VIAGRA Info

Women infected with HIV or at risk of becoming infected with HIV, the virus that causes AIDS, appear more likely to develop lung cancer than women in the general population, possibly because they are much more likely to smoke cigarettes, study findings hint.

People with HIV have a much higher risk for many cancers. Still, it is unclear whether HIV infection plays a role in the development of lung cancer, Dr. Alexandra M. Levine, at City of Hope National Medical Center in Duarte, California, and colleagues note in the Journal of Clinical Oncology.

To investigate, they compared lung cancer cases in 2,651 HIV-infected and 898 at-risk but uninfected women, who were 35 years old on average, with lung cancer cases estimated to occur among similarly aged women in the general population.

“We found a substantially increased risk of lung cancer among both HIV-infected and at-risk uninfected women compared with population-based expectations,” the team reports.

Specifically, population estimates suggested that the researchers would find between four and five lung cancer cases. Instead, over five years of follow up, they found 14 lung cancers - 12 in HIV-infected women and two in women at risk for HIV infection.

However, further analysis revealed that only smoking history and duration “were significantly associated with lung cancer” in the women with HIV or at risk for HIV infection.

Approximately two-thirds of women in the HIV group smoked. All of the women that developed lung cancer smoked, and over their lifetime smoked about double the amount of cigarettes as their lung cancer-free peers.

“As such, the development and implementation of smoking cessation programs aimed at HIV-infected persons will be of increasing importance,” the investigators wrote.

There were no lung cancer cases among the women who were lifetime non-smokers.

Several studies, Levine and colleagues note, have shown a significant increase in lung cancer among HIV-infected patients since the introduction of highly active AIDS drugs. Yet, they found no difference in lung cancer development among women infected with HIV before or after the availability of powerful AIDS drugs, suggesting, they say, that lung cancer is not associated with the use of AIDS drugs.

“The precise role of HIV infection, per se, in terms of the development or progression of lung cancer” needs further study, the researchers conclude.

SOURCE: Journal of Clinical Oncology, published online.

The urinary tract includes the kidneys, bladder, urethra and ureters — parts of the body that create, store and remove urine. A bacterial infection of the urinary tract is common.

The National Women’s Health Information Center says a urinary tract infection (UTI) may have these warning signs and should be evaluated by a doctor without delay:
A painful or stinging sensation during urination.
Feeling like you need to urinate frequently, but with little urine output.
A sensation of pressure in the lower abdominal area.
A bad odor or unusual appearance to urine, including a cloudy or reddish appearance.
Fatigue, fever or shakiness.

Reversing a trend of nearly five decades, birth weight in the U.S. may be on the decline, according to a new study.

From 1990 to 2005, birth weight decreased by 52 grams (1.83 oz) on average. The drop - from 3441 to 3389 grams - leaves the vast majority of babies in the safe range, and the overall health consequences of this development are unclear.

“It is important to study trends in low birth weight over time because an increasing proportion of the smallest babies could lead to increased resource requirements to address health concerns,” Sara Donahue of Boston University, who worked on the study, told Reuters Health.

Small babies (usually defined as lighter than 2500 grams, or 5.5 pounds) may face problems such as low blood sugar, lower body temperatures, or an increase in red blood cells, which can cause the blood to thicken and clot.

To track trends in birth weights, Donahue and her colleagues examined birth records for nearly 37 million newborns in the US, excluding California.

To make sure that the recent weight drop wasn’t related to changes in maternal age or life style, the researchers also analyzed data for half a million young mothers who were deemed to be at low risk of pregnancy complications. For children of these women, it turned out that birth weight decreased even more, going down 79 grams (2.79 oz).

The number of women giving birth to small newborns increased by one percent among the low-risk mothers, but remained stable overall.

By contrast, the number of women giving birth to large newborns (heavier than 4000 grams, or 8 pounds, 13 ounces) fell by 2.2 percent for the low-risk group and by 1.4 percent overall.

Large babies may be difficult to deliver, resulting in harm to the infant or requirement for cesarean section.

The average length of pregnancy decreased during the study period by 2.4 days (a bit less for the low-risk group), which could also have an effect on birth weight.

“Although the consequences of the modest differences over time in birth weight for gestational age that we observed here are uncertain, any underlying reasons for such a decline may themselves directly influence child health,” the authors write in the journal Obstetrics & Gynecology.

So far, the reasons for the weight decline are unknown, and none of the factors examined by the researchers — including maternal age, smoking, and hypertension — could explain the new trend.

SOURCE: Obstetrics & Gynecology

For those with the common mental illness known as generalized anxiety disorder, a new study has found that the brain processes emotions in abnormal ways.

The study authors say the research could provide new insight into better treatments for people suffering from debilitating anxiety.

“Patients experience anxiety and worry and respond excessively to emotionally negative stimuli, but it’s never been clear really why,” Dr. Amit Etkin, acting assistant professor of psychiatry and behavioral sciences at Stanford University and first author of the study, said in a news release.

In the study, researchers gave MRI brain scans to 17 people with generalized anxiety disorder and 24 healthy people. The researchers wanted to understand what happened in participants’ brains as they felt various emotions.

The study authors found that the brains of the participants reacted differently in some situations. The findings suggest that the prefrontal cortex is abnormal in people with generalized anxiety disorder, and the researchers think that knowledge could lead to better diagnosis and treatment.

Senior study author Dr. Alan Schatzberg, chair of psychiatry and behavioral sciences at Stanford University, said in the news release that the findings, published in the February online issue of American Journal of Psychiatry, could lead to greater understanding of the biology of psychopathology and how people respond to psychotherapy.

An AIDS vaccine that appears to have worked at least partly in Thailand may only temporarily protect patients, with the effects starting to wane after a year or so, researchers reported on Thursday.

That may explain why results of the experimental vaccine have been so difficult to interpret, said Dr. Nelson Michael, a colonel at the Walter Reed Army Research Institute of Research in Maryland, who helped lead the trial,

Michael’s team is trying to find out how or why it might have worked. They surprised the world last September when they showed the experimental vaccine cut the risk of infection by 31 percent over three years.

“It is very likely that this vaccine only worked for a short period of time,” Michael said in a telephone interview.

“It is a weak, a modest effect but something that we can build on.”

The vaccine is a combination of Sanofi-Pasteur’s ALVAC canarypox/HIV vaccine and the HIV vaccine AIDSVAX, made by a San Francisco company called VaxGen and now owned by the nonprofit Global Solutions for Infectious Diseases.

Michael told the Conference on Retroviruses and Opportunistic Infections in San Francisco that it may be possible to design a trial that will show better whether the vaccine can really help people.

Part of the problem, he said, was that the 16,000 Thai volunteers who tested the vaccine were not at especially high risk of AIDS infection.

He said he would work with Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, to design trials in Asia or Africa.

According to the United Nations, more than 33 million people are infected with the fatal and incurable virus, with 2.7 million new infections every year.

Even a vaccine that protected for just a year would be useful, Michael said.

“Is that ideal?” No,” Michael said. “But it is true there are vaccines like the flu vaccine where you have to get them every year.”

Within the next few weeks, Michael said studies will also start to try to find clues from the blood of the vaccinated volunteers.

“Everyone wants to know why this worked and what lab measurements we could take that could predict this,” he said.

Results will take roughly a year, he said, but labs all over the world will be looking for so-called correlates — measurements such as antibody levels that will show whether a vaccine has affected the immune system in the desired way.

“It is what I call an all-hands-on-deck exercise,” he said.

The AIDS virus has killed 25 million people since it was identified in the 1980s. Cocktails of drugs can control HIV but there is no cure. In 2007, Merck & Co ended a trial of its vaccine after it was found not to work, and in 2003, AIDSVAX used alone was found to offer no protection, either.

Waiting longer to start infants on solid food could make for slimmer adults, new research shows.

“The later you introduce complementary feeding to an infant, within the range of 2 to 6 months, the smaller is the risk that the infant will be overweight as adult,” Dr. Kim Fleischer Michaelson of the University of Copenhagen, one of the researchers on the study, told Reuters Health via E-mail.

Some studies have suggested that breastfeeding protects against obesity, although the data are not yet conclusive. The World Health Organization and American Academy of Pediatrics currently recommend that babies be breastfed exclusively until six months of age, and advise against introducing solid foods until then. But many parents start their children on solid foods earlier.

Michaelson and her team looked at a sample of 5,068 men and women born in Copenhagen between 1959 and 1961. At that time, Michaelson noted, parents were instructed to start giving their infant solid foods between four to six months of age, but many started sooner.

Half of the study participants were breastfed for at least two and a half months, while half started eating solid food at three and a half months of age or later. Seventeen percent of the babies started spoon feeding before two months of age, while 46 percent didn’t start until they were four months old or later.

At age one, babies who were breastfed for longer had lower body mass indexes - BMIs, standard measures used to gauge how fat or thin a person is. However, there was no association between duration of nursing and BMI in later childhood, adolescence or adulthood.

The researchers did find that the age at which parents introduced various types of foods to an infant did seem to have an effect on BMI in adulthood. “In our study the risk of overweight at age 42 years was reduced by 5 percent to 10 percent for each month introduction of complementary foods was delayed,” Michaelson explained.

“I think it is best to wait with complementary foods until the infant is about 6 months old,” she added. “But there is no reason to be too rigid about the age. Some infants will need complementary foods before the age of 6 months, but they should not get them before four months of age.”

SOURCE: American Journal of Clinical Nutrition

Appendicitis doesn’t necessarily lead to a burst appendix if the organ isn’t removed quickly, U.S. researchers say in a new study that challenges traditional belief.

The researchers also theorize that viral infections can cause appendicitis.

“Just as the traditional appendix scar across the abdomen is fast becoming history, thanks to new single-incision surgery techniques that hide a tiny scar in the bellybutton, so, too, may the conventional wisdom that patients with appendicitis need to be operated on as soon as they enter the hospital,” the study’s senior author, Dr. Edward Livingston, chief of gastrointestinal surgery at the University of Texas Southwestern Medical Center in Dallas, said in a news release from the hospital.

“Patients still need to be seen quickly by a physician, but emergency surgery is now in question,” he said.

Livingston and his colleagues analyzed 36 years of data from the National Hospital Discharge Survey and identified seasonal variations and clustering of appendicitis cases that, he said, support the theory that appendicitis may be a viral disease, like the flu.

It’s not clear what types of viruses may cause appendicitis, although the researchers said they were able to rule out various intestinal viruses and also ruled out flu and several other common infections as a direct cause.

Their analysis of appendicitis trends from 1970 to 2006 also indicated that immediate removal of the organ might not be necessary in all people, they said. Cases involving sailors at sea without access to immediate surgery and patients at children’s hospitals where emergency surgery was not standard practice suggest, according to the researchers, that non-perforated appendicitis can resolve without surgery.

The study is in the January issue of Archives of Surgery.

Appendicitis, which affects about 10 percent of the population, is the most common reason for general emergency medical surgery, according to background information in the news release. About 280,000 appendectomies are performed each year in the United States.

“Though appendicitis is fairly common, it still remains a frustrating medical mystery,” Livingston said. “While we know surgical removal is an effective treatment, we still don’t know the purpose of the appendix, nor what causes it to become obstructed.”

In some cases of ruptured abdominal aortic aneurysm, minimally invasive repair could be more effective at saving lives than traditional open surgery.

Abdominal aortic aneurysm (AAA) is a bulging of the aorta, the largest blood vessel in the body. If the aneurysm ruptures, it causes rapid blood loss and a high risk of death. Each year, 13,000 Americans die from ruptured AAA.

If detected before it ruptures, an AAA that’s two inches or larger can be repaired surgically or with minimally invasive endovascular aneurysm repair (EVAR). In an emergency, patients usually undergo open surgical repair, which involves general anesthesia, an abdominal incision up to 12 inches long, clamping of the aorta and replacing the enlarged section of the aorta with a fabric graft.

In EVAR, doctors use X-ray guidance to thread a catheter through an incision in the groin to the AAA. They advance a collapsed stentgraft, called an endograft, through the catheter, which, once in place, is expanded inside the aneurysm. The aorta’s blood flow is redirected through the endograft.

The report is scheduled to be presented Jan. 18 at the annual International Symposium on Endovascular Therapy in Hollywood, Fla.

SOURCE: International Symposium on Endovascular Therapy

Radiation from CT scans done in 2007 will cause 29,000 cancers and kill nearly 15,000 Americans, researchers said on Monday.

The findings, published in the Archives of Internal Medicine, add to mounting evidence that Americans are overexposed to radiation from diagnostic tests, especially from a specialized kind of X-ray called a computed tomography, or CT, scan.

“What we learned is there is a significant amount of radiation with these CT scans, more than what we thought, and there is a significant number of cancers,” said Dr. Rita Redberg, editor of the Archives of Internal Medicine, where the studies were published.

“It’s estimated that just from the CT scans done in one year, just in 2007, there will be 15,000 excess deaths,” Redberg said in a telephone interview.

“We’re doing millions of CT scans every year and the numbers are increasing. That is a lot of excess deaths.”

CT scans give doctors a view inside the body, often eliminating the need for exploratory surgery. But CT scans involve much higher radiation dose than conventional X-rays. A chest CT scan exposes the patient to more than 100 times the radiation dose of a chest X-ray.

About 70 million CT scans were done on Americans in 2007, up from 3 million in 1980. Amy Berrington de Gonzalez of the National Cancer Institute and colleagues developed a computer model to estimate the impact of so many scans.

They estimated the scans done in 2007 will cause 29,000 cancers. A third of the projected cancers will occur in people who were ages 35 to 54 when they got their CT, two-thirds will occur in women and 15 percent will arise from scans done in children or teens.

The researchers estimated there will be an extra 2,000 excess breast cancers just from CT scans done in 2007.

UNNEEDED TESTS

Redberg, who wrote a commentary on the studies, said U.S. doctors’ enthusiasm for the tests has led to an explosion in their use that is putting patients at risk.

“While certainly some of the scans are incredibly important and life saving, it is also certain that some of them were not necessary,” Redberg said.

In a separate study, Dr. Rebecca Smith-Bindman of the University of California, San Francisco, and colleagues analyzed data from 1,119 patients undergoing the 11 most common types of diagnostic CT scans at four institutions in 2008.

They found radiation dosage varied widely between different types of CT studies, from a median or midpoint of 2 millisieverts for a routine head CT scan to 31 millisieverts for a scan of the abdomen and pelvis, which often involves taking multiple images of the same organ.

By comparison, the average American is exposed to about 3 millisieverts of radiation a year from ground radon or flying in an airplane — a level not considered a risk to health.

The researchers said efforts need to be taken to minimize CT radiation exposure, including reducing the number of unnecessary tests, cutting the dose per study, and standardizing the doses across facilities.

Imaging equipment makers such as GE Healthcare, Siemens, Philips and Toshiba Medical Systems are working to develop low-dose CT scanners.

About three-quarters of women with breast cancer report some degree of sexual problems, according to results released at the 32nd Annual San Antonio Breast Cancer Symposium (SABCS).

Surveys have found that anywhere from a quarter to two-thirds of healthy women experience sexual problems. Given that such problems are a known side effect of breast cancer treatments that block hormone activity, researchers wanted to know how often women with breast cancer experienced them.

Dr. Shari B. Goldfarb of Memorial Sloan-Kettering Cancer Center (MSKCC) in New York and colleagues anonymously surveyed more than 500 women with breast cancer of any stage in outpatient clinic waiting areas at MSKCC’s Breast Cancer Center and at two community centers.

Most of the women surveyed were being treated with chemotherapy, including hormone-based therapies such as tamoxifen. The disease had spread beyond the breasts in about a quarter of the women.

About three-quarters of the women - 76 percent — had sexual problems, defined as a low score on a commonly used set of questions.

That rate is significantly higher than what is seen in healthy women, Goldfarb said.

Of women reporting sexual dysfunction, about four-fifths described their sexual symptoms as bothersome. About half of patients said that their symptoms were severely bothersome.

Typical symptoms were vaginal dryness or difficulty in becoming sexually aroused.

The study did not look at potential treatments for sexual problems such as lubricants, hormones, and counseling.

“With improved treatments for breast cancer, patients are living longer, and most women treated for early-stage breast cancer will become long-term survivors,” Goldfarb pointed out. “For this reason, quality of life and symptoms become increasingly important in the short-term, during treatment and in the long-term throughout survivorship.”