Ensuring more accuracy for those who need treatment:

Radical change in blood pressure diagnosis

The way blood pressure is diagnosed and treated is set to be revolutionised following new guidelines for the medical profession developed in conjunction with the British Hypertension Society (BHS).

It will mark the first time in over a century that the way blood pressure is routinely monitored by GPs has been changed.

A major feature of the new guideline is the recommendation that high blood pressure should be diagnosed using ambulatory blood pressure monitoring, a technique in which the patient wears a monitor for 24 hours to gauge how high their blood pressure is.

University of Leicester Professor Bryan Williams Chaired the NICE hypertension guideline.

He believes this new approach will mean that as many as 25% of people diagnosed as having high blood pressure using the current method of diagnosis, i.e. repeated measurement of blood pressure in the doctor’s clinic, may not be hypertensive and may not need treatment.

“This new guideline is going to change the way blood pressure is diagnosed and treated for millions of people around the world.The new approach will be more accurate in diagnosing high blood pressure and will ensure that the right people get treated.“We are using new technologies to improve the way we diagnose high blood pressure.

“It means that we will be more accurate in treating those who need treatment and in avoiding treating those who don’t.”

In accompanying research published simultaneously in the Lancet, the guideline group demonstrated that this new approach is highly cost-effective and even after taking account of the cost of the new technology, is likely to be cost saving for the NHS.“Even though these new devices cost between £1,000 - £2,000, our analyses suggest that by improving the speed and accuracy of diagnosis, we will actually save money by only targeting treatment at those who need and will benefit from treatment - this is good news for patients.

I am under no illusions about the challenges to implement this but I believe this guideline will be well received by both doctors and patients not just in England and Wales, but worldwide,” said Professor Williams, Professor of Medicine at the University and an honourary consultant physician at the University Hospitals of Leicester NHS Trust.

The new guideline also simplifies the treatment strategy for high blood pressure, focusing on the most effective treatments and also contains specific advice on the treatment of blood pressure in young adults and the very elderly.Professor Williams added: “We have spent more than a year looking at masses of new evidence from studies in great detail before coming to our conclusions.

I think the UK is leading the world in developing bold and progressive treatment strategies for high blood pressure.

The importance of this cannot be overstated for two reasons, first because high blood pressure is very common and affects about a quarter of all adults and more than half of adults over the age of 60 yrs, and second, because treating high blood pressure is one of the most effective ways of reducing the risks of heart disease and stroke.”

Sources: Leicester University, AlphaGalileo Foundation.

Disaster looms over addiction to painkillers

The actor Heath Ledger’s autopsy concluded that he died as a result of an ‘acute intoxication’ with a number of drugs, including the opioid painkiller oxycodone

They are the most powerful painkillers that family doctors have at their disposal, and as the queue of patients suffering from chronic pain grows longer doctors have been handing them out in greater numbers.

A review by the National Treatment Agency for Substance Abuse, published in June, found a six-fold increase in the prescribing of opioid analgesics by GPs from 228 million items in 1991 to 1.38bn items in 2009.

Brian Iddon, the former chairman of the All Party Parliamentary Group on Drug Misuse, which reported in 2009, warned that the UK faced a similar epidemic to that in North America within a decade. MesDes Spence, a GP in Glasgow, wrote in the BMJ that the increased prescribing of opioid for chronic pain e other than that caused by cancer - was a “disaster in the making”.

The increase is being driven by drug-company marketing that is fuelling patient demand.

As populations age in the UK and across Europe, and more succumb to conditions such as arthritis, between 20 and 50 per cent are estimated to suffer from chronic pain.

Chronic pain caused by injury or disease has been poorly treated in the past and specialists acknowledge the growing use of powerful painkillers is a sign of a more compassionate society, prepared to dispense comfort to those in need. But there is a risk, as doses rise and dependence grows, that the dangers outweigh the benefits.

The review, Addiction to Medicines, by the National Treatment Agency for Substance Abuse, found that 3,735 patients receiving treatment for addiction said their primary problem was with prescription medicines, just 2 per cent of the total in drug-treatment services.But the authors admitted that most of those with such a problem would be likely to seek treatment from their GPs.

Breakthrough offers hope in breast cancer fight

A naturally occurring molecule in bacteria can block the development of breast cancer, scientists have discovered, paving the way for the design of more potent and selective drugs.

The molecule, thiostrepton, clamps FOXM1, a cancer-causing protein present in greater amounts in breast cancer cells.

It switches on genes regulating the growth and division of cells, causes tumours to spread and triggers the growth of blood vessels.

Blocking this protein may prevent the development of cancer at an early stage as well as blocking its growth and spread according to the study published in Nature Chemistry.

Its lead author, Professor Shankar Balasubramanian, based at Cancer Research UK in Cambridge, said: “Before this research we weren’t aware of any natural product which could directly target a protein that controls gene activity. Yet intriguingly a molecule in bacteria û which also has strong antibiotic effects û does this very well, switching off cancer-causing genes in breast cancer cells.”

- The Independent

Point of entry for Ebola virus identified

Although outbreaks are rare, Ebola virus, the cause of Ebola hemorrhagic fever (EHF), is one of the deadliest known viruses affecting humans. According to the World Health Organisation (WHO), approximately 1,850 EHF cases with more than 1,200 deaths have been documented since the virus was identified in 1976.

EHF’s clinical presentation can be devastating: fever, intense weakness, and joint and muscle aches progress to diarrhea, vomiting, and in some cases, internal and external bleeding caused by disintegrating blood vessels. Currently, there is no approved vaccine and patients are treated only for their symptoms. Like anthrax and smallpox virus, Ebola virus is classified as a category A bioterrorism agent by the U.S. Centers for Disease Control and Prevention (CDC).

Until now, however, researchers had only a limited understanding of how Ebola virus gains entry to a host cell.

Using an unusual human cell line, scientists and collaborators have identified the Niemann-Pick C1 (NPC1) protein as crucial for Ebola virus to enter cells and begin replicating.

The discovery may offer a new and better approach for the development of antiviral therapeutics, as it would target a structure in the host cell rather than a viral component. The findings are reported online in Nature this week.

“Right now, people make therapeutics to inactivate the pathogen itself. But the problem is that pathogens can quickly change and escape detection and elimination by the immune system,” says former Whitehead Fellow Thijn Brummelkamp. “Here we get a good idea of the host genes that are needed for the pathogen to enter the cell for replication. Perhaps by generating therapeutics against those host factors, we would have a more stable target for antiviral drugs.”

The method developed by the Brummelkamp lab to identify host factors relies on gene disruption knocking out gene function in the host cells, one gene at a time and documenting which cells survive due to mutations that afford protection from viral entry.

But human cells are diploid with two copies of each chromosome and its genes. Researchers can reliably target and knock out one copy of a gene, but doing so for both copies is far more difficult and time-consuming. If only a single copy is silenced, the other continues to function normally and masks any effect of the knockout.

To sidestep this obstacle, Jan Carette, employed a technique he had previously applied to study the cytolethal distending toxin (CDT) family that is secreted by multiple pathogenic bacteria, including Escherichia coli, Shigella dysenteriae, and Haemophilus ducreyi. Each bacterial species has developed its own twists on the CDT structure, which may link to the target tissues of the toxin’s bacterium.

Using this virus and by altering the haploid cells somewhat, Carette and coauthors were able to pinpoint the cellular genes that Ebola virus relies on to enter the cell.

Source: Whitehead Institute for Biomedical Research

The dark side of prescription drugs

Mention of drug addiction typically conjures up images of strung-out users of heroin or crack cocaine. But a growing number of people are dependent on legal drugs, prescribed by their doctors, with a grip as unforgiving as that of their illegal counterparts. It is a problem that cannot keep being ignored.

Despite the efforts of campaigners, the blight of addiction to prescription medicines in particular opiate-based painkillers and benzodiazepine tranquillisers - remains low on the agenda and largely unexamined.

What glimmers of statistical light there are, are increasingly disturbing. Opiate painkillers are being dispensed at five times the rate they were 20 years ago, for example, while deaths involving codeine doubled between 2005 and 2009 alone.

In part, the problem reflects patient demand. There is a growing battery of drugs to combat anxiety and chronic pain, and sufferers are unsurprisingly keen to make use of them. But there is a balance to be struck. Patients may not be aware of the potency of their medication until it is too late, while GPs too often boost doses far above recommended levels if patients’ complaints continue.

The real worry is the unknown scale of the problem. While estimates suggest around 1.5 million people could be hooked on their medicine, the issue receives so little attention that there may be many more who are unaware they have a problem, and there is little support for those that do.

The piecemeal approach from the Department of Health so far is insufficient. Addiction to prescription drugs needs a coordinated response: clearer guidelines for doctors, closer monitoring of patients, tighter controls on drug marketing, more help for addicts.

But the crucial first step, as with addiction, is to face up to the fact there is a problem.

-The Independent

Bone marrow transplantation and cancer resistance

Bone marrow transplantation with genetically modified cells may prolong the period of cancer-free survival, suggests a study done recently.

Bone marrow, a spongy tissue inside bones, contains stem cells that produce blood cells, including leukocytes, erythrocytes and platelets.

Dr. Vivek Rangnekar and his team explore the transfer of bone marrow from Par-4/SAC-transgenic donor mice to control mice as a means of transferring anti-cancer potential. Par-4 (also known as PAWR) is a tumor suppressor protein that selectively induces apoptosis in cancer cells, but not normal cells.

This function of Par-4 is mediated by its central core domain, SAC. SAC-transgenic mice are resistant to the growth of spontaneous and inducible tumors.

After transplantation, the researchers discovered the expression of cancer-killer SAC-GFP activity in bone marrow cells of the recipient mice, implying the successful transfer and colonisation of the anti-cancer tissue from the donors. In addition, soluble Par-4 or SAC protein injected into mice inhibited the growth of metastatic tumors. Rangnekar, the Alfred Cohen Endowed Chair of Oncology Research at Markey, says the study shows promise for treating both primary and metastatic tumors.

“We are excited by the findings of this study as they indicate that secreted Par-4 is systemically active in mice,” Rangnekar said.

“Optimization of the bone marrow transplantation procedure using stem cells that are genetically modified to systemically secrete potent protein payloads of Par-4/SAC killer activity may offer a new approach to treat not only primary tumors but also metastatic tumors of diverse origin.”

Source: University of Kentucky

Diversified diets and food sources

Diversified diet will improve health and it will protect us from certain bone diseases. Therefore, we should be aware of those nutrients. So, what are those nutrients and their food sources?

* Calcium is the major nutrient that is responsible for bone formation. However, it is essential to take more calcium during childhood and adolescence, because, during 16-18 years bones reaches to its peak bone mass. Milk and other dairy products such as cheese, yoghurt etc. as well as small fish, canned fish, beans, spinach, sweet potato, pulses, nuts and cereals contain calcium.

* Phosphorus is important for bone formation. Many foods contain phosphorus. Among those foods, animal foods such as meat, poultry, fish as well as grain products are rich in phosphorus. However, this mineral lacks in milk and other dairy products although they are rich in calcium.

* Vitamin D regulates bone calcium absorption and resorption when change the blood calcium level. Sunlight is the main source of vitamin D for us as Sri Lankans. Herrings, sardine and fish liver oil are good animal sources while small portions of vitamin D can be taken from eggs, veal, beef, butter and vegetable oils. However, plants, fruits, and nuts are poor sources of vitamin D.

* Vitamin A involves in bone remodelling. Richest sources of vitamin A are fish oils, liver and other organ meats. Full-cream milk, butter, fortified margarine are also rich in vitamin A. Dark green leafy vegetables, carrots and deep orange sweet potato are plant sources.

* Vitamin K produces bone proteins. They involve in bone formation and in bone metabolism. This vitamin is found only in limited number of foods such as dark green leafy vegetables, spinach, cabbage, soy oil and certain types of cheese.

* Vitamin C stimulates collagen formation that is responsible for bone matrix formation. Fresh fruits and vegetables are rich in vitamin C.

To improve the bone health it is very much important to concern on food intake as well as physical activities. For that, should have diversified diet. That means foods that we take per day should consist of cereals or starchy roots, legumes, vegetables, fruits, milk and milk products, meat or fish. This type of diet will provide you with required types of nutrients and improve your bone health.

In contrast, diversified diet is not enough. With that, it is essential to do enough physical activities such as playing, running, swimming etc.

It will improve absorption of nutrients and improve proper functioning of bones. Smoking and excessive alcohol intake also badly affect on your bone health.

Therefore, prevent from bone diseases by improving your bone health through intake of diversified diets with sufficient level of physical activities and by following good lifestyle patterns. To do this do not wait until you become an adult, from the childhood practise good habits.

- Madusha Wijesinghe, Wayamba University.