Many countries lack capacity to prevent and treat hearing loss

28 February 2014 | GENEVA - Many of the countries who responded to a new WHO survey lack the capacity to prevent and care for hearing loss, according to a report published on International Ear Care Day, 3 March.

Results of the survey

“The results of this survey are a clear call to action for governments and partners to invest in hearing care especially at community and primary level.”

Dr Etienne Krug, Director of the WHO Department of Violence and Injury Prevention and Disability

WHO estimates that over 5% of the world’s population – 360 million people - has disabling hearing loss. The highest prevalence is found in the Asia Pacific, South Asia and sub-Saharan Africa. About half of all cases of hearing loss worldwide are easily prevented or treated.

A leading cause for hearing loss in younger ages, particularly in low- and middle-income countries, is untreated ear infections, which often presents with discharge from the ear. Vaccine-preventable infectious diseases such as rubella, meningitis, measles, or mumps can also lead to hearing loss.

Just 32 of the 76 countries who responded have developed plans and programmes to prevent and control ear diseases and hearing loss. According to the report, many lack trained health personnel, educational facilities, data and national plans to address the needs of those living with ear and hearing problems. The information received also indicates that the gap between need and services is greatest in sub-Saharan Africa.

“The results of this survey are a clear call to action for governments and partners to invest in hearing care especially at community and primary level,” says Dr Etienne Krug, Director of the WHO Department of Violence and Injury Prevention and Disability. “The programmes must aim to benefit all, including disadvantaged parts of the population who are least able to access hearing services.”

Prevention and treatment of hearing loss at primary level

Good ear care practices, such as reducing exposure to noise and avoiding insertion of objects into the ears, can prevent many from developing ear and hearing problems. A large percentage of people living with hearing loss can benefit from early identification and appropriate treatment.

For example, screening programmes for infant hearing can minimize the impact of hearing loss on a child’s development.

“Ear and hearing problems and the use of hearing aids are often associated with myths and misconceptions”, says Dr Shelly Chadha of the WHO unit for the Prevention of Blindness and Deafness. “National programmes should therefore not only focus on prevention and service provision but also on awareness raising.”

The national plans that already exist in some countries can serve as a model for countries that still lack strategies to better address disabling hearing loss. However, each country needs to develop a unique plan based on its specific situation, the prevalent causes of hearing loss as well as the available health infrastructure.

For more information please contact:

Tarik Jasarevic
WHO, Geneva
Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 79367 6214
E-mail:jasarevict@who.int

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Skin drug may treat type 1 diabetes

22 September 2013 Last updated at 19:30 ET

A drug that was used to treat a skin disorder has shown signs of being able to treat aspects of type 1 diabetes.

A small trial on US patients suggests that alefacept helps the body produce its own insulin, which is key for people with type 1 diabetes.

Type 1 diabetes affects around 400,000 people in the UK.

Researchers said the drug could be better than other treatments because it protects the immune system - but more research was needed.

The findings are published in The Lancet Diabetes & Endocrinology.

Alefacept (sold as Amevive) was used to treat the skin disorder psoriasis in the US before it was withdrawn by its manufacturer in 2011. The drug was never approved for the European drug market.

Psoriasis, like type 1 diabetes, is an autoimmune disorder that occurs when the immune system attacks healthy skin cells.

In clinical trials of the drug on psoriasis, the drug was found to attack specific types of T-cells that were also involved in attacking insulin-producing cells in type 1 diabetes.

So researchers, led by a team at Indiana University, Indianapolis, decided to investigate if it could have any effect on newly diagnosed type 1 patients.

Preserve insulin

In the trial, which is continuing, 33 patients received weekly injections of alefacept for 12 weeks, followed by a break of 12 weeks, and then another 12 weekly doses.

Another 16 participants were given placebo injections following the same schedule.

The researchers found no difference in how well the pancreas produced insulin two hours after eating food, but they did find "significant differences" between the two groups four hours after eating.

At this point, the group who received the drug showed they were able to preserve insulin while the placebo group's insulin levels decreased.

Continue reading the main story

What is type 1 diabetes?

Type 1 diabetes is an autoimmune condition, where the immune system attacks the cells of the pancreas that produce insulin.

This results in insulin deficiency and the body being unable to regulate blood sugar.

It tends to affect people before the age of 40, and often follows a trigger such as a viral infection.

• Living with type 1 diabetes

After 12 months, the same group showed no significant increase in insulin use, yet those in the placebo group did.

The first group also had fewer episodes of hypoglycaemia, low blood glucose levels. which are common in people with type 1 diabetes.

'Small successes'

Lead researcher Prof Mark Rigby, of Indiana University, said the first 12 months of the trial were encouraging.

"Although the primary endpoint was not met, several key secondary endpoints were significantly different between treatment groups, suggesting that alefacept might preserve pancreas cell function during the first 12 months after diagnosis."

He said the initial findings meant that in the future the drug "could be used to stabilise type 1 diabetes and prevent its progression" - but it was unlikely to be a cure.

He added that the trial would continue and further measurements would be taken after 18 months and 24 months.

Writing about the study in The Lancet, Dr Kevan Herold, of Yale University, said: "It is important to underscore these small successes since, as in other fields such as oncology and infectious diseases, the small achievements acquire greater significance when they are combined."

Karen Addington, chief executive of JDRF, the type 1 diabetes charity that helped fund the study, said the outcome was promising.

"The results of this study appear worthy of further exploration. Small steps forward such as this take us closer to a world without type 1 diabetes.

"It is a challenging and complex condition. But type 1 diabetes will one day be cured. It's a matter of time, money and excellent research."

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Treat the fungus among us with nontoxic medicinal compound

Sep. 12, 2013 — A Kansas State University microbiologist has found a breakthrough herbal medicine treatment for a common human fungal pathogen that lives in almost 80 percent of people.

Govindsamy Vediyappan, assistant professor of biology, noticed that diabetic people in developing countries use a medicinal herb called Gymnema slyvestre to help control sugar levels. He decided to study the microbiological use of Gymnema slyvestre -- a tropical vine plant found in India, China and Australia -- to see if it could treat a common human fungal pathogen called Candida albicans.

The investigation was successful on two levels: Vediyappan's research team found the medicinal compound is both nontoxic and blocks the virulence properties of the fungus so that it is more treatable. The results are important for human health, biomedical applications and potential drug development.

"We have shown that this compound is safe to use because it doesn't hurt our body cells, yet it blocks the virulence of this fungus under in vitro conditions," Vediyappan said. "Taking the medicine could potentially help patients control the invasive growth of the fungus and also help bring their sugar levels down."

Candida albicans is one of the major fungal pathogens in humans because it lives in oral and intestinal areas as a normal flora, Vediyappan said. But the fungus can overgrow and can cause oral, intestinal and genital infections. The fungus kills almost 30 percent of people who have it and it is a concern among cancer patients -- especially patients with neck or oral cancer -- HIV patients, organ transplant patients and other people with compromised immune systems.

The fungus can grow in two forms: a treatable yeast and a difficult-to-treat hyphal form. Once the fungus transforms from a yeast to a hyphal growth it becomes difficult to treat because the hyphal growth has long filament-like structures that can spread into various organs. Vediyappan's study aimed to block the hyphal growth form.

"Once it gets into the tissue, it spreads like roots and is difficult to contain by our immune system," Vediyappan said.

If the fungus remains in yeast form, it is easy to manage and does not invade tissues. Vediyappan's research team purified gymnemic acid compounds that prevented the transition stage from occurring and stopped the fungus spread. The gymnemic acids come from the leaves of Gymnema sylvestre, a traditional medicinal plant.

The research appears in the peer-reviewed journal PLOS ONE in an article titled "Gymnemic acids inhibit hyphal growth and virulence in Candida albicans."

Gymnema extract is commonly used to treat diabetes and other ailments because it is a cost-effective treatment, Vediyappan said. Often, people drink the extract to control their sugar levels or to lose weight.

Although Vediyappan's research team is not the first to discover gymnemic acid compounds, the team is the first to discover that the compounds block the fungal transition. The researchers found that the compounds work quickly, too, which was an important characteristic. The treatable fungal yeast can transition to a hyphal growth within 30 minutes of an infection. When the hyphal transition has occurred, it will grow into branched filaments.

The gymnemic acid compounds are nontoxic, which is especially important for cancer patients and other immunocompromised patients. The gymnemic acids can stop the unwanted invasive infection while preserving important healthy cells.

The Candida albicans fungus also makes a biofilm, which is a fungal cell collection that can be difficult to treat. The researchers found that the gymnemic acid compounds converted the biofilm back to treatable yeast cells.

"This compound prevents the biofilm formation because hyphae are the major builders of biofilms and biofilms are resistant to antifungals," Vediyappan said. "Yeast cells by themselves cannot make biofilms and are sensitive to antifungal treatments."

Another interesting aspect: The gymnemic acid compounds also stopped the growth of Aspergillus, another fungal pathogen that can affect heart transplant patients and leukemia patients.

Vediyappan plans future studies to research mode of action, potential drug development, diabetes applications and other ways to improve treatment for Candida albicans and other fungal pathogens.

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FDA Panel Backs Wider Use of Drug to Treat Early Stage Breast Cancer

THURSDAY, Sept. 12 (HealthDay News) -- U.S. advisers endorsed on Thursday the broader use of a drug already used to treat advanced breast cancer that also appears to shrink early stage breast tumors.

This could potentially offer women with early stage breast cancer a first-of-its-kind treatment option and the hope of less-invasive surgical procedures.

If approved to treat early stage tumors, the drug, Perjeta, might result in less invasive surgical treatment for women with HER2-positive early stage breast cancer. In that role, Perjeta (pertuzumab) would be the first cancer-fighting drug approved as a first-step breast cancer therapy in the United States.

A U.S. Food and Drug Administration advisory panel voted 13 to 0 to recommend approval of the drug. The FDA is not bound to follow the recommendations of its advisory panels but it usually does.

An FDA report that was posted online Tuesday said the drug looked promising in trials. The report also said, however, that drug-related cardiac concerns will require additional research.

Advisory panel chairman Dr. Mikkael Sekeres, a professor of medicine at the Cleveland Clinic, called Thursday's vote "a historic moment," The Associated Press reported.

"We are supporting the movement of a highly active drug for metastatic breast cancer to the first-line setting, with the hope that women with earlier stages of breast cancer will live longer and better," Sekeres said.

The FDA is considering "fast-track" -- or accelerated -- approval of Perjeta, which is made by Roche's Genentech division, the AP reported. Fast-track approvals usually are given to drugs that haven't been thoroughly tested but show promising results in early trials.

Panel members insisted Thursday that Genentech carry out more trials to ensure that Perjeta will enable breast cancer patients to live longer, healthier lives, the news service said.

Genentech estimated that about 15,000 women with HER2-positive early stage breast cancer could receive early treatment with Perjeta each year, Bloomberg News reported.

Cancer specialists welcomed the news earlier this week of the preliminary results for Perjeta.

"This is tremendously exciting," said Dr. Amy Tiersten, associate professor in the division of hematology and medical oncology at Mount Sinai Medical Center in New York City.

"Pertuzumab was FDA approved in 2012 for the treatment of metastatic breast cancer when it was shown that it improved survival when added to standard regimens for HER2-positive metastatic breast cancer," Tiersten said. Metastatic breast cancer is cancer that has spread to other parts of the body.

"But the really exciting information is when this can be translated into earlier stages of disease, where we can completely eradicate the disease and cure more women," she said.

The preliminary trial under discussion showed that when Perjeta was added to standard pre-surgical regimens for HER2-positive breast cancer, the chance of finding no cancer after the treatment was nearly doubled, Tiersten said.

Women who have chemotherapy before surgery and who achieve complete remission -- no cancer at the time of breast surgery -- have a much greater chance of being completely cured of their disease, she said.

Dr. Aye Moe Thu Ma, attending physician in breast surgical oncology with St. Luke's and Roosevelt Hospitals in New York City, also voiced enthusiasm.

"We currently have limited options for [first-step] treatment of breast cancer," Ma said. "I'm excited that this may provide a more specific treatment for people with HER2-positive cancer."

This means women may be able to keep their breasts because the tumor size is reduced before surgery, and some women may prefer this, she said.

Genentech is hoping for fast-track approval of Perjeta. The FDA can expedite approval for groundbreaking drugs as long as the drug maker pursues more research to show that the medication prolongs disease-free survival.

Both short- and long-term side effects will need to be examined to fully evaluate risks and benefits of this medication if it is approved, Ma added.

Perjeta is one of many newer biologic agents used to treat breast cancer. "These biologic or 'targeted' treatments work on breast cancer cells in a more specific way than some older treatments so there are many fewer casualties to normal cells translating into many fewer side effects for our patients," Tiersten said.

About one in eight women in the United States will develop breast cancer in her lifetime.

According to the Mayo Clinic, HER2-positive breast cancer is a breast cancer driven by a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells.

HER2-positive breast cancers typically are more aggressive than other types of breast cancer. But there are effective drug treatments, including trastuzumab (brand name Herceptin) and lapatinib (Tykerb). Both drugs can produce side effects, including congestive heart failure, according to the Mayo Clinic.

More information

The U.S. Department of Health and Human Services has more about early stage breast cancer.

Copyright c 2013?HealthDay. All rights reserved.

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Despite higher survival, brachytherapy to treat cervical cancer declines in US

Sep. 11, 2013 — A study by researchers at Brigham and Women's Hospital (BWH) found that brachytherapy treatment was associated with better cause-specific survival and overall survival in women with cervical cancer. The population-based analysis also revealed geographic disparities and decline in brachytherapy treatment in the United States. Brachytherapy is a type of cancer treatment in which radioactive implants are inserted directly into the tissue near the tumor site.

The study is published in the September 2013 issue of The International Journal of Radiation Oncology.

The researchers used the Surveillance, Epidemiology, and End Results (SEER) Database to identify 7,359 patients with advanced stage cervical cancer treated with external beam radiation therapy (EBRT) between 1988 and 2009. (The 18 SEER population-based registries cover approximately 28 percent of the US population and include Connecticut, New Jersey, Metropolitan Detroit, Iowa, New Mexico, Hawaii, Seattle, Utah, Alaska, San Francisco-Oakland, San Jose-Monterey, Los Angeles, Greater California, Kentucky, Louisiana, Metropolitan Atlanta, Rural Georgia, and Greater Georgia. The registries collect information about patient and tumor characteristics and first course of cancer-directed treatment.)

Of the 7,359 patients identified, the researchers found that 63 percent of these women received brachytherapy in combination with EBRT, and 37 percent received EBRT alone. Factors associated with higher odds of brachytherapy use included younger age, being married, earlier years of diagnosis, earlier stage and certain SEER regions.

Moreover, brachytherapy usage rate decreased from 83 percent in 1988 to 58 percent in 2009. There was a sharp decline from 43 percent to 23 percent in 2003. The researchers noted that the decline may be related to the decreasing incidence of cervical cancer and increased adoption of alternative treatment techniques, such as intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT).

In terms of patient survival, brachytherapy was associated with a higher four-year cause-specific survival (64.3 percent vs. 51.5 percent) and overall survival (58.2 percent vs. 46.2 percent) compared to EBRT alone. Brachytherapy treatment was also independently associated with better cause-specific survival and overall survival.

"The shift away from brachytherapy is concerning, and has directly lowered the survival rates of cervical cancer patients," said Akila Viswanathan, MD, MPH, director of BWH Gynecologic Radiation Oncology, senior study author. "High-quality brachytherapy must continue to be used, ideally with image-guidance, to maximize survival and minimize toxicity."

Brachytherapy is an important component of treatment that escalates the dose of radiation to the primary tumor while minimizing the dose to critical organs at risk. The standard treatment of locally advanced cervical cancer is EBRT with concurrent chemotherapy, followed by brachytherapy.

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Treat drug abuse as public health issue, US czar says

AppId is over the quota
AppId is over the quota

President Barack Obama's top adviser on drug policy called Monday for greater emphasis on treating drug abuse as a public health problem in the United States rather than as a crime.

In a speech at the Betty Ford Center in Palms Springs, California, Gil Kerlikowske blamed US laws punishing drug consumption for making it harder for drug addicts to get treatment.

"Our nation's drug problem should be treated as a public health issue, not just a criminal justice issue," he said.

"Too many laws and regulations that were established for the purpose of punishing or deterring drug use make no distinction between the person who continues to use drugs and the person who is on the pathway to recovery," he said.

Kerlikowske's Office of National Drug Control Policy in April unveiled a new counter-drug strategy that calls for more than 100 changes in US law and counter-drug programs.

His office estimates that 23.5 million Americans were in treatment for alcohol or narcotics addiction in March.

It also reported that cocaine consumption has fallen by 40 percent since 2006, and drug consumption generally has declined by a third since 1979 in the United States.

But marijuana use among the young remains stable, and authorities are alarmed by the rise of synthetic drugs with devastating effects.