July Issue of Journal Exercise and Sport Sciences Reviews

Adolescents

Inadequate evidence has been reported as the cause contradicting the use of medical interventions in adolescents and young adults with autism.(Medical News Today:26.9.2012)

According to a recent analysis by researchers at Vanderbuilt University and their findings published in Pediatrics, even though adolescents with autism are being prescribed medication, there is little to no evidence showing whether these medications are helpful.

Jeremy Veenstra-VanderWeele, M.D., assistant professor of Psychiatry, Pediatrics and Pharmacology and Vanderbilt Kennedy Center investigator commented, "We need more research to be able to understand how to treat core symptoms of autism in this population, as well as common associated symptoms such as anxiety, compulsive behaviors and agitation."

Because of this lack of evidence, clinicians, families and patients make hasty decisions regarding medication, often without completely knowing which treatments could make things better or what might make them worse. In previous research it has also been seen that even early age interventions do not have sufficient evidence to support any particular approach.

This specific analysis is a portion of research on interventions for adolescents and young adults with autism spectrum disorders that has found little evidence to support conclusions for all therapies currently used, good or bad.

These researchers investigated over 4,500 studies and specifically reviewed 32 studies on therapies for people ages 13 to 30 with autism spectrum disorders. They concentrated on the results, such as harmful and unfavorable effects of interventions, including educational, behavioral, vocational, and medical.

It was revealed that some treatments could improve social skills and educational outcomes like vocabulary or reading, but these studies were small and had little follow- ups.

The most constant finding was seen in relation to the effects of antipsychotic medications on reducing behaviors associated with autism such as aggressiveness and irritability. Harms seen with this type of medication include weight gain and sedation. There was limited to no evidence in favor of using medical interventions in adolescents and young adults with autism. In regards to vocational interventions, researchers saw them to be effective for some people but not others, with several study flaws present, reducing confidence in their conclusions.

New data from the Centers for Disease Control and Prevention states that one in 88 children suffers from an autism spectrum disorder. Boys outnumber girls 5-to-1, estimating that one in every 54 boys in the United States has autism. The authors concluded that much remains to be learned on the topic of interventions and adolescents with autism. Aging

Elderly Care

Tokyo Elderly Care Hospital Faces TB Outbreak (Med India: 11.7.2012)

A report says that the Tokyo Metropolitan Government said Monday 78 patients and staff at an elderly care center had contracted tuberculosis (TB), including three people who died.

In February, two in-patients at the dementia care wing of Tokyo Oume Hospital were diagnosed with TB, Jiji Press said.

A follow-up study by the local public health centre found a total of 78 infections in the wing, Jiji said without giving a breakdown of how many of them were patients and staff.

Of those, three people have died, including a man in his 60s who was one of the two original TB patients, the report said.

The infections might have spread as the man, who died in April, was seen walking around the wing and spitting on people, according to the report.

It was not immediately clear whether the two other deaths were directly related to tuberculosis, Jiji said.

Anti-ageing pills

Anti-ageing pills closer to reality(New Kerala: 18.7.201`2)

A pill that alleviates the worst aspects of ageing could be closer than we think, an expert says.

In fact, a drug already licensed to treat cancer is getting the results scientists are after, in animals. Professor Dame Linda Partridge, the director of the Institute of Ageing at University College London, said that when mice were fed the drug rapamycin, they lived longer, the Age reported.

But the drug also offered protection against neurodegenerative diseases, which are closely linked to ageing.

"Ageing is the main risk factor for all these horrible killer and chronic conditions — dementia, cardiovascular disease, cancer," Professor Partridge said.

"What we are trying to do here is hit the underlying ageing process itself through understanding mechanisms to protect against all these things at once, rather than treating them piecemeal.

"Rapamycin is beginning to look like a proof of principle that that kind of approach is going to work."

However, the drug — a natural product initially discovered in the soil of Easter Island — is also believed to have a downside.

It's an immune suppressant and is also used to prevent the body rejecting an organ after transplant.

But there's potential to boost the drug's health benefits while minimising its undesirable side-effects, Professor Partridge said.

Professor Partridge will deliver the 2012 Graeme Clark Oration in Melbourne tomorrow. (ANI

Ageing

How ageing impairs body's immune function(New Kerala 20.7.2012)

Researchers have identified one of the mechanisms by which ageing may compromise the ability of the immune system to fight infections and respond to vaccines.

The study from the Albert Einstein College of Medicine of Yeshiva University, conducted in ageing mice, showed that administering antioxidants might help reverse this loss of immune function.

"Ageing is known to affect immune function, a phenomenon known as immunosenescence, but how this happens is not clear," said study leader Laura Santambrogio, M.D., Ph.D., associate professor of pathology and of microbiology and immunology at Einstein. "Our study has uncovered several ways in which ageing can worsen the body's overall ability to mount an effective immune response," Santambrogio noted.

All cells generate chemicals called free radicals as a normal part of metabolism. These highly reactive, unstable molecules can readily damage proteins, lipids and other cellular components through oxidation (the reaction between oxygen and substances it comes in contact with).

Cells keep "oxidative stress" in check by producing several enzymes that are scavengers of free radicals. But in ageing, increased production of free radicals coupled with cells' decreased production of antioxidant enzymes cause a build-up of damaged proteins and other molecules that can be toxic to cells.

The current study is the first to examine whether age-related oxidative stress compromises the function of a type of immune cell called dendritic cells.

"Dendritic cells are known as the 'sentinels of the immune system' and alert the rest of the immune system to the presence of microbial invaders," explained Dr. Santambrogio.

"When you are exposed to viruses or bacteria, these cells engulf the pathogens and present them to the immune system, saying in effect, 'There's an infection going on, and here is the culprit-go get it,'" she explained.

Dr. Santambrogio, in collaboration with Einstein colleagues Fernando Macian-Juan, M.D., Ph.D. , and Ana Maria Cuervo, M.D., Ph.D. , isolated dendritic cells from ageing mice and found that oxidation-damaged proteins had accumulated in those cells and had caused harmful effects. For example, oxidatively modified proteins hampered the function of endosomes, the cell's organelle where pathogens are inactivated.

When the mice were injected with a potent antioxidant in the abdominal cavity daily for two weeks, some of the effects of oxidative stress were reversed.

This finding has implications for designing vaccines or therapies for humans, especially the elderly, whose weakened immune systems increase their susceptibility to infections and cancer, and reduces vaccine effectiveness.

"Many elderly people respond very poorly to vaccination, so perhaps a cycle of therapy with antioxidants before vaccination might improve their immune response to vaccines," Dr. Santambrogio stated.

The findings were published online this month in the journal Elderly Medicare Beneficiaries

Study Shows Increased Satisfaction Levels among Elderly Medicare Beneficiaries (Med India: 20.7.2012)

NY—Elderly beneficiaries enrolled in Medicare plans are more satisfied with their health insurance, have better access to care, and are less likely to have problems paying medical bills than people who get insurance through employers or those who purchase coverage on their own, according to a new Commonwealth Fund study published today in Health Affairs. The study also found that beneficiaries enrolled in private Medicare Advantage plans are less satisfied with their insurance than those with a traditional Medicare plan, and more likely to experience access problems.

The study, "Medicare Beneficiaries Less Likely To Experience Cost- And Access- Related Problems Than Adults With Private Coverage," by Commonwealth Fund researchers Karen Davis, Kristof Stremikis, Michelle Doty, and Mark Zezza, finds that only 8 percent of Medicare beneficiaries rated their insurance as fair or poor, compared with 20 percent of adults with employer insurance and 33 percent who purchased insurance on their own. As the federal government weighs proposals to cut Medicare spending, the analysis, based on results from The Commonwealth Fund Biennial Health Insurance Survey of 2010, suggests shifting Medicare beneficiaries into private plans could put the elderly at greater risk for not getting needed health care and being less satisfied with their insurance.

The study finds that Medicare beneficiaries have better access to care and greater financial protection than adults with private coverage. In 2010 about one-fourth (23%) of Medicare beneficiaries went without needed health care because of costs, compared with 37 percent of those with employer coverage. Adults with employer-based insurance (39%) and individual insurance (39 %) reported medical bill problems at almost double the rate of Medicare beneficiaries (21 %). The study finds that while health care access and medical bill problems worsened for adults with all types of coverage over the past decade, Medicare continued to provide better coverage during that time period.

"Medicare continues to do better than employer-sponsored and individual plans when it comes to providing people with good access to health care and adequate protection from burdensome medical bills," said Stremikis, senior researcher at The Commonwealth Fund. "Policies designed to move the elderly out of Medicare and into private plans need to be carefully designed, so as not to expose beneficiaries to the poorer access to care currently experienced by many working-age adults with private insurance."

The study found that those with individual and employer-based coverage were far more likely than Medicare beneficiaries to incur high out-of-pocket costs. Twenty-nine percent of elderly adults with Medicare reported spending 10 percent or more of their income on medical costs, compared to 37 percent of adults with employer-based insurance and 58 percent with individual insurance. Only 13 percent of Medicare beneficiaries were unable to pay for basic necessities such as food or rent or used up all their savings to cover medical bills, compared to 27 percent of adults with employer-based insurance and 33 percent with individual insurance.

Medicare Advantage vs. Traditional Medicare

Within Medicare, satisfaction rates differed depending on whether beneficiaries were enrolled in traditional Medicare plans or in Medicare Advantage plans offered by private insurance companies. Fifteen percent of elderly people with Medicare Advantage rated their insurance as fair or poor, compared with just six percent of those with traditional Medicare coverage.

The study also found that although Medicare Advantage enrollees were less likely to spend 10 percent or more of their income on premiums and out-of-pocket costs, they were more likely to report cost-related access problems than elderly adults with traditional Medicare. Thirty-two percent of beneficiaries with Medicare Advantage reported at least one access problem due to cost, compared with 23 percent of those with traditional coverage. The authors say this may in part reflect Medicare Advantage beneficiaries' experience with private HMO plans that offer lower premiums in return for limited access to a smaller network of providers.

Looking Ahead

The authors conclude that "in the policy debates over the Federal budget deficit, the affordability of Medicare, and the expansion of health insurance through the Affordable Care Act, listening to the experiences of individuals, whether covered by Medicare or private employer insurance, is important." Given the more positive experiences of those covered by Medicare, states may want to consider offering traditional Medicare coverage to non-elderly individuals through the state exchanges to be set up in 2014.

"As we expand insurance and move toward near-universal coverage, it is imperative that we ensure health plans provide financial protection and good access to care," said Commonwealth Fund President Karen Davis. "The achievements of Medicare in fulfilling the goals of health insurance coverage for beneficiaries can provide important lessons for the entire U.S. health system." Aging

Aging Heart Cells Rejuvenated by Modified Stem Cells (Science Daily:24.7.2012)

Damaged and aged heart tissue of older heart failure patients was rejuvenated by stem cells modified by scientists, according to research presented at the American Heart Association's Basic Cardiovascular Sciences 2012 Scientific Sessions. The study is simultaneously published in the Journal of the American College of Cardiology.

The research could one day lead to new treatments for heart failure patients, researchers said.

"Since patients with heart failure are normally elderly, their cardiac stem cells aren't very healthy," said Sadia Mohsin, Ph.D., one of the study authors and a post-doctoral research scholar at San Diego State University's Heart Institute in San Diego, Cal. "We modified these biopsied stem cells and made them healthier. It is like turning back the clock so these cells can thrive again."

Modified human stem cells helped the signaling and structure of the heart cells, which were biopsied from elderly patients. Researchers modified the stem cells in the laboratory with PIM-1, a protein that promotes cell survival and growth.

Cells were rejuvenated when the modified stem cells enhanced activity of an enzyme called telomerase, which elongates telomere length. Telomeres are "caps" on the ends of chromosomes that facilitate cell replication. Aging and disease results when telomeres break off.

"There is no doubt that stem cells can be used to counter the aging process of cardiac cells caused by telomere degradation," Mohsin said.

The technique increased telomere length and activity, as well as increasing cardiac stem cell proliferation, all vital steps in combating heart failure.

While human cells were used, the research was limited to the laboratory. Researchers have tested the technique in mice and pigs and found that telomere lengthening leads to new heart tissue growth in just four weeks.

"Modifying aged human cardiac cells from elderly patients adds to the cell's ability to regenerate damaged heart muscle, making stem cell engineering a viable option," Mohsin said. "This is an especially exciting finding for heart failure patients. Right now we can only offer medication, heart transplantation or stem cell therapies with modest regenerative potential, but PIM-1 modification offers a significant advance for clinical treatment."

Co-authors are Mohsin Khan, Ph.D.; Kathleen Wallach, B.S.; Travis Cottage, M.S.;Michael J Mcgregor, B.S.; and Mark A. Sussman, Ph.D. Author disclosures are on the abstract.

This study was supported by the National Institutes

Brain Aging

Concussions and Head Impacts May Accelerate Brain Aging(Science Daily: 1.8.2012)

Concussions and even lesser head impacts may speed up the brain's natural aging process by causing signaling pathways in the brain to break down more quickly than they would in someone who has never suffered a brain injury or concussion.

Researchers from the University of Michigan School of Kinesiology and the U-M Health System looked at college students with and without a history of concussion and found changes in gait, balance and in the brain's electrical activity, specifically attention and impulse control, said Steven Broglio, assistant professor of kinesiology and director of the Neurotrauma Research Laboratory.

The declines were present in the brain injury group up to six years after injury, though the differences between the study groups were very subtle, and outwardly all of the participants looked and acted the same.

Broglio, who is also affiliated with Michigan NeuroSport, stressed that the studies lay out a hypothesis where concussions and head impacts accelerate the brain's natural aging process.

The study appears in the July issue of journal Exercise and Sport Sciences Reviews.

"The last thing we want is for people to panic. Just because you've had a concussion does not mean your brain will age more quickly or you'll get Alzheimer's," Broglio said. "We are only proposing how being hit in the head may lead to these other conditions, but we don't know how it all goes together just yet."

Broglio stressed that other factors, such as lifestyle choices, smoking, alcohol consumption, physical exercise, family history and whether or not you "exercise" your brain also impact the brain's aging process. Concussion may only be one small factor. To begin to understand how concussions might impact brain activity and its signaling pathways, researchers asked the participants to perform certain tasks in front of a computer, and took images of their brains. The brains of the nonconcussed group showed a greater area of electrical activation than the participants with a history of brain injury.

The signaling pathways in our brains are analogous to a five-lane highway. On a new highway, traffic runs smoothly and quickly as all lanes are in top shape. However, during normal aging, the asphalt deteriorates and lanes might become bumpy or even unusable. Traffic slows.

Similarly, our brains start with all pathways clear to transfer electrical signals rapidly. As we age, the brain's pathways break down and can't transfer the information as quickly. Concussive and other impacts to the head may result in a 'pothole' on the brain's highway, causing varying degrees of damage and speeding the pathway's natural deterioration.

"What we don't know is if you had a single concussion in high school, does that mean you will get dementia at age 50?" Broglio said. "Clinically, we don't see that. What we think is it will be a dose response.

"So, if you played soccer and sustained some head impacts and maybe one concussion, then you may have a little risk. If you went on and played in college and took more head balls and sustained two more concussions, you're probably at a little bigger risk. Then if you play professionally for a few years, and take more hits to the head, you increase the risk even more. We believe it's a cumulative effect."

In the next phase of study, researchers will look at people in their 20s, 40s and 60s who did and did not sustain concussions during high school sports. They hope to learn if there is an increasing effect of concussion as the study subjects age.

Researchers from the departments of Physical Medicine and Rehabilitation, and Neurology, and the Michigan Alzheimer's Disease Center also participated in the study.

Elderly

Magic Carpet Could Help Prevent Falls in Elderly (Med India: 4.9.2012)

A 'magic carpet' developed by scientists could prevent elderly from falling. Plastic optical fibres, laid on the underlay of the carpet, can bend when anyone treads on it and map, in real-time, their walking patterns.

Tiny electronics at the edges act as sensors and relay signals to a computer. These signals can then be analysed to show the image of the footprint and identify gradual changes in walking behaviour or a sudden incident such as a fall or trip. They can also show a steady deterioration or change in walking habits, possibly predicting a dramatic episode such as a fall.

Scientists believe these smart carpets could be fitted in care homes or hospital wards, as well as in people's homes if necessary. Physiotherapists could also use the carpet to map changes and improvements in a person's gait.

The imaging technology is so versatile it could even be developed to detect the presence of chemical spillages or fire as an early-warning system.

The interdisciplinary team, from three academic Schools and the Photon Science Institute at The University of Manchester, used a novel tomographic technique similar to hospital scanners.

It maps 2D images by using light propagating under the surface of the smart carpet.

The researchers, led by Dr Patricia Scully from The University of Manchester's Photon Science Institute, believe the magic carpet could be vital not only for helping people in the immediate aftermath of a fall, but also in identifying subtle changes in people's walking habits which might not be spotted by a family member or carer.

"The carpet can gather a wide range of information about a person's condition; from biomechanical to chemical sensing of body fluids, enabling holistic sensing to provide an environment that detects and responds to changes in patient condition," Dr Scully said.

"The carpet can be retrofitted at low cost, to allow living space to adapt as the occupiers' needs evolve - particularly relevant with an aging population and for those with long term disabilities - and incorporated non-intrusively into any living space or furniture surface such as a mattress or wall that a patient interacts with," he added.

The new technology was presented at the Photon 12 conference.

National Policy on Elderly

Is there any hope for the 100 million elderly Indians? (World Newspapers: 17.9.2012)

•Regulars who meet Dattatray Rajderkar (86) and his wife Nanda (79) at the Sanjay Gandhi National park on their morning walks often remark on their health. Though Nanda needs help climbing steps, the senior couple is fit and unaffected by lifestyle diseases common among peers. Yet every remark on their good health, makes them sigh. “Its best if we breathe our last till we are hale and hearty like this,” says Rajderkar.

Nanda recounts, “After our daughter Manjusha was married in 1991, she moved to Toronto. She has two children and a job which keeps her as busy as her husband who works for the government there. Our son's death in a motorcycle accident in 1994 left us increasingly lonely. But it can't be helped,” says the septuagenarian. “At our age who wouldn't?”

There are also safety concerns. “Every day you open the paper and you see reports of macabre attacks on the elderly by thieves. Once we go back from our walk we rarely open the door,” points out Rajderkar.

Manjusha had invited them to live with her in 2000. “She was suggesting that we shift there permanently but we found it difficult to adjust to the cold climate. Also, which Indian parents go and live with daughters?”

While Manjusha flies down once-a-year to be with her parents, their relatives in Pune drop in once in a while.

•Ezmi Pereira is only 69, but her gnarled face and bent over posture makes her look much older. Until five years ago, she washed utensils at a private nursing home. “I was in the job for nearly 25 years. That and my boys, working forcaterers, ensured we didn't die of hunger.”

Her husband who worked in a garage was an alcoholic. His drinking and the regular fights left her bitter. “We would often have to go pick him up from the streets around the BDD chawl. When he died, my sons and I didn't even weep.”

After the clinic she worked for folded up, she began going to flats in the Worli neighbourhood as domestic help. A rasping cough and regular bouts of fever have now left her too weak to work. Her elder son is now married and has two school-going daughters. The one-room BBD chawl home is too small for this nuclear family. Ezmi sleeps in the lobby beside the drum where the family stores water. “I feel too weak to even get down the stairs. Most of the time I am lying on my bedding out of the house.”

Her daughter-in-law feels she may have TB and could infect her or her children and does not allow her to come in to even watch TV. “She keeps saying I must go on my own to the Sewri hospital and seek treatment but I am scared.”

Also, there is the question of money. “My younger one Walter went to the Gulf. He says he sends money for me, but my daughter-in-law says they get nothing,” she complained as she gathered her frock and sat down, seized by a coughing fit.

•Shridev Yadav, 70, puts the battered aluminium bucket of water down and stops to catch his breath. The red-checked gamcha wrapped around his waist is wet with his sweat and water from washing auto-rickshaws. He washes 62 autorickshaws each day from 3 am to 10:30 am and between 5 to 6:30 in the evening, across the Mahakali Caves neighbourhood in Andheri.

This mill worker who found himself jobless when the mill shut down, decided to head back to his native place in Jaunpur, Uttar Pradesh. “My own younger brother had usurped my land which I'd bought with my sweat and toil.” Dejected with the local authorities colluding with hisbrother and tired of the prolonged litigation, he came back to the city.

He sold the autorickshaw he owned to arrange money for his three daughters' weddings. Left with nothing, he began washing vehicles in early 2003. His only son, a charas addict, refuses to work. With one more daughter to wed, Yadav prays everyday that he shouldn't die before he has “completed his duty.”

Needs of the elderly The Rajderkars, Periera and Yadav are not isolated cases facing problems like finance, health, loneliness, abuse and neglect. The number of people above 60 is estimated to be 100 million (10 crore) in 2011, which is nearly 9% of the total population. With life spans rising by 60% in the last six decades, India is now home to second largest population of senior citizens. Alcohol Dependence

Alcohol

Alcohol and Birth Control Use in Teens May Result In High Blood Pressure(Medical News Today:13.7.2012)

Male adolescents who consume alcohol and teenage girls who are on the pill are more likely to have high blood pressure in later life, according to results from a large pregnancy follow-up study in Australia.

In addition, consuming too much salt and increasing body mass index (BMI) were associated with blood pressure levels in both sexes in late adolescence.

According to the researchers, the difference in blood pressure between adolescents with a healthier lifestyle and those with a less favorable lifestyle "are likely to significantly affect their risk of both ischemic heart disease and stroke in adulthood." They continue:

"Adolescence is a time of life when behaviors tend to become entrenched," and that "significant public health benefits may be achieved from implementation of a range of gender-appropriate lifestyle modifications within this age group of adolescents."

Between 1989 and 1992, 2,868 children were born to mothers who participated in the Western Australian Pregnancy Cohort (Raine) study. 1,771 of these children, now adolescents, were available for the study.

Study participant were asked about smoking, dietary patterns, alcohol consumption, physical activity, and prescription medications (including the use of oral contraceptives). The researchers then calculated the association between each of these factors and systolic and diastolic blood pressure.

The team found that girls not taking the Pill had an overall systolic blood pressure 9 mmHg lower than boys. Among the boys, the researchers found that BMI, alcohol consumption and urinary sodium were strongly linked with systolic blood pressure, and the association with salt and alcohol remained even when adjusted for BMI. Lower diastolic blood pressure was associated with regular physical exercise.

According to the researchers: 24% of the teenagers were pre-hypertensive or hypertensive 34% of overweight teenagers were either pre-hypertensive or hypertensive 38% of obese adolescents were either pre-hypertensive or hypertensive The team also found that girls who took the Pill were more likely to have high blood pressure. Results showed that the systolic blood pressure of girls taking the Pill (30% of the group) was 3.3 mmHg higher than those not on the Pill, and grew higher with increasing BMI. Alcohol consumption among girls did not affect blood pressure.

In an associated comment, Dr. Chi Le-Ha from the Royal Perth Hospital, Australia, explained:

"Adolescents need to be aware that a lifestyle which predisposes to fatness, high salt intake and alcohol consumption may lead to adverse health consequences in adult life. The effects are additive and already associated with hypertension. Moreover, teenage girls taking oral contraceptives should be advised about regular blood pressure monitoring."

Alcohol

Lesser evil: Wine is better for heart (The Times of India:14.9.2012)

New Delhi: This could come as a revelation for Indians who love their whisky, vodka and rum, but are yet to develop a taste for wine.

Scientists have found pinot noir — a light to medium-bodied red wine that boasts of considerable meal pairing versatility — to be the lesser evil. A Rhode Island hospital study announced on Tuesday says wine has more cardio-vascular benefits than vodka. A team from Rhode Island hospitals studied the effects of red wine and vodka on pigs with high cholesterol and found that the animals with a penchant for pinot noir fared better than their vodka-swigging counterparts. The paper is published in the September issue of the journal Circulation.

It says that red wine may offer increased protection due to its anti-oxidant properties. Red wine dilates blood vessels, while vodka causes more collateral vessels to develop. Several substances unique to red wine have been investigated for their antioxidant, pro- angiogenic and anti-inflammatory properties.

Frank Sellke, chief of cardiothoracic surgery at Rhode Island and Miriam Hospitals, said, “There has been previous research touting the benefits of moderate consumption of wine, but we wanted to test the effects of both wine and vodka in conjunction with high cholesterol as those who would be in this at-risk patient population typically have other medical issues, such as high cholesterol.”

Sellke, the study’s principal investigator, added, “What we found is that moderate consumption of both alcohols may reduce cardiovascular risk, but that red wine may offer increased protection due to its antioxidant properties.” In addition, it was determined that HDL, or good cholesterol, was significantly increased in the two alcohol-treated groups, while total cholesterol levels were unaffected.

HDL (good) cholesterol transports LDL (bad) to the liver where it is metabolized, which may assist in preventing hardening of the arteries, and other cardiac issues. Researchers determined that while both red wine and vodka can benefit the heart, they do so differently. Arthritis

Arthritis

Patients With or Without Rheumatoid Arthritis Receive Routine Cancer Screening: Study (Med India: 10.7.2012)

Rheumatoid arthritis and non-rheumatoid arthritis patients get routine screening for breast, cervical and colon cancer at similar rates, states study.

The ACR estimates that 1.3 million adult Americans are affected by RA—a chronic autoimmune disease characterized by systemic inflammation of the joints that over time may damage joints, impair daily function, and cause significant disability. Medical evidence confirms that despite early and aggressive treatment, RA patients have a decreased life expectancy compared to the general population. Previous research reports that cancer is one of the main causes of death for RA patients and patients with chronic disease may not receive preventive medical services including regular screenings for cancer.

"Early detection of common cancers can improve morbidity and mortality rates in those with chronic illnesses, such as RA," said Dr. Seoyoung C. Kim with the Division of Rheumatology and Division of Pharmacoepidemiology at Brigham and Women's Hospital in Boston, Mass. "Cancer screening tests are important in detecting malignancies at early stages for both chronically ill and healthy populations."

To further understand barriers to preventative medical care and raise awareness of the importance of early cancer screenings, Dr. Kim and colleagues examined screening rates for breast, cervical and colon cancer in RA patient compared to those without the disease. Using claims data from a major insurance provider, the team identified 13,314 patients with RA patients and 212,324 non-RA patients.

Analysis shows that on average both RA and non-RA groups were screened once every three years for cervical cancer and every two years for breast cancer. Among all participants 50 years and older, 12% of RA patients and 10% of non-RA patients had at least one colonoscopy each year. Women with RA were more likely to have an annual Pap smear, mammogram, fecal occult blood (FOB) test and colonoscopy than those without RA. Male RA patients were also more likely to have a colonoscopy compared to than those without RA. "Our findings indicate that RA patients were regularly screened for cervical, breast and colon cancer as recommended by the American Cancer Society," concludes Dr. Kim. "Cancer screenings rates among patients with RA were similar to the general population, which is different than previously published results. However, these earlier studies did not compare rates of cancer screenings in RA patients with a non-RA group." The authors suggest that patients and physicians be aware of the importance of preventive healthcare in patients with chronic diseases such as RA. They caution that results of this should not be generalized to those without medical insurance.

Arthritis

Moderate Drinking May Reduce Risk of Rheumatoid Arthritis(Science Daily: 11.7.2012)

Moderate consumption of alcohol is associated with a reduced risk of developing rheumatoid arthritis, suggests a study published on the British Medical Journal website.

The results show that women who regularly consume more than three alcoholic drinks a week for at least 10 years have about half the risk of developing rheumatoid arthritis compared with non-drinkers.

After adjusting for factors such as age, smoking and dietary habits, women who reported drinking more than three glasses of alcohol per week in both 1987 and 1997 had a 52% reduced risk of rheumatoid arthritis compared with never drinkers at both assessments.

These findings add to a growing body of evidence that long term moderate alcohol consumption is not harmful and may protect against a chronic disease like rheumatoid arthritis, say the authors. However, they stress that the effect of higher doses of alcohol on the risk of rheumatoid arthritis remains unknown.

Rheumatoid arthritis is a chronic inflammatory joint disorder that usually develops between the ages of 40 and 50. About 1% of the world's population is affected -- women three times more often than men. Some studies have shown that drinking alcohol is associated with a lower risk of rheumatoid arthritis, whereas others have found no association.

The relation between alcohol intake and rheumatoid arthritis remains controversial. So a team of researchers based in Sweden set out to analyse this association among 34,141 Swedish women born between 1914 and 1948.

Detailed information about alcohol consumption, diet, smoking history, physical activity and education level was collected in 1987 and again in 1997. Participants were followed up for seven years (Jan 2003 to Dec 2009) when they were aged 54-89 years, during which time 197 new cases of rheumatoid arthritis were registered.

The age-standardized rate of rheumatoid arthritis was smaller among women who drank more than four glasses of alcohol a week (7 per 10,000 person years) than among women who drank less than one glass a week (9.1 per 10,000 person years) as reported in 1997.

One standard glass of alcohol was defined as approximately 500 ml beer, 150 ml of wine or 50 ml of liquor.

The reduced risk was similar for all three types of alcoholic drink.

Further analyses made little difference to the results, supporting the theory that a moderate amount of alcohol may be a protective factor for rheumatoid arthritis. The authors suggest that this is most likely to be due to alcohol's ability to lower the body's immune response.

This is relevant because rheumatoid arthritis is an autoimmune disease -- it causes the immune system, which usually fights infection, to attack the cells that line the joints.

Knee arthritis

Why women are more prone to knee arthritis (The Tribune: 18.7.2012)

The knee joint is an extremely important hinge joint which helps perform varied movements like bending, twisting, climbing and kneeling. Therefore, it is more vulnerable to injuries due to a direct blow while hitting corners of the bed/table/door, twisting during walking on an uneven surface, etc. Load on the knees increases two times of the body weight while climbing up the stairs and threefold while climbing down.

Females are more prone to suffering from knee osteoarthritis after the age of 50 years due to the following reasons:

Genetics does play a key role in knee arthritis. Women whose mothers suffer from knee arthritis are more likely to develop it around the same age.

Women in our country have a tendency of gaining weight post-child birth (due to a combination of eating foods with a high fat content and lack of physical activity). An increase of one kilogramme of weight increases six kilogramme load on the knees. Obesity — Men become apple-shaped as the fat gets deposited around abdomen, and women become pear-shaped as the fat gets deposited around the buttocks. Wider hips with angling thigh bone put excessive pressure on the knees causing the knee cap shift sideways and rub the cartilage. This also overstretches thigh muscle quadriceps leading to pain in the upper part of the knee joint.

Females have less muscle mass as compared to men and hence less muscle support to the knee joint.

Women have more lax/flexible knees, making them more vulnerable to injuries.

Women have smaller ligaments which support the knee joint than men and hence knees are unstable.

Faulty biomechanics vis-a-vis bowleg, knock knees, etc, are more common among females. Under these conditions, the knee-cap moves towards one side rubbing against femur bone leading to pain.

Women wear high-heel shoes which pushes the body weight forward, placing more stress on the knees.

Cushioning of feet also changes with age, especially in females after menopause. An average foot has sufficient fat that acts as a shock absorber. With age, the fat content decreases, thereby reducing the shock absorbing capacity and placing more load on the knees.

Female hormone estrogen protects the knee cartilage which allows the smooth movement of the joint by reducing inflammation. Post-menopause estrogen levels decreases considerably, increasing the risk of developing knee arthritis.

Osteoporosis of the bones is more common in ladies after menopause due to reduced estrogen hormone.

Arthritis patients generally complain of knee pain while sitting or getting up which is alleviated while walking. As the disease progresses, pain is felt all the time.

The following precautions, if taken effectively, go a long way in reducing the load on the knee joint:

Avoid wearing high heels. If one has to wear heels due to short height or for looking nice, adequate physical activity with strengthening of muscles is mandatory. Strong muscles absorb the load of the body, thereby putting less pressure on the knees. During pregnancy diet may be increased for the child but it should be balanced and nutritive. Fats should be restricted. Physical activity along with appropriate exercises should be undertaken according to the trimester of pregnancy. If sitting cross-legged leads to pain/ discomfort, it is best avoided. Women sitting cross- legged especially at a place of worship are unable to get up. Pain/stiffness after a prolonged sitting is due to tightening of the thigh muscle quadriceps which control the knee joint. Secondly, knee cap patella, which generally floats when the knee is straightened, sits in a groove with bending and locks. After getting up and stretching, pressure decreases on patella and one feels better. Therefore, avoid prolonged sitting/ kneeling/deep squat, etc. Avoid walking on uneven or hard surface which increases load on the knees. TREATMENT

Women suffering from knee arthritis should maintain weight, wear sports shoes and knee brace, take Glucosamine/Diacerin for cartilage repair and undertake appropriate exercises. Hyaluronic acid injections dramatically alleviate the symptoms of pain, stiffness, etc.

The mechanism of action is by cushioning the knee joints and anti-inflammatory role.

EXERCISES

Aerobic activity — Low impact and non-weight-bearing aerobic exercises like cycling and swimming are ideal for the knees. Initiate with cycling/ walking in pool. When there is no pain on weight bearing, start walking for a short period of time. Increase the distance gradually every week till 20 minutes’ walking can be attained.

It is extremely important for females to protect their knees during younger age so as to prevent knee arthritis in older age. Total knee replacement is becoming popular as most women neglect the early signs of arthritis and try to treat it with medication only.

The writer is a former doctor/physiotherapist(ex), Indian cricket team. E-mail- [email protected]

Knee arthritis

Why women are more prone to knee arthritis (The Tribune: 18.7.2012)

Females are more prone to suffering from knee osteoarthritis after the age of 50 years due to the following reasons: Genetics does play a key role in knee arthritis. Women whose mothers suffer from knee arthritis are more likely to develop it around the same age.

Obesity — Men become apple-shaped as the fat gets deposited around abdomen, and women become pear-shaped as the fat gets deposited around the buttocks. Wider hips with angling thigh bone put excessive pressure on the knees causing the knee cap shift sideways and rub the cartilage. This also overstretches thigh muscle quadriceps leading to pain in the upper part of the knee joint.

Females have less muscle mass as compared to men and hence less muscle support to the knee joint.

Women have more lax/flexible knees, making them more vulnerable to injuries.

Women have smaller ligaments which support the knee joint than men and hence knees are unstable.

Faulty biomechanics vis-a-vis bowleg, knock knees, etc, are more common among females. Under these conditions, the knee-cap moves towards one side rubbing against femur bone leading to pain.

Women wear high-heel shoes which pushes the body weight forward, placing more stress on the knees.

Osteoporosis of the bones is more common in ladies after menopause due to reduced estrogen hormone.

Arthritis patients generally complain of knee pain while sitting or getting up which is alleviated while walking. As the disease progresses, pain is felt all the time.

The following precautions, if taken effectively, go a long way in reducing the load on the knee joint: Avoid wearing high heels. If one has to wear heels due to short height or for looking nice, adequate physical activity with strengthening of muscles is mandatory. Strong muscles absorb the load of the body, thereby putting less pressure on the knees. During pregnancy diet may be increased for the child but it should be balanced and nutritive. Fats should be restricted. Physical activity along with appropriate exercises should be undertaken according to the trimester of pregnancy.

If sitting cross-legged leads to pain/ discomfort, it is best avoided. Women sitting cross- legged especially at a place of worship are unable to get up. Pain/stiffness after a prolonged sitting is due to tightening of the thigh muscle quadriceps which control the knee joint. Secondly, knee cap patella, which generally floats when the knee is straightened, sits in a groove with bending and locks. After getting up and stretching, pressure decreases on patella and one feels better. Therefore, avoid prolonged sitting/ kneeling/deep squat, etc. Avoid walking on uneven or hard surface which increases load on the knees. TREATMENT

The mechanism of action is by cushioning the knee joints and anti-inflammatory role.

EXERCISES

The writer is a former doctor/physiotherapist(ex), Indian cricket team. E-mail- [email protected] Osteoporosis

Why diets high in salt up risk of kidney stones and osteoporosis (New Kerala: 26.7.2012)

Washington, July 25 Medical researchers at the University of Alberta may have solved why people who eat high-salt diets are prone to developing medical problems such as kidney stones and osteoporosis, the puzzle that has remained unknown to scientific community until now.

Principal investigator Todd Alexander and his team recently discovered an important link between sodium and calcium thorough their work with animal lab models and cells.

These both appear to be regulated by the same molecule in the body. When sodium intake becomes too high, the body gets rid of sodium via the urine, taking calcium with it, which depletes calcium stores in the body.

High levels of calcium in the urine lead to the development of kidney stones, while inadequate levels of calcium in the body lead to thin bones and osteoporosis.

"When the body tries to get rid of sodium via the urine, our findings suggest the body also gets rid of calcium at the same time," said Alexander, a Faculty of Medicine and Dentistry researcher.

"This is significant because we are eating more and more sodium in our diets, which means our bodies are getting rid of more and more calcium. Our findings reinforce why it is important to have a low-sodium diet and why it is important to have lower sodium levels in processed foods," he noted.

It's been known for a long time that this important molecule was responsible for sodium absorption in the body, but the discovery that it also plays a role in regulating calcium levels is new.

"We asked a simple question with our research – could sodium and calcium absorption be linked' And we discovered they are," said Alexander.

"We found a molecule that seems to have two jobs – regulating the levels of both calcium and sodium in the body. Our findings provide very real biological evidence that this relationship between sodium and calcium is real and linked," he added.

In their research, the team worked with lab models that didn't have this important molecule, so the models' urine contained high levels of calcium. Because calcium was not absorbed and retained by the body, bones became thin. Experts pointed out that this molecule could be a drug target to one day "treat kidney stones and osteoporosis."

Their findings were recently published in the peer-reviewed journal American Journal of Physiology – Renal Physiology. (ANI)

Arthritis

New treatment could halt arthritis spread (New Kerala: 1.8.2012)

Researchers have developed a potential new approach to treat chronic diseases such as arthritis, which involves the inflammation of one or more bone joints.

David Fairlie and his colleagues from The University of Queensland's Institute for Molecular Bioscience have developed an experimental treatment that effectively eases symptoms and stops the progression of the disease.

"Human enzymes called proteases stimulate the secretion of immune cells that, when the correct amount is released, play important roles in digestion, fighting infections and healing wounds," Fairlie was quoted as saying in the journal The Federation of American Societies For Experimental Biology.

"But in chronic inflammatory diseases such as arthritis, these enzymes continuously stimulate the release of immune cells, which cause inflammation when present at high levels. This leads to ongoing tissue damage," added Fairlie. Inflammation is the body's response to an injury, infection or illness, according to a Queensland statement.

Fairlie and his team have developed experimental compounds that block this stimulation and successfully reduce chronic inflammatory arthritis in experimental models.

If the treatment could be transferred to humans, it has the potential to reduce both the health and economic impacts of chronic inflammatory diseases. (IANS)

Arthritis

Stem cells may help prevent post-injury arthritis (New Kerala: 13.8.2012)

Researchers may have found a promising stem cell therapy for preventing osteoarthritis after a joint injury. Injuring a joint greatly raises the odds of getting a form of osteoarthritis called post- traumatic arthritis, or PTA. There are no therapies yet that modify or slow the progression of arthritis after injury.

Researchers at Duke University Health System have found a very promising therapeutic approach to PTA using a type of stem cell, called mesenchymal stem cells (MSCs), in mice with fractures that typically would lead to them developing arthritis.

Their findings could lead to a therapy that would be used after joint injury and before signs of significant osteoarthritis.

The scientists thought the stem cells would work to prevent PTA by altering the balance of inflammation and regeneration in knee joints, because these stem cells have beneficial properties in other regions of the body.

"The stem cells were able to prevent post-traumatic arthritis," said Farshid Guilak, Ph.D., director of orthopaedic research at Duke and senior author of the study.

The researchers also thought that a type of mice bred for their super-healing properties would probably fare better than typical mice, but they were wrong.

"We decided to investigate two therapies for the study, said lead author Brian Diekman, Ph.D., a postdoctoral researcher in the Guilak lab.

"We thought that stem cells from so-called superhealer mice would be superior at providing protection, and instead, we found that they were no better than stem cells from typical mice. We thought that maybe it would take stem cells from superhealers to gain an effect as strong as preventing arthritis after a fracture, but we were surprised - and excited - to learn that regular stem cells work just as well," he said.

Certain people appear to fall into the superhealer category, too. They bounce back quickly and heal well naturally after a fracture, while other people eventually form cases of arthritis at the fractured joint, said Guilak, who is a professor of orthopaedic surgery and biomedical engineering.

"The ability of the superhealer mice to have superior healing after a fracture may go beyond the properties of their stem cells and be some beneficial factor, like a growth factor, that we don't know about yet," Guilak said.

Diekman said the team looked at markers of inflammation and saw that the stem cells affected the inflammatory environment of the joint after fracture.

"The stem cells changed the levels of certain immune factors, called cytokines, and altered the bone healing response," said Diekman, who is also with the Duke Department of Biomedical Engineering. "We found that by placing the stem cells into low-oxygen conditions, they would grow more rapidly in culture so that we could deliver enough of them to make a difference therapeutically," Diekman said.

The study was published in Cell Transplantation. (ANI

Arthritis

Stem cells may help prevent post-injury arthritis (New Kerala: 13.8.2012)

Researchers may have found a promising stem cell therapy for preventing osteoarthritis after a joint injury.

Injuring a joint greatly raises the odds of getting a form of osteoarthritis called post- traumatic arthritis, or PTA. There are no therapies yet that modify or slow the progression of arthritis after injury.

Their findings could lead to a therapy that would be used after joint injury and before signs of significant osteoarthritis.

"The stem cells were able to prevent post-traumatic arthritis," said Farshid Guilak, Ph.D., director of orthopaedic research at Duke and senior author of the study.

The researchers also thought that a type of mice bred for their super-healing properties would probably fare better than typical mice, but they were wrong.

"We decided to investigate two therapies for the study, said lead author Brian Diekman, Ph.D., a postdoctoral researcher in the Guilak lab.

Diekman said the team looked at markers of inflammation and saw that the stem cells affected the inflammatory environment of the joint after fracture.

"The stem cells changed the levels of certain immune factors, called cytokines, and altered the bone healing response," said Diekman, who is also with the Duke Department of Biomedical Engineering.

"We found that by placing the stem cells into low-oxygen conditions, they would grow more rapidly in culture so that we could deliver enough of them to make a difference therapeutically," Diekman said.

The study was published in Cell Transplantation. (ANI

Osteoarthritis

Acupuncture may be low cost alternative to knee surgery for osteoarthritis (New Kerala: 22.8.2012)

Knee osteoarthritis patients who were treated with acupuncture had clinically significant improvements in pain levels, stiffness, and functional capacity after one month of treatment, researchers have found.

This suggests that acupuncture could be a low cost alternative to expensive knee surgery for osteoarthritis patients.

Their findings are based on 90 patients with knee osteoarthritis, who were referred for group acupuncture to two knee pain clinics in St Albans, Hertfordshire, in 2008 and subsequently monitored for two years. The clinics were set up in 2008 for NHS patients, and run in two GP practices by specially trained acupuncture nurses, to see whether this could improve care, while reducing costs, and offer a viable alternative to referrals for expensive knee replacement surgery

Knee replacement surgery works well, but it is not suitable for everyone, and as many as one in seven patients experience severe pain a few years after the procedure, say the researchers.

It also costs 5,000 pounds a pop, they add.

Out of 114 patients who were offered acupuncture for osteoarthritic knee pain in 2008, 90 accepted and were treated in the clinics. Their average age was 71. All the patients referred to the clinics had severe symptoms - constant pain, including at night, and inability to walk far - and would have been eligible for surgery.

They were given acupuncture once a week for a month after which the frequency was reduced to a session every six weeks.

Forty one patients were still attending the clinics after a year, and 31 were still receiving treatment after two years. Each patient received an average of 16.5 treatments.

A validated score (MYMOP), used to measure symptom control, functional capacity, and wellbeing, showed clinically significant improvements in pain levels, stiffness, and functional capacity after one month of treatment.

These improvements continued throughout the two year monitoring period, as assessed by MYMOP at six monthly intervals.

Based on the assumption that only two thirds of patients would take up an offer of acupuncture, the researchers calculated that the service could save the NHS around 100,000 pounds a year.

Each treatment costs the NHS 20 pounds. (ANI)

Arthritis

Rheumatoid Arthritis Infection Risk Identified (Med India:6.8.2012)

Scientists have managed to predict when rheumatoid arthritis patients are most likely to suffer infections. Not only is rheumatoid arthritis crippling and agonizing, it also makes the patient more vulnerable to infections that coincide with the disorder, increasing their risk of death. However, physicians have had a difficult time assessing the potential danger of infection an individual might face.

According to a Mayo Clinic study, a person's chances of having severe infections can be predicted by developing a risk score, which uses information regarding the impact the disease has on a patient, plus factors including age, corticosteroid use and if any other illnesses are present.

The findings, which were published in the American College of Rheumatology journal Arthritis & Rheumatism, came from medical records in the National Institutes of Health- funded Rochester Epidemiology Project of 584 individuals struggling with rheumatoid arthritis. The subjects were diagnosed between 1955 and 1994 and were observed until January 2000.

Almost half (252) of those studied needed hospitalization and/or intravenous antibiotic because of more than one severe infection. Collectively, the subjects had a total of 646 infections.

An infection risk score, based on those participants and other patients they observed, was created by the Mayo experts. In order to get an accurate calculation, scientists focused on certain factors, including: previous severe infections age corticosteroid use a low white blood cell count elevated results in a blood test used to detect signs of inflammation, called an erythrocyte sedimentation rate signs of rheumatoid arthritis outside the joints the existence of other serious conditions such as heart disease, diabetes, lung disease, heart failure, alcoholism, and vascular disease. The accuracy of the risk score was confirmed in a second group of people with rheumatoid arthritis from the same population.

Eric Matteson, M.D., chair of the Division of Rheumatology at Mayo Clinic and leading author, explained:

"Using a risk score in this way can alert physicians that their patient is at high risk for infection and needs more frequent follow-ups, measures for infection prevention and possible changes in treatments. Rheumatoid arthritis patients are at higher risk of infection, and that risk is clearly not just because of the arthritis drugs."

Further studies are required which focus on infection risk levels, so that patients may be prescribed the right drugs treat infections. The team added that infection risk impacts on what type of medications doctors may recommend, especially with regards to DMARDs (disease-modifying antirheuatic drugs). DMARDs are commonly used to treat rheumatoid arthritis.

In June 2012 German scientists tried to predict rheumatoid arthritis risk in an animal experiment with rabbits. They managed to successfully predict infection risk.

Atherosclerosis

Researchers Closer to Understanding Actions of Cells Involved in Atherosclerosis (Science daily;11.9.2012)

Researchers at St. Michael's Hospital are one step closer to understanding why plaque bursts in coronary arteries and causes heart attacks.

The clue might be something called microRNA-145. MicroRNAs are short chains of bossy molecules that scientists are increasingly coming to realize control a wide variety of biological processes.

Dr. Subodh Verma, a cardiac surgeon at St. Michael's, published a paper in the journal Circulation September 10, describing for the first time how microRNA-145 gene therapy can drastically reduce the severity and progression of atherosclerosis in mice.

In addition this approach appeared to make the atherosclerotic plaque more stable and less prone to burst.

Atherosclerosis, commonly called hardening of the arteries, is a condition in which fat, cholesterol and other substances build up in the walls of arteries and form hard structures called plaques. It is the leading cause of death in Canada.

Dr. Verma said most heart attacks occur when plaques rupture like a broken eggshell and release their contents into the artery. Researchers are therefore looking for ways to reduce the size of plaques and make them more stable.

One of the key questions is what causes the outer layer of the plaque to finally burst -- a layer of smooth muscle cells known as the fibrous cap. These cells undergo "phenotypic transformation" in response to various stressful environments and cardiovascular risk factors, making them more likely to rupture and cause heart attacks. MicroRNA-145 is one of the factors that appear to play a critical role in preventing the transformation of vascular smooth muscle cells into rupture-prone cells.

In atherosclerosis-prone animals, microRNA-145-based gene therapy reduced the plaque size by approximately 50 per cent and increased the collagen content of the plaque and fibrous cap area by 40 to 50 per cent, indicating that this therapy can reduce plaque buildup and also make it less prone to rupture, the inciting event of heart attacks.

The researchers also found that in human atherosclerotic plaques, the amount of microRNA-145 was reduced compared to normal arteries that were free of plaque, providing supporting human insights to the animal study.

"Atherosclerosis continues to be the number one killer in modern societies and finding new ways to treat this problem are needed," said Dr. Verma.

Dr. Fina Lovren, a senior research associate at St Michael's Hospital, carried out the experimental work on this project under the direction of Dr. Verma.

Hyponatremia

Hyponatremia Linked to Increased Risk of Death, Complications Following Surgery(Science daily;11.9.2012)

ScienceDaily (Sep. 10, 2012) — An observational study of nearly 1 million patients who underwent surgery suggests that preoperative hyponatremia (an electrolyte disorder in which sodium levels in the blood are low) was associated with an increased risk of complications and death within 30 days of surgery, according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.

Hyponatremia has been linked to increased morbidity and mortality in a variety of medical conditions but its association with perioperative (around the time of surgery) outcomes is uncertain, according to the study background.

Alexander A. Leung, M.D., of Brigham and Women's Hospital,Boston, and colleagues conducted a study using theAmericanCollegeof Surgeons National Surgical Quality Improvement Program database to identify 964,263 adults who underwent major surgery at more than 200 hospitals from 2005 through 2010. Preoperative hyponatremia (defined as sodium level <135mEq/L) was present in 75,423 surgical patients (7.8 percent).

"We found that preoperative hyponatremia was present in approximately 1 in 13 patients, and this group had a 44 percent increased risk of 30-day perioperative mortality, even after adjustment for all other potential risk factors," the authors note. "Preoperative hyponatremia was also associated with an increased risk of perioperative major coronary events, surgical site wound infections, pneumonia and prolonged hospital stays."

Preoperative hyponatremia was associated with a higher risk of 30-day mortality (5.2 percent vs. 1.3 percent). Hyponatremia also was associated with a greater risk of perioperative major coronary events (1.8 percent vs. 0.7 percent), wound infections (7.4 percent vs. 4.6 percent), pneumonia (3.7 percent vs. 1.5 percent), and prolonged median lengths of stay by about a day, according to the study results.

"Although this study provides evidence that preoperative hyponatremia is associated with perioperative morbidity and mortality, further research is needed to establish whether correcting preoperative hyponatremia will mitigate risks," the authors comment. "Legitimate concern should be raised about the safety of intervention as overly rapid or large changes to sodium levels over a short time can be potentially disastrous. Conversely, if monitored correction of hyponatremia is found to be safe and beneficial, it would strengthen causal inference and would be transformative to routine care since serum sodium is not presently recognized as an independent and reversible risk factor for perioperative complications."

Commentary: Is Preoperative Hyponatremia an Opportunity for Intervention?

In a commentary, Joseph A. Vassalotti, M.D., and Erin DuPree, M.D.,Mount Sinai Medical Center,New York, write: "Hyponatremia is familiar to physicians as the most common electrolyte disorder, occurring in up to 15 percent to 30 percent of hospitalized patients."

"Is there anything treating physicians can do to reduce the operative risk associated with hyponatremia? First, although routine assessment of serum sodium levels preoperatively is not recommended, 79 percent of patients had preoperative serum sodium testing in this study. Obviously, the first question should be whether serum sodium levels should be tested," they continue.

"The preoperative evaluation should strive to determine whether the patient is in optimal health and whether the individual's condition could be improved before surgery. Previous hyponatremia and conditions commonly associated with hyponatremia are reasonable indications to perform serum sodium assessment in a subpopulation of preoperative patients," they conclude.

Arthritis

AIIMS to soon start day care for arthritis (The Times of India:14.9.201)

New Delhi: For patients suffering from rheumatoid arthritis, an autoimmune disease that causes inflammation in joints, there is a good news. The All India Institute of Medical Sciences (AIIMS) is going to start ‘Rheumatology Day Care’ where patients will be able to receive specialized treatment in the form of intravenous infusions of biological agents, pulse therapy and joint injections.

According to Dr Uma Kumar, head of the clinical immunology and rheumatology service department, patients suffering from the advanced stage of the disease require intravenous infusions for pain management and reducing the inflammation. “Till now, we were able to treat a maximum of four patients daily because there was only one observation bed and the infusion takes two to four hours per patient. We also do certain diagnostic procedures, muscle biopsy and nerve biopsy. The new facility has six dedicate beds and we will be able to treat at least 16-20 patients now,” she said.

Kumar added that the facility, which is situated in the new private ward, will be inaugurated by the institute director Dr R C Deka on Friday. The rheumatology department at AIIMS gets 60 new cases every week and about 12,000 odd patients are registered for regular followup. Across India, about seven million people suffer from rheumatoid arthritis. Health experts say that the prevalence of the disease is more common in females.

Arthritis

Soaking in bath of salt water could ease agony of arthritis (New Kerala: 24.9.2012)

Scientists have a simple way to battle the agony of arthritis - soaking in a bath of salt water.

They say the saline solution reduces painful inflammation of the joints.

Even ordinary table salt in high concentrations can be used and, unlike conventional drugs, there are no unpleasant side effects.

"This research opens up exciting opportunities. What we've identified has the potential to be used to help so many patients," the Daily Express quoted Vincent Compan, of Manchester University's Faculty of Life Sciences, as saying.

Dr Compan and Dr Pablo Pelegrin found cells in the bodies of arthritis sufferers expand but salt water can reduce the swelling by dehydrating them. The salt worked the same whether it was injected into the body or absorbed through the skin via bandages soaked in saline or bathing.

"We have found that hypotonic solutions (low in salt) strongly activate inflammation at molecular level. Conversely, the use of hypertonic solutions (high in salt) was a potent inhibitor of such inflammatory signals at molecular level," Dr Pelegrin said. "Therefore, osmotherapy (dehydration) with hypertonic solutions could be beneficial in the management of inflammatory joint diseases, such as rheumatoid arthritis, either by prolonged soaking or by vapour pressure techniques," he noted.

The results were published in the journal Immunity. (ANI) Biomedical Science

DNA

Only mums’ blood can tell DNA of unborn baby (World Newspapers: 6.6.2012)

Stanford researchers have for the first time sequenced the genome of an unborn baby using only a blood sample from the mother.

The findings from the new approach are related to research that was reported a month ago from the University of Washington.

That research used a technique previously developed at Stanford to sequence a fetal genome using a blood sample from the mother, plus DNA samples from both the mother and father.

The whole genome sequencing in the new study, however, did not require DNA from the father — a significant advantage when a child’s true paternity may not be known (a situation estimated to affect as many as one in 10 births in this country) or the father may be unavailable or unwilling to provide a sample. The technique brings fetal genetic testing one step closer to routine clinical use.

“We’re interested in identifying conditions that can be treated before birth, or immediately after,” said Stephen Quake, PhD, the Lee Otterson Professor in the School of Engineering and professor of bioengineering and of applied physics.

“Without such diagnoses, newborns with treatable metabolic or immune system disorders suffer until their symptoms become noticeable and the causes determined,” he noted.

As the cost of such technology continues to drop, it will become increasingly common to diagnose genetic diseases within the first trimester of pregnancy, the researchers believe. In fact, they showed that sequencing just the exome, the coding portion of the genome, can provide clinically relevant information.

In the new study, the researchers at the Stanford University School of Medicine were able to use the whole-genome and exome sequences they obtained to determine that a fetus had DiGeorge syndrome, which is caused by a short deletion of chromosome 22. Although the exact symptoms and their severity can vary among affected individuals, it is associated with cardiac and neuromuscular problems, as well as cognitive impairment. Newborns with the condition can have significant feeding difficulties, heart defects and convulsions due to excessively low levels of calcium

“The problem of distinguishing the mother’s DNA from the fetus’s DNA, especially in the setting where they share the same abnormality, has seriously challenged investigators working in prenatal diagnosis for many years,” said Diana Bianchi, MD, executive director of the Mother Infant Research Institute at Tufts Medical Center, who was not involved in the Nature study.

“In this paper, Quake’s group elegantly shows how sequencing of the exome can show that a fetus has inherited DiGeorge syndrome from its mother,” she stated

Prenatal diagnosis is not new. For decades, women have undergone amniocentesis or chorionic villus sampling in an attempt to learn whether their fetus carries genetic abnormalities. These tests rely on obtaining cells or tissue from the fetus through a needle inserted in the uterus — a procedure that can itself lead to miscarriage in about one in 200 pregnancies. They also detect only a limited number of genetic conditions.

The new technique hinges on the fact that pregnant women have DNA from both their cells and the cells of their fetus circulating freely in their blood. In fact, the amount of circulating fetal DNA increases steadily during pregnancy, and late in the third trimester can be as high as 30 percent of the total.

The researchers plan to continue to develop the technology for eventual use in the clinic.

Stem Cells

Stem Cells from Amniotic Fluid (Medical News Today: 10.7.2012)

It is possible to take stem cells from amniotic fluid and reprogram them to a more versatile "pluripotent" state similar to embryonic stem cells and do this without inserting extra genes, according to a new study published online in the journal Molecular Therapy on 3 July.

Scientists from Imperial College London, and University College London Institute of Child Health, and colleagues, said their discovery means it may be possible to store stem cells from donated amniotic fluid for clinical and research use, offering a much needed alternative to the limited supply of embryonic stem cells.

"These cells have a wide range of potential applications in treatments and in research. We are particularly interested in exploring their use in genetic diseases diagnosed early in life or other diseases such as cerebral palsy," said co-senior author Dr Pascale Guillot, from the Department of Surgery and Cancer at Imperial.

Stem cells hold promise for regenerative medicine because they have the potential to become virtually any cell in the body. The current "gold standard" of human stem cells is the human embryonic stem cell (hESC), which is harvested from human embryos.

However, researchers and clinicians are keen to find alternatives to hESCs because of ethical concerns about using human embryos and also because of their limited availability.

Previous studies have shown it is possible to use other types of cell and, by introducing extra genes, often using viruses as carriers, make them almost as versatile or pluripotent as hESCs. For instance, scientists have reprogrammed human skin cells to behave like embryonic stem cells.

But this way of making induced pluripotent stem cells (iPSCs) is not efficient and there is also a risk that the DNA disruption that occurs (something the authors attribute to "random integration of the reprogramming transgenes into the host genome") will lead to tumors.

This new study is the first to make iPSCs without having to insert foreign genetic material into the cells.

Guillot and colleagues also found the iPSCs they made from amniotic fluid stem cells (AFSCs) showed some of the characteristics normally only seen in embryonic stem cells, that are not present in iPSCs made from adult cells.

Study co-senior author Dr Paolo De Coppi, from the UCL Institute of Child Health, and Great Ormond Street Hospital (GOSH), said:

"This study confirms that amniotic fluid is a good source of stem cells. The advantages of generating pluripotent cells without any genetic manipulation make them more likely to be used for therapy."

Amniotic fluid is a nourishing liquid that surrounds the fetus in the womb. As it contains cells from the fetus, including stem cells, it is sometimes used in a test called amniocentesis to screen for genetic diseases. The test, generally done in the first three months of pregnancy, carries a 1% risk of miscarriage.

For this study, Guillot, De Coppi and colleagues used stem cells (AFSCs) recovered from amniotic fluid taken for amniocentesis where the mothers had also given permission for it to be used for other purposes.

They then cultured the cells on a gelatinous protein medium developed for growing hESCs. They also added the drug valproic acid to the medium, which reprogrammed the AFSCs to a more primitive state. Extensive tests showed that the reprogrammed AFSCs were very similar to hESCs, for instance:

"The cells share 82% transcriptome identity with hESCs and are capable of forming embryoid bodies (EBs) in vitro and teratomas in vivo," write the authors.

Thus even after growing in culture for some time, the reprogrammed AFSCs had the potential to grow into functioning cells of many types, including liver, bone and nerve cells. They also kept this ability even after freezing and thawing.

In summarizing their achievement, Guillot said:

"Amniotic fluid stem cells are intermediate between embryonic stem cells and adult stem cells. They have some potential to develop into different cell types but they are not pluripotent. We've shown that they can revert to being pluripotent just by adding a chemical reagent that modifies the configuration of the DNA so that genes that are expressed in the embryo get switched back on."

He and his colleagues hope these findings show AFSCs have the potential to treat many diseases. Donated cells could be stored for clinical use, for research, and to screen drugs.

Previous research estimates that cells from 150 donors would provide a match for 38% of the population.

De Coppi said:

"At GOSH we have focused on building organs and tissues for the repair of congenital malformations, which are usually diagnosed during pregnancy. Finding the way of generating pluripotent cells from the fluid that surround the fetus in the womb move us one step further in the this direction."

Funds from the Genesis Research Trust, the Henry Smith Charity and the children's charity Action Medical Research, helped pay for the study.

Dr Caroline Johnston, Research Evaluation Manager with Action Medical Research said:

"These new findings could be a step forward for treatments of a wide range of diseases that affect babies and children."

The children's charity is also funding the team to investigate the therapeutic benefits of transplanting donated placental stem cells from healthy babies to babies with brittle bone disease. Long-Term Hormone

Long-Term Hormone Treatment Increases Synapses in Female Rats' Prefrontal Cortex (Science daily: 10.7.2012)

A new study of aged female rats found that long-term treatment with estrogen and a synthetic progesterone known as MPA increased levels of a protein marker of synapses in the prefrontal cortex, a brain region known to suffer significant losses in aging.

The new findings appear to contradict the results of the Women's Health Initiative, a long-term study begun in 1991 to analyze the effects of hormone therapy on a large sample of healthy postmenopausal women aged 50 to 79. Among other negative findings, the WHI found that long-term exposure to estrogen alone or to estrogen and MPA resulted in an increased risk of stroke and dementia. More recent research, however, suggests that starting hormone replacement therapy at the onset of menopause, rather than years or decades afterward, yields different results.

The new study, from researchers at the University of Illinois, is the first to look at the effects of long-term treatment with estrogen and MPA on the number of synapses in the prefrontal cortex of aged animals. The researchers describe their findings in a paper in the journal Menopause.

"The prefrontal cortex is the area of the human brain that loses the most volume with age," said U. of I. psychology professor and Beckman Institute affiliate Janice Juraska, who led the study with doctoral student Nioka Chisholm. "So understanding how anything affects the prefrontal cortex is important."

The prefrontal cortex, just behind the forehead in humans, governs what researchers call "executive function" -- planning, strategic thinking, working memory (the ability to hold information in mind just long enough to use it), self-control and other functions that tend to decline with age.

Most studies of the effects of hormone treatments on the brain have focused on the hippocampus, a structure important to spatial navigation and memory consolidation. The studies tend to use young animals exposed to hormones for very brief periods of time (one or two days to a few weeks at the most). They have yielded mixed results, with most research in young female animals indicating an increase in hippocampal synapses and hippocampal function after exposure to estrogen and MPA.

"For some reason, a lot of researchers still look at the effects of hormones in young animals," Chisholm said. "And there's a lot of evidence now saying that the aged brain is different; the effect of these hormones is not going to be the same."

The new study followed middle-aged rats exposed to estrogen alone, to no additional hormones, or to estrogen in combination with MPA for seven months, a time period that more closely corresponds to the experience of women who start hormone therapy at the onset of menopause and continue into old age. The researchers removed the rats' ovaries just prior to the hormone treatment (or lack of treatment) to mimic the changes that occur in humans during menopause.

"Our most important finding is that estrogen in combination with MPA can result in a greater number of synapses in the prefrontal cortex than (that seen) in animals that are not receiving hormone replacement," Chisholm said. "Estrogen alone marginally increased the synapses, but it took the combination with MPA to actually see the significant effect."

"Our data indicate that re-examining the effects of estrogen and MPA, when first given to women around the time of menopause, is merited," Juraska said.

Waste disposal

Wonders of waste disposal in Kanpur (The Indian Express: 25.7.2012)

We Indians have got so used to seeing garbage spilling over from municipal dustbins at street corners and often even strewn around in open public spaces, that we accept this phenomenon as inevitable. We look the other way with what seems like futile hope that some day, someone will find a solution to our problem and rid us of this major health hazard of urban living in India.

The integrated solid waste management project in Kanpur offers hope. Located on the western bank of the Ganga, Kanpur is an important industrial city of Uttar Pradesh, the largest state in India. With a population of 36 lakh (3.6 million) and a total area of 260 sq kilometres, the city is divided into 110 municipal wards. Kanpur has been home to textiles, leather, fertilisers and arms manufacturing, each with its capacity to pollute.

The state of solid waste management in Kanpur was no different from most other Indian cities until only a few years ago. Kanpur Nagar Nigam (KNN) had the responsibility for collecting, transporting and disposing of the solid waste generated in the city, estimated at about 1500 tonnes per day. There were numerous collection centres in the city, more than 400 of which were open dumps. A fleet of 132 vehicles and 3000 safai karmacharis were supposed to collect and transport the city garbage and dump it at an “authorised” site a few kilometres away from the city. This they did at an annual cost of Rs 42 crore, which has now come down to about half. Scientific disposal of the garbage was not even contemplated. The collection and transportation activity was financed out of grants from the state finance commission. A community of rag-pickers was involved in removing recyclable waste from the waste chain. It is worth recalling that it was only in 2000 that the Government of India, exercising its powers under the Environment (Protection) Act of 1986, notified the Municipal Solid Waste (Management and Handling) Rules. The Supreme Court played an important role in nudging the government to act in this area, which is otherwise the responsibility of the states. The Jawaharlal Nehru National Urban Renewal Mission (JNNURM) launched by the Government of India in 2005 further focused attention on the need to improve public service delivery in urban areas in general and solid waste management in particular, and provided funds to support such activity.

Seizing this opportunity, the KNN and the state government of Uttar Pradesh worked together to experiment with public-private partnership in transforming the system of solid waste management in the city.

On a recent visit to Kanpur, I was pleasantly surprised to find hardly any garbage on the streets. I visited what were earlier garbage collection centres in Shastri Nagar and near M.G. college, civil lines. These have now been converted into parks with the help of the local community. One of the largest dhalaos (open temporary dumpsite) has not only been converted to a park, but has become public space for expression of art; 11 art enthusiasts have made beautiful paintings on a wall which once stood testimony to public apathy towards urban hygiene. Yet another garbage collection centre has been converted into a ward office.

How did this happen? In June 2008, KNN gave a BOOT (build, own, operate, transfer) contract for processing and disposing of solid waste to A2Z Infrastructure, a private company, which was selected through a process of competitive bidding. Land (46 acres) was given free on a long lease of 30 years for the project. The plant to process 1500 tonnes per day capacity of solid waste was set up with a tipping platform, a pre- segregation unit, a composting unit, an RDF (Refuse Derived Fuel) unit, a plastic segregating unit, a briquette manufacturing unit, and a secured landfill in place.

Of the total project cost of Rs 110 crore, Rs 56.6 crore came from JNNURM and the rest from the private partner. Subsequently, the contract for collection and transportation was given to the same company, once again through a competitive bidding process. This created conditions in which the waste collection and transportation activities could be integrated with waste processing and its scientific disposal, with possibilities for revenue generation.

Door-to-door collection of garbage is being done in bins attached to rickshaws by safai mitras using hand gloves and protective masks. The garbage is directly unloaded into refuse compactor trucks of varying capacity, which can typically take the load of 40 to 50 bins. This way the garbage is compressed while being transported and more of it can be accommodated in the vehicle. There are still a few dumpsites on the streets, but they are on their way out. Each transport vehicle is equipped with GPS and every incidence of the compactor halt to collect garbage is monitored and recorded. This minimises the scope for deception and discourages fuel theft. Monthly user charges have been set by KNN in the range of Rs 30-50 for households, Rs 1000-6000 for industry and Rs 15 for the urban poor. These are collected by A2Z on behalf of KNN, and the monthly collection at present is Rs 0.75 crore. To sensitise people to the benefits of door-to-door collection, there was no charge in the first three months. As Vikram Singh, former municipal commissioner of Kanpur and the promoter of this partnership put it, “there is scope to recover up to Rs 1.5 crore from user charge collection”.

Rag-pickers have been given the opportunity of starting a new life. As Rajneesh Mehra of A2Z told me, “Some of the former rag-pickers (130, to be precise) now earn a regular salary as safai mitras, sport a bank ATM card, enjoy social security and health benefits, and their young kids have started going to schools. We plan to employ many more.”

The garbage is taken to a central site where it is sorted, segregated, transformed into a number of products of value, for example, premium quality compost, RDF, interlocking tiles from construction debris for use in footpath paving, etc. After selling off some other recyclable material, very little (less than 2 per cent or so) remains to be deposited in the landfill. The landfill, which was expected to fill up in seven years, may actually take much longer, thanks to the success in reusing most of the waste.

Kanpur Waste Management Plant is the largest producer of compost from organic waste; about 50 per cent of the waste collected from Kanpur is biodegradable. The quality of the compost is enhanced by scientific inputs coming from the R&D lab at the plant. The premium quality organic fertiliser is sold through fertiliser marketing companies like KRIBHCO, IPL, Coromandel, Green Star, and also directly under their own brand “Vasundhara”. The plant is not able to meet the growing demand for organic fertiliser thanks to the Fertiliser Control Order of 2010, which has defined the specifications of the compost made from organic sources, including food components and the scarcity of quality compost in the country.

In 2010, A2Z Infrastructure, the private company, invested Rs 110 crore of their own money in setting up a waste-to-energy plant, thus creating the largest integrated project in solid waste management in Asia. This power plant enabled the company to exploit the synergies between collection, processing and disposal. The plant produces 15 MW of electricity, using RDF produced in-house. It uses CFBC (Circulating Fluidised Bed Combustion) technology, an advanced fuel combustion technology from Germany. These boilers burn RDF, a fuel made from garbage at low temperatures ensuring that the plant does not emit any oxide of nitrogen or sulphur, nor dioxins and furans. It has negligible particulate emission, several times smaller than the national standards prescribed by the Central Pollution Control Board. This is the first use of CFBC technology in India and also its first use in less than 100 MW scale power plant in Asia. The plant has been registered with UNFCCC for carbon credits claiming certified carbon reductions achieved by CDM projects under the Kyoto protocol.

It is not surprising that the project has been recognised for its significant achievements. The Kanpur Nagar Nigam received the JNNURM award of excellence for Best City for Improvement in Solid Waste Management from the prime minister in 2011. While setting an example on solid waste for others, Kanpur must now address the challenge of liquid waste, joining hands with others to remove filth from the holy waters of the Ganga.

The writer is chairperson of ICRIER and former chairperson of the high-powered expert committee on urban infrastructure services

Surgical fraud

How ‘surgical fraud’ counts vary (The Indian Express: 25.7.2012)

In Raipur hospitals, a joke doing the rounds these days is: “Soon, someone will file an RTI to know the number of uteruses left in Chhattisgarh.” What has prompted it is, however, no joke. If a series of media reports in the state is to be believed, the uteruses of thousands of women have been removed in unnecessary operations.

These reports talk of doctors cheating BPL families by encouraging women to undergo hysterectomy so that the surgeons can collect insurance amounts under the Rashtriya Swasthya Bima Yojna. The RSBY provides cashless insurance of Rs 30,000 yearly to a BPL family; for a hysterectomy, a doctor can charge Rs 12,500.

These “thousands” are not in black and white. The only official figure the government or any media report has so far is of prima facie “fraudulent” operations on 22 women in three Raipur villages and the nine doctors who did these. The rest is allegedly all extrapolation.

What may have been hit by such reports is the RSBY, which has actually changed the lives of many. Besides, hysterectomies comprise less than 3 per cent of all RSBY claims in Chhattisgarh since it was introduced in 2009.

Following a preliminary probe, the government has held the nine doctors “prima facie guilty” and suspended them as the women “seemingly underwent hysterectomy without proper procedure”. The final report has not yet been submitted. The government has also sought data on every operation under the RSBY in the past 30 months, though there is no plan yet to probe these as is being reported.

THE NOISE

It was Dainik Bhaskar’s story ‘Cancer ka bhay dikhakar nikale garbhashay’ (Uteruses removed invoking the fear of cancer) that triggered the first charges. The reporter, said the story, had visited Raipur villages Manikchauri, Dongitarai and Hasda and found “dozens of cases” of uterus removal, “many of whom were women under 30”. Only two “case studies” were cited — both from Dongitarai.

One of the two women, Dropadi Bai, told The Indian Express she had undergone the operation of her own free will. Her clinical records suggested she could have avoided it but in many cases, The Indian Express found, the patients knew this and still went ahead.

Dainik Bhaskar ran a series of stories on “taabadtod surgery” across Chhattisgarh and cited figures of operations on 7,000 women since the RSBY was introduced in June 2009. “We sent a reporter to the three villages. We verified the records with other doctors and found that the operations were not required,” said Rajeev Singh, Dainik Bhaskar’s state editor. “These three villages were our only case studies... It is the duty of the government to investigate, and they are. We have RSBY figures and the figures raise suspicions.”

Other papers and TV channels picked up the story, but most of their reports have been short on detail and without verification of medical reports. “Some reporters got a random sample of some women in those villages, and extrapolated the figures for entire Chhattisgarh,” additional CEO (RSBY) in Chhattisgarh Vijendra Katare said.

Prompted to act under pressure against the 22 known cases, director (health services) Kamalpreet Singh said: “We are now getting details of each of these patients. We have suspended the doctors, but a final decision will be taken only after the report (of a fact- finding committee) is submitted.” Among the 22 are many non-RSBY cases, indicating that not all uteruses were “removed for insurance”.

THE RUSH

A few nursing homes have conducted over 300 such operations each under the RSBY, and their names are routinely flashed by papers. “Yes, some new doctors are doing wrongs to earn quick money. Establish their guilt and punish them, but don’t blame all doctors. There are many reputable names also. Check their records, meet their patients before writing about them,” said Dr R S Thakur of Ojasvi Hospital in Dhamtari. The hospital is among those whose clinical records are being verified.

Among the hospitals that find themselves in the dock is Gupta Hospital in Dhamtari, which has recorded the highest number of hysterectomies under the RSBY in Chhattisgarh. A Dainik Bhaskar report noted that Gupta Hospital had 604 hysterectomies in 900 days. In comparison, it said, the government-run Ambedkar Hospital in Raipur had seven.

Says Dr Prabhat Gupta of Gupta Hospital: “Yes, we conducted the operations. As for why Ambedkar Hospital had fewer patients, please ask them. If patients trust private doctors more, is it our fault, or because of the services we provide?”

He acknowledged a massive intake of BPL families, who now constitute 80 per cent of their patients. His son Dr Sumit Gupta explained: “There is a backlog of illnesses in poor families. Once you introduce a scheme like this, there will always be a rush for treatment. It will subside in a few years.” Also, a family knows that if it does not avail of the insurance, the amount will lapse after a year.

Figures before the RSBY are not available, but all doctors agree that the scheme has led to an at least 50 per cent increase — some say 70 — in the number of BPL families going for better healthcare. “The RSBY has caused a boom in private sector healthcare. With cash in hand, poor families obviously prefer private hospitals,” says Dr Rakesh Gupta of Raipur.

Chhattisgarh has seen 2,34,215 claims under the scheme so far, of which only 6,938 are hysterectomies. “If doctors cheat patients in this relatively complicated operation, they are more likely to cheat in simpler cases. Going by media accounts, the entire scheme should be marred by fraud,” an RSBY officer said.

Dr Rakesh Gupta, however, agreed the ratio of hysterectomies to all surgeries is suspicious. Of the 6,672 RSBY claims coming to Gupta Hospital, nearly 2,500 involved operations, one-fourth of these hysterectomies. The 341 hysterectomies at Ojasvi form around one-third of its surgeries. “If a hospital conducts one-third or one-fourth of its operations only of one kind, then it raises suspicions,” Dr Gupta said.

Insurance companies also seem to have had their doubts. RSBY officers in Raipur said Oriental Insurance Company and TAP Medsave had visited Gupta Hospital and inspected its records on several occasions, but found nothing dubious. Some alleged these hospitals had reached a deal with insurance agents and they are also part of the “racket”.

NEEDED OR NOT...

The doubts about the operations emerged largely because the patients concerned did not undergo proper tests before or after. Doctors admitted some tests were dispensed with and they exercised their “personal discretion”. “We largely go by clinical judgment,” said Dr Prajwal Soni of Soni Multispecialty Hospital in Razim, Gariaband. Two branches of this hospital together saw 409 hysterectomies.

Dr Soni is among those suspended. So is Dr Pankaj Jaiswal of Sewa Sadan Mata Rani Hospital in Gariband that recorded 513 hysterectomies. These two hospitals rank second and third, behind only Gupta Hospital, in terms of hysterectomies covered by the RSBY.

The Indian Express visited some patients of the two hospitals, including among the 22 whose cases are now being probed, got copies of their clinical records, and verified them with independent doctors in Raipur. The latter said hysterectomy had not been necessary in any of the cases and medication or other treatment could have worked. Said Dr Rakesh Gupta: “Removing such a vital organ without proper tests, and when a primary clinical examination clearly suggests it need not be removed, is not just medical negligence but criminal.”

There is another side to it. As Health Minister Amar Agarwal said, “There is no complaint so far from anywhere in the state.” The patients The Indian Express met, including those in the reproductive age between 30 and 45, confirmed this and added they had not been coerced.

In many cases, a village quack refers the woman to a pathologist or sonography centre, which then advises surgery. “There is a nexus working from village to city that pushes patients to doctors,” said endocrinologist Dr Biplab Bandyopadhyaya.

...THEY WANTED IT

There is another reason why women, especially in rural areas, opt willingly for hysterectomy. For them, the uterus is nothing but a “pouch for holding babies”, a “troublesome organ” associated with an often unwanted pregnancy and also the discomfort of menstruation. As many women of the ages 30-55 in villages and hospitals told this reporter, menstruation can be an extremely trying period, living as they do in houses without a toilet, where a shared pond is used for bathing, where sanitary pads are unavailable or rarely used, and where many taboos are associated with the process.

With husbands shying away from vasectomy or contraceptives, the women also live under a recurring fear of pregnancy. The sentiment is, “Get rid of the ‘burden’ once the family is complete”.

Devki Bai, 37, of Dongitarai had a pain in the abdomen and irregular periods for four or five years before she went in for the operation in April. Hers is among the cases being probed.

Armed with a smart card under the RSBY, Sonia Chelak of Hasda village too found it an easy option. In her early thirties, she has already had five children, including four daughters. Her husband is a labourer. She says she saw neighbourhood women opting for the operation and decided to have one too.

However, no one explains to these women the side-effects of uterus removal, such as hormonal disorders. Women confirm a gradual weakness after the operation, but would rather live with it than “suffer” the complications of having a uterus.

Dr Rakesh Gupta says that it’s the doctor’s duty to make women aware of these side- effects and to counsel them. “Let her insist. The doctor should never remove an organ when it’s not necessary," he said.

In fact, at least one major research paper on hysterectomies among women members of NGO SEWA had similar findings. As per the May 2011 paper in the international journal Reproductive Health Matters, nearly one-third of the insured women undergoing hysterectomy were younger than 35, and for them the operation was a way out of difficulties with menstruation and a range of gynaecological problems. Others didn’t want more children. “Women’s attitude towards menstruation was a significant driver in seeking hysterectomy,” said the paper.

It also found that many of the medical conditions mentioned in case of women who underwent hysterectomy were amenable to noninvasive, less expensive treatment options.

Incidentally the report covered not women in hinterland villages but Ahmedabad, among India’s most developed cities, and the insurance scheme was not a government one but that of SEWA.

Genes

Genes behind common childhood brain tumour identified(New Kerala:25.7.2012)

Researchers have identified several gene mutations responsible for the most common childhood brain tumor, called medulloblastoma.

The findings by researchers at the Stanford University School of Medicine and Lucile Packard Children's Hospital add evidence to the theory that the diagnosis is a group of genetically distinct cancers with different prognoses.

These and accompanying findings are likely to lead to less-toxic, better-targeted treatment approaches over the next two years, the researchers said.

"We tend to treat all medulloblastomas as one disease without taking into account how heterogeneous the tumours are at the molecular level," said Yoon-Jae Cho, MD, an assistant professor of neurology and neurological sciences at Stanford, a pediatric neurologist at Packard Children's and the senior author of the new research.

"This paper represents a finer-grained view of the genetic landscape of these tumors and provides us with some leads on how to develop new therapies," Cho stated.

The research is part of a large, ongoing effort to characterize genetic errors in medulloblastoma.

Current treatment for medulloblastoma, which originates in the cerebellum and affects about 250 U.S. children each year, begins with surgery to remove as much of the tumor as possible. Patients then receive a combination of radiation and chemotherapy, but the treatments are not tailored to the tumor's genetic characteristics. Cho's team extracted DNA from 92 medulloblastoma tumors and compared it with DNA from matched blood samples from the same patients, uncovering 12 significant "point mutations" — single-letter errors in the genetic code — that occurred frequently in the brain cancer. A handful of the mutations had been previously identified in smaller studies of medulloblastoma, but several mutations were novel in both medulloblastoma and in cancer.

Among the newly identified mutations was one in an RNA helicase gene, DDX3X, which Cho said is the second-most common mutation in medulloblastoma tumors.

"Mutations in this gene have now also been identified in other tumor types, such as chronic lymphocytic leukemia, and head and neck tumors," he said.

However, the researchers found that it was rare for the same gene mutated in several different patients' tumors. More commonly, mutations involving a set of genes regulating a single biological pathway were found in the tumors — a pattern that is emerging across cancer genome sequencing efforts.

Though no single tumor in the study carried all 12 mutations, the researchers were able to categorize the tumors according to which mutations they possessed.

"We now understand that there are certain tumors with particular genetic signatures that are really resistant to standard treatments," Cho said.

Children with medulloblastoma do not routinely have their tumors' genetic signatures characterized, but Cho believes that such characterization coupled with targeted therapies could greatly enhance tumor treatment.

About two-thirds of medulloblastoma patients now survive five years past diagnosis, but many survivors suffer lasting physical or intellectual side effects from their cancer treatments. Drugs tailored to a tumor's genetic profile have the potential to save more patients while reducing side effects, Cho said.

Several of the mutations discovered affect cellular signals that switch large groups of genes on and off.

"The dysregulation of these 'epigenetic programs' is becoming a common theme not only in medulloblastoma but across cancer," Cho said.

Such pathways may be good targets for cancer drugs; indeed, drugs targeting one such pathway (histone methyltransferases) are currently in pre-clinical development, while agents against another pathway (Hedgehog signaling pathway) are entering phase-2 clinical trials for medulloblastoma.

The research appeared online in Nature. (ANI) New Enzymes

Modeling of New Enzymes Helps Develop Therapies for Cocaine Abuse (Science Daily: 27.7.2012)

ScienceDaily (July 26, 2012) — Researchers from the University of Kentucky have designed and discovered a series of highly efficient enzymes that effectively metabolize cocaine. These high-activity cocaine-metabolizing enzymes could potentially prevent cocaine from producing physiological effects, and could aid in the treatment of drug dependency.

The results of this study by Chang-Guo Zhan et al are published in the journal PLOS Computational Biology.

The effectiveness of the enzymes' work was evaluated through modeling cocaine pharmacokinetics, the study of the body's action on administered external substances, such as cocaine, when the enzyme exists in the body. As there is no FDA-approved anti- cocaine medication, the medical and social consequences of cocaine abuse have made the development of anti-cocaine medication a high priority.

Administration of an enzyme to enhance cocaine metabolism has been recognized as a promising treatment strategy for overdose and abuse. A remarkable feature of the enzyme-based therapeutic approach is that one enzyme molecule can degrade many thousands of drug molecules per minute.

This pharmacokinetic modelling is a crucial step of enzyme-based therapy development for cocaine abuse. Furthermore, the general insights of the research should also be valuable for future development of an enzyme therapy for any addictive drug, as the general methodology of the modelling may be used to develop valuable models for evaluating the effectiveness of metabolic enzymes in detoxifying other drugs.

DNA

UNRAVELLING MYSTERY DNA may have predated origin of life itself (The Times of India:28.8.2012)

London: Scientists are closer to demonstrating that DNA can form spontaneously from chemicals thought to be present on the primordial Earth suggesting that DNA could have predated the birth of life itself. Deoxyribonucleic acid (DNA) is essential to almost all life on Earth, yet most biologists think that life began with Ribonucleic acid (RNA). Just like DNA, it stores genetic information. Prebiotic chemists have so far largely ignored DNA, because its complexity suggests it cannot possibly form spontaneously, the New Scientist reported. Conventional wisdom is that RNA-based life eventually switched to DNA because DNA is better at storing information. In other words, RNA organisms made the first DNA. The story makes more sense if DNA nucleotides were naturally present in the environment. Organisms could have taken up and used them, later developing the tools to make their own DNA once it became clear how advantageous the molecule was — and once natural supplies began to run low,” Christopher Switzer of the University of California, Riverside said. RNA can also fold into complex shapes that can clamp onto other molecules and speed up chemical reactions, just like a protein, and it is structurally simpler than DNA, so might be easier to make. In 2009 researchers finally managed to generate RNA using chemicals that probably existed on the early Earth. PTI

Blood clots

‘Clot nets’ to help in stroke recovery (The Times of India: 28.8.2012)

London: Using small nets to extract blood clots from patients’ brains instead of a coil may improve their recovery, two new studies have claimed. The latest methods involve a tiny wire cage instead of a coil. This pushes the clot up against the walls of the artery and enmeshes the clot in the wires, allowing doctors to pull the clot back out of the groin.

Two similar devices were compared with the current coil methods. One trial of 113 patients showed 58% had good brain function after three months, compared with 33% of those treated with the coil method, as well as a lower death rate.

Clots block blood vessels, starving parts of the brain of oxygen, which leads to symptoms such as paralysis and loss of speech. Two studies, presented in the Lancet medical journal, suggest extracting clots with nets could improve recovery, the BBC reported. There are already techniques for reopening blocked blood vessels in people’s brains.

Some patients will be given “clot-busting” drugs, but this needs to be in the hours just after the stroke and is not suitable for everyone. PTI Neurological Disorders

Studying Everyday Eye Movements Could Aid in Diagnosis of Neurological Disorders (Science Daily:31.8.2012)

Researchers at USC have devised a method for detecting certain neurological disorders through the study of eye movements.

In a study published August 30 in the Journal of Neurology, researchers claim that because Attention Deficit Hyperactivity Disorder (ADHD), Fetal Alcohol Spectrum Disorder (FASD) and Parkinson's Disease each involve ocular control and attention dysfunctions, they can be easily identified through an evaluation of how patients move their eyes while they watch television.

"Natural attention and eye movement behavior -- like a drop of saliva -- contains a biometric signature of an individual and her/his state of brain function or dysfunction," the article states. "Such individual signatures, and especially potential biomarkers of particular neurological disorders which they may contain, however, have not yet been successfully decoded."

Typical methods of detection -- clinical evaluation, structured behavioral tasks and neuroimaging -- are costly, labor-intensive and limited by a patient's ability to understand and comply with instructions.

To solve this problem, doctoral student Po-He Tseng and Professor Laurent Itti of the Department of Computer Science at the USC Viterbi School of Engineering, along with collaborators at Queen's University in Canada, have devised a new screening method.

Participants in the study were simply instructed to "watch and enjoy" television clips for 20 minutes while their eye movements were recorded. Eye-tracking data was then combined with normative eye-tracking data and a computational model of visual attention to extract 224 quantitative features, allowing the team to use new machine- learning techniques to identify critical features that differentiated patients from control subjects.

With eye movement data from 108 subjects, the team was able to identify older adults with Parkinson's Disease with 89.6 percent accuracy, and children with either ADHD or FASD with 77.3 percent accuracy.

Providing new insights into which aspects of attention and gaze control are affected by specific disorders, the team's method provides considerable promise as an easily deployed, low-cost, high-throughput screening tool, especially for young children and elderly populations who may be less compliant to traditional tests.

"For the first time, we can actually decode a person's neurological state from their everyday behavior, without having to subject them to difficult or time-consuming tests," Itti said.

Funding for the research came from the National Science Foundation, the Army Research Office, the Human Frontier Science Program and the Canadian Institutes of Health Research. Immune System

American Researchers Identify New Response Mechanism of Immune System Towards Infection (Med India:3.9.2012)

A previously undiscovered “first response” mechanism of the immune system when it detects infection has been identify by researchers at Albert Einstein College of Medicine at Yeshiva University.

The findings challenge the current understanding of immunity and could lead to new strategies for boosting effectiveness of all vaccines. The study, conducted in mice, published online today in the journal Immunity.

Grégoire Lauvau, Ph.D.One way the immune system protects the body against microbes like bacteria and viruses is with memory CD8+ T cells, so named because they can "remember" the invading organisms. If someone is later infected by that same microbe, memory CD8+ T cells recognize the invaders and multiply rapidly, forming an army of cytotoxic T cells to hunt down and destroy the microbes and the cells they've infected. This highly specific immune response forms the basis for most vaccines—but it can take several weeks for them to prime the immune system to respond to "real" infections.

This new study shows that the immune system has another, faster method for responding to infections that could be exploited to produce faster-acting vaccines.

"Our research has revealed that pathogen-specific memory CD8+ T cells are reactivated even before they recognize the antigen they previously encountered," said study leader Grégoire Lauvau, Ph.D., associate professor of microbiology and immunology at Einstein. (Antigens are protein fragments of microbes that trigger an immune response.)

Dr. Lauvau and his colleagues found that this fast-acting immune response is orchestrated by a type of white cell called inflammatory monocytes. After the immune system detects an infection, it recruits monocytes to the affected tissues, where they release inflammatory signals called cytokines. Those inflammatory signals not only activate every memory CD8+ T cell that has previously encountered a pathogen but also stimulate the activation of natural killer cells, another type of white blood cell.

The result is a protective immunologic environment capable of defending against microbes of any kind—viruses, bacteria or parasites. Only later do memory CD8+ T cells specific for that microbe's antigen begin to multiply, enabling the immune system to launch its focused attack on that particular microbe.

"We're not saying that recognizing the antigen is unimportant in the immune response," says Dr. Lauvau. "You do need the antigen later on, to cause memory CD8+ T cells to multiply and to get full pathogen-specific protection. But it doesn't seem to be needed during the days immediately following re-infection, when this early form of immunity is operating."

"It's too early to apply these findings clinically," said Dr. Lauvau. "For example, we still need to identify all of the cells and signaling molecules that are involved, and learn how and when the immune system switches from the first phase of protection to the second phase, where you have the antigen. But the important concept to take from this study is that it may be possible to improve vaccines by making this early, generalized immune response persist for a longer time until the later, targeted immune response kicks in."

Human biology

Junk’ gene switches in DNA behind range of diseases: Study(The Times of India:6.9.2012)

GINA KOLATA

Among the many mysteries of human biology is why complex diseases like diabetes, high blood pressure and psychiatric disorders are so difficult to predict and, often, to treat. An equally perplexing puzzle is why one individual gets a disease like cancer or depression, while an identical twin remains perfectly healthy.

Now scientists have discovered a vital clue to unraveling these riddles. The human genome is packed with at least four million gene switches that reside in bits of DNA that once were dismissed as “junk” but that turn out to play critical roles in controlling how cells, organs and other tissues behave. The discovery, considered a major breakthrough, has enormous implications because many complex diseases appear to be caused by tiny changes in hundreds of gene switches.

The findings are the fruit of an immense federal project, involving 440 scientists from 32 labs around the world. As they delved into the “junk” — parts of the DNA that are not actual genes containing instructions for proteins — they discovered it is not junk at all. At least 80 per cent of it is active and needed. The result is an annotated road map of much of this DNA, noting what it is doing and how. It includes the system of switches that control which genes are used in a cell and when they are used, and determine, for instance, is a cell becomes a liver cell or a neuron.

The findings have immediate applications for understanding how alterations in the non- gene parts of DNA contribute to human diseases, which may in turn lead to new drugs. They can also help explain how the environment can affect disease risk. In the case of identical twins, small changes in environmental exposure can slightly alter gene switches, with the result that one twin gets a disease and the other does not.

It’s Google maps,” said Eric Lander, president and founding director of the Broad Institute of Harvard and the Massachusetts Institute of Technology. Its predecessor, the Human Genome Project, which determined the entire sequence of human DNA, “was like getting a picture of earth from space,” he said. “It doesn’t tell you where the roads are, it doesn’t tell you what traffic is like at what time of the day, it doesn’t tell you where the good restaurants are, or cities or rivers.”

“Now you can follow the roads and see the traffic circulation. That’s exactly the same way we will use these data in cancer research.” Encode, for Encyclopedia of DNA Elements, provides a road map with traffic patterns for alternate ways to go after cancer genes, he said.

The discoveries were published on Wednesday in six papers in the journal Nature and in 24 papers in Genome Research and Genome Biology. In addition, The Journal of Biological Chemistry is publishing six review articles and Science is publishing yet another article.

In one of the Nature papers, researchers link the gene switches to a range of human diseases — multiple sclerosis, lupus, rheumatoid arthritis, Crohn’s disease, celiac disease — and even to traits like height. In large studies over the past decade, scientists found that minor changes in DNA sequences increase risk that a person will get those diseases. But those changes were in the junk, now often referred to as the dark matter — they were not changes in genes — and it was not clear what their significance was.

Human Genome

80% of human genome has an active role or function (The Hindu:6.9.2012) Insight into: The ENCODE data will help in explaining how genetic variants that do not affect the structure of encoded proteins could affect a person's susceptibility to disease. Photo: National Institutes of Health science and technology natural science

Junk DNA is actually populated by massive number of features that help gene regulation

In 2001, scientists thought only 20,000 genes comprising about one per cent of the human genome code for proteins. And the remaining genome was at best considered junk DNA! These were the findings of researchers who completed the Human Genome Project, the blue print of human biology.

If many researchers doubted this, the ENCODE project (ENCyclopedia Of DNA Elements), which was started in 2003 and picked up where the Human Genome Project had left off, has been proving that it is far from true.

The final results announced today (September 6) in 30 papers and published in three journals — Nature, Genome Research and Genome Biology — show why the ENCODE scientists think so.

Junk DNA

The junk DNA is indeed not a wasteland. “The vast desert regions have now been populated by hundreds of thousands of features that contribute to gene regulation. And every cell type uses different combinations and permutations of these features to generate its unique biology,” writes Brendan Maher, a Features Editor for Nature.

The researchers have presented today the results of 1,648 experiments done on 147 cell types.

To start with, the ENCODE project has found that not one per cent but 80.4 per cent of the genome has an active role or function. For instance, it could be “promoter” regions where “proteins bind to control gene expression” or “enhancer” regions that “regulate the expression of distant genes.”

The most important part is that genes comprise only 2 per cent of the genome. The regulatory regions are scattered in the 98 per cent of the genome. This underlines the fact that a major portion of the human genome is indeed not junk DNA.

“Specialised proteins (called regulatory factors), recognise specific DNA sequences in these regulatory regions, thereby creating switches that turn genes on and off, states a University of Washington press release. The on/off switches are otherwise called the regulatory DNA, and the genes are as good as useless in the absence of the switches (regulatory DNA).

Incidentally, in a very few cases, the switches are located far away from the genes they control, thus making it difficult to determine the relationship between the two.

A paper in Nature explains the important features of organisation and functioning of the human genome. It states that in 95 per cent of the cases, the genes are in close proximity to the regulatory switches.

To their amazement, the researchers found that most genes are not controlled by just one switch. Instead, the genes are regulated by more than a dozen switches. In other words, there is no one-to-one relationship between a gene and a switch.

“The scientists determined that genes are connected in a complex web. In this web, regulatory DNA regions typically control one or at most a few genes, but genes receive inputs from large numbers of regulatory regions,” states the release.

What is a gene

According to a paper in Nature by Thomas Gingeras from Cold Spring Harbor Laboratory and his team, the very meaning of a gene and “minimum unit of heredity” stands questioned. For instance, an overwhelming 75 per cent of the genome has its transcription done at “some points in some cells.”

According to conventional thinking, genes are copied (transcribed) into RNA molecules. This then serves as a template for making the necessary protein. But this belief may no longer be valid.

“It has been evident [since 2007] that there is much more to a gene than just a sequence that codes for protein, changing our concept of what defines a gene,” states a Genome Research release. “We now know that the genome is not a set of discrete genes, but rather a complex system of genes and regulatory regions, much of which is transcribed into RNA, including many RNAs that do not code for proteins but have critical cellular functions.”

Prof. Gingeras and his team also discovered a new class of functional RNAs. They also found that some parts of one gene or functional RNA can be found within another. These two observations completely change our understanding of genome architecture.

Useless DNAs?

Nature gets has a system in place to get rid of useless body parts or even DNAs. That being so, will nature still continue to harbour a large part of the genome that does not code for proteins?

ENCODE provides the answer. These ‘useless’ or non-coding stretches of the genome actually produce non-coding RNAs, which play a role in both activation and silencing of protein-coding genes.

Finding the genetic basis for diseases has been the goal of researchers during the last few years. The data from the functional non-coding regions provide hope for these researchers. Some genes associated with diseases are found in the non-coding regions of the genome, and are relatively “common” in the population.

“ENCODE is a foundation data set for understanding the human genome,” writes Ewan Birney, the coordinator of the ENCODE project in a paper in Nature.

ENCODE is a truly international collaborative effort — 442 scientists from 32 laboratories in the U.K., U.S, Spain, Singapore and Japan were involved. They generated and analysed over 15 terabytes (15 trillion bytes) of raw data. True to its international team effort, all of the data from the project is freely available to the public.

The ENCODE team found that 76 per cent of disease-associated variants in the non-gene regions are linked to the regulatory DNA. This sheds new light on the contributing factors for many diseases. More than changes in the gene per se, diseases may arise depending on changes in when, where and how genes are turned on.

Keywords: Human Genome Project, ENCODE project, ENCyclopedia Of DNA Elements, Nature, Genome Research, Genome Biology, junk DNA, DNA sequencing Bariatric and metabolic surgery

Bariatric and metabolic surgery (The Tribune: 12.9.2012)

A boon for obese and diabetics

Obesity which was once not a problem in India is a fast growing menace now. Succumbing to computers, cola and fast food cultures, incidence of obesity in India is more than 9% — about 60 million population is in the obesity zone. Punjab is the most obese state of India with figures as high as 35. No doubt, it was a disease of the developed world in the beginning, but now it has spread its tentacles to India and is engulfing very fast the new generation.

Obesity brings with it diseases like type-II diabetes, high cholesterol, high BP, snoring (sleep apnea) and joint pains. India tops the rank in diabetes mellitus in the world and it is estimated that by 2030 India will still be the number one in the incidence of diabetes in the whole world.

Though the main cause of obesity is genetics (about 60%), the rest 40% is because of the lifestyle and behavioral factors.

Proper diet and exercise should be the first step to combat obesity. But it is seen that with proper balanced diet and exercise, one can lose weight. However, once a person discontinues this regime, he may regain their weight.

Bariatric surgery is one miraculous surgery which helps to lose more than 70% of EWL (excess weight loss) and also helps in remission of diabetes mellitus type II, corrects the cholesterol level, cures snoring and sleep aponea. It is not a cosmetic surgery but a lifesaving surgery. Bariatric surgery works on the principle of rerouting your alimentary canal so that calories intake is less than the calories burnt.

For any individual to undergo bariatric surgery he or she has to be guided by BMI (body mass index). For a patient to be obese BMI>27.

Bariatric surgery is basially of two types:

(A) Restrictive

(B) Restrictive and malabsoptive

Restrictive:

1. Laparoscopic gastric sleeve resection:

(a) About 2/13rd of stomach along the greater curvature is removed, thus a small pouch of new stomach so formed has a capacity of approximately one ounce.

(b) Excess weight loss is about 50-60%.

2. Laparoscopic gastric band:

(a) A band of special material is placed around the upper end of the stomach. This creates a small pouch and narrow passage into the rest of the stomach.

(b) Excess weight loss is about 30-40%.

Restrictive and malabsoptive

1. Laparoscopic Roux-N-Y gastric bypass:

(a) This is the most common bariatric procedure. First, we create a small stomach pouch with staples or a vertical bank. This restricts food intake. Then we attach a ‘Y’ shaped section of the small intestine to the pouch to allow food to bypass the first and second segments of the small intestine. This reduces your body’s ability to absorb nutrients and calories.

The writer is a Jalandhar-based surgeon.

Cells

Found: Cells that may help diagnose cancer early (The Times of India:12.9.2012)

Washington: Scientists claim to have discovered a population of cells that could lead to early diagnosis of cancer and innovative therapeutic strategies for the deadly disease. Researchers at the Mount Sinai School of Medicine have identified a subpopulation of cells which display cancer stem cell properties, are resistance to chemotherapy and participate in tumour progression. Resistance to chemotherapy is a frequent and devastating phenomenon that occurs in cancer patients during certain treatments. Unfortunately, tumours that initially respond to chemotherapy eventually become resistant to it, contributing to tumour progression and death, the esperts said. The study showed that these new cancer “stem” cells, which have not been differentiated into more specific cell types, are capable of multiplying despite being exposed to chemotherapy, while differentiated cells die. The research Led by Dr Carlos Cordon- Cardo and Josep Domingo-Domenech generated cellular models of drug resistance by treating prostate tumour cell lines with increasing doses of chemotherapy drugs. PTI

Therapeutic Antibodies Devised

Powerful New Method for Finding Therapeutic Antibodies Devised: Technique Hones and Expands the Power of Large Numbers (Science Daily:12.9.2012)

Science Daily (Sep. 11, 2012) — Scientists at The Scripps Research Institute have found a new technique that should greatly speed the discovery of medically and scientifically useful antibodies, immune system proteins that detect and destroy invaders such as bacteria and viruses. New methods to discover antibodies are important because antibodies make up the fastest growing sector of human therapeutics; it is estimated that by 2014 the top-three selling drugs worldwide will be antibodies. The new technique, described in an article this week published online ahead of print by the journal Proceedings of the National Academy of Sciences, enables researchers to search large libraries of antibodies and quickly select the ones with a desired biological effect. It also provides for the creation of unusual, asymmetric antibodies whose capabilities extend beyond those of natural antibodies. The Scripps Research scientists demonstrated the power of the technique by using it to find an asymmetric antibody that almost perfectly mimics the activity of erythropoietin (EPO), a medically valuable hormone.

"Traditionally we've looked at antibodies as tools for binding to specific targets, but we should view them more generally, as tools for probing and altering functions in cells," said Richard Lerner, the Lita Annenberg Hazen Professor of Immunochemistry and member of the Department of Molecular Biology at Scripps Research who led the new study.

At the Vanguard

Lab-grown antibodies already represent a major part of the ongoing biotechnology revolution. Used as scientific probes or medical therapies, they recreate the versatility of natural antibodies, which are produced by immune cells in a vast diversity to bind to highly specific shapes on viruses, bacteria, and other targets.

Two decades ago, Lerner and his laboratory at Scripps Research, in parallel with the group of Sir Gregory Winter at the Laboratory of Molecular Biology in Britain, developed the first techniques for generating very large libraries of combinatorial antibodies and quickly isolating those that can bind to a desired target. Since then, such techniques have been used to find antibodies to treat cancer, arthritis, transplant rejection, and other conditions. Humira, an anti-inflammatory antibody that was discovered this way, is expected to be the world's top-selling drug this year. Belimumab (Benlysta®) was approved by the US Food and Drug Administration in 2011 to treat lupus, becoming the first new drug to treat the chronic, life-threatening inflammatory disease in more than 50 years.

Current antibody-discovery techniques have one big drawback, however. Although they can rapidly find antibodies that bind tightly to a known target, they can't rapidly determine which of those antibodies has useful biological activity. An antibody may bind tightly to a virus without affecting the virus's ability to infect cells, for example, or it may bind to a cellular receptor without activating that receptor. With current techniques, determining the overall biological effect of a target-binding antibody typically requires further, painstaking analysis.

A More Direct Path

In the new study, Lerner and his postdoctoral researcher Hongkai Zhang sought a method for rapidly finding antibodies that have a desired effect on cells, not just a desired ability to bind to a target. As a proof of principle, they aimed to discover an antibody that could mimic the activity of EPO, a hormone that stimulates red blood cell production. Drugs that mimic EPO's effect are commonly used to treat anemia and related conditions.

Zhang began by using traditional techniques to quickly sift through a large antibody library to find tens of thousands of antibodies that bind tightly to the EPO receptor. He then stepped beyond traditional techniques, by taking the genes that encoded these EPO- receptor-binding antibodies and inserting them into lentiviruses. Unlike the phage viruses used in traditional methods, lentiviruses can usefully infect mammalian cells, delivering their payloads -- antibodies, in this case -- into a more human-like cellular environment.

Zhang applied this new library of antibody-coding lentiviruses to a single, large culture of mammalian test cells. The cells were of a type that express EPO receptors and proliferate when these receptors are bound by EPO proteins -- or by antibodies that effectively mimic EPO. Each of these cells could host only a few viral particles at most, so in this way Zhang was able to distribute the entire library of EPO-receptor-binding antibodies broadly within the cell culture. Zhang also cultured the cells in a special way that prevented antibodies secreted by one cell from spreading easily to nearby cells and muddying any cause-effect relationship. "This concern over the diffusion of antibodies in the culture was one of the factors that had discouraged other researchers from using such a technique," said Zhang.

After the lentiviruses had delivered the antibodies to the cultured cells, Zhang was able to note which cells were proliferating the most -- signifying the presence of antibodies that mimic EPO. To identify the antibodies responsible, Zhang had only to harvest these faster-growing cells and sequence the antibody genes inside them.

This method quickly yielded an antibody that in a further test showed about 60 percent of the biological activity of natural EPO -- which was as good as any antibody EPO-mimic that had ever been described.

Opening the Door to the Unknown

But Zhang and Lerner also noted that many of the proliferating cells had been infected by multiple lentivirus particles, and contained sequences from more than one antibody. Puzzlingly, Zhang found that when he recreated antibodies from these sequences, and tested them individually or in combinations, they showed no significant EPO-mimicking effect. Further tests showed that the source of the EPO-mimicking effect in the test cells was an antibody that does not occur naturally.

An antibody of the type used in the study has a Y-shaped structure, normally with two identical binding arms. But the presence of multiple antibody genes within some of Zhang's test cells meant that, in a few cases, antibodies assembled themselves with two different binding arms. One of these "bispecific" antibodies turned out to bind to the EPO receptor -- which has two binding sites -- in a way that very accurately mimics the binding of a natural EPO molecule. "It turned out to be 100 percent as potent as authentic EPO in further tests," Zhang said.

The serendipitous finding represents another major innovation, for, in principle, it extends the medical and scientific antibody repertoire from the 100 billion or so known variants of same-armed antibodies to an astronomically higher number of bispecific variants. Experiments to test such variants will be limited by the maximum number of usable cells in cultures, but that number is still very high, on the order of 10 million. "That allows for a lot of unique binding events," said Lerner. "You probably can get almost anything that way."

Lerner emphasizes that this new antibody-engineering/discovery technique can be used not just against known targets such as the EPO receptor, but also against cellular functions involving targets that have not yet been found. "The real power of this technique is its ability to help us discover the unknown," he said.

Genetic test

Expert develop genetic test to predict Autism (The Asian Age: 14.9.2012)

Australian scientists have developed a genetic test to predict autism spectrum disorder in children, which could provide a long-sought way for early detection and intervention, according to a study published on Wednesday. About one in 150 children has autism, with symptoms ranging from social awkwardness and narrow interests to severe communication and intellectual disabilities, said researchers led by the University of Melbourne. The researchers used US data from more than 3,000 individuals with autism in their study to identify 237 genetic markers in 146 genes and related cellular pathways. By measuring these markers, which either contribute to or protect an individual from developing autism, scientists could assess the risk of developing autism. -Reuters

Antiretroviral therapy (ART)

Starting ART early prevents tuberculosis The Hindu:13.9.2012)

AP Antiretroviral therapy (ART) should be started before the CD4 count drops to less than 350. File Photo( That starting antiretroviral therapy (ART) in discordant couples, where one of the two partners is HIV positive, results in 96 per cent reduction in sexual HIV transmission became clear after the HPTN 052 trial. The trial took place between 2005 and 2010 in 12 countries, and had an intervention group and a control group.

The intervention group received ART, counselling, free condoms, testing and treatment for sexually transmitted infections. Except for ART, the control group got every other every medical and non-medical attention.

The YRG Care Medical Centre based in Chennai was one of the trial sites. They had recruited 250 volunteers. After completion of the trial, Dr. N. Kumarasamy, Principal Investigator of the trial and also the Chief Medical Officer at YRG Care undertook a sub- analysis whose primary objective was to investigate whether those in the intervention group showed any reduction in active TB incidence.

“We saw very significant reduction in TB incidence in those who got ART,” said Dr. Kumarasamy. “The trial has shown positive effects in TB prevention in those who are infected with HIV. So the ART programme should start medication on patients even before the CD4 count drops to less than 350.”

There may be the additional benefit of preventing active TB in HIV infected individuals, but will early initiation of ART not prove to be more expensive? “No, we found it to be cost effective, both to the participants and the programme offering ART,” he responded.

According to him, YRG Care in collaboration with Harvard University did the costing using an HIV microsimulation model. Data from India and South Africa were used to arrive at costing. “We found it to be cost effective if we start treatment early,” he said.

For the HIV positive individual, in the absence of early treatment the CD4 count tends to drop, thus putting him at risk of developing TB disease. “So there is a cost towards medicines and lost wages for the HIV infected person,” he said. For the programme, starting treatment early will prove to be expensive. “But there is cost when a patient becomes infected with active TB and is admitted. So early initiation of ART reduces cost in the long run,” he explained.

According to him, early initiation of ART has three benefits — it helps reduce HIV transmission, prevents TB and reduces cost in the long run.

Keywords: antiretroviral therapy, tuberculosis prevention, HIV transmission, HIV positive, ART programme

RELATED NEWS Incentives linked plan to detect TB cases Breathing uneasy over TB Says WHO: India has highest number of multidrug-resistant TB in South East Asia TB control must not be

Gene disorder

Gene disorder tied to large breasts killed Tutankhamun’ (The Times of India:14.9.2012)

London: Egyptian Pharoah Tutankhamun and many of his immediate predecessors may have died early due a rare genetic disorder, which led to their unusually large breasts, a new theory suggests. Hutan Ashrafian, a British surgeon believes it could explain the reason behind King Tut’s death in his teens. He points out that Tutankhamun and his immediate predecessors all died young and all had distinctly feminine physiques, the Daily Mail said.

Ashrafian believes the pharaohs suffered from a heritable form of temporal lobe epilepsy, which as well as accounting for their abnormally large breasts would also explain why two reportedly experienced religious visions. The condition is known to cause hallucinations particularly after exposure to sunlight. And the temporal lobe is also connected to parts of the brain which release hormones involved in sexual development, explaining the development of large breasts. Examination of Tutankhamun’s mummified body showed he had a fractured leg which could have been the result of an epileptic seizure. PTI

Hormones

When hormones go awry(The Tribune:14.9.2012)

The incidence of polycystic ovary syndrome is rising in preteens and adolescent girls. The syndrome is linked to changes in the level of certain hormones brought about by rising obesity rates, lack of physical activity, anxiety, erratic food habits and sleep patterns Dr Umesh Jindal The “Plus II syndrome”, is a term, which refers to the modern lifestyle of teenage girls studying in plus one and plus two classes. They are busy from 5 a.m. to 10 p.m. every day in attending school and tuitions. The time at home is utilised in preparing for home work and tests. Whatever “free” time they get, is spent in midnight chatting, socialising on social networking sites. Sleep is the main thing that is sacrificed; sleeping at odd hours i.e. past midnight becomes a norm. Meals are generally consumed from cold-packed tiffins or canteens and fast food joints. Chocolates and cold drinks comprise their energy sources for survival. They are often more tense than the adults because of pressures to compete and excel. The lack of physical activity, presence of anxiety and tension, irregular and erratic food habits and sleep patterns frequently lead to an excess of body weight and obesity. An estimated 50-80 per cent of these obese girls develop irregular menstrual cycles, excessive hair growth and acne/pimples. These are the classic symptoms of the polycystic ovary syndrome (PCOS) in this age group. The growing rate of PCOS is related to the epidemic of obesity. In a survey conducted in schoolchildren in Delhi, 32 per cent were found to be obese. Out of these, 80 per cent were girls showing signs of PCOS. PCOS is the most common endocrine disorder of women. There is no accurate data available from Indian population; this may range from 2.8 per cent to as high as 26 per cent, commonly believed to be 7-10 per cent. In a recent survey in South India, the incidence was 9.13 per cent. PCOS is responsible for approximately 20 per cent of all infertility and for 40 per cent cases of abnormal hair growth in women (hirsutism). Puberty is the transitional period between the immaturity of childhood and maturity of adulthood. Early changes in breast, pubic and axillary hair can be seen as early as 7-8 years of age. Pubertal period ranges from 8 years and completes at 16-18 years. Significant biochemical and hormonal changes occur at puberty which form the background of physical and physiological transformation of an immature baby girl into an adolescent and thereafter to a mature woman. Some of these changes, which are influenced by genetic and environmental factors, lead to the development of PCOS in adult life. Symptoms PCOS is a heterogeneous disorder of women of reproductive age. Characterised by irregular or absent menses and dominance of male hormones (androgens) over the female hormones is called hyperandrogenism. PCO is a conglomeration of symptoms. PCOS has multiple potential underlying causes and aggravating factors and variable clinical presentation. The current definition of PCOS is based on the Rotterdam Consensus meeting of the “European Society of Human Reproduction and Embryology” and the “American Society of Assisted Reproduction” on PCOS in 2003. It defines the syndrome of PCOS as the presence of any two of the following three criteria: Ultrasound appearance of polycystic ovaries Menstrual irregularity Excess of male hormones Ultrasound appearance of polycystic ovaries: Polycystic ovary is a misnomer, causing a lot of unnecessary anxiety. Many girls, their parents and even doctors think that this is a tumour-like growth, and may need surgery. Many are scared of even cancerous change. In fact, it refers to only an ultrasound appearance. These are clusters of fluid-filled, bubble-like structures. These are the normal eggs containing follicles which keep on developing and disappearing all the time. In PCOS, there are more number of these cysts as compared to that in a normal ovary. Irregular menses: Menses are generally irregular, infrequent or even absent. Sometimes, when menses occur after a long gap, the bleeding can be quite heavy or even very light. Excess of male hormones: The presence of excessive amount of male hormone may cause severe acne and excessive hair growth. Symptoms may include: Body hair growing on the chest, belly, face, and around the nipples, decreased breast size, thinning of the hair on the head, called male-pattern baldness, voice gets deeper. There are many skin changes like acne that gets worse or dark or thick skin markings and creases around the armpits, groin, neck, and breasts. The long-term risks of PCOS include infertility, sub-fertility, diabetes, hypertension, heart disease, high cholesterol, weight gain and obesity and endometrial cancer. Increasing incidence The main question is why this incidence is increasing. Can PCOD be treated or prevented? To answer the question, we have to look into some of the developmental changes which occur in a girl from her birth to complete maturation of the reproductive system. We also need to understand the points where this process is vulnerable. Deviation from normal can lead to the development of PCOS. Multiple factors and triggers have been identified. PCOS has been described to have a “two-hit” disease evolution. The first hit factors decide the predisposition of an individual girl and second hit factors decide the eventual development of the clinical picture. First Hit factors Genetic: There is a strong evidence of contribution of genetic factors. Daughter of mothers affected with PCOS have a higher chance of developing PCOS. However, no single gene has been identified. There are multiple genes which are involved at many different stages of hormone production and affect the development of the reproductive system. Still these genes need to be supported by second hit factors to be able to result in PCOS i.e. the “switch on or off” of genes theory. Parental genetic makeup: Besides this, problems like diabetes and obesity during pregnancy also influence the expression of genes of the baby, during intrauterine life, since there is a direct result of hormonal and biochemical environment on the baby. The baby’s organs like pancreas, body fat and genital organs all respond to high sugar or insulin levels secreted because of high-fat levels in mother’s body. Insulin is the hormone which converts sugar into energy. Substances bio-similar to male hormones: Exposure to medicines, environmental toxins etc. which have male hormone bio-similar properties, can disturb the precarious and immature hormonal system of the developing baby girl. Maternal obesity itself creates a strong androgenic environment. There is strong scientific evidence which is emerging in support of in-utero genesis of adult diseases for PCOS. Low-birth weight and catch-up growth: Low-birth weight babies have a tendency to catch-up growth and store fat. It is not uncommon to see a small thin infant girl to get obese near puberty. She is also often pampered and overfed by the parents. Higher secretion of insulin to compensate high utilisation of whatever is eaten, leads to development of resistance to the action of insulin which again leads to higher secretion of insulin. This insulin resistance has a direct effect on ovaries and obesity. High-birth weight and continued obesity: High-birth weight babies have a higher body mass and fat. They need increased insulin production to meet their requirement. Higher levels of insulin cause resistance to insulin and development of PCOS. Second Hit factors Late childhood and adolescent obesity: It switches on the genes responsible for the development of PCOS through increased insulin secretion and development of insulin resistance. Maintenance of balanced diet, good playing habits, active lifestyle and optimal weight during the preteen years can perhaps keep these genes in off mode. Sedentary lifestyle: Physical activity counters the effects of increased insulin and helps in maintaining the balance. Lack of physical activity in girls with sedentary lifestyle increases the development of insulin resistance. Stress, anxiety and depression: These are also responsible for modifying hormonal secretion. The master hormone gland, pituitary gland, controls all hormone producing glands. It is located in brain and is influenced by all types of emotional signals as well as the sleep pattern. Food and nutritional deprivation: Even lean and thin girls who are deprived of essential nutrients and calories may secrete more insulin and develop PCOS. This explains the development of PCOS in thin girls. Exaggerated physiological changes: In some girls there are exaggerated changes in thyroid and pancreas in response to growth and changing environment. This may contribute to development of PCOS. The individual needs to accept the challenge and face the problem with courage than with stress and depression.

Disease management The management of PCOS remains a challenge. Unfortunately, the PCO disease, which has developed once, can’t be reversed by any drug. However, with symptomatic management, the body functions, including menstrual problems and infertility can be satisfactorily treated. Weight gain and obesity is common in women with PCOS. Losing weight can help treat the hormone changes and health conditions such as diabetes, high blood pressure, or high cholesterol. Losing just 5 per cent of your body weight can help your hormone imbalance. Plenty of water, fresh and low-sugar fruits, green vegetables and high-fibre diet constitute the ‘mantra’ of any weight-loss programme. A slow and steady decrease of 3 to 4 kg a month will correct the hormonal milieu and set the “hormonal control axis” in order. The weight loss will not only cure the symptoms of PCOS but also boost the confidence of a teenager. Maintenance of optimal body weight at BMI (body mass index) of 20-23 is essential to avoid all short and long-term complications. Your doctor may recommend birth control pills to make the periods more regular. Such medicines may also help reduce abnormal hair growth after you take them for a few months. A diabetes medicine called glucophage (metformin) may also be recommended. Cancer

Cancer

New mechanism promotes growth and spread of cancer revealed (New Kerala: 12.7.2012)

In a new study, researchers have discovered a previously unknown mechanism that promotes the growth and spread of cancer.

According to a study by researchers at The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James) and at Children's Hospital in Los Angeles, tiny vesicles released by tumour cells are taken up by healthy immune cells, causing the immune cells to discharge chemicals that foster cancer-cell growth and spread,

The study uses lung cancer cells to show that the vesicles contain potent regulatory molecules called microRNA, and that the uptake of these molecules by immune cells alters their behaviour.

The process in humans involves a fundamental receptor of the immune system called Toll-like receptor 8 (TLR8).

The findings suggest a new strategy for treating cancer and diseases of the immune system, the researchers say, and a new role for microRNA in the body.

"This study reveals a new function of microRNA, which we show binds to a protein receptor," Dr. Carlo Croce, principal investigator of the study, said.

"This tells us that some cancer-released microRNAs can bind and activate a receptor in a hormone-like fashion, and this has not been seen before," he said.

MicroRNAs help control the type and amount of proteins that cells make, and they typically do this by binding with the messenger-RNA that encodes a protein.

"In this study we discovered a completely new mechanism used by cancer to grow and spread, therefore we can develop new drugs that fight tumors by entering this newly identified breach in cancer's fortress," Dr. Muller Fabbri, co-corresponding author and first author of the study from the University of Southern California, said.

"Equally exciting, we show that this mechanism involves a fundamental receptor of the immune system, TLR8, suggesting that the implications of this discovery may extend to other diseases such as autoimmune and inflammatory diseases," Fabbri said.

Key findings of the study include - lung tumour cells secrete microRNA-21 and microRNA-29a in vesicles called exosomes, and these exosomes are taken up by immune cells called macrophages located where tumour tissue abuts normal tissue.

Secondly, in human macrophages, microRNA-29a and microRNA-21 bind with TLR8, causing the macrophages to secrete tumour-necrosis-factor alpha and interleukin-6, two cytokines that promote inflammation.

Finally, increased levels of the two cytokines were associated with an increase in the number of tumors per lung in an animal model, while a drop in those levels led to a drop in the number per lung, suggesting that they also play a role in metastasis.

The study has been published in the early edition of the Proceedings of the National Academy of Sciences. (ANI)

Cancer cure

Cancer cure? Chemo can backfire (The Times of India: 7.8.2012)

It Can Cause Cells Near Tumour To Make Protein Which Resists Treatment

London: Chemotherapy can undermine itself by causing woundhealing cells around tumours to make a protein that helps the cancer resist treatment, a new study has claimed. Researchers from the Fred Hutchinson Cancer Research Centre in Seattle found that chemotherapy increases production of a protein which causes cancer cells to grow and resist treatment, the BBC reported. The study looked at fibroblast cells, which normally play a critical role in wound healing and the production of collagen, the main component of connective tissue such as tendons. Chemotherapy causes damage to DNA or deoxyribonucleic acid which leads the fibroblasts to produce up to 30 times more of a protein called WNT16B than they should. The protein fuels cancer cells to grow and invade surrounding tissue — and to resist chemotherapy. “Cancer therapies are increasingly evolving to be very specific, targeting key molecular engines that drive the cancer rather than more generic vulnerabilities, such as damaging DNA,” Peter Nelson, who led the research, was quoted as saying by the BBC. “Our findings indicate that the tumour microenvironment also can influence the success or failure of these more precise therapies,” Nelson said. Around 90% of patients with solid cancers, such as breast, prostate, lung and colon, that spread — metastatic disease — develop resistance to chemotherapy. Treatment is usually given at intervals, so that the body is not overwhelmed by its toxicity. But that allows time for tumour cells to recover and develop resistance. The study was published in Nature Medicine. The result paves the way for research into new, improved treatment, said Nelson. “For example, an antibody to WNT16B, given with chemotherapy, may improve responses (kill more tumour cells),” he said in an email exchange. “Alternatively, it may be possible to use smaller, less toxic doses of therapy.” AGENCIES

Chemotherapy

Chemotherapy Can Inadvertently Encourage Cancer Growth (medical News Today: 7.8.2012)

A new study from the US finds that in the process of targeting and killing off cancer cells, chemotherapy may also spur healthy cells in the neighbourhood to release a compound that stimulates cancer growth, eventually leading to treatment resistance. They hope their finding will lead to better therapies for cancer and buy precious time for patients with advanced cancer.

Senior author Peter S. Nelson, of the Human Biology Division at the Fred Hutchinson Cancer Research Center in Seattle, and colleagues, write about their findings in a paper published online on 6 August in Nature Medicine.

Nelson told the media:

"Cancer cells inside the body live in a very complex environment or neighborhood. Where the tumor cell resides and who its neighbors are influence its response and resistance to therapy."

The reason chemotherapy eventually fails when treating advanced cancer, said Nelson, is because the dose you would need to give the patient to wipe out the cancer would also kill the patient.

In the lab, you can "cure" almost any cancer: you just give a huge dose of toxic chemotherapy to the cancer cells in the petri dish.

But you can't do that to patients, because the high dose would not only kill cancer cells but also healthy cells, said Nelson. Researchers suggest their findings could pave the way for making cancer treatments more effective So treatment of common solid tumors has to be given as smaller doses paced out in cycles, to give healthy cells time to recover in the intervals.

But the drawback is that this approach may not kill all the cancer cells, and those that survive can become resistant to subsequent cycles of the chemotherapy.

In their study, Nelson and colleagues found one mechanism through which this can happen.

They studied a type of normal, non-cancerous cell, the fibroblast, that lives near cancer tumors.

In animals, fibroblasts help maintain connective tissue, which is found throughout the body and acts like a "scaffolding" that holds other types of cells and tissue. Fibroblasts are also important for healing wounds and producing collagen.

But under other, non-usual circumstances, they can behave in unexpected ways.

When their DNA is damaged, for instance by chemotherapy, fibroblasts can release a broad range of compounds that stimulate cell growth.

Nelson and colleagues examined cancer cells from prostate, breast and ovarian cancer patients who had been treated with chemotherapy, and found specifically, that when the DNA of fibroblasts near the tumor is damaged by chemotherapy, they start producing a protein called WNT16B in the microenvironment of the tumor.

And, they also found, when the protein reaches a high enough level, it causes cancer cells to grow, invade surrounding tissue, and resist chemotherapy.

"The expression of WNT16B in the prostate tumor microenvironment attenuated the effects of cytotoxic chemotherapy in vivo, promoting tumor cell survival and disease progression", they write.

Researchers already knew, that the WNT family of genes and proteins are important for growth of both normal and cancer cells, but this study now reveals they may also have a role in promoting treatment resistance.

The researchers saw some WNT proteins increased 30-fold, which was "completely unexpected", said Nelson.

Cancer treatments are becoming increasingly specific, using precise "sniper" approaches to target key molecules rather than general "scatter gun" approaches such as damaging DNA. The researchers say their findings suggest the microenvironment of the tumor can also play a role in the success or failure of these more precise approaches.

For example, the same cancer cell may react quite differently to the same treatment, in different microenvironments.

They suggest their discovery could help make treatments more effective, for instance by finding a way to block the tumor microenvironment's response.

Professor Fran Balkwill, a Cancer Research UK expert on microenvironments, told the press the study ties in with other studies that show "cancer treatments don't just affect cancer cells, but can also target cells in and around tumors".

Sometimes the effect can be helpful, said Balkwill, giving the example of when chemotherapy triggers health immune cells to attack nearby tumors.

"But this work confirms that healthy cells surrounding the tumor can also help the tumor to become resistant to treatment. The next step is to find ways to target these resistance mechanisms to help make chemotherapy more effective," he added.

Chemotherapy

A new tech that can cut side effects of chemotherapy (The Times of India:16.8.2012)

London: Scientists claim to have developed a new technique which dramatically reduces the harmful side effects of chemotherapy by blocking an oxygen-sensitive enzyme and streamlining the blood flow. Researchers from VIB/ KU Leuven, Belgium have found that chemotherapy combined with specific PHD2 inhibitors would make it more effective while reducing the harmful side effects. The effectiveness of chemotherapy is limited by the difficulties of delivering the anti-cancer drugs to the actual tumour, researchers said in a statement. Tumours are characterised by abnormally shaped blood vessels — they are irregular in shape, have weak textures and easily tear. These leaking blood vessels prevent anti-cancer drugs from reaching tumour cells while promoting metastasis. Secondly, chemotherapy can have seriously harmful effects on healthy organs, leading even to heart and kidney failure. Earlier research had already shown that reduced activity of the oxygen sensor PHD2 under hypoxic conditions resulted in a more streamlined vasculature. In the new study, Rodrigo Leite de Oliveira, Sofie Deschoemaker and Max Mazzone used mouse models to prove their earlier hypothesis that streamlining blood flow by inhibiting PHD2 can render cancer treatments more effective. Firstly, the better formed blood vessels ensure that the anticancer drugs are distributed throughout the tumour, thus increasing their impact. They also allow for smaller doses — a significant advantage when administering toxic drugs. The researchers further proved that inhibiting PHD2 results in the production of anti-oxidant enzymes were able to neutralise the harmful side effects of chemotherapy. PTI

Cancer

Proactive steps needed to fight cancer: Docs(World Newspapers:16.8.2012)

At an event held to laud the fighting spirit of cancer survivors in Ahmedabad, several doctors stressed on the need for better awareness about the dreaded disease.

Speaking on the occasion Dr SS Alurkar, medical oncologist said that it was possible to fight cancer provided it was detected at an early stage. “Several cancers, including leukaemia in children, can now be completely cured,” said Dr Alurkar. He further said more proactive steps, like banning of gutkha and other tobacco products, needed to be done to prevent head and neck cancer. Radiation oncologist Dr Kinjal Jani also stressed on the need for early detection. “There is a need for regular check-ups and pre-screening to ensure that cancer is detected at an early stage,” he said. Dr Jani said that there was also a considerable rise in cancer among the young due to tobacco-usage. “And in most of these cases they began tobacco consumption early in the childhood,” he said.

Dr Anagha Zope, breast surgeon said that incidence of breast cancer among young women are on the rise. “In this disease there is also a stigma and shame associated, which means women are not willing to come forward and talk about it,” she said.

Chemotherapy

Chemotherapy may impair speech in breast cancer patients (The Tribune: 12.9.2012)

WASHINGTON: Breast cancer patients treated with chemotherapy are at risk for mild cognitive deficits after treatment. This was concluded in a large meta-analysis conducted by researchers at Moffitt Cancer Center. The analytic review of previously published studies found that study participants on average had mild impairments in verbal abilities (such as difficulty choosing words) and visuospatial abilities (such as getting lost more easily).

The study noted that cognitive functioning varies across survivors, with some reporting no impairments and others reporting more severe or pervasive deficits.

"The objective of our analysis was to clarify existing research on cognitive functioning in patients who had received standard dose chemotherapy for breast cancer at least six months previously," said study lead author Heather S.L. Jim, an assistant member at Moffitt whose research focuses on the psychosocial and behavioral aspects of cancer survivorship." — ANI Brain Cancer

Key Mutations in Most Common Childhood Brain Cancer Discovered (med India: 23.7.2012)

Researchers link specific gene mutations to each of the four recognized subtypes of medulloblastoma, the most common malignant brain tumor of children. The discovery, reported July in the journal Nature, provides doctors with potential biomarkers for guiding and individualizing treatment and reveals prospective therapeutic opportunities for countering this devastating malignancy.

The study was conducted by a research team led by Scott Pomeroy, MD, PhD, Neurologist-in-Chief at Boston Children's Hospital and a neuro-oncologist at DF/CHCC; Yoon-Jae Cho, MD, formerly of Boston Children's and now at Stanford University School of Medicine; and Matthew Meyerson, MD, PhD, of Dana-Farber Cancer Institute and the Broad Institute.

Medulloblastomas occur in the cerebellum (the part of the brain that controls balance and other complex motor functions) and are treated with a combination of surgery, radiation and chemotherapy. Though overall survival hovers around 70 percent, most survivors are unable to live independently due to the lasting effects of both tumor and treatment.

Doctors have historically classified medulloblastoma patients as either standard or high risk based on biopsy results, but have long suspected that what we call medulloblastoma could actually be several different diseases. Over the last two years, studies by researchers including Pomeroy and his colleagues have bolstered this view by dividing medulloblastoma into four molecular subtypes based on gene expression profiles and copy number variations. Each subtype has a distinct survival rate, ranging from 20 to 90 percent.

"Not only do we now know how to stratify medulloblastomas genomically, we have a firm grasp of what gene mutations drive each molecular subtype," said Pomeroy, who has spent 20 years trying to understand the biological basis of the tumor's variability. "For the first time, we'll be able to classify and treat medulloblastoma based on molecular typing, providing the best therapy with the fewest long-term consequences."

In this new study, Pomeroy and his team used next generation sequencing technologies to read the full complement of protein-coding genes (also called the exome) of tumors from 92 patients. Within these tumors the team discovered that somatic (that is, non-heritable) mutations occur at very low frequency, one-tenth to one-hundredth of that seen in cancers of adults. Specific gene mutations clustered neatly into the four molecular subtypes, although the majority of genes (88%) were mutated only once in the entire tumor collection. Only 12 genes were mutated in more than one tumor, illustrating medulloblastoma's genetic heterogeneity.

Functionally, the mutated genes fell into two broad categories: genes like Shh and Wnt that play direct roles in molecular pathways controlling cell growth, and genes like DDX3X and GPS2 that play more of a coaching role, modulating the activity of other genes.

Taken as a whole, the study's results confirm the view of medulloblastoma as a family of tumors driven by disruptions in just a few common mechanisms. However, the form those disruptions take—the actual mutations or genomic changes—can vary from tumor to tumor.

"The results reflect two emerging genetic themes seen throughout childhood tumors," Pomeroy noted. "First, very low mutation rates, much lower than those seen in adult tumors, and second, the importance of mutations in genes that regulate the function of the cell's growth pathways but which aren't direct components of those pathways."

Some of the study's findings could be translated to patients relatively quickly. For instance, with the main mutations of each subtype in hand, it should soon be possible to rapidly classify individual medulloblastoma patients' tumors and tailor treatment appropriately based on each subtype's known prognosis. In addition, clinical trials of Shh-blocking drugs already under investigation for other cancers could begin within the next couple of years in patients with the medulloblastoma subtype driven by Shh mutations.

Pomeroy credits the high level of cooperation between groups at different institutions studying medulloblastoma as a significant factor in the progress made over the last few years. "Because of our collective efforts, medulloblastoma has gone from an important but obscure tumor to one that we understand better than many other cancers at the molecular level."

Brain Tumours

Gene variant that ups risk of brain tumours discovered (New Kerala:28.8.2012)

People who carry a "G" instead of an "A" at a specific spot in their genetic code have roughly a six-fold higher risk of developing certain types of brain tumours, a new study has found. The findings could help researchers identify people at risk of developing certain subtypes of gliomas which account for about 20 percent of new brain cancers diagnosed annually in the U.S. and may lead to better surveillance, diagnosis and treatment.

Researchers still have to confirm whether the spot is the source of tumours, but if it's not, "it is pretty close," said senior author Robert Jenkins, M.D., Ph.D., a pathologist at the Mayo Clinic Cancer Center.

"Based on our findings, we are already starting to think about clinical tests that can tell patients with abnormal brain scans what kind of tumour they have, just by testing their blood," Jenkins stated.

A few years ago, researchers began hunting for regions of the genome that might be associated with the development of gliomas. These groups observed a portion of chromosome 8 that contained single nucleotide polymorphisms or "SNPs" associated with brain tumours.

Since then, Dr. Jenkins and Margaret Wrensch, Ph.D., professor of neurological surgery at the University of California, San Francisco, have been using a combination of sophisticated genomic techniques to search for the SNP causing brain tumours to form.

They honed in on seven candidates. One -- the SNP called rs55705857 -- confers a relative risk approaching that is seen with BRCA1, the breast cancer gene. Interestingly, this region was only found through the most laborious method used by the researchers, next generation sequencing, suggesting that experimental and mathematical shortcuts may miss such rare, highly potent gene variants, Dr. Jenkins said.

Drs. Jenkins and Wrensch found that having the "G" guanine version of this SNP -- rather than the more common "A" adenine version -- was strongly associated with slower growing gliomas.

"Being able to tell people that the mass in their brain is this type of tumour is actually good news, because it has a much better prognosis than other brain tumours," Dr. Jenkins explained.

"So what is it that predisposes people to develop less aggressive, but still lethal, gliomas? That makes understanding the function of this variant even more important," he said.

As part of their work, the researchers compared the sequence of the gene variant throughout mammalian evolution and found that it has been conserved as far back as the platypus. Computer modeling indicated that the region may be a microRNA, a special kind of nucleic acid that controls the activity of genetic messages within cells.

The modeling places the SNP within the functional part of the microRNA, suggesting that a change in genetic code from an A to a G could have significant consequences. The research team is investigating whether the microRNA actually exists, and what its functional implications might be.

"The altered microRNA might target tumour suppressor genes, it might activate a cancer gene, it might be involved in regulating the stability of the genome, or there might be something else going on altogether. One of the big challenges of the current genomic era is to assign functions to all these new gene variants," Dr. Jenkins added.

The findings have been published online in the journal Nature Genetics. (ANI)

Brain Tumors

When Malignant Brain Tumors Appear at Multiple Sites Survival Statistics Show Hard Fight (MedIndia:28.8.2012)

According to research, when aggressive, malignant tumors appear in more than one location in the brain, patient survival tends to be significantly shorter than when the disease starts as a single tumor. This takes place even though patients in both groups undergo virtually identical treatments. The research is from the Cedars-Sinai Medical Center's Maxine Dunitz Neurosurgical Research Institute.

"We''ve known that certain independent factors, such as age at diagnosis, amount of residual tumor after surgery, and the patient's functional status are useful in predicting outcomes in patients with glioblastoma multiforme, but multifocal disease at time of onset has rarely been examined in this context. Two small previous studies were contradictory. Our study appears to confirm observations that disease in patients with more than one lesion is particularly challenging and that these patients tend to have worse outcomes. Matched survival analysis demonstrated that multifocal disease is a strong and negative independent prognostic factor," said Chirag G. Patil, MD, director of the Center for Neurosurgical Outcomes Research in the Department of Neurosurgery at Cedars-Sinai Medical Center.

The researchers compared outcomes of 47 patients who had multiple tumors with 47 who had a single lesion, matching them for age, functional impairment scores, extent of tumor removal and radiation therapy and chemotherapy. Median overall survival for the multifocal group was six months, compared to 11 months for those in the single tumor group.

Patil, first author of an article in the Aug. 24 Journal of Neurosurgery, noted that a comparatively large percentage of tumors in the multifocal group appeared to be "treatment resistant," continuing to grow even after patients underwent radiation therapy. Unlike earlier studies, nearly all of these patients were diagnosed and treated during the "temozolomide era," beginning in 2005 when this drug joined radiation therapy as the mainstay of glioblastoma treatment. Even so, 11 of the 47 patients in the multifocal group did not receive temozolomide because, the researchers suggest, disease progression is so quick that many patients are unable to start or complete standard therapies.

Patil said researchers believe cells of multifocal tumors may have an increased ability to migrate in the brain and invade normal tissue, leading to more rapid patient decline; recent advances in therapies for glioblastomas have not improved survival in these patients.

"A thorough investigation of the unique biology of these tumors and their invasive and migratory mechanisms is needed so we may develop a new generation of targeted therapies," said Patil, who received a Cedars-Sinai grant that will fund the study of genetic and biological differences between single tumors and those originating at multiple sites.

Glioblastoma multiforme is the most common and aggressive malignant tumor occurring in the brain, and patients typically survive 15 months when undergoing standard treatments. Other single-tumor patients in the larger pool from which those in this study were derived, had median survival of 16 months. The shorter 11-month survival of study patients is believed to result from the matching process: Because many of those with multiple-site tumors could not undergo complete tumor removal, their corresponding single-site patients had tumors with locations or characteristics that made them appropriate for biopsy only. Ovarian Cancer

Ovarian Cancer Screening Not Worth Risk Says US Expert Group(Medical News Today:12.9.2012)

An independent US expert group recommends against routine screening for ovarian cancer in women, because their view is the risks outweigh the benefits.

The US Preventive Services Task Force (USPSTF), an independent expert group that makes evidence-based recommendations about clinical preventive services, issued its final recommendation on screening for ovarian cancer on Tuesday.

The recommendation states:

"The USPSTF recommends against screening for ovarian cancer in women (D recommendation)."

The Task Force grades its recommendations according to one of five classifications (A, B, C, D, I) depending on the strength of evidence and size of net benefit (benefits minus harms).

Grade D means the Task Force "recommends against routinely providing [the service] to asymptomatic patients", and that it found "at least fair evidence that [the service] is ineffective or that harms outweigh benefits".

The recommendation is published in full in the 11 September issue of Annals of Internal Medicine.

The Task Force concludes there is currently no system of screening for ovarian cancer that is effective in reducing deaths.

The recommendation applies to women who show no signs of the disease and do not carry genetic mutations, such as BRCA1 and BRCA2, that are known to increase their risk of developing it.

"Currently, routine screening for ovarian cancer has no proven benefit and may actually lead to important harms," Task Force member and chair Virginia Moyer says in a press statement. A high percentage of women who have the screening receive false-positive results which then leads to them experiencing unnecessary harm, such as undergoing major surgery, she adds.

The Task Force do not take into account the costs of screening: their decision is based purely on assessment of benefits and harms.

The recommendation is in line with screening guidelines of other medical and public health bodies. For instance, neither the American Cancer Society nor the American Congress of Obstetricians and Gynecologists currently recommends ovarian cancer screening for average-risk women with no symptoms.

Moyer says there is "a critical need to develop better screening tests for ovarian cancer".

Ovarian cancer is an uncommon cancer, accounting for around 3% of all cancers in women. It is hard to detect: many women who develop the disease show no signs or symptoms in the early stages, which unfortunately means it is often diagnosed when treatment is less likely to succeed.

The American Cancer Society estimates that in 2012, about 22,280 women will be diagnosed with ovarian cancer and about 15,500 women will die from the disease. A woman's risk of getting ovarian cancer during her lifetime is about 1 in 71.

Several tests are used to screen for ovarian cancer, of which the two main ones are transvaginal ultrasound and a blood test for CA-125.

The transvaginal ultrasound test is where a probe is inserted in the vagina to aim sound waves at the organs in the pelvic area. Using the waves, the doctor can "see" the woman's reproductive organs, including the uterus, ovaries, cervix, and vagina. If something looks abnormal, further tests may be called for, often requiring surgery.

The CA-125 blood test looks for CA-125 protein, a tumor marker can be found in high amounts in women with ovarian cancer. However, a high CA-125 level does not always mean a woman has ovarian cancer. High levels of this substance also can be found in people with many other conditions, including pregnancy and liver problems.

The recommendation re-affirms the Task Force's 2004 position. In 2008, a review of the literature commissioned by the Task Force that looked at studies published since 2002, concluded there was no new evidence about the benefits of screening for ovarian cancer but found new data about observed harms of screening.

This latest recommendation follows a further "bridge search" to 2011, that focused on evidence from randomized, controlled trials that found three clinical studies: the PLCO Cancer Screening Trial, the UK Collaborative Trial of Ovarian Cancer Screening, and the Shizuoka Cohort Study of Ovarian Cancer Screening. Following a review of those three trials, the Task Force concludes:

"Of three randomized, controlled trials on ovarian cancer screening published during the search period, only one (PLCO Trial) published results on mortality. Those results are consistent with the current USPSTF guidelines for ovarian cancer screening among asymptomatic, average-risk women."

However, it also notes that:

"Information from the two other trials may be useful for the USPSTF to consider in the future: SCSOCS has been completed but mortality results have not yet been published, and UKCTOCS is ongoing through the end of 2014." Pancreatic Cancer

Pancreatic Cancer Risk May Be Reduced By High Dietary Antioxidant Intake (Medical News Today: 24.7.2012)

Individuals can significantly reduce their risk of developing pancreatic cancer by increasing their dietary intake of the antioxidant vitamins C, E, and selenium, say researchers who are leading the Norfolk arm of the European Prospective Investigation of Cancer (EPIC) study.

The study, published in the journal Gut, states that 1 in 12 of these cancers might be prevented if the association turns out to be casual.

More than a 250,000 people die each year around the world due to pancreatic cancer. In the UK, 7,500 people are diagnosed with the disease each year.

Only 5% of patients with pancreatic cancer survive beyond 5 years, say the researchers. Risk factors of the disease include, smoking, type 2 diabetes, and diet.

The team analyzed the health of more than 23,500 adults who participated in the Norfolk arm of the EPIC study between 1993 and 1992. Patients were aged 40 to 74 years old.

All study participates filled out a food diary tracking the types and amounts of food the consumed during a 7 day period. In addition, they detailed the methods they used to prepare the food.

The team then matched each entry in the food diary to one of 11,00 food items. They then used a specially designed computer program called DINER in order to calculate the nutrient values.

According to the researchers, 49 people developed pancreatic cancer within 10 years of participating in the study, and this figure increased to 86 people by 2010. On average, they survived six months after being diagnosed with pancreatic cancer. br> The nutrient intakes of participants diagnosed with the disease were compared with those of almost 4,000 healthy individuals in order to see if there were any differences. According to the researchers, weekly intake of selenium in the top 25% of consumption roughly reduced their risk of developing pancreatic cancer by 50% compared with those whose intake was in the bottom 25%.

In addition, patients were 67% less likely to develop the disease if their intake of vitamins C, Em and selenium was in the top 25% of consumption.

The researchers note that antioxidants may neutralize free radicals and curb genetically programmed influences, as well as stimulating the immune system response.

They explained:

"Other trials using antioxidant supplements have not produced such encouraging results, but this may be because food sources of these nutrients may behave differently from those found in supplements. If a causal association is confirmed by reporting consistent findings from other epidemiological studies, then population based dietary recommendations may help prevent pancreatic cancer."

Pediatric Cancer

Study Shows Long-Term Effects of Radiation in Pediatric Cancer Patients (Science Daily:22.8.2012)

For many pediatric cancer patients, total body irradiation (TBI) is a necessary part of treatment during bone marrow transplant- it's a key component of long term survival. But lengthened survival creates the ability to notice long term effects of radiation as these youngest cancer patients age. A University of Colorado Cancer Center study recently published in the journal Pediatric Blood & Cancer details these late effects of radiation.

"These kids basically lie on a table and truly do get radiation from head to toe. There is a little blocking of the lungs, but nothing of, for example, the brain or the kidneys," says Jean Mulcahy-Levy, MD, research fellow at the CU Cancer Center and the paper's first author.

Of 15 patients who received TBI before age 3, many developed endocrine and metabolic problems including testicular malfunction (78 percent), restrictive pulmonary disease due to high levels of blood triglycerides (74 percent), and cataracts (78 percent). Likewise, 90 percent of patients showed abnormally low levels of growth hormone, and 71 percent were considerably under height. Additional late effects of TBI included kidney, liver, skeletal and cardiac malfunction -- and three of four patients whose IQ had been tested before TBI showed cognitive decline. "Fifteen doesn't seem like a large number, but because we have such a good pediatric bone marrow transplant program here at Children's Hospital Colorado and radiation therapy program at the CU Cancer Center, we were able to get a large enough cohort of patients to see these overall effects," Mulcahy-Levy says.

The study supports the recommendations of the Children's Oncology Group for long term follow up care for children receiving TBI (survivorshipguidelines.org). Specifically, Mulcahy-Levy hopes that increasing awareness of likely effects will help patients and their doctors screen for, detect, and correct likely effects of TBI.

"It's not so much that you want to stop TBI, which is frequently a necessary part of treatment, but this study shows it's important know about these problems in order to address them appropriately and proactively," Mulcahy-Levy says.

Share this story on Facebook, Twitter, and Google: Prostate Cancer

Tea, Gold Nanoparticles Effective in Treating Prostate Cancer (Med India: 17.7.2012)

Gold nanoparticles and a compound found in tea leaves treat prostate cancer with fewer side effects than chemotherapy, say scientists. The study is being published in the Proceedings of the National Academy of Sciences.

"In our study, we found that a special compound in tea was attracted to tumor cells in the prostate," said Kattesh Katti, curators' professor of radiology and physics in the School of Medicine and the College of Arts and Science and senior research scientist at the MU Research Reactor. "When we combined the tea compound with radioactive gold nanoparticles, the tea compound helped 'deliver' the nanoparticles to the site of the tumors and the nanoparticles destroyed the tumor cells very efficiently."

Currently, doctors treat prostate cancer by injecting hundreds of radioactive 'seeds' into the prostate. However, that treatment is not effective when treating an aggressive form of prostate cancer, said Cathy Cutler, research professor at the MU Research Reactor and co-author of the study. The size of the seeds and their inability to deliver effective doses hampers their ability to stop the aggressive form of prostate cancer.

In the study, the MU scientists created nanoparticles that are just the right size. Instead of hundreds of injections, the team only used one or two injections, and the nanoparticles were more likely to stay very close to the tumor sites.

Cutler and Katti have been working with colleagues Raghuraman Kannan, Anandhi Upendran, Charles Caldwell as well as others in the Department of Radiology and at the MU Research Reactor to develop and design the nanoparticles to the correct shape and size to treat prostate cancer. If the nanoparticles produced are too small, they can escape and spread; if they are made large enough, the nanoparticles will stay inside the tumor and treat it much more effectively than current methods.

"Current therapy for this disease is not effective in those patients who have aggressive prostate cancer tumors," Cutler said. "Most of the time, prostate cancers are slow- growing; the disease remains localized and it is easily managed. Aggressive forms of the disease spread to other parts of the body, and it is the second-leading cause of cancer deaths in U.S. men. However, we believe the gold nanoparticles could shrink the tumors, both those that are slow-growing and aggressive, or eliminate them completely." "This treatment is successful due to the inherent properties of radioactive gold nanoparticles," Kannan said. "First, the gold nanoparticles should be made to the correct size, and second, they have very favorable radiochemical properties, including a very short half-life."

"Because of their size and the compound found in tea, the nanoparticles remain at the tumor sites," Upendran said. "This helps the nanoparticles maintain a high level of effectiveness, resulting in significant tumor volume reduction within 28 days of treatment."

In the current study, the team tested the nanoparticles on mice. Prior to human trials, the scientists will study the treatment in dogs with prostate cancer. Prostate cancer in dogs is extremely close to the human form of the disease.

"When it comes to drug discovery, MU is fortunate because we have a combination of experts in cancer research, animal modeling, isotope production and nanomedicine, and state-of-the-art research infrastructure to take discoveries from 'the bench to the bedside' and never leave campus," Katti said. "For example, we developed the nanoparticles here at our research reactor, which is one of the few places in the world that produces therapeutic, clinical grade radioisotopes. We then tested the radioactive gold nanoparticles in small animals in collaboration with other radiology researchers using testing facilities located at the Harry S. Truman Veterans Hospital. Our next steps include partnering with the College of Veterinary Medicine to treat larger animals with the hopes of having human clinical trials, held on our campus, soon."

Katti, Cutler, Kannan, Upendran and Caldwell were joined in the study by Ravi Shukla, Nripen Chanda and Ajit Zambre, all from the Department of Radiology.

Prostate Cancer

New Test May Help Predict Prostate Cancer (Science Daily:23.7.2012)

Karim Kader, MD, PhD, associate clinical professor at the UC San Diego School of Medicine, together with a team of researchers from Wake Forest University School of Medicine, have developed a genetic test to predict a man's risk for prostate cancer. Use of the test could reduce the need for repeat biopsies in men who have had a negative biopsy.

Results of the multicenter study were recently published online in the journal of European Urology.

"The genetic test outperformed the PSA test in assessing cancer risk," said Kader, co- investigator and urologic surgeon at UC San Diego Health System. "If results of this blood test were factored into prostate cancer predictors such as total free PSA, free PSA, number of core samples taken at biopsy, and family history, we would have a more accurate picture of a whether or not a man is likely to develop the sometimes fatal disease."

Kader and researchers evaluated 1,654 men in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) clinical trial. All the men had biopsies and consented to genetic studies that looked for the presence of germline single nucleotide polymorphisms (SNPs). SNPs are genetic variations within an individual's DNA sequence which may have a positive association with prostate cancer risk as well as other chronic diseases.

"Avoiding repeat procedures, particularly in older men, can help reduce the risk of infection and potential hospitalizations," said Kader. "The genetic score is available at any time in a man's lifetime and could be used as a pre-screening test thus leaving aggressive PSA screening to men at a higher genetic risk."

About 1 man in 6 will be diagnosed with prostate cancer during his lifetime. In 2012, more than 241,700 new cases of prostate cancer will be diagnosed. During the course of diagnosing patients, more than one million men are biopsied each year in the U.S. Approximately 30 percent go on to have repeat biopsies.

Funding for this study was partially supported by a National Cancer Institute RC2 grant (CA148463) and a research contract by GlaxoSmithKline.

Localized Prostate Cancer

Localized Prostate Cancer: Removal No Better Than Observation, Study (New Kerala: 24.7.2012)

A large study that followed men across the US diagnosed with localized prostate cancer for over 10 years found they lived just as long whether they had surgery to remove the prostate or underwent observation. The researchers say their findings support observation over surgery for men with localized prostate cancer, especially if it is low-risk.

In their study, which was published online on 19 July in the New England Journal of Medicine, researchers from the Prostate Cancer Intervention versus Observation Trial (PIVOT) describe how, following diagnosis, between November 1994 through January 2002, they enrolled 731 men with localized prostate cancer, randomly assigned them to receive either radical prostatectomy or observation, and then followed their progress.

Radical prostatectomy is a surgical procedure that removes the entire prostate gland and some surrounding tissue. The Study: Surgery Versus Observation The average age of the men at diagnosis was 67 years, and the method of diagnosis was through prostate specific antigen (PSA) blood tests and biopsies. About half the men went into the surgery group (364), and half into the observation group (367). Although the observation group did not have the surgery, they were able to receive palliative care and chemotherapy if their cancer got worse.

During the median follow-up of 10 years, 47% (171 men) in the surgery group died, compared with 49.9% (183) in the observation group. In their analysis, the researchers calculated the hazard ratio for this as 0.88, with confidence interval (CI) ranging from 0.71 to 1.08 (P=0.22), and an absolute risk reduction of 2.9 percentage points.

In the surgery group, 5.8% of the men (21) died from prostate cancer or treatment, compared with 8.4% (31) in the observation group. For this, the calculated hazard ratio was 0.63, with 95% CI ranging from 0.36 to 1.09 (P=0.09) and an absolute risk reduction of 2.6 percentage points.

These figures did not change when they took into account other potential influencing factors such as age, race, medical conditions, and the type of tumor.

21.4% of the men in the surgery group had a complication within the first 30 days, the most common being infection. One of the men also died during this period.

Two years after surgery, urinary incontinence and impotence (erectile dysfunction) were much more common among the men in the surgery group than in the observation group. Observation Better Option for Low Risk Categories The researchers classified the men, according to their PSA levels and Gleason scores, as having either low, intermediate, or high-risk prostate cancer.

The results showed that the men with low-risk cancer (PSA under 10, Gleason score under 7), were the least likely to benefit from radical prostatectomy.

The researchers say their findings support the idea that if the cancer is low risk, then observation is a better option for men with localized prostate cancer. "Active Surveillance" Has Overtaken "Watchful Waiting" Although prostate cancer is a serious disease, and statistics show that it is the leading cause of cancer death among American men, most men diagnosed with the disease die with it rather than of it. In fact, more than 2.5 million men in the US who have been diagnosed with prostate cancer are alive today.

One of the problems with prostate cancer screening is that it can't tell which cancers are aggressive and need treatment and which can be safely left alone and kept under observation. So, because of this, many men undergo surgery, which can often lead to unpleasant and sometimes long-lasting side effects such as impotence and incontinence.

However, the American Cancer Society says much has happened over the last few years to improve the treatment of prostate cancer patients. "Watchful waiting", until recently, was widely used. This meant waiting until the cancer caused symptoms before starting treatment.

But now, the more common approach is "active surveillance" or "expectant management", which involves regular PSA tests, rectal exams and biopsies to more closely assess the level of threat, and if this rises, then the doctor may recomment radical treatment. Men Should Understand Benefits Versus Risks of Screening Men with average risk of prostate cancer should talk to their doctors about screening from the age of 50 onwards, says the American Cancer Society. For men at higher risk, including those with a father or brother who has prostate cancer, and African-American men, should have this conversation from the age of 45, they urge.

In a recent statement, the American Society of Clinical Oncology (ASCO) suggests for men with shorter life expectancy, the risks of harms from PSA tests and subsquent unnecessary treatment probably outweigh the benefits.

But for men with longer life expectancy, the risk versus benefit balance is less clear, and patients should have "well-informed" conversations with their doctors about the harms, potential benefits and the appropriate management options should prostate cancer be found, says the ASCO.

Prostate Cancer Treatment

Golden Age of Prostate Cancer Treatment Hailed as Fourth Drug in Two Years Extends Life(Science Daily:16.8.2012)

The head of one of the UK's leading cancer research organisations has hailed a golden age in prostate cancer drug discovery as for the fourth time in two years results are published finding a new drug can significantly extend life. A study in the New England Journal of Medicine August 15 shows the drug enzalutamide can significantly extend life and improve quality of life in men with advanced prostate cancer -- in findings that could further widen the treatment options for men with the disease.

The Institute of Cancer Research, London, and its partner hospital The Royal Marsden NHS Foundation Trust jointly led the new Phase III trial of enzalutamide and the Phase III trials of two other drugs, cabazitaxel and abiraterone. Abiraterone was also discovered at The Institute of Cancer Research and was recently made available on the NHS. A further drug sipuleucel-T has also been shown to extend life in the two-year period.

Professor Alan Ashworth, chief executive of The Institute of Cancer Research (ICR), said cancer research in the UK was finally delivering new treatment options for men with advanced prostate cancer after a long period where the options were limited. Professor Ashworth said: "Advanced prostate cancer is extremely difficult to treat, and it's taken a massive coordinated effort to finally bring new drugs into the pipeline, after decades where there were no options once old-style hormone treatment stopped working.

"What we're seeing now is an unprecedented period of success for prostate cancer research, with four new drugs shown to extend life in major clinical trials in just two years, and several others showing promise. It truly is a golden age for prostate cancer drug discovery and development."

Professor Martin Gore, medical director of The Royal Marsden Hospital, said: "We are delighted with the recent progress that has been made in the treatment of advanced prostate cancer and to see the impact this is having on our patients, many of whom are living longer with a better quality of life as the result of these new drugs."

Enzalutamide, a new type of hormone treatment, was assessed in 1,199 patients with metastatic castration-resistant prostate cancer that had previously received chemotherapy, in a multinational, randomised placebo-controlled trial sponsored by pharmaceutical companies Medivation and Astellas.

Median survival with enzalutamide was 18.4 months, compared with 13.6 months for men receiving a placebo. Around 43 per cent of men taking enzalutamide as part of the AFFIRM trial reported an improved quality of life, compared with 18 per cent of men taking a placebo. In November last year, the trial's Independent Data Monitoring Committee recommended that the trial be stopped early and men who received the placebo be offered enzalutamide.

The Phase III trial was jointly led by Professor Johann de Bono, head of the Drug Development Unit at the ICR and The Royal Marsden.

Prostate Cancer

Scientists Discover Link Between Prostate Cancer And Vitamin A (medical News Today (6.9.2012)

A recent study, published in the journal Nucleic Acids Research has revealed that scientists, lead by professor Norman Maitland from the University of York, have discovered a connection between vitamin A and prostate cancer. His research has found a particular prostate cancer gene that is under the control of retinoic acid, a form of vitamin A.

These findings set the groundwork to test retinoic acid therapy and its ability to coerce prostate cancer stem cells to modify into more specialized cells. This process, known as differentiation, can kill these cells or increase their vulnerability to chemotherapy. ATRA (all-trans retinoic acid therapy), has been used successfully in patients with acute promyelomcytic leukaemia, improving survival rates from 0% to 80%. Prostate cancer is diagnosed in close to 40,000 men in the UK each year, with around 10,000 men dying annually.

Maitland recalls that low levels of vitamin A in the blood have always been associated with prostate cancer, but reasons why were not clear. This research has revealed the biological relationship between expressions of retinoic receptors and laboratory models of prostate cancers. Maitland and his team have discovered that the prostate transglutaminase, one of the most prostate-specific genes, is controlled by the retinoic acid signaling pathway.

He comments:

"When retinoic acid gets into a prostate cancer cell, it binds to one of three receptors in the nucleus of the cell. This binding then triggers a sequence of molecular events inside the nucleus which results in the TGP gene being turned on or off. We have shown that the same situation also applies to a number of other genes. All of these genes then tell the cell how to behave - to divide for example."

In prior research, Professor Maitland has suggested that differentiation therapies have been misused in cancer treatments, but can be an effective treatment if used in small doses.

Previously, oncologists have used retinoic acid at a toxic level. In the future, they will need to learn to use low level doses strong enough to change the properties of easily influenced cells. Some cells may react unpredictably. Maitland and his colleagues will investigate these effects before this treatment can be used on patients.

Prostate cancer

Vitamin A may be used to prevent prostate cancer (The Tribune: 12.9.2012)

LONDON: Scientists at the University of York have for the first time discovered a link between cancer cells and a deficiency of vitamin A.

Their research, published in the journal Nucleic Acids Research, showed cancer cells are under control of a derivative of the vitamin, known as retinoic acid, the Daily Express reported. They believe the research could lead to vitamin A as an anti-cancer treatment and generate new advice for people to ensure they include adequate levels of the nutrient in their diets.

Though the study was carried out on prostate cancer cells, Professor Norman Maitland of Yorkshire Cancer Research said it may apply to a number of other cancers. — ANI Stomach Cancer

Cutting Salt Could Reduce Stomach Cancer (medical News Today: 25.7.2012)

If people in the UK cut the amount of salt they consumed to the recommended daily maximum, it could prevent one in seven cases of stomach cancer, said the World Cancer Research Fund (WCRF) on Tuesday, after examining the latest figures for diet and cancer incidence.

The recommended daily maximum intake of dietary salt is 6.0 g, about the same as in a level teaspoon.

But people in the UK on average eat 43% more than this: 8.6 g of salt a day.

WCRF say that although there has been a significant downward trend in levels of salt consumed in the UK, from 9.5 g a day in 2000/01, to 8.6g in 2008, the latest year for which up to date figures are available, it is still too much.

The charity bases its estimates on the latest Food Standard Agency statistics on salt intake, and on cancer incidence data from the latest Office of National Statistics (ONS), Public Health Wales Cancer Incidence, ISD Scotland Cancer Statistics and the Northern Ireland Cancer Registry. One Traffic Light System on Food Labels WCRF want to see one standardized "traffic light" system on the front of food and drink packaging, to help bring down salt, fat and sugar consumption in the UK.

About three quarters of the salt consumed in the UK comes from eating processed food.

A 2011 survey said one fifth of the salt consumed in the UK comes from bought bread, which contains too much salt. There is a similar pattern in the US, where a federal report shows bread and rolls contribute more salt to the American diet than salty snacks.

WCRF say the UK needs a standard system with traffic light labelling on the front of packaging showing clearly the amount of salt, sugar, fat and saturated fat.

Kate Mendoza, their Head of Health Information, told the press:

"Standardised labelling among retailers and manufacturers - rather than the different voluntary systems currently in place - would help consumers make better informed and healthy choices." Cancer Research UK also wants to see standardized labelling as a way to help people control their salt intake:

"Improved labelling - such as traffic light labelling - could be a useful step to help consumers cut down," Lucy Boyd, an epidemiologist with Cancer Research UK, told the BBC.

She said the WCRF figures confirm a report they published recently: too much salt contributes significantly to the number of stomach cancer cases in the UK. Salt and Sodium Confusion One area that is confusing with different labels using different standards, is the difference between salt and sodium content.

Sometimes UK food labels don't show list salt, they list sodium content, as they do in the US. Salt is sodium chloride, and the sodium accounts for 40% of the weight.

So to work out how much salt is in the food whose label lists the sodium content, simply multiply the sodium content by 2.5: thus 0.4 g of sodium x 2.5 = 1 g of salt. 1,000 of Stomach Cancer Cases Could Be Avoided According to the latest figures, there are 7,500 new cases of stomach in the UK a year, with nearly 5,000 deaths due to the disease.

Cutting salt intake to 6.0 g a day would prevent 1 in 7, or 1,000 cases a year, say the WCRF.

It would also lead to other benefits, because salt is linked to high blood pressure, which is a risk factor for stroke and heart disease, and is also tied to osteoporosis and kidney disease.

Mendoza explained that stomach cancer is difficult to treat because most cases are not diagnosed until the cancer is well-established.

Because it is so advanced by the time it is caught, only about 15% of patients live more than 5 years after diagnosis, making stomach cancer the 7th leading cause of cancer death in the UK.

"This places even greater emphasis on making lifestyle choices to prevent the disease occurring in the first place - such as cutting down on salt intake and eating more fruit and vegetables," said Mendoza. Up to Date Evidence on Lifestyle and Cancer THe WCRF and the Association for International Cancer Research (AICR) maintain the Continuous Update Project (CUP), an ongoing review of cancer prevention research that offers up to date evidence on how a healthy diet and physical activity reduces cancer risk.

A team of scientists led by Dr Teresa Norat at Imperial College London carries out the ongoing systematic literature reviews. The CUP, which builds on the WCRF/AICR's 2007 Second Expert Report, is considered the world's biggest database of evidence on how lifestyle factors, such as food, diet, exercise and weight control affect cancer risk.

Currently, the cancers being updated include breast, colorectal, pancreatic, and prostate cancer. Endometrial, ovarian, bladder and kidney cancers are shortly to be added, and other cancers are also expected to join the database in the next year or two. Thyroid Cancer

Disparities Exist in Surgical Management of Thyroid Cancer(Science daily:24.9.2012)

A spectrum of disparities exist in the surgical management of well-differentiated thyroid cancer, according to new data presented at the 82nd Annual Meeting of the American Thyroid Association (ATA) in Québec City, Québec, Canada.

Current ATA guidelines for well-differentiated thyroid cancer recommend therapeutic neck dissection for clinically involved or metastatic disease and prophylactic central neck dissection for advanced tumors. However, even with established guidelines in place, the surgical management of cervical nodes varies greatly.

A team of researchers led by Katherine Hayes, MD, of Emory University in Atlanta, Ga., reviewed data on 127,192 patients with papillary and follicular thyroid cancer who were treated surgically from 1998 to 2009 to identify disparities in the extent of lymph node dissection during thyroidectomy. Variables examined included patient age, race, gender, insurance status and education level, hospital classification, surgical volume, and size of tumor.

Thyroidectomy alone was performed in 51.1%, while 48.9% also had lymph nodes dissected. Patients with tumors > 1 cm were significantly more likely to have nodes removed during surgery (RR 1.2, CI 1.19-1.22) relative to tumors < 1 cm. Older patients and African Americans were less likely to have any nodes removed (RR 0.75, CI 0.74- 0.77 and RR 0.64, CI 0.62-0.66, respectively). Patients treated at National Cancer Institute Designated Centers were more likely (RR 1.13, CI 1.1-1.15) to have > 3 lymph nodes removed, as were patients with tumors > 1 cm (RR 1.25, CI 1.21-1.28). However, women (RR 0.87, CI 0.85-0.88) and African Americans (RR 0.89, CI 0.85-0.93) consistently had fewer lymph nodes removed.

"These new data show that, in spite of existing guidelines, clinician preferences as well as patient characteristics all too often contribute to a number of disparities in the extent of surgery for well-differentiated thyroid cancer," said Elizabeth Pearce, MD, of the Boston Medical Center and Program Co-Chair of the ATA annual meeting. Thyroid Cancer

Novel Sequencing Tools to Play Important Role in Understanding Form of Papillary Thyroid Cancer: Research (Med India:26.9.2012)

According to data, next-generation sequencing analyses of the follicular variant of papillary thyroid carcinoma may elucidate the biological underpinnings and clinical behavior of an increasingly common disease. The data was presented at the 82nd ATA Annual Meeting in QuÃ©bec City, QuÃ©bec, Canada.

Papillary thyroid carcinoma, most common type of thyroid cancer, is the fastest growing cancer type in the United States and many other countries. The increase in incidence is largely attribute to a rise in the number of cases of follicular variant of papillary thyroid carcinoma. The follicular variant of papillary thyroid carcinoma is believed to behave in a clinical manner similar to usual or classical papillary cancer, but can be aggressive.RAS mutations are present in approximately 40% of follicular variant of papillary thyroid carcinomas, but little else is know about other mutations associated with the disease.

"A lack of understanding of molecular drivers of the follicular variant of papillary thyroid carcinoma greatly limits the ability to investigate reasons behind its increased incidence and hampers the development of more individualized management of patients," said Elizabeth Pearce, MD, of the Boston Medical Center and Program Co-Chair of the ATA annual meeting. "These new data suggest that novel genetic tools may shed new light in this important research area."

A team of researchers led by Lindsey Kelly, MD, at the University of Pittsburgh Medical Center, analyzed 501 samples of papillary thyroid carcinoma using a panel of next- generation sequencing tools. They found that 73% were positive for known mutations and 27% were negative for known mutations. The majority of the latter were determined to be follicular variant of papillary thyroid carcinoma. Further analyses of follicular variant of papillary thyroid carcinoma tumors revealed TPM3/NTRK1 fusion with a novel breakpoint, as well as several promising SNVs and SVs. These findings may allow better characterization of the biology and clinical behavior of follicular variant of papillary thyroid carcinoma. Child marriages

Child marriages: India acts mature (The Times of India:17.7.2012)

Mean Age At Marriage Above 18 Yrs In 8 States, Reveals Govt Health Survey

New Delhi: Incremental change appears to be taking place in India’s most backward states which have greatly reduced underage marriage over the last few years, data from the first Annual Health Survey (AHS) conducted by the census authorities indicates. The mean age at marriage is now over 18 in all eight least developed states. However, maternal and infant health is still in troubling shape.

The AHS, the world’s largest demographic survey, is being conducted by the office of the registrar general of India in all 284 districts of the Empowered Action Group (EAG) states — Rajasthan, Uttarakhand, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Bihar, Jharkhand and Odisha — and in Assam. Between them, these states have half the country’s population. The key source of such health data was until recently the National Family Health Survey, which the health ministry has now discontinued. Bizarrely, the government appears to have disabled the NFHS’ website and all links to NFHS reports from its websites. For the new AHS data, comparisons with the NFHS are not appropriate beyond broad trends, registrar general C Chandramouli said.

The AHS data clearly shows the states that are driving India’s population growth. Uttarakhand and Odisha are the only two among them with a Total Fertility Rate — average number of children born to a woman — under the 2010 national average of 2.5. UP and Bihar are the highest at 3.6 and 3.7 respectively while the rural areas of both states are close to 4.

One area of significant improvement would appear to be underage marriages, if NFHS data is taken as a rough comparison. In 2005-06, two-thirds of women, aged between 18 and 29, were married before the legal age of 18, according to the NFHS. But according to the new AHS data, just one-fifth of marriages in Bihar between 2007-09 were of women under 18. In Jharkhand, the proportion would appear to have gone down from 60% to 18%. At 22%, Rajasthan has the highest proportion of women under 18 getting married. Contraceptive use remains low despite improvements. Bihar has the lowest contraceptive prevalence with just over a third of women aged 15-49 using any method of family planning. Sitapur in UP has the lowest contraceptive use of any district with just 20% of women using any method.

Besides, contraception remains a slight misnomer; in all of these states, except Assam, where female sterilization is the main method of contraception, going up to 92% of all contraceptive use in Chhattisgarh, 87% in Bihar and 84% in MP.

Maternal and infant health are still worrying. Less than 5% of women in UP had a full ante-natal check-up, while Chhattisgarh, the best-performing of these states, was at just 20%. Less than half of pregnant women in Jharkhand and Chhattisgarh have safe deliveries and UP, Bihar and Uttarakhand are not far better. Over 40% of new mothers in Assam, Bihar, Jharkhand and Uttarakhand did not receive a post-natal check-up within 48 hours of their deliveries. At least one in five new mothers in all nine states received no post- natal check-up at all. Child Mortality

In India, 3 kids under 5 die every minute (The Tribune:17.9.2012)

Child mortality continues to be a national shame, with the latest child survival data collated by UNICEF revealing a shocking fact - three children under the age of five years died every minute in India last year, the highest anywhere in the world.

India saw 16,55,000 deaths of under-five children in 2011, which translates into 4,534 children every day and a whopping 188 every hour!

India was placed “ahead of” Nigeria in child deaths. Nigeria saw the second highest under five deaths last year, at 7,56,000, followed by Congo with 4.65 lakh, Pakistan with 3.52 lakh and China with 2.49 lakh.

These five countries accounted for around 50 per cent of the global under-five child deaths in 2011. Even war-torn Afghanistan lost lesser children under-five (1.28 lakh) than India in 2011.

Much of the mortality burden in India and the other problem nations can be attributed to high prevalence of infectious diseases.

An annual report by the UN Inter-agency Group for Child Mortality Estimation (UN- IGME) says the world saw 6.9 million deaths of under five children in 2011 as against 12 million in 1990. The reduction has been attributed to control of infectious diseases. For instance, measles deaths declined from 0.5 million in 2000 to 0.1 million in 2011.

Evidence shows pneumonia killed the most children in 2011, making up 18 per cent of global deaths. That makes for 1.3 million deaths, most of which occurred in South Asia and Sub-Saharan Africa.

The good news is - global under-five mortality is down from 87 children per 1,000 live births in 1990 (when the Millennium Development Goals were fixed) to 51 last year. Countries have to meet MDG targets by 2015.

India’s performance remains poor, with the under five mortality of 63 per 1,000 live births, much higher than the world average. India also has the highest under five mortality in the WHO’s South East Asia region. Globally, pneumonia killed the most - 18 per cent - children last year followed by pre- term birth complications which killed 14 per cent; diarrhoea 11 per cent; intra partum complications 9 per cent and malaria 4 per cent.

WORRYING STATS

 India had the highest under-five mortality (deaths per 1,000 live births) in South East Asia at 61, followed by Timor Leste at 55, Nepal at 50, Bhutan at 56, Bangladesh at 48, Indonesia at 35, Korea at 33, Sri Lanka at 17 and Maldives at 15  Infant mortality rate in India (deaths in the first year of life) is 47 per 1,000 live births  Neonatal mortality in India (deaths in first 28 days) is 32.3  India's female under-five mortality rate is higher at 64 as compared to that for males at 58 Depression

Depression

Face book Use Leads to Depression? No, Says Study (Science daily: 10.7.2012)

A study of university students is the first evidence to refute the supposed link between depression and the amount of time spent on Facebook and other social-media sites.

The University of Wisconsin School of Medicine and Public Health study suggests that it may be unnecessarily alarming to advise patients and parents on the risk of "Facebook Depression" based solely on the amount of Internet use.

The results are published online July 9 in the Journal of Adolescent Health.

Last year, the American Academy of Pediatrics released a report on the effects of social media on children and adolescents. The report suggested that exposure to Facebook could lead to depression.

Researchers led by Lauren Jelenchick and Dr. Megan Moreno surveyed 190 University of Wisconsin-Madison students between the ages of 18 and 23, using a real-time assessment of Internet activity and a validated, clinical screening method for depression.

The students were surveyed with 43 text-message questionnaires at random intervals over a seven-day period between February and December of 2011. The students were asked if they were currently online, how many minutes they had been online and what they were doing on the Internet.

The study found that the survey participants were on Facebook for over half of the total time online. When Jelenchick and Moreno evaluated the data including the depression- screening results, they found no significant associations between social-media use and the probability of depression.

"Our study is the first to present scientific evidence on the suggested link between social- media use and risk of depression," said Jelenchick, who just received a master's degree in public health from the University of Wisconsin School of Medicine and Public Health. "The findings have important implications for clinicians who may prematurely alarm parents about social-media use and depression risks." Moreno, a pediatrician who has been widely published in the area of social-media use among children and adolescents, advises parents to look at their children's social-media use in the context of their entire lives.

She says parents don't have to be overly concerned if their child's behavior and mood haven't changed, they have friends and their school work is consistent.

"While the amount of time on Facebook is not associated with depression, we encourage parents to be active role models and teachers on safe and balanced media use for their children," said Moreno.

Depression

Why the Thrill Is Gone: Potential Target for Treating Major Symptom of Depression(science Daily:12.7.2012)

Stanford University School of Medicine scientists have laid bare a novel molecular mechanism responsible for the most important symptom of major depression: anhedonia, the loss of the ability to experience pleasure. While their study was conducted in mice, the brain circuit involved in this newly elucidated pathway is largely identical between rodents and humans, upping the odds that the findings point toward new therapies for depression and other disorders.

Additionally, opinion leaders hailed the study's inventive methodology, saying it may offer a much sounder approach to testing new antidepressants than the methods now routinely used by drug developers.

While as many as one in six Americans is likely to suffer a major depression in their lifetimes, current medications either are inadequate or eventually stop working in as many as 50 percent of those for whom they're prescribed.

"This may be because all current medications for depression work via the same mechanisms," said Robert Malenka, MD, PhD, the Nancy Friend Pritzker Professor in Psychiatry and Behavioral Sciences. "They increase levels of one or another of two small molecules that some nerve cells in the brain use to signal one another. To get better treatments, there's a great need to understand in greater detail the brain biology that underlies depression's symptoms." The study's first author is Byung Kook Lim, PhD, a postdoctoral scholar in Malenka's laboratory.

Malenka is senior author of the new study, published July 12 in Nature, which reveals a novel drug target by showing how a hormone known to affect appetite turns off the brain's ability to experience pleasure when an animal is stressed. This hormone, melanocortin, signals to an ancient and almost universal apparatus deep in the brain called the reward circuit, which has evolved to guide animals toward resources, behaviors and environments -- such as food, sex and warmth -- that enhance their prospects for survival.

"This is the first study to suggest that we should look at the role of melanocortin in depression-related syndromes," said Eric Nestler, MD, PhD, professor and chair of neuroscience and director of the Friedman Brain Institute at Mount Sinai School of Medicine in New York. Nestler was not involved in the study but is familiar with its contents.

The specific causes of depression are not well understood. There is no laboratory test for depression -- the diagnosis is based mainly on patients' own reports of lethargy, despondency, despair and disturbances of appetite and sleep -- but a core symptom is anhedonia, also known as the blues.

In their search for new compounds to combat depression, however, drug developers typically have used tests of mouse behaviors that may not truly reflect this key feature of depression -- and may also limit the search for effective drugs. "Not all animal models are created equal," said Malenka.

In this study, Malenka and his colleagues instead tested a mouse's ability to experience enjoyment. In another departure from more common practice in studies of depression, the scientists conducted their behavioral measurements after exposing the mice to chronic stress -- the kind that we humans experience all too often -- rather than simply placing otherwise happy, normal mice in a single stressful situation.

"Depression in people often involves chronic stress," commented Nestler. "Tossing a person in a swimming pool and telling him to swim doesn't induce despair."

Yet it is precisely tests of this type that have been primarily used in the pharmaceutical industry's hunts for new antidepressants. Common animal assays of depression involve placing normal animals in stressful conditions and then measuring observable outcomes. One example is the "forced swim" test: throwing a rodent into water and measuring how long it takes for the animal to give up trying to swim -- an outcome assumed to indicate "behavioral despair."

This assumption is a red herring because it imputes a state of mind, despair, to rats and mice who not only can't talk about their feelings but who may not experience anything remotely like what we mean by the word despair, said Steven Hyman, MD, director of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard and the former provost of Harvard University. "Who interviewed the mouse? Maybe it stopped swimming to conserve energy."

In 2010, Hyman (who, like Nestler, has seen Malenka's study but played no role in it) and Nestler co-authored a widely acknowledged review in Nature Neuroscience criticizing the way animal assays are used in neuropsychiatric drug development. "Unfortunately, widely used behavioral tests [such as the forced-swim test] are not models of depression at all. Instead, they are rapid, black box tests developed decades ago to screen compounds for antidepressant activity," wrote Nestler and Hyman in their review article.

Moreover, Nestler and Hyman wrote, although a single dose of many currently used antidepressants can prolong the period during which an animal continues to struggle, single doses of these drugs are never effective in people. To relieve actual cases of human depression, they must be administered for weeks or months.

Assays such as the forced-swim test are relatively fast and cheap. But, said Hyman, they may be inadvertently screening out compounds that could be effective in restoring a depressed person's ability to experience pleasure even though they don't prolong an animal's struggle in response to a dunking.

Tests that directly measure an experimental animal's interest in pleasure-seeking appear to more faithfully reflect a true symptom of human depression, Nestler and Hyman said. One example is the so-called sucrose-preference test. If you give mice a choice between water and water containing dissolved sugar, they usually go for the sugar water. Chronically stressed mice lose that preference, just as people suffering depression induced by life's chronic stresses lose the joy of good food, sex, physical comfort and the like.

Malenka's team decided to use chronically stressed mice to explore the activity of a naturally occurring molecule, melanocortin.

"A few scattered studies had suggested that chronic stress increased melanocortin levels in the brain," he said. "And it was known that stressed animals have heightened numbers of receptors for melanocortin in the nucleus accumbens," a key region of the reward circuit. If this all-important circuit is working properly, it doles out pleasure when an animal achieves a desirable goal or experiences rewarding stimuli, such as food or sex. If it's not working properly, anhedonia is the result.

But it wasn't yet known, Malenka continued, whether melanocortin actually affected the nucleus accumbens or how. "We wanted to find out, because we were wondering if by modulating melanocortin's activity with a drug we could relieve or prevent a major symptom of depression."

Malenka's team subjected mice to chronic stress by confining them, for three to four hours a day, in small conical tubes with holes in them for air flow over a period of eight days. This stressful confinement clearly reduced the mice's preference for sugar water over plain water. (The animals also lost about 5-10 percent of their body weight, a frequent depression symptom.)

Rather than simply noting the altered sugar-preference behaviors in the stressed mice, the investigators used electrophysiological, biochemical and gene-transferring techniques to manipulate and, ultimately, to delineate the precise brain circuitry involved in the stress- elicited behavioral changes right down to the molecular level.

For example, the researchers scrutinized the nerve cells in the nucleus accumbens that contain receptors for melanocortin. Those nerve cells receive signals from a melanocortin-secreting nerve tract that impinges on them. The scientists found that both chronic stress and the direct administration of melanocortin diminished the signaling strength of some of the tiny electrochemical contacts, known as synapses, on a set of nerve cells in the nucleus accumbens that contain receptors for melanocortin. When these receptors were removed using a sophisticated laboratory trick, the same stressful confinement no longer caused changes in those nerve cells' synapses. Simultaneously, despite the weeklong stressful experience, the mice's sugar preference was returned to normal. Plus, the animals no longer lost weight.

To test whether preventing these stress-elicited biochemical changes in the brain also reduced the effects of stress on the mice's behavioral response to things besides food and sugar water, the research team substituted cocaine for sugar. They got the same constellation of results with cocaine as they had in their earlier experimentation -- further strong evidence that the chronic-stress-induced changes in the brain due to melanocortin action cause an animal to lose its ability to experience pleasure.

Importantly, Malenka and his associates also demonstrated that the brain circuit transmitting melanocortin's morose message to the reward circuitry operates independently of the circuitry responsible for making a mouse give up the ghost when the game gets too tough. Manipulating the melanocortin-associated pathway in the nucleus accumbens had no effect on the mice's performance in the forced-swim test. The stressed mice gave up just as easily when the melanocortin receptors in their nucleus accumbens were depleted as when they weren't.

By looking at the circuits and mechanisms underlying anhedonia, Malenka and his associates thus avoided a pitfall of research on mental diseases, said Hyman. "This study shows how animal research ought to be done," he said.

The melanocortin pathway is already of interest to drug companies, Malenka said, because it appears to be involved in appetite disorders. So companies already have melanocortin mimics and inhibitors at their disposal that could be used in clinical tests to determine whether managing patients' melanocortin signaling relieves anhedonia. This could have implications beyond treatments for depression because anhedonia manifests in other neuropsychiatric syndromes, such as schizophrenia, as well as in terminally ill people who have given up hope. Hypertension

Why Hypertension Increases Damage to Eyes of Diabetic Patients(Science Daily:13.7.2012)

Hypertension frequently coexists in patients with diabetes. A new University of Georgia study shows why the co-morbid conditions can result in impaired vision.

"Results showed early signals of cell death in eyes from diabetic animals within the first six weeks of elevated blood pressure. Later, the tiny blood vessels around the optic nerve that nourish the retina and affect visual processing showed signs of decay as early as 10 weeks after diabetic animals develop hypertension," said Azza El-Remessy, assistant professor in the UGA College of Pharmacy and director of the UGA clinical and experimental therapeutics program.

The study examined animals with early and established stages of diabetes that also had hypertension. The results, which highlight the importance of tight glycemic control and blood pressure control to delay diabetes-related vision loss, were published in the June issue of the Journal of Molecular Vision. The study was the first to understand or explain why combining increased blood pressure with diabetes would hurt blood vessels in the eye.

"The fact that controlling blood pressure in diabetic patients is beneficial has been shown through many major clinical trials," said Islam Mohamed, a third-year clinical and experimental therapeutics graduate student who co-authored the paper with El-Remessy. "Our study highlights the synergistic and immediate interaction between systemic hypertension and diabetes as two independent risk factors for persistent retina damage known as retinopathy. This emphasizes the importance of addressing different cardiovascular risk factors in a holistic approach for improving management and prevention of retinopathy."

According to the Centers for Disease Control and Prevention, 45 percent of adults in the U.S. suffer from diabetes, hypertension or high levels of cholesterol in the blood called hypercholesterolemia. Approximately 13 percent of U.S. adults suffer from a combination of two of the conditions, and 3 percent have all three.

Early intervention is a key factor in improving the outcome for patients.

"Health care providers, including pharmacists, should stress the importance of the tight control of blood sugar and blood pressure levels for their patients," El-Remessy said. "Providing patient education and counseling on how each of these metabolic problems independently can have accelerated devastating effects is critical and can result. Depression

Too much light at night causes depression (New Kerala: 25.7.2012)

Sleeping in a room with too much light can cause depression, experts claim.

Even just the glow from leaving the television on while you sleep can be enough to trigger the effect, the Daily Mail reported Tuesday.

Lack of darkness during sleeping hours can cause changes to the brain and depressive symptoms, according to animal studies.

Researchers believe staying up late to watch TV or go online might have the same impact on humans.

But the evidence also suggests the effects can be reversed by switching the lights off at night, the Mail said. (IANS)

Stress, Depression

Scientists Discover How Stress, Depression Shrink Brain(med India:13.8.2012)

People suffering from depression or stress suffer brain shrinkage, Yale scientists have discovered the cause behind this condition. A single genetic switch that triggers loss of brain connections in humans and depression in animal models.

The findings showed that the genetic switch known as a transcription factor represses the expression of several genes that are necessary for the formation of synaptic connections between brain cells, which in turn could contribute to loss of brain mass in the prefrontal cortex.

"We wanted to test the idea that stress causes a loss of brain synapses in humans. We show that circuits normally involved in emotion, as well as cognition, are disrupted when this single transcription factor is activated," said senior author Ronald Duman, the Elizabeth Mears and House Jameson Professor of Psychiatry and professor of neurobiology and of pharmacology. The research team analyzed tissue of depressed and non-depressed patients donated from a brain bank and looked for different patterns of gene activation.

The brains of patients who had been depressed exhibited lower levels of expression in genes that are required for the function and structure of brain synapses.

Lead author and postdoctoral researcher H.J. Kang discovered that at least five of these genes could be regulated by a single transcription factor called GATA1. When the transcription factor was activated, rodents exhibited depressive-like symptoms, suggesting GATA1 plays a role not only in the loss of connections between neurons but also in symptoms of depression.

Duman theorizes that genetic variations in GATA1 may one day help identify people at high risk for major depression or sensitivity to stress.

"We hope that by enhancing synaptic connections, either with novel medications or behavioural therapy, we can develop more effective antidepressant therapies," Duman said.

The findings were reported in latest issue of the journal Nature Medicine.

Stress, Depression

Scientists Discover How Stress, Depression Shrink Brain(med India:13.8.2012)

The brains of patients who had been depressed exhibited lower levels of expression in genes that are required for the function and structure of brain synapses.

Duman theorizes that genetic variations in GATA1 may one day help identify people at high risk for major depression or sensitivity to stress.

"We hope that by enhancing synaptic connections, either with novel medications or behavioural therapy, we can develop more effective antidepressant therapies," Duman said.

The findings were reported in latest issue of the journal Nature Medicine.

Depression

Depression may up risk of peripheral artery disease(The Tribune:22.8.2012)

Washington: A study of more than one thousand men and women with heart disease has found depression to be associated with an increased risk of peripheral artery disease (PAD). PAD is a circulatory problem in which narrowed arteries reduce blood flow to the limbs — usually the legs and feet — resulting in pain, reduced mobility and, in extreme cases, gangrene and amputation. Marlene Grenon, a vascular surgeon at San Francisco VA Medical Center and the University of California (SFVAMC) and an assistant professor of Surgery at UCSF, led the analysis of data from 1,024 participants in the Heart and Soul Study, a prospective study of men and women with coronary artery disease who were followed for an average of approximately seven years. — ANI

Depression

Rats to solve the mystery of depression (The Times of India: 4.9.2012) Jerusalem: A team of Israeli scientists have experimented on rats to see how they cope with stress, and hope the study would contribute to understanding the cause of human depression and suicide. Results of the study suggest that while exposure to stress in childhood increases the risk of depression, as one might expect, exposure to stress in adolescence may actually provide protection against depression and suicidal behaviour later in life. “This is the case even for adolescents who were genetically predisposed to suicide,” said the lead researcher, professor Gil Zalsman, deputy director and chief of the child psychiatry division of the Geha Mental Health Centre and associate professor in psychiatry at Tel Aviv University’s Sackler School of Medicine. The study also revealed the differences in the responses to stress between rats with a genetic predisposition to depression, meaning they have hormonal and behavioural abnormalities that emulate those found in depressed humans, and rats without a “depression gene”. The research tested rats of the Wistar-Kyoto strain, which are genetically predisposed to depression & Wistar rats, exposing them to different types of stress. PTI Disease

Spurt in viral fever as humidity rises (The Times of India: 26.7.2012)

Stomach Infection And Wheezing Common; Doctors Stress On Hygiene TIMES NEWS NETWORK

New Delhi: Scarcity of rain and the accompanying humidity has led to a spurt in fever and gastroenteritis cases. Doctors at city hospitals say 50% of the OPD patients have either of the two conditions.

Aggravation of asthma and wheezy bronchitis are being commonly seen among children. Doctors recommend basic precautions like eating healthy and maintaining personal hygiene to keep diseases at bay. “Every day, we are seeing 30-40 cases of stomach infection, triggered mostly by contaminated food and water,” said Dr Vikas Ahluwalia, consultant, internal medicine at Max Hospital, Saket.

He said children and the elderly are most vulnerable owing to poor immunity. Simple things like washing hands before eating, drinking filtered water and having fresh food can help prevent these diseases, he said. Dr M P Sharma, head of the gastroenterology department at Rockland Hospital, says diarrhoea, typhoid and other stomach-related infections are self-limiting and treatable but may turn fatal as well. “Very often, diarrhoea or stomach infection can cause severe dehydration and loss of sodium in the body. If not treated on time, it can endanger the patient's life. Have plenty of water to prevent dehydration and never delay treatment,” said Sharma.

Dr Sanjeev Bagai, senior consultant paediatrician and CEO Radiant Life, said viral infection spreads quickly among children who are vulnerable. “A weak immune system makes them susceptible to viral infections. It is easy to catch viral infection in crowded places like classrooms, theatres and buses,” he said. Bagai said cases of wheezing and aggravation of asthma among children have shot up over the past few weeks.

Dr Arup Basu, chest medicine specialist at Sir Ganga Ram Hospital, said infections are usually transmitted by droplets or by coming into contact with objects contaminated with the secretion of infected people. “Asthmatics and those suffering from lung diseases like Chronic Obstructive Pulmonary Disease must take special care and keep their medicines handy. If symptoms persist, consult a doctor immediately,” he said. Pink eyes or conjunctivitis, another highly contagious disease caused by bacterial and viral infection, is common during rains. Dr Sanjay Choudhary, an ophthalmologist, said maintaining hand hygiene really helps. “Currency notes are the biggest source of infection. Clean your hands before touching the eyes or rubbing them,” he said. LITTLE RAIN COULD MEAN FLU & PAIN Intermittent rain and high humidity levels cause a spurt in bacterial & viral infections. Here’s how to fight them

VIRAL GASTROENTERITIS An inflammation of the gastrointestinal tract, involving the stomach, intestines, or both. Caused mainly due to contaminated food and water Symptoms | Diarrhoea, abdominal cramps, nausea, vomiting, low fever with mild chills, headache, muscle ache, fatigue Prevention | Maintain personal hygiene. Eat freshly cooked food and avoid eating outside TYPHOID Caused by Salmonella typhi bacteria present in contaminated food or water Symptoms | Prolonged fever, abdominal pain, headache and loss of appetite Prevention | Drink boiled & filtered water. Wash hands frequently and avoid roadside food INFLUENZA INFECTIONS Symptoms | Headache, body ache, fever and nasal congestion Precaution | Virus spreads through coughing or sneezing or through contact. One should maintain hygiene & avoid crowded areas WHEEZY BRONCHITIS, ASTHMA Viral infection makes lining of lungs raw, aggravating asthma symptoms. High levels of humidity increase fungal spores in environment

VECTOR-BORNE DISEASES MALARIA Transmitted by the bite of infected anopheles mosquito. Parasites multiply in liver and infect red blood cells Symptoms | Headache, periodic chills, high fever Prevention | Keep surroundings clean and ensure there is no stagnated water. Use mosquito nets, repellents DENGUE Caused by Aedes aegypti mosquitoes that breed in pools of water Symptoms | Fever, skin rash, reduced white blood cells and low platelet count. Haemorrhagic fever caused by it can be fatal

Spreading Disease

New Contagion Model Examines Role of Airports in Spreading Disease (Medical News Today: 26.7.2012)

The first study to model the dynamics of disease spreading in the early stages of an outbreak, looked at 40 US airports and finds the one that would spread the disease from its home city to other places the fastest would be New York's Kennedy International Airport, followed by airports in Los Angeles, Honolulu, and San Francisco.

Researchers in the Department of Civil and Environmental Engineering (CEE) at Massachusetts Institute of Technology (MIT) write about their findings in a paper published online on 19 July in PLoS ONE. Model Focuses On Early Stages of Outbreak In the past ten years we have seen a number of disease outbreaks that have spread around the world. In 2003, the SARS outbreak took merely a few weeks to spread from Hong Kong to 37 countries, killing nearly 1,000 people in its wake. In 2009, the H1N1 "swine flu" pandemic killed nearly 300,000 people worldwide.

Such outbreaks heighten awareness that new pathogens could spread quickly around the world with the help of air travellers. To investigate such contagion patterns, scientists are building mathematical models that incorporate ideas from complex network systems and how information spreads in social networks.

Up to now, these models have focused on the final stages of outbreaks, looking at places that ultimately develop the highest infection rates.

But the MIT researchers took a different approach: they decided to focus on the early stages of epidemics and compare the likelihoods of spread from their home cities to other places through the largest 40 airports of the US.

Thus their model takes into account the travel patterns of individuals, the geographic location of airports, the differences in connectedness between airports, and the waiting times at individual airports. Bringing these factors together, the model then tries to predict where and how fast a disease might spread.

The researchers suggest this way of looking at the problem could help decide the best ways to contain infection and distribute vaccine and treatments in the first few days of an outbreak.

Senior author Ruben Juanes, the ARCO Associate Professor in Energy Studies at MIT's department of CEE, told the press:

"Our work is the first to look at the spatial spreading of contagion processes at early times, and to propose a predictor for which 'nodes' - in this case, airports - will lead to more aggressive spatial spreading."

"The findings could form the basis for an initial evaluation of vaccine allocation strategies in the event of an outbreak, and could inform national security agencies of the most vulnerable pathways for biological attacks in a densely connected world," he added. New Model Is More Realistic The model brings together two contrasting mobility patterns: one geophysical and the other human. The first comes from Juanes' studies of the flow of fluids through fracture networks in underground rocks, and the second comes from CEE's Marta González's studies that model human mobility patterns and trace contagion processes in social networks using cellphone data.

Incorporating these two sources of knowledge, the new MIT model departs from the conventional approach that assumes humans travel in a random diffusion pattern when moving from one airport to another.

The new model is more realistic. People don't travel randomly. They tend to repeat patterns. The team applied Monte Carlo simulations to González's studies of human mobility patterns to determine the likelihood of any single traveler flying from one airport to another.

And they also replaced the conventional random flow model with an "advective fluid" model that assumes the transport process relies on the properties of the substance that is moving.

A conventional random flow model would show that the biggest airport hubs in terms of traffic volume would be the most influential spreaders of disease.

But the team, with their more realistic model, showed that is not the case. Honolulu Airport: Less Traffic But Big Influence A random diffusion model would look at Honolulu airport, which has only 30% of the air traffic of New York's Kennedy International Airport, and conclude half its travellers would go on to San Francisco and half to Anchorage, taking the disease to those airports, passing it onto other travellers, who then in turn pass it on in further random travel patterns.

But the new MIT model looks at Honolulu airport and predicts, despite it having 70% less traffic, that in terms of disease spread, it is nearly as influential as New York's Kennedy International Airport.

This is because Honolulu airport occupies a unique position in the air transportation network. It is located in the Pacific Ocean and is well connected to distant, large and well-connected hubs. So it comes third, ahead of San Francisco, in the list of 40 US airports in terms of contagion-spreading influence.

Of the 40 US airports the model examined in terms of influence on disease spread, it puts Kennedy Airport in first place, followed by airports in Los Angeles, Honolulu, San Francisco, Newark, Chicago (O'Hare) and Washington (Dulles).

The top airport in terms of number of flights is Atlanta's Hartsfield-Jackson International Airport, but the model ranks it eighth in contagion influence. Boston's Logan International Airport ranks 15th.

González is the Gilbert W. Winslow Career Development Assistant Professor of CEE at MIT. She said the method they used is relatively new but very robust.

"The study of spreading dynamics and human mobility, using tools of complex networks, can be applied to many different fields of study to improve predictive models," said González, suggesting that the "incorporation of statistical physics methods to develop predictive models will likely have far-reaching effects for modeling in many applications". A Vergottis Graduate Fellowship and awards from the NEC Corporation Fund, the Solomon Buchsbaum Research Fund and the US Department of Energy helped to fund the study.

Multiple Sclerosis Treatment

New Clue from Research Points to Improved Therapies for Multiple Sclerosis Treatment (Med India:1.8.2012)

A new clue that emerged from Wayne State research could lead to new and improved treatments for Multiple sclerosis, an autoimmune disease that currently has no cure.

Wayne State University School of Medicine researchers, working with colleagues in Canada, have found that one or more substances produced by a type of immune cell in people with multiple sclerosis (MS) may play a role in the disease's progression. The finding could lead to new targeted therapies for MS treatment.

B cells, said Robert Lisak, M.D., professor of neurology at Wayne State and lead author of the study, are a subset of lymphocytes (a type of circulating white blood cell) that mature to become plasma cells and produce immunoglobulins, proteins that serve as antibodies. The B cells appear to have other functions, including helping to regulate other lymphocytes, particularly T cells, and helping maintain normal immune function when healthy.

In patients with MS, the B cells appear to attack the brain and spinal cord, possibly because there are substances produced in the nervous system and the meninges — the covering of the brain and spinal cord — that attract them. Once within the meninges or central nervous system, Lisak said, the activated B cells secrete one or more substances that do not seem to be immunoglobulins but that damage oligodendrocytes, the cells that produce a protective substance called myelin.

The B cells appear to be more active in patients with MS, which may explain why they produce these toxic substances and, in part, why they are attracted to the meninges and the nervous system.

The brain, for the most part, can be divided into gray and white areas. Neurons are located in the gray area, and the white parts are where neurons send their axons — similar to electrical cables carrying messages — to communicate with other neurons and bring messages from the brain to the muscles. The white parts of the brain are white because oligodendrocytes make myelin, a cholesterol-rich membrane that coats the axons. The myelin's function is to insulate the axons, akin to the plastic coating on an electrical cable. In addition, the myelin speeds communication along axons and makes that communication more reliable. When the myelin coating is attacked and degraded, impulses — messages from the brain to other parts of the body — can "leak" and be derailed from their target. Oligodendrocytes also seem to engage in other activities important to nerve cells and their axons.

The researchers took B cells from the blood of seven patients with relapsing-remitting MS and from four healthy patients. They grew the cells in a medium, and after removing the cells from the culture collected material produced by the cells. After adding the material produced by the B cells, including the cells that produce myelin, to the brain cells of animal models, the scientists found significantly more oligodendrocytes from the MS group died when compared to material produced by the B cells from the healthy control group. The team also found differences in other brain cells that interact with oligodendrocytes in the brain.

"We think this is a very significant finding, particularly for the damage to the cerebral cortex seen in patients with MS, because those areas seem to be damaged by material spreading into the brain from the meninges, which are rich in B cells adjacent to the areas of brain damage," Lisak said.

The team is now applying for grants from several sources to conduct further studies to identify the toxic factor or factors produced by B cells responsible for killing oligodendrocytes. Identification of the substance could lead to new therapeutic methods that could switch off the oligodendrocyte-killing capabilities of B cells, which, in turn, would help protect myelin from attacks.

The study, "Secretory products of multiple sclerosis B cells are cytotoxic to oligodendroglia in vitro," was published in the May 2012 edition of the Journal of Neuroimmunology and was recently featured in a National Multiple Sclerosis Society bulletin. Other WSU researchers involved in the study include Joyce Benjamins, Ph.D., professor and associate chair of neurology; Samia Ragheba, Ph.D., assistant professor of neurology and immunology & microbiology; Liljana Nedelkoskaa, research assistant in neurology; and Jennifer Barger, research assistant in neurology; as well as researchers at the Montreal Neurological Institute and McGill University in Montreal. The research was supported by a National Multiple Sclerosis Society Collaborative MS Research Center Award, the Canadian Institutes of Health Research and the Multiple Sclerosis Society of Canada.

Bird Flu

Bird Flu Spreads To Seals, May Threaten Humans ((Medical News Today: 1.8.2012) A new strain of flu virus that started in birds and then jumped to harbor seals may pose a threat to human health and wildlife, according to a new study due to be published this week in mBio, an open access online journal of the American Society for Microbiology.

The strain, called H3N8, was found in New England harbor seals. The study authors identified it from a DNA analysis of a virus that was linked to the die-off of 162 New England harbor seals in 2011. The DNA test was done on samples taken during autopsies on 5 of the seals.

Analysis reveals the new strain is able to target a protein in the human respiratory tract.

Anne Moscona, a pediatrician who researches emerging viruses at Weill Cornell Medical College in New York City, edited the study report. She told the press:

"There is a concern that we have a new mammalian-transmissible virus to which humans haven't been exposed yet. It's a combination we haven't seen in disease before."

The study authors, from Columbia University and the National Oceanic and Atmospheric Administration Outbreaks, and other research centers, point to the importance of monitoring new strains of flu that start in birds and adapt to infect mammals.

By studying and following the progress of the virus, scientists stand a better chance of being able to predict any emergent strains that could pose a threat to humans and start a new pandemic. Cause for Concern The study authors say we should be concerned about this new strain because it seems to have followed a similar path as the H1N1 "swine flu", that probably came from a reassortment of flu viruses in birds, pigs and humans.

It could be the first sighting of a new group of flu viruses with the potential to persist and move between species, they note.

The new virus appears to be a close relative of a flu strain that has been circulating in birds in North America since 2002, but adapted to living in mammals.

The virus has mutations that are known to make flu viruses more transmissible and cause more severe disease.

For instance, it is able to target a receptor called SAα-2,6, a protein found in the human respiratory tract. Scientists have suggested, that should for instance, the bird flu virus H5N1 adapt to human hosts, then the first step is likely to be a switch to bind to human rather than bird cell receptors.

Need to Consider New Routes Moscana says these findings raise two reasons to be concerned about H5N8. First, it is a new virus that infects mammals, and it may cross the species barrier and pose a threat to humans.

Second, the possibility that the threat from bird flu would come through seals has not been widely considered before.

She says pandemic flu can emerge unexpectedly via routes we have not thought of, and we need to be ready for that.

"Flu could emerge from anywhere and our readiness has to be much better than we previously realized," says Moscona.

"We need to be very nimble in our ability to identify and understand the potential risks posed by new viruses emerging from unexpected sources," she adds. Seal Deaths Not Unusual It is not unusual for large numbers of seals to die from flu-virus infections.

Last year, a report in the Boston Globe highlighted how the past few decades have seen notable seal die-offs in the Northeast of the United States, including a rash of flu deaths in 1979 and 1980. A link to bird flu was suspected then as well, the theory being that the mammals picked up the virus while sunning themselves on rocks covered with bird droppings.

In 2006, a morbillivirus (from a family of viruses that includes the one that causes measles in humans) killed hundreds of harbor and gray seals in New England. The same virus was behind the death of 20,000 seals a few years earlier in the United Kingdom.

Harbor seals are year-round inhabitants of the coastal waters of eastern Canada and Maine and occur seasonally along the southern New England to New Jersey coasts from September through late May, although a recent report from by the National Marine Fisheries Service, suggests scattered sightings and strandings have been recorded as far south as Florida.

At the last survey in 2001, the estimated population of harbor seals along the New England coast was 99,340.

Multiple Sclerosis

How Does Multiple Sclerosis Progress? Possible Clues Discovered (Medical News Today: 7.8.2012) Researchers have discovered that one or more substances produced by a certain type of immune cell may be involved in the progression of multiple sclerosis (MS), an autoimmune disease affecting the brain and spinal cord, may be involved caused by. The finding might lead to new, targeted treatments for those suffering from MS.

Leading researcher, Robert Lisak, M.D., a professor of neurology at Wayne State explained that B cells belong to a subset of circulating white blood cells (lymphocytes), which become immunoglobulin (antibodies) producing plasma cells when mature. However, B cells also seem to play a role in controlling other lymphocytes, particularly T cells, and help to regulate a healthy immune system.

The B cells attack the brain and spinal cord in patients with MS, which could be due to the fact that the nervous system and the meninges, the covering of the brain and spinal cord, produce substances that attract the B cells. Once within the meninges or central nervous system, the activated B cells secrete one or several substances that damage oligodendrocytes, i.e. cells that produce myelin, a protective substance, yet which do not seem to affect the immunoglobulins. The scientists observed that B cells seem to be more active in MS patients. This may explain whey these cells produce toxic substances and partially why they are attracted by the nervous system and the meninges.

Most of the brain is split into gray areas that contain neurons, and white areas, where neurons send their axons just like electrical cables carry messages, in order to communicate with other neurons and transfer messages from the brain to the muscles. The white parts of the brain have their particular color because the oligodendrocytes produce myelin, the axons' coating/insulation similar to that to the plastic coating of electrical cables, which is rich in cholesterol. Myelin accelerates communication along the axons, making it more reliable, yet when this coating degrades or is attacked, it can lead to 'leakages' or messages being sent to the wrong receptor during communication from the brain to other body parts. The team noted that oligodendrocytes also appear to play a role in other activities, which are vital for the nerve cells and their axons.

For their study, the team obtained B cells from the blood of 7 MS patients that had relapsed or were in remittance and from 4 healthy patients. The researchers grew the cells in a medium and collected the material the cells produced after removing them from the culture.

They grew the cells in a medium, and after removing them from the culture they collected the material the cells produced and implanted it together with the cells that produce myelin into the brain cells of animal models. They discovered that considerably more oligodendrocytes died within the MS group compared with the material produced by the B cells from the healthy patients. In addition, they also observed differences in other brain cells that interact with oligodendrocytes in the brain.

Lisak commented: "We think this is a very significant finding, particularly for the damage to the cerebral cortex seen in patients with MS, because those areas seem to be damaged by material spreading into the brain from the meninges, which are rich in B cells adjacent to the areas of brain damage."

The team is planning to continue their studies to find which B cells' toxic factor(s) is/are responsible for destroying oligodendrocytes, as this could potentially lead to new treatments that could switch off the oligodendrocyte-killing capabilities of B cells and therefore help to protect myelin.

Global 'sleeplessness epidemic'

Global 'sleeplessness epidemic' affects 150 million adults in developing world(World Newspapers: 7.8.2012)

A new study has revealed that levels of sleep problems in the developing world are far higher than previously thought and are approaching those seen in developed nations, linked to an increase in problems like depression and anxiety.

An estimated 150 million adults are suffering from sleep-related problems across the developing world, according to the first ever pan-African and Asian analysis of sleep problems, led by Warwick Medical School at the University of Warwick.

Warwick Medical School researchers have found a rate of 16.6 per cent of the population reporting insomnia and other severe sleep disturbances in the countries surveyed – close to the 20 per cent found in the general adult population in the West, according to nationwide surveys in Canada and the US.

The researchers, which also included academics from the INDEPTH Network in Ghana and the University of the Witwatersrand in South Africa, looked at the sleep quality of 24,434 women and 19,501 men aged 50 years and over in eight locations in rural populations in Ghana, Tanzania, South Africa, India, Bangladesh, Vietnam and Indonesia, and an urban area in Kenya.

They examined potential links between sleep problems and social demographics, quality of life, physical health and psychiatric conditions.

The strongest link was found between psychiatric conditions like depression and anxiety and sleep problems, mirroring trends seen in the developed world. There was striking variation across the countries surveyed – Bangladesh, South Africa and Vietnam had extremely high levels of sleep problems, in some cases surpassing Western sleeplessness rates.

However India and Indonesia reported relatively low levels of severe sleep problems.

The research also found a higher prevalence of sleep problems in women and older age groups, consistent with patterns found in higher income countries.

“Our research shows the levels of sleep problems in the developing world are far higher than previously thought,” said Dr Saverio Stranges, the leading author of the manuscript at Warwick Medical School.

Bangladesh had the highest prevalence of sleep problems among the countries analysed – with a 43.9% rate for women – more than twice the rate of developed countries and far higher than the 23.6% seen in men. Bangladesh also saw very high patterns of anxiety and depression.

Vietnam too had very high rates of sleep problems – 37.6% for women and 28.5% for men.

Meanwhile in African countries, Tanzania, Kenya and Ghana saw rates of between 8.3% and 12.7%.

However South Africa had double the rate of the other African countries – 31.3% for women and 27.2% for men.

India and Indonesia both had very low prevalence of sleep issues – 6.5% for Indian women and 4.3% for Indian men. Indonesian men reported rates of sleep problems of 3.9% and women had rates of 4.6%.

Sepsis

Sepsis killing more people than AIDS: Experts (Sep 13 is World Sepsis Day) (New Kerala:13.9.2012)

Sepsis, a condition caused by infections leading to multiple organ failure, is among the leading causes of deaths in India - killing more people than AIDS or cancer, say experts.

Awareness to the fatal condition, however, remains low, say doctors. Sepsis or septicemia is "body's reaction to infection", said Vivek Nangia, director, infectious diseases, at Delhi's Fortis Hospital.

It is a condition in which bacteria make toxins that cause the body's immune system to attack organs and tissues.

"Any infection in any part of body may cause sepsis," warned Nangia.

"Every hour, about 36 people die from sepsis. It causes more deaths than prostate cancer, breast cancer and HIV/AIDS combined. Globally, an estimated 18 million cases of sepsis occur each year," said Rajesh Chawla, vice-chancellor of the Indian Society of Critical Care Medicine (ISCCM), Delhi.

ISCCM, along with Global Sepsis Alliance, is organising a programme to spread awareness on Sepsis Thursday, marking the World Sepsis Day.

"Sepsis is quite a common cause of deaths. It is the third commonest cause resulting in death across the world, and in India it is probably the leading cause," observed Nangia.

Chawla said that although Sepsis was one of the most serious medical conditions, there was a tremendously low awareness among people, including medical professionals.

According to a recent Indian Intensive Care Case Mix and Practice Patterns study, one out of two patients who develop Sepsis die.

Nangia added that hospital picked infections which cause the disease might also be related to multi-drug resistant bacteria.

"When the infection is picked up in hospitals, it can be associated with the multi-drug resistant bacteria," he said, adding that there was a strict guideline on how to treat patients after detection of Sepsis.

"The patient has to be admitted and within first two hours, first shot of anti-biotic has to be given. After that detailed culture tests have to be done," he says. (IANS) HIV/AIDS

HIV/AIDS

Not positive enough for people (The Hindu: 12.7.2012)

http://www.thehindu.com/todays-paper/tp-miscellaneous/article3629582.ece - #http://www.thehindu.com/todays-paper/tp-miscellaneous/article3629582.ece - #Punitive laws pertaining to HIVare affecting the fight against the infectionin several countries including India,says UN report

Creating awareness on HIV:Students form a human chain.Photo: Akhilesh Kumar

According to a latest independent expert report, punitive laws and human rights abuses are costing lives, wasting money and stifling the global AIDS response.

The Global Commission report on “HIV and the Law: Risks, Rights and Health” finds evidence that governments across the world have wasted the potential of legal systems in the fight against HIV; and concludes that laws based on evidence and human rights strengthen the global AIDS responses.

More than 100 countries criminalise some aspect of sex work. The legal environment in many countries exposes sex workers to violence, and results in their economic and social exclusion. It also prevents them from accessing essential HIV prevention and care services.

In more than 60 countries, it is a crime to expose another person to, or transmit, HIV. More than 600 HIV positive people across 24 countries, including the United States, have been convicted of such crimes. These laws and practices discourage people from seeking an HIV test and disclosing their status. As many as 78 countries criminalise same-sex sexual activity. Iran and Yemen impose the death penalty for sexual acts between men; Jamaica and Malaysia punish homosexual acts with lengthy imprisonments. These laws make it difficult to prevent HIV among those most vulnerable to infection, the report points out.

Laws that criminalise and dehumanise populations at highest risk of HIV – including men who have sex with men, sex workers, transgender people and injecting drug users – drive people underground, away from essential health services and heighten their risk of HIV infection.

The report, released globally on Monday, coincides with the third anniversary of the Section 377 judgement in India that decriminalised homosexuality. Three years ago, in July 2009, a landmark judgement delivered by the Delhi High Court un-did decades of injustice to India’s homosexual community: Section 377 of the Indian Penal Code - that had been misused to target the gay community was finally repealed. Homosexuality was de-criminalized, which means, it is no longer illegal to be gay in India.

While the repealing of Section 377 came as a huge victory for the people with different sexual preferences, the situation remains grave for vulnerable groups. The people living with HIV (PLHIV) in India continue to be discriminated against. From being denied treatment at hospitals and being sacked from workplaces, to children being thrown out of school for being HIV + and tenants being asked to vacate houses, India joins a list of nations where the law does not stand up to protect the PLHIV community.

Since 2005, passport applicants have the option of identifying themselves as male, female, or “others’’ regardless of whether they have had sex change operations.

The Global Commission on HIV and Law – comprising former heads of state and leading legal human rights and HIV experts – based its report on extensive research and first- hand accounts from more than 1,000 people in 140 countries. The Commission, supported by the United Nations Development Programme on behalf of the Joint United Nations Programme on HIV/AIDS, found that punitive laws and discriminatory practices in many countries undermine progress against HIV.

Similarly, laws in some countries criminalise proven interventions for injecting drug users, including in Cambodia, China, Myanmar, Malaysia and the Philippines. In contrast, countries that legalise harm reduction services, like Switzerland and Australia; have almost completely stopped new HIV infections amongst injecting drug users.

Laws and customs that disempower women and girls – from genital mutilation to denial of property rights -- undermine their ability to negotiate safe sex and to protect themselves from HIV infection. As many as 127 countries, including India, do not have legislation against marital rape.

The report further points out that the laws and policies that deny young people access to sex education, harm reduction and reproductive and HIV services, help spread HIV. Excessive intellectual property protections that hinder the production of low cost medicines, especially second-generation treatments, impede access to treatment and prevention, it says.

Over the past three decades, scientific breakthroughs and billions of dollars of investments have led to the remarkable expansion of lifesaving HIV prevention and treatment programmes, which have benefitted countless individuals, families and communities. Yet, the Commissions report finds that many countries squander resources by enacting and enforcing laws that undermine these critical investments.

“Governments across the world have a responsibility to take bold action and repeal or amend laws that stem from ignorance, prejudice and intolerance’’, said JVR Prasada Rao, Commissioner and the UN Secretary General’s Special Envoy for AIDS, Asia and the Pacific.

HIV/AIDS

Time to turn the tide (Hindustan Times: 18.7.2012)

The world's collective response to HIV three decades ago can be summed up in one word: shameful. At worst, people living with HIV were, inexplicably, chained to their beds, detained, turned away from medical facilities, criminalised and deported. At best, they lost their jobs, were kicked out of schools and denied access to basic services. We responded to a virus by humiliating, stigmatising and punishing those infected. Our response to the virus was as painful, and sometimes as deadly as the virus itself.

Fortunately, impressive strides have since been made in the fight against HIV. In the last few years, major scientific advances have occurred and the number of new HIV infections, particularly among children, has been slowly declining, fewer people are dying from Aids-related causes, nearly half of those people eligible for antiretroviral treatment, including in low- and middle-income countries, are now receiving it, and treatment has become the new engine for prevention. HIV is no longer the certain death sentence it once was.

Yet, the stigma and discrimination faced by HIV-positive people remains high, in every region of the world. Even today, we continue to focus on punitive approaches to HIV such as the criminalisation of HIV transmission, non-disclosure and exposure. Entry restrictions against and deportation of HIV-positive non-nationals at borders are still far too common, particularly in the more affluent countries. The most vulnerable communities - the ones that least enjoy their fundamental human rights - also remain disproportionately more vulnerable to HIV infection - and this is no coincidence. The face of HIV has always been the face of our failure to protect human rights. One of the key drivers of Aids has always been, and remains, this failure to ensure human rights protection for marginalised communities, including prisoners, sex workers, drug users, people with disabilities and migrants, refugees and asylum seekers. Homophobia, gender discrimination, racial profiling and violence against women have further impeded efforts to effectively manage and contain the spread of HIV.

The theme of this year's International Aids Conference, which will be held in Washington DC from July 22-27, is 'Turning the Tide Together'. It is indeed now time to turn the tide. The human rights violations that have characterised the spread of HIV, and in many cases also the fight against it, must be curbed. The starting point is the recognition of all people as equal in the enjoyment of their human rights. Vulnerable populations that are most at risk must be included in national responses to HIV and given a chance to participate in making the policies that will affect them.

Human rights norms must accompany public health considerations to ensure that our laws, policies and programmes do not increase vulnerability to HIV or result in further human rights violations. Broad laws and policies that criminalise non-intentional HIV transmission, exposure and non-disclosure, target specific groups for mandatory HIV testing, and restrict travel of individuals based on HIV status alone are examples of such alarmist and misguided policies.

Advances in the right direction have been made, one of which - the lifting of travel restrictions - has enabled the US to host this important conference this year, after 22 years. But much remains to be done. Even in America, where laws are on the books to protect and promote the human rights of HIV-positive people, the extent to which they are respected and enforced is not clear.

More resources certainly need to be channelled into ensuring access to good quality lifesaving antiretroviral treatment, but also to human rights programmes, including raising awareness, training of healthcare providers and law enforcement officials, access to justice for HIV-positive individuals, fighting stigma and educating young people about safe sex. Funding the fight against Aids in this holistic fashion is not only necessary; it is also a human rights legal obligation. The current economic crisis cannot be an excuse for diminishing our investment in the response to Aids. This would result in a reversal in the gains made so far.

This is not a time for complacency. The UNAIDS has as its goal: zero new infections, zero Aids-related deaths and zero discrimination. At this year's conference, a gathering of high-level government officials, civil society, the international community and, importantly, people living with HIV, it is essential to drive home the point that in order to succeed, human rights must inform and motivate our response.

Navi Pillay is United Nations High Commissioner for Human Rights

The views expressed by the author are personal Pill to cut HIV risk

US nod for once-a-day pill to cut HIV risk (The Times of Indias: 18.7.2012)

Clinical Trials Show Drug ‘Truvada’ Significantly Prevents Infection, Says FDA

Washington: For the first time, a once-a-day pill which reduces the chance of contracting HIV among high risk groups “significantly” has got green signal in the US, where 1.2 million people are infected by the deadly disease. The drug,‘Truvada’ can now be used by those at high risk of the infection and anyone who may engage in sexual activity with HIV-infected partners, the Food and Drug Administration (FDA) announced. “In two large clinical trials, daily use of the drug was shown to significantly reduce the risk of HIV infection,” it said on Monday. However, some health workers and groups active in the HIV community opposed the approval for the once-a-day pill. There are concerns that circulation of such a drug could engender a false sense of security and mean people will take more risks. There have also been fears that a drug-resistant strain of HIV could develop. People diagnosed with HIV that without treatment develops into AIDS take antiviral medications to control the infection that attacks their immune system. In a statement, the FDA stressed that the drug should be used as part of a “comprehensive HIV prevention plan”, including condom use and regular HIV testing. Studies show that Truvada reduced the risk of HIV in healthy gay men — and among HIV-negative heterosexual partners of HIV-positive people — by between 44% and 73%. “In the 80s and early 90s, HIV was viewed as a life-threatening disease; in some parts of the world it still is. Medical advances, along with the availability of close to 30 approved individual HIV drugs, have enabled us to treat it as a chronic disease most of the time,” Debra Birnkrant, director of the Division of Antiviral Products at FDA, said. PTI GM bacteria prevents malaria transmission

In a breakthrough, US scientists have genetically modified a bacterium to kill the parasite that causes malaria before it infects humans. Researchers at Johns Hopkins Malaria Research Institute said their breakthrough could help prevent mosquitoes from transmitting malaria to humans. Malaria kills over 800,000 people worldwide every year, most of them are children. In the new study, published in the journal Proceedings of the National Academy of Sciences, the researchers modified the bacterium, called Pantoea agglomerans, to secrete proteins that are toxic to the malaria parasite, but not harmful to the mosquito or humans. The bacterium is commonly found in the mosquito’s midgut. It was found that the modified bacteria were 98 per cent effective in reducing the malaria parasite burden in the insects, the researchers said. PTI NIPPING IT IN THE BUD HIV/AIDS

Time to turn the tide (Hindustan Times: 18.7.2012)

Navi Pillay is United Nations High Commissioner for Human Rights

The views expressed by the author are personal Pill to cut HIV risk

US nod for once-a-day pill to cut HIV risk (The Times of Indias: 18.7.2012)

Clinical Trials Show Drug ‘Truvada’ Significantly Prevents Infection, Says FDA

New HIV infections

2011 saw 7,000 new HIV infections per day Funding key challenge; 10% global AIDS deaths in India(The Tribune:20.7.2012)

The world saw 7,000 new HIV infections a day in 2011, most among the youth and women. About 900 of these were in children below 15 years of age.

A new UNAIDS report released today says though the world has reduced new HIV infections by 20 per cent over the past decade, half of the treatment-seeking population remains out of the ambit of anti-retroviral therapy (ART).

The report, Together we will end AIDS, comes just before the XIX International AIDS Conference that begins in Washington on July 22. It shows that an estimated 34.2 million people were living with HIV in 2011. Of them, 4.2 million were in South and South East Asia. India housed 2.4 million, the largest infected population after South Africa’s. Of the 1.7 million AIDS-related deaths the world saw last year, around 1,70,000 were in India. This accounts for 10 per cent of the global burden.

That’s not to say that no progress was made. India specially did well by reducing new HIV infections by 50 pc over the past decade, states the report. It, however, red flags the issue of funding sector gap, saying the world HIV/AIDS programme will be short of around US$ 7 billion by 2015. This gap is despite the increased domestic budgets that far exceeded global funding over the recent years. The report lauds BRICS countries (Brazil, Russia, India, China and South Africa) for increasing domestic public spending on HIV by more than 120 per cent between 2006 and 2011.

“BRICS now fund, on average, more than 75 pc of their domestic AIDS responses. India, too, has committed to increase domestic funding to more than 90 pc in its next phase of the AIDS response,” it says.

The concern however is that global HIV AIDS funding remained static between 2008 and 2011 at around US$ 8.2 billion. This means the world won’t be able to put 15 million people in need of treatment on ART by 2015, as committed, unless countries push budgets handsomely.

“Countries most affected by the epidemic are taking ownership and demonstrating leadership in responding to HIV. However, it is not enough for international assistance to remain stable - it has to increase if we are to meet the 2015 goals,” says Michel Sidibé, Executive Director, UNAIDS.

VITAL STATISTICS

34.2 million living with HIV globally in 2011; 4.2 million in South, South East Asia; 2.4 million in India

25 lakh new infections globally; 3 lakh in Asia

3.3 children newly infected; 21 000 in Asia

17 lakh AIDS deaths globally; 2.7 lakh in Asia; around 1.7 lakh in India

7,000 new infections a day; 6,000 in adults (47% of these in women; 41% in 15 to 24 year olds) http://www.tribuneindia.com/2012/20120720/nation.htm - top#top

AIDS-Free Generation

New Report Describes Seven Essential Steps toward an AIDS-Free Generation(Science Daily:20.7.2012)

The end of AIDS is within our reach. But as the authors of a new special supplement in the August, 2012 Journal of Acquired Immune Deficiencies (JAIDS) point out, new financial investments -- and renewed commitments -- from countries around the world will be critical to fully implement proven treatment and prevention tools already at hand and to continue essential scientific research.

"Only then will an AIDS-free generation be possible," write the supplement's editors -- Richard Marlink, Wafaa El-Sadr, Mariangela Simao and Elly Katabira -- in their introduction.

"Are we willing to pay the price to turn the dream into a reality?" they ask.

Entitled "Engaging to End the Epidemic: Seven Essential Steps Toward an AIDS-Free Generation," the supplement identifies the seven key areas where money and political will must be focused to end AIDS. These include: 1.The promise and challenges of using antiretroviral drugs (ARVs) to prevent HIV transmission 2.New AIDS treatments, improving the ARV pipeline to treat those infected, and working toward a cure 3.Enhancing the role of government leaders, the private sector, and non-governmental organizations (NGOS) in driving local and national responses to the epidemic 4.Narrowing health disparities in preventing and treating AIDS caused by economic disempowerment, discrimination, and stigma 5.Preventing AIDS transmission from mothers to babies in low- and middle-income countries where access to prevention services are most limited, but where new drug interventions show AIDS could be virtually eliminated in infants and children 6.Funding the pursuit for AIDS vaccines, which are necessary to actually eliminate the disease 7.Maximizing and growing current investments in the global AIDS response, rather than decreasing funding. In addition to its humanitarian impact, money spent going forward is a good global and local investment because improving and sustaining people's health enables them to be productive members of society contributing to the growth of their nations' economies.

New HIV cases

New HIV cases decline by half in India: UN report(World Newspapers: 20.7.2012)

New HIV cases among adults have declined by half in India since 2000, according to a new UN report which praised India's contribution to AIDS response through manufacture of generic antiretroviral drugs.

Though rate of HIV transmission in Asia is slowing down, atleast 1,000 new infections among adults continue to be reported in the continent every day in 2011. An estimated 3,60,000 adults were newly infected with HIV in Asia in 2011, considerably fewer than 4,40,000 estimated for 2001, a new UNAIDS report has said.

"This reflects slowing HIV incidence in the larger epidemics, with seven countries accounting for more than 90% of people (in Asia) living with HIV - China, India, Indonesia, Malaysia, Myanmar, Thailand and Viet Nam," the report 'Together We Will End AIDS' said.

The UNAIDS lauded India for doing "particularly well" in halving the number of adults newly infected between 2000 and 2009 and said some smaller countries in Asia like Afghanistan and Philippines are experiencing increases in the number of people acquiring HIV infection.

It said a total 17 lakh people had died across the world due to AIDS related illness. In India, the figure for such deaths stood at 1.7 lakh in 2009.

The report says India has contributed enormously to the AIDS response.

"With 80% of these drugs being generics purchased in India, several billion dollars have been saved over the past five years. The country is also committed to new forms of partnership with low-income countries through innovative support mechanisms and South–South cooperation," the UNAIDS report says.

It also points out that India already provides substantial support to neighbouring countries and other Asian countries - in 2011, it allocated $430 million to 68 projects in Bhutan across key socio-economic sectors, including health, education and capacity-building.

In 2011 at Addis Ababa, the government of India further committed to accelerating technology transfer between its pharmaceutical sector and African manufacturers.

.India has committed to pay more than 90 per cent of its national strategic plan for 2012– 2017, compared with 10 per cent in 2009, the report said.

The UN body, however, pointed out that treatment coverage for HIV is low in Asia at 44 per cent. It said the number of people dying from AIDS-related causes has remained stable in Asia, where the number of people dying from AIDS-related causes in 2011 totaled an estimated 3,30,000, the largest number of deaths outside of sub-Saharan Africa.

The UN body said Brazil, Russian Federation, India, China and South Africa (BRICS) are leading the way in assuming greater responsibility for their domestic HIV responses. It pointed out that injecting drug use, unprotected sex between men and unprotected paid sex fuel the epidemics in this region and prevalence of HIV among these key populations at higher risk is high in many Asian countries. "An estimated 16 per cent of people who inject drugs in Asia are living with HIV, but prevalence of HIV infection is much higher in some places. Between 8 per cent and 32 per cent of men who have sex with men are living with HIV in cities in China, India, Indonesia, Myanmar and Thailand," it said.

The report said core prevention and treatment activities save lives and Antiretroviral therapy alone has added an estimated 14 million life-years among adults in low and middle income countries since 1995, with increasing gains as treatment coverage expands. "Implementing a core package of HIV prevention and treatment activities, together with critical enablers, would prevent a cumulative 12.2 million people from acquiring HIV infection and 7.4 million people from dying from AIDS related causes between 2011 and 2020 and add a further 29.4 million life-years," it said.

The report also said a contribution of only 0.1 per cent of gross domestic product from Brazil, the Russian Federation, India, China and South Africa could add as much as USD 10 billion to global international assistance.

The United Nations report said around 2.5 million people became newly infected with HIV last year, taking the total to 34.2 million people globally living with the deadly virus.

While almost 1.7 million people dying of AIDS-related illnesses in 2011, more than 8 million people received antiretroviral therapy during the year, up from 6.6 million people in 2010, an increase of more than 20 per cent.

The report said this has put the international community on track to reach the goal of 15 million people receiving HIV treatment by 2015, as set out by the 2011 Political Declaration on HIV and AIDS unanimously adopted by UN Member States.

HIV-positive women

Babies of HIV-positive women show exposure to antiretrovirals(New Kerala: 23.7.2012)

Hair and blood samples from three-month-old infants born to HIV-positive mothers surprisingly show exposure, both in the womb and from breast-feeding, to the antiretroviral drugs being taken by their mothers, says a study.

"We found high levels of exposure to three antiretroviral medications in the hair samples of 12-week-old infants who were uninfected by HIV," said study co-author, Monica Gandhi, associate professor of medicine at the University of California, San Francisco (UCSF). "From looking at plasma level data at the same time point, we believe that transfer of two of the medicines from mother to baby occurs exclusively in the womb and transfer of the third medication occurs both in the womb and through breastfeeding," said Gandhi, according to a California statement.

The findings could lead to new ways to protect infants from HIV transmission and to better understand the development of toxicities and resistance to the drugs, researchers from UCSF and Makerere University, Uganda, said.

A single plasma level of a medication reflects drug exposure over approximately 24 hours.

Measuring the concentrations of antiretrovirals in a small hair sample reveals exposure over the past month. (IANS)

AIDS

End of AIDS is within our reach (New Kerala: 23.7.2012)

In order to realise the dream of AIDS-free generation, experts say new financial investments – and renewed commitments – from countries around the world will be critical to fully implement proven treatment and prevention tools already at hand and to continue essential scientific research.

"Are we willing to pay the price to turn the dream into a reality?" they asked

The recommendations are the outgrowth of an international conference on AIDS convened at Harvard School of Public Health in December, 2011.

The conference brought together more than 200 global experts in the field from academia, government, non-governmental organizations, and the private sector in anticipation of the upcoming International AIDS Conference in Washington D.C. being held July 22-27, 2012.

The experts pointed out the seven key areas where money and political will must be focused to end AIDS.

These include: The promise and challenges of using antiretroviral drugs (ARVs) to prevent HIV transmission; New AIDS treatments, improving the ARV pipeline to treat those infected, and working toward a cure; Enhancing the role of government leaders, the private sector, and non-governmental organizations (NGOS) in driving local and national responses to the epidemic. They also pointed out steps like narrowing health disparities in preventing and treating AIDS caused by economic disempowerment, discrimination, and stigma, and preventing AIDS transmission from mothers to babies in low- and middle-income countries where access to prevention services are most limited, but where new drug interventions show AIDS could be virtually eliminated in infants and children.

Finally funding the pursuit for AIDS vaccines, which are necessary to actually eliminate the disease, at the same time maximizing and growing current investments in the global AIDS response, rather than decreasing funding.

In addition to its humanitarian impact, money spent going forward is a good global and local investment because improving and sustaining people's health enables them to be productive members of society contributing to the growth of their nations' economies.

Their recommendations appeared in a new special supplement in the August, 2012 Journal of Acquired Immune Deficiencies (JAIDS). (ANI)

HIV-infected patients

HIV-infected patients taking ART fail to keep disease in check (The Tribune: 25.7.2012)

Washington: HIV-infected young adults, blacks, injection drug users and those who lack health insurance are less likely to have the disease under control while taking antiretroviral drugs, according to results of a study by AIDS experts at Johns Hopkins and the University of Pennsylvania.

The study also pointed out that tens of thousands of Americans taking potent antiretroviral therapies, or ART, to keep their HIV disease in check may not have as much control over the viral infection as previous estimates have suggested. In what is believed to be the largest and longest review of viral load test results in people with HIV disease ever performed in the United States, researchers found that the number of people sustaining viral suppression — consistently, at 400 or less viral copies per millilitre of blood, year after year — is roughly 10 per cent less than previous estimates. — ANI Drug-resistant HIV

Drug-resistant HIV on rise in sub-Saharan Africa (The Tribune: 25.7.2012)

London: Experts including an Indian origin scientist have warned that drug-resistant HIV has been increasing in parts of sub-Saharan Africa over the last decade. The team, which reviewed studies on 26,000 untreated HIV-positive people in developing countries, said resistance could build up if people fail to stick to drug regimes, and because monitoring could be poor.

The researchers, from the World Health Organisation (WHO) and University College London (UCL), found the most rapid increase in drug resistance occurred in East Africa, at 29 per cent per year. In Southern Africa, it was 14 per cent per year.

There was no change in resistance over time in Latin America and in West and Central Africa. — ANI

HIV/AIDS pandemic

Ending global HIV/AIDS pandemic is within our reach (New Kerala:25.7.2012)

Ending the global HIV/AIDS pandemic may be possible by implementing a multifaceted global effort that expands testing, treatment, and prevention programs, as well as meets the scientific challenges of developing an HIV vaccine and possibly a cure, say researchers.

Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Md., made the recommendation at a JAMA media briefing at the International AIDS Conference.

Among the most important interventions is combination antiretroviral therapy, which significantly improves the health and longevity of individuals infected with HIV.

"Since the advent of antiretroviral therapy, the annual number of deaths due to AIDS has decreased by two-thirds in the United States. Globally, an estimated 700,000 lives were saved in 2010 alone due to the increased availability of antiretroviral therapy in low- and middle-income countries," Dr. Fauci and Gregory K. Folkers, M.S., M.P.H., also of the NIAID, wrote.

"Important challenges remain—notably finding the resources and developing the infrastructure to provide antiretroviral therapy to the estimated 8 million individuals with HIV infection who need these drugs but are not receiving them," they noted.

The researchers added that antiretroviral therapy could also prevent HIV infection by reducing the amount of virus in an infected person's blood and other body fluids, making it less likely that the virus will be transmitted to others. Also, antiretroviral therapy is highly effective in blocking mother-to-child HIV transmission.

Other important interventions include medical male circumcision, which offers a highly effective and durable way to protect heterosexual men from HIV infection; and potentially, pre-exposure prophylaxis with antiretroviral medications, which have shown promise in reducing an individual's risk of acquiring HIV infection.

"Each of these treatment and prevention strategies has a strong evidence base; with further refinement and scale-up and also when used in combination, they could have an extraordinary effect on decreasing the trajectory of the HIV pandemic," they said.

They said researchers are maintaining focus on 2 key scientific challenges that remain: the development of a vaccine and a cure. They wrote that modest success in a large-scale clinical trial of an HIV vaccine, promising results in animal models, and advances in structure-based vaccine design suggest that an HIV vaccine is feasible. The prospect of an HIV cure remains challenging.

The researchers concluded that ending the global HIV/AIDS pandemic "will require a global commitment of resources involving additional donor countries, strengthening health care systems overall, and fostering greater ownership by host countries of HIV/AIDS effort, including investing more in the health of their people. With collective and resolute action now and a steadfast commitment for years to come, an AIDS-free generation is indeed within reach."

Their recommendation appeared in the latest issue of JAMA, a theme issue on HIV/AIDS. (ANI)

AIDS

Cure for AIDS a step closer (New Kerala: 27.7.2012)

A cure for AIDS has got a step closer after it was found that a common cancer drug can purge the disease as it lies dormant in the body. Current treatments are effective at reducing levels of the disease in the bloodstream - but a drug that can "knock out" the disease when it lies dormant is thought to be key to a cure, the Daily Mail reported Thursday.

Tests on eight HIV-positive men found that the drug vorinostat was highly effective in "unmasking" the hidden reservoirs in the body - which the researchers say is a vital step towards eradicating HIV from the body.

"This work provides compelling evidence for a new strategy to directly attack and eradicate latent HIV infection," said David Margolis at the University of North Carolina at Chapel Hill.

The existence of persistent reservoirs of dormant HIV in the immune system that are not attacked by anti-AIDS drugs is believed to be a major reason why infection reemerges once patients stop taking their medication. (IANS)

HIV

New Once-a-day Pill to Treat HIV Approved by US (MedIndia:28.8.2012)

FDA has approved a new once-a-day pill to treat HIV infection. The single daily dose provides a complete treatment regimen for HIV infection, the US Food and Drug Administration said in a statement, and is part of a progression of increasingly simplified treatment options.

"Through continued research and drug development, treatment for those infected with HIV has evolved from multi-pill regimens to single-pill regimens," said Edward Cox, director of the Office of Antimicrobial Products in the FDA's Center for Drug Evaluation and Research.

"New combination HIV drugs like Stribild help simplify treatment regimens."

The new pill, previously called Quad, is made by Gilead Sciences in California and "should be available to patients by the end of the week," company spokeswoman Erin Rau told AFP.

The company said it tested the pill in two double-blind clinical trials of more than 1,400 patients. Results showed that Stribild performed as well or better than two other treatment combinations, and brought virus readings down to undetectable levels in around nine of 10 patients after 48 weeks.

"Therapies that address the individual needs of patients are critical to enhancing adherence and increasing the potential for treatment success," Gilead chief John Martin said in a company statement.

But some advocates say the new pill is priced far too high.

"We wanted to see (a price of) no more than the current drug," said Michael Weinstein, president of the AIDS Healthcare Foundation, referring to Gilead's previously approved three-in-one pill, Atripla. But he said the price will be about a third higher than the three- pill combo.

The new drug "is not a significant improvement over existing therapies," Weinstein told AFP, adding the cost will "severely limit access" to the new medication.

Gilead is charging wholesalers $28,500 a year for the drug, but said it will provide discounts to state assistance programs and has created a patient financial-assistance program, Rau said.

This is Gilead's third single-tablet anti-HIV combination therapy, the company noted, adding it is still seeking approval for the newest offering in Australia, Canada and the European Union.

To get the drug to HIV patients in the developing world, where millions lack access to effective treatment options, generic versions are being developed -- with permission and help from Gilead -- by a number of Indian manufacturers and the Medicines Patent Pool, a non-profit that helps facilitate generic drug-making.

The drug combines Truvada -- another Gilead offering approved in 2004, that combines emtricitabine and tenofovir disoproxil fumarate to fight an enzyme that HIV needs to replicate -- with elvitegravir, another enzyme-fighting drug, and cobicistat, which enhances the effects of elvitegravir.

The FDA said further study is required to determine the quad-drug's safety for women and children, how resistance may develop, and whether the drug interacts with other drugs.

Stribild will also be required to carry a label warning patients and health care providers the drug can cause fatal side effects, including severe liver problems, and a build-up of lactic acid in the blood. The FDA said the label is also required for many other HIV- fighting drugs. But Gilead said that during the studies, "most adverse effects were mild to moderate." The FDA said patients commonly experienced nausea and diarrhea.

The drug also weakened bones and caused or worsened kidney problems -- both of which will be mentioned in a warning on the drug's label.

Truvada was previously approved as a treatment for people infected with HIV to be used in combination with other antiretroviral drugs.

In July, it was also approved for use by healthy at-risk adults to prevent HIV, the first- ever daily pill approved for that purpose.

This year, the FDA also approved the first rapid HIV test that can be bought without a prescription and taken at home.

AIDS

New Clue To Slower Progression Of AIDS (Medical News Today:24.9.2012)

The average time from HIV infection to full-blown AIDS in the absence of treatment is about 10 years, and while some people succumb much sooner, others, known as the "slow progressors", can remain healthy for another 20 years or more. Now scientists at the University of California, Los Angeles (UCLA), believe they may have uncovered a new clue as to why.

They found HIV-infected people who carry a gene variant that causes the immune system to attack a particular section of a virus protein are more likely to be among the slow progressors.

The team, from the Multi-Center AIDS Cohort Study (MACS) in the UCLA AIDS Institute, report their findings in the October print issue of the Journal of Virology.

Scientists already know that a gene variant called HLA-B*57 (B57), present in under 5% of the general population, is carried by 40 to 85% of slow progressors. But even among those who carry this variant, speed of progression to AIDS can vary enormously.

Previous studies have shown that HLA-B genes activate killer T-cells in the immune system that recognize sections of proteins or epitopes in HIV. But it was not clear which. Also, much of the knowledge was derived from working on T-cell response after several years of infection. But the senior investigator on this new study, Beth D. Jamieson, a professor of medicine at the Geffen School of Medicine, and her colleagues, were of the view that the most critical responses are the ones that occur early during infection, which is the time when T-cells are still strong, and can make it hard for HIV to find places to hide in the body.

However, studies are further complicated by the fact that even if you study the immune responses in the early stages, you can't predict during these periods which people will eventually turn out to be slow progressors, making it very difficult to correlate immune responses with long-term outcomes.

This is where the Multi-Center AIDS Cohort Study (MACS) comes in: they have been freezing blood samples of thousands of men infected with HIV or at risk of becoming infected, every six months since 1984.

Having available such an incredibly long series of data points, good caretaking of frozen samples, accompanied by careful documentation of the health of participants, allowed the researchers to access blood samples from 14 people carrying the HLA-B57 gene taken shortly after HIV infection , along with their infection dates, and details of long-term outcomes.

Lead author Catherine Brennan, an assistant research scientist in the department of medicine at the David Geffen School of Medicine at UCLA, told the press:

"This allowed us to correlate early immune responses with long-term outcomes."

Jamieson explained that it was important compare killer T-cell responses only among the B57 variant carriers, rather than responses of carriers versus non-carriers.

"Since possession of the B57 variant is not sufficient, we wanted to determine what specific immune events in B57 carriers are associated with immune control of the virus," she said.

"We found that those who targeted the IW9 epitope early in infection had significantly longer times until onset of AIDS than those who did not. The finding that targeting of IW9 seems to be important is novel, as this epitope had been overlooked in many earlier studies of B57 and HIV," she added.

Although pleased with their findings, the team cautions that they should be treated as tentative, since the results come from only a small sample of 14 individuals.

They recommend repeating the study with a much wider pool of individuals.

They also point out that their findings merely propose a link: they do not suggest a cause and effect relationship.

The authors conclude: "This work, although not powered by a large cohort and necessarily exploratory in nature, does suggest that the role of IW9 targeting in B57-mediated protection merits closer attention."

"Understanding the detailed mechanisms by which B57 is associated with slow progression to disease will reveal underlying principles of immune control of HIV-1, which is critical for the development of rational vaccine-design strategies" they add. Alzheimer’s's disease

Spot Alzheimer’s

Spot Alzheimer’s 25 yrs before onset (The Times of India:13.7.2012)

5 Key Signs Identified That Can Help In Early Diagnosis And Treatment

London: Scientists have found five key signs of Alzheimer’s that can be detected up to 25 years before the onset of the degenerative disease, a finding which they say could lead to its early diagnosis and treatment. A team at Washington University School of Medicine who looked at families with a genetic risk of the disease assembled a “timeline” of the unseen progress of Alzheimer’s much before the symptoms appear, researchers said. Experts believe the ability to detect Alzheimer’s early would give the best chance of a successful treatment, BBC News reported. The study involved 128 people from the UK, US and Australia, who had a 50% chance of inheriting one of three mutations certain to cause early Alzheimer’s, which often develops in people during their 30s and 40s. This is much earlier than the more common form which generally affects people in their 60s. Those who carry the mutations will go on to develop the disease. The researchers took into account the age of the participants’ parents when they developed the disease — and therefore how many years it was likely to be before they too showed symptoms. Scientists underwent blood and spinal fluid tests as well as brain scans and mental ability assessments. The earliest change — a drop in spinal fluid levels of the key ingredient of Alzheimer’s brain plaques — can be detected 25 years before the anticipated age of disease onset, they suggested. Raised levels of tau, a structural protein in brain cells can be seen in spinal fluid at 15 years, and shrinkage can also be detected within parts of the brain. Scientists suggest that changes in the brain’s use of the sugar glucose and slight memory problems become apparent 10 years before symptoms would appear. Researchers also tested other members of the families without the inherited mutations — and found no changes in the markers they tested for. “This important research highlights that key changes in the brain, linked to the inherited form of Alzheimer’s disease, happen decades before symptoms show, which may have major implications for diagnosis and treatment in the future,” Clive Ballard, director of research at the Alzheimer’s Society, said. PTI New gene mutation may aid drug quest Astudy of a rare gene mutation that protects people against Alzheimer’s disease provides the strongest evidence yet that excessive levels of a normal brain substance, beta amyloid, are a driving force in the disease — bolstering hopes that anti-amyloid drugs already under development might alter the disease’s course or even prevent it. So far, the drugs have not succeeded. But scientists not connected with the new study said it suggested that the drug companies’ big bets on anti-amyloid treatments could yet pay off. The protective mutation, whose discovery was reported online on Wednesday in the journal Nature, is highly uncommon — it is not the reason most people do not develop Alzheimer’s. But what intrigues researchers is how it protects the brain. Mutations that cause Alzheimer’s lead to excessive amounts of beta amyloid in the brain; by contrast, the protective mutation slows beta amyloid production, so people make much less. NYT NEWS SERVICE

Alzheimer's

Brain scans to detect Alzheimer's decades ahead (New Kerala: 13.7.2012)

Experts hope to develop brain scans to detect early symptoms of dementia that may surface 25 years before patients and their families notice any outward development.

Scientists believe that sufferers' brains and spines undergo miniscule changes when they are in their 30s and 40s.

An US study involved 128 people whose parents had an inherited form of Alzheimer's, meaning they were highly likely to get the disease themselves. Scientists carried out brain scans and tests on the fluid in their spine, the New England Journal of Medicine reports.

They noticed that some people underwent changes in the spinal fluid 25 years before they were likely to notice the first symptoms of Alzheimer's. They also spotted certain deposits in their brains - or 'plaques' - that showed up 15 years sooner than memory loss or confusion were expected to appear.

The researchers based the 25-year figure on the assumption that each person would begin showing signs of the illness at roughly the same age as their parents, according to the Daily Mail.

Experts point out that this inherited form of Alzheimer's - which is responsible for less than one percent of all cases - is different from the normal form of the disease.

Randall Bateman from Washington University School of Medicine in St. Louis said: "A series of changes begins in the brain decades before the symptoms of Alzheimer's disease are noticed by patients or families, and this cascade of events may provide a timeline for symptomatic onset."

"As we learn more about the origins of Alzheimer's to plan preventive treatments, this timeline will be invaluable for successful drug trials," added Bateman. (IANS)

Alzheimer'

Gait Changes May Signal Cognitive Decline, Presage Alzheimer's(Medical News Today:17.7.2012)

Changes in gait, such as slower walking or a more variable stride and rhythm, may be early signs of mental impairments that can develop into Alzheimer's before such changes can be seen on neuropsychological tests, said researchers at a conference this week. They suggest diagnosing changes in gait could alert doctors to begin testing for cognitive decline.

A cluster of studies presented at the 2012 Alzheimer's Association's International Conference (AAIC) that is taking place until 19 July in Vancouver, Canada, are the first to link physical changes to the disease. The researchers suggest changes in walking pattern may start to show even before cognitive impairments appear. Gait Analysis Could Be Inexpensive Way to Detect Early Signs William Thies, Chief Medical and Scientific Officer of the Alzheimer's Association, told the press that as the baby boomer generation approaches the age of higher risk for dementia and Alzheimer's, doctors need to be increasingly aware of early signs.

"These studies suggest that observing and measuring gait changes could be a valuable tool for signaling the need for further cognitive evaluation," said Thies.

"For busy doctors who have limited time with their patients, monitoring deterioration and other changes in a person's gait is ideal because it doesn't require any expensive technology or take a lot of time to assess. It is relatively simple and straightforward," he added.

Linking changes in gait to cognitive impairment is not new: but until these studies, it has not been very clear which characteristics of gait (eg speed, rhythm or cadence, stride length) may be linked to a future cognitive decline. Gait Cadence, Speed and Amplitude In one of the studies, Rodolfo Savica and colleagues at the Mayo Clinic Study of Aging (MCSA) in the US, recorded the gait patterns of over 1,300 people at two different clinic visits, roughly 15 months apart. During those visits, the participants also underwent a battery of neurological and neuropsychological tests that assessed four areas of mental functioning: memory, executive, language, and visuospatial. 158 of the participants were diagnosed with MCI (mild cognitive impairment), and 11 with dementia.

When the researchers analyzed changes in the participants' patterns using GAITRite, a computer-based tool, they found those with lower cadence, speed and amplitude of stride length showed larger declines in overall cognition, memory and executive function:

"We observed an association between reduced gait velocity, cadence and stride length, and both global and domain-specific cognitive decline in our population," said Savica.

"These results support a possible role of gait changes as an early predictor of cognitive impairment," he added. Stride Speed and Variability Another study conducted in Switzerland, that analyzed measures of gait characteristics, also suggested stride speed and variability may track cognitive impairment.

Stephanie A Bridenbaugh, of the Basel Mobility Center, and colleagues, followed over 1,150 outpatients of average age 77 who were attending the Basel Memory Clinic and Basel Mobility Center, plus a group of cognitively healthy volunteers who were taking part in a Basel cohort study, from 2007 to 2011.

The participants underwent gait analysis by walking on a 10-meter long electronic track that had nearly 30,000 inter-connected pressure sensors. They did three types of walking task: one single and two dual.

In the single walking task, all they had to do was just walk normally on the electronic track. In one dual task, they walked normally but also counted backwards out loud, and in the other, they walked normally and called out names of animals they were shown.

To analyze the data, the researchers put the participants in groups, according to diagnosis: cognitively healthy, mild cognitive impairment (MCI), and Alzheimer's dementia (mild, moderate, and severe).

They found participants' gait became slower and more variable as their cognitive function declined. For all groups, walking speeds were slower during the dual tasks compared to the normal single task.

Bridenbaugh said: "Those with Alzheimer's dementia walked slower than those with MCI, who in turn walked slower than those who were cognitively healthy."

"A gait analysis will not replace a comprehensive neuropsychological assessment to diagnose a patient's cognitive status. Gait analysis, however, may prove to be an important tool to aid diagnosis, and record treatment effects or disease progression," she added. Other Findings from the Netherlands, US and Japan In another study, researchers at Erasmus Medical Center in Rotterdam, the Netherlands, found that certain cognitive functions were only associated with certain aspects of gait. For instance, speed of processing information was linked with gait rhythm, executive function was linked with pace and variability, while memory was not linked to any particular aspect of gait. Their research involved over 1,200 people over the age of 48 who were taking part in the the Rotterdam Study.

In a study from the US, researchers found that continuous in-home monitoring might be a more accurate way of assessing gait than single tests. Lisa Silbert, of Oregon Health & Science University in Portland worked with 19 dementia-free volunteers and found walking speed taken at a single time point may over-estimate walking ability in the elderly.

"Our data suggests that continuous in-home monitoring may provide a more accurate reflection of walking speed and may be more sensitive at detecting motor changes associated with future cognitive decline," said Silbert.

Researchers at Tohoku University Graduate School of Medicine, Sendai, Japan found that gait velocity declined significantly as severity of dementia increased. In their study, involving 525 community-dwelling people age 75 and older in Japan, they also measured brain atrophy using MRI, and found atrophy of the entorhinal cortex, a region that serves as a hub in a widespread network for memory and navigation, was significantly linked to gait velocity.