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ARTHRITIS KILLS YOU LIKE THE HEART CAN

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Arthritis is not an unknown entity and has been around since prehistoric times. It’s incidence has however certainly seen a dramatic rise in the last few decades. There are various types of arthritis that may not be entirely preventable. Osteo- arthritis is one of the commonest types and occurs entirely due to mechanical reasons. This article provides a short overview of the problems caused and possible solutions.

Due to the structure of our health system, we do not have a mechanism and culture to facilitate referrals to the appropriate specialist doctor. This is largely due to random distribution of speciality practitioners as well as incomplete knowledge about their expertise amongst the people. As people directly approach specialists, they might not always see the exact person suited to their problems. Similarly, it is too easy to get a variety of medicines and splints directly from the stores or even ‘online’ nowadays, that a lot of potentially harmful self- medication is rampant.

Movement is among the very most basic functions, which gets affected in severe arthritis. At present we do not have quantitative statistic measures to evaluate the disability caused in the general population due to arthritis. We accept heart disease as a common killer; heart attack being a sudden unforgettable event. However the total quantity of problems caused with sever arthritis is much higher. It presents gradually and in different forms:

  1. Immobile & elderly people get more prone to fractures as bones become weaker with decreased mobility.
  2. Severe arthritis can cause giving way of joints and falls on it’s own accord. Such fractures can get difficult to treat and often work as a beginning towards a slow and painful end.
  3. Various drugs – both prescribed and self- medicated can cause harmful side effects that lead to kidney failure, etc.
  4. Decreased mobility brings about decreased self- esteem and confidence, less productivity and mental health issues.
  5. Untreated osteoarthritis itself is self- propagating: by avoiding mechanical pressure on an affected joint, one strains the neighbouring joints and the other side, overall increasing the risks and making for further complexities in treatment.

Early detection and appropriately instituted treatment can go a long way in preserving quality of life. Similarly, the risks of various treatments need to be evaluated before resorting to operative or non- operative means of treatment in cases of severe end stage arthritis.

There is a lot of knee osteo-arthritis at younger ages in India owing to: (i) widely unrecognised and improperly treated knee injuries and (ii) common activities like squatting, sitting cross legged and praying in our cultures place high demands on the knees. The important preventive measure hence lie in getting appropriate attention if a seemingly simple knee injury does not recover in a couple of weeks. Various non- operative methods exist and are mainly effective in earlier stages of osteo- arthritis: medications, exercises, injections and the like. Treatment needs to be customised to the individual needs of the patient. Medications need to be titrated and monitored to avoid dangerous long- term side effects.

Surgery – What needs to be understood about surgery is that early and rightly directed Arthroscopic surgery can actually prevent arthritis from developing, after one has sustained certain cartilage or ligament injuries. This type of surgery can mostly be performed as a day procedure without admission and often doesn’t even entail stitches. People return to their work within days. This should hence not be viewed as a major event as compared to a fracture or general hospital admission for most other reasons.

Joint Replacement is proving to dramatically change the quality of life for patients riddled with severe end- stage arthritis. It is high time that myths regarding risks associated with such surgery are dispelled, as modern techniques have consistently enabled return to walking right from the day of surgery. This is planned surgery and hence the potential for proper organisation and enhanced recovery as opposed to fracture or emergency operations. For patients wanting to undergo such surgery, there are good services available in most Indian cities. There are an increasing number of dedicated units doing exclusive work, where the standards are bound to be better. At the same time, I would discourage people from travelling too far (more than 5- 6 hours or any flight) to have these procedures undertaken, as travelling back home soon after such surgeries is not without risk. Similarly, one must be in a position to manage stairs within three to four days of surgery too, unless one has not been doing stairs at all before. Only with a reasonable amount of independence, usually achieved within four to five days of surgery is a patient deemed fit to leave hospital, as we cannot guarantee good rehabilitation with the currently available infrastructure of home care services. The cost of surgery varies a lot with the city and set up. However, it does not mean that increased cost would guarantee important things like theatre standards and materials used. There are various standard prosthetic materials from various manufacturers that have shown to provide good results. Success depends on the technique of surgery than whether the implanted prosthetic is of local or foreign make.

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CANCER CARE IN AYURVEDA

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Physical and Psychological sufferings of patients dealing with a condition like Cancer has made a deep impact and galvanized our Cancer research efforts .In our quest to address these issues, we at Muniyal Ayurveda have designed and developed an innovative line of treatment for Cancer called Mahoshadha Kalpa

It is known that abnormal cell division is the genesis of cancer. But the exact cause for such a rapid and uncoordinated growth is not explained by modern medical science.

Our research leads us to believe that Disturbed Cellular Intelligence leads to abnormal cell division causing cancer. This disturbance can be attributed to vitiation of food, environment and consciousness. To correct this disturbance and awaken cellular intelligence an Integrated and Holistic approach is necessary which improves the overall health and brings about a strong sense of well-being in patients. This will bring about positive reinforcement both in the mind and body of the patient.

Mahoshada Kalpa
Kalpas are unique lines of treatment developed by Muniyal Ayurveda for treating chronic disorders. It is a combination of several Ayurvedic procedures, proprietary and classical ayurvedic medicines manufactured by Muniyal Ayurveda.
The treatment principle is developed on 3 pillars:

Curative: To Correct and control the abnormal cell division that leads to cancer. To control cancer growth progression and prevent metastasis.

Preventive: To detoxify the body by chelating heavy metals and scavenging free radicals. To achieve Bio-purification of the body

Rejuvenative: To Rejuvenate and Revitalize the patient both physically and mentally. This will immensely benefit the patient, who has been undergoing intense cancer treatment and interventions from a long duration. The rejuvenating treatment and therapies will help the patient start a fresh new life.

Lifestyle / supplementary care:

  • Prevention of food-related (Aahara) diseases by adopting clinical diet
  • Adoption of Dinacharya (daily regimen) and Rutucharya (seasonal regimen) to counter the environmental ill effects.
  • Practice of Samata and Maitri Dhyana, Yoga and Pranayama for Chitta Shuddhi and Vipassana Dhyana to control the cancer growth progression.
  • Rejuvenation of body cells by Pyramid therapy.

Benefits of Mahoshada Kalpa

  • Early restoration of health – prolongs life span.
  • No ill effects like hair fall, organ damage, etc.
  • Early treatment provides better efficacy and benefits.
  • Helps prevent Metastasis
  • Treatment is economical, compared to prevailing lines of treatment.
  • Can be used along with chemotherapy and radiation.
  • Proper spiritual guidance and counseling improves will power to face the disease, and wards-off fear of death.

More than 350 cancer patients have received the Mahoshadha Kalpa treatment. On evaluation, the results of this treatment have been highly encouraging. Results have been detailed in the case study reports.

We have successfully helped patients diagnosed with different types of cancer and under different stages of treatment as listed below

  • Recently diagnosed and not administered any form of conventional treatment,
  • Administered conventional treatments like chemotherapy and radiotherapy,
  • Discontinued chemo/radiotherapy.
  • Post-surgical procedures

Mahoshadha Kalpa treatment has provided complete cure in several cases of thyroid cancer, ovarian cancer, cervical cancer, lung cancer and lymphomas. In most cases we could help the patient in various aspects i.e.; improving the quality of life, prolonging life span and life expectancy, development of positive attitude, minimizing the adverse effects of chemotherapy and radiation.

This positive result has further encouraged us to work towards making this holistic line of treatment available to maximum number of people suffering from cancer.

Few Short case studies suggesting the effectiveness of Mahoshadha Kalpa

CASE 1
A 27 year old female patient approached Muniyal Ayurvedic Hospital and Research Centre with the complaint of a swelling in the anterior aspect of neck since two months. There was no apparent constitutional symptoms. She had consulted a surgeon with the presentation of “multi-nodular goiter”.
Cytological diagnosis: HASHIMOTO’S THYROIDITIS WITH OCCASIONAL
PAPILARY CLUSTERS. SUSPICIOUS FOR PAPILLARYCARCINOMA.
On examination, the swelling was firm, nodular and moving up during deglutition. No lymph nodes involved.
Blood Pressure : 150/100 mmHg.
Thyroid profile: T3 : 112 ng/dL(normal range: 60 – 200)
T4 : 2.6 µg/dL(normal range: 4.5 – 12.0)
TSH : 97.48 µIU/mL(normal range: 0.30 – 5.5)
Treatment: I. Oral medication: Muneks tablets, Kanchanara guggulu, Munipyrin tablets
II. Pyramid therapy
III. Meditation
After 45 days of above treatment, the swelling is markedly reduced
Blood Pressure: 140/86 mmHg.
Thyroid profile: T3 : 101 ng/dL(normal range: 60 – 200),
T4 : 6.3 µg/dL(normal range: 4.5 – 12.0)
TSH : 20.34 µIU/mL (normal range: 0.30 – 5.5)
She continued the treatment for six months, her TSH level came to 5.2 µIU/mL
with no clinical features.

CASE 2

A 61 years old lady with carcinoma of sigmoid colon, post-operative, post chemotherapy with the metastasis at Liver and Lungs approached our hospital with the complaint of loss of appetite, gaseous distension of abdomen and mild cough. She was treated under Mahoshadha Kalpa. She is on regular follow up since 12 months with substantial improvement in her condition.

Her SGOT and SGPT levels which was elevated have significantly come down with increase in appetite and reduction in gaseous distension of abdomen.

CASE 3

A diagnosed case of papillary carcinoma of thyroid, with a swelling in the anterior part of neck was treated under Mahoshadha Kalpa. He took the treatment for about 4 years with regular follow up.

He is also a diagnosed case of Left Ventricular Hypertrophy and renal failure. He had complaints of general debility, loss of appetite, pedal oedema and exertional dyspnea. He is showing improvement in all these symptoms, swelling of neck has reduced .Blood urea has reduced from 87.00 mg to 49.00 mg, serum creatinine from 2.1 to 1.8. Thyroid Stimulating hormone reduced from 46.5 to 14.53(normal: 0.3 – 5.5) within 45 days which eventually got normalised by the end of three months (4.8IU/ml). This patient eventually showed no symptoms of thyroid cancer and his swelling in the neck was completely relieved.

CASE 4

A female patient aged about 40 years with infiltrating ductal carcinoma of right breast, post-operative but without any chemotherapy or radiation is under the treatment of Mahoshadha Kalpa since last 1 1/2 years.

She has showed good improvement in general condition like weight, appetite and haemoglobin and has shown no signs of metastasis.

CASE 5

A 60 year old male patient with bronchogenic carcinoma of the upper lobe of left lung approached Muniyal Ayurvedic Hospital and Research Centre two years back with the complaint of severe cough and breathlessness. He has not received any conventional cancer treatment.

After 2 months of treatment his cough reduced significantly and there no signs of metastasis. Treatment was continued for a period of two years with no serious episodes of symptoms but with dramatic remission in respiratory symptoms. CT scan done indicated no signs of bronchogenic carcinoma.

CASE 6

A 30 year old lady with carcinoma of lung was on chemotherapy with severe adverse reactions like weakness, vomiting, and oral ulcers. Her lesion was found to be chemo resistant. She is under Mahoshadha Kalpa treatment since one year.

Her symptoms like cough and breathlessness have considerably reduced; adverse effects of chemotherapy has subsided. There are no signs of metastasis.

CASE 7

A60 year old male patient, a diagnosed case of bronchogenic carcinoma (post-operative and chemo resistant) approached with the complaints of cough with haemoptysis, dyspnea and general debility.

He is also a known case of Type II Diabetes mellitus. His complaints like haemoptysis, cough and dyspnea drastically reduced in a month’s treatment.

He became almost asymptomatic after the treatment for about 12 months. CT scan of lungs indicated no signs of carcinoma. He is continuing the treatment since 7 years.

CASE 8

A diagnosed case of carcinoma of oesophagus and hard palate approached for treatment under Mahoshadha Kalpa. He had the complaints of dysphagia, loss of appetite, loss of taste, general debility, and cough with whitish sputum.

During the course of treatment his cough was substantially reduced, appetite improved and taste sensation is slightly better. USG of abdomen did not show any signs of metastasis.

Follow up endoscopy indicated no signs of carcinoma.

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Am I having Diabetes ?

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Many people are unaware that they have diabetes, especially in its early stages when symptoms may not be present.

There is no definite way to know if you have diabetes without undergoing blood tests to determine your blood glucose levels.

However it is recommended that you do a blood sugar test if below symptoms are observed.

1.Frequent urination,

2.fatigue,

3. weight loss and

4. Excessive thirst,

5. Frequent infections (Bladder, skin, vaginal areas),

6. Nausea and vomiting.   

If you need any guidance or second opinion on your medical conditions visit www.medisensehealth.com/second-opinion

Many people are unaware that they have diabetes, especially in its early stages when symptoms may not be present.

Image Source: www.diabeteszone.org

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I Don’t Smoke or Drink, I Eat Well & Exercise. How Did I Still Get Cancer? An Oncologist Answers.

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Dr. Vishal Rao, an oncologist and head and neck surgeon at the Bangalore-based HealthCare Global (HCG) Cancer Center, writes about the debate on food safety in India and how it is related to cancer.

A 45-year-old man presented himself to an oncologist with the typical symptoms of stomach cancer. His worst fears came true, the biopsy reports showed positive results.

He led an extremely healthy lifestyle; exercised regularly, maintained a balanced diet and did not have any addictions. Yet, cancer had managed to conquer his system. The distraught man asked the doctor, “Why me?” The visibly uncomfortable doctor was speechless.

A lot of their patients may have maintained a healthy lifestyle and yet, end up succumbing to cancer. It may not be just tobacco; we have tons of other carcinogens, which have unfortunately entered our diet chart.

Some of the reports on food exports from India show we rank among the top in agri-food rejects to USA & EU as per the UNIDO reports. The key reasons for rejects implicated in the reports were – mycotoxins, microbial contamination, veterinary drug residues, heavy metals, unauthorised food additives, product composition and pesticide residues.

Ever wondered if this was the quality for exports, what could be the standards of internal consumption for us Indians? The Maggi trial that India witnessed recently opened the much-needed debate on food safety, exposing just the tip of the iceberg.

Let’s reflect on a few aspects of such safety issues. Why do we stand where we stand today?

Current status of food quality

“Diet and nutrition are two different aspects of food.” Is the current state of food quality in India a matter of implausible conjecture or a reality yet to dawn in the Indian mindset? Pesticides, preservatives and wasted calories seem to be the trends of the new Indian recipes.

Pesticides:

Recently a patient of mine walked into my outpatient clinic for a follow up visit. He brought with him a basket of fresh fruits as a token of his gratitude. While he handed it to me, he exclaimed, “Doc, these are not the regular ones which I keep for sale, these are ones grow for my own consumption.”

The larger question – is our farmer well educated about balancing the quantity of pesticides to be used for safe and optimal yield; or does he believe that more is better! (Dilution and mixing of pesticides in regulated quantity is key.)

A growing concern among consumers is the question – do we have too much pesticides in our food? Are these really harmful? Is there a way to prevent this?

I have heard that often export rejects from various countries look at India as a potential market — be it tyres, automobiles or food products. Thanks to poor consumer awareness and implicit trust of the consumer in the manufacturer to abide by ethical practices. This is further compounded by extremely poor vigilance and enforcement by government agencies.

The Endosulfan Tragedy in Kerala has killed over 4,000 people and many have been affected since the 1970’s. Endosulfan is an internationally banned insecticide that was earlier used in cashew plantations to increase the product yield.

The progeny of many of the survivors still suffer from conditions like macrocephaly, intellectual disabilities and cancer. Despite the ban made by UN, Endosulfan is still being used in India. Recent reports in media highlighted traces of endosulfan found in several vegetables. Personal interactions with farmers confirm their use of these banned pesticides owing to a quick, sustained and stable yield.

Yes, pesticide residues in food are a growing concern. It is, however, vital to consume healthy and nutritious food after washing them thoroughly. Avoiding fruits and vegetables in fear of residue pesticides would be more harmful that the consumption of minimal residues themselves in causing cancer. Organic foods from reported and accredited farms may be the way forward and needs encouragement from the agriculture department. Educational programmes for farmers from NGO’s and departments would pave the way in foundation of food safety in farms.

Insecticide act of India 1968 is awaiting amendments. The amended act awaits clearance in Rajya Sabha.

Preservatives:

Traditionally, preservatives were introduced into food products for keeping them safe and edible for long periods. Salt, sugar and vegetable oil are classical examples, which preserve food and provide the body with nutrition when consumed at required amounts (class 1 preservatives).

As technology and research has advanced, we have moved to synthetic preservatives which help store and protect food from spoilage for extremely long periods (class 2 preservatives). While they may protect the food, they’re definitely harming us. Studies suggest that synthetic food preservatives like Sodium benzoate and Sodium nitrite can cause hyper reactivity in children and have been linked to gastric cancer as well. These preservatives are commonly found in cold drinks, processed meat, canned food and most importantly, ready-to-make food products.

Adulterants:

Food colourants are another group of chemicals quintessentially placed in the “cancer causing family.” Natural food colourants like pure beet/ pomegranate juice, carrot juice, spinach powder, parsley juice, turmeric powder, blueberry juice and cocoa powder can be used at home and in industries. Their shelf life may be low but they add nutritive value to the food product as well.

Red 40, Blue 1 and Yellow 5 are common synthetic food colourants used in industries even though they have been proven to cause long-term health problems. Indeed the palak gravy you may be having may be onion based gravy with green colourant.

Adulterants range from chalk powder (common in milk), saw dust (found in chilli powder), non-permitted dyes (common in turmeric powder) to coal tar (found in tea powder). Vegetables like green chillies and green peas are coated with malachite green (highly carcinogenic and are used as dyes to study bacteria) to enhance the colour and fruits like apples are coated with wax give them a glossy finish.

Hygiene:

Street food is a delicacy for the Indian palate. Microorganisms are responsible for more deaths than cancer every year. Typhoid fever, botulism, amoebiasis, etc. are common food and waterborne infections. An unhygienic condition maintained by street vendors and eateries is a key factor behind the spread of these infections. Vehicular emission, carbon dioxide and air pollutants from the roads are also absorbed by these food items. The basic practice of washing one’s hands before touching any food ingredient is unspoken of. H. Pylori is a growing cause of gastric cancers. Can this be a cause of increasing contamination and adulteration?

Degreening Agents:

As our storage methods are not effective enough, fruits and vegetables cannot be stored for a long time. They are harvested when they are raw and treated with de-greening ripening agents like calcium carbide and ethylene. They make the fruits colourful and appealing to the customer. By consuming these fruits, the consumer has unknowingly reduced his/ her life expectancy.

Looking into the current scenario of food safety makes us wonder – how have we reached here and where are we heading?

Today’s times would be rightly called “instant, unlimited and more” era. Man is in search of instant – coffee, pizza, burger, food and even success instantly. Unlimited food seems to be the most attractive and sought after option to make a dining choice. The more the better is our current attitude. It would not be surprising to witness buy 1 and get 3 free at the current pace and times.

The implicit trust placed by the Indian consumer on manufacturer advertisement and tall claims is appreciable. However, the food industry is rapidly and exponentially growing. We hope to have food that is given instantly, lasts as long as possible and in sufficient quality that satiates the palate. The industry, in an attempt to satisfy the customer, would need to resort to best methods to prolong life, improve revenues and combat competition simultaneously. Would all of these steps be feasible without compromising food safety? Is it not time for the manufacturers to reinstate this trust in the consumer and lay ethical guidelines to protect the consumer?

Food standard and safety act of India is a comprehensive act. The paradox is the regulation and implementation of this act. These bodies have largely remained to provide and regulate license. We have hardly come across brands being suspended owing to poor quality compliance. Would it not be ideal to have monthly checks of 100 random food products, selected from random shops in random areas and scrutinised for food safety? Is it not time for us to amend and strongly enforce Insecticide act of India 1968 to protect our future generations and secure food safety standards?

“Into that heaven of freedom, my Father, let my country awake”

(Written by Dr. Vishal Rao)

Source:http://www.thebetterindia.com/85386/cancer/

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Hypertension may lead to stroke or cardio-vascular diseases: Indus Health Plus report

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The sample size for the study was 21,623 people who underwent preventive health check-up during January – December 2016

On the occasion of World Hypertension Day on May 17, 2017, a study by Indus Health Plus revealed that 27 per cent males and 24 per cent females from 25-35 years age group have reported of pre-hypertension. If left untreated, it would develop into hypertension eventually, leading to stroke or cardio-vascular diseases (CVDs). The sample size for the study was 21,623 people who underwent preventive health check-up during January – December 2016.

The report states that incidences of hypertension is increasing consistently in Mumbai area, with 35 per cent to 40 per cent urban people and 18 per cent to 20 per cent rural people suffering from it.

Amol Naikawadi, Preventive Healthcare Specialist, Indus Health Plus says, “90 per cent of the population are unaware about the silent symptoms of hypertension. Mumbaikars are not meeting healthy lifestyle recommendations that are important in preventing hypertension and its complications. While those from urban areas blamed work pressure and job insecurity for rising levels of stress and eventually hypertension, people from semi-rural and rural area blamed the increasing cost and increased in-house expenditure. If not treated on time, hypertension can lead to heart problems, renal and multiple organ failure. A timely and routine check-up can reduce the risk of hypertension.”

Source: http://www.expressbpd.com/healthcare/happening-now/hypertension-may-lead-to-stroke-or-cardio-vascular-diseases-indus-health-plus-report/385488/?SocialMedia

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Early MRI may lower costs for prostate cancer treatment

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Study finds MRI and MRI-guided biopsy cheaper long-term than standard ultrasound.

A diagnostic MRI followed by one of three MRI-guided biopsy strategies is a cost-effective method to detect prostate cancer, according to a new study out of Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center. Researchers compared MR-guided approaches to the current standard of transrectal ultrasound guided biopsies and found that these approaches yielded net health benefits that were well within commonly accepted threshold for costs-benefit ratios and thus are cost-effective strategies for detecting prostate cancer. The paradigm-shifting research was published in the preeminent journal Radiology.

“Many consider MRIs to be cost-prohibitive, especially when evaluating for a common entity such as prostate cancer. This was our expectation as well, prior to doing this work, but our study found the opposite. We found that performing MRI before biopsy and using that information to alter biopsy pathways would be a strategy that would add health benefits to the patient population in a cost effective manner,” said Vikas Gulani, MD, PhD, study advisor and associate professor of radiology, urology, and biomedical engineering at Case Western Reserve University School of Medicine, and member of both the Case Comprehensive Cancer Center and Case Center for Imaging Research.

The study was jointly first-authored by Shivani Pahwa, MD, department of radiology, and Nicholas Schiltz, PhD, department of biostatistics; and was developed in close collaboration with Lee Ponsky, MD, department of urology, and Mark Griswold, PhD, department of radiology.

The researchers found using MRI to help detect lesions and guide biopsies increased standardized quality-adjusted life years for patients and was cost-effective in 94.05% of simulations. The benefits were consistent across age groups, and could change how doctors identify and sample cancer lesions.

The current standard of care for detecting prostate cancer involves 12 biopsy samples collected during an invasive transrectal ultrasound. Since most tumors are not visible on ultrasound, up to 40% of clinically significant tumors are missed via this method, and many found are clinically insignificant. The approach regularly results in patients entering treatment pathways with potential negative side effects, to treat low-risk tumors. Biopsies may also cause bleeding and complications, increasing health care costs.

MRI offers a non-invasive alternative to transrectal ultrasound which can help better steer biopsy pathways. Doctors could use MRI to evaluate patients for potentially harmful lesions, and then use that information in one of three MRI guided strategies for biopsying potential foci of cancer, and bypass biopsy if a scan is completely negative. Although scans are expensive, they can add health benefits by triaging patients into proper treatment pathways. MR tends to miss low risk cancer, the overtreatment of which is a major contributor to high health and financial costs in prostate cancer. Similarly, a negative MRI is a very good predictor of exclusion of aggressive disease. A combination of such factors is likely the reason for the cost effectiveness of the MRI guided strategies. Current estimates place prostate cancer care costs in the United States at over $10 billion annually, and the price tag is rising.

The findings may help streamline prostate cancer treatment protocols to better serve patients. Said Gulani, “Costs are escalating in part due to expensive and inefficient diagnostic pathways, and placement of patients in incorrect treatment groups. If we can maximize efficiency in how we identify clinically significant lesions and diagnose patients, we can reduce unnecessary treatments for our patients, and reduce costs to our hospitals.”

Source: Case Western Reserve University

URL: https://www.sciencedaily.com/releases/2017/05/170517154720.htm

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Cancer-cardiac connection illuminates promising new drug for heart failure

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A team of researchers at the Gladstone Institutes uncovered a new strategy to treat heart failure, a leading contributor to mortality and healthcare costs in the United States. Despite widespread use of currently-approved drugs, approximately 40% of patients with heart failure die within 5 years of their initial diagnosis.

“The current standard of care is clearly not sufficient, which highlights the urgent need for new therapeutic approaches,” said Saptarsi Haldar, MD, an associate investigator at Gladstone and senior author of a new study featured on the cover of the scientific journal Science Translational Medicine. “In our previous work, we found that a drug-like small molecule called JQ1 can prevent the development of heart failure in mouse models when administered at the very onset of the disease. However, as the majority of patients requiring treatment already have longstanding cardiac dysfunction, we needed to determine if our strategy could also treat established heart failure.”

As part of an emerging treatment strategy, drugs derived from JQ1 are currently under study in early-phase human cancer trials. These drugs act by inhibiting a protein called BRD4, a member of a family of proteins called BET bromodomains, which directly influences heart failure. With this study, the scientists found that JQ1 can effectively treat severe, pre-established heart failure in both small animal and human cell models by blocking inflammation and fibrosis (scarring of the heart tissue).

“It has long been known that inflammation and fibrosis are key conspirators in the development of heart failure, but targeting these processes with drugs has remained a significant challenge,” added Haldar, who is also a practicing cardiologist and an associate professor in the Department of Medicine at the University of California, San Francisco. “By inhibiting the function of the protein BRD4, an approach that simultaneously blocks both of these processes, we are using a new and different strategy altogether to tackle the problem.”

Currently available drugs used for heart failure work at the surface of heart cells. In contrast, Haldar’s approach goes to the root of the problem and blocks destructive processes in the cell’s command center, or nucleus.

“We treated mouse models of heart failure with JQ1, similarly to how patients would be treated in a clinic,” said Qiming Duan, MD, PhD, postdoctoral scholar in Haldar’s lab and co-first author of the study. “We showed that this approach effectively treats pre-established heart failure that occurs both after a massive heart attack or in response to persistent high blood pressure (mechanical overload), suggesting it could be used to treat a wide array of patients.”

Using Gladstone’s unique expertise, the scientists then used induced pluripotent stem cells (iPSCs), generated from adult human skin cells, to create a type of beating heart cell known as cardiomyocytes.

“After testing the drug in mice, we wanted to check whether JQ1 would have the same effect in humans,” explained co-first author Sarah McMahon, a UCSF graduate student in Haldar’s lab. “We tested the drug on human cardiomyocytes, as they are cells that not only beat, but can also trigger the processes of inflammation and fibrosis, which in turn make heart failure progressively worse. Similar to our animal studies, we found that JQ1 was also effective in human heart cells, reaffirming the clinical relevance of our results.”

The study also showed that, in contrast to several cancer drugs that have been documented to cause cardiac toxicity, BRD4 inhibitors may be a class of anti-cancer therapeutics that has protective effects in the human heart.

“Our study demonstrates a new therapeutic approach to successfully target inflammation and fibrosis, representing a major advance in the field,” concluded Haldar. “We also believe our current work has important near-term translational impact in human heart failure. Given that drugs derived from JQ1 are already being tested in cancer clinical trials, their safety and efficacy in humans are already being defined. This key information could accelerate the development of a new heart failure drug and make it available to patients more quickly.”

Story Source:Materials provided by Gladstone Institutes.

URL: https://www.sciencedaily.com/releases/2017/05/170517143623.htm

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Costs for generic hepatitis C drugs available in India would be paid back in 5 to 10 years

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Use of the generic versions of directly-acting antiviral (DAA) drugs that are available in India to treat hepatitis C virus (HCV) infection is not only cost effective but actually saves lifetime costs for treating infected patients in that country. A report from an international research team appears in the open-access journal PLOS ONE and describes finding that the upfront costs of DAA are offset by the avoidance of costs incurred to treat late-stage disease.

“More than 9 million people are infected with HCV in India, and more than 70 million worldwide,” says Jagpreet Chhatwal, PhD, of the Institute for Technology Assessment at Massachusetts General Hospital (MGH), senior and corresponding author of the paper. “These persons are at risk of developing serious conditions such as cirrhosis and liver cancer, which can be fatal. However, only a fraction of them have been treated with these drugs so far.”

First introduced in 2011, DAAs such as sofosbuvir (Sovaldi) and ledipasvir (which is combined with sofosbuvir in Harvoni) have proven to be remarkably successful in the battle against HCV infection, with cure rates exceeding 95 percent. In developed countries, treatment with DAAs is very expensive — reaching nearly $65,000 in the U.S. — although it meets standards for cost effectiveness. In those countries the advent of these drugs has drastically changed the landscape of HCV infection. But other countries have lagged behind in their use.

Through agreements with the pharmaceutical companies that developed these drugs, generic drug manufacturers in India are now able to produce versions that cost as little as $300 for the entire duration of treatment. But the absence of data on the cost effectiveness of these drugs in that country and low budgets for HCV treatment have meant that only a small proportion of people needing these drugs have received them.

The research team — including investigators from Sanjay Gandhi Postgraduate Institute of Medical Sciences in Lucknow, India, and the World Health Organization — used a mathematical model to compare the outcomes of DAA treatment with those of no DAA treatment based on profiles of 30 hypothetical patients with characteristics typical of Indian patients with HCV infection. Factors incorporated into the model included the natural history of HCV disease, the costs of DAA administration, the costs of treating the adverse outcomes of HCV disease, and quality of life of individuals infected with HCV.

The model indicated that, compared with no DAA treatment, use of the generic drugs in HCV-infected Indian patients would increase life expectancy by more than eight years while reducing lifetime health care costs by more than $1,300 per person. Payback for the upfront costs of DAA drugs would be achieved in an overall average of less than 10 years — under 5 years for patients at advanced stages of HCV disease and almost 12 years if treatment begins at earlier stages. Even though there was wide variation in the factors — such as patient age, disease stage, and viral genotype — input to the model, results always indicated that generic DAA treatment reduced lifetime costs.

“Our hypothesis was that treatment would be cost saving, given the low drug costs in India. However, we were pleasantly surprised to find that the full payback was achieved so soon after treatment,” says Chhatwal, who is an assistant professor of Radiology at Harvard Medical School. “Our finding that treatment pays back its initial costs makes a very strong statement — that investment in HCV screening and treatment should be a priority for public health agencies in India and other countries where generic DAAs are available. It could also be argued that generic DAAs should be made available in other low- and middle-income countries where HCV infection is common and budgets for treatment limited.”

Lead author Rakesh Aggarwal, MD, DM, of the Department of Gastroenterology at Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), a WHO Collaborating Center on Viral Hepatitis, says, “This is a win-win situation for the low- and low-middle-income countries where the generic DAAs can be sold. If these countries spend money on HCV treatment today, they will recoup it in the form of reduced health care expenditure within less than one decade. There is hardly any other health care intervention with such good return. Our results should show political leaders in those countries that they have a wonderful opportunity to make a difference for their constituents.”

Story Source:Materials provided by Massachusetts General Hospital.

URL: https://www.sciencedaily.com/releases/2017/05/170517184519.htm

New gene therapy may ‘turn off’ asthma

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The findings showed that the single treatment may give life-long protection from asthma as well as those who have severe allergies to peanuts, bee venom, shell fish and other substances by de-sensitising the immune system to tolerate the protein.

Researchers have developed a new gene therapy that may help to ‘turn-off’ the immune response which causes allergic reaction such as asthma, or potentially lethal food allergies, researchers have found.

“When someone has an allergy or asthma flare-up, the symptoms they experience results from immune cells reacting to protein in the allergen,” said Ray Steptoe, Associate Professor at the University of Queensland in Australia.

The findings showed that the single treatment may give life-long protection from asthma as well as those who have severe allergies to peanuts, bee venom, shell fish and other substances by de-sensitising the immune system to tolerate the protein.

“The challenge in asthma and allergies is that these immune cells, known as T-cells, develop a form of immune ‘memory’ and become very resistant to treatments,” Steptoe said.

“We have now been able ‘wipe’ the memory of these T-cells in animals with gene therapy, de-sensitising the immune system so that it tolerates the protein,” he added.

For the study, detailed in the journal JCI Insight, the team took blood stem cells, and inserted a gene which regulated the allergen protein and put that into the recipients.

“Those engineered cells produced new blood cells that express the protein and target specific immune cells, ‘turning off’ the allergic response,” Steptoe noted.

The eventual goal would be a single injected gene therapy, that is simpler and safer which could be used across a wide cross-section of affected individuals, he said.

Source: http://indianexpress.com/article/lifestyle/health/new-gene-therapy-may-turn-off-asthma-4690204/

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Daily insulin shots for diabetes may be replaced by a monthly treatment

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By creating a controlled-release mechanism for a drug and optimising its circulation time in the body, the new biopolymer injection has the potential to replace daily or weekly insulin shots with a once-a-month or twice-a-month treatments for type 2 diabetes, researchers said.

Scientists, including one of Indian origin, have developed a technology that may provide weeks of glucose control for diabetes with a single injection, which would be a dramatic improvement over current therapies.

In primates, the treatment has been shown to last for weeks, rather than days, researchers at Duke University in the US said. By creating a controlled-release mechanism for a drug and optimising its circulation time in the body, the new biopolymer injection has the potential to replace daily or weekly insulin shots with a once-a-month or twice-a-month treatments for type 2 diabetes, they said. Many current treatments for type 2 diabetes use a signalling molecule called glucagon-like peptide-1 (GLP1) to cause the pancreas to release insulin to control blood sugar. However, this peptide has a short half-life and is cleared from the body quickly.

Researchers, including Ashutosh Chilkoti, from Duke University, have created a technology that fuses GLP1 to a heat-sensitive elastin-like polypeptide (ELP) in a solution that can be injected into the skin through a standard needle. Once injected, the solution reacts with body heat to form a biodegradable gel-like “depot” that slowly releases the drug as it dissolves. In animal experiments, the resulting therapy provided glucose control up to three times longer than treatments currently on the market. Researchers systematically worked to vary the design of the delivery biopolymer at the molecular level and found a sweet spot that maximised the duration of the drug’s delivery from a single injection.

“By doing so, we managed to triple the duration of this short-acting drug for type 2 diabetes, outperforming other competing designs,” said Chilkoti, senior author of study published in the journal Nature Biomedical Engineering. Researchers optimised their solution to regulate glucose levels in mice for 10 days after a single injection, up from the previous standard of 2-3 days. In further tests, the team found that the optimised formulation improved glucose control in rhesus monkeys for more than 14 days after a single injection, while also releasing the drug at a constant rate for the duration of the trial.

“What is exciting about this work was our ability to demonstrate that the drug could last over two weeks in non- human primates,” said Kelli Luginbuhl, a PhD student in the Chilkoti lab and co-author of the study.

Source: http://www.dnaindia.com/health/report-now-a-monthly-treatment-for-diabetes-may-replace-daily-insulin-shots-2463129

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