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Friday, 3 May 2013

Humans vs. Superbugs: Who Will Win?

Back in the late 1960s, U.S. Surgeon General Dr. William H. Stewart allegedly made this provocative, very definitive statement: “It is time to close the book on infectious diseases, and declare the war against pestilence won.”Fast forward 50 years and the U.K.’s Chief Medical Officer, Dame Sally Davies, had quite a different take, saying that antibiotic resistance to disease poses nothing less than an “apocalyptic” threat, reported The Guardian. The Centers for Disease Control added its voice, saying that antibiotic-resistant bacteria were a “nightmare,” and called for action.
So what happened in those 50 intervening years?
Nothing that you couldn't see coming, which may make the current state of affairs even more tragic. The truth is, antibiotic resistance goes way back. In 2012, a group of scientists from the University of Akron, Ohio, and McMaster University, in Ontario, Canada, reported in PLOS One on the discovery of antibiotic-resistant bacteria in an underground cave in New Mexico that has been isolated for about four million years. It helps to understand a few of the basics about resistance. First, there are two types—intrinsic andacquired. If a bacterium is intrinsically (or innately) resistant to a given antibiotic, the bacterium is resistant to a certain type of antibiotic coded into its DNA. Either due to the way the bacterium is structured or the way it functions, certain antibiotics are powerless against the germ.As we create more antibiotics and introduce them into the environment, in animals, and in humans, microbes get smarter. They evolve for survival; this is called acquired resistance. Bacteria can acquire resistance either through a genetic mutation or by receiving genetic material from other bacteria who already have resistance. In science-speak, this is referred to as “horizontal gene transfer.”The modern era of antibiotics really started in the early 1900s with German scientist Paul Ehrlich. While looking for something that could kill specific bacteria, he produced a chemical dye, commercially known as Salvarsan; this compound (arsphenamine) became a magic bullet treatment against syphilis. Then, in 1928, English scientist Alexander Fleming noticed something odd in one of the petri dishes in which he had been culturing bacteria: Mold had begun to grow. Around the mold, all the bacteria was gone—it had been killed; this mold was Penicillum notatum, what we know today as penicillin.A few years later, in 1935, German biochemist Gerhard Domagk created the first commercially available antibiotic, sulfonamide (or Prontosil as it was known then); these are the “sulfa drugs” we still use today and that have been used to treat infections that cause meningitis and pneumonia. By the late 1930s scientists Howard Florey and Ernst Chain had picked up on Fleming’s research and, after teaming up with an American agricultural company, they began producing penicillin as a widely available antibiotic—just in time for America’s entry into World War II. By the end of the war, penicillin was in mass production. With sulfa drugs and penicillin as huge success stories, the U.S. was beating back infectious disease.At least that’s what we thought. In the mid-1940s, Fleming saw what might be coming and issued a warning in the New York Times: We should avoid the overuse of penicillin if we want to stem the proliferation of antibiotic resistance, he said; even then, there was already growing resistance to sulfonamides, the first antibiotics.Even if Fleming’s message had sunk in, it’s clearly been forgotten today. According to a 2009 article in the New England Journal of Medicine, nearly three million kilograms—about 6.6 million pounds—of antibiotics were given to humans that year. A year later, twice as much—about 13 million kilograms—were given to animals. Other reports suggest that about half of the antibiotics prescribed in 2010 were not even needed. Antibiotic resistance is so worrisome to many infectious disease and other health experts that it even earned a spot in the World Economic Forum’s 2013 Global Risks Report.Today, members of the science and medical communities plead for more attention to the issue, but and as journalist Maryn McKenna writes in Wired magazine, the pleas are met with “instant alarm, followed almost immediately by apathy.”So what, truly, is the outlook? Are we doomed? Will the bugs eventually win—or do we have a shot at doing something about the growing resistance to superbugs like MRSA, carbapenem-resistant enterobacteriacae, and malaria? The Food and Drug Administration says it has groups on the case, like its Center for Drug Evaluation and Research and the government-initiated surveillance program, the National Antimicrobial Resistance Monitoring System (NARMS).But many say we are not doing nearly enough. The UK Health Protection Agency and Dame Davies say that the “pipeline [for antibiotics] is running dry” and that we have a broken model for antibiotic production. Drug companies favor medications for chronic diseases like diabetes and hypertension since these conditions require medications over years or decades, so are much more profitable than short-term treatments like antibiotics.The Infectious Disease Society of America (ISDA) reports that our progress toward the goal of developing 10 new antibiotics by 2020 is definitely not on track: Just two new antibiotics have been approved since 2009. And only seven more are in stages two or three of research and development—a figure ISDA calls “alarmingly low.” ISDA’s graph showing how many antibiotics have been approved over the past few decades makes this very clear: In the 1980s as many as 16 new antibiotics were approved.But there is hope. In the same New England Journal of Medicine piece, physicians outlined five areas of focus in the fight to beat the superbugs, as well as the current status of each (meaning whether we are making progress or not). Our goals, they said, should include:
• Preventing infection and resistance
• Refilling the antibiotic pipeline by aligning economic and regulatory approaches (making it easier to develop, approve, and distribute improved antibiotics)
• Preserving the antibiotics we already have and slowing resistance to these drugs (This may mean decreasing or eliminating use of the drugs in animals for growth, for example, and better public reporting on antibiotic use to get a clear idea of who’s using antibiotics and why, partly to help stem the prescribing of unnecessary drugs.)
• Looking at treatments that attack microbes with decreased potential to drive resistance, which may mean we need to develop methods that don’t kill bacteria, but prevent them from causing disease in people.
• Developing treatments that target the host (i.e., people and animals) rather than microbes to avoid making resistance worse.
Whatever efforts we undertake, though, one message is crystal clear: We can no longer be apathetic about antibiotic resistance.
In the coming weeks we’ll be taking a look at some of the superbugs posing the biggest threat, both in the U.S. (carbapenem-resistant enterobacteriacae, MRSA, gonorrhea) and abroad (drug-resistant tuberculosis and malaria).
Courtesy:Anna Tomasulo

Study: Exercise cuts kidney stone risk in women

Women have another reason to exercise: It may help prevent kidney stones. You don't have to break a sweat or be a super athlete, either. Even walking for a couple hours a week can cut the risk of developing this painful and common problem by about one-third, a large study found."Every little bit makes a difference" and the intensity doesn't matter — just getting a minimum amount of exercise does, said Dr. Mathew Sorensen of the University of Washington School of Medicine in Seattle.He led the study, which was to be discussed Friday at an American Urological Association conference in San Diego.About 9 percent of people will get a kidney stone sometime in their life. The problem is a little more common in men, but incidence has risen 70 percent over the last 15 years, most rapidly among women.Obesity raises the risk as do calcium supplements, which many women take after menopause. A government task force recently advised against supplements for healthy older women, saying that relatively low-dose calcium pills don't do much to keep bones strong but make kidney stones more likely.The new research involved nearly 85,000 women 50 and older in the government-funded Women's Health Initiative study. All had an exam to measure weight and height so doctors could figure out their body mass index, a gauge of obesity. They also filled out annual surveys on what they ate, so researchers could take into account things known to lower the risk of kidney stones, such as drinking a lot of fluids and eating less salt or meat.Participants said how much exercise they usually got and that was translated into "METs" — a measure of how much effort an activity takes. For example, 10 METs per week is about 2 1/2 hours of walking at a moderate pace, four hours of light gardening or one hour of jogging.After about eight years, 3 percent of the women had developed a kidney stone. Compared to women who got no leisure-time exercise, those who got up to 5 METs per week had a 16 percent lower risk for stones. The risk was 22 percent lower with 5 to 10 METs per week and 31 percent lower for 10 METs or more. Exercise beyond 10 METs added no additional benefit for kidney stone prevention.Exercise intensity didn't matter — just how much women got each week."We're not asking people to run marathons. This is just a very mild to moderate additional amount of activity," Sorensen said.Why might exercise help? It changes the way the body handles nutrients and fluids that affect stone formation. Exercisers sweat out salt and tend to retain calcium in their bones, rather than having these go into the kidneys and urine where stones form. They also tend to drink water and fluids afterwards, another plus for preventing stones."There's something about exercise itself that probably produces things in your urine that prevent stone formation," said one expert not involved in the work, Dr. Kevin McVary. He is chairman of urology at Southern Illinois University School of Medicine in Springfield, Ill., and a spokesman for the urology group. "It's not just being skinny or not being fat, it's something about the exercise that protects you."Exercise is known to cut the risk of heart disease, diabetes, high blood pressure and other conditions that raise the risk of kidney stones. Next, researchers want to study men and younger women to see if exercise helps prevent kidney stones in them, too .
Source:AP News

Teens with high blood pressure have less distress, better quality of life

German study in Psychosomatic Medicine has surprising findings on hypertension in adolescents

 Teenagers with high blood pressure appear to have better psychological adjustment and enjoy higher quality of life than those with normal blood pressure, suggests a study in the May issue of Psychosomatic Medicine: Journal of Biobehavioral Medicine, the official journal of the American Psychosomatic Society. The journal is published byLippincott Williams & Wilkins, a part of Wolters Kluwer Health.
"This is the first report linking elevated blood pressure to quality of life and psychosocial adaptation in a large epidemiological study of adolescents," according to the report by Dr Angela Berendes of University of Göttingen, Germany, and colleagues. The authors speculate on some possible reasons for their surprising results—including "repressed emotions" or even a "stress-dampening effect" of high blood pressure (hypertension).
High Blood Pressure Linked to Better Quality of Life in Teens
The researchers analyzed data on blood pressure, quality of life, and psychological distress in approximately 7,700 teenagers from a German nationwide study. Overall 10.7 percent of the teens had high blood pressure—a rate about twice as high as expected.
Not surprisingly, adolescents with hypertension were more likely to be obese and less physically fit than those with normal blood pressure. They spent more time watching TV or playing video games and had more adverse health behaviors, including alcohol consumption.
But unexpectedly, teens with high blood pressure were better off in several ways—including being more academically successful than those with normal blood pressure. Quality of life was also rated better by adolescents with high blood pressure, with higher scores in the areas of family life, self-esteem, and physical well-being.
The difference in quality of life remained significant after adjustment for other factors, and was supported by parental ratings of fewer emotional, conduct, and other problems. Teens with high blood pressure were also less likely to have problems with hyperactivity.
Associations May Reflect High Achievement, Repressed Emotions, or…?
High blood pressure is one of the most frequent chronic conditions, leading to high rates of illness and death. It can remain asymptomatic for years, causing blood vessel and organ damage if not detected and controlled.
Hypertension may start in childhood and adolescence, persisting into adulthood. Previous studies have found lower levels of psychological distress in adults who have high blood pressure but are unaware of it. In contrast, quality of life appears to be reduced for patients whose hypertension is diagnosed and treated.
The new study finds similar, "seemingly contradictory" results in adolescents. Although their study can't conclusively explain the associations, Dr Berendes and coauthors discuss some possible theories:

  • Teens who are more achievement-oriented and do better in school may experience increased stress, leading to higher blood pressure—but also to better self-esteem and quality of life.
  • Some teens may repress their negative emotions, causing them to have higher blood pressure—as well as to give higher ratings of psychological functioning and quality of life.
  • High blood pressure may actually act to dampen negative emotions—some studies have suggested that a rise in blood pressure may reduce perceived stress.

Whatever the explanations, the new study finds highly consistent links between high blood pressures, lower distress, and higher quality of life, suggesting "a real and epidemiologically relevant association," Dr Berendes and coauthors conclude. More research is needed to clarify the study implications—particularly in young patients who are unaware of and have yet to experience long-term damage related to high blood pressure.
Source:Psychosomatic Medicine Journal of Bio-behavioral Medicine

Health Ministry recommends compulsory licensing of three anti-cancer drugs

The Union Health Ministry has disclosed that it had recommended three cancer drugs, namely, Trastuzumab, Lxabepilone and Dasatinib to the Department of Industrial Policy & Promotion to put them under Compulsory Licensing (CL) under the provisions of the Indian Patents Act, 1970.
Although the administrative Department for the Indian Patents Act, 1970 is the Department of Industrial Policy and Promotion in the Ministry of Commerce and Industry, the Ministry of Health & Family Welfare, constituted an inter-ministerial committee to recommend to put such drugs, which are extremely costly and not affordable, under compulsory licensing under the provisions of the Indian Patents Act, 1970, Union health minister Ghulam Nabi Azad told Rajya Sabha recently.
On the basis of the recommendations of this Committee, the Union Health Ministry has recommended the three cancer drugs to put them under compulsory licensing, the Minister said in a written reply.
“The prices of drugs for many diseases, including cancer, have become extremely unaffordable for the common man in this country, which have also increased the pressures on the public health programmes. Compulsory licences under the Indian Patents Act, 1970 can be issued to generic producers. Generic version of the drugs leads to significant price reductions in developing countries,” he said.
It may be noted that Mumbai-based BDR Pharmaceuticals has already filed application for compulsory licence for anti-cancer drug Dasatinib, patented by pharma major Bristol Myers Squibb. BMS sells Dasatinib at around Rs. 1,68,000  for one month dose, but BDR has promised to sell it at Rs. 8100, it is learnt.
The first application for CL was the one filed by Natco Pharma to sell the cheaper version of Bayer AG’s cancer Drug Nexavar, triggering a highly-watched legal battle. The Indian company was granted the CL in an epoch-making verdict last year and the ruling was recently upheld by the IPAB recently.


Trying to Get Pregnant? Fertility Yoga may be the Answer

Yoga is an ancient Indian science involving the physical, mental and spiritual disciplines to improve the mind, body and soul.Fertility yoga, a recent concept, is a holistic therapy that focuses specifically on your reproductive health and makes you better prepared for pregnancy both physically and emotionally. Although yoga poses as such won't make you pregnant, it is the benefits of yoga in terms of stress busting, anxiety relief and healthier body and mind that might help you get pregnant. 
Timothy McCall, medical editor of Yoga Journal, says, "When you're under chronic stress, your brain shifts into survival mode and ratchets up production of stress hormones like cortisol and epinephrine, while slowing production of sex hormones. The combination can upset your ovulation schedule, making it difficult to become pregnant. Of course, a little stress is normal, but if you constantly feel wired, it's time to tackle your stress head-on". 
'The gradual unraveling of the complexities of neuroendocrinology have permitted increased understanding of the role that stress might play in infertility. Catecholamines, prolactin, adrenal steroids, endorphins, and serotonin all affect ovulation and in turn are all affected by stress' - agrees a study published in the journal Fertility and Sterility. And what better way to tackle stress and anxiety than yoga!
Yoga gurus recommend gentle yoga poses of Kripalu or basic Hatha yoga rather than vigorous yoga such as Ashtanga Vinyasa or Bikram yoga. They suggest avoiding any of the postures that cause compression on the abdominal wall, for example, ardha baddha padma pachimottanasana, janu sirsasana and Marichyasana postures in Ashtanga vinyasa yoga if you are trying to get pregnant. 
And now, Holistic fitness registered nurse and yoga instructor in Florida, Sherry Longbottom, claims to have developed her own style of fertility yoga which avoids poses that strain the body and favors simple poses to reduce anxiety and to get blood flow in the pelvic area. 
Although it may not be as beneficial as IVF treatments or hormone therapy, she says, "We live in fight or flight mode. That kind of life goes completely against what we're trying to look for in creating a fertile environment." 
And even if you are undergoing fertility treatments, yoga can be practiced as adjunct therapy. According to a study published in Fertility and Sterility - 'Yoga and meditation can help women experiencing the challenges of infertility. The practice of meditation and relaxation can help increase the clarity of the mind, maintain healthy body chemistry, and give patients the patience to undergo the rigors of infertility treatments'. 
Dr. James Goldfarb, the director of infertility and in-vitro fertilization at University Hospital Cleveland, approves of patients trying safe alternative therapies. 
"The bottom line I always tell patients is, it certainly can't hurt. We're very encouraging [that they] try whatever they find relief through. To say someone is going through IVF is going to be stressed is like saying someone is going to hit their thumb with their hammer and it's going to hurt. It's incredibly stressful," he comments. 
The ability of yoga to help with mental health as well as physical health was one reason Longbottom wanted to start the fertility yoga class. 
'Mind, body and spirit are all tied together; once you address those areas, you're taking care of your whole body', she says. 

Source:University Hospital Cleveland, 

Early Pregnancy Reduces Risk of Breast Cancer

 Early Pregnancy Reduces Risk of Breast Cancer Getting pregnant at a young age is known to protect a woman against breast cancer, suggests study. 
Researchers in BioMed Central found that Wnt/Notch signalling ratio is decreased in the breast tissue of mice which have given birth, compared to virgin mice of the same age.
In humans having a child before the age of 20 decreases risk of breast cancer by half. 
Using microarray analysis researchers from Basel discovered that genes involved in the immune system and differentiation were up-regulated after pregnancy while the activity of genes coding for growth factors was reduced. 
The activity of one particular gene Wnt4 was also down-regulated after pregnancy. 
The protein from this gene (Wnt4) is a feminising protein - absence of this protein propels a foetus towards developing as a boy. 
Wnt and Notch are opposing components of a system which controls cellular fate within an organism and when the team looked at Notch they found that genes regulated by notch were up-regulated, Notch-stimulating proteins up-regulated and Notch-inhibiting proteins down-regulated. 
Wnt/Notch signalling ratio was permanently altered in the basal stem/progenitor cells of mammary tissue of mice by pregnancy. 
Mohamed Bentires-Alj from the Friedrich Miescher Institute for Biomedical Research, who led this study said, "The down-regulation of Wnt is the opposite of that seen in many cancers, and this tightened control of Wnt/Notch after pregnancy may be preventing the runaway growth present in cancer." 
The research is published in the open access journal Breast Cancer Research.

The research is published in the open access journal Breast Cancer Research.


Scientists Discover New Target for Personalized Cancer Therapy

 Scientists Discover New Target for Personalized Cancer TherapyA novel method developed by scientists was found to disrupt the tumor growth signaling pathway, with findings that suggest a new treatment for breast, colon, melanoma and other cancers.The research team has pinpointed the cancer abnormality to a mutation in a gene called PIK3CA that results in a mutant protein, which may be an early cancer switch. By disrupting the mutated signaling pathway, the Case Western Reserve team, led by John Wang, PhD, inhibited the growth of cancer cells, opening the possibility to new cancer therapies. 
Cancer arises from a single cell, which has mutated in a small number of genes because of random errors in the DNA replication process. These mutations play key roles in carcinogenesis. 
"This discovery has a broad impact on the treatment of human cancer patients because so many cancers are affected by this particular mutation in the p110a protein, which is encoded by the PIK3CA gene," said Wang, an associate professor in the Department of Genetics and Case Comprehensive Cancer Center. 
"This is a significant advance because we can now disrupt this misdirected signaling pathway in cancer cells," the researcher added. 
"If you turn on a light, you have to turn on a switch. But in the case of the mutation of this protein, p110a turns on by itself," Wang explained. 
"The mutation rewires the circuit and is uncontrolled. This implies that if you break these wires, you can control the growth of cancer. Our current discovery may lead to finding less toxic drugs that can be used for personalized treatment for cancer patients in the future," he added. 
This research will impact the field by focusing us on new targets for treating and preventing metastasis in patients in a many different types of human cancers, noted Stanton Gerson, MD, Asa and Patricia Shiverick-Jane Shiverick (Tripp) Professor of Hematological Oncology, and director of Case Comprehensive Cancer Center and of Seidman Cancer Center at University Hospitals Case Medical Center. 
Their findings were published in the journal Cancer Cell.


Gene Expression Test Helps to Distinguish Risk Factor in Breast Cancer Patients

A test that measures the expression levels of 58 genes in oestrogen receptor-positive breast cancers can effectively differentiate between patients who are at higher and lower risk for having their cancer recur elsewhere in the body more than five years after diagnosis, researchers report.The new findings show that better individual risk prediction for women with these cancers is getting nearer, says study author Prof Michael Gnant from the Medical University of Vienna, Austria. 
Prof Gnant reported the findings at the 5th IMPAKT Breast Cancer Conference in Brussels, Belgium. The IMPAKT meeting presents cutting edge, 'translational' breast cancer research that is beginning to have an impact for patients. 
Metastasis after 5 years of follow-up is an important research issue, particularly in hormone-receptor positive breast cancer, Prof Gnant explains. 
"Despite all great progress we have made in the treatment of this most frequent subtype of breast cancer, some patients develop metastasis many years after their initial diagnosis. Extending adjuvant endocrine therapy to prevent this is an option, but comes with substantial side-effects and cost for society, and should therefore be reserved for those patients who really need it. Thus, better defining individual risk for late metastasis is an important medical and scientific need," Prof Gnant says. 
The PAM50 Risk of Recurrence (ROR) score used by the researchers in this study directly measures the expression levels of 58 different genes (50 discriminator genes and 8 controls). 
Prof Gnant and colleagues performed the PAM50 analysis on 1,478 patients who had taken part in the ABCSG-8 trial, which ran from 1996 to 2009. They found that the PAM50 ROR score provided significant prognostic information in addition to clinical factors with respect to late distant-relapse-free survival. 
After 11 years of median follow-up, of patients who were classified by the test as having low risk, 98.7% had not had a late metastasis between 5 and 10 years of follow-up, compared to 91.5% of those with a high PAM50 ROR score. This was true both for node-positive and node-negative disease. 
"It makes a huge difference whether a patient looks at an individual risk of 1.3% or 8.5% between years 5 and 10. This is more than six times as much risk. Such important information may well be implemented into individual treatment decisions," Prof Gnant says. 
The researchers conclude that the PAM50 ROR score can successfully be used to differentiate patients with respect to their risk for late metastasis, in addition to established clinical and pathological risk factors. 
This ability to predict late metastasis may be used in the future to identify patients with endocrine-responsive breast cancer who need or alternatively who can be spared extended adjuvant therapy, they say. 
"We have to admit that at this point we cannot prove definitely that we will improve the outcome in patients we have now identified as high risk by extending their adjuvant therapy, but it appears logical that this may be the case. At least as important, if we can define an individual patient reliably as low risk, we can spare her the burden of unnecessary treatment extension," Prof Gnant says. 
Commenting on the results, Dr W Fraser Symmans, Professor and Director of Research Operations, Department of Pathology at the University of Texas M.D. Anderson Cancer Center, USA, said they were important for prognostic testing of early breast cancers and for confidently limiting the duration of endocrine therapy to 5 years for women with low-risk disease. 
"In the last 6 months it has become clear that three prognostic tests, including the PAM50 ROR score, have similar prognostic utility that holds for up to 15 years after initial diagnosis. It is particularly exciting for the diagnostic community that such newer tests could be offered by pathology laboratories, and might not require centralised testing. I look forward to seeing the results of studies that report the inter-laboratory consistency of these tests for determining the long-term prognosis for early breast cancer patients who received 5 years of adjuvant endocrine therapy," Dr Symmans said.

Source:University of Texas M.D. Anderson Cancer Center


A New Gene can Make Cancer Less Lethal

 A New Gene can Make Cancer Less Lethal"This master regulator is normally turned off in adult cells, but it is very active during embryonic development and in all highly aggressive tumors studied to date," says Linda Resar, M.D., an associate professor of medicine, oncology and pediatrics, and affiliate in the Institute for Cell Engineering at the Johns Hopkins University School of Medicine. "Our work shows for the first time that switching this gene off in aggressive cancer cells dramatically changes their appearance and behavior." A description of the experiments appears in the May 2 issue of the journal PLOS ONE
Resar has been investigating genes in the master regulator's family, known as high mobility group or HMG genes, for two decades. In addition to their role in cancer, these genes are essential for giving stem cells their special powers, and that's no coincidence, she says. "Many investigators consider cancer cells to be the evil twin of stem cells, because like stem cells, cancer cells must acquire special properties to enable the tumor to grow and metastasize or spread to different sites," she explains. 
In a previous study , she and her team devised techniques to block the HMGA1 gene in stem cells in order to study its role in those cells. In their prior work, they discovered that HMGA1 is essential for reprogramming adult cells, like blood or skin cells, into stem cells that share most, if not all, properties of embryonic stem cells. 
In the newly reported study, the Resar team applied the same techniques to several strains of human breast cancer cells in the laboratory, including the so-called triple negative cells — those that lack hormone receptors or HER2 gene amplification. Triple-negative breast cancer cells tend to behave aggressively and do not respond to many of our most effective breast cancer therapies. The Resar team blocked HMGA1 expression in aggressive breast cancer cells and followed their appearance and growth patterns. 
"The aggressive breast cancer cells grow rapidly and normally appear spindle-shaped or thin and elongated. Remarkably, within a few days of blocking HMGA1 expression, they appeared rounder and much more like normal breast cells growing in culture," says Resar. The team also found that the cells with suppressed HMGA1 grow very slowly and fail to migrate or invade new territory like their HMGA1-expressing cousins. 
The team next implanted tumor cells into mice to see how the cells would behave. The tumors with HMGA1 grew and spread to other areas, such as the lungs, while those with blocked HMGA1 did not grow well in the breast tissue or spread to distant sites. 
"From previous work, we know that HMGA1 turns on many different genes needed during very early development, but it's normally turned off by the time we're born," says postdoctoral fellow Sandeep Shah, Ph.D., who led the study. "Flipping that master regulator back on seems to be necessary for a cancer to become highly aggressive, and now we've seen that flipping HMGA1 off again can reverse that aggressive behavior." 
The next step, Resar says, is to try to develop a therapy based on that principle. The team is working with other researchers at Johns Hopkins to see whether HMGA1-blocking molecules could be delivered to tumors inside nanoparticles. Another possible approach, she says, would be to block not HMGA1 itself, but one of the pathways or processes that it affects. 
Researchers at Johns Hopkins have identified a gene that, when repressed in tumor cells, puts a halt to cell growth and a range of processes needed for tumors to enlarge and spread to distant sites. The researchers hope that this so-called "master regulator" gene may be the key to developing a new treatment for tumors resistant to current drugs.
Source:Johns Hopkins University 

Wednesday, 1 May 2013

Educating and Advising Prescribers can Prevent Overuse of Antibiotics in Hospitals

A new study by Cochrane researchers suggests that prescribers of antibiotics in hospitals should be educated, advised or restricted from overuse or inappropriate use of the drugs on patients.
Some infections are no longer treatable due to bacterial resistance. Compared to infections caused by treatable bacteria, those caused by multidrug-resistant bacteria lead to more deaths, longer hospital stays and increased healthcare costs. Reducing inappropriate use of antibiotics should help to slow the spread of resistant bacteria. Achieving this is proving difficult as by most estimates, antibiotic use in hospitals is rising, with some evidence suggesting more than a third of prescriptions are inappropriate. 
The review, published in The Cochrane Library, included 89 studies from 19 countries, with most studies aiming to decrease excessive antibiotic use. The researchers analysed data from two types of studies. In persuasive studies, doctors were given advice and feedback about prescribing antibiotics. In restrictive studies, restrictions were placed on prescribing, for example, doctors might be required to seek approval from a specialist. Overall, prescribing in hospitals improved and data from 21 studies showed that hospital infections decreased. 
"Our review shows that a wide variety of different interventions have been successful in changing antibiotic prescription in hospitals," said lead researcher Peter Davey, who is based at the Population Health Sciences Division at the University of Dundee in Dundee, UK. "However, we need more studies that explore how these changes benefit patients and how they impact on healthcare costs." 
Restrictive methods yielded greater improvements in prescription, although no studies undertook direct comparisons between restrictive and persuasive methods. "The fact that restrictive methods work well is important because it supports restriction of antibiotic use when the need is urgent, such as in an outbreak situation," said Davey. "However, the evidence base would be enormously enhanced by direct comparisons with persuasive methods." 

Source:The Cochrane Library



One in Four Teens Admit Abusing Prescription Drugs at Least Once in Their Lives

A nationally projectable survey conducted by The Partnership and MetLife Foundation released on reveals the rising trend of drug abuse among teenagers with the results showing an increase of 33 percent. It added that one in four teens have misused or abused prescription drugs at least once in their lifetime.The Partnership Attitude Tracking Study (PATS) also found troubling data on teen misuse or abuse of prescription stimulants. One in eight teens (13 percent) now reports that they have taken the stimulants Ritalin or Adderall when it was not prescribed for them, at least once in their lifetime. 
Contributing to this sustained trend in teen medicine abuse are the lax attitudes and beliefs of parents and caregivers. In fact, nearly one-third of parents say they believe Rx stimulants like Ritalin or Adderall, normally prescribed for attention deficit hyperactivity disorder (ADHD), can improve a teen's academic performance, even if the teen does not have ADHD. Parents are not effectively communicating the dangers of Rx medicine misuse and abuse to their kids, nor are they safeguarding their medications at home and disposing of unused medications properly. 

The Partnership at Responds to Rx Epidemic with The Medicine Abuse Project 
In response to the continued high prevalence of teen prescription medicine abuse as reported in the 2012 PATS data, The Partnership at is helping educate parents, community stakeholders and others about the risks of this dangerous behavior. The Partnership at leads The Medicine Abuse Project, a multi-year initiative with the goal of preventing half a million teens from abusing prescription medicine by 2017. 
The Medicine Abuse Project provides comprehensive resources to parents, educators, health care providers, law enforcement officials and others about the growing problem of teen medicine abuse. The Project aims to mobilize parents and the public at large to take action and help solve the problem of teen substance abuse. This includes learning about the issue, talking with their kids about the dangers of misuse and abuse of prescription drugs and properly monitoring, safeguarding and disposing of excess Rx drugs in their homes. 

Drug Enforcement Administration (DEA) Holds Nationwide Prescription Take-Back Day on April 27th 
One way parents, grandparents and other caretakers can take immediate action is by participating in the upcoming DEA-facilitated National Prescription Drug Take-Back Day, taking place this Saturday, April 27, 2013. 
"Medicine cabinets are the number one access point for teens who want to misuse and abuse prescription drugs. That's why we are making a concerted effort to let parents and caregivers know how important it is to safely dispose of their unused, unwanted or expired medicines. Doing so can literally save a life," said Marcia Lee Taylor, SVP of Government Affairs at The Partnership at "This Saturday's DEA Take-Back event gives everyone a chance to protect their kids from the dangers that medicine abuse poses in their own homes. We should all take this simple step and clean out our medicine cabinets." 
Collection sites will be set up around the country, open for medicine drop-off between the hours of 10:00 a.m. and 2:00 p.m. Those interested in disposing of their medicine at a take-back location this Saturday can visit The Medicine Abuse Project website to find the nearest site to safely drop off their unused, unwanted or expired prescription medicines. In the five previous Take-Back events, more than 2 million pounds of prescription medicines were safely dropped off and removed from circulation. 
The DEA Take-Back Day provides a tangible way for parents to help curb medicine abuse. The PATS data released today confirms that misuse and abuse of prescription drugs is now a normalized behavior among teens.Concerning Trends in Teen Prescription Drug Abuse According to the New PATS Data (2008-2012)One in four teens (24 percent) reports having misused or abused a prescription drug at least once in their lifetime (up from 18 percent in 2008 to 24 percent in 2012), which translates to about 5 million teens. That is a 33 percent increase over a five-year period:

  • Of those kids who said they abused Rx medications, one in five (20 percent) has done so before the age of 14.
  • More than a quarter of teens (27 percent) mistakenly believe that "misusing and abusing prescription drugs to get high is safer than using street drugs," and one-third of teens (33 percent) say they believe "it's okay to use prescription drugs that were not prescribed to them to deal with an injury, illness or physical pain."
"These data make it very clear: the problem is real, the threat immediate and the situation is not poised to get better," said Steve Pasierb, President and CEO of The Partnership at "Parents fear drugs like cocaine or heroin and want to protect their kids. But the truth is that when misused and abused, medicines - especially stimulants and opioids - can be every bit as dangerous and harmful as illicit street drugs. Medicine abuse is one of the most significant and preventable adolescent health problems facing our families today. As parents and caring adults, we need to take action to address the risks that intentional medicine abuse poses to the lives and the long-term health of our teens." 

Significant Increase in Teen Abuse of Stimulants Ritalin and Adderall, Rx Painkiller Abuse Flattening 
Rx stimulants are a key area of concern, with misuse and abuse of Ritalin and Adderall in particular driving the noted increases in teen medicine abuse. Stimulants are a class of drugs that enhance brain activity and are commonly prescribed to treat health conditions including ADHD and obesity. The 2012 data found: 
  • One in eight teens (about 2.7 million) now reports having misused or abused the Rx stimulants Ritalin or Adderall at least once in their lifetime.
  • 9 percent of teens (about 1.9 million) report having misused or abused the Rx stimulants Ritalin or Adderall in the past year (up from 6 percent in 2008) and 6 percent of teens (1.3 million) report abuse of Ritalin or Adderall in the past month (up from 4 percent in 2008).
  • One in four teens (26 percent) believes that prescription drugs can be used as a study aid.
Abuse of prescription pain medicine remains at unacceptably high levels among teens, but the new PATS data show it may be flattening. Teen abuse of prescription pain relievers like Vicodin and OxyContin has remained stable since 2011 with one in six teens (16 percent) reporting abuse or misuse of an Rx pain reliever at least once in their lifetime. One in 10 teens (10 percent) admits to abusing or misusing an Rx painkiller in the past year. 

Parents' Missed Opportunity: Lax Attitudes and Permissiveness About Rx Drugs Linked to Teen Abuse

  • Parent permissiveness and lax attitudes toward abuse and misuse of Rx medicines, coupled with teens' ease of access to prescription medicines in the home, are key factors linked to teen medicine misuse and abuse. The availability of prescription drugs (in the family medicine cabinet, in the homes of friends and family) makes them that much easier to abuse. The new survey findings stress that teens are more likely to abuse Rx medicines if they think their parents "don't care as much if they get caught using prescription drugs, without a doctor's prescription, than they do if they get caught using illegal drugs."
  • Almost one-third of parents (29 percent) say they believe ADHD medication can improve a child's academic or testing performance, even if the teen does not have ADHD.
  • One in six parents (16 percent) believes that using prescription drugs to get high is safer than using street drugs.
  • Teens reported that during the last conversation they had with their parents regarding substance abuse, only 16 percent said they discussed the misuse or abuse of prescription pain relievers with their parents, and just 14 percent indicate the same for discussions about any type of prescription drug. In comparison, a majority of teens (81 percent) say they have discussed the risks of marijuana use with their parents, 80 percent have discussed alcohol and nearly one-third of teens (30 percent) have discussed crack/cocaine.
  • More than half of teens (56 percent) indicate that it's easy to get prescription drugs from their parent's medicine cabinet. In fact, about half of parents (49 percent) say anyone can access their medicine cabinet.
  • More than four in 10 teens (42 percent) who have misused or abused a prescription drug obtained it from their parent's medicine cabinet. Almost half (49 percent) of teens who misuse or abuse Rx medicines obtained them from a friend.
Teens are more likely to use prescription drugs if they believe that their parents are more lenient toward prescription drug misuse or abuse compared to illegal drug abuse, and their parents use drugs themselves.
  • One in five parents (20 percent) report that they have given their teen a prescription drug that was not prescribed for them.
  • The PATS survey also found that 17 percent of parents do not throw away expired medications, and 14 percent of parents say that they themselves have misused or abuse prescription drugs within the past year.



Green Tea Helps Lose Weight

A compound present in green tea extract could be effective for body weight control and type 2 diabetes, shows study.In order to ascertain whether green tea truly has the potential to control body weight and regulate glucose in type 2 diabetes, Jae-Hyung Park and his colleagues from the Keimyung University School of Medicine in the Republic of Korea conducted a study. 
The active constituents of green tea, which have been shown to inhibit intestinal glucose and lipid uptake, are a certain type of flavonoid called gallated catechins. 
The researchers had previously suggested that the amount of gallated catechins necessary to reduce blood glucose concentrations could be achieved from a daily dose of green tea. However, the amount of green tea needed to decrease lipid uptake from the gut is higher and has been shown to have adverse effects in humans. 
Once in the bloodstream, gallated catechins can actually increase insulin resistance, which is a negative consequence especially in obese and diabetic patients. 
For their study, the researchers tested the effects of green tea extract on body weight and glucose intolerance in both diabetic mice and normal mice fed a high-fat diet. 
To prevent a high dose of gallated catechins from reaching the bloodstream, they also used a non-toxic resin, polyethylene glycol, to bind the gallated catechins in the gut to prevent their absorption. 
They then looked at the effects on the mice of eating green tea extract alone, and eating green tea extract plus polyethylene glycol. They compared these against the effects of two other therapeutic drugs routinely prescribed for type 2 diabetes. 
Results showed that green tea extract in isolation did not give any improvements in body weight and glucose intolerance. However, when green tea extract was given with polyethylene glycol, there was a significant reduction in body weight gain, insulin resistance and glucose intolerance in both normal mice on a high fat diet and diabetic mice. 
The polyethylene glycol had the effect of prolonging the amount of time the gallated catechins remained in the intestines, thereby limiting glucose absorption for a longer period. 
Interestingly, the effects of the green tea extract in both the intestines and in the circulation were measurable at doses, which could be achieved by drinking green tea on a daily basis. 
In addition, the effects of green tea extract were comparable to those found when taking two of the drugs, which are currently recommended for non-insulin dependent diabetes. 
The researchers concluded that "dietary green tea extract and polyethylene glycol alleviated body weight gain and insulin resistance in diabetic and high-fat mice, thus ameliorating glucose intolerance. Therefore the green tea extract and polyethylene glycol complex may be a preventative and therapeutic tool for obesity and obesity-related type 2 diabetes without too much concern about side effects." 
The result was published in the Springer journal Naunyn-Schmedeberg's Archives of Pharmacology.



Research on Tea

 Health Benefits of Tea RevealedRecent studies have unlocked eight reasons to why we should drink tea. 
Tea contains a small amount of natural fluoride, a chemical that can help prevent tooth decay, she said.When fluoride mixes with saliva, bacteria can't produce the acid by-products that promote cavities. Additionally, fluoride works to repair teeth in the early stages of tooth decay, she explained. 
Studies also show catechins (antioxidants) in green tea extract may trigger weight loss by stimulating the body to burn calories and decreasing body fat, especially in the abdominal (belly) area. 
Thanks to its polyphenols (the antioxidants found in tea), sipping on a cup may have cancer-fighting effects. 
While the overall research is inconclusive, evidence shows the polyphenols in tea, particularly catechins, have biological activities that may be relevant to cancer prevention, Bannan noted. 
These antioxidants have also been shown to inhibit tumor growth: green teas specifically have been shown to activate detoxification enzymes that may help protect against tumor development. 
One study from Italy found drinking three cups of green tea daily prevented prostate cancer in men who had precancerous cells indicating the presence of the disease. 
However, because the studies are inconclusive, the National Cancer Institute does not recommend for or against the use of tea to reduce the risk of any type of cancer 
Scientists now agree the 'eight glasses of water a day' rule is misleading and drinks such as tea and coffee can hydrate the body just along with water. It's still a good idea to aim for moderate caffeine intake, with no more than one to two cups at a time. 
According to a study conducted in the Netherlands and published in the Archives of Internal Medicine, drinking tea was associated with a more than 50 percent reduction in severe atherosclerosis (hardening and narrowing of the arteries) in women who drank 1 to 2 cups a day. 
Another study, published in the journal Stroke, found that long-term consumption of black, green, oolong or white tea can cut the risk of strokes by as much as 60 percent. 
Researchers say the antioxidants, found abundantly in tea, may play a critical role in preventing heart diseases. 
Tea might also help in the prevention and treatment of neurological diseases, especially degenerative diseases like Alzheimer's. 
Research shows the polyphenols in green tea may help prevent neurotransmitters involved in brain function, like dopamine and epinephrine, from degrading. It may also inhibit senile plaques from depositing in the brain, which impairs cognition. 
Overall, one to two cups of green tea a day may boost your learning and memory. 
Further, green tea has been found to improve bone mineral density and strength. 
Studies have shown that elderly women who drank tea had higher bone density in their hips and less bone loss than women who didn't drink tea. 
White tea has been found to be effective at fighting infections caused by staph and streptococcus bacteria, pneumonia and tooth decay. 
Researchers think the natural chemicals contained in white tea might provide many benefits to the immune system and overall health. 

Tuesday, 30 April 2013

Risk of depression influenced by quality of relationships, U-M research says

Results of large, national study find people are better off not having a spouse than having poor relationship with one

The mantra that quality is more important than quantity is true when considering how social relationships influence depression, say U-M researchers in a new study.
After analyzing data from nearly 5,000 American adults, the researchers found that the quality of a person's relationships with a spouse, family and friends predicted the likelihood of major depression disorder in the future, regardless of how frequently their social interactions took place.
Individuals with strained and unsupportive spouses were significantly more likely to develop depression, whereas those without a spouse were at no increased risk. And those with the lowest quality relationships had more than double the risk of depression than those with the best relationships.
The study, which was published online today in PLOS ONE, assessed the quality of social relationships on depression over a 10-year period, and is one of the first to examine the issue in a large, broad population over such a long time period.
Nearly 16 percent of Americans experience major depression disorder at some point in their lives, and the condition can increase the risk for and worsen conditions like coronary artery disease, stroke and cancer.
"Our study shows that the quality of social relationships is a significant risk factor for major depression," says psychiatrist Alan Teo, M.D., M.S., a Robert Wood Johnson Foundation Clinical Scholar at U-M and the study's lead author. "This is the first time that a study has identified this link in the general population."
Digging deeper into the results, the researchers found that certain positive and negative aspects of relationships also predicted depression. Social strain and a lack of support – especially in spousal relationships and to some extent with family members – were both risk factors for developing depression later.
"These results tell us that health care providers need to remember that patients' relationships with their loved ones likely play a central role in their medical care," Teo says. "They also suggest that the broader use of couples therapy might be considered, both as a treatment for depression and as a preventative measure."
While the results confirmed the researchers' assumptions about relationship quality, they did not find a correlation between the frequency of social interactions and the prevalence of depression as predicted. Even if participants were socially isolated, having few interactions with family and friends, it did not predict depression risk. Teo says this finding should also translate to mental health treatment considerations.
"Asking a patient how she rates her relationship with her husband, rather than simply asking whether she has one, should be a priority," Teo says.
The researchers say that the study's significant effect size – one in seven adults with the lowest-quality relationships will develop depression, as opposed to just one in 15 with the highest quality relationships – indicates the potential for substantial change in the general population.
"The magnitude of these results is similar to the well-established relationship between biological risk factors and cardiovascular disease," Teo says. "What that means is that if we can teach people how to improve the quality of their relationships, we may be able to prevent or reduce the devastating effects of clinical depression."
Source:University of Michigan Health System 

EMA committee recommends approval of Xtandi for treatment of advanced prostate cancer

Astellas Pharma Europe Ltd., the European Headquarters of Tokyo-based Astellas Pharma Inc., and Medivation, Inc. have received a positive opinion from the European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP), recommending European Commission (EC) approval for Xtandi (enzalutamide) capsules for the treatment of adult men with metastatic castration-resistant prostate cancer whose disease has progressed on or after docetaxel therapy.
Enzalutamide is a novel, once-daily, oral androgen receptor signalling inhibitor. It inhibits multiple steps in the androgen receptor (AR) signalling pathway, which has been shown to decrease cancer cell growth and can induce cancer cell death (apoptosis).
The positive CHMP opinion is based on results from the phase III AFFIRM study which confirmed that enzalutamide demonstrated a statistically significant improvement (p<0 .0001="" 0.631="" 13.6="" 18.4="" 4.8="" a="" advantage="" all="" also="" an="" and="" by="" compared="" concluded="" endpoints.="" enzalutamide="" generally="" group="" hazard="" in="" median="" met="" months="" of="" overall="" patients="" placebo="" ratio="" secondary="" span="" study="" survival="" that="" the="" to="" tolerated="" versus="" was="" well="" with="">
The CHMP's positive recommendation will be reviewed by the European Commission (EC), which has authority to approve medicines for the European Union. Astellas anticipates a final decision from the EC shortly, as this usually occurs approximately 60 days after a CHMP recommendation.
Professor Johann de Bono, Professor of Experimental Cancer Medicine at The Institute of Cancer Research, London, and Head of the Drug Development Unit at The Royal Marsden NHS Foundation Trust, comments: “This is an important development in prostate cancer therapeutics that will provide a critically important new treatment option for patients with Combined medical and consumer health release advanced prostate cancer. Enzalutamide has a major impact on quality of life and survival from this common disease, and will hopefully become a key component of prostate cancer treatment initially in late stage disease following chemotherapy.”
Prostate cancer is the most frequently diagnosed cancer among European men and it is becoming more common. Advanced prostate cancer is defined as cancer that has spread outside of the prostate to other areas of the body (metastasised).
Patients with metastatic CRPC currently have few treatment options. There is an unmet need in this area for new compounds that target the cancer differently and which may provide alternative therapeutic options for patients at this late stage of their disease.
Enzalutamide is a novel, oral, once-daily androgen receptor signalling inhibitor. Enzalutamide inhibits androgen receptor signalling in three distinct ways: it inhibits testosterone binding to androgen receptors; nuclear translocation of androgen receptors; and DNA binding and activation by androgen receptors.
Xtandi (enzalutamide) was approved by the US Food and Drug Administration on August 31, 2012 for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) who have previously received docetaxel (chemotherapy).
The phase III AFFIRM trial is a randomised, double-blind, placebo-controlled, multinational trial evaluating enzalutamide (160 mg/day) versus placebo in 1,199 men with progressive metastatic castration-resistant prostate cancer who were previously treated with docetaxelbased chemotherapy. Enrolment was completed in November 2010 and the interim analysis was triggered at 520 events. The median age of study participants was 69 years at baseline. The AFFIRM study was conducted at sites in the United States, Canada, Europe, Australia, South America and South Africa.
The primary endpoint of the AFFIRM trial was overall survival. Key secondary endpoints included time to prostate-specific antigen (PSA) progression, radiographic progression free survival (rPFS) and time to first skeletal-related event (SRE).
Astellas Pharma Europe Ltd., is a pharmaceutical company dedicated to improving the health of people around the world through the provision of innovative and reliable pharmaceuticals.
Medivation, Inc. is a biopharmaceutical company focused on the rapid development of novel therapies to treat serious diseases for which there are limited treatment options.


Study: Interventional Treatment Gains Popularity Against Life-threatening Diseases

 Study: Interventional Treatment Gains Popularity Against Life-threatening DiseasesAkash Saxena, 55, was diagnosed with liver cancer. A transplant would have cost him Rs 17-18 lakh (Rs 1.7-1.8 million). He got to know about Interventional Radiology (IR) at this point and it eventually saved his life."I took two sittings of chemoembolization at an interval of 6-8 weeks and I started feeling better physically. Thereafter, the cancer was treated without much pain either," Saxena, a South Delhi resident, told IANS. 
Chemoembolization is a minimally invasive treatment for liver cancer. Under this therapy, the maximum dose of chemotherapy is given to tumor cells and the toxic effect of chemotherapy is minimal. Thousands of patients in India who are diagnosed with life-threatening diseases like spinal tumor; liver, lung or prostate cancer, stroke and uterine fibroids often require painful invasive surgeries and chemotherapy as part of their treatment. 
Now, interventional treatments - which are also proving to be cost-effective and less painful - offer a new lease of life to hundreds of such patients. 
In a country like India, where people are diagnosed with serious diseases every three minutes, while one dies of the disease every 13 minute, these practices are gaining popularity, mostly in big cities. The practice is very common in western countries, doctors said. 
Interventional Radiology is a sub-speciality of radiology and utilizes minimally-invasive therapy to diagnose and treat diseases in almost all organs, usually as an alternative to traditional open surgery. 
"The practice is a rapidly growing area of medicine for treating a wide variety of disorders and diseases and is playing a role in developing new techniques that may improve cancer treatment, including the use of magnetic particles to draw cancer-killing agents into tumours; and the delivery of genetic material, called gene therapy, to fight or prevent cancers," Pradeep Muley, senior consultant and Interventional Radiologist at Fortis Hospital, told IANS. 
It is also used to treat blockages inside arteries and veins, to block off blood vessels that nourish tumors, destroy malignant tumors using focused heat and freezing, drain blocked organ systems such as the liver, gallbladder and kidney and perform biopsies that would otherwise require surgical exploration. 
Muley said that these are generally easier for the patient because it involves no incisions, carries less risk, causes minimum pain, is very cost effective and usually has shorter recovery times. 
Stating that there has been a 25 percent increase in patients opting for this treatment and is expected to rise 300 percent in coming years, Muley said that 98 percent of the patients, however, still opt for surgery even in conditions like fibroids and adenomyosis where removing the uterus is not required at all. 
"I must say people in India are still not aware of the treatment," he said. 
Interventional radiology first evolved in the 1960s when angioplasty procedures were developed to treat blockages in arteries as an alternative to open surgical bypass. 
Since then, the ability of interventional radiology techniques to treat an ever-expanding list of conditions continues to grow. 
Similar to Interventional Radiology, Interventional Neuroradiology (neurology), used in diagnosing and treating serious diseases related to the head, neck and spine is also becoming a popular practise in the country, doctors said. 
"The practice is very significant in treating various conditions. Interventional neuroradiology plays a critical role in dealing with cerebrovascular diseases and strokes and treating them using minimally-invasive procedures," Vipul Gupta, head of Neurovascular Interventional Center at Institute of Neurosciences in Medanta the Medicity, told IANS. 
"It also avoids long term damage that may occur during open surgeries and is highly cost-effective too," he said. 
Every year, over 1,000 patients - the highest in north India - undergo treatment through this procedure at the institute. The trend is also gaining recognition in other major cities across India, the doctor said. 
Gupta said though the practice is gaining recognition both among the patients and medical community in the country, it is still at the initial stages. 
He said about 80 percent of patients across Europe, and about 70 percent of patients in the US prefer this treatment over open surgeries, while in India, the majority of patients still undergo open surgeries. 
But it is slowly gaining popularity. 
"The issue is that there are very few properly trained professionals in the country. Also, the awareness among the patients is low and there is lack of an appropriate setup and equipment. But I am sure it will soon become very popular in India too. After all, it is cost-effective and less painful," Gupta asserted.


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