Value of screening for kidney disease unclear

A new review unveiled that there is no research to prove tNew York, Apr 19  Screening people to catch early kidney disease may sound like a good idea, but there is no research to prove that it's worthwhile, according to a new review. 

In the US, about 11 percent of adults have chronic kidney disease, the vast majority of whom have early-stage disease. 

The disease is very common among older adults - more than 44 percent of Americans older than 70 have it - and high blood pressure and diabetes are the main risk factors. 

In its early stages, chronic kidney disease usually has no symptoms. But there are blood and urine tests that can catch signs of trouble, so it may sound logical to use them to screen everyone for early kidney dysfunction. 

The problem is, no clinical trials have tested the effectiveness of widespread screening, according to the new review published in the Annals of Internal Medicine. 

Nor have there been clinical trials to see whether routine monitoring of people with early kidney disease improves their long-term outlook. 

Controlled clinical trials - in which people are randomly assigned to have a particular intervention or not - are considered the "gold standard" of medical research. 

"This doesn't mean (screening and monitoring) are not beneficial," said Dr Howard Fink, a staff physician at the Veterans Affairs Medical Center in Minneapolis, who led the study. "The bottom line is that it's uncertain." 

Fink and his colleagues conducted the review of existing research on this subject for the US Preventive Services Task Force (USPSTF), a government-backed advisory group. The panel is currently revisiting its recommendations on kidney cancer screening; right now, there is no recommendation for or against it. 

And that's "unlikely to change," given the lack of clinical trials, according to Drs. Katrin Uhlig and Andrew Levey of Tufts Medical Center in Boston, who wrote an editorial published with the review. 

Before experts recommend widespread screening for a disease - which, by definition, means testing symptom-free people - they want evidence that the benefits outweigh the risks. 

"On its surface, it seems like screening for a disease would be beneficial," Fink said in an interview. 

But, he said, with any screening test, some people will get "false positive" results. And that will often lead to unnecessary (and possibly invasive) follow-up tests, extra costs and anxiety. 

With chronic kidney disease, there have been no studies on the benefits or harms of widespread screening. "Right now, all the screening-related harms are theoretical," Fink said. And so, too, are the benefits. 

It's also unclear whether it would be wise to routinely test all people with early-stage kidney disease to see if the problem is worsening over time. 

Fink noted that only a small percentage of people with early disease will actually progress to end-stage kidney failure - at which point dialysis or a kidney transplant are needed. 

The review did, however, find evidence that certain kidney disease treatments can slow the progression of the disease. 

Fink's team found 110 clinical trial reports on treatments. Overall, two types of blood pressure drugs - ACE inhibitors and angiotensin II-receptor blockers (ARBs) - lowered people's risk of developing end-stage kidney disease by about one-quarter to one-third. 

But that benefit was largely limited, Fink said, to people with diabetes and high blood pressure, plus large amounts of protein in the urine (known as macroalbuminuria). 

Based mainly on one trial, ACE inhibitors seemed to lower death risk in people with diabetes or cardiovascular disease. 

According to Fink, if screening is going to work, the "best chance" would come from targeting it to those people who are at increased risk and most likely to benefit from early treatment. 

Of course, many people with high blood pressure or diabetes will already be on an ACE inhibitor or ARB, Fink pointed out. So the added value of screening them for kidney disease is still not clear. 

On top of that, those same patients will usually automatically have their glomerular filtration rate (GFR), an important measure of how well the kidneys are working, reported after routine blood work at their doctor's office, said Uhlig. 

"This diminishes the benefit from screening," she told Reuters Health in an email. 

For patients, the main thing is to get their risk factors for kidney disease under better control, according to Uhlig. 

"Even without strong evidence on the benefits of screening for chronic kidney disease," she said, "risk factors like hypertension (high blood pressure) and diabetes require treatment to avoid kidney disease, as well as cardiovascular disease." 

As for people who already have early-stage kidney disease, some type of monitoring is needed, according to Uhlig. 

"However," she said, "how often and how depends on many factors: the type of disease, the speed with which the disease progresses, treatments, other healthcare problems." hat screening people to catch early kidney disease is worthwhile. 

Cancer patients rarely speak up about care problems

Many people who had problems with their cancer treatment never said anything to the doctor and almost none reported the problems to the hospitals New York, Apr 19  In a new survey of cancer patients, many people who'd had problems with their treatment never said anything to the doctor they thought was responsible - and almost none formally reported the problems to the hospital. 

Patients cited delays in treatment, surgical complications and other issues related to medical care, in addition to communication barriers or breakdowns between them and their doctors, as the most common potentially harmful problems. 

There could be many reasons why cancer patients don't always bring up concerns about those issues during treatment, according to the study's lead author. 

"Sometimes there's a situation where they're really still thankful for the care that they got, and so they don't want to hurt anybody by saying, 'Everything was great, except...' Or they don't want to do harm to their relationship (with their doctor)," said Kathleen Mazor, from Meyers Primary Care Institute and the University of Massachusetts Medical School in Worcester. 

Patients may also not want to dwell on some aspect of care that's in the past, she added. 

"When people are undergoing something like cancer, they really feel they need to put all their energy on looking forward," Mazor said. 

"They're thinking about getting better, moving forward, dealing with cancer and coming out the other end." 

In interviews with about 400 breast and colon cancer patients, more than one in five said something "went wrong" during their cancer care that could have been prevented - and caused or could have caused them physical or psychological harm. 

Seventy-eight patients, almost all women who'd been treated for breast cancer, completed interviews with Mazor and her colleagues about those treatment-related problems. 

About three-quarters of them cited communication problems with their doctor, such as not getting enough information or getting inaccurate information about their cancer. Specific examples include not being told about treatment options or being told their cancer would lead to death, only to have test results reveal it was treatable. 

Half said something went wrong during their medical care itself, such as surgical problems requiring additional surgery, infections, or perceived delays in treatment or diagnosis. 

Almost all cancer patients said that the problems with their doctor, whether communication-related or medical, had resulted in psychological harms, such as anger, fear and distress. The majority also cited physical harms like pain and the need for additional treatment. 

Study participants also mentioned financial costs, life disruptions such as missed work and a negative impact on their family stemming from the perceived treatment problems. 

Despite those consequences, just one-third of people the researchers interviewed said they'd discussed the harmful event with the doctor or nurse they believed was responsible. 

Ten of them reported the problem to the hospital administration, Mazor's team wrote in the Journal of Clinical Oncology. 

The message to patients is, "speak up," according to Mazor. 

"Sometimes patients think that something has gone wrong and it hasn't. But if you never tell anybody… they never have a chance to say, 'This is how it always goes,' or, 'We couldn't prevent that,'" she said. 

"If they can't say something to the person that they feel let them down or did something wrong, hopefully there's someone else like a nurse or their primary care physician or another physician that they can talk to and make their concerns known," she told Reuters Health. 

Dr Jeffrey Peppercorn, a breast cancer doctor from Duke University Medical Center in Durham, N.C., wrote in a commentary published with the study that addressing some of these problems may simply come down to doctors talking more with their patients and asking them to be open about concerns. 

"We need to more generally improve communication with patients about their experience over the course of care," he wrote. 

Mazor said hospitals can do their part by making it clear who people can go to if they feel something went wrong during their care, such as a patient advocate. 

More children surviving beyond five'

Better maternal care, smaller families, and birth spacing contributed to the decline in early childhood mortality, Nurul Islam Hasib reports as demographic and health survey result released Nurul Islam Hasib 
 Public Health Correspondent 

Dhaka, Apr 17  More children in Bangladesh are surviving beyond their fifth birthday thanks to better maternal health care, smaller families, and birth spacing by using contraceptives, says the demographic and health survey. 

One of the major highlights of the Bangladesh Demographic and Health Survey (BDHS) 2011 released on Tuesday in Dhaka is that the under-5 mortality rate has dropped to 53 from 65 per 1,000 births in four years, which means the country is on track of Millennium Development Goal-4. 

The mortality rate is now 53 per 1,000 births which was 65 in 2007. The MDG-4 targets to cut the deaths to 48 by 2015. 

The mortality rate was more than double (133) in 1993 when the first BDHS, a key source for monitoring, evaluation and preparing strategies for health sector, commenced. 

Under-1 mortality rate has also been reduced from 52 per 1,000 births to 43, while deaths of newborns within first month of birth reduced from 37 per 1,000 births in 2007 to 32 in 2011. 

However, the deaths within one month of birth account for 60 percent of mortality under five. 

Researchers say better maternal health care, smaller families, and birth spacing by using contraceptive methods contributed much to the decline in early childhood mortality. 

Confirming the trends shown in 2010 Bangladesh Maternal Mortality Survey, the BDHS indicates that more women are getting assistance of skilled birth attendants while giving birth. 

Now, almost one in three pregnant women, 32 percent, is assisted by trained health service providers during delivery while it was 21 percent in 2007. 

Paediatricians say more trained birth attendants mean less chance of newborn deaths. 

"One-fifth of the newborn deaths occur due to trouble in breathing (asphyxia) at birth," said Dr Khurshid Talukder, a paediatrician. 

He said it would be a great challenge for the government to keep newborn deaths low. 

"Breastfeeding within one hour of birth can be an option," he said as it gets newborn immune to infections, another major cause of deaths within one month of birth. 

However, Bangabandhu Sheikh Mujib Medical University has recently taken up a three-year programme to train up 20,000 birth-time attendants to help babies breathe using a kit called sucker machine, a bag and musk for artificial breathing. 

Apart from improving child survival, the latest BDHS also found lower fertility, increasing use of family planning methods and better care for expectant mothers. But malnutrition among children still remains high with little progress in the last four years. 

The survey is being carried out every 3 to 4 years since 1993-94. Based on the 2011 findings, the ongoing Health, Population and Nutrition Sector Development Plan (HPNSDP) targets of ministry of health and family welfare will be evaluated.

Acne drug tied to a doubled risk of eye problems

Pills used to treat acne have been linked to a two-fold risk of developing eye problems, such as pink eye, styes and dryness. New York, Apr 19  Prescription pills used to treat severe acne were linked to a two-fold risk of developing eye problems, such as pink eye, styes and dryness, in a large new study from Israel. 

Isotretinoin, which goes by brand names including Roaccutane, Claravis and Amnesteem, is known to have serious side effects, such as bone growth delays in teenagers and miscarriages and birth defects when taken by pregnant women. 

The medications are quite popular, however, for treating severe cases of acne in both teens and adults. 

According to Roche, the maker of Roaccutane, formerly known as Accutane, 16 million people worldwide have used that brand alone since 1982. 

Some eye problems are already more common in people with acne, but in the new study of nearly 15,000 Israeli adolescents and young adults, 14 percent of those taking isotretinoin were treated for eye conditions within a year of starting the drug. 

That compared to seven percent of an acne-free comparison group and 9.6 percent of subjects with acne who had never taken isotretinoin. 

"I would give parents the advice to (have their children) see an ophthalmologist before they take it, and every three months for the first year they take it, because if we catch things early we can fix them and not leave you with permanent side effects," said Dr. Rick Fraunfelder, a professor at Oregon Health and Science University and an expert in eye problems related to medications. 

Although eye problems have been documented among people taking the drugs, Fraunfelder, who was not involved in the new study, said past research has not detailed how common the issues are. 

To get an idea of how often eye problems develop among patients on isotretinoin, researchers at the Tel Aviv Medical Center collected information on users and non-users from the records of a large managed-care organization. 

Gabriel Chodick, a researcher at Tel Aviv University and one of the study authors, said that each year about one percent of adolescents in the Maccabi Healthcare Services system start isotretinoin treatment to clear up their acne. 

In the study group, whose average age was 16, nearly 2,000 people developed inflammatory eye conditions -- 991 who were taking isotretinoin, 446 with acne but not on the medication and 354 in the acne-free group. 

The most common complaint was conjunctivitis, also called pink eye, which is inflammation or infection in the eye.

Four out of every 100 people on isotretinoin were diagnosed with conjunctivitis, while about two out of every 100 people not on any acne medication were treated for conjunctivitis, the researchers reported in Archives of Dermatology. 

Chodick said one likely explanation for the increased risk of eye problems is that isotretinoin can disrupt the function of the meibomian glands on the eyelids. 

These glands produce an oily substance that prevents the eyes from drying, and if the glands don't work properly the eyes can become irritated or inflamed. 

"In addition, the presence of isotretinoin and its metabolites in the tear film may have a direct irritating effect on the (eye's) surface," Chodick told Reuters Health in an email. 

Roche would not comment on the study but a spokesperson pointed to possible side effects already listed in the medication's packaging labels, including eye problems such as conjunctivitis, decreased night vision and visual disturbances. 

Despite its potential hazards, the drug is still worth it for some patients, Chodick said. 

"Several studies have shown that acne can diminish a person's quality of life," he said. "Many of the adverse effects of systemic isotretinoin can be avoided or minimized if proper measures are introduced with, or soon after, introducing the drug." 

He said that doctors who prescribe these acne drugs should do so along with eye lubricants to prevent drying and irritation. 

"The beneficial preventive and therapeutic effects of using artificial tears should be discussed with the patients, especially for contact lens wearers," Chodick said. 

Fraunfelder urged people to seriously consider the side effects before starting isotretinoin treatment. 

"It's a relatively dangerous drug," he said. "The best way to avoid these side effects is if you do not take the drug at all." 

If people do opt for the treatment, he added, they should make sure to talk with their doctor about ways to prevent damage to the eyes. 

Breast cancer clutch of 10 diseases: Study

Scientists who conducted a major international study into the genetics of breast cancer say they can now classify the disease into 10 subtypes - a finding that points to more accurate, tailored treatment for individual patients in future. London, Apr 19  Scientists who conducted a major international study into the genetics of breast cancer say they can now classify the disease into 10 subtypes - a finding that points to more accurate, tailored treatment for individual patients in future. 

In research published in the journal Nature on Wednesday, a team led by scientists at the Cancer Research UK (CRUK) charity also found several completely new genes that drive breast cancer, offering potential targets for new types of drugs. 

Carlos Caldas, who co-led the study at CRUK's Cambridge Research Institute and the University of Cambridge said the findings mean breast cancer should now be seen as an "umbrella term" for a larger number of diseases. 

"Essentially we've moved from knowing what a breast tumour looks like under a microscope to pinpointing its molecular anatomy," he said. 

"This research won't affect women diagnosed with breast cancer today. But in the future, .. patients will receive treatment targeted to the genetic fingerprint of their tumour." 

Breast cancer is the most common cancer among women worldwide, accounting for 16 percent of all female cancer cases, according to the World Health Organisation. 

A study last year by the Institute for Health Metrics and Evaluation in the United States found that global breast cancer cases have more than doubled in just three decades, from 641,000 cases in 1980 to 1.6 million cases in 2010 - a pace that far exceeds global population growth. 

For the genetic study, Caldas's team worked with the BC Cancer Agency, based in Vancouver, Canada, and analysed 2,000 tumor samples taken from women diagnosed with breast cancer between five and 10 years ago. 

To get a detailed picture, they studied both DNA and RNA - which translates DNA into proteins - to find out which genes are switched on or off in each tumour sample. 

MOLECULAR MAP 

In a briefing for reporters, the researchers explained how this combined analysis of DNA and RNA helped reveal the identity of genes known as oncogenes - the drivers of cancer - and of tumour suppressor genes, which protect against cancer. 

This helped them reclassify breast cancer into 10 new categories based on gene activity rather than current tests, which look for the presence of so-called biomarkers such as oestrogen receptors or the cell surface receptor HER2. 

Drugs such as the generic tamoxifen, and aromatase inhibitors like AstraZeneca's Arimidex or Novartis's Femara, which block oestrogen activity, are already used in targeted treatment for breast cancer patients whose tumors produce large amounts of oestrogen receptor (ER). 

Roche's Herceptin is another targeted breast cancer drug which is given to patients whose tumours depend on HER2. 

Harpal Kumar, CRUK's chief executive, said the new findings would help oncologists make far more precise diagnoses for each breast cancer patient - "and that will enable us to make sure that we really target the right treatment to the right woman." 

The study "changes the way we think about breast cancer - no longer as one disease, but actually as 10 quite distinct diseases depending on which genes are really switched on and which ones aren't," he said. 

Samuel Aparicio, who co-led the study with the team in Vancouver, described the reclassification into 10 subtypes as a new "molecular map" of breast cancer which he said pointed to the potential development of new medicines. 

The scientists said the next step would be to find out how specific molecular patterns make tumours grow, and to seek out the faults that might respond to new drugs in the future. 

They said the information from this study would be made available to scientists worldwide in an effort to boost drug discovery and development.

Govt moves to seal Destiny fate

The government is considering steps against Destiny-2000 Ltd 'to protect people from deception', finance minister A M A Muhith said on Saturday. 

"A commission like the one on Jubok will be formed to bar asset transfer by such firms," Muhith told reporters at his office. 

Muhith's remarks followed recent newspaper reports on 'illegal banking' by Destiny Group. 

"Media reports on Destiny in the past few days have created an emergency-like situation," he said. "The government can't sit idle without taking action in this situation." 

"Jubok couldn't transfer all assets as its properties were confiscated. In that way, the clients can be compensated to some extent. A commission will be formed in the same manner," he said. 

He also said the finance and commerce ministries and relevant departments have already started working to form the commission. 

Jubo Karmasangsthan Society, better known as Jubok, was found guilty of illegal banking by a central bank investigation in July 2006. It was asked to repay Tk 1 billion it owed its depositors. 

Jubok was enlisted as a 'society' under the government's Registrar of Joint Stock Companies. 

Earlier, the parliamentary standing committee on commerce ministry decided to request the finance minister and the central bank governor for action against Destiny-2000 Ltd-like MLM companies. 

Following the parliamentary watchdog's move, the Bangladesh Bank on Apr 1 issued a circular warning people against investing in unapproved banking institutions. 

"It is to notify all that some institutions under different names are operating like banks in various districts across the country. They are collecting money from people by promising an abnormally higher rate of interest and profit," read the central bank statement. 

62 registered MLM Cos 

On mar 6 last year, then commerce minister Muhammad Faruk Khan had said there are 62 registered MLM companies operating in Bangladesh. 

He told parliament that only Destiny has 4.5 million clients. He had said other MLM companies had fewer clients than Destiny. Another prominent MLM company is Unipay-2 U. 

Asked about actions against Destiny, Muhith said, "I couldn't see the reports on Destiny by Bangladesh Bank and other organisations as I was abroad. I've seen them today (Saturday). It seems to me that Jubok-like actions are needed in this regard. We'll take those steps." 

He said the government is 'disturbed' by the media reports on Destiny. 

Two weeks ago, the central bank sent a report on Destiny to the finance ministry. The report alleged that Destiny-2000 was conducting illegal banking. 

Law on MLM Cos 

Finance minister on Saturday said the government has taken steps to formulate a law to bring MLM business under legal framework. 

The government took steps to formulate law after clients of another prominent MLM company Unipay-2 U took to the streets in 2010 following allegations of deception by the company. 

A commerce ministry official, requesting anonymity, told bdnews24.com that they have already finalised a draft of the law but could not present it to the cabinet due to objection by the public administration ministry. 

"The draft proposed to form a directorate and appoint staff there. But the public administration ministry is not giving its nod about recruiting manpower. So, the draft could not be presented to the cabinet," he said. 

Jubok clients not repaid even after 6 years 

Clients of Jubo Karmasangsthan Society, better known as Jubok, are yet to be repaid though six years have passed the MLM company was shut. 

After an investigation found Jubok guilty of illegal banking the central bank asked it to stop illegal operations and repay Tk 1 billion it owed its depositors by Mar 2006. 

The government shut Jubok as it had failed to repay its clients within the stipulated time. 

After the current government took charge, a commission headed by the former central bank governor Mohammed Farashuddin was formed to make proposals on Jubok and how to repay its clients. 

The commission proposed to sell Jubok's assets to repay the clients and also asked to form a permanent commission to oversee the matter. 

Following the proposal, the government formed a permanent commission headed by former joint secretary Rafikul Islam. But the Jubok clients are yet to be repaid.