Mild glucose intolerance in pregnancy may be an early identifier of women who are at increased risk of heart disease in the future, found a new study published in CMAJ (Canadian Medical Association Journal.)
In a large population-based cohort study, researchers from the University of Toronto and the Institute for Clinical Evaluative Sciences (ICES) studied data on 435,696 women in Ontario, Canada, who gave birth between April, 1994 and March, 1998. All women were followed until March 31, 2008. The study excluded women with pre-existing diabetes.
As cardiovascular disease is the leading cause of death in Canadian women, it is important to identify early predictors of future vascular risk. While women with gestational diabetes have a higher risk of cardiovascular disease than those without, it previously has not been known whether mild glucose intolerance in pregnancy is associated with heart disease. The study sought to answer this question.
Gestational diabetes is a condition leading to temporarily high blood sugars during pregnancy. It is an important risk factor for future type 2 diabetes. Women are generally screened for gestational diabetes with a glucose challenge test in the late second trimester. If the result is abnormal, they go on to have an oral glucose tolerance test to confirm the diagnosis.
"Women who had an abnormal glucose challenge test but then did not have gestational diabetes had an increased risk of future cardiovascular disease compared to the general population, but a lower risk than women who actually did have gestational diabetes," writes Dr. Baiju Shah, Institute for Clinical and Evaluative Sciences and coauthor.
They suggest that "in women with glucose intolerance during pregnancy, type 2 diabetes and vascular disease may develop in parallel, which is consistent with the "common soil" hypothesis for these conditions."
Current screening procedures for gestational diabetes might also provide a means for the early identification of women who are at risk for developing heart disease later in life.
In a related commentary, Dr. J. Kennedy Cruickshank and Dr. Moulinath Banerjee of the Manchester Royal Infirmary, University of Manchester, UK write that "what the study by Retnakaran and Shah shows is that we all have a great deal to learn from sub-clinical blood vessel changes in younger women who are likely overweight during pregnancy."
They suggest that diabetes research should focus on the blood vessel rather than glycemia.
Source
Canadian Medical Association Journal
Aug 27, 2009
Is Winter To Blame For Type 1 Diabetes?
Researchers from Finland have found a correlation between new cases of Type 1 diabetes and winter months.
The study analysed data of 31,000 children from 105 diabetes centres across 53 countries found a correlation between the season and the onset of Type 1 diabetes. Of the 42 centres that exhibited this seasonal trend, 28 centres had peaks of diagnosis in winter and 33 had troughs in summer.
Large study, strong correlation
Published in the journal 'Diabetic Medicine', the research also found that diabetes centres further away from the equator were more likely to have greater numbers of new cases in winter. This winter trend was more prevalent in boys, as well as in both sexes from the older age groups (5 to 14 years old).
"Results from previous studies in this area have been conflicting but this larger study shows a stronger correlation which is interesting, especially as we still don't know exactly why Type 1 diabetes develops", said Victoria King, Diabetes UK Research Manager.
"Investigating why we might be seeing this pattern could tell us more about what may be triggering the development of Type 1 diabetes.
"Despite this, the study looked at correlations over a relatively short period of time and not all centres that took part in the study showed the correlation between seasonality and diagnosis of Type 1 diabetes so more data are needed before more definite conclusions can be drawn", said King.
Viral infections
Lead author of the study, Elena Moltchanova, Statistician at the National Institute for Health and Welfare, Helsinki, said:
"Numerous reasons have been suggested for the apparent seasonality of the onset of Type 1 diabetes.
These include a seasonal variation in people's levels of blood glucose and insulin, seasonal viral infections, the fact that young people tend to eat more and do less physical activity during winter months and, similarly, that summer holidays provide a rest from school stress and more opportunity to play outdoors."
Source
Diabetes UK
The study analysed data of 31,000 children from 105 diabetes centres across 53 countries found a correlation between the season and the onset of Type 1 diabetes. Of the 42 centres that exhibited this seasonal trend, 28 centres had peaks of diagnosis in winter and 33 had troughs in summer.
Large study, strong correlation
Published in the journal 'Diabetic Medicine', the research also found that diabetes centres further away from the equator were more likely to have greater numbers of new cases in winter. This winter trend was more prevalent in boys, as well as in both sexes from the older age groups (5 to 14 years old).
"Results from previous studies in this area have been conflicting but this larger study shows a stronger correlation which is interesting, especially as we still don't know exactly why Type 1 diabetes develops", said Victoria King, Diabetes UK Research Manager.
"Investigating why we might be seeing this pattern could tell us more about what may be triggering the development of Type 1 diabetes.
"Despite this, the study looked at correlations over a relatively short period of time and not all centres that took part in the study showed the correlation between seasonality and diagnosis of Type 1 diabetes so more data are needed before more definite conclusions can be drawn", said King.
Viral infections
Lead author of the study, Elena Moltchanova, Statistician at the National Institute for Health and Welfare, Helsinki, said:
"Numerous reasons have been suggested for the apparent seasonality of the onset of Type 1 diabetes.
These include a seasonal variation in people's levels of blood glucose and insulin, seasonal viral infections, the fact that young people tend to eat more and do less physical activity during winter months and, similarly, that summer holidays provide a rest from school stress and more opportunity to play outdoors."
Source
Diabetes UK
Aug 19, 2009
What Is a Stroke? What Causes a Stroke?
A stroke is a condition where a blood clot or ruptured artery or blood vessel interrupts blood flow to an area of the brain. A lack of oxygen and glucose (sugar) flowing to the brain leads to the death of brain cells and brain damage, often resulting in an impairment in speech, movement, and memory.
The two main types of stroke include ischemic stroke and hemorrhagic stroke. Ischemic stroke accounts for about 75% of all strokes and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke. A hemorrhagic stroke occurs when a blood vessel on the brain's surface ruptures and fills the space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage). Both result in a lack of blood flow to the brain and a buildup of blood that puts too much pressure on the brain.
The outcome after a stroke depends on where the stroke occurs and how much of the brain is affected. Smaller strokes may result in minor problems, such as weakness in an arm or leg. Larger strokes may lead to paralysis or death. Many stroke patients are left with weakness on one side of the body, difficulty speaking, incontinence, and bladder problems.
Who gets stroke?
Anyone can suffer from stroke. Although many risk factors for stroke are out of our control, several can be kept in line through proper nutrition and medical care. Risk factors for stroke include the following:
* Over age 55
* Male
* African American, Hispanic or Asian/Pacific Islander
* A family history of stroke
* High blood pressure
* High cholesterol
* Smoking cigarettes
* Diabetes
* Obesity and overweight
* Cardiovascular disease
* A previous stroke or transient ischemic attack (TIA)
* High levels of homocysteine (an amino acid in blood)
* Birth control use or other hormone therapy
* Cocaine use
* Heavy use of alcohol
What causes stroke?
Ischemic strokes are ultimately caused by a thrombus or embolus that blocks blood flow to the brain. Blood clots (thrombus clots) usually occur in areas of the arteries that have been damaged by atherosclerosis from a buildup of plaques. Embolus type blood clots are often caused by atrial fibrillation - an irregular pattern of heart beat that leads to blood clot formation and poor blood flow.
Hemorrhage strokes can be caused by uncontrolled high blood pressure, a head injury, or aneurysms. High blood pressure is the most common cause of cerebral hemorrhage, as it causes small arteries inside the brain to burst. This deprives brain cells of blood and dangerously increases pressure on the brain.
Aneurysms - abnormal blood-filled pouches that balloon out from weak spots in the wall of an artery - are the most common cause of subarachnoid hemorrhage. If an aneurysm ruptures, blood spills into the space between the surfaces of the brain and skull, and blood vessels in the brain may spasm. Aneurysms are often caused or made worse by high blood pressure.
A study found that a Single Gene Defect Can Lead To Stroke And Deadly Diseases Of The Aorta And Coronary Arteries.
A less common from of hemorrhage stroke is when an arteriovenous malformation (AVM) ruptures. AVM is an abnormal tangle of thin-walled blood vessels that is present at birth.
A study found that migraines increase stroke risk during pregnancy.
What are the symptoms of stroke?
Within a few minutes of having a stroke, brain cells begin to die and symptoms can become present. It is important to recognize symptoms, as prompt treatment is crucial to recovery. Common symptoms include:
* Dizziness, trouble walking, loss of balance and coordination
* Speech problems
* Numbness, weakness, or paralysis on one side of the body
* Blurred, blackened, or double vision
* Sudden severe headache
Smaller strokes (or silent strokes), however, may not cause any symptoms, but can still damage brain tissue.
A possible sign that a stroke is about to occur is called a transient ischemic attack (TIA) - a temporary interruption in blood flow to part of the brain. Symptoms of TIA are similar to stroke but last for a shorter time period and do not leave noticeable permanent damage.
A study found that women are more likely to experience non-traditional stroke symptoms.
How is stroke diagnosed?
A stroke is a medical emergency, and anyone suspected of having a stroke should be taken to a hospital immediately so that tests can be run and the correct treatment can be provided as quickly as possible.
Physicians have several tools available to screen for stroke risk and diagnose an active stroke. These include:
* Physical assessment - blood pressure tests and blood tests to see cholesterol levels, blood sugar levels, and amino acid levels
* Ultrasound - a wand waved over the carotid arteries in the neck can provide a picture that indicates any narrowing or clotting
* Arteriography - a catheter is inserted into the arteries to inject a dye that can be picked up by X-rays
* Computerized tomography (CT) scan - a scanning device that creates a 3-D image that can show aneurysms, bleeding, or abnormal vessels within the brain
* Magnetic resonance imaging (MRI) - a magnetic field generates a 3-D view of the brain to see tissue damaged by stroke
* CT and MRI with angiography - scans that are aided by a dye that is injected into the blood vessels in order to provide clearer and more detailed images
* Echocardiography - an ultrasound that makes images of the heart to check for embolus
How is stroke treated?
The primary goal in treating ischemic stroke is to restore blood flow to the brain. This will be attempted using blood clot-busting drugs such as aspirin, heparin, or tissue plasminogen activators that must be administered within three hours of the stroke. In addition, surgical procedures may be performed that can open up or widen arteries. These include carotid endarterectomy (removal of plaque and widening of the carotid artery) and angioplasty (a balloon that widens the cartoid artery and is held open with a metallic mesh tube called a stent).
A study found that cholesterol lowering drugs can prevent stroke recurrence.
Hemorrhagic stroke is treated differently than ischmic stroke. Surgical methods used to treat this stroke variant include aneurysm clipping, aneurysm embolisation, and arteriovenous malformation (AVM) removal. Aneurysm clipping consists of a small clamp placed at the base of the aneurysm that isolates it from the circulation of it's attached artery and keeps the aneurysm from bursting or re-bleeding. Aneurysm embolisation (coiling) uses a catheter inserted into the aneurysm to deposit a tiny coil that coil fills the aneurysm, causing clotting and sealing off the aneurysm off from arteries. AVM removal is a surgical procedure to remove usually smaller AVMs or AMVs that are in more accessible portion of the brain in order to eliminate the risk of rupture.
US researchers found that patients who had experienced strokes as long as six months earlier were able to regain brain function through the help of a novel robotic device that they squeezed with their hand.
Most stroke victims will require rehabilitation after the event. A person's condition is generally dependent on the area of the brain and the amount of tissue that was damaged. It is common for the rehabilitation process to include speech therapy, occupational therapy, physical therapy, and family education.
A study carried out by researchers at the University of Illinois, Chicago found that Tai Chi helped stroke victims regain balance.
A new study has found that the short window of time to treat stroke patients can be expanded.
A stroke patient was intravenously injected with his own bone marrow stem cells as part of a research trial at The University of Texas Medical School at Houston.
How can stroke be prevented?
One way to prevent a stroke is to notice a transient ischemic attack (TIA) - or mini stroke - that provides symptoms similar to stroke. Knowing the symptoms of stroke can lead to earlier treatment and better recovery.
Much of stroke prevention is based on living a healthy lifestyle. This includes:
* Knowing and controlling blood pressure
* Finding out if you have atrial fibrillation
* Not smoking
* Lowering cholesterol, sodium, and fat intake
* Following a healthy diet
* Drinking alcohol only in moderation
* Treating diabetes properly
* Exercising regularly. Moderate aerobic fitness can reduce stroke risk, a study found.
* Managing stress
* Not using drugs
* A study found that drinking three cups of tea per day reduces the risk of stroke
* Taking preventive medications such as anti-platelet and anticoagulant drugs to prevent blood clots
* Cholesterol lowering drugs can prevent stroke recurrence
Written by Peter Crosta M.A.
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
The two main types of stroke include ischemic stroke and hemorrhagic stroke. Ischemic stroke accounts for about 75% of all strokes and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke. A hemorrhagic stroke occurs when a blood vessel on the brain's surface ruptures and fills the space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage). Both result in a lack of blood flow to the brain and a buildup of blood that puts too much pressure on the brain.
The outcome after a stroke depends on where the stroke occurs and how much of the brain is affected. Smaller strokes may result in minor problems, such as weakness in an arm or leg. Larger strokes may lead to paralysis or death. Many stroke patients are left with weakness on one side of the body, difficulty speaking, incontinence, and bladder problems.
Who gets stroke?
Anyone can suffer from stroke. Although many risk factors for stroke are out of our control, several can be kept in line through proper nutrition and medical care. Risk factors for stroke include the following:
* Over age 55
* Male
* African American, Hispanic or Asian/Pacific Islander
* A family history of stroke
* High blood pressure
* High cholesterol
* Smoking cigarettes
* Diabetes
* Obesity and overweight
* Cardiovascular disease
* A previous stroke or transient ischemic attack (TIA)
* High levels of homocysteine (an amino acid in blood)
* Birth control use or other hormone therapy
* Cocaine use
* Heavy use of alcohol
What causes stroke?
Ischemic strokes are ultimately caused by a thrombus or embolus that blocks blood flow to the brain. Blood clots (thrombus clots) usually occur in areas of the arteries that have been damaged by atherosclerosis from a buildup of plaques. Embolus type blood clots are often caused by atrial fibrillation - an irregular pattern of heart beat that leads to blood clot formation and poor blood flow.
Hemorrhage strokes can be caused by uncontrolled high blood pressure, a head injury, or aneurysms. High blood pressure is the most common cause of cerebral hemorrhage, as it causes small arteries inside the brain to burst. This deprives brain cells of blood and dangerously increases pressure on the brain.
Aneurysms - abnormal blood-filled pouches that balloon out from weak spots in the wall of an artery - are the most common cause of subarachnoid hemorrhage. If an aneurysm ruptures, blood spills into the space between the surfaces of the brain and skull, and blood vessels in the brain may spasm. Aneurysms are often caused or made worse by high blood pressure.
A study found that a Single Gene Defect Can Lead To Stroke And Deadly Diseases Of The Aorta And Coronary Arteries.
A less common from of hemorrhage stroke is when an arteriovenous malformation (AVM) ruptures. AVM is an abnormal tangle of thin-walled blood vessels that is present at birth.
A study found that migraines increase stroke risk during pregnancy.
What are the symptoms of stroke?
Within a few minutes of having a stroke, brain cells begin to die and symptoms can become present. It is important to recognize symptoms, as prompt treatment is crucial to recovery. Common symptoms include:
* Dizziness, trouble walking, loss of balance and coordination
* Speech problems
* Numbness, weakness, or paralysis on one side of the body
* Blurred, blackened, or double vision
* Sudden severe headache
Smaller strokes (or silent strokes), however, may not cause any symptoms, but can still damage brain tissue.
A possible sign that a stroke is about to occur is called a transient ischemic attack (TIA) - a temporary interruption in blood flow to part of the brain. Symptoms of TIA are similar to stroke but last for a shorter time period and do not leave noticeable permanent damage.
A study found that women are more likely to experience non-traditional stroke symptoms.
How is stroke diagnosed?
A stroke is a medical emergency, and anyone suspected of having a stroke should be taken to a hospital immediately so that tests can be run and the correct treatment can be provided as quickly as possible.
Physicians have several tools available to screen for stroke risk and diagnose an active stroke. These include:
* Physical assessment - blood pressure tests and blood tests to see cholesterol levels, blood sugar levels, and amino acid levels
* Ultrasound - a wand waved over the carotid arteries in the neck can provide a picture that indicates any narrowing or clotting
* Arteriography - a catheter is inserted into the arteries to inject a dye that can be picked up by X-rays
* Computerized tomography (CT) scan - a scanning device that creates a 3-D image that can show aneurysms, bleeding, or abnormal vessels within the brain
* Magnetic resonance imaging (MRI) - a magnetic field generates a 3-D view of the brain to see tissue damaged by stroke
* CT and MRI with angiography - scans that are aided by a dye that is injected into the blood vessels in order to provide clearer and more detailed images
* Echocardiography - an ultrasound that makes images of the heart to check for embolus
How is stroke treated?
The primary goal in treating ischemic stroke is to restore blood flow to the brain. This will be attempted using blood clot-busting drugs such as aspirin, heparin, or tissue plasminogen activators that must be administered within three hours of the stroke. In addition, surgical procedures may be performed that can open up or widen arteries. These include carotid endarterectomy (removal of plaque and widening of the carotid artery) and angioplasty (a balloon that widens the cartoid artery and is held open with a metallic mesh tube called a stent).
A study found that cholesterol lowering drugs can prevent stroke recurrence.
Hemorrhagic stroke is treated differently than ischmic stroke. Surgical methods used to treat this stroke variant include aneurysm clipping, aneurysm embolisation, and arteriovenous malformation (AVM) removal. Aneurysm clipping consists of a small clamp placed at the base of the aneurysm that isolates it from the circulation of it's attached artery and keeps the aneurysm from bursting or re-bleeding. Aneurysm embolisation (coiling) uses a catheter inserted into the aneurysm to deposit a tiny coil that coil fills the aneurysm, causing clotting and sealing off the aneurysm off from arteries. AVM removal is a surgical procedure to remove usually smaller AVMs or AMVs that are in more accessible portion of the brain in order to eliminate the risk of rupture.
US researchers found that patients who had experienced strokes as long as six months earlier were able to regain brain function through the help of a novel robotic device that they squeezed with their hand.
Most stroke victims will require rehabilitation after the event. A person's condition is generally dependent on the area of the brain and the amount of tissue that was damaged. It is common for the rehabilitation process to include speech therapy, occupational therapy, physical therapy, and family education.
A study carried out by researchers at the University of Illinois, Chicago found that Tai Chi helped stroke victims regain balance.
A new study has found that the short window of time to treat stroke patients can be expanded.
A stroke patient was intravenously injected with his own bone marrow stem cells as part of a research trial at The University of Texas Medical School at Houston.
How can stroke be prevented?
One way to prevent a stroke is to notice a transient ischemic attack (TIA) - or mini stroke - that provides symptoms similar to stroke. Knowing the symptoms of stroke can lead to earlier treatment and better recovery.
Much of stroke prevention is based on living a healthy lifestyle. This includes:
* Knowing and controlling blood pressure
* Finding out if you have atrial fibrillation
* Not smoking
* Lowering cholesterol, sodium, and fat intake
* Following a healthy diet
* Drinking alcohol only in moderation
* Treating diabetes properly
* Exercising regularly. Moderate aerobic fitness can reduce stroke risk, a study found.
* Managing stress
* Not using drugs
* A study found that drinking three cups of tea per day reduces the risk of stroke
* Taking preventive medications such as anti-platelet and anticoagulant drugs to prevent blood clots
* Cholesterol lowering drugs can prevent stroke recurrence
Written by Peter Crosta M.A.
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Improving Sleep And Pain In People With Osteoarthritis Using Cognitive Behavioral Therapy
A study in the Aug. 15 issue of the Journal of Clinical Sleep Medicine shows that the use of cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for older patients with osteoarthritis and comorbid insomnia.
Results showed that treatment improves both immediate and long-term self-reported sleep and pain in older patients with osteoarthritis and comorbid insomnia without directly addressing pain control. Participants who received CBT-I reported significantly decreased sleep latency (initially decreased by an average of 16.9 minutes and 11 minutes a year after treatment) and wake after sleep onset (initially decreased by an average of 37 minutes and 19.9 minutes a year after treatment), significantly reduced pain (initially improved by 9.7 points and 4.7 points a year after treatment) and increased sleep efficiency (initially increased by 13 percent and 8 percent a year after treatment). These improvements persisted in CBT-I patients (19 of 23) who were further assessed for sleep quality and perceived pain at a one-year follow-up visit.
According to lead author Michael V. Vitiello, PhD, professor at the University of Washington in Seattle, Wash., results indicate that insomnia is not merely a symptom of osteoarthritis but rather a co-existing illness. Vitiello said improving sleep can result in an improvement in osteoarthritis, which is particularly important because, at least in older adults, insomnia rarely exits by itself, rather it typically coexists with other illnesses, pain conditions and depression.
"The particular strength of CBT-I is that once an individual learns how to improve their sleep, study after study has shown that the improvement persists for a year or more," said
Vitiello. "What we and others are showing is that CBT-I can not only improve sleep but that improvement of sleep may lead to improvement in co-existing medical or psychiatric illnesses, such as osteoarthritis or depression, and in the case of our study, that these additional benefits can be seen in the long term."
A total of 23 patients with a mean age of 69 years were randomly assigned to CBT-I, while 28 patients with a mean age of 66.5 years were assigned to a stress management and wellness control group. Participants in the control group reported no significant improvements in any measure.
CBT-I intervention consisted of eight weekly, two-hour classes ranging in size from four to eight participants. All classes were conducted in an academic medical center in downtown Chicago and were spread out over the calendar year. Participants received polysomnographic assessment in their home in order to exclude individuals with sleep apnea. Sleep and pain were assessed by self-report at baseline, after treatment, and (for CBT-I only) at one year follow-up. Sleep logs were recorded prior to and after treatment and at the one year follow-up and included information about sleep latency, wake after sleep onset and sleep efficiency. Subjects were required to be over the age of 55, have insomnia symptoms that have persisted for at least six months and have been diagnosed with osteoarthritis. A majority of the sample was female. Volunteers were recruited from placements of brochures, memos and flyers in places where medical patients who qualified for the study might see them.
According to the study, sleep quality is a major concern for people with osteoarthritis, with 60 percent of people who have the disease reporting pain during the night. Chronic pain initiates and exacerbates sleep disturbance; disturbed sleep in turn maintains and exacerbates chronic pain and related dysfunction.
The findings indicate that successful treatment of sleep disturbance may improve the quality of life for patients in this population. The authors recommend that CBT-I, which specifically targets sleep, be incorporated into behavioral interventions for pain management in osteoarthritis and possibly for other chronic pain conditions as well.
The study: "Cognitive Behavioral Therapy for Insomnia Improves Sleep and Decreases Pain in Older Adults with Co-Morbid Insomnia and Osteoarthritis"
Source:
Kelly Wagner
American Academy of Sleep Medicine
Results showed that treatment improves both immediate and long-term self-reported sleep and pain in older patients with osteoarthritis and comorbid insomnia without directly addressing pain control. Participants who received CBT-I reported significantly decreased sleep latency (initially decreased by an average of 16.9 minutes and 11 minutes a year after treatment) and wake after sleep onset (initially decreased by an average of 37 minutes and 19.9 minutes a year after treatment), significantly reduced pain (initially improved by 9.7 points and 4.7 points a year after treatment) and increased sleep efficiency (initially increased by 13 percent and 8 percent a year after treatment). These improvements persisted in CBT-I patients (19 of 23) who were further assessed for sleep quality and perceived pain at a one-year follow-up visit.
According to lead author Michael V. Vitiello, PhD, professor at the University of Washington in Seattle, Wash., results indicate that insomnia is not merely a symptom of osteoarthritis but rather a co-existing illness. Vitiello said improving sleep can result in an improvement in osteoarthritis, which is particularly important because, at least in older adults, insomnia rarely exits by itself, rather it typically coexists with other illnesses, pain conditions and depression.
"The particular strength of CBT-I is that once an individual learns how to improve their sleep, study after study has shown that the improvement persists for a year or more," said
Vitiello. "What we and others are showing is that CBT-I can not only improve sleep but that improvement of sleep may lead to improvement in co-existing medical or psychiatric illnesses, such as osteoarthritis or depression, and in the case of our study, that these additional benefits can be seen in the long term."
A total of 23 patients with a mean age of 69 years were randomly assigned to CBT-I, while 28 patients with a mean age of 66.5 years were assigned to a stress management and wellness control group. Participants in the control group reported no significant improvements in any measure.
CBT-I intervention consisted of eight weekly, two-hour classes ranging in size from four to eight participants. All classes were conducted in an academic medical center in downtown Chicago and were spread out over the calendar year. Participants received polysomnographic assessment in their home in order to exclude individuals with sleep apnea. Sleep and pain were assessed by self-report at baseline, after treatment, and (for CBT-I only) at one year follow-up. Sleep logs were recorded prior to and after treatment and at the one year follow-up and included information about sleep latency, wake after sleep onset and sleep efficiency. Subjects were required to be over the age of 55, have insomnia symptoms that have persisted for at least six months and have been diagnosed with osteoarthritis. A majority of the sample was female. Volunteers were recruited from placements of brochures, memos and flyers in places where medical patients who qualified for the study might see them.
According to the study, sleep quality is a major concern for people with osteoarthritis, with 60 percent of people who have the disease reporting pain during the night. Chronic pain initiates and exacerbates sleep disturbance; disturbed sleep in turn maintains and exacerbates chronic pain and related dysfunction.
The findings indicate that successful treatment of sleep disturbance may improve the quality of life for patients in this population. The authors recommend that CBT-I, which specifically targets sleep, be incorporated into behavioral interventions for pain management in osteoarthritis and possibly for other chronic pain conditions as well.
The study: "Cognitive Behavioral Therapy for Insomnia Improves Sleep and Decreases Pain in Older Adults with Co-Morbid Insomnia and Osteoarthritis"
Source:
Kelly Wagner
American Academy of Sleep Medicine
New Lung Cancer Vaccines May Lower Costs, Accelerate Treatment
In one to three years, new therapeutic vaccines could change standard treatment regimens for the most commonly diagnosed lung cancer-nonsmall cell lung cancer. Therapeutic cancer vaccines (TCVs), currently in late-phase clinical trials, may be introduced as adjuvant therapy that reduces undesirable side effects caused by toxic radiation and chemotherapy, according to a recent Health Technology Forecast released by ECRI Institute® (www.ecri.org), an independent, nonprofit organization that researches the best approaches to improving patient care.
The vaccines, which could be considered "personalized medicine," are designed to stimulate the body's natural defenses against cancer. By attacking proteins and molecules associated with cancer development, TCVs have the potential to shrink tumors and slow their growth.
ECRI Institute reviewed preliminary results from ongoing trials released by four vaccine manufacturers in its report, "Therapeutic Vaccines for Lung Cancer©." If those preliminary results are upheld in ongoing phase III trials and eventually result in approval by the U.S. Food and Drug Administration, ECRI Institute researchers anticipate that TCVs will be widely implemented into lung cancer treatment programs.
"The current vaccines may only be successful in a select number of cancer cases," says Randall Hulshizer, M.S., lead author of the ECRI Institute report. "But we expect that future advances in therapeutic cancer vaccines may increase life quality and expectancy for lung cancer patients and could decrease the overall cost of treatment by reducing side effects and amount of chemotherapy or radiation needed."
ECRI Institute's evidence reports, forecasts, and guidance are researched and written by a multidisciplinary staff of 300 full-time doctoral-level scientists, clinicians, technologists, medical librarians, and other healthcare professionals, which includes Evidence-based Practice Center staff. Forecasts, technology assessments, and comparative-effectiveness reviews evaluate technologies along the continuum from innovation to wide diffusion into practice.
ECRI Institute has a rich history of providing assessments to hospitals, health systems, the U.S. Centers for Medicare & Medicaid Services and other federal agencies, as well as ministries of health and hospitals worldwide. To maintain objectivity in its research and publications, ECRI Institute requires all its employees to adhere to strict conflict-of-interest policies that keep employees at arm's length from medical product/pharmaceutical/biotechnology manufacturers and health plans.
Source
ECRI Institute
The vaccines, which could be considered "personalized medicine," are designed to stimulate the body's natural defenses against cancer. By attacking proteins and molecules associated with cancer development, TCVs have the potential to shrink tumors and slow their growth.
ECRI Institute reviewed preliminary results from ongoing trials released by four vaccine manufacturers in its report, "Therapeutic Vaccines for Lung Cancer©." If those preliminary results are upheld in ongoing phase III trials and eventually result in approval by the U.S. Food and Drug Administration, ECRI Institute researchers anticipate that TCVs will be widely implemented into lung cancer treatment programs.
"The current vaccines may only be successful in a select number of cancer cases," says Randall Hulshizer, M.S., lead author of the ECRI Institute report. "But we expect that future advances in therapeutic cancer vaccines may increase life quality and expectancy for lung cancer patients and could decrease the overall cost of treatment by reducing side effects and amount of chemotherapy or radiation needed."
ECRI Institute's evidence reports, forecasts, and guidance are researched and written by a multidisciplinary staff of 300 full-time doctoral-level scientists, clinicians, technologists, medical librarians, and other healthcare professionals, which includes Evidence-based Practice Center staff. Forecasts, technology assessments, and comparative-effectiveness reviews evaluate technologies along the continuum from innovation to wide diffusion into practice.
ECRI Institute has a rich history of providing assessments to hospitals, health systems, the U.S. Centers for Medicare & Medicaid Services and other federal agencies, as well as ministries of health and hospitals worldwide. To maintain objectivity in its research and publications, ECRI Institute requires all its employees to adhere to strict conflict-of-interest policies that keep employees at arm's length from medical product/pharmaceutical/biotechnology manufacturers and health plans.
Source
ECRI Institute
Stinging Insects Can Be Deadly
Legendary skateboarder Andy Kessler's death after being stung by an insect earlier this week is a reminder that stings can be deadly for those with stinging insect allergy. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), up to 5% of Americans are at risk for a severe, potentially life-threatening allergic reaction from insect stings.
Unfortunately, most people are not aware they are allergic to insect stings until after experiencing a reaction. An allergic reaction occurs when the immune system overreacts to the insect venom. When this happens, an allergic person's body produces an allergic substance called Immunoglobulin E (IgE) antibody, which reacts with the venom. This triggers the release of histamine and other chemicals that cause allergic symptoms and, in the most severe of cases, a rapid fall in blood pressure, loss of consciousness and sometimes even death.
Because a severe and sometimes fatal reaction can occur, it is important to know what common stinging insects look like. The most common stinging insects in the United States include:
- Yellow jackets - black with yellow markings, found in various climates
- Honeybees - a round, fuzzy body covered with dark brown and yellow markings
- Paper wasps - slender, elongated bodies that are black, brown or red and have yellow markings
- Hornets - black or brown with white, orange or yellow markings and are larger than yellow jackets
- Fire ants - reddish-brown ants living in large mounds, mostly in warmer climates
It is also critical for anyone with allergies to insect stings to take precautions to avoid a potentially dangerous reaction. The AAAAI recommends the following tips to avoid being stung:
- Avoid the "territory" of the stinging insect's nest. These insects are most likely to sting if their homes are disturbed.
- Remain calm, quiet and slowly move away from stinging insects. Do not swat them.
- Avoid brightly colored clothing and perfume outdoors that may attract stinging insects.
- Be careful when cooking, eating or drinking sweet beverages outdoors. Keep all food and beverages covered until consuming them.
- Avoid loose-fitting garments that can trap insects between material and the skin.
When to see an allergy specialist
If you have experienced a reaction to insect stings or you think you may be allergic, consult with an allergist/immunologist to accurately diagnose your condition. An allergist/immunologist is the best qualified medical professional trained to manage the prevention, diagnosis and treatment of allergies and asthma.
An allergist might also suggest allergy shots, also known as immunotherapy treatment. Venom immunotherapy shots take effect within just a few months. Venom immunotherapy is the closest thing to a "cure" for allergic reactions. It is shown to be 97% effective in preventing future allergic reactions. Patients should see an allergist/immunologist if they:
- Have reactions possibly due to insect stings for accurate identification of the specific allergen and consideration for immunotherapy (allergy shots).
- Have systemic reactions possibly due to biting insects, for accurate identification of the specific allergen.
- Have an allergic reaction (anaphylaxis) without an obvious or previously defined trigger.
- Have had anaphylaxis attributed to food, drugs or insect stings.
Source
AAAAI
Unfortunately, most people are not aware they are allergic to insect stings until after experiencing a reaction. An allergic reaction occurs when the immune system overreacts to the insect venom. When this happens, an allergic person's body produces an allergic substance called Immunoglobulin E (IgE) antibody, which reacts with the venom. This triggers the release of histamine and other chemicals that cause allergic symptoms and, in the most severe of cases, a rapid fall in blood pressure, loss of consciousness and sometimes even death.
Because a severe and sometimes fatal reaction can occur, it is important to know what common stinging insects look like. The most common stinging insects in the United States include:
- Yellow jackets - black with yellow markings, found in various climates
- Honeybees - a round, fuzzy body covered with dark brown and yellow markings
- Paper wasps - slender, elongated bodies that are black, brown or red and have yellow markings
- Hornets - black or brown with white, orange or yellow markings and are larger than yellow jackets
- Fire ants - reddish-brown ants living in large mounds, mostly in warmer climates
It is also critical for anyone with allergies to insect stings to take precautions to avoid a potentially dangerous reaction. The AAAAI recommends the following tips to avoid being stung:
- Avoid the "territory" of the stinging insect's nest. These insects are most likely to sting if their homes are disturbed.
- Remain calm, quiet and slowly move away from stinging insects. Do not swat them.
- Avoid brightly colored clothing and perfume outdoors that may attract stinging insects.
- Be careful when cooking, eating or drinking sweet beverages outdoors. Keep all food and beverages covered until consuming them.
- Avoid loose-fitting garments that can trap insects between material and the skin.
When to see an allergy specialist
If you have experienced a reaction to insect stings or you think you may be allergic, consult with an allergist/immunologist to accurately diagnose your condition. An allergist/immunologist is the best qualified medical professional trained to manage the prevention, diagnosis and treatment of allergies and asthma.
An allergist might also suggest allergy shots, also known as immunotherapy treatment. Venom immunotherapy shots take effect within just a few months. Venom immunotherapy is the closest thing to a "cure" for allergic reactions. It is shown to be 97% effective in preventing future allergic reactions. Patients should see an allergist/immunologist if they:
- Have reactions possibly due to insect stings for accurate identification of the specific allergen and consideration for immunotherapy (allergy shots).
- Have systemic reactions possibly due to biting insects, for accurate identification of the specific allergen.
- Have an allergic reaction (anaphylaxis) without an obvious or previously defined trigger.
- Have had anaphylaxis attributed to food, drugs or insect stings.
Source
AAAAI
Scientists Uncork Potential Health Benefit Of Drinking Red Wine
Scientists at Glasgow have shown how resveratrol, a powerful antioxidant found in red wine, works as an effective therapy for life-threatening inflammation.
Dr Alirio Melendez, a senior lecturer in the university's Division of Infection and Immunology, along with collaborators in Singapore, have solved a mystery which has puzzled experts since red wine was first identified as having health benefits. How does resveratrol control inflammation?
The study explains resveratrol's impact on inflammation as well as how it, or a derivative, can be used to treat potentially deadly inflammatory disease, such as appendicitis, peritonitis and systemic sepsis.
The findings have been published in the print edition of The FASEB Journal which belongs to the Federation of the American Societies for Experimental Biology.
"Strong acute inflammatory diseases such as sepsis are very difficult to treat and many die every day due to lack of treatment," said Dr Melendez, who is based at the University of Glasgow Biomedical Research Centre.
"Moreover, many survivors of sepsis develop a very low quality of life due to the damage that inflammation causes to several internal organs. The ultimate goal of our study was to identify a potential novel therapy to help in the treatment of strong acute inflammatory diseases."
The findings suggests that resveratrol may be utilised as a treatment for inflammatory diseases and may also lead to entirely new resveratrol-based drugs that are even more effective.
Resveratrol has been widely associated with health benefits ranging from anti-aging to boosting anti-viral treatments. Previous studies have found that resveratrol can help prevent blood clots and combat cancer.
"The therapeutic potential of red wine has been bottled up for thousands of years," said Gerald Weissmann, M.D. and editor-in-Chief of The FASEB Journal, "and now that scientists have uncorked its secrets, they find that studies of how resveratrol works can lead to new treatments for life-threatening inflammation."
The study follows previous work carried out by Dr Melendez published last month in the Proceedings of the National Association of Sciences of the USA (PNAS) journal.
The PNAS study showed how Dr Melendez and his team had discovered a method of reducing the impact of anaphylactic shock.
The team were the first in the world to pinpoint the molecule which amplifies the allergic reaction and to have successfully developed a biological agent to reduce the symptoms.
Source
Proceedings of the National Association of Sciences
Dr Alirio Melendez, a senior lecturer in the university's Division of Infection and Immunology, along with collaborators in Singapore, have solved a mystery which has puzzled experts since red wine was first identified as having health benefits. How does resveratrol control inflammation?
The study explains resveratrol's impact on inflammation as well as how it, or a derivative, can be used to treat potentially deadly inflammatory disease, such as appendicitis, peritonitis and systemic sepsis.
The findings have been published in the print edition of The FASEB Journal which belongs to the Federation of the American Societies for Experimental Biology.
"Strong acute inflammatory diseases such as sepsis are very difficult to treat and many die every day due to lack of treatment," said Dr Melendez, who is based at the University of Glasgow Biomedical Research Centre.
"Moreover, many survivors of sepsis develop a very low quality of life due to the damage that inflammation causes to several internal organs. The ultimate goal of our study was to identify a potential novel therapy to help in the treatment of strong acute inflammatory diseases."
The findings suggests that resveratrol may be utilised as a treatment for inflammatory diseases and may also lead to entirely new resveratrol-based drugs that are even more effective.
Resveratrol has been widely associated with health benefits ranging from anti-aging to boosting anti-viral treatments. Previous studies have found that resveratrol can help prevent blood clots and combat cancer.
"The therapeutic potential of red wine has been bottled up for thousands of years," said Gerald Weissmann, M.D. and editor-in-Chief of The FASEB Journal, "and now that scientists have uncorked its secrets, they find that studies of how resveratrol works can lead to new treatments for life-threatening inflammation."
The study follows previous work carried out by Dr Melendez published last month in the Proceedings of the National Association of Sciences of the USA (PNAS) journal.
The PNAS study showed how Dr Melendez and his team had discovered a method of reducing the impact of anaphylactic shock.
The team were the first in the world to pinpoint the molecule which amplifies the allergic reaction and to have successfully developed a biological agent to reduce the symptoms.
Source
Proceedings of the National Association of Sciences
Aug 11, 2009
What Is Chlamydia? What Causes Chlamydia?
Chlamydia, or chlamydial infection, is a sexually transmitted infection (STI) caused by Chlamydia trachomatis (C. trachomatis), a bacterium that only infects humans. Although we usually think of the sexually transmitted disease (STD), chlamydial infection refers to infection caused by any species of the Chlamydiaceae bacterial family.
Chlamydia is a common infectious cause of genital and eye diseases in humans. It is the leading bacterial STI worldwide.
USA - Approximately 2.3 million people in the USA are currently infected with Chlamydia. Less than half of the women in the U.S. who are at risk for Chlamydia are being screened for the sexually transmitted infection, according to the CDC (Centers for Disease Control and Prevention).
Recurring Chlamydial infections are prevalent in young women ages 14-19, according to a Yale Department of Epidemiology and Public Health study. Over half of the study's 411 participants were initially diagnosed with chlamydia and then, in a rate higher than previously recorded, nearly 30 percent reported repeated infection throughout the four-year Project.
UK - In the UK the number of new cases diagnosed each year has been steadily rising since the mid-1990s - it is now the most commonly diagnosed STI in the country. In 2004, 104,733 new diagnoses of Chlamydia were made - in 2005 there were 109,958 new diagnoses. According to the NHS (National Health Service), UK, women under the age of 25 who are sexually active have a 10% chance of becoming infected with C. trachomatis. The peak age range for male infection risk is 20 to 30 years.
Chlamydia is an easily treatable disease which, unfortunately, often has no early symptoms and is not treated until complications have emerged.
According to the World Health Organization (WHO) 15% of blindness cases worldwide were caused by Chlamydia conjunctivitis (trachoma) in 1995, dropping to 3.6% in 2002.
What is the difference between an STI and an STD?
A sexually transmitted infection (STI) is the infection, the entering of the bacterium, virus, or parasite into the human body (host).
When symptoms appear it is called a sexually transmitted disease (STD).
A person may have no symptoms and have an STI, while a person with an STD can't (STDs have symptoms). In short, everyone who has an STD also has an STI, but not everyone who has an STI has an STD - because not everyone has symptoms.
An STI is caused by a bacterium, virus or parasite from sexual intercourse or a sexual encounter. An STD is caused by an STI with a bacterium, virus or parasite from sexual intercourse or a sexual encounter.
What are sexually transmitted infections?
Sexually transmitted infections (STIs) are infections that spread primarily through person-to-person sexual contact. The word "primarily" is used here because sexual contact is the main or original source of infection and the main means of transmission; however, in some cases the infected person may pass the infection on without sexual contact, as might be the case when giving birth (mother infects baby), or if an infected person donates blood which is later used in a blood transfusion and infects a patient in hospital.
There are over 30 different sexually transmissible bacteria, viruses and parasites. Below is a list of the most common ones:
Common sexually transmissible bacterial infections
* Neisseria gonorrhoeae - causes gonorrhea or gonococcal infection.
* Chlamydia trachomatis - causes chlamydial infections.
* Treponema pallidum - causes syphilis.
* Haemophilus ducreyi - causes chancroid.
* Klebsiella granulomatis - previously known as Calymmatobacterium granulomatis causes granuloma inguinale or donovanosis.
Common sexually transmissible viral infections
* Human immunodeficiency virus - causes AIDS.
* Herpes simplex virus type 2 - causes genital herpes.
* Human papillomavirus - causes genital warts. 15 subtypes lead to cervical cancer.
* Hepatitis B virus - causes hepatitis and chronic cases may lead to cancer of the liver.
* Cytomegalovirus - causes inflammation in a number of organs including the brain, the eye, and the bowel.
Sexually transmissible parasitic organisms
* Trichomonas vaginalis - causes vaginal trichomoniasis, also known as "trich".
* Candida albicans - causes vulvovaginitis in women; inflammation of the glans penis and foreskin in men (balano-posthitis).
What are the symptoms of Chlamydia?
Some people refer to Chlamydia as a silent disease because there are rarely any noticeable symptoms initially. Experts say that approximately 50% of infected men and 70% of infected women will have no symptoms at all. Others will have such minor symptoms that the infection goes unnoticed.
Women
Genital Chlamydia does not usually present symptoms in women. However, there may be non-specific symptoms, including:
* Cystitis - inflammation of the bladder.
* A change in vaginal discharge.
* Slight lower abdominal pain.
Women with any of the symptoms mentioned above should visit their GP or family planning doctor. If a Chlamydia test is not offered, ask for one. If Chlamydia is not treated the following symptoms may emerge later:
* Pelvic pain.
* Pain during sexual intercourse - may be every time, or intermittently.
* Bleeding between menstrual periods.
See "Complications of Chlamydia" below for more symptoms in women.
Men - symptoms in men are usually from complications (see "Complications of Chlamydia" below).
What are the causes of Chlamydia?
Chlamydia is a sexually transmitted infection (STI). Chlamydia may be transmitted by:
* Having unprotected vaginal sex with an infected person.
* Having unprotected anal sex with an infected person.
* Having unprotected oral sex with an infected person.
* Having genital contact with an infected person.
As chlamydial infection often presents no symptoms, an infected person may pass it on to his/her sexual partner without knowing.
Childbirth - an infected mother can pass the infection on to her baby during childbirth. Sometimes the infection may lead to complications for the infant, such as pneumonia.
Chlamydia cannot be transmitted through:
* Contact with a toilet seat that has been used by an infected person.
* Sharing a sauna with infected people.
* Sharing a swimming pool with infected people.
* Touching a surface that an infected person had previously touched or coughed/sneezed on.
* Standing close to an infected person, inhaling the air after they have coughed or sneezed.
* Sharing an office with an infected colleague.
Chlamydophila pneumonia, which causes respiratory infections, including pneumonia, is different from C. trachomatis, the sexually transmitted infection. Chlamydophila pneumonia is an airborne bacterium and is not a sexually transmitted infection. This article focuses entirely on C. trachomatis.
A C. trachomatis variety causes LGV (lymphogranuloma venereum), another sexually transmitted disease which is more common in Africa, Southeast Asia, Central/South America and the Caribbean. Signs and symptoms include genital sores, fever and swollen nymph nodes in the groin area. In Europe LGV cases have increased, especially among homosexual and bisexual males. US authorities have expressed concern that LGV is slowly emerging in America too.
How is Chlamydia diagnosed?
Screening
As chlamydial infection frequently presents no symptoms health authorities in most nations recommend screening for some people. The US Centers for Disease Control and Prevention (CDC) recommends Chlamydia screening for:
* Women aged below 25 years - authorities recommend annual screening. Women under the age of 25 who are sexually active are at the highest risk of becoming infected.
* Pregnant women - Chlamydia screening should be done during the first prenatal exam. Women who have had several sexual partners should have another test before the expected delivery date.
* High risk males and females - regular screening is recommended for males and females who either do not regularly use a condom, those who have multiple sex partners, and people who have another sexually transmitted disease.
How is Chlamydia screening done?
* Women - traditionally the doctor or nurse would take a sample of the discharge from the cervix (swab). This was sent to the lab for culture or Chlamydia antigen testing. Nowadays women more commonly will do the procedure at home, either with a urine sample, or by taking a swab form the lower vagina. The swab is placed in a container and sent to a laboratory.
* Men - traditionally, a thin swab was inserted into the end of the urethra through the penis. The sample would be sent to the lab for testing. A urine test is more commonly used today. Although the urine test is not as reliable as using a swab, it is easier to do and painless. Scientists at the University of Cambridge, England, devised a new urine test can detect 84% of infections.
Sometimes a swab of the anus may be done.
Most countries have clinics that specialize in genito-urinary medicine (GUM). In the UK they are known as STI clinics or GUM clinics. UK GUM clinics have dedicated testing facilities, and often help people in contacting previous sexual partners so that they may also be tested and have treatment. Most GP practices also provide STI testing and advice.
What are the treatment options for Chlamydia?
Antibiotics are at least 95% effective in treating Chlamydia if the patient adheres to the doctor's instructions. In most cases they will be pills that the patient swallows. Treatment may consist of:
* Azithromycin (brand names APO-Azithromycin in Canada; Zithromax in Finland, Italy, UK, USA, Australia, Portugal, S. Africa, Canada, Thailand and Belgium; Zithromac in Japan; Vinzam / Zitromax in Spain; Zmax/Sumamed in Croatia; ATM, Aztrin, Zitrocin, Azibiot, Azifine, AziCip, Azi Sandoz, Aziswift in India, Azocam and Bactizith in Pakistan) - the patient receives just one dose.
* Doxycycline (brand names may be Vibramycin, Monodox, Microdox, Periostat, Vibra-Tabs, Oracea, Doryx, Vibrox, Adoxa, Doxyhexal, Doxylin, and Atridox) - the patient takes one or two tablets daily for one or two weeks. It is important that the course is completed if you don't want the infection to return.
Some patients, such as pregnant women, may be given alternative antibiotics. Doxycycline or tetracycline may affect the development of the baby's bones and teeth.
The following antibiotics may also be used: amoxicillin, ampicillin, clarithromycin, lymecycline, minocycline, ofloxacin, pivampicillin, erythromycin and rifampicin.
People taking the contraceptive pill or contraceptive patch will need to use additional contraception, such as condoms, because the antibiotics may interfere with their effectiveness. Ask your doctor how long you have to do this for.
Some patients may have the following side effects when they take the antibiotics:
* Diarrhea
* Stomach pain
* Stomach upset
* Nausea
In most cases the side effects will be mild. Patients taking doxycycline may have a skin rash if they are exposed to sunlight.
What are the complications of Chlamydia?
Early diagnosis and treatment greatly reduces the risk of complications. Complications can be prevented with regular screening, or by seeking medical attention as soon as symptoms appear.
Women - Chlamydia complications
* Pelvic Inflammatory Disease (PID) - Pelvic inflammatory disease is commonly caused by chlamydial infections. PID is an infection of the ovaries, fallopian tubes and uterus. PID significantly raises the risk of ectopic pregnancy - the fertilized egg does not settle and grow in the uterus; in most cases it will grow in the fallopian tubes, but may also grow in the ovary, cervix, or abdominal cavity. PID may also cause persistent pelvic pain.
* Cervicitis - inflammation of the cervix (neck of the womb). Symptoms may include a vaginal discharge which may contain pus, pain during intercourse, frequent urination, burning pain when urinating. In chronic cervicitis the cervix may swell and cysts may develop. The cysts may become infected. Some patients experience backache, deep pelvic pain, and constant vaginal discharge.
* Salpingitis - inflammation of the fallopian tubes. If the fallopian tubes become blocked the egg will not be able to pass along or enter the fallopian tube. There is a significant increase of ectopic pregnancy. Microsurgery is sometimes performed to clear the blockage.
* Bartholinitis - inflammation of the Bartholin gland, which produces the lubricating mucus to make sexual intercourse easier. The gland is located in either side of the vaginal opening. Chlamydial infection may cause it to become blocked and infected, leading to a Bartholin cyst. The cyst may develop into an abscess.
Men - Chlamydia complications
* Fertility - Spanish researchers found that Chlamydia can affect the quality of male sperm.
* Urethritis - the urethra, a tube which carries urine from the bladder to the end of the penis, becomes inflamed. Symptoms include a discharge with yellow pus, mucus with pus, or just clear mucus at the opening (the hole at the end of the penis where urine comes out). Untreated urethritis can lead to urethral stricture - the urethra narrows which makes it harder to urinate properly, creating pressure which may damage the kidneys.
* Epididymitis - Inflammation of the epididymis, a structure inside the scrotum (sack that holds the testicles) attached to the backside of the testis (testicles). Signs and symptoms include red, swollen and warm scrotum, testicle pain and tenderness which is usually on one side, painful urination, frequent urination, painful ejaculation, painful intercourse before ejaculation, lump in testicle, swollen inguinal nodes (lymph nodes in the groin), discharge from penis, and blood in the semen.
* Reiter syndrome - a chronic type of inflammatory arthritis. This can include just arthritis, conjunctivitis (inflammation of the eyes), and inflammation of the genital, urinary and gastrointestinal systems. The body's organs as well as the joints can become affected. Serious inflammation can affect the eyes, kidneys, heart, skin, lungs and mouth.
Prevention of Chlamydia
* Condoms - condoms significantly reduce the risk of becoming infected.
* Oral sex - the risk of infection is much higher if either sex partner does not know whether he/she is infected, or if the non-infected partner engages in oral sex without knowing whether the other person is infected.
* New sexual partner - if you have a new sexual partner and you can both be tested before sexual intercourse, your risk of infection is almost completely eliminated.
* Regular screening - regular screening for people in high risk groups reduces the risk of transmitting the infection or becoming infected.
* Avoid douching - douching lowers the number of "good bacteria" in the vagina, which raises the risk of infection - not just chlamydial infection but many other types of infection. Douching means using water or a medicated solution to clean the vagina. ACOG (American College of Obstetricians and Gynecologists) recommends against douching.
* Tell people - we can all help reduce the incidence of Chlamydia by telling people about Chlamydia, risks of infection, risk factors, the benefits of regular screening, using condoms, etc. Sexually transmitted infections are more common where ignorance is higher. Ignorance means not knowing enough about a disease, its risk factors, treatment, possible complications, and effective prevention measures.
Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Chlamydia is a common infectious cause of genital and eye diseases in humans. It is the leading bacterial STI worldwide.
USA - Approximately 2.3 million people in the USA are currently infected with Chlamydia. Less than half of the women in the U.S. who are at risk for Chlamydia are being screened for the sexually transmitted infection, according to the CDC (Centers for Disease Control and Prevention).
Recurring Chlamydial infections are prevalent in young women ages 14-19, according to a Yale Department of Epidemiology and Public Health study. Over half of the study's 411 participants were initially diagnosed with chlamydia and then, in a rate higher than previously recorded, nearly 30 percent reported repeated infection throughout the four-year Project.
UK - In the UK the number of new cases diagnosed each year has been steadily rising since the mid-1990s - it is now the most commonly diagnosed STI in the country. In 2004, 104,733 new diagnoses of Chlamydia were made - in 2005 there were 109,958 new diagnoses. According to the NHS (National Health Service), UK, women under the age of 25 who are sexually active have a 10% chance of becoming infected with C. trachomatis. The peak age range for male infection risk is 20 to 30 years.
Chlamydia is an easily treatable disease which, unfortunately, often has no early symptoms and is not treated until complications have emerged.
According to the World Health Organization (WHO) 15% of blindness cases worldwide were caused by Chlamydia conjunctivitis (trachoma) in 1995, dropping to 3.6% in 2002.
What is the difference between an STI and an STD?
A sexually transmitted infection (STI) is the infection, the entering of the bacterium, virus, or parasite into the human body (host).
When symptoms appear it is called a sexually transmitted disease (STD).
A person may have no symptoms and have an STI, while a person with an STD can't (STDs have symptoms). In short, everyone who has an STD also has an STI, but not everyone who has an STI has an STD - because not everyone has symptoms.
An STI is caused by a bacterium, virus or parasite from sexual intercourse or a sexual encounter. An STD is caused by an STI with a bacterium, virus or parasite from sexual intercourse or a sexual encounter.
What are sexually transmitted infections?
Sexually transmitted infections (STIs) are infections that spread primarily through person-to-person sexual contact. The word "primarily" is used here because sexual contact is the main or original source of infection and the main means of transmission; however, in some cases the infected person may pass the infection on without sexual contact, as might be the case when giving birth (mother infects baby), or if an infected person donates blood which is later used in a blood transfusion and infects a patient in hospital.
There are over 30 different sexually transmissible bacteria, viruses and parasites. Below is a list of the most common ones:
Common sexually transmissible bacterial infections
* Neisseria gonorrhoeae - causes gonorrhea or gonococcal infection.
* Chlamydia trachomatis - causes chlamydial infections.
* Treponema pallidum - causes syphilis.
* Haemophilus ducreyi - causes chancroid.
* Klebsiella granulomatis - previously known as Calymmatobacterium granulomatis causes granuloma inguinale or donovanosis.
Common sexually transmissible viral infections
* Human immunodeficiency virus - causes AIDS.
* Herpes simplex virus type 2 - causes genital herpes.
* Human papillomavirus - causes genital warts. 15 subtypes lead to cervical cancer.
* Hepatitis B virus - causes hepatitis and chronic cases may lead to cancer of the liver.
* Cytomegalovirus - causes inflammation in a number of organs including the brain, the eye, and the bowel.
Sexually transmissible parasitic organisms
* Trichomonas vaginalis - causes vaginal trichomoniasis, also known as "trich".
* Candida albicans - causes vulvovaginitis in women; inflammation of the glans penis and foreskin in men (balano-posthitis).
What are the symptoms of Chlamydia?
Some people refer to Chlamydia as a silent disease because there are rarely any noticeable symptoms initially. Experts say that approximately 50% of infected men and 70% of infected women will have no symptoms at all. Others will have such minor symptoms that the infection goes unnoticed.
Women
Genital Chlamydia does not usually present symptoms in women. However, there may be non-specific symptoms, including:
* Cystitis - inflammation of the bladder.
* A change in vaginal discharge.
* Slight lower abdominal pain.
Women with any of the symptoms mentioned above should visit their GP or family planning doctor. If a Chlamydia test is not offered, ask for one. If Chlamydia is not treated the following symptoms may emerge later:
* Pelvic pain.
* Pain during sexual intercourse - may be every time, or intermittently.
* Bleeding between menstrual periods.
See "Complications of Chlamydia" below for more symptoms in women.
Men - symptoms in men are usually from complications (see "Complications of Chlamydia" below).
What are the causes of Chlamydia?
Chlamydia is a sexually transmitted infection (STI). Chlamydia may be transmitted by:
* Having unprotected vaginal sex with an infected person.
* Having unprotected anal sex with an infected person.
* Having unprotected oral sex with an infected person.
* Having genital contact with an infected person.
As chlamydial infection often presents no symptoms, an infected person may pass it on to his/her sexual partner without knowing.
Childbirth - an infected mother can pass the infection on to her baby during childbirth. Sometimes the infection may lead to complications for the infant, such as pneumonia.
Chlamydia cannot be transmitted through:
* Contact with a toilet seat that has been used by an infected person.
* Sharing a sauna with infected people.
* Sharing a swimming pool with infected people.
* Touching a surface that an infected person had previously touched or coughed/sneezed on.
* Standing close to an infected person, inhaling the air after they have coughed or sneezed.
* Sharing an office with an infected colleague.
Chlamydophila pneumonia, which causes respiratory infections, including pneumonia, is different from C. trachomatis, the sexually transmitted infection. Chlamydophila pneumonia is an airborne bacterium and is not a sexually transmitted infection. This article focuses entirely on C. trachomatis.
A C. trachomatis variety causes LGV (lymphogranuloma venereum), another sexually transmitted disease which is more common in Africa, Southeast Asia, Central/South America and the Caribbean. Signs and symptoms include genital sores, fever and swollen nymph nodes in the groin area. In Europe LGV cases have increased, especially among homosexual and bisexual males. US authorities have expressed concern that LGV is slowly emerging in America too.
How is Chlamydia diagnosed?
Screening
As chlamydial infection frequently presents no symptoms health authorities in most nations recommend screening for some people. The US Centers for Disease Control and Prevention (CDC) recommends Chlamydia screening for:
* Women aged below 25 years - authorities recommend annual screening. Women under the age of 25 who are sexually active are at the highest risk of becoming infected.
* Pregnant women - Chlamydia screening should be done during the first prenatal exam. Women who have had several sexual partners should have another test before the expected delivery date.
* High risk males and females - regular screening is recommended for males and females who either do not regularly use a condom, those who have multiple sex partners, and people who have another sexually transmitted disease.
How is Chlamydia screening done?
* Women - traditionally the doctor or nurse would take a sample of the discharge from the cervix (swab). This was sent to the lab for culture or Chlamydia antigen testing. Nowadays women more commonly will do the procedure at home, either with a urine sample, or by taking a swab form the lower vagina. The swab is placed in a container and sent to a laboratory.
* Men - traditionally, a thin swab was inserted into the end of the urethra through the penis. The sample would be sent to the lab for testing. A urine test is more commonly used today. Although the urine test is not as reliable as using a swab, it is easier to do and painless. Scientists at the University of Cambridge, England, devised a new urine test can detect 84% of infections.
Sometimes a swab of the anus may be done.
Most countries have clinics that specialize in genito-urinary medicine (GUM). In the UK they are known as STI clinics or GUM clinics. UK GUM clinics have dedicated testing facilities, and often help people in contacting previous sexual partners so that they may also be tested and have treatment. Most GP practices also provide STI testing and advice.
What are the treatment options for Chlamydia?
Antibiotics are at least 95% effective in treating Chlamydia if the patient adheres to the doctor's instructions. In most cases they will be pills that the patient swallows. Treatment may consist of:
* Azithromycin (brand names APO-Azithromycin in Canada; Zithromax in Finland, Italy, UK, USA, Australia, Portugal, S. Africa, Canada, Thailand and Belgium; Zithromac in Japan; Vinzam / Zitromax in Spain; Zmax/Sumamed in Croatia; ATM, Aztrin, Zitrocin, Azibiot, Azifine, AziCip, Azi Sandoz, Aziswift in India, Azocam and Bactizith in Pakistan) - the patient receives just one dose.
* Doxycycline (brand names may be Vibramycin, Monodox, Microdox, Periostat, Vibra-Tabs, Oracea, Doryx, Vibrox, Adoxa, Doxyhexal, Doxylin, and Atridox) - the patient takes one or two tablets daily for one or two weeks. It is important that the course is completed if you don't want the infection to return.
Some patients, such as pregnant women, may be given alternative antibiotics. Doxycycline or tetracycline may affect the development of the baby's bones and teeth.
The following antibiotics may also be used: amoxicillin, ampicillin, clarithromycin, lymecycline, minocycline, ofloxacin, pivampicillin, erythromycin and rifampicin.
People taking the contraceptive pill or contraceptive patch will need to use additional contraception, such as condoms, because the antibiotics may interfere with their effectiveness. Ask your doctor how long you have to do this for.
Some patients may have the following side effects when they take the antibiotics:
* Diarrhea
* Stomach pain
* Stomach upset
* Nausea
In most cases the side effects will be mild. Patients taking doxycycline may have a skin rash if they are exposed to sunlight.
What are the complications of Chlamydia?
Early diagnosis and treatment greatly reduces the risk of complications. Complications can be prevented with regular screening, or by seeking medical attention as soon as symptoms appear.
Women - Chlamydia complications
* Pelvic Inflammatory Disease (PID) - Pelvic inflammatory disease is commonly caused by chlamydial infections. PID is an infection of the ovaries, fallopian tubes and uterus. PID significantly raises the risk of ectopic pregnancy - the fertilized egg does not settle and grow in the uterus; in most cases it will grow in the fallopian tubes, but may also grow in the ovary, cervix, or abdominal cavity. PID may also cause persistent pelvic pain.
* Cervicitis - inflammation of the cervix (neck of the womb). Symptoms may include a vaginal discharge which may contain pus, pain during intercourse, frequent urination, burning pain when urinating. In chronic cervicitis the cervix may swell and cysts may develop. The cysts may become infected. Some patients experience backache, deep pelvic pain, and constant vaginal discharge.
* Salpingitis - inflammation of the fallopian tubes. If the fallopian tubes become blocked the egg will not be able to pass along or enter the fallopian tube. There is a significant increase of ectopic pregnancy. Microsurgery is sometimes performed to clear the blockage.
* Bartholinitis - inflammation of the Bartholin gland, which produces the lubricating mucus to make sexual intercourse easier. The gland is located in either side of the vaginal opening. Chlamydial infection may cause it to become blocked and infected, leading to a Bartholin cyst. The cyst may develop into an abscess.
Men - Chlamydia complications
* Fertility - Spanish researchers found that Chlamydia can affect the quality of male sperm.
* Urethritis - the urethra, a tube which carries urine from the bladder to the end of the penis, becomes inflamed. Symptoms include a discharge with yellow pus, mucus with pus, or just clear mucus at the opening (the hole at the end of the penis where urine comes out). Untreated urethritis can lead to urethral stricture - the urethra narrows which makes it harder to urinate properly, creating pressure which may damage the kidneys.
* Epididymitis - Inflammation of the epididymis, a structure inside the scrotum (sack that holds the testicles) attached to the backside of the testis (testicles). Signs and symptoms include red, swollen and warm scrotum, testicle pain and tenderness which is usually on one side, painful urination, frequent urination, painful ejaculation, painful intercourse before ejaculation, lump in testicle, swollen inguinal nodes (lymph nodes in the groin), discharge from penis, and blood in the semen.
* Reiter syndrome - a chronic type of inflammatory arthritis. This can include just arthritis, conjunctivitis (inflammation of the eyes), and inflammation of the genital, urinary and gastrointestinal systems. The body's organs as well as the joints can become affected. Serious inflammation can affect the eyes, kidneys, heart, skin, lungs and mouth.
Prevention of Chlamydia
* Condoms - condoms significantly reduce the risk of becoming infected.
* Oral sex - the risk of infection is much higher if either sex partner does not know whether he/she is infected, or if the non-infected partner engages in oral sex without knowing whether the other person is infected.
* New sexual partner - if you have a new sexual partner and you can both be tested before sexual intercourse, your risk of infection is almost completely eliminated.
* Regular screening - regular screening for people in high risk groups reduces the risk of transmitting the infection or becoming infected.
* Avoid douching - douching lowers the number of "good bacteria" in the vagina, which raises the risk of infection - not just chlamydial infection but many other types of infection. Douching means using water or a medicated solution to clean the vagina. ACOG (American College of Obstetricians and Gynecologists) recommends against douching.
* Tell people - we can all help reduce the incidence of Chlamydia by telling people about Chlamydia, risks of infection, risk factors, the benefits of regular screening, using condoms, etc. Sexually transmitted infections are more common where ignorance is higher. Ignorance means not knowing enough about a disease, its risk factors, treatment, possible complications, and effective prevention measures.
Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
President Clinton, Pfizer, And Mylan Announce New Agreements To Lower Prices Of Medicines For Patients With Drug-Resistant HIV In Developing Countries
President Bill Clinton announced two important and complementary agreements today to enable better, more affordable treatments for patients on second-line antiretroviral (ARV) therapy for HIV/AIDS in the developing world. For the first time, a second-line regimen of four ARVs will be available for under $500 annually. Additionally, the cost of a key drug for treating tuberculosis (TB) in patients using second-line ARVs has been reduced by 60 percent, to $1 per dose.
"Thanks to the work of my Foundation's HIV/AIDS Initiative, 2 million people living with HIV/AIDS are now able to access lifesaving treatment," President Clinton said. "But their continued survival depends on uninterrupted access to medicines and quality and affordable health care throughout their entire life. Today's announcement will help ensure we can sustain treatment over a lifetime and better treat patients with both HIV and TB, two key steps in turning the tide of the global HIV/AIDS pandemic."
Addressing the need for more affordable second-line ARVs, Mylan and Matrix, a Mylan company, are making available all four drugs - atazanavir (ATV), ritonavir (RTV), tenofovir (TDF), and lamivudine (3TC) - needed to enable once-daily treatment of patients who have developed resistance to standard first-line ARVs. The four drugs will be available in three pills, with tenofovir and lamivudine combined into a single pill. The three pills are being made available today as separate products, with a total price of less than $475 annually. Matrix also will sell the pills together in one package - a "second-line-in-a-box" - at $425 annually starting in 2010. These new products and prices will be available to governments that are members of the Clinton Foundation's Procurement Consortium across Africa, Asia, Latin America, and the Caribbean. TDF+3TC is FDA approved, and ATV and RTV are pending approval by the World Health Organization (WHO).
Mylan Chairman and Chief Executive Officer Robert J. Coury said, "Ensuring sustainable access to effective treatments in the developing world is a critical element in the global fight against HIV/AIDS. Mylan and Matrix are proud to continue our commitment of creating and introducing innovative and affordable pharmaceutical solutions. This includes our 'second-line-in-a-box,' which will reduce patient pill burden and facilitate patient compliance. Our affordable, heat-stable version of ritonavir also represents another advance in the development of products that can withstand environmental conditions in parts of the world where treatment is desperately needed."
Citing the importance of integrating HIV/AIDS and tuberculosis treatment, President Clinton also announced an agreement with Pfizer to reduce the price and expand the availability of rifabutin, a drug used to treat tuberculosis in patients taking second-line ARVs. This marks CHAI's first pricing agreement with a research-based pharmaceutical company, as well as its first pricing agreement on tuberculosis. Pfizer will sell the product at $1 per 150 mg dose, or $90 for a full course of treatment over six months. This price will be available throughout developing markets in Africa, Asia, Eastern Europe, Latin America, the Middle East, and the Caribbean. Tuberculosis is the leading cause of death among HIV-positive patients. The WHO reports that over one-third of all individuals living with HIV also are infected with tuberculosis, resulting in over 450,000 deaths in 2007.
Jeffrey B. Kindler, Chairman and CEO of Pfizer stated that, "Pfizer is pursuing numerous global health projects like this one with the Clinton HIV/AIDS Initiative to find new ways to connect people to the medicines they need. "We are working on innovative solutions to bring health care to customers who have often been neglected in the past and do this in a socially responsible, sustainable, and commercially viable way."
"Second-line-in-a-box"
The new Matrix product announced today will create a more convenient second-line ARV treatment option. Patients will take three pills once a day instead of five or more pills twice a day (i.e. at least three in the morning and at least two in the evening) as required by alternative regimens. Additionally, the products will include the first ever heat-stable version of ritonavir, which does not require continuous refrigeration for its transport and distribution.
Noting advantages in convenience and affordability, WHO has identified the development of a second-line ARV therapy including atazanavir and ritonavir as a top priority. However, until now, this regimen has been largely unavailable since the existing ritonavir formulation required continuous refrigeration, a major challenge for developing countries with limited infrastructure. Countries have begun to adopt this regimen in national treatment guidelines in anticipation of improved product features and pricing, and the Clinton Foundation expects many more to follow suit to take advantage of the agreements announced today.
If fully adopted, the new products and prices would enable cumulative cost savings of $400 million over the next 5 years, when compared with recent prices paid for alternative regimens. Although only 3 percent of total patients on treatment in low-income and sub-Saharan African countries are taking second-line ARVs today, these patients account for nearly 20 percent of total ARV expenditures because of the high cost of second-line drugs compared to first-line drugs. These percentages will grow steadily in the coming years as increasing numbers of HIV/AIDS patients experience first-line treatment failure. There were between 200,000 and 250,000 second-line patients across the developing world at the end of 2008. This number is expected to double over the next three years.
UNITAID helped to make the second-line ARV price reductions announced today possible through its Second-Line Project, implemented by CHAI in partnership with UNITAID. UNITAID funding for this project has created a reliable market for key second-line medicines by increasing and aggregating demand across 25 beneficiary countries. Predictability of demand encourages suppliers to pursue accelerated R&D on new products and enables them to offer lower prices by achieving economies of scale and reducing production risks.
Treating tuberculosis co-infection in second-line HIV/AIDS patients
The agreement with Pfizer enables a more effective and affordable treatment option for second-line ARV patients who also require treatment for tuberculosis. The treatment of HIV-tuberculosis co-infection is complicated by an undesirable interaction between standard tuberculosis medicines and protease inhibitors - the class of ARVs that represent the backbone of second-line treatment. To counteract this effect, clinicians often adjust a patient's ARV therapy to increase the normal dose of certain drugs, producing higher levels of toxicity, worse treatment outcomes, and significantly higher costs. Pfizer's rifabutin does not interfere with protease inhibitors, allowing patients to take ARVs at normal doses.
WHO highlighted the importance of rifabutin by adding it to the Essential Medicines List (EML) in March 2009. The announcement with Pfizer today makes it more affordable to treat TB and HIV simultaneously among patients on second-line ARV therapy, cutting total drug costs by nearly $200 (or 33 percent) over a full six-month course of TB treatment when compared to the most-preferred current treatment option.
Ongoing efforts to ensure the quality and affordability of treatment
The financial support of UNITAID, the United Kingdom Department for International Development, and the Bill & Melinda Gates Foundation has enabled the Clinton Foundation to pursue this work. The two agreements announced today represent only the latest steps that the Clinton Foundation and its partners have taken to ensure that the highest quality treatments are available at the most affordable prices.
These agreements reflect CHAI's commitment to ensuring the availability of high-quality drugs. Pfizer's rifabutin is approved by the United States Food and Drug Administration (U.S. FDA). Pfizer also is preparing to file with the WHO Prequalification Programme. Matrix has received U.S. FDA approval for its tenofovir/lamivudine combination pill. Matrix has filed dossiers for atazanavir and heat-stable ritonavir with the WHO Prequalification Program and WHO Expert Review Panel (ERP); dossier submissions include data establishing bioequivalence to the reference drugs. Once approved by the WHO ERP, WHO Prequalification Program, or U.S. FDA, products can be purchased by governments using funds from the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
About the Clinton HIV/AIDS Initiative
Since 2002, the Clinton HIV/AIDS Initiative (CHAI), a project of the William J. Clinton Foundation, has assisted countries in implementing large-scale, integrated care, treatment, and prevention programs. CHAI works side-by-side with more than 20 countries in Africa, Asia, Eastern Europe, and Latin America and the Caribbean to build systems that will deliver HIV/AIDS treatment and health care by providing governments with technical assistance, leveraging human and financial resources, and facilitating the sharing of best practices across nationwide projects. CHAI also brokers agreements to lower prices of essential medicines and diagnostics, which are now accessible to more than 70 countries, representing more than 90 percent of people living with HIV/AIDS in the developing world. Today, 2 million people are receiving lifesaving treatments purchased under CHAI negotiated agreements. Learn more at www.clintonfoundation.org.
Source
Mylan and Pfizer
"Thanks to the work of my Foundation's HIV/AIDS Initiative, 2 million people living with HIV/AIDS are now able to access lifesaving treatment," President Clinton said. "But their continued survival depends on uninterrupted access to medicines and quality and affordable health care throughout their entire life. Today's announcement will help ensure we can sustain treatment over a lifetime and better treat patients with both HIV and TB, two key steps in turning the tide of the global HIV/AIDS pandemic."
Addressing the need for more affordable second-line ARVs, Mylan and Matrix, a Mylan company, are making available all four drugs - atazanavir (ATV), ritonavir (RTV), tenofovir (TDF), and lamivudine (3TC) - needed to enable once-daily treatment of patients who have developed resistance to standard first-line ARVs. The four drugs will be available in three pills, with tenofovir and lamivudine combined into a single pill. The three pills are being made available today as separate products, with a total price of less than $475 annually. Matrix also will sell the pills together in one package - a "second-line-in-a-box" - at $425 annually starting in 2010. These new products and prices will be available to governments that are members of the Clinton Foundation's Procurement Consortium across Africa, Asia, Latin America, and the Caribbean. TDF+3TC is FDA approved, and ATV and RTV are pending approval by the World Health Organization (WHO).
Mylan Chairman and Chief Executive Officer Robert J. Coury said, "Ensuring sustainable access to effective treatments in the developing world is a critical element in the global fight against HIV/AIDS. Mylan and Matrix are proud to continue our commitment of creating and introducing innovative and affordable pharmaceutical solutions. This includes our 'second-line-in-a-box,' which will reduce patient pill burden and facilitate patient compliance. Our affordable, heat-stable version of ritonavir also represents another advance in the development of products that can withstand environmental conditions in parts of the world where treatment is desperately needed."
Citing the importance of integrating HIV/AIDS and tuberculosis treatment, President Clinton also announced an agreement with Pfizer to reduce the price and expand the availability of rifabutin, a drug used to treat tuberculosis in patients taking second-line ARVs. This marks CHAI's first pricing agreement with a research-based pharmaceutical company, as well as its first pricing agreement on tuberculosis. Pfizer will sell the product at $1 per 150 mg dose, or $90 for a full course of treatment over six months. This price will be available throughout developing markets in Africa, Asia, Eastern Europe, Latin America, the Middle East, and the Caribbean. Tuberculosis is the leading cause of death among HIV-positive patients. The WHO reports that over one-third of all individuals living with HIV also are infected with tuberculosis, resulting in over 450,000 deaths in 2007.
Jeffrey B. Kindler, Chairman and CEO of Pfizer stated that, "Pfizer is pursuing numerous global health projects like this one with the Clinton HIV/AIDS Initiative to find new ways to connect people to the medicines they need. "We are working on innovative solutions to bring health care to customers who have often been neglected in the past and do this in a socially responsible, sustainable, and commercially viable way."
"Second-line-in-a-box"
The new Matrix product announced today will create a more convenient second-line ARV treatment option. Patients will take three pills once a day instead of five or more pills twice a day (i.e. at least three in the morning and at least two in the evening) as required by alternative regimens. Additionally, the products will include the first ever heat-stable version of ritonavir, which does not require continuous refrigeration for its transport and distribution.
Noting advantages in convenience and affordability, WHO has identified the development of a second-line ARV therapy including atazanavir and ritonavir as a top priority. However, until now, this regimen has been largely unavailable since the existing ritonavir formulation required continuous refrigeration, a major challenge for developing countries with limited infrastructure. Countries have begun to adopt this regimen in national treatment guidelines in anticipation of improved product features and pricing, and the Clinton Foundation expects many more to follow suit to take advantage of the agreements announced today.
If fully adopted, the new products and prices would enable cumulative cost savings of $400 million over the next 5 years, when compared with recent prices paid for alternative regimens. Although only 3 percent of total patients on treatment in low-income and sub-Saharan African countries are taking second-line ARVs today, these patients account for nearly 20 percent of total ARV expenditures because of the high cost of second-line drugs compared to first-line drugs. These percentages will grow steadily in the coming years as increasing numbers of HIV/AIDS patients experience first-line treatment failure. There were between 200,000 and 250,000 second-line patients across the developing world at the end of 2008. This number is expected to double over the next three years.
UNITAID helped to make the second-line ARV price reductions announced today possible through its Second-Line Project, implemented by CHAI in partnership with UNITAID. UNITAID funding for this project has created a reliable market for key second-line medicines by increasing and aggregating demand across 25 beneficiary countries. Predictability of demand encourages suppliers to pursue accelerated R&D on new products and enables them to offer lower prices by achieving economies of scale and reducing production risks.
Treating tuberculosis co-infection in second-line HIV/AIDS patients
The agreement with Pfizer enables a more effective and affordable treatment option for second-line ARV patients who also require treatment for tuberculosis. The treatment of HIV-tuberculosis co-infection is complicated by an undesirable interaction between standard tuberculosis medicines and protease inhibitors - the class of ARVs that represent the backbone of second-line treatment. To counteract this effect, clinicians often adjust a patient's ARV therapy to increase the normal dose of certain drugs, producing higher levels of toxicity, worse treatment outcomes, and significantly higher costs. Pfizer's rifabutin does not interfere with protease inhibitors, allowing patients to take ARVs at normal doses.
WHO highlighted the importance of rifabutin by adding it to the Essential Medicines List (EML) in March 2009. The announcement with Pfizer today makes it more affordable to treat TB and HIV simultaneously among patients on second-line ARV therapy, cutting total drug costs by nearly $200 (or 33 percent) over a full six-month course of TB treatment when compared to the most-preferred current treatment option.
Ongoing efforts to ensure the quality and affordability of treatment
The financial support of UNITAID, the United Kingdom Department for International Development, and the Bill & Melinda Gates Foundation has enabled the Clinton Foundation to pursue this work. The two agreements announced today represent only the latest steps that the Clinton Foundation and its partners have taken to ensure that the highest quality treatments are available at the most affordable prices.
These agreements reflect CHAI's commitment to ensuring the availability of high-quality drugs. Pfizer's rifabutin is approved by the United States Food and Drug Administration (U.S. FDA). Pfizer also is preparing to file with the WHO Prequalification Programme. Matrix has received U.S. FDA approval for its tenofovir/lamivudine combination pill. Matrix has filed dossiers for atazanavir and heat-stable ritonavir with the WHO Prequalification Program and WHO Expert Review Panel (ERP); dossier submissions include data establishing bioequivalence to the reference drugs. Once approved by the WHO ERP, WHO Prequalification Program, or U.S. FDA, products can be purchased by governments using funds from the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
About the Clinton HIV/AIDS Initiative
Since 2002, the Clinton HIV/AIDS Initiative (CHAI), a project of the William J. Clinton Foundation, has assisted countries in implementing large-scale, integrated care, treatment, and prevention programs. CHAI works side-by-side with more than 20 countries in Africa, Asia, Eastern Europe, and Latin America and the Caribbean to build systems that will deliver HIV/AIDS treatment and health care by providing governments with technical assistance, leveraging human and financial resources, and facilitating the sharing of best practices across nationwide projects. CHAI also brokers agreements to lower prices of essential medicines and diagnostics, which are now accessible to more than 70 countries, representing more than 90 percent of people living with HIV/AIDS in the developing world. Today, 2 million people are receiving lifesaving treatments purchased under CHAI negotiated agreements. Learn more at www.clintonfoundation.org.
Source
Mylan and Pfizer
Cancer Cells Are Protected By Our Own Immune System
During the very first few days of development of a cancer, our immune system recognizes cancer cells not as abnormal cells requiring eradication but as cells of the body that need to be protected. This result was obtained by the team led by David Klatzmann at the Laboratoire « Immunologie - Immunopathologies - Immunothérapies » (UPMC / CNRS / INSERM). It could enable major advances in the treatment of cancer. This work was published in the Journal of Clinical Investigation on August 3, 2009.
Since the beginning of the 20th century, scientists have postulated the existence of the "immunosurveillance" of cancer, by which the immune system recognizes cancer cells(1) as being abnormal as soon as they are produced by the body, and then eradicates them. It is only when these cells escape from the immune response that a cancer develops. However, the team led by David Klatzmann, Professor at UPMC, has just revealed that this concept is inexact: the "immunosurveillance" of cancers does exist, but in fact it protects tumor cells when they appear, in the same way as any other normal cells in the body.
When an immune response is induced by the body, two types of lymphocytes (specialized immune system cells) are particularly closely involved: regulatory T-cells and effector T-cells. The former recognize components arising from the body itself and protect tissues from attack using the immune system. By contrast, effector T-cells specifically recognize foreign components and their function is to destroy them.
Most studies focused on interactions between cancer cells and the immune system are performed once cancer development is already well-advanced, when the tumor mass is already organized and detectable. The researchers in the Laboratoire « Immunologie - Immunopathologies - Immunothérapies » (UPMC / CNRS / INSERM) focused on these interactions, but during the very first few days after the appearance of tumor cells. Using animal models, they showed that appearance of the very first cancer cells triggered an immediate response by regulatory T-cells which migrated rapidly towards the tumor(2). They recognized molecules on the cancer cells that were also expressed by normal tissues in the body. These regulatory T-cells then blocked the action of effector T-cells, thus preventing them from attacking and destroying the cancer cells. Activated at all times in order to protect healthy tissues, regulatory T-cells are mobilized much more rapidly and strongly than effector T-cells, which are resting before the tumor appears. The scientists also showed that if regulatory T-cells were absent from this first encounter between the immune system and tumor cells, effector responses of the immune system indeed developed and enabled eradication of the tumor.
Regulatory T-cells are thus the first to recognize a tumor and facilitate its development by preventing its eradication by effector T-cells. This suggests that the control of regulatory T-cells should be an essential component in the development of future therapies for cancer. This discovery also opens the way to other therapeutic opportunities, such as preventive anti-tumor vaccination.
(1) A cancer (or tumor) cell is a normal cell in the body that has undergone changes, such as uncontrolled proliferation, the invasion of adjacent tissues, the colonization of distal organs, or genetic instability, etc.
(2) Generically speaking, the term "tumor" designates an abnormal proliferation of cells. When malignant, this takes the name "cancer".
Source: CNRS
Since the beginning of the 20th century, scientists have postulated the existence of the "immunosurveillance" of cancer, by which the immune system recognizes cancer cells(1) as being abnormal as soon as they are produced by the body, and then eradicates them. It is only when these cells escape from the immune response that a cancer develops. However, the team led by David Klatzmann, Professor at UPMC, has just revealed that this concept is inexact: the "immunosurveillance" of cancers does exist, but in fact it protects tumor cells when they appear, in the same way as any other normal cells in the body.
When an immune response is induced by the body, two types of lymphocytes (specialized immune system cells) are particularly closely involved: regulatory T-cells and effector T-cells. The former recognize components arising from the body itself and protect tissues from attack using the immune system. By contrast, effector T-cells specifically recognize foreign components and their function is to destroy them.
Most studies focused on interactions between cancer cells and the immune system are performed once cancer development is already well-advanced, when the tumor mass is already organized and detectable. The researchers in the Laboratoire « Immunologie - Immunopathologies - Immunothérapies » (UPMC / CNRS / INSERM) focused on these interactions, but during the very first few days after the appearance of tumor cells. Using animal models, they showed that appearance of the very first cancer cells triggered an immediate response by regulatory T-cells which migrated rapidly towards the tumor(2). They recognized molecules on the cancer cells that were also expressed by normal tissues in the body. These regulatory T-cells then blocked the action of effector T-cells, thus preventing them from attacking and destroying the cancer cells. Activated at all times in order to protect healthy tissues, regulatory T-cells are mobilized much more rapidly and strongly than effector T-cells, which are resting before the tumor appears. The scientists also showed that if regulatory T-cells were absent from this first encounter between the immune system and tumor cells, effector responses of the immune system indeed developed and enabled eradication of the tumor.
Regulatory T-cells are thus the first to recognize a tumor and facilitate its development by preventing its eradication by effector T-cells. This suggests that the control of regulatory T-cells should be an essential component in the development of future therapies for cancer. This discovery also opens the way to other therapeutic opportunities, such as preventive anti-tumor vaccination.
(1) A cancer (or tumor) cell is a normal cell in the body that has undergone changes, such as uncontrolled proliferation, the invasion of adjacent tissues, the colonization of distal organs, or genetic instability, etc.
(2) Generically speaking, the term "tumor" designates an abnormal proliferation of cells. When malignant, this takes the name "cancer".
Source: CNRS
Minimally Invasive, Non-Surgical Procedure Shrinks Uterine Fibroids
Los Angeles resident Christina Simon, 39, was happily pregnant with her second child, but her joy was tempered during her third trimester. An ultrasound by her obstetrician-gynecologist found that, in addition to the baby, something else was growing in her uterus: fibroid tumors, non-cancerous growths of muscle and connective tissue in the uterus. Although Christina was concerned, the doctor assured her that she would keep an eye on the benign tumors' growth, and the pregnancy proceeded without incident.
But within two years, Christina began experiencing troublesome symptoms such as menstrual periods that were uncommonly heavy, painful cramps and a frequent urge to urinate. She first associated her symptoms with motherhood and her age. "I chalked it up to having kids later in life. I thought I had a weak bladder but in fact, it was the fibroids, pushing down on my bladder," she says.
During a routine pelvic exam in 2006, Christina's doctor discovered a large fibroid and quickly ordered an ultrasound. "Even though the tumor was benign, it was as big as a baby's head, and I looked pregnant. My doctor said it was unsafe to have a mass that large," Christina recalls.
The cause of fibroid tumors is still unknown, but experts believe that estrogen stimulates their growth. Fibroids grow larger in pregnant women and in those taking birth control pills, and they tend to shrink after menopause, although they may continue to grow in women who receive hormone replacement therapy. Uterine fibroids occur in about 40 percent of women, and in as many as 50 percent of African-American women like Christina.
The most common symptom is heavy menstrual bleeding which can cause anemia. Fibroids can range in size from a walnut to larger than a cantaloupe. If they grow large enough, they can result in heavy and/or prolonged periods, pelvic pain, bloating, frequent urination or urinary incontinence and constipation.
When Christina asked her gynecologist about treatment options, the doctor suggested she consider myomectomy (which removes the fibroids from the uterus surgically) or a hysterectomy (which removes the entire uterus). The doctor also made passing reference to a technique called embolization, but said she didn't know much about it.
"I left her office wondering if surgery was my only option," Christina says. "But it was up to me to find an alternative."
Christina started her search on the Cedars-Sinai website. There she learned about uterine fibroid embolization (UFE), a minimally invasive, non-surgical procedure that starves uterine fibroids by depriving them of their blood supply. Unlike a hysterectomy, UFE leaves the uterus intact and does not require general anesthesia.
Christina immediately made an appointment to see Marc L. Friedman, M.D., an interventional radiologist and Chief of Vascular and Interventional Radiology at Cedars-Sinai Medical Center in order to get a second opinion on her treatment. Friedman, who is the director of the UFE Program at Cedars-Sinai's S. Mark Taper Foundation Imaging Center, ordered an MRI to determine the location, size and number of Christina's tumors. "Luckily, I was a good candidate for UFE," she says. "We booked the procedure for the next month."
During UFE, Friedman carefully threaded a fine catheter through a tiny incision in the upper thigh and into the blood vessels leading to the fibroids. The catheter delivered tiny spheres (the size of a grain of sand) into the blood vessels, blocking blood flow to the main arteries that supply blood to the uterus. With their blood supply cut off, the fibroids died and began to shrink.
"Symptomatic uterine fibroids can have a significant effect on a patient's quality of life. The UFE procedure is becoming increasingly popular as more women are learning about it," Friedman said.
Post-procedure cramping and nausea were well-controlled with medication, and Christina felt better each day. "Within a week, I returned to work. In just two weeks, I was back to taking care of my family and playing tennis."
A follow-up MRI exam showed Christina's fibroids had shrunk dramatically. Best of all, her symptoms were gone.
UFE is not appropriate for every patient with uterine fibroids, but Christina urges any woman facing the prospect of hysterectomy and early menopause to find out if she is qualified for this outpatient, minimally invasive alternative.
"It's worth meeting with an interventional radiologist and asking about UFE," she says. "You'll get a lot more information, and you may be pleasantly surprised by your options."
Source
Cedars-Sinai Medical Center
But within two years, Christina began experiencing troublesome symptoms such as menstrual periods that were uncommonly heavy, painful cramps and a frequent urge to urinate. She first associated her symptoms with motherhood and her age. "I chalked it up to having kids later in life. I thought I had a weak bladder but in fact, it was the fibroids, pushing down on my bladder," she says.
During a routine pelvic exam in 2006, Christina's doctor discovered a large fibroid and quickly ordered an ultrasound. "Even though the tumor was benign, it was as big as a baby's head, and I looked pregnant. My doctor said it was unsafe to have a mass that large," Christina recalls.
The cause of fibroid tumors is still unknown, but experts believe that estrogen stimulates their growth. Fibroids grow larger in pregnant women and in those taking birth control pills, and they tend to shrink after menopause, although they may continue to grow in women who receive hormone replacement therapy. Uterine fibroids occur in about 40 percent of women, and in as many as 50 percent of African-American women like Christina.
The most common symptom is heavy menstrual bleeding which can cause anemia. Fibroids can range in size from a walnut to larger than a cantaloupe. If they grow large enough, they can result in heavy and/or prolonged periods, pelvic pain, bloating, frequent urination or urinary incontinence and constipation.
When Christina asked her gynecologist about treatment options, the doctor suggested she consider myomectomy (which removes the fibroids from the uterus surgically) or a hysterectomy (which removes the entire uterus). The doctor also made passing reference to a technique called embolization, but said she didn't know much about it.
"I left her office wondering if surgery was my only option," Christina says. "But it was up to me to find an alternative."
Christina started her search on the Cedars-Sinai website. There she learned about uterine fibroid embolization (UFE), a minimally invasive, non-surgical procedure that starves uterine fibroids by depriving them of their blood supply. Unlike a hysterectomy, UFE leaves the uterus intact and does not require general anesthesia.
Christina immediately made an appointment to see Marc L. Friedman, M.D., an interventional radiologist and Chief of Vascular and Interventional Radiology at Cedars-Sinai Medical Center in order to get a second opinion on her treatment. Friedman, who is the director of the UFE Program at Cedars-Sinai's S. Mark Taper Foundation Imaging Center, ordered an MRI to determine the location, size and number of Christina's tumors. "Luckily, I was a good candidate for UFE," she says. "We booked the procedure for the next month."
During UFE, Friedman carefully threaded a fine catheter through a tiny incision in the upper thigh and into the blood vessels leading to the fibroids. The catheter delivered tiny spheres (the size of a grain of sand) into the blood vessels, blocking blood flow to the main arteries that supply blood to the uterus. With their blood supply cut off, the fibroids died and began to shrink.
"Symptomatic uterine fibroids can have a significant effect on a patient's quality of life. The UFE procedure is becoming increasingly popular as more women are learning about it," Friedman said.
Post-procedure cramping and nausea were well-controlled with medication, and Christina felt better each day. "Within a week, I returned to work. In just two weeks, I was back to taking care of my family and playing tennis."
A follow-up MRI exam showed Christina's fibroids had shrunk dramatically. Best of all, her symptoms were gone.
UFE is not appropriate for every patient with uterine fibroids, but Christina urges any woman facing the prospect of hysterectomy and early menopause to find out if she is qualified for this outpatient, minimally invasive alternative.
"It's worth meeting with an interventional radiologist and asking about UFE," she says. "You'll get a lot more information, and you may be pleasantly surprised by your options."
Source
Cedars-Sinai Medical Center
Tumor Mutations Can Predict Chemo Success - Genetic Profiling Of Tumors Could Have 'immediate Impact' On Treating Cancer, Study Shows
New work by MIT cancer biologists shows that the interplay between two key genes that are often defective in tumors determines how cancer cells respond to chemotherapy.
The findings should have an immediate impact on cancer treatment, say Michael Hemann and Michael Yaffe, the two MIT biology professors who led the study. The work could help doctors predict what types of chemotherapy will be effective in a particular tumor, which would help tailor treatments to each patient.
"This isn't something that's going to take five years to do," says Yaffe, who, along with Hemann is a member of the David H. Koch Institute for Integrative Cancer Research at MIT. "You could begin doing this tomorrow."
The work could also guide the development of new chemotherapy drugs targeted to tumors with specific genetic mutations.
Hemann, Yaffe, and their colleagues report their results in the Aug. 15 issue of the journal Genes and Development. Koch Institute postdoctoral associates Hai Jiang and H. Christian Reinhardt are lead authors of the study, which the researchers say is one of the first examples of how genetic profiling of tumors can translate to improvements in patient treatment.
"There's a huge amount of genetic information available, but it hasn't made its way into clinical practice yet," says Hemann.
The research team focused on two proteins often involved in cancer, p53 and ATM. One of the first tumor suppressor genes discovered, p53 serves a watchdog function over a cell's genome, activating repair systems when DNA is damaged and initiating cell death if the damage is irreparable.
ATM is also involved in controlling the cell's response to DNA damage and is known to help regulate p53.
Mutations in p53, ATM or both are often seen in tumor cells. (ATM mutations occur in about 15 percent of cancers, and p53 is mutated in about 30 percent.)
Scientists have long tried to pin down a relationship between mutations in these genes and the effectiveness of DNA-damaging chemotherapy agents, but published studies have produced conflicting reports.
"It's been unclear whether the loss of p53 made tumors easier to treat or harder to treat. You could find examples of either case in the clinical literature," says Yaffe, adding that the same holds true for ATM.
The new study, conducted with human cancer cells, shows that tumors in which both p53 and ATM are defective are highly susceptible to chemotherapy agents that damage DNA. The double mutation prevents tumor cells from being able to repair DNA, and the cells commit suicide.
However, in cells where p53 is mutated but ATM is not, that type of chemotherapy is less effective. Remarkably, tumors where ATM is mutated but p53 is not turn out to be highly resistant to those types of chemotherapy.
With this new information, doctors could choose chemotherapy treatments based on the status of the p53 and ATM genes in a patient's tumor. Traditional DNA-damaging chemotherapy would be a good option for patients with both p53 and ATM mutations, but not for those with normal p53 and mutated ATM.
For patients who have normal ATM and mutated p53, other options might be better: New drugs that inhibit ATM, now in clinical trials, could improve tumors' susceptibility to chemotherapy in those patients.
The study shows the importance of studying cancer genes as a network, rather than trying to predict outcomes based on the status of single genes such as p53, says Robert Abraham, director of the cancer drug discovery program at Wyeth Pharmaceuticals.
Once ATM inhibitors are approved, "understanding the combined status of ATM and p53 should allow physicians to identify patients who should be treated with ATM inhibitors and chemotherapy and those for whom such a therapy could potentially be harmful," Abraham says.
In patients with normal p53 and mutated ATM, doctors could use drugs that target alternative DNA repair pathways. In their Genes and Development paper, the MIT researchers showed that treating such tumors with a drug that targets DNA-PK, another protein involved in DNA repair, renders them vulnerable to chemotherapy.
The MIT researchers collaborated with scientists from the Centre for Genotoxic Stress Research in Denmark, Helsinki University Central Hospital in Finland, and Uppsala University Hospital in Sweden.
The research was funded by the National Institutes of Health, the David H. Koch Fund, the Deutsche Forschungsgemeinschaft, the Deutsche Nierenstiftung, the Danish Cancer Society, the European Community, the Czech Ministry of Education and the Helsinki University Central Hospital Research Fund.
Source
MIT
The findings should have an immediate impact on cancer treatment, say Michael Hemann and Michael Yaffe, the two MIT biology professors who led the study. The work could help doctors predict what types of chemotherapy will be effective in a particular tumor, which would help tailor treatments to each patient.
"This isn't something that's going to take five years to do," says Yaffe, who, along with Hemann is a member of the David H. Koch Institute for Integrative Cancer Research at MIT. "You could begin doing this tomorrow."
The work could also guide the development of new chemotherapy drugs targeted to tumors with specific genetic mutations.
Hemann, Yaffe, and their colleagues report their results in the Aug. 15 issue of the journal Genes and Development. Koch Institute postdoctoral associates Hai Jiang and H. Christian Reinhardt are lead authors of the study, which the researchers say is one of the first examples of how genetic profiling of tumors can translate to improvements in patient treatment.
"There's a huge amount of genetic information available, but it hasn't made its way into clinical practice yet," says Hemann.
The research team focused on two proteins often involved in cancer, p53 and ATM. One of the first tumor suppressor genes discovered, p53 serves a watchdog function over a cell's genome, activating repair systems when DNA is damaged and initiating cell death if the damage is irreparable.
ATM is also involved in controlling the cell's response to DNA damage and is known to help regulate p53.
Mutations in p53, ATM or both are often seen in tumor cells. (ATM mutations occur in about 15 percent of cancers, and p53 is mutated in about 30 percent.)
Scientists have long tried to pin down a relationship between mutations in these genes and the effectiveness of DNA-damaging chemotherapy agents, but published studies have produced conflicting reports.
"It's been unclear whether the loss of p53 made tumors easier to treat or harder to treat. You could find examples of either case in the clinical literature," says Yaffe, adding that the same holds true for ATM.
The new study, conducted with human cancer cells, shows that tumors in which both p53 and ATM are defective are highly susceptible to chemotherapy agents that damage DNA. The double mutation prevents tumor cells from being able to repair DNA, and the cells commit suicide.
However, in cells where p53 is mutated but ATM is not, that type of chemotherapy is less effective. Remarkably, tumors where ATM is mutated but p53 is not turn out to be highly resistant to those types of chemotherapy.
With this new information, doctors could choose chemotherapy treatments based on the status of the p53 and ATM genes in a patient's tumor. Traditional DNA-damaging chemotherapy would be a good option for patients with both p53 and ATM mutations, but not for those with normal p53 and mutated ATM.
For patients who have normal ATM and mutated p53, other options might be better: New drugs that inhibit ATM, now in clinical trials, could improve tumors' susceptibility to chemotherapy in those patients.
The study shows the importance of studying cancer genes as a network, rather than trying to predict outcomes based on the status of single genes such as p53, says Robert Abraham, director of the cancer drug discovery program at Wyeth Pharmaceuticals.
Once ATM inhibitors are approved, "understanding the combined status of ATM and p53 should allow physicians to identify patients who should be treated with ATM inhibitors and chemotherapy and those for whom such a therapy could potentially be harmful," Abraham says.
In patients with normal p53 and mutated ATM, doctors could use drugs that target alternative DNA repair pathways. In their Genes and Development paper, the MIT researchers showed that treating such tumors with a drug that targets DNA-PK, another protein involved in DNA repair, renders them vulnerable to chemotherapy.
The MIT researchers collaborated with scientists from the Centre for Genotoxic Stress Research in Denmark, Helsinki University Central Hospital in Finland, and Uppsala University Hospital in Sweden.
The research was funded by the National Institutes of Health, the David H. Koch Fund, the Deutsche Forschungsgemeinschaft, the Deutsche Nierenstiftung, the Danish Cancer Society, the European Community, the Czech Ministry of Education and the Helsinki University Central Hospital Research Fund.
Source
MIT
Common Trigger In Cancer And Normal Stem Cell Reproduction Discovered By Stanford Scientists
Researchers at Stanford University School of Medicine have discovered, for the first time, a common molecular pathway that is used by both normal stem cells and cancer stem cells when they reproduce themselves.
In a paper published Aug. 7 in the journal Cell, Michael Clarke, MD, the Karel H. and Avice N. Beekhuis Professor in Cancer Biology, and his colleagues showed that breast cancer stem cells and normal breast stem cells turn down the creation of a specific group of cell signals when they are reproducing. Increasing the amount of one of these signals, called miR-200c, strongly suppressed the ability of both cancer stem cells and normal stem cells to divide and reproduce.
The discovery of a common regulatory pathway in both kinds of stem cells supports the idea that cancer stem cells and normal stem cells share fundamental properties. "This very strongly supports the cancer stem cell hypothesis," said Clarke, who is associate director of the Stanford Stem Cell Biology and Regenerative Medicine Institute and a member of the Stanford Cancer Center. "A lot of people have speculated that there was this molecular link between these two kinds of cells (cancer stem cells and normal stem cells), but this is the first time we have actually identified it."
The cancer stem cell hypothesis states that cancers are a collection of many different kinds of cells, only a very few of which create and sustain the cancer. These are the cancer stem cells, which share many traits with normal stem cells.
While most cells in the body cannot reproduce themselves, stem cells have the ability to do so, and can also create the cells that mature into various tissues. Blood stem cells, for instance, which reside in the bone marrow, have the ability to create new blood stem cells and also to create all the different types of mature blood cells.
While the current discovery is important evidence of how cancer stem cells operate, it does not automatically lead to new cancer therapies. "The problem is that if we attack cancer using this mechanism, it is also going to affect normal stem cells which are essential for our survival," Clarke said. But understanding how cancer cells sustain themselves may in the future offer new ways of attacking the disease. "The hope is that we can find nuances that distinguish between how normal stem cells renew themselves and how cancer stem cells do so, and then use those differences to attack only the cancer," said Clarke.
The research also demonstrates the power of conducting studies that zero in on cancer stem cells rather than screen all cancer tumor cells. In the past, for instance, scientists tried to gain insight into how cancer cells reproduce by looking at molecular signals in all the cancer cells in a tumor. But this molecular detective work did not reveal cancer stem cells' use of the miR-200c pathway, probably because signals from cancer stem cells were lost in a crowd of molecular signals from the far more numerous non-stem cells.
Clarke and his colleagues therefore isolated the cancer stem cells first and then did the analysis. Clarke noted that it is technically challenging to isolate cancer stem cells, which can be outnumbered by generic tumor cells 100 to 1, but the rewards can be dramatic.
By analyzing only stem cells, the link between the molecular signals that control reproduction in cancer stem cells and normal stem cells became apparent.
"If you are looking at all the cells in a tumor, it's like looking for a crying child lost in an auditorium of cheering people," Clarke said. "You can't hear the child crying until you remove everyone else from the auditorium, and then the sound will pop out."
Notes:
Other Stanford researchers involved in the project were Yohei Shimono, PhD; Maider Zabala, PhD; Robert Cho, MD; Neethan Lobo, PhD; Piero Dalerba, PhD; Dalong Qian, PhD; Acting Assistant Professor of Radiation Oncology Maximilian Diehn, MD, PhD; Huiping Liu, PhD; Sarita Panula, PhD; Eric Chiao, PhD; and Professor of Obstetrics & Gynecology Renee Reijo-Pera, PhD.
The research was supported by the California Breast Cancer Research Program of the University of California, the Fundacion Alfonso Martin Escudero, the Fulbright Foundation, the National Institutes of Health, the Breast Cancer Research Foundation, the Morton Family Foundation and the Ludwig Foundation.
Source:
Christopher Vaughan
Stanford University Medical Center
In a paper published Aug. 7 in the journal Cell, Michael Clarke, MD, the Karel H. and Avice N. Beekhuis Professor in Cancer Biology, and his colleagues showed that breast cancer stem cells and normal breast stem cells turn down the creation of a specific group of cell signals when they are reproducing. Increasing the amount of one of these signals, called miR-200c, strongly suppressed the ability of both cancer stem cells and normal stem cells to divide and reproduce.
The discovery of a common regulatory pathway in both kinds of stem cells supports the idea that cancer stem cells and normal stem cells share fundamental properties. "This very strongly supports the cancer stem cell hypothesis," said Clarke, who is associate director of the Stanford Stem Cell Biology and Regenerative Medicine Institute and a member of the Stanford Cancer Center. "A lot of people have speculated that there was this molecular link between these two kinds of cells (cancer stem cells and normal stem cells), but this is the first time we have actually identified it."
The cancer stem cell hypothesis states that cancers are a collection of many different kinds of cells, only a very few of which create and sustain the cancer. These are the cancer stem cells, which share many traits with normal stem cells.
While most cells in the body cannot reproduce themselves, stem cells have the ability to do so, and can also create the cells that mature into various tissues. Blood stem cells, for instance, which reside in the bone marrow, have the ability to create new blood stem cells and also to create all the different types of mature blood cells.
While the current discovery is important evidence of how cancer stem cells operate, it does not automatically lead to new cancer therapies. "The problem is that if we attack cancer using this mechanism, it is also going to affect normal stem cells which are essential for our survival," Clarke said. But understanding how cancer cells sustain themselves may in the future offer new ways of attacking the disease. "The hope is that we can find nuances that distinguish between how normal stem cells renew themselves and how cancer stem cells do so, and then use those differences to attack only the cancer," said Clarke.
The research also demonstrates the power of conducting studies that zero in on cancer stem cells rather than screen all cancer tumor cells. In the past, for instance, scientists tried to gain insight into how cancer cells reproduce by looking at molecular signals in all the cancer cells in a tumor. But this molecular detective work did not reveal cancer stem cells' use of the miR-200c pathway, probably because signals from cancer stem cells were lost in a crowd of molecular signals from the far more numerous non-stem cells.
Clarke and his colleagues therefore isolated the cancer stem cells first and then did the analysis. Clarke noted that it is technically challenging to isolate cancer stem cells, which can be outnumbered by generic tumor cells 100 to 1, but the rewards can be dramatic.
By analyzing only stem cells, the link between the molecular signals that control reproduction in cancer stem cells and normal stem cells became apparent.
"If you are looking at all the cells in a tumor, it's like looking for a crying child lost in an auditorium of cheering people," Clarke said. "You can't hear the child crying until you remove everyone else from the auditorium, and then the sound will pop out."
Notes:
Other Stanford researchers involved in the project were Yohei Shimono, PhD; Maider Zabala, PhD; Robert Cho, MD; Neethan Lobo, PhD; Piero Dalerba, PhD; Dalong Qian, PhD; Acting Assistant Professor of Radiation Oncology Maximilian Diehn, MD, PhD; Huiping Liu, PhD; Sarita Panula, PhD; Eric Chiao, PhD; and Professor of Obstetrics & Gynecology Renee Reijo-Pera, PhD.
The research was supported by the California Breast Cancer Research Program of the University of California, the Fundacion Alfonso Martin Escudero, the Fulbright Foundation, the National Institutes of Health, the Breast Cancer Research Foundation, the Morton Family Foundation and the Ludwig Foundation.
Source:
Christopher Vaughan
Stanford University Medical Center
Aug 6, 2009
In Parkinson's Fly Model, Dementia Induced And Blocked
Parkinson's disease is well-known for impairing movement and causing tremors, but many patients also develop other serious problems, including sleep disturbances and significant losses in cognitive function known as dementia.
Now researchers at Washington University School of Medicine in St. Louis have modeled Parkinson's-associated dementia for the first time. Scientists showed that a single night of sleep loss in genetically altered fruit flies caused long-lasting disruptions in the flies' cognitive abilities comparable to aspects of Parkinson's-associated dementia. They then blocked this effect by feeding the flies large doses of the spice curcumin.
"Clinical trials of curcumin to reduce risk of Parkinson's disease are a future possibility, but for now we are using the flies to learn how curcumin works," says author James Galvin, M.D., a Washington University associate professor of neurology who treats patients at Barnes-Jewish Hospital. "This should help us find other compounds that can mimic curcumin's protective effects but are more specific."
Galvin and senior author Paul Shaw, Ph.D., assistant professor of neurobiology, published their results in the journal Sleep on Aug. 1.
Galvin is an expert in cognitive impairments in human Parkinson's disease; Shaw studies sleep and the brain in fruit flies. The researchers decided collaborate based in part on evidence that increased sleep loss in Parkinson's patients can precede or coincide with increased severity in other Parkinsonian symptoms.
More than 74 percent of Parkinson's patients have trouble sleeping, and up to 80 percent of patients 65 and older who have Parkinson's disease for seven years will develop dementia, according to Galvin.
Shaw's lab has linked sleep loss to changes in the dopaminergic system of the brain, the part of the brain that produces the neurotransmitter dopamine and is at the center of the damage caused by Parkinson's.
"In healthy flies, sleep deprivation decreases dopamine receptor production and causes temporary learning impairments that are fully restored after a two-hour nap," Shaw says.
Shaw and Galvin studied fruit flies genetically modified to make a human protein called alpha-synuclein in their brains. Scientists don't yet know what alpha-synuclein does, nor have they found a fly counterpart for it. But they have shown that it aggregates in the brains of Parkinson's disease patients and believe the processes that cause the aggregations are harming dopamine-producing cells.
Prior studies of fruit flies with human alpha-synuclein in their brains showed that the flies, like human Parkinson's patients, also lose dopamine-producing neurons, have movement-related problems and develop alpha-synuclein aggregations. But scientists had yet to evaluate the flies for signs of dementia.
Lead author Laurent Seugnet, Ph.D., research associate at L'Ecole Supérieure de Physique Chimie Industrielles in France, first tested the flies' learning ability using a procedure he helped develop in Shaw's lab. For the test, Seugnet placed flies in a vial with two branches: one lighted branch containing quinine, a bitter-tasting substance flies prefer to avoid; and a darkened but quinine-free branch. After a few trials, normal flies learn to suppress their natural attraction to the light and fly into the darkened vial instead to avoid the quinine.
Flies with alpha-synuclein in their brains could still learn when they were middle-aged, or about 16 to 20 days old. But when Seugnet deprived them of sleep for 12 hours, he found that their ability to remember was more severely impaired than that of young healthy flies that had also been sleep-deprived.
"This was still true even 10 days later, so it seemed to be a lasting effect," says Seugnet.
Galvin had earlier found that curcumin, a derivative of the spice turmeric, blocks alpha-synuclein aggregation in cell models of Parkinson's disease. Based on this, Seugnet fed curcumin to a new batch of flies, repeated the tests and found middle-aged flies with alpha-synuclein retained their ability to learn as well as normal young flies.
"Thanks to this model our labs have created, Dr. Galvin and I can not only quickly test potential new treatments for these symptoms of Parkinson's, we can also move up our treatments in terms of the timeline along which the disorder develops," says Shaw. "That may give us a real chance to change the course of the disease."
Seugnet L, Galvin JE, Suzuki Y, Gottschalk L, Shaw PJ. Persistent short-term memory defects following sleep deprivation in a Drosophila model of Parkinson disease. Sleep, Aug. 1, 2009
Source:
Michael C. Purdy
Washington University School of Medicine
Now researchers at Washington University School of Medicine in St. Louis have modeled Parkinson's-associated dementia for the first time. Scientists showed that a single night of sleep loss in genetically altered fruit flies caused long-lasting disruptions in the flies' cognitive abilities comparable to aspects of Parkinson's-associated dementia. They then blocked this effect by feeding the flies large doses of the spice curcumin.
"Clinical trials of curcumin to reduce risk of Parkinson's disease are a future possibility, but for now we are using the flies to learn how curcumin works," says author James Galvin, M.D., a Washington University associate professor of neurology who treats patients at Barnes-Jewish Hospital. "This should help us find other compounds that can mimic curcumin's protective effects but are more specific."
Galvin and senior author Paul Shaw, Ph.D., assistant professor of neurobiology, published their results in the journal Sleep on Aug. 1.
Galvin is an expert in cognitive impairments in human Parkinson's disease; Shaw studies sleep and the brain in fruit flies. The researchers decided collaborate based in part on evidence that increased sleep loss in Parkinson's patients can precede or coincide with increased severity in other Parkinsonian symptoms.
More than 74 percent of Parkinson's patients have trouble sleeping, and up to 80 percent of patients 65 and older who have Parkinson's disease for seven years will develop dementia, according to Galvin.
Shaw's lab has linked sleep loss to changes in the dopaminergic system of the brain, the part of the brain that produces the neurotransmitter dopamine and is at the center of the damage caused by Parkinson's.
"In healthy flies, sleep deprivation decreases dopamine receptor production and causes temporary learning impairments that are fully restored after a two-hour nap," Shaw says.
Shaw and Galvin studied fruit flies genetically modified to make a human protein called alpha-synuclein in their brains. Scientists don't yet know what alpha-synuclein does, nor have they found a fly counterpart for it. But they have shown that it aggregates in the brains of Parkinson's disease patients and believe the processes that cause the aggregations are harming dopamine-producing cells.
Prior studies of fruit flies with human alpha-synuclein in their brains showed that the flies, like human Parkinson's patients, also lose dopamine-producing neurons, have movement-related problems and develop alpha-synuclein aggregations. But scientists had yet to evaluate the flies for signs of dementia.
Lead author Laurent Seugnet, Ph.D., research associate at L'Ecole Supérieure de Physique Chimie Industrielles in France, first tested the flies' learning ability using a procedure he helped develop in Shaw's lab. For the test, Seugnet placed flies in a vial with two branches: one lighted branch containing quinine, a bitter-tasting substance flies prefer to avoid; and a darkened but quinine-free branch. After a few trials, normal flies learn to suppress their natural attraction to the light and fly into the darkened vial instead to avoid the quinine.
Flies with alpha-synuclein in their brains could still learn when they were middle-aged, or about 16 to 20 days old. But when Seugnet deprived them of sleep for 12 hours, he found that their ability to remember was more severely impaired than that of young healthy flies that had also been sleep-deprived.
"This was still true even 10 days later, so it seemed to be a lasting effect," says Seugnet.
Galvin had earlier found that curcumin, a derivative of the spice turmeric, blocks alpha-synuclein aggregation in cell models of Parkinson's disease. Based on this, Seugnet fed curcumin to a new batch of flies, repeated the tests and found middle-aged flies with alpha-synuclein retained their ability to learn as well as normal young flies.
"Thanks to this model our labs have created, Dr. Galvin and I can not only quickly test potential new treatments for these symptoms of Parkinson's, we can also move up our treatments in terms of the timeline along which the disorder develops," says Shaw. "That may give us a real chance to change the course of the disease."
Seugnet L, Galvin JE, Suzuki Y, Gottschalk L, Shaw PJ. Persistent short-term memory defects following sleep deprivation in a Drosophila model of Parkinson disease. Sleep, Aug. 1, 2009
Source:
Michael C. Purdy
Washington University School of Medicine
Scientists Find New Human HIV From Gorillas
Scientists who found a new human immunodeficiency virus (HIV) in a Cameroonian woman living in Paris, have discovered it is an unusual variant of HIV-1 that could have come from gorillas.
The research that led to the findings was headed by Dr Jean-Christophe Plantier of the University of Rouen in France and is published in the 2 August online issue of Nature Medicine. Drs David Robertson and Jonathan Dickerson from the Faculty of Life Sciences at The University of Manchester, UK, were also involved in the study.
There are three established lineages of HIV-1, known as M, N, and O, which came from chimpanzees, but this new variant appears to be the prototype of a new lineage derived from gorillas and shows no evidence of recombination with the other known lineages, wrote the researchers.
They propose that the new lineage be called HIV-1 group P.
There are 33 million people worldwide living with AIDS which is caused by the HIV-1 virus group M (groups N and O are mainly confined to Cameroon).
HIV is a product of cross-species transmission of Simian Immunodeficiency Virus (SIV) found in chimpanzees, thought to have crossed to humans from eating infected bush meat.
While first recognized in 1980, HIV is thought to have started some 80 years earlier in and around the African country that is now called the Democratic Republic of Congo.
The 62-year old Cameroonian woman at the centre of the study moved to Paris in 2004 and began to have symptoms shortly afterwards. Her blood sample showed discrepancies in her viral load, and further tests revealed she was infected with a new strain of HIV that more closely resembled SIV from gorillas than HIV from humans.
However, before moving to Paris the woman had lived in a semi-urban part of the central west African Republic of Cameroon; she had not come into contact with bush meat or gorillas.
Because of this information and the fact further tests showed that the virus was able to replicate in human cells, the scientists suggest the strain may well appear elsewhere.
Robertson told the media that:
"The discovery of this novel HIV-1 lineage highlights the continuing need to monitor closely for the emergence of new HIV variants."
"This demonstrates that HIV evolution is an ongoing process. The virus can jump from species to species, from primate to primate, and that includes us; pathogens have been with us for millions of years and routinely switch host species," he added.
In the same way as the current swine flu pandemic is showing us, this is another example of how viruses can now move very quickly around the world because nowadays large numbers of humans travel long distances in a short space of time.
Plantier's team in France are part of a network of laboratories that has been monitoring HIV genetic diversity, while the The Manchester Life Sciences team helped with the computer-based evolutionary analysis.
"A new human immunodeficiency virus derived from gorillas."
Jean-Christophe Plantier, Marie Leoz, Jonathan E Dickerson, Fabienne De Oliveira, François Cordonnier, Véronique Lemée, Florence Damond, David L Robertson & François Simon.
Nature Medicine, Published online: 02 August 2009.
The research that led to the findings was headed by Dr Jean-Christophe Plantier of the University of Rouen in France and is published in the 2 August online issue of Nature Medicine. Drs David Robertson and Jonathan Dickerson from the Faculty of Life Sciences at The University of Manchester, UK, were also involved in the study.
There are three established lineages of HIV-1, known as M, N, and O, which came from chimpanzees, but this new variant appears to be the prototype of a new lineage derived from gorillas and shows no evidence of recombination with the other known lineages, wrote the researchers.
They propose that the new lineage be called HIV-1 group P.
There are 33 million people worldwide living with AIDS which is caused by the HIV-1 virus group M (groups N and O are mainly confined to Cameroon).
HIV is a product of cross-species transmission of Simian Immunodeficiency Virus (SIV) found in chimpanzees, thought to have crossed to humans from eating infected bush meat.
While first recognized in 1980, HIV is thought to have started some 80 years earlier in and around the African country that is now called the Democratic Republic of Congo.
The 62-year old Cameroonian woman at the centre of the study moved to Paris in 2004 and began to have symptoms shortly afterwards. Her blood sample showed discrepancies in her viral load, and further tests revealed she was infected with a new strain of HIV that more closely resembled SIV from gorillas than HIV from humans.
However, before moving to Paris the woman had lived in a semi-urban part of the central west African Republic of Cameroon; she had not come into contact with bush meat or gorillas.
Because of this information and the fact further tests showed that the virus was able to replicate in human cells, the scientists suggest the strain may well appear elsewhere.
Robertson told the media that:
"The discovery of this novel HIV-1 lineage highlights the continuing need to monitor closely for the emergence of new HIV variants."
"This demonstrates that HIV evolution is an ongoing process. The virus can jump from species to species, from primate to primate, and that includes us; pathogens have been with us for millions of years and routinely switch host species," he added.
In the same way as the current swine flu pandemic is showing us, this is another example of how viruses can now move very quickly around the world because nowadays large numbers of humans travel long distances in a short space of time.
Plantier's team in France are part of a network of laboratories that has been monitoring HIV genetic diversity, while the The Manchester Life Sciences team helped with the computer-based evolutionary analysis.
"A new human immunodeficiency virus derived from gorillas."
Jean-Christophe Plantier, Marie Leoz, Jonathan E Dickerson, Fabienne De Oliveira, François Cordonnier, Véronique Lemée, Florence Damond, David L Robertson & François Simon.
Nature Medicine, Published online: 02 August 2009.
Breakthrough Breast Cancer Audit Reveals Striking Differences In Breast Cancer Treatment Based On Age
Older breast cancer patients are not receiving a full range of treatment options, according to a report published in the British Journal of Cancer.
Data from the Breast Cancer Clinical Outcome Measures (BCCOM) Project, a pioneering audit of breast cancer treatment funded by Breakthrough Breast Cancer, also suggests regional differences in breast cancer care.
This is the first time that statistics on the treatment of symptomatic breast cancers in the UK have been brought together and analysed, and the results show that older women across the UK are less likely to receive standard treatments such as chemotherapy, radiotherapy or surgery than younger women with a similar diagnosis. Just 16% of patients over 65 received chemotherapy, compared with 77% of patients under 50.
Researchers at the West Midlands Cancer Intelligence Unit, who collected and analysed the data, also found that:
- 48% of women aged 80 and over did not receive any type of surgery, compared with just 3.5% of women under 50.
- Older women who did receive surgery were more likely to have a mastectomy. Only 42% of women aged 65 and over received breast conserving surgery, compared with 51% of women under 65.
- Only 31% of patients over 80 received radiotherapy, compared with 78% of patients under 50.
The report also highlights regional variations in the treatment breast cancer patients are receiving. Data were submitted by all 11 UK cancer registries, and, although the number of surgeons participating varied across the UK, there still appear to be differences between regions, particularly in whether patients had a mastectomy or less invasive breast conserving surgery. In the Trent Cancer Registry region (covering South Yorkshire, Derbyshire, Nottinghamshire, Lincolnshire, Leicestershire and Rutland) as many as 42% of reported cases with an invasive breast tumour smaller than 15mm, had a mastectomy rather than breast conserving surgery. Although some patients may choose to have a mastectomy, these figures are higher than can be explained through patient choice alone.
Guidance on the diagnosis and treatment of breast cancer from the National Institute for Health & Clinical Excellence (NICE) was published in February 2009 which sets out best practice standards of care across England and Wales, alongside guidelines from the Scottish Intercollegiate Guidelines Network (SIGN). Breakthrough hopes breast units across the country will review their own practices in light of the BCCOM Project data and these guidelines.
Maggie Alexander, Director of Policy & Campaigns at Breakthrough Breast Cancer, says:
"Breakthrough is concerned that there appear to be significant differences in treatment given to patients depending on their age. While older patients may be less likely to receive standard treatment, possibly due to patient choice or the underlying health of an individual, we need to better understand all the reasons why. All women should be offered appropriate treatment options no matter what their age and that's why we are now investigating this issue to find out what lies behind these differences.
"We hope that healthcare professionals will use these data to consider their own services and to review any areas which differ widely from other regions or clinical guidelines. Anyone concerned about their breast cancer treatment should talk to their doctor."
Dr Gill Lawrence, Director of the West Midlands Cancer Intelligence Unit, who led the project, says:
"This audit provides valuable national data on breast cancers which are detected symptomatically. By improving the quantity and quality of the information collected on the treatment of these breast cancers we can improve the quality of care for patients. We encourage breast units to review their services and to identify ways in which they can be improved. Although the data in this report are for breast cancers diagnosed in 2004, we are confident that the data highlight many issues which still exist today."
"It is essential that we continue to collect and analyse data on breast cancer treatment in the UK in order to build an even clearer picture of breast cancer services and continue the drive towards the best possible services for all."
Mr Hugh Bishop, Consultant Breast Surgeon, Royal Bolton Hospital NHS Foundation Trust says:
"The data from the BCCOM Project provide surgeons with an excellent opportunity to gain insight into how their services compare with others around the UK and to consider how the care they offer could be improved. Collecting data on the treatment we provide is vital if we are to continue to develop and improve services. By submitting data to the BCCOM Project, surgeons can make a real contribution to this crucial work, and I would encourage all surgeons to take part in the study."
The BCCOM Project asked surgeons from hospitals covered by the UK's 11 cancer registries to report on the diagnosis and treatment of all breast cancer cases detected symptomatically. Researchers at the West Midlands Cancer Intelligence Unit collected and analysed the data in order to provide a national audit of the diagnosis and treatment of symptomatic breast cancers. This allows the comparison of current practise at a surgical, hospital and regional level with national management guidelines and accepted best practise.
The BCCOM Project has been funded by Breakthrough Breast Cancer since 2003.
Notes
The Breast Cancer Clinical Outcome Measures (BCCOM) Project
The BCCOM Project aims to collect high quality data on breast cancer cases in order to compare current practices and clinical outcome. This important study has the potential to improve disease management and improve breast cancer service provision across the UK.
The BCCOM project aims to develop mechanisms to improve the collection of data for symptomatic breast cancer and to audit the management of these cancers in the UK. The data are obtained by tapping into existing sources such as the data currently collected by cancer registries. These data are then analysed to generate information on the clinical outcome of individual breast services. This allows the comparison of current practise at a surgical, hospital and regional level with national management guidelines and accepted best practise. The data collected are fed back to participating surgeons and also to the wider breast management team. This unique collection of data could improve breast cancer service provision and patient outcomes.
The BCCOM Project has been funded by Breakthrough Breast Cancer since 2003.
Source
Breakthrough Breast Cancer
Data from the Breast Cancer Clinical Outcome Measures (BCCOM) Project, a pioneering audit of breast cancer treatment funded by Breakthrough Breast Cancer, also suggests regional differences in breast cancer care.
This is the first time that statistics on the treatment of symptomatic breast cancers in the UK have been brought together and analysed, and the results show that older women across the UK are less likely to receive standard treatments such as chemotherapy, radiotherapy or surgery than younger women with a similar diagnosis. Just 16% of patients over 65 received chemotherapy, compared with 77% of patients under 50.
Researchers at the West Midlands Cancer Intelligence Unit, who collected and analysed the data, also found that:
- 48% of women aged 80 and over did not receive any type of surgery, compared with just 3.5% of women under 50.
- Older women who did receive surgery were more likely to have a mastectomy. Only 42% of women aged 65 and over received breast conserving surgery, compared with 51% of women under 65.
- Only 31% of patients over 80 received radiotherapy, compared with 78% of patients under 50.
The report also highlights regional variations in the treatment breast cancer patients are receiving. Data were submitted by all 11 UK cancer registries, and, although the number of surgeons participating varied across the UK, there still appear to be differences between regions, particularly in whether patients had a mastectomy or less invasive breast conserving surgery. In the Trent Cancer Registry region (covering South Yorkshire, Derbyshire, Nottinghamshire, Lincolnshire, Leicestershire and Rutland) as many as 42% of reported cases with an invasive breast tumour smaller than 15mm, had a mastectomy rather than breast conserving surgery. Although some patients may choose to have a mastectomy, these figures are higher than can be explained through patient choice alone.
Guidance on the diagnosis and treatment of breast cancer from the National Institute for Health & Clinical Excellence (NICE) was published in February 2009 which sets out best practice standards of care across England and Wales, alongside guidelines from the Scottish Intercollegiate Guidelines Network (SIGN). Breakthrough hopes breast units across the country will review their own practices in light of the BCCOM Project data and these guidelines.
Maggie Alexander, Director of Policy & Campaigns at Breakthrough Breast Cancer, says:
"Breakthrough is concerned that there appear to be significant differences in treatment given to patients depending on their age. While older patients may be less likely to receive standard treatment, possibly due to patient choice or the underlying health of an individual, we need to better understand all the reasons why. All women should be offered appropriate treatment options no matter what their age and that's why we are now investigating this issue to find out what lies behind these differences.
"We hope that healthcare professionals will use these data to consider their own services and to review any areas which differ widely from other regions or clinical guidelines. Anyone concerned about their breast cancer treatment should talk to their doctor."
Dr Gill Lawrence, Director of the West Midlands Cancer Intelligence Unit, who led the project, says:
"This audit provides valuable national data on breast cancers which are detected symptomatically. By improving the quantity and quality of the information collected on the treatment of these breast cancers we can improve the quality of care for patients. We encourage breast units to review their services and to identify ways in which they can be improved. Although the data in this report are for breast cancers diagnosed in 2004, we are confident that the data highlight many issues which still exist today."
"It is essential that we continue to collect and analyse data on breast cancer treatment in the UK in order to build an even clearer picture of breast cancer services and continue the drive towards the best possible services for all."
Mr Hugh Bishop, Consultant Breast Surgeon, Royal Bolton Hospital NHS Foundation Trust says:
"The data from the BCCOM Project provide surgeons with an excellent opportunity to gain insight into how their services compare with others around the UK and to consider how the care they offer could be improved. Collecting data on the treatment we provide is vital if we are to continue to develop and improve services. By submitting data to the BCCOM Project, surgeons can make a real contribution to this crucial work, and I would encourage all surgeons to take part in the study."
The BCCOM Project asked surgeons from hospitals covered by the UK's 11 cancer registries to report on the diagnosis and treatment of all breast cancer cases detected symptomatically. Researchers at the West Midlands Cancer Intelligence Unit collected and analysed the data in order to provide a national audit of the diagnosis and treatment of symptomatic breast cancers. This allows the comparison of current practise at a surgical, hospital and regional level with national management guidelines and accepted best practise.
The BCCOM Project has been funded by Breakthrough Breast Cancer since 2003.
Notes
The Breast Cancer Clinical Outcome Measures (BCCOM) Project
The BCCOM Project aims to collect high quality data on breast cancer cases in order to compare current practices and clinical outcome. This important study has the potential to improve disease management and improve breast cancer service provision across the UK.
The BCCOM project aims to develop mechanisms to improve the collection of data for symptomatic breast cancer and to audit the management of these cancers in the UK. The data are obtained by tapping into existing sources such as the data currently collected by cancer registries. These data are then analysed to generate information on the clinical outcome of individual breast services. This allows the comparison of current practise at a surgical, hospital and regional level with national management guidelines and accepted best practise. The data collected are fed back to participating surgeons and also to the wider breast management team. This unique collection of data could improve breast cancer service provision and patient outcomes.
The BCCOM Project has been funded by Breakthrough Breast Cancer since 2003.
Source
Breakthrough Breast Cancer
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