Monthly Archives: March 2016

World Tuberculosis Day: Present Scenario and Future Prospects

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Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis. It usually affects the lungs (pulmonary TB), but can affect other sites as well (extra-pulmonary TB). The disease usually spreads through air, for example by coughing. Overall, a relatively small proportion (5–15%) of the people infected with M. tuberculosis will develop TB disease during their lifetime.

World TB Day is celebrated every year on March 24 to commemorate Dr. Robert Koch, who announced his discovery of M. tuberculosis, on the same date in the year 1882

Incidence:

  • There were an estimated 9.6 million incident cases of TB globally, equivalent to 133 cases per 100,000 populations in the year 2014.
  • India, Indonesia, and China had the largest number of cases: 23%, 10% and 10% of the total cases, respectively.
  • An estimated 480,000 people developed multidrug-resistant TB (MDR-TB) globally in 2014.
  • The absolute number of incident cases has fallen over last few years; an average rate of reduction was 1.5% per year between 2000 and 2014, and 2.1% between the year 2013 and 2014. The cumulative reduction in the TB incidence rate from 2000 to 2014 was 18%.

Co-epidemics of TB and HIV

  • The probability of developing TB is much higher among people infected with human immune-deficiency virus (HIV).
  • Out of 9.6 million incident TB cases in 2014, there were approximately 1.1–1.3 million (11–13%) people living with HIV.
  • Almost three-quarters of these cases were noted in the African Region.

Mortality:

  • In the absence of treatment, the death rate of TB is very high.
  • There were an estimated 1.5 million TB deaths in 2014, including 0.4 million among people who were HIV-positive.

Treatment:

  • Effective drug molecules for TB were first developed in the 1940s. The most effective first-line anti-TB drug, rifampicin, became available in the 1960s.
  • The currently recommended treatment for new cases of drug-susceptible TB is a six-month regimen of four first-line drugs: isoniazid, rifampicin, ethambutol, and pyrazinamide.
  • MDR-TB, defined as resistance to isoniazid and rifampicin (the two most powerful anti-TB drugs), requires more expensive and more toxic drugs such as kanamycin, levofloxacin, cycloserine etc.
  • The duration of the current regimen recommended by World Health Organization (WHO) for MDR-TB is 20 months; however, treatment success rate is much lower for most patients with MDR-TB.

 

In 2014, the cost per patient treated for drug-susceptible TB ranged from US$ 100−500 in most countries with a high burden of TB. The cost per patient treated for MDR-TB was typically US$ 5000−10,000.

Between 2000 and 2014, TB treatment alone saved an estimated 35 million lives among HIV-negative people. Among HIV-positive people, TB treatment supported by anti-retroviral therapy (ART) saved an additional 8.4 million lives.

Research Pipeline

  • WHO has issued an interim guidance on the use of bedaquiline (in 2013) and delamanid (in 2014), two new drugs that have recently been recommended for the treatment of MDR-TB under specific conditions.
  • Additionally, eight new or re-purposed anti-TB drugs are in advanced phases of clinical development; some new chemical entities are discussed below:
    • For the first time in six years, an anti-TB drug candidate (TBA-354) was in Phase I testing. However, on 11 March 2016, TB Alliance announced discontinuation of the clinical development program of TBA-354 based on its safety and pharmacokinetic data.
    • PA-824 (pretomanid), currently in Phase II, is a potential cornerstone of future TB and drug-resistant TB treatment regimens.
    • Sutezolid (PNU-100480) and SQ109 are under development for the treatment of both drug-resistant and sensitive tuberculosis, and are currently in early Phase II testing.
  • Recent observational studies of the effectiveness of short-term regimens for MDR-TB in Niger and Cameroon found that a 12-month regimen (instead of current 20 months) was effective and well-tolerated in patients not previously exposed to second-line drugs.
  • Currently, there are 15 vaccines in Phase I or Phase II trials. However, for the time being, a vaccine that is effective in preventing TB in adults remains elusive.

Turacoz Healthcare Solutions is committed to spread the awareness on such social or healthcare-related issues as a part of their Corporate Social Responsibility (CSR) activity. Our medical writing team is well-versed with recent advances in various therapeutic areas which gives them a head start in various publication, clinical research and regulatory writing projects.

Colorectal Cancer – Spreading Awareness

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Overview : Colorectal cancer is the abnormal growth of cells in the colon or rectum (parts of the large intestine) that has the ability to invade or spread to other parts of the body. Over 95% of colon cancers are adenocarcinomas and usually begin as polyp in the inner-lining of the colon or rectum.

Other names: Colon cancer, rectal cancer, or bowel cancer

Symptoms: The symptoms of colon cancer vary depending on the location of the tumor within the colon. Following are the symptoms of colon cancer:

  • Rectal bleeding or blood in the stool
  • Dark-colored stool
  • Change in bowel movements
  • Change in stool consistency
  • Constipation
  • Diarrhea
  • Narrow stools
  • Weight loss

Risk Factor: Although colon cancer is non-contagious, several environmental and inherent risk factors are responsible for the development of this cancer. Some common risk factors associated with colon cancer are:

  • Increasing age
  • Excessive alcohol use
  • Obesity
  • Being physically inactive
  • Cigarette smoking
  • History of inflammatory bowel disease
  • Geneticmutations
  • Colorectalpolyps
  • Family history of colorectal cancer

 

Diagnostic tests and Examination:

  • High-sensitivityfecal occult blood test (FOBT) : It checks for hidden (occult) blood in the stool (feces). The test does not directly detect colon cancer, but is often used in clinical screening for the cancer. FDA approved two types of FOBT: Guaiac (GFOBT) and Immunohistochemical (IFOBT) to detect heme. Studies have shown that early detection using GFOBT can reduce the number of deaths due to colorectal cancer by 15 to 33%.
  • Sigmoidoscopy : Sigmoidoscopy is a procedure performed using a shorter flexible scope to examine just the sigmoid colon and rectum. Polyp removal and cancer biopsy can be performed through the sigmoidoscope. Studies have shown that people who have regular screening with sigmoidoscopy after age 50 years have a 60 to 70% lower risk of death due to cancer of the rectum.
  • Colonoscopy : Colonoscope, a flexible lighted tube with a lens for viewing and a tool for removing tissue is used to examine the rectum and entire colon. Colonoscopy is generally considered to be more accurate than barium enema X-rays, especially in detecting small polyps. If colon polyps are found, they are removed through the colonoscope and sent to the pathologist. Studies suggest colonoscopy reduces deaths from colorectal cancer by about 60 to 70%.
  • Barium enema X-ray : When colon cancer is suspected, lower gastrointestinal (GI) series (barium enema X-ray) is performed to confirm the diagnosis and locate the tumor. The barium outlines the large intestines on the X-rays. Tumors and other abnormalities appear as dark shadows on the X-rays.
  • Advanced stool DNA technique/Cologuard ®   : This test is an advanced stool DNA technique that detects altered DNA and/or hemoglobin in cancer cells. This is done through identifying nine DNA biomarkers in three genes that have been found in colorectal cancer and precancerous advanced adenomas. People identified as positive with this test are advised to undergo a colonoscopy.

 

Prevention:

  • Early detection and removal of precancerous colorectal polyps before they turn into cancerous. Even in cases where cancer has already developed, early detection still significantly improves the chances of a cure by surgically removing the cancerous polyps before the disease spreads to other organs. Screening has the potential to reduce colorectal cancer deaths by 60%.
  • Regular physical activity is associated with lower risk of colon cancer, but not rectal cancer.
  • Current dietary recommendations to prevent colorectal cancer include increasing the consumption of whole grains, fruits and vegetables, and reducing the intake of red meat.
  • Use of medications such as aspirin also appears to lower the risk of colon cancer. The use of combined estrogen and progesteronein hormone replacement therapy lowers the risk of colon cancer in postmenopausal women.

 

Management: Depends on various factors, including the person’s health and preferences and most importantly the stage of the tumor. When colorectal cancer is caught early, surgery can be curative however, when it is detected at later stages this is less expected and the treatment is often directed at palliation, to relieve symptoms caused by the tumor and keep the person as comfortable as possible.

  • Surgery: If the cancer is detected at a very early stage, it may be removed during a colonoscopy. This can either be done by an open laparotomy or sometimes laparoscopically. The colon may then be reconnected or a person may have a colostomy. Robotic surgery, where a surgeon sits at a control panel and operates very precise robotic arms to perform the surgery. This type of surgery is also being studied to see if it is effective as standard surgery.
  • Chemotherapy: In colon and rectum cancer, chemotherapy can be used in addition to surgery in certain cases. The decision to add chemotherapy in management depends on the stage of the disease. New ways to combine drugs already known to be active against colorectal cancer, such as irinotecan and oxaliplatin, to improve their effectiveness.
  • Radiation therapy: Patients who have previously been treated with chemotherapy, there is evidence that selective internal radiation therapy (SIRT) can prolong time to progression of non-resectable colorectal metastases in the liver.Radiotherapy decreases 50% of recurrence of rectal cancer, improves quality of life and increases survival by 6-12 months for patients with advanced disease.
  • Palliative care: Palliative care is medical care which focuses on treatment of symptoms with serious illness for improving the quality of life. It is recommended for a person who has advanced colon cancer.

 

Latest in Colon Cancer Research

Current research into cancer immunology may lead to advances in gene therapy and prognostic markers may be useful in identifying those tumors with a high recurrence rate:

  • Colorectalpolyps and tumors can release cells and DNA into the bloodstream as well as into stool. Researchers are studying whether the presence of an altered geneSEPT9 in blood can be used to screen for early-stage colorectal cancer.
  • New approaches which avoid the need for thorough cleansing of the colon, required for ‘virtual colonoscopy’, are being studied and developed. One approach is ‘fecal tagging’ with a contrast agent that is ingested over several days before the procedure. This technique is known as electronic cleansing (EC) which allows fecal material in the colon to be differentiated from colon tissue and aids in removing fecal material that is tagged by the agent.
  • Following lab tests OncotypeDx™ Colon Cancer Assay, ColoPrint™, and ColDx™ were developed to help predict the recurrence of colorectal cancer even after treatment.
  • Colorectal cancers that have gene changes known as microsatellite instability (MSI) have been found to be more likely to respond to the anti-PD-1 drug pembrolizumab (Keytruda®). A large phase II registration study (KEYNOTE-164) is ongoing to evaluate the efficacy and safety of pembrolizumab based on MSI status in patients with previously treated advanced colorectal cancers, and a phase III study (KEYNOTE-177) in a treatment naive patient population is also planned.

 

Did You Know?

  • March is colon cancer awareness month and doctors across the country are trying to remind patients the importance of screening for cancer.
  • As per WHO, colon cancer is the third most common cancer in men (10.0% of the total) and the second in women (9.2% of the total) worldwide.
  • Colon cancer risk is tied to red meat consumption. European study reported that 478,000 men and women found those who ate about five or more ounces of red meat per day were about 33% more risk to develop colon cancer.
  • Research has shown that aspirin, fish oils, aloe vera garlic, ginger and vitamin D have strong protective influence. All these should be in your diet.
  • Japanese research has strongly implicated salt as a major cause. Doubling your salt intake doubles your risk.
  • It is the second leading cause of cancer-relatedmortality in the United States. In 2014, 136,830 individuals were newly diagnosed with colorectal cancer and 50,310 colorectal cancer deaths in the United States.
  • Over the past decade, colorectal cancerincidence and mortality rates have decreased in all racial/ethnic populations except American Indians/Alaska Natives.
  • The incidence rates of cancer in men and women are similar <40 years’ age and at and above age 40 years, rates are higher in men.

World Glaucoma Week

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World Glaucoma Week (March 6-12, 2016) : Be Informed, Be Safe

Each year the World Glaucoma Association (WGA) and the World Glaucoma Patient Association (WGPA) come together to raise awareness about Glaucoma across the world. This joint initiative of WGA and WGPA is marked as “World Glaucoma Week” which is observed from March 6-12 each year worldwide.

What is Glaucoma?

‘Glaucoma’ is a group of progressive optic neuropathies that damage the optic nerve thereby resulting in degeneration of retinal ganglion cells, vision impairment, and blindness. Though unusually high intraocular pressure is been identified as the most common cause for glaucoma, yet this may not always be the case. The two most prevalent types of glaucoma are primary open-angle glaucoma (diagnosed in 90% of cases) and closed angle glaucoma. The common symptom of open angle glaucoma is a gradual loss of peripheral vison (generally in both eyes) which progresses to having a tunnel vision. Whereas, eye pain, blurred vision, nausea and vomiting, vision issues in low light, halos around light sources and red eyes are the common symptoms of closed angle glaucoma.

What is the Global Burden of Glaucoma?

Worrisome is the fact that most of the time onset of glaucoma (particularly in open angle glaucoma) are asymptomatic and disease go unnoticed by patients and healthcare professionals until it progresses to advance stages. Due to the silent nature of the disease, glaucoma is often labelled as ‘silent thief of sight’. It is worth mentioning that, glaucoma is the second leading cause of blindness globally, after cataract. The silent nature of the disease and rapid progression adds up to the global prevalence of glaucoma. In the year 2010, about 60 million people were found to be affected by glaucoma globally, and it is expected that the toll will rise up to 79 million people worldwide by 2020.

Who is at risk of having Glaucoma?

Even though glaucoma can affect any individual, but the risk increases if the individual is; over 60 years of age, have a family history of glaucoma, African Americans or Mexican American, uses steroids, have diabetes, high blood pressure and hypothyroidism, and other eye conditions.

What are the treatment Options?

Treatment of glaucoma varies according to the type of glaucoma, patient history, and advancement of the condition. Usually, the healthcare professional may prescribe medical interventions like; prostaglandins, beta blockers, carbonic anhydrase inhibitors, cholinergic or miotic agents, and alpha-adrenergic agents to relive intraocular pressure. Surgery is considered as therapeutic options if the drugs are not well-tolerated by the patient or if drugs fail to stop the progression of the disease. In such cases, healthcare professionals opt for surgeries like; trabeculoplasy, viscocanalostomy, and aqueous shunt implant.

What are the Preventive Measures?

Even though glaucoma cannot be prevented, but early screening and management of symptoms do reduces the advancement of disease and chances of having a complication. Proper awareness about the disease increases the chances of glaucoma getting a screening in its earlier stage thereby helping healthcare professionals in the timely management of the condition and preserving eyesight of the patient. Regular eye check-ups are recommended in the high risk group. It is also recommended that an individual should immediately consult a health care professional if anything unusual is observed in vision.

What should be done to Spread Awareness about Glaucoma?

‘Awareness is the first step for prevention’, and spreading awareness about glaucoma is anticipated to considerably lower the global burden of disease and associated blindness. World Glaucoma Week is one such initiative to aware masses about glaucoma.  The World Glaucoma Association (WGA) and the World Glaucoma Patient Association (WGPA) runs a week long awareness campaign to make people aware about the disease. It is recommended that healthcare professionals should involve their glaucoma patients as they organize a screening event in their local institute/hospital, should give a lecture to a patient support group, should participate in radio & TV shows to talk about glaucoma and to answer questions, and should contact newspapers to publish information about glaucoma. Additionally, all the health care professional are also suggested to run public health campaigns, eye checks up camps, and patient education classes for the high risk group. As a member of healthcare industry, we all should actively take up the responsibility to spread awareness about glaucoma in our own way. Remember to be informed is to be safe!