DOCSLIB.ORG

The Battle Is Not Over Until It Is Won

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Battle Is Not Over Until It Is Won HUMAN AFRICAN TRYPANOSOMIASIS SLEEPING SICKNESS The battle is not over until it is won Sleeping sickness, or human African trypa- melarsoprol. The latter, however, is still the nosomiasis, threatens millions of people in first-line treatment for the less commonT.b. 36 countries across sub-Saharan Africa. The rhodesiense HAT. Democratic Republic of the Congo bears the To contribute to the WHO elimination goal, a brunt, accounting for 83% of all cases. In the ‘test and treat’ strategy that would be imple- 1960s there were less than 5,000 patients mented at the primary healthcare level is on suffering from the disease in the whole of the the horizon, with potential simple oral pills continent. However, the end of the 20th cen- for both the early and late stage as well as tury – with internal conflict, competing health both types of HAT, that are currently in devel- priorities, and decolonization – witnessed a opment, along with new rapid diagnostics, halt in the successful control methods, and which together would remove the need for the number of cases reported rose painful and dangerous lumbar punc- steeply, peaking in 1998 with tures. This would mean that rural over 37,000 cases reported in health centres, rather than hos- that year. Nowadays, thanks pitals, will play an increasingly to the combined efforts of important role, especially as the WHO, National Sleeping number of reported cases con- Sickness Control Pro- tinues to dwindle. grammes, NGOs and other partners, the disease has once more been brought under control, and since 2010 the number of reported cases has fallen below 8,000. The WHO has laid out a roadmap to elimi- nate the disease as a public health problem by 2020, when less than one case per 10,000 inhabitants in at least 90% of endemic foci is expected.(1) Maximizing efficiency through a ‘WHO network’ of partners and stakehold- Ideal Target Product Profile ers(2) in order to achieve elimination is cur- for HAT rently underway. A new treatment for adults and The most advanced stage of the disease is children: determined after multiple and complex diag- > Effective against both stages of nostic procedures, including a painful lumbar the disease puncture, and is treated with a combina- > Active against both causative parasite tion of oral and intravenously administered sub-species: Trypanosoma brucei drugs. Nifurtimox-eflornithine combination gambiense and T.b. rhodesiense treatment (NECT), introduced by DNDi and > Less than 0.1% drug-related partners in 2009, was the first improved mortality treatment option for patients with advanced > At least 95% efficacy at 18 months sleeping sickness to be developed in 25 follow-up years, and has reduced the time required > Safe for pregnant and breastfeeding to spend in hospital during administra- women tion, from 14 to 10 days. By the end of 2012, > Easy to use: short-course NECT, which features on the WHO Essen- (7, maximum 10 days), oral, once a tial Medicines Lists for adults and children, day, requiring no monitoring was being used to treat 96% of late-stage > Affordable T.b. gambiense HAT patients in endemic > Adapted to tropical climates countries, thus virtually replacing the pre- (three-year shelf-life) vious and toxic arsenic-based treatment, (1) Control and surveillance of human African trypanosomiasis: report of a WHO technical committee (2013). World Health Organization. (2) http://www.who.int/neglected_diseases/HAT_roll_out_strategy_2013/en/# HumAN AfricAN TrypANoSomiASiS (HAT) FACT SHEET WHAT IS THE IMPACT OF HAT? WHAT ARE THE CURRENT Melarsoprol, still the only The number of reported cases in TREATMENTS AND THEIR drug available for stage 2 2012 was fewer than 8,000, but LIMITATIONS? T.b. rhodesiense, is a toxic the actual number of cases is Available treatments have arsenic derivative that causes estimated to be 20,000.(1) Fatal pain and fatal encephalopathies limitations, are difficult to T. b. gambiense if untreated, the disease affects administer, often toxic, and are in up to 5% of patients who (3) mainly those living in remote stage-specific. receive it, and is increasingly areas with limited access to ineffective, with reports of drug T. b. rhodesiense > Stage 1: pentamidine and Epidemic adequate health services. The resistance and treatment failure. suramin, require injections and Endemic disease is found in 36 countries are ineffective for stage 2. Eflornithine, today rarely used in sub-Saharan Africa, but alone, is difficult to administer 8 countries report 97% of all > Stage 2: NECT (nifurtimox- as treatment requires trained cases (see map), and over eflornithine combination health staff and an extended two-thirds of those are reported therapy), available since 2009, is hospital stay (56 intravenous in the Democratic Republic of a simplified therapy option for infusions taking two hours each the Congo.(2) Almost eliminated stage 2 T.b. gambiense sleeping to administer, over 14 days, four in the 1960s, transmission sickness, with only 14 injections times per day). increased again as a result of of eflornithine over 7 days and war, population displacement, 10 days of oral treatment with poverty, and the collapse of nifurtimox. While not the most adequate support to the control appropriate treatment to support activities conducted within elimination efforts as it requires health systems. a hospital setting, NECT does Recent successes and an provide a major improvement in impressive drop in the number case management. of reported cases call for renewed hope, but there is still work to be done, as some areas are not covered by surveillance and control efforts. WHAT IS DNDi DOING TO ADDRESS UNMET TREATMENT NEEDS? At its inception, DNDi’s short-term strategy was to make better use of existing HOW IS HAT TRANSMITTED? treatments by combining drugs already in use. In September 2009, DNDi and partners HAT is transmitted to humans by launched the first new treatment for sleeping sickness in 25 years: nifurtimox and two sub-species of the parasite eflornithine combination therapy (NECT). NECT was included on the WHO Essential Trypanosoma brucei (T. b.) Medicines List (EML) in 2009, and extended to the EML for children in 2013. Since June through the bite of the tsetse fly: T. b. gambiense (West and 2013, all countries endemic to T.b. gambiense are using NECT as first-line treatment Central Africa, responsible for for second stage HAT, with the exception of Nigeria. the vast majority of cases) and As a medium-term strategy, DNDi initiated a compound mining effort to identify existing T.b. rhodesiense (East Africa). chemical compounds with potential against kinetoplastid diseases. This resulted in the Man is the essential reservoir rediscovery of fexinidazole, which completed Phase I clinical development in 2011. for T.b. gambiense. Fexinidazole entered a pivotal Phase II/III study in 2012 and is currently recruiting WHAT ARE THE SYMPTOMS? patients in the DRC. Two complementary studies will examine efficacy and safety in adults HAT occurs in two stages: with stage 1 and early stage 2 HAT, and children aged 6-14 years. Sanofi is the industrial partner for this project. > Stage 1: the haemolymphatic stage – includes non-specific In order to build a strong pipeline for long-term drug discovery, DNDi initially established symptoms like headaches and a HAT Lead Optimization Consortium resulting in the identification of the Oxaborole bouts of fever (and generally SCYX-7158. SCYX-7158 successfully progressed through pre-clinical development, goes undiagnosed without entering Phase I clinical development in early 2012, which is nearing completion. Other active HAT surveillance). backup compounds were evaluated by the consortium and remain available for further i > Stage 2: the later, neurologic development if necessary. stage – occurs when the parasite crosses the blood-brain barrier In addition, DNDi supports the HAT Platform that was launched in Kinshasa, Democratic and is characterized by serious Republic of the Congo (DRC) in 2005. The HAT Platform is a clinical research and sleep cycle disruptions, access-supporting network that brings together key players in the fight against sleeping paralysis, progressive mental sickness from Angola, the Central African Republic, Chad, DRC, Republic of the Congo, deterioration, and ultimately, Sudan, South Sudan, Uganda and those involved in HAT from the international research without effective treatment, arena. death. A lumbar puncture is needed to differentiate between the two By 2018, DNDi aims to deliver from its HAT-specific portfolio: DRC-DND Tshiamala, Simon credits: Photo - stages to choose an appropriate > An oral, safe, effective treatment to be used for both stage 2 and stage 1 HAT treatment. (1) Control and surveillance of human African trypanosomiasis: report of a WHO expert committee (2013); WHO, Geneva, Switzerland (2) Eliminating human African trypanosomiasis: where do we stand and what comes next? Simarro PP, Jannin J, Cattand P (2008) PLoS Med 5: e55. doi:10.1371/journal.pmed.0050055. (3) Clinical description of encephalopathic syndromes and risk factors for their occurrence and outcome during melarsoprol treatment of human African trypanosomiasis. Blum J, Nkunku S, Burri C. (2001) Trop Med Int Health;6:390-400. 15 Chemin Louis Dunant – 1202 Geneva – Switzerland – Tel: +41 22 906 9230 – Fax: +41 22 906 9231 [email protected] – www.dndi.org.
Load more

Recommended publications
  • Autophagy in Trypanosomatids
    Cells 2012, 1, 346-371; doi:10.3390/cells1030346 OPEN ACCESS cells ISSN 2073-4409 www.mdpi.com/journal/cells Review Autophagy in Trypanosomatids Ana Brennand 1,†, Eva Rico 2,†,‡ and Paul A. M. Michels 1,* 1 Research Unit for Tropical Diseases, de Duve Institute, Université catholique de Louvain, Avenue Hippocrate 74, postal box B1.74.01, B-1200 Brussels, Belgium; E-Mail: [email protected] 2 Department of Biochemistry and Molecular Biology, University Campus, University of Alcalá, Alcalá de Henares, Madrid, 28871, Spain; E-Mail: [email protected] † These authors contributed equally to this work. ‡ Present Address: Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, King’s Buildings, University of Edinburgh, West Mains Road, Edinburgh EH9 3JT, UK. * Author to whom correspondence should be addressed; E-Mail: [email protected]; Tel.: +32-2-7647473; Fax: +32-2-7626853. Received: 28 June 2012; in revised form: 14 July 2012 / Accepted: 16 July 2012 / Published: 27 July 2012 Abstract: Autophagy is a ubiquitous eukaryotic process that also occurs in trypanosomatid parasites, protist organisms belonging to the supergroup Excavata, distinct from the supergroup Opistokontha that includes mammals and fungi. Half of the known yeast and mammalian AuTophaGy (ATG) proteins were detected in trypanosomatids, although with low sequence conservation. Trypanosomatids such as Trypanosoma brucei, Trypanosoma cruzi and Leishmania spp. are responsible for serious tropical diseases in humans. The parasites are transmitted by insects and, consequently, have a complicated life cycle during which they undergo dramatic morphological and metabolic transformations to adapt to the different environments.
    [Show full text]
  • COVID-19 Mrna Pfizer- Biontech Vaccine Analysis Print
    COVID-19 mRNA Pfizer- BioNTech Vaccine Analysis Print All UK spontaneous reports received between 9/12/20 and 22/09/21 for mRNA Pfizer/BioNTech vaccine. A report of a suspected ADR to the Yellow Card scheme does not necessarily mean that it was caused by the vaccine, only that the reporter has a suspicion it may have. Underlying or previously undiagnosed illness unrelated to vaccination can also be factors in such reports. The relative number and nature of reports should therefore not be used to compare the safety of the different vaccines. All reports are kept under continual review in order to identify possible new risks. Report Run Date: 24-Sep-2021, Page 1 Case Series Drug Analysis Print Name: COVID-19 mRNA Pfizer- BioNTech vaccine analysis print Report Run Date: 24-Sep-2021 Data Lock Date: 22-Sep-2021 18:30:09 MedDRA Version: MedDRA 24.0 Reaction Name Total Fatal Blood disorders Anaemia deficiencies Anaemia folate deficiency 1 0 Anaemia vitamin B12 deficiency 2 0 Deficiency anaemia 1 0 Iron deficiency anaemia 6 0 Anaemias NEC Anaemia 97 0 Anaemia macrocytic 1 0 Anaemia megaloblastic 1 0 Autoimmune anaemia 2 0 Blood loss anaemia 1 0 Microcytic anaemia 1 0 Anaemias haemolytic NEC Coombs negative haemolytic anaemia 1 0 Haemolytic anaemia 6 0 Anaemias haemolytic immune Autoimmune haemolytic anaemia 9 0 Anaemias haemolytic mechanical factor Microangiopathic haemolytic anaemia 1 0 Bleeding tendencies Haemorrhagic diathesis 1 0 Increased tendency to bruise 35 0 Spontaneous haematoma 2 0 Coagulation factor deficiencies Acquired haemophilia
    [Show full text]
  • Diseases of the Digestive System (KOO-K93)
    CHAPTER XI Diseases of the digestive system (KOO-K93) Diseases of oral cavity, salivary glands and jaws (KOO-K14) lijell Diseases of pulp and periapical tissues 1m Dentofacial anomalies [including malocclusion] Excludes: hemifacial atrophy or hypertrophy (Q67.4) K07 .0 Major anomalies of jaw size Hyperplasia, hypoplasia: • mandibular • maxillary Macrognathism (mandibular)(maxillary) Micrognathism (mandibular)( maxillary) Excludes: acromegaly (E22.0) Robin's syndrome (087.07) K07 .1 Anomalies of jaw-cranial base relationship Asymmetry of jaw Prognathism (mandibular)( maxillary) Retrognathism (mandibular)(maxillary) K07.2 Anomalies of dental arch relationship Cross bite (anterior)(posterior) Dis to-occlusion Mesio-occlusion Midline deviation of dental arch Openbite (anterior )(posterior) Overbite (excessive): • deep • horizontal • vertical Overjet Posterior lingual occlusion of mandibular teeth 289 ICO-N A K07.3 Anomalies of tooth position Crowding Diastema Displacement of tooth or teeth Rotation Spacing, abnormal Transposition Impacted or embedded teeth with abnormal position of such teeth or adjacent teeth K07.4 Malocclusion, unspecified K07.5 Dentofacial functional abnormalities Abnormal jaw closure Malocclusion due to: • abnormal swallowing • mouth breathing • tongue, lip or finger habits K07.6 Temporomandibular joint disorders Costen's complex or syndrome Derangement of temporomandibular joint Snapping jaw Temporomandibular joint-pain-dysfunction syndrome Excludes: current temporomandibular joint: • dislocation (S03.0) • strain (S03.4) K07.8 Other dentofacial anomalies K07.9 Dentofacial anomaly, unspecified 1m Stomatitis and related lesions K12.0 Recurrent oral aphthae Aphthous stomatitis (major)(minor) Bednar's aphthae Periadenitis mucosa necrotica recurrens Recurrent aphthous ulcer Stomatitis herpetiformis 290 DISEASES OF THE DIGESTIVE SYSTEM Diseases of oesophagus, stomach and duodenum (K20-K31) Ill Oesophagitis Abscess of oesophagus Oesophagitis: • NOS • chemical • peptic Use additional external cause code (Chapter XX), if desired, to identify cause.
    [Show full text]
  • Program and Abstracts
    Seventy 2019 years of Soixante-dix AU/ISCTRC Années de 1949 l’UA / CSIRLT 35TH GENERAL CONFERENCE OF THE INTERNATIONAL SCIENTIFIC COUNCIL FOR TRYPANOSOMIASIS RESEARCH AND CONTROL (ISCTRC) AND 18TH PATTEC NATIONAL COORDINATORS MEETING PROGRAMME AND ABSTRACTS BOOK 35TH GENERAL CONFERENCE OF THE INTERNATIONAL SCIENTIFIC COUNCIL FOR TRYPANOSOMIASIS RESEARCH AND CONTROL (ISCTRC) AND 18TH PATTEC NATIONAL COORDINATORS MEETING PROGRAMME AND ABSTRACTS BOOK ABOUT THE CONFERENCE Theme of the Conference Impact of African Trypanosomiasis on Human and Animal Health, Sustainable Agriculture and Rural Development in the face of challenges to sustainable investment in AAT control and HAT elimination”Members of the Scientific Committee The members of the 35th ISCTRC Scientific Committee that were appointed by the Director of AU-IBAR were drawn from various institutions working on Tsetse and Trypanosomiasis. The committee received and considered 140 abstracts addressing the various sub- themes of the conference. Prof. Ahmed Elsawalhy, Director of AU-IBAR, Chairperson Dr. James Wabacha, ISCTRC Secretary, Member Dr. Gift Wanda, Member Dr. Daniel Masiga, Member Dr. Jose Ramon Franco Rapporteur and Moderators Rapporteur General Grace Mulira Deputy Rapporteur General Njelembo Mbewe Moderators and rapporteurs for the various thematic sessions are as per the programme Presentation guidelines Allocated time for presentations: Each presentation will be allocated 10 minutes and 5 minutes for discussion. Viewing of posters There will be continuous viewing of the posters. The presenters for the posters will be at the stands during the coffee/tea breaks. There will be general discussion on the posters in the plenary on Thursday, 26th September 2019. Uploading of presentations in the conference computer Presenters who will be making presentation during the first day are IV requested to upload their presentation during registration on Sunday.
    [Show full text]
  • Somnology-Jr-Book.Pdf
    1 To Grace Zamudio and Zoe Lee-Chiong. 2 Preface Carpe noctem. Teofilo Lee-Chiong MD Professor of Medicine Division of Sleep Medicine National Jewish Health Denver, Colorado University of Colorado Denver School of Medicine Denver, Colorado Chief Medical Liaison Philips Respironics Murrysville, Pennsylvania 3 Abbreviations AHI Apnea-hypopnea index BPAP Bi-level positive airway pressure CPAP Continuous positive airway pressure CSA Central sleep apnea ECG Electrocardiography EEG Electroencephalography EMG Electromyography EOG Electro-oculography FEV1 Forced expiratory volume in 1 second GABA Gamma-aminobutyric acid N1 NREM stage 1 sleep N2 NREM stage 2 sleep N3 NREM stages 3 (and 4) sleep NREM Non-rapid eye movement O2 Oxygen OSA Obstructive sleep apnea PaCO2 Partial pressure of arterial carbon dioxide PaO2 Partial pressure of arterial oxygen REM Rapid eye movement sleep SaO2 Oxygen saturation SOREMP Sleep onset REM period 4 Table of contents Introduction 15 Neurobiology of sleep 16 Neural systems generating wakefulness 16 Neural systems generating NREM sleep 16 Neural systems generating REM sleep 16 Main neurotransmitters 17 Acetylcholine 17 Adenosine 17 Dopamine 17 Gamma-aminobutyric acid 17 Glutamate 17 Glycine 17 Histamine 18 Hypocretin 18 Melatonin 18 Norepinephrine 18 Serotonin 18 Physiology during sleep 19 Autonomic nervous system 19 Respiratory system 19 Respiratory patterns 19 Cardiovascular system 19 Gastrointestinal system 20 Renal and genito-urinary systems 20 Endocrine system 20 Growth hormone 20 Thyroid stimulating hormone
    [Show full text]
  • Section B – Abstracts
    ISSN 0142-193X TSETSE AND TRYPANOSOMIASIS INFORMATION QUARTERLY Volume 22 Part 1, 1999 Numbers 10713–10823 DFID Cirad-emvt 1999 Tsetse and Trypanosomiasis Information Quarterly SECTION A – NEWS PROGRAMME AGAINST AFRICAN TRYPANOSOMIASIS Fourth Meeting of PAAT Programme Committee The fourth meeting of the PAAT Programme Committee was convened at IAEA Headquarters, Vienna, Austria, from 25 to 27 November 1998. The objective of meetings of the PAAT Committee is, on the basis of technical and scientific advice forwarded from the Advisory Group Co-ordinators and the Liaison Officers, to provide the focus for collaborative efforts to alleviate trypanosomiasis in Africa. Discussions at the current meeting were largely devoted to matters arising from the meeting of the PAAT Advisory Group Co-ordinators convened in Harare, Zimbabwe, October 1998 (see TTIQ, 21 (4)). Progress since the last meeting was reviewed. This included: ISCTRC representation on the Programme Committee and increased donor involvement; considerable progress on the development of the information systems for both animal and human trypanosomiasis (both the prototype PAAT-IS for animal trypanosomiasis and the CD-ROM-based information system developed by WHO for the human disease were demonstrated and the need for cross-linkages between the two was stressed); evaluation of the socio-economic impact of trypanosomiasis and the identification of priority control strategies; development of position papers on technical and policy aspects of the PAAT following open discussion via e-mail (that on drug resistance having been published as the first in the new PAAT Technical and Scientific Series); production and distribution of a glossy brochure announcing PAAT; and initiation of a quarterly PAAT Newsletter.
    [Show full text]
  • The Trypanosomiases
    SEMINAR Seminar The trypanosomiases Michael P Barrett, Richard J S Burchmore, August Stich, Julio O Lazzari, Alberto Carlos Frasch, Juan José Cazzulo, Sanjeev Krishna The trypanosomiases consist of a group of important animal and human diseases caused by parasitic protozoa of the genus Trypanosoma. In sub-Saharan Africa, the final decade of the 20th century witnessed an alarming resurgence in sleeping sickness (human African trypanosomiasis). In South and Central America, Chagas’ disease (American trypanosomiasis) remains one of the most prevalent infectious diseases. Arthropod vectors transmit African and American trypanosomiases, and disease containment through insect control programmes is an achievable goal. Chemotherapy is available for both diseases, but existing drugs are far from ideal. The trypanosomes are some of the earliest diverging members of the Eukaryotae and share several biochemical peculiarities that have stimulated research into new drug targets. However, differences in the ways in which trypanosome species interact with their hosts have frustrated efforts to design drugs effective against both species. Growth in recognition of these neglected diseases might result in progress towards control through increased funding for drug development and vector elimination. Parasitic protozoa infect hundreds of millions of people similarities and discrepancies in their biology, the diseases every year and are collectively some of the most important they cause, and approaches to their treatment and control. causes of human misery. The protozoan order Kineto- plastida includes the genus Trypanosoma, species that cause The parasites and their vectors some of the most neglected human diseases. Superficially, there are many similarities between There are many species of trypanosome, and the group trypanosome species and the diseases they cause (table).
    [Show full text]
  • African Trypanosomiasis (Sleeping Sickness)
    Human African Trypanosomiasis (sleeping sickness) Professor Peter GE Kennedy Glasgow University Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK International Neuroinfectious Disease Conference Addis Ababa, Ethiopia, on February 27-28, 2010 Human African Trypanosomiasis (HAT)-Sleeping Sickness Trypanosoma brucei rhodesiense - East Africa Trypanosoma brucei gambiense - West Africa Estimated 60 million people at risk from HAT Approx. 100,000 existing cases of HAT in Africa Transmitted by tsetse fly of Glossina species Invasion of CNS leads to meningoencephalitis which is invariably fatal MelarsoprolInternational treatment Neuroinfectious is given Disease for CNS Conference disease. This treatmentAddis Ababa,kills about Ethiopia, 5% on February of patients 27-28, 2010from the PTRE FACTORS LEADING TO RE-EMERGENCE OF HAT • SOCIO-ECONOMIC INSTABILITY-AS DISRUPTS DISEASE SURVEILLANCE AND PUBLIC HEALTH SYSTEM (incl. War in Angola) • INADEQUATE FINANCIAL ALLOCATION OF CRITICAL RESOURCES TO DISEASE DURING PEACETIME • INCREASING PARASITE DRUG RESISTANCE • CHANGES IN CLIMATE AND VEGETATION • UNPREDICTED POPULATION MOVEMENTS OF ANIMAL RESEVOIRS International Neuroinfectious Disease Conference • CHANGESAddis IN Ababa, HOST Ethiopia, DISEASE on February SUSCEPTIBILITY 27-28, 2010 Stages of sleeping sickness Early haemolymphatic stage Late encephalitic stage-disease course is slower in gambiense ( many months- years) compared to rhodesiense ( weeks- few months) • The 2 stages may merge into eachother
    [Show full text]
  • Sleeping Sickness Disrupts the Sleep-Regulating Adenosine System 2 3 Short Title: Sleeping Sickness and Adenosine 4 5 Filipa Rijo-Ferreira*1,2, Theresa E
    Research Articles: Neurobiology of Disease Sleeping sickness disrupts the sleep- regulating adenosine system https://doi.org/10.1523/JNEUROSCI.1046-20.2020 Cite as: J. Neurosci 2020; 10.1523/JNEUROSCI.1046-20.2020 Received: 30 April 2020 Revised: 28 September 2020 Accepted: 11 October 2020 This Early Release article has been peer-reviewed and accepted, but has not been through the composition and copyediting processes. The final version may differ slightly in style or formatting and will contain links to any extended data. Alerts: Sign up at www.jneurosci.org/alerts to receive customized email alerts when the fully formatted version of this article is published. Copyright © 2020 the authors 1 Title: Sleeping sickness disrupts the sleep-regulating adenosine system 2 3 Short title: Sleeping sickness and adenosine 4 5 Filipa Rijo-Ferreira*1,2, Theresa E. Bjorness*3,4, Kimberly H. Cox1, Alex Sonneborn1,3, 6 Robert W. Greene1,3, and Joseph S. Takahashi1,2,# 7 8 1 Department of Neuroscience, Peter O’Donnell Jr. Brain Institute, University of Texas 9 Southwestern Medical Center, Dallas, TX 75390-9111, USA 10 2 Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, 11 Dallas, TX 75390-9111, USA 12 3 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, 13 TX 75390-9111, USA 14 4Research Service, VA North Texas Health Care System, Dallas, TX 75126 15 16 * co-authors 17 18 # Correspondence: [email protected] 19 20 21 Number of pages: 32 22 23 Number of figures: 7 24 25 Number of tables: 1 26 27 Number of words for abstract: 130 28 29 Number of words for introduction: 588 30 31 Number of words for discussion: 1259 32 33 Conflict of Interest Statement: The authors have nothing to declare.
    [Show full text]
  • Wake up Australia: the Value of Healthy Sleep
    WAKE UP AUSTRALIA: THE VALUE OF HEALTHY SLEEP REPORT BY ACCESS ECONOMICS PTY LIMITED FOR SLEEP HEALTH AUSTRALIA, OCTOBER 2004 WAKE UP AUSTRALIA: THE VALUE OF HEALTHY SLEEP Acknowledgements & Disclaimer This report was prepared by Access Dr Mark Howard Economics for the steering committee of Department of Respiratory Medicine, Sleep Health Australia, a nascent national Austin Health, Victoria sleep health organisation. It was funded by Professor Colin Sullivan an unrestricted grant from the ResMed Department of Medicine, Foundation Limited who had no part in the University of Sydney direction or findings contained in this report. A/Prof John Wheatley Access Economics would like to acknowledge Director, Department of Respiratory with appreciation the comments, prior Medicine, Westmead Hospital research and expert input from: Mr John Goss Dr Ral Antic Head, Summary Measures Unit, Director of Thoracic Medicine, Australian Institute of Health and Welfare Royal Adelaide Hospital Information in Section 3.2 of this report has Dr David Hillman been drawn from data collected by the Head, Department of Pulmonary Physiology, General Practice Statistics and Classification Sir Charles Gairdner Hospital, Perth Unit, Department of General Practice, Additional assistance was provided by: University of Sydney in collaboration with the Australian Institute of Health and Welfare. A/Prof Peter Cistulli, Director, Department of Respiratory and Sleep Medicine, St George Hospital, Kogarah, NSW While every effort has been made to ensure the accuracy of this document, the uncertain nature of economic data, forecasting and analysis means that Access Economics Pty Limited is unable to make any warranties in relation to the information contained herein. Access Economics Pty Limited, its employees and agents disclaim liability for any loss or damage which may arise as a consequence of any person relying on the information contained in this document.
    [Show full text]
  • Sleeping Sickness)
    NEUROLOGICAL PROGRESS The Continuing Problem of Human African Trypanosomiasis (Sleeping Sickness) Peter G. E. Kennedy, MD, PhD, DSc Human African trypanosomiasis, also known as sleeping sickness, is a neglected disease, and it continues to pose a major threat to 60 million people in 36 countries in sub-Saharan Africa. Transmitted by the bite of the tsetse fly, the disease is caused by protozoan parasites of the genus Trypanosoma and comes in two types: East African human African trypanosomiasis caused by Trypanosoma brucei rhodesiense and the West African form caused by Trypanosoma brucei gambiense. There is an early or hemo- lymphatic stage and a late or encephalitic stage, when the parasites cross the blood–brain barrier to invade the central nervous system. Two critical current issues are disease staging and drug therapy, especially for late-stage disease. Lumbar puncture to analyze cerebrospinal fluid will remain the only method of disease staging until reliable noninvasive methods are developed, but there is no widespread consensus as to what exactly defines biologically central nervous system disease or what specific cerebro- spinal fluid findings should justify drug therapy for late-stage involvement. All four main drugs used for human African trypano- somiasis are toxic, and melarsoprol, the only drug that is effective for both types of central nervous system disease, is so toxic that it kills 5% of patients who receive it. Eflornithine, alone or combined with nifurtimox, is being used increasingly as first-line therapy for gambiense disease. There is a pressing need for an effective, safe oral drug for both stages of the disease, but this will require a significant increase in investment for new drug discovery from Western governments and the pharmaceutical industry.
    [Show full text]
  • Multi-Discipline Review
    CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 209500Orig1s000 MULTI-DISCIPLINE REVIEW Summary Review Office Director Cross Discipline Team Leader Review Clinical Review Non-Clinical Review Statistical Review Clinical Pharmacology Review NDA 209500 Multi-disciplinary Review and Evaluation Caplyta (lumateperone) NDA/BLA Multi-Disciplinary Review and Evaluation Application Type NDA Application Number(s) 209500 Priority or Standard Standard Submit Date(s) September 27, 2018 Received Date(s) September 27, 2018 PDUFA Goal Date December 27, 2019 Division/Office Division of Psychiatry / Office of Drug Evaluation-I Review Completion Date December 20, 2019 Established/Proper Name Lumateperone (Proposed) Trade Name Caplyta Pharmacologic Class Atypical Antipsychotic Code name ITI-007 Applicant Intra-Cellular Therapies, Inc. Dosage form 42 mg Capsules Applicant proposed Dosing 42 mg by mouth once daily Regimen Applicant Proposed Schizophrenia/Adults Indication(s)/Population(s) Applicant Proposed 58214004 | Schizophrenia (disorder) SNOMED CT Indication Disease Term for each Proposed Indication Recommendation on Approval Regulatory Action Recommended Schizophrenia/Adults Indication(s)/Population(s) (if applicable) Recommended SNOMED 58214004 | Schizophrenia (disorder) CT Indication Disease Term for each Indication (if applicable) Recommended Dosing 42 mg by mouth once daily Regimen 1 Version date: October 12, 2018 Reference ID: 4537404 NDA 209500 Multi-disciplinary Review and Evaluation Caplyta (lumateperone) Table of Contents Table of
    [Show full text]