Weight-loss drug approved by FDA for use in US

According to official figures more than one-third of adults in the US are now obese. The obesity rate among American adults has approached 35%.  A new weight-loss drug Qsymia has been approved by the US Food and Drug Administration (FDA). The approvals are the first in the US for 13 years.


FDA had already approved another anti-obesity drug Belvig last month. Qsymia is a combination of drugs phentermine and topiramate which has been already approved by the FDA and is marketed for aiding weight loss and preventing seizures. Qsymia is recommended for patients who are overweight or obese and have at least one other weight-related condition. The findings from two studies showed an average weight loss of 6.7% and 8.9% among patients who took Qsymia, along with dietary changes and exercise.

The drug is not recommended for pregnant women as it may harm fetuses. The drug is also not recommended for patients with heart disease or who have recently suffered a stroke because the drug can increase heart rate. Further trials are needed to assess the impact of the drug on cardiac health.

Source: http://www.bbc.co.uk/news/world-us-canada-18881232

Drug Resistance Tuberculosis

Tuberculosis drug resistance is a man-made amplification of spontaneous mutations in the genes of tuberculosis bacilli. Anti-tuberculosis (TB) drug resistance is a major public health problem. It threatens the progress made in TB control and care Worldwide. Drug-resistant TB occurs when the drugs used to treat TB are misused or mismanaged in drug-susceptible TB patients.  The administration of improper treatment regimens, issues of drug compliance are the few actions that lies beneath the improper use of TB drugs. The drug resistance arises in region/places where TB control programmes are weaker.

Multidrug-resistant tuberculosis (MDR Tuberculosis) refers to resistance to two or more anti-tuberculosis drugs. The two most potent TB drugs isoniazid and rifampin are used to treat all persons with TB disease.  When sputum smear positive/active tuberculosis is treated with a single drug “acquired drug resistance” may be produced. The growth of susceptible strains to that drug is suppressed, but the multiplication of drug-resistant strains is permitted. Acquired drug resistance may be caused by irregular drug supply, inappropriate prescription, or poor adherence to treatment. Primary resistance may occur when a person is infected for the first time with a drug-resistant strain of tuberculosis from someone who harbors MDR tuberculosis and may not be receiving adequate treatment. WHO estimates that every year 490,000 MDR tuberculosis cases emerge, with more than 110,000 deaths. Surveillance data shows that several countries with the highest burden of tuberculosis have significant multidrug resistance tuberculosis. 

 

Extensively drug-resistant TB (XDR TB) is a rare type of MDR TB. XDR TB is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs.  XDR TB is resistant to the most potent TB drugs therefore; patients are left with much less effective treatment options. People with HIV infection and weaker immune system are more likely to develop TB disease once they are infected, and also have a higher risk of death once they develop TB. XDR TB is of special concern for people with HIV infection or other conditions that can weaken the immune system. The latest report of highly lethal strains of XDR tuberculosis underscores the potential threat of expanding resistance. XDR tuberculosis has been found in 45 countries; at least one case has been confirmed in these countries.  The highest rates of MDR tuberculosis are in countries of the former Soviet Union and China.  In the two countries with the highest tuberculosis burden, China and India, 8% and 5% of tuberculosis cases are estimated to have MDR tuberculosis. Drug-resistant tuberculosis in global "hot spots” has already reached a level at which the relatively inexpensive DOTS approach is not adequate to address the tuberculosis problem.

DOTS remain the most important intervention for preventing MDR tuberculosis. DOTS treat regular tuberculosis if, administered properly. It also prevents the development of drug-resistant tuberculosis. If drug-resistant tuberculosis is already present among a population programmatic management of MDR and XDR tuberculosis strategy should be considered. The DOTS and programmatic management of MDR and XDR tuberculosis needs to be an integrated approach. The most important way to prevent the spread of drug-resistant TB is by focusing on the issue of compliance. It is very crucial for the patient to understand that prescribed TB drugs should be taken regularly as directed. The prescribed doses should not be missed and treatment should not be stopped prematurely. Better counseling techniques needs to be in place, so that during patient follow-up the issues related to non-compliance should be diagnosed and addressed.  Another way to prevent drug-resistant TB is by avoiding exposure to known drug-resistant TB patients in closed or crowded places such as hospitals, prisons, or homeless shelters.

TUBERCULOSIS: DIAGNOSIS

Tuberculosis is diagnosed based on clinical symptoms, sputum smear microscopy (SSM), chest x-rays, culture and tuberculin skin test (TST). The clinical symptoms of active pulmonary Tuberculosis disease are cough for three or more weeks, spitting up blood in the sputum, weight loss, fever or night sweats for three or more weeks, fatigue, feeling unwell, and loss of appetite, chest pain or discomfort, shortness of breath or difficulty in breathing.

 

Sputum smear microscopy (SSM): The gold standard diagnosis for tuberculosis is sputum smear microscopy (SSM). It is a simple technology that allows visual identification of the tuberculosis bacilli. It is very specific and most reliable way of identifying the presence of tuberculosis bacilli. Sputum smear microscopy is used to detect acid-fast bacilli (AFB) in the sputum. The appearance of AFB in the sputum (smear positive) indicates transmittable pulmonary disease. Currently, sputum smear microscopy is the only diagnostic tool that is affordable for low-income countries.

Chest radiography has been used usually in the past to diagnose tuberculosis; it is however much less specific when compared to sputum smear microscopy.

Culture is a tool for tuberculosis diagnosis but is not used as a part of routine tests. Culture is a more sensitive laboratory technique and is usually done when the symptoms are strongly suggestive of tuberculosis and sputum smear microscopy/SSM is negative. (Example: Culture is recommended in cases of tuberculosis in children and HIV/AIDS patients, because in these cases the number of tuberculosis bacilli in the sputum is often reduced and sputum smears are less likely to be found positive.)  Growth on solid culture media takes three to four weeks and requires special laboratories while growth in liquid culture is much faster. The average time for detection is 10 to 14 days. This system is known as Mycobacteria Growth Indicator Tube (MGIT)-tuberculosis culture and can be used to diagnose multidrug resistant tuberculosis (MGIT-DST).

MODS (Microscopic Observation Drug Susceptibility) are an alternative liquid culture system for case detection and drug susceptibility testing which is still under research.

Tuberculin skin test (TST): A small amount of fluid – tuberculin – is injected in the skin in the lower part of the arm. A positive test is measured by the size of the indurations (hardness, bump, and swelling) at the injection site two to three days post-injection. In developing countries this test is not used as a diagnostic test. In the presence of prior history of BCG vaccination the (TST) test may be positive. Persons with a positive skin test reaction are in high-risk groups and are prescribed drug (isoniazid) daily, for nine months. Isoniazid kills tuberculosis bacteria that are inactive in the body and prevents the individual from developing active tuberculosis from latent infection.

TUBERCULOSIS FACTS

Prevalence of Tuberculosis

One third of the world's population is infected with Tuberculosis. It kills an estimated 1.5 to 2 million people each year. Tuberculosis is one of the world's leading killers; on average it kills one person every 15 seconds. About 95% of people infected with tuberculosis live in developing countries. In low-income countries tuberculosis is one of the world's top ten causes of death. The low and middle-income countries account for more than 90% of tuberculosis cases and deaths. Tuberculosis is one of the leading causes of death among women in developing countries. More than 900 million women are infected with tuberculosis worldwide.

The World Health Organization estimates that 8.8 million people develop active Tuberculosis disease every year.  Active Tuberculosis had a case fatality of about 50% before the dawn of antibiotics.

Impact

Tuberculosis has significant impact on economy and development. More than 75% of tuberculosis-related disease and death occurs in people between the ages of 15 and 54–the most economically active segment of the population. Tuberculosis interfere individual’s ability to work for months. It is estimated that the lost of earnings totals up to 30% of annual household income, while some families may lose 100% of their income. The impact of tuberculosis further aggravates poverty.

The World Bank and WHO has reported tuberculosis as a leading cause of "healthy years lost" among women of reproductive age. Women bear a disproportionate burden of poverty, ill-health, malnutrition, and diseases worldwide. Tuberculosis causes more deaths among women than all causes of maternal mortality combined. Women of reproductive age, once infected with tuberculosis are more susceptible to develop tuberculosis than their male counterpart. Further women of this age group are at greater risk of infection with both tuberculosis and HIV.

Causes

Tuberculosis is a disease caused by the bacterium Mycobacterium Tuberculosis. Poverty is the underlying cause of (tuberculosis) infection in rural areas. Overcrowded housing, lack of proper food, proper sanitation contributes to development of tuberculosis. About 70% to 80% patients have tuberculosis of the lungs. Although tuberculosis can infect any part of the body, it usually infects the lungs. The tuberculosis of the lungs is known as pulmonary tuberculosis, it can be either latent tuberculosis infection (aka/inactive) or active tuberculosis disease (infectious).

The individual with latent tuberculosis infection have no symptoms of tuberculosis, they don’t feel sick and are non-contagious. However, they usually react positively to a tuberculin skin test (TST) even though chest x-ray and sputum tests are normal. While individual with active pulmonary tuberculosis have symptoms of tuberculosis infection. They are contagious and usually react positively to a tuberculin skin test, may have abnormal chest x-ray and a positive sputum smear or tissue culture.

Types

Tuberculosis that occurs outside the lungs is known as extra-pulmonary tuberculosis. Besides the lungs, other parts of the body that can be commonly affected are the lymph nodes, brain, kidneys, bone. Tuberculosis can be latent in these sites as well. A person can concurrently have pulmonary and extra-pulmonary tuberculosis. Extra-pulmonary tuberculosis can be seen more often in immune-suppressed people and in children.

Tuberculosis is not spread by insects, blood supplies, water, dishes, or clothing, or by someone with latent tuberculosis. In a healthy person, the two major transmission factors for tuberculosis are: concentration of infected respiratory droplets in the air and, the period of time exposed to contaminated air.  Each person with active pulmonary tuberculosis can infect 10 to 15 people per year. Only patients having active tuberculosis of the lungs (pulmonary tuberculosis) or throat (laryngeal tuberculosis) can infect others. Anyone can become infected with tubercular bacilli; a person has to inhale only a small number of active tuberculosis bacilli to become infected. Tuberculosis bacilli may reside in the tissues of the body, but may not be active (growing, reproducing, and causing increasing damage in the host). 
Latent tuberculosis infection: Inactive tuberculosis is called as latent tuberculosis infection. In such cases tuberculosis bacteria are asleep. As long as the tuberculosis bacteria remain latent, they do not harm the body and are not contagious. People with latent tuberculosis infection are the ones who have been exposed to tuberculosis and have acquired the tuberculosis organism. Latent tuberculosis infection may develop into active tuberculosis infection when the immune system weakens. When latent tuberculosis gets “activated” it develops into a case of pulmonary tuberculosis (sputum smear positive) that is infectious and can be transmitted to others. The typical symptoms like cough, fever, night sweats, weight loss, and lack of energy develops. In some instances, the person may cough up blood when active pulmonary tuberculosis is more advanced. 
Some of the factors that increase the risk for progression from latent tuberculosis infection to active tuberculosis disease are HIV, weakened immune system, poor health status (e.g., cancer, substance abuse, diabetes). Women are more likely to progress from latent tuberculosis infection to active tuberculosis disease whereas; men are more likely to have latent tuberculosis infection.