Asthma

Asthma is a disease that affects your lungs. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Asthma can be controlled by taking medicine and avoiding the triggers that can cause an attack. You must also remove the triggers in your environment that can make your asthma worse.

CDC’s National Asthma Control Program works to help Americans with asthma achieve better health and improved quality of life. The program funds states, school programs, and non-government organizations to help them improve surveillance of asthma, train health professionals, educate individuals with asthma and their families, and explain asthma to the public.

Learn How to Control Asthma

Asthma is a disease that affects your lungs. It is one of the most common long-term diseases of children, but adults can have asthma, too. Asthma causes wheezing, breathlessness, chest tightness, and coughing at night or early in the morning. If you have asthma, you have it all the time, but you will have asthma attacks only when something bothers your lungs.

In most cases, we don’t know what causes asthma, and we don’t know how to cure it. We know that if someone in your family has asthma you are more likely to have it.

How Can You Tell if You Have Asthma?

It can be hard to tell if someone has asthma, especially in children under age 5. Having a doctor check how well your lungs work and check for allergies can help you find out if you have asthma.

During a checkup, a doctor will ask if you cough a lot, especially at night. He or she will also ask whether your breathing problems are worse after physical activity or at certain times of year. The doctor will then ask about chest tightness, wheezing, and colds lasting more than 10 days. He or she will ask whether anyone in your family has or has had asthma, allergies, or other breathing problems. Finally, the doctor will ask questions about your home and whether you have missed school or work or have trouble doing certain things.

The doctor may also do a breathing test, called spectrometer, to find out how well your lungs are working by testing how much air you can breathe out after taking a very deep breath before and after you use asthma medicine.

What Is an Asthma Attack?

An asthma attack may include coughing, chest tightness, wheezing, and trouble breathing. The attack happens in your body’s airways, which are the paths that carry air to your lungs. As the air moves through your lungs, the airways become smaller, like the branches of a tree are smaller than the tree trunk. During an asthma attack, the sides of the airways in your lungs swell and the airways shrink. Less air gets in and out of your lungs, and mucous that your body makes clogs up the airways.

You can control your asthma by knowing the warning signs of an asthma attack, staying away from things that cause an attack, and following your doctor’s advice. When you control your asthma:

• you won’t have symptoms such as wheezing or coughing,
• you’ll sleep better,
• you won’t miss work or school,
• you can take part in all physical activities, and
• you won’t have to go to the hospital.

What Causes an Asthma Attack?

An asthma attack can happen when you are exposed to “asthma triggers.” Your asthma triggers can be very different from someone else’s asthma triggers. Know your triggers and learn how to avoid them. Watch out for an attack when you can’t avoid your triggers. Some of the most common triggers are tobacco smoke, dust mites, outdoor air pollution, cockroach allergen, pets, mold, smoke from burning wood or grass, and infections like flu.

How Is Asthma Treated?

Take your medicine exactly as your doctor tells you and stay away from things that can trigger an attack to control your asthma.

Everyone with asthma does not take the same medicine.

You can breathe in some medicines and take other medicines as a pill. Asthma medicines come in two types—quick-relief and long-term control. Quick-relief medicines control the symptoms of an asthma attack. If you need to use your quick-relief medicines more and more, visit your doctor to see if you need a different medicine. Long-term control medicines help you have fewer and milder attacks, but they don’t help you while you are having an asthma attack.

Asthma medicines can have side effects, but most side effects are mild and soon go away. Ask your doctor about the side effects of your medicines.

Kidney Failure

• Kidneys are the organs that filter waste products from the blood. They are also involved in regulating blood pressure, electrolyte balance, and red blood cell production in the body.
• Symptoms of kidney failure are due to the build-up of waste products and excess fluid in the body that may cause weakness, shortness of breath, lethargy, swelling, and confusion. Inability to remove potassium from the bloodstream may lead to abnormal heart rhythms and sudden death. Initially kidney failure may cause no symptoms.
• There are numerous causes of kidney failure, and treatment of the underlying disease may be the first step in correcting the kidney abnormality.
• Some causes of kidney failure are treatable and the kidney function may return to normal. Unfortunately, kidney failure may be progressive in other situations and may be irreversible.

The list of causes of kidney failure is often categorized based on where the injury has occurred.

Perennial causes (pre=before + renal=kidney) causes are due to decreased blood supply to the kidney. Examples of perennial causes of kidney failure are:

• Hypo volemia (low blood volume) due to blood loss
• Dehydration from loss of body fluid (for example, vomiting, diarrhea, sweating, fever)
• Poor intake of fluids
• Medication, for example, diuretics ("water pills") may cause excessive water loss
• Abnormal blood flow to and from the kidney due to obstruction of the renal artery or vein.

 

Breast Cancer

Breast Cancer

Breast cancer is the most common cancer in pregnant women and tends to affect women in their mid-30s. Although only about 1 in every 1,000 pregnant women gets breast cancer, the disease can be devastating to both the mother and her child -- so it is essential that pregnant women and their doctors continue to do routine breast exams and thoroughly investigate any suspicious lumps.

A major problem is that a lot of changes take place in a woman's breasts during pregnancy. This makes it harder to identify suspicious lumps. In addition, breast cancer tumors in pregnant women are often larger and more advanced by the time they are detected than lumps in women of the same age who are not pregnant.

How is breast cancer diagnosed??

The best thing you can do while pregnant is to see your obstetrician regularly. These doctor visits, called prenatal (or "before birth") visits, are very important in keeping both you and your baby in the best possible health. During these visits, your obstetrician will perform a breast examination to check for suspicious breast changes.

It is also important to regularly perform breast exams on yourself. Your doctor or nurse can teach you how to do this properly.

If a suspicious lump is found, your doctor will likely ask you to get a mammogram or an ultrasound. As in all procedures that expose you to radiation when you are pregnant, the technicians will take extra care to shield your baby from radiation during the mammogram.

If the lump is still suspicious after these tests, the doctor will usually perform a biopsy. In fact, your doctor will often recommend that you get a biopsy even if the initial tests come back negative. During the biopsy, a small sample of the suspicious tissue will be removed with a needle or by making a small cut. This sample is then thoroughly examined using a microscope and other methods to detect any cancer cells.

CANCER

Cancer is major public health problem for Pakistan where annually about 148,000 new cancer cases are diagnosed and almost 100,000 die due to cancer. The most common cancers in Pakistan are oral, lung, liver, breast, cervical and blood/bone-marrow cancer.

The major risk factors for cancer include smoking, physical inactivity, unhealthy diet, infections (hepatitis B/C, Human Papilloma virus) and exposure to toxins. All these can be prevented by adopting health life style and appropriate vaccinations. Therefore there is a need to educate the people especially the younger age group about risk factors of cancer and their preventive measures.

Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. Not all tumors are cancerous; benign tumors do not spread to other parts of the body.

Dog Bite Rabies

Rabies is endemic in Pakistan, with human infections being mostly due to the dog bite and cases are mostly diagnosed on clinical grounds only. Although no data on human rabies cases is available at the national level but it was estimated that 2,000 to 5,000 people die of rabies every year. Human rabies is not a notifiable disease in Pakistan and there is also no nationally coordinated response to the diseases and its surveillance.

In the past, globally all stress was being given on the management of dog bite and rabies with introduction newer and cost-effective vaccines. Despite all this, the overall treatment cost of dog bite cases is high and beyond the reach of many countries. However, now there has been a shift in the rabies elimination and now there is more focus on dog vaccination (both Pet and stray dogs). It is estimated that this cost is many folds less than the treatment of dog bite cases.  Dr Huma Qureshi, ED. PHRC has been nominated as National Focal person for Zoonosis and she is working on Rabies prevention and control in Pakistan.

World Rabies Day:

The World Rabies Day is celebrated in the world on 28th of September 2016. The Global Alliance for Rabies Control this year proposed the theme "Educate, vaccinate, eliminate". PHRC being the focal point for zoonosis in Pakistan is celebrating 28th September as "World Rabies Day".  Information brochure on rabies (preventive measures and what to do in case of dog bite) has been developed and these will be disseminated to general public in Public parks of Islamabad (Daman-e-Koh, Fatima Jinnah Park F9, Shakar Parian and Lake View Park).

Hepatitis

Pakistan has 12 million cases of hepatitis B and C (HBV/HCV) and is therefore highest country in the world to have such a high disease occurrence. Viral hepatitis B and C cause chronic liver disease and its complications and death and is a major concern for Pakistan.

Federal government recognized the importance of disease prevention and took steps towards disease prevention and strategizing its control. Following steps are being undertaken along with some achievements.

1. SOVALDI, the new oral drug for hepatitis C treatment has been registered in Pakistan on fast track and through special negotiations; its cost has been reduced by 99% as compared to that in USA. The drug is being given on special prescription to date but shall be available freely in a week.
2. Birth dose of hepatitis B vaccine has been sorted by making the Provincial program and the Federal EPI sit together and share the resources. The Provincial programs shall procure the vaccine and hand it over to Provincial EPI which shall store it in their cold rooms and give to new born children at health facility through their own EPI worker who also gives BCG and polio on day of delivery. There is no added cost and compliance report shall be sent to hepatitis program.
3. Infection control. Reuse of injections and improper sterilization of medical devices in health care is the major reason for hepatitis spread in Pakistan. These issues come under infection control, therefore WHO in collaboration with Pakistan Health Research Council (PHRC) has developed infection control guidelines, posters, small pocket book in Urdu for each health care provider and also supplied heavy duty WHO approved needle cutters and sharp containers to all BHUs, RHCs, DHQ and THQ of 25 high hepatitis districts of Pakistan. Materials have been sent, trainings done and now monitoring is being done.
4. Hepatitis B and C survey was supported by the federal ministry of health in 2006 to see the exact situation of the disease. The figures of this survey are used on the world maps by WHO, CDC and all partners while referring to hepatitis situation in the world. The survey is widely referred by researchers.
5. Technical Advisory Group (TAG) on hepatitis has been gazette notified by the federal government. It has experts from all Provinces and from WHO and CDC. This group of hepatitis experts’ advice the Federal and Provincial governments on issues related to hepatitis using scientific authentic references and not wishes.

Future strategies

1. Develop viral hepatitis strategy. TAG requested WHO and CDC USA to assist Pakistan in developing viral hepatitis strategy. Both partners agreed and the strategy is being developed in consultation with Provincial hepatitis experts and program.
2. Create awareness about disease. The disease can be tackled once behaviors are changed. Very aggressive media campaigns are being planned to create awareness about risk factors of disease and how to prevent them.
3. Hepatitis C treatment guidelines. Guidelines are being developed through technical support of WHO and CDC to ease diagnosis and treatment of disease.
4. Working together. All related programs like National blood transfusion authority, HIV AIDS, EPI, MNCH etc are being taken on board so that each program handles its component on hepatitis and reports back to program. This will reduce duplication.
5. Creation of Provincial infection control program. Provinces are being sensitized to have infection control program which shall cater for needs of all programs. All hospitals should have active infection control committees with regular monthly meetings with the hospital administration to check compliance to infection control by hospital staff. A cadre of infection control nurse needs to be created to make this functional.

co-amplified renal cell carcinoma: a distinct entity with potential implications for clinical management

A subset of renal cell carcinomas shows TFEB overexpression secondary to MALAT1-TFEB gene fusion. As alternate mechanisms of TFEB overexpression are likely to have the same effect, we sought to determine the frequency of amplification of TFEB and the adjacent VEGFA gene at 6p21.1. As patients with metastatic renal cell carcinomas are managed with anti-VEGF therapies, we retrospectively assessed therapeutic response in patients with amplified tumors. Amplification status was analyzed for 875 renal cell carcinomas from our institution, a consultative case and 794 cases from The Cancer Genome Atlas. Cases were classified as having low level (5–10 copies), and high-level amplification (>10 copies), and were further analyzed for adjacent oncogene copy number status (n=6; 3 single-nucleotide polymorphism genomic microarray, 3 The Cancer Genome Atlas) and structural rearrangements (n=1; mate-pair sequencing). These were then reviewed for histopathology, immunophenotype, and response to VEGF-targeted therapy on follow-up. In all, 10/875 (1.1%) institutional cases, 1 consultative case, and 3/794 (0.4%) of The Cancer Genome Atlas cases showed TFEB high-level amplification, while 14/875 (1.6%) cases showed TFEB low-level amplification. All cases had associated VEGFA amplification. This was confirmed with evaluation for copy number changes (n=6). The 6p21.1 high and low-level amplified tumors occurred in adults (mean age: 66), with over half being ≥pT3 (13/25, 52%), and most showed oncocytic, tubulopapillary features and high grade (≥grade 3: 20/22, 91%). These were aggressive tumors with metastasis and death from renal cell carcinoma in 11 (of 24, 46%) cases. Four patients received targeted therapy and had a mean survival of 31 months (range: 17–50) post nephrectomy. In summary, a group of aggressive renal cell carcinomas show genomic amplification of the 6p21.1 region including TFEB and VEGFA genes and share morphologic features. Additional studies are warranted to determine whether these patients respond to anti-VEGF therapy.

Hepatitis C

Hepatitis C is an infectious disease affecting primarily the liver, caused by thehepatitis C virus (HCV). The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years. In some cases, those with cirrhosis will go on to develop liver failure, liver cancer, or life-threatening esophageal andgastric varices.

“Hepatitis” means inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis. Hepatitis is also the name of a family of viral infections that affect the liver; the most common types are Hepatitis A, Hepatitis B, and Hepatitis C.

Polio and Post-Polio Syndrome

Also called: Infantile paralysis, Poliomyelitis, PPS
Polio is an infectious disease caused by a virus. It attacks your nervous system. In rare cases, polio infection can cause paralysis. Polio vaccination will protect most people for life. The United States and most other countries eradicated polio decades ago, except for rare cases.
The disease most commonly affects young children. Poliovirus spreads in human waste. People usually get it from contaminated food or water. Symptoms include fever, tiredness, vomiting, neck stiffness, and leg and arm pain. Most infected people never have symptoms. No treatment will reverse polio paralysis. Moist heat, physical therapy and medicines might ease symptoms.
Some people who've had polio develop post-polio syndrome (PPS) years later. Symptoms include tiredness, new muscle weakness and muscle and joint pain. There is no way to prevent or cure PPS.
Polio Vaccine
What is polio?
Poliomyelitis (polio, for short) is caused by a virus. The virus can be spread by drinking water with the polio virus in it. It can also be passed by close contact, such as kissing, with an infected person. Polio is a serious illness. It can cause paralysis (when you can't move your arms and legs) or even death. Before the first polio vaccine was developed in the 1950s, thousands of children got polio every year. Fortunately, the use of the polio vaccine has made the disease very rare in most parts of the world.
How can polio be prevented?
You can keep your children from getting polio by making sure they get the polio vaccine.
What is the polio vaccine?
A vaccine is used to protect you from getting a disease. The polio vaccine, also called IPV, is given by injection (a "shot"). (It used to be given by drops in the mouth.)
When should my child be vaccinated?
Most children get 4 doses of polio vaccine on this schedule:
First dose when they are 2 months old.
Second dose when they are 4 months old.
Third dose when they are 6 to 18 months old.
Last dose when they are 4 to 6 years old.
Are there reasons not to get polio shots?
Your child should not get the polio shots if he or she is allergic to these medicines: neomycin, streptomycin or polymyxin B.
What are the risks of the vaccine?
Most people have no problems. Some people will have some pain or redness where the shot was given. Vaccines carry a small risk of serious harm, such as a severe allergic reaction.

About Malaria:

Malaria is a serious disease caused by a parasite. Infected mosquitoes spread it. Malaria is a major cause of death worldwide, but it is almost wiped out in the United States. The disease is mostly a problem in developing countries with warm climates. If you travel to these countries, you are at risk. There are four different types of malaria caused by four related parasites. The most deadly type occurs in Africa south of the Sahara Desert.
Malaria symptoms include chills, flu-like symptoms, fever, vomiting, diarrhea and jaundice. The disease can be life-threatening. However, you can treat malaria with medicines. The type of medicine depends on which kind of malaria you have and where you were infected.
Malaria can be prevented. When traveling to malaria-prone regions
See your doctor for medicines that protect you
Wear insect repellent with DEET
Cover up
Sleep under mosquito netting
Information for The General Public
Malaria can be a severe, potentially fatal disease (especially when caused by Plasmodium falciparum) and treatment should be initiated as soon as possible.
In endemic areas, the World Health Organization recommends that treatment be started within 24 hours after the first symptoms appear. Treatment of patients with uncomplicated malaria can be conducted on an ambulatory basis (without hospitalization) but patients with severe malaria should be hospitalized if possible.
In areas where malaria is not endemic, all patients with malaria (uncomplicated or severe) should be kept under clinical observation if possible.
Patients who have severe P. falciparum malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.
In some countries (but not the United States) some antimalarial drugs are found in suppository form.
Several antimalarial drugs are available for treatment by continuous intravenous infusion.
Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:
chloroquine
sulfadoxine-pyrimethamine (Fansidar®)
mefloquine (Lariam®)
atovaquone-proguanil (Malarone®)
quinine
doxycycline
artemisin derivatives (not licensed for use in the United States, but often found overseas)
In addition, primaquine is active against the dormant parasite liver forms (hypnozoites) and prevents relapses. Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquine until a screening test has excluded G6PD deficiency.
How to treat a patient with malaria depends on:
The type (species) of the infecting parasite
The area where the infection was acquired and its drug-resistance status
The clinical status of the patient
Any accompanying illness or condition
Pregnancy
Drug allergies, or other medications taken by the patient.

Stones, Heart Disease:

The results are consistent with findings from other recent studies and suggest that nephrolithiasis may reflect a systemic vascular disorder. In fact, lead author Brian Eisner, MD, observed that stone disease may be an early marker for heart disease.

“We found at least a 15% increased risk of heart disease in patients who had a history of kidney stones,” said Dr. Eisner, a fifth-year resident in urology at Massachusetts GeneralHospital in Boston. “We believe this is important when considering the overall health care and treatment of patients with stone disease.”

The etiology of nephrolithiasis is incompletely characterized, Dr. Eisner said. He, senior author Marshall Stoller, MD, professor of urology at the University of California in San Francisco, and colleagues have theorized that the initial stone event may be vascular in origin, so they examined whether a history of nephrolithiasis was associated with sub-sequent development of coronary disease in patients.

The researchers analyzed data from the Health Professionals Follow-Up Study, which included 45,988 men whose age range at baseline was 40-75 years. Dr. Eisner and his colleagues adjusted findings for age, BMI, thiazide diuretic use, antihypertensive and cholesterol-lowering medications, tobacco use, history of gout, hypertension, diabetes mellitus, fluid intake, and other dietary factors. The primary end point was coronary heart disease, defined as MI, angina, or need for coronary artery bypass graft surgery (CABG). Stroke, including ischemic or hemorrhagic cerebrovascular events, was the secondary end point.

A total of 4,747 patients (10.3%) reported a history of nephrolithiasis at baseline. After adjusting for confounders, Dr. Eisner's team found a 15% higher risk for coronary heart disease (CHD) among subjects with a history of nephrolithiasis compared with men without nephrolithiasis. A history of nephrolithiasis was associated with a 16% increased risk for MI, a 27% increased risk for angina, and a 15% increased risk for CABG.

“These were all highly statistically significant associations. There was no increased risk of stroke in these patients,” Dr. Eisner told Renal & Urology News. “We see stone formers very early in their life. Patients tend to be in their 20s, 30s, and 40s. We should consider possible in-creased risk of coronary disease in these patients as we care for them long-term.”

Previous studies also have linked kidney stone disease with heart disease. These include a study by Japanese investigators who compared 181 calcium oxalate stone formers and 187 control subjects. The team found a history of CHD in seven (3.9%) of the stone form-ers but none of the controls, according to a report in the International Journal of Urology (2005;12:859-863).

Heart Diseases:

Also called: Cardiac disease :
If you're like most people, you think that heart disease is a problem for other folks. But heart disease is the number one killer in the U.S. It is also a major cause of disability. There are many different forms of heart disease. The most common cause of heart disease is narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. This is called coronary artery disease and happens slowly over time. It's the major reason people have heart attacks.
Other kinds of heart problems may happen to the valves in the heart, or the heart may not pump well and cause heart failure. Some people are born with heart disease.
You can help reduce your risk of heart disease by taking steps to control factors that put you at greater risk:
Control your blood pressure
Lower your cholesterol
Don't smoke
Get enough exercise

Mental Health:

Mental health is the positive balance of the social, physical, spiritual, economic and mental aspects of one’s life and is as important as physical health. When people are mentally healthy they are able to live productive daily activities, maintain fulfilling relationships with others, and have the ability to adapt to change and cope with stress.Alternatively, mental illness is a psychological or behavioural phenomenon that leads to disorder or disability that is not part of normal development. Mental illness can occur when the brain (or part of the brain) is not working well or is working in the wrong way. When the brain is not working properly, one or more of its six functions will be disrupted (thinking or cognition, perception or sensing, emotion or feeling, signaling, physical functions and/or behavior). When these functions significantly disrupt a person’s life, we say that the person has a mental disorder or a mental illness.The World Health Organization notes that “Mental health is as important as physical health to the overall well-being of individuals, societies and countries. Yet only a small minority of the 450 million people suffering from a mental or behavioural disorders are receiving treatment” (The World Health Report 2001, Chapter 1). The WHO also indicates that 15 to 20 per cent of young people worldwide suffer from a mental disorder that would benefit from mental-health treatment. Currently, neuropsychiatric disorders contribute to almost one-third of the global burden of disease in this age group.While effective treatment for mental disorders is available, barriers including lack of health professionals, health care infrastructure, cost, as well as a strong and persistent stigma against people with mental disorders prevents millions of adults and youth from accessing and receiving the help they need to get well and say well.The more we learn about mental health, the better we understand the impact that mental health problems can have on personal, social, civic and economic development. Addressing mental health problems early in life enhances the opportunity for young people to get well and stay well through adulthood, improving not only the lives of individuals and families, but also enhancing civil society increasing opportunity for socio-economic development and encouraging global acceptance of human and cultural diversity.Mental health is a right, not a privilege. As global citizens it is important that we work together to provide the best care for people who are mentally ill and to ensure that physical and mental health are at the forefront of the international agenda.

Maternal Health & Child Mortality:

Maternal health is intimately connected with the health of a child therefore when we define barriers to maternal health, we can at the same time predict barriers to child mortality. In the most general sense, maternal health and child mortality is described as a mother’s ability to eat healthy, to have access to safe reproductive strategies, to seek and have access to the appropriate medical services, and to get educated on how to ensure that their life and the life of their baby remains healthy. Under the Millennium Development Goals, nations around the world have the opportunity to sign on to reduce the maternal mortality ratio by at least three quarters as soon as 2015 (www.unicef.org).Motherless children tend to be at a greater risk of death than children with mothers. Thousands of women die during childbirth [from complications] every minute around world, and in sub-Saharan Africa where there is a 1 in 16th chance of a woman dying during childbirth (www.unicef.org). Yet many of the factors (i.e. unsafe child birthing conditions) that lead to maternal mortality are for the most part preventable. A mother who has access to safe and effective medical services also has a better chance of raising a child (under the age of five) that does not suffer from a potentially fatal sickness such as Acute Respiratory Infection or diarrhoea (D’Souza, 2003). Moreover in a study by Gyimah, Takyi, & Addai (2006), researchers found that socio-economic factors, such as extreme poverty, was not one of the major predictors of maternal health and infant mortality, however religious and other very strong ideological beliefs were seen as more of a predictor of current disparities in the rates at which women seek reliable medical services.Some of the factors that directly contribute to poor maternal health and high frequencies of child mortality are: '''Haemorrhage''', '''obstructed labour''', '''hypertensive''' disorders in pregnancy, unsafe abortion, birth-related disabilities, and nutritional deficiencies. At least 30% of women worldwide lack '''antenatal''' care with 34% originating from Sub-Saharan Africa and 46% from South Asia (www.unicef.org). Highly infectious diseases such as HIV/AIDS put both mothers and their infants at a greater risk of long-term sickness and early mortality. Children left orphaned by HIV/AIDS are at a greater risk of dying in the first two years of becoming orphans than children with parents (www.unicef.org). High-risk deliveries also pose a major threat to child mortality such that each year about 8 million babies die worldwide during labour and delivery and remain at risk up until the infant’s first week of life (www.unicef.org). Maternal health organizations around the world have narrowed down four effective intervention strategies that have played a significant part in improving maternal health and reducing child mortality. The most important intervention specified by organizations such as UNICEF is the availability of quality medical services pre- and post-birth. This includes better-trained traditional (i.e. midwife) and formal (i.e. doctor) health care providers and available emergency '''obstetrics'''. As well, improving maternal nutrition practices during and after pregnancy is a strong predictor of the quality of health a newborn baby or infant will have once they are born. In addition counselling for mothers with HIV/AIDS or other infectious diseases (i.e. malaria) ensures that safer practices are utilized during mother-to-infant contact (i.e. breastfeeding). Finally, secondary education for girls has been shown to significantly increase the likelihood that mothers will have healthier pre-natal pregnancies and increase the survival rate of newly born babies.

Dieseas research:

Malaria:
We are part of a collaborative project headed by Austin Burt at Imperial College in London that is one of the Gates Foundation "Grand Challenge Projects in Global Health". Malaria is caused by a parasite that spends part of its life cycle inside the mosquito, and is passed along to humans by mosquito bites. The idea behind the project is to make mosquitoes resistant to the parasite by eliminating genes required in the mosquito for the parasite to live. Our part of the project is to use our computer based design methods (ROSETTA) to engineer new enzymes that will specifically target and inactivate these genes.

Anthrax:
We are using ROSETTA to help John Collier's research group at Harvard build models of anthrax toxin that should contribute to the development of treatments. You can read the abstract of a paper describing some of this work at

HIV:
One of the reasons that HIV is such a deadly virus is that it has evolved to trick the immune system. We are collaborating with researchers in Seattle and at the NIH to try to develop a vaccine for HIV. Our role in this project is central--we are using ROSETTA to design small proteins that display the small number of critical regions of the HIV coat protein in a way that the immune system can easily recognize and generate antibodies to. Our goal is to create small stable protein vaccines that can be made very cheaply and shipped all over the world.

Other viruses:
We have been collaborating with Pam Bjorkman's laboratory at Cal Tech to use the ROSETTA protein-protein docking methodology to build models of herpes simplex virus proteins in complex with human proteins.

Alzheimer's disease:
Alzheimer's and many other diseases are likely to be caused by abberant protein folding in which proteins form large aggregated structures called amyloids rather than folding up into their normal biologically active states. A big advance was made recently by David Eisenberg's research group at UCLA in solving the first structure of an amyloid. We are collaborating with their research group to use the structure to predict which parts of proteins are likely to form amyloids, which will be a first step to blocking amyloid formation and hopefully disease.

Cancer:
Cancer can be caused by mutations in key genes that disrupt normal cellular control processes. We are developing methods for cutting DNA at specific sites in the genome, and we will be targeting sites that are implicated in cancer. After these sites are cut, they should be repaired by the cell using a second, unmutated copy of the gene and the cell should no longer be cancerous. This is a very specific form of gene therapy that, if successful, will circumvent one the main objections to current gene therapy methods; namely, current methods insert the unmutated copy of a gene randomly into the genome, and if the insertion point happens to be near an oncogene, the gene therapy will cure one disease but cause another. Because our methods will target specific sites instead of random sites, they should avoid this pitfall.


Prostate Cancer:
The androgen receptor (AR) binds testosterone and is responsible for normal male development. When the AR becomes hypersensitive to testosterone, prostate cancer is the result. The current treatment for prostate cancer, called "hormone therapy", involves lowering the amount of testosterone available (sometimes by castration). Many malignant tumors are resistant to this therapy, however, so we are applying our protein design methodology to find different ways to inhibit the AR and to treat prostate cancer. Specifically, we are trying to design proteins that will disable the AR even in the presence of testosterone. We are doing this by designing proteins that will prevent the AR from entering the nucleus of the cell (which is where it does its dirty work), and also preventing it from binding DNA and activating tumor-specific genes even if it does get into the nucleus.

Biomedical research

Biomedical research (or experimental medicine), in general simply known as medical research, is the basic research, applied research, or translational research conducted to aid the body of knowledge in the field of medicine. Medical research can be divided into two general categories: the evaluation of new treatments for both safety and efficacy in what are termed clinical trials, and all other research that contributes to the development of new treatments. The latter is termed preclinical research if its goal is specifically to elaborate knowledge for the development of new therapeutic strategies. A new paradigm to biomedical research is being termed translational research, which focuses on iterative feedback loops between the basic and clinical research domains to accelerate knowledge translation from the bedside to the bench, and back again.
The increased longevity of humans over the past century can be significantly attributed to advances resulting from medical research. Among the major benefits have been vaccines for measles and polio, insulin treatment for diabetes, classes of antibiotics for treating a host of maladies, medication for high blood pressure, improved treatments for AIDS, statins and other treatments for atherosclerosis, new surgical techniques such as microsurgery, and increasingly successful treatments for cancer. New, beneficial tests and treatments are expected as a result of the human genome project. Many challenges remain, however, including the appearance of antibiotic resistance and the obesity epidemic.

Preclinical research
Preclinical research is research in basic science, which precedes the clinical trials, and is almost purely based on theory and animal experiments.
New treatments come about as a result of other, earlier discoveries — often unconnected to each other, and in various fields. Sometimes the research is done for non-medical purposes, and only by accident contributes to the field of medicine (for example, the discovery of penicillin). Clinicians use these discoveries to create a treatment regimen, which is then tested in clinical trials.

[edit] Clinical trials
Main article: Clinical trial
A clinical trial is a comparison test of a medication or other medical treatment, versus a placebo, other medications and devices, or the standard medical treatment for a patient's condition. Clinical trials vary greatly in size: from a single researcher in one hospital or clinic to an international multicenter trial with several hundred participating researchers on several continents. The number of patients tested can range from as few as a dozen to several thousands.

[edit] Funding
Main article: Research funding
Research funding in many countries comes from research bodies which distribute money for equipment and salaries. In the UK, funding bodies such as the Medical Research Council and the Wellcome Trust derive their assets from UK tax payers, and distribute this to institutions in a competitive manner.
In the United States, the most recent data from 2003[1] suggest that about 94 billion dollars were provided for biomedical research in the United States. The National Institutes of Health and pharmaceutical companies collectively contribute 26.4 billion dollars and 27.0 billion dollars, respectively, which constitute 28% and 29% of the total, respectively. Other significant contributors include biotechnology companies (17.9 billion dollars, 19% of total), medical device companies (9.2 billion dollars, 10% of total), other federal sources, and state and local governments. Foundations and charities, led by the Bill and Melinda Gates Foundation, contributed about 3% of the funding.
The enactment of orphan drug legislation in some countries has increased funding available to develop drugs meant to treat rare conditions, resulting in breakthroughs that previously were uneconomical to pursue.

[edit] Regulations and guidelines
Medical research is highly regulated. National regulatory authorities oversee and monitor medical research, such as for the development of new drugs. In the USA the Food and Drug Administration oversees new drug development, in Europe the European Medicines Agency (see also EudraLex), and in Japan the Ministry of Health, Labour and Welfare (Japan). The World Medical Association develops the ethical standards for the medical profession, involved in medical research. The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) works on the creation of rules and guidelines for the development of new medication, such as the guidelines for Good Clinical Practice (GCP). All ideas of regulation are based on a country's etchics standards code. This is why treatment of a particular disease in one country may not be allowed, but is in another.

Introduction

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