Indian Medicine

HONG KONG (Reuters) - Researchers in China and the United States have identified mutations of two genes which appear to make ethnic Chinese more susceptible to lung cancer, they wrote in the journal Cancer.

Their finding involves two genes, ABCB1 and ABCC1, which were previously thought to be linked to eliminating carcinogens from the lungs and protecting them against inhaled toxins.

In their study, the researchers analyzed the genes of 500 patients with lung cancer and 517 cancer-free participants in southeastern China.

"The investigators found that certain (gene) variants were found much more often in individuals with lung cancer than in cancer-free controls," they wrote in a statement.

Among those with cancer, 31 percent were found with a certain mutation of the ABCB1 gene, while 27 percent were found with a variant of the ABCC1 gene.

But those same mutations were found in only 15 percent and 12 percent of participants in the cancer-free group.

"The variant (of ABCB1) was particularly associated with an increased risk of cancer in women and in individuals under age 60 years. It also was linked to a major type of lung cancer called adenocarcinoma," the researchers said.

Another study published in the Lancet in October predicted that China would see 65 million deaths from chronic obstructive pulmonary disease (COPD) and 18 million deaths from lung cancer between 2003 and 2033 from smoking and biomass burning at home.

Those figures would account for 19 and 5 percent respectively of all deaths in China during that period, said the researchers at the Harvard School of Public Health.

Respiratory diseases are among the 10 leading causes of deaths in China. About half of Chinese men smoke. In more than 70 percent of homes, Chinese cook and heat their homes with wood, coal and crop residues.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - The results of a new study suggest that patients with psoriatic arthritis, a form of rheumatoid arthritis accompanied by psoriasis, may have "subtle" cardiac conduction disturbances. Researchers point out, however, that it is not yet known if these irregularities lead to serious heart disease.

"In surveying the literature, scant data were found regarding cardiac arrhythmias in psoriatic arthritis patients," researchers note in the Journal of Rheumatology. Cardiac arrhythmias are abnormal contractions of the heart that reduce its ability to efficiently pump blood. Symptoms may include shortness of breath, fainting or slow or rapid heart beat. Patients are at risk of stroke, congestive heart disease and sudden cardiac death.

Dr. Devy Zisman from Carmel Medical Center, Haifa, Israel, and colleagues compared the electrocardiogram (ECG) scans of 92 patients with psoriatic arthritis to those of 92 "controls," individual matched for age and sex, who did not have psoriatic arthritis.

"The major finding of our study," they report, "is a statistically significantly longer PR interval in the patients with psoriatic arthritis compared to individuals without psoriasis or arthritis." The lengthening of the PR interval is a sign of abnormal heart rhythm.

Compared with the controls, the average PR interval was 8.3 milliseconds, 5.5 percent longer in the psoriatic arthritis patients.

"Although the clinical relevance of this finding is questionable since the absolute difference was small, the importance of the observation is the implication of atrioventricular node involvement in the psoriatic arthritis systemic disease," Dr. Zisman and colleagues note.

The abnormal prolongation of the PR interval did not produce symptoms and no intervention was required. No statistical difference was apparent with respect to any other ventricular conduction disturbances studied.

There was also no apparent effect of methotrexate or nonsteroidal anti-inflammatory arthritis drug therapy on cardiac conduction. The effects of the newer biological treatments were not assessed in this study.

Based on their observations, Zisman and colleagues conclude that a large study with a long followup period is warranted to further investigate these conduction abnormalities and to see if they are related to cardiovascular disease.

SOURCE: Journal of Rheumatology, December 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - A vaccine to protect against infection with the bird flu virus, the pathogen experts fear is capable of causing pandemic disease in humans, proved safe and effective in a preliminary clinical trial with children, mirroring the results of a recent trial conducted in adults, Hungarian researchers report in the Pediatric Infectious Disease Journal.

Fluval (also called avian influenza A (H5N1) vaccine) was developed and produced by Omninvest LTD (Hungary), report Dr. Zoltan Vajo, of the National Center for Immunology and Allergy in Budapest, and co-authors.

Twelve healthy children, 9 to 17 years of age, received a single dose of Fluval by intramuscular injection. No side effects were detected.

On day 21, the rate of protection was 75 percent. Similar results using the same vaccine were reported last year following a clinical trial involving 146 adults.

This vaccine fulfilled all U.S. and European criteria required for licensure, the authors note.

Vajo's team also points out that Fluval requires only one dose, while other H5N1 vaccines approved by regulatory agencies require more doses, with at least two injections administered 21 to 28 days apart.

SOURCE: Pediatric Infectious Disease Journal, December 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters) - Genentech Inc notified doctors of 36 cases of eye inflammation among patients who received injections with the company's cancer drug Avastin (bevacizumab) to treat wet macular degeneration. The "off-label" use of Avastin for this eye condition is not approved by the U.S. Food and Drug Administration.

Wet macular degeneration, which is often age-related, is caused by an abnormal increased leakage from blood vessels under the retina, leading to loss of central vision.

Genentech, in a letter to healthcare providers, said its partner Roche Holding AG had informed it of the cases, which included 32 serious inflammatory reactions.

"These events were reported to Roche between November 4 and 20, 2008, from four different reporting sites," Genentech said.

Roche, which holds a majority stake in Genentech, markets Avastin to treat cancer in many markets outside the United States, including Canada.

Genentech sells Avastin in the United States for the treatment of lung and colon cancer. It also sells a similar drug called Lucentis (ranibizumab injection), a fragment of the Avastin antibody, which is approved to treat wet macular degeneration.

Although Avastin is not approved to treat this eye condition, many doctors have divided it into multiple doses and used it instead of the more costly Lucentis.

Genentech spokeswoman Krysta Pellegrino said 25 of the cases were from one lot of Avastin. A lot consists of 66,000 single-use vials. She said all quality specifications established for approved uses of Avastin were met.

About 2 percent of patients who receive Lucentis develop eye inflammation, Pellegrino said, but Genentech does not know what percentage of patients who receive off-label Avastin develop such inflammation.

The U.S. National Institutes of Health is sponsoring a head-to-head trial comparing Avastin and Lucentis for macular degeneration.

Should the drugs show comparable safety and effectiveness, the U.S. government could shift patients in the Medicare insurance program to less costly small doses of Avastin.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Mobile teleconsulting is a feasible way to evaluate remotely located patients who have just had a stroke, according to a report in the current issue of the journal Stroke. Although researchers found that hospital-based, land-line systems still provide better quality communication.

In a study involving 2 stroke centers and 14 local hospitals in Germany, investigators analyzed telephone consultations performed at fixed telemedicine workstations using high-speed Internet connections and laptops that could be taken to remote sites.

Specifically, the researchers compared the technical parameters, acceptability, and impact on immediate clinical decisions of consultations performed with the mobile vs land-line devices.

The teleconsultants reported that the process took longer when the laptops were used, despite almost identical download time measurements. They also rated the video and audio quality to be better with the hospital-based system.

Although the technical quality of the mobile communication was rated worse on both sides, "this did not affect the ability to make remote decisions like initiating thrombolysis," a "clot-busting" drug treatment for stroke, and the mobile system was technically stable, the authors report.

"During times of low teleconsultation frequency, this service can be provided from home or from elsewhere," Dr. Heinrich J. Audebert from Charite Universitatsmedizin in Berlin told Reuters Health. "Currently, the technical quality of mobile teleconsultation is not equivalent to landline connections."

He and his colleagues point out while mobile devices are feasible in low-frequency circumstances, a hospital-based device would ensure optimal quality when teleconsultation frequency is high.

"Telemedicine in stroke care is only an instrument to make stroke expertise more available," Audebert stressed. It does not replace on-site, high-quality stroke treatment. "Therefore, a lot of specialized infrastructure, training, and quality monitoring are needed in telemedicine networks."

"We are currently investigating the use of telemedicine in pre-hospital stroke care," Audebert added. "We use telemedicine equipment in ambulance cars and patients are examined via videoconferencing before they are admitted to the hospital."

SOURCE: Stroke, December 2008.

Copyright © 2008 Reuters Limited.