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PSA
Screening For Prostate Cancer Not Obsolete
Like with
any test there are false positive results, and the blood test
called PSA (short for Prostate Specific Antigen) has received
some criticism as a result. Negative comments likening it
to "Shooting flies with a bazooka" have been voiced,
and yet, statistics on the mortality due to prostate cancer
tell a different story.
In recent
years the mortality rate in North America is down by 25%,
and part of it is due to PSA. Currently there is no more effective
testing in place, so the alternative is not attractive. It
is like going back to the bad old times, where men where diagnosed
only, once the prostate cancer was advanced, had formed metastases,
and hopes for a cure were remote. There are promising new
tests under development which at one point in time will replace
the PSA, but for now it's still the best test available. The
only other way to find prostate cancer is by doing a biopsy.
National
Review Of Medicine, December 15,2004, page 22
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Vaccine
To Eradicate Cervical Cancer
Dr. Diane
M. Harper, a lead researcher from Dartmouth Medical School
in New Hampshire has called the results of a vaccination trial
against the Human Papilloma Virus (HPV) "extremely exciting
and encouraging". A simple vaccination against this virus,
which is the cause for cancer of the cervix, has the potential
to eradicate the vast majority of cervical cancers worldwide.
The injection in the study was tested on 1,113 women between
the ages 15 and 25 over an 18-month period. One hundred percent
of the patients of the vaccinated group escaped persistent
infection.
The protection
against initial HPV- infection was at 92 %.
At this point a much larger trial is set to begin, before
the vaccination can be licensed for general use. It will very
likely soon be a routine vaccination for young women. If it
is successful, it will be a powerful tool for prevention and
will save thousands of lives that otherwise would be lost
to cervical cancer. Even for those patients who dread shots,
a needle prick will be a small price to pay.
National
Review Of Medicine, December 15, 2004, page 27
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Doctor
Recommended Diet Against Obesity
After
overindulging over the holidays, new years resolutions often
have diets and life style choices high on the list.
These concerns are not something new. Doctors have had concerns
about heart disease, diabetes, bulging waistlines and elevated
cholesterol. For over three decades there have been concerns
that elevated insulin levels may be associated with heart
disease, and the constellation of symptoms was called "syndrome
X" and later the "insulin resistance syndrome".
Most recently
the evils that are associated with body fat have been called
the "metabolic syndrome".The problem has assumed
epidemic proportions: by 2001, 30% of US adults were considered
obese with a body mass index of over 30, and 50% were overweight
with a body mass index over 25. The form of type 2 diabetes
(the adult onset of the disease) is predicted to double in
the next 20 years. Physicians are reporting that they are
seeing increasing numbers of children who are obese and suffer
of type 2 diabetes. The major concern with an accumulation
of body fat is the area of the abdomen (think of the "apple
shape" with fat around the abdomen). This visceral fat
tissue is not just innocently sitting there stopping you from
closing buttons and zippers. It is very metabolically active
and the substances it releases are a threat to your health.
These fat cells secret pro-inflammatory substances called
"cytokines."
They also
form substances that influence blood-clotting, factors that
increase insulin resistance, substances like angiotensin,
which are signing responsible for high blood pressure as well.
Among the host of damaging substances is also the C-reactive
protein, which is recognized as a risk factor for heart disease.
There is only one solution: to reduce the risk, excessive
weight has to be shed. A sensible diet to achieve that goal
has to contain less saturated fat, more fiber, and low glycemic
index carbohydrates. Proper dietary habits are only one part.
The other as important measure is life style intervention,
which includes 2.5 to 3 hours of moderate exercise per week.
Many of the current diets promise weight loss without compromising
health. All of them promote weight loss, provided they are
strictly adhered to.
The high
protein diets (Atkins, Protein Power Plan) are useful for
rapid initial weight loss, however due to the overload of
protein long term use is highly questionable. Kidney dysfunction
as a consequence is a threat to health and no benefit at all!
Moderate carbohydrate diets, moderate fat, as well as moderate
protein will remain the answer for long-term life style changes.
It is also of significance that the glycemic index of carbohydrates
plays a major role. Food intake, which favors carbohydrates
with a low glycemic index, is associated with less heart disease.
It has also been documented that insulin levels are more stable.
Low glycemic carbohydrates include most vegetables, beans,
lentils, as well as fruit like apples, pears and oranges.
In contrast, high glycemic carbohydrates result in a fast
insulin release, which ultimately leads to insulin resistance.
Among these items are potatoes, crackers and other flour products,
rice, puffed or flaked breakfast cereals, and tropical fruit
(papayas, pineapple, melons).
For short-term
dieters, it is an option to embark on any of the current diets
without deleterious effects, no matter whether they are high-carb
or low-carb. But at this point only the diets with moderate
carbohydrates have shown to have some benefits on heart health.
Ultimately the wiser choice is to consume foods with a low
to moderate glycemic index, by increasing the intake of vegetable
proteins and oils and by choosing increased servings of vegetables
and fruit instead of highly processed items. So, when you
next walk through your supermarket, remember that most of
the good stuff is in the periphery, namely the area where
all the fresh, unprocessed or minimally processed foods are
found.
Metabolic
Syndrome Rounds, Oct. 2004, Vol. 2, Issues 8, St. Michael's
Hospital, University of Toronto/On/Canada
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Bone
Loss Non Reversible After Provera
Depo-Provera
has been used as an injectable form of contraception, but
the manufacturer (Pfizer Canada Inc.) has sent out warnings
to physicians about some quite serious side effects. New data
have shown that after two years of use significant bone density
loss can be seen.
What
is more alarming is the fact, that this loss does not seem
to be fully reversible, even if the medication is stopped.
The effect is bad enough for adults, but it becomes even more
alarming should adolescents receive the product: at a time
when they should build their bone density, they would be experiencing
the problem of bone density loss!
The amounts
of bone mineral density is not insignificant: a controlled
clinical study showed that women, who received the medication
for 5 years showed a decrease of bone density in the spine
and hip of 5 to 6 %. If the drug was stopped, there was a
partial recovery of the loss, but the longer the drug was
used, the less favorable was the recovery of bone density.
There has been some awareness in the past, that loss of bone
density could be a risk in the use of Depo-Provera, but there
was the thought that all would be well after discontinuing
the medication. This however is not the case after the new
research data, and it should caution women to stay away from
this form of birth control, if they are interested in maintaining
good bone health.
The
Medical Post, December 7,2004, page4
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Relapse
Of MS Reduced By New Drug
The effects
of MS have been devastating to people afflicted by the disease.
New research has brought treatments to combat the progression
of the illness, yet relapses after remission have remained
perplexing and frustrating to physicians and patients alike.
Interferon has been a tremendous help, but patients often
experienced flu-like symptoms after receiving interferon.
Treatment with steroids has been problematical as well.
The results
with Natalizumab (Antegren) are showing impressive results:
relapses of MS are reduced by two-thirds (compared to placebo)
The drug mechanism works by inhibiting the migration of aggressive
auto-immune cells into such tissues as the brain, where they
would cause inflammation, which in turn would cause MS lesions.
Dr. Paul O'Connor is the lead investigator of the trial and
chief of the MS clinic at St. Michael's Hospital in Toronto,
and he reports that this new medication gives double the effect
compared to previous drugs against MS. MRI scans also showed
90% less new lesions compared to patients who took placebo
(ineffective "fake" medication). Compared to previous
MS drugs the medication is safe and well tolerated. The administration
of the drug has to be done intravenously, so the patient would
need to make a trip to a clinic or hospital once a month.
On the
strength of the excellent results the approval process of
the drug is carried out only after one year of the study.
A second study involving approximately 1,200 patients is ongoing,
and the manufacturers of natazulinab (Elan Corp. and Biogen
Idec Inc.) are anticipating regulatory approval in the United
States. They are also seeking the approval of the drug with
Health Canada.
Addendum:
This drug was withdrawn
from the market as can be seen from this link.
The
Medical Post, November30, 2004, page 49
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