News in Brief

Chevron donates additional $25m to Global Fund to Fight AIDS, TB & malaria
Chevron, one of the world’s leading energy companies, announced in October that it will commit an additional US$25 million to The Global Fund to Fight AIDS, Tuberculosis and Malaria, raising its six-year investment in the organisation to $55 million. This contribution makes Chevron the single largest private sector donor to the organisation.

WHO group for Climate Change
The WHO has convened an informal group of countries within the UN Framework Convention on Climate Change process, to highlight the positive contribution of health protection and health promotion considerations to the international climate change negotiations, according to an IISD report – http://climate-l.org. The “Friends of Public Health” group aims to facilitate the inclusion of health concerns in future climate agreements, decision making, resource allocation and outreach activities, by emphasising the effectiveness of public health interventions in climate change adaptation and the immediate health co-benefits of reducing greenhouse gas (GHG) emissions.

US NIH launches Database of Genomic Structural Variation
The US National Institutes of Health has launched the Database of Genomic Structural Variation, or dbVar, to help scientists understand how differences in DNA contribute to human health and disease. The database will help track large-scale variations in DNA discovered in healthy individuals as well as those affected with disorders such as autism and cancer. The database was developed by the US National Center for Biotechnology Information. To access dbVar, visit www.ncbi.nlm.nih.gov/dbvar.

GSK to pay $750-m fine for bad drugs
GlaxoSmithKline has agreed to pay US$750 million and plead guilty to manufacturing and distributing adulterated drugs from a now closed plant in Puerto Rico, a Reuters report quoted the US Justice Dept as saying. Of the $750 million, Glaxo will pay $600 million to settle allegations that, because the drugs were adulterated, false claims for reimbursement were submitted to government healthcare programmes.

Succimer does not remove mercury from the body
Succimer, a drug used for treating lead poisoning, does not effectively remove mercury from the body, according to new research supported by the US NIH. Some families have turned to succimer as an alternative therapy for treating autism in the belief that these conditions are caused, in part, by mercury poisoning.
● Ref: doi:10.1016/j.jpeds.2010.08.036

US NIH grants award for microbiome-obesity study
Martin J. Blaser, MD, Professor of Internal Medicine at NYU Langone Medical Center has been granted one of only 20 US National Institutes of Health (NIH) Director’s Transformative Research Projects (T-R01) award for research entitled “Disappearing Gastrointestinal Microbiota in Epidemic Obesity”. The project will examine whether changes in the human microbiome as a result of antibiotic use early in life has fuelled the epidemic of obesity.

Paediatric radiation dose standardised
The Society of Nuclear Medicine (SNM) and the Society for Pediatric Radiology’s Board of Directors recently approved new North American Guidelines for Radiopharmaceutical Doses for Children – http://interactive.snm.org/index.cfm? PageID=9104 – These societies have expanded their paediatric radiation protection initiative by standardising doses (based on body weight) for 11 nuclear medicine procedures commonly performed in children.

New TB diagnostic test is fast

A molecular test designed to easily diagnose tuberculosis (TB) and detect a drug-resistant form of the bacterium that causes TB can provide much more specific, sensitive and rapid results than currently available TB diagnostics, according to a new study in the New England Journal of Medicine. In a test involving 1,730 patients with suspected drug-sensitive or multidrug-resistant pulmonary TB, the Xpert MTB/RIF TB test successfully identified 98% of all confirmed TB cases and 98% of patients with rifampin-resistant bacteria in less than two hours.

Antibiotic resistance genes in gut for up to two years
Short courses of antibiotics can leave normal gut bacteria harbouring antibiotic resistance genes for up to two years after treatment, say scientists writing in the 3 November 2010 issue of Microbiology. The researchers believe that this reservoir increases the chances of resistance genes being surrendered to pathogenic bacteria, aiding their survival and suggesting that the long-term effects of antibiotic therapy are more significant than previously thought.
 


Beware scanning children with CT


Radiologists from Johns Hopkins Children’s Center and elsewhere are sounding the alarm and urging judicious use of radiationbased imaging in children. They say that many scans are performed unnecessarily.

“CT scans save lives and have revolutionised medical diagnostics, but as physicians, we should remind ourselves that every CT scan we order now stays with a child for a lifetime,” said pediatric radiologist Melissa Spevak, MD, during a recent presentation at Hopkins. Her efforts are inspired by the “Image Gently” campaign of the Society for Pediatric Radiology and the Alliance for Safety in Pediatric Imaging.

Not only are children’s growing tissues and rapidly dividing cells more vulnerable to the effects of radiation, but exposure to radiation at an earlier age gives cancerous mutations that much more time to develop into full-blown disease, Dr Spevak says. And because of the difference in body size, a single CT scan can deliver a much higher dose of radiation to a child than to an adult.

Before ordering a CT scan, Dr Spevak says doctors should ask the following critical questions: “Is this the right test for this condition?” and “Can I obtain the answer in another way?” If the answer to the first question is yes and the answer to the second question is no, the next question should be, “What is the minimum dose that will give me the answer?”

The safe threshold for radiation exposure has not been defined, but cancer risk is cumulative, rising in proportion to the dose received, with each subsequent exposure increasing that risk, according to a 2005 landmark report by the US National Academy of Sciences.

Exactly how likely one is to develop cancer from medical imaging remains the subject of debate, but a 2007 study in the New England Journal of Medicine estimated that up to 2% of all cancers in the United States may stem from medical radiation.

Epidemiological studies have shown increased cancer among people exposed to nonmedical radiation at doses ranging from 5 to 150 millisieverts. The natural environmental radiation people absorb per year is between 3 and 3.5 mSv. An abdominal CT scan in an adult person delivers anywhere between 1 and 30 mSv or up to nine years worth of natural environmental radiation in a single dose. But an abdominal scan in a newborn may result in a much higher dose if the CT scanner settings are not adjusted to the infant’s smaller size. By comparison, a set of dental X-rays delivers 0.005 mSv, a chest X-ray delivers 0.01 mSv, and a mammogram delivers around 3 mSv.

Image Gently campaign www.pedrad.org/associations/5364/ig/



IDF launches D-NET forum for diabetes healthcare professionals

The International Diabetes Federation (IDF) recently launched D-NET – a Diabetes Education Network for Health Professionals. It is the first international forum aimed at enhancing diabetes education and management around the world.

The concept for D-NET was conceived during a meeting at the World Diabetes Congress in Montreal in 2009, where participants came up with the idea that such a network would provide valuable opportunities for health professionals and educators to learn from one another and to improve care for people with diabetes.

IDF was chosen to host the network because of its vast network of more than 200 diabetes associations worldwide.

The IDF says the online forum will provide the opportunity for health professionals to meet new colleagues, share best practices, find innovative solutions, and advance education and management of diabetes. They will also have access to emerging evidence and diabetes resources, along with videos featuring IDF Centres of Education around the world. A calendar of discussion topics, articles and more are available on the site.

Health professionals involved or interested in diabetes are invited to register at: http://d-net.idf.org



Lord Darzi heads up new Institute of Global Health Innovation

The pioneer of robotic surgery and former English health minister Professor Lord Ara Darzi is taking the helm of an institute at Imperial College London that aims to develop innovative approaches to global health challenges. The Institute of Global Health Innovation (IGHI), which was launched 4 October 2010, will bring together world-leading academics in medical science, engineering, business and health policy with the aim of improving people’s health and reducing health inequalities in developed and developing countries.

The IGHI will build upon Imperial’s expertise in global health and incorporate the College’s world-renowned strengths in technological innovation and multidisciplinary working. It will work closely with governments, NGOs and business to ensure that innovations in healthcare and health policy have a significant impact across the world.

Beside his many innovations Prof Darzi has been heavily involved in World Health Organisation initiatives to improve the safety of surgical patients across the world. “Healthcare systems all over the world are facing completely different pressures compared with 20 years ago. Life expectancy has increased dramatically, lifestyle diseases such as obesity are rife, and non-communicable diseases such as diabetes are increasingly becoming a problem in developing countries as well as in the West. We can’t just build more hospitals or buy more beds; the whole way in which we provide healthcare has got to change. The world is crying out for low cost, high impact technologies that can be employed widely across the globe,” said Prof Darzi.

“Imperial’s track record in coming up with major discoveries in medicine and engineering is unquestioned, but for those breakthroughs to have a real impact, they need to feed into policy. I’ve had a particular interest in policy for the last four or five years and I understand the different sorts of challenges facing us in healthcare across the world. I think the solutions are there, and the Institute of Global Health Innovation will provide us with a platform to make that change happen and to have that impact globally.”

The IGHI’s Deputy Chairman, Professor Guang-Zhong Yang, brings to the global health arena a wealth of expertise in engineering, having spent his career developing new medical and sensor technologies. One of his current projects is to develop miniature wireless sensors that can be worn on the body to monitor a patient’s health remotely. Such devices, he points out, will be useful for developed countries with burgeoning elderly populations as well as in deprived countries where healthcare services are limited.



NCD Alliance sets out plan of action for UN Summit

In less than one year’s time, a momentous opportunity will present itself to put noncommunicable diseases (NCDs) on the global health and development agenda. The UN High Level Summit on Non- Communicable Diseases in September 2011 is a global platform from which the world can be moved from rhetoric to action.

Since the UN Summit was announced on 13 May 2010, the four partners of the NCD Alliance –the International Diabetes Federation, World Heart Federation, the Union for International Cancer Control and the International Union Against Tuberculosis and Lung Disease (The Union) – have been hard at work putting together civil society plans and strategies for the Summit and the partnership structures to deliver strong outcomes. The historical decision to hold a Summit is something the NCD Alliance had been campaigning for since 2009.

Recently, the NCD Alliance launched its comprehensive NCD Alliance Plan for the United Nations Summit on Non- Communicable Diseases, which sets out a programme of work in the lead and immediate aftermath to the UN Summit.

“NCDs have been a silent killer for too long; the Alliance Plan signifies a strong and active global NCD community intent on making a difference. The UN Summit is our opportunity to fix the problem – we either use it or lose it,” said Professor Jean Claude Mbanya, International Diabetes Federation President.

“We need a platform to discuss solutions to the growing danger posed by NCDs, and agree on future action to tackle the epidemic. This document clearly lays out the Alliance’s goals and deliverables for the Summit,” added Professor Pekka Puska, President of the World Heart Federation.

NCDs (cardiovascular diseases, cancers, chronic respiratory diseases and diabetes) make the largest contribution to mortality both globally and in the majority of low- and middle- income countries. The UN Summit process will bolster progress towards building NCDs into global development targets for the future. To ensure certain key ‘asks’ are achieved from the Summit, including globally agreed approaches to NCD treatment and care, allocating sufficient resources to deliver global NCD interventions, and full implementation of the Framework Convention on Tobacco Control (FCTC), the NCD Alliance is coordinating a programme of technical work.

“NCDs account for over 60% of all global deaths; the UN Summit will bring great attention to this issue and hopefully lead to concrete outcomes to mark the turning point for NCDs,” said Dr S. Bertel Squire, President of The Union.

NCD Alliance www.ncdalliance.org



New oral medication approved for relapsing MS

In a major breakthrough, Novartis’ novel oral medication ‘Gilenya’ (fingolimod) for treating relapsing forms of multiple sclerosis – the most common forms of the disease – has received US FDA approval.

Gilenya is the first approved oral treatment indicated for relapsing forms of MS in the US. As a first-line treatment is has been shown to significantly reduce relapses and delay disability progression.

The Gilenya approval was based on the largest clinical trial programme ever submitted to date to the FDA for a new MS drug and included combined data from clinical studies showing significant efficacy in reducing relapses, the risk of disability progression, and the number of brain lesions detected by magnetic resonance imaging (MRI), a measure of disease activity, in people with relapsing forms of MS.

Gilenya showed superior efficacy by reducing relapses by 52% at one year compared with interferon beta-1a IM, a commonly prescribed treatment.

Gilenya is the first in a new class of drugs called sphingosine 1-phosphate receptor (S1PR) modulators.



New global plan aims to wipe out TB

A new roadmap for curbing the global epidemic of tuberculosis aims to save five million lives between 2011 and 2015 and eliminate TB as a public health problem by 2050 but comes with a price tag of US$47 billion, nearly half of which must still be found.

The Global Plan to Stop TB 2011-2015 developed by the World Health Organisation's (WHO) Stop TB Partnership builds on progress towards goals laid out in a 2006 plan to halve TB prevalence and death rates by 2015 and scale up TB diagnosis, treatment and care, but adds essential research targets including the development of faster methods to test and treat TB and to prevent it through an effective vaccine.

After peaking in 2004, the global incidence of TB is declining, but “far too slowly”, noted Mario Raviglione, director of WHO’s Stop TB Department, at the launch on 13 October of the plan in Alexandra, a Johannesburg township. The curable disease still affects some nine million people a year and claims nearly two million lives annually.

Specifically, the plan provides countries with guidance on how to improve TB control through scaling up existing interventions for its diagnosis and treatment and by making use of new diagnostic tests and drugs that will become available over the next five years. A new test that uses molecular line probe assays to detect multi-drug resistant (MDR-) TB in a few days instead of the weeks has already been introduced in some countries. Other tests that will soon be available can detect TB in a matter of hours.

Current TB drug regimens take six months to be effective for drug-susceptible TB and much longer for drug-resistant strains, during which time many patients are lost to follow-up. The pipeline of new TB drugs promises shorter treatment times. Meanwhile, nine TB vaccine candidates are in clinical trials and a new generation of TB vaccines is expected to be available by 2020.

The plan estimates that $10 billion alone is needed to fund further research and development over the next five years, about US$7 billion of which still needs to be raised. Out of the estimated $37 billion needed to implement the Global Plan’s TB diagnosis, treatment and care targets, a funding gap of about $14 billion remains. 
 

                                  
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