduction in blood transfusions. However,
previous studies have shown that de novo infections in single
haemodialysis units may still occur in the absence of
other parenteral risk factors. Furthermore, some
reports demonstrated that the duration of
haemodialysis is an independent predictor of HCV
infection in chronic haemodialysis patients |
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Preventive Strategies in Chronic Liver Disease: Cirrhosis |
Cirrhosis is
a diffuse process characterized by fibrosis and the conversion
of normal liver architecture into structurally abnormal nodules.
The modified Child-Pugh score, which ranks the severity of
cirrhosis based on signs and liver function test results, has
been shown to predict survival. Strategies have been established
to prevent complications in patients with cirrhosis. Esophageal
varices can be identified by endoscopy; if large varices are
present, prophylactic nonselective beta blocker therapy should
be administered. Alpha-fetoprotein testing and ultrasonography
can be effective in screening for hepatocellular carcinoma.
Vaccines should be administered to prevent secondary infections |
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Ramatex On Rack Again |
Their concerns
peaked last week, when at least two employees were forced to
return to the Philippines after being declared sick and unfit to
work, assertions they dispute. A group of about five were told
by the company nurse that they had contracted hepatitis C - a
viral infection of the liver. |
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Re-combo--On the Sides |
With the combo
came a combination of side effects that have left many hepatitis
patients suffering long after their treatment is through. |
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Recovery from
Hepatitis A |
An outbreak of
hepatitis A occurred in a north Georgia trailer park served by a
private well. Of 18 residents who were serosusceptible to
hepatitis A virus (HAV), 16 (89%) developed hepatitis |
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Refractory
Ascites |
Ascites, the
most common complication associated with cirrhosis, occurs in
50% of patients within 10 years of diagnosis of compensated
cirrhosis. Development of ascites is a poor prognostic
indicator, with a 50% 2-year survival, worsening significantly
to 20% to 50% at 1 year when it becomes refractory to medical
therapy. |
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Research & Policy Recommendations for Hepatitis C Virus (HCV)/HIV
Coinfection |
The
unfolding epidemic of hepatitis C virus (HCV) infection is a
serious and growing problem. An estimated 170 million people
around the world are infected. In the United States, at least
four million people have been exposed to HCV, and 2.7 million of
them have developed chronic hepatitis C. Chronically infected
persons can either remain asymptomatic, progress very slowly,
maintain mild to moderate liver scarring or develop serious
liver damage, such as cirrhosis or hepatocellular carcinoma (HCC).
Hepatitis C-related liver damage has become the chief cause for
liver transplantation in this country, and ten to twelve
thousand people die each year from HCV-associated end-stage
liver disease (ESLD). HCV disease is a particularly severe
problem for HIV-positive people. Up to a quarter of all people
with HIV in the U.S. may be coinfected with HCV. The progression
of hepatitis C is accelerated in HIV-positive individuals, and
HCV-related ESLD has become a leading cause of death in those
with HIV. |
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Researcher Says Disease Will Strain the State's Hospitals
and Transplant Units |
While
new cases of infection will decline in the future, Dr. Davis and
colleagues predict that more people who already have HCV
infection will experience progression of liver disease -- to
cirrhosis and hepatocellular carcinoma, for example. Chronic HCV
is the most common indication for liver transplantation in the
U.S., affecting 50 percent of all patients receiving liver
transplants. And, the disease frequently recurs following liver
transplantation, sometimes leading to cirrhosis and liver
failure a second time. |
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Researchers fear ultimate toll of hepatitis C may surpass AIDS
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A stealthy
enemy is lurking inside the bodies of millions of Americans that
some medical experts fear may prove as devastating as AIDS. |
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Researchers find 2 genes used by HCV |
New findings
published in the Proceedings of the National Academy of Sciences
by researchers at Immusol Inc. and the University of California
at San Diego (UCSD), reveal two human genes that the hepatitis C
virus (Hepatitis C Virus) uses to reproduce itself. |
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Risks of Liver and other types of Cancer |
Cancer risk in
patients with cirrhosis could be modified by factors such as
changes in hormonal levels, impaired metabolism of carcinogens,
or alteration of immunological status. |
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Safer Tattooing & Hepatitis C |
Rules to live
by if you wish to have a tattoo |
327 kb pdf |
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Screening for depression in a Hepatitis C population |
Depression is reported as a serious adverse event of antiviral
therapy used to treat patients with hepatitis C (Hepatitis C
Virus); therefore, there is a need to identify a reliable and
valid measure of depressive symptoms for this population |
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Search
Engine for Drug Names |
What's in a
name? The potential for thousands of prescription drug errors
each year, according to the Institute of Medicine. And now the
risk has the Food and Drug Administration asking what it can do
to avoid potentially confusing and dangerous medication
brandnames. |
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Severe dry
cracking skin |
The skin
protects the body from outside substances, chemicals, and
bacteria and contributes to temperature maintenance and other
homeostatic functions. |
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Sex and Hepatitis C Transmission |
While there is sufficient evidence to support the conclusion
that sexual transmission of hepatitis C virus (HCV) occurs,
quantifying the magnitude of an individual's risk of HCV
acquisition by sexual contact has been more challenging. The
available data suggest the efficiency of transmission by the
sexual route is low. Nonetheless, since sex is a common behavior
and the reservoir of HCV-infected individuals is substantial,
sexual contact likely contributes to the total burden of HCV
infection in the United States |
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Silent Liver Diseases in Autopsies from Forensic Medicine of
Tehran
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Most of the
chronic liver diseases, even in advanced stages, may cause no
prominent clinical signs or symptoms. They either go undiagnosed
or are found incidentally during general health check-ups,
investigations for other diseases, surgery, or autopsy. The
underlying causes of chronic liver diseases vary in different
geographic areas and are based on various factors such as
socioeconomic status, life style, diet, local or regional
infections, and other endemic diseases. |
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Silymarin, cirrhosis and diabetes: an abstract |
Several studies
have demonstrated that diabetic patients with cirrhosis require
insulin treatment because of insulin resistance. As chronic
alcoholic liver damage is partly due to the lipoperoxidation of
hepatic cell membranes, anti-oxidizing agents may be useful in
treating or preventing damage due to free radicals. |
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Sinistral portal hypertension
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Sinistral,
or left-sided, portal hypertension is a rare cause of upper
gastrointestinal haemorrhage. Isolated gastric varices result
from thrombosis or obstruction of the splenic vein resulting in
back pressure changes in the left portal system. The primary
pathology usually arises in the pancreas and common aetiologies
include pancreatitis and pancreatic neoplasms. Four illustrative
case histories from patients with sinistral portal hypertension
are discussed, followed by a review of the literature
highlighting the aetiology and management of this condition. |
Pdf 111 kb |
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Sjogrens
syndrome-What is it? |
Sjogren's
Syndrome is a chronic disorder that causes insufficient moisture
production in certain glands of the body. It occurs when a
person's normally protective immune system attacks and destroys
moisture-producing glands, including salivary glands and
lacrimal (tear-producing) glands. |
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The patient's perspective in hepatitis C: coping with HCV |
“…..the
complexity of managing some (CHC) chronic hepatitis C patients
may rapidly exceed the training, skills, and resources of their
primary care physician (PCP) or medical specialist…….
Investigators have reported CNS abnormalities in CHC patients
compared with uninfected controls” |
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The Ten Commandments For Hepatitis Survival |
Self-explanatory |
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Transfusion Related Acute Lung injury |
This is to
alert you to the possibility that patients who receive blood
products, particularly plasma-containing products, may be at
risk for Transfusion Related Acute Lung Injury (TRALI), a
serious pulmonary syndrome that can lead to death if not
recognized and treated appropriately. |
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Transplantation in the Patient with Hepatitis C |
HCV
infection is a significant problem in the patient with end-stage
renal disease. Nosocomial transmission of HCV in the
dialysis unit is a risk factor for HCV infection.
Dedicated machines and a larger nursing staff are
mandatory in units with a high prevalence of HCV
infection. HCV-positive patients should be tested for
HCV-RNA to document ongoing infection. Management of
HCV-RNA-positive patients on the waiting list includes biopsy
to provide interferon treatment if chronic hepatitis is
present. After transplantation, liver disease is more
frequent in HCV-positive patients than in HCV-negative
patients. In the long run, this leads to significant
liver complications. |
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Treatment of Patients with Cirrhosis and Portal Hypertension |
The VA
Hepatitis C Resource Center Program-Cirrhosis represents the end
stage of any chronic liver disease. Hepatitis C and alcohol are
currently the main causes of cirrhosis in the United States.
Two major syndromes result from cirrhosis: Two major syndromes
result from cirrhosis: portal hypertension and hepatic
insufficiency. |
Pdf 1059 kb |
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Type 2
Diabetes and HCV |
US researchers,
writing in the Annals of Internal Medicine, report the results
of a study which found that people over 40, who had antibodies
to hepatitis C, were over three times as likely as those without
antibodies to have type 2 diabetes. |
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Update from New Zealand’s battle with Hepatitis C |
Some New
Zealand hepatitis C sufferers living with "a time bomb in their
livers" now have a better chance of being cured with the
Government's agreement to a more effective treatment. |
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Vaccine for Hepatitis |
When we only
had tests for hepatitis A and hepatitis B it was called Non A
Non B hepatitis. It most often followed blood transfusion. We
know since 1988 that 97% of Non A Non B hepatitis is caused by
hepatitis C virus (Hepatitis C Virus). It is one of six viruses
(A,B,C,D,E,G) |
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Victims tell of tears, pain from hepatitis |
Too weak to
stand, Pamela Wallace asked if she could sit to address the
court. Once a faceless, nameless plaintiff in a class-action
lawsuit, Wallace chose Friday to identify herself, by name and
profession, by offering personal details and private longings,
and by detailing, once and for all, what she has lost |
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Vitiligo |
Vitiligo is an
autoimmune disease characterized by depigmentation of the skin
due to destruction of melanocytes. Interferons have been used
for the treatment of chronic hepatitis C and some malignancies.
We report interferon alpha-2a-induced vitiligo in a male patient
with chronic active hepatitis C. |
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Waiting for a liver - Hidden costs of the organ shortage |
Discussion
about the economics of end-stage liver disease has typically
focused on the high cost of liver transplantation, but the
management of complications in patients waiting for an organ can
also be very expensive. |
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WGO-OMGE Practice Guideline - Treatment of Esophageal Varices |
About 30% of patients with esophageal varices will
bleed within the first year of diagnosis. Despite all advances
in intensive care, bleeding episodes still carry a high
mortality, which mainly depends on the severity of the
underlying liver disease.
The mortality of any bleeding episode may range from <10%
in well compensated Child-Pugh A to >70% in advanced
Child-Pugh C cirrhotics, respectively. Once a patient has bled,
the risk of re-bleeding is high, reaching 80% within one year |
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What you need to know-liver biopsy |
Liver biopsy in
usually the most specific test to asses the nature and severity
of liver disease. |
14 kb pdf |
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When Family Members just can't Understand |
There are
probably few things in life that are more hurtful than being
rejected by family members when we need them most.
Unfortunately, many patients find that a diagnosis of hepatitis
C not only causes friends to scatter, but also contributes to
some families literally splitting apart. |
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When health supplements may do harm |
Dr Benjamin
Ansell article, describing visit to store specializing in
dietary supplements in search of ones that could prevent heart
attack, cautions that clerks know little about what supplements
contain and possible risks; notes that, despite claims by
manufacturers, pill forms of vitamins and supplements have
proved to be no more effective than placebos; |
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