Archives - AZ Clinical Trials

Congenital CMV: Understanding the Impact on Women and Children

Congenital cytomegalovirus (CMV) is a viral infection that affects many women and children worldwide and in Arizona. While CMV infection often goes unnoticed in healthy individuals, it can cause severe complications when transmitted from a pregnant woman to her unborn child. In this blog, we will discuss the impacts of congenital CMV on women and children, shedding light on its potential consequences and exploring preventive measures. What is Congenital CMV? Congenital CMV is when a baby is infected with the cytomegalovirus before birth. CMV is a common virus from the herpesvirus family and is mainly spread through bodily fluids such as saliva, urine, and blood. It is estimated that approximately 1% of all newborns are affected by congenital CMV, making it the most common viral infection during pregnancy. Impact on Women: Maternal Health: CMV infection during pregnancy typically does not cause any significant symptoms in the mother. However, pregnant women who contract the virus for the first time may experience flu-like symptoms, such as fever, fatigue, and swollen glands. These symptoms are often mild and may be mistaken for other common illnesses. Regular prenatal check-ups and screening for CMV can help detect the infection early. Emotional Stress: A diagnosis of congenital CMV can be emotionally challenging for expectant mothers. The uncertainty and potential health risks associated with the infection can lead to anxiety, stress, and feelings of guilt. Proper support should be provided to help women navigate this difficult period. Impact on Children: Hearing and Vision Loss: Congenital CMV is a leading cause of hearing loss in children. The virus can damage the auditory nerves, resulting in mild to severe hearing impairment or deafness. Additionally, it can affect the optic nerves, which may lead to visual impairments and even blindness. Neurological Complications: CMV can affect the developing brain, increasing the chances of neurological complications. Some children may experience developmental delays, intellectual disabilities, seizures, and motor skill impairments. These challenges can impact their overall quality of life and usually require specialized interventions and therapies. Preventative Options for CMV Education and Awareness: Raising awareness about congenital CMV is crucial in preventing its transmission. Pregnant women should be educated about the risks associated with the virus and the preventive measures they can take, such as practicing good hygiene, avoiding close contact with young children’s saliva and urine, and refraining from sharing food, drinks, or utensils. Prenatal Screening: Routine prenatal screening for CMV during pregnancy can help identify women who are at risk of transmitting the infection to their unborn child. Early detection allows for appropriate medical interventions and monitoring throughout the pregnancy. Clinical Trials: While there are medications to help treat the symptoms associated with the virus, there is currently no cure for CMV. CMV studies are underway to help bring us closer to finding new treatments and potentially a cure. Congenital CMV infection can have significant consequences for both women and children. While the impact on pregnant women is often mild, the potential long-term effects on children can be severe, including hearing and vision loss and neurological complications. By raising awareness and encouraging participation in local studies, we can strive to decrease the spread of CMV and make a difference in women’s and children’s lives! Arizona Clinical Trials is looking for women to join CMV vaccine clinical trials in and around Phoenix and Tucson. Click here to learn how to get involved today!

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In Clinical Research Age Does Matter. Learn more in our blog.

Recognizing the Value of Older Adults in Research

The month of May celebrated Older Americans Month, so join us in recognizing the value of older adults in research. Read below to learn more! Age Diversity in Clinical Research Clinical trials are essential in helping researchers develop new treatments and potential cures for diseases. However, including older adults in research is imperative to realizing the full potential of medical treatments. Yet, despite the critical role older adults play in clinical research, the older demographic is often underrepresented due to various obstacles such as economic constraints, communication issues, and physical mobility issues that hinder their ability to participate. These obstacles can have a domino effect and lead to an inadequate understanding of drug effects, dosage levels, and efficacy amongst a group of people who are seeking these treatments the most. As we age, our bodies undergo numerous changes that can leave us vulnerable to various health conditions. For example, older adults are at a higher risk of developing cardiovascular disease and obesity than other populations. These conditions can dramatically impact an individual’s quality of life, leading to a myriad of health complications and limitations. For this reason, it’s crucial that older adults are included in research studies that seek to understand and address these issues. Especially seeing as how medications and therapy’s function varies significantly among different age groups. By increasing older adults’ participation in clinical trials, we can ultimately lead to more targeted therapies and better healthcare for all age demographics. Additionally, a single person may be managing a combination of conditions simultaneously. Thus, understanding how new drugs may interact with their current health regimen is also relevant. All Ages Needed – One Size Does NOT Fit All The potential dangers of not considering age diversity can be detrimental. A one-size-fits-all approach cannot be applied to a broad range of patients. As it may affect the efficacy and safety of the treatment being tested. Age influences multiple factors in our bodies, such as metabolism, metabolic rate, and organ function, all of which could affect how a drug is processed. It’s important to ensure that patients in different age categories are represented in clinical trials. It can benefit these patients as the older community is the most impacted by the disease for which treatments are being tested. Ultimately, it leads to more robust research with accurate and meaningful results that can help future generations of patients. Age-related diversity should never be overlooked when considering patient eligibility in clinical trials. Through innovative research and collaborative efforts, we can work to help increase the participation of older adults in studies. At Arizona Clinical Trials, we are committed to increasing diversity in clinical research throughout the state. Help us make a change in public health by learning how you or a loved one can participate in local trials! Visit our website or contact us at (480) 360-4000 to learn more about current and upcoming study opportunities. Resources: https://www.appliedclinicaltrialsonline.com/view/importance-age-diversity-clinical-trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4640010/ https://academic.oup.com/ageing/article/51/5/afab282/6581615

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The Value of Vaccine Research

There is no denying the immense value of vaccine research on public health. While scientific research and advancements in vaccine technology may not always be visible. They have undoubtedly have made an impact on our society. Learn more about the vaccine research process and the importance of their continuance in our latest blog! Vaccines – The Development Process The vaccine development and approval process are highly regulated to ensure safety and efficacy. The first step is the preclinical stage, where vaccines are tested on animals. If successful, the vaccine moves on to clinical trials, which are conducted in four phases. In phase one, the vaccine is given to a small group of volunteers to test for safety and determine dosage. Phase two involves a larger group of people and tests for effectiveness and side effects. Now, phase three involves a much larger group of people and is used to confirm the vaccine’s safety and overall effectiveness. Next, if the vaccine is successful in all three phases, it can then be submitted for FDA approval. In phase four, drugs that have already been approved by regulatory agencies are put to further testing in larger and more diverse patient populations. Providing important data on any unexpected adverse effects, patient adherence, and practical applications in real-world settings. How Do Clinical Trials Contribute to Vaccine Development? Clinical trials are the essential ingredient in the recipe for vaccine development. Without them, researchers would not be able to evaluate the efficacy of a potential vaccine on a large scale. Clinical trials are the bridge between the lab and the community. They are meticulously designed and monitored to obtain reliable data on vaccine performance. Then once a vaccine passes the clinical trial stage, it can go to the market to benefit the masses. The Impact of Vaccine Research Immunizations have been a game-changer in public health, with vaccines preventing an estimated 4 million deaths yearly, according to the Centers for Disease Control and Prevention. Every vaccine available today is the product of years of thorough testing. The value of vaccine research cannot be overstated. With new and emerging diseases constantly threatening global health, it’s more important than ever to invest in developing effective vaccines. In addition to saving millions of lives per year, vaccines have the power to prevent diseases from spreading and protect vulnerable individuals from potentially deadly infections. Furthermore, vaccine research allows us to better understand the ways in which viruses and diseases spread and how our bodies respond to them. This knowledge is invaluable as it can lead to new treatments and prevention strategies. Clinical trials and vaccine development are the perfect pair, with each playing a crucial role in making sure we are one step closer to eradicating infectious diseases! Are you ready to make a difference? Take a shot at vaccine trials now enrolling at Arizona Clinical Trials! Visit our website to learn more about how you can participate. Making a change tomorrow starts with today! Resources: https://www.cdc.gov/vaccines/basics/test-approve.html https://historyofvaccines.org/vaccines-101/how-are-vaccines-made/vaccine-development-testing-and-regulation

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Cytomegalovirus: Understanding the Condition

While affecting a large portion of the population, cytomegalovirus (CMV) and its effects remain relatively unknown. So, what exactly is CMV? Take a closer look at this often-misunderstood virus in our latest blog. What is Cytomegalovirus? Commonly abbreviated as CMV, cytomegalovirus is a double-stranded DNA virus belonging to the herpes family, and once contracted, it can remain in the body long-term. The condition is quite common – it’s believed that most of us have been exposed to CMV at some point. In fact, it’s estimated that approximately half of all adults have been infected by age 40. CMV can be contagious yet completely asymptomatic in healthy individuals with strong immune systems. However, those with weakened immune systems and those in daily contact with children are more vulnerable to severe health effects. Warning Signs of CMV Cytomegalovirus is transmittable through body fluids such as saliva, urine, breast milk, and blood transfusion. While often going unnoticed in healthy adults, the virus can cause a wide range of symptoms affecting people of all ages. Symptoms may range from mild cold-like symptoms such as swollen lymph nodes to more severe signs such as seizures. The most prevalent symptoms include fatigue, fever, sore throat, and swollen glands. However, more severe symptoms may arise for the immunocompromised, such as issues with the lungs, intestines, and liver, such as hepatitis. CMV and Pregnancy Complications Although the condition can prove harmless for some, it can also result in serious health concerns for others. This is especially true for women, especially those who are pregnant. If an expecting mother is exposed to the virus during pregnancy, there is a chance they can pass it onto the fetus, known as congenital CMV. Possible health complications that can occur as a result include: Autism Developmental delays Epilepsy Hearing loss Hyperactivity Disorder Visual impairment Several tests are available, including urine tests, blood tests, and swabs of fluid samples in the case of newborn infections. Treatment depends on the severity of the virus. While there is no specific medication to treat CMV, antiviral drugs can be used to help shorten the duration. While cytomegalovirus has no cure, avoiding contact with those infected can help prevent its transmission. Eating nutritious food, practicing good hygiene, and getting tested early are small steps that could help decrease health risks. If you’ve had trouble shaking that cough, sneeze, and fatigue for longer than usual, it may be time to check in with a healthcare professional. With proper testing and treatment, the effects of CMV can be minimal. Cytomegalovirus Prevention Studies Since there’s no cure for cytomegalovirus, clinical trials are underway to help advance the research for this virus. The best way to avoid cytomegalovirus is to stay ahead of it! Learn more about our CMV vaccine enrolling clinical trials for women in and around the Phoenix and Tucson areas by visiting our website or calling us at (480) 360-4000 today! Resources: https://www.cdc.gov/cmv/overview.html https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cytomegalovirus-infection/ https://my.clevelandclinic.org/health/diseases/21166-cytomegalovirus

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The recent hepatitis outbreak in children.

Hepatitis: Why Children and Why Now?

The Sudden Wave of Hepatitis Amongst Children A recent upsurge in hepatitis cases involving children has caused alarm nationwide. Let’s dive into why this age group is suddenly experiencing a spike in occurrences. An Origin Story – How Cases of Hepatitis Amongst Children Began  The first flare-up of hepatitis in kids emerged in the United Kingdom in early April of this year. A total of 10 severe cases were brought to the attention of the World Health Organization. All of them were ages ten and younger. The numbers, however, did not end here. As of June 2022, thirty-three countries were combating the hepatitis outbreak in children and, when combined, equaled a sum of 920 reported cases. Arizona is considered to be one of the hot zones for activity. What You Should Know About Hepatitis Amongst Children When a child has hepatitis, they will experience an inflammation of their liver. A list of different viruses can cause this; however, the two most common are hepatitis B and hepatitis C. A link doctors are finding between the newfound cases in children involves a virus by the name of adenovirus. There is expected to be about 100 types of this virus and fifty percent known capable of infecting humans. When discussing hepatitis, you may often hear the terms acute and chronic hepatitis mentioned. Here’s what they mean. Acute hepatitis occurs when a child with no previous health issues begins to display liver concerns. Chronic hepatitis deals with predisposed children with ongoing issues with liver disease. Tell-Tale Symptoms of Hepatitis Amongst Children What’s particularly odd with this volume of cases is that it’s very unusual to encounter a healthy child with such severe liver injury suddenly. Children may even go on to develop Non-Alcoholic Liver Disease (NAFLD). This takes place when the liver becomes intruded with a fat named steatosis. If inflammation or scarring come about, it’s then called steatohepatitis or the more commonly used NASH. If you’re worried your child or a child that you know may be combating hepatitis, here are some signs to look out for. Fever Nausea or vomiting Stomach pain Diarrhea Yellowing of skin and eyes Flu-like symptoms Joint pain Loss of appetite Dark urine or Clay-colored stool Prevention of Hepatitis in Children is Around the Corner It’s hard to not feel overwhelmed when something concerns our little ones or ones we know, but thankfully there are preventative measures that can be taken to ensure the safety of those you care about. If there’s one thing kids love, it’s touching everything in sight. A simple implementation of routine handwashing throughout the day can go a long way in helping stop the spread of hepatitis from child to child. You can also assist on your end by providing the child with supportive care, such as introducing a healthy diet into their daily routine and assuring they receive the necessary rest. Medications are also frequently used for treatment, depending on the individual case. Last but most certainly not least are vaccines. Currently, vaccinations for hepatitis A and B are readily available. This is a tremendous precaution to employ especially in young children before the exposure that follows age. The Investigation Continues     To see so many cases of hepatitis affecting such a young demographic nationally and in the state of Arizona naturally bumps it up to the top concern for the CDC. At this time, adenovirus remains the believed leading cause for hepatitis in children, but investigation remains ongoing. The CDC is working with state and local health departments to help gather as much data as possible in hopes to best

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NASH and Cirrhosis

At their very root, non-alcoholic steatohepatitis (NASH) and cirrhosis are two medical conditions that affect the liver. However, this seemingly separate duo shares more in common than you may think. When NASH and cirrhosis get together, your liver is at the heart of their destruction. Knowing their similarities and how they differ is part of the ongoing education slowing a growing epidemic for our liver and overall health. What is NASH? NASH is the most severe form of non-alcoholic fatty liver disease (NAFLD). NAFLD is an umbrella term for various diseases that cause excess fat accumulation in the liver. Many individuals with NAFLD have a simple fatty liver without any complications. On the other hand, around 25% develop NASH. NASH is the chronic inflammation of the liver triggered by the immune system after enough fat accumulation. Over time, chronic inflammation starts to damage and scar the liver, leading to cirrhosis, liver cancer, and liver failure. What is Cirrhosis? Cirrhosis is a chronic, long-term condition where scar tissue replaces healthy liver tissue. Viruses like hepatitis, alcohol abuse and NAFLD like NASH are the most common causes of cirrhosis. In regards to NASH, the damage from chronic inflammation comes from the body’s healing response continuing when it’s meant to stop once repairs are complete. Instead of eliminating excess repair supplies like collagen, it continues depositing it. This results in fibrous scar tissue that spreads across and stiffens the liver. Without treatment, cirrhosis can lead to loss of liver function and progress to liver cancer and liver failure. A Growing Epidemic NAFLD is the most common chronic liver condition in the U.S. At the current rate, health experts expect NASH prevalence to increase 63% by 2030. Because most people don’t know they have NASH, we can only estimate how many individuals have it. While even the estimations can be scary, it’s never too late to get your liver health back on track. Many factors fuel NASH. However, obesity, diabetes, and other conditions caused by unhealthy lifestyle choices are among the most common causes. By knowing your risk for NASH, you and your provider can begin regularly monitoring your liver, and you can make healthier lifestyle changes. Together, these can significantly positively impact the progression and prevention of liver disease. Prioritizing Your Liver Health May be Easier Thank You Think! Prioritizing your liver health doesn’t have to be overwhelming. Arizona Liver Health has options to help you get started. Do you know you’re at risk for liver disease but haven’t gotten checked out? No problem! We offer a FREE fibroscan for adults at risk of liver disease that can quickly and painlessly determine your liver health. We also conduct clinical research studies to help expand care options for individuals living with liver disease. So, if your fibroscan results indicate the presence of a liver condition, our team will talk with you about enrolling study options that may help! Click on the links above to learn more, or call us today at (480) 470-4000. Sources: https://www.the-nash-education-program.com/what-is-nash/how-prevalent-is-nash/ https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-liver-disease-cirrhosis#:~:text=The%20most%20common%20causes%20of,triglycerides%2C%20and%20high%20blood%20pressure) https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis/symptoms-causes

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COVID-19, Evusheld, and Liver Patients

Evusheld is a long-acting investigational protective measure against COVID-19, featuring a combination of two monoclonal antibodies. The FDA recently gave its approval under an emergency use authorization (EUA). Evusheld is a game-changer for liver patients and other individuals with a compromised immune system. What is Evusheld, and Who Can Use It? Evusheld is a combination of two long-acting monoclonal antibodies: Tixagevimab Cilgavimab Scientists create monoclonal antibodies in a laboratory to act as your own antibodies. Their purpose is to restore, modify, and enhance the body’s immune system’s attack on harmful cells or contagions like COVID-19. Evusheld has approval under an EUA for the pre-exposure prevention of COVID-19 in adults and pediatric individuals at a higher risk of an inadequate immune response. This population includes immunocompromised people, such as those with cancer or transplant patients or anyone taking medicines that suppress the immune system. Eligibility Criteria: Adults and pediatric individuals (12 years of age and older weighing at least 88 pounds 40 kg): Who are not currently infected with SARS-CoV-2 and who have not had a known recent exposure to an individual infected with SARS-CoV-2, AND: Who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination, OR For whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of severe adverse reaction (e.g., severe allergic reaction) to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s). COVID-19 Protection Vs. Traditional Vaccine Route Though current COVID-19 vaccines are safe, well-tolerated, and effective, individuals with compromised immune systems face a different challenge. In some instances, some patients who are immunocompromised might not generate a robust enough immune response. As a result, they may remain susceptible to contracting COVID-19, even with completing a full vaccine series. In addition, the risk for severe illness is higher in immunocompromised people. One reason is because the virus can survive longer in their bodies. Evusheld is the latest research breakthrough providing hope to one of the most vulnerable populations in the ongoing COVID-19 pandemic. Now, “normal” is a little bit closer for even more individuals. At Arizona Clinical Trials and Arizona Liver Health, we specialize in conducting clinical research studies to improve care options for liver diseases and other conditions. We are excited about what Evusheld means for individuals with compromised immune systems due to the advanced stages of liver disease. In the meantime, we are still offering FREE fibroscans to adults at risk of liver disease and research studies you can join to help advance treatments for conditions that affect the liver. To learn more, contact us today at (480) 360-4000 or visit our website. Sources: https://www.health.com/condition/infectious-diseases/coronavirus/immunocompromised-covid-vaccine https://www.upmc.com/coronavirus/monoclonal-antibodies/immunocompromised-patients https://www.astrazeneca.com/media-centre/press-releases/2022/evusheld-long-acting-antibody-combination-recommended-for-approval-in-the-eu-for-the-pre-exposure-prophylaxis-prevention-of-covid-19.html https://www.fda.gov/media/154702/download

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Get the facts on hepatitis B

Get the Facts on Hepatitis B

Like many other liver diseases, hepatitis B is a “silent epidemic” because most people do not have symptoms for most of the disease progression. It is one of the most common serious liver infections globally and in the state of Arizona, despite the fact it’s preventable and treatable. It’s time to get the facts on hepatitis B. What is Hepatitis B, and How Does it Affect the Liver? Hepatitis B (HBV) is a viral infection caused by the hepatitis B virus. The word hepatitis means “liver inflammation”; in this case, HBV is the cause of the inflammation. HBV is a short-term illness for most people, while others develop a serious long-term infection. Chronic inflammation (swelling and reddening) can lead to liver damage, cirrhosis (hardening or scarring), liver cancer, and in some cases death. Hepatitis B spreads when bodily fluids like blood or semen from a person with the virus enter the body of someone without HBV. This can happen through: Sexual contact Sharing needles, syringes, or other IV drug use equipment From mother to baby at birth. Not everyone experiences symptoms with HBV. Symptoms include fatigue, loss of appetite, stomach pain, nausea, and jaundice for those who do. Hepatitis B is Treatable and Preventable The treatments your healthcare provider recommends will depend on the type of hepatitis B you have, acute or chronic. Acute hepatitis B infections Short-lived infections typically require that you get plenty of rest, drink lots of fluids, and maintain a nutritious and healthy diet to give your body the support it needs as it fights off the infection. Chronic hepatitis B infections There are seven FDA-approved drugs for hepatitis B for chronic, long-term infections. Two are injectable treatments that help boost the immune system to fight off the virus. The five other options are antivirals you take orally. These treatments help reduce inflammation and damage to the liver. The hepatitis B vaccine is available and recommended for all infants at birth and children up to 18 years. Since everyone is at some risk, all adults should consider getting the vaccine since it provides a lifetime of protection against a preventable chronic liver disease. Even more so, for those adults living with diabetes and those with an increased risk for infection (job, lifestyle, etc.). Arizona and Hepatitis B HBV disproportionately affects Asians and Pacific Islanders, which is also a growing population in Arizona. According to the CDC, Asian and Pacific Islanders make up less than 5 percent of the U.S. population. However, this community of those living with hepatitis B. Increasing awareness with community education and improving how HBV is detected and treated through clinical research studies has never been more critical. Arizona Liver Health has new hepatitis b studies starting soon! Visit our website to learn more about hepatitis b or contact us at (480) 470-4000. Sources: https://www.hepb.org/what-is-hepatitis-b/what-is-hepb/ https://my.clevelandclinic.org/health/diseases/4246-hepatitis-b https://www.azcentral.com/story/news/local/arizona/2016/08/15/asian-pacific-health-group-takes-aim-hepatitis-b-arizona/87670654/    

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Jaundice: A complication of NASH

Jaundice: A Complication of NASH

Jaundice is a yellowing of the eye sclera (the white part) and skin because there’s too much bilirubin in the blood. There are many causes of jaundice. However, for people living with liver disease, jaundice is a common nonalcoholic steatohepatitis (NASH) complication. Bilirubin, the Liver, and Jaundice Bilirubin is formed while recycling old or damaged red blood cells. The bilirubin travels through the bloodstream to the liver. Then, it binds with bile and moves through the bile ducts into the digestive tract for removal from the body. Jaundice can develop when bilirubin levels build up in the blood and deposit in the skin. Any disease or other factor that prevents bilirubin from being eliminated from the body can lead to jaundice. The most common causes are: Liver infections, like hepatitis Excessive alcohol consumption Gallstone disease Some medicines and herbal supplements Cirrhosis Cancer of the gallbladder or pancreas In addition, high bilirubin levels can cause an accumulation of substances the body forms when it breaks bile down. This can lead to itching all over the body. Hepatitis and Jaundice The word hepatitis means liver inflammation and is a crucial part of the damage to the liver NASH causes. NASH is a more severe form of fatty liver disease where there is an excessive accumulation of fat in the liver. While a simple fatty liver isn’t necessarily harmful, it can progress to NASH which is marked by chronic inflammation. In some individuals, the accumulation of fat in the liver triggers the body’s healing response. The immune response includes: Inflammation (increases oxygen-rich blood and other nutrients to damaged areas) Liver cell repair Application of collagen to protect healing areas Normally, this is a self-limiting reaction, which means that once repairs and healing are complete, the body sends a signal to the immune system to switch off the healing response. With NASH and other liver diseases, most people are unaware they have a condition because there are no noticeable symptoms at first. If you don’t know something is wrong, you also don’t seek treatment or make healthier lifestyle changes to reduce the amount of fat in the liver. This means that the liver continues accumulating fat and, therefore, continues the healing response. Eventually, chronic liver inflammation begins to scar and damage the liver replacing healthy liver cells with stiff, fibrous, non-functioning scar tissue. Over time, the liver can progress into cirrhosis, liver cancer, and liver failure. Without enough healthy cells, the liver cannot perform its vital functions, including moving the bilirubin through the bile ducts. Reducing the Prevalence of NASH The prevalence of NASH is growing at an alarming rate in America. There are no FDA-approved treatments available currently for NASH, but potential new options are being evaluated in clinical trials. Arizona Liver Health offers a FREE fibroscan to adults at risk of liver disease to check the health of their liver. To schedule your FREE fibroscan appointment or explore our enrolling NASH studies, contact us today at (480) 470-4000! Sources: https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-disease/jaundice-in-adults https://www.aafp.org/pubs/afp/issues/2017/0201/p164-s1.html https://my.clevelandclinic.org/health/diseases/15367-adult-jaundice

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