Pharmacy Information

Study: Weightlifting helps breast cancer survivors

2009-08-13T06:35:00.000-07:00

Breast cancer survivors have been getting bum advice.

For decades, many doctors warned that lifting weights or even heavy groceries could cause painful arm swelling. New research shows that weight training actually helps prevent this problem.

"How many generations of women have been told to avoid lifting heavy objects?" Dr. Eric Winer, breast cancer chief at the Dana-Farber Cancer Center in Boston, lamented after seeing the surprising results of the new study. "Women who were doing the lifting actually had fewer arm problems because they had better muscle tone."

The study was led by Kathryn Schmitz, an exercise scientist at the University of Pennsylvania, and funded by the federal government. Results are in Thursday's New England Journal of Medicine.

More than 2.4 million Americans are breast cancer survivors, and the study could mean a big difference in their quality of life. Cancer treatment-related arm swelling now appears to be one of many ailments made better by exercise - not worse, Schmitz said.

"Fifty years ago we told people who had a heart attack not to exercise anymore," and people with sore backs to heal with bed rest, Schmitz said. "It was well-meaning advice but it was polar opposite of the truth."

Women who have had radiation to the armpit, or lymph nodes removed to check for cancer, can suffer lymphedema - a buildup of fluids that causes painful and unsightly swelling of the arms or hands.

To avoid it, doctors have advised women to avoid using the affected arm to lift toddlers, carry a heavy purse or scrub floors. Even activities like golf and tennis raised concern.

Women think, "Oh, my God, I need to baby the arm," Schmitz said.

Lifting weights - which boosts mood, muscle mass, bone strength and weight control - was thought to be a bad idea for women prone to lymphedema.

Schmitz challenged that notion with a small study several years ago, finding that weight training did not make lymphedema worse.

Her new study is the first one large and long enough to give clear proof that this is so, and even suggests that weightlifting can help.
It involved 141 breast cancer survivors who had suffered lymphedema. Half were told not to change their exercise habits. The rest were given 90-minute weightlifting classes twice a week for 13 weeks at community gyms, mostly YMCAs.

They wore a custom-fitted compression garment on the affected arm and gradually worked up to more challenging weights and repetitions. For the next 39 weeks, they continued these exercises on their own.

The women's arms were measured monthly. After one year, fewer weightlifters had suffered lymphedema flare-ups - 14 percent versus 29 percent of the others. Weightlifters reported fewer symptoms and greater strength. Rates of change in arm size due to swelling were similar in both groups.

"I found it was really very effective. It not only gave me strength and mobility but it improved my balance and coordination," said one participant, Clare Faber, 66, of suburban Philadelphia. "It really does offer women hope."

Another participant, Gay McArthur, 56, of Smithfield, N.J., has continued weightlifting on her own since the study ended.

"When I first got diagnosed with lymphedema, they said I couldn't lift more than five pounds," she said. But weight training caused no problems and has made her feel better, she said.

It also should save money, though the study did not measure this, Wendy Demark-Wahnefried, of the University of Texas M.D. Anderson Cancer Center in Houston, wrote in an editorial in the medical journal. In the study, the group of weightlifters made only 77 visits to doctors or physical therapists for lymphedema flare-ups versus 195 visits for the others, she noted.

Another part of the study is evaluating whether weight training can prevent a first case of lymphedema in breast cancer survivors; results are expected soon, Schmitz said.

Breast cancer survivors should not rush into weight training - that could trigger problems. Schmitz suggests:

* Have a certified fitness professional teach you how to do the exercises properly.
* Start slow, with a program that gradually progresses.
* Wear a well-fitting compression garment during workouts.
Source: http://www.northjersey.com/news/health/Study_Weightlifting_helps_breast_cancer_survivors.html

Tanning Beds Pose Serious Cancer Risk, Agency Says

2009-08-13T06:33:00.000-07:00

Article date: 2009/07/28
By Rebecca V. Snowden

Tanning beds pose a greater cancer risk than previously believed, according to the International Agency for Research on Cancer (IARC), the World Health Organization (WHO) agency that developed the most widely used system for classifying carcinogens. The group has elevated tanning beds to its highest cancer risk category – "carcinogenic to humans" (Group 1). Tanning beds had previously been classified as "probably carcinogenic to humans."

IARC's decision was based on a comprehensive review of current research, which shows tanning bed use raises the risk of melanoma of the skin by 75% when use starts before the age of 30. The agency also found a link between tanning bed use and risk of melanoma of the eye. Melanoma accounts for less than 5% of skin cancer cases but causes a large majority of skin cancer deaths.

The findings are published in The Lancet Oncology.

Most skin cancers are caused by too much exposure to ultraviolet (UV) rays. Much of this exposure comes from the sun, but it also comes from manmade sources, such as tanning beds. Because of the popularity of tanning among young people, both the World Health Organization and the International Commission on Non-ionizing Radiation Protection recommend that the use of indoor tanning should be restricted in anyone under the age of 18.

The American Cancer Society recommends people avoid tanning beds altogether.

"This new report confirms and extends the prior recommendation of the American Cancer Society that the use of tanning beds is dangerous to your health, and should be avoided," says Len Lichtenfeld, MD, deputy chief medical officer of the American Cancer Society. "Young women in particular are the heaviest users of tanning beds, and, as noted in the report, are at the greatest risk of causing harm to themselves."

The report also puts to rest the argument that tanning with UVA light is safe, Lichtenfeld says.

"Previously, the cancer-causing effects of ultraviolet light were thought to be primarily related to UVB, or ultraviolet B radiation. This new report now extends the cancer-causing effects of solar or sun-related radiation to UVA light, as well," he says. In the past 30 years, the IARC has evaluated the cancer-causing potential of more than 900 likely candidates, placing them into one of five groups, with Group 1, carcinogenic to humans, being the highest risk.

TNF Blockers May Increase Cancer Risk in Kids

2009-08-13T06:30:00.000-07:00

Article date: 2009/08/05
By Rebecca V. Snowden

Kids and teens treated with drugs called tumor necrosis factor (TNF) blockers may be at an increased risk for lymphoma and other cancers, according to the US Food and Drug Administration (FDA), which is updating black box warnings for the drugs.

The FDA's decision is based on a yearlong review of the childhood cancer risk associated with TNF blocker drugs, which are used to treat rheumatoid arthritis, Crohn's disease, and other inflammatory diseases.

These drugs -- which include adalimumab (Humira), etanercept (Enbrel), certolizumab pegol (Cimzia), golimumab (Simponi), and infliximab (Remicade) -- work by blocking tumor necrosis factor, a protein that's overproduced in some immune system diseases. The FDA started investigating the drugs in 2008 after evidence suggested that interfering with TNF may also increase the risk of some life-threatening infections and certain cancers.

This analysis found children and teens taking these drugs had an increased risk of cancer, with cases occurring on average after 30 months of treatment. About half were lymphomas, and some were fatal.

The FDA said it was working with TNF drug manufacturers, including Johnson & Johnson, Abbott, and Wyeth, to better understand the childhood cancer risk associated with these drugs.

If your child is taking or considering taking a TNF blocker, discuss the risks and potential benefits with your doctor.

Cancers in children often are hard to recognize. Parents should be sure that their children have regular medical check-ups and watch for any unusual signs or symptoms that do not go away. These may include:
* an unusual lump or swelling
* unexplained paleness and loss of energy easy bruising
* an ongoing pain in one area of the body
* limping
* unexplained fever or illness that doesn't go away
* frequent headaches, often with vomiting
* sudden eye or vision changes
* sudden unexplained weight loss

These symptoms are more likely to be caused by something other than cancer, but they should be checked out by your child’s doctor.

Vietnam's A/H1N1 flu situation

2009-08-13T06:25:00.000-07:00

Vietnam confirmed 33 more cases of A/H1N1 influenza, raising the total number of flu patients in the country to 1,211, said a report of the website of Vietnam's Ministry of Health on Wednesday.

Among the newly-reported cases, one patient was a seller of a supermarket in the central Gia Lai province of Vietnam. This is the first supermarket in the country reported A/H1N1 flu case, according to local newspaper Liberty Saigon on Wednesday.

The flu continues speeding wide in schools in Hanoi, the capital city of Vietnam, said the ministry.

So far, 883 patients have recovered and been discharged from hospitals. The rest are being quarantined and treated, said the report.

Vietnam confirms 2nd death of A/H1N1 influenza

The Vietnamese Ministry of Health confirmed that a 52-year-old woman in Ho Chi Minh City died of A/H1N1 influenza, becoming the country's second death of the flu, local newspaper the New Hanoi reported Thursday.

The woman was admitted to the Hospital No. 115 on Aug. 6 after having high body temperature, coughing and vomiting, said the newspaper. Her sample was tested positive to A/H1N1 influenza later.

The patient was transferred to Pham Ngoc Thach Hospital on Aug.10 because her condition deteriorated. She died on the same day due to respiratory failure, said the newspaper.

The ministry on Thursday confirmed 64 more cases of A/H1N1 influenza, raising total number of flu patients in the country to 1,275. Vietnam confirmed the country's first death of A/H1N1 influenza in the central province of Khanh Hoa last week.

Overview of the current Pandemic H1N1 2009 situation

2009-08-13T06:23:00.000-07:00

Pandemic (H1N1) 2009 is continuing to spread throughout Viet Nam. The spread of the virus to all countries, worldwide, is considered inevitable.

It is important to note that this pandemic is currently referred to as of “moderate” severity based upon the global situation. The overwhelming majority of patients are recovering without the need for hospitalization or even medical care, the levels of severe cases are similar to the levels we expect for seasonal influenza, and the health care systems are able to cope with the number of people seeking care.

With the increasing spread of H1N1 in Viet Nam, we expect that there will be a number of people who have serious complications and some will die.

Experience from other countries shows there are certain groups considered to be at “high risk” of serious complications from Pandemic (H1N1) 2009. People with a chronic condition, such as cardiovascular disease, respiratory disease such as asthma, diabetes, and cancer are currently among the people considered to be at high risk of serious complications from influenza.

There is evidence that pregnant women are also at high risk for more severe disease – especially those in the second and third trimester. And, a recent report suggests obesity may be another risk factor for severe disease.

Any one who has one of these conditions should seek medical advice if they develop influenza like symptoms.

The symptoms of pandemic H1N1 are similar to seasonal influenza, such as fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting and diarrhoea.

The virus is transmitted by inhaling infected droplets expelled by talking, coughing, or sneezing; or by touching contaminated hands or surfaces, the same as the normal seasonal flu.

The best protection measures for H1N1 are the SAME as for any influenza virus:

* Wash your hands with soap and water frequently and thoroughly. You may also use an alcohol-based hand sanitizer if soap and water are not available.
* Avoid touching your eyes, nose, and mouth without washing your hands first.
* Cover your mouth and nose when you cough and sneeze by using your sleeve, a tissue, or a mask.
* Avoid or reduce the time spent in close contact with people who appear unwell and/or have a fever and cough.
* Reduce the time spent in crowded settings if possible.
* Keep a distance of at least 1 meter between you and other persons especially if they have influenza-like symptoms.
* Improve airflow in your living space by opening windows.
* Practice good health habits including getting adequate sleep, eating nutritious food, and keeping physically active.
* STAY HOME IF YOU HAVE A FEVER, COUGH and/or SORE THROAT

NOTE: WHO no longer requires countries to report all cases of pandemic H1N1 and many countries are no longer routinely testing for the virus. However, countries are continuing to monitor changes in the virus that may be important for case management and vaccine development.

When there is sustained community transmission, the detection, laboratory confirmation and investigation of all cases, including those with mild illness, is extremely resource-intensive. In some countries, this strategy is absorbing most national laboratory and response capacity, leaving little capacity for the monitoring and investigation of severe cases and other exceptional events. Moreover, the counting of individual cases is no longer essential for monitoring the risk posed by the pandemic virus or to guide implementation of the most appropriate response measures. Despite these changes in reporting requirements.

Given the change in reporting requirements, we will only update the number of globally reported cases on a weekly basis. It is important to keep in mind that the number of cases reported will understate the real number of cases.

Source: http://www.wpro.who.int/vietnam/sites/dcc/h1n1/

Public Knowledge of Benefits of Breast and Prostate Cancer Screening in Europe

2009-08-12T00:13:00.000-07:00

Gerd Gigerenzer, Jutta Mata, Ronald Frank

Affiliations of authors: Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany (GG); Faculty of Human Kinetics, Technical University Lisbon, Lisbon, Portugal (JM); Gesellschaft für Konsumforschung Association, Nuremberg, Germany (RF)

Correspondence to: Gerd Gigerenzer, PhD, Harding Center for Risk Literacy, Max Planck Institute of Human Development, Lentzeallee 94, 14195 Berlin, Germany (e-mail: gigerenzer@mpib-berlin.mpg.de).

Making informed decisions about breast and prostate cancer screening requires knowledge of its benefits. However, country-specific information on public knowledge of the benefits of screening is lacking. Face-to-face computer-assisted personal interviews were conducted with 10 228 persons selected by a representative quota method in nine European countries (Austria, France, Germany, Italy, the Netherlands, Poland, Russia, Spain, and the United Kingdom) to assess perceptions of cancer-specific mortality reduction associated with mammography and prostate-specific antigen (PSA) screening. Participants were also queried on the extent to which they consulted 14 different sources of health information. Correlation coefficients between frequency of use of particular sources and the accuracy of estimates of screening benefit were calculated. Ninety-two percent of women overestimated the mortality reduction from mammography screening by at least one order of magnitude or reported that they did not know. Eighty-nine percent of men overestimated the benefits of PSA screening by a similar extent or did not know. Women and men aged 50–69 years, and thus targeted by screening programs, were not substantially better informed about the benefits of mammography and PSA screening, respectively, than men and women overall. Frequent consulting of physicians (r = .07, 95% confidence interval [CI] = 0.05 to 0.09) and health pamphlets (r = .06, 95% CI = 0.04 to 0.08) tended to increase rather than reduce overestimation. The vast majority of citizens in nine European countries systematically overestimate the benefits of mammography and PSA screening. In the countries investigated, physicians and other information sources appear to have little impact on improving citizens’ perceptions of these benefits.

CONTEXT AND CAVEATS

Prior knowledge

Given the harms that can ensue from cancer screening procedures, people’s decisions as to whether to undergo cancer screening should be based on a realistic knowledge of its benefits.

Study design

Face-to-face-interviews were conducted among a representative sample of men and women in nine European countries, who were asked to choose among estimates of the number of fewer cancer-specific deaths (per 1000 individuals screened) by prostate-specific antigen and mammography screening, respectively. Participants were also queried as to their sources of medical information.

Contribution

This study found dramatic (by an order of magnitude or more) overestimation of the benefits (absolute cancer-specific mortality reduction) of mammography and prostate-specific antigen testing in the vast majority of women and men, respectively, in all countries surveyed. Frequent consultation of sources of medical information (including physicians) was not associated with more realistic knowledge of the benefits of screening.

Implications

A basis for informed decisions by people about participation in screening for breast and prostate cancer is largely nonexistent in Europe, suggesting inadequacies in the information made available to the public.

Limitations

The influence of the public's overestimation of screening benefits on actual participation in screening was not addressed in this study, and the work was restricted to European countries.

From the Editors

Fore more details: http://jnci.oxfordjournals.org/cgi/content/abstract/djp237

Ovarian cancer: Women in early stages can have surgery without losing fertility, study finds

2009-08-12T00:10:00.000-07:00

Young women diagnosed with an early stage of ovarian cancer may be able to have surgery for the disease without losing their fertility.

Traditionally, treatment of ovarian cancer involves removal of both ovaries and the uterus, which puts younger women into menopause and ends their chances of bearing a child. But a study published Monday in the journal Cancer, by researchers at Columbia University College of Physicians and Surgeons, showed that five-year survival rates for stage 1 ovarian cancer patients were the same for women who had both ovaries removed and women who had just the cancerous ovary removed.

The five-year survival rates were also similar among women who had the uterus removed compared to those who didn't.

"If the woman is young, premenopausal and is considering future childbearing, she does not need a hysterectomy and she does not need to be completely castrated," said Dr. Beth Karlan, director of the Women's Cancer Research Institute at Cedars-Sinai Medical Center. She was not involved in the research. "It is safe to do a conservation procedure and still effect cure and allow the woman to appreciate her life goals. ... With stage 1, cure is a very realistic goal."

Ovarian cancer, the fifth-leading cause of cancer deaths in women, occurs most often in postmenopausal women and is often detected only after it's advanced. However, up to 17 percent of ovarian cancers occur in women 40 or younger. With rates of the disease in that age group believed to be rising, more attention is being paid to options that preserve fertility.

Freezing eggs or embryos before the removal of the ovaries is one avenue for women who want to preserve the option of having children. However, removal of the ovaries and uterus is unappealing for reasons other than fertility, said Dr. Jason Wright, the lead author of the study and an assistant professor of women's health. The loss of hormones produced by these organs can increase a woman's chances of developing some other diseases and diminish quality of life.

It is not clear yet whether premenopausal women who have completed childbearing would benefit from organ-preserving surgery for early-stage ovarian cancer.

By Shari Roan Tribune Newspapers

Calcium curious: How much is enough?

2009-08-12T00:07:00.000-07:00

We seem to get more mail about calcium than any other single nutrient. The questions and comments vary, but many reflect the same exasperation. On the one hand, we've been told to take calcium pills to keep bones strong, prevent osteoporosis and reduce the risk of fracture. On the other, information seems to keep popping up that calls into question the value of calcium -- and even suggests that large amounts might be counterproductive. Throw in the occasional query about calcium absorption and which calcium pills to take, and the mailbag -- or, more literally, the e-mail inbox -- gets full.

Here are some of the questions we get most often:

QHow much calcium should I be getting on a daily basis??

AThe official recommendation is 1,000 milligrams a day for adults ages 19 to 50 and 1,200 mg for those past the half-century mark. Those amounts include calcium from all sources: dairy products, other food and drinks, and calcium supplements. But there's a dissenting point of view that 600 mg to 1,000 mg a day is sufficient, perhaps more healthful. Dr. Walter C. Willett, chairman of the Harvard School of Public Health and a member of the Health Letter's editorial board, is a leading voice among the dissidents.

QHow much calcium am I getting if I don't take a supplement?

AA reasonably good diet that includes some fruit and vegetables provides about 200 mg to 300 mg daily -- and that's without any dairy products. A cup of milk adds another 300 mg, and the typical serving of many dairy products provides 150 mg or more (cheese lovers should go for the hard stuff -- it has more calcium). So a well-rounded diet with some servings of milk and dairy products puts you well into the neighborhood of 600 mg to 800 mg a day.

QAnd what about the supplements -- which type should I take?

AThis presupposes you should be taking a calcium supplement, but we'll deal with that question below.

Most calcium supplements are made with either calcium carbonate or calcium citrate. Calcium carbonate needs stomach acid to be absorbed, so if it is the source of calcium in your supplement (you may need to read the fine print), it's best to take it just after a meal. Calcium citrate isn't as dependent on stomach acid, so it can be taken any time. People taking medications that reduce stomach acid -- such as the proton-pump inhibitors (Prevacid, Prilosec) or the H2 blockers (Tagamet, Zantac) -- should take a calcium citrate supplement because lower amounts of stomach acid mean they won't absorb calcium carbonate properly.

QCan calcium help prevent dangerous fractures?

AWell, this is the question, isn't it, because fracture prevention is the main reason we fret over calcium intake. Take a dash of evidence, mix in some impeccable logic, and you can come up with a cogent argument that calcium prevents fractures.

High calcium intake does result in high levels of calcium in the blood. High blood levels prevent the release of parathyroid hormone, a hormone that promotes bone resorption, a breaking down of bone tissue that releases calcium into the blood. If calcium levels in the blood are low, bone resorption can help nudge them back to normal. But in the process, bones get weaker and are more likely to fracture. In theory, keeping calcium levels in the blood high prevents that chain of events from happening.

But in several epidemiological studies, including some based at Harvard, people with high calcium intake haven't, as a group, broken fewer bones than people with skimpy intake. Randomized trials, which have made head-to-head comparisons between calcium and a placebo, have shown some improvement in bone density but not so much in the prevention of fractures.

So why the inconsistency between the expected benefits and the way this has played out in studies? One possible explanation is that in the long run, there are other factors -- muscle strength, balance, physical activity, Vitamin D intake -- that outweigh calcium intake in determining fracture risk.

Studies have repeatedly found that we're far better off getting most of our nutrients from food rather than from pills. With calcium, it's more complicated. In many ways, dairy products, and milk in particular, are ideal for supplying the mineral. The calcium content is high and easily absorbed. But when dairy comes into the diet, saturated fat comes with it, and high saturated fat intake increases cardiovascular risk. Furthermore, a few studies suggest that dairy food itself increases the risk of certain cancers.

These reservations notwithstanding, food is the preferred way to get calcium. The best food choices for calcium include non-fat dairy products (in limited amounts), as well as certain types of fish (canned salmon and sardines) and vegetables (collard greens are a winner). Whether you need to "top it off" with a supplement depends on your diet and whether you're trying to adhere to the official recommendations.

More questions? E-mail health_letter@hms .harvard.edu and put "calcium" in the subject line. We'll post the questions and answers on our Web site, health.harvard.edu. Address: Harvard Health Letter, 10 Shattuck St., Floor 2, Boston, Mass., 02115.

Copyright © 2009, Chicago Tribune

How to keep your eyes safe in the sun

2009-08-12T00:06:00.000-07:00

Good-quality sunglasses are the best way to protect your eyes from damaging rays that can lead to vision problems and cancer. Here are some tips:

Read the label. Sunglasses should block 99 to 100 percent of both types of ultraviolet rays -- UVA and UVB -- and most high-energy visible radiation, or HEV, rays.

Don't go too cheap (even for kids). Sun damage is cumulative from infancy. Shades are especially important for light-colored eyes; dark eyes provide limited protection.

Try wraparounds. The design limits stray light coming from above and to the side of glasses. If that model doesn't appeal, try large frames that sit close to your face, or look for glasses with an added anti-reflective coating.

Cover contacts. Because contact lenses only shield part of the eye, you still need shades.

Go dark enough. Glasses should let roughly 20 percent of light penetrate (lightly tinted lenses may let in 75 percent). Some designs darken depending on how bright it is.

Think comfort. Pay attention to earpieces and the bridge of the nose, and try on different types of frames to compare weight.

Ask about colors. Certain tints are better at blocking certain kinds of rays. Some eye doctors say gray is best for absorbing a wide variety, for example.

Keep them on. Be vigilant in higher-risk situations: between 10 a.m. and 2 p.m., when the sun is hottest, and in wide open places with reflective surfaces -- including the beach. Be aware that some medications heighten sun sensitivity.

Copyright © 2009, Chicago Tribune

Colon cancer survival improved with Aspirin

2009-08-12T00:04:00.000-07:00

Some people diagnosed with colon cancer who take Aspirin may reduce their risk of dying from the disease by nearly 30 per cent compared with those who don't take the pills, a new study suggests.

Acetylsalicylic acid (ASA) was developed as a painkiller and marketed as a headache medication or to treat aches and pains. Research has also suggested its regular use may help to prevent colorectal cancer in people at high risk of the disease.

In Wednesday's issue of the Journal of the American Medical Association, Dr. Andrew Chan of Harvard Medical School in Boston and his colleagues reported patients who already have colon cancer may benefit from taking Aspirin along with surgery and chemotherapy.

"It's exciting that an inexpensive, commonly used medication may be of benefit among this group of patients who are worried about having their cancer recur," Chan said.
Tumour typing

But ASA didn't work for everyone, he noted. It was most effective in patients with the most common type of tumour which overproduces the COX-2 enzyme.

The finding makes sense, the researchers said, since Aspirin blocks the effects of the enzyme, which is thought to contribute to the progression and spread of tumours.

In the observational study, Chan and his colleagues analyzed data from two large, ongoing studies of health professionals. Researchers tracked 1, 279 men and women with nonmetastatic colorectal cancer who were followed for an average of 12 years.

Among the 549 participants who used Aspirin regularly after their cancer diagnosis, 81 died from colorectal cancer, or about 15 per cent. In comparison, among the 730 people who didn't use Aspirin, 141 died of the disease, or about 19 per cent.

The 29 per cent relative reduction in risk of cancer death was found after taking other cancer risk factors into account, such as family history. The team also found a 21 per cent lower risk for overall mortality among those taking the drug.

ASA seemed to help those stage I, II and III of the disease.

"These results suggest that Aspirin may influence the biology of established colorectal tumors in addition to preventing their occurrence," the study's authors wrote.

"Our data also highlight the potential for using COX-2 or related markers to tailor Aspirin use among patients with newly diagnosed colorectal cancer. Nonetheless, because our data are observational, routine use of Aspirin or related agents as cancer therapy cannot be recommended, especially in light of concerns over their related toxicities, such as gastrointestinal bleeding."

Some tumours will continue to grow despite taking the drug, the study's authors warned.
'Wonderful and easy tool'

The findings are good news, but more research is needed, agreed Barry Stein, a colorectal cancer survivor and president of the Colorectal Cancer Association of Canada.

"Having in the toolbox so to speak, a simple Aspirin to assist in the treatment of the disease, following, for example, the removal of a tumour to prevent its recurrence, is a wonderful and easy tool to have."

In an editorial accompanying the study, Dr. Alfred Neugut of Columbia University Medical Center in New York said the study "comes as close as it can to offering patients a way to help themselves."

Neugut, who was not involved in the study but has done similar research, said if ASA becomes the standard of care in colon care, Cox-2 testing may become routine. It shouldn't add much to the cost of standard tumour tissue testing, he said.

Chan, Stein and Neugut all said colorectal patients should talk to their oncologist before starting to take ASA.

The best defense against colorectal cancer is still early detection of polyps, Stein said.

Approximately 20,000 new cases of colorectal cancer are diagnosed in Canada every year, and roughly 8,500 Canadians will die from the disease every year. One in 14 men and one in 16 women can expect to develop colorectal cancer during their lifetimes.

The study was funded by the National Cancer Institute and the National Institutes of Health.

Aspirin shows promise for colon cancer patients

2009-08-12T00:02:00.000-07:00

Score another win for the humble aspirin. A study suggests colon cancer patients who took the dirt-cheap wonder drug reduced their risk of death from the disease by nearly 30 percent.

Aspirin already is recommended for preventing heart attacks and strokes, along with its traditional use for relief of minor aches and pains. Its merit in colon cancer prevention has been tempered by its side effects, bleeding from irritation of the stomach or intestines.

The new study suggests patients who already have colon cancer may benefit from taking aspirin along with surgery and chemotherapy. In a separate analysis of a subgroup of patients, only those with the most common type of tumor, those that overproduce the Cox-2 enzyme, saw a benefit.

"The paper is absolutely incredible, and I don't gush normally," said Dr. Alfred Neugut of Columbia University Medical Center in New York who has done similar research but was not involved in the new study. In an accompanying editorial, Neugut wrote that the study "comes as close as it can to offering patients a way to help themselves."

"This is certainly something patients would want to discuss with their doctors," said Dr. Andrew Chan of Harvard Medical School in Boston, who led the study, which appears in Wednesday's Journal of the American Medical Association.

It's too early for an across-the-board recommendation however, both Chan and Neugut said. The results should be confirmed in an experiment where patients would be randomly assigned to take aspirin or a dummy pill. A study based in Singapore that's now recruiting patients may verify aspirin's benefit.

Chan's study was observational, meaning researchers merely observed what patients were already doing, such as taking aspirin regularly for headaches. It's possible that factors other than aspirin accounted for the difference in cancer deaths.

Colorectal cancer is the second leading cause of cancer death in the United States after lung cancer. The National Cancer Institute estimates that nearly 50,000 Americans will die from it this year.

The researchers analyzed data from two large ongoing studies, the Nurses' Health Study and the Health Professionals Follow-up Study.

They looked at nearly 1,300 people with colorectal cancer who'd been followed for an average of 12 years. All the patients in the study had surgery for colon cancer and many also had chemotherapy.

Among the 549 participants who used aspirin regularly after their diagnosis, 81 died from colorectal cancer (about 15 percent). In contrast, among the 730 people who didn't use aspirin, 141 died of the disease (about 19 percent).

Taking into account other cancer risk factors, such as family history, the researchers calculated aspirin's overall benefit: a 29 percent reduction in risk of cancer death.

"It's exciting that an inexpensive, commonly used medication may be of benefit among this group of patients who are worried about having their cancer recur," Chan said.

About one-third of the tumors could be tested for Cox-2. Aspirin helped only those patients whose tumors tested positive for the enzyme. That makes sense, Chan said, because aspirin blocks the enzyme, which is thought to play a role in cancer's spread.

If aspirin becomes the standard of care in colon cancer, testing for Cox-2 may become routine, Neugut said. That wouldn't add much to costs, he said, because tumor tissue already is tested and a Cox-2 test could be easily added.

By CARLA K. JOHNSON, AP Medical Writer Carla K. Johnson, Ap Medical Writer

50 mln women in Asia at risk of HIV infection - UNAIDS

2009-08-11T23:59:00.000-07:00

By Tan Ee Lyn

BALI, Indonesia, Aug 11 (Reuters) - Fifty million women in Asia are at risk of being infected with HIV because of the risky sexual behaviour of their husbands or boyfriends, leading health experts said in a report on Tuesday.

More than 90 percent of the 1.7 million women now living with HIV in Asia became infected while being in monogamous, long-term relationships with men who engaged in risky sex behaviour, the report launched by UNAIDS said.

These include men who had other sexual partners or who were drug users.

"We need to target men who engage in paid sex, injecting drug users, men who have sex with men, who can transmit the virus to their partners," Jean D'Cunha, regional director of the United Nations Development Fund for Women in South Asia, told a news conference held on the margins of an HIV/AIDS conference in Bali.

"We need to question the attitudes, values and behaviour and transform these so that women would be less vulnerable to HIV/AIDS."

While the issue of gender inequality is often ignored or laughed off, experts say it cannot be taken lightly in the context of HIV/AIDS, a disease that can be transmitted through sexual contact and which is incurable.

Sex workers, who have very little bargaining power to begin with, are usually forced to comply when their clients refuse to use condoms. Back home, the wives of these men too have no power to demand that condoms be used even if they know about the risky sexual behaviour of their husbands.

While the fight against the AIDS epidemic has seen progress on some fronts, women continue to bear the brunt of it. Women make up 35 percent of all adult HIV infections in Asia now, up from 17 percent in 1990.

REVERSING A CULTURE

Maire Bopp-Allport, head of the Pacific Islands Aids Foundation, contracted the AIDS virus from her boyfriend around 1996. Today, she is a familiar figure in the global fight against the disease.

"At the heart of the issue is thousands of years of education to our males that it's okay to think that women are there to simply serve them and do everything they want. We need to bring a new culture where it's not okay," she told Reuters.

"They need to be able to think that the abuse of a woman is the abuse of their daughters when their daughters become women," she added.

(Reporting by Tan Ee Lyn, Editing by Don Durfee and Sanjeev Miglani)

Costa Rican president has swine flu

2009-08-11T23:55:00.000-07:00

By John McPhaul

SAN JOSE (Reuters) - Costa Rican President Oscar Arias is suffering from the H1N1 virus, making him the first head of state known to have contracted swine flu.

Nobel Peace Prize winner Arias, 68, has a mild case of the virus which he tested positive for on on Tuesday after feeling unwell at the weekend, the government said.

Arias is at home and plans to do some work from there.

"Apart from the fever and a soar throat, I feel well and in good shape to carry out my work by telecommuting. I expect to return to all my duties on Monday," he said in a statement.

The H1N1 flu outbreak, declared a pandemic on June 11, has spread around the world since emerging in April and could eventually affect 2 billion people, according to estimates by the U.N. World Health Organization. More than 20 people have died of swine flu in Costa Rica.

Arias suffers from asthma. While the vast majority of swine flu cases have not been serious, infected people who have other medical conditions are most susceptible to complications.

"The tests ... show that there is no other complication," Information Minister Mayi Antillon said.

Some of the president's duties have been given to Cabinet ministers for the moment.

Last month, Arias brokered talks to try to end a political crisis in Honduras after President Manuel Zelaya was ousted in a coup on June 28.

Negotiations broke down two weeks ago over whether Zelaya can return to power and Arias' illness is unlikely to affect the situation in Honduras.

Arias won the Nobel prize in 1987 for a peace plan to end Central American civil wars and guerrilla conflicts.

He first served as president from 1986-90 and was re-elected in 2006 on a promise to end corruption and take the small country into a Central American free trade pact with the United States.

Arias broke Costa Rica's decades-old diplomatic relations with Taiwan in 2007 to establish ties with rival Beijing, saying his country could no longer ignore China's growing power in the world.

Doctors ordered Arias last year to stop talking for a month due to a vocal chord ailment. He communicated by writing and typing.

(Writing by Alistair Bell, editing by Anthony Boadle)

International development minister urges firms to pool HIV patents

2009-07-13T02:40:00.000-07:00

Drug companies should give up their patent rights to HIV medicines to help prevent the deaths of millions of people in poor countries, a British government minister will say this week.

The international development minister, Mike Foster, will call on pharmaceutical companies to put lives before profits, as the all-party parliamentary group on Aids publishes a report this week detailing the scale of the "treatment timebomb". By 2030, they estimate, 50 million people will need new drugs, which are currently prohibitively expensive, to keep them alive.

Three million people are on cheap, basic HIV drug combinations, but they are only a third of those in need and resistance is growing to these drugs both in the developing world and in the west.

New and improved drugs are urgently required, but they are expensive, and cheap generic copies of the newest drugs can no longer easily be made and sold because of tightened intellectual property rules in India and China.

The UK generally has a very close relationship with the drug companies, which regard patents as the means of recouping the substantial costs of researching and developing new drugs.

But Foster says they must change their stance on HIV. He wants companies to contribute to a "patent pool", which the international drug-purchasing facility, Unitaid – set up by a number of donor countries, including the UK – is trying to establish.

"While it is absolutely vital that we work to reduce the human cost of HIV by focusing our efforts on preventing new infections, we must also face up to the stark reality of the treatment challenge we face. The pharmaceutical industry has an opportunity to act now to help prevent future human catastrophe. It is time for them to state their clear commitment to make new HIV medicines affordable to those who need them most."

According to the all-party report, if HIV patents are put in a pool, generics companies – which make the cheap combinations now used in Africa – will be permitted to make low-cost copies of newer drugs and devise new combinations in a single pill, which is important for people living in poverty.

The report lays out in stark terms the coming crisis. "It took political activism almost a decade ago to make life-saving drugs available to the poor in developing countries," it says. "Only a third of those who need it are on treatment and this treatment will not work for them forever. Political activism is needed once more to ensure that the next generation of drugs is available to the world's poorest in future."

MP David Barrow, who chairs the group, said: "We are sitting on a treatment timebomb. We must reduce the price of second-line medicines and less toxic first-line medicines before millions need them. We cannot sleepwalk into a situation where we can only afford to treat a tiny proportion of those infected."

The only way to end the HIV/Aids epidemic is to prevent infection, the report says, but because the drugs suppress the virus, those receiving treatment are much less likely to pass it on.
Sarah Boseley, health editor

Michael Jackson coroner's drug report

2009-07-13T02:34:00.000-07:00

MICHAEL Jackson had lethal levels of powerful painkiller Demerol and heroin substitute methadone in his body when he died, The Sun can reveal.

Tests show the tragic star had taken a cocktail of drugs strong enough to have killed any normal person instantly.

This is it ... narcotic note written by doctor to tragic Jackson

But he had been on vast quantities so long his body became tolerant to huge doses - until his fatal collapse on Thursday of last week.

The shock findings are in preliminary toxicology reports submitted to the Los Angeles county coroner’s office.

The contents were revealed as sources predicted Jacko’s death could result in manslaughter or even MURDER charges.

A case insider told The Sun: “Michael Jackson was a walking drug store when he died — he never stood a chance.”

'Walking drug store' ... what Jacko was taking

As well as lethal levels of DEMEROL and METHADONE, blood tests found high levels of antianxiety drug XANAX.

Also present were lower levels of PROPOFOL — an anaesthetic for hospital use only, but which Jackson used as a sleeping draft.

A significant amount of narcotic DILAUDID, normally used to numb post-surgery pain, was discovered.

Found ... detox info at Jackson's house

In addition there were “therapeutic” levels of FENTANYL, another post-op painkiller 100 times more potent than morphine, plus prescription painkiller VICODIN, anti-anxiety pills VALIUM and the sleeping drug AMBIEN.

The insider said: “The body can build up extreme tolerances to huge doses of drugs but eventually it overloads and just shuts down. That is what happened to Michael.

Pressure

“Tests showed that as well as Demerol and methadone, he had taken four more painkillers and anaesthetics plus anti-anxiety pills.

“This is sure to increase pressure on police to establish exactly how one man obtained so many prescription medications — and which doctors were responsible.

“There is increasing talk of manslaughter charges if it can be shown he was given drugs without proper regard for his safety.”

Police Chief William Bratton said he was waiting for the final toxicology reports, currently weeks away.

He added: “Based on those, we will have an idea what we are dealing with. Are we dealing with a homicide or are we dealing with accidental overdose?”

The early findings support The Sun’s exclusive revelation that 50-year-old King of Pop was given an injection of Demerol about 40 minutes before his heart stopped.

Jackson’s dermatologist Dr Arnold Klein — the close pal rumoured to be the father of two of the star’s three children — has already admitted occasionally giving Jackson Demerol after surgery.

But he insisted he had warned him about Propofol, also known as Diprivan.

'Quit' ... Dr Arnold Klein

Pacific Coast News

Klein said: “I knew at one point he was using Diprivan was on tour in Germany. I told him he was absolutely insane. I said, ‘You have to quit it. This drug, you can’t repeatedly take’.”

Jackson last toured Germany in 1997 — indicating he may have been taking the potentially lethal medication for at least 12 years.

At least four doctors are at the core of the investigation. One, personal physician Dr Conrad Murray, was with Jacko when he collapsed.

Yesterday a letter from a Dr Alex Farshchian and dated July 21, 2002, emerged suggesting Jackson trade his dependence on Demerol for injectable painkiller Buprenex.

Said to have been found at Jackson’s rented house and published on a US website, it said: “Buprenex is the potent narcotic I told you about last week. It is just like the D but better.” The letter suggests a five to seven-day program “that offers you the solution”.

The doctor adds: “I have everything ready. This is it.”

Eerily, seven years later This Is It would be the title Jackson chose for his comeback shows.

A scribbled note found near his drug stash, possibly written by Jackson, said: “Buprenex does the same as Demerol, the only difference is you can’t become an addict on Buprenex.”

Evidence ... painkiller note, perhaps scrawled by Michael Jackson

Another letter — headed Outpatient Detoxification Sheet — names methadone as the most common way to treat drug dependency.

Meanwhile documents and snaps from the Santa Barbara County Sheriff’s department also emerged showing the depths of Jackson’s drug habit were uncovered in 2003.

Officers raided his Neverland home while probing child abuse claims — and found powerful narcotics, syringes, vials and IV bags.

Jackson had been so desperate to score prescription drugs that he even used his best friend’s identity.

Among the police snaps is one showing a bottle of anti-anxiety drug Alprazolum, also known as Xanax, in the name Frank Tyson — prescribed by Dr Klein.

Tyson’s real name is Frank Cascio. He is a pal’s son who Jackson befriended as a toddler and put on his payroll when he turned 18.

Prescription ... pills for 'Frank'

Frank hung out with him at Elizabeth Taylor’s Swiss chalet in Gstaad in September 1993. And Jackson often sought sanctuary in Frank’s New Jersey home — once spending three months there.

It is thought Frank, now 30, had no idea Jackson was using his name like this — though the star frequently begged aides to get him prescription drugs to top up his own legal supply.

In 2004 bodyguard Chris Carter told investigators he used several names to get prescriptions, including those of ranch manager Jesus Salas and employee Joe Marcus.

Carter also claimed Jacko was once so “spaced out” he fell flat on his face in a hotel — but still continued the drug binge which five years later would lead to his death.

The progress of the drug addictions is to be mapped by a battery of tests — to Jackson’s BRAIN.

Shock ... Sun front pages on Jackson

The Sun

It was removed before Tuesday’s memorial service and slices will show when he first suffered drug reactions.

Renowned pathologist Dr Michael Baden said: “Everything from whether he was beaten as a child to any small tumours, or previous overdoses that he may have suffered, will show up.

“The brain results will determine if he was given improper medication, and how authentic statements provided by his physicians were.”

THE human body can build up a startling tolerance to morphine-based and tranquilliser drugs, writes Health and Science Editor Emma Morton. The phenomenon, tachyphylaxis, means larger and larger doses are needed to have an effect. This puts massive pressure on the heart, triggering heart failure.

n.parker@the-sun.co.uk

Non-Drug Therapies

2009-07-13T02:30:00.000-07:00

When people talk about "alternative therapies" or "alternative medicine" they are talking about kinds of treatment that are different from the medicines or surgery usually prescribed by MDs and other mainstream health professionals. Some people even define alternative medicine as treatments that aren't taught in U.S. medical schools and aren't available at U.S. hospitals. Conventional American health professionals are becoming more interested in these treatments, however.

Some alternative therapies have long histories in other parts of the world and some are recent developments. What they have in common is that the safety and effectiveness of most of them have not been proven by well-designed scientific studies. Some of them may be very helpful, but they must be chosen and used with care.

The list of alternative therapies changes over time as new approaches emerge and others are proven safe and effective and become part of conventional health care. In epilepsy, for instance, the ketogenic diet began as an alternative therapy but has been scientifically tested and is rapidly being accepted as a conventional therapy for certain kinds of patients.

Precisely defined, alternative medicine is used in place of conventional medicine. In actual practice, however, most people who use so-called alternative therapies also receive conventional treatments from a physician. In this situation, better terms might be "complementary" or "integrative" medicine.

Are alternative therapies the same as complementary and alternative medicine (CAM)?
Another popular term for these therapies is "complementary and alternative medicine" (often shortened to CAM). When two things are complementary, they work together, with each one making up for the shortcomings of the other. Complementary therapies, therefore, are used in addition to conventional therapies to try to improve results or quality of life. For instance, people with epilepsy who are taking seizure medicines prescribed by their doctor may also use CAM to try to achieve better seizure control or to reduce side effects.

Therapies listed as CAM are generally the same ones indicated by the term "alternative therapies." The difference lies in whether the person also uses conventional therapies.

What is integrative medicine?
Some people who are interested in CAM, including many doctors, want to emphasize that complementary and alternative therapies can be a valuable addition to conventional medical care. They use the term "integrative medicine" to emphasize that both types of treatment are combined (integrated) in the patient's care. Practitioners of integrative medicine generally emphasize those CAM therapies that have been the most thoroughly tested.

Where can I find out more?
The United States government has had an agency working in the area of alternative therapies since 1993. The current name of this agency (which is part of the NIH, the National Institutes of Health) is the National Center for Complementary and Alternative Medicine (NCCAM). The NCCAM website is a reliable source of up-to-date information and links to other resources.

Topic Editor: Steven C. Schachter, M.D.

Alzheimer's disease drug treats traumatic brain injury, report GUMC researchers

2009-07-13T02:27:00.000-07:00

They say the findings cement relationship between the two brain disorders

Vienna, Austria – The destructive cellular pathways activated in Alzheimer's disease are also triggered following traumatic brain injury, say researchers from Georgetown University Medical Center (GUMC). They say this finding suggests that novel therapy might successfully target both conditions.

In an oral presentation at the Alzheimer's Association 2009 International Conference on Alzheimer's Disease, the scientists will show that deactivating these pathways in part by using a gamma secretase inhibitor - a class of Alzheimer's disease drugs currently being tested - reduced loss of neurons in animal models of traumatic brain injury and protected the animals against motor and cognitive deficits.

"The goal for both diseases is to prevent neuronal cell death, and this study suggests that one therapy could possibly work for both," says the study's lead author, neuroscientist Mark Burns, PhD, an assistant professor at GUMC.

Both disorders are associated with build-up of beta amyloid, a toxic brain peptide. This substance is commonly found in the brains of elderly patients who died from Alzheimer's disease, but has also been found in a third of traumatic brain injury victims, some of whom are children, Burns says. It is also known that people who experience such a brain injury have a 400 percent increased risk of developing Alzheimer's disease.

Burns says that buildup of beta amyloid occurs in a second wave of damage that follows immediate "necrotic" death of nerve cells after traumatic brain injury. This secondary injury can last months, if not years, resulting in large holes within brain tissue.

Amyloid peptides are produced when a long brain protein known as the amyloid precursor protein (APP) is cut in two by the enzyme beta secretase, and then cut once again by a second enzyme known as gamma secretase. Agents that inhibit the activity of gamma secretase are now being studied as treatment for Alzheimer's disease.

In this study, researchers used mice that were either treated with DAPT, an experimental gamma secretase inhibitor, or mice which were "BACE knock-outs" – so called because they were genetically altered in such a way that they could not produce beta secretase. In unaltered and untreated "normal" mice, brain injury resulted in a rapid accumulation of beta amyloid, along with cognitive and motor deficits. But DAPT and BACE knock-out mice had brain lesions that were as much as 70 percent smaller than control animals and they experienced minimal impairment.

The findings further cement the connection between Alzheimer's disease and traumatic brain injury, Burns says, and show that "modulation of beta and gamma secretase may provide novel therapeutic targets for the treatment of traumatic brain injury."

###

The study was funded by grants from the National Institutes of Health and by the Klingel Family Foundation. The scientists report no potential financial conflicts in this research. Georgetown University has filed a patent application for the technology involved in this research.

About Georgetown University Medical Center

Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through Georgetown's affiliation with MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, the world-renowned Lombardi Comprehensive Cancer Center and the Biomedical Graduate Research Organization (BGRO), home to 60 percent of the university's sponsored research funding.

Contact: Karen Mallet
km463@georgetown.edu
215-514-9751
Georgetown University Medical Center

WHO likely to give H1N1 jab guidance on Monday

2009-07-13T02:25:00.000-07:00

Source: Reuters
* WHO expert set to give briefing on flu vaccine Monday
* H1N1-resistant cases have raised interest in jab
(updates with WHO spokeswoman saying briefing likely on Monday)

The World Health Organisation (WHO) will probably hold a media briefing on Monday to issue guidance about the need for a H1N1 influenza jab, a WHO spokeswoman said on Friday.
"The recommendations are still in the process of being developed," Fadela Chaib told a news briefing in Geneva, where the United Nations agency is based.
"The press conference will probably be on Monday," she later told Reuters.
Marie-Paule Kieny, WHO director of the Initiative for Vaccine Research, would give a news briefing once the recommendations emerging from the closed-door WHO meeting on Tuesday are approved by WHO Director-General Margaret Chan.

The WHO raised its influenza pandemic alert to the highest level on June 11 in response to the worldwide spread of H1N1, a newly discovered virus strain commonly known as swine flu.

Vaccine makers such as Sanofi-Aventis , Novartis , Baxter , GlaxoSmithKline and Solvay are seeking WHO guidance about whether to ramp up production of jabs for the strain, to keep making seasonal flu vaccines, or to produce a combination.

The discovery of three isolated cases of H1N1 flu in Denmark, Japan and Hong Kong that resisted treatment with the anti-viral drug Tamiflu, made by Roche and Gilead , has raised interest in a jab to prevent infection.

The WHO said earlier this week that Tamiflu-resistant H1N1 flu does not appear to be spreading in a sustained or worrisome way. All patients with the resistant variety have recovered fully, and their viruses were sensitive to treatment with the other anti-viral recommended by the WHO, the inhaled drug Relenza made by Glaxo under license from Biota .
(Reporting by Laura MacInnis and Stephanie Nebehay; Editing by Louise Ireland)

U.S. Moves Forward With Preparations For H1N1 Vaccination Campaign

2009-07-13T02:24:00.000-07:00

The Obama administration on Thursday said a nationwide vaccination program could begin as early as mid-October to protect Americans from the H1N1 (swine flu) virus and pledged $350 million to help prepare communities across the country for this effort, the Washington Times reports (Ward, 7/9).

"I think it's clear that although we were fortunate not to see a more serious situation in the spring when we first got news of this outbreak, the potential for a significant outbreak in the fall is looming," President Obama said, speaking by phone from the G8 summit in Italy to U.S. health officials who gathered in Maryland for a daylong flu summit organized by his Cabinet, AFP/Yahoo! News reports. "We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation," he said.

"The White House has drawn up a battle plan for taking on the virus when influenza season returns to the northern hemisphere in several weeks' time," contingent on the development of a viable H1N1 vaccine. Clinical trials on the first H1N1 vaccine are scheduled to start next month, according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "We know that a safe and effective vaccine is the best means of both preventing the disease in individuals and stopping the community spread of the virus," HHS Secretary Kathleen Sebelius said (Zeitvogel, 7/9).

"The federal government should get about 100 million doses of vaccine by mid-October, if the current production by five companies goes as planned," the Washington Post writes. "But enough vaccine for wide use by the 120 million people especially vulnerable to the newly emerged strain of H1N1 influenza virus will not be available until later in the fall" (Brown/Hsu, 7/10).

Sebelius told the group gathered at the summit that children, pregnant women, people with chronic illness, the elderly and health workers and will be the first to receive the vaccine, CNN reports.

Reuters reports: "The government is also considering buying even more antiviral drugs, including more of GlaxoSmithKline's inhaled drug Relenza and pediatric doses of Roche AG's Tamiflu" as well as a drug nearing the end of clinical trials, which "would help address the issue of resistance," the news service writes (Fox, 7/9).

The Washington Times writes: "HHS is making $350 million in grants available to state and local governments to get ready, with $260 million slotted to help communities prepare for a vaccination program, and $90 million to help hospitals plan for a surge of patients" (7/9). "The federal government has spent about $1 billion so far on pandemic flu vaccine, with about $7 billion available for further purchases and other pandemic countermeasures," according to the Washington Post (7/10).

H1N1's Impact On World GDP; Zimbabwe's Vulnerabilities

Dow Jones Newswires/NASDAQ examines the impact H1N1 is having on the world gross domestic product and the ongoing fear of the devastating effects the virus could have on developing countries (Quinton, 7/9). VOA News explores conflicting reports over whether or not the H1N1 virus has arrived in Zimbabwe, a country just beginning to rebound after a cholera epidemic has claimed the lives of more than 4,000 since August 2008 (Nyaira, 7/8).

This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery at globalhealth.kff.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

Dramatic drop in deaths from most common cancers

2009-07-13T02:19:00.000-07:00

The death toll from three of the UK's most common cancers has dropped to its lowest level for almost 40 years* - according to new figures released by Cancer Research UK.

Mortality rates for breast, bowel, and male lung cancer** are at their lowest since 1971 even though more than 100,000 people are now diagnosed with these kinds of cancers every year.

Breast cancer deaths peaked in 1989 with 15,625 women dying from the disease. The latest figures for 2007 show that figure has dropped to 11,990 which is equivalent to a drop in mortality rates of 36 per cent.

Bowel cancer deaths peaked in 1992 with 19,598 men and women dying from the disease. In 2007 16,007 died - equivalent to a drop in mortality rates of 31 per cent.

And the number of men dying from lung cancer peaked in 1979 at 30,391 but dropped to 19,637 in 2007 - a drop in mortality rates of 53 per cent.

Although more people are getting cancer because the population is living longer, Cancer Research UK believes that fewer are dying from the disease because new and better treatments and screening are making a real difference. And deaths from lung cancer have been falling as more people give up smoking.

While the new figures show that great progress is being made in the battle to beat cancer, there is still much more to be done. And that is the theme of the charity's new national TV advertising campaign launching on Sunday July 12th to improve awareness of the disease and to raise money for further research.

Appearing in the TV advertisement is Audrey Williams - a 50 year old artist and mother of two from Streatham in London who was diagnosed with breast cancer in 2002.

"I just feel so lucky to be here," she said. "I want everyone to know that more and more people are surviving cancer thanks to the work being done by Cancer Research UK. I found a lump in my breast when I was having a shower. After a mastectomy I had reconstruction but my body rejected the implants. It was a difficult time but I think it helps to stay cheerful and to try and keep your sense of humour to get through.

"The important thing about the TV advertisement is that we aren't actors; we are all real people who have gone through cancer and we can reach out to others and tell anyone who is worrying about symptoms to make that trip to the doctor because if they do have cancer the chances of surviving it are greater than ever."

Harpal Kumar, chief executive of Cancer Research UK, said: "Years of research are behind the dramatic progress being made in the fight against Britain's common cancers. Survival rates have doubled in the last thirty years and the work of Cancer Research UK has been at the heart of that progress.

"Our research is behind 19 of the top 20 drugs used to treat cancer patients worldwide today. Our work has underpinned the huge progress we are now seeing in preventing more deaths from lung cancer. And our progress over decades has helped to develop radiotherapy as a major form of treatment for half of all cancer patients.

"But research is expensive and - because we rely completely on donations from the public - we can only continue this vital work with people's support."

Scientists at Cancer Research UK have been responsible for vital discoveries in the quest to understand how cancer develops and how best to treat the disease.

Cancer Research UK funded large trials that proved the benefits of tamoxifen for breast cancer patients and other trials have shown how to prevent the disease in high risk post-menopausal women. In 1995, the charity showed that two X-rays were better than one in detecting more breast cancers and reducing recall rates. This contributed to a widespread change in clinical practice with two-view mammography now used by all the national screening centres.

The charity's laboratory work is behind many life-saving drugs, such as Herceptin, which has given hope to thousands of women with a particular type of breast cancer. Early work on aromatase inhibitors paved the way for anastrozole, a new gold standard of care for the most common type of breast cancer.

Cancer Research UK scientists contributed to key trials of the drug capecitabine, used to treat both bowel and breast cancer. And they showed that Taxol is an effective treatment for breast cancer; it is now also used for advanced lung cancer.

Cancer Research UK has also made a series of breakthroughs pinpointing new regions of the genome linked to breast, bowel, prostate, lung and brain cancer as well as funding more than 100 clinical trials in the UK at any time.

The charity's chief scientist, Professor Sir David Lane, discovered the p53 protein which is faulty in many cancers and this paved the way for many treatments being tested in clinical trials today.

Cancer Research UK scientists helped to develop the drug cisplatin and later discovered carboplatin which has fewer side effects than cisplatin and is widely used in treating ovarian, lung and head and neck cancers.

Temozolomide, now used worldwide to treat the most common form of brain cancer, is another drug discovered in the charity's laboratories and developed through early clinical trials.

Notes:

* *UK figures routinely collated by Cancer Research UK since 1971
* Breast cancer deaths in women were 12,472 (rate = 37.5 per 100,000 women) in 1971; 15,625 (rate = 41.6) at the peak in 1989; and 11,990 (rate = 26.7) in 2007.
* Bowel cancer deaths were 18,110 (rate = 28.9 per 100,000 persons) in 1971; 19,598 (rate = 25.5) at the peak in 1992; and 16,007 (rate = 17.7) in 2007.
* Male lung cancer deaths were 28,395 (rate = 106.9 per 100,000 men) in 1971; 30,391 (rate = 108.5) at the peak in 1979; and 19,637 (rate = 51.5) in 2007.
* **Lung cancer mortality rates in women under 75 increased by seven per cent over the last 30 years but have fallen by four per cent in the last 10 years.
* The difference in lung cancer trends between men and women reflect variations in past smoking behaviour.

An Experimental Drug Eases Poisonous Scorpion Stings in Children, a Study Finds

2009-05-14T05:00:00.000-07:00

By RONI CARYN RABIN
Published: May 13, 2009

Scorpion stings rarely leave a trace, so when 10-year-old Michael Moerdler-Green woke up at 3 a.m. during a recent family trip to Phoenix, all he knew was that his leg hurt. But as the scorpion’s poison began to spread, his body started to tingle, his eyes rolled around in his head and his legs and arms began to flail.

At the emergency room of Phoenix Children’s Hospital, doctors offered Michael’s parents a choice of treatments: heavy sedation to quell the boy’s symptoms, or an experimental scorpion antivenom made in Mexico but not approved by the Food and Drug Administration for use in the United States.

The boy’s father, Dr. David Moerdler-Green, chose the antivenom. A new study suggests he made the right decision.

No other antivenom specifically for scorpion stings is available in the United States, and a small clinical trial of young children stung by bark scorpions has found that most of those given the investigational drug recovered within two hours, while children given a placebo had symptoms that lasted four hours or more and required heavy sedation and hospitalization.

The study is to be published on Thursday in The New England Journal of Medicine.

“It was like a miracle,” said Dr. Moerdler-Green, who is head of radiology at St. Barnabas Hospital in the Bronx. His son was able to leave the hospital just an hour after receiving the medication. “How many people go into the emergency room around the world and are able to get medication and be cured in the course of one hour?”

Dr. Leslie V. Boyer, principal investigator of the new study, said the trial, though small, demonstrated that the effects of bark scorpion venom could be quickly reversed.

“Using this antivenom in the emergency room will make intensive care treatment unnecessary for most patients,” said Dr. Boyer, who is director of a venom research institute at the University of Arizona College of Medicine in Tucson.

Although 8,000 Arizona residents are stung by poisonous scorpions each year, most adults recover without needing medical treatment. Each year about 200 young children, however, suffer severe neurotoxic symptoms, including trouble breathing, after being stung.

Wider use of the scorpion antivenom, called Anascorp, could make treatment much easier in rural areas and small towns in the state that do not have pediatric intensive care units and usually have to helicopter children to hospitals for care, Dr. Boyer said.

A professor at Arizona State University used to make her own scorpion antivenom. She retired in 1999, leaving behind her recipe and enough of the drug to last about five years. Ever since, the state has been using up its inventory.

In the new study, children from ages 6 months to 18 years who were admitted to a pediatric intensive care unit in Tucson after being stung by scorpions were randomly assigned to receive either Anascorp or a placebo. Eight received the antivenom, and seven received a placebo.

Within two hours, children who had received Anascorp recovered from most of their symptoms; within four hours, the children recovered completely, the researchers found. None of the children who received the drug had detectable levels of scorpion venom in their blood an hour after infusion.

By contrast, children who received the placebo treatment required sedation at levels 65 times higher than did the children who received antivenom. Symptoms persisted for more than four hours in all but one of the children receiving the placebo, the researchers found, and some were hospitalized for up to 48 hours.

--NYTimes--

Hope of new prostate cancer test

2009-05-14T04:56:00.000-07:00

Scientists have found a potential new way to assess whether prostate cancer is aggressive.
They have found tiny bubbles of fat in the urine may hold the key information needed to decide what type of treatment the patient needs.
If prostate cancer is aggressive it requires urgent treatment, but this is not appropriate for patients with slow-growing forms of the disease.
The study appears in Cancer Research UK's British Journal of Cancer.

"This approach holds promise as a non-invasive test of malignancy that could help men and their doctors in the future"

John Neate
Prostate Cancer Charity

Prostate cancer is the most common cancer in men in the UK.
Each year around 34,000 men are diagnosed with the disease, and around 10,000 die from it.

But while the disease can be a killer, in its more benign form it often requires nothing other than close monitoring and the patient often eventually dies from another, unrelated condition.
Until now, researchers have used levels of proteins, like prostate specific antigen (PSA), produced by cancer cells to try to spot the aggressive tumours.
But this can throw up inaccurate results, and lead to people unnecessarily undergoing treatment which can have long-term side effects, such as incontinence and impotence.

Direct from tumour

The latest work focused on fatty capsules called exosomes that are flushed out of the body in the urine.
Scientists found that in patients with prostate cancer exosomes contain molecules that come directly from the tumour itself.
These molecules, which contain a type of genetic material called RNA, can be used to figure out which genes are turned on and off in the cancer - and thus whether it is aggressive or not.
The researchers, led by Dr Jonas Nilsson, from the VU University Medical Centre in Amsterdam, hope the discovery will enable them eventually to develop a more effective test for aggressive tumours.
John Neate, of the Prostate Cancer Charity, said the study was a step towards finding a reliable way to identify aggressive forms of the disease.
But he warned it was a small study, and scientists would need to examine exosomes from a larger number of men before they could assess the reliability of the technique.

Acceptability?

He also said the need to massage the prostate to increase the likelihood that the relevant molecules were released into the urine might reduce its acceptability as a mass screening tool.
Mr Neate added: "Nevertheless, this approach holds promise as a non-invasive test of malignancy that could help men and their doctors in the future.
"Possibly the most significant research question in prostate cancer is how to distinguish early, and with confidence, the potentially life-threatening prostate tumours from the slow growing form of the disease.
"Then treatments could be refined and concentrated on the aggressive cancers where the benefits of treatment far outweigh the risk of side-effects, which can seriously affect a man's quality of life.

---BBC---

WHO Avoids Assigning Severity Scale to H1N1 Flu

2009-05-14T04:52:00.000-07:00

The World Health Organization (WHO) said today it is unable to assign a severity scale to the influenza A (H1N1) epidemic for the reason that disease characteristics and responses of countries vary.

Dr. Sylvie Briand, with the WHO Global Influenza Programme, spoke today at a media briefing in Geneva. As of 1:00 am EDT, 33 countries had reported 5728 confirmed cases of influenza A (H1N1) infection.

According to Dr. Briand, the WHO pandemic alert level phases are mainly based on the transmission of the virus and its geographical spread, while "the severity itself is assessed by other means." Currently, the pandemic alert level has remained at level 5 out of 6, indicating community-based outbreaks in a single WHO region.

The severity of a potential pandemic is based on 3 factors: "the [characteristics of the] virus, the vulnerability of the population, and the intervention we can put in place to reduce the impact of severe disease," Dr. Briand said.

Assessing severity is important for helping countries determine their response to an outbreak, but at a global level, a severity index is "not very helpful" because "severity will vary from place to place," she said.

Dr. Briand pointed out that while wealthier countries may have the resources to mount a more effective response to an outbreak, some developing parts of the world such as West Africa are already used to coping with epidemics and may be at an advantage due to having healthcare systems in place. This is referred to as the "resilience" of a country, she said.

Dr. Briand also emphasized that oseltamivir and zanamivir are effective against this novel H1N1 strain, which is in contrast to the seasonal influenza strain, which is resistant to these antiviral drugs.

News reports are circulating regarding a claim by an eminent Australian influenza researcher that human error may have been involved in creating this strain. Adrian Gibbs, 75, said in an interview that he intends to publish a report suggesting the new strain may have accidentally evolved in eggs that scientists use to grow viruses and drugmakers use to make vaccines.

WHO spokesperson Gregory Hartl said the WHO is looking into evidence regarding these claims, but "it is way too soon to say anything." He added that the WHO's main task is to assess the current risk level and to "help member states to be prepared to respond."

The US Centers for Disease Control and Prevention (CDC) today is reporting 3009 laboratory-confirmed cases in 44 states and Washington, DC.

Yesterday the CDC issued a dispatch in the Morbidity and Mortality Weekly Report on novel influenza A (H1N1) virus infections in pregnant women. As of May 10, 20 probable or confirmed cases had been reported in pregnant women. Of the women, 3 have been hospitalized and 1 woman died.

The CDC is recommending that pregnant women with confirmed, probable, or suspected novel influenza A (H1N1) virus infection should receive antiviral treatment for 5 days.

---MedScape--

Human error behind H1N1? WHO probes

2009-05-14T04:47:00.000-07:00

The World Health Organization is investigating a claim by an Australian researcher that the swine flu virus circling the globe may have been
created as a result of human error.

Adrian Gibbs, 75, who collaborated on research that led to the development of Tamiflu drug, said that he intends to publish a report suggesting the new strain may have accidentally evolved in eggs scientists use to grow viruses and drugmakers use to make vaccines. Gibbs said he came to his conclusion as part of an effort to trace the virus’s origins by analyzing its genetic
blueprint.

“One of the simplest explanations is that it’s a laboratory escape,” Gibbs said on Wednesday. “But there are lots of others.”

The World health Organization received the study last weekend and is reviewing it, Keiji Fukuda, the agency’s assistant director-general of health security and environment, said in an interview on May 11.

Gibbs, who has studied germ evolution for four decades, is one of the first scientists to analyze the genetic makeup of the virus that was identified three weeks ago in Mexico and threatens to touch off the first flu pandemic since 1968.

---The Times of India---

Influenza A(H1N1) - update 27

2009-05-14T04:45:00.000-07:00

As of 06:00 GMT, 13 May 2009, 33 countries have officially reported 5728 cases of influenza A(H1N1) infection.

Mexico has reported 2059 laboratory confirmed human cases of infection, including 56 deaths. The United States has reported 3009 laboratory confirmed human cases, including three deaths. Canada has reported 358 laboratory confirmed human cases, including one death. Costa Rica has reported eight laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Brazil (8), China (3, comprising 1 in China, Hong Kong Special Administrative Region, and 2 in mainland China), Colombia (6), Cuba (1), Denmark (1), El Salvador (4), Finland (2), France (13), Germany (12), Guatemala (3), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Norway (2), Panama (29), Poland (1), Portugal (1), Republic of Korea (3), Spain (98), Sweden (2), Switzerland (1), Thailand (2), and the United Kingdom (68). WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus.

Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases, including influenza.
---WHO---

Cisplatin

2009-05-12T08:26:00.000-07:00

Cisplatin is a chemotherapy drug that was approved by the Federal Drug Administration (FDA) in 1978 and is used to treat patients suffering from malignant pleural mesothelioma. Cisplatin is administered when surgical procedures are not an option, and it is often used in combination with other chemotherapy drugs, including Alimta. Manufactured by Bristol Myers Squibb, Cisplatin is also used to treat ovarian and lung cancer and is a highly effective method of mesothelioma treatment that is often recommended by oncologists.

Cisplatin is administered intravenously and may be given along with other drugs, such as anti-nausea medication and antibiotics that prevent buildup of Cisplatin within the kidneys. Your doctor will determine how often you receive Cisplatin and for how long, but patients who receive Cisplatin in tandem with Alimta will follow a 21-day treatment cycle.

Because Cisplatin was developed three decades ago, the side effects associated with this drug are often much more severe. Side effects include damage to the kidneys, (which is often prevented by administering other drugs, such as a diuretic or sodium polystyrene sulfonate, during Cisplatin treatment) serious nausea, depleted levels of calcium, potassium and other nutrients, loss of appetite, tiredness, hair loss, and an increased risk of infection. Because cancer treatment in general has become so advanced since Cisplatin was first developed, doctors are generally able to control the unpleasant side effects associated with Cisplatin treatment in an effort to make the patient more comfortable.

Other drugs similar to Cisplatin include Carboplatin, generally used to treat cancer of the lung, head and neck, and Oxaliplatin, which is most often used to treat colorectal cancer.

As with any mesothelioma cancer drug, your doctor will decide whether or not Cisplatin is a beneficial option for treating your cancer.

Cancer Centers

2009-05-12T08:22:00.000-07:00

National

National Cancer Institute
National Institutes of Health
Bethesda, MD 20892
301-496-4000
800-4-CANCER
800-422-6237

Alabama

University of Alabama at Birmingham
Comprehensive Cancer Center
Basic Health Sciences Building
1824 Sixth Avenue South
237 T.I.
Birmingham, AL 35294-3300
205-934-5077

Arizona

University of Arizona Cancer Center
1501 North Campbell Avenue
Tucson, AZ 85724
520-626-7383

California

Jonsson Comprehensive Cancer Center at UCLA
Box 951781
Los Angeles, CA 90095-1781
800-825-2631
310-825-5268

USC/Norris Comprehensive Cancer Center
1441 Eastlake Avenue MS #83
Los Angeles, CA 90033-0800
323-865-0816

City of Hope National Medical Center
Beckman Research Institute
1500 East Duarte Road
East Duarte, CA 91010-3000
626-359-8111
Comprehensive Cancer Center

Salk Institute
Cancer Center
10010 North Torrey Pines Road
La Jolla, CA 92037
619-453-4100 x1386
Cancer Center

The Burnham Institute
10901 North Torrey Pines Road
La Jolla, CA 92037
619-455-6480 x3209
Cancer Center

University of California at Irvine
Cancer Center
Building #23 4th Floor
101 The City Drive
Orange, CA 92868
714-456-6310
Clinical Cancer Center

UCSF Stanford Health Care
300 Pasteur Drive
Stanford, CA 94305
650-723-4000

University of California at San
Diego Cancer Center
9500 Gilman Drive
La Jolla, CA 92093-0658
619-534-7600
Clinical Cancer Center

Colorado

University of Colorado Cancer Center
4200 East 9th Avenue
Denver, CO 80262
Clinical Cancer Center

Connecticut

Yale Comprehensive Cancer Center
Yale University School of Medicine
333 Cedar Street
New Haven, CT 06520-8028
203-785-4095

Florida

Sylvester Comprehensive Cancer Center
University of Miami Medical School
1475 Northwest 12th Avenue, Room 4023
Miami, FL 33136

H. Lee Moffitt Cancer Center
12902 Magnolia Drive
Tampa, FL 33612-9497
813-979-3050

Hawaii

Cancer Research Center of Hawaii
University of Hawaii at Manoa
1236 Lauhala Street
Honolulu, HI 96813
808-586-3013
Clinical Cancer Center

Illinois

Robert H. Lurie Cancer Center
Northwestern University
303 East Chicago Avenue
Olson Pavilion, Room 8250
Chicago, IL 60611
312-908-5250
Clinical Cancer Center

University of Chicago Cancer
Research Center
5841 South Maryland Avenue
Chicago, IL 60637
Clinical Cancer Center

Indiana

Purdue University Cancer Center
Hansen Life Sciences Research Building
South University Street
West Lafayette, IN 47907-1524
765-494-9129 Cancer Center

Maine

The Jackson Laboratory
600 Main Street
Bar Harbor, ME 04609-0800
207-288-6041
Cancer Center

Maryland

The Johns Hopkins Oncology Center
600 North Wolfe Street
Baltimore, MD 21287-8943
410-955-8822

Massachusetts

Center for Cancer Research
Massachusetts Institute of Technology
77 Massachusetts Avenue, Room E17-110
Cambridge, MA 02139-4307
617-253-6422
Cancer Center

Dana-Farber Cancer Institute
44 Binney Street
Boston, MA 02115
617-632-3000

Michigan

University of Michigan
Comprehensive Cancer Center
102 Observatory
Ann Arbor, MI 48109-0724
313-936-1831

Barbara Ann Karmanos
Cancer Institute
110 East Warren Avenue
Detroit, MI 48201
1-800-KARMANOS

Minnesota

University of Minnesota
Cancer Center
Box 806, 420 Delaware Street, S.E.
Minneapolis, MN 55455
612-624-8484
Comprehensive Cancer Center

Mayo Cancer Center
Mayo Foundation
200 First Street SW
Rochester, MN 55905
507-284-3753
Clinical Cancer Center

Nebraska

University of Nebraska Medical Center
Eppley Cancer Center
600 South 42nd Street
Omaha, NE
402-559-7081
Cancer Center

New Hampshire

Norris Cotton Cancer Center
Dartmouth-Hitchock Medical Center
One Medical Center Drive
Lebanon, NH 03756-0001
603-650-6300

New Jersey

The Cancer Institute of New Jersey
Robert Wood Johnson Medical School
195 Little Albany Street, Room 2002B
New Brunswick, New Jersey 08901
732-235-8064
Clinical Cancer Center

New York

Albert Einstein College of Medicine
Cancer Research Center
Chanin Building
1300 Morris Park Avenue
Bronx, NY 10461
718-430-2302
Cancer Center

American Health Foundation
320 East 43rd Street
New York, NY 10017
212-953-1900
Cancer Center

Cold Spring Harbor Laboratory
P.O. Box 100
Cold Spring Harbor, NY 11724
516-367-8383
Cancer Center

Herbert Irving
Comprehensive Cancer Center
College of Physicians and Surgeons
701 West 168th Street, Room 1509
New York, NY 10032
212-305-6921

Kaplan Cancer Center
New York University Medical Center
550 First Avenue
New York, NY 10016
212-263-5349
Clinical Cancer Center

Memorial Sloan-Kettering
Cancer Center
1275 York Avenue
New York, NY 10021
800-525-2225
212-639-6561

Roswell Park Cancer Institute
Elm and Carlton Streets
Buffalo, NY 14263-0001
213-845-5770
800-767-9355

University of Rochester Cancer Center
601 Elmwood Avenue
Rochester, NY 14642
716-275-6292
Clinical Cancer Center

Albert Einstein College of Medicine
Cancer Research Center
Chanin Building
1300 Morris Park Avenue
Bronx, NY 10461
718-430-2302

North Carolina

UNC Lineberger Comprehensive
Cancer Center
University of North Carolina
School of Medicine Chapel Hill
CB#7295
Chapel Hill, NC 27599-7295
919-966-3036

Duke Comprehensive Cancer Center
Duke University Medical Center
Box 3843
Durham, NC 27710
919-684-5613

Comprehensive Cancer Center of
Wake Forest University at Bowman
Gray School of Medicine
Medical Center Boulevard
Winston-Salem, NC 27157
336-716-7971

Ohio

Ohio State University
Comprehensive Cancer Center
Arthur G. James Cancer Hospital
300 West 10th Avenue
Columbus, OH 43210
614-293-4878

Case Western Reserve University
Cancer Research Center
11100 Euclid Avenue
Cleveland, OH 44106
Comprehensive Cancer Center

Oregon

Oregon Cancer Center
Oregon Health Sciences University
3181 S.W. Sam Jackson Park Road, L609
Portland, OR 97201-3098
503-464-1617
Clinical Cancer Center

Pennsylvania

Fox Chase Cancer Center
7701 Burholme Avenue
Philadelphia, PA 19111
215-728-3600

Wistar Institute Cancer Center
3601 Spruce Street
Philadelphia, PA 19104-4268
215-898-3926
Cancer Center

University of Pennsylvania Cancer Center
16 Penn Tower
3400 Spruce Street
Philadelphia, PA 19104
215-662-6334

University of Pittsburgh Cancer Institute
3471 5th Avenue
Pittsburgh, PA 15213-2592
412-692-4670

Kimmel Cancer Center
233 South 10th Street
Philadelphia, PA 19107
215-503-4645
Clinical Cancer Center

Jefferson Cancer Center
Thomas Jefferson University
233 South 10th Street
Philadelphia, PA 19107
215-503-4645

Tennessee

Vanderbilt Cancer Center
Vanderbilt University
649 Medical Research Building II
Nashville, TN 37232
800-811-8480
615-936-5847
Clinical Cancer Center

St. Jude Children's Research Hospital
332 North Lauderdale Street
Memphis, TN 38105
901-495-3300
Clinical Cancer Center

Texas

The University of Texas
M.D. Anderson Cancer Center
1515 Holcolmbe Boulevard
Houston, TX 77030
713-792-7500

San Antonio Cancer Institute
8122 Datapoint Drive, Suite 600
San Antonio, TX 78229
210-616-5580

Utah

Huntsman Cancer Institute
University of Utah Health
Sciences Center
15 North 2030 East, Room 2100
Salt Lake City, UT 84112
801-581-4048
801-581-4330
Clinical Cancer Center

Vermont

Vermont Regional Cancer Center
University of Vermont
Medical Alumni Building
Burlington, VT 05405-0068
802-656-4414

Virginia

Cancer Center
University of Virginia Health
Sciences Center
Box 334
Charlottesville, VA 22908
804-924-2562
Clinical Cancer Center

Massey Cancer Center
Medical College of Virginia
401 College Street
Richmond, VA 23298
804-828-0450
Clinical Cancer Center

Washington

Fred Hutchinson Cancer Research Center
1100 Fairview Avenue
P.O. Box 19024
Seattle, WA 98109-1024
206-667-5000

University of Washington
Academic Medical Center
Seattle, WA

Washington, D.C.

Lombardi Cancer Research Center
Georgetown University Medical Center
3800 Reservoir Road NW
Washington, DC 20007
202-687-2110

Wisconsin

McArdle Laboratory for Cancer Research
University of Wisconsin
1400 University Avenue, Room 1009
Madison, WI 53706-1599
608-262-2177
Cancer Center

University of Wisconsin
Comprehensive Cancer Center
600 Highland Avenue
Madison, WI 53792-0001
608-263-8600

Mesothelioma Treatment

2009-05-12T08:18:00.000-07:00

Treatment of malignant mesothelioma using conventional therapies in combination with radiation and or chemotherapy on stage I or II Mesothelioma have proved on average 74.6 percent successful in extending the patients life span by five years or more [commonly known as remission][this percentage may increase or decrease depending on date of discovery / stage of malignant development] (Oncology Today, 2009). Treatment course is primarily determined by the staging or development. This is unlike traditional treatment such as surgery by itself which has proved only be 16.3 percent likely to extend a patient's life span by five years or more [commonly known as remission]. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.

Surgery

Surgery, by itself, has proved disappointing. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008) A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.

Radiation

For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.[14] Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.

Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.

Chemotherapy

Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery.[15] This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.

Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.

In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.

Immunotherapy

Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.

Heated Intraoperative Intraperitoneal Chemotherapy

A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.[17] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.

This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

Mesothelioma Epidemiology

2009-05-12T08:15:00.000-07:00

Incidence

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States. Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.

Risk factors

Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.

Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.

The combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer, bronchial carcinoma). The Kent brand of cigarettes used asbestos in its filters for the first few years of production in the 1950s and some cases of mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.

Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.

Exposure

Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villages in Turkey have death rates of 51% attributed to erionite related mesothelioma.[citation needed]

Occupational

Exposure to asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.

The documented presence of asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.

Commercial asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.

Paraoccupational secondary exposure

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos related diseases.[citation needed] This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

Asbestos in buildings

Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.

Environmental exposures

Incidence of mesothelioma had been found to be higher in populations living near naturally occurring asbestos. For example, in Cappadocia, Turkey, an unprecedented mesothelioma epidemic caused 50% of all deaths in three small villages. Initially, this was attributed to erionite, however, recently, it has been shown that erionite causes mesothelioma mostly in families with a genetic predisposition.

Mesothelioma Pathophysiology

2009-05-12T08:11:00.000-07:00

The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibres in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fibre can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibres from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibres may be deposited in the gut after ingestion of sputum contaminated with asbestos fibres.

Pleural contamination with asbestos or other mineral fibres has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers). However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.fibres.

Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibres. It has been suggested that in humans, transport of fibres to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localised lesions of accumulated asbestos fibres in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumour.

Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibres remain unclear despite the demonstration of its oncogenic capabilities. However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibres has not yet been achieved. In general, asbestos fibres are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.

Analysis of the interactions between asbestos fibres and DNA has shown that phagocytosed fibres are able to make contact with chromosomes, often adhering to the chromatin fibres or becoming entangled within the chromosome. This contact between the asbestos fibre and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.

Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:

* Neurofibromatosis type 2 at 22q12
* P16INK4A
* P14ARF

Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:

* Inactivation of tumor suppressor genes
* Activation of oncogenes
* Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
* Activation of DNA repair enzymes, which may be prone to error
* Activation of telomerase
* Prevention of apoptosis

Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.

Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos

Mesothelioma: Questions and Answers

2009-05-12T08:08:00.000-07:00

Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the mesothelium, a protective sac that covers most of the body's internal organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles.

1. What is the mesothelium?

The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs) to glide easily against adjacent structures.

The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.

2. What is mesothelioma?

Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.

3. How common is mesothelioma?

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.

4. What are the risk factors for mesothelioma?

Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.

Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.

5. Who is at increased risk for developing mesothelioma?

Asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.

The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.

There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

6. What are the symptoms of mesothelioma?

Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.

7. How is mesothelioma diagnosed?

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.

A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.

Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.

8. How is mesothelioma treated?

Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.

* Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.

* Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

* Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).

To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.

9. Are new treatments for mesothelioma being studied?

Yes. Because mesothelioma is very hard to control, the National Cancer Institute (NCI) is sponsoring clinical trials (research studies with people) that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is an important treatment option for many patients with mesothelioma.

People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the Cancer Information Service (CIS) (see below) at 1–800–4–CANCER. Information specialists at the CIS use PDQ®, NCI's cancer information database, to identify and provide detailed information about specific ongoing clinical trials. Patients also have the option of searching for clinical trials on their own. The clinical trials page on the NCI's Cancer.gov Web site, located at http://www.cancer.gov/clinicaltrials on the Internet, provides general information about clinical trials and links to PDQ.

People considering clinical trials may be interested in the NCI booklet Taking Part in Cancer Treatment Research Studies. This booklet describes how research studies are carried out and explains their possible benefits and risks. The booklet is available by calling the CIS, or from the NCI Publications Locator Web site at http://www.cancer.gov/publications on the Internet.

Related NCI materials and Web pages:

* National Cancer Institute Fact Sheet 3.21, Asbestos Exposure: Questions and Answers
(http://www.cancer.gov/cancertopics/factsheet/Risk/asbestos)
* Clinical Trials Home Page
(http://www.cancer.gov/clinicaltrials)
* Malignant Mesothelioma Home Page (http://www.cancer.gov/cancertopics/types/malignantmesothelioma)
* Taking Part in Cancer Treatment Research Studies
(http://www.cancer.gov/clinicaltrials/Taking-Part-in-Cancer-Treatment-Research-Studies)

Mesothelioma

2009-05-12T07:59:00.000-07:00

Mesothelioma is a form of cancer that is almost always caused by exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart, the pericardium (a sac that surrounds the heart) or tunica vaginalis.

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing mesothelioma. Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases risk of other asbestos induced cancer. Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law).

The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.

Signs and symptoms
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions.

Mesothelioma that affects the pleura can cause these signs and symptoms:

* chest wall pain
* pleural effusion, or fluid surrounding the lung
* shortness of breath
* fatigue or anemia
* wheezing, hoarseness, or cough
* blood in the sputum (fluid) coughed up (hemoptysis)

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

* abdominal pain
* ascites, or an abnormal buildup of fluid in the abdomen
* a mass in the abdomen
* problems with bowel function
* weight loss

In severe cases of the disease, the following signs and symptoms may be present:

* blood clots in the veins, which may cause thrombophlebitis
* disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
* jaundice, or yellowing of the eyes and skin
* low blood sugar level
* pleural effusion
* pulmonary emboli, or blood clots in the arteries of the lungs
* severe ascites

A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.

VIETNAM MEDI-PHARM EXPO 2009

2009-05-09T16:01:00.000-07:00

16th Vietnam International Medical and Pharmaceutical Exhibition
“VIETNAM MEDI-PHARM EXPO 2009”

Dear Sir/ Madam,

Aiming at introducing new achievements of science and technology in Medi-Pharm field, Vietnam Pharmaceutical Companies Association (VNPCA) in cooperation with Vietnam Medical Equipment Association and Vietnam National Trade Fair and Advertising Company (VINEXAD) – Ministry of Industry and Trade to organize successfully International Medical and Pharmaceutical Exhibitions in Hanoi. These annual exhibitions have attracted huge participation of local and foreign medical and pharmaceutical Enterprises.

VIETNAM MEDI-PHARM EXPO 2009 will be held in Hanoi from 2 – 5 December, 2009. With the purpose of best serving community healthcare and preventing deseases, the exhibition will showcase the most advanced and latest medical and pharmaceutical products of high quality from Vietnam and other parts of the world. This is also an actual activity when Vietnam is an official member of WORLD TRADE ORGANIZATION (WTO), the interchange of information, science, technology and mommodities more and more developed.
The Ministry of Health welcomes the active participation and support of all medical and pharmaceutical Enterprises from Vietnam and foreign countries in this exhibition.

I wish VIETNAM MEDI-PHARM EXPO 2009 brilliant success.

Yours faithfully,

SAIGON MEDI PHARM EXPO 2009

2009-05-09T15:58:00.000-07:00

From Minister of Health to medical & pharmaceutical companies
Participate in SAIGON MEDI-PHARM EXPO 2008

Dear Sir/ Madam,

On behalf of the Minsitry of Health of Vietnam, I warmly welcome all medical and pharmaceutical companies participate in the 9th International Medical and Pharmaceutical Exhibition in Ho Chi Minh City - SAIGON MEDI PHARM EXPO 2009 from 19 – 22 August, 2009 at Ho Chi Minh City International Exhibition & Convention Centre (HIECC), 446 Hoang Van Thu Str., Tan Binh Dist., Ho Chi Minh City, Vietnam.

SAIGON MEDI-PHARM EXPO 2009 with the participation of hundreds local and foreign Groups, Enterprises will showcase advancements and latest achievements in medical and pharmaceutical fields; modern medicines, medical, laboratory, technology and science products; healthcare and treatment services… This is a golden opportunity for professionals, specialists and businessmen to meet, exchange experiences, introduce products and services, extend international relationship, access hi tech facilities in order to apply latest achievements in examination, treatment and protection of people’s health.
Ministry of Health of Vietnam highly appreciates all participants in this event and well note the endeavour of VIMEDIMEX MEDI-PHARMA JSC and VIETNAM NATIONAL TRADE FAIR & ADVERTISING COMPANY (VINEXAD) to make SAIGON MEDI-PHARM EXPO become a prestiged and specialized exhibition, contribute to push up manufacturing and dealing activities and the development of healthcare course in Vietnam.

I wish the exhibition great success and exhibitors fruitful results through the exhibition.

Yours faithfully,

.

Zoladex

2009-05-08T09:33:00.000-07:00

Brand name: Zoladex
Generic name: Goserelin acetate

Why is Zoladex prescribed?
Zoladex relieves the symptoms of advanced prostate cancer in men and advanced breast cancer in premenopausal women. In combination with other forms of therapy, it is also prescribed during treatment of early prostate cancer.

In addition, it can be used in the treatment of endometriosis, a condition in which tissue from the lining of the uterus invades the abdomen. If you are scheduled for surgical removal of the lining, the drug may be used to thin the lining prior to the operation.

Zoladex works by reducing levels of testosterone in men and estrogen in women. These hormones can encourage the growth of certain cancers.

Most important fact about Zoladex
Symptoms may actually get worse during the first few weeks of therapy. However, as hormone levels subside, you should begin to feel an improvement.

How should you take Zoladex?
Doses are implanted under the skin of the upper abdomen every 4 or 12 weeks by your physician or a nurse.

* If you miss a dose...
Make an appointment as soon as possible.

What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using Zoladex.

* Side effects may include:
Acne, application site reactions, breast development in men or enlargement in women, breast tenderness or pain, change in sex-drive, depression, dizziness, emotional problems, flu symptoms, fluid retention and swelling, hair growth in women, headache, hot flashes, infection, insomnia, lethargy, loss of appetite, loss of breast tissue in women, lung problems, nausea, nervousness, pain, rash, sexual impairment, sore throat, sweating, urinary problems, vaginal dryness, vaginal inflammation, voice changes, weak heart, weakness, weight gain

Why should Zoladex not be prescribed?
If Zoladex gives you an allergic reaction, it cannot be used. It should also be avoided during pregnancy and breastfeeding, and if you have unexplained abnormal vaginal bleeding. Women of childbearing age should use nonhormonal contraceptive measures while taking Zoladex.

Special warnings about Zoladex
Zoladex therapy can weaken the bones and cause bone pain. In men under treatment for prostate cancer, it has been known to cause osteoporosis and fractures. If you are a heavy drinker, smoke a lot, have family members with brittle bones, or take anticonvulsant drugs or steroids (such as prednisone), make sure your doctor is aware of the situation.

Men with a blockage in the tube from the kidney to the bladder (the ureter) or a case of spinal cord compression should get treatment for these conditions before beginning Zoladex therapy.

Severe allergic reactions, including hives and swelling of the lips and throat, have been reported with drugs similar to Zoladex. If these symptoms occur, call your doctor immediately.

When given with sex hormones, Zoladex may lead to overstimulation of the ovaries. It has also been known to cause ovarian cysts.

Women should remember that even though Zoladex stops menstruation, it is possible to become pregnant if you miss a dose. Since Zoladex could harm the developing baby, it's important to observe strict contraceptive precautions throughout Zoladex therapy.

If you are taking Zoladex to relieve endometriosis, your doctor may recommend hormone-replacement therapy to limit the effects of the reduced estrogen levels that result from Zoladex therapy.

Possible food and drug interactions when taking Zoladex
No interactions have been reported.

Special information if you are pregnant or breastfeeding
Zoladex can harm developing babies and newborn infants. It must not be used during pregnancy or breastfeeding.

Recommended dosage for Zoladex
Typically, the doctor will implant a dose of 3.6 milligrams every 4 weeks. Treatment for endometriosis lasts no longer than 6 months. Cancer therapy generally continues for a longer term.

For prostate cancer, the doctor can administer a longer lasting implant of 10.8 milligrams every 12 weeks. When the drug is given with flutamide, the treatment is one 3.6-millgram implant followed by one 10.8-milligram implant 4 weeks later.

If the drug is being used in preparation for endometrial surgery, you'll receive 1 or 2 implants before the operation.

Overdosage
An overdose of Zoladex is highly unlikely, and if one were to occur, it would not cause any harm.

---Collected---

What Are the Risk Factors for Bladder Cancer?

2009-05-08T09:27:00.000-07:00

A risk factor is anything that changes your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers, including lung and bladder cancer. But risk factors don't tell us everything. Having a risk factor, or even several, does not mean that you will get the disease.

Many people with one or more risk factors never develop bladder cancer, while others with this disease have no known risk factors. It is important, however, to know about risk factors so that a person can take appropriate actions such as changing a health behavior or being monitored closely for a potential cancer. Because the bladder is the final exit from the body for many chemicals, these are the major risk factors for bladder cancer.

Smoking

The greatest risk factor for bladder cancer is smoking. Smokers are more than twice as likely to get bladder cancer as nonsmokers. Smoking causes about half of the deaths from bladder cancer among men (48%) and almost a third of bladder cancer deaths in women (28%). Some of the carcinogens (cancer-causing chemicals) in tobacco smoke are absorbed from the lungs and get into the blood. From the blood, they are filtered by the kidneys and concentrated in urine. These chemicals in urine damage the cells that line the inside of the bladder. This damage increases the chance of cancer developing.

Workplace exposures

Certain industrial chemicals have been linked with bladder cancer. Chemicals called aromatic amines, such as benzidine and beta-naphthylamine, which are sometimes used in the dye industry, can cause bladder cancer.

Other industries that use certain organic chemicals also may put workers at risk for bladder cancer if exposure is not limited by good workplace safety practices. The industries carrying highest risks include the makers of rubber, leather, textiles, and paint products as well as printing companies. Other workers with an increased risk of developing bladder cancer include painters, hairdressers, machinists, printers, and truck drivers (these because of exposure to diesel fumes).

Cigarette smoking and workplace exposures may act together to cause bladder cancer. Also, smokers who work with the cancer-causing chemicals noted above have an especially high risk of developing bladder cancer.

Race

Whites are about twice as likely to develop bladder cancer as African Americans and Hispanics. The reason for this difference is not well understood. Asians have the lowest incidence of bladder cancer.

Age

The risk of bladder cancer increases with age. Over 70% of people with bladder cancer are older than 65 years old.

Gender

Men get bladder cancer at a rate 4 times greater than women.

Chronic bladder inflammation

Urinary infections, kidney and bladder stones, and other causes of chronic bladder irritation have been linked with bladder cancer (especially squamous cell carcinoma of the bladder), but they do not necessarily cause bladder cancer. Schistosomiasis (also known as bilharziasis), an infection with a parasitic worm called Schistosoma hematobium that can get into the bladder, is also a risk factor for bladder cancer. In countries where this parasite is common, squamous cell cancers of the bladder are seen much more often. This parasite is an extremely rare cause of bladder cancer in the United States.

Personal history of bladder cancer

Urothelial carcinomas can form in many areas in the bladder as well as in the lining of the kidney, the ureters, and urethra. Having a cancer in any part of the urinary tract lining puts you at higher risk of forming another tumor. The tumor can form in the same area as before, or in another part of the urothelium (lining). This is true even when the first tumor is completely removed. For this reason, people who have had bladder cancer need close, routine medical follow-up.

Bladder birth defects

Before birth, there is a connection between the belly button and the bladder. This connection, called the urachus, normally disappears before birth. If part of this connection remains after birth, it could become cancerous. Cancers that start in the urachus are usually made up of malignant gland cells and are adenocarcinomas. Cancer starting in this way is rare, causing less than a half of 1% of bladder cancers. However, it does represent about one third of the adenocarcinomas of the bladder, which are also rare.

There is another rare birth defect called exstrophy, which greatly (about 400-fold) increases a person's risk of developing bladder cancer. In exstrophy, the skin, muscle, and connective tissue in front of the bladder fail to close completely so that there is a hole or defect in the wall of the abdomen. This leaves the inside of the bladder exposed to chronic infection, which may eventually lead to formation of an adenocarcinoma of the bladder.

Genetics

People who have family members with bladder cancer have an increased risk of getting it themselves. In some cases, these family members were all exposed to the same cancer- causing chemical. Another factor may be that their bodies are slow to break down toxins. This is determined by certain genes they inherit (like GST and NAT). People who inherit versions of these genes that lead to slow breaking down of chemicals are more likely to develop bladder cancer.

Bladder cancer does seem to run in some families. For a small number of people, this is because they inherited a gene syndrome, for example:

A mutation of the retinoblastoma (Rb1) gene can cause cancer of the eye in infants, and also increases the risk of bladder cancer.

Cowden disease, caused by mutations in a gene called PTEN, is linked to cancers of the breast and thyroid. People with this disease also have a higher risk of bladder cancer.

Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome (also known as Lynch syndrome) is mainly linked to colon and endometrial cancer. People with this syndrome also have an increased risk of bladder cancer.

Chemotherapy and radiation therapy

High doses of the chemotherapy drug cyclophosphamide (Cytoxan) or ifosfamide (Ifex) increase the risk of bladder cancer. A drug called mesna can be used with these drugs to protect the bladder from irritation and decrease the risk of bladder cancer.

People who are treated with radiation to the pelvis are more likely to develop bladder cancer.

Arsenic

Arsenic in drinking water has been associated with an increased risk of bladder cancer. The chance of being exposed to arsenic depends on where you live and whether you get your water from a well or from a system that meets the standards for arsenic content.

Low fluid consumption

Not drinking enough fluids increases the risk of bladder cancer. People who drink a lot of fluids each day have a lower rate of bladder cancer. This is thought to be because they empty their bladders often. By doing this, they keep chemicals from lingering in their bodies.

Last Medical Review: 01/27/2009
Last Revised: 01/27/2009

Source: ACS

More information of H1N1 Flu (Swine Flu)

2009-05-08T09:19:00.000-07:00

What should you know about H1N1 Flu?
H1N1 Flu is a respiratory disease caused by type A inuenza viruses. The Centers for Disease Control and Prevention (CDC) has determined that the new H1N1 Flu cases are caused by an inuenza strain called H1N1, which appears to be easily transmitted from person to person. The most common method of transmission is airborne, and it is also possible to become infected by touching a surface with the virus on it and then touching one's mouth or nose. The CDC is advising people to wash their hands frequently, and also to avoid surfaces that might be contaminated.
Please note that the country’s food supply is not impacted by the swine u investigation, according to the U.S.
Department of Agriculture and the CDC. H1N1 Flu viruses are not transmitted by food and cannot be caught by eating properly cooked pork products.

What symptoms should you watch for?
If you develop u-like symptoms, such as fever, body aches, runny nose, sore throat, nausea, vomiting, or diarrhea, you should seek attention from your health care provider.

Emergency warning signs:
If you become ill and experience any of the following warning signs, seek emergency medical care.
In children, emergency warning signs that need urgent medical attention include:
• Fast breathing or difficulty breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
In adults, emergency warning signs that need urgent medical attention include:
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough

How can you protect yourself and your family?
Currently, there is no vaccine available to protect against H1N1 Flu. There are, however, everyday steps to help protect your health:
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash
immediately after using.
• Wash your hands frequently using soap and warm water, especially after you cough or sneeze.
Alcohol-based hand cleaners or sanitizers are also eective.
• Avoid touching your eyes, nose or mouth.
• Avoid close contact with people who are ill.
• If you do get sick with inuenza, stay home from work or school and limit contact with others to keep
from infecting them.

Where can I get more information?
Centers for Disease Control and Prevention: http://www.cdc.gov/swineu/
U.S. Department of Health & Human Services: http://www.hhs.gov/
World Health Organization: http://www.who.int/csr/disease/swineu/en/index.html

Safer Sex

2009-05-06T20:30:00.000-07:00

The reason why sexual activity is a risk for HIV transmission is because it allows for the exchange of body fluids. Researchers have consistently found that HIV can be transmitted via blood, semen and vaginal secretions. However, researchers have also confirmed that some sexual practices are associated with a higher risk of HIV transmission than others.

I believe everybody-regardless of their HIV status-should enjoy sex to the fullest. Though the facts about HIV transmission are the same for HIV positive and HIV negative men and women, even the tiniest bit of misunderstanding about how HIV is (and isn't) spread can lead to a lot of confusion when it comes to making important decisions about safer sex.

There are a few basic facts to consider:

Abstinence is the only 100-percent way to avoid HIV and other sexually transmitted infections.
If you have a partner who has tested negative for HIV, does not inject drugs and is having sexual contact only with you, there is minimal risk of being infected with the virus.
Being infected with a sexually transmitted infection (STI) can increase an HIV-positive person's chance of transmitting HIV, just as it can increase an HIV-negative person's chance of acquiring HIV.
An HIV-positive person with a detectable viral load is more infectious-more likely to transmit the virus to somebody else-that an HIV-positive person who is receiving antiretroviral treatment and has an undetectable viral load.
Safer sex practices, including correct and consistent use of condoms for vaginal or anal sex, can reduce the spread of HIV and other STIs.
Getting intoxicated or high on drugs, including alcohol, can impair judgment and cause people to forget to take care of themselves-or their sexual partners.
Safer sex is not just about vaginal, anal or oral intercourse. Masturbation (alone or with someone else), body rubbing, erotic massage and kissing-they're all fun, no-risk activities.

How is HIV Transmitted?

2009-05-06T20:28:00.000-07:00

HIV enters the body through open cuts, sores or breaks in the skin; through mucous membranes, such as those inside the anus or vagina; or through direct injection. There are several ways by which this can happen:

Sexual contact with an infected person. Anal or vaginal intercourse without a condom with a partner who is either positive or does not know his or her HIV status account for the vast majority of sexually-transmitted HIV cases in the U.S. and elsewhere. Oral sex is not an efficient route of HIV transmission, but it can happen. Kissing, massage, masturbation and "hand jobs" do not spread HIV.
Sharing needles, syringes or other injection equipment with someone who is infected.
Mother-to-child transmission. Babies born to HIV-positive women can be infected with the virus before or during birth, or through breastfeeding after birth.
Transmission in health care settings. Healthcare professionals have been infected with HIV in the workplace, usually after being stuck with needles or sharp objects containing HIV-infected blood. As for HIV-positive healthcare providers infecting their patients, there have only been six documented cases, all involving the same HIV-positive dentist in the 1980s.
Transmission via donated blood or blood clotting factors. However, this is now very rare in countries where blood is screened for HIV antibodies, including in the United States.

HIV has been detected in saliva, tears and urine. However, HIV in these fluids is only found in extremely low concentrations. What's more, there hasn't been a single case of HIV transmission through these fluids reported. HIV cannot be transmitted through day-to-day activities such as shaking hands, hugging or casual kissing. You cannot become infected from a toilet seat, drinking fountain, or sharing food or eating utensils with someone who is positive. You also cannot get HIV from mosquitoes.

Since the beginning of the HIV/AIDS epidemic, new or potentially unknown routes of transmission have been thoroughly investigated by state and local health departments, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC). To date, no additional routes of transmission have been recorded, despite a national system designed to detect unusual cases.

---Source: POZ---

Radiation Therapy

2009-05-06T20:22:00.000-07:00

What do you think of when you hear the word radiation? Do you think of getting X-rays of your teeth or a broken bone? Or do you think of something dangerous? Radiation is tricky to understand because you can't see it. It's a process in which energy is given off in the form of particles or rays. For example, the sun emits a kind of radiation.

Radiation is everywhere - in soil, water, food, building materials, and even our own bodies. Too much of it can be harmful, but in the right amounts, radiation has many uses. It can be used to make X-rays, create electricity, and even power submarines. And radiation can also be used to help people with cancer.

Radiation therapy (say: ray-dee-ay-shun ther-ah-pee) is one form of treatment for kids or adults who have cancer. Both adults and kids can get cancer, but kids don't get it very often. Cancer is a disease that causes normal cells in the body to grow out of control. If left untreated, these cells can grow throughout the body, making the person very sick. Radiation therapy kills cancer cells and keeps them from growing and multiplying. The fewer cancer cells, the better, because then a person can start feeling well again.

How Is Radiation Given?

Cancer can be treated with radiation therapy alone or in combination with chemotherapy or surgery. Chemotherapy (say: kee-mo-ther-uh-pee) is a treatment that uses medicine to destroy cancer cells. Some people may first have surgery to remove cancer cells or tumors and then have radiation therapy. Each person's treatment depends on the kind of cancer they have.

A doctor called an oncologist (say: on-kah-loh-jist) will make the decision about whether radiation therapy is best for the patient. Sometimes people stay in the hospital to get radiation therapy, but in most cases, the patient comes to the hospital or doctor's office for treatment and goes home afterward.

Radiation therapy can be given in two ways. A person may receive radiation directed to the outside of the body called external radiation. Or a person may receive radiation therapy that places the radiation inside the body, which is called internal radiation therapy (putting radioactive material directly in the tumor). Some people may receive both types of radiation therapy, but internal radiation is rarely used to treat the kinds of cancer kids get.

What Happens During Radiation Therapy?

Because the radiation treatment needs to be just right, the patient must go through a simulation first. During this process, the person lies on an X-ray table while the radiation therapist uses a special machine called a simulator to define the treatment area. When the therapist knows exactly which area of the body will get the radiation treatment, he or she marks it with ink. This "tattoo" should not be wiped off because these spots help to position the radiation for each treatment.

At each appointment, a large machine is positioned to deliver the exact amount of radiation necessary to kill the cells. It usually takes only a few minutes for a person to receive the daily dose of radiation. During a radiation treatment, a person has to lie still.

People who are having external radiation therapy usually visit the hospital on weekdays for several weeks. These doses of radiation are small, but they are strong enough to kill cancer cells. The radiation also can damage normal cells. Weekend breaks from radiation treatments give normal cells a chance to recover and let new, healthy cells grow.

How Does Radiation Therapy Make a Person Feel?

Getting a radiation treatment doesn't hurt and you do not see, smell, or feel the radiation. But these treatments can cause some temporary health problems called side effects. The kinds of side effects experienced by the patient depend on the location of the radiation and the dose, or how much radiation the patient receives. Common side effects include hair loss, rash, nausea, vomiting, and diarrhea. All of these side effects get better as the effects of the radiation wear off.

For a kid getting radiation therapy, it's normal to feel a little nervous. One important thing to remember is that a kid's parents will be there to help. Also, doctors, nurses, and other health care workers can answer questions and help patients feel comfortable. It's a good idea to visit the center where the treatment will be done, so the patient can see the place and meet the people who work there. Here are some more tips to help a person feel better during treatment:

Get plenty of sleep.
Try to eat healthy meals and drink plenty of fluids.
Ask the doctor about medicine to help with nausea and stomach upset.
Keep affected skin protected from the sun and ask about getting a special cream if a rash develops.

After the radiation treatments, patients visit the doctor for follow-up care. In many cases, the person will be well on the way to being cancer free.

Reviewed by: Maureen F. Edelson, MD
Date reviewed: February 2007

Influenza A virus subtype H1N1

2009-05-06T20:14:00.000-07:00

Influenza A virus subtype H1N1, also known as A(H1N1), is a subtype of influenzavirus A and the most common cause of influenza (flu) in humans. Some strains of H1N1 are endemic in humans, including the strain(s) responsible for the 1918 flu pandemic which killed 50–100 million people worldwide. Less virulent H1N1 strains still exist in the wild today, worldwide, causing a small fraction of all influenza-like illness and a large fraction of all seasonal influenza. H1N1 strains caused roughly half of all flu infections in 2006. Other strains of H1N1 are endemic in pigs and in birds.

In March and April 2009, hundreds of laboratory-confirmed infections and a number of deaths were caused by an outbreak of a new strain of H1N1.

Nomenclature

The various types of influenza viruses in humans. Solid squares show the appearance of a new strain, causing recurring influenza pandemics. Broken lines indicate uncertain strain identifications.

Influenza A virus strains are categorized according to two proteins found on the surface of the virus: hemagglutinin (H) and neuraminidase (N). All influenza A viruses contain hemagglutinin and neuraminidase, but the structure of these proteins differs from strain to strain due to rapid genetic mutation in the viral genome.

Influenza A virus strains are assigned an H number and an N number based on which forms of these two proteins the strain contains. There are 16 H and 9 N subtypes known in birds, but only H 1, 2 and 3, and N 1 and 2 are commonly found in humans.

Spanish flu

The Spanish flu, also known as La Gripe Española, or La Pesadilla, was an unusually severe and deadly strain of avian influenza, a viral infectious disease, that killed some 50 million to 100 million people worldwide over about a year in 1918 and 1919. It is thought to be one of the most deadly pandemics in human history. It was caused by the H1N1 type of influenza virus.

The Spanish flu caused an unusual number of deaths because it may have caused a cytokine storm in the body. (The recent epidemic of bird flu, also an Influenza A virus, had a similar effect.) The Spanish flu virus infected lung cells, leading to overstimulation of the immune system via release of cytokines into the lung tissue. This leads to extensive leukocyte migration towards the lungs, causing destruction of lung tissue and secretion of liquid into the organ. This makes it difficult for the patient to breathe. In contrast to other pandemics, which mostly kill the old and the very young, the 1918 pandemic killed unusual numbers of young adults, which may have been due to their healthy immune systems being able to mount a very strong and damaging response to the infection.

The term "Spanish" flu was coined because Spain was at the time the only European country where the press were printing reports of the outbreak, which had killed thousands in the armies fighting the First World War. Other countries suppressed the news in order to protect morale.

Russian flu

The more recent Russian flu was a 1977–1978 flu epidemic caused by strain Influenza A/USSR/90/77 (H1N1). It infected mostly children and young adults under 23 because a similar strain was prevalent in 1947–57, causing most adults to have substantial immunity. Some have called it a flu pandemic but because it only affected the young it is not considered a true pandemic. The virus was included in the 1978–1979 influenza vaccine.

North American flu

In the 2009 swine flu outbreak, the virus isolated from patients in the United States was found to be made up of genetic elements from four different flu viruses – North American Mexican influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe – "an unusually mongrelised mix of genetic sequences." This new strain appears to be a result of reassortment of human influenza and swine influenza viruses, in all four different strains of subtype H1N1. However, as the virus has not yet been isolated in animals to date and also for historical naming reasons, the World Organisation for Animal Health (OIE) suggests it be called "North-American influenza".
On April 30, 2009 the World Health Organization began referring to the outbreak as "Influenza A" instead of "swine flu"., and later began referring to it as "Influenza A(H1N1)". Several complete genome sequences for U.S. flu cases were rapidly made available through the Global Initiative on Sharing Avian Influenza Data (GISAID). Preliminary genetic characterization found that the hemagglutinin (HA) gene was similar to that of swine flu viruses present in U.S. pigs since 1999, but the neuraminidase (NA) and matrix protein (M) genes resembled versions present in European swine flu isolates. The six genes from American swine flu are themselves mixtures of swine flu, bird flu, and human flu viruses.[19][20] While viruses with this genetic makeup had not previously been found to be circulating in humans or pigs, there is no formal national surveillance system to determine what viruses are circulating in pigs in the U.S.

---Wikipedia---

1918 Influenza A (H1N1) Fact Sheet

2009-05-06T20:07:00.001-07:00

Quick Facts

Agent Type: Virus
Lethality: Low
Transmission: Highly contagious
Treatment: Oseltamivir (Tamiflu), zanamivir (Relenza), amantadine, and rimantadine antivirals, vaccine
Status: Select Agent
Delivery: Inhalation

The "Spanish" flu pandemic of 1918 and 1919 caused the deaths of 20-50 million people worldwide including up to 675,000 in the U.S. While only about 1% of those infected with the virus died, it became one of the deadliest viruses ever known to man. The 1918 flu has been described as capable of sickening and killing a person on the same day. The virus is an H1N1 type A influenza. Symptoms of infection were similar to, but more severe than typical, seasonal flu. Viral pneumonia leading to acute respiratory distress was the primary cause of death. Recently, the virus was reconstituted from frozen tissue samples from a woman who died from the virus.

History:

Unlike seasonal flu, where most deaths are seen in the elderly and children under 2-years-old, almost half of the deaths associated with the 1918 pandemic were in adults between 20 and 40-years-old. Scientists theorize that this could be because people over the age of 40 had previously been exposed to a similar flu that gave them some immunity. As the 1918 flu spread through the United States, public gatherings were reduced to prevent infections since doctors had no way to fight the infections.

However, the virus was able to cross the ocean with troops arriving to fight in Europe during World War I. Foreign troops soon became exposed to the virus and carried it back to their home countries starting new waves of infection.

Spanish Flu?:

Although it is not known where the 1918 flu virus began infecting humans and transmitting from person-to-person, the U.S. experienced its first wave of illness in the spring of 1918. It was dubbed the “Spanish” flu because Spanish newspapers published many reports of the pandemic while publications from nations involved in the World War I refrained. Some scientists think the “Spanish” flu designation might have been in error because of reports of it cropping up outside of the region before it affected the Spanish population. It is still unclear where the virus and the pandemic originated.

Reconstituted Virus:

When the 1918 flu disappeared, no samples of the virus were retained for scientific study. In 1997, however, scientists recovered fragments of the virus’s RNA genome from the preserved remains of infected people. The genome of the flu virus is composed of 8 RNA segments. Recently, scientists were able to remake 1918 flu using a technique called reverse genetics. They started by making DNA copies of the virus genome segments because DNA is easier to manipulate in the lab than RNA. Each of those copies was then placed into a larger piece of circular DNA called a plasmid. Those eight DNA circles are then put into an animal cell. The animal cell produces the proteins that correspond to the 8 segments which then form the flu virus. The technique also allows scientists to selectively manipulate individual parts of the virus when doing experiments.

Mechanism:

Flu strains are named for the H and N proteins, hemagglutinin and neuraminidase, which stick out from the surface of the virus like spikes. These protein spikes allow influenza to infect and damage cells and are what the immune system recognizes. The hemagglutinin spike allows the virus to bind to and enter cells. After co-opting the cells molecular machinery to produce more viruses, the neuraminidase spike is used to escape the cell, destroying it in the process. The 1918 influenza is an H1N1 strain and research on the reconstituted virus shows that it was particularly infective and had the unusual property of being able to infect mice, which typical human influenza strains cannot.

Treatment:

During the 1918 pandemic doctors did not have vaccines, antivirals, or antibiotics to treat or prevent infections and associated complications. Since then, four drugs have been developed to fight influenza infections; amantadine, rimantadine, oseltamivir (Tamiflu) and zanamivir (Relenza). Tamiflu and amantadine have both been shown to be effective against engineered viruses containing the parts of the 1918 flu and vaccines have also protected mice against viruses with some of the 1918 influenza components. However, it is still unclear whether drugs or vaccines would be effective against the fully reconstituted 1918 influenza virus. Currently, the U.S. only has 2.5 million doses of Tamiflu in its stockpile, raising concerns that we have not adequately prepared for a potential pandemic caused by avian H5N1 influenza.

---Sources: WHO, CDC, NIAID, NIH, HHS---

Who Gets Cancer?

2009-05-06T10:43:00.001-07:00

Over one million people get cancer each year. About 1 out of every 2 American men and 1 out of every 3 American women will have some type of cancer at some point during their lifetime. Anyone can get cancer at any age; but about 77% of all cancers are diagnosed in people age of 55 and older. Cancer can be found in Americans of all racial and ethnic groups, but the rate of cancer occurrence (called the incidence rate) varies from group to group.

Today, millions of people are living with cancer or have been cured of the disease. The sooner a cancer is found and the sooner treatment begins, the better a patient's chances are of a cure. That's why early detection of cancer is such an important weapon in the fight against cancer.

Last Medical Review: 02/24/2009
Last Revised: 02/24/2009

--ACS--

What Is Cancer?

2009-05-06T10:35:00.000-07:00

Defining Cancer

Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems.

Cancer is not just one disease but many diseases. There are more than 100 different types of cancer. Most cancers are named for the organ or type of cell in which they start - for example, cancer that begins in the colon is called colon cancer; cancer that begins in basal cells of the skin is called basal cell carcinoma.

Cancer types can be grouped into broader categories. The main categories of cancer include:

Carcinoma - cancer that begins in the skin or in tissues that line or cover internal organs.
Sarcoma - cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.
Leukemia - cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood.
Lymphoma and myeloma - cancers that begin in the cells of the immune system.
Central nervous system cancers - cancers that begin in the tissues of the brain and spinal cord.

Origins of Cancer

All cancers begin in cells, the body's basic unit of life. To understand cancer, it's helpful to know what happens when normal cells become cancer cells.

The body is made up of many types of cells. These cells grow and divide in a controlled way to produce more cells as they are needed to keep the body healthy. When cells become old or damaged, they die and are replaced wit

h new cells. However, sometimes this orderly process goes wrong. The genetic material (DNA) of a cell can become damaged or changed, producing mutations that affect normal cell growth and division. When this happens, cells do not die when they should and new c

ells form when the body does not need them. The extra cells may form a mass of tissue called a tumor.

Not all tumors are cancerous; tumors can be benign or malignant.

Benign tumors aren't cancerous. They can often be removed, and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body.
Malignant tumors are cancerous. Cells in these tumors can invade nearby tissues and spread to other parts of the body. The spread of cancer from one part of the body to another is called metastasis.

Some cancers do not form tumors. For example, leukemia is a cancer of the bone marrow and blood.

Cancer Statistics

A new report from the nation's leading cancer organizations shows that, for the first time since the report was first issued in 1998, both incidence and death rates for all cancers combined are decreasing for both men and women, driven largely by declines in some of the most common types of cancer.

Estimated new cases and deaths from cancer in the United States in 2008:

New cases: 1,437,180 (does not include nonmelanoma skin cancers)
Deaths: 565,650

---NCI---

1 additional swine flu case confirmed in New Jersey

2009-05-06T10:33:00.001-07:00

Health officials have confirmed another case of swine flu in New Jersey.

The patient is a 12-year old Camden County girl. Health officials say she traveled to an affected state and did not return to school while sick. She was not hospitalized and has recovered.

Seven other cases had been confirmed, but on Tuesday health officials said one turned out to be a false positive. The federal Centers for Disease Control and Prevention now says a 22-year old Bergen County woman did not have the swine flu strain.

The state Department of Health and Senior Services says all New Jersey cases have been mild and no one has been hospitalized.

Leading Canadian AIDS Researcher to Join American Institute

2009-05-06T10:31:00.001-07:00

Rafick-Pierre Sékaly, one of Canada’s premier AIDS researchers, is moving his work from Montreal to the United States because of better funding in America, CBC News reports. Sékaly was chosen to be scientific director of the new Vaccine and Gene Therapy Institute in Florida.

“I think if you really want to prevent other scientists from leaving this country, this great country, you really need to reinvest massively into basic sciences,” said Sékaly, who has published more than 200 articles in such scientific journals as Nature, Nature Medicine and the Journal of Experimental Medicine. The Canadian researcher is optimistic about the move, saying that he expects to more than double his $3.5 million research budget because of President Barack Obama’s efforts to boost funding for science.

In January, the Canadian government called for $147.9 million in budget cuts over three years to three agencies that provide research grants to universities.

Study: Blacks and Latinos Worry More Than Whites About HIV

2009-05-06T10:30:00.002-07:00

Contracting HIV is a bigger concern among African Americans and Latinos than whites, according to a new study funded by the Kaiser Family Foundation as reported by The St. Louis American.

According to the report, when asked, “Bearing in mind the different ways people can be infected with HIV, how concerned are you personally about becoming infected with HIV?” Thirty-eight percent of African-American and 25 percent of Latino respondents replied that they were “very concerned.” Six percent of whites gave the same answer. Additionally, 10 percent of whites polled said they feel that HIV/AIDS is a more urgent health problem than it was a few years ago, compared with 40 percent of African Americans and 35 percent of Latinos.

While African Americans make up 12 percent of the U.S. population, they represent about half of all new HIV/AIDS cases, according to the Centers for Disease Control and Prevention (CDC). Recently, in cooperation with 14 nationally known African-American groups, officials from the White House and the CDC announced a five-year initiative titled “Act Against AIDS” to focus on education, prevention and treatment among the black population.

New Jersey’s Only Free HIV Testing Clinic to Close Doors

2009-05-06T10:30:00.001-07:00

The Bergen County, New Jersey, Health Department is closing its only free HIV testing clinic, NorthJersey.com reports. Advocates worry that the closure will endanger the $4 million in annual grant money that Bergen and Passaic counties receive annually through the Ryan White CARE Act.

According to the article, the Bergen County Counseling Center in Hackensack has provided HIV testing for people without health insurance for 20 years.

“I’m in total disbelief this is happening,” says Catherine Correa, director of the Ryan White Grants Division of the Paterson Department of Human Services. “There will be a gap in services, and we will be out of compliance…. They are absolutely putting the money in jeopardy.”

However, Bergen County spokesman Brian Hague maintained that the county would not forfeit its federal Ryan White grant money. “We basically have to provide public education about HIV [to retain the Ryan White funds],” Hague said. “We fulfill that requirement.”

Another reason for shuttering the testing clinic, he said, was that new state funding requirements would mean the center must remain open on nights and weekends, adding to county expenses during a difficult budget cycle. In addition, to receive $100,000 in state funding for the center, the county has to provide $100,000 in matching funds.

No flu cases detected, border gates on full alert

2009-05-06T10:26:00.000-07:00

Although no cases of influenza A (H1N1) have been detected in Vietnam so far, the Ministry of Health has asked relevant agencies and forces to be on full alert at border gates, including airports and seaports, to deal with first possible cases of infection in a timely manner.

At a meeting in Hanoi on May 1, Health Minister Nguyen Quoc Trieu asked border provinces to expand the quarantine service, closely monitor any suspected cases and prepare sufficient medicine, respirators and other equipment if an epidemic breaks out.

He requested that the directors of all provincial and municipal healthcare departments establish hotlines, enhance the dissemination of public information and deploy personnel to work around the clock at hospitals and preventive healthcare centres.

Vietnamese are advised to wash their hands with anti-bacteria solutions before taking meals and not to travel to influenza-hit areas. They should seek medical attention if they develop any symptoms of influenza-like illness.

By May 2, influenza A (H1N1) has spread to 15 countries with 615 cases of infection confirmed. Mexico has confirmed 397 human cases, including 16 deaths, while the US has reported 141 cases, with one death. Elsewhere, the new strain of the deadly virus has attacked Austria, Canada, Denmark, France, Germany, Israel, the Netherlands, New Zealand, Spain, Switzerland and the United Kingdom.

Prevention efforts intensified

In HCM City: a delegation of the municipal People’s Committee inspected influenza prevention efforts at Tan Son Nhat international airport – the country’s largest.

Since April 26 the airport has received nearly 30,000 foreigners, including 730 coming from influenza-hit countries. However, no cases of infection have been detected. Two thermal scanners installed at the airport have been operating at full capacity to ensure everyone is screened. All airport staff have been provided with face masks.

The airport has reserved an isolation room for 15 passengers, a hall that can accommodate 100 people and necessary equipment to deal with possible first cases.

On May 1, the municipal People’s Committee held an urgent meeting on prevention work with the participation of representatives of relevant agencies and 24 districts and precincts in the city.

Vice Mayor Nguyen Thanh Tai asked those responsible for prevention efforts to keep a close watch on the movement of travellers at the city’s airport and seaports and immediately quarantine any suspected cases if detected to ensure the new strain of virus cannot spread across the community. He asked all hospitals to prepare necessary medicine and equipment in case of emergencies.

The city has agreed to buy additional thermal scanners to be installed at the airport as soon as possible, said he.

Dr Pham Van Nghiem from the Municipal Department of Health said that his department has printed 500,000 new declaration forms to be delivered to air passengers entering the city. It has also received 1,500 face masks and 5,000 Tamiflu tablets from the Ministry of Health.

In Can Tho City: The largest city in the Mekong River Delta has established two task forces provided with chemical disinfectant and sprayers to deal with any possible cases of infection. Ninh Kieu, Cai Rang, O Mon and Phong Dien districts have deployed personnel and prepared equipment, including chemical disinfectant, means of transport and hospital beds, as a precaution against a worst-case scenario.

Thermal scanners have also been installed at Can Tho air terminal to detect passengers with a high fever.

---VOVNews---

THE TOP 200/FAST MOVER DRUG LIST 2008-2009

2009-05-06T10:23:00.000-07:00

Brand/trade name	Generic name	Drug group
Norvasc	Amlodipine	1
Altace	Ramipril	1
Tenormin	Atenolol	1
Avapro	Irbesartan	1
Accupril	Quinapril	1
Catapres, Catapres TTS	Clonidine	1
Cozaar	Losartan	1
Cartia XT, Tiazac, Dilacor XR, Cardizem LA	Diltiazem	1
Diovan	Valsartan	1
Nifedical XL, Procardia, Adalat	Nifedipine	1
Vasotec	Enalapril	1
Caduet	Amlodipine/Atorvastatin	1
Prinivil, Zestril	Lisinopril	1
Lotensin	Benazepril	1
Calan, Isoptin, Covera HS	Verapamil SR	1
Nitroquick, Nitrostat	NTG	1
Inderal, Inderal LA, InnoPran XL	Propranolol	1
Lopressor, Toprol XL	Metoprolol	1
Benicar	Olmesartan	1
Coreg, Coreg CR	Carvedilol	1


Brand/trade name	Generic name	Drug group
Aldactone	Spironolactone	2
Lasix	Furosemide	2
HCTZ	HCTZ	2
Maxzide/Dyazide	Triamterene/HCTZ	2
Plavix	Clopidogrel	2
Coumadin	Warfarin	2
Lovenox	Enoxaparin	2
Ecotrin	ASA, EC	2
Lopid	Gemfibrozil	2
Crestor	Rosuvastatin	2
Pravachol	Pravastatin	2
Lipitor	Atorvastatin	2
Mevacor	Lovastatin	2
Niaspan	Niacin	2
Lovaza	Omega-3 ethyl esters	2
Tricor	Fenofibrate	2
Vytorin	Simvastatin/Ezetimibe	2
Zetia	Ezetimibe	2
Zocor	Simvastatin	2
Digitek, Lanoxin	Digoxin	2
Brand/trade name	Generic name	Drug group
Diovan HCT	Valsartan/HCTZ	3
Tenoretic	Atenolol/Chlorthalidone	3
Avalide	Irbesartan/HCTZ	3
Ziac	Bisoprolol/HCTZ	3
Benicar HCT	Olmesartan/HCTZ	3
Hyzaar	Losartan/HCTZ	3
Lotrel	Amlodipine/Benazepril	3
Prinzide, Zestoretic	Lisinopril/HCTZ	3
K-Dur, K-Tab, Klor-Con, K-lyte	KCl	3
Bentyl	Dicyclomine	3
Prevacid	Lansoprazole	3
Protonix	Pantoprazole	3
Zantac	Ranitidine	3
Levsin, Levbid, Nulev	Hyoscyamine	3
Zofran	Ondansetron	3
Reglan	Metoclopramide	3
Nexium	Esomeprazole	3
Aciphex	Rabeprazole	3
Prilosec	Omeprazole	3
Pepcid	Famotidine	3
Brand/trade name	Generic name	Drug group
Valtrex	Valacyclovir	4
Zovirax	Acyclovir	4
Cleocin	Clindamycin	4
Diflucan	Fluconazole	4
Macrobid	Nitrofurantoin Macrocystals	4
Rheumatrex	Methotrexate	4
Flagyl, Metrocream, Metrogel	Metronidazole	4
Pyridium	Phenazopyridine	4
Bactrim, Septra	Trimethoprim/Sulfamethoxazole	4
Amoxil, Trimox	Amoxicillin	4
Augmentin	Amoxicillin/Clavulanic Acid	4
Biaxin XL, Biaxin	Clarithromycin	4
Keflex	Cephalexin	4
Cipro	Ciprofloxacin	4
Periostat, Vibra-tabs, Doryx	Doxycycline	4
Levaquin	Levofloxacin	4
Minocin	Minocycline	4
Omnicef	Cefdinir	4
Veetids, Pen Vee K	Penicillin VK	4
Sumycin	Tetracycline	4
Zithromax	Azithromycin	4
Brand/trade name	Generic name	Drug group
Allegra	Fexofenadine	5
Clarinex	Desloratidine	5
Vistaril, Atarax	Hydroxyzine	5
Flovent, Flonase	Fluticasone	5
Nasacort AQ	Triamcinolone Acetonide	5
Nasonex	Mometasone	5
Rhinocort Aqua	Budesonide	5
Zyrtec-D	Cetirizine/Pseudoephedrine	5
Benadryl	Diphenhydramine	5
Tussionex	Hydrocodone/Chlorpheniramine	5
Atrovent	Ipratropium	5
Spiriva	Tiotropium	5
Advair Diskus	Fluticasone/Salmeterol	5
Proventil, Ventolin Solution, ProAir HFA	Albuterol Aerosol	5
Serevent Diskus	Salmeterol	5
Combivent	Ipratropium/Albuterol	5
Zyrtec	Cetirizine	5
Allegra-D	Fexofenadine/Pseudoephedrine	5
Singulair	Montelukast	5
Tessalon	Benzonatate	5
Brand/trade name	Generic name	Drug group
Celebrex	Celecoxib	6
Voltaren	Diclofenac Sod.	6
Mobic	Meloxicam	6
Motrin, Advil	Ibuprofen	6
Relafen	Nabumetone	6
Naprosyn, Anaprox	Naproxen	6
Medrol	Methylprednisolone	6
Deltasone	Prednisone oral	6
Tylenol/Codeine	Acetaminophen/Codeine	6
Duragesic	Fentanyl transderm	6
Vicodin, Lortab, Lorcet, Norco, Zydone,	Hydrocodone/APAP	6
Percocet, Endocet, Roxicet	Oxycodone/APAP	6
OxyContin	Oxycodone	6
Darvocet-N	Propoxyphene-N/APAP	6
Ultram	Tramadol	6
Ultracet	Tramadol/APAP	6
Skelaxin	Metaxolone	6
Zanaflex	Tizanidine	6
Soma	Carisoprodol	6
Flexeril	Cyclobenzaprine	6
Lodine	Etodolac	6
Brand/trade name	Generic name	Drug group
Adderall, Adderall XR	Amphetamine mix	7
Concerta, Ritalin, Methylin	Methylphenidate	7
Strattera	Atomoxetine	7
Dexedrine	Dextroamphetamine	7
Ambien, Ambien CR	Zolpidem	7
Restoril	Temazepam	7
Lunesta	Eszoplicone	7
Elavil	Amitriptyline	7
Cymbalta	Duloxetine	7
Xanax	Alprazolam	7
Klonopin	Clonazepam	7
Ativan	Lorazepam	7
Pamelor	Nortriptyline	7
Buspar	Buspirone	7
Wellbutrin (SR, XL) Zyban	Bupropion	7
Provigil	Modafinil	7
Ionamin	Phentermine	7
Sinemet	Carbidopa/Levodopa	7
Imitrex	Sumitriptan	7
Fioricet, Esgic	Butalbital/APAP/Caf	7
Valium	Diazepam	7
Brand/trade name	Generic name	Drug group
Aricept	Donepezil	8
Namenda	Memantine	8
Celexa	Citalopram	8
Depakote	Valproic acid	8
Effexor, Effexor XR	Venlafaxine	8
Prozac, Sarafem	Fluoxetine	8
Lamictal	Lamotrigine	8
Lexapro	Escitalopram	8
Lithobid	Lithium	8
Neurontin	Gabapentin	8
Paxil	Paroxetine	8
Phenobarbital	Phenobarbital	8
Dilantin	Phenytoin Sod.	8
Remeron	Mirtazapine	8
Risperdal	Risperidone	8
Seroquel	Quetiapine	8
Topamax	Topiramate	8
Desyrel	Trazodone	8
Zoloft	Sertraline	8
Zyprexa	Olanzapine	8
Chantix	Varenicline	8
Brand/trade name	Generic name	Drug group
Glucophage, Riomet	Metformin	9
Actos	Pioglitazone	9
Amaryl	Glimepiride	9
Avandia	Rosiglitazone	9
Lantus	Insulin Glargine	9
Glucotrol	Glipizide	9
Glucovance	Glyburide/Metformin	9
Diabeta, Micronase, Glynase	Glyburide	9
Humalog/Novolog	Insulin Lispro/Insulin Aspart	9
Humulin N, Humulin R	Insulin	9
Patanol/Pataday	Olopatadine	9
Xalatan	Latanoprost	9
Timoptic	Timolol	9
Alphagan	Brimonidine	9
Bactroban	Mupirocin	9
Folic Acid	Folic Acid	9
Epogen, Procrit	Erythropoietin	9
Zyloprim	Allopurinol	9
Miralax, Glycolax	Polyethylene Glycol 3350	9
Phenergan/Codeine	Promethazine/Codeine	9
Brand/trade name	Generic name	Drug group
Actonel	Risedronate	10
Fosamax	Alendronate	10
Evista	Raloxifene	10
Aviane, Alesse, Ortho Novum, Ovcon, Ovral, Ortho-Cept, Sprintec, Yasmin, Yaz	Monophasic OC	10
Kariva, Mircette, Ortho Novum 10/11	Biphasic OC	10
Ortho Tri-Cyclen, Ortho Tri-cyclen Lo, Tri-Sprintec, Trivora-28	Triphasic OC	10
Detrol, Detrol LA	Tolterodine	10
Ditropan, Oxytrol	Oxybutynin	10
Flomax	Tamsulosin	10
Cardura	Doxazosin	10
NuvaRing	Etonogestrel/Ethinyl Estradiol	10
Provera	Medroxyprogesterone	10
Ortho Evra	Norgestromin/Ethinyl Estradiol	10
Premarin	Estrogen	10
Prempro	Estrogen/Progestin	10
Synthroid, Levoxyl, Levothroid, Thyroid-Armour, Unithroid	T3,T4, Thyroid	10
Nor-QD, Micronor	Norethindrone	10
Cialis	Tadalafil	10
Viagra	Sildenafil	10
Avodart	Dutasteride	10

Vietnam, US discuss Agent Orange/dioxin issues

2009-05-06T10:18:00.000-07:00

A conference of the Vietnamese and US Pressure Group on Agent Orange/dioxin was held in Da Nang city on April 21 to review new progress in dealing with the consequences of Agent Orange/dioxin used by the US army during the war in Vietnam.

Present at the meeting were representatives of the Ford Foundation, UNICEF, the Office of the national steering board for overcoming the consequences of toxic chemicals used by the US during the Vietnam war (Office 33), the Vietnam Association for Victims of AO/dioxin (VAVA), Da Nang city, Quang Tri and Dong Nai provinces and a number of non-governmental organisations.

The participants help strong opinions about an agreement on the group’s forthcoming action plan and presented various solutions to resolve all the problems that have arisen during the process of dealing with the effects of the AO/dioxin.

Representatives of Office 33 delivered a comprehensive report on the AO/ dioxin issue in Vietnam and the progress of detoxification work being done at Da Nang and Bien Hoa airports.

Da Nang city and Quang Tri and Dong Nai provinces reported on the effects of AO/dioxin in their localities and possible cooperation programmes in the future.

According to Ton Nu Thi Ninh, who is the initiator and former co-chair of the Vietnam-US Pressure Group on AO/dioxin, the group is the most effective way of ensuring a concentrated approach by Vietnam and the US in the AO/dioxin matter.

Dr. Charles Bailey, Director of the Ford Foundation’s Special Initiative on AO/dioxin, said that in the 1960s, US troops used AO and other defoliants to destroy about 10 percent of forests and trees in Vietnam’s central and southern regions.

Chemicals containing dioxin are very harmful to people, he said, adding that even though the AO/dioxin was used by the US during the war, it remains an outstanding matter as exposure to AO/dioxin and chronic diseases are closely related to the increasing number of children being born with deformities.

AO/dioxin victims in Vietnam include soldiers and civilians who were present in the areas that were sprayed with AO/dioxin in the 1060s, their descendants and those who live near the former demilitarized zones contaminated by the dioxin.

---VOVNews---

Hanoi hosts 2009 Pharmacy Expo

2009-05-06T10:17:00.000-07:00

Nearly 350 stands showcasing of more than 200 leading Vietnamese and international companies will be displayed at the 2009 Pharmacy Expo in Hanoi from May 13-16.

The companies represent China, India, Japan, the Republic of Korea, Singapore, France, Germany, Switzerland and the US.

The Expo will be an excellent chance for the host country to access modern medical equipment and new drugs from developed nations.

Visitors to the Expo will also be able to get a free medical check up and consultancy.

---VOVNews---