`Breakthrough' Drug for Liver Cancer A drug already used to treat kidney cancer has proven so successful with liver cancer that a clinical trial was ended early, says a June 4 HealthDay News report of a study announced at the American Society of Clinical Oncology annual meeting. Advanced liver cancer patients who received Nexavar generic: sorafenib ; lived about three months longer than those who received placebo. Liver cancer is a leading cause of cancer deaths worldwide and tough to treat. Taken in tablet form, the drug "is the first systemic therapy to prolong survival in [liver cancer] patients, " said Joseph Llovet, MD, the study's lead author. An American Cancer Society official said these findings will change the standard of practice. The drug is made by Bayer. New STI More Common Than Gonorrhea Mycoplasma genitalium, a sexually transmitted infection first identified in the 1980s, is now more prevalent among young adults in this country than Neisseria gonorrhea. A study of 2, 932 men and women ages 18 to 27 found genitalium infection rates of of 1.0% vs. 0.4% for gonorrhea. Prevalence increased 10% with each additional sexual partner, according to a Reuters Health news report on the study, which was published in the American Journal of Public Health in June. There are no commercial assays to detect genitalium and many infections are asymptomatic, although they can cause urethritis in men. Genitalium can be treated with antibiotics, although no official recommendations exist. Diabetes Takes 8 Years of Life Diabetics aged 50 and older died about 8 years earlier than their nondiabetic counterparts in an analysis of data from the Framingham Heart Study, an ongoing research project of the National Heart, Lung, and Blood Institute. People with diabetes also were significantly more likely to develop cardiovascular disease, although life expectancy was not further shortened by CVD. The study was reported in the June 11 issue of the Archives of Internal Medicine. Uncertainty About Diabetes Drug Avandia, an oral medication taken to lower blood sugar in type 2 diabetics, is the subject of controversy after an FDA safety alert and early release by the New England Journal of Medicine of a study finding that the drug increases heart attack risk by 43%. GlaxoSmithKline makes the drug generic: rosiglitazone maleate ; and "strongly disagrees" with the conclusions in the article. The researchers themselves acknowledge limitations of their study, and NEJM published three editorials to shed light on what is and is not known. The American Diabetes Association's vice president of clinical affairs said, "We don't feel this is an emergency situation" in a May 25 HealthDay News article. The FDA says it has not confirmed the clinical significance of the NEJM study, that other data contradict its findings and that it will continue to review the data. The agency also points out the risks inherent in switching medications. Find the alert at fda.gov cder drug infopage rosiglitazone. The NEJM article is at : content.nejm cgi content full NEJMoa073394. XDRTB in the News It was all over the media in May: A U.S. citizen with extensively drugresistant tuberculosis traveled through Europe and Canada, raising the specter of infected fellow travelers. When he returned home, he was held in forcible hospital isolation. Experts and pundits weighed in from all sides, raising awareness about a growing threat at a time when U.S. tuberculosis cases having been falling. For an informative Medscape article on XDRTB, complete with treatment options and future strategies, see "The Emergence and Impact of Extensively Drug-Resistant Tuberculosis" by Christopher Lettieri, MD, available at medscape viewarticle 557459.
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Nondiabetic 6-month-old male C57BL 6 mice were obtained from the colony maintained by National Institute of Aging under contractual agreement with Harlan Sprague Dawley, Inc. Indianapolis, IN ; . Animals, identified by clipped toes, were housed four per cage ; with free access to water and were maintained at a constant temperature on a 12-h light-dark cycle. The animal treatment and care protocols conformed to National Institutes of Health guidelines and were performed using a University of Arkansas for Medical Sciences Institutional Animal Care and Use Committees-approved protocol. Animals n 8 per group ; were fed 5 g of food per day with pelleted chow F05072, Bio-Serv, Frenchtown, NJ ; supplemented with rosiglitazone maleate Avandia, GlaxoSmithKline, King of Prussia, PA ; at the concentration of 0.14 mg g of chow. The control group was fed the same amount of nonsupplemented chow. Animals were fed every other day for 7 wk, and food intake per cage and body weights of individual animals were monitored. At the end of the experiment the average intake of rosiglitazone per gram body weight per cage was calculated and resulted in the dose of 20 g measure bone formation rates, mice were injected ip with 30 g g body weight of tetracycline 7 and 2 d before they were killed.
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The first two authors contributed equally to this work. For reprints and all correspondence: Yoon-Koo Kang, Division of Oncology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Poongnap-dong, Songpa-gu, Seoul, Korea. E-mail: ykkang amc oul.kr and avapro.
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University or Company Name Oregon Health & Science University Contact Name Mary Foley, PhD Phone 503-494-8309 Fax 503-494-4729 E-mail folemary ohsu Faculty Contact and Department Martin Kelly, Ph.D., Department of Physiology and Pharmacology Please complete the following information. Note: Some sections below may not apply to every technology. Summary.
Brand Name Precose Glyset Glucophage Glucophage XR Riomet Starlix Prandin Amaryl Glucotrol Glucotrol XL Micronase, Diabeta Glynase PresTab ACTOS Avandiw Glucovance Avandamet Metaglip Avandaryl Generic Name acarbose miglitol metformin metformin -extended release metformin liquid ; nateglinide repaglinide Glimepiride Glipizide Glipizide- long acting glyburide glyburide micronized ; pioglitazone rosiglitazone metformin + glyburide metformin + rosiglitazone metformin + glipizide rosiglitazone + glimepiride Thiazolidinediones Increases the body's sensitivity to insulin. Combination medications These are combination of medications listed above. See notes above regarding how the individual medications work and comments. Takes 4-6 weeks to see effects on blood glucose control. Class & How It Works Alpha-glucosidase inhibitors Decrease digestion and absorption of carbohydrate in the small intestine to blunt after-meal increase in blood glucose. Biguanides Decrease production of glucose by the liver. Comments Take with first bite of each meal. May cause diarrhea, gas and bactroban.
KATP ; channels and produce membrane hyperpolarization are effective in suppressing spontaneous action potentials and isolated contractions of bladder smooth muscle. KATP channel openers are less effective in blocking neurally evoked than spontaneous bladder contractions and therefore should be more active in suppressing unstable bladder contractions during bladder filling and not interfere with normal voiding. Oral administration of ZD6169 reduces voiding frequency in rats and dogs without lowering blood pressure 17 ; . Intravesical administration in rats increases the bladder volume for inducing a micturition reflex and also decreases the frequency and amplitude of spontaneous bladder contractions and reduces voiding pressure in both normal and outlet-obstructed animals 17, 18 ; . It has been suggested that the drug acts not only on bladder smooth muscle but also on capsaicin-sensitive bladder afferents to reduce afferent firing induced by bladder distention or chemical irritation of the mucosa 18 ; . 2. Tachykinin antagonists and afferent peptides Tachykinins released in the bladder can act on: 1 ; NK-1 receptors in blood vessels to induce plasma extravasation and vasodilation; 2 ; NK-2 receptors to stimulate the bladder contractions; and 3 ; NK-2 receptors on primary afferent terminals to increase excitability during bladder filling or during bladder inflammation 18 ; . Substance P also acts on 4.
The avandia prescribing information leaflet now states, thiazolidinediones, including rosiglitazone, cause or exacerbate congestive heart failure in some patients and baycol.
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Synopsis A Canadian health technology assessment organisation CCOHTA ; has published a systematic review on the clinical efficacy and safety of riluzole for the treatment of amyotrophic lateral sclerosis. It concludes that: Riluzole has the potential to reduce serious morbidity in some patients at the cost of causing some drug intolerance withdrawals due to adverse events ; . There is no information to describe the impact of riluzole on quality of life or time to tracheostomy. More adequate reporting of adverse events is needed to complete the clinical picture. To access the document, go to: : ccohta publications pubs e and search by keyword, Riluzole and biaxin.
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Andrea K. Greiling, Leslie P. Boss, Lani S. Wheeler ABSTRACT: Although asthma deaths in children are rare, most asthma deaths should be preventable. No information has been identified in the professional literature addressing the occurrence of asthma deaths in schools. This investigation identified asthma deaths that occurred in US schools between 1990 and 2003 and the circumstances surrounding those deaths. Data were obtained through newspaper articles in the LexisNexis database and death certificates. Between 1990 and 2003, 38 asthma school deaths were reported. Eighteen 47 percent ; identified deaths occurred among black children and 12 31 percent ; among white. Twenty-seven 72 percent ; of the deaths occurred among teens. Of the fatal asthma attacks, 16 42 percent ; occurred while the children were participating in a physically active event. Twelve 31 percent ; children died while waiting for medical assistance. Due to the nature of these data, inferences may be subject to source bias. For the identified asthma deaths, key findings include the following: 1 ; most deaths occurred in teens and high school students; 2 ; frequently, the precipitating event was related in time to exercise; and 3 ; a delayed response or hesitancy of school staff to provide medical assistance may have contributed to some of the deaths. Although few school-related asthma deaths are reported each year, the true number is unknown. Key factors in managing the disease and preventing asthma deaths and exacerbations in schools include identification of students with diagnosed asthma, communication with parents and health care providers, removal of triggers in the immediate school environment, and maximizing access to needed medications. J SchHealth.2005; 75 8 ; : 286-290.
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Paolo Ruggiero, Laura Pancotto, Laura Lauretti, Giuseppe Del Giudice, Novartis Vaccines & Diagnostics s.r.l., Research Center, Siena, Italy Giacomo Rossi, Department of Veterinary Science, University of Camerino, Matelica, Italy Francesco Tombola, Department of Biomedical Sciences, University of Padova, Italy F ra n CNR Institute of Neuroscience, Section for Biomembranes, Padova, Italy Supported partly by a CNR Target Project Biotechnology grant and a University of Padova Young Investigator grant Correspondence to: Paolo Ruggiero, Novartis Vaccines & Diagnostics s.r.l., Research Center, Via Fiorentina 1, Siena I-53100, Italy. paolo ggiero novartis Telephone: + 39-577-243111 Fax: + 39-577-243564 Received: 2006-10-09 Accepted: 2006-12-01 Ruggiero P, Rossi G, Tombola F, Pancotto L, Lauretti L, Del Giudice G, Zoratti M. Red wine and green tea reduce H pylori - or VacA-induced gastritis in a mouse model. World J Gastroenterol 2007; 13 3 ; : 349-354.
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The thiazolidinediones improve glycemic control by improving insulin sensitivity, therefore, depending on the presence of insulin for their mechanism of action. Studies indicate the thiazolidinediones improve insulin sensitivity in muscle and adipose tissue and inhibit hepatic gluconeogenesis.20 They are highly selective and potent agonists for the peroxisome proliferatorsactivated receptor-gamma PPAR ; that are found in adipose tissue, skeletal muscle, and the liver. Activation of PPAR regulates the transcription of insulin-responsive genes involved in the control of glucose production, transport, and utilization of fatty acid metabolism. There are two thiazolidinedione products available. Table 1 lists the brand and generic names of the products in this class, while Table 2 compares their FDA approved indications. Combination products are reviewed in a separate section at the end of this document. This review encompasses all dosage forms and strengths. Table 1. Thiazolidinedione Products in this Review Generic Name * Formulation Example Brand Name Pioglitazone Oral Actos Rosiglitazone Oral Avandia.
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Drug Activity: Cardiant Mechanism of Action: Cytokine-Agonist; Cytokine-Antagonist Compound Name: None Given Use: Agents for the treatment of myocardial infarction and cardiac failure comprising a gp130 ligand such as LIF leukemia inhibitory factor ; or gp130 mutants are claimed. These agents are stated to mobilize stem cells to damaged cardiac muscle and provide a mechanism for stimulating the differentiation of cells into cardiac muscle cells. Advantage: No suitable advantage given. Biological Data: Mice treated with LIF were shown to have improved cardiac function compared to controls table 1, page 51 ; . Chemistry: Sequences provided in source document. 37 pages Drawings, for example, patient information.
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Or via direct effects on the cardiac muscles socalled diabetic cardiomyopathy ; . Bell1 described heart failure as "the frequent, forgotten, and often fatal complication of diabetes, " and called for its early detection and timely treatment in patients with diabetes. Heart failure may be more likely to develop in diabetic patients with poor glycemic control.2 The United Kingdom Prospective Diabetes Study, 3 involving more than 3, 600 patients with diabetes, found that the incidence of heart failure declined by 16% for each 1% reduction in hemoglobin A1c. Many patients with diabetes and heart failure need to take multiple drugs for each condition, and the possible side effects and interactions can be challenging to manage. Compounding the problem, care is compartmentalized: cardiologists deal with the heart failure, endocrinologists deal with the diabetes, and one specialist may be unaware of the impact--good or bad--of the treatment prescribed by the other specialist. Moreover, little attention has been paid to the side effects of antidiabetes drugs in patients with chronic heart failure. Insulin has long been associated with sympathetic overactivation and sodium retention. Some sulfonylurea drugs are thought to abolish ischemic preconditioning, leaving the myocardium more susceptible to injury. Metformin is contraindicated in patients with heart failure because it is thought to cause lactic acidosis if the patient has renal dysfunction, which is common in patients with heart failure. BENEFITS OF TZDs The two TZDs available in the United States-- rosiglitazone Avandiz ; and pioglitazone Actos ; --are increasingly used as first-line and second-line agents for treating type 2 diabetes mellitus, making up a substantial proportion of the oral antidiabetic drug market share. TZDs directly improve insulin sensitivity, pancreatic beta-cell function, and endothelial function. They work in the cell nuclei by binding and activating peroxisome proliferatoractivated receptor gamma PPAR gamma ; , which presumably regulates the transcription of insulin-responsive genes involved in the control of glucose production, transport, and.
CANADIAN JOURNAL OF ANAESTHESIA TABLE I Demographic data Treatment group Age yr ; Weight kg ; Menses Oral Contraceptives Felsche clips Mean procedure Duration min ; Associated procedure!5 NS nonsignificant. 31 1.2 65.4 ; 4 19.0% ; 6 28.6% ; 46 4 5 ; Control group 30 1.3 68.6 ; 7 32.3% ; 7 32.3% ; 43 3 0 0% ; NS 0.05.
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In the US, a diabetes drug Rezulin4 troglitazone ; advertised to the public has now been withdrawn for safety reasons. Troglitazone was withdrawn from the UK in 1997 because of liver toxicity. It remained available in the US until March 2000 and was advertised to the public, as well as to doctors. By the time it was withdrawn it had generated US$2.1 billion in sales within 3 years. However, it had also been named as the suspected cause of 391 deaths. There is no evidence of lives saved by using this drug; like many new drugs, it simply had not been studied for long enough or in large enough groups of patients. Two new drugs in same class; Avandia rosiglitazone ; and Actos pioglitazone ; , are currently being advertised to the US public despite warnings of serious cardiac risks. This example highlights a key public health concern with direct-toconsumer advertising: the rapid, widespread use of new drugs before risks or benefits are fully known.
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