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May 22
First Patients Treated In India Using CyberKnife Radiosurgery
Accuray Incorporated (Nasdaq: ARAY), a global leader in the field of radiosurgery, announced today that the first patients in India have been treated using CyberKnife radiosurgery. The CyberKnife System, which is located at the Apollo Specialty Cancer Hospital in Chennai, India, treated six patients in its first week of operation, with eight more patients in the treatment planning process being readied for treatment.

"Our new CyberKnife System allows us to deliver highly precise radiosurgical treatments to patients with tumors throughout the body," said Prathap C. Reddy, M.D., executive chairman, Apollo Hospitals Group. "We are very glad to have begun treating patients and look forward to witnessing the benefits that the System offers, including real-time tracking of tumors that move with respiration."

The CyberKnife treatment team at Apollo Hospital consists of a trained team of highly experienced radiation oncologists, radiation therapists and a neurosurgeon. The team plans to focus on CyberKnife radiosurgery for lung, liver and prostate treatment as well as head, neck and spine treatments. Lung cancer is currently one of the leading cancer incidences and causes of death amongst men in India. (National Cancer Registry, ICMR-New Delhi)

"Since India is the second most populous nation in the world, we are excited that CyberKnife radiosurgery is now an option for its population and that the first patients have received treatment," said Eric P. Lindquist, senior vice president and chief marketing officer at Accuray. "We believe this is just the first step in the opening of a large market for the CyberKnife System, as illustrated by the momentum within this System's first week of use."

Advanced Medical Systems (headquartered in Singapore), the company responsible for placing the CyberKnife at Apollo Hospital, will assist in marketing and providing end user support for the new CyberKnife System through its Accuray trained team of engineers and applications specialists based in India.

May 22
Chagas Disease Not Addressed By World Health Assembly
The World Health Organization (WHO) has cut short its annual health ministers meeting because of influenza A (H1N1) preparations and has postponed discussions about Chagas disease. Much needed progress in diagnosing and treating people for this neglected disease must not be further delayed, warned the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today.

This week's World Health Assembly (WHA), the annual gathering of health ministers in Geneva, was an opportunity for countries to commit collectively to stepping up the fight against Chagas, a largely neglected tropical disease endemic in many Latin American countries, which affects an estimated 14 million people and kills about 15,000 people every year.

"At the 100th anniversary of the discovery of Chagas we had expected that the WHA would adopt a resolution where all affected countries agree to integrate care of acute and chronic Chagas patients into their primary healthcare systems, and to invest more in research," said Roger Teck, MSF director of operations. "People affected by this neglected disease are once again neglected. However, even though Chagas is now off the WHA agenda, this should not be used as an excuse for inaction. Governments of endemic countries should step up through developing and implementing better national and international protocols to fight Chagas."

Chagas programs have traditionally focused on preventing the disease by controlling the "kissing bugs," the blood-sucking insects that transmit the disease. But MSF's experience in Honduras, Nicaragua, Guatemala, and Bolivia since 1999 has shown that prevention is far from enough.

"The focus on prevention ignores the needs of those who are already infected and are suffering in silence. In endemic countries, governments should actively screen, diagnose, and treat many more patients," said Gemma Ortiz, senior advocacy officer for Chagas at MSF. "Access to diagnostics and treatment must be made a priority."

MSF also urges WHO member states to review a range of alternative financing mechanisms, such as prize funds, to stimulate research and development for better tools to diagnose and treat Chagas patients in all stages of the disease. The lack of commercial incentives to invest in research and development has meant that Chagas has been neglected for decades.

May 21
Schizophrenia Still Misunderstood, Research Finds
A new study conducted by SANE Australia finds almost half of all Australians still have a very limited understanding of schizophrenia and the everyday reality of living with the illness.

The study (conducted in conjunction with Virtual Medical Centre), surveyed nearly 900 people with 49 per cent admitting to having a poor understanding of schizophrenia and its impact.

'The findings are disappointing but not surprising,' says SANE Australia's Executive Director Barbara Hocking. 'A lot of education is still needed about the realities of schizophrenia - the fact is, with treatment, the majority of those affected lead full lives and participate in the community.

'Unfortunately there is still a lot of stigma and discrimination towards those with schizophrenia, which is not helped by persistent myths about the illness. The most common myth confuses schizophrenia with so-called 'split personality', which is not the case.

'Another myth is that people affected by schizophrenia are violent, when in fact research shows that they are more likely to be victims of violence than to commit violent acts themselves.'

One in a hundred people will develop schizophrenia during their lives. More males than females are affected and 75% develop the illness between 16 and 25 years.

Schizophrenia is an illness which influences the normal functioning of the brain, affecting its ability to interpret information and make sense of the world. Symptoms can include confused thinking, delusions, hallucinations, difficulty expressing emotions and withdrawal from others. There is no cure for schizophrenia but treatment, which includes medication, psychological therapy and community support and accommodation programs, can do much to reduce and even eliminate the symptoms.

'Through events such as Schizophrenia Awareness Week we can hope to break down the stigma surrounding the illness by encouraging conversation and help-seeking behaviour,' says Ms Hocking.

SANE produces a number of education resources about schizophrenia to help people understand and make sense of the illness, as a first step to coping with its effects. SANE also operates a StigmaWatch program, which works with the community to monitor media portrayals of mental illness and suicide, advocating for an end to misrepresentations of schizophrenia.

May 21
Link Between Obstructive Sleep Apnea And Diabetic Retinopathy
The eyes may be the window into the soul, but they may also contain important medical information. According to new research presented at the American Thoracic Society's 105th International Conference in San Diego on May 19, patients with diabetes who have retinopathy should also be screened for obstructive sleep apnea (OSA).

"We know from our earlier research that 23 percent of men with type 2 diabetes have OSA and this is under-recognized and under-treated," said Sophie D. West, M.D., of the Oxford Centre for Respiratory Medicine in the United Kingdom, who led the research. "This study suggests that OSA is linked to retinopathy in type 2 diabetes."

The researchers analyzed data from 118 men who had participated in the earlier study on the prevalence of OSA in type 2 diabetes in Oxford, England, and who also had retinal images to review. (All patients with type 2 diabetes in the U.K. are offered annual retinal screening to look for signs of retinopathy.) The images were studied by ophthalmology graders for evidence of retinopathy and the sleep study data was reviewed to determine the presence or absence of OSA.

The researchers found that retinopathy was present in more than half - 54 percent - of those who had OSA, compared to fewer than a third - 31 percent - of those without OSA, independent of the effects of glucose control, age, body mass index, high blood pressure and the duration of the diabetes. This was statistically significant.

"These results suggest an association between OSA and retinopathy that should be further investigated," said Dr. West. "While the study only analyzed data from men, there is no reason to believe that gender would play a role in the results."

There has been very little work previously regarding the relationship between OSA and retinopathy. Previous studies have found strong links between poor glucose control and high blood pressure with retinopathy and these have been the main areas upon which treatment has been targeted in diabetes in order to prevent retinopathy from developing and to delay its progression. However, in this study, OSA had a far stronger relationship with retinopathy than did glucose control or high blood pressure.

"While there is clearly more research to be done, there is an immediate implication to consider," said Dr. West. "Our message would be for doctors and nurses who see patients with type 2 diabetes to consider whether they could have OSA and whether they should therefore be referred for a sleep study."

Symptoms of possible OSA include snoring, apneas (stopping breathing) and daytime sleepiness. "Future research will try to determine whether the treatment for OSA, that is continuous positive airway pressure (CPAP), can delay the development or progression of retinopathy, associated with diabetes."

May 21
Those With Darker Skin Might Be More Susceptible To Nicotine Addiction, Study Finds
Blacks and others with darker skin might be at greater risk for tobacco addiction than whites and those with lighter skin because the greater the amount of melanin, the coloring pigment in skin, the more nicotine appears to be stored, according to preliminary findings published in the journal Pharmacology, Biochemistry and Behavior, the New York Times reports. For the study, lead researcher Gary King, a professor of biobehavioral health at Pennsylvania State University, looked at 150 black smokers and measured their levels of melanin and cotinine, a byproduct of nicotine. They also surveyed the participants to determine the level of their smoking habit.

Those with the most melanin were found to smoke the most and have the most cotinine in their system. They also had the highest level of dependence on tobacco. The findings might indicate why some people are more affected by nicotine than others.

May 21
Folic Acid May Improve Asthma, Allergies
Folic acid, or vitamin B9, may help treat allergic reactions and allergy symptoms, according to researchers from the Johns Hopkins Children's Center.

Folate occurs naturally in food while folic acid is the synthetic form of this vitamin. Sources include cereals, baked goods, leafy vegetables, asparagus, fruits, legumes, yeast, mushrooms and organ meat (such as beef liver or kidneys).

Previous studies have noted a potential link between folate and inflammatory conditions such as heart disease.

In the study, funded by the National Institutes of Health (NIH), researchers reviewed medical data from in 8,083 patients ages 2-85 who participated in the 2005-2006 National Health and Nutrition Examination Survey (NHANES). During the study, serum folate levels and total IgE levels were measured. IgE, or immunoglobulin E, is a class of antibodies that mediates allergic reactions. The authors also recorded asthma and respiratory symptoms.

Higher levels of folate were linked to lower IgE levels, fewer reported allergies, less wheezing and a lower likelihood of developing asthma. People with the lowest folate levels (less than eight nanograms per milliliter of blood) had a 40 percent increased risk of wheezing, 30 percent increased risk of having elevated IgE levels, 31 percent increased risk of allergic symptoms and a 16 percent higher risk of asthma compared to those with the highest levels of folate (above 18 nanograms per milliliter of blood).

However, additional research is needed to confirm these early findings and to determine exactly how folate may work. The researchers plan to compare the effects of folic acid to placebo in people with allergies and asthma.

May 21
WHO Urges H1N1 Vaccine Producers To Give 10 Per Cent To Poor Countries
The World Health Organization (WHO) urged pharmaceutical companies to donate at least 10 per cent of their H1N1 pandemic swine flu vaccine to poor countries, or at least offer them lower prices, to ensure that they don't get left out as it is likely that demand will outstrip capacity to supply in the months ahead.

Six out of 30 major drug companies have agreed to do so. Their chiefs met with UN Secretary General Ban Ki-moon and WHO Director-General Dr Margaret Chan in Geneva where health ministers from nearly 200 member countries are currently attending the 62nd World Health Assembly.

Ban said there was still a need for vigilance over the H1N1 virus:

"We may be in a grace period with H1N1 but we are still in the danger zone," said Ban, as reported by the BBC.

By grace period Ban was referring to Chan's opening speech on Monday where she used the phrase "grace period" to refer to the fact that the virus has not yet reached developing countries, giving us time to help them prepare for it.

She said if and when the virus reaches developing countries they were likely to be more vulnerable and experience a higher proportion of serious cases and deaths than we have seen so far because their populations carried 80 per cent of the world's burden of chronic diseaeses such as HIV/AIDS, malaria and tuberculosis.

According to the WHO, there are now nearly 10,000 confirmed cases of new H1N1 swine flu in 40 countries, including 79 deaths, most of them in Mexico where the outbreak was first reported.

Many rich countries such as Britain, Canada, Denmark, France and Switzerland have already agreed contracts with drug companies to supply millions of doses of pandemic vaccines as they come off the production line.

However, Chan said the drug companies have given "very serious commitments" to helping developing countries when she met them on Tuesday.

Ban called for global solidarity in confronting the new H1N1 virus, and said it was important for the drug companies and governments to work together to lessen the impact.

Solidarity "must mean that all have access to drugs and vaccines," said Ban, according to a report by the Associated Press.

"Partnerships with the private sector are absolutely vital," he added.

But the manufacturers said it will take months to produce large quantities of the vaccine, and production cannot start before mid-July, which is weeks later than anticipated.

One of the reasons that the manufacturers will not be able to start making vaccine until mid-July is because the new H1N1 strain is proving very slow to grow in laboratories, said the WHO.

Eric Althoff, a spokesman for Novartis AG, a large Swiss drug company said:

"I don't think that all of the answers are there yet."

GlaxoSmithKline PLC, which is British based, said they would donate 50 million doses and offer more at discount prices.

According to the AP report, another drug company with much less capacity said they would share half their doses. The WHO did not say which company as the deal was still in negotiation.

And other smaller companies also said they would offer 10 per cent of their vaccine doses to the UN at lower prices.

There is also confusion about how many doses will be available and by when. Some experts say 5 billion doses should be ready within a year of starting full scale production, while others say that is too optimistic.

David Fedson, a vaccine expert who used to be a medical professor at the University of Virginia, said we need to be cautious about predictions, and just "go forward with production as quickly as possible".

Another area of debate is whether to dedicate all vaccine making capacity to the new H1N1 strain and not develop any seasonal flu vaccine for the coming season. Seasonal flu kills up to half a million people worldwide every year.

The United States has not reserved any swine flu vaccine capacity, and is working to enhance seasonal flu production capacity so that it can switch over to pandemic flu vaccine if necessary.

May 19
Genetic Factors Play Lead Role For Adolescent Crime Victims
Genes trump environment as the primary reason that some adolescents are more likely than others to be victimized by crime, according to groundbreaking research led by distinguished criminologist Kevin M. Beaver of The Florida State University.

The study is believed to be the first to probe the genetic basis of victimization.

"Victimization can appear to be a purely environmental phenomenon, in which people are randomly victimized for reasons that have nothing to do with their genes," said Beaver, an assistant professor in FSU's nationally top-10-ranked College of Criminology and Criminal Justice. "However, because we know that genetically influenced traits such as low self control affect delinquent behavior, and delinquents, particularly violent ones, tend to associate with antisocial peers, I had reasons to suspect that genetic factors could influence the odds of someone becoming a victim of crime, and these formed the basis of our study."

Beaver analyzed a sample of identical and same-sex fraternal twins drawn from a large, nationally representative sample of male and female adolescents interviewed in 1994 and 1995 for the National Longitudinal Study of Adolescent Health. "Add Health" interviewers had gathered data on participants that included details on family life, social life, romantic relationships, extracurricular activities, drug and alcohol use, and personal victimization.

The data convinced Beaver that genetic factors explained a surprisingly significant 40 to 45 percent of the variance in adolescent victimization among the twins, while non-shared environments (those environments that are not the same between siblings) explained the remaining variance. But among adolescents who were victimized repeatedly, the effect of genetic factors accounted for a whopping 64 percent of the variance.

"It stands to reason that, if genetics are part of the reason why some young people are victimized in the first place, and genetics don't change, there's a good chance these individuals will experience repeat victimization," Beaver said.

Findings from the study are described in a paper to be published in a July 2009 special issue of the journal Youth Violence and Juvenile Justice dealing with biosocial criminology. Beaver served as lead author of the paper, "The Biosocial Underpinnings to Adolescent Victimization," ­which currently can be accessed on the journal's Web site. His co-authors are criminology graduate students Brian Boutwell and J.C. Barnes of Florida State and Jonathon A. Cooper of Arizona State University.

"It is possible that we detected this genetic effect on victimization because it is operating indirectly through behaviors," Beaver said. "The same genetic factors that promote antisocial behavior may also promote victimization, because adolescents who engage in acts of delinquency tend to have delinquent peers who are more likely to victimize them. In turn, these victims are more likely to be repeatedly victimized, and to victimize others."

Thus, write Beaver and his colleagues, victims of crime are not always innocent bystanders targeted at random, but instead, sometimes actively participate in the construction of their victimization experiences.

May 19
Simple, Inexpensive Blood Test Could Speed Diagnosis Of Muscular Dystrophy In Boys
Boys show signs of Duchenne Muscular Dystrophy (DMD) for 2 ½ years before they obtain a diagnosis and disease-specific treatment, about the same length of delay children have endured for the past 20 years despite advances in genetic testing and treatment. A simple and inexpensive blood test for any boy with symptoms and signs of motor delays and abnormalities could speed up the process while pilot studies on newborn screening are conducted.

Recent University of Rochester Medical Center research published in the Journal of Pediatrics shows that boys who are eventually diagnosed with DMD show signs of the disease for more than a year before families bring it to the attention of a health care provider. It takes another year before these children are screened with a serum CK test - a simple and inexpensive blood test for creatine kinase, an enzyme that leaks out of damaged muscle.

"The CK test is an easily available and cheap test," said Emma Ciafaloni, M.D., associate professor of Neurology at the University of Rochester Medical Center and author of the paper. "If they get the test and the diagnosis earlier, they can start treatment earlier and access the best care in the appropriate clinics and the best available services in their school. Early diagnosis will avoid unnecessary and costly tests and numerous unnecessary referrals to the wrong specialists. Parents and maternal relatives can also seek genetic counseling before they plan to have more children."

DMD, the most common muscular dystrophy in children is a particularly devastating form of the disease that affects 1 in 3,500 boys. It is an X-linked recessive genetic disease with onset of symptoms in boys between 2 and 6 years old. It progresses rapidly, rendering patients wheelchair bound by 10 or 11 years old. Most patients die in their mid-late 20s.

The Centers for Disease Control and Prevention-funded study analyzed medical records of 453 boys born since 1982 with DMD or Becker Muscular Dystrophy in the Muscular Dystrophy Surveillance, Tracking and Research Network (MD STARnet). Of those, 156 boys had no known family history of muscular dystrophy. The first signs of the disease in those boys were seen at an average of 2 ½ years old, but the average age when families brought the signs to the attention of a health care provider was 3 ½ years old. The average age for children to receive the CK test or to see a neurologist was more than 4 ½ years old.

May 19
Tongue And Pharyngeal Exercises May Benefit Patients With Mild To Moderate OSA
Practicing certain tongue and pharyngeal exercises may reduce symptoms of mild to moderate obstructive sleep apnea (OSA), according to new research being published in the second issue for May of the American Journal of Respiratory and Critical Care Medicine.

Although CPAP is the gold standard treatment for severe OSA, the vast majority of subjects from epidemiological studies have mild or moderate OSA. The compliance to CPAP among mild to moderate OSA is variable, and there are only a few forms of alternative treatments for this large number of subjects and patients.

"It was commonly thought among doctors that strengthening and toning oropharyngeal muscles would have no benefit to the patient during sleep, but a recent study showed that didgeridoo playing helped decrease snoring and OSA," said Geraldo Lorenzi-Filho, M.D., Ph.D. "This was a change of paradigm, and indicated that not everything you do during the day is lost during sleep."

Dr. Lorenzi-Filho and colleagues investigated the effects of exercises on the symptoms of OSA in the first randomized, controlled study to do so. They recruited a group of 31 recently-diagnosed patients, who were evaluated for OSA severity using polysomnography. Snoring frequency and intensity, daytime sleepiness and sleep quality were assessed using self-reports and validated questionnaires. The subjects were the randomized to two groups - the exercise group and the control group. Each of the 16 individuals in the exercise group underwent a daily and weekly regimen of tongue and pharyngeal exercises. The 15 individuals in the control group underwent a sham treatment regimen involving deep breathing and nasal lavage with a saline solution.

After three months, there were no significant changes to OSA symptoms in the control group. However, the treatment group showed significant improvements in lowest oxygen saturation levels in blood, subjective sleepiness, snoring symptoms and quality of sleep scores.

Additionally, while there were no changes in abdominal circumference in either group, neck circumference decreased significantly in the treatment group with no concomitant changes in body mass index.

"These data suggest that the exercises were able to promote remodeling of the upper airways," Said Dr. Lorenzi-Filho.

Overall, the treatment groups showed a 40 percent decrease in OSA severity. Ten of the 16 patients in the treatment group who had originally been classified as having moderate OSA based on their apnea-hypopnea index (AHI) score were reclassified as having either mild (eight) or no OSA (two). "This was nearly two thirds of the treatment group, whereas none of the control group were reclassified with a milder disease," said Dr. Lorenzi-Filho. "This indicates to us that these exercises have significant potential to improve symptoms in sufferers of OSA."

"The muscles of the upper airways are extremely complex and the mechanisms leading to OSA are far from being well understood," said Dr. Lorenzi-Filho. "A strong muscle may be working on the wrong direction and not necessarily helping to open the airways. The overall set of exercises we tested target the correct physiology of the upper airway and should promote remodeling of the upper airways."

This was the first rigorous study of the subject, and the evidence supports that certain exercises do, in fact, aid in remodeling the upper airways in such a way as to reduce OSA symptoms.

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